Pharmacology

By: Jan Michael Khalid L. Macarambon, RN

Definition of Terms
Pharmacology ² is the science of drugs and their effects on biological systems y Drug ² a chemical that can cause a change in a biological system y Medicine ² is a formulation of a drug (e.g., tablet, capsule, etc.)
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Drug Classification
Chemical ² according to structure y Pharmacologic ² according to physiologic activities and mechanisms of action y Therapeutic ² according to therapeutic indications
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µ y Trade/Brand name ² proprietary name owned by the company that manufactures the drug. Example: Chemical name ² N-Acetyl-para-aminophenol Generic name ² Acetaminophen Trade/Brand name ² Acephen. Tynenol y . AKA ´nonproprietary name.Drug Names Chemical name ² chemical structure of the compound y Generic name ² name selected by the original manufacturer of the drug based on the chemical structure that is used worldwide as established through the committee on International Nonproprietary names of the WHO.

Drug Sources Plants (morphine) y Animals (insulin) y Minerals (calcium) y y Most modern drugs are synthetic chemical compounds .

Pharmacodynamics
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Is the process by which drugs influence the cell physiology to achieve the desired result

´WHAT THE DRUG DOES TO THE BODYµ

Pharmacodynamics
Drugs can: 1. Inhibit 2. Activate 3. Replace They interact with specific sites called receptors Receptors ² cellular proteins or nucleic acids that regulate the cellular activities

Pharmacodynamics
Receptors are regulated in two ways: 1. Agonists (activators) ² bind to the receptor and act to produce a pharmacologic effect 2. Antagonists (blockers) ² bind to the receptor and prevent the cell from producing an effect

distributes it to its site of action.Pharmacokinetics y Is the process by which the body absorbs the drug into the bloodstream. metabolizes it. and excretes it ´WHAT THE BODY DOES TO THE DRUGµ .

Absorption Distribution Metabolism/biotransformation Excretion . 2.Pharmacokinetics ´ADMEµ 1. 3. 4.

Pharmacokinetics .

Factors Affecting Pharmacokinetics Age y Diseases y Individual Differences y Psychological Factors y Type & Amount of Drug Prescribed y Social Factors y .

Routes of Administration .

NG. gastrostomy. capsules. duodenostomy tubes are also included y Assess client·s ability to take oral medications y .Oral Pills. tablets. buccal. liquids y SL.

Intradermal Injection Sites Ventral forearm y Upper chest y Shoulder y .

Subcutaneous Injection Sites Outer aspects of the arms & thighs y Hip and lower abdomen y Above the iliac crest y .

Intramuscular Ventrogluteal ² for 1 year and above y Preffered site y .

Intramuscular y Vastus lateralis ² below 1 year old .

Intramuscular y Dorsogluteal ² clients w/ welldeveloped gluteal muscles .

Intramuscular y Deltoid .

Other Routes Intravenous y Topical ² skin. rectal y Respiratory inhalation y . vaginal. otic. nasal. ophthalmic.

Infectious Antibacterials y Antivirals y Antifungals y Antiparasitics y Antihelminthics y .

Cephalosporins ² cephalexin. Chloramphenicols. Penicillins ² pen G. Sulfonamides ² cotrimoxazole 4. Lincosamides ² clindamycin d. DNA Synthesis Inhibitors a. Protein Synthesis Inhibitors a. Antimetabolites a. Cell Wall Inhibitors a. Aminoglycosides ² gentamycin. Macrolides ² erythromycin c. amoxicillin b. tetracyclines 3. cefuroxime c.Antibacterials 4 Major Types: 1. Metronidazole . Quinolones ² ciprofloxacin b. amikacin b. Glycopeptides ² vancomycin 2.

Erythromycin . Aminoglycoside . bone marrow depression 6.hepatitis .bone problems 5. Quinolones ² insomnia 4.nephrotoxicity & ototoxicity 2. photosynsetivity 3. Chloramphenicol . Tetracyclines .Gray syndrome. Sulfonamides .Steven-Johnson·s syndrome.Antibacterials Adverse effects : 1.

Check client·s history of allergies.Antibacterials Nursing considerations : 1. Report for diarrhea . Collect appropriate specimen for C & S before starting antibiotics. . Monitor adverse effects. 2.pseudomembranous colitis (clindamycin) 6. 3. Pregnant precautions. 5. Avoid administering erythromycin and quinolones with food. 4.

acyclovir (Zovirax). zidovidine (Retrovir) y . ganciclovir (Cytovene). amantidine (Symmetrel). They only control the growth of virus but it does not cure y Prototype . vidarabine (ViraA).Antivirals Mechanism of action . ribavirin (Virazole).inhibits virus specific enzymes involve in DNA synthesis.

6. 4. Pregnant and breastfeeding precautions.granulocytopenia. Monitor CBC and creatinine level. nausea. headache. y . Take amantidine after meals. 3.Antivirals Adverse Effects . 5. nervousness. nephrotoxicity Nursing consideration : 1. Give ribavirin only with aerosol generator. Administer IV antivirals to avoid crystallization in renal tubules. 2. thrombocytopenia. Refer for signs of bleeding.

ketoconazole (Nizoral) y Adverse effects nephrotoxicity and neurotoxicity.amphotericin B (Fungisone). nystatin. joint pains. bone marrow depression. chills.inhibit the synthesis of fungal sterol y Prototype . fluconazole (Diflucan). abdominal pain and headache y .Antifungals Mechanism of action . fever.

