Pharmacology Table
DRUG LIST ANTIBIOTICS *All antibiotics have GI effects| Aminoglycosides | -micin i.e. gentamicin -mycin i.e. vancomycin, neomycin | Side effects: –Ototoxicity –Nephrotoxicity -GI irritation Vancomycin: Red man syndrome; administer over 60 minutes | -Assess for allergies esp. anaphylactic allergies -Monitor appropriate lab values prior to administration i.e. aminoglycosides with BUN and Cr -Monitor for adverse effects and report to HCP if they occur -Monitor ins and outs -Encourage fluid intake -Emphasize importance of completing full prescribed course |
| Cephalosporins (broad spectrum) | Cef- i.e. cefaclor, cefradoxil, cefdinir, cefotaxime, cephalexin | -GI disturbances –Nephrotoxicity -Superinfections i.e. C. difficile Similar to penicillins; contraindicated for clients with penicillin sensitivity | |
| Floroquinolones Floroquinol(one) bone marrow depression | -floxacin i.e. ciprofloxacin, gatifloxacin | Headache, dizziness, insomnia, depression -GI effects –bone marrow depression i.e. thrombocytopenia -photosensitivity, fever, rash | |
| Macrolides | -thromycin i.e. azithromycin, erythromycin | -GI effects -pseudomembranous colitis (c. diff colitis) -superinfections –Hepatotoxic -causes a prolonged QT interval, which may lead to sudden cardiac death due to torsades de pointes | |
| Penicillins | -cillin i.e. amoxicillin, carbenicillin, ampicillin | -hypersensitivity reactions, including anaphylaxis -related to cephalosporins -GI effects | |
| Sulfonamides | Sulfa- i.e. sulfadiazine, sulfasalazine | –hepatotoxic and nephrotoxic –bone marrow depression i.e. thrombocytopenia -photosensitivity -ANY RASH WITH SULFONAMIDES MUST BE REPORTED TO HCP! | |
| Tetracyclines | -cyclines i.e. doxycycline, tetracycline | -GI effects –hepatotoxicity -teeth staining and bone damage -photosensitivity, hypersensitivity **Can cause pill induced esophagitis. Clients taking this should sit upright for a period of time after ingestion to prevent tablet from lodging in esophagus | |
| Antifungal medications | Amphotericin B -nazole i.e Fluconazole Ketoconazole | -gastrointestinal effects -neuritis, dizziness, headache, malaise, drowsiness, hallucinations | |
| Antiviral medications | -clovir i.e. acyclovir, ganciclovir, foscarnet | -hearing loss (ototoxicity) -peripheral neuritis |
CARDIOVASCULAR MEDICATIONS
| Anticoagulants | Oral: Warfarin, Dabigatran, Rivaroxaban Parenteral: Dalteparin, Heparin, Enoxaparin, Desirudin, Fondaparinux, Tinzaparin, Argatroban | Prevent clot formation by inhibiting factors in clotting cascade and decreasing blood coagulability i.e. in MI, mechanical heart valves, DVT, atrial fibrillation, unstable angina | Side effects: Hemorrhage Hematuria Thrombocytopenia Hypotension | -contraindicated in clients taking NSAIDs, gingko and ginseng, corticosteroids, vit K containing foods (have this in moderation; no sudden increase or decrease) -contraindicated with active bleeding -Heparin-Induced Thrombocytopenia can be ironic in that it can cause stroke and embolism |
| Thrombolytic medications | -teplase i.e. alteplase, reteplase, tenecteplase | Activates plasminogen which digests plasmin and dissolves clots in cases of MI, DVT, occluded shunts and pulmonary emboli | Bleeding Dysrhythmias Allergic reactions | -Contraindicated in active bleeding, history of hemorrhagic brain attack (stroke), intracranial or intraspinal surgery within the last 2 months, uncontrolled HTN -Apply direct pressure over a puncture site for 20 to 30 minutes -Used only for acute, life-threatening conditions Antidote: Aminocaproic acid |
