Unformatted text preview: ex: 5:00am+ 12= 1700 PM
Drugs and their antidotes
1. acetaminophen (Tylenol)- acetylcycteine
2. benzodiazepine - flumazenil
3. coumadin - vitamin k
4. Heparin- Protamin Sulfate
5. cyanide poisoning - methylene blue
6. digitalis - digibind
7. ethylene poisoning - antizol
8. Curare - tensilon
9. iron - desferal
10. lead - edetate disodium (edta), dimercaprol (bal), succimer (chemet)
11. lovenox - protamin sulfate
12. magnesium sulfate - calcium gluconate
13. morphine sulfate (opiod) – IV Naloxone hydrochloride
• Opiod toxicity s/sy:
Small (constricted) pupils
Changes in heart rate ↓ BP, ↓pulse, ↓ RR
14. methotrexate - leucovorine
15. mestinon - atropine sulfate
16. neostigmine - pralidoxime chloride (pam)
17. penicillin - epinephrine
Use: Used as part of a treatment plan for problem drinking. Creates an unpleasant reaction
when drinking alcohol, which reduces the desire to drink. Take at night. Contraindication: Potential contact with alcohol by both inhalation of paint or wood stain fumes
as well as by skin contact with these substances; any contact with any amount or any form of
alcohol will cause an alcohol- Disulfiram reaction, which is extremely uncomfortable and may
even lead to shock and cardiac arrhythmias.
If you drink alcohol while on this drug, you will experience uncomfortable symptoms such as:
• Severe nausea & vomiting
• Severe Head-aches
• Body-face flushing
• Blurred vision
** Chronic alcohol abuse is the most common cause of hypomagnesia (<1.5); which may result
in cardiac arrest.
o Manifestation includes: increased neuromuscular irritability, tremors, tetany, and
➢ Alcohol withdrawal symptoms: Restlessness, irritable, agitated, Tremors, elevated
temperature, nocturnal leg cramps, complaints of pain symptoms, fever, ↑HR ↑pulse,
delusions and hallucinations.
Early symptoms: tremors, elevated ↑pulse, hyper-alert, startled easily, anxiety,
anorexia; signs begin a few hrs after reduction of alcohol intake and peak 24-48 hrs.
✓ Chlordiazepoxide (Librium)USE: Treats anxiety, symptoms of alcohol withdrawal, and tremor
➢ Cocaine withdrawal = sever cravings, depression
o S/Sy of use: insomnia, rhinorrhea, facial pain , hypersomnia, fatigue ➢ Heroin (NARCOTIC) withdrawal = Runny nose, yawning
diarrhea, tremors (remember flu like symptoms) , fever, muscle & joint pain, o Heroin overdose: No breathing, Shallow breathing, slow or difficulty breathing, small
pupils, dry mouth, tongue discoloration, low BP, weak pulse, bluish- colored lips and
o Narcan (naloxone)- given as the antidote; client will experience: Nausea, vomiting,
restlessness, abdominal cramping (Opioid w/d symptoms).
➢ Barbiturate withdrawal- N/V, tachycardia, coarse tremors, seizures
➢ Opioid withdrawal- Nausea, vomiting, restlessness, abdominal cramping.
➢ Cannabis derivatives withdrawal: insomnia, hyperactivity, decreased appetite
➢ Amphetamine withdrawal- – depression, disturbed sleep, restlessness, disorientation
Narcotics Depressants Stimulants Hallucinogens Heroine
TMT: symtoms of w/d
subside w/ decreased
Narcotic withdrawal symptoms: flulike symptoms, night sweats, elevated temperature,
decreased deep tendon reflexes.
▪ Diazepam (Valium)
USE: can be given to stop seizures
▪ Alprazolam (Xanax)
▪ Lorazepam (Ativan)
▪ chlordiazepoxide (Librium)USE: Treats anxiety, symptoms of alcohol withdrawal, and tremor.
SE: blurred vision, drowsiness, constipation, slurred speech, anorexia, dermitis,
Interventions: Give after meals or with milk to decrease GI irritation.
▪ Buspirone (BuSpar): Used for treatment of general anxiety disorder (GAD)
Action: Binds to serotonin and dopamine receptors Anti-Depressants
Monoamine Oxidase inhibitors (MAOI’s)
(eg. Phenelzine Sulfate (Nardil) , MARPLAN, & PARNATE & ELEVIL (Amitriptyline)
USE: Best for depression associated with acute anxiety attacks, phobic attacks, or many physical complaints.
