Pharmacology Notes

MISAMIS UNIVERSITY
Ozamiz City 7200, Philippines

Tel No. +63 88 521-0367 / Telefax No. +63 88 521-2917
E-mail Address: mu@mu.edu.ph
CERTIFIED: ISO 9001:2015 Risk Management – Det Norske Veritas, The Netherlands
ACCREDITED: Philippine Association of Colleges and Universities Commission on Accreditation
(PACUCOA)
HANDOUTS
MODULE 1.1 – 2.4
PHARMACOLGY
Prepared by: Celada, Kyrriel J.

November 2, 2020
Module 1.1
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PHARMACOLOGY BASICS
INSTRUCTION TO PHARMACOLOGY
LEARNING OUTCOME
 Discuss the basic concepts of pharmacology and their application to drug therapy.
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INTRODUCTION TO PHARMACOLOGY
 PHARMACOLOGY
o Is the study of the biological effect of chemicals.
 DRUGS
o Are the chemicals that are introduced into the body to cause some sort of change.
 PHARMACOTHERAPEUTICS
o Or clinical pharmacology, the branch of pharmacology that uses drugs to treat, prevent, and
diagnose disease
SOURCES OF DRUGS
 NATURAL SOURCES
o Chemicals that might prove useful as drugs can come from many natural sources, such as plants,
animals, or inorganic compounds.
 PLANTS
 ANIMAL SOURCES
 INORGANIC COMPOUNDS
 SYNTHETIC SOURCES
o Drugs are developed synthetically after chemicals in plants, animals, or the environment
DRUGS AND THE BODY
 PHARMACODYNAMICS
o Is the process by which a drug works or affects the body.
o Drugs may work by replacing a missing body chemical, by stimulating or depressing cellular
activity, or by interfering with the functioning of foreign cells.
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 PHARMACOKINETICS
o is the study of how the body deals with a drug.
o The balance of absorption, distribution, metabolism and excretion of the drug determine the
concentration of a drug in the body.
 ABSORPTION
o refers to what happens to a drug from the time it is introduced to the body until it reaches the
circulating fluids and tissues
 DISTRIBUTION
o involves the movement of a drug to the body’s tissues
 METABOLISM
o the chemical reactions that the body uses to convert drugs and other chemicals into nontoxic
substances
 EXCRETION
o is the removal of a drug from the body
FACTORS INFLUENCING DRUG EFFECTS
 Weight
 Age
 Gender
 Physiological factors (e.g. diurnal rhythm, electrolyte balance, etc.)
 Pathological factors (e.g. disease)
 genetic factors
 Immunological factors
 Psychological factors
 Environmental factors
 Drug tolerance
 Cumulation effects
 Interactions
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THE NURSING PROCESS IN PHARMACOLOGY

LEARNING OUTCOMES
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MISAMIS UNIVERSITY
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Summarize the pharmacology basics, including the key concepts of pharmacokinetics, pharmacodynamics, and
pharmacotherapeutics, key types of drug interactions and adverse reactions, and the nursing process.
TOPIC OUTLINE:
Nursing Process in Pharmacology
 Assessment
 Nursing Diagnosis
 Planning
 Implementation
 Evaluation
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 ASSESSMENT
o Before Administration, During Administration, After Administration
 Prior to administration:
 Obtain a complete health history including data on anaphylaxis, asthma, or
cardiac disease, plus allergies, drug history, and possible drug interactions.
 Obtain ECG and vital signs; assess in context of client’s baseline values.
 Assess respiratory status, especially breathing pattern.
 Assess neurological status and level of consciousness.
NURSING DIAGNOSIS
o NANDA International defines the nursing diagnosis as a “clinical judgment about individual,
family, or community responses to actual or potential health problems or life processes.”
 Potential Nursing Diagnosis
 Airway Clearance, Ineffective
 Breathing Pattern, Ineffective
 Sleep Pattern, Disturbed, related to somnolence or agitation
PL ANNING: PATIENT OUTCOMES
o A written care plan serves as a communication tool among health care team members that helps
ensure continuity of care.
 The plan consists of two parts:
1. Patient outcomes, or expected outcomes, which describe behaviors or results
to be achieved within a specific time
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2. Nursing interventions needed to achieve those outcomes.
 Planning: Client Goals and Expected Outcomes
 The client will:
o Report relief allergic symptoms such as congestion, itching, or postnasal
drip
o Demonstrate an understanding of the drug’s action by accurately
describing drug side effects and precautions.
IMPLEMENTATION
o Implementation can involve a multidisciplinary approach, depending on the needs of the patient
and his family
 THERAPEUTIC INTERVENTION
 PATIENT/FAMILY EDUCATION
 DISCHARGE PLANNING
EVALUATION
o Evaluation is an ongoing process, and reassessment leads to the development of new nursing
diagnoses and nursing interventions based on the patient’s response to treatment.
o Based on the outcome criteria established during planning
 Evaluation of Outcome Criteria
 Evaluate the effectiveness of drug therapy by confirming the client goals and
expected outcomes have been met.
 The client reports of allergic symptoms such as urticaria, congestion, and
postnasal drip.
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MODULE 2.1 HEMATOLOGIC DRUGS

ELABORATING NURSING RESPONSIBILITIES ON HEMATOLOGIC DRUG
LEARNING OUTCOMES
Elaborate nursing responsibilities, using the nursing process, on the different classes of drugs that affect the
blood and cardiovascular, and respiratory systems, uses and actions of these drugs, absorption, distribution,
metabolization, and excretion of these drugs, drug interactions and adverse reactions to these drugs.
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HEMATINIC DRUGS: IRON

Pharmacotherapeutics:
 Iron: Iron deficiency anemia
 Vitamin B12: Pernicious anemia
 Folic Acid: Megaloblastic anemia and Alcohol abuse
 Epoetin Alfa: Normocytic anemia and Chronic renal failure
Pharmacokinetics:
 Iron: Oral parenteral
 Vitamin B12: Parenteral, oral, and intranasal forms
 Folic Acid: Synthetic folic acid is readily absorbed
 Epoetin Alfa: Subcutaneous, IV
Pharmacodynamics:
 Iron: Production of hemoglobin
 Vitamin B12: Replaces vitamin B12 that the body normally would absorb from the diet
 Folic Acid: For normal RBC production and growth.
 Epoetin Alfa: Structurally like erythropoietin
DRUG INTERACTIONS
 Antacids
 Spinach
 Whole-grain breads and cereals
 Coffee and tea
 Eggs
 Milk products
 Tetracycline
 Cimetidine
ADVERSE REACTIONS
 Gastric irritation
 Constipation
 Teeth stain
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IMPLEMENTATION
 Don’t give iron dextran with oral iron preparations.
 If administering iron IM, use a 19G or 20G needle that’s 2′′ to 3′′ long. Inject into the upper outer
quadrant of the buttock. Use the Z-track method to avoid leakage into subcutaneous tissue and staining
of the skin.
 Minimize skin staining with IM injections of iron by using a separate needle to withdraw the drug from
its container.
 IV iron is given if the patient has insufficient muscle mass for deep IM injection
 Promote a varied diet that’s adequate in protein, calories, minerals, and electrolytes.
 Encourage foods high in iron as applicable to help delay the onset of iron deficiency anemia.
 Administer IV fluids and electrolytes as necessary to provide nutrients. Oral food intake or tube feedings
are preferable to IV therapy.
 Promote measures to relieve anorexia, nausea, vomiting, diarrhea, pain, and other signs and symptoms.
 Arrange for a nutritional consult as needed.
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HEMATINIC DRUGS: VITAMIN B12

DRUG INTERACTIONS
 Alcohol
 Aspirin
 Amino Salicylic Acid
 Neomycin
 Chloramphenicol
 Colchicine
ADVERSE REACTION: N/A
IMPLEMENTATION
 Correct underlying disorders that contribute to mineral and electrolyte deficiency or excess.
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__________________________________________________________________________________________
HEMATINIC DRUGS: FOLIC ACID

DRUG INTERACTIONS
 Methotrexate
 Sulfasalazine
 Hormonal contraceptives
 Aspirin
 Triamterene
 Pentamidine
 Trimethoprim
 Phenytoin
ADVERSE REACTIONS
 Erythema
 Itching
 Rash
 Anorexia
 Nausea
 Altered sleep patterns
 Difficulty concentrating
 Irritability overactivity
IMPLEMENTATION
 If using the IM route, don’t mix folic acid and other drugs in the same syringe.
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HEMATINIC DRUGS: EPOETIN ALFA

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DRUG INTERACTIONS: N/A
ADVERSE REACTION
 Hypertension
 Headache
 Joint pain
 Nausea and vomiting
 Edema
 Diarrhea
 Seizures
 Chest pain
 Skin reactions at the injection site
 Dizziness
 Deep vein thrombosis
 Transient ischemic attack.
IMPLEMENTATION
 Give the IV form of the drug by direct injection.
 Additional heparin may be needed to prevent blood clotting if the patient is on dialysis.
 Promote a varied diet that’s adequate in protein, calories, minerals, and electrolytes. Delaying tactics
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ANTICOAGUL ANT DRUGS: HEPARIN

 Heparin: Venous thromboembolism, Disseminated intravascular coagulation and Acute myocardial
infarction
 Warfarin: thromboembolism
 Antiplatelet: Several indications
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Pharmacokinetic:
 Heparin: Continuous IV infusion
 Warfarin: Oral anticoagulants
 Antiplatelet: Oral- 1-2 hours and IV – 15-20 minutes
Pharmacodynamics:
 Heparin: Inhibits the formation of thrombin and fibrin by activating antithrombin III
 Warfarin: Alters the ability of the liver to synthesize vitamin and K–dependent clotting factors
 Antiplatelet: Aspirin inhibits clot formation by blocking the synthesis of prostaglandin and Clopidogrel
inhibits platelet aggregation by inhibiting platelet fibrinogen binding
DRUG INTERACTIONS
 Oral anticoagulants
 NSAIDs Iron dextran
 Antihistamines
 Digoxin
 Nicotine
 Nitroglycerin
 Protamine sulfate
ADVERSE REACTIONS
 Bleeding
 Bruising
 Hematoma formation
 Necrosis of the skin
 Thrombocytopenia
IMPLEMENTATION
 Carefully and regularly monitor PTT. Anticoagulation is present when PTT values are 11 /2 to 2 times
the control values.
 Don’t administer heparin IM; avoid IM injections of any anticoagulant, if possible.
 Keep protamine sulfate available to treat severe bleeding caused by the drug.
 Notify the prescriber about serious or persistent adverse reactions.
 Maintain bleeding precautions throughout therapy.
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 Administer IV solutions using an infusion pump, as appropriate.
 Avoid excessive IM injection of other drugs, to minimize the risk of hematoma.
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ANTICOAGUL ANT DRUGS: WARFARIN

DRUG INTERACTIONS:
 A diet high in vitamin
 K Phenytoin
ADVERSE REACTIONS
 Minor bleeding
 Bruises and hematomas
 Neurosis or gangrene of the skin
 Warfarin is contraindicated during pregnancy. The effects of oral anticoagulants can be reversed with
phytonadione (vitamin K1).
IMPLEMENTATION
 Carefully and regularly monitor PT and INR values.
 Keep vitamin K available to treat frank bleeding caused by warfarin.
 Administer the drug at the same time each day.
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ANTICOAGULANT DRUGS: ANTIPLATELET DRUGS

DRUG INTERACTIONS
 Antacids
 Cimetidine
 Methotrexate
 Valproic acid
ADVERSE REACTIONS
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 Anaphylaxis
 Bleeding
 Stomach pain
 Heartburn
 Nausea
 Constipation
 Blood in the stool
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THROMBOLYTIC DRUGS
Pharmacotherapeutics: Thromboembolic disorders
To dissolve thrombi in arteriovenous cannulas
Pharmacokinetics: IV or intracoronary
Pharmacodynamics
Thrombolytic drugs convert plasminogen to plasmin, which lyses (dissolves) thrombi, fibplasma proteins.
DRUG INTERACTIONS
 Heparin
 Antiplatelet drugs
 NSAIDs
 Thrombolytic drugs convert plasminogen to plasmin, which lyses (dissolves) thrombi, fibrinogen and
other plasma protein.
ADVERSE REACTIONS
 Bleeding
 Allergic responses
IMPLEMENTATION
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 Administer IV solutions using an infusion pump as appropriate; reconstitute solutions according to
facility protocol.
 Avoid excessive IM, IV, or subcutaneous administration of other drugs to minimize the risk of
hematoma.
 Administer heparin with thrombolytics according to facility protocol.
 Have antiarrhythmics available; monitor cardiac status closely.
 Avoid invasive procedures during thrombolytic therapy.
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MODULE 2.1 RESPIRATORY DRUGS

