DRUGS AFFECTING

RESPIRATORY
BRONCHODILATORS
MOA
üsympathomimetic (b-receptor
agonist) bronchodilators, dilate
airways.
üxanthine bronchodilators,
stimulate CNS for respiration.
INDICATIONS
üBronchospasm
üAsthma
üBronchitis
üCOPD
ADVERSE EFFECTS
üPALPITATIONS AND TACHYCARDIA
üRESTLESSNESS, NERVOUSNESS,
TREMORS
üANOREXIA, N/V, HEADACHE AND
DIZZINESS
NSG CONSIDERATIONS
üCONTRAINDICATED TO
HYPERTHYROIDISM, CARDIAC
DYSRYTHMIA, OR UNCONTROLLED
SEIZURE DISORDER
üUSED WITH CAUTION IN PATIENT
WITH HTN AND NARROW ANGLE
GLAUCOMA
ANTI HISTAMINES
ANTI-HISTAMINES
üH1 RECEPTORS
üMEDIATE SMOOTH MUSCLE CONTRACTION
üDILATION OF CAPILLARIES

üH2 RECEPTORS
üGASTRIC ACID SERETION
ANTI-HISTAMINES (DRUGS)
üDIPENHYDRAMINE
üCHLORPENIRAMINE
üFEXOFENADINE
üLORATADINE – NON SEDATING
üCETIRIZINE – NON SEDATING
DECONGESTANTS
 DECONGESTANTS
üAGENTS WHICH CONSTRICT DILATED BLOOD
VESSELS IN THE NASAL MUCOSA BY STIMULATION
NERVE RECEPTOS IN VASCULAR SMOOTH
MUSCLESREDUCED BLOOD FLOW TO EDEMATOUS
AREASLOWED MUCUS FORMATION BETTER
DRAINAGE
 DECONGESTANTS
3 GROUPS
üADRENERGICS
üANTICHOLINERGICS
üCORTICOSTEROIDS
ANTITUSSIVES
ANTI TUSSIVES
üCOUGH SUPPRESANT
üADVISED ONLY WHEN IT SERVES A USEFUL
PURPOSE AND CAUSES RESPIRATORY DISCOMFOT
AND/OR SLEEP DISTURBANCE
ANTI TUSSIVES
üNON –NARCOTIC
üLESSEFFECTIVE AND NO ANALGESIC PROPERTIES
üEXAMPLES (DEXTROMETHORPAN, BENZONATATE)
üNARCOTIC
üSUPPRESS COUGH REFLEX BY A DIRECT EFFECT ON
THE COUGH CENTER  MEDULLA OBLONGATA
üEXAMPLE (CODEINE, HYDROCODONE
EXPECTORANTS
ANTI TUSSIVES
üAID IN THE EXPECTORATION OF EXCESSIVE MUCUS
BY BREAKING DOWN AND THINNING OUT THE
SECRETIONS
üIT MAY REDUCE SPUTUM VISCOCITY – ABSENCE OF
DATA
üEXAMPLES (GUIAFENESIN- MOST POPULAR,
AMMONIUM CL – WITH SERIOUS ADVERSE EFFECTS,
IODIDES – WITH HYPERSENSITIVTYISSUES
BRONNCHODILATORS
BRONCHODILATORS
üPHARMACOTHERAPY FOR ALL COPD
üDILATES THE BRNCHI AND BRONCHIOLES
MOA
üSYMPHATOMIMETIC BRONCHODILATORS(B-
RECEPTOR AGOINIST)
ü DILATES AIRWAYS

üXANTHINE BRONCHODILATORS
üSTIMULATES CNS FOR RESPIRATION
INDICATIONS
üBRONCHOSPASM
üASTHMA
üBRONCHITIS
üCOPD
ADVERSE EFFECTS
üPALPITATIONS AND TACHYCARDIA
üRESTLESNESS, NERVOUSNESS, TREMORS
üANOREXIA, N/V, HEADACHE, DIZZINESS
NSG CONSIDERATIONS
üCONTRAINDICATED HYPERTHYROIDISM, CARDIAC
DYSRHYTMIA OR UNCONTROLLED SEIZURE
DISORDER
üSHOULD BE USED WITH CAUTION IN PATIENT
