Lehman's Med important facts

Antibiotics, psychotropics, and cardiac drugs

CHF, A-fib or Supraventricular arrhythmias.

to increase myocardial contractility, decrease SA node activity and Decrease Cardiac conduction rates.

Bradycardia, arrhythmias, yellow-green halos around visual images, nausea, anorexia, headache.

-may require a loading dose to achieve a therapeutic effect.
-Monitor serum levels as window between therapeutic and toxic levels is narrow.
-Monitor Apical Pulse for one minute prior to administration. Hold for pulse< 60 or > 120 and notify MD.
-Hypomagnesemia, Hypokalemia and Hypercalcemia contribute to toxicity.

Diltiazem (Cardizem)
Nicardipene (Cardene)
Nifedipine (Procardia)
Verapamil (Calan)
Amlodipine (Norvasc)

Decreased influx of calcium ions into calcium channels of myocardium and peripheral vasculature.

HTN, Angina.

Headache, fatigue, dizziness, edema, arrhythmias, hypotension, CHF. Bradycardia for Verapamil and Diltiazem.

Nadolol (Corgard)
Propranolol (Inderal)
Metoprolol (Lopressor)
Atenolol (Tenormin)
Metoprolol Succinate (Toprol XL)
Carvedilol (Coreg)

Blocks beta-adrenergic receptor stimulation

HTN, Tachycardia,CHF, angina.

Bradycardia, CHF, Hypotension, worsened peripheral vascular disease, bronchospasms, depression, heart block, fatigue.

-can mask symptoms of hypoglycemia.

Enalapril (Vasotec)
Lisinopril (Prinivil or Zestril)
Ramopril (Altace)
Quinapril (Accupril)

Inhibit conversion of Angiotensin I to Angiotensin II. Results in decreased vasoconstriction and decreased aldosterone secretion.

HTN, CHF.

Impaired renal function, neutropenia, Headache, Hypotension, Cough, Angioedema, Hyperkalemia,
Lightheadedness.

-Severe first dose hypotension can occur warn patient.

Valsartan (Diovan)
Losartan (Cozaar)
Candesartan (Atacand)

Block angiotensin II receptors resulting in decreased vasoconstriction and decreased aldosterone secretion.

same as ACE inhibitors except lower incidence of cough and angioedema.

decreases platelet aggregation. Centrally acting antipyretic, analgesic and antinflammatory.

Pain, fever, inflammation, prophylaxis of cardiovascular disease.

Prolonged bleeding time, Tinnitus, Abnormal Liver Functions, Worsened Asthma, Ulcers, GI Bleed.

Diclofenac Sodium (Voltaren) Ketorolac Tromethamine (Toradol)
Flurbiprofen (Ansaid) Sulindac (Clinoril)
Ibuprofen (Motrin) Naproxen Sodium (Naprosyn)
Indomethacin (Indocin) Piroxican (Feldene)
Nabumetone (Relafen)

Decrease pain and inflammation through inhibition of prostaglandin.

Musculoskeletal Pain, Arthritis, Headache, Mild to Moderate Pain.

Abdominal Pain, GI Bleed, Renal Toxicity, Elevated liver Enzymes, Worsened Bronchospasms, Fluid Retention, Hypertension.

Celecoxib (Celebrex) Possible association with MI

(Similar to NSAIDS but less incidence of GI Bleed or Ulcers)

Indicated for Insomnia:
Flurazepam (Dalmane)
Temazepam (Restoril)
Zolpidem (Ambien)
Alprazolam (Xanax)
Diazepam (Valium)
Lorazepam (Ativan)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin)

has shorter half-life less AM “hangover” less tendency for tolerance or rebound insomnia.

Enhances GABA a CNS depressant neurotransmitter.

Anxiety, Muscle relaxants, Anticonvulsants, Alcohol Withdrawal.

Drowsiness, Lethargy, Ataxia, Hypotension, Dry Mouth, Addiction.

-Do not withdraw abruptly.
-The elderly are vulnerable to accumulation and toxicity.

Fluoxetine (Prozac)
Paroxetine (Paxil)
Setraline(Zoloft)
Citalopram (Celexa)
Escitalopram (Lexapro)

Decreases re-uptake of Serotonin a neurotransmitter.

Depression, Anxiety

Tremors, anxiety, insomnia, nausea, anorexia, diarrhea, constipation, increased appetite, weight loss, seizures

Cannot be given within 14 days of administration of an MAO inhibitor: can trigger Hypertensive crisis. Assess for suicide risk

Duloxetine (Cymbalta)
Venlafaxine (Effexor)

Inhibits re-uptake of Serotonin and Neurepinephrine

Depression and Anxiety

Same as SSRIs plus increased BP

Anticonvulsant, Affective disorders.

