RESPIRATORY

UPPER RESPIRATORY DRUGS

Antihistamines
-blocks H1 receptors
- Do not let your patient take
this drug before going out
(driving)
-Fall Precaution (SEDATION)
1st Generation
- block both histaminic and ● Diphenhydramine
muscarinic receptors; passing (Benadryl)
the blood-brain barrier
can cause:
- Drowsiness
- Dry mouth
- Decreased secretions
- Anticholinergic symptoms
(cant pee, see, spit, poop)

2nd Generation ● Loratadine

”non-sedating antihistamines” ● Cetirizine
- mainly block histaminic
receptors do not or only
minimally cross the blood-brain
barrier.
- Little to no sedative effect
- Causes fewer anticholinergic
Symptoms
- Used for allergy symptoms
like RHINITIS, itchy watery
eyes, sneezing
For motion sickness and hives

Decongestants Nasal Decongestants ● Pseudoephedrine

- type of medicine that can ● Phenylephrine
provide short-term relief for a
blocked or stuffy nose (nasal
congestion).

Systemic Decongestants
- Relieves nasal congestion for
a long period of time.

Intranasal - effective for treating allergic ● Beclomethasone

Glucocorticoids/Steroids rhinitis ● budesonide
- they have an ● flunisolide
anti-inflammatory action = ● fluticasone
decreases the allergic ● Mometasone
rhinitis symptoms ● triamcinolone

Antitussives - Used to treat your patient’s (ABCD)

cough ● Antitussives
- also known as cough ● Benzonatate
suppressants. (non-opioid)
● Codeine
(opioid)
● Dextromethorphan
(opioid)

Expectorants - loosen the bronchial ● Guaifenesin

secretions so they can be ● Hydration
eliminated by coughing

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 RESPIRATORY

- can be used with or without

other pharmacologic agents

Mucolytics MOA: breaks down the ● Acetylcysteine

molecules in the mucus to help
it to become less viscous

LOWER RESPIRATORY DRUGS

BRONCHODILATORS (BAM) (dilates bronchioles in lungs)

Beta 2 Agonist - “-buterol” ● Albuterol (acute asthma

B - buterol
B - brutal asthma attacks
- 1st drug used during a severe attack)
asthma attack and the fastest ● Levalbuterol
acting bronchodilators ● Salmeterol (moderate to
- beta 2 agonist which activates severe asthma)
beta 2 in the lungs which
dilates the bronchi – resulting
an increase air flow , but it also
activates the Beta 1 (heart) –
which makes the heart goes
crazy
- common s/e: rapid heart rate

Anticholinergics - ending in “-tropium” ● Ipratropium

- MOA: Blocks secretions: you ● Tiotropium
can’t see(glaucoma), you can’t
urinate(urinary retention), you
cant spit or can’t
Defecate; blocks acetylcholine
- These medications dry the
body out
- Used for moderate to severe
asthma attack and
COPD
- It is a longer acting
bronchodilator that reduces
secretions
- is commonly given in
combinations with
ALBUTEROL

Methylxanthines - ending in “-phylline” ● Theophylline

- Can be very toxic because it ● Aminophylline
KEY POINTS: 3 Ts can race your heart rate
1. T – toxic over 20 (mcg/ml) –
can only be given 10-20
2. T – tonic clonic seizures
(no. 1 sign for severe toxicity)
and always the 1st priority of a
nurse
common signs & symptoms:
anorexia, nausea and vomiting,
restlessness/insomnia
3.T - Tachycardia and

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 RESPIRATORY

dysrhythmias

ANTI-INFLAMMATORY AGENTS (SLM)

Steroids - “-sone” ● Beclomethasone

- decreases the swelling (decreases the Bronchi
4s of steroids: in lungs)
S - swelling and inflammation ● Prednisone (decreases
S - slow onset swelling for P as in
S - sugar increase person
S - sore mouth (infection)

Leukotriene Inhibitor - “-lukast” ● Montelukast

- Prevention for asthma attacks ● Zafirlukast
MEMORY TRICK: OLL only and NOT during ACUTE
Opens airway ATTACKS
Long term management - NOT A RESCUE DRUG
Long onset (1-2 weeks to reach - This med only prevents
therapeutic range) inflammation that causes
asthma attack

Mast Cell Stabilizers - PREVENTS activity ● Cromolyn

induced asthma

UPPER RESPIRATORY EFFECTS AND INTERVENTIONS

Diphenhydramine
(1st gen antihistamine)
- primarily used to treat rhinitis
- can be administered orally
intramuscularly or intravenously
(orimin)
s/e: 1. give the oral form of the
• Drowsiness is a major side drug with meals to decrease
effect. gastric distress.
2. administer the IM form in a
Drug interactions: large muscle.
• should not be taken with 3. instruct the patient not to
alcohol, narcotics, hypnotics or leave his or her bed after
barbiturates because it can taking the drug for this may
cause CNS depression. cause injuries.
4. inform the patient that this
should not be taken if he or she
is taking alcohol or other CNS
depressants.
5. warn the patient to avoid
driving if he or she is taking the
medication

Pseudoephedrine s/e:
(Nasal decongestant) Nervousness
Palpitations
- used for rhinitis or nasal Weakness
congestion, works by Insomnia
causing vasoconstriction of the
respiratory tract mucosa. *Possible rebound congestion
when you stop using it*
*This drug is actually a key
ingredient in Meth so you can’t
buy over the
counter*

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 RESPIRATORY

Phenylephrine CONTRAINDICATIONS:
- OTC (NSD)
- Hypertension
- Cardiac disease
- Hyperthyroidism
- Diabetes Mellitus

Intranasal Glucocorticoids s/e: - spray should be directed away

Headache from the nasal septum, and
Nasal irritation patient should sniff gently
Pharyngitis - continuous use of this drug
Fatigue may cause dryness of the nasal
Insomnia mucosa
Candidiasis

(Antitussives)
Benzonate
s/e:
-Works by having an anesthetic Constipation
effect in the vagal nerve Sedation
receptor in the airway GI upset

Codeine s/e:
-Binds to opioid receptors in Sedation
the CNS and decreases the Respiratorydepression
patients cough reflex Hypotension
Its an opioid medication

Dextromethorphan s/e:
-Suppressing the cough reflex Dizziness
in the medulla Possible sedation (high doses)

(Expectorants) - Teach patient to take the

Guaifenesin s/e: (minimal) medications with a full
- most common expectorant glass of water
- used for a non-productive GI upset
cough dizziness
- Works by reducing the
viscosity of secretions, so it
helps thin the secretions;
making the cough productive

Hydration
- the best natural expectorant

Acetylcysteine
(Mucolytics) s/e: - use this medication
- for pulmonary disorders that Bronchospasm cautiously with patients
have thick mucus with asthma, Nausea,
secretions Vomiting and rash, give
patients head ups that
this medication smells
like rotten eggs

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 RESPIRATORY

LOWER RESPIRATORY EFFECTS AND INTERVENTIONS

(Beta 2 Agonist) *remember not to use
Salmeterol Drugs given during acute fluticasone or salmeterol for
- is a beta 2 agonist as well but asthma attack: (AIM) first
it is a slower acting sign of acute asthma attack.
bronchodilator (NOT RESCUE 1. Albuterol (B2A)
INHALER) and not to be 2. Ipratropium *Key tip: ONLY rescue inhaler
used during an acute asthma (Anticholinergics) during an acute asthma attack,
attack 3. BEFORE using a steroid inhaler
- is commonly used Methyl-prednisolone/solumedrol
combination of steroids for a (Steroid) - always last since
LONG term control of they act slow
MODERATE to SEVERE
ASTHMA.

Albuterol s/e: (3T)

- AAAAAmps up the body Tachycardia and palpitation ● teach patients not to
Tremor take it at bed time
Toss and turning at night (unless ordered)
(Insomnia/difficulty in sleeping)

How do we evaluate if the Patient Education:

medication is
effective?
- Decrease in RR (example
from 34 to 24)
- Oxygen saturations at least
90% or higher
Albuterol Nebulizer for 3 rounds – if it doesn’t work
expected findings after
treatment will result to:
-Increased productive cough
-Reports decreased anxiety
-Mild bilateral hand tremors
- Avoid beta blockers- atenolol
(Causes Bronchospasm)
- NSAIDS-Naproxen, Ibuprofen
(worsens an asthma)
- During an extreme asthma
attack we instruct patients to
take 2-4 puffs every 20 minutes
after 3 doses (notify the
physician)
For administration:
- Make sure you shake it before
you take it
Key point: always make sure to
shake it well
- Then you breathe all the way
out, push the inhaler, inhale
then hold for a few seconds,
then exhale

Albuterol w/ Steroids For cleaning your MDI:

- correct order would be - Always clean the mouth piece
the following: 1 to 2 times per week with
● ALBUTEROL first to warm water (not to be done
bronchodilate and open every use)
the lungs Reminder: Only steroids can be
● STEROIDS second to get washed every after use
all that powder down

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 RESPIRATORY

into the lungs (deep)

Anticholinergics s/e: *Treat the dry mouth and

(anticholinergics;
bronchodilators)
Dry mouth throat for all anticholinergics:
Hoarseness ● Using gum/ candy
● Drink fluids
Contraindications:
Patients who are already dry

Methylxanthines KEY POINTS: 3 Ts • Teach patient to avoid beta

1. T – toxic over 20 (mcg/ml) –
can only be given 10-20
2. T – tonic clonic seizures
(no. 1 sign for severe toxicity)
and always the 1st priority of a
nurse
common signs & symptoms:
anorexia, nausea and vomiting,
restlessness/insomnia
3.T - Tachycardia and
dysrhythmias
blockers that lower the heart
rate while on THEOPHYLLINE
because it blocks the effects of
theophylline
• Alert the Physician of
tachycardia before giving the
next dose
Patient Education
Drugs that increase toxicity
risk:
• Cimetidine (H2blocker)given
for heart burn
• Ciprofloxacin (antibiotics)

> Always take the drug in the

morning
> Avoid caffeine
> AVOID ALL STIMULANTS
> STOP taking the drug if the
patient is for a cardiac
stress test (because it can
augment the test)

Beclomethasone s/e: Patient education:

(Steroids) • Sugar increase - • Slow onset (not a rescue
(because steroids naturally drug) DO NOT USE SONE as
increases sugar, glucocorticoids
1st drug of choice for an
naturally increases the glucose)
asthma attack but rather 3rd in
– no need to report since line
it is an expected finding • DO NOT USE Fluticasone or
Salmeterol for first
• Sores for the mouth sign of acute asthma attack
(infection) - • REMEMBER TO USE AIM for
because steroids suppresses acute asthma attack
the immune system leading to
slow wound healing and sore in REMEMBER:
the mouth 1. Use spacers to prevent oral
THRUSH
(candida) infection
2.Teach patient to rinse the
mouth after each use
3. DO NOT SWALLOW WATER
4. Always wash the mouth
piece out with warm water

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 RESPIRATORY

5. Clean it daily for steroids,

weekly for
albuterol

Montelukast What if a patient complaints to

(Leukotriene Inhibitor)
you that he/she has been on
montelukast for 5 days and
states that the medication is
NOT working, what is your best
response?
● Advice the patient that
this drug has a long
onset meaning the drug
reaches its therapeutic
effect 1-2 weeks

Cromolyn - Taken 15 minutes before

(Mast Cell Stabilizers) exertion for maximum
effects
- Use 10-15 minutes
before physical activity

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 CARDIOVASCULAR DRUGS

Cardiac Glycoside/ ● MOA: inhibits sodium-potassium pump ● Digoxin

Digitalis Glycoside → Increase in intracellular sodium - a secondary drug
→ Influx of calcium for heart Failure
→ Cardiac muscle fibers contract more
efficiently
● Effective in treating heart failure (also
known as cardiac failure) or previously
referred as Congestive Heart Failure (CHF)
● Obtained from the purple and white fox
glove plant

Phosphodiesterase ● MOA: increases stroke volume and cardiac ● Milrinone Lactate

Inhibitors output and promotes vasodilation - high alert
● First-line medication for heart failure medication
● Positive inotropic group of drugs given to
treat acute heart failure (HF)

ANTIANGINAL DRUGS

Nitrates ● MOA: acts directly on the smooth muscle ● Nitroglycerin

of blood vessels causing relaxation and ● Isosorbide dinitrate
dilation ● Isosorbide mononitrate
● Cause generalized vascular and coronary
vasodilation → increases blood flow to the
myocardial cells
● Reduces myocardial ischemia but can
cause hypotension

Beta Blockers ● MOA: Blocking the action of the ● Atenolol

catecholamines epinephrine and - cardioselective
norepinephrine → decreases the heart rate ● Metoprolol Tartrare
and blood pressure - cardioselective
● Blocks beta1 and beta2 receptor sites ● Nadolol
Beta1 blocked → decreases heart rate - non-cardioselective
Beta2 blocked → bronchoconstriction ● Propranolol HCl
- non-cardioselective

Calcium Channel ● MOA: relax coronary spasm (variant angina), ● Amlodipine

Blockers and relax peripheral arterioles (stable angina), ● Diltiazem HCl
decreasing cardiac oxygen demand ● Felodipine
● Also decreases cardiac contractility, afterload ● Isradipine
and peripheral resistance, and reduces the
● Nicardipine HCl
workload of the heart → decreases the need
for oxygen demand ● Nifedipine
● Calcium activates myocardial contraction → - Most potent
increasing the workload of the heart and the - Prescribed in
need for oxygen hospital
● Thus, blocking the calcium channel will prevent - Associated with
in increasing the workload of the heart and cardiac death
need for oxygen ● Nisoldipine
● Verapamil HCl
 ANTIDYSRHYTMIC DRUGS

CLASS I: Sodium ● MOA: decrease sodium influx into ● Disopyramide phosphate

Channel Blockers cardiac cells ● Procainamide HCl
● Responses to these drugs are: ● Quinidine sulfate
→ increased conduction velocity in ● Lidocaine
cardiac tissues ● Mexiletine HCl
→ suppression of automaticity, which ● Flecainide
decreases the likelihood of ectopic foci ● Propafenone HCl
→ increased recovery time or
repolarization or refractory period
→ these medications can serve as an
important mechanism by suppressing
tachycardias that are caused by
abnormal conduction

ClASS II: Beta ● MOA: decrease conduction velocity, ● acebutolol HCl

Blockers automaticity and recovery time or ● esmolol
refractory period ● propranolol HCl
● Beta blockers are more frequently ● sotalol HCl
prescribed for dysrhythmias than
sodium channel blockers
● should be gradually reduced in dose
upon discontinuation

CLASS III: Drugs ● Used in emergency treatment of ● Adenosine

that prolong ventricular dysrhythmias when other ● Amiodarone HCl
Repolarization antidysrhythmics are ineffective ● Dofetilide
● Ibutilide
● Sotalol

CLASS IV: Calcium ● MOA: blocks calcium influx ● Verapamil HCl

Channel Blockers → Decreases excitability and ● Diltiazem
contractility of the myocardium

DIURETICS

Thiazide and ● MOA: Acts on the distal convoluted ● Chlorothiazide

Thiazide-Like Drugs renal tubule beyond the loop of Henle ● Hydrochlorothiazide
to promote sodium chloride and water ● Bendroflumethiazide
excretion with nadolol
● used for patients with normal renal ● Methyclothiazide
function ● Chlorthalidone
● Causes loss of sodium, potassium, and ● Indapamide
magnesium ● Metolazone
● Promotes calcium reabsorption
● Should be administered in the morning

LOOP (High Ceiling) ● MOA: Acts on the thick ascending Loop ● Furosemide
Diuretics of Henle to inhibit chloride transport of ● Bumetanide
sodium into the circulation and inhibit ● Ethacrynic acid
passive reabsorption of sodium ● torsemide
 ● More effective than other diuretics
● sodium and water are lost together with
potassium, calcium, and magnesium

Carbonic Anhydrase ● MOA: Block the action of the enzyme ● Acetazolamide

Inhibitors carbonic anhydrase which is needed to ● Methazolamide
maintain the body’s acid base balance.
Inhibition of this enzyme causes
increased sodium potassium and
bicarbonate excretion
● Metabolic acidosis can occur with
prolonged use
● Used primarily to decrease intraocular
pressure (IOP) in patients with chronic
open-angle glaucoma
● Loss of Na, K and HCO3 (potassium
wasting)
● Hemolytic anemia and renal calculi can
occur
● Contraindicated: 1st trimester of
Pregnancy

Potassium-Sparing ● Will not excrete potassium (potassium ● Spironolactone

Diuretics will be spared for excretion) ● Eplerenone
● Closely monitor K level of patient ● Amiloride HCl
● Watch out for hyperkalemia (main side ● Triamterene
effect of the medication) since K is
retained in the body
● Spironolactone (very common
potassium-sparing diuretic)
● Discontinue the diuretic if potassium is
already more than 5.0 mEq/L
● Photosensitivity

ANTIHYPERTENSIVES

Diuretics ● Promote sodium depletion which ● Hydrochlorothiazide

decreases extracellular fluid volume
● Wherever sodium goes, water follows
(how this medication works)
● Expels or excretes the sodium from the
body through urination and the water
follows the sodium
● Effective as 1st line drugs for treating
mild hypertension

Sympatholytics ● When alpha1 is stimulated, the ● Beta adrenergic blockers

arterioles and venules constrict. This ● Alpha-adrenergic
increased peripheral resistance and blockers
increases BP ● Centrally acting alpha2
● When alpha2 is stimulated, it decreases agonists
sympathetic activity, increases vagus ● Adrenergic neuron
 activity, decreases cardiac output, blockers
decrease serum Epinephrine, NE, and ● Alpha1- and beta1-
renin release. Thereby, reducing adrenergic blockers
peripheral vascular resistance and
increased vasodilation

● When beta1 receptors are stimulated,

they increase HR and increases the
heart strength or contraction or
contractility which increases BP
● When beta2 receptors are stimulated,
they induce bronchodilation

Sympatholytics:

Beta Adrenergic ● It blocks beta1 receptor sites ● Acebutolol

Blockers ● Slows down the heart rate and thereby ● Atenolol
decreasing blood pressure ● Bisprolol fumarate
● Blocks beta2 as well, resulting in ● Carvedilol
bronchoconstriction - nonselective
● Cardioselective – beta blockers that only ● Metoprolol
block beta1 receptors ● Nadolol
● Nonselective/Noncardioselective – ● Pindolol
blocks both beta1 and beta2 receptor ● Propranolol
sites - nonselective

Alpha-Adrenergic ● Blocks alpha1 receptors on the vessels ● Doxazosin

Blockers and vasodilation and decreased blood ● Prazosin
pressure result ● Terazosin
● Phenoxybenzamine HCl

Centrally Acting ● Stimulates alpha2 receptor sites ● Methyldopa

Alpha2 Agonists ● Clonidine
- Orally and
transdermal
patch
● Guanfacine

Adrenergic Neuron ● Blocks norepinephrine release from the ● Reserpine

Blocker sympathetic nerve endings - Most potent drug
● When norepinephrine release is blocked used to control
from the sympathetic nerve endings, hypertension
there will be a decrease in NE release
→ lowered blood pressure
● Potent antihypertensive drugs
Alpha1 and Beta1 ● We need to block alpha1 receptors ● Labetalol HCl
Adrenergic Blockers because when stimulate, they can
increase BP. When alpha1 receptors are
blocked, it results to a decreased
resistance to blood flow, thereby
lowering the blood pressure
● When beta1 receptors are stimulated,
they increase HR. If blocked, it results
in decreased HR and atrioventricular
(AV) contractility. Thereby, reducing BP

Direct Acting ● MOA: Act by relaxing the smooth ● Hydralazine and

Arteriolar muscle of the blood vessel minoxidil
Vasodilators → vasodilation → BP decrease, and ● Nitroprusside
sodium and water are retained →
peripheral edema → diuretics can be
given

Angiotensin-Converti ● When ACE is inhibited, ● Benazepril

ng Enzyme (ACE) ➔ Inhibits the formation of Angiotensin ● Captopril
inhibitors II (vasoconstrictor) and blocks release ● Enalapril maleate
of aldosterone (promotes sodium ● Perindopril
retention and potassium excretion) ● Ramipril
➔ Sodium is excreted along with water ● Moexipril
and potassium is retained and lowers
peripheral resistance. *** Can be administered with
● Irritated cough is the primary effect food except for Moexipril, which
should be taken on an empty
stomach ***

