Therapeutic: Antiangical agent

Pharmacologic: Beta- adrenergic antagonist

Therapeutic effects: Treats HF, HTN, Stable angina, and acute MI.

MOA: Blocks beta1-adrenergic receptors in the heart. It slows the heart rate and reduces contractility.

Route: PO,IV

Adverse Effects: Bradycardia, hypotension, fatigue, weakness, dizziness

Blackbox warning- Abrupt discontinuation should be avoided in patients with ischemic heart disease. Doses should be gradually reduced over 1-2 weeks. 

Contraindications- Should not be used in pts with severe bradycardia, advanced AV heart block, cardiogenic shock, or decompensated HF

Treatment overdose: Atropine or isoproterenol to reverse bradycardia. 

Nursing considerations: Orthostatic hypotension, fall risk, dizziness, do not operate machinery

Therapeutic: Antianginal drug

Pharmacologic: Organic nitrate, vasodilator

Therapeutic Effects: Rapid-acting forms can be taken while an acute angina episode is in progress.

MOA: Relaxes both arterial and venous smooth muscle.Venous dilation decreases the amt of blood returning to the heart.

Route: PO, Sublingual tab, sublingual spray, buccal tablet, transdermal patch, topical ointment

Adverse Effects: Flushing of the face, throbbing transient headache (results from vasodilation), orthostatic hypotension, syncope

Contraindications: In pts with preexisting hypotension, shock, head injury with increased intracranial pressure, head trauma

Drug overdose:IV admin of normal saline for hypotension. Methylene blue for methemoglobinemia.

Nursing: Med kept in metal container (loses effect in light), burning, tingling, sweet-tasting sensation is common, teach about headache, risk for hypotension, earliest sign of oncoming angina pain- sit or lie down and take drug. If pain not relieved by 3 sublingual tabs over 15 min- call 911.

Therapeutic: Drug for heart failure

Pharmacologic: Cardiac glycoside, inotropic agent

Therapeutic Effects: Increase the strength of myocardial contraction, positive inotropic action. Increases cardiac output.

MOA: Inhibits NA+, K+, -ATPase. The release of calcium ions produce a more forceful contraction of myocardial fibers.

Route: PO, IV

Adverse effects: Ventricular dysrhythmias, which may result in sudden cardiac death. Also AV block, atrial dysrthymias, sinus bradycardia. Drug may produce unusual visual effects such as halos, changes in color perception, and photophobia.

Contraindications: Pts with AV block or ventricular dysrhythmias unrelated to HF should not take drug.

Overdose: Administer digoxin immune Fab (Digibind). It consists of digoxin-specific antibodies, which form a complex with digoxin that prevents the drug from reaching the tissues and is removed from renal excretion.

Nursing: Beers List (b/c of decreased excretion). Small therapeutic window (monitor for toxicity). Need to check apical pulse for 1 min-  >60.  Take med at same time daily.

Therapeutic: Nonnarcotic analgesic, antipyretic, antiplatelet

Pharmacologic: Salicylate, NSAID

Therapeutic effects: Reduce pain, inflammation, and fever, prevention of thromboembolic events, stroke prophylaxis in pts with hx of transcient  ischemic attacks

MOA: Inhibits COX1 and COX2 which leads to reduced prostaglandin synthesis. Results in lowering body temp and causes peripheral vasodilation and sweating.

Route: PO, Rectal

Adverse Effects: Risk of hypersensitivity- brochospasm, laryngeal edema, anaphylaxis, stomach irritation, heartburn, nausea, vomiting, diarrhea, stomach pain, hematologic effects, nephrotoxic and hepatotoxicity if use long term.

Contraindications: Pt who have salicylate sensitivity. Children and teenagers should not be given- Reyes syndrome. 

Overdose: Salicylism=acute/chronic aspirin overdose, serum salicylate level >200 mcg/mL.

Nursing: Monitor for GI irritation/bleeding, renal function lab values, urinary output in older patients. Do not use in children or teenagers. Discontinue aspirin 7-14 days prior to surgery/dental procedure.

*People on coumadin/heparin can only take Tylenol

Therapeutic: Antiplatelet agent

Pharmacologic: ADP receptor blocker

Therapeutic effects: Prophylaxis of arterial thromboembolism to reduce the risk of stroke and MI. Also given to prevent thrombi formation in pts with unstable angina, coronary artery stents, or to prevent postoperative DVT.

MOA:Inhibits ADP receptors on platelets and prolongs bleeding time by irreversibly inhibiting platelet aggregation. 

Route: PO

Adverse Effects: Flulike syndrome, headache, diarrhea, dizziness, bruising, upper resp tract infection, rash, pruritus.

