Pharm 3

Burn/wound healing, constipation, cold sores/increases menstrual flow and acute renal failure

prevent kidney stones, UTI prevention because it fights E Coli, vit C supp, antioxidants, digestive aid, decreased elimination of many drugs renally excreted/severe allergic reactions, diarrhea, stomach upset in large quantities

Anticholinergic/motion sickness, also postop nausea and vomiting, contraindicated in glaucoma, 72 hr transdermal patch behind ear

H1 receptors block acetylcholine in brain to relieve nausea and vomiting/Vistaril, Dramamine, Antivert, motion sickness, not all are effective as antiemetics, contraindicated with glaucoma, caution with peds

CNS depressants/Block dopamine from receptor sites and CTZ/prevents nausea and vomiting from drugs, radiation and surgery/innefective in motion sickness, cause sedation/Compazine and Phenergan most used

Reglan/increases GI motility and gastric emptying by releasing acetylcholine in GI tract/can cause extrapyramidal side effects, contraindicated in pts with breast cancer, seizure disorders or GI obstruction, for diabetic, chemo and postop

OndanSETRON and graniSETRON/used for chemo, radiation and postop

psychoactive substance in marijuana/Dronabinol/decreases perception of nausea, improves appetite, AIDS and cancer pts, glaucoma

• Take drugs before causative event
• Tea, broth, gelatins are good to try after acute vomiting
• Meds may cause drowsiness
• Take meds 30 before and every 4-6 hrs

• Omit antiemetic if pt is hypotensive or excessivly drowsy
• Side effects: sedation, anticholinergic effects, extrapyramidal effects, when used with other CNS can be addictive, so not drive or operate heavy machinery, decrease stimuli, help rest, oral care is important, replace fluids

ulcer on esophagus, stomach, or duodenum/from H pylori, NSAIDS, acid and pepsin/also smoking, ethanol, bile, aspirin, steroids, stress

epigastric pain=gnawing or burning 1-3 hrs after meals, relieved by food or antacids, nausea, vomiting, dyspepsia, heartburn

when amount of gastric juice that refluxes into esophagus exceeds normal limit=hyperacidity

• neutralize acids
• raise pH
• aluminum has low neutralizing capacity and slow onset and may cause constipation=Amphogel
• magnesium has high neutralizing capacity and rapid onset, may cause diarrhea=milk of magnesia

• calcium may cause acid rebound, kidney stones but has rapid onset
• Combinations may be used=maalox, mylanta both mg and al
• may also contain simethicone=antiflatulence
• may cause problems with absorbtion when taken with other meds

• histamine causes strong stimulation of gastric acid secretion
• inhibits basal secretion of gastric acid and secretion stimulated by histamine, acetylcholine and gastrin
• end in INE

• proton pump inhibitors
• inhibits gastric acid secretion
• Prilosec, Nexium, Prevacid, Protonix

• inhibits gastric acid secretion
• increases mucus and bicarbonate secretion
• Cytotec
• indicated for clients at high risk for GI ulceration and bleeding and taking high doses of NSAIDS
• contraindicated in preg, induces abortion

• prevent and treat peptic ulcer disease
• coats gastric and duodenal mucosa
• low incidence of adverse effects
• give 2 hrs before or after drugs
• dissolve in water in slurry

• multiple drugs needed to eradicate
• 2 antimicrobials= amoxicillin, metronidazole, tetracycline
• Pepto Bismol
• PPI or H2

• PPI's first choice in most pts
• H2 receptor drugs 2nd in defense
• antacids used prn for heartburn and ab discomfort
• simethicone for flatulence
• sucralfate must be taken b4 meals

• 2 common causes PUD=infection and NSAID use
• To minimize reflux:elevate HOB, small meals, avoid supine for 1-2 hrs after meals
• minimize fats, choc, citrus, coffee
• avoid smoking and obesity
• take meds with 8 oz water
• do not take OTC meds for > 2 weeks
• Cimetidine can increase toxicity of many drugs (rarely used now)

