Summary

Summary

Terbutaline is a beta-2 agonist that is given to delay preterm labor by relaxing the uterus. Radioactive iodine is an antithyroid treatment that lowers thyroid levels by specifically
Adverse effects include maternal pulmonary edema, as well as maternal and fetal tachycardia. destroying thyroid tissue. It’s used to treat hyperthyroidism, including hyperthyroidism that
occurs in the autoimmune condition Graves’ Disease. Patients need to social distance when
Key Points taking radioactive iodine to avoid exposing others, and pregnant women should never take
radioactive iodine, as it’s a known teratogen. Because most or all of the thyroid tissue is
o Terbutaline destroyed by the radioactivity, patients will develop hypothyroidism and will need to take
o Mechanism
daily thyroid supplements to maintain thyroid levels within normal levels.
o Beta-2 Adrenergic Agonist

o Activities beta2-adrenergic receptors causing bronchial and uterine smooth
muscle relaxation (tocolysis) Key Points
o Clinical Use
o Decreases intensity and frequency of uterine contractions
o Radioactive Iodine
o Mechanism
o Can be used for up to 24 hours
o Iodine is taken up by the thyroid gland and damages it, lowering the amount of
o Reverses effects of oxytocin
o Used to delay preterm labor or to stop contractions because of fetal distress
thyroid hormones that are released
o Given as a single-dose pill capsule
o Asthma
o Patients taking radioactive iodine should maintain their distance from others
o Induces bronchodilation similar to other beta-2 agonists (e.g. albuterol)
o Including using separate utensils, bathrooms, towels, etc.
o Side Effects and Adverse Reactions
o Clinical Use
o Maternal Pulmonary Edema
o Treats Hyperthyroidism
o Mechanism is unclear
o Graves Disease (thyrotoxicosis)
o Maternal and fetal tachycardia
o Is a permanent cure, but it may take up to a month for symptoms of
o Maternal hypotension
hyperthyroidism to subside
o In smaller doses may be used for thyroid function studies

o Thyroid cancer
o Side Effects and Adverse Reactions
o Hypothyroidism
o Cold intolerance, edema, bradycardia, weight gain, depression
o Patients who undergo radioactive iodine will need to take thyroid
supplements for the rest of their life.
o Teratogenic
o Metal taste
o Swollen saliva glands
o Radiation sickness
o Hematemesis, epistaxis, intense nausea and vomiting
o Bone marrow depression

Summary Summary

Oral contraceptive pills, or OCPs for short, contain a combination of the hormones estrogen and progesterone. As
contraceptives, these drugs are used to prevent pregnancy, however they carry a risk of causing blood clots. For this reason, Levothyroxine, often called by its brand name Synthroid, is a medication used to increase
OCPs are not recommended in patients with a prior history of blood clots, those who smoke, or patients who have thyroid hormone levels. It’s used to treat hypothyroidism and should be taken by patients on
hypertension.
an empty stomach first thing in the morning. If the dose is too high, Levothyroxine can cause
Key Points hyperthyroidism which may manifest as a variety of symptoms including insomnia,
tachycardia or palpitations, and weight loss.
o Oral Contraceptive Pills (OCPs)
o Key Drugs

o Estrogen Key Points
o Most common synthetic estrogen used is ethinyl estradiol (EE)
o Progesterone o Levothyroxine (Synthroid)
o Many different types of progestin: norethindrone, ethynodiol diacetate, norgestrel,
o Mechanism
levonorgestrel, desogestrel, norgestimate, etc.
o OCPs can include a combination of estrogen and progesterone, or some are progesterone-only o Synthetic version of the thyroid hormone thyroxine (T4)
o Mechanism o Dose will be adjusted based on regularly scheduled blood work
o Estrogen o Clinical Uses
o Inhibits ovulation by preventing formation of a dominant follicle o Hypothyroidism
o Progesterone
o Myxedema coma
o Suppresses the luteinizing hormone (LH) surge that is required for ovulation
o Alters the uterine lining so it's not as favorable for implantation o Hashimoto’s Disease (chronic lymphocytic thyroiditis)
o Thickens cervical mucus o Simple goiter
o Clinical Use o Usually is a life-long therapy
o Contraception o May take up to a month before effects are seen
o One pill taken daily
o Side Effects and Adverse Reactions
o 21 days of active pills, followed by 7 days of inert pills during which the user may experience
withdrawal bleeding. Some manufacturers will include iron supplementation in the inert o Drug/food interactions
pills to prevent iron-deficiency anemia. o Best taken first thing in the morning on an empty stomach, before food
o Backup contraception should be used for the first 7 days after starting OCPs and other medications
o Menstrual Irregularity o Antacids, soy, dietary fiber, calcium, and iron can impair the absorption of
o OCPs can be used to alter hormone balance to correct for irregular menses
o Side Effects and Adverse Reactions
levothyroxine
o Increased risk for blood clots o Hyperthyroidism
o Not recommended for people with a history of clots o Tachycardia, palpitations
o Deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), o Weight loss
or cardiovascular accident (CVA) stroke o Insomnia
o Not recommended for those who smoke or have hypertension
o Anxiety
o At a higher risk for blood clots
o Do not smoke while taking oral contraceptives o Diaphoresis
o Report severe leg pain and swelling (DVT), loss of vision or headaches (stroke), or o Amenorrhea
chest pain (PE or MI) o Abdominal effects
o Contraindicated with history of estrogen-dependent tumors o Nausea/vomiting, Abdominal cramping, Diarrhea, Anorexia
o E.g. certain types of breast cancer, endometrial cancer, ovarian cancer
o Decreased bone density
o Breast tenderness
o Normal, expected side effect. No need to report.
o Spotting between menses
o Normal, expected side effect. No need to report.
o Increased risk for cervical cancer
o Does NOT protect against sexually transmitted infections (STIs)
Summary Summary

