Pharma Handouts Rev 3

PHAMACOLOGY
a. Is the study of drugs (chemicals) that alters the function of living organism.
b. Drug therapy also called pharmacotherapy, is use of drug to prevent, diagnose, or treat signs and symptoms, and disease
processes.
PHARMACOKINETICS
a. “Drug movement through the body.”
b. “What the body does to the drug” to reach the site of action.
Specific Processes:
a. Absorption
b. Distribution
c. Metabolism (biotransformation)
d. Excretion
1. Absorption - The process that occurs from the time the drug enters the bloodstream to be circulated.
 Factors that affects the rate and extent of drug absorption:
a. Dosage form
b. Route of administration
c. Blood flow to the site of administration
d. GI function
e. Presence of food or other drugs
2. Distribution
a. The transport of drug molecules within the body.
b. Most drug molecules enter and leave the bloodstream at the capillary level.
c. Distribution depends largely on the adequacy of blood circulation.
d. Most important factor of drug distribution is protein binding.
e. Distribution of blood into the CNS is limited because of blood-brain barrier, which compose of capillaries with tight walls,
limits movement of drug molecules into brain tissues.
f. Only drugs that are lipid soluble or have a transport system can cross the blood-brain barrier and reach the therapeutic
concentration in brain tissue
g. Distribution of blood into the CNS is limited because of blood-brain barrier, which compose of capillaries with tight walls,
limits movement of drug molecules into brain tissues.
h. Only drugs that are lipid soluble or have a transport system can cross the blood-brain barrier and reach the therapeutic
concentration in brain tissue
4. Metabolism
a. Method by which drugs are inactivated or biotransformed by the body.
b. The liver is the single-most important site of drug metabolism, the process by which drugs are change into new, less
active chemicals.
5. Excretion
a. Refers to elimination of the drug from the body.
b. Most drugs are excreted by the kidneys, bowel, lungs, and skin.
c. The kidneys plays the, most important role in drug excretion.
d. Kidney dysfunction can lead to toxic levels of a drug in the body because the drug cannot be excreted.
Pharmacodynamic
a. “How the drug affects the body.”
b. The science that deals with the interactions between the chemical components of living systems and the foreign
chemicals, including drugs that enters those systems.
Factors Affecting the Body’s Response to a Drug
1. Weight
a. The recommended dose of a drug is based on drug evaluation studies and is targeted at a 150-pound person.
b. People who are much heavier may require larger doses to get a therapeutic effect from a drug because they have
increased tissues to perfuse and increased receptor sites in some reactive tissue.
c. People who weigh less than the norm may require smaller doses of a drug . Toxic effects may occur at the
recommended dose if the person is very small.
2. Age
a. Age is a factor primarily in children and older adults.
b. Children metabolize many drugs differently than adults do, and they have immature systems for handling drugs.
c. Older adults undergo many physical changes that are a part of the aging process. Their bodies may respond very
differently in all aspects of pharmacokinetics—less effective absorption, less efficient distribution because of fewer
plasma proteins and less efficient perfusion, altered biotransformation or metabolism of drugs because of age-
related liver changes, and less effective excretion owing to less efficient kidneys.
3. Gender
a. Physiological differences between men and women can influence a drug’s effect.
b. When giving IM injections, for example, it is important to remember that men have more vascular muscles, so the
effects of the drug will be seen sooner in men than in women.
c. Women have more fat cells than men do, so drugs that deposit in fat may be slowly released and cause effects for a
prolonged period. For example, gas anesthetics have an affinity for depositing in fat and can cause drowsiness and
sedation sometimes weeks after surgery.
d. Women who are given any drug should always be questioned about the possibility of pregnancy because, as stated
previously, the use of drugs in pregnant women is not recommended unless the benefit clearly outweighs the
potential risk to the fetus.
4. Physiologic factors
a. Physiological differences such as diurnal rhythm of the nervous and endocrine systems, acid–base balance,
hydration, and electrolyte balance can affect the way that a drug works on the body and the way that the body
handles the drug.
b. If a drug does not produce the desired effect, one should review the patient’s acid–base and electrolyte profiles and
the timing of the drug.
5. Pathologic factors
a. The disease that the drug is intended to treat can change the functioning of the chemical reactions within the body
and thus change the response to the drug.
b. Other pathological conditions can change the basic pharmacokinetics of a drug. For example, GI disorders can affect
the absorption of many oral drugs.
c. Vascular diseases and low blood pressure alter the distribution of a drug, preventing it from being delivered to the
reactive tissue, thus rendering the drug nontherapeutic.
d. Liver or kidney diseases affect the way that a drug is biotransformed and excreted and can lead to toxic reactions
when the usual dose is given.
6. Genetic factors
a. Some people lack certain enzyme systems necessary for metabolizing a drug, whereas others have overactive
enzyme systems that cause drugs to be broken down more quickly.
b. Pharmacogenomics is a new area of study that explores the unique differences in response to drugs that each
individual possesses based on genetic makeup.
c. Trastuzumab (Herceptin) is a drug that was developed to treat breast cancer when the tumor expresses human
epidermal growth factor receptor 2—a genetic defect seen in some tumors. The drug has no effect on
tumors that do not express that genetic defect. This drug was developed as a personalized or targeted medicine
based on genetic factors.
7. Immunologic factors
a. People can develop an allergy to a drug. After exposure to its proteins, a person can develop antibodies to a drug.
With future exposure to the same drug, that person may experience a full-blown allergic reaction.
b. Sensitivity to a drug can range from mild (e.g., dermatological reactions such as a rash) to more severe (e.g.,
anaphylaxis, shock, and death).
8. Psychological factors
a. The patient’s attitude about a drug has been shown to have an effect on how that drug works. A drug is more likely
to be effective if the patient thinks it will work than if the patient believes it will not work. This is called the placebo
effect.
b. Some people who believe that they can influence their health actively seek health care and willingly follow a
prescribed regimen. Other people do not trust the medical system.
c. As the caregiver most often involved in drug administration, the nurse is in a position to influence the patient’s
attitude about drug effectiveness.
9. Environmental factors
a. Some drug effects are enhanced by a quiet, cool, nonstimulating environment. For example, sedating drugs are given
to help a patient relax or to decrease tension.
b. Reducing external stimuli to decrease tension and stimulation help the drug be more effective.
c. Other drug effects may be influenced by temperature . For example, antihypertensives that work well during cold,
winter months may become too effective in warmer, environments, when natural vasodilation may lead to a release
of heat that tends to lower the blood pressure.
d. If a patient’s response to a medication is not as expected, look for possible changes in environmental conditions.
10. Tolerance
a. The body may develop a tolerance to some drugs over time.
b. Tolerance may arise because of increased biotransformation of the drug, increased resistance to its effects , or other
pharmacokinetic factors.
c. When tolerance occurs, the drug no long causes the same reaction. Therefore, increasingly larger doses are needed
to achieve a therapeutic effect.
d. Example: The longer morphine is taken, the more tolerant the body becomes to the drug, so that larger and larger
doses are needed to relieve pain.
11. Cummulation effects
a. If a drug is taken in successive doses at intervals that are shorter than recommended, or if the body is unable to
eliminate a drug properly, the drug can accumulate in the body, leading to toxic levels and adverse effects.
b. Some people take all of their medications first thing in the morning, so that they won’t forget to take the pills later in
the day.
c. Others realize that they forgot a dose and then take two to make up for it.
12. Interactions
a. When two or more drugs or substances are taken together, there is a possibility that an interaction can occur,
causing unanticipated effects in the body.
b. Alternative therapies, such as herbal products, act as drugs in the body and can cause these same interactions.
c. Certain foods can interact with drugs in much the same way.
d. Usually this is an increase or decrease in the desired therapeutic effect of one or all of the drugs or an increase in
adverse effects.
PRINCIPLES OF MEDICATION ADMINISTRATION
Medication- Is a substance administered for the diagnosis, cure, treatment, or relief of symptom or prevention of disease.
Pharmacology – is the study of the effect of drug on living organism.
Pharmacy- is the art of preparing, compounding, and dispensing drugs.
Medication administration - is a basic nursing function that involves skillful technique and consideration of patient’s development
and safety.
I. Ten “Rights” of Medication Administration
1. Right Medication - The medication given was the medication ordered the nurse compares the label of the medication
container with medication form. The nurse does this 3 times.
2. Right Dose
a. The dose appropriate for the client
b. Double-check calculations that appears questionable
c. Know the usual dosage range of the medication
3. Right Time
a. Give the medication at the right frequency and at the right time ordered according to agency policy.
b. Medications given within 30 minutes before or after the scheduled time are considered to meet the right time
standard.
c. Medication that must act at certain times are given priority ( e.g insulin should be given at a precise interval
before a meal )
4. Right Route- Make certain that the route is safe and appropriate for the client.
5. Right Client
a. The patient’s full name is used. The middle name or initial and date of birth should be included to avoid
confusion with other patient.
b. Check the client’s identification band with each administration of a medication.
6. Right Documentation
a. Document medication administration after giving it, not before.
b. If medication is not given, follow the agency policy for documenting the reason why.
c. Sign medication sheet immediately after administration of the drug.
7. Right Education- Explain information about the medication to the client.
8. Right to Refuse
a. Adult client have the right to refuse medication.
b. The nurse’s role is to ensure that the client fully informed of the potential consequences of refusal and to
communicate the client’s refusal to the health care provider.
9. Right Assessment- Some medication requires specific assessment prior to administration. (Vital signs, lab results).
10. Right Evaluation- Conduct appropriate follow-up (e.g. was the desired effect achieved or not?)
II. – Practice Asepsis – wash hand before and after preparing the medication to reduce transfer of microorganisms.
III. – Nurse who administer the medications are responsible for their own action. Question any order that you considered
incorrect (may be unclear or inappropriate)
IV. – Be knowledgeable about the medication that you administer
“A FUNDAMENTAL RULE OF SAFE DRUG ADMINISTRATION IS: “NEVER ADMINISTER AN UNFAMILIAR MEDICATION”
V. – Keep the Narcotics in locked place.
VI. – Use only medications that are in clearly labeled containers. Relabelling of drugs is the responsibility of the Pharmacist.
VII. – Return liquid that are cloudy in color to the pharmacy.
VIII. – Before administering medication, identify the client correctly
IX. – Do not leave the medication at the bedside. Stay with the client until he actually takes the medications.
X. – The nurse who prepares the drug administers it. Only the nurse prepares the drug knows what the drug is. Do not accept
endorsement of medication.
XI. – If the client vomits after taking the medication, report this to the nurse in-charge or physician.
XII. – Preoperative medications are usually discontinued during the postoperative period unless ordered to be continued.
XIII.- When a medication is omitted for any reason, record the fact together with the reason.
XI. – When the medication error is made, report it immediately to the nurse in-charge or physician. To implement
necessary measures immediately. This may prevent any adverse effects of the drug.
Medication Administration
1. Oral administration
Advantages
a. The easiest and most desirable way to administer medication
b. Most convenient
c. Safe, does not break skin barrier
d. Usually less expensive
Disadvantages
a. Inappropriate if client cannot swallow and if GIT has reduced motility
b. Inappropriate for client with nausea and vomiting
c. Drug may have unpleasant taste
d. Drug may discolor the teeth
e. Drug may irritate the gastric mucosa
f. Drug may be aspirated by seriously ill patient.
Drug Forms for Oral Administration
a. Solid: tablet, capsule, pill, powder
b. Liquid: syrup, suspension, emulsion, elixir, milk, or other alkaline substances.
c. Syrup: sugar-based liquid medication
d. Suspension: water-based liquid medication. Shake bottle before use of medication to properly mix it.
e. Emulsion: oil-based liquid medication
f. Elixir: alcohol-based liquid medication. After administration of elixir, allow 30 minutes to elapse before giving water. This
allows maximum absorption of the medication.
“NEVER CRUSH ENTERIC-COATED OR SUSTAINED RELEASE TABLET”
a. Crushing enteric-coated tablets – allows the irrigating medication to come in contact with the oral or gastric mucosa,
resulting in mucositis or gastric irritation.
b. Crushing sustained-released medication – allows all the medication to be absorbed at the same time, resulting in a
higher than expected initial level of medication and a shorter than expected duration of action
2. SUBLINGUAL
a. A drug that is placed under the tongue, where it dissolves.
b. When the medication is in capsule and ordered sublingually, the fluid must be aspirated from the capsule and placed
under the tongue.
c. A medication given by the sublingual route should not be swallowed, or desire effects will not be achieved
Advantages:
a. Same as oral
b. Drug is rapidly absorbed in the bloodstream
Disadvantages
a. If swallowed, drug may be inactivated by gastric juices.
b. Drug must remain under the tongue until dissolved and absorbed
3. BUCCAL
a. A medication is held in the mouth against the mucous membranes of the cheek until the drug dissolves.
b. The medication should not be chewed, swallowed, or placed under the tongue (e.g sustained release nitroglycerine,
opiates, antiemetic, tranquilizer, sedatives)
c. Client should be taught to alternate the cheeks with each subsequent dose to avoid mucosal irritation
Advantages:
a. Same as oral
b. Drug can be administered for local effect
c. Ensures greater potency because drug directly enters the blood and bypass the liver
Disadvantages- If swallowed, drug may be inactivated by gastric juice
4. TOPICAL – Application of medication to a circumscribed area of the body.
1. Dermatologic – includes lotions, liniment and ointments, powder.
a. Before application, clean the skin thoroughly by washing the area gently with soap and water, soaking an involved
site, or locally debriding tissue.
b. Use surgical asepsis when open wound is present
c. Remove previous application before the next application
d. Use gloves when applying the medication over a large surface. (e.g. large area of burns)
e. Apply only thin layer of medication to prevent systemic absorption.
2. Opthalmic - includes instillation and irrigation
a. Instillation – to provide an eye medication that the client requires.
b. Irrigation – To clear the eye of noxious or other foreign materials.
c. Position the client either sitting or lying.
d. Use sterile technique
e. Clean the eyelid and eyelashes with sterile cotton balls moistened with sterile normal saline from the inner to the
outer canthus
f. Instill eye drops into lower conjunctival sac.
g. Instill a maximum of 2 drops at a time. Wait for 5 minutes if additional drops need to be administered. This is for
proper absorption of the medication.
h. Avoid dropping a solution onto the cornea directly, because it causes discomfort.
i. Instruct the client to close the eyes gently. Shutting the eyes tightly causes spillage of the medication.
j. For liquid eye medication, press firmly on the nasolacrimal duct (inner cantus) for at least 30 seconds to prevent
systemic absorption of the medication.
3. Otic Instillation – to remove cerumen or pus or to remove foreign body
a. Warm the solution at room temperature or body temperature, failure to do so may cause vertigo, dizziness, nausea and
pain.
b. Have the client assume a side-lying position (if not contraindicated) with ear to be treated facing up.
c. Perform hand hygiene. Apply gloves if drainage is present.
d. Straighten the ear canal:
 0-3 years old: pull the pinna downward and backward
 Older than 3 years old: pull the pinna upward and backward
e. Instill eardrops on the side of the auditory canal to allow the drops to flow in and continue to adjust to body temperature
f. Press gently but firmly a few times on the tragus of the ear to assist the flow of medication into the ear canal.
g. Ask the client to remain in side lying position for about 5 minutes
h. At times the MD will order insertion of cotton puff into outermost part of the canal. Do not press cotton into the canal.
Remove cotton after 15 minutes.
4. Nasal
 Nasal instillations usually are instilled for their astringent effects (to shrink swollen mucous membrane)
 To loosen secretions and facilitate drainage or to treat infections of the nasal cavity or sinuses.
 Decongestants, steroids, calcitonin.
a. Have the client blow the nose prior to nasal instillation
b. Assume a back lying position, or sit up and lean head back.
c. Elevate the nares slightly by pressing the thumb against the client’s tip of the nose. While the client inhales, squeeze the
bottle.
d. Keep head tilted backward for 5 minutes after instillation of nasal drops.
e. When the medication is used on a daily basis, alternate nares to prevent irritations
5. Inhalation – use of nebulizer, metered-dose inhaler
a. Semi or high-fowler’s position or standing position. To enhance full chest expansion allowing deeper inhalation of the
medication
b. Shake the canister several times. To mix the medication and ensure uniform dosage delivery
c. Position the mouthpiece 1 to 2 inches from the client’s open mouth. As the client starts inhaling, press the canister down
to release one dose of the medication. This allows delivery of the medication more accurately into the bronchial tree
rather than being trapped in the oropharynx then swallowed
d. Instruct the client to hold breath for 10 seconds. To enhance complete absorption of the medication.
e. If bronchodilator, administer a maximum of 2 puffs, for at least 30 second interval. Administer bronchodilator before
other inhaled medication. This opens airway and promotes greater absorption of the medication.
f. Wait at least 1 minute before administration of the second dose or inhalation of a different medication by MDI
g. Instruct client to rinse mouth, if steroid had been administered. This is to prevent fungal infection.
6. Vaginal – drug forms: tablet liquid (douches), jelly, foam and suppository.
a. Close room or curtain to provide privacy.
b. Assist client to lie in dorsal recumbent position to provide easy access and good exposure of vaginal canal, also allows
suppository to dissolve without escaping through orifice.
c. Use applicator or sterile gloves for vaginal administration of medications.
Vaginal Irrigation – is the washing of the vagina by a liquid at low pressure. It is also called douche.
a. Empty the bladder before the procedure
b. Position the client on her back with the hips higher than the shoulder (use bedpan)
c. Irrigating container should be 30 cm (12 inches) above
d. Ask the client to remain in bed for 5-10 minute following administration of vaginal suppository, cream, foam, jelly or
irrigation.
7. RECTAL – can be use when the drug has objectionable taste or odor.
a. Need to be refrigerated so as not to soften.
b. Apply disposable gloves.
c. Have the client lie on left side and ask to take slow deep breaths through mouth and relax anal sphincter.
d. Retract buttocks gently through the anus, past internal sphincter and against rectal wall, 10 cm (4 inches) in adults, 5
cm (2 in) in children and infants. May need to apply gentle pressure to hold buttocks together momentarily.
e. Discard gloves to proper receptacle and perform hand washing.
f. Client must remain on side for 20 minute after insertion to promote adequate absorption of the medication.
8. PARENTERAL- administration of medication by needle.
A. Intradermal – under the epidermis.
a. The site are the inner lower arm, upper chest and back, and beneath the scapula.
b. Indicated for allergy and tuberculin testing and for vaccinations.
c. Use the needle gauge 25, 26, 27: needle length 3/8”, 5/8” or ½”
d. Needle at 10–15 degree angle; bevel up.
e. Inject a small amount of drug slowly over 3 to 5 seconds to form a wheal or bleb.
f. Do not massage the site of injection. To prevent irritation of the site, and to prevent absorption of the drug into the
subcutaneous.
B. Subcutaneous – vaccines, heparin, preoperative medication, insulin, narcotics.
The site: outer aspect of the upper arms, anterior aspect of the thighs, abdomen, scapular areas of the upper back, ventrogluteal,
dorsogluteal.
a. Only small doses of medication should be injected via SC route.
b. Rotate site of injection to minimize tissue damage.
c. Needle length and gauge are the same as for ID injections
d. Use 5/8 needle for adults when the injection is to administer at 45 degree angle; ½ is use at a 90 degree angle.
e. For thin patients: 45 degree angle of needle
f. For obese patient: 90 degree angle of needle
g. For heparin injection:
h. Do not aspirate.
i. Do not massage the injection site to prevent hematoma formation
j. For insulin injection:
k. Do not massage to prevent rapid absorption which may result to hypoglycemic reaction.
l. Always inject insulin at 90 degrees angle to administer the medication in the pocket between the subcutaneous and
muscle layer. Adjust the length of the needle depending on the size of the client.
m. For other medications, aspirate before injection of medication to check if the blood vessel had been hit. If blood appears
on pulling back of the plunger of the syringe, remove the needle and discard the medication and equipment.
C. Intramuscular
a. Needle length is 1”, 1 ½”, 2” to reach the muscle layer
b. Clean the injection site with alcoholized cotton ball to reduce microorganisms in the area.
c. Inject the medication slowly to allow the tissue to accommodate volume.
Sites:
1. Ventrogluteal site
a. The area contains no large nerves, or blood vessels and less fat. It is farther from the rectal area, so it less
contaminated.
b. Position the client in prone or side-lying.
c. When in prone position, curl the toes inward.
d. When side-lying position, flex the knee and hip. These ensure relaxation of gluteus muscles and minimize discomfort
during injection.
e. To locate the site, place the heel of the hand over the greater trochanter, point the index finger toward the anterior
superior iliac spine, and then abduct the middle (third) finger. The triangle formed by the index finger, the third
finger and the crest of the ilium is the site.
2. Dorsogluteal site
a. Position the client similar to the ventrogluteal site
b. The site should not be used in infant under 3 years because the gluteal muscles are not well developed yet.
c. To locate the site, the nurse draws an imaginary line from the greater trochanter to the posterior superior iliac spine.
The injection site id lateral and superior to this line.
d. Another method of locating this site is to imaginary divide the buttock into four quadrants. The upper most quadrant
is the site of injection. Palpate the crest of the ilium to ensure that the site is high enough.
e. Avoid hitting the sciatic nerve, major blood vessel or bone by locating the site properly.
3. Vastus Lateralis
a. Recommended site of injection for infant
b. Located at the middle third of the anterior lateral aspect of the thigh.
c. Assume back-lying or sitting position.
4. Rectus femoris site –located at the middle third, anterior aspect of thigh.
5. Deltoid site
a. Not used often for IM injection because it is relatively small muscle and is very close to the radial nerve and radial
artery.
b. To locate the site, palpate the lower edge of the acromion process and the midpoint on the lateral aspect of the arm
that is in line with the axilla. This is approximately 5 cm (2 in) or 2 to 3 fingerbreadths below the acromion process.
6. Z tract injection
a. Used for parenteral iron preparation. To seal the drug deep into the muscles and prevent permanent staining of the
skin.
b. Retract the skin laterally, inject the medication slowly. Hold retraction of skin until the needle is withdrawn
c. Do not massage the site of injection to prevent leakage into the subcutaneous.
GENERAL PRINCIPLES IN PARENTERAL ADMINISTRATION OF MEDICATIONS
1. Check doctor’s order.
2. Check the expiration for medication – drug potency may increase or decrease if out-dated.
3. Observe verbal and non-verbal responses toward receiving injection. Injection can be painful. Client may have anxiety, which
can increase the pain.
4. Practice asepsis to prevent infection. Apply disposable gloves.
5. Use appropriate needle size. To minimize tissue injury.
6. Plot the site of injection properly. To prevent hitting nerves, blood vessels, bones.
7. Use separate needles for aspiration and injection of medications to prevent tissue irritation.
8. Introduce air into the vial before aspiration. To create a positive pressure within the vial and allow easy withdrawal of the
medication.
9. Allow a small air bubble (0.2 ml) in the syringe to push the medication that may remain.
10. Introduce the needle in quick thrust to lessen discomfort.
11. Either spread or pinch muscle when introducing the medication. Depending on the size of the client.
12. Minimized discomfort by applying cold compress over the injection site before introduction of medicati0n to numb nerve
endings.
13. Aspirate before the introduction of medication. To check if blood vessel had been hit.
14. Support the tissue with cotton swabs before withdrawal of needle. To prevent discomfort of pulling tissues as needle is
withdrawn.
15. Massage the site of injection to haste absorption.
16. Apply pressure at the site for few minutes. To prevent bleeding.
17. Evaluate effectiveness of the procedure and make relevant documentation.
D. Intravenous
The nurse administers medication intravenously by the following method:
1. As mixture within large volumes of IV fluids.
2. By injection of a bolus, or small volume, or medication through an existing intravenous infusion line or intermittent
venous access (heparin or saline lock)
3. By “piggyback” infusion of solution containing the prescribed medication and a small volume of IV fluid through an
existing IV line.
a. Most rapid route of absorption of medications.
b. Predictable, therapeutic blood levels of medication can be obtained.
c. The route can be used for clients with compromised gastrointestinal function or peripheral circulation.
d. Large dose of medications can be administered by this route.
e. The nurse must closely observe the client for symptoms of adverse reactions.
f. The nurse should double-check the six rights of safe medication.
g. If the medication has an antidote, it must be available during administration.
h. When administering potent medications, the nurse assesses vital signs before, during and after infusion.
Frequently Abused Street Drugs and Their Potential Health Consequences
DRUG STREET NAMES CLASS HEALTH CONSEQUENCES
1. Amphetamines Uppers, whites, Stimulant Hypertension, tachycardia, insomnia,

dexies restlessness
2. Amyl nitrate Boppers, pearls Stimulant Tachycardia, restlessness, hypotension,
3. Anabolic steroids Roids, muscle Steroid Hypertension, hyperlipidemia, acne,

