Classification Proton Pump Inhibitors pantoprazole

Indications Gastritis Short term GERD Confirmed gastric or duodenal ulcers Erosive esophagitis Adverse Effects Generally well tolerated Concerns over long term use gastric tumors observed in animals Omeprazaole has some drug interactions

Contraindications Known drug allergy

Mechanism of Action Drugs bind to and inhibit the proton pump that secretes HCl into the stomach leads to a reduction in gastric acid secretion

Nursing Considerations Caution should be used with patients with a history of liver disease as this may prolong drug t1/2 Patients taking both a PPI and H2 antagonist must take them far apart Long term use of PPI and H2 antagonists results in reduced vit B12 levels Drugs must be taken 30 min before large meal

Classification acetaminophen Nonopioid analgesic (Pain medication for mild to moderate pain), antipyretic (prevent or reduce fever). PO/RECT 325-650 mg q46hr prn, max 4g/day.

Indications Mild to moderate pain or fever, arthralgia (pain in a joint), dental pain, dysmenorrhea (painful menstruation or abdominal cramps), headache, myalgia (pain in a muscle), osteoarthritis. Adverse Effects drowsiness, nausea, vomiting, abdominal pain, GI bleeding, seizure, renal failure, leukopenia, rash, hypersensitivity, cyanosis, jaundice, coma, death, CNS stimulation, delirium followed by vascular collapse.

Contraindications Hypersenstivity, intolerance to tartrazine, alcohol, table sugar, saccharin, depending on product.

Mechanism of Action May block pain impulses peripherally that occur in response to inhibition of prostaglandin synthesis; does not possess anti-inflammatory properties; antipyretic action results from inhibition of prostaglandins in the CNS.

Nursing Considerations Assess health status and alcohol usage before administering. Assess for pain (type and location), use pain scale. Allergic reactions like rash, if it occurs product may have to discontinued. Decreasing output may indicate renal failure.

Classification Laxative , emollient; stool softener.docusate sodium Brand name: Colace PO 50-300mg/day ENEMA 4ml Mechanism of Action Increases water, fat penetration in intestine; allows for easier passage to stool.

Indications Prevention of dry or hard stools.

Contraindications Hypersensitivity, obstruction, fecal impaction, nausea/vomiting

Adverse Effects Bitter taste throat irritation, nausea, anorexia, cramps, diarrhea, rash.

Nursing Considerations Assess the cause of constipation. Cramping, rectal bleeding, nausea, vomiting; if these symptoms occur, product should be discontinued. Tell patient not to break, crush or chew tab only swallow. Oral sol can be diluted in milk or fruit juice to decrease bitter taste. Inform patient that product may take up to three days to soften stools. Teach patient to increase fluid intake unless on fluid restrictions. Teach patient to notify any imbalance occur;

Classification

Indications

Contraindications
Allergy, Hypoglycemia, Some antacids, Iodine containing contrast mediums.

Type2 dibetes mellitus Antidiabetic, oral. Metformin Brand name: Glucophage, Fortamet PO 500mg bid

Mechanism of Action Acts by decreasing the hepatic production of glucose (gluconeogenesis). Helps to decrease intestinal absorption of glucose. Helps to improve insulin receptor sensitivity. Does not increase insulin secretion, thus does not cause hypoglycemia.

Adverse Effects
Diarrhea, Nausea, Metallic taste in mouth, Anorexia

Nursing Considerations
Must be taken with meals. Must stop medication 48 hours prior to iodine radiological studies

Classification

Indications

Contraindications

Water soluble vitamin vitamin B12

PO/IM

Folic Acid Deficiency Pernicious Anemia Pregnancy

Antacids Peptic ulcer disease Inflammatory intestinal disorders Anemia other than folic acid deficiency or pernicious anemia
Nursing Considerations
Client education related to goals of therapy Vitamin B12 must be prepared in an IM route for patients with pernicious anemia (they lack an intrinsic factor from the gastric parietal cells which permits oral absorption) Should not exceed recommended daily amounts; many vitamins are available in flavors and shapes that appeal to children and often treated as candy Vitamin B12 is often low r/t 10-30% absorbed in food

Mechanism of Action Aids in the production of DNA and RNA Essential for erythropoiesis

