Digoxin:Uses: cardiotonic/ cardioglycoside/ antiarrhythmic Contraindications: ventricular fibrillationAdverse reactions:

• GI disturbances (anorexia,nausea,vomiting)• Fatigue• Weakness• Headache• Drowsiness• Ocular disturbances (halos, green or yellow color)

Drug interactions: • AMIODARONE: increase toxicity• BETA-BLOCKERS, CALCIUM CHANNEL BLOCKERS: additive effect• K-DEPLETING DIUhctRETICS: increase toxicity• SYMPATHOMIMETICS: increase risk of arrhythmias

Toxicity level: 2.5 mg/mLTherapeutic level: 0.5-2 mg/mLAntidote: digoxin immune FAB (digibind)Effect in hormones:

• Increase serum ESTROGEN• Decrease serum LUTEINIZING HORMONE• Decrease serum TESTOTERONE• Can cause gynecomastia: enlarged breast in men

Hydrochlorothiazide(HCTZ):• Thiazides and Sulfonamides diuretics MOST COMMON use diuretics• Prevent the reabsorption of sodium and chloride (direct action on end of distal tubule)• ANTIHYPERTENSIVE

Uses: Tx. mild-moderate HYPERTENSION (stage 1&2) THIAZIDE:

• drug of choice to start antihypertensive therapy• given once a day by mouth • K supplement may also be required ( HYPOKALEMIA induce by medication)• NOT USE when pregnant or breastfeeding Contraindications:

• Anuria • Hypersensitivity to sulfonamides and thiazides • Renal decompensation

Adverse reactions: • Water loss and electrolyte depletion (hypokalemia, hyponatremia, dehydration)• Acute hypotensive episodes• Hyperglycemia

Side effects: • Increase urinary frequency• K-depletion• Orthostatic hypotension• Headache• GI disturbances• Photosensitivity

Interactions: • Cholestyramine & Colestipol : descrease absortion effects• Increase risk of Digoxin toxicity

• Increase risk of Lithium toxicity

PROPANALOL: (Inderal LA)Uses: antidysrhythmic/ class II drug/ beta-blocker

• Reduce heart rate• Prevents rennin realease• Slow SNS

Multiple uses:• Cardiac dysrhythmias • Migrane• Angina• MI• Phenchromocytoma

Contraindications: • cardionic shock• sinus bradycardia• bronchial asthma• hypersensitivity to propranolol hydrochloride

Potassium sparing diuretics:• amiloride: midamor• spironolactone: aldactone• triamterence: dyrenium

How they work:• take out H2O and sodium, save K+• change the creation of proteins that affect the exchange of sodium and potassium

Teaching:• Take med. as order • with FULL glass of water• eat K+ rich foods • get rid of other risk factors: losing weight, lower NA+ intake, STOP smoking, exercise, AVOID

stress/emotional pressure• keep taking medication even when feeling better, keep seeing healthcare provider regularly

Dr choose medication to prevent DIGITALIS TOXICITY in pts with poor function or disease of kidney (nephrotic syndrome)

PVD (peripheral vascular disease):• blockage or narrowing of arteries (outside side of the brain and heart)

Causes: • decrease blood flow producing cold extremities, thin shinny skin, decrease hair growth on legs and

pain walking • elevated blood cholesterol• diabetes• smoking• hypetension• inactivity• overweight/obesity

Treatment:• antianginals (pain)• vasodilators (open/expand)

• 2 major goals:-manage s/s (leg pain: resume physical activities)-STOP progression of atherosclerosis (reducing risk for heart attack and strokes)

Complications:• Critical limb ischemia: open sore that don’t heal/ causing gangrene• Stroke and heart attack: fat deposit can build up in arteries that supply your heart and brain

Interactions:• Antihypertensive: stronger action on PVD• Alcohol: can cause hypertension

Hyperlipidemia medications:• Reduce cholesterol level in blood

HMG-COA reductase inhibitors: (-statin)• first CHOICE DRUG • costly but best tolerated• lower LDL levels• (rosuvastatin, atorvastatin, simvastatin, pravastatin, lovastatin,fluvastatin)

Fibric acid derivates: • GEMFRIBROZIL & FENOFIBRATE preferred drugs/ less adverse reactions and more effective• Lower triglycerides and increase HDL levels

Bile acid sequestrants:• Increase cholesterol excretion and reduce LDL levels• (cholestyramine, cloestipol, colesevetam)