Cardiomyopathy cancer, vertigo
4. Barbiturates Downers, reds Depressant Bradycardia, hypotension,
laryngospasm,
ataxia, impaired thinking

5. Benzodiazepines M&Ms, Uncle Milty Depressant Confusion, fatigue, impaired memory,
Impaired coordination
6. Cannabis Pot, grass, weed, Mixed CNS Drowsiness, elation, dizziness, memory
With formaldehyde THC; fry sticks; lapse, hallucinations
With cocaine primo
7. Cocaine Snow, blow, crack Stimulant Tachycardia, hypertension,

confused thinking, hallucinations,
8. Fentanyl Jackpot, China white Opioid Sedation, arrhythmias, shock, cardiac
arrest, decreased respirations,
constipation
9. Gamma- GHB, fantasy, Depressant Memory loss, hypotension,

hydroxybutyrate liquid X, liquid E, somnolence
“date rape” drug
10. Heroin Brown sugar, joy, Opioid Sedation, arrhythmias, shock, cardiac
crank, fairy dust arrest decreased respirations,
constipation
11. Ketamine Super acid, special K Depressant Paralysis, loss of sensation,

disorientation, psychic changes
12. LSD Acid, sunshine, Hallucinogen Hallucinations, hypotension, changes in
blotter acid thinking, Loss of social control
13. MDMA Ecstasy, b-bombs, Hallucinogen Hallucinations, psychic change, loss of

go, Scooby snacks memory,hypotension, cardiac arrest
14. Methamphetamine Crystal, glass, speed, Stimulant Hypertension, tachycardia,restlessness,

working mother’s cocaine,
crystal meth changes in thinking
15. Methylphenidate Ritalin Stimulant Agitation, tachycardia, hypertension,

hyperreflexia, fever
16. Morphine Mort, Miss Emma Opioid Sedation, arrhythmias, shock, cardiac
arrest, decreased respirations,
constipation
17. OxyContin Oxy, Oxycotton, Opioid Sedation, arrhythmias, shock,

Oxy 80s, hillbilly heroin, decreased respirations, constipation,
poor man’s heroin, cardiac arrest
cotton
18. PCP Angel dust, zombie; Hallucinogen Acute psychosis, HF, death, seizures,
with steroids juices memory loss
19. Peyote Button, mesc Hallucinogen Acute psychosis, tremor, altered

perception, death
20. Rohypnol Rophies Amnesiac Date rape drug, loss of memory,

immobility
21. Viagra/MDMA Sextasy Hallucinogen, Severe hypotension, hallucinations,
ED drug increased sexual function
FDA Pregnancy Categories

a. The Food and Drug Administration (FDA) has established five categories to indicate the potential for a systemically
absorbed drug to cause birth defects.
b. The key differentiation among the categories rests on the degree (reliability) of documentation and the risk–benefit ratio.
1. Category A: Adequate studies in pregnant women have not demonstrated a risk to the fetus in the first trimester of
pregnancy, and there is no evidence of risk in later trimesters.
2. Category B: Animal studies have not demonstrated a risk t0 the fetus but there are no adequate studies in pregnant women,
or animal studies have shown an adverse effect, but adequate studies in pregnant women have not demonstrated a risk to
the fetus during the first trimester of pregnancy, and there is no evidence of risk in later trimesters.
3. Category C: Animal studies have shown an adverse effect on the fetus but there are no adequate studies in humans; the
benefits from the use of the drug in pregnant women may be acceptable despite its potential risks, or there are no animal
reproduction studies and no adequate studies in humans.
4. Category D: There is evidence of human fetal risk, but the potential benefits from the use of the drug in pregnant women
may be acceptable despite its potential risks.
5. Category X: Studies in animals or humans demonstrate fetal abnormalities or adverse reaction; reports indicate evidence
of fetal risk. The risk of use in a pregnant woman clearly outweighs any possible benefit.
Regardless of the designated Pregnancy Category or presumed safety, no drug should be administered during
pregnancy unless it is clearly needed.
I- Drugs Affecting the Nervous System

