Must Know Drugs: Psych, Complex, Peds/OB, Community

1. Must Know Drugs:Psych, Complex, Peds/OB, Community Compiled by Hannah Giboney

2. Psych

3. Valproic Acid (Depakote, Depakene)Ziprasidone (Geodon)Lithium carbonate • Anticonvulsant • Uses: partial, generalized and absence seizures, bipolar d/o, and migraine h/a • S/E: GI effects, hepatotoxicity, pancreatitis, thrombocytopenia • Contraindications: liver d/o • Interactions: phenytoin and phenobarbital

4. Bupoprion (Wellbutrin, Zyban) • Atypical antidepressant; smoking deterrant • S/E: h/a, dry mouth, constipation, increased HR, nausea, restlessness, weight loss, seizures • Contraindications: seizure d/o, pts on MAOIs • Interventions: monitor for seizures, sip on fluids for dry mouth, fiber for constipation; take daily, emphasize compliance (1-3 weeks before effects); don't d/c abruptly

5. Risperidone (Risperdal)Olanzapine (Zyprexa) • Atypical Antipsychotic • Uses: schizophrenia, levodopa-induced psychosis • S/E: agranulocytosis, seizures, DM, weight gain, heart muscle inflammation • Contraindications: agranulocytosis, immunosuppressive/anticancer meds, seizure d/o, DM • Interventions: signs of DM/weight gain, monitor for seizures, CBC

6. Paroxetine (Paxil) • SSRI • Uses: major depression, OCD, bulimia, PDD, panic d/o, PTSD • S/E: sexual dysfunction, weight gain, Serotonin synd (2-72hr--mental confusion, agitation, anxiety), w/d syndrome, hypoNa, rash, sleepiness, lightheadedness • Contraindications: pts on MAOIs, Warfarin, TCAs, Lithium, NSAIDs, or anticoagulants • Interventions: take w/ food, take daily, encourage compliance, no effects until 1-3 weeks

7. Benztropine mesylate (Cogentin) • Anti-parkinson: Centrally-acting anticholinergic • Symptomatic relief from dyskenesias • S/E: NV, anticholinergic effects, antihistamine effects • Contraindications: pts w/ narrow-angle glaucoma • Interventions: warn about possible sudden loss of effects of meds, may be weeks-months before noticeable effects

8. Haloperidol (Haldol) DecanoateFluphenazine (Prolixin-Decanoate) • Conventional Antipsychotic • Uses: schizophrenia, bipolar d/o, tourette's synd, delusional d/o, schizoaffective d/o, dementia, huntington's chorea • s/e: seizures, EPS, anticholinergic effects, neuroleptic malignant syndrome • contraindications: pts in a coma, severe depression, parkinson's, prolactin-dependent breast cancer, severe hypotension; pts on anticholinergic agents, CNS depressants or levodopa • Interventions: take on a regular schedule, 4-6 weeks before effects

9. Complex

10. Epinephrine (Adrenalin) Adrenergic Agonist Used for cardiac stimulation in cardiac arrest; for bronchodilation in asthma or allergic/anaphylactic reactions; produces mydriasis; produces local vasoconstriction when combined with local anesthetics and prolongs anesthetic action by decreasing blood blow to the site S/E: dysrhythmias, tachycardia, angina, restlessness, urgency or urinary incontinence Interventions: monitor VS, lung sounds, UOP & ECG; administer through a large vein

11. Norepinephrine (Levophed) • Adrenergic Agonist • Stimulates the heart in cardiac arrest; vasoconstricts and increases the BP in hypotension and shock • S/E: dysrhythmias, tachycardia, angina, restlessness, urgency or urinary incontinence • Interventions: monitor VS, lung sounds, UOP & ECG; administer through a large vein

12. Dopamine Hydrochloride (Intropin) • Adrenergic Agonist • Increases BP and cardiac output through positive inotropic action and increases renal blood flow through its action on alpha and beta receptors • Used to treat mild renal failure caused by low cardiac output • S/E: dysrhythmias, tachycardia, angina, restlessness, urgency or urinary incontinence • Interventions: monitor VS, lung sounds, UOP & ECG; administer through a large vein

