common nursing medications

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ANTIBACTERIALS CEPHALOSPORINS
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….
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cefactor cefepime cefdinir cephalexin (KEFLEX) SUPRAX
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cephalexin (KEFLEX)
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skin & skin stucture, PNEUMONIA, otitis media, UTI, septicemia, bone/joint ———————————————– no food restrictions but w/ food decrease GI issues ———————————————— adverse: SEIZURES PSEUDOMEMBRANOUS COLITIS rashes n/v/d urticaria blood dyscrasis serum sickeness superinfection ——————————- keep epinephrine in case of anaphylactic
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serum sickness
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arthalgia, and fever, usually occurs after 2nd dose, resolves after drug discontinued
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superinfection s/s
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genital & anal itching sore mouth throat/ tongue/oral mucosa abd cramps diarrhea black hairy tongue
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cefepime
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skin, bone, joint, UTI, gyn, resp, intra – abd ——————————————————- SEIZURES COLITIS PHELBITIS IV SITE rashes urticaia bleeding serum sickness
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SUPRAX
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otitis media, BROCHCITIS, UTIs ————————————- no food restrictions ———————————— colitis nephrotoxicity renal pts possible oral / vaginal candidiasis diar abd cramping ———————————— contraindications: PCN, other cephlosporins
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ERYTHROMYCINS/ MACROSLIDES
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azithromycin clarithromycin clarithromycin ext rel erythromycins
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potency
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azithromycin and clarithromycin appear to be more potent than erythromycin
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azithromycin
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upper & lower resp, bronchitis, PNEUMONIA, GONERRHEA ——————————————– 1 hr before or 2 hrs after meals magnesium & aluminum anatacids decrease absorption —————————————— diziness/drowisness headache ANGIOEDEMA chest pain/palpitations colitis abd pain n/v/d cholestatic jaundice nephritis photosensitivity
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clarithromycin
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bronchitis, pnuemonia, CHLAMYDIAL infections (off label use) ——————————————- tablets no food & admins suggestions do not give suspension w/ food ——————————————— antacid precautions general symptoms
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erythromycins
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upper & lower resp, peroperative intestinal antisepsis ——————————————— prexisting hepatic disease ———————————— absorbed better on empty stomach give 1 hr before or 2 hrs after food ————————————— renal/hepatic impairment pt – high doses HEARING LOSS reversible colitis
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hepatioxicity s/s
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fever malise abd pain malaise
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FLUOROQUINOLONES
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ciproflaxin ext – rel ciproflaxin tablet AVELOX CIPRO SUSPENSION LEVAQUIN
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AVELOX (moxifloxacin hydrochloride)
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pneumonia, bronchitis, CONJUCTAVITIS…. ——————————————– no food adminstration suggestions ———————————————— opthalmic – irritation decreases visual acuity, eye discharge, eye pain, eye itching ————————————————- antacids, iron prep, sulcrafte may decrease absorp give 4 hrs before or 8 hrs after
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ciproflaxin
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complicated UTI, GONERRHEA, CONJUNCTAVITIS, resp… ——————————————– SEIZURES STEVEN JOHNSON SYNDROME OPTHAMOLIC; bad taste, crusting in corner of eye (resloves 1-7 days) dizziness/drowsiness headache acute psyhcoses* tremors colitis abd pain phlebitis IV site tendonitis / tendonitis rupture* cocurrent use w/corticosteriods increase risk of tendon rupture —————————————————- ENCORAGE PT TO CONSUME ACID RICH +CITRUS FRUITS AND CRANBERIES TO ACIDIFY URINE ( TO PREVENT CRYSTALURIA) antacids, iron preparations, sulcrafate mayy decrease absorption caffine, oral anticoag may increase effects of drug
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LEVAQUIN ( levofloxacin)