Black box warning- Poor metabolizers will exhibit less therapeutic effect and more adverse cardiovascular events.

Contraindications: In patients with active bleeding or pts with high risk for bleeding

Drug interactions: anticoagulants, antiplatelet agents, NSAIDS, thrombolytic agents, aspirin

Overdose: No specific therapy- Platelet transfusions may help prevent hemorrhage. 

Nursing:Monitor for bleeding more frequently. Do not stop drug unless approved by provider. Do not use with NSAIDS, aspirin, OTC drugs.

Therapeutic: None

Pharmacologic: Thrombolytic/firbinolytic

Therapeutic Effect: Identical to human tPA. Treatment of thrombotic stroke. 

MOA: To convert plasminogen to plasmin, which then dissolves fibrin clots.

Route: IV

Adverse effects: Bleeding. (Spontaneous ecchymoses, hematomas, epistaxis)

Contraindications: History of stroke in past 3 months, recent trauma or surgery, active bleeding, uncontrolled HTN

Drug interactions: Anticoagulants, antiplatelet agents, NSAIDS

Overdose: No specific tx. May require blood, blood products, or hemostatics.

Nursing: Monitor for bleeding. Remain quiet and on bed rest while on medication. Worry about microclots, throwing a PE (may break up a clot you need ex/post surgery)

Therapeutic: Anticoagulant

Pharmacologic: Indirect thrombin inhibitor

Therapeutic effect: For acute thromboembolic disorders where rapid anticoagulation is necessary.

MOA: Activates the enzyme antithrombin III, which inhibits thrombin. 

Routes: Subcutaneous, IV bolus injection, or continuous infusion (no PO)

Adverse effects: Abnormal bleeding is common. 

Black box warning- Epidural or spinal hematomas may occur when heparin or LMWHs are used in pts receiving spinal anesthesia or lumbar puncture. Heparin induced thrombocytopenia (HIT) is a serious complication.

Contraindications: Pts with active internal bleeding, serious bleeding pathologies, severe HTN, recent trauma, intracranial hemorrhage, or bacterial endocarditis. 

Drug interactions: Oral anticoagulants, including warfarin, potentiate heparin activity 

Treatment Overdose: Protamine sulfate - administered IV to neutralize the anticoagulant activity of heparin. 

Nursing:Monitor aTTP time- if becomes excessively prolonged or bleeding is observed, discontinue drug and anticoagulant activity will be lost within hours. Long-term  may result in drug-induced osteoporosis and increase risk of fractures. Avoid smoking or drinking alcohol. May significantly increase risk of bleeding.

Therapeutic: Anticoagulant

Pharmacologic: Vitamin K antagonist

Therapeutic effect: long-term prophylaxis of arterial thromboembolism, including prevention of stroke and MI, DVT. 

MOA: inhibits 2 enzymes involved in formation of activated Vit K, which is required in synthesis in clotting factors II,VII,IX,X. Inhibits synthesis of new clots.

Route: PO

Adverse effects: abnormal bleeding, may occur in any body system. May release pieces of atheromatous plaque from vessel walls, resulting in systemic cholesterol microembolization and severe cases may lead to gangrene or amputation.

Blackbox warning- Can cause major or fatal bleeding, regular monitoring of INR is required.

Contraindications: Pts with recent trauma, active internal bleeding, serious bleeding disorders, intracranial hemorrhage, severe HTN, bacterial endocarditis, or severe hepatic or renal impairment. 

Pregnancy Cat = Cat. X

Treatment overdose: PO or parenteral administration of Vitamin K. (Reverses anticoagulation effects within 6 hrs.)

Nursing: Monitor for bleeding more frequently. Blackbox warning for bleeding and hemorrhage. Use extra precautions during sex bc cat x so can cause birth defects.

Therapeutic: Antiulcer drug

Pharmacologic: Proton pump inhibitor

Therapeutic effects: Short term therapy of active peptic ulcers. 

MOA: Reduces acid secretion in the stomach by binding irreversibly to the enzyme H+, K+, -ATPase. Inhibits final pathway involved in acid secretion and effectively inhibits the active proton pumps.

Route: PO

Adverse effects: headache, nausea, diarrhea, rash, and abdominal pain

Contraindications: hypersensitivity to the drug.

Treatment Overdose: overdose is uncommon and treated symptomatically.

Nursing: Monitor hepatic function lab values. Take med 30 mins before meals, pref breakfast (bc proton pump initiated when start chewing). immediately report severe or persistent diarrhea accompanied by fever. Do not take with Plavix. 

Therapeutic: Antituberculosis agent, antimycobacterial

Pharmacologic: Mycolic acid inhibitor

Therapeutic effects: Treatment of M. tuberculosis infections.