1. Narcotic agonist (opioid agonist)
a. Codeine
b. Fentanyl citrate
c. Hydromorphone hcl
d. Meperidine hcl
e. Morphine So4
f. Methadone hcl
g. oxycodone
Action:
a. Opioids agonist reduce pain by binding to opiate receptor sites in the PNS and the CNS.
b. When these drugs stimulates the opiate receptors, they mimic the effect of endorphins (naturally occurring opiates that
are part of the body’s own pain relief system.)
Adverse reactions
a. Decrease respiratory rate - most common
b. Flushing
c. Orthostatic hypotension
d. Pupil constriction
e. With meperidine:
a. Tremors
b. Palpitation
c. Tachycardia
d. Delirium
e. Neurotoxicity and seizure
Nursing considerations
a. Naloxone hcl- Opioid antagonist blocks the effects of opioid by occupying the opiates receptor sites, displacing the opioid
attached to opiates receptors and further blocking these sites.
b. Naltrexone hcl
c. Provide oxygen, ventilation and other resuscitation measures when the drug is used.
d. Take vital signs especially b/p and r/r
e. Be prepared to give continuous I.V naloxone infusion to control adverse effects of epidural morphine.
2. NSAID
 Typically use to combat inflammation. Their anti-inflammatory effect equals that of aspirin.
 Also have analgesic and antipyretic effect.
Adverse reactions
a. Abdominal pain
b. Bleeding
c. Anorexia
d. Diarrhea
e. Ulcer
f. Liver toxicity
g. Dizziness
h. confusion
a. Administer oral NSAID with 8 0z water to ensure adequate passage into the stomach.
b. Have client sit up for15 to 30 min after taking medication to prevent it from lodging in the esophagus.
c. Give drugs with milk or meals or antacids to reduce adverse GI reactions
3. Anxiolytics
a. Librium – watch for signs of leukopenia, hypotension
b. Equanil – metabolizes extensively in the liver & interferes w/ liver function tests.- decreases PT if on coumadin
c. Atarax - does not cause tolerance & can be used temporarily when other anti-anxiety agents have been abused
d. Valium
e. Serax – useful for treating elderly clients. Does not rely on liver for metabolism
Nursing Considerations
a. Take vital signs before giving the drugs
b. Implement safety precautions
c. Have an antidote at bedside- Romazicon
4. Anticonvulsants
1. BARBITURATES
Action: Used as an anticonvulsant besides being a sedative
“TAL / AL “
a. Secobarbital (seconal)
b. Phenobarbital (luminal)* commonly used anticonvulsant barbiturate
c. Methohexital (Brevital)
d. Amobarbital (Amital)
2. BENZODIAZEPINES
a. diazepam is drug of choice for Rx of STATUS EPILIPTICUS
b. clorazepate is use w/ other antiepileptic agents to control partial seizures
3. HYDANTOINS
a. Used to depress abnormal neuronal charges & prevent spread of seizures
b. also used to treat dysrhythmias
c. A/R: gingival hyperplasia, alopecia, hyperglycemia, blood dyscracias
d. Seizure precaution & dental hygiene
e. Give IV with normal saline & never with dextrose
4. CNS STIMULANTS
AMPHETAMINES
a. increase the release of catecholamines (NE from stored sites near terminals)
b. Block the re-uptake of dopamine & NE following release into the synapse, & inhibit the action of MAO
c. Increase stimulating effect on cerebral cortex
 DOXAPRAM (DOPRAM)
 METHYLPHEMDATE Hcl (Ritalin)- side effect- insomia
 PEMOLINE (Cylert)
 CAFFEINE
5. Antiparkinsonian
DOPAMINERGIC MEDS
a. Amantidine (Symmetrel)
b. Bromocriptine (Parlodel)
c. Carbidopa-levodopa (Sinemet)
1. Restores the balance of neurotransmitters acetylcholine & dopamine in the CNS decreasing S/Sx of
parkinsonism such as rigidity, tremors, bradykinesia, stooped forward behavior, shuffling gait & masked facies
2. LEVODOPA- precursor to dopamine in the brain
3. For levodopa avoid vitamin B6 & eat low-CHON food -B6 decreases the effect of levodopa
4. Do not discontinue meds abruptly
5. Urine & perspiration may be discolored & stain clothing but this is harmless
A/R:
 involuntary body movements
 urinary retention
 Constipation
 Dizziness
6. Antimyasthenic
a. Neostigmine bromide (Prostigmin)
b. Pyridostigmine bromid (Mestinon)
a. Used to control myasthenic symptoms
b. Take meds on time…MG impairs breathing & swallowing
c. Take a.c. for best absorption
d. Medication for life
c. Edrophonium chloride (Tensilon) - is used to diagnose myasthenia gravis & differentiate cholinergic crisis (drug overdose)
1. Prepare resuscitative equipment & antidote: atropine SO4
2. dx as M.G. if client shows marked improvement in muscle tone within 30-60 seconds after injection lasting 4-5
minutes- positive Tensilon Test
3. dx as cholinergic crisis when muscle tone does not improve upon injection…negative Tensilon Test
4. S/Sx: muscle twitching around eyes & face
7. Anticholinergic
a. Blocks cholinergic receptors in the CNS, thereby suppressing acetylcholine activity
b. They also lyse and block the effects of parasympathetic nervous system (PNS) so they are also called
as parasympatholytics.
c. Atropine, benztropine mesylate (Cogentin), biperiden HCl (Akineton) Trihexyphenidyl HCl (Artane), scopolamine,
d. A/R: tachycardia, palpitation, blurred vision, dry mouth & secretions, urinary retention, constipation, restlessness,
confusion, pupil dilation, photophobia, cycloplegia, increased intraocular pressure, dizziness, insomnia
1. Use with cautions in client with glaucoma
2. Client to have regular eye check-up for increase in IOP
3. Take vital signs
4. Check urine output
5. Avoid aspirin, caffeine, smoking to decrease gastric acidity
6. Provide comfort measures (e.g., sugarless lozenges, lighting control, small and frequent meals)
8. Psychotropic
A. Antianxiety or anxiolytic agents --zolam -zepam -zepate -zepoxide
Benzodiazepines
 Alprazolam (Xanax)
 Chlordiazepoxide (Librium)
 Clobazepam (Onfi)
 Clonazepam (Klonopin)
 Clorazepate (Tranxene)
 Diazepam (Valium)
 Estazolam (ProSom)
 Flurazepam (Dalmane)
Some common side effects-drowsiness, sedation, confusion, dependence and withdrawal symptoms, stomach upset, nausea,
constipation, sexual dysfunction.
a. Assess baseline vital signs.
b. Assess blood pressure, pulse and respiration if IV administration.
c. Implement safety precautions to prevent injury
d. Provide frequent sips of water for dry mouth.
e. Provide fluids and fiber for constipation.
f. Evaluate therapeutic response, mental state and physical dependency after long-term use.
B. Antidepressants
1. Selective serotonin reuptake inhibitor-Fluoxetine (prozac), Paroxetine (Paxil),Sertraline hcl (Zoloft)
a. Is used to treat depression, panic attacks, obsessive compulsive disorder, a certain eating disorder (bulimia), and a
severe form of premenstrual syndrome (premenstrual dysphoric disorder).
b. This medication may improve the mood, sleep, appetite, and energy level and may help restore your interest in daily
living.
c. It may decrease fear, anxiety, unwanted thoughts, and the number of panic attacks.
d. It may also reduce the urge to perform repeated tasks (compulsions such as hand-washing, counting, and checking)
that interfere with daily living.
e. Fluoxetine may lessen premenstrual symptoms such as irritability, increased appetite, and depression. It may
decrease binging and purging behaviors in bulimia.
2. Tricyclic- Elavil, Vivactil, Sinequan, Aventyl, Tofranil, Norpramin
a. This medication is used to treat mental/mood problems such as depression.
b. It may help improve mood and feelings of well-being, relieve anxiety and tension, help you sleep better, and increase
your energy level.
c. This medication belongs to a class of medications called tricyclic antidepressants.
d. It works by affecting the balance of certain natural chemicals (neurotransmitters such as serotonin) in the brain.
e. Usually take at least two weeks to take effect
3. MAOi- Marplan, Nardil, Parnate
inhibit enzyme, monoamine oxidase, w/c breaks down NE & serotonin, increasing the concentration of these
neurotransmitters.
a. This medication treats depression by restoring the balance of certain natural substances (neurotransmitters) in
the brain.
b. Can improve the mood and feelings of well-being.
c. Usually, this medication is used in persons who have not responded to treatment with other drugs.
Common side effects of Anti-depressants
1. dizziness
2. drowsiness
3. tiredness
4. weakness
5. problems sleeping (insomnia)
6. constipation
7. upset stomach
8. dry mouth
1. Take vital signs
2. Implement safety precautions
3. Increase fluid intake and high fiber foods to counteract constipation
4. Avoid thyramine-rich food to prevent hypertensive crisis
a. Aged cheese (except cottage cheese, cream cheese), Cheddar cheese and Swiss cheese are high in tyramine and
should be avoided.
b. Canned foods such as sardines, soy sauce & catsup
c. Organ meats (chicken gizzard & liver) & Process food (salami/bacon). High in Na
d. Red wine (alcohol)
e. Soy sauce
f. Cheese burger
g. Banana, papaya, avocado, raisins (all over ripe fruits except apricot)
h. Yogurt, sour cream, margarine;
i. Mayonnaise
j. OTC decongestants
k. Pickled foods, Pickled herring
C. Neuroleptic (antipsychotic) agents
 blocks dopamine receptors in basal ganglia of brain, inhibiting transmission of nerve impulses.
Uses:
1. Schizophrenia
2. acute mania
3. depression and organic conditions
4. Non-psychiatric cases: Nausea and vomiting, pre-anesthesia, intractable hiccups.
Phenothiazine-“AZINE”
1. Fluphenazine (Prolixin)*
2. phenazine (Tindal)
3. Pherphenazine (Trilafon)
4. Promazine (Sparine)
5. Chlorpromazine (Thorazine)*#1 that causes photosensitivity/photophobia;
6. Mesoridazine (Serentil)
7. Thioridazine (Mellaril)*
8. Prochlorperazine (Compazine)* #1 commonly used anti emetic
9. Compazine causes anticholinergic side effects
10. Trifluoperazine (Stelazine)
II. Butyrophenones-“ PERIDOL”
1. Haloperidol (Haldol, Serenase)* #1 drug used for extreme violent behaviour- Instruct patient taking Haldol to wear
sunscreen
2. Droperidol (Inapsine)
III. Thioxanthenes “THIXENE”
a. Chlorprothixene (Taractan
b. Thiothixene (Navane)
IV. Atypical Antipsychotics-“DONE” /” ZAPINE” or “APINE”
1. Olanzapine (Zyprexia)
2. Clozapine (Clozaril) #1 that causes Agranulocytosis & Blood Dyscrasia
3. Loxapine (Loxitane)
4. Risperidone (Risperidone) #1 drug for Korsakoff’s psychosis
5. Molindone (Moban)
6. Aripiprazole (Abilify) newest antipsychotic drug
ACUTE/COMMON SIDE-EFFECTS FOR PROLONGED USED OF ANTIPSYCOTICS
 Extrapyramidal Symptoms (EPS) Common Signs & Symptoms:
1. Definition of EPS: Reversible side effect (except TARDIVE DYSKINESIA), which is a result of neurological dysfunction of
the Extrapyramidal System.
2. Patients taking with prolonged antipsychotic medications should always be assessed for symptoms of extrapyramidal
symptoms.
1. Akathisia –another word: Motor restlessness . 1-6 wks
a. Signs of motor restless: Foot tapping, finger fidgeting, can’t sit down for more than 15 minutes and pacing back & forth.
b. Patient is unable to remain still
2. Dystonia
a. #1 cardinal Sign: Oculogyric crisis -involuntary rolling of eyeballs, neck shoulder, jaw and throat spasm (dysphagia) . 2-5
days
3. Pseudoparkinsonism-Drug-induced Parkinsonism
a. Pill-rolling tremors.
b. Mask-like face
c. flat affect
d. shuffling gait or festinating gait
e. cogwheel rigidity.
4. Tardive Dyskinesia- irreversible. This is an EMERGENCY!!!
a. TONGUE (tongue rolling & tongue protrusion) lip smacking,
b. tongue rolling
c. protrusion of the tongue
d. vermicular or vermiform tongue rolling
5. Akinesia – absence of kinetic movements
ANTI- EPS MEDICATION
a. Procyclidine (kemadryl, kemadrin)
b. Artane ( trihexyphenydyl)
c. Cogentin (Benztropine mesylate)
d. Akineton (biperiden Hcl)
e. Bromocriptine (Parlodel)
f. Benadryl (Diphenhydramine)
g. Amantadine (Symmetrel)
ADVERSE EFFECT OF ANTIPSYCHOTIC DRUGS:
1. Neuroleptic Malignant Syndrome RARE, LIFE-THREATENING : (EXTREME EMERGENCY):
a. #1 Cardinal Sign -High fever
b. Elevated blood pressure and diaphoresis are indicative of Neuroleptic malignant syndrome, which is a medical
emergency
c. Tremors, muscle rigidity
d. Tachycardia, Tachypnea
e. Sweating, hyperkalemia
f. Stupor, incontinence, renal failure
Medical Management
a. Discontinue all drugs STAT
b. Ventilation
c. Hydration
d. Nutrition
e. renal dialysis
f. hydrotherapeutic measures
g. ANTIDOTE: Dantrolene (Dantrium) or Bromocriptine (Parlodel)
h. Bromocriptine is both an Antiparkinsons & Anti prolactin
D. Antimanic and Mood-stabilizing agents
For: (Mood disorder specifically Mania (Bipolar Disorder)
USES:
1. Elevate mood when client is depressed
2. decreases mood when client is in manic
3. used in acute manic, bipolar prophylaxis
4. ACTS by reducing adrenergic neurotransmitter levels in cerebral tissue through alteration of sodium transport.
5. affects a shift in intraneural metabolism of NOREPINEPHRINE
Action:
a. hyperactivity and balance or stabilize the mood
b. Effect: 1 wk.
CODE: “LITH”
Lithium CO3 – Eskalith, Lithane, Lithobid
Lithium Citrate – Cibalith - S
Therapeutic Serum Level:
 0.5-1.5 mEq (local/CGFNS)
 0.6 – 1.2 mEq (NCLEX)
a. Early in therapy: Serum levels measured q 2-3 times per week; 12 hours after the last dose. Long-term: q 2-3 months.
b. Before lithium is begun baseline RENAL, CARDIAC, and THYROID status obtained.
c. Antidote: 1. DIAMOX (ACETAZOLAMIDE) carbonic anhydrase inhibitor (for open angle glaucoma)
Nursing Considerations:
1. Before extracting Lithium serum level .Lithium fasting 12 hrs . check vital signs
2. Avoid diuretics to prevent hyponatremia
3. Avoid strenuous exercise/activities . gym works
4. Avoid sauna baths
5. Avoid caffeine . because it is a diuretic
6. For hypernatremia . AVOID Na CO3
7. Avoid taking soda and/or soda drinks
