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CNS=brain and spinal cord

Adrenergic system, think adrenaline.Neurotransmitter=norepinephrine

Sympathomimetic= adrenergic agonist

Fight or flight

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Sympathetic Response

Pupils Dilate

Bronchodilation

Tachycardia

Blood vessel constriction

Relaxation of GI system

Bladder relaxes

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Parasympathetic System Cholinergic system

Neurotransmitter=acetylcholine

Cholinergic agonist

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When cholinergic system is activated:

Pupils constrict

Bronchioles constrict

Vessels dilate

Decreased HR

Increased peristalsis

Increased Salivation

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Cholinergic drug

Metoclopramide (Reglan)

To treat GERD, decrease nausea treats gastroparesis

Because it makes things move thru the gastric systemquicker, faster gastric emptying.

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Class: Cholinergic agonist

Drug: metocloprmaide (Reglan)

DISTONIC REACTION

USE: Treats gastroesophageal reflux disease and

gastroparesis (slow emptying of the stomach)

ASSESSMENT: Great for diabetic pts. Who sometimes

suffer with gastroparesis

MONITOR BOWEL SOUNDS!!!!

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Anticholinergic

Prototype drug=Atropine

From belladonna plant

Major uses:

Pre-op to decrease oral and respiratory secretions

Bradycardia-increases heart rate by blocking vagal

stimulation

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Antispasmodic, decreases peristalsis, part of drug

Lomotil

Atropine Side Effects

dry mouth

tachycardia

constipation

urine retention (caution for BPH)

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decrease perspiration

blurred visiondilates eyes(NOT for use inGLAUCOMA)

Class: Anticholinergic

DRUG: Atropine

USE: Reduces salivation, increases heart rate, dilates

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Positive inotropic effect- increases force

contraction

Negative inotropic effect-decreases force of

contraction

Positive chronotropiceffect- increases HR

Negative chronotropic effect-decreases HR

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Lanoxin (Digoxin)

Positive inotrope

Negative chronotrope

ACTION: increases force of contractions

decreases HR

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USE: HF, and dysrhythmias

Usually requires a loading dose

NARROW THERAPEUTIC RANGE- check serum levels

(normal 0.5-2)

Assess apical pulse for 1 full minute hold for

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Hypokalemia

Renal impairment (Monitor BUN and Creatinine

IV Administration

Teach pt. how to take own pulse and teach foods hi in K+.

Antidote= DIGIBIND

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CLASS: Cardiac glycoside

DRUG: Lanoxin (Digoxin)

USE: Treats CHF, atrial tachycardia, flutter or fibrillation

ASSESSMENT: Obtain drug hx, baseline pulse rate, asses

for signs and symptoms of digitalis toxicity

(anorexia, n/v, bradycardia, cardidysrhythmias, visual disturbances (halos)).

INTERVENTIONS: Check apical pulse -

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Check serum digoxin levels (0.5-2)

Check K+ levels (3.5-5.3)

SIDE EFFECTS: Anorexia, n/v, HA, blurred vision (yellow

green halos), diplopia, photophob

drowsiness, fatigue confusion.

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NITRATES

Nitroglycerin

SL, spray, topical, IV, patch (off period)

Nursing: Know BP

SE: hypotension, HA, dizziness

Sublingual: q5min x3, if no relief in hospital

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>move to morphine IV

Fresh supply q3 months, keep in dark bottle,

should feel tingle or bite.

CLASS: Nitrate class-opens vessels lowers

(antianginals)

DRUG: nitroglycerine

USE: to control angina pectoris (angina pain)

ASSESSMENT: Baseline VS, health and drug

(contraindicated for marked hypotension or a

myocardial infarction)

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INTERVENTIONS: Monitor VS, Have pt sit or lie down

when taking nitrate for the 1st time. Q5 min x3. Then offer

sips of water before giving sublingual. NO VIAGRA (severehypotension)

SE: n/v, HA, dizziness, syncope, weakness,

confusion, pallor, rash, drymouth

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RAAS System

Low BP sensed by body

Kidneys release rennin

Angiotensin I from liver

Converted to Andiotensin II by ACE

Adrenal glands secrete aldosterone (the Na+

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saver)

