Pharmacology (C-NCM106)
DRUG STUDY
DRUG NAME CLASSIFICATION MECHANISM OF ACTION THERAPEUTICS
a.) Oxytocin Oxytocic Agents/Exogenous MOA Synthetic oxytocin elicits the same Indications:
Generic Name: Oxytocin Hormones pharmacological response produced by Antepartum
Brand Name: Pitocin, endogenous oxytocin, with cervical  Initiation or improvement of
Syntocinon dilation, parity, and gestational age as uterine contractions, where this
Appearance: predictors of the dose response to is desirable and considered
 Pitocin (Oxytocin) oxytocin administration for labor suitable for reasons of fetal or
Vial: 10 iu per mL (1mL, stimulation. Oxytocin increases the maternal concern, in order to
10mL) sodium permeability of uterine myofibrils, achieve vaginal delivery.
indirectly stimulating contraction of the  Induction of labor in patients
uterine smooth muscle. The uterus with a medical indication for the
responds to oxytocin more readily in the initiation of labor, such as Rh
presence of high estrogen concentrations problems,
and with the increased duration of maternal diabetes, preeclampsia  Adverse Effects: To the mother: nausea,
pregnancy.  at or near term, when delivery is
in the best interests of mother
Ampule: 0.5mL and fetus or when membranes
are prematurely ruptured and
delivery is indicated.
 Stimulation or reinforcement of
labor, as in selected cases of
uterine inertia.
 As adjunctive therapy in the
management of incomplete or
inevitable abortion. In the first
trimester, curettage is generally
considered primary therapy. In
second trimester abortion,
oxytocin infusion will often be
 Syntocinon (Oxytocin)
successful in emptying
Ampule: 5 iu per 1mL
the uterus.  and when fetal position is
Postpartum
 Produce uterine contractions
during the third stage of
labor and to control postpartum
bleeding or hemorrhage.
Contraindications:
 Patients that hypersensitive to
the drug
 When patients’ vaginal delivery
isn’t advice (placenta previa,
vasa previa, invasive cervical
carcinoma, genital herpes), when
cephalopelvic disproportion is
present, or when the delivery
requires conversion, as in
transverse lie.
EFFECTS
Side Effects: To the mother: uneven heart
rate (fast or slow), excessive bleeding
long after childbirth, severe headache,
blurred vision, pounding in your neck or
ears, confusion, severe weakness, feeling
unsteady. To the baby/fetus: slow
heartbeats or abnormal heart rate, yellow
appearance of the baby’s skin (jaundice),
convulsion (seizure), eye problems,
problems with breathing, muscle tone,
and other signs of health
vomiting, more intense or frequent
contractions, anaphylactic shock,
premature ventricular contractions,
postpartum hemorrhage, pelvic
hematoma, cardiac arrhythmia,
subarachnoid hemorrhage, fatal
afibrinogenemia, hypertensive episodes,
rupture of the uterus, abruptio placentae,
tetanic uterine contractions, tachycardia,
coma, impaired uterine blood flow,
increased uterine motility, death from
oxytocin-induced water intoxication. To
the neonate: bradycardia, premature
ventricular contractions and other
arrhythmias, permanent CNS or brain
damage, fetal death, neonatal seizures,
low APGAR score, neonatal jaundice,
neonatal retinal hemorrhage.
NURSING CONSIDERATIONS
Assessment & Drug Effects:
 Monitor fluid intake and output.
Anti-diuretic effect may lead to
fluid overload, seizures, and coma
from water intoxication.
 Monitor and record uterine
contractions, HR, BP, intrauterine
pressure, fetal HR, and blood loss
at least every 15 minutes.
 Maintain the patient in a sitting or
lateral recumbent position to
promote placental infusion.
 All patients receiving oxytocin IV
must be under continuous
observation by trained personnel
who have a thorough knowledge
of the drug.
 Discontinue oxytocin infusion
immediately if uterine
hyperactivity or fetal distress
occurs. Administer oxygen to the
mother. Mother and fetus must be
evaluated by the responsible
practitioner.
 Drug is used to induce or
reinforce labor only when pelvis
is known to be adequate, when
vaginal delivery is indicated,
when fetal maturity is assured
favorable. Use drug only in
hospital where critical care
facilities and prescriber are
immediately available.
Patient & Family Education:
 Explain the use and
administration of drug to patient
and family.
 Instruct the patient to promptly
report adverse reactions.

