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PHARMACOLOGY Greek term pharmakon – drug or medicine Logos – the truth about or rational discussion Clinical pharmacology is the

study of drugs in humans. A drug is any chemical that can effect living processes. Pharmacology –Study of the biological effects of chemicals Pharmacotherapeutics – Clinical pharmacology involving drugs use to treat, prevent, or diagnose a disease NURSING PROCESS AND MEDICATION ADMINISTRATION 1. ASSESSMENT Allergies Pattern of health care Understanding of the disease process Financial support 2. Physical Assesment Age and weight Social support at home Chronic condition 3. Diagnostic test, laboratory test 4. Medication History Prescriptions OTCS Herbals Response to medications Nursing Diagnosis Human response to illness Drug therapy may only be a part of the total picture Drug therapy is incorporated in the total picture PLANNING 1. identify possible intractions 2. client and family education 3. gather equipment, review procedures, safety measures, timing and frequency of drugs 4. storage of drugs IMPLEMENTATION 1. Maximising therapeutic effects 2. Minimizing adverse effects 3. SIX rights of medication administration EVALUATION Monitor the patient response to drug therapy expected outcome Unexpected outcome The 5 RIGHTS of Medication Administration Right drug Right dose Right time Right route Right patient WHAT OTHER RIGHTS TO ENSURE SAFETY IN GIVING DRUGS? Right to: Consistent system Analysis A “ double check The entire system of medication administration Ordering, preparing, dispensing, documenting

RIGHT TO: • Proper drug storage • Proper documentation • Actual dosage preparation • Accurate dosage calculation and preparation • Careful checking of orders • Patient’s safety SIX ELEMENTS OF A DRUG ORDER 1. Name of the patient 2. Date order is written 3. Name of medication 4. Dosage which includes size, frequency and number of doses 5. Route of delivery 6. Name and signature of the prescriber DRUG NAMES 1. Chemical Name Describe the chemical structure and composition 2. Generic Name Non propriety name given by USANC 3.Brand Name Registered trademark EXAMPLES Chemical Name Propionic acid Generic Name Ibuprofen Brand Name Motrin Pharmacologic Principles DRUG Any chemical that affects the physiologic mechanism of a living organism PHARMACOLOGY The study or science of drugs Pharmacologic Principles 1.PHARMACEUTICS Study of Drug forms Deals with the delivery system The rate at which drug is dissolved and absorbed a.1. Pharmaceutical phase Dose of formulated drug ↓ Administration ↓ Disintegration and dissolution of the drug in the body a.2. Pharmacokinetic phase drug available for absorption ↓ Absorption, distribution, metabolism, excretion a.3. Pharmacodynamic Phase Drug available for action ↓ Drug receptor interaction ↓ Effect 2. Pharmacokinetics The study of what actually happens to a drug from the time it enters the body until it has left the body A. Absorption - movement of drug from the site of administration

B. Distribution transport of a drug to the bloodstream C. Metabolism alteration of a drug in the body D. Elimination elimination of the drug or its compound in the body PHARMACOKINETICS 1. Absorption the route of administration affects the rate and extent of absorption of that drug A. Enteral B. Parenteral C. Topical The extent of drug is called Bioavailability A. Absorption of oral drugs Varies according to the dosage form and route Status of the absorptive surface portions of the small intesines may be missing or damaged Rate of blood flow to the intestines sepsis ,excersise labor Activity of the stomach food increases gastric acid production leading to decreased Ph . Status of gastric motility fast or slow transmit time due to pathology, conditions which might delay transmission Some drugs are taken with an empty stomach with a full glass of water Other drugs should be taken with a full stomach to avoid gastric irritation or to enhance absorption Drugs that are given by the oral route → Mesenteric blood system → Liver for biotransformation before travelling into general circulation and this is called ↓ FIRST PASS EFFECT FACTORS AFFECTING DRUG ACTION 1. ABSORPTION - refers to the time the drug enters the body to the bloodstream. Factors: A. Dosage Form B. Route of administration a) Parenteral – generally rapid b) Intravenous and Intra-arterial – most rapid c) Intramuscular and Subcutaneous - Absorption is fast when given in aqueous base -Depends on condition of blood flow -Impaired peripheral circulation and shock will delay absorption

c. Diarrhea can cause drugs not to be absorbed d. Constipation may delay absorption 2. DISTRIBUTION Drugs are distributed first to areas that have extensive blood supplies heart kidney liver brain Areas of slower distributions are: muscles, skin, fats Sites like Bone and Brain might be very difficult for drugs to reach due to barriers or poor blood supply FACTORS THAT AFFECT DISTRIBUTION 1. Protein Binding albumin is the main protein to bind with drugs drugs that are bound to protein are not available for use and called PROTEIN BOUND Drugs not bound to protein are available to act at the intended site of action and excert their effects and this is called: FREE DRUG IF THE PATIENT HAS LOW ALBUMIN More drugs is available and the patient may have increased adverse effects 2. Water soluble VS Fat soluble Water soluble: tend to stay in the blood stream and have a slow absorption in the tissues Fat Soluble: distributed to the tissues more quickly 3. Blood Brain Barrier difficult for drugs to pass thru and will allow some fat soluble drugs to pass thru 4. Placental Barrier Metabolism Also known as BIOTRANSFORMATION It takes place mainly in the liver and produces: A. Inactive metabolite B. More soluble compound C. A more potent metabolite ORGANS RESPONSIBLE FOR METABOLISM LIVER KIDNEYS SKELETAL MUSCLES LUNGS PLASMA INTESTINAL MUCOSA FACTORS AFFECTING METABOLISM 1. Age elderly has decreased hepatic enzymes neonates has immature liver functions 2. Foods grapefruits and other foods 3. Diseases Cardiovascular or renal dysfunction . Illness – pathologic condition: shock = decrease peripheral vascular circulation = slow absorption patients who are vomiting nephrotic syndrome or malnutrition = decrease protein (for distribution) kidney failure = decrease dose 5. Psychological aspect Placebo – drug dosage form such as tablet or capsule; has no pharmacologic activity; has no active ingredient 6. Tolerance – person begins to require higher dose to produce the same effect

d) Intradermal – absorption is slow and
confined to area of injection only

e) Oral – rate and degree of absorption
-depends on G.I. motility, presence of foods, gastric pH and other drugs taken C. Lipid Solubility – affects absorption as it passes the G.I. mucosa D. G.I. Motility a. Stomach empties slowly with food and delay absorption b. Most oral drugs are best absorbed if given before meals or between meals

It will stay in the body for long Pharmacodynamics The mechanism of drug action in living tissue How the drug alter the system A. iron.many medications become entirely inactivated by the liver the first time they go through it. vitamins etc. METABOLISM Process of metabolism is a sequence of chemical events that change a drug as it enters the body. Peak The time the drug takes its full therapeutic response Time to change dressings or do painfull procedures 3.go directly into the liver via portal before entering systemic circulation . tolerance A decreasing response to repeated doses 5. thyroid drugs Palliative – high dose opioids for cancer Supportive – fluids and electrolytes Prophylactic – antibiotics during surgery Empiric – experience shows it works. Half life The time it takes for the original amount of the drug in the body to be removed Example: Short ½ life – need to be taken frequently Compliance maybe a problem Acyclovir 5x daily Long half life – may have adverse effects . Additive effect – smaller doses can be given with the same effect ie. Synergestic effect – 2 drugs have better effect than given alone • HCTZ plus enalapril . lipidemia Supplemental/replacement therapy – insulin. Duration The time the drug concentration is sufficient to elicit a therapeutic response How long it is going to last to anticipate the next dose 4. Therapeutic effect – positive change Drugs excert their actions in 3 ways: Receptor interactions Enzyme interactions NON SPECIFIC INTERACTIONS 1. trough – lowest blood level Blood is drawn at specific times before and after administration to know the amount of drug in the body Factors of Monitoring 1. 4. Insufficient amounts of hormones such as insulin can affect metabolism of drug in the liver. no evidence 1. Drug concentration Consider pathologic conditions 3. heart attack Maintainance therapy – HPN. EXCRETION Kidney is the main organ Liver Bowel MORE PHARMACOKINETIC PRINCIPLES 1. Enzyme interactions Alters the enzyme necessary for a certain body function Ace Inhibitors – alters the enzyme pathway 3. Dependence Physiologic and psychologic need for a drug 6. Interactions a. Therapeutic index • Ratio of safety • A low therapeutic index indicates a greater chance of adverse reaction 2. Trough The lowest blood level of a drug 5. Non specific interactions Alters the cell structure after some crucial process Antibiotics Pharmacotherapeutics The use of drugs and its clinical indications to prevent and treat a disease Acute therapy –stroke. Beta 2 drug agonist Antagonist Drugs that attach to the cell and block other drugs from attaching to the cell Benadryl is an antagonist 2. Age – infants and elderly has reduced ability to metabolized some drugs Nutrition – Liver enzymes involved in metabolism rely on adequate amounts of lipids. 3. Receptor interaction Key in a lock Agonist Drugs that fit well and elicit their own response Exa. Cumulative effect = drug accumulation =drug toxicity -rate of consumption > rate of metabolism and excretion DECREASED METABOLISM RESULTS IN: • Accumulation of drugs • Prolonged action of drugs • Possible toxic effects FACTORS THAT INCREASED METABOLISM • Drugs that stimulate the formation of new enzymes • Barbiturates • Rifampicin • Drugs may leave the system more quickly or diminished therapeutic effects. Tylenol and codeine b.7. Patient’s condition Stress and anxiety 4. Liver is the principal site Oral medications . Dependence – addiction or habituation withdrawal symptoms 8.Therapeutic drug monitoring Some drug have a very narrow range oftherapeutic and toxic effects Digoxin and gentamycin are closely monitored 2. Peak level – highest blood level 3. Onset The time the drug takes it therapeutic effect 2.

