Appendix J

Cholinesterase Inhibitors
* Neostigmine (Prostigmin)
ACTION: Prevent the enzyme cholinesterase (CHE) from inactivating
acetycholine (ACh), thereby increasing the amount of ACh available at
receptor sites. Transmission of nerve impulses is increased at all sites
responding to ACh as a transmitter
Therapeutic Use (TU)
increases muscle strength by increasing ACh effects at motor neurons in
Myasthenia Gravis
Causes reversal of nondepolarizing neuromuscular blocking agents (tubocurarine)
following surgery
Side Effects/Adverse Effects
Increased GI motility and secretion, bradycardia & urinary Urgency due to
excessive muscarinic stimulation
0
* 1) If effects become intolerable notify primary care provider, Side effects
can be treated with ATROPINE
Cholinergic Crisis- excessive muscarinic stimulation and respiratory depression
from neuromuscular blockade
0
* Treat with Muscarinic effects with ATROPINE
0

* Provide resp. support through mechanical ventilation

Contraindications (CI) :
In clients with obstruction of GI and GU system
Pregnancy Risk Category C
Med food/ Interaction

Atropine : counteracts the effects of Neostigmine (Nursing interventions:

ATROPINE is used to treat NEOSTIGMINE TOXICITY.if no recovery is
noted apply mechanical ventilation until full muscle function is regained)
Tubocurarine : Neostigmine reverses neuromuscular blockade after surgical
procedures and overdose
Succinylcholine (increase neuromuscular blockade) : Avoid concurrent use
Client Education : Start at low dosages and titrate until desired muscle

function is achieved, Encourage the client to keep track of self doasage

administration, recognize signs of INADEQUATE DOSING, such as difficulty
swallowing and signs of overmedication, such as urinary urgency, Advise the
client to wear a medical alert bracelet
Effectiveness : Decreased fatigued, improved muscle strength as demonstrated
by chewing, swallowing and performing hygiene
Neuromuscular blocking agent
Drug : Tubocuraine (non-depolarizing) & Succinycholine (Depolarizing)
Action: Neuromuscular blocking agents block Ach at the neuromuscular
junction resulting in muscle relaxation and hypotension. They d/n cross the
blood-brain barrier so complete paralysis can be achieved w/o loss of
consciousness or decreased pain sensation
USE:
Used as adjuncts to general anesthesia to promote muscle relaxation
Used to control spontaneous respiratory movements in clients receiving
mechanical ventilation
These Meds are used to diagnosis MYASTHENIA GRAVIS
Succinycholine is preferred for : Seizure contol during electroconvulsive
therapy, endotracheal tubation, endoscopy
S/E
Respiratory Arrest from paralyzed respiratory muscles (NI: monitor respirations
and vitals continuously, equipment ready for resuscitation)
Hypotension resulting from HISTAMINE RELEASE and GUANGLIONIC BLOCKADE,
Bradycardia and dysrhythmias
S/E of SUCCINYLCHOLINE (ANECTINE)
Malignant hyperthermia: 109.4 F (NI: Monitor vitals, stop med, ice or ice
saline to cool the client, Administer Dantrolene: decreases metabolic
activity of the skeletal muscle)
Prolonged Apnea due to low Pseudocholinesterase (NI : Test clients
blood and hold med if pseudo levels are low)
0HyperKalemia
Med/food Int
General anesthetics are often used concurrently in surgery
Aminoglycosides, tetracyclines : increase effects of neuromuscular blockade
Neostigimine & Prostigmin) and other Cholinesterase inhibitors :

decrease the effects of non-depolarizing neuromuscular blockers, such as

Tubucurarine; increase the effects of depolarizing neuromuscular blockers,
such as Succinylcholine
Education: Continous Cardiac and respiratory monitoring (have life support
equipment handy)
Effectiveness: Muscle relaxation during surgery, absence of seizures in EC
Therapy, Successful Endotracheal intubation, No spontaneous respiratory
movements
Classification : Adrenergic Agonist
Drug : Epinephrine (Adrenaline) other drugs Dopamine and Dobutamine
Action : Catecholamine adrenergic agonists c/n be taken by the oral route,
d/n cross the blood brain barrier and the duration is short
Receptors
Alpha1 : Activation of receptors in arterioles of skin, viscera ad mucous
membranes, and veins lead to vasoconstriction
Beta1 : Heart stimulation leads to increased HR. increased Myocardial
contractility, increased rate of conduction through the AV node, Activation
of receptors in the kidney lead to release of rennin
Beta2 : Activation of receptors in the arterioles of the heart, lungs, and
skeletal muscles leading to vasodilation, Bronchial stimulation leads to
bronchodilation, activation of receptors in the uterine smooth muscles
causes relaxation, activation of receptors in the liver causes glycogenesis,
activation of skeletal muscles leads to muscle contraction
Dopamine : activation of receptors in the kidney cause the renal blood
vessels to dilate
Estrogen acting on Alpha1
VASOCONSTRICTION
TU: Increases B/P, decreases congestation of nasal mucosa, Manages superficial
bleeding, slows absorption of local anesthetics
Estrogen acting on Beta 1
Increases HR, Myocardial contractility, rate of conduction through the AV
Tx: AV Block and Cardiac Arrest

Estrogen acting on Beta2

Bronchodilation
Tx : Asthma
S/E :
Hypertensive crisis : Due to Vasoconstriction of Alpha 1 receptors (NI:
Continuous Cardiac monitor).Dysrhythmias : Do to activating Beta1
receptors which increases the workload of the heart and the oxygen
demand of the heart
Contraindications- Pregnancy Risk C, In clients with Tachydysrhythmias and
v.Fib
Med/Food Int- Avoid use of MAOIs in clients receiving Epinephrine.Tricylic
Antidepressants increase the effects of epinephrine, may need to lower
epinephrine dosage.General Anesthetics and epi can cause Dsyrhythmias
so monitor ECG and notify primary care provider for signs of chest pain,
increased HR
Phentolamine Treats Epinephrine Toxicity
Propranolol treats Chest Pain and dysrhythmias
Education- Must be administered IV by continuous infusion,
continuous ECG monitoring
Effectiveness- urine output greater than 30ml/hr, improved mental
status, systolic blood pressure maintained at greater than equal to
90mm hg
Classification : Alpha Adrenergic Blockers (Sympatholytics)
Drug : PRAZOSIN (MINIPRESS)
Action: Venous and arterial dilation. Smooth muscle relaxation of
the prostatic capsule and bladder neck
TU: Tx: HTN
Doxazosin mesylate (Cardura) may be used to decrease symptoms of
benign prostatic hypertrophy (BPH) (e.g urgency, frequency, dysuria)
S/E

First-Dose Orthostatic Hypotension (NI: first dose may be given at

night, monitor blood pressure for 2hr after the initiation of tx, instruct
clients to avoid activity for the first 12-24hr, encourage pt. to change
positions slowly)
Contraindications (CI) : Pregnancy risk C. CI in clients with
hypersensitivity to medication
Med/Food Int
Anti-hypertensive Medications
NSAIDs and Clonidine decrease Anit-HTN effects
Effectiviness
*decrease in b/p, reduction in benign prostatic hypertrophy
symptoms
Classification : Centrally Acting Alpha2 Agonists
Drug : Clonidine (Catapres)
Action :
Act in the CNS to decrease sympathethic outflow. This results in a decrease
of norepinephrine (NE) released from sympathetic nerves, thereby
decreasing the amount of NE that is available to stimulate the adrenergic
receptors (both alpha and beta receptors) of the heart and peripheral
vascular system
decreases sympathetic outflow to myocardium, results in bradycardia and
decrease cardiac output (CO)
decreases in synmpathetic outflow to peripheral vasculature results in,
vasodilation, which leads to decrease blood pressure
S/E
Drowsiness and Sedation
Dry Mouth (encourage the client to chew gum or hard candy, symptoms resolves
in 2 to 4 weeks)
Rebound HTN: Discontinue CLONIDINE gradually over the course of 2 to 4 days
Med & Food Int
Antihypertensive Meds (may have hypotensive additive effects)
Prazosin, MAOIs and Tricyclic Antidepressants (May counteract antihypertensive effects)
Alcohol : CNS Depressants

Education- Pregnancy must be ruled out before treatment is begun

Administer Twice a day in divided doses
Transdermal patches applied every seven days
Effectiveness- decreased blood pressure, absence of pain

Classification : Adrenergic Neuron-Blocking Agents

Drug: Reserpine
Action- Depletion of NE from postganglionic symphathetic neurons which
decreases the activation of alpha and beta adrenergic
receptors..This slows HR and Reduces Cardiac Output
TU: Tx HTN and Can be, but is less commonly used to treat Psychotic
States
S/ESevere Depression (NI: educate about signs of depression such as early
morning insomnia, decreased appetite, change in mood
Cardiovascular Effects : Bradycardia, orthostatic hypotension, nasal congestion
((due to depletion of Noreepinephrine (NE))Bradycardia caused by
decreased activation at the beta1 receptors, hypotension and nasal
congestion caused by dec. activation at alpha receptors
0 GI Effects : Increase secretion of gastric acid causing Ulcer Formation
CI: Patients who have a hx of Depression
Classification : Beta Adrenergic Blockers (Sympatholytics)
Drugs : Propranolol and Metoprolol
Action : decrease HR, Myocardial contractility (inotropic), rate of
conduction through the AV.Metoprolol blocks at Beta1 receptor, Propranolol
(Inderal) blocks at Beta 2 receptor
TU: Angina Pectoris, HTN, Cardiac Dysrhythmias, MI, Heart Failure,
Other uses : hyperthyroidism, migraine headache, stage fright, glaucoma
S/E of Metoprolol (lopressor): Bradycardia (Administer Atropine and
Isoproterenol) Decrease In Cardiac output (Metoprolol may take like 1 to

