endocrine medications

ENDOCRINE MEDICATIONS

I. PITUITARY MEDICATIONSA. Description

1. Anterior pituitary gland: Secretes growth hormone (GH), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), and gonadotropins (follicle-stimulating hormone, or FSH, and luteinizing hormone, or LH)

2. Posterior pituitary gland: Secretes antidiuretic hormones (ADH, vasopressin) and oxytocinB. Growth hormones and related medications

1. Uses the side effects2. Implementation

a. Assess child’s physical growth and compare growth with standardsb. Recommend annual bone age determinations for children receiving growth hormonesc. Monitor blood and urine glucose levelsd. Teach the client and family about the importance of follow-up regarding blood and urine

glucose testing

Growth Hormones and Related MedicationsMedication(s) Use Side effects

Somatrem (Protropin) Growth failure Development of antibodies to GH

Somatropin (Humatrope) Growth failure Headache, muscle pain, weakness, mild hyperglycemia, allergic reaction (rash, swelling), pain at injection site

Sermorelin (Geref) Growth failureDiagnose pituitary function

Pain, swelling, redness at injection site; facial flushing, nausea, vomiting, headache, altered taste, chest tightness

Bromocriptine (Parlodel) Acromegaly Nausea, headache, dizziness

Octreotide (Sandostatin) Acromegaly Diarrhea, nausea, abdominal discomfort, increased glucose

II. ANTIDIURETIC HORMONESA. Description

1. Enhance reabsorption of water in the kidneys by the distal renal tubules, promoting an antidiuretic effect and regulating fluid balance and causes vasoconstriction and increased muscle tone of the bladder, GI tract, uterus, and blood vessels

2. Used in diabetes insipidus3. Available in parenteral (IM, SC) or nasal preparation

B. Antidiuretic hormones Desmopressin acetate (DDAVP, Stimate) Lypressin (Diapid) Vasopressin (Pitressin)

C. Side effects1. Flushing2. Headache3. Nausea and abdominal cramps4. Water intoxication5. Hypertension with water intoxication6. Nasal congestion with nasal administration

D. Implementation1. Monitor weight2. Monitor intake and output (I & O) and urine osmolality3. Monitor electrolytes4. Restrict fluid intake as prescribed to prevent water intoxication5. Monitor for signs of water intoxication, such as drowsiness, listlessness, and headache6. Instruct the client in how to use the intranasal medication7. Instruct the client to report signs of water intoxication or symptoms of headache or shortness of

breath

III. THYROID HORMONES (Thyroid enhancers)A. Description

1. Control the metabolic rate of tissues and accelerate heat production and oxygen consumption2. To replace hormonal deficit in the treatment of hypothyroidism, myxedema, or cretinism3. Enhance the action of oral anticoagulants, sympathomimetics, and antidepressants, and decrease

the action of insulin, oral hypoglycemics, and digitalis preparations4. Available in oral and parenteral (IV) preparations5. Phenytoin (Dilantin) and aspirin can enhance the action of thyroid hormone

B. Thyroid hormones Levothyroxine (Synthroid, Levothyroid, Levoxyl) Liothyronine (Cytomel) Liotrix (Thyrolar) Thyroglobulin (Proloid) Thyroid (Thyrar)

C. Side effects1. Nausea and vomiting2. Cramps and diarrhea3. Weight loss4. Nervousness and tremors5. Headache6. Hypertension7. Tachycardia and dysrhythmias8. Sweating and heat intolerance9. Insomnia10. Toxicity: Hyperthyroidism

D. Implementation1. Assess client for history of medications currently being taken2. Monitor vital signs

HTTP://WWW.COLLEGEOFNURSING.CJB.NET ST. MICHAEL’S COLLEGE, INC. – ILIGAN CITY

3. Monitor weight4. Monitor triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) levels5. Instruct the client to take the medication at the same time each day, preferably in the morning

without food6. Instruct the client in how to monitor pulse rate7. Advise the client to report symptoms of hyperthyroidism, such as tachycardia, chest pain,

palpitations, and excessive sweating8. Instruct the client to avoid foods that can inhibit thyroid secretion, such as strawberries, peaches,

pears, cabbage, turnips, spinach, kale, Brussels sprouts, cauliflowers, radishes, and peas9. Advise the client to avoid over-the-counter medications10. Instruct the client to wear a Medic-Alert bracelet

IV. ANTITHYROID MEDICATIONS (Thyroid inhibitors)A. Description

1. Inhibit the synthesis of thyroid hormone2. Used for hyperthyroidism, or Grave’s disease3. Available in oral and parenteral (IV) preparations

B. Antithyroid medications Iodine solution (Lugol solution, potassium iodide solution) Methimazole (Tapazole) Propylthiouracil (PTU)

C. Side effects1. Nausea and vomiting2. Diarrhea3. Hypersensitivity4. Agranulocytosis5. Iodine: bitter taste, stains teeth (local oral effect on mucosa and teeth)6. Toxicity: Hypothyroidism7. Iodism: Characterize by vomiting, abdominal pain, metallic taste in the mouth, rash, and sore

salivary glandsD. Implementation

1. Monitor vital signs2. Monitor T3, T4, and TSH levels3. Monitor weight4. Instruct the client to take medication with meals to avoid gastrointestinal (GI) upset5. Instruct the client in how to monitor the pulse rate6. Inform the client of side effects and when to notify the physician7. Advise the client to contact the physician if a fever or sore throat develops8. Instruct the client in the signs of hypothyroidism9. Instruct the client regarding the importance of medication compliance and that abruptly stopping

the medication could cause thyroid crisis (thyroid storm)10. Instruct the client to monitor for signs and symptoms of thyroid crisis (fever, flushed skin,

confusion and behavioral changes, tachycardia, dysrhythmias, and signs of heart failure)11. Instruct the client to monitor for signs of Iodism12. Advise the client to consult physician before eating iodized salt and iodine-rich foods13. Instruct the client to avoid acetylsalicylic acid (aspirin) and medications containing iodine

V. PARATHYROID MEDICATIONSA. Description

1. Parathyroid hormone regulates serum calcium levels2. Low serum levels of calcium stimulate parathyroid hormone release3. Hyperparathyroidism results in a high serum calcium level and bone demineralization, and

medication is used to lower the serum calcium level4. Hypoparathyroidism results in a low serum calcium level, which increases neuromuscular

excitability, and the treatment includes calcium and vitamin D supplements5. Parathyroid and antihypercalcemic agents may cause hypermagnesemia6. Calcium salts and administered with digoxin (Lanoxin) increases the risk of digoxin toxicity7. Oral calcium salts reduce the absorption of tetracycline hydrochloride

