Nu 104 week 3 discussion cns, endocrine, and respiratory medications

CNS Medications Analgesic Drugs 

Opiods o 3 classes  Meperidine-like drugs  Methadone-like drugs  Morphine-like drugs o Mechanism of Action  Agonist – binds to an opioid pain receptor in the brain and causes an analgesic – response – the reduction of pain sensation.  Agonist-Antagonist - (partial agonist or mixed agonist) binds to a pain receptor and causes a weaker pain response than does a full agonist.  Antagonist – binds to a pain receptor but does not reduce pain signals. It functions as a competitive antagonist because it competes with and reverses the effects of agonist and agonist-antagonist drugs at the receptor sites. o Side Effects **Important to Know** – CNS depression (most serious), hypotension, flushing, bradycardia, sedation, disorientation, euphoria, lightheadedness, dysphoria, N & V, constipation, biliary tract spasm, urinary retention, itching, rash, wheal formation, respiratory depression and possible aggravation of asthma. o Contraindications – allergy, head injury, respiratory problems (severe asthma), morbid obesity, sleep apnea, myasthenia gravis, paralytic ileus and pregnancy. o Route/s of Administration – P.O., IV, IM, SC o Common Drugs  codeine sulfate  meperidine HCl (Demerol)  methadone HCl (Dolophine)  morphine sulfate  propoxyphene HCl  hydromorphone  oxycodone Page 1 of 25



 fentanyl  others Non-opioid and Miscellaneous Analgesics o Mechanism of Action – Blocks peripheral pain impulses by inhibiting prostaglandin synthesis. o Side Effects – rash, N & V. o Contraindications – drug allergy, severe liver disease, and genetic disease known as G6PD deficiency. o Route/s of Administration – P.O., PR o Common Drugs  acetaminophen  tramadol  transdermal lidocaine

General and Local Anesthetics 

General Anesthetics o Mechanism of Action – progressive reduction of sensory and motor CNS functions. o Side Effects – Dose dependent, myocardial depression is common.

Hepatotoxicity, and methoxyflurane can cause significant respiratory depression. o Contraindications – drug allergy, pregnancy, narrow-angle glaucoma, and known susceptibility to malignant hyperthermia (increase temp, muscle rigidity, tachycardia) from prior experience w/anesthetics. o Route/s of Administration – PR, Inhalation, IV, IM o Common Drugs  isoflurane  sevoflurane  ketamine  nitrous oxide – only inhaled  propofol  Drugs for Moderate Sedation (Conscious Anesthesia) o Mechanism of Action – does not cause complete loss of consciousness and does not normally cause respiratory arrest. Allows the patient to relax and have markedly reduced or no anxiety, yet still maintain his or her own open airway, and respond to verbal commands. o Side Effects – Mild amnesia (which is desired). o Pediatric Discharge Considerations **Know**  Based on whether the following criteria are met:  A & O compared w/baseline neurologic assessment  Protective swallowing and gag reflexes are intact.

Page 2 of 25





VS are stable and consistent w/baseline values for at least 30 minutes after last dosing.  SpO2 is at least 95% on room air 30 minutes after the last dose.  Pain rating is at baseline levels or less.  Ambulation is at baseline level  Adult is present to get the patient home and remain w/patient for at least two half-lives of the various drugs used for the anesthesia.  If a reversal drug was administered, there has been time for the drug to be excreted. o Route/s of Administration – PO, IV o Common Drugs  Benzodiazepine, usually midazolam w/an opioid, usually fentanyl or morphine. Propofol is also a common agent used.

Local Anesthetics o Central  Spinal  Intrathecal  Epidural  Peripheral  Infiltration  Nerve Block  Topical o Mechanism of Action – work by rendering a specific portion of the body insensitive to pain by interfering w/nerve transmission. o Side Effects – Limited, and of little clinical importance in most cases. Spinal headache. o Contraindications - allergy o Route/s of Administration – PR, Topical o Common Drugs  Benzocaine  Cocaine  Chloroprocaine  Procaine  Proparacaine  Propoxycaine  Tetracaine

Page 3 of 25



Neuromuscular Blocking Drugs (can still hear everything, must use pain medicine or anxiety medicine w/these) o Depolarizing  Mechanism of Action – Works similarly to the neurotransmitter acetylcholine (ACh). They bind in place of ACh to cholinergic receptors at the motor endplates of muscle nerves or neuromuscular junctions. o Non-depolarizing  Mechanism of Action – also bind to ACh receptors at the neuromuscular junction, but instead of mimicking ACh, they block its actions. Are competitive antagonists of ACh. o Side Effects – muscle damage, elevated potassium, muscle pain w/depolarizing, hypotension w/non-deploraizing. o Contraindications – allergy, previous hx of malignant hyperthermia, penetrating eye injuries, and narrow-angle glaucoma. o Route/s of Administration – IV, IM o Common Drugs  Short-acting  mivacurium  Intermediate-acting  atracurium  rocuronium  vecuronium – most common in ICU on ventilator  Long-acting  doxacurium  pancuronium – most common in ICU on ventilator  tubocurarine