Niacin/ nicotinic acid:• Lowers triglycerides and increases HDL levels (adverse effect: flushing in face w/ nicotic acid)

Selective cholesterol absorption:• Limits the absorption of cholesterol in foods

Angina:• Chest pain due to lack of blood supply taking O2 and nutrients to the heart/ narrowing or constriction

of smooth muscle in small coronary arteries (muscle hurts form lack of O2)S/S:

• Pain• Discomfort

Causes: • Smoking• High cholesterol• High BP• Diabetes

Treatment:• Nitrates: (short and long acting)• Rapid-acting (amyl nitrate, sublingual nitroglycerin, sublingual/chewable isosorbide

dinitrate) -relieve acute angina• Long-acting:

• prevent and treat angina attacks when they are more likely to occur• reduce severity and frequency• reduce heart work in case of MI and chronic heart failure

• beta blockers/class II drugs (-LOL)• calcium channel blockers/ class IV drugs (verapamil)

• act directly in smooth muscle/dilate arteriesTeaching/Diet:

• STOP smoking

• Limit alcohol & salt• Increase physical activity• Lose weight• Balanced diet (vegs, fruits, increase K+ and Mg)• AVOID sat. fats • Reduce stress• Tx. hypertension/hyperlipidemia • AVOID CAFFEINE

THIAZIDES lower calcium levels:• Promote reabsorption of calcium

Nitroglycerin:Uses:

• Trandermal patch: recent MI/ long term prophylaxis of angina• IV (critical care unit): control severe angina in acute MI and pain during procedures (cardiac

catherization)• Oral/sublingual/buccal: acute relief of angina• Can cause severe DROP in BP

Contraindications: • Allergy to aspirin• Tolerance can develop• Given with other antihypertensive/ DROP in BP can be severe• Smoking decreases effect

Storage & Teaching:• Dark colored glass bottle• New prescription every 3 months (lose strength in 3 months)• Old drugs should be thrown away• Produces throbbing headache (should last no longer than 20min)• NOTIFY dr. if blurred vision/persist headache/dry mouth• Topical ointment: tightly close/refrigerate, use in thin layer of skin, don’t massage/hairless spot• Check B/P and pulse before applying medication

DIURETICS how to discontinue? Gradually to avoid developing of serous edema

Tx for dehydration:

Lidocaine: • Anesthetic effect/ causes numbness or loss of feeling in an area of body apply• Treats emergency heart rhythm problems

Uses:• Antiarrhythmic: rapid control of acute ventricular arrhythmias following MI. cardiac catherization,

cardiac Sx• Local anesthesia: infiltration/nerve block for dental/surgical procedure, labor• Topical anesthesia: local lesion disorders• Dermal patch: relief of chronic pain (post-herpetic neuralgia)

Antidysrhythmic medications:• Class I drugs/sodium channel blockers: lengthen the effective refractory period of atria and

ventricular myocardium , slowing the fast inward current cause by sodium (quianidine, procainamide, disopyramide)

• Class II drugs/beta-blockers/-LOL : reduce sympathetic excitation to the heart (propranolol, esmolol, acebutolol)

• Class III drugs/K+ channel blockers: lengthen action potential duration (amiodarone, bretylium, dofetilide, ibutilide, sotalol)

• Class IV drugs/ calcium channel blockers: selectively block the ability of calcium to enter the myocardium/prolong resting period in the AV node ( verapamil)

Constipation: • Common side effect in pts taking CHOLESTYMINE and COLESTIPOL (antihyperlipidemic medications)

Teaching and Diet:• Increase fluid intake ( at least 2quarts per day)• High- fiber diet (orange juice,bran, whole grain, fruits such as figs, prunes, bananas)• Regular exercise routine (daily walk or active or passive exercise)

NITRATE compounds help in CORONARY ARTERY DISEASE:• Causing smooth muscle to relax in arterial and venous circulation • Less pressure for the heart to pump (arterial relaxation)• Decrease venous return to the heart (venous relaxation)• Less use on O2 by muscle • Less workload of heart

Diuretics: HELP in treatment of hypertension:• Indirectly reduce B/P by producing sodium and water loss • Lowering the tone or rigidity of the arteries• Blocks sodium reabsorption in the nephron

Quinidine: • Antiarrhythmic/ class I • toxic effects: Cinchonism

S/s of toxicity: • Tinnitus• light headedness• headache• fever• vertigo• N/V

S/s that required immediate intervention: • Fainting• light headedness• loss of consciousness

(All this reduces blood flow to the brain; and can cause death)-this condition is known as Quinidine Syncope

