Drugs : Cardiovascular

CARDIAC GLYCOSIDES:

Digoxin (Lanoxin)

Action : Increases force of myocardial contraction (positive inotropic effect). Decreases rate of conduction (negative chronotropic effect) while increasing refractory period of the AV node. Positive inotropic effect improves blood supply to vital organs and kidneys, providing a diuretic effect. Has a slow onset and shorter duration of action than other cardiac glycosides. Is eliminated through the kidneys. Digoxin elixir is better absorbed by the GIT than digoxin tablets.

Use : CHF, atrial fibrillation; atrial flutter; paroxysmal atrial tachycardia.

A/E : With toxicity there are many symptoms that make it difficult to distinguish from the condition being treated. Arrhythmias, bradycardia: arrhythmias more frequently seen in children; anorexia,nausea, vomiting, diarrhea; headaches, fatigue, confusion, insomnia, convulsions; visual disturbances: blurred vision, green or yellow tint or halos; hypersensitivity. Toxicity occurs more quickly in presence of low serum potassium. Quinidine-digoxin reaction may occur. When digoxin is stabilized in clients receiving quinidine, serum digoxin levels could double, leading to possible toxicity.

Nsg. Implications:

a. Half-life is longer in elderly

b. Monitor CBC, serum electrolytes, liver and renal function tests, and ECG

c. Hold if apical rate is below 60 or greater than 120 beats per min. in adults, below 90/min in infants, or below 70/min in children up to adolescence.

d. Monitor I&O and daily weights; potassium levels. Encourage foods high in potassium.

e. Monitor digoxin levels therapeutic range (0.5-2.0ng/ml).

f. Give after meals if with GI distress.

g. Do not confuse digoxin with digitoxin (Crystodigin) as they are not the same.

h. IM injections are painful and absorption is erratic. Avoid IM injections if possible and give in large muscle mass.

i. Digoxin antidote: Digoxin Immune Fab (Digi-bind)

Discharge Teachings:

a. Take radial pulse and notify physician if toxicity symptoms occur.

b. Take dose the same time each day and do not skip or double up on dose.

c. Avoid high-sodium foods. Increase dietary intake of potassium.

d. Daily weights

e. Separate digoxin from other pills in pillbox.

*take the short quiz below...

1. What is most important for the nurse to teach a mother of a 2 month old child who is on digoxin?

a. Take apical pulse before giving digoxin

b. Take weight daily

c. Provide foods high in potassium

d. Monitor I&O

A - Children and infants are prone to arrhythmias, which are a toxic effect of digoxin. Teaching the mother to take an apical pulse will help to identify if there is a potential for arrhythmias.

2. Which of the following cardiac glycosides is preferred for clients who have renal failure?

a. Digoxin (lanoxin)

b. Digitoxin (Crystodigin)

c. Deslanoside (Cedilanid-D)

d. Amrinone (Inocor)

B - Digitoxin is eliminated and metabolized through the hepatic system and not the kidneys; is considered safer to use in clients with renal failure.

3. A mother asks the nurse which pulse rate indicates a dose of digoxin should be withheld for her 2 month old child. The nurse responds, "Hold the digoxin if the pulse rate is:

a. below 60beats/min

b. below 70beats/min

c. below 90beats/min

d. below 120 beats/min

C - Fewer than 90 beats/min in an infant is a sign of bradycardia, which could indicate digoxin toxicity.

4. The nurse would know that the mother understands teaching about A/E's of digoxin if she said:

a. "I'll call the physician if my child's pulse is below 120beats/min."

b. "If my child develops a rash I'll use A&D ointment."

c. "I will call the physician daily to report my child's weight and daily intake and output."

d. "I will notify the physician if my child vomits or develops diarrhea."

D - Vomiting and diarrhea are A/E's of digoxin therapy and may also be symptoms of digoxin toxicity; should be reported to physician for follow-up.

Drugs : Classifications VIII

PAIN MEDICATIONS
Local Anesthetics
o Benzocaine and Antipyrine (Auralgan)
o Bupivacaine (Marcaine)
o Capsaicin (Capsin, Zostrix)
o Cocaine
o Dibucaine (Nupercainal)
o Lidocaine (Anestacon Topical, Xylocaine)
o Lidocaine (ELA-Max)
o Lidocaine and Prilocaine (EMLA) Pramoxine

Migraine Headache Medications

o Acetaminophen with Butalbital w/wo Caffeine (Fioricet, Medigesic, Repan, Sedapap-10 Two-Dyne, Triapin, Axocet, Phrenilin Forte)
o Almotriptan (Axert)
o Aspirin with Butalbital and Caffeine (Fiorinal with Codeine)
o Eletriptan (Relpax)
o Naratriptan (Amerge)
o Rizatriptan (Maxalu
o Serotonin 5-HT1 Receptor Agonists
o Sumatriptan (Imitrex)
o Zolmitriptan (Zomig)

Narcotics
o Acetaminophen with Codeine (Tylenol No 1,2,3,4)
o Alfentanil (Alfenta)
o Aspirin with Codeine (Empirin No. 2,3,4)
o Buprenorphine (Buprenex)
o Butorphanol (Stadol)
o Codeine
o Dezocine (Dalgan)
o Fentanyl (Sublimaze)
o Fentanyl Transdermal (Duragesic)
o Fentanyl Transmucosal (Actiq, Fentanyl Oralet)
o Hydrocodone and Acetaminophen (Lorcet, Vicodin)
o Hydrocodone and Aspirin (Lortab ASA)
o Hydrocodone and Ibuprofen (Vicoprofen)
o Hydromorphone (Dilaudid)
o Levorphanol (LevoDromoran)
o Meperidine (Demerol)
o Methadone (Dolophine)
o Morphine (Roxanol. Duramorph, MS Contin)
o Nalbuphine (Nubain)
o Oxycodone (OxyContin, OxyIR, Roxicodone)
o Oxycodone and Acetaminophen (Percocet, Tylox)
o Oxycodone and Aspirin (Percodan. PercodanDemi)
o Oxymorphone (Numorphan)
o Pentazocine (Talwin)
o Propoxyphene (Darvon)
o Propoxyphene and Acetaminophen (Darvocet)
o Propoxyphene and Aspirin (Darvon Com pound-65, Darvon-N with Aspirin)
o Sufentanil (Sufenta)

Nonnarcotic Agents
o Acetarninophen [APAP] (Tylenol)
o Aspirin (Bayer, St. Joseph)
o Tramadol (Ultram)
o Trarnadol/Acetaminophen (Ultracet)

Nonsteroidal Antiinflammatory Agents
o Celecoxib (Celebrex)
o Diclofenac (Cataflarn, Voltaren)
o Diflunisal (Dolohid)
o Etodolac (Lodine)
o Fenoprofen (Nalfon)
o Flurbiprofen (Ansaid)
o Ibuprofen (Motrin, Rufen, Advil)
o Indomethacin (Indocin)
o Ketoprofen (Orudis, Oruvail)
o Ketorolac (Toradol)
o Meloxicam (Mobic)
o Nabumetone (Relafen)
o Naproxen (Aleve, Naprosyn. Anaprox)
o Oxaprozin (Daypro)
o Piroxicam (Feldene)
o Rofecoxib (Vioxx)
o Sulindac (Clinoril)
o Tolmetin (Tolectin)
o Valdecoxib (Bextra)

Miscellaneous Pain Medications
o Amitriptyline (Elavil)
o Imipramine (Tofranil)
o Tramadol (Ultrarn)

RESPIRATORY AGENTS
Antitussives, Decongestants and Expectorants
o Acetylcysteine (Mucomyst)
o Benzonatate (Tessalon Perles)
o Codeine
o Dextromethorphan (Mediquell, Benylin DM, PediaCare 1)
o Guaifenesin (Robitussin)
o Guaifenesin and Codeine (Rohitussin AC, Brontex)
o Guaifenesin and Dextromethorphan (Many OTC Brands)
o Hydrocodone and Guaifenesin (Hycotuss Expectorant, others)
o Hydrocodone and Homatropine (Hycodan)
o Hydrocodone and Pseudoephedrine (Entuss-D, Histussin-D, others)
o Hydrocodone, Chlorpheniramine, Phenylephrine, Acetaminophen and Caffeine (Hycomine)
o Potassium Iodide
o Pseudoephedrine(Sudafed, Novafed, Afrinol)

Bronchodilators
o Albuterol (Proventil, Ventolin)
o Albuterol and Ipratropium (Combivent)
o Aminophylline
o Bitolterol (Tornalate)
o Ephedrine
o Ephinedrine (Adrenalin, Sus-Phrine)
o Formoterol (Foradil Aerolizer)
o Isoetharine (generic)
o Isoproterenol (Isuprel)
o Levalbuterol (Xopenex)
o Metaproterenol (Alupent, Metaprel)
o Pirbuterol (Maxair)
o Salmeterol (Serevent)
o Terbutaline (Brethine, Bricanyl)
o Theophylline (Theolair, Somophyllin-CRT)

Respiratory Inhalants
o Acetylcysteine (Mucomyst, Mucosil)
o Beclomethasone (Beconase, Vancenase Nasal Inhaler)
o Beractant (Survanta)
o Budesonide (Pulmicort)
o Calfactan (lnfasurf) Colfosceril Palmitate (Exosurf Neonatal)
o Cromolyn sodium (Intal, Nasalcrom, Opticrom)
o Dexamethasone, Nasal (Dexacort Phosphate Turbinaire)
o Flumisolide (AeroBid, Nasalide)
o Fluticasone, Oral, Nasal(Flonase, Flovent)
o Fluticasone Propionate and Salmeterol Xinafoate (Advair Diskus)
o Ipratropium (Atrovent) Nedocromil (Tilade)
o Triamcinolone (Aristocort, Kenalog)
o Cromolyn sodium (Intal, Nasalcrom, Opticrom)
o Dexamethasone, Nasal (Dexacort Phosphate Turbinaire)
o Flumisolide (AeroBid, Nasalide)
o Fluticasone, Oral, Nasal(Flonase, Flovent)
o Fluticasone Propionate and Salmeterol Xinafoate (Advair Diskus)
o Ipratropium (Atrovent) Nedocromil (Tilade)
o Triamcinolone (Aristocort, Kenalog)

