Class Drug names Clinical uses Mechanism of action Adverse Effects Contraindications/Interactions Nursing implications Patient Teaching

Antacids Aluminum salt, Neutralize stomach acid Symptom masking of serious GI Electrolyte disturbances and GI Assess for heart failure, Shake tablets, chew liquids.
magnesium salt, secretions problems obstruction bradycardia/tachycardia, Take 1-2 hours before other medications
calcium salt, Prevent proton pump Aluminum: constipation Chelation and absorption issues electrolyte imbalances, past renal
sodium activation by stimulating Magnesium: diarrhea with other drugs from pH change problems
bicarbonate secretion of mucus, Calcium: kidney stones, milk- in the stomach
bicarbonate, and alkali syndrome
prostaglandins
H2 receptor Cimetidine Peptic ulcers, Block H2 receptor to prevent Cimetidine: impotence and Liver/kidney dysfunction Assess liver/kidney function prior, Take 1-2 hours before antacids
antagonists (Tagamet), gastritis, parietal cells from secreting gynecomastia LOC, and monitor BP No smoking allowed!
Ranitidine, esophagitis, acid Ranitidine and famotidine: Monitor stools for blood
**(-dine) Famotidine hiatal hernias, Increase in pH, decrease in thrombocytopenia May raise concetration of other
**It takes 2 to and gastric acid secretion Confusion and disorientation in drugs as it binds to P-450,
dine (dinner) hyperacidity elderly patients inhibiting drug metabolism
Proton-pump Lansoparzole **10-14 day Bind to ATPase enzymes and C. diff, pneumonia, and Diazepam, phenytoin, and May mask symptoms of an Take before meals
inhibitors (Prevacid), treatment for block the final step in the acid osteoporosis when on long- warfarin increased effects underlying disease Lansoprazole is crushable
Omeprazole helicobacter producing pathway term/high doses Assess swallowing capacity
**(-azole) (Prilosec), pylori adjunt with Decrease in acid secretion
Rabeprazole clarithromycin
(AcipHex), and amoxicillin
Pantoprazole
(Protonix), Stress ulcer
Esomeprazole prophylaxis,
(Nexium) Zollinger-Ellison
syndrome, GERD,
and acute ulcer
treatment
Adsorbents Subsalicylate Diarrhea Coat GI walls, causing Reye's syndrome, darkening of Acute GI problems: collitis, Darkened stools are normal
(Pepto-bismol) bacterial elimination tongue/stools, blue tongue, intestinal obstruction Don't take with other salicylate drugs
tinnitus, metal-like taste, and Warfarin (increased bleeding time)
constipation Oral diabetic drugs (decreased
absorption)
Probiotics Saccharimyces C. diff infectionsSuppress the growth of Can treat both constipation and diarrhea, and can also be
boulardii diarrhea-causing bacteria, found in yogurt, milk, and soy
(Florastor) reestablishment of normal
flora in the GI tract
Bulk-forming Psyllium Safest, long-term Aborsption of water into the Fluid/electrolyte imbalances, Drug allergy Mix with 8 oz. of water and take immediately after mixing to
laxatives (Metamucil), for constipation bowel impaction, abdominal pain prevent hardening in the esophagus
Methylcellulose Resemble dietary
(Citrucel) fiber
Emollient Docusate salts Stool softening Lubrication of fecal material Lipid pneumonia, skin rashes, Drug allergy Decreases absorption of fat soluble vitamins (D, E, A, K)
laxatives (Colace, Surfak), decreased vitamin absorption,
mineral oil electrolyte imbalances
Hyperosmotic Polyehylene Upset stomach Distention and increased Drug allergy Take glucosate with 6 oz. of water
laxatives glycol (PEG), Constipation peristalsis
Sorbitol, Glycerin, Inadequate
Lactulose magnesium
Saline laxatives Magnesium Inhibition of water Magnesim toxicity (tied to renal Drug allergy Effects felt almost immediately
