Midterm - NCM 106

NCM 106
BSN2 1st Sem MIDTERM 2020
NURSING PROCESS ON PHARMACOLOGY

The Nursing Process – a decision-making problem-solving process – to
provide efficient & effective care.
-the application of the nursing process with drug therapy ensures that the client receives the best,
safest, most efficient scientifically-based holistic care.
1.Assessment – is an information-gathering phase to complete a database of information about a

patient.
Assessment includes:
● History
● Physical exam
● Interpretation of lab results
● Diagnostic tests
● Allergies
● Current medications
● Why patient is taking drugs
● Condition of patient’s skin
● Use of tobacco
● Alcohol
● Coffee
● Caffeine-containing beverages
● Current medical problems (that may affect the manner in w/c the drug metabolize)
● Language & literary skills of the patient
METHODS OF DATA COLLECTION

● Interviewing
● Direct & indirect questioning
● Observation
● Medical records review
● Head-to-toe physical exam
● Nursing assessment
1
DATA ARE CATEGORIZED INTO:
● Objective data – any information gathered through senses or that w/c is seen, heard, felt or
smelled.
● Subjective data– includes all spoken information shared by the patient such as complaints,
problems or stated needs like patient complaints of dizziness, headache, vomiting & feeling hot
for 10 days.
OBJECTIVE DATA MAY BE OBTAINED FROM:

● Physical assessment
● Nursing history
● Past & present medical history
● Results of laboratory tests
● Diagnostic studies/procedures
● Measurement of vital signs, weight, & height;
● Medication profile – include but are not limited to any & all drug use; use of home or folk
remedies & herbal &/or homeopathic treatments, plant or animal extracts, & dietary
supplements
- intake of alcohol, tobacco & caffeine; current or past history of illegal drug use; use of
over-the-counter (OTC) medications like aspirin, acetaminophen, vitamins, laxatives,
cold preparations, sinus medications, antacids, acid reducers, antidiarrheals & mineral &
elements, use of hormonal drugs like testosterone, estrogen, progestins & oral
contraceptives, past & present health history & associated drug regimen(s)
ASSESSMENT INCLUDE:
a. Past history – when we get the past history of the client, we ask for chronic conditions by taking
the patient’s history of illnesses w/c can influence the drug to be taken, the drug use or use of
other drugs that are prescribed by a doctor. Any allergies or exposure to a drug allergen can
provoke a future reaction or provide a caution for the use of a drug, food, & animal product.
Part of assessment in past history is the level of education, level of understanding of a disease &
therapy, social supports, financial support & pattern of healthcare.
b. Physical Assessment – weight, age, physical parameters related to disease or drug effects
2.Problem identification & diagnosis – simply a statement of the patient’s status from a
nursing perspective. This focuses on the identification of a patient’s actual & potential health problems.
This consists of 3 key elements.
3 Key Elements in Problem Identification:

● The Problem (P)
● Etiology (E)
2
● Signs & symptoms (S)
e.g.
-Non-compliance r/t inability to accept diagnosis & treatment regimen as evidenced by not taking the
medication as ordered.
-Anxiety r/t to hair loss secondary to chemotherapy as evidenced by restlessness, facial tension &
insomnia.
3.Planning – this includes effective planning for the responsible delivery of the nursing care w/c
includes care-related goals & objective-based diagnosis w/c taken in consideration of the patient’s
physical, psychological & socio-cultural lifestyle means.
A drug regimen is the systematic plan for drug therapy w/c states:
● What drugs have been ordered
● When they are to be given
● Route of administration to be used
The major purpose of the planning phase is to prioritize the nursing diagnoses & specify goals &
outcome criteria, including the time frame for their achievement.
The planning phase provides time to obtain special equipment for interventions, review the possible
procedures or techniques to be used & gather information for oneself. This will lead to the provision of
safe care if professional judgment is combined w/ the acquisition of knowledge about the patient & the
medications to be given.
4.Implementation – actual nursing interventions used to meet expected outcomes. They are
identified during the planning phase & result in a set of instructions. In the implementation phase, we
do the:
● Proper drug administration meaning the nurse must consider the rights to ensure safe &
effective drug administration.
● Comfort measures – more likely to be compliant w/ the drug regimen if the effects of taking
drugs are not too uncomfortable.
● Placebo effect – the anticipation that a drug will be helpful has proved to have tremendous
impact on the actual success of the drug therapy.
● Inclusion of the patient & family education – patients to become more responsible w/ their
own care, they should have all the information necessary to ensure safe & effective drug
therapy.
In the implementation phase, the nurse intervenes on behalf of the patient to address specific patient
problems & needs. This is done through independent nursing actions & collaborative activities such as
physical therapy, occupational therapy, music therapy & implementation of medical orders.
3
The family, significant others, & caregivers assist in carrying out this phase of the NCP. Specific
interventions that relate to particular drugs like giving a particular cardiac drug only after monitoring the
patient’s pulse & blood pressure.
We can also do non-pharmacologic interventions that enhance the therapeutic effects of medications &
patient education are major components of the implementation phase.
7 RIGHTS OF SAFE MEDICATION
● Right medication – medication that is given is the right medication. Errors in this are made or
done when the pharmacy incorrectly dispenses the medication similar to the ordered
medication. The nurse administers a medication that has a similar name. The nurse administers a
medication not prepared by them that’s why when you are the medication nurse, give what you
have prepared. Error can be made if the nurse incorrectly identifies a medication & always listen
for cues from the patient. They state that they have never seen this medication before or it
doesn’t look the same, reject the medication order.
● Right Patient – giving the medication for whom it was intended. To avoid errors, we need to
use 2 identifiers: (1) Ask patients to state their name & (2) Check the name band w/ the
medication administration record. Computerized charts in the room will allow the nurse to scan
the arm band. In long term care facilities, pictures are sometimes used.
● Right dosage – patient is given the dose that was ordered & the dose is appropriate for the
patient. We can avoid errors if the pharmacist & the nurse are aware of the usual dosage of the
medication. We have to double check w/ the physician whenever there is a question about the
dose. Be sure that the drugs that require calculation are done correctly & double checked.
● Right route – medication is given only the route that was ordered & that the route is safe &
appropriate for the patient. We should know the usual routes of administration for drugs to be
given & always double check the route of administration.
● Right time – the drug was given at the correct time as ordered or according to agency policy.
Most institutions consider a medication to be given on time if given 30 mins before or after the
prescribed time. We have to watch medications that cannot be given w/ food so they are given
before a meal & meds that must be given w/ a meal need to be given w/ meals.
● Right reason – very important to make sure that the right med was ordered.
4
● Right documentation – nurses need to document the delivery of the medication soon after it
is given so meds are not given again. Be sure to follow the agency policy on the documentation.
Always remember the W’s when documenting med administration on the patient’s chart.
W’s in Documentation
● When (time)
● Why – assessment, symptoms or complains
● What – what is the med, dose, route
● Where – site
● Was – medication tolerated & if known, was it helpful to the patient?
5.Evaluation – part of the continuing process of patient’s care that leads to changes in assessment,
diagnosis, planning & intervention. The patient is usually evaluated continually for therapeutic response
& occurrence of any adverse drug effects & the occurrence of drug-drug, drug-food, drug-alternative
therapy or drug-laboratory tests interactions. Some drug therapy requires evaluation on specific
therapeutic levels so w/ regards to the evaluation, this determines if our goals have been met
satisfactorily. It should be done not only at the end of the process but should go on from the start of
assessment & initial interview w/ the patient.
QUESTIONS THAT CAN BE USED FOR EVALUATION:

a. Does the patient exhibit sign that medication is effective?
b. Are there any secondary effects?
c. Are there drug interactions that may lead to toxicity?
d. Is the patient taking the medication as ordered?
DRUGS ACTING ON THE REPRODUCTIVE SYSTEM

REPRODUCTIVE SYSTEM
- It is basically the system in our body that includes our sex organs in certain
parts of our brain.
- These system in our bodies allows us to reproduce, it allows us to make baby’s,

combining genetic material from a biological mother’s egg and a genetic material from
a biological father’s sperm to make an offspring, this is through sexual intercourse
Most Important Sex Organs
MALE MAJOR ORGANS (IMPORTANT ORGANS)
Testis
- (it has two and it is homologous), the most important structures, sort of the
structures that it is built around in the male, it produces a contribution to a baby,
5
they make small mobile cells that carry genetic material into the female to fuse a
genetic material to cause pregnancy, these small motile cells are SPERM; the testes
are constantly producing lots and lots of sperm which produce millions per day which
is different from the female ovary.
Penis
- use to deliver sperm inside the female mate to increase the chance that it meets
the egg
FEMALE MAJOR ORGANS (IMPORTANT ORGANS)
Ovary
- (it has two and it is homologous), they came in the same precursor in
development, ovaries are responsible for producing the female’s genetic contribution to
a baby that is the egg, it is a lot different from the male testes; ovary produces/
releases 1 egg per month
Uterus
- basically, really thick muscular organ that is capable of stretching out and it is
actually where the baby is actually developing during pregnancy and until birth
Breasts
- are important because they produce milk during pregnancy and afterwards by a
process called lactation; lactation happens due to a series of hormones that generally
release during pregnancy, this feed and nourish the growing baby, and it plays an
important role in creating a stronger immune system for the baby.
CHEMICAL HORMONE
- The reproductive system also produces chemicals whose signals have a really
strong influence over activities of our body.
⮚ Beside from producing the sperm and egg, the reproductive system also produces
chemicals who signals and have a really strong influence over the activities in our
bodies; we call this chemicals HORMONES, and because they came in our
reproductive system, we refer to them as our sex hormones.
MALE SEX HORMONE
✔ TESTOSTERONE - which is actually producing the testes is responsible for many

masculine traits such as body hair, deepening of the voice, muscle growth and
evenly linked to levels of aggression in males.
FEMALE SEX HORMONE
6
The ovary is the primary producer of hormones like estrogen and progesterone.
✔ ESTROGEN & PROGESTERONE - play a major role in the timing of egg release
from the ovaries and estrogen is also responsible for the development of a lot of
feminine traits. E.g., breast development;
⮚ So, there is the making of the sperm and the egg and there is a production of the
major sex hormones. It does one more thing really important and that is to
coordinate the meeting of the sperm and the egg and it does that by the male’s
penis and female’s vagina.
⮚ These two organs are used to ensure that the sperm and the egg meet each other
so the penis actually deposits sperm within the vagina so that sperm has the
better chance in reaching and fertilizing the egg released inside the reproductive
tract.
⮚ The reproductive system is actually controlled by the brain. There is an

area in the brain called HYPOTHALAMUS that sits in the brain just about in the
middle. The HYPOTHALAMUS releases a hormone called GONADOTROPIN
RELEASING HORMONE (GnRH).
⮚ GnRH affects another part of the brain called the ANTERIOR

PITUITARY GLAND just under the hypothalamus. And anterior pituitary releases
2 hormones these are the LEUTINIZING HORMONE (LH) and FOLLICLE
STIMULATING HORMONE (FSH) these two primarily affect the male and female
sex organs. So, the males’ testis and females’ ovaries to control their
functions.
⮚ Pregnancy is a huge part of reproduction and certainly the most long-

lasting part. Pregnancy results when the sperm successfully fertilizes an egg to
create a zygote - is a first cell in a new organism that has genetic material from
both mom and dad and that genetic material has come from the sperm and the
egg that have fused. The zygote goes through the series of development and
eventually implants itself within the inner wall of a woman’s uterus to grow
⮚ Gestation is the development of the fetus into a baby, the development

of all the organs including their brains, spinal cord, lungs, cardiovascular system,
reproductive system, all the systems in their body. Gestation ready the developing
infant to be born which takes about 9 months, when the baby’s ready to come out
from the uterus into the world, a number of hormonal changes takes place in the
mother’s body. These signals ready her to push the baby out of the body in other
words give birth to the baby, she then goes to the process of labor.
⮚ Labor also known as parturition to give birth to the baby. After the baby
was born, he/she will be given a name.
7
⮚ THE FEMALE REPRODUCTIVE SYSTEM WORKS IN A CYCLICAL
FASHION and altering the components of this cycle can have a variety effect to the
body. Hormones and hormonal like agents are primary drugs that affect the female
reproductive system. The female sex hormones can both uses to replace missing
hormones or to decrease the release of indigenous(?) hormones. The female sex
hormones include estrogen and progesterone.
THERAPEUTIC ACTION
The desired and beneficial actions of female sex hormones are as follows.
ESTROGENS - is responsible for the development of the female reproductive system,

this is also used to prevent conception and to stimulate the ovulation of women with
HYPOGONADISM.
Examples of Estrogen Drugs
1. Estradiol - w/c is the drug of choice
- Estrogen: use for replacement therapy when ovarian activity is blocked or

absent, it is also use less often for palliative and preventive therapy during
menopause
Indication: - development of female reproductive system
2. Estrogens - it is used for replacement therapy when ovarian activity is blocked

or absent. It is used less often for palliative and preventive therapy during menopause.
ACTIONS AND INDICATIONS
Estrogen is important for:
✔ Development of female reproductive system
✔ Affect the release of FSH and LH
✔ Use for capillary dilatation
-Fluid retention
-Protein Anabolism
-Thinning of the cervical mucus
-Conserve Calcium and Phosphorus
-Bone formation
-Inhibit ovulation
-Prevent Postpartum breast discomfort
3. Conjugated estrogens
8
4. Esterified estropipate
PHARMACOKINETICS
Usually absorbed in the GI tract, metabolized in the liver & excreted in the urine. This
may cross the placenta & may enter the breastmilk.
PROGESTINS – usually inhibits the secretion of FSH & LH. It also prevents follicle
maturation & ovulation as well as uterine contraction. The exact mechanism of action
in its function as a contraceptive is not known but it is thought that circulating
progestins & estrogens trick the hypothalamus & pituitary & prevent the release of
Gonadotropin Releasing Hormone & the Follicle Stimulating Hormone & Luteinizing
Hormone. Therefore, the follicle development & ovulation are prevented
Progestin Drugs that are usually given:

● Norethindrone acetate (P) – drug of choice.
● Desogestrel
● Drospirenone
● Etonogestrel
● Levonorgestrel
● Medroxyprogesterone
● Progesterone
● Norgestrel
Progestins are used as contraceptives w/c is most effective in combination w/

estrogens.
INDICATIONS:
● Progestins transform proliferative endometrium into a secretory endometrium.
● Inhibit secretion of FSH & LH.
● Prevent follicle maturation & ovulation.
● Inhibit uterine contraction.
PHARMACOKINETICS
This is well-absorbed by the body & also undergo hepatic metabolism or it is
metabolized in the liver. This is excreted in the urine & it is also known to cross the
placenta & enter the breastmilk.
ESTROGEN RECEPTOR MODULATOR
Estrogen Receptor Modulator drugs that are usually given:

● Raloxifene (p) – drug of choice
● Toremifene
9
The use of this drug is to produce some positive effects of estrogen replacement & limit
the adverse effects.
INDICATION OF RALOXIFENE
The action/indication of raloxifene has modulating effects. This is also used to:
● Stimulate specific estrogen receptor sites
● Increase bone mineral density w/o stimulating the endometrium in women
● For menopausal osteoporosis
PHARMACOKINETICS
It is absorbed in the GI tract & metabolized in the liver. It is excreted in the feces. This
is also known to cross the placenta & enter the breastmilk.
CONTRAINDICATION/CAUTION
Estrogen is contraindicated to patients w/ known allergy to the medicine, pregnancy
& w/ idiopathic vaginal bleeding & it is given w/ caution to patients who are
breastfeeding.
Progestins are contraindicated to patients w/ known allergy, for pregnant women w/

idiopathic vaginal bleeding, w/ pelvic inflammatory disease or PID, endometriosis &
patients who have undergone pelvic surgery. They should be given w/ caution to
patients’ w/ epilepsy, migraine, headaches, asthma, cardiac or renal dysfunction who
have the potential for exacerbation.
Estrogen Receptor Modulators are contraindicated to patients w/ known allergy,

pregnant women & lactating. This is given w/ caution to patients w/ venous
thrombosis or smoking.
ADVERSE EFFECTS OF ESTROGEN

● Bleeding
● Menstrual irregularities
ADVERSE EFFECTS OF PROGESTINS

● Those that are given as oral contraceptives usually have adverse effects of
thromboembolic disorders.
● Those that are given as dermal patch contraceptives, the usual adverse effect is
local irritation.
● Progestins given as vaginal gel, the usual adverse effects are headache,
nervousness, constipation, breast enlargement & perineal pain.
ADVERSE EFFECTS OF ESTROGEN RECEPTOR MODULATORS

● GI upset
● Changes in fluid balance
10
● Venous thromboembolism
NURSING CONSIDERATIONS
When administering female sex hormones & estrogen receptor modulators, first is the
nursing assessment.
The important thing the nurse should include in conducting assessment, history
taking & examination is/are:
● Assess for the cautions & contraindications like drug allergies, cardiovascular
diseases, metabolic bone disease, history of thromboembolism.
Rationale: To prevent any untoward complications.
● Perform a thorough physical assessment. E.g. Assess for the bowel sounds, skin
assessment, VS, mental status of the client.
Rationale: To establish baseline data before the drug therapy begins & to
determine the effectiveness of the therapy. This is also to evaluate for
occurrence of any adverse effects associated w/ the drug therapy.
● Assist pelvic & breast exams.

Rationale: Ensure specific collection for the pap smear & also to obtain a
history of the patient's menstrual cycle. This is to provide baseline data &
monitor for any adverse effects that may occur.
● Arrange for an ophthalmic exam.

