Isocarboxazid

Tranylcypromine sulfate (Parnate)

Phenelzine sulfate (Nardil)

Monoamine oxidase inhibitors (MAOIs) antidepressants

SE:  postural hypotension, if foods with tyramine ingested, can have hypertensive crisis: H/A, sweatiing, palpitations, stiff neck, intracranial hemorrhage, potentiates alcohol and other meds

NC:  Inhibits monoamine oxidase enzyme, preventing destruction of norepinephrine, epinephrine, and serotonin, avoid foods with tyramine-aged cheese, liver, yogurt, herring, yeast, beer, wine, sour cream, pickled products, avoid caffeine, antihistamines, amphetamines, takes 3-4 weeks to work, avoid tricyclics until 3 wks after stopping MAOIs, monitor VS, sunblock required

Amitriptyline hydrochloride (Elavil)

Imipramine (Torfranil)

Desipramine hydrochloride (Norpramin)

Doxepin (Sinequan)

Nortriptyline (Pamelor)

Tricyclic antidepressants

SE:  sedation/drowsiness, expecially with Elavil, blurred vision, dry mouth, diaphoresis, postural hypotension, palpitations, N/V, constipation, urinary retention, increased appetite

NC:  increases brain amine levels, suicide risk high after 10-14 days b/c of increased energy, monitor VS, sunblock required, increase fluid intake, take dose a5t bedtime (sedative effect), use sugarless candy or gum for dry mouth, delay of 2-6 weeks before noticeable effects

Fluoxetime (Prozac)

Paroxetine (Paxil)

Sertraline hydrochloride (Zoloft)

Citalopram (Celexa)

Venlafaxine (Effexor)

Selective serotonin reuptake inhibitors (SSRI) antidepressants

SE:  palpitations, bradycardia, N/V, diarrhea or constipation, increeased or decreased appetite, urinary retention, nervousness, insomnia

NC:  decreases neuronal uptake of serotonin, take in AM to avoid insomnia, takes at least 4 weeks to work, can potentiate effect of digoxin, coumadin, and Valium, used for anorexia, not suicidal or homicidal

Bupropion (Wellbutrin, Zyban)

Trazodone (Desyrel)

Heterocyclic antidepressants

SE:  dry mouth, nausea

NC:  may require gradual reduction before stopping, avoid use with ETOH, other CNS depressants fot up to 1 week after end of therapy

Saint John's Wort

herbal antidepressant

SE:  dizziness, hypertension, allergic skin rxn, phototoxicity

NC:  avoid use of St. John's wort and MAOI within 2 weeks of each other, do not use alcohol, contraindicated in pregnancy, avoid exposure to sun and use sunscreen, discontinue 1 to 2 weeks before surgery.

Herbal interactions with antidepressants

St. John's wort interacts with SSRIs; do not take within 2 weeks of MAOI

Ginseng may potentiate MAOIs

Avoid Ma huang or ephedra with MAOIs

Kava should not be combined witgh benzodiazepines or opiods due to increased sedation

Increase use of Brewer's yeast with MAOIs can increase BP

Lispro (Humalog)

Aspart (NovoLog)

rapid acting insulin

Onset of action:  5-15 minutes

Peak action:  1h, 40-50 min

Duration of action:  3h, 4-6h

Time of adverse rxn:  midmorning-trembling, weakness

NC:  patient should eat within 5-15 minutes after injection; also used in insulin pumps

Regular (Humulin R, Noolin R, Ilein II Regular)

Short acting insulin

Onset of action: 30-60 min

peak action:  2-3h

duration of action:  4-6h

time of adverse rxn:  midmorning, midafternoon: weakness, fatigue

characteristics:  clear solution; given 20-30min before meal; can be alone or with other insulins

Isophane (NPH)