Elaborating Nursing Responsibilities on Respiratory Drugs
LEARNING OUTCOMES
 Elaborate nursing responsibilities, using the nursing process, on the different classes of drugs that affect
the blood and cardiovascular, and respiratory systems, uses and actions of these drugs, absorption,
distribution, metabolization, and excretion of these drugs, drug interactions and adverse reactions to
these drugs.
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BETA2-ADRENERGIC AGONISTS
Pharmacotherapeutics
Asthma and COPD prevention of exercise-induced asthma
Pharmacokinetics
Oral, inhalation
Pharmacodynamics
Relax smooth muscle in the airways and allow increased airflow to the lungs.
DRUG INTERACTIONS
 Beta-adrenergic blockers
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ADVERSE REACTIONS
 Paradoxical bronchospasm
 Tachycardia
 Palpitations
 Tremors
 Dry mouth
 Hypertension
IMPLEMENTATION
 Report insufficient relief or worsening condition.
 Obtain an order for a mild analgesic if a drug-induced headache occurs.
 Don’t use long-acting beta2-adrenergic agonists for reversing bronchospasm during an acute asthma
attack.
 For the inhalation formulation, teach the patient to hold his breath for several seconds after inhalation
and wait at least 2 minutes before taking another inhalation of the drug.
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ANTICHOLINERGICS (IPATROPIUM)
Asthma
COPD
Rhinorrhea
Pharmacokinetics
Inhalation
Pharmacodynamics
Inhibits muscarinic receptors, which results in bronchodilation.
DRUG INTERACTIONS
 Antimuscarinic
 Anticholinergic agents
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ADVERSE REACTIONS
 Nervousness
 Tachycardia
 Dizziness
 Headache
 Paradoxical bronchospasm
 Difficulty urinating
 Constipation
 Dry mouth
IMPLEMENTATION
 Report insufficient relief or a worsening condition.
 Obtain an order for a mild analgesic if a drug-induced headache occurs.
 Be aware that the drug isn’t effective for treating acute episodes of bronchospasm when rapid response
is needed.
 Monitor the medication regimen. Total inhalations shouldn’t exceed 12 in 24 hours, and total nasal
sprays shouldn’t exceed 8 in each nostril in 24 hours.
 If more than one inhalation is ordered, 2 minutes should elapse between inhalations. If more than one
type of inhalant is ordered, always give the bronchodilator first and wait 5 minutes before administering
the other inhalant.
 Give the drug on time to ensure maximal effect.
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CORTICOSTEROIDS
Treatment and prevention of asthma exacerbations
Pharmacokinetics
Oral
IV
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Pharmacodynamics: Inhibit the production of cytokines, leukotrienes, and prostaglandins; the recruitment of
eosinophils; and the release of other inflammatory mediators
DRUG INTERACTIONS
 Hormonal contraceptive
 Ketoconazole
 Macrolide antibiotics
 Barbiturates
 Cholestyramine
 Phenytoin
ADVERSE REACTIONS
 Mouth irritation
 Oral candidiasis
 Upper respiratory tract infection
 Cough and hoarseness
 Hyperglycemia
 Headache
 Insomnia
 Growth suppression in children
IMPLEMENTATION
 Report insufficient relief or worsening of condition.
 Give oral doses with food to prevent GI irritation.
 Take precautions to avoid exposing the patient to infection.
 Don’t stop the drug abruptly.
 Avoid prolonged use of corticosteroids, especially in children.
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EXPECTORANTS-GUAIFENESIN
Pharmacotherapeutics Colds
Minor bronchial irritation
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Bronchitis
Influenza
Sinusitis
Bronchial asthma
Emphysema.
Pharmacokinetics: Oral
Pharmacodynamics: Reduces the thickness, adhesiveness, and surface tension of mucus, making it
easier to clear it from the airways. It also provides a soothing effect on mucous
membranes of the respiratory tract.
DRUG INTERACTIONS:
 N/A
ADVERSE REACTIONS
 Vomiting
 Diarrhea
 Drowsiness
 Nausea
 Abdominal pain
 Headache
 Hives or skin rash
IMPLEMENTATION
 Administer the medication as directed; give with a full glass of water as appropriate.
 Be aware that the drug may interfere with laboratory tests for 5-hydroxyindoleacetic acid and
vanillylmandelic acid.
 Report ineffectiveness of the drug to the prescriber; also report if the patient’s cough persists or if signs
and symptoms worsen.
 Encourage the patient to perform deep-breathing exercises.
 Advise the patient not to take other medications, OTC products, or herbal remedies unless approved by
the prescriber or a pharmacist.
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ANTITUSSIVES
Pharmacotherapeutics: Serious, nonproductive cough
Pharmacokinetics: Oral. Excreted in breastmilk.
Pharmacodynamics: Suppress the cough reflex by direct action on the cough center in the medulla of
the brain, thus lowering the cough threshold
DRUG INTERACTIONS
 Monoamine oxidase (MAO) inhibitors
 Alcohol
 Barbiturates
 Sedative-hypnotics
 Phenothiazines
IMPLEMENTATION
 Advise the patient not to take other medications, OTC products, or herbal remedies until talking with the
prescriber or a pharmacist.
 Tell the patient taking an opioid antitussive to avoid driving and drinking alcohol.
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DECONGESTANTS
Pharmacotherapeutics: Allergic rhinitis
Vasomotor rhinitis
Acute coryza
Sinusitis
Pharmacodynamics: Cause vasoconstriction by directly stimulating alpha-adrenergic receptors in the
blood vessels of the body
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DRUG INTERACTIONS
 Epinephrine and norepinephrine
 Dopamine
 Dobutamine
 Isoproterenol
 MAO inhibitors
ADVERSE REACTIONS
 Nervousness
 Restlessness and insomnia
 Nausea
 Palpitations and tachycardia
 Difficulty urinating
 Elevated blood pressure
IMPLEMENTATION
 Advise the patient not to take other medications, OTC products, or herbal remedies until talking with the
prescriber or a pharmacist.
 Identify and correct hypoxia, hypercapnia, and acidosis, which may reduce drug effectiveness or
increase adverse reactions, before or during ephedrine administration.
 Don’t crush or break extended-release forms of the drug.
 Give the last dose at least 2 hours before bedtime to minimize insomnia.
 Instruct the patient to limit his use of intranasal forms to 3 to 5 days to prevent rebound congestion.
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MODULE 2.1 CARDIOVASCULAR DRUGS

Elaborating Nursing Responsibilities on Cardiovascular Drugs
LEARNING OUTCOMES
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 Elaborate nursing responsibilities, using the nursing process, on the different classes of drugs that affect
the blood and cardiovascular, and respiratory systems, uses and actions of these drugs, absorption,
distribution, metabolization, and excretion of these drugs, drug interactions and adverse reactions to
these drugs.
__________________________________________________________________________________________
PRELOAD
 Volume of blood in ventricles at end of diastole (end diastolic pressure)
o Increased in:
 Hypervolemia, Regurgitation of cardiac valves, Heart Failure
AFTERLOAD
 Resistance of let ventricle must overcome to circulate blood
o Increased in:
 Hypertension, Vasoconstriction
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CARDIAC GLYCOSIDE -DIGOXIN

Pharmacotherapeutics: Heart failure
Atrial fibrillation and flutter
Supraventricular tachycardia
Pharmacokinetics: Oral (capsule, elixir, and tablet)
Pharmacodynamics: Boosts intracellular calcium at the cell membrane, enabling stronger heart
contractions
DRUG INTERACTIONS
 St. John’s wort Ginseng
ADVERSE REACTIONS
 Digoxin toxicity
 Abdominal pain and diarrhea
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 Headache
 Irritability
 Depression and insomnia
 Confusion
 Blurred or yellow vision
 Arrhythmias – bradycardia
 Complete heart block.
IMPLEMENTATION
 Keep in mind that patients with hypothyroidism are extremely sensitive to cardiac glycosides and may
need lower doses. Reduce the dosage in patients with impaired renal function.
 Before giving a loading dose, obtain baseline data (heart rate and rhythm, blood pressure, and electrolyte
levels) and question the patient about recent use of cardiac glycosides (within the previous 3 weeks).
Before giving the drug, take the patient’s apical pulse for 1 full minute.
 Withhold the drug and notify the prescriber if the pulse rate slows to 60 beats/minute or less.
 Infuse the IV form of the drug slowly over at least 5 minutes.
 Withhold the drug for 1 to 2 days before elective cardioversion. Adjust the dose after cardioversion.
 Remember that colestipol and cholestyramine bind with the drug in the intestine.
 Teach the patient about digoxin, including signs and symptoms of digoxin toxicity.
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ANTIARRHYTHMIC DRUGS-CLASS IB LIDOCAINE)

Pharmacotherapeutics: Ventricular tachycardia
Ventricular fibrillation
Pharmacokinetics: Oral, Topical, Injectables
Pharmacodynamics: Work by blocking the rapid influx of sodium ions during the depolarization phase
of the heart’s depolarization-repolarization cycle.
DRUG INTERACTIONS
Phenytoin
Propranolol
 Procainamide and quinidine
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 Rifampin
 Theophylline
 Beta-adrenergic blocker
ADVERSE REACTIONS
 Drowsiness
 Light-headedness
 Paresthesia
 Sensory disturbances
 Hypotension
 Bradycardia
 Seizures
 Respiratory and cardiac arrest.
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ANTIARRHYTHMIC DRUGS –CLASS II (BETA BLOCKERS)

Pharmacotherapeutics: Atrial flutter
Atrial fibrillation
Paroxysmal atrial tachycardia
Pharmacokinetics: Oral, IV
Pharmacodynamics: Block beta-adrenergic receptor sites in the conduction system of the heart. As a
result, the ability of the SA node to fire spontaneously (automaticity) is slowed.
DRUG INTERACTIONS
 Phenothiazines
 Antihypertensive drugs
ADVERSE REACTIONS
 Arrhythmias
 Bradycardia
 Heart failure
 Hypotension GI reactions, such as nausea, vomiting, and diarrhea
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 Bronchoconstriction
 Fatigue
IMPLEMENTATION
 Don’t crush sustained-release tablets.
 Take safety precautions if adverse CNS reactions occur.
 Notify the prescriber about adverse reactions.
 Use IV forms of these drugs for treating acute arrhythmias; they may be given as a loading dose IV or
diluted with normal saline solution and given by intermittent infusion.
 Check the apical pulse before giving the drug. If you detect extremes in pulse rate, withhold the drug
and call the prescriber immediately.
 Administer the drug with meals as indicated.
 Before any surgical procedure, notify the anesthesiologist that the patient is receiving this drug.
 Don’t discontinue the IV form of the drug abruptly; symptoms may worsen with increased tachycardia,
arrhythmias, or hypertension.
 Provide patient teaching.
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ANTIARRHYTHMIC DRUGS –CLASS III (AMIODARONE)

Pharmacotherapeutics: Ventricular tachycardia
Ventricular fibrillation
Pharmacodynamics: Delay repolarization and lengthen the refractory period and duration of the action
potential
DRUG INTERACTIONS
 Quinidine
 Procainamide
 Phenytoin levels
 Warfarin
ADVERSE REACTIONS
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 Vary widely and commonly lead to drug discontinuation. A common adverse effect is aggravation of
arrhythmias.
IMPLEMENTATION
 During and after administration, make sure proper equipment and facilities, such as cardiac monitoring,
intracardiac pacing, a cardioverter-defibrillator, and medication for treatment of sustained ventricular
tachycardia, are available.
 Correct hypokalemia and hypomagnesemia before therapy to reduce the risk of arrhythmias.
 Remember that admixtures and approved diluents are chemically and physically stable for 24 hours at
room temperature or 48 hours if refrigerated.
 Be aware that sustained-release and extended-release medications aren’t interchangeable.
__________________________________________________________________________________________
ANTIARRHYTHMIC DRUGS –CLASS IV (CALCIUM CHANNEL BLOCKERS)

