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PHARMACOLOGY a. immediately notify the nursing supervisor, the prescribing physician, and
Pharmacology the
- most simply defined as study of drug. pharmacist.
b. assess the client’s condition and provide any necessary care.
Fundamentals of Pharmacology 9. For postpartum women, advice to take drugs after breastfeeding.
1. Pharmacokinetics Administration of Drugs :
- study of drug’s changes as it enters and passes through the body.
a. absorption Routes and Nursing considerations:
b. distribution 1. Enteral – oral, sublingual, rectal, gastric tubes
c. biotransformation - capsulated pill, sustained release and enteric coated should not be crushed.
d. excretion 2. Parenteral – IV, IM, SQ, ID, IT, IA, epidural.
- vastus lateralis (safest site for IM)
2. Pharmacodynamics 3. Topical – skin, inhalants, mucus membrane.
- mechanism by which drugs produce changes in body tissue.
a. desired effect - intended action of drugs Eye medications :
b. adverse effect - harmful unintended reactions - administer eyedrops first then ointment.
c. side effects – consequence reactions - use a separate bottle for each client.
d. toxicity – the degree which something is poisonous - instruct the client to tilt the head backward, open eyes and look up.
digoxin = 0.5 – 2.0 ng/mL - avoid contact of medication bottle to the eyeball.
lithium = 0.5 – 1.5 mEq/L - place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canthus for 30-60 seconds.
Safety and Efficacy - instruct the client to close the eye gently.
Nursing Principles :
1. Always verify the Five Rights . Ear drops
a. the right medications - in infant and children younger than 3 y.o, pull pinna downward and
b. the right client backward.
c. the right dosage - in older children and adult, upward and backward.
d. the right form, route and technique - direct the solution on the wall of the ear canal, not directly on the ear drum.
e. the right time
2. Chart drug administration only after its been given, never before.
3. Never leave the medication on cart or tray unattended.
4. Chart observed therapeutic and adverse effects accurately and fully.
5. Check history for allergies and potential drug interactions before CLASSIFICATIONS OF DRUGS
administering a
newly ordered drug. DRUGS AFFECTING THE CENTRAL AND AUTONOMIC SYSTEM
6. Inform the prescribing physician of any observed adverse effects; if cannot be
located, inform the nursing supervisor Cholinergic Agents (Parasympathomemitics)
7. Question drug orders that are unclear, that appear to contain errors, or that Prototype :
have - synthetic acetylcholine, pilocarpine, carbachol, bethanecol (Urocholine),
potential to harm. edrophonium (Tensilon), neostigmine (Prostigmine), pyridostigmine
8. Take the following actions if an error occurs : (Mestinon).
Mechanism of action :
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- stimulates cholinergic receptors by mimicking acetylcholine or inhibition of terbutaline, albuterol, isoproterenol.

enzyme cholinesterase. Mechanism of actions :
Indications : - stimulate alpha and beta adrenergic receptor directly or trigger the release
- glaucoma, urine retention, Myasthenia Gravis of
- antidote to neuromuscular blocking agents : tricyclic antidepressants and catecholamines indirectly causing sympathetic effects.
atropine Indications :
Adverse effects : - cardiopulmonary arrest, hypotension
- blurring of vision, miosis - COPD and asthma, nasal congestions
- increase in salivation, intestinal cramps - allergic reaction, anaphylactic shock
- bronchoconstriction, wheezing, DOB Adverse effects :
- hypotension and bradycardia - restlessness, insomnia, tremors, nausea
Nursing considerations : - palpitations, angina, tachycardia, HPN
1. Warn & monitor clients of the side effects. Nursing considerations :
2. Have atropine available for use as antidote. 1. Contraindicated in clients w/ hyperthyroidism,
pheochromocytoma & cardiovascular disease.
Cholinergic Blocking Agents (Parasympatholytics, Anticholinergics) 2. Monitor vital signs and advice precautions.
Prototype : 3. Should be taken with food.
- atropine, scopalamine (Triptone), dicyclomine (Bentyl),
propantheline (Pro-Banthine). ADRENERGIC BLOCKING AGENTS
Mechanism of actions : Prototype :
- block the binding of acetylcholine in the receptors of parasympathetic a. Alpha blockers
nerves. - phentolamine (Regintine), phenoxybenzamine, prazosin (Minipress),
Indications : reserpine (Serpasil), terazosin (Hytrin)
- use preoperatively to dry up secretions. - clonidine (Catapress), methyldopa (Aldomet)
- treat spasticity of GI or urinary tract. b. Beta blockers
- use for treatment of bradycardia, asthma, parkinsonism. - atenolol (Tenormin), esmolol (Brevibloc),
- use for antidote in organophosphate poisoning. metoprolol (Lopressor), nadolol (Corgard),
Adverse effects : propanolol (Inderal), timolol ( Blocadren)
- dry mouth , dilatation of pupils, tachycardia Mechanism of actions :
- urinary retention, ileus, heat stroke a. alpha blockers
Nursing considerations : - inhibits action of a-receptors in vascular smooth muscle to cause
1. Keep client’s in cool environment. vasodilatation.
2. Watch out for signs of heatstroke and dehydration. b. beta blockers
3. Encourage clients to increase fluid intake and use of sugarless gum/candy - compete with epinephrine in b-receptors in heart, pulmonary airways,
for dry peripheral
mouth. circulation and CNS.
4. For GI spasticity, administer 30 minutes before meals and at bed time. Indications :
- Raynaud’s disease, hypertension, pheochromocytoma.
Adrenergic Agents (Sympathomimetics) - angina, arrhythmias, mitral valve prolapse, glaucoma
Prototype : Adverse effects :
- epinephrine, norepinephrine, ephedrine, dopamine, dobutamine, - orthostatic hypotension, bradycardia, CHF
phenylephrine, - depression, insomnia and vertigo
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- bronchospasm and dyspnea, nasal stuffiness, cold extremities c. Miscellaneous