Lente

Intermediate-acting insulin

onset of action:  2-4h

peak action:  6-12h

duration of action:  16-20h

time of adverse rxn:  early evening: weakness, fatigue

characteristics:  white and cloudy solution; can be given after meals

glargine (Lantus)

very long acting insulin

onset of action:  1h

peak action:  continous (no peak)

duration of action:  24h

characteristics:  maintains blood glucose levels regardless of meals; cannot be mixed with other insulins; given at bedtime

action:  reduces blood glucose levels by incrfeasing glucose transport across cell membranes; enhances conversion of glucose to glycogen

indications:  type I diabetes; type 2 diabetes not responding to oral hypoglycemic agents; gestational diabetes not responding to diet

SE:  hypoglycemia

NC:  teach patient to rotate sites to prevent lipohypertrophy, fibrofatty masses at injection sites; do not inject into these masses, only regular insulin can be given IV all can be given SQ

herbal interactions:  bee pollen, ginkgo biloba, glucosamine may increase blood glucose, basil, bay leaf, chromium, echinacea, garlic, ginseng may decrease blood glucose

Glimepiride (Amaryl)

Glipizide (Glucotrol)

Glyburide (Micronase)

Sulfonylurea antidiabetics

SE:  GI symptoms and dermatologic rxns

NC:  Only used if some pancreas beta cell function, stimulates release of insulin from pancreas, many drugs can potentiate or interfer with action, take with food if GI upset occurs

Metformin (Glucophage)

Biguanide antidiabetics

SE:  Nausea, diarrhea, abdominal discomfort

NC:  No effect on pancreatic beta cells; decreases glucose production by liver, not given if renal impairment, can cause lactic acidosis, avoid alcohol, do not give with alpha-glucodiase inhibitors

Acarbose (Precose)

Miglitol (Glyset)

Alpha glucosidase inhibitor antidiabetics

SE:  abd discomfort, diarrhea, flatulence

NC:  delays digestion of carbohydrates, must be taken immediately before a meal, an be taken alone or with other agents

Rosiglitazone (Avandia)

Pioglitazone (Actos)

Thiazolidinedione antidiabetics

SE:  infection, H/A, pain, rare cases of liver failure

NC:  decreases insulin resistance and inhibits gluconeogenesis, regularly scheduled liver-function studies, can cause resumption of ovulation in perimenopause

Repaglinide (Prandin)

Meglitinide antidiabetic

SE:  hypoglycemia, GI disturbances, URIs, back pain, H/A

NC:  increases pancreatic insulin release, med should not be taken if meal skipped

Action:  stimulates insulin release from functioning beta cells in pancreas; increases insulin receptor sensitivity

Indications:  type 2 diabetes

NC:  take before breakfast, if GI upset, may be taken in divided doses before meals, monitor serum glucose levels, avoid alcohol, taching for disease: dietary control, symptoms of hypoglycemia and hyperglycemia, good skin care

Herbal interactions:  bee pollen, ginkgo biloba, glucosamine may increase blood glucose, basil, bay leaf, chromium, echinacea, glarlic, ginseng may decrease blood glucose

reverses hypoglycemia

SE:  N/V

NC:  given SQ or IM, onset 8-10 min with duration of 12-27 min, should be part of emergency supplies for diabetes, may repeat in 15 minutes if needed

Bismuth subsalicylate (Pepto-Bismol, Kaopectate)

antidiarrheal

SE:  darkening of stools and tongue, constipation

NC:  give 2 h before of 2 h after other meds to prevent impaired absorption, encourage fluids, take after each loose stool until diarrhea controlled, notify physician if diarrhea not controlled in 48h, absorbs irritants and soothes intestinal muscle, do not administer for more than 2 ddays in presence of fever or in patients less than 3 years of age, monitor for salicylate toxicity, use cautiously if already taking aspirin, avoid use before x-rays (is radiopaque)

