Ncm 206 Pharmacology Finals

rei, keanna, dale (❛ ֊ ❛„)♡

● 3 types:
Topics:
I. Drugs affecting the Upper and Lower Respiratory
NARCOTIC Codeine, hydrocodone
Tracts
II. Drugs used to treat Obstructive Pulmonary Disease
III. Analgesics NON-NARCOTIC DM dextromethorphan
IV. Anti-inflammatory Drugs
V. Anti-Gout agents COMBINATION Guaifenesin (non-narcotic) &
VI. Anti-Tubercular Drugs codeine (narcotic)
VII. Drugs affecting the Gastrointestinal system
VIII. Other GI agents Other antitussives
IX. Anti Diabetic Drugs
● MOA: directly act on respiratory tract to suppress
coughing
DRUGS AFFECTING THE UPPER AND ● Example:
LOWER RESPIRATORY TRACTS ○ terpin hydrate (available in generic only) –
stimulates secretory cells in the respiratory tract
○ Drugs that keep airways open and allow gasses to move lining = more copious secretion = buffers the
efficiently irritation in the respiratory tract wall that stimulates
the cough
Definition of Drugs (Respiratory) ○ benzonatate (Tessalon) – acts as a local anesthetic
on the respiratory passages, lung, pleura, blocking
● ANTITUSSIVES
the effectiveness of stretch receptors that stimulate
○ Blocks cough reflex
cough reflex
● DECONGESTANTS ● CI: post-op; asthma, emphysema
○ Decrease blood flow to the upper respiratory tract
and decrease the overproduction of secretion CONTRAINDICATIONS
● ANTIHISTAMINES ● CLIENTS need to cough to maintain airway
○ Block the release or action of histamine ● careful with Asthma & Emphysema = cough
suppression = accumulation of secretions & loss of
● EXPECTORANTS
respiratory reserve
○ Increase productive cough to clear the airway
● With hypersensitivity, history of addiction to narcotics
● MUCOLYTICS
○ Liquefy respiratory secretion to aid the clearing of ADVERSE EFFECTS:
the airways ● Drying effect on mucous membrane
● Drowsiness
COUGH PREPARATIONS ● Respiratory depression (for opioid antitussives)
● Constipation (for opioid antitussives)
○ Drugs used due to the presence of cough
● Preparations containing codeine or similar analgesics
There are three classes of cough preparations: are not generally recommended in children & should
I. Antitussives be avoided altogether in those under 1 year of age
II. Expectorants
III. Mucolytics CONSIDERATIONS:

● Observe for excessive suppression of the cough

I. Antitussives reflex (inability to cough effectively when secretions
are present).
● Drugs that suppress cough
○ This is a potentially serious adverse effect because
● Some act within the CNS, some act peripherally
retained secretions may lead to lungs collapse,
● ACT on the COUGH-CONTROL CENTER in the
pneumonia, hypoxia, hypercarbia, and respiratory
medulla
failure
● Indicated in a dry, hacking, nonproductive cough
● Not to be taken longer than recommended
that interferes with rest & sleep
● Assess if cough persists
● Indicated when coughing can cause severe pain or
● Other measures – humidity, cool temperature, fluids,
can make the patient exhausted
use of lozenges, CPT
○ Ex. when px had chest or abdominal surgery
● (for liquid preparation) Do not give water after
administration of cough syrups (soothing effect on
RT)

