304 Med Cards – Flashcards

Classification: Antiarrhythmics MOA: increases contractility by inhibiting sodium/potassium ATPase pump in myocardial cells Side Effects: Arrhythmias, Mental disturbances, Diarrhea Safe Dosage: IV: 8-12 mcg/kg (0.008-0.012 mg/kg) total loading dose; administer 50% initially PO: 10-15 mcg/kg total loading dose; administer 50% initially; then may cautiously give 1/4 the loading dose q6-8hr twice Why Prescribed: Monitor ECG throughout IV admin.

Classification: Beta 1 blockers MOA: Blocks response to beta-adrenergic stimulation; cardioselective for beta1 receptors at low doses, with little or no effect on beta2 receptors Side Effects: bradycardia, HF, Pulmonary edema Safe Dosage: 5 mg rapid IV q2min, up to 3 doses; then, 15 minutes after last IV, 50 mg PO q6hr for 48 hours; then 50-100 mg PO q12hr If full IV dose not tolerated: 25-50 mg PO q6hr after last IV Why Prescribed: Acute myocardial infarction, Congestive heart failure, Hypertension, Angina, to decrease BP and HR Nursing Implications: Monitor BP, ECG, and pulse frequently Monitor Vitals every 5-15 minutes

Classification: antihypertensives, Beta Blockers MOA: Nonselective beta-adrenergic and alpha1-adrenergic blocking agent with no intrinsic activity for use in congestive heart failure and hypertension Side Effects: bradycardia, HF, Pulmonary edema, Stevens-Johnson syndrome Safe Dosage: Maximum recommended dosage: 85 kg: 50 mg PO twice daily Why Prescribed: Congestive Heart Failure, Hypertension, Left Ventricular Dysfunction Following Myocardial Infarction, Angina Pectoris Nursing Implications: Monitor BP and pulse frequently Monitor I+O

Classification: Histamine H2 Antagonist MOA: Blocks H2 receptors of gastric parietal cells, leading to inhibition of gastric secretions Side Effects: Arrhythmia, hepatitis, anaphylaxis Safe Dosage: Acute treatment: 20 mg PO/IV q12hr or 40 mg PO at bedtime for 4-8 weeks 40 mg PO at bedtime Why Prescribed: Duodenal Ulcer, Benign Gastric Ulcer, Gastroesophageal Reflux Disease, Hypersecretory conditions, heartburn Nursing Implications: may be sensitive and no alcohol consumption, as well as kidneys may be effected so note intake/ output/ color/ etc.

Classification: Beta 2 Agonist MOA: Beta2 receptor agonist with some beta1 activity; relaxes bronchial smooth muscle with little effect on heart rate Side Effects: Bronchospasm, Tremors, Insomnia, Nervousness Safe Dosage: Nebulizer solution: 2.5 mg BID/TID PRN; 1.25 - 5 mg q4-8hr PRN for quick relief Aerosol metered-dose inhaler: 180 mcg (2 puffs) inhaled PO q4-6hr; not to exceed 12 inhalations/24 hr Powder metered-dose inhaler: 180 mcg (2 puffs) inhaled PO q4-6hr; not to exceed 12 inhalations/24 hr; in some patients 1 inhalation (90 mcg) q4hr may be sufficient Why Prescribed: Bronchospasm Nursing Implications: observe for bronchospasms

Classification: Anticholinergics MOA: Anticholinergic agent; inhibits vagally mediated reflexes by antagonizing acetylcholine action; prevents increase in intracellular calcium concentration that is caused by interaction of acetylcholine with muscarinic receptors on bronchial smooth muscle Side Effects: tachycardia, dry throat, bronchospasm Safe Dosage: Inhaler: 2 actuations q6hr, then additional actuations PRN; not to exceed 12 actuations/day Nebulizer: 2.5 mL (500 mcg) q6-8hr Why Prescribed: COPD, Perennial Allergic/Nonallergic Rhinitis Nursing Implications: Prime before initial use by releasing 2 test sprays into air; repeat priming if unused for ≥3 days

