Drug

Drug Class

Mechanism of Action

Adverse Effects

Nursing Implications

Naloxone Hydrochloride

Naltrexone (ReVia)

____1___

____2_______

Anxiety, irritability, chills, hot flashes, rhinorrhea, diarrhea, confusion, abdominal cramps, nausea vomiting

Use with caution in patients with cardiac disease – Monitor for cardiac arrythmias.

****After the nurse had administered to a patient to reverse opioid effect, what should they look for ____3_____

Gabapentin, Venlafaxine, Bupivacaine, Baclofen, Cyclobenzaprine, Ketamine, Duloxetine, Nortriptyline

___4_____

Activate innate immune responses to create a local immuno-competent environment at the injection site. 

respiratory depression,

sedation,

constipation

urinary retention

nausea

Depending upon the medication used. **

Aspirin, Diclofenac, Ibuprofen, Ketoprofen, Ketorolac, Meloxicam, Naproxen, Celecoxib

Non-Opioid analgesics

NSAIDS-Inhibits COX-1 and COX-2, inhibits prostaglandins.

ASA- causes irreversible inhibition of COX (different from NSAIDs)

GI distress

Peptic Ulcer disease

Kidney and liver impairment

Tarry stools

Blood dyscrasias: thrombocytopenia, leukopenia, neutropenia, hemolytic anemias Bone marrow depression and impaired coagulation

Monitor (labs): __5___ & __6___

(hint: look at Adverse effects)

Teach Patient:

Take with meals or milk to reduce GI irritation

Avoid drinking alcohol, smoking and aspirin when taking other NSAIDs

Morphine

Fentanyl

Hydromorphone

Codeine Sulfate

Meperidine (do not use in elderly)

Methadone

____7___

___8_____

1. ___9_____*

2. ___10____*

3. ____11___*

4.Cough suppression

5. Itching

6. Pupil Constriction

7. Diaphoresis and flushing

Antidote: ___12________

1. Monitor vital signs (_13_ & _14__)

2. Teach patient to rise slowly.

3. Monitor for constipation

Administered: IV, Transdermal, Transmucosal, Nasal Spray, PO, Sublingual spray

Antidote: 15. ______ (opioid antagonist)

Drug

Drug Class

Mechanism of Action

Adverse Effects

Nursing Implications

Acetaminophen

16. ____ and 17. ___ (not anti-inflammatory)

Inhibits prostaglandin synthesis

· Can cause 18___ (which main organ) damage

· Dark urine

· rash

· Clay colored stools

Antidote: 19. ____

Monitor: 20. _______

Teach:

Careful when taking with other medications that already contains 21. ____ (i.e., Percocet)

Buprenorphine

(used to treat opioid addiction)

Agonist-antagonist

Indicated for:

Used an 22. ___ and to treat 23. _____ addiction

1. Headache

2. Drowsiness

3. Nausea, vomiting

4. Increased sweating

5. Inability to sleep

Avoid driving or drinking when taking this medication.

Do not take with other narcotics

Pentazocine (nalbuphine, butorphanol

Agonist-antagonist

Antagonist: Acts on opioid receptor sites

Agonist: produces an antagonistic effect when given to patients taking opioids

· Respiratory depression**

· Nausea, vomiting diarrhea

· 24. _____*

· Tachycardia

· 25. _____

Monitor vitals especially: (hint adverse reaction column) ___26__and ___27___

Naloxone (Narcan)

___28__

Blocks and reverses effects. Binds to receptors in the brain

· _29__

· _30___

Administration: IV, intranasal, IM, subQ

*if administered before opioid -blocks effects, if administered after opioid, it will reverse the effects of drug

Drug

Drug Class

Mechanism of Action

Adverse Effects

Nursing Implications

Lidocaine (Lidoderm)

Topical analgesic

 Local anesthetic used to relieve neuropathic pain (postherpetic neuralgia)

· Redness or irritation to skin

· Dizziness

· Confusion

· Cautioned in patients who are taking Class I antiarrhythmic drugs

Treat: neuralgia due to herpetic

Wash hands after handling

Apply to area that is painful.

Gabapentin (Neurontin)

Treats: Neuropathic Pain

Antiseizure

31._______

· Drowsiness

· Dizziness

· Tiredness

· Tremors

Indication (Used to Treat)

32. _______

1. Teach patient medication is used to alleviate pain and not for the Rx’s original purpose.

Pregabalin (Lyrica)

Indicated for: neuropathic pain associated with diabetic neuropathy, postherpetic neuralgia

Antiseizure/Antidepressant

 binds to calcium channels and decreases the inflow of calcium at nerve endings.

· dizziness*

· Somnolence* which often persist as long as the drug is being taken.

· 3. Blurred vision may develop during early therapy, but resolves with continued drug use"

· Pregabalin (33)does/does not interact with oral contraceptive.

· Does not alter any antiseizure drugs studied (carbamazepine, lamotrigine, phenobarbital, phenytoin, topiramate, valproic acid, and tiagabine)"

Drug

Drug Class

Mechanism of Action

Adverse Effects

Nursing Implications

Prednisone

Prednisolone

Glucocorticoids

Decrease Inflammation

Short term:

Weight gain, hyperglycemia

Long term: bone loss, adrenal suppression, exogenous glucocorticoid- Cushing Syndrome

Monitor: __34___ in clients with diabetes

Methotrexate

Other DMARDS

Hydroxychloroquine

Leflunomide

Sulfasalazine

Non-biologic

DMARDS

Slows disease progress and decreased joint destruction

(Methotrexate Only)

Contraindicated in pregnancy.

Can cause fetal death and congenital abnormalities.

Blackbox Warning (Methotrexate):

______36_______

(Methotrexate Only)

Should be taken with __35___(vitamin?) to reduce GI and hepatic toxicity.

Teach:

Patient should receive annual influenza.

Avoid people who are sick and perform frequent handwashing