NCLEX Meds

Drugs that relieve pain. Two types are non-narcotic analgesics for mild pain and narcotics for severe pain

• 1st Generation:
• Asprin (ASA= actyl salicyclic acid)
• Indomethacin (Indocin)
• Ibuprofen (motrin)
• Naproxen, Naprosyn, Anaprox (aleve)
• Ketoprofen
• Ketorolac (Toradol)

• 2nd Generation:
• Celecoxib (celebrex)

• Actions:
• NSAIDs inhibit prostaglandins
• COX-2 inhibitors block the enzyme responsible for inflammation without blocking the COX-1 enzyme
• ASA has antiplatelet activity

• Indications:
• pain, fever, arthritis, dysmenorrhea
• ASA: transient ischemic attacks, prophylaxis of MI, ischemic stroke, angina
• Ibuprofen: gout, dental pain, musculoskeletal disorders

• Side Effects:
• headache, eye changes, dizziness, somnolence, GI disturbances, constipation, bleeding, rsh

• Nursing considerations:
• take with food or after meals, periodic ophthalmic exam, monitor liver and rental function, avoid OTC drugs,
• Post op clients with adequate pain relief have fewer complications and a shorter recovery
• pain is the 5th vital sign and needs to be assess with others

• Uses:
• Treatment of mild to moderate pain, reduce inflammation, reduce fever and prevent platelet aggregation and reduce heart atacks and strokes

• Side Effects:
• Short term use-GI bleeding, heartburn, occational n/v
• Prolonged high dose (overdosage)- salicylism: metabolic acidosis, respiratory alkalosis, dehydration, fluid and electrolyte imbalance, tinnitus

• Nursing Considerations:
• Observe for bleeding gums, bloody or black stools, bruises
• Give with milk, water or food or use enteric coated tablets (Ecotrin) to minimize gi distress
• Contraindication- GI disorders, severe anemia, vitamin K deficiency
• Cannot give to children <16 years of age especially with a viral illness due to potential for Reye's syndrome.

• Trick to remember:
• many of the generic names end in -profen

• Uses:
• analgesic, anti-pyretic, anti-inflammatory

• Side effects:
• Much less stomach upset than ASA but can cause n/v diarrhea and constipation.
• Skin eruption, dizziness, headache, fluid retention
• May ose a risk to patients with hypertension or heart disease and rarely causes Stevens Johnson syndrome

• Nursing Consideration:
• Use cautiously with asprin allergy, give with milk

• Side Effects:
• Peptic ulcer, ulcerative colitis, headache, dizziness, bone marrow suppression

• Nursing Considerations:
• Observe for bleeding tendencies
• Monitor I and O

• Side effects:
• headache, dizziness, epigastric distress

• Nursing considerations:
• administer with food
• optimal therapeutic response is seen after 2 weeks of treatment
• use cautiously in patient with history of aspirin allergy

• Side Effects:
• Peptic ulcer disease, GI bleeding, prolonged bleeding, renal impairment

• Nursing implications:
• dosage is decreased in clients > 65 yr or with impaired renal function
• Duration of treatment is <5 days

• Trick to remember:
• only one drug now on the market, ends in "-coxib"

• Uses:
• Osteoarthritis, rheumatoid arthritis, acute pain with inflammation

• Side effects:
• fatigue, anxiety, depression, nervousness, n/v, anorexia, dry mouth, constipation, dyspepsia, potential CV risk, renal toxicity, contraindicated in those with sulfonamid allergy, ASA or NSAID allergy

• Nursing consideration:
• COX-2 inhibitor
• increasing dose does not appear to increase effectiveness

• acetaminophen (Tylenol)
• salicylates (ASA, Asprin)

• Actions:
• antiprostaglandin activity in hypothalamus reduces fever; causes peripheral vasodilation; anti-inflammatory actions

• Indicaions:
• fever

• Side effects:
• GI irritation, occult bleeding, tinnitus, dizziness, confusion, liver dysfunction (acetaminophen)

• Nursing considerations:
• Aspring contraindicated in clients less than 21 yrs old due to risk for Reye's syndrome
• Asprine contraindicated in clients with bleeding disorders due to anticlotting activity
• NSAIDS are also used for fever

• Trick to remember:
• any time you see "-apap" or a pain med ending in "-cet" tylenol is there

