Nursing Pharmaclogy

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Naloxone: Trade name - Narcan
Narcotic Antagonist
Naltrexone: Trade Name - Revex
Narcotic Antagonist
Pentazocine: Trade Name - Talwin
Partial narcotic agonist
PO or injectable
Buprenophrine: Trade Name - Buprenex
Partial Narcotic Agonist
Injectable only
Butorphanol: Trade Name - Stadol
Partial Narcotic Agonist
Nasal Spray
Injectable
Nalbuphrine: Trade name - Nubian
Partial Narcotic Agonist
Injectable
Morphine: Trade Name - Many
Full Narcotic Agonist
Extensive first pass effect (90% loss)
rapid tolerance
P.O. or injectable (PCA Pump)
Codeine: Trade Name - Many
Full Narcotic Agonist
Use - Antitussive, Pain
Good Cough Relief
Meperidine: Trade Name - Demerol
Full Narcotic Agonist
DO NOT USE WITH MAOIs
DO NOT USE WITH SEIZURE DISORDERS
Methadone: Trade Name - Dolophine
Full Narcotic Agonist
Use - Detox of narcotic addicted patient, pain
Fentanyl: Trade Name - Oralet
Preanesthetic Med
Lollipop given 20-40 min prior to desired effect.
Also used for conscious sedation.
Also used transdermal (Duragesic Patch)
Risk of Hypoventillation
Hydrocodone: Trade Name - Vicodin, Lortab, etc.
Full Narcotic Agonist
P.O. use for pain
Risk for liver failure due to acetominophen in formula.
Oxycodone: Trade Name - Oxycontin, Percodan, Percocet, etc.
Full Narcotic Agonist
P.O. use for pain
Risk for liver failure due to acetominophen in formula.
Epinephrine: Trade Name - Many
Direct Acting Sympathomimetic
Receptors - ALL alpha and beta agonist.
Action - SNS Stimulation
Uses - Cardiac Stimulant (Children) Anaphylaxis, Used with local anesthetics to keep them local
Norepinephrine: Trade Name - Levophed
Direct-Acting Sympathomimetic
Receptors - alpha 1 agonist.
Action - Increased vasoconstriction reflex, decreased heart rate.
Use - Septic Shock
S.E. - Increased BP
Dopamine: Trade Name - Intropin
Direct-Acting Sympathomimetic
Receptor - Dapamine Agonist
Action-Low Doses:Good Renal blood flow
High Doses:Increased BP
Increases Cardiac Contractility
Uses - Shock
S.E.- Increased BP & HR
Dobutamine: Trade Name - Dobutrex
Direct Acting Sympathomimetics
Receptor - Beta 1 Agonist (Heart Only)
Action - Increases efficiency of heart beat and cardiac contractility
Use - DRUG OF CHOICE for Cardiac Stimulation.
S.E.- Increased HR
Phenylephrine: Trade Name - Neo-Synephrine
Direct-Acting Sympathomimetic
Receptor - Alpha 1 agonist
Actions - Vasoconstriction reflex
Uses - Paraxysmal Atrial Tachycardia (PAT), cold meds, Pupil Dilation.
S.E.- decreased HR
Ritodrine: Trade Name - Yutopar
Direct-Acting Sympathomimetic
Receptor - Beta 2 agonist
Action - Uterine relaxation
Uses - Prevent premature labor/delivery
S.E.- Fluid in respiratory system
Phenylpropanolamine: Trade Name - AYDS, Dymetapp, Dexotrim
Indirect-Acting Sympathomimetic
Receptor - Alpha 1 agonist
Action - Vasoconstriction
Uses - Congestion, Diet Aid
S.E.- HTN (10-30mm Hg), Axniety, Agitation
Pseudoephedrine: Trade Name - Sudafed
Indirect-Acting Sympathomimetic
Receptor - Alpa 1 Agonist
Action - Vasoconstriction
Uses - Nasal Congestion
S.E.- HTN (5-10mm Hg)
Phenoxybenzamine: Trade Name - Dibenzyline
Sympatholytic
Receptors - Blocks Alpha 1&2
Action - Vasodilation
Uses - Pheochromocytoma
S.E.- decreased BP
Phentolamine: Trade Name - Regitine
Sympatholytic
Receptors - Blocks Alpha 1&2
Action - Vasodilation
Uses - Shock, Control of Peripheral Resistance (Fast onset/offset)
S.E.- Decreased BP
Labetolol: Trade Name - Trandate
Sympatholytic
Receptors - Blocks Alpha 1, Beta 1&2.
Action - Decrease BP
Uses - HTN, esp. post-MI
S.E. Postural Hypotension
Propranolol: Trade Name - Inderal
Sympatholytic
Receptors - Blocks Beta 1&2
Actions - Vasodilation
Uses - HTN
S.E.- decreased HR, use with caution (if at all) in smokers, asthmatics, or diabetics. Decreased Exercise tolerance. Do not d/c abruptly!