Diphenoxylate hydrochloride and atropine sulfate (Lomotil)

antidiarrheal

SE:  sedation, dizziness, tahycardia, dry mouth, paralytic ileus

NC:  onset 40-60 min, monitor fluid and electrolytes, increases intestinal tone and decreases peristalsis, may potentiate action of barbiturates, depressants

Optium alkaloids (Paregoric)

antidiarrheal

SE:  narcotic dependence, nausea

NC:  acts on smooth muscle to increase tone, administer with glass of water, discontinue as soon as stools are controlled

Amphoteriein B (Fungizone)

Antifungal

SE:  IV:  nicknamed "amphototerrible", GI upset, hypokalemia-ionduced muscle pain, CNS disturbances in vision, hearing, peripheral neuritis, seizures, hematological, renal, cardiac, hepatic abnormalities, skin irritation and thrombosis if IV infiltrates

NC:  refrigerate med and protect from sunlight, monitor vital signs; report febrile rxn or any change in function, especially nervous system dysfunction, check for hypokalemia, meticulous car and observation of injection site

Nystatin (Mycostatin)

antifungal

SE:  mild GI distress, hypersensitivity

NC:  Discontinue if redness, swelling, irritation occurs, instruct patient in good oral, vaginal, skin hygiene

Flucanoral (Diffucan)

antifungal

SE:  N/V, diarrhea, elevated liver enzymes

NC:  drug excreted unchanged by kidneys; dosage reduced if creatine clearance is altered due to renal failure, administer after hemodialysis

Trimethobenzamide HCl (Tigan)

antiemetic

SE:  drowsiness, H/A

NC:  Give IM deep into upper outer quadrant of gluteal muscle to reduce pain and irritation

Prochlorperazine dimaleate (Compazine)

antiemetic

SE:  Drowsiness, orthostatic hypotension, diplopia, photosensitivity

NC:  Check CBC and liver function with prolonged use, wear protective clothing when exposed to sunlight

Ondansetron (Zofran)

antiemetic

SE:  H/A, sedation, diarrhea, constipation, transient elevations in liver enzymes

NC:  new class of antiemetics-serotonin receptor antagonist, administer 30 min prior to chemotherapy

Thiethylperazine maleate (Torecan)

antiemetic

SE:  transient leukopenia, extrapyramidal symptoms, orthostatic hypotension, blurred vision, photosensitivity, dry mouth, constipation, urine retention

NC:  give deep IM, stay in bed for 1 h after receiving drug, wear protective clothing when exposed to sunlight

Metoclopramide (Reglan)

antiemetic

SE:  restlessness, anxiety, drowsiness, extrapyramidal symptoms, dystonic rxns

NC:  monitor BP, avoid activities requiring mental alertness, take before meals, used with tube feeding to decrease residual and risk of aspiration administer 30 min prior to chemo

Meclizine (Antivert, Bonine)

antiemetic

SE:  drowsiness, dryh mouth,blurred vision, excitation, restlessness

NC:  contraindicated with glaucoma, avoid activities requiring mental alertness

Dimenhydrinate (Dramamine)

antiemetic

SE:  drowsiness, palpitations, hypotension, blurred vision

NC:  avoid activities requiring mental alertness

Promethazine (Phenergan)

antiemetic

SE:  drowsiness, dizziness, constipation, urinary retention, dry mouth

NC:  if used for motion sickenss, take 1/2 to 1 h before traveling; avoid activities requiring alertness, avoid alcohol, other CNS depressants

Droperidol (Inapsine)

antiemetic

SE:  seizures, arrhythmias, hypotension, tachycardia

NC:  often used either IV or IM in ambulatory care settings; observe for extrapyramidal symptoms (dystonia, extended neck, flexed arms, tremor, restlessness, hyperactivity, anxiety), which can be reversed with anticholinergics

Colchicine (Colsalide)

antigout med

SE:  GI upset, agranulocytosis, peripheral neuritis

NC:  analgesic, anti-inflamatory, give with meals, Check CBC, I/O, for acute gout in association with NSAIDs