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general/usual ———————————— no food & adm precautions encourage acidic fuits and cranberry juice to acidy urine antacid precautions adm slowly not less than 60 mins ——————————————– SEIZURES dizziness/drowsiness headache acute psychoses colitis tendonitis/tendon rupture* cocurrent corticosteriod use increases tendon rupture Stevens – Johnson Syndrome
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PENICILLINS
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hx of allergies to PCN, cephlosporins
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amoxicillin amoxicillin – clavulante ampicillin dicloxacillin penicillin VK
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amoxicillin
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general ———————————- adm w/out regard to food may decrease effec ORAL CONTRACEP may increase effects of warfarin ————————————— seizures colitis n/v/d urticaria blood dyscrasis serum sickness superinfection
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amoxicillin – clavulante
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same as amoxicillin
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ampicillin sodium
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hx sensitivity to PCN or cephlasporins may reduce eff of ORAL CONTRACEPT ——————————————- pain @ injection site thrombophelbitis headache
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TETRACYCLINES
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doxycycline hyclate minocycline tetracycline
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doxycycline hyclate
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antacid precautions ORAL CONTRACEPTIVES iron prepar may impair abs ————————————– hx tetracyclines or sulfites ———————————- photosensitivity DO NOT ADM IV OR SUB Q
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minocycline
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hx tetracyclines or sulfites ORAL CONTR st joh’s wort may increase photosen ————————————– dizzness poss severe photosen VERTIGo poss altered pigment of mucous mem (rare aviod bedtime doses
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ANTIFUNGALS
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fluconazole itraconazole terbinafine tablet
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tetracycline
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poss severe photosen WOMEN SHOULD AVIOD IN LAST HALF OF PREGNANCY -FETAL DEVELOP DISCOLORATION OF TEETH < 8YR CHIL AVOID BETIME DOSES topical may turn skin/ fabric yellow – reves
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ANTIVIRALS
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acyclovir valaclovir
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acyclovir
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g & zoster herpes, shingles, chickenpox ——————————————- seizures general RENEAL FAILURE THROMBOYLITIC – THROMBOCYTEPENIC PURPURA HEMOLTIC UREMIC SYNDROME ( all caps mor likey immuno supp pt) ———————————– give without regard to food ——————————–
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renal failure s/s
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abd pain decreased urination decreased appetite increased thirst n/v
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INFLUENZA AGENTS
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amantadine (Symmetrel) rimantadine (Flumadine) RELENZA (zanamivir) TAMUFLU (oseltamivir)
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amantadine
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(Symmetrel) Apparently not given as a flu shot anymore?…www.nlm.nih.gov www.mayoclinic.com antiviral medicine & antidyskinetic medicine. can be used to treat Parkinson’s. It is used to prevent or treat certain influenza (flu) infections (type A). may be given alone or along with flu shots. Amantadine will not work for colds, other types of flu, or other virus infections.
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rimantadine hydrochloride (Flumadine)
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influenza A ——————– use caut in hepatic/renal pts caution pts against taking ACTAMINOPHEN, ASA, OR OCMPUNDS CONTAINING THESE DRUGS
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RELENZA (zanamivir)
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influenza ———————– broncho spasms may occur in pts w. hx of …COPD /asthma
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TAMIFLU (oseltamivir)
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influenza ————————– give without regard to food ——————————— dosage adjust renal pts —————————— give w/ out regard to food
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MISCELLANEOUS
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clindamycin metronidazole nitrofurantoin sulfamexthoxazole – trimethoprim
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clindamycin
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general ———— arrythmias p.colitis diarrr bitter taste (IV)