Metoprolol: Trade Name - Lopressor, Toprol XL
Sympatholytic
Receptor - Beta 1 Specific
Uses - HTN, Less bronchospasm
S.E. decreased BP
Pilocarpine: Trade Name - Pilocar, OcusertPilo
Cholinergic
Receptor - muscarinic agonist
Use - Glaucoma
Bethanechol: Trade Name - Urecholine
Cholinergic
Receptor - muscarinic agonist
Uses - Urinary retention, GI Atony
Physostigmine: Trade Name - Antilirium
Cholinergic
Action - AChE inhibitor
Use - Glaucoma, anticholinergic toxicity
Donepizil: Trade Name - Aricept
Cholinergic
Action - AChE inhibitor
Use - Alzeimer's Disease
Atropine: Preanesthetic Med.
Anticholinergic - decreases secretions.
Scopolamine: Trade Name - Transderm Scop
Anticholinergic
Action - ACh antagonist
Uses - Motion Sickness
S.E.-Anticholinergic
Propantheline: Trade Name - Probanthine
Anticholinergic
Action - Large, Charged ACh agonist
Uses - Diarrhea, ulcers, (Local GI effect)
S.E.- Anticholinergic
Trihexyphenidyl: Trade Name - Artane
Parkinson's Disease Drug
Anticholinergic
Causes tachycardia
Causes mydriasis (excessive dilation of the pupil)
Benztropine: Trade Name - Cogentin
Parkinson's Disease Drug
Anticholinergic
Causes Tachycardia
Causes Mydriasis (excessive dilation of the pupil)
Succinylcholine: Trade Name - Anectine
Depolarizing Neuromuscular Blocker
(Only depolarizing in use)
Action - Shortest-acting:Onset 30 sec-1 min, duration: 5 min.
Uses - Facilitation of intubation, endoscopy.
S.E.- Watch for Malignant Hyperthermia
Curare: Trade Name - Mivacurium,Pancurium, etc.
Neuromuscular Blocker (paralytic)
Always use shortest acting, most reversible drugs.
Malignant Hyperthermia: Presents as muscle rigidity, tremors, and HIGH fever soon after exposure to neuromuscular blockers.
Treatment is to d/c the causative drug, bring temperature down with cooling measures (drugs won't work), and treat muscle spasms with Dantolene (Dantrium)
Topiramate: Trade Name - Topamax
Class- 2nd line anticonvulsant
Uses - Seizure, MIGRAINE prophalaxis, alcoholic/cocaine aversion, weight loss
Botox: Blocks ACh release from nerve terminals, relaxes muscles.
Metaxalone: Trade Name - Skelaxin
Muscle Relaxant
Baclofen: Trade Name - Lioresal
CNS Drug for muscle spasms
Pemoline: Trade Name - Cylert
CNS Stimulant
Uses - Narcolepsy, ADD
Less potential for abuse.
Methylphenidate: Trade Name - Ritalin, Concerta, Attendate, etc.
CNS Stimulant
Uses - Narcolepsy, ADD
DO NOT USE with MAOIs
DO NOT USE with seizure disorders
d-amphetamine: Trade Name - Dexedrine (Adderall, Strattera)
CNS Stimulant
Use - Narcolepsy, ADD
DO NOT USE with MAOIs
DO NOT USE with Seizure Disorders
Phenobarbital: Trade Name - Luminal
Anticonvulsant
MOA- Interacts with GABA receptor on nerve. This interaction increases chloride flux across nerve, causing decreased nerve firing.
Diazepam: Trade Name - Valium
Anticonvulsant
MOA- Interacts with GABA receptor on nerve. This interaction increases chloride flux across nerve, causing decreased nerve firing.
Used IV for status epilepticus (as are other BZDs), PO, IM for other seizure disorders.
Lorazepam: Trade Name - Ativan
Preanesthesia Med
Benzodiazepine (BZD)
Produces sedation and amnesia
Midazolam: Trade Name - Versed
Benzodiazepine (BZD)
Uses - Sedation, Amnesia, Induction of anesthesia
Alprazolam: Trade Name - Xanax
Benzodiazepine (BZD)
Use - Antianxiety
Olanzepine: Trade Name - Zyprexa
Atypical Antipsychotic
Use - Psychosis
ADRs - Headache, agitation, nervousness
Use - "Negative" symptoms of psychosis, mania.
DRUG OF CHOICE (DOC) for psychosis with negative symptoms (withdrawn,etc.)
Used to reorient a patient to society.
Risperidone: Trade Name - Risperdal
Atypical Antipsychotic
Use - Psychosis
ADRs - CNS Stimulation, EPS, headache
Used for "negative" symptoms of psychosis
Clozapine: Trade Name - Clozaril
