TOP 40 DRUGS

A
1. ACETAMINOPHEN (Tylenol)

EFFECTS:
Analgesic (mild to moderate pain)
Antipyretic
NO anti-inflammatory effect
NO platelet effect
THERAPEUTIC LEVEL: 10 30 mg/dL
ANTIDOTE: Acetylcysteine (Mucomyst)
ADVERSE EFFECTS: hepatotoxic

2. AMINOGLYCOSIDES

STREPTOMYCIN/ GENTAMYCIN
Obtain Peak and trough level
o Peak level 30 minutes after taking the drug
o Trough level 30 minutes before the next dose
Adverse effects:
Neurotoxic
Ototoxic therapeutic to Menieres disease to relieve from vertigo (but this is the last resort because
it will lead to permanent deafness)
Nephrotoxic Monitor BUN

3. ANESTHESIA

REGIONAL
Epidural anesthesia
o Given in epidural space
o side effect: Hypotension

Spinal anesthesia (Sub-Arachnoid Block/ intrathecal)

o
o

Given in subarachnoid space

side effect: Spinal headache

GENERAL
Intravenous
Inhalational

4. ANTICOAGULANTS AND THROMBOLYTICS

WARFARIN SODIUM
(Coumadin)
Blocks vitamin K and clotting factors synthesis
thus preventing prothrombin formation***
2 to 5 days

Thrombosis and embolism

Atrial fibrillation with embolization

Adjunct treatment of coronary occlusion

Action
Onset
Use

Route

Oral

Expressed in
Antidote
Laboratory
test
Usage
Effect

Milligrams
Vitamin K/ Phytonadione (AquaMEPHYTON)
Prothrombin time (PT)
Normal value:11 to 15 seconds
Long term therapy
Slow

HEPARIN
(Hepalean)
Blocks conversion of prothrombin to thrombin
30 seconds to 1 minute

Thrombosis and embolism

Prevention of clotting in heparin lock sets, blood samples and during

dialysis

Treatment of disseminated intravascular coagulation

SQ, IV
(DO NOT give IM, may lead to hematoma and pain)
Units
Protamine sulfate
Partial Thromboplastin Time (PTT)
Normal value: 60 to 70 seconds; 2 to 2.5 times the control
Activated Partial thromboplastin time (APTT)
Normal value: 30 to 45 seconds; 1.5 to 2 times the control
Short term therapy
Quick

Coumadin and Heparin CAN BE GIVEN together

Heparin-induced side effect: thrombocytopenia***

WHAT ARE THE DRUGS THAT ENHANCE THE EFFECTS OF ANTICOAGULANTS?

4A Aspirin, Antihistamines, Alcohol, Antibiotics
5G Ginseng, Garlic, Ginger, Ginko biloba, Guiafenesin

ANTICOGULANT prevents clot formation

THROMBOLYTICS dissolves clot
USE: pulmonary embolism, coronary artery thrombosis, DVT, MI
SIDE EFFECT: bleeding
1 | TOP DRUGS

NURSING CONSIDERATIONS:

Start therapy as soon as possible after thrombus appears as thrombi older than 7 days react poorly
to streptokinase***

Heparin is discontinued before streptokinase is started

IM injections are contraindicated

ANTIDIOTE: aminocaproic acid (Amicar)
Examples: streptokinase (Streptase) PROTOTYPE; alteplase (Activase), urokinase (Abbokinase),
reteplase (Retavase), tenecteplase (TNKase), anistreplase (Eminase)

5. ANTI DEPRESSANTS

2 weeks interval in shifting from one type of anti-depressant to another

Antidepressant effect: 2 4 weeks
Problem in DEPRESSION:
Decrease norepinephrine
Decrease serotonin

3 common groups:
(1) TCA
(2) SSRI
(3) MAOI

Tricyclic Antidepressants (TCA) increases norepinephrine and/or serotonin in CNS by blocking the
reuptake of norepinephrine by presynaptic neurons
1. Imipramine (Tofranil)
2. Amitriptyline (Elavil)