CNS Depressants and Muscle Relaxants 

Benzodiazepines and Miscellaneous Hypnotic Drugs (HINT: ends in pam) o Mechanism of Action – depress CNS. Sedative effect. Affect the thalamus, hypothalamus, and the limbic systems of the brain. o Side Effects – headache, drowsiness, paradoxical excitement, nervousness, dizziness or vertigo, cognitive impairment, and lethargy. o Contraindications – allergy, narrow-angle glaucoma, and pregnancy. o Route/s of Administration – PO, IV, IM o Common Drugs  Benzodiazepines  Long-acting

Page 4 of 25





o clonazepam (Klonopin), diazepam (Valium), flurazepam (Dalmane)  Intermediate-acting o alprazolam (Xanax), lorazepam (Ativan), temazepam (Restoril)  Short-acting o eszoplicone (Lunesta), midazolam (Versed), ramelteon (Rozerem), triazolam (Halcion), zalepion (Sonata), zolpidem (Ambien) Barbiturates  Mechanism of Action – CNS depressant that act primarily on the brainstem in an area called the reticular formation. Act by reducing the nerve impulses traveling to the area of the brain called the cerebral cortex. Inhibit nerve impulse transmission.  Side Effects – CNS, drowsiness, lethargy, dizziness, hangover, and paradoxical restlessness or excitement. Long term on normal sleep architecture can be detrimental. Deprive people of REM sleep. Can result in agitation and an inability to deal w/normal daily stress. Rebound phenomenon can occur when barbiturate is stopped and REM sleep once again takes place. Nightmares can often ensue.  Contraindications – allergy, pregnancy, significant respiratory difficulties, and severe kidney or liver disease. Use w/caution in elderly patients.  Route/s of Administration – IV, IM, PO, PR  Common Drugs o Ultra short-acting  mephohexital, thiopental o Short-acting  Pentobarbital (Nembutal), secobarbital (Seconal) o Intermediate-acting  Butabarbital (Butisol) o Long-acting  Phenobarbital (Luminal), mephobarbital (Mebaral) Muscle Relaxants  Mechanism of Action – works within the CNS. Dantroline directly affects skeletal muscles by decreasing the response of the muscle to stimuli. Exerts its action by decreasing the response of the muscle to stimuli.  Side Effects – euphoria, lightheadedness, dizziness.

Page 5 of 25

  

Contraindications – allergy, renal impairment.

Route/s of Administration - PO Common Drugs o dantrolene (Dantrium) o baclofen (Lioresal) o cyclobenzaprine (Flexeril) o metaxalone (Skelaxin) o tizanidine (Zanaflex)

CNS Stimulants & Related Drugs 

Indications o ADHD & Narcolepsy  Mechanism of Action – stimulate brain r/t mental alertness. Elevate mood, increase mental alertness, decrease fatigue. Increase respiratory rate. Need drug holiday at least one day a week.  Side Effects – chest pain, insomnia, tremor, headache, dry mouth (think about things speeding up)  Contraindications – allergy, cardiac structural anomaly, anxiety, tick disorders.  Route/s of Administration - PO  Common Drugs  Amphetamines  methylphenidate—Ritalin  atomoxetine—Strattera  modafinil—Provigil o Obesity (Anorexiants)  Mechanism of Action – CNS stimulants that are believed to work by suppressing appetite control centers in the brain.  Side Effects – With the exception of diethylpropion, anorexiants may raise blood pressure and cause heart palpitations and even dysrhythmias at higher dosages. Ironically, at therapeutic dosages, they may actually reflexively slow the heart rate.  Contraindications – allergy, any severe cardiovascular disease, uncontrolled HTN, hyperthyroidism, glaucoma, mental agitation, hx of drug abuse, eating disorders with the previous 14 days.  Route/s of Administration - PO  Common Drugs  phentermine—Adipex  orlistat—Xenical Page 6 of 25

o Migraine  Mechanism of Action – Triptans treat headache that has already stated, stimulate 5 HT receptors in cerebral arteries, causing vasoconstriction and normally reducing or eliminating headache symptoms.  Side Effects – vasoconstrictor effects, including effects on coronary circulation. Local irritation at the site of an injection. Tingling, flushing, and congested feeling in head or chest.  Contraindications – To Triptans: allergy, presence of serious cardiovascular disease. To Ergot Alkaloids: Uncontrolled HTN, cerebral, cardiac, or peripheral vascular disease, dysrhythmias, glaucoma, coronary or ischemic heart disease.  Route/s of Administration – PO, SC, Nasal Sprays  Common Drugs  Serotonin receptor agonists o sumatriptan—Imatrex o Ergot alkaloids o ergotamine—Cafergot o Analeptic-responsive respiratory depression syndromes (neonatal apnea)  Mechanism of Action – work by stimulating areas of the CNS that control respiration, mainly the medulla and spinal cord.  Side Effects – Vagal effects: stimulation of gastric secretions, diarrhea, and reflex tachycardia. Vasomotor effects: flushing and sweating of skin.