10. incompatibility – when given together one deteriorates • Furosemide and heparin • Hazy color of parenteral drugs can occur when incompatible with i. and clarity) 6. meds in powder. 4. Check expiry date and look for any changes that may indicate decomposition(color. 13. Verify all now or questionable orders with physician or nurse-in-charge. Record administration of drug immediately and accurately/ chart any omission. Use only medications in clearly labeled containers and check label 3x (from pharmacy/ cabinet. Adverse effects 2 broad categories 1. Tolerance – person begins to require higher dose to produce the same effect 7. 11. give only meds that you personally prepared. do not contaminate containers. Dispose all used items in sink or toilet. Inform client of medication. For errors in administration.c. know drug’s purpose. If client vomits. Psychological aspect • Placebo – drug dosage form such as tablet or capsule. etc. before and after preparation) 5. Be sure meds are identified for each client. shaped like a capsule and coated for ease of swallowing Capsule Solid form for oral use. then record it right. has no pharmacologic activity. initial it. Antagonistic – 2 drugs have lesser effect than with either drug alone • Antacids with tetracycline d. Ex: Antacids inhibit the dissolution of ketoconazole Aluminum containing antacids inhibit the absorption of tetracycline • Only unbound drug is pharmacologically ACTIVE • ADDITIVE EFFECT. Adverse reactions a.2 drugs with similar action are taken for a doubled effect ex: propoxyphene + aspirin=added analgesic effect • SYNERGISTIC EFFECT. Check for any allergies(skin tenting prior to administration) 9. Drug 1 + Drug 2 = decrease activity of drug 1 and drug 2. place caps upside down. Practice aseptic techniques: wash hands. flexible oval when r disk moistened by ocular fluid. side effects. and give rationale. liquid. Hypersensitivity reactions b. medication errors 2. Pharmacologic reactions 8. Confirm or ask client’s name and counter check with ID bracelet/tag 8. 2. report immediately. action.v tubings 7. Assist client as needed. Be knowledgeable about meds you administer 3. releases medication for up to 1 week . odor. Aspirin + codeine=increased analgesic effect • Examples of drug destroyed by the acidity of the stomach INSULIN and GENTAMYCIN Brownish discoloration of the teeth-Tetracycline GRAY BABY SYNDROME. or oil form encased by gelatin shell Elixir Clear fluid containing water and/or alcohol. Common Dosage Forms Form Caplet Description Solid form for oral use.the combined effect of 2 drugs is greater than the sum of the effect of each drug given alone ex. has no active ingredient 6. i. Do not leave meds at bedside. Observe the 7 rights of drug administration: Give the right dose of the right drug to the right client at the right time by the right route and approach.e. usually has sweetener Enteric Tablet coated with tablet materials that dissolve in intestine. Cumulative effect = drug accumulation =drug toxicity -rate of consumption > rate of metabolism and excretion Drug Interactions action of one drug is altered by the action of another drug Drug 1 + Drug 2 = increase activity of drug 1 and drug 2. For safety. 14. 12. Contraindications • Should not be given if contraindicated • Aspirin with gastric ulcer • Allergic to drug • Pregnant • Impaired liver or kidney function 5. designed for oral use. Stay with client until meds are taken. Dependence – addiction or habituation -withdrawal symptoms 8. technique and purpose. 7. where medication is absorbed Extract Concentrated form made by removing active portion of meds from its other components Glycerite Solution of medication combined with glycerin (at least 50%) external use Intraocula Small.bone marrow toxicity----Chloramphenicol Drug Administration Principles of drug administration 1. report to physician.

sugar. rectum) Via skin Use gloves. dysphagia). not rubbed Liniment: rubbed into skin gently but firmly Powder: dusted lightly to cover affected area thinly Transdermal patches: remove backing and place patch in area with little hair. inform physician. otherwise consider a liquid preparation For enteric-coated tablets: don’t crush or give with antacids. also contains binders(adhesive). for insertion into body cavity(rectum or vagina) Suspensio Fine drug particles n dispersed in liquid medium which settles on standing. use gloves to avoid drug absorption Nitroglycerin patch: take blood pressure before and after application Via nose Have client blow nose. disintegrators(for tablet dissolution). parenterally. for children. nose. ovoid. unconscious or unable to swallow. vagina. if client vomits after taking meds. or externally. and fillers(for convenient tablet size) Tincture Alcohol or water-alcohol medication solution Transder Meds in semipermeable mal patch membrane disk or patch absorbed thru skin slowly over long period Troche/ Flat & round form lozenge dissolved in mouth to release meds. shaped into globules.g.Liniment Lotion Preparation usually containing alcohol. and mucilage Routes of administration Via the mouth Oral Take with 50-100 ml of cold fluid unless contraindicated Contraindications: GI dysfxn(vomiting). gauze or sterile applicators Cleanse skin with soap & warm water to remove encrustation that blocks contact and absorption of new meds. contains flavoring. eye. can also be instilled into body Supposito Pellet-shaped solid with ry gelatin. lubricants. Major Routes of Administration ORAL ADMINISTRATION OF MEDICATIONS Advantages Convenient Inexpensive to administer Disadvantages: Absorption varies from person to person Oral meds may irritate GI tract Client must cooperate Absorption: two gates of absorption Gastrointestinal tract Capillary walls Most of an oral dose is absorbed in the small intestine Rate and degree of absorption depends on pH of stomach contents Food in stomach Gastric emptying time Coating on medication preparation Topical medications(skin. so shake before using Syrup Medication dissolved in concentrated sugar solution. or oblong shapes Solution Liquid that may be used orally. may contain flavoring for palatability Tablet Powder form pressed into hard disks or cylinders. NPO preor post-op Disadvantages: gastric irritation. or soapy emollient that is applied to the skin Medication in liquid suspension applied externally to protect skin Remember Sit client upright to enhance swallowing When preparing solid meds: only scored tablets may be broken Crush tables only when appropriate( e. inactivation by gastric acid. elderly. Do not give again. lie supine and breath thru mouth Pill Solid form containing 1 or more meds. . oil. Remember Lotion and creams: applied lightly. unpleasant taste or odor. ear. milk When preparing liquid meds: Shake suspensions & pour away from label to prevent dirtying it Read amount at meniscus & at eye level Wipe lip and neck of bottle before recapping it Evaluate client’s response to meds after 30 min. teeth discoloration.

