Meperidine (Demerol)

Morphine (SE: bradycardia, shock, cardiac arrest, tachycardia, thrombocytopenia, respiratory arrest, apnea) [Contraindicated c hemorrhage, bronchial asthma, increased ICP]

Codeine (Paveral) [antitussive] (Action: decreases cough reflex, GI motility) (SE: circulatory collapse, n/v, anorexia, constipation, anaphylaxis) (Contraindications: respiratory depression, increased ICP, seizure disorders, severe respiratory disorders, breastfeeding)

Classification: Opioid Analgesic

Action: Depresses pain impulse transmission at the spinal cord level by acting with opioid receptors. Rx - moderate to severe pain.

SE: drowsiness, dizziness, confusion, headache, sedation, euphoria, increased ICP, seizures, respiratory depression

Interactions: MAOIs, procarbazine

Rx of OD: Naloxone (Narcan) 0.2-0.8mg IV, O2, IV fluids, vasopressors.

Assess respiratory rate, character, rhythm; notify M.D if RR <10 and shallow.

Heparin

Coumadin (Warfarin) - depresses hepatic synthesis of vit K. Antidote = Vit. K. SE: fever, diarrhea, hepatitis, hematuria, hemorrhage, agranulocytosis, leukopenia, eosinophilia, rash, exfoliative dermatitis, purple toe syndrome. Monitor PT & for fever, rash, uticaria.

Lovenox (enoxaparin) - inactivates factors Xa/IIa. SE: Hemorrhage, hypochromic anemia, thrombocytopenia. Not interchangeable with heparin or other LMWH.

Classification: Anticoagulant; antithrombotic

Action: Prevents conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing inhibitory effects of antithrombin III.

SE: fever, hematuria, hemorrhage, thrombocytopenia, anemia, rash, anaphylaxis.

Nursing Considerations: Assess for bleeding gums, petechiae, ecchymosis, black tarry stools, hematuria, epitaxis, decrease in Hmt and B/P. Monitor aPTT 1.5-2.5 x control.

Pt teaching: use soft bristle toothbrush, avoid contact sports, use electric razor, avoid IM injections.

Antidote: Protamine sulfate

Nitro-Bid (Ointment) - measured on supplied papers.

Nitrostat (SL)

Nitro-Dur (Transdermal) - apply a new patch daily, remove after 12-14hrs. to prevent tolerance

Classification: coronary vasodilator, antianginal

Action: Decreases preload, afterload; decreases left ventricular end-diastolic pressure, systemic vascular resistance; dilates coronary arteries, improves blood flow through coronary vasculature, dilates arterial & venous beds systemically.

SE: headache, flushing, dizziness, postural hypotension, collapse.

Considerations: Never use erectile dysfunction products [ sildenafil, tadalafil, vardenafil] may cause severe hypotension, death.

Digoxin (Lanoxin)

digoxin immune FAB (ovine)/Digibind - antidote to digoxin. Action: antibody fragments bind to free digoxin to reverse toxicity. SE: CHF, a-fib, hypokalemia, impaired respiratory function, rapid RR.

Assess: hypokalemia & CHF

Classification: Cardiac glycoside, inotropic, antidysrhythmic

Action: Inhibits the Na+ K+ ATPase making more Ca2+ available for contractile proteins = increased CO [+ inotropic effect]; increases the force of contraction; decreases HR [ - chronotropic effect]; decreases AV conduction speed.

SE: headache, dysrhythmias, hypotension, AV block

Cautious in use c geriatric patients, hypokalemia [digoxin toxicity], hypothyroidism, AV block, renal dz, ventricular dysrhythmias.

Assess: apical pulse for 1 min. before giving ( if <60 in adult or <90 in infant, hold med. notify M.D; note rate, rhythm, character. K+ level. Therapeutic level = 0.5-2ng/ml.