Cardiotonic medications:• Increases the strength or force of the contraction (pumping)

• Slow the heart rateUses:

• treat heart failure• rapid or irregular heartbeats (atrial fibrillation, atrial flutter, and frequent premature ventricular

contractions (PVCs) or paroxysmal atria tachycardia)

Contraindications: • Patients with symptoms of digitalis toxicity• Or if patients’ condition has worsened since the last time the medication was given. • History of hypersensitivity• full AV block• atherosclerosis• HTN• Cardiomyopathy• Phenochromocytoma• ventricular fibrillation• liver and kidney diseases• hyperthyroidism • Pregnancy and breast feeding.

Adverse Reactions: • dysrhythmias• bradycardia• bigeminal VPC’s,• AV node block• excessive fatigue• confusion• blurred vision (yellow-green vision)• GI disturbances (anorexia, nausea, vomiting)

Vasodilators:Side effects:

• dizziness• headache• weakness• tachycardia• flushing• postural hypotension• dysrhythmias• confusion• severe rash• nervousness• tingling• sweating• (some disappear within a few weeks if they are mild and if the patient can keep taking the

medication)

Migraine medications:Uses:

• vasodilator• prevention and treatment of vascular headaches

Ergot Alkaloids (Erganol):• Used if triptans are not effective, and for other smooth muscle spasmogenic effects.• For pregnant women for oxytocic (labor- inducing).

Triptans (Imitrex): taken if OTC (Aspirin, Ibuprofen) meds don’t work.Teaching:

• take meds as ordered (avoid poisoning or overdose)• no alcohol or CNS agents• Dress warmly and don’t allow arms and legs to get cold after taking tryptan or ergot meds.• contact DR if: numbness, coldness of extremities, or pain in the legs during walking• oral meds may produce stomach upset (take with milk or meals)• Common side effects: headache, nausea, vomiting, diarrhea, dizziness, and light headedness when

rapidly changing positions.• after taking meds, pt. should lie down in a quiet, dark room (soft music or relaxation techniques may

benefit)• Contact PCHP ASAP if: more than 8 mg of oral ergotamine (Erganol) is needed to relieve pain.• pregnant or suspect that are pregnant DO NOT TAKE MEDICATION

Drug of choice of STATUS EPILEPTICUS:• benzodiazepines: DIAZEPAM (VALIUM) via IV

Other that may be used:• Amytal• Phenobarbital• Cerebyx• Dilantin• Tegretol

Antivertigo-Antiemtic:Uses:

• control nausea• vomiting• motion sickness• may also be used to treat hiccups

Medications:• chlorpromazine (Thorazine) & prochlorperazine (Compazine)- N/V & hiccups• promethazine (Phenergan)- N/V associated with Sx & anesthesia• ondansetron (Zofran)- N/V with chemotherapy• raglan• antivert- anticholinergic properties• Dramamine- motion sickness• Benadryl- antihistamine/antiemetic/sedative properties/ antitussive

Teaching: • take meds as ordered (don’t double dose)• if med is for motion sickness, pt. should take it 30 to 60 minutes before

Departure and 30 minutes before meals thereafter.• while taking these meds pts should not drive, operate dangerous

machines, or do anything that requires alertness.• pt. shouldn’t take any other meds w/out notifying PHCP (avoid CNS

depressants, including alcohol, because of sedative effect)

• pts get very sleepy while taking these meds (but its brief and it will disappear if they keep taking the med)

• Keep out of reach of children and others for whom it is not prescribed. • Over dosage of this med may be toxic.

Dopaminergic medications:• Control s/s of Parkinson’s disease• DO NOT CURE THE DISEASE

Adverse reactions:• Dysrhythmias• muscle twitching• psychotic reactions• rigidity• diarrhea• epigastric distress• GI bleeding• N/V• blurred vision• Alopecia• bitter taste• hot flashes• rash• urinary retention

Early signs of toxicity:• muscle twitching• blepharospasm (eyelid spasm)

Medications: • Amantadine (Symmetrel)• Bromocriptine (Parlodel)• Carbidopa (Lodosyn)• Carbidopa-Levodopa

Benzodiazepines:

Uses:• treat partial seizures• treat Lennox-Gastaut syndrome (petit mal variance)• In patients who have FAILED to respond to succinimide drugs

Other uses: • relieve anxiety, tension, and fears that occur by themselves or as a result of illness• (management of delirium tremens after alcohol withdrawal• premedication for surgical and endoscopic procedures or electric cardioversion• treatment of convulsive disorders• relief of muscle spasm)

Complications: • Liver may be affected with long term use• Risk of congenital malformations and neonatal depression during pregnancy• Use w/ caution w pts w/renal failure• Drug dependency.

