PHARMACOLOGYACE Inhibitors [-pril] Commonly Used: Captopril, Enalapril, Fosinopril, Moexipril, Perindopril Lisinopril 20-40 mg/day Can cause HA, dizziness, fatigue, tachy Notify if taking diuretic!! Action: Any group of antihypertensive drugs that relax arteries and promote renal excretion of salt and water by inhibiting the activity of an angiotensin converting enzyme. Indications: Treat- HTN, CHF Lower risk of stroke and heart attack Side Effects: Postural hypotension (head rush; dizzy spell) Fatigue Loss of appetite N/V; diarrhea HyperK Insomnia Could exacerbate non-productive cough Angioedema Difference between ACE inhibitors and ARBs cough and hyperkalemia are not S/Es of ARBs Nursing Considerations/Education: Meds cause retention of K+ Hence, monitor electrolytes (watch for K) Elderly clients at highest risk for postural hypotension DO NOT abruptly discontinue meds rebound hypertension can occur Monitor BP frequently If take BP and is low, elevate pts legs by adjusting the bed and placing in Trendelenburg position Notify MD if dizziness persists Interactions/Contraindications Drug-Food Absorption if taken with food: Wait at least one hour after taking meds before eating Drug-Drug If pt taking diuretics, notify MD if on Lisinopril Contraindications If pt has impaired renal function be cautious Desirable Outcomes BP WNL Improved survival rates for pts suffering from acute MI workload on cardiovascular system or absence of chest pain

Alpha Blockers [-zosin] Commonly Used: Alfuzosin, Prazosin, Tamsulosin, Doxazosin, Silodosin, Terazosin, Reserpine (Serpasil) Action: Help relax certain muscles and help small blood vessels remain open. Work by keeping norepinephrine from tightening muscles in the walls of smaller arteries and veins. Indications: Treat- HTN, BPH, Raynauds Disease, Pheochromocytoma (Adrenal gland tumors) Side Effects: Expected: nausea, drowsiness, nasal congestion, wt. gain, edema Orthostatic hypotension, and sodium & water retention may occur Nursing Considerations/Education: Monitor: fluid retention, edema, BP When rising from bed, breathe slowly for a few minutes and rise slowly to avoid OH Typically NOT preferred as first tx option for high BP If BP difficult to control, alpha blockers may need to be combined with other drugs like diuretics Interactions/Contraindications Drug-Drug Avoid OTC meds Drug-Food Prazosin (Minipress) best time to take initial dose @ bedtime Decrease salt intake + foods include: banana, oatmeal Contraindications Tamsulosin should not be prescribed to pts with coronary atherosclerosis Desirable Outcomes Renal blood flow of pt will be correctly maintained Reduction in symptoms of BPH (noticeable) BP will be decreased within 15 minutes following oral administration in hypertensive pts

Angiotension II Inhibitors-ARBS [-sartan] Commonly Used: Candesartan, Eprosartan, Irbesartan, Losartan, Olmesartan, Telmisartan, Valsartan Brand names include- Diovan, Micardis, Benicar, Cozaar, Avapro, Teveten, Atacand Action: Block action of angiotensin II, allowing the blood vessels to widen, thus making it easier for the heart to pump blood Indications: Treats- HTN, CHF, Kidney Failure in Diabetes, Chronic Kidney Diseases, Scleroderma Side Effects: Expected- HA, Dizziness, lightheadedness, nasal congestion, vomiting & diarrhea, back & leg pain, Hyperkalemia, Angioedema, Dry Cough Nursing Considerations/Education Notify MD if edema occurs Do not stop taking drugs until DR is consulted Change positions slowly Watch for hypotension (may be reduction in fluid volume through excessive perspiration, dehydration, vomiting, & diarrhea) Have blood drawn for potassium levels Interactions/Contraindications Drug/Drug Drug/Food Contraindications PREGNANCY CATEGORY D-not to be taken by preg moms or if breastfeeding Caution in pts with hypovolemia, hepatic, or renal dysfunction Hold Telmisartan if menstruation delayed Desirable Outcomes Prevention and treatment of diabetic neuropathy Decrease in sodium & potassium retention Decrease in hearts workload Improvement in pts unable to tolerate ACE inhibitors

Antianginals [-nitrate] Commonly Used: Erythrityl Tetranitrate (Cardilate); Isosorbide Mononitrate (Imdur, Monoket); Isosorbide Dinitrate (Iso-Bid, Isordil, Isotrate, Sorbitrate); Nitroglycerine (NTG, Nitrostat, Nitrolingual); Nitroglycerine ointment 2% (Nitro-Bid, Nitrol, Nitrodisc, Transderm-Nito) Action: Relax smooth muscle, producing vasodilator effect on the peripheral veins and arteries with more prominent effects on the veins. Indications: Treats- Angina Controls- Perioperative BP Side Effects: HA, blurred vision & dry mouth; Postural hypotension; syncope; reflex tachycardia Nursing Considerations/Education: Sublingual Nitroglycerine Given for immediate response Can give clients 3 doses in every five minute intervals Avoid abrupt changes in posture Nitroglycerine patch Remove before defibrillation or cardioversion Prevent tolerance to nitrates: 12 hour no nitrate period Purpose of transdermal patch prevent chest pain, and allow pts to maintain ADLs Topical application is used for sustained protection against angina attacks Avoid contact with skin Report to MD: continuous headaches, blurred vision, or dried mouth Keep medicine a tightly closed, dark glass container to ensure potency Interactions/Contraindications Drug/Drug Drug/Food Contraindications Limit Alcohol: it will potentiate postural hypotension Desirable Outcomes Prevention of chest pains (d/t coronary artery disease) Acute relief of an attack of angina pectoris Decrease in demand of cardiac oxygen

Antidysrhytmics Commonly Used: Class I: Na Channel Blockers: Procainamide, Disopyramide (Norpace), Amiodarone, Quinidine Sulfate ( Quinidex) Uses: SVT, A. flutter, A. Fib, V tach Class I B: Mexiletine, Lidocaine (Xylocaine), Tocainide Class I C: Flecainide, Encainide, Propafenone Class II: Beta Blockers: Metoprolol, Atenolol, Propranolol, Timolol, Esmolol Short term use for ventricular dysrhythmias only Class III: K Channel Blockers: Sotaolol, Amiodarone, Bretylium, Ibutilide Uses: conversion of A. fib (oral), Recurrent V fib or V tach CI: PREG D; AV block, bradycardia, infants No grapefruit Class IV: Calcium Channel Blockers: Diltiazem, Verapamil Uses: A fib, A flutter, SVT Others: Atropine Sulfate Action: cardiac excitability and relay cardiac conduction in either the atrium or ventricle. Lastly, increase rate of repolarization. Indications: Treat- Ventricular dysrhythmia, Supraventricular dysrhythmia, Ventricular fibrillation, Atrial flutter, Bradycardias or PVCs related to slow HR Side Effects: Nursing Considerations/Education: Monitor: for dysrhythmias precipitated by treatment Hook pt up to cardiac monitor and assess for changes in rhythm Avoid giving IV injections rapidly Notify MD if joint pain and inflammation occur Apical pulse then BP If dry mouth can offer patients sugar free gum Interactions/Contraindications Drug/Drug DIG enhances cardiac depressant effects NEVER administer Lidocaine that has epinephrine in it; loading dose followed by maintenance dose of 1-4 mg/min Drug/Food Contraindications Disopyramide (Norpace) contraindicated for pts with CHF In patients with sinus or AV node blocks Desirable Outcomes Abnormal cardiac function will be corrected, and there will be a decrease in electrical conduction Clients may either have a increase or decrease in automaticity