Humulin R (short acting; regular) [onset:30min; peak:2.5-5hrs; duration: 6hrs]

Humulin N (intermediate acting; NPH) [onset:1.5-4hrs.; peak:4-12hrs.; duration: 12hrs.]

Lantus (long acting; insulin glargine) [onset: 5hrs.; no peak; duration: >/= 24hrs.]

Classification: antidiabetic; pancreatic hormone

Action: decreases blood glucose by transport of glucose into cells and the conversion of glucose to gycogen.

SE: lipodystrophy, hypoglycemia, anaphylaxis

Considerations: insulin requirements may increase during stress/illness/surgery; rotate inj. sites within one anatomical location- abd, upper back, thighs, upper arm, buttocks; IV route - only regular- monitor glucose (hypoglycemia) & K+ level.

bumetanide (Bumex)

furosemide (Lasix)

Classification: loop diuretic

Action: act on descending loop of Henle by inhibiting reabsorption of chloride & sodium.

SE: chest pain, circulatory collapse, loss of hearing, hypokalemia, hypochloremic alkalosis, hypomagnesemia, hyperuricemia, hypocalcemia, hyponatremia, hyperglycemia, nausea, acute pancreatitis, jaundice, polyuria, renal failure, thrombocytopenia, leukopenia, granulocytopenia, rash, pruritis, StevensJohnson syndrome.

Interactions: aminoglycosides, hypokalemia

Teaching: increase fluid intake 2-3L/day, may need to take K+ supplements, rise slowly, take c food/milk for GI sxs, take in am, use sunscreen.

Classification: Thiazide diuretice, antihypertensive

Action: acts on distal tubule and ascending limb of loop of Henle by increasing excretion of water, sodium, chloride, potassium.

SE: dizziness, fatigue, weakness, hypokalemia, n/v, anorexia, hepatitis, urinary freguency, uremia, glucosuria, aplastic anemia, hemolytic anemia, leukopenia, agranulocytosis, thrombocytopenia, neutropenia, rash, hyperglycemia, hyperuricemia.

Considerations: daily weight, I&O, avoid ETOH, same as Lasix & Bumex

Classification: potassium-sparing diuretic

Action: competes with aldosterone at receptor sites in distal tubule, resulting in excretion of Na+, Cl-, H2O, retention of K+ & phosphate.

SE: hyperkalemia, diarrhea, bleeding, vomiting, hepatocellular toxicity, agranulocytosis, rash, pruritis.

Interactions: arginine (herb) - fatal hypokalemia.

Considerations: electrolytes; daily weight, I&O, signs of metabolic acidosis[drowsiness,restlessness] avoid foods high in K+[oranges, bananas, dried apricots, dates, salt substitues]

clonidine (Catapres)

Classification: antihypertensive

Action: inhibits sympathetic vasomotor center in CNS, reduces impulses in sympathetic nervous system; decreases B/P, HR, CO; prevents pain signal transmission in CNS by a-adrenergic receptor stimulation of the spinal cord.

SE: drowsiness, sedation, headache, fatigue, orthostatic hypotension, palpitations, CHF, n/v, malaise, dry mouth, rash.

Precautions: DM, CRF, Raynaud's dz, COPD, thyroid dz, asthma, recent MI.

Interactions: life-threatening elevations in B/P with tricyclics & B-blockers.

Can be used in opioid withdrawal. Rx of OD -- tolazoline, atropine, DOPamine.

hydrALAZINE (apresoline)

Classification: antihypertensive, direct acting peripheral vasodilator

Action: vasodilates arteriolar smooth muscle by direct relaxation; reduces B/P c reflex increases in HR, SV, CO.

SE: headache, tremors, dizziness, anxiety, palpitations, reflex tachycardia, angina, shock, n/v, anorexia, diarrhea, leukopenia, agranulocytosis, thrombocytopenia, lupuslike sxs.

Considerations: assess B/P q5min. x 2hrs, then q1hr x 2 hrs, then q4hr.; assess pulse & for JVD q4hr.; daily weight & I&O; LE prep, ANA titer bf starting therapy; take c meals; notify M.D is chest pain, severe fatigue, fever, muscle/joint pain.