Atypical Antipsychotic
Use - Schizophrenia in patients who cannot tolerate other antipsychotics.
ADRs - Very few EPS, but agranulocytosis may be seen.
Used for some of the "negative" symptoms of psychosis (because of 5-HT blockade).
Haloperidol: Trade Name - Haldol
Antipsychotic
Uses - Psychosis, Tourettes's Syndrome
ADRs - DRAMATIC EPS (worst of all drugs), withdraw slowly
Prochlorperazine: Trade Name - Compazine
Antipsychotic
Uses - Nausea and Vomiting
ADRs - Fewer EPS than chlorpromazine
Blocks DA Receptors in the Chemoreceptor Trigger Zone (CTZ), blocks vomiting.
Main drug used for vomiting
Thioridazine: Trade Name - Mellaril
Antipsychotic
Uses - Psychosis, hiccoughs
ADRs - Fewer EPS than chlorpromazine.
P.O. ONLY
Chlorpomazine: Trade Name - Thorazine
Antipsychotic
Uses - Psychoses, Schizophrenia, hiccoughs
ADRs - Extrapyramidal Symptoms, Sedation, Anticholinergic
This class of drugs called neuroleptics (blocked, dull, blunted emotions)Older drug, but still used.
Lithium: Trade Name - Lithobid, Eskalith
Treats Manic-Depressive Disorders.
Considerations - Increased Na levels cause decreased Li levels and vice-versa. Pt. on Na restriction, or in hot weather at risk for Li toxicity.
S.E.- Gi upset, polyuria, FINE TREMOR at theraputic doses. Chronic use may cause diabetes incipidius/dehydration with resulting Li toxicity.
0.5-1.5 mEq = Theraputic Dose
1.2 mEq = risk for toxicity
1.5-3.0 mEq = Coma, death
Phenelzine: Trade Name - Nardil
MAOI
Use - Depression when TCAs/SSRIs fail
ADRs - Interaction with foods that contain tyramine. Interaction with meperidine (demerol) and sympathomimetics (decongestants, etc) couse a huge release of NE, resulting in Hypertensive Crisis, seizures, Arrhythemia, strokes.
Paroxetine: Trade Name - Paxil
SSRI
Use - Depression, OCD, pain, PMDD (PMS), migraine.
ADRs - Nausia, nervousness (take in AM)
headache, anorexia. May increase risk of suicide (esp in teens). Decreased Sex Drive is main reason for d/c.
DO NOT STOP ABRUPTLY, due to mood swings, suicide ideation, psychosis, seizures.
Citalopram: Trade Name - Celexa
SSRI
Uses - Depression, OCD, pain, PMDD (PMS), migraine
ADRs - Nausia, nervousness (take in AM)
headache, anorexia, may increase risk of suicide (esp in teens) Decreased Sex Drive is main reason for d/c
Bupropion: Trade Name - Wellbutrin
Antidepressant
MOA - Blocks reuptake of NE & DA
Uses - Depression,OCD,pain,PMDD (PMS)Migraine
ADRs- Agitation, Headache, Dry mouth, constipation, weight loss, GI Upset, dizziness, tremor, insomnia, blurred vision, tachycardia, seizures
Fluoxetime: Trade Name - Prozac
SSRI
Use - Depression,OCD,PMDD (PMS), migraine
ADRs- Nausia, Nervousness (take in AM) headache,anorexia,may increase risk of suicide(esp in teens),decreased sex drive is main reason for d/c.
Is the only antidepressant approved for teens.
Safafem is "Girly Prozac"
Amitryptiline: Trade Name - Elavil
Tricyclic Antidepressant (TCA)
MOA- blocks reuptake of NE, 5-HT
Uses - Depression,Panic,Agoraphobia, OCD,pain,preventing migraines, Depression+Panic,Peripheral Neuropathies.
ADRs- Anticholinergic effects, sedating, 2-3 weeks before antidepressant effect is seen.
Isoflurane: Trade Name - Forane
General Anesthetic - Inhalation
Less arrhythmias than Halothane
Better skeletal muscle relaxation (with neuromuscular blocker on board)
Less potent than Halothane
Halothane: Trade Name - Flouthane
General Anesthitic - Inhalation
Most widely used.
Doesn't give good skeletal muscle relaxation.
May cause arrhythemias.
Nitrous Oxide: General Anesthetic - Inhalation
Used alone in Dental procedures
Used in conjunction with halothane for rapid induction and for analgesia/amnesia.
Lidocaine: Trade Name - Xylocaine
Local anesthetic - Amide class
Fast onset: <1 minute
Longer Duration: ~2 hours