DRUG NAME
b.) Isoxsuprine HCL
Generic Name: Isoxsuprine
Brand Name: Vasodilan,
Duvadilan, Duvaprine, Uteprine
Appearance:
 Tablet: 10 mg and 20mg
References:
https://www.drugs.com/mtm/oxytocin.html
https://www.rxlist.com/pitocin-drug.htm#dosage
CLASSIFFICATION MECHANISM OF ACTION
Peripheral Vasodilators MOA: A beta-adrenergic agonist that
causes direct relaxation of uterine and
vascular smooth muscle. Its vasodilating
actions are greater on the arteries
supplying skeletal muscle than on those
supplying skin. It is used in the treatment
of peripheral vascular disease and in
premature labor.
 In fetal distress when delivery
isn’t imminent, in prematurity, in
other obstetric emergencies, and
in patients with severe toxemia
or hypertonic uterine patterns.
THERAPEUTICS
Indications:
 For the relief of symptoms
associated with cerebrovascular
insufficiency.
 In peripheral vascular disease of
arteriosclerosis obliterans,
thromboangitis obliterans
(Burger’s Disease) and Reynaud’s
disease.
Contraindications:
 Should not be given immediately
during postpartum.
 If there is a presence of arterial
bleeding .
 Pregnancy Category C
https://www.rxlist.com/pitocin-drug.htm#side_effects
https://www.news-medical.net/drugs/Syntocinon.aspx
EFFECTS
Side Effects: chest pain or irregular
heartbeat, weakness, nausea, vomiting.
Adverse Effects: hypotension, maternal
and fetal tachycardia, chest pain, nausea,
vomiting, dizziness, abdominal distress,
severe rash, hypocalcemia, pulmonary
edema, swelling (lips, tongue, face), hives
NURSING CONSIDERATION
Assessment:
 Assess the patient's V/S
during treatment
 Take BP lying and standing as
orthostatic hypotension is
common.
 Monitor for intensity and length
of uterine contractions and FHS
Patient Education:
 Advise patient to make position
changes slowly as fainting may
occur.
 Instruct the patient to promptly
report adverse reactions.
https://go.drugbank.com/drugs/DB08941 https://www.drugs.com/pro/isoxsuprine-hydrochloride.html
https://www.drugs.com/mtm/isoxsuprine.html#side-effects https://www.everydayhealth.com/drugs/isoxsuprine#top
https://www.mims.com/philippines/drug/info/isoxsuprine?mtype=generic https://www.mims.com/philippines/drug/info/isoxsuprine?mtype=generic
https://www.syrianclinic.com/med/en/ProfDrugs/Isoxsuprinepd.html https://www.pdr.net/drug-summary/Pitocin-oxytocin 1666#:~:text=MECHANISM%20OF
%20ACTION&text=Oxytocin%20increases%20the%20sodium%20permeability,the%20increased%20duration%20of%20pregnancy.
 CASE ANALYSIS

Case #1 

Mr. Bockel., age 72, has asked the physician for “help with a private matter.” He tells the health care provider that he would like to try Viagra, “that drug that helps with a certain problem.” 
1. What assessment findings may contraindicate the use of sildenafil (Viagra) by Mr. Bockel?
 Contraindicated if Mr. Bockel is hypertensive to drug or its components and in those taking organic nitrates or GC stimulators.
 Use cautiously in patients age 65 and older; in patients with hepatic or severe renal impairment, retinitis pigmentosa bleeding disorders, or active peptic ulcer disease; in those who have suffered an MI,
stroke, or life threatening arrhythmia within past 6 months; in those with history of cardiac failure, CAD, uncontrolled high or low BP, or anatomical deformation of penis (carvenosal fibrosis, or Peyronie
disease); and in those with conditions that may predispose them to priapism (as sickle cell anemia, multiple myeloma, or leukemia).
 Vision loss, including permanent loss of vision has been reported in patients taking drug for erectile dysfunction and may be a sign of nonarteritic anterior ischemic optic neuropathy (NAION). Risk may
increase with history of vision loss. Other risk factors for NAION include low cup-to-disk ratio (“crowded disk”), CAD, diabetes, HTN, hyperlipidemia, smoking, and age older than 50.
 Pulmonary vasodilators used to treat PAH can worsen the CV status of patients with pulmonary veno-occlusive disease (PVOD). Use in patients with PVOD isn’t recommended. If pulmonary edema occurs
after drug is administered for PAH, consider the possibility of PVOD.
 Safe and effective use of drug to treat PAH in patients with sickle cell anemia hasn’t been established.
 Safe use of drug to treat PAH in children hasn’t been established.
 Decreased hearing and hearing loss have been reported. Obtain prompt medical attention for hearing loss.