13. Lidocaine (Xylocaine) • Class IB antidysrhythmic: sodium channel blocker. Local Anesthetic. • suppress dysrhythmias by inhibiting abnormal pathways of electrical conduction through the heart; block conduction of pain impulses in certain area • S/E: fluid retention; orthostatic hypotension, constipation; CNS excitation; spinal h/a, urinary retention • Interventions: monitor HR, RR, BP, ECG; monitor serum drug levels; ensure administration of correct form; IV form must have an infusion pump; limit fluid & salt intake; monitor resp/thyroid/neruo functions; increase fiber

14. Adenosine (Adenocard) • Antidysrhythmic • Restoration of normal sinus rhythm (SVT only) • S/E: orthostatic hypotension, constipation; fluid retention (weight gain, peripheral edema, SOB) • Interventions: monitor HR, RR, BP, ECG; maintain therapeutic serum drug levels; do not give w/ food that affects absorption; IV form must have an infusion pump; limit fluid & salt intake; monitor resp/thyroid/neruo functions; increase fiber intake

15. Eptifibatide (Integrillin) & Abciximab (ReoPro) • Antiplatelet: GPIIb/IIIa Inhibitor • Inhibit the aggregation of platelets in the clotting process, prolonging the bleeding time • Used in the prophylaxis of long-tem conplications following myocardial infarction, coronary revascularization, stents, and brain attacks (stroke) • Contraindications: pts w/ bleeding d/o and known sensitivity • S/E: GI bleeding, bruising, hematuria, tarry stools • Interventions: determine sensitivity before administration, monitor VS, give w/ food if GI bleeding occurs, monitor bleeding time & for S/E r/t bleeding; educate pt how to take & how to monitor for S/E

16. Tissue Plasminogen Activator (tPA) • Thrombolytic • Activate plasminogen which generates plasmin (an enzyme that dissolves clots) • Uses: 4-6 hours onset of MI; arterial thrombosis, DVT, occluded shunts or catheters & pulmonary emboli • Contraindications: internal bleeding; hx of stroke, intracranial problems, recent surgery; hepatic/renal dz; uncontrolled HTN; recent CPR • S/E: bleeding, dysrhythmias, fever, allergic rxns • Interventions: aPTT, PT, fibrinogen level, hematocrit, and platelet count; monitor VS & pulses; monitor for bleeding, excretions for occult blood, for neruo changes, hypotension, tachycardia; avoid injection; direct pressure over puncture site 20-30min; electric razor & brush teeth gently

17. Nesiritide (Natrecor) • Vasodilator,diuretic • recombinant version of human BNP that vasodilates arteries and veins • used in treatment of decompensated HF • S/E: hypotension, confusion, dizziness, dysrhythmias • Interventions: give by continuous IF infusion via pump, monitor BP, cardiac rhythm, urine output, body weight, monitor for signs of resolving HF

18. Propofol (Diprivan) • IV General Anesthetic: loss of consciousness & eliminate response to painful stimuli • Uses: adjunct to inhalation anesthetics, induction/maintenance of anesthesia, amnesia • S/E: resp/CV depression, bacterial infection • Interventions: use open vial w/n 6hr; injected into a large vein after IV lidocaine has been injected into the site to decrease pain • Interactions: CNS depressants/stimulants, opioid analgesics\ • Implicated in Michael Jackson’s death

19. Midazolam Hydrochloride (Versed) • Benzodiazepine: anxiolytic • Action: Depress CNS, muscle-relaxing, anticonvulsant • Contraindications: acute narrow-angle glaucoma; use cautiously in children & adults; abrupt w/d can be life-threatening • S/E: phlebitis at IV site, apnea, laryngospasm,resp depression, cardiac arrest • Toxicity: somnolence, confusion, diminished reflexes, coma, agitation, restlessness, discomfort, anxiety • Interventions: liver/renal function test results & CBC, reduced dose for elderly & impaired liver function; fall precautions; avoid alcohol, taper dose to stop