3 months for effects to work) AV Block (D/n administer beta-blocker)

Orthostatic hypotensive, rebound myocardium excitation (use of
beta blockers shouldnt be abruptly stopped, discontinue over 1 to 2
weeks)
S/E of Propranolol (Inderal) : Bronchoconstriction (Avoid in asthmatic
clients), Glycogenolysis is inhibited (Contraindicated in Diabetic pt.s
treat diabetic pt.s with Beta1 agent)
Contraindications
Beta adrenergic blockers are contraindicated in clients with AV block and Sinus
BradyCardia
Non-Selective beta-adrenergic blockers are contraindicated in clients with
asthma, bronchospasms and heart Failure
Use cardioselective Beta-adrenergic blockers cautiously in clients with heart
failure, asthma, bronchospasm, diabetes, hx of allergies and depression
MED and Food Int
CCBs (Verapamil &Diltiazem (Cardizem) : intensifies the effects of betablockersmonitor closely
Antihypertensive Meds : Increases Hypotensive effectsmonitor b/p
Insulin- prevents glycogenolysis: may need to adjust dosage of insulin when
using Propranolol (Inderal)
Education- Self monitor HR and B/p, D/N crush or chew extended release
tablets, avoid sudden changes in position
Effectiveness- Absence of chest pain, cardiac dysrhythmias, normal b/p,
control of signs of HF
Classification : Muscarinic Agonists
Drug : Bethanechol (Urecholine)
Action : Binds reversibly to muscarinic cholinergic receptors and causes
activation, the principal structures affected by muscarinic activation are the
heart, exocrine glands, smooth muscles, and eye
At the heart : Causes Bradycardia
At Exocrine Glands : Causes increase sweat, salivation, bronchial secretions,
and secretion of gastric acid
In the Smooth muscles of the lung and GI Tract : Promote contraction
In the bladder : contracts the detrusor muscle and relaxs the trigone and
sphincter causeing BlADDER EMPTYING

TU : Tx for Urinary Retention in post opt and post pardum pt. NOT urinary
retention caused by physiological obstruction..b/c it cam cause injury due
to increased pressure
S/E : Hypotension and bradycardia. Excessive salivation ,increased sec. of
gastric acid, abdominal cramps and diarrhea
CI : Patients with low blood pressure, gastric ulcers, intestinal obstruction
(can rupture the bladder) patients with asthma (it causes
bronchoconstriciton), hyperthyroid patients (Can cause dysrhythmias)

Classification : Muscarinic Antagonists (Anticholinergic Drugs)

Drug: Atropine
Action : completely block the action of acetylcholine at muscarinic
receptors. Exerts its influence primarily on the heart, exocrine glands,
smooth muscles, and eye, just like the muscarinc agonist
At the heart : increase HR
Exocrine Glands : decrease secretion of salivation, bronchial glands, sweat
glands and decreases gastric secretions
Smooth muscles: Atropine causes relaxation of the bronchi, decreased tone
of the urinary bladder detrusor and decreased tone and motility of the GI
Eye : Dilates the pupil (mydriasis) focuses the lens for far vision (cycloplegia)
CNS: can cause mild excitation at therapeutic doses, Toxic doses can causes
delirium & hallucinations
TU:Helps during eye examinations for disorders of the eye. Tx Bradycardia.
Tx : diverticulitis by decreasing tone and motility in the smooth muscles of
the intestine. Used to Reverse Muscarinic Poisioning, Can treat Peptic Ulcers
disease, Asthma (by bronchodilating)

S/E : Xerostomia (Dry Mouth), Blurred Vision (paralyze ciliary muscle focus
on far objects causes blurred vision) photophobia (paralysis of iris sphincter
prevents constriction of the pupil) (NI: where glasses 4photophobia-when
unable to adapt to bright light)
Urinary Retention and Constipation (blockade of muscarinic receptors
increase the pressure w/in bladder and increases the tone of the urinary
sphincter and trigone)
Anhidrosis (absence of sweat), Tachycardia, Asthma(cause thickening and
drying of bronchial secretions
Drug Interactions : Anti-histamines, phenothiazines, antipsychotics, tricyclic

antidepressantshave anticholinergic effects and can enhance the effects of

Atropine
Note : Anti-cholinergic means blockade at Muscarinic Receptors-not blockade at
all cholinergic receptors
Classification : Ganglinic Blocking Agents
Drugs : Mecamylamine
Action : Blocks transmission through the ganglia of the ANS by completing
with Ach for binding to nicotinic receptors
TU : Are used ONLY to decrease blood pressure, treats primary HTN in
selected patients, only used when b/p c/n be reduced by all other
medications
S/E :
Antimuscarinic effects (dry mouth, blurred vision, photophobia, urinary
retention, constipation, tachycardia, anhidrosis)
Orthostatic hypotension (by dilating veins causes pooling of blood
decreasing blood return to the heart, reducing CO and subsequent fall in
b/p)
CNS Effects ( tremor convulsions, and mental aberrationds)

Central Nervous System Drugs

Drugs for Parkinsons disease
Dopaminergic Drugs:
Anti-Parkinsons Medications
Dopaminergics: Levodopa (increases dopamine [DA] synthesis)
-levodopa plus carbidopa (Sinemet)
-Carbidopa (blocks levodopa destruction)
Dopamine agonists: pramipexole (Mirapex)
Centrally acting anticholinergics: Benztropine (Cogentin)
Dopamine releaser (Antiviral): Amantadine (Symmetrel)
Classification:
Dopaminergics:
Medications: Levodopa (Dopar, Larodopa), levodopa plus carbidopa (Sinemet)
Actions:
-Levodopa crosses the blood brain barrier and is taken up by dopaminergic nerve terminals and
converted to dopamine (DA). This newly synthesized DA is released into the synaptic space and
causes stimulation of DA receptors

- Carbidopa does not possess any therapeutic effects, but is used to augment levodopa.
Carbidopa inhibits conversion of levodopa to DA in the intestine and periphery, and thereby allows for
increase amounts of levodopa to reach the CNS
Dopamine agonists:
Medications: Pramipexole (Mirapex), Ropinirole (Requip), bromocrptine (Parlodel)
Actions:
-Act directly on DA receptors
Centrally Acting Anticholinergics:
Medications: Benztropine (Cogentin), Trihexyphenidyl (Artane)
Actions: These medications block acetylcholine at muscarnic receptors, which assists in maintaining
the balance between dopamine and acetylcholine in the brain.
Dopamine releaser (Antiviral):
Medications: Amantadine (Symmetrel)
Actions: Antiviral stimulate DA release, prevent dopamine reuptake, and may block cholinergic and
glutamate receptors
Therapeutic Uses:
- These medications do not halt the progression of Parkinsons disease (PD): however, they do
offer symptomatic relief from dyskinesias (e.g., bradykinesis, resting tremors, and muscle
rigidity).
- Levodopa may be used as a first-line medication for PD treatment
- Pramipexole (Mirapex) is used as monotherapy in early-stage PD, and used in conjunction with
levodopa in late- stage PD. It is used often in younger clients who are more able to tolerate
daytime drowsiness and postural hypotension
Side/Adverse Effects: Nursing Interventions and Client Education
Dopaminergics: levodopa- usually dose dependant
- N&V, drowsiness
o Administer in small doses at the start of treatment and with food
- Dyskinesias (e.g.), head bobbing, tics, grimacing, tremors)
o Decrease dosage of medication, but the decrease may result in resumption of PD
symptoms
- Orthostatic hypotension
o Monitor the clients b/p
o Instruct the client about signs of postural hypotension
- Cardiovascular effects from beta1 stimulation (e.g., tachycardia, palpitations, irregular
heartbeat)
o Monitor the clients vital signs
o Use cautiously in clients with cardiovascular disorders
o Monitor ECG
- Psychosis (e.g., visual hallucinations, nightmares)
o Administer antipsychotic medications such as clozapine (Clozaril) if symptoms occur.
- Discoloration of sweat and urine
o Advise the client that this is a harmless side effect
- Activation of malignant melanoma
o Avoid use of medication in clients with skin lesions that have not been diagnosed

Dopamine Agonists: Pramipexole (Mirapex)

Sleep attacks
Daytime sleepiness
o Advise the client to avoid the use of other CNS depressants such as alcohol
Orthostatic hypotension
Psychosis
Dyskinesisas
Nausea
Centrally acting anticholinergics: benztropine (Cogentin)
N&V
Atropine-like effects (e.g., dry mouth, blurred vision, mydriasis, urinary retention, constipation)
o Advise the client to chew sugarless gum, eat foods high in fiber, and increase water
intake to at least 8 to 10 glasses of water/day
antihistamine effects (e.g. sedation, drowsiness)
Antiviral: amatadine (Symmetrel)
CNS effects (e.g., confusion, dizziness, restlessness)
Atropine-like effects\
Discoloration of skin, also called livido, reticularis
o Advise the client that discoloration of the skin will subside when the medication is
discontinued

Levodopa plus cardidopa (Sinemet)

