Topic 2.1: Antibiotics: Unit 2: Anti-Infective Medications

UNIT 2: ANTI-INFECTIVE MEDICATIONS
TOPIC 2.1: ANTIBIOTICS

CLASSIFICATION:
 Beta-Lactams (Penicillins, Cephalosporins )
 Macrolides (Erythromycin)
 Fluoroquinolones
 Tetracyclines
 Aminoglycosides
 Sulphonamides
 Monobactams
 Quinolones (Fluoroquinolones)
PURPOSE OF ANTIBIOTICS:
 Known as antibacterial
 They slow down or destroy the growth of bacteria
 Antibiotics can’t treat viral infections such as: colds, flu, mono, and coughs
 They treat bacterial infections such as: strep throat, STDS, and UTIs
 Kill bacteria with gram negative or positive antibiotics, based on classification of bacteria
MECHANISM OF ACTION:
 Sulphonamides:
 Prevents synthesis of folic acid
 Only affects organism that synthesize their own folic acid
 They don’t kill bacteria, they prevent growth
 Penicillins:
 Enter the bacteria via the cell wall
 They bind to penicillin-binding protein causing disruption
 Bacteria cells die but other body cells don’t
 Cephalosporins:
 5 generations
 Very similar to Penicillin, is semisynthetic, and widely used in clinical practise
 Tetracyclines:
 Bacteriostatic, and prevents protein synthesis and growth
 Don’t mix with diary
 Aminoglycosides:
 Super toxic, has many side effects
 Bactericidal, and mostly gram negative
 Quinolones:
 Effective gram negative
 Can alter DNA
 Bactericidal
 Monobactam
 Prevents protein synthesis with bacterial wall
 Bacteriostatic
INDICATIONS:
 Sulphonamides
 Have a broad spectrum of antibacterial activity.
 Penicillins
 Indicated for the prevention and treatment of infections caused by susceptible bacteria
 Macrolides (Erythromycin)
 Has the ability to irritate the GI tract, which stimulates smooth muscle and GI mobility.
 Helps in facilitating the passage of feeding tubes from the stomach into the small bowel
 Tetracyclines
 Prevents growth of gram negative and positive organisms, and even that of some
protozoa
 Used to treat acne in adolescents and adults
 Aminoglycosides
 Used in combination with other antibiotics for synergistic effects
 Quinolones
 If taking diary, take medication one hour after consumption
CONTRAINDICATIONS:
 Sulphonamides
 Contraindicated in pregnant women at term and babies under 2 months
 Penicillins and Cephalosporins
 Known drug allergy, obtain accurate history regarding types of reactions
 Macrolides
 Often used as alternative drugs for patients with allergies to B-Lactam antibiotics
 Tetracyclines
 Most be avoided by pregnant/nursing women
 Should not be given to children under the age of 8
ADVERSE EFFECTS:
 Diarrhea, vomiting, abdominal cramps
 Allergic reactions: SOB, hives, rashes, swelling of lips and tongue, fainting
 Tetracyclines: discolouration of teeth in nursing children
 Vaginal discharge
NUSRING IMPLICATIONS:
 Assess drug allergies, renal, liver and cardiac function
 Penicillins and Cephalosporins : take oral dose with water not juice, and monitor for allergic
reaction for at least 30 mins
 Sulphonamides: take oral dose with food, 2000-3000ml of fluids per 24 hours
 Macrolides: Erythromycin is enhanced when taken on empty stomach
 Tetracycline: Avoid daily products, sunlight and tanning beds
HERBALS:
Cranberry:
- Used for bladder, stomach, liver disorders, diabetes, and wounds
- Today it is used for to treat UTIs, and can be made into supplements
- Hasn’t been shown to be an effective treatment for UTIs
- Drinking cranberry juice is safe
- Large amounts can cause tummy aches, and increase risk on kidney stones
- If you have a UTI seek medical help
Goldenseal
- Used for skin disorders, ulcers and fevers
- Currently used to treat colds, hay fever, ulcers, GI and mouth issues, and eye inflammation
- Little research has been done
- Pregnant/breastfeeding mums shouldn’t take it, and not to be given to infants
- Bebeerine that is found in Goldenseal can cause or worsen jaundice in babies.
TOPIC 2.2: ANTIVIRALS

 Cytomegalovirus (CMV)
 Hepatitis virus
 Herpesviruses
 HIV
 Influenza virus
 Respiratory syncytial virus (RSV)
PURPOSE OF ANTIVIRALS:
 Kill or supress the virus by destroying virions
 Prevents replication of virus, and stops what is producing the virus
 Prevents the fusion process
 Treats infections caused by viruses other than HIV and AIDS
 Blocks the activity of polymerase enzyme, resulting in impaired viral replication
 Treats non-HIV viruses: HSV, VZV, flu virus, CMV, and hepatitis
ADVERSE EFFECTS:
 Healthy cells are often killed, resulting in serious toxicities
 Acyclovir: nausea, vomiting, diarrhea, headache, burning when topically applied
INTERACTIONS:
 Acyclovir: increased levels of acyclovir due decreasing renal clearance
 Zanamivir: not recommended for people with breathing problems
PURPOSE OF ANTIRETROVIRALS:
 Reduces the viral load, limits viral replication
 Treats HIV and AIDS
 Blocks activity of the enzyme reverse transcriptase (promotes the synthesis of new viral DNA)
 Prevents production of new viral DNA, and viral fusion
ADVERSE EFFCTS:
 Lipid abnormalities or redistribution of fat stores under the skin (humps)
NURSING IMPLICATIONS:
 Antiviral drug: assess head to toe, baseline vital signs, and nutritional status
 Instruct patient to start therapy with antiviral meds at earliest signs
 Monitor adverse and therapeutic effects
TOPIC 2.3: ANTITUBERCULAR
CLASSIFICATIONS:
 Primary (1st line) – Oral
- Isoniazid: primary drug
- Ethambutol hydrochloride
- Pyrazinamide
 Secondary (2nd line ) – injectable
 Protein wall synthesis inhibitors: streptomycin, rifabutin, rifampin, and rifapentine
 Cell wall synthesis inhibitors: isoniazid
 Other mechanism of actions: ethambutol, isoniazid, and pyrazinamide
INDICATIONS:
 Combination of isoniazid and ethambutol has been used to treat pregnant women with TB
without complications
 Rifampin is another drug that is safe for pregnancy, likely to be chosen to treat advance TB
CONTRAINDICATIONS:
 Contraindications to ethambutol is optic neuritis (inflammation that damages the optic nerve)
 Chronic alcohol use when associated with liver damage
ADVERSE EFFECTS:
 Ethambutol: blindness, and optic neuritis
 Rifampin: red-orange discolouration of urine, stool, sputum and tears
 Isoniazid (INH): liver damage, hypergylcemia, vision problems
INTERACTIONS:
 Drugs that interact with intertubercular drugs can cause significant effects
 Decreased isoniazid levels and therapeutic effects, hepatotoxicity, and increased toxicity
NURSING IMPICATIONS:
 Remind patient that they are contagious, and instruct proper hygiene, rest and nutrition
 Patient shouldn’t consume alcohol while taking meds
 Observe for adverse effects: fatigue, fever, nausea, vomiting, numbness, tingling
 Rifampin causes oral birth control to be ineffective
 Can cause urine, sputum, stool, and tear to be red
TOPIC 2.4: ANTIFUNGALS AND ANTIPARASITICS