Pharmacotherapeutics: Relieve angina, lower blood pressure, and restore normal sinus rhythm.
Pharmacodynamics: Inhibit calcium ion influx across cardiac and smooth-muscle cells, thus decreasing
myocardial contractility and oxygen demand. They also dilate coronary arteries
and arterioles.
DRUG INTERACTIONS
 Grapefruit juice
 Alcohol
ADVERSE REACTIONS
 Heart failure
 Bradycardia
 AV block
 Ventricular asystole
 Ventricular fibrillation
 Pulmonary edema
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IMPLEMENTATION
 Know that sustained-release and extended-release drug forms aren’t interchangeable.
 Fluid and sodium intake may need to be restricted to minimize edema.
 Notify the prescriber about adverse reactions.
 Use IV forms of the drug for treating acute arrhythmias; cardiac monitoring is required during
administrations.
 Withhold the dose and notify the prescriber if the patient’s systolic pressure drops below 90 mm Hg or
his heart rate drops to less than 60 beats/minute• Help the patient walk because dizziness can occur.
__________________________________________________________________________________________
ANTI-ANGINAL DRUGS –NITRATES (NITROGLYCERIN)

Pharmacotherapeutics: Relieve and prevent angina
Pharmacokinetics: Sublingually (under the tongue), buccally (in the pocket of the cheek), as
chewable tablets, as lingual aerosols (sprayed onto or under the tongue), or via
inhalation (amyl nitrite)
Pharmacodynamics: Nitrates cause the smooth muscle of the veins and, to a lesser extent, the arteries
to relax and dilate. By reducing preload, nitrates reduce ventricular size and
ventricular wall tension. This, in turn, reduces the oxygen requirements of the
heart.
DRUG INTERACTIONS
 Alcohol
 Anticholinergic drug
 Calcium channel blockers
ADVERSE REACTIONS
 Headache
 Hypotension
 Dizziness
 Increased heart rate
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IMPLEMENTATION
 Tablets may be given on an empty stomach, either 30 minutes before or 1 to 2 hours after meals. Tell the
patient to swallow tablets whole, not chew them.
 Have the patient sit or lie down when receiving the first nitrate dose. Take his pulse and blood pressure
before giving the dose and when the drug action starts.
 Don’t give a beta-adrenergic blocker or calcium channel blocker to relieve acute angina.
 Withhold the dose and notify the prescriber if the patient’s heart rate is less than 60 beats/minute or his
systolic blood pressure drops below 90 mm Hg, or follow the prescriber’s ordered parameters for
withholding the medication.
 Dilute IV nitroglycerin with D5W or normal saline solution for injection, using a glass bottle.
 Administer sublingual nitroglycerin tablets at the first sign of an attack, placing the medication under the
tongue until it’s completely absorbed. The dose can be repeated every 5 minutes up to three doses.
 Place topical ointments on paper as prescribed; then place the paper on a non-hairy area and cover it
with plastic. Remember to rotate application sites and make sure you don’t get any ointment on your
fingers.
 Remove a transdermal patch before defibrillation. Aluminum backing on the patch may explode with
electric current.
 Be aware that the drug may initially cause headache until tolerance develops or the dosage is minimized.
__________________________________________________________________________________________
ANTIHYPERTENSIVES-ACE INHIBITORS
Pharmacotherapeutics: Treat hypertension, after acute MI
Pharmacodynamics: By reducing aldosterone secretion, ACE inhibitors promote the excretion of
sodium and water, reducing the amount of blood the heart needs to pump and
reducing blood pressure
DRUG INTERACTIONS
 NSAIDs
ADVERSE REACTIONS
 Headache
 Fatigue Dry, nonproductive, persistent cough
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 Angioedema
 GI reactions
 Increased serum potassium concentrations
 Tickling in the throat
 Transient elevations of BUN and serum creatinine levels
IMPLEMENTATION
 If giving orally, administer the drug before meals as indicated
 Prevent or minimize orthostatic hypotension by helping the patient to get up slowly and by telling the
patient not to make sudden movements.
 Maintain the patient’s nonpharmacologic therapies, such as sodium restriction, calorie reduction, stress
management, and exercise program.
 To improve adherence of a transdermal patch, apply an adhesive overlay. Place the patch at a different
site each week and remove the old patch before applying the new one.
__________________________________________________________________________________________
ANTIHYPERTENSIVES-ANGIOTENSIN II RECEPTOR
BLOCKING AGENTS
Pharmacotherapeutics: Hypertension
Irbesartan and losartan are indicated for patients with type 2 diabetes
Bound to plasma proteins.
Pharmacodynamics: Prevents the vasoconstricting and aldosterone-secreting effects of angiotensin II
(a potent vasoconstrictor), resulting in a blood pressure decrease.
DRUG INTERACTIONS
 Fluconazole
 NSAIDs
 Rifampin
 Potassium supplements
 Lithium
ADVERSE REACTIONS
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 Headache
 Fatigue
 Cough and tickling in the throat
 Angioedema
 GI reactions
 Increased serum potassium
 Transient elevations of BUN and serum creatinine levels.
o ARBs shouldn’t be used during the second and third trimester of pregnancy
IMPLEMENTATION
 If giving orally, administer the drug with food or at bedtime as indicated.
 Maintain the patient’s nonpharmacologic therapies, such as sodium restriction, calorie reduction, stress
management, and exercise program.
 To improve adherence of a transdermal patch, apply an adhesive overlay. Place the patch at a different
site each week and completely remove the old patch before applying the new one to prevent overdose.
 Remove a transdermal patch before defibrillation to prevent arcing.
 Periodic eye examinations are recommended.
__________________________________________________________________________________________
ANTIHYPERTENSIVES-BETA-ADRENERGIC ANTAGONISTS
DRUG INTERACTIONS
 Antacids
 NSAIDs
 Lidocaine
ADVERSE REACTIONS
 Bradycardia, angina, heart failure, and arrhythmias, especially
 AV block
 Fainting
 Peripheral edema
 Dizziness
 Shock
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 Diarrhea
o Suddenly stopping a beta-adrenergic blocker may trigger angina, hypertension, arrhythmias, and
acute MI.
IMPLEMENTATION
 Don’t discontinue IV administration abruptly.
__________________________________________________________________________________________
ANTIHYPERTENSIVES-CALCIUM CHANNEL BLOCKERS

DRUG INTERACTIONS:
 Calcium salts and vitamin D
 Digoxin Carbamazepine
ADVERSE REACTIONS:
 Headache
 Dizziness
 Weakness
 Orthostatic hypotension
 Heart failure
 Hypotension
 Palpitations
 Arrhythmias
 Bradycardia
 AV block
IMPLEMENTATION
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 Assist the patient with ambulation during the start of therapy because dizziness can occur.
 Advise the patient that fluid and sodium intake may need to be restricted to minimize edema.
__________________________________________________________________________________________
MODULE 2.2 PAIN MEDICATION

SUMMARIZING NURSING RESPONSIBILITIES ON PAIN MEDICATIONS
LEARNING OUTCOMES
 Synthesizing Nursing Responsibilities on Drugs that Affect the Neurologic, Muscular, and Endocrine
Systems, including Pain Medications
__________________________________________________________________________________________
SOMATIC
 Can be superficial (skin, muscles) or deep (joints, tendons, bones)
 Nociceptors are involved
 Often well localized
 Usually described as throbbing or arching
VISCERAL
 Involves hollow organ and smooth muscle nociceptors that are sensitive to stretching, hypoxia and
inflammation
 Pain is usually referred, poorly localized, vague and diffuse
 May be associated with automatic symptoms (e.g., pallor, sweating, nausea, blood pressure and heart
rate changes)
__________________________________________________________________________________________
SALICYLATES-ASPIRIN
Pharmacotherapeutics: Pain, fever, rheumatoid arthritis, and osteoarthritis
Pharmacokinetics: Routes: Oral
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Absorption/Distribution: Small Intestine
Metabolism: Liver
Excretion: Kidneys, breastmilk
Pharmacodynamics: Inhibits the synthesis of prostaglandin. Prostaglandin is a chemical mediator that
sensitizes nerve cells to pain and inflammation.
DRUG INTERACTIONS
 Heparin
 Methotrexate
 Oral antidiabetic agents and insulin
 Corticosteroids
 Alkalinizing drugs
 Antacids
 ACE inhibitors
 Beta blockers
 NSAIDs
ADVERSE REACTIONS
 Gastric distress
 Nausea
 Vomiting
 Bleeding tendencies
 Hearing loss
 Diarrhea
 Thirst
 Tinnitus
 Confusion
 Dizziness
 Impaired vision
 Hyperventilation
 Reye’s syndrome
IMPLEMENTATION
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 Give aspirin with food, milk, antacids, or a large glass of water to reduce GI reactions.
 If the patient has trouble swallowing the drug, crush tablets or mix them with food or fluid. Don’t crush
enteric-coated aspirin.
 Withhold the dose and notify the prescriber if bleeding, salicylism (salicylate poisoning, characterized
by tinnitus or hearing loss), or adverse GI reactions occur.
 Stop aspirin 5 to 7 days before elective surgery as ordered.
__________________________________________________________________________________________
ACETAMINOPHEN-PARACETAMOL
Pharmacotherapeutics: Pain and fever, not affecting inflammation and platelet
Absorption/Distribution: GI tract, placenta
Metabolism: Liver
Excretion: Kidneys, breastmilk
Pharmacodynamics: Acts directly on the heat-regulating center in the hypothalamus
DRUG INTERACTIONS
 Warfarin
 Thrombolytic drugs
 Phenytoin
 Barbiturates
 Carbamazepine
 Rifampin
 Isoniazid
 Chronic alcohol use
 Loop diuretics
 Zidovudine
ADVERSE REACTIONS
 Liver toxicity
 Skin rash
 Hypoglycemia
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 Neutropenia
IMPLEMENTATION
 Administer the liquid form of the drug to children and other patients who have difficulty swallowing.
 When giving oral preparations, calculate the dosage based on the concentration of drug because drops
and elixir have different concentrations (for example, 80 versus 120 mg/mL).
 Use the rectal route in young children and other patients for whom oral administration isn’t feasible.
__________________________________________________________________________________________
NON-SELECTIVE NSAIDS
(Ibuprofen, Diclofenac, Ketorolac, Mefenamic acid, and Naproxen)
Pharmacotherapeutics: Inflammation, pain, rarely used on fever
Absorption/Distribution: GI tract
Metabolism: Liver
Excretion: Kidneys
Pharmacodynamics: Inhibits prostaglandin synthesis and cyclooxygenase activity
Drug Interactions
Fluconazole
Phenobarbital
Rifampin
Oral anticoagulants
Aminoglycosides
ACE inhibitors
Beta-adrenergic blockers
Digoxin
Lithium
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ADVERSE REACTIONS
 Abdominal pain and bleeding

 Anorexia
 Diarrhea
 Nausea
 Drowsiness
 Headache
 Dizziness and confusion
 Tinnitus and vertigo
 Depression
 Bladder infection
 Blood in urine
 Kidney necrosis
 Hypertension
 Heart failure
 Pedal edema
IMPLEMENTATION
 Administer oral NSAIDs with 8 oz (240 mL) of water to ensure adequate passage into the stomach.
 Have the patient sit up for 15 to 30 minutes after taking the drug to prevent it from lodging in the
esophagus.
 As needed, crush tablets or mix with food or fluid to aid swallowing.
 Give the drug with meals or milk or administer it with antacids to reduce adverse GI reactions.
__________________________________________________________________________________________
SELECTIVE NSAIDS–CELECOXIB
Pharmacotherapeutics: Osteoarthritis, rheumatoid arthritis, acute pain, primary dysmenorrhea, and
familial adenomatous polyposis
Pharmacokinetics: Routes: Oral, intrathecal, IV
Absorption/Distribution:
Metabolism: Liver
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Excretion: Kidneys, Feces
Pharmacodynamics: Selectively blocks the COX-2 enzyme, thereby inhibiting prostaglandin synthesis,
without the adverse GI effects associated with COX-1 inhibition by nonselective
DRUG INTERACTIONS
 Lithium ACE inhibitors
 Diuretics
 Warfarin
 Herbal preparations:
o Dong quai
o Feverfew
o Garlic
o Ginger
o Ginkgo
o Horse chestnut
o Red clover
ADVERSE REACTIONS
 Dyspepsia
 Nausea and vomiting GI ulcers
 Hypertension
 Fluid retention
 Dizziness
 Headache
 Rash
IMPLEMENTATION
 Although the drug can be given without regard to meals, food may decrease GI upset.
 Before starting treatment, be sure to rehydrate the patient.
 Although the drug may be used with low aspirin dosages, the combination may increase the risk of GI
bleeding.
 NSAIDs such as celecoxib can cause fluid retention; closely monitor the patient who has hypertension,
edema, or heart failure.
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__________________________________________________________________________________________
PHENA ZOPYRIDINE HYDROCHLORIDE

