PHARMACOLOGY (NCMA216)  Pharmacist – licensed to prepare , dispensed

drugs
Week 2
 DRUGS - a synthetic chemicals obtained from
Cornerstone – drug discovery process plants, animals, or product of genetic engineering

` Medical Chemist / Pharmacist 

a substance that causes a change in
organism’s physiology or psychology when
consumed
 MEDICINE – a chemical preparation which usually
Create the candidate Test the physiologic but necessarily contains 1 or more drugs, when
compound activity administered with the intention of producing a
therapeutic effect
HISTORY:
- herbal, natural substance (plant extracts)
Specialist and Possible: yes or no
scientist - Traditional meds varies between cultures and
1. Toxicologist - adverse affect of chemical maybe specific to particular
substance on living organisms in treatment toxins PRIMITIVE MEN gathered the knowledge of healing and
2. Microbiologist - compound medicine by observing nature and noticing animals

3. clinicians - doctors/physicians , experts
Pharmacology – science of drugs
Greek word: pharmakon /pharmacos - drug/spell/poison
logia - study/knowledge
-experimental science which has for its purpose the study
of changes brought about in living organisms by chemically
acting substance (w/ the exception of food) whether used
for therapeutic purpose or not
effect exert
MAIN FXN OF PHARMA:
1. Screening for desired activity
Otzi – (copper age) carried fungus for medical purposes
HIPPOCRATES – Father of medicine
was the first to attempt to separate the
practice of medicine from religion and
superstition
Babylonia – prescription was written in clay tablets
EGYPTIAN – Erb’s papyrus written document for herbal
meds 1500 bc
Chinese - Pen Psao – Great herbal
Materia medica - 40 vol of plant remedies
17th century – Nicholas Culpeper translated and use
pharmacological texts

2. Determining the modes of action  plants and disease they could treat
th
18 century – clinical pharmacology
3. Quantifying drug activity when clinical methods
are not available 
drugs in humans and their optimal use in
patient
Ex : Amoxicillin – MATERIA MEDICA – first recorded reference to the world
of pharmacology
1. cure for strep throat
book containing information about pharmacy,
2. inhibits the synthesis of cell wall mucopeptide by the
pharmacognosy (concerned w/medical drugs
bacteria that cause infection
obtained from plants), posology and used of
3. measures the desirability drugs
Fredrich Serturner – first isolated morphine from opium
Pharmacy – is the study of drugs, its origin, chemical and injected himself and 3 other friends
structure, preparation, administration, action, metabolism
and excretion 18TH – 19TH CENTURY

 pharmacology is different from pharmacy Extract of foxglove plants – dropsy (CHF)

preparing and dispensing discovered : William Withering
 Posology – drug dosage
 contains digoxin / digitoxin
 which now we called digitalis EXPERIMENTAL PHARMACOLOGY – actions of animals
under laboratory conditions
Morphine
PHARMACOPOEIA
- From the opium poppy plant Papaver somniferum
• It is an official code containing a selected list of the
- Fredrich Serturner , first to isolate morphine to established drugs and medicinal preparations with
opium and injected by himself and 3 more other descriptions of their physical properties and tests identity,
friends purity and potency. USP, etc
Contains QUININE
- Isolated by French researcher Pierre Joseph IP: Indian Pharmacopoeia
Pelletier, 1820
BP: British Pharmacopoeia
Importance of pharma in nursing
USP: United states Pharmacopoeia
1. Competence and confidence in administering
medication safely Drug/Medicine
2. Understanding drugs and how it affects patient • Any substance use for the treatment of disease ,
prevention of illness
3. Identify and respond to drug interactions,
reactions and side effect and to treat accordingly • “ droog”
4. To know when to use SOURCES :
5. To understand the process of intake, absorption, 1. Animal
distribution, metabolism and elimination
2. Plants
6. To know the application of pharmacology in
nursing with regard to 12 rights 3. Minerals or inorganic products

- Patient - expiration date - refused for LEGAL REGULATIONS OF DRUGS

- drug - to refuse administration

- Reason - documentation- client
- Dose - assessment/evaluation education
- Route - response
Subdivision of pharmacology
IMMUNO PHARMACOLOGY – immunological actions of
the drugs in the body and dev’t of antibodies ex: vaccine
PHARMACOECONOMICS – aims to quantify the cost and Safety during pregnancy
benefits of drugs when used therapeutically, cost vs price
PHARMACOKINETICS – LADME , what the body does to
the drugs
PHARMACODYNAMICS – biochemical and physiological
effect of drugs and MOA, what the drugs does to the body
PHARMACOTHERAPEUTICS – deals w/ the use of drugs in
prevention and tx of disease
CLINICAL PHARMACOLOGY – study of drugs in
humans/animals when given in dse conditions
- physicians, pharmacist, clinical
pharmacologist, scientist

DRUG NAME
GENERIC NAME – a name approved by the medical or
pharmaceutical associations in the original country of
manufacture and is adopted by all countries
- nonproprietary name or common name
- RA 6675 OR Generic Act of 1988
BRAND NAME – is developed by the company requesting
approval for the drug and identify it as exclusive property
of that company
- Tradename / official name/ proprietary
name
CHEMICAL NAME – it is the name which is important to
the chemist due to its atom placement and chemical
structures
Drug action
THERAPEUTIC EFFECT – desired effect
- primary effect intended
SIDE EFFECT – secondary effect / unintended effect
- do not hinder the main effect of the drug
- mostly foreseen by physician and usually told
to be aware of it
ADVERSE EFFECT – severe side effect
- harmful and undesirable
- it can hinder the treatment and can lead
to more complications
BENADRYL /CITRIZINE/VIRLIX
TE: antihistamine
SE: dizziness, drowsiness
GLUTATHIONE
TE:
SE:
CYTOXAN / MITOMYCIN
TE:
SE:
• CONTRAINDCATION – a condition that serves to
withhold a certain treatment
EX: children and teenagers w/ viral infxn should not
be given ASA – r/o Reyes syndrome
• DRUG INTERACTION - reaction between 2 or more
drugs when taken at the same time EX: an HIV woman
taking ART – ask if taking birth control pills – ART
makes pills less effective
• DRUG-FOOD INTERACTION- a reaction between
food/beverage and drugs
• DRUG TOXICITY – deleterious effect of the drug w/c
results to over dosage, locomotor function, very young
and very old are more susceptible
• DRUG ALLERGY – immunologic reaction to certain
medicine
• DRUG TOLERANCE – low or decrease response to a
drug that is use repeatedly
EX: opioids, antibiotic, corticosteroids
Principles of drug administration
• RN are responsible for own action, illegible order
should be questioned or clarified
• RNs should be knowledgeable about the
medication
• WHAT YOU PREPARE, YOU ADMINISTER
• If the RN is uncertain about the calculation, ask
the other nurse to double check it
• Do not leave the medication at bedside
 • If any adverse reaction were noted assess and po -by mouth
report it immediately
IV. RIGHT ROUTE
• MEDICATION ERROR – assess the patient and  Oral
report immediately  Sublingual
 Buccal
I. RIGHT CLIENT
 Inhalation
IDENTIFYING THE PATIENT
 Topical
1.Always use 2 patient identifiers
 Instillation
2. Be vigilant in preparing medication
 By injection – IV, IM, SC, ID, IO
- Avoid distraction
3. Ask for patient allergies  Transdermal
4. Assessment comes before meds Oral medication
administration\ Most common route
5. Communicate with your patient before
and after administration Safer
7. Avoid “workaround”
Inexpensive
8.
II. RIGHT DRUG/MEDICATION CONTRAINDICATIONS:
DOCTORS ORDER
• Component of drug order  Client is vomiting
 Client with intestinal or gastric suction
• Date and time the order is written  Unconscious client
 inability to swallow
• Drug name
ADVANTAGES:
• Drug dosage
1.Easy to administered
• Route of administration
2.chance of taking improper dose is absent
• Frequency and duration of administration
3. no wastage
• Any special instructions
4. suit all ages
• Physician or any healthcare provider
• To / verbal order (should be signed by doctor
immediately) – signature of the license
practitioner who took the order should be present
III. Right Time
CATEGORIES OF DRUG ORDERS
 STANDING - patient received medicine at
scheduled intervals
BID QID TID TROCHE - A solid dosage form of drug with anesthetic and
antiseptic effect in the mouth.
 SINGLE ORDER – one time ex: Give Seconal tab
100mg hs, before surgery PARENTERAL MEDICATIONS

 PRN – medicine ordered to administer on AS

NEEDED BASIS
ex: 50mg Tramadol injection
 STAT – NOW , IMMEDIATELY
AC – before meals
PC – after meals
q- every