Medications:• Clonazepam (Klonopin)• Clorazepate (Tranxene)• Diazepam (Valium)

Meds for Anxiety: • Ativan• Valium• Xanax

Teaching:• Take meds exactly as ordered! If you miss a dose it should be taken ASAP, • If it is w/in 1or 2 hrs of the regular dosage time. If it is later than 2 hrs, skip dose and take next dose

on time• Keep regular DR appointments.• Don’t drive, operate hazardous machinery, or perform activities requiring alertness.• Notify PHCP if any new or troublesome symptoms occur (ulcers or sores in the mouth, hallucinations,

and feelings of confusion, difficulty sleeping, skin rash, jaundice, bradycardia, difficulty breathing, sore throat and fever, unusual nervousness, excitement, irritability, depression, or eye pain.

• keep away from children• notify PHCP if pt begins new meds• AVOID alcohol• Smoking cigarettes and use of caffeinated beverages (coffee, cola) can decrease the effect of

antianxiety agents.• Not for pregnant women or breast feeding. • may be habit forming (pt should use it for the least time possible)

Klonopin: Uses:

• Oral treatment of petit mal seizures in children.• Chronic use may result in impaired physical or mental functions in the developing child (might not

become apparent until years later)

BenadrylUses: antihistamine/antiemetic/sedative properties/ antitussive

Lithium: Uses:

• bipolar disorder (manic depressive psychosis) who are in an acute manic phase• To prevent recurrent episode of mania in the bipolar pt.

Teaching:• Take meds as ordered! (even if the pt doesn’t feel better because it may take several weeks before

any changes occur)• to avoid GI upset take with milk or food• if pt takes too much Lithium or becomes dehydrated, the pt should AVOID activities that cause

excessive sweating (strenuous exercise, sunbathing, hot tub baths) and things that produce excessive urination (consuming large amounts of caffeine in coffee, tea, or cola drinks)

• Contact DR if pt doesn’t feel well

• side effects are usually mild and disappear with time• Notify DR if any new or troublesome symptoms such as vomiting, nausea, shakiness, trembling, jerky

movements of arms and legs, or generalized weakness & abd. pain • keep away from children• Pt should wear a medic alert bracelet or necklace and carry a medical id card stating the name of the

drug.• pts will need to have the level of the drug in the blood (serum lithium levels)measured frequently so

that the drug can be kept at a proper level and side effects may be reduced• Pt will need these blood tests every few days when beginning treatment, and every 1 to 2 months.

S/s of toxicity:• diarrhea• vomiting• muscle weakness• drowsiness• ataxia• Older adult pts are often more sensitive to lithium toxicity• Pts who develop diarrhea or become ill and do not eat are at increased risk of toxicity

Early side effects of lithium toxicity:• excessive thirst• polyuria (frequently seen in older adults)

Antipsychotic drugs:• long-term therapy:• schizophrenia• psychotic depression• mania or organic brain syndrome

Action: • sedate and slow the pts down• blocks dopamine in brain• used in combination with tranquilizers

First generation-conventional antipsychotic drugs:• Chlorpromazine (Thorazine)-popular and inexpensive• Promazine• Prolixin• Trilifon• Stelazine• Compazine- antiemetic• Serentil• Melllaril

First generation-conventional nonphenothiazine:• Navane • Haldol-calm demented and manic pts • Taractan• Loxitane• Mobane

• Orap

Antidepressants: Tricyclic Antidepressants:

• Amitriptyline• Tofanil• Aventyl

Uses: • to relieve the symptoms of severe depression that has internal biologic causes (endogenous

depression)• mild depression caused by factors in the pts life• less commonly used for bipolar disorders as additional therapy

Monoamine Oxidase Inhibitors: (MAOIs):• Pamate• Nardil

Uses:• relieve s/s of severe reactive or endogenous depression ( TCA therapy didn’t work)• electroconvulsive therapy or other modes of psychotherapy• Considered 2nd line treatment for depression because of their serious adverse effects. NOT APROVED

FOR CHILDREN

Selective serotonin reuptake inhibitors: (SSRI):• Lexapro• Prozac• Celexa• Paxil• Zoloft• Luvox CR

