9.

For postpartum women, advice to take drugs

PHARMACOLOGY after breastfeeding.
Administration of Drugs :
Pharmacology
- most simply defined as study of drug. Routes and Nursing considerations:
1. Enteral – oral, sublingual, rectal, gastric tubes
Fundamentals of Pharmacology - capsulated pill, sustained release and enteric
1. Pharmacokinetics coated should not be crushed.
- study of drug’s changes as it enters and 2. Parenteral – IV, IM, SQ, ID, IT, IA, epidural.
passes through the body. - vastus lateralis (safest site for IM)
a. absorption 3. Topical – skin, inhalants, mucus membrane.
b. distribution
c. biotransformation Eye medications :
d. excretion - administer eyedrops first then ointment.
- use a separate bottle for each client.
2. Pharmacodynamics - instruct the client to tilt the head backward,
- mechanism by which drugs produce changes open eyes and look up.
in body tissue. - avoid contact of medication bottle to the
a. desired effect - intended action of eyeball.
drugs - place prescribed dose in the lower conjunctival
b. adverse effect - harmful sac.
unintended reactions - instruct the client to press the inner canthus
c. side effects – consequence for 30-60 seconds.
reactions - instruct the client to close the eye gently.
d. toxicity – the degree which
something is poisonous Ear drops
digoxin = 0.5 – 2.0 ng/mL - in infant and children younger than 3 y.o, pull
lithium = 0.5 – 1.5 mEq/L pinna downward and backward.
- in older children and adult, upward and
Safety and Efficacy backward.
Nursing Principles : - direct the solution on the wall of the ear canal,
1. Always verify the Five Rights . not directly on the ear drum.
a. the right medications
b. the right client CLASSIFICATIONS OF DRUGS
c. the right dosage
d. the right form, route and technique DRUGS AFFECTING THE CENTRAL AND
e. the right time AUTONOMIC SYSTEM
2. Chart drug administration only after its been
given, never before. Cholinergic Agents (Parasympathomemitics)
3. Never leave the medication on cart or tray Prototype :
unattended. - synthetic acetylcholine, pilocarpine,
4. Chart observed therapeutic and adverse carbachol, bethanecol (Urocholine),
effects accurately and fully. edrophonium (Tensilon), neostigmine
5. Check history for allergies and potential drug (Prostigmine), pyridostigmine (Mestinon).
interactions before administering a Mechanism of action :
newly ordered drug. - stimulates cholinergic receptors by mimicking
6. Inform the prescribing physician of any acetylcholine or inhibition of
observed adverse effects; if cannot be enzyme cholinesterase.
located, inform the nursing supervisor Indications :
7. Question drug orders that are unclear, that - glaucoma, urine retention, Myasthenia Gravis
appear to contain errors, or that have - antidote to neuromuscular blocking agents :
potential to harm. tricyclic antidepressants and atropine
8. Take the following actions if an error occurs : Adverse effects :
a. immediately notify the nursing supervisor, - blurring of vision, miosis
the prescribing physician, and the - increase in salivation, intestinal cramps
pharmacist. - bronchoconstriction, wheezing, DOB
b. assess the client’s condition and provide any - hypotension and bradycardia
necessary care.
Nursing considerations :
1. Warn & monitor clients of the side effects.
2. Have atropine available for use as antidote.
Cholinergic Blocking Agents
(Parasympatholytics, Anticholinergics)
Prototype :
- atropine, scopalamine (Triptone),
dicyclomine (Bentyl),
propantheline (Pro-Banthine).
Mechanism of actions :
- block the binding of acetylcholine in the
receptors of parasympathetic nerves.
Indications :
- use preoperatively to dry up secretions.
- treat spasticity of GI or urinary tract.
- use for treatment of bradycardia, asthma,
parkinsonism.
- use for antidote in organophosphate
poisoning.
Adverse effects :
- dry mouth , dilatation of pupils, tachycardia
- urinary retention, ileus, heat stroke
Nursing considerations :
1. Keep client’s in cool environment.
2. Watch out for signs of heatstroke and
dehydration.
3. Encourage clients to increase fluid intake and
use of sugarless gum/candy for dry
mouth.
4. For GI spasticity, administer 30 minutes
before meals and at bed time.
Adrenergic Agents (Sympathomimetics)
Prototype :
- epinephrine, norepinephrine, ephedrine,
dopamine, dobutamine, phenylephrine,
terbutaline, albuterol, isoproterenol.
Mechanism of actions :
- stimulate alpha and beta adrenergic receptor
directly or trigger the release of
catecholamines indirectly causing sympathetic
effects.
Indications :
- cardiopulmonary arrest, hypotension
- COPD and asthma, nasal congestions
- allergic reaction, anaphylactic shock
Adverse effects :
- restlessness, insomnia, tremors, nausea
- palpitations, angina, tachycardia, HPN
Nursing considerations :
1. Contraindicated in clients w/ hyperthyroidism,
pheochromocytoma & cardiovascular disease.
2. Monitor vital signs and advice precautions.
3. Should be taken with food.
ADRENERGIC BLOCKING AGENTS
Prototype :
a. Alpha blockers
- phentolamine (Regintine), phenoxybenzamine,
prazosin (Minipress),
reserpine (Serpasil), terazosin (Hytrin)
- clonidine (Catapress), methyldopa (Aldomet)
b. Beta blockers
- atenolol (Tenormin), esmolol (Brevibloc),
metoprolol (Lopressor), nadolol (Corgard),
propanolol (Inderal), timolol ( Blocadren)
Mechanism of actions :
a. alpha blockers
- inhibits action of a-receptors in vascular
smooth muscle to cause vasodilatation.
b. beta blockers
- compete with epinephrine in b-receptors in
heart, pulmonary airways, peripheral
circulation and CNS.
Indications :
- Raynaud’s disease, hypertension,
pheochromocytoma.
- angina, arrhythmias, mitral valve prolapse,
glaucoma
Adverse effects :
- orthostatic hypotension, bradycardia, CHF
- depression, insomnia and vertigo
- bronchospasm and dyspnea, nasal stuffiness,
cold extremities
Nursing considerations :
1. Administer oral alpha-blockers with milk to
minimize GI side effects.
2. Administer oral beta-blockers before meals
and at a.m. if insomnia occurs.
3. Check client’s apical pulse rate before drug
administration, refer if below 60 bpm.
4. Hypotensive precautions.
5. Warn clients not to drive or operate
dangerous machinery until he/she has
adjusted to medications.
SKELETAL MUSCLE RELAXANTS AGENTS
Prototype :
- methacarbamol (Robaxin), baclofen
(Lioresal), dantrolene (Dantrium),
metaxalone (Skelaxin), orphanedrine
(Norgesic), chlorzoxazone
Mechanism of actions:
- depress CNS
- inhibit calcium ion release in the muscle
- enhance the inhibitory action of GABA
(gamma-amino butyric acid)
Indications :
- for acute musculoskeletal pain
- for muscle spasticity associated with multiple
sclerosis, cerebral palsy, CVA, and
spinal cord injury.
Adverse effects :
- hypotonia, ataxia, hypotension, drowsiness
 - blurred vision, bradycardia, depression, urine
retention
Nursing considerations :
1. Caution clients that mental alertness may be
impaired.
2. Monitor neuromuscular status, bowel and
bladder functions.
3. Inform clients that maximum benefit of
baclofen is attained for 1-2 months.
4. Reduce baclofen dosage gradually because of
associated withdrawal symptoms :
Confusion, hallucinations, paranoia & rebound
spasticity.
