Alendronate

(Fosimax)

Type: Oral Biphosphate

Action: Decrease number and activity of osteoclast

Use: osteoporosis

Contraindicated: esophageal abnormalities

Use Cautiously In: renal impairment

Drug Interactions: decreases effects of antacids and calcium supplements. Increases effects of phosphate supplements. Food and beverages decrease absorption.

ADRs: hypocalcemia, esophagitis, vomiting, diarrhea, atypical femoral fractures

Roloxifene

(Evista)

Type: Selective Estrogen Receptor Modulator (SERM)

Actions: acts like endogenous estrogen in some tissues, works as an estrogen antagonist in other tissues

Uses: osteoporosis and breast cancer

Contraindicated: history of DVT's, pregnancy, breast feeding

Drug Interactions: decrease effects of levothyroxin

Ibuprophen

(Advil)

Type: cycooxygenase (COX) inhibitors, NSAID

Uses: anti-inflammatory, mild-moderate pain, fever

Action: inhibits prostoglandin formation in the CNS

ADRs: GI upset, dyspepsia, abdominal pain, GI bleed, fluid retention, edema, hypertension, renal damage

Drug Interactions: alcohol, anticoagulants, antiplatelet drugs

Nursing Care: may cause GI ulcers, may cause renal failure, pregnancy category D in 3rd trimester, teach to avoid alcohol use

Cyclbenzaprne

(Flexeril)

Type: Central Acting Muscle Relaxant

Action: has anticholinergic properties

Uses: reduce spasticity associated with MS, spinal cord injury, cerebral palsy but not with stroke

ADRs: may cause dry mouth, urinary retention, blurred vision

Furosemide

(Lasix)

Type: Loop diurretic 

Action: inhibit reabsorption of sodium, Cl-, and water in the ascending loop of Henle

Uses: to increase urine output

ADRs: risk for hypovolemia, risk for hypokalemia, risk for low Na, Cl, Mg, and Ca, *reversible ototoxicity, increased LDLs and decreased HDLs

Contraindications: allergy to sulfonomides, anuria, hypovolemia, electrolyte imbalance

Interactions: digitalis/digoxin (increased risk for toxicity, connected to K+ depletion), lithium (decreased excretion), antihypertensives (hypotension), NSAIDs (decreased effectiveness), when used with other ototoxic drugs increased risk of hearing loss

Nursing Care: hydration, I/O, electolytes, BP, weight hypokalemia s/sx, administer in AM, lung sounds, discuss K+ rich foods with pt, supplement K+ 

Hydrochlorothiazide

Type: thiazide diuretic

Action: decrease reabsorption of Na, Cl, water, and bicarbonate in distal tubules

Use: often drug of first choice in essential HTN, mild or fluid retention caused by moderate heart failure and hepatic or renal disease

ADRs: low Na, Cl, Mg, Ca, dehydration, increased LDL, lowered HDL, hyperglycemia, hyperuricemia, blood dyscrasias (rare), photosensitivity

Contraindicated: with sulfonamide allergy, pregnancy cat. B, may precipitate attack of gout, diabetes (must monitor)

Interactions: digitalis/digoxin (increased risk for toxicity, connected to K+ depletion), lithium (decreased excretion), antihypertensives (hypotension), NSAIDs (decreased effectiveness)

Nursing Care: same as for Loops, monitor for gout, monitor blood glucose in DM, monitor weight (report +/- 2lbs in 2 days)

Benzodiazepine

(Diazepam: Valium)

Type: Benzodiazepine

Action: bind to chloride channel that functions as the GABA receptor--> increased frequency of opening of this channel, potentiate GABA activity at all its sites

Uses: sedation, skeletal muscle relazation, and anticonvulsant activity

Interactions: alcohol, CNS depressants, opioid analgesics, anesthetics, tricyclic antidepressants

Nursing Care: close monitoring is necessary because dosage of one or both drugs may need to be adjusted, watch for CNS/respiratory depression (antidote is flumazenil), watch for hallucinations, violent behavior, monitor I/O and vital signs, warn about ETOH, drugs are PRN requiring nursing judgment

ADRs: pregnancy category D, daytime drowsiness, hangover, rebound insomnia, respiratory depression, withdrawl syndrome (anxiety, insomnia, CNS excitability that my progress to convulsions, *All BDZs are capable of causing physical depenence when used on a chronic basis* 

Metformin

(Glucophage)

Type: Biguanide

Action: decreases hepatic gluconeogenesis, decreases insulin resistance, decreases GI glucose absorption

Use: diabetes mellitus type II and metabolic syndrome

Contraindications: clients with renal insufficiency, dehydrated patients, patients >80 years old, disease states associated with risk for lactic acidosis, should not be used during pregnancy (category B), chronic ETOH use

ADRs: abdominal bloating/discomfort, diarrhea, metallic taste, agitation, sweating, headache, lactic acidosis (rare), elderly need to start at lower doses

Interactions: ETOH (lactic acidosis), cimetadie and furosemide may increase effects, herb/supplement compliments: B12 and folic acid prevent anemia and high homocysteine levels. Herb interactions: avoid ginkgo biloba (glucose intolerance), avoid guar gum (decreases absorption or activity)

Nursing Care: monitor glucose, monitor liver and renal function, pt education on starting with lower dose to avoid GI symptoms, slight weight loss, hypoglycemia, take WITH meals, drink plenty of fluids 

Rapid Acting Insulin

(Humalog)