Nursing considerations : - carbamazepine (Tegretol), diazepam, clorazepate (Tranxene),
1. Administer oral alpha-blockers with milk to minimize GI side effects. valproic acid (Dapakene), ethosuximide (Zarontin).
2. Administer oral beta-blockers before meals and at a.m. if insomnia occurs. Mechanism of action :
3. Check client’s apical pulse rate before drug administration, refer if below 60 - treat seizures by depressing abnormal neuronal activity in motor cortex.
bpm. Adverse effects :
4. Hypotensive precautions. - sedation & drowsiness, gingival hyperplasia
5. Warn clients not to drive or operate dangerous machinery until he/she has - diplopia, nystagmus, vertigo, dizziness
adjusted to medications. - thrombocytopenia, aplastic anemia
Nursing considerations :
1. Advise female clients to use contraceptives.
SKELETAL MUSCLE RELAXANTS AGENTS 2. Inform clients taking phenytoin that harmless urine discoloration is
Prototype : common.
- methacarbamol (Robaxin), baclofen (Lioresal), dantrolene (Dantrium), 3. Warn clients with diabetes that hydantoins may increase blood sugar level
metaxalone (Skelaxin), orphanedrine (Norgesic), chlorzoxazone and that
Mechanism of actions: valproic acid may produce a false positive result in urine ketone test.
- depress CNS 4. Teach clients receiving carbamazepine to identify symptoms of bone marrow
- inhibit calcium ion release in the muscle depressions.
- enhance the inhibitory action of GABA (gamma-amino butyric acid) 5. Reassure that barbiturates are not addictive at a low dosage.
Indications : 6. Avoid taking alcohol with barbiturates.
- for acute musculoskeletal pain 7. Administer IV phenytoin slowly to avoid cardiotoxicity.
- for muscle spasticity associated with multiple sclerosis, cerebral palsy, CVA, 8. Avoid mixing other drugs in same syringe with phenytoin.
and
spinal cord injury.
Adverse effects :
- hypotonia, ataxia, hypotension, drowsiness ANTIPARKINSONIAN AGENTS
- blurred vision, bradycardia, depression, urine retention Prototype :
a. Anticholinergic agents
- trihexyphenidyl (Artane), benztropine (Congentin)
Nursing considerations : b. Dopaminergic agents
1. Caution clients that mental alertness may be impaired. - Levodopa, carbidopa-levodopa (Sinemet), amantidine (Symmetrel),
2. Monitor neuromuscular status, bowel and bladder functions. pergolide (Permax), selegiline (Eldepryl), bromocriptine.
3. Inform clients that maximum benefit of baclofen is attained for 1-2 months. Mechanism of actions :
4. Reduce baclofen dosage gradually because of associated withdrawal a. anticholinergic agents
symptoms : - inhibit cerebral motor centers.
Confusion, hallucinations, paranoia & rebound spasticity. b. dopaminergic agents
- increasing dopamine concentrations or
enhancing neurotransmitter functioning.
ANTICONVULSANTS Adverse effects of dopaminergic agents:
Prototype : a. levodopa – nausea, vomiting, anorexia, orthostatic hypotension,
a. Hydantoins - phenytoin (Dilantin) dark-colored urine and sweat
b. Barbiturates - phenobarbital ( Luminal) b. amantidine – ankle edema, constipation
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c. bromocriptine – palpitations, tachycardia c. Miscellaneous

Nursing considerations : - chloral hydrate (Noctec), buspirone (Buspar), paraldehyde (Paral)
1. Give dopaminergic agents after meals to reduce GI symptoms. Mechanism of actions :
2. Reassure client that levodopa may cause harmless darkening of urine and a. Benzodiazepines
sweat. - increase the effect of inhibitory neuro transmitter GABA
3. Avoid taking Vit B6 (pyridoxine) with levodopa because it speed up (gamma-amino butyric acid)
metabolism. b. Barbiturates and Miscellaneous agents
4. Educate clients to minimize orthostatic hypotension. - depress CNS
5. Elevate leg to reduce ankle edema. Indications :
- induce sleep, sedate and calm clients

CENTRAL NERVOUS SYSTEM STIMULANTS Adverse effects :

Prototype : - hangover-effect, dizziness, CNS depression
- amphetamines, methylphenidate (Ritalin) - respiratory depression, drug-dependence
Mechanism of actions : Nursing considerations :
- increase excitatory CNS neurotransmitter activity and blocks inhibitory 1. Warn clients of injuries and falls.
impulses. 2. Brief period of confusion and excitement upon waking up is common with
Indications : benzodiazepines.
- for obesity (amphetamines) 3. Warn clients not to discontinue medications abruptly without consulting a
- attention deficit hyperactivity disorders physician.
- narcolepsy 4. Avoid alcohol while taking these drugs.
- drug-induced respiratory depressions. 6. Rotate and don’t shake the ampules of barbiturates. Don’t mix with other
Adverse effects : drugs.
- nervousness, insomnia, restlessness 7. Warn female clients that diazepam is associated with cleft lip.
- hypertension, tachycardia, headache
- anorexia, dry mouth.
Nursing considerations : ANTIDEPRESSANTS AND MOOD DISORDER DRUGS
1. Should be given at morning. Prototype :
2. Don’t stop amphetamine abruptly to avoid withdrawal symptoms. a. Tricyclic antidepressants
3. Monitor blood pressure and pulse. - amitriptyline (Elavil), protriptyline (Vivactil),
4. Ice chips or sugarless gum for dry mouth. - imipramine (Tofranil), desipramine
5. Watch out for growth retardation in children taking methylphenidate. b. MAO (monoamine oxidase inhibitors )
- isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Pernate)
DRUGS AFFECTING MENTAL FUNCTIONING c. Second-generation antidepressants
- fluoxetine (Prozac), trazodone (Desyrel)
Sedatives, Hypnotics, and Anxiolytics d. Lithium
Prototype : Mechanism of actions :
a. Benzodiazepines a. Tricyclic antidepressants
- diazepam (Valium), lorazipam (Ativan), - increase receptor sensitivity to serotonin and/or norepinephrine.
alprazolam (Xanax), flurazepam (Dalmane) b. MAO inhibitors
b. Barbiturates - inhibit the enzyme MAO that metabolize the neurotransmitters
- amobarbital, phenobarbital, secobarbital norepinephrine and
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serotonin. an irreversible tardive dyskinesia as manifested by :

c. Second – generation antidepressants a. lip smacking
- inhibits the reuptake of serotonin. b. fine wormlike tongue movement
d. Lithium c. involuntary movements of arms and leg.
- increase serotonin & norepinephrine uptake - Neuroleptic malignant syndrome
Adverse effects : a. fever, tachycardia, tachypnea, diaphoresis, cardiovascular collapse
- dry mouth, blurred vision, urine retention, constipation (anticholinergic b. muscle rigidity, seizures.
effects) - orthostatic hypotension
- orthostatic hypotension, insomnia
- hypertensive crisis (MAO) Nursing considerations :
- dehydration (Lithium). 1. Teach family members the signs of EPS and NMS, and report to physician
Nursing considerations : immediately.
1. Caution client to rise slowly to reduce the effects of orthostatic hypotension. 2. Normalization of symptoms may not occur for several weeks after beginning
2. Take antidepressant with food to enhance absorption of
3. Explain to client that full response may take several weeks (2 weeks). therapy .
4. Assess client for constipation resulting from tricyclic antidepressant use. 3. Avoid administering haloperidol intravenously
4. Watch out of neutropenia with clozapine.
5. Client taking MAO inhibitors should avoid tyramine-rich foods to avoid 5. Watch out for orthostatic hypotension and photosensitivity with
hypertensive crisis. phenothiazine.
- aged cheese, sour cream, yogurt, beer, wine, chocolate, soy sauce and yeast 6. Be sure that oral doses are swallowed, and not hoarded.
- pentholamine (Regintine) is the drug of choice for hypertensive crisis.
6. Inform physician and withhold fluoxetine if client develop rashes.
7. Take lithium with food to reduce GI effects DRUGS USED IN PAIN MANAGEMENT
- > 1.5 mEq/L blood level may cause toxicity manifested by:
confusion, lethargy, seizures,hyperreflexia. General Anesthetics
- maintain salt and adequate fluid intake Prototype :
- tremors may occur but it is temporary a. Inhalation anesthetics
- monitor white blood cell count (increase). - enflurane (Ethrane), halothane
- isoflurane (Forane), nitrous oxide
ANTIPSYCHOTIC DRUGS (NEUROLEPTICS) b. Injection anesthetics
Prototype : - fentanyl (Sublimaze), ketamine (Ketalar),
a. Phenothiazines thiopental Na (Penthotal), etomidate (Amidate)
- chlorpromazine (Thorazine), Mechanism of actions :
- trifluoperazine (Stelazine), - cause CNS depression, by producing loss of consciousness,
- thioridazine (Mellaril) unresponsiveness to pain
b. Other Agents stimuli, and muscle relaxation.
- clozapine (Clozaril), haloperidol (Haldol) Nursing considerations :
Mechanism of action : 1. Instruct client NPO for 8 hours before administration.
- block dopamine receptor in the limbic system, hypothalamus, and 2. Monitor cardio pulmonary depression and hypotension.
other regions of the brain. 3. Monitor urinary retention.
Adverse effects : 4. Monitor body temperature
- Extra pyramidal symptoms such as dystonia, pseudoparkinsonism, and - malignant hyperthermic crisis :
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dantrolene (antidote) abruptly in the narcotic-dependent clients.