| Antiplatelet medications | Aspirin, clopidogrel, cilostazol, dypiridamole, ticlopidine | Inhibit aggregation of platelets in clotting process, thereby prolonging bleeding time | GI bleeding Bruising Hematuria Tarry stools | -may be used with anticoagulants -used in prophylaxis of long-term complications following MI, CAD, stents, and strokes |
| Positive inotropes/cardiotonic medications | Dobutamine Dopamine Imanrinone Milrinone | Stimulate myocardial contractility and produce a positive inotropic effect for heart failure –increases CO, decreasing preload, improving blood flow to periphery and kidneys and increasing fluid excretion | Dysrhythmias Hypotension Thrombocytopenia Adverse effects: Hepatotoxicity Hypersensitivity- wheezing, SOB, pruritus, urticaria (hives, clammy skin and flushing | -used for IV administration; administer with IV infusion pump -monitor electrolyte (may lower K) and liver enzyme levels (may increase due to hepatotoxicity), platelet count, and renal function studies |
| Cardiac glycosides | Digoxin | Stimulates myocardial contractility by inhibition of sodium-potassium pump –slows HR (negative chronotrope) and slows conduction velocity (negative dromotrope) | -GI effects -headache -visual disturbances: diplopia, blurred vision, photophobia -drowsiness –bradycardia -fatigue, weakness | -used for HF and cardiogenic shock, anything atrial (tach, fibrillation, flutter) -Early signs of digoxin toxicity present as GI symptoms (anorexia, nausea, vomiting, diarrhea); then heart rate abnormalities and visual disturbances appear –hypokalemia can cause digoxin toxicity; toxic levels above 0.5 to 2 are toxic (POTASSIUM COMPETES WITH DIGOXIN) |
| Peripherally acting Alpha Adrenergic blockers | -zosin i.e. doxazosin, prazosin, terazosin | Decrease sympathetic vasoconstriction resulting in vasodilation and decreased BP | Orthostatic hypotension Reflex tachycardia Drowsiness Nasal congestion Sodium and water retention | -Monitor for fluid retention and edema -Avoid over the counter meds -change positions slowly to prevent orthostatic hypotension |
| Centrally acting Adrenergic blockers | Clonidine Guan- i.e. Guanabenz, Guanfacine Methyldopa | Causes vasodilation, reducing peripheral resistance | Na and water retention Drowsiness Bradycardia Hypotension | -contraindicated in impaired liver function -Do not discontinue meds abruptly as it can lead to severe rebound HTN |
| ACE inhibitors and ARBs | -prils i.e. perindopril, enalapril -sartans i.e. losartan, eprosartan | Causes vasodilation; treats HTN and CHF | Hyperkalemia Hypotension Persistent dry cough (ACEI) Angioedema (ACEI)** Hypoglycemia with DM | -can cause hyperkalemia! Avoid use with potassium supplements and potassium-sparing diuretics -Report side effect angioedema to the HCP right away -teratogenic drugs |
| Nitrates | Isosorbide Nitroglycerin | Vasodilates and improves blood flow in MI | Vasodilation/ Orthostatic hypotension Flushing or pallor Confusion Reflex tachycardia Dry mouth | -administer up to three times in 15 mins; if after 5 mins symptoms have not been relieved at home, call 911 right away -always assess BP before administration and lower head of bed if hypotension occurs -administer sublingually -keep in a dark tightly closed bottle; cannot be mixed with other drugs |
| Beta blockers | -lol i.e. metroprolol, bisoprolol | Block release of cathecholamines thus decreasing HR and BP | Bradycardia Bronchospasm Hypotension Dizziness | –contraindicated in clients with asthma, bradycardia or stroke, DM -assess for resp distress and for signs of wheezing and dyspnea -can mask symptoms of hypoglycemia i.e. tachycardia and nervousness; monitor BG |