Tx of OD: vasopressors, volume expanders for shock, if PO - lavage/ activated charcoal.

benazapril (Lotensin)

Classification: antihypertensive

Action: inhibit angiotensin-converting enzyme (ACE); Lotensin in combination with thiazide diuretics gives a blood-pressure-lowering effect greater than that seen with either agent alone.

SE: Head and Neck Angioedema, Intestinal Angioedema, Hypotension, Neutropenia/Agranulocytosis, Hepatic Failure, h/a, dizziness, cough, fatigue, somnolence, postural hypotension, nausea.

Precautions: renal impairment, hyperkalemia, cough, liver impairment, report infection sxs immediately.

Aluminum hydroxide

Classification: antacid, hypophosphatemic, antiulcer

Action: neutralizes gastric acidity, binds phosphates in GI tract which are then excreted.

SE: constipation, obstruction,  hypophosphatemia.

Considerations: phosphate levels (hypophosphatemia=anorexia, weakness, fatigue, bone pain, hyporeflexia) give c H20; stools may appear white/speckled; separate other medications by 2 hr.

Magnesium hydroxide (Philips' Milk of Magnesia)

Classification: electrolyte; anticonvulsant; saline laxative, antacid

Action: inreases osmotic pressure, draws fluid into colon, neutralizes HCl.

SE: flaccid paralysis, circulatory collapse, n/v, anorexia, cramps.

Considerations: assess for magnesium toxicity - thirst, confusion, decrease in reflexes; give c 8oz of H2O, can give citrus fruit after administering to counteract unpleasant taste.

Calcium carbonate

Classification: antacid, calcium supplement

Action: neutralizes gastric acidity

SE: constipation

Contraindicated: hypercalcemia, hyperparathyroidism, bone tumors.

Considerations: Milk-alkali syndrome - n/v, disorientation, h/a; monitor Ca2+ levels (8.5-10.5); increase fluid intake to 2L.

alpraxolam (Xanax) [short-acting]

lorazepam (Ativan) [sedative, hypnotic, short-acting; potentiates the actions of GABA; SE: apnea; cardiac arrest (rapid IV); Assess for suicidal tendencies]

diazepam (Valium) [anticonvulsant, skeletal muscle relaxant, central acting, long-acting; enhances presympathetic inhibition, inhibits spinal polysynaptic afferent paths; SE: neutropenia, respiratory depression]

Classification: antianxiety; benzodiazepine

Action: depresses subcortical levels of CNS (limbic system & reticular formation)

SE: dizziness, drowsiness, orthostatic hypotension, ECG changes, tachycardia, blurred vision.

Conraindicated: angle-closure glaucoma, hepatic dz; ETOH, anticonvulsants, antihistamines, sedatives & opioids increase CNS depression.

Assess for physical dependency; Tx of OD: flumazenil

levothyroxine (Synthroid)

Classification: Thyroid hormone

Action: increases metabolic rate, controls protein synthesis, increases cardiac output, body temp, renal blood flow, O2 consumption, blood volume, growth, and development at cellular level.

SE: anxiety, insomnia, tremors, thyroid storm, tachycardia, palpitations, angina, dysrhythmias, cardiac arrest.

Contraindicated: adrenal insufficiency, recent MI, throtoxicosis, hypersensitivity to beef.

Considerations: take in am at same time daily on empty stomach; report excitability, irritability, anxiety -- OD; avoid foods high in iodine - iodized salt, soybeans, tofu, turnips, high-iodine seafood.

 paroxetine (Paxil)

Classification: antidepressant; SSRI

Action: inhibits CNS neuron uptake of serotonin

SE: h/a, drowsiness, anxiety, tremor, dizziness, seizures, nausea, dry mouth, diarrhea, constipation, abnormal ejaculation, sweating

Contraindicated: pregnancy (D), pts taking MAOIs, pimozide, thioridazine - potentially fatal. Paxil may decrease digoxin levels.