Ipratropium and tiotropium are inhaled anticholinergic medications. By inducing Second generation antihistamines include the drugs loratadine, fexofenadine, and cetirizine.
bronchodilation, these drugs can be used to treat COPD and asthma. These drugs are notably They are mainly used to treat seasonal allergies, but can also be used to treat mild allergic
different in their time course. Ipratropium is a fast-acting drug that can be combined with reactions, as well as nausea and vomiting. Second generation antihistamines do not cause
albuterol in a rescue inhaler to treat acute asthma and COPD exacerbations. On the other drowsiness or anticholinergic side effects.
hand, Tiotropium is a slow-acting medication that is taken chronically as a maintenance
medication, to prevent exacerbations from happening in the first place. The main side effect Key Points
of both drugs is dry mouth, which can be mitigated by rinsing the mouth out with water after
the use of the inhaler. o Second Generation Antihistamines
o Also called nonsedating antihistamines

o Key Drugs
Key Points
o Loratadine (Claritin)
o Fexofenadine (Allegra)
o Ipratropium, tiotropium
o Cetirizine (Zyrtec)
o Mechanism
o Desloratadine
o Anticholinergic
o Mechanism
o Blocks muscarinic receptors on the bronchioles, causing bronchodilation
o Antihistamine
o Administered as a capsule that contains powder that must be put into a
o Competes with histamine at the H-1 receptor sites to reduce the effects of
special inhaler. The capsule should not be swallowed.
histamine
o Clinical Uses
o Clinical Use
o COPD and Asthma
o Allergies
o Ipratropium is short-acting
o Seasonal allergies (sneezing, nasal congestion, etc.)
o Fast onset, short duration
o May be used to treat mild allergic reactions, e.g. pruritus (itchiness),
o Ipratropium may be used along with albuterol as a rescue treatment
hives/rash
for acute exacerbations
o Nausea and vomiting
o Tiotropium is long-acting
o Side Effects and Adverse Reactions
o Slow onset, long duration
o Very few side effects compared to first generation antihistamines.
o Should not be taken orally; comes in capsule form that should be
o Do not cause drowsiness or anticholinergic effects
put into a capsule aerosolizer
o Tiotropium is a long-acting drug used as a maintenance treatment. It
should not be used as a rescue inhaler.
o **When combined with albuterol, ipratropium may be used for acute asthma and
COPD exacerbations, but keep in mind that the albuterol is the key rescue
medication. Ipratropium is simply used to help promote bronchodilation. It should
not be used alone to treat asthma attacks.
o Side Effects and Adverse Reactions
o Local anticholinergic effects
o Dry mouth
o Advise patients to sip on fluids and suck on sugar-free hard candies
o Rinse out mouth after inhaler use
o Hoarseness
Summary Summary
Opioids are a large class of drugs typically used to treat moderate to severe pain. Important drug names to know include morphine and the
related drug hydromorphone, codeine and the related drugs oxycodone and hydrocodone, tramadol, fentanyl, buprenorphine, and
methadone. Opioids carry a risk of dependence and addiction, but they are considered safe when used as prescribed. The biggest adverse Antitussives are drugs that work to treat coughing, and include the opioid drugs
effect of opioids is respiratory depression, so it’s extremely important to monitor the patient’s respiratory rate throughout treatment. Other
expected side effects include constipation, sedation, orthostatic hypotension, urinary retention, nausea and vomiting, as well as miosis. The dextromethorphan and codeine. Suppression of coughing can lead to an accumulation of
antidote of an acute opioid intoxication is naloxone, which can be used to reverse the effects of opioids in the event of an overdose. airway secretions, the most notable side effect of taking these drugs. Other side effects
Key Points
common to opioids can also occur, including constipation, respiratory depression, nausea and
o Opioids vomiting, and orthostatic hypotension. Lastly, as opioid drugs, these drugs have abuse
o Key Drugs
o Fentanyl potential since they may cause tolerance and dependence.
o Morphine, Hydromorphone (Dilaudid)
o Hydromorphone is approximately 6x more powerful than morphine
o Codeine, Hydrocodone, Oxycodone Key Points
o Methadone
o May also be used as part of an addiction treatment regimen o Antitussives
o Tramadol
o Buprenorphine o Key Drugs
o Mechanism o Dextromethorphan (Benylin)
o Opioid analgesics / Opioid agonists o Codeine