ANTIFUNGAL CLASSIFACTIONS:
 Fluconazole
 Nystatin
 Fungi are a group of microorganisms that include: yeasts and moulds
 Also known as antimycotic meds that treat and prevent mycosis.
 Flucytosine: interferes with DNA synthesis resulting in fungal cell death
 Nystatin: binds to sterols in cell membrane lining resulting in fungal cell death. Doesn’t
bind to human cell membrane or kill human cells
INDICATIONS:
 Flucytosine: passes into CSF and prevents the growth of cryptococcal fungi, effective in the
treatment of cryptococcal meningitis
 Flucytosine: the most effective for combating serious infections
CONTRAINDICATIONS:
 Common: drug allergies, liver/kidney failure, and porphyria
ADVERSE EFFECTS:
 Fluconazole: nausea, vomiting, diarrhea, stomach pain, increased liver enzymes, use with
caution in patients with kidney/liver dysfunction
 Nystatin (topical): nausea, vomiting, anorexia, diarrhea, rash, urticaria
INTERACTIONS:
 Co-administration of 2 drugs that are metabolized by this system may result in competition for
enzymes, resulting in higher levels of one of the drugs.
 Assess for hypersensitivity, obtain baseline vital signs, complete blood count and liver/renal
function
 During IV infusions monitor input and output.
 Some oral forms should be given with meals and some require an empty stomach…CHECK!
ANTIMALARIAL:
 Attacks the parasite during asexual phase, when it is vulnerable
 Binds to parasite nucleoproteins, prevents and interferes with protein synthesis and alters pH
with parasite
INDICATIONS:
 Used to kill Plasmodium organisms (the parasite that causes malaria)
CONTRAINDICATIONS:
 Drug allergies, tinnitus (ringing in the ear), pregnancy (quinine), severe kidney or haematological
dysfunction
ADVERSE EFFECTS:
 Primary GI effects: nausea, vomiting, diarrhea, anorexia, and abdominal pain.
 Assess the presence of malarial symptoms
 Meds are taken weekly with at least 180-240ml of water or other fluids
ANTIPROTOZOALS
 Metronidazole
 interferes with DNA, resulting in prevention of protein synthesis and cell death.
INDICATIONS:
 effective against forms of bacteria, protozoa and helminths
CONTRAINDICATIONS:
 Known drug allergies
 Serious kidney and liver dysfunction
ADVERSE EFFECTS:
 Headaches, dizziness, fatigue, blurred vision, dry mouth, nausea, vomiting, diarrhea,
constipation, and rash.
ANTITHELMINTIC – MECHANISM OF ACTION:
 Destroy these organisms by disrupting their structures
ADVERSE EFFECTS:
 Nausea, vomiting, diarrhea, dizziness, and headache
 Urine discolouration and hemolytic anemia
INDICATIONS:
 Anthelmintic drugs are used to treat roundworm, tapeworm, and fluke infections
CONTRAINDICATIONS:
 Known drug allergy
 Obtain a through travel history and history of food eaten, especially meat and fish
 Assess patient’s household for helminth infection
HERBAL:
Tea Tree Oil
- Used for acne, athlete’s foot, lice, nail fungus, cuts, and insect bites.
- Topical use only, and shouldn’t be swallowed (can cause confusion and ataxia-loss of muscle
coordination)
UNIT 3: ANALGESIC MEDICATIONS
OPIOIDS
CLASSIFICATIONS:
 Agonists
 Agonists -Antagonists
 Antagonists (non analgesic)
 Agonists
 Binds to an opioid pain receptor in the brain
 Causes an analgesic response (reduction of pain sensation)
 Agonists – Antagonists aka partial agonists
 Binds to a pain receptor
 Causes a weaker pain response than a full agonist does
 Antagonists
 A non-analgesic
 Binds to pain receptors but doesn’t reduce pain signals
 They are called competitive antagonists because they compete and reverse the effects of
agonist and agonist-antagonist drugs
INDICATIONS:
 Used to alleviate moderate to severe pain
 Strong opioids such as Fentanyl, sufentanil and alfentanil are used in combination with
anaesthetics.
 They help maintain a balanced state of anaesthesia
 When taken in large doses, it goes to NS and depresses the part of the brain that controls the
diaphragm causing the lack of breathing. (Respirations must be done when taking an opioids)
CONTRAINDICATIONS:
 Known drug allergy, severe asthma
 Extreme caution: respiratory insufficiency, elevated intracranial pressure, morbid obesity, sleep
apnea, bowel paralysis, and pregnancy.
ADVERSE EFFECTS:
 CNS depression: most serious adverse effect
 Nausea, vomiting, constipation, biliary tract spasm, urinary retention, itchiness
 Pinpoint pupils indicating a possible overdose
INTERACTIONS:
 Mixes with alcohol, antihistamines, benzodiazepines, and other CNS depressants can cause
respiratory depressant effects
 Check dosages carefully (follow proper admin guidelines)
 Constipation is a common adverse effects (adequate fluid and fibre intake)
 Monitor adverse and therapeutic effects, oral forms should be taken with food
NON-OPIOIDS
CLASSIFICATION:
 Acetaminophen (Tylenol)
 Most widely used non-opioid analgesic
 Little to no anti-inflammatory effects, and available OTC
 Similar to salicylates
 Blocks pain impulses peripherally by preventing prostaglandin synthesis
INDICATIONS:
 Helps mild to moderate pain and fevers
 An appropriate substitute for aspirin
CONTRAINDICATIONS AND INTERACTIONS:
 Should not be taken if: drug allergy, liver dysfunction or failure, G6PD deficiency
 Dangerous interaction may occur if taken with alcohol or other drugs that are hepatotoxic
 Perform a thorough pain assessment
TOXICITY AND MANAGING OVERDOSE

When a patient is experiencing a severe respiratory depression an opioid antagonist should be
given
Narcan: we give it if one is experiencing an overdose, blocks narcotic receptors for a while
Titrate: giving someone smaller doses of the drugs, limiting the amount of drugs they intake
NON-STEROIDAL ANTI-INFLAMMATORIES
NSAIDs
A large and chemically diverse group of drugs that have:
 Analgesic activities
 Anti-inflammatory activities
 Antipyretic activities
 Aspirin platelet prevention
 Prevents the leukotriene pathway, the prostaglandin pathway or both
 Helps relieve pain, headaches and inflammation by blocking activity of the enzyme COX
 COX promotes the synthesis of prostaglandins (causes pain and inflammation)
INDICATIONS:
 Treats: rheumatoid arthritis, osteoarthritis, mild to moderate pain and acute gout
CONTRAINDICATIONS:
 Known drug allergy, risks of bleeding, vitamin K deficiency, rhinitis and peptic ulcer disease
ADVERSE EFFECTS AND NURSING IMPLICATIONS
 Heartburn, severe GI bleeding, acute kidney injury, edema, hepatotoxicity, tinnitus and hearing
loss
 Educate patient of various adverse effects, watch closely for bleeding stool
HERBALS:
Willow Bark
- Acts like aspirin, so it is used for pain, cold, flu and weight loss
- Can slow blood clotting, and contains chemical that might increase the amount of acetazolamide in
the blood.
Passionflower
- Used for anxiety, sleep problems, pain , and applied to skin for burns
- Can be used to make tea, or pills
- Considered safe but can cause drowsiness
- Should not be used during pregnancy, can cause contractions
ASPIRIN:
 Classified as a non-steroidal anti-inflammatory drug, aka as NSAID
 Treats pain, fever and inflammation
REYE’S SYNDROME:
 A rare disorder that causes brain and liver damage
 Usually occurs in children who have had a recent viral infection: chickenpox or the flu
 Taking aspirin to treat such an infection greatly increase the risk of Reye’s
UNIT 4: NEUROMUSCLAR MEDICATIONS
TOPIC 4.1: ANESTHETICS
CLASSIFICATION:
 General Anaesthetics (GA)
 Drugs for Procedural Sedation (PS)
 Local Anaesthetics (LA)
 Neuromuscular Blocking Drugs (NBD)
GENERAL ANAESTHETICS:
Drugs that induce a state in which the CNS is altered to produce degrees of:
 Pain relief, depression of consciousness, skeletal muscle relaxation and reflex reduction
MECHANIAN OF ACTIONS: (GA)
 Fat soluble drugs are stronger anaesthetics than water soluble drugs (nerve cell membranes
have a high lipid content)
 Overall effects: reduction of sensory and motor CNS functions, and progressive depression of
cerebral and spinal cord function
INDICATIONS: (GA)
 Used during surgical procedures, produces: unconsciousness, and muscle relaxation
 Rapid onset: quickly metabolized
ADVERSE EFFECTS: (GA)
 Sites affected: heart, peripheral circulation, liver, kidneys, and respiratory tract
 Myocardial depression is commonly seen
 Always assess past history of surgeries and response to anaesthesia.
PROCEDURAL SEDATION:
 Doesn’t cause complete LOC or respiratory arrest
MECHANISM OF ACTIONS (PS):
 Anxiety and sensitivity to pain are reduced and patient can’t recall the procedure
 Gives the ability to maintain airway and respond to verbal commands, used for minor surgeries
 Rapid recovery time. Propofol is a common drug used
LOCAL ANAESTHETICS:
 Also called regional anaesthetics
MECHANISM OF ACTION: (LA)
 Used to render a specific portion of the body insensitive to pain. You don’t lose LOC
 Interferes with nerve impulse transmission of specific areas of the body
INDICATIONS AND CONTRAINDICATIONS: (LA)
 Used for surgical, dental, diagnostic procedures, and treatments of certain types of persistent
pain
 Contraindications: known drug allergy
ADVERSE EFFECTS: (LA)
 Spinal headaches. Treatment: bed rest, caffeine, blood patch
INTERACTIONS: (LA)
 Few interaction occur
 When mixed with enflurane, halothane or epinephrine can lead to dysrhythmias
NEUROMUSCULAR BLOCKING DRUGS
 Prevents nerve transmission in skeletal and smooth muscle, resulting in muscle paralysis
 Patient rendered unable to breathe independently, mechanical ventilation is required to
prevent brain damage or suffocation
MECHANISM ACTION: (NMBD)
 Paralyze the skeletal muscle required for breathing: intercostal muscles and diaphragm
 Depolarizing drugs: binds to ACh, muscles become paralyzed
 Non depolarizing drugs: short, intermediate and long acting
INDICATIONS: (NMBD)
 Maintains skeletal muscle paralysis to facilitate controlled ventilation during surgical procedures
CONTRAINDICATIONS: (NMBD)
 History of: malignant hyperthermia, eye injuries, glaucoma
ADVERSE EFFECTS: (NMBD)
 Muscle spasm, muscle pain hyperkalemia (high potassium in the blood)
 Respiratory muscle paralysis occurs with these drugs
 Vitals, ABCs, oxygen sat, all body systems monitored.
TOPIC 4.2: PSYCHOTHERAPEUTIC MEDICATIONS

CLASSIFICATIONS:
 Anxiolytics (Benzodiazepines)
 Mood Stabilizers (Lithium)
 Antidepressants (1st generation-Tricyclics & MAOIs, 2nd generation-SSRI & SNRIs)
 Antipsychotic drugs (Conventional, Atypical)
BENZODIAZEPINES –
 Depresses activity in the brainstem and limbic system
 Believed to increase the action of GABA
INDICATIONS AND CONTRAINDICATIONS:
 Effective for short-term treatment of anxiety, as they stop symptoms of anxiety quickly
 Contraindications: known allergies, glaucoma, and pregnancy due to risk for teratogenic
effects
ADVERSE EFFECTS AND INTERACTIONS:
 Decreased CNS activity, sedation, dizziness, nausea, vomiting, constipation
 Loss of coordination, amnesia
 Alcohol and CNS depressants can cause CNS depression or death
LITHIUM:
 Used to alleviate the symptoms of acute mania
 Also effective for the maintenance treatment of bipolar disorder and depression.
 A variety of meds can be used with lithium to regulate mood and achieve stability such
as benzodiazepine and antipsychotic drugs
ADVERSE EFFECTS:
 Most serious adverse effect is cardiac dysrhythmia
 Other effects: drowsiness, slurred speech, seizures, hypothyroidism
ANTIDEPRESSANTS – 1st GENERATION