Angiotensin II ● Act on the renin angiotensin ● Losartan

Receptor Blockers aldosterone system (RAAS) ● Valsartan
(ARBs) ● Difference between ARBs and ACE ● Irbesartan
inhibitors: ● Candesartan
➔ ARBs block angiotensin II from the ● Olmesartan
angiotensin I receptors found in many ● Telmisartan
tissues
➔ ACE inhibitors inhibit the angiotensin *** May be used as 1st line
converting enzyme in the formation of treatment for hypertension ***
angiotensin
● ARBS cause vasodilation and decreased
peripheral resistance.
● Unlike the ACE inhibitors, ARBs do not
cause the constant irritated cough

Direct Renin ● Binds with renin ● Aliskiren

Inhibitor ➔ Cause reduction in angiotensin I and
II and aldosterone levels (because it all
starts with the conversion of
angiotensinogen to angiotensin I which
is caused by renin)

Calcium Channel ● block the calcium channel in the ● Verapamil

Blockers/Calcium vascular smooth muscle, promoting - used to treat
Antagonist vasodilation chronic
● In vasodilation, this helps promote in hypertension,
lowering the BP angina pectoris,
and cardiac
dysrhythmia
● Diltiazem HCl
● Amlodipine
● Felodipine
● Nicardipine
● Nifedipine
- immediate
release of
nifedipine is not
administered at
home but in the
hospital because
the medication is
associated to
sudden death)
● Nisoldipine

ANTICOAGULANTS

Heparin ● This medication is administered Antidote:

subcutaneously for prophylaxis or
through intravenous to treat acute ● Protamine Sulfate
thrombosis
➔ Thrombosis refers to clot formation
● This medication is poorly absorbed
orally that is why it is given
subcutaneously or intravenously. This
medication prolongs clotting time
➔ It delays the clotting of the blood.
● This can decrease platelet count
causing thrombocytopenia

Warfarin ● An oral anticoagulant which inhibits Antidote:

hepatic synthesis of vitamin K
● Administered by mouth ● Vitamin K
● Can also prolong clotting time
● This medication is used mainly to
prevent thromboembolic conditions
such as thrombophlebitis, and
embolism formation caused by atrial
fibrillation
Heparin Toxicity – Protamine Sulfate
● To Easily Remember: in Heaven, there is Peace
Warfarin Toxicity – Vitamin K
● To Easily Remember: in War, there is Killing

ANTIPLATELET

Antiplatelet/ ● Prevents platelet aggregation ● Aspirin

Antithrombotics ● Objective of this medication is also ● Cilostazol
to prevent formation of blood clot ● Clopidogrel
same as the anticoagulant, but they ● Prasugrel
just differ in their mechanism of ● Cangrelor
action
➔ For anticoagulant: prolongs
clotting time or slows down your
body’s process of making clots
➔ Antiplatelet: prevents platelet
aggregation or clumping of the
platelet

THROMBOLYTICS

Thrombolytics ● Clot buster ● Alteplase (Tissue

● Attack and dissolve blood clots that Plasminogen Activator
have formed already or tPA)
● Thromboembolism (refers to the ● Tenecteplase
occlusion of an artery or vein ● Streptokinase
caused by a thrombus or embolus
or a clot) results in ischemia that
causes necrosis of a tissue distal to
the obstructed area
● It takes approximately 1-2 weeks
for the blood clot to disintegrate by
natural fibrinolytic mechanisms

ANTIHYPERLIPIDEMIC

Bile-acid Sequestrants ● It reduces low density lipoprotein ● Cholestyramine

cholesterol level by binding bile ● Colesevelam
acids in the intestine ● Colestipol HCl
➔ NOTE: LDL and VLDL = bad
cholesterol
➔ HDL = good cholesterol

Fibrates/Fibric Acid ● If this medication is taken with ● Fenofibrate

 warfarin, bleeding might occur. - commonly used
Better assess the medications in the clinical
that the patient is taking area
● Gemfibrozil
- More effective in
reducing VLDL
levels than for
reducing LDL

Nicotinic Acid/B3 ● Very effective at lowering ● Niacin

cholesterol levels

Cholesterol Absorption ● Acts on the cells of small intestine ● Ezetimibe

Inhibitor to inhibit cholesterol absorption

Hepatic 3-hydroxy ● Decreases concentration of ● Atorvastatin Ca

3-methylgutaryl-coenzyme
A (HMG-CoA) reductase
inhibitors/ Statins
cholesterol, LDL, and slightly ● Rosuvastatin
increases HDL cholesterol ● Simvastatin
● While taking this medication,
serum liver enzyme should be
monitored and while eye
examination is needed because
cataract formation may result

DRUGS TO IMPROVE PERIPHERAL BLOOD FLOW

Drugs to improve ● A common problem in older ● Cilostazol

peripheral blood flow adults is peripheral arterial ● Pentoxifylline
disease which is also called as
peripheral vascular disease
Mechanism of actions:

1) Inhibition of the bacterial cell wall synthesis

2) Alteration of membrane permeability
3) Inhibition of protein synthesis
4) Inhibition of bacterial RNA and DNA synthesis
5) Interference with cellular metabolism

Antibiotic Combination Effects Examples:

-Combining two or more
antibiotics in a single person.
1) Additive Clarithromycin (macrolide) +
-clarithromycin + amoxicillin Amoxicillin-clavulanate
-equal to the sum of the effects (penicillin)
of two antibiotics ( 50%-50%)
2) Potentiative
- clavulanate increases effect of
amoxicillin
-amoxicillin+clavulanate
-( 70%-30%)
- occurs when one antibiotic
potentiates the effect of the
second antibiotic increasing its
effectiveness
3) Antagonistic
- combination of bactericidal +
bacteriostatic medication
decreasing its effectiveness

- penicillin (bactericidal +
tetracycline ( bacteriostatic)

3 major Adverse reaction to Definition Nursing Interventions

Antibacterials
1) Hypersensitivity • Commonly known as Make sure before starting an
allergy antibiotic
• Result to anaphylactic  Obtain thorough history
shock to make sure that the
• Cause patient is not sensitive
• Vascular collapse towards the antibiotic.
• Laryngeal edema
• Bronchospasm
• Cardiac arrest
• Signs and Symptoms
 Rash
 Pruritus
 hives
 2) Superinfection • Secondary infection that
result of the disruption of
the normal microbial flora
of the body from the
antibiotic therapy
• Infection over infection
3) Organ toxicity • Insult to the liver and
kidney because of their
involvement in drug
metabolism and excretion

Classifications
Narrow Spectrum Broad Spectrum
• Act against one type of organism • Act against multiple organism (both gram
positive and negative bacteria)
Example: • Used to treat infections when the offending
• Penicillin and Erythromycin used to treat microorganism has not been identified.
gram positive infections Examples:
• Tetracyclines, 3rd & 5th generation
Cephalosporins

Penicillin
- treat staphylococcus infection
-referred as beta-lactam antibiotics

MOA: interferes with the bacterial cell wall snythesis

Types of Penicillins Definition Medication

1) Basic Penicillins • First introduced to treat • Penicillin G
staphylococcus infection • Procaine Penicillin
• Penicillin V

2) Broad Spectrum Penicillins • Treat gram- positive& • Amoxicillin

( Aminopenicillins) gram-negative bacteria • Amoxicillin-
• NOT penicillinase resistant Clavulanate
• Ineffective against S. • Ampicillin
aureus • Ampicillin-Sulbactam

3) Penicillinase Resistance • Treat penicillinase- • Dicloxacillin sodium

( Antistaphylococcal) producing S. aureus • Nafcillin
• Ineffective against gram- • Oxacillin Sodium
negative bacteria
• Inactivate penicillin
 4) Extended-Spectrum • Treatment of difficult to • Piperacillin
(Antipseudomonal) eradicate & gram negative tazobactam
bacteria (pseudomona
• NOT penicillinase resistant aeruginosa)

5) Beta-lactamase Inhibitor • Drug combined to • Clavulanic Acid

penicillinase sensitive • Sulbactam
• Penicillins: ( • Tazobactam
amoxicillin, ampicillin,
piperacillin)

NURSING INTERVENTION:
1) Obtain specimen for laboratory culture and antibiotic sensitivity testing
2) Instruct client to take antibiotics with meals
3) Monitor for signs and symptoms of hypersensitivity and superinfection
4) Assess for bleeding if high doses of penicillin is given
5) Strictly adhere to the prescribed duration of the treatment.

Other Beta-Lactam Antibiotics Medication (less nephrotoxic Side effects and Adverse
than any antibacterials) Reactions:
• Considered bactericidal 1) Aztreonam • Headache
• Treatment of skin infection • Nausea
• Binds to specific penicillin- 2) Imipenem and Cilastatin • Vomiting
proteins located inside the • Treatment of UTI • Diarrhea
bacterial cell wall 3) Meropenem • Anemia
• Treatment of meningitis, • Eosinophilia
• Effective against a broader intraabominal, respiratory, • Neutropenia
spectrum of activity than and skin infections • Rash
many other beta-lactam • Angioedema
antibacterials • Seizure
• CDAD ( Clostridium-
difficile- associated-
diarrhea)

Cephalosporins
• Discovery: a fungus called Cephalosporium acremonium that is found to be active against gram
positive and negative bacteria and resistant to beta-lactamase
• Causes cell lysis
• Considered bactericidal

MOA:
Inhibit bacterial enzymes necessary for bacterial cell wall synthesis
Generation Description Medication S/A reactions
1st generation • Effective mostly against gram- • Cefadroxil *nausea
positive bacteria • Cefazolin *vomiting
• (streptococci)(staphylococci) sodium *diarrhea
• and some gram-negative • Cephalexin *increased
bacteria bleeding
• (Escherichia coli and species tendency
of Klebsiella Proteus *nephrotoxity
• Salmonella
• Shigella)
2nd generation • Same effectiveness as first • Cefaclor
generation but with broader • Cefoxitin sodium
spectrum against other negative • Cefuroxime
bacteria • Cefotetan
• ( Haemophilus influenzae) • Cefprozil
• (Neisseria gonorrhea & monohydrate
meningitidis)
• (Enterobacter species)
• And several anaerobic
organisms
3rd generation • Same effectiveness as 1st and • Cefdinir
2nd gen • Cefixime
• Also effective against gram- • Ceftibuten
negative bacteria • Cefotaxime
• (Pseudomonas aeruginosa) • Ceftazidime and
• (Serratia) Avibactam
• ( Acinebacter species) • Cefpodoxime
• But with increased resistance to • Ceftazidime
destruction by beta-lactamase • Ceftriaxone
4th generation • Similar to 3rd generation drug • Cefipime
and highly resistant to most
beta-lactamase bacteria with
broad spectrum antibacterial
activity and good penetration to
CSF:
• Effective against
• (Escherichia coli)
• (Pseudomonas aeruginosa)
• (Klebsiella)
• (Proteus)
• (Streptococcus species)
And certain staphylococci
5th generation -similar to 3rd and 4th gen • Ceftaroline
-broad spectrum fosamil
- the only cephalosporins effective • Ceftolozane and
against methicillin-resistant Tazobactam
Staphylococcus aureus (MRSA)
NURSING INTERVENTIONS:
1) Culture the infecting bacteria before cephalosporin therapy is started.
2) Monitor for signs and symptoms of superinfection
3) Instruct client to avoid consuming alcohol
4) Advise patient to ingest buttermilk, yogurt, to prevent superinfection of the intestinal flora
5) Strictly adhere to the prescribed duration of treatment even when symptoms of infection
have ceased
6) Infuse all IV cephalosporins over 30 minutes or as ordered to prevent pain and irritation.

