Diabetes Medications

Medication Why patient is receiving Nursing implications How you know it’s working Adverse Reactions
Things in common for all Type 1 Diabetes - Monitor blood glucose Blood glucose in normal range Hypoglycemia
insulin: Type 2 Diabetes - Control blood glucose
- Monitor for S/S of - At highest risk for
hypoglycemia hypoglycemia during insulin’s
- Rotate injection site to PEAK time, so give a snack at
- prevent lipodystrophy the peak time

Insulin: Rapid Acting (- log) Type 1 Diabetes - Onset = 15 minutes Blood glucose in normal range hypoglycemia
Lispro (Humalog) Type 2 Diabetes - Peak = 30 minutes to 90
aspart (Novolog) minutes
- Duration 3 to 5 hours
- Administer 15 minutes
before eating or just after
meals

Insulin: Short Acting (- R) Type 1 Diabetes - Onset=30 to 60 minutes Blood glucose in normal range hypoglycemia
Type 2 Diabetes - Peak=2 to 4 hours
Regular insulin - Duration = 5 to 8 hrs
(Humulin R, Novolin R) - Clear solution
- Most common insulin that
can be given IV **
- Give 30 minutes before
eating or even after eating
- Give 15g carbohydrate
snack at peak of insulin

Insulin: Intermediate Acting: Type 1 Diabetes - Onset = 1 to 3 hours Blood glucose in normal range hypoglycemia
(-N) Type 2 Diabetes - Peak = 8 hours
Isophane insulin (NPH), - Duration = 12 to 16 hours
Humulin N, - Cloudy in color
Novolin N - administered SQ
- agitated before
administration

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Insulin: Long Acting (L-) Type 1 Diabetes - Onset = 1 hour Blood glucose in normal range hypoglycemia
Insulin glargine (Lantus Type 2 Diabetes - Peak = NONE
Insulin detemir (Levemir) - Duration = 20 to 26 hrs
- Cannot be given in
combination with other
insulin's; must use separate
syringe

(so if patient needs 2 different

types and one of them is Long
Acting, you need to administer
them via 2 injections, using 2
different syringes at 2 different
sites)

Combination Insulin: (Hum-) Type 1 Diabetes - Onset = varies (5-10) Blood glucose in normal range hypoglycemia
Humulin 70/30 Type 2 Diabetes minutes depends on insulin
Humalog 75/25 combination)
Humalog 50/50 - Peak = varies
- Duration = varies (10-16 hrs)
A mixture of NPH and Regular - Cloudy in color
or NPH and Humalog - agitated before
administration
70/30=70 units NPH and 30
units of Regular insulin per 1 ml - Onset, peak and duration
will vary depending on types
of insulins mixed
Oral Anti-diabetic Meds Type 2 Diabetes only - Avoid alcohol use Blood glucose in normal range - Weight Gain
Sulfonylureas Glycemic control - Beta-adrenergic blocking - hypoglycemia
- glipizide(Glucotrol) agent may mask or delay
- glyburide(DiaBeta) hypoglycemia
- glimepiride(Amaryl) - Monitor sulfa allergies
- Monitor for S/S of rash, GI
disturbances
- Give with breakfast

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Oral Anti-diabetic Meds Prevention of Type 2 Diabetes - Monitor for s/s of lactic Blood glucose in normal range Hypoglycemia when used with
Biguandies Type 2 Diabetes management acidosis (dyspnea, increased other antidiabetic
- metformin (Glucophage) RR, hyperventilation)
Gestational diabetes
Lactic acidosis
- metformin with glyburide - Monitor kidney function
(Glucovance) (BUN & creatinine) GI distress (N/V, diarrhea)
- Withhold 48 hrs before
studies meds with contrast
dye and 48 hours after study-
contributes to renal failure

- Monitor for signs &

symptoms of diarrhea,
nausea, vomiting,
decreased appetite

Non-Insulin Injectable Drugs: Type 1&2 diabetes that failed - Monitor blood glucose Blood glucose in normal range - Hypoglycemia
Amylin Mimetics to reach good glucose control - Do not mix with insulin (use - Injection site reactions
2 different syringes) - May alter the absorption
pramlintide(Symlin)
Compliments effects of insulin - Given SQ of other drugs- give
- Give before food separately

Non-Insulin Injectable Drugs: Type 2 diabetes - Monitor blood glucose Blood glucose in normal range Hypoglycemia
Incretin Mimetics - Do not mix with insulin Pancreatitis
exenatide(Byetta) - Given SQ

liraglutide(Victoza)

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Other Oral Medications you may see in Patients with Diabetes:

Thiazolidinediones: - Glycemic control for type 2 - Monitor for hyperglycemia Blood glucose in normal range - Heart failure
pioglitazone(Actos) diabetes - Monitor liver function Control BG levels - Renal retention of fluid
- Add on to metformin - Monitor weight - Hepatotoxicity
rosiglitazone(Avandia)
- Increase risk for pregnancy - Upper respiratory infections
with oral contraceptive - Hypoglycemia when used
with insulin or other
medication

Metglitinides (glinides) - Type 2 Diabetes - Monitor blood glucose Blood glucose in normal range Hypoglycemia
repaglinide(Prandin) - Used with metformin or - Eat within 30 minutes after Control BG levels Weight gain
thiazolidinedione’s for BG taking medication
nateglinide(Starlix)
control

Alpha-glucosidase inhibitors: - Type 2 Diabetes - Monitor blood glucose Blood glucose in normal range - Flatulence, cramps,
acarbose(Precose) - Monitor HgbA1 C Control BG levels abdominal distention,
- Diet and Exercise - Cannot give to patient with borborygmus abdominal
miglitol(Glyset) Lower HgbA1c
gastrointestinal or can you sounds, and diarrhea
dysfunction or cirrhosis
- Effective among Latinos and - Liver dysfunction
African-Americans

Dipeptidyl Peptidase-4 Type 2 Diabetes - Monitor blood glucose Blood glucose in normal range - Hypoglycemia
Inhibitors (DPP-4) - Upper respiratory infections
Control BG levels
sitagliptin(Januvia) - Headache
Lower HgbA1c
- Abdominal pain
vildagliptin(Galvus)

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 Surgical
SurgicalMeds
Meds
Surgical Medications

Medication Why patient Nursing implication How will you Adverse

receiving med the med is reactions
working
dantrolene (Dantrium) Malignant • Assess patient • Clinical • Hepatotoxic
hyperthermia manifestations ity
• Recognize s/s of malignant
subside or
hyperthermia
eliminated
• Notify
surgeon/anesthesiologist
• Assess liver function tests
(LFTs)
PAIN MEDS
Things in common for all Things in
pain meds: common for all
pain meds:
• Assess pain level
• Reports of
• Assess effectiveness of decreased pain
medication.
• Fewer non-
verbal pain
indicators

• Increased
activity level
activity level
Opioids — Severe pain
Opioid Severe pain • Monitor vital signs • Reports of • Respiratory
• Monitor O2 sat decreased pain
• morphine depression
• Monitor sedation level
• hydromorphone • Bowels • Fewer non- • respiratory
(Dilaudid) • LOC verbal pain
arrest
• Patient education: no indicators
chewing of pills • Change in
• Increased LOC/sedation
activity level
level
• Constipation
• Urinary
Retention

