drug 

dose

time

route

patient

documentation

garlic

(allium sativum)

common uses: antispasmodic, antiseptic, antibacterial and antiviral, antihypertensive, antiplatelet, lipid reducer.

Adverse effects: dermatitis, vomiting, diarrhea, anorexia, flatulence, antiplatelet activity.

Potential drug interactions: inhibits iodine uptake. may interact with warfarin, diazepam, protease inhibitors. use with nsaids may enhance bleeding.

contraindications: pt who are to have surgery within 2 wks and pt with hiv or diabetes. 

common uses:

constipation, atherosclerosis, hypercholesterolemia, constipation, bladder inflammation.

adverse effects:

diarrhea

drug interactions:

antidiabetic drugs. Anticoagulant drugs

Ginkgo 

(ginkgo biloba)

Drug interactions:

aspirin, nsaid's, warfarin, heparin, anticonvulsants, tricyclic antidepressants

Common use:

improve physical endurance and concentration. stress reduction.

drug interaction:

reduce effectiveness of anticoagulants and immunosuppressants, but enhance effectiveness of anticonvulsants and antidiabetic drugs.

Common uses: 

depression, anxiety, sleep disorder,nervousness.

Adverse effects: 

Gi upset, fatigue, dizziness, confusion, dry mouth, photosensitivity

DRUG INTERACTIONS:

MAOI, selective serotonin reuptake inhibitors, cyclosporine, tetracycline, tyramine-containing foods, opioids, digoxin, estrogen, theophylline.

Adrenergic Blockers

(dilate peripheral blood vessels and decrease b/p.)

Phentolamine

tamsulosin

silodosin

Anesthetics 

General 

(produce tranquilization and sleep before invasive procedure)

etomidate

fentanyl

midazolam

propofol

droperidol

Anesthetics

Local

inhibit conduction of nerve impulses from sensory nerves

Lidocaine

procaine

tetracaine

antacids 

neutralize gastric acidity and decrease rate of gastric emptying

sub groups: aluminum, magnesium, calcium, combination.

drugs: 

aluminum hydroxide

bismuth

calcium carbonate

magnesium oxide

sodium bicarbonate

Antianginals

(nitrates, calcium channel blockers, b-adrenergic blockers)

Nitrates: dilate coronary arteries and dilate systemic arteries

Calcium channel blockers: dilate coronary arteries and decrease sa/av  node conduction

B-adrenergic blockers: decrease heart rate

amyl nitride

isosorbide

nitroglycerin

B adrenergic blockers

(end in olol)

Atenolol

metoprolol

nadolol

dipyridamole

calcium channel blockers

(mostly "ines")

amlodipine

ranolazine

nicardipine

diltiazem

verapamil

Antianxiety Agents

(most cause decrease in cns excitability)

Benzodiazepines (am) &

miscellaneous drugs

Benzo's:

alprazolam

clonazepam

diazepam

lorazepam

midazolam

chlordiazepoxide

Miscellaneous:

buspirone

hydroxyzine

venlafaxine

Antiasthmatics:

bronchodilators

adrenergics

corticosteroids

bronchodilators:

(antiasthmatics)

albuterol

atropine

formoterol

isoproterenol

Theophylline

terbutaline

levalbuterol

Corticosteroids

(antiasthmatics)

budesonide

cortisone

hydrocortisone

methyprednisolone

prednisone

anticholinergics

(parkinsonism, nausea and vomiting, cycloplegic mydriatics, decrease gi motility (diarrhea), decrease gastric secretions.)

atropine

benztropine

dicyclomine

Anticoagulants

interfere with blood clotting

warfarin

heparin

anticonvulsants

(for seizures)

Barbiturates:

clonazepam (klonopin)

phenobarbital

primidone

Hydantoins:

phenytoin

Succinimides:

ethosuximide

Misc:

Gabapentin (neurontin)

Antidepressants

Tetracyclines

Tricyclics

MAOI

SSRI

miscellaneous

Tetracyclines 

(antidepressants)

