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Func. class: Adrenergic B2-agonist, sympathomimetic, bronchodilator

Action: causes bronchodilation by action on b2 (pulmonary) receptors levels of cAMP, which relaxes smooth muscle; produces bronchodilation, CNS, cardiac stimulation,as well as increased duyresis and gastric acid secretion; longer acting than isoproterenol

uses: prevention of excercise-induced asthma,acute bronchospasm, bronchitis, emphysema,bronchuectasis,or ither reversible airway obstruction
unlabeled uses:hyperkalemia in dialysis patients

Dosages and routes: to prevent excercise-induced bronchospasm 'Adult: INH (meterd dose inhaler)2puffs 15 min before excercising/Other respiratory conditions 'Adult and Child>12:INH(metered dose inhaler)2 puffs q4h;PO 2-4 mg tid-qid,nto to exceed 8mg; NEB/IPPB 2.5mg tid-qid 'Geriatrics:PO 2mg tid-qid,may increase gradually to 8mg tid-qid 'Child 2-12yr: INH(metered dose inhaler) 0.1mg/kg tid (max 2.5mg tid-qid);NEB/IPPB 0.1=0.15mg/kg/dose tid-qid or 1.25mg tid-qid for child 10-15kg or 2.5mg tid-qid>15kg

Available forms: Aerosol 90mcg/actuation;oral sol 2mg/5mL;tabs 2,4mg;E-R 4,8mg; INH sol 0.5,0.83,1,2,5mg/mL;powder for INH (ventodisk)200,200mcg;INHcap 200mcg;100mcg/spray,80,200 INH/canister

Side effects: bronchospasm, tremors,anxiety,insomnia,headache,dizziness,restlessness.

Contraindications:hypersensitivity to sympathomimetics,tachydysrhythmias,severe cardiac disease,heart block

Precautions:pregnany,lactation,cardiac disorders, hyperthyroidism,diabetes mellitus,hypertension,prostatic hypertrophy,narrow-angle glaucoma,seizures,excercis-induced bronchospasm (aerosol)in children <12 years, hypoglycemia, seizure disorder.

Pharmokinetics:well absorbed PO, extensively metabolized in the liver and tissues,crosses placenta,breast milk,blood-brain barrier
PO:onset 1/2hr,peak2-3hr,duration4-6hr,HL2.7-6hr
PO-ER:onset 1/2hr,peak2-3hr,duration8-12hr
INH: onset 5-15min,peak0.5-2hr,duration2-6hr,HL 4hr

Nursing considerations:
'respiratory function: vital capacity,forced expiratory volume, ABGs;lung sounds,heart rate rhythm,B/P,sputum(baseline and peak)
'That patient has apynot recieved theophylline therapy before giving does
'patient's ability to self-medicate
'for evidence of allergic reactionsbronchospasm; hold medication, notify prescriber if bronchospasm occurs.
PO route
'do not break,crush,or chew ER tabs
• With meals to decrease gastric irritation
• Oral solution to children (no alcohol, sugar)

breath, remove, exhale slowly: give INH at least I min apart
• NEB/IPPB diluting 5 mg/ml sol/2.5 ml 0.9% NaCI for INH: other sol do not require dilution; for NEB 02 flow or compressed air 6-10 11mL
• Gum, sips of water for dry mouth
• Storage in light-resistant container, do not expose to temperatures over 86° F (30°C)
• Therapeutic response: absence of dysnea, wheezing after 1 hr, improved airway exchange, improved ABGs
Teach patient/family:
• To use exactly as prescribed; take missed dose when remembered, alter dosing schedule
• Not to use OTC medications: excess
stimulation may occur
• Use of inhaler; review package insert
with patient; use demonstration. return
• To avoid getting aerosol in eyes; blurring vision may result
• To wash inhaler in warm water daily
and dry
• To avoid smoking, smoke-filled rooms,
persons with respiratory infections
That paradoxical bronchospasm may
occur and to stop drug immediately. call
• To limit caffeine products such as chocolate, coffee, tea, and colas
Treatment of overdose: Administer
B1-adrenergic blocker