MOA: Inhibits the synthesis of mycolic acid, an essential cell-wall component of mycobacteria.Treatment of active disease requires multi-drug therapy (Rofampin or B6). 

Routes: PO, IM (only if PO not available)

Adverse effects: rash and fever. Neurotoxicity- paresthesia of feet/hands, convulsions, optic neuritis, dizziness, coma, memory loss, various psychoses

Black box warning- hepatotoxicty- should be monitored for jaundice, fatigue, elevated hepatic enzymes, or loss of appetite. 

Contraindications- no absolute contraindications.

Drug interactions- Many. 

Treatment Overdose: may be fatal and mostly symptomatic.  Pyridoxine may be infused in dose equal to isoniazid to prevent seizures and to correct metabolic acidosis.

Nursing: Monitor hepatic function values. Avoid alcohol- risk of liver toxicity. Take medication consistently.

Therapeutic: Antibacterial

Pharmacologic: Folic acid inhibitor, sulfonamide

Therapeutic effect: Commonly used to treat UTI prophylaxis and in the pharmacotherapy of complicated and uncomplicatedUTI.

MOA: SMZ and TMP are inhibitors of the bacterial metabolism of folic acid. Each drug inhibits a separate enzyme in the metabolic pathway, creating a synergistic combination.

Route: PO, IV

Adverse effects: Nausea and vomiting are the most common. Hypersensitivity- skin rash, pruritus, fever, anaphylaxis, Steven-Johnson syndrome.

Contraindications: Pts with hypersensitivity to sulfites, sulfonamides, or chemically related to agents such as thiazide diuretics.

Drug interactions: May enhance effects of oral anticoagulants.

Treatment overdose: Acidification of the urine will increase the renal elimination of trimethoprim.

Nursing: monitor hepatic and renal function lab values, carefully monitor for diarrhea in young children/older adults.

Therapeutic: Antiepileptic drug

Pharmacologic: GABA analog

Therapeutic effect: Controls partial seizures with out without secondary generalization. Also used to treat postherpetic neuralgia and restless-leg syndrome

MOA: Anticonvulsant action is unknown. 

Route: PO

Adverse effects: drowsiness, fatigue, nystagmus, dizziness, viral infections,weight gain, gastric upset

Contraindications: In pts who are pregnant or nursing.

Treatment overdose: Results in dyspnea, sedation, double vision, and slurred speech. Renal dialysis used to treat overdose.

Nursing: Monitor pediatric pts closely. Report behavior changes - hostility, mood swings, hyperkinesias. Report suicidal thoughts or unusual behaviors. If nausea occurs, take med with food.  Do not consume alcohol.

Therapeutic: Antiepileptic drug, antianxiety agent, skeletal muscle relaxant

Pharmacologic: Benzodiazepine, GABA receptor agonist

Therapeutic effect: Status epilepticus. Also used to prevent seizures in pts who have received toxic substances or during the acute phase of alcohol or benzodazepine withdrawl. Also used for management of anxiety disorder.

MOA: enhances action of GABA in the brain, inhibiting abnormal neuronal discharges characteristics of seizures.

Route:IV, IM, PO, rectal

Adverse effects: Cardiovascular collapse. Should assess for hypotension, tachycardia, edema which are precursors to cardiovascular collapse. Drowsiness, fatigue, ataxia, dizziness, vertigo.

Contraindications: Pts with depressed vital signs, shock, or those with acute alcohol intoxication.

Preg Cat: Cat D.

Treatment overdose: Flumazenil (Romazicon) is administered for overdose of diazepam - a specific benzodiazepine receptor antagonist that reverses CNS depression.

Nursing:  Beers List - increased risk for falls. Monitor pulse and resp rate. Risk for confusion. Keep a written account of seizure activity- noting time of onset, duration, type of seizure, and behavior postseizure. Use second form of birth control. Do not consume with alcohol.

Therapeutic: Antiepileptic drug

Pharmacologic: Hydantoin, neuronal sodium channel modulator

Therapeutic effects: Prophylactic therapy for all types of seizures except absence seizures. Used to prevent seizures during neurosurgery or eclampsia. 

MOA: Inhibits seizure activity by delaying the influx of sodium ions in neurons, thereby slowing the propagation and spread of abnormal discharges.

Route: PO, IV

Adverse effects (MANY): Very toxic drug- must be monitored closely. Lethargy, headache, drowsiness, dizziness. High doses may cause nystagmus, confusion, ataxia, coma, and seizures. Bradycardia, ventricular fibrillation, hypotension, phlebitis. Liver necrosis, agranulocytosis, leukopenia, thrombocytopenia and aplastic anemia.