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 Surgical
SurgicalMeds
Meds
Surgical Medications

Opioid Agonist (non-opioids) — Moderate pain

Opioid Agonist (Non- Moderate • Asses pain level • Reports of • Respiratory
opioid) pain 60 min after oral decreased
depression
administration pain
oxycodone/acetaminophen • Vitals • Constipation
• Fewer non-
(Percocet) • O2 sat
verbal pain • Urinary
• Sedation level indicators
hydrocodone • Bowels retention
acetaminophen (Lortab • LOC • Increased
• Cough
• Patient education activity level
• Note suppression
acetaminophen • change in
dosing LOC/sedation
• Give with food to level
decrease GI upset

Analgesic/Antipyretic — Mild pain

Analgesic/Antipyretics Mild pain • Not to exceed • Reports of • Hepatotoxicity
decreased
4g/day • Elevated liver
acetaminophen (Tylenol) pain
function
• Give with food to • Fewer non-
tests
decrease verbal pain
GI upset indicators • Jaundice
• Increased
• Patient education
activity level

NSAIDS—mild – moderate pain

Nonsteroidal • Vitals • Reports of • Gastric ulcer
Anti-inflammatory Drugs decreased
• Labs: H/H • Bleeding
(NSAIDs) pain
Mild pain • Patient education • Ototoxicity
• Fewer non-
ibuprofen (Motrin)
verbal pain
indicators
• Increased
activity level

NSAIDs cont’d… • Vitals • Reports of • Bleeding

decreased
• Labs: H/H • Peptic ulcers
ketorolac (Toradol) Moderate pain
pain • Patient education
• Fewer non-
verbal pain
indicators
• Increased
activity level

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 Surgical Meds
Surgical Medications

Corticosteroids—↓ inflammation
Corticosteroids Decrease • Vitals • Decrease in •
inflammatory inflammatory
• Labs Thromboembolism
prednisone (Sterapred) response
response
• I&O • Hyperglycemia
methylprednisolone • Decrease in • Decreased
• Weights
(Solumedrol) reports of
wound
• Wound/skin status pain
healing
• Wean off. Do not • Stable WBC,
• Fluid retention
stop temperature,
abruptly blood • Osteoporosis
glucose

Antiemetics—↓ N/V
Antiemetic: Nausea and • Assess for N/V • Decrease or • Excessive
absence sedation
Vomiting • IV patency
promethazine (Phenergan) N/V • Respiratory
(N/V) • Effectiveness of depression
metoclopramide (Reglan) parenteral • Increased
administration 30 activity and
prochlorperazine
min after food/fluid
(Compazine)
giving intake
ondansetron (Zofran) • I&O
• Document
quantity of emesis

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 Antibiotics,Antibiotics,
Infection, Infection, & Immunity Meds
and Immunity Meds
Medication Why patient Nursing implication How will you Adverse reactions
receiving med the med is
working
1st generation NSAIDS
• Analgesic: • Patient education ↓ in pain, • Bleeding
acetylsalicylic acid (Aspirin) For mild to Assess: fever,
• Gastric ulcer
moderate pain • Allergies inflammation
1st generation NSAID • Ototoxicity
• Antipyretic • Labs
• Anti-inflammatory
• Vital signs
• Inhibits platelet • Pain
aggregation
• Assess for:
—Bleeding
—Ototoxicity
—Gastric ulcer

• Analgesic • Patient education ↓ in pain, • GI Bleeding

Ibuprofen (Motrin, Advil) For mild to Assess: fever,
• Gastric ulcer
moderate pain • Allergies, Vitals, inflammation
1st generation NSAID Pain level
Safer than ASA; • Antipyretic • Labs
• less incidence of GI • Anti-inflammatory
•Give with food to ↓
ulcer/bleeding GI upset

acetaminophen (Tylenol) • Analgesic • Patient education ↓ in pain, • Hepatotoxicity

• Antipyretic Assess: fever
• No anti-inflammatory effects
• Allergies, Vitals,
• no GI bleed or renal impairmen
Pain level
• no platelet aggregation
• Labs ***will not see
a ↓
• Should not be taken with
for acetaminophen inflammation
alcohol due to liver dysfunction
(drugs):
• Max daily dosing
4g/day
Glucocorticoid/Steroid
Glucocorticoids • Anti-inflammatory • Patient education ↓ in • Osteoporosis
• Assess: inflammation
• Steroid: prednisone, • Hyperglycemia
Immunosuppression • Allergies, Vitals,
methylprednisolone
Pain level • Fluid retention
• Labs
• Patient must be weaned off • Impaired wound
— NO abrupt stopping of drug
• weight healing
• Blood sugar

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 Antibiotics, Infection, & Immunity Meds
Antibiotics, Infection, and Immunity Meds
• Skin Integrity • ↑ incidence of
infection

Epinephrine
Epipen • For emergency Patient education: S/S of • Tachycardia
treatment of • Must carry with anaphylaxis
• Do not refrigerate • Palpitations
anaphylaxis them at all times; subside
• Epinephrine helps reverse teach patient how to • Nervousness
use it.
anaphylaxis by
• Administers IM
stimulating b2 adrenoreceptors dose of epinephrine
at outer thigh
—bronchodilation occurs,
and • Store at room
temperature
— swelling is reduced.
• Inject as soon as SX
begin

Antibiotics
Penicillin Used for a variety of • Check cultures Normalization • Anaphylaxis
infections • allergies of vitals and
• Most common cause of drug
• vital signs labs
allergy
• Labs Patient feels
• Allergic reactions can be mild to
better
life
• wound sites Improved
threatening
• clinical s/s clinical picture

• Cross-sensitivities
Cephalosporins • Infection Poorly absorbed from Normalization • Anaphylaxis
• broad-spectrum GI tract; usually given of vitals and
• cephalexin, cefepime,
antibiotic. parenterally. labs
ceftriaxone, cefazolin
Used for a wide Have few adverse Patient feels
Can you give a cephalosporin if
variety of infections. effects. better
the patient has
Improved
a penicillin allergy?
• Check cultures clinical picture
Cross-sensitivities; • allergies
Patients who are allergic to • vital signs
penicillin (PCN) are probably
allergic to all the other cillins and • labs
may also be allergic to
Cephalosporin (cross sensitivity) • wound sites
• clinical s/s

** Should not be

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 Antibiotics,Antibiotics,
Infection, Infection, & Immunity Meds
and Immunity Meds
given to patient
severe reactions to
penicillin.