hydroxide (Milk reabsorption, increasing water insufficiency), electrolyte
of magnesia), and electrolytes in the bowel imbalances, increased thirst,
Magnesium diarrhea
citrate (Citroma)
Stimulant Senna (Senokot), Bowel emptying Nerve stimulation causing Nutrient malabsorption, skin Drug allergy Bisacodyl should be taken on an empty stomach
laxatives Bisacodyl before surgery peristalsis and fluid in the rash, electrolyte imbalances, Do NOT take mlks/antacids/juices for at least 1 hour after
(Dulcolax) colon discolored urine, rectal irritation taking medication
Misc. drugs Simethicone Fart reduction Antiflatulent effect: Altered
(Mylicon) elasticity of mucus coated gas
bubbles, breaking them down
Antihistamines Dimenhydrinate Motion sickness, Inhibition of ACh by binding to Drowsiness, dizziness, Narrow-angle glaucoma Sugarless gum and hard candy may be needed for dry mouth
(Dramamine), nonproductive H1 receptors, preventing confusion, blurred vision, dilated Pediatric patients may expereince paradoxical effects
Diphenhydramine cough, allergy cholinergic stimulation, thus pupils, urinary retention, dry (hyperactivity)
(Benadryl), symptoms, preventing nausea and mouth
Meclizine sedation vomiting Psychomimetic effects in older
(Antivert) adults
Nausea pathway includes: GI
tract, labyrinth (inner ear),
cerebral cortex,
chemoreceptor trigger zone,
medullary vomiting center
Serotonin Ondanestron Go-to antiemetic Block 5-HT3 (serotonin) Diarrhea, prolonged QT interval, Drug allergy Category B, can possibly cause Tylenol should be used for any associated headaches, avoid
blockers (Zofran) for chemo- receptors in the GI tract and headache, rash, bronchospasm cleft palate in the fetus during 1st aspirin (increased bleeding)
induced nausea vomiting center trimester Take 30-60 minutes before chemotherapy
and vomiting Can cause dysrhythmias Avoid CNS depressants or acitivities requiring mental
Hyperemesis IM, IV, oral 2-5 mins., infusions alterness/motor skills
gravidarum over 15 mins.
(pregnancy Assess for dehydration and
nausea/vomiting) electorlyte imbalances, skin
Nausea reduction turgor, mucous membranes for
dryness, longtiudinal furrows in
the tongue
Thyroid Levothyroxine Hypothyroidism Replacement of endogenous Cardiac dysrhythmias when Drug allergy, recent myocardial Watch doses carefully, usually in Switching between different brands can destabilize the course
replacement thyroid hormone taken in high doses, infarction, adrenal insufficiency, mcg but gets mistaken as mgs of treatment
palpitations, tachycardia, hyperthyroidism Assess T3, T4, TSH levels Take on an empty stomach in the morning to avoid insomnia
hypertension, insomnia, tremors Avoid anticoagulants (increased Review cardiac history and Avoid iron/calcium supplementation
bleeding), digoxin, hypoglycemic monitor cardiac irregularities
medications
Radioactive Hyperthyroidism Ablation (destruction) of the Metallic-like taste, Pregnancy (category D), bone Assess for thyroid storm Avoid eating foods high in iodine (soy, tofu, turnips, seafood,
Iodine and thyroid thyroid gland hypothyroidism, live and bone marrow suppression, liver function Never withdraw abruptly iodized salt in meals)
cancer marrow toxicity Monitor for leukopenia (sore
throat, fever, lesions)
Antithyroids Methimazole Hyperthyroidism Inhibit iodine molecules that Liver and bone marrow toxicity, Drug allergy, scalp abnormalities Monitor BUN and creatinine, Take with food
Propylthyiouracil are required to make the increased BUN and creatinine, in the fetus leukopenia (fever, sore throat,
(PTU) precursors to T3 and T4 hepatitis, thrombocytonpenia, lesions)
lymphadenopathy,
agranulocytosis