Contraindications: In pts who have developed a rash, sore throat, fever, oral ulcers.

Preg Cat: Cat D

Treatment overdose: Treated with activated charcoal with gastric lavage.

Nursing: Increased risk for falls due to lethargy, drowsiness, dizziness. Monitor peds patients for gingival hyperplasia- encourage dental visits. Hairloss. Report if rash appears or have suicidal thoughts. Take med with food if nausea occurs. Med may change urine from pink to red-brown color but not harmful. Increase intake of Vit D and calcium-rich foods but dont take med with meals containing vit D or calcium. No alcohol. Use backup birth control. Monitor labs.

Therapeutic: Tricylic antidepressant

Pharmacologic: Norepinephrine reuptake inhibitor

Therapeutic effects: Treats major depressive disorder (takes 2- 6 weeks to achieve full therapeutic effect). Also treats bed wetting in children.

MOA: Blocks the reuptake of norepinephrine and serotonin into presynaptic nerve terminals, results in increased action of both neurotransmitters in neurons. Also blocks acetylcholine receptors - treating enuresis.

Route: PO, IM (rare)

Adverse effects: Orthostatic hypotension (most common), dizziness, confusion, drowsiness, diarrhea, dry mouth, increased appetite, jaundice, urinary retention, rash, pruritus, photosensitivity. Weight gain is common.

Blackbox warning- Increased risk of suicidal thinking and behavior in children, adolescents, and young adults.

Contraindications: In pts with seizure disorders bc lowers seizure threshold. Use with caution in pt with suicidal tendencies, urinary retention, prostatic hyperplasia, cardiac or hepatic disease, intraocular pressure, or hypothyroidism.

Treatment Overdose: May be life threatening- symptoms include mixed mania and depression followed by a coma. Medical management includes treating possible seizures, hypotension, and dysrhythmias.

Nursing: Increased risk for falls. Monitor in elderly- urinary retention, dry mouth, or other anticholinergic effects. Full therapeutic effect takes 2-6 weeks to appear. Change positions slowly to prevent dizziness or fainting. Maintain all recommended follow up appts for ECG. Back up contraception barrier. Anticholinergic effects may occur such as dry mouth- increase fluids, suck on sugarless candy. Drug should not be withdrawn abruptly but tapered off. 

Therapeutic: Antidepressant, antianxiety agent

Pharmacologic: Selective serotonin reuptake inhibitor (SSRI)

Therapeutic effect: Treats major depressive disorder. Also used to treat bulimia nervosa, pediatric depression, OCD in adults and children.

MOA: Blocks the uptake of neurotransmitter serotonin (but not norepinephrine) at the neuronal presynaptic membrane. 

Route: PO

Adverse effects: Nausea, vomiting, diarrhea, anorexia, cramping, flatulence.

Blackbox warning- Increase risk of suicidal thinking and behavior in children, adolescents, and young adults. Pts should be monitored closely. 

Contraindications: Hypersensitivity to fluoxetine is a contraindication.

Treatment Overdose: Can result in seizures, somnolence, and rarely death. Supportive treatment includes gastric lavage and activated charcoal.

Nursing: Monitor daily weights in children and older adults to assess weight loss and proper nutrition. Increased risk for falls. Monitor hepatic and renal function lab values bc may affect metabolism and excretion. Full therapeutic effect will take 2-6 weeks. Take last dose before 4pm to prevent insomnia. Report any suicidal thoughts, palpitations, major changes in sexual function, excessive weight gain, or excessive drowsiness. Seratonin syndrome = euphoria, hypothermia, hallucinations.

Therapeutic: Antidepressant

Pharmacologic: Monoamine oxidase inhibitor

Therapeutic effect: Treats major depression. Used off label to treat OCD, panic disorder, and social anxiety disorder, migraine prophylaxis.

MOA: Binds irreversibly to MAO. This intensifies the actions of endogenous epinephrine, norepinephrine, serotonin, and dopamine in the CNS.

Route :PO

Adverse effects: Hypertensive crisis precipitated by foods containing tyramine, which can induce fatal intracranial bleeding. Dizziness and orthostatic hypotension.

Blackbox warning- Increase the risk of suicidal thinking and behavior in children, adolescents, and young adults.

Contraindications: Pts with schizophrenia, cardiovascular or cerebrovascular disease, hepatic or renal impairment,  or pheochromocytoma.

Treatment overdose: Is serious and can result in death if untreated. Symptoms include seizures or depression. Induction of gastric lavage with activated charcoal may be beneficial.

