• Ritalin
• For the treatment of Attention Deficit/Hyperactivity Disorder
• Assess for heart-related side effects and report immediately
• Child may need drug holiday due to growth delay

• Inotropine
• It treats hypotension, shock, low cardiac output, and poor organ perfusion
• Monitor EKG for arrhythmias and blood pressure.

• Antipsychotic to treat Schizophrenia
• Blocks dopamine receptors
• Side effects EPS (Extrapyramidal symptoms).
  • Akathisia: Feeling restless like you can’t sit still. 
  • Dystonia: When your muscles contract involuntarily. 
  • Parkinsonism: Symptoms are similar to Parkinson’s disease. 
  • Tardive dyskinesia: Facial movements that happen involuntarily.
• Treatment for EPS: diphenhydramine or benztropine.

• Treatment for leukemia
• Given IV only
• Monitoring: electrolytes, uric acid, hepatic function, complete blood count with differential, and  signs and symptoms of peripheral neuropathy

• Treatment given after menopause
• Estrogen replacement
• Risk of PE, DVT, stroke and MI 

• Treatment for scabies and lice
• For scabies: Apply lotion once and leave on for 8 to 12 hours.
• For Lice: Use the shampoo and leave on for 4 minutes with hair uncovered then rinse with warm water and comb with a fine tooth comb.

• Treatment of alcohol withdrawal
• Don’t take with alcohol

• NSAID
• Treats: Osteoarthritis, rheumatoid arthritis, gout, bursitis, and tendonitis.

• Treats hypothyroidism
• Takes weeks to work
• Take in the morning and on an empty stomach. 
• Side effects: think symptoms of hyperthyroidism (anxiety and tachycardia)

• A weak diuretic
• Treats Glaucoma and high altitude sickness.
• This medication can decrease headache, tiredness, nausea, dizziness, and shortness of breath that can occur when you climb quickly to high altitudes
• Do not take if allergic to sulfa

• Sucralfate is a unique anti-ulcer drug. It is a basic aluminum salt of sucrose octasulfate. 
• Treats ulcers by coating the ulcer
• Take before meals.

• Bactrim
• Antibiotic  for ear infections, bronchitis, pneumonia, urinary tract infections (UTIs), & intestinal infections
• Do not take if allergic to sulfa
• Common side effect: diarrhea so drink plenty of fluids to prevent dehydration.

• Medication of choice for Ventricular tachycardia

• Medication of choice for Supraventricular tachycardia SVT

• Medication of choice for asystole/ bradycardia with symptoms
• Also used to reduce secretions

• Medication of choice for anaphylactic shock

• Medication of choice for bipolar disorder
• Watch for hyponatremia which potentiates toxicity.

• Works for both atrial and ventricular dysrhythmias

• Drug of Choice for Torsades de Pointes and pre-eclampsia to prevent seizures.  It is a CNS depressant!

• Reduces nausea

• Do not give in sickle cell crisis due to possible seizures
• GIVE to clients with pancreatitis and avoid morphine. Morphine causes spasms of sphincter of oddi.

• Use Z track to prevent leakage into SQ tissues. Iron irritates and discolors tissues.
• The oral form discolors teeth-rinse mouth. Give with vitamin C to increase Absorption (orange juice)

• Sublingual give every 5 minutes for chest pain/angina. If no relief after 3 doses, the client is likely having an  MI
• Headache is a common symptom because it vasodilates vessels in the brain

• Under 16, do not give aspirin for pain due to Reyes Syndrome (Encephalopathy)
• Educate clients on the potential for bleeding, especially GI bleeding. Report dark, tarry stools

• Too much prednisone, think Cushing: buffalo hump, moon face, hyperglycemia, & hypertension.
• Sample question: A client with Addison Disease has been on Cortisone for a long time. What findings do you expect? The answer is not Addison symptoms but Cushing symptoms.
• Do not stop abruptly to prevent addisonian crisis. 

Phenobarbital

• Class: Barbiturate
• Mechanism of action: Increases the effects of GABA, which reduce neuronal excitability by inhibiting nerve transmission. CNS depressants.
• Examples: Phenobarbital, Butalbital, and Primidone
• Problem: Low Therapeutic Index. 10 to 40 mcg/m.  Better to use bendodiazepines, which are safer.
• Phenobarbital can be taken during pregnancy but Dilantin is contraindicated.
• Barbiturate withdrawals symptoms: ↑ Temp, restlessness, convulsions, nausea, vomiting, & sleeping problems.