| Calcium channel blockers | -dipine i.e. amlodipine, felodipine Verapamil Diltiazem | Promote vasodilation of coronary and peripheral vessels | Bradycardia Reflex tachycardia as a result of hypotension Changes in liver and kidney function | -better choice for clients with asthma -monitor kidney function tests -DO NOT ADMINISTER WITH GRAPEFRUIT JUICE as it can lead to severe hypotension |
| Miscellaneous vasodilator | Nesiritide | Vasodilates arteries and veins in CHF | Hypotension Confusion Dysrhythmias | Administer by continuous infusion via IV pump Monitor BP, cardiac rhythm, urine output and body weight |
| Adrenergic Agonists | Dopamine Epinephrine | Positive inotropes increases BP and cardiac output | Tachycardia | -Epinephrine used for cardiac stimulation in cardiac arrest (asystole) |
| HMG-CoA Reductase Inhibitors (statins) | -statin i.e. atorvastatin, rosuvastatin | Lowers serum cholesterol | Elevated liver enzyme levels Muscle cramps (myopathy) Nausea, abd pain or cramps Dizziness, headache Blurred vision (Cataract formation) | –Lovastatin is highly protein-bound and should not be administered with anticoagulants and should be administered with caution in clients taking immunosuppressive medications -instruct client to receive annual eye exam because meds can cause cataract formation –Hepatotoxic -HCP should be notified when client experiences muscle aches (monitor CK and myoglobin levels) |
| Antidysrhythmics | Amiodarone | Pulmonary fibrosis Photosensitivity Peripheral neuropathy Tremor Corneal deposits Bluish skin discoloration Poor coordination | Used to treat anything ventricular (V tach or PVCs) |
| Thiazide diuretics | -thiazide i.e. Chlorothiazide, cholorthalidone, hydrochlorothiazide, indapamide, metolazone | Increase sodium and water excretion by inhibiting sodium reabsorption in kidneys | Hypokalemia, hyponatremia Hypovolemia Hypotension Photosensitivity *Hyperglycemia | -not effective for IMMEDIATE diuresis -used with caution in the client taking lithium because lithium toxicity can occur (due to lack of sodium) -instruct client to take meds in morning to prevent nocturia and sleep interruption -change positions slowly to prevent orthostatic hypotension -instruct client with DM to check BG periodically |
| Loop diuretics (Potassium-wasting diuretics) | -ide i.e. Furosemide, Torsemide, ethacrynic acid, bumetanide | Inhibit sodium and chloride reabsorption from the loop of Henle and the distal tubule | Hypokalemia, hyponatremia Thrombocytopenia Hyperuricemia Dehydration Orthostatic hypotension Ototoxicity and deafness | -more rapid than thiazide diuretics -causes hypo of all electrolytes; monitor electrolytes, Mg, BUN, Cr, and uric acid levels -monitor digoxin (due to hypokalemia) or lithium (hyponatremia) toxicity -administer furosemide IV slowly to prevent ototoxicity |
| Potassium-sparing diuretics | Spironolactone, triamterene, amiloride HCl, eplerenone | Promotes sodium and water excretion AND potassium retention | Hyperkalemia Nausea, vomiting, diarrhea Rash Dizziness, weakness | -contraindicated in severe kidney or hepatic disease and severe hyperkalemia -monitor for HYPERKALEMIA!! –avoid salt substitutes because they contain potassium |
| Osmotic diuretics | Mannitol | Increases osmotic pressure of the GFR, inhibiting reabsorption of water and electrolytes -used with chemo to induce diuresis | Fluid and electrolyte imbalances Pulmonary edema Tachycardia from the rapid fluid loss Hyponatremia and dehydration | -can be used to decrease ICP |
DIABETIC DRUGS **Watch for hypoglycemia during peaks! INSULIN