Respiratory effects: Tachycardia. Skeletal muscle effects: muscular tension and tremors. Neurologic effects: reduced deep tendon reflexes.  Contraindications – allergy, peptic ulcer disease, and serious cardiovascular conditions.  Route/s of Administration – PO, IV  Common Drugs  Caffeine  Theophylline  Aminophylline – Pro Drug, metabolizes into Theophylline, then metabolizes into Caffeine.  Doxapram – contraindicated in infants.

Antiepileptic Drugs (anticonvulsants) 

Mechanism of Action – Evidence indicates that they alter the movement of sodium, potassium, calcium, and magnesium ions. Increase the threshold of activity in the area of the brain called the motor cortex. Reduce the nerve’s response to incoming electrical or chemical stimulation. Act to limit the spread of seizure discharge from its origin. Done by

Page 7 of 25

   

suppressing transmission of impulses from one nerve to the next. Decrease the speed of nerve impulse conduction within a given neuron.

Side Effects – birth defects, dizziness, drowsiness, anorexia, confusion, ataxia, cognitive impairment, agitation, headache, hepatotoxicity, pancreatitis, Contraindications – allergy, pregnancy (sometimes must be taken during pregnancy).

Route/s of Administration – PO, IV, Rectal Common Drugs o Phenobarbital o Primidone o Phenytoin o Fosphenytoin o Oxcarbazepine – Trileptal o Carbamazepine – Tegretol o Lamotrigine – Lamictal o Levetiracetam – Keppra o Pregabalin – Lyrica o Topiramate – Topamax o Valporic Acid - Depakote

Antiparkinson Drugs 



MAO Inhibitors (Indirect-Acting) o Mechanism of Action – breakdown of catecholamines, such as dopamine, norepinephrine, and epinephrine, as well as serotonin. Increases level of dopamine. o Side Effects – dizziness, insomnia, hallucinations, ataxia, agitation, depression, paresthesia, diarrhea, nausea, hypotension or HTN, etc. o Contraindications – allergy, do not use w/demerol o Route/s of Administration - PO o Common Drugs  Selegiline  rasagiline Dopamine Modulator (Indirect-Acting) o Mechanism of Action – appears to work by causing the release of dopamine and other catecholamines from their storage sites, or vesicles in the presynaptic fibers of nerve cells within the basal ganglia that have not yet been destroyed by the disease process. o Side Effects – dizziness, insomnia, and nausea o Contraindications - allergy o Route/s of Administration - PO Page 8 of 25









o Common Drugs  Amantadine Catechol Ortho-Methyltransferase Inhibitors (Indirect-Acting) o Mechanism of Action – Block COMT. COMT is the enzyme that catalyzes the breakdown of the body’s catecholamines. Tolcapone acts both centrally and peripherally. Entacapone cannot cross the blood-brain barrier, so can act only peripherally. o Side Effects – GI upset, urine discoloration. The can also worsen dyskinesia that may already be present. o Contraindications – allergy, Tolcapone - in cases of liver failure. o Route/s of Administration - PO o Common Drugs  Entacapone  Tolcapone Nondopamine Dopamine Receptor Agonists (Direct-Acting) o Mechanism of Action – work by causing direct stimulation of dopamine receptors in the brain. o Side Effects – edema, fatigue, syncope, dizziness, drowsiness, GI upset o Contraindications – allergy, concurrent use w/opioid analgesic meperidine is also contraindicated due to well-documented drug interactions between MAOIs and meperidine. o Route/s of Administration - PO o Common Drugs  Bromocriptine - Parlodel  Pramipexole – Mirapex  Ropinirole - Requip Dopamine Replacement Drugs o Mechanism of Action – stimulate presynaptic dopamine receptors to increase brain levels of dopamine. o Side Effects – palpitations, hypotension, urinary retention, depression, dyskinesia o Contraindications – angle-closure glaucoma, because they can raise intraocular pressure. They can be cautiously used w/open-angle glaucoma. Undiagnosed skin condition, because can activate malignant melanoma. o Route/s of Administration - PO o Common Drugs  Levodopa  Carbidopa-levodopa combination Anticholinergic Drugs o Mechanism of Action – Block the effects of the neurotransmitter acetylcholine at cholinergic receptors in the brain as well as in the rest of the body.

Page 9 of 25

o Side Effects – tachycardia, confusion, memory impairment, rash, hyperthermia, constipation, dry throat, nose, or mouth, N & V, urinary retention, blurred vision, fever o Contraindications – allergy, glaucoma o Route/s of Administration – PO, IV o Common Drugs  Benztropine - Cogentin Psychotherapeutic Drugs 