Insulin therapy Insulin lispro Humalog = Rapid Replaces insulin not made or Hypoglycemia (confusion, Corticosteroids, estrogen, Draw up clear insulin before Educate patients that they cannot mix different insulin types
(Humalog) acting defectively made by the body sweating, shock), weight gain, diuretics, thyroid drugs, cloudy Teach patiets to wear medical alert jewelry or have a medical
Regular insulin Humulin R = Exogenous functions as a lipodystrophy and injection sites nonselective beta blockers Ideal blood glucose levels between alert card on their person
(Humulin R) Short acting substitute for endogenous 70-100 mg/dL Insulin should be stored at room temperature
Glargine (Lantus) Lantus = Long hormone Corticosteroids can increase glucos Avoid smoking/alcohol, smoking can increase lactic acidosis
acting levels risk
Give 50% dextrose to treat Nurse should recheck blood glucose before meals and at
Type 1 diabetes hypoglycemia (IV if patient is bedtime, or every 4-6 hours
unconscious)
Rapid and short HBA1C is a hemoglobin linked to sugar, tested over 120 days
acting for high Humalog given SubQ or SQ pump with a goal of 7% or less in diabetic patients
glucose levels -Onset: 5 to 15 min
after meals -Peak: 1 to 2 hours Hyperglycemia: Faster blood glucose level of 126 mg/dL or >
Long or -Duration: 3 to 5 hours Hypoglycemia: Blood glucose level < 70 mg/L or above 50
intermediate -Given 15 min before meals, non- mg/dL with S/S of hypoglycemia
acting for lower combinable
glucose levels Humulin R given IV bolus, IV
infusion, intramuscular, or SQ
-Onset: 30 to 60 min
-Peak: 2.5 hours
-Duration: 6 to 10 hours
-Only insulin given IV
-Given 30 min before meals,
cannot combine with glargine or
glulisine
Lantus (Basal insulin)
-Onset: 1 to 2 hours
-Peak: none
-Duration: 24 hours
-Dosed once daily, or every 12
hours
-Clear colorless
-Gives a constant level of insulin
(long acting)
-Non-combinable
Biguanides Metformin First-line Type 2 Decreases glucose production GI effects: N/V/D, bloating Renal disease/dysfunction Can be combined with insulin Take with food to avoid GI effects
(Glucophage) diabetes (with in the liver, decreases Cardiopulmonary disease Second-line: addition of second
lifestyle intestinal absorption of oral med.
modifications) glucose, increases insulin Held if: contrast will be used for
receptor sensitivity imaging and/or two days before
anesthesia
Sulfonylureas Glimepiride Early stages of Bind to beta cells in the Hypoglycemia (confusion, Hypoglycemia, ethanol, old age,
(Amaryl) Type 2 diabetes pancreas and stimulate the sweating, shock), weight gain, sulfonamides
Glipizide (require working release of insulin, can also nausea, epigastric fullness,
(Glucotrol) beta cells in the decrease secretion of glucagon heartburn
Glyburide pancreas)
(DiaBeta)
Glinides Repaglinide Increase insulin production
(Prandin) from the pancreas, similarly to
Nateglinide sulfonylureas
(Starlix)
Thiazolidineiones Pioglitazone Enhanced sensitivity of insulin Heart failure
(Actos) receptors
Rosiglitazone
(Avandia)
Alpha- Acarbose Reversible inhibition of the Flatulence, diarrhea, abdominal GI issues: Bowel irritable
glucosidase (Precose) enzyme alpha-glucosidase, pain, hypoglycemia (IV or oral syndrome, malabsorptions,
inhibitors Miglitol (Glyset) delaying absorption pure glucose given) intestinal obstructions
Dipeptidyl Sitagliptin Delay breakdown of incretin
peptidase 4/IV (Januvia) hormones by inhibiting the
inhibitors (DPP 4) Linagliptin enzyme DPP-4/IV, reducing
(Onglyza) fasting and postprandial
Linagliptin glucose concentrations
(Tradjenta)
Aloglipin (Nesina)
SGLT2 inhibitors Canagliflozin Used when kidneys Risk of ketoacidosis
(Invokana) are working
properly