Nursing: Obtain a comprehensive health hx including cardiovascular, hepatic, and renal disease. Monitor caffeine intake- can potentiate hypertensive reactions. Monitor pt closely for first few weeks while drug takes effect. Increased risk for falls. Monitor hepatic and renal function lab values. Evaluate culturally specific diets for high-tyramine foods and assist with food substitutes. Full effect may take 2-6 weeks. Report headache, neck stiffness, palpitations, insomnia, change in urinary pattern or color. Avoid alcohol. If sedation occurs-take med at bedtime. Change positions slowly to prevent dizziness and possible fainting. 

Therapeutic: Antiepileptic drug, antimanic drug

Pharmacologic: GABA agonist

Therapeutic effects:  Treats epilepsy.Form valproate after absorption or enter the brain. 

MOA: Increases concentrations of the inhibitory neurotransmitter GABA in the brain. Abnormal neuron discharges are suppressed, leading to decreased seizure activity.

Route: IV, PO

Adverse effects: Nausea, vomit, diarrhea, abdominal pain, and diminished appetite. Headache, tremor, dizziness.

Blackbox warning- Serious hepatotoxicity has been reported in infants younger than age 2. Life threatening pancreatitis has been reported.

Contraindications: Pts with bleeding disorders, cirrhosis, congenital metabolic disorders, and autoimmune deficiency syndrome.

Preg Cat: Cat D

Treatment Overdose: May be serious and include sedation, heart block, deep coma, and death. Narcan used to reverse CNS depression, and hemodialysis can lower drug serum levels.

Nursing: Risk for falls. Monitor hepatic lab values in pediatric patients (risk for hepatotoxicity), particularly those under age 2. Drug has potential for severe birth defects. 

Therapeutic: Antianxiety agent, sedative- hypnotic, antiseizure agent

Pharmacologic: Benzodiazepine, GABA receptor agonist

Therapeutic effect: Routine management of GAD and to reduce anxiety prior to surgical or medical procedures.

Used off label for insomnia, seizure, and the prevention or control of acute symptoms associated with ethanol withdrawl.

MOA: Potentiates the actions of GABA,  an inhibitory neurotransmitter in the CNS. Capable of causing all levels of CNS depression from simple relaxation to induction of sleep to coma.

Route: PO, IM, IV

Adverse effects: Dizziness, ataxia, drowsiness, blurred vision, vertigo, sedation, and confusion. Decreases BP, Pulse.

Contraindicated: During pregnancy, unless pt's condition is life threatening.

Preg Cat.- Cat D

Treatment overdose: Causes sedation, lethargy, coma. Gastric lavage and activated charcoal may be administered.

Nursing: Beers List - Risk for falls. Incorporate measures to enhance sleep- avoid caffeinated drinks within 6 hours of bedtime. Do not consume alcoholic drinks. Drug has potential for birth defects. Short acting-  potential for dependancy. 

Therapeutic: Sedative- hypnotic

Pharmacologic: Nonbenzodiazepine anxiolytic, miscellaneous CNS depressant

Therapeutic effects: Short-term (7-10 days) treatment of insomnia.

MOA: Enhances the action of GABA, the inhibitory neurotransmitter. Binds only to one specific type (Omega-1). 

Route: PO

Adverse effects: Dizziness, diarrhea, daytime drowsiness. N, V, Depression, confusion, amnesia.

Contraindications: Hypersensitivity to zolpidem, otherwise none.

Treatment overdose: Can cause serious impairment of consciousness and may be fatal. Benzodiazepine antagonist flumazenil will reverse the sedative effectves but may precipitate seizures. 

Nursing: Increased risk for falls. Take drug immediately prior to expected sleep. Have caregivers observe nighttime behavioral activities such as sleepwalking, sleep-eating, or sleep-driving and to report activities immediately.  Do not take drug after a meal bc it will reduce its effectiveness.

Therapeutic: Sedative- hypnotic, antiepileptic drug

Pharmacologic: Barbiturate, GABA receptor agonist

Therapeutic effects: Schedule IV drug. IV route used for emergency situations such as status epilepticus and should be administered slowly. Approved for short-term tx of insomnia. 

MOA: Binds to GABA receptors, where it enhances the activity of GABA.

Route: PO, IM, IV

Adverse effects: Coma, Stevens-Johnson syndrome, angioedema, and thrombophlebitis. Oversedation, "hangover" effect, lethargy, hallucinations.

Contraindications: Pts with hypersensitivity to barbiturates, suicidal ideation or previous suicide attempt, preexisting CNS depression, severe resp disease, severe pain, or hyperthyroidism.

Preg Cat: Cat D

Treatment Overdose: Medical emergency and can be fatal. Activated charcoal is administered, followed by gastric lavage.

Nursing: Beers List.  Take med exactly as instructed and do not discontinue unless advised to bc seizures may result. Never consume alcohol. Store away in secure place to avoid misuse or accidental overdosage.  High addictive potential. 

