Top 100 Drugs for Nur 105

aripiprazole (Abilify)
Therapeutic: antipsychotic, mood stabilizers Pharm: dihydrocarbostyril
MOA: Appears to be due to agonist activity at dopamine D2 and 5-hydroxytryptamine 5-HT(1A) receptors and antagonist activity at 5-HT(2A) receptors. Also has alfa2 receptor blocking activity.
Side Effects: Abnormal gait, confusion, depression, hostility, extremity tremor, angina, bradycardia, hypo/hypertension, palpitations, prolonged QT interval, dry skin, pruritus, photosensitivity, ulcers, ear pain, N/V, anorexia, dysphagia, flatulence, GERD, tongue edema, urinary incontinence, anemia, muscle cramp, dehydration
Labs: May cause increase creatinine phosphokinase. Monitor CBC frequently in initial months of therapy. May cause leukopenia, neutropenia, or agranulocytosis (Discontinue if occurs). Monitor blood glucose and cholesterol levels.
INTERVENTIONS: Assess mental status, weight/BMI, fasting blood glucose/cholesterol levels, BP. Monitor for tardive dyskinesia (uncontrolled movement of mouth, face, extremities, contact HCP ASAP, irreversible). Neuroleptic Malignant Syndrome (fever, respiratory distress, tachycardia, seizures, pallor, incontinence)
ADMIN: PO: Once daily, w/o regards to meals
TEACH: Change positions slowly, avoid driving, contact HCP if thoughts of suicide/depression.




darbepoetin (Aranesp)
Therapeutic: antianemics Pharm: Hormone
(erythropoiesis stimulating agents)
MOA:Stimulates erythropoiesis (production of red blood cells). Indicated:Anemia associated with chronic kidney disease (CKD).
Chemotherapy-induced anemia in patients with non-myeloid malignancies.
Side Effects: seizure, dizziness, fatigue, cough, dyspnea, bronchitis, HF, MI, Stroke, Thromboembolic events, edema, HTN, angina, hypotension, N/V, abdominal pain, nausea, pruritus, pure red cell aplasia, myalgia, arthralgia, back pain, limb pain, fever sepsis, allergic reaction, increase tumor growth.
Labs: May increase WBC & Platelets. Monitor CBC w/ differential. Transfusion may be required still for severe symptomatic anemia. Institute seizure precautions for a 1.0g/dL hbg.

efavirenz, emtricitabine, tenofovir
Therapeutic: antiretroviral
Pharm: efavirenz(non nucleoside reverse transcriptase inhibitors)
emtricitabine(nucleoside reverse transcriptase inhibitors) tenofovir(nucleoside reverse transcriptase inhibitors)

MOA’S: tenofovir:Active drug (tenofovir) is phosphorylated intracellularly; tenofovir diphosphate inhibits HIV reverse transcriptase resulting in disruption of DNA synthesis.
emtricitabine: Phosphorylated intracellularly where it inhibits HIV reverse transcriptase, resulting in viral DNA chain termination.
efavirenz: Inhibits HIV reverse transcriptase, which results in disruption of DNA synthesis.

Therapeutic effect:Slowed progression of HIV infection and decreased occurrence of sequelae.
Increases CD4 cell counts and decreases viral load.

Side effects: emtricitabine: CNS: dizziness, headache, insomnia, weakness, depression, nightmares
GI: abdominal pain, diarrhea, nausea, SEVERE HEPATOMEGALY WITH STEATOSIS, dyspepsia,, vomiting
Derm: rash, skin discoloration
MS: arthralgia, myalgia
Neuro: neuropathy, paresthesia
Resp: cough, rhinitis
Misc: fat redistribution, immune reconstitution syndrome
tenofovir: CNS: depression, headache, weakness
GI: HEPATOMEGALY, (with steatosis), diarrhea, nausea, abdominal pain, anorexia, vomiting, flatulence
GU: proximal renal tubulopathy, renal impairment
F and E: LACTIC ACIDOSIS, hypophosphatemia
Derm: rash
MS: ↓ bone mineral density, osteomalacia
Misc: immune reconstitution syndrome
efavirenz: CNS: abnormal dreams, depression, dizziness, drowsiness, fatigue, headache, impaired concentration, insomnia, nervousness, psychiatric symptomatology
GI: HEPATOTOXICITY, nausea, abdominal pain, anorexia, diarrhea, dyspepsia, flatulence
GU: hematuria, renal calculi
Derm: rash, sweating, pruritus
Endo: hypercholesterolemia, hypertriglyceridemia
Neuro: hypoesthesia
Misc: fat redistribution, immune reconstitution syndrome
Intervention/labs: Monitor viral load and CD4 cell count regularly during therapy.
Monitor liver function tests in patients with a history of hepatitis B or C or underlying liver disease. May cause ↑ serum AST, ALT, and GGT concentrations. If moderate to severe liver function test abnormalities occur, efavirenz doses should be held until levels return to normal. Discontinue if liver function abnormalities recur when therapy is resumed.
May cause ↑ in total cholesterol and serum triglyceride levels.
Obtain a pregnancy test prior to starting therapy. May cause fetal harm if administered during first trimester of pregnancy.
May cause false-positive urine cannabinoid results. Assess patient for CNS and psychiatric symptoms. May cause ↑ AST, ALT, bilirubin, creatine kinase, serum amylase, serum lipase, and triglycerides.May cause ↑ or ↓ serum glucose. May cause ↓ neutrophil count. Assess patient for change in severity of HIV symptoms and for symptoms of opportunistic infections during therapy.
May cause lactic acidosis and severe hepatomegaly with steatosis. These events are more likely to occur if patients are female, obese, or receiving nucleoside analogue medications for extended periods of time. Monitor patient for signs (increased serum lactate levels, elevated liver enzymes, liver enlargement on palpation). Therapy should be suspended if clinical or laboratory signs occur.
Test patients for chronic hepatitis B virus (HBV) before initiating therapy. Emtricitabine is not indicated for treatment of HBV. Exacerbations of HBV have occurred upon discontinuation of emtricitabine. Calculate creatinine clearance prior to and periodically during therapy and when clinically indicated.
Monitor serum phosphate periodically during therapy in patients at risk for renal impairment. May cause hypophosphatemia in patients with renal impairment.
May cause hyperglycemia and glycosuria.

Contraindicated: hypersensitivity, use of NSAIDS, Lactation, pregnancy, hepatic impairment, concurrent use of pimozide, midazolam, triazolam, voriconazole, St. John’s wort, or ergot derivatives

bevacizumab (Avastin)
Therapeutic: antineoplastics Pharm: monoclonal antibodies
MOA: A monoclonal antibody that binds to vascular endothelial growth factor (VEGF), preventing its attachment to binding sites on vascular endothelium, thereby inhibiting growth of new blood vessels (angiogenesis).
Side effects: CNS: reversible posterior leukoencephalopathy syndrome (RPLS) Assess( headache, seizure, lethargy, confusion, blindness)
CV: HF, THROMBOEMBOLIC EVENTS, hypertension, hypotension
Resp: HEMOPTYSIS, non-gastrointestinal fistulas, nasal septum perforation
GU: nephrotic syndrome, ovarian failure, proteinuria
Misc: WOUND DEHISCENCE, impaired wound healing, infusion reactions Contraindicated: hypersensitivity, serious recent bleeding, hemoptysis, First 28 days after major surgery, Pregnant, lactation.

Interventions: surgical wounds should be fully healed before administering. Assess for signs of GI perforation; Assess for signs of hemorrhage; Monitor BP, infusion reactions, signs of HF. Labs: monitor for Proteinuria. May cause hypokalemia, bilirubinemia, thrombocytopenia, leukopenia. Is teratogenic advise female patients to use effective contraception.

Avonex (interferon beta-1a)
THERAPEUTIC CLASS: Multiple Sclerosis Agent; Immune Modifier
PHARMACOLOGICAL CLASS: Interferon, Escherichia coli derivative
MOA: Antiviral, immunoregulatory; action not clearly understood; biologic response-modifying properties mediated through specific receptors on cells, inducing expression of interferon-induced gene products.
USES: Ambulatory patients with relapsing or remitting MS
UNLABELED USES: Useful in AIDS-related Kaposi’s sarcoma, malignant melanoma, metastatic renal cell carcinoma, cutaneous T-cell lymphoma, acute non-A/non-B hepatitis, chronic hepatitis C
SIDE EFFECTS: Suicide attempts, increase BP, tachycardia, depression, seizures, migraines, decreased lymphocytes, ANC, WBC and myasthenia
INTERVENTIONS: Notify prescriber of increased temperature, chills, muscle soreness, fatigue, depression, symptoms of hepatoxicity, monitor mental status for suicidal thoughts.
LABS: CBC, differential, platelet counts, BUN, creatinine ALT, urinalysis; if neutrophil count <750/mm3 or if AST/ALT is 10 x normal, discontinue product

Avonex Pen

Pt self injects
Pt to remove one Administration Dose Pack from the refrigerator to warm to room temperature (about 30 min beforehand)
Hold the Avonex pen with the glass syringe tip pointing up
Inject into the upper outer thigh by holding the pen at a 90-degree angle to the injection site.
Firmly push the body of the pen down against the thigh to release the safety lock.
Push the activation button with the thumb and count to 10 then pull the pen straight out of the skin. The display will appear yellow if full dose is received.

THERAPEUTIC CLASS: Multiple Sclerosis Agent; Immune Modifier
PHARMACOLOGICAL CLASS: Interferon, Escherichia coli derivative
MOA: Antiviral, immunoregulatory; action not clearly understood; biologic response-modifying properties mediated through specific receptors on cells, inducing expression of interferon-induced gene products.
USES: Ambulatory patients with relapsing or remitting MS
UNLABELED USES: Useful in AIDS-related Kaposi’s sarcoma, malignant melanoma, metastatic renal cell carcinoma, cutaneous T-cell lymphoma, acute non-A/non-B hepatitis, chronic hepatitis C
SIDE EFFECTS: Suicide attempts, increase BP, tachycardia, depression, seizures, migraines, decreased lymphocytes, ANC, WBC and myasthenia
INTERVENTIONS: Notify prescriber of increased temperature, chills, muscle soreness, fatigue, depression, symptoms of hepatoxicity, monitor mental status for suicidal thoughts.
LABS: CBC, differential, platelet counts, BUN, creatinine ALT, urinalysis; if neutrophil count <750/mm3 or if AST/ALT is 10 x normal, discontinue product

Benicar (olmesartan)
THERAPEUTIC CLASS: Antihypertensive
PHARMACOLOGICAL CLASS: Angiotensin II Receptor (type AT1) antagonist
MOA: Blocks the vasoconstrictor and aldosterone-secreting effects of an angiotensin II; selectively blocks the binding of angiotensin II to the AT1 receptor found in tissues.
USES: Hypertension, alone or in combination with other antihypertensives
SIDE EFFECTS: Angioedema, hyperkalemia, hypotension, dizziness, headache, upper respiratory infection
INTERVENTIONS: Monitor renal function, BP, pulse q4hr, note rate, rhythm and quality
LABS: Obtain electrolytes, sodium, potassium, chloride baselines for renal and hepatic studies before therapy begins.