Aplastic Anemia, Agranulocytosis, Thrombocytopenia, Dizziness, Sedation, GI Distress.

-Monitor serum blood levels.
-Monitor CBC.

Anticonvulsant, Antiarrthymic.

Slows sodium channels.

Pancytopenia, Megoblastic Anemia, Ataxia, Slurred Speech, Confusion, Arrthymias, Hypotension, Gingival Hyperplasia, Lupus Erthymatosous.

-Monitor serum blood levels, CBC, B12, and Folic acid Levels.

Anticonvulsant, Neuropathic pain, Agitation

Fatigue, somnolence, dizziness, ataxia, peripheral edema, nausea, vomiting, constipation, decreased WBC count.

-withdrawal slowly if discontinued,
-can cause false positive for urine protein.

Anticonvulsant

Fatigue, Somnolence, Ataxia, Dizziness, Bone Marrow Depression, Psychosis, Suicidal Behavior

Haloperidol (Haldol)
Thioridazine (Mellaril)
Thiothixene (Navane)

Atypicals:
Olanzapine (Zyprexa)
Risperidone (Risperdal)
Quetiapine (Seroquel)

Psychosis, Agitation.

Extrapyramidal symptoms (Parkinson like rigidity and tremors)., Tardive Dyskinesia, Neuroleptic Malignant Syndrome (High Fever, Tachycardia, Tachypnea, Diaphoresis, rare but often fatal)., Sedation, Confusion, Constipation, Urinary Retention, Dry Mouth, orthostatic hypotension.

-Haldol and Navane have a high rate of EPS but a lower rate of sedation.
-Mellaril has a low incidence of EPS but a high rate of sedation.
-Atypicals cause less EPS but tend to cause weight gain.

METAPROTERAL (ALUPENT)(short acting)
ALBUTEROL (PROVENTIL) (short acting)
Salmeterol (Serevent) (long acting)
Levalbuterol (Xopenex) (Short Acting)

Asthma, Bronchospasm.

Work by increasing action of sympathetic nervous system at Beta receptors.

Tremors, Agitation, Tachycardia, HTN, Palpitations.

-Can be given by MDI(Metered Dose Inhaler) or Nebulization,
-Effective for routine or PRN use.
-Teach proper use of inhaler.

Maintenance treatment of bronchospasms associated with COPD.

Works by inhibition of the Parasympathetic Nervous System.

Nervousness, Dizziness, palpitations, tachycardia, cough

-Not appropriate for emergency use.
-Teach proper use of MDI.

Prophylaxis and symptomatic relief of bronchospasm of Asthma or COPD.

Restlessness, Dizziness, Seizures, Headache, Tachycardia, Palpitations, Hypotension, Nausea and Vomiting.

-Monitor serum blood levels.

BECLOMETHASONE (BECLOVENT, VANCERIL)
Triamcinolone (AZMACORT)
Fluticasone (Flovent)

Decrease airway inflammatory response with topical steroid.

Bronchospastic disease not responsive to Bronchodilators.

Hoarseness, Fungal Infections of Mouth and Throat.

-Not for Acute use.
-Instruct patient to rinse mouth after use to prevent candidiasis.
-Administer after Bronchodilators if being given concurrently.

Advair: combines Flovent with Serevent
Combivent: combines albuterol with Atrovent

PREDNISONE
Methylprednisolone (Medrol)
Dexamethasone (Decadron)

Potent antiinflammatory has glucocorticoid and mineralcorticoid effects.

Severe Inflammation, Allergic Reactions, Bronchospasms.

Psychosis, Edema, Fluid Retention, Hyperglycemia, Immunosupression, Hypokalemia, GI Bleed, Poor Wound Healing, GI Distress.

-Abrupt Withdrawal causes rebound inflammation and can be fatal.
-Administer with food or milk.

Hydrochlorithiazide (HCTZ) etc.

Inhibits sodium reabsorption in the distal renal tubule.

HTN, Edema

Hypotension, hypokalemia, hyponatremia hyperglycemia, volume depletion, gout.

Bumetandine (Bumex)
Furosemide (Lasix)

Renal Failure, CHF, HTN.

More potent than thiazide. Inhibits sodium reabsorption in renal tubule at loop of henle.

Blood Dyscrasias, Volume Depletion, Orthostatic Hypotension, Hypokalemia, hyponatremia Hyperglycemia.

Spironolacane (Aldactone)
Triamterene (Dyenium)

Edema, HTN, CHF.

Inhibits distal convoluted tubule aldosterone receptors

Hyperkalemia, Headache, Anorexia, Dehydration, Elevated BUN, Acidosis, Hypotension.

DYAZIDE (Triamterene 50mg and HCTZ 25mg)

MAXZIDE (Triamterene 75mg and HCTZ 50mg)

Given to minimize potassium imbalances caused by other diuretics.

