Pharmacology (C-NCM106)
DRUG STUDY
DRUG NAME
a.) Ivermectin
Generic Name: Ivermectin
Brand Name: Stromectol
Appearance:
 Stromectol (Ivermectin)
Oral Tab: 3mg (white,
round, flat, bevel-edged
tablets)
 Sklice (Ivermectin)
Lotion: 5mg
(off-white/tan lotion)
CLASSIFICATION
Antihelmintics / Antiparasitic drug
MECHANISM OF ACTION
MOA: Ivermectin is a member of the
avermectin class of broad-spectrum
antiparasitic agents which have a unique
mode of action. Compounds of the class
bind selectively and with high affinity to
glutamate-gated chloride ion channels
which occur in invertebrate nerve and
muscle cells. This leads to an increase in
the permeability of the cell membrane to
chloride ions with hyperpolarization of
the nerve or muscle cell, resulting in
paralysis and death of the parasite.
Compounds of this class may also interact
with other ligand-gated chloride channels,
such as those gated by the
neurotransmitter gamma-aminobutyric
acid (GABA).
The selective activity of compounds of this
class is attributable to the facts that some
mammals do not have glutamate-gated
chloride channels and that the
avermectins have a low affinity for
mammalian ligand-gated chloride
channels. In addition, ivermectin does not
readily cross the blood-brain barrier in
humans.
Ivermectin is active against various life-
cycle stages of many but not
all nematodes. It is active against the
tissue microfilariae of Onchocerca
volvulus but not against the adult form. Its
activity against Strongyloides
stercoralis is limited to the intestinal
stages.
THERAPEUTICS
Indications:
Treatment of:
 Strongyloidiasis due to the
nematode parasite Strongyloides
Stercoralis.
 Onchocerciasis due to the
nematode parasite Onchocerca
Volvulus.
Contraindications:
 STROMECTOL (ivermectin) is
contraindicated in patients who
are hypersensitive to any
component of this product.
 Pregnancy (category c)
EFFECTS
Side Effects: eye pain or redness, puffy
eyes, problems with visions, severe skin
rash, itching, rash with pus, confusion,
change in your mental status, balance
problems, trouble walking,
lightheadedness, dizziness, loss of
appetite, bloating, constipation,
weakness.
Adverse Effects: neck and back pain, red
eye, conjunctival hemorrhage, dyspnea,
urinary and/or fecal incontinence,
difficulty in standing and walking, mental
status changes, lethargy, stupor, seizures,
coma, edema, asthenia, dizziness, nausea,
vomiting, diarrhea, ataxia, abdominal
pain, paresthesia, urticarial, contact
dermatitis, fever, swollen glands,
stomach pain, joint pain, swelling in your
hands or feet, swollen and tender lymph
nodes, fast heart rate, trouble breathing,
loss of bladder or bowel control, neck or
back pain, seizures, blistering or peeling
skin, hive, headache, tingling of hands or
feet, loss of coordination, tachycardia,
pruritus, arthralgia/synovitis.
NURSING CONSIDERATIONS
Assessment & Drug Effects:
 Monitor for therapeutic
effectiveness: Indicated by
negative stool samples.
 Monitor for cardiovascular effects
such as orthostatic hypotension
and tachycardia.
 Monitor for and report
inflammatory conditions of the
eyes.
Patient & Family Education
 Get a follow-up stool examination
to determine effectiveness of
treatment. Treatment for worms
does not kill adult parasites;
repeated follow-up and
retreatment are usually needed.
 Notify physician if eye discomfort
develops.
 Do not breast feed while taking
this drug without consulting
physician.