Anxiolytic Drugs o Mechanism of Action – decrease anxiety by reducing over activity in the CNS. o Side Effects – overexpression of their therapeutic effects, in particular CNS depression. Can also cause hypotension. Paradoxical reactions to the benzodiazepines and antihistamines, including hyperactivity and aggressive behavior. Amnesia, anorexia, sedation, lethargy, fatigue, confusion, drowsiness, dizziness, ataxia, headache, visual changes, weight gain or loss, nausea, weakness. o Contraindications – allergy, narrow-angle glaucoma, pregnancy. o Route/s of Administration – PO, IM o Common Drugs  Benzodiazepines  alprazolam—Xanax  diazepam—Valium  lorazepam—Ativan  Miscellaneous  buspirone—Buspar Mood Stabilizing Drugs o Mechanism of Action – used for bipolar illness. Affects catecholamine and serotonin levels. o Side Effects – N & V, diarrhea, dry mouth, anorexia, abdominal pain. o Contraindications - renal failure, cardiovascular insufficiency, Addison’s disease and untreated hypothyroidism. Cautious w/sodium level changes from diet, sweating, etc. o Route/s of Administration - PO o Common Drugs  Lithium Tricyclic Antidepressants (1st Generation antidepressant. NOTE: overdose is most likely lethal) o Mechanism of Action – corrects imbalances of serotonin and norepinephrine.

Page 10 of 25





o Side Effects – anorexia, dry mouth, blurred vision, constipation, sexual dysfunction, altered blood glucose levels, urinary retention, agitation, anxiety, ataxia, cognitive impairment, sedation, headache, insomnia, skin rash, photosensitivity, weight changes, orthostatic hypotension, blood dyscrasias o Contraindications – allergy, MAO inhibitors in last 14 days, pregnancy, cardiovascular disease, hx of seizures o Route/s of Administration - PO o Common Drugs  amitriptyline - Elavil MAO Inhibitors (can cause a hypertensive crisis) o 1st Generation  Common Drugs  isocarboxazid  phenelzine  tranylcypromine  selegiline nd o 2 Generation  Mechanism of Action – SSRI’s – inhibit serotonin uptake. SNRI’s inhibit serotonin and norepinephrine.  Side Effects – anxiety, dizziness, drowsiness, headache, mild GI disturbance, sexual dysfunction, asthenia, tremor, hepatotoxicity.

Seratonin Syndrome  Contraindications – allergy, use of MAOI’s in the previous 14 days, and therapy w/certain antipsychotic drugs. Also hx of cardiac disease or seizures.  Route/s of Administration - PO  Common Drugs  trazadone—Desyrel (antidepressant)  flouxetine—Prozac (SSRI)  bupropion—Wellbutrin (antidepressant)  mirtazapine—Remeron (SNRI)  duloxetine—Cymbalta (SNRI) Antipsychotic Drugs o Mechanism of Action – work to block dopamine in the brain. Affect emotion, cognitive and motor function. o Side Effects – neuroleptic malignant syndrome, myoglobin anemia, extrapyramidal movements, dystonia, akasthesia, tardive dyskinesia o Contraindications – allergy, also taking CNS depressants, traumatic brain damage, liver and kidney disease o Route/s of Administration – PO, IM, IV Page 11 of 25

o Common Drugs  Butyrophenone  haloperidol—Haldol  Atypical antipsychotics  clozapine—Clozaril  risperidone—Risperdol Substance Abuse 







Opioids o Mechanism of Action – work by blocking receptors in the CNS. Perception of pain is blocked. o Side Effects – diuresis, meiosis, convulsions, N & V, and respiratory depression. o Contraindications – allergy, pregnancy, respiratory depression or severe asthma when resuscitative equipment is not available, and paralytic ileus. o Route/s of Administration - PO o Common Drugs  Heroin Stimulants o Mechanism of Action – stimulate the CNS, cardiovascular, and urinary system. o Side Effects – restlessness, tremor, anxiety, syncopal episodes, suicidal or homicidal ideations, hypothermic reaction. o Contraindications – allergy, HTN, cardiovascular disease. o Route/s of Administration – PO, Inhalation o Common Drugs  Cocaine  Meth Depressants o Mechanism of Action – decrease nerve transmission to the brain. o Side Effects – dry mouth, distorted sense of time, drowsiness, sedation, loss of coordination, dizziness, blurred vision, headaches, etc. o Contraindications – allergy, dyspnea, glaucoma, airway obstruction o Route/s of Administration – PO, Inhalation o Common Drugs  Marijuana  Roofies  GHB Alcohol o Mechanism of Action – CNS depressant

Page 12 of 25



o Side Effects – serious neurologic and mental disorders associated w/long term excessive ingestion. Confusion, ataxia, nystagmus, Wernicke’s encephalopathy, Korsakoff’s psychosis, hallucinations, nutritional and vitamin deficiencies. o Contraindications – coumadin, pregnancy, other CNS depressants, while taking Flagyl or Tylenol o Route/s of Administration - PO Nicotine o Mechanism of Action – works by directly stimulating the autonomic ganglia of the nicotinic receptors. o Side Effects – tremors, convulsions, respiratory depression, HTN o Route/s of Administration - Inhalation Endocrine Medications

Pituitary Drugs  



 

Mechanism of Action – differ depending on the drug, but overall they either augment or antagonize the natural effects of the pituitary hormones.

Side Effects – most are specific to the individual drug, but include fatigue, malaise, headache, increase or decrease in blood glucose levels, GI disturbances, dyspnea, arthralgia, conduction abnormalities.