- Abnormal movements, psychiatric disorders
Contraindications/Precautions
Levodopa
- Pregnancy Risk Category C
- Contraindicated in clients with malignant melanoma
- Do not use w/in 2 weeks of MAOI use
- Use cautiously in clients with heart disease and psychiatric disorders
Pramipexole (Mirapex)
- Pregnancy Risk Category C
- Use cautiously in clients with liver and kidney impairment
Anticholinergic agents
- Contraindicated in clients with narrow-angle glaucoma
- Use cautiously in older adults, the very young, clients with enlarged prostate glands, and a
history of urinary retention
Medication/Food Interactions
-

Dopaminergics: levodopa
Proteins interfere with levodopa absorption and transport across the blood-brain barrier. High
protein meal decrease therapeutic effects.
o Proteins trigger an off episode
o Advise the client to eat protein in several portions during the day
Conventional-antipsychotic agents (e.g., chlorpromazine [Compazine], haloperidol [Haldol]
decrease therapeutic effects.
o Avoid use with levodopa
o To treat levodopa-induced psychosis, use the atypical antipsychotic clozapine (Clozaril)

Pyridoxine decrease therapeutic effects

o Advise client to avoid vitamin preparations that contain pyridoxine
MAOIs cause hypertension
o Avoid concurrent use
Carbidopa, dopamine agonists, anticholinergics, COMT inhibitors, and dopamine
releasers increase therapeutic effects
o These medications can be used concurrently to increase the beneficial effects of
levodopa
Dopamine agonists: pramipexole (Mirapex)
Levodopa- concurrent use has beneficial and harmful interactions. Use with levodopa can
decrease motor control fluctuations and allow for lower dosage of levodopa. Concurrent use
can also increase the risk of orthostatic hypotension and dyskinesias
Levodopa plus carbidopa (Sinemet)
Beneficial interactions include allowing for lower dosage of levodopa, decrease cardiovascular
responses to dopamine in the periphery, and decrease nausea.

Cholinesterase Inhibitors
Prototype Medication: Neostigime (Prostigmin)
Action: Prevent the enzyme cholinesterase (ChE) from inactivating acetylcholine (Ach), thereby
increasing the amount of Ach available at receptor sites. Transmission of nerve impulses is increased
at all sites responding to Ach as a transmitter.
Therapeutic Uses:
- Neostigmine (Prostigmin) increase muscle strength by increasing Ach effects at motor neurons
in myasthenia gravis
- Neostigmine causes reversal of nondepolarizing neuromuscular blocking agents (tubocurarine)
following surgery
Side/Adverse Effects:
- Excessive muscarine stimulation as evidenced by increased GI motility, increased GI
secretions, bradycardia, and urinary urgency
o Side effects may be treated with atropine
- Cholinergic crisis excessive muscarnic stimulation and respiratory depression from
neuromuscular blockade
o Muscarinic effects can be treated with atropine
o Provide respiratory support through mechanical ventilation and oxygen
Contraindications/Precautions
- Pregnancy Risk Category C
- Contraindicated in clients with obstruction of GI and GU system
- Use cautiously in clients with seizure disorders, hyperthyroidism, peptic ulcer disease, asthma,
bradycardia, and hypotension.
Medication/Food Interactions
Atropine-counteracts the effects of neostigmine
- Used to treat neostigmine toxicity
- Monitor the client closely and provide mechanical ventilation until the client has regained full
muscle function
Turocurarine:
- Neostigmine reverses neuromuscular blockade after surgical procedures and overdose.

Monitor the client for return of respiratory function. Support respiratory function as necessary.
If used to treat overdose, provide mechanical ventilation until the client has regained full
muscle function
Succinylcholine: increase blockade
- Avoid concurrent use
Drugs for Epilepsy (Antiepileptics) AEDs
Select Prototype Medications:
Barbiturates: Phenobarbital (Luminal)
Hydantoins: phenytoin (Dilantin)
Benzodiazepines: diazepam (Valium)
Lorazepam (Ativan)
Carbamazepine (Tegretol)
Ethosuximide (Zarontin)
Valproic acid (Depakote)
Gabapentin (Neurontin)
Action: AEDs control seizure disorders by various mechanism, which include
- Slowing the entrance of sodium and calcium back into the neuron and, thus extending the time
it takes for the nerve to return to its active state
- Suppressing neuronal firing, which decreases seizure activity and prevents propagation of
seizure activity into other areas of the brain
- Potentiating the inhibitory effects of gamma butyric acid (GABA) and thereby suppressing
seizure activity.
Therapeutic Uses
- Treatment of generalized seizures
o Tonic clonic ( Grand mal)
o Absence seizures (Petit mal)
o Atonic seizures
o Myoclonic seizures
o Status epilepticus
o Febrile seizures
- Treatment of partial seizures
o Simple partial
o Complex partial
- Complete eradication of seizure activity
Medications/ Therapeutic Uses
Phenobarbital (Luminal)
- Used for partial seizures and generalized tonic-clonic seizures
- Not effective against absence seizures
Phenytoin (Dilantin)
- Is effective against all major forms of epilepsy except absence seizures
- Use IV route for status epilepticus
- Antidysrhythmic
Carbamazepine (Tegretol)
- Used for the treatment of partial (simple and complex) seizures, tonic-clonic seizures, bipolar
disorder and trigeminal and glossopharyngeal neuralgias
Ethosuximide (Zarontin)
- Only indicated for absence seizures

Valproic acid (Depakote)

- Used for partial, generalized and absence seizures, bipolar disorder and migraine headaches.
Gabapentin (Neurontin)
- Used a single agent for control of partial seizures. The medication is also used for neuropathic
pain and the prevention of migraine headaches.
Diazepam (Valium)
- Status epilepticus
Side/Adverse Effects: Nursing Interventions and Client Education
Barbiturates: Phenobarbital (Luminal)
- CNS effects in adults manifest as drowsiness, sedation, confusion, and anxiety; in children,
CNS effects manifest as irritability and hyperactivity
- Toxicity (e.g., nystagmus, ataxia, respiratory depression, coma, pinpoint pupils, hypotension,
death)
o Stop medication. Administer oxygen and maintain respiratory function with ventilatory
support
o Monitor clients vital signs
Hydantoins: phenytoin (Dilantin)
- CNS effects (e.g., nystagmus, sedation, ataxia, double vision)
- Gingival hyperplasia- softening and overgrowth of gum tissue resulting in tenderness and
bleeding gums
o Advise the client to maintain good oral hygiene
- Skin rash
o Stop medication
- Teratogenic (e.g. cleft palate, heart defects)
o Avoid use in pregnancy
- Cardiovascular effects (e.g. dysrhythmias, hypotension)
o Administer at slow IV rate and in dilute solution to prevent adverse CV effects
- Endocrine and other effects (e.g., coarsening of facial features, hirsutism, and interference with
vitamin D metabolism)
o Encourage the client to consume adequate amounts of calcium and vitamin D
Carbamazepine (Tegretol)
- Cognitive function is minimally affected, but CNS effects can occur
o Administer in low doses initially and then gradually increase dose
o Administer dose at bedtime
- Blood dyscrasias (e.g., leucopenia, anemia, thrombocytopenia)
o Obtain the clients baseline CBC and platelets. Perform ongoing monitoring of CBC and
platelets
o Observe the client for signs of bruising and bleeding gums
- Teratogenesis
- Hyo-osmolarity promotes secretion of ADH which inhibits water excretion by the kidneys,
and places the client with heart failure at risk for fluid overload
o Monitor serum sodium periodically.
o Monitor the client for edema, decrease urine output and hypertension.
- Skin disorders (e.g., dermatitis, rash, Stevenson-Johnson syndrome
o Treat mild reactions with anti-inflammatory or antihistamine medications
o Medications should be discontinued if there is a severe reaction

Ethosuximide (Zarontin)
- Gastrointestinal effects N&V
- CNS effects
Valproic acid (Depakote)
- Gastrointestinal effects
- Hepatoxicity (e.g., anorexia, abdominal pain, jaundice)
o Medication should be prescribed in lowest effective dose
- Pancreatits as evidenced by nausea, vomiting, and abdominal pain
o Monitor amylase level
o Medication should be discontinued if pancreatitis develops
- Thrombocytopenia
o Monitor platelet count
o Advise client to observe for signs of bruising
Gabapentin (Neurotin)
- CNS effects
- Respiratory depression
o Monitor clients vital signs
o Have resuscitation equipment ready
o Administer oxygen\
- Anterograde amnesia
o Monitor clients memory loss
- Teratogenic (e.g., cleft palate, heart defects)
Contraindication/Precautions
Barbiturates- contraindicated in clients with intermittent porphyria
Phenytoin contraindicated in clients with sinus bradycardia, sinoatrial blocks, second- and third degree
AV block, or stokes-Adam syndrome
Carbamazepine- contraindicated in clients with bone marrow suppression or with bleeding disorders
Valproic Acid- contraindicated in clients with liver disorders.
Medication/Food interactions
Phenytoin (Dilantin)
- Oral contraceptives, warfarin (Coumadin), and glucocorticoids- phenytoin causes a
decrease effects of these medications due to the stimulation of hepatic drug-metabolizing
enzymes
o Advise the client to increase dose of oral contraceptives
- Alcohol, diazepam (valium), cimetidine (tagamet), and valproic acid increase phenytoin
levels.
- Carbamazepine (Tegretol), Phenobarbital, and chronic alcohol use decrease phenytoin
levels.
- CNS depressants (e.g., barbiturates, alcohol)
o Additive CNS depressant effects can occur with concurrent use
Carbamazepine (Tergretol)
- Oral contraceptives and warfarin (Coumadin) carbamazepine causes decrease in the
effects of these medications due to stimulation of hepatic drug-metabolizing enzymes
- Grapefruit juice inhibits metabolism, and thus increase carbamazepine levels
- Phenytoin and phenobarbital- decrease the effects of carbamazepine
Valproic acid (Depakote)