  Soolantra (Ivermectin)
Cream: 10mg (white to
pale yellow hydrophilic
cream)
DRUG NAME
b.) Remdesivir Novel Antiviral drug / Nucleotide
Generic Name: Remdesivir Analogs
Brand Name: Veklury
Appearance:
 Vial: 100mg (lyophilized
for reconstitution)
 Solution: 100mg/20ml
or 5mg/ml (concentrated
solution)
CLASSIFFICATION MECHANISM OF ACTION
MOA: Remdesivir is an inhibitor of the
SARS-CoV-2 RNA-dependent RNA
polymerase (RdRp), which is essential for
viral replication. Remdesivir is
an adenosine nucleotide prodrug that
distributes into cells where it is
metabolized to a nucleoside
monophosphate intermediate by
carboxyesterase 1 and/or cathepsin A,
depending upon the cell type. The
nucleoside monophosphate is
subsequently phosphorylated by cellular
kinases to form the pharmacologically
active nucleoside triphosphate metabolite
(GS-443902). Remdesivir triphosphate
(RDV-TP) acts as an analog of adenosine
triphosphate (ATP) and competes with
high selectivity (3.65-fold) over the
natural ATP substrate for incorporation
into nascent RNA chains by the SARS-CoV-
2 RNA-dependent RNA polymerase, which
results in delayed chain termination
(position i+3) during replication of the
viral RNA. In a biochemical assay
assessing RDV-TP incorporation by the
MERS-CoV RdRp complex, RDV-TP
inhibited RNA synthesis with an IC50
value of 0.032 μM. RDV-TP can also inhibit
viral RNA synthesis following its
incorporation into the template viral RNA
as a result of read-through by the viral
polymerase that may occur at higher
nucleotide concentrations. When
remdesivir nucleotide is present in the
THERAPEUTICS
Indications:
Treatment of:
 Filoviruses (Ebola viruses,
Marburg virus)
 Coronaviruses (SARS-CoV, MERS-
Co-V, SARS-CoV-2)
For COVID-19 Infection
 Indicated for adults and pediatric
patients aged ≥12 years who
weigh ≥40 kg for treatment of
COVID-19 requiring
hospitalization
 Day 1 loading dose: 200mg IV
infused over 30-120 minutes
 Day 2 and after: 100mg IV q/day
 Paramyxoviruses (parainfluenza
type III virus, Nipah virus, Hendra
virus, measles, and mumps virus)
 Pnemoviridae (respiratory
syncytial virus)
Contraindications:
 Patients with alanine
aminotransferase (ALT) levels
>5-times upper limit of normal or
severe hepatic dysfunction
 Adult and pediatric patients (>28
days old) with severe renal
impairment described as eGFR <
30 ml/min
 Neonates (at least 7 days to ≤ 28
days old) with serum creatinine
≥1 mg/dL
EFFECTS
Side Effects: headache, pounding in neck
and ears, itching, sweating, light-headed
feeling,
Adverse Effects: changes in heart rate,
rash, fever, nausea, shortness of breath or
wheezing, sweating, swelling (lips, face,
throat), shivering, liver injury (due to
increase in liver enzymes), hypotension,
arrhythmia, cardiac arrest, dyspnea,
acute respiratory failure, acute
respiratory distress, pneumothorax,
pulmonary embolism, anemia,
lymphopenia, hyperglycemia, pneumonia,
septic shock, elevated lipase, diarrhea,
vomiting, constipation, poor appetite,
gastroparesis, lower GI bleeding, hepatic
manifestation (by Grade 1-4 increase in
serum transaminases), acute kidney
injury, worsening underlying chronic
kidney disease, hypernatremia,
hypokalemia, contact dermatitis,
pruritus, delirium, pyrexia, insomnia,
multi-organ dysfunction,
hypersensitivity/anaphylactic reactions
related to the infusion.
NURSING CONSIDERATION
 Pediatric patients (greater than
28 days old) must have an eGFR
determined and full-term
 Neonates (at least 7 days to less
than or equal to 28 days old)
must have serum creatinine
determined before starting
VEKLURY and during treatment
as clinically appropriate
 Closely monitor for any acute
changes in clinical status, drug-
drug reactions..
 Perform hepatic laboratory
testing in all patients before
starting VEKLURY and during
treatment as clinically
appropriate.
 Determine prothrombin time in
all patients before starting
VEKLURY and monitor during
treatment as clinically
appropriate
 viral RNA template, the efficiency of
incorporation of the complementary
natural nucleotide is compromised,
thereby inhibiting viral RNA synthesis.
Remdesivir triphosphate is a weak
inhibitor of mammalian DNA and RNA
polymerases, including
human mitochondrial RNA polymerase.

