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Opioid Agonist
-Prototype drug: morphine
-Mechanism of action: binds with mu & kappa receptor sites
-Primary use: acute and chronic pain
-Adverse effects: respiratory depression, dysphoria (restlessness & anxiety)
-Drowsy or anxious
-Count respirations before giving morphine, 10 or below resp. rate do not administer
Antagonist
-Prototype drug: naloxone (Narcan)
-Mechanism of action: interact with receptors
-Primary use: to reverse respiratory depression and other acute symptoms of opioid addiction, toxicity
-Must give something else for pain
Salicylates
-Prototype drug: aspirin (ASA)
-Mechanism of action: as anticoagulant, antipyretic, anti-inflammatory, and analgesic
-Adverse effects: with high doses may cause GI distress and bleeding
-May increase action of oral hypoglycemic agents
-Heart attack–anticoagulant
NSAIDS
-Prototype drug: ibuprofen (Motrin)
-aspirin, ibuprofen, Cox-2 inhibitors
-Mechanism of action: to inhibit cyclooxygenase and prevent formation of prostaglandins
-Adverse effects: GI upset, acute renal failure
-aspirin is more potent than ibuprofen
-Primary use: for musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis, mild to moderate pain, reduction of fever, primary dysmenorrheal pain
Selective Cox-2 Inhibitors
-Prototype drug: celecoxib (Celebrex)
-Mechanism of action: is similar to the NSAIDs
-Primary use: to relieve pain, fever, inflammation
-Adverse effects: mild and related to GI system
-No inhibition of COX-1
-Do not affect blood coagulation
-Were treatment of choice for moderate to severe inflammation
-Less side effects than ASA
Nonopioid Nonalgesics
-Prototype drug: acetaminophen (Tylenol)
-Mechanism of action: to treat fever: at the level of the hypothalamus and causes dilation of peripheral blood vessels enabling sweating and dissipation of heat
-Primary use: treatment of fever and to relieve pain
-Adverse effects: uncommon with therapeutic doses
Triptans
-Prototype drug: sumatriptan (Imitrex)
-Mechanism of action: to act as serotonin agonists, constricting certain intracranial vessels
-Primary use: to abort migraines with or without auras
-Adverse effects: GI upset
Ibuprofen
-Alternate to aspirin
-Inhibits COX-1 and COX-2
-Common side effect- nausea and vomiting
-Causes less gastric irritation and bleeding than aspirin
-Half life:2-4 hours
-Duration: 4-6 hours
Aspirin
-Treats inflammation by inhibiting both COX-1 and COX-2
-Readily available, inexpensive, effective
-Large doses needed to relieve severe inflammation
-Adverse effects: Irritates digestive system, may cause bleeding, salicylism may occur, tinnitus, dizziness, headache, excessive perspiration
Systemic Glucocorticoids
-Effective in treating severe inflammation
-Naturally released from adrenal cortex
-Suppress histamine and prostaglandins
-Can inhibit immune system to reduce inflammation
-Serious adverse effects: suppression of adrenal-gland function, hyperglycemia, mood changes, cataracts, peptic ulcers, electrolyte imbalances, osteoporosis
-Can mask infections
-Contraindicated in active infections
Treatment with Glucocorticoids
-Used for short-term treatment of acute inflammation
-Long-term treatment:
Keep dose as low as possible
Use alternate-day dosing
Cushing’s syndrome may result
Discontinue gradually
Systemic Glucocorticoids
-Prototype drug: prednisone (Meticorten)
-Mechanism of action: being metabolized to an active form of glucocorticoid
-Primary use: to treat inflammation
-Adverse effects: long-term therapy may result in Cushing’s syndrome, bruising
-Half life: 3.5 hours
-Duration: 24-36 hours
-Pregnancy Category: C
-IM injections
Antipyretics
-Prototype drug: acetaminophen (Tylenol)
-Mechanism of action: to reduce fever by direct action at level of hypothalamus and dilation of peripheral blood vessels
-Enables sweating and dissipation of heat
-Primary use: to relieve pain and reduce fever; no anti-inflammatory actions
-Adverse effects: possible liver damage, causes less gastric irritation than aspirin, does not affect blood coagulation
Should not exceed 2 grams per 24 hour period or 4 extra strength Tylenol
Penicillin
-Prototype drug: penicillin G (Pentids)
-Mechanism of action: to kill bacteria by disrupting their cell walls
-Primary use: as a drug of choice against streptococci, pneumococci, and staphylococci organisms that do not produce penicillinase
-Also medication of choice for gonorrhea and syphilis
-Adverse effects: diarrhea, nausea, vomiting, superinfections, anaphylaxis
-Avoid cephalosporins if client has history of severe penicillin allergy
-Monitor for hyperkalemia and hypernatremia
-Monitor cardiac status, including ECG changes
-Pregnancy category B
Cephalosporins
-Prototype drug: cefotaxime (Claforan)
-Mechanism of action: to act with broad spectrum activity against gram-negative organisms