 Tricyclic: block reuptake of neurotransmitters, helps to regulate malfunctioning neurons
 MAOIs: used to treat Parkinson’s disease, atypical depression or mood disorders
INDICATIONS:
 Tricyclic: used to treat neuropathic pain syndromes, insomnia, and sometimes anorexia
 MAOIs: alleviates the symptoms of depression
ADVERSE EFFECTS:
 Tricyclic: sedation, impotence, and orthostatic hypotension
 MAOIs: stem for interactions with food and other meds: CV effects
ANTIDEPRESSANT – 2nd GENERATION
 SSRIs: prevention of serotonin reuptake
 SNRIs: prevention of serotonin and norepinephrine with exception of bupropion
 Patient should be educated about the time it takes before therapeutic effects of
antidepressants are realised, could take weeks.
INDICATIONS:
 SSRIs and SNRIs: depression is their primary indication
 Treats other mental and physical disorders
CONTRAINDICATIONS:
 SSRIs and SNRIs: history of heart disease or seizures
 Insomnia, weight gain, and sexual dysfunction
 Interactions: highly bound to albumin
ANTIPSYCHOTICS
 Used to treat serious mental health disorders.
 Atypical differs from conventional in that they tend to have better adverse
effects.
MECHANISM OF ACTIONS:
 Block dopamine receptors in the brain, which decreases dopamine concentration the
CNS
 For psychosis associated with mental health, most commonly schizophrenia
 Contraindications: CNS depression, brain damage, liver/kidney disease, epilepsy
ADVERSE EFFECTS:
 Insulin resistance, weight gain, involuntary muscle symptoms
 Assess head to toe assessment, blood pressure, LOC, and mental status
 Small amounts of meds should be dispensed at a time to lower risks of suicide attempts
HERBAL:
Kava
- Used for anxiety, may have a small effect on reducing it
- Linked to a risk of severe liver disease (combining kava with alcohol)
- Can cause dry, yellow skin and heart problems
TOPIC 4.3: SEDATIVE AND HYPNOTICS

CLASSIFICATIONS:
 Benzodiazepines
 Non-Benzodiazepines
 Hypnotics: cause sleep
 Barbiturates
BENZODIAZEPINES
 Depress CNS activity, calming effect of the CNS
 Affects hypothalamic, thalamic and limbic
 Do not suppress REM (rapid eye movement) sleep as much as barbiturates do
INDICATIONS:
 Sedation, sleep induction, skeletal muscle relaxation, agitation or anxiety relief, and
anxiety related depression
ADVERSE EFFECTS:
 Headaches, downiness, dizziness, cognitive impairment, vertigo, fall hazard for older
adults
INTERACTIONS:
 Food and drug interactions with grapefruit and grapefruit juice.
 CNS depressants: alcohol, opioids, muscle relaxants
NON-BENZODIAZEPINES
 Demonstrate hypnotic efficacy
 Generally cause less disruption of normal sleep
 Used for short-term treatment and symptomatic relief of insomnia
HYNOTICS
 Cause sleep
 A sedative can become a hypnotic if given in large enough doses
 In low doses, calm CNS without causing sleep.
 Has a more potent effect on CNS than sedatives have
BARBITURATES
 Site of action: brainstem
 Potentiating the action of GABA, causing prevention of nerve impulses travelling to
cerebral cortex
INDICATIONS:
 Sedatives, anaesthesia for surgical procedures
ADVERSE EFFECTS:
 Vasodilation, vertigo, respiratory depression, coughing, vomiting, Steven-Johnson
syndrome
INTERACTIONS:
 MAOIs prolong the effects of barbiturates
 Obtain vitals, intake and output
 Administer hypnotics 30-60 minutes before bedtime for effectiveness
 Avoid alcohol and other CNS depressants
 Monitor for therapeutic effects
HERBAL:
Melatonin:
- Natural hormone that plays a role in sleep
- Helps with jet lag, delayed sleep phase disorder insomnia
- May worsen mood in people with dementia, side effects are uncommon
Valerian:
- Used for insomnia, anxiety, menopause and depression
- Knowledge is limited, and unknown if it relieves the symptoms listed above
- Should not be taken with alcohol or sedatives
TOPIC 4.4: (CNS) STIMULANTS

CLASSIFICATIONS:
 ADHD
 Anti-Narcoleptics
 Anorexiants
 Antimigraine
 Analeptics
DRUGS FOR ADHD AND NARCOLEPSY:
 CNS stimulants are the first-line drugs of choice for both
 Amphetamines: stimulate areas of the brain associated with mental alertness
 Causes: Tend to speed up body systems. Mood elevation, increased mental alertness and
capacity to work, decreased fatigue and drowsiness, and prolonged wakefulness
 Respiratory effects: relaxation of bronchial smooth muscle, and increased respiration
INDICATIONS:
 Amphetamines: treats ADHD and narcolepsy as well as obesity
 No currently approved in Canada
CONTRAINDICATIONS:
 Amphetamines: Known allergies and cardiac structural abnormalities
 Must not be used in patients who have received therapy with any MAOIs in the preceding 14
days.
ANOREXIANTS:
MECHANISM OF ACTIONS:
 Irreversibly preventing the enzyme lipase
 Results in reduced absorption pf dietary fats and increased fat elimination
INDICATIONS:
 Used to treat obesity but effectiveness has not been proven
 None available in Canada
ADVERSE EFFECTS:
 Headaches, upper respiratory infections, GI distress and fecal incontinence
ANTIMIGRANE
 Reduce the production of inflammatory neuropeptides, known as abortive therapy
 Abortive therapy treats a headache that has started
 Ergot: constrict or narrow blood vessels in brain
INDICATIONS:
 For abortive therapy of an acute migraine headache
CONTRAINDICATIONS:
 Triptans: Can cause serious CV disease because of the vasoconstrictions of the med
 Ergot: CV, cerebral and PV disease and hypotension
ADVERSE EFFECTS:
 Irritation at injection site, tingling, vomiting, dizziness, and muscle pain
ANALEPTICS
 Used less frequently
 Stimulate areas of CNS that control respirations (mainly medulla and spinal cord)
INDICATIONS:
 Used to stimulate respirations (neonatal apnea)
ADVERSE EFFECTS:
 Elevated respiratory rate, diarrhea, tremors, sweating
CONTRAINDICATIONS:
 Drug allergy, peptic ulcer disease (especially for caffeine) and serious CV conditions
 Assess for abnormal cardiac rhythms, seizures, palpitations, and liver problems
 For children baseline height and weight
 ADHD: last daily dose should be given 4-6 hours before bedtime to reduce insomnia, and take on
empty stomach 30-45 minutes before meals
TOPIC 4.5: ADRENERGIC AND ADRENERGIC

BLOCKING MEDICATIONS
CLASSIFICATIONS:
 Adrenergics
 Adrenergic Blockers (a-Blockers, B- Blockers)
ALL ABOUT THE SYMPATHETIC NERVOUS SYSTEM
Mimic the effects of SNS neurotransmitters norepinephrine, epinephrine and dopamine
ADRENERGICS
 Transmission takes place at the junction between the nerve
DIRECT- ACTING SYMPATHOMIMETIC
 binds directly to receptor and causes a physiological response
 The drug pretends to be epinephrine (direct substitute aka replacement)
INDIRECT- ACTING SYMPATHOMIMETIC
 Drug doesn’t go to the receptor sites (indirect pulling it out)
ADVERSE EFFECTS:
 Male ejaculation, vasoconstriction of blood vessels, relaxation of GI smooth muscle, dilated
pupils
 Treatment of asthma, bronchitis and conjunctival congestion
 Salbutamol- help people with asthma
 Contraindications: known allergies and hypertension
INTERACTIONS:
 Many drug interaction happen with adrenergic drugs,
 Results in the diminished adrenergic effect.
 Ask patient if they have a history of CV disease because these drugs will work hard on the heart
ADRENERGIC BLOCKERS (a-Blockers, B- Blockers)

 Bind to adrenergic receptors but prevent stimulation of SNS
 Have the opposite effect of adrenergic drugs
 Beta blockers are the most effective blood pressure medication (decreases heart rate)
INDICATIONS:
 a-Blockers
 reduces PV resistance causing you blood pressure to reduce
 used to treat hypertension
 B-blockers
 Work by decreasing the demand of myocardial energy and oxygen consumption
 Helps shift the supply and demand ratio, allowing more oxygen to reach the heart
muscle
CONTRAINDICATIONS:
 a-Blockers
 known allergy and PVD
 B-blockers
 Known allergy and acute decompensated heart failure , pregnancy, bradycardia
ADVERSE EFFECTS:
 a-Blockers
 hypotension, edema, chest pain, dizziness, weakness, vomiting, constipation, dry mouth
 B-blockers
 May interfere with normal responses to hyperglycema
 Masking signs and symptoms. Use caution in patient with diabetes mellitus
 Instruct patient that these m edications should never be stopped abruptly
 REMEMBER BETA BLOCKERS WILL MASKS SYMPTOMS OF HYPERGYLCEMIA
HERBAL:
Ephedra
- Used for colds, fever, flu, headaches, asthma, nasal congestion and wheezing
- Banned due to unreasonable risk of injury or death
- May intensify or cause seizure in people with the disorder
- Pregnant or breastfeeding women should avoid it
TOPIC 4.6: CHOLINERGIC AND CHOLINERGIC

BLOCKING MEDICATIONS
CLASSIFICATIONS:
 Cholinergics (Direct-Indirect Acting)
 Cholinergics Blockers
ALL ABOUT PARASYMPATHETIC NERVOUS SYSTEM
Mimic effects of parasympathetic nervous system neurotransmitter acetylcholine (ACh)
CHOLINERGIC
 When ACh binds directly to receptor sites stimulation occurs
DIRECT ACTING:
 Bind to cholinergic receptors activating them
INDIRECT ACTING:
 Known as cholinesterase inhibitors
 Cholinesterase is an enzyme that packs up ACh
 Cholinesterase inhibitors- prevent cholinesterase from eating ACh
CONTRAINDICATIONS:
 Known drug allergy, GI or GU tract obstruction
 Bradycardia, epilepsy, hypotension
ADVERSE EFFECTS:
 Overstimulation of the parasympathetic nervous system
 Effects of the CV system is complex
 Instruct patient that these medications should never be stopped abruptly
 Overdosing can cause life threatening problems
 Monitor therapeutic effects
CHOLINERGICS BLOCKERS
 Stops the rest and digest from initiating
MECHANISM OF ACTIONS
 Drugs that blocks the action of ACh in the parasympathetic nervous system
 Largely competitive antagonists because they compete with ACh
 Major site of action: the heart, respiratory/GI tract , bladder, eye and exocrine glands
INDICATIONS:
 Decreases muscle rigidity and diminishing tremors (helps with Parkinson’s)
 Affects the heart’s conduction, low doses: slow the heart rate, high doses: increase heart rate
CONTRAINDICATIONS:
 Known drug allergy, glaucoma, acute asthma and CV instability
ADVERSE EFFECTS:
 Increased heart rate, restlessness, delirium, dilated pupils, decreased salivation and GI mobility
 Urinary retention, decreased sweating
 Medication should be taken exactly as prescribed
 Patients may experience sensitivity to light and may need to wear sunglasses
 Anticholinergics taken by older adult patients may lead to higher risk for heatstroke
HERBAL:
American Ginseng
- Orally taken, for stress, and to boost immunity
- Used to fight infections: colds and flu
- Considered safe but not when pregnant, have diabetes (can lower BS too much)
- DO NOT combine: MAOIs, Coumadin, and antidiabetes drugs
Ginkgo
- Used for dementia, eye problems and leg pain
- No evidence that it is helpful to health
- Eating it fresh can be poisonous
TOPIC 4.7: ANTICONVULSANTS