Contraindications – can initiate major physiologic changes, so all of them should be used w/special caution in client’s w/acute or chronic illnesses such as migraine headahces, epilepsy, and asthma.

Route/s of Administration – PO, IV, SC, IM Common Drugs o Anterior Pituitary  cosyntropin (Cortrosyn)  somatotropin (Humatrope)  somatrem (Protropin)  octreotide (Sandostatin) o Posterior Pituitary  vasopressin (Pitressin)  desmopressin (DDAVP)

Page 13 of 25

Thyroid & Antithyroid Drugs 



Thyroid Drugs o Mechanism of Action - Thyroid preparations are given to replace what the thyroid gland cannot produce to achieve normal thyroid levels (euthyroid).

Thyroid drugs work the same way as thyroid hormones. o Side Effects - Cardiac dysrhythmia is the most significant adverse effect, but may also cause: Tachycardia, palpitations, angina, hypertension, insomnia, tremors, headache, anxiety, nausea, diarrhea, menstrual irregularities, weight loss, appetite changes, sweating, heat intolerance, others o Contraindications - Drug allergy, Recent MI, Adrenal insufficiency, Hyperthyroidism o Route/s of Administration – PO, IM, IV o Common Drugs  levothyroxine – Synthroid or Levothyroid (Drug of choice because its hormonal content is standardized; therefore, its effect is predictable)  liothyronine (Cytomel)  liotrix (Thyrolar)  thyroid Antithyroid Drugs o Mechanism of Action - Inhibit the incorporation of iodine molecules into tyrosine. Inhibits formation of thyroid hormone. o Side Effects – drowsiness, headache, vertigo, paresthesia, GI disturbances, hepatitis, loss of taste, smoky urine, decreased urine output, rash, pruritus, myalgia, arthralgia, nephritis, hypothrombinemia, lymphadenopathy, bleeding, thrombocytopenia, etc. o Contraindications – allergy, pregnancy o Route/s of Administration - PO o Common Drugs  thioamide derivatives  methimazole (Tapazole)  propylthiouracil (PTU)

Antidiabetic Drugs 

Insulins o Mechanism of Action – functions as a substitute for the endogenous hormone.

Serves to replace the insulin that is either not made or is made defectively in a diabetic patient.

Page 14 of 25



o Side Effects – brain damage, shock, and possible death from excessive insulin dosing. Others include weight gain, lipodystrophy at site of repeated injections.

Rare cases allergic reaction. o Contraindications – allergy, never to be administered to an already hypoglycemic patient. o Route/s of Administration – SC o Common Drugs (4 classes) **Know**  Humalog – Rapid-Acting w/15 min onset  Novolin R – Short-Acting w/30 – 60 min onset  Lantus – Long-Acting w/slow absorption over next 24 hrs. Typically given once/day, but may be given q 12 hrs if needed.  NPH – Intermediate-Acting w/onset of 1 to 2 hrs  Humulin 70/30 – Fixed-Combination w/onset of 1 to 2 hrs Oral Antidiabetic Drugs o Biguanide (1st line)  Mechanism of Action – works by decreasing glucose production by the liver. May also decrease intestinal absorption of glucose and improve insulin receptor sensitivity.  Side Effects – GI disturbances are the most common. Also may experience a metallic taste.  Contraindications – client’s w/renal disease or renal dysfunction. Can increase risk of lactic acidosis. Others include alcoholism, hepatic disease, heart failure, metabolic acidosis, etc.  Route/s of Administration - PO  Common Drugs  Metformin (only drug in this class and considered 1st line drug) o Sulfonylureas (2nd generation)  Mechanism of Action – bind to specific receptors on beta cells in the pancreas to stimulate the release of insulin.  Side Effects – hypoglycemia is the most common and depends on eating habits, and presence of hepatic or renal disease. Also weight gain, skin rash, nausea, epigastric fullness, and heartburn.  Contraindications – hypoglycemia, potential for cross-allergy in patients who are allergic to sulfonamide ABT’s.  Route/s of Administration – PO  Common Drugs  glipizide – Glucotrol  glyburide – Diabeta  glimepiride – Amaryl

Page 15 of 25

o Glinides  Mechanism of Action – increase insulin secretion from pancreas w/much shorter duration.  Side Effects – hypoglycemia, weight gain  Contraindications – similar to those for the sulfonylureas.  Route/s of Administration - PO  Common Drugs  repaglinide – Prandin  nateglinide - Starlix o Thiazolidinediones (Glitazones)  Mechanism of Action – acts by regulating genes involved in glucose and lipid metabolism. Work to decrease insulin resistance by enhancing the sensitivity of insulin receptors.  Side Effects – increased risk of heart failure, peripheral edema, and weight gain.  Contraindications – clients w/New York Heart Association class III or IV heart failure and use caution in client’s w/liver or kidney disease.  Route/s of Administration - PO  Common Drugs  pioglitazone – Actos (only one in use) o Alpha-Glucosidase Inhibitors (less commonly used)  Mechanism of Action – work by reversibly inhibiting the enzyme alphaglucosidase that is found in small intestine.  Side Effects – high incidence of flatulence, diarrhea, and abdominal pain.