. O.Client may wipe but not blow nose. Maintain for 2-3 min. have her void prior -Position: dorsal recumbent.Repeat if client closes eyes prematurely For eye ointment Squeeze thin stream along inner edge of lover conjunctiva from inner to outer canthus. Inhalant medications (Metered-dose Inhalers. quickly draw meds without needle touching rim Also.While client looks up. over bedpan if for irrigation -Use gloves.With client side-lying. Use gloves.Contraindications to decongestants (most common nasal med): Heart dse. then retract labia with nondominant hand. adults ≈ 4 in) and hold buttocks together as client may expel suppository.S. Hold dropper 1 cm above the ear & instill meds. do not expel air in ampule To expel bubbles. use thumb/ forefinger to pull down cheekbone and pull up lid exposing lower conjunctiva .D.With dominant hand.Assess eardrum perforation( contraindication to irrigation) or discharge (clean if present) . draw up air equal to amount of meds needed & inject air into vial.= right eye. Position: upright (sitting or standing) Shake inhaler then have client inhale & exhale deeply -3 point or lateral hand position: client holds inhaler.= both eyes Gently clean eyelid of crusts or discharge using gauze in saline. insert tapered end past internal anal sphincter (kids≈ 2 in. straighten ear canal by pulling ear up and backward(adult & older children). DM.Position head as follows for 5 min (to ensure absorption) Remember Posterior pharynx: head tilted or extended backward Ethmoid and sphenoid sinus: head hyper extended or tilted over edge of bed (Parkinson’s position) Frontal & maxillary sinus: hyper extended and side wards (Proetz’s) .Meds may produce unpleasant taste or coughing . tap syringe to move bubbles up & draw back plunger slightly then push to expel air VIAL PREPARATION (SOLUTION) Multi-dose vials: Wipe off rubber stopper with alcohol pledget Without contaminating plunger.U. provide privacy. Client remains in position for 1520minutes Via rectum . O.Warm meds in hands (to avoid vertigo). Hold ampule upside down. apply water-based lubricant on rounded end of suppository & insert 3-4 inches down along posterior wall of the vaginal canal . A. MDI) These clients depend on meds for adequate control of airway obstruction & must learn selfadministration. change dulled needle Vial Preparation (Powder for Reconstitution) .Ask client to lie on side& breathe slowly thru the mouth . and hypertension Via eye Recall: O. twist tube to break stream. Before injecting into client. Explain procedure .D. then lightly rub lid in circular motion Via ear . -Hold breath for 10 sec then exhale thru pursed lips. Keep tip below fluid level & allow pressure in vial to fill syringe. For suppositories: .=left eye. jelly or irrigating solutions (douche) Insert applicator 2-3 inches down and deposit meds.Apply lubricant. If aspirated. foams. .= left ear.U. A. may prefer self administration.For irrigation: place towel under client’s head and have client hold basin under ear. For eye drops . thumb at bottom of mouthpiece & index & middle finger at the top. down and backward (infants) .Store suppositories in the ref to avoid melting For creams. Don’t touch eye with container. keep tip of needle under fluid to avoid aspirating bubbles. client inhales deeply & presses canister.Provide privacy. being careful not to touch nose with applicator . This prevents negative pressure buildup & aids in drawing up meds. = right ear. Slowly irrigate with ≈50ml of fluid & allow all fluid to drain out Via vagina -Decrease client anxiety: explain procedure.Drop prescribed meds and ask client to blink or close eyes . Client closes eyes. PARENTERAL MEDICATIONS AMPULE PREPARATION Tap neck to move fluid down ampule then snap off neck towards self. Insert needle thru center (thinnest part) of rubber seal. Always wipe from inner to outer canthus.S.Recall: A.Place dropper or atomizer 1 cm above nares &squeeze quickly.= both ears . -Place inhaler in mouth or 1-2 in away with spacer (ensures drug is inhaled & not just deposited on tongue or throat) -Simultaneously.

in the event of hypersensitivity reaction. Place roller clamp 1-2 inches below drip chamber & move to “off” position. Press swab over site before removing needle. Mixing Medications 2 Vials: Inject air into vial A & withdraw needle (tip must not touch the solution) Inject air into vial B & withdraw meds. • Apply tourniquet & select a vein large enough for the catheter • Use the most distal site in the non-dominant arm. medication absorption cannot be delayed by tourniquet • DELTOID Position: lateral. medication absorption can be delayed by tourniquet Disadvantages: small muscle mass. Massage area except for Z-track or heparin injection Most common site for heparin injection is the abdomen INTRAMUSCULAR INJECTION SITES Absorbed across capillary wall Rate of absorption depends on How water soluble is the medication? How much blood flows to site of injection? Adverse effects: discomfort. sitting. Insert needle quickly. 5% dextrose in water hypotonic exerts less osmotic pressure than plasma examples: 2. limited to small volume doses. requires accurate technique • VASTUS LATERALIS Position: sitting. Always use gloves to prevent contact with client blood. Look for blood return then fully lower needle or catheter ( remove stylet if ONC before lowering) • Stabilize catheter. give meds & release tubing. 5% dextrose in lactated Ringer's solution INTRAVENOUS ADMINISTRATION Venipuncture • Prepare infusion set. prone.replace fluid. possible local tissue injury INTRAMUSCULAR INJECTION SITE • VENTROGLUTEAL Position: Supine lateral Advantages: Anatomic landmarks well defined. bevel up. lactated Ringer's solution. Remove needle & roll vial in palms. avoiding bruised or tender areas & rotating sites as much as possible for repeated injections. supine Advantages: good site for infants. connect to infusion set & secure with tape IV PUSH VIA HEPARIN LOCK Use SASH method S: flush with 2 ml saline A: administer meds S: flush with 2 ml saline H: flush with 10-100 units heparin IV PUSH VIA EXISTING LINE Occlude primary IV line by pinching tubing just above injection port closest to patient. bevel up.45% hypertonic exerts higher osmotic pressure than plasma (draws water out of the cells) examples: 5% dextrose in normal saline 0. close to nerves. free of major nerves Disadvantages: special attention required to avoid sciatic nerve or femoral structures if long needle is used INTRAVENOUS THERAPY use .9%. Do not shake. • Prime or fill drip chamber & tubing with solution • Remove any air bubbles by tapping tubing. in the event of hypersensitivity reaction. Re-insert if with blood Inject slowly. Use a filter needle when drawing up reconstituted meds Advantages: readily accessible. slightly distal to the site. let dry. Insert spike to fluid bag. medication absorption cannot be delayed by tourniquet • DORSOGLUTEAL Position: Prone Advantages: muscle mass suited for deep IM or Ztrack injections Disadvantages: Requires correct/accurate site and technique to avoid injury to major nerves and vascular structures. free of major nerves Disadvantages: in the event of hypersensitivity reaction. Clean site with alcohol swab. supine .5% dextrose in water. • Dilate vein: Open / close client’s fist or milk arm towards site • Cleanse site then anchor vein using the thumb and stretch skin opposite the direction of insertion • For both butterfly needle and over-the-needle catheter: Insert at 20-30 degree angle.9%. then release hold to decrease pain Aspirate for blood. Inject new needle into vial A & withdraw meds Vial to Ampule: Draw meds from vial first then from ampule Administering Injections Select Appropriate site.Prepare diluent & inject into vial. size acceptable for multiple injections. Change needle. half strength normal saline 0. muscle mass suited for deep IM or Z-track injections. electrolytes and other nutrients for clients who cannot eat or drink adequately types of IV therapy solutions osmotic pressure similar to that of plasma examples: normal saline 0.

45L= 450 ml Apothecary System System rarely used. Won’t is a word of bereavement. Will is a word of beauty Can is a word of power MEDICATION CALCULATIONS Metric System To convert within the metric system. Ought is a word of duty. SUBCUTANEOUS ADMINISTRATION Absorbed across capillary wall Rate of absorption depends on How water soluble is the medication? How much blood flows to site of injection? Adverse effects: discomfort. basic unit is grain Uses small Roman numerals (gr xvi= 16 grains). Label rate and time PIGGYBACK Add med solution bag to an existing line Connect IV tubing to medication bag. Fractions (1/3 gr) Weight 60 grains= 1 dram 8 grains= 1 ounce 12 grains= 1 pound Volume 60 minims= 1 fluidram 16 fluidram= 2 fluidounce= 1 pint 1 gallon= 4 quarts= 8 pints Household System Familiar to most people but not as accurate as metric system Househol d 1 drop 15 drops 1 tsp 1 tbsp 1 ounce 1 glass= 1 measurin g cup 2 measurin g cups 1 quart 1 gallon 2.IV INFUSION Inject meds thru port in IV bag with rubber stopper not thru air vent or port for IV tubing. Can’t is a word of defeat. use the following diluents: IM= use 2cc IV=/<500mg= use 5 cc IV> 500mg= use 10 cc Parenteral Injection .2 pounds 1 inch Metric 0. possible local tissue injury SUCCESS IS TAKEN ONE STEP AT A TIME I CAN Did is a word of achievement. simply divide or multiply multiples of 10 1000mg= 1 g. 0.06 ml 1ml 5 ml 15 ml 30 ml 240 ml 480 ml= 500 ml 960 ml= 1 L 3840 ml= 4 L 1 kg 2.54 cm 60 mg Apothecary 1 minim 15 minims 1 fluidram= 60 min 4 fluidram 1 fluidounce 8 fluid ounce 1 pint 1 quart 1 gallon 1 grain CALCULATIONS Drug Dosage Remember to convert the same unit before calculating Basic formula for unknown volume (ml) of drug needed(x): X(ml)= D/S X known quantity For drugs that need to be diluted. same height if tandem. I CAN Try is a word each hour. 1= 1000ml. Hang med bag higher than primary fluid bag if piggyback.