B. Medications to Treat Calcium Disorders1. Calcium supplements

a. Calcium carbonate (BioCal, Caltrate 600, Rolaids, Tums)b. Calcium carbonate, oyster-shell delivered (OsCal 500, Oysco, Oyst-Cal)c. Calcium citrate (Citracal)d. Calcium glubionate (Calcionate, Neo-Calglucon)e. Calcium gluconatef. Dibasic calcium phosphateg. Tribasic calcium phosphate (Posture)

2. Vitamin D supplementsa. Calcifediol (Calderol)b. Calcitriol (Calcijex, Rocaltrol)c. Dihydrotachysterol (Calciferol, Drisdol)

3. Calcium regulatorsa. Alendronate (Fosamax)b. Calcitonin human (Cibacalcin)c. Calcitonin salmon (Calcimar, Miacalcin)d. Etidronate (Didronel)e. Pamidronate (Aredia)f. Risedronate (Actonel)g. Tiludronate (Skelid)

4. Antihypercalcemicsa. Edetate disodium (Disotate, Endrate)b. Gallium nitrate (Ganite)

C. Implementation1. Monitor electrolyte and calcium levels2. Assess for signs and symptoms of hypocalcemia and hypercalcemia3. Assess for symptoms of tetany in the client with hypocalcemia4. Instruct the client in the signs and symptoms of hypercalcemia and hypocalcemia5. Instruct the client to check over-the-counter medication labels for the possibility of calcium

content6. Instruct the client receiving oral calcium to maintain an adequate intake of vitamin D enhances

absorption of calcium

VI. ADRENOCORTICOTROPIC HORMONES


A. Description1. Stimulate the adrenal cortex to secrete cortisol2. Produce an anti-inflammatory effect3. Used to diagnose adrenocortical disorders (See below: Medications Used in Diagnosing Adrenal

Gland)4. Used to treat acute multiple sclerosis5. Available in oral, parenteral (IM, IV), inhalation, intraarticular, and topical, including ophthalmic

preparationsB. Medications for Adrenal Replacement Therapy

Betamethasone (Celestone) Cortisone (Cortone) Fludrocortisone (Florinef) Hydrocortisone (Cortef) Triamcinolone (Aristocort, Kenacort) Dexamethasone (Decadron) Methylprednisone (Depo-Medrol, Solu-Medrol) Prednisolone (Delta-Cortef, Prelone) Prednisone (Orasone, Deltasone, Meticorten)

C. Medications Used in Diagnosing Adrenal Gland Corticotropin (Acthar) Corticotropin repository (Acthar gel) Cosyntropin (Cortrosyn)

D. Side effects1. Nausea and vomiting2. Increased appetite3. Mood swings4. Petechiae5. Water and sodium retention6. Hypokalemia7. Hypocalcemia

E. Implementation1. Monitor vital signs2. Monitor I & O, weight, and for edema3. Monitor for signs of infection4. Monitor electrolyte and calcium level5. Avoid administering to the client with adrenocortical hyperfunction6. Instruct the client to decrease salt intake7. Instruct the client to report side effects such as muscle weakness, edema, petechiae, ecchymoses,

decrease in growth, decreased wound healing, and menstrual irregularities8. Monitor for adverse effects when the medication is discontinued; dose should be tapered and not

stopped abruptly, because adrenal hypofunction may result9. Advise the client to wear Medic-Alert bracelet

VII. CORTICOSTEROIDSA. Description

1. Produce metabolic effects

2. Alter the normal immune response and suppress inflammation3. Promote sodium and water retention and potassium excretion4. Produce anti-inflammatory, antiallergic, and anti-stress effects5. May be used as a replacement for adrenocortical insufficiency

B. Medications for Adrenal Replacement Therapy Betamethasone (Celestone) Cortisone (Cortone) Fludrocortisone (Florinef) Hydrocortisone (Cortef) Triamcinolone (Aristocort, Kenacort) Dexamethasone (Decadron) Methylprednisone (Depo-Medrol, Solu-Medrol) Prednisolone (Delta-Cortef, Prelone) Prednisone (Orasone, Deltasone, Meticorten)

C. Side effects1. Hyperglycemia2. Hypokalemia3. Sodium and water retention4. Edema5. Cause muscle wasting, osteoporosis, growth retardation in children, peptic ulcer, increased serum

glucose levels, hypertension, convulsions, mood swings, cataracts, glaucoma, fragile skin, hirsustism, altered fat distribution

6. Mask the signs and symptoms of infectionD. Contraindications and cautions

1. Contraindicated in hypersensitivity, psychosis, and fungal infections2. Use with caution in diabetes mellitus3. Dexamethasone (Decadron) decreases the effects of oral anticoagulants and oral antidiabetic

agents4. Increase the potency of medications taken concurrently, such as aspirin, and nonsteroidal anti-

inflammatory drugs (NSAIDs), thus increasing the risk of GI bleeding and ulceration5. Use of potassium-wasting diuretics increases potassium loss, resulting in hypokalemia6. Barbiturates, phenytoin (Dilantin), and rifampin (Rifadin) decrease the effect of prednisone7. The action of dexamethasone (Decadron) is decreased by the use of phenytoin (Dilantin),

theophylline, rifampin (Rifadin), barbiturates, and antacids8. NSAIDs, aspirin, and estrogen increase the effect of dexamethasone (Decadron)9. Should be used with extreme caution in clients with infections because they mask the signs and

symptoms of infection10. Advise the client to wear Medic-Alert bracelet

E. Implementation1. Monitor vital signs2. Monitor serum electrolytes and blood glucose level3. Monitor for hypokalemia and hyperglycemia4. Monitor I & O, weight, and for edema5. Monitor for hypertension6. Assess medical history for glaucoma, cataracts, peptic ulcer, mental health disorders, or diabetes

mellitus


7. Monitor the older client for signs and symptoms of increased osteoporosis8. Assess for change in muscle strength9. Prepare a schedule for the client on short-term, tapered doses10. Instruct the client to take at mealtime or with food11. Advise the client to eat foods high in potassium12. Instruct the client to avoid individuals with respiratory infections13. Advise the client to inform all health care providers of taking the medication14. Instruct the client to report signs and symptoms of a medication overdose or Cushing’s

syndrome, including a moon-face, puffy eyelids, edema in the feet, increase bruising, dizziness, bleeding, and menstrual irregularities

15. Note that the client may need additional doses during periods of stress, such as surgery16. Instruct the client not to stop medication abruptly, as abrupt withdrawal can result in severe

adrenal insufficiency17. Advise the client to consult with the physician before receiving vaccinations18. Advise the client to wear Medic-Alert bracelet

