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

thyroid drugs Palliative – high dose opioids for cancer Supportive – fluids and electrolytes Prophylactic – antibiotics during surgery Empiric – experience shows it works. iron.many medications become entirely inactivated by the liver the first time they go through it. Onset The time the drug takes it therapeutic effect 2. Therapeutic effect – positive change Drugs excert their actions in 3 ways: Receptor interactions Enzyme interactions NON SPECIFIC INTERACTIONS 1. vitamins etc. 4. 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 . Trough The lowest blood level of a drug 5. Interactions a. 3. Therapeutic index • Ratio of safety • A low therapeutic index indicates a greater chance of adverse reaction 2. Insufficient amounts of hormones such as insulin can affect metabolism of drug in the liver. Synergestic effect – 2 drugs have better effect than given alone • HCTZ plus enalapril . EXCRETION Kidney is the main organ Liver Bowel MORE PHARMACOKINETIC PRINCIPLES 1.go directly into the liver via portal before entering systemic circulation . Receptor interaction Key in a lock Agonist Drugs that fit well and elicit their own response Exa. Drug concentration Consider pathologic conditions 3. 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 drug monitoring Some drug have a very narrow range oftherapeutic and toxic effects Digoxin and gentamycin are closely monitored 2. Additive effect – smaller doses can be given with the same effect ie. 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. Dependence Physiologic and psychologic need for a drug 6. 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. It will stay in the body for long Pharmacodynamics The mechanism of drug action in living tissue How the drug alter the system A. Peak The time the drug takes its full therapeutic response Time to change dressings or do painfull procedures 3. Liver is the principal site Oral medications . Dependence – addiction or habituation withdrawal symptoms 8. Tylenol and codeine b. 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. lipidemia Supplemental/replacement therapy – insulin. METABOLISM Process of metabolism is a sequence of chemical events that change a drug as it enters the body. Peak level – highest blood level 3. heart attack Maintainance therapy – HPN. tolerance A decreasing response to repeated doses 5.7. Enzyme interactions Alters the enzyme necessary for a certain body function Ace Inhibitors – alters the enzyme pathway 3. Age – infants and elderly has reduced ability to metabolized some drugs Nutrition – Liver enzymes involved in metabolism rely on adequate amounts of lipids. no evidence 1. Patient’s condition Stress and anxiety 4.

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

eye. for insertion into body cavity(rectum or vagina) Suspensio Fine drug particles n dispersed in liquid medium which settles on standing. Do not give again. sugar. parenterally. inactivation by gastric acid. if client vomits after taking meds. vagina. can also be instilled into body Supposito Pellet-shaped solid with ry gelatin. ovoid. gauze or sterile applicators Cleanse skin with soap & warm water to remove encrustation that blocks contact and absorption of new meds. oil.Liniment Lotion Preparation usually containing alcohol. rectum) Via skin Use gloves. use gloves to avoid drug absorption Nitroglycerin patch: take blood pressure before and after application Via nose Have client blow nose. 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. 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. dysphagia). NPO preor post-op Disadvantages: gastric irritation. . disintegrators(for tablet dissolution). 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. may contain flavoring for palatability Tablet Powder form pressed into hard disks or cylinders. or externally. Remember Lotion and creams: applied lightly. for children. so shake before using Syrup Medication dissolved in concentrated sugar solution. teeth discoloration. contains flavoring. shaped into globules. or oblong shapes Solution Liquid that may be used orally. inform physician. 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. lie supine and breath thru mouth Pill Solid form containing 1 or more meds. unconscious or unable to swallow. lubricants. and mucilage Routes of administration Via the mouth Oral Take with 50-100 ml of cold fluid unless contraindicated Contraindications: GI dysfxn(vomiting). also contains binders(adhesive). unpleasant taste or odor. otherwise consider a liquid preparation For enteric-coated tablets: don’t crush or give with antacids. ear.g. 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. nose. elderly.