Vancomycin • Most widely used • Assess for allergies. Normalization • Renal failure
antibiotic in • Check cultures, labs, of vitals and
• Red Man Syndrome occurs due • Ototoxicity
hospitals. vitals, wound sites labs
to rapid infusion of vanco that
• peak & trough • Red man
releases histamine
• MRSA levels as prescribed. Patient feels
syndrome
better
• causes facial flushing, rash,
• Allergy to penicillin Use with caution in Improved
pruritus,
renal impairment. clinical picture
hypotension, tachycardia
• Assess for adverse
• Drug of choice for many MRSA
response
infections although there are
• IV use only
other drugs that treat it.
UNLESS treating C.
Dif
• Daptomycin, clindamycin,
Infection! C.Diff =
linezolid
NO IV
• IV infusions need to
be given at least over
one hour; no faster.
(infuse 1 hr or longer)
• Use IV pump.
Fluoroquinolones Broad spectrum • Assess for allergies Normalization • C. Difficile
antibiotic • Check cultures of vitals and
• ciprofloxacin infection
• Check vitals labs
• Used for UTIs • Tendon rupture
• labs Patient feels
• respiratory • Photosensitivity
better
infections • wound sites Improved
clinical picture
• skin.
Tetracyclines Broad spectrum • Assess for allergies Normalization • Yellow/brown
antibiotic • Check cultures of vitals and tooth
Calcium in the milk bids to
• Check vitals labs discoloration
antibiotic and prevents gut
• Used less often
absorption
• labs Patient feels • Hepato/renal
• Treats acne & better
Take tetracycline: toxicity
H. Pylori bacteria • wound sites Improved
• 2 hours before or 6 hours after: clinical picture • Photosensitivity
- antacids • Do not give with
- calcium supplements calcium/milk/iron
- zinc products
- laxatives containing
magnesium.

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 Antibiotics,Antibiotics,
Infection, Infection, & Immunity Meds
and Immunity Meds
• 2 hours before or 4 hours after:
- iron preparations
- vitamin products that
contain iron

Aminoglycosides Narrow spectrum • Assess for allergies Normalization * Ototoxicity

antibiotics • Check cultures of vitals and
• amikacin, gentamycin, * Nephrotoxicity
• Check vitals labs
tobramycin
• Treats serious
gram (-) bacterial • labs Patient feels
Narrow spectrum antibiotics are
infections better
used for the specific infection • wound sites
Improved
when
clinical picture
the causative organism is known • peak & trough
and levels.
will not kill as many of the normal
microorganisms in the body as • NOT typically used
the broad- spectrum antibiotics. PO route, use
parenteral
Used for gm negative (-) bacteria
only

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 Respiratory Meds
Respiratory Medication Chart

Medication Why patient Nursing How would the nurse Adverse Reactions
receiving med? Implications know med is working?

TB Meds
isoniazid (INH) • Tuberculosis • Take B6 for • Blood culture • Hepatoxicity
deficiency negative
• Prophylaxis TB • Peripheral
treatment • Take on an • Absence of TB
empty neuropathy
bacilli
stomach

• Avoid alcohol

• Avoid food
containing
tyramine and
histamine

• Medication
compliance
6 – 12 months

rifampin (Rifadin) • Tuberculosis • Turns body fluid • Absence of TB • Hepatoxicity

orange bacilli

• May need to
wear eye glasses

• Take on empty
stomach

• Give 1 hour
before other TB
drugs

• Decreases
effectiveness of
several meds (oral
contraceptives,
beta blockers,
anticoagulants
(coumadin),
steroids, oral
hypoglycemic med

pyrazinamide (PZA) • Tuberculosis • Monitor liver • Absence of TB • Hepatoxicity

enzymes bacilli
• Nongouty

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 Respiratory Meds
Respiratory Medication Chart

• Monitor arthralgia
hepatitis

• Do not give
with
preexisting
liver disease

ethambutol • Tuberculosis • Monitor visual • Absence of TB • Optic neuritis

(Myambutol) acuity before bacilli
and monthly
• May take with
food

Bronchodilators
Bronchodilators: • Relieve • Carry SABA at • Tachycardia
(table 24- 4 & 5) bronchospasm all times. • Breathing gets • Palpitation
better (short • BP changes
Short Acting Beta • Bronchodilato • Long term- acting) • headache
Agonist (SABA) r should be • nausea
• albuterol • taken to • Attacks are • restlessness
(Proventil, prevent preventive (long • tremors
ProAir, attacks and is acting) • nervousness
Ventolin) usually taken • dizziness
in conjunction • throat dryness
• levalbuterol with an anti- and irritation
(Xopenex) inflammatory • bad or unusual
agent. taste in the
Long Acting Beta mouth.
Agonist (LABA) • Salmeterol
(Serevent)
• formoterol (Foradil) cannot be
administered
• salmeterol with a spacer.
(Serevent)
• Bronchodilato
r should be
taken before a
steroid inhaler

• Wait at least 5
minutes
between other
inhaled drugs.

Anticholinergic • Relieve • Ipratropium is • Breathe easier • Dry mouth

Drugs bronchospasm short acting • Pharynx
must be used • Auscultate irritation
• Ipratropium several times breath • May

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 Respiratory Meds
Respiratory Medication Chart

(Atrovent) • Bronchodilato per day sounds. increase

r intraocular
• Tiotropium • Short-acting pressure in
• Improve Gas can be used as patients
(Spiriva)
Exchange a rescue with
inhaler glaucoma.
• Spiriva should • Tremors
not be used • Spiriva -longer
for an acute acting can be
attack. taken once
per day.

• Spiriva comes
in a capsule
and should
not be
swallowed.

Corticosteroids
Inhaled • Anti- • Take
Corticosteroids inflammatory bronchodilato Improved breathing • Hyperglycemia
r first before
fluticasone steroids • Osteoporosis
(Flovent) • Improved • Use spacer
breathing
budesonide • Long-term
(Pulmicort) therapy
• Not for acute
attacks
• Good oral
hygiene
• Do not stop
taking
abruptly

Corticosteroids
Systemic • Anti- • Take • Prevention of • Hyperglycemia
inflammatory medication as exacerbations • Osteoporosis
methylprednisolon prescribed • Peptic ulcer
e (Medrol) • Improved disease
• Symptoms breathing
prednisolone resolve 3-10
(Prelone) days

prednisone
(Deltasone,

Page 3 of 4

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 Respiratory Meds
Respiratory Medication Chart

Orasone)

Cromones

cromolyn • Anti- • Must use on Decrease in mucus Cough and irritation

(Cromolyn) inflammatory regular basis
even if there
nedocromil (Tilade) are no
symptoms

• Not a rescue
inhaler

• Unpleasant
taste
(nedocromil)

Phosphodiesterase • Severe • Used in Decrease in • Diarrhea

Type 4 Inhibitors: Chronic COPD combination inflammation, cough, • Reduced
with and excessive mucus appetite
roflumilast tiotropium, a production • Weight loss
(Daliresp) long-acting • Nausea
inhaled beta2 • Headache
agonist, or an • Back pain
inhaled • Insomnia
glucocorticoid • Depression
• Dose is 500
mcg daily
• Give with or
without food

Other Respiratory medications:

• Antipyretics – Fever
• Antitussives – Cough
• Decongestants – to relieve congestion
• Antihistamines – to treat allergy
• Antibiotics – infection

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 Drugs Used to Treat Acute
Cardiac MedsCoronary Syndrome
This table lists drugs used in the emergency treatment of acute coronary syndrome and other types of chest pain. After oxygen, aspirin, and nitroglycerin are
given, the patient’s status and presentation determine which other drugs should be used.