V.
VI.
VII.
VIII.
TRANSDERMAL
• Site: TRUNK or LOWER ABDOMEN
• With HAIR : clip , do not shave
• Avoid CUTS, BURNS , ABRASIONS
OPHTHALMIC
• Clean the eyelid from inner to outer canthus
• If liquid Instruct patient to LOOK UP before
administration
• Instill correct numbers of eye drop
• Instruction: DO PUNCTAL OCCLUSION for 30 sec
• If ointment discard the first bead
• Squeeze 2cm on the lower conjunctival sac
• Instruction: CLOSE EYE BUT DON’T SQUEEZE THE
EYLID
OTIC
• Clean the pinna and the meatus of the ear canal
• Warm the medication
ADULT : 3 year old and up – pull the pinna upward and
backward
CHILD : less than 3 year old – pull the pinna downward and
backward
Instruction: REMAIAN SIDE LYING POSITION FOR 5 mins
RIGHT ASSESSMENT – requires the appropriate data
to be collected before administration of the drugs
(secure client history or any drug interactions and
allergy)
RIGHT DOCUMENTATION – nurse should immediately
record the appropriate information about the drug
administered (name of drug/dose/route/time and
date/nurse initial or signature)
RIGHT TO EDUCATE – client teaching
RIGHT TO REFUSE
Pharmacodynamics: Drug – Receptor Interactions
• Effect of drugs in the body
• Drug acts – either activate or inhibit regular
Body process to give biological response
primary or secondary physiologic effect
or both
ex: diphenhydramine hydrochloride
1º - tx allergy / desirable at bedtime, sedate
2º - CNS depression /undesirable if client is working
Types of drugs action(effect or response)
1. STIMULATION – selective enhancement of the level of
activity of specialized cells
 Adrenaline – stimulates the heart
2. INHIBITION OR DEPRESION – selective cut back of
specialized cell’s activity
 Quinidine – depressed the heart
3. REPLACEMENT – use of natural metabolites, hormones
in deficiency state
 Fer-in-sol infusion in Anemia
4. IRRITATION – noxious effect and is particularly applied
to less specialized cell
 counterirritants increase blood flow to the site
(balm oil, essential oil,
menthol)
5. CYTOTOXIC ACTIONS – drugs that selectively kill
invading parasites
 anthelmintic drugs such as mebendazole
6.ANTIMICROBIAL ACTION – drugs that prevent, inhibit or
kill infectious organism
7. MODIFICATION OF IMMUNE SYSTEM – drugs that
modify , enhance or depress immune system
Mechanism of action
1. PHYSICAL ACTION
 OSMOSIS – drug retains water by osmosis as
osmotic diuretics. Ex: Mannitol
 ADSORPTION – drugs holds diverse substances
including toxins and liquids on its surfaces
thereby inactivating them EX: Activated Charcoal
2. CHEMICAL ACTION
Ex: Antacids (NaHCO3) contains neutralizes gastric
acidity
3. BODY CONTROL SYSTEM
 ENZYMES – drugs may inhibit or activate certain
enzymes
 Ex: 1. Erythromycin are known inhibitor of
metabolism of Theophylline , concurrent
administration may cause CNS toxicity
seizure
 2. Grape fruit juice is a CYP3A4 inhibitor
can cause significant interactions to
midazolam, simvastatin higher
plasma concentration
Pharmacodynamics
a) Receptor interactions
 Key in a lock
 Drug binds to a specific site on the cell (called a
receptor site) and modifies the function of the cell
 How many drugs work
 How strong a drug binds to the receptor site is
called the AFFINITY for that binding site
A cellular macromolecule to which a medication binds to
initiate its effects is called RECEPTOR
Dose-response relationship
DOSE RESPONSE – relationship between the minimal vs
the maximal amount of drugs dose needed to produce the
desired drug response
2 CONCEPTS DESCRIBES THIS RELATIONSHIP:
1. POTENCY – amount of drug needed to elicit a specific
physiologic response high
(strength) - concentration low
- drug that produce greater effect at lower
dose is more potent – (should be
given at small dose)
 it depends on the affinity for a drug for receptor
as well as the number of
receptors available
EX: FENTANYL - high potency at low
concentration
MORPHINE- minimal potency at low
concentration
Fentanyl is 100x more potent than morphine
(0.1mg Fentanyl = 10mg Morphine)
2. EFFICACY (activity) – effect of drug
MAXIMAL EFFICACY – largest effect that a drug can
produce
 point at which increasing a drug dosage no longer
increases the desired
effect
 a drug w/ high maximal efficacy is not always
desirable
EX: 1. for headache – use Biogesic not Morphine
2. if you want to remove just a modest volume
of water use Hydrochlorothiazide rather than using
Furosemide
 3. antibiotics – 1st gen rather than using 4th gen PEAK: 30 MINS AFTER INFUSION
THROUGH : 30 MINS PRIOR TO THE NEXT INFUSION
WHAT FACTORS AFFECTS THE EFFICACY:
• DOA (DURATION OF ACTION) –
1. Drug-receptor interaction or the affinity of the length of time the drug has an
receptor effect
2. Route of administration EX:
3. Absorption ANESTHESIA
4. Distribution through the body ONSET – S1 – Analgesia/induction phase
5. Clearance from the blood or site of action PEAK – S2 – Excitement
Parameters of drug action DURATION – S3 – Operative phase
MTC – S4 – Coma Death
PHARMACOKINETICS

THERAPEUTIC WINDOW
• Range based on the minimum effective
therapeutic concentration and the minimum toxic
concentration for a specific toxic effect
EX : Theophylline
Minimum therapeutic concentration is 8mg/L
therapeutic window is at 8-18mg/L
Toxic effect observed at 18mg/L LIBERATION
EX: Lithium  is the first step in the process by which medication
enters the body and liberates the active ingredient
Minimum therapeutic concentration is 0.8 mmol/L
that has been administered
therapeutic window is at 0.8-1.2 mmol/L
 The release of the drug from its dosage form
Toxic effect observed 1.2 mmol/L
2 phases:
TOLERANCE – decrease responsiveness to a drug over the
course of therapy Disintegration – breakdown into smaller parts
PLACEBO EFFECT – drug response not attributed to Pharmaceutic / Dissolution – amount of drug substance
chemical properties of drugs that goes into solution/ further breakdown into smaller
part in the GI
can be +/- and may be influence by
beliefs, attitudes and expectations  Immediate – the medicine is formulated to release
the medicinal drug w/o delay
• ONSET – time it takes to reach the minimum
 Delayed – the medicine is formulated to release
effective concentration (MEC) after the
sometime after it is taken
administration of drugs
 Extended – the drug is formulated to make the
• PEAK – when the drug reaches the plasma drug available over an extended period allowing a
concentration / highest blood concentration reduction in dosing frequency compared to
immediate or delay.
Absorption
 the process by which the drug is transferred
MOVEMENT ACROSS THE CELL MEMBRANE CAN OCCUR
VIA:
1. PASSIVE TRANSPORT – process in which drugs
cross cell membranes. Exception are drugs
administered IV or inhaler (asthma drugs) requires
no energy
2. ACTIVE TRANSPORT – when drugs move against a
concentration slope. It requires energy in the form
of ATP .
ex: ions, vitamins , sugars and amino acids that need to
be absorb in the small intestine
2 Types of Passive Transport:
1. Facilitated Diffusion - it helps larger , water
soluble and polar medications moves across the
membrane through transport protein like carriers
2. Passive Diffusion – which helps small lipid soluble
and non-polar medication moves across the
membrane from higher to lower concentration
 Absorption occurs at slower rates when drug is
administered by the oral, IM, or subcutaneous
routes because the complex membrane systems
of GI mucosal layers, muscle and skin delay drug
passage
 Sublingual, IV or inhaled drugs are usually
absorbed much faster
Example of FACTORS THAT AFFECT ABSORPTION:
 1. Intestinal interference – most absorption of
oral drugs occurs in small Intestine. If a patient
has had large sections of small intestine surgically
removed, drug absorption decrease because of
the reduced surface area
 2. Liver lowered levels- drugs absorbed by the
small intestine are transported to the liver before
being circulated to the body (FIRST- PAST
EFFECT). Liver metabolism may inactivate the
drug; if so, the first pass effect lowers the amount
of active drug released into systemic circulation.
Therefore higher drug dosage must be
administered to achieved the desired effect.
 3. More blood, more absorption – increase blood
flow improves drug absorption. Reduced blood
flow decrease drug absorption. EX: gluteal
muscle can accommodate a larger volume of drug
than deltoid muscle but blood flows faster
through deltoid muscle that’s why the muscle
area selected for IM administration is the deltoid
 4. Whatcha eatin’? – High fat meals and solid
foods slow the rate at which contents leave the
stomach and enter the intestines, delaying
intestinal absorption of a drug.
DISTRIBUTION
Is the process by which the drug leaves the bloodstream
and enters the instertitium or the cell of the tissue
Distribution is affected by following factors
1. Blood flow
2. Capillary permeability
3. Binding of drugs to the protein
4. Lipid fat solubility
GO WITH THE FLOW
• After a drug has reached the bloodstream, its
distribution in the body depends on the blood
flow. The drug is distributed quickly to those
organs with a large supply of blood, including
heart, liver and kidneys. Distribution to other
internal organs, skin, fat and muscle is slower.
BREACHING THE BARRIER
• The ability of the drug to cross the cell membrane
depends on whether the drug is water or lipid
soluble. Lipid soluble drugs easily cross cell
membranes, it can also cross the blood-brain
barrier and enter the brain. Water soluble can’t.
IN A BIND
• As a drug travels through the body, it comes in
contact with proteins, such as plasma protein
albumin. The portion of drug that’s bound to
protein is inactive and can’t exert therapeutic
effect. Only those that are free or unbound
portion remain active.
 I. MODIFICATION - drugs are modified by means of
oxidation, reduction to be more excretable
II. CONJUGATION- those insufficiently polar
molecules may then pass to phase II in which it
will be conjugated by glutathione, sulfates and
glycerin groups
III. EXCRETION – metabolized further to aid their
transport
IV. Drug half-life is the time it takes for the amount of
drug in the body to be reduced by half.
Example:
4 major compartments: BLOOD PLASMA/
FAT/EXTRACELLULARFLUID/INTRACELLULAR Ibuprofen has a half life of about 2 hours.
if the patient takes 200 mg, in 2 hours, 50% of the drug will
be gone, leaving 100 mg.
after 2 hours - 50 mg.
after 2 hours – 25 mg
after 2 hours – 12.5 mg
after 2 hours – 6.25 mg