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

Change needle. free of major nerves Disadvantages: special attention required to avoid sciatic nerve or femoral structures if long needle is used INTRAVENOUS THERAPY use . lactated Ringer's solution. Inject new needle into vial A & withdraw meds Vial to Ampule: Draw meds from vial first then from ampule Administering Injections Select Appropriate site. avoiding bruised or tender areas & rotating sites as much as possible for repeated injections. supine . Press swab over site before removing needle. Use a filter needle when drawing up reconstituted meds Advantages: readily accessible.45% hypertonic exerts higher osmotic pressure than plasma (draws water out of the cells) examples: 5% dextrose in normal saline 0. let dry. muscle mass suited for deep IM or Z-track injections. Re-insert if with blood Inject slowly. 5% dextrose in water hypotonic exerts less osmotic pressure than plasma examples: 2. give meds & release tubing. size acceptable for multiple injections. requires accurate technique • VASTUS LATERALIS Position: sitting. 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.5% dextrose in water. close to nerves. 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. half strength normal saline 0. Insert needle quickly. 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. bevel up. medication absorption cannot be delayed by tourniquet • DELTOID Position: lateral. medication absorption can be delayed by tourniquet Disadvantages: small muscle mass. • Prime or fill drip chamber & tubing with solution • Remove any air bubbles by tapping tubing. supine Advantages: good site for infants. Mixing Medications 2 Vials: Inject air into vial A & withdraw needle (tip must not touch the solution) Inject air into vial B & withdraw meds. Do not shake. possible local tissue injury INTRAMUSCULAR INJECTION SITE • VENTROGLUTEAL Position: Supine lateral Advantages: Anatomic landmarks well defined. bevel up. limited to small volume doses.9%. free of major nerves Disadvantages: in the event of hypersensitivity reaction. Place roller clamp 1-2 inches below drip chamber & move to “off” position. 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. slightly distal to the site. Always use gloves to prevent contact with client blood.9%. in the event of hypersensitivity reaction. sitting. prone.Prepare diluent & inject into vial. • Apply tourniquet & select a vein large enough for the catheter • Use the most distal site in the non-dominant arm. Insert spike to fluid bag. • 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. Clean site with alcohol swab. Look for blood return then fully lower needle or catheter ( remove stylet if ONC before lowering) • Stabilize catheter. in the event of hypersensitivity reaction. Remove needle & roll vial in palms. 5% dextrose in lactated Ringer's solution INTRAVENOUS ADMINISTRATION Venipuncture • Prepare infusion set. then release hold to decrease pain Aspirate for blood.replace fluid.

Won’t is a word of bereavement. simply divide or multiply multiples of 10 1000mg= 1 g. Label rate and time PIGGYBACK Add med solution bag to an existing line Connect IV tubing to medication bag. Can’t is a word of defeat.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. 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. Will is a word of beauty Can is a word of power MEDICATION CALCULATIONS Metric System To convert within the metric system. 1= 1000ml. I CAN Try is a word each hour.45L= 450 ml Apothecary System System rarely used.2 pounds 1 inch Metric 0.IV INFUSION Inject meds thru port in IV bag with rubber stopper not thru air vent or port for IV tubing. same height if tandem. possible local tissue injury SUCCESS IS TAKEN ONE STEP AT A TIME I CAN Did is a word of achievement. Hang med bag higher than primary fluid bag if piggyback. basic unit is grain Uses small Roman numerals (gr xvi= 16 grains). Ought is a word of duty. 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. use the following diluents: IM= use 2cc IV=/<500mg= use 5 cc IV> 500mg= use 10 cc Parenteral Injection . 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.