o Primarily bind to the mu-opiate receptors to provide analgesia (pain relief)
o Weak activation of the kappa-opiate receptors to also provide analgesic effect o Mechanism
o Cause CNS depression o Codeine suppresses the cough reflex by depressing the CNS
o Clinical Use o Codeine is an opioid, and dextromethorphan is a partial-opioid, meaning it
o Pain (analgesia)
o Used only for moderate to severe pain works on some (but not all) of the opioid receptors.
o Pain is best controlled when opioid is given before the pain becomes unbearable o Clinical Uses
o Cough suppression o Cough suppression
o Codeine has antitussive effects
o Side Effects o Codeine is used for chronic nonproductive cough
o Addiction/Dependence o Dextromethorphan is found in many different cough products
o Range between schedule I and schedule V controlled substance categories o Most effective at treating a dry, nonproductive cough.
o Short-term use of narcotics for acute pain is considered safe and not likely to cause dependence or
addiction. o Productive coughs are better treated with a mucolytic to mobilize
o Symptoms of withdrawal syndrome include irritability, nausea, vomiting, sweating, restlessness, secretions
tachycardia, and hypertension o Side Effects and Adverse Reactions
o Respiratory depression
o Monitor respiratory rate frequently. Respiratory rate should be above 12 breaths per minute. o Accumulation of airway secretions
o Use opioids with caution in people with these risk factors: elderly, underlying pulmonary disease, o Suppressing the cough reflex may prevent pulmonary secretions to build up
obesity, history of smoking, history of snoring, opiate naive, and post-surgery in the lungs
o Constipation
o Patient will often be prescribed a mild laxative to be taken as needed o Do not give to patients with COPD or other respiratory disorders
o Increase fiber and fluid intake in diet o Respiratory depression
o Tolerance does NOT develop to this side effect o Due to CNS depression in medulla
o Avoid in patients with paralytic ileus (e.g. post-op); use NSAIDs like ketorolac instead
o Sedation o Stimulate the patient to breathe if respiratory rate drops below 12
o Do not take opioids with other CNS depressants (e.g. alcohol) breaths/minute.
o Orthostatic hypotension o Antidote is naloxone
o Opioids dilate peripheral blood vessels and can cause hypotension that is most noticeable upon
standing o Constipation
o Advise patient to rise slowly to avoid sudden drop in blood pressure o Due to opioid suppression of gut motility
o Miosis (pupil constriction) o Nausea/vomiting
o Pinpoint pupils can indicate opioid overdose
o Tolerance does NOT develop to this side effect o Orthostatic hypotension
o Urinary retention o May also be accompanied by dizziness or drowsiness
o Monitor intake and output o Advise patients to change positions slowly to avoid sudden drop in blood
o Nausea/Vomiting
o Patients can take the drug with food to reduce GI irritation with orally-administered opioids pressure
o Pruritus (itching) o Abuse potential
o When giving via IV push, administer over 2-3 minutes to avoid pruritus, as well as nausea and flushing. o Only use for a short duration
o Antidote
o Naloxone (Narcan) o Abuse potential is higher for codeine, but dextromethorphan can instill
o Reverses the effects of opioid overdose (respiratory depression, sedation, hypotension) euphoria in high doses and therefore does have some potential for abuse
o Often multiple doses will be required. The nurse must carefully monitor respiratory rate to ensure
the patient doesn’t fall back into respiratory depression.
Summary Summary

Theophylline is a medication that is used to treat asthma and COPD. It is a slow-acting drug and should not be used
in emergency situations. Theophylline causes lots of drug interactions, which can contribute to drug level Hypokalemia is the medical term for low potassium, specifically potassium levels below 3.5 in
fluctuations above its narrow therapeutic range. Importantly, symptoms of theophylline toxicity start to appear the blood. Causes of hypokalemia include medications like loop diuretics, thiazide diuretics,
above a dose of 20 micrograms per milliliter. Mild symptoms of toxicity include GI distress and CNS stimulation. To and insulin. Hypokalemia can also be caused by GI fluid loss, Cushing syndrome, and
avoid exacerbating the CNS stimulation, patients should avoid caffeine while on treatment. More severe symptoms metabolic alkalosis.
of toxicity seen at higher doses include seizures and arrhythmias.