This is done especially to patients who are wearing contact lenses because of
hormonal changes that can alter the fluid in the eye & curvature of the cornea
w/c eventually can change the fit of contact lenses & alter visual acuity.
● Monitor laboratory test results like urinalysis, renal & hepatic function test.
Rationale: Done to determine possible need for reduction in dose & evaluate for
toxicity.
SOME NURSING DIAGNOSIS THAT WE CAN FORMULATE IN THE USE OF THIS

DRUG THERAPY:
● Ineffective tissue perfusion r/t changes in the blood vessels brought about by
drug therapy & risk of thromboemboli.
● Excess fluid volume r/t fluid retention.
● Acute pain r/t systemic side effects of the GI tract & headache.
NURSING IMPLEMENTATION
These are vital nursing interventions done in patients who are taking female sex
hormones & estrogen receptor modulators.
11
● Administer drug w/ food. (The purpose is to prevent GI upset)
● Provide analgesic. (For the relief of pain/headache as one of its adverse
effects)
● Provide small frequent meals. (To assist w/ nausea & vomiting)
● Monitor for swelling & changes in vision. (Fit of contact lenses; this is to
monitor for fluid retention & fluid changes.)
● Provide comfort measures. (This will help patient tolerate the drug effects)
● Provide safety measures. (Like adequate lighting, raise side rails to prevent
injuries)
● Educate clients on drug therapy. (To promote understanding & compliance
w/ the medication)
NURSING EVALUATION
EVALUATION
> care should be evaluated to determine the effectiveness of the drug or the drug
therapy
> the nurse should:
1. Monitor patient’s response to therapy

EX:
● Prevention of pregnancy
● Decreasing the risk factor for Coronary Heart Disease (CHD)
● Palliation of certain cancers
2. Monitor for adverse effects

EX:
● GI upset
● Edema
● Changes in secondary sex characteristics
● Headaches
● Thromboembolic episodes
● Breakthrough bleeding
3. Evaluate patients understanding on drug therapy
> by asking the patient to name the drug, its indication, and adverse effects to
watch out for
4. Monitor compliance to drug therapy
Next drug that is acting or affecting the reproductive system is the: FERTILITY DRUGS
- This are drugs that stimulate the female reproductive system
EX:
12
● Cetrorelix
● Chorionic Gonadotropin
● Chorionic Gonadotropin alpha
● Clomiphene (p) – drug of choice for fertility drug
● Follitropin alpha
● Follitropin beta
● Ganirelix
● Lutropin alfa
● Menotropins
● Urofollitropin
● Urofollitropin, purified
INDICATIONS;
> The therapeutic actions and indications of this drugs
Women without primary ovarian failure who cannot get pregnant – after 1
yr. of trying; may be a candidate for the use of fertility drugs
Stimulates the follicle development and ovulation – in functioning ovaries
Stimulates hypothalamus to increase FSH and LH – w/c leads to ovarian

follicular development & maturation of ova; this is also given in sequence
with HCG to maintain follicle and hormone production
PHARMACOKINETICS
🞈 It is well absorbed
🞈 It is metabolized in the liver
🞈 Excreted in the kidneys through urine
🞈 This should not be used during pregnancy or lactation
CONTRAINDICATION (Cautions)
Patients who have presence of:
⚪ Primary ovarian failure

⚪ Thyroid and/or Adrenal Dysfunction
⚪ Ovarian cyst
Caution:
⚪ Breastfeeding
⚪ Thromboembolic disease
⚪ Respiratory disease
13
ADVERSE EFFECTS
It increases:
◻ Multiple and birth defects

◻ Ovarian overstimulation
◻ Headache
◻ Fluid retention
◻ Bloating
◻ Uterine bleeding and gynecomastia
● NURSING ASSESSMENT
1. Assess for cautions and contraindications
EX. Drug allergies

Primary ovarian failure
Ovarian cyst
Rationale: to prevent any untoward complications
2. Perform thorough physical assessment

Skin condition of the client
Vital signs
Neurologic status
Rationale: to establish baseline data before the drug therapy begins and also to
determine the effectiveness of the therapy and to evaluate for occurrence of any
adverse effects associated with the drug therapy
3. Assist with the pelvic and breast exam – this is to ensure specimen collection
for pap smear and Obtain history of the patient’s menstrual cycle
Rationale (pelvic, breast exam and ensuring specimen collection): to provide baseline
data and to monitor for any adverse effects that may occur
4. Monitor laboratory test results

Hormonal levels
Perineal hepatic function test
14
Rationale: to determine possible needs for a reduction of dose and evaluate for
ovarian hyperstimulation
● NURSING DIAGNOSIS
- These are the examples of ND that can be formulated in the use of drug therapy
1. Acute pain r/t headache, fluid retention or GI upset

2. Sexual dysfunction r/t alterations in normal hormone control
3. Disturb body image r/t the drug treatment and diagnosis
● IMPLEMENTATION
- Nursing interventions that the nurse can do to patients who are taking fertility
drugs
1. Assess the cause of dysfunction – before beginning therapy
Rationale: To ensure appropriate use of the drug
2. Complete pelvic exam – before each of use of the drug
Rationale: To rule out ovarian enlargement, Pregnancy or Uterine problems
3. Check urine estrogen and estradiol levels – before beginning therapy
Rationale: To verify ovarian function
4. Administer with appropriate dose of HCG – as indicated
Rationale: To ensure beneficial effects
5. Discontinue drug at any sign of ovarian stimulation – and arrange for

hospitalization
Rationale: To monitor and support the patient if this occurs
6. Provide with a calendar of treatment days – and explanation of adverse effects
Rationale: To anticipate and instruction on when intercourse should occur to

increase the therapeutic effectiveness of the drug
7. Provide warnings about risk and hazards of multiple births
Rationale: So, patient can make informed decisions about drug therapy
8. Offer support and encouragement

Rationale: This is to deal w/ low self-esteem issues associated with infertility
9. Provide comfort measures
Rationale: To help patient tolerate drug effects
15
10. Educate on drug therapy
Rationale: To promote understanding and compliance to drug therapy
● EVALUATION
- The nurse must monitor the patient’s response to therapy specifically on:
Ovulation
- The nurse must monitor for adverse effects like: Abdominal bloating, Weight
gain, Ovarian overstimulation and Multiple births
- The nurse must also evaluate patient’s understanding on drug therapy by
asking patient to name the drug, its indication, and adverse effects to watch for
- The nurse must monitor patient’s compliance to the drug therapy
DRUGS AFFECTING THE FEMALE REPRODUCTIVE SYSTEM
UTERINE MOTILITY DRUGS

⮚ Stimulate uterine contractions to assist labor (oxytocics) or induce abortions
(abortifacient)
OXYTOCICS
⮚ Focuses on its Therapeutic Actions
The desired and beneficial actions of oxytocics are:
1. To stimulate uterine contractions like the action of the hypothalamic hormone oxytocin
stored in the posterior pituitary
2. Directly affects neuroreceptor sites to stimulate uterine contractions and especially
effective in the gravid uterus
3. The oxytocin in a synthetic form of the hypothalamic hormone also stimulates lacteal
glands in the in the breast to contract, promote milk in lactating women
INDICATION:
✔ Prevention and treatment of uterine atony
after delivery thus reducing the risk of postpartum hemorrhage
SOME EXAMPLES OF OXYTOCIC DRUGS:

✔ Ergonovine
16
✔ Methylergonovine
✔ Oxytocin - the drug of choice
PHARMACOKINETICS
⮚ Oxytocics are rapidly absorbed after parenteral or oral administration, usually metabolized
in the liver and is excreted through urine and feces
⮚ Administered IM or IV are also used in a nasal form to stimulate milk or what we call the
let-down in lactating women.
⮚ Oxytocin causes the breast to push out or 'let down' the milk
CONTRAINDICATIONS AND CAUTIONS

1. Allergy to oxytocics
⮚ This is to prevent hypersensitivity reactions
2. Cephalopelvic disproportions, unfavorable fetal position, uterine atony, early pregnancy
⮚ The reason for this is that it can be compromised by uterine stimulation
⮚ Oxytocic is used with caution to patients
with coronary disease and hypertension. This is due to the effect of the arterial
contraction which affects blood pressure or compromised coronary blood flow
ADVERSE EFFECTS
✔ Excessive effects: uterine hypertonicity and spasm, uterine rupture, postpartum
hemorrhage, decrease fetal heart rate
✔ Common effects: GI upset, headache, nausea, dizziness
✔ Ergonovine and methylergonovine can cause ergotism which is manifested by nausea,
blood pressure changes, weak pulse, dyspnea, chest pain, numbness and coldness in
extremities, confusion, excitement, delirium, involution or coma.
❖ NURSING ASSESSMENT
1. Assess for contraindications and cautions.
Example:
✔ Drug allergy
✔ Current status of lactation
✔ Uterine atony
17
✔ Hypertension
⮚ To prevent any untoward complications

Example:
✔ Neurological status
✔ Vital signs
✔ Labor patterns
✔ Uterine tone
⮚ To establish baseline data before the drug therapy begins and to determine the
effectiveness of therapy. Also, to evaluate for occurrence of any adverse effects associated
with drug therapy
3. Monitor Lab test results

Example:
✔ Drug relation studies
✔ CBC or complete blood count
⮚ To evaluate hematological studies
❖ NURSING DIAGNOSIS
EXAMPLES:
✔ Acute pain r/t to increase frequency and
intensity of uterine contractions or headache
✔ Excess fluid volume r/t to egotism or
water intoxication
❖ NURSING INTERVENTIONS
■ Ensure fetal position and cephalopelvic
proportions to prevent serious complications of delivery
■ Regulate oxytocin delivery using an
infusion pump during contractions if it is being given to stimulate labor to regulate
appropriately
■ Monitor BP and FHR frequently during and
after administration. This is to monitor any adverse effects
■ Monitor uterine tone and involution and
bleeding to ensure safe and therapeutic drug use
18
■ Provide comfort measures. This is to help
the patient to tolerate drug effects
■ Educate client on drug therapy to promote
understanding and compliance
❖ NURSING EVALUATION
⮚ Evaluation will be focused on the effectiveness of the drug therapy
■ Monitor response to therapy like the
uterine contraction, prevention of hemorrhage
■ Monitor adverse effects like BP change,
uterine hypertonicity, water intoxication
■ Evaluate patient’s understanding on drug
therapy by asking the name of the drug, its indications and adverse effects that we have to
watch out for.
■ Monitor patient’s compliance to drug
Therapy
ABORTIFACIENT
⮚ The action of this drug is to stimulate uterine activity, dislodging any implanted
thromboplastin, and preventing implantation of any fertilized egg
INDICATIONS
✔ Evacuation of uterine contents via intense uterine contraction
✔ Has been approved for use to terminate pregnancy at 12 to 20 weeks from the date of last
menstrual period
SOME EXAMPLES OF ABORTIFACIENT DRUGS:

✔ Carboprost
✔ Dinoprostone (P) (drug of choice)
✔ Millepristone
PHARMACOKINETICS
⮚ Abortive drugs are well absorbed when administered and is metabolized in the liver and
excreted in the urine
CONTRAINDICATIONS
1. Allergy to abortifacients and prostaglandins
19
⮚ To prevent hypersensitivity reactions
2. After 20 weeks from the last menstrual period because giving this will be too late into a
pregnancy for an abortion
3. Active Pelvic Inflammatory Diseases (PID), Cardiovascular Disease (CV), hepatic, renal and
pulmonary disease because this can be exacerbated by the effects of the drug
4. Women on lactation because the patient has the potential for serious effects on the
neonate. Or the drug has serious potential effects on the neonate
5. Asthma, hypertension, adrenal disease because this can be exacerbated by the drug effects
6. Acute vaginitis, scarred uterus because this can be aggravated by uterine contraction
ADVERSE EFFECTS
✔ Due to exaggeration of desired effects which can lead to abdominal cramping, heavy
uterine bleeding, perforated uterus and uterine rupture
✔ Signs & Symptoms: headache, nausea, vomiting, diarrhea, diaphoresis, back ache and rush
❖ NURSING ASSESSMENT
Example:
✔ Drug allergy
✔ Active PID, CV
⮚ Aims to prevent any untoward complications

Example:
✔ Neurological status
✔ Vital signs
✔ Skin conditions
⮚ To establish baseline data before the drug therapy begins and to determine the
effectiveness of therapy. Also, to evaluate for occurrence of any adverse effects associated
with drug therapy
3. Monitor Lab test results

Example:
20
✔ Hemoglobin
✔ Leukocyte count
✔ CBC
⮚ To monitor for excess bleeding
❖ NURSING DIAGNOSIS
EXAMPLES:
✔ Acute pain r/t to uterine contractions or headache
✔ Ineffective coping r/t to abortion or fetal death
❖ NURSING INTERVENTIONS
■ Administer via route indicated. What
The route given or indicated is what we should follow. Follow manufacturer’s directions for
storage and preparation to ensure safe and therapeutic use of the drug
■ Confirm the age of pregnancy before
administering the drug to ensure appropriate use of the drug
■ Confirm that abortion or uterine
evacuation is complete by assessing the vaginal bleeding and passing of tissue in the
vaginal blood to avoid potential bleeding problems
■ Monitor blood pressure frequently during
and after administration to assess for adverse effects
■ Monitor uterine tone and involution and
the amount of bleeding during and for several days after use of the drug to ensure
appropriate response and recovery from the drug
■ Provide comfort measures to have patient
tolerate the drug effects
■ Educate the client on drug therapy to
promote understanding and for compliance
❖ NURSING EVALUATION
⮚ Evaluation will be focused on the responses of the patient to the therapy
■ Monitor the evacuation in the uterus
■ Monitor for adverse effects like the GI
upset, BP changes, nausea, hemorrhage
■ Evaluate patient understanding on drug
therapy by asking the name of the drug, its indications and adverse effects to watch for
■ Monitor the patient’s compliance to the
21
drug therapy
DRUGS AFFECTING THE MALE REPRODUCTIVE SYSTEM
⮚ This drug is used to affect the male reproductive system including androgen or male steroid
hormone anabolic steroids then drugs that act to improves penile dysfunction
ANDROGEN
⮚ Are male sex hormone which include the testosterone that produce in the testes and
androgens producing the anginal gland.
⮚ Testosterone is the primary natural androgen and in the classic androgen used today.
⮚ It is used for treatment certain breast cancer and hypogonadism
⮚ Condition where an develop testes
⮚ All testosterone are class three controlled substances with meaning this may lead to
moderate to low physical dependence.
THERAPEUTIC ACTION
● Growth and development of male sex organs and the maintenance of secondary male sex
characteristic
✔ Like deepening of the voice, facial hair etc.
● Increase the retention of nitrogen, sodium potassium, and phosphorus and decrease the
urinary excretion of calcium.
● Increase protein here Nitrogen potassium and phosphorus and decrease the urinary
excretion of calcium
● Increased protein anabolism in degrees putting catabolism
✔ when we talk about anabolism this is a process by which the body utilize energy
that is released by the catabolism
● Increases the production of the red blood cells.
INDICATIONS
ANDROGEN is indicated for the following medical condition
● Danazol is used for the treatment of endometriosis, fibrocystic breast disease, and
hereditary angioedema.
⮚ Danazol does this by inhibiting the hypothalamic pituitary adrenal and
gonadotropin releasing hormones leading to a drop in follicle stimulating hormone
and luteinizing hormone.
PHARMACOKINETICS
22
✔ ANDROGEN is long acting and available in several forms it is also absorbed and
widely distributed throughout the body.
❖ The following are contraindication and caution for the use of hydrogens
1. Allergy to Androgens or other ingredients in the drug.
✔ this will prevent hypersensitivity reactions another
2. contraindicated to PREGNANCY AND LACTATION
✔ The reason for this is for the potential adverse effects on the neonate it is not clear
whether androgen and their breast milk
3. Presence of prostate or breast cancer in men.
✔ Because this is aggravated by the testosterone effect of the drug the
4. Liver dysfunction and Cardiovascular diseases
✔ This can be exacerbated by the effects of the hormones
5. Topical forms of testosterone have a black box warning alerting user to the risk of virilization
in children who come in contact with the drug from touching the clothes and skin of the
menus in the drug
6. Danazol has black box warning also regarding the risk of thromboembolic events fetal
abnormalities hepatitis an intracranial hypertension
ADVERSE EFFECTS
✔ the use of androgens may result to

● ANDROGENIC EFFECTS
⮚ Patient will have acne, Edema (?)meaning decrease hair distribution deepening of
the voice, oily skin in hair, weight gain, decrease in breast size and testicular
atrophy
● ANTIESTROGEN EFFECTS
⮚ to these are flushing, sweating, fasciitis, nervousness and emotional lability.
● COMMON EFFECTS
⮚ one is headache, headache may relate to fluid and electrolytes changes next to
headache is dizziness sleep disorders and fatigue rush and altered serum
electrolytes
● LIFE THREATENING EFFECT
⮚ that has been documented in patients with hepatocellular cancer.
NURSING CONSIDERATION
❖ Start with NURSING ASSESSMENT These are the important things that the
nurse should include in conducting assessment is to retake an exam.
23
1. The nurse must Assess for the mentioned caution and contraindications
✔ like the drug allergy, hepatic dysfunction, cardiovascular diseases etc.
✔ Rationality for this is to prevent any untoward complications
2. Perform a thorough physical exam
✔ like the skin assessment, mental status, abdominal exam
✔ The rationale is to establish baseline data drug therapy or before the drug begins. It
is also to determine effectiveness of therapy and evaluate for the occurrence of any
adverse effects associated with drug therapy.
NURSING DIAGNOSIS
❖ we can use for this drug
1. DISTURBED BODY IMAGE related to androgenic effects

2. SEXUAL DYSFUNCTION related to androgenic effects
IMPLEMENTATION OR INTERVENTIONS
1. The nurse must monitor responses carefully when beginning the therapy
✔ This is the dose accordingly.
2. Removed an old dermal system before applying a new system to clean, dry and intact
skin.
✔ To ensure accurate administration and decreased risk of toxicity.
3. Monitor liver function periodically with long term therapy and arrange to
discontinue the drug at any sign of hepatic dysfunction.
4. Provide thorough patient teaching
✔ like measures to avoid adverse effects and warning signs, need for regular
evaluation and monitoring of the blood pressure.
✔ The reason being is to enhance the patient’s knowledge about the drug therapy and
to promote compliance with drug regimen.
5. Provide safety measures
✔ like adequate lighting, raise side rails.
✔ This is to prevent injuries.
EVALUATION
1. Monitor patient’s response to therapy

✔ like the onset of puberty, maintenance of male sexual characteristics.
✔ like androgenic effects, hypoestrogenic effects, serum electrolyte imbalance.
3. Evaluate the patient's understanding on drug therapy
24
✔ we do this by asking the name of that drug, its indication adverse effects that
patients should watch for
4. Monitor patient’s compliance to the drug therapy
ANABOLIC STEROIDS
⮚ The next drug that is affecting the male reproductive system is the
⮚ These are testosterone analogues that have been developed to produce the tissue
building effects of testosterone with less androgenic effects the
THERAPEUTIC ACTION
⮚ It promotes body tissue building process

⮚ Reverses catabolic or tissue destroying processes
⮚ Increases in hemoglobin and red blood cell mass
INDICATIONS
⮚ Anemia, certain cancers, and angioedema

⮚ Promote weight gain and tissue repair. clean the ability to patients and routing anabolism in
patients who are receiving long term or because steroid therapy
⮚ known to be used illegally for the enhancement of athletic performance by promoting
increased muscle mass (?) strength and endurance.
EXAMPLE OF ANABOLIC STEROID
● Oxandrolone
- The drug of choice
● Oxymetholone
PHARMACOKINETICS
❖ Anabolic steroids are given orally the onset is low; it is also metabolized in the
liver and excretes the kidney through urine.
● allergy to androgens or other ingredients in the drug.

✔ is to prevent hypersensitivity reactions
● Pregnancy and lactation
✔ this is for potential masculinization in neonates or in other words producing certain
male secondary sex characteristics in females.
● Liver dysfunction
✔ Because the drug metabolizes the liver and is known to cause hepatotoxicity.
25
● Coronary disease
✔ which has the potential increase in cholesterol level through the effect of the drug
on the liver
● Prostate / breast cancer in males.
✔ this types of diseases or cancers can be exacerbated by these drugs
ADVERSE EFFECTS
1. In prepubertal males. Virilization

✔ Phallic enlargement (?) increased skin pigmentation.
2. In post-pubertal males: Inhibition of testicular function, gynecomastia, testicular atrophy,
priapism (painful and continual erection of the penis) baldness and change in libido.
3. In women: adverse effects of these drugs are hirsutism, hoarseness deepening on the
Voice, clitoral enlargement, baldness, menstrual irregularities.
NURSING ASSESSMENT

✔ for example, drug allergy, pregnancy and lactation, Cardiovascular diseases etc.
✔ Is to prevent Any untoward complications
2. Perform a thorough physical assessment
✔ which is to establish baseline data before the drug therapy begins and to determine
effectiveness of the therapy.
✔ And, to evaluate any adverse effects associated with the drug therapy.
3. Arrange for radiographs of the long bone in children to assess for testosterone effects on
growth.
NURSING DIAGNOSIS
Here are some examples of nursing diagnoses that we can use.
1. Disturbed body image related to systemic effects

2. Acute pain related to gastrointestinal or CNS effect.
NURSING IMPLEMENTATION
1. Administer with food if the GI effects are severe to relieve GI distress.

