TI
high TI: wide safety monitoring. No need for serum monitoring.

low TI: have medication levels monitoring. ie trough levels: blood drawn immediately before the next dose

agonist
mimics receptor activity
(ie morphine)

antagonist
blocks normal receptor activity

Transdermal meds
-wash skin with soap and water
-place on hairless portion
-make sure old one is gone.

Parenteral medications
Site:
-vastus lateralis under 2
-ventral gluteal 2ml
-deltoid 1ml max

Intradermal
Vol: 0.01-0.1ml
Needle: tuberculin with 26-27 gauge
Angle: 5-15

Subcutaneous
ie heparin and insulin

Vol: max 1.5ml
3/8-5/8, 25-27 or insulin syringe 28-31
Angle: 90

*pinch up skin

Intramuscular
Vol: 1-3ml
Needle: 18-27 (22-27 gauge). 1-1.5 inch
Ang;e: 90

IV access
trauma: 16 gauge
surgical: 18 gauge
Medical: 22-24 gauge

Benzodiazepine (-pam)
ie diazepam, lorazepam, chlordiazepoxide (librium)

Action: enhance gamma0aminobutyric acid in CNS

Adverse:
CNS depression
Anterograde amnesia
Respiratory depression (give flumenazil)
Paradoxical rsponse

Contra:
alcohol and other depressants

Buspirone
class: atypical anxiolytic

Adverse:
Dizziness, nausea, headache
(take with food)

Contra:
-MAOI antidepressants due to hypertensive crisis
-grapefruit juice, erythromycin, ketoconazole, St. John’s increase the effects

NSG:
3-6 weeks for full effect.
-used because there is less chance for dependency

SSRI
Paroxetine, Fluoxetine
Sertaline
Escitalopram
Fluvoxamine

Action: inhibits serotonin reuptake

Adverse:
(Sweat, sex, Serotonin syndrome, salt)
N/V, diaphoresis, tremor, fatigue, drowsiness
sexual dysfunction (LATE)
weight gain
Gi bleed
Hyponatremia
Bruxism (treat with buspirone)
Withdrawal

Contra
-with other antidepressants

NSG:
-take in the morning.

Serotonin syndrome
agitation, confusion, disorientation
Hallucinations
Hyperreflexia, tremors, incoordination
fever, diaphoresis

Starts 2-72 hours after start.

Angina/MI
Definitive sign of angina: relieved by rest and nitroglycerin. Less than 15 minutes

MEDS
1) vasodilators (ie nitro)

2) analgesics (ie morphine sulfate)
-watch for constipation, respiratory depression, hypotension

3) beta blockers (is metoprolol)
-watch for bradycardia and hypotension, asthmatics

4) thrombolytics (ie streptokinase and alteplase)

5) antiplatelets (ie aspirin and plavix)
-tinnitus=aspirin toxicity

6) anticoagulants

Good sources of potassium
baked potatoes
tomato juice
orange juice
bananas

Pulmonary edema
pink frothy sputum
orthopnea
decreased urinary output
persistent cough
tachypnea

Digoxin toxicity
fatigue, muscle weakness, confusion, visual changes, loss of appetite

Do NOT take digoxin with antacids.

Count apical pulse for 1 minute.

Lithium
less than 1.5
-GI issues, polyuria, FINE tremors

1.5-2.0
-GI issues, mental confusion, COARSE tremors

2.0-2.5
polyuria, tinnitus, seizures, death

NSG: give urea, mannitol, aminophylline, gastric lavage
-take with food,
-teratogenic
-can cause goiter/hypothyroidism

CONTRA: NSAIDS!

Mood stabilizing antiepileptics
carbamazepine
-ADVERE: CNS effects, blood dyscrasias, Steven Johnsons rash

valproic acid
-ADVERSE: liver, pancreas, thrombocytopenia
-CONTRA: grapefruit juice, phenytoin, warfarin.

lamotrigine
-ADVERSE: Steven Johnsons rash, double/blurred vision.