Miscellaneous Respiratory Agents
o Alpha1-Protease Inhibitor (Prolastin)
o Dornase Alfa (Pulmozyme)
o Montelukast (Singulair)
o Omalizumab (Xolair)
o Zafirlukast (Accolate)
o Zileuton (Zyflo)

URINARY/GENITOURINARY AGENTS
o Alprostadil (Caverject, Edex)
o Alprostadil Urethral Suppository (Muse)
o Ammonium Aluminum Sulfate (Alum)
o Belladonna and Opium Suppositories (B & 0 Supprettes)
o Bethanechol (Urecholine, others)
o Dimethyl Sulfoxide [DMSO] (Rimso-50)
o Flavoxate (Urispas)
o Hyoscyamine (Anaspaz,
o Cystospaz, Levsin)
o Methenamine (Hiprex, Urex)
o Nalidixic acid (NegGram)
o Neomycin-Polymyxin Bladder Irrigant [GU Irrigant]
o Nitrofurantoin (Macro dantin, Furadantin, Macrobid)
o Oxybutynin (Ditropan, Ditropan XL, Oxytrol)
o Pentosan polysulfate (Elmiron)
o Phenazopyridine (Pyridium)
o Potassium citrate (Urocit-K)
o Potassium citrate and Citric acid (Polycitra-K) Sildenafil (Viagra)
o Sodium citrate (Bicitra)
o Tadalafil (Cialis)
o Tolterodine (Detrol, Detrol LA)
o Trmethoprim (Trimpex Proloprim)
o Vardenafil (Levitra)

Benign Prostatic Hyperplasia Medications
o Doxazosin (Cardura)
o Dutasteride (Avodart) Propecia)
o Finasteride (Proscar,
o Tamsulosin (Flomax)
o Terazosin (Hytrin)

WOUND CARE
o Becaplermin (Regranex Gel)
o Silver nitrate (Dey-Drop)

MISCELLANEOUS THERAPEUTIC AGENTS
o Drotrecogin alfa (Xigris)
o Megestro Acetate (Megace)
o Metaraminol (Aramine)
o Naltrexone (ReVia)
o Nicotine Gum (Nicorette, Nicorette DS)
o Nicotine Nasal Spray (Nicotrol NS)
o Nicotine Transdermal (Habitrol, Nicoderm, Nicotrol, ProStep)
o Potassium iodide
o Sodium Polystyrene sulfonate (Kayexalate)
o Triethanolamine (Cerumenex)

Drugs : Classifications VII

HEMATOLOGIC AGENTS
Anticoagulants
o Ardeparin (Normitlo)
o Argatroban (Acosa
o Bivalirudin )Angiomax)
o Daltepann (Fragmin)
o Enoxaparin (Lovenox)
o Fondaparinux (Arixtra)
o Heparin
o Lepirudin (Refludan)
o Protamine
o Tinzaparin (Innohep)
o Warfarin (Coumadin)

Antiplatelet Agents
o Abciximab (ReoPro)
o Aspirin (Bayer, St. Joseph)
o Clopidogrel (Plavix)
o Dipyridamole (Persantine)
o Dipyridamole and Aspirin (Aggrenox)
o Eptifibatide (lntegrilin)
o Reteplase (Retavase)
o Ticlopidine (Ticlid)
o Tirofiban (Aggrastat)

Antithrombotic Agents
o Alteplase, Recombinant [TPA] (Activase)
o Aminocaproic acid (Amicar)
o Anistreplase (Eminase)
o Aprotinin (Trasylol)
o Dextran 40 (Rheomacrodex)
o Reteplase (Retavase)
o Streptokinase (Streptase, Kabikinase)
o Tenecteplase (TNKase)
o Urokinase (Abbokinase)

Hematopoietic Stimulants
o Darbepoetin alfa (Aranesp)
o Epoetin Alfa [Erythropoietin, EPO] (Epogen, Procrit)
o Filgrastim [G-CSF1 (Neupogen)
o Oprelvekin (Neumega)
o Pegfilgrastim (Neutasta)
o Sargramostim [GM CSF] (Prokine, Leukine)

Volume Expanders
o Albumin (Albuminar, Buminate, Albutein)
o Dextran 40 (Rheomacrodex)
o Hetastarch (Hespan)
o Plasma Protein Fraction (Plasmanate)

Miscellaneous Hematologic Agents
o Antihemophilic Factor VIII (Monoclate)
o Desmopressin (DDAVP, Stimate)
o Pentoxifylline (Trental)

IMMUNE SYSTEM AGENTS
lmmunomodulators
o Adalimumab (Humira)
o Anakinra (Kineret)
o Etanercept (Enbrel)
o Interferon Alfa (Roferon-A, Intron A)
o Interferon Alfacon-I (Infergen)
o Interferon Beta-1b (Betaseron)
o Interferon Gamma-lb (Actimmune)
o Peg interferon alfa 2b (PEG-Intron)

Immunosuppressive Agents
o Azathioprine (Imuran)
o Basiliximab (Simulect)
o Cyclosporine (Sandimmune. Neoral)
o Daclizumab (Zenapax)
o Lymphocyte Immune Globulin [Antithymocyte Globulin, ATG] (Atgam)
o Muromonab-CD3 (Orthoclone OKT3)
o Mycophenotate Mofetil (CellCept)
o Sirolimus (Rapamune)
o Steroids, Systemic
o Tacrolimus (Prograf, Protopic)

Vaccines/Serums/Toxoids
o CMV Immune Globulin [CMV-IG IV] (CytoGam)
o Diphtheria and Tetanus Toxoids
o Diphtheria Tetanus Toxoids, and Acellular Pertussis Adsorbed
o Diphtheria, Tetanus Toxoids, and Acellular Pertussis Adsorbed, Hepatitis B (recombinant), and Inactivated Poliovirus Vaccine (IPV) Combined (Pediarix)
o Haemophilus B Conjugate Vaccine (ActHIB, HibTITER, Pedvax HIB, Prohibit, Comvax)
o Hepatitis A Vaccine (Havrix, Vaqta)
o Hepatitis A (inactivated) and Hepatitis B Recombinant Vaccine (Twinrix)
o Hepatitis B Immune Globulin (HyperHep, H-BIG)
o Hepatitis B Vaccine (Engerix-B, Recombivax HB)
o Immune Globulin, intravenous (Gamimune N, Sandoglobulin, Gammar IV)
o Influenza (Fluzone, FluShield, Fluvirin)
o Meningococcal Polysaccharide Vaccine (Menomune)
o Pneumococcal Vaccine,
o Polyvalent (Pneumovax-23)
o Pneumococcal 7-Valent Conjugate (Prevnar)
o Tetanus immune Globulin
o Tetanus Toxoid
o Varicella Virus Vaccine (Varivax)


MUSCULOSKELETAL AGENTS
Antigout Agents
o Allopurinol (Zyloprim, Lopurin, Alloprim)
o Colchicine
o Probenecid (Benemid)
o Sulfinpyrazone (Anturane)

Muscle Relaxants
o Baclofen (Lioresal)
o Carisoprodol (Soma)
o Chlorzoxazone (Paraflex, Parafon Forte DSC)
o Cyclohenzaprine (Flexeril)
o Dantrolene (Dantrium)
o Diazepam (Valium)
o Metaxalone (Skelaxin)
o Methocarbamol (Robaxin)
o Orphenadrine (Norflex

Neuromuscular Blockers
o Atracurium (Tracrium)
o Mivacurium (Mivacron)
o Pancuronium (Pavulon)
o Pipecuronium (Arduan)
o Succinylcholine (Anectine, Quelicin, Sucostrin)
o Vecuronium (Norcuron)

Miscellaneous Musculoskeltal Agents
o Edrophonium (Tensilon)
o Leflunomide (Arava)
o Methotrexate (Folex, Rheumatrex)

OB/GYN AGENTS
Contraceptives
o Estradiol Cypionate and Medroxyprogesterone acetate (Lunelle)
o Etonogestrel/Ethinyl Estradiol (NuvaRing)
o Levonorgestrel Implants (Norplant)
o Medroxyprogesterone (Provera, Depo-Provera)
o Norgestrel (Ovrette)
o Norelgestromin and Ethinyl Estradiol, Ortho Evra (Ortho)
o Oral Contraceptives, Monophasic
o Oral Contraceptives, Biphasic
o Oral Contraceptives, Triphasic
o Oral Contraceptives, Progestin Only

Emergency Contraceptives
o Ethinyl Estradiol, Levonorgestrel (Preven)
o Levonorgestrel (Plan B)

Estrogen Supplementation Agents
o Esterified Estrogens (Estratab, Menest)
o Esterified Estrogens with Methyltestosterone (Estratest)
o Estradiol (Estrace)
o Estradiol Transdermal (Estraderm)
o Estrogen, Conjugated (Premarin)
o Estrogen, Conjugated, Synthetic (Cenestin)
o Estrogen, Conjugated with Medroxyprogesterone (Prempro, Premphase)
o Estrogen, Conjugated with Methyl progesterone (Premarin with Methyl Progesterone)
o Estrogen, Conjugated with Methyltestosterone (Premarin with Methyltestosterone)
o Ethinyl Estradiol (Estinyl, Feminone)

Vaginal Preparations
o Amino-Cerv pH 5.5 Cream
o Miconazole (Monistat)
o Nystatin (Mycostatin, Nilstat)
o Terconazole (Terazol 7)
o Tioconazole (Vagi stat)