Betaseron (interferon beta-1 b)
THERAPEUTIC: Anti-multiple sclerosis agent, immune modifier
MOA: antiviral and immunoregulatory properties reduce MS flare-ups
Indications: Relapsing multiple sclerosis, MS patients who experienced first clinical episode and have MRI consistent with MS
SIDE EFFECTS: Suicidal thoughts, depression, insomnia, incoordination, dyspnea, edema, angina, HTN, autoimmune hepatitis, increased liver enzymes, N&V, urinary urgency, erectile dysfunction, menstrual disorders, spontaneous abortion, hyper or hypothyroidism, injection site necrosis, muscle spasm and allergic anaphylaxis.
INTERVENTIONS: Use caution with history of depression or suicidal tendencies, CHF, or potential for pregnancy. Monitor and teach family to watch for signs of depression and suicidal thoughts. Instruct to report s/s of injection site necrosis, worsening HF, or pregnancy to HCP.
LABS: Monitor Hgb, WBC, platelets, liver and thyroid function labs.

S Corl

nebivolol (Bystolic)
Therapeutic: antihypertensives
Pharm: beta-blockers
MOA: Blocks stimulation of beta-adrenergic receptor sites, selective for beta1 (myocardial) receptors.
SIDE EFFECTS: dizziness, fatigue, HA
INTERVENTIONS: Monitor BP, ECG, and pulse prior to admin. Monitor I/O ratios and daily weights. Assess for S/S of HF
LABS: May cause increase BUN, uric acid, triglycerides, and decrease HDL cholesterol and platelet count
ADMIN: PO: Without regard to food. Taper d/c over 1-2 weeks.
TEACH: How to check pulse/BP. Check pulse daily, BP bi-weekly. May mask some signs of hypoglycemia, monitor BG closely. Avoid driving (dizziness). Notify HCP is difficulty breathing or signs of HF appear. Women-Avoid breastfeeding.

Celebrex (celecoxib)
MOA: inhibits the enzyme COX-2. This enzyme is required for the synthesis of prostaglandins.
Has analgesic, anti-inflammatory, and antipyretic properties.
USES: Decreased pain and inflammation caused by arthritis or spondylitis. Management of acute pain including primary dysmenorrhea.
SIDE EFFECTS: MI, stroke, thrombosis, edema, SJS, rash, dermatitis, GI bleeding, abdominal pain, dyspepsia,nausea, diarrhea, insomnia, HA, and dizziness.
INTERVENTIONS: Watch for signs of rash- dc if rash is present. assess pt for allergies to sulfa, asprin, or NSAIDS. Instruct pt to watch out for heptatoxicity and GI toxicity.

Cialis (tadalafil)
THERAPEUTIC CLASS: erectile dysfunction agent & vasodilator
PHARMACOLOGICAL CLASS: phosphodiesterase type 5 inhibitors
MOA: Increases cyclic guanosine monophosphate (cGMP) levels by inhibiting phosphodiesterase type 5 (PDE5) an enzyme responsible for the breakdown of cGMP. cGMP produces smooth muscle relaxation of the corpus cavernosum, which in turn promotes increased blood flow and subsequent erection. cGMP also leads to vasodilation of the pulmonary vasculature.
USES:Erectile dysfunction (ED) & Benign prostatic hyperplasia (BPH)
SIDE EFFECTS: HA, hearing loss, nasal congestion,vision loss, hypotension, dyspepsia, priaprism, flushing, and back and limb pain.
INTERVENTIONS: take 30 min before sexual activity and not more than once a day.Do not take with nitrates.

Combivent Respimat (ipratropium bromide and albuterol)
THERAPEUTIC CLASS: two bronchodialator
MOA: antagonizes acetylcholine receptors, producing bronchodilation (ipratroprium) stimulates beta 2 adrenergic receptors, relaxing airway smooth muscle (albuterol)
SIDE EFFECTS:.Headache, dizziness, nausea, dry mouth, shaking (tremors), nervousness, or constipation

Copaxone (glatiramer acetate)
-Therapeutic class: Immunomodulatory agent

-Pharmacological class: Immunomodulator

-MOA: The mechanism(s) are not fully understood. However, glatiramer acetate is thought to act by modifying immune processes that are believed to be responsible for the pathogenesis of MS. This hypothesis is supported by findings of studies that have been carried out to explore the pathogenesis of experimental autoimmune encephalomyelitis, a condition induced in animals through immunization against central nervous system derived material containing myelin and often used as an experimental animal model of MS. Studies in animals and in vitro systems suggest that upon its administration, glatiramer acetate-specific suppressor T-cells are induced and activated in the periphery.
Because glatiramer acetate can modify immune functions, concerns exist about its potential to alter naturally-occurring immune responses. There is no evidence that glatiramer acetate does this, but this has not been systematically evaluated
USES: Multiple sclerosis

-Contraindications: Hypersensitivity to mannitol or glatiramer

-Side effects: Chest pain, dyspnea, anxiety, flushing, skin necrosis or lipoatrophy at injection site

Complera (emtricitabine, rilpivirine, tonofovir)
-Therapuetic class: antiretrovirals

-Pharmacological: nucleoside

-Use: Management of HIV, complete regimen for treatment naive adults

-MOA: Emtricitabine- phosphorylated intracellularly where it inhibits HIV reverse transcriptase, resulting in viral DNA chain termination RILIPIVIRINE- inhibits HIV replication by noncompetetivley inhibiting HIV reverse transcriptase, TENOFOVIR- phosphorylated intratracellularly where it inhibits HIV reverse transcriptase resulting is disruption of DNA synthesis. ALL SLOW PROGRESSION OF HIV AND DECREASE OCCURRENCE OF SEQUELAE

-SE: Hepatotoxicity, renal impairment, decreased bone density, post-treatment acute exacerbation of hepatitis B, fat redistribution, immune reconstitution syndrome.

-Contraindications: concurrent use of other antiretrovials –

-Monitor for depression, and liver function, bone density

rosuvastatin (Crestor)
Therapeutic: lipid-lowering agents
Pharm: HMG-CoA reductase inhibitors
INDICATIONS: Management of primary hypercholesterolemia and mixed dyslipidemias. SLow progression of atherosclerosis.
MOA: Inhibit an enzyme, HMG-CoA reductase, which is responsible for catalyzing an early step in the synthesis of cholesterol
SIDE EFFECTS: Confusion, dizziness, HA, chest pain, peripheral edema, ABD cramps, constipation, diarrhea, flatus, heartburn, erectile dysfunction, rashes, pruritus, hyperglycemia, rhabdomyolysis
INTERVENTIONS: Obtain dietary history (regards to fat)
LABS: Serum cholesterol and triglycerides, monitor Liver function tests (AST/ALT). May also increase alkaline phosphatase and bilirubin levels. If muscle tenderness, monitor creatine kinase levels
ADMIN: PO: Take anytime of the day, w/o regard to food. Avoid giving with grapefruit. Admin antacid at least 2hr after
TEACH: Notify HCP if signs of liver injury or if unexplained muscle pain occurs, especially with fever or malaise. Use effective contraception. Avoid breastfeeding. Importance of follow up exams to determine effectiveness.

Daptomycin (Cubicin)
Functional class: Anti-infective

Chemical class: Lipopeptides

Action: A new class anti-infective; binds to the bacterial membrane and results in a rapid depolarization of the membrane potential, leading to inhibition of DNA, RNA, & protein synthesis.

Side Effects: heart failure, Leukocytosis, anemia, thrombocytopenia, pseudomembranous colitis, nephrotoxicity.

Contraindications: Hypersensitivity

Assess I&O ratio
compromised renal system
Blood studies
Culture & Sensitivity
BP, Respiratory status
Allergies prior to treatment

dexlansoprazole (Dexilant)
Functional class: Antiulcer, PPI

Chemical class: Benzimidazole

Action: Suppresses gastric secretion by inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cells, blocking the final step of acid production.

CNS: anxiety, seizures
HEMA: neutropenia, thrombocytopenia, pernicious anemia, thrombosis
EENT: pneumonia

Contraindications: Hypersensitivity

Assess GI system (bowel sounds q8h, abdominal pain, swelling, anorexia.
Hepatic Studies (AST, ALT, alkaline phosphate during treatment).
Swallow caps completely, do not crush. May sprinkle on food and consume immediately.
Report severe diarrhea
Educate pt. to avoid hazardous activities b/c drug may cause dizziness to occur.
Do not mix w/ alcohol.

Duloxetine ( Cymbalta)
Functional class: Antidepressant

Chemical class: Serotonin- norepinephrine reuptake inhibitor.

Action: inhibits neuronal serotonin & norepinephrine reuptake.

CNS: insomnia, anxiety, dizziness, tremor
CV: thrombophlebitis, peripheral edema, hypertension
INTEG: photosensitivity, bruising, sweating
GI: N/V/C, dry mouth, dysphagia
GU: urinary hesitation/ retention/ frequency
EENT: abnormal vision
Contraindications: Alcoholism, glaucoma, jaundice

Elevate legs if peripheral edema occurs
-Advise pt to use sugarless gum, hard candy, or frequent sips of water for dry mouth
-Black Box warning: suicidal tendencies
-Assess mental status

valsartan (Diovan)
Therapeutic: antihypertensives
Pharm: Angiotensin II receptor Antagonists
INDICATIONS: Management of HTN
MOA: Blocks vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites, including vascular smooth muscle and the adrenal glands
SIDE EFFECTS: Dizziness, depression, fatigue, HA, hypotension, chest pain, edema, rashes, nasal congestion, rhinitis, ABD pain, diarrhea, N/V, impaired renal function, hyperkalemia, angioedema
INTERVENTIONS: Assess BP/pulse, signs of angioedema, signs of HF (monitor daily weights and fluid overload)
LABS: Renal function and electrolyte levels (K+, BUN< and creatinine may by increased). May cause increase in AST/ALT, and bilirubin. May cause increase in uric acid, decrease in H&H, neutropenia, and thrombocytopenia. ADMIN: PO: Without regard to food TEACH: Avoid salt substitutes. Change positions slowly. Avoid driving (dizziness). Notify HCP if swelling of face, eyes, lips, or tongue occur. D/c if pregnant. Importance of follow up exams for evaluating effectiveness. Check BP/pulse weekly.

Etanercept (Enbrel)
Therapeutic: antirhuematics; Pharm: anti-TUF agents Indications: To decrease progression, signs and symptoms of rheumatoid arthritis, juvenile arthritis, ankylosing spondylitis, psoriatic arthritis or plaque psoriasis when response has been inadequate to other disease-modifying agents. Actions: binds to tumor necrosis factor (TNF), making it inactive. TNF is a mediator of inflammatory response. Therapeutic Effects: decreased inflammation and slowed progression of arthritis, spondylitis, or psoriasis. Side Effects: CNS: headache, dizziness, weakness. EENT: rhinitis, pharyngitis. Resp: upper respiratory tract infection, cough, respiratory disorder. GI: abdominal pain, dyspepsia. Derm: psoriasis, rash. Hemat: pancytopenia. Local: injection site reactions. Misc: infections, malignancy, sarcoidosis. Assess for signs and symptoms of systemic fungal infections. Monitor CBC with differentially periodically during therapy. Administer a TB skin test prior to administration of etanercept. Pt with active latent TB should be treated for TB prior to therapy. Needle cover of the prefilled syringes contain latex and should not be handled by people with latex allergies. Assess injection site rotation. Assess ROM, degree of swelling, and pain before and periodically during therapy.