WITH HPN AND NARROW ANGLE GLAUCOMA
üINSTRUCT CLIENTE NOT TO STOP MEDICATION
ABRUPTLY
üAVOID TAKING NSAID WHILE TAKING STEROID
NSG CONSIDERATIONS
üTAKE INHALED BRONCHODILATORS FIRST BEFORE
TAKING INHALED STEROID AND RINSE MOUTH
AFTER USING
DRUGS
SYMPHATOMIMETIC XANTHINE
ALBUTEROL AMINOPHYLLINE
SALBUTAMOL THEOPHYLLINE
ISOPROTERENOL
SALMETEROL
TERBUTALINE
ANTI-HISTAMINES
MOA
üBLOCKS H1
üDECREASE NASOPHARYNGEAL SECRETIONS AND
DECREASE NASAL ITCHING BY BLOCKING
HISTAMINE IN H1 RECEPTOR
INDICATIONS
üCOMMON COLDS, RHINITIS, N/V, URTICARIA,
ALLERGIES AND AS SLEEP AID
NSG CONSIDERATIONS
üADMIONISTER WITH FOOD AND DRINK
üGIVEN IM VIA Z-TRACK METHOD OR ORALLY
üPRECAUTIONS IN HANDLING MACHINE AND
DRIVING WHILE TAKING THESE DRUGS
üICE CHIPS OR CANDY FOR DRY MOUTH
DRUGS
ASTEMIZOLE (HISMANAL)
LORATADINE (CLARITIN)
BROMPHENIRAMINE (DIMETAPP)
DIPENHYDRAMINE (BENADRYL)
CETIRIZINE (ITERAX)
CELESTAMINE (TAVIST)
CORTICOSTEROIDS
MOA
üACT AS AN ANTI-INFLAMMATORY AGENTS AND
REDUCE EDEMA OF THE AIRWAYS AS WELL AS
PULMONARY EDEMA
ADVERSE EFFECTS
üCUSHING’S SYNDROME
üNEUTROPENIA
üOSTEOPOROSIS
NSG CONSIDERATIONS
üTAKE DRUGS AT MEAL TIME OR WITH FOOD
üEAT FOODS HIGH IN POTASSIM, LOW IN SODIUM
üINSTRUCT THE CLIENT NOT TO STOP
MEDICATION ABRUPTLY TO PREVENT ADRENAL
INSUFFICIECY
üTAKE INHALED BRONCHODILATORS FIRST
BEFORE TAKING INHALED STEROIDS AND RINSED
MOUTH AFTER USING.
ANTI-TB DRUGS
TUBERCULOSIS
üMEDS LAST 6-12 MOS
üMASKS WORN ALL THE TIME
üSPUTUM SAMPLES EVERY 2-4 WEEKS
ü3 NEGATIVE CILTURES ON 3 DIFFERENT DAYS
ANTI-TB (TB-DRUGS)
üRIFAMPICIN
üINH
üPYRAZINAMIDE
üETHAMBUTOL
üSTREPTOMYCIN
 ANTI-TB (TB-DRUGS)
üRIFAMPICIN
üGIVEN ON EMPTY STOMACH WITH
8OZ OF H2O, 1 HOUR BEFORE OR 2
HOURS AFTER MEAL AND AVOID
TAKING ANTACIDS MEDICATION
üHEPATOTOXIC THUS AVOID ALCOHOL
üURINE,FACE,SWEAT AND TEARS WILL
 ANTI-TB (TB-DRUGS)
üINH
üSHOULD BE GIVEN 1HOUR BEFORE OR
2 HOURS AFTER MEALS BECAUSE FOOD
MAY DELAY ABSORPTION
üSHOULD BE GIVEN 1 HOUR BEFORE
ANTACIDS
üNOTIFY FOR S/S OF HEPATOTOXICITY
AND NEUROTOTOXICITY
ANTI-TB (TB-DRUGS)
üPYRAZINAMIDE
üGIVEN FOR 2 MONTHS
üINCREASE SERUM URIC ACID AND
CAUSE PHOTOSENSITIVITY
ANTI-TB (TB-DRUGS)
üETHAMBUTOL
üCONTRAINDICATED IN CHILDREN
UNDER 13 YEARS OLD
üOBTAIN VISUAL ACUITY – CAUSE
OPTIC NEURITIS
üNOTIFY HCP IF ANY VISUAL
PROBLEMS OCCURS
ANTI-TB (TB-DRUGS)
üSTREPTOMYCIN
üAMINOGLYCOSIDE ANTIBIOTIC GIVEN
IM.