8. Oral fluid intake – 3 L /day; increase Na – 3mg/day
 Increase Na = decreases Lithium effect
 For hypernatremia . AVOID Na CO3
 Avoid taking soda and/or soda drinks
 Decrease Na = increase Lithium intoxication . MORE dangerous!!!!
II- Optalmic Medications
1. MYDRIATICS/CYCLOPLEGICS
1. Are generally muscarinic receptor blockers.
2. These include atropine, cyclopentolate, homatropine, scopolamine and tropicamide.
3. They are indicated for use in cycloplegic refraction (to paralyze the ciliary muscle in order to determine the true refractive
error of the eye) and the treatment of uveitis.
4. A/R: photophobia, impaired distant vision, increased IOP, blurred vision, reduced lacrimation.
Nursing Consideration
1. Take vital signs
2. Protect eyes from bright lights
3. Implement safety precautions
4. Use with caution if with glaucoma
2. MIOTICS
1. Cholinergic drug that causes miosis (contraction) of the pupil & contraction of the ciliary muscle of the eye
2. Decreases IOP in glaucoma & achieves miosis in cataract surgery
3. Is used to treat glaucoma,
4. CARpine, CARbachol, piloCARpine, demeCARium
5. A/R low toxicity level:
a. transient hypotension
b. decreased heart rate
c. blurred vision
d. focusing difficulty
1. Take vital signs
2. Advise not to change position abruptly
3. Safety precautions
III- CARDIOVASCULAR DRUGS
1. Beta adrenergic Blockers
a. Inhibit response to beta-adrenergic stimulation
b. Block release thus decreasing of epinephrine and norepinephrine HR & BP
c. Used for angina, dysrhythmias, prevention of MI & glaucoma
d. A/R: Bradycardia, Hypotension, weakness & fatigue, bronchoconstriction
BETA1 ADRENERGIC ( CARDIO SELECTIVE) BLOCKING AGENTS
-acebutolol (Sectral)
-atenolol (Tenormin, Atenol, Premorphine)
-metoprolol (apo-metoprolol, betaloc)
BETA1 & 2 ADRENERGIC (nonselective) BLOCKING AGENTS
-nadolol (corgard)
-pindolol (visken)
-propranolol( inderal, novopranol)
-timolol (blocadren, betin, temserin)
1. Hold if BP & HR not within parameters prescribed by MD
2. Not to D/C meds abruptly…rebound HPN, tachycardia, angina
3. Early signs of hypoglycemia such as tachycardia & nervousness can be masked by these drugs…monitor blood sugar
4. Use with caution if with asthma or COPD because of bronchoconstriction
2. Calcium channel blockers
Action:
1. Decrease cardiac contractility by relaxing smooth muscle and the workload of the heart…thus decreasing need for O2
2. Promote vasodilation of coronary & peripheral vessels
 verapamil (Calan, Isoptin)
 nifedipine (Procardia)
 felodipine (Plendil)
 diltiazem (Cardizem)
 Amlodipine (Norvasc)
3. A/R: Bradycardia, Hypotension, Dizziness, Lightheadedness
1. Instruct client how to take HR & to inform MD if dizziness persists
3. CENTRALLY ACTING SYMPATHOLYTICS
a. Stimulate alpha receptors in medulla causing reduction in sympathetic action in heart; decreases rate to inhibit
vasoconstriction & reduce peripheral resistance.
b. clonidine (Catapres), methyldopa (Aldomet)
c. A/R: Na & H2O retention, edema & hypotension
1. Instruct client how to take HR & to inform MD if dizziness persists
4. PERIPHERALLY-ACTING ALPHA ADRENERGIC BLOCKERS
1. Decrease sympathetic vasoconstriction by reducing the effects of NE at the peripheral nerve endings,resulting to
vasodilation & decreased BP
2. prazoline (Minipress), phentolamine (Regitine)
3. A/R: orthostatic hypotension, Na & H2O retention, edema and weight gain
4. Client to rise slowly, decrease Na intake & monitor for fluid retention & edema
5. ACE INHIBITORS
1. ACE inhibitors produce vasodilation by inhibiting the formation of angiotensin II. This vasodilation reduces arterial
pressure, preload and afterload on the heart.
2. Benazepril (Lotensin), Captopril, Enalapril (Vasotec), Fosinopril, Lisinopril (Prinivil, Zestril), Moexipril, Perindopril,
Quinapril (Accupril)
Side Effects
1. Cough
2. Red, itchy skin or rash
3. Dizziness, lightheadedness or faintness upon rising
4. Salty or metallic taste or a decreased ability to taste
5. Physical symptoms
6. Swelling of your neck, face, and tongue
7. High potassium levels
8. Kidney failure.
1. Take vital signs especially blood pressure
2. Instruct client to take Capoten 20 minutes to 1 hour a.c.
3. Not to D/C meds abruptly because it causes rebound HPN
4. If dizziness persist, report to MD
5. Taste for food may be diminished during 1 st month of therapy
6. Antianginal
NITRATES
a. nitroglycerin (Nitrostat, Nitrolingual)
b. nitroglycerin ointment 2% (Nitrol, Transderm-Nitro)
c. Produce vasodilation & improved myocardial O2 consumption
d. C/I in client with severe hypotension
e. A/R: Headache, orthostatic hypotension, dizziness, weakness & faintness
SUBLINGUAL
a. Offer sips of H2O before taking the drug since dryness may inhibit absorption
b. Leave under tongue until fully absorbed, not swallowed
c. Do not take fluids after placing the drug, delay swallowing the saliva (hCl acid cancels the effects of the drugs)
d. Take 1 tab for pain following q5 minutes for a total of 3 doses. If pain not relieved in 15 minutes, seek MD help…..
may indicate MI
e. Stinging/burning feeling means tablet is fresh
f. Store in brown or amber color container to protect from lights
TOPICAL
1. Remove ointment from previous dose, rotate sites & avoid touching ointment
2. Squeeze ribbon into prescribed length on applicator paper
3. Sites: chest, back, abdomen, upper arm & anterior thigh
TRANSMUCOSAL- BUCCAL
1. Alternate the cheek to prevent mucositis
2. Do not take fluids after placing the drug, delay swallowing the saliva (hCl acid cancels the effects of the drugs)
TRANSDERMAL
1. Place in a non-hairy area
2. Remove patch after 12 hours to prevent drug tolerance
3. Remove before MRI
4. Do not operate microwave oven to prevent first degree burn
TRANSLIGUAL
1. Spray the drug within the tongue
2. Do not take fluid or swallow saliva after taking the drug
ORAL
1. Take with water
IV
1. Always use an IV infusion pump
2. Cover the IV bottle and tubing with aluminum foil to protect from light
3. Preferably use glass IV container
7. Antidysrhythmic
GROUP 1- generally inhibit the fast sodium channel in cardiac muscle resulting in an increased refractory period
a. Disopyramide phosphate (NORPACE)
Procainimide hcl (PROCAN)
Quinidine (QUINIDEX)
b. Lidocaine (XYLOCAINE)
c. Flecainide
GROUP 2
BETA BLOCKERS THAT DECREASE STIMULATION OF THE HEART
Beta 1 selective antagonists
1. cardiogenic blockers;block Beta1 cardiac receptors
2. atelonol (ternonim), acebutolol sectral, metoprolol (betaloc)
Beta 2 Selective
1. Nonseletive Beta Adrenergic
Beta1 & beta2 blockers blocking agents
2. nadolol (corgard), oxyprenelol (trasicor), pindolol (visken) propranolol (inderal) , timolol
GROUP 3
generally do not affect depolarization but work by prolonging cardiac repolarization
a. Anti-adrenergic; positive inotropic action
b. Bretylium, amiodarone hcl (cordarone)
GROUP 4
a. Calcium antagonist action= depression of heart & smooth muscle contraction, decreased automaticity, & decreased
conduction velocity
b. Verapamil, felodipine, amlodipine
Side Effects
1. Problems in liver, kidneys, thyroid or lungs
2. Tiredness.
3. Nausea
4. Shortness of breath
1. Assess your patient's apical pulse rate and rhythm before administering an antiarrhythmic.
2. Monitor his cardiac rate and rhythm continuously when therapy starts or any time the dosage is adjusted.
3. Check his vital signs frequently.
8. Digitalis glycosides
Digoxin (Lanoxin)
 Inhibit sodium-potassium pump
 positive inotropic action
 negative chronotropic action and domotropic
Indications:
1. Used for CHF
2. atrial tachycardia
3. atrial fibrillation & flutter
COMMON S/E- weakness, fatigue, vomiting, diarrhea, arrhythmia & PR < 60bts/min
DIGITALIS TOXICITY
1. loss of appetite
2. Nausea and vomiting
3. extreme fatigue
4. diarrhea, abdominal cramps
5. weakness of the arms & legs
6. psychiatric disturbances (nightmares, agitation, listlessness, or hallucination)
7. visual disturbances ( hazy, blurred vision, difficulty reading & green and yellow color, flickering lights, rainbows)
8. Dysrythmias (Bradycardia, PVC)
Nursing Intervention
1. Take APICAL PULSE 1 full minute; don’t give for Adult <60/min; child < 90 beats/min
2. monitor potassium level specially if under diuretics therapy
3. Increase K+ rich food: fresh & dried fruits, fruit juices, vegetables & potatoes
4. Monitor HR & hold if below 60 & above 100 (adults)
5. Antidote: digoxin immune FAB (Digibind)
6. Life threatening toxicity: ventricular tachycardia, fibrillation, severe sinus bradycardia
7. 80% DIGOXIN excreted by kidneys; half-life is 36-120H
8. 90% DIGITOXIN metabolized by liver; half-life is 120-210H
9. Adrenergic agonist
1. Dobutamine (Dobutrex)
a. Increases myocardial force & C.O. through beta receptors stimulation
b. Used in clients with CHF
c. Stimulates heart muscle and improves blood flow by helping the heart pump better.
d. Dobutamine is used short-term to treat cardiac decompensation due to weakened heart muscle.
Common side effects
 nausea, vomiting; fever, tingly feeling; headache; or leg cramps.
Toxic Effects (Notify MD right away)
1. shortness of breath (even with mild exertion), swelling, rapid weight gain;
2. chest pain, fast or pounding heartbeats;
3. a light-headed feeling, like you might pass out;
4. wheezing, chest tightness;
5. dangerously high blood pressure-severe headache, blurred vision, buzzing in your ears, anxiety, confusion, uneven
heartbeats, seizure; or signs of infection in your catheter--pain, swelling, warmth, redness, oozing, or skin changes
where the medicine is injected.
2. Dopamine (Intropin)
1. is indicated for the correction of hemodynamic imbalances present in the shock syndrome due to myocardial
infarction, trauma, endotoxic septicemia, open-heart surgery, renal failure, and chronic cardiac decompensation as in
congestive failure.
2. Increases BP & C.O. & increases renal outflow through its action on alpha & beta receptors
3. Treat mild renal failure due to decreased C.O.
Side Effects
1. Ventricular arrhythmia
2. Atrial fibrillation (at very high doses)
3. Ectopic beats
4. Fast heart rate
5. Chest pain (angina)
6. Palpitation
7. Cardiac conduction abnormalities
8. Widened QRS complex
9. Slow heart rate
10. Low blood pressure (hypotension)
11. High blood pressure (hypertension)
12. Vasoconstriction
13. Shortness of breath
14. Nausea and vomiting
15. Increase ocular pressure
16. Headache, dizziness
1. Monitor blood pressure, pulse, and peripheral pulses every 15 minutes.
2. Monitor hourly urine output. Cardiac monitor should be used on patients receiving dopamine infusion.
3. Epinephrine (adrenalin)
1. Cardiac stimulation during cardiac arrest, bronchodilation asthma & allergy, mydriasis
2. Promotes vasoconstriction when combined with local anesthetics to promote prolonged anesthetic action by
decreased blood flow to area
4. Isoproterenol (Isuprel)
 Stimulates beta receptors & used for cardiac stimulation and bronchodilation
5. norepinephrine (Levophed)
1. Stimulates heart in cardiac arrest
2. Vasoconstricts & increases BP during hypotension & shock
3. A/R: tachycardia, angina, restlessness
4. If extravasation occurs, infiltrate with normal saline & phentolamine (Regitine)
10. DIURETIC
a. 1st step for younger clients w/ tachycardia & marked lability of BP
b. initial dose is less than full Rx dose
c. Diuretics are used to promote the excretion of water and electrolytes by the kidneys.
d. Example: thiazide diuretics, loop diuretics,potassium-sparing diuretics
Thiazide diuretics- Hydrochorothiazide
a. Increases renal excretion of sodium, chloride, water, potassium, and calcium.
b. Indications: edema, HPN
c. Monitor signs of electrolyte imbalance especially hypokalemia
d. Frequentlt monitor weight and blood pressure
Loop diuretics- Furosemide (lasix)
a. Most potent diuretics available, producing the greatest volume of diuresis.
b. Common adverse effects:
 Electrolyte imbalance
 Orthostatic hypotension
 hyperurecemia
1. Give diuretics in the morning to ensure that major diuresis occurs before bedtime.
2. Give iv push slowly
3. Weigh the patient each morning immediately after voiding and before breakfast, with the same type of clothing and
using the same scale.
Potassium-sparing diuretics- Spironolactone(aldactone)
1. Urinary excretion of sodium, water, chloride and calcium ions. The excretion of potassium and hydrogen ions decreases.
2. Indications:
a. Edema
b. Diuretic-induced hypokalemia
c. Cirrhosis
d. CHF
e. HPN
1. Give diuretics in the morning. To prevent nocturia, administer diuretic before 6pm
2. Take safety precautions for all ambulatory patient until the response to diuretics is known
3. Keep urinal or commode readily available to the client
11. Anticoagulants/Antiplatelet
1. Heparin Na (Liquaemin Na)
1. Prevents thrombin from converting fibrinogen to fibrin
2. Prevents thromboembolism
3. Therapeutic dose does not dissolve clots, but prevents new thrombus formation
4. Blood levels:
a. normal APTT is 20-36 seconds;
b. maintain APTT is 1.5-2.5 times normal;
c. APTT therapy should be measured q 4-6H during initial therapy & then daily
Common side effects of Heparin are:
a. Easy bleeding and bruising
b. pain, redness, warmth, irritation, or skin changes where the medicine was injected
c. itching of your feet
d. bluish-colored skin.
Nursing consideration
1. Monitor clotting time; normal is 8-15 minutes; maintain clotting time 15-20 minutes
2. Observe for signs of bleeding
3. Inject SQ into the abdomen with 25-28g at 90 degrees angle; don’t aspirate or rub injection site
4. Antidote is protamine SO4
