NUR206 Final exam Medications

• Phenothiazine
• FGA-Control positive symptoms of schizophrenia.

Adverse: Orthostatic hypotension, weight gain, anticholinergic, EPS-dyskinesia, granulocytosis (thorazine mainly), photosensitivity, NMS-fever key ID.

• Non phenothiazine
• FGA

Adverse: anticholinergic, EPS, Leukocytosis

similar SE profile as other FGA non-phenothiazine.

longer acting form.

Atypical antipsychotics


Treats positive and negative symptoms of schizophrenia w/o significant EPS

• SE: EPS for all
• Clozaril: weekly blood draws for 6 months due to agranulocytosis. Monitor for NMS and EPS

• Monitor CBC and lipids for all. HDL > 40 
• LDL <100, Total cholesterol <200, Triglycerides <150

Anticholinergic drugs 

Acts on the EPS to reduce disturbing symptoms

anticholinergic SE

Alcohol deterrents

Prevents breakdown of alcohol-severe alcohol SE if alcohol ingested.

treatment of alcohol dependence-reduces craving. does not reduce withdrawal symptoms.

Benzodiazepines

Anxiolytic 

Adverse: Sedation, Drowsiness, Ataxia, Dizziness, Irritability, Blood dyscrasias, increased tolerance.

Administer at bedtime-Danger if combined with alcohol. Do not stop taking medication abruptly

• NonBenzodiazepine
• Anxiolytic

SE: Dizziness or daytime drowsiness

Ambien mainly used for short-term treatment of insomnia.

Remelteon- also used for long term treatment of insomnia.

Buspar may take several weeks for effects intended for short term use.

Tricyclic-Antidepressant- TCA-have also been used for OCD

Adverse: Anticholinergic effects, CNS sedation, Cardiovascular effects-tachycardiac, orthostatic, hypotension, prolongation of Qtc interval, GI effects N/V, Narrow therapeutic index.

2-6 for TCA avoid alcohol, lethal in overdose.

MAOI-antianxiety

• Adverse: tachycardia, anticholinergic, Hypertensive crisis(avoid- Aged cheese, red wine, beer, beef and chicken, liver, yeast, yogurt, soy sauce, chocolate, bananas.
• -Headaches, palpitations, increased BP

• SSRI-Antidepressant
• Takes 2-4 weeks. Wait 14 days between MAOI and SSRI switching.

Adverse: Insomnia, headaches, decreased appetite, dizziness, drowsiness. Sexual dysfunction, Weight gain.

Serotonin syndrome: Defined by at least 3 symptoms ( Rapid onset of AMS, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, diarrhea. 

Avoid St. johns wort.

• Atypical antidepressant
• used for insomnia, dementia with agitation, effective 2-4 weeks after treatment is initiated.

SNRI-antidepressant

Adverse: anticholinergic, sexual dysfunction withdrawal symptoms with abrupts cessation )agitation, tremors, headache, nightmares.

NDRI

Adverse: Insomnia, tremor, anoreia, weight loss, dry mouth, sleep disturbances, poor appetite, sexual dysfunction, sedation.

Lowers seizure threshold

Mood stabilizing drug

Therapeutic level: 0.5-1.5 mEq/L monitor first 2-3 days and once every 2-3 months. stay hydrated 1-2l a day. 

Diuretics induced sodium depletion can increase lithium causing toxicity: Coma, COnvulsions, and death may occur. 

• Adverse: nausea, fatigue, thirst, hand tremors, weight gain, hypothyroidism, early signs of toxicity, diarrhea, vomiting drowsiness, muscle weakness, lack of coordination.
• possible renal impairment

Lithium is excreted by kidney-Maintain adequate serum levels.

Assess electrolytes, Sodium.

baseline renal, cardiac, thyroid, salt usage consistent-more sodium in diet.

Anticonvulsant Mood Stabilizers

Adverse: Nausea, anorexia, hepatotoxicity, tremors, sedation, headache, dizziness, ataxia, blood dyscrasias, vision changes.

• Do not stop taking abruptly
• Bradycardia, hypotension, syncope, dysrhythmias.

Beta blockers can mask symptoms of hypoglycemia or may prolong a hypoglycemic reactions

Avoid Grapefruit juice with all medications especially CCB due to them potentiating the Hypotensive or bradycardia properties.

Elevated liver enzymes may cause Rhabdomyolysis. 

Obtain liver baseline-monitor every 6m-CPK levels. avoid grapfruit juice-report muscle tenderness. certain antibiotics may icnrease risk of Rhabdo by 40%.