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metronidazole
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give with food or milk seizures headaches abd pain anorexia dry moth, furry tongue, uplsant taste urticaria REDISH BROWN URINE —————————— avoid alcohol during tx and at least 1 day after tx -may cause disulfiram like reaction: flushing, n/v, abd cramps, headache
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nitrofurantoin
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UTIs adm w/ food or milk oral suspension – rinse mouth – teeth stain dizziness nystagmus headache CHEST PAIN p colitis abd pain n/v/d hepatitis? RUST/BROWN DISCOLORATION URINE PHOTOSENSITIVITY PERIPHERAL NEUROPATHY superinfection: (foul smelling urine, perineal irritation, dysuria) ————————— CONTRAINDIC: < 1 month preg, and near term preg
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sulfamexthoxazole – trimethoprim
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could not find
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ace inhibitors
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angiotensin-converting-enzyme inhibitor LOWER BLOOD PRESSURE / CHF supresses renin – angiostension- aldosterone system PREVENTS CONVERSION OF ANGIOTENSION I TO ANGIOTENSION II; A POTENT VASOCONSTICTOR NSAIDS MAY REDUCE EFFECTIVENESS OF ALCOHOL & concurrent use of diretics may increase hypoensive effects K SPARING DIUR & K SUPP may cause; HYPERKALEMIA LITHIUM – may increase lithum toxicity off label use: diabetic neuropathy monitor I&O; expect to d/c diuretics 2-3 days before beg. lisinopril therapy auculatate for rales remind pt to rise slowly from lying to sitting permitting legs to dangle from bed
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African Americans
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are generally less responsive to beta blockers (Propanolol (Inderal) and angio tension converting (ACE inhibitors) (ex enapril (Vasotec)
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severe BP drop
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place client in supine position, elevate legs, encourage fluids
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CARDIO ACE INHIBITORS “end in pril”
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fosinopril lisinopril quinapril ramipril
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fosinopril
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MAY INCREASE LITHIUM & DIGOXIN TOXICITY USE CAUIOUSLY BEFORE SURGERY ——————————- COUGH – may not subside until med d/c dizziness fatique headache TASTE DISTURBANCES HYPERKALEMIA anorexia PROTEINURIA AGRANULOCYTOSIS ANGIOEDEMA – swell of face & lips
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lisinopril
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has caused fetal / neonatal morbitiy/mortality expect to d/c diuretics 2-3 days before beg. lisinopril therapy pts w/ autoimmune: agranulocytosis & neutropenia pts w/ autoimmune CBC & blood chem q 2 weeks for 3 months
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quinapril
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give w/out regard to food GARLIC – may increase hypotensive effect GINSENG – may worsen hypertension POTASSIUM SPARING DIURETICS – may cause hyperkalemia ALCOHOL – may increase effects NSAIDS – may drecrease effectiveness COUGH HYPOTENSION TASTE DISTURBANCES PROTEINURIA ANGIOEDEMA AGRANULOCYTOCYI
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ramipril
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same as lisinopril!!!
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ACE INHIBITORS / CALCIUM CH. BLOCKERS
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TARKA
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ACE INHIBITOR / DIURETIC COMBINATIONS
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what about precautions to expect order to d/c directics 2-3 dyas before starting pril??
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fosipril – hydroclorothiazide (HCT) lisinopril – hydroclorothiazide quinapril – hydroclorothiazide
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ANGIOTENSION II RECEPTOR ANTAGONISTS COMBINATIONS
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losartan/losartan-hydroclorothiazide AVAPRO / AVALIDE BENICAR / BENICAR HCT MICARDIS / MICARDIS/HCT
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ANTILIPEMICS
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cholestyramine WELCHOL
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cholestyramine (questran)
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never give in dry form – mix w/ liquids off label use – diarrhea CONSTIPATION ANTICOAGS -may increase effects by decreasing levels vit K DIGOXIN, FOLIC ACID, PCN, PROPANONOL, TETRACYCLINES,ORAL VANCOMYCIN, THIAZIDES, THYROID HORMONES – may bind and reduce effectiveness of these drugs
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WELCHOL (Colesevelam)