Macrolides Medication

• Referred to as broad spectrum 1) Erythromycin

MOA: inhibit protein synthesis in susceptible • First macrolide discovered
bacteria
• Bacteriostatic when given low dose • Derived from a fungus like bacteria,
• Bactericidal when given high doses Streptomyces erytheus
• Active against mostly gram-positive and
moderately gram-negative • Oral preparation contains acid-resistant salts
to decrease dissolution in the stomach
Administration:
 Orally • Absorbed in the duodenum
 IV ( make sure to infuse slowly to avoid
unnecessary pain or phlebitis) • If given IV: intermittent infusion dilued in NSS
(to prevent phlebitis)
Treatments:
• GI • DOC for the treatment of
• Skin and soft tissue infections
• Diphtheria • Mycoplasmal pneumonia
• Impetigo contagiosa • Legionnaire’s disease
• STIs

Extended Macrolide Medication S/A reactions Drug interaction

Group
• Medication that 1) Clarithromycin • Nausea  Erythromycin
contains • Treatment for URTI • Diarrhea should not be
derivatives of caused by • Vomiting taken with
erythromycin Streptococcus • Abdominal clindamycin and
pyogenes& cramping lincomycin
pneumoniae because they
 • ABSORBED in the
duodenum
• For extended-
release formulation
: (bronchodilator)
Given once a day for 1
week
• For immediate-
release formulation:
• Given twice a day
for 1 week
2) Azithromycin
• Treatment of upper
and lower RTI, STI’s
, and skin infection
• If given IV :
intermittent
infusion diluted in
NSS
• Superinfection compete for
:CDAD receptor sites
• Conjunctivitis  Increase serum
• Hepatotoxixity level
• Theophyllines–
• Carbamazepine-
(anticonvulsant)
• Warfarin-
( anticoagulant)
 Antacids may
reduce
azithromycin
levels when taken
at the same time.
 Administer
antacids 2hrs
before or after
administration of
azithromycin

• If given orally :
administer 1 hour
before meals or 2
hours after meal

NURSING INTERVENTIONS:
1) Obtain a sample from the infected area for C&S before starting azithromycin therapy.
2) Monitor vital signs, urine output and laboratory values.
3) Specific to oral preparation of azithromycin: administer with water NOT fruit juice, administer with
food when GI upset occurs, chewable tablets should not be swallowed
4) Dilute IV preparation in an appropriate amount of solution
5) Instruct to take full course of antibiotic therapy.

Oxazolidinones Medications S/A reactions

• MOA: inhibit protein 1) Linezolid • Nausea
synthesis • Treatment of nosocomial • Headache
• Can be bactericidal or pneumonia, bacteremia, • Diarrhea
bacteriostatic MRSA, VREF, respiratory • Vomiting
• Effective against gram- and skin infections • Anemia
positive infections 2) Tedizolid • Thrombocytopenia
• Treatment of skin infection • CDAD
• Serotonin syndrome
Lincosamides Medications S/A reactions Drug Interactions
• MOA: inhibit 1) Clindamycin • Nausea • Clindamycin and
bacterial protein • More widely • Vomiting licomycin are
synthesis prescribed • Stomatitis incompatible with
• Can be • NOT effective against • Rashes • Aminophylline
bacteriocidal or gram-negative • Colitis • Phenytoin
bacteriostatic bacteria • Anaphylactic • Barbirutates
depending on shock • ampicillin
the dosage • Active against most
gram-positive
organisms, including
S. aureus and
anaerobic organisms

2) Lincomycin
• Treatment
• Bacteremia
• Septicemia
• Intraabdominal
• Respiratory
• Bone/joint
• Skin infections

Glycopeptides Medications S/A Reactions Drug interaction

• considered as 1) Vancomycin • Nephrotoxicity • Dimenhydrinate
bactericidal hydrochloride • Ototoxicity can mask
antibiotic • Used against drug- • Headache ototoxity when
resistant S. aureus • Dizziness taken with
• Fatigue vancomycin
• Serve as • Fever
prophylaxis for • Nausea • Increased
cardiac surgical • Vomiting nephrotoxicity
procedure to • Flatulence when
patients allergic to • Abdominal vancomycin is
penicillins Pain taken with
• Diarrhea
Administration: • Furosemide
• Back pain
-Orally • Aminoglycoside
• Peripheral
- IV ( too rapid could • Amphotericin B
edema
cause Red Man • Collistin
• Injection site
syndrome or RedNeck • Cisplastin
reaction
Syndrome) • Cyclosporine
• Red man
Sydrome
2) Telavancin
 • Treat selected • Hypotension • Vancomycin
gram-positive • Tachycardia inhibits
bacteria and skin • Wheezing methotrexate
infection • Dyspnea excretion and
• A semisynthetic • Paresthesia can increase
derivative for • Erthyema methotrexate
vancomycin • Pruritus toxicity
• Urticaria
• Has bactericidal • Eosinophilia • Oral
action against • Neutropenia vancomycin
MRSA • Phlebitis absorption may
decrease when
• CDAD
• Given once daily taken with
• Hypokalemia
cholestyramine
• Renal failure
and colestipol.
• Stevens-
Johnsons
Syndrome

Ketolides Medication S/A Reactions Drug interactions

• MOA: binds to 1) Telithromycin • Visual • Telithromycin levels are
sites on • First and only disturbances increases when taken
bacterial drug (blurred concurrently with
ribosomes ( • Used for adults vision and • Antilipidemics
causing the 18 years of age diplopia) (simvastatin,lavastatin,
change in and older for the • Headache atorvastatin)
protein treatment of • Dizziness
function mild to moderate • Altered taste • Itraconazole
leading to cell CAP • Nausea • Ketoconazole
death) • Vomiting • Benzodiazepines
Administration: • Diarrhea • Class A or III
• Can be • ORALLY – • Liver failure antidysrhthmics may lead
bactericidal or unaffected by • Exacerbation to life-threatening
bacteriostatic food intake of dysrhythmias
myasthenia •
gravis • Blood levels of
telithromycin are
decreased when taken
with rifampin, phenytoin,
carbamazepine

• Increased blood levels of

cisapride and pimozide
when taken telithromycin

• Digoxin, metoprolol,
midazolam, ritonavir,
 sirolimus and tacrolimus
increase when taking
telithromycin

• Lead to ergot toxicity

when taken with ergot
alkaloid derivatives

Signs of Ergo Toxicity:

Severe peripheral vasospasm
and impaired sensation

Lipopeptides medication S/A Reactions Drug interactions

MOA: bind to the 1) Daptomycin • Hypotension - Increased risk
bacterial membrane - Treatment of • Hypertension of
causing rapid skin infections, • Anemia rhabdomyolysis
depolarization of its MRSA, • Numbness and elevated
membrane potential endocarditis, • Tingling level of
bacteremia • Dizziness creatinine
• Inhibit protein, • Insomnia phosphokinase
DNA, and RNA Administration: • Pain or burning on if given with 3-
synthesis -IV dose of 4mg/kg urination hydroxi-3-
• These actions daily • Nausea methylglutaryl
leads to cellular coenzyme A
• Vomiting
death (HMG-CoA)
• Diarrhea
reductase
• Constipation
inhibitors
• Pallor
• Chest pain - Daptomycin
• Hypokalemia toxicity may be
• Hyperglycemia increased
• Hypoglycemia when given
• Bleeding with
• Rhabdomyolysis tobramycin.
• Pleural effusion
- Warfarin may
lead to
increased
bleeding when
taken with
daptomycin.
Tetracylines Medication S/A reactions Drug interaction
1) Short acting • Photosensitivity • Avoid taking
a) Tetracyline (sunburn antacid,calcium
reactions) and iron this
especially with inhibits
2) Intermediate demeclocycline absorption
acting • Difficulty
a) Demeclocyline maintaining
hydrochloride balance (
-treatment for minocycline cause
respiratory damage the the
infection vestibular ear)
3) Long acting • Nephrotoxicity(
a) Doxycycline high dose of
hyclate tetracycline)
- Treatment for • Superinfection
acne vulgaris • Nausea
b) Minocycline • Vomiting
hydrochloride • Diarrhea
- Treatment for
respiratory
infection

(taken with food, best

absorbed with milk)
4) Miscellaneous
a) Omadacycline
- Treatment for
CAP
b) Eravacycline
- Treatment for
complicated
intraabdominal
innfection
NURSING INTERVENTION:
1)

Glycyclines Medication s/a REACTIONS Drug interaction

1) Tigecycline • Nausea • Warfarin increases
• Vomiting leads to bleeding
• Abdominal pain
• Diarrhea
• CDAD
Same as
tetracylines
Aminoglycosides Medication S/A reactions Drug interaction
Administration: 1) Streptomycin • Ototoxicity
-IV sulfate • Nephrotoxicity
IM • superinfection
2) Amikacin
sulfate and
Tobramycin
sulfate

3) Neomycin
sulfate

Fluoroquinolones Medication S/A reactions

1) Ciprofloxaxin • Dysgeusia
• Anorexia
2) Levofloxacin • Dry mouth
• Syncope
• Flushing
3) Moxifloxacin • Irritability
• Dizziness
•
Nursing Intervention:
1) Obtain a sample from the infected area
2) Urine output atleast 750 ml per day
3) Increase fluid intake to more than 2L per day
4) Check lab result (BUN and serum creatinine)
5) Check for signs and symptoms for superinfection

Unclassified antibacterial drugs Medications

- Do not belong to a major group of drug 1) Chloramphenicol
2) Quinupristin dalfopristin
3) Oblitaxoximab