Pharmacotherapeutics: Pain, burning, urgency, and frequency associated with urinary tract infections
Pharmacokinetics: Routes:
Absorption/Distribution: Unknown
Metabolism: Liver
Excretion: Kidneys
Pharmacodynamics: Has a local anesthetic effect on the urinary mucosa
IMPLEMENTATION
 Administer the drug with food to minimize nausea.
 Advise the patient that the drug colors urine red or orange and may stain fabrics and contact lenses.
 Notify the prescriber if the drug is ineffective and urinary tract pain persists.
__________________________________________________________________________________________
OPIOID AGONISTS –MORPHINE, CODEINE,

TRAMADOL
Pharmacotherapeutics: Acute and chronic pain, pain in terminal illnesses
Metabolism: Liver
Excretion: Kidneys, Biliary tract
Pharmacodynamics: Reduce pain by binding to opiate receptor sites in the peripheral nervous system
and the CNS. When these drugs stimulate the opiate receptors, they mimic the
effects of endorphins.
DRUG INTERACTIONS
 Amitriptyline
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 Protease inhibitors
 Phenytoin
 Diazepam
 Rifampin
 Tricyclic antidepressants
 Phenothiazines
 Anticholinergics
 Carbamazepine
 Warfarin
 Beta-adrenergic blockers
 Alcohol
 Sedatives
 Hypnotics
 Anesthetics
ADVERSE REACTIONS
 Flushing
 Pupil constriction
 Tremors
 Palpitations
 Tachycardia
 Delirium
 Neurotoxicity
 Seizures
IMPLEMENTATION
 Keep resuscitative equipment and a narcotic antagonist (naloxone) available.
 Give the IV form of the drug by slow injection, preferably in diluted solution. Rapid IV injection
increases the risk of adverse effects.
 Give IM or subcutaneous injections cautiously to a patient with a decreased platelet count and to a
patient who’s chilled, hypovolemic, or in shock; decreased perfusion may lead to drug accumulation and
toxicity.
 Rotate injection sites to avoid induration.
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 Carefully note the strength of the solution when measuring a dose. Oral solutions of varying
concentrations are available.
 For maximum effectiveness, give the drug on a regular dosage schedule rather than as needed.
 Institute safety precautions.
 Encourage a postoperative patient to turn, cough, and breathe deeply every 2 hours to avoid atelectasis.
 If GI irritation occurs, give oral forms of the drug with food.
 Be aware that withdrawal symptoms, including tremors, agitation, nausea, and vomiting, may occur if
the drug is stopped abruptly.
__________________________________________________________________________________________
OPIOID ANTAGONISTS –NALOXONE HCL,

NALTREXONE HCL
Pharmacotherapeutics: Opioid overdose, drug abuse
Pharmacokinetics: Routes: Naloxone - IM, sub cut, or IV, Naltrexone - Oral
Metabolism:
Excretion:
Pharmacodynamics: Block the effects of opioids by occupying the opiate receptor sites, displacing
opioids attached to opiate receptors and blocking further opioid binding at these
sites. (Competitive inhibition)
DRUG INTERACTIONS
 Opioid agonist
 Opioid addict
ADVERSE REACTIONS
 Edema
 Hypertension
 Palpitations
 Phlebitis
 Shortness of breath
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 Anxiety
 Depression
 Disorientation
 Dizziness and headache
 Nervousness
 Anorexia
 Diarrhea or constipation
 Thirst
 Urinary frequency
 Liver toxicity
IMPLEMENTATION
 Provide oxygen, ventilation, and other resuscitation measures when the drug is used in the management
of acute opiate overdose and when the patient has severe respiratory depression.
 Keep in mind that these drugs are effective in reversing respiratory depression only when it’s caused by
opioids. When they’re used for this purpose, monitor the patient for tachypnea.
 Be prepared to give continuous IV naloxone infusion to control adverse effects of epidural morphine.
__________________________________________________________________________________________
ANTI-INFLAMMATORY, ANTIALLERGY AND IMMUNOSUPPRESSANT DRUGS

LEARNING OUTCOME
Review nursing responsibilities, using the nursing process, on the different classes of drugs that affect the
immunologic system and integumentary systems, including drugs to manage inflammation and infection, uses
and actions of these drugs, absorption, distribution, metabolization, and excretion of these drugs, drug
interactions and adverse reactions to these drugs.
Drugs and the immune system

 Immune and inflammatory responses protect the body from invading foreign substances. Certain classes
of drugs can modify these responses:
 Antihistamines
 Corticosteroids
 Immunosuppressants (no corticosteroids)
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 Uricosurics
Antihistamines
 Antihistamines primarily act to block histamine effects that occur in an immediate (type I)
hypersensitivity reaction, commonly called an allergic reaction.
Antihistamine
Histamine-1 Receptor Antagonists
Pharmacotherapeutics (how drugs are used)
Antihistamines are used to treat signs and symptoms of type I hypersensitivity reactions, such as:
 Allergic rhinitis (runny nose and itchy eyes caused by a local sensitivity reaction)
 Vasomotor rhinitis (rhinitis not caused by allergy or infection)
 Allergic conjunctivitis (inflammation of the eye membranes)
 Urticaria (hives)
 Angioedema (submucosal swelling in the hands, face, and feet).
Beyond the obvious
Antihistamines have other therapeutic uses. Many are used primarily as antiemetics (to control nausea and
vomiting). They can also be used as adjunctive therapy to treat an anaphylactic reaction after serious signs and
symptoms are controlled. Diphenhydramine can be used to help treat Parkinson’s disease and drug- induced
extrapyramidal reactions (abnormal involuntary movements). Because of its ant serotonin qualities,
cyproheptadine may be used to treat Cushing’s disease, serotonin associated diarrhea, vascular cluster
headaches, and anorexia nervosa.
Pharmacokinetics (how drugs circulate)
H1-receptor antagonists are absorbed well after oral or parenteral administration. Some can also be given
rectally. With the exception of loratadine and desloratadine, antihistamines are distributed widely throughout
the body and central nervous system (CNS).
On the alert
Fexofenadine, desloratadine, and loratadine are nonsedating antihistamines. Because these drugs only
minimally penetrate the blood-brain barrier, they aren’t widely distributed throughout the CNS. As a result, they
produce fewer sedative effects than other antihistamines. Antihistamines are metabolized by liver enzymes and
excreted in urine, with small amounts secreted in breast milk. Fexofenadine, mainly excreted in feces, is an
exception. Cetirizine undergoes hepatic metabolism.
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Pharmacodynamics (how drugs act)
H1-receptor antagonists compete with histamine for H1 receptors on effector cells (the cells that cause allergic
signs and symptoms), blocking histamine from producing its effects.
Implementation:
 Reduce GI distress by giving antihistamines with food.
 Follow the manufacturer’s guidelines for IV administration.
 If administering the drug IM, alternate injection sites to prevent irritation. Give IM injections into large
muscles.
 Provide sugarless gum, hard candy, or ice chips to relieve dry mouth.
Increase the patient’s fluid intake (if allowed) or humidify the air to decrease thickened secretions.
 Notify the prescriber if tolerance is observed because thepatient may require a substitute antihistamine.
Corticosteroids
 Corticosteroids suppress immune responses and reduce inflammation.
 Glucocorticoids
 Mineralocorticoids
Corticosteroids: Glucocorticoids
Most glucocorticoids are synthetic analogues of hormones secreted by the adrenal cortex. hey exert anti-
inflammatory, metabolic, and immunosuppressant effects. drugs in this class include:
 Beclomethasone
 Betamethasone
 Cortisone
 Dexamethasone
 hydrocortisone
 Corticosteroid
Glucocorticoids
 Pharmacotherapeutics. Glucocorticoids are used as replacement therapy for patients with
adrenocortical insufficiency. They’re also prescribed for immunosuppression (such as in allergic
reactions) and disorders requiring treatment by reduction of inflammation (such as arthritis). They’re
also prescribed for their effects on the blood and lymphatic systems.
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 Pharmacokinetics. Glucocorticoids are well absorbed when administered orally. After IM
administration, they’re completely absorbed. Glucocorticoids are bound to plasma proteins and
distributed through the blood. They’re metabolized in the liver and excreted by the kidneys.
 Pharmacodynamics: >suppressing the redness, edema, heat, and tenderness; prevent leakage of plasma
from capillaries; decrease antibody formation in injured or infected tissues
Implementation
 Give the drug early in the day
 Give drug with food
 Avoid exposure to infection
 Don’t stop the drug abruptly
 Avoid prolonged use
Corticosteroid: Mineralocorticoids
Mineralocorticoids affect electrolyte and water balance.
One mineralocorticoid is fludrocortisone acetate, a synthetic analogue of hormones secreted by the adrenal
cortex.
Corticosteroid: Mineralocorticoids
 Pharmacotherapeutics. Fludrocortisone acetate is used as replacement therapy for patients with
adrenocortical insufficiency (reduced secretion of glucocorticoids, mineralocorticoids, and androgens).
Keeping things in balance. Fludrocortisone acetate may also be used to treat salt-losing congenital
adrenogenital syndrome (characterized by a lack of cortisol and deficient aldosterone production) after
the patient’s electrolyte balance has been restored.
 Pharmacokinetics. Fludrocortisone acetate is absorbed well and distributed to all parts of the body. It’s
metabolized in the liver to inactive metabolites and excreted by the kidneys.
 Pharmacodynamics. Fludrocortisone acetate affects fluid and electrolyte balance by acting on the distal
renal tubule to increase sodium reabsorption and potassium and hydrogen secretion.
Implementation
 Administer as prescribed
 Notify prescriber for adverse effects
 Notify prescriber if HPN occurs
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 Monitor electrolyte levels
URICOSURIC DRUGS
Uricosurics act by increasing uric acid excretion in urine. The primary goal in using uricosurics is to prevent or
control the frequency of gouty arthritis attacks.
Corticosteroid: Uricosurics
 Pharmacotherapeutics Probenecid and sulfinpyrazone are indicated for the treatment of: chronic gouty
arthritis tophaceous gout (the deposition of tophi or urate crystals under the skin and into joints).
 Pharmacokinetics. Uricosurics are absorbed from the GI tract. Distribution of the two drugs is similar,
with 75% to 95% of probenecid and 98% of sulfinpyrazone being protein bound. Metabolism of the
drugs occurs in the liver, and excretion occurs primarily through the kidneys. Only small amounts of
these drugs are excreted in feces.
 Pharmacodynamics. Probenecid and sulfinpyrazone reduce the reabsorption of uric acid at the
proximal convoluted tubules of the kidneys. This results in excretion of uric acid in urine, reducing
serum urate levels.
Implementation
Give the medication with milk, food, or antacids to minimize GI distress. Continued disturbances may
indicate a need to lower the dosage.
Drink up!
Encourage the patient to drink fluids to maintain a minimum daily output of 2 L of water per day. Sodium
bicarbonate or potassium citrate may be needed to alkalinize urine. These measures prevent hematuria, renal
colic, uric acid stone formation, and costovertebral pain. Begin therapy when an acute attack subsides. Keep in
mind that the drug contains no analgesic or anti-inflammatory agents and isn’t useful during acute gouty
attacks. Be aware that the drug may increase the frequency, severity, be aware that the drug may increase the
frequency, severity, and duration of acute gouty attacks during the first 12 months of therapy. Prophylactic
colchicine or another anti-inflammatory is given during the first 3 to 6 months. Instruct the patient to avoid
drugs that contain aspirin, which may precipitate gout.
__________________________________________________________________________________________
MODULE 2.3
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SUMMARIZING NURSING RESPONSIBILITIES ON GASTROINTESTINAL DRUGS
Learning Outcomes:
Summarize nursing responsibilities, using the nursing process, on the different classes of drugs that affect the
gastrointestinal, urinary, and reproductive systems, uses and actions of these drugs, absorption, distribution,
metabolism, and excretion of these drugs, drug interactions and adverse reactions to these drugs.
GASTROINTESTINAL SYSTEM
Digests and absorbs nutrients and fluids. Excretes metabolic wastes
ANTI-ULCER DRUGS –SYSTEMIC ANTIBIOTICS