Miscellaneous Ob/Gyn Agents
o Dinoprostone (Cervidil Vaginal Insert, Prepidil Vaginal Gel)
o Gonadorelin (Lutrepulse)
o Leuprolide (Lupron)
o Magnesium Sulfate
o Medroxyprogesterone (Provera, Depo-Provera)
o Methylergonovine (Methergine)
o Mifepristone [RU486] (Mifeprex)
o Oxytocin (Pitocin)
o Terbutaline (Brethine, Bricanyl)

Drugs : Classifications VI

ENDOCRINE SYSTEM AGENTS
Antidiabetic Agents
o Acarbose (Precose)
o Chiorpropamide (Diabinese)
o Glimepiride (Amaryl)
o Glipizide (Glucotrol)
o Glyburide (DiaBeta, Micronase)
o Glyburide/Metformin (Glucovance)
o Insulins
o Metformin (Glucophage)
o Miglitol (Glyset)
o Nateglinide (Starlix)
o Pioglitazone (Actos)
o Repaglinide (Prandin)
o Rosiglitazone (Avandia) Tolazamide (Tolinase)
o Tolbutamide (Orinase)

Hormone and Synthetic Substitutes
o Calcitonin (Cibacalcin. Miacalcin)
o Catcitriol (Rocaltrol)
o Cortisone
o Desmopressin (DDAVP, Stimate)
o Dexamethasone (Decadron)
o Fludrocortisone acetate (Florinef)
o Glucagon
o Hydrocortisone (Cortef, Solu-Cortef)
o Methylprednisolone (Solu-Medrol)
o Metyrapone (Metopirone)
o Prednisolone (Delta Cortef, others)
o Prednisone (Deltasone, others)
o Vasopressin (Pitressin)

Hypercalcemia Agents
o Etidronate (Didronel)
o Gallium nitrate (Ganite)
o Pamidronate (Aredia)
o Plicamycin (Mithracin)
o Zoledronic acid (Zometa)

Obesity
o Sibutramine (Meridia)

Osteoporosis Agents
o Alendronate (Fosamax)
o Raloxifene (Evista)
o Risedronate (Actonel)
o Teriparatide (Forteo
o Zoledronic acid (Zometa)

Thyroid/Antithyroid
o Levothyroxine (Synthroid)
o Liothyronine (Cytomel)
o Methimazole (Tapazole)
o Potassium iodide (SSKI)
o Propyithiouracit [PTU]

Miscellaneous Endocrine Agents
o Demeclocycline, Declomycin)
o Diazoxide (Hyperstat, Proglycem)
o Metyrosine (Demser)

EYE (OPHTHALMIC) AGENTS
Glaucoma Agents
o Acetazolamide (Diamox)
o Apraclonidine (lopidine)
o Betaxolol (Kerlone) Betagan)
o Brimonidine (Aiphagan)
o Brinzolamide (Azopt)
o Carteolol (Cartrol, Ocupress Ophthalmic)
o Dipivefrin (Propine)
o Dorzolamide (Trusopt)
o Dorzolamide and Timolol (Cosopt)
o Echothiophate Iodine (Phospholine Ophthalmic)
o Latanoprost (Xalatan)
o Levobunolol (A-K Beta,
o Levocabastine (Livostin)
o Lodoxamide (Alomide Ophthalmic)
o Timolol (Blocadren)

Ophthalmic Antibiotics
o Bacitracin (AK-Tracin Ophthalmic)
o Bacitracin and Polymyxin B (AK-Poly-Bac
o Ophthalmic, Polysporin Ophthalmic)
o Bacitracin, Neomycin and Polymyxin B (AK Spore Ophthalmic, Neosporin Ophthalmic)
o Bacitracin, Neomycin, Polymyxin B and Hydrocortisone (AK Spore HC Ophthalmic, Cortisporin Ophthalmic)
o Ciprofloxacin (Ciloxan)
o Erythromycin (Ilotycin Ophthalmic)
o Gentamicin (Garamycin, Genoptic, Gentacidin, Gentak)
o Neomycin and Dexamethasone (AK-Neo- Dex Ophthalmic NeoDecadron Ophthalmic)
o Neomycin, Polymyxin-B and Dexamethasone (Maxitrol)
o Neomycin, Polymyxin-B and Prednisolone (Poly-Pred Ophthalmic)
o Ofloxacin (Ocuflox Ophthalmic
o Silver Nitrate (Dey Drop)
o Sulfacetamide (Bleph-10, Cetamide. Sodium Sulamyd)
o Sulfacetamide and Prednisolone (Blephamide)
o Tobramycin (AKTob, Tobrex)
o Tobramycin and Dexamethasone (TobraDex)
o Trifluridine (Viroptic)

Other Ophthalmic Agents
o Artificial Tears (Tears Naturale)
o Cromolyn (Opticrom)
o Cyclopentolate (Cyclogyl)
o Dexamethasone, Ophthalmic (AK-Dex Ophthalmic, Decadron Ophthalmic)
o Emedastine (Emadine)
o Ketorolac (Acular)
o Ketotifen (Zaditor)
o Lodoxamide (Alomide)
o Naphazoline and Antazoline (Albalon-A Ophthalmic)
o Naphazoline and Pheniramine (Naphcon A)
o Olopatadine (Patanol)

GASTROINTESTINAL AGENTS
Antacids
o Alginic acid (Gaviscon)
o Aluminum carbonate (Basaljel)
o Aluminum hydroxide (Amphojel, AlternaGEL)
o Aluminum hydroxide with Magnesium carbonate (Gaviscon)
o Aluminum hydroxide with Magnesium hydroxide (Maalox)
o Aluminum hydroxide with Magnesium hydroxide and Simethicone (Mylanta, Mylanta II, Maalox Plus)
o Aluminum hydroxide with Magnesium Trisilicate (Gaviscon, Gaviscon-2)
o Calcium carbonate (Tums, Alka-Mints)
o Magaldrate (Riopan, Lowsium)
o Simethicone (Mylicon)

Antidiarrheals
o Bismuth Subsalicylate (Pepto-Bismol)
o Diphenoxylste with Atropine (Lomotil)
o Kaolin/Pectin (Kaodene, Kao-Spen, Kapectolin, Parepectolin)
o Lactobacillus (Lactinex Granules)
o Loperamide (Imodium)
o Octreotide (Sandostatin, Sandostatin LAR)
o Paregoric [Camphorated Tincture of Opium]

Antiemetics
o Aprepitant (Emend)
o Chlorpromazine (Thorazine)
o Dimenhydrinate (Dramamine, others)
o Dolasetron (Anzemet)
o Dronabinol (Marinol)
o Droperidol (Inapsine)
o Granisetron (Kytril)
o Meclizine (Antivert)
o Metoclopramide (Reglan, Octamide)
o Ondansetron (Zofran)
o Palonosetron (Aloxi)
o Prochlorperazine (Compazine)
o Promethazine (Phenergan)
o Scopolamine (Transderm-Scop)
o Thiethylperazine (Torecan)
o Trimethobenzamide (Tigan

Antiulcer Agents
o Cimetidine (Tagamet)
o Esomeprazole (Nexium)
o Famotidine (Pepcid)
o Lansoprazole (Prevacid)
o Nizatidine (Axid)
o Omeprazole (Prilosec)
o Pantoprazole (Protonix)
o Rabeprazole (Aciphex)
o Ranitidine (Zantac)
o Sucralfate (Carafate)

Cathartics/Laxatives
o Bisacodyl (Dulcolax)
o Docusate calcium (Surfak)
o Docusate potassium (Dialose)
o Docusate sodium (Doss, Colace)

Glycerin Suppositories
o Lactulose (Chronulac. Cephula)
o Magnesium citrate
o Magnesium hydroxide (Milk of Magnesia)
o Mineral Oil
o Polyethylene Glycol- Electrolyte Solution (GoLYTLY, CoLyte)
o Psyllium (Metamucil, Serutan, Effer Syllium)
o Sorbitol

Enzymes
o Pancreatin (Creon)
o Pancrelipase [Lipase, Protease. Amylase] (Pancrease, others)

Miscellaneous GI Agents
o Alosetron (Lotronex)
o Balsalazide (Colazal)
o Dexpanthenol (llopan Choline Oral, Ilopan)
o Dibucaine (Nupercainal)
o Dicyclomine (Bentyl)
o Hydrocortisone Rectal (Anusol-HC Suppository, Cortifoam Rectal, Proctocort)
o Hyoscyamine (Anaspaz,Cystospaz, Levsin)
o Hyoscyamine, Atropine, Scopolamine and Phenobarbital (Donnatal)
o Infliximab (Remicade)
o Mesalamine (Rowasa, Asacol, Pentasa)
o Metoclopramide (Reglan, Clopra, Octamide)
o Misoprostol (Cytotec)
o Olsalazine (Dipentum)
o Pramoxine (Anusol Ointment, Procto foam-NS)
o Pramoxine with Hydrocortisone (Enzone, Proctofoam-HC)
o Propantheline (Pro-Banthine)
o Sulfasalazine (Azulfidine)
o Tegaserod maleate (Zelnorm)
o Vasopressin (Pitressin)