Epoetin alfa (Epogen)
Therapeutic: antianemics Pharm: hormones, erythropoiesis stimulating agents
Indications: Anemia associated with chronic kidney disease, anemia secondary to zidovudine (AZT) therapy in HIV-infected patients. Anemia from chemotherapy in patients with nonmyeloid malignancies. Reduction of need for allogeneic red blood cell transfusions in patients undergoing elective, noncardiac, nonvascular surgery. Action: stimulates erythropoiesis (production of red blood cells). Therapeutic Effects: Maintains and may elevate RBCs, decreasing the need for transfusions. Side Effects: CNS: seizures, headaches. CV: HF, MI, stroke, thromboembolic events, hypertension. Derm: transient rashes. Endo: restored fertility, resumption of menses. Misc: increased mortality and increased tumor growth. Monitor BP before and during therapy. Monitor for signs and symptoms of anemia. Monitor dialysis shunts (thrill and bruits) and status of artificial kidney during hemodialysis. Heparin dose may need to be increased to prevent clotting. May cause increase in WBCs and platelets. May decrease bleeding time. Monitor serum ferritin, transferrin, and iron levels to assess need for concurrent iron therapy. Monitor renal function studies and electrolytes. Notify HCP if chest pain, SOB, or swelling in the extremities occur

cetuximab (Erbitux)
Therapeutic: antineoplastics (decreased tumor growth and spread)
Pharm: monoclonal antibodies
INDICATIONS: Locally/regionally advanced squamous cell carcinoma of the head/neck with radiation
MOA: Binds to EGFR, preventing the binding of endogenous epidermal growth factor(EGF), preventing cell growth and differentiation processes.
SIDE EFFECTS: malaise, depression, HA, insomnia, cough, dyspnea, cardiopulmonary arrest, pulmonary embolism, sudden cardiac death, ABD pain, constipation, diarrhea, N/V, anecform dermatitis, dehydration, fever, infusion reactions
INTERVENTIONS: Assess for infusion reactions for 1hr after infusion. Onset/worsening of pulmonary symptoms. Dermatologic toxicities (rash, dry skin, fissuring).
LABS: determine K-Ras mutation and EGFR-expression status. May cause anemia/leukopenia. Monitor serum electrolytes (decreasing Mg, K, Ca)
Premeditate with histamine(1) antagonist 30-60min prior to first dose. Do not shake or dilute. Should be piggybacked. Observe for 1hr after.
TEACH: Wear sunscreen and limit exposure. Use adequate contraception. Avoid breast feeding.

raloxifene (Evista)
Therapeutic: bone resorption inhibitors
Pharm: selective estrogen receptor modulators
INDICATIONS: Treatment and prevention of osteoporosis in postmenopausal women
MOA: Binds to estrogen receptors, producing estrogen-like effects on bone, resulting in reduced resorption of bone and decreased bone turnover
SIDE EFFECTS: Stoke, thromboembolism, leg cramps, hot flashes
INTERVENTIONS: Assess for bone mineral density using xray, serum, and urine bone turnover markers
LABS: May cause increase apolipoprotein(A1) and reduced serum total cholesterol, LDL, fibrinogin, apolipoproteinB, and lipoprotein. May cause increase hormone binding globulin, w/ increased total hormone concentrations. May cause decrease in Ca, inorganic phosphate, total protein, albumin, and platelet count
ADMIN: PO: w/o regard to food, Ca supplement should be added if intake is inadequate
TEACH: Discontinue smoking/alcohol. Regular weigh-bearing exercise. Notify HCP ASAP if leg pain, swelling (legs, hands, feet), sudden chest pain, SOB occur. Avoid becoming pregnant.

fluticasone propionate (Flovent HFA) (Flonase)
THERAPEUTIC CLASS: corticosteroid


INDICATIONS: sprayed into the nose to help relieve stuffy or runny nose, irritation, sneezing, allergies, or hay fever.

MOA: binding affinity for the human glucocorticoid receptors.

SIDE EFFECTS: Bloody mucus, nosebleeds, cough, HA, nausea, SOB, Vomiting, Diarrhea, fever, weakness, loss of appetite.

NURSING ACTIONS: instruct patient to inhale 1 spray into each nostril every day. report any mucus membrane irritation.

Dexmethylphenidate (focalin XR)
Therapeutic/pharmacological class- CNS stimulant

Indications- treatment of ADD/ADHD; symptomatic treatment of narcolepsy

Action- produces CNS and respiratory stimulation with weak sympathomimetic activity

Side effects-
CNS: hyperactivity, insomnia, restlessness, tremor, dizziness, headache, irritability
EENT: blurred vision
CV: HTN, palpitations, tachycardia, hypotension
GI: anorexia, constipation, cramps, diarrhea, dry mouth, metallic taste, n/v
Deem: rashes
Neuro: akasthasia, dyskinesia
Misc: fever, hypersensitivity reactions, physical dependence, psychological dependence, suppression of weight gain (children), tolerance

Contraindications- hypersensitivity, hyperexcitable states, hyperthyroidism, psychotic personalities, suicidal or homicidal tendencies, glaucoma, motor tics, family hx or dx of Tourette’s, concurrent use of MAO inhibitors

Nurse actions:
Monitor BP, pulse, and RR; remember it has potential for abuse; assess attention span, impulse control, and interactions with others; monitor weight biweekly; monitor for behavior changes; assess fingers periodically for signs of peripheral vasculopathy; monitor CBC w/ diff and platelet count

Take as prescribed before 6pm; weight will be assessed 2-3 times weekly; avoid caffeine containing beverages; report palpitations or insomnia; parents should notify school nurse of med regimen

HPV Vaccine (Gardasil)
Therapeutic class- vaccines/immunizing agents

Indications- prevention of cervical, vulvar, and anal cancers and genital warts (in females) and anal cancer and genital warts (in males)

Action- vaccination results in antibodies to HPV viruses that are causative agents for cervical, vulvar, vaginal, and anal cancers and genital warts

Contraindications- hypersensitivity, thrombocytopenia/bleeding disorder, OB

Side effects-
Neuro: fainting
Local: injection site reactions
Misc: anaphylaxis (rare)

Nurse actions:
Assess VS; do not give to pt with current or recent febrile illness (low grade fever and mild upper respiratory infection is ok); monitor pt for 15 min after injection for fainting; pt should remain lying down or seated to prevent falls/injury

Do not dilute; give full dose in prefilled syringe; shake well; solution should be cloudy and white; administer IM in deltoid or high anterolateral area of thigh

Vaccine not intended for tx of active genital warts or cervical cancer and won’t protect from diseases not caused by HPV; does not replace routine cervical cancer screening or prevent other STDs; notify HCP of all meds being taken; notify HCP if pregnancy is planned/suspected; report adverse reactions to HCP

Imatinib (Gleevec)
THERAPEUTIC CLASS: antineoplastics/ PHARMACOLOGIC: Protein- tyrosine kinase inhibitor. ACTION: Inhibits Bcr-Abl tyrosine kinase created in patients with chronic myeloid leukemia. CONTRAINDICATIONS: Pregnancy, hypersensitivity PRECAUTIONS: Breastfeeding, geriatric patients, GI bleeding, bone marrow suppression, cardiac/renal/hepatic disease. SIDE EFFECTS: CNS: hemorrhage, headache, dizziness, insomnia. CV: heart failure, cardiac tamponade, cardiac toxicity. EENT: blurred vision, conjunctivitis GI: Nausea, dyspepsia, abdominal pain, GI hemmorhage. HEMA: Neutropenia, thrombocytopenia, INTEG: Rash, pruritis, alopecia, photosensitivity META: weight gain, fluid retention, hypokalemia MS: cramps, pain, arthralgia, myalgia RESP: Cough, dypnea, pleural effusion, pneumonia NURSING IMPLICATIONS: Monitor for fluid retention. Monitor for tumor lysis syndrome ( malignant disease progression, high WBC counts, hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia and dehydration. LAB TESTS: Monitor liver function monthly. Monitor CBC weekly for first month, biweekly for second month, and periodically for rest of therapy. PATIENT TEACHING: Avoid grapefruit. May cause drowsiness or dizziness.

Herceptin ( trastuzumab)
THERAPEUTIC CLASS: antineoplastics PHARM CLASS: monoclonal antibodies INDICATIONS: First-line treatment of mestastatic breast cancer. ACTION: Binds to HER2 sites in breast cancer tissue and inhibits proliferation of cells that overexpress HER2 protein. CONTRAINDICATIONS: Chinese hamster ovary cell protein. SIDE EFFECTS: CNS: Dizziness, numbness, insomnia, neuropathy CV: Tachycardia, CHF GI: N/V, anorexia, diarrhea, hepatotoxicity HEMA: Anemia, leukopenia INTEG: Rach, acne, herpes simplex META: Edmea. peripheral edema RESP: Cough, dyspnea, pulmonary edema, acute respiratory distress syndrome. NURSING CONSIDERATIONS: Black box warning: CHF, other cardia symptoms: dyspnea, coughing, gallop; obtain full cardiac workup including ECG, echo. Symptoms of infection may be masked by product. Assess for pulmonary toxicity: dyspnea, ARD’s, pulmonary hypertension. Increase fluids to 2-3 liter a day. TEACH: To report sore throat, fever, diarrhea, vomiting.

Humalog ( Insulin Lispro)
THERAPEUTIC CLASS: Antidiabetic PHARM CLASS: Pancreatics ACTIONS: Lower blood glucose by stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production in type 1 and type 2 diabetes. ONSET: 15 minutes PEAK: 1- 2 hours DURATION: 3-4 hours CONTRAINDICATIONS: Hypoglycemia SIDE EFFECTS: ENDO: Hypoglycemia LOCAL: erythema, lipodystrophy, pruritis. NURSING IMPICATIONS: Assess for hypoglycemia( restlessnes, cold sweats, confusion, irritability). Insulin is high alert drug. Must be verified by second RN. Severe hypoglycemia must be immediately treated with IV glucose, glucagon, or epinephrine.

