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

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Must Know Drugs: Psych, Complex, Peds/OB, Community Compiled by Hannah Giboney * * * * * * * * * * * * * * * * * * * * * * * * Erythromycin Opthalmic ointment or ... – PowerPoint PPT presentation

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Title: 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) Decanoate Fluphenazine
(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 Jacksons 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 FE 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 gt9 mg/dL
  • Contraindications Mother severe (pre)eclampsia,
    vaginal bleeding, intrauterine infection, cardiac
    dz.                    Fetus gestational age
    gt37wks, cervical dilation gt4cm, 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/IO/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 gt6hrs 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 gt6hr
    before bed (gt14hr 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, IO, 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 (gt12
    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 IO, 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 IO, encourage fluid intake,
    initiate safety precautions (CNS effects) IV, IM
  • Educate importance of compliance
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