Func. class: bone-resorption inhibitor

chem. class: bisphosphonate

Action: absorbs calcium phosphate crystal in bone and may directly block dissolution of hydroxyapatite crytaIs of bone;inhibits normal and abnormal bone resabsorption,mineralization

Uses: Treatment and prevention of osteoporosis in postmenopausal women,treatment of osteoporosis in men, Paget's disease,treatment of corticosteroidinduced osteoporosis in postmenopausal
women not receiving estrogen and men
who are on continuing corticosteroid
treatment with low bone mass

Osteoporosis in postmenopausal women
. Adult and geriatic: P0 10 mg daily or 70 mg qwk
Paget’s disease
• Adult and geriatric:PO 40mg dailyX 6mo,consider retreatment for relapse
Prevention ofosteoporosis
• Adult: P0 5 mg daily or 35 mg qwk
corticosteroid-induced osteoporosis in postmenopausal women (not recieving estrogen)
• Adult: P0 10mg daily
corticosteroid-induced osteoporosis in men or premenopausal women
. Adult: P0 5 mg daily
Available forms: Tabs 5,10,35,40,70mg;oral sol 70 mg/5 ml

SIDE EFFECTS:Headache,Abdomnial pain,nausea, vomiting,acid reflux,hypokalemia

Rapidly cleared from circulation, taken up mainly by bones, eliminated primarily through kidneys

Assess: hormonal status if a woman, prior to treatment
. For osteoporosis: bone density test before and during treatment
. For Paget's disease: increased skull size,bone pain,headache;decreased vision,hearing
. Electrolytes: renal function studies: Ca,P,Mg,K
. For hypercalcemia: paresthesia,twitching, laryngospasm,Chvostek's, Trousseau's signs
• Alk phos levels, baseline and periodically. 2X upper limit of normal is indicative of Paget's disease
• For 6 months to be effective in Paget's disease: take with 8oz of water 30 min before 1st food, beverage, or medication of the day
• Storage in cool environment, out of direct sunlight
• Therapeutic response: increased bone mass,absence of fractures
Teach patient/family:
• To remain upright for 30 nuin after dose to prevent esophageal irritation, if dose is missed, skip dose, do not double doses or take later in day
• To take in am before food, other meds,take with 6-8 oz of water only (no mineral water)
• To take calcium,vit D if instructed by health care provider
• To use weight-bearing exercise to increase bone density
• To let health care provider know if pregnant or if pregnancy is planned or if breastfeeding


Func. class: Antigout drug,antihyperuricemic

Chem. class: Xanthene oxidase inhibitor

Action: Inhibits the enzyme xanthine oxidace, reducing uric acid synthesis

Uses: Chronic gout, hyperuricemia associated with malignancies, recurrent calcium oxalate calculi. uric acid calculi

Increased uric acid levels in malignancies
• Adult: P0 6OO-80O mg/day in divided doses,start up to 3 days prior to chemotherapy IV INF 200-4O0 mg/m2/day,max 600 mg/day
• Child 6- lOyr: Po 300 mg/day
• Child <6yr: PO 15O mg/day
• Child: IV INF 200 mg/m2/day initially as a single dose or divided q6-12h
• Adult: P0 100mg/day,increase qwk based on uric acid levels,max 800mg/day;maintenance dose 100-200mg
Renal dose
• Adult: P0 CCr 60ml/min 200mg/day;CCr 40ml/min 150mg/day;CCr 20ml/min 100 mg/day;CCr 10 ml/min 100 mg/qod;CCr <10 mI/min 100 mg 3x/wk;IV CCr 10-20 mL/min 200 mg/day;CCr 3-10 mL/min 100mg/day; CCr<3 mL/min 100 mg/day at intervals
Recurrent calculi
• Adult: P0 200-300 mg daily
Uric acid nephropathy prevention
• Adult and child >10 yr:PO 600-800mg dailyX 2-3 days
Available forms:Tabs, scored 100,300 mg;in 500mg/vial