Probenecid (Benemid)

antigout med

SE:  Nausea, constipation, skin rash

NC:  for chronic gout, reduces uric acid, check BUN, renal function tests, encourage fluids, give with milk, food, antacids, alkaline urine helps prevent renal stones

Allopurinol (Zyloprim)

antigout med

SE:  GI upset, H/A, dizziness, drowsiness

NC:  blocks formation of uric acid, encourage fluids, check I/O, check CBC and renal function tests, give with meals, alkaline urine helps prevent renal stones, avoid ASA bc it inactivates drug

Chlorpheniramine maleate (Chlor-Trimeton)

antihistamine

SE:  drowsiness, dry mouth

NC:  most effective if taken before onset of symptoms

Diphenhydramine HCl (Benedryl)

antihistamine

SE:  drowsiness, nausea, dry mouth, photosensitivity

NC:  don't combine with alcoholic beverages, give with food, use sunscreen

Promethazine HCl (Phenergan)

antihistamine

SE:  drowsiness

NC:  reduce dose or give every other day for patients with renal or hepatic dysfunction

Cholestyramine (Questran)

Colestipol (Colestid)

HMG-COA reductase inhibitors

Folic acid derivatives

Nicotinic acid

bile acid sequestrant antilipemics

SE:  constipation, rash, fat-soluble vitamine deficiency, abd pain and bloating

NC:  Increasesloss of bile acid in feces; decreases cholesterol, sprinkle powder on noncarbonated beverage or wet food, let stand 2 min, then stir slowly, administer 1h before or 406h after other meds to avoid blocking absorption, instruct patient to report constipation immediately

Lovostatin (Mevacor)

Pravastatin (Pravachol)

Simvastatin (Zocor)

Atorvastatin (Lipitor)

Fluvastatin (Lescol)

Rosuvastatin (Crestor)

HMO-CoA reductase inhibitors (anti-lipemic statins)

SE: myopathy, increased liver enzyme levels

NC:  decreases LDL cholesterol levels; causes peripheral vasodilation, take with food; absorption is reduced by 30% on an empty stomach; avoid alcohol, contact clinician if unexplained muscle pain, especially with fever or malaise, take at night, give with caution with decreased liver function

Niacin (Niacor, Niaspan)

Nicotinic acid anti-lipemic

SE:  flushing, hyperglycemia, gout, upper GI distress, liver damage

NC:  decreases total cholesterol, LDL, triglycerides, increases HDL, flushing will occur several hours after med is taken, will decrease over 2 wk, also used for pellegra and peripheral vascular disease, avoid alcohol

Fenofibrate (Tricor)

Gemfibrozil (Lopid)

folic acid derivative antilipemic

SE:  abdominal pain, increased risk for gallbladder disease, myalgia and swollen joints

NC:  decreases total cholesterol, VLDI, and triglycerides, administer before meals, instruct clients to notify health care provider if muscle pain occurs

Captopril (Capoten)

Enalapril (Vasotec)

Lisinopril (Zestril, Prinivil)

Benazepril (Lotensin)

Fosinopril (Monopril)

Quinapril (Accupril)

Ramipril (Altace)

Ace inhibitors

SE:  gastric irritation, peptic ulcer, orthostatic hypotension, tachycardia, myocardial infarction, proteinuria, rash, pruritis, persistent dry nonproductive cough, peripheral edema

NC:  decreased absorption if taken with food-give 1 h ac or 2 h pc, small, frequent neals, frequent mouth care, change position slowly, can be used with thiazide diuretics.