| NPH | Basal long acting | Onset: 6 h Peak: 8-10 h Duration: 12 h | Cloudy suspension; precipitates and therefore cannot be given IV (can overdose client) “N for not so fast and not in the bag” –never given at bedtime (can cause hypoglycemia while asleep) -given twice daily |
| Glargine (lantus), Detemir | Basal long acting | No essential peak Duration: 12-24 h | -little to no risk for hypoglycemia; only safe insulin for bedtime |
| Regular i.e. humulin R, novolin R | Postprandial short acting | Onset: 1 h Peak: 2 h Duration: 4 h | –best for IV use (i.e. DKA) -“R for rapid and run insulin” |
| Lispro (Humalog), Aspart, Glulisine (LAG) | Postprandial short acting | Onset: 15 mins Peak: 30 mins Duration: 3 h | –give as client begins to eat, with meals not before meals (not AC) -ensure client eats within 15 minutes of administration |
| Biguanides | Metformin | Supresses hepatic production of glucose and increases insulin sensitivity | Diarrhea Lactic acidosis GI disturbances Metallic taste in mouth Hypoglycemia | -DO NOT TAKE same day of iodine contrast procedures i.e. cardiac catheterization (can induce lactic acidosis) Discontinue 24-48 hours prior to test |
| Sulfonylureas | Chlorpropamide Gli(___)ide i.e. glimepiride, glipizide, glyburide Tol(___)ide i.e. tolazamide, tolbutamide | Stimulate the beta cells to produce more insulin | Hypersensitivity reaction Weight gain GI disturbances Hypoglycemia | -Cross reaction with sulfa antibiotics (sulfonamides); if client has allergic reaction to either one, DISCONTINUE |
| Meglitinides | -linide i.e. nateglinide, repaglinide | Stimulate beta cells to produce more insulin -short duration of action; less chance of blood glucose-lowering effects | Hypoglycemia GI disturbances | Very fast onset of action allows client to take medication with meals and skip medication when a meal is skipped |
| Gliptins (DPP-4 inhibitors) | -gliptins i.e. sitagliptin, saxagliptin | Block the action of DPP-4, which destroys the hormone incretin (incretin help body produce more insulin when needed; inhibition causes more insulin to be produced) | Flulike symptoms (runny nose, headache, nausea, stomach pain) Rash GI problems | |
| Thiazolidinediones | -glitazone i.e. ciglitazone, darglitazone, englitazone | Insulin-sensitizing agents that lower blood glucose by decreasing hepatic glucose production and improving target cell response to insulin | Hepatotoxicity Increased bone fractures Increased LDLs | -Monitor for elevated ALTs and ASTs |
PSYCH DRUGS *All psych drugs have indications for WEIGHT GAIN and HYPOTENSION *Always taper medications down and never stop dosing abruptly
| Serotonin Reuptake Inhibitors (SSRIs) Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) | -lopram i.e. citalopram Sertraline Fluoxetine Fluvoxamine Venlafaxine Duloxetine | Antidepressants that work through inhibition of serotonin reuptake | Contraindications: St. John’s Wort, MAOIs Side effects: Anticholinergic- dry mouth Blurred vision Constipation Drowsiness *Insomnia Toxic effects: Agranulocytosis Priapism | -Monitor client for increased risk of suicidality esp. during improved mood and increased energy levels, and changes in doses -Instruct to change positions slowly to avoid ortho hypotension -Be aware of potential for Serotonin Syndrome Signs and symptoms include: Mental status changes (Anxiety, agitation, restlessness) and autonomic/neuromuscular hyperactivity (fever, muscle rigidity, shivering, diaphoresis, tachycardia, HTN, tremors) è Risk greatly elevated with concurrent use of MAOIs -Can cause insomnia; do not administer at bedtime |
