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S.G.R.D INSTITUTE OF NURSING, PANDHER, AMRITSAR

DRUG
STUDY
SUBJECT- MEDICAL SURGICAL NURSING

SUBMITTED TO:

MRS. SATINDER KAUR

ASSISTANT PROFESSOR
MEDICAL SURGICAL NURSING

SUMBITTED BY:

CHARANJIT KAUR
MEDICAL SURGICAL NURSING
M.SC NURSING 1ST YEAR

10/08/2020
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1. ANTI-HYPERTENSIVE DRUGS

GROUPS MECHANISM OF DIFFERENCE WITH NURSING RESPONSIBILITY

ACTION OTHER HYPERTENSIVE
A. ACE inhibitors Angiotensin II  Assess for the mentioned
Angiotensin inhibit the Receptor Blockers act on contraindications to this drug
-converting peripheral the same mechanism (e.g. renal
enzymes conversion of as ACE inhibitors do. The impairment, hyponatremia, hyp
inhibitors angiotensin I to only difference is that ovolemia, etc.) to prevent
(ACE angiotensin II by they restrain the activity potential adverse effects.
Inhibitors) inhibiting the of a different molecule.  Obtain baseline status for
SUFFIX: -pril enzyme ACE, As a result blood vessels weight, vital signs, overall skin
thereby tend to expand, which condition, and laboratory tests
decreasing the lowers your blood like renal and hepatic function
availability of ATII, pressure. tests, serum electrolyte, and
which can then complete blood count (CBC)
stimulate the ACE inhibitor acts by with differential to assess
production and preventing the formation patient’s response to therapy.
secretion of of aldosterone, thus  Monitor renal and hepatic
aldosterone from dilating the blood vessels function tests to alert doctor
the adrenal cortex and increasing fluid loss for possible development of
(specifically the through urination. renal and/or hepatic failure as
zona well as to signal need for
glomerulosa). reduced drug dose.

B. A ACEI and ARBs work on  Educate patient and family

Angiotensin antihypertensive the same pathway to members about drug’s effect to
II-Receptor agents that exert stop high blood pressure, the body and manifestations
Blockers their action by but each type of that would need reporting to
SUFFIX: blocking medication works at enhance patient knowledge on
-sartan vasoconstriction different spot in the drug therapy and promote
and release of process. adherence.
aldosterone  Provide comfort measures (e.g.
through selective quiet environment, relaxation
blocking of techniques, etc.) to help patient
angiotensin II tolerate drug effects.
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receptors in  Monitor renal and hepatic

vascular smooth function tests to alert doctor
muscles and for possible development of
adrenal cortex. renal and/or hepatic failure as
well as to signal need for
reduced drug dose.
C. Calcium- The mechanism Calcium channel  Educate patient on importance
channel by which calcium blockers (CCBs) are a of healthy lifestyle choices
blockers channel blockers relatively which include regular exercise,
SUFFIX: work is complex. new antihypertensive cla weight loss, smoking cessation,
-dipine The excitation- ss. The effect of first‐line and low-sodium diet to
contraction CCBs on the prevention maximize the effect of
coupling of of cardiovascular events, antihypertensive therapy.
cardiac cells as compared with other  Provide comfort measures for
occurs through antihypertensive drug the patient to tolerate side
voltage- classes, is unknown. effects (e.g. small frequent
dependent meals for nausea, limiting noise
calcium channels and controlling room light and
which are temperature to prevent
incidentally, also aggravation of stress which can
found on skeletal increase demand to the heart,
and smooth etc.
muscle.
D. These Vasodilators act directly  Monitor patient for any
Vasodilator antihypertensive on the smooth muscle of manifestations that could
s agents exert their arteries to relax their decrease fluid volume inside
effect by acting walls so blood can move the body (e.g.
directly on more easily through vomiting, diarrhea, excessive
smooth muscles. them; they are only used sweating, etc.) to detect and
Consequently, in hypertensive treat excessive hypotension.
there will emergencies or when  Emphasize to the client the
be muscle relaxati other drugs have failed, importance of strict adherence
on and and even so are rarely to drug therapy to ensure
vasodilation. Both given alone. maximum therapeutic effects.
of these will cause
drop in blood
pressure.
Or
Vasodilators relax
the muscles in the
walls of blood
vessels, especially
in small arteries
called arterioles.
This widens the
blood vessels and
allows blood to
flow through
them more easily.
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As a result, blood
pressure falls.
E. Renin It slows down the Renin comes one level  Monitor BP periodically; take
Inhibitor production of higher than angiotensin trough readings, just prior to
renin, an enzyme converting enzyme (ACE) the next scheduled dose, when
produced by your in the renin-angiotensin possible.
kidneys that starts system. Inhibitors of  Lab tests: Monitor liver
a chain of renin can therefore function tests, BUN and
chemical steps effectively reduce creatinine, serum potassium,
that increases hypertension and CBC with differential,
blood pressure. periodically.