ANTICONVULSANTS
Prototype :
a. Hydantoins - phenytoin (Dilantin)
b. Barbiturates - phenobarbital ( Luminal)
c. Miscellaneous
- carbamazepine (Tegretol), diazepam,
clorazepate (Tranxene),
valproic acid (Dapakene), ethosuximide
(Zarontin).
Mechanism of action :
- treat seizures by depressing abnormal
neuronal activity in motor cortex.
Adverse effects :
- sedation & drowsiness, gingival hyperplasia
- diplopia, nystagmus, vertigo, dizziness
- thrombocytopenia, aplastic anemia
Nursing considerations :
1. Advise female clients to use contraceptives.
2. Inform clients taking phenytoin that harmless
urine discoloration is common.
3. 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. Teach clients receiving carbamazepine to
identify symptoms of bone marrow
depressions.
5. Reassure that barbiturates are not addictive at
a low dosage.
6. Avoid taking alcohol with barbiturates.
7. Administer IV phenytoin slowly to avoid
cardiotoxicity.
8. Avoid mixing other drugs in same syringe with
phenytoin.
ANTIPARKINSONIAN AGENTS
Prototype :
a. Anticholinergic agents
- trihexyphenidyl (Artane), benztropine
(Congentin)
b. Dopaminergic agents
- Levodopa, carbidopa-levodopa (Sinemet),
amantidine (Symmetrel),
pergolide (Permax), selegiline (Eldepryl),
bromocriptine.
Mechanism of actions :
a. anticholinergic agents
- inhibit cerebral motor centers.
b. dopaminergic agents
- increasing dopamine concentrations or
enhancing neurotransmitter functioning.
Adverse effects of dopaminergic agents:
a. levodopa – nausea, vomiting, anorexia,
orthostatic hypotension,
dark-colored urine and sweat
b. amantidine – ankle edema, constipation
c. bromocriptine – palpitations, tachycardia
Nursing considerations :
1. Give dopaminergic agents after meals to
reduce GI symptoms.
2. Reassure client that levodopa may cause
harmless darkening of urine and sweat.
3. Avoid taking Vit B6 (pyridoxine) with levodopa
because it speed up metabolism.
4. Educate clients to minimize orthostatic
hypotension.
5. Elevate leg to reduce ankle edema.
CENTRAL NERVOUS SYSTEM STIMULANTS
Prototype :
- amphetamines, methylphenidate (Ritalin)
Mechanism of actions :
- increase excitatory CNS neurotransmitter
activity and blocks inhibitory impulses.
Indications :
- for obesity (amphetamines)
- attention deficit hyperactivity disorders
- narcolepsy
- drug-induced respiratory depressions.
Adverse effects :
- nervousness, insomnia, restlessness
- hypertension, tachycardia, headache
- anorexia, dry mouth.
Nursing considerations :
1. Should be given at morning.
2. Don’t stop amphetamine abruptly to avoid
withdrawal symptoms.
3. Monitor blood pressure and pulse.
4. Ice chips or sugarless gum for dry mouth.
5. Watch out for growth retardation in children
taking methylphenidate.
 DRUGS AFFECTING MENTAL FUNCTIONING
Sedatives, Hypnotics, and Anxiolytics
Prototype :
a. Benzodiazepines
- diazepam (Valium), lorazipam (Ativan),
alprazolam (Xanax), flurazepam (Dalmane)
b. Barbiturates
- amobarbital, phenobarbital, secobarbital
c. Miscellaneous
- chloral hydrate (Noctec), buspirone
(Buspar), paraldehyde (Paral)
Mechanism of actions :
a. Benzodiazepines
- increase the effect of inhibitory neuro
transmitter GABA
(gamma-amino butyric acid)
b. Barbiturates and Miscellaneous agents
- depress CNS
Indications :
- induce sleep, sedate and calm clients
Adverse effects :
- hangover-effect, dizziness, CNS depression
- respiratory depression, drug-dependence
Nursing considerations :
1. Warn clients of injuries and falls.
2. Brief period of confusion and excitement upon
waking up is common with
benzodiazepines.
3. Warn clients not to discontinue medications
abruptly without consulting a physician.
4. Avoid alcohol while taking these drugs.
6. Rotate and don’t shake the ampules of
barbiturates. Don’t mix with other drugs.
7. Warn female clients that diazepam is
associated with cleft lip.
ANTIDEPRESSANTS AND MOOD DISORDER
DRUGS
Prototype :
a. Tricyclic antidepressants
- amitriptyline (Elavil), protriptyline (Vivactil),
- imipramine (Tofranil), desipramine
b. MAO (monoamine oxidase inhibitors )
- isocarboxazid (Marplan), phenelzine (Nardil),
tranylcypromine (Pernate)
c. Second-generation antidepressants
- fluoxetine (Prozac), trazodone (Desyrel)
d. Lithium
Mechanism of actions :
a. Tricyclic antidepressants
- increase receptor sensitivity to serotonin
and/or norepinephrine.
b. MAO inhibitors
- inhibit the enzyme MAO that metabolize the
neurotransmitters norepinephrine and
serotonin.
c. Second – generation antidepressants
- inhibits the reuptake of serotonin.
d. Lithium
- increase serotonin & norepinephrine uptake
Adverse effects :
- dry mouth, blurred vision, urine retention,
constipation (anticholinergic effects)
- orthostatic hypotension, insomnia
- hypertensive crisis (MAO)
- dehydration (Lithium).
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.
- 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
- > 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).
ANTIPSYCHOTIC DRUGS (NEUROLEPTICS)
Prototype :
a. Phenothiazines
- chlorpromazine (Thorazine),
- trifluoperazine (Stelazine),
- thioridazine (Mellaril)
b. Other Agents
- clozapine (Clozaril), haloperidol (Haldol)
Mechanism of action :
- block dopamine receptor in the limbic
system, hypothalamus, and
other regions of the brain.
Adverse effects :
- Extra pyramidal symptoms such as
dystonia, pseudoparkinsonism, and
an irreversible tardive dyskinesia as
manifested by :
a. lip smacking
b. fine wormlike tongue movement
 c. involuntary movements of arms and leg.
- Neuroleptic malignant syndrome
a. fever, tachycardia, tachypnea,
diaphoresis, cardiovascular collapse
b. muscle rigidity, seizures.
- orthostatic hypotension
Nursing considerations :
1. Teach family members the signs of EPS and
NMS, and report to physician
immediately.
2. Normalization of symptoms may not occur for
several weeks after beginning of
therapy .
3. Avoid administering haloperidol intravenously
4. Watch out of neutropenia with clozapine.
5. Watch out for orthostatic hypotension and
photosensitivity with phenothiazine.
6. Be sure that oral doses are swallowed, and
not hoarded.
DRUGS USED IN PAIN MANAGEMENT
General Anesthetics
Prototype :
a. Inhalation anesthetics
- enflurane (Ethrane), halothane
- isoflurane (Forane), nitrous oxide
b. Injection anesthetics
- fentanyl (Sublimaze), ketamine (Ketalar),
thiopental Na (Penthotal), etomidate
(Amidate)
Mechanism of actions :
- cause CNS depression, by producing loss of
consciousness, unresponsiveness to pain
stimuli, and muscle relaxation.
Nursing considerations :
1. Instruct client NPO for 8 hours before
administration.
2. Monitor cardio pulmonary depression and
hypotension.
3. Monitor urinary retention.
4. Monitor body temperature
- malignant hyperthermic crisis :
dantrolene (antidote)
5. Avoid alcohol or CNS depressants for 24 hours
after anesthesia.
6. In patient who received halothane, monitor
signs of hepatic fatal side effects :
- rash, fever, nausea, vomiting
- jaundice and altered liver function.