Selective Serotonin Reuptake Inhibitor (SSRI) inhibits CNS neuron uptake of SEROTONIN*** (thus
increasing the level of serotonin); DOES NOT AFFECT norepinephrine
1. Fluoxetine (Prozac)
2. Sertraline (Zoloft)

SIDE EFFECTS: hypotension, arrhythmias, blurred vision, constipation, urinary retention, dry mouth
NURSING CONSIDERATIONS:

Check BP and PR

Give drug at BEDTIME

Changing from TCA to MAOI, patient must discontinue TCA for 14 days

2 to 4 weeks needed before the full therapeutic effect happens

TCA OVERDOSE (anticholinergic toxicity):

o Coma, convulsion
o Ataxia, agitation
o Stupor, sedation

SIDE EFFECTS: hypotension, headaches, arrhythmias, insomnia, dry mouth, weight loss, sexual
dysfunction
NURSING CONSIDERATIONS:
o Give drug in the MORNING
o Takes 4 weeks for full effect
o Changing from MAOI to SSRI, patient must discontinue MAOI for 2 weeks
o Changing from SSRI to MAOI, patient must discontinue SSRI for 5 weeks
o Monitor for weight
o Provide oral hygiene

Monoamine Oxidase Inhibitor (MAOI) acts as a psychomotor stimulator or psychic energizers; blocks
oxidative deamination of naturally occurring monoamines (epinephrine, norepinephrine, serotonin) causing
CNS stimulation
1. tranylcypromine (Parnate)
2. isocarboxazid (Marplan)
3. phenelzine (Nardil)

SIDE EFFECTS: Hypertensive crisis happens if the drug is taken with tyramine-containing foods
o S - weating
C - onstipation
o H - eadache, HPN
O - rthostatic hypotension
o U - rinary retention
P - hotophobia, dilated pupils
o N - ausea, Neck stiffness
A - granulocytosis
o T - achycardia

AVOID
o
o
o
o
o
o
o

tyramine or tryptophan containing foods:

Aged meat, avocado
Banana, beans
Chocolates, coffee, cheese (cheddar, aged, swiss), chicken and beef liver
Drinks that are fermented (wine, beer)
Smoked fish, soy sauce, sour cream, sausage
Pickled foods (herring)
Overripe foods
2 | TOP DRUGS

o
o
o

Raisins
Tea
Yogurt, yeast

ALLOW: cottage and cream cheese***

Monitor BP
Therapeutic effect are achieved within 10 days to 4 weeks

6. ANTI-GOUT

COLCHICINE (Novocolchine) NSAID anti-inflammatory

o
o

ALLOPURINOL (Zyloprim) prevent production of uric acid by inhibiting the enzyme xanthine oxidose
o
o

SIDE EFFECTS: diarrhea, abdominal cramps

NURSING CONSIDERATIONS:

DO NOT give IM or SQ, this may lead to irritation

Administer drug after meals

No more than 12 tablets should be given in a 24 hour period

USE: prophylactic for attacks of gout; clients with calcium oxalate calculi
SIDE EFFECTS: hepatotoxic

PROBENECID (Benemid)/ SULFINPYRAZONE (Anturane) uricosuric agents

o

DRUGG OF CHOICE to reduce serum uric acid by increasing its renal excretion

7. ANTI-PARKINSONS

Problem in PARKINSONS:
Decrease DOPAMINE
Increase ACETYLCHOLINE

Dopaminergic Drugs (increase dopamine)

1. Amantadine (Symmetrel)
2. Levodopa (L-dopa)
3. Levodopa-Carbidopa (Sinemet)

Anticholinergic Drugs (decrease Acetylcholine)