These drugs block

a chemical in your
body called renin.
This action helps
widen your blood
vessels, which
lowers your blood
pressure.
F. Beta- Beta blockers are Beta-blockers are not  Before you administer selective
blockers competitive always effective for beta-blockers, measure your
antagonists that everyone but can work patient's apical and radial
SUFFIX: -olol block the receptor very well in combination pulses.
or lol sites for the with other drugs for high  If your patient has diabetes,
endogenous blood pressure such as monitor his blood glucose
catecholamines diuretics or alpha- levels.
epinephrine blockers.  Also, monitor his fluid balance
(adrenaline) and by measuring intake and output
norepinephrine and by obtaining daily weights.
(noradrenaline)  Report any significant changes
on adrenergic to his physician.
beta receptors, of
the sympathetic
nervous system,
which mediates th
e fight-or-flight
response.

2. ANTIBIOTICS

CLASS MECHANISM OF INDICATION NURSING RESPONSIBILITIES

ACTION
Cephalosporin Exert bactericidal  The treatment of strep throat,  Provide the following
and bacteriostatic pneumonia, tonsillitis, staph patient teaching:
effects by infections, skin infections, otitis safety precautions
interfering with media, kidney and bladder (e.g. changing
the cell-wall infections, bone infections and
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building ability of gonorrhea positions, avoiding

bacteria during hazardous tasks, ec.),
cell division. drinking lots of fluids
Therefore, they and to maintain
prevent the nutrition even
bacteria from bio though nausea and
synthesizing the vomiting may occur,
framework of report difficulty
their cell walls. breathing, severe
Macrolides Macrolides exert  Aerobic and anaerobic headache, fever,
their antibiotic gram-positive cocci, diarrhea, and signs of
effect by binding except for most infection.
irreversibly to the enterococci,
50S subunit of many Staphylococcus  Provide safety
bacterial aureus strains measures to protect
ribosomes. (especially methicillin- the patient if CNS
This action is resistant strains), and effects
mainly some Streptococcus (e.g. confusion,
bacteriostatic, pneumoniae and S.pyog disorientation,
meaning that enes strains. numbness) occur.
bacterial growth
and reproduction
are inhibited, in  Monitor infection site
contrast to and presenting signs
bactericidal and sympoms
antibiotics which throughout course of
directly kill drug therapy because
bacteria. failure of these
Macrolides can be manifestations to
bactericidal in resolve may indicate
high the need to reculture
concentrations. the site.
Tetracyclines Inhibit protein  Treatment of infections
synthesis leading caused by susceptible  Educate client on
to inability of the strains: Ricketssiae, drug therapy to
bacteria to M.pneumoniae, promote
multiply. The B.recurrentis, understanding and
affected protein is H.influenzae, H.ducreyi, compliance.
similar to protein Bacteroides spp.,
found in human V.comma, Shigella spp.,
cells so these D.pneumoniae, and  Ensure that patient
drugs can be toxic S.aureus. receives full course of
to humans at high  Adjunct in treatment of aminoglycosides as
concentrations. protozoal infections. prescribed, divided
around the clock to
Fluoroquinolon Interfere with the  Treating infections increase
es action of DNA (respiratory, urinary effectiveness and
enzymes tract, and skin) caused decrease the risk for
necessary for by susceptible strains: development of
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growth and E.coli, P.mirabilis, resistant strains of

reproduction of K.pneumoniae, bacteria.
the bacteria. P.vulgaris, M.morganii,
Has little cross- P.aeruginosa,
resistance but H.influenzae, S.aureus,
misuse of this S.epidermidis,  Assess for the
drug for a short N.gonorrhoeae, and mentioned cautions
time will lead to group D streptococci. and contraindications
existence of (e.g. drug allergies,
resistant strains. CNS depression, CV
disorders, etc.) to
Aminoglycosid Exert bactericidal  Infections caused by prevent any
es effect through susceptible strains: untoward
inhibition of Pseudomonas complications.
protein synthesis aeruginosa, Escherichia
in susceptible coli, Proteus spp.,  Evaluate patient
strains of gram- Klebsiella-Enterobacter- understanding on
negative bacteria. Serratia group, drug therapy by
Specifically, they Citrobacter spp., and asking patient to
bind to a unit of Staphylococcus spp. name the drug, its
the bacteria  Serious infections indication, and
ribosomes and susceptible to penicillin adverse effects to
cause misreading when penicillin is watch for.
of the genetic contraindicated.
code leading to
cell death.