20. Mannitol (Osmitrol) • Osmotic diuretic • increase osmotic pressure of glomerular filtrate • used for oliguria, prevent RF, decrease ICP, decrease IOP; used with chemotherapy to induce diuresis • S/E: F&E imbalance, pulmonary edema, NV, H/A, tachycardia, hypoNa, dehydration • Interventions: monitor VS, weight, UOP, electrolyte levels, lungs & heart sounds, dehydration, neuro status, IOP, ICP; change position slowly, do not give if med has crystallized in vial

21. Naloxone Hydrochloride (Narcan) • Opioid Antagonist • Treat resp depression from opioid OD • Interventions: monitor BP, HR, RR Q 5min, then Q 15min, then Q 30min until pt is stable • Place pt on cardiac monitor to monitor rhythm, auscultate breath sounds, have resuscitation equipment available; don't leave unattended, monitor pt for several hours

22. Sodium bicarbonate (bicarb) • Orally: Antacids • Action: Reacts w/ gastric acid to produce neutral salts or salts of low acidity; inactivate pepsin and enhance mucosal protection but don't coat the ulcer crater to protect it from the acid and pepsin; elevates gastric pH above 5 • Uses: PUD and GERD • take on a schedule; chew thoroughly and follow w/ water or milk; shake liquid prep before administration; allow 1 hour between antacid  and other meds • S/E: rapid onset, liberating carbon dioxide, increasing intraABD pressure, and promotes flatulence; used w/ caution w/ HTN and HF; can cause systemic alkalosis in pts w/ Renal Impairment

23. Sodium bicarbonate (bicarb) • IV: Weak alkaline; used to treat acidosis (esp metabolic), • Action: Shifts carbonic acid/carbon dioxide equilibrium toward base raising blood pH • Uses: acidosis, hyperkalemia, cardiac arrest

24. Peds/OB

25. Mg sulfate • CNS depressant • Produce uterine relaxation & suppress uterine activity in order to prevent preterm birth. Used for preeclamptic pts to prevent seizures. • S/E: depress resp, depress DTRs, hypotension, extreme muscle weakness, flushing, decreased UOP, pulmonary edema, serum Mg levels >9 mg/dL • Contraindications: Mother: severe (pre)eclampsia, vaginal bleeding, intrauterine infection, cardiac dz.                    Fetus: gestational age >37wks, cervical dilation >4cm, fetal demise, lethal fetal anomaly, chorioamnionitis, acute fetal distress, and chronic intrauterine growth restriction • Interventions: use controller pump; monitor DTRs, resp & UOP; Mg levels, keep Ca gluconate at bedside (antidote)

26. Oxytocin (Pitocin) • stimulates smooth muscle of the uterus & induces contraction of the myocardium; intranasal/IM/IV • Uses: induce/augment labor, control postpartum bleeding, promote milk letdown; induce/complete abortion • S/E: rare; allergies, dysrhythmias, BP changes, uterine rupture, water intoxication; nasal vasoconstriction (intranasal); uterine hypertonicity; hypotension/rebound HTN; postpartum hemorrhage • Interventions: monitor VS/weight/I&O/LOC/lung sounds, the freq, duration, force of contractions & resting uterine tone, fetal HR Q 15min; give IV via infusion monitoring device; don't leave unattended; monitor for hypertonic contractions, uterine hyperstimulation or nonreassuring fetal HR, signs of water intoxication; document. If necessary, turn on her side, increase IV NS rate, & give O2 via face mask

27. Betamethasone • Corticosteroid that increases the production of surfactant • Use: pt in preterm labor 28-32 wks gestation whose labor can be safely inhibited for 48 hours • S/E: decreased resistance to infection; pulmonary edema secondary to Na and fluid retention; elevated blood glucose levels in pt w/ DM • Interventions: monitor maternal VS, lung sounds, for edema, signs of infection, WBC, blood glucose levels

28. Concerta, Adderall, Ritalin • CNS Stimulant: amphetamines • stimulate the cerebral cortex of the brain; increase alertness & sensitivity to stimuli • Uses: narcolepsy and ADHD; adjunctive therapy for exogenous obesity • S/E: irritability, restlessness, tremors, tachycardia, dysrhythmias, HTN, dry mouth, anorexia/weight loss, ABD cramping, diarrhea/constipation, hepatic failure, psychoses, impotence, dependence and tolerance, high potential for abuse • Interventions: monitor VS, mental status, CBC, WBC, platelet; degree of inattention, impulsivity, hyperactivity, sleepiness; height/weight/growth of child; take before food; avoid caffeine/alcohol; take >6hrs before bed