2. If he is a candidate for therapy with Viagra, what patient teaching should he receive?
 Advice patient that drug shouldn’t be used with nitrates or GC stimulators under any circumstances. Revatio and Viagra, or other PDE5 inhibitors used for erectile dysfunction shouldn’t be used together.
 Advice patient of potential cardiac risk of sexual activity, especially in presence of CV risk factors. Instruct the patient to notify prescriber and refrain from further activity if such symptoms as chest pain,
dizziness, or nausea occur when starting sexual activity.
 Warn patient that erections lasting longer than 4 hours and priapism (painful erections lasting longer than 6 hours) may occur; tell patient to seek immediate medical attention if either of these occurs.
Penile tissue damage and permanent loss of potency may result if priapism isn’t treated immediately.
 Inform patient that drug used for erectile dysfunction doesn’t protect against sexually transmitted diseases; advice patient to use protective measures such as condoms.
 Advice patient receiving HIV medications of the increased risk of sildenafil adverse events, including low BP, visual changes, and priapism, and to promptly report such symptoms to prescriber. Tell patient
not to exceed 25mg of sildenafil.
 Instruct the patient to take drug for erectile dysfunction 30 mins to 4 hours before sexual activity; maximum benefit can be expected less than 2 hours after ingestion.
 Advice patient that drug can be taken without regard of food.
 Inform patient that impairment of color discrimination (blue, green) may occur and to avoid hazardous activities that rely on color discriminaton.
 Instruct patient to immediately notify prescriber if vision or hearing changes.
 Caution patient to take drug only as prescribed.
3. What concerns would there be about his liver function? About his vision? 
 Vision: Vision loss, including permanent loss of vision has been reported in patients taking drug for erectile dysfunction and may be a sign of nonarteritic anterior ischemic optic neuropathy (NAION). Risk
may increase with history of vision loss and low cup-to-disk ratio (“crowded disk”).
 Liver: According to the US National Library of Medicine National Institutes of Health, the highest levels among the control groups in terms of liver function tests were observed remarkably on the 28th day.
The reason for this is due to the damage of prolonged biliary retention on liver cells. The decrease in ALP and TBIL levels in liver function tests were significant in the group treated with sildenafil for 10
days. On the 28th day, a decrease in all liver function tests, except for ALT, was seen in all the sildenafil groups. This result shows that the long-term use of sildenafil is effective in recovery of liver function
tests that decreased due to obstructive jaundice.

4. When should he take this medication? 

Instruct the patient to take drug for erectile dysfunction 30 mins to 4 hours before sexual activity; maximum benefit can be expected less than 2 hours after ingestion and advice patient that drug can be
taken without regard of food.

Case #2 

Ms. Casey, age 24, has decided that she wants to try oral birth control, and is in the nurse practitioner’s office today for an evaluation. During the health history, she tells the nurse that she has never used
oral contraceptives but that she is currently sexually active. She also states that she takes no other medications or herbal products. After a physical assessment, the nurse practitioner prescribes norethindrone and
ethinyl estradiol oral contraceptive. 
1. What laboratory test is most important to check before Ms. Casey starts the oral contraceptive?
 Blood count: to determine the absolute number of formed elements in the blood, red blood cells, white blood cells and platelets. From this, the specialist may conclude that anemia, blood loss,
inflammatory processes, hematopoietic diseases and coagulation disorders, among others, may occur.
 Bilirubin: is produced as a yellow breakdown of red blood cells in the spleen, liver and certain lymph nodes. Its levels may increase in cases of increased red blood cell breakdown, liver disease, and biliary
obstruction. Normal total bilirubin: 5 to 17 μmol/l (3 to 10 mg/l).
 GOT (glutamate oxaloacetate aminotransferase): an enzyme involved in the metabolism of amino acids. It is normally present in small amounts in the blood but increases in case of organ damage. A lower GOT
value can be found in pregnant women. Its normal value is 18-31 U/l in women.
 GPT (glutamate pyruvate aminotransferase): an enzyme produced in liver cells that shows the damage that has taken place there. Normally, it is also present in small amounts in the blood, increasing in case of
damage. Its normal value is 7-30 U/l in women.
 GGT (gamma glutamyl transferase): an enzyme produced by the liver, pancreas, and kidneys. Its value is considered when examining the liver and bile ducts. The most reliable signaling parameter. Normal value
for women is 8-40 U/l, 9-50 U/l.
 Alkaline phosphatase: present in greater amounts in the liver and in the cells that make up bones. Alkaline phosphatase adult normal value: 40-115 U/l
 APC resistance: the assay is suitable for detecting activated protein C resistance caused by the Leiden mutation. The presence of hereditary APC-R can lead to deep vein thrombosis. This is due in most cases to
the Leiden mutation.
 Protein C and Protein S: parts of the system that prevents excessive blood clots. They regulate the rate of blood clots so that blood clots only form where the injury itself is. Their low levels cause an inherited
predisposition to thrombosis.
 Anti-thrombin III: plays an important role in the regulation of blood coagulation processes. It blocks the action of a number of blood clotting factors (thrombin and factors IX, X, XI, XII) to prevent excessive
clotting.
 Prothrombin: one of the coagulation factors produced by the liver. The Prothrombin time (PI) test measures how long it takes for a clot to form in a blood sample. The PI test examines the uniform function of
coagulation factors and the ability of the body to clot within a reasonable time.
 APTI: activated partial thromboplastin time, which examines the function of the coagulation cascades. The so-called coagulation cascade is suitable for closing damaged tissues or injuries by blood clot formation.
This promotes healing. Acquired or inherited deficiency of one or more coagulation factors causes abnormal functioning of the factors. In this case, we cannot talk about stable clot formation, i.e. increased bleeding
or clotting may occur.
 Prothrombin gene mutation: a genetic abnormality that leads to thrombophilia (predisposition to thrombosis).