15 degrees 2-3 mm deep to form a wheal Kids: 0.5 ml/ dose ID Ventral forearm. inject slowly. obese and emaciated SC Lateral upper arm.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. palm used to down.½” (adult) Hold like Z-track: dart.5 ml/ dose Answer: 7. If no back flow. tuberculin 5/8” needle Encircle bevel up. decrease Insert at 90 irritation deg.20 secs.1.73 = 35. skin.3 L: 1” ml (kids). palm down.5 ml/ dose Answer: 7. scapula IM Gluteus. 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. Aspirate.8 0r 36mg 1. 1.5.G: 211 ml 23 Adult: 2.27 L: 3/8”.619.62 m2 x 100 mg Demerol= 62/1. Based on Body Surface Area (BSA). anterior & medial thigh Kids: 0.1 ml Adults: 1. Insert at 45 deg for ext & thin client. Hold injections syringe like a dart. adult dose for Demerol is 100 mg/ dose Solution: Child’s BSA= square root of (15 kg x 92 =1380/ 3600 =0. Preparation is 250 mg/ 5 ml. 20 gtts/ml) depends on manufacturer Unless specified. Stock dose is 2 mg/5 ml Solution: 0. remove needle and release Example: Salbutamol 0. use drop factor 15 gtts/ml (most common) Example: LRS 1L to consume in 8 hours.most accurate 2. scapula. 15. 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. Based on kg Body Weight (BW) 3.1 ml G: 26 Stretch don’t (max) L: 3/8”. wait 10.12 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 1.3 ml G: 25.15 mg/kg/dose x 20 kg x 5 ml/ 2mg = 7.15 mg/kg/ dose for a child weighing 20 kg. ant thigh.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. 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. 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 . 90 deg for abdomen.Site syringe needle method remarks Pediatric Drug Dosage 1. insert massage. chest 0. at the site 5.62 m2 Child’s dose = 0. ½” Pinch skin to Don’t form SC fold aspirate or (needle massage should be ½ heparin or width of insulin fold).5. Preparation is 250 mg/ 5 ml.73 m2) Example: 3 year old child weighs 15 kg with a height of 92 cm is to be given Demerol. 5/8”.1392 or 0. Based on Age: Fried’s Rule (birth to 12 months): Infant’s dose= age in months/150 x adult dose Young’s rule (1. abdomen ( 1 inch from umbilicus).

age 48.Antianxiety (Anxiolytic) . pain relief in Ml. proteins Don’t increase rate if infusion lags behind NARCOTIC ANALGESICS Case Study Mrs.9 NaCl. • Monitor respiratory rate and depth before giving drug. respiratory depression Nursing Implications • Assess client's pain before giving medication.nausea.General Anesthetics .Antidepressants . surgery. vomiting CNS depression .perspiration increased P. relief of dyspnea occurring in pulmonary edema or acute left ventricular failure. ileus.provides high calorie IV nutrition. Relief of moderate to severe pain.pulse increased P.Cholinesterase Inhibitors .Anticonvulsives . 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.drowsy D. 1 kcal/ ml with amino acids. Linda Boyd. Use. D5 NM. and euphoria. and periodically thereafter.. • The first sign of tolerance is usually a decreased duration of effect of the analgesic. Acts on opioid receptors in CNS and induces sedation. 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.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 . . hirsutism. electrolytes.Antipsychotic .puke increased P.pressure increased P. vitamins and minerals PARENTERAL NUTRITION For clients who are unable to digest or absorb enteral nutrition ( GI obstruction.pain increased NEUROLOGICAL (INCLUDING ANESTHETICS) . CNS Agents 6 D’s: D.depressed respirations D. analgesia. is admitted to the local hospital for an abdominal hysterectomy. D5 0.Local Anesthetics ANTICONVULSANTS action .dizzy D. D10 water Nutrient Solutions/ TPN hyperalimentation. PostoperatiVely she is placed on meperidine (Demerol) 100 mg IM every 4 hours prn. PROTOTYPE-MORPHINE SULFATE Action.dizziness. lipids. dextrose. tremors. 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. electrolytes.decreased GI peristalsis and urine output D.1000 ml/ 24 hrs= 42 ugtts/ min therefore.Antiparkinson Agents . D5 0. preoperative medication.Hypnotics . LRS Hypotonic: D5 water.9% NaCl. drowsiness phenytoin: ataxia.Antimanic Agents .45% NaCl. Adverse Effect.decreased BP 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. hypotension nursing interventions give medication with food . D5 NR Isotonic: 0.