Miscellaneous antidepressants: • Wellbutrin• Effexor• Cymbalta• Remeron• Desyrel• Maprotiline• Pristique• Nefazadone

Uses: • drugs of choice for most depressive disorders• low adverse effect profile• short term treatment of out pt with a diagnosis that is listed in the category of major depressive

disorders• treat smoking cessation (Wellbutrin) • OCD

Complications:

• may increase the risk for birth defects if taken while pregnant• Hypertension• Seizures• Hypothermia• cardiorespiratory arrest• coma• hypotension• tachycardia• shock• mental confusion• Impotence

Teaching:• take meds as ordered• take w food to avoid GI distress• should NOT be stopped suddenly ( symptoms will increase)• meds may cause drowsiness• AVOID driving or other activities that require alertness• Pt should notify PHCP if drowsiness or decreased alertness persists longer than 2 weeks and

interferes with usual activities. • dryness of the mouth may occur• Chewing sugarless gum, sucking on hard candy or rinsing mouth may help. • may cause red or pink urine or photosensitivity• MAOI discontinue two wks before pt has Sx that requires anesthesia

Therapeutic effect:• inhibit the reuptake of specific neurotransmitters• hence increasing their levels at the nerves within the brain• SSRI will affect serotonin levels in the brain

5 major anticonvulsants or AED ANTIEPILEPTIC groups:• Barbiturates• Benzodiazepines• Hydantoins• Succinimides• Aminobutyric acid (GABA) analogues

Tetracyclic compounds:• Mirtazapine (Remeron)• Trazadone (Desyrel)• Maprotiline

Uses:• Major depressive disorder and anxiety associated with depression.

Adverse reactions:• Desyrel (causes early menses, hematuria, urinary frequency• pts who abruptly stop meds may experience a sudden increase in dangerous symptoms

General adverse effects:• dizziness• drowsiness• dysrhythmias• hypertension & hypotension• rash

• purities• constipation• N/V• Anorexia• Diarrhea• appetite increase• dyspepsia• impotence in males• menstruation complaints• dry mouth• urinary frequency• headache• tremors,• confusion• blurred vision• hostility• insomnia sedation• excessive sweating• disturbed concentration

S/s of toxicity:• Shivering• Diarrhea• Confusion• Fever• severe muscle tightness• seizures• death

Barbiturates:• anticonvulsants to control and prevent grand mal seizures• treat status epilepticus (if other therapy DON’T work)• Treat seizures caused by tetanus, fever, drugs.

Action:• primarily on brain stem reticular formation• reducing nerve impulses that go to the cerebral cortex• depressed respiratory system• slows activity of nerves and muscles• raises the seizure threshold (or the level of electrical activity that must be produce before a seizure

will occur)S/s of toxicity:

• exaggerated CNS depression• slow shallow respirations• myosis• tachycardia• areflexia (absence of reflexes)• shock or coma or death

Teaching:• tolerance addiction and dependence may occur• Take as prescribed• do not d/c even if have not had seizures• no driving (drowsiness effect)

• look for slow breathing• Notify DR if rash fever unusual bleeding bruising S/T, jaundice or abd pain• Pt may have excessive dreaming when drugs are d/c, this should lessen each night• Elixirs should be kept in tight closed brown glass bottle• No ALCOHOL • Wear a medic alert bracelet• Notify PHCP if undergoing any Sx• Don’t use if pregnant

Dilantin:Uses:

• partial seizures and status epilepticus• May treat migraine and trigeminal neuralgia

Class: HYDANTOINSS/s of toxicity:

• Ataxia• Coma • Dysarthria• Hypotension• Nystagmus• unresponsive pupils

Teaching:• see dentist q 6mths especially when taking Dilantin (CAUSES HYPERPLASIA- OVERGROWTH OF

GUMS)

Parkinson’s disease why does it occur:• It involves an imbalance in chemical neurotransmitters within the brain• too much acetylcholine and not enough dopamine in the basal ganglia• meds replace dopamine and control symptoms (DO NOT cure Parkinson)• block acetylcholine at postsynaptic muscarinic cholinergic receptor sites and elevate levels of

dopamine

s/s:• muscle tremors while at rest• slow movement• rigidity• muscle weakness a characteristic shuffling• forward pitch gait (resulting in changes in posture and balance)

XANAX: Uses:

• relive anxiety tension and fears that occur by themselves or as result of illness• Delirium tremens after alcohol withdrawal• premedication for surgical and endoscopic procedures or electric cardioversion• Treatment of convulsive disorders.