Save Na+ means Save H2O

Pituitary gland secretes ADH(no pee hormone)

Re-establish BP

BETA BLOCKERS

olols, alols, ilols

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Examples:

Beta IAtenolol (Tenormin)

Cavedilol (Coreg)

Beta 2 ( not for resp. pts)

Propranolo (Inderal) non selective

EBP: for HF to prevent remodeling of hea

dysrhythmias

BETA BLOCKERS

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Can be used for panic attacks

Situational anxiety

Inderal 90 min prior can decrease test anxiety

Decreases migraine HA ( action unknown)

Assess BP and Pulse

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CLASS: Beta-blocker

USE: Antidysrhythmnic and adrenergic blockers

ASSESSMENT: Health and drug hx, Baseline VS and ECG.

Check cardiac enzyme results

INTERVENTIONS: Monitor VS (hypotension can occur), IV

push or bolus-administer over 2-3 mins, Monitor ECH

SE: dizziness, nausea, HA, hypotension, diaphore

fatigue, constipation or diarrhea, occasionally impotence

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Calcium Channel Blockers verapamil (Calan)

nifedipine(Procardia)

diltiazem(Cardizem)

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amlodipine(Norvasc)

Assess Bp and P, hold for SBP

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Inhibits liver enzymes (CYP450) that would

metabolize drug

Interactions with grapefruit juice can last 72 hours

from as little as 8 oz of juice

Simvastatin (Zocor) 300% increase vs. atorvastatin

(Lipitor) 25%

Florida has highest incidence of problems

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ACE Inhibitors prils

Used to treat HTN

ACE=angiotensin converting enzyme

ACTION: drug does not let angiotensin I

convert to angiotensin II

Angiotensin II is a potent vasoconstrictor

Capoten (captopril), lisonopril, monopril

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DECREASES BP BUT NO EFFECT ON

PULSE!!!!!!!!!!!!!!!

ACE INHIBITORS

Used with DM and HTN

Prevents stroke, MI due to inflammation

Used for renal protection-decreases pressure in

glomerulus.

Why: angiotensin II increases inflammation,

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clots and resistance to insulin

PRILS AND K+

Prils can lead to hyperkalemia

MD can add a thiazide diuretic

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Other SE: cough (gender differences)

More with males!

DIURETICS

Used to decrease Bp-lose Na+ and water follows

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decreased BP

Used for edema-cardiac, renal or liver origin

Used to decrease fluid overload as with pulmonary

edema or increase intracranial pressure

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Loop Diuretics

Work in loop of Henle in kidney by inhibiting re-absorption of Na+

Client will void

Lost in urine: Na+, Cl-, H2O, Ca+, Mag+ and K+

Increase renal blood flow by 40%

OK to use with RENAL CLIENT

Furosemide (Lasix) 20mg, 40mg, 80mg

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LASIX: last 6 hours

KNOW K+ LAB

Give early in day

Daily wt, and I & O

Monitor specific labs

Assess lung sounds

Assess for edema

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Get up slowly assess for orthostasis

Monitor for Dig toxicity

Teach foods high in potassium

CLASS: Loop Diuretic

Drug: furosemide (Lasix) Duration: PO=6-8

IV=2hr

USE: To treat fluid retention/fluid overloaded caused

by CHF, renal dysfunction, cirrhosis, hypertension,

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THIAZIDE CLASS DIURETICS

Chemically related to sulfa: ASSESS FOR

SULFA ALLERGY

Hydrochlorothiazide (HCTZ)

Action: lose Na+, Cl-, H2O, K+

INCREASES Calcium, Glucose, Uric Acid

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Used for HTN and edema

NOT FOR EMERGENCY SITUATIONS

Client needs normal renal functioning

Caution with diabetics

THIAZIDE CLASS DIURETICS

Teach foods high in Potassium

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Daily wt, I&O

Give in AM

Assess glucose

Monitor for onset of gout

Assess for Dig Toxicity

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CLASS: Thiazide Class

USE: Increase urine output; treat hypertension

edema from CHF, hepatic cirrhosis, renal dysfunction

ASSESSMENT: Assess wt, vs, urine output, serumchemistry values for baseline, Check peripheral

extremities for edema. Drug hx

INTERVENTIONS: Monitor VS, serum electrolytes (K,

glucose, uric acid, cholesterol levels) S and sx of

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hypokalemia (muscle weakness, leg cramps, cardiac

dysrhythmias.