Classification: Gastrointestinal, Herbals MOA: acid producing bacteria that inhibit or decrease growth of harmful microorganisms in the gut by producing lactic acid Side Effects: bloating, gas, nausea, rash, and infection Safe Dosage: depends on manufacturer- some dosing includes 1-2 capsules daily Why Prescribed: Intestinal Flora Restoration Nursing Implications: take soon after starting antibiotic and continue after stopping antibiotic treatment

Classification: Diuretic MOA: Loop diuretic; inhibits reabsorption of sodium and chloride ions at proximal and distal renal tubules and loop of Henle; by interfering with chloride-binding cotransport system, causes increases in water, calcium, magnesium, sodium, and chloride Side Effects: Hyperuricemia, Hypokalemia, Stevens -Johnson Syndrome Safe Dosage: 20-80 mg PO once daily; may be increased by 20-40 mg q6-8hr; not to exceed 600 mg/day Why Prescribed: Edema, Hypertension Nursing Implications: Use caution in diabetes mellitus, systemic lupus erythematosus, liver disease, renal impairment Agent is potent diuretic that, if given in excessive amounts, may lead to profound diuresis with water and electrolyte depletion Watch for skin rash in patient frequently during therapy

Classification: antiurolithics, mineral and electrolyte MOA: replacement of phosphorus in deficiency states Side Effects: Hyperkalemia, arrhythmias, cardiac arrest Safe Dosage: PO 250-500 mg Why Prescribed: treatment and prevention of phosphate depletion, can prevent calcium stones in ureters Nursing Implications: assess for hypokalemia, hypophosphatemia Lab tests- monitor serum phosphate and electrolytes

Classification: Thyroid Products MOA: Synthetic T4; thyroid hormone increases basal metabolic rate, increases utilization and mobilization of glycogen stores, promotes gluconeogenesis; involved in growth development and stimulates protein synthesis Side Effects: tachycardia, tremors, angina pectoris Safe Dosage: 1.7 mcg/kg or 100-125 mcg PO qDay; not to exceed 300 mcg/day Why Prescribed: Hypothyroidism Nursing Implications: assess apical pulse and BP prior to and during therapy Watch for toxicity and OD Avoid undertreatment or overtreatment, which may result in adverse effects Use caution in cardiovascular disease, HTN, endocrine disorders, osteoporosis, or myxedema Symptoms may be exacerbated or aggravated in patients with diabetes mellitus and insipidus

Classification: Antigout agent, Xanthine Oxidase Inhibitors MOA: Xanthine oxidase inhibitor; inhibits conversion of hypoxanthine to xanthine to uric acid; decreases production of uric acid without disrupting synthesis of vital purines Side Effects: Renal Failure, Rash, Nausea Safe Dosage: Mild: 100 mg/day PO initially; increased weekly to 200-300 mg/day Moderate to severe: 100 mg/day PO initially; increased weekly to 400-600 mg/day PO: 600-800 mg divided q8-12hr, starting 1-2 days before chemotherapy Why Prescribed: Gout, Antineoplastic-Induced Hyperuricemia Nursing Implications: Hepatotoxicity, Use with caution in renal impairment

Classification: Corticosteroids MOA: Potent anti-inflammatory corticosteroid with vasoconstrictive properties Side Effects: Headache, Upper Respiratory Infection Safe Dosage: 2 sprays in each nostril qDay Why Prescribed: Perennial Nonallergic Rhinitis Nursing Implications: Chickenpox and measles: Serious or fatal course in susceptible individuals; unvaccinated or immunologically unexposed children or adults should avoid exposure Delays wound healing of nasal septal ulcers, trauma, or surgery; best to administer after healing has occurred

Classification: Acetylcholinesterase Inhibitor MOA: Increases acetylcholine from surviving presynaptic nerve terminals by modulating the nicotinic acetylcholine receptor. Glutamate and serotonin levels may increase Side Effects: bradycardia, AV block, Serious skin reactions may occur Safe Dosage: Conventional: 4 mg PO q12hr ER: 8 mg PO qAM Moderate:: Not to exceed 16 mg/day Why Prescribed: Alzheimer Disease, Hepatic Impairment, Renal Impairment Nursing Implications: Monitor for respiratory adverse events in patients with a history of severe asthma or obstructive pulmonary disease