2. chills. 3. 5. With oral candidiasis. Dilute amphotericin B with sterile water solution not with electrolyte solution. let nystatin tablet dissolve in mouth rather than swallowing it.Antifungals Nursing considerations : 1. Report for signs of bleeding. infection & fatigue . GI upset. Refrain ketoconazole with antacids. 4. joint and muscle pain will subside as amphotericin B continues. Tell clients that fever.

primaquine. mefloquine. quinine.Antiparasitics 2 Types: y Antimalarial ² chlroquine. furozolidone (Furoxone) . iodoquinol. pyrimethamine y Antiamebiasis ² metronidazole (Flagyl).

depleting folates. & reducing nucleic acid production y Antiamoeba ² block protein synthesis .Antiparasitics Mechanisms of action: y Antimalarial ² alters protozoal DNA.

tinnitus. Refer cinchonism during quinine treatment: . fever. 3. headache.Antiparasitics Nursing considerations : 1. 4. . vertigo. and visual changes. 2. Take seizure precautions while administering antimalarial drugs. Administer anti-malarial drugs with food. Inform clients that iodoquinol falsify thyroid function test for up to 6 months.

thiabendazole. niclosamide (Niclocide). praziquantel (Biltricide) y Mechanism of action ² paralyze larva and adult helmints by acting on parasite microtubules y .Antihelminthics Prototype ² mebendazole (Vermox). piperazine (Antepar).

3. Treat all the family members for nematodes infection to prevent recurrence. headache. Other antihelmintics should be chewed. dizziness.GI upset. Praziquantel must swallowed rapidly because of its bitter taste to avoid gagging. urinary odor (thiabendazole).Antihelminthics Adverse effects . y . fatigue Nursing considerations : 1. 2.

Oncologic Alkylating Agents y Antitumor Antibiotic Agents y Antimetabolites y Mitotic Inhibitors y Hormonal Medications y .

y .Alkylating Agents inhibits cell production by causing cross linking of DNA Busulfan ² hyperuricemia Chlorambucil ² gonadal suppression Cisplatin ² ototoxicity and nephrotoxicity Cyclophosphamide ² hemorrhagic cystitis.

Antitumor Antibiotic Agents interfere in DNA and RNA synthesis Plicamycin ² affects bleeding time Doxurubicin ² cardiotoxicity Bleomycin ² pulmonary toxicity y .

Antimetabolites y replace normal proteins required for DNA synthesis by inhibiting the S phase Cytarabine ² hepatotoxicity 5-flourouracil ² phototoxicity reaction and cerebellar dysfunctions 6-marcaptopurine ² hyperuricemia Methotrexate ² photosensitivity. given with leucoverin to lessen its toxicity .

numbness .Mitotic Inhibitors y prevent mitosis acting on the M phase causing cell death Vincristine sulfate ² neurotoxicity.

elevate cholesterol & triglycerides level Diethylstilbestrol ² impotence and gynecomastia in men y .Hormonal Medications block the normal hormones in hormone sensitive tumors Tamoxifen citrate ² visual problems.

anti-emetic.use soft toothbrush and electric razor menstrual changes y . B-12. folic acid rich food y .avoid NSAIDs y .provide rest periods bleeding y .reassure that menstruation will resume y .monitor for signs of infection y .minimize invasive procedures y .bland diet. ice chips diarrhea.Side Effects stomatitis y .notify physician if WBC is <2000/mm3 y .reassure that it is temporary y .reverse isolation . nausea and vomiting y . replace fluids and electrolytes y . avoid strong mouthwash y . hats and head scarf skin pigmentation y .low bacteria diet anemia y .encourage o wear wigs.inform that it is only temporary tumor lysis syndrome y .force fluids infection y .hyperuricemia & hyperkalemia y .alopecia y .iron.soft tooth brush.

6.Neurologic 1. 4. 2. 8. 7. 5. 3. Cholinergic Agents/Parasymphatomimetics Anticholinergics/Parasymphatolytics Adrenergic Agents/Symphatomimetics Adrenergic Blocking Agents Skeletal Muscle Relaxants Anticonvulsants/Antiepileptics Antiparkinsonian Agents CNS Stimulants .

Cholinergic Agents Mechanism of action ² stimulates cholinergic receptors by mimicking acetylcholine or inhibition of enzyme cholinesterase y Indications ² glaucoma. urine retention. Myasthenia Gravis. antidote to neuromuscular blocking agents : tricyclic antidepressants and atropine y .

bronchoconstriction. wheezing. miosis. neostigmine (Prostigmine). DOB. pilocarpine. increase in salivation. pyridostigmine (Mestinon) y Adverse effects ² blurring of vision. hypotension and bradycardia y . edrophonium (Tensilon). carbachol.Cholinergic Agents Prototype ² synthetic acetylcholine. intestinal cramps. bethanecol (Urocholine).

Warn & monitor clients of the side effects.Cholinergic Agents Nursing considerations : 1. 2. Have atropine available for use as antidote. .

asthma. parkinsonism. y .Anticholinergic Agents Mechanism of action ² block the binding of acetylcholine in the receptors of parasympathetic nerves y Indications ² use preoperatively to dry up secretions. use for treatment of bradycardia. treat spasticity of GI or urinary tract. use for antidote in organophosphate poisoning.

propantheline (Pro-Banthine) y Adverse effects . ileus. dilatation of pupils. tachycardia. dicyclomine (Bentyl). scopalamine (Triptone).Anticholinergic Agents Prototype ² atropine. urinary retention.dry mouth . heat stroke y .