Antiemetics [-setron] Commonly Used: Chlorpromazine hydrochloride (Thorazine), Promethazine (Phnergan), Prochlorperazine (Compazine), Thiethylperazine maleate (Toreacn), Hydroxyzine (Atarax, Vistaril), Dimenhydrinate (Dramamine, Marmine), Metoclopramide (Reglan), Aprepitant (Emend), Droperidol (Inapsine), Trimethbenzamide (Tigan), Dolasetron (Ansemet), Granisetron (Kytril), Ondasetron (Zofran) Action: Depress chemoreceptor trigger zone and vomiting center. Indications: Pt experiencing motion sickness, intractable hiccups, gastro esophageal reflux & gastroparesis (gastrointestinal hypomobility) Also used to prevent and treat postoperative nausea and vomiting. Also may be given as a prophylaxis of chemotherapy related emesis. Choice of antiemetic is determined by the cause of N/V Side Effects: expected- drowsiness or sedation, blurred vision, dry mouth, fatigue, constipation, and difficulty urinating. Pt may also become photosensitive. Nursing Considerations/Education: Limit odors in pts room Protect pt from injury SQ injections may cause tissue irritation & necrosis Discontinue med if pt exhibits uncontrolled rhythmic movements of face or limbs or blurred vision Interactions/Contraindications Drug/Drug Drug/Food Limit oral intake to clear liquids when nauseated and or vomiting Contraindications Droperidol should be administered in extreme caution in presence of prolonged QT syndrome Desirable Outcomes Pt will have control (& prevention) of vomiting, decrease in gastrointestinal secretions and motility, and they may inhibit secretion of saliva and sweat.

Antifungals [-nazole] Commonly Used: Amphotericin B (Fungizone), Clotrimazole (Lotrimin, Gyne-Lotrimin), Fluconazole (Diflucan), Griseofulvin (Fulvicin), Ketoconazole (Nizoral), Terconazole (Terazol) Metronidazole (Flagyl), Miconazole (Micatin, Monistat3), Nystatin (Mycolog), Oxiconazole (Oxistat) Action: Usually destroy fungi and inhibit fungal growth Indications: Treat- vaginal fungal infections, candidiasis, dermal infections, tinea infections, diaper dermatitis, and scaling due to dandruff Acyclovir- Herpes simplex type I Side Effects: Nausea, vomiting, HA, vaginal irritation, erythema, peeling, pruritus & urticarial, hepatotoxicity Nursing Considerations/Education: Can be orally taken or topically applied Urine may turn red/brown when taking Flagyl Monitor Creatinine levels when administering Amphotericin B Avoid exposure to sun med increases photosensitivity Creams are not recommended to use with tampons or diaphragms Avoid contact with eyes, nose, mouth, and do not swallow Return to MD if no results are obtained after 4 weeks of tx Monitor for hypersensitivity Interactions/Contraindications Drug/Drug Drug/Food Take Griseofulvin with foods high in fat (ex. Milk or ice cream) to decrease GI upset and assist in absorption Contraindications Avoid alcohol during tx Desirable Outcomes Disruption of fungal cell mitosis Alteration of permeability of fungal cell membrane Fungistatic and fungicidal in vitro against a wide variety of yeast and yeast like fungi

Antibiotics Commonly Used: Penicillin V (PEN VEE K), Amoxicillin (amoxil), Clarithromycin (Biaxin) and Azithromycin (Zithromax) Gentamycin (Garamycin), Amikacin (amikin), Ceftazidime (Fortaz), Cefepime (Maxipime), Ciprofloxacin (Cipro), Moxifloxacin (Avelox), Trtracycline (Achromycin), Doxycycline (Vibramycin) Prefixes: Floroquinolones floxacin Cephalosporins often start with cef or ceph Action: Inhibit bacterial DNA, inhibit protein synthesis, interfere with formation of bacterial cell wall Indications: Treat- skin/skin structure infection, respiratory tract infections, gonococcal and community or hospital acquired infections. Also in cases of meningitis, and as surgical prophylaxis and inhalation of anthrax Side Effects: HA, hypotension, and skin rash. Photosensitivity. May have signs of pain and tenderness and injection site. Hearing loss is irreversible. Assess peak and trough levels to determine toxic levels Nursing Considerations/Education: It is better to start with first generation antibiotic classes as to prevent development of resistance Minimize using higher generation in less severe infections and in those in which risk factors for multidrug resistance are not present Take blood cultures BEFORE starting antibiotics Assess for ototoxicity (change in hearing, ringing inears, dizziness, or unsteady gait) Assess for nephrotoxicity (Monitor BUN and Creatinine) Avoid direct or artificial sunlight Interactions/Contraindications Drug/Drug Dilute solution and administer slowly to decrease phlebitis on IV site If present, discontinue IV and put warm ice packs on IV site Drug/Food Drink 2-3 L of fluid daily Absorption is reduced by milk products and antacids Take oral Doxycycline with food Contraindications Fluoroquinolones contraindicated with pt with epilepsy, QT prolongation, pre-exisiting CNS lesions, CNS inflammation, or suffered a stroke Desirable Outcomes Negative bacterial result on culture and negative infection post-opAMINOGLYCOSIDES1. Think A mean old mycin2. Powerful antibioticsto treat severe, life-threatening, resistant infections3. All aminoglycosides end in mycin, but not all drugs that end in mycin are aminoglycosides. For example..a. Azithromycin, clarithromycin, erythromycin thromycin NOT4. Examples of aminoglycosides: Streptomycin, Cleomycin, Tobramycin, Gentamicin, Vancomycin, Clindamycin5. Toxic Effects: a. The most famous feature of the worlds most famous mouse (ears)i. Toxic effect: ototoxicityii. Must monitor hearing, balance, tinnitusb. The human ear is shaped like a kidneyi. Toxic effect: nephrotoxicityii. Monitor: creatinine1. Best indicator of kidney function2. 0.6-1.2 mg/dLc. The number 8 drawn inside the ear reminds you of:i. Cranial nerve 8 (Drug toxic to)ii. Frequency of administration: Every 8 hours6. Route of Administrationa. Give IM or IVb. Do not give PO (not absorbed) except in these two cases:i. Hepatic encephalopathy1. Also called Liver Coma, Ammonia-Induced Encephalopathy2. When want a sterile bowel3. Due to a high ammonia levelii. Pre-op Bowel surgery1. REMEMBER this military sound off:a. NEOmycinb. KANmycinc. WHO CAN STERILIZE MY BOWEL? NEO KANd. ^ PO, 2 bowel sterilizers7. Trough and Peak Levelsa. Reason for drawing TAP levels: narrow therapeutic rangeb. Time table:ROUTETROUGH (lowest)PEAK (highest)