5 ml/ dose ID Ventral forearm.5. chest 0. remove needle and release Example: Salbutamol 0. 1.5 ml/ dose IV Fluid Flow Rate/ Regulation Basic formula: Macrodrip Gtts/min= amount of solution in ml/min x drop factor Drop factor ( 10. Based on Body Surface Area (BSA). 15.20 secs. decrease Insert at 90 irritation deg. wait 10. inject slowly. Insert at 45 deg for ext & thin client.5 ml/ dose Answer: 7.5 ml/ dose Answer: 7. Preparation is 250 mg/ 5 ml. Based on Age: Fried’s Rule (birth to 12 months): Infant’s dose= age in months/150 x adult dose Young’s rule (1. anterior & medial thigh Kids: 0.12 years): Child’s dose= age in years/age in yrs + 12 x adult dose Clark’s Rule: Child’s dose= wt of child in lbs/150 lb x adult dose BSA (m2)= square root of weight (kg) x height (cm) 3600 Child’s dose= child’s BSA x adult dose adult BSA (average is 1. drop factor 15 gtts/ml Solution: 1 L/ 8 hrs x 1000 ml/ 1L x 1 hour/60 mins x 15 gtts/ ml= 31 gtts/ min Answer: 31 gtts/ min Short Cut Formula: Microdrip Ugtts/min= ml/ hr since drop factor is always 60 ugtts/min & 1 hr= 60 mins Drop conversion: 1 gtt= 4 ugtts Example: LRS 1 L in 24 hours Answer: 42 ugtts/ min Solution: 1 L/ 24 hours x 1ooo ml/ 1 L x 1 hour/ 60 mins x 60 ugtts/ ml= 42 ugtts/ min or .1392 or 0. 20 gtts/ml) depends on manufacturer Unless specified.5.1 ml Adults: 1.73 = 35.15 mg/kg/ dose for a child weighing 20 kg. ant thigh. Stock dose is 2 mg/5 ml Solution: 0.73 m2 Answer: 36 mg Based on kg Body Weight (BW) X (ml)= mg/kg/dose x wt in kg x known quantity stock dose Example: Paracetamol 15 mg/kg/dose for child weighing 20 kg. ½” Pinch skin to Don’t form SC fold aspirate or (needle massage should be ½ heparin or width of insulin fold). palm down. 5/8”. use drop factor 15 gtts/ml (most common) Example: LRS 1L to consume in 8 hours.Site syringe needle method remarks Pediatric Drug Dosage 1. Stock dose: 250/ 5 ml Solution: Child’s dose= 15 mg x 20 kg x 5 ml = 1500 kg/dose / 250 mg= 6mg Answer: 6 ml/ dose Example: Amoxicillin 30 mg/kg/day for a child weighing 20 kg. at the site 5.3 ml G: 25. If no back flow.15 degrees 2-3 mm deep to form a wheal Kids: 0.8 0r 36mg 1. 90 deg for abdomen. skin.62 m2 x 100 mg Demerol= 62/1. palm used to down.62 m2 Child’s dose = 0.3 L: 1” ml (kids). Based on kg Body Weight (BW) 3. insert massage. abdomen ( 1 inch from umbilicus). obese and emaciated SC Lateral upper arm.619. Hold injections syringe like a dart. Preparation is 250 mg/ 5 ml.15 mg/kg/dose x 20 kg x 5 ml/ 2mg = 7. to be given every 6 hours Solution: 50 mg/kg/day x 30 kg x 5 ml/ 250 mg = 30 ml/ day 30 ml/ 4= 7. scapula IM Gluteus. scapula.most accurate 2.G: 211 ml 23 Adult: 2. tuberculin 5/8” needle Encircle bevel up.½” (adult) Hold like Z-track: dart.27 L: 3/8”.1.73 m2) Example: 3 year old child weighs 15 kg with a height of 92 cm is to be given Demerol.1 ml G: 26 Stretch don’t (max) L: 3/8”. adult dose for Demerol is 100 mg/ dose Solution: Child’s BSA= square root of (15 kg x 92 =1380/ 3600 =0. to be given 3x a day Solution: 30 mg/kg/day x 20 kg x 5 ml/250 mg= 12 ml/day 12 ml/ 3= 4ml/ dose Answer: 4 ml/ dose Example: Cefalexin 50 mg/ kg/ day for a child weighing 30 kg. Aspirate.

45% NaCl. lipids. D5 NR Isotonic: 0.pulse increased P. hirsutism.9 NaCl.Cholinesterase Inhibitors .9% NaCl. ileus.Anticonvulsives . vomiting CNS depression . D5 0..pressure increased P. • Monitor respiratory rate and depth before giving drug. trauma) If less than 10% dextrose solution Catheter inserted in peripheral vein & threated into subclavian/ SVC If more than 10% dextrose central venous catheter direct to SVC TPN Requires monitoring of glucose. Linda Boyd. drowsiness phenytoin: ataxia. relief of dyspnea occurring in pulmonary edema or acute left ventricular failure.depressed respirations D. hypotension nursing interventions give medication with food .perspiration increased P. . PROTOTYPE-MORPHINE SULFATE Action. reversal of analgesia Nursing implications: Rescucitative equipments readily available monitor clients for bleeding Narcotic Antagonists -reverses narcotic induced respiratory depression: Naloxone (Narcan) 5 P’s P. Use.dizziness. electrolytes. proteins Don’t increase rate if infusion lags behind NARCOTIC ANALGESICS Case Study Mrs. D5 0. electrolytes.decreased BP D. Adverse Effect.Antiparkinson Agents .puke increased P. Relief of moderate to severe pain.Antianxiety (Anxiolytic) . age 48. is admitted to the local hospital for an abdominal hysterectomy.Local Anesthetics ANTICONVULSANTS action . CNS Agents 6 D’s: D. LRS Hypotonic: D5 water. D10 water Nutrient Solutions/ TPN hyperalimentation. and periodically thereafter.drowsy D.drug dependence Narcotic Antagonist: Naloxone hydrochloride ( Narcan ) action : Occupies receptor sites and reverse effects of agonist drugs Use : Postoperative respiratory depression Adverse effects: hypertension.modifies bioelectric activity at subcortical and cortical areas examples diazepam (Valium) magnesium sulfate phenytoin (Dilantin) phenobarbital (Luminal) use: prevents seizures adverse effects blood dyscrasias gastric effects . • The first sign of tolerance is usually a decreased duration of effect of the analgesic. PostoperatiVely she is placed on meperidine (Demerol) 100 mg IM every 4 hours prn.decreased GI peristalsis and urine output D.1000 ml/ 24 hrs= 42 ugtts/ min therefore.General Anesthetics . pain relief in Ml.Antimanic Agents . tremors. dextrose.provides high calorie IV nutrition.Antidepressants . and euphoria. surgery.pain increased NEUROLOGICAL (INCLUDING ANESTHETICS) . respiratory depression Nursing Implications • Assess client's pain before giving medication. analgesia. ml/ hr= ugtts/min Titration: Desired mg/volume in gtts= delivery rate/regulation 1 cc= 15 gtts Example: 1 gram Lidocaine in 500 cc D5 water at 2 mg/ min Solution: 1 gm = 2mg/min 500 cc X 1000 mg = 2mg/min (1 cc= 15 gtts ) 7500 gtts X 1000 mgX= 2mg/min (7500 gtts) X= 2mg/min (7500 gtts) 1000 mg X= 15 gtts/min = 60 ugtts/ min ( 1 gtt= 4 ugtts) Answer: 15 gtts/ min SOLUTIONS Electrolyte Solutions: Hypertonic: D5 LRS. Acts on opioid receptors in CNS and induces sedation.Hypnotics .nausea. preoperative medication. D5 NM.dizzy D. 1 kcal/ ml with amino acids. vitamins and minerals PARENTERAL NUTRITION For clients who are unable to digest or absorb enteral nutrition ( GI obstruction.Antipsychotic .