CLASSIFICATIONS:
 Antiepileptic
 Anticonvulsants
ANTIEPILEPTIC
 Many antiepileptic increase GABA levels to normal range, reducing the potential for seizures
 Increase the threshold of activity in the motor cortex of the brain (makes it hard for a nerve to
be excited)
 They suppress the transmission of impulses from one nerve to the next (limiting the spread of a
seizure discharge)
 Decrease the speed of nerve impulse conduction
 Low levels of GABA are associated with seizures
INDICATIONS:
 Indicated for management of all types of epilepsy (prevent of control or prevent activity)
CONTRAINDICATIONS:
 Pregnancy is a common one
ADVERSE EFFECTS
 Many patients can’t tolerate the effects and the therapy must be withdrawn
 Skin reactions and immune reactions are extremely common
INTERACTIONS:
 Many of the antiepileptic drugs can interact with each other, requiring close monitoring of the
patient
 Many of these drugs induce hepatic metabolism
 Teach patient that therapy is long term and possibly lifelong (not a cure)
 Monitor for therapeutic and adverse effects
TOPIC 4.8: ANTIPARKINSONISM MEDICTIONS
CLASSIFICATIONS:
 Dopamine Replacement Therapy
 Indirect-acting Dopaminergics (Monoamine Oxidase Inhibitors)
 Anticholinergics
DOPAMINE REPLACEMENT THERAPY

MEHANISM OF ACTION:
 Stimulate presynaptic dopamine receptors to increase brain levels of dopamine
 Must be administered orally as levodopa
 Levodopa is the biological precursor of dopamine and can penetrate into the (CNS)
 Dopamine replacement drugs are used to directly restore dopaminergic activity in PD
 Contraindications: cases of angle closure glaucoma (the drugs can raise intraocular pressure)
 Contraindications: drugs not used in patients with any undiagnosed skin conditions because
they can activate malignant melanoma (cancer)
ADVERSE EFFECTS :
 Cardiac dysrhythmias, hypotension, chorea, muscle cramps and GI distress
MONOAMINE OXIDASE INHIBITORS

 Role of MAO enzymes is the breakdown of catecholamines such as: dopamine, norepinephrine,
epinephrine, and serotonin.
 As PD progresses, it becomes more difficult to manage it with levodopa
ANTICHOLINERGIC
 Block the effects of the neurotransmitter ACh at the cholinergic receptor in the brain.
 The purpose of their use is to reduce excessive cholinergic activity in the brain
 Used to treat muscle tremors and rigidity associated with PD
 Assess for signs and symptoms of PD.
 Inform patient not to take other medications with PD drugs unless checked with doctor
TOPIC 4.9: MUSCULOSKELETAL MEDICATIONS
CLASSIFICATIONS:
 Muscle relaxants (baclofen)
 Nonsteroidal Anti-inflammatories (CHECK UNIT 3)
 Antigout (Allopurinol)
 Antirheumatics (methotrexate)
MUSCLE RELAXANTS – BACLOFEN

 Muscle relaxants act in the CNS to relieve pain associated with skeletal muscle spasms often
following low back strain
 Similar in action as other CNS depressants such as diazepam.
 Baclofen is one of the more effective drugs and derivative of GABA
 Believed to work by depressing nerve transmission in the spinal cord
CONTRAINDICATIONS AND ADVERSE EFFECTS
 Severe renal impairment
 Adverse effects: CNS and skeletal muscle
INTERACTIONS:
 Alcohol and benzodiazepines: caution needs to be used to avoid overdose
ANTIGOUT – ALLOPURINOL:
 Inhibits the enzyme xanthine oxidase, preventing uric acid production
 Indicated for patients whose gout is caused by excess production of uric acid
 Contraindicated in patients with a hypersensitivity to it
 Only for oral use
ANTIRHEUMATICS – METHOTREXATE
 Anticancer drug that is used to treat rheumatoid arthritis
 Adverse effect: bone marrow suppression
 Contraindications: not used in patients with active bacterial infections
 Nursing implications: assess contraindications of patients with active bacterial infections
HERBALS:
Glucosamine sulfate: orally, topically and parenteral
- Naturally occurring chemical found in the body (in fluid around the joints)
- Taken by mouth for: osteoarthritis, glaucoma, weight loss, and pain
- Safe for adults but warning for people who are: pregnant/nursing, asthma, shellfish allergy,
diabetes, surgery, and hypertension same for Chondroitin sulfate
Chondroitin sulfate:
- Chemical found in cartilage around joints in the body
- Used for osteoarthritis, also taken by mouth for HIV/AIDS and available as an eye drop
- Effective for osteoarthritis and UTIs but not for dry eyes, acid reflux and joint pain
UNIT 5: RESPIRATORY MEDICATIONS
TOPIC 5.1: ANTITUSSIVES, ANTIHISTMAINES,
DECONGESTANTS AND EXPECTORANTS
CLASSIFICATIONS: COLD MEDICATIONS
 Antihistamines (non-sedating vs traditional)
 Decongestants
 Antitussives
 Expectorants
ANTIHISTAMINES
 Directly compete with histamine for specific receptor sites (histamine antagonists)
 H1 antagonists: are of greatest value in the treatment of nasal allergies (hay fever). They help
alleviate only the symptoms of a cold but don’t the destroy the virus causing it
 H2 antagonists: stomach
 Blocks the histamine receptors (this what is causing the allergy symptoms)
 Preventing the release and actions of histamine stored within the cells
 Compete with histamine for unoccupied receptors
INDICATIONS AND CONTRAINDICATIONS
 Manages nasal allergies, hay fever, and colds, and helps with motion sickness
 In respiratory tract, antihistamines causes the bronchial tree to relax
 Contraindications: they are not to be used during acute asthma attacks
Salbutamol (Ventolin) is a rapid acting bronchodilator and should be used in serious asthma attack
cases. In extreme cases epinephrine is usually the urgent medication
ADVERSE EFFECTS:
 Drowsiness is the chief effect.
NON SEDATING VS TRADITIONAL:
 Non-sedating antihistamines were developed to eliminate many of the adverse effects of
older antihistamines.
 Non-sedating antihistamines peripherally block the action of histamine and have fewer CNS
effects
 Traditional antihistamines are older drugs that work peripherally and centrally.
 Traditional antihistamines have anticholinergic effects, making them more effective than non-
sedating
DECONGESTANTS
MECHANISM OF ACTION AND INDICATIONS:
 Used for their ability to shrink engorged nasal mucous membranes and relieve nasal stiffness
 Indication: reduce the nasal congestion and swelling associated with cold, hay fever and other
allergies
 Nervousness, insomnia, tremors and palpitations
 Mixing with MAOIs may result in additive effects resulting high blood pressure
ANTITUSSIVES:
 Come in many oral dosage forms and are available with or without prescription
 Most narcotic antitussives are only available in prescription
EXPECTORANTS:
MECHANISM OF ACTION, INDICATIONS AND ADVERSE EFFECTS
 1st is reflex stimulation and 2nd is direct stimulation of the secretory glands in the respiratory
tract
 Indications: used to relief of productive cough, and suppression of cough
 Adverse effects are minimal
TOPIC 5.2: RESPIRATORY MEDICATIONS