Sublingual30 min before next dose5-10 mins after drug dissolve

IV30 min before next dose15-30 min after drug finished

IM30 min before next dose30-60 min after drug given

SQ30 min before next doseSee diabetes lecture

PO30 min before next doseForget about it.

DrugsUse & DosageIndicationSide Effects/AdverseTeaching & LabsContraindication

CIPROFLOXACINANTHRAX

Anticoagulants [-parin] Commonly Used: Heparin, Enoxaparin (Lovenox), Dalteparin sodium (Fragmin), Warfarin sodium (Coumadin) Action: Inactivate or decrease synthesis of clotting factors Indications: Treat- thrombosis, pulmonary embolism, atrial fibrillation, MI Side Effects: Bleeding gums, hypotension, hematuria, epistaxis, thrombocytopenia, hemorrhagic tendency Nursing Considerations/Education: Heparin Antidote- Protamine sulfate Warfarin Antidote- Vitamin K Consult with physician before taking vitamins INR and protime monitored weekly Dont take herbal meds When administering med SQ NEVER rub injection site Observe signs of bleeding, and instruct pt what not and what to do to prevent bleeding Interactions/Contraindications Drug/Drug Women using oral contraceptives, anticoagulants may decrease effectiveness if taken together Drug/Food Contraindications NOT RECOMMENDED FOR PREGNANT AND LACTATING WOMEN Desirable Outcomes Prolonged PT time Prevention of new thrombus formation Reduction of risk of heart attack and stroke

Antidepressants Commonly Used: MAOIs: Isocaraboxazid (Marplan), Phenelzine sulfate (Nardil), Tranylcypromine sulfate (Parnate) TCAs: [-tyline] [-pramine]; Notriptyline hydrochloride (Aventyl), Imipramine hydrochloride (Toftranil), Amitriptyline hydrochloride (Elavil) Bupropion (Wellbutrin and Zyban), Doxepin hydrochloride (Sinequan) SSRIs: Fluoxetine (Prozac), Sertraline hydrochloride (Zoloft), Paroxetine hydrochloride (Paxil), Fluvoxamine (Luvox), Venlafaxine (Effexor) Action: MAOIs: TCAs: SSRIs: increase extracellular level of serotonin Indications: treat- Depression; also pts with OCD, Bulimia, and Enuresis (in children) Tx enuresisTCA Imipramine hydricgkirude (Tofranil) Side Effects: H/A, nausea, restlessness, photosensitivity, anticholinergic effects Adverse: seizures SSRIs & MAOIs huge tendency to develop insomnia TCAs may have feelings of sedation Nursing Considerations/Education: May take 2- weeks after start of tx for med to have response SSRI & MAOI Take in morning TCA No activities that require alertness Discontinuing: No not abruptly discontinue Before surgery bc may have adverse interactions with anesthetics Interactions/Contraindications Drug/Drug Drug/Food Avoid alcoholic beverages, foosd that require bacteria or molds for their prep, or foods that contain tyramine MAOIs Avoid TYRAMINE! [aged cheeses, beer, avocados] Could cause severe hypertensive crisis which will then cause BP as well as PR and temperature and could cause tremors Contraindications Desirable Outcomes Symptoms of depression being controlled Reduction of seizure threshold Obese clients appetite may be suppressed

Antihistamines Commonly Used: Benadryl (Diphenhydramine) Promethazine hydrochloride (Phenergan), Hydroxyzine hydrochloride (Vistaril, Atarax), Cetirizine (Zyrtec, Fexofenadine (Allegra), Fluticasone (Flonase, Flovent), Triamcinolone (Nasacort) Action: Block histamine receptor sites and control protein synthesis and prevent inflammation Indications: Treat- allergy symptoms, cure congestion, otitis media, motion sickness, & urticarial Should not be used in treatment of asthma Benedryl topical- urticaria Side Effects: Expected- drowsiness, dizziness Watch for signs of urinary retention, constipation, & hypotension blurred vision, dry mouth, & GI irritation Children may exhibit paradoxical reaction Nursing Considerations/Education: Always should be taken in moderation Take 30 mins before an event that will trigger motion sickness Candy or ice chips for dry mouth could also help with condition of pt Avoid SC injection and administer IM meds in a large muscle to prevent tissue irritation Monitor for signs of urinary dysfunction Give IM Diphenhydramine for allergy using 1.4 mg using gauge 22 needle Interactions/Contraindications Drug/Drug Drug/Food Administer one hour prior to eating (Benadryl) Contraindications DO NOT take with alcohol Desirable Outcomes Decrease in symptoms of histamine excess and decreas in post op nausea Aid in sleeping Potentiated effect of preop narcoticsBeta-Adrenergic Blockers [-lol] Commonly Used: Metoprolol (Lopressor), Atenolol (Tenormin), Propranolol (Inderal), Nadolol (Corgard), Carvedilol (Coreg), Esmolol (Brevibloc) Action: Decreases cardiac workload, decrease myocardial o2 consumption Indications: Treat- Angina, dysrhythmias, HTN, & migraine headaches Also recommended for tx of glaucoma & acute MI Side Effects: Usual- N/V, hyperglycemia, hypotension, and depression. Bradycardia, bronchospasm Agranulocytosis (Low WBC) Propranolol diminished sexual function Metoprolol frequent side effect: Impotence Nursing Considerations/Education: Monitor for signs of CHF If observed that pulse of BP is not WNL HOLD MEDS! Monitor signs of hypotension if displaying orthostatic hypotension change their positions slowly Assess any respiratory distress and signs of wheezing & dyspnea If patient on insulin, instruct pt to monitor BGM levels DO NOT stop taking abruptly bc can cause rebound hypertension, rebound tachy, or an angina attack can occur Evidence of pt building drug tolerance gradual increase in BP Interactions/Contraindications Drug/Drug Drug/Food Avoid grapefruit juice while on antihypertensives as it increases the level of the medicine in the blood Contraindications COPD pts not advised to take beta blockers Desirable Outcomes Decrease in BP and HR Decrease in occurrence of chest painCalcium Channel Blockers [dipine] Commonly Used: Amlodipine, Verapamil, Nifedipine, Diltiazem, Felosipine, & Nicardipine Action: blocks calcium channel receptors which causes decrease in cardiac contracility Indications: Cure- HTN, Dysrhythmias, Chronic Stable Angina Side Effects: Headache, Hypotension, Bradycardia Nursing Considerations/Education: Monitor pt for signs of CHF, liver enzymes and kidney function tests Monitor patient with cardiac monitor when administering med Assess peripheral edema and weight gain Teach pt to monitor pulse daily DO NOT chew or crush sustained release tablets Notify MD ASAP if dizziness or fainting occurs Keep fast acting nitrateson in hand in case of acute attacks Interactions/Contraindications Drug/Drug Drug/Food If taking antihypertensives DO NOT drink GRAPEFRUIT JUICE bc increases level of medicine in blood Contraindications Desirable Outcomes Correction of abnormal heart rhythm, decrease in occurrence of chest pain, HR, & BP