imipramine (Tofranil) monoamine oxidase inhibitors (MAOIs): isocarboxazid (Marplan).mouth not stop taking antiparkinsonian meds suddenly: may precipitate parkinsonian crisis .gingival hyperplasia U. ANTIDEPRESSANTS action: increase norephinephrine at subcortical neuroeffector sites examples norepinephrine blockers (tricyclic.caution with hazardous activities .monitor client response to medication.administer medication as per schedule . don't mix with other IV fluids. benzhexol. tongue protrusion CHOLINESTERASE INHIBITORS action prevents breakdown of acetylcholine at nerve endings facilitates transmission of impulses across myoneural junction strengthens muscle contractions including respiratory muscles examples edrophonium chloride (Tensilon) for diagnostic purposes neostigmine bromide (Prostigmin) ambenonium chloride (Mytelase) use: treat myasthenia gravis Adverse effects gastric irritation: nausea. monitor blood lab results. pergolide) . benserazide) Amantadine Dopamine postsynaptic receptor agonists (bromocriptine. dizziness.change position cautiously.wiith phenytoin: monitor condition of oral mucosa. do not discontinue avoid driving and other potentially hazardous activities phenytoin: good oral hygiene. increased twitching.monitor vital signs during period of dosage adjustment .soft tooth brush.minimize Vitamin B6 in diet. TCAs): amitriptyline (Elavil). because it hinders drug's effectiveness . liver. ophenadrine) L-Dopa + peripheral decarboxylase inhibitor (carbidopa. lisuride.wear medic alert jewelry and ID .take with meals .levodopa . renal obstruction peritonitis nursing interventions .keep atropine sulfate available for overdosage .administer medication with food . phenelzine sulfate (Nardil) selective serotonin reuptake inhibitors: fluoxetine (Prozac). and blood studies teach clients avoid alcohol notify physician of unusual symptoms carry medical alert information take medication on schedule.teach client . vomiting. monitor urine renal. ataxia. sertraline (Zoloft) use: treat melancholia. frequent dental visits Phenytoin: adverse effects: PHENYTOIN: P-450 interactions Hirsutism Enlarged gums Nystagmus Yellow-browning of skin Teratogenicity Osteomalacia Interference with B12 metabolism (hence anemia) Neuropathies: vertigo. headache Anticonvulsant Agents Phenytoin (Dilantin) G. depression adverse effects norepinephrine blockers potentiate anticholinergics and CNS depressants orthostatic hypotension drowsiness. diarrhea hypersalivation CNS disturbances orthostatic hypotension toxicity: pulmonary edema. grimacing.sweat and urine may be dark colored . confusion CNS stimulation Nursing responsibilities . sit at first feeling of faintness.reinforce client education .use alternate birth control M.toxicity: personality changes. don’t use abruptly ANTIPARKINSON AGENTS action anticholinergics: block or compete at central acetylcholine receptors dopamine agonists: activation of dopamine receptors Parkinsonism: drugs SALAD: Selegiline Anticholinenergics (trihexyphenidyl. may need to adjust dosage . respiratory failure.preventive dental check-up S. bronchospasm Contraindications intestinal obstruction.

monitor client for hypertensive crisis SSRIs and MAOIs should not be given concurrently or close together ANTIMANIC AGENTS action: reduces adrenergic neurotransmitter levels in cerebral tissue examples antimanic agents: lithium carbonate (Lithane) alternative antimanic agents: carbamazepine (Tegretol). cardiac toxicity) blood dyscrasias .MAOIs potentiate alcohol. beer.cogwheel rigidity . akathisia. bipolar disorder adverse effects .observe for suicidal tendencies measures I. thioridazine (Mellaril) – can cause skin irritation or contact dermatitis benzisoxazole: risperidone (Risperdal) thioxanthenes: chlorprothixene (Taractan) butyrophenones: haloperidol (Haldol) adverse effects excessive sedation jaundice orthostatic hypotension urinary retention anorexia dry mouth hypersensitivity reactions (such as photoallergic reaction. TCA. MAOI 1. wine.increased urination T. SSRI’s: Paxil.thirst increased H.consult physician alcohol or CNS depressants Psychiatric Agents Antidepressants: SSRI. Nardil Avoid Tyramine rich foods: may cause hypertensive crisis -aged cheese. avocado . pickled foods. Luvox.6.headache & tremors I.renal failure .slurred speech .evaluate vital signs S. pseudoparkinsonism.unsteady M.monitor salt ( decrease lithium level with excess sodium) ANTIPSYCHOTICS action blocks dopamine hydrochloride receptors in the CNS and sympathetic nervous system examples phenothiazines: chlorpromazine (Thorazine).2 meq/ml) I.level.relieves symptoms. vomiting. weak muscles.therapeutic (0. MAOI’s : Mar Par Nar: Marplan.metallic taste .1. Celexa. Parnate.stopping drug abruptly is out! S.Sexual/ changes in libido.respiratory depression nursing interventions monitor blood levels avoid concurrent administration of adrenergic drugs evaluate client's response to medication teach client effect of medication may take several weeks high intake of fluids and normal sodium toxicity signs: diarrhea.planning pregnancy. smoked fish. Prozac. chocolate) orthostatic hypotension SELECTIVE SEROTONIN REUPTAKE INHIBITORS may interact with tryptophan insomnia headache sexual dysfunction gastric irritation contraindications acute schizophrenia mixed mania and depression suicidal tendencies narrow angle glaucoma nursing interventions monitor effect of medication maintain suicide precautions especially as depression lifts give SSRIs in morning.effect has a delayed onset of 7. red wine. akinesia.driving is out until response to drug is determined E. barbiturates. impotence. cheese. take medication with meals L.disorientation .side effect C. confusion etc. antihistamines hypertensive crisis with ingestion of foods high in tyramine (pickled herring.excess voiding and extreme thirst . beer. beef.agranulocytosis extrapyramidal side effects: dystonia. clonazepam (Klonopin) use: control of manic phase of mood disorders. ale.21 days P.CNS stimulation N. liver.hand tremors . TCAs at bedtime teach client do not take OTC medication without physician approval avoid hazardous activities effect of medication may take up to four weeks MAOIs: teach client to avoid food containing tyramine.nausea S. Skin: photosensitivity 3.instruct client to report undesirable effects O. not a cure! E. Zoloft CNS.increase fluids U. tardive dyskinesia General Concepts for Antidepressants: D.

increase in 3D’s: drowsiness. librium.respiratory arrest . ativan. dec BP E.severe hypertension . deliruim. rigidity. The nurse instructions in the plan regarding: a) Monitoring the child’s intake and output daily b) Checking the child’s blood pressure before the administration of the medication c) Providing oral hygiene.allergic reactions . sleep disorders. hyper/hypotension.not given if w/HPN. procaine HCL (Novocaine) nerve block: bupivacaine HCL (Marcaine). respiratory failure Antipsychotics S.neuroleptic malignant syndrome: fever. respiratory distress IV barbiturates: respiratory depression.neuroleptic malignant syndrome C.teach to rise slowly from supine Y.increased intracranial pressure . muscle rigidity.yellow Nitrogen – black Nitrous oxide – blue Abbocath: White – 27g 25.yes. tremors A. methohexital sodium (Brevital) IV and IM nonbarbiturates: midazolam HCL (Versed). tachycardia.tardive dyskinesia.convulsions A. lidocaine HCL (Xylocaine) spinal: dibucaine (Nupercaine). dizziness. orthostatic hypotension E. alcohol withdrawl adverse reactions CNS disturbances: dizziness drowsiness. diazepam. serax. ketamine HCL (Ketaject) use: used in combination for surgical anesthesia adverse effects inhalation anesthetics: excitement and restlessness. psychiatric disturbances contraindications . hypotension. tachycardia.cardiac decompensation nursing interventions have oxygen and emergency treatment available monitor vital signs use precautions if agent flammable use safety precautions when client induced Helium – brown O2. ether.cardiac arrhythmias. lethargy.avoid abrupt discontinuation after prolonged use N.CVA . drug abuse X. agitation.anticholinergic.arrhythmias.extrapyramidal (akathisia).yellow 21 – blue 19 – pink 18 – green LOCAL ANESTHETICS action: decreases nerve membrane permeability to sodium ion influx examples topical: benzocaine. nausea and vomiting. chlordiazepoxide (Librium):physical dependency and withdrawl finsings after long term use azapirones: buspirone (Buspar) uses: anxiety. alcohol shld be avoided GENERAL ANESTHETICS action: depresses the CNS through a progressive sequence PROGRESSIVE SEQUENCE OF GENERAL ANESTHESIA .agranulocytosis. cardiac arrest . orthostatic hypotension skin rash blood dyscrasias contraindications hypersensitivity acute narrow angle glaucoma liver disease examples inhalation anesthetics: cyclopropane. cocaine. enflurane (Ethrane). addiction N. nitrous oxide IV barbiturates: thiopental sodium (Pentothal). confusion. especially care of the gums d) Administering the medication one hour before food intake ANTIANXIETY (ANXIOLYTIC) action: depress CNS examples benzodiazepines: alprazolam (Xanax). renal/liver dysfxn. laryngospasm IV and IM nonbarbiturates: respiratory failure. endocrine (libido) A nurse is preparing a plan regarding home care instructions for the parents of a child with generalized tonic-clonic seizures who is being treated with oral phenytoin (Dilantin). midazolam I.xanax. mepivacaine HCL (Carbocaine) use: pain control while client is conscious adverse effects .sedation & sunlight sensitivity T.enhances axn of GABA Co2 – gray Air.

