Acetaminophen

Well-tolerated. Metabolized by liver. >4g/day = hepatotoxicity.

Morphine

Opioid

Relieves pain, drowsiness, mental clouding, anxiety reduction sense of well-being

s/e: analgesia, sedation, resp. depression, cough suppression, constipation

Nursing: resp <12.. withhold med. If emesis (vomiting) treat with antiemetic.

Opioid

s/e: confusion, sedation, weakness, resp. depression, constipation, dry mouth, sweating

Remove MAOIs previous 14 days – may be fatal 

NSAID

Reduce fever/inflammation

s/e: GI distress, heartburn, nausea

Alcohol intensifies s/e

Take w/food or full glass of water

Stop 1 week before surgery

NSAID

s/e: GI bleeding, constipation, n/v, Stevens Johnson Syndrome

NSAID

Decrease pain, fever, inflammation

Better tolerated than others

Most common s/e: GI disturbances

Capsaicin Cream

Topical Analgesic

OA

s/e: rash, burning sensation

Do not use with external heat source (heading pad) – risk for burns 

Loop diuretic

Most effective

Blocks Na+ and Cl+ reabsorption

s/e: hyponatremia, hypoochloremia, dehydration – MONITOR BP

Useful in pt with renal impairment b/c can promote diuresis even when renal blood flow is low

CAN add thiazide diuretic 

Thiazides (hydrochlorothiazide and chlorithiazide)

Spironolactone

K+ sparing diuretic

Retention of K+, excretion of Na+

s/e: hyperkalemia, deepening of voice

NEVER combo with K+ supplements, salt substitutes, or other K+ sparing diuretics

Avoid ACE inhibitors

Triamterene

K+ sparing diuretic

s/e: acts more quickly than spironolactone; hyperkalemia, n/v, leg cramps, dizziness

NEVER use with another K+ sparing diuretic or supplement or salt substitute

For prevention/treatment of hypokalemia

Must be diluted (40mEq/L)

K+ levels and renal function monitored before admin to ensure adequate output of urine

Treatment of potassium toxicity/hyperkalemia

K+ slowly, diluted (mix in bag) NEVER more than 10mEq/hr.

Monitor heart with K+ and BEST practice is: not in secondary bag or piggyback

Withhold foods and meds with K+

How to counteract extracellular K+ induced cardiotoxicity (continued)

Infuse bicarb (if acidosis present)

Rapid acting insulin

Humalong, Novolog

Onset: 15-30 min

Peak: 0.5-2.5 hr

Duration: 3-6 hr

Regular Insulin, Humulin R

Onset: 30-60 min

Peak: 1-5 hr

Duration: 6-10 hr

NPH, Humulin N

Onset: 60-120 min

Peak: 6-14 hr

Duration: 16-24 hr

Glargine, Detemir

Onset: 60-120 min

Peak: None (levels are steady with no discernable peak)

Duration: 24 hr

Oral hypoglycemic (metformin, sulfonureas)

Biguanide – Metformin

NOT used for 48 hr after IV contrast

Used for hyperglycemia

Reduces glucose production by the LIVER

1^st choice for prediabetes or type 2 – used for prevention – NO WEIGHT GAIN

DO NOT USE in kidney, liver, HF

Sulfonureas (glipizide, glyburide)

Increases insulin production from PANCREAS

s/e: hypoglycemia, wt. gain

Thiazolidinediones – pioglitazone (Actos)

Increases glucose uptake in MUSCLE

Decreases endogenous glucose production

Most effective for Diabetes Type I

s/e: increase risk for MI, stroke, wt. gain, edema

Levothyroxine (Synthroid)

Replaces thyroid hormones in hypothyroidism

s/e: headache, insomnia, cramps, tachycardia, chest pain, sweating, hyperthyroidism, menstrual irregularities, heat intolerance, wt. loss

Treatment of hyperthyroidism

#1 choice for NON-pregnant adults

Damages thyroid tissue to limit hormone secretion

Effects seen in 2-3 months

s/e: need for lifelong thyroid hormone replacement, dry mouth and throat (use salt and soda gargle)