CLASSIFICATIONS:
 Bronchodilators (B-Adrenergic Agonists, Anticholinergics, Xanthine Derivatives)
 Nonbronchodilating Respiratory (Leukotriene Receptor Antagonists, Corticosteroids
BRONCHODILATORS: relax the bronchial smooth muscle.
B-ADRENERGIC AGONISTS
MECHANISM OF ACTION AND INDICATIONS:
 Dilate airways by stimulating the B-adrenergic receptors located throughout the lungs
 Used to treat and prevent acute attacks
 Relief of bronchospasm related to asthma, COPD, and pulmonary diseases
CONTRAINDICATIONS:
 Uncontrolled cardiac dysrhythmias
 High risk of stroke (because of the vasoconstrictive drug action)
ADVERSE EFFECTS:
 angina pain, tremor, vascular headaches, insomnia, restlessness and anorexia
INTERACTIONS:
 monitor patients with diabetes, an increase in blood glucose levels can occur
ANTICHOLINGERICS
 ACh causes bronchial constriction and narrowing of the airways.
 Anticholinergics bind to the ACh receptors, preventing ACh from binding.
 Result: bronchoconstriction is prevented, airways dilate
ADVERSE EFFECTS:
 Dry mouth or throat, nasal congestion, urinary retention, headache, coughing and anxiety
XANTHINE DERIVATIVES
 Cause bronchodilation by increasing levels of energy-producing cAMP
 Xanthine does this by competitively preventing phosphodiesterase (enzyme the breaks down
cAMP)
 cAMP plays a role in maintain open airways (increased airflow)
INDICATIONS AND CONTRAINDICATIONS
 Xanthine is used to dilate the airways in patients with asthma or COPD
 Uncontrolled cardiac dysthymias, seizures, hyperthyroidism and peptic ulcers
ADVERSE EFFECTS:
 Nausea, vomiting, anorexia, gastroesophageal reflux during sleep and hyperglycemia
NONBRONCHODILATING RESPIRATORY:
LEUKOTRIENE RECEPTOR ANTAGONISTS (good guys) – MECHANISM OF ACTION
 Substances released when a trigger like cat hair/dust starts chemical reaction in the body
 Leukotrienes cause inflammation, bronchoconstriction and mucus production
 Results: coughing, wheezing, and SOB
 They prevent leukotrienes from attaching to receptors in lungs
INDICATIONS, CONTRAINDICATIONS AND ADVERSE EFFECTS
 Long term treatment and prevention of asthma in adults and children
 Contraindication: Allergy to: povidone, lactose, titanium dioxide
 Adverse effects: liver dysfunction, headache, nausea and diarrhea
CORTICOSTEROIDS
 Restore or increase the responsiveness of bronchial smooth muscle to B-adrenergic receptor
stimulation
 Results in more Salbutamol (Ventolin)
INDICATIONS, CONTRAINDICATIONS AND ADVERSE EFFECTS:
 Administered by inhalation
 Used in treatment of pulmonary diseases because they have anti-inflammatory effects
 Contraindications: not meant as sole therapy for acute asthma attacks
 Adverse effects: coughing, dry mouth, oral fungal infections
 B-Adrenergic Agonists: Salbutamol, if used too much it loses its B2-specific actions
 Xanthine Derivatives: beware of contraindications, and smoking (enhances xanthine
metabolism)
 Leukotriene Receptor Antagonists: make sure it is not used for acute asthma
 Corticosteroids: teach patient how to keep inhaler and nebulizer clean after use
UNIT 6: CARDIOVASULAR MEDICATIONS
TOPIC 6.1: ANTIHYPERTENSIVES
 Important considerations in planning drug therapy are whether the patient has multiple medical
problems and the impact it will have on the patient.
 Sexual dysfunction in males is a common adverse effect of almost any antihypertension drug,
and most common reason for nonadherence to drug therapy
DIURECTICS:
 Highly effective class of antihypertensive drugs
 First line for the treatment of hypertension
 Primary therapeutic effect is decreasing volumes of plasma and extracellular fluid
 Leads to a decrease in cardiac output and total peripheral resistance – overall decreases
workload of the heart.
ADRENERGIC
 Indications:
 Used to treat hypertension and various forms of glaucoma
 Lack of norepinephrine production reduces blood pressure
 Adverse Effects:
 Bradycardia with reflex tachycardia, orthostatic and post exercise hypotension
 Dry mouth, drowsiness, dizziness, depression, edema, constipation, and sexual
dysfunction
 Headaches, sleep disturbances, nausea, rash and palpitations
 a-blockers- change positions slowly when taking the drug
 abrupt dosage changes of CV meds can be hazardous to the patient
 can cause disruption in blood counts, serum electrolytes and kidney function
 Indications:
 can cause additive CNS depression when taken with alcohol, benzos, and opioids
ANGIOTENSIN-CONVERTING ENZYME INHIBITORS (ACE-inhibitors)

 ability to reduce BP by decreasing SVR by preventing vasodilators
 used as one of the first-line drugs in treatment of both hypertension and heart failure.
 Mechanism of action:
 Prevent angiotensin converting enzyme which coverts angiotensin 1 to angiotensin 2
 Angiotensin induces aldosterone which can increase BP
 Primary effects: CV and renal
 Indications:
 Considered a choice of hypertensive patients with heart failure
 ACE prevent water and sodium reabsorption
 Prevents the cardioprotective effect
 Fatigue, dizziness, headache, impaired taste
 Mood changes, hyperkalemia, angioedema (rare but fatal)
 Dry, non-productive cough.
 Contradictions:
 Known allergy, especially a previous reaction to angioedema (laryngeal swelling)
 baseline potassium of 5 mmol/L or higher and decline kidney function
 Interactions:
 NSAIDS (ibuprofen) can reduce the antihypertensive effect of ACE inhibitors
 Giving lithium and carbonate and ACE inhibitors together can results in lithium toxicity
 Hyperkalemia can occur when ACE inhibitors and potassium supplements/diuretics
ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs)

 Similar to ACE inhibitors
 Block the binding of angiotensin II to type 1 angiotensin II receptors.
 ARBs affect primarily vascular smooth muscle and adrenal gland
 ARBs block vasoconstrictions and the secretion of aldosterone
 Indications:
 May be used alone or in combination with other drugs such as diuretics
 Used for treatment of heart failure
 Contraindications:
 Known allergies, pregnancy and lactation
 Need to be used cautiously in older adults and in patients with kidney dysfunction
 BP and apical pulse need to be assessed before and after drug therapy
 Most common: upper respiratory infections and headache
 Dizziness, inability to sleep, diarrhea, heartburn, dyspnea, back pain
 Nasal congestion, fatigue
 Interactions:
 ARBs can promote hyperkalemia when taken with potassium supplements (less likely
than ACE)
CALCIUM CHANNEL BLOCKERS (CCBs)

 Prevent calcium from entering cells of the heart and blood vessel walls – resulting in
decreased BP
 Relax and widen blood vessels
 Indication:
 Used to treat hypertension, angina and supraventricular tachycardia
 Cause smooth muscle relaxation by blocking the binding of calcium to its receptors.
 Constipation, bradycardia, heart block, hypotension, dizziness and dyspnea
 Known drug allergy, acute MI, 2nd and 3rd degree block
 Hypotension
 Interactions:
 Grapefruit juice (increases the bioavailability of CCBs in nifedipine
VASODILATORS
 Useful as antihypertensive drugs because they can cause peripheral vasodilation
 Causes a reduction in SVR
 Indications:
 Used to treat hypertension
 Sodium nitroprusside and intravenous diazoxide are used when BP is severely elevated
 Known drug allergy, hypotension, cerebral edema, head injury, acute heart attack
 Coronary artery disease
 Dizziness, headache, anxiety, tachycardia, edema,
 Dyspnea, nausea, vomiting, hepatitis, SLE, vitamin B and rash
 T-wave electrocardiographic changes, angina, breast tenderness, thrombocytopenia
 Platelet aggregation
 Patient teaching: Vasodilator
 Avoid alcohol, hot tubs, hot showers, saunas, and hot weather
PATIENT TEACHING:
 Don’t stop drugs abruptly (can lead to a stroke)
 Oral forms should be taken with meals
 Avoid smoking and eating foods that are high in sodium
 Encourage supervised exercises
 Watch diet, stress levels, weight and alcohol intake
TOPIC 6.2: ANTIANGINAL AND PERIPHERAL

VASODILATORS
NITRATES
 Dilate all blood vessels
 Indications:
 Used to treat or prevent heart pain caused by heart disease (angina)
 Treats acute angina attacks
 Severe anemia, closed-angle glaucoma, hypotension and severe head injury
 Most include CV system and headaches
 If nitrate induced vasodilation happens too fast the CV system overcompensates and
increase heart rate
 Interactions:
 Hypotensive effects when combined with alcohol, B-blockers and CCBs
 Patient teachings: take apical pulse for 1 full minute
B-BLOCKERS
 Works by decreasing the demand of myocardial energy and oxygen consumption
 Helps shift the supply and demand ratio, allowing more oxygen to reach the heart
muscle
 Known allergy and acute decompensated heart failure, pregnancy, bradycardia
 Masking signs and symptoms.
 Use caution in patient with diabetes mellitus
 May interfere with normal responses to hyperglycema
 Fatigue, insomnia, and weakness
 May lead to cardiac rhythm problems, decreased SA and AV
 Decreased systolic and diastolic BP
 Patient teachings
 Instruct patient that these medications should never be stopped abruptly
 REMEMBER BETA BLOCKERS WILL MASKS SYMPTOMS OF HYPERGYLCEMIA
TOPIC 6.3: HEART FAILURE MEDICATIONS

CARDIAC GLYCOSIDES
 Digoxin is the only one available
 Works directly on the heart muscle
 Slows down the heart rate and increases the force with which the heart muscle
contracts
 Indications:
 Used to treat heart failure and atrial fibrillation
 Known allergy, 2nd and 3rd degree heart block, atrial fibrillation
 Caution to those reduced kidney function
 GI: anorexia, nausea, vomiting, diarrhea
 CNS: headache, fatigue, confusion, convulsions
 CV: hypotension, bradycardia, tachycardia
 Eye: coloured vision, halo vision
 Interactions:
 Caution: ginseng, hawthorn, licorice, and St. John’s wort.
 Patient teaching:
 Check serum potassium and magnesium levels to prevent toxicity
 Check calcium levels
 Always check apical pulse
 Oral digoxin should not be taken with fiber
TOPIC 6.4: ANTIDYSRHYTHMIC MEDICATIONS
LIDOCAINE: IB drug
 Blocks sodium channels, decreasing the rate of contractions in the heart
 Can be only be administered via IV because of extensive first- pass effect
 Indications:
 Used to treat ventricular tachycardia and fibrillation
 Most effective/ important drug.
 CNS effects: twitching, convulsions, and confusion
 Respiratory depression or arrest
 Bradycardia, dysrhythmia, hypotension, anxiety, metallic taste
 People who are hypersensitive to it
 SA or AV intraventricular block
 Those who have Stokes- Adams or Wolff-Parkinson-White syndrome
 Nursing implications:
 Assess the CV system, BP and heart rate
ATENOLOL: Class II drug

 Indications:
 A cardio selective B-blocker
 Blocks the B-adrenergic receptors that are in the heart
 Used to treat hypertension and angina
 Dizziness, tiredness and nausea
 May reduce blood flow to hands and feet
 Contradictions:
 Those with severe bradycardia (slow heart rate)
 2nd or 3rd degree heart block
 heart failure, cardiogenic shock, and hypersensitivity
METOPROLOL
 Indications:
 A cardio selective B-blocker
 Used to treat hypertension, angina and improve survival after a heart attack
 Dizziness, constipation, SOB, fatigue
 Coughing/wheezing, diarrhea, rashes and temporary mental confusion
 Contraindications: same as Atenolol
 Those with severe bradycardia (slow heart rate)
 2nd or 3rd degree heart block
 heart failure, cardiogenic shock, and hypersensitivity
VERAPAMIL HYDROCHLORIDE: calcium channel blocker
 Mechanism of Action:
 Prevents calcium ion influx across calcium channels in cardiac conduction tissue
 Indications:
 Used to treated hypertension
 Relaxes blood vessels so blood can flow more easily
 Adverse effects:
 Constipation, bradycardia, heart block
 Hypotension, dizziness and dyspnea
NURSING IMPLICATIONS: anti-dysrhythmia