Antiplatelets Commonly Used: Aspirin, Clopidogrel (Plavix), Pentoxifylline (Trental), Cilostazol (Pletal), Ticlopidine (Ticlid) Action: Inhibits the aggregation of platelets in the blotting process and prevents thrombus formation. Therefore, they prolong the bleeding time of pts. Indications: CVA, MI, RHD, Pericarditis, Pulmonary Embolism, Acute Coronary Syndrome, and pts with DVT Side Effects: Common- bruising, hematuria, GI bleeding & neutropenia. Some pts may have tarry stools Adverse- abdominal pain Nursing Considerations/Education: Instruct to take measures to prevent bleeding, and if bleeding occurs, monitor the time of occurrences. Use of electric razor If patient took entire aspirin bottle get ABG resultd Interactions/Contraindications Drug/Drug Do not take OTC meds containing aspirin or NSAIDS without consulting DR Drug/Food Always give with food or antacids to minimize GI upset Contraindications Pts with a history of peptic ulcers Desirable Outcomes Prevention of: Stroke, MI, and vascular death (after recent attack) Relief of intermittent claudication in lower extremities (legs)

Benzodiazepines [-zolam] [-zepam] Commonly Used: Alprazolam (Xanax), Midazolam (Versed); Clonazepam (Klonopin), Diazepam (Valium), Oxazepam (Serax) & Lorazepam (Ativan) Others- chlordiazepoxide (Librium), Zolpidem (Ambien), Buspirone (Bu Spar), Eszopiclone (Lunesta) Action: Depress the CNS of a pt and produce relaxation with could cause depression of the limbic system Indications: Anxiety, tension, muscle spasms. May also be prescribed for acute alcohol withdrawal and as preoperative med Side Effects: Hypotension, urinary incontinence, constipation, slurred speech, blurred or double vision. Some pts could have amnesia, tremor, and ataxis. Most pts have signs of daytime sedation Intoxication- somnolence, confusion, and diminished reflexes to coma Flumazenil (Romazicon) IV reverses toxicity in 5 mins Nursing Considerations/Education: Monitor liver and renal function tests and blood counts Assess for symptoms of leukopenia (sore throat, fever, weakness) Avoid tasks that require mental alertness Physical dependency commonly develops Tapered gradually over 2-6 weeks to lessen withdrawal symptoms Med is anticonvulsant drug Interactions/Contraindications Drug/Drug Do NOT mix Librium or Valium with any other drug or IV fluidinject directly into a vein over a 1 minute period Drug/Food Zolpidem (Ambien) full glass of water on empty stomach Contraindications Not meant to be taken if breast feeding Desirable Outcomes Anxiety level will be reduced Muscles will be relaxed and could have a sedative-hypnotic feelingCardiac Glycosides Commonly Used: Digoxin (Lanoxin) & Digitoxin (Crystodigin) Action: produce positive inotropic action that increases the force of myocardial contraction by decreasing the conduction of the impulses through the AV node Indications: Supraventricular tachy, CHF, A. Fib, A. Flutter Side Effects: Anorexia, N/V, Visual Disturbances, Fatigue, Drug-indced dysrhythmias, photophobia Dig Intoxication: Nursing Considerations/Education: Monitor pt for cardiac abnormalities such as PVs. Assess for an apical pulse greater than 60 before administering these meds Contact physician immediately for apical pulses less than 60, signs of confusion, or abnormal Dig levels Hold med if apical HR is less than 60 for an adult and less than 90 for a child Pt vomits more than twice, Hold next dose of Lanoxin and notify MD Interactions/Contraindications Drug/Drug Therapeutic Drug Levels: (0.8-2.0) S/S Toxicity: Antidote: Digoxin immune FAB (Digibind) Quinidine & Verapamil both increase plasma levels of Digitalis Drug/Food Diet: low-salt diet & a potassium supplement Dont mix meds with food or antacids Contraindications Desirable Outcomes Decreased conduction of the heart cells Increases cardiac output and blood flow to the kidneys Change to normal sinus rhythm

Diuretics: Water Pills Commonly Used: Loop Diuretics Furosemide (Lasix), Torsemide (Demdex), & Bumetanid (Bumex) Thiazide Diuretics [-thiazide] Only should be used in pts with normal renal functions Chlorothiazide (Diuri), Methylchothiazide (Aquatensen; Enduron), & Hydrochlorothiazide (HydroDIURIL; Esidrix) Osmotic Diuretics Mannitol (Osmitrol) & Urea (Ureaohil) Prolonged use of Mannitol can cause metabolic acidosis Potassium Sparing Diuretics Spirinolactone (Aldactone), Triamterene (Dyrenium), & Amiloride (Midamor) Carbonic Anhydrase Inhibitors Action: Rid bodys water and sodium Indications: HTN, Glaucoma, Edema, Hypercalcemia, Hepatic cirrhosis, Renal disease Side Effects: Common- dehydration Hypokalemia, orthostatic hypotension, hyponatremia, hyperglycemia Mannitol- pulmonary edema Nursing Considerations/Education: Always administer in the MORNING Maintain rehydration efforts Monitor potassium levels (hypokalemia) Monitor for orthostatic hypotension Monitor BP & Food intake and output Daily weights Interactions/Contraindications Drug/Drug Cautious in pts taking Digoxin & Lithium Drug/Food Contraindications Thiazide- Only to be used in pts with NORMAL KIDNEY FUNCTION Prolonged use of Mannitol can cause metabolic acidosis Desirable Outcomes Relief of congestion Maintenance of Acid Base imbalances Restore volume status of pts Pt will have diuresis Prevention of sodium, K, or chloride reabsorption

