Classification Angiotensin II receptor blockers (ARB's)

Drug/Trade Cozaar

Drug/Generic Losartan

Basic action Dilation of arterioles and veins.

Related Decision Pre-administration Assessments Making (notify or hold) Patient Teaching Baseline BP. High risk patients: renal artery stenosis, if SBp <100 or hr<60, Avoid grapefruit juice, history of hypersensitivity to ARB's. HOLD and call. monitor pulse, change positions slowly, maintain good oral hygiene, wear sunscreen to avoid photosensitivity reaction. Baseline BP. High risk patients: renal artery stenosis, if SBp <100 or hr<60, history of hypersensitivity to ARB's. HOLD and call. Avoid grapefruit juice, monitor pulse, change positions slowly, maintain good oral hygiene, wear sunscreen to avoid photosensitivity reaction. Take as needed and only as prescribed.

Common Adverse Effects Antidote Dizziness, fainting, migranes, vertigo, malaise, dyspepsia, anorexia, constipation, impotence, nocturia, UTI.

Angiotensin II receptor blockers (ARB's)

Diovan

Calsartan

Dilation of arterioles and veins.

Dizziness, fainting, migranes, vertigo, malaise, dyspepsia, anorexia, constipation, impotence, nocturia, UTI.

Antacid

Maalox

Aluminum Hydroxide, Magnesium Hydroxide

Neutralizing acid in gut, Hypertension, HF producing neutral salts

Monitor pH in esophagus, x-ray of upper GI If SBp <90 mmHg , pregnant, lactating women, anemia, HOLD and call.

Constipation, diarrhea, sodium loading

Anti-anginal

Nitro-Dur

Nitroglycerin Patch

Nitrates dialate coronary arteries, decreasing preload, dilate systemic arteries, causing decreased afterload.

Before administering an antianginal drug, obtain and record a thorough description of the patients anginal pain as well as a history of allergy to the nitrates or calcium channel blockers and of other disease processes that would contraindicate administration of the drug Assess the physical appearance of the patient, auscultate the lungs for adventitious sounds, and obtain a baseline ECG and vital signs

Apply to hairless area of skin. Remove after 12 hrs to prevent tolerance. Do not stop taking medication unless directed by your physician.

Irritation of skin, postural hypotension, headache, flushing, dizziness,nausea, edema, and drowsiness. Also rash, dysrhythmias, and fatigue.

Anti-anginal

Nitrostat

Nitroglycerin SL

Nitrates dialate coronary arteries, decreasing preload, dilate systemic arteries, causing decreased afterload.

Before administering an antianginal drug, obtain and record a thorough description of the patients anginal pain as well as a history of allergy to the nitrates or calcium channel blockers and of other disease processes that would contraindicate administration of the drug Assess the physical appearance of the patient, auscultate the lungs for adventitious sounds, and obtain a baseline ECG and vital signs

If SBp <90 mmHg , Dissolve tab under pregnant, lactating tongue when pain women, anemia, HOLD begins. and call.

Postural hypotension, headache, flushing, dizziness,nausea, edema, and drowsiness. Also rash, dysrhythmias, and fatigue.

Antibiotic

Ancef

Cefazolin

Weaken cell wall, Blood culture to determine organism causing lysis and death. Inhibits bacterial cell division Assess for signs of infection

Allergic reactions

IM can be painful.

Diarrhea, stomach pain, upset stomach mild diarrhea, constipation, vaginal itching and discharge, dizziness.