****Not used much anymore, used to be used for seizures****

Therapeutic: Antidiarrheal

Pharmacologic: Opioid 

Therapeutic effect: Oral opioid, Schedule IV controlled substance. Slows peristalsis, allowing for additional water reabsorption from the intestine to form solid stools. Acts within 45- 60 minutes. Effective for mod- severe diarrhea

MOA: Acts on the smooth muscle cells of the intestine to slow peristalsis.

Route: PO

Adverse Effects: No analgesic properties and extremely low potential for abuse. May experience dizziness, lethargy, drowsiness.

Contraindicated: Pts with hypersensitivity to the drug, severe hepatic impairment, obstructive jaundice, and diarrhea.

Treatment overdose: Overdose may be serious. Naloxone may be administered to reverse resp depression within minutes.

Nursing: Monitor bowel sounds in older adults for development of constipation, particularly from prolonged use. Monitor electrolyte levels in young children and older adults- greater risk for electrolyte imbalances. Monitor for increased agitation, hallucinations, or confusion in older adults. Do not take this drug if on antibiotic therapy with provider approval. 

Therapeutic: Antimanic, agent for bipolar disorder

Pharmacologic: Alkali metal ion salt

Therapeutic effects: Treats bipolar disorder. Effective in controlling acute manic episodes charachteristic of bipolar disorder and in preventing recurrence of mania and depression. Lithium decreases euphoria, hyperactivity, and other symptoms without causing sedation.

MOA: Unknown. Likely acts by changing neurotransmitter balance in specific brain regions.  Increases the synthesis of serotonin.

Route: PO

Adverse effects: Muscle weakness, lethargy, nausea, vomiting, polyuria, nocturia, headache, dizziness, drowsiness, tremors, confusion. 

Blackbox warning: Closely related to serum concentrations and may occur at doses close to therapeutic levels. Monitor regularly during therapy.

Contraindications: Serious cardiovascular or renal impairment and severe dehydration or sodium depletion. Older adults and debilitated pts must be carefully monitored.

Preg Cat: Cat D

Treatment Overdose: Treated with supportive measures such as emesis or lavage, maintaining airway and resp function. Dialysis if intoxication is severe.

Nursing: Health hx of depression and mania symptoms. Assess baseline vitals, weight, and labs - esp serum sodium, CBC, hepatic, and renal values. Monitor drug levels, weight, CBC, electrolytes, and urinalysis for protein, albumin, and glucose periodically. Report thirst, dizziness, lethargy, confusion, muscle weakness, or polyuria immediately. Assess older adult for signs of sodium imbalance or dehydration. Full effect takes 2-3 weeks to appear. Weigh self weekly- report gain or loss of 1 kg in a day or 2 kg in a week. Maintain normal sodium diet and fluid intake. Avoid caffeine or alcohol. Report excessive thirst, urination, dizziness, muscle weakness, tachycardia, palpitations, or confusion. Do not discontinue drug abruptly. 

**Risk for lithium toxicity= starts with increasing tremors, N, V - dont feel well. Once toxic = confusion, sweating, can lead to seizures and death

Therapeutic: Antipsychotic (second-generation atypical)

Pharmacologic: Dopamine antagonist

Therapeutic effects: Atypical antipsychotic.  Initially approved to treat negative psychotic symptoms in people with schizophrenia and related psychoses. 

MOA: Unknown. Believed the drug acts by blocking the binding of dopamine to its receptors in the various brain regions. Highest affinity for type D2, less for D1.

Route: PO, IM

Adverse effects: Drowsiness, N, V, Constipation, and increased salivation.

Blackbox warning- not indicated for tx of dementia- related psychosis.

Contraindications- Caution in pts with severe CNS depression, seizures, dysrhythmias, hypotension, diabetic ketoacidosis, and suicidal ideation.

Treatment Overdose: Symptoms include confusion, sedation, hypotension, and dysrhythmias. Tx includes gastric lavage and maintenance of cardiovascular function.

Nursing: Risk for falls. Monitor cardiovascular and resp function. Monitor glucose, cholesterol, and lipid profiles, and weight frequently.Take exactly as prescribed daily. Report symptoms of hyperglycemia, thirst, urinary freq, and unusual hunger. Weigh daily and report weight gain (often given Metformin bc high risk for developing TII Diabetes). Mix PO solution with exact amount of drug with water, coffee, OJ, or low fat milk. Do not drink alcohol. Cont all scheduled lab tests. Sensitivity to sun (sunburn). Glastomastia (milk from male breasts in extreme)

Therapeutic: Atypical antipsychotic

Pharmacologic: Dopamine system stabilizer (DSS)

Therapeutic effects: Controls both the positive and negative symptoms of schizophrenia and improves cognition with only minimal risk of EPS.