LOCAL AND TOPICAL ANESTHETIC
Prototype :
local : bupivacaine, lidocaine, tetracaine,
procaine, mepivacaine, prilocaine
topical : benzocaine, butacaine,
dibucaine,lignocaine
Mechanism of action :
- block transmission of impulses across nerve
cell membrane.
Adverse effects :
- cardiac dysrhythmias
Nursing considerations :
- lignocaine + prilocaine (EMLA cream) should be
applied topically 60 minutes before
procedure.
- administer cautiously to the areas of large
broken skin.
- observe for fetal bradycardia in pregnant
clients.
ANALGESICS
Prototype :
a. Narcotic analgesics
- codeine, meperidine (Demerol) morphine,
butorphanol (Stadol)
nalbuphine (Nubain)
b. Non – narcotic analgesic
NSAIDs – aspirin (aminosalicylic acid),
mefenamic acid (Ponstan),
ibuprofen (Motrin), naproxen,
ketoprofen (Orudis), ketorolac.
paracetamol and acetaminophen (Tylenol)
Mechanism of actions :
a. Narcotic analgesics
- alter pain perception by binding to opiod
receptors in CNS.
b. Non- narcotic analgesic
- relieves pain and fever by inhibiting the
prostaglandin pathway.
Nursing considerations :
1. Monitor respiratory depression & hypotension
in clients taking narcotic analgesic.
2. Injury and accident precautions in clients
taking narcotic analgesic.
3. Warn clients about possibility of
dependency,and do not discontinue narcotics
abruptly in the narcotic-dependent clients.
4. Naloxone is antidote for narcotic overdose.
5. Advice clients to take NSAIDs with food and
monitor bleeding complications.
6. Aspirin is contraindicated in clients below 18
years old with flu-like symptoms.
7. Monitor hearing loss in clients taking aspirin.
8. Monitor liver function in clients taking
acetaminophen.
9. N-acetylcysteine is antidote for paracetamol
overdose.
DRUGS AFFECTING THE CARDIOVASCULAR Indications :
SYSTEM - used in the prophylaxis of long-term
complication following M.I, coronary
ANTICOAGULANTS revascularization, and thrombotic CVA.
Prototype : Nursing considerations :
- Heparin (SQ and IV) - Monitor bleeding time ( NV = 1-9 mins)
Warfarin (Orally) - Take the medication with food.
Mechanism of actions :
a. Heparin CARDIAC GLYCOSIDES
- prevents thrombin from converting Prototype:
fibrinogen to fibrin. - digoxin (Lanoxin) and digitoxin (Crystodigin)
b. Warfarin Mechanism of actions :
- suppress coagulation by acting as an - increase intracellular calcium, which causes
antagonist of vitamin K after 4-5 days. the heart muscle fibers to contract more
efficiently, producing positive inotropic &
Indications : negative chronotropic action.
- thrombosis, pulmonary embolism, myocardial Indications :
infarction - use for CHF, atrial tachycardia and fibrillation
Adverse effect : Nursing considerations :
- bleeding - Monitor for toxicity as evidence by :
Nursing considerations : nausea, vomiting, anorexia, halo vision,
1. HEPARIN sodium confusion, bradycardia and heart blocks .
- if given SQ don’t aspirate or rub the injection - Do not administer if pulse is less than 60 bpm.
site (above the scapula - best site). - Should be caution in patient with
- therapeutic level 1.5-2.5 times normal PTT; hypothyroidism and hypokalemia.
normal PTT is 20-35 sec. = 50-85 sec. - Antidote : Digi-bind
- antidote : (protamine sulfate) - Phenytoin is the drug of choice to manage
digitalis-induced arrhythmia.
2. WARFARIN sodium (coumadin) Nitrates
- warfarin is used for long-term . Prototype :
- onset of action is 4-5 days. - isosorbide dinitrate (Isordil)
- therapeutic level is 1.5-2.5 times normal PT; - nitroglycerine (Deponit, Nitrostat)
normal PT = 9.6 -11.8 sec. = 25 - 30 sec. Mechanism of action :
INR = 2 - 3 - produce vasodilatation including coronary
- should be taken at the same time of the day artery.
to maintain at therapeutic level. Indications :
- reduce intake of green leafy vegetables. - angina pectoris, MI, peripheral arterial
- antidote : Vitamin K ( Aquamephyton) occlusive disease.
Adverse effects:
THROMBOLYTICS - headache, orthostatic hypotension .
Prototype :
Streptokinase, Urokinase Nursing Considerations :
Mechanism of actions : 1. Transdermal patch
- activates plasminogen to generates plasmin - apply the patch to a hairless area using a
(enzyme that dissolve clots). new patch and different site each day.
Indications : - remove the patch after 12-24 hours, allowing
- use early in the course of MI (within 4-6 10-12 hours “patch free” each day to
hours of the onset) prevent tolerance.
Nursing considerations : 2. Sublingual medications :
- monitor bleeding - note the BP before giving the medication.
- antidote : Aminocarpic acid - offer sips of water before giving because
dryness may inhibit absorption.
Antiplatelet Medications - one tablet for pain and repeat every 5 mins.
Prototype: aspirin, Dipyridamole (Persantin) for a total of three doses; if not relieved
Clopidoigrel (Plavix), Ticlopidine after 15 mins., seek medical help.
Mechanism of action : - stinging or burning sensation indicates that
- inhibit the aggregation of platelet thereby the tablet is fresh.
prolonging bleeding time. - instruct patient not to swallow the pill
 - sustained release medications should be CALCIUM-CHANNEL BLOCKERS
swallowed and not to be crush. Prototype :
- protect the pills from light. - Nifedipine (calcibloc, adalat), Amlodipine
(norvasc), Felodipine (Plendil)
ANTI-ARRHYTHMIC DRUGS Verapramil (Isoptin)
Class I (block Na channels) Mechanism of action :
IA - quinidine, procainamide - decrease cardiac contractility and the
IB - lidocaine workload of the heart, thus decreasing the
IC - flecainamide need for O2.
Class II (Beta-blockers) - it also promote vasodilatation of the coronary
propanolol, esmolol and peripheral vessels.
Class III (block K channels) Indications :
amiodarone, bretylium - hypertension, angina, arrhythmia
Class IV (block Ca channels) Adverse effects :
verapramil, diltiazem - bradycardia, hypotension, headache
Nursing considerations : - reflex tachycardia, constipation
1. Watch out for signs of CHF. Nursing considerations :
2. Have client weigh themselves and report - Administer between meals to enhance
weight gain. absorption.
3. Watch out for signs of lidocaine toxicity : - Take client’s pulse rate before each dose,
- confusion and restlessness withhold if pulse is below 60 bpm.
- Refer for signs of congestive heart failure.
ANTILIPEMICS
Prototype : DIURETICS
a. cholesterol-lowering agents - usually given at morning
- cholestyramine, colestipol, lovastatin CARBONIC ANHYDRASE INHIBITORS
b. triglyceride-lowering agents - Acetazolimide (Diamox)
- gemfibrozil, clofibrate - increase Na+, K+, & HCO3 secretion, along
Mechanism of actions : with it is H2O
- interfere with cholesterol synthesis as well as - metabolic acidosis
decreasing lipoprotein & triglyceride synthesis. OSMOTIC DIURETIC
Nursing considerations : - Mannitol
- monitor liver functions while using statins. - Increase osmotic pressure of the glomerular
- prevent constipation, flatulence, cholelithiasis filtrate.