2. The nurse needs to assess for what other potential risk factors before Ms. Casey begins the oral contraceptive?
 Unintended Pregnancy: While birth control pills are highly reliable in preventing pregnancy, there is the possibility that you could become pregnant. This is especially true if you miss a dose or do not
take the pills regularly. Excess weight or obesity may also increase your risk of pregnancy. The excess weight may affect how well the pills work in your body.
 Blood Clots: Oral contraceptive pills can increase your risk of developing blood clots in the veins in your legs. These can become life threatening if the blood clots leave your legs and travel into you lungs. The
risk of blood clots is increased more in people who smoke.
 Cholesterol Levels: There are different kinds of birth control pills. Some are combination pills, with estrogen and progestin, while others are "mini-pills" with just progestin. Estrogen may affect triglyceride
levels and total cholesterol levels—increasing HDL "good" cholesterol and decreasing LDL "bad" cholesterol. Progestin may cause "good" cholesterol to lower and "bad" cholesterol to rise. For most women, these
changes in blood levels are not strong enough to have a poor effect on your health.
 Migraine Headaches: Certain oral contraceptives may trigger a migraine, especially those containing estrogen. If you have migraines, talk to your doctor about your contraceptive options.
 High Blood Pressure: Taking birth control pills may increase the risk of high blood pressure. This risk may be greater if you have other conditions, like obesity, having a family history of high blood pressure,
or smoking. If you take birth control pills, your doctor will check your blood pressure. If you already have high blood pressure, talk to your doctor about other contraceptive options.
 Cardiovascular Disease: Women aged 35 or older who smoke heavily and take birth control pills have an increased risk of having a heart attack or stroke. You may have an even greater risk if you have other risk
factors (like a family history of cardiovascular disease, high cholesterol, or high blood pressure). If you want to take birth control pills, you should first quit smoking since smoking increases your chance of
developing many other health problems.
 Cancer: Taking birth control pills for many years may increase the risk of certain types of cancer, like cervical cancer. Researchers are still investigating the link between birth control pills and breast cancer. Some
studies have found that there is an increased risk, while others studies have come to the opposite conclusion. According to the National Cancer Institute, there appears to be a slight increase in risk, but the risk
level goes back to normal after 10 years of stopping birth control pills. It is important to remember that there are many other risk factors for cancer. If you are at high risk for breast cancer (like having certain
types of genes or a family history) or other types of cancer, talk to you doctor about the best contraceptive for you.
3. After 6 months, Ms. Casey calls the office and states, “I forgot to take my birth control pills for 3 days in a row. What do I do now?” 
 If the patient forget to take one of her combined oral contraceptive pills (each pill contains both an estrogen and progestin), the patient should take it as soon as she remember. Take the next pill at the
normal time. This may mean that the patient will take two pills in the same day. Continue taking the pills as prescribed. If the patient miss more than two pills, the patient should use a backup method of
birth control (like condoms and spermicide) for seven days in a row. If patient did not take a pill for over 48 hours, therefore, patient will not be protected against pregnancy again until taken the pill every
day for 7 days in a row.
Other Options:
  Contact your doctor, nurse, or pharmacist for the most specific instructions on what to do if you miss one or more birth control pills.
 Review the specific patient package insert that accompanies your birth control pill pack. Look for the section in your patient package insert that addresses what to do if you miss any pills.
 If you are confused at any time about what to do if you have missed any birth control pills, either do not have sexual intercourse or use a reliable backup barrier method of birth control (like a condom and
spermicide) each time you have sex. Keep taking your birth control pill each day until you can talk to your doctor or clinic.
 Be truthful with yourself: if you think you can't reliably keep up with a pill every day, choose a more foolproof method of birth control like the IUD, implant, or injection. Talk to your doctor or clinic about these
choices.

References:
Nursing2021 Drug Handbook by Walters Kluwer
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048637/
https://medicover.hu/en/laboratory-tests/laboratory-test-packages/laboratory-tests-before-the-use-of-first-contraceptive-pill/#:~:text=and%20maternal)%20sides.,The%20laboratory%20test%20includes%20the
%20following%20items,that%20prevents%20excessive%20blood%20clots.
https://www.drugs.com/article/birthcontrolpill-missed.html