HIV & Anti Agents Commonly Used: Non-Nucleoside Reverse Transcriptase Inhibitors or NNRTIs Nevirapine (Viramune), Delavirdine (Rescriptor) & Efavirenz (Sustiva) Nucleoside Reverse Transcriptase Inhibitors or NRTIs Abacavir (Ziagen), Stavudine (Zerit) & Didanosine (Videx) Protease Inhibitors Sawuinavir (Fortovase & Invirase), Indinavir (Crixivan) & Nelfinavir (Viracept) Fusion Inhibitors Enfuvirtide (Fuzeon) Action: see outcomes Indications: Do not cure AIDS or reduce risk of transmission Side Effects: rashes, diarrhea, V/ anemia, neutropenia, peripheral neuropathy, liver damage and lipodystrophy, GI discomfort Nursing Considerations/Education: When injecting Enfuvirtide pt should use insulin syringe to decrease the reaction of this drug CD4 count & viral load should be regularly tested Avoid exposure to infection Always wash hands on regular basis Report any sore throat, fever, or other gins of infection directly to me or MD Take medication same time each day bc it will maintain consistency in blood level If pt taking Lopinavir (Kaletra) discontinue if serum amylase significantly elevated Interactions/Contraindications Drug/Drug Drug/Food If pt taking Invirase & Crixivan instruct to eat foods high in fat Take food when taking prescribed meds except in drugs like Videx and Agenerase. Contraindications Desirable Outcomes Prevent HIV from multiplying & destroying infection fighting CD4 cells Prevention of infection Prevention of HIV advancing to AIDS

Insulins Commonly Used: Rapid Acting Insulin Lispro (Humalog), Aspart (Novolog) Short Acting Insulin Regular insulins- Humulin R & Novolin R Immediate Acting Insulin Humulin NPH & Lente (Novolin L) Long Acting Insulin Ultralente (Humulin U) Very Long Acting insulin Glargine (Lantus) Never mix Lantus with other insulins Premixed Insulin Primarily a combo of different categories NPH 70% & Regular 30% (Humulin 70/30) NPH 75% & Lispro 25% (Humalog Mix 75/25)

Action: facilitates transport of glucose, potassium, and magnesium into muscle and fat cells Indications: Prescribed to treat DM Type I and II Side Effects: hypoglycemia, HA, blurred vision, wt. gain, skin reactions, lipodystrophy Hypoglycemia: cold, clammy, sweating Nursing Considerations/Education: When drawing upREGULAR before LONG-ACTING (Clear before Cloudy) Administering insulin IV Never cleanse skin with alcohol before injection Rotate injection sites to prevent lipodystrophy Regular insulin is the only type of insulin that can be administered IV Do NOT shake insulin bottles before use Do NOT administer cold insulin Interactions/Contraindications Drug/Drug Never mix Lantus with other Insulins Drug/Food Short Acting take 20-30 mins before eating meals Rapid Acting advise client to eat immediately after administering med Contraindications Desirable Outcomes Decrease in serum glucose Diabetic condition maintained and controlled

Oral Hypoglycemic Commonly Used: Sulfonylureas Chlorpropamide (Diabinase) Tolbutamide (Orinase) Orinase can cause Disulfiram type of rx when alcohol is ingested Biguanide Metformin (Glucophage) Alpha Glucosidase Inhibitor Acarbase (Precose) CI: IBS Miglitol (Glyset) Thiazolidinediones Pioglitazone (Actos) Rosiglitazone (Avandia) Meglitinides Nateglinide (Starlix) Repaglinide (Prandin) Action: stimulate beta cells which help our body to secrete more insulin Indications: Treat DM type II Side Effects: jaundice, hypoglycemia, GI disturbance, & edema; skin reactions; dizziness, nausea, wt. gain Nursing Considerations/Education: Monitor: Liver function tests **Compliance Avoid OTCs unless prescribed by DR Interactions/Contraindications Drug/Drug Interactions: CCB, OC, Glucocorticoids, Phenothiazines, & Thiazide Diuretics Drug/Food Take with meals; eat before taking Contraindications Desirable Outcomes BGM will be WNL & Hyperglycemia will be controlled

NSAIDS Commonly Used: Acetylsalicylic acid (Aspirin, ASA) Most common agent responsible for accidental poisoning in small children Discontinue 3-7 days prior to surgery Ibuprofen (Advil, Motrin) Fenoprofen (Nalfron) Naproxen (Naprosyn) Acetaminophen (Tylenol, Tempra) Overdose agent Acetylcysteine Diclofenac (Voltaren) Action: used as analgesic, antipyretic & anticoagulant drugs. Also inhibit prostaglandin synthesis Indications: Treat diseases like RA, bursitis, osteoarthritis, and tendinitis. Also used for pain, fever, headaches Side Effects: Salicylism, Tinnitus, Gastric irritation, Dizziness, Rash, Dermatitis, Erosive gastritis with bleding, Hypotension, Blood dyscrasias, Sodium and water retention Nursing Considerations/Education: Monitor bleeding tendencies of pts Monitor for toxicity (especially if taking with CCB) If overdose suspected contact poison control center (1-800-222-1222) Interactions/Contraindications Drug/Drug Do NOT give to pt on Anticoagulant Monitor for toxicity (especially if taking with CCB) Drug/Food Take NSAID with water, milk or food. Should not take on empty stomach Contraindications Do NOT give to pts with liver or renal diseases Do NOT give to children with flu symptoms bc of risk of Reyes syndrome Do NOT crush or cut enteric-coated forms Desirable Outcomes Relief of pain due to reduction in pain intensity Fever reduction and swelling reduction

Opioid Commonly Used: Hydrocodone (Vicodin), Hydromorphone (Dilaudid), Oxycodone (OxyContin, Percocet), Meperidine hydrochloride (Demerol), Methadone, Morphine sulfate Action: reduces intensity of pain signals reaching the brain; block the action of opioids assisting in withdrawal and also help suppress peristalsis Indications: acute or chronic pain; sometimes diarrhea; withdrawal Side Effects: itching, muscle rigidity, NV, euphoria, apathy and impaired judgement Sedation, cough suppression, paralytic ileus, respiratory depression & constriction of pupils Overdose can lead to: coma, respiratory depression, and death Methadone- watch for signs of respiratory depression & toxicity Nursing Considerations/Education: OD antidote- Narcan (Demerol) 50 mg through IM No activities that require mental alertness Do not stop taking abruptly Be aware of drug tolerance in pts Increase fluid intake Interactions/Contraindications Drug/Drug Drug/Food Contraindications Do not use if pregnant Desirable Outcomes

