Comprehensive Pharm Review PDF

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Comprehensive Pharmacology Review The following provides an outline for the prototype drugs (in bold) covered in NR293. Students should be able to identify the mechanism of action, side effects, drug interactions, and nursing considerations for each drug, as well as general information about the drug class.

I. Pharmacology Fundamentals   

Protein binding - FAILED3-W Half life Therapeutic window – lithium, phenytoin, digoxin, Tegretol,

II. Infection Problems How and when are antimicrobials prescribed? What nursing considerations and patient education are important to remember?  

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Sulfonamides o Sulfamethoxazole/trimethoprim (Bactrim) Penicillins o Oxacillin o Ampicillin Cephlosporins o Cefriaxone (Rocephin) Tetracyclines o Doxycycline hyclate (Vibramycin) Aminoglycosides (‘little mycin’s) o Gentamicin sulfate o Tobramycin Macrolides (‘big mycin’s) o Clarithromycin (Biaxin) Fluoroquinolones o Ciprofloxacin (Cipro) Antifungals o Ketoconazole o Metronidazole (Flagyl) Anti TB Drugs  Isoniazid (INH)  Pyridoxine (Vitamin B)  Rifampin (Rifadin)  Ethambutol (Myambutol)

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Antimicrobial Drug Reminderss 

Penicillins: don’t take with acidic juices or carbonated beverages may reduce absorption

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Cephalosporins (Cefa’s)…don’t use if allergic to penicillins

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Macrolides (are “mycins”)…think “ototoxic” and “nephrotoxic”

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Aminoglycosides (are “mycins”)…assess renal and hearing function 1st (8th cranial nerve “Acoustic” – whisper test) Pencillins and cephalasporins may inactivate aminoglycosides…so give separately

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Tetracyclines (avoid milk products and antacids, administer on empty stomach, no under 8 y.o d/t turning teeth brown, use alternate birth control.)

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Fluoroquinolones (“floxins”)…take with full glass of H20, wear sunblock, no in kids

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Sulfonamides…don’t take if pregnant, breast feeding, under 2, renal or hepatic problems; may increase hypoglycemic effect and effect of Coumadin; Take with a full glass of water to prevent crystallization in urine

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Anti-tubercular: … monitor liver and renal function, avoid ETOH.

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Rifampin has MANY drug interactions including oral contraceptives and may cause urine, saliva, and sweat to turn orange.

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Anti-fungals (“azoles”) …don’t take if pregnant, most interact with other anti-infectives

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Ketocanazole has MANY drug interactions

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Anti-virals: …long term use may cause gingival hyperplasia

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Anti-malarials…don’t confuse “quinine” an anti-malarial with “quinidine” and anti-dysrhymic!

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Anthelmintic…metronidazole (Flagyl) may be used as anti-bacterial, antoprotazoal and antihelmintic. It will kill bacteria good bacteria in gut too, so may decrease absorption of Vitamin K. Will also cause disfulram like reaction if taken with alcohol. Administer antihelminthics after meals to decrease GI disturbance; do not take if pregnant; assess other members of the family to see if they are infected.

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Obtain cultures prior to therapy - do you know how to obtain peaks and troughs?

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Give medication round the clock

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Monitor kidney and liver function studies because that’s where most antibiotics are metabolized and excreted.

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Think “ototoxic” and “nephrotoxic” with “mycins” (macrolides and aminoglycosides

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Most common side effects of antibiotics… nausea, vomiting, diarrhea.

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Assess for allergy prior to admin; If you’re allergic, wear an alert bracelet.

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Generally use an alternate form of birth control.

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Identify therapeutic use – prophylactic vs. empiric vs. definitive

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Cancer & Immunosuppressant Drugs What nursing interventions and patient are important to remember when administering chemo drugs? 

