Nursing Drugs

• Diazepam (valium)
• Lorazepam (ativan)
• Alprazolam (xanax)
• Clonazepam (klonopin)

• Chlordiazepoxide (librium)
• Midazolam (versed)- •reduces anxiety and pt’s memory of uncomfortable or painful procedures that do not require general anesthesia •* limited to use as sedative and anesthetic during invasive medical or surgical procedures
• Action:
• •depress activity in the brainstem and limbic system

• propranolol (inderal) is a commonly used beta blocker- antianxiety for stage fright.
• bupropion (zyban)-is used for smoking cessation treatment

• •Trazodone (desyrel) – frequently prescribed for sleep.* ( need to monitor with males for side effect-priapism-inappropriate or prolonged penile erection)
• •Bupropion (wellbutrin)
• •SSRIs
• •Fluxetine (prozac)
• •Paroxetine (Paxil)
• •Sertraline (zoloft)
• •Fluvoxamine (Luvox)
• •Citalopram (celexa)
• •Mechanism of action
• •Selectively inhibit serotonin reuptake
• •Little or no effect on norepinephrine or dopamine reuptake
• •Results in increased serotonin concentrations at nerve endings
• •ADVANTAGE over tricyclics and MAOIs: little or no effect on cardiovascular system

• •Venlafaxine (effexor)
• •Nefazodone (serzone)
• •Mirtazapine (remeron)

• •BARBITUARATES – not commonly used in clinical practice for long-term treatment of anxiety due to produces many adverse effects and interactions; habit forming and low-therapeutic index (narrow dose range with in drug effectiveness and above that range is rapidly toxic)
• •Miscellaneous agent-buspirone (BuSpar) nonsedating and non-habit forming

• Phenelzine (Nardil)
• Tranylcypromine (Parnate)
• Disadvantage: potential to cause hypertensive crisis when taken with tryramine (amino acid found in aged cheese, or other aged, overripe, or fermented foods)
• Action:
• •Inhibit the MAO enzyme system in the CNS
• •Amines (dopamine, serotonin, norepinephrine) are not broken down, resulting in higher levels in the brain

• •Amitriptyline (elavil, endep)
• •Doxepin (Sinequan)
• •Imipramine (tofranil)
• •Desipramine (norpramine)
• •Nortriptyline (aventyl, pamelor)
• Action:
• •Block reuptake of neurotransmitters causing accumulation at the nerve endings

•clonidine (Catapres)

• •methyldopa (Aldomet)
• –Can be used for hypertension in pregnancy
• Action:
• –Stimulate alpha2-adrenergic receptors in the brain
• –Decrease sympathetic outflow from the CNS
• –Decrease norepinephrine production
• –Stimulate alpha2-adrenergic receptors, thus reducing renin activity in the kidneys
• •Results in decreased blood pressure

• •doxazosin (Cardura)
• •terazosin (Hytrin)
• •Results in
• –Decreased BP
• –Increased urinary flow

• •ProPranolol
• •Atenolol
• •Bystolic

• •Reduction of heart rate (beta1-receptor blockade)
• •Vasodilation (alpha1-receptor blockade) –carvedilol (Coreg) and labetalol
• –Result in decreased blood pressure

• –Treatment of hypertension
• –Some used to relieve symptoms of BPH
• •tamsulosin (Flomax)
• –Management of severe HF when used with cardiac glycosides and diuretics

• Drug of choice for diabetics.
• •captopril (Capoten)
• –Very short half-life
• •enalapril (Vasotec)
• –Available in oral and parenteral forms
• •lisinopril (Prinivil and Zestril) and quinapril (Accupril), others
• –Newer drugs, long half-lives, once-a-day dosing

•Captopril and lisinopril are NOT prodrugs

–Prodrugs are inactive in their administered form and must be metabolized in the liver to an active form so as to be effective

–Captopril and lisinopril can be used if a patient has liver dysfunction, unlike other ACE inhibitors that are prodrugs

• Does not produce dry caugh
• •losartan (Cozaar, Hyzaar)
• •valsartan (Diovan)
• •eprosartan (Teveten)
• •irbesartan (Avapro)

•Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction.