May also elevate levels of hepatic enzymes.  Contraindications – not recommended for use in clients w/inflammatory bowel disease, malabsorption syndromes, or intestinal obstruction.  Route/s of Administration - PO  Common Drugs  Acarbose – Precose  Miglitol - Glyset o Dipeptidyl Peptidase IV (DPP-IV) Inhibitors  Mechanism of Action – work by delaying the breakdown of incretin hormones by inhibiting the enzyme DPP-IV.  Side Effects – most common are URI, headache, diarrhea. Hypoglycemia can also occur. Cases of pancreatitis have also been reported.  Contraindications - allergy  Route/s of Administration - PO  Common Drugs (only 3 available)  Sitagliptin – Januvia Page 16 of 25

 Saxagliptin – Onglyza  Linagliptin - Tradjenta o Amylin Agonists  Mechanism of Action – work by mimicking the action of the natural hormone amylin.  Side Effects – nausea, vomiting, anorexia, and headache  Contraindications – clients w/gastroparesis or those taking drugs that alter gastrointestinal motility.  Route/s of Administration - PO  Common Drugs  Pramlintide – Symlin (only one available) o Incretin Mimetics  Mechanism of Action – enhance glucose-dependent insulin secretion, suppress elevated glucagon secretion, and slow gastric emptying.  Side Effects – nausea, vomiting, diarrhea. Rare cases of hemorrhagic or necrotizing pancreatitis have been reported. May also experience weight loss of 5 to 10 pounds.  Contraindications - allergy  Route/s of Administration - PO  Common Drugs (only 2 available)  Exenatide  Liraglutide Adrenal Drugs 

   

Mechanism of Action – related to their involvement in the synthesis of specific proteins. o corticosteroids—modify enzyme activity o aldosterone—acts on distal renal tubules to promote sodium resorption o cortisol—inhibition of inflammatory and immune responses o glucocorticoids—control the inflammatory response Side Effects – heart failure, edema, HTN, convulsions, headache, vertigo, mood swings, nervousness, insomnia, weight gain, etc.

Contraindications - Drug allergy, Cataracts, Glaucoma, PUD, Mental health problems, DM, Sepsis Route/s of Administration – PO, IV Common Drugs o Glucocorticoids  Adrenocorticotropic hormone

Page 17 of 25



betamethasone (Celestone), cortisone (Cortef), dexamethasone (Decadron), hydrocortisone, methylprednisone (Solu-Cortef), triamcinolone (Kenalog) o Mineralocorticoids  Aldosterone  desoxycorticosterone, fludrocortisone (Florinef) Women’s Health Drugs 



Estrogens o Mechanism of Action – the binding of estrogen to intracellular estrogen receptors stimulates the synthesis of DNA, RNA, and proteins, which are the building blocks for all living tissue. o Side Effects – thromboembolic events are the most serious. Nausea is the most common. Photosensitivity may also occur. One common dermatologic effect of note is chloasma – brownish, macular spots on the forehead, cheeks, lips, and neck. Others are HTN, tender breasts, fluid retention, headaches, GI disturbances, etc. o Contraindications – allergy, estrogen-dependent cancer, undiagnosed abnormal vaginal bleeding, pregnancy, and active thromboembolic disorder or hx of this disorder. o Route/s of Administration – PO, TD o Common Drugs  conjugated estrogens—Premarin  esterified estrogens—Estratab  estradiol—Estrace  estradiol transdermal—Estraderm Progestins o Mechanism of Action – produce the same physiologic responses as those produced by progesterone itself. o Side Effects – most serious is liver dysfunction, commonly manifested as jaundice, thrombophlebitis, and thromboembolic disorders such as pulmonary embolism. Also N & V, amenorrhea, spotting, edema, weight gain or loss, rash, pyrexia, somnolence or insomnia, depression. o Contraindications – similar to those for estrogens. o Route/s of Administration - PO o Common Drugs  medroxyprogesterone—Depo-Provera  megestrol—Megace  Page 18 of 25





Contraceptive Drugs o Mechanism of Action – prevent ovulation by inhibiting the release of gonadotropins and by increasing uterine mucous viscosity, which results in decreased sperm movement and fertilization of the ovum and possible inhibition of implantation of a fertilized egg into the endometrial lining. o Side Effects – HTN, thromboembolism, alterations in carbohydrate and lipid metabolism, increases in serum hormone concentrations, and alterations in serum metal and plasma protein levels. o Contraindications – allergy, pregnancy, known high risk for or hx of thromboembolic events such as MI, venous thrombosis, PE, or stroke. o Route/s of Administration – PO, IM, TD, Intravaginal – Nuva-Ring o Common Drugs  Ortho-Novum  Loestrin  Tri-Norinyl  Yaz  Depo-Provera  NuvaRing Osteoporosis Drugs o Mechanism of Action – Bisphosphonates work by inhibiting osteoclast-mediated bone resorption, which in turn indirectly enhances bone mineral density. Others include SERM’s, Calcitonin, Teriparatide – differs from others in that it stimulates bone formation, Denosumab – blocks osteoclast activation. o Side Effects – hot flashes and leg cramps are the most common. o Contraindications – Vary by drug.  Biphosphates – allergy, hypocalcemia, esophageal dysfunction, and the inability to sit or stand upright for at least 30 minutes after taking.  SERM’s – women w/known allergy, pregnancy, venous thromboembolic disorder.  Calcitonin – allergy or allergy to salmon due to drug being salmon derived.  Teriparatide – to the use of teriparatide include drug allergy.  Denosumab – to the use of denosumab are hypocalcemia, renal impairment or failure, and infection. o Route/s of Administration – PO, IM, SC, Nasal Spray o Common Drugs  Biphosphates—alendronate--Fosamax  SERM’s—raloxifene—Evista  calcitonin—Calcimar  teriparatide—Forteo Page 19 of 25