| Monoamine Oxidase Inhibitors (MAOIs) | PITS Phenelzine Isocarboxacid Tranylcypramine Selegiline | Inhibits metabolism of amines, NE, and serotonin thus improving mood and preventing depression | RISK OF: With SSRIs: Serotonin Syndrome With TCAs: hypertensive crisis Antidote for hypertensive crisis: phentolamine IV | -given at the last resort when no other antidepressant therapies are effective -TYRAMINE- CONTAINING FOODS may cause hypertensive crisis; avoid BAR (bananas, avocadoes and raisins or dried fruit), organ meats and processed meats, and aged cheeses |
| Tricyclic Antidepressants (TCAs) | -triptyline i.e. amitriptyline, nortriptyline -pramine i.e. desipramine, imipramine | Antidepressants which block NE and serotonin reuptake | Side effects: Anticholinergic Blurred vision Constipation Drowsiness *Sedation Urinary retention | -Concurrent use with MAOIs can lead to hypertensive crisis –Cardiac toxicity can occur and all clients should receive an ECG before treatment and after –antidote for TCA overdose: physostigmine |
| Mood stabilizers | Lithium Quetiapine Olanzapine Risperidone Carbamazepine | Stabilizes mood | Lithium is a competitive binder with sodium– hyponatremia can cause toxicity -therapeutic level is 0.6-1.2; toxic is >2 -Lithium is teratogenic Side effects: Peeing Pooping Paresthesis Weight gain Drowsiness Anticholinergic | –Avoid anything that has any diuretic effects i.e. diuretics, coffee, tea, cola -dehydration can cause lithium toxicity -Instruct client to maintain a fluid intake of six to eight glasses of water |
| Benzodiazepines | -zepam i.e. clonazepam, diazepam, oxazepam -lam i.e. alprazolam, triazolam Chlordiazepoxide | Antianxiety; minor tranquilizer | Side effects: Anticholinergic Blurred vision Constipation Drowsiness**- can lead to somnolence | -contraindicated in glaucoma and should be used cautiously in children and older adults -used for induction of anesthesia, muscle relaxant, alcohol withdrawal syndrome, tranquilizer –antidote for benzo overdose: flumazenil -can only be given for 2-4 weeks, not a long term drug |
| Barbiturates | -barbital i.e. anobarbital sodium Choral hydrate Eszopiclone Zolpidem Zaleplon | Used for short-term treatment of insomnia for sedation to relieve anxiety, tension and apprehension | Side effects: Dizziness Confusion Agranulocytosis | -maintain safety by supervising ambulation and using side rails at night -avoid driving or operating hazardous equipment if drowsiness, dizziness or unsteadiness occurs |
| Antipsychotics | Typical: (older-think EPS as main side effect) Haloperidol Loxapine Chlorpromazine Atypical: Olanzapine Quetiapine Risperidone **Aripriprazole (not a proton pump inhibitor) | Reduces psychotic symptoms Typical antipsychotics are better indicated for positive symptoms (t like +) i.e. delusions, hallucinations, illusions Atypical better for negative symptoms i.e. anhedonia, catatonia | Side effects: Anticholinergic Blurred Vision Constipation Drowsiness *EPS- Typical i.e. parkinsonism, dystonia, rigidity, tremors Haldol- Torsades de pointes (can be fatal as it can lead to V. fib or pulseless V. tach) | -Administer with food or milk to decrease gastric irritation -protect liquid concentration from light -inform that some meds may cause a harmless change in urine color to pinkish to red-brown **Neuroleptic Malignant Syndrome (Haldol is most commonly tested)- characterized by altered mental status (lethargy, decreased LOC), muscle rigidity, hyperthermia (>40 C), tachycardia, HTN, tachypnea Treated by: supportive measures i.e. control temp (dantrolene), control agitation by benzodiazepines, and add dopamine agonist (bromocriptine) antipsychotic decrease dopamine levels |
RESPIRATORY MEDICATIONS *For any respiratory medication, think sympathetic effects!