5. Avoid alcohol or CNS depressants for 24 hours after anesthesia. 4. Naloxone is antidote for narcotic overdose.
6. In patient who received halothane, monitor signs of hepatic fatal side effects : 5. Advice clients to take NSAIDs with food and monitor bleeding complications.
- rash, fever, nausea, vomiting 6. Aspirin is contraindicated in clients below 18 years old with flu-like
- jaundice and altered liver function. symptoms.
7. Monitor hearing loss in clients taking aspirin.
8. Monitor liver function in clients taking acetaminophen.
LOCAL AND TOPICAL ANESTHETIC 9. N-acetylcysteine is antidote for paracetamol overdose.
Prototype :
local : bupivacaine, lidocaine, tetracaine, procaine, mepivacaine, prilocaine DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM
topical : benzocaine, butacaine, dibucaine,lignocaine
Mechanism of action : ANTICOAGULANTS
- block transmission of impulses across nerve cell membrane. Prototype :
Adverse effects : - Heparin (SQ and IV)
- cardiac dysrhythmias Warfarin (Orally)
Nursing considerations : Mechanism of actions :
- lignocaine + prilocaine (EMLA cream) should be applied topically 60 minutes a. Heparin
before - prevents thrombin from converting fibrinogen to fibrin.
procedure. b. Warfarin
- administer cautiously to the areas of large broken skin. - suppress coagulation by acting as an
- observe for fetal bradycardia in pregnant clients. antagonist of vitamin K after 4-5 days.

ANALGESICS Indications :
Prototype : - thrombosis, pulmonary embolism, myocardial infarction
a. Narcotic analgesics Adverse effect :
- codeine, meperidine (Demerol) morphine, butorphanol (Stadol) - bleeding
nalbuphine (Nubain) Nursing considerations :
b. Non – narcotic analgesic 1. HEPARIN sodium
NSAIDs – aspirin (aminosalicylic acid), mefenamic acid (Ponstan), - if given SQ don’t aspirate or rub the injection site (above the scapula - best
ibuprofen (Motrin), naproxen, ketoprofen (Orudis), ketorolac. site).
paracetamol and acetaminophen (Tylenol) - therapeutic level 1.5-2.5 times normal PTT;
Mechanism of actions : normal PTT is 20-35 sec. = 50-85 sec.
a. Narcotic analgesics - antidote : (protamine sulfate)
- alter pain perception by binding to opiod receptors in CNS.
b. Non- narcotic analgesic 2. WARFARIN sodium (coumadin)
- relieves pain and fever by inhibiting the prostaglandin pathway. - warfarin is used for long-term .
Nursing considerations : - onset of action is 4-5 days.
1. Monitor respiratory depression & hypotension in clients taking narcotic - therapeutic level is 1.5-2.5 times normal PT;
analgesic. normal PT = 9.6 -11.8 sec. = 25 - 30 sec.
2. Injury and accident precautions in clients taking narcotic analgesic. INR = 2 - 3
3. Warn clients about possibility of dependency,and do not discontinue - should be taken at the same time of the day to maintain at therapeutic level.
narcotics - reduce intake of green leafy vegetables.
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- antidote : Vitamin K ( Aquamephyton) digitalis-induced arrhythmia.

Nitrates
THROMBOLYTICS Prototype :
Prototype : - isosorbide dinitrate (Isordil)
Streptokinase, Urokinase - nitroglycerine (Deponit, Nitrostat)
Mechanism of actions : Mechanism of action :
- activates plasminogen to generates plasmin (enzyme that dissolve clots). - produce vasodilatation including coronary artery.
Indications : Indications :
- use early in the course of MI (within 4-6 hours of the onset) - angina pectoris, MI, peripheral arterial occlusive disease.
Nursing considerations : Adverse effects:
- monitor bleeding - headache, orthostatic hypotension .
- antidote : Aminocarpic acid
Nursing Considerations :
Antiplatelet Medications 1. Transdermal patch
Prototype: aspirin, Dipyridamole (Persantin) - apply the patch to a hairless area using a new patch and different site each
Clopidoigrel (Plavix), Ticlopidine day.
Mechanism of action : - remove the patch after 12-24 hours, allowing 10-12 hours “patch free” each
- inhibit the aggregation of platelet thereby prolonging bleeding time. day to
Indications : prevent tolerance.
- used in the prophylaxis of long-term complication following M.I, coronary 2. Sublingual medications :
revascularization, and thrombotic CVA. - note the BP before giving the medication.
Nursing considerations : - offer sips of water before giving because dryness may inhibit absorption.
- Monitor bleeding time ( NV = 1-9 mins) - one tablet for pain and repeat every 5 mins. for a total of three doses; if not
- Take the medication with food. relieved
after 15 mins., seek medical help.
CARDIAC GLYCOSIDES - stinging or burning sensation indicates that the tablet is fresh.
Prototype: - instruct patient not to swallow the pill
- digoxin (Lanoxin) and digitoxin (Crystodigin) - sustained release medications should be swallowed and not to be crush.
Mechanism of actions : - protect the pills from light.
- increase intracellular calcium, which causes the heart muscle fibers to
contract more
efficiently, producing positive inotropic & negative chronotropic action. ANTI-ARRHYTHMIC DRUGS
Indications : Class I (block Na channels)
- use for CHF, atrial tachycardia and fibrillation IA - quinidine, procainamide
Nursing considerations : IB - lidocaine
- Monitor for toxicity as evidence by : IC - flecainamide
nausea, vomiting, anorexia, halo vision, confusion, bradycardia and heart Class II (Beta-blockers)
blocks . propanolol, esmolol
- Do not administer if pulse is less than 60 bpm. Class III (block K channels)
- Should be caution in patient with hypothyroidism and hypokalemia. amiodarone, bretylium
- Antidote : Digi-bind Class IV (block Ca channels)
- Phenytoin is the drug of choice to manage verapramil, diltiazem
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Nursing considerations : Mechanism of action :