Classification: Acetylcholinesterase Inhibitor MOA: Reversible acetylcholinesterase inhibitor that causes an increase in concentrations of acetylcholine, which in turn enhances cholinergic neurotransmission Side Effects: Anorexia, Abdominal Pain, N+V, Headache Safe Dosage: Initial: 1.5 mg PO q12hr Increase by 1.5 mg/dose q2Weeks; not to exceed 6 mg PO q12hr Initial: 1.5 mg PO q12hr Increase by 1.5 mg/dose q4Weeks; not to exceed 6 mg PO q12hr Why Prescribed: Alzheimer Dementia, Parkinson Dementia Nursing Implications: Medication errors with transdermal patches have resulted in serious adverse events; some cases have required hospitalization, and in rare instances, medication errors have led to death

Classification: Acetylcholinesterase Inhibitor MOA: Acetylcholinesterase inhibitor that causes an increase in concentrations of acetylcholine, which in turn enhances cholinergic neurotransmission Side Effects: Abdominal pain, agitation, aggression, cholecystitis, convulsions, heart block (all types), hemolytic anemia, hepatitis, hyponatremia, neuroleptic malignant syndrome, pancreatitis, rash, rhabdomyolysis, QTc prolongation, Stevens Johnson syndrome toxic epidermal necrolysis and torsade de pointes Safe Dosage: 5 mg PO qHS initially, may increase to 10 mg qDay after 4-6 weeks; may further increase to 23 mg/day after 3 months if warranted Why Prescribed: Alzheimer's Disease Nursing Implications: Take at bedtime before retiring Risk of GI bleed, especially in patients with history of gastric ulcer or those on NSAIDs Cholinesterase inhibitors are likely to exaggerate succinylcholine-type muscle relaxation during anesthesia Cholinesterase inhibitors may have vagotonic effects on the sinoatrial and atrioventricular nodes manifesting as bradycardia or heart block

Classification: NMDA Antagonist MOA: Low- to moderate-affinity uncompetitive N-methyl-D-aspartate (NMDA) receptor (NMDAR) antagonist that binds preferentially to NMDAR-operated cation channels, blocking receptor only under conditions of excessive stimulation, with no effect on normal neurotransmission Side Effects: Cardiac failure congestive, Agranulocytosis, leukopenia, Pancreatitis, Hepatitis, Suicide risk Safe Dosage: Tablet: 5 mg PO once daily initially; increased by increments of 5 mg/day each week; maintenance target dosage (>5 weeks): 20 mg/day PO divided q12hr Extended-release capsule: 7 mg PO qDay initially; may be increased by increments of 7 mg/day each week; maintenance target dose is 28 mg PO qDay Why Prescribed: Alzheimer-Type Dementia Nursing Implications: Use caution in cardiovascular disease, seizure disorder, ophthalmic disease, hepatic and/or renal impairment

Classification: Antidiabetics, Insulin MOA: Regulates glucose metabolism Side Effects: Hypoglycemia, Hypokalemia, Itching Safe Dosage: Type 1: Total maintenance daily insulin requirement may vary; it is usually between 0.5 and 1 unit/kg/day Type 2: 10 units/day SC Why Prescribed: Diabetes Nursing Implications: Learn all preparation and usage instructions from your health care professional and the product package Onset: less than 15 minutes Peak: 1-2 hours Duration: 3-4 hours

Classification: Antidiabetics, Insulin MOA: Protein hormone Side Effects: Hypoglycemia, Insulin resistance, Lipodystrophy Safe Dosage: Total daily insulin requirement may vary and is usually between 0.5-1 unit/kg/day Why Prescribed: Indicated to improve glycemic control in adults and children with diabetes mellitus Nursing Implications: Learn all preparation and usage instructions from your health care professional and the product package Onset: less than 15 minutes Peak: 1-2 hours Duration: 3-4 hours