Considerations: assess mental status, orthostatic B/P measurement q 4hr - if B/P drops 20mmHg hold product and notify prescriber, assess for EPS in geriatric pts. Therapeutic effect may take 1-4wks.

venlafaxine (Effexor)

Classification: antidepressant

Action: Potent inhibitor of neuronal serotonin & norepinephrine uptake, weak inhibitor of dopamine

SE: emotional lability, vertigo, suicidal ideation in children/adolescents, seizures, migraine, abnormal vision, ear pain, dysphagia, eructation, rectal hemorrhage, anorgasmia, dysuria, hematuria, metrorrhagia, vaginitis, impaired urination, uterine hemorrhage, vaginal hemorrhage, agranulocytosis, aplastic anemia, neutropenia, pancytopenia, peripheral edema, weight loss/gain, bronchitis, dyspnea, malaise, neck pain.

Contraindicated: c MAOIs - hyperthermia, rigidity, rapid fluctuation of VS, mental status changes, neuroleptic malignant syndrome.

amitriptyline (Elavil)

Classification: antidepressant; tricyclic

Action: blocks the reuptake of norepinephrine, serotonin into nerve endings, increasing their action in nerve cells. For major depression. Not typically used in geriatric patients - strong anticholinergic & sedative properties.

SE: dizziness, drowsiness, seizures, orthostatic hypotension, ECG changes, tachycardia, hypertension, dysrhythmias, blurred vision, constipation, dry mouth, paralytic ileus, hepatitis, urinary retention, agranulocytosis, thrombocytopenia, eosinophilia, leukopenia, aplastic anemia.

Contraindicated c MAOIs - hyperpyretic crisis, seizures, hypertensive episode

procainamide (Pronestyl)

Classification: antidysrhythmic - Class IA

Action: Dpresses excitability of cardiac muscle to electrical stimulation and slows conduction in atrium, bundle of His, and ventricle increases refractory period.

SE: h/a, dizziness, hypotension, heart block, cardiovascular collapse & arrest, agranulocytosis, thrombocytopenia, neutropenia, hemolytic anemia.

Contraindicated in SLE, severe heart block.

Considerations: Continuous ECG monitoring (IV) - increased PR/QRS segments;CBC q2wk x 3 months; Toxicity - confusion, drowsiness, n/v, tachydysrhythmias, oliguria. CNS effects - dizziness, confusion, psychosis, paresthesias, seizures (discontinue product) Notify prescriber - if lupuslike sxs appear [joint pain, butterfly rash, fever, chills, dyspnea] & of leukopenia [sore mouth, gums, throat] & thrombocytopnia [bleeding, bruising] 

lidocaine (Xylocaine)

Classification: antidysrhythmic - Class Ib

Action: increases electrical stimulation threshold of ventricle, His-Purkinje system - which stabilizes cardiac membrane & decreases automaticity. Used for ventricular dysrhythmias.

SE: h/a, dizziness, seizures, hyptension, bradycardia, heart block, cardiovascular collapse/arrest, methemoglobinemia, repiratory depression.

Consideration: continuous ECG monitoring for increased PR/QRS segments - decrease rate, watch for increased ventricular ectopic beats, B/P. Malignant hyperthermia - tachypnea, tachycardia, changes in B/P, increased temp.

propranolol (Inderal)

Classification: Antihypertensive, antianginal, antidysrhythmic - Class II; b-blocker

Action: nonselective b-blocker with negative inotropic chronotropic, dromotropic properties.

SE: fatigue, bradycardia, CHF, pulmonary edema, dysrhythmias, laryngospasm, agranulocytosis, thrombocytopenia, bronchospasm.