3.Anticholinergic Agents Nursing considerations : 1. Keep client in cool environment. . For GI spasticity. Watch out for signs of heatstroke and dehydration. 4. Encourage clients to increase fluid intake and use of sugarless gum/candy for dry mouth. administer 30 minutes before meals and at bed time. 2.

hypotension. anaphylactic shock y . COPD and asthma. nasal congestions. allergic reaction.Adrenergic Agents Mechanism of action ² stimulate alpha and beta adrenergic receptor directly or trigger the release of catecholamines indirectly causing sympathetic effects y Indications ² cardiopulmonary arrest.

phenylephrine.epinephrine. HPN y . dopamine. tachycardia. ephedrine. isoproterenol y Adverse Effects ² restlessness. norepinephrine. angina. tremors.Adrenergic Agents Prototype . dobutamine. albuterol. terbutaline. palpitations. nausea. insomnia.

2. 3. pheochromocytoma & cardiovascular disease. Monitor vital signs and advice precautions. .Adrenergic Agents Nursing considerations : 1. Should be taken with food. Contraindicated in clients w/ hyperthyroidism.

timolol ( Blocadren) .Adrenergic Blocking Agents 2 Types: y Alpha blockers ² phentolamine (Regintine). clonidine (Catapress). reserpine (Serpasil). terazosin (Hytrin). methyldopa (Aldomet) y Beta blockers ² atenolol (Tenormin). metoprolol (Lopressor). nadolol (Corgard). propanolol (Inderal). prazosin (Minipress). esmolol (Brevibloc). phenoxybenzamine.

Adrenergic Blocking Agents Mechanism of actions: y Alpha blockers ² inhibits action of areceptors in vascular smooth muscle to cause vasodilatation y Beta blockers ² compete with epinephrine in b-receptors in heart. pulmonary airways. peripheral circulation and CNS .

glaucoma y Adverse effects .Raynaud·s disease. hypertension.orthostatic hypotension. mitral valve prolapse. angina.Adrenergic Blocking Agents Indications . pheochromocytoma. cold extremities y . bronchospasm and dyspnea. nasal stuffiness. bradycardia. depression. arrhythmias. insomnia and vertigo. CHF.

Administer oral beta-blockers before meals and at a. 3. Warn clients not to drive or operate dangerous machinery until he/she has adjusted to medications. Check client·s apical pulse rate before drug administration. . 5.Adrenergic Blocking Agents Nursing considerations : 1. 4. refer if below 60 bpm. Administer oral alpha-blockers with milk to minimize GI side effects.m. if insomnia occurs. 2. Hypotensive precautions.

Skeletal Muscle Relaxants Mechanism of action ² depress CNS. enhance the inhibitory action of GABA (gamma-amino butyric acid) y Indications ² for acute musculoskeletal pain. for muscle spasticity associated with multiple sclerosis. cerebral palsy. y . and spinal cord injury. inhibit calcium ion release in the muscle. CVA.

urine retention y . metaxalone (Skelaxin). baclofen (Lioresal). dantrolene (Dantrium).Skeletal Muscle Relaxants Prototype ² methacarbamol (Robaxin). ataxia. hypotension. orphanedrine (Norgesic). blurred vision. drowsiness. bradycardia. depression. chlorzoxazone y Adverse effects ² hypotonia.

Monitor neuromuscular status. Reduce baclofen dosage gradually because of associated withdrawal symptoms : Confusion. 2. 4. Inform clients that maximum benefit of baclofen is attained for 1-2 months. bowel and bladder functions. . paranoia & rebound spasticity.Skeletal Muscle Relaxants Nursing considerations : 1. hallucinations. 3. Caution clients that mental alertness may be impaired.

diazepam. clorazepate (Tranxene). valproic acid (Dapakene). ethosuximide (Zarontin) .Anticonvulsants 3 Types: y Hydantoins ² phenytoin (Dilantin) y Barbiturates ² phenobarbital (Luminal) y Miscellaneous ² carbamazepine (Tegretol).

diplopia. thrombocytopenia. nystagmus. vertigo. gingival hyperplasia. aplastic anemia y .Anticonvulsants Mechanism of action ² treat seizures by depressing abnormal neuronal activity in motor cortex y Adverse effects ² sedation & drowsiness. dizziness.

5. 7. Avoid taking alcohol with barbiturates.Anticonvulsants Nursing considerations : 1. Warn clients with diabetes that hydantoins may increase blood sugar level and that valproic acid may produce a false positive result in urine ketone test. 4. Administer IV phenytoin slowly to avoid cardiotoxicity. 2. 3. . 6. 8. Teach clients receiving carbamazepine to identify symptoms of bone marrow depressions. Inform clients taking phenytoin that harmless urine discoloration is common. Advise female clients to use contraceptives. Avoid mixing other drugs in same syringe with phenytoin. Reassure that barbiturates are not addictive at a low dosage.

bromocriptine . pergolide (Permax). benztropine (Congentin) y Dopaminergic agents ² Levodopa. amantidine (Symmetrel).Antiparkinsonian Agents 2 Types: y Anticholinergic agents ² trihexyphenidyl (Artane). carbidopa-levodopa (Sinemet). selegiline (Eldepryl).

Antiparkinsonian Agents Mechanism of actions: y Anticholinergic agents ² inhibit cerebral motor centers y Dopaminergic agents ² increasing dopamine concentrations or enhancing neurotransmitter functioning .

anorexia. constipation y bromocriptine ² palpitations. orthostatic hypotension. tachycardia . dark-colored urine and sweat y amantidine ² ankle edema.Antiparkinsonian Agents Adverse effects of dopaminergic agents: y levodopa ² nausea. vomiting.