1st generation antipsychotics
(-azine and Haldol)
chlorpromazine
Fluphenazine
Perphenazine
Thiothixene

Adverse effects
-Acute dystonia aka neck, face, back, tongue spasms (EMERGENCY! give benztropine/Cogentin or benadryl)
*monitor 5hr to 5 days

-Parkinsonism (give benztropine, benadryl, amantadine/Symmetrel)

-EPS (akathisia, tardive dyskinesia)

-Neuroleptic malignant syndrome
(high fever, muscle rigidity, coma) give valium and dantrolene

-Anticholinergic effects

-Neuroendocrine effects
-seizure
-skin
-orthostaic hypotention, sedation, sexual dysfunction
-agranulocytosis
-dysrhythmias

Second generation
ie risperidone
(done, pine, abilify)

Action: block serotonin, dopamine

ADVERSE effects
-diabetes, weight gain, high cholesterol
-mild EPS
-anticholinergic, sedation, orthostatic hypotention

Quetiapine
effects include diabetes, weight gain, cholesterol, CATARACTS

Clozapine
low risk of EPS
high risk of weight gain etc,
Agranulocytosis (get baseline WBC)

DO NOT use immunosupressants

Tardive dyskinesia
lip smaking, tongue protrusion, grimacing

Parkinsonism
-bradykinesia
-RIGIDITY, tremors
-shuffling gait
-drooling

Akathisia
unable to be still.

Detoxification Meds
1) Benzodiazepines
(chlorodiazepoxide, diazepam, lorazepam)
-seizure precaustions

2) adjunct
carbamazepine (for seizures), clonidine (Catapres)(depression of autonomic response), Inderal (decrease in craving)

Abstinence maintenance
1) Disulfiram/Antabuse
-aversion therapy

2) Naltrexone
-opioid antagonist, supresses craving.
-take with meals

3) Acamprosate (Campral)
-helps with anxiety and restlessness
-watch for diarrhea

Support withdrawal from opioids
1) methadone
NSG: taper.

2) Clonidine (Catapres)
helps with the autonomic hyperactivity effects from withdrawal
-anticholinergic effects include dry mouth

3) buprenorphine
-decreases cravings

Support smoke withdrawal
1) Buproprion
-decreases craving
-avoid stimulants

3) gum (use only 6 months), patch, spray.

4) Varenicline (Chantix)
-promotes release of dopamine
-Watch for HTN, loss of glycemic control, N and V, insomnia, depression

Cholinesterase inhibitors
ie neostigmine
Ambenonium, pyridostigmine, edrophonium

Action: increases amount of AcH available.

ADVERSE:
-muscarine stimulation (GI motility, increased GI secretions, bradycardia, urinary urgency): Give ATROPINE.
-cholinergic crisis

Antiparkinsons
1) *Levodopa/carbidopa*
-watch for NV. (NO pyridoxine foods)
-Dyskinesia (give amantadine)
-orthostatic hypotention
-Psychosis
-discoloration
-CVA effects

2) dopamine agonists: *bromocriptine, pramipexole*
-watch for sleepiness, orthostatic hypotension, psychosis, impulse control disorders, dyskinesias

2) Dopamine releaser: amantadine
-CND effects
-atropine effects
-skin discoloration

3) COMT inhibitors: -capones
-liver

4) MAO-B inhibitors: selegiline
-insomnia
-hypertensive crisis with tyramine

5) centrally acting anticholinergics: benztropine, trihexylphenidyl
-atropine effects
-antihistamine effects
-nausea and vomiting (avoid high protein snacks)

Pyridoxine foods
AVOIDED when using levodopa/carbidopa.

protein rich foods
whole grain
banana
liver
legumes
green veggies.