29. Atomoxetine (Strattera) • CNS stimulant • S/E: tachycardia, anorexia/weight loss, elevated BP, dizziness, agitation • Interventions: monitor CNS s/e, BP; obtain baseline ECG; avoid OTC; take last dose >6hr before bed (>14hr if XR); monitor height/weight in children; several weeks before therapeutic effect

30. Fluticasone/Salmeterol (Advair) • Corticosteroid + long acting bronchodilator • Uses: prevent asthma attacks or flare-ups of COPD (not for acute attacks or dyspnea) • S/E: h/a, churg-strauss syndrome • Caution: DM, glaucoma, seizure d/o, pheochromocytoma • Interactions: beta-blockers, ketoconazole, MAOIs • Interventions: assess VS, resp status; allow 1-2min between inhalations; take regardless of symptoms; do not use as rescue inhaler

31. Montelukast (Singulair) • Leukotriene modifier • Action: inhibit bronchoconstriction caused by specific antigens & reduce airway edema and smooth muscle contraction • Use: prophylaxis/treatment of chronic bronchial sthma • Contraindication: pts w/ hypersensitivity & breast-feeding mothers; use w/ caution w/ impaired hepatic function • Interaction: inhaled glucocorticoids increase risk of upper resp infection • S/E: H/A, NV, dyspepsia, diarrhea, generalized pain, myalgia, fever, dizziness • Intervention: monitor VS, lung sounds (rhonchi/wheezing), liver function lab values, for cyanosis; take 1hr before or 2 hr after meals; increase fluid intake; don't self-d/c

32. Terbutaline (Brethine) • beta-adrenergic agonist • Used to stop preterm labor by relaxing smooth muscles, inhibiting uterine activity & causing bronchodilation • s/e: SOB, coughing, tachypnea, pulmonary edema, tachycardia, palpitations, chest pain, hypotension, fluid retention, decreased urine production, tremors, dizziness, muslce cramps, weakness, h/a, hypokalemia, hyperglycemia, hypocalcemia • interventions: monitor for s/e; put pt on her side; monitor VS, weight, I&O, fluid restriction, comfort measures

33. dinoprostone (Cervidil) • prostaglandin E2 • “ripen” the cervix (dilation and effacement), stimulate uterine contractions, given vaginally • Uses: preinduction cervical ripening, induction of labor, induction of abortion • S/E: diarrhea, NV, stomach cramps, fever, chills, fllushing, h/a, hypotension, tachysystole (>12 contractions in 20min w/o alteration in fetal HR pattern), hyperstimulation of uterus, fetal passage of meconium • Contraindications: • Interventions: monitor VS, cervical ripening, Bishop score, s/e; void before administration, maintain supine position w/ lateral tilt or side-lying for 30-40min

34. Erythromycin • Opthalmic ointment or drops are bacteriostatic & bactericidal • Use: prophylactic measure to protect against N. gonorrhoeae & C. trachomatis • Interventions: cleanse neonate's eyes before instilling drops or ointment, instill into conjunctival sacs w/n 1hr after delivery; don't flush eyes after instillation • Oral • Various bacterial infections; otitis media, bronchitits • Adverse effect: GI UPSET; DIARRHEA

35. Ferrous Fumarate (Hemocyte F) • Antianemic: iron supplement (same as ferrous sulfate, but different concentration of iron) • Uses: treat/prevent Fe-def anemia • Contraindications: non-Fe-def anemia • S/E: NV, constipation, dark stools, epigastric pain, teeth staining (liquid) • Interactions: tetracyclines, ascrobic acid, antiulcer meds • Intervention: assess nutritional status, bowel function; monitor CBC/BMP; monitor for toxicity/OD (stomach pain, fever, NV); warn about stools; instruct to take 1hr before/after food (unless GI discomfort)