1. Watch out for signs of CHF. - decrease cardiac contractility and the workload of the heart, thus decreasing
2. Have client weigh themselves and report the
weight gain. need for O2.
3. Watch out for signs of lidocaine toxicity : - it also promote vasodilatation of the coronary and peripheral vessels.
- confusion and restlessness Indications :
- hypertension, angina, arrhythmia
ANTILIPEMICS Adverse effects :
Prototype : - bradycardia, hypotension, headache
a. cholesterol-lowering agents - reflex tachycardia, constipation
- cholestyramine, colestipol, lovastatin Nursing considerations :
b. triglyceride-lowering agents - Administer between meals to enhance absorption.
- gemfibrozil, clofibrate - Take client’s pulse rate before each dose, withhold if pulse is below 60 bpm.
Mechanism of actions : - Refer for signs of congestive heart failure.
- interfere with cholesterol synthesis as well as
decreasing lipoprotein & triglyceride synthesis. DIURETICS
Nursing considerations : - usually given at morning
- monitor liver functions while using statins. CARBONIC ANHYDRASE INHIBITORS
- prevent constipation, flatulence, cholelithiasis - Acetazolimide (Diamox)
- encourage increase fluid and fiber intake. - increase Na+, K+, & HCO3 secretion, along with it is H2O
- metabolic acidosis
OSMOTIC DIURETIC
ANTI – HYPERTENSIVE - Mannitol
- Increase osmotic pressure of the glomerular filtrate.
Angiotensin-Converting Enzyme (ACE) Inhibitors - hypotension
Prototype : THIAZIDE DIURETICS
captopril (Capoten), enalapril (Vasotec), quinapril, lisinopril - hydrochlorothiazide
Mechanism of actions : - blocks Na and K reabsorption; reabsorb Ca
- prevent peripheral vasoconstriction by blocking conversion of angiotensin I - hypercalcemia
to LOOP DIURETICS
angiotensin II decreasing peripheral resistance. - Furosemide (Lasix)
Adverse effect : - blocks Na, K, and Ca reabsorption
- it cause hyperkalemia - hypocalcemia
- induce chronic cough POTASSIUM SPARING DIURETICS
Nursing considerations : - Spironolactone (Aldactone)
- not to discontinue medications because it can cause rebound hypertension. - excrete Na and water but it reabsorb K
- avoid using K+ sparing diuretics. - hyperkalemia

CALCIUM-CHANNEL BLOCKERS
Prototype : RESPIRATORY MEDICATIONS
- Nifedipine (calcibloc, adalat), Amlodipine (norvasc), Felodipine (Plendil)
Verapramil (Isoptin) Bronchodilators
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Prototype : - Take inhaled bronchodilators first before taking inhaled steroids, and rinse
Symphatomimetic Xanthines mouth
- albuterol, salbutamol - aminophylline after using.
- isoproterenol, salmeterol - theophylline
- terbutaline
MAST CELL STABILIZERS
Mechanism of actions: Prototype : cromolyn sodium (Intal)
- sympathomimetic (b-receptor agonist) bronchodilators, dilate airways. Mechanism of action :
- xanthine bronchodilators, stimulate CNS for respiration. - stabilize mast cells that release histamine triggering asthmatic attacks.
Indications : Nursing Consideration:
- bronchospasm, asthma, bronchitis, COPD. - Should be given before asthmatic attacks.
Adverse effects : - Administer oral capsule at least 30 mins before meals for better absorption.
- palpitations and tachycardia - Drink a few sips of water before & after inhalation to prevent cough &
- restlessness, nervousness, tremors unpleasant taste
- anorexia, nausea and vomiting, headache, dizziness. - Assess for lactose-intolerance.
Nursing considerations :
- Contraindicated hyperthyroidism, cardiac dysrhythmia, or uncontrolled ANTI-HISTAMINES (H-1 BLOCKERS)
seizure Protoytype :
disorder. - Astemizole (Hismanal), Loratidine (Claritin),
- Should be used with caution in patient with HPN and narrow-angle Brompheniramine (Dimetapp),
glaucoma. Diphenhydramine (Benadryl),
Cetirizine (Iterax), Celestamine (Tavist).
Mechanism of action :
- decrease nasopharyngeal secretions and decrease nasal itching by blocking
histamine
in H1-receptor.
GLUCOCORTICOIDS (CORTICOSTEROIDS) Indications :
Prototype : - common colds, rhinitis, nausea and
- dexamethasone, budesonide, fluticasone, prednisone, beclomethasone. vomiting, urticaria, allergies and as sleep aid.
Mechanism of actions : Nursing Considerations :
- act as anti-inflammatory agents and reduce edema of the airways, as well - Administer with food and drink.
as - Given IM via Z-track method or orally.
pulmonary edema. - Precautions in handling machine and driving while taking these drugs.
Adverse effects : - Ice chips or candy for dry mouth
- Cushing’s syndrome, neutropenia. osteoporosis
Nursing considerations : ANTI-TUBERCULOSIS
- Take drugs at meal time or with food. Prototype :
- Eat foods high in potassium, low in sodium. First line Second line
- Instruct client to avoid individuals with RTI. - Isoniazid (INH) - Cycloserine
- Instruct client not to stop medication abruptly, it should be tapered to prevent - Rifampicin (Rifadin) - Kanamycin
adrenal insufficiency - Ethambutol - Ethonamide
- Avoid taking NSAID while taking steroids. - Pyrazinamide - Para-aminosalicylic acid
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- Streptomycin Antacids
Prototype :
- active tuberculosis are treated with drug combination for 6-9 mos. - aluminum/magnesium compounds (Maalox)
- multidrug-resistant strain (MDR-TB) are medicated for 1 year up to 2 years - sodium bicarbonate (Alka-Seltzer)
- given before meals - calcium carbonate (Tums)
- magnesium hydroxide (Milk of Magnesia).
Isoniazid Mechanism of actions :
- should be given 1 hr before or 2 hrs after meals because food may delay - neutralize the stomach acidity.
absorption. Adverse effects :
- should be given at least 1 hr before antacids. - metabolic alkalosis, stone formation
- instruct to notify physician for signs of hepatoxicity (jaundice), and - electrolyte imbalance
neurotoxicity - diarrhea (magnesium), constipation (aluminum).
numbness of extremities. Nursing considerations :
- administer with Vitamin B6 to counteract the neurotoxic side effects. - Give 1 hr after meals.
- avoid alcohol. - Avoid giving medications within 1-2 hrs of antacid administration
(decreases absorption).
Rifampicin - Take fluids to flush after intake of antacid suspensions.
- given on an empty stomach with 8 0z. of water, 1 hour before or 2 hours after - Monitor for changes of bowel patterns.
meals
and avoid taking antacids with medications.
- hepatotoxic thus avoid alcohol.
- instruct the client that urine, feces, sweat, and tears will be red-orange in HISTAMINE – 2 BLOCKERS
color. Prototype :
- cimetidine (Tagamet), ranitidine (Zantac),
Pyrazinamide famotidine (Pepcid), nizatidine (Axid).
- given for 2 months. Mechanism of action:
- increase serum uric acid and cause photosensitivity. - blocks H2 receptors in the stomach, reducing
acid secretions.
Ethambutol Nursing considerations :
- contraindicated in children under 13 years old. - Given before or with meals
- obtain a baseline visual acuity because it can cause optic neuritis. - Avoid giving other drugs with cimetidine
- Instruct the client to notify the physician immediately if any visual problems - Gynecomastia may developed with chronic use of cimetidine.
occurs.
Streptomycin
- aminoglycoside antibiotic given IM. Proton – Pump Inhibitors (PPI)
- nephrotoxic and ototoxic. Prototype :
- obtain baseline audiometric test and repeat every 1-2 months because the - omeprazole (Losec), Lansoprazole (Lanz), pantoprazole (Pantoloc).
medications impairs the CN VIII. Mechanism of action :
- inhibit the proton H+ to combine with Cl- toform hydrochloric acid.
Nursing considerations :
DRUGS AFFECTING GASTROINTESTINAL SYSTEM - Given before meals preferably at morning.
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Indications :
Mucosal Barriers - ingestion of poisonous or toxic substances.
Prototype : Nursing considerations :
- sucralfate (Carafate), misoprostol (Cytotec). - Consult poison control center before induction of vomiting.
Mechanism of action : - Administer ipecac syrup with large amount of fluid.
- coats the mucosa to prevent ulcerations.
Nursing consideration : DRUGS AFFECTING THE ENDOCRINE SYSTEM
- Given before meals.
- Misoprostol is contraindicated for pregnants. THYROID AGENTS
- Sucralfate cause constipation. Prototype :
- Proloid (thryroglobulin )
- Synthroid (levothyroxine)
Anti-diarrheal Agents - Cytomel ( liothyronine).
Prototype : Mechanism of action :
- diphenoxylate (Lomotil), loperamide (Imodium), kaolin/pectin mixture - function as natural or synthetic hormones.
(Kaopectate). Nursing considerations :
Mechanism of actions : - Taken in the morning.
- decrease stomach motility and peristalsis. - Caution with coronary artery disease.
Nursing considerations : - Monitor for signs of hyperthyroidism and refer for decreasing the dose.
- Monitor for rebound constipation.
- Be cautious taking if with infectious diarrhea. PARATHYROID AGENTS
- Monitor atropine toxicity with diphenoxylate. Prototype :
- Clay, white or pale stool is common with kaopectate. a. calcitonin (Calcimar), etidronate (Didronel),
b. calcitrol (Rocaltrol), calcifediol (Calcedrol)
Laxatives Mechanism of action :
a. lactulose (Cephulac), Na biphosphate (Fleet a. reduce bone resorption
enema) & magnesium salt (Milk of Magnesia) b. promotes calcium absorption
- retain fluid and distend intestine Nursing considerations :
b. ducosate (Dialose) - Monitor signs of calcium imbalance
- emulsify fecal fat and water - Report for bone pains.
c. bisacodyl (Dulcolax) & senna (X-prep) - Remain sitting upright after taking etidronate.
- irritates intestinal mucosa and
stimulate intestinal smooth muscles Oral Hypoglycemic Agents (OHA)
d. bulk-forming laxative (Metamucil) 1. Sulfonylureas
- increase fecal bulk and water content - stimulate insulin secretions and increase tissue sensitivity to insulin.
e. mineral oil First Generation :
- lubricates & prevent colon absorption Chlorpropamide (Diabenese)
- disulfiram precautions
EMETICS Tolbutamide (Orinase)
Prototype : ipecac syrup, apomorphine - congenital defect
Mechanism of actions : Second Generation :
- induce vomiting through stimulation of vomiting center of medulla. Glypizide, Glymepiride
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2. Biguanides - Aspirate short acting first, then long or intermediate (cloudy).