| Bronchodilators (beta 2 agonists) | -ol i.e. albuterol, formoterol, salmeterol Terbutaline (also a tocolytic drug) | Relax smooth muscle of bronchi and dilate airways; promotes sympathetic response | Side effects: Palpitations and tachycardia Hypertension Dysrhythmias Restlessness, anxiety, tremors Hyperglycemia | -assess vitals and lung sounds -given as rescue drug along with ipratropium (only drugs used for acute asthma exacerbations) |
| Methylxanthines | -phylline i.e. Theophylline Aminophylline | Stimulate CNS and respiration, dilate coronary and pulmonary vessels, cause diuresis and relax smooth muscle –muscle spasm relaxer | Dysrhythmias Seizures* Tachycardia Insomnia Restlessness GI effects Signs of toxicity: Anorexia Nausea, vomiting Insomnia, restlessness Cardiac toxicity | -if administered with beta 2 agonist, cardiac dysrhythmias may result -administer with or after meals to decrease GI irritation -therapeutic level is 10-20; toxic level is >20 -IV infusions should be administered slowly and via an infusion pump -Usually given to relax airways during bronchospasm before bronchodilators can be effective -cimetidine and ciprofloxacin can dramatically increase serum theophylline levels and should not be used in these clients |
| Anticholinergics | -tropium i.e. tiotropium, ipratroprium | Results in bronchodilation due to blocking of muscarinic receptors in the bronchioles (anti-acetylcholine) antiparasympathetic therefore sympathetic effects | drying of secretions* Dry mouth Blurred vision Urinary retention Hypertension Constipation | -clients with peanut allergies should not take ipratropium because it contains soya lecithin, which is in the same plant family as peanuts -contraindicated in clients with glaucoma |
| Glucocorticoids | -sone i.e. beclomethasone, prednisone, fluticasone -ide i.e. ciclesonide, flunisolide | Long term treatment of inflammation associated with asthma | Immunosuppression | -Monitor for signs of infection and report to HCP i.e. fever, high WBCs -Not used for acute exacerbations –Rinse mouth after use to prevent oral candidiasis or thrush infection |
| Leukotriene modifiers | -lukast i.e. montelukast, zafirlukast | Used in prophylaxis and treatment of chronic asthma (not used for acute exacerbations) -inhibit bronchoconstriction caused by specific antigens and reduce edema and smooth muscle constriction | Immunosuppression Nausea, vomiting Dyspepsia Generalized pain, myalgia | -Coadministration of inhaled glucocorticoids increase the risk of upper respiratory infections -monitor liver function lab values i.e. ALT, AST |
| Antihistamines | Dimenhydrinate Dipenhydramine -tadine i.e. loratadine, olapatadine Cetirizine | Prevents a histamine response; used for common cold, rhinitis, nausea and vomiting | drying effect* Drowsiness, fatigue Dizziness Urinary retention Constipation Dry mouth | -Can cause CNS depression if taken with alcohol, opioids, tranquilizers or barbiturates -suck on hard candy or ice chips for dry mouth -contraindicated for glaucoma |
| Nasal decongestants | Pseudoephedrine (ephedrine looks similar to epinephrine) -zoline i.e. naphazoline, tetrahydrozoline, xylometazoline | Reduce fluid secretion | Major sympathetic effects* Hypertension (due to vasoconstriction) Hyperglycemia Restlessness, insomnia, nervousness | -contraindicated in HTN, cardiac disease, hyperthyroidism, or DM -should NOT be used for longer than 48 hours due to tolerance and rebound nasal congestion (vasodilation) |
| Opioid antagonists | Naloxone Naltrexone Alvimopan | Reverse respiratory depression in opioid overdose | Nausea, vomiting Tremors, Sweating Hypertension Tachycardia | –Avoid use for non-opioid respiratory depression -Re-occurrence of respiratory depression can occur if duration of opiate effects exceed duration of antagonist- re-administer if needed |