F. Mineralocorticoids1. Description

a. Steroid hormones that enhance the reabsorption of sodium and chloride and promote the excretion of potassium and hydrogen from the renal tubules, thereby helping to maintain fluid and electrolyte balance

b. Used for replacement therapy un primary and secondary adrenal insufficiency in Addison’s disease

2. Medication: Fludrocortisone (Florinef)3. Side effects

a. Sodium and water retentionb. Hypokalemiac. Hypocalcemiad. Increased susceptibility to infectione. Delayed wound healingf. GI distressg. Diarrhea or constipationh. Increased appetitei. Weight gainj. Insomniak. Mood swingsl. Abdominal distention

4. Implementationa. Monitor vital signsb. Monitor weightc. Monitor electrolytes and calcium levelsd. Instruct the client to take medication with food or milke. Instruct the client to consume a high-potassium dietf. Instruct the client not to stop the medication abruptlyg. Instruct the client to notify the physician of signs of infection, muscle aches, sudden weight

gain, or headaches occurh. Instruct the client to avoid exposure to disease or trauma

i. Instruct the client not to take aspirin or any other medication without consulting the physician

j. Instruct the client to wear a Medic-Alert bracelet

VIII.ANDROGENSA. Description

1. Used either to replace deficient hormones or to treat hormone-sensitive disorders2. Can cause bleeding if the client is taking oral anticoagulants (increase the effect of

anticoagulants)3. Cause decreased serum glucose concentration, thereby reducing insulin requirements in the client

with diabetes mellitus4. Hepatotoxic medications are avoided with the use of androgens because of the risk of additive

damage to the liver5. Usually avoided in men with known prostatic or breast carcinoma because androgens often

stimulate growth of these tumors

B. Androgens Fluoxymesterone (Android-F, Halotestin) Methyltestosterone (Android, Testred, Virilon) Testosterone (Andro, Histerone, Testaqua) Testosterone (Androderm, Testoderm) Testosterone (Testopel pellets) Testosterone cypionate (Andronate, Depotest, Virilon-IM) Testosterone enanthate (Delatest, Delatestryl, Everone) Testosterone propionate (Testex)

C. Side effects1. Masculine secondary sexual characteristics (body hair growth, lowered voice, muscle growth)2. Bladder irritation and urinary tract infections3. Breast tenderness4. Gynecomastia5. Priapism6. Menstrual irregularities7. Virilism8. Edema9. Nausea, vomiting, or diarrhea10. Acne11. Changes in libido12. Hepatotoxicity

D. Implementation1. Monitor vital signs2. Monitor for edema, weight gain, and skin changes3. Assess mental status and neurological function4. Assess for signs of liver dysfunction, including right upper quadrant abdominal pain, malaise,

fever, jaundice, pruritus5. Assess for the development of secondary sexual characteristics6. Instruct the client to take with meals or a snack


7. Instruct the client to notify the physician if Priapism develops8. Instruct the client to notify the physician if fluid retention occurs9. Instruct women to use a nonhormonal contraceptive while on therapy

IX. ESTROGEN AND PROGESTINSA. Description

1. Estrogens are steroids that stimulate female reproductive tissue2. Progestins are steroids that specifically stimulate the uterine lining3. Estrogen and progestin preparations may be used to stimulate the endogenous hormones to

restore hormonal balance or to treat hormone-sensitive tumors (suppress tumor growth)B. Estrogens

Chlorotrianisene (Tace) Dienestrol (Dienestrol) Diethylstilbestrol (DES) Estradiol (Estrace, Climara, Estraderm, FemPatch, Vivelle) Estradiol cypionate (Depo-Estradiol) Estradiol valerate (Delestrogen) Estrogens, conjugated (Premarin) Estrogens, esterified (Estratab) Estrone (Aquest, Estragyn 5) Estropipate (Ogen Ortho-Est) Ethinyl Estradiol (Estinyl)

C. Progestins Hydroxyprogesterone (Hylutin) Levonorgestrel (Norplant) Medroxyprogesterone (Cycrin, Provera) Medroxyprogesterone (Depo-Provera) Medroxyprogesterone and conjugated estrogens (Premphase, Prempro) Megestrol (Megace) Norethindrone acetate (Aygestin) Progesterone (Prometrium) Progesterone (Gesterol, Crinone, Progestasert)

D. Contraindications and cautions1. Estrogens

a. Contraindicated in clients with breast cancer, endometrial hyperplasia, or endometrial cancerb. Increase the risk of toxicity when used with Hepatotoxic medications

2. Progestins: Contraindicated in clients with thromboembolitic disorders, and avoided in clients with breast tumors or hepatic disease

E. Side effects1. Monitor vital signs2. Monitor for hypertension3. Assess for edema and weight gain4. Advise the client not to smoke5. Advise the client to undergo routine breast and pelvic examinations

X. ORAL CONTRACEPTIVES

A. Description1. These medications contain combination of estrogen and progestin or a progestin alone2. Estrogen-progestin combinations suppress ovulation and change the cervical mucus, making it

difficult for sperm to enter3. Medications that contain only progestins are less effective than the combined medications4. Usually taken for 21 consecutive days and stopped for 7 days, then the administration cycle is

repeated5. Provide reversible prevention of pregnancy6. Useful in controlling irregular or excessive menstrual cycles7. Risk factors associated with the development of complications related to the use of oral

contraceptives include smoking, obesity, and hypertension8. Contraindicated in women with hypertension or thrombolytic disease9. Avoided with the use of Hepatotoxic medications10. Interfere with the activity of bromocriptine (Parlodel) and anticoagulants and increase the toxicity

of tricyclic antidepressants11. May alter blood glucose levels

B. Side effects1. Breakthrough bleeding2. Excessive cervical mucus formation3. Breast tenderness

C. Implementation1. Monitor vital signs and weight2. Instruct the client in the administration of the medication (it may take up to 1 week for full

contraceptive effect to occur when the medication is begun)3. Instruct the client with diabetes mellitus to monitor blood glucose levels carefully4. Instruct the client to report signs of thromboembolitic complications5. Instruct the client to notify the physician if vaginal bleeding or menstrual irregularities occur or if

pregnancy is suspected6. Inform the client that many medications interfere with the effectiveness of birth control pills7. Instruct the client to perform breast self-examination monthly and about the importance of yearly

physical examinations8. If the client decides to discontinue the oral contraceptive to become pregnant, recommend that the

client use an alternative form of birth control for 2 months after discontinuation to ensure more complete excretion of hormonal agents before conception