• •Benzothiazepines
• –diltiazem (Cardizem, Dilacor)
• •Phenylalkamines
• –verapamil (Calan, Isoptin)
• •Dihydropyridines
• –amlodipine (Norvasc), bepridil (Vascor), nicardipine (Cardene)
• –nifedipine (Procardia), nimodipine (Nimotop)

• •diazoxide (Hyperstat)
• •hydralazine HCl (Apresoline)
• •minoxidil (Loniten)
• •sodium nitroprusside (Nipride, Nitropress)

• —bumetanide (Bumex)
• —furosemide (Lasix)
• —torsemide (Demadex)
• Action:
• —Act directly on the ascending limb of the loop of Henle to inhibit chloride and sodium resorption
• —Increase renal prostaglandins, resulting in the dilation of blood vessels and reduced peripheral vascular resistance

• —amiloride (Midamor)
• —spironolactone (Aldactone)
• —triamterene (Dyrenium)
• Risk of hyperkalemia.
• Action:
• —Work in collecting ducts and distal convoluted tubules
• —Interfere with sodium-potassium exchange
• —Competitively bind to aldosterone receptors
• —Block resorption of sodium and water usually induced by aldosterone

• —Thiazide diuretics
• —hydrochlorothiazide HTZ (Esidrix, HydroDIURIL)
• —chlorothiazide (Diuril)
• —trichlormethiazide (Metahydrin)
• —Thiazide-like diuretics
• —metolazone (Mykrox, Zaroxolyn)
• Action:
• —Inhibit tubular resorption of sodium, chloride, and potassium ions
• —Action primarily in the distal convoluted tubule
• —Result: water, sodium, and chloride are excreted
• —Potassium is also excreted to a lesser extent
• —Dilate the arterioles by direct relaxation

• acetazolamide (Diamox)
• methazolamide (Neptazane)

CAIs block the action of carbonic anhydrase, thus preventing the exchange of H+ ions with sodium and water

• mannitol (Osmitrol)
• Action:
• —Work mostly in the proximal tubule
• —Nonabsorbable, producing an osmotic effect
• —Pull water into the renal tubules from the surrounding tissues
• —Inhibit tubular resorption of water and solutes, thus producing rapid diuresis

• •Adverse effects
• –G/I-MOM can cause diarrhea, Aluminum and calcium may cause constipation
• –F/E- can cause metabolic alkalosis

• –cimetidine (Tagamet)
• –rantidine (Zantac)
• –famotidine (Pepcid, Pepcid AC)
• –nizatidine (Axid)
• •Action
• –prevents histamine from stimulating the H2 receptors located on the gastric parietal cells
• –reduces the volume of gastric acid secretion

• –lansoprazole (Prevacid)
• –omeprazole (Prisolec)
• –pantoprazole (Protonix)
• –rabeprazole (Aciphex

• –sucralfate (Carafate)-used to tread stress ulcers
• –misoprostol (Cytotec)-miscarriage
• •Mechanism of action
• –reacts with gastric acid to form a thick paste to selectively adhere to the ulcer surface- these molecules of sulfated sucrose are attracted to and bind with the base of ulcers
• –decreases gastric acid

• –psyllium (Metamucil)-natural
• –methycellulose (Citrucel)-synthetic
• Action:
• –stimulates peristalsis by absorbing water increasing bulk of feces to form emollient gel and causes dilation of intestine initiating reflex bowel activity promoting bowel movement
• –used for chronic diarrhea

• –polyethylene glycol-electrolyte solution (Golytely), lactulose (Enulose), glycerin (fleet suppository)
• •Mechanism of action:
• –draws water into the G/I tract increasing fecal water content, resulting in distension, increased peristalsis, and evacuation

• –magnesium citrate (Citrate of Magnesia)
• –magnesium hydroxide (MOM)
• •Mechanism of action
• –draws water into the small intestine- are a salt
• –commonly used for rapid evacuation of the bowel in preparation for some GI diagnostic tests (colonoscopy)

• castor oil
• –cascara sagrada
• –senna/ sennosids (Senokot)/(Ex-Lax Gentile Nature)
• –bisacodyl (Dulcolax)
• •Mechanism of action– can affect entire GI tract, action is in proportion to dose, most likely of all laxatives to cause dependence
• –irritates intestine
• –stimulates peristalsis

• –docusate potassium (Kasof)
• –docusate calcium (Surfak)
• –docusate sodium (Colace, Correctol)
• •Mechanism of action- soften fecal impaction through the passage of water and lipids into fecal matter, facilitate easy bowel movements for patients with anorectal conditions (hemorrhoids), may be used prophalactially to prevent constipation in high risk patients

• –mineral oil
• Mechanism of action – eases passage of stool by preventing water from leaving the stool, lubricates the intestines

• –bismuth subsalicylate (Pepto-Bismol)
• –attapulgite (Kaopectate)
• –activated charcoal
• •Mechanism of action-
• –coats the walls of the G/I tract, absorbing the bacteria or toxins causing diarrhea
• –promotes intestinal adsorption of fluids and electrolytes