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adm w/ meals & drink may decrease mat nutri & breast fed infants ASA, clindamycin, digoxin, fureosemide, glipizide, hydrocortisone, imipramine, NSAID, phenytoin, propanolol, tetracyclines, thaiazide, diuretics, vit A,D,E,K ( fat sol) may decrease abs of these drugs
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CHOLESTEROL ABSORBPTION INHIBITORS
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ZETIA
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cholesterol absorption inhibitors
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such as ezetimibe – act in the gut wall to prevent cholesterol absorption through the intestinal villi
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ZETIA (ezetimibe)
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give w/out regard to food contr: concurrent use w/ HMG-CoA reductase inhibitors (“statins”.. ie atorovastatin, lovastatin) in pts w/ hepatic disease back pain abd pain
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FIBRATES
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general give w/ meals? antihyperlipedemic that enhances synthesis of lipoprotein lipase and reduces triglyceride -rich lipoproteins and VLDL’s
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TRICOR TRILPIX
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TRICOR
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may be given w/out regard to food contra: gallbladder disease, severe renal or hepatic dysfunction inter: HMG-COA reductase drugs which increase occurance of rhabdomyolysis , renal failure serious reaction – fenofibrate may increae excret of cholesterol into bile leading to choleithiasis
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TRILIPIX
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couldn’t find anywhere
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MHG-coA REDUCTASE INHIBITORS “statins”
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inhibit HMG-CoA reductase – a enzyme required for the last regulated step in cholesterol synthesis ( prevents conversion of MHG-CoA into mevalonate, a precursor to
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pravastain simvastatin CRESTOR LIPITOR
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pravastain (Pravachol)
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dosage in hepatic and renal pts may be adjusted interactions: erythromycin, immunosup,niacin may increase acute renal failure & rhabdomyolsis serious – malignancy & cataracts contra: pregnancy – fetal toxicity
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simvastatin (Zocor)
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contr: active hepatic or elevated LFTs interactions: erythromycin, immunosup, naicin, ketoconazole, ittraconazole – may increase blood concen of drug causing muscle inflam, myalgia, weakness
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CRESTOR (rosuvasatin calcium)
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contra: active hepatic disease, pregnancy (did not list renal concerns) renal concerns – should notexceed 10 mg/day interact: cyclosporine, naicin, gemoibrozil increase risk of myopathy
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LIPITOR (atorvastatin)
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contr: active hepatic disease, unexplained elevated LFT’s, pregancy interactions: antacids, propanol decreases drugs activity erythromycin, gemfibrozil, nictonic acid -increases risk of acute renal failure, rhabdomyolysis digoxin, oral contraceptives, warfarin itraconazole may increase drug concentration -producing severe muscle inflammation,pain,weakness s/e: HEADACHE, myalgia serious reactions: cataracts, photosensitivity
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NIACINS
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NIASPAN SIMCOR
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NIASPAN
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an antilipedemic water soluble vitamin that is a component of two coenzymes tissue respiration, lipid metabolism, gylcogenolysis. Inhibits synthesis of VLDLs contra: active peptic ulcer disease, hepatic dysfunction, hypersensitivity to TARTRAZINE (frequently seen in patients w/sensitity to aspirin, severe hypotension alcohol may increase s/e of flushing lavastatin, pravastatin, simvastatin may increase risk of acute renal failure, rhabdmyolysis Frequent s/e FLUSHING (face and neck occuring within 20 mins of drug administration lasting 30-60min,GI upset, puritis
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SIMCOR
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FYI gemfibrozil (lopid)
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a fibric acid derivste that inhibits lipolysis of fat in adipose tissue.Inhibits synthesis of VLDL carrier protein apoliprotein B contr: liver dysfunction, gall bladder disease, severe renal dysfunction s/e: dyspepsia serious reactions: cholethiasis, pancreatitis,acute pendictitis