2. Monitor endocrine in hepatic functions, serum electrolytes before and periodically
during the therapy.
✔ This is so that the dose can be adjusted appropriately, and severe adverse effects
can be avoided.
3. Provide thorough patient teaching.
26
✔ for example, measures to avoid adverse effects, warning signs, need for regular
evaluation and assessment of taking the blood pressure of the client
✔ This is to enhance the patient’s knowledge about the drug therapy and to promote
compliance with the drug regimen.
EVALUATION
✔ Here are some aspects of care that should be evaluated to determine the
effectiveness of drug therapy.
1. Monitor patient’s response to therapy.
✔ These are the things that we need to monitor if there is an increase in nematic reap
the protein anabolism so on and so forth.
✔ like for example androgenic effects, serum electrolytes disturbances, hepatic
dysfunction etc.
3. Evaluate the patient's understanding on drug therapy by asking the patient to name the
drug it’s indication, and adverse effects to watch for. that we need to watch for
4. Monitor the patient’s compliance to the drug therapy
DRUGS FOR TREATING PENILE ERECTILE DYSFUNCTION
⮚ This is a condition in which the corpus cavernosum does not fill with blood to allow for
penile erection.
❖ The approve drugs for treatment of penile erectile dysfunctions or (?)
dysfunction includes:
▪ PROSTAGLANDIN
▪ ALPROSTADIL, and
▪ PHOSPHODIESTERASE TYPE 5N(PDE5) receptor inhibitor sildenafil.
THERAPEUTIC ACTION
✔ The desired and beneficial actions or drugs for the treatment of penile erectile
dysfunction are as follows
● Alprostadil acts locally to relax the vascular smooth muscle and allow felling of the
corpus cavernosum, causing penile erection.
● PDE5 receptors inhibitor
✔ The nitrous oxide activates the enzyme cycling guanosine, monophosphate to cause
smooth muscle relaxation and increased blood flow.
❖ Have you been hearing about corpus cavernosum?
❖ The CORPUS CAVERNOSUM are the 2 columns of tissue running along the sides
of the penis that when blood feels this tissue it causes an erection.
INDICATIONS
27
● Prostaglandin and Phosphodiesterase type 5n receptor inhibitors are indicated for the
treatment of penile erectile dysfunction.
PHARMACOKINETICS
✔ after injection alprostadil in metabolized to in activate compounds in the lungs and

✔ while the Phosphodiesterase 5 inhibitors are well absorbed from the GI tract it
undergoes metabolism in the liver and excreted in the feces
✔ The patient is encouraged to take the drug an hour before anticipated sexual
stimulation
1. Phosphodiesterase Presence of Any anatomical obstruction or condition that might be
predisposed to priapism.
✔ The reason being is there is that risk that can be exacerbated by this drug.
2. Contraindicated for patients who have penile implants.
3. Bleeding disorders, Cardiovascular diseases, optic neuropathy, severe hepatic and renal
disorder.
ADVERSE EFFECTS
● Local effects associated with alprostadil: pain at injection site, infection, priapism, fibrosis,
rash.
● Effects associated with PDE5 inhibitors: headache, flushing, dyspepsia, urinary tract
infection, diarrhea, dizziness, possible eight cranial nerve toxicity and loss hearing.
● Potential life-threatening effect that has been documented is hepatocellular cancer.
NURSING ASSESSMENT
1. Assess for the mentioned cautions and contraindications.

2. Perform a thorough physical assessment
3. Evaluate laboratory tests for bleeding time and liver function monitor potential adverse
effects on the liver.
✔ with regards to the cautions and contraindications we have to monitor for drug
allergy penile implants bleeding disorders this prevents untoward complications
● Perform physical assessment
✔ meaning we need to establish baseline data before the drug therapy begins so for us
to determine the effectiveness of the therapy.
● Evaluation of the laboratory test for bleeding time and liver function to monitor potential
adverse effects on the liver.
NURSING DIAGNOSIS
28
✔ We have here some examples of Nursing Diagnosis that we can use for patients
taking drugs for the treatment of penile dysfunction.
1. Disturbed body image related to the effects of the drug or the drug effects.
2. Sexual dysfunction related to drug effects.
IMPLEMENTATION OR INTERVENTION
1. Assess the cause of dysfunction before beginning therapy.

✔ The reason is to ensure appropriate use of these drugs.
2. Monitor patients with vascular disease for any signs of exacerbation.
✔ so that the drug can be discontinued before severe adverse reactions or severe
adverse effects can occur.
3. Monitor response carefully when beginning the therapy.
✔ The reason is so that the dose can be adjusted accordingly.
4. Provide thorough patient teaching.
✔ Like measures to avoid adverse effects, warning signs of or if there is a need for
regular evaluation and monitoring of that the blood pressure
✔ The rationale for such is to enhance the patient’s knowledge about the drug therapy
and to promote compliance with the drug regimen.
EVALUATION
✔ we need to evaluate the and determine the effectiveness of the drug therapy.
1. Monitor the patient’s response to the therapy.
✔ If there is any improvement on the penile erection
2. Monitored for adverse effects.
✔ like dizziness, flushing, local inflammation or infections
3. Evaluate the patient's understanding of the drug therapy.
✔ by asking the patient to name the drug it's indication and adverse effects.
4. Monitor the patient’s compliance to drug therapy
DRUGS ACTING IN THE CARDIOVASCULAR SYSTEM

PHARMACOLOGY OF ANTIHYPERTENSIVE DRUG
⮚ Hypertension or high blood pressure is a quite common disorder affecting many people
who typically don’t even notice.
⮚ Any symptoms now in order to gain a better understanding of pharmacology of

antihypertensive agents, first we need to review a basic physiology of blood or blood
pressure regulation. So, when we talk about blood pressure, we are generally referring to
the force or tension of blood pressing against the artery walls, now this pressure in the
29
arteries is maintained by among other things contraction of the left ventricle or systemic
vascular resistance elasticity of the arterial walls as well as blood volume.
⮚ In other words, blood pressure is simply a product of Cardiac Output and Systemic
Vascular Resistance (SVR).
⮚ There are a couple of major symptoms involved in blood pressure regulation. First Arterial
Blood Pressure – is regulated by presence of sensitive neurons called baroreceptors
located in the aortic arch and carotid sinuses.
EX. If blood pressure falls to low, those baroreceptors can send signals to the agila medulla
causing release of catecholamines and thus increasing sympathetic activity through the
activation of alpha and beta receptors, so activation of beta-1 receptors causes increase in
heart rate and stroke volume and thus increase cardiac output. Which leads to increasing blood
pressure. On the other hand, activation of alpha-1 receptors on smooth muscle causes
vasoconstriction and thus increase in vascular resistance w/c again leads to increase in blood
pressure.
- Another major system involved in blood pressure regulation is the Renin-Angiotensin

Aldosterone System.
- So, we also have baroreceptors in the kidneys that respond to fall in blood pressure or
reduction of blood flow by releasing enzymes called Renin. Additionally, Renin secretion is also
stimulated by Sympathetic activation of beta-1 receptors in the kidneys now renin is necessary
for the production of Angiotensin II (Very important vasoconstrictor w/c constricts systemic
blood vessels thus increasing peripheral resistance; It also constricts renal blood vessels and
stimulates Aldosterone secretions w/c leads to sodium and water retention thereby increase
bp, cardiac output and ultimately increase bp)
WHAT IS HYPERTENSION
- Is defined as either a sustainable systolic pressure of greater than 140 millimeters per
mercury (>140 mmHg) or a sustained diastolic bp of greater than 90 millimeters per
mercury (>90 mmHg)
BLOOD PRESSURE (BP) = Cardiac Output (CO) X Systemic Vascular Resistance (SVR)
HYPERTENSION – results from the increased peripheral vascular arteriolar smooth muscle tone
- In other words, it is a state of elevated blood pressure w/c is the pressure exerted on
the walls of the arteries
- SYSTOLIC BP – is the bp during systole or myocardial contraction
30
- DIASTOLIC BP – is the bp during diastole or myocardial relaxation
- May occur secondary to other diseases but more than 90% of patients have essential hypertension that
happens w/ no identifiable cause
CLASSIFICATION OF BP
NORMAL – (lesser) <120 systolic; <80 diastolic
PREHYPERTENSION – from 120-139 systolic; 80-89 diastolic
STAGE 1 HYPERTENSION – from 140-159 systolic; 90-99 d
STAGE 2 HYPERTENSION =/> 160 systolic; =/> 100 d
Although many patients have no symptoms, CHRONIC HYPERTENSION can lead to heart disease
and stroke, it is also an important risk factor in the development of CHRONIC KIDNEY DISEASE
and HEART FAILURES
ANGIOTENSIN CONVERTING ENZYMES OR ACE INHIBITORS –

antihypertensive agents that act in the lungs to prevent the conversion of Angiotensin I to
Angiotensin II w/c is a potent vasoconstrictor
THERAPEUTIC ACTION
1. It prevents the production of Angiotensin II w/c is a potent vasoconstrictor and a
stimulator of aldosterone release, bp is decreased w/ resultant loss of serum sodium
and fluid but w/ a slight increase in serum potassium
INDICATIONS:
● Primarily indicated for HYPERTENSION and can be used alone in combination w/ other
drugs.
● Aside from its indication in treating Hypertension, it is also combined w/ diuretics and
digoxin in the treatment of HEART FAILURE AND LEFT VENTRICULAR DYSFUNCTION –
the resultant effects are decreased in peripheral resistance and blood volume leading to
decreased cardiac workload
● It is also approved for the treatment of DIABETIC NEPHROPATHY – in w/c the renal
artery is being damaged by diabetes, so it is thought that decreasing stimulation of
angiotensin receptors in the kidney will slow down the damage in the renal artery
PHARMACOKINETICS:
31
Ace inhibitors are taken orally w/ the onset of 15 mins, its half-life is 2 hours and this is
metabolized in the liver and also excreted through the urine
CONTRAINDICATIONS AND CAUTIONS:

1. Allergy to ACE inhibitors – this is not given to patients’ w/ allergy to this drug to prevent
severe hypersensitivity reaction
2. Renal Impairment
3. Heart Failure
4. Hyponatremia and Hypovolemia
Given w/ caution:
5. Pregnancy and Lactation – because of the potential adverse effects to the fetus and can
decrease in milk production
ADVERSE EFFECTS
1. Gastrointestinal – it will manifest irritation, ulcer, constipation and liver injury
2. Genito Urinary – it will manifest to renal insufficiency, renal failure and proteinuria
3. Cardiovascular – reflex tachycardia, chest pain, heart failure, cardiac arrhythmias
4. ENT – alopecia, dermatitis, and photosensitivity
NURSING CONSIDERATIONS:
I. NSG ASSESSMENT
- As nurses, we need to
1. Assess for the mentioned contraindications to this drug
EX. Renal impairment, Hyponatremia and Hypovolemia
R: To prevent potential adverse effects.
2. Obtain baseline status for weight, vital signs, overall skin condition, and laboratory tests
like renal and hepatic function tests, serum electrolyte, and complete blood count (CBC)
w/ differential
R: To assess the patient’s response to the therapy
NURSING DIAGNOSIS
1. Decreased cardiac output r/t effect of drug in increasing fluid volume excretion
2. Impaired skin integrity r/t dermatological effects of the drug
32
3. Increased risk for infection r/t potential decreasing effect of drug to circulating blood
cells
INTERVENTIONS/IMPLEMENTATIONS
1. Educate patient on importance of healthy lifestyle choices w/c include regular exercise,
weight loss, smoking cessation, and low-sodium diet to maximize the effect of
antihypertensive therapy
2. Administer drug on empty stomach one hour before or two hrs. after meal to ensure
optimum drug absorption
3. Monitor renal and hepatic function tests, to alert the doctor for possible development
of renal or hepatic failure
4. Monitor for presence of manifestations that signal decreased in fluid volume
EX. Diarrhea, vomiting, dehydration
5. Educate patient and family members about drug’s effect to the body and manifestations
that would need reporting to enhance patient’s knowledge on drug therapy and
promote adherence
EVALUATION
1. Monitor patient’s response to therapy through bp monitoring
2. Monitor for adverse effects EX. Hypotension, Arrhythmias, Renal failure, Cough
3. Evaluate patient understanding on drug therapy by asking patient the name of the drug,
its indication, and adverse effects to watch for
4. Monitor patient compliance to drug therapy
ANGIOTENSIN II-RECEPTOR BLOCKERS (ARBS)

- Are hypertensive agents that exert their action by blocking vasoconstriction and release
of aldosterone through selective blocking Angiotensin II Receptors in vascular smooth
muscles and adrenal cortex
- Its main actions are to block the bp raising effect of the renin or renin angiotensin
aldosterone system or the RAAS
INDICATIONS
● Like ace inhibitors, they can used alone for treatment of hypertension or in combination
w/ other antihypertensive agents
33
● Utilized in the treatment of heart failure for patients who do not respond to ace
inhibitors by blocking the effects of angiotensin receptors in vascular endothelium,
● This drug is able to slow down the progress of renal disease in patients with type 2
diabetes and hypertension
PHARMACOKINETICS
- ARBS are taken orally and has a half-life of 2 hrs. this is also metabolized in the liver and
excreted through the urine and feces
CONTRAINDICATIONS/CAUTIONS
1. Allergy to ARBS – to prevent severe hypersensitivity reactions
2. Renal and Hepatic impairment
3. Hypovolemia
4. Pregnancy and Lactation – this can cause potential adverse effects to the fetus and
potential termination of pregnancy b/wn the 2nd and 3rd trimester
ADVERSE EFFECTS
1. CNS – a patient receiving arbs can manifest/show signs of headache, dizziness, syncope,
weakness
2. Respiratory – the client may have/manifest symptoms of upper respiratory tract
infections and cough
3. Gastrointestinal – diarrhea, abdominal pain, nausea, dry mouth, and tooth pain
4. ENT – rash, alopecia, and dry skin
NURSING ASSESSMENT
1. Assess for the contraindications to this drug. Like drug allergy, hypovolemia. This to
prevent potential adverse effects
2. Obtain baseline status for weight, vital signs, overall skin condition, and laboratory tests
like renal and hepatic function tests, serum electrolyte to assess patient’s response to
therapy
NSG DIAGNOSIS
1. Ineffective tissue perfusion r/t fluid excretory effect of the drug
2. Impaired skin integrity r/t dermatological effects of the drug
34
3. Risk for injury r/t CNS side effects of the drug
NSG INTERVENTIONS
1. Educate patient on importance of healthy lifestyle choices w/c include regular exercise,
weight loss, smoking cessation, and low-sodium diet to maximize the effect of
antihypertensive therapy
2. Administer drug w/ food to prevent GI distress associated w/ drug intake
3. Monitor renal and hepatic function tests to alert doctor for possible development of
renal and/or hepatic failure as well as to signal need for reduced drug dose
4. Provide comfort measures. Like a quiet environment, relaxation techniques. This is to
help the patient tolerate drug effects
5. Educate patients and family members about the drug's effect on the body and
manifestations that would need reporting. To enhance patient knowledge on drug
therapy and promote adherence
EVALUATION
> we need to evaluate what we have done, what we have implemented to the client, that is to
determine the effectiveness of the drug therapy
1. Monitor patient response to therapy through bp monitoring.
2. Monitor for adverse effects. Like skin reactions, cough, headache
3. Evaluate patient understanding on drug therapy
4. Monitor patient compliance to drug therapy
CALCIUM CHANNEL BLOCKER

- Antihypertensive agents that decrease the bp, cardiac workload and myocardial
consumption of oxygen. Since these drugs can significantly decrease cardiac workload,
they are effective in the treatment of angina
THERAPEUTIC ACTION
● These drugs inhibit the movement of calcium ions across myocardial and arterial
muscle cell membranes, as a result, action potential of these cells is altered and cell
contractions are blocked.
● The resultant effect of this drugs includes: Depressed Myocardial Contractility, Slow
Cardiac Impulse in Conductive Tissues, and Arterial Dilation and relaxation
INDICATIONS
35
● like ace inhibitors, arbs they can also be Used alone for treatment of hypertension or in
combination w/ other antihypertensive agents
● the extended-release preparations are usually indicated for hypertension in adults
● For children, calcium channel blockers are the drug group that is first considered in
cases of hypertension in this age group, that needs drug therapy
● This is not allowed during pregnancy and especially for adults
● For older adults, w/c are more susceptible to drug toxicity especially because of
underlying conditions that would interfere w/ metabolism and excretion of drugs. So, if
an older adult is taking this drug, their renal and hepatic function should always be
monitored.
PHARMACOKINETICS
− The caution channel blocker
− is given orally and the onset is 30 to 60 minutes
− its half-life is usually 7 hours.
− This metabolizes in the liver and excretes through the urine.
CONTRAINDICATION/CAUTIONS
1. Allergy to calcium-channel blockers
− To prevent severe hypersensitivity reactions
2. Heart block (sick sinus syndrome)
− This can be exacerbated by conditions slowing the effect of the drug.
3. Renal and hepatic impairment
− This can alter metabolism and excretion of drugs which can increase the risk for
toxicity.
4. Pregnancy and lactation
− This drug can cause potential adverse effects to the fetus and should not be use unless
the benefit to the mother clearly out wastes the risk to the fetus
− It is not clear whether this drug can enter the breast milk so another method of feeding
is implemented for lactating mothers who are taking this drug.
ADVERSE EFFECTS
CNS: headache, dizziness, light-headedness, fatigue
CV: hypotension, bradycardia, peripheral edema, heart block
GI: nausea, hepatic injury
EENT (eyes, ears, nose & throat): rash, skin flushing
36
i. NURSING ASSESSMENT
− Assess for the mentioned contraindications to this drug
− (Like rush, headache or bradycardia which to prevent potential adverse effects)
− Monitor cardiopulmonary status closely as the drug can cause severe effects on these
two body systems.
ii. NURSING DIAGNOSIS

1. Decreased cardiac output related to hypotension and vasodilating effect of the drug.
2. Risk for injury related to cardiovascular and CNS adverse drug effects.
iii. INTERVENTIONS/IMPLEMENTATIONS
1. Educate the client or patient on the importance of healthy lifestyle choices
− which includes regular exercise, weight loss, smoking cessation, & low sodium diet to
maximize the effect of the antihypertensive therapy
2. Monitor blood pressure and heart rate and rhythm
− To detect possible development of adverse effects
3. Provide comfort measures for the patient to tolerate side effects
− Like small frequent nails, if they are experiencing nausea, limiting noise and controlling
room light and temp.
− To prevent aggravation of stress which can increase demand to the heart.
4. Educate patient and family members
− About the effects of the drug and the manifestations that would need reporting to
enhance patient knowledge on the drug therapy & to promote adherence.
5. Emphasize to the client the importance of strict adherence to drug therapy
− To ensure maximum therapeutic effects
iv. EVALUATION
1. Monitor patient response to therapy through blood pressure monitoring
2. Monitor for presence of mentioned adverse effects
3. Monitor for effectiveness of comfort measure
4. Monitor for compliance to drug therapy regimen
5. Monitor laboratory tests
VASODILATORS
37
− Direct vasodilators are used when the previous drugs mentioned are not effective
− These anti-hypertensive agents are reserved for severe hypertension and hypertensive
emergencies
Therapeutic action of vasodilators

− These anti-hypertensive agents exert their effect by acting directly on smooth muscles
− Consequently, there will be muscle relaxation on vasodilation.
− Both of these will cause a drop in blood pressure.
INDICATIONS
1. This drug is only used for hypertension cases that do not respond to other drug therapies.
2. Nitroprusside a vasodilator is used in maintaining controlled in hypotension during surgery
3. Nitroprusside is also administered intravenously. Hydralazine is available for oral,
intravenous and intramuscular use. Minoxidil is available for oral use only.
PHARMACOKINETICS
− This drug is or the vasodilators are given intravenously.
− Usually, the onset is 1 to 2 minutes w/ a half-life of 2 minutes.
− This drug is metabolized by a liver and excreted through urine.
This drug is contraindicated to the patients with
● Allergy to direct vasodilators – to prevent severe hypersensitivity