• –Atropine
• –Belladonna alkaloids (Donnatal)
• •Mechanism of action
• –Antimotility- decrease peristalsis, decrease muscle tone , used in combination with adsorbents and opiates

• –Codeine
• –loperamide
• –diphenoxylate/atropine
• •Mechanism of action- decrease bowel motility, secondary- reducing pain related to diarrhea and abdominal cramping, allow for water absorption due to decreased peristalsis

• Lactobacillus acidophilus (Bacid, Lactinex)
• Mechanism of action- suppresses growth of bacteria by restoring the natural flora of the bowel, they are natural organisms obtained from bacterial cultures, may need to be given post antibiotic therapy

• –scopolamine
• •Mechanism of action
• –depresses the chemoreceptor trigger zone in the CNS- block acetocholine receptors

• –meclizine (Antivert)
• –diphenhydramine
• •Mechanism of action
• –blocks HI receptors- inhibit acetocholine by binding with H1 receptors preventing cholinergic stimulation

• –thiethylperazine maleate (Torecan)
• –prochlorperazine (Compazine)
• •Mechanism of action
• –Depresses chemoreceptor trigger zone in CNS- block dopamine receptors

• –Metoclopramide (Reglan)
• •Mechanism of action
• –stimulates motility of upper G I tract- blocks dopamine in the CTZ desensitizing CTZ to impulses from the GI tract

• –ondansetron (Zofran)
• –granisetron (Kytril)
• Mechanism of action- block serotonin receptors in GI tract, CTZ, and VC

• •Fast acting (beta-2 selective)
• •albuterol (Proventil, Ventolin) – MDI/nebulizer
• •metaproterenol (Metaprel, Alupent) – MDI/nebulizer
• •terbutaline (Brethine, Bricanyl) – PO, SQ, inhaled

• •epinephrine-adrenaline (alpha, beta1 & 2) IV, SQ, inhaled
• (Primatene)
• •isoproterenol (Isuprel) (beta1 & 2) IV, inhaled

• •Long acting
• •salmeterol (Serevent) (beta-2 selective) Inhaled
• •DO NOT use in acute attack because is not fast acting
• Action:
• •Bronchodilates à inhibits bronchoconstriction induced by release of histamine/substances during antigen/antibody reactions or anaphylaxis
• •Relieves bronchospasm
• •Reduces airway resistance
• •Increases vital capacity

• •aminophylline (Aminophylline, Palaron) IV, Rectal
• •oxtriphylline (Choledyl, Apo-Oxtriphylline) PO
• •theophylline (Bronkodyl) PO
• •caffeine cup of coffee
• Action:
• •Mechanism of Action –
• •Increase cAMP …
• Direct effect on smooth muscle around airway … relaxes bronchial muscles around airway so when taking deep breath … à decreased resistance à bronchodilation
• •Stimulates CNS
• CARDIAC muscle à increase force of contraction
• •Produces diuresis- cardiac function, blood flow to the kidneys
• Inervention:
• •limit xanthine containing foods- colas, coffee, and chocolate – see same side effects as with caffeine

•block action of acetylcholine- prevent bronchoconstriction à produce local bronchodilation

• •ipratropium (ATROVENT) Inhalation
• •Ipratropium + albuterol (COMBIVENT) Inhalation

• •montelukast (Singulair) PO
• •zafirlukast (Accolate) PO
• •zileuton (Zyflo)
• Action:
• block leukotriene receptors …prevent constriction/mucous, etc.

•cromolyn sodium (Instal)- mouth/nose spray- used for exercise induced asthma

•nedocromil sodium (Tilade)-

• •Mechanism of Action
• •Mast cells: similar to lymphocytes but
• •Heavily located in tissues of respiratory tract
• •Stationary (do not circulate in blood stream)
• •Stabilize the membrane of mast cells to prevent release of histamine
• •histamine promotes …bronchoconstriction, vasoconstriction

• 1. beclomethasone (Vanceril, Beclovent)
• 2. budesonide (Pulmicort)
• 3. flunisolide (AeroBid)
• 4. fluticasone (Flovent)
• 5. triamcinolone (Azmacort)
• 6.dexamethasone (Decadron)
• given PO or IV (systemic)
• 7. cortisone (Prednisone) given PO
• 8. methylprednisolone (Solu-Medrol, Solu-Cortef) given IV- (systemic)

acetylcysteine (Mucomyst, Mucosil, Airbron)-

• •rifampin (Rifadin, Rimactane, Rofact)
• •isonazid (INH, Nydrazid, Lanizid)
• •pyrazinamide (PZA) -
• •Use sunscreen while taking PZA- susceptible to sunburn.
• •ethambutal (Myambutol)
• •Streptomycin
• •rifabutin (Mycobutin)