• Do not use Cytotec if pregnant or planning pregnancy
• Magnesium can cause diarrhea
• Aluminum or calcium can cause constipation
• For acute PUD, treatment for 4-8 wks
• antacids taken 1-2 hrs before meals or after meds

• Follow manufacturers recommendations for with/without foods
• Shake liquids before dosing
• Chew antacids and drink with water
• be aware of drug-drug reactions

• changes in metabolism of cholesterol, fat and pretein resulting in hyperglycemia (high blood sugar)
• cells need insulin to move glucose into cell

client does not produce insulin

client is resistant to insulin

• 70-120
• >126

• may occur in childhood or young adult but can at any age
• autoimmune disorder that destroys beta cells in pancreas
• NO insulin is produced so client requires insulin replacement
• Spmptoms: polyuria, polydipsia, polyphagia and weight loss
• Associated with more ketoacidosis, remal failure and end organ damage

• High blood sugars due to insulin resistance
• They produce insulin but cannot get into cells and cells starve
• Usually adults, gradual onset, often obese
• Controlled with diet and exercise, oral antidiabetics
• Associated with more heart attacks and strokes
• Risk factors: genetic, obesity, sedentary life, race (AA, hispanics, native americans)

• Only therapy for Type 1 pts
• May be used for type 2 if not controlled without other meds or lifestyle change
• Increased need for insulin:stress, . .
• Blood sugars determin amt insulin needed

• Abdomen: absorbs quickly (not w/i 2 in of naval)
• Arms: Absorb slower than ab
• Thighs and butt: Absorb slowest

• Humalog
• Onset 15 min, Peak: 1-2 hrs Duration 3-5 hrs
• Synthetic
• Used with longer acting insulin
• Doses taken immediately prior to eating

• Short acting
• Humalin R, Novolin R
• Onset: 30-60 min, Peak 2-3 hrs, Duration: 6-10 hrs
• Drug of choice in emergency, severe infections, surgery and preg
• Only insulin given IV

• intermediate
• Humalin N
• Onset: 1-2 hrs, Peak: 4-8 hrs, Duration: 10-18 hrs
• Long term use
• Cloudy fluid must be mixed before aspirating into syringe
• Hypoglycemia may be experienced mid to late afternoon

• NPH 70/30 Humalin or Novalin 70/30
• Cloudy and must be mixed
• O, P, D same as if taken separate

• Glargine (lantus) or insulin Detemir (levemir)
• Onset: 1-2 hrs, no peak, duration 24 hrs
• Provides small amounts all day long

• SQ with insulin syringe
• Room temp
• Discard after 30 days
• Keep in fridge

• Clear-Cloudy-Cloudy-Clear
• Inject air equal to insulin units
• Expel air bubbles and verify correct dose
• Rotate injection sites

• Thiazolidinediones
• Biguanides

• Sulfonylureas
• Glinides

Alpha-glucosidase inhibitors

• Increase endogenous insulin secretion0makes body make more insulin
• Side effects: hypoglycemia, weight gain, no specific effect on plasma lipids or BP, least expensive
• Glyburide, Glipizide
• Problem if allergic to sulfa

• Block enzymes that digest starches in small intestine
• Must be taken at beginning of meal
• S/E: Flatulence, ab discomfort, no effect on lipids or BP, no weight gain, contraindicated in pts with inflammatory bowel or cirrhosis
• Acarbose (precose)

• Decrease hepatic glucose production and increase insulin mediated peripheral glucose uptake
• S/E: diarrhea, ab discomfort, lactic acidosis, decrease in LDL and triglycerides, no weight gain, possible weight loss, contraindicated in pts with impaired renal function (monitor BUN and creatinine)
• Affects dyes in radiology so stop day b4 and 2 days after
• Metformin