Antibiotic Fluoroquinolones

Levaquin

Levofloxacin

HOLD for adverse reaction

Take on an empty stomach or with food. Wait 6 hours before taking anti-acids. Do not skip a dose or double up. Complete entire course of treatment unless directed by physician. Watch for unusual bleeding, bruising, dizziness, rash, fever, difficulty breathing

Anticoagulant

Lovenox

Enoxaparin

Prevents thrombus formation

Black tarry stools, falling Bp, bleeding gums, nose bleed, bleeding from surgery site.

bleeding, low platelet count 100,000/mm3 HOLD and call

Dizziness, H/A, insomnia, edema, Protamine constipation, N/V, urinary retention, sulfate rash, anemia

Classification Antidote for Opioids

Drug/Trade Naloxone

Drug/Generic Narcan

Basic action Pre-administration Assessments Blocks the effects of Monitor respiratory rate, rhythm, depth, pulse, ECG, opioids (CNS and Bp, LOC respiratory depression) Blocks the effect of the Monitor Bp, P, R. Access for level of nausea/vomiting. chemoreceptor trigger zone in the medulla, resulting in antiemetic properties. Reduces the activity of HR, rhythm the vagus nerve, which deactivates the vomiting

Related Decision Making (notify or hold) Patient Teaching Only give for suspected n/a opioid overdose/toxicity

Common Adverse Effects n/a

Antidote

Antiemetics

Phenergan

Promethazine

Tachycardia, delirium, dizziness, blurred vision, dysphagia, no nausea/vomiting, HOLD and call If you have PKU, history of long QT syndrome, liver disease, electrolyte imbalance, irregular heart beat HOLD and call

Change positions slowly, rinse mouth frequently, keep good oral hygiene.

Confusion, disorientation, sedation.

Antiemetics

Zofran

Ondansetron

Take with a full glass of Diarrhea, headache, constipation, water. Do not miss weakness, tiredness, dizziness. follow up appointments with doctor. Take exactly as prescribed. Regular checkup should include ECG. Do not double up on a missed/skipped dose.

Antihypertensive ACE inhibitors

Zestril

Lisinopril

Hypertension - blocks Bp, P, weight, lungs for rales/crackles, dyspnea (SOB), the conversion of peripheral edema, jugular venous distention. angiotensin 1 to the vasoconstrictor angiotensin II, increases the plasma renin levels and reduces aldosterone levels, resulting in systemic vasodilation, lowers the blood pressure.

SBp <100 or HR <60, serious adverse effects e.g. angioedema HOLD and call

Takes same time daily. Change positions slowly, taste impairment generally resolves in 8-10 weeks.

Dizziness, fatigue, H/A (headache), hypotension, cough, upset stomach, nausea, constipation, renal dysfunction, renal failure, rash, hyperkalemia, muscle cramps, fever, back pain.

Antihypertensive ACE inhibitors

Altace

Ramipril

Supresses RAAS, inhibits Bp, P, weight, lungs for rales/crackles, dyspnea (SOB), ACE, results in dialation peripheral edema, jugular venous distention. of arterial, venous vessels.

SBp <100 or HR <60, serious adverse effects e.g. angioedema HOLD and call

Takes same time daily. Change positions slowly, taste impairment generally resolves in 8-10 weeks.

Dizziness, fatigue, H/A (headache), 0.9% NaCl IV inf, hypotension, cough, upset stomach, hemodialysis. nausea, constipation, renal dysfunction, renal failure, rash, hyperkalemia, muscle cramps, fever, back pain. Dyspepsia, dizziness, confusion, headache, flushing, tinnitus, nausea, vomiting, heartburn, rash, urticaria, bruising, hyperpnea, Reye's syndrome (children).

Antiplatelet

Bayer

Asprin

Platelet aggregation inhibitor.

Inhibits prostaglandin synthesis, resulting in analgesia, anti-inflammatory activity, and platelet aggregation inhibition; reduces fever by acting on the brain's heat-regulating center to promote vasodilation and sweating.

Hypersensitivity to salicylates or NSAIDs; hemophilia, bleeding ulcers, or hemorrhagic states.

Take with food, milk, or a glass of water. Do not consume alcohol. Take as directed. Do not double up on doses unless directed by your doctor.

Classification Drug/Trade Antiulcer, proton pump Protonix inhibitors

Drug/Generic Pantoprazole

Basic action Binds to an enzyme in the presence of acidic gastric pH, preventing final transport of H+ ions into the gastric lumen.