Headache,Nausea,vomiting,anorexia,malaise,Agranulocytosis,thrombocytopenia,aplastic anemia,leukopenia, bone marrow supression,eosinophilia,renal failure
Contraindications: Hypersensitivity
Precautions: Pregnancy (C), lactation,
renal/hepaic disease, children

P0: Peak 2-4nhr; excreted in feces,urine; half-life 2-3 hr,terminal half-life
IV: half-life 1 hr

. uric acid levels q2wk: uric acid levels should be 6 mg/dl or less
• CBC,AST,BUN,creatinine before starting treatment, periodically
• I&O ratio:increase fluids to 2L/day to present stone formation and toxicity
• For rash,hypersensitivity reactions,discontinue
• For gout: joint pain,swelling; may use with NSAIDS for acute gouty attacks
PO route
•with meals to prevent GI symptoms; may crush and add to foods or fluids
• A few days before antineoplastic therapy
Intermittent IV INF route
• Reconstitute 30-mL vial with 25 ml of sterile water for inj; dilute to desired conc with 0.9% NaCI for inj or D5 for inj. begin inf within 10 hr
Solution incompatibilities:
Amikacin, amphotericin B, carmustine,cefotaxime, chlorproMAZINE,cimetidine,clindamycin,cyarabine,dacarbazine, DAUNOrubicin,diphenhydrAMINE, DOXOrubicin,doxycycline,droperidol,floxuridine, gentamicin,haloperidol,hydrOXYzine,idarubicin,imipenem,cilastatin,mechlorethamine,meperidine,metoclopramide,methylPREDNISolone,minocycline,nalbuphine,netilmicin,ondansetron, prochlorperazine, promethazine,sodium bicarbonate,streptozocin,tobramycin,vinorelbine
• Therapeutic response: decreased pain in joints, decreased stone formation in kidneys;decreased uric acid levels
Teach patient/family:
• That tabs may be crushed
• To take as prescribed;if dose is missed,take as soon as remembered;do not double dose
• To increase fluid intake to 2 L/day
• To report skin rash,stomatitis,malaise,fever,aching;drug should be discontinued
• To avoid hazardous activties if drowsiness or dizziness occurs
• To avoid alcohol,caffeine; will increase uric acid levels
. To avoid large doses of vit C: kidney stone formation may occur
. To reduce dairy products,refined sugaars,sodium, meat if taking for calcium oxalate stones


Func. class: antianxiety

Chem. class: benzodiazepine

Action: Depresses subcortical levels of CNS,including limbic system,reticular formation

Uses: Anxiety,panic disorders,anxiety,with depressive symptoms
Unlabeled uses: Depression,social phobia, premenstrual dysphoric disorders

Anxiety disorder
. Adult:P0 0.25-0.5 mg tid,not to exceed 4 mg/day in divided doses
• Geriatric: P0 0.125-0.25 mg bid; increase by 0.125 as needed
Panic disorder
. Adult: P0 0.5 mg tid may increase,max 10 mg/day; ext rel tabs (Xanax XR)give daily in am 0.5-1 mg initially, maintenance 1-10 mg daily
Premenstrual dysphoric disorders
• Adult: P0 0.25 mg bid-qid,starting on day 16-18 of menses,taper over 2-3 days when menses occurs
Social phobia
• Adult: P0 2-8 mg/day
Hepatic dose
• Reduce dose by 50%
Available forms: Tabs 0.25,0.5,1,2mg;ext rel tabs (Xanax XR) 0.5,1,2,3mg; orally disintegrating tabs 0.25,0.5,1,2mg

ECK changes, tachycardia, blurred vision, orotstatic hypotension.