Drugs : Classifications V

DERMATOLOGIC AGENTS
o Acitretin (Soriatane)
o Acyclovir (Zovirax)
o Alefacept (Amevive)
o Anthralin (Anthra-Derm)
o Amphotericin B (Fungizone)
o Bacitracin (Baci-IM)
o Bacitracin, Topical (Baciguent)
o Bacitracin and Polymyxin B, Topical (Polysporin)
o Bacitracin, Neomycin and Polymyxin B, Topical (Neosporin Ointment)
o Bacitracin, Neomycin, Polymyxin B and Hydrocortisone, Topical (Cortisporin)
o Bacitracin, Neomycin, Polymyxin B and Lidocaine, Topical (Clomycin)
o Calcipotriene (Dovonex)
o Capsaicin (Capsin, Zostrix)
o Ciclopirox (Loprox)
o Ciprofloxacin (Cipro)
o Clindamycin, Topical (Cleocin-T)
o Clotrimazole and Betamethasone (Lotrisone)
o Dibucaine (Nupercainal)
o Doxepin, Topical(Zonalon)
o Econazole (Spectazole)
o Erythromycin, Topical
o Gentamicin, Topical
o Haloprogin (Halotex)
o Imiquimod (Aldara)
o Isotretinoin [13-cis Retinoic acid] (Accutane)
o Ketoconazole (Nizoral)
o Lactic Acid and Ammonium Hydroxide (Lac-Hydrin)
o Lindane (Kwell)
o Metronidazole (MetroGel)
o Miconazole (Monistat)
o Minoxidil (Loniten, Rogaine)
o Mupirocin (Bactroban)
o Naftifine (Naftin)
o Nystatin (Mycostatin, Nilstat)
o Nystatin and Triamcinolone
o Oxiconazole (Oxistat)
o Penciclovir (Denavir)
o Permethrin (Nix, Elimite)
o Tolnaftate (Tinactin)
o Pimecrolimus (Elidel)
o Pramoxine (Anusol Ointment. Proctofoam-NS)
o Pramoxine and Hydrocortisone (Enzone, Proctofoam-HC)
o Podophyllin (Podocon-25, Condylox Gel05%, Condylox)
o Tretinoin, Topical[Retinoic Acid] (Retin-A, Avita)
o Selenium Sulfide (Exsel Shampoo, Selsun Blue Shampoo, Selsun Shampoo)
o Silver Sulfadiazine (Silvadene)
o Steroids, Topical
o Tacrolimus (Prograf)
o Tazarotene (Tazorac)
o Terbinafine (Lamisil)
o Witch Hazel

DIETARY SUPPLEMENTS
o Calcium acetate (Calphron, Phos-Ex. PhosLo)
o Calcium Glubionate (Neo-Calglucon[OTC])
o Calcium Gluceptate
o Calcium salts [calcium chloride and gluconate
o Cholecalciferol [Vitamin D3] (Delta D)
o Cyanocobalamin[Vitamin B,2}
o Ferric gluconate Complex (Ferrlecit)
o Ferrous gluconate (Fergon)
o Ferrous sulfate
o Folic acid
o Iron Dextran (DexFerrum, InFeD)
o Magnesium Oxide (Mag-Ox 400)
o Magnesium sulfate
o Phytonadione [Vitamin K] (Aqua- MEPHYTON)
o Potassium Supplements Kaon, Kaochlor, K-Lor, Slow-K, Micro-K, Klorvess)
o Pyridoxine [Vitamin B5J
o Sodium bicarbonate [Bicarbonate]Thiamine [Vitamin B1]

EAR (OTIC) AGENTS
o Acetic acid and Aluminum acetate (Otic Domeboro)
o Benzocaine and Antipyrin (Auralgan)
o Ciprofloxacin and Hydrocortisone (Cipro HC Otic)
o Neomycin, Colistin and Hydrocortisone(Cortisporin-TC Otic Drops)
o Neomycin, Colistin, Hydrocortisone and Thonzonium(Cortisporin-TC Otic Suspension)
o Neomycin, Polymyxin and Hydrocortisone (Cortisporin Ophthalmic and Otic)
o Polymyxin B and Hydrocortisone (Otobiotic Otic)Sulfacetamide and Prednisolone (Blephamide)
o Triethanolamine (Cerumenex)

Drugs : Classifications IV

CNS AGENTS

Antianxiety Agents
o Aiprazolam (Xanax)
o Buspirone (BuSpar)
o Chiordiazepoxide (Librium)
o Clorazepate (Tranxene)
o Diazepam (Valium)
o Doxepin (Sinquan, Adapin)
o Hydroxyzine (Atarax, Vistaril)
o Lorazepam (Ativan, others)
o Meprobamate (Equanil, Miltown) Oxazepam (Serax)

Anticonvulsants
o Carbamazepine (Tegretol)
o Clonazepam (Klonopin )
o Diazepam (Valium)
o Ethosuximide (Zarontin )
o Fosphenytoin (Cerebyx)
o Gabapentin (Neurontin )
o Lamotrigine Lumictal
o Levetiracetam (Keppra)
o Lorazepam (Ativan, others)
o Oxcarbazepine (Trileptal)
o Pentobarbital (Nembutal)
o Phenobarbital
o Phenytoin (Dilantin)
o Tiagabine (Gabitril)
o Topiramate (Topamax)
o Valproic acid (Depakene, Depakote)
o Zonisamide (Zonegran)

Antidepressants
o Amitriptyline (E1avil)
o Bupropion (Welibutrin, Zyban)
o Citalopram (Celexa)
o Desipramine (Norpramin)
o Doxepin (Sinequan, Adapin)
o Escitalopram (Lexapro)
o Fluoxetine (Prozac, Sarafem)
o Fluvoxamine (Luvox)
o Imipramine (Tofranil)
o Maprotiline (Ludiomil)
o Mirtazapine (Remeron)
o Nefazodone (Serzone)
o Nortriptyline (Aventyl, Pamelor)Paroxetine (Paxil)
o Phenelzine (Nardil)
o Sertraline (Zoloft)
o Trazodone (Desyrel)
o Trimipramine (Surmontil) Venlafaxine (Effexor)

Antiparkinson Agents
o Amantadine (Symmetrel)
o Benztropine (Cogentin
o Bromocriptine (Parlodel)
o Carbidopa/Levodopa (Sinemet)
o Entacapone (Comtan)
o Pergolide (Permax)
o Pramipexole (Mirapex)
o Procyclidine (Kemadrin)
o Selegiline (Eldepryl)
o Trihexyphenidyl (Artane)

Antipsychotics
o Aripiprazole (Abilify)
o Chiorpromazine (Thorazine)
o Clozapine (Clozaril)
o Fluphenazine (Prolixin, Permitil)
o Haloperidol (Haldol)
o Lithium carbonate(Eskalith)
o Mesoridazine(Serentil)
o Molindone (Moban)
o Olanzapine (Zyprexa)
o Perphenazine (Trilafon)
o Prochiorperazine (Compazine)
o Quetiapine (Seroquel)
o Risperidone (Risperdal)
o Thioridazine (Mellaril)
o Thiothixene (Navane)
o Trifluoperazine (Stelazine)
o Ziprasidone (Geodon)

Sedative Hypnotics
o Chloral hydrate
o Diphenhydramine (Benadryl)
o Zaleplon (Sonata)
o Estazolam (ProSom)
o Flurazepam (Dalmane)
o Hydroxyzine (Atarax, Vistaril)
o Midazolam (Versed)
o Pentobarbital (Nembutal)
o Phenobarbital
o Propofol (Diprivan)
o Quazepam (Doral)
o Secobarbital (Seconal)
o Temazepam (Restoril)
o Triazolam (Halcion)
o Zolpidem (Ambien)

Miscellaneous CNS Agents
o Atomoxetine (Strattera)
o Galantamine (Reminyl)
o Nimodipine (Nimotop)
o Rivastigmine (Exelon)
o Sodium oxybate (Xyrem)
o Tacrine (Cognex)

Drugs : Classifications III

CARDIOVASCULAR AGENTS

Aldosterone Antagonist
o Eplerenone (lnspra)

Alpha 1-Adregenic Blockers
o Alfuzosin (Uroxatral)
o Prazosin (Minipress)
o Terazosin (Hytrin) Doxazosin (Cardura)

Angiotensin-Converting Enzyme Inhibitors
o Benaiepril (Lotensin)
o Captopril (Capoten)
o Enalapril and Enalaprilat (Vasotec)
o Fosinopril (Monopril)
o Lisinopril (Prinivil, Zestril)
o Moexipril (Univasc)
o Perindopril (Aceon)
o Quinapril (Accupril)
o Ramipril (Altace)
o Trandolapril (Mavik)

Angiotensin II Receptor Antagonists
o Candesartan (Atacand)
o Eprosartan (Teveten)
o Irbesartan (Avapro)
o Losartan (Cozaar)
o Olmesartan (Benicar)
o Telmisartan (Micardis)
o Valsartan (Diovan)

Antiarrhythmic Agents
o Adenosine (Adenocard )
o Amiodarone (Cordarone.
o Pacerone) Atropine Propafenone (Rythmol)
o Digoxin (Lanoxin, Lanoxicaps)
o Dofetilide (Tikosyn)
o Esmolol (Brevibloc)
o Flecainide (Tambocor)
o Ibutilide (Corvert)
o Lidocaine (Anestacon Topical, Xylocaine)
o Methoxamine (Vasoxyl)
o Mexiletine (Mexitil)
o Moricizine (Ethmozine)
o Procainamide (Pronestyl, Procan)
o Quinidine
o Sotalol (Betapace, Betapace AF)
o Disopyramide (Norpace, NAPAmide)
o Tocainide (Tonocard)

Beta-Adrenergic Blockers
o Acebutolol (Sectral)
o Atenolol (Tenormin)
o Atenolol and ChlorthaIidone (Tenoretic)
o Betaxolol (Kerlone)
o Bisoprolol (Zebeta)
o Carteolol (Cartrol, Ocupress Ophthalmic)
o Carvedilol (Coreg)
o Labetalol (Trandate, Normodyne)
o Metoprolol (Lopressor, Toprol XL)
o Nadolol (Corgard)
o Penbutolol (Levatol)
o Pindolol (Visken)
o Propranolol (Inderal)
o Timolol (Blocadren)

Calcium Channel Antagonists
o Amlodipine (Norsasc)
o Bepridil (Vascor)
o Diltiazem (Cardizem, Dilacor, Tiazac)
o Felodipine (Plendil)
o Isradipine (DynaCirc)
o Nicardipine (Cardene)
o Nifedipine (Procardia, Procardia XL, Adalat, Adalat CC)
o Nimodipine (Nimotop)
o Nisoldipine (Sular) Verapamil (Calan, Isoptin)