•Combination of INH and ethambutol has been found to be safe in pregnancy

• approved by FDA for symptomatic
• Treatment of AD
• acrine- in 1993
• Donepezil- in 1997
• Rivastigmine- 2000
• Galantamine- 2001
• Cholinergic hypothesis
• Cholinergic neurons are lost in AD
• Resulting in decreased levels of
• acetylcholine
• Cholinesterase inhibitors (ChEIs)prevent
• the breakdown of acetylcholine
• Benefits- increased cognition and day to day function and behavior symptoms
• Key to benefits from ChEIs- prompt
• initiation of therapy

• codeine sulfate
• meperidine HCl (Demerol)
• methadone HCl (Dolophine)
• morphine sulfate
• propoxyphene HCl (Darvon)
• hydromorphone (Dilaudid)
• fentanyl (Duragesic)
• tramadol HCl (Ultram)
• oxycodone (OxyContin, Roxicodone)

tylenol

• Acetic acids (Voltaren, Indocin)
• Carboxylic acids (salicylates) (ASA, Toradol)
• Propionic acids (Naprosyn, Aleve)
• COX-2 inhibitors (Celebrex, Vioxx)
• Fenamic acids (Ponstel)
• Napthylalkanones (nonacidic) (Relafin) Oxicams (Feldene)

allopurinol (Zyloprim)-reduce production of uric acid

colchicine - reduce inflammatory response to deposits of urate crystals in joint tissue

• probenecid (Benemid) \ increase excretion
• sulfinpyrazone (Anturane) / of uric acid in the urine

• auranofin (Ridura)
• Injectables:
• adalimumab (Humera)
• abatacept (Orencia)
• aurothioglucose }
• gold sodium thiomalate } (Aurolate)
• leflunomide (Arava)

barbituates, phenobarbitol, pentobarbital

• diazepam Valium
• lorazepam Ativan *
• Alprazolam Xanax
• oxazepam Serax
• chlordiazepoxide HCl Librium

• žShort acting
• ¡temazepam Restoril
• ¡triazolam Halcion

• žLong acting
• ¡estazolam Prosom
• ¡flurazepam Dalmane

• • zalepion Sonata
• • zolpidem Ambien
• • eszoplicone Lunesta

• ˜Barbitruates
• Phenobarbitol
• ˜Hydantoins
• Phenytoin – Dilantin
• Fosphenytoin - Cerebyx
• ˜Iminostilbenes
• Carbamazepine – Tegretol, Carbatrol
• Oxcarbazepine – Trileptal
• ˜Valporic Acid – Depakote, Depakene

• ˜Gabapentin – Neurontin- also used to treat neuropathic pain
• ˜Lamotrigine – Lamictal – also used for bipolar disorder
• ˜Pregabalin – Lyrica – schedule V controlld substance- more commonly used for neuropathic pain.

• ˜Direct-acting drugs
• acetylcholine (Miochol-E)-used for surgical miosis-rapid acting-short duration
• carbachol (Carboptic)
• pilocarpine (Pilocar) (also ocular insert form)-commonly seen
• ˜Indirect-acting drugs
• echothiophate (Phospholine Iodide)
• Action:
• ˜Cause pupillary constriction (miosis), which leads to reduced IOP caused by increased outflow of aqueous humor

• ˜brimonidine (Alphagan)
• ˜apraclonidine (Iopidine)-used to inhibit perioperative intraocular pressure increases rather than to treat glaucoma
• ˜epinephryl (Epinal)
• ˜dipivefrin (Propine)
• Action:
• ˜Mimic the sympathetic neurotransmitters epinephrine and norepinephrine
• ˜Stimulate the dilator muscle to contract
• Result is increased pupil size (mydriasis)
• ˜Enhance aqueous humor outflow through the canal of Schlemm
• IOP is reduced

• ˜Selective beta1-blocker
• betaxolol (Betoptic)
• ˜Nonselective beta1- and beta2-blockers
• carteolol (Ocupress)
• levobunolol (Betagan Liquifilm)
• metipranolol (Optipranolol)
• timolol (Timoptic, Betimol)-increases the outflow of aqueous humor as well as decrease in its formation.
• Action:
• ˜Reduce IOP by
• Reducing aqueous humor formation
• Increasing aqueous humor outflow
• ˜Do not affect pupil size, accommodation, or night vision