Phenytoin and Phenobarbital concurrent use with valproic acid increase the levels of these
medications

Drugs for migraines:

Nonsteroidal Anti-inflammatory drugs
aspirin (Ecotrin):
Action:
Prevents platelets from clumping together by inhibiting enzymes and factors that normally lead to
arterial clotting
Uses:

Primary prevention of acute MI

Prevention of reinfarction in clients following acute MI
Prevention of stroke

Side effects:
GI effects such as bleeding, hemorrhagic stoke
Interactions:
Nsaids, heparin, warfarin
Local Anesthetics
Ester-type Local anesthetics: procaine (Novocain)
Amide-type Local anesthetics: lidocaine (Xylocaine)
Action:
Decrease pain by blocking conduction of pain impulses in a circumscribed area. Loss of consciousness
does not occur
Use:
Dental procedures
Minor surgical procedures
Labor and delivery
Diagnostic procedures
Side effects:
CNS excitation (seizures, followed by resp. depression, leading to unconsciousness), Hypotensiins,
cardio suppression aeb bradycardia, heart block, and cardiac arrest, allergic rxns, spinal headache and
urinary retention
General Anesthetics
Inhalation Anesthetics: halothane (Fluothane)
Action:
Produces loss of consciousness, loss of all sensations, relaxation of muscles, and memory loss
Uses:
Anesthesia for surgery
Diagnostic procedures
Cardiological procedures
Relief of pain
Muscle relaxation

Side effects:
Hypotension, respiratory and cardiac depression, malignant hyperthermia, hepatotoxicity
Interactions: CNS depressants (barbiturates, benzodiazepines, alcohol), CNS stimulants
(amphetamines, cocaine), Opioid analgesics (morphine), succinylcholine
Intravenous Anesthetics: thiopental (Pentothal)
Action:
Produce loss of consciousness and elimination of response to painful stimuli
Uses:
Adjunct to inhalation anesthetics
Induction and maintenance of anesthesia
Amnesia
Side effects:
Respiratory and cardiovascular depression (hypotension)
Interactions:
CNS depressants (barbiturates, benzodiazepines, alcohol), CNS stimulants (amphetamines, cocaine),
Opioid analgesics (morphine),
Opioid (narcotic) Analgesics and Antagonists
Pure Opioid Agonists: Morphine sulfate
Action:
Act on mu receptors and to lesser degree on kappa receptors. Activation of mu receptors produces
analgesia, respiratory depression, euphoria, and sedation.
Uses:
Relief of moderate to sever pain
Sedation
Reduction of bowel motility
Side effects:
Respiratory depression, constipation, orthostatic hypotension, urinary retention, coughs suppression,
sedation
Interactions:
CNS depressants (barbiturates, benzodiazepines, Phenobarbital, alcohol), anticholinergic agents
(antihistamines and tricyclic depressants, MAIOs, antihypertensive
Agonist-Antagonist Opioid: pentazocine (Talwin)
Action:
Compared to pure opioid agonists, these have a low potential for abuse causing little euphoria and less
respiratory depression
Uses:
Relieve mild to moderate pain, not severe pain
Side effects:
Abstinence syndrome (cramping, hypertension, vomiting)
Pure Opiod Antagonists: naloxone (Narcan)
Action:
Interfere with the action of opioids by competing for opioid receptors. Opioid antagonists have no
effect in the absence of opioids.
Uses:
Treatment of opioid overdose

Reversal of effects of opioids, such as respiratory depression

Reversal of respiratory depression in an infant

Side effects:
Tachycardia and tachypnea, abstinence syndrome (cramping, hypertension, vomiting)
Antipsychotic drugs
Traditional antipsychotic: chlorpromazine (Thorazine), haloperidol (Haldol)
Actions:
Dopamine, acetylcholine, histamines, and norepinephrine receptors in the brain and periphery are
blocked.
Uses:
Schizophrenia
Bipolar disorders
Tourettes syndrome
Delusional disorders
Schizoaffective disorder
Dementia and other organic mental syndromes
Huntingtons chorea
Side effects:
Early extrapyramidal symptoms: acute dystonia (severe spasms of the tongue, neck, face, and back),
parkinsonism tremors, akathisia (inability to stand still or sit). Late extrapyramidal symptoms: (tardive
dyskinesia). Neuroleptic malignant syndrome ( sudden high grade fever, blood pressure fluctuations,
dysrhythmias), anticholinergic effects.
Interactions:
Anticholinergic agents, CNS depressants (barbiturates, benzodiazepines, Phenobarbital, alcohol),
Levodopa
Atypical Antipsychotics: clozapine (Clozaril)
Action:
Block serotonin and dopamine receptors
Uses:
Severe schizophrenia
Psychosis induced by levodopa therapy
Side effects:
Agranulocytosis, seizures, new onset diabetes, weight gain, inflammation of the heart muscles
Interactions:
Immunosuppressive medications
Antidepressants:
Tyicyclic Antidepressants: imipramine (Tofranil)
Action:
Block reuptake of norepinephrine and serotonin
Uses:
Depression
Bipolar disorders

Side effects:
Orthostatic hypotension, anticholinergic effects, cardiac toxicity, sedation
Interactions:
MAOIs, antihistamines, epinephrine, ephedrine, alcohol, benzodiazepines, opioids
Selective Serotonin Reuptake Inhibitors: fluoxetine (Prozac)
Action:
Block reuptake of serotonin
Uses:
Major depression
OCD
Bulimia nervosa
PMDD
Panic disorders
PTSD
Side effects:
Sexual dysfunction, weight gain, serotonin syndrome (mental confusion, agitation, anxiety),
withdrawal syndrome, hyponatremia, rash
Interactions:
MAIOs, Coumadin, tricyclic antidepressnats and lithium, NSAIDs and anticoagulants
Monoamine Oxidase Inhibitors: phenelzine (Nardil)
Action:
Block MAO-A in the brain thereby increasing the amount of norepinephrine and serotonin available
for transmission
Uses:
Atypical depression
Bulimia nervosa
OCD
Side effects:
CNS stimulation, orthostatic hypotension, hypertensive crisis
Interactions:
Ephedrine, amphetamine, tricylic antidepressants, SSRIs antihypertensices, Demerol, Tyramine rich
foods
Atypical Antidepressants: bupropion HCL (Wellbutrin)
Action:
Inhibit dopamine uptake
Uses:
Treatment of depression
Aid to quit smoking
Side effects:
Headache, dry mouth, constipation, increase heart rate, nausea, restlessness, weight loss, seizures
Interactions:
MAOIs
Drugs for Bipolar Disorder
Lithium carbonate, carbamazepine (Tegrertol), valproic acid (Depakote)

Action:
Produces neurochemical changes in the brain including serotonin receptor blockade
Uses:
Treatment of bipolar (they control episodes of acute mania, and help to prevent the return of
mania or depression)
Alcoholism
Bulimia
Schizophrenia
Side effects:
GI effects, tremors, polyuria, renal toxicity, goiter and hypothyroidism, teratogenesis
Interactions:
Diuretics, NSAIDs, anticholinergics
CLASS: Adrenergic Agonists
PRO: epinephrine and dopamine (catecholamine)
ACTION: vasoconstriction (up BP), bronchodialation, increase heart rate
SE: hypertensive crisis, dysrythmias
CONTRA: tachydysrhythmia and ventricular fibrillation
IINTERACT: MAOIS and general anesthetics
INTERVENTIONS: IV only and ECG monitoring
CLASS: Alpha Adrenergic Blockers
PRO: prazosin (minipress)
ACTION: dilate arteries and veins
USES: hypertension
SE: orthostatic hypertension (first dose at night, change position slow)
INTERACT: antihypertensive meds (hypotension), NSAIDS counteract the effects
INTERVENTIONS: take with food and first dose at night
CLASS: centrally acting alpha2 agonist
PRO: clonidine (catapres)
ACTION: lower sympathetic outflow, lower nowepinephrine, lower BP
USE: hypertension
SE: drowsiness (will diminish), dry mouth (resolves in 2-4 wks)
INTERACT: antihypertensive meds (hypotension), prazosin (counteract effects), alcohol
INTERVENTIONS: take large dose at night to lower drowsiness, transdermal patches
changed every 7d
CLASS: beta adrenergic blockers (beta blockers)
PRO: metoprolol (lopressor), propranolol (inderal)
ACTION: lower HR, lower myocardial contractility, lower conduction through AV node
USE: angina pectoris, hypertension, dysrythmias, MI, heart failure
SE: bradycardia, lower cardiac output (1-3 months for beneficial effects),
bronchoconstriction (avoid
asthma pt)
INTERACT: pt with AV block and sinus bradycardia, calcium channel blockers (intensifies),
insulin
INTERVENTIONS: avoid sudden position changes