1. Akineton
2. Cogentin
3. Artane
4. Benadryl

8. ANTI-PSYCHOTIC (MAJOR TRANQUILIZERS)

USE: Schizophrenia
1. Haloperidol (Haldol)
2. Chlorpromazine (Thorazine)
NURSING CONSIDERATIONS:
Take drug AFTER meals***
SIDE EFFECTS:
HYPOtension
Agranulocytosis/ leukopenia (sore throat) serious side effect***
NEUROLEPTIC MALIGNANT SYNDROME (HYPERthermia/ diaphoresis, HYPERtension)
pink-red urine (normal: thorazine)

9. ASPIRIN/ SALICYLATES/ ACETYLSALICYLIC ACID

4 EFFECTS:
1) Anti platelet reduce risk of myocardial infarction and transient ischemic attack
2) Anti-inflammatory rheumatic fever, Kawasaki disease, rheumatoid arthritis
3) Antipyretic fever
4) Analgesic mild to moderate pain

ASPIRIN TOXICITY
Tinnitus early sign of salicylism
Metabolic acidosis late sign of salicylism
Epistaxis, nephrotoxic

NURSING CONSIDERATIONS:
ANTIDOTE: activated charcoal (can also give Ipecac syrup to induce vomiting of aspirin)
Give the drug with full stomach after meals Aspirin is ulcerogenic
Monitor CBC, Prothrombin time, renal and liver functions
If (+) ASA allergy, give other anti-platelet drug like Clopidogrel or Ticlopidine***
AVOID Aspirin in patients with viral infection to prevent Reyes Syndrome***
AVOID Aspirin with OHA causes hypoglycemia***
3 | TOP DRUGS

AVOID Aspirin with anticoagulant (Coumadin, Heparin) high risk for bleeding (additive effect)

10.

ATROPINE SULFATE (Atropair, AtroPen)

MODE OF ACTION:
block neurotransmitter acetylcholine
inhibits parasympathetic actions

USES: pre-op medication to reduce secretions and bradycardia; produces mydriasis

CONTRAINDICATED in acute glaucoma***, prostatic hypertrophy
NURSING CONSIDERATION:
Check BP and PR

B
11.

BETA-BLOCKERS
2 TYPES:
SELECTIVE
Beta 1 only
Atenolol, metoprolol
(Lopressor)

MODE OF ACTION: inhibit or blocks sympathetic stimulation of beta receptors in the***

HEART decreasing myocardial oxygen consumption and demand by:

decreases heart rate***

decreases force of myocardial contraction

12.

NON-SELECTIVE
Beta 1 and 2
propanolol (Inderal), timolol
(Blocadren),

EYES decreases intraocular pressure (IOP) by:

decreasing aqueous humor formation and increases aqueous humor outflow (such as glaucoma)

Change of position gradually

Take pulse before taking drug***

BRONCHODILATOR
USE: bronchospasms, asthma
EXAMPLES:
BETA-ADRENERGIC: abuterol (Proventil, Ventolin), metaproterenol (Alupent)
XANTHINES: theophylline (Theo-Dur) PROTOTYPE, aminophylline (Truphylline)
THERAPEUTIC LEVEL OF THEOPHYLLINE: 10 20 mcg/ml
SIGN OF THEOPHYLLINE TOXICITY:
Tachycardia
nausea and vomiting
FOODS TO BE AVOID:
ICE TEA caffeine and caffeine containing foods because Theophylline is a xanthine derivative which
has same effect with caffeine

C
13.

14.

CLOPIDOGREL (Plavix)/ Ticlopidine (Ticlid) ANTIPLATELET***

USE: prevent blood clots by inhibiting platelets to coagulate***
INDICATION: heart attack, stroke, or vascular diseases
NURSING CONSIDERATION:
Take with 1 full glass of water
Can be take with or without food
AVOID:
Alcohol
Coumadin, Heparin

CHEMO DRUGS
Methotrexate (folic acid antagonists) - inhibits DNA (protein) synthesis causing cell death
do not give together with Vitamin B9
Tamoxifen is the primary hormonal agent used in breast cancer treatment today.
NURSING INTERVENTIONS FOR CHEMOTHERAPEUTIC SIDE EFFECTS
SIDE EFFECTS
Nausea and
vomiting
Constipation