(Amoxicillin, Clarithromycin, Metronidazole, and Tetracycline)
Pharmacotherapeutics: Indicated for H. pylori eradication to reduce the risk of a duodenal ulcer
Pharmacokinetics: Excretion: Kidneys
Pharmacodynamics: Treats H. pylori infection
DRUG INTERACTIONS:
 Digoxin
 Methoxyflurane
ADVERSE REACTIONS:
 Mild GI disturbances.
 Disulfiram-like reaction (nausea, vomiting, headache, cramps, flushing)
 Amoxicillin may cause diarrhea
IMPLEMENTATION
 Administer drugs as appropriate for the patient’s condition and diagnosis.
 Use measures to prevent or minimize peptic ulcer disease and gastric acid-induced esophageal disorders.
 Observe the patient for improvement in signs and symptoms.
 Instruct the patient to take the full course of antibiotics.
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HOW ANTIBIOTIC RESISTANCE HAPPENS

1. Lots of germs. A few are drug resistant.
2. Antibiotic kill bacteria causing the illness, as well as good bacteria protecting the body from infection.
3. The drug-resistant bacteria are now allowed to grow and take over.
4. Some bacteria give their drug-resistance to other bacteria, causing more problems.
__________________________________________________________________________________________
ANTIULCER DRUGS –ANTACIDS

Pharmacotherapeutics: Indigestion, heartburn, dyspepsia (burning or indigestion), and gastroesophageal reflux
disease (GERD)
Absorption/Distribution: GI Tract (Local-stomach)
Metabolism:
Excretion: Feces
Pharmacodynamics: Reduces the total amount of acid in the GI tract, allowing peptic ulcers time to heal
DRUG INTERACTIONS
 Oral drugs
 Digoxin
 Phenytoin
 Ketoconazole
 Iron salts
 Isoniazid
 Quinolones
 Tetracycline
ADVERSE REACTIONS
 Magnesium-based antacids
 Diarrhea
 Calcium and aluminum-based antacids
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 Constipation Electrolyte imbalances
 Increased serum aluminum
IMPLEMENTATION
 Manage constipation with laxatives or stool softeners or ask the prescriber about switching the patient to
a magnesium preparation.
 If the patient suffers from diarrhea, obtain an order for an anti-diarrheal as needed, and ask the
prescriber about switching the patient to an antacid containing aluminum.
 Shake the container of a liquid form well.
 When giving the drug through a nasogastric (NG) tube, make sure that the tube is patent and placed
correctly. After in stilling the drug, flush the tube with water to ensure passage to the stomach and to
clear the tube.
__________________________________________________________________________________________
ANTI-ULCER DRUGS –H2 RECEPTOR ANTAGONISTS

(Cimetidine, Famotidine, Nizatidine, and Ranitidine)
Pharmacotherapeutics: Duodenal and gastric ulcers, Zollinger-Ellison syndrome, reflux esophagitis or upper GI
bleeding
Pharmacokinetics Routes:
Absorption/Distribution: GI Tract, excluding Famotidine
Metabolism: Liver
Excretion: Kidneys
Pharmacodynamics: Blocks histamine from stimulating the acid-secreting parietal cells of the stomach
DRUG INTERACTIONS
 Propranolol
 Benzodiazepines
 Tricyclic antidepressants
 Theophylline
 Procainamide
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 Quinidine
 Lidocaine
 Phenytoin
 Calcium channel blocker
 Cyclosporine
 Carbamazepine
 Opioid analgesics
 Carmustine
 Alcohol
ADVERSE REACTIONS
 Cimetidine and ranitidine: Headache, dizziness, malaise, muscle pain, nausea, diarrhea or constipation,
rashes, itching, loss of sexual desire, gynecomastia, and impotence.
 Famotidine and nizatidine: Headache, constipation or diarrhea and rash
IMPLEMENTATION
 Administer a once-daily dose at bed time to promote compliance. Twice-daily doses should be
administered in the morning and evening; multiple doses, with meals and at bed time.
 Don’t exceed the recommended infusion rates when administering H2-receptor antagonists IV.
 Administer antacids at least 1 hour before or after H2-receptor antagonists. Antacids can decrease drug
absorption.
 Anticipate dosage adjustments for the patient with renal disease.
 Avoid stopping the drug abruptly.
__________________________________________________________________________________________
ANTI-ULCER DRUGS –PROTON PUMP INHIBITORS

(Esomeprazole, Lansoprazole, Omeprazole, Pantoprazole, and Rabeprazole)
Pharmacotherapeutics: Gastric ulcers, duodenal ulcers, erosive esophagitis, and symptomatic GERD
Pharmacokinetics Routes: Oral, IV
Absorption/Distribution: Small intestine, bypass stomach
Metabolism: Excretion:
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Pharmacodynamics: Blocks the last step in gastric acid secretion by combining with hydrogen, potassium, and
adenosine triphosphate in the parietal cells of the stomach.
DRUG INTERACTIONS
 Diazepam
 Phenytoin
 Warfarin
 Ketoconazole
 Digoxin
 Ampicillin
 Iron salts
ADVERSE REACTIONS
 Abdominal pain
 Diarrhea Nausea and vomiting
IMPLEMENTATION
 Administer the drug 30 minutes before meals.
 Dosage adjustments aren’t needed for patients with renal or hepatic impairment.
 Tell the patient to swallow capsules whole and not to open or crush them.
 When giving IV, check the package insert and your facility’s policy for reconstitution, compatibility,
and infusion time information.
__________________________________________________________________________________________
ADSORBBENT DRUGS –ACTI VATED CHARCOAL

Pharmacotherapeutics: Acute oral poisoning
Not indicated: Acute poisoning from mineral acids, alkaline, cyanide, ethanol, methanol, iron, sodium chloride
alkali, inorganic acids, or organic solvents.
Absorption/Distribution: Not absorbed
Metabolism: Not metabolized
Excretion: Feces (Unchanged)
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Pharmacodynamics: Attracts and binds toxins in the intestine, they inhibit toxins from being absorbed from the
GI tract
DRUG INTERACTIONS
 Oral medications
ADVERSE REACTIONS
 Black stool
 Constipation
IMPLEMENTATION
 Don’t give the drug to a semi-conscious or unconscious patient unless the airway is protected, and an
NG tube is in place for instillation.
 Mix the powdered form with tap water to form the consistency of thick syrup. Add a small amount of
fruit juice or flavoring to make it more palatable.
 Give by NG tube after lavage if needed. Down with dairy
 Don’t give the drug in ice cream, milk, or sherbet; these may reduce absorption.
 Repeat the dose if the patient vomits shortly after administration.
 Keep airway, oxygen, and suction equipment nearby.
 Follow treatment with a stool softener or laxative to prevent constipation.
 Tell the patient that this stool will be black.
__________________________________________________________________________________________
ANTI-FL ATULENT DRUGS –SIMETHICONE

Pharmacotherapeutics: Functional gastric bloating, postoperative gaseous bloating, diverticular disease, and
spastic or irritable colon
Metabolism: Intestinal lumen
Excretion: Feces (Unchanged)
Pharmacodynamics: Creates foaming action in the GI tract. It produces a film in the intestines that disperses
mucus-enclosed gas pockets and helps prevent the information.
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DRUG INTERACTIONS
 Simethicone doesn’t interact significantly with other drugs.
ADVERSE REACTIONS
 Excessive belching
 Flatus
IMPLEMENTATION
 Make sure that the patient chews the tablet form before swallowing.
 If giving the suspension form, make sure to shake the bottle or container thoroughly to distribute the
solution.
 Inform the patient that the drug doesn’t prevent gas formation.
 Encourage the patient to change his position frequently and to ambulate to help pass flatus.
__________________________________________________________________________________________
DIGESTIVE DRUGS
Pharmacotherapeutics: Dehydrocholic acid: Constipation and promotes bile flow
Pancreatic enzymes: Pancreatitis Cystic fibrosis Steatorrhea
Absorption/Distribution: GI Tract (Local)
Metabolism:
Excretion: Feces
Pharmacodynamics: Dehydrocholic acid-increases the output of bile in the liver.
Pancreatic enzymes-replace missing or deficient normal pancreatic enzymes.
DRUG INTERACTIONS
 Antacids
 Folic acid
 Iron
ADVERSE REACTIONS
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 Dehydrocholic acid: Abdominal cramping, biliary colic, and diarrhea.
 Pancreatic enzymes: Diarrhea, nausea, and abdominal cramping
IMPLEMENTATION
 Administer the drug before or with each meal as applicable.
 For older infants, the powdered form may be mixed with apple sauce and given before meals.
 Avoid contact with or inhalation of the powder form; it may be irritating.
 Older children may take capsules with food.
 Tell the patient not to crush or chew enteric-coated dosage forms. Capsules containing enteric-coated
microspheres may be opened and their contents sprinkled on a small amount of soft food, such as apple
sauce. Follow administration with a glass of water or juice.
 Review food preferences and diet orders with the patient and his family.
 Provide food and fluids that the patient enjoys at time she prefers, if possible.
 Treat signs and symptoms or disorders that may interfere with nutrition, such as pain, nausea, vomiting,
or diarrhea.
 Consult with a dietitian if special diets are ordered. Provide foods the patient likes, selecting
nutritionally better choices that fall within the prescribed diet.
__________________________________________________________________________________________
LAXATIVES – HYPEROSMOLAR DRUGS

Pharmacotherapeutics: Glycerin
Bowel retraining
Lactulose
Constipation
Reduce ammonia production
Saline compounds
Prompt and complete bowel evacuation
Metabolism:
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Excretion:
Pharmacodynamics: Produces a bowel movement by drawing water into the intestine. Fluid accumulation
distends the bowel and promotes peristalsis and a bowel movement.
DRUG INTERACTIONS
 Oral drugs
 PEG
ADVERSE REACTIONS
 Glycerin
 Weakness and fatigue
 Lactulose
 Abdominal distention, gas, and abdominal cramps, nausea and vomiting, diarrhea, hypokalemia,
hypovolemia, and increased blood glucose level.
 Saline compounds
 Weakness, lethargy, dehydration, hypernatremia, hypermagnesemia, hyperphosphatemia, hypocalcemia,
cardiac arrhythmias, and shock.
IMPLEMENTATION
 Time drug administration so that bowel evacuation doesn’t interfere with scheduled activities or sleep.
 Shake suspensions well; give with a large amount of water as applicable.
 If administering the drug through an NG tube, make sure that the tube is placed properly and is patent.
After instilling the drug, flush the tube with water to ensure passage to the stomach and to maintain tube
patency.
 Don’t crush enteric-coated tablets.
 Make sure that the patient has easy access to a bedpan or bathroom.
 Institute measures to prevent constipation.
__________________________________________________________________________________________________
LAXATIVES – DIETARY FIBER AND RELATED BULKFORMING

SUBSTANCES
(Methylcellulose, Polycarbophil, and Psyllium hydrophilic mucilloid)
Pharmacotherapeutics: Constipation
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Acute myocardial infarction (MI)
Cerebral aneurysms
Irritable bowel syndrome
Diverticulosis
Absorption/Distribution: Not absorbed
Metabolism:
Excretion: Feces
Pharmacodynamics: Increases stool mass and water content, promoting peristalsis.
DRUG INTERACTIONS
 Digoxin
 Warfarin
 Salicylates
ADVERSE REACTIONS
 Flatulence
 Sensation of abdominal fullness
 Intestinal obstruction
 Fecal impaction
 Esophageal obstruction
 Severe diarrhea
IMPLEMENTATION
 Time drug administration so that the drug’s effects don’t interfere with scheduled activities or sleep.
 Mix drugs as directed and give with a large amount of water, as applicable.
 Keep in mind that the laxative effect usually occurs in 12 to 24 hours but may be delayed for up to 3
days.
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__________________________________________________________________________________________________
LAXATIVES –EMOLLIENTS
Pharmacotherapeutics: Recent MI or surgery
Disease of the anus or rectum
Increased intracranial pressure (ICP)
Hernias
Metabolism: Bile
Excretion: Bile in feces
Pharmacodynamics Emulsify the fat and water components of feces in the small and large intestines and
stimulate electrolyte and fluid secretion from intestinal mucosal cells.
DRUG INTERACTIONS
 Oral drugs
 Drugs with narrow therapeutic index
ADVERSE REACTIONS
 Bitter taste
 Diarrhea
 Throat irritation
 Mild, transient abdominal cramping
IMPLEMENTATION
 Shake suspensions well; give with a large amount of water as applicable.
patency.
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__________________________________________________________________________________________________
LAXATIVES –STIMULANTS
 Emptying the bowel before general surgery
 Sigmoidoscopic or proctoscopic procedures
 Radiologic procedures such as barium studies
 Constipation
Pharmacokinetics:
 Routes:
 Absorption/Distribution: Minimally absorbed
 Metabolism: Liver
 Excretion: Urine and feces
Pharmacodynamics:
 Stimulate peristalsis and produce a bowel movement by irritating the intestinal mucosa or stimulating
nerve endings of the intestinal smooth muscle. Bisacodyl, Cascara sagrada, Castor oil, Phenolphthalein,
and Senna
DRUG INTERACTIONS
 Oral drugs
 Adverse Reactions
 Weakness
 Nausea
 Abdominal cramps
 Mild inflammation of the rectum and anus
 Urine discoloration
IMPLEMENTATION
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 Shake suspensions well; give with a large amount of water as indicated.
patency.
__________________________________________________________________________________________________
LAXATIVES –LUBRICANTS (MINERAL OIL)