Adverse Effects Rash Diarrhea Discoloration of urine

Classification Fluoroquinolones ciprofloxacin (Cipro) levofloxacin (Levaquin) moxifloxacin (Avelox)

Indications Pyelonephritis Urinary Tract Infection Pneumonia GI infections

Contraindications Liver disease Kidney disease Warfarin use (increases serum concentration) Not to be used in children under the age of 18 (safety has not been established)

Gram-negative bacteria Gram-positive bacteria

PO/IV

Mechanism of Action Inhibition of bacterial enzymesstops DNA synthesis in the cell

Adverse Effects N/V/D Photosensitivity Tendon injury (tendonitis r/t apoptosis and decreased collagen synthesis in a tendon)

Nursing Considerations
Clients must complete full course of treatment Encourage fluids to produce a urine output of 1,2001,500mL/day to avoid crystalluria (drug crystals in the urine) Avoid exposure to sunlight

Classification Calcium Channel Blockers diltiazem hydrochloride (Cardizem CD) amlodipine (Norvasc) nifedipine (Adalat) verapamil (Isoptin) PO/IV Mechanism of Action Dilates and relaxes arterial muscle, decreases blood pressure and heart rate, thus decreasing cardiac workload

Indications Angina Pectoris Hypertension Atrial Fibrillation Atherosclerosis Tachycardia

Contraindications Allergy Digoxin use (increases serum digoxin levels) -blocker use (additive effects to both medications)

Adverse Effects Hypotension Bradycardia Nausea Headache Dizziness

Nursing Considerations Thorough cardiovascular assessment is required prior to administration immediate release forms have a very short duration and require frequent administration

Classification Loop Diuretics furosemide (Lasix)

Indications Congestive Heart Failure Mitral Regurgitation Hypertension

Contraindications Steroids (may lead to hypokalemia) Digoxin (may lead to hypokalemia) Anuria Kidney failure

PO/IV

Mechanism of Action
Acts on loop of Henle to block chloride and sodium re-absorption (reduces fluid volume and removes fluid from the body) Help to decrease preload and central venous pressures

Adverse Effects
Dizziness N/V/D Tinnitus Headache Hypokalemia Hyperglycemia Muscle cramping Dehydration Urinary frequency

Nursing Considerations
Thorough cardiovascular assessment is required prior to administration Monitor potassium levels Monitor glucose levels Instruct client to decrease diet of sodium-rich foods Client should report a weight loss of more than 2 lb/week Serum electrolytes should be closely monitored r/t frequent changes in kidney function Tinnitus can be avoided by dividing oral doses Greater risk for hypotension and excessive diuresis

Classification Angiotensin-Converting Enzyme (ACE) Inhibitors

Indications

Contraindications Allergy Hyperkalemia Renal Failure

Congestive Heart Failure Atrial Fibrillation Tachycardia ramipril (Altace) Mitral Regurgitation enalapril sodium (Vasotec) Hypertension perindopril erbumine (Coversyl) PO/IV Mechanism of Action Adverse Effects

Nursing Considerations
Thorough cardiovascular assessment is required prior to administration Used in children > 6 years of age Use with caution in adolescent girls who are sexually active (may cause birth defects) High plasma concentrations are common r/t decreased renal function

Inhibits angiotensinconverting enzyme angiotensin I angiotensin II vasoconstriction aldosterone secretion sodium and water reabsorption

Headache Dizziness Orthostatic hypotension Dry cough Hypotension Hyperkalemia

Classification

Indications
Asthma Inflammatory Bowel Disease Rhinitis Pruritis Chronic Obstructive Pulmonary Disease

Contraindications
Allergy Cataracts Glaucoma Peptic ulcer disease Psychiatric problems Systemic infections

Corticosteroids
fluticasone (Flovent) PO/IV/IM/TOPICAL/INH

Mechanism of Action Adverse Effects

Gonadocorticoids: (androgens) contribute to onset of puberty Mineralocorticoids: recall function of aldosterone Glucocorticoids: (cortisol) 1. Increase blood glucose by inhibiting insulin secretion and promoting gluconeogenesis 2. Breakdown lipids and proteins 3. Suppress the inflammatory response 4. Influence CNS to affect mood Impaired wound healing Masking of infections Hypokalemia Peptic ulcers Edema Sodium/fluid retention Nausea Anxiety Weight gain Heart failure Increased intraocular pressure Fragile skin Candidiasis (inhaler use)