● Cerebral insufficiency – which can be exacerbated by the drug’s action to cause sudden
drop in blood pressure
● Peripheral vascular diseases, Coronary Artery disease, heart failure tachycardia –
because this condition can be exacerbated by sudden drop in BP
– it can cause potential adverse effects to the fetus and should not be used unless the
benefit to the mother clearly adds weight to the fetus. The drug can enter the breast
milk and can cause adverse effects to the neonate.
– If needed by the lactating mothers, another method of feeding is instituted
ADVERSE EFFECTS:
1. Central Nervous System – headache, dizziness, anxiety
2. Cardiovascular – reflex tachycardia, heart failure, edema, chest pain
38
3. Gastrointestinal – nausea, vomiting, GI upset
4. EENT – rash, lesions (e.g., minoxidil is associated with abnormal hair growth)
5. When using nitroprusside which is metabolized into cyanide, it can cause cyanide
toxicity which is characterized by dyspnea, ataxia, loss of consciousness, distant heart
sound and dilated pupil.
6. Nitroprocyte suppresses iodine uptake which leads to the development of
hypothyroidism
1. Assess for the mentioned contraindications to this drug
- We need to assess for contraindications to this drug like drug allergy, coronary
artery disease, cerebral insufficiency to prevent potential adverse effects
2. Obtain baseline status for weight, vital signs, overall skin condition and laboratory tests
like renal and hepatic function tests, serum and electrolyte to assess patient’s response
to therapy

1. Decreased tissue perfusion related to changes in volume of blood pumped out by
the heart
2. Acute pain related to GI distress, headache, and skin effects of the drug
iii. NURSING INTERVENTIONS

1. Educate patient on importance of healthy lifestyle choices
2. Monitor blood pressure and heart rate and rhythm closely to evaluate for the
effectiveness and ensure quick response should the BP falls rapidly
3. Provide comfort measures to tolerate the side effects – ex. Small frequent feeding
for nausea, limiting noise and controlling room light temperature to prevent
aggravation of stress
4. Monitor patients for any manifestations that could decrease fluid volume inside the
body – ex. Vomiting, diarrhea and excessive sweating. This is to detect and treat
excessive hypotension
5. Educate patient and family members about drug’s effect to the body and
manifestations that would need reporting
6. Emphasize to the client the importance of strict adherence to drug therapy
iv. NURSING EVALUATION
39
1. Monitor patient response to therapy through blood pressure monitoring
2. Monitor for presence of mentioned adverse effects (e.g., hypotension, GI distress,
skin reaction, etc.)
3. Monitor for effectiveness of comfort measures.
4. Monitor for compliance to drug therapy regimen
5. Monitor laboratory tests
OTHER ANTI-HYPERTENSIVE AGENTS

1. Diuretics (Thiazide and thiazide-like diuretics)
✔ To increase the excretion of sodium and water from the kidney
- Bendroflumethiazide
- Chlorothiazide
- Hydrochlorothiazide
- Hydroflumethiazide
- Methyclothiazide
- Trichlormethiazide
2. Ganglionic Blocker
- Mecamylamine – occupies the receptor sites of autonomic neurons, blocking the effects
of acetylcholine at both sympathetic and parasympathetic ganglia
3. Rebin Inhibitor
- Aliskerin – directly inhibits renin, leading to decreased plasma renin activity and
inhibiting the conversion of angiotensinogen to angiotensin
4. Sympathetic Nervous System Blocker

✔ They block vasoconstriction and decrease heart rate.
✔ Decrease muscle contraction and increase release of renin
A. Beta-blocker – acebutolol, atenolol, metoprolol, nebivolol
B. Alpha-and-beta blockers – carvedilol, guanabenz
C. Alpha-adrenergic blockers
D. Alpha-blocker
E. Alpha agonists
ANTI-HYPOTENSIVE AGENTS
- Severe hypotension or chock puts the body in serious jeopardy. It is often an acute
emergency situation with treatment required to save the patient’s life.
40
1. Sympathetic Adrenergic Agonists / Vasopressors
- They react with sympathetic adrenergic receptors to cause the effects of a sympathetic
stress response
- Ex. It increases BP, increases blood volume, increases the strength of cardiac muscle
contraction
- Dobutamine, dopamine, ephedrine, epinephrine, isoproterenol, metaraminol,
norepinephrine, phenylephrine
ADVERSE EFFECTS:
1. Decreased GI activity
2. Nausea and constipation
3. Increased respiratory rate and changes in BP
4. Headache
5. Changes in peripheral blood flow with numbness, tingling, and gangrene in extreme
cases
2. Alpha-specific adrenergic agents
- Ex. Midodrine – activates alpha-receptors in arteries and veins to produce an
increase in vascular tone and an increase in BP
ADVERSE EFFECTS:
1. Piloerection
2. Child and rash
3. Hypertension
4. bradycardia
5. Dizziness
6. Vision changes
7. Vertigo
8. Headache
9. Problems with urination
CARDIOTONIC
- This are drugs to increase contractility of the heart muscle for patient’s w/ heart failure
- Cardiotonic drugs affects the cellular calcium levels in the heart muscle leading to increase
contractility
HEART FAILURE – is a condition in w/c the heart fails to pump blood around the body
effectively
41
CARDIAC GLYCOSIDES
- This were originally derived from the digitalis plant and this plant were once ground up to
make digitalis leaf
- Today Digoxin or usually called Lanoxin is the drug most often used to treat heart failure
DIGOXIN; Drug of choice; Lanoxin (brand name)

> Indicated to treat heart failure and atrial fibrillation
ACTION
- increases cellular calcium and allows more calcium to enter myocardial cell during
depolarization w/c cause positive inotropic effect, meaning there is increase force of
contraction (lumalakas ang contraction ng heart)
- increase renal perfusion w/ a diuretic effect, so you will be expecting the patient will be
urinating frequently and decrease in renin release
- this drug has also negative chronotropic effect w/c means it slows the heart rate and slowed
conduction through atrio-ventricular node
PHARMACOKINETICS
- taken orally w/ the onset of 30-120 mins and with a half-life of 30-40 hours and usually
- it is also given IV w/ the onset 5-30 mins it acts much faster when given intravenously
ADVERSE EFFECTS
● Headache
● Weakness
● Drowsiness
● Visual disturbance
● Arrhythmias
● GI upset
● Monitor pulse for 1 full minute before administering dose – hold the drug if less than
normal
42
● Have a dosage double-checked by another nurse before administration – because of its
adverse effects
● Administer IV doses very slowly at least 5 mins
● Monitor Digoxin level (0.5 to 2mg/ml) – if not, patient will have digoxin toxicity
● Avoid administering the oral drug w/ food or antacids
● Standby potassium salts, lidocaine (arrhythmias), Phenytoin (seizure), Atropine (increase
HR)
PHOSPHODIESTERASE INHIBITORS
- belong to second class of drugs that acts as cardiotonic or inotropic agents
- this includes:
● Inamrione and milrinone
INAMRINONE – drug of choice

INDICATIONS:
- short-term treatment of HF in patients who have not responded to digitalis, diuretics, or
vasodilators
ACTIONS:
- blocking the enzyme phosphodiesterase w/c leads to an increase in myocardial cell
- increases calcium levels in the cell causing stronger contraction and prolong response to
sympathetic stimulation
- directly relaxes vascular smooth muscles
PHARMACOKINETICS
- this drug is given immediately and the onset is immediate, so once tit s given patient will feel
the effects immediately; half-life is 3.6-5.8 hours, this is metabolized in the liver and excreted in
the urine and feces.
ADVERSE EFFECTS
● Arrhythmias
● Hypotension
● Nausea
● Vomiting
43
● Thrombocytopenia
● Pericarditis
● Pleuritic
● Fever
● Chest pain
● Burning at injection site
● Assess cardiac status closely including pulse and blood pressure
● Inspect skin and mucous membranes for color and check nail beds and capillary refill
● Protect drug from light to prevent drug degradation
● Monitor platelet results
● Monitor I&O
ANTIARRHYTHMIC AGENTS
- address arrhythmia by altering cells’ automaticity and conductivity
> all cells in the heart are capable of undergoing spontaneous contractions w/c we call
automaticity; therefore, these cells are capable of generating excitatory impulses, the
disruption in the conduction of these impulses affect contractility of the heart as well as the
volume of blood pumped by the heart each minute or what we call the cardiac output
ARRHYTHMIA – is the term applied for disruptions that interfere w/ generation of impulse and
conduction of these impulses to the myocardium
- also called dysrhythmia involves changes in the automaticity and conductivity of the heart
cells, there are 2 concepts of vitals to be mastered: the conductivity and automaticity
CONDUCTIVITY – is the property of the heart cells to transmit spontaneous impulses

starting from the Sinoatrial (SA) node, activating all parts of the heart muscle almost
spontaneously
- it is the basis of cardiac contraction and relaxation, allowing the heart to beat
THE DIFF AREAS OF SPECIALIZED CONDUCTIVITY INCLUDE:

● SA node – impulse generation of 60-100 impulses per minute
● AV node – 40-50 impulses per minute
● Ventricular muscle cells – 10-20 impulses per minute
44
AUTOMATICITY – is the property of the heart cells
to undergo spontaneous depolarization during relaxation.
This is because at this point, potassium flows out of the
cell while sodium moves inside: the condition necessary
to produce an action potential
WHAT IS AN ACTION POTENTIAL?

- the heart generates its own electrical impulse for the
muscle to contract, Pacemaker cells initiate that electrical
impulse. This video is not about the pacemaker cells. We
will focus on the voltage passing through contractile myocardial cells.
The red rounded corner square will represent the cardiac cell. Within that cell you can see a
small amount of sodium (represented by a saltshaker); a small amount of calcium (represented
as a bone); and a large amount of potassium (banana).
The amount of each electrolyte is indicated by how full each item is.
The potassium is 90% full and the sodium and calcium are only about 10% full.
Outside the cell are the same 3 electrolytes: The potassium, calcium and sodium
Outside the cell, potassium is only about 10% full and sodium and calcium are about 90% full
All these electrolytes have a positive charge, so having more positive charges outside the cell
makes the inside of the cell negative
45
Let’s just pretend that we can count the number of items in each electrolyte
190 = outside the cell ; 110 = inside the cell
Inside a cell is a positive charge of 110 VS. outside the cell w/ a positive charge of 190.
190 is greater than 110 so this means there are less positive ions in the cell.
46
Sodium moves slowly into the cell, and then rapidly, causing potassium to exit the cell. The exit
of potassium rush into the cell and all electrolytes have changed places
Now the inside of the cell is more positive than the outside. This switching of electrolytes is
what causes the voltage change across that cell membrane.
Horizontal line representing time, and a vertical line measuring millivolt.
Slowly moving sodium is coming into the cell. When the millivolts reach about -70, the sodium
rushes into the cell, changing the inside of the cell to a +20
47
That rushing of sodium stimulates potassium to exit the cell. As potassium exits the cell it
causes a decrease in +ions inside the cell.
Now, calcium starts entering. The exchange b/wn potassium leaving and the calcium entering is
equal, so no voltage change is happening. This is called the plateau.
Now, the cell does not like this. So, it starts pumping sodium out and potassium in. At the same
time, calcium is reabsorbed out of the cell. These events happen w/ every heartbeat and a
normal heart rate is about 80 bpm. The cell is now back to its baseline, and ready to start again
FIVE PHASES OF ACTION POTENTIAL
PHASE 0 – DEPOLARIZATION PHASE:

- stage in w/c cell reaches point of stimulation. This phase is characterized by open sodium
gates and sodium ions rushing towards the cell leading to action potential. There is absence of
charge difference b/wn the outside and the inside of the membrane
PHASE 1
- a very short period wherein concentration of sodium equalizes inside and outside of the cell
PHASE 2 – PLATEAU PHASE:

- stage in w/c cells is trying to go back to its resting stage (repolarization). The cell becomes less
permeable to sodium, potassium begins to leave the cell, and calcium starts to enter the cell.
PHASE 3 – RAPID REPOLARIZATION PHASE:

- stage in w/c the sodium gates are closed and potassium flows out of the cell
PHASE 4 – RESTING PHASE:

- stage in w/c sodium-potassium pump restores the cell’s resting membrane potential in
preparation for the next action potential
TYPES OF ARRHYTHMIAS
1. Change in rate. EX: Tachycardia and Bradycardia
2. Stimulation of ectopic focus – there is Premature Atrial Contraction or PACs, usually
when a patient is attached to a cardiac monitor
Premature Ventricular Contraction (PVCs)
Atrial Flutter and/or Fibrillation and
Ventricular Fibrillation
48
3. Alterations in conduction through the muscle
Heart blocks and Bundle Branch Block
ARRHYTHMIA CAN BE TRIGGERED BY THE FF:

1. Electrolyte disturbances
2. Decrease oxygen supply to the cells
3. Structural damage of the conduction system
4. Drug effects
5. Acidosis
6. Lactic acid accumulation
CLASSES OF ANTIARRHYTHMICS
CLASS I ANTIARRHYTHMICS – blocks sodium channels in the cell membrane during
the action potential
- this class is local anesthetics and membranes stabilizing agent because of their ability to bind
more quickly to sodium channels
ACTION:
- it stabilizes cell membrane by depressing phase 0 of the action potential, they bind to sodium
channels and change the duration action potential of the cell
> under the Class I:
● Class I A drugs – depress phase 0 and prolong duration of action potential

● Class I B drugs – somewhat depress phase 0 and shorten duration of action potential\
● Class I C drugs – markedly depress phase 0 and extremely slows conduction but has little
effect on the duration of action potential
Always remember that a class I antiarrhythmics acts on the face zero of the action potential.
INDICATIONS
● Primarily indicated for decreasing workload of heart and relieving heart failure.
● Digoxin (an example) is especially indicated for atrial flutter, atrial fibrillation, &
paroxysmal atrial tachycardia.
❖ Usually indicated for emergency cases, the evaluation of drug regimen should be done
carefully and regularly to ensure the effectiveness and the safety of the patient.
❖ This drug can enter the breast milk and has been associated w/ various side effects
49
PHARMACOKINETICS
This drug is usually given IM & IV
✔ IM – the onset is 5 to 10 minutes
✔ IV – it has an immediate onset
● The half-life of this drug is usually 10 minutes, then from 10 minutes it can reach up to 1
and half hours.
● This is metabolized in the liver and excreted through the urine
CONTRAINDICATION/CAUTIONS:
1. Allergy to class I antiarrhythmics
2. Bradycardia, Heart Block – unless there is an artificial pacemaker in place so the conduction
altering effect of the drug can lead to total heart block.
3. HF, Hypotension, Shock – this can be exacerbated by the effects of drugs by action
potential.
4. Electrolyte Imbalance – it can alter the drug effectiveness
5. Renal, Hepatic Dysfunction – can interfere w/ drug bioavailability and excretion.
6. Pregnancy and Lactation - should be used in caution because it can cause potential adverse
effects to the fetus or neonate.
ADVERSE EFFECTS:
CNS: Dizziness, Drowsiness, Fatigue. Twitching, Mouth Numbness, Slurred Speech, Vision
Changes, Tremors.
CV: Arrhythmias, Hypotension, Vasodilation, Potential for Cardiac Arrest
RESPIRATORY: Respiratory Depression
HEMA: Bone Marrow Depression
EENT: Rash, Hypersensitivity Reactions, Hair Loss
CLASS II ANTIARRHYTHMICS
− Interferes w/ action potential by blocking beta receptors in the heart and kidneys.
− This, in turn, blocks phase 4 of action potential.
− A Beta-Adrenergic Blockers
THERAPEUTIC ACTION
● It engages in competitive inhibition or beta receptors, specifically found in the heart and
kidneys – there is decrease in heart faith, excitability and cardiac output.
● Conduction through the AV node also slows down.
50
● In the kidneys the release of renin is decreased, these effects decrease BP and stabilizes the
highly excitable heart as a result workload of a heart is lessened.
INDICATIONS
● This class is specifically indicated for treatment of Supraventricular Tachycardia &
Premature Ventricular Contractions (PVCS)
● For children – antiarrhythmics are not often use for this age group
● For adults – this is usually indicated for emergency cases, the evaluation of drug regimen
should be done carefully and regularly to ensure the effectiveness and the safety of the
patient.
● This drug can enter the breast milk and has been associated w/ various side effects.
● ANTIARRHYTHMICS, III, IV ARE STRICTLY PROHIBITED TO LACTATING WOMEN.
● This is indicated for adults, older adults, that are more susceptible to drug toxicity because
of underlying conditions that would interfere w/ metabolism and excretion of the drug.
● The renal and hepatic functions should always be monitored.
PHARMACOKINETICS
Given Orally and IV
✔ ORAL – the onset is usually 20 to 30 minutes
✔ IV – the onset is immediate
● Both have a half-life of 3 to 5 hours.
● Metabolize in the liver and excreted through the urine.
CONTRAINDICATION/CAUTIONS:
1. Sinus Bradycardia (<45 beats per min), Heart Block – it can be exacerbated the therapeutic
effects of the drug
2. HF, Cardiogenic Shock, Asthma, Respiratory Depression – can be exacerbated by the
blocking beta receptors.
3. Pregnancy & Lactation – because it can cause potential adverse effects to the fetus or
neonate.
4. Diabetes, Thyroid Dysfunction – can be altered by blockage of beta receptors.
5. Renal, Hepatic Dysfunction – these diseases can interfere w/ the bioavailability and
excretion of drugs.
ADVERSE EFFECTS
CNS: Dizziness, Fatigue. Dreams, Insomnia
CV: Arrhythmias, Hypotension, Bradycardia, AV Blocks, Alteration in Peripheral Perfusion
RESPIRATORY: Bronchospasm, Dyspnea
51
GI: Anorexia, Diarrhea, Constipation, Nausea, Vomiting
OTHER: Loss of Libido, Decreased Tolerance to Exercise, Alterations in Blood Glucose Level
CLASS III ANTIARRHYTHMICS

− This class prolongs and slows down the outward movement of potassium during phase 3
of action potential. These drugs act directly on the heart muscles to prolong
repolarization and refractory period.
− All of these drugs are pro-arrhythmic and have the possibility of inducing arrhythmias,
THERAPEUTIC REACTION
1. Has the ability to prolong refractory period and repolarization
2. Increases the threshold for ventricular fibrillation
3. Used to treat life threatening arrhythmias, for which no other drugs have been effective
4. Acts on peripheral tissues to decrease peripheral resistance
INDICATIONS:
● Amiodarone
− Is the drug of choice for ventricular fibrillation and pulseless ventricular tachycardia
− Usually given to adults indicated for emergency cases
PHARMACOKINETICS
This drug is usually given orally with a 2-3 days onset.
✔ IV - immediate onset
● Half-life when it is given is 10 days
● Metabolized by the liver and excreted by through the urine