Contraindications: Pregnancy (D),hypersensitivity to benzodiazepines,narrow-angle glaucoma,psychosis, lactation, addiction
Precautions: Geriatric, debilitated, hepatic disease

P0: Well absorbed;widely distributed;onset 30 mmn: peak 1-2 hr;duration 4-6hr;therapeutic response 2-3 days;metabolized by liver(CYP3A4);excreted by kidneys;crosses placenta, breast milk;half-life 12-15 hr

Nursing Considerations
'mental status: anxiety, mood, sensorium, affect,sleep pattern,drowsiness,dizziness,especially in geriatric
'B/P lying,standin;pulse;if systolic B/P drops 20mmHg,hold drug,notify prescriber
'hepatic,bloodstudies:AST,ALT,bilirubin,creatinine,LDH,ald phos,CBC;may cause neutropenua,decreased Hct,increased LFTs
'for indications of increasing tolereance and abuse
physical dependency,withdrawal symptoms: anxiety, panic attacks,agitation,convulsions,headache,nausea, vomiting,muscle pain,weakness;withdrawal seizures may occur after rapid decrease in dose or abrupt discontinuation;since duration of action is short, considered to be the drug of choice in lhe geriatric
PO route
. With food or milk for GI symptoms
• Tabs may be crushed,mixed with food or fluids if patient is unable to swallow medication whole;do not break,crush,or chew ext rel (XR)
• May divide total daily doses into more times/dav, if anxiety occurs between doses
• Orally disintegrating tabs on tongue to dissolve
• Therapeutic response:decreased anxiety, restlessness,sleeplessness
Teach patient/family:
• Not to double doses;take exactly as prescribed;if dose is missed,take within 1 hr as scheduled
• That drug may be taken with food
• Not to use for everydav stress or longer than 4 mo unless directed by prescriber;not to take more than prescribed amount;may be habit forming;memory impairment is a sign of long-term use
• To avoid OTC preparations unless approved by prescriber
. To avoid driving, activities that require
alertness, since drowsiness may occur
• To avoid alcohol ingestion or other psychotropic medications unless directed by prescriber
• Not to discontinue medication abruptly after long-term use
• To rise slowly or fainting may occur,especially geriatric
• That drowsiness may worsen at beginning of treatment
Treatment of overdose: Lavage,VS,supportive care, flumazenil


Func. class: antidepressant-tricyclic

Chem. class: tertiary amine

Action: block reuptake of norepinephrine,serotonin into nerve endings,increasing action of norepinephrine,serotonin in nerve cells
Uses: major depression
unlabeled uses:chronic pain management,prevention of cluster/migraine headaches,fibromyalgia.
Dosage and Routes
'adult:PO 75mg/day in divided doses, may increase to 150mg/day,not to exceed 300mg/day;IM 20-30 mg qid,or 80-120mg at bedtime
'geriatric and adolescent:PO 30mg/day in divided doses,may be increased to 100mg/day
cluster/migraine headache (unlabeled)
'adult:PO 50-150mg/day
chronic pain (unlabeled)
'adult: PO 75-150mg/day
'Adult: P0 10-50mg/nightly
available forms:tabs 10,25,50,75,100,150mg;inj 10mg/ml;syr 10mg/5ml
side effects: seizures,ECK changes,tachycardia,hypertension,dysrhythmias,hepatitis,thrombocytopenia,and agranulocytosis.
Contraindications:hypersensitivity to tricyclics,recovery phase of myocardial infarction
precautions: pregnancy (c),suicidal patients,seizure disorders,prostatic hypertrophy,schizophrenia,psychosis, severe depression,increased intraocular pressure,narrow-angle glaucoma,urinary retention, renal/hepatic/cardiac disease, hyperthyroidism, electroshock therapy,elective surgery <12yr,lactation,geriatric

PO/IM:onset45 min,peak 2-12hr,therapeutic response 4-10 days;metabolized in liver;excreted in urine,feces;crosses placenta,excreted in breast milk,half-life 10-46hr