Tricyclics 

(antidepressant)

amitriptyline (ELAVIL)

buPROPion (Wellbutrin)

duloxetine (Cymbalta)

trazadone (Desyrel)

MAOI's

(antidepressant)

SSRI's

(antidepressant)

escitalopram (Lexapro)

sertraline (Zoloft)

Antidiabetics

Insulin isophane suspension (NPH)

Regular insulin (Humulin R)

Insulin glargine (Lantus)

Insulin detemir (Levemir)

Metformin (Glucophage)

pioglitazone (Actose)

Sitagliptin (Januvia)

NPH 

Insulin isophane suspension 

cloudy solution

intermediate acting

Rapid acting insulins

(within 15 min of meal)

insulin lispro (Humalog)

insulin aspart (Novolog)

insulin glulisine (Apidra)

Short acting insulin

Regular insulin (Humulin R)

can be given by i.v. 

onset of action 30-60 min

duration: 6-10 hr

glucose level         amount 

<140  none

141-199 2 units

200-249 4 units

250-299  6 units

300 or more     8 units

Antidysrhythmics

for PVC's,

tachycardia

hypertension

atrial fibrillation

angina pectoris

amiodarone (Cordarone)

verapamil (Calan)

digoxin (Lanoxin)

atropine (Atropine Sulfate)

lidocaine

phenytoin (Dilantin)

esmolol

propranolol

procainamide(Pronestyl)

quinidine

Antihypertensives

end in 

"il"

"ine"

lisinipril (prinvil, Zestril)

enalapril (vasotec)

fosinopril (Monopril)

lisinipril (Zestril)

quinapril (Accupril)

ramipril (Altace)

clonidine (Catapres)

guanfacine (Tenex)

methyldopa (Aldomet)

doxazosin (Cardura)

terazosin (Hytrin)

Antiinfectives

Antiinfectives 

(categories)

penicillins

cephalosporins

aminoglycosides

sulfonamides

tetracyclines

monobactam

erythromycins

quinolones

amoxicillin

ampicillin

cloxacillin

avoid milk!

doxycycline

minocycline

tetracycline

aminoglycosides

azithromycin

gentamicin

streptomycin

antilipidemics

(lower cholesterol)

genfibrozil (Lopid)

cholestyramine (Questran)

Niacin (nicotinic acid)

atorvastatin (Lipitor)

amantadine

benztropine

bromocriptine

carbidopa-levodopa

Antiplatelet 

prevent MI and stroke

Antipsychotic

Lithium

mirtazapine (Remeron)

clozapine (Clozaril)

aripiprazole (Abilify)

risperidone (Risperdal)

chlorpromazine (Thorazine)

butyrophenone (Haldol) 

Antipyretics

reduce fever

acetaminophen 

aspirin

ibuprofen

naproxen

magnesium salicylate

antiretrovirals

Block DNA synthesis

of virus

amantadine (Symmetrel) *influenza

abacavir

ritonavir

indinavir

tenofovir

didanosine

Antituberculars 

inhibit RNA or DNA of bacilli

streptomycin

ethambutol

pyrazinamide

antitussive/expectorant

suppress cough reflex and/or liquefying and reducing viscosity of secretions

acetylcysteine

ammonium chloride

benzonatate

codeine

dextromethorphan

diphenhydramine

hydrocodone

antivirals

ACE INHIBITORS 

beneficial in heart failure bc they prevent sodium and water resorption by inhibiting aldosterone secretion. This causes diuresis, decreases blood volume and return to heart.

Digoxin 

(cardiac glycoside)

b4 administering: check electrolyte levels, drug levels, apical pulse (1min) if pulse is <60 bpm or >100bpm hold and notify prescriber. 

Antidote: digoxin immune Fab. give over 30min parenteral (sometimes as iv bolus)

Somatic (skeletal muscles)

Visceral (organs)

Deep (below skin level)

Visceral and superficial

usually Superficial (skin)requires opioids for relief.

Somatic pain responds to nonopioid analgesics.