cardiac arrhythmia I. specific action dependent on type of drug. as prescribed.tetanic contractions O. For this patient. tinnitus.oxygen decrease in fetus C.headache . GI distress. c) Administer metoclopramide (Reglan) and dexamethasone (Decadron). metaproterenol (Alupent) xanthines: adverse effects .stop smoking during therapy .monitor EKG. hepatotoxicity aspirin sensitivity.tachycardia .- hypotension nursing interventions .do take with food S.have oxygen and emergency equipment available .monitor theophylline levels (normal ten to 20 mcg/dl) . inc. increase heart rate act on the autonomic nervous system examples beta-adrenergic: abuterol (Proventil.CBC.patellar reflex decreased NSAIDs N. d) Withhold fluids for the first 4 to 6 hours after chemotherapy administration.urine output decreased R.respiratory rate decreased P.BP decreased U. avoid crowds R. and vital signs . platelets.stop 5.pressure is elevated I.undesirable effect C. “BIRTH” bone marrow depression.teach clients .couselling regarding reproductive issues E. the nurse should give the highest priority to which action in the care plan? a) Serve small portions of bland food.7 days before surgery Antineoplastic Agents C. theophylline (TheoDur) acts on bronchial smooth muscle epinephrine HCL (Adrenalin) .severe cardiac disease nursing interventions .intoxication with water T. vital signs during therapy .monitor A.monitor intake and output.palpitations .dysrhythmias contraindications .if spinal anesthesia.for control of convulsion in preeclampsia or eclampsia Mg SO4 Toxicity: decreased BURP B.tachydysrhythmias .S. b) Encourage rhythmic breathing exercises.increases the rate and strength of cardiac contraction through the sympathetic nervous system isoproterenol HCL (Isuprel) .monitor vital signs during local anesthesia . Ventolin).irregularity in fetal heart rate alcohol S.narrow angle glaucoma . Respiratory Drugs Bronchodilators MUCOLYTICS/EXPECTORANTS action mucolytics: disrupt molecular bonds and thins mucus expectorants: stimulate a gastric mucosal reflex to increase production of lung mucous examples mucolytic: acetylcysteine (Mucomyst) expectorant: guaifenesin (Robitussin) uses: asthma acute or chronic bronchopulmonary disease cystic fibrosis mucomyst: acetaminophen toxicity .take medication as prescribed only .tremors . asthma adverse effects .increases the heart rate by stimulating the beta-adrenergic blocking agent of the sympathetic nervous system use: bronchospasms. renal toxicity.avoid OTC drugs A 40-year-old patient who’s receiving chemotherapy for breast cancer develops nausea and vomiting.encourage handwashing.take with meals .hypersensitivity .dizziness .nausea and vomiting Magnesium not give inhibits prostaglandin D.antiemetics before drug N.gastric disturbances .anxiety .recommend a wig for alopecia Mucolytics Antitussives Antituberculosis agents Antihistamines Anti-inflammatory BRONCHODILATORS action: dilate air passages in the lungs. keep client flat for 6-12 hours to prevent headaches WOMEN’S HEALTH RELATED AGENTS OXYTOCIN ( PITOCIN) P.

nausea . have regular eye exams Just know your R.gastric irritation .monitor client response to therapy .teach client .adverse side effects .drowsiness .dry mouth .humidify client's room .ototoxicity . pneumonia.diarrhea reduced absorption of calcium and iron nursing interventions shake oral suspension well monitor client's response to treatment administer with 8 oz glass of water teach client avoid overuse of antacids dietary restrictions for ulcers need for diet high in calcium and iron for clients on low sodium diets: antacids contain sodium may color stools whitish Antiulcers Respiratory Agents B.take no fluids directly after oral administration . so stops tubercle bacilli from multiplying (first line) or functioning (second line) examples . bronchitis.if CNS disturbances are if become pregnant .evaluate heart rate and blood pressure A.ethambutol .constipation.relaxation techniques eat foods rich in B-complex vitamins .avoid use of alcohol . reflux esophagitis. respiratory congestion.bronchospasm .oropharyngeal irritation .avoid driving and other hazardous activity especially if taking narcotic type . TB.blood dyscrasias take medication as ordered .I.monitor blood work during therapy .do take plenty of fluids .suppresses mycobacterial cell-wall synthesis • second line capreomycin (Capastat) pyrazinamide (PZA) adverse effects .monitor blood counts with long term therapy .antitussives add to the effects of alcohol • first line ethambutol (Myambutol) decreases mycobacterial RNA synthesis isoniazid (INH) .arm identification (asthma) T. cystic not to take fluids immediately after medication .gastric effects contraindications increased intracranial pressure status asthmaticus nursing interventions .P.streptomycin .emphasize no smoking ANTITUBERCULOSIS AGENTS action: appears to inhibit RNA synthesis.suppressed absorption of fat and vitamin B complex contraindications severe renal disease hypersensitivity nursing interventions .breathing and coughing techniques R.S Managing gastrointestinal conditions Antacids action neutralizes gastric acid coats stomach lining examples aluminum hydroxide gel (Amphojel) aluminum and magnesium hydroxides (Maalox) magaldrate (Riopan) use: peptic ulcers.teach client . emphysema adverse effects .visual disturbances .dextromethorphan (Robitussin) use: colds.dizziness contraindications hypothyroidism iodine sensitivity nursing interventions .increase fluid intake . especially before treatment ANTITUSSIVES action: to supress coughs through medullary cough center or indirect action on sensory nerves examples narcotic: codeine. hydrocodone bitartrate (Hycoda) nonnarcotic . take safety precautions .encourage coughing and deep breathing. intestinal obstruction magnesium compounds .ethambutol: report eye problems. hiatal hernia adverse reactions aluminum compounds .liver disturbances .CNS disturbances .teach client .isoniazid .monitor respiratory status .have 8 or more glasses of fluids E.increase fluid intake if not contraindicated .tremors H.

increase fluid intake . or passage of bloody stools Gastrointestinal Agents Anti-ulcer: H2 receptor antagonists: tidine drugs: NO WINE JUST DINE D. antacids.visual disturbances. constipation. dizziness.narrow.actions decrease acetylcholine release block release of histamines inhibit secretion of pepsin inhibit proton pump examples anticholinergics. and caffeinated beverages .administer on empty stomach . check apical pulse and heart rhythm. anorexia older clients more prone to toxicity monitor drug levels therapeutic range 0. nausea and vomiting.avoid antacids within one to two hours of other antiulcer drugs . chlorodiazepoxide (Librax) h2 blockers . diarrhea. tachycardia. gastroesophageal reflux disease(GERD). omeprazole (Prilosec) uses: management of peptic ulcer disease.identify and report signs of toxicity . spicy food. ranitidine (Zantac) pepsin inhibitor . vomiting of blood. and ranitidine (Zantac).don’t take with antacids I.0 mg/ml toxic range > 2 mg/ml diuretics may increase chance of toxicity monitor intake and output Client teaching .8 to 2.daily weights: report two pound increase ANTIHYPERTENSIVES action: dilates peripheral blood vessels examples hydralazine HCL (Apresoline) enalapril maleate (Vasotec) reserpine (Serpasil) prazosin HCL (Minipress) methyldopa (Aldomet) clonidine (Catapres) contraindications heart block children . constipation.dry mouth. skin reash. belladonna tincture.lansoprazole (Prevacid). and anorexia bradycardia xanthopsia muscle weakness dysrhythmia Nursing Interventions before giving glycoside.inform physician of bleeding N. decreased increasing abdominal pain.teach clients .angle glaucoma renal failure liver disease nursing interventions .avoid alcohol.cardiac arrhythmias in adults . pruritis.eliminate smoking .medication can take up to two weeks for full effect .for atrial fibrillation: take pulse and report if below 60 or above 100 or changes in rhythm . alcohol or NSAIDs E.elevate head of bed A patient with peptic ulcer is about to begin a therapeutic regiment that includes a bland diet.avoid antacids within 30 minutes of sucralfate . d) Increase the intake of fluids containing caffeine. c) Avoid aspirin and products that contain aspirin. & urinary retention .sucralfate is nonabsorbable. b) Stop taking the drugs when the symptoms subside.headaches. protects gastric mucosa from hydrochloric acid production adverse reactions . Which instruction should the nurse provide before this patient is discharged? a) Eat three balanced meals every smoking.cimetidine (Tagamat). Cardiovascular Drugs Cardiac glycosides Antihypertensives Thrombolytics Lipid-lowering agents Antianginals Hypotension and shock Anticoagulants Antidysrhythmics Cardiac Glycosides CARDIAC GLYCOSIDES action: makes heart beat slower but stronger improves pumping ability of heart increases force of heart's contraction decreases rate of contraction increases cardiac output examples digitoxin (Crystodigin) digoxin (Lanoxin) Use congestive heart failure atrial flutter atrial fibrillation Contraindications ventricular tachycardia ventricular fibrillation second and third degree heart block Adverse Side Effects gastrointestinal effects such as nausea and vomiting.administer other drugs one to two hours after sucralfate . Report if < 60 bpm Report for toxicity in children .sucralfate (Carafate) proton pump inhibitor . impotence . occasional constipation contraindications anticholinergics .