CARDIOVASCULAR
MEDICATIONS
ANTI-COAGULANTS
MOA
üHEPARIN (SQ AND IV)
üPREVENTS THROMBIN FROM CONVERTING
FIBRINOGEN TO FIBRIN
üWARFARIN (ORAL)
üSUPRESS COAGULATION BY ACTING AS AN ANTAGONIST OF VITAMIN
K AFTER 4-5 DAYS
INDICATIONS
üTHROMBOSIS
üPULMONARY EMBOLISM
üMI
ADVERSE EFFECTS
üBLEEDING
NSG CONSIDERATIONS
üHEPARIN SODIUM IF GIVEN SQ DON’T ASPIRATE
OR RUB THE INJECTION SITE (ABOVE THE
SCAPULA  BEST SITE)
üTHERAPEUTIC LEVEL 1.5-2.5 TIMES NORMAL PTT
üNORMAL PTT IS 20-35 SECONDS = 50-85 SECONDS
üANTIDOTE PROTAMINE SULFATE
NSG CONSIDERATIONS
üWARFARIN SODIUM (COUMADIN)
üWARFARIN IS USED FOR LONG TERM
üONSET OF ACTION IS 4-5 DAYS
üTHERAPEUTIC LEVEL IS 1.5-2.5 TIMES NORMAL PT
üNORMAL PT 9.6-11.8 SECONDS = 25-30 SECONDS
üINR = 2-3
üSHOULD BE TAKEN AT THE SAME TIME OF THE DAY TO MAINTAIN
THERAPEUTIC LEVEL
üREDUCE INTAKE OF GREEN LEAFY VEGETABLES
üANTIDOTE  VITAMIN K (AQUAMEPHYTON)
THROMBOLYTICS
MOA
üACTIVATES PLASMINOGEN TO GENERATE
PLASMIN (ENZYME THAT DISSOLVE CLOTS)
INDICATIONS
üUSE EARLY IN THE COURSE OF MI (WITHIN 4-6
HOURS OF THE ONSET)
NSG CONSIDERATIONS
üMONITOR BLEEDING
üANTIDOTE  AMINOCARPIC ACID
DRUGS
üSTREPTOKINASE
üUROKINASE
ANTIPLATELET
MEDICATIONS
MOA
üINHIBITS AGREGATION OF PLATELET THEREBY
PROLONGING BLEEDING TIME
INDICATIONS
üUSED IN THE PROPHYLAXIS OF LONG TERM
COMPLICATION FOLLOWING MI, CORONARY
REVASCULARIZATION AND THROMBOTIC CVA
NSG CONSIDERATIONS
üMONITOR BLEEDING TIME
üNORMAL VALUE (1-9MINS)
üTAKE THE MEDICATION WITH FOOD
DRUGS
üASPIRIN
üDIPYRIDAMOLE (PERSANTIN)
üCLOPIDOGREL (PLAVIX)
üTICLOPIDINE
CARDIAC GLYCOSIDES
MOA
üINCREAE INTRACELLULAR CA WHICH CAUSES
THE HEART MUSCLE FIBERS TO CONTRACT MORE
EFFICIENTLY, PRODUCING POSITIVE (+)
INOTROPIC AND (-) CHRONOTROPIC ACTION
INDICATIONS
üUSED FOR CHF, ATRIAL TACHYCARDIA AND
FIBRILLATION
NSG CONSIDERATIONS
üMONITOR TOXICITY AS EVIDENCE BY
üN/V, ANOREXIA, HALO VISION, CONFUSION,
BRADYCARDIA AND HEART BLOCKS
üDO NOT ADMINITER IF PULSE IS <60BPM
üSHOULD BE CAUTION IN PATIENT WITH
HYPOTHYROIDISM AND HYPOKALEMIA
üANTIDOTE  DIGIBIND
üPHENYTOIN  DOC TO MANAGE DIGITALIS
INDUCED ARRHTYMIA
DRUGS
üDIGOXIN (LANOXIN)
üDIGITOXIN (CRYSTODIGIN)
NITRATES
MOA
üPRODUCE VASODILATION INCLUDING CORONARY
ARTERY
INDICATIONS
üAP
üMI
üPERIPHERAL ARTERIAL OCCLUSIVE DISEASE
ADVERSE EFFECTS
üHEADACHE
üORTHOSTATIC HYPOTENSION
NSG CONSIDERATIONS
üTRENSDERMAL PATCH  APPLY THE PATCH TO A