| Tuberculosis Agents | Isoniazid Rifampin Ethambutol Pyrazinamide Rifabutin Rifapentine | Treats active tb; treatment goes for 6-9 months for otherwise healthy clients (immunosuppressed clients can go for as long as 9-12 months) Isoniazid treatment can be used for latent tb | Hepatotoxicity Ototoxicity Neurotoxicity (numbness and tingling) Dry mouth Dizziness Red secretions (rifampin) | -after 2-3 weeks of treatment, risk of transmission is greatly reduced -when one med is discontinued abruptly, resistance can occur (MDR-TB) -decrease efficacy of oral contraceptives; other means of birth control must be used -Take pyridoxine (vit B6) to prevent neuropathy |
| Folate antimetabolite, antineoplastic, immunosuppressant drugs | Methotrexate | -treats malignancies, Rheumatoid Arthritis and psoriasis -CONTRAINDICATED in pregnancy unless abortion is warranted i.e. ectopic pregnancy | Bone marrow suppression Immunosuppression Hepatotoxicity Photosensitivity | -Clients should be instructed to get vaccinated with inactivated vaccines, avoid crowds and persons with known infections (as though they are being treated with chemo- antineoplastic drug) -Avoid alcohol as it is HEPATOTOXIC |
| Anticonvulsants | Phenytoin | Used to treat tonic-clonic seizures | Therapeutic range is 10-20 mcg/mL Anything >20 is toxic Main side effect: Gingival hyperplasia Toxic effects: Gait unsteadiness/Ataxia Horizontal nystagmus CNS effects | -Good oral hygiene can limit symptoms of gingival hyperplasia |
| NSAIDs | Ibuprofen Naproxen Indomethacin | Indicated for pain i.e. joint and inflammation | Tarry stools (due to GI bleeding) Nephrotoxicity Hypertension (sodium retention) Fluid overload | Contraindicated in CHF due to sodium retention and associated HTN -Contraindicated in clients taking Lithium (again due to associated sodium retention) -Take with food to prevent GI upset –Bleeding risk associated when taken with aspirin, anticoagulants and other NSAIDs |
| Proton pump inhibitors | -prazole i.e. Omeprazole Pantoprazole | Decreases acid production in stomach | Associated with increased risk of pneumonia C. diff diarrhea Calcium malabsorption (osteoporosis) | -may increase risk of C. diff infection due to lack of acid production in stomach leading to loss of gastric protection |
| Aspirin | Antipyretic, anti-inflammatory, antiplatelet and prophylactic treatment in recurrent MI | Tinnitus Hyperthermia Reye’s syndrome in peds | Contraindicated in administration to children due to risk of Reye’s syndrome (except in Kawasaki disease) | |
| Corticosteroids | -sone i.e. prednisone, bethametasone | Used for lack of corticosteroids in body (i.e. Addison’s), immune diseases | Hyperglycemia Immunosuppression Bone and muscle catabolism GI irritation | -Do not discontinue abruptly –Increase dose of corticosteroid therapy in Addison’s disease during times of stress as a stress response can cause a sudden decrease in cortisol levels and can trigger an Addisonian crisis -Recommend diets high in calcium, protein and low in fat and simple carbs while on treatment –Cataracts are a side effect of corticosteroids |
| Anticholinergics | Benztropine | Used to treat tremors in Parkinson’s disease | Blurred vision Dry secretions Constipation Urinary retention (contraindicated in BPH) | -contraindicated in glaucoma as it can precipitate an acute glaucoma episode |
- Do not administer anything sedative i.e. opioids, benzodiazepines, barbiturates to clients with increased ICP as it can mask somnolence and decreasing LOC
- Always monitor blood pressure in vasodilating medications prior to administration i.e. ACE inhibitors, nitrates
- Neuroleptic Malignant Syndrome and Malignant Hyperthermia are similar in terms of symptoms! i.e. muscle rigidity, hyperthermia, mental status changes, tachycardia, tachypnea—difference lies in causes
| Neuroleptic Malignant Syndrome | Malignant Hyperthermia |
| · Causes: Antipsychotics and low dose phenothiazines used as antiemetics i.e. Haldol, chlorpromazine · Treated by: dantrolene for hyperthermia, benzodiazepines for anxiety and agitation, and dopamine agonist bromocriptine | · Causes: inhaled anesthetics ie. Halothane, muscle relaxant i.e. succinylcholine · Treated by: dantrolene for hyperthermia, benzodiazepines for anxiety and agitation, NO bromocriptine |