MIDTERM EXAM REVIEW

GUIDE
 CNS agents
• CNS stimulants
• Amphetamines – controlled subtance ( addictive), need prescription of a doctor with s2 license
• Narcolepsy – sleepiness, dangerous if your are driving
• Adhd
• Behavior – restless and cannot concentrate because of low dopamine
• Usually diagnosed on or before age 7
• Intelligence is usually not affected
• Decreased attention span – hyper activity
• Drug : methylphenidate given in the morning on an empty stomach.
• Avoid - caffeine
• Anorexiants – given to control weight
• Analeptics - Methylxanthines
• CNS DEPRESSANTS
• SEDATIVE-HYPNOTICS
• ANESTHETICS
• ANALGESICS
• ANTICONVULSANTS
• ANXIOLYTICS
• ANTIDEPRESSANTS
 SLEEP DISORDER

• Non pharmacologic methods to aid person to sleep

• Arise at specific hour in the morning
• Take a few or no daytime nap
• Take a warm bath, listen to quiet music before bedtime
• Drug - sedatives
• CNS depressant drugs
• Barbiturates – sedative-hypnotic
• Benzodiazepine – sedative – hypnotic
• Should not be given together with antihistamine
Alprazolam ( Benzodiazepine overdose) - give flumazenil
Coagentin – anticholinergics – prescribed for patient with parkinsons disease –
observe bowel movement for constipation.
Antipsychotic drugs – for patient with schizoprenia
Lithium – Indicated for mania and bipolar
Lethal level is more than 2 mEq/L
Therapeutic level is 0.6 – 1.2 mEq/L
 ALCOHOL WITHDRAWAL/
HEADACHE
• Nursing interventions
• Check client frequently
• Monitor vs every 15 minutes
• Provide a quiet non stimulating environment

• Primary headache – if the cause in non organic

 TYPES OF CARDIAC DRUGS
1. ANTIHYPERTENSIVE
2. CARDIAC GLYCOSIDES
3. ANTI-ANGINAL DRUGS
4. ANTI-ARRHYTHMIC DRUGS
 ANTIHYPERTENSIVE DRUGS
• Lowers bp
• Diuretics – can cause hypokalemia ( Potassium 3.5 or less)
• (Hydrochlorathiazide, Furosemide)

• Beta-blockers = “olol” = slow HR and narrow bronchi

• Calcium channel blockers - calms the heart and control the blood
pressure (Nifedipine, Verapamil)
• Angiotensin-converting enzyme inhibitors = “pril” = increase HR
• Angiotensin II receptor blockers = “sartan” = increase HR
• Vasodilators – decrease bp, dilates vessels, decrease vascular resistance
• Nitroglycerin
• Should never be given together with viagra because it could lead to widening
of the blood vessels, dropping the blood pressure so low, arrhythmia and heart
attack.
• Myocardial Infarction - Unrelieved pain in cardiac disease after morphine
administration.
 NURSING CONSIDERATIONS

• Do not leave the patients bedside when you are giving a newly
prescribed antihypertensive especially beta blockers.
• Monitor – bp, breathing and blood sugar
• Angiotensin-converting enzyme inhibitors - Side effect – nausea and
vomiting
• Pril and sartan are given to patients with low heart rate.
• Aspirin are given as anti-clumping and anti- clogging effect for
better blood circulation.
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 RESPIRATORY AGENTS
• Asthma – is a chronic disease
• Manifested by - bronchoconstriction, inflammation, excess mucus
• Initial Manifestation – Dyspnea
• Lab Result : IgE – Cause of asthma is due to allergens
• Drugs:
• Bronchodilators
• B2 agonist ( b2 receptors in the lungs) and methylxanthines (analeptics) –
dilate bronchioles, prevent bronchoconstriction
• Watch out for nausea and tremors
• Side effect - palpitations
• Anti inflammatory
• Corticosteroids / Inhaled Glucocorticoids, anti leukotrienes (Montilukast),
mast cell stabilizers) – anti inflammatory
• Hyposensitization - injecting subcutaneously a dose of offending
allergens to a child with asthma.
• Communicate which will requires the child with asthma to use only few
words to say.
 • Priority during asthma attack – treat bronchoconstriction
• Before exercise -
• SABA – acute asthma attack (albuterol)
• LABA – maintenance (salmetrol)
• B2 agonists drugs ends in “terol”

• Inhaled Glucocorticoids ( Cromloyn sodium) – anti inflammatory. Shake

the inhaler before use. Give 15-20 minutes before exercise
• Status epilepticus – unresponsive to the usual medications for asthma
• Patient taking EXPECTORANTS should increase fluid intake.
• Decongestants – use only for 3 days if nose drops
• Side effects of Ipratropium (Anticholinergics) – constipation, diarrhea,
dryness of the mouth
 GIT AGENTS

1. Constipation
• Drug of choice - Laxatives - safest and most natural type – Bulk-forming
laxative ( lactulose)
• Chemical stimulants - stimulates the colon muscles inducing the bowel
movement.
2. Diarrhea
• Antidiarrheal drugs – Loperamide
• Side effects – constipation
 PEPTIC ULCER
1. Acid-suppressing drugs
• Antacids – blocks the production of gastric acid, mildest form (least likely
to cause side effects is Aluminum/Magnesium combination)
• Magnesium hydroxide
• H2 receptor antagonists – Cimetidine, Ranitidine
• Proton-pump inhibitors
Mucosal protective agents – gastric protective
• Sucralfate – allows the ulcer to heal by forming a paste-like substance,
coating the stomach mucosa, thus preventing gastric acid irritation
• Maalox – (Alleviation of burning pain)
• Prostaglandin analogue - Misoprostol (Cytotec) – protect stomach lining
 NURSING CONSIDERATIONS

• Antacid and Cimetidine should be given at least one hour apart .

• Advise patient not to smoke if taking cimetidine.
• Side effect of anticholinergics = urinary retention
• Take Sucralfate 1 hour before meals.
• Peptic ulcer disease secondary to helicobacter pylori – will be
prescribed two classes of antibiotics.
• elevated titer of Helicobacter pylori - treatment will include Pepto-Bismol
(Antacid) and antibotics.
 ENDOCRINE AGENTS

• ANTIDIABETIC AGENTS
• 1. Insulin onset peak
• Fast acting - Humalog 5-15 min 30-60 mins
• Short-acting – Humalog R 30 min 1-3 hours
• NPH – Humalog N 1-2 hrs 4-8 hours
• Long- acting - Lantus 30 mins no peak
• Remember that the highest chance the patient will have hypoglycemia will be
when the insulin is already in PEAK effect
• Store unused insulin in the refrigerator
• Allow the insulin to be in room temperature before injecting in the subcutaneous.
• 2. Oral hypoglycemic agents
• Sulfonylureas – stimulate pancreatic beta cells – avoid alcohol

• Meglitinides

• Biguanides

• Thiazolidinediones

• Alpha-glucosidase inhibiors - delay the absorption of glucose, leading to lower

glucose levels.
• Hyperthyroidism – Thyroid storm
• Antithyroid drugs
• Inderal – check if patient has history of asthma
• Tapazole – methymazole – check for antithyroid toxicity
(decrease bp and heart rate)
• Glucocorticoid
• Prophylthiouracil
• Lugols solution - helps block release of thyroid hormones in
thyroid storm
• SE – change in taste
• Avoid aspirin
• Hypothyroidism
• Thyroid replacement drugs
• Levothyroxine – Synthroid
Nursing Considerations:
• Take the drug same time everyday
• Never change the brand of drug – consult with your doctor if you
like to change the drug