Beta Blocker

Treat dysrhythmias, reduce HR, B

Used for PREVENTING migraines

s/e: hypotension, depression

Act on kidney and promote excretion of sodium and water

Primary drug choice for HF, decrease BP

Vasodilator

s/e: cough

ACE inhibitor

Monitor for hypotension

s/e: cough

Spironolactone (Aldactone)

K+ sparing diuretic

Monitor K+

Use with caution in pts taking digoxin

Avoid K+ foods (bananas, oranges)

Vasodilator

Cause vasodilation by acting on smooth muscle of heart vessel wall

Vasodilator

Used for treatment of HF in African Americans – approved only for this ethnic group

Directly block acetylcholine that is released during HF – decrease BP, HR

Increase dosage slowly every 2 weeks

Carvedilol (Coreg)

Beta blocker

Overdose = bradycardia, hypotension, bronchospasm

Obtain standing BP 1 hr after admin to assess tolerance

Abrupt withdrawal: sweating, palpitations, headaches

Verapamil (Calan)

Ca+ blocker

s/e: dizziness, flushing

Use with caution in cardiac pts

Atenolol (Tenormin)

Beta blocker

Reduce BP & HR

s/e: hypotension, bronchospasm nightmares, depression, weakness

Monitor HR/BP regularly

Enalapril (Vasotec)

ACE inhibitor

Vasodilator

s/e: hypotension, COUGH, dizziness, loss of taste, skin rash

Avoid aspirin, NSAIDs, diuretics

Givin IV over 5 minutes

Monitor BP

Hydrochlorothiazide 

Thiazide diuretic

Secrete Na+ and Cl-

s/e: f/e imbalances, vertigo, weakness, headache,

Monitor for orthostatic hypotension

Advise pt to supplement with K+ rich foods 

Captopril (Capoten)

ACE inhibitor

Vasodilator

s/e: COUGH, hypotension, dizziness, loss of taste, skin rash

Given PO for hypertensive crisis

Safe range: 0.5-0.8

Always check levels before admin

s/s of toxicity: yellow halos, anorexia, nausea (then give digibend) 

Either enhance the release or supply of DA or antagonize/block effects of neurons 

Levodopa with Carbidopa (Sinemet)

Antiparkinsonian

1^st drug to be used

Monitor for dyskinesia

Take 1 hr before breakfast

Effects may take several weeks/months

May wear off after a year’s use: then they take parlodel, permax, requip, Mirapex

Antiparkinson

Takin if Sinomet wears off

Pt may become dizzy due to orthostatic hypotension

Notify Dr. if severe headache develops

Valproid acid (Depakote)

Therapeutic range: 50-125

Sumatriptan (Imitrex)

Relief of migraine

Levodopa (Dopar)

How long until it takes effect?

Limit protein intake to evening meal to decrease aborsption impairment

Overdose: “freezing”, dyskinesia, slow movement of the neck

Treatment for iron-deficiency anemia

s/e: GI disturbances, can stain teeth, so dilute liquid with juice or water and admin through straw, rinse mouth after

NSAID

Prolonged half-life—taken less often

Decrease pain, fever, inflammation

Better tolerated than others

Most common s/e: GI disturbances

Celecoxib (Celebrex)

Last drug of choice for long-term management of pain

Corticosteroid

Intraarticular Injection

Antiinflammatory

Preferred treatment for severe hypomagnesemia

Persistent diarrhea/C. diff

Valproid acid (Depakote)

Therapeutic range: 50-125

Antiseizure 

Phenytoin (Dilantin)

Sumatriptan (Imitrex)

Relief of migraine

PO, nasal, subq

Vasoconstriction to relieve pressure

s/e: coronary vasospasm; chest pressure

Avoid if pregnant 

Bromocriptine (Parlodel)

Activate DA

Used in early PD with levodopa

s/e: confusion, nightmares, agitation, hallucinations, paranoid delusions, dyskinesias, postural hypotension

Promotes DA

Takes up to 6 months for therapeutic range

Limit protein intake to evening meal to decrease aborsption impairment

Can cause hypertensive crisis if pt is taking MAOIs

Overdose: “freezing”, dyskinesia, slow movement of the neck