5. 4. Give dopaminergic agents after meals to reduce GI symptoms.Antiparkinsonian Agents Nursing considerations : 1. 2. Elevate leg to reduce ankle edema. 3. Educate clients to minimize orthostatic hypotension. Avoid taking Vit B6 (pyridoxine) with levodopa because it speed up metabolism. Reassure client that levodopa may cause harmless darkening of urine and sweat. .

attention deficit hyperactivity disorders. narcolepsy. drug-induced respiratory depressions y .CNS Stimulants Mechanism of action ² increase excitatory CNS neurotransmitter activity and blocks inhibitory impulses y Indications ² for obesity (amphetamines).

headache. dry mouth y .CNS Stimulants Prototype ² amphetamines. restlessness.nervousness. methylphenidate (Ritalin) y Adverse effects . anorexia. tachycardia. hypertension. insomnia.

. Ice chips or sugarless gum for dry mouth.CNS Stimulants Nursing considerations : 1. Should be given at morning. 3. 2. Don·t stop amphetamine abruptly to avoid withdrawal symptoms. 4. Monitor blood pressure and pulse. 5. Watch out for growth retardation in children taking methylphenidate.

hypnotics.Psychiatric Sedatives. & anxiolytics y Antidepressants & mood stabilizers y Antipsychotics/neurolepti cs y .

secobarbital y Miscellaneous ² chloral hydrate (Noctec). buspirone (Buspar). paraldehyde . lorazipam (Ativan). phenobarbital.Anxiolytics 3 Types: y Benzodiazepines ² diazepam (Valium). flurazepam (Dalmane) y Barbiturates ² amobarbital. alprazolam (Xanax).

Anxiolytics Mechanism of actions: y Benzodiazepines ² increase the effect of inhibitory neuro transmitter GABA (gamma-amino butyric acid) y Barbiturates and Miscellaneous agents ² depress CNS .

drug-dependence y .Anxiolytics Indications .hangover-effect. dizziness. CNS depression. respiratory depression.induce sleep. sedate and calm clients y Adverse effects .

4. 2. Rotate and don·t shake the ampules of barbiturates. Warn clients of injuries and falls.Anxiolytics Nursing considerations : 1. 3. Brief period of confusion and excitement upon waking up is common with benzodiazepines. Warn clients not to discontinue medications abruptly without consulting a physician. Don·t mix with other drugs. 6. 5. . Avoid alcohol while taking these drugs. Warn female clients that diazepam is associated with cleft lip.

imipramine (Tofranil). tranylcypromine (Parnate) y Second-generation antidepressants ² fluoxetine (Prozac). protriptyline (Vivactil). trazodone (Desyrel) y Lithium .Antidepressants 4 Types: y Tricyclic antidepressants ² amitriptyline (Elavil). phenelzine (Nardil). desipramine y MAO (monoamine oxidase inhibitors) ² isocarboxazid (Marplan).

Antidepressants Mechanisms of actions: y Tricyclic antidepressants ² increase receptor sensitivity to serotonin and/or norepinephrine y MAO inhibitors ² inhibit the enzyme MAO that metabolize the neurotransmitters norepinephrine and serotonin y Second ² generation antidepressants ² inhibits the reuptake of serotonin y Lithium ² increase serotonin & norepinephrine uptake .

dry mouth. dehydration (Lithium) . urine retention.Antidepressants y Adverse effects . constipation (anticholinergic effects). insomnia. orthostatic hypotension. blurred vision. hypertensive crisis (MAO).

Antidepressants
Nursing considerations : 1. Caution client to rise slowly to reduce the effects of orthostatic hypotension. 2. Take antidepressant with food to enhance absorption 3. Explain to client that full response may take several weeks (2 weeks). 4. Assess client for constipation resulting from tricyclic antidepressant use. 5. Client taking MAO inhibitors should avoid tyramine-rich foods to avoid hypertensive crisis such as aged cheese, sour cream, yogurt, beer, wine, chocolate, soy sauce and yeast. Pentholamine (Regintine) is the drug of choice for hypertensive crisis. 6. Inform physician and withhold fluoxetine if client develop rashes. 7. Take lithium with food to reduce GI effects ² > 1.5 mEq/L blood level may cause toxicity manifested by: confusion, lethargy, seizures, hyperreflexia, maintain salt and adequate fluid intake, tremors may occur but it is temporary, monitor white blood cell count (increase).

Antipsychotics
2 Types: y Phenothiazines ² chlorpromazine (Thorazine), trifluoperazine (Stelazine), thioridazine (Mellaril) y Other Agents ² clozapine (Clozaril), haloperidol (Haldol)

Antipsychotics
Mechanism of action ² block dopamine receptor in the limbic system, hypothalamus, and other regions of the brain y Adverse effects -Extra pyramidal symptoms such as dystonia, pseudoparkinsonism, and an irreversible tardive dyskinesia as manifested by : lip smacking, fine wormlike tongue movement, involuntary movements of arms and leg. -Neuroleptic malignant syndrome ² fever, tachycardia, tachypnea, diaphoresis, cardiovascular collapse, muscle rigidity, seizures. -Orthostatic hypotension
y

Teach family members the signs of EPS and NMS. Watch out for orthostatic hypotension and photosensitivity with phenothiazine. Be sure that oral doses are swallowed. 5. Normalization of symptoms may not occur for several weeks after beginning of therapy. Watch out of neutropenia with clozapine. 3. Avoid administering haloperidol intravenously. and not hoarded. 4.Antipsychotics Nursing considerations : 1. 2. and report to physician immediately. . 6.

Musculoskeletal General Anesthetics y Local & Topical Anesthetics y Analgesics y .

halothane. nitrous oxide y Injection anesthetics ² fentanyl (Sublimaze). ketamine (Ketalar). isoflurane (Forane).General Anesthetics 2 Types: y Inhalation anesthetics ² enflurane (Ethrane). etomidate (Amidate) . thiopental Na (Penthotal).