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BETA-BLOCKERS
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atenolol carvedilol metroprolol metroprolol succinate ext- rel nadolol propanolol BYSTIC COREG CR
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beta blockers
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indicated for hypertension, angina pectoris, arryhtmias, to PREVENT MIs MIGRANES,GLOUCOMA ALL BETA BLOCKERS MAY MASK TACHYCARDIA THAT OCCURS W /HYPOGLYCEMIA action: Beta Adrenergic blockers selectively block beta1adrenergic receptors located primarily in the myocardium and beta2 adrenergic rectors located primarily in bronchial and vascular smooth muscle. by occuping beta receptor sites these agents prevent endogenous or administered epinephrine and norepinephrine from exerting their effects ( keeping heart rare constant).The results are basic opposites to sympathetic stimulation. effects beta 1: slow heart rate, decreasing cardiac output and contractility. effects beta 2: bronchconstriction, and increased airway constrictionin asthma & COPD pts beta blockers : decrease the sinus rate,&sinoarterial,&AV conduction & increasing the refractory period in the AV node. decreases myocardial oxygen demand
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atenolol 1 (tenormin)
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off label uses: tremors, migranes contra: cardiogenic shock, overt heart failure, 2,3rd degree block, severe bradycardia Cimetidine – may increase blood concent DIURETICS & other antihypertensives- may increase hypotensive effect INSULIN, ORAL HYPOGLYCEMICSmay mask symptoms of hypoglycemiaand prolong hypoglycemic effects NSAIDS – may DECREASE antihypertensive effects
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atenolol for acute MI
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give 5mg over 5 mins. In those tolerating full10mh IV dose begin 50 mg tablets after last IV dose, followed by another 50 mg dose 12hrs later. Thereafter, give 100mg once/day or 50 mg b.i.d for 6-9 days. for those who do not tolerate full IV dose – give 50 mg PO bid or 100 mg once per day for at least 7 days
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atenolol 1
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may be crushed give IV push over 5 mins if pulse < than 60 or systolic <90-withhold s/e:frequent hypotension manifested as cold extremities, constipation/dia, diaphoresis, dizziness, fatique, headache, nausea occasional: insomnia, urinary frequency, impotence or decreased libido, depression serious reactions: overdose may produce bradycardia, hypotension *atenolol admin may precipaitate CHF /MI in cardiac pts. may cause peripheral ischemai in those w/ exisitng peripheral vascular disease pregancy di not adminster after 1st trimester assess for CHF: distended neck veins, dyspnea on exertion, lying down, night cough, peripheral edema advise pt to rise slowy from a lying position, and dangle legs from side of bed before standing
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carvedilol (coreg) 1
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FYI (non selective beta blocker) theraputic action:CREATES VASODILATION contra: bronchial asthma, cardiogenic shock, pulmonary edema, 2&3rd degree AV block, severe bradycardia interactions: Calcium blockers -increase conduction disturbances Catapress – may potentiate BP effects Cimetidine – may increase drug effects Diuretics & other antihypertensives increase hypotensive effect Insulin & oral hypoglemics – can mask symptoms of hypoglcemia and prolong hypoglycemic effects of these drugs
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CALCIUM CHANNEL BLOCKERS
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amoldipine diltazem ext -rel nifedipine ext- rel verapamil ext -rel
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CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS
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CADUET
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DIGITALIS GLYCOSIDES
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digoxin
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DIURETICS
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furosemide hydrochlorothiazide metolazone spirolactone – hydrochlorthiazide toresemide triameterene – hydochlorothiazide
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ANTIDEPRESSANTS SELECTIVE SERATONIN REUPTAKE INHIBITORS (SSRIs)
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citalopram fluoxetiene paroxetine paroxetine ext-rel sertraline LEXAPRO
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SERATONIN NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs)
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venalfaxine CYMBALTA EFFEXOR XR PRISTIQ
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carvedilol (coreg) 2