Considerations: Notify prescriber is HR <60/ systolic B/P <90; assess I&O ratio, CCr is kidney damage;  watch for fluid overload; continuous ECG monitoring; do not discontinue abruptly - precipitate life-threatening dysrhythmias, excerbation of angina, MI; take product at same time qday; decrease dose over 2wks to prevent cardiac damage.

 diltiazem (Cardizem)

Verapamil ( SE: Stevens-Johnson syndrome) [Assess I&O ratio - daily weights, crackles, weight gain, dyspnea, JVD - CHF]

Classification: Ca2+ channel blocker, antiarrhythmic class IV.

Action: inhibits Ca2+ influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle, dilates coronary arteries, slows SA/AV node conduction times, dilates peripheral arteries. (IV) - Tx a-fib, flutter, paroxysmal supraventricular tachycardia.

 SE: h/a, fatigue, drowsiness, dysrhythmia, edema, CHF, heart block, nausea, constipation, ARF.

Contraindicated: hypotension <90 systolic & <60 diastolic.

Considerations: take c full glass of water before meals & hs; to report dizziness, SOB, palpitations; limit caffeine; avoid grapefruit juice.

captopril (Capoten)

Classification: antihypertensive; ACEI

Action: selectively suppresses renin-angiotensin-aldosterone system; inhibits ACE preventing conversion of angiotensin I to angiotensin II.

SE: hypotension, tachycardia, nephrotic syndrome, acute reversible renal failure, neutropenia, agranulocytosis, pancytopenia, thrombocytopenia, angioedema, bronchospasm, dyspnea, cough.

Contraindicated: K+-sparing diuretics

Considerations: Renal studies, take  1hr before or 2hr after meals; avoid salt substitutes, high K+/Na+ foods; avoid sunlight; notify prescriber of mouth sores, sore throat, fever etc.; monitor B/P.

carbamazepine (Tegretol)

Classification: Anticonvulsant

Action: appears to decrease polysynaptic responses and block post-tetanic potentiation.

SE: drowsiness, paralysis, worsening of seizures, hypertension, CHF, dysrhythmias, AV block, nausea, constipation, diarrhea, hepatitis, hepatic porphyria, renal failure, thrombocytopenia, leukopenia agranulocytosis, leukocytosis, aplastic anemia, eosinophilia, rash, Stevens-Johnson syndrome.

Interactions: MAOIs-fatal

Considerations: Blood studies [RBC, Hct, Hgb, reticulocyte counts q wk for 4wks then q3-6months, if myelosuppression occurs - d/c; monitor for blood dyscrasias ( fever, sore throat, bruising, rash, jaundice); monitor for toxicity (bone marrow suppressin, n/v, ataxia, diplopia, cardiovascular collapse, Stevens-Johnson syndrome).

phenytoin (Dilantin)

Classification: anticonvulant; antidysrhythmic

Action: inhibits spread of seizure activity in motor cortex by altering ion transport; increases AV conduction.

SE: v-fib, hepatitis, nephritis, agranulocytosis, leukopenia, aplastic anemia, thrombocytopenia, megaloblastic anemia, LE, Stevens-Johnson syndrome, toxic epidermal necrolysis.

Contraindicated: bradycardia, SA & AV block, pregnancy (D)

Considerations: Assess for hypersensitivity syndrome 3-12wks after start of rx [ rash, temp, lymphadenopathy], hepatotoxicity, renal failure, rhabdomyolysis; for beginning rash of S-J syndrome or toxic epidermal necrolysis - d/c phenytoin. Therapeutic level = 7.5-20. Proper oral hygiene to prevent gingival hyperplasia.

 diclofenac sodium (Voltaren)

ketorolac (Toradol) - aspirin, other NSAIDs can increase Toradol levels & is contraindicated. Monitor for hepatic dysfunction [jaundice, yellow sclera & skin, clay-colored stools], Monitor for CV thrombotic events [MI, stroke], Assess for adequate renal function bf administering.

Valdecoxib (Bextra) - taken off the market due to increased risk of serious heart problems and skin reactions.