• Uses:
• analgesic, antipyretic. has essentially no antiinflammatory effects

• Side effects:
• overdosage may be fatal, GI side effects are not common, hepatotoxicity

***Acetylcysteine (Mucomyst, Acetadote) is the antidote for Tylenol overdose***

• 1st generation:
• Diphenhydramine (Benadryl)
• Chloropheniramine (Chlortrimeton)
• Promethazine HCL (Phenergan)

• 2nd generation:
• Loratadine (Claritin)
• Fexofenadin (Allegra)
• Ceftirizine (Zyrtec)

• Action:
• blocks the effects of histamine at peripheral H1 receptor sites; anticholinergic, antipruritic effects

• Indications:
• allergic rhinitis, allergic reactions, chronic idiopathic urticaria

• Side Effects:
• depression, nightmares, sedation, dry mouth, gi upset, bronchospasm, alopecia

• Nursing considerations:
• administer with food, good mouth care, sugarless lozenges for dry mouth, good skin care, use caution when performing tasks requiring alertness (ex. driving a car), avoid alcohol

• Trick to remember:
• usually the generic names will end in "-amine"

• Uses:
• used to treat mild to sevee allergies, colds, motion sickness and insomnia

• Side Effects:
• sedation (although children and some adults may have the opposite reation), CNS effects, anti-cholinergic efects

• Side effects:
• drowsiness, dry mouth

• Nursing considerations:
• most efective if taken before onset of symptoms

• Side Effects:
• drowsiness, n/v, dry mouth, photosensitivity

• Nursing considerations:
• don't combine with alcohol, give with food, use sunscreen

• Side Effects:
• agranulocytosis, drowsiness, dry mouth, photosensitivity

• Nursing considerations:
• give with food, use sunscreen

• Uses:
• mild to severe allergies

• Side effects:
• essentially no sedation with these but may cause some drowiness

• Nursing consideration:
• reduce dose or give every other day for patient with renal or hepatic dysfunction

• Cortisone acetate
• Hydrocortison (Solu-Cortef)
• Dexamethasone (Decadron)
• Methylprednisolone (Solu-Medrol)
• Prednisone (Deltrasone)
• Beclomethasone
• Betamethasone
• Budesonide (Pulmicort)

• Acton:
• stimulates formation of glucose (gluconeogenesis) and decrease use of glucose by body cells; increase formation and storage of fat in muscle tissue; alters normal immune system

• Indications:
• Additions disese, Crohn's diesease, COPD, lupus erythematosus, leukemias, lymphomas, myelomas, head trauma, tumors to prevent/treat cerebral edema, also used to reduce inflammation in rheumatoid arthritis, asthma lupus etc

• Side Effects:
• increased susceptibility to infection (may mask symptoms of infection due to antiinflammatory action), psychosis (nightmares areoften first sign), depression , weight gain, hypokalemia, hypocalcemia, stunted growth in children, petechiae, buffalo hump, adrenal insufficiency, osteoporosis, glucose intolerance, insomnia, delayed wound healing

• Nursing considerations:
• Prevents/supresses cell mediated immune reactors
• Used for adrenal insufficiency
• Overdosage produces Cushings syndrom
• Abrupt withdrawl of drug may cause headache, n/v, and papilledema (Addisonian crisis)
• Stress may lead to increased need for steriods
• Check weight, BP, I and O and weight
• Used cautiously in history of TB (may reactivate)
• Administer with antacids
• Do not stop abruptly
• monitor fluid and electrolyte balance
• don't discontinue abruptly
• monitor for signs of infection
• Solu-Medrol also used for arthritis, asthma, allergic reactions and cerebral edema
• Decadron also used for allergic disorders, cerebral edema, asthma attack and shock

• Herbal interactions:
• cascara, senna, celery seed, juniper may decrease serum potassium; when taken with corticosteroids may increase hypoglycemia
• Ginseng taken with corticosteroids maycause insomnia
• echinacea may counteract effects of corticosteroids
• Licorice potentiates effects of corticosteriods

• Montelukast (singulair)
• Zafirlukast (accolate)
• Zileuton (Zyflo)

• Trick to remember:
• most generic names end in "-kast"