Cimetidine (Tagamet)
Famotidine (Pepcid)
Nizatidine (Axid)
Ranitidine (Zantac)

Douodenal Ulcers, Esophagitis and esophageal reflux.

Blocks H2 receptors

Blood Dyscrasias, diarrhea, nausea, constipation.

Tagamet has more interactions with other drugs than the other H2 blockers.

Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Pantoprazole (protonix)
Esomeprazole (Nexium)
Rabeprazole (Aciphex)

Esophagitis, Gastroesophogeal reflux disease, Duodenal Ulcer

Inhibits gastric parietal cell proton pump

headache, dizziness, cough, nausea, vomiting, constipation, flatulence

-Can increase serum levels of diazepam, phenytoin and coumadin monitor closely.

Chlorpromide (Diabinese)
Glipizide (Glucotrol)
Glyburide (Diabeta, Micronase)
Glimepiride (Amaryl)

Glucose Control in Type II Diabetes Mellitus.

Stimulate beta cell activity in the pancreas

Hypoglycemia, dizziness, jaundice.

-Monitor Blood Glucose if indicated.
-Look for symptoms of hypoglycemia.
-Educate patient about his disease, diet and management of hypoglycemic episodes.

Rosiglitazone(Avandia)
Pioglitazone (Actos)

Adjunct to diet and insulin control of Type II diabetes.

Insulin sensitizer.

Headache, peripheral edema, elevated liver enzymes, nausea, diarrhea, hypoglycemia when used in conjunction with insulin.

-monitor liver enzymes,
-monitor blood glucose for response/ hypoglycemia. Contraindicated in CHF

Adjunctive control of blood glucose in Type 2 diabetes.

Decreased hepatic glucose production and insulin sensitizer.

diarrhea, nausea, vomiting, bloating, lactic acidosis, megablastic anemia

Contraindicated for patients with impaired renal function (increased risk of lactic acidosis) Hold when patient dehydrated or receives contrast dyes.

Levothyroxine (Synthroid) (Levoxyl)
Thyroid Dessicated (Armour Thyroid)

Hypothyroidism

Thyroid hormone replacement

Toxicity as evidenced by nervousness, insomnia, tachycardia, arrhythmias, angina, HTN, heat intolerance.

-Monitor TSH and other thyroid values.

Prevention of thrombus formation.

Inhibits production of Vitamin K dependent clotting factors.

Hemorrhage, GI Bleed, Bruises, Anemia secondary to bleeding.

-Monitor Protime/INR closely.
-Vitamin K is an antidote to Coumadin.
-Avoid Concurrent administration of ASA or NSAIDS.
- Educate patient about risks and precautions associated with drug.

Cardiovascular prophylaxis by decreased platelet aggregation

hemorrhage, edema, and ulcer

Use caution with NSAIDS, ASA or coumadin due to increased risk of bleeding or ulcer

Prevention or treatment of DVT or thromboembolism

Inhibits thrombin and conversion of fibrinogen to fibrin

Bleeding/hemorrhage

Monitor platelet count and PTT for heparin. Lab monitoring not required for low molecular weight heparins after initiation. Do not aspirate or rub subcutaneous injection.

Parkinson's

Increases CNS availability of Dopamine

Nervousness, Hemolytic Anemia, Delirium, Hallucinations, Ataxia, Orthostatic Hypotension, Nausea and Vomiting, anorexia, Urinary Retention.

Adjunctive to Sinemet for Parkinsons

Decreases peripheral metabolism of Sinemet increases amount available to CNS.

Dyskinesias, Hypotension, Diarrhea, Hallucinations, and Syncope

Combination of Sinemet and Comtan

Donzepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Reminyl)

Mild to moderate dementia of the Alzheimer's Type.

Inactivates acetocholinesterase an enzyme that breaks down acetylcholine.

Headache, insomnia, dizziness, depression, vertigo, ataxia, aphasia, syncope, HTN, hypotension, atrial fib, cataracts, blurred vision, nausea, diarrhea, vomiting, fecal incontinence, weight loss.

Alzheimer’s

Decreases NMDA an excitatory neurotransmitter

Somnolence, Hallucinations, Fatigue, Nausea, Vomiting, and Constipation

Morphine
Hydromorphone (Dilaudid)
Meperidine (Demerol)
Codeine
Oxycodone
Oxycodone with Acetominophen (Percocet)
Hydrocodone with Acetominphen (Vicodin)
Long acting Oxycodone (Oxycontin)
Fentanyl (Duragesic)

Moderate to severe pain

Binds to opiate receptors

Respiratory Depression, Sedation, Nausea/Vomiting, and Constipation

Give oral forms with food. Titrate to pain levels. Monitor bowel function. Administer Laxative as ordered for patient using more than 1-2 days. Long-term use will result in withdrawal symptoms if stopped abruptly.