Naloxone (narcan) for overdose

Naltrexone (trexan) to maintain opioid free state

OPIOIDS 

When giving opioids:.

Antidote for tricyclic antidepressants

sodium bicarbonate

Benzodiazepine 

reversal agent:

for alcohol withdrawal

for overdose of the benzo Ativan, give Romazicon (flumozenil)

Enteral 

(route of med admin)

·         Oral meds

·         Sublingual meds(under tongue)

·         Buccal (between cheek and gum)

parenteral 

route of administration

·         Intradermal  (inj under the epidermis)

·         Subcutaneous (inj into adipose beneath dermis)

·         Intraarterially (arterial)

·         Intramuscularly (inj of the muscle beneath the subcutaneous adipose)

·         Intrathecally (through the theca of the spinal cord into the subarachnoid space.)

·         Intraarticularly (joint)

·         Intravenously  (through vein)

·         Transdermal

·         Inhaled

phenytoin 

(Dilantin)

antiepileptic drug

primarily indicated for management of tonic-clonic seizures.

avoid continuous iv infusion 

flush after bolus

oral care important when taking po

risk of osteoperosis w/long term use

therapeutic drug levels are 10-20mcg/ml.

Monitor patient closely

Lithium 

therapeutic range:

0.6-1.5 

monitor sodium levels and keep within 135-145 mEq/L

This drug is used for mania and bipolar, also for maintenance for prevention of such episodes.

Drug interactions: thiazide diuretics, angiotensin converting enzyme inhibitors, calcium channel blockers, and nsaids.

Lithium available PO only.

Digoxin 

therapeutic range

therapeutic:  0.5-2 

Give potassium supplements if potassium is less than 3, or foods high in potassium (bananas, oj)

MAOI's 

what foods to avoid

foods that contain tyramine

Coumadin 

antidote:

ascorbic acid

baseline:

weight, height, growth and development, vitals, cbc, sleep patterns.

avoid tyramine foods 

(beer, wine, aged cheese, artificial sweeteners, chocolate, caffeine.)

Barbs: phenobarbital, primidone

Hydantoins: phenytoin, fosphenytoin

Iminostilbenes: tegretol, carbatrol

unspecified: valproic acid

other: gabapentin, neurontin, lyrica, topamax, lamictal

MAO

Monoamine oxidase 

breaks down dopamine, norepinephrine , epinephrine, serotonin. 

MAO inhibitors are used for parkinsons. 

used as antiviral for influenza as well as for early parkinsons. 

avoid anticholinergics and cns stimulants.

foods with tyramine:

cheddar, blue cheese, swiss cheese, herring, sausage, salami, pepperoni, poultry, beef or chicken liver, brewers yeast, fava beans.

stimulate sympathetic nervous system

mimic effects of SNS neurotransmitters *norepinephrine, epinephrine, dopamine.

Alpha and Beta Adrenergic

B-Adrenergic Agonist responses

(beta is primarily in the heart)

relax- bronchial, gi, uterine smooth muscle

glycogenolysis

cardiac stimulation

vasoconstriction

cns stimulation

relax gi 

constriction of bladder sphincter

constraction of uterus

dilated pupils

bronchodilation, uterine relaxation, glycogenolysis in the liver,

increased renin secretion in kidneys, relax gi muscles.

alpha 1 adrenergics

for nasal congestion:

adrenergics:

nursing implications

monitor for :

decreased edema

increased urinary output

return to normal vitals

improved skin color and temp

increased LOC.

therapeutic effects (asthma)

normal rr, improved breath sounds, increased air exchange, improved blood gases, increased activity tolerance.

adrenergic blockers:

cause venous dilation.

used for hypertension

Indications:

angina, cardioprotective, dysrthythmias, migraine, antihypertensive, heart failure, glaucoma (topical use)

used for anxiety. sometimes for pms. 

avoid grapefruit juice

cryoprecipitate

fresh frozen plasma

packed red blood cells

plasma protein fraction

whole blood

manage acute bleeding 

(50% slow or 20% rapid loss)

suggested guidelines for blood products:

management of bleeding

20% or less (slow loss) use crystalloids

20-50% (slow loss) use dextran or hetastarch

over 50% slow or 20% acute use whole blood or prbc and or ppf and ffp

80% or more, for every 5 units of blood, give 1-2 units ffp and 1-2 units platelets to prevent hemodilution of clotting factors and bleeding.

