major pharm review

8/11/2019 Major Pharm Review

1/14

Hematologic & Immune System MedicationsCLASSIFICATION

NAME

MECHANISM

OF ACTION

INDICATIONS SIDE EFFECTS NURSIN

CONSIDERAT

AND !ATIE

EDUCATIO

Cyto"an

Antineoplastic,immunosuppressa

nts

Death of rapidly

replicating malignant

cells.

or prevent an immune

response and suppressthe immune system

Cancers, lymphomas,

myelomas, leukemias.

Prevent organ transplantrejection.

Tx for autoimmune

diseases

! suppression"

#pancytopenia$,

%&'&D, hepatotoxic,alopecia, cardio(

pulmo. fi)rosis

*x for infecti

*x for hemor

!onitor '+!onitor kidn

# fluids$

Take meds -&meals.

Folic Acid

Antianemic,

vitamin

!aintains and restores

normal erythropoiesis.

Prevention and Tx of

megalo)lastic anemias.During pregnancy"

promotes normal fetal

gro-th. Prevent %TD.

Allergic *x

*ashesfever

!onitor folat

/levels0 1 0

2ncourage to

foods in 3oacid"

#veggies, orgameats$

Cyanoco#alamin

e

$%it '()*

Antianemic,

vitamin

Corrects manifestations

of pernicious anemia.

#!egalo)lastic anemia,45 lesions, and neuro

damage$

'it./ deficiency, to

meet demands.

Confirmed -& +chilling

Anaphylaxis

Diarrhea

5tching0ypokalemia

Pain at inj. site

4iven 5!

6ife(long

medication4ive -& meal

2ncourage to

animal produ

Fe++ous Sul,ate

5ron supplement,

antianemic

Prevent and Tx iron

deficiency.

%eed for hemoglo)information.

Prevent and Tx iron

deficiency anemia.

45 upset #constipation,

dk stools$,hypotension,

+ei7ures, stains teeth#P8$ or skin #5!$,Anaphylaxis

Assess )o-el

dk stool #( oc)ld$

!onitor P a0*9 0102ncourage to

gr. leafy vegg

and organ me

take -& 8: to a)sorp.

P8" ;se stra-

track 5!

Lo-eno"

#2noxaprin$

Anticoagulant,

lo- molecular

heparin

Prophylactic&

Prevention of further

throm)us #clot$formation.

D'T,

P2( throm)oem)oli,

ischemic complications9

(prevents clots, especially inimmobile patients).

leeding, anemia,

throm)ocytopenia,

di77iness, 0A,constipation, %&'

Assess s&s of

)leeding and

hemorrhageAssess nuero

pulmonary fx

!onitor CCAntidote"

!+otamine su

E.ogen

#2rythropoetin$

0ormone,antiane

mic

!aintains and may

elevate *Cs

Tx of anemia assoc. -&

renal failure or A5D+

therapy.

0T%, arthralgias,

fatigue, 0A,

+25


2/14

ast+ointestinal System MedicationsCLASSIFICATION

NAME

MECHANISM

OF ACTION


CONSIDERATIONS

!ATIENT EDUCATI

Lactulose

8smotic, laxative

-ater content and

softens the stool. p0 of colon= %0>

Tx of chronic

constipation!anagement of

hepatic

encephalopathy.

elching, cramps,

distention,flatulence, diarrhea,

hyperglucemia

Assess a)dominal

distention, )o-el soustools

!onitor mental statu

4, %0>Take -& fruit juice

Desmo.+essin

#DDA'P$

0ormone,

antidiuretic &vasopressin

Controls )leeding in

hemophilia.Prevents nocturnal

enuresis

!aintains approp.

-ater content inDia)etes 5nsip.

Controls )leeding in

hemophilia!anagement of

nocturnal enuresis9

Tx of D.5.

Dro-siness,

pharyngitis, drymouth, anaphylaxis

Assess allergy sympt

lung sounds and )ronsecretions

!aintain fluid intake

?@@(/@@@ ml&dayAvoid 28T0

Neomycin

Aminoglycosides$

Anti(infectives

acterialcidal action.