Methyldopa (Aldomet)

antihypertensive

SE:  Drowsiness, dizziness, bradycardia, hemolytic anemia, fever, orthostatic hypotension

NC:  Monitor CBC, monitor liver function, take at hs to minimize daytime drowsiness, change position slowly

Clonidine (Catapres)

antihypertensive

SE:  drowsiness, dizziness, dry mouth, H/A, dermatitis, severe reboung hypertension

NC:  don't discontinue abruptly, apply patch to nonhairy area

Atenolol (Tenormin)

antihypertensive

SE:  bradycardia, hypotensiuon, bronchospasm

NC:  once per day dose increases compliance, check apical pulse; if less than 60 bpm hold dose and call physician, don't discontinue abruptly, masks signs of shock and hypoglycemia

Metoprolol (lopressor)

antihypertensive

SE:  Bradycardia, hypotension, heart failure

NC:  give with meals, teah pt to check pulse before each dose, take apical pulse before administration, withholdif pulse less than 60 bpm, don't discontinue abruptly

Nadolol (corgard)

antihypertensive

SE:  bradycardia, hypotension, heart failure

NC:  teach pt to check pulse before each dose, check apical pulse before administering, withhold if pulse less than 60 bpm, don't discontinue abruptly

Hydralazine (Apresoline)

antihypertensive

SE:  H/A, palpitations, edema, tachycardia, lupus, erythematosus-like syndrome

NC:  give with meals, observe mental status, check for wgt gain, edema

Minoxidil

antihypertensive

SE:  tachycardia, angina pectoris, edema, increase in body hair

NC:  teach pt to check pulse; check apical pulse before administration, monitor I/O, wgt

Captopril (Capoten)

Enalapril (Vasotec)

Lisinopril (Zestril, Prinivil)

antihypertensive

SE:  dizziness, orthostatic hypotension

NC:  report swelling of face, lightheadedness, ACE-inhibitor med

Propranolol (Inderal)

antihypertensive

SE:  weakness, hypotension, bronchospasm, bradycardia, depression

NC:  beta blocker, blocks sympathetic impulses to heart, client take pulse at home before each dose, dosage should be reduced gradually before discontinuing

Nifedipine (Procardia)

Verapamil (Calan)

Diliazem (Cardizem)

antihypertensive

SE:  hypotension, dizziness, GI distress, liver dysfunction, jitteriness

NC:  calcium-channel blocker; reduces workload of left ventricle, coronary vasodilator; monitor blood pressure during dosage adjustments, assist with ambulation at start of therapy

Lithium

tx bipolar

SE:  H/A, dizziness, impaired vision, fine hand tremors, reversible leukocytosis

NC:  use for control of manic episodes in psychosis, mood stabilizer, blood levels must be monitored frequently, GI symptoms can be reduced if taken with meals, therapeutic effects preeded by lag of 1-02 weeks, signs of intoxication--vomiting, diarrhea, drowsiness, muscular weakenss, ataxis, dosage is usually halved during depressive stages of illness, normal blood target level= 1-1.5 mEq/L, check serum levels 2-3 times weekly when started and monthly while on maintenance; serum levels should be drawn in AM prior to dose, should have fluid intake of 2,500-3,000 mL/day and adequate salt intake

Carbamazepine (Tegretol)

tx bipolar

SE:  dizziness, vertigo, drowsiness, ataxia, CHF, aplastic anemia, thrombocytopenia

NC:  mood stablizer used with bipolar disorder, traditionally used for seiqures and trigeminal neuralgia, obtain baseline urinalysis, BUN, liver function tests, CBC, shake oral suspension well before measuring dose, when giving by NG tube, mix with equal volume of water, 0.9% NaCl or D5 W, then flush with 100 ml after dose, take with food or milk, avoid hazardous activities

Divalproex sodium (Depakote)

tx bipolar disorder

SE:  sedation, pancreatitis, indigestion, thrombocytopenia, toxic hepatitis

NC:  mood stablizers used with bipolar disorder, traditionally used for seizures, monitor liver function tests, platelet out before starting med and periodically after med, teach lient symptoms of liver dysfunction (malaise, fever, lethargy), monitor blood levels, take with food or milk, avoid hazardous activities