General Anesthetics y Mechanism of action ² cause CNS depression. and muscle relaxation . unresponsiveness to pain stimuli. by producing loss of consciousness.

Avoid alcohol or CNS depressants for 24 hours after anesthesia. 2.rash. Instruct client NPO for 8 hours before administration.General Anesthetics Nursing considerations : 1. monitor signs of hepatic fatal side effects : . fever. Monitor body temperature ² malignant hyperthermic crisis : dantrolene (antidote) 5. jaundice and altered liver function. 6. 4. In patient who received halothane. vomiting. Monitor urinary retention. . nausea. Monitor cardio pulmonary depression and hypotension. 3.

prilocaine y Topical : benzocaine. tetracaine.lignocaine y Mechanism of action ² block transmission of impulses across nerve cell membrane . lidocaine. mepivacaine. butacaine. procaine.Local & Topical Anesthetics 2 Types: y Local : bupivacaine. dibucaine.

Local & Topical Anesthetics Adverse effects ² cardiac dysrhythmias y Nursing considerations : 1. Lignocaine + prilocaine (EMLA cream) should be applied topically 60 minutes before procedure. y . 3. Administer cautiously to the areas of large broken skin. 2. Observe for fetal bradycardia in pregnant clients.

butorphanol (Stadol). naproxen. meperidine (Demerol) morphine. ketorolac paracetamol and acetaminophen (Tylenol) .Analgesics 2 Types: y Narcotic analgesics ² codeine. mefenamic acid (Ponstan). ketoprofen (Orudis). nalbuphine (Nubain) y Non ² narcotic analgesic ² NSAIDs ² aspirin (aminosalicylic acid). ibuprofen (Motrin).

y Non-narcotic analgesic ² relieves pain and fever by inhibiting the prostaglandin pathway.Analgesics Mechanisms of action: y Narcotic analgesics ² alter pain perception by binding to opioid receptors in CNS. .

5. Monitor hearing loss in clients taking aspirin. . 3. Injury and accident precautions in clients taking narcotic analgesic. Warn clients about possibility of dependency. Naloxone is antidote for narcotic overdose. Monitor respiratory depression & hypotension in clients taking narcotic analgesic. Aspirin is contraindicated in clients below 18 years old with flulike symptoms.Analgesics Nursing considerations : 1. Monitor liver function in clients taking acetaminophen. 4. 2. and do not discontinue narcotics abruptly in the narcotic-dependent clients. N-acetylcysteine is antidote for paracetamol overdose. 7. 6. 8. Advice clients to take NSAIDs with food and monitor bleeding complications. 9.

Cardiovascular y y y y y y y y y y y y Anticoagulants Thrombolytics Hemostatic Agents Antiplatelets Cardiac Glycosides Nitrates Anti-arrhythmics Antilipemics ACE Inhibitors Calcium-Channel Blockers Diuretics Vasodilating Agents .

Heparin ² SQ & IV 2. Warfarin ² Oral Mechanism of actions : y Heparin ² prevents thrombin from converting fibrinogen to fibrin.Anticoagulants 2 Types: 1. y Warfarin ² suppress coagulation by acting as an antagonist of vitamin K after 4-5 days .

myocardial infarction y Adverse effect ² bleeding y .Anticoagulants Indications ² thrombosis. pulmonary embolism.

Nursing Considerations HEPARIN sodium y if given SQ don·t aspirate or rub the injection site (above the scapula . y antidote : (protamine sulfate) 1. y normal PTT is 20-35 sec. = 50-85 sec.best site).5 times normal PTT.5-2. y therapeutic level 1. .

onset of action is 4-5 days. y y y y y y y WARFARIN sodium (coumadin) warfarin is used for long-term. reduce intake of green leafy vegetables.Nursing Considerations 2.8 sec.6 -11. = 25 .5 times normal PT. therapeutic level is 1. antidote : Vitamin K ( Aquamephyton) . should be taken at the same time of the day to maintain at therapeutic level.30 sec.5-2. normal PT = 9.

use early in the course of MI (within 4-6 hours of the onset) y Prototype ² Streptokinase. Urokinase y Nursing considerations .Thrombolytics Mechanism of action ² activates plasminogen to generates plasmin (enzyme that dissolve clots) y Indication .monitor bleeding. antidote : Aminocaproic acid y .

Konakion) y .Vitamin K (aquaMEPHYTON. Protamine sulfate.Hemostatic Agents Mechanism of action ² terminates/stops bleeding y Indications ² treatment of bleeding as a side effect for anticoagulant/thrombolytic therapy y Prototype ² Aminocaproic acid (Amicar). Tranexamic acid (Hemostan).

coronary revascularization.I.Antiplatelets Mechanism of action ² inhibit the aggregation of platelet thereby prolonging bleeding time y Indication . and thrombotic CVA y .used in the prophylaxis of long-term complication following M.

aspirin. Dipyridamole (Persantin). Clopidoigrel (Plavix). Ticlopidine y Nursing Considerations . take the medication with food y .Monitor bleeding time ( NV = 1-9 mins).Antiplatelets Prototypes .

atrial tachycardia and fibrillation y .Cardiac Glycosides increase intracellular calcium. which causes the heart muscle fibers to contract more efficiently. producing positive inotropic & negative chronotropic action y Indications ² use for CHF.

anorexia. halo vision. 4. Antidote : Digi-bind 5. 2. Should be caution in patient with hypothyroidism and hypokalemia. vomiting. Phenytoin is the drug of choice to manage digitalis-induced arrhythmia y . bradycardia and heart blocks. Do not administer if pulse is less than 60 bpm. Monitor for toxicity as evidence by : nausea. 3.Cardiac Glycosides Prototype ² digoxin (Lanoxin) and digitoxin (Crystodigin) Nursing considerations : 1. confusion.

peripheral arterial occlusive disease y Prototype ² isosorbide dinitrate (Isordil). Nitrostat) y Adverse effects ² headache orthostatic hypotension y . MI.Nitrates Mechanism of action ² produce vasodilatation including coronary artery y Indication ² angina pectoris. nitroglycerine (Deponit.