Humalog Kwikpen (insulin lispro)
THERAPUTIC CLASS: Antidiabetic, pancreatic hormone
CHEMICAL CLASS: Modified structes of endogenous human insulin
MOA: Decreased blood glucose by transport of glucose into cells and the conversion of glucose to glycogen, indirectly increases blood pyruvate and lactate, decreases phosphate and potassium
DOSE: Humalog Kwikpen comes in a refillable quick admin pen that is filled with 3ml cartridges,
SIDE EFFECTS: Hypoglycemia, rebound hyperglycemia, Flushing, rash, urticarial, warmth, lipodystrophy, swelling, redness, Blurred vision, dry mouth
CONTRAINDICATORS: Hypoglycemia, allergy
OVERDOSE: Dextrose 50% (D-50) IVP, or Glucagon 1mg iv/im

Humira (adalimumab)
THERAPUTIC CLASS: Antirheumatic agent,(disease modifying), immunonodulator
CHEMICAL CLASS: Recombinant human IgGI monoclonal antibody, DMARDs
MOA: binds and inhibits tumor necrosis factor alpha, reducing inflammation and altering immune response
USES: Used to treat rheumatoid arthritis, Crohn’s Dz, ulcerative colitis, psoriasis, and other conditions caused by overactive immune system responses
SIDE EFFECTS: Headaches, Hypertension, Rash, injection site reaction, Abdominal pain, nausea, hepatic damage, uti, Sinusitis, flulike symptoms, back pain, lupus like syndrome, risk of cancer, risk of infections, infections may be fatal
CONTRAINDICATORS: Active infection

Invega Sustenna (paliperidone palnitate E-R injection)
THERAPUTIC CLASS: Anti-psychotic
CHEMICAL CLASS: Benzisoxazole derivative
MOA: exact mechanism of action unknown; antagonizes dopamine D2 receptors, serotonin 5-HT2A receptors, others
USES: Treatment for schizophrenia
DOSES: 39-234 mg IM qmo
SIDE EFFECTS: EPS: pseudoparkinsonism, akathisia, dystonia, drowsiness, insomnia, agitation, anxiety, dizziness, orthostatic hypotension, N/V, anorexia, constipation, xerostomia, weight gain, Insulin increase, blurred vision
CONTRAINDICATORS: Breastfeeding, geriatric pts, seizure disorders, AV block, QT prolongation, torsade de pointes, hypersensitivity to this product or risperidone

Isentress (raltegravir)
Trade Name: Isentress
Generic Name: raltegravir

Therapeutic: antiretrovirals
Pharmacologic: integrase strand transfer inhibitors(INSTIs)

Inhibits HIV-1 integrase, which is required for viral replication

Adverse Reactions/Side Effects
CNS: SUICIDAL THOUGHTS, headache, depression, dizziness, fatigue, insomnia, weakness.
CV: myocardial infarction.
GI: diarrhea, abdominal pain, gastritis, hepatitis,
nausea, vomiting.
GU: renal failure/impairment.
Hemat: anemia, neutropenia.
Metab: lipodystrophy.

Monitor for anxiety, depression, suicidal ideation, and paranoia during therapy.
Assess for rash periodically during therapy. Discontinue therapy if severe or if accompanied with fever,
general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or eosinophilia.


Januvia (sitaGLIPtin)
Trade Name: Januvia
Generic Name: sitagliptin

Therapeutic: antidiabetics
Pharmacologic: enzyme inhibitors

Inhibits the enzyme dipeptidyl peptidase-4 (DPP-4), which slows the inactivation of incretin hormones, resulting in increased levels of active incretin hormones. These
hormones are released by the intestine throughout the day, and are involved in regulation of glucose homeostasis. Increased/prolonged incretin levels result in an increase
in insulin release and decrease in glucagon levels.

Adverse Reactions/Side Effects
CNS: headache.
GI: PANCREATITIS, nausea, diarrhea.
GU:acute renal failure. Resp:
upper respiratory tract infection, nasopharyngitis.
MS: arthralgia, back pain, myalgia.
Misc: allergic reactions including ANAPHYLAXIS, ANGIOEDEMA, rash, urticaria.

Monitor for signs of pancreatitis (nausea, vomiting, anorexia, persistent severe abdominal pain, sometimes radiating to the back) during therapy. If pancreatitis occurs, discontinue sitagliptin and monitor serum
and urine amylase, amylase/creatinine clearance ratio, electrolytes, serum calcium, glucose, and lipase.

Advise patient to stop taking sitagliptin and notify health care professional promptly if symptoms of hypersensitivity reactions (rash; hives; swelling of face, lips, tongue, and throat; difficulty in breathing or swallowing) or pancreatitis occur.

Lantus (insulin glargine)
Trade Name: Lantus
Generic Name: insulin glargine
Route: Subcutaneous

Rationale: Used to treat high blood sugar levels (hyperglycemia) in type I and type II diabetics.

Therapeutic Class: Antidiabetic Hormones

Chemical Class: Pancreatics

Mechanism of Action: Stimulates glucose uptake by skeletal muscle and fat, inhibiting hepatic glucose production.

Endo: Hypoglycemia
Integ: Lipodystrophy, pruritus, erythema, swelling
Resp: Anaphylaxis
Contraindications: Hypersensitivity, hypoglycemia

Assess for signs of hypoglycemia and hyperglycemia. Monitor body weight periodically, monitor blood glucose every 6 hours during therapy.

Antidote it oral glucose for mild overdose. IV glucose, glucagon, or epinephrine for severe overdose.

Onset: 3-4 hours
Peak: None
Duration: 24 hours

• High Alert Drug.

Lantus Solostar Pen (insulin glargine)
Trade Name: Lantus Solostar Pen
Generic Name: insulin glargine
Route: Subcutaneous

Rationale: Used to treat high blood sugar levels (hyperglycemia) in type I and type II diabetics.

Therapeutic Class: Antidiabetic Hormones

Chemical Class: Pancreatics

Mechanism of Action: Stimulates glucose uptake by skeletal muscle and fat, inhibiting hepatic glucose production.

Endo: Hypoglycemia
Integ: Lipodystrophy, pruritus, erythema, swelling
Resp: Anaphylaxis
Contraindications: Hypersensitivity, hypoglycemia

Assess for signs of hypoglycemia and hyperglycemia. Monitor body weight periodically, monitor blood glucose every 6 hours during therapy.

Antidote it oral glucose for mild overdose. IV glucose, glucagon, or epinephrine for severe overdose.

Onset: 3-4 hours
Peak: None
Duration: 24 hours

• High Alert Drug.

Latuda (lurasidone HCL)
Trade Name: Latuda
Generic Name: lurasidone HCL
Route: Subcutaneous

Rationale: Used to treat schizophrenia.

Therapeutic Class: Antipsychotics

Chemical Class: Benzoisothiazole

Mechanism of Action: Effect may mediate via effects on central dopamine Type 2 (D2) and serotonin Type 2 (5HT2a) receptor antagonism.

CNS: Neuroleptic malignant syndrome, seizures, suicidal thoughts, akathisia, drowsiness, parkinsonism, agitation, anxiety, cognitive/motor impairment
CV: Bradycardia, orthostatic hypotension, syncope, tachycardia
Endo: Hyperglycemia, hyperprolactinemia
Integ: NA
GI: Nausea, esophageal dysmotility
EENT: Blurred vision
Resp: NA
Contraindications: Hypersensitivity, concurrent use of strong CYP3A4 inhibitors or inducers .

Monitor patient’s mental status, assess weight and BMI periodically throughout therapy. Monitor mood changes, blood pressure, and patient to be sure medication is taken not hoarded in cheeks. Monitor for development of neuroleptic malignant syndrome. Monitor CBC frequently during initial month of therapy.

No antidote listed

Levemir (insulin detemir)
Trade: Levemir

Generic: insulin detemir

Functional class: Antidiabetic, pancreatic

Chemical class: Modified structures of endogenous human insulin

Action: Decreased blood glucose by transport of glucose into cells and the conversion of glucose to glycogen, indirectly increases blood pyruvate and lactate, decreases phosphate and potassium; insulin may be human (processed by recombinant DNA technologies)

**Long Acting**
Onset: 40 minutes-2 hours
Peak: unknown
Duration: Up to 24 hours

HEMA: Hypoglycemia, rebound hyperglycemia
INTEG: Flushing, rash, urticaria, warmth, lipodystrophy, swelling, redness
EENT: Blurred vision, dry mouth

Decrease: potassium, calcium
Interference: LFTs, thyroid function studies

Nursing considerations:
Hypoglycemia reaction: HA, tremors, fatigue, weakness
Hyperglycemia reaction: frequent urination, thirst, fatigue, hunger
Ketoacidosis: nausea, thirst, polyuria, dry mouth, decreased B/P, dry flushed skin, acetone breath, Kussmaul respirations

Overdose Treatment: 25 gram D50W IV, or 1mg Glucagon IM

Lucentis (ranibizumab)
Functional class: Ophthalmic

Chemical class: Selective vascular endothelial growth factor antagonist

Uses: Macular degeneration, macular edema after retinal vein occlusion, diabetic macular edema

Action: Binds to receptor-binding site of active forms of vascular endothelial growth factor A (VEGF-A) that causes angiogenesis and cell proliferation

CNS: Dizziness, HA
GI: Constipation, nausea
EENT: Blepharitis, cataract, conjunctival hemorrhage/hyperemia, detachment of retinal pigment epithelium, dry/irritation/pain in eye, visual impairment, vitreous floaters, ocular infection
MISC: Hypertension, UTI, thromboembolism, nonocular bleeding
RESP: Bronchitis, cough, sinusitis, URI

Nursing considerations:
Eye changes: redness, sensitivity to light, vision change, increased intraocular pressure change; report infection immediately
If eye becomes red, sensitive to light, painful or change in vision, seek immediate care from ophthalmologist

Lunesta (eszopiclone)
Functional class: Sedative/Hypnotic, Nonbenzodiazepine

Chemical class: Cyclopyrrolone

Action: Interacts with GABA receptors

Uses: Insomnia

– Controlled substance Schedule IV –

CNS: Worsening depression, suicidal thoughts/actions, hallucinations, HA/migraine, daytime drowsiness, restlessness, sleep driving/walking, anxiety
CV: Peripheral edema, chest pain
INTEG: Rash, angioedema
GI: Dry Mouth, bitter taste
GU:Gynecomastia, dysmenorrhea

Contraindications: Ethanol Intoxication, geriatric patients, severe hepatic disease, abrupt discontinuation, COPD, depression, labor, sleep apnea, substance abuse, suicidal ideation

Increase: CNS depression
Decrease: product action– food

Nursing Considerations:
Sleep patterns: ability to go to sleep, stay asleep, early morning awakening;
Abuse of product; anaphylaxis/angioedema- monitor initial dose

Provide: alternate methods to improve sleep: reading, quiet environment, warm bath

Daytime drowsiness/memory problems may occur so do not engage in hazardous activities; Avoid use after high fat meal; Notify prescriber of suspected/planned pregnancy
avoid alcohol

Lyrica (pregabalin)
Therapeutic: analgesics, anticonvulsants
Pharmacologic: gamma aminobutyric acid (GABA) analogues, nonopiod analgesics

MOA: Binds to calcium channels in CNS tissues which regulate nerotransmitter release. Does not bind to opiod receptors. Decreased neoropathic or post-herpetic pain. Decreased partial-onset seizures.