Classification: Antidiabetics, Insulin MOA: Protein hormone; stimulates glucose uptake by peripheral cells Side Effects: Hypoglycemia, Tachycardia, Lipodystrophy Safe Dosage: Rapid-acting human insulin analogue indicated to improve glycemic control in adults and children with type 1 or 2 diabetes mellitus Why Prescribed: Diabetes Nursing Implications: Learn all preparation and usage instructions from your health care professional and the product package Onset: less than 15 minutes Peak:1-2 hours Duration: 3-4 hours

Classification: Antidiabetics, Insulin MOA: Regulates glucose metabolism Side Effects: Hypoglycemia, Insulin resistance, Lipodystrophy Safe Dosage: Dose adjustments should be based on regular blood glucose testing Why Prescribed: Diabetes type 1 and 2, Diabetic Ketoacidosis Nursing Implications: Learn all preparation and usage instructions from your health care professional and the product package Onset: 30-60 minutes Peak: 2-4 hours Duration: 5-7 hours

Classification: Antidiabetics, Insulin MOA: Regulates glucose metabolism Insulin NPH and insulin regular is a combination insulin product with intermediate action that has more rapid onset than that of insulin NPH alone Side Effects: Hypoglycemia, Lipodystrophy, Hypokalemia Safe Dosage: Type 1: Usual daily maintenance range is 0.5-1 unit/kg/day Type 2: Suggested guidelines for beginning dose: 0.2 unit/kg/day Why Prescribed: diabetes Nursing Implications: Learn all preparation and usage instructions from your health care professional and the product package Onset: 2-4 hours Peak: 4-10 hours Duration: 10-16 hours

Classification: Antidiabetics, Insulin MOA: Insulin and its analogues lower blood glucose by stimulating peripheral glucose uptake Side Effects: Hypoglycemia, Tachycardia, Headache Safe Dosage: Once daily dosage: Administer SC with evening meal or at bedtime Twice daily dosage: Administer SC with morning meal and either with evening meal, at bedtime, or 12 hr after the morning dose Why Prescribed: Diabetes Nursing Implications: Learn all preparation and usage instructions from your health care professional and the product package Onset: 3-4 hours Peak: 3-14 hours Duration: 6-24 hours

Classification: Antidiabetics, Insulin MOA: Insulin and its analogues lower blood glucose by stimulating peripheral glucose uptake Side Effects: Headache, Lipodystrophy, Tachycardia Safe Dosage: Indicated for once-daily SC administration; exhibits relatively constant glucose-lowering profile over 24 hr Why Prescribed: Diabetes Nursing Implications: Learn all preparation and usage instructions from your health care professional and the product package Onset: 3-4 hours Peak: none Duration: 24 hours

Classification: Laxatives, Bulk Producing MOA: Bulk-producing laxative Side Effects: Abdominal cramping, Flatulence, Impaction Safe Dosage: 2.5-7.5 g in 8 oz of water PO, up to 30 g/d divided PO or 1 teaspoonful or 1 tbs in 8 oz of water PO qD-TID, depending on product Why Prescribed: Constipation Nursing Implications: Contraindications of Hypersensitivity, GI obstruction, fecal impaction, symptoms of appendicitis or acute surgical abdomen, GI ulceration, dysphagia, rectal bleeding

Classification: Laxatives MOA: Irritates smooth muscle of intestine and possibly colonic intramural plexus, thus in turn increasing peristalsis Increases intestinal fluid accumulation and laxation by altering water and electrolyte secretion Side Effects: Abdominal Cramping, Fluid and Electrolyte imbalances, Excessive Diarrhea Safe Dosage: 5-15 mg PO once daily; if complete evacuation required, 30 mg PO once daily Why Prescribed: Constipation Nursing Implications: Avoid chronic use; may cause laxative dependence Avoid using in patients with gastroenteritis