Medication Action/Function Nursing Implications Patient education Adverse reactions

Oxygen • Maximizes O2 delivery to prevent cell • 2-15 L/minute via • Improved O2 sats
death during MI appropriate device for
amount of O2 ordered • Goal- Keep O2
• Increases arterial saturation- is the saturation at 95% or
• For MI- no more than 2-4
key to ↑ myocardial oxygen supply, higher
L/min via NC
and helps relieve pain of MI
• Monitor O2 saturation • Semi-Fowler’s position
regularly; keep at ³ 95%

Statins • i Cholesterol, LDL, and triglycerides • Monitor cholesterol and • Give in evening • Myalgia—m. pain
3-hydroxy-3-methylglutaryl LFTs Q 3-6 months • Arthalgia—joint pain
• h HDL • Avoid grapefruit
coenzyme A statins (HMG-CoA) • Hepatotoxicity
- Liver fxn i
atrovastatin (Lipitor) - jaundice
rosuvastatin (Crestor)
lovastatin (Mevacor)
simvastatin (Zocor)

Diuretics • Helps to i BP • Measure I&Os, daily weights • Given in morning or at • Electrolyte imbalances
dinner
Thiazide diuretics • Excrete increased volume • Vitals, labs, nutrition • Hypokalemia
hydrochlorothiazide (h urinary output)
• s/s dehydration • Dehydration
(Hydrodiuril) • Heart failure—decrease preload i so
fluid volume is excreted

Loop diuretics • Helps to i BP • Measure I&Os, daily weights • Give IV or PO • Electrolyte imbalances
- works very fast
• Excrete increased volume • Vitals, labs, nutrition • Hypokalemia
furosemide (Lasix)
(h urinary output)
• s/s dehydration • Dehydration
bumetanide (Bumex)
• Heart failure- decrease preload i so

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 Drugs Used to Treat Acute
Cardiac MedsCoronary Syndrome
fluid volume is excreted
Aldosterone Receptor Blocker • Helps to i BP • Measure I&Os, daily weights Should result in iBP, • Hyperkalemia
Potassium Sparing Diuretics • Vitals, labs, nutrition h urinary output, and a
• Excrete increased volume
• s/s dehydration stable K+ level
spironolactone (Aldactone) (h urinary output)
• No potassium supplements
• conserve K+ ***

Angiotensin Converting Enzyme • Treats HTN, heart failure • Assess • Can cause annoying • First dose effect
(ACE) Inhibitors —pril - allergies cough
• Block Angiotensin receptor • Angioedema
- BP
• i levels of Angiotensin II Þ leads to –life threatening
catopril (Capoten), enalapril - renal fxn
(Vasotec), lisinopril (Prinivil) dilation of blood vessels Þ i afterload - cough
• Cough
• Improves heart failure survival - safety
• helps prevent remodeling of the heart
during heart failure
• slows renal impairment
Angiotensinogen II Receptor • Treats HTN, heart failure • Assess allergies, BP, renal • Usually used when ACE • Angioedema
Blockers (ARBs) —sartan fxn, safety inhibitors are causing –life threatening
• Block Angiotensin receptor
coughing in the patient
losartan (Cozar), candesartan • i levels of Angiotensin II Þ leads to
(Atacand), valsartan (Diovan) dilation of blood vessels Þ i
afterload

• Improves heart failure survival

• helps prevent remodeling of the heart
during heart failure

Calcium Channel Blockers —pine • Treats HTN • Assess allergies, BP, renal • Heart block
fxn, safety
• Blocks calcium channels in blood • Postural hypotension
amlodipine (Norvasc)
vessels and in SA node of heart • Monitor bowels
- acts on arterioles, so will i BP • EKG changes
but • Promotes vasodilation and myocardial
not the heart rate perfusion
nifedipine (Procardia), nicardipine • Decreases afterload
(Cardene), verpamil (Calan),

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 Drugs Used to Treat Acute
Cardiac Coronary Syndrome
Meds
diltiazem (Cardizem) • i HR

Beta Blockers (Cardio selective) • Reduces catecholamines, leading to: • Assess BP, heart rate, renal • PO or IVP for • Bradycardia
- dilated vascular beds fxn, labs, respiratory status tachycardia
• Hypotension
- slower HR and/or HTN
atenolol (Tenormin)
metoprolol (Lopressor, Toprol XL) - lower BP • Don’t give to patients with • EKG changes Þ Heart block
signs of LV heart failure
• Decrease size of infarction i
5 mg IVP q 5 ming max
• Decrease cardiac workload i • Watch for hypotension and
15mg
• Treats HTN, heart failure, CAD • Decrease HR and BP i bradycardia
• Treats ACS, angina • Decrease myocardial oxygen demand
i
(lets heart rest)
• Decreases mortality
Beta Blockers (non-Cardio • Treats HTN, heart failure • Assess BP, heart rate, renal • Bradycardia
selective) • Acts on RR too fxn, labs, respiratory status
• Bronchoconstriction
carvedilol (Coreg), • Decrease cardiac workload
labetolol (Trandate), • Decrease HR and BP
proplanolol (Inderdal) • Will ALSO decrease RR ***
• Decrease myocardial oxygen demand
• Treats HTN, heart failure, CAD • Decreases mortality
• Treats ACS, angina

Alpha II Adrenergic Agonists • Treats HTN • Give at night— • Rebound HTN if stopped
• lowers BP causes drowsiness abruptly
methyldopa (Aldomet)
• Can also be used in tx of ADHD • Can be given by
clonidine (Catapres)
transdermal patch
Vasodilators • Treats HTN, angina • Allow patient to rest • Do not use alcohol when • Hypotension
• Goal: i chest pain and i BP taking nitro
• Monitor for hypotension • Headache is a common side
Nitroglycerin (Nitrate)
• Improves blood flow to myocardium and • Do not use with ED effect
hydralazine (Apresoline) • i myocardial O2 demand bradycardia; monitor BP!!
drugs
• i afterload; can drop BP • Take acetaminophen
Maintenance Meds: • Start at low IV dosage;
• Keep tablets in dark (Tylenol) for HA
isorbide dinitrate (Isordil) • Take 1 tab q 5 min up to 3x till relief titrate upward to achieve
bottle in cool, dark place
isorbide mononitrate (Imdur) - Call 911 if pain not relieved by 3 tabs pain relief
OR

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 Drugs Used to Treat Acute
Cardiac MedsCoronary Syndrome
• 5—100 mcg/kg/minute by IV infusion • Replace q 6 months
• Do not use if:
• Dilates blood vessels; vasodilation of - suspected RV MI • Keep nitro with them
coronary & peripheral arteries - hx of phosphodiesterase always
inhibitor (PDI) use for ED • Tingling with sublingual
doses is GOOD- means its
• do not use with
working!
SBP <90 mm Hg or HR <50