XI. FERTILITY MEDICATIONSA. Description

1. Act to stimulate follicle development and ovulation in functioning ovaries and are combined with human chorionic gonadotropin (HCG) to maintain the follicles once ovulation has occurred

2. Contraindicated in the presence of primary ovarian function, thyroid or adrenal dysfunction, ovarian cysts, pregnancy, or idiopathic uterine bleeding

3. Used with caution in clients with thromboembolitic or respiratory diseasesB. Fertility medications

Bromocriptine (Parlodel) Chorionic gonadotropin (A.P.L., Profasi) Clomiphene (Clomid)


Follitropin beta (Follistin) Menotropins (Humegon, Pergonal) Urofollitropin (Metrodin, Fertinex)

C. Side effects1. Risk of multiple births and birth defects2. Ovarian overstimulation (abdominal pain, distention, ascites, pleural effusion)3. Headache4. Fluid retention and bloating5. Nausea6. Uterine bleeding7. Ovarian enlargement8. Gynecomastia9. Febrile reactions

D. Implementation1. Instruct the client regarding administration of the medication2. Provide a calendar of treatment days and instructions on when intercourse should occur, to

increase therapeutic effectiveness of the medication3. Provide information about the risks and hazards of multiple births4. Instruct the client to notify the physician if signs of ovarian stimulation occur5. Inform the client about the need for regular follow-up for evaluation

XII. MEDICATIONS FOR PENILE ERECTION DYSFUNCTIONA. Description

1. Alprostadil (Caverject, MUSE) is a prostaglandin that relaxes smooth muscle and promotes blood flow into the corpus cavernosum

2. Sildenafil (Viagara) may be classified as a cardiovascular agent and selectively inhibits receptors and increases nitrous oxide levels, allowing blood into the corpus cavernosum

3. Contraindicated in the presence of any anatomical obstruction or condition that might predispose to Priapism and in clients with penile implants

4. Caution should be used in clients with penile implants5. Sildenafil (Viagara) is used cautiously in clients with coronary artery disease, active peptic ulcer,

or retinitis pigmentosa6. Sildenafil (Viagara) cannot be administered to clients taking any organic nitrates

B. Side effects1. Alprostadil (Caverject, MUSE): Pain at the injection site, infection, Priapism, fibrosis, rash2. Sildenafil (Viagara): Headache, flushing, dyspepsia, urinary tract infection, diarrhea, dizziness,

rashC. Implementation

1. Perform a thorough assessment of health and medication history2. Instruct the client regarding administration of the medication; Alprostadil (Caverject, MUSE) is

injected, and Sildenafil (Viagara) is taken orally3. Inform the client of the side effects necessitating the need to notify the physician

XIII.MEDICATIONS FOR DIABETES MELLITUSA. Insulin and oral hypoglycemic medications

1. Description

a. Insulin increases glucose transport into cells and promotes conversion of glucose to glycogen, decreasing serum glucose levels

b. Oral hypoglycemic agents stimulate the pancreas to produce more insulin and increase the sensitivity of peripheral receptors to insulin, thereby decreasing serum glucose levels

2. Contraindications and concernsa. Insulin is contraindicated in clients with hypersensitivityb. Oral hypoglycemic agents are contraindicated in type 1 diabetes mellitus and in individuals

allergic to sulfonylureasc. Sulfonylureas can affect cardiac function and oxygen consumption and lead to cardiac

dysrhythmiasd. Use of hypoglycemic medications with beta-adrenergic blocking agents masks signs and

symptoms of hypoglycemiae. Anticoagulants, chloramphenicol (Chloromycetin), clofibrate (Atromid-S), salicylates,

propranolol (Inderal), monoamine oxidase inhibitor (MAOIs), pentamidine (pentam-300), and sulfonamides may cause hypoglycemia

f. Corticosteroids, sympathomimetics, thiazide diuretics, phenytoin (Dilantin), thyroid preparations, oral contraceptives, and estrogen compounds may cause hyperglycemia

g. Side effects of the sulfonylureas include gastrointestinal symptoms and dermatological reactions; hypoglycemia can occur when an excessive dose is administered or when meals are omitted or delayed, food intake is decreased, or activity is increased

h. Chlorpropamide (Diabenese) can cause a disulfiram (Antabuse) type of reaction when alcohol is ingested

B. Oral hypoglycemic medications1. Prescribed for clients with type 2 diabetes mellitus2. Sulfonylureas

a. Classified as firs- or second-generation sulfonylureasb. Stimulate the beta cells to produce more insulinc. First-Generation Sulfonylureas: are rarely used

Short-acting Tolbutamide (Orinase)

Intermediate-acting Acetohexamide (Dymelor) Tolazamide (Tolinase)

Long-acting Chlorpropamide

d. Second-generation Sulfonylureas Glipizide (Glucotrol, Glucotrol XL) Glyburide (DiaBeta, Micronase, Glynase) Glimepiride (Amaryl)

3. Nonsulfonylureasa. Affect the hepatic and gastrointestinal production of glucoseb. May be used in combination with a sulfonylureas

Biguanide(s): reduce the rate of endogenous glucose production by liver; increase the use of glucose by muscle and fat cells; metformin (Glucophage) Metformin (Glucophage)


Alpha Glucosidase Inhibitor: block digestion of complex carbohydrates and slow absorption of glucose Acarbose (Precose) Miglitol (Glyset)

Thiozolidinediones: improve insulin sensitivity, thus improving peripheral glucose uptake Troglitazone (Rezulin) Pioglitazone (Actos) Rosiglitazone (Avandia)

Meglitinide: stimulate quick release of insulin by beta cells Rapaglinide (Prandin)

4. Implementationa. Assess the client’s knowledge of diabetes mellitus and the use of oral antidiabetic agentsb. Obtain a medication history regarding the medications that the client is currently takingc. Assess vital signs and blood glucose levelsd. Instruct the client to recognize symptoms of hypoglycemia and hyperglycemiae. Instruct the client to avoid over-the-counter medications unless prescribed by the physicianf. Instruct the client not to ingest alcohol with sulfonylureasg. Inform the client that insulin may be needed during stress, surgery, or infectionh. Instruct the client in the necessity of compliance with prescribed medicationi. Advise the client to obtain a Medic-Alert bracelet

C. Insulin1. Primarily acts in the liver, muscle, and adipose tissue by attaching to receptors on cellular

membranes and facilitating the passage of glucose, potassium, and magnesium2. Available in three forms: human, beef, and pork; human and purified pork insulins are less

antigenic; administered parenterally; brands or forms should not be substituted without medical supervision