 denosumab—Prolia Fertility Drugs o Mechanism of Action – works by blocking estrogen receptors in the uterus and brain. o Side Effects – tachycardia, DVT, hypovolemia, dizziness, headache, flushing, depression, restlessness, anxiety, nervousness, fatigue, GI disturbances, Urticaria, etc. o Contraindications – allergy, primary ovarian failure, uncontrolled thyroid or adrenal dysfunction, liver disease, pituitary tumor, abnormal uterine bleeding, ovarian enlargement of uncertain cause, sex hormone-dependent tumors, pregnancy. o Route/s of Administration - PO o Common Drugs  clomiphene—Clomid Uterine Stimulants o Mechanism of Action – during childbirth, oxytocin stimulates uterine contractions, and during lactation it promotes the movement of milk. o Side Effects – hypotension or HTN, chest pain, headache, dizziness, fainting, N & V, diarrhea, vaginitis, vaginal pain, cramping, leg cramps, joint swelling, chills, fever, weakness, blurred vision. o Contraindications – allergy, PID, cervical stenosis, uterine fibrosis, high-risk intrauterine fetal positions before delivery, placenta previa, hypertonic uterus, uterine prolapse, or any condition in which vaginal delivery is contraindicated, etc. o Route/s of Administration – PO, Vaginal Suppository, IM, IV, Cervical Gel o Common Drugs  dinoprostone—Prostin E2 (prostaglandin)  methylergonovine—Methergine (ergot)  oxytocin—Pitocin (oxytocic) Drugs for Preterm Labor Management o Mechanism of Action – Indomethacin is the most effective and works by inhibiting prostaglandin activity. Nifedipine inhibits myometrial activity by blocking calcium influx. o Common Drugs  Nonpharmacologic treatment – bed rest, sedation, and hydration  Tocolytics  terbutaline (beta-adrenergic)—Brethine  Magnesium sulfate (electrolyte)  indomethacin (NSAID)—Indocin  nifedipine (CCB)—Procardia Page 20 of 25



corticosteroids Men’s Health Drugs

Androgens and Other Drugs Pertaining to Men’s Health o Mechanism of Action – the natural and synthetic androgens and the synthetic anabolic steroids have effects similar to those of the endogenous androgens.

Stimulate the synthesis of RNA at the cellular level, thereby promoting cellular growth and reproduction. They also retard the breakdown of amino acids. o Side Effects – androgenic steroids can cause the devastating effect of a condition known as peliosis of the liver – formation of blood-filled cavities in the liver. Is rare. Other serious effects are liver cancer, cholestatic hepatitis, jaundice, and abnormal liver function. Also may cause fluid retention. Also headache, changes in libido, anxiety, depression, acne, male pattern baldness, hypotension, etc. o Contraindications – allergy, known androgen-responsive tumors, use of sildenafil, vardenafil, and tadalafil in cardiovascular disorders. Concurrent use of erectile dysfunction drugs and nitrates may cause severe hypotension, which may not respond to tx. Finasteride is contraindicated in women and children. o Route/s of Administration – PO, IM, Patch, Gel o Common Drugs  finesteride—Proscar  sildenafil—Viagra  testosterone—AndroGel

Antihistamines, Decongestants, Antitussives, & Expectorants Antihistamines (Histamine Antagonists)  Mechanism of Action – work by blocking the histamine receptors on the surfaces of basophils and mast cells, thereby preventing the release and actions of histamine stored within these cells.  Side Effects – drowsiness is the chief complaint. Also, dry mouth, changes in vision, difficulty urinating, and constipation.  Contraindications – allergy, narrow-angle glaucoma, cardiac disease, kidney disease, HTN, bronchial asthma, COPD, PUD, seizure disorder, BPH, pregnancy.  Route/s of Administration – PO, IM, IV  Common Drugs o Alkylamines—chlorpheniramine—Chlor-Trimeton o Ethanolamines—diphenhydramine—Benadryl o Phenothiazine—promethazine—Phenergan Page 21 of 25

o Piperidines—hydroxyzine—Vistaril o Miscellaneous—loratadine--Claritin Decongestants  Mechanism of Action – they constrict the small arterioles that supply the structures of the upper respiratory tract, primarily the blood vessels surrounding the nasal sinuses.