 By knowing the half-life, the time it takes for a drug

to reach a steady state (plateau drug level) can be
determined
Plasma Protein Binding CONSIDERATIONS FOR METABOLISM:
Plasma consists of Drug metabolism can be affected by age, habits, gender
and disease
> ~90% water,
Elimination
> ~8% plasma proteins
• The kidney is the most important organ for the
> ~2% other organic or inorganic species.
excretion of drugs and/or their metabolites. Some
Many drugs bind to the plasma proteins as they have low compounds are also excreted via bile, sweat,
water solubility. saliva, exhaled air, or milk, the latter a possible
source of unwanted exposure in nursing infants.
Plasma protein binding limits distribution. Drug excretion may involve one or more of the
following processes.
Metabolism/biotransformation
A. Renal Glomerular Filtration
Glomeruli permit the passage of most drug molecules, but
- The process in which the body inactivate the drugs
restrict the passage of protein-bound drugs. Changes in
The enzyme system in the liver is the primary site for glomerular filtration rate affect the rate of elimination of
metabolism – FIRST PASS EFFECT drugs which are primarily eliminated by filtration (e.g.,
digoxin)
(LIVER FILTERS)
B. Renal Tubular Secretion
CYTOCHROME p450 System – is a liver enzyme
The kidney can actively transport some drugs (e.g.,
That convert active drugs to inactive drug dicloxacillin) against a concentration gradient, even if the
drugs are protein-bound. (Actually, only free drug is
transported, but the protein-drug complex rapidly
3 Phases: dissociates.) A drug called probenecid competitively
inhibits the tubular secretion of the penicillin, and may be - Is a systematic and continuous collection,
used clinically to prolong the duration of effect of the organization, validation and documentation of
penicillin's. information
C. Change in urine pH 4 types of nursing assessment:
Affects drugs excretion ex: NaHco3 (antacid) causes urine 1. Initial nursing assessment
to be alkaline , alkaline urine prompts the excretion of
drugs that are weak acids (ASPIRIN,BARBITURATES) 2. Problem focused

OTHER ROUTES: 3. Emergency Assessment

PULMONARY: 1. Volatile Anesthetics such as nitrous 4. Time lapsed

oxide – rapid excretion 1. Initial nursing assessment: Performed within specified
2. agents w/ increase blood and tissue time after admission. To establish a complete database for
solubility is slowly excreted problem identification.

ex: Ethanol – that’s why it is used to measure Eg: Nursing admission assessment
concentration in breath of vehicle drivers 2. Problem-focused assessment : To
Application of nursing process determine the status of a specific problem identified in an
Nursing process is a critical thinking process that earlier assessment.
professional nurses use to apply the best available Eg: hourly checking of vital signs of fever patient
evidence to caregiving and promoting human functions
and responses to health and illness (American Nurses 3. Emergency assessment: During emergency
Association, 2010). situation to identify any life threatening situation.
Eg: Rapid assessment of an individual's airway, breathing
Purposes of nursing process status, and circulation during a cardiac arrest.
• To identify a client's health status and actual or potential 4. Time-lapsed reassessment: Several months after
health care problems or needs. initial assessment. To compare the client's current
To establish plans to meet the identified needs. health status with the data previously obtained.
Types of Data
• To deliver specific nursing interventions to meet those
needs. Two types: subjective data and objective data.
1. Subjective data, also referred to as symptoms or covert
data, are clear only to the person affected and can be
described only by that person.
Itching, pain, and feelings of worry are examples of
subjective data.
2. Objective data, also referred to as signs or overt data,
are detectable by an observer or can be measured or
tested against an accepted standard. They can be seen,
heard, felt, or smelled, and they are obtained by
observation or physical examination.
For example, a discoloration of the skin or a blood
Assessment pressure reading is objective data.
 collecting data Sources of Data
 organize data Sources of data are primary or secondary.
 validate data 1. Primary : It is the direct source of information. The
client is the primary source of data.
 document data
2. Secondary: It is the indirect source of information. All
sources other than the client are considered secondary
sources. Family members, health professionals, records
and reports, laboratory and diagnostic results are
secondary sources.
Example:
 Nurse Kim is knowledgeable about volume excess
or fluid overload. She knows that findings
associated with this include cough, dyspnea,
crackles, tachypnea, tachycardia and elevated BP.
 The nurse knows that which of the following
clients has the lowest risk of obesity and Diabetes
Mellitus
Diagnosis
 Analyzing data
 Identifying health problems, risk and strengths
 Formulate diagnostic statements
 This is the nurse’s clinical
Judgement about client’s experience
To health problem
Example:
Acute pain related to abdominal surgery as evidenced by
patient discomfort and pain scale.
Potential Errors in Choosing a Nursing Diagnosis
Formulation of nursing diagnosis
A client reports discomfort at the insertion site of
an IV catheter, area is slightly reddened
 The nurse formulates a nursing diagnosis ie
Discomfort.
 But fail to consider the Risk for infection.
Don't use medical terms in nursing diagnosis
• Self care deficit,Hygiene related to Stroke
•Self care deficit,Hygiene related to weakness secondary
to Stroke
Errors in Choosing a Nursing Diagnosis
Don't combine two problems at the same time
 Pain and fear related to upcoming abdominal
surgery
 Pain related to tissue injury secondary to
abdominal surgery as evidenced by pain 6/10.
Don't make statements that are legally inadvisable
 Impaired skin integrity R/T infrequent turning aeb
3cm ankle ulcer
 Impaired skin integrity R/T immobility related to
fracture.
Planning
 Prioritize problems/diagnoses
 Formulate goals / desired outcomes
 select nursing intervention
 write nursing intervention
FACTORS EFFECTING PRIORITIES:
1. Client health ,values and beliefs
2. Client’s priorities
3. Resources available to the nurse and client
4. Urgency of health problem
5. Medical treatment plan
MACROS criteria- For Goal
Measurable and observable
A chievable and time limited Peripheral Nervous System (PNS) - Located outside the
brain & spinal cord
Client centred
*
Realistic
Autonomic Nervous System (ANS) & the somatic
Outcome written
The PNS receives stimuli from the CNS & initiates
Short responses to the stimuli after it's interpreted by the brain
PLANNING EXAMPLE At the back
• The nurse recognize problems and emphasize
which ones are more important and must be
attended to first, depending on patient needs. She
sets priorities.
• The nurse is arranging care of the client with
COPD, understanding that the client is most likely
to experience respiratory acidosis.
Neuropharmacology
NERVOUS SYSTEM : regulates most body system using
direct connections called nerves that enable a person to
sense and respond to stimuli.
BASIC FUNCTIONS:
1. SENSATION – monitors changes and events
occurring in and outside the body. Such changes
are known as stimuli and the cells that monitor
them are called receptors.
2. INTEGRATION – interpretation of sensory
information to determine the appropriate
response
3. REACTION – motor output or activation of
muscles or glands typically via the release of
neurotransmitter.
CENTRAL NERVOUS SYSTEM – is the body’s primary
nervous system consist of 1. BRAIN 2.
SPINAL CORD

DRUGS AFFECTING THE SYMPATHETIC NERVOUS SYSTEM

1. ADRENERGIC AGONIST/SYMPATHOMIMETICS
2.ADRENERGIC ANTAGONIST/BLOCKERS/
Nervous System
SYMPATHOLICS
Central Nervous System (CNS) - Brain and spinal cord
Adrenergic Receptors
Adrenergic Agonists are drugs that lead to stimulation of
the adrenergic receptors. In doing so, adrenergic agonists
generally simulate activation of certain aspects of the
sympathetic nervous system and are thus also known as
"sympathomimetic".
CLASSIFICATION OF SYMPATHOMIMETICS ACCORDG TO
THEIR EFFECT IN THE ORGAN CELLS
Direct acting adrenergic agonist
Epinephrine interacts with both a and B receptors.
At low doses - B2 effects (vasodilation) on the vascular
system predominate, At high doses - al effects
(vasoconstriction) are strongest.
Actions
1. Cardiovascular –
Strengthens the contractility of the myocardium (positive
inotropic: B1 action) and increases its rate of contraction
(positive chronotropic: ẞ 1 action).
Activates ẞ 1receptors on the kidney to cause renin
release.
Constricts arterioles in the skin, mucous membranes, and
viscera (al effects), and it dilates vessels going to the liver
and skeletal muscle (B 2 effects).
Cumulative effect is an increase in systolic blood pressure
& slight decrease in diastolic pressure.
Therapeutic uses
Anaphylactic shock :
 Intramuscular - 1: 1000
 Subcutaneous - 1: 1000
 Intravenous - 1:10000
 Epinephrine is the drug of choice for the
treatment of Type I hypersensitivity reactions in
response to allergens.
Bronchospasm:
Epinephrine relieves brochospasm.
Cardiac arrest :
Epinephrine may be used to restore cardiac rhythm in
patients with cardiac arrest like drowning & electrocution.
DRUG INTERACTIONS OF EPINEPHRINE
1. EPINEPHRINE + DECONGESTANT = ADDITIVE
EFFECT
2. EPINEPHRINE + DIGOXIN = CARDIAC ARRYTHMIA
3. BETABLOCKERS (“OLOLS”) CAN
ANTAGONIE/DISAFFECT THE ACTION OF
EPINEPHRINE
4. TRICYCLIC ANTIDEPRESSANTS AND MAOI +
EPINEPHRINE = ALLOW EPINEPHRINE ‘S EFFECT TO
BE INTENSIFIED AND PROLONGED
5. COCAINE + EPINEPHRINE= EXAGERRATED
CARDIOVASCULAR ACTIONS, BECAUSE COCAINE
PREVENTS REUPTAKE OPF CATECHOLAMINES
INTO ADRENERGIC NEURON
Also called sympathomimetic, are drugs that mimic the
effects of the SNS and are used to stimulate the adrenergic
receptors within the SNS. The adverse effects associated
with these drugs are usually also a result of sympathetic
stimulation.
Adrenergic agonists include;
1. alpha- and beta-adrenergic agonists - which
stimulate both types of adrenergic receptors in
the SNS
2. alpha-specific adrenergic agonists - stimulate
only alpha receptors
3. beta-specific adrenergic agonists - stimulate only
beta-receptors
CENTRAL ACTING ALPHA AGONIST (alpha 2 adrenergic)
Central-acting agents lower your heart rate and reduce
your blood pressure.
Blocks the signals from the brain to the nervous system
that speed up your heart and narrow your veins and
arteries
As a result, heart doesn't pump as hard and your blood
flows more easily through your blood vessels.
• Drug that blocks the effects of adrenergic
neurotransmitter
• Mostly block the Alpha and Beta receptors
They block in 2 ways:
1. By occupying the receptor
2. By inhibiting the release of neurotransmitter
norepinephrine and epinephrine
Why do we need to block adrenergic neurotransmitter?
plays a major role in the regulation of arterial pressure.
Activation of these nerves to the heart
1. increases the heart rate (positive chronotropy)
2.contractility (positive inotropy)
3. velocity of electrical impulse conduction (positive
dromotropy).
2 classification of adrenergic antagonist
 ALPHA-and-BETA ADRENERGIC AGONISTS
 Epinephrine
 Dopamine
 Ephedrine
 Norepinephrine
Dopamine