Related Decision Pre-administration Assessments Making (notify or hold) Patient Teaching Assess patient routinely for epigastric or abdominal Take as directed, even if pain, occult blood in stool, emesis, or gastric aspirate feeling better. Avoid alcohol, aspirin or NSAID's, foods that cause GI irritation. Report onset of black, tarry stools; diarrhea; or abdominal pain to physician promptly. Do not break, chew or crush tablets.

Common Adverse Effects Antidote Headache, insomnia, diarrhea, abdominal pain, flatulence, pancreatitits, rash, hyperglycemia, weight loss/gain, hyponatremia, hypomagnesemia, myalgia, pneumonia, Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylaxis, angioedema, Rhabdomyolysis (is the breakdown of muscle fibers that leads to the release of muscle fiber contents (myoglobin) into the bloodstream. Myoglobin is harmful to the kidney and often causes kidney damage).

Beta Blocker, Antianginal, antihypertensive Biguanides (oral hypoglycemic)

Lopressor

Metoprolol

Blocks beta receptors in Baseline ECG, Bp, HR, anginal attacks, I & O heart, reducing h/r

HR<45/min HOLD and call

Change positions slowly, teach how to take pulse, drowsiness

Fatigue, weakness, ED

Glucophage

Metformin

Lowers blood glucose and improves glucose tolerance three ways: inhibits glucose production in the liver, reduces glucose absorbtion in the gut, sensitizes glucose receptors which increases glucose uptake in response to whatever insulin may be available.

Identify patients with or at risk of developing renal insufficiency, liver disease, severe infection, heart failure, history of lactic acidosis, or shock or other conditions that can cause hypoxemia.

Take immediate release Nausia, diarrhea, and appetite tablets twice daily, with reduction. the morning and evening meals. Alcohol increases the risk of lactic acidosis and should be avoided. Signs include hyperventilation, myalgia, malaise, and unusual comnolence. Seek immediate medical attention.

Bronchodilator

Proventil

Albuterol

Bronchodilation

Assess lung sounds (observe for wheezing), p, Bp, monitor pulmonary function tests.

Wheezing HOLD and call Shake inhaler. Take deep, slow breath in and squeeze inhaler while inhaling. Hold for 10 seconds. 1 Minute interval between puffs. Rinse mouth after dosing and wipe mouth piece. Avoid grapefruit juice, monitor pulse, change positions slowly, maintain good oral hygiene, wear sunscreen to avoid photosensitivity reaction.

Nervousness, restlessness, tremor; headache, insomnia, hoarseness, dry irritated nose and throat, increased sputum.

Calcium Channel Blocker

Norvasc

Amlodopine

Blocking of calcium Check Bp and p before administering. Assess for signs If SBp <90, HR <60, channels, Systemic of CHF, peripheral edema, rales/crackles, dyspnea, HOLD and call. vasodilation, decreasing weight gain, jugular vein distention. blood pressure

Dizziness, fatigue, H/A (headache),

Classification Calcium Channel Blocker

Drug/Trade Cardizem

Drug/Generic Diltiazem

Basic action Blocking of calcium channels, Systemic vasodilation, decreasing blood pressure

Related Decision Pre-administration Assessments Making (notify or hold) Check Bp and p before administering. Assess for signs If SBp <90, HR <60, of CHF, peripheral edema, rales/crackles, dyspnea, HOLD and call. weight gain, jugular vein distention.

Patient Teaching Avoid grapefruit juice, monitor pulse, change positions slowly, maintain good oral hygiene, wear sunscreen to avoid photosensitivity reaction.