SE: Hypertensive crisis resulting from intake of dietary tyramine. (H/A, nausea, increased HR &
BP) MAOI Teaching • Avoid Tyramine containing foods: aged cheese, red wine, chocolate, beer,
processed meat, soy sauce, coffee, Dried fruits (figs, raisins, dates), bananas, avocados,
and yogurt. •
• Watch BP if pt cheats on diet for HTN crisis
Should be discontinued 2 weeks before surgery MOOD-Stabilizers
Lithium carbonate (Eskalith):
Lithium is an anti-manic used to treat bipolar disorder, mild thirst is an expected side effect,
other side effects include fine hand tremor, polyuria, metallic taste, & weight gain (about 20lbs).
Early signs of toxicity: Nausea/Vomiting, slurred speech, & muscle weakness/twitching
Advanced signs of toxicity: Coarse hand tremors, diarrhea, persistent GI upset, slurred speech,
mental confusion, incoordination, Ataxia (uncoordinated walking) (severe toxicity).
NURSING IMPLICATIONS OF LITHIUM
✓ Administer with meals
✓ SERUM LITHIUM LEVELS AT LEAST TWICE WEEKLY – THEN MONTHLY
✓ THERAPEUTIC LEVELS - 0.5 – 1.5 mEq/L
✓ Lithium Toxicity: greater than >2.0 mEq/L
✓ Maintain an adequate intake of sodium –excretion of lithium depends on normal lithium
levels **With hold medication and obtain blood lithium level.
**MAINTAIN NORMAL SODIUM INTAKE Anti-Psychotic
- Initial treatment for crisis; Eg. Olanzapine (zyprexa) Haloperidol (Haldol)
Use: Typical- Treats mental illness (such as schizophrenia), behavior problems, agitation, and
symptoms of Tourette's syndrome.
SE: hematologic problems, primarily blood dyscrasia, and EPs symptoms, Galactorreah
(spontaneous flow of milk), gynecomastia (growth of male mammory glands).
o Monitor VS ever 30 mins. – This med lowers BP and causes postural hypotension Anti-consultants
(eg. Phenytoin (Dilantin))
USE: Treatment of tonic-clonic seizures, status epilepticus, and treatment of seizures after
Adverse effects: Nystagmus (involuntary eye movement), dysarthria, slurred speech, ataxia, Gingival
hyperplasia, bone marrow suppression, hirsutism (hairy).
o May make urine pink, red or red-brown
• Do not administer with Milk
• If given in suspension; DO NOT SHAKE the bottle
• Monitor phenytoin toxicity level •
• THERAPEUTIC level: 10-20 g/ml
Phenytoin Toxicity: greater than >30 mcg/mL
Toxicity effects: Nystagmus (involuntary eye movement), ataxia, slurred speech • can cause folate and Vitamin D deficiencies. Folate deficiencies can cause anemia, symptoms
reflective of these nutritional deficiencies; good sources of folate are green leafy vegetables
(kale), legumes, tomatoes and various fruits such are oranges and cantaloupe; good sources of
vitamin D include milk.
S/SY of Anemia
• Shortness of breath
• Fatigue/ weakness
S/SY vit D deficiency
• Muscle weakness
• Bone pain
• Tiredness Phenobarbital (Luminal)
USE: long term treatment of tonic-clonic seizures, simple partial, febrile seizures; used as a
emergency control status epilepticus (IV form) .
Adverse effects: drowsiness, deep coma, hypotension, respiratory depression, and nightmares. Carbamazepine (Tegretol)
USE: Treats partial seizures, Tonic-clonic seizure; treatment of trigeminal neuralgia,
Contraindications: interferes with the action of hormonal contraceptives; client should
use another form of birth control. Wear sunscreen can cause (photosensitivity)
Valproic acid (Depakote)
Therapeutic levels 50-100 mcg .Toxicity s/s include chills, fevers, abdominal pains, s/s of liver
disease Biguanide Oral Hypoglycemic
Treats type 2 diabetes.
SE: metallic taste, abdominal cramps,
Interventions: take with food Cardiac Glycoside
LANOXIN (digoxin) Digitalis
Use: Treats certain heart rhythm problems (atrial fibrillation). Also used to treat heart failure,
usually in combination with a diuretic (water pill) and an angiotensin-converting enzyme (ACE)
-↑ myocardial contraction and left ventricular output→ increased CO ➢ 0.25 mg is the digitalizing dose and should be administered in divided doses over
➢ Caution: check for apical pulses for 1 min before administration; watch out for
toxicity that can cause dangerous dysrhymias
➢ Apical pulse: between the 4th and 5th intercostal space at the mid-claviclular line
➢ When the pts rhythm is AFIB and the heart rate is less than <60 bpm or greater than
>100/min, or the rhythm becomes regular, the nurse may with hold the med and
notify physician bc this may indicate the development of AV conduction block
➢ Direct IV administration; requires infusing over 5mins; use diluted solution
immediately; observe IV site; extravasation can lead to tissue irritation and
➢ Normal Heart Rate for an infant is 120-160 bpm (resting); bradycardia is rate below
80-100; withhold medication if rate is below <90-110;
➢ Infant TOXICITY: excessive slowing of beats may indicate digitalis toxicity.