Immediate precursor of norepinephrine &
epinephrine
 Endogenous dopamine may have more
important effects in regulating sodium
excretion and renal function.
 Features distinguishing from norepinehrine &
epinephrine
- 8 2-5 µg/kg/min - D1 receptors - renal
vasodilation
- 3 5-10 µg/kg /min - ẞ1 receptors - ↑
cardiac output
- >10 µg/kg/min -a 1 receptors –
vasoconstriction
Dopamine contd..
 Its deficiency in the basal ganglia leads to
Parkinson's disease, which is treated with its
precursor levodopa.
 Dopamine antagonists are antipsychotic drugs.
 Therapeutic uses - used in conditions with low
cardiac output with compromised renal function
 Iv infusion regulated by monitoring of BP & rate of
urine formation.
Mixed-Acting Sympathomimetics
Ephedrine
 The plant Ephedra vulgaris, has been used in
traditional Chinese medicine for 2,000 years for
the treatment of asthma and hay fever, as well as
for the common cold
 Ephedrine is a noncatechol,it has high
bioavailability and a relatively long duration.
 It releases NE and activates ẞ2 receptors directly.
 Crossess BBB, it is a powerful stimulant.
 Nowadays only used to treat hypotension with
spinal anaesthesia
 Repeated dosing – tachyphylaxis
Norepinephrine
A hormone secreted by certain nerve endings of the
Sympathetic nervous system.
Released in response to stress, classified as a neuro
transmitter that is released from neurons
Side effects
 Difficulty in breathing
 Swelling of face (lips, tongue, or throat)
• ALPHA-SPECIFIC ADRENERGIC AGONISTS
Alpha-1 specific Adrenergic Agonists:
Phenylephrine
Midodrine
 • Alpha-2 specific Adrenergic Agonists:
Clonidine
Methyldopa
• BETA-SPECIFIC ADRENERGIC AGONISTS : ( Beta1
and Beta2 )
ü Isoproterenol ü Albuterolü Arformoterolü Indacaterolü
Levalbuterolü Metaproterenolü Olodaterolü Salmeterol
• Beta-1 specific adrenergic agonists
ü Dobutamine INTRODUCTION TO DEPRESSION
• Beta-2 specific adrenergic agonists 1. Anxiety is an emotional state commonly caused by the
perception of real or danger that threatens the security of
ü Terbutaline
an individual.
ü Isoxsuprine
2.It allows a person to prepare for or react to
Alpha 1 specific adrenergic environmental changes.
3. Anxiety can produce uncomfortable nature.
The Symptoms of Anxiety
1. Sweating 5. GI Discomfort
2. Shaking 6. Lack Of Sleep
3. Palpitation 7. Lack Of Concentration
4. Blushing 8. Irritation
TYPES OF ANXIETY
• Panic Disorder-unreasonable fear spreading for
ALBUTEROL SULFATE
10-20min
• Beta, adrenergic agonist, is selective for beta2- • Generalized Anxiety Disorder-experienced when
adrenergic receptors , its response is relaxation of person thinking about no. of events
bronchial smooth muscle and bronchodilation • Social Anxiety Disorder-means fear about
interaction with social programs.
• Activates only the B2 receptor of smooth muscle • Obsessive Compulsive Disorder-repeated
in the lungs experience of specific image or thoughts.
• High dose : increase heart rate
• Half life : via oral inhalations 2.7 to 6 hours
DRUG INTERACTION:
1. Albuterol + MAOI = hypertensive crisis
2. Beta agonist (beta blockers) + albuterol = hinders/inhibit
the action of albuterol
SE: Tremors, restlessness, nervousness

SEDATIVE/HYPNOTICS ANXIOLYTICS
• Major therapeutic use is to relief anxiety
(anxiolytics) or induce sleep (hypnotics).
• Hypnotic effects can be achieved with most
anxiolytic drugs just by increasing the dose.
• The distinction between a "pathological" and
"normal" state of anxiety is hard to draw, but in
spite of, or despite of, this diagnostic vagueness,
anxiolytics are among the most prescribed
substances worldwide.
BARBITURATES
• Barbiturates is a sedative-hypnotics, a type of
central nervous system (CNS) depressant used to
treat insomnia, seizures, and headaches.
• Available under the following different brand
names: amobarbital (Amytal), secobarbital
(Seconal), butabarbital (Butisol), pentobarbital
(Nembutal), belladonna and phenobarbital
(Donnatal), butalbital/acetaminophen/caffeine.
• Barbiturates are classified as Schedule II
substances, meaning they have definite potential
for physical and psychological dependence and
abuse. Barbiturates may be habit-forming.
Tolerance, psychological dependence, and
physical dependence may occur especially
following prolonged use of high doses of
barbiturates.
BENZODIAZEPINES
• enhance GABA effect to cause inhibition of
impulse transmission.
Examples: Diazepam, Lorazepam, Clonazepam
• are a class of psychoactive drugs whose core
chemical structure is the fusion of a benzene ring
and a diazepine ring. The first such drug,
chlordiazepoxide (Librium), was discovered
accidentally by Leo Sternbach in 1955, and made
available in 1960 by Hoffmann–La Roche, which,
since 1963, has also marketed the benzodiazepine
diazepam (Valium).
• In 1977 benzodiazepines were globally the most
prescribed medications.
• They are in the family of drugs commonly known
as minor tranquilizers.
• resulting in sedative, hypnotic (sleep-inducing),
anxiolytic (anti-anxiety), anticonvulsant, and
muscle relaxant properties. High doses of many
shorter-acting benzodiazepines may also cause
anterograde amnesia and dissociation.
Non – Benzodiazepines
EX: Paraldehyde, Meprobamate, Chloral hydrate,
Zolpidem, Diphenhydramine
• The first three nonbenzodiazepine drugs to enter
the market were the "Z-drugs", zopiclone,
zolpidem and zaleplon. These three drugs are all
sedatives used exclusively for the treatment of
mild insomnia. They are safer than the older
barbiturates especially in overdosage and they
may, when compared to the benzodiazepines,
have less of a tendency to induce physical
dependence and addiction, although these issues
can still become a problem. This has led to the Z-
drugs becoming widely prescribed for the
treatment of insomnia particularly in elderly
patients Non-benzodiazepines generally cause less
disruption of normal sleep architecture than
benzodiazepines. Psychomotor and memory
impairment may be less problematic with non-
benzodiazepines, especially when compared to
longer-acting benzodiazepines..
NURSING CONSIDERATIONS
Avoid abrupt discontinuation after prolonged use
Not given if BP is elevated, with renal and hepatic
condition, with history of drug abuse
Xanax(Alprazolam),Ativan(Lorazepam), Serax (Oxazepam)-
brand names
Increase in 3D’s – Drowsiness, dizziness, decrease in BP
Enhance action of GABA
Teach to rise slowly from supine
Yes , Alcohol and caffeine should be avoided
Antipsychotic drugs
 Antipsychotic drugs (also called neuroleptics or
major tranquilizers) are used primarily to treat
schizophrenia (a biologic illness), but they are also
effective in other psychotic states, including manic
states with psychotic symptoms such as
 grandiosity, paranoia, and hallucinations, and
delusions.
 Antipsychotic drugs are not curative and do not
eliminate the chronic thought disorder, but they
often decrease the intensity of hallucinations and
delusions and permit the person with
schizophrenia to function in a supportive
environment.
History of antipsychotic drugs
 Antipsychotic drugs have been used in Western
medicine for more than 50 years.
 Chlorpromazine (1952) and Reserpine were the
first drugs found to be useful in schizophrenia.
 Tricyclic and MOA inhibitor antidepressant in
1957-58.
 Major novel antipsychotics are selective serotonin
reuptake inhibitor and it has been introduced in
1980s.
 Little attention was paid to Cade's report in 1949
that Lithium could be used for excitement and
mania: its effective use started in the 1960s and
now it has a unique place in psychiatry.
Classification of antipsychotic drugs
PHARMACOLOGICAL CLASSIFICATION
FIRST-GENERATION ANTIPSYCHOTIC (low potency)
• Chlorpromazine, Prochlorperazine, Thioridazine
FIRST-GENERATION ANTIPSYCHOTIC (high potency)
Fluphenazine, Haloperidol, Pimozide, Thiothixene
SECOND GENERATION ANTIPSYCHOTIC
Aripiprazole, Asenapin, Clozapine, Iloperidone
• Lurasidone, Olanzapine, Quetiapine, Paliperidone,
Risperidone, Ziprasidone
CLASSIFICATION OF ANTIPSYCHOTIC DRUGS
Typical antipsychotics
 Phenothiazines
• e.g. chlorpromazine, fluphenazine,
thioridazine
 Butyrophenones
• e.g. haloperidol, droperidol
 Thioxanthines
• e.g. chlorprotixen, thiothixene
atypical Antipsychotics
• Chozapine, Risperidone, sulpiride,
sertindole, Seroquel, olanzapine,
quetiapine
Classification of antipsychotic drugs
CHEMICAL CLASSIFICATION
 Phenothiazines
• Aliphatic side chain: Chlorpromazine,
triflupromazine
• Piperidine side chain: Thioridazine
• Piperazine side chain: Trifluoperazine,
fluphenazine
 Butyrophenones: Haloperidol, Trifluperidol,
Penfluridol
 Thioxanthenes: Flupenthixol
 Other heterocyclics: Pimozide, Loxapine
 Atypical antipsychotics: Clozapine, risperidone,
olanzapine, quetiapine, aripiprazole, ziprasidone
PHARMACOTHERAPY FOR MENTAL ILLNESS
First-generation antipsychotics
• The first-generation antipsychotic drugs (also
called conventional, typical, traditional
antipsychotics) are or competitive inhibitors at a
variety of receptors, but their antipsychotic effects
reflect competitive blocking of D2 dopamine
receptors.
• First-generation antipsychotics are more likely to
be associated with movement disorders,
particularly for drugs that bind tightly to
dopaminergic neuroreceptors, such as
haloperidol.
Pharmacotherapy of metal illness
Second-generation antipsychotic drugs
• The second generation antipsychotic drugs (also
referred to as "atypical" antipsychotics) have
fewer extrapyramidal symptoms (EPS) than the
first-generation agents, but are associated with a
higher risk of metabolic side effects, such as
diabetes, hypercholesterolemia, and weight gain.
• The second-generation drugs appear to owe their
unique activity to blockade of both serotonin and
dopamine receptors.