Centrally Acting Antihypertensive Agents
o Clonidine (Catapres)
o Methyldopa (Aldomet)

Diuretics
o Acetazolamide (Diamox)
o AmiIoride (Midamor)
o Burnetanide (Bumex)
o Chlorothiazide (Diuril)
o Chlorthalidone (Hygroton)
o Furosemide (Lasix)
o Hydrochiorothiazide (HydroDIURIL Esidrix)
o Hydrochiorothiazide and Amiloride (Moduretic)
o Hydrochlorothiazide and Spironolactone (Aldactazide)
o Hydrochlorothiazide and Triamterene (Dyazide, Maxzide)
o Indapamide (Lozol)
o Metolazone (Zaroxolyn)
o Mannitol
o Spironolactone(Aldactone)
o Torsemide (Demadex)
o Triamterene (Dyrenium)

Inotropic/Pressor Agents
o Amrinone (Inocor)
o Digoxin (Lanoxin, Lanoxicaps)
o Dobutamine (Dobutrex )
o Dopamine (Intropin)
o Epinephrine (Adrenalin Sus-Phrine)
o Isoproterenol (Isuprel, Medihaler-tso)
o Methoxamine (Vasoxyl)
o Milrinone (Primacor)
o Nesiritide (Natrecor)
o Norepinephrine(Levophed) Phenylephrine (Neo-Synephrine)

Lipid-Lowering Agents
o Atorvastatin (Lipitor)
o Cholestyramine (Questran)
o Colesevelam (Weichol)
o Colestipol (Colestid)
o Ezetimibe (Zetia)
o Fenofibrate (Tricor)
o Fluvastatin (Lescol)
o Gemfibrozil (Lopid)
o Lovastatin (Mevacor)
o Niacin (Nicolar)
o Pravastatin (Pravachol)
o Rosuvastatin (Crestor)
o Simvastatin (Zocor)

Vasodilators
o Alprostadil [Prostaglandin E1] (Prostin VR)
o Epoprostenol (Flolan)
o Fenoldopam (Corlopam)
o Hydralazine (Apresoline)
o Isosorbid Dinitrate (Isordil. Sorbitrate)
o Isosorbide Mononitrate (Ismo. Imdur)
o Minoxidil (Loniten, Rogaine)
o Nitroglycerin (Nitrostat, Nitrolingual, Nitro-Bid Ointment Nitro-Bid IV, Nitrodisc, Transderm-Nitro)
o Nitroprusside (Nipride, Nitropress)
o Tolazoline (Priscotine)
o Treprostinil sodium (Remodulin)

Drugs : Classifications II

Antineoplastic Agents
Alkylating Agents
o Altretamine (Hexalen)
o Busulfan (Myleran)
o Carboplatin (Paraplatin)
o Cisplatin (Platinol AQ)
o Procarbazine (Matulane)
o Triethylene-triphosphamide (Thio-Tepa, TESPA, TSPA)

Nitrogen Mustards
o Chlorambucil (Leukeran)
o Cyclophosphamide (Cytoxan, Neosar)
o Ifosfamide (Ifex, Holoxan)
o Mechlorethamine (Mustargen)
o Melphalan [I-PAM] (Alkeran)

Nitrosoureas
o Carmustine [BCNU] (BiCNU)
o Streptozocin (Zanosar)

Antibiotics
o Bleomycin sulphate (Blenoxane)
o Dactinomycin (Cosmegen)
o Daunorubicin (Daunomycin, Cerubidine)
o Doxorubicin (Adriamycin, Rubex)
o Idarubicin (Idamycin)
o Mitomycin (Mutamycin)
o Pentostatin (Nipent)
o Plicamycin (Mithracin)

Antimetabolites
o Cytarabine [ARA-C] (Cytosar-U)
o Cytarabine Liposomal (DepoCyt)
o Floxuridine (FUDR)
o Fludarabine (Fludara)
o Fluorouracil [5-FUJ] (Adrucil)
o Gemcitabine (Gemzar))
o Mercaptopurine [6-MP] (Purinethol)Methotrexate (Folex, Rheumatrex)6-Thioguanine (Tabloid)

Hormones
o Anastrozole (Anmidex)
o Bicalutamide (Casodex) Estramustine phosphate (Estracyt, Emcyt)
o Fluoxymesterone (Halotestin)
o Flutamide (Eulexin)
o Fulvestrant (Faslodex)
o Goserelin (Zoladex)
o Leuprolide acetate (Lupron, Viadur)
o Levamisole (Ergamisol)
o Megestrol acetate (Megace)
o Nilutamide (Nilandron)
o Tamoxifen acetate (Nolvadex)Triptorelin (Trelstar Depot, Trelstar LA)

Mitotic Inhibitors
o Etoposide ]VP-161 (VePesid)
o Vinblastine (Velban, Velbe)
o Vincristine (Oncovin, Vincasar PFS)
o Vinorelbine (Navelbine)

Miscellaneous Antineoplastic Agents
o Aldesleukin [Interleukin- 2, IL-2] (Proleukin)
o Aminoglutethimide (Cytadren)
o L-Asparaginase (Elspar, Oncaspar)
o BCG (TheraCys, Tice BCG)
o Cladribine (Leustatin)
o Dacarbazine (DTIC)
o Docetaxel (Taxotere)
o Gefitinib (Iressa)
o Hydroxyurea (Hydrea, Droxia)
o Imatinib mesylate (Gleevec)
o Irinotecan (Camptosar)
o Letrozole (Femara)
o Leucovorin (Wellcovorin)
o Mitotane (Lysodren)
o Mitoxantrone (Novantrone)
o Paclitaxel (Taxol)
o Pentostatin (Nipent)
o Rasburicase (Elitek)
o Topotecan (Hycamtin)
o Tretinoin [Retinoic acid] (Vesanoid)

Drugs : Classifications I

Allergy
Antihistamines
o Cetirizine (Zytec)
o Chlorpheniramine (Chlor-Trimeton)
o Chemastine fumarate (Tavist
o Cyproheptadine (Periactin)
o Desloratadine (Clarinex)
o Diphenhydramine (Benadryl)
o Fexofenadine (Allegra)
o Hydroxyzine (Atarax, Vistaril)
o Lorastadine (Claritin)

Miscellaneous Antiallergenic Agents
o Budesonide (Pulmicort)
o Cromolyn (Cromolyn sodium)
o Montelukast (Singulair)

Antidotes
o Acetylcysteine (Mucomyst)
o Amifostine (Ethyol)
o Charcoal (Activated Charcoal, Actidose-Aqua, CharcoAid, Charcodate)
o Dexrazoxane (Zinecard)
o Digoxin Immune FAB (Digibind)
o Flumazenil (Romazicon)
o Ipecac Syrup (OTC Syrup)
o Mesna (Mesnex)
o Naloxone (Narcan)
o Physostigmine (Antilirium, Isopto, Eserine)
o Succimer (Chemet)

Antimicrobial Agents
Antibiotics
Aminoglycosides
o Amikacin (Amikin)
o Gentamicin (Garamycin)
o Neomycin (Mycifradin)
o Streptomycin
o Tobramycin (Nebcin)

Carbapenems
o Entrapenem (Invanz)
o Imipenem-Cilastatin (Primaxin)
o Meropenem (Merrem)

Cephalosporins, First Generation
o Cefadroxil (Duricef)
o Cefazolin (Ancef, Kefzol)
o Cephalexin (Keflex, Keftab)
o Cephalothin (Keflin)
o Cephradine (Velosef)

Cephalosporins, Second Generation
o Cefacior (Ceclor)
o Cefmatozole (Zefazone)
o Cefonicid (Monocid)
o Cefotetan (Cefotan)
o Cefoxitin (Mefoxin)
o Cefprozil (Cefzil)
o Cefuroxime (Ceftin [oral], Zinacef [parenteral])
o Loracarbef (Lorabid)

Cephalosporins, Third Generation
o Cefdinir (Omnicef)
o Cefditoren (Spectracef)
o Cefixme (Suprax)
o Cefoperazone (Cefobid)
o Cefotaxime (Claforan)
o Cefpodoxime (Vantin)
o Ceftazidime (Fortaz, Ceptaz, Tazidime, Tazicef)
o Ceftizoxime (Cefizox)
o Ceftriaxone (Rocephin)

Cephalosporins, Fourth Generation
o Cefepime (Maxipime)

Fluoroquinolones
o Ciprofloxacin (Cipro)
o Gaitfloxacin (Tequin)
o Levofloxacin (Levaquin)
o Lomefloxacin (Maxaquin)
o Moxifloxacin (Avelox)
o Norfloxacin (Noroxin)
o Ofloxacin (Floxin, Ocuflox Ophtalmic)
o Sparfloxacin (Zagam)

Macrolides
o Azithromycin (Zithromax)
o Clarithromycin (Biaxin)
o Dirithromycin (Dynabac)
o Erythromycin (E-Mycin, Ilosone, Erythrocin)
o Erythromycin and Sulfisoxazole (Eryzole, Pediazole)

Penicillins
o Amoxycillin (Amoxil, Polymox)
o Amoxycillin-Clavulanate (Augmentin)
o Ampicillin (Amcill, Omnipen)
o Ampicillin-Sulbactam (Unasyn)
o Dicloxacillin (Dynapen, Dycill)
o Mezlocillin (Mezlin)
o Nafcillin (Nallpen)
o Oxacillin (Bactocill, Prostaphlin)
o Penicillin G Aqueous (Potassium or Sodium) (Pfizerpen, Pentids)
o Penicillin G Benthazine (Bicillin)
o Penicillin G Procaine (Wycillin)
o Penicillin V (Pen-Vee K, Veetids)
o Piperacillin (Pipracil)
o Piperacillin-Tazobactam (Zosyn)
o Ticarcillin (Ticar)
o Ticarcillin-Clavulanate (Timentin)