Inotropes • Tx of chronic heart failure patients in • Assess vitals, labs, K+, I&O, • Take pulse for 1 full min Know s/s of toxicity: **
sinus rhythm or A. fib dysrythmias before taking med
• Blurred vision
digoxin (Lanoxin)
• increases contractility Þ h cardiac • Excreted through renal • Take dose at same time • Yellow halo
output system - need good kidney every day • Anorexia
• Tx of chronic heart failure
• Slows conduction thru AV nodeÞ • Fatigue
patients fxn • do not skip doses or
• m. weakness
in sinus rhythm or A. fib iHR double dose
• VERY narrow therapeutic • confusion
• Call HCP if miss a dose
• Inhibits sympathetic activity window (0.5 – 2.0 ng/dL)
• therapeutic levels: 0.5 – 2.0
• Must have stable
ng/dL • If its working, should see: • Hold med if HR < 60 and - low potassium = RF toxicity
potassium level; take K+
- h in exercise tolerance ** notify HCP
supplement as directed
- adequate urine output
• absorbed thru GI track- •Report toxicity s/s to HCP
- absorbed thru GI track—don’t take
with antacids— blocks absorption •Do not take with

- High K+ interferes with therapeutic antacids

effects (h K+ levels = i digoxin )
Anticoagulants—reduce formation of fibrin
Heparin • Treat—DVT, PE • Assess for drug allergy, • General patient edu. for • Hemorrhage
• Prevent— VTE (prophylaxis) vitals DVTs, PEs, etc. • Heparin induced
• Antidote: protamine sulfate • Labs thrombocytopenia (HIT)
• Stops original clot from expanding
over slow IV infusion - PTT/aPTT ** • Given IV or SubQ
• Prevent additional clots from forming HIT—formation of antibodies
- Platelets
against heparin-platelet
• Used in conjunction with PCI or • For tx of ACS or emergency: - H/H
complex; causes platelets to
fibrinolytics - give 60 units/Kg (max 5,000 units) • Assess for s/s bleeding
i by 45 - 50% in 4-14 days
IVP (bruises, blood in stool,
petichiae)

StudentNurseGuides
 Drugs Used to Treat Acute
Cardiac MedsCoronary Syndrome
followed by infusion of 12
units/Kg/hr

Low molecular weight heparin • Treat—DVT, PE • For patient w/ stable •General patient edu. for • Hemorrhage
Less risk for bleeding • Prevent— VTE (prophylaxis) DVTs, PEs, etc.
DVT/PE
- to prevent future clots • Heparin induced
* enoxaparin (Lovenox) • Enoxaparin only for < 75 yrs • How to administer on thrombocytopenia (HIT)
• Given subQ
old and normal renal function self at home
* enoxaparin (Lovenox), cont’d…
• Used for short term tx
• Assess:
• for short term tx • Used in conjunction
• Can be given for pt to admin at home - Vitals must be normal
• Antidote: protamine sulfate with PCI or fibrinolytics
- Assess for drug allergies
• For tx of ACS or emergency:
- Labs—platelets, H/H
• Used in conjunction with PCI or - give 30 mg IVP
- Bleeding s/s
fibrinolytics
• Precaution- need good
kidney fxn!

* warfarin (Coumadin) • Treat and prevent DVT, PE • Assess for drug allergy, • Written patient Hemorrhage
vitals education is required!!!
• Takes 3-4 days to become effective
• for long term tx • Labs
• Have consistent vitamin
• Antidote: vitamin K • For long term treatment - INR
K levels in diet
- H/H
• Bleeding—blood shot eyes
- too much all of a sudden
• Precautions—need good can i Coumadin effects
kidney fxn; tell HCP/dentist
• Avoid NSAIDs, salicylates, &
OTC drugs **
Anticoagulants, cont’d…
Factor Xa inhibitors • Treat—DVT, PE • Assess vitals, allergies, labs, • Drug is expensive • Bleeding
• Work on factor Xa to i thrombin • Prevent—DVT, PE, VTE bleeding s/s
• Sub Q • Less frequent monitoring
fondaparinux (Arixtra)
required
• i thrombin
• No antidote
• No antidote ***

StudentNurseGuides
 Drugs Used to Treat Acute
Cardiac Coronary Syndrome
Meds
rivaroxaban (Xarelto) • Treats—DVT, PE • Assess vitals, allergies, labs, • Bleeding
• Prevents—DVT, PE bleeding s/s
• Treats arterial diseases
• PO

dabigatran (Pradexa) • Treats— Atrial fibrillation • Assess vitals, allergies, labs, • Bleeding
• Prevents—thrombin & fibrin bleeding s/s
• treats—A. fib
formation • antidote—dialysis
• antidote—dialysis
• PO

Antiplatelet Medications • Analgesic: mild to moderate pain • Monitor for drug allergy Desired effects: • Bleeding
• prevent platelet aggregation • Antipyretic • Labs—BUN, creatinine ↓ in pain, fever, • Gastric ulcer
Þ thrombosis in arteries • Anti-inflammatory inflammation • Ototoxicity
• Vital signs, Pain
• Inhibits platelet aggregation • Renal impairment
• Inhibits vasoconstriction • Assess for: • Needs to be given • Salicylism
acetylsalicylic acid (Aspirin) sometime within 24 hrs of
- s/s of bleeding, ototoxicity,
1st generation NSAID • reduces further arterial occlusion or re gastric ulcer onset of an MI event
occlusion; i chance of reoccurrence - do not need to give
- Ibuprofen blocks aspirin’s
st
• 162-325 mg PO: 1 dose chewed antiplatelet effect more than once;
• continue daily at 75 - 162 mg - Give PO chewed
indefinitely

clopidogrel (Plavix) • Inhibits platelet aggregation •Assess for s/s bleeding • Often seen in patients • Bleeding
•Assess for allergies, vitals, who have had an MI
• prevent development of thrombosis
ticagrelor (Brillinta) labs
in • used to keep stent open
arteries by i platelet aggregation

Fibrinolytics • Dissolves/breaks down original clot in • Monitor for s/s of bleeding • Be aware of • Bleeding
coronary arteries contraindications for
alteplase, retaplase • Delivered during cath lab to
fibrinolytics
• Give per facility’s protocol keep arteries patient while
tpa within first 6 - 12 hrs of onset of clot is removed
symptoms (ideally 1 – 2 hrs)

StudentNurseGuides
 Drugs Used toCardiac
Treat Acute
MedsCoronary Syndrome
• Use ONLY if cardiac cath lab
for PCI not available within 90
min. of arrival

Glycoprotein (GP) IIb–IIIa • Prevents fibrinogen from attaching to • Dosage per manufacturer’s • Start prior to PCI • Bleeding
Inhibitors active platelets at site of thrombus protocol • Monitor patient for
• Often used during cardiac bleeding.
• Binds to platelets to slow aggregation
abciximab (ReoPro) catheterization when • Monitor platelet count.
eptifibatide (Integrelin) • Stops expansion of original clot and physician getting thrombus
tirofiban (Aggrastat) prevents additional clots from out
forming