- facilitates insulin action on the peripheral receptor site.
Metformin and Glucophage (Glucovance)
- side effect is lactic acidosis
3. Alpha-glucosidase inhibitors
- delay carbohydrate absorption in the intestinal system.
Acarbose (Precose) – side effect is diarrhea
4. Thiazolinidine
- increase tissue sensitivity of insulin.
Rosiglitazone (Avandia)
5. Meglitinides
- stimulate insulin release in pancreatic B-cells.
Repaglinide (Prandin)
- Alcohol is recommended for cleansing bottle but not with skin.
- Pinch skin, avoid I.M, don’t aspirate.
- Rotate the injection site an inch a part.
- Prefilled syringes are stored vertically, needle-up.
- May increase dose during illnesses.
- Used bottles stored in room temperature, unused bottle stored in refrigerator.
- Monitor for acute hypoglycemia :
a. 3-4 commercially prepared glucose tablet
b. 4-6 ounce of fruit juice or regular soda
c. 2-3 teaspoon or honey
d. Glucagon 1 gm SQ or IM
e. D50-50 IV.

Nursing considerations :
- Effective only for type II DM. ESTROGENS AND PROGESTINS
- Contraindicated to pregnant & breastfeeding. Prototype :
- Given before meals. - conjugated estrogen (Premarin), estrone (Bestrone), estradiol (Estrace),
- Monitor for signs of hypoglycemia. diethylstilbestrol (DES).
Indications :
- prostate cancer, contraceptions
- estrogen replacement
Adverse effects :
Insulin estrogen - endometrial CA, gallbladder disease, HPN, migraine, breast
Insulin Onset Peak Duration tenderness
progesterone - altered menstrual flow, risk of thrombo embolism
Immediate-acting 0.15h 0.5–1h 5h Nursing considerations :
(lispro) 1. Mix estrogen or progestins prior to IM administration by rolling vials
Short-acting 0.5-1 h 2-4 h 5-7h between palms.
(regular, semilente) 2. Monitor blood pressure
Intermediate-acting 1-3 h 6-12 h 18-24 h 3. Teach patient how to perform BSE.
(NPH, lente) 4. Regular follow-up examination is required to detect associated risk of
Long-acting 4-6h 10-30 h 24-36 h acquiring CA
(ultralente)
Mixed 0.5 h 4-8 h 25 h
(regular 30%, NPH 70%) DRUGS AFFECTING LABOR and LACTATION

Nursing considerations : Uterine Stimulating Agents

- Usually given before meals. Protoytpe :
- Roll the bottle in palm of hands, don’t shake. a. Oxytocin (Pitocin), ergonovine (Ergotrate), methylergonovine (methergine)
- Inject amount of air that is equal to each dose b. carbopost (Prostin), dinoprostone (Prostin E2)
into the bottle – short acting last (clear). Mechanism of actions :
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a. stimulates uterine smooth muscles 3. Quinolones - insomnia

b. ripening of cervix
Adverse reactions :
- fetal bradycardia (oxytocin),
- hypertension (ergonovine), palpitations
- allergic reactions (Prostaglandins)
Uterine Inhibiting Agents (Tocolytic)
Prototype :
- ritodrine (Yutopar), terbutaline (Brethine)
Mechanism of actions :
- relaxes the uterus by stimulating the B2- adrenergic receptors
Adverse effects :
- tremors, nausea, vomiting and tachycardia
4. Tetracyclines - bone problems
5. Chloramphenicol - Gray syndrome, bone marrow depression
6. Erythromycin - hepatitis
Nursing considerations :
1. Collect appropriate specimen for C & S before starting antibiotics.
2. Check client’s history of allergies.
3. Avoid administering erythromycin and quinolones with food.
4. Pregnant precautions.
5. Report for diarrhea - pseudomembranous colitis (clindamycin)
6. Monitor adverse effects.

Lactation Suppressants Antiviral Agents

Prototype : Prototype :
- bromocriptine (Parlodel) - acyclovir (Zovirax), ganciclovir (Cytovene),
Mechanism of action : vidarabine (Vira-A), amantidine (Symmetrel),
- decrease serum prolactin levels ribavirin (Virazole), zidovidine (Retrovir).
Adverse effects : Mechanism of actions :
- drowsiness, headache, nausea, palpitations - inhibits virus specific enzymes involve in DNA
synthesis. They only control the growth of
DRUGS FOR TREATING INFECTION virus but it does not cure.
Adverse effects :
Antibacterial Agents - granulocytopenia, thrombocytopenia, nausea,
1. Cell wall inhibitors nervousness, headache, nephrotoxicity.
a. penicillins - pen G, amoxicillin, cloxacillin
b. cephalosphorins - cephalexin, cefaclor Nursing consideration :
c. glycopeptide - vancomycin - Pregnant and breastfeeding precautions.
2. Protein synthesis inhibitors - Administer IV antivirals to avoid crystallization in renal tubules.
a. aminoglycosides - amikacin, gentamycin - Give ribavirin only with aerosol generator.
b. macrolide - erythromycins, roxithromycin - Monitor CBC and creatinine level.
c. lincosamides - clindamycins - Refer for signs of bleeding.
d. chloramphenicol, tetracyclines - Take amantidine after meals.
3. Antimetabolites - blocks folic acid synthesis
a. Sulfonamides - cotrimoxazole Antifungal Agents
4. DNA synthesis inhibitors Prototype :
a. quinolones - ciprofloxacin, ofloxacin - amphotericin B (Fungisone), nystatin,
b. metronidazole fluconazole (Diflucan), ketoconazole (Nizoral).
Adverse effects : Mechanism of actions :
1. Aminoglycoside - nephrotoxicity & ototoxicity - inhibit the synthesis of fungal sterol.
2. Sulfonamides - Steven-Johnson’s syndrome, photosynsetivity Adverse effects :
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- nephrotoxicity and neurotoxicity praziquantel (Biltricide).