➢ Take digoxin at the same time everyday, AM
➢ Do not take anti-acids at the same time . Separate meds by at least 2 hrs
➢ Digoxin THERAPEUTIC LEVEL 0.5- 2.0 ng/ml
➢ Digoxin Toxicity greater than >2.4 ng/ml
SE: anorexia, Nausea, vomiting, fatigue (early effects of digitalis toxicity), bradycarida,
yellow or green halo around objects especially lights
Antidote: Digifab (Digibind)
Drug-drug interactions- verapamil, amiodarone, quinine, erythromycin, tetracycline, or
Herbals: don’t admin with St. John’s wort as it decreases effectiveness of digoxin; digoxin
toxicity when admin with ginseng and licorice
*** A low potassium level (hypokalemia) could increase the serum digoxin sensitivity level. It
can rapidly deteriorate to ventricular tachycardia or sudden death. Analgesics
NSAID’s (non- steroidal anti-inflammatory)
Side effects: Headache, dizziness, gastrointestinal distress, pruritus, and rash
Aspirin (acetylsalicylic acid)
Use: Treats pain, fever, arthritis, and inflammation. It may also be used to reduce the risk of
SE: ringing in the ears, GI & duodenal ulcers, bleeding, GI symptoms, nausea, dyspepsia
Toxicity: ringing in the ears, headache, hyperventilation, agitation, confusion, sweating, GI
distress and diarrhea
Contraindications: cross-sensitivity between tartrazine & aspirin; an allergic response to one
may indicate an allergic response to another.
- Do not give to children; can cause Reye syndrome: Sudden (acute) brain damage and liver
function problems. Not an NSAID Acetaminophen (Paracetamol) - Tylenol
Use: Treats minor aches and pain and reduces fever
Complications- Overdose: hepatic toxicity is a serious complication resulting from acute acetaminophen
overdose that manifests 1-3 days after initial ingestion; there is an increase in the serum transaminase
liver enzymes, (ALT) and (AST); PT should also be monitored as acetaminophen prolongs it. Pyridium (Phenazopyridine)
USE: Relieves pain, burning, and discomfort caused by urinary tract infections and other urinary
SE: yellow discoloration of the skin or sclera indicates medication accumulation due to renal
Use: This medication relaxes blood vessels allowing more blood to flow through. This improves
blood flow to the heart. Oral dose forms are used to prevent angina (chest pain). This
medication is NOT for treating an attack of chest pain that is already happening.
Nitroglycerin (SL, no chewing, check the effectiveness of med, MR q 5 min. for 15 min.)
CLIENT EDUCATION regarding response to chest pain
➢ Vasodilators can cause orthostatic hypotension
➢ Stop activity and rest
➢ Place Nitroglycerin tablet under tongue to dissolve
➢ If pain is unrelieved in 5 min, the client should call 911
➢ The client can take up to 2 more doses or Nitroglycerin at 5-min intervals
➢ Remind client headache is a common side effect
➢ Encourage the client to sit and lie down slowly
➢ keep med in a dark container
** When a client first takes a nitrate, the nurse expects which symptom that often occurs?
Betablockers "olol"- Blocks the beta1-adrenergic receptors in the cardiac tissues. They are as
effective as anti-anginals b/c Decrease heart rate and decrease myocardial contractility. Propranolol (Inderal)
Use: Treats high blood pressure, angina (chest pain), irregular heartbeat, migraine headaches,
tremors, and lowers the risk of repeated heart attacks.
Warning: May mask symptoms of hypoglycemia, removing your body’s early warning system.
CAUTION diabetic patients about this.
Contraindicated in clients w/ asthma bc it can cause bronchospasms.
ACE-Inhibitors (Angiotensin-Converting Enzyme inhibitors) "pril”
These drugs treat hypertension and congestive heart failure. All generics end in "pril”
BENZAPRIL (Lotensin), LISINOPRIL (Zetril), CATOPRIL (Capoten), ENALAPRIL (Vasotec) SE: hypotension, dry cough, N & V, headache, angioedema (swelling of the face, lips, tongue,
throat), salty or metallic taste, Irregular heartbeats (this could be caused by too much potassium in
your blood). Considerations:
o Monitor ↑ k (potassium) levels, ace inhibitors cause the body to retain potassium.
o Avoid foods high in potassium.
o Do not use salt substitutes (they contain potassium)
o Signs of too much potassium in the body include confusion, irregular heartbeat,
nervousness, numbness or tingling in hands, feet or lips, shortness of breath or difficulty
breathing, and weakness or heaviness in legs. Calcium channel blockers (End in “Pine”)
• Diltiazem (Cardizem)
TMT: essential (age related) HTN Also treats angina.