• ˜Topical ophthalmic preparations
• brinzolamide (Azopt)
• dorzolamide (Trusopt)
• ˜Oral forms
• acetazolamide (Diamox)
• Action:
• ˜Available in oral forms for treatment of glaucoma – these would be diuretics and can be used as adjunct to ophthalmic medications
• ˜Inhibit the enzyme carbonic anhydrase, which reduces aqueous humor formation in the eye
• ˜Result is decreased IOP

• ˜Glycerin usually tried first
• Can cause hyperglycemia
• ˜Mannitol used if glycerin is unsuccessful
• ˜Isosorbide and urea may also be used
• Action:

• ˜Create ocular hypotension by producing an osmotic gradient
• ˜Water is forced from the aqueous and vitreous humors into the bloodstream
• ˜Result is reduced volume of intraocular fluid, thus reduced IOP

• ˜Newer class of drugs for glaucoma
• ˜Three drugs
• latanoprost (Xalatan)
• •Most popular
• travoprost (Travatan)
• bimatoprost (Lumigan)
• Action:
• ˜Reduce IOP by increasing the outflow of aqueous fluid-not reducing its production
• ˜Increase uveoscleral outflow of fluid
• ˜Used in the treatment of glaucoma

• ˜Effects on eye color
• In some persons with hazel, green, or blue/brown eyes, eye color will change permanently to brown
• Color change occurs even if medication stopped

• Nondopamine-receptor agonists
• Ergot: bromocriptine
• Nonergot: pramipexole, ropinirole, apomorphine

• Dopamine replacement drugs
• Carbidopa, carbidopa-levodopa

• ˜MAOI inhibitors: selegiline, rasagiline
• COMT inhibitors: entacapone, tolcapone
• Presynaptic dopamine release enhancer: amantadine

• ˜Anticholinergic drugs
• Benztropine, others
• ˜Antihistamines
• Diphenhydramine

• ˜MAOIs break down catecholamines in the CNS, primarily in the brain
• ˜Selegiline is a selective MAOB inhibitor
• Causes an increase in levels of dopaminergic stimulation in the CNS
• ˜Used in combination with levodopa or levodopa-carbidopa

• ˜Amantadine (Symmetrel)
• Action: Indirect-acting
• Causes release of dopamine from storage sites at the end of nerve cells that are still intact
• Blocks reuptake of dopamine into the nerve endings, allowing more to accumulate both centrally and peripherally
• Does not stimulate dopamine receptors directly

• Tolcapone (Tasmar) and entacapone (Comtan)
• ˜Inhibit COMT, the enzyme responsible for the breakdown of levodopa, the dopamine precursor
• ˜Prolong the duration of action of levodopa; reduce wearing off phenomenon
• ˜Therapeutic effects of COMT inhibitors may be noticed within a few days; it may take weeks with other drugs

• ˜Nondopamine dopamine receptor agonists (NDDRAs)
• Ergot derivatives (bromocriptine and pergolide)
• Nonergot drugs (pramipexole, ropinirole, apomorphine)

• ˜Nondopamine dopamine receptor agonists (NDDRAs)
• Ropinirole (Requip)
• •Newer, nonergot NDDRA
• •Used for PD and restless leg syndrome
• Apomorphine (Apokyn)
• •Newer, nonergot dopamine agonist
• •Subcutaneous injection

• ˜Direct-acting
• Bromocriptine (Parlodel)
• ˜Directly stimulate dopamine receptors
• ˜Activate dopamine receptors and stimulate production of more dopamine
• ˜Pergolide (Permax) is another direct-acting drug with a different mechanism of action

• •Levodopa and carbidopa are CONTRAINDICATED in patients with angle-closure glaucoma
• •Common side effects:
• Cardiac dysrhythmias; hypotension; muscle cramps and GI disturbances.
• •DO NOT GIVE WITH ANTACIDS
• •Do not give with benzodiazepines or MAOIS
• ˜Levodopa preparations may darken the patient’s urine and sweat

• ˜benztropine mesylate (Cogentin)
• Also used to treat extrapyramidal symptoms caused by use of antipsychotic drugs
• ˜Trihexyphenidyl (generic only)
• ˜Antihistamines also have anticholinergic properties
• diphenhydramine (Benadryl)
• Action:
• ˜Anticholinergics block the effects of ACh
• ˜Used to treat muscle tremors and muscle rigidity associated with PD
• These two symptoms are caused by excessive cholinergic activity
• ˜Does not relieve bradykinesia (extremely slow movements)

• ˜ACh accumulates because of the imbalance of dopamine
• ˜As a result, overstimulation of the cholinergic excitatory pathways occurs
• Muscle tremors and muscle rigidity
• Cogwheel rigidity
• Pill-rolling movement of fingers and head bobbing while at rest