CLASS: ACE inhibitors

PRO: captopril, enalapril
ACTION: block production of angiotensin II, vasodilation (arteries), excrete NA, retain K
USES: heart failure, hypertension, MI
SE: 1st dose orthostatic hypotension (stop med for 2-3 days if taking diuretic), cough,
hyperkalemia
CONTRA: 2nd and 3rd trimester pregnancy
INTERACT: diuretics (stop med for 2-3 d), K supplements, lithium (can up lithium levels),
NSAIDS
(decrease
andtihypertensive effect)
INTERVENTIONS: captopril taken 1h before meals
CLASS: ARBs
PRO: losartan
ACTION: blocks action of angiotensin II, vasodialation, excrete NA, retain K
USES: reduce hypertension
SE: angioedema
CONTRA: 2nd and 3rd trimester pregnancy
INTERACT: antihypertensive med (additive effect)
INTERVENTIONS: take with or w/o food
*(ARBs not as effective as ACE inhibitors because they only block the action and not the
production of angiotensin II)
CLASS: Calcium Channel Blockers
PRO: verapamil (affect heart and vessels)
ACTION: blocks vasodilation in arteries, lower contraction force, lower HR, slower AV
conduction
USES: angina pectoris, hypertension, cardiac dysrythmias
SE: Orthostatic hypertension, peripheral edema, constipation
INTERVENTIONS: weigh daily, prescribe diuretic for edema, up fluid intake and fiber, IV
admin over 2-3 min
CONTRA: cautiously use digoxin, beta blockers, and grapefruit juice
PRO: nifedipine (affect only vessels)
ACTION: blocks vasodilation in arteries
USES: angina pectoris, hypertension, cardiac dysrythmias
SE: reflex tachycardia, peripheral edema
INTERVENTIONS: administer beta blocker if tachy, prescribe diuretic for edema, IV admin
over 2-3 min
CONTRA: cautiously use digoxin, beta blockers, and grapefruit juice
CLASS: organic nitrates
PRO: nitroglycerine
ACTION: lower cardiac O2 demand, dilating veins and decreasing preload
USES: angina, periop (control BP or produce hypotension), heart failure
SE: headache (take aspirin), tolerance
CONTRA: traumatic head injury (increase intracranial pressure)
INTERACT: alcohol, cautiously use with CCB, beta blockers, diuretics, Viagra (hypotension)

INTERVENTIONS: angina attack 1) take rapid-acting 2) wait 5 min 3) can take 2 more
doses at 5 min intervals if unrelieved
CLASS: cardiac glycosides
PRO: digoxin
ACTION: increase force of contraction, decrease HR
USE: heart failure, dysrhythmias (A Fib)
SE: dysrhythmias if toxic
INTERACT: thiazide diuretics, ACE and ARB, dopamine
INTERVENTIONS: take same time daily, avoid OTC drugs, do not take potassium-sparing
diuretics, treat dysryhthmias with lidocaine, trear bradycardia with atropine
CLASS: antidysrythmic meds
PRO: Sodium Channel Blockers 1A (procainamide)
ACTION: decrease electrical conduction, decrease rate of repolorization
USE: Afib, Aflutter
SE: lupus, cardiotoxicity
INTERACT: antichollinergics
PRO: Sodium Channel Blockers 1B (lidocaine)
ACTION: decrease electrical conduction, increase rate of repolorization
USE: short term dysrhythmias
SE: CNS effects, resp. arrest
INTERACT: cimetidine, beta blockers phenytoin
INTERVENTIONS: do not crush
INTERVENTIONS: never administer with epinephrine, administrations is usually loading
dose followed by maintenance dose of 1-4 mg
CLASS: statins
PRO: Lipitor, lovastatin
ACTION: increase LDL receptors to remove greater amt of LDL, increase HDL
USES: hypercholesterolemia
SE: hepatotoxicity (up in serum tranaminase), myopathy
CONTRA: pregnancy
INTERACT: fibrates (up myopathy), grapefruit juice
INTERVENTION: lovastatin take with evening meal, increase med dose if taking
erythromycin
CLASS: bile-acid sequestrants
PRO: cholestyramine (questran)
ACTION: increase LDL receptors to remove more LDL
USES: use adjunct with HMG CoA reductase inhibitors (atorvastatin)
SE: so systemic effects, constipation
INTERACT: digoxin, warfarin, thiazide (all interfere with absorption)
INTERVENTION: take other med 1hr before or 4hr after
CLASS: loop diuretics
PRO: furosemide (lasix)
ACTION: block reabsorption of Na, Cl, and H2O in loop of henle
USE: pulmonary edema, conditions not responsive to other diuretics, renal impairment

SE: dehydration, hypotension, ototoxicity, hypokalemia

CONTRA: diabetes (cautious)
INTERACT: digoxin, antihypertensives, lithium, NSAIDS
INTERVENTION: weigh in morning, avoid administering late in day
CLASS: thiazide diuretics
PRO: hydochlorothizaide
ACTION: block reabsorption of Na, Cl, and H2O in early distal convoluted tubule
USE: essential hypertension, edema, liver and kidney disease
SE: dehydration, hypokalemia, hyperglycemia
CONTRA: lower kidney function
INTERACT: digoxin, lithium
INTERVENTION: monitor K levels, eat foods high in K
CLASS: potassium-sparing diuretics
PRO: spironolactone
ACTION: block aldosterone, potassium retension, Na and H20 secretion
USES: combined with other diuretics for K sparing effects, heart failure
SE: hyperkalemia
INTERACT: ACE and K+ supplements (hyperkalemia)
INTERVENTION: only given orally, avoid K+ salt substitutes

Gastrointestinal Drugs: Start on p. 891 in Lehne

Drugs for Peptic Ulcer Disease
An example antibiotic regiment for H pylori would include:
Omeprazole + Amoxicillin + Clarithromycin for 10 days-remember
that none is effective alone and a multi-drug regiment is to prevent
development of resistance to H pylori. Other options listed in p. 894
H2 Receptor Antagonists-Cimetidine [Tagamet], Ranitidine hydrochloride
[Zantac]
Action: blocks receptor H2 receptor sites in PARIETAL cells lining the
stomach
Therapeutic Use: GERD
Sides/Adverse Effects: Decreased libido and impotence (keep away from
your partner)
Contraindications/Precautions: Pregnancy Cat. B. Careful with older
folks can cause antiadrenergic effects like impotence and CNS effects like
confusion.
Interactions: Increases the levels of Warfarin and Phenytoin
(anticonvulsant).
Interventions/Education: remember the drugs ending in tidine can be
administed IV in acute situations. Also eat 6 small meals.
Proton Pump Inhibitor Omeprazole [Prilosec]
Action: reduce gastric acid secretion by irreversibly inhibiting the enzymes
that produces gastric acid so it stays in the system for a few weeks. They
also reduce basal and stimulated acid production.

Therapeutic Use: Ulcers, GERD, and hypersecretory conditions like

Zollinger-Ellison syndrome.
Sides/Adverse Effects: Insignificant with short term use.
Contraindications/Precautions: Preg C. Caution in children and women
who are breastfeeding. Increase risk for pneumonia.
Interactions: delayed absorption of ampicillin, digoxin, iron and
ketocanazole
Interventions/Education: Do not crush, crew or break sustained-release
capsules.
Mucosal Protectants Sucralfate [Carafate]
Action: uses acidic environment of stomach and duodenum into a viscous
substance that adheres to an ulcer and protects from further injury.
Therapeutic Use: Acute duodenal ulcers and maintained therapy.
Sides/Adverse Effects: increase dietary fiber to decrease constipation.
Contraindications/Precautions: Preg B and contraindicated in those with
hypersensitivity
Interactions: May interfere with absorption of phenytoin, digoxin, warfarin
and ciprofloxacin so spread out meds by 2h.
Interventions/Education: empty stomach 1h before meals
Antacids Aluminum hydroxide gel [Amphojel]
Action: neutralize gastric acid and inactivate pepsinmucosal protection
may come into play by stimulating the production of prostaglandins.
Therapeutic Use: PUD by promoting healing and relieving pain.
Symptomatic relief for GERD.
Sides/Adverse Effects: Can cause constipation. Can lead to
hypophosphatemia.
Contraindications/Precautions: Preg Cat. C. DO not administer to clients
with perforation or obstruction
Interactions: Al binds with warfarin and tetracycline which interferes with
absorption
Interventions/Education: Chew it up real good and drink 8oz of H20 or
milk.
Drugs for NSAID-- Induced Ulcers
Misoprostol
Action: works on the GI tract to decrease acid secretion, increase the
secretion of bicarbonate and protective mucous and promote vasodilatation
to maintain submucosal blood flow.
Therapeutic Use: to prevent gastric ulcers in clients using NSAID longterm
Sides/Adverse Effects: Diarrhea and abdominal painnotify provider the
dose may need to be reduced.
Contraindications/Precautions: remember this drugs causes
contractions of the uterus which could lead to spontaneous abortion.
Interactions: NONE its a miracle!!!

Interventions/Education: Besides ensuring contraception use teach client

to take with meals and at bedtime.