2. Warfarin Na (Coumadin)
1. Decreases prothrombin activity & prevents the use of vitamin K by the liver
2. Prolongs clotting time & monitor PT (prothrombin time)
3. Used mainly to prevent thromboembolitic conditions such as thrombophlebitis, pulmonary embolism, embolism caused
by heart valve damage, atrial fibrillation & MI
4. Given 2-3 months after an MI to prevent DVT
5. Average PT is 9.5 to 12.5 seconds & normal INR is 1.3 and below (2.0 to 3.0 therapeutic level if under Coumadin)
6. Goal is to raise the INR to 2 to 3
7. Observe for signs of bleeding
8. Antidote: Vitamin K (AquaMEPHYTON)
3. Clopidogrel (Plavix)
1. Is an inhibitor of platelet activation and aggregation through the irreversible binding of its active metabolite to the P2Y12
class of ADP receptors on platelets.
2. Used to treat patients with acute coronary syndrome, heart attack (myocardial infarction), peripheral vascular disease,
and ischemic strokes.
Side effects
1. Headaches or dizziness.
2. Nausea.
3. Diarrhea or constipation.
4. Indigestion (dyspepsia)
5. Stomach ache or abdominal pain.
6. Nosebleeds.
7. Increased bleeding or easy bruising.
1. Monitor patient for signs of thrombotic thrombocytopenic purpura (low platelet count, neuro symptoms, renal
dysfunction, fever).
2. Monitor for signs and symptoms of bleeding (urine, stool, hematoma, epistaxis, petechiae).
3. May cause elevation of serum liver enzymes–establish baseline enzymes and bilirubin levels.
4. Do not drink grapefruit juice while taking clopidogrel. Grapefruit juice may increase the effects of your medicine, and
make you bleed or bruise more easily.
4. Ticlopidine (Ticlid)
a. Is an oral drug that inhibits the ability of platelets to clump and form blood clots.
b. It prevents blood clots by binding to the P2Y12 receptor on platelets, preventing adenosine diphosphate (ADP) from
activating platelets.
c. Works by blocking platelets from sticking together and prevents them from forming harmful clots.
d. It helps keep blood flowing smoothly in the body.
Side effects
1. Diarrhea
2. Stomach upset or pain
3. Nausea
4. Vomiting
5. Dizziness
6. Ringing in your ears
7. Itching
8. Increased bleeding or easy bruising.
1. Instruct patient to immediately report signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or
black, tarry stools.
2. Remind patients to take medication as directed to reduce the risk of stroke even if they are asymptomatic.
12. THROMBOLYTIC
1. Activates plasminogen which generates plasmin
2. Thrombolytic therapy is the administration of drugs called lytics or “clot busters” to dissolve blood clots that have acutely
(suddenly) blocked your major arteries or veins and pose potentially serious or life-threatening implications.
3. Used 4-6 hrs after MI to restore blood flow, limit myocardial damage, preserve left ventricular function
4. The most commonly used drug for thrombolytic therapy is tissue plasminogen activator (tPA), Eminase (anistreplase)
Retavase (reteplase) Streptase (streptokinase, kabikinase)
5. C/I: active bleeding, history of thoracic, pelvic or abdominal surgery within the last 10 days
6. A/R: bleeding & allergy
7. Check APTT, PT, fibrinogen, platelet count
Side effects
1. Bruising or bleeding at the access site.
2. Damage to the blood vessel.
3. Migration of the blood clot to another part of vascular system.
4. Kidney damage in patients with diabetes or other pre-existing kidney disease.
Absolute Contraindications for Thrombolytic Treatment
a. Recent intracranial hemorrhage (ICH)
b. Structural cerebral vascular lesion.
c. Intracranial neoplasm.
d. Ischemic stroke within three months.
e. Possible aortic dissection.
f. Active bleeding or bleeding diathesis (excluding menses)
1. Perform routine care in a gentle manner to avoid bruising or injury.
2. Careful assessment of the patient for contraindications in the patient's medical history, assessment of potential allergic
and bleeding complications, and evaluation of the reperfusion markers.
3. Direct or indirect pressure may be needed to control the bleeding.
4. Monitor for bleeding, hypotension & tachycardia
5. Avoid injections; apply pressure to puncture site for 20-30 minutes
6. Use electric razors
7. Brush teeth gently
8. Antidote: aminocaproic acid (Amicar)
13. Antilipidemics
 Reduce serum level of cholesterol, triglycerides & low- density lipoprotein when diet alone is not enough
 Elevated levels of these will place client at high risk for CAD
 Normal Cholesterol
a. Less than 200 mg/dL
b. 200 and 239 mg/dL is considered borderline high
c. 240 mg/dL and above is considered high.
d. LDL cholesterol levels should be less than 100 mg/dL.
 Normal Triglyceride
a. Normal — Less than 150 mg/dL), or mmol/L
b. Borderline high — 150 to 199 mg/dL (1.8 to 2.2 mmol/L)
c. High — 200 to 499 mg/dL (2.3 to 5.6 mmol/L)
Statins include:
1. Atorvastatin (Lipitor)- Atorvastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by
slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of
the arteries and block blood flow to the heart, brain, and other parts of the body.
 Fluvastatin (Lescol)
 Lovastatin.
 Pitavastatin (Livalo)
 Pravastatin (Pravachol)
 Rosuvastatin calcium (Crestor)
 Simvastatin (Zocor)
2. BILE ACID SEQUESTRANTS - cholestyramine (Questran)
a. Mix powder thoroughly with juice & H2O
b. A/R: constipation & PUD
Side effects
1. Gastrointestinal symptoms such as diarrhea.
2. Cold symptoms such as a runny or stuffy nose.
3. Joint pain.
4. Insomnia.
5. Urinary tract infection.
6. Nausea.
7. Loss of appetite.
8. Indigestion symptoms such as stomach discomfort or pain.
Contraindications
1. Untreated decreased level of thyroid hormones.
2. Alcoholism.
3. Hemorrhage in the brain.
4. Liver failure.
5. Liver problems.
6. Decreased kidney function.
7. Condition with muscle tissue breakdown called rhabdomyolysis.
8. Recent operation.
1. Take this drug once a day, at about the same time each day, preferably in the evening
2. May be taken with food
3. Do not drink grapefruit juice while taking this drug.
4. Check serum liver enzymes
5. Eye exam annually for cataract
IV- Chemotherapeutic Drugs
1. Antimetabolites- (foster cancer cell death by interfering with cellular metabolic process.)
Methotrexate with leucovorin calcium – leucovorin calcium is a folic acid analog that interferes with mitotic process by
blocking the folic acid.
Related drugs: (5–fluorouracil or FU, purinethol, cytosar-U).
Nursing implication.
a. Leucovorin calcium is frequently given to prevent toxicity when high doses of methotrexate are given.
b. Instruct client to avoid self-medication with over the counter vitamins (folic acid and derivatives may alter drug
response).
2. Alkalyting agents- produce cytoxic effects by damaging DNA and interfering with cell replication. Most effective against
rapidly dividing cells.
Adverse effects:
a. Bone marrow depression
b. Alopecia
c. Gonadal suppression,
d. hemorrhagic and non-hemorrhagic cystitis,
e. N/V
Related drugs: (cytoxan, platinol, myeleran, leukeran).
NursingConsiderations:
a. Force fluids
b. Assess for signs and symptoms of unexplained bleeding.
c. Assess leukocytes count frequently.
d. Monitor CBC, uric acid, electrolytes, thrombocytosis and hepatic/renal function at least twice a week.
e. Instruct client to report hematuria or dysuria immediately
3. Plants or Vinca alkaloids -acts on cells undergoing mitosis, thus stopping cell division.
Adverse effects:
a. peripheral neuropathy
b. Cramps
c. Constipation
d. N/V
e. Stomatitis
f. alopecia,
g. leukopenia,
h. Photosensitivity.
1. Do not give IM or SC as tissue necrosis can occur.
2. Monitor bowel function
3. Frequent neurologic checks
4. Monitor CBC and platelets
5. Advise client to avoid overexposure to sun.
Related drugs: vincristine (oncovin), vinblastine (velban)
4. Antibiotic Antineoplastic agents- attaches to DNA and prevents DNA synthesis in vulnerable cells
Adverse effects:
1. N/V
2. Stomatitis
3. Hyperpigmentation of skin and nails
4. Alopecia.
Related drugs: Mitomycin, Plicamycin Blenoxane, Dactinomycin.
Nursing implication
1. Do not give SC or IM- local reaction and skin necrosis may occur.
2. Do not mix with other drugs
3. Monitor CBC, serum uric acid levels
4. Frequent mouth care
5. Cient needs sufficient fluids to prevent hyperuricemia
6. Assist client with information on wigs and head coverings before hair loss starts,
7. Wear gloves to prepare this drug
8. Wash skin with soap and water if powder or solution contacts skin, urine is red colored for 1-2 days after
administration, clears within 48 hours
5. Antineoplastic affecting hormonal balance -keeps cancer cells in resting phase/alter the endocrine environment to make
it less conducive for growth of the cancer cells.
Related drugs- Antiestrogenic
a. Nolvadex(tamoxifen)
b. Megace (Megestrol)
c. Cytadren (adrenal steroid inhibitor),
d. Lupron (gonadotropin-releasing hormone analogue)
Side Effects
 hot flashes, flushing,
 changes in menstrual periods
 nausea, abdominal cramps
 leg cramps, muscle pain
 bone pain
 cough
 swelling
 fatigue, headache
 hair thinning
 depression
 loss of sexual ability/interest (in men).
Summary of Effects of Chemotherapy
1. Antineoplastic drugs affects both normal and Cancer cells by disrupting cell function and division at various points
of cell cycle.
2. Most cancer drugs are most effective against cells that multiply rapidly – neoplasm, bone marrow cells, cells in the GI
tract, and cells in the skin or hair follicles. Adverse reaction to cancer drugs tend to occur in these organs.
3. Chemotherapeutic agents should not be used during pregnancy or lactation. Congenital defects may occur in the
fetus.
V- Antibiotics
a. The goal of antibiotic therapy is to reduce the population of invading bacteria to a size that the human immune response can
deal with.
b. Antibiotics are made in three ways:
 By living microorganisms
 By synthetic manufacture
 Through genetic engineering.
c. Antibiotics may either be bacteriostatic (preventing the growth of bacteria) or bactericidal (killing bacteria directly), although
several antibiotics are both bactericidal and bacteriostatic, depending on the concentration of the particular drug.
d. Major classes of antibiotics:
 Aminoglycosides
 Carbapenems
 Cephalosporins
 Fluoroquinolones,
 Penicillins
 Penicillinase-resistant drugs
 Sulfonamides
 Tetracyclines
 Disease-specific antimycobacterials-antitubercular and leprostatic drugs.
e. To determine which antibiotic will effectively interfere with the specific proteins or enzyme systems for treatment of a specific
infection, the causative organism must be identified through a culture.
f. Sensitivity testing is also done to determine the antibiotic to which that particular organism is most sensitive (e.g., which
antibiotic best kills or controls the bacteria).
g. In some cases, antibiotics are given in combination because they are synergistic, meaning their combined effect is greater than
their effect if they are given individually.
h. In some situations, antibiotics are used as a means of prophylaxis, or prevention of potential infection.
Classifications of Bacteria
Gram-positive
a. Bacteria are those whose cell wall retains a stain known as Gram’s stain or resists decolorization with alcohol during
culture and sensitivity testing.
b. Gram-positive bacteria are commonly associated with infections of the respiratory tract and soft tissues.
c. An example of a gram-positive bacterium is Streptococcus pneumoniae, a common cause of pneumonia.
Gram-negative
a. Bacteria are those whose cell walls lose a stain or are decolorized by alcohol.
b. These bacteria are frequently associated with infections of the genitourinary (GU) or GI tract.
c. An example of a gram-negative bacterium is Escherichia coli, a common cause ofcystitis.
Aerobic
a. Bacteria depend on oxygen for survival
b. Examples of obligately aerobic bacteria include and Mycobacterium tuberculosis and Nocardia asteroides.
c. With the exception of the yeasts, most fungi are obligate aerobes. Also, almost all algae are obligate aerobes .
Anaerobic
a. Bacteria (e.g., those bacteria associated with gangrene) do not use oxygen.
b. Two examples of obligate anaerobes are Clostridium botulinum and the bacteria which live near hydrothermal vents on
the deep-sea ocean floor.
Major classes of antibiotics:
1. AMINIGLYCOSIDES
a. Are a group of powerful antibiotics used to treat serious infections caused by gram-negative aerobic bacilli.
b. Aminoglycosides include amikacin (Amikin), gentamicin (Garamycin), kanamycin (Kantrex), neomycin (Mycifradin),
streptomycin (generic), and tobramycin (TOBI,Tobrex).
c. The aminoglycosides are bactericidal. They inhibit protein synthesis in susceptible strains of gram-negative bacteria.
d. These drugs are used to treat serious infections caused by susceptible strains of gram-negative bacteria, including
e. Pseudomonas aeruginosa, E. coli, Proteus species, the Klebsiella–Enterobacter–Serratia group, Citrobacter species,
and Staphylococcus species such as S. aureus.
f. The aminoglycosides are poorly absorbed from the GI tract but rapidly absorbed after intramuscular (IM) injection,
reaching peak levels within 1 hour.
g. Contraindications and Cautions: known allergy to any of the aminoglycosides; renal or hepatic disease, pre-existing ear
problem
Adverse Effects
1. (CNS) effects include ototoxicity, possibly leading to irreversible deafness; vestibular paralysis resulting from drug
effects on the auditory nerve; confusion; depression; disorientation; and numbness, tingling, and weakness related to