gingival hyperplasia U.soft tooth brush. dizziness.wear medic alert jewelry and ID . depression adverse effects norepinephrine blockers potentiate anticholinergics and CNS depressants orthostatic hypotension drowsiness. benzhexol. increased twitching. lisuride.reinforce client education . TCAs): amitriptyline (Elavil).administer medication as per schedule .monitor vital signs during period of dosage adjustment . bronchospasm Contraindications intestinal obstruction. respiratory failure. headache Anticonvulsant Agents Phenytoin (Dilantin) G.take with meals . ataxia. and blood studies teach clients avoid alcohol notify physician of unusual symptoms carry medical alert information take medication on schedule. ophenadrine) L-Dopa + peripheral decarboxylase inhibitor (carbidopa.levodopa . pergolide) . phenelzine sulfate (Nardil) selective serotonin reuptake inhibitors: fluoxetine (Prozac). sertraline (Zoloft) use: treat melancholia. because it hinders drug's effectiveness . 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.caution with hazardous activities . imipramine (Tofranil) monoamine oxidase inhibitors (MAOIs): isocarboxazid (Marplan).keep atropine sulfate available for overdosage . do not discontinue avoid driving and other potentially hazardous activities phenytoin: good oral hygiene. vomiting. monitor blood lab results.wiith phenytoin: monitor condition of oral mucosa. benserazide) Amantadine Dopamine postsynaptic receptor agonists (bromocriptine.preventive dental check-up S.mouth care. don't mix with other IV fluids.monitor client response to medication. sit at first feeling of faintness.do not stop taking antiparkinsonian meds suddenly: may precipitate parkinsonian crisis . renal obstruction peritonitis nursing interventions . liver.teach client .toxicity: personality changes.sweat and urine may be dark colored .use alternate birth control M.change position cautiously. confusion CNS stimulation Nursing responsibilities .administer medication with food . 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. monitor urine renal. grimacing. ANTIDEPRESSANTS action: increase norephinephrine at subcortical neuroeffector sites examples norepinephrine blockers (tricyclic. diarrhea hypersalivation CNS disturbances orthostatic hypotension toxicity: pulmonary edema. may need to adjust dosage . 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.minimize Vitamin B6 in diet.

CNS stimulation N. smoked fish.1. red wine. Prozac. antihistamines hypertensive crisis with ingestion of foods high in tyramine (pickled herring.increased urination T.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. 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.slurred speech .thirst increased H. 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. Nardil Avoid Tyramine rich foods: may cause hypertensive crisis -aged cheese. pseudoparkinsonism.effect has a delayed onset of 7. 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).hand tremors . Luvox. pickled foods. tardive dyskinesia General Concepts for Antidepressants: D. confusion etc.level.no alcohol or CNS depressants Psychiatric Agents Antidepressants: SSRI.stopping drug abruptly is out! S. impotence. bipolar disorder adverse effects .cogwheel rigidity .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).driving is out until response to drug is determined E. akathisia. Zoloft CNS.evaluate vital signs S.observe for suicidal tendencies N. beef.disorientation .Sexual/ changes in libido.metallic taste . liver. not a cure! E.headache & tremors I.relieves symptoms.therapeutic (0. vomiting. take medication with meals L. wine. ale. MAOI 1. Parnate.unsteady M.agranulocytosis extrapyramidal side effects: dystonia. TCA. MAOI’s : Mar Par Nar: Marplan. SSRI’s: Paxil.excess voiding and extreme thirst .consult physician R. beer.planning pregnancy.safety measures I. Skin: photosensitivity 3.MAOIs potentiate alcohol.nausea S. weak muscles.side effect C. Celexa.21 days P.instruct client to report undesirable effects O. barbiturates.2 meq/ml) I. clonazepam (Klonopin) use: control of manic phase of mood disorders. cardiac toxicity) blood dyscrasias . beer. cheese.renal failure .increase fluids U. avocado .6. akinesia. 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.