- encourage increase fluid and fiber intake. - hypotension
THIAZIDE DIURETICS
ANTI – HYPERTENSIVE - hydrochlorothiazide
Angiotensin-Converting Enzyme (ACE) - blocks Na and K reabsorption; reabsorb Ca
Inhibitors - hypercalcemia
Prototype : LOOP DIURETICS
captopril (Capoten), enalapril (Vasotec), - Furosemide (Lasix)
quinapril, lisinopril - blocks Na, K, and Ca reabsorption
Mechanism of actions : - hypocalcemia
- prevent peripheral vasoconstriction by POTASSIUM SPARING DIURETICS
blocking conversion of angiotensin I to - Spironolactone (Aldactone)
angiotensin II decreasing peripheral - excrete Na and water but it reabsorb K
resistance. - hyperkalemia
Adverse effect :
- it cause hyperkalemia
- induce chronic cough RESPIRATORY MEDICATIONS
Nursing considerations : Bronchodilators
- not to discontinue medications because it can Prototype :
cause rebound hypertension. Symphatomimetic Xanthines
- avoid using K+ sparing diuretics. - albuterol, salbutamol - aminophylline
- isoproterenol, salmeterol - theophylline
- terbutaline
 Mechanism of actions:
- sympathomimetic (b-receptor agonist)
bronchodilators, dilate airways.
- xanthine bronchodilators, stimulate CNS for
respiration.
Indications :
- bronchospasm, asthma, bronchitis, COPD.
Adverse effects :
- palpitations and tachycardia
- restlessness, nervousness, tremors
- anorexia, nausea and vomiting, headache,
dizziness.
Nursing considerations :
- Contraindicated hyperthyroidism, cardiac
dysrhythmia, or uncontrolled seizure
disorder.
- Should be used with caution in patient with
HPN and narrow-angle glaucoma.
ANTI-HISTAMINES (H-1 BLOCKERS)
Protoytype :
- Astemizole (Hismanal), Loratidine (Claritin),
Brompheniramine (Dimetapp),
Diphenhydramine (Benadryl),
Cetirizine (Iterax), Celestamine (Tavist).
Mechanism of action :
- decrease nasopharyngeal secretions and
decrease nasal itching by blocking histamine
in H1-receptor.
Indications :
- common colds, rhinitis, nausea and
vomiting, urticaria, allergies and as sleep aid.
Nursing Considerations :
- Administer with food and drink.
- Given IM via Z-track method or orally.
- Precautions in handling machine and driving
while taking these drugs.
- Ice chips or candy for dry mouth

GLUCOCORTICOIDS (CORTICOSTEROIDS) ANTI-TUBERCULOSIS

Prototype : Prototype :
- dexamethasone, budesonide, fluticasone, First line Second line
prednisone, beclomethasone. - Isoniazid (INH) - Cycloserine
Mechanism of actions : - Rifampicin (Rifadin) - Kanamycin
- act as anti-inflammatory agents and reduce - Ethambutol - Ethonamide
edema of the airways, as well as - Pyrazinamide - Para-aminosalicylic
pulmonary edema. acid
Adverse effects : - Streptomycin
- Cushing’s syndrome, neutropenia.
osteoporosis - active tuberculosis are treated with drug
Nursing considerations : combination for 6-9 mos.
- Take drugs at meal time or with food. - multidrug-resistant strain (MDR-TB) are
- Eat foods high in potassium, low in sodium. medicated for 1 year up to 2 years
- Instruct client to avoid individuals with RTI. - given before meals
- Instruct client not to stop medication abruptly, it
should be tapered to prevent Isoniazid
adrenal insufficiency - should be given 1 hr before or 2 hrs after
- Avoid taking NSAID while taking steroids. meals because food may delay absorption.
- Take inhaled bronchodilators first before taking - should be given at least 1 hr before antacids.
inhaled steroids, and rinse mouth - instruct to notify physician for signs of
after using. hepatoxicity (jaundice), and neurotoxicity
numbness of extremities.
MAST CELL STABILIZERS - administer with Vitamin B6 to counteract the
Prototype : cromolyn sodium (Intal) neurotoxic side effects.
Mechanism of action : - avoid alcohol.
- stabilize mast cells that release histamine
triggering asthmatic attacks. Rifampicin
Nursing Consideration: - given on an empty stomach with 8 0z. of water,
- Should be given before asthmatic attacks. 1 hour before or 2 hours after meals
- Administer oral capsule at least 30 mins before and avoid taking antacids with medications.
meals for better absorption. - hepatotoxic thus avoid alcohol.
- Drink a few sips of water before & after - instruct the client that urine, feces, sweat, and
inhalation to prevent cough & unpleasant taste tears will be red-orange in color.
- Assess for lactose-intolerance.
 Pyrazinamide
- given for 2 months.
- increase serum uric acid and cause
photosensitivity.
Ethambutol
- contraindicated in children under 13 years old.
- obtain a baseline visual acuity because it can
cause optic neuritis.
- Instruct the client to notify the physician
immediately if any visual problems occurs.
Streptomycin
- aminoglycoside antibiotic given IM.
- nephrotoxic and ototoxic.
- obtain baseline audiometric test and repeat
every 1-2 months because the
medications impairs the CN VIII.
DRUGS AFFECTING GASTROINTESTINAL
SYSTEM
Antacids
Prototype :
- aluminum/magnesium compounds (Maalox)
- sodium bicarbonate (Alka-Seltzer)
- calcium carbonate (Tums)
- magnesium hydroxide (Milk of Magnesia).
Mechanism of actions :
- neutralize the stomach acidity.
Adverse effects :
- metabolic alkalosis, stone formation
- electrolyte imbalance
- diarrhea (magnesium), constipation
(aluminum).
Nursing considerations :
- Give 1 hr after meals.
- Avoid giving medications within 1-2 hrs of
antacid administration
(decreases absorption).
- Take fluids to flush after intake of antacid
suspensions.
- Monitor for changes of bowel patterns.
HISTAMINE – 2 BLOCKERS
Prototype :
- cimetidine (Tagamet), ranitidine (Zantac),
famotidine (Pepcid), nizatidine (Axid).
Mechanism of action:
- blocks H2 receptors in the stomach, reducing
acid secretions.
Nursing considerations :
- Given before or with meals
- Avoid giving other drugs with cimetidine
- Gynecomastia may developed with chronic
use of cimetidine.
Proton – Pump Inhibitors (PPI)
Prototype :
- omeprazole (Losec), Lansoprazole (Lanz),
pantoprazole (Pantoloc).
Mechanism of action :
- inhibit the proton H+ to combine with Cl- toform
hydrochloric acid.
Nursing considerations :
- Given before meals preferably at morning.
Mucosal Barriers
Prototype :
- sucralfate (Carafate), misoprostol (Cytotec).
Mechanism of action :
- coats the mucosa to prevent ulcerations.
Nursing consideration :
- Given before meals.
- Misoprostol is contraindicated for pregnants.
- Sucralfate cause constipation.
Anti-diarrheal Agents
Prototype :
- diphenoxylate (Lomotil), loperamide (Imodium),
kaolin/pectin mixture (Kaopectate).
Mechanism of actions :
- decrease stomach motility and peristalsis.
Nursing considerations :
- Monitor for rebound constipation.
- Be cautious taking if with infectious diarrhea.
- Monitor atropine toxicity with diphenoxylate.
- Clay, white or pale stool is common with
kaopectate.
Laxatives
a. lactulose (Cephulac), Na biphosphate (Fleet
enema) & magnesium salt (Milk of Magnesia)
- retain fluid and distend intestine
b. ducosate (Dialose)
- emulsify fecal fat and water
c. bisacodyl (Dulcolax) & senna (X-prep)
- irritates intestinal mucosa and
stimulate intestinal smooth muscles
d. bulk-forming laxative (Metamucil)
- increase fecal bulk and water content
e. mineral oil
- lubricates & prevent colon absorption
EMETICS
Prototype : ipecac syrup, apomorphine
Mechanism of actions :
- induce vomiting through stimulation of
vomiting center of medulla.