Dilantin

• Treats seizures
• Therapeutic Dilantin level 10 to 20 mcg/mL
• When given IV only use saline. DO NOT use dextrose, it will precipitate.
• Toxicity: ALOC, confusion, nystagmus, & ataxia

• Mechanism of action: Increases the effects of GABA (an inhibitory neurotransmitted. Think GABA relaxes).
• Uses: Seizures, Prior to an invasive procedure, Anxiety, and insomnia. 
• Examples: Alprazolam, Lorazepam, Diazepam (Valium) & Clorazepate. They mostly end with PAM.
• Medication of choice for status epilepticus: Diazepam (Valium).
• Avoid: Alcohol and opioids.
• Toxicity: Bradycardia, repiratory depression, extreme drowsiness, and slurred speech.
• Antidote: Flumazenil

• Mechanism of Action: HMG-CoA Reductase inhibitor. HMG-CoA Reductase is necessary for the synthesis of cholesterol in the liver.  With its inhibition, cholesterol is reduced. 
• Examples: Known as STATINS.  These medications end with -statin: Pravastatin & Simvastatin.
• Goal of treatment: Lower LDL to < 100 mg/dl and increase HDL to > 60 mg/dl.  LDL is bad cholesterol and HDL is good cholesterol. 
• LDL: fatty substance that sticks to vessels and causes atherosclerosis.
• HDL: fatty substance that removes LDL from the bad to prevent atherosclerosis.
• Side effects:
  • Rhabdomyolysis: Breakdown of skeletal muscle. Check Creatine Kinase level.
  • Liver Injury: Monitor ALT & AST. Watch for jaundice, abdominal pain in RUQ, and nausea.
• Food interactions: Avoid Grapefruit to prevent toxicity.

• Uses: Lower BP, treat angina, & antidysrhythmics.
• Mechanism of action: Block beta receptors so norepinephrine and epinephrine cannot bind.
• Beta 1 Receptors: Heart and Kidneys.
• Beta 2 Receptors: Lungs & Vascular Smooth Muscle.
• Non-selective beta blocker (affects both heart and lungs): Propranolol- Avoid in asthma.
• Selective Beta Blockers (Only Beta 1): Can be used in asthma since not Beta 2 (Lungs): Atenolol, Esmolol, & Metoprolol.
• Contraindications: Do not use Non-selective Beta Blockers in Asthma. Do not use any Beta Blockers in uncompensated heart failure or cardiogenic shock (Clients with peripheral edema and pulmonary edema).
• Beta Blocker overdose: Bradycardia, hypotension, Dyspnea, ALOC, & 2nd & 3rd degree AV Blocks

• Mechanism of action: Block Calcium Channels in vascular smooth muscle and heart.
• Uses: HTN, angina, and arrhythmias (Verapamil and Diltiazem)
• Examples: Antidysrhythmias: Verapamil and Diltiazem
• Examples: Antihypertensives: Felodipine, Nifedipine, and Amlodipine (Note ending -pine)
• Side effects:
  • Constipation: Increase fiber, decrease fat, and increase fluids in diet.
  • Gingival Hyperplasia: Good oral Hygiene.
  • Hypotension: Monitor Blood pressure
  • Safety: Calcium Channel blockers can increase Digoxin Toxicity. Do NOT Eat grapefruit to prevent CCB toxicity. 

• Mechanism of action: Inhibit the renin-angiotensin-aldosterone system (RAAS), inactivate bradykinin by breaking it down, and prevent conversion of Angiotensin I to Angiotensin II.
• Angiotensin II: Causes vasoconstriction and increases aldosterole. If it is inhibited, vasodilation and a decrease of aldosterone will occur (↓ Na+ & ↑ K+). 
• Again, ↓ SVR and BP, causes kidneys to excrete sodium and water, causes kidneys to retain potassium. 
• Examples:  the -prils. Captopril, Enalapril, Benazepril.
• Uses: Systolic dysfunctional heart failure, hypertension, and good after an MI.
• Side effects:
  • Angioedema: swelling deep in the skin. Very dangerous. Swelling of the face and difficulty breathing.
  • Hyperkalemia: Avoid salt substitutes, low potassium diet.  Greater risk of hyperkalemia is client is on both spironolactone and an ACE inhibitor. Watch for tall, peaked T waves.
  • Persistent cough: Benign.  Occurs due to Bradykinin build up in the airways. Teach clients not to stop medication and ask MD to change to another medication. 