Classification: Laxative, Stool Softener MOA: Surfactant laxative, reduces tension of oil-water interface of the stool; enhances incorporation of water and fat into stool, causing stool to soften Side Effects: Abdominal cramping, excessive bowel activity, intestinal obstruction Safe Dosage: PO: 50-500 mg/day in single daily dose (eg, at bedtime) or divided q6hr PR: 50-100 mg of docusate liquid, given as retention or flushing enema Why Prescribed: Constipation Nursing Implications: Electrolyte imbalance may occur with excessive use Excessive use may result in dependence

Classification: laxatives MOA: Hyperosmotic agent Side Effects: Excessive bowel activity Safe Dosage: 2-3 g suppository, retain 15 min, PRN constipation OR 5-15 mL of rectal solution as an enema Why Prescribed: Constipation Nursing Implications: GI obstruction, severe impaction

Classification: laxatives MOA: Constipation: Hyperosmotic agent increases stool water contents, softens stool, promotes peristalsis, and reduces blood ammonia concentration Portal systemic encephalopathy: Breakdown of lactulose to organic acids by colonic bacteria acidifies colonic contents, thereby subsequently inhibiting diffusion of ammonia back to blood; agent also enhances diffusion of NH3 from blood into gut, where it is converted to NH4+ Side Effects: Dehydration, diarrhea, excessive bowel activity Safe Dosage: Solution: 15-30 mL (10-20 g) PO once daily; may be increased to 60 mL (40 g) once daily PSE: 30-45 mL (20-30 g) PO q6-8hr, adjusted until 2-3 soft stools/day; if acute, may be given q1-2hr until 2-3 soft stools/day Why Prescribed: Constipation, Portal Systemic Encephalopathy Nursing Implications: Monitor for electrolyte imbalance when drug is used for >6 months or in patients predisposed to electrolyte abnormalities Avoid using other laxatives concomitantly

Classification: Antiparkinson agent, dopamine agonist MOA: Carbidopa: Inhibits aromatic amino-acid decarboxylase in peripheral tissues; this, in turn, inhibits peripheral breakdown of levodopa, thereby increasing availability of levodopa at blood-brain barrier and allowing a lower levodopa dose Levodopa: Metabolic precursor of dopamine, a neurotransmitter depleted in Parkinson disease; crosses blood-brain barrier to be converted by striatal enzymes to dopamine Side Effects: Edema, Anxiety, Confusion Safe Dosage: Immediate release: 25 mg/100 mg q8hr or 10 mg/100 mg PO q6-8hr initially; levodopa may be increased by 100 mg/day every 1-2 days Carbidopa should be 70-100 mg/day but not to exceed 200 mg/day; levodopa not to exceed 800 mg/day Sinemet CR: 50 mg/200 mg PO q12hr initially; may be increased up to 1600 mg/day of levodopa; doses must be given at least 6 hours apart Why Prescribed: Parkinson Disease & Parkinsonlike Disorders Nursing Implications: Severe cardiovascular, pulmonary, renal, hepatic, or endocrine disease; monitor disease parameters Increased risk for hallucinations and psychosis when taking levodopa; other psychiatric symptoms include decreased impulse control and compulsive behaviors, depression, and suicidality

Classification: Antiparkinson Agent, Dopamine Agonist MOA: Potent nonergoline dopamine agonist specific for D2 and D3 subtypes, possibly within caudate putamen in brain Side Effects: Syncope, Somnolence, Viral Infections Safe Dosage: 0.25 mg PO q8hr for 1 week initially, then increased weekly by 0.25 mg q8hr; if necessary, after week 4, may be increased weekly by 1.5 mg/day up to 9 mg/day, then increased weekly by 3 mg/day up to 24 mg/day Why Prescribed: Parkinson Disease, Restless Legs Syndrome Nursing Implications:May cause psychotic-like behavior; abnormal thinking and behavior can consist of one or more of a variety of manifestations including paranoid ideation, delusions, hallucinations, confusion, disorientation, aggressive behavior, agitation, and delirium; risk may be increased in the elderly Risk of orthostatic hypotension with extended-release formulation