Indications :
- ingestion of poisonous or toxic substances.
Nursing considerations :
- Consult poison control center before
induction of vomiting.
- Administer ipecac syrup with large amount of
fluid.
 - Contraindicated to pregnant & breastfeeding.
DRUGS AFFECTING THE ENDOCRINE - Given before meals.
SYSTEM - Monitor for signs of hypoglycemia.

THYROID AGENTS Insulin

Prototype : Insulin Onset Peak
- Proloid (thryroglobulin ) Duration
- Synthroid (levothyroxine)
- Cytomel ( liothyronine). Immediate-acting 0.15h 0.5–1h
Mechanism of action : 5h
- function as natural or synthetic hormones. (lispro)
Nursing considerations : Short-acting 0.5-1 h 2-4 h
- Taken in the morning. 5-7h
- Caution with coronary artery disease. (regular, semilente)
- Monitor for signs of hyperthyroidism and Intermediate-acting 1-3 h 6-12 h
refer for decreasing the dose. 18-24 h
(NPH, lente)
PARATHYROID AGENTS Long-acting 4-6h 10-30 h
Prototype : 24-36 h
a. calcitonin (Calcimar), etidronate (Didronel), (ultralente)
b. calcitrol (Rocaltrol), calcifediol (Calcedrol) Mixed 0.5 h 4-8 h
Mechanism of action : 25 h
a. reduce bone resorption (regular 30%, NPH 70%)
b. promotes calcium absorption
Nursing considerations : Nursing considerations :
- Monitor signs of calcium imbalance - Usually given before meals.
- Report for bone pains. - Roll the bottle in palm of hands, don’t shake.
- Remain sitting upright after taking etidronate. - Inject amount of air that is equal to each dose
into the bottle – short acting last (clear).
Oral Hypoglycemic Agents (OHA) - Aspirate short acting first, then long or
1. Sulfonylureas intermediate (cloudy).
- stimulate insulin secretions and increase - Alcohol is recommended for cleansing bottle
tissue sensitivity to insulin. but not with skin.
First Generation : - Pinch skin, avoid I.M, don’t aspirate.
Chlorpropamide (Diabenese) - Rotate the injection site an inch a part.
- disulfiram precautions - Prefilled syringes are stored vertically, needle-
Tolbutamide (Orinase) up.
- congenital defect - May increase dose during illnesses.
Second Generation : - Used bottles stored in room temperature,
Glypizide, Glymepiride unused bottle stored in refrigerator.
2. Biguanides - Monitor for acute hypoglycemia :
- facilitates insulin action on the peripheral a. 3-4 commercially prepared glucose tablet
receptor site. b. 4-6 ounce of fruit juice or regular soda
Metformin and Glucophage (Glucovance) c. 2-3 teaspoon or honey
- side effect is lactic acidosis d. Glucagon 1 gm SQ or IM
3. Alpha-glucosidase inhibitors e. D50-50 IV.
- delay carbohydrate absorption in the
intestinal system.
Acarbose (Precose) – side effect is diarrhea ESTROGENS AND PROGESTINS
4. Thiazolinidine Prototype :
- increase tissue sensitivity of insulin. - conjugated estrogen (Premarin), estrone
Rosiglitazone (Avandia) (Bestrone), estradiol (Estrace),
5. Meglitinides diethylstilbestrol (DES).
- stimulate insulin release in pancreatic B-cells. Indications :
Repaglinide (Prandin) - prostate cancer, contraceptions
- estrogen replacement
Nursing considerations :
- Effective only for type II DM.
 Adverse effects :
estrogen - endometrial CA, gallbladder disease,
HPN, migraine, breast tenderness
progesterone - altered menstrual flow, risk of
thrombo embolism
Nursing considerations :
1. Mix estrogen or progestins prior to IM
administration by rolling vials between palms.
2. Monitor blood pressure
3. Teach patient how to perform BSE.
4. Regular follow-up examination is required to
detect associated risk of acquiring CA
DRUGS AFFECTING LABOR and LACTATION
Uterine Stimulating Agents
Protoytpe :
a. Oxytocin (Pitocin), ergonovine (Ergotrate),
methylergonovine (methergine)
b. carbopost (Prostin), dinoprostone (Prostin E2)
Mechanism of actions :
a. stimulates uterine smooth muscles
b. ripening of cervix
Adverse reactions :
- fetal bradycardia (oxytocin),
- hypertension (ergonovine), palpitations
- allergic reactions (Prostaglandins)
Uterine Inhibiting Agents (Tocolytic)
Prototype :
- ritodrine (Yutopar), terbutaline (Brethine)
Mechanism of actions :
- relaxes the uterus by stimulating the B2-
adrenergic receptors
Adverse effects :
- tremors, nausea, vomiting and tachycardia
Lactation Suppressants
Prototype :
- bromocriptine (Parlodel)
Mechanism of action :
- decrease serum prolactin levels
Adverse effects :
- drowsiness, headache, nausea, palpitations
DRUGS FOR TREATING INFECTION
Antibacterial Agents
1. Cell wall inhibitors
a. penicillins - pen G, amoxicillin, cloxacillin
b. cephalosphorins - cephalexin, cefaclor
c. glycopeptide - vancomycin
2. Protein synthesis inhibitors
a. aminoglycosides - amikacin, gentamycin
b. macrolide - erythromycins, roxithromycin
c. lincosamides - clindamycins
d. chloramphenicol, tetracyclines
3. Antimetabolites - blocks folic acid synthesis
a. Sulfonamides - cotrimoxazole
4. DNA synthesis inhibitors
a. quinolones - ciprofloxacin, ofloxacin
b. metronidazole
Adverse effects :
1. Aminoglycoside - nephrotoxicity & ototoxicity
2. Sulfonamides - Steven-Johnson’s syndrome,
photosynsetivity
3. Quinolones - insomnia
4. Tetracyclines - bone problems
5. Chloramphenicol - Gray syndrome, bone
marrow depression
6. Erythromycin - hepatitis
Nursing considerations :
1. Collect appropriate specimen for C & S before
starting antibiotics.
2. Check client’s history of allergies.
3. Avoid administering erythromycin and
quinolones with food.
4. Pregnant precautions.
5. Report for diarrhea - pseudomembranous
colitis (clindamycin)
6. Monitor adverse effects.
Antiviral Agents
Prototype :
- acyclovir (Zovirax), ganciclovir (Cytovene),
vidarabine (Vira-A), amantidine (Symmetrel),
ribavirin (Virazole), zidovidine (Retrovir).
Mechanism of actions :
- inhibits virus specific enzymes involve in DNA
synthesis. They only control the growth of
virus but it does not cure.
Adverse effects :
- granulocytopenia, thrombocytopenia, nausea,
nervousness, headache, nephrotoxicity.
Nursing consideration :
- Pregnant and breastfeeding precautions.
- Administer IV antivirals to avoid crystallization
in renal tubules.
- Give ribavirin only with aerosol generator.
- Monitor CBC and creatinine level.
- Refer for signs of bleeding.
- Take amantidine after meals.
Antifungal Agents
Prototype :
- amphotericin B (Fungisone), nystatin,
fluconazole (Diflucan), ketoconazole (Nizoral).
Mechanism of actions :
- inhibit the synthesis of fungal sterol.
Adverse effects :
- nephrotoxicity and neurotoxicity
- bone marrow depression
- chills, fever, joint pains, abdominal pain and
headache.