Used for neuropathis pain associated with diabetic peripheral neuropathy or with spinal cord injury. Fibromyalgia.

myopathy (known or suspected) & lactation. HF, hx of drug dependence

Adverse/ Side effects:
CNS: suicidal thoughts, dizziness, drowsiness
CV: edema
EENT: blurred vision
GI: dry mouth, constipation, abd. pain
Hemat: throbocytopenia
Metab: weight gain
allergic reactions, fever

Nsg Considerations:
Monitor closely for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts.
May cause increase in creatine kinase levels
may decrease platelet count
Discontinue gradually over 1 wk at least

Caution pt to avoid driving or activities needing alertness…
Promptly report unexplained muscle pain/tenderness/weakness, dc is myopathy is suspected
Advise pt/family to notify HCP if thoughts of suicide/depression ect. occur
Inform it may cause edema/weight gain
avoid alcohol or other CNS depressants

pg 1024 Davis Drug Guide

Namenda (memantine)
Therapeutic: anti-Alzheimer’s agents
Pharm: N-methyl-D-aspartate antagonist

MOA: binds to CNS N-methyl-Dapartate (NMDA) receptor sites, preventing binding of glutamate, an excitatory neurotransmitter. Decreased symptoms of dementia/cognitive decline. Does not slow progression. Cognitive enhancement. Does not cure disease.

Used for moderate to severe dementia/neurocognitive disorder associated with Alzheimer’s disease

Contraindications: Severe renal impairment, concurrent use of other NMDA antagonists, drugs/diets that cause alkaline urine; conditions that increase urine pH

Adverse/ Side effects:
CNS: dizziness. fatigue, headache, sedation
CV: hypertension
Derm: rash
Gi: diarrhea, wt gain
GU: urinary frequency
Hemat: anemia

Nrsg Considerations:
Assess cognitive function periodically
May cause anemia (labs)
Admin. oral solution using syringe provided do not dilute or mix

instruct how and when to admin. memantine and how to titrate dose.
Improvement in cognitive functioning may take months

pg 800 Davis Drug Guide

Nasonex (mometasone)
Therapeutic: anti-inglammatories (steroidal)
Pharm: corticosteroids (nasal)

MOA: potent, locally acting anti inflam and immune modifier. Decreases symptoms of allergic or nonallergic rhinitis decrease in symptoms of nasal polyps.

Used for seasonal or perennial allergic rhinitis. Tx of nasal polyps

Contraindications: active untreated infections, diabetes or glaucoma, systemic corticosteroid therapy

Adverse/ Side effects:
CNS: dizziness, headache
EENT: epistaxis, nasal burning/congestion/irritation/perforation/ulceration, pharyngitis, rhinorrhea, sneezing
GI: dry mouth, esophageal candidiasis, n/v
Endo: adrenal suppression, growth suppression
Resp: bronchospasm, cough
Anaphlyaxis, angioedema

Nrsg Considerations:
monitor nasal stuffiness/discharge
Long-term therapy should have periodic otolaryngologic exams
monitor growth rate in children
Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic therapy.

Shake well before use, warn of temporary nasal stinging
gently blow nose to clear nostrils prior to admin
Instruct to stop med & notify HCP if signs of anaphylaxis or changes in vision
If symptoms don’t improve within 1 mo or worsen then notify HCP

pg 351 Davis Drug Guide

B Corbett

B Corbett

B Corbett

NovoLOG (insulin aspart)
…Therapeutic Class.
Pharm. Class.
Used for both type 1 and 2 diabetes
MOA:Lowers blood glucose by :
stimulating glucose uptake in skeletal muscle and fat,
inhibiting hepatic glucose production. Onset: <15 min. Peak : 1-2hours. Duration: 3-4 hours Side effects: Endo: HYPOGLYCEMIA Local: lipodystrophy, pruritis, erythema, swelling Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS Assess for symptoms of hypoglycemia (anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; nightmares or trouble sleeping; excessive hunger; headache; irritability; nausea; nervousness; tachycardia; tremor; weakness; unsteady gait)and hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, polyuria; loss of appetite; nausea; vomiting; unusual thirst) during therapy. Monitor body weight periodically. Changes in weight may necessitate changes in insulin dose. LABS: Monitor blood glucose every 6 hr during therapy, more frequently in ketoacidosis and times of stress. A1C may be monitored every 3-6 mo to determine effectiveness. OVERDOSE: Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated by ingestion of oral glucose. Severe hypoglycemia is a life-threatening emergency; treatment consists of IV glucose, glucagon, or epinephrine.

NovoLOG Flexpen ( insulin aspart)
… Same MOA and side effects as NovoLOG aspart. FLexpen is prefilled and disposable. Must use a new needle with each injection.

NuvaRING (etonogestrel/ethinyl estradiol)
…Therapeuctic:Contraceptives Pharm Class: Hormones MOA:Provide a fixed dosage of estrogen/progestin over a 21-day cycle. Ovulation is inhibited by suppression of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). May alter cervical mucus and the endometrial environment, preventing penetration by sperm and implantation of the egg. Prevention of pregnancy.
Decreased severity of acne.
Decrease in menstrual blood loss.
Decrease in premenstrual disphoric disorder.
Decrease in vasomotor symptoms or symptoms of vulvar and vaginal atrophy due to menopause.
Increase in folate levels and prevention of neural tube defects. SIDE EFFECTS:CNS: depression, headache

EENT: contact lens intolerance, optic neuritis, retinal thrombosis


F and E: Drosperinone-containing products only- hyperkalemia

GI: PANCREATITIS, abdominal cramps, bloating, cholestatic jaundice, gallbladder disease, liver tumors, nausea, vomiting

GU: amenorrhea, breakthrough bleeding, dysmenorrhea, spotting, Intrauterine levonorgestrel only- uterine imbedment/uterine rupture

Derm: melasma, rash

Endo: hyperglycemia

MS: Injectable medroxyprogesterone only- bone loss

Misc: weight change
Instruct patient to take oral medication as directed at the same time each day.f single daily dose is missed: Take as soon as remembered; if not until next day, take 2 tablets and continue on regular dosing schedule. If 2 days in a row are missed: Take 2 tablets a day for the next 2 days and continue on regular dosing schedule, using a second method of birth control for the remaining cycle. If 3 days in a row are missed: Discontinue medication and use another form of birth control until period begins or pregnancy is ruled out; then begin a new cycle of tablets.

Orencia (abatacept)
Therapeutic class: antirheumatic
DMARD(disease modifying antireumatic drug)

Action: inhibits T-lymphocytes, inhibits tumor necrosis factor interferon-y interleukin-2 which are involved in immune and inflammatory reactions

CNS: Headache, dizziness
CV: hypertension, hypotension
INTEG: rash, injection site reaction, flushing, pruritus
GI: Abdominal pain, dyspepsia, nausea
Hypersensitivity and TB: Do not use with adalimumab, etanercept, infliximab, anakinra

TB before treatment

Dilute to administer. Use non protein binding filter, give over 30 minutes
Monitor injection site for pain swelling
Monitor for pain, stiffness, ROM, swelling of joints during treatment
Immunizations should be brought up to date before treatment. Do not give vaccines immunizations while on treatment.

Do not use corticosteroids or immunosuppressives

Oxycontin (oxycodone HCL)
Therapeutic class: opioid analgesic
Chemical class: opioid agonist

Action: Binds to opiate rectors in the CNS, Alters the perception of and response to painful stimuli, while producing generalized CNS depression

Side effects:
CNS: CONFUSION, SEDATION, dizziness, dysphoria, floating, feeling, hallucinations, headache, unusual dreams
EENT: blurred vision, diplopia, miosis
CV:orthostatic hypotension
GI:CONSTIPATION, dry mouth, choking, GI obstruction, nausea, vomiting
GU:urinary retention
Derm:flushing, sweating
Misc:physical dependence, psychological dependence, tolerance

Assess BP, pulse, and respirations before administer. If respirations are less than 10/min, assess level of sedation

Teach: Report any symptoms of CNS changes, allergy; W/drawal symptoms may occur-nausea, vomiting, cramps, fever, faintness, anorexia
Avoid CNS depressants, alcohol
Avoid driving, operating machinery if drowsiness occurs. Take with meal to prevent GI upset

Overdose: to reverse respiratory depression or come Naloxone (Narcan) dilute 0.4 mg ampule of naloxone in 10 mL of 0.9% NaCl and administer 0.5 mL (0.02 mg) by IV push every 2 min. For children and patients weighing less than 40 kg dilute 0.1 mg of naloxone in 10 mL of 0.9% NsCl for a concentration of 10 mcg/mL and administer 0.5 mcg/kg every 2 min. Titrate dose to avoid withdrawal, seizures and severe pain

Pradaxa (dabigatran etexilate mesylate)
Therapeutic: anticoagulant
Chemical: Thrombin Inhibitor

Direct inhibitor of thrombin, it reversibly binds to the thrombin active site

CNS: Fever, intracranial bleeding, headache
CV: HEART FAILURE, hypotension
HEMA: Hemorrhage
GI: nausea, vomiting, diarrhea, SERIOUS INTERNAL HEMORRHAGE
GU: hematuria, UTI, Abnormal kidney function

Contraindacations: Major bleeding

for bleeding gums, Petechiae, Ecchymosis
Monitor aPTT

Increased risk of bleeding with antiplatelets, NSAID, salicylates

to use soft bristle toothbrush, avoid contact sports, and use an electric razor

Prevnar 13 (Strep Pneumonia vaccine)
Class: Pneumococcal vaccine

Erythema induration, tenderness, nodule formation at injection site, fever, fatigue, headache, myalgia, arthralgia, chills

Hypersensitivity to all components including diphtheria toxoid; moderate-severe febrile illness

– Previous immunization history and history of hypersensitivity.
– Latex allergy as some prefilled syringes may have latex components.

– Inform pt of potential side effects.
– If fever higher than 103°F or any signs of anaphylaxis occurs, contact HCP.
– Review next scheduled immunization.

Prezista (darunavir)
Therapeutic class: antiretrovirals
Chemical class: protease inhibitors

Action: Inhibits human immunodeficiency virus (HIV-1) protease, this prevents maturation of virus.