Proton Pump Inhibitors [-prazole] Commonly Used: Omeprazole (Prilosec) In combination with antibiotic (such as Clarithromycin- Biaxom)- treat pts with Helicobacter pyori infection in duodenal ulcer Lansoprazole (Prevacid) Sprinkle granules over food. Do not chew granules Esomeprazole (Nexium)-inhibits secretion of hydrochloric acid Pantoprazole (Protonix) Action: suppresses gastric acid secretion Indications: Dyspepsia, Heart Burn Side Effects: HA, dizziness, abdominal pain. Diarrhea, rashes. Nursing Considerations/Education: Never crush or chew meds, never open capsules Interactions/Contraindications Drug/Drug Drug/Food Take drugs before eating (30 mins) Contraindications Desirable Outcomes Decrease in esophageal reflux

Respiratory Commonly Used: Bronchodilators Action: relax smooth muscles of the bronchi, reducing airway resistance Indications: treat diseases like acute & chronic asthma, bronchitis, & COPD Common: Epinephrine (Adrenaline) Theophylline (Theodur) Increases risk of Dig Toxicity Decreases effects of Lithium & Phenytoin Albuterol (Proventil & Ventolin) Ipatropium bromid (Atrovent) Side Effects: Nursing Considerations/Education: Interactions/Contraindications Drug/Drug Drug/Food Contraindications Desirable Outcomes Anti-Tubercular Action: broad spectrum antibiotic, specific to TB Bacillii Indications: treat Pulmonary Tuberculosis & Extrapulmonary Tuberculosis Common: Isoniazid (INH) Combine with Vitamin B6 (Pyridoxine) to prevent peripheral neuritis S/E: peripheral neuritis Rifampicin (Rifadin) Orange body secretions Ethambutol (EMG & Myambutol) Pyrazinamide (PZA & Fibrazid) Side Effects: Hepatotoxicity Nursing Considerations/Education: Monitor Liver Function Interactions/Contraindications Drug/Drug Drug/Food Contraindications Desirable Outcomes If drug has taken effect, pt will no longer be contagious when sputum culture is negative Decongestant Action: produce constriction of dilated arterioles. Pts taking decongestants will have short relief of nasal congestion Indications: short relief of nasal congestion; treating allergic rhinitis, hay fever, & acute coryza Common: Ephedrine HCL (Bronkotabs & Tedral) Phenylephrine (Neo-Synephrine) Oxymetazoline (Afrin) Side Effects: Nursing Considerations/Education: Interactions/Contraindications Drug/Drug Drug/Food Contraindications Desirable Outcomes Overall for Respiratory Meds Monitor patient for cardiac dysrhythmias and blood levels of meds Provide client with adequate hydration If using MDI gargle after each dose and use a spacer to decrease candidiasis S/E for pt using MDI: oropharyngeal candidiasis Instruct pt NOT TO TAKE OTC MEDS WHERE EPHEDRINE IS A COMMON INGREDIANT Evaluate meds if using OTC drugs as home remedies General side effects: Headache, HTN, Tremors, Dysrhythmias, Palpitation & tachycardia, Gastric upset, Optic neuritis, Anxiety, Insomnia, Dry mouth (if using inhaler)

Statins (HMG-CoA Reductase Inhibitors) [-statin] Commonly Used: Atorvastatin (Lipitor) Lovastatin (Mevacor) Highly protein bound and should not be administered with anticoagulant Need SGPT levels monitored regularly Simvastatin (Zocor) Inhibits hepatic synthesis of cholesterol Pravastatin (Pravachol) Fluvastatin (Lescol) Rosuvastatin (Crestor) Action: LDL cholesterol; usually do not LDL Indications: Treat- hyperlipidemia, dyslipidemia, & hypercholesterolemia Side Effects: nausea, HA, blurred vision, muscle pain Rashing, flushing, GI disturbances Elevated liver enzymes, hyperglycemia, hyperuricemia Nursing Considerations/Education: Monitor liver enzymes, BGM, BUN Assess and monitor for increase in muscle pain and liver enzyme Annual eye exam should be facilitated as so to monitor the formation of cataract Interactions/Contraindications Drug/Drug Drug/Food Take with evening meal Contraindications Never give to pt w preexisting gallbladder disease Desirable Outcomes Reduction of the risk of CAD Reduction of risk (& reoccurrence) of stroke

Thrombolytics Commonly Used: Alteplase (t-PA, Activase) Streptokinase (Streptase, Kabikinase) Reteplase (Retavase) Urokinase (Abbokinase) Action: converts plasminogen to plasmin to begin fibrinolysis. Used to bind fibrin in a thrombus and initiate fibrinolysis Indications: treat acute MI, central venous catheter clearance, acute pulmonary embolism, DVT Side Effects: Bleeding, dysrhythmias, fever, allergic reactions, and hypotension Nursing Considerations/Education: Antidote for thrombolytic OD: Aminocaproic acid (Amicar) Used only in acute, life-threatening conditions Obtain baseline V/Ss & Coagulation studies Meds must be infused through IV infusion pump Monitor for neuro changes and all secretions for occult blood Apply direct pressure over venipuncture site for 20-30 mins Instruct pt to use electric razor for shaving and to brush teeth gently Interactions/Contraindications Drug/Drug Drug/Food Contraindications CI in patients with: active internal bleeding, uncontrolled HTN, hx of hepatic disease, renal disease, CVA, intracranial problems, surgery or trauma Desirable Outcomes Blood flow will be restored and emboli will be dissolved

Vasopressors Commonly Used: Dopamine (Intropin) Dobutamine (Dobutrex) Inamrinone (Inocor) Epinephrine hydrochloride (Adrenalin) Norepinephrine (Levophed) Isoproterenol (Isuprel) Action: cause vasoconstriction of the blood vessels so as to increase BP & myocardial contractility, stroke volume, and cardiac output. Also used to enhance renal blood flow. Indications: Anaphylactic shock & cardiac arrest. Some pts with asthma Side Effects: angina, restlessness, tachy, dysrhythmias Urgency, urinary incontinence Nursing Considerations/Education: Monitor pts UO Normal urine output 30-40 ml/hr Monitor V/S, lung sounds, ECG Must administer these drugs through a large vein If extravasation occurs STOP infusion immediately and infuse area with alpha adrenergic antagonist Phentolamine (Regitine) Interactions/Contraindications Drug/Drug Drug/Food Contraindications Do not give to pts with tachydysrhythmias or ventricular fibrillation Desirable Outcomes