-Primary use: for serious infections of lower respiratory tract, central nervous system, genitourinary system, bones, blood and joints
-Adverse effects: hypersensitivity, anaphylaxis diarrhea, vomiting, nausea, pain at injection site
-Assess for presence or history of bleeding disorders, may reduce prothrombin levels
-Assess renal and hepatic function
-Avoid alcohol
-Pregnancy Category B
-IM injections
Tetracycline
-Prototype drug: tetracycline HCL (Achromycin, others)
-Mechanism of action: effective against broad range of gram-positive and gram-negative organisms
-Primary use: clamydiae, rickettsiae, and mycoplasma
-Adverse effects: superinfections, nausea, vomiting, diarrhea, discoloration of teeth, photosensitivity
-Contraindicated for clients who are pregnant or lactating
-Effect on linear skeletal growth of fetus and child
-Contraindicated in children less than 8 years of age
-Permanent mottling and discoloration of teeth
-Tetracycline decrease effectiveness of oral contraceptives
-Use caution in clients with impaired kidney or liver function
-Photosensitivity may result
-Do not take with milk products, iron supplements, magnesium-containing laxatives, or antacids
Macrolide
-Prototype drug: erythromycin (E-Mycin)
-Mechanism of action: to act as spectrum similar to that of penicillins
-Primary use: for serious urinary, respiratory, nervous, or GI infections
-Adverse effects: nausea, abdominal cramping, ototoxiciy, and nephrotoxicity
-Most severe is hepatotoxicity
Aminoglycoside
-Prototype drug: gentamycin (Garamycin)
-Mechanism of action: to act as broad-spectrum, bacteriocidal antibiotic
-Monitor for ototoxicity and nephrotoxicity
-Hearing loss may occur after therapy has been completed
-Neuromuscular function may also be impaired
-Increase fluid intake, unless otherwise contraindicated, to promote excretion
Vancomycin
-(Vancocin) effective for MRSA infections
-Adverse effects: ototoxicity, nephrotoxicity, red man syndrome
-Sometimes referred to as the last chance drug for resistant infections
Fluoroquinolone
-Prototype drug: ciprofloxacin (Cipro)
-Mechanism of action: to inhibit bacterial DNA gyrase
-Affects bacterial replication and DNA repair
-Primary use: for respiratory infections, bone and joint infections, GI infections, ophthalmic infections, sinusitis, and prostatitis
-Adverse effects: nausea, vomiting, diarrhea, phototoxicity, headache, dizziness
-Monitor white blood count
-Monitor client with liver and renal dysfunction
-May affect tendons, especially in children (Achilles)
Sulfonamide
-Prototype: trimethroprim-sulfamethoxazole (Sulfa or Bactrim) (TXM)
-Primary use: UTI, skin infections, acute bronchitis
-Adverse effects: skin rashes, nausea, vomiting, agranulocytosis or thrombocytopenia. Steven Johnson Syndrome
-Decreases WBC count
Antifungal drugs- Superficial Infections
-Prototype drug: nystatin (Mycostatin)
-Mechanism of action: binds to sterols in the fungal-cell membrane, allowing leakage of intracellular contents
-Primary use: Candida infections of intestines, vagina, skin, mouth
-If used orally: swish and swallow
-Adverse effects: minor skin irritation, nausea, vomiting, diarrhea
Antifungal Drugs- Systemic Infections
-Prototype drug: fluconazole (Diflucan)
-Mechanism of action: to act by interfering with synthesis of ergosterol
-Primary use: to treat fungal infections in CNS, bone, eyes, urinary tract, respiratory tract
effective against Candida species
-Adverse effects: nausea, vomiting, diarrhea reported at high doses
Antifungal
-Prototype drug: metronidazole (Flagyl)
-Mechanism of action: to act as antiprotozoal drug that also has antibiotic activity against anaerobic bacteria
-Primary use: Treats most forms of amebiasis
-Adverse effects: anorexia, nausea, diarrhea, dizziness, headache, dry mouth, unpleasant metallic taste
-Do not use alcohol while taking
-May affect glycemic control in diabetic clients; monitor blood sugar
Antifungal Drugs- Systemic Infections
-Prototype drug: amphotericin B (Fungizone)
-Mechanism of action: binds to ergosterol in fungal-cell membranes
-Causes them to become permeable or leaky
-Primary use: Includes most fungi pathogenic
-Adverse effects: fever, chills, vomiting, headache at beginning of therapy
-Phlebitis common during IV therapy
-Nephrotoxicity, electrolyte imbalances common
-Cardiac arrest, hypotension, dysrhythmias possible
-Can cause kidney damage
-Closely monitor fluid and electrolyte status
-Can cause ototoxicity
-Assess for hearing loss, vertigo, unsteady gait, tinnitus
-Monitor IV site frequently
-Monitor vital signs frequently
AntiHelminthic Drugs
-Prototype drug: mebendazole (Vermox)
-Mechanism of action: as broad-spectrum antihelminthic drug
-Primary use: to treat wide range of helminth infections
-Adverse effects: as worms die, abdominal pain, distension, and diarrhea may be experienced

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