Parkinson’s
• Drug therapy is an important part of treatment of
Parkinson’s Disease, a progressively neurologic
disorder characterized by 4 cardinal features:
1. Muscle rigidity - inflexibility
2. Akinesia – loss of voluntary muscle movement
3. Tremors at rest
4. Disturbances of posture and balance
1. Anticholinergic agents achieve their effect in
treating Parkinson’s disease by antagonizing which
nervous system? a. Autonomic b. Peripheral c.
Parasympathetic d. Sympathetic
2. Myasthenia crisis and cholinergic crisis are the
major complications of myasthenia gravis. Which
of the following is essential nursing knowledge
when caring for a client in crisis?
a. weakness and paralysis of the muscles for
swallowing and breathing occur in either crisis
b. cholinergic drugs should be administered to
prevent further complications associated with the
crisis
c. the clinical condition of the client usually improves
after several days of treatment
d. loss of body function creates high levels of
anxiety and fear
3. A client with myasthenia gravis reports the occurrence
of difficulty chewing. The physician prescribes
pyridostigmine bromide (Mestinon) to increase muscle
strength for this activity. The nurse instructs the client to
take the medication at what time, in relation to meals?
a. after dinner daily when most fatigued
b. before breakfast daily
c. as soon as arising in the morning
d. thirty minutes before each meal
4. A client is hospitalized for observation after
experiencing tonic-clonic seizure. The physician orders
phenytoin sodium (Dilantin) 300 mg p.o. daily for long tern
seizure control. The nurse formulates a teaching plan
based on which statement about how this drug helps to
prevent and treat seizure?
a. It increases the discharge of noradrenergic neurons
b. It increases the amount of the neurotransmitter
gamma-aminobutyric acid (GABA)
c. It alters ion movement across cell membranes
d. It reduces polysynaptic transmission
5. . After one week of antidepressant medication, Kate still
manifests depression. The nurse evaluates this as;
a. Unusual because action of antidepressant drug is
immediate
b. Unexpected because therapeutic effectiveness
takes within a few days
c. Expected because therapeutic effectiveness takes
2-4 weeks
d. Ineffective result because perhaps the drug's
dosage is inadequate
6. A client who has been receiving amitriptyline (Elavil) for
1 week reports not having a bowel movement for 5 days.
The nurse would interpret this in which of the following
ways?
a. The client is demonstrating somatic
preoccupations associated with depression
 b. The client is experiencing memory loss associated The impulse is spread to A.V at this time we get
with TCA therapy “PR” interval on ECG paper.
c. The client may be constipated due to the Then impulse spread to Bundle of His, Bundle
anticholinergic effects of TCAs Branches & Purkinji fibers through AV node & both
ventricles start to depolarize & we can get a waves
d. The client would be more likely to be complex on ECG paper which is known as “QRS” complex.
experiencing diarrhea as a side effect
Then the both ventricles start to repolarize & in
7. The client is started on chlorpromazine (Thorazine) 200 early stage we can get “ST” segment & later “T” wave on
mg PO q.i.d. The client should be assessed for which of the graphic paper.
following high-incidence side effects?
Anti-hypertensive drugs
a. dry mouth, constipation and blurred vision c.
cogwheel rigidity and drooling IDIOPATHIC /ESSENTIAL/PRIMARY HYPERTENSION
b. severe agranulocytosis  > 90 % , 15 – 40 YRS
c. increased anxiety  Genetic inheritance
d. c. cogwheel rigidity and drooling SECONDARY HYPERTENSION
CARDIOVASCULAR  Renal artery disease
 Pheochromocytoma
 Renal parenchymal disease
 Toxemia of pregnancy
OTHER BETA BLOCKERS
1. NADOLOL non selective beta receptor /
blocks B1& B2 receptor site
2. CARTEOLOL
3. BISOPROLOL - B1 selective blocker
4. PINDOLOL , ACEBUTOLOL – a partial agonist beta
blocker w/ some intrinsic sympathomimetic
Inherent rate activity. This drugs a particularly beneficial for
patients w/ bradyarrythmias or peripheral
 SA NODE 60-100 BPM vascular disease
 AV NODE 40-60 BPM
 BUNDLE OF HIS 40-60 BPM PRECAUTIONS: not given to patients w/ Heart block, Brady
 LEFT AND RIGHT BUNDLE cardia, CHF, COPD
 BRANCHES 20-40 BPM SE: Bradycardia, Hypotension, Rebound hypertension ( be
 PURKINJE FIBERS 20-40 BPM cautious when abruptly stopped)
ELECTRICAL CONDUCTION OF THE HEART
Impotent when use w/ Inderal
The normal site of impulse formation in the heart
is S.A node & then it spread to A.V node, Bundle of His, OTHER BETA BLOCKER
Bundle Branches & Purkinji network. This is the complete
electrical activity of heart. 1. LABETELOL have both Beta blocking and
vasodilating effects
During all this procedure the heart is depolarizes
& repolarizes under the effect of the electrical impulse & 2. CARVEDILOL
we can get same waves on the graphic paper. 3. NEBIVOLOL
Initially when impulse is generating through the 4. ESMOLOL – B1 selective blocker that is rapidly
S.A node, both atria start to depolarize which result as a metabolized via hydrolysis by RBC.
deflection on ECG paper which is known as “P” wave.
 used for management of intra and post
operative hypertension and sometimes for
hypertensive emergencies, particularly when
HTN is associated w/ Tachycardia.
If the problem is altered raas
RENIN-ANGIOTENSIN-ALDOSTERONE-SYSTEM
Role of raas in control of bp
 Kidney Protection
 Cardio Protection
 Vascular protection
Ace inhibitors (“ pril”)
 Recommended as first line treatment of
hypertension in patients w/ a variety of
compelling indications including high coronary
disease risk or history of DM , stroke, heart
failure , MI
 It dilates arterioles which improves renal blood
flow and decrease blood fluid volume
 Reduce both cardiac pre load and afterload,
thereby decreasing cardiac work
1. CAPTOPRIL (CAPOTEN) usually tolerated by most
of patient
2. ENALAPRIL (VASOTEC)
3. LISINOPRIL (ZESTRIL)
4. RAMIPRIL (ALTACE)
- Is not given to patient w/ renal dysfunction
because this drugs may cause further decrease in
renal blood flow
WOF: Hypotension , Hyperkalemia
AE : Reflex Tachycardia , cough , dizziness
Better to give on empty stomach for better absorption
ADVANTAGES: 1. no postural hypotension
2. Safe in Asthmatic patient, DM and peripheral vascular
disease
3. Long term has potential to reduce incidence of Type 2
DM
4. No rebound hypertension on withdrawal
Angiotensin antagonist/
angiotensin receptor blockers (“sartan”)
1. LOSARTAN 4. TELMISARTAN
2. CANDESARTAN 5. TELMISARTAN
3. VALSARTAN 6. IRBESARTAN
ARBS produce arteriolar and venous dilatation and block
aldosterone secretion, thus lowering BP and decreasing
salt and water retention
AE: HYPERKALEMIA
WOF: HYPOTENSION
CI: 1.( teratogenicity) Pregnant women
2. Bilateral renal artery stenosis
Interacts: K sparing diuretics
Anti hypertensive drugs
nursing responsibilities
 most common SE: orthostatic hypotension
 take meds on regular basis
 assume sitting or lying position for a few minutes
 change position gradually
 avoid very warm bath, prolonged sitting or
standing
 avoid tyramine rich food
Diuretics
Loop diuretics:
• The loop diuretics act promptly by blocking sodium and
chloride reabsorption in the kidneys, even in patients with
poor renal function or those who have not responded to
thiazide diuretics. Loop diuretics cause decreased renal
vascular resistance and increased renal blood flow.
Diuretics
• K+ Sparing:
 potassium-sparing diuretics (spironolactone, and
eplerenone) are competitive antagonists that
either compete with aldosterone, or directly
block epithelial sodium channel (amiloride).
Anti-angina drugs
Angina – a condition of acute cardiac pain caused by
inadequate blood flow to the myocardium due to either 1.
plaque occlusion 2. spasm of other coronary arteries
Characteristics of pain:
1. tightness, pressure in the center of the chest and
pain radiating in the left arm
2. Pain last for a minutes
VASODILATORS
DIRECT ACTING ANTIHYPERTENSIVE DRUGS
 NITRATES
- Reduce venous tone , w/c decrease the workload
of the heart and promotes vasodilation
- Relax vascular smooth muscle
- Causes general vasodilation
INDICATION: acute or chronic angina attacks
nitrates cause the smooth muscle of the veins, and to
lesser extent the arteries to relax and dilate.
• When the veins dilate – less blood return to the
heart
reduce the amount of blood in ventricles at the end
of diastole, when the ventricles are full
by reducing the preload, nitrates reduce the
ventricular size and ventricular wall tension (the left
ventricle doesn’t have to stretch as much to pump
blood) which reduce the oxygen requirement of the heart
FORMS OF NITRATES:
1. Sublingual – Isosorbide Dinitrate (SL,Chewable)
Pharmacokinetics: taken SL, absorbed rapidly
and directly into JV and Rt. Atrium
- can repeat dose if pain is not relieved w/in 5 minutes
but do not give more than 3 tabs
2. Topical – ointment and ( transdermal patch – longer
acting nitrates )
• should not removed w/ bare hands
• Do not defib when there is Nitroglycerin patch
3. Translingual, oral extended – Isosorbide mononitrate
- release capsule and sustained
release tablet or capsule
SE: 1. Headache , dizziness, hypotension, weakness
Reflex tachycardia- may occur if nitrates are given too
rapidly
Drug Interactions: 1. Betablockers, calcium channel
blockers
3. Alcohol can enhance the hypotensive effect of the
nitrates
NURSING CONSIDERATIONS:
1. Monitor for adverse effect – headache, dizziness,
tachycardia, orthostatic hypotension , flushing ,
palpitations
2. Monitor vital signs
3. Treat headache with acetaminophen or ASA
DRUG INTERACTIONS:
1. Severe hypotension can result when nitrates
interact with alcohol
2. Sildenafil shouldn’t be taken w/in 24 hrs of
nitrates because of possible hypotensive effect
3. Absorption of sublingual nitrates may be delayed
when taken with anticholinergic drugs (atropine,
scopolamine)
4. CCB + nitrates may caused light headedness,
orthostatic hypotension, fainting or blurred vision
Most common Adverse Reaction: HEADACHE
BETA –ADRENERGIC ANTAGONIST/BETA BLOCKERS
 ATENOLOL
 CARVEDILOL
 METOPROLOL TARTRATE
 NADOLOL
 PROPRANOLOL HYDROCHLORIDE
 3. Heart will respond to other impulses generated by
the cardiac cell (other than SA node)
4. Heart will respond to impulses travelling the extra
pathways
MOA:
1. Blocks the adrenergic stimulation of the heart
2. Depress the myocardial excitability and
contractility
3. Decrease conduction velocity in cardiac tissue
CLASSIFICATION OF CCB 4. Increase recovery time (repolarization/ resting)
INDIRECT ACTING VASODILATORS/ CALCIUM CHANNEL
BLOCKERS (“DIPINE”)
1. Relax the coronary artery spasm in variant angina
Relax peripheral arterioles in stable angina which
decrease O2 demand
2. Decrease the cardiac contractility , afterload and
peripheral resistance thus decreasing the workload of the
heart
3. Reduce the force contraction of the heart