- bone marrow depression Mechanism of actions :
- chills, fever, joint pains, abdominal pain and headache. - paralyze larva and adult helmints by acting on parasite microtubules.
Adverse effects :
- GI upset, urinary odor (thiabendazole)
Nursing considerations : - headache, dizziness, fatigue
- Dilute amphotericin B with sterile water solution not with electrolyte Nursing considerations :
solution. 1. Treat all the family members for nematodes infection to prevent recurrence.
- Tell clients that fever, chills, GI upset, joint and muscle pain will subside as 2. Praziquantel must swallowed rapidly because of its bitter taste to avoid
amphotericin B continues. gagging.
- With oral candidiasis, let nystatin tablet dissolve in mouth rather than 3. Other antihelmintics should be chewed.
swallowing it.
- Refrain ketoconazole with antacids.
- Report for signs of bleeding, infection & fatigue. ANTI-NEOPLASTIC DRUGS

General considerations :
ANTIPARASITIC AGENTS - kills or inhibit the reproduction of neoplasmic cells but as well as normal
Prototype : cells.
a. Antimalarial - it could be cell cycle phase specific or cell cycle non-specific.
- chlroquine, mefloquine, primaquine, - preferably given through IV route.
quinine, pyrimethamine
b. Antiamebiasis
- metronidazole (Flagyl), iodoquinol, Prototype :
furozolidone (Furoxone). 1. Alkylating Agents
Mechanism of actions : - inhibits cell production by causing cross linking of DNA
a. antimalarial – alters protozoal DNA, depleting folates, & reducing nucleic a. Busulfan – hyperuricemia
acid b. Chlorambucil – gonadal suppression
production c. Cisplatin – ototoxicity and nephrotoxicity
b. antiamoeba – block protein synthesis. d. Cyclophosphamide – hemorrhagic cystitis.
Nursing considerations : 2. Antitumor Antibiotic Agents
1. Administer anti-malarial drugs with food. - interfere in DNA and RNA synthesis
2. Take seizure precautions while administering a. Plicamycin – affects bleeding time
antimalarial drugs. b. Doxurubicin – cardiotoxicity
3. Refer cinchonism during quinine treatment: c. Bleomycin – pulmonary toxicity.
- tinnitus, headache, vertigo, fever, and visual changes.
4. Inform clients that iodoquinol falsify thyroid function test for up to 6 months.
3. Antimetabolites
- replace normal proteins required for DNA synthesis by inhibiting the S
ANTIHELMINTIC phase
Prototype : a. Cytarabine – hepatotoxicity
- mebendazole (Vermox), thiabendazole, b. 5-flourouracil – phototoxicity reaction and cerebellar dysfunctions
niclosamide (Niclocide), piperazine (Antepar), c. 6-marcaptopurine – hyperuricemia