Thrombolytics • Used if angioplasty is unavailable for • Continuously monitor for Teach patient s/s to • Reperfusion dysrhythmias
tx s/s bleeding report (bruising, bleeding,
alteplase (tPA), reteplase of STEMIs any neuro changes) • Bleeding
• Monitor neuro status—
(Retavase), tenectaplase (TNK)
• lyses clot that is obstructing the neuro changes can indicate
coronary artery grestores perfusion to brain bleed
the myocardium
• Screen for bleeding risk
• Need to be given emergently within before administering med
6-12 hours after onset of STEMI ***
• Screen for bleeding risk first !!

acetylsalicylic acid (Aspirin) • Analgesic: mild to moderate pain • Monitor for drug allergy ↓ in pain, fever, • Bleeding
• Antipyretic • Labs inflammation • Gastric ulcer
1st generation NSAID • Anti-inflammatory • Vital signs, Pain • Ototoxicity
Used as an antiplatelet for MIs • Inhibits platelet aggregation Absence of thrombotic • Renal impairment
• Assess for:
• reduces further arterial occlusion or events • Salicylism
- s/s of bleeding, ototoxicity,
re-occlusion; i chance of
gastric ulcer
reoccurrence
- Ibuprofen blocks aspirin’s
• 162-325 mg PO: 1st dose chewed antiplatelet effect
• continue daily at 75 - 162 mg
indefinitely

StudentNurseGuides
 Drugs Used to Treat Acute
Cardiac Coronary Syndrome
Meds
Ibuprofen (Motrin, Advil) • Analgesic for mild to moderate pain • Allergies, Vitals, Pain level ↓ in pain, fever, • GI Bleeding
• Antipyretic • Labs inflammation • Gastric ulcer
1st generation NSAID • Anti-inflammatory • Otoxicity
Safer than ASA; • Give with food to ↓ GI
less incidence of GI ulcer/bleeding upset

- Ibuprofen blocks aspirin’s

antiplatelet effect

- NSAIDs should only be used for

brief periods because of effects on
platelet function and thinning of
MI scar

acetaminophen (Tylenol) • Analgesic • Allergies, Vitals, Pain level ↓ in pain, fever • Hepatotoxicity
• Antipyretic • Labs - Inc. liver fxn tests
• No anti-inflammatory effects ***
- Jaundice
• no GI bleed or renal impairment
For acetaminophen (drugs): ***will not see a ↓
• no platelet aggregation
• Max daily dosing 4g/day inflammation
• Should not be taken with alcohol
due to liver dysfunction

Opioid—severe pain (8-10)

morphine • Severe pain • Monitor vital signs • Reports of decreased • Respiratory depression
- check BP before giving! pain, fewer non-verbal • Respiratory arrest
• Emergent use in MIs
2- 4mg by IV push q5 to 15 min • Monitor O2 sat pain indicators • D in LOC/sedation level
Þ to a max of 15mg • i ventricular pre load • Monitor sedation level
• Increased activity level
• Constipation
• i cardiac O2 requirements • Bowels • Urinary Retention
• Decreased anxiety
• LOC
• can drop the BP
• Patient education:
• can help with anxiety
- no chewing of pills

StudentNurseGuides
 Drugs Used to Treat Acute Coronary Syndrome
hydromorphone (Dilaudid) • Severe pain • Monitor vital signs • Reports of decreased • Respiratory depression
• Monitor O2 sat pain, fewer non-verbal • Respiratory arrest
• Monitor sedation level pain indicators • D in LOC/sedation level
• Bowels • Constipation
• Increased activity level
• LOC • Urinary Retention
• Patient education:
- no chewing of pills

StudentNurseGuides
 GI Meds
Why patient Nursing How would nurse Adverse reactions
receiving med implications know if drug
working?
Reversal Agents
naloxone HCl (Narcan) *opioid reversal Assess O2 sat, • O2 sat ↑ • tachycardia
(IV, IM, SQ, Nasal)
vitals, LOC Assess • improved LOC & • agitation
antagonist for opioids
(opioid antagonist; effectiveness ↓ sedation
(ex: narcotics)
reverses
• normalization of flumazenil (Romazicon)
effects of narcotics)
vitals • Seizures
flumazenil (Romazicon) *Non-opioid
reversal • Patient reports no
antagonist for non-
opioids pain
(ex: benzodiazepines)

Antacids *Neutralizes gastric • Assess bowel • Patient free of GI • diarrhea
acid distress
magnesium hydroxide • constipation
status
(Maalox, Mylanta)
• ↓/absent reports • systemic alkalosis
• GERD
aluminum hydroxide • Do not take of s/s

• Ulcer disease other PO meds
(Amphogel)
within 1-2h of

calcium carbonate antacid
(Tums)

Proton Pump Inhibitors •↓ production of • Assess for s/s • Absent/↓reports • Can ↑risk of:
GI bleed, of GI s/s
(PPI) *gastric acid o fractures
GI distress
lansoprazole (Prevacid) • Ulcer disease • Stable H/H, vital o pneumonia
omeprazole (Prilosec) signs
• GERD o acid rebound
esomeprazole (Nexium)
pantoprazole (Protonix) • Hypersecretory o C-diff
condition
• confusion
—prazole
• GI bleed
Histamine (H2)
Antagonists
cimetidine (Tagamet)
famotidine (Pepcid)
ranitidine (Zantac)
—idine

sucralfate (Carafate) • Forms *protective • Give * 1H • Absent/↓ reports • No known serious

StudentNurseGuides
 GI Meds
barrier before meals & of GI adverse effects
over ulcer at *HS s/s
• Constipation
• protects from HCL • Assess H/H, • Stable H/H, vital
vital signs
• Gastric ulcer signs

• Duodenal ulcer • Do not give
with other *PO
meds

misoprostol (Cytotec) • ↓ production of • Check *LMP of • Stable H/H, vital * Miscarriage

female
*gastric acid signs • Angioedema— rare
patient
• Gastric ulcer • Absent/↓ reports • Diarrhea/constipation
• Check H/H, vital
of • Abdominal pain
signs
GI s/s
• Patient
education:
birth control

Anti-diarrheal To alleviate • Assess: Absent/↓ in • Constipation

o Bowel status
loperamide (Imodium) diarrhea diarrhea • Drowsiness
o Abdominal
pain
o I&O

• Encourage
fluids

Anti-emetics Nausea/vomiting • Assess bowel Absent/↓ of nausea Sedation

Promethazine status
(Phenergan)
• Assess
metoclopramide
effectiveness
(Reglan)
prochlorperazine
(Compazine)
ondansetron (Zofran)

Corticosteroids * Anti-inflammatory • Assess for Absent/↓ in • Thromboembolism

adverse
methylprednisolone in UC/CD diarrhea, pain * hyperglycemia
responses
(Solumedrol)
* impaired wound healing
• Assess blood
prednisone (Sterapred) • Fluid overload
glucose
• Worsening of