NURSING INTERVENTIONS
Administer antiemetics befoore chemotherapy;
Withhold food and fluids for 4 to 6 hours before treatment
Increase fluids and fiber intake
4 | TOP DRUGS

Diarrhea
Pruritus/ urticaria
Stomatitis
Alopecia
Skin
pigmentation
Nail changes
Anemia
Neutropenia
Thrombocytopeni
a
Hemorrhagic
cystitis
Urine color
changes

Replace fluids, low fiber diet

Provide good skin care
Provide good oral care (water/ NSS); avoid hot and spicy
food
Reassure that it is temporary; encourage to wear wigs,
hats or head scarf
Reassure that it is temporary
Reassure that nails may grow normally after
chemotherapy
Bed rest; provide frequent rest periods
Protect from infection;
AVOID crowded places; fresh fruits and raw foods
Bleeding precaution
AVOID aspirin and anticoagulants, bruising, use of
straight razors;
USE a soft-bristle toothbrush
Provide 2 to 3 liters fluids per day
Reassure that it is harmless

D
15.

DIAZEPAM (Valium)

USE: Drug of choice for status epilepticus***

EFFECTS:
Anxiolytic
Anti-convulsant
Muscle relaxant

NURSING CONSIDERATIONS:
DO NOT MIX with other drugs
DO NOT withdraw abruptly
AVOID alcohol, smoking, activities that requires alertness
May cause physical dependence
Oral form should be given BEFORE MEALS***

Examples: alprazolam (Xanax), clorazepate (Tranxene), flurazepam (Dalmane), midazolam (Versed),

triazolam (Halcion), chlordiazepoxide (Librium), clonazepam (Klonopin), lorazepam (Ativan)

16.

DIGOXIN (Lanoxin)

Effects:
o (+) inotropic increases FORCE OF CONTRATION increase cardiac output increase kidney
perfusion increase urine output
o (-) chronotropic decreases HEART RATE decrease oxygen demand of the heart muscles***

Digoxin toxicity nausea, yellow color vision, arrhythmia, sign of hypokalemia (weakness, muscle cramps)

3 parameters to check BEFORE giving Digoxin:

1) Heart rate (apical pulse)*
2) Serum potassium
3) Serum Digoxin level

Urine output sign of drug effectivity***

Antidote: Digoxin immune Fab (Digibind)

17.

DIURETICS
CLASSIFICATIO
NS

KSPARING
KWASTING

Potassium
Sparing

Carbonic
Anhydrase
Inhibitors (CAI)
Loop Diuretics
Osmotic Diuretics

SITE OF
ACTION*
**
Distal
tubule

EXAMPLES

INDICATIONS

Spironolactone (Aldactone)
Amiloride (Modiuretic,
Midamor)
Triamterene (Dyrenium)

Mild diuretic, CHF,

HPN

Proximal
tubule

Acetazolamide (Diamox)

Menieres disease,
OPEN glaucoma

Loop of
Henle
Glomerulu
s

Furosemide (Lasix)
Bumetanide (Bumex)
Mannitol
Osmitrol

Severe edema and

HPN
Increased ICP

SPECIAL NURSING
INTERVENTIONS
Avoid potassium-rich
foods (banana***,
potatoes, spinach,
broccoli, nuts, prunes,
tomatoes, oranges,
peaches, papaya)

Fastest diuretic to take

effect
Warm solution to avoid
crystallization
5 | TOP DRUGS

Thiazide and
Thiazide-like

Distal
tubule

Glycerin
Urea
Hydrochlorothiazide
Chlorothiazide (Diuril)
Metolazone

Electrolytes removed through diuretics:

HPN (Not effective

for immediate
dieresis)

potassium, calcium, sodium***

NURSING CONSIDERATIONS:
1. Monitor blood pressure (first/ before) and weight (second/ after)
2. Administer in the MORNING
3. Administer with FOOD
EVALUATION: for effectiveness of therapy

Weight loss

Increased urine output

Resolution of edema

Decreased congestion

Normal BP

E
18.