Classification: NSAIDs; nonopioid analgesic

Action: inhibits prostaglandin synthesis by decreasing enzyme needed for biosynthesis; antipyretic.

SE: dizziness, h/a, CHF, dysrhythmias, MI, stroke, laryngeal edema, jaundice, cholestatic hepatitis, hepatotoxicity, nephrotoxicity, dysuria, hematuria, oliguria, azotemia, cystitis, UTI, blood dyscrasias [thrombocytopenia: bruising, fatigue, bleeding, poor healing], bronchospasm, anaphylaxis.

Contraindicated: if allergy to aspirin, iodides, other NSAIDs, asthma.

celecoxib (Celebrex) 

Classification: NSAIDs, antirheumatic; COX-2 inhibitor

Action: inhibits prostaglandin synthesis by selectively inhibiting COX-2 - enzyme needed for biosynthesis.

SE: fatigue, anxiety, depression, nervousness, paresthesia, stroke, MI, tachycardia, CHF, GI bleeding/ulceration, nephrotoxicity, blood dyscrasias, platelet aggregation, serious/fatal stevens-johnson syndrome, toxic epidermal necrolysis.

Contraindicated in pregnancy (D). Notify prescriber of GI sxs - black tarry stools, cramping, rash, edema of extremities, weight gain; of chest pain, skin eruptions - d/c immediately. Do not exceed recommended dose.

albuterol

metaproterenol (Alupent) - Hypertensive crisis - MAOIs & tricyclics. Contraindicated in angle-closure glaucoma & cardiac dysrhythmias c tachy.

Classification: adrenergic B2-agonist, sympathomimetic, bronchodilator

Action: bronchodilation by acting on B2 (pulmonary) receptors by increasing levels of cAMP-relaxes smooth muscle; cardiac stimulation, increased diuresis and gastric acid secretion.

SE: tremors, anxiety, restlessness, bronchospasm.

Considerations: that pt has not received theophylline before dose; monitor for paradoxical bronchospasm (d/c immediately); limit caffeine products.

Classification: corticosteroids; inhalation; antiasthmatic

Action: decreases inflammation by inhibiting mast cells, macrophages, leukotrienes; antiinflammatory, vasoconstrictor properties. For chronic Tx.

SE: pharyngitis, oral candidiasis, eosinophilic conditions, angioedema, Churg-Strauss syndrome, upper respiratory infection, bronchospasm.

Considerations: adrenal insufficiency (nausea, weakness, fatigue, hypotension, hypoglycemia, anorexia - can occur when changing from systemic to inhalation corticosteroids), rinse mouth out after each dose, give at 1min. intervals; use bronchodilator first.

dexamethasone (Decadron)

methylprednisolone (Solu-Medrol) - glucocorticoid; immediate-acting. Not as many SE. Do not drink c grapefruit juice. Do not give intrathecally. Increase intake of K+ & Ca2+.

prednisone - glucocorticoid, intermediate-acting; minimal mineralcorticoid activity; avoid vaccinations.

Classification: Corticosteroid; long-acting

Action: Decreases inflammation by suppression of migration of polymorphonuclear leukocytes, fibroblasts, reversal of increased capillary permeability and lysosomal stabilization.

SE: depression, flushing, sweating, seizures, hypertension, circulatory collapse, thrombophlebitis, embolism, diarrhea, nausea, abdominal distention, GI hemorrhage, increased appetite, pancreatitis, thrombocytopenia.

Considerations: assess for hyperglycemia & hypokalemia; infection [product masks sxs], can take c food/mild to decrease GI sxs, do not d/c abruptly - adrenal crisis can occur.

Cimetidine (Tagamet)

Famotidine (Pepcid) – decreases gastric secretion while pepsin remains at a stable level.  SE: dizziness, constipation [ increase fluids & bulk ].

Ranitidine (Zantac) – Not as many SE; hepatotoxicity, anaphylaxis (rare); assess mental status; do not take OTC maximum dose for more than 2 wks.