Tetracyclines
o Doxcycline (Vibramycin)
o Tetracycline (Achromycin V, Sumycin)

Miscellaneous Antibacterial Agents
o Aztreonam (Azactam)
o Clindamycin (Cleocin, Cleocin-T)
o Fosfomycin (Monurol)
o Linezolid (Zyvox)
o Metronidazole (Flagyl, MetroGel)
o Quinupristin-Dalfopristin (Synercid)
o Trimethoprim-Sulfamethoxazole [Co-trimaxozole] (Bactrim, Septra)
o Vancomycin (Vanoccin, Vancoled)

Antifungals
o Amphotericin B (Fungizone)
o Amphotericin B Cholesteryl (Amphotec)
o Amphotericin B Lipid Complex (Abelcet)
o Ampotericin B Liposomal (AmBisome)
o Caspofungin (Cancidas)
o Clotrimazole (Lotrimin, Mycelex)
o Clotrimazole and Betamethasone (Lotrisone)
o Econazole (Spectazole)
o Flucomazole (Diflucam)
o Itraconazole (Sporanox)
o Ketoconazole (Nizoral)
o Miconazole (Monistar)
o Nystatin (Mycostatin)
o Oxiconazole (Oxistat)
o Terbinafine (Lamisil)
o Triamcinolone and Nystatin (Mycolog-II)
o Voriconazole (VFEND)

Antimycobacterials
o Clofazimine (Lamprene)
o Dapsone (Avlosulfon)
o Ethambutol (Myambutol)
o Isoniazid (INH))
o Pyrazinamide Rifabutin (Mycobutin
o Rifampin (Rifadin)
o Rifapentine (Priftin
o Streptomycin

Antiprotozoals
o Nitazoxanide (Alinia)

Antiretrovirals
o Abacavir (Ziagen)
o Amprenavir (Agenerase)
o Atazanavir (Reyataz)
o Bortezomib (Velcade)
o Delavirdine (Re) scriptor)
o Didanosine [ddI]
o Efavirenz (Sustiva)
o Emtricitabine (Emtrivia)
o Enfuvirtide (Fuzeon)
o Indinavir (Crixivan)
o Lamivudine (Epivir, Epivir-HBV)
o Lopinavir/Ritonavir (Kaletra)
o Nelfinavir (Viracept)
o Nevirapine (Viramune)
o Ritonavir (Norvir)
o Saquinavir (Fortovase)
o Stavu dine (Zerit)
o Tenofovir (Viread)
o Zalcitabine (Hivid)
o Zidovudine (Retrovir)
o Zidovudine and Lamivudine (Combivir)

Antivirals
o Acyclovir (Zovirax)
o Adefovir (Hepsera)
o Amantadine (Symmetrel)
o Cidovovir (Famvir)
o Foscarnet (Foscavir)
o Ganciclovir (Cytovene, Vitrasert)
o Interferon Alfa-2b and Ribavirin Combination (Rebetron)
o Oseltamivir (Tamiflu)
o Palivizumab (Synagis)
o Peg interferon alfa 2 a (Pegasys)
o Penciclovir (Denavir)
o Ribavirin (Virazole)
o Rimantadine (Flumadine)
o Valacyclovir (Valtrex)
o Valganciclovir (Valcyte)
o Zanamivir (Relenza)

Miscellaneous Antimicrobial Agents
o Atovaguone (Mepron)
o Atovaquone/Proguanil (Malarone)
o Pentamidine (Pentam 300, NebuPent)
o Trimetrexate (Neutrexin)

Herbal Medicines

Herb : Medicinal Claim

Alfalfa : Source of carotene (vitamin A); contains natural fluoride
Aloe : Healing agent
Basil leaf : Remedy to inhibit vomiting
Bee pollen : Renewal of enzymes, hormones, vitamins, amino acids, and others
Bilberry leaf : Increases night vision, reduces eye fatigue
Black cohosh : Relieves menstrual cramps; same effects as estrogen
Blue cohosh : Regulates menstrual flow; emergency remedy for allergic reactions to bee stings
Butternut bark : Works well for constipation
Capsicum (Cayenne) : Normalizes blood pressure; stops bleeding on contact
Cascara sagrada bark : Remedies for chronic constipation and gallstones
Chamomile flower : Excellent for a nervous stomach; relieves cramping associated with the menstrual cycle
Cranberry : Bladder or kidney infection
Dandelion leaf and root : Detoxify poisons in the liver; beneficial in lowering blood pressure
Echinacea root : Treat strep throat, lymph glands
Eucalyptus leaf : General medicinal
Feverfew herb : Migraines; helps reduce inflammation in arthritis joints
Garlic capsules : “Nature’s antibiotic”
Ginger root : Remedy for sore throat
Ginkgo biloba : Improves blood circulation to the brain
Ginseng root, Siberian : Resistance against stress; slows the aging process
Goldenseal : Treatment of bladder infections, cankers, mouth sores, mucous membranes, and ulcers
Hawthorn : Strengthens and regulates the heart; relieves insomnia
Kava kava root : Induce sleep and help calm nervousness
Licorice root : Mild laxative
Oregano leaf : Settles the stomach after meals, helps treat colds
Rhubarb root : Powerful laxative
Saw palmetto berry : Mucus in the head and nose
Senna leaf : Splendid laxative
St. John’s wort : Correct irregular menstruation; anti-depressant
Thyme leaf : Relief of migraine headaches
Witch hazel bark and leaf : Restores circulation; for stiff joints

Drugs:Endocrine System Questions

1. The nurse is teaching a patient about insulin injections. Which statement is correct?

a. Insulin needs to be shaken well before being drawn up into the syringe

b. Long-acting insulins are clear in color

c. When putting regular and NPH insulin in the same syringe, draw regular insulin up first

d. NPH is compatible with regular and lente insulin

C - Regular insulin should be drawn up before NPH insulin when putting the two together in one syringe.

2. The nurse tells the patient that she can minimize local skin reactions to insulin by:

a. injecting it slowly

b. always refrigerating it

c. giving it in divided doses

d. bringing it to room temperature before administering

D - Insulin should be at room temperature before injecting to decrease occurrence of lipodystrophy.

3. Which statement by the patient indicates a need for further teaching by the nurse?

a. "I will inject my insulin at a 90degrees angle."

b. "I will take more insulin when I go to my exercise class."

c. "I will always have some kind of sugar with me in case I have a hypoglycemic reaction."

d. "I will carefully draw up my doses of insulin."

B - Exercise increases glucose use in the body, so a decreased dose of insulin may be needed.

4. A patient tells the nurse that his brother has Type I diabetes and he takes insulin. The patient asks the nurse why his brother cannot take an oral anti-diabetic agent. The nurse explains that oral anti-diabetic agents are not effective in Type I diabetes because people with this type:

a. have little or no endogenous insulin that can be released

b. are allergic to oral anti-diabetic agents

c. would need so much of an oral anti-diabetic agent that it would be financially prohibitive for them to take one

d. would ahve more episodes of hypoglycemia iwth oral antidiabetic agents

A - Oral antidaibetic agents can only work when the client has endogenous insulin, which is not the case in Type I diabetes.

5. A person should not take tolbutamide (Orinase) if allergic to:

a. penicillin

b. insulin

c. sulfa

d. caffeine

C - Clients who are allergic to sulfa drugs cannot take tolbutamide (Orinase), which is a sulfonylurea.

6. A patient will need more teaching about tolbutamide (Orinase) if he makes the following statement:

a. "I will get a medic alert bracelet that says I'm diabetic taking tolbutamide (Orinase)."

b. "I'm glad I can still have wine with my meals."

c. "If I go outside, I'll stay out of the sun or use sunscreen."

d. "I know that tolbutamide (Orinase) will help control my diabetic condition."

B - Alcohol combined with oral hypoglycemics can trigger a hypoglycemic reaction.

7. Which of the following is the desired response of vasopressin (Pitressin)?

a. lower urine specific gravity

b. lower urine output

c. treat hypotension

d. control polyphagia

B - The goal of vasopressin is to lower urine output; replacement for the ADH hormone.

8. A patient complains of GI distress following administration of vasopressin (Pitressin). The nurse should instruct the patient to:

a. eat crackers after taking the dose

b. take a warm bath to reduce abdominal cramping

c. lie down for 30 minutes following administration

d. drink glass of water with each dose

D - Drinking a glass of water with each dose will decrease GI symptoms.

9. Which statement should be included in a patient's teaching concerning hydrocortisone (Cortisol) therapy?

a. take aspirin to treat fever

b. take hydrocortisone (Cortisol) before meals

c. restrict caffeine and alchol intake

d. restrict potassium intake

C - Hydrocortisone can cause GI distress and even lead to a peptic ulcer with long-term use. Caffeine and alcohol can further increase GI distress and should be restricted.

10. Hydrocortisone (Cortisol) is discontinued gradually to prevent:

a. anaphylaxis

b. diabetic coma

c. adrenal insufficiency

d. cardiovascular collapse

C - Adrenal insufficiency can occur with abrupt removal of corticosteroids. Corticosteroids are gradually discontinued so that the adrenal glands can begin to secrete corticosteroids independently.

11. Before administering levothyroxine (Synthroid) to a patient, the nurse should:

a. check the patient's pulse

b. listen to the patient's chest

c. take the temperature

d. assess the patient's neuro status

A - An adverse effect of levothyroxine is tachycardia; the nurse should check the patient's pulse before administration.