Teaching• pt may not be able to think or react quickly• pt should change to sitting or standing position slowly to prevent falls

• Notify DR if you have ulcers of sores in mouth, hallucinations feelings of confusion, difficulty sleeping skin rash jaundice, bradycardia difficulty breathing S/T, fever, unusual nervousness, excitement, irritability, depression, or eye pain

• no smoking or caffeinated drink b/c will decrease effect of XANAX• Can be habit forming use short term only• To reduce overdose use smallest dose with pts that have Hx of drug addiction.

S/s of toxicity:• Sleepiness• Confusion• Coma• diminished reflexes• hypotension

Tricyclic Antidepressants:Uses:

• relieve symptoms of severe depression• mild depression caused by factors in pts life• Less commonly used for bipolar disorders as additional therapy.

Teaching:• may take up to 8wks before pt feels better• No ALCOHOL• Take with food to avoid GI distress• Do not stop suddenly b/c will increase symptoms• If drowsiness lasts longer than 2wks notify dr. • chew sugarless gum or suck on hard candy or rinse mouth frequently to relieve dryness of mouth• Elavil causes red or pink color in urine, and photosensitivity• In elderly might have lightheadedness dizziness or faintness to reduce this pt should move slowly

when changing position• STOP before Sx that requires anesthesia• Notify DR if urinary retention, constipation, blurred vision, or excessive sleep.

S/s of toxicity• stimulation of CNS( irritability,agitation,hallucinations,delirium, twitching, hypertonia, hyperreflexia

and nystagmus, hyperpyrexia)• HTN• seizures (commonly in children)• CNS stimulation is followed by CNS depression (drowsiness, areflexia, hypothermia, hypotension,

dysrhythmias, respiratory depression, coma, cardiorespiratory arrest

Nardil (phenelzine):• MAOIs /antidepressant

Uses: • Depression refractory to other therapy• Electroconvulsive therapy

Side effects:• Sedation• Hypertension• Crisis• Wight gain• Orthostatic hypertension•

Parnate: • MAOIs/ antidepressant

Uses:• Depression refractory to other therapy• improvement of symptoms seen 1-3wks after therapy • higher incidence of hypertensive reactions with this drug than with other MAOIs inhibitors treats

endogenous depressionAdverse reactions:

• hypotension• dysrhythmias• ataxia• drowsiness• hallucinations• hyperactivity• insomnia• seizures• tremors• HA• vertigo• anorexia• constipation• photosensitivity• skin rash• dysuria• incontinence• blurred vision• dry mouth• edema• impotence

Diet:• foods with more than 6mf of tyramine per serving must be avoided• Ex aged cheeses, air dried sausages (pepperoni), fermented soy products (soy and teriyaki sauce),

sauerkraut, and all tap beers• Beer and wines, hearty red wines• yeast extracts, meat tenderizers, beef or chicken liver, cured meats, dried or cured fish• figs , bean pods, raisins, bananas, avocados, sour cream, yogurt, caffeine all this causes

HYPERTENSION

What medications are used for bedwetting?• (Tofranil)/ tricyclic antidepressant: used in children and alcohol or cocaine dependence

Antacids:

Neutralize HCL increase gastric pH Inhibits pepsin a gastric enzyme

Uses:

Peptic ulcers disease Gastritis

Gastric ulcer Peptic esophagitis Hiatal hernia Gastric hyperacidity GERD

Adverse reactions:

Malaise Anorexia Bowel obstruction Diarrhea Frequent burping Thirst Muscle weakness

Teaching:

Take 1hr after meals do not switch to another antacid or take new drugs fluid and fiber intake should be maintained Chew tabs thoroughly before swallowing Shake liquid preps well, and store in cool place for better taste If taking aluminum containing antacid pt diet must contain phosphorus Many pts d/c antacids b/c of the flavor Antacids w/laxative effect should be taken at bedtime to allow adequate rest before bowel is stimulated Fluid intake should be increased and pt who is taking antacids that cause constipation should be monitored These drugs may be alternated w/antacids that have cathartic like actions like those containing magnesium

Contraindications:

CHF PREGNANT HTN EDEMA RENAL FAILURE

Proton-Pump inhibitors:

Irreversibly STOP the acid secretory pump

Medications:

Esomeprazole- Nexium (take 1hr before eating) Lansoprazole- Prevacid (used for H-pylori with ATB) Omeprazole- Losec Pantoprazole- protonix (delayed release used daily for 8 weeks, IV)