3. Available in rapid-acting, intermediate-acting, and long-acting forms; rapid-acting and intermediate-acting forms are available in mixed preparations (e.g., Humulin 70/30, which contains 70% NPH and 30% regular insulin)

4. Prescribed for clients with type 1 diabetes mellitus5. Storing insulin

a. Exposure to extremes in temperature is avoided; insulin should not be frozen or kept in direct sunlight or a hot car

b. Before injection, insulin should be at room temperaturec. If a vial of insulin will be used up in a month, it may be kept at room temperature; otherwise,

the vial should be refrigerated6. Insulin injection sites

a. The main areas for injections Abdomen Arms (posterior surface) Thighs (anterior surface) Hips

b. Insulin injected into the abdomen may absorb more evenly and rapidly than at other sitesc. Systemic rotation within one anatomical area is recommended to prevent lipodystrophy;

client should be instructed not to use the same site more than once in a 2- to 3-week periodd. Injections should be 1.5 inches apart within the anatomical areae. Heat, massage, and exercise of the injected area can increase absorption rates and may result

in hypoglycemiaf. Injection into scar tissue may delay absorption of insulin

7. Administering insulina. To prevent dosage errors, be certain that there is a match of the insulin concentration noted

on the vial with the calibration of units on the insulin syringe; the usual concentration of insulin is U 100 (100 units per mL)

b. Most insulin syringes have a 27- to 29-gauge needle that is approximately 0.5 inch longc. Before use, roll, not shake (to avoid bubbles) the insulin bottle to ensure that the insulin and

ingredients are mixed well; otherwise an inaccurate dose will be drawnd. Premixed insulins (NPH to regular insulin) are available as 70/30 (most commonly used),

80/20, 60/40, 50/50e. A 3-week supply of insulin may be prepared and kept in the refrigerator; prefilled syringes

should be kept flat or with the needle in an upright position to avoid clogging of the needlef. Inject air into the insulin bottle (a vacuum makes it difficult to draw up the insulin)g. It is recommended to draw up the Regular (shorter-acting) insulin firsth. Regular insulin may be mixed with any other type insulini. Insulin zinc suspensions may be mixed only with each other and Regular insulin, not with

other types of insulinj. Administer a mixed dose of insulin within 5 to 15 minutes of preparation; after this time the

Regular insulin binds with the NPH insulin and its action is reducedk. Aspiration is generally not recommended with self-injectionl. Administer insulin at a 45- to 90-degree angle and at a 45- to 60-degree angle in thin personsm. REMEMBER: Regular insulin is the only type of insulin that can be administered by IV

D. Glucagon1. A hormone secreted by the alpha cells of the islets of Langerhans in the pancreas2. Increases blood glucose by stimulating glycogenolysis in the liver


3. Can be administered by SC, IM, or IV routes4. Used to treat insulin-induced hypoglycemia when the client is semiconscious and is unable to

ingest liquids5. The blood glucose level begins to increase within 5 to 20 minutes after administration6. Instruct the family in the procedure for administration7. Read about additional information regarding implementation for severe hypoglycemia

E. Diazoxide (Proglycem)1. Increases blood glucose by inhibiting insulin release from the beta cells and stimulating the

release of epinephrine from the adrenal medulla2. Used to treat chronic hypoglycemia caused by hyperinsulinism resulting from islet cell cancer or

hyperplasia3. It is not used for hypoglycemic reactions from insulin

Common Types of InsulinType Onset Peak Duration

Rapid-acting insulinLispro (Humalog) 10 to 15

minutes1 hour 3 hours

Short-acting insulinHumulin Regular 0.5 to 1

hour2 to 3 hours 4 to 6 hours

Intermediate-acting insulinHumulin NPHHumulin Lente

3 to 4 hours3 to 4 hours



Long-acting insulinHumulin Ultralente 6 to 8 hours 12 to 16 hours 20 to 30 hoursPremixed insulin70% NPH and 30%Regular

0.5 to 1 hour

2 to 12 hours 18 to 24 hours

PHARMACOLOGY

FACTORS AFFECTING DRUG ABSORPTION1. ABSORPTION 2. DISTRIBUTION = plasma-protein binding, volume of distribution, barriers (blood- brain & placental), obesity & receptor combination3. METABOLISM = oral meds, age, nutrition & hormones4. EXCRETION = renal excretion, drugs affecting elimination of other drugs, blood

concentration levels

GENERAL PRINCIPLES OF DRUG ADMINISTRATION

1.Confirm client diagnosis & appropriateness of meds2.Identify all concurrent meds & any potential C/I & allergies3.Research drug compatibilities, action, purpose, route, C/I, S/E4.Calculate dosage accurately especially for pediatric clients5.Check for expiration date of meds6.Compare drug label 3x (when removing meds from cabinet, before & after medications)

7.Confirm client’s identity 8.Provide client teachings9.Stay with client until meds is gone; don’t leave at bedside10. After giving meds, leave client in position of comfort11. Give meds w/n 30 minutes of prescribed time.12. To ensure safety do not give a medication that someone else prepared

SEVEN RIGHTSRIGHT CLIENTRIGHT DRUGRIGHT DOSERIGHT ROUTERIGHT TIMERIGHT DOCMENTATIONRIGHT DRUG PREPARATION & ADMINISTRATION

GENERAL CONSIDERATIONS FOR ORAL MEDS1.Assess oral cavity & ability to swallow meds2.Enteric-coated meds must not be crushed. Only scored tablets can be broken

3.Do not administer alcohol-based products like elixirs to alcohol dependent persons4.Have patients swallow meds except for sublingual & buccal route. Do not allow fluids 30 minutes after giving meds. Give iron preparation using straw to prevent teeth staining.5.When giving meds via NGT, do not mix with food. Give before or after meals & flush tubing with 30 ml of H2O Check for tube patency before giving medications.

GENERAL CONSIDERATIONS FOR PARENTERAL MEDS1.Select appropriate needle size & syringe for ID, SQ, IM ROUTES2.Use tuberculin syringe for meds less than 1 ml3.Draw up air equal to amount of meds needed4.Inject air to vial to prevent negative pressure & aid in aspirating meds5.Ampule: place needle into ampule to draw meds & use filter needle to avoid glass shards6.Select & rotate sites avoiding bruised or tender areas7.Insert needle quickly with bevel side up. Aspirate to check for blood except heparin. If blood is present, remove needle & start again. For giving IV meds, blood return is desired8.Apply gentle pressure after giving injections except for heparin & Z-track.