1. AV Block. Ibultilide and Dofetilide – exacerbate this health condition
2. Renal, Hepatic Dysfunction – interfere with bioavailability and excretions of drugs
3. Shock, Hypotension, Respiratory Depression, Prolonged QT Interval (the one you see I the
ECG)– depressed action potential can worsen these
ADVERSE EFFECTS:
CNS – weakness, dizziness
52
Cardiovascular – arrhythmias, heart failure
Gastrointestinal – nausea, vomiting, GI distress
Amiodarone is associated with liver toxicity, ocular abnormalities and very serious cardiac
arrhythmias
CLASS IV ANTIARRHYTHMICS
− Include two calcium-channel blockers named Diltiazem and Verapamil
− This class blocks the movement of calcium towards the cell membrane
ACTIONS
- Usually depresses the action potential generation and slows down the phase 1 and 2 of
action potential
- Slows both conduction and automaticity
INDICATIONS
● Other uses of diltiazem and verapamil include treatment for hypertension and angina
● Usually indicated for emergency cases
PHARMACOKINETICS
✔ ORALLY - onset of 30-60 minutes
✔ IV - immediate onset
● Half-life of 3.5-6hours
● Metabolized in the liver and excreted by through the urine
CONTRAINDICATIONS:
1. Allergy to calcium-channel blockers
2. Heart block (sick sinus syndrome)
3. Heart failure, hypotension
4. Pregnancy, lactation
5. Renal and hepatic dysfunction
ADVERSE EFFECTS
CNS – weakness, dizziness, fatigue, depression, headache
CV – hypotension, shock, edema, heart failure arrhythmia
GI – nausea, vomiting, GI distress
53
1. Assess for the mentioned contraindications to this drug – check for renal dysfunction,
heart block, HF, etc. to prevent potential adverse effects
2. Conduct thorough physical assessment before beginning drug therapy – we need to
establish baseline status, determine the effectivity and evaluate the potential adverse
effects
3. Assess patient’s neurological status – to determine potential CNS drug effect
4. Assess cardiac status closely – by getting the BP, heart rate, rhythm, heart sounds, etc.
to determine whether the change in drug dose is imperative
5. Monitor respiratory rate, rhythm, and depth – to assess for respiratory depression and
the exchange associated with the development of heart failure
6. Monitor laboratory test results including CBC, renal and liver function tests. – to
determine the needs in possible change of dose and identify and toxic effects

1. Decreased cardiac output related to cardiac effects of the drug
2. Ineffective tissue perfusion related to decreased blood flow to different parts of the
body
3. Altered sensory perception related to CNS drug effects
4. Risk for injury related to weakness and dizziness
iii. NURSING INTERVENTIONS

1. Titrate the dose to the smallest amount enough to manage arrhythmia – to
decrease the risks of drug toxicity
2. Monitor cardiac rhythm closely – for us to detect serious potential adverse effects
and to evaluate drug effectiveness
3. Provide comfort and safety measures – ex. Raising side rails, adequate room
lighting, noise control, etc.
4. Ensure maintenance of emergency drugs and equipment at bedside – to promote
prompt treatment in cases of severe toxicity
5. Educate patient on drug therapy including drug name, its indication and adverse
effects to watch out for – enhance the patient’s understanding to the drug therapy
which will eventually promote adherence to drug regimen
iv. NURSING EVALUATION

1. Monitor patient response to therapy through assessment of cardiac output and
rhythm
2. Monitor for adverse effects (e.g., sedation, respiratory depression, CNS effects)
54
3. Evaluate patient understanding on drug therapy by asking patient the name the
drug, its contraindication and adverse effects to watch for
4. Monitor patient compliance to the drug therapy
ANTI ANGINAL
⮚ Used to help restore the appropriate supply-demand ratio in oxygen delivery to the
myocardium.
⮚ An imbalance in this ratio will be manifested by pain which is most commonly due to
coronary artery disease or CAD. In CAD lumens in the blood vessels become narrow so that
blood is no longer able to flow freely to the muscle cells. The narrowing may be caused by
heromas or fatty tumors. This deposit causes damage to the intimal lining of vessels. The
body response to the lack of oxygen in the heart muscles is pain which is what we call
angina.
55
3 TYPES OF ANGINAS
⌧ Stable angina (pain is relieved by rest)
● Which mean is that the pain can be relieve by rest
⌧ Unstable angina (preinfarction angina)
● Which mean is that the preinfarction angina
⌧ Prinzmetal angina (spasm of blood vessel)
● Which mean is that spasm of blood vessel
Anginal agents are effective and maybe used in combination to achieve good pain control.
Antianginal drugs has defined classification we have the three most common
Antianginal drugs:
NITRATES
Are antianginal agents that provide fast action to directly relax smooth muscles and
depress muscle tone without affecting nerve activity. Nitrates reduce preload and
myocardial muscle tensions by dilating the veins, they reduce after the load by dilating
the arteries both of this action lower oxygen demand by decreasing the workload of the
heart.
THERAPEUTIC ACTION: the main effect is drop in systemic drop pressure to

compensate by decreasing the blood flow
to healthy arteries and veins because effective vessels already loss their elasticity
DRUG CHOICE: Nitroglycerin
INDICATIONS: treatment of acute angina, prophylaxis of angina, intravenous

treatment of angina unresponsive to beta-blockers or organic nitrates, perioperative
hypertension, and heart failure associated with acute. MI: to produce controlled
hypotension during surgery.
PHARMACOKINETICS
-for its route it can be given in different ways
through IV which is onset: 1-3 minutes; duration: 3-5 minutes.
56
It can be also be given sublingually has an onset of 1-3 minutes and a duration of 30-60
minutes
It can be also given through translingual spray which has an onset of 2 minutes and a
duration of 30-60 minutes.
It can be given as a transmucosal tablet which has an onset of 1-2 minutes and a
duration of 3-5 minutes
It can be given also as an oral tablet which has an onset of 20-45 minutes and a duration
of 8-12 hours.
As a topical ointment which has an onset of 30-60 minutes and a duration of 4-8 hours
and
transdermal patch which has an onset of 30-60 minutes and a duration of 2-4 hours
now its half-life is 1-4 minutes and it is metabolized the liver and it excreted
ADVERSE EFFECTS: Hypotension, headache, dizziness, tachycardia, rash, flushing,

nausea, vomiting, sweating, and chest pain.
NURSING ASSESSMENT
❖ Presence of mentioned contraindications and cautions

❖ Skin color and integrity. Especially for transdermal patch or topical forms of
nitrates
❖ Pain and activity level
❖ Neurological status level of consciousness. Affect, reflexes etc.
❖ Cardiopulmonary status (like BP). Taking heart rate in full minute
❖ Electrocardiogram as ordered
❖ Laboratory tests (CBC, LIVER AND KIDNEY FUNCTION TESTS. ETC…)
● BETA-BLOCKERS
● CALCIUM CHANNEL BLOCKERS
NURSING DIAGNOSIS
57
⇨ Decreased cardiac output related to vasodilation and hypotensive effects of the drug.
⇨ Risk for injury related to adverse effects on neurological and cardiovascular status.
⇨ Ineffective tissue perfusion related to low oxygen supply to myocardial cells.
NURSING INTERVENTIONS
● Instruct patients not to swallow sublingual preparations to ensure therapeutic effects.
● Ask for the presence of a burning sensation to ensure drug potency.
● Protect drugs from sunlight to maintain drug potency.
● For sustained release forms. Take drugs with water and do not crush because these
preparations need to reach GIT intact.
● Rotate injection sites and provide skin care as appropriate.
● Avoid abrupt stop of long-term therapy. Taper doses for 4-6 weeks.
● Provide comfort measures.
EVALUATION
● Monitor patient response to therapy (Pain assessment)
● Monitor for presence of mentioned adverse effects.
● Monitor for effectiveness of comfort measures.
● Monitor for compliance to drug therapy regimen.
● Monitor laboratory tests.
BETA-ADRENERGIC BLOCKERS
-are drugs which block or lyse the effects of sympathetic stimulation. They are also called
SYMPATHOLYTICS.
ACTION OF THE DRUG:

It decreases blood pressure, contractility, and heart rate by blocking the beta receptors in the
heart and chuchu apparatus of the kidney. These combined effects reduce the oxygen demand
of the heart. This is usually used in therapy with nitrates because of reduced adverse effects
and increased exercise tolerance. It is not indicated for variant angina because therapeutic
drugs can cause vasospasm.
DRUG CHOICE: Metoprolol
INDICATIONS:
✔ Treatment of stable angina pectoris
58
✔ Used for treatment of hypotension
✔ Prevention of Reinfarction in MI patients
✔ Treatment of stable, symptomatic Heart failure.
PHARMACOKINETICS
Can be given orally, just an onset of 15 minutes and a duration of 15-19 hours. Can also be
given through IV, immediate onset and has a duration of 15-19 hours, its half-life is 3-4 hours
and metabolize in the liver and excreted in the urine.
ADVERSE EFFECTS:
Dizziness, vertigo, heart failure, arrhythmia, gastric pain, flatulence, diarrhea, vomiting, potence
and decreased exercise tolerance.
NURSING ASSESSMENT:
● Assess for presence of mentioned contraindications and cautions.
● Assess neurological status.
● Monitor blood pressure and heart rate accurately.
● Auscultate lungs to determine presence of possible respiratory adverse effects.
● Check color and sensation of extremities. Measure capillary refill.
● Monitor laboratory test results (electrolyte level and renal function tests)
NURSING DIAGNOSIS
⇨ Decreased cardiac output related to decreased heart rate, blood pressure, and
contractile properties of the heart.
⇨ Ineffective tissue perfusion related to decreased blood flow to the heart.
⇨ Risk for injury related to possible alterations in CNS while on drug therapy.
NURSING INTERVENTIONS:
● Give drugs as ordered following safe and appropriate administration.
● Provide comfort measures.
● Monitor cardiopulmonary status closely.
● Educate clients about the need to not abruptly stop therapy as this can lead to rebound
hypertension and myocardial infarction.
EVALUATION:
59
● Monitor patient response to therapy (pain assessment)
CALCIUM-CHANNEL BLOCKERS
-are drugs which block heart contraction by inhibiting movement of calcium ions, thereby
altering arterial and cardiac muscle action potentials.
-they basically produce vasodilation and relief of spasm.
ACTION OF THE DRUG:

Blocking contractions, loss of muscle tone vascular vasodilation occur consequently decreasing
peripheral resistance. Also release vasospasm and variant angina to which eventually decreases
the blood flow to the heart.
INDICATIONS:
✔ Treatment of Variant Angina

✔ Chronic Angina
✔ Effort –associated angina
PHARMACOKINETICS
Given orally and Intravenously, it has a half life of 3/2 to 6 hours and a maximum up to 7 hours.
Metabolize in the liver and excreted in the urine.
CONTRAINDICATIONS/CAUTIONS:
⌧ Allergy to drugs
⌧ Heart block and sick sinus syndrome
⌧ Renal and hepatic dysfunctions
⌧ Heart failure
ADVERSE EFFECTS
CNS: Dizziness, lightheadedness, fatigue and headache
GI: Nausea, hepatotoxicity effect of the drug
60
CV: Hypotension, Bradycardia, Peripheral edema
EENT: Flushing, rash
NURSING ASSESSMENT:
● Assess for presence of mentioned contraindications and cautions.
● Inspect skin color and integrity to determine presence of adverse effects on skin.
● Assess the patient's complaint of pain and the activity level prior to and after the onset
of pain.
● Monitor cardiopulmonary status closely as the drug can cause severe effects on these
two body systems.
NURSING DIAGNOSIS
⇨ Decreased cardiac output related to hypotension and vasodilating effect of the drugs.
⇨ Risk for injury related to cardiovascular and CNS adverse drug effects.
NURSING INTERVENTIONS:
● Monitor blood pressure and heart rate and rhythm.
● Provide comfort measures for the patient to tolerate side effects.
● Educate clients on measures to avoid angina attacks.
● Emphasize to the client the importance of strict adherence to drugs.
● Therapy to ensure maximum therapeutic effects.
EVALUATION:
● Monitor patient response to therapy.
LIPID LOWERING AGENTS

- these drugs are sometimes called antihyperlipidemic agents used to treat hyperlipidemia (an
increase in the level of lipids in the blood).
- the lipid-lowering agents lower serum levels of cholesterol and various lipids. These include
bile acid sequestrants, HMG-COA reductase inhibitors, and cholesterol and cholesterol
absorption inhibitors.
61
BILE ACID SEQUESTRANTS
Example of drugs under this are:
- CHOLESTYRAMINE (P)- the drug of choice
- COLESEVELAM
- COLESTIPOL
THERAPEUTIC ACTIONS AND INDICATIONS:

● Bind with bile acids in the intestine to form an insoluble complex that is then excreted in
the feces.
● The serum levels of cholesterol and LDL will decrease.
For its pharmacokinetics, this is not absorbed systemically. They act while in the intestines and
secreted directly in the feces.
● Allergy to the drug
● Complete Biliary Obstruction
● Abnormal Intestinal Function
● Pregnancy or Lactation
ADVERSE EFFECTS:
A person receiving these drugs would sometimes manifest:
● Headache
● Anxiety
● Fatigue
● Drowsiness
● GI Irritation
● Increased bleeding time
For the bile acid sequestrants,
1. We need to mix the dry form of the drug in juice, soups, or liquids.
2. Tablets are not chewed or crushed.
3. Drug is given before meals
4. Oral med: 1 hour before and 4-6 hours after the bile sequestrants.
62
HMG-COA REDUCTASE INHIBITORS:
Examples of drugs under this are:
- ATORVASTATIN (P)- w/c is the drug of choice
- FLUVASTATIN
- LOVASTATIN
- PRAVASTATIN
- ROSUVASTATIN
- SIMVASTATIN

● It blocks HMG-COA reductase from completing the synthesis of cholesterol.
● Indicated as adjuncts with diet and exercise for the treatment of increased cholesterol
and LDL levels.
For its pharmacokinetics, these are all absorbed from the GI tract and undergo first pass
metabolism in the liver, they are excreted through feces & urine.
CONTRAINDICATIONS AND CAUTION:

● Allergy
● Active liver disease or a history of alcoholic liver disease
ADVERSE EFFECTS:
● GI effects
● CNS effects
For HMG-COA Inhibitors
1. Avoid using grapefruit juices- may alter the metabolism leading to fatal rhabdomyolysis
with renal failure
2. Administer at bedtime
CHOLESTEROL ABSORPTION INHIBITOR:

Drug under this is,
● Ezetimibe
63
● It works in the brush border of the small intestine to decrease the absorption of dietary
cholesterol from the small intestine.
For its pharmacokinetics, this is absorbed well after oral administration, reaching peak levels for
4-6 hours.

● Allergy to the drug
● Pregnancy or lactation
● Severe liver disease
ADVERSE EFFECTS:
● Mild abdominal pain & diarrhea
● Headache
● Dizziness
● Fatigue
● Upper respiratory tract infection
● Back pain
● Muscles aches and pains
For cholesterol absorption inhibitors,
1. Monitor serum cholesterol levels daily
DRUGS AFFECTING BLOOD COAGULATION:

- is a complex process that involves vasoconstriction, platelet clumping or aggregation and
casket of clotting factors produced in the liver.
- the system must maintain an implicit balance between the tendency to clot and form a solid
state all coagulation and the need to un-clot or reverse coagulation to keep the vessels open
and the blood flowing.
- these orders that are directly related to the clotting process include thromboembolic disorder
in w/c too much clotting can lead to emboly and occlusion of blood vessels and hemorrhagic
disorders including hemophilia in w/c lack of efficient clotting can lead to excessive blood loss.
DRUGS AFFECTING CLOT FORMATION AND RESOLUTION:
64
- These drugs decrease the formation of the platelet plug by decreasing the responsiveness of
the platelets to stimuli that would cause them to stick and aggregate on a vessel wall.
ANTIPLATELET AGENTS:
The drugs affect clot formation & resolution,
● ASPIRIN (P) – the drugs of choice
● CILOSTAZOL
● CLOPIDOGREL
● DIPYRIDAMOLE
● EPTIFIBATIDE
● SULFINPYRAZONE
● TICLOPIDINE
TIRO
THERAPEUTIC ACTIONS & INDICATIONS

● Blocks receptor sites on the platelet membrane, preventing platelet-platelet interaction
w/ other clotting chemicals.
● Treat cardiovascular diseases that are prone to produce occluded vessels;
● For maintenance of venous & arterial grafts;
● To prevent cerebrovascular occlusion;
● Adjuncts to thrombolytic therapy in the treatment of MI (myocardial infarction)
PHARMACOKINETICS
It is commonly administered orally. These are well absorbed & highly bound to plasma proteins.
This is metabolized in the liver & excreted in the urine. This also enters the breastmilk
CONTRAINDICATIONS & CAUTIONS

● Allergy
● Use w/ caution to clients w/ known bleeding disorder; recent surgery; & closed head
injury.
ADVERSE EFFECTS
● Increased bruising & bleeding while brushing teeth
● Nausea & GI distress
1. ANTICOAGULANTS:
65
● Heparin (P) – drug of choice
● Warfarin

● Interfere w/ the normal cascade of events involved in the clotting process.
● Warfarin causes a decrease in the production of Vitamin K – dependent clotting factors
in the liver.
2. THROMBOLYTIC AGENTS:
● Alteplase
● Reteplase
● Streptokinase
● Tenecteplase
● Urokinase (P) – drug of choice.

● Work to activate the natural anticlotting system – conversion of plasminogen to
plasmin.
PHARMACOKINETICS
This is usually given IV & are cleared from the body after liver metabolism. They cross the
placental barrier.

● Allergy
● Any bleeding condition
● Pregnancy
ADVERSE EFFECTS
● Common w/ the use of thrombolytic agents
OTHER DRUGS W/C ALSO AFFECTS CLOTTING

FORMATION & RESOLUTION:
● Low-molecular-weight heparins (Dalteparin, Enoxaparin, Tinzaparin)
● Anticoagulant adjunctive therapy (Lepirudin, Protamine Sulfate, Vitamin K)
66
● Hemorrheologic agents (Pentoxifylline)
● C-reactive protein (Drotrecogin alfa)

● Inhibit thrombus & clot formation by blocking factors XA & IIA.
● A Xanthine-decreases platelet aggregation & decreases fibrinogen concentration in
blood.

● Allergy
ADVERSE EFFECTS
● Allergy
DRUGS USED TO CONTROL BLEEDING

Bleeding disorders are treated w/ clotting factors & drugs that promote the coagulation
process. This includes antihemophilic agents & hemostatic agents.
1. Antihemophilic agents
● Antihemophilic factor (P) – drug of choice
● Antihemophilic factor recombinant
● Coagulation factor VIIA
● Factor IX complex

● These drugs replace clotting factors that are either genetically missing or low in a
particular type of hemophilia: (Hemophilia – is a genetic lack of clotting factors)
PHARMACOKINETICS
This is given IV & processed by the body in the same way that naturally occurring clotting
factors are processed in the plasma. It has a half-life of 24-36 hours.
2. Hemostatic agents
● These are used to stop bleeding & may either be systemic or topical.
a)SYSTEMIC
67
● Aminocaproic acid
THERAPEUTIC ACTIONS & INDICATIONS OF SYSTEMIC HA:

● Inhibits plasminogen-activating substance & has some antiplasmin activity.
● Used to prevent body-wide or systemic clot breakdown, thus preventing blood loss.
PHARMACOKINETICS
It is available both in oral & IV forms. This is rapidly absorbed & widely distributed. It is excreted
unchanged in urine. With a half-life of 2 hours.
B) TOPICAL
● Absorbable gelatin
● Human fibrin sealant
● Microfibrillar collagen
● Thrombin
● Thrombin recombinant
THERAPEUTIC ACTIONS & INDICATIONS OF TOPICAL HA:

● Used for surface injuries where small blood vessels are damaged & blood is slowly &
continually lost.
PHARMACOKINETICS
These are available in spray, sponge & absorbable gelatin sponge.
DRUGS USED TO TREAT ANEMIAS
Anemia results from some alterations in erythropoiesis, the process of RBC production w/c
occurs in the myeloid tissue in the bone marrow.
Anemia can be categorized as deficiency, iron deficiency, megaloblastic like folic acid or Vitamin
B12 deficiency or hemolytic. (i.e., sickle cell)
Erythropoiesis-stimulating agents
68
Patients who are no longer able to produce enough erythropoietin in the kidney may benefit
from the treatment w/ exogenous erythropoietin (EPO), w/c is available as the drugs epoetin
alfa, darbepoetin alfa, & methoxy polyethylene glycol-epoetin beta.
69
● Epoetin alfa acts like the natural glycoprotein erythropoietin to stimulate the production
of RBCs in the bone marrow. This is indicated to treat anemia w/ renal failure & for
patients on dialysis; for anemia associated w/ AIDS therapy; & for anemia associated w/
cancer chemotherapy when the bone marrow is depressed & the kidneys may be
affected by the toxic drugs.
PHARMACOKINETICS
All drugs can be given IV or by subcutaneous injection. This is metabolized in the serum w/c
slow onset & fix from 5-24 hours.