MOA: Combination of partial agonist activity at dopamine type 2 and serotonine type 2 receptors and antagonist activity at 5ht2A receptors.

Route: PO, IM

Adverse effects: drowsiness, insomnia, agitation, hyper/hypotension, light-headedness, anxiety, headache, restlessness, EPS, akathisia, N, V, constipation

Black box warning- Not indicated for tx of dementia-related psychosis. 

Contraindications- Lactation, seizure disorders, or hypersensivity to use of aripiprazole. 

Treatment overdose: Can cause vomiting, tremor, drowsiness, but fatalities not reported. No specific tx.

Nursing:Risk for falls, monitor cardiovascular and resp function more freq. Monitor pts under age 24 more closely. Monitor glucose, chol, lipid profiles, and weight freq. Take exactly as prescribed and do not discont. unless advised to. Take med daily. Report symptoms of hyperglycemia such as increased thirst, urinary freq, unusual hunger, Notify provider of weight gain. Cont all scheduled lab tests and therapy. If taking PO solution- mix exact amt with water, coffee, OJ, milk. Do not drink alcohol. 

Therapeutic: Antipsychotic (first generation)

Pharmacologic: Phenothiazine, dopamine antagonist

Therapeutic effect: Low-potency antipsychotic that blocks several types of receptors within and outside the CNS, including dopamine, histamine, norepinephrine, and acetylcholine receptors. Major use to treat symptoms of schizophrenia and other psychotic disorders.

MOA: Acts by blocking post-synaptic dopamine receptors.

Routes: PO, Rectal, IM, IV (only for severe cases)

Adverse effects: Headache, anticholinergic symptoms (dry mouth, anorexia, N, V, constipation), weight gain, anemia, phototoxicity, blurred vision, dry eyes, and glaucoma.

Blackbox warning- Not indicated for tx of dementia-related psychosis. 

Contraindications: CAD, Severe hyper/ hypotension, blood dyscrasias, coma, brain damage, bone marrow depression, alcohol or barbiturate withdrawl, glaucoma, hepatic dysfunction, and children <6months.

Treatment overdose: Will cause profound CNS depression, seizures, hypotension, and EPS. Tx is supportive and may include vasopressors and antiseizure drugs. Airway and gastric lavage provided if taken PO.

Nursing: Monitor ped pts for adverse effects. Risk of falls in elderly. Assess elderly for urinary retention related to anticholinergic effects. Take drug exactly as prescribed. Refrain from alcoholic beverages. Cont scheduled lab tests and therapy.

Therapeutic: Antipsychotic (first generation)

Pharmacologic: Nonphenothiazine, dopamine antagonist

Therapeutic effect: Treats both acute and chronic psychotic disorders.

MOA: Depresses the cerebral cortex, hypothalamus, and limbic system- parts of the brain that control activity and aggression. 

Route: PO, IM

Adverse effects: Drowsiness and EPS. Life-threatening adverse effects include TD, NMS, agranulocytosis, resp dep, and laryngospasm. 

Blackbox warning- Not indicated for tx of dementia-related psychosis.

Contraindications- Parkinson's disease, seizure disorders, coma, alcoholism, severe mental depression, CNS depression, or lactatoin.

Treatment overdose: Result in sedation, resp depression, coma, hypotension, and severe EPS.

Nursing: Same as other first generation antipsycotics (Chlorpromazine)

Therapeutic: Antibacterial

Pharmacologic: Cell wall inhibitor, first-generation cephalosporin

Therapeutic effect: A beta-lactam antibiotic used for the tx and prophylaxis of bacterial infections, particularly those that are caused by susceptible gram-positive organisms. 

MOA: Inhibits bacterial wall synthesis by binding to specific PBPs. Drug is bacteriocidal, exhibits a broad spectrum, and is sensitive to beta lactamase.

Route: IM and IV

Adverse effects: Rash and diarrhea.

Contraindicated: in pts who are allergic to any drug in cephalosporin class and those hypersensative to PCN.

Treatment overdose: No specific therapy is available. Pts are treated symptomatically.

Nursing: Monitor renal function lab values more freq. monitor for diarrhea. Consult before drinking alcohol - can cause flushing, throbbing in the head/neck, resp difficulty, N, V, sweating, thirst, chest pain, blurred vision, and confusion. Report severe or persistent diarrhea.

Therapeutic: Antibacterial

Pharmacologic: Cell wall inhibitor, natural PCN

Therapeutic effect: narrow spectrum, includes most gram-positive bacteria. Many gram-negative bacteria are resistant. Drug of choice for tx of infections shown to be susceptible by culture and sensitivity.