1
 2
● To cough effectively, let the client sit upright, taking
several slow deep breaths
II. Expectorants
● Help patient expectorate
● Render the cough more productive by stimulating
the flow of respiratory tract secretions
● Guaifenesin is most commonly used
● Water is a good expectorant
● Available alone & as an ingredient in many
combination cough & cold remedies
Therapeutic action:
Productive Cough
Reduce adhesiveness & Easier movement of less
surface tension of fluids viscous secretions
(lessen ang pagkadikit
dikit ng fluids)
● Guaifenesin
○ 100-400 mg q4hpo
● Terpin hydrate – an iodine preparation
○ IODIDES – potassium/ sodium iodides
- Ex of iodides: (SSKI) - saturated solution of
Iodides
ADVERSE EFFECTS:
● GI SYMPTOMS: nausea, vomiting, anorexia
○ Action: small frequent meals
● Headache, dizziness, occasionally mild rash
○ Action: avoid driving or strenuous activities
● Avoid OVERDOSAGE- DRUG is an OTC drug
CONSIDERATIONS:
● Assess lung sounds, secretions (color, consistency,
amount), know the underlying cause, should not be
used for more than one week, seek consultation if
persistent
● Deep breathing and coughing exercises
● Increase oral fluid intake to liquify secretions
● Small frequent meal
● Avoid driving or operating hazardous machinery
● Avoid excessive use of OTC
III. Mucolytics
● Breakdown mucus
● Reacts directly with mucus to make it more watery.
This should help make the cough more productive
● Administered by nebulization or by direct instillation
● Dosage:
○ Acetylcysteine
■ 100 mg two to four times daily
■ 200 mg two to three times daily
■ 600 mg once daily
○ Bromhexine
■ 8-16 mg three times daily PO
○ Carbocisteine
■ 750 mg three times daily, then 1.5g daily in
divided doses
■ ambroxol, dornase alfa, erdosteine
Acetylcysteine (FLUIMUCIL)
● Usually available as an effervescent or can be
parenteral preparation
● AFFECTS the mucoproteins in the RT secretions by
splitting apart disulfide bonds that are responsible
for holding mucus materials together == decrease in
the tenacity and viscosity of the secretions
● NORMALIZES hepatic glutathione levels in liver and
binds with a hepatotoxic metabolite of
acetaminophen (manages acetaminophen toxicity)
INDICATIONS:
● WITH difficulty mobilizing and coughing up secretions
(COPD, cystic fibrosis, pneumonia, TB)
● Atelectasis (lung collapse) - because of thick mucus
● Diagnostic bronchoscopy - when there is need to
clear out the respiratory tract particularly the
bronchioles
● Post-op patients
● px with tracheostomies
CONTRAINDICATIONS:
● CASES of bronchospasm (like in asthma), peptic
ulcer and esophageal varices – increased secretions
could aggravate the problem
ADVERSE EFFECTS:
● GI upset: stomatitis
● rhinorrhea, bronchospasm
● Occasional rash
CONSIDERATIONS:
● SCREEN for the ff conditions:
○ History of allergy to the drug, presence of acute
bronchospasm, peptic ulcer & esophageal varices
● PA: skin color & lesions to check for proper blood
flow or perfusion; BP & PR - cardiac response of the
drug; Respiratory Rate & Breath Sounds– to
determine drug effectiveness
● AVOID combining with other drug in the nebulizer
because it may cause formation of crystals clogging
up the tubing
● WIPE off the residue from a face mask and face if
given via nebulizer with face mask
● Assess lung sounds and respiratory status to
determine effectivity of drug
● May be given through nebulization, IV, PO or instilled
in ET tube
● Avoid combining with other drugs in the nebulizer
● (for parenteral) Dilute with sterile water for injection
2
 3
● Patients receiving by face mask should have the
residue wiped off the face mask and off their face
with plain water
● Use cautiously in adults or individuals with severe
respiratory insufficiency
● Administer PO mix with iced liquid, about 17 doses
over a 4-day period of acetaminophen overdose
DECONGESTANTS
2 types:
I. NASAL – nasal spray/ drops or tablet (topically,
inhalation, orally)
II. SYSTEMIC (alpha-adrenergic agonists)
NASAL DECONGESTANTS
● Topical administration:
○ Response is rapid & intense
● Oral administration:
○ Response are delayed, moderate & prolonged
● Classified as Sympathomimetics are used to
reduce nasal congestion
○ Mimetics - can mimic the effect of stimulating the
SNS
● Reduces nasal congestion through: Stimulate
alpha1-adrenergic receptors on nasal blood
vessels, which causes vasoconstriction & hence
shrinkage of swollen membranes
○ Congestion within nasal lining is caused by
dilation of blood vessels
○ When blood vessels dilate it causes high
permeability of the capillary wall thus allowing
shifting of fluid into interstitial spaces thus
resulting to congestion
● MOA:
○ ADRENERGIC/ SYMPATHOMIMETICS
○ Stimulate alpha-adrenergic receptors
○ Constrict dilated BV in the nasal mucosa by
stimulating alpha-adrenergic nerve receptors in
vascular SM
↓ BLOOD FLOW = SHRINK SWOLLEN MEMBRANES
↑ MUCUS AND DRAINAGE
↓ DISCOMFORT
DECONGESTANTS
● Indicated for common colds, sinusitis, allergic rhinitis,
otitis media
● Usually adrenergic or sympathomimetics (local
vasoconstriction = decrease blood flow to the irritated
and dilated capillary on the mucous membranes
lining the nasal passages and sinus cavities
ADVERSE EFFECTS:
● FREQUENT or PROLONGED USE == REBOUND
CONGESTION (return of congestion) then leads to or
is known as:
○ Rhinitis medicamentosa – are bound congestion
that accompany frequent and prolonged use of
these drugs
TOPICAL NASAL DECONGESTANTS
● Sympathomimetic, immediate onset, less chance of
systemic effects, available in nasal spray
● Example:
○ ephedrine (Kondon’s nasal)
○ oxymetazoline (Aftrin)
○ phenylephrine (Coricidin)
○ tetrahydrozoline (Tyzine)
○ xylometazoline (Otrivin)
● CI:
○ lesion or erosion on the mucous membrane, HPN,
DM, thyroid disease, coronary disease
- Because the effect of drug causes
vasoconstriction
- lesion/erosion: slows the healing
● AE:
○ local stinging and burning sensation, rebound
congestion (longer than 3-5 days),
sympathomimetic effects (increased pulse, BP and
urinary retention)
● DI:
○ + cyclopropane/ halothane anesthesia = serious CV
effects
○ + other sympathomimetics = toxic effect
○ + other sympatholytics = non effective
TOPICAL NASAL STEROID DECONGESTANTS
● Another form of decongestants
● Steroid - anti inflammatory
● Directly block the effect of inflammation
● Takes several weeks to be really effective and are
more often used in cases of chronic rhinitis and post
nasal polyps removal
● Example:
○ beclomethasone, budesonide, dexamethasone,
flunisolide, fluticasone, triamcinolone
○ “sone”
● CI:
○ acute infections (candida albicans infections),
airborne infection (chicken pox, measles),
pulmonary tuberculosis
- Because the drug suppresses inflammation and
immune response
- CI to acute inf because secondary inf can set in
● AE:
○ same with topical + post nasal surgery or trauma =
monitor closely for it suppresses healing
3
4
■ CONSTRICTION of extravascular smooth
ORAL DECONGESTANTS 🠆 muscle lining the nasal cavity
● Shrink the nasal mucous membrane by stimulating ■ Prevents/reduces INCREASED
the alpha adrenergic receptors in the nasal mucous CAPILLARY PERMEABILITY
membrane ■ ANTI-CHOLINERGIC EFFECTS: dry
● Example: mouth; constipation; blurred vision,
urinary retention
● CI:
○ conditions exacerbated by sympathetic activity ● Example:
● AE: ○ First generation – have greater anti-cholinergic
○ rebound congestion, effect with resultant drowsiness; can lessen anxiety;
○ sympathetic effects (anxiety, tenseness, has sedative effect
restlessness, tremors, arrhythmias, sweating, ■ azatadine (Optimine)
pallor) ■ cetirizine (Reactine)
CONSIDERATIONS: ■ diphenhydramine (Benadryl)
■ promethazine (Phenergan)
● proper drug administration
○ Clear nasal passages before using ○ Second generation - indicated when the patient
○ Tilt the head back when applying the drops or spray need still to continue working or needs to be alert
○ Keep it tilted back for a few seconds after even after taking the drug
administration ■ desloratadine (Clarinex)
● Not to use more than 5 days (topical), not more than ■ fexofenadine (Allegra)
7 days (PO), not more than 3 weeks (topical ■ loratadine (Claritin)
steroids), seek medical care if s/sy persist ● CI:
● OTC, do not inadvertently combine drugs leading to ○ pregnancy & lactation, hepatic & renal impairment,
overdosage caution with cardiac arrhythmias (increase Q-T
● Provide safety measures intervals)
● Other measures to help relieve the discomfort of ● AE:
congestion: ○ drowsiness & sedation, drying of respiratory and GI
○ Humidity - better on a cold environment mucous membrane (skin eruption and itching),
○ More Fluids arrhythmias, dysuria, urinary hesitancy, GI upset,
○ Cool environment nausea, thickening of mucous, difficulty coughing,
○ Avoid smoke – filled areas tightening of the chest
● Peppermint may be used as nasal decongestant
ACTIONS:
● Administer on an empty stomach
ANTIHISTAMINES ● Response is individualized
● MOA: selectively block the effect of histamine – 1 ● Frequent mouth care (to lessen dry mouth since it
receptor sites = decrease allergic response may lead to anorexia & nausea)
● Can relieve itchy eyes, swelling, congestion, drippy ○ Sugarless candy
nose buy ○ lozenges
● Have anti-cholinergic and anti-pruritic effects ● Take at bed time or safety measures if taken during
○ Anti-cholinergic: blocks the action of the day
acetylcholine (neurotransmitter released by the ○ Do not drive
cholinergic receptors at synapses) thus it inhibits ○ Do not operate dangerous machinery
the PNS by selectively blocking the binding of ● Increase humidity
acetylecholine to its receptor in nerve cells ○ Place pans of water throughout the house
● Also called as H1 BLOCKER or H1 ANTAGONISTS ○ Avoid smoke filled area
● Compete with histamine for receptor sites thus ○ Increase oral fluid intake
preventing HISTAMINE RESPONSE ● Void before each dose - to prevent accidents
○ Because once histamine i released, histamine is ● Skin care
one of the inflammatory mediator and one of its ● Caution to avoid excessive dosage of other OTC
common effect is Vasodilation ● Avoid alcohol
● Do not affect RELEASE of HISTAMINE but BLOCK ADDITIONAL INFO
action of Histamine @ H1 Receptor Sites ● Cough into the fold of your arm to trap secretions

4
5

Chest Physiotherapy CONDITIONS UNDER COPD

● Can be done to help movement of secretion Pulmonary Emphysema (pink puffers)

● Increase production of secretions or thick, sticky
secretions ● The air sacs (alveoli) of the lungs are enlarged and
● With impaired removal of secretions damaged, which reduces the surface area for the
● Ineffective coughing exchange of oxygen and carbon dioxide.
○ Alveoli - actual site of exchange of gasses
Techniques: ● Primarily caused by smoking
● Postural drainage
○
uses gravity and various positions
● Percussion
○ involves clapping with cupped hands on the chest
wall
● Vibration
○ hand is pressed firmly over the appropriate
segment of the chest wall, and muscles of upper
arm and shoulder are tested (isometric contraction),
done with flattened, none cupped hands
Chronic Bronchitis
CONSIDERATIONS:
● Perform 3 hours AC or PC ● Chronic bronchitis is a condition when repeated lung
● Bronchodilators 20 minutes prior inflammation damages the lungs.
● Remove tight/constricting clothing ● Chronic inflammation in the lungs causes scarring of
● Each prescribed position for postural drainage = 3-5 the airways and excessive production of mucus
minutes that results in a chronic cough.
● Place towel over the area percussed (approx 3 mins ● Commonly called as “smoker’s” cough.
during inspiration and expiration) ● Cigarette smoking, or exposure to second-hand
● Vibrate each area during exhalations of 4-5 deep cigarette smoke is the primary cause of chronic
breaths bronchitis symptoms.
● POST: comfortable position, mouth care

DRUGS USED TO TREAT OBSTRUCTIVE

PULMONARY DISEASE

I. XANTHINES
II. SYMPATHOMIMETICS
III. ANTICHOLINERGICS Bronchiectasis
IV. INHALED STEROID
V. LEUKOTRIENE RECEPTOR ANTAGONISTS ● Chronic, irreversible dilation of the bronchi and
VI. MAST CELL STABILIZERS bronchioles
○ Bronchi and brocnhioles are passageways of air
Chronic Obstructive Pulmonary Disease (COPD) but it is irreversibly dilated and becomes dilated
for life
● Any process that limits airflow on expiration
● May be caused by the following:
● COPD – group of chronic lung diseases associated
○ Pulmonary infections and obstruction in the
with persistent or recurrent obstruction of airflow
bronchus;
● Irreversible condition
○ aspiration of foreign bodies or any material from
the respiratory system;
○ pressure from tumors, dilated blood vessels and
enlarged lymph nodes.
Asthma