LAXATIVES
Surfactants Docusate Sodium [Colace]
Action: lower surface tension of the stool to allow penetration of H20
Therapeutic Use: short term use r/t pregnancy or opoid use. To relieve
painful elimination (hemorrhoids)., prevent straining, decrease risk of fetal
impaction of immobile, promote peristalsis due to aging
*other info below
Stimulant Laxatives Bisacodyl [dulcolax]
Action: stimulate intestinal peristalsis-act on the colon by reducing water
and electrolyte absorption and increasing the secretion of water and ions
into the intestine.
Therapeutic Use: prior to surgery, short term treatment caused by high
opoid use.
Sides/Adverse Effects: discourage clients from using suppositories on a
regular basis as it may cause burning and can lead to proctitis.
*other below
Osmotic Laxatives-magnesium hydroxide [Milk of Mag]
Action: Osmotic lax draw H2O into the mass of stool stretching
musculature and stimulating peristalsis
Therapeutic Use: used in clients to prevent painful elimination, prep for
surgery of diagnostic test, evacuate bowel after ingestion of poison or
antihelminthic to rid body of dead parasites.
Sides/Adverse Effects: Can lead to accumulation of toxic level of Mg
(avoid in folks with renal dysfunction). Osmotics can also cause
dehydration.

*General Information for this group:

Sides/Adverse Effects: GI irritation-do not crush or chew enteric-coated
tablets.
Contraindications/Precautions: Contraindicated in clients with fecal
impaction, bowel obstruction, and acute surgical abdomen to prevent
perforation-also in clients with nausea, cramping and abdominal pain. Warn
clients with heart disease to avoid laxatives that contain sodium.
Interactions: Milk and antacids can destroy enteric coating of bisacodyl.
Interventions/Education: Obtain a complete history of laxative use and
provide teaching as appropriate. Teach client that chronic laxative use can
lead to fluid and electrolyte imbalances. Promote fiber food so that normal
bowel function may be resumed.

Anitemetics
Serotonin Antagonists Ondansetron [Zofran]
Action: blocks serotonin receptors in the chemoreceptor trigger zone (CTZ)

and antagonizing the serotonin receptors on the afferent vagal neurons that
travel from the upper GI tract to CTZ
Therapeutic Use: Sides/Adverse Effects: prevents emesis related to
chemo, radiation therapy and postoperative recovery
Sides/Adverse: Headache, diarrhea, dizziness
*see below
Dopamine Antagonists Prochlorperazine [Compazine]
Action: Anitemetic effects result from blockade of dopamine receptors in
the CTZ.
Therapeutic Use: prevents emesis r/t chemo, opoid and postoperative
recovery
Sides/Adverse Effects: EPS Extrapyramidal symptoms i.e. restlessness,
anxiety, spasms of the neck and facetreat with an anticholinergic like
benadryl
*See below
Cannabinoids; dronabinol [Marinol]
Action: unknown
Therapeutic Use: Control vomiting and nausea(CINV) in chemo
Sides/Adverse Effects: Potential for dissociation, dysphoria
Contraindications/Precautions: avoid using in clients with mental health
disorders
* See Below

*General information for this group:

*General Contraindications/Precautions- Use cautiously with children
and older adults due to EPS sides.
Interactions: CNS depressants such as opoid medications can intensity
CNS depression of antiemetics; antihypertensives concurrent use can
intensify hypotensive effects of antiemetics; anticholinergics like
antihistamines concurrent use can intensify anticholinergic effects of
antiemetics.
Nursing Interventions: Antiemetics prevent or treat nausea and vomiting
from various causes match with cause. Using a combination allows for lower
dosage and decrease the risk of side effects i.e. EPS system.
Drugs for Adrenal insufficiency (Not in ATI-found in pharm)
Hydrocortisone (a glucocorticoid)
Prototype glucocorticoids
Key function replacement therapy used for acute adrenal
insufficiency/nonendocrine applications used to treat a broad spectrum of nonendocrine
disorders.
Adverse Effects When taken in large doses to treat nonendocrine disorders,
glucocorticoids are highly toxic. High dose therapy include adrenal suppression and
productive cushing syndrome.
Fludrocortisone (mineralocorticoid)

Prototype mineralocorticoid
Key function treats addisons disease, primary hypoaldosteronism, and
congenital adrenal hyperplasia. (In most cases used with glucocorticoid)
Adverse Effects When dosage is too high, salt and water are retained in excess,
while excessive amounts of potassium are lost. Expansion of blood volume,
hypertension, edema, cardiac enlargement, hypokalemia.
Intervention monitor weight gain, elevation of b/p, and hypokalemia.
Womens Health
Estrogen (ATI pg 488-490)
Prototype Conjugated equine estrogens (Premarin)
Estradiol (Estrace)
Action: estrogens are hormones needed for growth and maturation of the female
reproductive tract and secondary sex characteristics. Estrogens block bone resorption
and reduce low density lipoprotein levels. At high levels, estrogens suppress the release
of follicle stimulating hormone needed for conception.
Uses: contraception, relief of potmenopausal symptoms (hot flashes, mood
changes), prevention of postmenopausal osteoporosis, treatment of dysfunctional
uterine bleeding and endometriosis, treatment of prostate cancer.
Side Effects: Endometrail and ovarian cancers occur when prolonged estrogen is
the only potmenopausal therapy, potential risk for estrogen-dependent breast cancer,
embolic events, impotence, and decrease libido in males
Nursing interventions: Give the client progestins alson with estrogen, instruct
the client to report persistent vaginal bleeding, encourage regular self-breast exams and
mammograms, discourage smoking, monitor pain, swelling, warmth of legs for emboli
(make sure pt takes the med at the same time each day)
Interaction: estrogens can decrease the effectiveness of warfarin. (monitor INR)
Use of phenytoin with estrogen can increase the risk of toxicity (monitor signs of
toxicity)
Contraceptive Agents (ATI pg 493-494)
Combination Oral Contraceptives
Ethinyl Estradiol/norethindrone
Progestin-Only Oral Contraceptives
Norethindrone
Long-Acting Contraceptives
Subdermal progestin implant (Norplant)
Depot medroxyprogesterone acetate
Drugs for Emergency Contraception
Leveonorgestrel alone
Ethinyl estradiol/levonorgestrel (the Yuzpe Regimen)
PROTOTYPE: OVCON 35 (Necon 1/35, ortho-novum)
Action: Oral contraceptives decrease fertility by inhibiting ovulation, thickening
cervical mucus, and making the lining of the endometrium less favorable for
implantation.
Uses: Oral contraceptives are used to prevent pregnancy.
Side Effects: Thromboembolic events, hypertension, breakthrough or abnormal
uterine bleeding, cervical cancer

Nursing Interventions: Discourage smoking, report warmth, edema, etc, may be

emboli, monitor b/p, evaluate pt for possibility of pregnancy if two or more periods
missed, routine pap smear.
Interactions: Carbamazephine, Phenobarbital, phenytoin, rifampin, tetracyclines,
and ampicillin-oral contraceptive effectiveness decreases with concurrent use of these
medications (Use additional contraceptive measures). Warfarin and oral hypoglycemicsoral contraceptives decrease the effects of these meds(check INR)
Drugs for infertility(NOT FOUND IN ATI)
Drugs for controlled ovarian stimulation
Clomiphene
Menotropins
Human chorionic gonadotropin
Drugs for hyperporlactinemia
Cabergoline (dopamine agonist)
Uterine Stimulatns and Relaxants
Uterine Stimulatns (Oxytocics) (ATI pg 481-483)
Prototype Oxytocin (Pitocin, Syntocinon)
Other med (Methylergonovine (Methergine)
Action: Uterine stimulants increases the strength, frequency, and length of
uterine contractions.
Uses: Induction of labor, enhancement of labor, delivery of afterbirth, to control
postpartum bleeding, fetal stress testing, intranasal promotion of milk let down.
Side Effects: Uterine rupture, hypertensive
Nursing intervention: Monitor the length, strength, and duration of contractions,
have magnesium sulfate on standby to relax the myometrium, monitor the pt for
symptoms of hypertension (headache, nausea, vomiting)
Interactions: vasopressors-can lead to hypertension (avoid use of oxytocin and
vasopressors, monitor b/p)
Uterine Relaxants (Tocolytics)
Prototype terbutaline sulfate (brethine)
Magnesium sulfate
Action: Terbutaline selectively activates beta2 adrenergic receptors, resulting in
uterine smooth muscle relaxation.
Uses: IV or SC terbutaline can be used for up to 48 hr to delay preterm labor.
Side Effects: tachycardia, palpitations, chest pain, tremors, anxiety, headache.
Nursing Interventions: Monitor the pt for these beta1 side effects, intervene
based on tolerance and physiological impact, monitor the pt for beta2 skeletal muscle
stimulant side effects.
CAUTION: Lactation enters breast milk
Interactions: adrenergic agonists-concurrent use can cause additive effects,
MAOIs-concurrent use can lead to hypertension, Beta blockers-concurrent use can blunt
effect (monitor for tachycardia, tremors, b/p)
***Terbutaline should be administered IV or SC due to high first pass effect
with oral administration.
MENS HEALTH