StudentNurseGuides
 GI Meds
• Assess vitals osteoporosis/↑fractures
• Assess weight
Drugs for Ulcerative Colitis & Crohn’s Disease:
• Immunodulator
• Immunosuppressant therapy
• 5-aminosalicylic acid
Immunomodulator Used for • Assess for • Absent/↓ in * Liver dysfunction
diarrhea, pain, diarrhea, pain
infliximab (Remicade) mild to moderate • With
GI bleed
immunosuppressants,
CD/UC • Absence of GI
• Assess LFTs,
bleed
Immunosuppressant H/H, and * Miscarriage

vitals
therapy • Stable H/H, WBC,
• Patient & vital signs
azathioprine (Imuran)
education
cyclosporine (Neoral)
• Lots of adverse
methotrexate (Trexall)
reactions

• Assess LMP in
5-aminosalicylic acid
female patients
drug
sulfasalazine (Azulfidine)
mesalamine
(Asacol/Pentasa)
olsalazine (Dipentum)

StudentNurseGuides
 Urinary Tract Meds
□ Medications for the urinary tract

Medication Why patient Nursing implications How would nurse Adverse reactions
receiving med know if drug
working?
phenazopyridine (Pyridium) Urinary tract Patient education: ↓/absence of pain Renal & hepatic
analgesic • Stains urine orange toxicity
• Pyridium is used for relief of
burning, pain associated
• Hydration—drink renal toxicity s/s?:
with UTI: Non-opioid
- numbs urethra and 3-4 L fluids/day • edema
analgesic
uriters Monitor: • elevated

• BUN/creatinine BUN/creatinine,
• It has a specific local
• LFTs • weight gain
analgesic effect in the
• hypertension
urinary tract, promptly
hepatic toxicity s/s?:
relieving burning and pain
• Jaundice

• pruritus
• ascites
• elevated LFTs

nitrofurantoin (Macrodantin) Urinary tract Patient teaching: ↓/absence of • Hepatotoxicity

antibiotic • Stains urine brown s/s of UTI • CDT diarrhea
• Hydration
**Give with milk or meals to
reduce GI upset Monitor:
• Urinalysis
• WBCs
• LFTs
• Bowel status

ciprofloxacin (Cipro) Antibiotic Patient education: ↓ in s/s of UTI • severe sunburn

• causes • C diff infection
• Fluoroquinolone; Can be
photosensitivity
used for a wide variety of
• Can cause Achilles
infections
• Avoid in under tendon rupture injury
age 18 (disrupts cartilage).
alpha-adrenergic blockers * Relaxes smooth • Monitor BP & ↓difficulty voiding Hypotension
muscle in bladder urinary output ↑ urinary output Cardiac dysrhythmia
terazosin (Hytrin) neck to enhance
urine flow: BPH • Patient Safety:
doxazosin (Cardura)
assist with activity if
tamsulosin (Flomax) patient gets dizzy
**Taken for life
• Assess for bladder
distention

anti-androgen agents Shrinks prostate • Assess urinary ↓ difficulty voiding Prostate Cancer
finasteride (Proscar) *Takes 6-12 months output
↑ urinary output Angioedema
dutasteride (Avodart)
• Assess for bladder
distention

StudentNurseGuides
 Musculoskeletal Meds Musculoskeletal Meds

Medication Why patient Nursing implications How would nurse know How would a nurse
receiving med if drug working? recognize an adverse
reaction?

Bisphosphonates • Osteopenia • Report onset of • Decrease bone loss • Dysphagia

dysphagia or dyspepsia (difficulty swallowing)
alendronate (Fosamax) • Osteoporosis • Decrease pain
• Take on empty • Dyspepsia
ibandronate (Boniva) • Increase ADLs
stomach first (indigestion)
thing in morning with a
risendronate (Actonel) FULL glass of water • Osteonecrosis of jaw*

zoledronic acid (8 oz) • Esophageal erosion

(Reclast) (IV) • Take 30 minutes
before food or drink &
* phos = phosphorus;
remain
take biphosphonates for
phosphorus; prevent upright 30 after ***
osteoclast activity • IV infuse over
15 – 30 minute
Calcium (with Vitamin To treat: Patient education: • ↑ calcium levels • Kidney stones
D if Needed) (b/c kidney stones can
• hypocalcemia • Monitor calcium, • Stabilization of
be made of calcium)
calcium carbonate vitamin D, & phosphorus osteoporosis/
(Oscal) • osteoporosis/ levels osteopenia • Hypercalcemia—due
with/without vitamin D osteopenia to too much calcium
• Admin with vitamin D
• Take 1/3 of daily dose • Hypophosphatemia
calcium citrate
(Citracal) at bedtime ***
• Encourage fluids *If calcium goes ↑ then
• Assess history of phosphorus goes ↓
urinary stones
Vitamin D • Treat Patient teaching: • ↑ calcium levels • Hypercalcemia
hypocalcemia
cholecalciferol • Admin with calcium • Stabilization of • Hypophosphatemia
(Vitamin D3) • ↓ vitamin D levels osteoporosis
• Evaluate calcium, • Hypervitaminosis D
/osteopenia
vitamin D, & phosphorus
levels

Estrogen Prevention & • Monitor symptoms of • ↑ bone mineral • Deep vein thrombosis
Agonist/Antagonists treatment of venous density (BMD)
• Pulmonary embolus
postmenopausal thromboembolism
raloxifene (Evista) • Decrease in
osteoporosis • Fetal Harm
• Monitor liver function osteoporosis fractures
test (AST/ALT) • Thrombotic stroke
• Adequate intake of
calcium and Vitamin D

StudentNurseGuides
 Musculoskeletal Meds Musculoskeletal Meds

Disease-Modifying • To treat • Establish LMP—avoid • ↓ pain • GI ulcer

Antirheumatic Drugs rheumatoid arthritis crowds, etc
• Increase ability to • bone marrow
(DMARDs):
• Work to suppress • Monitor liver enzymes, perform ADLs suppression
the body's & creatinine.
Methotrexate • altered hepatic &
overactive immune
(Rheumatrex) • Decrease ability to kidney function
and/or
fight
etanercept (Enbrel) inflammatory • teratogenic—affets
off infection
systems fetus
infliximab (Remicade)
• Discuss contraception,
last menstrual cycle?

Non-steroidal Anti- ↓ inflammatory • Give with food to • Decrease in reports of • GI ulcers

inflammatory drugs effects of disease decrease GI distress pain
• Bleeding
(NSAIDS) for pain in mild RA
• Monitor for GI bleed • Increase ability to • Ototoxicity
perform ADLs
ibuprofen (Motrin)
Salicylate acetylsalicylic
acid (Aspirin)

Glucocorticoids • ↓ inflammatory Monitor • ↓ in reports of pain • Osteoporosis

effects of disease blood sugar,
Prednisone • Increase ability to • Fluid overload
for pain in mild RA. vitals,
(Deltasone, Sterapred) perform ADLs
skin integrity, • Hyperglycemia
methylprednisolone • Frequently given weight, incisional sites
• Decreased wound
(Solumedrol) IV for acute
healing
exacerbation
• Impaired or
decreased immunity

• Glaucoma

StudentNurseGuides
 Neuro Meds
Medication Why is the What are the nursing How will I know if What would the nurse look
patient taking implications? this medication is for if the patient is having an
this medication? working? adverse response?