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Cell cycle non-specific – cytotoxic at any phase o Alkylating agents - Cyclophosphamide (Cytoxan) o Antibiotics – bone marrow suppression ; doxorubicin (Adriamycin) may cause severe dig toxicity Cell cycle specific – cytotoxic at specific phase o Antimetabolites - Side effects hair loss; nausea, vomiting, diarrhea, myelosuppression  Methotrexate (MTX) – folic acid derivative acts as folate antagonist..  Fluorouracil (5-FU) – pyrimidine antagonist o Mitotic inhibitors  Vinca alkaloids – Vincristine (IV only) antidote to extravasation = hyaluronidase Miscellaneous o Hormonal agents  Leuprolide (prostate cancer)  Selective estrogen receptor modulators – Tomxifen (breast cancer) o Imatinib (Gleevec) – inhibits action of enzyme causing chronic myeloid leukemia (CML).

III. Nervous / Sensory System Drugs 

CNS Stimulants 1. ADHD (Amphetamines) - methylphenidate (Adderall; Ritalin) 2. Narcolepsy – provigil 3. Apnea - doxapram 4. Migraines – sumatriptan (Imitrex); Caffeine / methylxanthines Ergot alkaloids 5. Obesity – phentermine

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CNS Depressants 1. Benzodizepine – lorazepam (Ativan); alprazolam (Xanax) 2. Barbiburates – phenobarbital 3. Non-benzo’s – “Zzzz’s” – zolpidem (Ambien); zaleplon (Sonata); esZoiclone (Luminal) 4. Muscle Relaxants (Centrally acting) – baclofen (Lioresal); cyclobenzaprine (Flexeril) 5. Muscle Relaxants (Direct acting) – dantrolene (Dantrium)

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Psychotherapeutics 1. Anti-anxiolytics – alprazolam (Xanax); Non-Benzo – Busbar 2. Mood stabilizers – Lithium (Lithobid, Eskalith) 3. Antidepressants –  TCA’s – amitriptyline (Elavil); imipramine (Tofranil)  MAOI’s – phenelzine (Nardil); selegiline (Emsam)  SSRI’s; SNRI’s – fluoxetine (Prozac); paroxetine (Paxil); citalopram (Celexa); sertraline (Zoloft); escitalopram (Lexapro); duloxetine (Cymbalta).  Tetrcyclics – mirtazapine (Remeron)

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4. Antipsychotics – schizophrenia  Phenothyazines – thorazine (block dopamine receptors in certain areas of the brain).  Phenylbutylpipieridiens (haloperidol – Haldol)  Atypical – clozapine (Clozaril)  Benzisoxazole – risperidone (Resperdal)  Quinolinone – aripiprazole (Abilify) Side effects of most antipsychotics are extrapyramidal symptoms. (movement disorders i.e. tremors, contractions, bradykinesia, rigidity, tardive dyskinesia) 

Anti-epileptics 1. Hydantoins – phenytoin (Dilatin); fosphenytoin 2. Barbiturates – phenobarbital 3. Iminostilbenes – carbamazepine (Tegretol) 4. Miscellaneous – valproic acid (Depakote); tiagabine (Gabatril)

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Parkinson’s – either to replace dopamine or treat symptoms 1. dopamine replacement - Carbidopa-Levodopa (Sinemet) 2. MAO-B (selegiline); COMPT inhibitor (entacapone); Ergot (bromocriptine); anticholinergic - Benztropine (Cogentin) - anticholinergic

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Myasthenia Gravis - cholinergic agonists 1. Pyridostigmine (Mestinon) 2. Endrophonium (Tensilon)

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Alzheimers – cholinergic agonists; acetylcholinesterase inhibitors 1. donepezil (Aricept)

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Pain & Immune Modulators  Opioids – morphine; oxycodone; hydromorphone (Dilaudid); fentanyl (Sublimaze); meperidine (Demerol)  Non-opioids – acetaminophen (Tylenol); aspirin; ibuprofen (Advil)

IV. Respiratory System Drugs 

Anti-histamines – H1 receptor blockers – diphenhydramine (Benadryl); loradatine (Claritin)

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Decongestants – adrenergic agonists – pseudephedrine

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Antitussives – codeine; dextramethorphan ; benzonatate

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Expectorants – guaifenesin

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Asthma Drugs 1. Adrenergic agonist bronchodilators – albuterol; metaproterenol (Alupent); levabuterol (Xopenix) terbutaline. What’s the difference between selective and non-selective beta agonists?