Pharmacotherapeutics: Treat constipation and maintain soft stools
Absorption/Distribution: Mesenteric lymph nodes, intestinal mucosa, liver, and spleen
Metabolism: Liver
Excretion: Feces
Pharmacodynamics: Lubricates the stool and the intestinal mucosa and prevents water reabsorption from the
bowel lumen. The increased fluid content of feces increases peristalsis.
DRUG INTERACTIONS
 Hormonal contraceptives
 Anticoagulants
 Sulfonamides
ADVERSE REACTIONS
 Nausea
 Vomiting
 Diarrhea
 Abdominal cramping
IMPLEMENTATION
 When giving mineral oil by mouth, give it on an empty stomach.
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 Perform rectal administration according to facility protocol.
__________________________________________________________________________________________
ANTI-DIARRHEAL DRUGS –OPIOID-REL ATED DRUGS

(Diphenoxylate with atropine & Loperamide)
Pharmacotherapeutics: Acute, nonspecific diarrhea
Chronic diarrhea
Absorption/Distribution: Blood
Metabolism: Liver
Excretion: Feces
Pharmacodynamics: Slows GI motility by depressing the circular and longitudinal muscle action (peristalsis) in
the large and small intestines. These drugs also decrease expulsive contractions throughout the colon.
DRUG INTERACTIONS
 Atropine
 Barbiturates
 Alcohol
 Opioids
 Tranquilizers
 Sedatives
ADVERSE REACTIONS
 Abdominal discomfort or distention
 Drowsiness and fatigue CNS depression
 Tachycardia Paralytic ileus
IMPLEMENTATION
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 Administer the drug exactly as prescribed.
 Correct fluid and electrolyte disturbances before starting the drug; dehydration may increase the risk of
delayed toxicity in some cases.
 Use naloxone to treat respiratory depression caused by over dose.
 Take safety precautions if the patient experiences adverse CNS reactions.
__________________________________________________________________________________________
SUMMARIZING NURSING RESPONSIBILITIES ON

GENITOURINARY DRUGS
LEARNING OUTCOMES
______________________________________________________________
THIA ZIDE AND THIA ZIDE-LIKE DIURETICS

Pharmacotherapeutics: Hypertension
Edema caused by kidney or liver disease, mild or moderate heart failure, and
corticosteroid and estrogen therapy
Diabetes insipidus
Absorption/Distribution: Metabolism: Vary in metabolism
Excretion: Kidneys, placenta, and breastmilk
Pharmacodynamics Promote the excretion of water by preventing their absorption of sodium in the kidneys.
DIURETICS THIAZIDES (chronic)
Give For!
C- CHF Early Stage
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H- Hypertension (1st line)
A- Assessing Renal
L- Liver Disease (fluid)
K- kidney disease (fluid)
P- Pregnancy
U- Urine Output <30hr/400-24hr
B- Breast Feeding
Look For!
N- Na-Sodium Decreased
E- Edema Decreased
W- Weight Decreased
GI- Glucose Increased
CI- Chloride Decreased
U- Urine output Increased
B- Blood Pressure Decreased
The Nurses Note!
T- Tinnitus Doesn’t Cause
Orthostatic Vitals assess
P- Monitor Potassium Encourage Potassium Rich Foods
DRUG INTERACTIONS
 Lithium
 NSAIDs
 COX2 inhibitors
ADVERSE REACTIONS
 Hypovolemia
 Hypokalemia
 Hyperglycemia
 Hyponatremia
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IMPLEMENTATION
 Give the drug in the morning to prevent nocturia from disrupting the patient’s sleep.
 Consult a dietitian about providing the patient with a high potassium diet.
 Administer potassium supplements as prescribed to maintain the patient’s serum potassium level within
an acceptable range.
 Keep a urinal or bedpan within reach of the patient or ensure that a bathroom is easily accessible.
 Prevent falls from dizziness.
__________________________________________________________________________________________
SUMMARIZING NURSING RESPONSIBILITIES ON DRUGS FOR

FLUIDS AND ELECTROLYTES BALANCE
LEARNING OUTCOMES
__________________________________________________________________________________________________
POTASSIUM
(Potassium acetate, Potassium Chloride, Potassium Gluconate, Potassium Phosphate)
Pharmacotherapeutics: Hypokalemia: Vomiting, diarrhea, or nasogastric suction