SE: orthostatic hypotension, dizziness,photosensitivity, electrolyte imbalances

OSMOTIC DIURETICS

Mannitol

Action: Increases oslmolality of plasma causing

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dieresis

Used: Treat increased ICP-cerebral edema and to

decrease IOP(glaucoma)

Potent K+ WASTER

ICU SETTING, assess serum osmolality

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CLASS: Osmotic Diuretic POTENT

DIURETIC

USE: Prevents kidney failure, decreases intracranialpressure (ICP), decreases intraocular pressure (IOP). Used

in emergency situations such as head injuries

SE: fluid and electrolyte imbalance, pulmonary edema from

rapid shift of fluids, n/v, tachycardia from fluid loss,acidosis

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K+ sparing diuretics

Aldosterone-sodium saver

These drugs are aldosterone antagonist

ACTION: promote NA+ and water excretion

Spironalactone(Aldactone)

SE: hyperkalemia, need adequate renal function,

assess K levels

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Used for long term control of FVE as with cirrhosis of

liver

NO salt substitutes (they are hi in K)

Daily wt

I & O

For all client on all diuretics-need low salt diet

CLASS:K+ sparing diuretic

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DRUG: sprionolactone (Aldactone)

USE: Reduce body fluid and sodium

ASSESSMENT: Drug hx especially K supplements or

salt substitute, baseline vs and serum levels

INTERVENTIONS: Monitor urinary output, Monitor vs,

Observer for signs and symptoms of hyperkalemia

SE: photosensitivity, rash, dizziness, weakness

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Medications for circulatory

disorders

Blood Stasis aggregation of platelets blood

coagulates thrombus will form inhibits blood flow

COULD LEAD TO MI, DVT, OR PE

Why older adult may take ASA 81-325 mg daily

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Heparin

Subcut, IV

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Can be used for prophylaxis or for acute event

Prolongs clotting time

LAB: PTT partial thromboplastin time

Therapeutic is 1.5-2.5xbaseline

ANTIDOTE=protamine sulfate

Assess for bleeding, use soft toothbrush,

electric shaver

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CLASS: Anticoagulants

DRUG: Heparin

USE: Prevents blood clotting

ASSESSMENT: Health hx, Drug hx, Baseline labs (PTT 60-

70) (aPTT 20-40)

INTERVENTIONS: Monitor vs (increase pulse rate followed

b d d li i di fl id

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by a decreased systolic pressure can indicate a fluid

volume deficit-external or internal bleeding)

ANTITDOTE: Protamine NOSE: bleeding, itching, burning

LMWH

Wt. based enoxaparin (Lovenox)

Used post op for DVT prevention or for acute event

Lower risk of bleeding

Can teach client how to self inject for home use

f bl di

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Assess for bleeding

CLASS: Anticoagulants/ low-molecular weight heparin

DRUG: enoxaprin (Lovenox)

USE: For thromboembolism, prevents and treats DVT and

pulmonary embolism

SE: bleeding

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Warfarin (Coumadin)

Oral

Inhibits hepatic synthesis of Vitamin K dependant

clotting factors

Used for chronic A-Fib, prosthetic heart valves,

chronic anticoagulation needs

LAB PT ith INR

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LAB: PT with INR

Therapeutically thin when INR 2-3

ANTIDOTE: Vitamin K parenterally

Has long half life

Highly protein bound

SE: assess for bleeding-stools, GI

AVOID NSAIDS

AVOID foods rich in Vitamin K

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CLASS: anticoagulant

DRUG: warfarin (Coumadin)

ASSESSMENT: Baseline labs (PT 11 12 5) and (INR2 3)