• Fibric acid derivatives
•  Lowers elevated cholesterol

adverse: Diarrhea, dyspepsia, monitor liver, CBC and electrolytes every 3-6m.

• CK-MB specific to myocardial cells onset-4-8hr
• return to normal in 48 -72hour

• Troponin specific to myocardial muscle protein
• <0.03-Onset 1 hour
• returns to normal in 5-14 days

Fibrinolytic agents

Streptokinase: Adverse: anaphylactic response, hemorrhagic infarction, dysrhythmias. DO not administer heparin or oral anticoagulants until thrombin time is less than twice that of control.

Tenecteplase: can cause hypotension

Urokinase-non antigenic-has same adverse effects as streptokinase.-administer heparin or oral anticoagulant following urokinase therapy.

Alteplase: interacts with heparin increasing risk of bleeding. alters coagulation only at the thrombus not systemically. t-PA treatment of choice, half life is 3-7 mins.

Thiazides

Adverse: hypokalemia, hypercholesterolemia, sexual dysfunction.

monitor for gout, renal failure, increased risk for drug toxicity.

Loop diuretic

Adverse: Hypokalemia, hyperuricemia, sexual dysfunction-monitor electrolytes

Potassium-sparing diuretics

• Adverse: hyperkalemia, sexual dysfunction, watch for hyperkalemia with renal failure, ace inhibitors or nsaid use. 
• increased drug toxicity. give after meals.

Antihypertensive- ARB

Adverse: hypotension, renal failure, hepatitis, fatigue.

Combined alpha and beta

• Contraindicated with HF, HB, COPD and asthma.
• May cause dyshythmias.

Decreased BP with central alpha receptors. 

Rebound HTN if abruptly discontinued.

ACE-Inhibitors

Adverse- Proteinuria, neutropenia, COUGH

Remain in bed for 3 hours after first dose, observe for acute renal failure.

• Heparin: adverse-agranulocytosis, leukopenia, hepatitis: assess Ptt, Hgb, Hct
• Antagonist is protamine sulfate

Warfarin: Adverse-agranulocytosis, hepatitis, leukopenia. Assess: PT antagonist is vitamin K

Always monitor for signs of bleeding/stroke

• used for HF
• Positive inotropic effects and negative chronotropic, negative dromotropic.

Adverse: mainy, dysrhythmias, N/V, blurred vision, yellow-green halos, hypotension, fatigue

• Monitor electrolytes: hypokalemia increases risk for digoxin toxicity.  
• Check apical pulse: call if less than 60BPM

Therapeutic range is 0.5-2.0

• alkylating agent
• used for hodgkin disease, leukemia, neuro, retinoblastomas and multiple myeloma.

Adverse: cystitis, stomatitis, alopecia, bone marrow suppression, nephrotoxic, ototoxic, seizures.

Antitumor antibiotics

used for sarcoma, neuroblastoma, head and neck tumors, testicular, ovarian, breast cancer, hodgkin disease, AML and lymphocytic leukemia.

Adverse: bone marrow suppression, anorexia, n/v, alopecia cardiac toxicity.

Monitor for cardiac dysrhythmias urine will turn red and encourage voiding.

• Antineoplastic
• Comfort measures for stomatitis, maintain hydration.

can cause renal dysfunction, N/V, hepatitis, myelosupression.

Plant alkaloids-antineoplastic

Adverse: Neurotoxic-causes permanent neuropathy, weakness, bone marrow suppression, paresthesia, jaw pain, constipation, alopecia, headaches, stomatitis, n/v

Monitor for neurotoxicity

Corticosteroid. S&S related to increased cortisol/ adrenal gland hormones.

HTN, Hyperglycemia, decreased immune system, hirsutism, osteoporosis-increased calcium possibly, impaired wound healing.

Monitor potassium, glucose, sodium, daily weight checks. must taper off slowly.

Monoclonal antibodies

Adverse: bronchospasms, dyspnea, ARDS, hypotension, ventricular dysfunction or HF.

• systemic effects noted by receiving beam radiation: fatigue and altered tastes.
• tissue fibrosis and scarring, changes to organs underneath, alopecia, n/v, diarrhea, sexual and fertility changes, skin changes.

• Week 1: taste changes leads to nutrition issues.
• Week 2: thicker secretions dependent on what type of cancer you're being treated for.
• Week 3: more discomfort in throat
• Week 4: pain when swallowing
• Week 5: Skin changes
• week 6: severe sunburn to skin
• Week 7: thick secretions, more pain, dysphagia, breaks in skin like wet sunburn.