drug effects on other nerves.
2. Renal toxicity, which may progress to renal failure, is caused by direct drug toxicity in the glomerulus, meaning that the
drug molecules cause damage (e.g., obstruction) directly to the kidney.
3. Bone marrow depression may result from direct drug effects on the rapidly dividing cells in the bone marrow, leading, for
example, to immune suppression and resultant superinfections.
4. GI effects include nausea, vomiting, diarrhea , weight loss, stomatitis, and hepatic toxicity. These effects are a result of
direct GI irritation, loss of bacteria of the normal flora with resultant superinfections, and toxic effects in the mucous
membranes and liver as the drug is metabolized.
5. Cardiac effects can include palpitations, hypotension, and hypertension.
6. Hypersensitivity reactions include purpura, rash, urticaria, and exfoliative dermatitis.
1. Assess for possible contraindications or cautions: known allergy, history of renal or hepatic disease; preexisting hearing
loss; and current pregnancy or lactation status.
2. Perform a physical assessment to establish baseline data for assessing the effectiveness of the drug and the occurrence of
any adverse effects associated with drug therapy.
3. Perform culture and sensitivity tests at the site of infection.
4. Conduct orientation and reflex assessment, as well as auditory testing, to evaluate any CNS effects of the drug.
5. Assess vital signs: respiratory rate and adventitious sounds to monitor for signs of infection or hypersensitivity
reactions; temperature to assess for signs and symptoms of infection; blood pressure to monitor for cardiovascular
effects of the drug.
6. Perform renal and hepatic function tests to determine baseline function of these organs and, possibly, the need to adjust
dose.
7. Provide safety measures to protect the patient if CNS effects, such as confusion, disorientation, or numbness and
tingling, occur.
8. Provide small, frequent meals as tolerated; frequent mouth care; and ice chips or sugarless candy to suck if stomatitis
and sore mouth are problems to relieve discomfort.
9. Provide adequate fluids to replace fluid lost with diarrhea.
10. Ensure that patient is hydrated at all times during drug therapy to minimize renal toxicity from drug exposure.
11. Instruct the patient about the appropriate dosage regimen and possible adverse effects to enhance patient knowledge
about drug therapy and to promote compliance.
2. CARBAPENEMS
1. Are relatively new classes of broad-spectrum antibiotics effective against gram-positive and gram-negative bacteria.
2. The carbapenems are bactericidal. They inhibit cell membrane synthesis in susceptible bacteria, leading to cell death
3. These drugs are used to treat serious infections caused by susceptible strains of:
 Streptococcus pneumoniae
 Haemophilus influenzae
 Moraxella catarrhalis
 Staphylococcus aureus
 Streptococcus pyogenes
 Escherichia coli
 Peptostreptococcus
 Klebsiella pneumonia
 Clostridium clostridiiforme
 Eubacterium lentum
 Bacteroides fragilis
 Bacteroides distasonis,
 Bacteroides ovatus
 Bacteroides thetaiotamicron
 Bacteroides uniformis
 Proteus mirabilis
 Pseudomonas aeruginosa
 Acinetobacter baumannii
 Streptococcus agalactiae,
 Porphyromonas asaccharolytica
 Prevotella bivia
4. They are indicated for treating serious intra-abdominal, urinary tract, skin and skin structure, bone and joint, and
gynecological infections.
5. These drugs are rapidly absorbed if given IM and reach peak levels at the end of the infusion if given IV.
6. Doripenem is the newest drug of the class. It is given IV every 8 hours by a 1-hour IV infusion for 5 to 14 days.
7. Contraindications and Cautions: known allergy to any of the carbanems or beta-lactams; seizure disorders, meningitis,
lactation. Ertapenem is not recommended for use in patients younger than 18 years of age.
Adverse Effects
1. GI tract- Pseudomembranous colitis, Clostridium difficile diarrhea, and nausea and vomiting can lead to serious
dehydration and electrolyte imbalances.
2. CNS effects can include headache, dizziness, and altered mental state. Seizures have been reported when carbapenems
are combined with other drugs. Monitor patients to provide safety measures if any of these occur.
1. Check culture and sensitivity reports to ensure that this is the drug of choice for this patient.
2. Ensure that the patient receives the full course of the carbapenem as prescribed to increase effectiveness and decrease
the risk for the development of resistant strains of bacteria.
3. Monitor the site of infection and presenting signs and symptoms (e.g., fever, lethargy) throughout the course of
drug therapy. Failure of these signs and symptoms to resolve may indicate the need to reculture the site.
4. Monitor the patient regularly for signs of pseudomembranous colitis, severe diarrhea, or superinfections to effectively
arrange for discontinuation of drug or decreased dose, as appropriate, if any of these toxicities occurs.
5. Provide safety measures to protect the patient if CNS effects such as confusion, dizziness, or seizures, occur.
6. Provide small, frequent meals as tolerated to relieve GI discomfort. Also provide adequate fluids to replace fluid lost
with diarrhea, if appropriate.
9. Provide the following patient teaching:
 Take safety precautions, such as changing position slowly and avoiding driving and hazardous tasks , if CNS effects
occur.
 Try to drink a lot of fluids and to maintain nutrition (very important) even though nausea, vomiting, and diarrhea may
occur.
 Report difficulty breathing, severe headache, severe diarrhea, fever, and signs of infection.
3. CEPHALOSPORINS
a. The cephalosporins are both bactericidal and bacteriostatic, depending on the dose used and the specific drug involved.
b. In susceptible species, these agents basically interfere with the cell wall–building ability of bacteria when they divide; that
is, they prevent the bacteria from biosynthesizing the framework of their cell walls.
c. The bacteria with weakened cell walls swell and burst as a result of the osmotic pressure within the cell.
d. It is important to reserve cephalosporins for appropriate situations because cephalosporin-resistant bacteria are
appearing in increasing numbers.
e. The cephalosporins are primarily metabolized in the liver and excreted in the urine. These drugs cross the placenta and
enter breast milk.
Classifications of Cephalosporins
1. First-generation cephalosporins are largely effective against the same gram-positive bacteria that are affected by
penicillin G, as well as the gram-negative bacteria Proteus mirabilis, E. coli, and Klebsiella pneumoniae (use the letters
PEcK as a mnemonic device to remember which bacteria are susceptible to the first-generation cephalosporins). First-
generation drugs include cefadroxil (Duricef), cefazolin (Ancef, Zolicef), and cephalexin (Keflex, Biocef).
2. Second-generation cephalosporins are effective against the previously mentioned strains, as well as Haemophilus
influenzae, Enterobacter aerogenes, and Neisseria species (remember HENPeCK). Second-generation drugs are less
effective against gram-positive bacteria. These include cefaclor (Ceclor), cefoxitin (Mefoxin), cefprozil (Cefzil), and
cefuroxime (Ceftin, Zinacef).
3. Third-generation cephalosporins, which are effective against all of the previously mentioned strains, are relatively weak
against gram-positive bacteria but are more potent against the gram-negative bacilli, as well as against Serratia
marcescens (remember HENPeCKS). Third-generation drugs include cefdinir (Omnicef), cefoperazone (Cefobid),
cefotaxime (Claforan), cefpodoxime (Vantin), ceftazidime (Ceptaz, Tazicef), ceftibuten (Cedax), ceftizoxime (Cefizox), and
ceftriaxone (Rocephin).
4. Fourth-generation cephalosporins are in development. The first drug of this group, cefepime (Maxipime), is active
against gram-negative and gram-positive organisms, including cephalosporin-resistant staphylococci and P. aeruginosa.
Fourth-generation drugs also include cefditoren (Spectracef).
Contraindications and Cautions
1. Avoid the use of cephalosporins in patients with known allergies to cephalosporins or penicillins because cross-sensitivity
Is common.
2. Use with caution in patients with hepatic or renal impairment because these drugs are toxic to the kidneys and could
interfere with the metabolism and excretion of the drug.
3. Use with caution in pregnant or lactating patients because potential effects on the fetus and infant are not known; use
only if the benefits clearly outweigh the potential risk of toxicity to the fetus or infant.
Adverse Effects
1. GI tract and include nausea, vomiting, diarrhea, anorexia, abdominal pain, and flatulence. Pseudomembranous
colitis—a potentially dangerous disorder—has also been reported with some cephalosporins.
2. CNS symptoms include headache, dizziness, lethargy, and paresthesias.
3. Nephrotoxicity is also associated with the use of cephalosporins, most particularly in patients who have a predisposing
renal insufficiency.
4. Superinfection- because of the death of protective bacteria of the normal flora.
2. Ensure that the patient receives the full course of the carbapenem as prescribed to increase effectiveness and decrease
the risk for the development of resistant strains of bacteria.
3. Monitor the site of infection and presenting signs and symptoms (e.g., fever, lethargy) throughout the course of
drug therapy. Failure of these signs and symptoms to resolve may indicate the need to reculture the site.
4. Monitor the patient regularly for signs of pseudomembranous colitis, severe diarrhea, or superinfections to effectively
arrange for discontinuation of drug or decreased dose, as appropriate, if any of these toxicities occurs.
5. Provide safety measures to protect the patient if CNS effects such as confusion, dizziness, or seizures, occur.
6. Provide small, frequent meals as tolerated to relieve GI discomfort. Also provide adequate fluids to replace fluid lost
with diarrhea, if appropriate.
9. Provide the following patient teaching:
 Take safety precautions, such as changing position slowly and avoiding driving and hazardous tasks , if CNS effects
occur.
4. FLUOROQUINOLONES
a. Are a relatively new synthetic class of antibiotics with a broad spectrum of activity.
b. Fluoroquinolones interfere with the action of DNA enzymes necessary for the growth and reproduction of the bacteria.
c. The fluoroquinolones are indicated for treating infections caused by susceptible strains of gram-negative bacteria.
d. These infections frequently include urinary tract, respiratory tract, and skin infections.
e. In 2001, it was approved for prevention of anthrax infection in areas that might be exposed to germ warfare. It is also
effective against typhoid fever.
f. The fluoroquinolones are absorbed from the GI tract, metabolized in the liver, and excreted in the urine and feces. These
drugs are widely distributed in the body and cross the placenta and enter breast milk.
1. Fluoroquinolones are contraindicated in patients with known allergy to any fluoroquinolone and in pregnant or lactating
patients because potential effects on the fetus and infant are not known.
2. Use with caution in the presence of renal dysfunction , which could interfere with the metabolism and excretion of the
drug.
3. These drugs have been associated with lesions in developing cartilage and therefore are not recommended for use in
children younger than 18 years of age.
Adverse Effects
1. The most common are headache, dizziness, insomnia, and depression related to possible effects on the CNS
membranes.
2. GI effects include nausea, vomiting, diarrhea, and dry mouth, related to direct drug effect on the GI tract and possibly
to stimulation of the chemoreceptor trigger zone (CTZ) in the CNS.
3. Immunological effects include bone marrow depression, which may be related to drug effects on the cells of the bone
marrow that rapidly turn over.
4. Photosensitivity- avoid sun and ultraviolet light exposure and to use protective clothing and sunscreens.
1. Take safety precautions, including changing position slowly and avoiding driving and hazardous tasks, if CNS effects occur.
2. Try to drink a lot of fluids and to maintain nutrition (very important), although nausea, vomiting, and diarrhea may occur.
3. Avoid ultraviolet light and sun exposure, using protective clothing and sunscreens.
4. Report difficulty breathing, severe headache, severe diarrhea, severe skin rash, fainting spells, and heart
palpitations.
5. PENICILLINS AND PENICILLINASE RESISTANT ANTIBIOTICS
a. With the prolonged use of penicillin, more and more bacterial species have synthesized the enzyme penicillinase to
counteract the effects of penicillin.
b. Penicillin-resistant antibiotics include nafcillin and oxacillin.
c. The penicillins and penicillinase-resistant antibiotics produce bactericidal effects by interfering with the ability of
susceptible bacteria to build their cell walls when they are dividing.
d. The penicillins are indicated for the treatment of streptococcal infections, including pharyngitis, tonsillitis, scarlet fever,
and endocarditis; pneumococcal infections; staphylococcal infections; fusospirochetal infections; rat-bite fever;
diphtheria; anthrax; syphilis; and uncomplicated gonococcal infections.
e. They are sensitive to the gastric acid levels in the stomach and should be taken on an empty stomach to ensure
adequate absorption.
f. If penicillins and penicillinase-resistant antibiotics are taken concurrently with tetracyclines, a decrease in the