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ASSESSMENT: Baseline labs (PT 11-12.5) and (INR2-3)

ANTIDOTE: Vitamin K

SE: anorexia, n/v, diarrhea, abdominal cramps, rash, fever,

bleeding

ANTIPLATELET MEDICATIONS

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ANTILIPEMICS (lipid lowering)

Cholesterol lab testing-need fasting blood sample

Total Cholesterol 60)

LDL-lethal cholesterol (want

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Triglycerides-high triglycerides mean more

arthersclerosis

Try non-pharmacological reduction: decrease fats,exercise, lower BP, stop smoking (smoking raises

LDL)

STATINS HmG-CoA reducatase in liver

Lovastatin (Mevacor)

Simvastatin (Zocor)

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Simvastatin (Zocor)

Atorvastatin (Lipitor)

Pravastatin (Pravachol)

Rosuvastatin (Crestor)-strongest boost of HDL

Statins inhibit HmG-CoA reductase which is

responsible for production of LDL-which is produced

primarily at night

Statins work best when taken at bedtime: Exception

is Lipitor

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STATINS

MD will start with dose that decreased LDL by 30-

40% (so in this case dose will start high)

Statins reduce total cholesterol

Decrease plaque formation and prevents rupture

Shrink plaque to prevent stroke

Anti-inflammatory effects

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May need to reduce does but not stop med

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May need to reduce does but not stop med

Assess CPK, AST, and ALT

No grapefruits or grapefruit juice

Dont stop med abruptly-stopping abruptly can cause

cholesterol levels to rise

LOWERING TRIGLYCERIDES

Triglycerides-increase risk for heart disea

neuropathy, and fatty liver

New me Lovaza(Reliant)

Omega 3 fish oil

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Omega 3 fish oil

Eat fish or take 1000mg of fish oil

Ezetimibe (Zetia) lowers triglycerides

Zetia works in GI tract to inhibit chol absorption,

usually combined with statin for optimum effect

Exetimibe+simvastatin=Vytorin

CLASS: antilipemics/anticholesterol TOXIC TO

LIVER

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SKELETAL MUSCLE RELAXANTS

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(CENTRALLY ACTING)

Uses: muscle spasm, and disease characterized by

involuntary motor activity

Depressess CNS

Carisoprodol (Soma)

Cyclobenzprin (Flexeril)

Metaxalone (Skelaxin)

SE: drowsiness NO ALCOHOL

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MUSCLE RELAXANTS

Taper to off-do not stop abruptly

For short term use-3 weeks or less

Take with food to decrease GI upset

Do not operate car or machinery

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SKELETAL MUSCLE RELAXANT

(DIRECT ACTING)

Drug: dantrolene (Dantrium)

Potent muscle spasm relaxer, direct effect on muscle

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If treatment is needed for > 8 weeks

Start with lowest does and increase only if needed

MS, spinal cord injury

Potential for liver toxicity=hepatotoxic

Used to treat malignant hyperthermia(increased

temp during surgery)

CLASS: Centrally acting-skeletal muscle relaxants

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DRUG: Carisoprodol (Soma)

USE: To relaz skeletal muscles (for acute or severe)

ASSESSMENT: Medical hx(contraindicated for pts

severe renal or liver disease, glaucoma, myasthenia gravis)

Baseline vs Health hx to identify cause (acute or chronic)

INTERVENTIONS: Monitor serum liver enzyme, record vs,

Observer for CNS side effects (dizziness)

SE: n/v. dizziness, weakness, insomnia, asthmatic attack,

tachycardia, hypotension, diplopia(double Vision)

DRUG: Flexeril

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USE: Short term tx of muscle spasms

INTERVENTIONS: Offer with food to avoid GI upset

SE:GI UPSET

CLASS: Peripherally acting-skeletal muscle relaxant

DRUG: dantrolene(Dantrium)

USE: For chronic neurologic disorders causing spasms such

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as spinal cord injuries, stroke, MS

AVOID ALCOHOL WITH CNS DEPRESSANTS.