Sulfonamides Medications Topical and Opthalmic S/A reactions

preparations
- Selectively 1) Sulfadiazine 1) Mafenide • Skin rashes
inhibit 2) Sulfasalazine acetate • Itching
bacterial cell 3) Trimethropim- - Prevention for • Hemolytic
wall without sulfamethoxazole sepsis in cases anemia
affecting the of 2nd and 3rd • Aplastic anemia
normal cells degree burn • Leuokopenia
2) Silver • Anorexia
Sulfonamide
MOA: inhibit bacterial Treatment for • Crystalluria
synthesis of folic acid burns • Hematuria
(bacteriostatic) • Photosensitivity
• Cross sensitivity
TREATMENT:
- UTI
- Newborn eye
prophylaxis
- Ear infection
3) Sulfacetamide
sulfate
Ophthalmic prep : liquid
drops, ointment and
treatment for ocular
infections after an eye
injury
Topical prep: cream,
gel, lotion, or cleanser

- Treat
seborrheic
dermatitis and
acne
NURSING INTERVENTION:
1) Administer sulfonamide with full glass of water
2) Increase oral fluid intake at least 2L/day
3) Closely monitor urine output
4) Check signs and symptoms for infection

Nitroimidazole Medication S/A reactions

MOA: disrupt DNA and protein 1) Metronidazole • Tongue
synthesis • Urine discoloration
2) Tinidazole • Superinfection
- Used a prophylaxis for • Headache
surgical infections to • Dizziness
treat 3) Secnidazole • Weakness
• Cdad • Dry mouth
• Anaerobic infections • Anorexia
• Amoebiasis • Dysgeusia
• Giardiasis • Vomiting
• Trichomoniasis • Diarrhea
• Bacterial vaginosis
• Ance rosacea
 ANTIRETROVIRAL MEDICATIONS
Nucleoside/Nucleotide ● First antiretroviral drug used to treat Zidovudine
Reverse Transcriptase HIV Didanosine
Inhibitors (NRTI) ● “Nukes”, nucleoside analogues - take 30 min- 2 hrs
after meal for
maximum
absorption
Stavudine
Lamivudine
Abacavir
Tenofovir
Emtricitabine

Non-Nucleoside Reverse ● “Non-nukes” Delavirdine

Transcriptase Inhibitors ● ​Primary advantage: reserves a Efavirenz
(NNRTI) PI-based therapy for future use - first choice drug
● Disadvantage: prevalence of - only NNRTI that
NNRTI- resistant viral strains and penetrates the
low generic barrier of NNRTIs cerebrospinal fluid
development of resistance - caution in
pregnancy
Etravirine
Nevirapine
Rilpivirine

Protease Inhibitors (PI) ● sustained viral suppression, Atazanavir

immunologic function, and Atazanavir/cobistat
prolonged survival Darunavir
Darunavir/cobistat
Fosamprenavir
Indinavir
Lopinavir/ritpnavir
Nelfinavir
Saquinavir
Ritonavir
- not recommended
if used as a sole
PI, instead should
be used as a
boosting agent
Tipranavir

Fusion (Entry) Inhibitors ● Only agent approved: enfuvirtide Enfuvirtide (T20)

(FI) T20 - only indicated in
combination with
other ARV drugs
for patients who
require salvage
therapy (aka
rescue therapy)
- not for HIV-2

Chemokine (CCR5) ● Only agent in this class: maraviroc Maraviroc

Coreceptor Antagonists - patients with
evidenced viral
replication and
HIV-1 strains
resistant to
multiple ART
(antiretroviral
therapy)
- metabolized in the
liver

Integrase Strand Transfer ● Integrase- enzyme that HIV needs Dolutegravir

Inhibitors to multiply and divide; without it, it Elvigravir
(INSTI) cannot replicate Raltegravir
● Used for the treatment of HIV-1
infection with at least 2 or 3 other
ARVs
 VACCINES
Inactivated ● These vaccines contain the whole Anthrax Vaccine
or components of a killed Hepatitis A Vaccine
microorganism Influenza Vaccine
Japanese Encephalitis
Vaccine
Meningococcal vaccine
Pertussis vaccine
Poliomyelitis Vaccine
Rabies vaccine
Typhoid Vaccine

ANTHRAX
- SC
- Do not freeze
- Prophylaxis: 0, 2, 4 weeks after
exposure

HEPATITIS A
- IM
- Do not freeze
- Routinely given children 12-23
months, high
- risk populations, close contacts
to person with HIV

INFLUENZA
- IM/ ID
- Given annually to people 6
months and above
- avoid administering to patient
with reaction to eggs

JAPANESE ENCEPHALITIS
- SC
- 35-46 degrees F before and after
reconstitution
- Asian Travelers- transmitted
through a mosquito, and this is
usually found in Asian countries

MENINGOCOCCAL
- SC/ IM
- protects
- against serogroups A, C, W, and
Y.
- First dose is given at between 11
to 12 years old with booster at 16
y.o.

PERTUSSIS
- IM
- DTaP, DPT, and Penta vaccine
- DTap and Tdap: US brands of
the vaccines
- DTP and Pentavalent vaccine:
Philippines

POLIOMYELITIS
- IM/ SC/ ORAL
- OPV (oral polio vaccine)
- Children should receive a series
of 4 inactive polio vaccine
injections at 2 mos, then 4 mos,
6 mos, 6-18 mos, and a booster
at 4-6 y.o.

RABBIES
- IM/ ID
(Pre-exposure)
1st dose: prior to potential exposure
2nd dose: 7 days after the first dose
3rd dose: 21 or 28 days after the second
dose
 (Post-exposure)
Days 0, 3, 7, and 14, 28 (5th dose;
for immunocompromised individuals)

Post-exposure schedule for immunized

individuals: Days 0 and 3

TYPHOID
- SC
- For travelers going to different
countries

Live attenuated ● These vaccines contain live but Influenza

weakened microorganism Mumps
● Not for immunocompromised Rotavirus
Rubella
Tuberculosis Vaccine
(Bacille Calmette- Guerin
(BCG))
Typhoid
Varicella
Yellow Fever
Herpes Zoster

INFLUENZA
- IM (anually)
- Avoid administering to children
<2 y.o. Or adults > 50 y.o.
- It is invasive (route: nose)

MUMPS
- SC
- Can be frozen
- Contraindicated in pregnancy
- Contained in MMR vaccine
(mumps, measles,
and rubella vaccine)

ROTAVIRUS
- ORAL

RV5:given in 3 doses at ages 2mo, 4

mos, and 6 mos

RV1: given in 2 doses at ages 2 mos

and 4 mos

RUBELLA
- SC
- Can be frozen
- Contained in MMR vaccine
o 1st dose at 12 through 15 mos
o 2nd dose at 4 through 6 years

TUBERCULOSIS
- ID/ SC
- Administer at birth

TYPHOID
- ORAL
- Patients with exposure to
salmonella typhi

VARICELLA
- SC
- For patients with chickenpox and
herpes zoster

1st dose: 12-15 months

2nd dose: 4-6 years old

YELLOW FEVER
- SC
 - Administer to person with > 9
months traveling to or living in
high-risk areas (South
America and Africa)

HERPES ZOSTER
- SC
- Administer to people aging > 50
years old (because if >50,
patients usually have weakened
immune system)

Toxoids ● These vaccines contain inactivated Diphtheria Vaccine

toxins that can no longer produce Tetanus Toxoid
harmful diseases but stimulate
formation of antitoxins

DIPHTHERIA
- DTap, DPT, penta vaccine
- IM
- Combined as DTaP, TdaP, DT
and Td
- DTap is used for active immunity
in those 6 weeks to 6 years old
- Tdap is a single dose used as an
active booster given 10 years old
and older

TETANUS TOXOID
- IM
1st dose: 2 months
2nd dose: 4 months
3rd dose: 6 months
4th dose: between 15-18 months
5th dose: between 4-6 years

Booster Shots: every 10 years

For pregnant women

Conjugate ● These vaccines require a protein or Haemophilus Influenzae

toxoid from an unrelated organism type B (HiB) vaccine
to link to the outer coating of the
disease-causing microorganism Meningococcal
Haemophilus Influenzae
Type B Conjugate
Vaccine

Pneumococcal (PCV)
Vaccine

HAEMOPHILUS INFLUENZAE TYPE B

(HiB)
- IM
- Do not freeze (may decrease
potency)

MENINGOCOCCAL HAEMOPHILUS
INFLUENZAE TYPE B
 - Recommended for
children/adolescents aging 10-18
year old who are in increased
risk

PNEUMOCOCCAL
- IM/SC
- PCV23 (protects 23)
- PCV13 (protects 13)
- PCV 13 is recommended for
children < 5 yrs
- old
o 1st dose: 2 months
o 2nd dose: 4 months
o 3rd dose: 6 months
o 4th dose: 12-15 months

Recombinant subunit ● Involve the insertion of some of the Hepatitis B

genetic material of a pathogen into Human Papillomavirus
another cell or organism, where the
antigen is then produced in massive
quantities.

HEPATITIS B
- IM
- Do not freeze
- Recommended for health care
professionals

HUMAN PAPILLOMAVIRUS
- IM
- Protect vaccine from light and
shake well
- before administering
- Recommended for preteen boys
and girls at age 11 or 12 (usually
the age where they practice
sexual activities)

Adjuvant ● Substance added to vaccine to Aluminum hydroxide

increase the body’s immune
response to the vaccine Aluminum phosphate

Aluminum potassium
sulfate

Live ● These vaccines contain live Measles

microorganism Smallpox

MEASLES
- SC
- Can be frozen
- Protect from light and discard
after 8 hours
- Discard remains after 8 hrs
because it will be ineffective
- MMR and MMRV
- Contraindicated in pregnancy

SMALLPOX
- Given through percutaneous skin
prick of 1 jabs using a steel
bifurcated needle
- Protect from light
- Use within 6-8 hours after
reconstitution then discard
- Vaccinate only when exposed to
smallpox
- Contraindicated in pregnancy
 ANTICANCER DRUGS
Alkylating Drugs ● One of the largest groups of Nitrogen mustard
anticancer drugs Nitrosoureas
● High doses = Acute Myeloid Alkyl sulfonates
Leukemia Triazines
Ethylenimines

NITROGEN MUSTARD Bendamustine

-Used as a part of combination Chlorambucil
regimens in treatment of Hodgkin Estramustine
and Non-hodgkin's lymphoma and Ifosfamide
as palliative chemotherapy in lung MechlorethamineHCl o
and breast cancers Melphalan
Cyclophosphamide
- severe vesicant:
causes tissue
necrosis
- patient should be
well hydrated to
prevent
hemorrhagic
cystitis