Classification: H2-histamine receptor antagonist.

Action: Inhibits histamine at H2-receptor site in the gastric parietal cells inhibits gastric acid secretion.

SE: confusion, h/a, seizures, dysrhythmias, diarrhea, paralytic ileus, jaundice, agranulocytosis, thrombocytopenia, neurtopenia, aplastic anemia, increase in PT, exfoliative dermatitis.

Considerations: assess gastric pH (5 or >); Take c meals for prolonged effect. Gynecomastia & impotence may occur but are reversible. 

Simvastatin (Zocor) 

Rosuvastatin (Crestor) – SE: h/a, dizziness, abd pain, flatus, diarrhea, dyspepsia, heartburn, kidney failure, liver dysfunction, thrombocytopenia, hemolytic anemia, leucopenia, rash, pruritus, MS: asthenia, muscle cramps, arthritis, arthralgia, myositis, rhabdomyolysis, pharyngitis.

Classification: antilipidemic

Action: inhibits HMG-CoA reductase enzyme, reducing cholesterol synthesis.

SE: liver dysfunction, rhabdomyolysis, myositis

Contraindicated in pregnancy (X)

Consideration: Assess for signs of rhabdomyolysis [muscle tenderness, increased CPK levels – d/c]

Ezetimibe (Zetia)

Classification: Antilipemic; cholesterol absorption inhibitor

Action: inhibits absorption of cholesterol by the small intestines.

SE: myalgias, arthralgia

Considerations: can administer s regard to meals.

Alendronate (Fosamax) 

Ibandronate (Boniva) – does not inhibit bone formation and mineralization… absorbs Ca2+ phosphate crystals in bone. More potent than other products. SE: hypomagnesemia, hypophosphatemia, hypocalcemia. For bone pain, use analgesics.

Classification: bone-resorption inhibitor; bisphosphonate

Actions: decreases rate of bone resorption and may directly block dissolution of hydroxyapatite crystals of bone; inhibits normal & abnormal bone resorption, mineralization.

SE: perforation, angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis.

Contraindicated: delayed esophageal emptying or inability to stand for 30min or hypocalcemia.

Considerations: BDT done before  & during treatment, monitor for hypercalcemia; take c 8oz. of water 30min before 1^st food, beverage or medication of the day, remain upright for 30min. after dose; take vit D supplements & do weight bearing excercises.

Raloxifene (Evista) 

Classification: hormone modifier, selective estrogen receptor modulator (SERM)

Action: reduces resorption of bone and decreases bone turnover; mediated through estrogen receptor binding.

SE: CVA, nausea, hot flashes, leg cramps, pulmonary embolism.

Contraindicated in pregnancy (X) & women c active hx of DVT

Considerations: B/P, weight gain, BDT baseline & during treatment. D/C drug 72hrs to prolonged immobilization.

Tadalafil (Cialis) 

Vardenafil (Levitra) – SE: insomnia; contraindicated in congenital/acquired QT prolongation. Serious dysrhythmias can occur if taken c [class Ia/III antiarrhythmics, clarithromycin, droperidol, procainamide, quinidine, quinolones]

Sildenafil (Viagra) – antihypertensive, peripheral vasodilator as well… product absorption is reduced c intake of high fat meal.

Classification: impotence agent

Action: inhibits phosphodiesterase type 5; enhances erectile function by increasing the amount of cGMP, causing smooth muscle relaxation and increased blood flow into the corpus cavernosum; improves erectile function for up to 36hrs.

SE: h/a, flushing, dizzine, MI, sudden death, CV collapse, dyspepsia, nasal congestion, UTI, diarrhea, nonarteritic ischemic optic neuropathy.

Contraindicated in pts taking organic nitrates regularly or intermittently & a-adrenergic antagonist

Considerations: do not use more than once/day; seek medical attention if erection lasts longer than 4hrs. D/C if vision loss occurs.