MOA: Inhibits bacterial wall synthesis by binding PBPs. Penicillin G is bacertiocidal and destroyed by penicillinase.

Route: IM, IV

Adverse effects: Well tolerated and adverse effects are uncommon. Most serious effect is hypersensitivity reaction. 

Contraindicated: In pts hypersensitive to PCN or cephalasporins.

Treatment overdose: No specific therapy is available. Pt is treated symptomatically.

Nursing: Monitor hepatic and renal function lab values more freq. Monitor cardiac status in older adults. Monitor for diarrhea. Immediately report severe or persistent diarrhea.

Therapeutic: Antibacterial

Pharmacologic: Cell wall inhibitor

Therapeutic effects: Used for the tx and prophylaxis of susceptible bacterial infections. Effective against most gram-positive organisms. Most effective for tx MRSA infections.

MOA: Kills bacteria mainly by inhibiting bacterial cell wall synthesis, also affects the plasma membrane and interferes with ribonucleic acid synthesis (RNA).

Route: IV, PO

Adverse effects: may cause syndrome of flushing, hypotension, tachycardia, and rash on upper body = called red man syndrome. Syndrome can be minimized by infusing the drug over at least 60 minutes. Other adverse effects - N, rash, fever, and chills.

Contraindications: Pts who have experienced previous hypersensitivity to this drug. 

Treatment overdose: May result in renal impairment, patients are treated supportively to maintain kidney function. 

Nursing: Monitor renal function lab values more freq., monitor hearing and balance - esp in older adults to detect early signs of ototoxicity. Carefully monitor for diarrhea. Maintain adequate fluid.

Therapeutic: Antibacterial

Pharmacologic: Bacterial protein synthesis inhibitor, macrolide

Therapeutic effect:  Treatment and prophylaxis of susceptible bacterial infections. For patients who are allergic to PCNs or have a PCN- resistant infection.

MOA: Inhibits bacterial protein synthesis by binding the 50S ribosomal subunit. Considered bacteriostatic but may be bacteriocidal in high doses. 

Route: PO, topical, IV

Adverse effects:N,V, abdominal cramping- rarely serious enough to discont med.

Contraindicated:Hypersensitivity to drugs in macrolide class. Drug therapy must be monitored carefully in pts with impaired hepatic or biliary function due to poss of Cholestatic hepatitis - a type of liver inflammation caused by obstruction of bile ducts.

Treatment overdose: No specific therapy available. Pts are treated symptomatically. 

Nursing: Monitor hepatic function lab values more freq. Carefully monitor for diarrhea. 

Therapeutic: Antibacterial

Pharmacologic: Bacterial protein synthesis inhibitor, aminoglycoside

Therapeutic effect: Used for the tx and prophylaxis of susceptible bacterial infections. Primarily for serious infections caused by aerobic, gram-negative bacilli. 

MOA: Inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit. It is bacteriocidal that is causes premature termination of the growing polypeptide chain.

Route: IM, IV, topical

Adverse effects: Resistance to Gentamicin is increasing and cross-resistance among aminogylcosides has been reported. 

Blackbox warning- Neurotoxicity- otoxocity, Neuromuscular blockage and resp paralysis, Nephrotoxicity.

Preg Cat: Cat D

Treatment Overdose: Can result in serious kidney damage and ototoxicity. No specific therapy is available, tx'd symptomatically. 

Nursing: Monitor renal function lab values, monitor for changes in hearing/balance freq, monitor for diarrhea. 

Therapeutic: Antibacterial

Pharmacologic: Bacterial DNA replication inhibitor, fluoroquinolone

Therapeutic effect: Second generation fluoroquinolone. Prescribed for UTI, sinusitis, pneumonia, skin, bone and joint infections, infectious diarrhea, and certain eye infections.

MOA: Inhibits bacterial DNA gyrase and topoisomerase, ciprofloxacin affects bacterial replication and DNA repair. 

Route: PO, IV, opthalmic and otic drops

Adverse effects: Well tolerated, serious adverse effected uncommon.  N, V, diarrhea. May be taken with food to diminish GI upset. 

Blackbox warning- Tendinitis and tendon rupture may occur in all ages. Risk esp in >60 yr in kidney, heart, and lung transplant recipients. 

Treatment overdose: No specific tx, tx'd symptomatically. 

Nursing: Monitor older adults for joint pain, tendon pain, or difficulty with gait. Increased risk of tendonitis and tendon rupture. Carefully monitor for diarrhea. Do not take products containing magnesium or calcium, iron, or aluminum within 2 hrs of taking drug. Report sudden joint or tendon pain, tendinitis, or difficulty walking/ movement.