● Inflammatory disorder that involves the

hyperresponsiveness characterized by
bronchospasm, wheezing, mucus secretions and
dyspnea
5
 6
● Often separated since it is reversible ■ If person stops smoking, lessen the dosage to
prevent drug toxicity
TYPES OF DRUGS NURSING CONSIDERATIONS:
● Caution if taken with coffee, cola, chocolate and tea
XANTHINES ○ Because drug contains caffeine
● Monitor blood level for toxicity
● AKA: Methylxanthine Derivatives ○ therapeutic level 10-20 ug/mL;
● PO, IV ○ first sign of toxicity = NAUSEA;
● MOA: also known as bronchodilators because they ○ late sign= TREMORS
have direct effect on the smooth muscles of the ● Instruct client as follows:
respiratory tract, both in the bronchi and in the blood ○ Be compliant with dosing, schedule and blood work
vessels ○ Do not crush or alter dosage form
● Directly affecting the mobilization of calcium within ○ Take with milk or food if with GI upset
the cell (stimulating prostaglandins resulting in ○ Avoid smoking
smooth muscle relaxation thus increasing the vital Note: monitor drug level every 3-6 months
capacity that has been impaired by bronchospasm or
air trapping SYMPATHOMIMETICS
● Inhibit release of slow-reacting substance of
anaphylaxis (SRSA) and histamine, decreasing ● MOA: mimic the effects of the SNS at therapeutic
bronchial swelling and narrowing level they are specifically beta 2 selective agonist
○ SRSA and histamine are common inflammatory (dilation of bronchi with increased rate and depth of
mediators respiration)
● They stimulate the SNS particularly the beta 2
Xanthine Derivatives
receptor resulting to dilation of bronchi with increased
● Theophylline is a bronchodilator which relaxes rate and depth of respiration
smooth muscle of the bronchi, it is used for reversible ● EXAMPLE:
airway obstruction ○ epinephrine (Adrenaline)
● It acts by inhibiting phosphodiesterase (an enzyme), ○ terbutaline sulfate (Brethine)
thereby increasing CYCLIC ADENOSINE ○ salbutamol (Ventolin)
MONOPHOSPHATE (cAMP), leading to ○ isoproterenol HCL (Isuprel)
bronchodilation ○ isoetharine HCL (Bronkosol)
○ metaproterenol sulfate (Alupent)
INHIBIT phosphodiesterase
🠋 Four Main Receptors
↑ cAMP ● Stimulating the sympathetic nervous system will
🠋 stimulate four receptors
Bronchodilation
● Alpha 1
● Example: ○ INCREASE FORCE OF CONTRACTION,
○ aminophylline vasoconstriction = HPN, mydriasis, decreased
○ caffeine salivary secretions
○ dyphylline ● Alpha 2
○ oxtriphylline ○ inhibits release of NOREPINEPHRINE = dilates
○ theophylline BV, decrease GI motility & tone
● USES: bronchial asthma (a reversible condition),
SYMPATHOMIMETICS - BETA 2 AGONISTS:
bronchospasm associated with COPD
● Beta 1
● CI:
○ INCREASE HR & force of contraction, increase
○ GI problems, coronary disease, respiratory
RENIN = HPN
dysfunction, renal/ hepatic disease, alcoholism,
hyperthyroidism ● Beta 2
○ dilates bronchioles, GI and uterine relaxation,
● AE:
increase blood sugar, increase blood flow in the
○ above therapeutic level: GI upset, irritability,
skeletal muscles
tachycardia, seizure, brain damage, death
■ Drug reaches toxic level ● CI:
○ HPN, dysrrythmias, cardiac disease,
● DI:
hyperthyroidism
○ + nicotine = increase metabolism in the liver
○ + smoking = dosage must be increased
6
 7
● AE: ● Beta 2 adrenergic + anticholinergic = albuterol +
○ anxiety, tremors, HA, tachycardia, restlessness, ipatropium bromide (combivent)
palpitations, rebound bronchospasm,
ANTICHOLINERGIC BRONCHODILATOR
hyperglycemia, insomia, dysrrythmias, urinary
retention ● ipratropium bromide (Atrovent) – less systemic effect
● DI: + theophylline = increase cardiac effect ● If given with albuterol sulfate (Combivent) = more
effective and longer duration of action
CONSIDERATIONS: ● AE: anticholinergic effects (dizziness, HA, fatigue,
● Assess respiratory, cardiac status & ABG (arterio nervousness, dry mouth, sore throat, palpitations,
blood gas) to determine the effectivity of gas and urinary retention
exchange
● Instruct how to use inhaler or respiratory apparatus at CONSIDERATIONS:
home ● Adequate hydration
● Administer with meal if with GI upset ● Void before each use - because of urinary retension
● Emphasize compliance with dosage and schedule which is caused by anticholinergic
(minimal amount needed for the shortest period ● Safety measures
necessary) ● Review use of inhaler with the patient (caution not to
● Drug of choice vary with each individual exceed 12 inhalations in 24 hours)
● For exercise induced asthma: take 30-60 minutes ● Small frequent meal & lozenges - to counter act
before exercising dryness

ANTICHOLINERGIC
● ANTICHOLINERGIC - can inhibit the effect of
parasympatholytic
● Drugs that affect the PARASYMPATHETHIC
NERVOUS SYSTEM (PNS) is called:
○ CHOLINERGIC – also known
parasympathomimetics mimics parasympathetic
neurotransmitters = ACETYLCHOLINE
■ MUSCARINIC receptors = stimulate SM and
slows HR
■ NICOTINIC receptors – affect the skeletal
system
● Antimuscarinic/ ANTICHOLINERGIC bronchodilators
○ Blocks the action of acetylcholine in bronchial
smooth muscle, this reduces intracellular cGMP, a
bronchoconstrictive substance
■ Cyclic guanosine monophosphate (cGMP)
○ Used for maintenance therapy
bronchoconstriction associated with chronic
bronchitis & emphysema
Ipratropium (Atrovent)
● Administered by AEROSOL
● ONSET 15 mins; PEAK 1-2 hrs; DURATION 3-4 hrs
● When used with beta agonist inhalant or with
glucocorticoid/ cromolynadminister it 5 minutes
before using ipatropium bromide
INHALED STEROIDS
● MOA: decrease inflammatory response in the airway
○ promotion of beta 2 adrenergic receptor activity
● EXAMPLE:
○ Inhaled: beclomethasone
○ Tablet: triamcinolone, dexamethasone, prednisone,
prednisolone, methylprednisolone
○ IV: dexamethasone, hydrocortisone
● CI: emergency, infection of respiratory system
● AE:
○ sore throat, hoarseness, coughing, dry mouth,
pharyngeal & laryngeal fungal infection
as NURSING ACTIONS:
● NOTE: Not to be used in emergency cases
● Rapidly absorbed but take 1-4 weeks to reach
effective level
● Do not administer to treat an acute asthma attack
or status asthmaticus
● Taper systemic steroid carefully
● Use decongestant drops before using the inhaled
steroids
● Rinse mouth after using inhaled steroid
● Monitor signs of respiratory infection
of
LEUKOTRIENE RECEPTOR ANTAGONIST
● MOA: blocks receptors for the production of
leukotrienes D4 and E4 (leukotriens are
components of SRSA or components of an
inflammatory mediator); blocks:
○ Neutrophil & eosinophil migration
○ Neutrophil & monocyte aggregation
○ Leukocyte adhesion
○ Increased capillary permeability
○ Smooth muscle contraction
7
 8
● Blockingthe receptor for leukotrienes blocks the effect ● Pain mediators will stimulate nerve endings to send
of inflammation an impulse to the brain. Pain sensation will be
● EXAMPLE: interpreted by the brain.
○ Zafirlukast (Accolate) (adults & children > 12) ○ There is a delay in realizing or pain interpretation
○ zileuton (Zyflo) because there is a need for the pain signal to be
○ montelukast (Singulair) (6 yrs old - 12) delivered to the brain and interpret it as pain
● CI: hepatic / renal impairment, pregnancy & lactation ● Release of pyrogens causing release of pain
● AE: HA, dizziness, myalgia, N/V, diarrhea, abdominal mediators like histamine that has an inflammatory
pain, increase liver enzyme response
○ Inflammation in injured area
NURSING ACTIONS:
○ Reddened and swelling in area of injury
● Oral granule packets should not be opened until
○ Histamines increases capillary permeability
ready for use (max 15 min)
○ Blood will go sa interstitial spaces then causing
● If + aspirin hypersensitivity / NSAIDS =
swelling
bronchoconstriction
■ When there is injury, the initial reaction is that
● Recommended for prevention
there will be momentary vasoconstriction then
● Chewable tablets = swallowing whole altered
will be immediately followed by vasodilation
absorption
increasing the blood flow.
● Take during evening = maximum effectiveness
■ Increase of blood flow will cause release of
inflammatory mediators
MAST CELL STABILIZER Another explanation
● MOA: prevents the release of inflammatory and ● Injury/tissue damage causes release of arachidonic
bronchoconstricting substances when mast cells acid stimulating the release of prostaglandin (another
are stimulated to release these substances because inflammatory mediator) with the help of
of irritation or presence of antigen cyclooxygenase 1 and cyclooxygenase 2 (are
enzymes that help in the production of prostaglandin)
● EXAMPLE:
○ Cyclooxygenase 1- could block platelet aggregation
○ cromolyn – inhaled , may not reach its peak effect
because once magdikit dikit it can cause clot
for 1 week, pt > 2 yo, maintenance
○ Cyclooxygenase 2 - also help in the production of
○ nedocromil – prevent bronchospasm and acute
prostaglandin that are responsible for pain and
asthma attack; pt > 12 yo, more effective
inflammation
● CI: hypersensitivity, pregnancy, lactation
● Aspirin is given to those with CVA or stroke as it is an
● AE:
antiplatelet aggravate and prevent blood clot
○ occasional (cromolyn) = swollen eyes, HA, nausea,
dry mucosa
○ (nedocromil)= HA, dizziness, fatigue, tearing, GI
upset, cough
NURSING ACTIONS:
● Avoidance of dry and smoky environment, humidifier,
fluids
● Do not abruptly discontinue
● PO administer before meal and at bed time
● Safety precautions