GI: HEPATOTOXICITY, constipation, D/N/V
Endo: hyperglycemia
Metab: body fat redistribution
Misc: immune reconstitution syndrome

Hepatic impairment and Sulfa allergy

-Allergy to sulfonamides
-Development of a rash that is maculopapular and self-limited
-For SJS or TEN

This is not a cure for AIDS and does not reduce the risk of transmission. This can cause redistribution of body fat, causing central obesity. It may lead to dorsocervical fat enlargement (buffalo hump)

Pristiq (desvenlafaxine)
Therapeutic class: antidepressants
Chemical class: selective serotonin/norepinephrine reuptake inhibitors

Inhibits serotonin and norepinephrine reuptake in the CNS; decreases depressive symptomatology

CNS: Neuroleptic malignant syndrome, seizures, suicidal thoughts, anxiety, dizziness, drowsiness, insomnia, HA, teeth grinding, vertigo
EENT: Increased intraocular pressure, mydriasis
Resp: eosinophilic pneumonia, interstitial lung disease
CV: hypertension
GI: Decreased appetite, constipation, nausea
GU: male sexual dysfunction
Derm: erythema multiforme, SJS, TEN, sweating
F and E: hyponatremia
Hemat: increased risk of bleeding
Misc: serotonin syndrome

Hypersensitivity to venlafaxine or desvenlafaxine; Concurrent use of MAO inhibitors

– Mental status and mood changes; increased signs of depression
– Suicidal tendencies
– BP, appetite, nutrition, weight
– Signs of serotonin syndrome (agitation, hallucinations, coma)
– Skin rash – discontinue immediately as this can lead to SJS

This may increase fasting serum total cholesterol, LDL, cholesterol, and triglycerides

– Patient, family, caregivers to notify HCP for any signs of suicidal tendencies
– May cause drowsiness/dizziness
– Avoid taking with alcohol as this can increase bleeding
– Notify HCP for signs of rash

epoetin alfa (Procrit)
Functional class: Antianemic, Biologic Modifier, Hormone
Chemical class: Amino Acid polypeptide

Action: Erythropoietin is one factor controlling rate of red cell production; product is developed by recombinant DNA technology.

CNS: Seizures, Coldness, Sweating
CV: Hypertension, Hypertensive Encephalopathy, CHF, DVT
INTEG: Pruritus, Rash, Inj Site Reaction
EENT: Cough

MISC: Iron Deficiency, Bone Pain
Contraindications: Uncontrolled Hypertension

Nursing Considerations:
-Labs: Urinalysis, Protein, Blood, BUN, Creatinine, Ferritin, Transferrin
-Report drop in I&O <50mL/hr -Assess for pure cell aplasia (PRCA) in absence of other causes, evaluate by testing sera for recombinant erythropoietin antibodies; any loss of response to epoetin should be evaluated -Teach patient to avoid driving or hazardous activity during beginning of tx -Take iron supplements, Vit B12 as directed

infliximab (Remicade)
Therapeutic class: antirheumatics (DMARDS), gastrointestinal anti-inflammatories
Chemical class: monoclonal antibodies

Action: Neutralizes and prevents the activity of tumor necrosis factor-alpha (TNF-alpha), resulting in anti-inflammatory and antiproliferative activity.

Side Effects:
CNS: fatigue, HA, anxiety, depression, dizziness, insomnia
EENT: conjunctivitis
Resp: upper respiratory tract infection, bronchitis, cough
CV: chest pain, HTN, hypotension, tachycardia, HF
GI: abdominal pain, n/v, constipation, diarrhea, flatulence
GU: dysuria, urinary frequency, UTI
Derm: acne, alopecia, dry skin, ecchymosis, erythema, rash
Hemat: neutropenia
MS: arthritis, back pain, involuntary muscle contraction
Neuro: paresthesia

Misc: infections, malignancy, sarcoidosis, fever, infusion rx
Contraindications: hypersensitivity to infliximab , murine (mouse) proteins, or other components in the formulation;HF; Lactation

Nursing considerations:
– assess for infusion-related reaction (fever, chills, urticaria, pruritis)
– monitor pts who develop infection while on this closely
– monitor liver function tests periodically
– monitor CBC periodically during therapy
– D/C if symptoms of blood dyscrasias (persistent fever) occur
– may cause dizziness; avoid driving or other activities until response is known
– advise pt to assess skin periodically

sevelamer carbonate (Renvela)
Functional class: electrolyte modifiers
Chemical class: phosphate binders

Action: a polymer that binds phosphate in the GI tract, preventing its absorption

GI: bowel obstruction/perforation, esophageal obstruction, diarrhea, dyspepsia, vomiting, choking, constipation, dysphagia, flatulence, nausea

Contraindications: hypersensitivity; hypophosphatemia; bowel obstruction

Nursing Considerations:
Monitor phosphorous, calcium, bicarbonate, and chloride levels
Administer with meals
Do not break, chew, or crush tablets

C Lores

C Lores

C Lores

A Lowrey

A Lowrey

A Lowrey

Brand name: Spiriva Handihaler
Trade name: tiotropium bromide
Route: capsule, powder for inhalation
Functional class: bronchodilator
Chemical class: anticholinergics
Indications: long term maintenance treatment bronchospasm d/t COPD. Reducing exacerbations in patients with COPD.
Action: Acts as anticholinergic by selectively and reversibly inhibiting M2 receptors in smooth muscle airways.
Therapeutic effect: decreased incidence and severity of bronchospasm.
Resp: paradoxical bronchospasm (wheezing)
CV: tachycardia
INTEG: rash, angioedema
GI: dry mouth, constipation
GU: urinary difficulty
EENT: glaucoma
Contraindications: hypersensitivity to tiotropium or ipratropium and atropine/milk proteins
Nursing interventions:
Assess respiratory status before administration and at peak of medication (5 mins). If wheezing occurs, withhold medication and call HCP. Capsules are for inhalation only, do not swallow; and they must be placed in Handihaler before use.
Rinse mouth after use and practice good oral hygiene. Notify HCP of signs of angioedema.
Do not spray in eyes, may cause blurred vision.
Teach: used for long term tx, not for immediate relief

Brand name: Sprycel
Trade name:dasatinib
Functional class: antineoplastic
Chemical class : protein-tyrosine kinase inhibitor
Action: Inhibits PDGFR-B tyrosine kinase created in chronic myeloid leukemia (CMI).
CNS: pins and needles senstation
CV: chest pain
HEMA: neutropenia, thrombocytopenia, bleeding.
INTEG: rash, pruritus
GI: bloody or tarry stools, constipation, N/V, anorexia, abdominal pain
GU: decrease in amount of urine
EENT: pleural effusion
Contraindications: Pregnancy (D), hypersensitivity.
Assess ANC and platelets
Renal toxicity if bilirubin >3
Hepatoxicity, CBC
Fluid retention, edema, weight monitoring, & lung sounds.
Administer meds after a meal w a large glass of H2O. Do not crush, break, or chew tablet. Avoid grapefruit. Avoid taking an antacid within 2 hours before and after medicine. May cause severe birth defects, males and females must use birth control for all sexual activity while using this drug.

Brand name: Stelara
Trade name: ustekinumab
Route: injection
Functional class: Antipsoriatic agent/immunosuppressant
Chemical class: N/A
Action: Interleukin (IL)-12, IL-23 Inhibitor
Therapeutic effect: used to treat moderate to severe plaque psoriasis in adults.
CNS: headache, leukoencephalopathy
HEMA: bleeding
INTEG: pruritus, skin irritation, erythema
Musc: lower back or side pain
GU: painful or difficult urination
EENT: cough or hoarseness
Misc: fever, chills
Contraindications: hypersensitivity, sepsis, active infections, latex allergy, ever received allergy shots or used an Epipen
Assess for injection site pain, swelling.
Teach not to receive live vaccinations during treatment.

Strattera (atomexetine HCL)
Therapeutic Class: agents for attention deficit disorder
Pharm. Class: selective norepinephrine reuptake inhibitors
Uses:Attention-Deficit/Hyperactivity Disorder (ADHD)
Action: Selectively inhibits the presynaptic transporter of norepinephrine
Therapeutic effect: increased attention span
Available in PO Capsules
Side Effects:
CNS: SUICIDAL THOUGHTS, dizziness, fatigue, mood swings,insomnia
CV: hypertension, orthostatic hypotension,tachycardia
GI: HEPATOTOXICITY, dyspepsia, nausea, vomiting, constipation
GU:dysmenorrhea, ejaculatory problems, ↓ libido, erectile dysfunction
Metabolic: ↓ appetite, weight/growth loss
Assess attention span, impulse control
Monitor growth, body height, and weight in children.
Monitor behavior for suicidal thoughts or depression

Stribild (elvitegravir/cobicistat/emtricitabine/tenofovir)
THER. CLASS: antiretrovirals
PHARM. CLASS: integrase strand transfer inhibitors; enzyme inhibitors; nucleoside reverse transcriptase inhibitors
USES: management of HIV infection
ACTION: Elvitegravir- inhibits an enzyme necessary for viral replication.
Cobicistat- enhancing systemic exposure to elvitegravir.
Emtricitabine- inhibits HIV reverse transcriptase, causing viral DNA chain termination
Tenofovir- disruption of HIV DNA synthesis
THERAPEUTIC EFFECT:Slowed progression of HIV infection
CONTRAINDICATIONS: severe renal or hepatic impairment
MS: ↓ bone mineral density INTERVENTIONS:
Assess for change in HIV symptoms
Monitor bone mineral density
Monitor viral load and CD4 cell count
Monitor for lactic acidosis (n/v, stomach discomfort)
monitor for superinfection

Suboxone (buprenorphine/naloxone) Controlled Substance Schedule: III
THER. CLASS: opioid addiction agents
PHARM. CLASS:opioid agonists antagonists; opioid antagonists
USES: Maintenance treatment of opioid dependence
ACTION:Buprenorphine- Binds to opiate receptors in the CNS.
Sublingual naloxone- no pharmacological effect; present to discourage injection of product by opioid-dependent patients.
THER. EFFECT: Suppression of withdrawal symptoms during detoxification and maintenance from opioids
CNS: headache, insomnia
GI: constipation, glossodynia, nausea, oral hypoesthesia, oral mucosal erythema, vomiting
Derm: hyperhydrosis
Avoid other CNS depressants

budesonide/formoterol fumarate dihydrate (Symbicort)
Rationale for patient: prevents bronchospasm in people with asthma or COPD

Functional class: Anti-inflammatory (steroidal), bronchodilator
Chemical class: corticosteroid, adrenergic

Action: Symbicort contains a combination of budesonide and formoterol. Budesonide is a steroid that reduces inflammation in the body. Formoterol is a bronchodilator that relaxes muscles in the airways to improve breathing.

CNS: HA, confusion, chest pain, SOB, tremor, nervousness, decreased libido
CV: tachycardia
Integ: thinning skin, easy bruising
GI: nausea, vomit, diarrhea
GU: mensral probs
EENT: pounding in neck & ears

Contraindications: hypersensitivity; do not take if <12 years old; do not take if you are breatfeeding Do not breastfeed while taking. Always rinse mouth out after using to help prevent thrush.

palivizumab (Synagis)
Rationale for Patient: prevention of serious respiratory tract disease due to respiratory syncytial virus (RSV)

Functional class: antivirals
Chemical class: monoclonal antibodies

Action: neutralizes and inhibits fusion of RSV virus; subsequently inhibits viral replication.