• B/P lying,standing;pulse q4h;if systolic B/P drops 20 mm Hg,hold drug,notify prescriber;take vital signs q4h in patients with cardiovascular disease
• Blood studies: CBC,leukocytes,differential, cardiac enyzmes if patient is receiving long-term therapy
• Hepatic studies: AST,ALT,bilirubin
• Weight qwk;appetite may increase with drug
• ECG for flattening of T wave, the prolongation of QTc interval, bundle branch block,AV block, dyrhythmias in cardiac patients
• EPS primarily in geriatric: rigidity,dystonia,
• Mental status: mood, sensorium,affect,suicidal tendencies;increase in psychiatric symptoms: depression,panic
• Urinary retention,constipation:constipation is most likely to occur in children and geriatric
• Withdrawal symptoms: headache,nausea,vomiting, muscle pain, weakness: do not usually occur unless drug was discontinued abruptly
. Alcohol consumption; if alcohol is consumed,hold dose until morning
PO route
• Increased fluids, bulk in diet if constipation, urinary retention occur. especially geriatric
• With food or milk for GI symptoms
• Crushed if patient is unable to swallow
medication whole
• Dosage at bedtime if oversedation occurs during day;may take entire dose at bedtime;geriatric may not tolerate once/day dosing
• Storage at room temperature;do not freeze
• Assistance with ambulation during beginning therapy,since drowsiness/dizziness occurs
• Gum;hard,sugarless candy or frequent sips of water for dry mouth
• Therapeutic response:decrease in depression, absence of suidical thoughts
Teach patient/family:
• To take medication as directed: do not double dose;that therapeutic effects may take 2-3wk
• To use caution in dnving,other activities requiring alertness because of drowsiness,dizziness, blurred vision;to avoid rising quickly from sitting to standing,especially geriatric
• To avoid alcohol ingesion,other CNS depressants
• Not to discontinue medication quickly after long-term use:may cause nausea,headache,malase
• To wear sunscreen or large hat, since photosensitivity occurs
'That contraception is recommended during treatment
Treatment of overdose: ECG monitoring,lavage, administer anticonvulsant,sodium bicarbonate


Func. class: antianginal, antihypertensive, clacium channel blocker

Chem. class: Dihydropyridine

Action: Inhibits calcium ion influx across cell membrane during cardiac depolarization: produces relaxation of coronary vascular smooth muscle, peripheral vasculur smooth muscle;dilates coronary vascular arteries;increases mvocardial oxygen delivery in patients with vasospastic angina
Uses: Chronic stable angina pectoris,hypertension, vasospastic angina (Prinzmetal's? angina);may coadminister with other antihypertensives, antianginals

• Adult:P0 5-10 mg daily
• Adult:PO 2.5-5mg daily intially,max 10 mg/day
Hepatic dose/elderly
Adult:P0 2.5 mg/day: may increase up to 10 mg/day (antihypertensive):5 mg/day;may increase up to 10 mg/day (antianginal)
Available forms: Tabs 2.5,5,10mg

contraindications: Sick sinus syndrome, 2nd- or 3rd-degree heart block,hypersensitivity;severe aortic stenosis,obstuctive CAD
Precautions: Pregnancy (c),CHF,hypotension,hepatic injury,lactation,children,geriatric

P0: Onset not determined,peak 6-12hr,half-life 30-50 hr,increased in geriatric, hepatic disease; metabolized by liver,excreted in urine(90% as metabo
lites),protein binding >95%
• Cardiac status: B/P pulse, respiration,ECG;some patients have developed severe angina,acute Ml after calcium channel blockers if obstructive CAD is severe
• I&O ratio,weight daily;peripheral edema,dyspnea, jugular vein distention,crackles that are signs of CHF
PO route
. Once a day,without regard to meals
• therapeutic response: decreased anginal pain, decreased R/P,increased exercise tolerance
Teach patient/family:
• To take drug as prescribed,do not double or skip dose
• To avoid hazardous activities until stabilized on drug,dizziness is no longer a problem
• To avoid OTC drugs,grapefruit juice unless directed by prescriber
• To comply in all areas of medical regimen:diet, exercise,stress reduction,drug therapy,smoking cessation
• To notify prescriber of irregular heartbeat, shortness of breath,swelling of feet and hands, severe dizziness,constipation,nausea,hypotension
• To use correct technique in monitoring pulse,to contact prescriber if pulse <50 bpm
• To change positions slowly,to prevent orthostatic hypotension
• To continue with good oral hygiene to prevent gingival disease
• To notify all health care providers of this drug use
Treatment of overdose: Defibrillation,B-agonists,IV calcium inotropic agents,diuretics,atropine for AV block,vasopressor for hypotension
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