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2. Anticholinergics – ipatropium 3. Methylxanthines – theophylline 4. Leukotriene receptor antagonists – montelukast (Singulair) 5. Corticosteroids – beclomethasone; triamcinolone; hydrocortisone; methylprednisolone 6. Mast Cell Stabilizer – cromolyn 7. Immune modulator – omalizumab (Xolair)

V. Cardiovascular System Drugs 

Positive Inotropes – digoxin; nesiritide; milrinone  Cardiac Glycosides - digoxin  Milrinone

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Anti-anginals – (Vasodilators)  Nitroglycerin

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Adrenergic Agonists - (“pressors”) – dobutamine; levophed; dopamine  Dobutamine

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Anti-hypertensives – Seven Classifications What’s the formula for blood pressure? 1. Andrenergic Agents (Agonists and Blockers)  Alpha 2 agonists (lonely alpha 2’s) ---methyldopa and clonidine 

Alpha 1 blockers (“sin’s”) – doxazosin, terazosin, tamsulosin

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Beta 1 and 2 blockers (“olol’s) – metoprolol; propranolol; carvidelol; nebivolol

2. ACE inhibitors (“pril’s”) – lisinopril 3. ARB’s (“sartan’s”) – losartan 4. Direct renin inhibitors - aliskerin 5. Calcium Channel Blockers (“pines” + Vera and Dil) – amlodipine; verapamil; diltiazem 6. Direct peripheral vasodilators - hydralazine 5

7. Diuretics – 5 classifications  Loop - furosemide

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Thiazides – hydrochlorothiazide

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Osmotics - mannitol

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Potassium sparing - spironolactone

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Carbonic anhydrase – acetazolamide

Coagulation Modifiers 1. Anti-coagulants - heparin; warfarin; enoxaparin; daltaparin; fondaparinux 2. Antiplatelets - aspirin; clopidrogel; anagrelide; dypridamole 3. Thrombolytics – alteplase

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Anti-Lipemics 1. HMG-CoA Reductase Inhibitors (Statins) – atorvastatin (Lipitor) 2. Bile Acid Sequestrants – cholestyramine; cholestipol; colesevelam 3. Fibric acid derivative – gemfibrozil (Lopid) 4. Nicotinic Acid - Niacin 5. Cholesterol Absorption Inhibitor – ezetimibe (Zetia)

VI. Endocrine System Drugs 

Pituitary Drugs  Growth hormone (somatropin- Humatrope) 

Growth hormone suppressant (octreotide – Sandostatin)

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Adrenocorticoptropic hormone (corticotropin – Acthar; cosyntropin – Cortrosyn)

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Antidiuretic hormone (desmopressin – DDAVP; vasopression – Pitressin)

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Thyroid stimulating hormone - (thyrotropin (Thyrogen)

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Thyroid  thyroid hormone (levothyroxine – Synthroid; Armour thyroid) 

radioactive Iodine (I-131);

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Propothiouracil (PTU)

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tapazole (Methimazole)

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calcitonin (Miacalcin)

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Parathyroid Drugs 1. Parathyroid Hormone – terapartide (Forteo – PTH) 2. Vitamin D Analogue - calcitriol (Rocatrol)

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Adrenal Drugs 1. Mineralcorticoid - fludrocortisone (Florinef) 2. Glucocorticoids (Deltasone – prednisone; Solu-Medrol-methyl-prednisolone) 3. Adrenal suppressant – aminoglutethimide

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Oral Anti-diabetic Drugs 1. Biguanides – metformin (Glucophage) 2. Sulfonylureas (“Glee club”) – glimepiride, glipizide, glyburide 3. Meglitinides (“Glee club cousin P.S.” – repaglinide (Prandin); nateglinide (Starlix) 4. Thiazolinediones – pioglitazone (Actos) 5. Alpha glucosidase inhibitors (starch blockers) - ascarbose (Precose) 6. DPP-IV inhibitors (“gliptans”) – sitagliptan (Januvia) 7. SGLT2 inhibitors (“gilfozin’s”) – dapciglifozin (Farxiga); canglifozin (Invokana) 8. Other – bromocriptine; coleselvelam