Nursing Considerations
Careful monitoring for adverse effects Long-term use may cause osteoporosis (decrease absorption & increase excretion of calcium) Long-term use may cause Cushings disease/syndrome Oral glucocorticoids should be given in the morning to decrease amount of adrenal suppression Oral glucocorticoids should be given with milk or food to decrease GI upset Growth retardation is possible. Thus, smaller doses should be considered and accurate weekly height and weight must be documented Corticosteroids often aggravate other conditions (i.e. hypertension, CHF, diabetes, infection)

Classification Beta-adrenergic Agonist (2Agonist) salmeterol (Serevent)

Indications Asthma Bronchitis COPD

Contraindications Allergy Cardiac dysrhythmia Hypertension (medications cause vasoconstriction) Under the age of 6 is limited Beta-blocker use (inhibits bronchodilation)

Bronchodilator PO/INH

Mechanism of Action Dilates airways by stimulating 2-adrenergic receptors in lung tissue (bronchodilation)

Adverse Effects Tachycardia Insomnia Tremors Hyperglycemia

Nursing Considerations
Cardiac and respiratory assessments Hold breath for 5-10 seconds post inhalation Use a spacer or Aero chamber for administration Wait 2 minutes between inhalations Rinse mouth after inhalation

Classification

Indications
Bronchospasm in COPD Chronic bronchitis emphysema

Contraindications
Hypersensitivity pregnancy

Tiotropium bromide
Spiriva Anticholinergic bronchodilator INH cap-18 mcg Mechanism of Action

Adverse Effects
Depression Paresthesia angina pectoris Edema Chest pain Dry mouth abd pain UTI Dyspepsia GERD

Nursing Considerations
Use drug for maintainance of COPD, not for acute bronchospasm. Watch for any hypersenstivity.

Competitive ,reversible inhabitation of muscarinic receptors leads to bronchodilation.

Classification

Indications
Hypercholestremia Hyperlipidemia

Contraindications
Hypersenstivity pregnancy

Simvastin
Antilipidemic PO 5-40 mg daily

Mechanism of Action

Adverse Effects
Headache N/D Constipation abd pain

Nursing Considerations

Inhibits HMG-COA reductase enzyme, which reduces cholesterol synthesis.

Classification Escitalopram cipralex

Antidepressant PO 10 mg daily

Indications
General anxiety disorder Major depressive disorder

Contraindications

Mechanism of Action

Adverse Effects
Headache Nervousness Insomnia Drowsiness Dizziness Fatigue Seizures Delusion Hallucinations

Nursing Considerations

Inhibits CNS neuron uptake of secretion but not of norepinephrine.

Classification

Indications
Short term treatment of constipation Bowel or rectal preparation for surgery

Contraindications
Hypersenstivity Rectal fissures Abd pain N/V Pregnancy

Bisocodyl
Laxative PO 10-15 mg

Mechanism of Action

Adverse Effects
Muscle weakness N/V/D Anorexia Cramps Rectal burning Hypokalemia Tetany

Nursing Considerations
Blood, urine electrolyte is produced if used too often I & O to identify fluid loss Cramping, rectal bleeding, or N/V happens often discontinue the medication.

Acts directly on intestine by increasing motor activity, though to irritate colonic intramural plexus.

Classification Antigout
Zyloprim PO 100-300 mg tabs

Indications
Gout or hyperuricemia Malignancies Uric acid nephropathy

Contraindications
Hypersentivity Kidney stones Blood dyscrasias Peptic ulcers Renal impairment Sulfa allergy

Mechanism of Action

Adverse Effects
Fever, leukopenia Drowsiness Hypersenstivity Peripheral neuropathy Epistaxis N/V/D Myopathy Chills Renal failure Agranucytosis Thrombocytopenia Aplastic anemia

Nursing Considerations
Monitor uric acid level to evaluate effectiveness Monitor I& O Monitor CBC , hepatic and renal functions.

Reduces uric acid production by inhibiting xanthine oxidase.