EPINEPHRINE
Ideal drug for cardiac arrest
Drug of choice for STATUS asthmaticus
Therapeutic property for bronchial asthma and anaphylactic shock: bronchodilation effect
Epinephrine + anesthesia prolongs the function of anesthesia

G
19.

GASTRIC DRUGS
Classifications:
Cytoprotective agents coats/ cover the gastric lining (give BEFORE meals)
Histamine2 blockers decrease hydrochloric acid production (give WITH meals)
Antacid neutralize gastric acidity (give AFTER meals)
Proton Pump Inhibitor decrease hydrochloric acid production (give BEFORE meals)
Best time to give these drugs: at bedtime

H
20.

HERBAL DRUGS that cause BLEEDING

GINKO BILOBA
GINGER
GARLIC
GINSENG

I
21.

IMCI DRUGS: IRON

1 dose daily x 14 days

AGE or
WEIGHT

TABLET
Ferrous sulphate 200mg + 250
mcg Folate
(60 mg elemental iron)

2 to 4 months
(4 to <6 kg)
4 to 12 months
(6 to <10 kg)
1 to 3 years
(10 to <14 kg)
3 to 5 years
(14 to <19 kg)

22.

SYRUP
Ferrous sulphate 150 mg
per 5 ml
(6 mg elemental iron per
ml)
2.5 ml (1/2 tsp)

DROPS
Ferrous sulphate 25
(25 mg elemental iron
per ml)
0.6 ml

4 ml (3/4 tsp)

1 ml

tablet

5 ml (1 tsp)

1.5 ml

1 tab

7.5 ml (1.5tsp)

2 ml

IMCI DRUG: VITAMIN A

VITAMIN A CAPSULES

AGE
6 months to 12 months
12 months to 5 years

100,000 IU
1
2 capsules

200,000 IU
capsule
1 capsules
6 | TOP DRUGS

23.

IMCI DRUG: MEBENDAZOLE/ ALBENDAZOLE

AGE or WEIGHT
12 months to 24 months
24 months to 59 months

24.

Albendazole 400 mg
tablet
or 200 mg tablet
1

Mebendazole 500 mg
tablet
1
1

INSULIN
MODE OF ACTION: decreases blood sugar by
Increasing glucose transport across cell membranes
Enhancing conversion of glucose to glycogen
TYPE
ULTRA RAPID
Lispro (Humalog), Aspart (Novolog)

DESCRIPTION
Route: SQ

ONSET
> 15
minutes

PEAK
30 60
minutes

DURATION
34
hours

RAPID-ACTING:
Regular, Humulin R

Color: Clear
Route: IV, SQ

30 min 1 hr

2 4 hrs

6 8 hrs

INTERMEDIATE-ACTING:
NPH/ Neutral Protamine Hagedorn
(Insulin Isophane Suspension),
Humulin N
LONG-ACTING:
Ultralente (extended insulin zinc suspension)
Humulin U

Color: Cloudy
Route: SQ

1 2 hrs

6 8 hrs

18 24 hrs

Color: Cloudy
Route: SQ

3 4 hrs

16 20 hrs

30 to 36 hrs

PEAK TIME time of hypoglycemic episodes

1 ml of insulin = 100 units of insulin
U100 insulin syringe is 100 units
Administer insulin in room temperature
ROUTE: SQ
45 degree (for skinny patient)***
90 degrees (for fat patients)

Area:
Abdomen fastest absorption
Deltoid
thigh
buttocks

AVOID:
massage and apply compression (increase absorption)
aspirate after injection
shake. Gently roll vial in between palms
Cold insulin lipodystrophy

STORAGE:
In room temperature last for 1 month
Refrigerated once opened last for 3 months

ADJUSMENT OF DOSE:
increase insulin requirement Infection, Stress, Illness
decrease insulin requirement Breast feeding (Antidiabetic effect)

Mixing of insulin: (Aspirate 1st clear, Inject air 1st cloudy)

(1) Inject air to NPH
(2) Inject air to Regular
(3) Aspirate Regular
(4) Aspirate NPH

Most common used:

U100 (1)
U40 (2)

25.