Androgens
Prototype Testosterone enanthate (Delatestryl)
Action: Androgens are a hormone needed for growth and maturation of male sex
organs and secondary sex characteristics. This hormone promotes skeletal muscle
growth in sexually mature males.
Uses: Androgens are used for treatment of hypogonadism in androgen deficient
men, treat delayed puberty, treat androgen-responsive breast cancer.
Side Effects: Hepatotoxicity, Cardiovascular risk high LDL, lower HDL, edema,
virilism effects, males- acne, facial hair, gynecomastia, impotence, priapism, femalesdeeper voice, unusual hair growth, clitoral enlargement, menstrual irreg, acne.
Hyercalcemia
Nursing interventions: Liver function test, check cholesterol levels, edema, low
sodium diet, hypercalcemia
Interactions: Warfarin, oral hypoglycemic, and glucocorticoids-androgen effects
on metabolism can increase med levels of these meds. Heaptotoxic drugs can increase
the risk of liver damage. (monitor INR, signs of bleeding, infection, liver function)
***Instruct pt to report weight fain of more than 2 pounds in a week.
Drugs for Erectile Dysfunction
Prototype sildenafil (Viagra)
Action: augments the effects of nitric oxide released during sexual stimulation
resulting in enhanced blood flow to corpus cavernosum and penile erection.
Uses: treat erectile dysfunction
Side effects: MI, sudden death, priapism
Nursing Interventions: Monitor pt risk factors and history with regard to
cardiovascular health, notify dr if erection lasts more than 4 hr.
**Do not take with Nitroglycerine
Interaction: Organic nitrates (nitroglycerin)-can lead to fatal hypotension,
Ketoconazole, erythromycin, grapefruit juice-inhibit metabolism of sildenafil thereby
increases plasma level of med
**Instruct pt to take 1 hr before sexual activity and limit use to once a day
Drugs for Benign Prostatic Hyperplasia (NOT IN ATI)

Drugs for IBS

Alosetron (Lotronex)
Only approved for treating women with severe, diarrhea-predominant IBS that has
lasted for 6 or more months. Causes selective blockade of type 3 serotonin
receptors, which are found primarily on neurons that innervate the viscera.
It decreases abdominal pain, increases colonic transit time, reduces
intestinal secretions, and increases absorption of H2O and Na.
Side EffectsMost common complication is constipation, which can be
complicated by impaction, bowel obstruction, and perforation. Can also
cause ischemic colitis (intestinal damage secondary to reduced blood flow).

Drug InteractionsNo known adverse interactions with other drugs.

Drugs for Bacterial Infections

Penicillin G (Bicillin LA)
Destroys bacteria by weakening the bacterial cell wall. Med of choice for grampositive cocci, such as streptococcus pneumonia, meningitis.
Side EffectsAllergies/anaphylaxis, renal impairment,
hyperkalemia/dysrhythmias with high doses of penicillin G.
Interventionsinterview client for prior allergy, observe client for 30 min
following administration of parenteral penicillin. Monitor clients kidney
function and I&O. Monitor clients cardiac status and electrolyte levels.
Drug Interactions
Aminoglycosidespenicillin inactivates aminoglcyosides when missed in the
same IV solution. Oral contraceptives
Apicillindecreases oral contraceptive efficacy.
Cephalosporins (use cautiously in pts with renal impairment)
CephalothinNot in ATI,Pharm,Mosbys drug book.
Cephalosporins are similar to penicillins, they destroy the bacterial cell wall.
Side Effectsallergic/hypersensitivity/anaphylaxis. Bleeding tendencies,
Thrombophlebitis, Cross allergy to penicillin.
InterventionsIf signs of allergy appear, stop immediately, observe for signs of
bleeding, if bleeding administer parenteral vitamin K and stop
cephalosporin, to avoid thrombophlebitis rotate injection sites and
administer slowly over 3-5min. Also assess patient for allergy to penicillin.
Drug Interactions
Disulfiram reaction (intolerance to alcohol) occurs with combined use of some
cephalosporins with alcohol, but not cephalotin.
Probenecid delays renal excretion
Other

Imipenem (Primaxin) (use cautiously in pts with renal impairment)

Destroys bacterial cell walls causing destruction of micro-organisms.
Primarily used with other antibiotics for broad spectrum with serious infections.
Side EffectsAllergy/hypersensitivity, GI symptoms(nausea,vomiting,diarrhea),
Suprainfection
InterventionsMonitor the patient for signs of allergic reactions. Observe client
for any GI signs, notify primary caretaker, and watch I&O. For
suprainfection, monitor patient for signs of colitis (e.g., diarrhea, oral
thrush, vaginal yeast infection) and intervene accordingly.
Drug InteractionsNone listed.
Vancomycin (Vancocin) (use cautiously in pts with renal impairment)
Destroys bacterial cell walls.
Primarily used for serious infections caused by MRSA. Also used in antibioticassociated pseudomembranous colitis.
Side EffectsOtotoxicity, Infusion reaction (e.g., rashes, flushing, tachycardia,
hypotension), and Thrombophlebitis.
InterventionsAssess client for signs of hearing loss, obtain a baseline hearing
test prior to administration, tell pt. to inform care provider if hearing loss
occurs. To avoid infusion reactions, infuse vancomycin slowly over 60 min.
To avoid thrombophlebitis, rotate injection sites and monitor infusion site for
redness, swelling, and inflammation.
Drug InteractionsNone listed.
Bacteriostatic Inhibitors of Protein Synthesis
Tetracyclines
Tetracycline Hydrochloride (Sumycin)
Broad-spectrum antibiotics that inhibit micro-organism growth by preventing
protein synthesis (bacteriostatic).
Medication of choice topically and orally for acne vulgaris.

Side EffectsGI discomfort (cramping, nausea, vomiting, diarrhea, esophageal

ulceration), Yellow/brown tooth discoloration and/or hypoplasia of teeth
enamel can occur, Hepatotoxicity, Photosensitivity, Suprainfection of the
bowel. Should be avoided by pregnant women.
InterventionsMonitor client for signs of GI upset. To avoid tooth discoloration
and enamel problems, avoid giving to children under 8 years of age. To
avoid hepatotoxicity, avoid giving high doses via IV. For photosensitivity,
avoid long exposure to sun. For suprainfection, monitor GI system.
Drug Interactions
Milk products, calcium supplements, iron supplements, magnesiumcontaining laxatives, and most antacids. Tetracyclines should be taken
on an empty stomach with water. Give 1 hour before and 2 hours after
meals and/or supplements containing calcium/magnesium.
Oral contraceptives. Instruct the pt to report signs of reduced levels, such as
breakthrough bleeding. Dose of oral contraceptive may need to be
increased.
Macrolides
Erythromycin (E-Mycin)
Slows the growth of micro-organisms by inhibiting protein synthesis.
Used primarily to treat infections in patients with a penicillin allergy.
Side EffectsGI discomfort (nausea, vomiting, epigastric pain),
Thrombophlebitis.
InterventionsTo avoid GI discomfort, administer with meals. To avoid
thrombophlebitis, administer slowly and in a dilute solution
Drug Interactions
Antihistamines, theophylline (asthma med), carbamazepine
(anticonvulsant), and warfarinconcurrent use with these meds
could result in toxicity so avoid use of these with erythromycin.
Oxazolidinomes
Linezolid (Zyvox)
Works well against MRSA and vancomycin-resistant enterococci (VRE). Inhibits

bacterial protein synthesis

Side EffectsGenerally well tolerated. Most common side effects are diarrhea,
nausea, and headache. Can cause myelosuppression, manifesting as
anemia, leucopenia, thrombocytopenia, or pancytopenia.
InterventionsMonitor for GI upset signs, and if pt. is receiving Linezolid for
more than 2 weeks, CBC should be done weekly.
Drug Interactions
Linezolid is a weak inhibitor of monoamine oxidase (MAO), and hence poses a risk
for hypertensive crisis. Can also cause hypertensive crisis in conjunction
with foods high in tyramine.
Glycylcylines
Tigecycline (Tygacil)
A tetracycline derivative designed to overcome resistant bacteria. Active against
a broad spectrum of bacteria, including many resistant strains.
Side EffectsBecause it is a tetracycline derivative, side effects are very similar
to those of tetracyclines. Most common side effects were nausea and
vomiting. Should be avoided by pregnant women.
Interventions-- Monitor client for signs of GI upset. To avoid tooth discoloration
and enamel problems, avoid giving to children under 8 years of age. To
avoid hepatotoxicity, avoid giving high doses via IV. For photosensitivity,
avoid long exposure to sun. For suprainfection, monitor GI system.
Drug InteractionsMinimal interactions, can delay the clearance of warfarin so
coagulation should be monitored.
Others
Clyndamycin (Cleocin)
Inhibits bacterial protein synthesis. Effective against most anaerobic bacteria and
most gram-positive aerobes.
Side EffectsAntibiotic-associated pseudomembranous colitis (AAPMC). This is
the most severe toxicity. The cause is suprainfection of the bowel with
C.difficile. AAPMC is characterized by profuse, watery diarrhea (10-20
stools /day), abdominal pain, fever, and leukocytosis. Stools often contain
mucous or blood.