Excessive urination
Cystic fibrosis
Burns
Excessive antidiuretic hormone levels
Therapy with a potassium-depleting diuretic
Laxative abuse
Alkalosis Insufficient potassium intake from starvation, anorexia nervosa,
alcoholism, or clay ingestion
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Metabolism:
Excretion: Feces and sweat
Pharmacodynamics: Potassium moves quickly into
ICF to restore depleted potassium levels and reestablish balance.
It’s an essential element in determining cell membrane potential and excitability.
DRUG INTERACTIONS
 Potassiumsparing diuretics
 ACE inhibitors
ADVERSE REACTIONS
 Oral potassium
 Nausea, vomiting, abdominal pain, and diarrhea.
 Enteric-coated tablets
 Small-bowel ulcerations, stenosis, hemorrhage, and obstruction.
 IV infusion
 Pain at the injection site, phlebitis, cardiac arrest, and hyperkalemia
IMPLEMENTATION
 Use potassium cautiously if the patient is also receiving a potassiumsparing diuretic or an ACE inhibitor.
 When administering potassium IV, dilute the preparation before infusion.
 Give diluted IV potassium slowly to prevent life-threatening hyperkalemia.
 Never give potassium as an IV bolus or IM injection.
 Don’t mix IV potassium phosphate in a solution that contains calcium or magnesium because
precipitates will form.
 Monitor the patient’s IV site regularly for signs of phlebitis.
 Give oral potassium with or after meals to minimize GI distress.
 Give antiemetics or antidiarrheals as needed if the patient develops vomiting or diarrhea.
__________________________________________________________________________________________________
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CALCIUM
Pharmacotherapeutics: Acute hypocalcemia
Magnesium intoxication
Helps strengthen myocardial tissue after defibrillation
Blood transfusion
Absorption/Distribution: Duodenum and jejunum
Metabolism:
Excretion: Feces and urine
Pharmacodynamics: Moves quickly into
ECF to restore calcium levels and reestablish balance.
DRUG INTERACTIONS
 Digoxin
 Tetracyclines
 Atenolol
 Total parenteral nutrition
ADVERSE REACTIONS
 Hypercalcemia drowsiness, lethargy, muscle weakness, headache, constipation, and a metallic taste in
the mouth.
 ECG changes, cardiac arrhythmias, cardiac arrest, and coma.
 IV administration - venous irritation.
 IM injection - severe local reactions, such as burning, necrosis, and tissue sloughing.
IMPLEMENTATION
 Give an IV infusion slowly to prevent a high calcium level from reaching the heart and possibly causing
arrhythmias and cardiac arrest.
 Keep the patient recumbent for 15 minutes after injecting calcium.
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 If extravasation occurs, stop the IV infusion and apply warm, moist compresses to the area.
 Only give calcium IM in an emergency and only when the IV route is impossible to use. If using the IM
route, give the injection in the gluteal muscle for an adult or in the lateral thigh for an infant or young
child.
 Give oral calcium supplements 1 to 2 hours after meals.
 Give calcium and digoxin slowly and in small amounts to avoid precipitating arrhythmias during therapy
with both drugs.
__________________________________________________________________________________________________
MAGNESIUM
Pharmacotherapeutics: Symptomatic magnesium deficiency
Treat or prevent preeclamptic and eclamptic seizure activity
Ventricular arrhythmias
Pharmacokinetics: Routes: IV, IM
Metabolism:
Excretion: Urine (Unchanged), Breastmilk
Pharmacodynamics: Magnesium sulfate replenishes and prevents magnesium deficiencies. It also
prevents or controls seizures by blocking neuromuscular transmission
DRUG INTERACTIONS
 Digoxin
 Alcohol
 Opioids
 Antianxiety drugs
 Barbiturates
 Antidepressants
 Hypnotics
 Antipsychotic drugs
 General anesthetics
 Succinylcholine
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ADVERSE REACTIONS
 Hypotension
 Circulatory collapse
 Flushing
 Depressed reflexes
 Respiratory paralysis
 IM injections - pain and induce sclerosis
IMPLEMENTATION
 Keep IV calcium gluconate available to reverse the respiratory depression that an infusion of magnesium
sulfate can cause. A knee -jerk reaction.
 Test the patient’s knee -jerk and patellar reflexes before giving each dose.
 Use parenteral magnesium cautiously in a patient with renal impairment because renal impairment
increases the risk of hypermagnesemia.
 Administer magnesium sulfate slowly, no faster than 150 mg/ minute. Injecting a bolus dose too rapidly
can trigger cardiac arrest.
 Monitor the patient’s vital signs and deep tendon reflexes during an infusion of magnesium.
 Check the patient’s serum magnesium level after each bolus dose; if he’s receiving a continuous IV drip,
check the serum magnesium level at least every 6 hours.
 Place the patient on continuous cardiac monitoring during replacement therapy.
 Monitor the patient’s urine output before, during, and after magnesium sulfate infusion. Notify the
practitioner if the output is less than 100 mL over 4 hours.
__________________________________________________________________________________________
SODIUM
Pharmacotherapeutics: Hyponatremia
Pharmacokinetics: Routes: Oral and parenteral
Metabolism:
Excretion: Urine, sweat, tears, and saliva
Pharmacodynamics: Replaces deficiencies of sodium and chloride ions in blood plasma
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DRUG INTERACTIONS
 No significant drug interactions have been reported with sodium chloride.
ADVERSE REACTIONS
 Pulmonary edema
 Hypernatremia
 Potassium loss
IMPLEMENTATION
 Use cautiously in elderly and postoperative patients as well as in patients with heart failure, circulatory
insufficiency, renal impairment, or hypoproteinemia. Every breath you take.
 Teach the patient to recognize signs and symptoms of pulmonary edema, including shortness of breath,
coughing, anxiety, wheezing, and pallor.
__________________________________________________________________________________________________
ALKALINIZING DRUGS
Pharmacotherapeutics: Metabolic acidosis
Metabolism: Not metabolized
Excretion: Urine (Unchanged)
Pharmacodynamics: Separates in the blood, providing bicarbonate ions that are used in the blood’s buffer
system to decrease the hydrogen ion concentration and raise blood pH.
DRUG INTERACTIONS
 Ketoconazole
 Lithium
 Salicylates
 Amphetamines
 Quinidine
 Pseudoephedrine
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 Methenamine
ADVERSE REACTIONS
Sodium bicarbonate:
 Metabolic alkalosis, cerebral dysfunction, tissue hypoxia, and lactic acidosis, gastric distention and
flatulence
Sodium citrate:
 Metabolic alkalosis, tetany, aggravate existing heart disease, laxative effect.
Sodium lactate:
 Metabolic alkalosis, water retention and edema
Tromethamine:
 Phlebitis or irritation at the injection site, hypoglycemia, respiratory depression, and hyperkalemia.
IMPLEMENTATION
 If the patient is receiving sodium bicarbonate, sodium lactate, or tromethamine, watch the IV site for
extravasation. If extravasation occurs, elevate the affected limb, apply warm compresses, and administer
lidocaine.
 For a patient receiving tromethamine, check the IV site for phlebitis or irritation and don’t give the drug
for more than 24 hours.
 Teach the patient and his family about the prescribed drug.
__________________________________________________________________________________________________
ACIDIFYING DRUGS
Pharmacotherapeutics: Metabolic alkalosis
Metabolism: Liver
Excretion: Kidneys
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Pharmacodynamics: Acetazolamide - increases the excretion of bicarbonate, lowering blood pH. Ammonium
chloride - lowers the blood pH after being metabolized to urea and hydrochloric acid
Ascorbic acid -directly acidifies urine.
DRUG INTERACTIONS
 Spironolactone
ADVERSE REACTIONS
 Acetazolamide
 Nausea and vomiting, anorexia, diarrhea, altered taste, drowsiness, and aplastic anemia
 Ammonium chloride
 Metabolic acidosis
 Ascorbic acid
 GI distress and hemolytic anemia
IMPLEMENTATION
 Administer an IV acidifying drug slowly to prevent pain or irritation at the infusion site as well as other
adverse reactions.
 Teach the patient and his family about the prescribed drug, and tell them to report adverse reactions to
the practitioner.
 If twitching occurs with ammonium chloride therapy, withhold the next dose and notify the practitioner.
 Give a mild analgesic if a headache results from high-dose ascorbic acid therapy.
 If insomnia occurs, suggest relaxation techniques before bedtime or request a hypnotic for the patient.
__________________________________________________________________________________________________
MODULE 2.4
CHEMOTHERAPEUTIC AGENTS
CHEMOTHERAPEUTIC DRUGS
 Are used to destroy both organisms that invade the body (e.g., bacteria, viruses, parasites, protozoa,
fungi) and abnormal cells within the body (e.g., neoplasms, cancers).
 These drugs affect cells by altering cellular function or disrupting cellular integrity, causing cell death,
or by preventing cellular reproduction, eventually leading to cell death.
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o Anti-infective agents
o Antibiotics
o Antiviral agents
o Antifungal agents
o Antiprotozoal agents
o Anthelminthic agents
o Antineoplastic agents
__________________________________________________________________________________________________
ANTI-INFECTIVE AGENTS
 Are drugs designed to target foreign organisms that have invaded and infected the body of a human host.
__________________________________________________________________________________________________
ANTIBIOTICS
 Are chemicals that inhibit specific bacteria—to deal with each new threat.
 Are made in three ways: by living microorganisms, by synthetic manufacture, and, in some cases,
through genetic engineering.
 may either be:
o Bacteriostatic (preventing the growth of bacteria)
o Bactericidal (killing bacteria directly)
o Bacteriostatic and bactericidal
ANTIBIOTIC THERAPY
 Antibiotics work by disrupting protein or enzyme systems within a bacterium, causing cell death
(bactericidal) or preventing multiplication (bacteriostatic).
 The proteins or enzyme systems affected by antibiotics are more likely to be found or used in bacteria
than in human cells.
 The primary therapeutic use of each antibiotic is determined by:
o the bacterial species that are sensitive to that drug,
o the clinical condition of the patient receiving the drug, and
o the benefit-to-risk ratio for the patient.
 The longer an antibiotic has been available, the more likely it is that mutant bacterial strains resistant to
the mechanisms of antibiotic activity will have developed.
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ANTIBIOTICS
 The most common adverse effects of antibiotic therapy involve:
o The GI tract (nausea, vomiting, diarrhea, anorexia, abdominal pain)
o superinfections (invasion of the body by normally occurring microorganisms that are usually
kept in check by the normal flora).
CLIENT TEACHING
 The most common adverse effects of antibiotic therapy involve:
o the GI tract (nausea, vomiting, diarrhea, anorexia, abdominal pain)
o superinfections (invasion of the body by normally occurring microorganisms that are usually
kept in check by the normal flora).
 A patient and family teaching program should address those issues mentioned previously, as well as:
 the proper dosing procedure for the drug (even if the patient feels better)
 the importance of keeping a record of any reactions to antibiotics.
__________________________________________________________________________________________________
ANTIVIRAL AGENTS
 Viruses cause a variety of conditions, ranging from warts, to the common cold and “flu,” to diseases
such as chickenpox and measles.
 Viruses are particles of DNA or RNA surrounded by a protein coat that survive by injecting their own
DNA or RNA into a healthy cell and taking over its functioning.
 Agents for Influenza A and Respiratory Viruses Agents for Herpes Virus and Cytomegalovirus Agents
for HIV and AIDS Anti-Hepatitis B agents Anti-Hepatitis C agents Locally Active Antiviral Agents.
 Because viruses are contained within human cells, it has been difficult to develop drugs that are
effective antivirals and yet do not destroy human cells. Antiviral agents are available that are effective
against only a few types of viruses.
 Influenza A and respiratory viruses cause the signs and symptoms of the common cold or “flu.” The
drugs that are available to prevent the replication of these viruses are used for prophylaxis against these
diseases during peak seasons and to treat disease when it occurs.
 HIV, which specifically attacks helper T cells, may remain dormant in these cells for long periods and
has been known to mutate easily.
 Antiviral agents that are effective against HIV and AIDS include:
o nonnucleoside and NRTIs,
o protease inhibitors, fusion inhibitors,
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o CCR5 coreceptor antagonists, and
o integrase inhibitors
o all of which affect the way the virus communicates, replicates, or matures within the cell.
 These drugs are known as antiretroviral agents.
 Recently three drugs have been approved to treat hepatitis B infection: adefovir, entecavir, and
telbivudine. Some antivirals are available only for the local treatment of viral infections, including warts
and eye infections. These drugs are not absorbed systemically.
__________________________________________________________________________________________________
ANTI-FUNGAL AGENTS
 Fungal infections in humans range from conditions such as the annoying “athlete’s foot” to potentially
fatal systemic infections.
 An infection caused by a fungus is called a mycosis.
 Fungi differ from bacteria in that the fungus has a rigid cell wall that is made up of chitin and various
polysaccharides and a cell membrane that contains ergosterol.
o Systemic Antifungals
o Topical Antifungals
o Other Antifungals
 Systemic antifungals alter the cell permeability, leading to leakage of cellular components.
 Because systemic antifungals can be very toxic, patients should be monitored closely while receiving
them.
 Adverse effects may include hepatic and renal failure.
 Local fungal infections include vaginal and oral yeast infections (Candida) and a variety of tinea
infections, including athlete’s foot and jock itch.  Topical antifungals are agents that are too toxic to be
used systemically but are effective in the treatment of local fungal infections.
 Proper administration of topical antifungals improves their effectiveness. They should not be used near
open wounds or lesions.
 Topical antifungals can cause serious local irritation, burning, and pain. The drug should be stopped if
these conditions occur.
__________________________________________________________________________________________________
ANTIPROTOZOAL AGENTS
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 Infections caused by protozoa—singlecelled organisms that pass through several stages in their life
cycles, including at least one phase as a human parasite—are very common in several parts of the world.
 In tropical areas, where protozoal infections are most prevalent, many people suffer multiple infestations
at the same time.
o Anti-malarial agents
o Other protozoal agents
 Antimalarial drugs are usually given in combination form to attack the Plasmodium at various stages of
its life cycle. Using this approach, it is possible to prevent the acute malarial reaction in individuals who
have been infected by the parasite.
 Antimalarial agents attack the parasite at the various stages of its development inside and outside the
human body.
 Other protozoal infections
 Other protozoal infections include amebiasis, leish- maniasis, trypanosomiasis, trichomoniasis,
giardiasis, and Pneumocystis carinii.
 Patients receiving antiprotozoal agents should be monitored regularly to detect any serious adverse
effects, including loss of vision, liver toxicity, and so on.
__________________________________________________________________________________________________
ANTHELMINTHIC AGENTS
 The anthelmintic drugs act on metabolic pathways that are present in the invading worm but are absent
or significantly different in the human host.
 Helminths are worms that cause disease by invading the human body.
 Helminths that affect humans include:
o nematodes (round-shaped worms) such as pinworms, hookworms, threadworms, whipworms,
and roundworms; and
o platyhelminths (flatworms), which include tapeworms and flukes.
 Patient teaching is important for decreasing the stress and anxiety that may occur when individuals are
diagnosed with a worm infestation.
__________________________________________________________________________________________________
ANTI-NEOPLASTIC AGENTS
 Antineoplastic drugs can work by affecting cell survival or by boosting the immune system in its efforts
to combat the abnormal cells
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o Alkylating agents
o Antimetabolites
o Antineoplastic antibiotic
o Mitotic inhibitors
o Hormones and hormone modulators
o Cancer cell-specific agents
o Miscellaneous antineoplastic
o Antineoplastic adjunctive therapy
 Antineoplastic drugs affect both normal cells and cancer cells by disrupting cell function and division at
various points in the cell cycle; new drugs are being developed, such as protein kinase inhibitors, to
target cancer cell–specific functions.
 Cancer drugs are usually most effective against cells that multiply rapidly (i.e., proceed through the cell
cycle quickly). These cells include most neoplasms, bone marrow cells, cells in the GI tract, and cells in
the skin or hair follicles.
 The goal of cancer chemotherapy is to decrease the size of the neoplasm so that the human immune
system can deal with it.
 Antineoplastic drugs are often given in combination so that they can affect cells in various stages of the
cell cycle, including cells that are emerging from rest or moving to a phase of the cycle that is disrupted
by these drugs.
 Adverse effects associated with antineoplastic therapy include effects caused by damage to the rapidly
multiplying cells, such as bone marrow suppression, which may limit the drug use; GI toxicity, with
nausea, vomiting, mouth sores, and diarrhea; and alopecia (hair loss).
 Chemotherapeutic agents should not be used during pregnancy or lactation because they may result in
potentially serious adverse effects on the rapidly multiplying cells of the fetus and neonate.
 The newest drugs developed as antineoplastic agents target very specific enzyme systems or processes
used by the cancer cells but not by healthy human cells.
 These drugs are not as toxic to the patient as traditional antineoplastic drugs.
__________________________________________________________________________________________
ANTI-INFLAMMATORY, ANTIALLERGY, AND

IMMUNOSUPPRESSANT DRUGS
LEARNING OUTCOME
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DRUGS AND THE IMMUNE SYSTEM
 Immune and inflammatory responses protect the body from invading foreign substances. Certain classes
of drugs can modify these responses:
o Antihistamines
o Corticosteroids
o Immunosuppressants (non-corticosteroids)
o Uricosurics
__________________________________________________________________________________________________
ANTIHISTAMINES
 Antihistamines primarily act to block histamine effects that occur in an immediate (type I)
hypersensitivity reaction, commonly called an allergic reaction.
 Antihistamine Histamine -1 Receptor Antagonists
Pharmacotherapeutics: Allergic/vasomotor rhinitis
Allergic conjunctivitis
Urticaria
Angioedema
Pharmacokinetics: Route: oral; parenteral
Absorption/distribution: throughout the body & CNS
Metabolism: metabolized by liver enzymes
Excretion: kidneys; liver
Pharmacodynamics: Blocks histamine from producing its effects
IMPLEMENTATION
 Given with food
 When given IM, alternate injection site
 Provide sugarless gum, hard candy or ice for dry mouth
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 Increase fluid intake (if allowed)
 Notify prescriber if tolerance is observed
__________________________________________________________________________________________________
CORTICOSTEROIDS
 Corticosteroids suppress immune responses and reduce inflammation. •Glucocorticoids
•Mineralocorticoids
Corticosteroid GLUCOCORTICOIDS
 Most glucocorticoids are synthetic analogues of hormones secreted by the adrenal cortex. hey exert anti-
inflammatory, metabolic, and immunosuppressant effects. drugs in this class include:
o Beclomethasone
o Betamethasone
o Cortisone
o Dexamethasone
o Hydrocortisone
Pharmacotherapeutics: Replacement therapy