.one tablet for pain and repeat every 5 mins.sustained release medications should be swallowed and not to be crush. y .apply the patch to a hairless area using a new patch and different site each day. for a total of three doses.stinging or burning sensation indicates that the tablet is fresh.remove the patch after 12-24 hours.instruct patient not to swallow the pill y . y .protect the pills from light. if not relieved after 15 mins. allowing 10-12 hours ´patch freeµ each day to prevent tolerance. y .Nitrates Nursing Considerations : 1. seek medical help. y .offer sips of water before giving because dryness may inhibit absorption. Transdermal patch y . y . . 2. Sublingual medications y . y .note the BP before giving the medication.

procainamide IB . diltiazem y .flecainamide y Class II (Beta-blockers) propanolol. esmolol y Class III (block K channels) amiodarone.AntiAnti-arrhythmics Class I (block Na channels) IA . bretylium y Class IV (block Ca channels) verapramil.quinidine.lidocaine IC .

2. 3.confusion and restlessness .AntiAnti-arrhythmics Nursing considerations : 1. Watch out for signs of CHF. Watch out for signs of lidocaine toxicity : . Have client weigh themselves and report weight gain.

Antilipemics Mechanism of action ² interfere with cholesterol synthesis as well as decreasing lipoprotein & triglyceride synthesis Prototype : y cholesterol-lowering agents ² cholestyramine. atorvastatin (Lipitor) y triglyceride-lowering agents ² gemfibrozil. lovastatin. clofibrate y . colestipol.

. y .encourage increase fluid and fiber intake. flatulence. cholelithiasis y .Antilipemics Nursing considerations : y .monitor liver functions while using statins.prevent constipation.

lisinopril y Adverse effects ² it cause hyperkalemia. induce chronic cough y . enalapril (Vasotec).ACE Inhibitors Mechanism of action ² prevent peripheral vasoconstriction by blocking conversion of angiotensin I to angiotensin II decreasing peripheral resistance y Prototype ² captopril (Capoten). quinapril.

avoid using K+ sparing diuretics.not to discontinue medications because it can cause rebound hypertension. y . .ACE Inhibitors Nursing considerations : y .

arrhythmia y . it also promotes vasodilatation of the coronary and peripheral vessels y Indications ² hypertension. thus decreasing the need for O2.CalciumCalcium-Channel Blockers Mechanism of action ² decrease cardiac contractility and the workload of the heart. angina.

Amlodipine (norvasc). Felodipine (Plendil). constipation y . headache. adalat).CalciumCalcium-Channel Blockers Prototype ² Nifedipine (calcibloc. Verapramil (Isoptin) y Adverse Effects ² bradycardia. hypotension. reflex tachycardia.

withhold if pulse is below 60 bpm. .Take client·s pulse rate before each dose.Refer for signs of congestive heart failure.CalciumCalcium-Channel Blockers Nursing considerations : y . y . y .Administer between meals to enhance absorption.

Spironolactone (Aldactone) y .Mannitol y .hyperkalemia y . along with it is H2O y .excrete Na and water but it reabsorb K y . & HCO3 secretion.Diuretics CARBONIC ANHYDRASE INHIBITORS y .blocks Na and K reabsorption.Acetazolimide (Diamox) y .hypocalcemia POTASSIUM SPARING DIURETICS y .hypotension THIAZIDE DIURETICS y . and Ca reabsorption y .hypercalcemia LOOP DIURETICS y .metabolic acidosis OSMOTIC DIURETIC y .increase Na+.Furosemide (Lasix) y . K+.hydrochlorothiazide .blocks Na. reabsorb Ca y .Increase osmotic pressure of the glomerular filtrate. y . K.

Antitussives.Respiratory Bronchodilators y Glucocorticoids y Mast Cell Stabilizers y Antihistamines (H1) y Anti-TB y Decongestants. & Expectorants y .

Bronchodilators 2 Types: 1. terbutaline 2. theophylline . salbutamol. Xanthines ² aminophylline. isoproterenol. Symphatomimetic ² albuterol. salmeterol.

asthma.xanthine bronchodilators ² stimulate CNS for respiration Indications ² bronchospasm.Bronchodilators Mechanism of actions: y . COPD . bronchitis.sympathomimetic (b-receptor agonist) bronchodilators ² dilate airways y .

Bronchodilators
Adverse effects ² palpitations and tachycardia, restlessness, nervousness, tremors, anorexia, nausea and vomiting, headache, dizziness Nursing considerations : y - Contraindicated hyperthyroidism, cardiac dysrhythmia, or uncontrolled seizure disorder y - Should be used with caution in patient with HPN and narrow-angle glaucoma
y

Glucocorticoids
Mechanism of action ² act as antiinflammatory agents and reduce edema of the airways, as well as pulmonary edema y Prototype ² dexamethasone, budesonide, fluticasone, prednisone, beclomethasone y Adverse effects ² Cushing·s syndrome, neutropenia, osteoporosis
y

Glucocorticoids
Nursing considerations : y - Take drugs at meal time or with food. y - Eat foods high in potassium, low in sodium. y - Instruct client to avoid individuals with RTI. y - Instruct client not to stop medication abruptly, it should be tapered to prevent adrenal insufficiency y - Avoid taking NSAID while taking steroids. y - Take inhaled bronchodilators first before taking inhaled steroids, and rinse mouth after using.

y .Administer oral capsule at least 30 mins before meals for better absorption.Assess for lactose-intolerance y .Drink a few sips of water before & after inhalation to prevent cough & unpleasant taste y .Mast Cell Stabilizers Mechanism of action ² stabilize mast cells that release histamine triggering asthmatic attacks y Prototype ² cromolyn sodium (Intal) Nursing Consideration: y . y .Should be given before asthmatic attacks.