Po-erful anti)ioticsused to treat serious

infections caused )y

gram #($ )acteria

To suppress 45

)acteria= %0>=preventing hepatic

coma.

Tx for skin -ounds

and infections

8totoxicity,

nephrotoxicity,hypomagnesium,

muscle paralysis,

hypersensitivity

+hort(term 5' or 5!

Assess for infection, daily -eight,

0earing loss

!onitor mental statu

renal fx

/antac

$Ranitidine*

Tagamet

$Cimetidine*

Antiulcer agents,

histamine 0/antagonist

0ealing and preventingulcers. symptoms of

42* and secretions ofgastric acid.

Prevents acidinactivation of

pancreatic en7ymes.42*D, multiplepeptic ulcers.

Prevent and Tx

heart)urn, acid

indigestion, sourstomach

Confusions, 0A,di77iness,

arrhythmias,impotence,gynecomastia,

throm)ocytopenia

Take meds )efore meand )edtime

Dont stop taking mea)ruptly%o 28T0 or other C

depressants

Avoid taking meds

antacids*educe stress and he

heal ulcers

Assess a)dominal paoccult )lood,

!onitor CC

/


3/14

Neu+ological System MedicationsCLASSIFICATION

NAME

MECHANISM

OF ACTION


CONSIDERAT

AND !ATIEN

EDUCATIO

Rilu0ole

$Rilute1*

4lutamate

antagonist

2xact mechanism of

action in A6+ isunkno-n.

+lo-s the deterioration

of motor neurons )ycounteracting the

excitatory

glutaminergic

path-ays.

+lo-s the progress

of Amyotrophic6ateral +clerosis.

!ay delay the need

for a tracheostomy,not a cure for A6+.

Di77iness, tiredness,

upset stomach, stomachpain, diarrhea,

muscle -eakness or

aches, anorexia, 0A

!onitor liver fu

liver en7ymes.!onitor BC.

Take on an empt

stomach # hour)efore or / hour

meals$. Avoid dr

or eating a lot of

caffeine. Avoid echarcoal()roiled

foods.

!+ostigmin$neostigmine*

Anticholinesteras

e

Antimyasthenics,cholinergics

Provide symptomaticrelief )y concent. 8favaila)le Ach at

neuromuscular junction

= muscle fx.

5mproved )ladder(emptying in pt -ith

urinary retention.

5mprovement inmuscle strength in!4.

Prevention and Tx

of post(op )ladder

distention andurinary retention or

ileus.

+25


4/14

'aclo,en

Antispasticityagents, skeletal

muscle relaxants

5nhi)its reflexes at

spinal level.

muscle spasticity9)o-el and )ladder fx

may also )e improved.

Tx of reversi)le

spasticity due to

!+ or spinal cordlesion

+25


5/14

enitou+ina+y System MedicationsCLASSIFICATIO

N NAME

MECHANISM

OF ACTION


CONSIDERATIO

!ATIENT EDUC

DIURETICSLoo. Diu+etics

3urosemide#6asix$

umetanide#umex$

2thacrynic acid

#2decrin$

5nhi)it sodium 1

chloride rea)sorption

from loop of 0enle anddistal renal tu)ule.

renal excretion of0/8, %a, Cl, !g, 0, and

Ca.

'asodilation=peripheral resistance=P

2dema associated

-ith"

C03

0epatic or

renaldisease

Adjunct therapy

for control of

0T%.

Di77iness, 0A, tinnitus,

hypotension, %&'&D,

constipation, dehydration,hypokalemia,

hyperglycemia,hyperuricemia,neutropenia,

agranulocytosis, cramps,

Throm)ocytopenia,spasms

!onitor '+ #P

and fluid status

!onitor daily -5&8, serum elec

values.

Assess edema #

1 location$, lun

sounds, skin turmucous mem)r

!onitor potass

levels #.?(?.@$.

!onitor )lood

#@@ mg&d6$ (in loop&thia7

diuretics.