SQ ADMINISTRATION1.Use 25g to 27g, ½ to 1 inch needle2.Maximum volume of 1.5 ml3.Pinch skin to form SC fold & insert at 45 degrees in thigh or arm & 90 degrees in abdomen4.Possible sites: lateral aspect of upper arm, anterior thigh, abdomen…1 inch from umbilicus & scapular area

ID ADMINISTRATION INTRADERMAL ADMINISTRATION

1.Use 26g to 27g, 1" needle on a 1 ml or tuberculin syringe (vol approximately 0.1 ml)2.Insert needle at 10-15 angle with 1-2 mm depth with needle bevel upward3.When wheal appears, do not massage..mark4.Possible sites: ventral forearm, scapula, upper chest


IM ADMINISTRATION1.Use 18 g to 23 g, 1-2 inch needle, maximum volume is 5 ml2.Stretch skin taut3.Insert at 90 degrees angle. 45 degrees for infants & children4.Possible sites: gluteus medius (ventrogluteal & dorsogluteal, vastus lateralis (anterior thigh), rectus femoris(medial thigh) & deltoid5.For Z-track: 20-22 g, 2-3 inches long with a different needle to draw meds; draw skin laterally with non-dominant hand to ensure meds enter muscle; wait 10 sections before removing injection; do not massage to lock irritating substances in place

IV ADMINISTRATION1.Check site for complications (redness, swelling, tenderness)2.Check blood return3.Prepare meds according to manufacturer’s specifications4.Prepare tubing according to requirement: micro or macro tubing5.Change tubing & dress site every 24-72 days depending on hospital policy & label appropriately6.Never hang solutions more than 24 hours 7.Use syringe infusers & infusion pumps

IV PRECAUTIONS1.Monitor the risk for fluid overload especially in patients with respiratory, cardiac, renal & liver diseases. Elderly clients & very young clients cannot tolerate excessive fluid volume2.Clients with CHF cannot tolerate solutions containing sodium3.Clients with diabetes mellitus does not typically receive dextrose (glucose) solutions4.Lactated Ringer’s Solution contain potassium & should not be given to clients with renal failure

COMPLICATIONS OF IV THERAPYCOMPLICATIONS OF IV THERAPY1.INFECTION LOCAL: redness, swelling & drainage at site SYSTEMIC: fever, chills, HA, tachycardia, malaise

*the longer the site, the higher the risk*at risk are HIV/AIDS patients & those receiving chemo*assess for the S/Sx of infection, maintain strict asepsis in IV site care, monitor WBC, check the integrity of solutions, change tubings & dressings q 24-72 hrs, prepare to obtain blood culture from venipuncture device

2.PHLEBITIS/THROMBOPHLEBITIS PHLEBITIS: redness, heat & tenderness at site, sluggish IV THROMBOPHLEBITIS: hard & cordlike vein

*use IV cannula smaller than vein*avoid lower extremities as the site & areas of flexion

3. INFILTRATION edema, pain & coolness at site d/t seepage of IV fluid outside vein & into the interstitial space; may or may not have blood return

*caused when devise dislodged or perforates vein or when vein backs up pressure d/t venospasm*infiltrated if no backflow of blood upon lowering fluid container or after occluding the vein proximal to site and IV continues to flow

*remove infiltrated IV, elevate extremity & apply cold or warm compress based on MD’s order4. CIRCULATORY OVERLOAD increased BP, distended jugular veins, rapid breathing dyspnea, moist cough & crackles *use infusion pump esp. for clients at risk of overload and time tape *if it occurs, KVO rate, elevate head of bed, assess for edema & inform MD

* *if these occurs, remove & restart in opposite extremity apply warm & moist compress; inform doctor

5. AIR EMBOLISM tachycardia, dyspnea, hypotension, cyanosis & decreased LOC

*occurs when air bolus enters vein through inadequately primed IV line, from loose connection, tubing change & IV removal*if S/Sx occur, clamp the tubing, turn the patient on the left side with the head lowered

(Trendelenburg position) to trap area in the right atrium, call MD right away

CONSIDERATIONS IN GIVING OPTHALMIC MEDS1.Have patient lie on back or sit w/ head turned to the affected side to facilitate gravitational flow2.Cleanse eyelids & eyelashes with sterile gauze pads soaked with physiologic saline saline3.Keep eye open by pulling down on cheekbone with thumb & pointer finger to expose lower conjunctiva4.Place the necessary drops near the outer canthus & away from cornea5.If using ointment, squeeze into lower conjunctiva & move from inner to outer canthus. Do not touch tip to the eye & twist tube to break medication stream6.Let patient blink 2-3 times7.Press on nasolacrimal glands8.Wipe excess meds starting from inner canthus9.Droppers & ointments are for individual clients & never shared

CONSIDERATIONS IN GIVING OTIC MEDS1.Clean outer ear using wet gauze pad.2.Straighten ear canal:

pull pinna up & back for adults; pull pinna down & back for children under 33.Instill necessary number of drops along side of canal without touching ear with dropper. Maintain ear position until meds has totally entered canal4.Have client remain on side for 5-10 minutes to allow meds to reach to reach inner ear.

CONSIDERATIONS IN GIVING TOPICAL MEDS1.Cleanse area to remove old meds using gauze with soap & warm water2.Spread medication evenly & thinly wearing gloves if the skin is broken3.When applying nitroglycerin ointment, take the client’s BP 5 minutes before & after application4.Wash hands after applying to prevent self-absorption5.For transderm patches, wear gloves to prevent self absorption & place in an area with little hair. Press down edges to secure patch

CONSIDERATION OF GIVING VAGINAL MEDS1.Let client void2.Drape to provide privacy & wear gloves3.Place client on bedpan in a dorsal recumbent position with hips & knees flexed4.Cleanse perineum with warm, soapy water working from inner to outer5.Moisten suppository with water-soluble lubricant6.Separate labia & insert 2 inches…angled downward & backward7.Provide pillow under buttocks & let patient remain in that position for 15-20 minutes (no sphincter to hold suppository in place)8.Provide with pads

CONSIDERATION OF RECTAL MEDS

1.Check patient’s bowel function/ability to retain the enema or suppositoryHTTP://WWW.COLLEGEOFNURSING.CJB.NET ST. MICHAEL’S COLLEGE, INC. – ILIGAN CITY

2.Store suppositories in the refrigerator3.Provide privacy & position client left laterally4.Don gloves & moisten suppository with water-soluble lubricant

5.Insert suppository tapered end 1st & insert 2 inches to pass the internal sphincter6.Hold buttocks together.7.Encourage patient to retain: suppositories for 10-20 minutes; enema for 20-30 minutes