RATE : RR interval
RHYTHM: R to R interval
P WAVE : Atrial Depolarization/Atrial activity / Atrial
contraction
QRS COMPLEX: Ventricular depolarization/Ventricular
activity/Ventricular contraction
------Atrial repolarization/resting
T WAVE: Ventricular repolarization/resting
ST SEGMENT : should be flat
-------- Indicative of ischemia, infarction, strain
Types

Antidysrhythmic drugs
Cardiac Dysrhythmias / Arrhythmia – abnormal beats
4 things happens:
1. Heart beats faster
2. Heart beats slow

FOR HEART BLOCKS
ATROPINE
• A prototype antimuscarinic drugs
• Atropine is a naturally occurring “belladonna
alkaloid” that can be extracted from plants such as
deadly nightshade (Atropa belladonna), Jimson
weed & mandrake. It is a competitive antagonist
of all five known muscarinic receptors (m1-m5),
and when administered systemically, it
antagonizes the “rest and digest” effects produced
by the parasympathetic nervous system. It has
numerous medical uses, including temporary
relief from bradycardia or AV-block, as an antidote
for cholinesterase poisoning or poisoning by
mushrooms containing muscarine.
• Decrease cardiovascular response to vagal
stimulation resulting in tachycardia
HEART FAILURE
condition in which the heart can't pump enough blood to
meet the body's needs. Heart failure does not mean that
your heart has stopped or is about to stop working. It
means that your heart is not able to pump blood the way it
should. It can affect one or both sides of the heart.
S/SX: Fatigue, irregular heart beat, reduce ability to
exercise, rapid weight gain, chest pain
Cardiac Glycosides
DIGITALIS - began being used as early as 1200 AD, making
it as one of the oldest drug
Effects: 1. + inotropic action increasing myocardial
contraction stroke volume
2. – chronotropic action decreasing the heart rate
3. – dromotropic action decreasing the conduction
of the heart cells
Therapeutic level of Digoxin: .5-2.0 nanogram/ml
SE: Digitalis toxicity
Nursing Consideration: Less than 60PR don’t give
ANTIDOTE: Digibind / Digoxin immune fab
ANTICOAGULANTS
 Drugs that help prevent the clotting (coagulation)
of blood
 Coagulation will occur instantaneously once a
blood vessel has been severed
 Blood begins to solidify to prevent excessive
blood loss and to prevent invasive substances
from entering the bloodstream.
DRUGS AFFECTING THE RESPIRATORY SYSTEM
2. Nasal systemic decongestants
DRUGS FOR UPPER RESPIRATORY INFECTION
COMMON COLD – the most prevalent type of URI
- adult have an average of 2 to 4 colds per year
- children have an average of 4 to colds12 per year
- not considered as a life threatening illness but it
does cause physical and mental discomfort
- caused by rhinovirus and affects the nasopharyngeal
tract. Although many types of viruses can cause a common
cold, rhinoviruses are the most common culprit.
Drugs for cough
A cold virus enters your body through your mouth, eyes or
nose. The virus can spread through droplets in the air
when someone who is sick coughs, sneezes or talks.
ACUTE RHINITIS – Inflammation of the mucous
membranes of the nose, usually accompanies the common
cold
ALLERGIC RHINITIS - often called hay fever, caused by
pollen or foreign substance such as animal dender
DRUGS FOR COMMON COLDS:
1. ANTIHISTAMINE – are H1 blockers or H1 Drugs for lower respiratory infection
antagonist
action: it competes w/ histamine for receptor sites and
prevent a histamine response
compound w/c is released by cells in response to injury
and in allergic and inflammatory reaction

Steroids

Nursing considerations
Breathing and coughing techniques
Relaxation techniques
Evaluate heart rate and BP
Appropriate positioning
Tremors
Have 8 or more glass of fluid
Emphasize NO SMOKING
DRUGS OF THE GI TRACT
ANTI-EMETIC DRUGS
Vomiting/Emesis – expulsion of gastric contents or
removal of non toxic or harmless substance from the
body after ingestion
2 CAUSES:
1. Due to GI illness - either by obstruction or
gastroenteritis
2. Secondary cause - either 1. severe visceral pain
2. severe systemic illness
3. specific condition such as
pregnancy , increase ICP, toxins, chemotherapy
sessions or effect of selected medicines, disturbance
of the middle ear that affects the equilibrium
 Non pharmacological measures should be
used first when vomiting occurs :
Tea, Gelatin, Gatorade, Pedialyte
Crackers and dry toast maybe helpful
Non- prescription anti emetics
• Usually used to prevent motion sickness but have
minimal effect on controlling severe vomiting
resulting from antineoplastic agents , radiation
and toxins
• When use for motion sickness – should be taken
30mins before travel
I: SELECTIVE ANTIHISTAMINE ANTI-EMETICS/H1
RECEPTOR ANTAGONIST
DRUGS: Cyclizine Hcl Meclizine Hcl
Promethazine
Diphenhydramine Hcl
Dimenhydrinate
Use: it inhibits vestibular stimulation in the middle ear
SE: similar to those of anti-cholinergics (drowsiness,
Dryness of the mouth , constipation)
Nsg Responsibilities: 1. Not to use with Alcohol
2. Not to operate machine or drive
Prescription anti-emetics
1. Anti- histamine – scopolamine (L-hyoscine)
2. Anti cholinergic -anticholinergic antiemetic's are
agents that block muscarinic receptors and inhibit
cholinergic transmission from the vestibular nuclei
to the vomiting center. Anticholinergic
antiemetic's are mainly used to prevent or treat
motion sickness.
Ex: Meclizine , Diphenhydramine
3. Dopamine Antagonist – Metoclopramide,
Domperidone, Haloperidol
4. Benzodiazepines – combination effect of
sedation , reduction of anxiety or possibly
depression of vomiting center EX: Lorazepam
5. Serotonin Antagonist- found to be highly effective
for treatment of N/V w/ fewer side effects
6. Glucocorticoids – suggested as the first line drug
for low level emetogenic chemo and radiation
therapy Ex: Dexamethasone
7. Cannabinoids
Dopamine antagonist / d2 receptor antagonist
- Suppress emesis by blocking Dopamine receptor
in CTZ
DRUGS:
1. PHENOTHIAZINE – use for vomiting resulting rom
surgery, anesthetics, chemotherapy and radiation
sickness EX: Chlorpromazine , Prochlorperazine
edisylate
 - commonly given at night before Drugs for diarrhea
treatment, the day of the treatment and
Diarrhea – frequent liquid stools w/c is a symptoms of
for 24 hrs after treatment intestinal disorder, loose, watery, bowel movements
1. BUTYROPHENONES – blocks the D2 receptors in CAUSES:
the CTZ
1. Food
- use to treat post operative N/V
and emesis associated w/ toxins 2. Fecal impaction