ANALGESICS
● Analgesic are drug for pain; pain killers
● Relieves pain
What Causes Pain?

● There should be a cause; usually by an injury

● Injury can be because prick , slice/cut accidents, and NON- OPIOID/ NON NARCOTIC
blunt incidents = causes tissue damage and pain
● USES: mild to moderate pain of the skeletal muscle
sensation
& joint (including pain on injury site)
● Release of pain mediators

8
9
○ NOT addictive & are less potent than narcotic
analgesics, most analgesics have an antipyretic
effect
○ effective for dull, throbbing pain of HA,
dysmenorrhea, pain from inflammation, minor
abrasions, muscular pain and mild-moderate
arthritis
● MOA: act on peripheral nervous system at the pain
receptor sites by inhibiting prostaglandin
synthesis
● EG: aspirin, acetaminophen, ibuprofen, naproxen
ASPIRIN
● a salicylate, oldest non narcotic analgesic drug
● MOA: inhibit synthesis of prostaglandin (inhibits Cox
1 and 2)
○ Primary effect: analgesic (antipyretic, anti
inflammatory, anti platelet)
● CI: children < 12 y.o. (Reye’s syndrome - condition
where it can cause liver damage)
● DI:
○ + warfarin, heparin, thrombolytics = increase
bleeding
○ ibuprofen + insulin / OHA = hypoglycemia
● SE: gastric irritation (take antacid to lessen irritation
but should not be taken together; 1-2 hours apart),
excess bleeding might occur during the first two days
of menstruation
NURSING RESPONSIBILITIES:
● take with food; with glass of water
● monitor platelet, bleeding time Prothrombine time
● d/c aspirin 7 days prior to surgery
ACETAMINOPHEN (Tylenol, Tempra)
● MOA: weakly inhibits prostaglandin synthesis which
decreases pain sensation & heat
○ is safe, effective analgesic & antipyretic drug used
for muscular aches & fever caused by viral
infections
○ causes no / little gastric distress; does not interfere
with platelet aggregation, no anti inflammatory
effect
● Same with paracetamol, differs in what country
● CI: severe hepatic / renal disease, alcoholism,
hypersensitivity
● DI:
○ + caffeine = increase effect
○ + oral contraceptives, anticholinergics = decrease
effects
● SE/AE: hepatotoxicity, early symptoms of hepatic
damage (N/V, diarrhea & abdominal pain)
NURSING CONSIDERATIONS:
● liver enzymes, self medication should not be used for
more than 10 days for adults & 5 days for children
● keep out of children’s reach
● acetylcysteine (antidote)
○
A mucolytic drug that liquifies respiratory
secretions.
○ It also enhances the activity of glutathione levels in
the liver, which traps metabolites of toxic drugs.
Thus, preventing toxicity.
● no alcohol
NARCOTIC ANALGESICS / OPIOID
ANALGESICS
● MOA: binds to opiate receptors in the CNS,
reduces stimuli from sensory nerve end, pain
threshold is increased
○ Prevent transmission of pain stimulus so there will
be no translation/interpretation of pain
● Addictive
● USES:
○ moderate – severe pain
○ suppresses pain muscles
○ suppresses respiratory & coughing by acting on
the respiratory & cough centers in the medulla of
the brainstem
○ most opioids with exception to meperidine
(Demerol) have an antitussive property
■ Antitussive: suppresses coughing
● have 2 isomers (levo & dextro)
○ levo - isomers: produce an analgesic effect only,
can cause physical dependence
○ dextro – isomers: do not cause physical
dependence
○ both levo & dextro: posses an antitussive
response
● CI: with respiratory dysfunction, head injuries,
increase ICP, hepatic & renal disease, alcoholism
● DI:
○ + alcohol, sedatives- hypnotics & other CNS
depressants = increase CNS depression
○ may increase ALT / AST
● SE:
○ N/V (particularly in ambulating patients)
○ constipation (less in demerol) (increase OFI)
○ moderate decrease of blood pressure,
○ orthostatic hypotension (high dose)
○ antitussive effect (except demerol)
○ CNS: drowsiness, dizziness, confusion, sedation,
○ PUPIL CONSTRICTION – pinpoint pupil – sign of
toxicity
● Examples:
○ Codeine: not as potent as morphine
○ Morphine sulfate: potent analgesics (can depress
respiration), effective against MI, dyspnea –
pulmonary edema, pre op meds
○ meperidine (Demerol): shorter duration of action
than morphine, potency varies according to dosage
■ most commonly used narcotic for alleviating post
op pain, no antitussive property
9
10
■ preferred in pregnancy (does not diminish
ANTI-INFLAMMATORY DRUGS
uterine contractions & causes less neonatal
respiratory depression)
■ not prescribed for long term use NONSTEROIDAL ANTI-INFLAMMATORY
● withdrawal symptoms called ABSTINENCE ● Salicylate (aspirin)
SYNDROME occurs 24 – 48 hours after last narcotic ● Non-salicylates
dose (irritability, diaphoresis, restlessness, muscle
twitching, tachycardia, hypertension) Non-salicylates