• Uses:
• Decrease inflammation, bronchoconstriction, and mucus production in asthma, COPD

• Side Effects:
• Liver injury, headache, GI disturbances

• Nursing Considerations:
• used for prophylactic maintenance therapy of asthma in adults and children

• *Zyflo- instruct clients that liver function tests may be monitored
• Not interactions with theophylline

• Amitriptyiline (Elavil)
• Nortriptyline (Pamelor)
• Imipramine (Tofranil)
• Anafranil
• Norpramin

• Trick to remember:
• some will end in "-triptyline"

• Actions:
• inhibits presynaptic reuptake of neurotransmitters norepinephrine and serotonin; anticholinergic action at CNS and peripheral receptors

• Indications/Uses:
• Depression, obstructive sleep apnea, treatment of bipolar disorder, neuropathy pain, or prevention of migraine headaches

• Side Effects:
• sedation, anticholinergic effects (dry mouth, blurred vision), confusion, photosensitivity, disturbed concentration, orthostatic hypotension due to antiadrenergic effects, bone marrow suppression, urinary retention, cardiac toxicity, seizures

• Nursing Considerations:
• Therapeutic effects in 1-2 weeks; maximum response in 6-9 weeks
• May be administered in a daily dose at night to promote sleep and decrease side effects during the day
• Orthostatic hypotension precautions
• Instruct patient that side effects will decrease over time
• sugar lozenges for dry mouth
• do not abruptly stop taking medications (headache, vertigo, nightmares , malaise, weight change)
• Avoid alcholo, sleep inducing drugs, OTC drug
• avoid exposure to sunlight, wear sunscreen
• Antidote- physostigmine (Antilirium)

• highly anticholinergic and one of the most sedating and cardiotoxic antidepressant
• also used for diabetic neuropathy, back surgeries, neurogenic pain, and episiotomies because it helps soothe nerve endings

least toxic TCA. Prescribed for older adult patients instead of haldol who are depressed, agitated, and suffering from insomia due to it being somewhat sedating and having a good side effect profile (no EPS, risk for falls or hypotention as with haldol)

• the oldest TCA. none of the newer antidepressants has proven to be move effective. proven to be effective in the treatment of childhood enuresis due to its anticholinergic properties.
• should be used with care in children because of its cardiovascular effects

• high risk of suicide. strong potentiator of serotonin, but is not typically prescribed for depression but is the drug of choic for OCD
• *Luvox-SSRI for OCD comes before Anafranil due to side effects of anfranil

• appears to be the most toxic TCA. It's an activating antidepressant and thus may be advantageous for apathetic, lethargic, and hypersomnic pathetics. It should be used with care in children due to its aforementioned effects on child's cardiovascular system.
• *If nothing else works for vegetative signs of depression, this works. This is the only real time its used because of its side effect profile.

• Fluoxetine (Prozac)
• Escitalopram (Lexapro)
• Citalopram (Lexapro)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
• Fluvoxamine (Luvox)
• Celexa

• Trick to remember:
• generic names may end in "-oxetine" or "-pram"

• Action:
• inhibits CNS neuronal uptake of serotonin; acts as stimulant counteracting depression and increasing motivation

• Indications/Uses:
• Depression with fever serious side effects than TCAs, OCD, obesity, bulimia

• Side Effects:
• headache, dizziness, nervousness, insominia, drowsiness, anxiety, tremor, dry mouth, GI upset, tremor, taste changes, sweating, URI, painful menstruation, sexual dysfunction, weight gain (pts we are too depressed to eat start to feel better and eat), CNS stimulation, potential for serotonin syndrome (especially if you mix meds, even herbs such as St. Johns Wart)

• Nursing considerations:
• take in AM
• takes 4 weeks for full effect
• good mouth care
• do not administer with MAOIs- risk of serotonin syndrome
• monitor for thrombocytopenia, leuopenia, and anemia
• Less side effect profile if you start at 1/2 dose 1st week then full dose. Always wean off these meds.

good choice for use during pregnancy

associated with cleft lip and cleft palate if used during pregnancy

can be used for nursing while breast feeding (less half life- larger molecule)

• Pristiq
• Cymbalta
• Effexor

• Action:
• inhibits serotonin and norepinephrine reuptake in the central nervous system, works as both an antidepressant and pain inhibitor