Onset: <15 minutes (rapid)

Peak: 1 hour

Duration: 3.5-4.5 hours

Fast Acting Insulin

(Humulin R)

Onset: 30 minutes

Peak: 2-4 hours

Duration: 6-8 hours

*Always take with food*

Intermediate Acting Insulin

(NHP/Humulin N)

Onset: 60-120 minutes

Peak: 6-12 hours

Duration: 18-24 hours

70/30 Mix Insulin

(NHP/Regular-Humulin 70/30)

Onset: 30 minutes

Peak: 2-12 hours

Duration: up to 24 hours

Long Acting Insulin

(Lantus)

Onset: 70 minutes

Peak: n/a

Duration: 24 hours or longer

Phenytoin

(Dilantin)

Type: hydantoin

Action: dampens CNS activity by delaying influx of sodium ions across neuronal membranes slowing the spread of the electrical charges in the brain that cause seizures

Use: antiepileptic

ADRs: CNS effects (slurred speech, blurred vision, A/N/V, insomnia, confusion), bradycardia, hypotension, V-fib, gingival hyperplasia, leukopenia, thrombocytopenia

Interactions: IV form of dilantin interacts with EVERYTHING, creates emboli

Nursing Care: monitor neuro status and seizure activity, monitor appropriate lab values, protect client during seizures, monitor for ADRs, oral care, avoid stress, avoid ETOH and OTC medications, do not stop drug suddenly, notify provider if bruising, sore throat, or other symptoms of blood dyscrasias occur

Valporic Acid

(Depakene)

Type: valproate

Action: increases concentrations of GABA in the brain, Suppresses abnormal neuron discharge

Use: antiepileptic

ADRs: n/v, diarrhea, constipation, weight gain/loss, hepatotoxicity, bone marrow suppression, thrombocytopenia

Nursing Care: monitor neuro status and seizure activity, monitor appropriate lab values, protect client during seizures, monitor for ADRs, oral care, avoid stress, avoid ETOH and OTC medications, do not stop drug suddenly, notify provider if bruising, sore throat, or other symptoms of blood dyscrasias occur

ACE Inhibitors

(-pril)

Action: decreases vascular tone by inhibiting angiotensin converting enzyme and reduces water and sodium reabsorption by inhibiting aldosterone

Use: lower blood pressure by vasodilating and reducing sodium and water absorption

Contraindications: renal artery stenosis, angioedema, pregnancy (category C in first trimester, category D in second and third trimesters and during lactation), use precautiosly in impaired renal function, hypovolemic/hypnatremic states, hyperkalemia

ARBs

(-sartan)

Action: blocks the effects of aldosterone, and vasoconstricing effects of angiotensin II

Contraindications: use cautiously in impaired renal function, hypovolemic/hyponatrmic states, pregnancy (same as ACEs)

ADRs: less than ACEs, hypotension, dizziness, fatigue, headache, impaired renal function

Nursing Care: monitor I/O, K+ levels, renal function

Calcium Channel Blockers

Action: inhibits influx of calcium into cells, reduces vasoconstriction, dilates coronary and peripheral arteries, relaxes arterial smooth muscle

Contraindications: pregnancy category C, heart block, unstable angina, hypotension, bradycardia, use catiously in patients on beta blockers and digoxin

HMG-CoA Reductase Inhibitors

(Statins)

Action: inhibits the synthesis of cholesterol in the liver

ADRs: myopathy, GI upset, headache, rashe, impotency and insomnia (rare)

Interactions: MANY, increased liver toxicity, grapefruit juice, decrease levels of CoQ10 which can promote their HTN and heart failure, low energy

Vitamin D

Use: necessary for the effective reabsorption of calcium

ADRs: hypercalcemia, increased risk of cardio vascular disease, especially CHF

Contraindications: patients with cancer, patients with chronic kidney disease

Interactions: digoxin, thiazides, diuretics

Nursing Care: monitor kidney function, monitor calcium levels

Fluticasone Propionate

(Flovent)

Type: glucocorticoid

Action: acts my reducing inflammation

Use: inhaled-drugs of choice for long-term prophylaxis of asthma, oral-used for short term therapy of severe, acute asthma (under 10 days)

ADRs: oropharyngeal candidiasis

Contraindications: not recommended for pregnant or breast feeding women, use with precaution in hypertenstion, GI disease, congestive heart failure, thromboembolic disease, *do not use during an acute asthma attack*

Nursing Care: reinforce daily use, teach to rinse mouth after use, check proper inhaler use, bronchodilator inhaler should be used 10-15 minutes before corticosteroid inhaler. Assess for hypertension, allergic rhinitis, asthma, heart disease, blood clots, cushing's, fungal infections, diabetes mellitus (must closely monitor glucose levels), infection. Monitor vitals. 

Albuterol

(Proventil HFA)

Type: beta-adrenergic agonist

Action: selectivity binds to beta2-adrenergic receptors in bronchial smooth muscle to cause bronchodilation

Use: albuterol is a "rescue" medication for use when having active wheezing and for the prevention of exercise-induced bronchospasm, best suited for chronic asthma

ADRs: headaches, throat irritation, nervousness, restlessness, tachycardia

Contraindications: should not be used if client has a history of dysrhythmia or MI, limited use in children under 6 years, not recommended for women who are breast-feeding

Nursing Care: assess vital signs prior to administation, respiratory and pulse rate, lung sounds, respiratory effort, skin color, asses O2 sat level