NERVOUS SYSTEM

CNS PNS

BRAIN SPINAL CORD SOMATIC AUTONOMIC

ADRENERGIC CHOLINERGIC 1.ALPHA

2.BETA

NEUROLOGIC MEDSANALGESICS

1.NARCOTIC ANTAGONISTS a.) morphine-like derivatives

codeine (codeine SO4); morphine (roxanol); levorphanol (levodromoran)b.) meperidine-like derivatives

fentanyl (sublimaze); meperidine (Demerol)c.) methadone-like derivatives

methadone, dolophine2. NARCOTIC PARTIAL AGONISTS NARCOTIC ANTAGONISTS

* Butorphanol Tartrate (Stadol), Nalbuphine, Pentazocine *naloxone, naltrexone (trexan)3. NON-STEROIDAL ANTI-INFLAMMATORY *salycilates ( aspirin= reye’s syndrome, avoid < 18, GIT irritant)

*ibuprofen, mefenamic acid, naproxyn ( naprosyn), ketoprufen (orudis)4. MISCELLANEOUS ANALGESIC AGENTS

*acetaminophen (Tylenol)

ANXIOLYTICS

BARBITURATES phenobarbital; mephobarbital; methabarbital; amobarbitalBENZODIAZEPINES diazepam (Valium) lorazepam (Ativan) chlorazepate (Tranxene), NONBENZODIAZEPINEdiphenhydramine (Benadryl) doxylamine (Unisom) buspirone(Buspar)NONBARBITURATESHydroxyzine (vistaril), Atarax, Meprobamate (Equanil)

ANTICONVULSANTS

BARBITURATESMephobarbital (mebaral); Metharbital (gemonil); Phenobarbital (luminal)BENZODIAZEPINESClonazepam (klonopin); Clorazepate (tranxene); Diazepam(valium)HYDANTOINSEthotoin (peganone); Mephenetoin (mesantoin); Phenytoin (dilantin)MISCELLANEOUScarbamazepine (Tegretol)lorazipam (Ativan),MgSO4, Valproic acid (Depakene)SUCCINIMIDESEthosuximide (zarantoin); Methoximide (celontin); Phensuximide (milontin)

NEUROLEPTICS (Antipyschotic Agents/ Antischizophrenic/Major Tranquilizers)

ANTIDEPRESSANTANTIDEPRESSANTMAOI *isocarboxazid (marplan) * tranylcypromine sulfate (parnate), phenylzine sulfate (nardil)Tricylics * Amitriptyline hcl (Elavil) *Imipramine (Tofranil) * Desipramine hcl (pertofrane, norpramin)SSRI (Selective serotonin reuptake inhibitors * Fluoxetine (proxac), Paroxetine (Paxil), Sertraline hcl (Zoloft)

PHENOTHIAZINESPHENOTHIAZINESChlorpromazine(Thorazine) – severe hypotensive effectMesoridazine(Serentil)Thioridazine(Mellaril)Fluphenazine(Prolixin,Permitil) – long-acting formProchlorperazine(Compazine)Perphenazine(Trilafon)Trifluoperazine(Stelazine)Thioredazine (Mellaril)- retinitis pigmentosa above 800 mgBenzisoxasole:Risperidone(Risperdal)

COMPARISON OF CHARACTERISTICS OF ANTICOAGULANT DRUGSCOMPARISON OF CHARACTERISTICS OF ANTICOAGULANT DRUGS

HEPARIN COUMADIN


ONSET OF ACTION immediate slow (24-48hrs)ROUTE OF ADMIN parenteral oralDURATION OF ACTION short (<4hrs) long (approximately 2-5 days)LABTES T APTT PTANTIDOTE Protamine SO4 Vitamin K, whole blood or plasmaCOST expensive inexpensive

THROMBOLYTIC MEDsTHROMBOLYTIC MEDsSalteplase (Activase, t-PA tissue plasminogen activator); Urokinase (Abbokinase)Streptokinase (Streptase, Kabikinase)

ANTIHEMOPHILICANTIHEMOPHILICFACTOR VIII; factorate, hemofil-T, humafac, koate, profilate

ANTIINHIBITOR COAGULANT COMPLEXAutoplex, feiba VH immuna

FACTOR IX COMPLEXcontains factor II, VII, IX & X (vit K coagulant factor) ; hemophilia

SYSTEMIC HEMOSTATICS aminocaproic acid (AMIKAR, EPSIKARON); competetive antagonist of plasminogen C/I in intravascular active clotting

TOPICAL HEMOSTATICSabsorbable gelatin sponge (Gelfoam); absorbable gelatin film (Gelfilm); absorbable gelatin powderoxidized cellulose

CARDIOVASCULAR

ANTILIPIDEMICSBILE ACID SEQUESTRANTS cholestyramine (Questran)*Mix powder thoroughly with juice & H2O *A/R: constipation & PUDHMGCoA REDUCTASE INHIBITORSatorvastatin (Lipitor) ;simvastatin (Zocor)*Check serum liver enzymes & eye exam annually for cataract

OTHERSclofibrate (Lopid) *Don’t take with anticoagulants

ANTIHYPERTENSIVESSTEP 1 DIURETIC (1st step for younger clients w/ tachycardia & marked lability of BP)STEP 2 BETA-BLOCKING AGENT

Beta 1adrenergic (cardioselective) blocking agents : Acetabulol (sectral); atenolol (tenormin); metoprolol (betaloc)

Beta 1 & 2 (nonselective) blocking agents:Nadolol (corgard), pindolol (visken), propranolol (inderal, novopranol), timolol

ADRENERGIC INHIBITING AGENT. *.clonidine, methyldopa, reserpine, prazoline ; *usually diuretic added to prevent fluid retention

STEP 3 VASODILATOR AGENT* hydralazine ; … added w/ adrenergic blocking agent & diuretic decrease workload

STEP 4 GUANETHEDINE, MINOXIDIL, OR ANGIOTENSIN INHIBITORS CAPTOPRIL OR ANALAPRIL

ANTIDYSRHYTMIC

GROUP 1generally inhibit the fast sodium channel in cardiac muscle resulting in an increased refractory perioda.Disopyramide phosphate (NORPACE); Procainimide hcl (PROCAN); Quinidine (QUINIDEX)b.Lidocaine (XYLOCAINE)c.Flecainide