 Take meds as scheduled, don’t skip or double up for missed meds
 Contact physician if a dose is missed
 During therapy monitor heart rate, BP, skin colour, temp, heart and lung sounds
TOPIC 6.5: ANTILIPIDEMICS

HYDROXYMETHYLGLUTARYL – COENZYME A REDUCTASE INHIBITORS
 Lower blood cholesterol level by decreasing the rate of cholesterol production
 Indications:
 First line drug therapy for elevated LDL-C (most dangerous form of dyslipidemia)
 Reduce LDL-C concentrations
 Known drug allergy and pregnancy
 Liver disease or elevation of liver enzymes
 Most common: GI disturbance, rash, headaches
 Elevations in liver enzymes levels
 Interactions:
 Caution in patients taking oral anticoagulants
 Limit intake of grapefruit and grapefruit juice
 Nursing Implications:
 Not to be used in patients who have liver disease or increased liver enzymes
 Assesses intake of alcohol
 May require fat-soluble vitamins if on meds for a long period of time
BILE ACID SEQUESTRANTS

 Bind to bile and prevent the resorption of bile acids from small intestine
 Indications:
 Lowers LDL cholesterol
 Used to manage type II hypolipoproteinemia (abnormally elevated levels of lipids in the
blood)
 Biliary or bowel obstruction and PKU
 Common: constipation
 Heartburn, vomiting, nausea, belching and bloating
 Take with meals to reduce adverse effects
 Interactions:
 High doses will decrease the absorption of fat soluble vitamins (A, D,E and K)
 All other drugs should be taken 1 hour before or 4-6hours after taking bile acid
sequestrates
 Careful assessments of contraindications
 Should be mixed thoroughly with food or fluids
UNIT 7: HEMATOLOGIC MEDICATIONS
TOPIC 7.1: COAGULATION MODIFIERS
ANTICOAGULANTS: Heparin and Warfarin
 Prevent the formation of clots or thrombus
 Indications:
 Prevent clot formation where there is a high chance of the formation
 Includes: MI, unstable angina, A-fib
 Warfarin- strongly contraindicated in pregnancy
 Bleeding the main complication
 Warfarin toxicity or overdose- discontinue
 Interactions:
 Aspirin and warfarin increase risk of bleeding when taken with heparin
 Patient education:
 Avoid foods high in vitamin K (tomatoes, dark green veggies)
 Many herbal products could increase bleeding: garlic, St. John’s, ginger, feverfew, ginkgo
 Effects are seen immediately, and PTT are done daily
ANTIPLATELETES:
 Aspirin has antiplatelet effects
 Indications:
 Prevent blood cells called platelets from clumping together to form a clot
 thrombocytopenia, active bleeding, leukemia, injury, GI ulcer
 Vitamin K deficiency and recent stroke
 CNS: Downiness, dizziness, confusion, flushing
 GI: nausea, vomiting, GI bleeding, diarrhea
 Hematological: thrombocytopenia, leukopenia, hemolytic anemia, bleeding,
neutropenia
 Interactions:
 NSAIDs increase bleeding potential
 Patient teachings:
 Monitor abnormal bleeding
THROMBOLYTIC DRUGS
 Responsible for dissolving clots (thrombus)
 Indications:
 Activates conversion of plasminogen to plasmin = enzyme that breaks down thrombus
 History of major surgery, trauma or bleeding
 Most common: internal, intracranial and superficial bleeding
 Hypersensitivity, anaphylactoid reactions, nausea, vomiting and hypotension
 Monitor IV site for bleeding, redness or pain
 Monitor for bleeding gums, nose, mucous membrane and internal bleeding
 Monitor for decreased BP and increased pulse
ANTIFIBRINOLYTIC DRUGS
 Mechanism of action and indication:
 Promotes blood clotting by preventing blood clots from breaking down
 Used in treatment of excessive bleeding
 Disseminated intravascular coagulation
 CV: dysthymias, orthostatic, hypotension, bradycardia
 CNS: headache, dizziness, fatigue, hallucinations, convulsions
 GI: nausea, vomiting, abdominal cramps, diarrhea
 Interactions:
 Estrogen or oral contraceptives
 Caution when giving to patient taken: lithium carbonate, heparin, alcohol and
epinephrine
TOPIC 7.2: ANTI-ANEMICS

ERYTHROPOIESIS- STIMULATING AGENTS
 Epoetin alfa:
 normally secreted by kidneys in response to decreased RBCs
 promotes the synthesis of RBCs
 Alfas are used to treat anemia associated with end-stage kidney disease
 Ineffective without adequate body iron stores and bone marrow function
 Contradictions:
 In cases of uncontrolled hypertension and patients who develop pure red cell aplasia
 Should not be given if patient has uncontrolled hypertension
 Use cautiously in patients who have a history of seizures
 Hypertension, fever, headaches, pruritus, rash, nausea, vomiting
 Injection site reaction, arthralgia
IRON
 Oxygen carrier in both hemoglobin and myoglobin
 Used in the bon marrows to make haemoglobin, excess iron is stored as ferritin
 Indications:
 Supplements are used to prevent or treat anemia
 Hemochromatosis (iron overload), hemolytic anemia
 Any other anemia that is not associated with iron deficiency
 Nausea, vomiting, diarrhea, constipation, dark stool, cramps
 Dosage is important (excess iron can lead to iron toxicity)
 Interactions:
 Enhanced when given with ascorbic acid
 Decreased when given with antacids and calcium
 Oral forms should be taken between meal for max absorption
 Oral forms should be taken with juice but not milk or antacid
 Encourage patient to eat food that is high in iron
 Take liquid iron via straw to avoid staining tooth enamel
FOLIC ACID
 Used for erythropoiesis and for synthesis of DNA and RNA
 Not active in ingested form
 Indications:
 Used to prevent and treat folic acid deficiency
 Also treat spina bifida
 Any anemia not related to folic acid deficiency
 Not to be used to treat anemia until underlying cause of anemia and type has been
determined
 Allergic reaction or yellow discoloration of urine
 Determine the cause of anemia before administering folic acid
 Give oral folic acid with food
 Encourage patients to eat food that are high in folic acid
UNIT 8: URINARY MEDICATIONS
TOPIC 8: DIURETICS/URINARY MEDICATIONS
CARBONIC ANHYDRASE INHIBITORS
 Mechanism of action
 Reduces the formation of hydrogen and bicarbonate ions
 This results in the reduction in the availability of the ions
 An undesired effect of CAIs is the elevation of blood glucose levels, causing glycosuria in
patients who have diabetes
 Indications:
 Treats glaucoma, edema, epilepsy, and high-altitude sickness.
 Hyponatremia, hypokalemia, severe kidney or liver dysfunction
 Adrenal gland insufficiency and cirrhosis
 Acidosis (too much acid in the body), hypokalemia
 Drowsiness, anorexia, parethesias, hematuria, urticaria,
 Photosensitivity and melena (blood in stool)
 Interactions:
 Because CAIs can cause hypokalemia, an increase in digoxin toxicity may occur when
CAIs and digoxin are combined
 Assesses sodium and potassium levels
 Do not use diuretics drug if patient has history kidney or liver dysfunction.
 When given with digoxin, there is an increased risk of digoxin toxicity because of
hypokalemia
LOOP DIURETICS
 Act at the ascending loop of Henle in the kidney
 Prevent sodium chloride and potassium reabsorption
 Indications:
 Used to manage edema associated with heart failure
 Treats liver or kidney disease, and hypertension
 Hepatic coma and severe electrolyte loss
 Dizziness, headaches, tinnitus, blurred vision
 Nausea, vomiting, diarrhea, agranulocytosis
 Hypokalemia, hyperglycemia, hyperuricemia, hypomagnesemia
 Concern for patients taking the drug and neurotoxic and ototoxic
 Monitor glucose levels
OSMOTIC DIURECTICS
 Mannitol is most commonly used (nonabsorbable)
 It increases osmotic pressure in the glomerular filtrate, pulling water into the renal
tubules
 Reduces cellular edema and increases urine production
 Indications:
 Used in treatment of acute kidney failure
 Used to promote the excretion of toxic substances
 Severe kidney disease, pulmonary edema and active intracranial bleeding
 Convulsions, thrombophlebitis, and pulmonary congestion
 Less common: Headaches, chest pain, tachycardia blurred vison, chills and fevers
 Teach patient to eat more potassium rich foods when taking any diuretic
POTASSIUM – SPARING DIURETICS

 Interfere with sodium-potassium exchange
 Indications:
 Don’t promote the secretion of potassium in the urine
 used as adjunctive therapy with other drugs
 threats hypertension and manages congestive heart failure
 Hyperkalemia, severe heart failure or anuria
 Dizziness, headaches, cramps, nausea, vomiting, diarrhea
 Urinary frequency, weakness, hyperkalemia
 Interactions:
 ACE inhibitors or potassium supplements can cause hyperkalemia when combined with
drug
 NSAIDs can decreases the blood flow to kidneys
 Avoid foods high in potassium
 Monitor for hyperkalemia
THIAZIDES AND THIAZIDE – LIKE DIURETICS

 Prevent the resorption of sodium, potassium and chloride
 Results in osmotic water loss
 Indications:
 Used to treat edema, idiopathic hypercalciuria, hypertension
 Diabetes insipidus
 Hepatic coma, anuria, and severe kidney failure
 Reduced potassium levels
 Elevated levels of calcium, lipids, glucose, uric acid
 Interactions:
 Excessive consumption of liquorice can lead to hypokalemia when combined with drug
 Assess patient’s serum levels of potassium
 Monitor blood glucose levels
UNIT 9: GASTROINTESTINAL MEDICATIONS