effectiveness of the penicillins results.
1. Use with caution in patients with hepatic or renal impairment because these drugs are toxic to the kidneys and could
interfere with the metabolism and excretion of the drug.
2. Use in patients who are pregnant and in lactating patients should be limited to situations in which the mother clearly
would benefit from the drug, because diarrhea and superinfections may occur in the infant.
Adverse Effects
1. GI tract- major adverse effects of penicillin therapy. Common adverse effects include nausea, vomiting, diarrhea,
abdominal pain, glossitis, stomatitis, gastritis, sore mouth, and furry tongue.
2. Hypersensitivity reactions may include rash, fever, wheezing , and, with repeated exposure, anaphylaxis that can
progress to anaphylactic shock and death.
1. Try to drink a lot of fluids and to maintain nutrition (very important) even though nausea, vomiting, and diarrhea may
occur.
2. Report difficulty breathing, severe headache, severe diarrhea, dizziness, weakness, mouth sores, and vaginal itching or
sores to a health care provider.
6. SULFONAMIDES
a. The sulfonamides, or sulfa drugs, are drugs that inhibit folic acid synthesis. Folic acid is necessary for the synthesis of
purines and pyrimidines, which are precursors of RNA and DNA. For cells to grow and reproduce, they require folic acid.
b. Sulfonamides include sulfadiazine (generic), sulfisoxazole (Gantrisin), sulfasalazine (Azulfidine), and cotrimoxazole
(Septra, Bactrim).
c. Effective against gram-negative and gram-positive bacteria such as Chlamydia trachomatis and Nocardia and some strains
of H. influenzae, E. coli, and P. mirabilis.
d. The sulfonamides are teratogenic; they are distributed into breast milk (see contraindications and cautions).
1. Contraindicated during pregnancy because the drugs can cause birth defects, as well as kernicterus ; and during lactation
because of a risk of kernicterus, diarrhea, and rash in the infant.
2. They should be used with caution in patients with renal disease or a history of kidney stones because of the possibility of
increased toxic effects of the drugs.
Adverse Effects
1. Renal effects - are related to the filtration of the drug in the glomerulus and include crystalluria, hematuria, and
proteinuria
2. CNS effects -include headache, dizziness, vertigo, ataxia, convulsions, and depression (possibly related to drug effects on
the nerves).
3. GI effects - such as nausea, vomiting, diarrhea, abdominal pain, anorexia, stomatitis, and hepatic injury.
4. Immunologic effect- Bone marrow depression may occur and is related to drug effects on the cells that turn over rapidly
in the bone marrow.
5. Dermatological effects include photosensitivity and rash related to direct effects on the dermal cells.
1. Administer oral drug on an empty stomach 1 hour before or 2 hours after meals with a full glass of water to promote
adequate absorption of the drug.
2. Avoid driving or operating dangerous machinery because dizziness, lethargy, and ataxia may occur.
3. Try to drink a lot of fluids and maintain nutrition (very important), even though nausea, vomiting, and diarrhea may
occur.
4. Report difficulty in breathing, rash, ringing in the ears, fever, sore throat, or blood in the urine.
7. TETRACYCLINES
a. Tetracyclines are indicated for treatment of infections caused by Rickettsiae, M. pneumoniae, Borrelia recurrentis,
H. influenzae, Haemophilus ducreyi, Pasteurella pestis, Pasteurella tularensis, Bartonella bacilliformis, Bacteroides
species, Vibrio comma, Vibrio fetus, Brucella species, E. coli, E. aerogenes, Shigella species, Acinetobacter calcoaceticus,
Klebsiella species, Diplococcus pneumoniae, and S. aureus.
b. Their absorption is affected by food, iron, calcium, and other drugs in the stomach.
c. Tetracyclines are concentrated in the liver and excreted unchanged in the urine.
d. Patients who take oral contraceptives should be advised to use an additional form of birth control while receiving the
tetracycline.
1. Contraindicated in patients during pregnancy and lactation because of effects on developing bones and teeth.
2. Tetracyclines should be used with caution in children younger than 8 years of age because they can potentially
damage developing bones and teeth.
3. Contraindicated in client with hepatic or renal dysfunction because they are concentrated in the bile and excreted in the
urine.
Adverse Effects
1. GI tract- major adverse effects- nausea, vomiting, diarrhea, abdominal pain, glossitis, and dysphagia. Fatal hepatotoxicity
related to the drug’s irritating effect on the liver has also been reported.
2. Skeletal effects involve damage to the teeth and bones. Because tetracyclines have an affinity
for teeth and bones, they accumulate there, weakening the structure and causing staining and pitting of teeth and
bones.
3. Hematological effects are less frequent, such as hemolytic anemia and bone marrow depression secondary to the
effects on bone marrow cells that turn over rapidly.
4. Hypersensitivity reactions reportedly range from urticaria to anaphylaxis and also include intracranial hypertension.
1. Try to drink a lot of fluids and maintain nutrition (very important) even though nausea, vomiting, and diarrhea may occur.
2. Use a barrier contraceptive method because oral contraceptives may not be effective while a tetracycline is being used.
3. Know that superinfections may occur. Appropriate treatment can be arranged through the health care provider.
4. Use sunscreens and protective clothing if sensitivity to the sun occurs.
5. Know when to report dangerous adverse effects, such as difficulty breathing, rash, itching, watery diarrhea, cramps, or
changes in color of urine or stool.
8. ANTIMYCOBACTERIALS
a. Mycobacteria—the group of bacteria that contain the pathogens that cause tuberculosis and leprosy.
b. The bacterium Mycobacterium tuberculosis causes tuberculosis, the leading cause of death from infectious disease in the
world.
c. Mycobacterium leprae causes leprosy, also known as Hansen disease, which is characterized by disfiguring skin lesions
and destructive effects on the respiratory tract.
d. Mycobacterium avium-intracellulare, which causes mycobacterium avium complex (MAC), is seen in patients with AIDS
or in other patients who are severely immunocompromised. Rifabutin (Mycobutin), which was developed as an
antituberculosis drug, is most effective against M. avium-intracellulare.
e. The antituberculosis drugs are always used in combination to affect the bacteria at various stages and to help to
decrease the emergence of resistant strains.
Antituberculosis Drugs
A. The first-line drugs for treating tuberculosis are isoniazid (Nydrazid), rifampin (Rifadin), pyrazinamide (generic),
ethambutol (Myambutol), streptomycin (generic), and rifapentine (Priftin). (RIPES)
B. The second-line drugs include ethionamide (Trecator-SC), capreomycin (Capastat), cycloserine (Seromycin), and rifabutin
(Mycobutin). kanamycin (Kantrex), other second-line drugs are aminoglycoside, and ciprofloxacin (Cipro), ofloxacin
(Floxin), and levofloxacin (Levaquin), which are fluoroquinolones
C. When rifampin and INH are used in combination, the possibility of toxic liver reactions increases.
Leprostatic Drugs
A. The antibiotic used to treat leprosy is dapsone (generic), which has been the mainstay of leprosy treatment for many
a. years, although resistant strains are emerging.
B. Dapsone inhibits folate synthesis in susceptible bacteria.
C. Dapsone is used to treat Pneumocystis carinii pneumonia in AIDS patients and for a variety of infections caused by
a. susceptible bacteria, as well as for brown recluse spider bites.
1. Contraindicated for patients with any known allergy to these agents.
2. Contraindicated with severe renal or hepatic failure, which could interfere with the metabolism or excretion of the drug.
3. Contraindicated for patients with severe CNS dysfunction, which could be exacerbated by the actions of the drug.
4. If an antituberculosis regimen is necessary during pregnancy, the combination of isoniazid, ethambutol, and rifampin is
considered the safest.
Adverse Effects
1. CNS effects, such as neuritis, dizziness, headache, malaise, drowsiness, and hallucinations, are often reported and are
related to direct effects of the drugs on neurons.
2. Hepatitis (symptoms include loss of appetite, nausea, vomiting, fatigue, malaise, and weakness),
3. GI tract, causing nausea, vomiting, anorexia, stomach upset, and abdominal pain. (very common)
4. Rifampin, rifabutin, and rifapentine cause discoloration of body fluids from urine to sweat and tears (harmless). Alert
patients that in many instances orange-tinged urine, sweat, and tears may stain clothing and permanently stain contact
lenses.
5. Hypersensitivity reactions.
6. Ethambutol caused lesions in the optic nerves and the optic chiasm, causing a diminished visual acuity in an often normal
fundus exam.(optic neuritis)
7. Pyrazinamide can precipitate gout flares by decreasing renal excretion of uric acid. (hyperurecemia)
1. Try to drink a lot of fluids to maintain nutrition (very important) even though nausea, vomiting, and diarrhea may occur.
2. Use barrier contraceptives and understand that oral contraceptives may not be effective if antimycobacterials are being
used.
3. Understand that normally some of these drugs impart an orange stain to body fluids. If this occurs, the fluids may stain
clothing and tears may stain contact lenses.
4. Report difficulty breathing, hallucinations, numbness and tingling(take vit B6), worsening of condition, fever and chills, or
changes in color of urine or stool.
9. KETOLIDES
1. Telithromycin (Ketek) is the only approved drug in the class.
2. Telithromycin is effective against S. pneumoniae, including certain multidrugresistant strains, H. influenzae, M.
catarrhalis, Chlamydophila pneumoniae, and Mycoplasma pneumoniae.
3. Telithromycin is available as an oral drug only.
4. The drug is widely distributed, may cross the placenta, and does pass into breast milk.
1. Contraindicated for patients with known congenital prolonged QT interval, bradycardia, or any proarrhythmic condition
such as hypokalemia to avoid potentially serious cardiac effects.
2. Contraindicated for patients with myasthenia gravis, which is a black box warning with this drug because of the risk of
potentially fatal respiratory failure.
Adverse Effects
1. GI tract: nausea, vomiting, taste alterations, and the potential for pseudomembranous colitis.
2. Superinfections are common, related to the loss of normal flora bacteria.
3. Serious hypersensitivity reactions, including anaphylaxis, have occurred.
10. LINCOSAMIDES
a. Clindamycin- Treatment of severe infections when penicillin or other, less toxic antibiotics cannot be used.
b. The lincosamides are rapidly absorbed from the GI tract or from IM injections and are metabolized in the liver and
excreted in the urine and feces.
1. Use lincosamides with caution in patients with hepatic or renal impairment, which could interfere with the metabolism
and excretion of the drug.
2. Use during pregnancy and lactation only if the benefit clearly outweighs the risk to the fetus or neonate. (These drugs
cross the placenta and enter breast milk)
Adverse Effects
1. Severe GI reactions, including fatal pseudomembranous colitis.
2. Some other toxic effects that limit usefulness are pain, skin infections, and bone marrow depression.
11. MACROLIDES
1. Macrolides include erythromycin (Ery-Tab, Eryc, and others), azithromycin (Zithromax), clarithromycin (Biaxin), and
dirithromycin (Dynabac).
2. The macrolides, which may be bactericidal or bacteriostatic, exert their effect by binding to the bacterial cell membrane
and changing protein function.
3. Treatment of infections in patients allergic to penicillin; drug of choice for treatment of Legionnaire’s disease,
infections caused by Corynebacterium diphtheriae, Ureaplasma species, syphilis, mycoplasma pneumonia, and
chlamydial infections.
4. Macrolides may be used as prophylaxis for endocarditis before dental procedures in patients with valvular heart disease
who are allergic to penicillin.
5. Azithromycin and clarithromycin are mainly excreted unchanged in the urine, making it necessary to monitor renal
function when patients are taking these drugs.
1. Contraindicated for viral, fungal, or mycobacterial infections of the eye , which could be exacerbated by loss of bacteria
of the normal flora.
2. Use with caution in patients with hepatic dysfunction, which could alter the metabolism of the drug, and in those with
renal disease, which could interfere with the excretion of some of the drug.
3. Use with caution in lactating women because macrolides secreted in breast milk can cause diarrhea and superinfections
in the infant and in pregnant women because of potential adverse effects on the developing fetus
2. Monitor hepatic and renal function test values before therapy begins to arrange to reduce dose as needed.
3. Ensure that the patient receives the full course of the medication as prescribed to eradicate the infection and to help
prevent the emergence of resistant strains.
4. Ensure that the patient swallows the tablet whole; it should not be cut, crushed or chewed, to ensure therapeutic
dose of the drug.
5. Food in the stomach decreases absorption of oral macrolides. Therefore, the antibiotic should be taken on an empty
stomach with a full, 8-oz glass of water 1 hour before or at least 2 to 3 hours after meals.