Corticosteroids MS & MG • Vitals • Decrease in • Thromboembolism

exacerbations inflammatory
methylprednisolone • Labs response • Hyperglycemia
(Solumedrol) Decrease
inflammatory • I&O • Decrease in • Decreased wound healing
response • Weights reports of pain • Fluid retention
• Wound/skin status • Stable WBC, • Osteoporosis
temperature, blood
• Wean off. glucose
Do not stop abruptly

Anticholinesterase or
antimyasthenics • Patient education
Used to treat Improvement in SX
• Fasciculation
pyridostigmine Myasthenia • Eat 45 min to 1
bromide (Mestinon) Gravis (MG) hour afterwards • Abdominal pain
• Assess med effect • Excessive muscarinic
on symptoms stimulation

Anticholinesterase ŸA positive tensilon • Bradycardia

inhibitor test:
confirms DX of MG —Have antidote readily
edrophonium chloride Used to Can’t be used to treat available (Atropine)
diagnose MG MG - 30 seconds after
(Tensilon)
injection, facial • Sweating
muscle weakness
should improve for • cramping
about 5 minutes

Ÿ A negative
tensilon test:
No improvement in
facial muscle
weakness
(pt doesn’t have
MG)

Meds for Parkinson’s Thing in Common

Disease for All Parkinson’s

StudentNurseGuides
 Neuro Meds
Disease Meds:

Improvement in
Symptoms
Dopamine • May require drug Improvement in • nausea, vomiting
replacement free holiday if Symptoms
• dyskinesia’s
effectiveness of
Parkinson’s med decreased • cardiovascular effects
levodopa/carbidopa Disease (PD) • High protein foods • psychosis
(Sinemet) may ↓ effects **Can make urine
• Carbidopa ↑ effects dark as a side effect
of levodopa

Anticholinergic agent Controls • Dysrhythmia

tremors & • Contraindicated Improvement in
benztropine mesylate • Urinary retention
rigidity of PD with glaucoma symptoms
(Cogentin) • Uncontrolled twitching

Antiviral agent • Assess for • Confusion

Controls Improvement in
effectiveness of
tremors & symptoms • Lightheadedness
drug
rigidity of PD • Anxiety
amantadine • Effectiveness may
hydrochloride wear off quickly • Blurred vision
(Symmetrel)
• Effectiveness of • Constipation
drug intensified
when given with • Urinary retention
anticholinergic
agent

Dopamine agonists • Nausea

Controls Ÿ May be used as Improvement in
tremors & secondary drug after symptoms • Dyskinesia’s
rigidity in early levodopa/carbidopa • Urinary retention
bromocriptine
PD loses effectiveness
mesylate (Parlodel) • Psychosis
Ÿ Used for a drug
holiday from
levodopa/carbidopa
when it loses
effectiveness

Ÿ Assess for

StudentNurseGuides
 Neuro Meds
drowsiness/dizziness

Monoamine oxidase B Ÿ When combined with

inhibitors levodopa/carbidopa can • Hypertensive crisis
May delay reduce “wearing off” Improvement in
neuro- effect symptoms • Insomnia
degeneration of • Orthostatic hypotension
selegiline (Eldepryl)
PD —Extends the
effectiveness of • Dizziness
levodopa/carbidopa • GI upset

Ÿ Instruct patient to
avoid foods that contain
tyramine &
sympathomimetic drugs

COMT inhibitors
• Dyskinesia’s
PD Ÿ ↑ duration of action in Improvement in
levodopa or carbidopa symptoms • Orthostatic hypotension
entacapone (Comtan)
• Hallucination
• Insomnia

StudentNurseGuides
 Reproductive MedsReproductive Meds

Medication Why patient Nursing implications How would nurse Adverse

receiving med know if drug reactions
working?
Gardisil To prevent HPV Assess for: Remains free of HPV None
• Allergies infection
• Sexually active
Patient education Remains free of
reproductive cancers

bisacodyl (Dulcolax) Constipation • Assess for Patient free of diarrhea

o Allergies constipation
o bowel sounds
o bowel movements
o abdominal pain
• Encourage oral fluids
• Contraindicated in
bowel obstruction

Phosphodiesterase type 5 Erectile • Patient education Patient will have an Priapism

(PDE-5) dysfunction • Contraindicated when erection
Hypotension
taking nitrates
sildenafil (Viagra)
vardenafil (Levitra) • Evaluate home meds
• Instruct patient they
tadalafil (Cialis) may develop a
headache or flushing

• Evaluate for heart

disease

StudentNurseGuides
Reproductive Meds

StudentNurseGuides
 Psychotropic Meds
Antipsychotics Antipsychotics Antidepressants
Second -Generation Selective Serotonin and
First-Generation
Risperidone (Risperdal) Norepinephrine Reuptake
Haloperidol (Haldol) Quetiapine (Seroquel) Inhibitors (SNRI’s)
Fluphenazine (Prolixin) Olanzapine (Zyprexa)
Aripiprazole (Abilify) Venlafaxine (Effexor)
Thioridazine (Mellaril) Duloxetine (Cymbalta)
Chlorpromazine (Thorazine) Ziprasidone (Geodon)
Clozapine (Clozaril) Desvenlafaxine (Pristiq)
Thiothixene (Navane) Levomilnacipram (Fetzima)
Perphenzine (Trilafon) Paliperidone (Invega)
Lurasidone (Latuda) Atomoxetin (Stattera)
Molidone (Moban)
Antidepressants Antidepressants Antidepressants
Monoamine Oxidase Inhibitors
Selective Serotonin Reuptake Atypical
(MAOI’s)
Inhibitors (SSRI’s)
Selegiline (Eldepryl) Bupropion (Wellbutrin)
Isocarboxazid (Marlpan) Escitalopram (Lexapro) Mirtazapine (Remeron)
Phenelizine (Nardil) Fluoxetine (Prozac) Trazadone (Desyrel)
Tranycypromine (Parnate) Paroxetine (Paxil)
Sertraline (Zoloft)
Citalopram (Celexa)

Tricyclics Mood Stabilizers Benzodiazepines

Imipramine (Tofranil) Lithium Chlordiazepoxide (Librium)

Amitriptyline (Elavil) Lorazepam (Ativan)
Doxepin (Sinequan) Clonazepam (Klonopin)
Nortriptyline (Pamelor) Diazepam (Valium)
Alprazolam (Xanax)

Anticonvulsants Psychostimulants Long Acting Antipsychotics

Divalproex (Depakote) Methylphenidate (Ritalin, 1st Generation

Lamotrigine (Lamictal) Concerta) Haloperidol Decanoate
Carbamazepine (Tegretol) Fluphenazine Decanoate
Dexmethylphenidate (Focalin)
Dextroamphetamines/
2nd Generation
amphetamine (Adderall) Risperdal Consta
Lisdexamfetamine (Vyvanse) Abilify Maintena
Invega Sustenna

StudentNurseGuides