TOPIC 9: GI MEDICATIONS
ANTACIDS
 Neutralizes gastric acidity
 They don’t prevent the overproduction of acid but help to neutralize acid secretion
 Stimulate the secretion of mucus, prostaglandins, and bicarbonate from cells
 Indications:
 Used for acute relief associated with peptic ulcer, gastritis, gastric hyperacidity and
reflux
 Known allergy
 Severe kidney failure or electrolyte disturbances and GI obstruction
 Milk of magnesia can cause diarrhea
 Constipation, alkalosis (excess antacid)
 Calcium products can cause kidney stones
 Assess for allergies
 Patient with heart failure or hypertension should not use drug with high sodium content
H2 ANTAGONISTS
 Compete with histamine for H2 receptors
 Depress the production of HCl
 Indications:
 Used to treat GERD, PUD, and erosive esophagitis
 Used for stress ulcer prophylaxis
 Liver and kidney dysfunction
 Confusion and disorientation
 Jaundice, headaches, GI upset, hypotension
 Increased prolactin secretion, alopecia, urticaria
 Thrombocytopenia, neutropenia, sweating
 Assess for impaired renal/liver function
 Take 1-2 hours before antacids
PROTON PUMP INHIBITORS

 PPIs bind irreversibly to the proton pump
 Prevents the movement of hydrogen ions, blocking gastric acid secretion
 Indications:
 First-line therapy for erosive esophagitis
 Reduce the production of acid in the wall of stomach
 Prevents/heals ulcers
 Similar to H2 receptor antagonist
 Interactions:
 Increased chance of bleeding when taking with warfarin sodium
 Food may decrease absorption of the PPIs
 Capsules may be opened and mixed with apple juice
ANTIDIARRHEALS: adsorbents, anticholinergics, opiates, probiotics
 Absorbents: act by coating the walls of GI tract, binding to causative bacteria for
elimination
 Anticholinergics: slows peristalsis, and reduce gastric secretion. Used in combination
with absorbents and opiates.
 Opiates: decreases bowel motility, and reduced pain associated with diarrhea
 Probiotics: helps patients with antibiotic induced diarrhea
 Indications:
 Used for treatment of diarrhea of various types and levels
 Anticholinergics and opiates are used in more severe cases of diarrhea
 Intestinal obstruction or colitis
 Absorbents: Dark stool, constipation, tinnitus, black tongue
 Anticholinergics and opiates: urinary retention, sexual dysfunction, blurred vision,
bradycardia, hypotension, drowsiness, dry skin
LAXATIVES: bulk-forming, emollient, hyperosmotic, saline, stimulant
 All laxatives promotes bowel movement
 They absorb water into intestine, distending the bowel to move
 Bulk-forming: acts like fibre, they absorb water into intestine
 Emollient (stool softener)
 Hyperosmotic: increases fecal water content, resulting in distention
 Indications:
 TREAT CONSTIPATION
 Caution: abdomen surgery, pain nausea and vomiting
 Bulk-forming: gas formation, electrolyte imbalance, allergic reaction
 Emollient: rashes, lipid pneumonia, decreased vitamins absorptions
 Hyperosmotic: bloating, rectal irritation, electrolyte imbalance
 Saline: magnesium toxicity, cramping, increased thirst, diarrhea
 Stimulant: rashes, gastric/rectal irritation, discolouration urine
 Nursing Implications: laxatives
 Do an abdominal assessment
 When vomiting, having abdominal pain or nausea don’t take laxative
 High fibre diet and increased fluid intake
 Tablets should be swallowed whole with water, not crushed or chewed
UNIT 10: ENDOCRINE MEDICATIONS
TOPIC 10.1: ANTIDIABETIC MEDICATIONS
BIGUANIDE: Metformin
 Considered a first-line drug, especially for patients with a body mass index over 25
 Used orally for type 2 diabetes
 Decreases hepatic glucose production
 Indications:
 Causes moderate weight loss
 Useful for those who are overweight and obese
 Caution in patients with kidney disease and dysfunctional
 Bloating, nausea, cramping, feeling full, and diarrhea
 Metallic taste, hypoglycaemia, and vitamin b12
 Interactions:
 The use of iodine with the drug can cause acute kidney injury and lactic acidosis
 Take with meals to reduce GI effects
 Metformin will need to be discontinued if patient is to undergo studies with contrast
dye
SULFONYLUREAS and GLINIDES

 Stimulates the release of insulin
 Decreases the secretion of glucagon
 Not used for type 1 diabetes
 Indications:
 Should not be used in patients with advanced diabetes dependent on insulin
 Once insulin is started, sulfonylureas are stopped
 Hypoglycemia
 Be aware of the potential for cross-allergy
 Most common: hypoglycemia and weight gain
 Skin rash, nausea, epigastric fullness and heartburn
Injectable antihyperglycemic drugs

INCRETIN MIMETICS
 Enhances glucose dependent insulin secretion
 Suppresses elevated glucagon secretion and slows gastric emptying
 Indications:
Only for those with type 2 diabetes who have been unable to achieve blood glucose
control
 Should not be used in patients with end stage kidney failure or impairment
 Nausea, vomiting, and diarrhea
 Rapid weight loss
GLUCOSE ELEVATING
 Glucagon is a natural hormone that is available sub cut
 Given when a quick response is needed for severe hypoglycemia
 May induce vomiting
 Roll unconscious patient onto side before giving injection
 Treats the unconscious hypogylcemic patient
PATIENT TEACHING:
 Ensure 5 rights
 Monitor blood glucose levels before administering
TOPIC 10.2: PITUITARY AND ADRENOCORTICAL

HORMONES
PITUITARY DRUGS: octreotide acetate, Somatropin, vasopressin
 Octreotide acetate: antagonizes the effects of the natural GH (prevents GH release)
 Somatropin: promotes linear growth in children who lack normal amount of the
hormone
 Vasopressin: mimic the action of ADH
 Indications:
 Octreotide acetate: alleviates certain symptoms of carcinoid tumours
 Somatropin: stimulates skeletal growth in patients
 Vasopressin: prevents or controls dipsia (excessive thirst)
 Octreotide acetate: fatigue, malaise, headaches, diarrhea, vomiting, dyspnea, arthralgia,
increased/decreased BP
 Somatropin: headache, hypergylcemia, hypothyroidism, rash, urticaria
 Vasopressin: increased BP, fever vertigo, heartburn, cramps, nasal irritation tremor,
sweating
 Patient teachings:
 Use caution in patients with decreased liver or kidney function
 Don’t discontinue drugs abruptly
ADRENAL CORTICOSTEROIDS
 Supress inflammation
 Adverse effects: can influence every body system
 Should not be taken with alcohol, caffeine, aspirin or NSAIDs
 Take at the same time everyday
 Rinse mouth with lukewarm water to prevent fungal infections after med
 Clear nasal passages before giving a nasal med
TOPIC 10.3: THYROID AND ANTITHYROID

THYROID REPLACEMENT
 Function the same way as the thyroid hormone
 Induce changes in metabolic rates, growth and development of the body
 Indications:
 Regulates heart and digestive function
 MI, adrenal insufficiency and hyperthyroidism
 Result of overdose
 Most significant: cardiac dysrhythmia
 Tachycardia, angina, hypertension, insomnia, tremors, headaches, anxiety
 Nausea, cramps, and diarrhea
 Sweating, fever, menstrual irregularities
 During pregnancy treatment for hypothyroidism should continue
 Fetal growth may be retarded if mother’s hypothyroidism isn’t treated during pregnancy
 Take once daily in morning to decrease chance of insomnia
ANTITHYROID
 Used to treat hyperthyroidism
 Contraindication:
 Known allergy
 Serious effect: liver and bone marrow toxicity
 Drowsiness, headache, vertigo, cloudy urine, loss of taste
 Paraesthesia, hepatitis, leukopenia, bleeding
 Agranulocytosis, myalgia, rash, increased blood urea nitrogen and serum creatinine
levels
 Better tolerated when given with food
 Give at same time every day, and never stop drug abruptly
 Avoid foods that are high in iodine (seafood, soy sauce, tofu, salt)
TOPIC 10.4: WOMEN’S HEALTH

ESTROGENS
 Indications:
 Treats or prevents disorders that result from estrogen deficiency
 Contraindications: progestin
 Drug allergy
 Estrogen dependent cancer
 Pregnancy, abnormal vaginal bleeding
 Most serious: thrombolytic events
 Most common: Nausea
 Vomiting, diarrhea, constipation, stomach pain, chloasma,
 Tender breasts, fluid retention, carbohydrate tolerance, headaches, amenorrhea
 Interactions: progestin
 Oral anticoagulants: decrease estrogen activity
 Rifampin, smoking, St. John’s wort
PROGESTINS
 Indications:
 Treats functional uterine bleeding
 Alone or combined with estrogen to prevent conception
 Cholestatic jaundice, thrombophlebitis, thromboembolic
 Nausea, vomiting, spotting, edema, weight gain or loss, depression
 Teaching Implications for estrogen and progestin:
 Give oral doses with meal to reduce GI problems
 Report weight gain
 Wear sunscreen or avoid the sun
CONTRACEPTIVES
 Prevents ovulation and implantation of a zygote
 Used to prevent pregnancy
 Hypertension, edema, dizziness, headaches, migraines, depression, stroke
 Nausea, vomiting, anorexia, increased weight, jaundice
 Amenorrhea, breast changes cervical erosion, breakthrough bleeding
DRUGS FOR OSTEOPOROSIS: Bisphosphonates

 Indication:
 Works by preventing osteoclast-mediated bone resorption, enhancing bone density
 Prevents and treats osteoporosis
 Inability to sit or stand upright for at least 30 minutes after taking med
 Headache, GI upset, joint pain,
 Risk for esophageal burn
 Risk of osteonecrosis of jaw
 Take med with a full glass of water when waking up and 30 minutes before eating
 Emphasize that patient should sit upright for at least 30 minutes after taking med
UTERINE STIMULANTS
 Medications used to alter uterine contractions
 Promote labour, and reduce risk of postpartum hemorrhage
 Hypertension, hypotension, chest pain
 Headache, dizziness, fainting, nausea, vomiting
 Vaginal pain, cramping, swelling, fever, chill, blurred vision, weakness
 Follow guidelines carefully
 Monitor vital sign and fetal condition
TOCOLYTICS
 Used to stop labour that beings before term
 Prevents premature birth
TOPIC 10.5: MEN’S HEALTH