IRON SUPPLEMENTS
SIDE EFFECTS:
dark stools (tarry stool)
constipation
abdominal cramps
Tablet: give with citrus juice (orange, tomato)
Liquid: give with citrus juice (orange, tomato) and straw
IM: Z-track method (DO NOT massage)
BEST given with empty stomach (1 hour before meals*** or 2 hours after meals)
Citrus juice is AVOIDED with iron elixir preparation
7 | TOP DRUGS

L
26.

27.

LACTULOSE (Duphalac, Cephulac)

Laxative
SIDE EFFECT: ammonia binder (therapeutic to patient with hepatic encephalopathy)***

LITHIUM
Anti-mania
Therapeutic Level: 0.5 1.5 mEq/L***
Lithium toxicity (nausea and vomiting, anorexia, abdominal cramps, diarrhea)
PREPARATIONS:
o Tablets: 300, and 450mg.
o Capsules: 150, 300, and 600 mg.
o Syrup: 300 mg/5 ml
(NO parenteral preparation)***
Maintain diet:***
o increase fluid (3L/day)
o Increase Na (3 gm/day)

M
28.

29.

30.

MAGNESIUM SULFATE
tocolytic agent
USE: premature labor, anticonvulsants in pregnancy induced hypertension (PIH)
Check:
o
deep tendon reflex (DTR) FIRST reflex lost with CNS toxicity
o Check RR (at least >12 breaths/ min
o Check urine output (at least 30 mL/ hr)
Therapeutic level = 4 to 8 mg/dL
ANTIDOTE: calcium gluconate

METRONIDAZOLE (Flagyl)
Anti-amoeba
AVOID alcohol (Metronidazole + Alcohol = Disulfiram-like effect)

MORPHINE SULFATE (Duramorph)

INDICATION: moderate to severe pain, pain relief in myocardial
EFFECT:
o induce sedation and euphoria
o analgesia
o anxiolytic
o DECREASES preload and afterload
o DECREASES workload
o DECREASES Peripheral vascular resistance
SIDE EFFECTS:
Miosis

Orthostatic hypotension

Respiratory depression

Produces tolerance and dependence

Hyperglycemia

infarction and burns

Increase urinary retention/ constipation

Nausea and vomiting
Euphoria
Sedation/ dizziness

NURING CONSIDERATIONS:
Assess clients pain before giving medication
Check before and after the respiration
May lead to tolerance

FIRST SIGN of tolerance is decrease duration of effect of the analgesic

AVOID activities that require alertness, alcoholic beverages, smoking, CNS depressants, sedatives,
muscle relaxants
Change position gradually

N
31.

NITRATES AND NITROGLYCERINE (Nitro-bid, Nitrodur, Nitrostat IV)

MODE OF ACTION: vasodilator
8 | TOP DRUGS

USE: angina pectoris and hypertension

SIDE EFFECTS OF NITRATES: headache, flushing, orthostatic hypotension, dizziness
Other Related drugs: isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur)
SUBLINGUAL form: 0.15 0.6 mg
No more than 3 tablets should be taken in a 15 minute period (one tablet every 5 minutes); if pain not
relieved after 15 minutes and 3 tablets, notify physician immediately
SIGN OF POTENCY: burning sensation under tongue
Drink water first BEFORE taking drug

OINTMENT
applied to a hairless or clipped/ shaved area
new site should be used with each new dose
use ruled applicator paper that comes with ointment to measure dose
wear gloves during application
leave applicator on site and cover it with plastic wrap and secure it with tape