• Decrease insulin resistance be making muscle and adipose cells more sensitive to insulin and suppress hepatic glucose production
• S/E: weight gain, edema, hypoglycemia with insulin, contraindicated in pts with abnormal liver function or heart failure
• improves HDL and triglycerides
• Avandia-risk for heart probs

• Stimulate insulin secretion (rapidly and for short duration) in presence of glucose
• Tak 30 minutes before meals
• Not taken if meal is skipped
• S/E: hypoglycemia, weight gain, no effect on plasma levels
• repaglinide

• Slows inactivation on incretin hormones DDP4
• Stimulates insulin secretion
• Slows gastric emptying
• Increases satiety
• S/E:potential for hypoglycemia, weight loss, nausea, vomiting, diarrhea
• Januvia

• Pregnancy: insulin injections only, no oral
• Pts with DM 2 may need more agents in conjuntion with diet and exercise
• Teach clients to monitor fingerstick BS
• Teach pts symptoms of hypoglycemia and hypoglycemia
• Have 2nd nurse double check doses
• Pts should wear medic alert bracelet

• Polyuria=increased urination
• Polydipsia=increased thirst
• polyphagia=increased hunger
• weight loss fatigue, infections, rapid onset, insulin dependant, genetic, 10-15 yrs

Tachycardia, irritability, restless, hungry, diaphoresis, depressioon

bee pollen, ginko biloba, glucosamine

basil, bay leaf, chromium, echinacea, garlic, ginseng,

• severe pain, decrease perception of pain, produce sedations, decrease effect of prostaglandin
• Schedule II (high abuse poten)
• Orally goes through significant first pass effect
• Metabolized in liver and excreted thru kidneys

• oral, IM, SQ
• oral doses larger than inject
• Effects may be therapeutic or adverse depending on use

• Analgesia
• CNS depression
• Depressed mental and physical
• REspiratory depression
• N/V
• pupil constrication

• Slowed motility
• Constipation
• Smooth muscle spasms in bowel and bilary tract

• Bind to opoid receptors in brain and spinal cods
• Activate endogenous analgesia system
• Used to prevent pain, relieve severe cough, slow GI tract
• Contraindicated in pts with respiratory dep, chronic lung dis, liver or kidney disease, increased intracranial press, allergy

• Reduce moderate to severe pain
• Schedule II
• Produce analgesia, CNS depression, respiratory depression, GI depression
• Activate endogenous analgesia system
• PO, IM SQ
• Contraindicated in liver disease, resp dep, lung disease, prostatic hypertrophy, ICP or hypersensitivity

• IV onset 10-20 min
• IM onset 30 m in
• SC onset 60-90
• PO peaks at 60 min with 5-7 hr duration

naturally occuring opiod alkaloid analgesic and antitussive

• similar to codeine
• often in combo
• Loritab=combo hydrocodone and acetaminophen

• Dilaudid
• semisynthetic derivative of morphine
• More potent than morphine

• Demerol
• Synthetic similar to morphine

• Dolophine
• Synthetic like morphine
• Often used in detox and maintaince of opoid addicts

• semisynthetic derivitave of codeine
• Also mixed with ASA or acetaminaphhen
• Percodan/Persocet

• Duragesic
• transdermal patch
• 72 hr duration
• chronic severe pain or cancer pain

• Reverse or block analgesia, CNS and respiratory dep and other effects of opiod agonists
• Complete and replace reseptors
• Narcan most common
• Therapeutic effect w/i minutes and last 1-2 hrs
• May require multiple doses

• Morphine drug of choice for severe pain (good for cancer pts)
• If 2 analgesics ordered, use least potent to relieve pain
• Non opoid/Analgesic combos-alternate or concurrent, synergistic effects (Lortab)

• Oral preferred
• IV for rapid relief
• PCA
• Continuous IV
• Epidural
• Rectal supp
• Skin patches

• Pain often undertreated
• Labor and delivery drugs may affect neonate
• Pain expression differs by age
• Calculate doses carefully!