All injection and topical forms of anesthesia may cause heart block or arrhythemias because ...caines block Na channels into excitable cells (e.g. heart muscle)
When giving by injection, ASPIRATE!
Bupivacaine: Trade Name - Marcaine
Local Anesthetic
Slow onset: >10minutes
Long Duration: 3+ hours
Used for spinal,epidural,infiltration, and nerve block anesthesia
May cause arrhythemias
When giving by injection, ASPIRATE!
Levodopa: Trade Name - L-Dopa
1st drug to treat Parkinson's Disease
Crosses BBB and is converted to DA.
98% of L-Dopa is metabolized in first pass effect.
Carbidopa: Trade Name - Lodosyn
Parkinson's Disease Drug
Inhibits dopa decarboxylase in the periphery.
Used togetherwith L-Dopa, eliminates much of the first pass effect.
Amantadine: Trade Name - Symmetrel
Antiviral Drug used to treat Parkinson's Disease.
Increases Dopamine release from nerve terminals.
Ketamine: Trade Name - Ketalar
Street Name - Special K
General Anesthetic - IM/IV
Produces dissociative anesthesia/analgesia
Poor muscle relaxation
Hallucinations common even after procedure.
Thiopental: Trade Name - Pentothal (truth serum)
General Anesthetic - IM/IV
Ultra-Short acting barbiturate
Rapid onset, brief duration: <15 min.
Used with nitrous oxide
Secobarbital: Trade Name - Seconal
Preanesthesia Med
Barbiturate
Ordered the night before surgery to induce sleep (3-6 Hours)
Hydroxyzine: Trade Name - Vistaril
Preanesthetic Med
Antihistamine that causes mild sedation
Ordered the night before the procedure to induce sleep.
Diphenhydramine: Trade Name - Benadryl
Preanesthetic Med
Antihistamine that causes mild sedation
ordered the night before the procedure.
Promethazine: Trade Name - Phenergan
Preanesthetic Med
Antipsychotic that is sedative, anticholinergic, antihistamine, antienetic, and enhances analgesia.
Droperidol: Trade Name - Inapsine
Preanesthetic Med
Antipsychotic that is sedative, anticholinergic, antihistamine, antiemetic, enhances analgesia
Glycopryrrolate: Anticholinergic, decreases secretions.
Gabapentin: Trade Name - Neurontin
Class- 2nd Level anticonvulsant
Uses - Adjunct for seizures, migraine, chronic pain, peripheral neuropathies.
ADRs- Fatigue, dizziness, aches and pains, edema.
Felbamate: Trade Name - Felbatol
Class- 2nd Line anticonvulsant
Use - severe epilepsy
Carbamazepine: Trade Name - Tegretol
Anticonvulsant
MOA- Stabilizes neuronal membrane by decreasing Na & K flux across membrane during an action potential.
Start with low dose, increase weekly.
Autoinduction
RED FLAG DRUG
Toxicity includes: bone marrow supression, sedation, vertigo, nausia,rashes (Stevens-Johnson Syndrome),hepatitis,fluid retention (increased ADH secretion)
Drug Interactions - MANY
Fosphenytoin: Trade Name - Cerebyx
Anticonvulsant
MOA- Stabilizes neuronal membrane by decreasing Na & K flux across membrane during Action Potential
May saturate enzymes responsible for its metabolism.
RED FLAG DRUG
Toxicity: nystagmus(Involuntary oscillation of the eyeball),ataxia,sedation, gingival hyperplasia, rashes(Stevens-Johnson Syndrome), Cardiovascular collapse with rapid infusion.
Drug Interactions - MANY
Phentoin: Trade Name - Dilantin
Anticonvulsant
MOA- Stabilizes neuronal membrane by decreasing Na & K flux across membrane during an action potiental.
May saturate enzymes responsible for its metabolism.
RED FLAG DRUG
Toxicity: Nystagmus (Involuntary oscillation of the eyeball), ataxia, sedation, gingival hyperplasia, rashes (Stevens-Johnson Syndrome), cardiovascular collapse with rapid infusion.
Drug Interactions - MANY
Narcotic Antagonists: Naloxone (Narcan)
Naltrexone (Revex)
Both treat narcotic overdose and reduce respiratory depression post-operatively.
Both WILL induce withdrawl syndrome - this may be life-threatening!
Considerations Using Benzodiazepines: BZDs have a high theraputic index, OD with alcohol may be fatal.