NURSING CONSIDERATIONS: ● parachlorobenzoic acid

● VS do not give if RR is < 10/ min, BP < 90/70 mmHg ○ indomethacin (Indocin)
● Administer before pain reaches its peak to maximize ○ sulindac
the effectiveness ○ tolmetin
● Should not taken with alcohol or sedative - hypnotics ● pyrazolone derivatives
● Check urine output & bowel elimination ○ phenylbutazone
● Assist patient in ambulation ● Propionic acid derivatives
● Have naloxone (Narcan) ready as antidote ○ ibuprofen (Alaxan, Advil)
● Do not abruptly withdraw medicine ○ naproxen (Flanax)
● Assess for toxicity due to overdosage ○ ketoprofen (Orudis)
● Instruct about deep breathing & coughing exercises
● Fenamates
especially in patients with altered pulmonary function
○ meclofenamate (Meclofen)
NARCOTIC ADDICTED PERSON ○ mefenamic acid (ponstan)
● Oxicam
● METHADONE: a narcotic but causes less
○ meloxicam (Mobic)
dependency that the narcotics it is replacing
● Helps the narcotic addicted person to withdraw from ● Phenylacetic acid derivatives
narcotics without causing withdrawal symptoms ○ diclofenac Na (Voltaren, Cataflam)
● Given OD (longer half life) ○ ketorolac (Toradol)
● Selective COX2 inhibitors
NARCOTIC ANTAGONIST
○ celecoxib
● Antidotes for overdoses of narcotic analgesics
● MOA: inhibits the enzyme cyclooxygenase (COX)
● Have higher affinity to the opiate receptor site than
that is needed for the biosynthesis of prostaglandin
the narcotic being taken
● Blocks the receptor & displaces any narcotic that ● USES:
would be at the receptor, thus inhibiting the narcotic ○ reduce inflammatory process
action ○ relieve pain
● Reverses respiratory and CNS depression ○ reduce fever
● EG: naloxone (Narcan) - IM, IV ● CI: severe renal and hepatic disease. GI bleed,
● NSG: VS q5, q15, q30 until stable hypersensitivity
○ aspirin: tinnitus, vertigo, bronchospasm esp
NARCOTIC AGONIST - ANTAGONIST asthmatic
● a narcotic antagonist is added to a narcotic agonist ● SE: GI irritation, anorexia, N/V, dizziness, confusion,
to decrease narcotic abuse hearing loss, heartburn, drowsiness
● EG: ● AE: GI bleed, tinnitus, life threatening (BM
○ pentazocine (Talwin) depression, hepatotoxicity, bronchospasm, cardiac
○ Butorphanol tartrate (Stadol) dysrhythmias)
○ Nalbuphine HCL (Nubain) ● DI: + anticoagulants, anti platelets, thrombolytics =
○ Buprenorphine (Buprenex) increase GI bleed
NURSING RESPONSIBILITIES:
● Take with meals
● Check hypersensitivity
● Monitor bleeding
● Avoid alcohol
● Inform client that it may take several weeks to
experience the desired effect of some NSAIDs

10
 11
● Direct client to inform the dentist or surgeon before a ● probenecid (Benemid)
procedure when taking ibuprofen or other NSAIDs for ○ Uricosuric agent
a continuous period ○ Increase rate of uric acid excretion by inhibiting its
reabsorption
STEROIDAL ANTI-INFLAMMATORY ○ Should not be used in acute attack (but as a
maintenance)
● CORTICOSTEROIDS ● sulfinpyrazone (Anturane)
● MOA: suppress the intensity of the inflammatory ○ More potent than probenecid
process; can control inflammation by suppressing or
● allopurinol (Zyloprim)
preventing many of the components of inflammatory
○ Uric acid inhibitor, not anti inflammatory
process at the injured site
○ Inhibits final step of uric acid biosynthesis
● USES: Myocarditis, pericarditis, arthritis, tendonitis, ○ Useful for client who do not respond well to
bursitis, ulcerative colitis, dermatitis uricosurics
● Eg: ● USES:
○ cortisone acetate (Corstitan) ○ control acute inflammation of the attack
○ hydrocortisone (Cortisol) ○ Increase excretion of uric acid
○ prednisone (Deltasone) ○ Decrease production of uric acid
○ fluticasone (Flixotide) ○ Gouty arthritis
○ dexamethasone (Decadrone) ○ Control uric acid production with antineoplastic drug
○ betamethasone (Celestone) therapy
○ budesonide (Budecort)
● SE: kidney stones, N/V, diarrhea, HA, flushed skin &
● Major side effects: rash, metallic taste, drowsiness
○ Buffalo hump - accumulation of fat on the back of
● AE: BMD
the neck
○ Moon face - rounded, puffy face NURSING RESPONSIBILITIES:
○ Immunosuppressant effect - inability of the ● Fluid intake (at least 2L/day)
immune system to respond to antigenic stimulation ● Alkaline urine: Milk, Fruits except cranberries,
○ Growth retardation plums, prunes, Most vegetables, Small amount of
○ Mood swing beef
○ Acne ○ Acidic urine promote stone formations
○ Truncal obesity ● Compliance, low purine foods: (high) beer, wine,
○ Sterility shellfish, legumes, gravy, organ meat, salmon,
○ Cardiac dysrhythmias – tachycardia most common sardines
○ Inhibited CHON synthesis ● CBC
○ Hypokalemia, hypocalcemia, hyperglycemia, ● Acetaminophen instead of ASA “Acetyl Salicylic
hypernatremia, hypertension Acid” or Aspirin (elevate uric acid)
● Avoid large doses of Vit C
NURSING CONSIDERATIONS:
● Take with food
● Usually recommended for short term use
● Taper off slowly to prevent adrenal insufficiency
● High CHON, potassium, calcium, low sodium intake ANTI-TUBERCULAR DRUGS
(to prevent water retention)
● Daily weight, report weight gain > 5 lbs
● Check CBC. Strengthen immune system
TUBERCULOSIS
● Take with food ● Caused by ACID-FAST BACILLUS
● Avoid vaccines without APs approval ● Mycobacterium tuberculosis (causative agent);
transmitted through droplets dispersed in the AIR
ANTI-GOUT AGENTS through coughing/sneezing;
● Have an outer coat of MYCOLIC acid that protects
● Drugs to address high uric acid them from many disinfections allows them to survive
Common Drugs ○ Mycolic acid - gives protection to bacilli from being
destroyed or killed by disinfectants.
● colchicine (Novovolchine)
Mycobacterium tuberculosis
○ Anti inflammatory
○ Inhibits migration of leukocytes at inflamed site ● Acid-fast aerobic rod
○ Does not inhibit uric acid, does not promote uric ○ Aerobic microorganism - needs oxygen to survive
acid excretion ● Slender rod-shaped bacteria

11
 12
● Grows slowly ○ Doubtful or probable - zone diameter 5-10mm
● Sensitive to heat and UV light ○ Positive - 10mm or more
○ Despite the heat or temperature in the Philippines,
MANAGEMENT:
there are still a lot of TB cases.
● Has an outer waxy capsule that makes them more ● Simultaneous administration of 3 or more drugs
resistant to destruction (multi-drug therapy)
● MODE OF TRANSMISSION: airborne droplet; ○ increases the therapeutic effects of medication and
coughing, sneezing, talking decreases the development of resistant bacteria
● Course of treatment: average 6-12 months
RISK FACTORS
Note: Pathophysiology of TB
● Close contact with someone who has active TB
● Immunocompromised status
● Substance use
● Preexisting medical condition
○ also have other conditions/disorders
● Malnourishment
● Living in crowded places

CLINICAL MANIFESTATIONS

● Low grade fever

● Cough
● Night sweats
● Fatigue
● Weight loss
● Hemoptysis ● Whenever you inhale the droplet nuclei, this can pass
○ when bacilli has already ulcerated to lung tissue down to bronchial tuba and lodge to respiratory
bronchioles. Eventually, macrophages will be able to
eat up the bacilli or surround the bacilli leading to the
development of singe-gray white granulomatous
lesions (containing the macrophages with eaten-up
bacilli). This is called the Ghon’s Focus. These
lesions will become soft as more fluid gets into them.
The central portion will become soft, and cheesy, and
○ Cavitary or cavitation - when tubercle bacilli has will undergo caseous necrosis. Tubercule bacilli, free
invaded lung tissue or inside macrophages drain along lymph channels.
Thus, leading to caseous granuloma. Eventually, this
CLINICAL MANIFESTATIONS can further erode extensively (erode blood vessels
(DIAGNOSTIC TESTS) and tissue), and whenever pt coughs = hemoptysis.
● As it erodes deeper, it can form an air-filled cavity,
● Mantoux test, PPD (Tuberculin Skin Test)
cavitary, and spread to other organs and the blood
● Chest X-Ray
circulatory, resulting in miliary tuberculosis.
● Sputum Exam (collect sputum specimens for AFB, 3
consecutive AM specimen)
○ Most definitive test
1st Line Drugs (RIPES)
○ Test for the presence of acid-fast bacillus ● RIPE - Orally
● S - Parenteral; IM
TUBERCULIN SKIN TEST; PPD/MANTOUX TEST ● Cavitation - holes on the lung tissues
● Uses Purified Protein Derivative - taken from dead
1st Line Drugs Mechanism of Side Effects
tb bacteria then injected to skin Action
● Intradermal test done to detect tuberculosis infection;
does not differentiate active from dormant infections Rifampicin ● Alters DNA & Orange colored
○ The test will only tell if you are exposed to the bacilli RNA activity in urine/body fluids;
or cannot differentiate it whether you are having an the bacterium hepatotoxic (can
active or dormant infection. damage the liver)
(bacteriostatic)
● 0.1ml solution containing 0.5 tuberculin units of PPD ● Best taken on
● Results: read within 48-72 hours empty stomach
○ Negative-zone diameter ＜5mm
12
13
● For MDRs
● Protect from
● Para-aminosalicylic acid, kanamycin, cycloserine,
light (since it is
capreomycin
photosensitive)