Common Adverse Effects Dizziness, fatigue, H/A (headache),

Antidote

Cardiac Glycosides

Digoxin

Lanoxin

increases force of HR, rhythm ventricular contraction, increasing cardiac output

HR < 60 beats/min, or rhythm change HOLD and call

Diuretic - Loop

Furosemide

Lasix

Block reabsorption of sodium and chloride reabsorption Block reabsorption of sodium, preventing reabsorption of water

SBp, Apical

Diuretic - Thiazide

HydroDiuril

Hydrochlorothiazide

Bp, HR

Take exactly as prescribed. Limit salt intake to 2 mg daily. Avoid excess fluids. Do not double up on missed doses. SBp < 90 or apical <60 Take in morning. Do HOLD and call not stop taking, do not double up on missed doses. Bp below Renal Dose in the morning. impairment, cv disease, Will increase urine diabetes millitus, sulfate output. Monitor Bp and allergies, ACE inhibitors, signs of hyperkalemia edema (pitting) (muscle cramps)

Fatigue, nausea, vomiting

Digitek

Increase thirst, dizziness, constipation, headache, muscle cramps Dizziness, dry mouth, headache

Glucocorticoid

Advair Diskus

Fluticasone

Anti-inflammatory

FEV1

PEF < 80%

Hypnotic/Benzodiazepin Restoril es

Temazepam

Increases the effect of Assess sleep patterns before and periodically the neurotransmitter throughout course of therapy. GABA, causing sedation.

Gargle after dosing. 1 min between puffs. Monitor and record PEF. Not a rescue inhaler. Depression, suicidal, or Prepare environment history of addiction for sleep (quiet, dark HOLD and call. room), avoid nicotine and caffeine. Do not increase does without health care professional consultation. Avoid alcohol and other depressants.

Oropharyngeal candidiasis, dysphonia, cough, headache

Dizziness, weakness, unsteadiness, headache, depression.

Romazicon

LABA Laxative

Colace

Salmeterol Docusate sodium

Bronchodilation Stool softener by facilitating water penetration

Hard stool, no bm

Abdominal pain, impacted stool, diverticulitis, ulcerative colitis

Laxative

Ducolax

Bisacodyl

Stool softener by facilitating water penetration

Hard stool, no bm

Take with a full glass of Cramping, stomach pain water, increase fluids, exercise after eating. Do not over use. Use briefly and the smallest amount. Abdominal pain, Take with a full glass of Cramping, stomach pain impacted stool, water, increase fluids, diverticulitis, ulcerative exercise after eating. colitis Do not over use. Use briefly and the smallest amount.

Classification Laxative

Drug/Trade MOM

Drug/Generic Magnesium Hydroxide

Basic action Stool softener by facilitating water penetration

Pre-administration Assessments Assess patient for abdominal distention, presence of bowel sounds, usual pattern of bowel function. Assess color, consistency, and amount of stool produced.

Related Decision Making (notify or hold) Do not administer at bedtime or late in the day, electrolyte imbalance, or no longer constipated.

Patient Teaching Common Adverse Effects Do not take within 2 hr Diarrhea of taking other medications. Increase bulk in the diet, fluid intake, mobility. Drink a full glass of water and take on an empty stomach. Do not take within 2 hr Diarrhea of taking other medications. Increase bulk in the diet, fluid intake, mobility. Drink a full glass of water and take on an empty stomach.

Antidote

Laxative

Senokot

Senna

Stool softener by facilitating water penetration

Assess patient for abdominal distention, presence of bowel sounds, usual pattern of bowel function. Assess color, consistency, and amount of stool produced.

Do not administer at bedtime or late in the day, electrolyte imbalance, or no longer constipated.

Multivitamin

TheragranM/minerals/iron

Multivitamin w/min/Fe Dietary supplement for Check levels in CBC vitamin deficiencies

Signs of nutritional deficiency, alcohol intolerance.

Non Opioid Analgesic, Antipyretic

Tylenol

Acetaminophen

Opioid Analgesics Moderate to Strong

OxyContin

Oxycondone

Inhibits the synthesis of prostaglandins that may serve as mediators of pain, primarily in the CNS. Binds to opiate receptors in the CNS, alters perception of and response to painful stimuli while production generalized CNS depression.

Assess for location and severity of pain, increased temperature, alcohol usage, OTC drugs. Evaluate hepatic, hematologic, and renal function prior and periodically during prolonged, high dose therapy. Assess level of consciousness, Bp, P, R prior to administration and 20 minutes after.