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

asthma adverse effects . avoid crowds R. inc.severe cardiac disease nursing interventions .if spinal anesthesia.respiratory rate decreased P. c) Administer metoclopramide (Reglan) and dexamethasone (Decadron).E. d) Withhold fluids for the first 4 to 6 hours after chemotherapy administration.intoxication with water T. b) Encourage rhythmic breathing exercises.stop smoking during therapy . metaproterenol (Alupent) xanthines: aminophylline.gastric disturbances .nephrotoxicity.recommend a wig for alopecia Mucolytics Antitussives Antituberculosis agents Antihistamines Anti-inflammatory BRONCHODILATORS action: dilate air passages in the lungs. “BIRTH” bone marrow depression. specific action dependent on type of drug.stop 5.irregularity in fetal heart rate N.headache .narrow angle glaucoma .monitor EKG.pressure is elevated I.tachydysrhythmias .- hypotension nursing interventions .monitor theophylline levels (normal ten to 20 mcg/dl) .teach clients .dysrhythmias contraindications . Ventolin).monitor A. and vital signs .tachycardia .take medication as prescribed only . keep client flat for 6-12 hours to prevent headaches WOMEN’S HEALTH RELATED AGENTS OXYTOCIN ( PITOCIN) P. 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 . renal toxicity.take with meals .have oxygen and emergency equipment available . the nurse should give the highest priority to which action in the care plan? a) Serve small portions of bland food. vital signs during therapy . increase heart rate act on the autonomic nervous system examples beta-adrenergic: abuterol (Proventil.monitor intake and output.for control of convulsion in preeclampsia or eclampsia Mg SO4 Toxicity: decreased BURP B.undesirable effect C.palpitations . GI distress.anxiety .encourage handwashing.tetanic contractions O.S. as prescribed.patellar reflex decreased NSAIDs N. tinnitus.dizziness .7 days before surgery Antineoplastic Agents C.urine output decreased R.tremors .BP decreased U. hepatotoxicity aspirin sensitivity. theophylline (TheoDur) acts on bronchial smooth muscle epinephrine HCL (Adrenalin) .cardiac arrhythmia I.nausea and vomiting Magnesium Sulfate.hypersensitivity .couselling regarding reproductive issues E.increases the heart rate by stimulating the beta-adrenergic blocking agent of the sympathetic nervous system use: bronchospasms.increases the rate and strength of cardiac contraction through the sympathetic nervous system isoproterenol HCL (Isuprel) . platelets.report adverse effects .avoid OTC drugs A 40-year-old patient who’s receiving chemotherapy for breast cancer develops nausea and vomiting.do not give inhibits prostaglandin D. For this patient.do take with food S.oxygen decrease in fetus C.CBC.no alcohol S.monitor vital signs during local anesthesia .antiemetics before drug N.

do take plenty of fluids .I.tremors H.if CNS disturbances are evident.streptomycin .bronchospasm . respiratory congestion.antitussives add to the effects of alcohol • first line ethambutol (Myambutol) decreases mycobacterial RNA synthesis isoniazid (INH) .blood dyscrasias .to eat foods rich in B-complex vitamins .oropharyngeal irritation . pneumonia.teach client .teach client .gastric effects contraindications increased intracranial pressure status asthmaticus nursing interventions .ototoxicity .nausea .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.gastric irritation .dizziness contraindications hypothyroidism iodine sensitivity nursing interventions .liver disturbances .monitor blood counts with long term therapy .ethambutol .report if become pregnant . bronchitis.monitor respiratory status . especially before treatment ANTITUSSIVES action: to supress coughs through medullary cough center or indirect action on sensory nerves examples narcotic: codeine.do not to take fluids immediately after medication .increase fluid intake .suppresses mycobacterial cell-wall synthesis • second line capreomycin (Capastat) pyrazinamide (PZA) adverse effects .take no fluids directly after oral administration .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 . so stops tubercle bacilli from multiplying (first line) or functioning (second line) examples .drowsiness .CNS disturbances . reflux esophagitis.adverse side effects .avoid use of alcohol .monitor blood work during therapy .arm identification (asthma) T.dry mouth .visual disturbances .dextromethorphan (Robitussin) use: colds.encourage coughing and deep breathing.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. hiatal hernia adverse reactions aluminum compounds .humidify client's room . cystic fibrosis.monitor client response to therapy .P. take safety precautions .E.increase fluid intake if not contraindicated .avoid driving and other hazardous activity especially if taking narcotic type .constipation.isoniazid .ethambutol: report eye problems.relaxation techniques E.evaluate heart rate and blood pressure A.have 8 or more glasses of fluids E.to take medication as ordered . intestinal obstruction magnesium compounds .teach client . hydrocodone bitartrate (Hycoda) nonnarcotic . emphysema adverse effects .breathing and coughing techniques R. TB. have regular eye exams Just know your R.