Nursing considerations :
- Dilute amphotericin B with sterile water solution
not with electrolyte solution.
- Tell clients that fever, chills, GI upset, joint and
muscle pain will subside as
amphotericin B continues.
- With oral candidiasis, let nystatin tablet dissolve
in mouth rather than swallowing it.
- Refrain ketoconazole with antacids.
- Report for signs of bleeding, infection &
fatigue.
ANTIPARASITIC AGENTS
Prototype :
a. Antimalarial
- chlroquine, mefloquine, primaquine,
quinine, pyrimethamine
b. Antiamebiasis
- metronidazole (Flagyl), iodoquinol,
furozolidone (Furoxone).
Mechanism of actions :
a. antimalarial – alters protozoal DNA, depleting
folates, & reducing nucleic acid
production
b. antiamoeba – block protein synthesis.
Nursing considerations :
1. Administer anti-malarial drugs with food.
2. Take seizure precautions while administering
antimalarial drugs.
3. Refer cinchonism during quinine treatment:
- tinnitus, headache, vertigo, fever, and
visual changes.
4. Inform clients that iodoquinol falsify thyroid
function test for up to 6 months.
ANTIHELMINTIC
Prototype :
- mebendazole (Vermox), thiabendazole,
niclosamide (Niclocide), piperazine (Antepar),
praziquantel (Biltricide).
Mechanism of actions :
- paralyze larva and adult helmints by acting on
parasite microtubules.
Adverse effects :
- GI upset, urinary odor (thiabendazole)
- headache, dizziness, fatigue
Nursing considerations :
1. Treat all the family members for nematodes
infection to prevent recurrence.
2. Praziquantel must swallowed rapidly because
of its bitter taste to avoid gagging.
3. Other antihelmintics should be chewed.
ANTI-NEOPLASTIC DRUGS
General considerations :
- kills or inhibit the reproduction of neoplasmic
cells but as well as normal cells.
- it could be cell cycle phase specific or cell cycle
non-specific.
- preferably given through IV route.
Prototype :
1. Alkylating Agents
- inhibits cell production by causing cross
linking of DNA
a. Busulfan – hyperuricemia
b. Chlorambucil – gonadal suppression
c. Cisplatin – ototoxicity and nephrotoxicity
d. Cyclophosphamide – hemorrhagic cystitis.
2. Antitumor Antibiotic Agents
- interfere in DNA and RNA synthesis
a. Plicamycin – affects bleeding time
b. Doxurubicin – cardiotoxicity
c. Bleomycin – pulmonary toxicity.
3. Antimetabolites
- replace normal proteins required for DNA
synthesis by inhibiting the S phase
a. Cytarabine – hepatotoxicity
b. 5-flourouracil – phototoxicity reaction and
cerebellar dysfunctions
c. 6-marcaptopurine – hyperuricemia
d. Methotrexate – photosensitivity
- given with leucoverin to lessen its
toxicity.
4. Mitotic Inhibitors (Vinca Alkaloids)
- prevent mitosis acting on the M phase
causing cell death
a. Vincristine sulfate – neurotoxicity, numbness
5. Hormonal Medications and Enzymes
- block the normal hormones in hormone
sensitive tumors
a. Tamoxifen citrate – visual problems
– elevate cholesterol & triglycerides level
b. Diethylstilbestrol – impotence and
gynecomastia in men.
Side Effects:
stomatitis
- bland diet, avoid strong mouthwash
- soft tooth brush, ice chips
diarrhea, nausea and vomiting
- anti-emetic, replace fluids and electrolytes
alopecia
- reassure that it is temporary
- encourage o wear wigs, hats and head scarf
skin pigmentation
- inform that it is only temporary
tumor lysis syndrome
- hyperuricemia & hyperkalemia
 - force fluids
infection
- notify physician if WBC is <2000/mm3
- monitor for signs of infection
- reverse isolation
- low bacteria diet
anemia
- iron, B-12, folic acid rich food
- provide rest periods
bleeding
- avoid NSAIDs
- minimize invasive procedures
- use soft toothbrush and electric razor
menstrual changes
- reassure that menstruation will resume.
THE END
REVIEW QUESTIONS
SITUATION: Mr. Hero Fernando, a 60
year-old bank manager had
experienced a sensation of chest
tightness, chest pain, sweating and a
feeling of apprehension. A diagnosis
of CAD with angina pectoris was
established
1. The physician orders for nitroglycerin
tablet. The nurse knows that the
pharmacological action of the drug is:
a. To dissolve the atheromatous
plaque in the coronary artery
b. Constrict the venous vessels and
capillaries
c. Dilate the coronary arteries
d. Decrease the myocardial
consumption of oxygen
2. The nurse gave instructions to the patient
on nitroglycerin intake. He remarked, “I
think I will try not to take too many of
these pills.” At this instance, the nurse’s
BEST reply would be:
a. “I agree, nitroglycerin can cause
drug addiction, that is why you
must not take too many of the
pills”
b. “I must inform you that
nitroglycerin is non-habituating
and you should take the pills
many times to relieve the pain”
c. “You will be needing only three
tablets to ease the pain and if
unrelieved, you must seek
medical attention”
d. “ There is no problem with
continuous daily intake because
nitroglycerin does not cause a
tolerance effect”
3. The nurse must emphasize to the patient
which ONE of the following side-effects of
nitroglycerin:
a. Headache c.
Nausea and vomiting
b. Hypertension d. Visual
changes
4. What other information must the nurse
provide to the patient taking the
nitroglycerin?
a. Keep the tablet in a clear
container
b. Take the tablet with meals
c. Continue to take as many tablets
of nitroglycerin until chest pain
subsides
d. A burning sensation under the
tongue is expected
5. The nurse applies the ordered
nitroglycerin ointment on the patient’s
chest wall. Which nursing action is
considered inappropriate?
a. The nurse chooses a hairless
area
b. She spreads the ointment with
her fingers
c. She removes the ointment on the
skin from the previous dose
d. She rotates the sites of ointment
application
6. The nurse gives which of the following
discharge instructions to this patient with
angina regarding nitroglycerin therapy?
a. Only take the nitroglycerin as
desired
b. The drug should be taken before
engaging in exertional activities
c. The tablet should be taken only in
the morning
d. If the drug does not relieve the
pain, increase the frequency of
the dose
7. Hero asked the nurse what he could do
about his concern about sex activity. The
nurse best suggests:
a. Tell him to avoid sex for several
months while his heart is on
therapy
b. Suggests that his wife assume
the top position
c. Tell him to avoid sex on days
when he is anxious
d. Advise that he should have sex
only once a month
8. The nurse understands that her discharge
teaching is effective regarding life style
modification when the patient says:
a. “I know that I will need to eat less,
so I will eat once a day only”
b. “I will stay on bed most of the time
so I wont experience chest pain”
c. “I will stop what I’m doing
whenever I have pain and take
the pill”
 d. “I need to enroll in a gym class to
have a vigorous exercise to
condition my heart”
SITUATION: Manny is admitted to the
medical ward with the diagnosis of
essential hypertension. He had
hypertensive emergency 2 hours ago and
was hospitalized for further observation.
9. The nurse administers prescribed anti-
hypertensive meds. If it can be any of the
following, she will check the pulse prior to
giving:
a. Nifedipine
b. Metoprolol
c. Clonidine
d. Captopril
10. After administering a blood-pressure
lowing agent, the nurse must caution the
patient:
a. To avoid straining during
defecation
b. To avoid low-sodium and
potassium diet
c. To avoid abrupt change of
positions
d. To take warm shower
immediately after taking the drug
11. The nurse prepares to give a diet
appropriate for a hypertensive patient.