12. A client taking propylthiouracil (PTU) calls the physician's office and complains of chills, fever, and sore throat. Which nursing action is appropriate?

a. Tell the client it sounds like she has the flu and that she should drink lots of fluids, take aspirin, and get extra rest.

b. Tell her to come in immediately for a throat culture and blood work as this may be a serious drug reaction of PTU.

c. Expect the physician to prescribe another thyroid antagonist drug as this is an allergic reaction.

d. Tell the client that these are expected drug reactions and that they will subside in a few days.

B - Symptoms of chills, fever and sore throat while receiving propylthiouracil (PTU) require throat culture and blood work right away.

13. A client calls the gynecology clinic and states she thinks she is pregnant even though she has consistently taken her birth control pills. The nurse tells her to:

a. continue taking the pills and see the physician

b. stop taking the pills and see the physician

c. continue taking the pills and see if menses occurs in the next cycle

d. stop taking the pills for this cycle; wait 28 days and start them again

B - If the client is taking birth control pills and believes she is pregnant, she should stop taking the pills and see the physician.

14. The "minipill" oral contraceptive contains:

a. estrogen

b. progestin

c. estrogen and progestin

d. none of the above

B - The "minipill" oral contraceptive contains only progestin.

15. The nurse sets up a patient's oxytocin (Pitocin) infusion. Which of the following are nursing considerations in caring for clients receiving oxytocin infusions?

a. The nurse should increase the infusion by 23 U/min every 15 minutes until there is a pattern of contractions.

b. Time-tape the solution and use microdrip tubing to monitor the rate.

c. Use an infusion pump and piggyback infusion into primary infusion line.

d. Monitor the client's temperature every 15 minutes.

C - Oxytocin (Pitocin) infusion should be administered on an infusion pump and piggybacked into a primary infusion line to control rate of infusion and to minimize and/or prevent potentially dangerous adverse effects of oxytocin (Pitocin).

16. Which statement concerning methylergonovine (Methergine) is correct? Methylergonovine is given:

a. to induce labor

b. in the first stage of labor

c. after placental delivery

d. IV prophylactically to prevent post-partum hemorrhage

C - Methergine is given after placental delivery because it can cause uterine tetany, and is given IM.

Drugs: ANS Questions

1. A patient is started out on a low dose level of dopamine hydrochloride (Intropin) IV. Which of the following can the nurse expect?

a. A decrease in glomerular filtration rate

b. A decrease in the force of myocardial contractions

c. An increase in urine output

d. An increase in tactile sensation

C - Dopamine at low doses causes dilation of renal and mesenteric arteries, which in turn causes increased urine output.

2. Which nursing action is NOT appropriate for a patient receiving IV Dopamine hydrochloride (Intropin)?

a. The nurse will monitor V/S frequently

b. The nurse will check the IV infusion site frequently for extravasation

c. The nurse will infuse the drug via macrodrip tubing and will adjust the rate manually

d. The nurse will check client extremities for temperature and color

C - Dopamine needs to be infused via a minidrip tubing and attached to an infusion pump for accurate administration.

3. The patient experiences extravasation at the insertion site of dopamine hydrochloride (Intropin) IV. The infusion is stopped. What should be done next?

a. Warm compresses should be applied to the IV site

b. An ice pack should be applied to the IV site

c. The extremity with the IV site should be elevated on two pillows

d. The IV site should be infiltrated with phentolamine (Regitine).

D - If extravasation occurs with dopamine administration, the IV site should be infiltrated with phentolamine (Regitine) immediately after discontinuing the infusion.

4. When high doses of dopamine hydrochloride are given IV for treatment of shock, what effect would the nurse be looking for?

a. Increased BP

b. Decreased HR

c. Increased RR

d. Elevated body temperature

A - High doses of dopamine hydrochloride stimulate alpha-adrenergic activity, which causes increased BP.

5. Which drug produces effects that closely mimic high doses of dopamine hydrochloride (Intropin)?

a. Atropine sulfate

b. Ephedrine

c. Isoproterenol (Isuprel)

d. Norepinephrine (Levophed)

D - Dopamine given in high doses has effects that closely mimic norepinephrine (Levophed)

6. A woman calls the physician's office and states that she has vomited each time she has taken ergotamine tartrate (Ergomar). The nurse's best response is:

a. "Vomiting is a common A/E. Tell the physician so he can prescribe an anti-emetic for you."

b. "Stop taking the drug immediately. Vomiting is a toxic drug effect."

c. "You must be allergic to the drug. Notify the physician."

d. "Vomiting is a transient effect and it will eventually go away."

A - Ergotamine has emetic effects; vomiting is a common side effect. The client needs an antiemetic to help control this problem.

7. Which group of individuals should not receive ergotamine tartrate (Ergomar)?

a. Diabetic clients

b. Asthmatic clients

c. Alcoholic clients

d. Pregnant women

D - Ergotamine has an oxytoxic effect; it is C/I in pregnant women.

8. The nurse should relate all of the following information about ergotamine tartrate to a patient receiving the medication EXCEPT:

a. take the drug as soon as you feel a migraine headache coming on

b. have your blood pressure checked routinely when taking this drug

c. increase the dose as needed to help control your migraines

d. tell the physician if you have any numbness or tingling in your toes and fingers

C - Ergotamine tartrate is a drug that is abused by clients by altering dosage amount. Only the physician should change the dose of the drug.

9. When preparing the drug bethanechol chloride (Urecholine) the nurse knows that:

a. IM or IV is the preferred route

b. bethanecol chloride should be given with food

c. breath sounds should be monitored

d. constipation is a frequent A/E

C - Breath sounds should be monitored to assess for wheezing and bronchospasm.

10. Which drug would be given to treat neostigmine (Prostigmine) overdose?

a. Acetylcholine acetate (Miochol)

b. Atropine sulfate

c. Bethanicol (Urecholine)

d. Lidocaine (Xylocaine)

B - Atropine sulfate, an anti-cholinergic is the antidote for neostigmine (Prostigmine).

11. Which of the following effects of atropine sulfate would the nurse expect a patient having this medication exhibit?

a. Dry mouth

b. Increased bronchial secretions

c. Tachycardia

d. Miosis

A - Atropine sulfate causes dry mouth and decreases secretions, which is why it is given as a pre-anesthetic.

12. Which statement indicates that the client needs more teaching concerning the use of atropine sulfate?

a. "I will brush my teeth and see my dentist regularly."

b. "I will eat low-residue foods to prevent diarrhea."

c. "I will take my medication at least a half hour before meals."

d. "I will stay in my air conditioned house on hot and humid days."

B - Atropine can cause constipation; high-fiber foods and fluids should be encouraged.

13. Which adverse effect would the nurse NOT expect to see with trihexyphenidyl HCl (Artane) therapy?

a. Dizziness

b. Dry mouth

c. Diarrhea

d. Suppression of sweating

C - Artane is an anti-cholinergic that can cause constipation, not diarrhea.

14. A patient has symptoms that are not improving, so the physician starts her on levodopa (Larodopa) as an adjunct with trihexyohenidyl HCl (Artane). Which statement by the patient indicates understanding of proper use of levodopa (Larodopa)?

a. "If symptoms get worse I will stop taking this drug."

b. "I will not eat liver or boxed cereals."

c. "If I have a cold I will take aspirin or a cold remedy."

d. "I will eat eat foods low in residue to prevent diarrhea."

B - Vitamin B6 (pyridoxine) reverses the therapeutic effects of levodopa (Larodopa); clients should restrict their intake of foods high in vitamin B, such as whole-grain cereals, fortified cereals, liver and green vegetables.

15. Which instruction should the nurse give to clients taking bromocriptine (Parlodel)?

a. "Take one hour before meals."

b. "Do not use birth control pills as contraceptives."

c. "This drug causes infertility and use of contraceptives will not be necessary."

d. "Adverse effects will be reduced if taken during the day."

B - Oral contraceptives antagonize the effects of bromocriptine (Parlodel). Another method of birth control should be used.

Drug Salad

ACE INHIBITORS

- It lowers blood pressure by stopping the angiotensin converting enzyme in the lung, which reduces the vasoconstrictor, angiotensin II. In other words, when you are playing cards, you may block the aces so your opponent will not win. This indeed will lower your blood pressure:

How do I remember all of these medications?

It's actually insanely easy!!! Remember they are pills and if you put an R after the P, you have a PRIL; these medications all end in PRIL.

Captopril

Enalapril

Lisinopril

Fosinopril

Ramipril

Benzaepril

What do I need to evaluate?

1. Blood pressure - since these meds reduce vasoconstriction, the pressure may go down too low. Observe for dizziness and/or tachycardia.

2. Some undesirable effects include an annoying dry cough, angioedema of the face, lips, tongue and pharynx. Uncommon side effects include rash & taste disturbances.

3. Monitor for hyponatremia and hyperkalemia

4. With Captopril, agranulocytosis or neutropenia may occur (ask about sore throats).

ALLOPURINOL (ZYLOPRIM)

Allopurinol (Zyloprim) is the DOC to prevent GOUT, decreases uric acid synthesis. Uric acid is the end product of purine metabolism. Condition of hyperurecemia may also occur in individuals receiving chemotherapy (secondaray gout). Meds for an acute attack may include colchicine, indomethacin (Indocin), or naproxen (Naprosyn).

Gout is generally rapid with swelling and a painful joint. Typically the uric acid crystals are in the large toe, but may also involve ankles and knees. During an acute attact, protect the affected joint by immobilizing the joint. Encourage gradual weight reduction. Instruct the client to avoid salicylates. Encourage high fluid intake (>3L/day) to increase excretion of uric acid & to prevent the development of uric acid stones.

Teach clients to avoid foods high in purines such as organ meats, shell fish, and preserved fish (anchovies, sardines) and avoid alcohol. We would like to see the urine output increased to 2 liters per day to help decrease the risk of stones. Clients at risk for stones may be given trisodium citrate for urine alkalinization.

Remember - clients with renal insufficiency should receive a reduced dose of Allopurinol.