NITROSOUREAS Carmustine
- Effective in the treatment of brain Lomustine
cancer since these drugs cross Streptozocin
the blood brain barrier

ALKYL SULFONATES Busulfan

- Used for the treatment of - Oral, IV
myelogenous leukemia

TRIAZINES Decarbazine
- Used to treat metastatic Temozolomide
malignant melanoma

ETHYLENIMINES Thiotepa
- Used in the treatment of breast Altretamine
and ovarian cancer

Antimetabolites ● “interfere” Folic Acid Antagonists

● CCS; Takes effect during S phase of Pyrimidineanalogues
the cell cycle (when DNA synthesis Purine Analogues
and metabolism take place) Ribonucleotide
Reductase Inhibitors
(Enzyme Inhibitors)

FOLIC ACID ANTAGONISTS Pemetrexed

- used to treat malignant and Methotrexate
non-malignant conditions - affects cells with
high metabolic
rates
- can be used in
ectopic pregnancy
because this can
cause apoptosis
of fetal cells

PYRIMIDINE ANALOGUES Azacytidine,

- Used in the treatment of breast, Cepecitabine, Cytarabine,
colorectal, GI, head and neck Floxuridine, Gemcitabine
cancer HCl, 5-Fluorouracil
- IV for solid tumors
- Topical for
superficial basal
cell carcinoma
and acitinic
keratosis

PURINE ANALOGUES Cladribine

- Used for hairy cell leukemia Clofarabine
Fludarabine
Mercaptopurine
Nelarabine
 Pentostatin
Thioguanine

RIBONUCLEOTIDE REDUCTASE Hydroxyurea

INHIBITORS
- Used for the treatment of head
and neck cancer

Antitumor Antibiotic ● Similar to natural antibiotics, Anthracyclines

however they do not treat infection Others
● Used to treat leukemias and many
solid tumors

ANTHRACYCLINES Daunorubicin
Epirubicin
Idarubicin
Doxorubicin
- Used to treat
many solid and
hematogenous
tumors except for
acute
Myelogenous
Leukemia
- Monitor
cardiotoxicity

OTHERS Dactinomycin
Mitomycin
Bleomycin
- Affects cells
during G2 phase

Plant Alkaloids ● Derived from plants Vinca alkaloids

Taxanes
Epipodophyllotoxins
Camptothecin analogues
Retinoids

VINCA ALKALOIDS Vinblastine

- Antimicrotubule compound Vinorelbine
- Derived from periwinkle plant Vincristine

TAXANES Docetaxel
- Antimicrotubule compound Palitaxel
- Derived from yew tree

EPIPODOPHYLLOTOXINS Etoposide
- The only plant alkaloids that act Teniposide
on S phase of the cell cycle
- Derived from apple trees

CAMPTOTHECIN ANALOGUES Irinotecan

- Are water soluble and have a Topotecan
broad range of antitumor
properties
- Derived from Chinese tree

RETINOIDS Bexarotene
- Regulator for cell reproduction,
proliferation, and differentiation
- orally or topically
- Derived from Vitamin A

Hormones and Hormonal MOA: mask the cancer cells and prevent Corticosteroids
Antagonists them from producing hormones Estrogens
Antiestrogens
Aromatase inhibitors
Gonadotropin-releasing
hormone
Progestins
Antiandrogens
 CORTICOSTEROIDS Prednisone
- Suppress the inflammatory
process associated with tumor
growth

ESTROGEN Estrogen Conjugate

- Used to slow the growth of
hormone- dependent tumors

ANTI- ESTROGENS Fulvestrant

- Block the effects of estrogen thus
slowing or shrinking cancers

AROMATASE INHIBITORS Anastrazole

- Used in treatment of hormonally Letrozole
sensitive breast cancer for Exemestane
women who had their ovaries
removed.

GONADOTROPIN- RELEASING Leuprolide

HORMONE ANALOGUES OR Goserelin
ANTAGONISTS
- Suppress the secretion of
follicle-stimulating hormone and
luteinizing hormone from the
pituitary gland

PROGESTINS Hydroxyprogesterone-
- Used for renal and endometrial Caproate
cancers Megestrol
Medroxyprogesterone
acetate

ANTIANDROGENS Bicalutamide
- Block the effects of testosterone Flutamide
thus slowing or shrinking cancers

BIOLOGIC RESPONSE MODIFIERS

Interferons ● Are found naturally in the body and
also produced in the laboratory
● Work directly on cancer cells to slow
their growth or cause cancer cells to
behave more like normal cells
Type I- Interferon alpha,
Interferon beta
Type II- Interferon gamma

(TYPE I) interferon alpha-2b

INTERFERON ALPHA - Used for the
- MOA: bind to cell receptors for treatment of hairy
biologic activities followed by cell leukemia,
activation of tyrosine AIDS-related
kinase Kaposi sarcoma,
malignant
melanoma, and
non Hodgkin
lymphoma
-IV, IM, SC

(TYPE I) Interferon beta 1b

INTERFERON BETA - SC
- MOA: inhibits the - Incremental
proinflammatory cytokines titration is required
responsible for triggering the every 2 weeks
autoimmune reaction - Week 1 and 2:
- Indicated for the treatment of 62.5mcg every
multiple sclerosis other day
- Week 3 and 4:
125 mcg every
other day
- Week 5 and 6:
187.5 mcg every
other day

(TYPE II) interferon gamma

INTERFERON GAMMA - SC
- Used for the treatment of chronic
granulomatous disease and
osteoporosis

Colony-Stimulating ● These are proteins that stimulate the Erythropoietin stimulating

Factors growth, maturation, and agents
differentiation of bone marrow stem
cells. Granulocyte colony
● Decrease length of posttreatment stimulating factor
neutropenia
● Minimize myelosuppresive toxicity Granulocyte- macrophage
● Reduce bone marrow transplant colony stimulating factor
recovery
● Enhance macrophage and fungus
destroying abilities
● Prevent severe thrombocytopenia

ERYTHROPOIETIN STIMULATING Epoetin alfa

AGENTS Darbepoetin alfa
- Erythropoietin is produced by the
kidney and stimulates the
production of red blood cells in
the bone marrow
- Used if blood transfusion is
not an option

GRANULOCYTE COLONY Filgratism

STIMULATING FACTORS Pegfilgratism
- Naturally produced by
macrophages, endothelium, and
other immune cells
- Used for chronic neutropenia
in chemotherapy

GRANULOCYTE- MACROPHAGE Sargramostim

STIMULATING FACTORS
- Naturally produced by bone
marrow, B and T lymphocytes,
and monocytes
Interleukin 2 ● AKA Lymphokines Aldesleukin
● Naturally produced by T-lymphocyte

Keratinocyte Growth
Factor
 5F - Special Conditions (Part 1)

DRUGS DURING PREGNANCY

Medication Drug Example(s) Side Effects

1. Iron Products ● Used to prevent ● Ferrous Sulfate ● Nausea

maternal ● Ferrous ● Constipation
iron-deficiency anemia Gluconate ● Black tarry stool
● Pregnant Mothers - ● Ferrous ● GI irritation
take twice as much of Fumarate ● Epigastric pain
Iron for fetal ● Vomiting
development ● Discoloration of urine
● Greatest demand ● Diarrhea
occurs: 3rd trimester:
22.4mg/day
● 1st Trimester: 6.4
mg/day
● 2nd trimester: 18.8
mg/day
NOTE:
patients are still advised to
take iron even after birth (6
weeks postpartum)

2. Folic Acid ● Deficiency in early ● Vitamin B9 ● Allergic

pregnancy = ● Folate bronchospasm
spontaneous abortion ● Rash
or birth defects, esp. ● Pruritus
neural tube defects ● Erythema
(e.g. spina bifida and ● General malaise
anencephaly)
● Women who are
planning pregnancy:
0.4-0.8mg (one month
before or 2-3 months)
Recommended Daily Dosage
of Folic Acid:
● Child-bearing age: 400
mcg [for birth deficit
prevention]
● During pregnancy: 600
mcg
 DRUGS THAT DECREASE UTERINE MUSCLE CONTRACTILITY
(PRETERM LABOR/PTL)

Medication Drug Example(s) Side Effects

1. Tocolytic Therapy

a. Beta - ● Stimulates Beta 2 - Terbutaline Maternal Side Effects

Sympathomim receptors on uterine (BSD):
etic Drugs smooth muscle ● Tremors
● Frequency and ● Dizziness
intensity of uterine ● Nervousness
contractions decrease ● Tachycardia
as the muscle relaxes ● Hypotension
● Orally, parentally ● Chest pain
(SubQ/IVTT) ● Palpitation
● Nausea
NOTE: FDA does not ● Vomiting
recommend the use of ● Hyperglycemia
injectable terbutaline for and hypokalemia
prevention of PL (preterm
labor)/ Prolonged treatments More serious adverse
reactions:
Nursing Intervention: ● Pulmonary edema
● Maintain patient in left ● Dysrhythmias
lateral position to ● Ketoacidosis
facilitate uteroplacental ● Anaphylactic shock
perfusion
Fetal side effects (BSD):
● Tachycardia
● Potential
hypoglycemia

b. Magnesium ● Calcium antagonist and Magnesium Sulfate ● Flushing

Sulfate CNS depressant
● Parenteral magnesium Antidote for MS TOXICITY
sulfate relaxes the
smooth muscle of the
uterus through calcium
displacement
● More commonly given as
tocolytic
● Administered as 4-6g IV
loading dose over
20-30 minutes followed
by a 1-2g/hr continuous
infusion for at least 24
hours
● Feeling of increased
warmth (normal s/e)
● Calcium Gluconate ● Perspiration
● Dizziness
● Nausea
● Headache
● Lethargy
● Slurred speech
● Sluggishness
● Nasal congestion
● Heavy eyelids
● Blurred vision
● Decrease GI action
● Increased pulse rate
● Hypotension

NOTE:
Increased severity is
evidenced by depressed
reflexes, confusion and
 magnesium toxicity
(respiratory depression
and arrest, circulatory
collapse, cardiac arrest)

Side effects in neonate

(MS):
● Respiratory
depression
● Slight hypotonia with
diminished reflexes
● Lethargy for 24-48
hours