ANTIHISTAMINES (H1 BLOCKERS)

Histamine is chemical mediator stored in mast cell

that causes part of allergic response

Action: compete for histamine receptor site to

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decrease nasopharyngeal secretions

Have anticholinergic properties (urinary retention,dry secretions, dry mouth) CAUTION: with BPH and

glaucoma

SE: drownsiness

Prototype: diphenhyramine (Benadryl)

Assess for urinary Retention

H1 BLOCKERS

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CNS depression

Do not mix with alcohol, narcotics

Can also use nasal inhaler

2nd

generation H1 BLOCKERS Loratadin (Claritin)

Fexofenagine (Allegra)

More specificity=less sedation

Use before allergy onset

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CLASS: H1 Blockers (Antihistamines)

DRUG: Dephendydramine(Benedryl)

USE: Treats allergic rhinitis, itching, prevents m

sickness;sleep aid: antitussive

ASSESSMENT: Baseline vs, Drug hx, Assess for s& sx of

urinary dysfunction(retention, dysuria, and frequency), CBC

Cardiac and Respiratory status

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CLASS: 2nd Generation antihistamines

DRUG: Allegra

USE: Treats allergic rhinitis and rhinorrhea

MISC: Has less sedative effect

DRUG: Claritin

USE: Relief of allergic rhinitis and urticaria

MISC: Long acting

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DRUG: Zyrtec

USE: For allergic rhinitis

MISC: Has few anticholinergic effects.

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SE: restless, tremors, HA, elevated BP, elevated

glucose

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glucose

Nasal spray overuse causes rebound nasalcongestion

BEWARE with HTN or cardiac history

Pseudoephedrine can cause MI, stroke due to HTN

BEWARE cold preparations-look at ingredients

For stuffy ear in airplane-nasal inhaler can help

decrease ear pain

CLASS: Decongestants

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DRUG: pseudoephedrine (Sudafed)

USE: allergic rhinitis

ASSESSMENT: Drug hx, health hx (contraindicated or

cautioned in pts with hypertension, cardiac disease,

hyperthyroidism, and diabetes

SE: jittery, nervous restlessness, hypertension,

increased blood glucose levels

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CLASS: Decongestants

DRUG: nasal sprays

USE: Stimulate the alpha-adrenergic receptors, thus

producing vasoconstriction of the capillaries within the

nasal mucosa (shrinks the nasal mucous and

membranes and reduces fluid

MISC: Frequent use can result in tolerance and rebound

nasal congestion(rebound vasodilatation instead of

vasoconstriction)

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RESPIRATORY

EXPECTORANTS ANTITUSSIVES

Loosen Bronchial secretions

cough center in

Hydration is best expectorant

DRUG: guaifenesin-take with full

cough may be good

Glass H2O. Give before meal.

Narcotic:codeine

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Narcotic:codeine

Non-narcotic-dextromethrophan

Give

after meal.

CLASS: Expectorants

DRUG: guaifenesin

USE: For dry, unproductive cough

ASSESSMENT: Take with glass of water to loosen mucus

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SE: n/v

CLASS: Antitussive

DRUG: codeine narcotic

USE: suppresses the cough reflex

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reduces viscosity of tenacious secretions

ASSESSMENT D h t i di t d ith COPD

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ASSESSMENT: Drug hx, contraindicated with COPD,

pulmonary disease, chronic productive cough,

hypersensitivity, MAOIs

MISC: DO NOT USE ALCOHOL

SE: nausea, dizziness, drowsiness, sedation

SHORT ACTING BETA 2 AGONIST (SABA)

Asthma-bronchial constriction and inflammation

Albuterol (Proventil)

Fast acting rescue inhaler

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Action: bronchodilation

SE: nervous, tremor, tachycardia

Teach client to carry at all times

Monitor HR

Teach correct use of inhaler (spacer)

WAIT 1 MINUTE FOR SECOND PUFF

Levalbuterol (Xopenex) for hand held nebulizer

treatments

LONG ACTING BETA AGONIST

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LONG ACTING BETA AGONIST

(LABA)

Salmeterol(Serevent)