EX: Haloperidol , Droperidol 3. Bacteria

2. BENZODIAZEPINE – indirectly control N/V that 4. Toxins

may occur w/ cancer chemotherapy 5. Drug reaction
Serotonin-receptor antagonist
6. Laxative abuse
• Suppress the N/V by blocking the serotonin (5-
HT3) receptors in the CTZ and blocking the vagal 7. Stress and anxiety
nerve terminal in GI tract
CLASSIFICATION:
Drugs: ONDANSETRON
1. ACUTE – sudden onset , last than 2 days
METOCHLOPRAMIDE (clomitene, gastrosil, metvex)
2. CHRONIC – 2 weeks or longer
GRANISETRON
DRUGS CAUSING DIARRHEA:
SE: Headache , diarrhea, dizziness, fatigue
1. Magnesium antacids
Cannabinoids
2. Antibiotics
SE: 1. mood changes
3. Quinidine
2. Euphoria
4. GI prokinetic drugs
3. Drowsiness
PRINCIPLES OF TREATMENT:
4. Nightmares
1. Rehydration - ORS , Probiotics
5. Depersonalization
- IV therapy (LR)
NURSING RESPONSIBILITIES
2. Nutrition
 Monitor I and O
3. Drug therapy
 For patients taking cannabinoids WOF: drugs that
Opiates and opiate related agents
increase its toxic effect
 Collect data regarding emesis (amount, type and
frequency)
 Monitor vitals
 Monitor the electrolytes
 Know the causes of vomiting

Adsorbents anti-diarrhea
 Decrease absorption of many agents including
Digoxin, clindamycin, Quinidine and OHA
 Acts by coating the wall of GI tract and adsorbing
bacteria or toxins that causes diarrhea
  Take blood pressure, contraindicated to
patient with hypotension

Tamsulosin Hcl (Tamsolin)

1.terazosin (Hytrin) - long acting A1
2.doxazosin (Cardura)- long acting A1
3.tamsulosin (Flomax)
DRUGS OF GENITO URINARY TRACT
4.alfuzosin (Uroxatral)- long acting A1
Benign prostatic hyperplasia
5.silodosin (Rapaflo)- subtype selective
A type of drug that has anti androgenic effects used
primarily in the treatment of enlarged prostate. (benign
prostatic hyperplasia) and male pattern hair loss.
1. Finasteride (Proscar)
Indication: used primarily to patient with benign prostatic
hyperplasia in men with enlarged prostate.
Action: blocks the action of an enzyme called 5a-reductase
- changes testosterone to another hormone that cause the
prostate to grow or hair loss in male.
BPH Complications
It decrease prostate size and the effect only last as long as
Bladder Stones the medicine is taken.

Urinary Tract Infections Administration: can be given with or without food

Hematuria
Acute Urinary Retention
Bladder Decompensation: normal mucosa→ trabeculation
→ cellules & sacules→ diverticulae→ detrusor muscle
failure.
Urinary Incontinence: overflow incontinence or urge
incontinence
Upper Urinary Tract Deterioration and Azotemia
Drug for prostate
• Tamsulosin Hcl (Tamsolin) – SUB TYPE SELECTIVE
Indication: Treatment of benign prostatic hyperplasia to
relieve symptoms of urinary obstruction
Action: relaxes the bladder muscles, These medications
relax the muscle of the prostate and bladder neck, which
allows urine to flow more easily.
Side effects: impotence, abnormal ejaculation, dizziness,
swelling in hands or feet, weakness, headache, skin rash.
Anti muscarinic drugs
1.Trospium chloride - treat an overactive bladder.
By relaxing the muscles in the bladder, Trospium improves
your ability to control your urination. It helps to reduce
leaking of urine, feelings of needing to urinate right away,
and frequent trips to the bathroom.
Administration: 1. Take tablet 1 hour before meals or on
an empty stomach at least 1 hour before
meal
2.Alcohol should not be consumed within 2
hours of administration.
Diuretics

Nursing Considerations: • Thiazide diuretics: Thiazide

 Take 30 minutes following meals, do not diuretics, such hydrochlorothiazide and chlorthalidone,
open, chew, or crush lower blood as pressure initially by increasing sodium and
 Contraindication to patient with history of water excretion. Thiazide diuretics can induce
orthostatic hypotension
hypokalemia, hyperuricemia and, to a lesser extent,
hyperglycemia in some patients.
Thiazide diuretics: Hydrochlorothiazide (HydroDIURIL,
Microzide)
Actions
• Interferes with sodium transport across tubules of the
cortical diluting segment of the
nephron
• Increases renal excretion of sodium, chloride, water,
potassium, and calcium
• Increases bicarbonate, magnesium, phosphate, bromide,
and iodide excretion
• Decreases excretion of ammonia, causing increased
serum ammonia levels
Indications
• Edema
• Hypertension
Nursing considerations
• Monitor for adverse effects, such as pancreatitis,
hematologic disorders, and electrolyte
imbalances, especially hypokalemia (symptoms of
hypokalemia include leg cramps and
muscle aches).
• Frequently monitor weight and blood pressure.
• Assess for signs of orthostatic blood pressure changes,
which could lead to falls and
injuries.
Loop diuretics
• Act on thick ascending loop of Henle
• Inhibit chloride transport of sodium into the
circulation (passive reabsorption of sodium)
• Sodium and water are lost together with
potassium, calcium, and magnesium
• Affects glucose and can cause hyperuricemia
1. Saluretic (sodium-chloride losing)
2. Natriuretic (sodium losing)
 Furosemide
 Bumetanide
 Ethacrynic acid
Loop diuretics: Furosemide
Actions
• Inhibits sodium and chloride reabsorption in the
ascending loop of Henle, thus
increasing renal excretion of sodium, chloride, and water
• Increases excretion of potassium (like thiazide diuretics)
• Produces greater maximum diuresis and electrolyte loss
than a thiazide diuretic
Indications
• Acute pulmonary edema
• Edema
• Hypertension
Nursing considerations
• Monitor for adverse effects, such as pancreatitis,
hematologic disorders, and electrolyte
imbalances (especially hypokalemia).
• Monitor weight and blood pressure frequently.
• Signs of hypokalemia may include leg cramps and muscle
aches.
Loop diuretics warning
Loop diuretics, with the exception of ethacrynic acid,
contain sulfa. A patient who has an allergy to sulfa may
experience an allergic reaction to loop diuretics. Use with
caution and alert the patient to this possibility.
Pharmacotherapeutics
Loop diuretics are used to treat edema associated with
renal disease, hepatic cirrhosis and heart failure as well as
to treat hypertension (usually with a potassium-sparing
diuretic or potassium supplement to prevent hypokalemia
Osmotic diuretic
• Increases osmolality (concentration) and sodium
reabsorption in the proximal tubule and loop of
Henle
• Excretes sodium, chloride, potassium, and water
Uses:
§Prevents kidney failure
§Decrease intracranial pressure
§Decrease intraocular pressure
MANNITOL
Potent potassium-wasting diuretic
Carbonic anhydrase inhibitor - Harold Merskey (1964) IASP 1979 -
• Blocks the action of carbonic anhydrase needed to Algesia (from Greek work algesis) sensitivity to the pain.
maintain the body’s acid-base balance (hydrogen
and bicarbonate ion balance)
• Causes increased sodium, potassium, and
bicarbonate secretion (metabolic acidosis)
§Used primarily to decrease IOP in open-angle glaucoma
Acetazolamide
Potassium sparing diuretic
• Weaker than thiazide and loop diuretics
• Does not excrete potassium
PAIN- unpleasant sensory and emotional experience
• Hyperkalemia may occur if potassium supplement related to tissue injury.
is given simultaneously
PAIN TOLERANCE – amount pain a person can endure
• Avoid K-rich food without having it interfere with normal
§Monitor K-level (3.5-5.5 meq) functioning.
Spirinolactone (Aldactone) FACTORS:
Triamterene 1. Age
Amiloride 2. Gender
Eplerenone 3. Culture/ethnicity
ANALGESICS and ANTI-INFLAMMATORY 4. Previous experience
DRUGS 5. Anxiety level
Pain
• Pain is a common condition and has a significant
influence on the quality of life. Pain is the main reason
nowadays for which patients address healthcare services.
The concept of pain relief as a human right has gained
more and more ground at a global level to help overcome
the barriers against an efficient pain management.
• Confronted with this trend, health professionals must
have the knowledge regarding analgesics to assure an
efficient and not least safe pain treatment.
• Analgesic : A drug that selectively relieves pain by acting Non-opioid analgesics, antipyretics & nsaid
in CNS or on peripheral pain mechanism, without
significantly altering consciousness. SALYCILATES – the most commonly used pain medications.
They’re used to control pain and reduce
• Anesthesia: Anesthesia means loss of sensation.
Anesthetic agent is one which bring about loss of all fever and inflammation.
modalities of sensation, particularly pain, along with a - Cheap, easy and reliable
reversible loss of consciousness.
 ASA, Acetaminophen, Ibuprofen, Naproxen
. Pain: The International Association for the Study of Pain
(IASP) defined pain as "an unpleasant sensory and  Usually purchased OTC except for the
emotional experience associated with actual or potential cyclooxygenase 2 (COX-2) inhibitors (EX:
tissue damage or described in terms of such damage". CELOCOXIB)
 - It relieved pain by inhibiting the synthesis
prostaglandin.
- It reduce fever by stimulating the hypothalamus
and producing peripheral blood vessel dilatation
and increased in sweating. This promotes heat
loss through the skin and cooling by evaporation.
ASA inhibits platelet aggregation by interfering with the
production of thromboxane A2,
A substance that is necessary for platelet aggregation.
That’s why it is used to enhance
Blood flow during myocardial infarction or to prevent such
occurrence or recurrence
Of MI or Ischemic heart disease or stroke
• Salicylates reduce fever by stimulating the
hypothalamus and producing peripheral
blood vessel dilation and increased sweating. This
promotes heat loss through the skin and cooling by
evaporation. Also, because prostaglandin E increases body
temperature, inhibiting its production lowers fever
Adverse reactions
The most common adverse reactions to salicylates include
gastric distress, nausea,
vomiting, and bleeding tendencies. (Choline magnesium is
a salicylate that doesn’t
increase bleeding time.) Other adverse reactions include:
• hearing loss (when taken for prolonged periods)
• diarrhea
• thirst
• tinnitus
• confusion
• dizziness
• impaired vision
• hyperventilation (rapid breathing)
• Reye’s syndrome (when given to children with
schickenpox or flulike symptoms)
During long-term therapy, monitor serum salicylate levels.
A therapeutic level in a
patient with arthritis is 10 to 30 mg/ml.
ACETAMINOPHEN – a para aminophenol derivatives first
marked in the mid 1950 as an analgesic and anti-pyretic
drugs used for
1. muscular aches and pains
2. To reduce fever caused by viral infections in
infants, children and even adults
 non opioid drug but not an NSAID’s
 Safe , effective drug , cause little to no gastric
distress and doesn’t interfere w/ platelet
aggregation
 It reduces fever by acting directly to the heat
regulating center in hypothalamus
Drug interaction:
1. Risk of liver toxicity when used together with
phenytoin, barbiturates, rifampin and INH
2. The effect of loop diuretics and zidovudine may be
reduced when taken with acetaminophen
Other AR:
1. Skin rash
2. Hypoglycemia (when overdose)
3. neutropenia
4. Acetaminophen can produce these drug
interactions:
5. • It may slightly increase the effects of oral
anticoagulants, such as warfarin, and
6. thrombolytic drugs.
7. • The risk of liver toxicity is increased when
phenytoin, barbiturates, carbamazepine,
8. rifampin, and isoniazid are combined with
acetaminophen. This risk is also increased with
chronic alcohol use.
9. • The effects of loop diuretics and zidovudine may
be reduced when taken with acetaminophen.
skin rash or other serious skin reactions
• hypoglycemia (with overdose)
• neutropenia.
Non selective nsaid
- Inhibits prostaglandin synthesis by blocking two
enzymes known as cyclooxygenase-1 (COX-1) and
cyclooxygenase-2 (COX-2).
Ex: Indomethacin, ibuprofen, diclofenac, ketorolac,
mefenamic acid, naproxen, meloxicam
1. Take the drug with meals or milk to reduce
adverse GI disturbances
2. Don’t give the medicine to children younger than
12 years old
3. Using the drug with ASA, alcohol, corticosteroids
may increase the risk of adverse GI disturbances
4. Record and repot any signs of bleeding such as
dark colored urine, unusual gum bleeding
• dysmenorrhea (painful menstruation)
• migraines
• tendinitis
• mild to moderate pain.
The following conditions respond favorably to treatment
with NSAIDs:
• Ankylosing spondylitis (an inflammatory joint disease
that first affects the spine)
• Moderate to severe rheumatoid arthritis (an
inflammatory disease of peripheral joints)
• Osteoarthritis (a degenerative joint disease) in the hip,
shoulder, or other large joints
• osteoarthritis accompanied by inflammation