Ophthalmic Mydriatics Common Atropine (Isopto Atropine) Toxicity can produce dry mouth, hallucinations, HA, fever, and urinary retention or constipation which can worsen narrow-angle glaucoma Homatropine (Isopto Homatropine) Tropicamide (Mydriacyl) Cyclopentolate (Cyclogyl) Phenylephrine (Mydfrin) Action: Block response of sphincter muscle of iris, causing pupillary dilatation Indication: Preoperative for eye surgeries and during eye exams Side Effects: tachy, dermatitis, conjunctivitis. Photosensitivity. Interactions/Contraindications Drug/Drug Drug/Food Contraindications: Patients with glaucoma, cardiac dysrhythmias, and cerebral atherosclerosis. Caution in elerly pts and those with prostatic hypertrophy, DM, and Parkinsonism Desired Outcomes: Mydriasis (pupillary dilatation) Cylopegia (relaxation of ciliary muscles) Miotics Common Pilocarpine hydrochloride (IsoptoCarpine, Pilocar) Carbachol (Miostat, Isoptocarbachol) Acetylcholine chloride (Miochol) Pilocarpine nitrate (Pilofrin, Pilagan) Isoflurophate (Floropryl) Action: contract ciliary muscle, causing pupillary constriction. Indications: Used to treat chronic open-angle and closed-angle glaucoma and miosis during eye surgeries. Side Effects: HA, decreased vision in poor lighting, local irritation, and eye pain. Some pts also may develop myopia Miotic toxicity can produce vertigo and syncope, cardiac dysrhythmias, hypotension, tremors, or seizures Interactions/Contraindications Drug/Drug Drug/Food Contraindications: Pts with retinal detachment, adhesions between the iris and lens, or inflammatory diseases. Use in caution in pts with asthma, HTN, corneal abrasion, hyperthyroidism, coronary vascular disease, UTI, GI obstruction, ulcer diseases, Parkinsonism, and bradycardia Desirable Outcomes Reduction in intraocular pressure and increase in the outflow of aqueous humorOverall Nursing Considerations/Education: In administering eye drops: OS: Left Eye OU: Both Eyes OD: Right Eye Monitor for toxic/side effects and allergic response and report eye pain to DR Instruct pt to apply punctual occlusion to the lacrimal duct during and immediately after instillation of drops to decrease systemic absorption Tell pts to avoid driving or operating heavy machinery 24 hours after instillation of meds, unless otherwise allowed by DR

OTC Remedies Commonly Used: Ibuprofen (Advil, Midol, Motrin) Pain and Fever Loratadine (Claritin) Runny nose and itchiness Bisacodyl (Dulcolax) commonly used for constipation Ranitidine (Zantac) Heartburn Drug taken best at night to suppress acid reduction Bismuth Subsalicylate (Pepto-Bismol) most pts use for diarrhea, nausea, and upset stomach Aluminum Hydroxide (Gaviscon, Maalox) heartburn and upset stomach Benzocaine (Orajel) toothache Acetaminophen (Tylenol) pain or fever Watch out for Reyes Syndrome if changes in behavior with N/V occur, and immediately consult with DR Bilirubin labs Side Effects: rashes and itchiness, dizziness, N/V, diarrhea, constipation, drowsiness (especially with cold medicines), heart burn, and respiratory depression Nursing Considerations/Education: Interactions/Contraindications Drug/Drug Drug/Food Contraindications Desirable Outcomes

Herbal Remedies Action: alternative plant derived meds to provide relief of symptoms of diseases Commonly Used: Aloe Indications: topical skin ailment; constipation Side Effects: abdominal pain, diarrhea Black Cohosh Indications: Premenstrual syndrome (PMS); Acne; Osteoporosis Side Effects: Upset stomach, HA, Vaginal spotting or bleeding, Wt. gain Echinacea Indications: Suppresses inflammation Side Effects: Fever, N/V Feverfew Indications: Migraine, fever, suppresses inflammation Side Effects: nervousness and insomnia, heartburn, diarrhea or constipation, N/V Garlic Indications: HTN, Hyperlipidemia, Atherosclerosis Side Effects: Heartburn, N/V, Diarrhea Ginger Indications: Motion sickness, diarrhea, osteoarthritis Side Effects: Heartburn, stomach upset Ginkgo Biloba Indications: Impotence, Impaired circulation, Weak memory Side Effects: stomach upset, HA, bleeding Goldenseal Indications: Bacterial, fungal, and protozoal infections Side Effects: Ureterotonic Kava Indications: Anxiety, insomnia, muscle relaxant Side Effects: CNS damage, liver damage, skin problems Can exacerbate Parkinsons disease CI: patients taking antipsychotics, benzodiazepines, and barbiturates Ma huang/Ephedra Indications: bronchospasms, obesity Side Effects: agitation and palpitations, HTN, insomnia St. Johns Wort Indications: Depression Side Effects: GI disturbance, fatigue, dizziness, dry mouth, photosensitivity CI: patients taking antidepressants Saw palmetto Indications: BPH, cough, asthma Side Effects: Mild GI upset, HA Valerian Indications: Insomnia Side Effects: HA, daytime drowsiness, palpitations, GI upset, cardiac abnormality

Nursing Considerations/Education: Inappropriate use may lead to adverse effects and even death Avoid consuming alcohol while into these meds These alternatives may have certain interaction with some drugs Interactions/Contraindications Drug/Drug Warfarin is most often potentiated with herbal medicines Drug/Food Contraindications Desirable Outcomes

BioterrorismCategory A (Most Serious) Small pox Inhaled transmission Dies from septicemia (Blood infection-only one from this group that dies from this) Rash starts around mouth first (early ID & isolation is crucial to contain) Tularemia Inhaled Chest symptoms (coughing, chest pain, sputum) Dies from respiratory failure Treat with Streptomycin (watch hearing and creatinine) Anthrax Spread by inhalation Looks like flu (chest symptoms and achy muscles) Dies from respiratory failure Treat with Cipro, PCN, and streptomycin Plague Spread by inhalation Has the 3 Hs: Hemoptysis (coughing up blood) Hematemesis (vomiting blood) Hematochezia (bloody diarrhea) Dies from respiratory failure and DIC Treat with Doxycycline and Mycins No longer communicable after 24 hours of treatment Hemorrhagic fever [Ebola] 21 day time frame Primary symptoms are petechair and ecchymosis High % fatal Die of DIC Botolism Ingested (drink/eat) Has 3 major symptoms: Descending paralysis (starts at head-goes down to diaphragm) Fever But is alert Dies from respiratory failureCategory B: All others. A long list.Category C Hanta virus Nipeh virusChemical AgentsMustard Gas Blisters (Vesicant, eventually cover airway)Cyanide Respiratory arrest. Treat with Sodium Thiosulfate IVPhosgine chloride ChokingSarin Nerve agent. Symptoms (Cholinergic Effects) Bronchorrhea Bronchoconstriction Salivation Lacrimating Urination Diaphoresis/diarrhea GI upset Emesisi. Symptoms (Cholinergic Effects)1. Bronchorrhea2. Bronchoconstriction3. Salivation4. Lacrimating5. Urination6. Diaphoresis/diarrhea7. GI upset8. Emesis All chemical agents require only soap and water cleansing except for Sarin, which requires a bleacha. Nursing Actions: Bioterrorism- Isolation, Antibioticsb. Chemical: Decontaminationi. Send all suspected cases to decontamination centerii. Remove all clothingiii. Chemical hazard double bagiv. Incineratedv. Shower in soap and water (bleach- sarin)vi. Discharged in government clothes