Isoniazid ● Inhibits cell wall Peripheral Drug Combination:

or INH MYRIN-P = Etham + Rifam + INH + PZA
synthesis neuropathy
COMBIPAK = Rifam + INH + PZA
(bactericidal) ● Manifested by (can be for children since no EMB)
and peeling and RAMBUTOL = Rifam + Etham
● Blocks numbness on
pyridoxine (B6) fingertips, lips Note: Tb patients take multiple drugs to prevent
which is used for or toes development of resistant strain to the anti tb drugs. This
intracellular ● PYRIDOXINE makes the drug more effective
enzyme 10-50 mg also Consideration / Responsibility:
production; and prescribed to
good vitamin for avoid ● Determine history, exposure, PPD tuberculin test &
nerve functions peripheral rxn, CXR, and any allergies
● Take before neuropathy ● Medical history - CI = severe hepatic diseases; check
meals ● Can result to liver enzyme values, bilirubin, BUN, S. crea
neuritis ● Evaluate S/S of peripheral neuropathy
● Assess hearing changes - Ototoxicity (adverse
Pyrazinamide ● Both; rapidly Hepatotoxic, effect to streptomycin)
or PZA bacteriostatic & ototoxic ● INH - 1hr ac or 2 hrs pc - FOOD decreases
slowly Photosensitivity absorption rate
hyperuricemia ● Give pyridoxine (Vit B6) prevent peripheral
bactericidal
(high uric acid in
● NAVDA, GI neuropathy
blood)
upset - take w/ ● EYE exam (INH & Ethambutol) - visual disturbances
food ● Not to take with antacids - decreases absorption
● Protect from ● Avoid alcohol - increased risk of hepatotoxicity;
light ● Avoid direct sunlight & decreased risk of
photosensitivity
Ethambutol ● Inhibits cellular Nephrotoxicity ● RIFAMPICIN - urine, feces, saliva, sputum, sweat,
or EMB metabolism (kidney damage)/ tears – harmless red-orange color;
(bacteriostatic) visual ● Contact lens - may be permanently stained
disturbances =
● Not to be given ● Take lots of fluids
(optic neuritis -
to children 6 affects RED & ● Use barrier contraceptives – OCP may not be
yrs/< (can’t GREEN effective
reliably monitor discrimination) or ● Take drugs as prescribed
vision) color blindness
● Taken 6 months due to prolonged Interventions for the undesirable effects of INH
to 1 year use
LUNGS
● Liver enzymes - must be monitored
Streptomycin ● First drug to Ototoxicity -
Sulfate ● Use cautiously with renal dysfunction
treat TB tinnitus & hearing
● No alcohol
“aminoglycoside” impairment
● Because ● Give pyridoxine
(highly toxic aminoglycoside ● Should take on empty stomach/screen vision
drug) is known to
● Available in damage CN 8
parenteral (only or vestibular
nerve
parenteral); IM
● Can only be Drugs affecting the
given to TB with GASTROINTESTINAL SYSTEM
cases of
cavitation ● Used to treat peptic ulcer disease and gastric
hyperacidity

2nd Line Drugs GI DRUGS:

I. Antacids
● When 1st line drugs are not effective II. Histamine 2 Receptor Antagonist

13
14
III. Anticholinergic agents Anticholinergic Agents
IV. Proto Pump Inhibitor
V. Cryoprotective ● Acetylcholine is the chief neurotransmitter of the
VI. Prostaglandin Analogue parasympathetic nervous system, the part of the
autonomic nervous system (a branch of the
Histamine 2 Receptor Antagonists peripheral nervous system) that contracts smooth
muscles, dilates blood vessels, increases bodily
● MOA: block the H2 receptors of the parietal cells secretions, and slows heart rate.
of the stomach, thus reducing gastric acid secretion ○ Epinephrine for sympathetic nervous system
and concentration ● AKA: anti-spasmodics
○ Histamine is a chemical responsible for stimulating ○ It lessens the contraction of the smooth muscles of
the parietal cells of the stomach to produce the GI system and relieves spasm
hydrochloric acid ● MOA: decreases acetylcholine by blocking the
● USES: treatment ulcer, prevention of stress ulcer, cholinergic receptors
hyperacidity, patients on prolonged NPO/ pre ○ reduces gastric acid secretion, decreases smooth
operative, GI bleed muscle motility and delays gastric emptying time
● Examples: ○ stimulate gastric secretions = ulcerations
○ cimetidine (Tagamet) ● Example:
○ ranitidine (Zantac) ○
Atropine sulfate, belladonna alkaloids, hyoscyamine
○ famotidine (Pepcid) sulfate
○ nizatidine (Axid) ● USES:
● DI: ○ adjunct therapy for PUD (peptic ulcer disease)
○ + digoxin / anticoagulants = increases their action ○ spasms and cramping associated with irritable
○ + antacid = decrease effectiveness bowel syndrome
● SE: ● SE:
○ HA, confusion, nausea, diarrhea, abdominal pain, ○ tachycardia, urinary retention, dry mouth, HA,
anemia, constipation, severe bradycardia (IV constipation
administration)
RESPONSIBILITIES:
● Cimetidine Induced Gynecomastia (for men) /
● Monitor bowel elimination
Galactorrhea (for women)
● Take before meals
○ One common side effect; reversible; when drug is
● Give antacids 2 hours after anticholinergic
being discontinued, gynecomastia and galactorrhea
can also be eliminated
○ Cimetidine can inhibit or have an effect on Proton Pump Inhibitor (PPI)
producing hyperprolactin or hyperprolactinemia, ● MOA: suppresses the final step of gastric acid
increasing the prolactin level in the blood among production by inhibiting hydrogen - potassium
men, which can lead to gynecomastia. For women, ATPase enzyme.
it can lead to galactorrhea, which is the production ○ inhibit up to 90% than H2 blockers
of milk despite not being pregnant.
● Example:
INTERVENTIONS: ○ omeprazole (Losec)
● Administer before meals ○ pantoprazole (Pantoloc)
○ Meals can lessen the effect of the drug ○ esomeprazole (Nexium)
● Reduced doses of drug are needed by older adults ○ lanzoprazole (Prevacid)
● Administer IV drug in 20-100 mL solution ● USES:
● Do not administer at the same time with antacids, ○ short term treatment of erosive esophagitis
give an hour before or 2 hours after ○ omeprazole – long term treatment of duodenal ulcer
● Avoid smoking because it hampers the effectiveness ○ treatment of H. pylori, active benign gastric ulcers
of the drug ● INTERACTIONS:
● Drug-induced impotence and gynecomastia – ○ may increase concentration of oral anticoagulants,
reversible diazepam, phenytoin if with omeprazole
● Relaxation technique
● SE:
○ Stress can increase hydrochloric acid production
○ headache, abdominal discomfort, dizziness,
● Eat foods rich in Vit B12 to prevent deficiency as a
flatulence, diarrhea
result of drug therapy
NURSING INTERVENTIONS:
● Take before meals
14
 15
● Regular medical check-up

Cryoprotective
● AKA: Pepsin inhibitor / Mucosal Protective Drug
● MOA: forms a barrier/coating at the ulcer site
● Example:
○ sucralfate (Iselpin)
○ rebamipide (Mucosta)
● SE: constipation (not systemically absorb)
● DI: may impede absorption of warfarin, phenytoin,
theophylline
INTERVENTIONS:
● Take before meals; as prescribed (4-8 weeks)
● Take one hour apart from antacid
● Digoxin: administer sucralfate at least 2 hours apart

Prostaglandin Analogue
● MOA: decrease vagal activity
○ inhibits gastric acid secretion & protects the mucosa OTHER GASTROINTESTINAL AGENTS
○ promotes secretion of sodium bicarbonate and
cytoprotection mucus OTHER GI DRUGS:
■ Lessen the production of acid and creates a I. Anti-flatulents
II. Anti-emetics
protection by producing cytoprotection mucus III. Emetics
● USE: PUD IV. Laxatives/Cathartics
● Example: misoprostol (Cytotec) V. Anti-diarrheals
VI. GI stimulants
● SE: diarrhea, abdominal pain