or headache .adverse side effects . neck and ears reduced absorption of fat-soluble vitamins disruption of liver function muscle tenderness or weakness (rhabdomyolysis) nursing interventions . closely monitor client . and certain antibiotics) one hour before or four hours after administration of cholestryramine and colestipol.bradycardia . so that they will not react with bile-acid-binding resins ANTIANGINALS: NITRATES examples: nitroglycerin. pulmonary emboli contraindications active bleeding cerebral embolism/thrombosis/hemorrhage recent intraarterial diagnostic procedure or surgery recent major surgery neoplasms of the CNS severe hypertension nursing interventions .to report blurred vision.encourage intake of foods high in vitamin B teach client low sodium diet change positions slowly take medication as instructed avoid hazardous activities protect medication from heat and light hypersensitivity pregnancy/lactation active liver disease adverse side effects skin flushing gastric upset niacin: temporary.dizziness . Activates conversion of plasminogen to plasmin. digoxin. severe GI symptoms. warfarin. Plasmin is able to break down clots (fibrin).to report muscle weakness or tenderness . such as thiazide diuretics. colestipol: Give other medications (e.deterioration in renal function . renal functioning .if hypotension.agranulosis Nursing interventions . never go near the microave ANTIANGINALS: BETA – ADRENERGIC AGENTS THROMBOLYTICS action: binds with plasminogen to dissolve thrombi (clots) in coronary arteries within four to six hours of myocardial infarction. dizziness contraindications hypersensitivity severe anemia hypotension hypovolemia nursing Interventions monitor for orthostatic hypotension monitor for tolerance with long term use administer every five minutes but not more than three tablets in 15 minutes if pain not relieved after 15 minutes and three tablets.tachycardia . headache. examples streptokinase (Streptase) urokinase (Abbokinase) uses: myocardial infarction deep venous thrombosis.teach client .keep available: aminocaproic acid (fibrinolysis inhibitor) LIPID-LOWERING AGENTS (ANTILIPEMIC) action and use: lower LDL levels by reducing the synthesis of cholesterol and/or triglycerides.blood work and eye exams will be necessary during treatment . isosorbide dinitrate (Isordil) action: dilate arterioles which lowers peripheral vascular resistance (afterload) uses: treatment and prevention of acute chest pain caused by myocardial ischemia adverse effects: postural hypotension.monitor for allergic reactions .g. Use: primary hypercholesterolemia examples cholestyramine (Questran) atorvastatin (Lipitor) colestipol (Colestid) nicotinic acid (Niacin) contraindications: . sitting and standing .orthostatic hypotension .monitor vital signs and blood pressure.about low-cholesterol high-fiber diet . flushing.monitor for hearing changes. intense flushing of face.monitor coagulation studies .monitor liver function tests . notify physician immediately instruct client -take pulse before taking medication -take oral preparations without food -when to seek medical attention -not to chew or swallow sublingual tabs -make position changes slowly -carry drug so that it is always within reach but avoid exposure to body heat and light -replace drug approximately every six months -avoid alcohol ingestion -With nitroglycerin patch..with cholestyramine.monitor for bleeding .sexual dysfunction .monitor cholesterol levels .

nifedipine (Adalat).instruct client . Report weight gain of five pounds or greater . epinephrine: anaphylactic shock Hypotension and shock adverse effects: dysrhythmias. hypertension side effects: in children not known . dobutamine (Dobutrex) actions: increase cardiac not use discolored solution .monitor ECG if used for dysrhythmia .weigh daily. diltiazem (Cardizem) action: prevent the movement of extracellular calcium into the cell resulting in coronary and peripheral artery dilation uses: stable angina.monitor chest pain .tachydysrhythmias .monitor ECG continuously during administration . (+) chronotrope uses: dopamine and dobutamine: hypovolemic and cardiogenic shock.hypersensitivity . hypotension.correct hypokalemia before administering . Tremors.monitor ECG if using for dysrhythmia . GI disturbances.cardiogenic shock .stop the drug gradually Anticoagulants action: disrupt the blood coagulation process.protect solution from light . flushing of the skin contraindications: hypersensitivity nursing interventions . drowsiness.ventricular fibrillation . dysrhythmias.hypersensitivity . thereby suppressing the production of fibrin examples heparin: parenteral administration coumadin (Warfarin): oral administration use pulmonary embolism deep vein thrombosis myocardial infarction atrial fibrillation .cardiogenic shock .take pulse before taking drug .monitor injection site for extravasation .hypersensitivity .protect injectable solution from light ANTIANGINALS: CALCIUM CHANNEL BLOCKERS examples: verapamil (Isoptin).start drug slowly and increase according to health care provider's orders .weigh daily.change position slowly ACE INHIBITORS Captopril (an ACE inhibitor): side effects CAPTOPRIL: Cough Angioedema/ Agranulocystosis Proteinuria/ Potassium excess Taste changes Orthostatic hypotension Pregnancy contraindication/ Pancreatitis/ Pressure drop (first dose hypertension) Renal failure (and renal artery stenosis contraindication)/ Rash Indomethacin inhibition Leukopenia/ Liver toxicity Hypotension and shock NATURAL AND SYNTHETIC CATECHOLAMINES examples: epinephrine. dizziness.avoid alcohol . dizziness with epinephrine contraindications .administer on an empty stomach . anxiety. dopamine (Intropin).cardiac failure nursing interventions .examples: propranolol (Inderal).limit caffeine consumption . GI disturbances. hypotension.Hypotension and shock nursing interventions .administer with food .cardiac failure nursing interventions .administer with infusion pump . tissue necrosis if extravasation occurs. dysrhythmias side effects: blood dyscrasias. metoprolol (Lopressor) action: inhibit sympathetic stimulation of beta receptors in the heart decreases heart rate and force of myocardial contraction thus decreasing myocardial oxygen consumption uses: reduces frequency and severity of acute anginal attacks. Report weight gain of five pounds or greater . (+) inotrope. flushing of the skin contraindications .avoid hazardous activities until stabilized on drug .protect injectable solution from light Beta-blockers: main contraindications ABCDE: Asthma Block (heart block) COPD Diabetes mellitus Electrolyte (hyperkalemia contraindications .increase fluids to counteract constipation .monitor ECG if using for dysrhythmia .monitor vital signs frequently .administer on an empty stomach .