GROUP 2BETA BLOCKERS THAT DECREASE STIMULATION OF THE HEARTBeta 1 selective antagonists*cardiogenic blockers; block Beta1 cardiac receptors*atelonol (ternonim), acebutolol sectral, metoprolol (betaloc)Beta 2 Selective*mucolytics & bronchodilatorsNonseletive Beta Adrenergic blocking agents ; (beta 1 & beta 2 blockers) * nadolol (corgard), oxyprenelol (trasicor), pindolol (visken)propranolol (inderal) , timolol

GROUP 3* generally do not affect depolarization but work by prolonging cardiac repolarization•Anti adrenergic; positive inotropic action•Bretylium, amiodarone hcl (cordarone)

GROUP 4•Calcium antagonist action= depression of heart & smooth muscle contraction, decreased atomaticity, & decreased condction velocity• verapamil

BRONCHODILATOR/XANTHINESAminophylineIsoproterenol, isuprelTerbutaline SO4, BrethrineAtroventAlbuterol, proventilEpinephrine, adrenalinAcetylcysteine, mucomystIntal


GIT MEDSANTACIDS & MUCOSAL PROTECTIVESsucralfate (carafate); magnesium hydroxide ( milk of magnesia); aluminum hydroxide ( amphojel, alu-cap)calcium carbonate, tums

H2 BLOCKERScimetidine (tagamet); ranitidine, (zantac)

PANCREATIC ENZYME REPLACEMENTpancreatin (creon); pancrelipase (cotazym, vickase, pancrease)

MEDS Rx HEPATIC ENCEHALOPATHYlactulose (cephulac) ; neomycin (mycifradin)

LAXATIVESBulk Forming Laxatives: Psylium Hydrophillic Mucilloid (Metamucil)Stool Softeners: Docusate Calcium (Surfak); Docusate Sodium ( Colace)Lubricants: Mineral oilStimulant Cathartics: Bisodyl (Dulcolax); Cascara (Castor oil)

RENAL DRUGS

DIURETICSProximal Tubule Diuretics:

Carbonic Andydrase Inhibitors= actazolamide (diamox)

Diluting Segment DiureticsDiluting Segment DiureticsThiazide Diuretics=chlorothiazide (diuril)

Loop DirureticsLoop DirureticsFurosemide (Lasix)

Distal Tubule DiureticDistal Tubule DiureticAmiloride (Midamor); Spironolactone (Aldactone); Trieamtrine

Osmotic DiureticOsmotic DiureticManitol (Osmitrol); Isosrbide; Urea (ureaphil)

URINARY TRACT ANTISEPTICSNitofurantoin (Furadantin, Furalan, Macrobid)

URINARY ANALGESICSPhenazopyridine Hcl (Pyridium)

CHOLINERGICBethanecol Chloride (Duvoid, urecholine)

ANTISPASMODICOxybutynin chl (Ditropan); Probanthine Bromide (Probranthine)

HEMATOPOIETIC GROWTH FACTOREpoetin alfa (Epogen, procrit)

PREVENTING ORGAN REJECTIONImmunosuppressants: cyclosporine sandimmune; Cytotoxic Meds: azathioprine (imuran)

ANTIVIRAL AGENTSAcyclovir (Zovirax);Zydovudine(AZT, Retrovir) Related Drugs: didanosine (Videx), Lamivudine (Epivir) & Zalcitabine (ddC)

Protease inhibitor= inavir (Invirase); *A/R: photosensitivity = ritonavir (Norvir); *A/R: increase triglyceride levels =stavudine (d4T, Zerit)

ANTIMICROBIALSSULFONAMIDES-Sulfisoxazole (Gantrisin)PENICILLINS-penicillin G potassium; probenecid (benemid)CEPHALOSPORINS- 1st Generation = cefazolin sodium (Ancef)

2nd Generation= cefoxidin sodium (Mefoxin) 3rd Generation= cefotaxim (claforan)

QUINOLONES -ciprofloxacin (ciprobay); -chloramphenicol (chloromycetin); -tetracycline hydrochloride (achromycin V)

AMINOGLYCOSIDES- gentamicin (garamycin); - vancomycin hcl (vancocin)LINCOMYCIN -clindamicin hcl (cleocin, dalacin C); -lincomycin hcl (lincocin)MACROLIDE -erythromycin

ANTIFUNGAL

Amphoterizin B (fun gizone); disrupts cell membrane; Rx systemic fungal infections & meningitisButoconazole nitrate (femstat)Ketonazole (nizoral)Miconazole (monistat)Nystatin (mycostatin))

ANTITURBECULAR DRUGS

ISONIAZID (INH)*Initial TTT against PTB; prophylaxis for high-risk groups*A/R: peripheral neuritis)…give vitamin B6 (pyridoxine); hepatitis…check liver enzymes frequently; hyperexcitability*Taken on empty stomach, avoid alcohol & interferes with Phenytoin (Dilantin) requiring lowering of INH dose

ETHAMBUTOL (MYAMBUTOL)*A/R: optic neuritis & loss of red-green color discrimination but it’s reversible

RIFAMPICIN*A/R: hepatitis, flu-like syndrome, may turn body fluids (urine, tears, saliva etc. ) orange*Interacts with anticoagulants, oral contraceptives, oral hypoglycemics, methadone & corticosteroids

STREPTOMYCIN*A/R: cranial nerve 8 damage (roaring, ringing & feeling of fullness in the ear); vestibular damage (dizziness & vertigo)

PYRAZINAMIDE*A/R: increased uric acid causing gout or hepatitis


INTEGUMENTARY DRUGS

ACNE PRODUCTS Isotretinoin (Accutane)

BURNS PRODUCT Mafenide (Sulfamylon); nitrofurazone (Furacin); silver sulfadiazine (Silvadene, Flint SSD); silver nitrate

ANTINEOPLASTIC MEDS

ALKYLATING MEDICATIONSchlorambucil (Leukeran) & mechlorethamine HCl (Mustargen) ALKALYTING AGENTScisplatin (Platinol); cyclophosphamide (Cytoxan)ANTITUMOR ANTIBIOTIC MEDSplicamycin (Mithracin); daunorubicin (Cerubidine); bleomycin SO4 (Blenoxane); doxorubicin (Adriamycin) & idarubicin (Idamycin)ANTIMETABOLITE MEDSCytarabine HCl (ara-C, Cytosar-U); 5-Fluorouracil (5-FU; Adrucil); 6-mercatopurine (Purinethol)Methotrexate (Folex)…given with leukovorin (folinic acid)VINCA (PLANT) ALKALOIDSvincristine SO4 (Oncovin)

HORMONAL MEDS & ENZYMESaspariginase (Elspar)mitotane (Lysodren)tamoxifen citrate (Nolvadex)Diethylstilbestrol (DES, Stilphostrol)


endocrine medications

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