Chewable tablets Hypersensitivity to preservatants, should be chewed colorants, allergies. completely before swallowing. Follow a well balanced diet. Stool may be black from iron. Renal disease, allergies, Notify physician if rash Upset stomach, heartburn, nausea. glucose deficiency, develops, avoid alcohol overdose or toxicity consumption. HOLD and call R <10, unable to wake patient, HOLD and call Do not increase dosage without consulting physician first. Avoid alcohol. Warn about addiction.

acetylcysteine

Confusion, sedation, dizziness, Narcan/Naloxon dysphoria, euphoria, hallucinations, e blurred vision, miosis, diplopia, respiratory depression, hypotension, bradycardia, constipation, n/v, urinary retention, sweating, physical and psychological dependence, tolerance. Confusion, sedation, dizziness, Narcan/Naloxon dysphoria, euphoria, hallucinations, e blurred vision, miosis, diplopia, respiratory depression, hypotension, bradycardia, constipation, n/v, urinary retention, sweating, physical and psychological dependence, tolerance. Confusion, sedation, dizziness, Narcan/Naloxon dysphoria, euphoria, hallucinations, e blurred vision, miosis, diplopia, respiratory depression, hypotension, bradycardia, constipation, n/v, urinary retention, sweating, physical and psychological dependence, tolerance.

Opioid Analgesics Moderate to Strong

Percocet

Oxycondone/Acetamino Binds to opiate Assess level of consciousness, Bp, P, R prior to phen receptors in the CNS, administration and 20 minutes after. alters perception of and response to painful stimuli while production generalized CNS depression.

R <10, unable to wake patient, HOLD and call

Do not increase dosage without consulting physician first. Avoid alcohol. Warn about addiction.

Opioid Analgesics Strong

MorPHINe

Morphine

Binds to opiate Assess level of consciousness, Bp, P, R prior to receptors in the CNS, administration and 20 minutes after. alters perception of and response to painful stimuli while production generalized CNS depression.

R <10, unable to wake patient, HOLD and call

Do not increase dosage without consulting physician first. Avoid alcohol. Warn about addiction.

Classification Potassium Imbalance

Drug/Trade K-Dur/Potassium

Drug/Generic Potassium Chloride

Basic action Pre-administration Assessments conduction of nerve Lab Values impulses in heart, brain, and skeletal muscle

Related Decision Making (notify or hold) Patient Teaching Common Adverse Effects Monitor Lab values Take with a full glass of Mild nausea, upset stomach, water. Do not stop diarrhea. taking without talking to DR first. Keep appointments for blood work and ECG. Cardiovascular anomalies HOLD and call Take on an empty Insomnia, irritability, changes in stomach 30 to 60 menstrual periods, appetite changes, minutes before weight changes. breakfast. Can be a life long therapy. Avoid overheating, follow regular blood testing.

Antidote Kayexelate

Thyroid Hormones

Synthroid

Levothyroxine

Replacement therapy for natural thyroxine

TFT (Thyroid functioning test)

Advair Diskus (Salmeterol & Fluticasone) Albuterol (Proventil inhalant) Altace (Ramipril) Aspirin Cardizem (Diltiazem) Cozaar (Losartan) Diovan (Valsartan) Epogen (Epoetin Alfa) Glucophage (Metformin) Lanoxin (Digoxin) Lasix (Furosemide) Levaquin (Levofloxacin) Lopressor (Metoprolol) Lovenox (Enoxaparin) Morphine Sulfate Nitro-Dur (Nitroglycerin Patch) Nitroglycerin SL Norvasc (Amlodopine) Percocet (Oxycodone/Acetaminophen) Plavix (Clopidogrel) Protonix (Pantoprazole) Retrovir (Zidovudine) Synthroid (Levothyroxin) Tenormin (Atenolol) Vasotec (Enalapril) Zestril (Lisinopril)