!otassium7

s.a+ing

Diu+etics

+pironolactone

#Aldactone$

Amiloride#!idamor$

Triamterene#Dyrenium$

Beak diuretic andantihypertensive.

locks effects ofaldosterone in renal

tu)ule, causing loss of

%a and 0/8 andretention of potassium.

Preventshypokalemia

caused )y other

diuretics.;sed -ith other

diuretics to treat

edema or 0T%.Spironolactone:

0yperaldosteronis

m. !anagement ofC03.

Di77iness, 0A, cramps,%&'&D, urinary freFuency,

-eakness, hyperkalemia.

Spironolactone:

Clumsiness,

gynecomastia, amenorrhea

Change positionto prevent 80.

5f receiving dig-atch for digita

toxicity.

foods high inpotassium #)an

oranges, potatofish, raisins$

Take in A! to

sleep distur).

?


6/14

Osmotic

Diu+etics

!annitol

#8smitrol,

*esectisol$

Pulls -ater into )lood

vessels and nephrons

from surroundingtissues= inhi)its

rea)sorption of

0/8 and electrolyes,along -ith toxins from

kidney.

Adjunct tx of "

8acute oliguricrenal failure

8edema

85CP or

intraocular pressure

8excretion of toxic su)stances.

Confusion, 0A,

hypotension, rash, nausea,

anorexia, dry mouth,thirst, diuresis,fluid and

electrolyte im)alances.

*eport to !D"

0* or syncope,gain /l)s or mo

*eport adverse %&'&D

0ypokalemia #m

-eakness 1 t-lethargy, irregu

pulse$

enitou+ina+y System MedicationsCLASSIFICATIO

N NAME

MECHANISM

OF ACTION


CONSIDERATIONS

!ATIENT EDUCAT

!2os.2ate

'inde+s

Se-elame+

#*enagel$

electrolyte

modifiers

inds -ith phosphate

in the 45 tract,

preventing itsa)sorption.

*eduction of the

level of

phosphorus in the)lood of patients

-ith end(stage

renal disease

#2+*D$.

%ausea

'omiting

Diarrhea

Dyspepsia

Constipation

3latulence

Assess 45 side effe

!onitor serumphosphorus, calcium

)icar)onate, chlorid

levels

+-allo- -hole #Do

crush or che-$

Take all other

medicines at least ohour )efore or three

hours after.Take -ith meals.

Aluminum

2yd+o"ide

#Alu(Cap$

antacids,

phosphate

)inders

Prevent a continuingrise in serum phosphate

levels )y decreasing the

a)sorption ofphosphate from

intestinal tract

%eutrali7es gastric acidand inactivates pepsin

Treatment for0yperphosphatemi

a, hypocalcemia in

C*3.

Adjuct therapy in

treating gastric

ulcers,hyperacidity,

indigestion.

Constipation

0ypophosphate

mia

** Prolong use leads to

toxicity: neuro symptoms

and osteomalacia. M

may recommend !alcium!arbonate instead**

Assess gastric pain!onitor phosphate

calcium levels.

Take -ith full glass

-ater

+hould )e s-allo--hole @(? minut

)efore meals.

G


7/14

Calcium Salts

Calcium

acetate

#Calphron,

Phos6o$

Calciumca+#onate

#Titralac, Calci(che-$

Calcium

gluconate

#Halcinate$

!ineral 1

electrolyte

replace&supplements

!aintain cell

mem)rane and

capillary permea)ility.

*eplacement of

calcium deficiency.

Control ofhyperphosphatemia in

end(stage renal disease-ithout promoting

aluminum a)sorption.

!alcium carbonate:

!+otects 2ea+t ,+om

e,,ects o,

2y.e+1alemia

Tx and prevention

of hypocalcemia.

2mergency tx of

hyperkalemia and

hypermagnesemiaand adjunct in

cardiac arrest.

!alcium acetate:Control of

hyperphosphatemi

a in 2+*D.

!alcium

carbonate:

!ay )e used asantacid.

Cardiac Arrest

Arrhythmias

radycardia

Constipation

Phle)itis

+yncope

Tingling

Calculi

0ypercalciuria.

!onitor '+ #P 1

and 2C4 freF.