do not take over-the-counter (OTC) medications without health care provider's approval ANTIDYSRHYTHMICS Action : prevent abnormal heart rhythms action depends on type of antidysrhythmics drug examples class I:sodium channel blockers quinidine (Quinidex). and the nurse notes bilateral crackles. sputum . decreases myocardial excitability and contractility class II: beta blockers propranolol (Inderal).inhibits influx of calcium ions across cell membrane during cardiac contraction.V. The nurse determines that further teaching is necessary if the client makes which statement? a) “This diet will help lower my blood pressure.avoid alcohol and smoking . c) Administer the prescribed diuretic.GI disturbances. don’t relieve the pain. decreased BP .heparin: monitor APTT (activated partial thromboplastin time) . Which drug order should the nurse question? a) Heparin b) Dexamethasone (Decadron) c) Methyldopa (Aldomet) d) Phenytoin (Dilantin) A patient with heart failure has been receiving an I.alcohol is out.coumadin: vitamin K .avoid trauma . What should the nurse do first? a) Notify the physician.rise slowly E. red or pink-tinged urine.use a soft toothbrush .monitor client for symptoms of hemorrhage such as increased pulse.have antidote ready . use an electric razor .allergic responses such as chills. dec alcohol E. b) Discontinue the I.coumadin . APTT increases by a factor of 1.diarrhea. red or black bowel movements. decreases conduction and excitability of myocardial cells class IV: calcium channel blockers .verapamil (Isoptin).heparin: protamine sulfate .” b) “I take the tablet with a full glass of water. infusion at 125 ml/hour. rashes. fever and urticaria .stay on medications S.eating must be considered S.use cautiously if client tends to bleed (hemophilia.INR (International normalized ratio) two to three .do baseline blood studies before therapy . ask about allergy T. dizziness R.undesirable responses: drowsiness.nausea and vomiting.skipping or stopping is a n0. Which statement from the patient indicates that further teaching is necessary? a) “I store the tablets in a dark bottle.” A nurse has completed diet teaching for a client on a low-sodium diet for the treatment of hypertension.” c) “This diet is not a replacement for my antihypertensive medications.evaluate cultures. and tachycardia. lidocaine.inform provider prior to taking other meds C.digoxin (Lanoxin).wear medical alert jewelry: wearer takes anticoagulants . adenosine (Adenocard). access device.monitor superinfections E.evaluate renal/ liver dysfxn D. The physician prescribes several drugs for this patient. abdominal cramps contraindications hemophilia leukemia peptic ulcer blood dyscrasias nursing interventions .do not use a straight razor.pressure (blood) monitor R. as needed. the nurse is discussing the medication regime with a patient who takes nitroglycerin (Nitrostat) for angina. minutes apart.n0 U. reduces cardiac excitability and dilates main coronary arteries others . ANTIBIOTICS M.” A patient with an arteriovenous malformation has been admitted with a hemorrhagic stroke. temperature . stabilizes cell membrane class III: conduction delayers bretylium (Bretylol). peptic ulcer) . diarrhea.take medication at same time every day . improves pumping ability of the heart CARDIOVASCULAR AGENTS P.” d) “I’ll go to the hospital if three tablets.” c) “I wait for my tongue to tingle when I take a tablet. slows heart rate.adverse side effects . Now the patient is short of breath.avoid salicylates (such as aspirin) .5 to 2 . d) Slow the infusion and notify the physician.” b) “The reason I need to lower my salt intake is to reduce fluid retention.normal 12 seconds .V.normal 40 seconds .avoid IM injections teach client .take full course E.blood levels of the anticoagulant may be monitored .” d) “Frozen foods are lowest in sodium.monitor PT (prothrombin time) . jugular vein distention.take yogurt I. therapeutic levels.eliminate smoking Medical surgical planning.remind to exercise. headaches.cultures prior to initial dose any signs of bleeding.

A patient with a urinary tract infection (UTI) receives a prescription for cotrimoxazole (Septra) 2 tablets by mouth daily for 10 days. sweating H. Lithium.not healing quickly G. Your initial assessment confirms a nursing diagnosis of deficient fluid volume. Which outcome indicates that treatment has been effective? a) Fluid intake of less than 85 oz (2.Infection G. . hyperglycemia increase in BP. dexamethasone. c) Blood pressure of 90/50 mm Hg.bleeding I.masculinization of female infants 2. b) Urine output of more than 200 ml/hour.increase metabolic rate. Tetracycline.monitor H.GI upset CORTICOSTEROIDS Some People Get Cold S.headache.fetal metabolic alkalosis 9.Hypo/hyperthyroidism.TSH. T4. d) Pulse rate of 126 beats/minute.neonatal bleeding. Which of these findings should the nurse recognize as an adverse drug effect? a) Dysuria b) Leg cramps c) Tachycardia d) Blurred vision ANTITHYROID PREPARATIONS For hyperthyroidism: methimazole (tapazole). Iodides.yellow staining of teeth. inhibit bone growth. Thalidomide. ANTIPROLIFERATIVE AGENTS) Action Highly toxic agents that attack all rapidly dividing cells. appetite N.cleft lip and palate 13. mental retardation 12. ANTINEOPLASTICS (CYTOTOXIC.Calcium decreased The nurse is preparing a care plan for a 35-yearold patient with Addison’s disease. which direction should the pinna be pulled to straighten the ear canal? a) Up and back b) Down and back c) Laterally d) The pinna should never be pulled.Sodium increased P. cogenital heart defects how to take a pulse O. cyclophosphamide (Cytoxan): produce breaks in DNA molecule and cross-linking of strands thus interfering with DNA replication. b) Mineralocorticoid deficiency c) Melanocyte-stimulating hormone excess d) Melanocyte-stimulating hormone deficit Thyroid Preparations For Hypothyroidism: Levothyroxine T4 (synthroid). Vitamin K.sodium increase.500 ml) in 24 hours. propylthiouracil (PTU) B.Vitamin A.ffalo hump S. Sodium bicarbonate.bleeding disorder ENDOCRINE AGENTS CORTICOSTEROIDS (end in one: prednisone. Which of the following etiologic factors establishes this nursing diagnosis? a) Glucocorticoid excess. Which nursing diagnosis is most appropriate for this client? a) Risk for infection b) Excess fluid volume c) Urinary retention d) Hypothermia The nurse should expect to administer which of these drugs to a patient with diabetes insipidus? a) Desmopressin (DDAVP) b) Furosemide (Lasix) c) Regular insulin d) 10% dextrose A 55-year-old female with Addison’s disease has been admitted to the nursing unit with dehydration.action D. cortisone. Steroids.cleft lip and palate.cushing.nerve deafness 10. HR. betamethasone.000 ml in 24 hours b) Decreased flank and abdominal discomfort c) Absence of bacteria on urine culture d) Normal red blood cell (RBC) output TERATOGENS 1. both normal and malignant Represents a systemic approach that bases its action on disruption of the cell life cycle Most agents modify or interfere with DNA synthesis Examples Alkalyting agents: mechlorethamine HCl (Nitrogen Mustard).phocomelia. decreased intrauterine growth 8. not given to children below 7 6.Androgen. Which observation best demonstrates that the patient followed the prescribed regimen? a) Increased urine output to not change brands of drugs A patient with hypothyroidism is receiving levothyroxine (Levothroid). T3. Liothyronine T3 (Cytomel) T.congenital heart defects 5.monitor R.hyperbilirubinemia 7. Anticonvulsant (Dilantin). Salicylates(aspirin).Potassium decreased G. cardiac and lung defect 3. hydrocortisone) C.give with food When assessing the ear canal of a 1-year-old client. Barbiturates.observe clinical improvement in 3-4 days symptoms b U. most effective in hematologic malignancies A patient with diabetes insipidus has been receiving intranasal administration of a synthetic vasopressin.CNS defects 11.goiter. 50 mcg by mouth daily.Glucose increased C. Streptomycin.

Vincristine. frequent. lubricate lips as indicated • For stomatitis. eye protectors and protective clothing when in contact with injectable solutions. control or palliate results of neoplasm May be used as an adjunct to surgery and radiation Adverse effects: result from the damage to normal cells • Nausea/ vomiting. stomatitis. anxiety • Myelosuppression Nursing interventions • Monitor lab studies as ordered • Monitor IV administration site for extravasation • Maintain strict asepsis • Administer antiemetic agents as ordered and prophylactically before chemotherapy. give small. infection • use a soft-bristle toothbrush • avoid use of razors Guidlines for reducing risks when handling cytotoxic antineoplastic drugs • wear a mask to avoid inhaling powder when handling a powder form of a drug. • wear gloves when handling linens contaminated with drugs for at least 48 hours after contamination. aspirin products. • wash hands thoroughly before and after exposure to drugs. constipation • Alopecia. • follow organizational procedure to clean-up after chemical spill. . bind directly with DNA changing its configuration and inhibiting replication Antimetabolites: methotrexate. anemia. paresthesia. emotional support and anxiolytics as ordered Teach client • medications and side effects • alopecia is temporary • avoid bruising. anorexia • Diarrhea. avoid harsh. cytosine arabinoside. pruritus. chills • Sterility. • Give antihistamines as ordered • Withhold food and fluids for four to six hours before treatment • Between treatments. prostate. fever. 6mercaptopurine. and persons with infections • conserve energy • recognize signs of bleeding. Etoposide: Bind to substances needed to form mitotic spindle. bruising • Hemorrhagic cystitis • Cardiomyopathy • Fatigue. rash.Antitumor antibiotics: Biomycin. amenorrhea • Depression. use topical anesthetics before eating and as indicated • Apply lotion to skin as indicated. used in cancers of the breast. alterations in taste. thus preventing cell division Hormones and hormone inhibitors: Tamoxifen alters the endocrine environment to make it less conducive to cell growth. 5-fluorouracil. most effective against rapidly growing tumors enzymes necessary for cell function and replication Plant alkaloids: Vinblastine. floxuridine. bland meals • Give antidiarrheals as ordered • Monitor for signs of dehydration and encourage fluids as tolerated • Provide frequent oral hygiene. drying soaps • Provide a restful environment. 6-thioguanine: inhibit DNA synthesis. • dispose of contaminated materials in puncture-proof containers labeled as hazardous material. dyspnea. and other reproductive organs Routes of administration • Intravenous (peripheral or central venous access) • Oral • Intraarterial • Intraperitoneal • Intrapleural • Intrathecal • Via ventricular reservoir Use: To cure. dermatitis. • do not prepare drugs in eating places Wear gloves.