Bronchodilation

Slow onset-long duration

NOT FOR ACUTE ATTACK

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PREVENTIATIVE MEDS

ANTICHOLINERGICS: block parasympathetic system

to allow SNS to dominate

RESULT:brochodilation

RESULT: anticholinergic effects-decreased secretions

SHORT-ACTING INHALER: ipratropium (Atrovent)

LONG ACTING INHALER ti t i (S i i )

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LONG ACTING INHALER: tiotropium (Spiriva)

PREVENENTATIVE ANTI-INFLAMMATORY

MEDS

Inhaled corticosteroids-take daily

Fluticasone (Flovent)

Ri th ft t id i h l

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Rinse mouth after steroid inhaler

(Bronchodilator 1st

, Steroid 2nd

)

NSAID inhaler-daily for prevention

Cromolyn (Intal)

Stabilizes mast cells

Leukotriene antagonist- daily

Montelukast (Singulair)

Monitor liver enzymes

Inhaled acetylcysteine (mucomyst)

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Inhaled acetylcysteine (mucomyst)

Mucolytic

Decreases thickness and stickiness of

secretions

Have suction available, assess resp. status

Beware nausea and vomiting in client due to

secretions

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CLASS: Mucolytics

DRUG: mucomyst

USE: act like detergents by liquefying and loosening thickmucous secretions

INTERVENTIONS: Do not mix with other drugs

SE: n/v, stomatitis (oral ulcers), runny nose

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CLASS: NSAID inhaler

DRUG: Cromolyn (Intal)

USE: For chronic asthma and prophylactic use. Suppresses

inflammation in the bronchial tube; does not have broncho-

dilating effects. Precent the release of histamine.

ASSESS: Administer by inhalation

INTERVENTIONS: Must be taken daily

SE: cough, bad taste

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CLASS: leukotrience modifiers.

DRUG: Singulair

USE: Prevention and maintenance tx of asthma

ASSESS: Health hx (caution in pts with severe liverdisease) Check liver function test.

SE: HA, dizziness, fatigue, nasal congestion, cough,

sorethroat, dental pin, influenza, dyspepsia, abdominal

pain, rash

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METHYLXANTHINE CLASS

Theophylline (Theo-Dur) PO

Aminophylline IV

Acts like caffeine

Action: smooth muscle relaxation of resp system

USE: asthma, COPD

Stimulates CNS leads to dieresis tremors cardiac

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Stimulates CNS, leads to dieresis, tremors, cardiac

dysrthymias

THEOPHYLLINE (cont)

PO theophylline (Theo-Dur)

Narrow therapeutic index 10-20 mcg/ml

Monitor serum drug levels

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Monitor serum drug levels

IV aminophylline- use pump and give slowly

Smoking increases metablosim of drug

NURSING: monitor lung sounds, adequate

hydration, avoid caffeine, assess for excessivecardiac and CNS response

CLASS: methylxanthine

DRUG: Theophylline (PO)

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p y ( )

USE: Promotes bronchodilation, treats asthma and COPDASSESSMENT: Monitor theophylline serum frequently (10-

20)

INTERVENTIONS: Pt. should avoid caffeinated products and

increase fluid intake

SE: anorexia, n/v, gastric pain, intestinal bleeding,

nervousness, dizziness, HA, irritability, cardiac

dysrhythmias, tachycardia, palpitations, marked

hypotension, hyperreflexia, seizures , adverse CNS

reactions

CLASS: methylxanthine

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y

DRUG: amniophilline (IV)

USE: Promotes bronchodilation, treats asthma and COPD

ASSESSMENT: Rapid IV administration can cause dizziness,

flushing, hypotension, severe bradycardia, palpitations

CORTICOSTEROIDS

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CORTICOSTEROIDS

Prednisone

inflammatory

Cortisone

in ONE!!!!!!