8)serve for s&s of

hypocalcemia#paresthesia, muscl

t-itching, colic$

!onitor pt on digitglycosides for sign

toxicity.

!onitor phosphate

levels and electroly

3or0yperphosphatemi

hypocalcemia9 mus

take -ith food.

Endoc+ine System MedicationsCLASSIFICATIO

N NAME

MECHANISM

OF ACTION


CONSIDERATIONS

!ATIENT EDUCAT

Synt2+oid

#levothyroxine$

0ormones,

thyroidpreparations

meta)olic rate of)ody tissues.

*estores normal

hormone )alance.

+uppresses thyroidcancer.

*eplacement&su)stitution in

diminished or

a)sent thyroid

function.Thyroid cancer

#thyrotropin(

dependent$

5rrita)ility, 5nsomnia,0A, arrhythmias,

tachycardia, -eight

loss, Cardiovascular

Collapse, 0T%, C8

Assess AP 1 P. 3tachyarrhythmias 1

chest pain.

!onitor thyroid

function9 )lood 1 uglucose.

4ive )efore )reakf#to avoid insomnia$

I


8/14

Ta.a0ole

#methima7ole$

!+o.ylt2iou+acil

#PT;$

Thioamides,

Antit2y+oidagents

Prevents the formation

of thyroid hormone

-ithin the thyroidcells= serum levels

of thyroid hormone.

"loc#s the utili$ation o%

iodine& preventssynthesis o% thyroid

hormone

Palliative

treatment of

hyperthyroidism.

*ash, %&', lethargy,

dro-siness,

)radycardia,Agranulocytosis

Methima$ole:

! suppression

P':45 distress

Monito+

2y.e+t2y+oidism

+es.onse#tachycardipalpitations, insomnia,fever, heat

intolerance, tremors, -

loss$

Monito+

2y.ot2y+oidism#intolerance to cold,

constipation, dry skin, -eakness$

Assess skin for rash

or s-ollen nodes.4ive )efore )reakf

+eafood and iodine

may )e restricted.!onitor CC 1

differential.

!onitor for s&s ofinfection or )leedin

'+omoc+i.tine

#Parlodel$

Dopamine

agonist&antineoplastic

Direct dopamine

agonist on dopaminereceptor sites in

su)stantia nigra.

5nhi)its 40 secretion.Antiparkinson agent.

Tx of acromegaly.

Tx of Parkinson9

hyperprolactinemia assoc. -ith

pituitary

adenomas, femaleinfertility assoc.

-ith

hyperprolactinemia.

Confusion, di77iness,

hypotension, %&', 0A,visual distur)ances,

a)dominal pain, leg

cramps, fatigue, nasalcongestion

!onitor thyroid

function, glucosetolerance, and 40

levels.

Assist -ith am)ulaAvoid tasks that reF

alertness, motor ski

until response to drTeach contraceptiv

#other than P8$Calcium

gluconate

!ineral 1electrolyte

replace&

supplements

Act as activator intransmission of nerve

impulses and

contraction of cardiac,skeletal, and smooth

muscle.

3or

hypoparathyroidis

m.

*eplacement of Ca

in deficient states.

Arrhytmias,constipation, phle)itis,

cardiac arrest

Assess 1 monitor" 2C4, 1 renal fx

Assess 1 monitor

electrolytes" !g, P!onitor serum and

urine Ca levels

5'( push slo-ly, ta)@ min(hr after m

liFuids )efore meal

Mine+al7

co+ticoids

Flud+oco+tison

e

#3lorinef$

0ormones&

corticosteroids

%a rea)sorption inrenal tu)ules and H

and 0 excretion= %a1 0/8 retention

Adrenal

insufficiency#Addisons$9

replacementtherapy in

com)ination -ith

glucocorticoid.Tx of salt(losing

adrenogenital

syndrome.

3rontal and occipital

0A, arthralgia,-eakness, )lood

volume, edema, 0T%,C03, rash, anaphylaxis,

hypokalemia

Assess '+, )reath

sounds, -eight, tissturgor9 reflexes and

)ilateral grip strengserum electrolyte.