Uses:

Short-term Tx of active duodenal ulcers Severe erosive esophagitis GERD

Sal-tropine (atropine sulfate):Classification:

Antiarrhythmic Antispasmodic Antidote Cycloplegic Antisecretory Anticholinergic

Uses:

IBS (irritable bowel syndrome)

Laxatives:

Laxatives have a high rate of overuse and they destroy the body’s natural emptying rhythm when they are used excessively

Overuse of laxatives robs the bowel of its ability to perform on its ownTeaching:

To reduce the potential of chronic laxative use and dependency the pt should be taught nondrug measures like increasing fluid intake 6-8 glasses of water each day

High fiber foods like OJ, FIGS, BANANAS, PRUNES, BRAN BREADS, WHOLE GRAIN CEREALS, GREEN LEAFY VEGGIES, and FRESH FRUITS

Abuse of laxative: OVERUSE OF ANY LAXATIVE CAN LEAD TO ATONIC CONSTIPATION AND CREATE DEPENDANCE ON THE

LAXATIVEChenodiol:

acts on the liver/ increase breakdown of radiolucent cholesterol gallstones

Simethicone:Classification:

antiflatulentUses:

flatulence gastric bloating postop gas pain

Drugs: Mylanta Mylicon

Availability: Suspension Tablets

Teaching: Chew tabs thoroughly before swallowing shake suspension well before using give after meals and at bedtime as needed

Know your 5 major classifications of laxatives and how each workBulk-forming:

absorb water and expand increasing both the bulk moisture content of stool The increased bulk stimulates peristalsis and the absorbed water softens the stool

Uses: simple constipation atonic constipation when the colon loses muscle tone as a result of overuse of other cathartics Postpartum older adult and weakened pts

Treats: diverticulitis and IBS

Fecal softener: soften stool by lowering the surface tension which allows the fecal mass to be softened by intestinal fluids inhibit fluid an electrolyte reabsorption by the intestine Reduce straining at stool such as in pts with hernia, cardiovascular disease, postpartum pts, and after rectal Sx

Hyperosmolar: Produce an osmotic effect on the colon by distending the bowel with fluid accumulation promoting peristalsis and bowel movement

Medications: lactulose and glycerin: Tx. simple constipation

Saline laxative: produce an osmotic effect by drawing water into the intestinal lumen of the small intestine and colon cleanse bowel for exams Hasten evacuation from worms and poison

Lubricant: create barrier between feces and the colon wall that prevents the colon from reabsorbing fecal fluid softening the stool and also eases the passage of feces through the intestine

Uses: To avoid straining in pts with MI, aneurysm, stroke or hernia or after abd or rectal Sx.

Stimulant: increase peristalsis by several mechanisms depending on the agent Primary stimulation of common nerves, stimulation of sensory nerves in the intestinal mucosa direct stimulation of smooth muscle and inhibition of water and electrolyte reabsorption from the intestinal

lumen (castor oil)Uses:

constipation from prolonged bed rest or poor dietary habits or constipation induced by other drugs cleanse the bowel for exams

Antidiarrheal: Reduce fluid content of the stool decrease peristalsis and motility of the intestinal tract Increase smooth muscle tone diminish digestive secretions

Adverse effects: tachycardia dizziness drowsiness fatigue HA Sedation Pruritus abd distention constipation dry mouth urinary retention physical dependence

Contraindications: Should not be used in pts with diarrhea caused by poisoning until the toxin has been removed from the GI tract Should not be used for long term Long periods cause dehydration. Increase fluid intake.

Lactulose/glycerin: Classification:

Hyperosmolar laxativeAction:

Promotes increase peristalsis

Bowel evacuation Decreases serum ammonia concentrations

-may require 24-48 hrs to produce a normal BM-saline laxatives produce result in 2-8hrs, should not be taken at bedtime

Emetics:Uses:

in emergency to induce vomiting acts directly into the vomiting centerMedications:

syrup of IPECACColace (docusate):

Classification: fecal softener

Action: increases infiltration of liquid to form a softer stool

Uses:In pts that need to avoid strainingTeaching:

act within 24-48 hrs to produce a normal BM take it with milk or OJ with the laxative to mask the bitter taste do not use for more than 1 week increase fluid intake & exercise high fiber diet

Pancreatic enzymes: Action:

promote digestions by acting as replacement therapy when the body’s natural pancreatic enzymes are lacking not secreted or not absorbed