d) Increase the intake of fluids containing caffeine. ranitidine (Zantac) pepsin inhibitor . protects gastric mucosa from hydrochloric acid production adverse reactions .sucralfate is nonabsorbable.teach clients .visual disturbances.cardiac arrhythmias in adults . alcohol or NSAIDs E. and ranitidine (Zantac). dizziness.actions decrease acetylcholine release block release of histamines inhibit secretion of pepsin inhibit proton pump examples anticholinergics.administer on empty stomach . gastroesophageal reflux disease(GERD).narrow.avoid antacids within one to two hours of other antiulcer drugs .lansoprazole (Prevacid). 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. diarrhea. and anorexia bradycardia xanthopsia muscle weakness dysrhythmia Nursing Interventions before giving glycoside.increase fluid intake . & urinary retention . pruritis. skin reash.angle glaucoma renal failure liver disease nursing interventions . vomiting of blood. belladonna tincture.headaches.don’t take with antacids I. Report if < 60 bpm Report for toxicity in children . omeprazole (Prilosec) uses: management of peptic ulcer disease.dry mouth. or passage of bloody stools Gastrointestinal Agents Anti-ulcer: H2 receptor antagonists: tidine drugs: NO WINE JUST DINE D. occasional constipation contraindications anticholinergics .no smoking. constipation. decreased secretions. impotence . Which instruction should the nurse provide before this patient is discharged? a) Eat three balanced meals every day.inform physician of bleeding N. constipation.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 .sucralfate (Carafate) proton pump inhibitor . check apical pulse and heart rhythm.8 to 2.identify and report signs of toxicity . antacids. spicy food. chlorodiazepoxide (Librax) h2 blockers . nausea and vomiting.cimetidine (Tagamat).for atrial fibrillation: take pulse and report if below 60 or above 100 or changes in rhythm .eliminate smoking .0 mg/ml toxic range > 2 mg/ml diuretics may increase chance of toxicity monitor intake and output Client teaching .avoid antacids within 30 minutes of sucralfate . b) Stop taking the drugs when the symptoms subside. anorexia older clients more prone to toxicity monitor drug levels therapeutic range 0.report increasing abdominal pain.elevate head of bed A patient with peptic ulcer is about to begin a therapeutic regiment that includes a bland diet. c) Avoid aspirin and products that contain aspirin.avoid alcohol. and caffeinated beverages .medication can take up to two weeks for full effect .administer other drugs one to two hours after sucralfate . tachycardia.

teach client .tachycardia .dizziness . renal functioning . Plasmin is able to break down clots (fibrin).monitor for bleeding .monitor cholesterol levels . 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.if hypotension. severe GI symptoms. warfarin.bradycardia . 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.g.with cholestyramine. 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. headache. so that they will not react with bile-acid-binding resins ANTIANGINALS: NITRATES examples: nitroglycerin.adverse side effects .monitor vital signs and blood pressure.monitor coagulation studies .monitor for hearing changes. and certain antibiotics) one hour before or four hours after administration of cholestryramine and colestipol. digoxin.agranulosis Nursing interventions .blood work and eye exams will be necessary during treatment .monitor for allergic reactions .. colestipol: Give other medications (e. neck and ears reduced absorption of fat-soluble vitamins disruption of liver function muscle tenderness or weakness (rhabdomyolysis) nursing interventions . Activates conversion of plasminogen to plasmin.about low-cholesterol high-fiber diet . intense flushing of face.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. such as thiazide diuretics. flushing. closely monitor client . Use: primary hypercholesterolemia examples cholestyramine (Questran) atorvastatin (Lipitor) colestipol (Colestid) nicotinic acid (Niacin) contraindications: .to report muscle weakness or tenderness . sitting and standing .to report blurred vision. examples streptokinase (Streptase) urokinase (Abbokinase) uses: myocardial infarction deep venous thrombosis.sexual dysfunction .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. 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 .orthostatic hypotension .deterioration in renal function . or headache .monitor liver function tests . 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.