Potassium (K)

normal levels: 3.4 to 5 mEq/L

Hyperkalemia : serum potassium exceeding 5.5 mEq/L

Hypokalemia : less than 2 mEq/L

Hypokalemia 

symptoms

anorexia, hypotension, lethargy, mental confusion, muscle weakness, nausea. 

later symptoms:

cardiac dysrhythmias, neuropathy, paralytic ileus, secondary alkalosis.

IV potassium

(if given too rapidly causes cardiac arrest.)

causes pain at injection site.

pt on cardiac monitor give no faster than 20 mEq/hr 

for pt not on cardiac monitor give no faster than 10 mEq/hr

iv admin of sodium bicarbonate

calcium gluconate

follow up with sodium polystyrene sulfonate or hemodialysis.

sodium polystyrene sulfonate 

(potassium exchange resin)

for hyperkalemia

given orally usually

1mEq of potassium is lost per gram of resin administered.

can lower calcium and magnesium

Hyponatremia

(low sodium)

serum levels below

135 mEq/L

Symptoms:

lethargy, hypotension, stomach cramps, vomiting, diarrhea, seizures. Causes: excessive perspiration, prolonged diarrhea or vomiting, renal disorders, adrenocortical impairment.

Hypernatremia

(High sodium)

Levels over 145 mEq/L

Symptoms: red flushed skin, dry sticky mucous membranes, increased thirst, temp elevation, decreased or absent urination, edema, hypertension.

causes:

poor renal excretion, inadequate water consumption, dehydration.

Hyponatremia 

treatment:

Mild: oral admin of sodium chloride tablets 

Pronounced depletion: NS or lactated Ringers

Hypernatremia 

treatment:

increase fluid intake and diet restrictions.

In serious cases diuretics may be required to enhance urinary sodium excretion. IV dextrose in water may be beneficial.

synercid

(antibiotic)

Discontinue the warfarin, administer iv injection of vitamin K (phynadione) 

·         Do not massage or rub before or after injection

·         In abdomen between pelvic bone

·         Leave in 10 seconds, apply pressure for one minute

·         Do not aspirate before injection this can cause  hematoma formation

·         Inject in the “love handles”

·         Internal bleeding

·         Intracranial bleeding

·         Superficial bleeding

·         Hypersensitivity

·         Anaphylactoid reactions

·         Nausea

·         Vomiting

·         Hypotension

·         Cardiac dysrhythmia

Blood glucose of less than 50mg/dl

·         confusion,

·         irritability,

·         tremor,

·         sweating.

·         Later symptoms: hypothermia and seizures

·         Increased thirst

·         Headaches

·         Difficulty concentrating

·         Blurred vision

·         Frequent urination

·         Fatigue (weak, tired feeling)

·         Weight loss

Insulin

when to take what 

·         Lispro – take 15 min prior to meal

·      

   Regular insulin- 30 min prior to meal

·        

NPH – 30-60 minutes prior to meal.

normal:  25-30 seconds

on Heparin:   45-70 seconds

Normal: 11-13 sec

On anticoagulant: 18 sec

Normal : 2-3

On warfarin: 2.5-3.5

(INR evaluates coagulation while on warfarin. The results of test reflect the dose give 36-72 hours prior to testing)

·         Avoid in pregnancy and lactating women

·         Do not give to children under 8

·         Cause discoloration of permanent teeth and tooth enamel hypoplasia in children and fetus, retards fetal skeletal development

·         Cause photosensitivity. Avoid with lupus

·         Do not take with antacid, antidiarrheals, dairy, calcium, enteral feeding, oral anticoagulants. They decrease effects of other antibiotics and birth control.