Classification: Lipid Lowering Agent, Statins MOA: HMG-CoA reductase inhibitor; inhibits rate-limiting step in cholesterol biosynthesis by competitively inhibiting HMG-CoA reductase Side Effects: Diarrhea, Nasopharyngitis, Arthralgia Safe Dosage: 0-20 mg PO qDay initially Starting dose in patients requiring larger LDL-C reduction (ie, >45%): 40 mg PO qDay Maintenance: 10-80 mg PO qDay Why Prescribed: Hyperlipidemia, Hypertriglyceridemia, Cardiovascular Disease Prevention Nursing Implications: Avoid eating grapefruit or drinking grapefruit juice

Classification: Lipid Lowering Agent, Statins MOA: HMG-CoA reductase inhibitor; inhibits the rate-limiting step in cholesterol biosynthesis by competitively inhibiting HMG-CoA reductase Side Effects: Upper respiratory infection, abdominal pain, headache Safe Dosage: Usual dosage range: 5-40 mg PO qDay Initial: 10-20 mg PO qDay in the evening Why Prescribed: hypercholesterolemia Nursing Implications: Avoid eating grapefruit or drinking grapefruit juice

Classification: Lipid Lowering Agent, Statins MOA: HMG-CoA reductase inhibitor; inhibits the rate-limiting step in cholesterol biosynthesis by competitively inhibiting HMG-CoA reductase Side Effects: N+V, Diarrhea, Headache Safe Dosage: 10-40 mg PO qDay; not to exceed 80 mg/day Why Prescribed: Hyperlipidemia, Primary Prevention of Coronary Events, Secondary Prevention of Cardiovascular Events Nursing Implications: It is important to continue taking this medication even if you feel well. Most people with high cholesterol or triglycerides do not feel sick. It may take up to 4 weeks before you get the full benefit of this drug.

Classification: Lipid lowering agents MOA: Possibly inhibits acyl CoA: 1,2-diacylglycerol acyltransferase, increases peroxisomal beta-oxidation in liver; may decrease hepatic triglyceride synthesis; plasma lipoprotein lipase activity may increase Side Effects: Eructation, Infection, Flu-like symptoms Safe Dosage: 4 g (4 capsules) PO qDay or 2 g (2 capsules) PO BID Why Prescribed: Hypertriglyceridemia Nursing Implications: If you are using the enteric-coated capsules, swallow the capsules whole. If you are using the chewable form of this product, chew thoroughly before swallowing

Classification: Antianxiety agent MOA: Binds receptors at several sites within the CNS, including the limbic system and reticular formation Side Effects: Drowsiness, Xerostomia, Depression Safe Dosage: 0.25-0.5 mg PO q6-8hr; titrate to effect q3-4Days; not to exceed 4 mg/day Why Prescribed: Anxiety, Panic Disorder, Anxiety Associated With Depression Nursing Implications: This medication may cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. Can also cause addictive behaviors.

Classification: Anticonvulsants, Antianxiety, Benzodiazepines MOA: Sedative hypnotic with short onset of effects and relatively long half-life Side Effects: Sedation, Dizziness, Weakness Safe Dosage: Initial: 2-3 mg PO q8-12hr PRN; not to exceed 10 mg/day Maintenance: 2-6 mg/day PO divided q8-12hr Why Prescribed: Anxiety Disorders, Short-Term Treatment of Insomnia, Preoperative Sedation, Anxiety Relief, & Anterograde Amnesia, Status Epilepticus Nursing Implications: learn all preparation and usage instructions from your health care professional with injections

Classification: Gastrointestinal, Herbals MOA: Cinnamic Acid - hypoglycemic properties Side Effects: may irritate mucous membranes and excessive doses may cause hypoglycemia Safe Dosage: 1-6 grams (1 teaspoon = 4.75 grams) of cassia cinnamon PO qD for up to 4 months Why Prescribed: Diabetes Type 1 & 2, GI antispasmodic/antiflatulent, diarrhea, dysmenorrhea, cold, influenza, general antimicrobial Nursing Implications: body has a hypersensitivity to it