G - Gulp 3 liters of fluid per day

O - Organ meats or wines not allowed

U - Urine output increased to 2 liters/day

T - Teach

AMINOPHYLLINE TOXICITY

Aminophylline (bronchodilator) is a wonderful & effective drug that relaxes & expands the bronchi reversing airway obstruction. This drug is commonly used in clients with problems such as: asthma, croup, chronic bronchitis & COPD.

Story: A girl named, Amily Toxicity received too much of this drug. We recommend that you stay out of her way! When she gets too much of this wonder drug, she THROWS UP. Amily has an "A" on her name for "hyperACTIVITY". When the level gets high, Amily starts bouncing off the walls. The "T" is for "TACHYCARDIA". Amily is so active that her heart rate must race (tachycardia) to keep up with her.

The therapeutic range for aminophylline level is 10-20 mcg/ml.

*Keep your eyes open, and your assessments will tell you the story about the effectiveness of this drug. If signs of toxicity occur, report to the provider or check the TBL.

ANTACIDS

Mag has had a history of an ulcer, but feels much better now since antacids coat her stomach lining. She, however, has developed another serious problem with DIARRHEA!!!! This is a major side effect of antacids containing magnesium such as Milk of Magnesia. The diarrhea must get under control or she will need to meet ALKALI, a cousin, which will assist her in correcting the metabolic acidosis which may occur as a complication from the diarrhea. Mag should be monitored for dehydration, hypokalemia, hyponatremia. If Mag were to remain on magnesium oxide for prolonged therapy, the magnesium level should be monitored periodically.

AL is also in the family and is taking an aluminum antacid such as amphogel for his ulcer symptoms. As you can see, Al's problem is constipation. He is so full of it that he can't get rid of it. CONSTIPATION is a major side effect of antacids containing aluminum.

Remember - Teach clients to take antacids one hour after meals and to refrain from taking other oral medications within 1-2 hours of any antacid.

ANTI-ANXIETY

Clients who are anxious may feel like they are going 'BATS". These BATS will assist you in remembering these anti-anxiety drugs:

B - BETA ADRENERGIC BLOCKERS may be used for a rapid heart rate

- BENZODIAZEPINES such as alprayalam (Xanax), chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan) and others decrease anxiety by depressing the limbic and subcortical central nervous system.

A - ANTIHISTAMINES such as hydroxyzine (Atarax) may decrease anxiety if the client is a potential abuser of benzodiazepines.

T - TRICYCLICS and MAO inhibitors may be used for panic attacks.

S - SSRI's may be effective in managing anxiety

ANTI-COAGULANTS

Coumadin and Heparin are used to inhibit thrombus and clot formation. They chip away at the clot to make it smaller. Clotting times will be prolonged which will assist in maintaining the flow or "stream of blood."

The key to successfully remembering the lab reports and antidotes for the appropriate anticoagulants are to think of (H) looking like 2 tt's in Heparin. The lab report necessary to evaluate while clients are on heparin is Ptt. The antidote has also 2 t's in it (protamine sulfate).

Coumadin's antidote is vitamin K. C and K sound alike which help with association. The lab report which needs to be monitored is Pt.

Labs now report INR (international normalized ratio) values. The range for most clients on anticoagulants is 2-3. The exceptions are mechanical heart valves and recurrent thromboembolism clients who should be anticoagulated to an INR of 3-4.5.

ANTICHOLINERGICS

The major side effects of these medications are easily seen below. Some examples of these medications include: Atropine, Methantheline (Banthine), and Dicyclomine hydrochloride (Bentyl). Of course, these drugs are given because of the desirable effects of decreasing salivation, lacrimation, urination, diarrhea and GI motility. Blurred vision and dilated pupils are also side effects. It's when we get too much that we get in trouble.

4 CAN'Ts: (Side Effects)

CAN'T PEE

CAN'T SEE

CAN'T SPIT

CAN'T SHIT

Remember - These meds are contraindicated in closed an open angle glaucoma, prostatic hypertrophy and obstructive bowel disease.

BETA-BLOCKERS

Beta blockers are a group of drugs that can be remembered using the acronym BETA. People taking these drugs may need TLC.

B - BRONCHOSPASM (so we don't want to give them to people with asthma or bronchoconstrictive disease!).

E - ELICITS A DECREASE IN CARDIAC OUTPUT AND CONTRACTILITY

T - TREATS HYPERTENSION

A - AV CONDUCTION DECREASES (short for treats arrhythmias, especially fast ones by decreasing the heart rate and cardiac output!)

REMEMBER STOP BETA-BLOCKERS WITH BRONCHOCONSTRICTIVE DISEASES.

T - TENORMIN (atenolol) used for hypertension and angina (watch for renal impairment as this drug is renally excreted)

L - LOPRESSOR (metoptolol) used for hypertension and angina (C/I in sinus bradycardia, 2nd or 3rd degree block, metabolized in liver and NOT renally excreted).

C - CORGARD (nadolol) used for hypertension and angina ( renally excreted, C/I in bronchial asthma, sinus bradycardia or 2nd or 3rd degree heart block).

CALCIUM CHANNEL BLOCKERS

This group of medications are often called "Don't Give a Flip Pills" by the clients who take them because that's exactly how they feel. Their blood pressure is lowered (calcium influx blocked), pulse is decreased, and if they move too quickly they get dizzy. They are much happier being a couch potato and taking life easy. A few examples of the calcium channel blockers include Cardizem, Cardene, Procardia and Calan. Each of these common Calcium Channel Blockers have a Ca in them which makes it easy to remember! These medications should be administered with meals and milk. Some general undesirable effects of these medications include constipation, bradycardia, peripheral edema, hypotension, dizziness, heart blocks, and worsening of CHF.

Remember - Calcium Channel blockers should not be given in clients who are in CHF or cardiogenic shock because they can decrease the heart rate too much.

LOOP DIURETICS

Lou la Bell has been given a loop diuretic such as Lasix or Ethacrynate Sodium and is very dizzy. Her blood pressure has decreased too much after her excessive peeing. You would also feel as if you were spinning in a tube over the falls if you lost this much urine (volume). It may be very useful to teach her to get up slowly so she won't fall.

The life guard must blow his whistle in order to get her some assistance. She feels that the ringing in her ears just won't go away. Dizziness and ringing in the ears are major adverse effects from loop diuretics.

A few other adverse reactions include : hypokalemia, hypocalcemia (tetany), hyperglycemia, and hyperurecemia. While aplastic anemia and agranulocytosis may occur, they are RARE!

Remember - Keep a close watch on blood pressure, potassium and calcium levels. Teach foods high in potassium and calcium. Potassium supplements may be necessary.

DILANTIN (DIAL AT TEN)

Dilane has a seizure and is taking the drug dilatin. She does not feel well and is calling the nurse at 10:00am. Her therapeutic level for Dilantin should be 10-20mcg/ml (EASY TO REMEMBER. THERE IS A TIN (TEN) IN DILANTIN). Her adverse reactions from this medication include gingival hyperplasia, GI disturbances, hepatotoxicity, ataxia, hypocalcemia, & decrease in absorption of Vit. D (milk and sunshine will help this problem).

If Dilane's level becomes toxic, be sure to inform the provider. The drug will likely be decreased.

Remember - Teach good oral hygiene and nutrition.

NSAIDs

NSAIDs are a group of medications that prevent prostaglandin synthesis.

What does it mean? Prostaglandins contribute to the following: inflammation, body temperature, pain transmission, platelet aggregation and other actions. These prostaglandins are not stored, but are released on demand.

What type of physical problems may benefit from NSAIDs? Fever and inflammation (ie. arthritis) can be reduced by these medications.

Are there any undersirable effects from NSAIDs? There are several undesirable effects that the nurse mus assess and educate clients to report. These include GI upset or bleeding, ototoxicity (ringing of the ears), hepatic necrosis, or nephritis.

As a nurse, what should be included in the plan of care?

1. Administer medications with food to decrease GI irritation.

2. Teach clients about actions and side effects and report any dark, tarry stools, "coffee ground or bloody emesis", other GI distress or ringing of the ears.

3. Instruct client to inform health care providers about these medications prior to any dental or otehr type of surgery. NSAIDs should be discontinued approximately 5-7 days before the procedure to prevent any complications of bleeding.

4. NSAIDS are not the drugs of choice if the client has any compromise in either the renal or the liver.

5. Evaluate the effectiveness of the NSAIDs.

PITOCIN

Pitty Pitocin, this pregnant woman, is slow to begin active labor, so the Doc decides to induce by using PITOCIN. Watch for those major side effects!

Visualize Pitty sitting in a row boat looking into a PIT watching the "TETANIC" sink into the ocean" (OCIN). Complications of this drug are TETANIC CONTRACTIONS. Pitocin of course is a stimulant; so as Pitty watches the ship sink, her PRESSURE elevates! Just as a sinking ship takes in all that salty WATER, poor Pitty is left holding the excess fluid in her body (observe I & O). She gets so nervous with all this happening that she goes into CARDIAC ARRHYTHMIAS causing Pitty's baby OXYGEN hunger and FETAL HEART IRREGULARITIES. This is so upsetting to Pitty that she gets NAUSEATED and VOMITS all over the row boat.

STOP THAT PITOCIN DRIP!!!!

TYLENOL (ACETAMINOPHEN OVERDOSE)

A major undesirable effect of tylenol overdose is hepatic necrosis. It is like we have taken a hammer and beaten "the hell out of the liver". The dose of tylenol should not exceed 4g/day. Other side effects are negligible with recommended dosage. With acute poisoning, the following adverse effects may occur: anorexia, nausea and vomiting, epigastric or abdominal pain, HEPATOTOXICITY, hypoglycemia, and hepatic coma.

Tylenol (Acetaminophen) is a very useful drug for pain and fever. (Refer to Poison Control for more specific plans).

Remember - Do not administer to clients with liver disease.