Penicillins and Exert bactericidal  Treatment of

Penicillinase- effect by streptococcal infections
Resistant interfering with (e.g. pharyngitis,
Antibiotics the ability of tonsillitis, scarlet fever,
susceptible endocarditis).
bacteria to build  Treatment of
their cell walls meningococcal meningiti
when they are s if given at high doses
dividing. These
drugs prevent the
bacteria from bio
synthesizing the
framework of the
cell wall, and the
bacteria with
weakened cell
walls swell and
then burst from
osmotic pressure
within the cell.
Sulfonamides Inhibit folic acid  Treatment of infections
synthesis required caused by susceptible
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as precursors of strains: C.trachomatis,

RNA and DNA. Nocardia, and some
They strains of H.influenzae,
competitively E.coli, and P.mirabilis.
block  No longer used much
paraaminobenzoic but they remain an
acid to prevent inexpensive and
synthesis of folic effective treatment for
acid in susceptible UTIs and trachoma,
bacteria that especially in developing
synthesize their countries where cost is
own folates for an issue.
the production of  Can also be used in
RNA and DNA. treatment of sexually
transmitted diseases.

3. CARDIAC DRUGS

DRUGS NURSING RESPONSIBILITIES

Cardiac Glycosides  Check drug dose and preparation carefully
to avoid medication errors because drug
EXAMPLES: has narrow safety margin.
Deslanoside  Do not administer drug with food and
Digitoxin antacids to prevent decreased in drug
digoxin absorption.
 IMPORTANT!  Count apical pulse for one full
minute before administering drug to
monitor for adverse effects.
 Assess pulse rhythm to detect arrhythmias
which are early signs of drug toxicity.
 Drug is withheld if pulse is less than 60
beats per minute in adults and 90 beats per
minute in infants.
 Apical pulse is taken after one hour and if it
remains low, nurse must document it,
withhold the dose, and inform doctor.
Phosphodiesterase Inhibitors  Assess for the mentioned contraindications
to this drug (e.g. fluid volume deficit, acute
EXAMPLES: MI, hypersensitivity, etc.) to prevent
amrinone, inamrinone potential adverse effects.
cilostazol  Protect drug from light to prevent drug
milrinone from degradation.
 Assess skin condition, noting presence of
petechiae and other manifestations of easy
bruising and bleeding to assess presence of
thrombocytopenia.
 Monitor intravenous injection site to
promote prompt interventions in cases of
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burning sensation and/or irritation.

 Provide comfort measures (e.g. small
frequent meals for GI upset, instituting
safety measures for drowsiness and
weaknesses, and providing adequate room
lighting for patients with visual
disturbances) to help patient tolerate drug
effects.

4. INSULIN

EXAMPLES ONSET PEAK DURATION NURSING

RESPONSIBILITIES
Short-acting  humulin R 30 2 8 hours  Monitor body
 novalin R minutes hours weight
Always carry
course of sugar
Fasting or not 
 Monitor
hypo/hyperglyc
emia
Intermediate-  humulin N 2 hours 8 20-24  Cloudy
acting  novolin NPH hours hours suspension.
insulin:  Must be rotated
before drawing
up.
 Give before
breakfast or
bedtime.
Long-acting  Ultralente  2 hours 12 24 hours For Ultralente
insulin:  Glargine hours  Cloudy solution
 give before
breakfast,
dinner, or
before bedtime.
 Can be mixed
with R insulin.
For Glargine
 Do not mix with
other insulins.
 Monitor every
6hrs.
Rapid-acting  Lispro 15 1 hour  3 hours  Assess if fasting
insulin: (Humalog) minutes or not 
 Aspart Assess blood
(Novolog) work
Be aware of
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stress or
infection - can
affect insulin
dose
Assess blood
glucose before
admin
Premixed  novalin 30 mins 2.5- 4-12 hours  Rotate injection
insulin hours  sites.
 Store at room
temperature.
 Never mix
premixed and
pure insulin.
 Eat with food

REFERENCE

Insulin Medications Flashcards | Quizlet. (2017). Quizlet.com. Retrieved 30 September 2017, from

https://quizlet.com/10836247/insulin-medications-flash-cards/

Acker CG, Johnson JP, Palevsky PM et al.  Hyperkalemia in hospitalized patients: causes, adequacy of treatment, and results
of an attempt to improve physician compliance with published guidelines.  Arch Intern Med  1998;158:917-24.  

Bauman, R. (2014) Microbiology with Diseases by Taxonomy. Pearson Benjamin Cummings.

MUTNICK, A., FECITT, S., & ROGERS, B. (1987). CARDIAC DRUGS. Nursing, 17(10), 58-62.
http://dx.doi.org/10.1097/00152193-198710000-00023

Class 9 Types of insulin Flashcards - Pnur 155 Pharmocology | Brainscape. (2017). Brainscape.com. Retrieved 30 September
2017, from https://www.brainscape.com/flashcards/class-9-types-of-insulin-3587160/packs/5160973