● Uncontrolled hypertension
● Allergy
● Lactation
AGENTS USED FOR IRON-DEFICIENCY ANEMIA

The iron preparation available includes ferrous fumarate, ferrous gluconate, ferrous sulfate,
ferrous sulfate exsiccated, iron dextran, iron sucrose, & sodium ferric gluconate complex.

● Iron preparations elevate the serum iron concentration. They are either converted to
hemoglobin or trapped in reticuloendothelial cells for storage & eventual release &
conversion into usable form of iron for RBC production.
● Indicated for the treatment of iron-deficiency anemias & may also be used as adjunctive
therapy in patients receiving an erythropoiesis-stimulating drug.
PHARMACOKINETICS
This is primarily absorbed from the small intestine by an active transport system. They are
bound to transfer & transport in the blood. Small amounts are lost daily in the sweat, urine,
sloughing of the skin & mucosal cells & sloughing of intestinal cells as well as menstrual flow
among women.

● Allergy
● Hemochromatosis; hemolytic anemias (may increase serum iron levels & cause toxicity)
● Peptic ulcer, colitis or regional enteritis
70
ADVERSE EFFECTS
GI irritation:
● GI upset
● Anorexia
● Nausea
● Vomiting
● Diarrhea
● Dark stools
● Constipation
AGENTS USED FOR OTHER ANEMIAS:

Agents used for megaloblastic anemias:
● Folic acid
● Leucovorin
● Vitamin B12

● Given as replacement in high-demand states such as pregnancy & lactation.
PHARMACOKINETICS
Parenteral drugs are preferred for patients w/ potential absorption problems.
Agent used for sickle cell anemia

● Hydroxyurea

● Taken for several months. Increases the amount of fetal hemoglobin produced in the
bone marrow & dilutes the formation of the abnormal hemoglobin in adults.
PHARMACOKINETICS
This is given orally, absorbed well from the GI tract.
● Inform clients that anti-anemic agents usually cause dark stools.
71
● Encouragement to increase intake of fluid to prevent constipation.
● Give health teachings on the common side effects & provide assistance.
DRUGS ACTING ON THE RESPIRATORY SYSTEM

DRUGS ACTING ON THE UPPER RESPIRATORY TRACT
● These drugs work to keep the airways open and gases moving efficiently.
ANTITUSSIVE
● These drugs suppress the cough reflex.
The Drugs under this are:
● Codeine
● Dextromethorphan (p)
● Benzonatate
● Hydrocodone
Therapeutic actions and indication:
● Act directly on the medullary cough center of the brain to depress the cough reflex.
● Others have a direct effect on the respiratory tract.
● These drugs are indicated for nonproductive cough.
Pharmacokinetics: This is rapidly absorbed metabolizing delivery and excreting in the urine, this
should not be used in pregnancy and lactation.
Dextromethorphan
● To control the non-productive cough, it depresses the cough presence to the medulla to
control the cough spasm.
● Half-life of 2-6 hours
-metabolize in the liver and excreted in the urine.
Adverse effect: Dizziness, depression and dry mouth.
● Assess respiration and adventitious sounds
● Ensure that drug is not taken any longer than recommended
● Provide other measures to relieve coughing.
72
DECONGESTANTS
● It decreases the over production of secretion by causing local vaso secretion
3 TYPES
1. Topical Nasal
2. Oral
3. Topical Nasal Steroid Decongestant
Topical Nasal:
● EPHEDRINE (P)
● OXYMETAZOLINE
● PHENYLEPHRINE
● TETRAHYDROZOLINE
● XYLOMETAZOLINE
Therapeutic Actions and Indications:
● Sympathomimetics – imitate the effects of the SNS to cause vasoconstriction leading to

decreased edema and inflammation of nasal membranes.
Pharmacokinetics: Immediate and less chance of systemic effects.
Oral: Pseudoephedrine (p)
● Taken orally to decrease nasal congestion related to common cold, sinusitis, and allergic
rhinitis.
● Also used to relieve pain and congestion of otitis media.
● Shrink mucous membrane by stimulating the alpha-adrenergic receptors.
Pharmacokinetics: widely distributed in the body, metabolizing the liver, and excreted in the
urine.
TOPICAL NASAL STEROID DECONGESTANTS:
● Beclomethasone
● Budesonide
● Dexamethasone
● Flunisolide (P)
73
● Fluticasone
● Triamcinolone
● Very popular in the treatment of allergic rhinitis

● Produce direct local effect that blocks many of the complex reactions responsible for
anti-inflammatory response
Pharmacokinetics: the action is not immediate and requires 1 week for changes.
Nursing Consideration:
● Have the patient clear the nasal passages before using the drug.
● Take the drugs regularly.
ANTIHISTAMINES
First Generation Antihistamine
● Buclizine
● Cyclizine
● Dexchlorpheniramine
● Diphenhydramine (p)
● Meclizine
● Chlorpheniramine clemastine
● Dimenhydrinate
● Hydroxyzine
● Promethazine
● Block the release or action of histamines.

● Relief from itchy eyes, selling, congestion, drippy nose.
● Used for amelioration of allergic reactions.
Pharmacokinetics: well absorbed orally and metabolize the liver and excreted in the feces and
urine.
Second Generation Antihistamine
● Azelastine
● Desloratadine
74
● Levocetirizine
● Cetirizine
● Fexofenadine
● Loratadine
Therapeutic Actions and Indications: has less sedating effects
Pharmacokinetics; well absorbed orally with action ranging to 1-2 hours.
Adverse Effects: Drowsiness, sedation, Dizziness, Epigastric Distress, Thickening of Bronchial

Secretions, Urinary Frequency, Rash, Bradycardia.
Nursing Consideration:
● Administer Drug on Empty Stomach

● Dry Mouth: Suggest Sugarless Candies or Lozenges.
EXPECTORANTS (Guaifenesin)
Therapeutic Actions and Indications: enhances the output of respiratory tracts fluids by
reducing the adhesiveness and surface tension of these fluids.
Pharmacokinetics: rapidly absorbed with an onset of 30mins in duration of 4-6 hours.
MUCOLYTICS
⮚ Acetylcysteine
⮚ Dornase Alfa
Therapeutic Actions and Indications: affects the mucoproteins in the respiratory secretions
by splitting apart disulfide bonds that are responsible for holding the mucus material
together.
Pharmacokinetics; administered by nebulization or direct installation, half-life of 6.25

hours.
Adverse Effect: nausea, stomatitis, urticaria, bronchospasm, rhinorrhea.
Nursing Considerations:
● Avoid combining with other drugs in a nebulizer.

● Dilute concentrate with sterile water for injection.
● Provide health teaching on the use of nebulizer.
75
DRUGS ACTING ON THE LOWER RESPIRATORY TRACT
Bronchodilators/Antiasthmatics
● Medications used to facilitate respirations by dilating the airways.

● Xanthines
● Sympathomimetics
● Anticholinergics
Therapeutic Actions and Indications: has a direct effect on the smooth muscle of the
respiratory tract, both in the bronchi and in the blood vessels.
Pharmacokinetics: rapidly absorbed in the GI tract when given orally and widely distributed and
metabolized in the urine. Half-life of 3-15 hours for non-smoker and 4-5 hours to smoker
Adverse Effects: irritability, restlessness, dizziness, palpitations, life threatening…
Nursing Consideration: administer oral drugs with food or milk.
SYMPATHOMIMETICS (Epinephrine)
● Mimics the effects of the sympathetic nervous system.

● Used as bronchodilators and are Beta2 selective agonists.
Pharmacokinetics: available only as inhalants, this has-life is unknown but it metabolizes

normal neural pathways.
Adverse Effects: fear, anxiety, restlessness, headache, nausea, decreased renal formation,
pallor, palpitation, etc.
Anticholinergics (Ipratropium and Tiotropium)

Therapeutic Actions and Indications: block or antagonize the action of the neurotransmitter
acetylcholine at vagal-mediated receptor sites.
Pharmacokinetics: excreted unchanged in the urine, used as an inhalation agent, half-life is

unknown but it is metabolized by neural pathways.
Adverse Effects: Nervousness, Dizziness, Headache, Nausea, GI distress, cough, Palpitations.
DRUGS AFFECTING INFLAMMATION
76
● Drugs used to affect inflammation are the inhaled steroids, the leukotriene, receptors,
and a mast cell stabilizer.
Inhaled Steroids
● Beclomethasone
● Budesonide
● Flunisolde
● Fluticasone
● Triamcinolone
Therapeutic Actions and Indications: decrease the effectiveness of the inflammatory cells.
Effects: Decreased swelling associated with inflammation and promotion of Beta-Receptor

activity that promote smooth muscle relaxation and inhibit bronchoconstriction.
Pharmacokinetics: rapidly absorbed from the respiratory tract but they take 2-3 days for
effectiveness. Has a Half-life of 2-3 hours.
Nursing Considerations:
- Do not administer to treat an acute asthma attack or status asthmaticus

- Have the patient use decongestant drops before using the inhaled steroid
- Have the patient rinse the mouth after using inhaler
Leukotriene Receptor Antagonist (Zafirlukast)

- Selectively and competitively block or antagonize receptors for the production of

leukotrienes.
Pharmacokinetics: given orally with rapidly onset
Adverse effect: headache, dizziness, nausea, generalized pain and fever infection.
Nursing consideration: administer drug on empty stomach to increase bioavailability.
Mast Cell Stabilizer (Cromolyn)

Therapeutic Actions and Indications: inhibit the release of histamine and inhibit the release of
SRSA.
77
Pharmacokinetics: inhaled capsule may reach effect for 1 week, slow onset.
Adverse Effect: headache, dizziness, nausea, sore throat, etc.
Lung Surfactant
- These are naturally occurring compounds or lipoproteins containing lipids and proteins
that reduce the surface tension within the alveoli, allowing expansion of the alveoli for
gas exchange.
DRUGS: Beractant, Calfactant, and Protectant.
Therapeutic Actions and Indications: used to replace the surfactant that is missing in the lungs
of neonates with RDS.
Pharmacokinetics: instill directly on trachea
Adverse effect: patent ductus arteriosus, radychardai. Etc.
DRUGS ACTING ON THE GASTROINTESTINAL SYSTEM

DRUGS ACTING IN THE GASTROINTESTINAL SYSTEM
- drugs acting in the gastrointestinal system for most gastrointestinal disorders
treatment is conservative symptomatic and supportive typically it begins with diet
therapy rest and stress management so if these are ineffective
- It may require drug therapy or surgery so the drug therapy may be used to one is
treat a specific disease such as a digestive enzyme deficiency hepatic
encephalopathy acute poisoning peptic ultra-ulcer disease or gastroesophageal
reflux
- The next one is to control the signs and symptoms of disease such as nausea,
vomiting epigastric pain dyspepsia flatulence diarrhea and constipation depending
on the disorder
- the doctor may select for or form the peptic ulcer drugs anti-flatulence digestants,
anti-diarrhea and laxatives or perhaps anti-matrix and with the new teeth she can
take on more solid foods digestion starts in the mouth teeth grind up the food then
special glands under the tongue pump out saliva to help break down and lubricate
78
- the food on the it's 12 hours 13 foot journey through the gut will pass from the
stomach into the coils of the small intestine before finally passing into the large
intestine.
–Waves of contracting muscle keep the food moving in a process called
PERISTALSIS. These contractions are so powerful we can even do it upside down.
This is how food travels to our body and into ours into the stomach.
- Food enters the stomach through a hole at the top the stomach is a bag of muscle
that churns squashes and squeezes foods into liquid at the same time acids break
the food down the stomach walls or the stomach walls protect themselves with a
lining mucus and without the acids could digest parts of the stomach itself causing
stomach ulcers.
- about an hours later the stomach squeezes the broken down food out through a
tiny hole called "the pyloric sphincter"
- The food enters the small intestine an 11 foot coil of tube where we absorb most
of the nutrients the interior wall of the small intestine is lined with millions of
microscopic projections called "VILLI" this increases the surface area of the gut
making it easier to absorb nutrients.
- First the pancreas pump out a juice that neutralizes stomach acid then bile the
liver breaks down the fats into the tiny droplets smaller droplets are easier for the
intestine to absorb after an hour and half
- the small intestine has absorbed most of the nutrients from the food it's time for
what remains to move on and enters the large intestine through this the illusive
sphincter which is above that keeps our foods from going back where it came from
what's left is a mix of waste food and dead cell form the walls of the gut.
- The large intestine job is to extract water from it lots of the bacteria live here too
it is not because of an infection we actually need them they produce enzymes that
breaks down complex carbohydrates in our food carbohydrates we couldn't
otherwise digest and finally about 12 hours we expelled what's left of our first
meal.
GASTROINTESTINAL DRUGS
79
- H2 receptor blocker reduce the acid producing stomach lining so the blocker are
orally consumed to reduce the production of acid in the stomach
Examples:
✔ Clonidine
✔ Famotidine
✔ Nizatidine
✔ Ranitidine
- The drugs is dissolved when it enters their stomach
- It then passes through the small intestine, where it is absorbed into the
bloodstream
- The drug then movers along the bloodstream up, back towards the heart
- The h2 blocker stops the production of the stomach acid produced in the gastric
pits within the stomach lining.
- The gastric pits are made up of cells, in which the production of acid is located in
the parietal cell.
- The parietal cell has receptors that need to be stimulated to produce the acid.
The will be stimulated by:
✔ gastrin
✔ acetylcholine
✔ histamine
- causing the creation of hydrochloric acid, which is then dispensed into the pits to
be released into the stomach.
- To reduce the production of acid, the h2 blockers will prevent the histamine
receptor to be stimulated.
- The h2 blockers travel through the capillaries that run within the stomach lining.
- The dry goes through the interstitial cells, finding its way to the histamine
receptor.
- The histamine is produced by the Enterochromaffin cell (ECL)
80
- While the other receptors are still stimulated, the h2 blocker blocks the histamine
from the receptor, preventing the production of the acid.
PHARMACOKINETICS
- For pharmacokinetics cemetery nizatidine and ranitidine are absorbed rapidly and
completely from the GI tract
- FAMOTIDINE isn't absorbed completely so food and antacids may reduce the
absorption of h2 receptor of antagonist so these drugs are distributed widely
through with throughout the body metabolized by the liver and excreted primarily
in the urine
ADVERSE EFFECTS
✔ CONSTIPATION, DIARRHEA, NAUSEA

✔ DIZZINESS
✔ HEADACHE
✔ IMPOTENCE, LOSS OF LIBIDO
✔ MALAISE
✔ MYALGIA
✔ PRURITUS, RASH
✔ REVERSIBLE AGITATION, CONFUSION, DEPRESSION, HALLUCINATIONS
- Now usually this adverse reaction may occur in patients receiving h2 receptor
antagonist especially in geriatric patients in those with altered hepatic or renal
function
CIMETIDINE
- which is drug of choice and ranitidine may produce this reaction Headache is
the most common reaction and occurs in about 2% of patients followed by
constipation or diarrhea and rash reversible confusion agitation depression
and hallucinations may also occur so these reactions are more common in
patients receiving cimetidine especially in severely ill or elderly patients with
decreased renal function.
NURSING CONSIDERATION:
81
✔ DON'T GIVE ANTACID WITHIN 1 HOUR OF H2-RECEPTOR ANTAGONIST
ADMINISTRATION
✔ MONITOR THE PATIENT FOR PROFOUND BRADYCARDIA
✔ GIVE AN I.V H2-RECEPTOR ANTAGONIST TO A CRITICALLY ILL PATIENT
✔ GIVE THE H2-RECEPTOR ANTAGONIST WITHOUT REGARD TO MEAL
✔ DILUTE CIMETIDINE, FAMOTIDINE, AND RANITIDINE BEFORE I.V
ADMINISTRATION
✔ ENCOURAGE THE PATIENT TO EXPRESS CONCERNS
✔ CONSULT THE PRESCRIBER ABOUT SUBSTITUTING A DIFFERENT H2-
RECEPTOR ANTAGONIST
✔ TEACH THE PATIENT AND HIS CAREGIVER ABOUT THE PRESCRIBED DRUG
ANTACIDS
How do antacids work? - When we eat food our stomach secretes hydrochloric acid
this acids help to digest food however, sometimes when excess acid is produced it
rises from the stomach and reaches the esophagus or throat causing acidity or
heartburn - Now in order to neutralize the acid we take an
ANTACIDS
- Antacids work on simple chemistry principles, acid plus alkali produces salt and
water.
- contains alkaline like calcium carbonate or aluminum hydroxide when we take an
antacid alkali reacts with the hydrochloric acid present in our throat stomach
forming salt and water and thus neutralizing the acid in this way Antacids give us
relief from heartburn or acidity.
- Antacids or this OTC drugs or Over the Counter Drugs is used alone or with other
drugs its indication is to treat peptic ulcer disease for its pharmacogenetics antacids
don't need to be absorbed or do not need to be absorbed treat peptic ulcers they
work locally in the stomach dissolving in the gastric acid so these drug are
distributed throughout the gastrointestinal tract they do not undergo metabolism
andyan are eliminated primarily into fees
- Antacids works in the stomach dissolving in stomachs acid itself also imposes
neutralize they gastric acid reducing the total acid in the gastrointestinal tract and
82
allowing ulcers to heal they do not work by coating ulcers or the lining of the GI
tract they're usually relieve pain symptoms often acid in digestion heartburn
dyspepsia and Gerd this may be used to control hypophosphatemia in patient with
renal failure now these are also used to prevent stress ulcers and GI bleeding during
times of severe physical stress
ADVERSE EFFECTS
- A patient receiving Sodium bicarbonate usually may experiences gastric rupture
systemic alkalosis with systemic alkalosis usually the person may experience or
manifest headache, nausea irritability weakness tetany and confusion that person
receiving Sodium bicarbonate or antacid may also experience hypokalemia gastric
acid rebound - Gastric rupture, systemic alkalosis ( headache, nausea, irritability,
weakness, tetany, confusion), hypokalemia, gastric acid rebound
*monitor for evidence of hypoalbuminemia
*watch for evidence of hypophosphatemia with aluminum antacid use
*asses the patient for constipation
*urge the patient to drink plenty of fluid and eat a high - fiber diet
*shake the suspension well and have the patient drink 6 to 80 oz water
PROTON PUMP INHIBITION
- Acid produce in the stomach to help breaks down food that is eaten it is produced
by a proton pump which is found in the lining of the stomach
- sometimes the contents of these stomach flows backwards up into the food pipe
which also hold the esophagus all the way up into the throat which cause symptoms
such as Cough or Sneeze and Voice Problem this is called
"LARYNGOPHARYNGEAL REFLUX" (LPR) to help with the symptoms of the reflux
doctors may prescribe tablets or capsule from a group of medicine called "PROTON
PUMP INHIBITORS" (PPIs) there are number of different PPIs for example
:omeprazole, lansoprazole and pantoprazole and esomeprazole
83
-they all work by blocking the proton pump to reduce the amount of acid in the
stomach as a result they can reduce acid reflux which may help relieve the
symptoms of the Lpr.
PHARMACOKINETICS
- for pharmacokinetics proton pump inhibitors this drugs is unstable in acid they
are available only in enteric coated forms now after orals administration the entire
coated drugs bypass the stomach so upon reaching the small intestine they dissolve
and absorbed rapidly so these are highly protein bound extensively metabolized by
the liver to inactive compounds and then eliminated in the urinary
ADVERSE EFFECTS
Specifically by omeprazole, usually a patient receiving omeprazole may experience
or manifest HEADACHE, DIZZINESS, VERTIGO, INSOMNIA, RASH, DIARRHEA,
ABDOMINAL PAIN, NAUSEA, VOMITING, UPPER RESPIRATORY INFECTION
SYMPTOMS, COUGH.
✔ GIVE AN ANTACID WITH THE PROTON-PUMP INHIBITOR.

