Pharmacology

A medication used in the treatment and/or prevention of nausea and vomiting

-5-HT3 Receptor Antagonists
-Dopamine Antagonists
-Antihistamines (H1 histamine receptor antagonists)
-Cannabinoids

-Dolasetron (Anzemet)
-Granisetron (Kytril, Sancuso)
-Ondansetron (Zofran)
-Tropisetron (Navoban)
*It's 'Tron' to the rescue!

-Promethazine (Phenergan)
-Prochlorperazine (Compazine)
-Metoclopramide (Reglan): this one is different in generic names because it can have some different side effects - watch for extra-pyramidal side effects

-Diphenhydramine (Benadryl)
-Dimenhydrinate (Gravol, Dramamine)
-Meclizine (Bonine, Antivert)

-Cannabis
-Dronabinol (Marinol)

Most antiemetics can cause sedation so watch out for additive effect if given with narcotic analgesics and protect your client from injury

Decrease stomach acid by inhibiting the gastric proton pumps that make the acid - they stop the acid at the pump!

-Omeprazole (prilosec, zegerid, omepral, omez)
-Lansoprazole (prevacid, zoton, inhibitol)
-Dexlansoprazole (kapidex, dexilant)
-Esomeprazole (nexium, esotrex)
-Pantoprazole (protonix, somac, pantozol, zentro)
*Think of a pump in your stomach just churning out the acid - Zole is the nice guy who shuts off the pump

'Zole' is very friendly (well-tolerated by most clients) but can cause vitamin B12 deficiency if he stays around too long (long-term use)

Act by increasing nitric oxide which opens and relaxes the blood vessels of the penis causing increased blood flow (helping lead to getting and keeping an erection)

-Sildenafil (viagra)
-Vardenafil (levitra)
-Tadalafil (cialis)
*'Fil' helps the nitric oxide to fill the penis

While 'Fil' is a great guy (well-tolerated by most clients), he does have a few side effects (headache, flushing, back pain, and muscle aches (with Levitra), temporary vision changes (including 'blue vision' with viagra)). Not all men can spend time with 'Fil'; men who have heart problems, uncontrolled blood pressure issues, history of stroke, or a health problem that can cause priapism

-Liquid can cause teeth staining; drink with a straw and rinse mouth afterwards
-IM can cause skin staining; Z track method should be used
-Antacids and tetracyclines reduce absorption; separate use by at least 2 hours
-Vitamin C increases absorption but also increases incidence of GI complications
-Instruct clients to take on an empty stomach unless it causes GI distress, then take with food
-Clients may experience dark green or black stool
-Increase water and fiber intake unless contraindicated

-Liver
-Egg yolks
-Muscle meats
-Yeast

-Hypercholesterolemia (helps increase HDL)
-Prevention of coronary events
-Protection against MI and stroke for clients with diabetes

-Atorvastatin (lipitor)
-Simvastatin (zocor)
-Lovastatin (mevacor)
-Pravastatin (pravachol)
-Rosuvastatin (crestor)
-Fluvastatin (lescol)

*Protect the liver and muscles 'stat'
-Risk of hepatotoxicity; baseline testing, 12 weeks, then every 6 months; AVOID ALCOHOL
-Risk for myopathy and peripheral neuropathy; clients need to report muscle weakness and/or aches, pain, tingling, and tenderness
-CK levels will be monitored periodically during treatment

-Heparin sodium prevents thrombin from converting fibrinogen to fibrin. It is administered IV or SQ
-Enoxaparin (lovenox) is a low-molecular weight heparin. It has the same action as heparin but has a longer half-life. It is administered subQ
-Protamine sulfate is the antidote for heparin
-Administer heparin when there is the likelihood of clot formation, such as with MI or DVT
-Risk for bleeding is the major side effect
-Instruct clients to avoid corticosteroid use, salicylates, NSAIDs, green leafy vegetables, and foods high in Vitamin K
-Normal activated partial thromboblastin time (aPTT) is 20-36 seconds, but to maintain a therapeutic level of anticoagulation while on heparin, the aPTT should be 1.5-2 times normal (60-80 seconds)

-Coumadin interferes with coagulation factors by antagonizing Vitamin K
-Oral administration is typically used. Clients may need continued heparin infusion via IV until therapeutic effect of Coumadin is experienced (3-5 days)
-Use is contraindicated in clients with low platelet counts or uncontrolled bleeding
-Mephyton (trade name for Vitamin K) is the antidote
-Advise clients to avoid foods that are high in Vitamin K, and avoid the use of acetaminophen, glucocorticoids, and aspirin. Should wear a medical alert bracelet
-Doses are typically taken once daily
-INR and PT are monitored; PT should be 1.5-2 times control and INR should be 2-3. Target INR is 3-4.5 for clients with a mechanical heart valve
-NO coumadin for pregnant women! Heparin may be safely used in pregnancy

-Aspirin (ecotrin)
-Clopidogrel (plavix)
-Pentoxifylline (trental)

-Observe for signs of weakness, dizziness, and headache and report them if they occur. These may be signs of hemorrhagic stroke.
-Bleeding time should be assessed carefully. Coffee ground emesis or bloody, tarry stools should be reported. Watch for bruising, petechiae, and bleeding gums
-Avoid NSAIDs, heparin, warfarin, and corticosteroids