d. Methotrexate – photosensitivity
- given with leucoverin to lessen its toxicity.
4. Mitotic Inhibitors (Vinca Alkaloids)
- prevent mitosis acting on the M phase causing cell death
a. Vincristine sulfate – neurotoxicity, numbness
5. Hormonal Medications and Enzymes
- block the normal hormones in hormone sensitive tumors
a. Tamoxifen citrate – visual problems
– elevate cholesterol & triglycerides level
b. Diethylstilbestrol – impotence and gynecomastia in men.
Side Effects:
stomatitis
- bland diet, avoid strong mouthwash
- soft tooth brush, ice chips
diarrhea, nausea and vomiting
- anti-emetic, replace fluids and electrolytes
alopecia
- reassure that it is temporary
- encourage o wear wigs, hats and head scarf
skin pigmentation
- inform that it is only temporary
tumor lysis syndrome
- hyperuricemia & hyperkalemia
- force fluids
infection
- notify physician if WBC is <2000/mm3
- monitor for signs of infection
- reverse isolation
- low bacteria diet
anemia
- iron, B-12, folic acid rich food
- provide rest periods
bleeding
- avoid NSAIDs
- minimize invasive procedures
- use soft toothbrush and electric razor
menstrual changes
- reassure that menstruation will resume.
THE END
REVIEW QUESTIONS
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SITUATION: Mr. Hero Fernando, a 60 year-old bank manager had
experienced a sensation of chest tightness, chest pain, sweating
and a feeling of apprehension. A diagnosis of CAD with angina
pectoris was established
1. The physician orders for nitroglycerin tablet. The nurse knows that the
pharmacological action of the drug is:
a. To dissolve the atheromatous plaque in the coronary artery
b. Constrict the venous vessels and capillaries
c. Dilate the coronary arteries
d. Decrease the myocardial consumption of oxygen
2. The nurse gave instructions to the patient on nitroglycerin intake. He
remarked, “I think I will try not to take too many of these pills.” At this
instance, the nurse’s BEST reply would be:
a. “I agree, nitroglycerin can cause drug addiction, that is why you
must not take too many of the pills”
b. “I must inform you that nitroglycerin is non-habituating and
you should take the pills many times to relieve the pain”
c. “You will be needing only three tablets to ease the pain and if
unrelieved, you must seek medical attention”
d. “ There is no problem with continuous daily intake because
nitroglycerin does not cause a tolerance effect”
3. The nurse must emphasize to the patient which ONE of the following
side-effects of nitroglycerin:
a. Headache c. Nausea and vomiting
b. Hypertension d. Visual changes
4. What other information must the nurse provide to the patient taking
the nitroglycerin?
a. Keep the tablet in a clear container
b. Take the tablet with meals
c. Continue to take as many tablets of nitroglycerin until chest
pain subsides
d. A burning sensation under the tongue is expected
5. The nurse applies the ordered nitroglycerin ointment on the patient’s
chest wall. Which nursing action is considered inappropriate?
a. The nurse chooses a hairless area
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b. She spreads the ointment with her fingers
c. She removes the ointment on the skin from the previous dose
d. She rotates the sites of ointment application
6. The nurse gives which of the following discharge instructions to this
patient with angina regarding nitroglycerin therapy?
a. Only take the nitroglycerin as desired
b. The drug should be taken before engaging in exertional
activities
c. The tablet should be taken only in the morning
d. If the drug does not relieve the pain, increase the frequency of
the dose
7. Hero asked the nurse what he could do about his concern about sex
activity. The nurse best suggests:
a. Tell him to avoid sex for several months while his heart is on
therapy
b. Suggests that his wife assume the top position
c. Tell him to avoid sex on days when he is anxious
d. Advise that he should have sex only once a month
8. The nurse understands that her discharge teaching is effective
regarding life style modification when the patient says:
a. “I know that I will need to eat less, so I will eat once a day only”
b. “I will stay on bed most of the time so I wont experience chest
pain”
c. “I will stop what I’m doing whenever I have pain and take the
pill”
d. “I need to enroll in a gym class to have a vigorous exercise to
condition my heart”
SITUATION: Manny is admitted to the medical ward with the diagnosis
of essential hypertension. He had hypertensive emergency 2 hours ago
and was hospitalized for further observation.
9. The nurse administers prescribed anti-hypertensive meds. If it can be
any of the following, she will check the pulse prior to giving:
a. Nifedipine
b. Metoprolol
c. Clonidine
d. Captopril
10. After administering a blood-pressure lowing agent, the nurse must
caution the patient:
a. To avoid straining during defecation
b. To avoid low-sodium and potassium diet
c. To avoid abrupt change of positions
d. To take warm shower immediately after taking the drug
11. The nurse prepares to give a diet appropriate for a hypertensive
patient. Which food should the nurse include in the menu?
a. Canned meat loaf
b. Scallops and shrimps
c. Fresh citrus juice and cake
d. Butter and pork steaks
12. If the physician orders Captopril as the home medication for the high
BP, the nurse must caution that the side-effect of this drug that is
disturbing is:
a. Rashes
b. Cough
c. Pruritus
d. Ringing of the ears
13. If the client is discharged with home medication of Propranolol
hydrochloride, the nurse must include in her medication-teaching plan
which one?
a. Take the medication on an empty stomach
b. Obtain blood pressure readings regularly
c. Perform active exercises to prevent Hypotension
d. Caution to avoid hazardous activities after taking the drug
14. The nurse determines that the following drugs are calcium channel
blockers that can be prescribed by the physician to the patient. One is
not included:
a. Nifedipine
b. Verapamil
c. Telmisartan
d. Diltiazem
SITUATION: Joseph,, 50 y.o. Businessman awakens in the middle of the
night with dyspnea, bilateral basilar rales and frothy sputum. He is
brought to the Mulawin hospital. His diagnosis is congestive heart
failure.
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15. The physician gives the patient furosemide and digoxin. The nurse’s d. Flavored gelatin and iced tea
main concern is to:
a. Take the central venous pressure reading 21. The nurse obtains an apical pulse of 78 beats/min. She is bringing the
b. Observe for decrease edema next dose of digoxin and then proceeds to do which one action below?
c. Observe for signs and symptoms of hypokalemia a. Withhold the drug and notify the physician
d. Force fluids b. Start IV infusion of Digibind (digoxin antibody)
c. Instruct patient to consume more meat and nuts
16. The mechanism of action of dioxin that makes it useful in patients with d. Administer the drug
CHF is that it:
a. Produces a negative inotropic effect SITUATION: Armida, an 18-year-old adolescent is seen in the health
b. Increases cardiac conduction center because of easy fatigability and frequent dizziness
c. Enhances cardiac contractility 22. The health center physician determines that she has iron-deficiency
d. Increases the heart rate anemia. The nurse will anticipate the doctor to order for:
a. Bone marrow aspiration
17. The nurse is very vigilant about digoxin overdose. Which one statement b. Hemoglobin level determination
below by the patient may alert the nurse of a possible development of c. Platelet count
toxicity? d. BUN and Creatinine
a. “Nurse, I don’t feel like eating for the past few days” 23. A drug is administered to correct anemia, such as an iron. This drug is
b. “I am having constipation lately” classified as:
c. “I am developing a nagging cough and night terrors” a. Antihelminthic
d. “I am experiencing dryness of the eyes and sandy sensation” b. Anticoagulant
c. Hematinic
18. The nurse evaluates that the drug digoxin is effective when the patient d. Antihistaminic
manifests:
a. Decreased bowel sounds 24. The nurse administers the oral iron tablet. She will give the medication:
b. Increased urine output a. With milk and dairy products
c. Increased drowsiness b. With antacids to minimize gastric upset
d. Decreased sympathetic response of the body c. With fruit juices like calamansi and orange
d. With a full glass of coffee or tea
19. The following manifestations must be assessed by the nurse to detect
beginning digitalis toxicity, with the exception of: 25. The nurse instructs the patient to eat iron-rich foods. She determines
a. Nausea and vomiting that her teaching is effective when the client will choose:
b. Palpitations a. Pomelo juice and hamburger
c. Diplopia and visual yellow-green halos b. Gelatin and marshmallows
d. Hypertension c. Lean meat and buttered corn
d. Liver and eggyolk
20. The nurse instructs the patient on diet modification during digitalis
therapy. She is certain that her teaching is effective when the patient 26. The doctor decides to order Iron dextran one ampoule. The nurse
will choose all the foods items below, except: prepares to administer the drug:
a. Fresh orange juice and potato fries a. Intravenously. Slow IV push
b. Dried mangoes and tomato juice b. Intamuscular, Z-track method
c. Broccoli salad with bean sprouts c. Subcutaneous
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d. Intrathecal c. Partial thromboplastin time

d. Prothrombin consumption test
27. The nurse must warn the patient taking oral iron preparations that it
can cause which side effect/s? 32. The above laboratory value must is considered therapeutic if the result
a. Yellowish discoloration of the skin and mucus membrane is about:
b. Darkening of stool color a. 3 times the normal
c. Anorexia and loss of hair b. 2 times the normal
d. Ulceration of the skin and cough c. Equals the normal
d. Less than the normal
28. The patient remained pale and weak, upon further examination, it was
determined that she has pernicious anemia. The pathophysiology of 33. The nurse must administer heparin to Mrs. Amor. She determines that
this hematological disorder is: the most common routes of administration are:
a. Absence of Vitamin E in the diet a. IV and IM
b. Presence of excessive iron in the liver b. SC and IV
c. Absence of intrinsic factor in the stomach c. ID and IM
d. Temporary bone marrow depression. d. IV and intrathecal

DRUGS THAT AFFECT THE HEMATOLOGICAL SYSTEM 34. When the nurse is monitoring the patient for heparin overdose, she is
SITUATION: Mrs. Rosalinda Amor, 23 year-old actress is admitted observing for the following signs/symptoms, except?
because of a diagnosis of deep vein thrombosis. a. Ecchymoses
29. The nurse employs which of the following non-pharmacological b. Positive Homan’s sign
measures in caring for Mrs. Amor? c. Dark, cola-colored urine
a. Ice compress over the involved leg TID d. Epistaxis
b. Elevate the legs with a pillow
c. Maintain on strict bed rest with minimal bathroom privileges 35. Which one effect of heparin therapy will cause nursing concern?
d. Massage the involved area a. Thrombocytopenia
b. Constipation
30. The physician orders Heparin sodium for Mrs. Amor. The nurse c. Bone marrow depression
understands the reason for this therapy is that: d. Dizziness
a. Heparin will dissolve the clots in the inflamed veins to prevent
emobolization 36. In the event of an overdose of heparin injection, the nurse prepares
b. There is a need to prevent further clot formation in the which one antidote for toxicity?
involved vessels a. Phytomenadione
c. Heparin will anticoauglate the blood by inhibiting vitamin K b. Atropine Sulfate
metabolism c. Protamine sulfate
d. The clot formed in the vein must be lysed by activating plasmin, d. Deferoxamine chelators
the action of heparin
37. The doctor switched from standard heparin to low molecular weight
31. If the doctor orders for heparin therapy monitoring, the nurse must heparin injection. The advantage of LMWH over the standard heparin
obtain which laboratory tests from the lab unit? is:
a. Prothrombin time a. The LMWH can be administered IM
b. Clotting time b. The LMWH does not need frequent laboratory monitoring
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c. The LMWH has a better potency