!onitor for

hypokalemia.Avoid infections9 a

fresh fruits and veg

or -ash very carefu

J


9/14

Endoc+ine System MedicationsCLASSIFICATIO

N NAME

MECHANISM

OF ACTION


CONSIDERATIO

AND !ATIEN

EDUCATION

luco7

co+ticoid

Celestone

#)etamethasone$

Co+tisone

#Cortone

Acetate$

Co+te,

#hydrocortisone$

Med+ol#methyprednisol

one$

Delta7Co+te,

#prednisolone$

Deltasone

#prednisone$

Corticosteroids

5nitiate complex

reactions responsi)lefor

anti(inflammatory and

immunosuppressiveeffects.

Causes release of

epinephrine fromadrenal medulla.

+timulate of glucose

levels for energy.

Bhen com)ined -ithmineralocorticoids

some of these drugs

can )e used in

replacement therapyfor adrenal

insufficiency.

!anagement of adrenal

insufficiency.

;sed systemically and

locally for chronic

diseases including"inflammatory, allergic,

hematologic,

neoplastic, autoimmune

disorders.

5mmunosupressant s in

prevention of organ

rejection.

!anagement of acutespinal cord injury

(methylprednisolone)

Depression

euphoria

0T% Peptic ulcers

%&'

-ound healing

Adrenal

suppression

0yperglycemia

Beight gain

%a 1 0/8

retention

C03 5mmunosuppressi

on

8steoporosis

!uscle -asting

Cushingoid

appearance.

Administer daily

A!.

Do not discontin

a)ruptly.

Protect from

infection or inva

procedures.

Caution in pts -

D! or peptic ul

!onitor 5&8, dai-eight 1

electrolytes.

+igns of fluid

retention.

4ive -ith meal.

!onitor for s&s oadrenal insuffici

#0A, hypotensio

-t. loss, -eakne

K


10/14


11/14

Digo"in

#6anoxin$

Digitalis

glycosides

force of

myocardial

contraction. cardiac output

and heart rate.

Tx of C03, atrial

fi)rillation 1

atrial flutter,tachyarrhythmias

0A, -eakness,

dro-siness, visual

distur)ances, %&'arrhythmias,

fatigue,

)radycardia, 45upset

!onitor apical pulse for

min )efore administration.

0old if NG@ )pm.!onitor pulse, -t., 5&8 and

2C4.

Adm. 5' slo-ly O? min,avoid 5!.

!onitor electrolytes 1digoxin levels

Therapeutic level" @.?(/9toxic O/

0ave Digoxin immune 3A

availa)le.

Multi7System MedicationsCLASSIFICATIO

N NAME

MECHANISM

OF ACTION


CONSIDERATIONS AND

!ATIENT EDUCATIONDo.amine

vasopressor&adre

nergic

+m. Dosesstimulate

dopaminergic

receptors,producing renal

vasodilation. 6g.

doses stimulate

dopaminergic and)eta adrenergic

receptors,

producing cardiacstimulation and

renal vasodilation

Cardiac output,P, and improves

renal )lood flo-.

Tachycardia,ectopic )eats,

anginal pain,

hypotension,dyspnea, %&', 0A

!onitor P, 0*, 2C4,cardiac output, and urinary

output continuously.

*eport chest pain, dyspnea,num)ness, tingling, or

)urning of extremities.

Inde+al

#propanalol$

eta )lockers

locks )eta(

adrenergic

receptors in theheart and kidney,

has a mem)rane(

sta)ili7ation effect

and influence ofsympathetic

nervous system. 0* 1 P,suppression of

arrhythmias 1

prevent !5

!anagement of

0T%9 angina

pectoris9arrhythmias.

Prevention and

management of

!5.Prevent vascular

0A.!anagethyrotoxicosis.

radycardia,

C03, cardia

arrhythmias, heart)locks, C'A,

pulmonary

edema, gastric

pain, flatulence,%&'&D, exercise

tolerance,impotence.

!onitor P and Pulses

Pts on 5' must have

continuous 2C4 monitor.0ypotensive effect is

associated -ith cardiac

output.