DRUGS THAT INCREASE UTERINE MUSCLE CONTRACTILITY

Medication Drug Example(s) Side Effects

1. Uterotrophic Drugs - enhance muscle contractility

a. Oxytocin ● For labor induction and Oxytocin w use of UNDILUTED

augmentation oxytocin:
● To establish adequate ● Hypertension
contraction pattern that ● Dysrhythmia
promotes labor progress ● Uterine
(every 2-3 minutes that hyperstimulation
last for 50-60 seconds ● Tachysystole
with moderate intensity)
ADVERSE REACTION:
● Seizure
● Water intoxication

b. Ergot ● Used after the delivery of Methylergonovine Maleate ● Uterine cramping

Alkaloids the baby and placenta - Most commonly ● Nausea
● Acts by direct smooth used ergot ● Vomiting
muscle cell-receptor derivative ● Dizziness,
stimulation - PO, IM (frequent) ● HypertensioN with IV
● Not used during labor - IV = only during administration
(fetal hypoxia and rupture emergency ● Sweating
the uterus) situations ● Tinnitus
● Chest pain
NOTE: ● Dyspnea
Patients with preexisting ● Itching
or gestational ● Sudden severe
hypertension or peripheral headache
vascular disease should
not receive ergot Toxicity signs (Ergotism):
derivatives ● Pain in the arms, legs
and lower back
● Numbness
 ● Cold hands and feet
● Muscular weakness
● Diarrhea
● Hallucinations
● Seizure
● Blood
hypercoagulability

DRUGS FOR WOMEN’S REPRODUCTIVE HEALTH

Medication Drug Example(s) Side Effects

1. Combined ● One of the most Ethinyl Estradiol ● Withdrawal

Hormonal commonly used methods ● Most commonly used bleeding or menses
Contraceptive of reversible synthetic estrogen
contraception found in CHCs
● Contain a synthetic ● New CHC contains
version of estrogen and a Estradiol valerate
compound progestin
Progestin
MOA: ● Natural or synthetic
1. Estrogen components of hormones that have
CHC products inhibits progesterone-like
ovulation by preventing effects
the formation of a ● Have contraceptive
dominant follicle properties and balance
2. Dominant follicle does not out estrogen
mature
3. Estrogen remains at a Type of CHC BY DAYS:
consistent leveL
4. Estrogen is not able to 21 days tablet pack
reach the peak to - 21 days of active pills
stimulate the luteinizing that contains
hormone surge estrogen and
5. Luteinizing hormone progestin followed by
surge is suppresseD a 7 days free period
6. Ovulation is (she has 7 days pill
PREVENTED; thus free)
PREGNANCY DOES - After the 7 days pill
NOT OCCUR free period she can
7. Progestin component also then start a new 21
prevents the LH surge days tablet pack

28 days tablet pack

- Contains 21 pills with
estrogen and
progestin and on the
last 7 pills (counters)
these pills doesn't
contain any
hormones (7 days pill
free)
<3 Ethinyl Estradiol and
NorelGestromin
Transdermal Patch
● Weekly form of CHC
patch
● Placed on skin of the
buttocks, stomach,
upper outer arm, or
upper torso
● Placed once a week for
3 weeks in a row.
● The 4th week is patch
free
● Place on clean dry skin
● Placement on or near
the breast should be
avoided
● If the patch is partially or
completely detaches
from the skin, a new
patch should be applied

<3 Ethinyl Estradiol and

Etonogestrel Transvaginal
Contraception
● in a form of a 2-inch
flexible indwelling
vaginal ring
● non-biodegradable,
transparent, odorless
(produces like the
quantities of estrogen
and progestin found
in lower-dose CHC
products
● placed during the first
5 days of
menstruation and left
in place for 3 weeks
and removed for 1
week
● Correct insertion:
place the ring into the
middle or upper third
of the vagina

NOTE:
All three are taken or applied
for 21 days or 3 weeks.
Followed by 7 days or
1-week
pill-free/patch-free/ring-free
period
2. Progestin-only Progestin-only ● Withdrawal
Contraception contraceptive pills bleeding or
Products ● also called mini pill menses
● MOA: (1) alters
cervical mucus, (2)
interferes
endometrial lining, (3)
decreases fallopian
tube peristalsis, (4)
interferes with LH
surge and thereby
inhibits ovulation
● taken continuously
without a break within
a 3 hour window
● It takes 4-6 hours for
the progestin to
thicken the cervical
mucus
● All 28 pills contain an
active hormone

Depot
medroxyprogesterone
acetate
● injectable progestin
● flexible dosing
schedule every 11-13
week
● the DMPA vial or
prefilled syringe
should be vigorously
shaken prior to
administration to
ensure a uniform
drug suspension
● DMPA 150mg/1 mL
is given by deep IM
into the ventral
gluteus or deltoid
muscle
● reduction of bone
marrow density
● encourage women to
increase calcium and
vitamin D intake

Progestin Implant
● a single rod device
that Contains 68mg
of etonogestrel
● implanted in the inner
side of the upper
non-dominant arm
 ● it need to be
removed no later that
3 years after the date
of insertion
● may not be as
effective in women
who have a body
mass index greater
than 30 or those who
are obese or those
who are on drugs
that can induce liver
enzymes

5F Special Conditions (Part 2)

DRUGS USED IN OPHTHALMIC CONDITIONS

1. Mydriatics and Cycloplegics

Medication Drug Example(s) Side Effects

a. Anticholinergics Mydriatics (Dilate Pupils) ● Atropine sulfate Side effects of topical

Medications ● Phenylephrine anticholinergics:
Cycloplegics (Paralyze the hydrochloride
muscle accommodation) ● Cyclopentolate ● xerophthalmia (dry
hydrochloride eyes)
Indication: Diagnostic ● Homatropine ● Photophobia
procedure and ophthalmic hydrobromide ● Blurred vision
surgery ● Tropicamide
Systemic Effects:
Contraindication: Patients
with angle-closure NOTE: These medications ● Xerostomia
glaucoma are given topically in a form ● Cephalgia
of EYEDROPS ● Constipation

● Are used as mydriatics DAPIPRAZOLE - to reverse Serious Systematic

and cycloplegics) drug-included mydriasis with Effects:
● MOA: : block the use of phenylephrine
acetylcholine from ● Increased IOP
attaching to cholinergic ● Psychosis
receptors resulting in ● Seizures
both dilation of the ● Hypotension
pupils and paralysis of ● Tachycardia
the muscle of ● Cardiovascular
accommodation collapse
● Respiratory
depression
● Muscle rigidity
Administration of
Eyedrops:

1. Perform hand hygiene

 and wear gloves
2. Instruct patients to lie
down or sit back in a
chair and have them
look at the ceiling.
3. Remove any discharge
by gently wiping from
the inner to outer
canthus.
4. Gently draw the skin
down below the
affected eye to expose
the conjunctival sac.
5. Notify patients
immediately before
drops are administered
so they are prepared to
avoid blinking when
drops hit the
conjunctiva.
6. Administer the
prescribed number of
drops into the center of
the sac. If the drug is
placed directly on the
cornea, it can cause
discomfort or damage.
Avoid touching eyelids
or eyelashes with the
dropper.
○ Gently press on
the lacrimal duct
with a sterile
cotton ball or
tissue for 1-2
minutes after
installation to
prevent systemic
absorption through
the lacrimal canal
○ Instruct patient to
keep their eyes
closed for 1-2
minutes after
instillation to
promote
absorption

Administration of Eye
Ointment:

1. Perform hand hygiene

and wear gloves
2. Instruct patients to lie
 down or sit back in a
chair and have them
look at the ceiling
3. Remove any discharge
by gently wiping from
the inner to outer
canthus. Use separate
cloth for each eye
4. Gently draw the skin
down below the
affected eye to expose
the conjunctival sac.
5. Prepare patients by
explaining that
ointment will be placed
in the eye so they can
help by not blinking
6. Squeeze a strip of
ointment (about 4 inch
unless stated
otherwise) onto the
conjunctival sac.
Medication placed
directly to the cornea
can cause discomfort
or damage. Avoid
touching eyelids or
eyelashes with the
applicator tip.
7. Instruct patients to
close their eyes for 2-3
minutes
8. Instruct patients to
expect blurred vision
for a short time. If
possible, apply at
bedtime

2. Anti-Glaucoma Agents

Medication Drug Example(s) Side Effects

a. Prostaglandin ● are the front-line ● Bimatoprost Side effects:

Analogues medications for the ● Latanoprost ● Change of the color
treatment of ● Tafluprost of the iris (increasing
glaucoma, a ● Travoprost the brown
condition resulting in pigmentation)
blindness due to the NOTE: Given at bedtime ● Darkening of the
death of retinal eyelids
ganglion cells. ● Eyelash
These drugs act by hypertrichosis
lowering intraocular Macular edema
pressure (IOP), a ● Blurred vision
major risk factor for ● Redness of the
 glaucoma. conjunctiva
● Itching or stinging or
the eye
● Bronchospasms
● Dizziness
● Dyspnea
● Myalgia

b. Beta-Adrenergic ● First-line drugs used Nonselective Side Effects and

Blocker in treatment of Beta-blockers: Adverse Reactions:
glaucoma ● Carteolol
● Decrease IOP by ● Levobunolol ● Eye discomforts
decreasing the ● Timolol ● Miosis (some)
production of ● Vision problems at
aqueous humor Selective Beta-Blockers: night
● Betaxolol ● Can lower heart rate
● Worsen bradycardia,
AV heart block and
heart failure
● Can prevent
adequate
bronchodilation in
patients who have
asthma and other
obstructive
pulmonary diseases

c. Alpha-Adrenergic ● Control or prevent ● Apraclonidine Side Effects and

Agonist elevation of IOP post ● Brimonidine Adverse Effects
surgically by (topical use):
decreasing by ● Burning
decreasing production ● Stinging
and improving outflow ● Blurred vision
of aqueous humor ● Headache
● Major site of action: ● Corneal erosion
CILIARY BODY ● Keratitis
● Contraindications: ● Arrhythmias
persons on MAOI ● Asthma
therapy

d. Cholinergic Agents ● Causes miosis 2 types: Side Effects & Adverse

- Constriction of Reactions
the pupil and 1. Cholinergic Agonists
contraction of the ● Cardiac
ciliary muscle ● Direct acting cholinergics irregularities
● Widens the trabecular that directly stimulate ● diarrhea
meshwork to improve cholinergic receptors ● hyperhidrosis
outflow of excess have the same action as ● respiratory
aqueous humor parasympathetic depression
● Opening or widening neurotransmitter ● urinary incontinence
the drainage angle acetylcholine. ● Iritis
● uveitis
Example: ● retinal detachment
● Pilocarpine ● ocular irritation and
 pain
● Lacrimation
2. Cholinesterase ● myopia with blurred
Inhibitor vision
● paradoxical ocular
Example: hypertension
● Echothiophate