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Non-insulin Injectable Anti-diabetic Drugs 1. Amylin mimetics - pramlintide (Symlin) 2. Incretin mimetics - exanatide (Byetta) 3. GLP-agonist – liraglutide (Victoza)

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Insulin Injectables 1. Rapid – insulin lispro; insulin aspart; insulin glulisine 2. Short – regular (Novolin R; Humulin R) 3. Intermediate – NPH (Novolin N; Humulin N) 4. Long – detemir (Levemir); Glargine (Lantus)

 Blood Cell modifiers 1. Erythropoietin (Epogen; Procrit) 2. (Neupogen)

Gastrointestinal System Drugs 

Acid Controlling Drugs 1. Antacids (aluminum based - Amphojel; magnesium based- Milk of Mag; calcium based-Tums) 2. H2 inhibitors ( “dine’s”) cimetidine – Tagamet; ranitidine-Zantac; famotidine - Pepcid; 3. PPI’s (“zoles”) omeprazole – Prilosec; lansoprazole – Prevacid; pantoprazole - Protonix 4. Mucosal Protective – sucralfate (Carafate) 5. Prostaglandin Analogue - misoprotolol (Cytotec) 6. Anticholinergic (GI and GU indications) – propantheline (ProBanthine)

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Bowel Disorder Drugs 1. Laxatives a. Bulk forming – psyllium (Metamucil); methylcellulose (Citrucel) b. Stimulants / Irritants – bisacodyl (Dulcolax) c. Osmotics / Saline – lactulose; mag citrate d. Stool softeners – ducosate sodium e. Lubricants – mineral oil 2. Anti-diarrheals a. Opiates – codeine + diphenoxylate (Lomotil) b. Anticholinergics – belladonna + atropine c. Adsorbents – bismuth subsalicylate (Pepto Bismol) d. Prokinetics – lactobacillus acidophilus e. Stomatostatin analogues – octreotide (Sandostatin) 3. Crohns / Ulcerative Colitis – infliximab (Remicade)

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Anti-emetic and Anti-nausea Drugs 1. Anticholinergics- scopolamine 2. Antihistamines H1 blockers – dimenhydranate (Dramamine); meclizine (Antivert) 3. Dopaminergic antagonists – prochloperazine (Compazine); promethazine (Phenergan) 4. Prokinetics – metoclopramide (Reglan) 5. Serotonin antagonists – ondansetron (Zofran) 6. Tetrahydrocannabinoids – dronabinol (Marinol)

VII.

Men’s and Women’s Health Drugs Genitourinary System Drugs 

Vasodilators (erectile dysfunction) – tadalafil (Cialis); sildenafil (Viagra)

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Alpha 1 blockers (BPH) – tamsulosin (Flomax)

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Cholinergics-Muscarinics (“M3 makes you pee”) – bethanachol (Urocholinel)

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Anti-cholinergic (overactive bladder) – tolteradine (Detrol); oxybutynin (Ditropan)

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Local anesthesic – pyridium

Musculoskeletal System Drugs  Osteoporosis – o Biphosphonates – alendronate – Fosamax; risedronate - Actonel; ibandronate – Boniva; Zoledronic acid – Reclast ; Zometa (hypercalcemia) o

Biologic – denosumab (Prolia)

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Gout – allopurinol; cholchicine; probenicid

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Arthritis – Biologics (adalimumab – Humira; infliximab – Remicade; entanerecept – Enbrel)

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Arthritis – Non-biologics (methotrexate; NSAIDs – celecoxib (Celebrex); diclofenac (Voltaren); diflunisal (Dolobid); indomethacin (Indocin); Nabumetone (Relafen); piroxicam (Feldene)

Integumentary System Drugs 

istretonoin

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