flushing of the skin contraindications .monitor injection site for extravasation .stop the drug gradually Anticoagulants action: disrupt the blood coagulation process.Hypotension and shock nursing interventions . dizziness. Report weight gain of five pounds or greater . tissue necrosis if extravasation occurs.instruct client .cardiac failure nursing interventions .monitor chest pain . anxiety.weigh daily. (+) inotrope.administer with food .avoid hazardous activities until stabilized on drug .hypersensitivity .cardiogenic shock . dopamine (Intropin). GI disturbances. 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.administer on an empty stomach .start drug slowly and increase according to health care provider's orders .weigh daily.monitor ECG if used for dysrhythmia .examples: propranolol (Inderal). flushing of the skin contraindications: hypersensitivity nursing interventions .avoid alcohol . Tremors.ventricular fibrillation .monitor ECG if using for dysrhythmia .hypersensitivity .protect injectable solution from light ANTIANGINALS: CALCIUM CHANNEL BLOCKERS examples: verapamil (Isoptin). drowsiness.cardiogenic shock .protect solution from light .increase fluids to counteract constipation . GI disturbances.limit caffeine consumption .monitor ECG continuously during administration .administer on an empty stomach .hypersensitivity . diltiazem (Cardizem) action: prevent the movement of extracellular calcium into the cell resulting in coronary and peripheral artery dilation uses: stable angina.tachydysrhythmias .cardiac failure nursing interventions .safety in children not known . (+) chronotrope uses: dopamine and dobutamine: hypovolemic and cardiogenic shock. hypertension side effects: headache.monitor ECG if using for dysrhythmia .protect injectable solution from light Beta-blockers: main contraindications ABCDE: Asthma Block (heart block) COPD Diabetes mellitus Electrolyte (hyperkalemia contraindications . dobutamine (Dobutrex) actions: increase cardiac output.correct hypokalemia before administering . hypotension. dysrhythmias. dizziness with epinephrine contraindications . thereby suppressing the production of fibrin examples heparin: parenteral administration coumadin (Warfarin): oral administration use pulmonary embolism deep vein thrombosis myocardial infarction atrial fibrillation .administer with infusion pump . dysrhythmias side effects: blood dyscrasias. epinephrine: anaphylactic shock Hypotension and shock adverse effects: dysrhythmias.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. hypotension. Report weight gain of five pounds or greater .monitor vital signs frequently .do not use discolored solution . nifedipine (Adalat).take pulse before taking drug .

temperature . improves pumping ability of the heart CARDIOVASCULAR AGENTS P.stay on medications S.coumadin .” d) “I’ll go to the hospital if three tablets. stabilizes cell membrane class III: conduction delayers bretylium (Bretylol). dizziness R.avoid trauma .5 to 2 .” A nurse has completed diet teaching for a client on a low-sodium diet for the treatment of hypertension.avoid alcohol and smoking .monitor superinfections E.” b) “I take the tablet with a full glass of water. dec alcohol E. rashes. fever and urticaria .” d) “Frozen foods are lowest in sodium.use cautiously if client tends to bleed (hemophilia.wear medical alert jewelry: wearer takes anticoagulants . and the nurse notes bilateral crackles.do not use a straight razor.normal 12 seconds . access device. headaches.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). abdominal cramps contraindications hemophilia leukemia peptic ulcer blood dyscrasias nursing interventions . jugular vein distention.remind to exercise.V. decreases conduction and excitability of myocardial cells class IV: calcium channel blockers . ANTIBIOTICS M.report any signs of bleeding.heparin: protamine sulfate .undesirable responses: drowsiness. diarrhea. as needed.alcohol is out.blood levels of the anticoagulant may be monitored . reduces cardiac excitability and dilates main coronary arteries others . WBC.skipping or stopping is a n0.take full course E.coumadin: vitamin K . Which statement from the patient indicates that further teaching is necessary? a) “I store the tablets in a dark bottle. adenosine (Adenocard).at therapeutic levels. red or black bowel movements. 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. decreased BP .n0 U.diarrhea. The physician prescribes several drugs for this patient.INR (International normalized ratio) two to three .evaluate renal/ liver dysfxn D. d) Slow the infusion and notify the physician.monitor PT (prothrombin time) . red or pink-tinged urine.” c) “This diet is not a replacement for my antihypertensive medications.do baseline blood studies before therapy . minutes apart. infusion at 125 ml/hour.rise slowly E.have antidote ready .avoid salicylates (such as aspirin) .digoxin (Lanoxin).heparin: monitor APTT (activated partial thromboplastin time) .verapamil (Isoptin).inform provider prior to taking other meds C. The nurse determines that further teaching is necessary if the client makes which statement? a) “This diet will help lower my blood pressure.allergic responses such as chills.GI disturbances.use a soft toothbrush . What should the nurse do first? a) Notify the physician. sputum .cultures prior to initial dose A. b) Discontinue the I. slows heart rate. use an electric razor . c) Administer the prescribed diuretic. APTT increases by a factor of 1.V.” b) “The reason I need to lower my salt intake is to reduce fluid retention. the nurse is discussing the medication regime with a patient who takes nitroglycerin (Nitrostat) for angina.avoid IM injections teach client .adverse side effects . decreases myocardial excitability and contractility class II: beta blockers propranolol (Inderal).monitor client for symptoms of hemorrhage such as increased pulse.inhibits influx of calcium ions across cell membrane during cardiac contraction.take medication at same time every day . Now the patient is short of breath.take yogurt I. and tachycardia. peptic ulcer) .nausea and vomiting. don’t relieve the pain.” c) “I wait for my tongue to tingle when I take a tablet.evaluate cultures. lidocaine.normal 40 seconds . ask about allergy T.eating must be considered S.pressure (blood) monitor R.” A patient with an arteriovenous malformation has been admitted with a hemorrhagic stroke.eliminate smoking Medical surgical planning.