TRANSDERMAL PATCH
Apply a patch once a day only
Rotate site
Place patch in non-hairy area
Determine a base region and remove the old patch
Wear gloves during application

IV form: 5 mcg/ min

dilute IV nitroglycerine in 5% dextrose or 0.9% sodium chloride and titrate every 3 to 5 minutes

STORAGE:
store in original dark glass container in a cool, dry place.
date bottle when opening
discard after 6 months

NURSING CONSIDERATIONS:
Change position gradually to prevent dizziness
HEADACHE is a sign that the drug is taking effect. It will discontinue with long term use.
AVOID alcohol, hot baths
Carry drug at all times
DO NOT administer nitrates with sildenafil (Viagra), both drugs are vasodilator which may lead to
HYPOTENSON

32.

NONI JUICE
Scientific name: Morinda citrifolia
High in fiber
Use for diabetes clients

O
33.

OCTREOTIDE (SANDOSTATIN)***
Inhibits GROWTH HORMONE, GLUCAGON, INSULIN
2 formulations:
Sandostatinis a short acting version
Sandostatin LARis a long acting version.
Sandostatin
subcutaneous injection***
It may be necessary to take the shot several
times a day.
The injection sites should be rotated regularly

34.

Sandostatin LAR
intramuscular injection
This medication is generally given once every 4 weeks
Sandostatin LAR should NOT be given by S.C. or IV
routes.
The preferred site for injection is the hip, because it is
painful given into the arm.

COMMON SIDE EFFECT: constipation***

OXYTOCIN (Pitocin)
stimulate uterine contraction
USE: postpartum bleeding, labor induction
ADVERSE EFFECTS: uterine hyperstimulation, arrhythmias, tachycardia, hypertension
Given IM or IV (IV via piggyback and delivered with an infusion pump)
Observe fetal hypoxia or distress

P
35.

PANCREATIC ENZYMES
9 | TOP DRUGS

36.

37.

USE: aid in digestion; cystic fibrosis

Give WITH MEALS***
Expected outcome of the drug is absence of steatorrhea***
EXAMPLES: pancreatin (Dizymes), pancrelipase (Cotazym)

PHENYTOIN (Dilantin)
USE: seizure
SIDE EFFECT: gingival hyperplasia, may turn urine pink, red, or red-brown
ADVERSE EFFECTS: hepatotoxic, Steven-Johnsons syndrome
DO NOT administer IM
Give drug with NSS BEFORE AND AFTER (flushing) drug administration
Provide oral hygiene, Use soft, bristled toothbrush
Takes 7 to 10 days to achieve therapeutic serum level
Therapeutic level: 10 20 mg/ dl

PRE-OPERATIVE MEDICATIONS
PURPOSE: to facilitate anesthesia induction***
PRE-OP DRUGS

MODEOF ACTION

MUSCLE
RELAXANT

Relaxes smooth and

skeletal muscles

OPIATE AGONISTS
(Narcotic
analgesic)

Increases pain
threshold thus
needing lesser
amount of
anesthesia
Decrease mucus and
saliva production

ANTICHOLINERGIC

Examples
Midazolam
Diazepam
Lorazepam
Alprazolam
Morphine
sulfate
Fentanyl citrate
Codeine
Diphenhydrami
ne
Atropine sufate
Scopolamine
Hydrobromide

WATCH
OUT
BP

Avoid rapid injection

to prevent shock

RR

Antidote: naloxone
(narcan)

HR

Causes constipation

S
38.