Which food should the nurse include in
the menu?
a. Canned meat loaf
b. Scallops and shrimps
c. Fresh citrus juice and cake
d. Butter and pork steaks
12. If the physician orders Captopril as the
home medication for the high BP, the
nurse must caution that the side-effect of
this drug that is disturbing is:
a. Rashes
b. Cough
c. Pruritus
d. Ringing of the ears
13. If the client is discharged with home
medication of Propranolol hydrochloride,
the nurse must include in her medication-
teaching plan which one?
a. Take the medication on an empty
stomach
b. Obtain blood pressure readings
regularly
c. Perform active exercises to
prevent Hypotension
d. Caution to avoid hazardous
activities after taking the drug
14. The nurse determines that the following
drugs are calcium channel blockers that
can be prescribed by the physician to the
patient. One is not included:
a. Nifedipine
b. Verapamil
c. Telmisartan
d. Diltiazem
SITUATION: Joseph,, 50 y.o.
Businessman awakens in the middle of
the night with dyspnea, bilateral basilar
rales and frothy sputum. He is brought to
the Mulawin hospital. His diagnosis is
congestive heart failure.
15. The physician gives the patient
furosemide and digoxin. The nurse’s main
concern is to:
a. Take the central venous pressure
reading
b. Observe for decrease edema
c. Observe for signs and symptoms
of hypokalemia
d. Force fluids
16. The mechanism of action of dioxin that
makes it useful in patients with CHF is
that it:
a. Produces a negative inotropic
effect
b. Increases cardiac conduction
c. Enhances cardiac contractility
d. Increases the heart rate
17. The nurse is very vigilant about digoxin
overdose. Which one statement below by
the patient may alert the nurse of a
possible development of toxicity?
a. “Nurse, I don’t feel like eating for
the past few days”
b. “I am having constipation lately”
c. “I am developing a nagging cough
and night terrors”
d. “I am experiencing dryness of the
eyes and sandy sensation”
18. The nurse evaluates that the drug digoxin
is effective when the patient manifests:
a. Decreased bowel sounds
b. Increased urine output
c. Increased drowsiness
d. Decreased sympathetic response
of the body
19. The following manifestations must be
assessed by the nurse to detect
 beginning digitalis toxicity, with the
exception of:
a. Nausea and vomiting
b. Palpitations
c. Diplopia and visual yellow-green
halos
d. Hypertension
20. The nurse instructs the patient on diet
modification during digitalis therapy. She
is certain that her teaching is effective
when the patient will choose all the foods
items below, except:
a. Fresh orange juice and potato
fries
b. Dried mangoes and tomato juice
c. Broccoli salad with bean sprouts
d. Flavored gelatin and iced tea
21. The nurse obtains an apical pulse of 78
beats/min. She is bringing the next dose
of digoxin and then proceeds to do which
one action below?
a. Withhold the drug and notify the
physician
b. Start IV infusion of Digibind
(digoxin antibody)
c. Instruct patient to consume more
meat and nuts
d. Administer the drug
SITUATION: Armida, an 18-year-old
adolescent is seen in the health center
because of easy fatigability and frequent
dizziness
22. The health center physician determines
that she has iron-deficiency anemia. The
nurse will anticipate the doctor to order
for:
a. Bone marrow aspiration
b. Hemoglobin level determination
c. Platelet count
d. BUN and Creatinine
23. A drug is administered to correct anemia,
such as an iron. This drug is classified as:
a. Antihelminthic
b. Anticoagulant
c. Hematinic
d. Antihistaminic
24. The nurse administers the oral iron tablet.
She will give the medication:
a. With milk and dairy products
b. With antacids to minimize gastric
upset
c. With fruit juices like calamansi
and orange
d. With a full glass of coffee or tea
25. The nurse instructs the patient to eat iron-
rich foods. She determines that her
teaching is effective when the client will
choose:
a. Pomelo juice and hamburger
b. Gelatin and marshmallows
c. Lean meat and buttered corn
d. Liver and eggyolk
26. The doctor decides to order Iron dextran
one ampoule. The nurse prepares to
administer the drug:
a. Intravenously. Slow IV push
b. Intamuscular, Z-track method
c. Subcutaneous
d. Intrathecal
27. The nurse must warn the patient taking
oral iron preparations that it can cause
which side effect/s?
a. Yellowish discoloration of the skin
and mucus membrane
b. Darkening of stool color
c. Anorexia and loss of hair
d. Ulceration of the skin and cough
28. The patient remained pale and weak,
upon further examination, it was
determined that she has pernicious
anemia. The pathophysiology of this
hematological disorder is:
a. Absence of Vitamin E in the diet
b. Presence of excessive iron in the
liver
c. Absence of intrinsic factor in the
stomach
d. Temporary bone marrow
depression.
DRUGS THAT AFFECT THE
HEMATOLOGICAL SYSTEM
SITUATION: Mrs. Rosalinda Amor, 23
year-old actress is admitted because of a
diagnosis of deep vein thrombosis.
29. The nurse employs which of the following
non-pharmacological measures in caring
for Mrs. Amor?
a. Ice compress over the involved
leg TID
b. Elevate the legs with a pillow
c. Maintain on strict bed rest with
minimal bathroom privileges
d. Massage the involved area
30. The physician orders Heparin sodium for
Mrs. Amor. The nurse understands the
reason for this therapy is that:
 a. Heparin will dissolve the clots in
the inflamed veins to prevent
emobolization
b. There is a need to prevent further
clot formation in the involved
vessels
c. Heparin will anticoauglate the
blood by inhibiting vitamin K
metabolism
d. The clot formed in the vein must
be lysed by activating plasmin,
the action of heparin
31. If the doctor orders for heparin therapy
monitoring, the nurse must obtain which
laboratory tests from the lab unit?
a. Prothrombin time
b. Clotting time
c. Partial thromboplastin time
d. Prothrombin consumption test
32. The above laboratory value must is
considered therapeutic if the result is
about:
a. 3 times the normal
b. 2 times the normal
c. Equals the normal
d. Less than the normal
33. The nurse must administer heparin to
Mrs. Amor. She determines that the most
common routes of administration are:
a. IV and IM
b. SC and IV
c. ID and IM
d. IV and intrathecal
34. When the nurse is monitoring the patient
for heparin overdose, she is observing for
the following signs/symptoms, except?
a. Ecchymoses
b. Positive Homan’s sign
c. Dark, cola-colored urine
d. Epistaxis
35. Which one effect of heparin therapy will
cause nursing concern?
a. Thrombocytopenia
b. Constipation
c. Bone marrow depression
d. Dizziness
36. In the event of an overdose of heparin
injection, the nurse prepares which one
antidote for toxicity?
a. Phytomenadione
b. Atropine Sulfate
c. Protamine sulfate
d. Deferoxamine chelators
37. The doctor switched from standard
heparin to low molecular weight heparin
injection. The advantage of LMWH over
the standard heparin is:
a. The LMWH can be administered
IM
b. The LMWH does not need
frequent laboratory monitoring
c. The LMWH has a better potency
d. The LMWH does not cause
bleeding problems
38. The nurse reads the chart and notes for
an order of oral Warfarin sodium, while
the patient is on heparin therapy. The
nurse will:
a. Question the order because of
potential excessive bleeding if
given simultaneously
b. Administer the drug as ordered
c. Withhold the heparin and
administer the Warfarin orally
d. Report the error to the nurse
supervisor as the patient may be
at risk for toxicity
39. IF Mrs. Amor is discharge with warfarin
sodium, the nurse must include in her
discharge teaching which one?
a. Keep Vitamin A ampule available
for injection c/o the health center
in case of emergency
b. Report any bright red blood in the
stool or urine
c. Take aspirin to manage the
headache side-effect of the drug
d. Utilize firm toothbrush when
brushing to prevent build up of
plaques and gingival hyperplasia
40. The nurse must remind the patient that
warfarin therapy is monitored with the use
of which laboratory examinations?
a. PT and PTT
b. PT and INR
c. Clotting time and bleeding time
d. Platelet count and PT
SITUATION: Mrs. Avery had a previous
attack of mild stroke and coronary artery
disease. She is taking Aspirin.