cortisone. most effective in hematologic malignancies A patient with diabetes insipidus has been receiving intranasal administration of a synthetic vasopressin.500 ml) in 24 hours.congenital heart defects 5. b) Urine output of more than 200 ml/hour.monitor H. T4.ffalo hump S.give with food When assessing the ear canal of a 1-year-old client.review how to take a pulse O.observe clinical improvement in 3-4 days I.Sodium increased P. appetite N. b) Mineralocorticoid deficiency c) Melanocyte-stimulating hormone excess d) Melanocyte-stimulating hormone deficit Thyroid Preparations For Hypothyroidism: Levothyroxine T4 (synthroid).neonatal bleeding. 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.hyperbilirubinemia 7. Sodium bicarbonate. HR. Streptomycin.bleeding disorder ENDOCRINE AGENTS CORTICOSTEROIDS (end in one: prednisone.Hypo/hyperthyroidism. Anticonvulsant (Dilantin). T3. cogenital heart defects 4. dexamethasone. decreased intrauterine growth 8.GI upset CORTICOSTEROIDS Some People Get Cold S.not healing quickly G. hyperglycemia increase in BP.cushing. Tetracycline. Which observation best demonstrates that the patient followed the prescribed regimen? a) Increased urine output to 2. Barbiturates. Liothyronine T3 (Cytomel) T.headache.do not change brands of drugs A patient with hypothyroidism is receiving levothyroxine (Levothroid). Iodides.nerve deafness 10.Infection G.yellow staining of teeth.bleeding I. Your initial assessment confirms a nursing diagnosis of deficient fluid volume. not given to children below 7 6.sodium increase.action D. ANTIPROLIFERATIVE AGENTS) Action Highly toxic agents that attack all rapidly dividing cells.TSH.Potassium decreased G.cleft lip and palate 13.phocomelia.monitor R. inhibit bone growth. 50 mcg by mouth daily. 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. cyclophosphamide (Cytoxan): produce breaks in DNA molecule and cross-linking of strands thus interfering with DNA replication. c) Blood pressure of 90/50 mm Hg. 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). Thalidomide. ANTINEOPLASTICS (CYTOTOXIC. mental retardation 12.Glucose increased C. cardiac and lung defect 3.goiter.Androgen.masculinization of female infants 2. Which outcome indicates that treatment has been effective? a) Fluid intake of less than 85 oz (2. 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).CNS defects 11. propylthiouracil (PTU) B.fetal metabolic alkalosis 9. Lithium.cleft lip and palate. betamethasone. . Which of the following etiologic factors establishes this nursing diagnosis? a) Glucocorticoid excess. d) Pulse rate of 126 beats/minute.A patient with a urinary tract infection (UTI) receives a prescription for cotrimoxazole (Septra) 2 tablets by mouth daily for 10 days. Steroids. hydrocortisone) C.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.Vitamin A.increase metabolic rate. sweating H. Salicylates(aspirin). Vitamin K.Calcium decreased The nurse is preparing a care plan for a 35-yearold patient with Addison’s disease.like symptoms b U.

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

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