STEROIDS

USE: bronchial asthma, Addisons disease, allergies

Examples: hydrocortisone (Cortisol), prednisone (Strap red), dexamethasone (Decadron),
methylprednisone (Solu- medrol), betamethasone (Celestone)

THERAPEUTIC EFFECTS:
Anti-inflammatory
Hormonal replacement

SIDE EFFECTS:
Long term use: Adrenal insufficiency***, osteoporosis
Short term use:

Cushings syndrome: Immunosuppressant, hypokalemia, edema

Immunosuppression therapeutic to AUTOIMMUNE DISEASES like nephrotic

syndrome, SLE, multiple sclerosis, Rheumatoid arthritis, for organ transplant,
hyperthyroidism, allergies)

hypocalcemia, GI ulcer

NURSING CONSIDERATIONS:
Give with food
Give in the morning (before 9 am)

Take medication with breakfast (corresponds to biorhythms and reduces gastric irritation)
Watch out for infection
Taper the dose (abrupt withdrawal may lead to acute adrenal crisis)
Parenteral form: Give IM avoid SQ

Oral form: Give it WITH food or milk, may cause gastric irritation

Topical creams: DO NOT apply in broken skin and near eyes

Wear medic alert bracelet
Isolation precaution
AVOID:

AVOID immobility to prevent osteoporosis

AVOID crowd to prevent infection

AVOID sunlight
DIET: Restrict sodium, alcohol and caffeine; high potassium foods
Carry extra medication during travel.
Adjust medications during periods of acute or chronic stress such as pregnancy or infections; contact
health care provider.
10 | TOP DRUGS

39.

SYMPATHETIC AND PARSYMPATHETIC

SYMPATHETIC
SNS (Adrenergic)
Dumping Syndrome, MG
Atropine
Cholinesterase
fight or flight response
(BIOAMINE THEORY)
Epinephrine (Adrenaline) faster release but
short acting
Norepinephrine
Dopamine
Serotonin
(Increase) HR, RR, BP
(Decrease) peristalsis, UO, secretions
Pupil dilation (mydriasis)
Bronchodilation
Hyperglycemia

PARASYMPATHETIC
PNS (Cholinergic)
Glaucoma, GERD
Prostigmine
Anticholinesterase
Sleep and digest response
Acetylcholine slowly release but
long acting

(Decrease) HR, RR, BP

(Increase) peristalsis, UO, secretions
Pupil constriction (miosis)
Bronchoconstriction
Diarrhea
Urinary frequency
Miosis (constriction)
Bradycardia
Bronchoconstriction
Erection/ emesis
L
Salivation

T
40.

THYROID AND ANTI-THYROID DRUGS

THYROID AGONISTS used to increase blood thyroid hormones

LEVOTHYROXINE (Synthroid)
USE: hypothyroidism (myxedema), cretinism (congenital hypothyroidism)
SIDE EFFECTS: insomnia, tachycardia, diarrhea
NURING CONSIDERATIONS:
Taper the dose
Monitor vital signs (temperature, BP, PR)
Give the drug in the morning (due to insomnia side effect)
CONTRAINDICATIONS:
Cabbage, Cauliflower
Peaches, Peas, Pears
Raddish, turnips
Spinach
The normal maintenance dose of levothyroxine:
adult is 0.1 to 0.2 mg daily
infants 0 to 6 months of age is 0.025 to 0.05 mg daily
children 1 to 5 years of age, 0.075 to 0.1 mg daily
children 6 to 12 months of age, 0.05 to 0.075 mg daily.

THYROID ANTAGONISTS used to decrease blood thyroid hormones

A.

ANTITHYROID DRUGS inhibit synthesis/production of thyroid hormones***

Examples: propylthiouracil (PTU, Propacil, Propyl-Thyracil), methimazole (Tapazole)

B. IODIDES inhibit secretion/ release of thyroid hormone;

_ decrease vascularity of the thyroid gland (for thyroidectomy preparation)
Examples: Potassium Iodide Saturated Solution (Lugols solution)
Give at least 10 day before surgery

SIDE EFFECTS:
agranulocytosis (sore throat)
paresthesias
bleeding (inhibits vitamin K)
Taper the dose
Monitor vital signs (temperature, BP, PR)
AVOID iodine, iodine containing foods and sea foods
ORAL form: dilute with water or juice (to improve taste) and use straw (to prevent discoloration)

11 | TOP DRUGS