Dont stop med a)ruptly, itthro-s in L heart )lock


12/14

Code D+ugsCLASSIFICATION

NAME

MECHANISM

OF ACTION


CONSIDERATIONS

AND !ATIENT

EDUCATIONE.ine.2+ine

Adrenergic,

sympathomimetic

*eacts at alpha(

and )eta(

receptor sites inthe +%+ to

cause

)ronchodilation,

0*, **, P.

Treatment of shock,

)ronchospasm.

!anagement ofsevere allergic

reactions, cardiac

arrest.

%ervousness, tremor

restlessness, angina,

arrhythmias, 0T%,tachycardia, 0A, %&'

insomnia,

hyperglycemia

Assess pulmonary

function" lung sounds,

respiratory pattern9pulse, P.

!onitor 2C49 for

arrhythmias, chest

pain.Correct hypovolemia

prior to 5' use.

!ay cause serum H

and glucose.Sodium

'ica+#onate

Antiulcer,

alkalini7ing

%eutrali7es or gastric

acidity=

gastric p0.

Acts asalkalini7ing

agent )y

releasing)icar)onate

ions.

*elief ofhyperacidity9

!anagement of

meta)olic acidosis9

Treatment of certaindrug intoxications.

!eta)olic alkalosis,gas,

4astric acid re)ound,

hypernatremia,

hypocalcemia,hypokalemia, %a 1

0/8 retention

Assess 45 1 renalfunction, serum

electrolytes.

Assess signs of

acidosis&alkalosis,A4s

Do.amine

Adrenergic,sympathomimetic

inotropics,

vasopressors

+timulatesdopaminergic

receptors"cardiac output,

P, and

improved renal

)lood flo-

Choice for tx ofshock. Arrhythmias, angina,0ypotension,

tachycardia, dyspnea,%&', 0A,

!onitor P, 0*,2C4, C8.

!onitor urinary outputfreFuently.

Palpate peripheral

pulses and assess

appearance ofextremities.

At+o.ine

Anticholinergic,antiarrhythmic

5nhi)its the

action of

acetylcholine,)locking the

effects of

parasympathetic

%+.0*, 45 1

respiratory

secretions.

Antidote for

cholinergic 8D and

mushroom poisoning.Pre(op to

secretions.

*estores cardiac rate

and arterial pressure.

Dro-siness, )lurred

vision, tachycardia, dry

mouth, urinaryhesitancy, constipation,

decreased s-eating.

Assess '+ and 2C4.

!onitor 5&8.

Assess a)domen and)o-el sounds.

8)serve for toxicity or

8D9

antidotephysostigmine.

4ive @ mins. )efore

meals.

/


13/14


14/14

Nit+oglyce+ines

Antianginal,nitrates

*elief or

prevention of

anginal attacks. cardiac output

P

Acute 1 long term

prophylactic

management ofangina pectoris.

Adjunct tx of C03

1 acute !5.Production of

controlledhypotension.

Di77iness, 0A,

hypotension,

tachycardia,restlessness, )lurred

vision, rash, flushing,

%&', -eakness.

0A is common s&e.

Assess anginal pain.

!onitor P 1 pulse.

!onitor 2C4.P8" Administer hr

)efore or / hr after

meals -& full glass of-ater.

+6" 0old ta)let undertongue until dissolved9

avoid eating ordrinking.

Change position slo-ly

#prevent 80$

Do#ut+e"

#Do)utamine$

Adrenergics,

inotropics

5ncreasedcardiac output

-ithout

significantly

increased heartrate.

Treatment of C03)ecause

myocardial

contractility -ithout

much change in rateand doesnt 8/demand of heart

muscle.

0T%, 0*, prematureventricular

contractions, +8, 0A,

angina pectoris,

arrhythmias,hypotension, %&',

phle)itis.

!onitor P, 0*, 2C4,C8, urinary output.

Palpate peripheral

pulses and assess

extremities.!onitor electrolytes,

;%, Creat,

prothrom)in time.Check for signs of

extravasation.

>

major pharm review

Documents