CNS: fever
Hema: thrombocytopenia
Integ: rash
Local: erythema, induration
Misc: hypersensitivity reactions including ANAPHYLACTOID REACTIONS and ANAPHYLAXIS
Contraindications: hypersensitivity

Use cautiously in PTs who have Hx of thrombocytopenia or bleeding disorders. First dose should be administered prior to RSV season. Monitor platelet count during therapy. Assess S&S of anaphylaxis.

levothyroxine (Synthroid)
Rationale for Patient: thyroid supplementation in hypothyroidism

Functional class: hormones
Chemical class: thyroid preparations
Action: Replacement of or supplementation to endogenous thyroid hormones. Principal effect is increasing metabolic rate of body tissues: Promote gluconeogenesis, increase utilization and mobilization of glycogen stores, Stimulate protein synthesis, Promote cell growth and differentiation, Aid in the development of the brain and CNS

CNS: HA, insomnia, irritability
CV: angina pectoris, arrhythmias, tachycardia
Endo: hyperthyroidism
Integ: sweating
GI: ABD cramps, diarrhea, vomit
Metab: heat intolerance, weight loss
Contraindications: hypersensitivity

Assess apical pulse and BP; assess for chest pain or tachyarrhythmias.
Overdose is treated by induction of emesis or gastric lavage, followed by activated charcoal.

Tarceva (erlotinib)
Therapeutic: Antieoplastics
Pharmacologic: Enzyme Inhibitors
MOA: Inhibits the enzyme tyrosine kinase, which is associated with human epidermal growth factor receptor (EGFR); blocks growth stimulation signal sin cancer cells.
Therapeutic Effects: Decreased spread of lung and pancreatic cancer with increased survival.
Side Effects:
EENT: Conjunctivitis, corneal perforation, corneal ulceration
RESP: Dyspnea, cough, Interstitial Lung Disease
GI: Hepatotoxicity, GI Perforation, Diarrhea, Abdominal Pain, Nausea, Vomiting
DERM: Rash, Dry Skin, Pruritus, Bullous and Exfoliative Skin Disorder
GU: Renal Failure
Assess respiratory status prior to administration
Assess for Diarrhea
Assess Eyes for vision changes
Assess for GI pain
Lab Test Considerations:
Monitor liver function (AST, ALT, Bilirubin, Alkaline Phosphate)
Monitor for Renal Failure and dehydration
Monitor INR
Patient Teaching:
Take as directed
Notify HCP if diarrhea occurs, nausea, skin rash, or cough occurs
Wear sunscreen and protective clothing while in the sun
Use other methods of contraception for at least two weeks after completion of therapy
Discontinue smoking while taking this drug

Tecfidera (dimethyl fumarate)
Therapeutic: Anti-multiple Sclerosis Agents
MOA: Activates Nuclear Factor (Nrf2) pathway involved in cellular response to oxidative stress.
Therapeutic Effects: Decreased incidence/severity of relapse with decreased progression of lesions and disability.
Side Effects:
GI: Abdominal pain, diarrhea, nausea, dyspepsia, increased liver enzyme, vomiting
DERM: Flushing, srythema, prutitus, rash
HEMAT: Lymphopenia
Monitor for signs and symptoms of infections
Lab Test Considerations:
Monitor CBC
May cause decreased lymphocyte counts
May cause increased hepatic transaminases
May cause transient increase
Patient Teaching:
Take as directed
May cause flushing

Treanda (bendamustine)
Therapeutic: Antieoplastics
Pharmacologic: Bensimidazoles
MOA: Damages DNA resulting in death of rapidly replicating cells.
Therapeutic Effects: Decreased proliferation of leukemic cells. Death of lymphoma cells
Side Effects:
CNS: Fatigue, Weakness,
RESP: Cough
GI: Nausea, vomiting, diarrhea
DERM: Toxic epidermal necrolysis, SJS,
HEMAT: Anemia, Leukopenia, neutropenia, thrombocytopenia
METAB: Hyperuricemia
Lab Test Considerations:
Monitor CBC
Assessment :
Monitor for bone marrow depression
Assess for tumor lysis syndrome
Monitor IV site
Monitor I and O

Brand Name: Truvada
Generic name: emtricitabine, tenofovir
Functional class: Antiretroviral
Chemical class: Nucleoside reverse transcriptase inhibitor (NRTI)

Action: Synthetic nucleoside analog of cytosine. Inhibits replication of HIV virus by competing with the natural substrate and then becoming incorporated into cellular DNA by viral transcriptase, thereby terminating cellular DNA chain

CNS: Headache, Depression, Insomnia, Asthenia
INTEG: Rash, skin discolorization
GI: N/V/D, Anorexia, Abdominal Pain
Resp: Cough
Contraindications: N/A

BBW: Lactic Acidosis
-BBW: Hepatic insufficiency, chronic hepatitis B virus
-Assess Renal/Hepatic Function Tests
-Teach, GI complaints resolve after 3-4 weeks of treatment
-Take at same time each day to maintain blood level
-Controls symptoms of HIV but does not cure
-Changes in body fat distribution may occur

Brand Name: Treanda
Generic Name: bendamustine
Functional class:
Antineoplastic alkylating agent

Chemical class:
Nitrogen mustard

Cross-linking DNA that causes single strand and double strand breaks, inhibits several mitotic and antimetabolite properties

CNS: Asthenia, fatigue
CV: Hypertensive crisis
HEMA: Thrombocytopenia, leucopenia, anemia, lymphocytopenia, neutropenia, secondary malignancy
INTEG: bulbous rash, pruritis
GI: N/V, stomatitis
GU: Renal failure
SYST: anaphylaxis, severe skin toxicities

Hepatic disease, renal impairment, hypersensitivity to this product or mannitol
– AST, ALT, bilirubin, BUN, uric acid
– bleeding, bruising, petechiae, hematuria
– cold, cough, fever, (may indicate infection)

– avoid use of aspirin, ibuprofen, razors, commercial mouthwash

Brand Name: Ventolin HFA, Proventil
Generic Name: albuterol
Functional class:
Adrenergic B 2-agonist, sympathomimetic, bronchodilator

Chemical class:

bronchodilation by action on b2(pulmonary) receptors by increasing levels of cAMP which relaxes smooth muscle, produces Bronchodilation CNS, cardiac stimulation, as well as increased diuresis and gastric acid secretion, longer acting than isoproterenol

CNS: Tremors, anxiety, insomnia, headache, dizziness, slimulation, restlessness, hallucinations, flushing, irritability
CV: Palpitations, tachycardia, angina, hyper/hypotension, dysrhythmias
INTEG: muscle cramps
RESP: cough, wheezing, dyspnea, bronchospasm, dry throat
GI: Heartburn, nausea, vomiting
EENT: Dry nose, irritation of nose and throat
MISC: Flushing, sweating, anorexia, bad taste/smell changes, hypokalemia

– Respiratory function
– That pt. has not received theophylline therapy before giving dose
– Evidence of allergic reactions
– Paradoxical bronchospasm, hold medication, notify prescriber

– Limit caffeine / give gum, sips of water for dry mouth

Therapeutic response:
Absence of wheezing after 1 hr, improved airway

OD Treatment:
b1 adrenergic blocker

Brand Name: Vesicare
Generic name: solifenacin
Therapeutic: urinary tract antispasmodics
Pharmacological: anticholinergics
Decreases symptoms of overactive bladder. Acts as a cholinergic receptor antagonist; antagonizes bladder smooth muscle contraction.
Oral peak-unknown; onset- 3-8hr; duration 24 hr. Contradicted in urinary retention and angle-closure glaucoma. Major S/E- angioedema, constipation, dry mouth, tachycardia, blurred vision, hallucinations, confusion, headache, drowsiness, palpitations.
Only comes in tablet form- must be swallowed whole.
Monitor patient for voiding pattern.
Teach patient to not share drug with anyone and to notify HCP if Hives, facial, and tongue swelling.

Generic: sildenafil
Brand: Viagra
Therapeutic: erectile dysfunction agents. vasodialtors
Pharmacological: phosphodiesterase type 5 inhibitor
Therapeutic effect: enhanced blood flow to the corpus cavernosum and erection to allow sexual intercourse. Requires sexual stimulation.
PO Onset- within 1 hr; Peak 30-120 min; duration up to 4hr
Contradicted in women, children, and concurrent use of nitrates
Major S/E- headache, MI, sudden death, dyspepsia, flusing
Caution patient not to take drug with alpha adrenergic blockers and nitrates. May increase chance of hypotension
Taken with warfarin may increase bleeding.
Patient teaching: only take once a day. Seek medical attention if chest pain occurs or an erection lasting longer than 4 hours.

Generic: liraglutide
Brand: Victoza
Therapeutic: antidiabetics
Pharmacological: glucagon like peptide-1 receptor agonist
Therapeutic effect: improved glycemic control
Sub Q Onset- within 4 weeks; peak 8weeks, duration- unkown.
Contradicted i n Type 1 diabetes, diabetic ketoacidosis
S/E- thyroid C-cell tumors, pancreatitis, anaphylaxis, angioedema. Most common S/E diarrhea, nausea, and vomiting.
Labs: monitor serum HbAd1c
Monitor Pt- hypoglycemia, thyroid nodules, abdominal pain

H Mcgrew

H Mcgrew

H Mcgrew

Brand Name: Welchol
Generic Name: colesevelam
therapeutic: lipid-lowering agents
pharmacologic: bile acid sequestrants

indications: adjunctive therapy to diet and exercise for the reduction of LDL cholesterol in patients with primary hypercholesterolemia. adjunctive therapy to diet and exercise to improve glycemic control in patients with type 2 diabetes.

MOA: binds bile acids in the GI tract resulting in increased clearance of cholesterol. Decreases cholesterol and blood glucose.

Administration: PO

contraindications: complete biliary obstruction

side effects:
EENT: irritation of the tongue
GI: abdominal discomfort, constipation, nausea, fecal impaction, flatulence, hemorrhoids
DERM: irritation, rashes
F&E: hyperchloremic acidosis
METAB: vitamin A, D, and K deficiency

Nursing Implications: obtain diet history especially in regard to fat consumption

Lab Considerations: serum cholesterol and triglyceride levels should be evaluated before and during therapy. may cause prolonged PT.

Brand Name: Xarelto
Generic Name: rivaroxaban
therapeutic: anticoagulants
pharmacologic: antithrombotics, factor Xa inhibitors

indications: prevention of DVT. reduction in risk of stroke/systemic embolism in patients with nonvalvular atrial fibrillation

MOA: acts as selective factor X inhibitor that blocks the active site of factor Xa, inactivating the cascade of coagulation. prevents blood clots and subsequent pulmonary emboli following knee/hip replacement

Administration: PO, 10, 15 or 20 mg tablets

contraindications: active major bleeding, severe renal impairment, prosthetic heart valves, moderate to severe hepatic impairment, lactation

side effects:
CNS: syncope
DERM: blister, pruritus
HEMAT: bleeding
MS: muscle spasm

Nursing Implications: assess for signs of bleeding, unusual bruising, black tarry stools

Lab Considerations: may cause increased serum AST, ALT, total bilirubin and GGT levels

Brand Name: Xeloda
Generic Name: capecitabine
therapeutic: antineoplastics
pharmacologic: antimetabolites

indications: metastatic colorectal cancer, colon cancer following primary resection, metastatic breast cancer

MOA: inhibits DNA and RNA synthesis by preventing thymidine production causing death in rapidly replicating cells particularly malignant ones.