Dexamethasone- inflammation of the brain

Steroids used for: inflammatory conditions

(autoimmune disorders), allergic reactions, prevent

organ rejection

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GLUCOCORTICOIDS

Hydrocortisone cream: allergic and inflammatory

conditions (topically)

Fluticasone (Flovent): inhaled to decrease

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inflammation in lungs

Prednisone (PO): suppress immune system, anti-

inflammatory

Methylprednisolone (Solu-medrol): IV

Dexamethason (Decadron): IV to decrease swelling in

brain

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STEROIDS

Mineralocorticoid effect: salt retaining property

Na+ and H2O retention, Increase BP,

K+ loss

Glucocorticoid effect: anti-inflammatory

INCREASE GLUCOSE

Decreases immune system

Affect carbohydrate, protein, and fat metabolism

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Altered fat deposit: moon face and buffalo hum(longterm use, think end stage COPD pt)

Protein-muscle wasting, paper thin skin

SIDE EFFECTS OF STEROIDS

From high does or long term use

Increased blood glucose

Abnormal fat deposits

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Muscle wasting

Sodium and water retention

Demineralization of bone

K+ loss

Increases susceptibility to infection

Delayed wound healing

GI irritation

SE cont.

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Steroid iduces psychosis, mood changes

Sleep disturbance

Stunted growth in adolescents

No live virus vaccinations

Caution with diabetics, NSAID use, K+ wasting

diuretics

Taper to off-no abrupt discontinuation

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NURSING CONSIDERATIONS

OF STEROIDS

Teach to take as prescribed

Daily wts, and report gain

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Assess BP, I and O, edema

Low salt diet

Assess blood sugar

Protect self from infection, assess for

infection

Protect frail skin-PAPER TAPE

Give with meal to avoid GI upset

WT. bearing , calcium, Vit D to prevent bone

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loss

Sleep routine

Teach possible mood swings

Teach to taper long term use, do not stopabruptly

Cope with body image changes

CLASS: Steroids

USE: inflammation

ASSESSMENT: health and drug hx

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INTERVENTIONS: use with caution in diabetic patients

SE: increase glucose and sodium. Decrease K+, moon face,

buffalo hump

ANTIEMETICS Vomit=emesis

Antiemetic=anti-vomit drug

Chemoreceptor trigger vomiting center in

medulla

I l l i N&V

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Inner ear plays a role in N&V

NON-PRESCRIPTION FOR

NAUSEA

Antihistamines and antiemetics

Dimenhydrinate (Dramamine)

For motion sickness-take 30 min prior to travel

Meclizine (Antiver): used for vertigo

Many of these meds have anticholinergic properties

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ANTI EMETICS

Prescription antihistamines:

Hydroxyzine (Vistaril)

SE: drowsiness

Anticholinergic class

Scopolamine (Transderm-scop) patch

behind ear

Great for motion sickness

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Effective for 3 days

ANTI EMETICS

Phenothiazine class: Inhibit CTZ in medulla

Promethazine (Phenergan)

Sedative effect

Also have antihistamine and

anticholinergic effects

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anticholinergic effects

Drowsiness, dry mouth, urine retention,

constipation

BEWARE DISTONIC EFFECT

Serotonin receptor antagonist: blocker

serotonin receptors in CTZ, and vagal nerve in

GI TRACT

Ondansetron (Zofran)

ANTIDIARRHEALS

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Assessment: hyperactive bowel sounds

Important due to loss of fluid and electrolyte

imbalances

Try Gatorade and Pedialyte

MD may want stool for culture and O and P

Opiate related medications

Loperamide (Immodium)- OTC

Diphenoxylate (Lomotil)-presecription

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Opiates decrease peristalsis

Chemically related to opiates

Lomotiol also 50 % atropine to decrease

secretions and discourage abuse

LAXATIVES

Try nonpharmacological ways to prevent

constipation: fluids, fiber, activity, privacy

Osmotic Laxative: hyperosmolar salts pull water into

colon increase bulk and peristalsis

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colon, increase bulk and peristalsis

Sodium salts: phosphor-soda

Magnesium salts: MOM, magnesium citrate

K+ salts

Result: loose, watery stool, good for bowel cleansing

for testing

SE: abdominal cramping, diarrhea

OSMOTIC LAXATIVES

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GoLYTELY: has electrolytes added-

isotonic

Used for bowel prep

3-4 liters over 3 hours

Best when cold

Want stool to be clear prior to

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irritating sensory nerve ending

Bisacodyl (Dulcolax)

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SE: N & V, abdominal cramps

Good for bowel prep

Bulk forming laxative=natural fiber

Large soft stool

Mix and bedside, drink

immediately, follow with full glass

of water

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Used with narcotic, after surgery,

after MI, no straining

Simethicone-anti gas only

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S e co e a gas o y

Pink tablet-chew

Mylicon

Used with babies too.