H1 Blockers Mechanism of action ² decrease nasopharyngeal secretions and decrease nasal itching by blocking histamine in H1receptor y Indications ² common colds. urticaria. rhinitis. nausea and vomiting. allergies and as sleep aid y .

Astemizole (Hismanal). y .Precautions in handling machine and driving while taking these drugs. Loratidine (Claritin).Ice chips or candy for dry mouth y . Diphenhydramine (Benadryl). y . Celestamine (Tavist) Nursing Considerations : y .Administer with food and drink. Cetirizine (Iterax). y .H1 Blockers Prototype .Given IM via Z-track method or orally. Brompheniramine (Dimetapp).

AntiAnti-TB First Line: y Rifampicin y Isoniazid y Pyrazinamide y Ethambutol y Streptomycin y Second Line: y Cycloserine y Kanamycin y Ethonamide y Para-aminosalicylic Acid y .

y .multidrug-resistant strain (MDR-TB) are medicated for 1 year up to 2 years y .AntiAnti-TB .given before meals y .active tuberculosis are treated with drug combination for 6-9 mos.

Rifampicin
- given on an empty stomach with 8 0z. of water, 1 hour before or 2 hours after meals and avoid taking antacids with medications. y - hepatotoxic thus avoid alcohol. y - instruct the client that urine, feces, sweat, and tears will be redorange in color.
y

Isoniazid
y y y

y y

- should be given 1 hr before or 2 hrs after meals because food may delay absorption. - should be given at least 1 hr before antacids. - instruct to notify physician for signs of hepatoxicity (jaundice), and neurotoxicity, numbness of extremities. - administer with Vitamin B6 to counteract the neurotoxic side effects. - avoid alcohol.

Pyrazinamide
- given for 2 months. y - increase serum uric acid and cause photosensitivity.
y

contraindicated in children under 13 years old. y .obtain a baseline visual acuity because it can cause optic neuritis.Ethambutol .Instruct the client to notify the physician immediately if any visual problems occurs. y . y .

Streptomycin .aminoglycoside antibiotic given IM. y . y .nephrotoxic and ototoxic. y .obtain baseline audiometric test and repeat every 1-2 months because the medications impairs the CN VIII.

Decongestants 2. Expectorants .Cough & Cold Remedies 3 Types: 1. Antitussives 3.

usually by constricting arterioles & reducing blood flow to the area y Prototype ² phenylephrine y .Decongestants Mechanism of action ² acts through sympathomimetic action.

Antitussives Mechanism of action ² suppresses the cough center in the medulla y Prototype ² dextromethorpan y .

thus liquefying secretions and allowing for easier expectoration during a cough y Prototype ² guaifenesin (Robitussin) y .Expectorant Mechanism of action ² facilitate the secretion of fluid in the respiratory tract.

Gastrointestinal Antacids y H2 Blockers y Proton-Pump Inhibitors y Mucosal Barriers y Anti-diarrheals y Laxatives y Emetics y Antiemetics y .

magnesium hydroxide (Milk of Magnesia) y . calcium carbonate (Tums). sodium bicarbonate (Alka-Seltzer).Antacids Mechanism of action ² neutralize the stomach acidity y Prototype ² aluminum/magnesium compounds (Maalox).

constipation (aluminum) . electrolyte imbalance.Antacids y Adverse effects .metabolic alkalosis. diarrhea (magnesium). stone formation.

Monitor for changes of bowel patterns. y . y .Give 1 hr after meals.Antacids Nursing considerations : y . y .Avoid giving medications within 1-2 hrs of antacid administration (decreases absorption). .Take fluids to flush after intake of antacid suspensions.

famotidine (Pepcid). nizatidine (Axid) y .H2 Blockers Mechanism of action . ranitidine (Zantac). reducing acid secretions y Prototype ² cimetidine (Tagamet).blocks H2 receptors in the stomach.

Gynecomastia may develop with chronic use of cimetidine .Avoid giving other drugs with cimetidine y .H2 Blockers Nursing considerations : y .Given before or with meals y .

y . Lansoprazole (Lanz).to form hydrochloric acid y Prototype ² omeprazole (Losec). pantoprazole (Pantoloc) Nursing considerations : y .ProtonProton-Pump Inhibitors Mechanism of action ² inhibit the proton H+ to combine with Cl.Given before meals preferably at morning.

Sucralfate cause constipation. y .Misoprostol is contraindicated for pregnants.Given before meals. y . misoprostol (Cytotec) Nursing consideration : y .Mucosal Barriers Mechanism of action . y .sucralfate (Carafate).coats the mucosa to prevent ulcerations y Prototype .

kaolin/pectin mixture (Kaopectate) y .AntiAnti-diarrheals Mechanism of action ² decreases stomach motility and peristalsis y Prototype ² diphenoxylate (Lomotil). loperamide (Imodium).

y . white or pale stool is common with kaopectate. y .Monitor for rebound constipation.Monitor atropine toxicity with diphenoxylate. y .Be cautious taking if with infectious diarrhea.Clay. .AntiAnti-diarrheals Nursing considerations : y .