36. Rhogam • Uses: prevent anti-Rh (D) antibody formation in Rh-neg pts exposed to Rh-positive blood (from baby) • S/E: elevated temp, site tenderness • contraindications: Rh-positive women, hx of systemic allergic rxn to preps containing human immunoglobulins; not for newborn infant • Intervention: IM injection at 28 wks gestation & w/n 72hr after delivery; not IV; monitor for temp elevation

37. Vitamin K (AquaMEPHYTON) • necessary to assist in production of active prothrombin • Use: prophylaxis & tx of hemorrhagic dz of the newborn • S/E: hyperbilirubinemia in newborn • Interventions: protect med from light; give during early neonatal period, in lateral aspect of mid-3rd of the vastus lateralis muscle of thigh; monitor for bruising at injection site and for bleeding from cord; monitor for jaundice and bilirubin level

38. Amoxicillin, Amoxicillin-clavunalate (Augmentin) • Broad-Spectrum Penicillin; clavunalate helps make it penicillinase resistant • Action: inhibit growth of bacteria; beta-lactamase resistant • Uses: prophylaxis bacterial endocarditis; 1st choice for meningitis • S/E: GI effects (upset stomach, sore mouth, furry tongue); superinfections; hypersenxitivity rxns (anaphylaxis) • Interventions: assess for allergies, monitor lab values, monitor I&O, encourage fluid intake, initiate safety precautions (CNS effects); IV, IM • Educate: importance of compliance

39. Zidovudine (AZT) • NRTI • Uses: tx HIV and AIDS; prophylaxis in exposed healthcare workers, HIV+ mothers, HIV+ sexual partners • Action: inhibit the activity of reverse transcriptase • S/E: NV, anemia, leukopenia, myopathy, fatigue, h/a • use 3 or 4 meds (highly active antiretroviral therapy: HAART) to delay or reverse loss of immune function, preserve health, and prolong life

40. Community

41. Rifampin • 1st-line TB agent to inhibit bacterial RNA synth; used with at least one other anti-TB med • Contraindication: pts w/ hypersensitivity • Interactions: decreases effects of oral anticoagulants, oral hypoglycemics, Chloromycetin, Lanoxin, Norpace, Mexitil, Diflucan, Dolophine, Dilantin, Calan, and others. • S/E: hypersensitivity rxn, heartburn, NVD, red-orange body secretions, vision changes, hepatotoxicity, hepatitis, increased uric acid levels, blood dyscrasias, colitis • Intervention: CBC, uric acid, LFT; monitor stools (colitis); mental status • Education: warn about s/e; take as prescribed; avoid alcohol

42. Isoniazid (INH) • 1st-line med for TB • bactericidal; used in combo w/ other anti-TB meds • Contraindications: pts w/ hypersensitivity or w/ acute liver dz • Interactions: increase risk of toxicity or Tegretol & Dilantin; may decrease ketoconazole concentrations; tyramine foiods • S/E: hypersensitivity rxns, peripheral neuritis, neurotoxicity, hepatotoxicity, pyridoxine (vit B6) deficiency, irritation at inj site w/ IM, NV, dry mouth, dizziness, hyperglycemia, vision changes, hepatitis • Interventions: monitor LFT, CBC, blood glucose levels; give 1hr before or 2hr after food & 1hr before Al antacids; pyridoxine reduces risk of neurotoxicity; total compliance

43. lamivudine (Epivir) • NNRTIs • Uses: HIV and AIDS • Action: inhibit the activity of reverse transcriptase • S/E: nausea, nasal congestion • use 3 or 4 meds (highly active antiretroviral therapy: HAART) to delay or reverse loss of immune function, preserve health, and prolong life

44. Bicillin • PCN G • Action: inhibit growth of bacteria (gram positive narrow spectrum: S. pneumo, S. pyogenes, syphillis); • Uses: prophylaxis becterial endocarditis; 1st choice for meningitis; • S/E: GI effects (sore mouth, furry tongue); superinfections; hypersenxitivity rxns (anaphylaxis) • Interventions: assess for allergies, monitor lab values, monitor I&O, encourage fluid intake, initiate safety precautions (CNS effects); IV, IM • Educate: importance of compliance