5. Keep in mind that it may take 1 to 2 weeks to • acute gouty arthritis (urate deposits in the joints)
achieve full anti-inflammatory effects • dysmenorrhea (painful menstruation)
Nonselective NSAIDs warning • migraines
Before administering an NSAID to a patient, be aware of its • tendinitis
risks to special populations:
• mild to moderate pain.
• Children: Some NSAIDs aren’t recommended for use in
children.
• Elderly people: The risk of ulcers increases with age.
• Pregnant women: Ketoprofen, naproxen, flurbiprofen,
and diclofenac are category B drugs. Etodolac, ketorolac,
meloxicam, nabumetone, and oxaprozin are category C
drugs.
• Nursing mothers: Most NSAIDs are excreted in breast
milk. In general, nonselective
• NSAIDs shouldn’t be administered to nursing
mothers
All in favor?
The following conditions respond favorably to treatment
with NSAIDs:
• Ankylosing spondylitis (an inflammatory joint disease
that first affects the spine)
• Moderate to severe rheumatoid arthritis (an
inflammatory disease of peripheral joints)
• Osteoarthritis (a degenerative joint disease) in the hip,
shoulder, or other large joints
• osteoarthritis accompanied by inflammation
• acute gouty arthritis (urate deposits in the joints)
Selective nsaid
CELECOXIB/CELEBREX – are highly protein bound, primarily
to albumin and is extensively distributed in the tissue
- Prostaglandin produce by COX 2 are associated
with pain and inflammation. The selective NSAIDs
also called COX 2 inhibitors, this are NSAIDs that
selectively blocks COX2, relieving pain and
inflammation.
- They produce fewer side effect such as stomach
damage
Morphine sulfate
- Used to treat osteoarthritis, rheumatoid arthritis,
acute pain, primary dysmenorrhea • Is the standard against which the effectiveness
and the adverse reaction of other pain medication
Drug Interactions: metabolized by the liver is measured.
1. Celecoxib decreases the clearance of lithium, ACTION: acts on opiate receptors in the CNS
which can result in lithium toxicity
INDICATION: for pain
2. Reduces the effect of ACE inhibitors and diuretics
NSG CONSIDERATIONS: 1. monitor the patient for adverse
3. Celecoxib + Warfarin = increase PT levels (so effects such as sedation, euphoria, seizures, dizziness,
bleeding may occur) nightmares, bradycardia, shock, nausea, constipation,
vomiting, cardiac arrest
4. Celecoxib interacts with herbal preparations,
garlic, ginger. Gingko, horse chestnut (bleeding ANTIDOTE: NALOXONE
will occur)
PHARMACODYNAMICS: reduce pain by binding to opiate
Opioid agonists & antagonist receptor site in the PNS & CNS.
Also called narcotic agonists include opium derivatives and They mimic the effect of endorphins
synthetic drugs with similar properties
- Used to relieve and decrease pain without causing
the person to lose consciousness
- Some opioid agonists also have antitussive and
anti diarrheal effects
OPIOID OPPONENT
Opioid antagonists aren’t pain medications. They block the
effects of opioid agonist and used to reverse adverse drug
reaction such as respiratory and CNS depression, produced
by those drugs.
• Besides reducing pain, opioid agonists, especially
OPIOID AGONIST
morphine, affect the smooth muscle of the GIand
1. Codeine genitourinary tracts (the organs of the
reproductive and urinary systems).
2. Fentanyl citrate
• These drugs also cause blood vessels to dilate,
3. Hydrocodone especially in the face, head, and neck. In addition,
they suppress the cough center in the brain,
4. Meperidine hydrochloride
producing antitussive effects and causing
5. Methadone hydrochloride constriction of the bronchial muscles.

6. Morphine sulfate • Morphine relieves shortness of breath in the

patient with pulmonary edema (fluid in the lungs)
7. tramadol or left-sided heart failure (inability of the heart to
 pump enough blood to meet the body’s needs). It • Methyl naltrexone is used to treat opioid-induced
does this by dilating peripheral blood vessels, constipation not responsive to laxatives in
keeping more blood in the periphery, and patients who are taking opioids continuously for
decreasing cardiac preload. pain.
Mixed opioid agonist-antagonists Anesthesia
• Buprenorphine hydrochloride Inhale or inject?
• Butorphanol tartrate Commonly used general anesthetics given by inhalation
include:
• Nalbuphine hydrochloride
• Desflurane
• Pentazocine hydrochloride (combined with pentazocine
lactate, naloxone, Hydrochloride, aspirin, or • Sevoflurane
acetaminophen).
• Enflurane
Mixed opioid agonist-antagonists are sometimes
prescribed in place of opioid agonists because they have a • Isoflurane
lower risk of drug dependence. Mixed opioid agonist- • Nitrous oxide.
antagonists also are less likely to cause respiratory
depression and constipation, although they can produce Pharmacodynamics
some adverse reactions.
Inhalation anesthetics work primarily by depressing the
Opioid Antagonists CNS, producing loss of consciousness, loss of
responsiveness to sensory stimulation (including pain), and
Opioid antagonists attach to opiate receptors, but don’t muscle relaxation. They also affect other organ systems.
stimulate them, and have a greater attraction for opiate
receptors than opioids do. As a result, they prevent opioid Pharmacodynamics
drugs, enkephalins, and endorphins from producing their
Inhalation anesthetics work primarily by depressing the
effects.
CNS, producing loss of consciousness, loss of
Opioid antagonists include: responsiveness to sensory stimulation (including pain), and
muscle relaxation. They also affect other organ systems.
• naloxone hydrochloride
• naltrexone hydrochloride
• methyl naltrexone
Pharmacokinetics
• Naloxone is administered IM, sq, or IV.
• Naltrexone is administered orally in
tablet or liquid form. Both drugs are metabolized by the
liver and excreted by the kidneys.
Pharmacotherapeutics
• Naloxone is the drug of choice for managing an
opioid overdose. It reverses respiratory
depression and sedation and helps stabilize the
patient’s vital signs within seconds after
administration.
• Because naloxone also reverses the analgesic
effects of opioid drugs, a patient who
was given an opioid drug for pain relief may complain of
pain or even experience withdrawal symptoms.