Dependence may occur (withdraw slowly)

Drug interactions with other CNS depressants (alcohol)
Considerations using Barbiturates: Barbiturates are inducers of microsomal enzymes (lots of drug interactions) RED FLAG DRUG.

These drugs can cause respiratory depression.

Physical/psychological dependence and tolerance (not to respiratory depression) with prolonged use.
Neuroleptic Malignant Syndrome: High Fever
Like an Allergic Reaction to Drug
Fever doesn't respond to antipyretics
Muscle rigidity

Is an emergency - take to ER
Need skeletal muscle relaxant, cooling blanket.
Anticholinergic Effects: Blurred Vision (Can't See)
Dry Mouth (Can't Spit)
Urinary Retention (Can't Pee)
Constipation (Can't Sh..)
Confusion
Agents that cause the greatest EPS cause the least anticholinergic effects
ALL antipsychotics are anticolinergic.
Tardive Dyskinesias: Involuntary movement of face, trunk, hands, extremities, affecting self-care

Late-developing, irreversible (after 2 years) due to supersensitivity of DA receptors.

Use drug holidays to avoid this, to reevaluate the CNS disorder, and maintain effectiveness of the drug.
Drug Interactions of Antipsychotics: Antipsychotics have an additive or synergistic effect with:
Alcohol, tell patient not to drink with antipsychotics.
CNS Depressants
Anticholinergics(decongestants, weight loss drugs)
Drugs with anticholinergic side effects
Side Effects Of Antipsychotics: Blockade of central DA Receptors causes

1)Extrapyramidal Symptoms (EPS)
2)Tardive Dyskinesias
3)Anticolinergic Effects
4)Sedation
5)Other:Orthostatic Hypotension, Photosensitivity,thermoregulatory effects.
6)Neuroleptic Malignant Syndrome.
Extrapyramidal Symptoms: Distonias(painful neck contractions)
Akathisias(restlessness)
Pseudo-Parkinsonism(tremor,rigidity, motor dysfunction) *30% incidence
Haloperidol (Haldol)has worst EPS

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