 Men with major CV disorders, especially if they use nitroglycerin
 Use of finasteride is contraindicated for women (pregnancy and children)
 FINASTERIDE
 Prevents thinning of hair
 Not for treatment of female baldness
 Teratogenic in pregnant women
 Women need to wear gloves when handing
 SILDENAFIL CITRATE
 TESTOSTERONE
 Finasteride: loss of libido and erection
 Ejaculatory dysfunction, hypersensitivity reactions, severe myopathy
 50% decrease in PSA concentration
 Pregnant women should not touch crushed or broken hormone drugs
 Educate patient on proper drug admin intake
UNIT 11: IMMUNE SYSTEM MEDICATIONS

TOPIC 11.1: IMMUNOLOGIC AGENTS
ACTIVE IMMUNIZATIONS: Toxoids and Vaccines
 They target particular infectious diseases
 Exposes the body to an antigen to generate an adaptive immune response
 TOXOIDS:
 Substances that contain antigens
 Stimulate an artificial active immune response
 VACCINES:
 Microorganisms that can stimulate the production of antibodies against particular
organisms
 Adverse Effect:
 Can be treat with acetaminophen because they are minor
 Minor: Fever, adenopathy, headache, soreness at injection site
 Severe: high fever, convulsions, anaphylactic reaction, shock, unconsciousness
 Rash, cyanosis dyspnea
PASSIVE IMMUNIZATIONS: antitoxins, antiserums, antivenins

 Occurs naturally between a mother and fetus
 Actually antibodies, that kill or inactive the pathogen
 ANTITOXINS:
 Antibody that neutralizes a toxin
 ANTISERUMS:
 Blood serum containing antibodies
 Injected to treat or protect against specific diseases
 ANTIVENINS:
 Is a antiserum containing antibodies against venom
 Used to prevent or minimize the effect of poison
 Can be treat with acetaminophen because they are minor
 Minor: Fever, adenopathy, headache, soreness at injection site
 Severe: high fever, convulsions, anaphylactic reaction, shock, unconsciousness
 Rash, cyanosis dyspnea. Serum sickness: edema in tongue, throat and face
TOPIC 11.2: ANTINEOPLASTIC AGENTS
CYTOTOXIC ANTIBIOTICS
 Prevent the enzyme topoisomerase II, which leads to DNA strand break down
 Indications:
 Used to treat tumours, and some hematological malignancies
 Hair loss, nausea, vomiting and myelosuppression
 Severe effects: Pulmonary fibrosis, liver and CV toxicity, heart failure
 Interactions:
 When combined with chemotherapy drug they tend to increase toxicities
UNIT 12: DRUGS THAT AFFECT OTHER BODY SYSTEMS
TOPIC 12.1: TOPICAL MEDICATIONS
 ANTIBACTERIAL
 Used to prevent skin infections
 ANTIACNE
 Used for treatment and prevention of acne
 Adverse effects: inflammatory reactions like: excessively red and edematous blisters,
crusted skin, alterations skin pigmentations
 ANTIFUNGALS
 Treat dermatophyte infections and yeast and yeast like fungi infections
 Adverse effects: local irritation, pruritus, burning sensation and scaling
 ANTIVIRALS
 Does not cure viral skin infections but may reduce healing time and pain
 Adverse Effects: stinging, itching and rash
 ANAESTHETICS
 Used to reduce pain or pruritus associated with: insect bites, sunburn and poison ivy
 Used numb the skin before pain injection
 ANTIPRURITICS AND ANTI-FLAMMATORIES
 Antipruritic: antihistamine and corticosteroids (anti-inflammatory, antipruritic effects)
 Anti-inflammatories: corticosteroids (relieves inflammations and pruritic dermatoses)
 Adverse effects: skin reactions (acne eruptions, allergic contact dermatitis, burning
sensations, dryness, itching, skin fragility, hypopigmentation, purpura, hirsutism,
folliculitis, and swelling in face)
 ANTIPSORIATIC
 Used to fight against psoriasis
 Sunlight is antipsoriatic (Vitamin D can help reduce inflammation in the body)
 Adverse effect: increase risk of infection
 SKIN PREPATION DRUGS
 Isopropyl alcohol (70%) most commonly used to prepare the skin when drawing blood
or giving injections
 Shown to lower bacterial count on skin
 NURSING IMPLICATIONS:
 Protect affected area from sunlight
 Systemic absorption is higher in young and old patients
 Always document
 Don’t double up on dose if dose is missed
TOPIC 12.3: MINERALS, FLUIDS AND ELECTROLYTES
MINERALS
CALCIUM
 Most abundant mineral element in the body
 Highest concentration in bones and teeth
 Requires vitamin D
 Involved in the proper development and maintenance of teeth and bones
 Cofactor in clotting reactions
 Indications:
 Used to treat calcium deficiencies
 Used as a dietary supplement for breastfeeding and pregnant mums
 Hypercalcemia, ventricular fibrillation and known allergy
 Hypercalcemia
 Vomiting, anorexia, nausea, constipation
MAGNESIUM
 Required for muscle contraction and nerve function
 Indications:
 Used to treat magnesium deficiency
 Maintain pre-eclampsia and eclampsia
 Heart block, kidney failure, Addison’s disease and hepatitis
 Difficult bowel movements, CNS depression, heart block, hypothermia
 Tendon reflex loss, respiratory distress
PHOSPHORUS
 Used for the development and maintenance of skeletal system and teeth
 Used for treatment of deficiency and dietary supplement
 Diarrhea, vomiting, nausea, confusion, weakness and breathing difficulties
FLUIDS
CRYSTALLOIDS
 Don’t contain colloids
 Maintains fluids, and promote urinary flow
 Indications:
 Better than colloids for emergency short-term plasma volume expansion
 Known drug allergy, severe electrolyte disturbance, hypovolemia
 Due to fluid overload: edema
 Affects CNS
 Acidosis and alkalosis
COLLOIDS
 Mechanism of action
 Can increase the COP
 They can’t pass into extravascular spaces, resulting in higher concentration of solutes
inside blood vessels
 Indications:
 Superior to crystalloids because they can maintain the plasma volume for longer periods
of time
 Hypervolemia
 They have no oxygen carrying ability, and contain no clotting factors
 Impaired coagulation and potential of bleeding and impaired platelet function
BLOOD PRODUCTS
 Related to their ability to increase COP and plasma volume
 Achieve the same outcome as colloids and crystalloids
 They can be incompatible with the recipient’s immune system
 Incompatibility can result in reactions and anaphylaxis
ELECTROLYTES
POTASSIUM
 Muscle contraction, the transmission of nerve impulses and regulates heartbeat
 Indicated in the treatment or prevention of potassium depletion
 Hyperkalemia, acute dehydration, untreated Addison’s disease
 Diarrhea, nausea, vomiting,
 GI bleeding, and ulceration
 Phlebitis is associated with IV administration
SODIUM
 Involved in the control of water distribution
 Fluid and electrolyte balance and osmotic pressure of body fluids
 Indications:
 Treats or prevents sodium depletion and hyponatremia
 Sodium chloride is used for this purpose
 Known drug allergy and hypernatremia
 Nausea, vomiting and cramps
 Venous phlebitis can be caused by parenteral administration

Topic 2.1: Antibiotics: Unit 2: Anti-Infective Medications

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UNIT 2: ANTI-INFECTIVE MEDICATIONS

TOPIC 2.1: ANTIBIOTICS

TOPIC 2.2: ANTIVIRALS

TOPIC 2.4: ANTIFUNGALS AND ANTIPARASITICS

TOXICITY AND MANAGING OVERDOSE

TOPIC 4.2: PSYCHOTHERAPEUTIC MEDICATIONS

ANTIDEPRESSANTS – 1st GENERATION

TOPIC 4.3: SEDATIVE AND HYPNOTICS

TOPIC 4.4: (CNS) STIMULANTS

TOPIC 4.5: ADRENERGIC AND ADRENERGIC

ADRENERGIC BLOCKERS (a-Blockers, B- Blockers)

TOPIC 4.6: CHOLINERGIC AND CHOLINERGIC

TOPIC 4.7: ANTICONVULSANTS

DOPAMINE REPLACEMENT THERAPY

MONOAMINE OXIDASE INHIBITORS

MUSCLE RELAXANTS – BACLOFEN

TOPIC 5.2: RESPIRATORY MEDICATIONS

ANGIOTENSIN-CONVERTING ENZYME INHIBITORS (ACE-inhibitors)

ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs)

CALCIUM CHANNEL BLOCKERS (CCBs)

TOPIC 6.2: ANTIANGINAL AND PERIPHERAL

TOPIC 6.3: HEART FAILURE MEDICATIONS

ATENOLOL: Class II drug

NURSING IMPLICATIONS: anti-dysrhythmia

TOPIC 6.5: ANTILIPIDEMICS

BILE ACID SEQUESTRANTS

TOPIC 7.2: ANTI-ANEMICS

POTASSIUM – SPARING DIURETICS

THIAZIDES AND THIAZIDE – LIKE DIURETICS

UNIT 9: GASTROINTESTINAL MEDICATIONS

PROTON PUMP INHIBITORS

SULFONYLUREAS and GLINIDES

Injectable antihyperglycemic drugs

TOPIC 10.2: PITUITARY AND ADRENOCORTICAL

TOPIC 10.3: THYROID AND ANTITHYROID

TOPIC 10.4: WOMEN’S HEALTH

DRUGS FOR OSTEOPOROSIS: Bisphosphonates

TOPIC 10.5: MEN’S HEALTH

UNIT 11: IMMUNE SYSTEM MEDICATIONS

PASSIVE IMMUNIZATIONS: antitoxins, antiserums, antivenins

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