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give w/ FOOD hypoglycemia may occur in pts w/ previously well controlled diabetes if pulse < than 60 or systolic <90-withhold serious reactions:profound bradycardia, hypotension, cardiogenic shock or cardiac arrest admin may precipaitate CHF /MI in cardiac pts. may cause peripheral ischemai in those w/ exisitng peripheral vascular disease pregancy do not adminster after 1st trimester pt who wear contact lenses may experience decreased tearing
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metroprolol tartrate (Lopressor)
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for mild to moderate hypertension,early and late tx after MI off label uses: anxiety,tremors, thyrotoxicosis, vascualr headache contr:cardogenic shock, MI w/ HR <45 systolic <100, overt heart failure, 2&3rd degree block, sinus bradycardia Cimetidine – may increase drug effects Diuretics & other antihypertensives increase hypotensive effect Insulin & oral hypoglemics – can mask symptoms of hypoglcemia and prolong hypoglycemic effects of these drugs s/e; diminshed sexual function, insomnia, fatique, weakness rare-nightmares
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nadolol
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tablets may be crushed HR<45, systolic<90-hold contra: COPD, pt on MAIO therapy bronchial asthma, cardogenic shock,2&3rd degree heart block, sinus bradycardia,uncontrolled cardiac failure Cimetidine – may increase drug effects Diuretics & other antihypertensives increase hypotensive effect Insulin & oral hypoglemics – can mask symptoms of hypoglcemia and prolong hypoglycemic effects of these drugs assess for CHF: distended neck veins, dyspnea on exertion, lying down, night cough, peripheral edema
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propanolol (Inderal) 1
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can crush scored tablets Give same time each day Give UNDILUTED for IV PUSH DO NOT EXCEED 1MG/MINUTE INJECTI IV INFUSION – GIVE 1 MG OVER 10-15 MINS RAYNAUD’S SYNDROME s/s -examine pts fingers for numbness, lack of color pt SHOULD NOT take OTC cold preparations especially those that contain stimulants, without physican approval pulse <60, systolic <90 hold
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propanolol (Inderal) 2
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Diuretics & other antihypertensives increase hypotensive effect Insulin & oral hypoglemics – can mask symptoms of hypoglcemia and prolong hypoglycemic effects of these drugs IV PHENYTOIN- may decrease cardiac depressant rate
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BYSTIC -couldn’t find
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COREG CR -couldn’t find
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CALCIUM CHANNEL BLOCKERS
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inhibits calcium ion movement across cell membranes depressing contraction/ relaxing arterial smooth muscle, decreasing total peripheral resistance and hence reducing blood pressure; reduce myocardial oxygen demand, depress firing of Sinus node (heart’s normal pacemaker), slows AV conduction, decreases heart in angina, it increases blood flow to the heart muscle mosby’s
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amoldipine diltiazem ext-rel nifedpine ext-rel verapamil ext-rel
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amoldipine (Norvasc) besylate, mesylate or maleate
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hydropyridine (DHP) class antihypertensive, angina pectoris. AVOID GRAPEFRUIT JUICE =exces hypot Contra: Breast feeding Cardiogenic shock Unstable angina Aortic stenosis: Amlodipine causes vasodilation, which can result in reduced cardiac output in patients with severe aortic stenosis. severe coronary artery disease-amlodipine can increase the frequency and severity of angina or actually cause a heart attack on rare occasions. This phenomenon usually occurs when first starting amlodipine, or at the time of dosage increase PERIPHERAL EDEMA, headache
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diltiazem ext-rel (cardizem)
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contra: acute MI FYI: wikepedia Recent research has shown diltiazem is able to reduce cocaine cravings in drug-addicted rats.[17] This is believed to be due to the effects of calcium blockers on dopaminergic and glutamatergic signalling in the brain.[18] Diltiazem also enhances the analgesic effect of morphine in animal tests, without increasing respiratory depression,[19] and reduces the development of tolerance.[20] Diltiazem is also being used in the treatment of anal fissures. It can be taken orally or applied topically with increased effectiveness.[21] When applied topically, it is made into a cream form using either vaseline or Phlojel. Phlojel absorbs the diltiazem into the problem area better than the vaseline base.