Traditional antiepileptics
phenobarbital
primidone
Phenytoin
Carbamazepine
Valproic acid
Ethosuximide

Newer antiepileptics
lamatrigine
Levetiracetam
Topiramate
Oxcarbazepine
Gabapentin
Pregabalin
Tiagabie

Barbituates: phenobarbital, primidone
-depressant/sedative
-toxicity (nystagus, ataxia, pinpoint pupils, hypotention)
-decrease warfarin and BC effects

Hydantoins: phenytoin
-CNS effects (nystagmus, double vision)
-gum overgrowth
-rash
-CVA, endocrine
-Vit D and D metab

avoid alcohol, warfarin, BC

Ethosuximide
-GI effects
-CNS effects (sleepiness)

*USE FOR ABSENCE seizures

Topiramate
T: teratogenic
M: metabolic acidosis
A: angle closure glaucoma

Gabapentin
-CNS effects
ie sleepy, dizzy, ataxia, fatigue, edema, nystagmus

Brimonidine (alpha adrenergic agonist)
action: lowers IOP (should be less than 21) decreases production of aqueous humor.

ADVERSE:
hypotension, drowsiness
-watch for concurrent use with antihypertensives.

Carbonic anhydrase inhibitor
acetazolamide
methazolamide

ADVERSE:
-cross sensitivity with sulfa drugs
-BMS
-GI
-Na/K depletion
-flulike symptoms
-CNS disturbances
-glucose disturbances

Neuromuscular blocking agents
Depolarizing
succinylcholine
ACTION: causes sustained depolarization=muscle paralysis

NON-depolarizing
Pancuronium, atracurium, vecuronium
Action: muscle contraction by blocking AcH at end plate.
Reversal: neostigmine (increases amount of Ach)

ADVERSE:
-respiratory arrest
-hypotension
-hyperkalemia
CONTRA:
-aminoglycosides ec

Muscle relaxants and antispasmodics
Centrally acting: diazepam
Peripherally acting: dantrolene
OTHER: baclofen, cyclobezaprine

Dantrolene
ADVERSE:
-liver toxicity
-muscle weakness
-CNS depression

Baclofen
ADVERSE:
-nausea, constipation, urinary retention

Muscarinic agonist (ie bethanechol)
Action: stimulation of the muscarine receptors on the GU tract, causing relaxation of the trigone and contraction of detrusor to help with urinary retention

ADVERSE:
-sweating, tearing, urgency, bradycardia, hypotention

Muscarinic Antagonists (oxybutynin)
Use: urinary incontinence
Action: inhibits, preventing voiding.

ADVERSE:
-anticholinergic (so can increase intraocular pressure)
-CNS effects

Nonbenzodiazepine sedatives
ie zolpidem (ambien)
-Sonata
-Trazodone

Adverse:
daytime sleepiness.

NSG:
-notify if you’re to become pregnancy
-take at HS
-absorb on empty stomach
-get 8 hours of sleep.

rameltron
class: melatonin agonist

ADVERSE:
-sleepiness
-hormonal effects (amenorrhea), decreased libibo

IV anesthetics
Barbituates: is pentobarbital
-fentanyl
-benzos (ie ativan)

ADVERSE
-respiratory depression
-bacterial infection with ketamine
-hallucinations

leukotriene modifiers
ie montelukast
Zileuton

Action: prevent effects of leukotrienes, thereby suppressing inflammation.

ADVERSE:
-liver

antitussives-opioids
ie codeine/hydrocodone

suppresses cough

Adverse:
-take with food due to GI distress
-CNS depressant
-abuse potential

ATI PHARM REVIEW

methotrexate

cytoxan (cyclophosphamide)

sumatriptan
contraindicated with:

sulfasalazine
treats ulcerative colitis

gentamicin

lubiprostone

leuprolide

verapamil

ibandronate
use: prevent osteoporosis

initiating IV on dehydrated adult

unit dose medication system

hydroxychloroquine (plaquenil)

EMLA

calcitonin

misoprostol (Cytotec)

amitriptyline

tadalafil (Cialis)

desmopressin

alteplase

amphotericin B
use: treats systemic fungal infection

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