✔ FOR A PATIENT WHO CAN'T SWALLOW CAPSULES, OPEN ESOMEPRAZOLE OR
LANSOPRAZOLE CAPSULES, SPRINKLE THE CONTENTS ON SOFT FOOD, AND
HAVE THE PATIENT SWALLOW IT IMMEDIATELY
✔ DON'T OPEN OMEPRAZOLE CAPSULES
✔ TEACH THE PATIENT AND HIS CAREGIVER ABOUT THE PRESCRIBED DRUG
MUCOSAL PROTECTANTS
- First up is sucrose or sucralan the brand is CARAFATE which is given as a tree to
treat and prevent both stomach and duodenum or duodenal ulcers on the small
intestine
- the mode of action is it forms a thick protective layer overlooking the ulcer which
provide a physical barrier against the stomach acid and enzymes, it's kind like a
band aid over an open wound or you can think of its feelings like a path hole like a
road
84
- the big key point here is we take this to an empty stomach 1 or 2 hours before or
after foods or meds
- DO NOT take any other meds and don't be a chick question are asked a lot about
taking antacids or antacids with themselves medication we're avoiding anything and
everything so just think sucralfATE 2hrs before or after you ate and it's best at bed
time, it's better taking late.
PROSTAGLANDIN - Under this Misoprostol example of drug, its therapeutic action
and indication this drug inhibits gastric acid secretion and increases bicarbonate
and mucus production in the stomach protecting the stomach lining
PHARMACOKINETICS
- this given is given orally and it is rapidly absorbed by gastrointestinal tract
- this is metabolize the liver and excreted in the urine
- this drug crosses the placental barrier and also enters breast milk
ADVERSE EFFECTS
- Nausea, diarrhea, abdominal pain, flatulence, vomiting, excessive bleeding
or spotting, hypermenorrhea, dysmenorrhea, and miscarriage
✔ PERFORM A PREGNANCY TEST AND ASSESS NORMAL MENSTRUAL

ACTIVITY
✔ PROVIDE THE PATIENT WITH BOTH WRITTEN AND ORAL
INFORMATION REGARDING THE ASSOCIATED RISKS OF PREGNANCY
DRUGS USED TO TREAT DIGESTIVE ENZYME DYSFUNCTION
- When we talk about DIGESTIVE ENZYME, this is substances that produce in
the GI tract to break down foods into useful nutrients
- TWO DIGESTIVE ENZYMES that available for replacement in conditions that
result into normal level of this enzyme
1. SALIVA SUBSTITUTE
2. PANCRELIPASE
THERAPEUTIC ACTIONS AND INDICATIONS
85
✔ Saliva substitute contains electrolytes and carboxymethyl-cellulose to
act as a thickening agent in dry mouth conditions making the food bolus
easy to swallow
PHARMACOKINETICS
- This is available as a solution and in halogens form? (not sure hahaha) and
also on swab stick for oral administration in the mouth
- This is not absorbs systematically
DRUGS AFFECTING GASTROINTESTINAL MOTILITY
- This drugs used to affect the motor or motility of GI tract and can do
gastrointestinal tract
- They can used to speed up or improve the intestinal movement
- So under the drugs affecting GI tract motility we have
A. LAXATIVE
- UNDER LAXATIVE
1. CHEMICAL STIMULANTS
- Bisacodyl
- Cascara
- Castor oil (p)
- Senna
✔ The chemical stimulants work at the beginning at small intestine

down to the rest of GI tract by irritating the nerve plexus and it is also use
when through evacuation of intestine is desirable
PHARMACOKINETICS
- This is minimally absorbs and exert effects directly in GI tract
2. BULK LAXATIVES (mechanical stimulants)

- Magnesium citrate as a drug of choice all though there are also other drugs
that most often use which is the LEXULOUS??
THERAPEUTIC AND INDICATION
86
- this increase the motility of GI tract by increasing the fluid in the intestinal
contents which enlarges bulk, stimulates local sector and activate local
activity
PHARMACOKINETICS
- This drugs is taken orally directly effective within GI tract and generally
absorbs systematically
3. LUBRICANTS
- Docusate
- Glycerin
- Mineral oil (P) (common choice)
✔ Are oils that lubricate the intestinal wall and soften the stool,
allowing smooth passage
B. GASTROINTESTINAL STIMULANTS
- Dexpanthenol
- Metoclopramide (P) (drug of choice)
✔ Stimulates parasympathetic activity within the GI tract thus

increasing GI secretions and motility
PHARMACOKINETICS
- This drug is given IM or IV and it has a peak effect of 60-90 minutes
- This is metabolize in the liver and secreted in the urine and feces
- This drug can also cross the placental barrier and enter breast milk
C. ANTIDIARRHEALS
- Bismuth Subsalicylate
- Loperamide (P) (drug of choice)
- Opium derivatives
87
THERAPEUTIC ACTIONS AND INDICATION
✔ Slows the motility of the GI tract through direct action on the living of
the GI tract to inhibit local reflexes through direct action on the muscles on
the GI tract to slow activity, or through CNS centers that cause GI spasm
and slowing
PHARMACOKINETICS
- This absorbs in GI tract or after oral administration and metabolize in the
liver and excreted in urine
D. IRRITABLE BOWEL SYNDROME DRUGS

- Lubiprostone
- Alosetron
- Tegaserod
- Hyoscyamine
✔ Distress, bouts of diarrhea, or constipation, bloating, nausea,

flatulence, headache, fatigue, depression and anxiety
E. ANTIEMETIC AGENTS
- Decrease nausea which reduces the urges to vomit
- Antihistamine, phenothiazine, serotonin receptor antagonist
PHARMACOKINETICS
- Oral antihistamine antiemetic are absorbs well from GI tract and
metabolize primarily at liver
- So there inactive metabolize are excreted in the urine
- Phenothiazine antiemetic and serotonin receptor antagonists are absorbs
well and metabolize in the liver and excreted in urine and feces
ADVERSE EFFECTS
- ANTIHISTAMINE AND PHENOTHIAZINE ANTIEMETICS PRODUCE SOME
DROWSINESS. ANTIHISTAMINES MAY CAUSE PARADOXICAL CNS
STIMULATION
88
- ANTIHISTAMINE ANTIEMETICS MAY CAUSE MILD NAUSEA, EPIGASTRIC
DISTRESS, OR ANOREXIA.
- HYPOTENSION AND ORTHOSTATIC HYPOTENSION WITH TACHYCARDIA,

SYNCOPE, AND DIZZINESS ARE COMMON ADVERSE REACTIONS TO THE
PHENOTHIAZINE ANTIEMETICS
- HYPERSENSITIVITY REACTIONS, MANIFESTED BY RASHES AND
PHOTOSENSITIVITY
✔ Take seizure precautions if giving a phenothiazine antiemetic to a

patient prone to seizures
✔ If giving an antihistamine to a child, watch for evidence of
paradoxical CHS stimulation
✔ Observe the patient for extrapyramidal symptoms
✔ Evaluate hematologic test results for signs of blood dyscrasias
✔ Assess the patient regularly for vision and hearing changes
DRUGS ACTING IN THE ENDOCRINE SYSTEM
ENDOCRINE SYSTEM
Our body is always in motion when we are cold, our body shivers, when we are hot our body
sweats. Our body engages in these activities to keep our internal temperature constant.
HOMEOSTASIS
The ability of the body to maintain a constant internal state.
❖ One major way of body maintaining homeostasis is through the endocrine system.
ENDOCRINE SYSTEM
The system of glands that produce hormones to regulate and control bodily activities.
❖ The endocrine system controls a number of important functions throughout the body
including GROWTH & DEVELOPMENT, METABOLISM & HOMEOSTASIS.
❖ There are many different hormones in the body and each is responsible for different
functions: estradiol, testosterone, insulin, growth hormone & epinephrine.
89
Hormones work in similar manner:
❖ A gland detects a change in the body’s internal environment. ThIS gland then increases the
secretions of the hormones w/c enters the bloodstream. Hormones travel through the blood
and can have potential effects throughout the body. However, hormones will not act on
every cell hormone, activate target cells by binding to specific receptors on the inside or
outside of target cells. What a hormone binds to a receptor, the receptor sends a signal
throughout the cell just like a megaphone, a hormone message is amplified inside the cell,
this signal goes a long way, just a few hormones can induce great change.
❖ Once hormones have succeeded in sending their message to their target cells,
homeostasis is achieved. The gland decreases the secretions of the hormones the
mechanism by w/c glands stops negative hormone is called NEGATIVE FEEDBACK
NEGATIVE FEEDBACK
A mechanism by w/c a system regulates itself or a response
EXAMPLE:
❖ House regulates temperature using negative feedback: when the thermostat detects a
decrease in temperature, it sends a message to the furnace? To produce heat. When the
thermostat detects that the room temperature is back to normal, it stops sending the
message to the furnace? A furnace? Will turn on and off several times a day to keep the
temperature relatively constant.
❖ Using a hormone: a person eats a meal, so as the food is digested and glucose is absorbed
in the bloodstream, glucose levels begin to rise. It is very important for this glucose to be
removed from the blood or otherwise it will cause damage to important organs such as
LIVER, BRAIN & KIDNEYS. Thus to maintain blood glucose levels, insulin is released from
an endocrine gland, the PANCREAS. The pancreas increases blood glucose and releases
insulin into the blood. So insulin travels to the blood and binds to receptors and muscle fat
tissue, the liver upon binding to receptors. Insulin causes the increases in glucose
transporters allowing the excess glucose to be taken from the blood and stored in the liver
for future use. This uptake of glucose by the liver and other organs for storage restores
blood glucose levels to a balance or balance state, and homeostasis has been achieved.
Because blood levels have reached homeostasis the pancreas will stop releasing insulin
and this is one type of hormone involved in the endocrine system.
❖ Remember the gland of the endocrine system sends its messages to the body. In a similar
manner, a gland sends a change in the body and secretes a hormone, and hormones travel
through the blood and another hormone is receptor specific, a hormone signal is amplified
and finally hormones are regulated by feedback, many times negative feedback.
ENDOCRINE SYSTEM
The endocrine system works to maintain the internal homeostasis and integrate the body’s
response to the external environment. Their activities and functions are closely related thus
referring to them as neuro-endocrine systems.
90
The endocrine system is composed of glands and hormones. It regulates growth and
development, reproduction, energy using the body and electrolyte balance.
The hypothalamus produces stimulating and inhibiting factors that travel to the anterior pituitary
by a nerve network that delivers the ADH and oxytocin to be stored in the posterior pituitary until
the hypothalamus stimulates the release. The pituitary gland has 3 lobes the anterior lobe -
which produces stimulating hormone in response to hypothalamic stimulation, posterior lobe -
stores the ADH and Oxytocin, intermediate lobe - produces endorphins and kephalines to
modulate the interceptors.
A. HYPOTHALAMIC AND PITUITARY AGENTS

1. Drugs Affecting Hypothalamic Hormones
❖ The hypothalamus uses a number of hormones or factors to stimulate or inhibit the release
of hormones from the anterior pituitary. These factors are growth hormone-releasing
hormone (GHRH), thyrotropin releasing hormone (TRH), gonadotropin-releasing hormone
(GnRH), corticotropin-releasing hormone (CRH), and prolactin-releasing hormone (PRH).
Factors that inhibit the release of hormones are somatostatin (growth hormone-inhibiting
factor) and prolactin releasing-inhibiting factor (PIF).
2 TYPES OF DRUGS AFFECTING HYPOTHALAMIC HORMONES
1. AGONISTS
HORMONES:
✔ Corticotropin-releasing hormone
✔ Gonadorelin
✔ Goserelin
✔ Sermorelin
ACTIONS: Stimulate the release of adrenocorticotropic hormone (ACTH) from the anterior
pituitary and is used to diagnose Cushing disease.
2. ANTAGONISTS
HORMONES:
✔ Abarelix
✔ Ganirelix acetate
✔ Leuprolide (P)
✔ Nafarelin
ACTIONS: Blocks the release of hypothalamic releasing hormones.
REMARKS:
The hypothalamic hormones are not all available for pharmacological use; those available are
used for diagnostic testing, for treating some forms of cancer or adjuncts in fertility programs.
2. Drugs Affecting Anterior Pituitary hormones

⮚ These are agents that affect pituitary functions w/c are mainly used to mimic or antagonize
the effects of specific pituitary hormones. They can either be used as replacement therapy
or for diagnostic purposes.
CLASSIFICATION: Growth hormone agonists

DRUG NAME:
✔ Somatropin (p)
91
✔ Somatropin rDNA origin
ACTIONS: Used purely as a replacement for anterior pituitary hormones.
INDICATIONS: Treatment of children with growth failure; replacement for GH deficiency.
CLASSIFICATION: Growth hormone antagonists

DRUG NAME:
✔ Bromocriptine mesylate (p)
✔ Octreotide
✔ Pegvisomant
ACTIONS: Has inhibitory factor. Inhibits release of gastrin, glucagon, and insulin. Inhibits GH
release.
INDICATIONS: Treatment of acromegaly in patients who are not candidates for or cannot
tolerate other therapy.
CLASSIFICATION: Drugs affecting other anterior pituitary hormones

DRUG NAME:
✔ Chorionic gonadotropin
✔ Chorionic gonadotropin alpha
✔ Corticotropin
✔ Cosyntropin
✔ Menotropins
✔ Thyrotropin alfa
ACTIONS: Acts like LH and stimulates the production of testosterone and progesterone.
INDICATIONS: Used as fertility drug; Used for diagnostic purposes; Adjunctive treatment for
radioiodine ablation of thyroid tissue remnants to patients who have undergone a near-total or
total thyroidectomy.
Pharmacokinetics
⮚ It is widely distributed in the body and localizes in highly perfused tissues, particularly the
liver and kidney. Excretion occurs through the urine and feces.
Contraindications and Cautions

⮚ Any known allergy.
⮚ Presence of closed epiphyses or with underlying cranial lesions, and with abdominal
surgery
and acute illness secondary to complications of open-heart surgery.
Adverse Effects
⮚ Development antibodies to GH and subsequent signs of inflammation and autoimmune-type
reactions, such as swelling and joint pain, and the endocrine reactions of hypothyroidism and
insulin resistance.
3. Drugs Affecting Posterior Pituitary Hormones
- The posterior pituitary stores two hormones produced by the hypothalamus: antidiuretic
hormone (ADH, also known as vasopressin) and oxytocin. ADH possesses antidiuretic,
hemostatic, and vasopressor properties.
B. ADRENOCORTICAL AGENTS
92
There are three types of corticosteroids; androgens, glucocorticoids, and mineralocorticoids.
1. Glucocorticoids
⮚ They stimulate an increase in glucose levels for energy. They also increase the rate of
protein breakdown and decrease the rate of protein formation from amino acids.
Drugs: beclomethasone, betamethasone, budesonide, cortisone, dexamethasone,
hydrocortisone, flunisolide, methylprednisolone, prednisolone(p), triamcinolone.
⮚ Most glucocorticoids are synthetic analogs of hormones secreted by the adrenal cortex,
they exert anti-inflammatory, metabolic, & immunosuppressive effects.
⮚ Researchers believed that glucocorticoids inhibit immune response by suppressing or

preventing cell immediate immune reactions, reducing the levels of leukocytes, monocytes,
& iocenophiles?. They also decrease the binding of immunoglobulins through cell surface
receptors.
⮚ Glucocorticoids suppress the redness, edema, heat and tenderness associated with the
inflammatory response. They start on the cellular levels, stabilizing the lysosomal?
membrane. This is a structure within the cell that contains digestive enzymes. So that it
does not release/store hydrolytic enzymes into the cells.
⮚ It also prevents leakage of plasma from capillaries, suppress the migration of leukocytes
and the cells that kill and digest microorganisms, and inhibit phagocytosis meaning cellular
ingestion & destruction of solid substances
⮚ Enter target cells and bind to cytoplasmic receptors, initiating many complex reactions that
are responsible for anti-inflammatory and immunosuppressive effects.
⮚ Indicated for short-term treatment of many inflammatory disorders, to relieve discomfort,

and to give the body a chance to heal from the effects of inflammation.
⮚ They block the actions of arachidonic acid - is actually the chemical messenger first
released by our muscles during intense weight training, controlling the core physiological
response to exercise and regulating the intensity of growth signals. When we have tissue
injury, inflammation is involved in the healing of wounds.
⮚ They also impair the ability of phagocytes to leave the bloodstream and move to injured
tissues, and they inhibit the ability of lymphocytes to act within the immune system.
PHARMACOKINETICS
● Glucocorticoids are well-absorbed when administered orally.
● After IM administration, they are completely absorbed.
● Glucocorticoids are bound to plasma proteins & distributed through the blood.
● They are metabolized in the liver & excreted by the kidneys.
● Presence of any known allergy; in presence of an acute infection; & with lactation.
93
● Use w/ caution in patients w/ diabetes; w/ acute peptic ulcers; w/ other endocrine
disorders; & pregnancy.
ADVERSE EFFECTS
● Methylprednisolone is associated w/ increased toxicity. (Usually, a patient may
experience vertigo, headache, hypotension, shock, sodium & fluid retention,
amenorrhea, increased appetite, weight gain, immunosuppression, aggravation or
masking of infections, impaired wound healing. This is when a patient is taking
methylprednisolone.)
● Children are at risk for growth retardation associated w/ suppression of the

hypothalamic-pituitary system. (Glucocorticoids can reduce the effects of antidiabetic
drugs so we need to monitor the glucose levels of patients w/ diabetes closely.)
MINERALOCORTICOIDS
● They affect electrolyte levels & homeostasis. This steroid hormone directly affects the
levels of electrolytes in the system.
● The classic mineralocorticoid is aldosterone. Aldosterone holds sodium & so w/ water in
the body & causes the excretion of potassium by acting on the renal tubule.
One mineralocorticoid is fludrocortisone acetate w/c is a synthetic analogue of hormones

secreted by the adrenal cortex.
Fludrocortisone is the drug of choice under mineralocorticoids.
PHARMACOKINETICS
● Fludrocortisone acetate is well-absorbed & distributed to all parts of the body.
● This is metabolized in the liver to inactive metabolites & excreted by the kidneys.
● Presence of allergy
● Clients w/ severe hypertension, heart failure or cardiac disease
● Use this drug w/ caution in pregnancy & lactation.
ADVERSE EFFECTS are related to the increased fluid volume seen in sodium & water
retention.
● Headache
● Edema
● Hypertension
● Heart failure
● Arrhythmia
● Weakness & possible hypokalemia
● Allergic reactions ranging from skin rash to anaphylaxis
THYROID & PARATHYROID AGENTS