When the blood vessels are stimulated by alpha-adrenergic drugs, they constrict.  Side Effects – nervousness, insomnia, palpitations, and tremor, mucosal irritation and dryness.  Contraindications – allergy, narrow-angle glaucoma, uncontrolled cardiovascular disease, HTN, diabetes, hyperthyroidism, and prostatitis, etc.  Route/s of Administration – PO, Inhalation, Topical  Common Drugs o beclomethasone—Beconase o budesomide--Rhinocort o fluticasone—Flonase o ciclesonide--Omnaris Antitussives  Mechanism of Action – suppress the cough reflex through direct action on the cough center in the CNS (medulla).  Side Effects – common ones include dizziness, headache, sedation, nausea, constipation, pruritis, nasal congestion, vomiting, and dry mouth.  Contraindications – allergy is the only absolute. Others include opiod dependency, and high risk for respiratory depression.  Route/s of Administration - PO  Common Drugs o benzonatate—Tessalon Perles o codeine o dextromethorphan—Robitussin Expectorants  Mechanism of Action – 2 different mechanisms of action. 1st is reflex stimulation – Guafenesin only. 2nd is direct stimulation of the secretory glands in the respiratory tract.  Side Effects – are minimal, but include nausea, vomiting, and gastric irritation.  Contraindications - allergy  Route/s of Administration - PO  Common Drugs o guaifenesin—Mucinex (only one currently available) Page 22 of 25

Respiratory Medications Beta-Adrenergic Agonists  Mechanism of Action – dilate the airways by stimulating the beta2-adrenergic receptors located throughout the lungs.  Side Effects – insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, and vascular headache are some.  Contraindications – allergy, uncontrolled HTN or cardiac dysrhythmias, and high risk of stroke because of the vasoconstrictive drug action.  Route/s of Administration – PO, inhalation, IM, IV, SC  Common Drugs o albuterol—Proventil, Ventolin o ephedrine o epinephrine—Adrenalin o metaproterenol—Alupent o levalbuterenol—Xopenex o pirbuterol—Maxair o salmeterol—Serevent o terbutaline—Brethine Anticholenergics  Mechanism of Action - prevent bronchoconstriction, which indirectly causes airway dilation. Also help reduce secretions in COPD clients.  Side Effects - – most common are dry mouth or throat, nasal congestion, heart palpitations, GI distress, urinary retention, increased intraocular pressure, headache, coughing, and anxiety.  Contraindications– allergy. Should NOT be used w/someone who has allergy to peanuts and caution w/client who has acute narrow-angle glaucoma and prostate enlargement.  Route/s of Administration - Inhalation  Common Drugs o ipratroprium—Atrovent o tiotroprium—Spiriva

Xanthine Derivatives  Mechanism of Action – cause bronchodilation by increasing the levels of the energyproducing substance cAMP.  Side Effects – common ones are N & V, and anorexia. Also GERD, sinus tachycardia, extrasystole, palpitations, and ventricular dysrhythmias.

Page 23 of 25

  

Contraindications – allergy, uncontrolled cardiac dysrhythmias, seizure disorders, hyperthyroidism, and peptic ulcers.

Route/s of Administration – PO Common Drugs o aminophylline—metabolized into theophylline o theophylline—metabolized into caffeine

Leukotriene Receptor Antagonists  Mechanism of Action – 1st subclass of LTRA’s acts by an indirect mechanism and inhibits the enzyme 5-lipoxygenase, which is necessary for leukotriene synthesis. Zyflo is the only drug available in this class. 2nd subclass LTRA’s act more directly by binding to the D4 leukotriene receptor subtype in respiratory tract tissues and organs.  Side Effects – differ depending on specific drug. Most common are headache, nausea, dizziness, and insomnia. Can lead to liver dysfunction. Monitor liver enzymes early in therapy.  Contraindications – allergy to the drug, allergy to povidone, lactose, titanium dioxide, or cellulose derivatives is also important to note.  Route/s of Administration - PO  Common Drugs o montelukast—Singulair (2nd subclass) o zafirlukast—Accolate (2nd subclass) o zileuton—Zyflo (1st subclass) Corticosteroids (Glucocorticoids)  Mechanism of Action – have actions similar to those of the natural steroid hormone cortisol, which is chemically the same as the drug hydrocortisone. Exact mechanism has not been determined. It is thought that they have the dual effect of both reducing inflammation and enhancing the activity of beta agonists. Essentially work by stabilizing the membranes of cells that normally release bronchoconstricting substances.  Side Effects – main ones include pharyngeal irritation, coughing, dry mouth, and oral fungal infections.  Contraindications – allergy, hypersensitive to glucocorticoids, in patients whose sputum tests positive for Candida organisms, and in patients with systemic fungal infection, as the corticosteroids can suppress the immune system.  Route/s of Administration – Inhalation, PO, IV, IM  Common Drugs o fluticasone propionate—Flonase o methylprednisolone—Solu-Medrol

Page 24 of 25

Others 

Phosphodiesterase-4 Inhibitor o roflumilast (Daliresp)



Monoclonal Antibody Antiasthmatic o omalizumab (Xolair)

Page 25 of 25