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nifedpine ext-rel (procardia, adalat)
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nondihydropyridine (non-DHP) class uses: HTN, angina, prev/control supraventricular tachy CONTRA: aortic stenosis, severe hypot AVOID GRAPEFRUIT extended-release tablet may contain lactose serious reactions – may precipitate CHF, MI pt w/peripheral ischemia overdose may produce nausea FREQUENT: peripheral edema headache dizziness flushed skin Occas: muscle cramps somnolence palpitations nasal congestion cough wheezing
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verapamil (isoptin)
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CONTRA: a fib/flutter, heart block, vent tachy AVOID GRAPEFRUIT JUICE
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CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBO
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Caduet (amlodipine besylate (Norvasc) /atorvastatin calcium (Liptior)
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used to tx high BP, angina, high cholesterol AVIOD GRAPRFRUITJUICE drug may infrequently cause muscle problems (rhabdomyolysis). muscle pain/tenderness/weakness (especially with fever or unusual tiredness), change in the amount of urine
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DIGOXIN (lanoxin)
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mosby: a cardiac glycoside that INCREASES the influx of of calcium from extra cellular into intracellular (SO OPOSITE OF CALICUM CHANNEL BLOCKER) cardiac glycosides acty directly on myocarium in to INCREASE the force of contraction, leading to INCREASED stroke volume, INCREASED cardiac output, DREASING FIRING OF av NODE, Uses: A fib, cardiogenic shock w/ pulmonary edema SIBERIAN GINSING may increase serum levels DIG TOXICITY: GI disturbances neurological disturbances (fatigue, headache, depression, weakness, drowsiness, nighmares facial pain, *occular disturbances (halos, photophobia *yellow,green color perceptions AVOID GIVING IM (severe irrit, erratically absorbed) if have to give IM, give deep w/ in muscle and massage. give no more than 2 ml at any one site GIVE IV SLOWLY OVER 5 MINS excessive slowing HR may be 1st sign of toxicity
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glycoside (FYI)
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a glycoside is any molecule in which a sugar group is bonded
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diuretics
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furosemide (loop) hydrochorlothiazide (thiazide) metolazone (potassium sparing)(distal tubule) spirolactone (potassium sparing)(distal tubule) torosemide (loop diuretic ascending loop of henle triamterene HCTZ (potasium sparing distal tubule)
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asscending loop of henle (Loop diuretic) distal tubule (potassium sparing) renal cortical diluting tubule (thiazide) proximal tubule (osmotic)
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furosemide (lasix)
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LOOP DIURETIC ehnaces excretion of NA, CL, K by direct action of ascending limb loop of henle. offlabel use: tx of hypercalcemia GIVE W/ FOOD / give during day to prevent nocturia OTOTXICITY (vertigo,tinnitus) CAN EXACERBATE DIABETES, LUPUS, GOUT PANCREATITIS IV PUSH over 1-2 mins encourage: apricots, raisins, potatoes, orange juice, legumes, whole grains, meat
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hydrochorlothiazide
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blocks reabsorption at the cortical diluting segment of distal tubules CAUTION IN THOSE W/ SULFONAMIDE SENSITIV OFF LABEL USES: diabetes, prevention of calcium containing renal calculi
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metolazone (zaroxolyn)
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blocks reabsorption at distal convoluted tubal, distal tubule increasing renal excretion of sodium =POTASSIUM SPARING HYPERGLYCEMIA MAY OCCUR DURING PROLONGED THERAPY
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spirolactone HCTZ (aldactone)
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POTASSIUM SPARING distal tubule inteferes w/ sodium reabsorbption by inhibiting action of aldosteronepromoting water and sodium excretion and increasing potassium retention CONTRA: acute renal insufficency, anuria, BUN and creatine more than 2x parameters, HYPERkalemia ACE INHIBITORS (i.e, capotpril) potasium containing meds, potassium supplements increase risk of hyperkalemia S/E: HYPERKCALEMIA in renal insuff pts, pts taking potasium supplements HYPONATREMIA caution pt to AVOID consuming potasium supp or high potassium foods HYPERKALEMIA S/S: ARRTHYMIAS, BRADYCARDIA, EKG CHANGES TENTED T WAVES, WIDENING QRS COMPLEX, ST SEGMENT DEPRESSION
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torosemide (demadex)
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LOOP DIURETIC -enhances excretion of electrolytes at ascending limb loop of henle INTERACTIONS: amphotercin B, nephrotoxic meds, ototoxic meds NSAIDS may decrease diuretic effect S/E headache, dizziness, rhinitis
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triamterene HCTZ (dyrenium)
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POTASIUM SPARING interferes w/ sodium and potasium exchange in distal tubule INCREASES SODIUM DECREASES POTASIUM INCREASES MAGESIUM DECREASES CALCIUM LOSS

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