·         Take tetracycline with a full glass of water (8 ounces).

·         Penicillin increases the effects of Coumadin (warfarin)

·         W/ patient on iv penicillin (if they have a reaction i.e. difficulty breathing) stop the infusion immediately

                                    antiseptics                       disinfectants

Where used                  living tissue                              nonliving objects

Toxic?                           No                                            yes                  .

Potency                                    lower                                       higher              .

Action                          inhibits growth                         kills                 ..

Antidote for heparin is

protamine sulfate

Antidote for warfarin (Coumadin) is

Vitamin K.

Never split suppositories of an adult dosage (o.d. can occur easily)

Report the following symptoms immediately:

Dizziness, lightheadedness, drowsiness, hallucinations, changed level consciousness, sluggish pupil response,

IF THESE OCCUR HOLD MEDS UNTIL PRESCRIBER RESPONDS

ALWAYS WATCH VITALS WHEN GIVING OPIOIDS TO PEDS IF RR DROPS BELOW 12 HOLD MEDS AND NOTIFY PRESCRIBER

Prevent nerve transmission in skeletal and smooth muscles, leading to paralysis.

Used with general anes. For surgery.

Paralyze skeletal muscles required for breathing

BE SURE THE PATIENT IS MECHANICALLY VENTILATED PRIOR TO ADMINISTERING NMBD

NEVER MISTAKENLY GIVE AN NMBD! THE PERSON WOULD BE UNABLE TO MOVE OR SPEAK BUT WOULD BE FULLY CONSCIOUS OF WHAT IS HAPPENING TO THEM.

USE ONLY AS AN ADJUNCT TO GENERAL ANESTHESIA!!!!

Work within CNS. Best when used w/ rest and therapy

Reduse choreiform movement in patients w/ huntingtons, parkinsons, or trigeminal neuralgia. Baclofen relieves hiccups

OVERDOSE: no antidote, treat with supportive measures. Maintain airway and keep artificial respiration readily available. ECG should be used and larg IV fluids to avoid crystalluria

·         take meds on empty stomache 45 min before eating for max effect

·         weaning is necessary 

antidote for 

BETA BLOCKERS

NO ANTIDOTE

ABC'S OF CARE

SPECIAL CONSIDERATOIN WHEN GIVING:

OPIATES

SEDATIVES

NSAIDS

ANTICOAGULANTS

ANTICHOLINERGICS

ANTIDEPRESSANTS

ANTIHYPERTENSIVES

CARDIAC GLYCOSIDES

CNS DEPRESSANTS

CULTURAL CONSIDERATIONS:

AFRICAN

FOLK MEDICINE 

HEALERS

CULTURAL CONSIDERATIONS:

HISPANIC

LUCK AND LIFESTYLE= HEALTH

SIN = ILLNESS

HOT/COLD

CULTURAL CONSIDERATIONS

EUROPEAN

TRADITIONAL HEALTH BELIEFS

SOME USE FOLK MEDICINE

cultural considerations

asian

traditional medicine

herbalists and physicians

uncommon but potentially fatal. reaction to general anesthesia. 

rapid increase in body temp, hr, rr, and muscular rigidity

muscle relaxers

desired outcome

desired outcome: relief of pain from muscle spasticity, relaxed skeletal muscles

muscle relaxers

mechanism of action

action: 

depressant effect on cns, result in relaxation and mild weakness of muscles. decrease force of muscle contraction and decrease in muscle stiffness

onset of action (injected 10-15 min) 

(oral 1-2 hr)

contraindicated w/severe cardiovascular disease

no more than two injections of sumatriptan in 24hr period

keep journal of migraines

avoid tyramine

DILANTIN

antiepileptic drug

AKA (phenytoin)

narrow therapeutic index (plasma level 10-20)

pt w/ liver failure (or malnourished) keep levels well below 20mcg/ml

iv dilantin give SLOW push

via i.v. no more than 50mg/min

flush w/saline

avoid continuous infusion