Classification: antiglaucoma, prostaglandin agonist MOA: Prostaglandin F2-alpha analog; incr outflow of aqueous humor Side Effects: Blurred vision, Burning and stinging, Foreign body sensation Safe Dosage: 1 drop in affected eye qDay in evening Why Prescribed: Elevated Intraocular Pressure, Open-angle glaucoma Nursing Implications: want to make sure entire eye drop makes it into the eye; teaching how to use the eye drops

Classification: antiglaucoma, prostaglandin agonist MOA: Prostaglandin F2-alpha analog; incr outflow of aqueous humor Side Effects: Ocular hyperemia, Decreased visual acuity, Cataract Safe Dosage: Instill 1 gtt in affected eye qDay Why Prescribed: Open-Angle Glaucoma Nursing Implications: watch for Hypersensitivity and make sure they are not pregnant or be cautious with pregnancy

Classification: Antiglaucoma, Alpha Agonist MOA: Alpha-2 adrenergic receptor agonist; decrease aqueous humor secretion, increase uveoscleral outflow Side Effects: Oral dryness, Ocular hyperemia, Photophobia Safe Dosage: 1 gtt in affected eye(s) TID, approximately 8 hours apart Treatment of anterior ischemic optic neuropathy Why Prescribed: Open-Angle Glaucoma or Ocular Hypertension, Optic Neuropathy (Orphan) Nursing Implications: Use with caution in depression, cerebral/coronary insufficiency, Raynaud's, orthostatic hypotension Wait 15 min before inserting soft contact lenses

Classification: Antiglaucoma, Carbonic Anhydrase Inhibitor MOA: Sulfonamide and carbonic anhydrase inhibitor that reduces the secretion of hydrogen ion at renal tubule and increases excretion of bicarbonate, potassium, sodium, and water, which in turn decreases aqueous humor secretion Side Effects: Ocular burning, stinging, discomfort, Ocular allergic reactions, Stevens-Johnson syndrome, Toxic epidermal necrolysis Safe Dosage: Instill 1 gtt in affected eye(s) q8hr Why Prescribed: Ocular Hypertension Nursing Implications: Absorbed systemically, potential risk of adverse effects similar to those for systemic sulfonamides (eg, Stevens-Johnson synd, blood dyscrasias, fulminant hepatic necrosis, and toxic necrolysis) may occur with ophthalmic use

Classification: Beta-Blockers, Nonselective MOA: Blocks response to beta-adrenergic stimulation to beta1 and beta2 receptors; may reduce blood pressure by decreasing sympathetic outflow; produces negative chronotropic and inotropic activity through unknown mechanism Side Effects: Arrhythmia, Bradycardia, Syncope, Dyspnea Safe Dosage: 10-30 mg PO q12hr Why Prescribed: Hypertension, Acute Myocardial Infarction, Migraine, Prophylaxis Nursing Implications: peripheral vascular disease, cerebrovascular insufficiency, liver disease, renal impairment, CHF, thyrotoxicosis Sudden discontinuation can exacerbate angina and lead to myocardial infarction Bronchial asthma/COPD is a contraindicator Warn patients against interruption or discontinuation of beta-blocker without physician advice

Classification: Antipsychotics, 1st generation MOA: Phenylbutylpiperadine; antagonizes dopamine D1 and D2 receptors in brain; depresses reticular activating system and inhibits release of hypothalamic and hypophyseal hormones Side Effects: Parkinsonism, Anticholinergic effects, ECG changes, Seizures Safe Dosage: Moderate disease, 0.5-2 mg q8-12hr initially Severe disease, 3-5 mg q8-12hr initially; not to exceed 30 mg/day Why Prescribed: Schizophrenia, Psychosis, Tourette Disorder Nursing Implications: Risk of sudden death, torsades de pointes, and prolonged QT interval from off-label IV administration of higher than recommended dose: monitor ECG if administering IV If patient has history of clinically significant presence of either risk factor, monitor complete blood count (CBC) frequently during first few months of therapy; discontinue drug at first sign of clinically significant WBC decline <1000/μL in absence of other causative factors, and continue monitoring WBC count until recovery