NURSING RESPONSIBILITIES: ANTI-FLATULENTS

● Special consideration: Drug must not be given to any
women pt complaining of hyperacidity, who can be ● MOA: aids in breaking up gas bubbles trapped in
possibly pregnant. the intestines; increases gastric emptying
○ Misoprostol can increase uterine contraction, which ● USES: post operative patients, children with colic
can somehow cause abortion ● Example:
● Take with food ○ simethicone (Kremil-S, Simeco)
● No alcohol, NSAIDs, aspirin, smoking ○ domperidone (Motilium)
○ can cause uterine contractions ● SE:
○ constipation, LBM (domperidone), dry mouth,
abdominal cramps

NURSING INTERVENTIONS:
● Increase oral fluid intake
● Manage constipation: high fiber (bran, grain, fruits),
ambulation
● Auscultate bowel sounds
● Avoid gas forming foods (apples, broccoli, cabbage,
coconuts, egg plant, milk, radish, onions)
● Manage diarrhea

ANTI-EMETICS
● MOA: used to control vomiting
○ Vomiting center in the cerebral cortex
1. phenothiazines

15
 16
● Decrease the response to chemoreceptor trigger ● MOA: irritates the stomach and stimulates the CTZ
zone (CTZ) by inhibiting the dopaminergic receptors and vomiting center in the medulla
○ chlorpromazine (Thorazine) ● USES: overdose; accidental poisoning
○ prochlorperazine maleate (Compazine) ● Example: ipecac syrup, apomorphine HCL
○ promethazine
● SE:
2. anti-histamines ○ toxicity, CNS depression (decrease RR and BP),
may be abused by bulimic patients, nausea,
● Block the action of acetylcholine in the brain to
diarrhea, GI upset
decrease nausea and vomiting
○ diphenhydramine (Dramamine) NURSING INTERVENTIONS:
○ cyclizine HCL (Marezine) ● Have ipecac at home in case of accidental
○ meclizine HCL (Bonamine) poisoning, note expiration date
○ hydroxyzine pamoate (Vistaril) ● Never administer to comatose or semi-comatose
○ diphenhydramine HCL (Benadryl) patients or accidentally ingest caustic substances
○ promethazine (Phenergan) (ammonia, chlorine bleach, toilet cleaners or battery
acid)
3. Anti-cholinergics
● Can be very messy and may be difficult for a child to
● Prevent motion sickness by decreasing the GI digest
motility and secretions ● Administer 10 mL of ipecac followed by a glass of
○ scopolamine (Triptone) water in children < 1 y.o.
○ 15 mL for children > 1 y.o.
4. cannabinoids ○ 15-30 mL followed by several glasses of water for
adults
● Active ingredients of marijuana
● May repeat ipecac dose in 30 mins if the first dose
○ dronabinol
does not produce emesis
○ nabilone
● Never give with or after activated charcoal. If needed,
5. Others give before the activated charcoal, activated
charcoal is given via lavage if emetics are ineffective
● Increases gastric emptying
● Monitor VS especially RR because apomorphine can
○ metoclopramide HCL (Plasil)
cause respiratory depression and hypotension
○ trimethobenzamide HCL (Tigan)
● USES: severe nausea, vomiting, before & after LAXATIVES / CATHARTICS
chemotherapy, motion sickness
● SE/AE: ● To eliminate fecal matter
○ anticholinergic effects ● Laxatives: promote soft stools
○ drowsiness (anti histamines) ● Cathartics: promote soft watery stool with some
○ orthostatic hypotension cramping
○ extrapyramidal findings (phenothiazines):
parkinson’s disease symptoms – tremors, muscle Groups
rigidity, bradykinesia
○ Hypersensitivity, photosensitivity 1. Osmotic laxatives

● Pull water into the colon and increases water in the

feces to increase bulk which stimulates peristalsis
NURSING INTERVENTIONS: ○ Hyperosmolar salts
● Motion sickness: take 30 mins - 1 hour before the ○ Saline products (composed of sodium or
activity that causes nausea magnesium)
● Caution the patient about sedative effects, implement ○ cephulac (Lactulose)
safety measures ○ Glycerin
● Give vistaril via Z-track route/ deep IM ○ Sodium biphosphate
○ Solution is trapped into the deep muscle 2. Contact laxatives/ stimulants/ irritants
● Avoid alcohol
● Avoid use in pregnant women during 1st trimester ● Increase peristalsis by irritating the nerve endings
● Increase OFI to prevent dehydration in the intestinal mucosa
○ senna (Senokot)
○ Bisacodyl (Dulcolax)
EMETICS
○ Castor oil