Administration: PO. 1250mg/m² twice daily for 14 days followed by 7 day rest period, given in 3 week cycles

contraindications: severe renal impairment, pregnancy, lactation

side effects:
CNS: fatigue, headache
EENT: eye irritation, rhinorrhea
CV: edema, chest pain
GI: diarrhea, necrotizing enterocolitis, abdominal pain
DERM: dermatitis, hand and foot syndrome, nail disorder
F&E: dehydration
HEMAT: anemia, leukopenia, thrombocytopenia
MS: arthralgia, myalgia
NEURO: peripheral neuropathy
RESP: cough, dyspnea

Nursing Implications: assess mucous membranes, number & consistency of stools and frequency of vomiting. assess for hand-and-foot syndrome (numbness, tingling, swelling, blistering).

Lab Considerations: therapy should be interrupted if serum bilirubin ↑ to 1.5 times normal or greater. monitor PT or INR if patient taking warfarin.

Brand Name: Xgeva
Generic Name: denosumab
Ther. Class: Bone resorption inhibitors
Pharm Class: Monoclonal antibodies

– Prevention of skeletal-related events in patients with bone metastases from solid tumors
-Giant cell tumor of bone that is unresectable or where surgical resection is likely to result in severe morbidity.

MOA: Monoclonal antibody that binds specifically to the human receptor activator of the nuclear factor Kappa-B-ligand (RANKL), which is required for formation, function, and survival of osteoclast. Binding inhibits osteoclast formation, function, and survival.

Ther. effects: Decreased bone resorption with decreased occurence of fractures. Increased bone mass.

Administration: SubQ
Adult dose:
-120mg every 4 wks (metastasis from solid tumors)
-120mg q4wks plus with additional 120mg given on days 8 and 15 of first month therapy ( Giant cell tumor of bone)

-Pregnancy – category X
-Don’t use while lactating
-Hypocalcemia (correct before admin)*adequate Vitamin C and Vitamin D supplement required
-Concurrent use with immunosuppressants or disease resulting in immunosuppression ( risk for infection)

Pediatrics: safety and effectiveness not established

GI: PANCREATITUS, diarrhea, vomiting
GU: Cystitis
Derm: Dermatitis, rashes, eczema
MS: back pain, extremity pain, musculoskeletal pain, atypical femoral fracture, osteonecrosis of the jaw, suppression of bone turnover
Resp: Dyspnea, cough
MISC: Hypersensitivity, ANAPHYLAXIS, infection

Nurse Implementations:
Patients should receive calcium 1000 mg and 400IU vitamin D daily with treatment
-Explain if dose missed, take injection as soon as possible
-Encourage balanced diet and regular exercise
-stop smoking, reduce alcohol intake
-Advise HCP of hypersensitivity immediately

Brand Name: Xolair
Generic Name: omalizumab
Ther. Class: Antiasthmatics
Pharm Class: Monoclonal antibodies
Pregnancy Category: B

Indications: Moderate to severe asthma not controlled by inhaled corticosteroids

Ther effect: Decreased incidence of exacerbations of asthma

Route/Dosage: SubQ
150-375 mg q2-4 wks (Determined by pretreatment serum IgE level and body weight)
Pediatrics: <12 safety not established SE: Analphylaxis local: injection site reaction Assessment: -Assess lung sounds prior to and during treatment -signs of allergic reaction Teaching: -Explain reason for drug -Instruct patient not to discontinue or reduce other asthma medications, especially an inhaled corticosteroids, without consulting HCP - Notify HCP immediately of allergic reaction

Brand Name: Zetia
Generic Name: ezetimibe
Ther. Class: Lipid-lowering agent
Pharm Class: Cholesterol absorption inhibitors
Pregnancy category: C
Route/Dosage: PO
Adult: 10mg daily
Pediatrics: <10 yrs Safety not established Indications: Alone or with other agents (HMG-CoA reductase inhibitors) in the management of the dyslipidemias including primary hypercholesterolemia, and homozygous sitosterolemia. MOA: Inhibits absorption of cholesterol in the small intestine Ther. effects: Lowering of cholesterol, a known risk factor for atherosclerosis. Contraindications: -Hypersensitivity -Acute liver disease -Moderate to severe hepatic impairment -Concurrent use of fibrates -OB: May cause fetal harm -Lactation: Potential for adverse effects SE: GI: Cholecystitis, cholelithiasis, increase in liver enzymes, nausea, pancreatitis Derm: Rash Misc: ANGIOEDEMA Assessment: -Dietary history, especially fat consumption Teaching: -Take med same time daily, even if feeling well -Use med in conjunction with diet restrictions(fst, cholesterol, alcohol) -Notify HCP if unexplained muscle pain, tenderness, or weakness

Brand Name: Zostavax
Generic Name: Zoster Vaccine
Ther. Class: vaccines/immunizing agents

Pharm. Class: active immunizer

Indications: reduces risk of shingles in victims greater than 50 years old

MOA: Boosts immunity by actively immunizing against the varicella-zoster virus.

Thera. Effects: Reduced risk of shingles and its sequelae

Administered: Subcut; onset, peak and duration unknown

Side Effects: swelling, redness, pain, swelling

Contraindications: History of anaphylactic reactions to gelatin, neomycin, or other vaccine components, do not administer to Pt’s that are pregnant , have Active TB or acute febrile illness (101.3 f).

Nursing considerations: Assess patient for immunosuppressant medications or reactions to previous vaccines. Administration may result in a more extensive vaccine-associated rash or disseminated disease in immunocompromised patients.

Teaching: Advise patient to notify health care professional if pregnancy is planned or expected. Pregnancy should be avoided for 3 mo after administration of vaccine.

Brand Name: Zytiga
Generic Name: abiraterone acetate
Ther. Class: antineoplastics

Pharm. Class: enzyme inhibitors

Indications: Used With prednisone in the treatment of metastatic castration-resistant prostate cancer

MOA: Inhibits the enzyme 17,-hydroxylase/C17,20-lyase, which is required for androgen production. May also result in increased mineralocortocoid production.

Thera. Effects: Decreased androgen production with decreased spread of androgen-sensitive prostate cancer

Administered: PO; onset unknown, peak 2hr, duration 12hr

Side effects:
Resp: cough
CV: arrhythmia, edema, hypertension
GI: HEPATOTOXICITY, diarrhea, dyspepsia
Derm: hot flush
Endo: adrenocortical insufficiency (due to concurrent prednisone)
F and E: hypokalemia
GU: nocturia, urinary frequency
MS: fracture, joint pain/discomfort

Contraindicated: In Pt’s with hepatic impairment, pregnany, nursing mothers, Heart failure or Infections.

Nursing Considerations: Hypertension and electrolytes must be treated prior to administration. must be taken 1hr prior to food, do not crush or chew.

Labs: Monitor AST, ALT, and bilirubin prior to, every 2 wks for 3 mo, and monthly thereafter. Interupt teatment if any values raise x5.

Teaching: Pregnant women can not touch the pills, Men need to wear a condom.

Brand Name: Zyvox
Generic Name: linezolid
Ther. Class: anti-infectives

Pharm. Class: oxazolidinones

Indications: Treats Infections Caused by vancomycin-resistant Enterococcus faecium, Staphylococcus aureus,
Streptococcus pyogenes or Streptococcus agalactiae,
Community-acquired pneumonia caused by Streptococcus pneumoniae.

MOA: Inhibits bacterial protein synthesis at the level of the 23S ribosome of the 50S subunit.

Thera. Effects: Bactericidal action against streptococci; bacteriostatic action against enterococci and staphylococci.

Administered: PO; onset rapid, peak 1-2hr and dur. 12hr
IV; onset rapid, peak end of Infus. and dur. 12hr

Side Effects:
CV: headache, insomnia
EENT: teeth discoloration, tongue discoloration
GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, ↑ liver enzymes, nausea, taste alteration, vomiting
Endo: hypoglycemia
F and E: lactic acidosis
Hemat: thrombocytopenia
Neuro: optic neuropathy, peripheral neuropathy

Contraindicated: Hypersensitivity;
Phenylketonuria (suspension contains aspartame);
Uncontrolled HTN, pheochromocytoma, thyrotoxicosis, or concurrent use of sympathomimetic agents, vasopressors, or dopaminergic agents (↑ risk of hypertensive response);
Concurrent or recent (<2 wk) use of monoamine oxidase (MAO) inhibitors (↑ risk of hypertensive response); Carcinoid syndrome or concurrent use of SSRIs, TCAs, triptans, meperidine, or buspirone (↑ risk of serotonin syndrome). Nursing consideration: Monitor bowel function, V/S. Report pseudomembranous colitis. Labs: May cause ↑ AST, ALT, LDH, alkaline phosphatase and BUN. May cause hypoglycemia. Teaching: Avoid foods high in tyramines. Instruct patient to notify health care professional if changes in vision occur or immediately if diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care professionals

Finginod (Gilenya)
Therapeutic: anti-multiple sclerosis agents
Pharmacologic: receptor modulators

Indications: tx of relapsing forms of MS

Action: converted by sphingosine kinase to the active metabolite fingolimod-phosphate, which binds to sphingosine 1- phosphate receptors, resulting in decreased migration of lymphocytes into peripheral blood. This may decrease lymphocyte migration into the CNS

Contraindications: MI, unstable angina, TIA, or class 3 or 4 HF within 6 mod; 2nd or 3rd degree heart block or sick sinus syndrome (in the absence of a pacemaker); QT interval > or = to 500 msec; concurrent use of class 1a or 3 antiarrhythmics; active acute/chronic untreated infections; lactation

Side effects:
CNS- progressive multifocal leukoencephalopathy, headache
EENT- blurred vision, eye pain, macular edema
Resp- cough, decreased pulmonary function
CV- asystole, bradycardia, heart block, QT interval prolongation, HTN, syncope
GI- diarrhea, elevated liver function tests
Hemat- leukopenia, lymphopenia
MS- back pain
Misc- increased risk of infection

Nursing actions:
Monitor pulse and BP hourly for bradycardia for at least 6 hrs after 1st dose; obtain baseline EKG before 1st dose and at end of observation period; monitor for signs of infection during and for 2 mos after discontinuing therapy; perform an ophthalmologic exam before starting fingolimod, 3-4 mos after initiation, and if visual disturbances occur; monitor visual acuity at baseline and during routine exams; monitor pulmonary function tests for decline periodically during therapy; obtain spirometry and diffusion lung capacity for carbon monoxide when indicated; assess for s/s of multifocal leukoencephalopathy

Labs: obtain baseline liver function tests before starting; may cause elevated liver transaminases; monitor liver function tests of symptoms develop

Give once a day w/o regard to food

Take as directed; notify HCP if s/s of liver dysfunction, infection, new onset of dyspnea, or changes in vision occur; do not receive live attenuated vaccines during and for 2 mos after treatment due to risk of infection; patients who haven’t had chickenpox or vaccinations should consider varicella zoster virus vaccine prior to starting therapy and postpone starting fingolimod for 1 mo to allow full effect of vaccine; advise female pt to use contraception during and for at least 2 mos after discontinuing therapy; notify HCP immediately if pregnancy is planned/suspected or if breastfeeding

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