Immunosuppression
Reduction of inflammation
Pharmacokinetics: Route: oral; IM
Absorption/distribution: bound to plasma proteins and distributed through the
blood
Metabolism: metabolized in the liver
Excretion: kidneys
Pharmacodynamics: Inhibit immune responses i.e., suppressing the redness, edema, heat, and
tenderness.
IMPLEMENTATION
 Give the drug early in the day
 Give drug with food
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 Avoid exposure to infection
 Don’t stop the drug abruptly
 Avoid prolonged use
Corticosteroid MINERALOCORTICOIDS
 Mineralocorticoids affect electrolyte and water balance.
 One mineralocorticoid is fludrocortisone acetate, a synthetic analogue of hormones secreted by the
adrenal cortex
Pharmacotherapeutics: Replacement therapy
Treatment of salt-losing congenital adrenogenital syndrome
Pharmacokinetics: Route: oral
Absorption/distribution: all parts of the body
Excretion: kidneys
Pharmacodynamics: Affects fluid and electrolyte balance by acting on the distal renal tubule to
increase sodium reabsorption and potassium and hydrogen secretion.
IMPLEMENTATION
 Administer as prescribed
 Notify prescriber for adverse effects
 Notify prescriber if HPN occurs
 Monitor electrolyte levels
__________________________________________________________________________________________________
URICOSURIC DRUGS
 Uricosurics act by increasing uric acid excretion in urine.
 The primary goal in using uricosurics is to prevent or control the frequency of gouty arthritis attacks.
Corticosteroid URICOSURICS
Pharmacotherapeutics: Treatment of chronic gouty arthritis tophaceous gout (the deposition of tophi or
urate crystals under the skin and into joints).
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Absorption/distribution: GI tract, protein bound
Excretion: kidneys.
Pharmacodynamics: Probenecid and sulfinpyrazone reduce the reabsorption of uric acid at the
proximal convoluted tubules of the kidneys. This results in excretion of uric acid
in urine, reducing serum urate levels.
IMPLEMENTATION
 Give the medication with milk, food, or antacids to minimize GI distress. Continued disturbances may
indicate a need to lower the dosage.
__________________________________________________________________________________________
ANTI-INFECTIVE DRUGS
LEARNING OUTCOME
Four types of anti-infective drugs:
1. Antibacterial
2. Antiviral
3. Antitubercular
4. Antifungal
__________________________________________________________________________________________________
SELECTING ANTI-INFECTIVE DRUGS

 Microorganism must be isolated through growing a culture.
 Its susceptibility to various drugs must be determined.
 Location of the infection must be considered.
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 The cost of the drug, potential adverse effects and the possibility of allergies
__________________________________________________________________________________________________
ANTIBACTERIAL DRUGS
Antibacterial drugs, also known as antibiotics, are drugs that either kill bacteria or inhibit the growth of bacteria.
They’re mainly used to treat systemic
Aminoglycosides
Penicillin
Cephalosporins
Tetracyclines
Clindamycin
Macrolides
Vancomycin
Carbapenems
Monobactams
__________________________________________________________________________________________________
AMINOGLYCOSIDES (Antibacterial)
Pharmacotherapeutics: Bactericidal, effective against:
Gram-negative bacilli
Some aerobic gram-positive bacteria
Mycobacteria
Some protozoa.
Pharmacokinetics: Routes: IV or IM (except neomycin)
Absorption/Distribution: extracellular fluid
Metabolism: not metabolized
Excretion: kidneys
Pharmacodynamics: Bactericidal drugs against susceptible
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Organisms by binding to the bacteria’s 30S subunit, thereby interrupting protein
synthesis
And causing the bacteria to die.
IMPLEMENTATION
 Keep the patient well hydrated
 Don’t add or mix other drugs with IV infusions
 Follow the manufacturer’s instructions for reconstitution, dilution, and storage of drugs; check
expiration dates.
 Shake oral suspensions well before administering them.
__________________________________________________________________________________________________
PENICILLIN (ANTIBACTERIAL)
Pharmacotherapeutics: Wide a spectrum of antimicrobial activity; cover gram-positive, gram-negative,
and anaerobic organisms
Pharmacokinetics: Route: IM, po
Absorption/Distribution: duodenum and the upper jejunum
Metabolism: liver to inactive metabolites
Excretion: kidneys
Pharmacodynamics: Bactericidal, bind reversibly to several enzymes outside the bacterial cytoplasmic
membrane
IMPLEMENTATION:
 Give at least 1 hour after bacteriostatic antibacterial drugs
 For oral penicillin, give at least 1 hour before or 2 hours after meals
 Deep IM in large muscle
 For IV, don’t mix with other drugs or temporarily stop infusion of primary drug
__________________________________________________________________________________________________
CEPHALOSPORINS (ANTIBACTERIAL)
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Pharmacotherapeutics: First Generation- primarily against gram positive organisms
Second generation- gram negative bacteria (anaerobes)
Third generation- gram negative organism
Fourth- gram positive and gram-negative organism (broad spectrum)
Pharmacokinetics: Route: oral, but mostly parenteral
Absorption/distribution: GI tract
Metabolism: mostly not metabolized
Excretion: kidneys; but some in feces via bile
Pharmacodynamics: Inhibit cell-wall synthesis by binding to the bacterial PBP enzymes located on the
cell membrane
IMPLEMENTATION
 Administer cephalosporins at least 1 hour before bacteriostatic antibacterial drugs
 Refrigerate oral suspensions (stable for 14 days)
 Administer an IM dose deep into a large muscle mass
 Don’t add or mix other drugs with IV infusions
 Ensure adequate dilution of the IV infusion and rotate injection sites every 48 hours
__________________________________________________________________________________________________
TETRACYCLINES (ANTIBACTERIAL)
Pharmacotherapeutics: Broad-spectrum ▪ gram-positive and gram-negative aerobic and anaerobic
bacteria
Spirochetes
Mycoplasmas
Rickettsia
Chlamydia
Gonorrhea
Some protozoa.
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Pharmacokinetics: Route: oral; IV
Absorption/Distribution: duodenum when taken orally; widely into body tissues
and fluids and concentrated in bile.
Metabolism: mostly not metabolized
Excretion: kidneys
Pharmacodynamics: Bacteriostatic, meaning they inhibit the growth or multiplication of bacteria
Penetrate the bacterial cell by an energy -dependent process
IMPLEMENTATION
 Don’t give with food
 Don’t give one hour before bedtime
 Monitor bacterial and fungal superinfection
 Monitor IV injection sites
__________________________________________________________________________________________________
CLINDAMYCIN (ANTIBACTERIAL)
Pharmacotherapeutics: Most aerobic gram-positive organisms
Anaerobic intra-abdominal, pleural, mor pulmonary infections
Pharmacokinetics: Route: oral; IM; IV
Absorption/Distribution: widely in the body
Metabolism: metabolized by the liver
Excretion: kidneys
Pharmacodynamics: Bacteriostatic, inhibits bacterial protein synthesis and may also inhibit the binding
of bacterial ribosomes
IMPLEMENTATION
 Don’t refrigerate oral suspension
 Give capsule with full glass of water
 Check IV site for phlebitis
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 Inject deep IM and rotate sites
__________________________________________________________________________________________________
MACROLIDES (ANTIBACTERIAL)
Pharmacotherapeutics: Broad-spectrum
Gram-positive and gram-negative bacteria
Drug of choice for treating
Mycoplasma pneumoniae
Absorption/Distribution: absorbed in duodenum: widely distributed except CSF
Metabolism: metabolized by the liver
Excretion: high concentration in bile; small amount in urine
Pharmacodynamics:
IMPLEMENTATION
 Give with full glass of water and give 1-hour ac or 2 hours pc
 Coated tablet maybe taken with meals
 Tell patient not to drink tablets with fruit juices
__________________________________________________________________________________________
VANCOMYCIN (ANTIBACTERIAL)
Pharmacotherapeutics: Active against gram-positive organisms
Pharmacokinetics: Route: oral; IV
Absorption/Distribution: diffuses well into pleural, pericardial, synovial, and
ascitic fluids.
Metabolism: unknown
Excretion: mostly in the kidneys, small amount in the liver and biliary tract
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Pharmacodynamics: Inhibits bacterial cell-wall synthesis, damaging the bacterial plasma membrane.
When the bacterial cell wall is damaged, the body’s natural defenses can attack
the organism.
IMPLEMENTATION
 Oral form of the drug is stable for 2 weeks
 IV infusion: dilute in 200 mL of D5W over 60 minutes
 Check IV site for phlebitis
 Don’t give via IM
 Refrigerate after reconstitution
__________________________________________________________________________________________
CARBAPENEMS (ANTIBACTERIAL)
Pharmacotherapeutics: Broad-spectrum
Pharmacokinetics: Route: IV
Absorption/Distribution: widely distributed
Metabolism: rapidly metabolized in the tubules of the kidneys
Excretion: kidneys
Pharmacodynamics: Bactericidal, they exert antibacterial activity by inhibiting bacterial cell-wall
synthesis.
IMPLEMENTATION
 Don’t give by direct IV bolus
 Shake well when reconstituting powder
 Monitor hydration patient’s status
__________________________________________________________________________________________
MONOBACTAMS (ANTIBACTERIAL)
Pharmacotherapeutics: Effective against a variety of gram-negative aerobic organisms
Pharmacokinetics: Route: IM, IV
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Absorption/Distribution: rapidly and completely absorbed and widely distributed
Metabolism: metabolized partially
Excretion: excreted primarily in urine as unchanged drug
Pharmacodynamics: Bactericidal, activity results from inhibition of bacterial cell-wall synthesis. It
binds to the PBP-3 of susceptible gram-negative bacteria, inhibiting cell-wall
division and resulting in lysis
IMPLEMENTATION
 Monitor patients with immediate hypersensitivity
 Give IV bolus slowly @ 3 to 5 minutes
 Give infusion over 20 minutes to 1 hour
 Give IM injections into a large muscle
__________________________________________________________________________________________
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Pharmacology Notes

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MISAMIS UNIVERSITY

Ozamiz City 7200, Philippines

Prepared by: Celada, Kyrriel J.

THE NURSING PROCESS IN PHARMACOLOGY

MODULE 2.1 HEMATOLOGIC DRUGS

HEMATINIC DRUGS: IRON

HEMATINIC DRUGS: VITAMIN B12

HEMATINIC DRUGS: FOLIC ACID

HEMATINIC DRUGS: EPOETIN ALFA

ANTICOAGUL ANT DRUGS: HEPARIN

ANTICOAGUL ANT DRUGS: WARFARIN

ANTICOAGULANT DRUGS: ANTIPLATELET DRUGS

MODULE 2.1 RESPIRATORY DRUGS

MODULE 2.1 CARDIOVASCULAR DRUGS

CARDIAC GLYCOSIDE -DIGOXIN

ANTIARRHYTHMIC DRUGS-CLASS IB LIDOCAINE)

ANTIARRHYTHMIC DRUGS –CLASS II (BETA BLOCKERS)

ANTIARRHYTHMIC DRUGS –CLASS III (AMIODARONE)

ANTIARRHYTHMIC DRUGS –CLASS IV (CALCIUM CHANNEL BLOCKERS)

ANTI-ANGINAL DRUGS –NITRATES (NITROGLYCERIN)

ANTIHYPERTENSIVES-CALCIUM CHANNEL BLOCKERS

MODULE 2.2 PAIN MEDICATION

 Abdominal pain and bleeding

PHENA ZOPYRIDINE HYDROCHLORIDE

OPIOID AGONISTS –MORPHINE, CODEINE,

OPIOID ANTAGONISTS –NALOXONE HCL,

ANTI-INFLAMMATORY, ANTIALLERGY AND IMMUNOSUPPRESSANT DRUGS

Drugs and the immune system

ANTI-ULCER DRUGS –SYSTEMIC ANTIBIOTICS

HOW ANTIBIOTIC RESISTANCE HAPPENS

ANTIULCER DRUGS –ANTACIDS

ANTI-ULCER DRUGS –H2 RECEPTOR ANTAGONISTS

ANTI-ULCER DRUGS –PROTON PUMP INHIBITORS

ADSORBBENT DRUGS –ACTI VATED CHARCOAL

ANTI-FL ATULENT DRUGS –SIMETHICONE

LAXATIVES – HYPEROSMOLAR DRUGS

LAXATIVES – DIETARY FIBER AND RELATED BULKFORMING

LAXATIVES –LUBRICANTS (MINERAL OIL)

ANTI-DIARRHEAL DRUGS –OPIOID-REL ATED DRUGS

SUMMARIZING NURSING RESPONSIBILITIES ON

THIA ZIDE AND THIA ZIDE-LIKE DIURETICS

SUMMARIZING NURSING RESPONSIBILITIES ON DRUGS FOR

Pharmacotherapeutics: Hypokalemia: Vomiting, diarrhea, or nasogastric suction

ANTI-INFLAMMATORY, ANTIALLERGY, AND

Pharmacotherapeutics: Replacement therapy

SELECTING ANTI-INFECTIVE DRUGS

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