● When thyroid function is low, thyroid hormone needs to be replaced to ensure adequate
metabolism & homeostasis in the body.
● When the thyroid function is too high, the systemic effects as thioamide & iodine
solutions.
94
THYROID AGENTS:
● Thyroid hormones (Levothyroxine is the drug of choice)
● Antithyroid agents
● Iodine solutions
THYROID HORMONES

● These drugs increase the metabolic rate of the body tissues, increasing oxygen
consumption, respiration, heart rate, growth & maturation, & metabolism of fats,
carbohydrates & proteins.
● Indicated for replacement therapy.
PHARMACOKINETICS
● The thyroid hormones are absorbed variably from the GI tract, distributed in the plasma
& bound to serum proteins.
● They are metabolized through deiodination or the removal of iodine from a compound,
primarily in the liver & excreted unchanged in feces.
▪ Thyroid hormones increase the heart rate & cardiac output so the amount of blood
pumped by the heart each minute. They may increase the heart’s sensitivity to
catecholamines & increase the number of beta-adrenergic receptors in the heart or the
stimulation of beta receptors in the heart increases the heart rate & contractility.
▪ Thyroid hormones may increase the blood flow to the kidneys & increase the
glomerular filtration rate or the amount of plasma filtered through the kidneys each
minute esp in patients w/ hypothyroidism & eventually producing diuresis.
CONTRAINDICATIONS/CAUTIONS:
● Any known allergy to the drug & during an acute thyrotoxicosis or w/ acute MI
(myocardial infarction)
● Should be given w/ caution to women who are lactating
ADVERSE EFFECTS
● Skin reaction & loss of hair
● Symptoms of hyperthyroidism
● Arrhythmias
● Hypertension
● Anxiety
● Sleeplessness
● Difficulty swallowing
ANTITHYROID AGENTS
● Thioamides
● Antithyroid agents are drugs used to block the production of thyroid hormone & treat
hyperthyroidism w/c include thioamide & iodide solutions. These groups of drugs are not
chemically related but they both block the formation of thyroid hormones w/ the thyroid
gland.
THERAPEUTIC ACTIONS & INDICATIONS:
95
● Thioamides lower thyroid hormones by preventing the formation of thyroid hormone in
the thyroid cells. (They partially inhibit the conversion of the T4 to T3 at cellular levels.
Examples of thioamides are PTU (propylthiouracil) & methimazole)
● Iodine solutions in high doses block thyroid function. They cause the cells to become
oversaturated w/ iodine & stop producing hormones.
● Indicated for: treatment of hyperthyroidism & thyroid blocking in a radiation emergency
PHARMACOKINETICS
● Thioamides are well-absorbed from the GI tract & concentrated in the thyroid gland.
● Methimazole w/c is an example of a drug under thioamides that has an onset of action of
30-40 minutes & picks in about 60 minutes. Some excretions are detected in the urine.
● For the iodine solutions, this is rapidly absorbed from the GI tract & widely distributed
throughout the body fluids. It is excreted through the urine.
PARATHYROID AGENTS
● Drugs used to treat disorders that affect the serum calcium levels.
● This can either be an antihyperglycemic agent or an antihyperglycemic agent.
● These were further classified into bisphosphonates & calcitonins.
● The parathyroid glands are four very small groups of glandular tissue located at the back
of the thyroid gland. This produces the parathyroid hormone & calcitonin to maintain the
body’s calcium balance. The parathyroid hormone or PTH is the most important
regulator of serum calcium levels in the body.
PARATHYROID HORMONE:
● Antihyperglycemic agents
Usually, a deficient level of parathyroid hormone results in hypocalcemia or calcium deficiency.

The vitamin D stimulates Ca absorption from the intestine & restores the serum Ca to a normal
level.
Hypothyroidism is treated primarily w/ vitamin D & if necessary, a dietary supplement of Ca.
DRUGS UNDER ANTIHYPERGLYCEMIC AGENTS

● Teriparatide – parathyroid hormone genetically engineered from e.coli bacteria. This
was approved to increase bone mass in post-menopausal women & men w/ primary or
hypogonadal osteoporosis.
● Calcitriol
● Dihydrotachysterol
THERAPEUTIC ACTIONS & INDICATIONS:

● Teriparatide stimulates new bone formation, leading to increase in skeletal mass.
● Vitamin D compounds regulate the absorption of Ca & phosphate from the small
intestines, mineral resorption in the small intestine, mineral resorption in bone &
reabsorption of phosphate from the renal tubules. With once a day administration,
teriparatide stimulates new bone formation & leading to an increase in skeletal mass.
PHARMACOKINETICS
● Calcitriol & Dihydrotachysterol are well-absorbed from the GI tract & widely distributed
throughout the body.
● They are stored in the liver, fat muscles, skin & bones.
96
● They are metabolized in the liver & excreted in the bile w/ some traces found in the
urine.
CONTRAINDICATIONS & CAUTIONS:

● Allergy to any known component of the drug.
● Hypercalcemia or vitamin D toxicity.
● Teriparatide is associated w/ osteosarcoma – so it is limited to postmenopausal women
who have osteoporosis.
ADVERSE EFFECTS
● GI Effects: metallic taste (food might taste metallic), nausea, vomiting, dry mouth,
constipation & anorexia.
● CNS Effects: Weakness, headache, somnolence, & irritability
DIABETES MELLITUS
● Is a group of disorders that’s caused by improper function of the hormone insulin w/c is
secreted by the pancreas.
● This results in dysregulation of blood glucose levels in the body specifically resulting in
hyperglycemia or high blood sugar w/c is the hallmark of diabetes.
● Since diabetes is a group of disorders, this implies that there are multiple different
conditions that can lead to diabetes mellitus.
3 MAJOR TYPES OF DIABETES: (BREAKDOWN)

● Type I
● Type II
● Misc.
▪ In response to an increase in blood glucose levels, the pancreas produces & secretes a
hormone known as “insulin” into the bloodstream.
▪ This insulin acts on cells throughout the body to remove the glucose from the
bloodstream by either taking it up to use it for energy or to store it in the form of
glycogen. As a result, the blood glucose levels decrease. And this decrease in blood
glucose levels then serves as a feedback mechanism to inhibit the pancreas from
secreting more insulin.
▪ There are two major steps in insulin pathway: 1) Insulin must be secreted by the
pancreas in response to this increase in blood glucose level. 2) The cells throughout the
body must respond to the insulin in order to carry out its metabolic functions in order to
lower the glucose levels. This mechanism can be thought of as similar to that of a
thermostat in an air conditioning w/n a home. When the temperature goes up, this is
sensed by the thermostat w/c then sends an electrical signal to turn on the air
conditioner w/c will then decrease the temperature.
▪ As the temperature goes down, this will inhibit the thermostat from continuously keeping
the air conditioner on.
▪ TYPE I DIABETES presents mostly during childhood & it is caused by a genetic

predisposition plus some sort of environmental trigger exactly what this is isn’t quite
known. But the combination of these two results in an autoimmune disorder in w/c the
immune system attacks the beta cells of the pancreas to prevent them from producing
insulin.
97
▪ TYPE II DIABETES typically although not always present during adulthood & its even
more strongly associated w/ a genetic predisposition. In type II Diabetes, instead of this
unknown trigger, the genetic predisposition is accompanied w/ other predisposition or
predisposing conditions such as obesity or hypertension. This combination of factors
results in an inability of these cells throughout the body to respond to insulin.
▪ Although TYPE I & TYPE II DIABETES are the most common causes of diabetes
mellitus, there are a couple other important causes of the disease & this include diabetes
caused by medications known as “drug-induced diabetes” & this commonly occurs w/ a
group of medications that are known as “glucocorticoids” w/c are steroid medications
most frequently prescribed to decrease inflammation throughout the body such as w/
conditions like chronic asthma or Crohn’s disease.
▪ Another miscellaneous cause of DM is diabetes that’s associated w/ pregnancy known

as “gestational diabetes”.
▪ In TYPE I DIABETES, this autoimmune attack on the beta-cells of the pancreas prevents
the production & secretion of insulin into the blood. Thus, type I diabetes inhibits this first
step in the insulin pathway & since it decreases the production of insulin, it’s referred to
as “insulin deficiency”.
▪ In TYPE II DIABETES as well as drug-induced & GD, the pancreas continues to secrete
insulin. However, it’s the cells throughout the body that are unable to adequately
respond to it. These mechanisms inhibit the second step in the insulin pathway & this is
known as “insulin resistance” w/c can be thought of as a relative insulin deficiency.
▪ Thermostat analogy: If either the thermostat or air conditioner is broken, the system as a
whole doesn’t work. The temperature inside the house is gonna continue to rise,
similarly in DM, it doesn’t matter whether the underlying mechanism affects this first step
such as w/ type I diabetes or the second step as w/ type II diabetes, drug-induced
diabetes & gestational diabetes. Regardless, there is gonna be either insulin deficiency
or relative insulin deficiency. This pathway will not work & the body won’t be able to
decrease glucose levels. This results in an increased level of glucose w/c is known as
“hyperglycemia” w/c is the hallmark in finding DM.
INSULIN
⮚ Patients with type 1 diabetes require an external source of insulin to control their glucose
levels
⮚ Patients with type 2 diabetes may also need insulin at times
TYPES OF INSULIN
1. RAPID-ACTING, such as LISPRO

2. SHORT-ACTING, such as REGULAR INSULIN
3. INTERMEDIATE-ACTING, such as NPH
4. LONG-ACTING, such as GLARGINE
98
PHARMACOKINETICS
⮚ Insulin isn’t effective when taken orally because the GI tract breaks down the protein
molecule before it reaches the bloodstream
⮚ All insulin are given subcutaneously
⮚ Absorption of subcutaneous insulin varies according to the injection site, the blood
supply and the degree of tissue hypertrophy at the injection site
⮚ The regular insulin may also be given IV as well as dialysis fluid infused in the peritoneal
cavity for patients on peritoneal dialysis therapy
⮚ After absorption into the bloodstream, insulin is distributed all throughout the body
⮚ The insulin responsive tissues are located in the liver, adipose tissue and muscle
⮚ Insulin is metabolized primarily in the liver and to a lesser extent in the kidneys and muscles
⮚ It is excreted in the feces and urine
There are no CONTRAINDICATION but CARE has to be done when giving in pregnant mothers
ADVERSE EFFECTS
✔ Hypoglycemia
✔ Ketoacidosis
✔ There is local reaction in the injection sites including the lipodystrophy
⮚ As nurses, we will be preparing the insulin suspension
MIXING THE INSULIN
❖ Swirl the vial gently or rotate it between your palms or between your palm and thigh. don’t
shake the vial vigorously; doing so causes bubbling and creates air in the syringe
❖ Lispro Insulin has a rapid onset of action and should be given within 15 minutes before
meals
❖ Insulin Glargine can't be diluted or mixed with any other insulin or solution or given IV.
❖ The Regular Insulin may be mixed with NPH or Lente Insulin in any proportion. When
mixing regular insulin with NPH insulin, always draw up regular insulin into the syringe first.
❖ The regular insulin is clear while the NPH is cloudy, so the technique there is clear first
before cloudy. After we have prepared it, we give it immediately to avoid the loss of
potency.
❖ Do not use insulin that has changed in color or become granular. Throw it in a receptacle
where we put in the syringe.
❖ Make sure to check the expiration date on the vial before using it
Now, when we administer the insulin through IV, use only REGULAR INSULIN and inject it
directly at the ordered rate into the vein through an intermittent infusion device or into a port
close to the IV site or IV access site
Make sure to review how we give a subcutaneous medication or a subcutaneous injection
99
● Assess the patient’s blood glucose level regularly, before and after therapy. We monitor the
level more frequently if the patient is under stress or pregnant
● Monitor the patient’s urine ketone level and the glucose level is elevated
● Keep in mind that the patient transferring from insulin therapy to oral antidiabetics needs
glucose monitoring at least three times daily before meals
● Assess for adverse reactions and drug interactions
● Monitor the injection sites for local reactions
● Assess the patient’s compliance with drug therapy and other aspects of treatment
● Assess the patient’s and family’s knowledge of drug therapy
PHARMACOLOGY
DIABETES MELLITUS TYPE 2
⮚ The PANCREAS is made up of different

types of cells. One of which is the B-CELLS, the ones that produce the hormone insulin
⮚ Skeletal muscles which actually use
glucose as a source of energy
⮚ After we eat a meal, there is an increase in
blood glucose. The glucose can absorb the blood. With the increase in blood glucose, this will
act to stimulate the B-Cells of the pancreas to release the hormone insulin. So the insulin
vesicles from the B-Cells are being released into the bloodstream. Insulin enters the
bloodstream where causes its physiological functions which includes going to the liver,
stimulating glucose uptake in the liver as well as stimulating glucose uptake in the skeletal
muscle
⮚ Insulin essentially functions by trying to lower the blood glucose by making glucose get
taken up by these different tissues
⮚ Diabetes mellitus is characterized by insulin resistance. So the effects of insulin on body
tissues doesn’t work properly so the insulin cannot stimulate glucose uptake to tissues from
the blood and as a result, you have sort of persistent high blood glucose.
⮚ There is an increase in blood glucose with insulin resistant so this will eventually lead to B-
CELL ATROPHY. Its cell failure which makes the whole problem a lot worst and in cause of
this, it is important to treat patients with diabetes
⮚ Non-pharmacological interventions such as diet and exercise but medications are useful
for patients with diabetes and include insulin subcutaneous injections but these are typically
seen for patients with type 1 diabetes but can also be seen in some patients with serious
type 2 when there is B-Cell atrophy.
ACTUAL PHARMACOLOGICAL MEDICATION
1. BIGUANIDE (Metformin)
⮚ Metformin is a first line treatment for

patients with type 2 diabetes and is essentially what they do is that they will cause an increase
in insulin sensitivity, increase glucose uptake, as well as decreasing glycogenolysis
⮚ In the liver, insulin stimulates glucose
moving into the cell and essentially it will also stimulate glucose to store as glycogen.
⮚ Metformin also inhibits the actual
breakdown of glycogen to glucose so that the glucose is not released into the blood
100
❖ Side effects:
✔ Gastrointestinal upset
✔ Anorexia
✔ Lactic acidosis
❖ Contraindications:
✔ For those who have liver and renal dysfunction
2. INSULIN SECRETAGOGUES (Sulfonylureas)
⮚ This stimulates the B-Cell in the pancreas

to release insulin secretagogues
⮚ It will basically force the B-Cell to pump
out insulin
⮚ Sulfonylureas does this by inhibiting the
potassium transporter, preventing the reflux of potassium causing depolarization of the B-Cells
which will then lead to the release of insulin from the vessel
❖ Side effects:
✔ Hypoglycemia
✔ Weight gain
3. INSULIN SENSITIZER (Thiazolidinediones)
⮚ They work by increasing the insulin

sensitivity as well as decreasing free fatty acid (FFA) release
⮚ They inhibit the release of FFA from the
adipose tissues as well as they stimulate the insulin sensitivity which is essentially will lead to
increasing glucose uptake to tissues and decreasing glucose release into the bloodstream
❖ Side effects:
✔ Anemia
✔ Congestive heart failure
✔ Peripheral oedema
✔ Fracture
✔ Congestive heart failure
✔ Liver failure
4. ALPHA GLUCOSIDASE INHIBITORS (Acarbose)
⮚ The next medication work on the small

intestine. In the lumen, there are short carbohydrate molecules that are being broken down into
the macromolecule glucose. Glucose is being absorbed and enters the blood. The enzymes are
responsible for the final breakdown of carbohydrates especially disaccharides into the small
intestine. All these enzymes are brush border enzymes for glucosidase and these are present
on the apical surface of the small intestinal cells.
⮚ This literally inhibits these enzymes causing decrease in glucose absorption and thus,
decreasing the blood glucose
❖ Side effects:
✔ Flatulence
101
✔ Cramps
✔ Diarrhea
❖ Contraindications
✔ Inflammatory bowel disease (IBD)
5. GLP-1
⮚ The final medication for diabetes mellitus
type 2 are the ones who work like a hormone produced by the intestinal cells called GLP-1. This
actually normally stimulates B-Cells in the pancreas to release insulin and so this group of
medications are actually GLP-1 analogues. GLP-1 analogues bind to GLP-1 receptors
causing an increase in insulin release thus they usually make the effects of GLP-1
❖ Side effects:
✔ Headache
✔ Muscle weakness
✔ Type 1 diabetes mellitus
✔ Diabetic ketoacidosis (DKA)
102

Midterm - NCM 106

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Midterm - NCM 106

Uploaded by

Copyright:

Available Formats

NCM 106

BSN2 1st Sem MIDTERM 2020

NURSING PROCESS ON PHARMACOLOGY

1.Assessment – is an information-gathering phase to complete a database of information about a

METHODS OF DATA COLLECTION

OBJECTIVE DATA MAY BE OBTAINED FROM:

3 Key Elements in Problem Identification:

7 RIGHTS OF SAFE MEDICATION

QUESTIONS THAT CAN BE USED FOR EVALUATION:

DRUGS ACTING ON THE REPRODUCTIVE SYSTEM

- These system in our bodies allows us to reproduce, it allows us to make baby’s,

Most Important Sex Organs

MALE MAJOR ORGANS (IMPORTANT ORGANS)

FEMALE MAJOR ORGANS (IMPORTANT ORGANS)

MALE SEX HORMONE

✔ TESTOSTERONE - which is actually producing the testes is responsible for many

FEMALE SEX HORMONE

⮚ The reproductive system is actually controlled by the brain. There is an

⮚ GnRH affects another part of the brain called the ANTERIOR

⮚ Pregnancy is a huge part of reproduction and certainly the most long-

⮚ Gestation is the development of the fetus into a baby, the development

ESTROGENS - is responsible for the development of the female reproductive system,

Examples of Estrogen Drugs

1. Estradiol - w/c is the drug of choice

- Estrogen: use for replacement therapy when ovarian activity is blocked or

Indication: - development of female reproductive system

2. Estrogens - it is used for replacement therapy when ovarian activity is blocked

ACTIONS AND INDICATIONS

Estrogen is important for:

✔ Development of female reproductive system

✔ Affect the release of FSH and LH

✔ Use for capillary dilatation

-Thinning of the cervical mucus

-Conserve Calcium and Phosphorus

-Prevent Postpartum breast discomfort

Progestin Drugs that are usually given:

Progestins are used as contraceptives w/c is most effective in combination w/

ESTROGEN RECEPTOR MODULATOR

Estrogen Receptor Modulator drugs that are usually given:

Progestins are contraindicated to patients w/ known allergy, for pregnant women w/

Estrogen Receptor Modulators are contraindicated to patients w/ known allergy,

ADVERSE EFFECTS OF ESTROGEN

ADVERSE EFFECTS OF PROGESTINS

ADVERSE EFFECTS OF ESTROGEN RECEPTOR MODULATORS

● Assist pelvic & breast exams.

● Arrange for an ophthalmic exam.

SOME NURSING DIAGNOSIS THAT WE CAN FORMULATE IN THE USE OF THIS

> the nurse should:

1. Monitor patient’s response to therapy

2. Monitor for adverse effects

4. Monitor compliance to drug therapy

- This are drugs that stimulate the female reproductive system

> The therapeutic actions and indications of this drugs

Stimulates the follicle development and ovulation – in functioning ovaries

Stimulates hypothalamus to increase FSH and LH – w/c leads to ovarian

Patients who have presence of:

⚪ Primary ovarian failure

◻ Multiple and birth defects

1. Assess for cautions and contraindications

EX. Drug allergies

Rationale: to prevent any untoward complications

2. Perform thorough physical assessment

4. Monitor laboratory test results