E. Carbonic Anhydrase ● Decrease IOP by Topical: ● CNS: Lethargy,

Inhibitors decreasing the ● Brinzolamide drowsiness,
production of ● Dorzolamide headache, seizure,
aqueous humor paresthesias
● Indicated for both Systemic: ● GI: Nausea,
open-angle and ● Acetazolamide vomiting, diarrhea,
acute closed-angle dysgeusia and
glaucoma anorexia
● Not as effective as ● Polyuria, increased
other drugs for thirst and fluid and
glaucoma electrolyte
● Carries GREATER disturbance
risk of adverse ● May promote
effects hyperuricemia
● May worsen liver
disease
● Should not be given
to patients with
sulfonamide allergy
reaction

DRUGS FOR WOMEN’S REPRODUCTIVE HEALTH

1. Anti Infectives

Medication Drug Example(s) Side Effects

a. Acute Otitis ● Occurs more often in ● Oral: Amoxicillin is the

Media (OAM) children
● Related to dysfunction of
eustachian tube,
especially after an upper
respiratory infection from
a virus
● Streptococcus
pneumoniae is the most
common pathogen
● Immunization of PCV 13
as prophylaxis
DOC
- Dosage: 80-90 mg/kg
every 12 hours for 70-10
days (children 6 months
and older) - Dosage:
500-875 mg for every
8-12 hours (adults)
● Azithromycin and
clarithromycin
● Cephalosporins
● Benzocaine (for otalgia)

b. Acute Otitis ● Swimmer’s ear ● Topical antibacterial or

 Externa (AOE) ● Infection of the external antifungal
auditory canal ● Anti Inflammatory
● Pseudomonas aeruginosa (corticosteroid)
and staphylococcus ● Analgesic
aureus are the pathogens ● Neomycin and Polymyxin
most often responsible B with Hydrocortisone
(Contraindicated for
Nursing Interventions: perforated Tympanic
● Complete culture and membranes TM)
sensitivity testing if ● Chloramphenicol
ordered before starting (contraindicated for
drug therapy perforated TM)
● Ensure TM patency before
administering ear drops ● Fluroquinolones (safe to
other than use for incompetent TM)
fluoroquinolones ● Acetic Acid
● Provide relief of ● Clotrimazole (for severe
associated pain if present fungal infection)
● Assess for the
development of
superinfections

Patient Teaching
● Instruct patient to
complete the entire course
of medication (Usually 1-
14 days) and not to stop
medication when the ear
feels better
● If a patient is prone to
OTITIS EXTERNA after
swimming or showers,
give instruction on
prevention of Otitis
Externa.

2. Cerumenolytics

Cerumenolytics ● Given to patients with ● Carbamide Peroxide

Impacted Cerumen ● Mineral Oil (2-5 drops 2x
● Preparations: a day for 4 days)
water-based, non-water,
non-oil based
● Warm the water to prevent
nausea and vomiting
● Irrigating solution (mixed
with warm water):
○ Hydrogen peroxide
3% in 1:1 solution
with warm water
○ normal saline or
acetic acid (vinegar)
mixed with warm
water
Contraindication of Irrigation:
● Perforation of the
tympanic membrane and
prior hypersensitivity
● there’s no use of the
irrigating solution if the TM
is perforated

Administration of Eardrops:

1. Perform hand hygiene and

wear gloves
2. Ensure the medication is
at room temperature
3. Instruct the patient to sit
up with the head tilted
slightly towards the
unaffected side. This
position straightens the
external ear canal for
better visualization.
Maintain this position for
2-3 minutes to facilitate
drops reaching the
affected area.
4. Pull down and back on the
auricle for a child younger
than 3 years of age. For a
child older than 3 years or
an adult. Pull upward and
outward on the auricle.
5. Instill the prescribed
number of drops. Take
measures to avoid
allowing drops to fall
directly on the tympanic
membrane. Drops should
be aimed at the side of the
ear canal and should be
allowed to run down into
the ear
6. Do not contaminate the
dropper.
 DRUGS USED IN DERMATOLOGIC CONDITIONS

1. Topical Anti Acne Drugs

Medication Drug Example(s) Side Effects

Benzoyl Peroxide ● Antibacterial agent that

kills propionibacterium
acnes
● Releases free radical
oxygen species that
oxidize bacterial protein
● Resolution of acne : 4-6
weeks
● Applied as cream, lotion
or gel once or twice a
day

Retinoids ● Derivatives of vitamin A ● Tretinoin

● Used for mild to ● Adapalene
moderate acne ● Tazarotene
● Mainstay for topical
therapy
● Tazarotene is
contraindicated with
pregnancy

NOTE: Should not be used

before or after extended sun
exposure sunburn

Azelaic acid ● Has antibacterial,

anti-inflammatory and
milk comedolytic
treatment
● As effective as benzoyl
peroxide and tretinoin
combined

Salicylic Acid ● A comedolytic ● Burning

treatment ● Pruritus
● Erythema

Antibiotic ● Clindamycin and ● Tetracycline

erythromycin are ● Erythromycin
recommended topical ● Clindamycin
antibiotics for acne therapy
● Severe painful acne may
be treated with steroid
injection

NOTE: NOT RECOMMENDED

AS MONOTHERAPY DUE TO
THE DEVELOPMENT OF
 ANTIBIOTIC RESISTANCE

2. Systemic Antiacne Drugs

Oral Antibiotics ● Doxycycline (DOC)

● Minocycline (DOC)
● Tetracycline
● Amoxicillin

NOTE: Tetracycline should

not be used among the very
young & pregnant parents
● May cause dental
discoloration of the
developing teeth
● Have teratogenic effects
on the fetus

Isotretinoin ● A derivative of vitamin A ● Cheilitis

taken orally ● Dizziness
● For severe cystic acne ● Cephalgia
that is not responsive to ● Conjunctivitis
conventional therapy ● Skin irritation
● Intake of drug 4-6 ● Pruritus
month ● Epistaxis
● Myalgia
NOTE: ● Arthralgia
● Patients should not take ● Temporary hair
vitamin K concomitantly thinning
(it can increase its ● Photosensitivity
adverse effects) ● Depression
● Should not be given ● Suicidal tissue
during pregnancy

Medication for Psoriasis

Medication Drug Example(s) Side Effects

1. Topical Drugs ● Corticosteroids

● Vitamin D Analogues
● Tazarotene
● Calcineurin Inhibitors
● Salicylic acid
● Anthralin
● Coal tar

2. Systemic Drugs
 TOPICAL DRUGS

Medication Drug Example(s) Side Effects

Corticosteroids ● Principal treatment for Cutaneous Side

majority of the patients Effects:
● the usual length of ● Skin atrophy
treatment is 4 weeks ● Acne
● Telangiectasia
● Folliculitis
● Striae distensae
● Purpura

Systemic Side Effects:

● Cataracts
● Glaucoma
● Suppression of the
hypothalamic-pituit
ary-adrenal axis

Synthetic Vitamin ● Avoid ultraviolet light ● Calcipotriene (available Local Side Effects:
D Analogue in solution, foam, and ● Burning
cream) ● Pruritus
● Edema
● Peeling
● Dryness
● Erythema

Systemic Side Effects:

● Hypercalcemia
● Suppression of
parathyroid
hormone

Topical Tazarotene ● A retinoid ● Local irritation

● May be used
concurrently with
moisturizer and topical
corticosteroids

Topical Calcineurin ● not approved for infants ● Tacrolimus ● Burning and

Inhibitors and children younger ● Pimecrolimus Pruritus of the
than 2 years old skin when
● pregnancy category C applied
immediately
after bathing

Topical Salicylic ● keratolytic agent

Acid ● topical salicylates may be
absorbed systemically and
cause toxicity
● should not be used in
 children due to the risk of
Reye Syndrome

Anthralin ● Commonly used for short ● Skin irritation

contact therapy ● Staining of
adjoining skin,
nails, and
clothing

Coal Tar ● available in shampoos,

lotions, creams, and bath
solutions
● has an unpleasant odor
and can cause burning and
stinging sensation
● rarely used

Ultraviolet A ● Photochemotherapy - a ● Erythema

(UVA) combination of UV ● Pruritus
radiation and psorian ● irregular
derivative methoxsalen pigmentation
(photosensitive drug) ● Nausea and
● Psoralen and Ultraviolet vomiting
A (PUVA): Permits lower ● Blisters
doses of methoxsalen and ● Melanonychia
UVA to be given ● hypertrichosis
● squamous cell
Contradictions: carcinoma
● lupus erythematosus
● xeroderma
pigmentosum
● porphyria

2. Systemic Drugs for Psoriasis

Medication Drug Example(s) Side Effects

Methotrexate ● a folate antimetabolite ● Nausea

that slows high growth ● Anorexia
fraction ● Stomatitis
● Can cause toxicity to ● Fatigue
liver and lungs
● Teratogenic effect (must
not be given to pregnant
women)

Before administration these

must be obtained:
● History
● Physical
● laboratory tests
● chest radiograph

Cyclosporine ● most effective ● Hypertrichosis

 systematic preparation ● Cephalgia
for psoriasis ● Paresthesia
● it must be administered ● myalgia
on a consistent schedule ● Arthralgia
with regard to time of ● Asthenia
day and in relation to ● fatigue
meals to decrease
serum level variations

Acitretin ● vitamin A derivative Noncutaneous adverse

● least effective drug as effects:
monotherapy and is usually ● Hyperlipidemia
used concurrently with ● Pancreatitis
phototherapy ● Elevated
● Contraindicated with ● Transaminases
pregnancy ● Pseudotumor -
cerebri-like
symptoms

Biologic ● High cost Tumor Necrosis Factor

Response (TNF) Inhibitors:
Modifiers 1. Tumor Necrosis Factor ● Etanercept
(TNF) Inhibitors ● Infliximab
● Adalimumab
a. TNF inhibitors are drugs
that help stop Interleukin Antagonists:
inflammation and are Ustekinumab
used worldwide to treat
inflammatory conditions
such as rheumatoid
arthritis (RA), psoriatic
arthritis, juvenile
idiopathic arthritis,
inflammatory bowel
disease (Crohn's and
ulcerative colitis),
ankylosing spondylitis,
and psoriasis

b. have a risk of severe

opportunistic infection

2. Interleukin Antagonists