16
17
3. Bulk forming
● Natural fibrous substance that promotes large, soft
stools by absorbing water into the intestine,
increasing fecal bulk and peristalsis; nonabsorbable
agents
○ psyllium (Metamucil)
4. Emollients/ stool softeners
● Lubricants to prevent constipation, decrease
straining during defecation = lower surface tension
and promotes water accumulation in the intestine and
stool
○ docusate sodium (Colace)
5. Lubricants
● Lessen irritation to hemorrhoids, cause lipid
pneumonia if accidentally aspirated
○ Mineral oil
● SE: dehydration, electrolyte imbalance
(hypokalemia), abdominal cramps
NURSING INTERVENTIONS:
● Monitor for misuse of these drugs, can be a habit
forming, short-term use (tone of bowel)
● Take drug within one hour of any other drug
● Monitor serum electrolytes
● Assess bowel elimination pattern: discontinue if
diarrhea persists, rectal bleeding, cramping
● Do not give if obstruction is suspected (abdominal
pain with fever, nausea and vomiting)
● Teach exercise and high fiber diet to promote
elimination
● Clients who should avoid straining may benefit from a
lubricant laxative
● Mineral oil enemas work well without causing severe
strain in clients who had a recent heart attack and
fecal impaction
● Mineral oil enemas also work well if saline is
contraindicated
● Bulk forming laxatives which come in flavored and
sugar free forms would be mixed in 8-10 oz of water
or juice and drink immediately followed by a full glass
of water.
● Take on an empty stomach.
ANTI-DIARRHEALS
● USES: short-term diarrhea, irritable bowel syndrome,
overdose
Groups
1. adsorbents
● Removes toxins by binding with them and forms a
coating over the mucosa
○ bismuth subsalicylate (Pepto-Bismol)
○ Activated charcoal
○ Kaolin
○ pectin
2. opiates
● Decrease intestinal motility
○ paregoric (camphorated opium tincture)
○ codeine
○ diphenoxylate HCL + atropine sulfate (Lomotil)
○ loperamide (Imodium)
3. Anticholinergic
● Alcohol + kaolin + pectin + paregoric = parapectolin
● Scopolamine hydrobromide (Donnagel)
● SE: constipation; dizziness; OPIATES = abuse
potential, urinary retention, dry mouth, flushing
NURSING INTERVENTIONS:
● Know how to administer properly.
● Encourage clear liquids, avoid fried foods or milk
products
○ Can aggravate diarrhea
● Instruct: relieve symptoms, not cure the disease
● Notify physician if diarrhea persists longer than 48
hours or if abdominal pain occurs
● Assess elimination, dehydration
● Activated charcoal is a powder that must be mixed
with water during administration
● Monitor VS (opiates causes CNS depression)
GASTROINTESTINAL STIMULANTS
● MOA: stimulates motility of the upper GI tract and
increase the rate of gastric emptying without
stimulating gastric, biliary or pancreatic secretions
,
● USES: gastroesophageal reflux, treat urinary
retention & abdominal distention
● Example:
○ bethanecol chloride (Urecholine)
○ metoclopramide (Plasil)
○ domperidone (motilium)
● CI: Mechanical obstruction, perforation, GI
hemorrhage
● SE/AE:
○ Restlessness, drowsiness, dizziness, insomnia, HA,
N/V, salivation, decrease CR, BP, increase lung
secretion & LBM
NURSING INTERVENTIONS:
● Administer 30 minutes before meal and at bedtime
● Monitor pulse, BP when large doses are taken
because of the risk of hypotension
● Monitor I & O
ANTI DIABETIC DRUGS
17
 18
● DIABETES - a metabolic disorder and caused by a ○ Too much glucose may result to:
problem in pancreas a. Polyphagia - excessive hunger; cells are starved
● PANCREAS - responsible in regulating blood because glucose stays in the blood and is not
glucose and release of glucagon utilized
b. Polydipsia - excessive thirst
Regulation of Blood Glucose c. Polyuria - frequent or excessive urine elimination;
too much glucose in blood attracts water
● Low blood glucose → pancreas → Glucagon Insulin
released by Alpha cells of pancreas → liver ● MOA: primarily acts in the liver, muscle and adipose
releases glucose into blood → achieve normal blood by attaching to the receptors on cellular membranes
glucose levels facilitating the passage of glucose, potassium and
● High blood glucose → pancreas → Insulin magnesium
● PC: B
released by Beta cells of pancreas → muscle and
● Derived from: Animal/ human
fat cells take in glucose from blood → achieve
○ Pork (one different amino acid)
normal blood glucose levels ○ Beef (four different amino acids)
● Normal Glucose Level - 80 - 100 ● Route: SQ, IV, IM
PANCREAS
Type Onset Peak Duration
● Tiny clusters of cells called “Islets of Langerhans”
RAPID Acting: Lispro 5 min 0.5-1 2-4 hrs
● 3 types of ISLETS CELLS (Humalog)** hr
a. Alpha cells - Glucagon - hormone that increases
blood glucose level SHORT Acting: Regular 0.5-1 2-4 hrs 6-8 hrs
b. Beta cells - Insulin - hormone that decreases Insulin; Humulin R** hr
glucose level
INTERMEDIATE Acting: 1-2 hrs 6-12 18-24 hrs
c. Delta cells - Somatostatin - inhibits insulin; NPH (neutral protamine hrs
glucagon; growth hormone; TSH release hagedorn); Humulin N;
Lente insulin
INSULIN LONG Acting: Ultralente 5-8 hrs 14-20 30-35 hrs
hrs
● May not be produced by the pancreas, resulting to
Type I DM or there is sufficient production of insulin COMBINATIONS:
in the pancreas ● Humulin 70/30 (70% 0.5 hr 4-8 hrs 22-24 hrs
NPH & 30% Regular)
● Functions:
● Humalog 75/25 (75% 0.5-6 20-24 hrs
○ Transports and metabolizes glucose for energy lispro protamine & 15 min hrs
○ Stimulates storage of glucose in the liver and 25% lispro)
muscles (glycogen)
○ Signals the liver to stop the release of glucose
● S/E & A/E:
○ Enhances storage of dietary fat in adipose tissue
1. Hypoglycemic or insulin shock
○ Accelerates transports of amino acids into cells
○ Somogyi effect (rebound hyperglycemia)
TYPES OF DIABETES MELLITUS ■ Hypoglycemic conditions (2-4am) followed by
hyperglycemia
● TYPE I ■ d/t stimulates the release of hormones (cortisol,
○ Pancreas unable to produce insulin thus resulting to glucagons, and epinephrine) to increase blood
more glucose that will be circulating in the blood or glucose lipolysis, gluconeogenesis,
what we call “hyperglycemia” glycogenolysis
■ Insulin produced by the pancreas is responsible ○ Dawn phenomenon - requires increase insulin
for lowering the glucose level dose in early morning hours
● TYPE II ■ d/t increase plasma glucose concentration
○ There is still a production of insulin from the because of increase cortisol and growth
pancreas, however, it may not be sufficient to lower hormone secretion
down the glucose ■ MX: lightheadedness, nervousness, tremors,
○ HYPERGLYCEMIA - end or common effect of excess perspiration, cold clammy skin,
insufficient or absence of insulin, wherein glucose is tachycardia, slurred speech, memory lapses,
not being absorbed or utilized by the cells thus confusion, seizure, blood glucose <60 mg/dL
increasing glucose in the blood resulting in poly 2. Ketoacidosis (hyperglycemic reaction)
manifestation. ○ Inadequate amount of insulin
18
19
○ Sugar cannot be metabolized, uses fatty acids
for energy
○ MX: extreme thirst, fruity breathe, kussmaul
breathing, rapid pulse, dry mucous membrane,
poor skin turgor, blood glucose >250 mg/dL
STORING INSULIN
● Avoid exposure to extreme temperature (should not
be frozen or kept in direct sunlight or a hot car)
● Before injection should be at room temperature (less
irritating to tissue)
● Unopened vials are refrigerated until needed
● Once insulin has been opened:
○ At room temperature for one month
○ In the refrigerator for 3 months (lose their strength
otherwise)
● Pre-filled syringes should be stored in a refrigerator
and should be used within 1-2 weeks
INSULIN PUMP
● Dosage instructions are entered into the pump’s
small computer and the appropriate amount of insulin
is then injected into the body in a calculated,
controlled manner
● Insulin is delivered from the device through a plastic
tube with a metal or plastic needle placed subQ
INSULIN JET INJECTORS
● Needle less
● Delivered directly through the skin into the fatty tissue
● Delivered under high pressure (stinging, pain,
burning and bruising may occur)
units in the insulin syringe, the usual concentration is
U 100 (100 units/mL)
● Before use, roll not shake (to avoid bubbles) the
insulin bottle to ensure that the insulin and the
ingredients are mixed well otherwise an inaccurate
dose will be drawn
● Pre-filled syringes should be kept flat or with needle
in an upright position to avoid clogging of the needle
● Inject air into the insulin bottle (a vacuum makes it
difficult to draw up insulin)
● It is recommended to draw up regular insulin (short
acting) first because regular insulin may be mixed
with other insulin
● Insulin zinc suspensions may be mixed only with
each other and regular, not with other types
● Administer a mixed dose of insulin within 5-10
minutes of preparation; after this time the regular
insulin bind with the NPH insulin and its action is
reduced
● Aspiration is not generally recommended with self
injection insulin
● Administer insulin at a 45-90 degree angle
● Regular insulin is the only type of insulin which can
be administered IV
ORAL ANTIDIABETIC DRUGS
● AKA: Oral hypoglycemic drugs/agents (OHA)
● Indication: DM type 2
I. Sulfonylureas
II. Non-sulfonylureas
III. Meglitinides
IV. Incretin Modifiers

INSULIN INJECTION SITES

A. SULFONYLUREAS
● Main area of injection: abdomen, arms (posterior
● Stimulates pancreatic beta cells to secrete more
surface), thigh (anterior surface) and hips
insulin; increases the insulin receptors; increasing the
● Insulin injected in the abdomen may be absorbed
ability of the cells to bind insulin for glucose
more rapidly than the other sites
metabolism
● Systemic rotation within one anatomical area is
recommended to prevent lipodystrophy ● A.1 First Generation
○ Lipoatrophy - depression under the skin surface; ○ Short-acting: Tolbutamide (Orinase)
animal insulin ○ Intermediate-acting:
○ Lipohypertrophy - a raised lump of knot on the skin ■ Acetohexamide (Dymelor),
surface ■ Tolazamide (Tolinase)
● Do not use the same site more than once in a 2-3 ○ Long-acting: Chlorpropamide (Diabinese)
week period ● A.2 Second Generation
● Injections should be 1.5 inches apart within the ○ Glimepiride (Amaryl)
anatomical area ○ Glipizide (Glucotrol)
● Heat, massage, and exercise of the injected area can
increase absorption rates = hypoglycemia B. NON-SULFONYLUREAS
● Injection into the scar tissue may delay absorption
● B.1 Biguanides - decrease hepatic production of
ADMINISTERING INSULIN glucose from stored glycogen.
○ Not promote the breakdown of glycogen into
● To prevent dosage errors, be certain that there is glucose in the liver
concentration noted on the vial with the calibration of ○ Eg. Metformin
19
 20
● B. 2 Alpha-Glucosidase Inhibitor - inhibit the
digestive enzyme in the small intestine responsible
for the release of glucose from complex CHO in the
diet
○ Eg. acarbose; miglitol

C. MEGLITINIDES
● Stimulate beta cells to release insulin
○ Eg. repaglinide; nateglinide

D. INCRETIN MODIFIER
● Increase level of incretin hormones = increase
insulin secretion, decrease glucagon secretion
● Promotes beta cells to increase insulin secretion and
alpha cells to decrease glucagon secretion

TYPE I TYPE II
- best managed by the - managed by the
administration of administration of oral
insulin SQ or IV for hypoglycemic agents
the regular type of
insulin.

20