DRUG NAME CLASSIFICATION MECHANISM OF ACTION THERAPEUTICS EFFERCTS NURSING CONSIDERATIONS

c.) Lianhua Qingwen Antiviral drug MOA: Lianhua Qingwen Capsule could act
Generic Name: Lianhua on SARS-CoV-2 via multiple components,
Qingwen targets, and pathways. Its main
Brand Name: N/A ingredients kaempferol, quercetin, and
Appearance: luteolin have better combinations with
 Capsule/Granule Mpro, while indigo, glycyrrhetinic acid,
and stigmasterol can target the ACE2;
thereby, it is possible to cure COVID-
19 found that Lianhua Qingwen Capsule
could significantly inhibit the replication
of SARS-CoV-2 in cells and reduce the
expression of viral particles and the
upregulation of inflammatory cytokines
TNF-α, IL6, MCP-1, and IP-10 caused by
SARS-CoV-2 infection, in a dose-
dependent manner in host cells. It has a
comparable antiviral potency against the
SARS-CoV-2 with an IC50 value of
411.2 μg/ml speculated that Lianhua
Qingwen Capsule activity against COVID-
19 was exerted through its active
ingredients quercetin, luteolin,
kaempferol, glycyrrhetinic acid,
stigmasterol, and indigo, which influenced
inflammatory cytokine targets to regulate
the AGE-RAGE, IL17, JAK-STAT, and
TNF .signaling pathways and other
signaling pathways to restrain the viability
of SARS-CoV-2 and improve the clinical
symptoms of patients with COVID-19. New
studies have proved that Lianhua Qingwen
Capsule can effectively reduce the motility
chemotaxis potential of macrophages in
the acute lung injury (ALI) model and
reduce the recruitment of monocyte
macrophages by downregulating MCP.
In vivo, Lianhua Qingwen Capsule can
effectively inhibit the infiltration of
macrophages, further reduce the edema of
lung tissue, reduce the temperature
fluctuation caused by ALI, and alleviate
the lung pathological injury of ALI.
Indications:
 Potential antiviral effects in the
treatment of COVID-19. It could
reduce the level of inflammation
in patients, improve respiratory
symptoms, inhibit concurrent
bacterial infection, and improve
the immune response.
 Innovative Patent Chinese
medicine for the treatment of
influenza
 Recommended drug for the
diagnosis and treatment of
respiratory infectious diseases.
Contraindications:
 Patients with alanine
aminotransferase (ALT) levels
>5-times upper limit of normal or
severe hepatic dysfunction.
 Adult and pediatric patients (>28
days old) with severe renal
impairment described as eGFR <
30 ml/min.
 Neonates (at least 7 days to ≤ 28
days old) with serum creatinine
≥1 mg/dL.
Side Effects: N/A
Adverse Effects: nausea, diarrhea,
vomiting, abdominal pain, dry mouth,
skin rash, itching, dizziness, renal
toxicity, back pain, headache, tachycardia,
facial redness, loss of appetite, increase in
gamma glutamyl aminotransferase,
hypotension, edema, elevated aspartate
transferase, leukopenia,
 Before beginning therapy,
thoroughly assess underlying
 disease and medical history,
including allergies.
 Assess baseline VS and
nutritional status.
 Assess for contraindications,
 conditions, conditions that may
indicate cautious use, and
 potential drug interactions.
 Instruct patients to consult their
physician before taking any other
medication, including OTC
medications.
 Emphasize the importance of
good hygiene.
 Inform patients that antiviral
agents are nor cures, but do help
to manage symptoms.
 Instruct patients on the
importance of taking these
medications exactly as prescribed
and for the full course of
treatment
REFERENCES:
https://www.rxlist.com/stromectol-drug.htm#precautions
https://medlineplus.gov/druginfo/meds/a607069.hml
https://www.rxlist.com/sklice-drug.htm#indications
https://www.rxlist.com/soolantra-drug.htm#description
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/I055.html
https://go.drugbank.com/drugs/DB00602
https://www.rxlist.com/consumer_remdesivir_rdv/drugs-condition.htm
https://www.drugs.com/mtm/remdesivir.html
https://reference.medscape.com/drug/veklury-remdesivir-4000090
https://www.ncbi.nlm.nih.gov/books/NBK563261/
https://go.drugbank.com/drugs/DB14761
https://www.ncbi.nlm.nih.gov/books/NBK563261/
https://www.drugs.com/ppa/remdesivir.html
https://www.hindawi.com/journals/ecam/2020/3196375/
https://www.frontiersin.org/articles/10.3389/fphar.2021.668407/full
https://www.sciencedirect.com/science/article/pii/S2095754821000260
https://www.liebertpub.com/doi/10.1089/acm.2020.0310
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501551/
https://www.sciencedirect.com/science/article/pii/S2095754821000260
https://www.ddb.gov.ph/images/Board_Regulation/2021/BOARD_REG_NO._1_S._2021.pdf
https://www.businesswire.com/news/home/20201130005420/en/Lianhua-Qingwen-Capsules-Launched-in-Philippine-Market