CLONIDINE HYDROCHLORIDE

 Catapres
 Dixarit
 Duraclon

Therapeutic Class: ANTIHYPERTENSIVE

Pharmacologic Class: CENTRALLY ACTING ALPHA AGONIST

Mechanism of Action
Thought to stimulate alpha2 receptors and inhibit the central vasomotor centers,
decreasing sympathetic outflow to the heart, kidneys, and peripheral vasculature, and lowering
peripheral vascular resistance, blood pressure, and heart rate.

Indication
 Essential and renal hypertension
 Severe cancer pain that is unresponsive to epidural or spinal opiate analgesia or other
more conventional methods of analgesia
 Pheochromocytoma diagnosis
 Migraine prophylaxis
 Dysmenorrhea
 Vasomotor symptoms of menopause
 Opiate dependence
 Alcohol withdrawal
 Smoking cessation
 Attention deficit hyperactivity disorder

Common Adverse Reactions

CNS: drowsiness, dizziness, sedation, weakness
CV: bradycardia, severe rebound hypertension
GI: constipation, dry mouth
Skin: constipation, dry mouth

Contraindication and Caution

• Transdermal form is contraindicated in patients hypersensitive to any component of the
adhesive layer of transdermal system.
• Epidural form is contraindicated in patients receiving anticoagulant therapy, in those with
bleeding diathesis, in those with an injection site infection, and in those who are
hemodynamically unstable or have severe CV disease.
• Use cautiously in patients with severe coronary insufficiency, conduction disturbances,
recent MI, cerebrovascular disease, chronic renal failure, or impaired liver function.

Nursing Consideration
• Drug may be given to lower blood pressure rapidly in some hypertensive emergencies.
• Monitor blood pressure and pulse rate frequently. Dosage is usually adjusted to patient's
blood pressure and tolerance.
• Elderly patients may be more sensitive than younger ones to drug's hypotensive effects.
DISULFIRAM
 Antabuse

Therapeutic Class: Alcohol deterrent

Pharmacologic Class: Aldehyde

Mechanism of Action
Blocks oxidation of alcohol at the acetaldehyde stage. Excess acetaldehyde produces a highly
unpleasant reaction in the presence of even small amounts of alcohol.

Indication
 Adjunct to management of alcohol abstinence

Adverse Reactions
CNS: drowsiness, headache, fatigue, delirium, depression, neuritis
EENT: optic neuritis
GI: garlic or garlicky aftertaste
GU: impotence
Skin: acneiform or allergic dermatitis, occasional eruptions
Other: disulfiram reaction precipitated by alcohol use

Contraindication and Caution

 Contraindicated in patients hypersensitive to drug or other thiram derivatives used in pesticides
and rubber vulcanization; in those with psychoses, myocardial disease, or coronary occlusion; in
those receiving metronidazole, paraldehyde, alcohol, or alcohol-containing products; and in those
experiencing alcohol intoxication or who have ingested alcohol in preceding 12 hours.
 Don’t give drug during pregnancy.
 Use with caution in patients also receiving phenytoin therapy and in those with diabetes mellitus,
hypothyroidism, seizure disorder, cerebral damage, nephritis, or hepatic cirrhosis or insufficiency.

Nursing Consideration
 Never give drug to a patient who is in a state of alcohol intoxication or without the patients full
knowledge.
 Perform complete physical examination and laboratory studies, including CBC, SMA-12,and
transaminase level, before therapy and repeat regularly.
 A severe disulfiram reaction can cause respiratory depression, CV collapse, arrhythmias, MI,
acute heart failure, seizures, unconsciousness, and death.
 The longer the patient remains on the drug, the more sensitive he becomes to alcohol.
 Caution patients family that drug should never be given to patient without his full knowledge;
severe reaction or death could results if patient; drinks alcohol.
NALTREXONE HYDROCHLORIDE
 Vivitrol
 ReVia

Therapeutic Class: Opioid cessation agent

Pharmacologic Class: Opioid antagonist

Mechanism of Action
Probably reversibly blocks the effects of I.V. opioids by competitively occupying opiate receptors
in the brain.

Indication
 Adjunct for maintaining opioid-free state in detoxified patients
 Alcohol dependence
 Cholestatic pruritus
 Severe pruritus

Adverse Reactions
CNS: insomnia, anxiety, nervousness, headache, depression
CV: hypertension
GI: nausea, vomiting, abdominal pain, anorexia, constipation
GU: delayed ejaculation, decreased potency
Hepatic: hepatoxicity
Musculoskeletal: muscle and joint pain
Skin: injection site reaction, rash
Other: chills

Contraindication and Caution

 Contraindicated in patients hypersensitive to drug or dependent to opioids, those receiving
opioids analgesics, those who fail the naloxone challenge test or who have a positive urine screen
for opioids, or those in acute opioid withdrawal.
 Contraindicated in patients with acute hepatitis or liver failure. Use cautiously in patients with
mild hepatic disease or history or recent hepatic disease.

Nursing Consideration
 Discontinue drug if patient develops symptoms and/or signs of acute hepatitis.
 Don’t begin treatment for opioid dependence until patient receives naloxone challenge, a test of
opioid dependence. If sign and symptoms of opioid withdrawal persists after naloxone challenge,
don’t give drug.
 Patient must be completely free from opioids before taking naltrexone or severe withdrawal
symptoms may occur. Patients who have been addicted to short-acting opioids, such as heroin and
meperidine, must wait at least 7 days after last opioid dose before starting drug.
 Use drug only as part of a comprehensive rehabilitation program.
 Advise patient to carry medical identification and to tell medical personnel that he takes
naltrexone.
ONDADSETRON
 Zuplenz
 Zofran

Therapeutic Class: Antiemetic

Pharmacologic Class: Selective serotonin receptor antagonist

Mechanism of Action
May block 5-HT3 in the CNS in the chemoreceptor trigger zone in the peripheral nervous system
on nerve terminals of the vagus nerve.

Indication
 To prevent nausea and vomiting from highly emetogenic chemotherapy
 To prevent postoperative nausea and vomiting
 To prevent nausea and vomiting from radiation therapy in patients receiving total body
irradiation, single high dose fraction to abdomen, or daily fractions to abdomen.
 Nausea and vomiting of pregnancy
 Postanesthetic shivering
 Opioids related pruritus

Adverse Reactions
CNS: dizziness, fatigue, headache, malaise, sedation, extrapyramidal syndrome, fever
CV: arrhythmias, chest pain
GI: constipation, diarrhea, abdominal pain, decreased appetite, xerostomia
GU: gynecologic disorders, urine retention
Respiratory: hypoxia
Skin: rash, pruritus
Other: chills, injection site reaction

Contraindication and Caution

 Contraindicated in patients hypersensitive to drug.
 Contraindicated for use with apomorphine.
 Rarely, transient ECG changes, including prolonged QT interval, have been reported. Monitor
patient carefully.
 Use cautiously in patients with hepatic impairment.

Nursing Consideration
 Drug may increase the risk for prolonged QT interval and torsades de pointes. Monitor ECG in
patients with congenital long QT syndrome, in those with electrolyte imbalances such as
hypokalemia or hypomagnesemia, in those with heart failure or bradyarrhythmias, and in those
taking other medications that can prolong the QT interval.
 Monitor liver function test results. Don’t exceed 8 mg in patients with hepatic impairment.
 Caution patient to contact his health care provider immediately if he experiences signs and
symptoms of abnormal heart rate or rhythm, such as palpitations, dyspnea, or dizziness.
 Instruct patient to immediately report difficulty breathing after drug administration.
 Tell patient to immediately report discomfort at insertion site.