d. The LMWH does not cause bleeding problems
38. The nurse reads the chart and notes for an order of oral Warfarin
sodium, while the patient is on heparin therapy. The nurse will:
a. Question the order because of potential excessive bleeding if
given simultaneously
b. Administer the drug as ordered
c. Withhold the heparin and administer the Warfarin orally
d. Report the error to the nurse supervisor as the patient may be
at risk for toxicity
39. IF Mrs. Amor is discharge with warfarin sodium, the nurse must include
in her discharge teaching which one?
a. Keep Vitamin A ampule available for injection c/o the health
center in case of emergency
b. Report any bright red blood in the stool or urine
c. Take aspirin to manage the headache side-effect of the drug
d. Utilize firm toothbrush when brushing to prevent build up of
plaques and gingival hyperplasia
40. The nurse must remind the patient that warfarin therapy is monitored
with the use of which laboratory examinations?
a. PT and PTT
b. PT and INR
c. Clotting time and bleeding time
d. Platelet count and PT
SITUATION: Mrs. Avery had a previous attack of mild stroke and
coronary artery disease. She is taking Aspirin.
41. The reason aspirin is utilized as an anti-platelet medication is because:
a. Aspirin can prolong the bleeding time
b. Aspirin affects the thromboxane production of the platelet
c. Aspirin interferes with the receptor binding of the platelets
d. Aspirin blocks the degranulation process inhibiting release of
histamine
42. The nurse administers aspirin:
a. On an empty stomach to increase absorption
b. With meals
c. In Between meals
d. Intramuscularly
43. Mrs. Avery had a sudden severe and prolonged chest pain. Acute MI is
suspected. The nurse anticipates the doctor to order a fibrinolytic, and
this may be:
a. Tranexamic Acid
b. Dipyridamole
c. Steptokinase
d. Coumadin
44. If the above drug is ordered to be given IV drip, the nurse must be
aware of which potential effect?
a. Hypersensitivity reaction
b. Congestive heart failure
c. Further damage to the myocardium
d. Excessive clot formation
45. If the patient is receiving tissue-plasminogen activator, the nurse must
make which one priority intervention?
a. Have heparin sodium available
b. Monitor closely the renal status
c. Observe for psychotic symptoms
d. Obtain a stand by Aminocaproic acid
SITUATION: A patient is determined to have hypercholesterolemia and
is admitted in the hospital for treatment of her condition. The doctor
ordered Lovastatin OD.
46. The nurse determines that the BEST time to give the drug is:
a. In the morning before breakfast to promote absorption
b. In the afternoon to promote sleep because it is sedating
c. At bedtime
d. In between meals
47. The nurse is knowledgeable about the mode of action of lovastatin that
it:
a. It Inhibits the formation of chylomicrons in the intestinal cells
b. It prevents the enzyme that synthesizes cholesterol
c. It binds with bile acids and cholesterol promoting excretion
d. It promotes cholesterol metabolism in the adipose tissue to
lower the plasma cholestero
48. The nurse is prepared to provide comfort measure to the common side
effects of the drug. She monitors the patient for:
a. Abdominal fullness, flatulence and diarrhea
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b. Confusion and psychoses e. Canned goods and wine

c. Palpitations and arrhythmias
d. Hypertension and rashes 53. The patient is receiving theophylline capsule OD. The nurse cautions
the patient to avoid foods with components similar to theophyline and
49. The nurse must monitor for these serious adverse effects of lovastatin. they can be:
Which one is not included? a. Sugar and cream
a. Glaucoma b. Coffee and chocolate
b. Cataract c. Spinach and broccoli
c. Myositis d. Beans and aged cheese
d. Hepatic failure e. Canned goods and wine

The nurse reads the drug order sheet and is most concern to 54. The nurse is administering acetylcysteine nebulization to a patient. It is
consult the physician if he orders: very much important to keep which item below at bedside?
e. Paracetamol a. Scissors
f. Gemfibrozil b. Ambu bag
g. Vitamin supplements c. Suction machine
h. Omeprazole d. Tracheostmy set
e. NG tube
50. The nurse is giving Guaifenesin to a patient. She includes in her
teaching which of the following interventions? 55. After giving diphenhydramine to the patient, the nurse must ensure
a. Warn the patient that extreme drowsiness may occur that the patient understands the teachings below, EXCEPT:
b. Offer a full glass of water a. Refrain from manipulating delicate machines
c. Nausea and vomiting are potential problems alleviated by b. Take sugarless candy in the mouth to relieve dryness
small frequent meals c. Avoid taking the drug with alcohol
d. Suggest to buy a nebulizer machine to be used at home d. Check pulse rate before taking the drug
e. Vitamin ADEK supplements because of impaired absorption e. Manage gastric upset by taking it with food

51. To be able to detect the effectiveness of Salbutamol, the nurse should 56. The nurse watches out for a side-effect associated with intake of
check for: codeine sulfate and provides appropriate intervention, this can be:
a. Blood pressure and CVP readings a. Constipation- provide liberal fluids
b. Urinary output per hour b. Excitement- provide less stimulation
c. Breath sounds c. Tachycardia- administer lidocaine
d. Level of consciousness d. Polyuria- give the drug in the morning
e. Pupillary reflexes e. Tachypnea- position on semi-fowler’s

52. The patient is receiving theophylline capsule OD. The nurse cautions
the patient to avoid foods with components similar to theophyline and
they can be: 57. Terbutaline sulfate is administered to a patient with asthma. If the
a. Sugar and cream patient has another disease, the nurse is most vigilant and cautious if
b. Coffee and chocolate this condition exists:
c. Spinach and broccoli a. Hypothyroidism
d. Beans and aged cheese b. Rheumatoid arthritis
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c. Diabetes mellitus 62. The second generation anti-histamines like cetirizine have the
d. Polycystic ovarian disease advantage over the first generation antihistamines like
e. Emphysema diphenhydramine because second generation antihistamines:
a. Have shorter duration of action that can be reversed rapidly
58. The nurse is administering oxymetazoline nasal decongestant. She b. Have less sedation and anticholinergic properties
includes in her care plan all of the following interventions, EXCEPT? c. Posses less drug sensitivity reactions
a. Instruct the patient to clear the nasal passage of mucus before d. Have a greater safety profile
instilling e. Have less abuse potential
b. Remind patient to keep the head tilted for a few seconds after
administration 63. The nurse cautions the patient taking diphenhydramine (Benadryl) to
c. Advise increased fluid intake expect all of the following side effects, except?
d. Encourage the use for one week for better effect a. Dry mouth
e. Caution that tachycardia and urinary retention may occur with b. Blurred vision
systemic absorption c. Urinary frequency
d. Drowsiness
59. The physician asks the nurse for an anticholinergic drug to be used for e. Dizziness
the asthmatic patient. The nurse obtains from the pharmacy which
drug? 64. The nurse must remember to administer theophylline slowly or with an
a. Albuterol infusion pump because this drug, if given rapidly can cause:
b. Terbutaline a. Increased alertness
c. Metaproterenol b. Severe hypotension
d. Ipratropium bromide c. Tachycardia
e. Salbutamol d. Pallor
e. Headache
60. The physician orders dextromethorphan for a patient who is
complaining of very uncomfortable coughing. The nurse understands
that this drug acts to suppress cough by:
a. Increasing the secretions of the bronchial glands
b. Removing the irritation from the respiratory tract
c. Inhibiting the medulla oblongata cough center
d. Inhibiting the stretch receptors in the lungs
e. Triggering the vagal responses

61. Inhaled corticosteroid like beclomethasone is administered to the

patient with asthma. It is important for the nurse to stress that this
drug:
a. Acts rapidly to decrease inflammation
b. Promotes the secretion of mucus
c. May depress the immune function
d. Highly effective in terminating acute asthma attack
e. Is habituating and addicting