InterventionsWatch for signs of AAPMC, or other GI problems. If AAPMC is

present, vigorous replacement therapy with fluids and electrolytes is usually
indicated. Drugs that decrease bowel motility should NOT be used because
they may worsen the symptoms.
Drug InteractionsThe site at which clyndamycin binds overlaps the binding
sites for erythromycin and chloramphenicol. As a result, concurrent use of these
with clyndamycin is not suggested.
Drugs for Bacterial Infections
Class: Aminoglycosides (Bactericidal Inhibitors of Protein Synthesis)
Pro Drug- Gentamicin
Uses: Medication of choice for aerobic gram negative bacilli ( escherichia coli, pneumoniae, etc)
Side Effects: Ototoxicity (discontinue if this occurs), Nephrotoxicity (Monitor BUN, Creatinine and
I&O.
Do not mix Aminoglycosides with penicillins in the same IV solution.
Class: Fluoroquinolones
Pro Drug- Ciprofloxacin
Uses: A broad spectrum antimicrobial, can be used on gram positive or negative bacteria. Medication
of choice for clients who have inhaled anthrax.
Side Effects: GI discomfort, Achilles tendon rupture ( observe for swelling, redness or pain and to
report to primary care provider and stop med).
Do not give to children < 18, Warfarin levels can be increased with Ciprofloxacin, Do not use dairy
products, antacids or salts until 1 hr before or 2 hrs after med is administeed.
Class: Cyclic Lipopeptides
Pro Drug- Daptomycin
Uses: Can kill all gram positive bacterias.
No need to monitor plasma level, Only side effect may be muscle injury due to IV. Does not have any
significant interactions. Can be used for MRSA
Class: Sulfonamides and Trimethoprim
Pro Drug- Trimethoprim/Sulfamethoxazole (Bactrim)
Drug- Sulfisoxazole
Drug- Trimethoprim
Uses: inhibit bacterial growth by preventing synthesis of folic acid, med of choice for UTIs.
Side Effects: Do not administer to patients allergic to sulfa, thiazide diuretics, loop diuretics. Can cause
crystalluria so increase fluid intake, photosensitivity, if sore throat or pallor notify provider.
Drugs for TB
Pro Drug- Isoniazid (INH)
Drug- Rifampin
Drug- Pyrazinamide
Drug- Ethambutol
Uses: Inhibits growth of mycobacteria, indicated for latent TB. INH daily for 6 months.
Side Effects: Peripheral neuropathy (give 50-200mg of vitamin B6 daily), Hepatotoxcity

Interacts with Phenytoin and levels may need to be adjusted, Avoid alcohol. Take on an empty
stomach.
Drugs for Funal Infections
Pro Drug- Polyene Macrolides (Amphotericin B)
Drug- Azoles (Itraconazole)
Drug- Echinocandins (Caspofungin)
Uses: Used for systemic fungal infections, Azoles are used for superficial fungal infections.
Side Effects: Infusion reactions (pretreat with diphenhydramine), Nephrotoxicty (monitor I&O, BUN),
Hypokalemia
Give 1 Liter of saline on day of amphotericin infusion. Contraindicated in renal failure patients. Avoid
use with antimicrobials such as aminoglycosides.

Viral Infections
Drugs for Cytomegalovirus Infection
Action: prevents the reproduction of viral DNA
Uses:
- medication of choice for herpes simplex virus, varicella zoster virus, and
cytomegalovirus
- Ganciclovir is treatment choice for CMV retinitis in immunocompromised pts with
HIV, and transplant pts at risk for CMV infection
Pro drug: acyclovir (Zovirax)
SE:
- phlebitis and inflammation at site of injection
- Nephrotoxicity
- mild discomfort
Contraindications:
- should be used cautiously in pts with renal impairment, dehydration, and pts taking
nephrotoxic meds
Interventions:
- administer slowly over 1 hr
- ensure adequate hydration during infusion and 2 hr after to minimize nephrotoxicity
Other: Ganciclovir (Cytovene), ribavirin (Rebetol)
SE:
- granulocytopenia and thrombocytopenia
- reproductive toxicity
Contraindications:
- pregnancy
- pts with neutrophils count <500/mm3
Interventions:
- obtain baseline CBC and platelet count and monitor
- if neutrophils count is <500/mm3, stop treatment, cell counts improve within 3-5
days

- advise women to avoid pregnancy during coarse of therapy and for 90 days after end
of therapy
- inform men of risk for sterility
Education:
- use rubber gloves for topical administration to avoid transfer of virus to other parts of
body
- acyclovir diminishes symptoms but does not cure virus
- refrain from sexual activity when lesions are present
- pts with healed lesions should continue to use protection during sexual activity to
prevent transmission of virus

Childhood Immunizations
Hepatitis B: doses given at birth, 1-2 mo, and 6-18 mo
~ SE: local reaction (anorexia, soreness, fatigue), anaphylaxis
~ Contraindicated in pts with a prior history of anaphylactic reaction and/or and allergy to
Bakers yeast
Diptheria and tetanus toxoids and pertussis vaccine (DTaP): doses at 2, 4, 6, 15-18mo, and at 4-6
years
~ SE: encephalopathy (fever, irritability, persistent crying that cant be consoled),
seizures, and/or local reaction at site of injection
~ Contraindicated in children with: severe febrile illness, history of prior anaphylactic
reaction to DTaP, occurrence of encephalopathy 7 days after administration of
DTaP immunization
Tetanus and diphtheria toxoids and pertussis vaccine (Tdap): 11-12 years
Tetanus and diphtheria (Td) booster: every 10 years following DTaP
Haemphilus influenza Type B (Hib): doses at 2, 4, 6, and 12-15 mo
Inactivated poliovirus vaccine (IPV): doses at 2, 4, 6-18mo, and 4-6 years
~ SE: vaccine associated paralytic poliomyelitis and/or local reaction
Measles, Mumps, Rubella vaccine (MMR): doses at 12-15 mo and at 4-6 years
~SE: local reactions (fever, rash, swollen glands), anaphylaxis
~ Contraindicated in:
- pregnant women and children who are allergic to eggs, gelatin, and neomycin
- history of thrombocytopenia
- immunocompromised children
- pts with advanced HIV
- pts who just received blood products or immunoglobulins
Varicella vaccine: single dose at 12-18 mo or 2 doses administered 4 wks apart after age 13
~ SE: varicella like rash
~ Contraindicated for:
- women who are pregnant
- clients with cancer
- pts with history of allergy to neomycin and/or gelatin
- immunocompromised pts
- children with congenital immunodeficiency
- pts taking immunosuppressive meds
Pneumococcal conjugate vaccine (PCV): doses at 2, 4, 6, and 12-15 mo
~SE: mild local reaction, fever
Hepatitis A: 2 doses 6 mo apart after 12 mo

Influenza vaccine: annually beginning at 6 mo (Oct thru Nov is ideal time)

~ SE: Guillain-Barre syndrome, local reaction, fever
~ Contraindicated in pts with:
- acute febrile illness
- hypersensitivity to eggs
Meningococcal vaccine (MCV4): dose at age 11-12
~ SE: mild local reaction
Uses: prevention of childhood of infectious diseases and their complications
Action: Immunizations produce antibodies that provide active immunity. May take
months to have an effect but confer long-lasting protection against infectious
diseases.
Nursing interventions:
~ in infants and young children, IM vaccinations are given in the vastus lateralis
muscle
~ for older children, adolescents, and adults, vaccinations are given in the deltoid
muscle
~ avoid administering aspirin to children to treat fever following immunization
due to the risk of the development of Reye syndrome

Adult Immunizations
Influenza Vaccine: given one dose annually after age 50 (earlier if specific risk factors such as
chronic disease)
Pneumococcal polysaccharide vaccine (PPV): one dose at age 65, and revaccinated every 6-8 years
after initial vaccination
Meningococcal vaccine: students entering college and living in college dormitories if not
previously immunized
Tetanus diphtheria (Td) booster: every 10 years
Action: Prevent infectious diseases through the production of antibodies that provide
active immunity
Uses: prevention of infectious diseases and their complications
Side effects: local reaction (redness, swelling, pain) at injection site, low grade fever,
risk of systemic allergic reaction (urticaria, anaphylaxis), small risk of GuillainBarre syndrome
Contraindications/precautions:
~ acute febrile illness- dont give until symptoms resolve
~ hypersensitivity to eggs
Nursing Interventions:
~ administer IM deep in the deltoid muscle
~ have emergency meds and equipment on standby in case of the occurrence of an
allergic reaction

Anticancer Drugs
Alkylating Agents
- Nitrogen mustards: cyclophosphamide (Cytoxan, Neosar)

Platinum compounds:
- cisplatin (Platinol AQ)
Antimetabolites
- Folic acid analog: methotrexate (Rheumatrex, Trexall)
- Pyrimidine analog: cytarabine (Cytosar-U)
- Purine analogs: mercaptopurine (Purinethol)
Antitumor Antibiotics:
- doxorubicin (Adriamycin, Rubex)
Mitotic Inhibitors:
- vincristine (Oncovin)
- paclitaxel (Taxol, Onxol)
Topoisoomerase Inhibitors:
- topotecan (Hycamtin)
- irinotecan (Camptosar)
Cytotoxic Medications:
- asparaginase (Elspar)
- hydroxyurea (Hydrea)
- procarbazine (Matulane)
Breast Cancer: antiestrogen:
- tamoxifen (Nolvadex)
Prostate Cancer:
- leuprolide (Lupron)
Progestins:
- megestrol acetate (Megace)
Action: Destroy cancer cells, as well as healthy cells, by preventing the replication of DNA
Uses: Used in the treatment of a variety of cancers
Side Effects:
- Bone marrow suppression
~ monitor CBC
~ assess for bruising and bleeding gums
~ instruct pt to avoid crowds and contact with infectious individuals
- GI discomfort
- Alopecia
~ advise that hair loss will occur 7-10 days after beginning of treatment and will
last for a maximum of 2 mo after last administration of chemo agent
- Muscositis (GI tract)
~ assess for mouth sores
- Reproductive toxicity such as congenital abnormalities, amenorrhea, menopausal
symptoms and atrophy of vaginal epithelium, and sterility in males
~ advise females against becoming pregnant while taking meds
~ advise male clients to consider sperm banking prior to treatment
- Hyperuricemia
~ monitor kidney function, BUN, and creatinine
~ increase fluid intake and monitor I&O
~ administer allopurinol if uric acid level is elevated
Nursing interventions:
- dosage of agents should be individualized