PSYCHOTROPIC DRUGSNote: All psych drugs cause a decrease in BP and weight change1. Phenothiazinesa. All end in zineb. Very potentc. Immediate onsetd. Ex. Thorazine, Compazinee. Actions:i. Does not cure disease. Reduces symptomsii. Large doses: Psychotic symptoms (Hallucinationsiii. Small doses: Nausea/Vomitingiv. Major: Tranquilizersf. Side Effects: (remember ABCDEFG)i. Anticholinergic Effectsii. Blurred vision and Bladder retentioniii. Constipationiv. Drowsinessv. Extra Pyramidal Syndrome (EPS)vi. FPhotosensitivityvii. AGranulocytosis (low WBC count-immunosuppression)viii. Teach patient to report sore throat and any S/S of infection to DRg. Nursing Care: treat side effects. Number one nursing diagnosis is safety.h. Deconate after name of drug means it is long acting (at least 2 weeks to month) IM form given to non-compliant patients2. Tricyclic Antidepressantsa. Antidepressantb. mood elevators to treat depressionc. Ex. Elavil, Tofranil, Aventyl, Desyreld. pram, -tripe. Side Effects: (Elavil starts with E so this group goes through E)i. Anticholinergic Effectsii. Blurred vision and Bladder retentioniii. Constipationiv. Drowsinessv. Euphoriaf. Must take meds for 2-4 weeks before beneficial effects3. Benzodiazepinesa. Antianxiety meds (considered minor tranquilizers)b. Always have pam, -lam in the namec. Prototype: Diazepam (Valium)d. Indications:i. Induction of anestheticii. Muscle relaxantiii. Alcohol withdrawaliv. Seizuresespecially status epilepticusv. Facilitates mechanical ventilatione. Tranquilizers work quicklyi. Must not take for more than 90 days/3 weeks-3 mosii. Keep on Valium until Elavil kicks inf. Side Effects:i. Anticholinergic Effectsii. Blurred vision and Bladder retentioniii. Constipationiv. Drowsinessg. #1 Nursing DX: Safety4. Monoamine Oxidase (MAO) Inhibitorsa. Antidepressantsb. Depression is thought to be caused by a deficiency of norepinephrine, dopamine, and serotonin in the brain. Monoamine oxidase is the enzyme responsible for breaking down norepinephrine, dopamine, and serotonin. MAO inhibitors prevent the breakdown of these neurotransmitters and thus restore more normal levels and decrease depression.c. 2-4 weeksd. Drug Names:i. Mar-planii. Nar-diliii. Par-natee. Side Effectsi. Anticholinergic Effectsii. Blurred vision and Bladder retentioniii. Constipationiv. Drowsinessf. Interactions: (Patient Teaching)i. To prevent severe, acute, sometimes fatal hypertensive (stroke) crisis, the patient MUST avoid all foods containing TYRAMINE.1. Foods containing TYRAMINE:a. Fruits and veggies(remember salad BAR)i. AVOID:1. Bananas2. Avocados3. Raisins (any dried fruits)b. Grains: all okay except things made from active yeastc. Meatsi. No organ meats: liver, kidney, tripe, heart, etcii. No preserved meats: smoked, dried, cured, pickled, hot dogsd. Dairyi. No aged cheeseii. No yogurtiii. Cannot eat brick cheesee. Otheri. No alcohol, elixirs, tinctures, caffeine, chocolate, licorice, soy sauceii. Drug Interactions:1. Teach patient not to take OTC meds unless they are prescribed5. Lithiuma. An electrolytenotice ium ending as in potassium, etcb. Used for treating BPD (manic depression)it decreases maniac. Side Effects: (The 3 Ps)i. Peeing (Polyuria)ii. Pooping (Diarrhea)iii. Paresthesia (First sign of electrolyte imbalance)d. Toxic:i. Tremors, metallic taste, severe diarrhea or any other neuro signs besides paresthesiaii. #1 intervention: keep hydratediii. If sweating, give electrolyte drink as well as fluidse. Note: Closely linked to sodium. Monitor sodium levels. Low sodium levels prolong lithiums half-life, causing lithium toxicity. High sodium levels decrease the effectiveness of Lithium.i. Will only work as prescribed if Sodium normal!!6. Prozac (Fluoxetine)a. Prozac is a SSRI (Antidepressant)b. Similar to Elavil (A tri-cyclic antidepressant)same infoc. Side Effects:i. Anticholinergic Effectsii. Blurred vision and Bladder retentioniii. Constipationiv. Drowsinessv. Euphoriad. Prozac causes insomnia, so give before 12 nooni. If BID give at 6A & 12 Ne. When changing the dose of Prozac for a adolescent or young adult watch for suicidal ideation7. Haldol (Haloperidol)a. Also has deconate form [IM, long acting, given to pts who wont take pillsb. Same info as Thorazinec. Very potentd. Immediate onsete. Actions:i. Does not cure disease. Reduces symptomsii. Large doses: Psychotic symptoms (Hallucinationsiii. Small doses: Nausea/Vomitingiv. Major: Tranquilizersf. Side Effects: (remember ABCDEFG)i. Anticholinergic Effectsii. Blurred vision and Bladder retentioniii. Constipationiv. Drowsinessv. Extra Pyramidal Syndrome (EPS)vi. FPhotosensitivityvii. AGranulocytosis (low WBC count-immunosuppression)viii. Teach patient to report sore throat and any S/S of infection to DRg. Nursing Care: treat side effects. Number one nursing diagnosis is safety.h. **Elderly patients may develop Neuroleptic Malignant Syndrome (NMS), a potentially fatal hyperpyrexia (fever) with a temp of >104 F from overdose. Dose for elderly patient should be HALF of usual adult dose. 8. Clozaril (Clozapine)a. Second generation atypical antipsychoticb. Used to treat severe schizophreniac. Advantage: it does not have side effects A, B, C, D, E, or F (much less)d. Disadvantage: it DOES have side effect: Agranulocytosis (worse than cancer drug in susceptible patients)e. For first month need WBC counts weekly. If WBC LOW STOP!f. Do not confuse with Klonopin (Clonazepam)9. Zoloft (Sertraline)a. Another SSRI like Prozacb. S/E ABCDEc. 2-4 weeks to workd. Also causes insomnia but CAN be given in eveningse. Watch for interaction with:i. St. Johns wort- serotonin syndrome *deadly1. Sweating2. Apprehension impending sense of doom3. Dizziness4. HEAD-acheii. Warfarin (Coumadin)- watch for bleeding (may need to lower warfarin dose)1. When take Zoloft- warfarin and INR stays UP