DrugQuiz..1b

Analgesics
 Opioids
o Examples
 morphine, hydrocodone/acetaminophen (Vicodin), hydromorphone
(Dilaudid), fentanyl (Duragesic Patch), tramadol (Ultram)
o Action
 bind to opioid receptors in brain, spinal cord, and other areas of the body;
reduce the sending of pain messages to brain
o Uses
 moderate-severe pain that may not respond will to other meds
o Common Side Effects
 N&V, constipation, drowsiness, sedation, lightheadedness, stomach upset,
flushing
o Serious Adverse Reactions
 respiratory depression, allergic reactions including itchiness and
bronchospasm
o Contraindications
 pregnancy, breastfeeding, significant respiratory disease, comatose
patients, phaeochromocytoma
 take caution when giving to children
o Interactions
 drugs that affect liver function can increase or decrease elimination of
opioids
o Teaching
 don’t stop without talking to the prescriber
 don’t stop suddenly because withdrawal may occur
 tolerance builds when taken over a long period of time, so dosage may
need to be adjusted
 avoid alcohol
 take with food or milk to prevent upset stomach
 NSAIDS
o Examples
 aspirin, celecoxib (Celebrex), ibuprofen (Motrin), naproxen (Aleve),
ketorolac (Toradol)
o Action
 block COX enzymes and reduce prostaglandins throughout the body;
reduces inflammation, pain, and fever
o Uses
 treat inflammation, mild-moderate pain, and fever
 headache, arthritis, sports injuries, menstrual cramps
 aspirin used to inhibit clotting to prevent CVA and MI
 celebrex can be used to prevent formation and growth of colon polyps
o Side Effects
 most common: nausea, vomiting, diarrhea, constipation, decreased
appetite, rash, dizziness, headache, and drowsiness
 more serious: stomach pain, swelling of feet/ankles, tinnitus (aspirin
especially)
 most serious: kidney failure, liver failure, ulcers, and prolonged bleeding
after sx

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Serious Adverse Reactions
 allergic reaction: SOB
 Reye’s Syndrome with aspirin use in children/teenagers with
chickenpox/influenza
 increase risk of potentially fatal stomach/intestinal adverse reactions:
bleeding, ulcers, and perforation
o Contraindications
 kidney/liver/stomach problems, heart disease, HTN, diabetes, bld
problems, asthma, eye problems, nasal polyps, severe/long-lasting HA,
and allergies, pregnancy, breastfeeding
 do not use for tx of pain resulting from CABG
o Interactions
 reduce action of diuretics
 decrease elimination of lithium and methotrexate
 increased bleeding when used with other meds that increase bleeding
 may raise BP, so may cancel out action of drugs used to treat HTN
 increase negative effects of cyclosporine on kidney function
o Teaching
 take with full glass of water, food, milk, or an antacid
 stay in upright position for at least 30 min after consumption
 seek immediate medical attention if taking for migraine and the pain isn’t
relieved or worsens
 limit alcohol and use caution when engaging in activities requiring
alertness
 avoid prolonged sun exposure, use sunscreen, wear protective clothing
Benzodiazepines
 Examples
o alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam
(Ativan), midazolam (Versed)
 Action
o exact mechanism of action is unknown; reduce activity of the brain and spinal
cord by increasing effects of the neurotransmitter, GABA
 Uses
o anxiety, seizures, insomnia
o sometimes for general anesthesia, sedation for sx, muscle relaxation, alcohol
withdrawal, N&V, depression, and panic attacks
 Common Side Effects
o most common: sedation, dizziness, weakness, and unsteadiness
o less common: feeling of depression. loss of orientation, HA, sleep disturbance
 Serious Adverse Reactions
o physical dependence; suddenly stopping after a few months of daily tx may cause
withdrawal, and may even produce seizures, tremors, muscle cramping, vomiting,
and sweating
 Contraindications
o liver/kidney disease, pregnancy, breastfeeding, alcohol use
o take caution with elderly patients
 Interactions
o cause excessive sedation when taken with other CNS depressants (alcohol,
barbiturates, narcotics, and tranquilizers)

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elimination of benzodiazepines is slowed by drugs that slow liver elimination
antacids may reduce absorption rate from intestine
pt shouldn’t drink grapefruit juice
smoking decreases effectiveness
 Teaching
o do not stop suddenly; does must be tapered slowly
Anticholinergics
 Examples
o atropine, oxybutynin (Ditropan)
 Action
o oppose action of acetylcholine; inhibit transmission of parasympathetic nerve
impulses, thereby reducing spasms of smooth muscles; balance production of
dopamine and acetylcholine in the body
 Uses
o GI disorders like diarrhea, overactive bladder, and incontinence; asthma, COPD,
dizziness, motion sickness, HTN, Parkinson’s; sometimes depression, sleep
disorders, certain types of toxic poisoning, and as an aid to anesthesia
 Common Side Effects
o dry mouth, blurred vision, constipation, drowsiness, sedation, hallucinations,
memory impairment, difficulty urinating, confusion, delirium, decreased sweating
 Signs of Overdose
o dizziness, severe drowsiness, fever, severe hallucinations, confusion, trouble
breathing, clumsiness, slurred speech, fast HR, flushing/warmth of skin
 Contraindications
o myasthenia gravis, hyperthyroidism, glaucoma, enlarged prostate, postural
hypotension, severe colitis, blockage of urinary tract, tachycardia, HF, severe dry
mouth, hiatal hernia, severe constipation, liver disease, Down’s syndrome,
pregnancy
 Interactions
o other anticholinergics or drugs with anticholinergic side effects
o ACE Inhibitors antagonize action of anticholinergics
o drugs like Spiriva, Atrovent, and KCl tablets can enhance action of
anticholinergics
 Teaching
o these raise body temp, so avoid hot baths/showers, use extra caution to not
become overheated during exercise
o avoid alcohol
Bisphosphonates
 Examples
o alendronate (Fosamax), ibandronate (Boniva)
 Action
o slow bone loss by increasing bone formation and decreasing bone turnover
 Uses
o osteoporosis, Paget’s disease, cancer metastatic to bone, postmenopausal women
with vertebral compression fractures or total hip bone density T-score below -2.5,
elderly men with non-traumatic fractures
 Common Side Effects
o fever and flu-like symptoms when receiving through IV
o hypocalcemia, constipation or diarrhea, fatigue, feeling sick, gas, bloating

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Serious Adverse Reactions
o gastroesophageal irritation, ostenecrosis of the jaw, kidney damage
Contraindications
o pregnancy, chronic kidney disease, hypocalcemia, osteomalacia, Vit D deficiency
o Oral bisphosphonates shouldn’t be used in pts with serious esophageal disease or
those who can’t stay upright for an hour
o use caution in pts with high PTH, gastric/intestinal bypass sx, and children
Interactions
o food, caffeine, milk, orange juice, and antacids reduce absorption
o use caution with other drugs that cause stomach/esophagus irritation, like aspirin
Teaching
o do not take oral doses with food, tea, coffee, or chocolate milk
o stay upright for 30-60 minutes after taking medication
o do not take other medications at the same time
o follow with a small sip of water to decrease risk of esophageal erosion