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PHAMACOLOGY

Frequently Abused Street Drugs and Their Potential Health Consequences

DRUG STREET NAMES CLASS HEALTH CONSEQUENCES

1. Amphetamines Uppers, whites, Stimulant Hypertension, tachycardia, insomnia,

3. Anabolic steroids Roids, muscle Steroid Hypertension, hyperlipidemia, acne,

ataxia, impaired thinking

7. Cocaine Snow, blow, crack Stimulant Tachycardia, hypertension,

9. Gamma- GHB, fantasy, Depressant Memory loss, hypotension,

11. Ketamine Super acid, special K Depressant Paralysis, loss of sensation,

13. MDMA Ecstasy, b-bombs, Hallucinogen Hallucinations, psychic change, loss of

14. Methamphetamine Crystal, glass, speed, Stimulant Hypertension, tachycardia,restlessness,

15. Methylphenidate Ritalin Stimulant Agitation, tachycardia, hypertension,

17. OxyContin Oxy, Oxycotton, Opioid Sedation, arrhythmias, shock,

19. Peyote Button, mesc Hallucinogen Acute psychosis, tremor, altered

20. Rohypnol Rophies Amnesiac Date rape drug, loss of memory,

FDA Pregnancy Categories

I- Drugs Affecting the Nervous System

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