41. The reason aspirin is utilized as an anti-
platelet medication is because:
a. Aspirin can prolong the bleeding
time
 b. Aspirin affects the thromboxane
production of the platelet
c. Aspirin interferes with the
receptor binding of the platelets
d. Aspirin blocks the degranulation
process inhibiting release of
histamine
42. The nurse administers aspirin:
a. On an empty stomach to increase
absorption
b. With meals
c. In Between meals
d. Intramuscularly
43. Mrs. Avery had a sudden severe and
prolonged chest pain. Acute MI is
suspected. The nurse anticipates the
doctor to order a fibrinolytic, and this may
be:
a. Tranexamic Acid
b. Dipyridamole
c. Steptokinase
d. Coumadin
44. If the above drug is ordered to be given IV
drip, the nurse must be aware of which
potential effect?
a. Hypersensitivity reaction
b. Congestive heart failure
c. Further damage to the
myocardium
d. Excessive clot formation
45. If the patient is receiving tissue-
plasminogen activator, the nurse must
make which one priority intervention?
a. Have heparin sodium available
b. Monitor closely the renal status
c. Observe for psychotic symptoms
d. Obtain a stand by Aminocaproic
acid
SITUATION: A patient is determined to
have hypercholesterolemia and is
admitted in the hospital for treatment of
her condition. The doctor ordered
Lovastatin OD.
46. The nurse determines that the BEST time
to give the drug is:
a. In the morning before breakfast to
promote absorption
b. In the afternoon to promote sleep
because it is sedating
c. At bedtime
d. In between meals
47. The nurse is knowledgeable about the
mode of action of lovastatin that it:
a. It Inhibits the formation of
chylomicrons in the intestinal cells
b. It prevents the enzyme that
synthesizes cholesterol
c. It binds with bile acids and
cholesterol promoting excretion
d. It promotes cholesterol
metabolism in the adipose tissue
to lower the plasma cholestero
48. The nurse is prepared to provide comfort
measure to the common side effects of
the drug. She monitors the patient for:
a. Abdominal fullness, flatulence
and diarrhea
b. Confusion and psychoses
c. Palpitations and arrhythmias
d. Hypertension and rashes
49. The nurse must monitor for these serious
adverse effects of lovastatin. Which one is
not included?
a. Glaucoma
b. Cataract
c. Myositis
d. Hepatic failure
The nurse reads the drug order
sheet and is most concern to
consult the physician if he orders:
e. Paracetamol
f. Gemfibrozil
g. Vitamin supplements
h. Omeprazole
50. The nurse is giving Guaifenesin to a
patient. She includes in her teaching
which of the following interventions?
a. Warn the patient that extreme
drowsiness may occur
b. Offer a full glass of water
c. Nausea and vomiting are
potential problems alleviated by
small frequent meals
d. Suggest to buy a nebulizer
machine to be used at home
e. Vitamin ADEK supplements
because of impaired absorption
51. To be able to detect the effectiveness of
Salbutamol, the nurse should check for:
a. Blood pressure and CVP
readings
b. Urinary output per hour
c. Breath sounds
d. Level of consciousness
e. Pupillary reflexes
52. The patient is receiving theophylline
capsule OD. The nurse cautions the
patient to avoid foods with components
similar to theophyline and they can be:
a. Sugar and cream
b. Coffee and chocolate
c. Spinach and broccoli
d. Beans and aged cheese
e. Canned goods and wine
53. The patient is receiving theophylline
capsule OD. The nurse cautions the
patient to avoid foods with components
similar to theophyline and they can be:
a. Sugar and cream
b. Coffee and chocolate
c. Spinach and broccoli
d. Beans and aged cheese
e. Canned goods and wine
54. The nurse is administering acetylcysteine
nebulization to a patient. It is very much
important to keep which item below at
bedside?
a. Scissors
b. Ambu bag
c. Suction machine
d. Tracheostmy set
e. NG tube
55. After giving diphenhydramine to the
patient, the nurse must ensure that the
patient understands the teachings below,
EXCEPT:
a. Refrain from manipulating
delicate machines
b. Take sugarless candy in the
mouth to relieve dryness
c. Avoid taking the drug with alcohol
d. Check pulse rate before taking
the drug
e. Manage gastric upset by taking it
with food
56. The nurse watches out for a side-effect
associated with intake of codeine sulfate
and provides appropriate intervention, this
can be:
a. Constipation- provide liberal fluids
b. Excitement- provide less
stimulation
c. Tachycardia- administer lidocaine
d. Polyuria- give the drug in the
morning
e. Tachypnea- position on semi-
fowler’s
57. Terbutaline sulfate is administered to a
patient with asthma. If the patient has
another disease, the nurse is most vigilant
and cautious if this condition exists:
a. Hypothyroidism
b. Rheumatoid arthritis
c. Diabetes mellitus
d. Polycystic ovarian disease
e. Emphysema
58. The nurse is administering oxymetazoline
nasal decongestant. She includes in her
care plan all of the following interventions,
EXCEPT?
a. Instruct the patient to clear the
nasal passage of mucus before
instilling
b. Remind patient to keep the head
tilted for a few seconds after
administration
c. Advise increased fluid intake
d. Encourage the use for one week
for better effect
e. Caution that tachycardia and
urinary retention may occur with
systemic absorption
59. The physician asks the nurse for an
anticholinergic drug to be used for the
asthmatic patient. The nurse obtains from
the pharmacy which drug?
a. Albuterol
b. Terbutaline
c. Metaproterenol
d. Ipratropium bromide
e. Salbutamol
60. The physician orders dextromethorphan
for a patient who is complaining of very
uncomfortable coughing. The nurse
understands that this drug acts to
suppress cough by:
a. Increasing the secretions of the
bronchial glands
b. Removing the irritation from the
respiratory tract
c. Inhibiting the medulla oblongata
cough center
d. Inhibiting the stretch receptors in
the lungs
e. Triggering the vagal responses
61. Inhaled corticosteroid like
beclomethasone is administered to the
patient with asthma. It is important for the
nurse to stress that this drug:
 a. Acts rapidly to decrease
inflammation
b. Promotes the secretion of mucus
c. May depress the immune function
d. Highly effective in terminating
acute asthma attack
e. Is habituating and addicting

62. The second generation anti-histamines

like cetirizine have the advantage over the
first generation antihistamines like
diphenhydramine because second
generation antihistamines:
a. Have shorter duration of action
that can be reversed rapidly
b. Have less sedation and
anticholinergic properties
c. Posses less drug sensitivity
reactions
d. Have a greater safety profile
e. Have less abuse potential

63. The nurse cautions the patient taking

diphenhydramine (Benadryl) to expect all
of the following side effects, except?
a. Dry mouth
b. Blurred vision
c. Urinary frequency
d. Drowsiness
e. Dizziness

64. The nurse must remember to administer

theophylline slowly or with an infusion
pump because this drug, if given rapidly
can cause:
a. Increased alertness
b. Severe hypotension
c. Tachycardia
d. Pallor
e. Headache