PEPTIC ULCER DISEASE

(PUD)

Peptic ulcer: can be esophagus, stomach, duodenum,

GI tract

HCl secreted from paretal cells of stomach

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p

Pepsin=digestive enzyme activated at pH of 2

Ulcer=loss of mucosal barrier

Helicobacter Pylori (H-pylori) Linked to PUD when ulcer not caused by NSAIDS

Noninvasive breath test can detect H-pylori

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Nicotine relaxes sphincter so easier to reflux

Acoid spicy, greasy foods

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Elevate HOB

Sit up with meals and after

No eating prior to bed

Loose clothing at waist

PROGRESSION

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Antacids=good

H2 antagonist=better

Proton pump inhibitor=best

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ANTACIDS

Action: neutralize existing stomach acid

Take 1 hr prior and 3 hrs after meal and at bedtime

Liquid antacid take with water so it reaches stomach

DO NOT MIX ANTACIDS WITH OTHER MEDS

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ANTACIDSMAGNESIUM BASED ALUMINUM BASED

Maalox Amphojel

Mylanta

Constipation

SE: Diarrhea

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phosphate, used

Maaloz combines both

renal clients to

Magnesium and aluminum to

eliminate

Counter act diarrhea and constipation.

Phosphorus.

ANTACIDS

CALCIUM BASED SODIU

BICOARBONATE

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Calcium carbonate

Seltzer

Tums

Constipation

Constipation

Systemically absorbed

Tumes use to increase Ca

metabolic acidosi

For osteoporosis and in

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cause hypernatrem-

Renal clients. BEWARE:HYPERCALCEMIA!! ia

H2 BLOCKERS

Histamine receptor antagonist

Used to prevent and treat ulcers and GERD

Action: decreases gastric acid secretion by inhibiting

H2 receptors in stomach

Cimetidine (Tagamet)

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Ranitidine (Zantac)

Famotidine (Pepci)

Nizatidine (Axid)

Take prior to meal and at bedtime.

H2 SIDE EFFECTS

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PROTON PUMP INHIBITORS (PPIs)

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Action: suppress gastric acid secretion by inhibitingATPase enzyme system in gastric parietal cells

Inhibit gastric acid secretions 90% better than H@

antagonist.

Omeprazole (Prilosec)

Lansoprazole (Prevacid)

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Blocking acid production decreases release of

intrinsic factor which is needed to bind to B12.

Acid also kills food borne pathogens

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PPI use increase risk of food born illness.

PPI AND B12

Need acid to absorb iron

of PPI- B12

B12 stored in liver for 5 years M

supplement

OTHERS

PEPSIN INHIBITOR

PROSTAGLANDIN ANALOGUE

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Sucralfate (Carafate)

Prostaglandin

Adheres to ulcer to protect it Misoprosto

Does not decrease acid

Take 1 g QID(before meals For c

NSAIDS

And at bedtime)

O C

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ORAL ANTIDIABETIC Oral hypogylcemics used for Type II diabetes

Pancreas still producing some insulin

Key to all oral hypoglycemic is to read the action of

drug- are they working on pancreas to stimulate

more insulin or working in the liver to decrease

hepatic production of glucose

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CLASS: SULFONYUREAS

Assess for allergy to sulfa

Stimulates pancreatic beta cells to secrete insulin

Glimepiride (Amaryl)

Glipzide (Glucotrol, Glucotrol XL)

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May be combined with other oral hypoglycemic

meds.

Withhold 48 hrs before and after test using IV

t t d l ti id i d l f il

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contrast dye, lactic acidosis and renal failure maydevelop!!!!!!!!!!!!!!!!!