• Mechanism of action: Prevent Angiotensin II Type I Receptors from binding with Angiotensin II.
• Actions: ↓ SVR, ↓ BP, ↓ blood volume through excretion of sodium and water.
• Again: Vasodilation, Sodium excretion, and Water excretion.
• Examples: end with -sartan. Losartan.
• Uses: Hypertension, Diabetic nephropathy in type 2 diabetes, and heart failure.
• Side effects: 
  • Cough is rare because do not they do not increase bradykinin build-up in the airways like ACE inhibitors.
  • Hyperkalemia
  • Like most antihypertensives: Orthostatic hypotension. Change position slowly. 
• Do not stop abruptly to prevent rebound hypertension. 

• Uses: Infections of the skin, bone, eyes, ears, abdomen and pelvic areas. Kill Klebsiella pneumoniae and Pseudomonas aeruginosa.  Target mostly Gram NEGATIVE organisms. 
• Mechanism of Action: They are bacteriocidal and inhibit bacteria protein synthesis.
• Administration: Parenteral route mostly since poorly absorbed in the GI Tracts. 
• Examples: Vancomycin, Gentamicin, Amikacin, Neomycin, and Streptomycin (Neomycin used to lower ammonia level in hepatic encephalopathy).
• Side effects:
  • Renal impairment.  Nephrotoxicity. Monitor potassium, BUN and Creatinine, and urine output. 
  • Tinnitus: ototoxicity.
  • Vancomycin- red man syndrome, client turns red if given fast.
• Monitor levels due to nephrotoxicity and ototoxicity:
  • Peak: Highest concentration of the medication in the blood. Draw 30 minutes after infusion is complete.
  • Trough: Draw immediately before dose is due. Lowest concentration of medication in the blood. 

• Mechanism of action: Bactericidal by inhibiting bacteria DNA replication.
• Uses: Bactericidal.  Kill Gram POSITIVE bacteria such as Streptococcus pneumoniae.  UTIs
• Examples:E Moxifloxacin, Ciprofloxacin, Levofloxacin.  Notice the ending – floxacin.
• Side Effects:
  • Crystalluria: Flouroquinolones make urine alkaline.  Drink plenty of water.
  • Prolonged QT interval and Torsades. Especially is given with meds such as Amiodarone.
  • Tendon inflammation or rupture (Esp. Achilles Tendon): Report pain swelling, snap feeling or immobility.
  • C. Diff: Report Abdominal pain, fever, frequent watery stools to MD and collect stool for C. Diff.
  • Do not administer with antacids.  Decreases absorption. Give Flouroquinolones and 2 hours later give antacid.

• Mechanism of action: Bacteriostatic. Affect the creation of proteins by bacteria and target subunit 50S on the ribosome. 
• Uses: Effective against Gram Positive organisms such as Streptococcal, Chlamydia, Corynecbacterium diptheriae.  Treat H. Pylori. Treats C.Diff (Fidaxomicin).
• Examples: Azithromycin, Clarithromycin, & Erythromycin.
• Side effects: 
  • Prolongs QT interval leading to Torsades. Especially if also taking Amiodarone, Quinine, Quinolones, Doxepin, and Haldoperidol.
  • Cholestatic Jaundice: Occurs specially with erythromycin.  Elevated bilirubin, Dark colored urine, and Yellowing of the sclera. 
  • Reversible Ototoxicity:
  • Take on empty stomach, with 8 ounces of water. If GI symptoms take with food. 

• Mechanism of action: Inhibit bacterial cell wall synthesis and have a beta-lactam ring that binds with penicillin-binding proteins to inhibit cross-linking within the cell wall.
• Examples: Cefoxitin and Cefotetan (2nd Generation). Ceftriaxone, Ceftaroline.
• Uses: Ceftroline (5th generation) treats MRSA.  Works agaist infections from gram-positive and gram-negative bacteria. Useful against skin infection, resistant bacteria, meningitis, and other infections.
• Important: Penicillin and Cephalosporins both have a beta-lactam ring so there is cross-sensitivity/allergy risk
• Adverse/Side Effects
  • Hypoprothrombinemia: Look for bruising, ecchymosis, bleeding.
  • Hypersensitivity reaction: skin rash and pruritis or even anaphylaxis. Discontinue cephalosporin. 
  • Pseudomembranous colitis and C. Diff: Elevated WBC, fever, watery stool, abdominal cramps, and again leukocytosis. 
  • Disulfiram-like reaction:  nausea, vomiting, flushing, sweating, and headache if alcohol is ingested. 
  • Warning: Never give Ceftriaxone with calcium solutions because it will precipitate.