Laxatives a. ducosate (Dialose) x .irritates intestinal mucosa and stimulate intestinal smooth muscles d. lactulose (Cephulac).increase fecal bulk and water content mineral oil x . e.retain fluid and distend intestine b. bulk-forming laxative (Metamucil) x . c.emulsify fecal fat and water bisacodyl (Dulcolax) & senna (X-prep) x . Na biphosphate (Fleet enema) & magnesium salt (Milk of Magnesia) x .lubricates & prevent colon absorption .

ipecac syrup.Emetics Mechanism of action ² induce vomiting through stimulation of vomiting center of medulla y Indications ² ingestion of poisonous or toxic substances y Prototype . apomorphine y .

Consult poison control center before induction of vomiting. y . .Emetics Nursing considerations : y .Administer ipecac syrup with large amount of fluid.

Antiemetics Mechanism of action ² inhibit the vomiting reflex y Prototype ² metoclopramide (Plasil) y .

Endocrine Thyroid Agents y Parathyroid Agents y Oral Hypoglycemic Agents y Insulin y Estrogen/Progesterone y .

Synthroid (levothyroxine).Thyroid Agents Mechanism of action ² function as natural or synthetic hormones y Prototype ² Proloid (thryroglobulin ). Cytomel ( liothyronine) y .

. y . y .Caution with coronary artery disease.Monitor for signs of hyperthyroidism and refer for decreasing the dose.Taken in the morning.Thyroid Agents Nursing considerations : y .

calcitrol (Rocaltrol).Remain sitting upright after taking etidronate y . promotes calcium absorption y Prototype ² calcitonin (Calcimar). y . etidronate (Didronel). calcifediol (Calcedrol) Nursing considerations : y .Parathyroid Agents Mechanism of action ² reduce bone resorption.Report for bone pains.Monitor signs of calcium imbalance y .

Oral Hypoglycemics Sulfonylureas y Biguanides y Alpha-glucosidase Inhibitors y Thiazolinidine y Meglitinidines y .

Glymepiride y .Sulfonylureas . First Generation : y Chlorpropamide (Diabenese) ² disulfiram precautions y Tolbutamide (Orinase) ² congenital defect Second Generation : y Glypizide.stimulate insulin secretions and increase tissue sensitivity to insulin.

facilitates insulin action on the peripheral receptor site.Biguanides y . Metformin and Glucophage (Glucovance) ² side effect is lactic acidosis .

delay carbohydrate absorption in the intestinal system. Acarbose (Precose) ² side effect is diarrhea .AlphaAlpha-glucosidase Inhibitors y .

increase tissue sensitivity of insulin. Rosiglitazone (Avandia) .Thiazolinidine y .

Repaglinide (Prandin) .stimulate insulin release in pancreatic Bcells.Meglitinidines y .

semilente) Intermediateacting (NPH. 30%. Lente) Long-acting (ultralente) Mixed (reg.Insulin Insulin Immediate-acting (lispro) Short-acting (regular. NPH 70%) Onset ¼-½ ½-1 Peak ½-1 2²4 Duration 3 6²8 1²2 6 ² 12 18 ² 24 2²4 ½ 10 ² 30 4²8 24 ² 36 25 .

y . 2-3 teaspoon or honey d.Pinch skin.Alcohol is recommended for cleansing bottle but not with skin.Aspirate short acting first.Roll the bottle in palm of hands. y .Rotate the injection site an inch a part. 4-6 ounce of fruit juice or regular soda c.Used bottles stored in room temperature. y . avoid I. 3-4 commercially prepared glucose tablet b. unused bottle stored in refrigerator. D50-50 IV. y .Insulin Nursing considerations : y . y . y .Monitor for acute hypoglycemia : a. Glucagon 1 gm SQ or IM e.M. y . .Inject amount of air that is equal to each dose into the bottle ² short acting last (clear). needle-up. y . y .Prefilled syringes are stored vertically. y .May increase dose during illnesses. don·t shake. don·t aspirate. then long or intermediate (cloudy).Usually given before meals.

Estrogens & Progesterones Prototype ² conjugated estrogen (Premarin). migraine.altered menstrual flow. contraceptions. diethylstilbestrol (DES) y Indications ² prostate cancer. gallbladder disease. estrogen replacement Adverse effects : estrogen . estrone (Bestrone).endometrial CA. risk of thrombo embolism y . HPN. estradiol (Estrace). breast tenderness progesterone .

. Teach patient how to perform BSE. Mix estrogen or progestins prior to IM administration by rolling vials between palms. Monitor blood pressure. 4. 2. 3. Regular follow-up examination is required to detect associated risk of acquiring CA.Estrogens & Progesterones Nursing considerations : 1.

Gynecologic Uterine Stimulating Agents y Uterine Inhibiting Agents y Lactation Suppressants y .

palpitations y . carbopost (Prostin).allergic reactions (Prostaglandins) y .hypertension (ergonovine). ripening of cervix y Prototype ² Oxytocin (Pitocin). dinoprostone (Prostin E2) Adverse reactions : y . y . ergonovine (Ergotrate).fetal bradycardia (oxytocin).Uterine Stimulating Agents Mechanism of action ² stimulates uterine smooth muscles. methylergonovine (methergine).

vomiting and tachycardia y .adrenergic receptors y Prototype ² ritodrine (Yutopar). nausea.Uterine Inhibiting Agents (Tocolytics) Tocolytics) Mechanism of action ² relaxes the uterus by stimulating the B2. terbutaline (Brethine) y Adverse effects ² tremors.

Lactation Suppressants Mechanism of action ² decrease serum prolactin levels y Prototype ² bromocriptine (Parlodel) y Adverse effects ² drowsiness. nausea. palpitations y . headache.

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