They are made from pork pancreasUses:

poor digestion predigestive purposes replacement therapy relieve symptoms of cystic fibrosis, pancreatic CA, or chronic inflammation of the pancreas GI bypass tumor obstructing the pancreatic or common bile duct

Teaching: capsules should be swallowed at meal time Granules should be taken with meals b/c the body will not receive any benefit from them Direct exposure to the powder b/c it produces strong irritation (asthma) balanced diet with fat starch and protein ( prevent indigestion)

Carafate:Classification:

antiulcerUses:

short-term treatment (up to 8 weeks) of duodenal ulcerTeaching:

take meds on empty stomach given in adjunction with antacids (take antacid 30 min before or after sucrafate) relieve dry mouth with sour hard candy and sips of tepid water

Antabuse (DISULFIRAM): Uses:

management of ALCOHOLISM DISULFIRAM reaction:

flushing and warming to face severe throbbing HA SOB

Chest pain N/V/D Sweating Weakness Hyperventilation Tachycardia Syncope Confusion

Severe reactions Dysrhythmias Respiratory distress cardiovascular collapse MI acute CHF convulsions DEATH

Adverse reactions: drowsiness fatigue HA Optic neuritis (impaired vision, decrease color perception, blindness) Psychotic reactions Restlessness Acneiform eruptions Dry mouth Elevation of serum liver enzymes levels Hepatoxicity Metallic-garlic after taste Impotence

. DO NOT USE in patients: myocardial disease coronary occlusion psychosis

EXTREME CAUTION: DM Epilepsy cerebral damage hypothyroidism nephritis hepatic stenosis insulin insufficiency

Teaching: Pt should give permission for medication to be used Reactions may occur 2wks after 1st dose the longer patient takes drug the more sensitive they will be to alcohol

Cat’s claw: IBS Potential interaction with anticoagulants, ASA, NSAIDs and antiplatelet agents

Aspirin: Analgesic/ antipyretic/ anti-inflammatory/anticoagulant

Action: Reduces incidence of MI in men older than 50 Drug of choice in ischemic stroke Reduces inflammatory response Reduces intensity of pain Inhibits platelet aggregation

Uses:

Mild-moderate pain & fever RA Juvenile arthritis Osteoarthritis Rheumatic fever TIAs Cerebral thromboembolism MI Kawasaki’s disease

Contraindications: Hypersensitivity to salicylates &NSAIDs Asthma Rhinitis Nasal polyps Bleeding disorder Children viral infections Pregnancy

Precautions: Platelet/bleeding disorders Renal/hepatic impairment Dehydration Erosive gastritis Peptic ulcer disorders Caution in children (Reyes syndrome)

Teaching: Do not crush or chew enteric coded tablets AVOID alcohol Report tinnitus and abd. pain, bleeding Therapeutic anti-inflammatory effect in 1-3 weeks

NSAIDs: stop production prostaglandins, and inhibit cyclooxygenase inhibit platelet clumping aggregation but it appears to be dose related

Uses: rheumatic diseases DJD OA acute musculoskeletal problems LONGTERM management for arthritis pain from dental extraction minor Sx soft tissue athletic injuries

Teaching: take meds as order take with mil to minimize gastric irritation chronic arthritis (1-2 weeks) maintain meds levels in the body if missed dose, take it as soon as possible do not take ASA or any other anti-inflammatory drug

Osteoarthritis choice of treatment:

TYLENOL

Advil/Motrin:

NSAIDs Antirheumatic Analgesic Antipyretic Antidysmenorrheal

vascular HA

Teaching:

avoid ASA and alcohol take it with food, milk or antacids may cause dizziness avoid tasks that required alertness report tinnitus, resp. difficulty, bruising/bleeding, swelling of extremities, chest pain/palpitations

Uric acid what does it indicate if high/what condition High uric acid levels cause excess uric acid to form crystals usually in the kidneys and joint spaces The result is swelling or increased tissue edema heat inflammation and severe pain the syndrome called GOUT Eating red meats and drinking alcohol will increase chances of getting gout

Gout: is a form of arthritis caused when the body takes too much (overproduction) or does not get rid of (under

excretion) uric acid and may manifest at any jointUric acid:

comes from the metabolism of protein and is present in the blood within very specific range

Allopurinol: effective in reducing uric acid levels in blood no analgesic or anti-inflammatory properties NOT for acute gout

Uses: Prophylactically for repeated or chronic gout increase uric acid levels in renal patients decrease the amount of circulating urate(uric acid) and the deposition of urate promote reabsorption or urate deposits