Key Points Symptoms of hypokalemia include arrhythmias, specifically manifesting on EKG as flattened T
waves and prominent U waves. Other symptoms include decreased or shallow respirations,
o Theophylline muscle cramps, muscle weakness, and constipation.
o Mechanism
o Belongs to drug class of methylxanthines
o Bronchodilator
Treatment of hypokalemia is performed by replenishing potassium through an IV or oral
o Inhibits phosphodiesterase (PDE) enzyme, thus increasing cAMP and relaxing form. IV potassium should NEVER be given through an IV push. Instead, the potassium must
bronchial smooth muscle, resulting in bronchodilation be diluted in saline and given through a pump at a maximum rate of 10 milliequivalents per
o Taking the medication in the morning will allow for maximum bronchodilation hour. On the other hand, oral potassium may cause the side effect of esophagitis. This can be
during the day
o Clinical Uses
prevented by advising the patient to remain upright for 30 minutes after ingestion and to take
o Chronic Asthma the potassium with plenty of food and water.
o Long-term control
o Used only when other drugs have proved ineffective due to narrow therapeutic Key Points
range and several adverse reactions
o COPD
o Hypokalemia
o Long-term control
o Low blood potassium <3.5 mEq/L
o Used only when other drugs have proved ineffective due to narrow therapeutic
o Hypo=low
range and several adverse reactions
o Side Effects and Adverse Reactions o Kal=potassium
o Drug interactions o Emia=in the blood
o Increase theophylline levels o Causes
o Beta blockers, cimetidine, fluoroquinolone antibiotics o Medications
o Patients should avoid caffeinated products o Potassium-wasting diuretics
o Worsens side effects (e.g. CNS stimulation, tachycardia, restlessness) o Loop diuretics
o Decrease theophylline levels o Thiazide diuretics
o Barbiturates, carbamazepine, phenytoin, rifampin, St. John’s Wort o Insulin
o Do not give with beta-2 agonists
o Pushes potassium out of the bloodstream and into the cell
o A synergistic effect can occur that may cause cardiac dysrhythmias
o Albuterol
o Theophylline increases digoxin levels and lowers lithium levels
o Amphotericin B
o Toxicity symptoms begin > 20 mcg/mL
o Narrow therapeutic range of 5-15 mcg/m o Corticosteroids
o Mild Toxicity o Licorice root
o GI Distress o GI Fluid Loss
o Anorexia, nausea, vomiting, diarrhea, abdominal pain o Diarrhea
o CNS stimulation o Vomiting
o Restlessness, irritability, insomnia, headache o Prolonged NG suction
o Worsened by caffeine use o Wound drainage
o Severe Toxicity o Cushing’s Syndrome
o Seizures
o Increased cortisol
o Arrhythmias (tachyarrhythmias)
o Alkalosis
o Hyperglycemia
o Water intoxication
o Symptoms
o Cardiovascular
o Arrhythmias
 o Weak pulse
o Hypotension
o EKG changes
o Flat T wave
o Prominent U wave
o ST depression
o Prolonged PR interval
o Respiratory
o Shallow respirations
o Diminished breath sounds
o Respiratory failure
o Neuromuscular
o Muscle cramps
o Often the first sign of hypokalemia
o Weakness
o Hyporeflexia
o Confusion
o GI
o Constipation
o Decreased bowel sounds
o Paralytic ileus
o Can lead to small bowel obstruction (SBO)
o Abdominal distention
o Nursing Interventions
o IV Potassium (KCl)
o Never given via IV push, IM or SC
o Rapid infusion can spike blood potassium levels and cause cardiac
arrest
o Always diluted and given through an infusion pump.
o Maximum recommended rate is 10 mEq/hr
o KCl can cause irritation and discomfort at the IV site; if irritation
occurs, slow the infusion
o Oral potassium
o May cause stomach upset. GI discomfort can be minimized by taking
potassium with food and a full glass of water
o May cause esophagitis, so patient should remain upright for at least 30
minutes following ingestion, as well as take with plenty of water
o Increase potassium-rich foods in diet
o Replace potassium-losing diuretics (e.g. thiazide diuretics) for potassium-sparing
diuretics (e.g. spironolactone)