Drug-drug interactions with beta-blockers, digoxin, carbamazepine, Prazosin (Minipress-alpha
blocker), quinidine; don’t mix with beta-adrenergic meds within 48 hours of each other
Nursing implications: Avoid grapefruit juice because can lead to toxic level of drug, encourage
fiber and fluid because of constipation side effects Antibiotics
Name Action Side
-Toxic shock syndrome
(*can be uses in
Hydrochloride, Bleomycin Cephalosporin
-Infections of skin,
(Helicobacter pylori) For bacterial infections
-C.diff -Respiratory infections
-Otitis media (ear
-UTI -Photosensitivity -Red neck or red man
Occurs when IV -Nephrotoxicity
Nephrotoxicity Considerati Check C&S.
renal function, hearing
Warn client to use
peak and trough level -Discoloration of
-Blood dyscrasia Superinfection
-Nephrotoxicity in high
Do not take anti-acids
w/I 1-3 hrs after taking
Do not give to children
younger than 8
-use sunblock Drug-drug
s -Penicillins decrease
warfarin's effec too rapid:
of face, neck, chest,
-hepatic and renal
-Check C&S before
-Give over 1 to 2 hours
-Monitor IV site.
-Monitor renal function
tests and hearing.
Monitor client for
- never give IV push Eat yogurt & acidophilus
milk to maintain normal
-patient with a history of
PCN would also be
allergic to cephalosporin -Do Not take w/ milk
-Do not take w/
-Decrease effects of
-Digoxin absorption is
increased leading to
toxicity. ***Nephrotoxicity (renal toxicity)- When kidney damage occurs, you are unable to rid your
body of excess urine, and wastes. Your blood electrolytes (such as potassium, and magnesium)
will all become elevated. Nephrotoxicity can be temporary with a temporary elevation of lab
values (BUN and/or creatinine) **Super infection: infection occurring after or on top of an earlier infection, especially following
treatment with broad-spectrum antibiotics. Antibiotics
Drink w/ plenty of fluids; may cause crystalluria and stone formation
Do not take w/ milk or yogurt – decreases the absorption of cipro
Do not at the same time as vitamins Immunosuppressant
Use: This medication is used to prevent organ rejection in people who have received a liver,
kidney, or heart transplant. It’s also used to treat severe rheumatoid arthritis and a certain skin
condition (severe psoriasis).
• reduction in urine output
Hypertension and tremor
• Other common: headache, gingival hyperplasia, elevated hepatic enzymes
• Periodic blood counts are necessary to ensure WBC's don't fall below 4,000 or platelets
• Long-term therapy increases risk of malignancy - especially lymphomas and skin cancers
Interactions: DO NOT take with grapefruit juice b/c the bioavailability of cyclosporine will
increase from 20 to %200. Hormone replacement therapy
Treats hypothyroidism. Also treats an enlarged thyroid gland and thyroid cancer.
SE: nervousness, insomnia, irritable, headache, fever, hot flashes, sweating Tapazole (methimazole)
Treats hyperthyroidism (too much thyroid hormone produced by the thyroid
SE: flue like, sore throat, easy bruising
-Ginkgo is an antiplatelet agent and CNS stimulant given for dementia syndrome; increase
risk of bleeding when given with NSAID’s.
- Herbal Licorice- used for digestive system complaints including stomach ulcers, heartburn,
colic, and ongoing inflammation of the lining of the stomach (chronic gastritis).
people use licorice for sore throat, bronchitis, cough, and infections caused by bacteria or
➢ Contraindication: Do not take if you have HF or taking digoxin; ; can increase
potassium loss and ma cause digoxin toxicity Drugs affecting blood coagulation Heparin
IV or SQ
Prevents clots in the blood vessels before or after surgery
or during certain medical procedures. Warfarin (Coumadin)
Prevent new blood clots from forming, and helps to keep
existing blood clots from getting worse. This medicine is a
blood thinner (anticoagulant). -Labs - APTT
-Protamine sulfate (antidote) for an abnormal lab value
- if pt is on heparin they must also be on Coumadin -Labs= PT, INR 2-3
if pt is Afib or has had sx its 2-4
-Pt. can go home w/ this
-Always give at 5pm in a health care setting
- Give Vitamin K (antidote) for an abnormal lab value (eg
PT/INR 4.5-5) SE: Bleeding, decreased LOC = intracranial bleeding
Heparin and oral anticoagulants, salicylates, penicillins, or
cephalosporins, nitroglycerine SE: bleeding, bruising Nausea, loss of appetite, or
Considerations: DO NOT increase foods w/ high vit K;
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