• Use non drug measures and non opoids when possible
• Use opiods with short half life
• Start low and increase gradually
• May take longer to metabolize due to slower liver function
• Monitor urine output for kidney function

• Stay in bed 30-60 after injectable opoid
• Counsel on constipation prevention
• Take PO doses with water or after meal
• Do not crush long acting pills
• Do not cut patches
• Do not drive or operate heavy mach
• No alcohol or other sedative
• Adverse effects: low BP, sedation, confusion

• Check vitals:rate depth and rhythm
• If respiration less than 12/min delay/omit and call provider
• If BP low, call provider
• Lie down for injection and 30 min after
• Give IV doses slow in small amount
• Side rails up and call for assistance
• Have wasted meds witnessed and cosigned

• Statement of relief
• Decreases S&S of pain
• Sleep
• Increase in activity

• Respiratory depression
• Hypotension
• Excessive sedation
• N/V
• constipation

Act centrally and peripherally to block transmission of pain impulses

• Chemical mediators in most tissue
• Regulate cell function
• normal inflammatory response-causing pain, fever, edema
• Stimulated by infection, dehydration, act as pyrogens

• Cyclooxygenase is enzyme needed to produce prostaglandin
• ASA NSAIDS and Acetaminophen inactivate cyclooxygenases
• COX1 and 2-help you for clots
• block COX1 and you increase adverse effects
• block COX 2 and you increase therapeutic effects
• Best=Celecoxib

• Aspirin and most NSAIDS inhibit platelet aggregation
• platelets become slippery
• at risk for bleeding
• Acetaminophen and Cox2 do not affect platelet function

• PUD
• GI or bleeding disorders
• Caution in pts with asthma
• impaired renal function
• Allergic to ASA=possible allergy to non ASA NSAIDS
• ASA not for kids

• well absorbed orally
• onset of action 15-30 min, peak 1-2 hrs
• food slows absorption, but decreases GI effects
• Distributed to all body tissues and platelets (good for ppl with cardiovas disease because it makes platelets slippery and prevents clots

• well absorbed orally
• onset of action 30 min, peaks 1-2 hrs, lasts 4-6 hrs
• adults and kids take safely

• Strong antiinflammatory effect
• More seve adverse effects: GI ulceration, bone marros, hemo anemia
• IV indo used to treat patent ductus arteriosus in infants

• Pain relief, not for antiinflammatory
• Orally or IV
• parentarelly compares to morphine for post op pain relief
• limited to 5 days use because bleeding/kidney damage

• well absorbed orally
• peaks 3 hrs
• Dosed 1/day
• Low GI adverse effects
• May increase BP in pts with hypertension
• BLACK BOX warning: May increase rick of MI

• effective for mild pain relief
• no nausea, vomiting, or GI bleeding
• no interfecence in clotting
• no antiinflammatory effects
• peaks 1/2 to 2 hrs
• Toxic metabolite=do not give more than 4000 mg/day
• Do not use if kidney or liver disease

Tx: Gout by preventing uric acid production

• Usually taken together to treat pain from osteoarthritis
• Gluc may cause drowsiness, headache, GI distress
• Chondroiton may cause GI distress

• Can take COX 2 with daily low dose ASA
• If one NSAID not effective, try another
• For inflammation, improvement may occur 24-48 hrs with ASA, 1-2 wks with NSAID
• Avoid ASA week before surgery and after to avoid bleeding probs
• Avoid alcohol

• Take with full glass of water and food
• Do not take enteric coated with antacid
• Increase fluids with NSAIDS to protect kidneys
• Dont exceed 4000 mg acetaminophen per day
• Avoid alcohol, Watch for salicylate toxicity

• Increaced HR
• Tinnitus, dizziness, confusion, drowsiness, N/V

• Monitor for evidence of bleeding (black or tarry stools, bruises, bleeeding gums)
• Lab work: CBC for hemoglobin hematocrit
• BUN and Creatinine for kidney function
• Monitor intake and output:
• Intake 3000 mL per day
• Output 30-60 ML per day