HAIRLESS AREA USING A NEW PATCH AND
DIFFERENT SITE EACH DAY
üREMOVE THE PATCH AFTER 12-24 HOURS, ALLOWING 10-
12 HOURS “PATCH FREE” EACH DAY TO PREVENT
TOLERANCE
NSG CONSIDERATIONS
üSL MEDICATIONS
üNOTE THE THE BP BEFORE GIVING THE MEDS
üOFFER SIPS OF WATER BEFORE GIVING BECAUSE
DRYNESS MAY INHIBIT ABSORPTION
üPROTECT THE PILLS FROM LIGHT
üINSTRUC PATIENT NOT TO SWALLOW THE PILL
üONE TABLET FOR PAIN AND REPEAT EVERY 5MINS
FOR A TOTAL OF THE DOSES; IF NOT RELIEVED
AFTER 15MINS SEEK MEDICAL HELP
DRUGS
üISOSORBIDE DINITRATE (ISORDIL)
üNITROGLYCERIN (DEPONIT, NITROSTAT)
ANTI-ARRHYTMIC
DRUGS
DRUGS
üCLASS I (BLOCK Na CHANNELS)
üIA – QUINIDINE, PROCAINAMIDE
üIB – LIDOCAINE
üIC - FLECAINAMIDE
üCLASS II (BETA-BLOCKERS
üPROPANOLOL , ESMOLOL
DRUGS
üCLASS III (BLOCK K CHANNELS)
üAMIODARONE
üBRETYLIUM
üCLASS IV (BLOCK Ca CHANNELS)
üVERAPAMIL
üDILTIAZEM
NSG CONSIDERATIONS
üWOF FOR SIGNS OF CHF
üHAVE THE CLIENT WEIGH THEMSELVES AND
REPORT WEIGHT GAIN
üWOF THE SIGNS OF LIDOCAINE TOXICITY
(CONFUSION AND RESTLESSNESS)
DRUGS AFFECTING
THE ENDOCRINE
SYSTEM
THYROID AGENTS
MOA
üFUNCTION AS NATURAL OR SYNTHETIC
HORMONES
NSG CONSIDERATIONS
üTAKEN IN MORNING
üCAUTION WITH CAD
üMONITOR FOR SIGNS OF HYPERTHYROIDISM AND
REFER FOR DECREASING THE DOSE
DRUGS
üPROLOID (THYROGLOBULIN)
üSYNTHROID (LEVOTHYROXINE)
üCYTOMEL (LIOTHYROXINE)
PARATHYROID AGENTS
MOA
üREDUCE BONE RESORPTION
üPROMOTES CALCIUM ABSORPTION
NSG CONSIDERATIONS
üMONITOR SIGNS OF CALCIUM IMBALANCE
üREPORT FOR BONE PAINS
DRUGS
üCALCITONIN (CALCIMAR)
üETIDRONATE (DIDRONEL)
üCALCITROL (ROCALTROL)
üCALCIFEDIOL (CALCEDROL)
INSULIN
INSULIN
INSULIN ONSET PEAK DURATION
IMMEDIATE- 0.15H 0.5-1H 5H
ACTING (LISPRO)
SHORT-ACTING 0.5-1H 2-4H 5-7H
(REGULAR,
SEMILENTE)
INTERMEDIATE- 1-3H 6-12H 18-24H
ACTING (NPH,
LENTE)
LONG-ACTING 4-6H 10-30H 24-36H
(ULTRALENTE)
MIXED (REGULAR 0.5H 4-8H 25H
30% , NPH 70%)
NSG CONSIDERATIONS
üUSUALY GIVEN BEFORE MEALS
üROLL THE BOTTLE IN PALM OF HANDS AND
DON’T SHAKE
üINJECT THE AMOUNT OF AIR THAT IS EQUAL TO
EACH DOSE INTO THE BOTTLE
üASPIRATE SHORT ACTING FIRST THEN LONG OR
INTERMEDIATE
NSG CONSIDERATIONS
üALCOHOL IS RECOMMENDED FOR CLEANSING
BOTTLE BUT NOT WITH SKIN
üPINCH SKIN, AVOID IM AND DON’T ASPIRATE
üROTATE THE INJECTION SITE AN INCH A PART
üPREFILLED SYRINGES ARE STORED VERTICALLY,
NEEDLE UP
üMAY INCREASE DOSE DURING ILLNESSES
üUSED BOTTLES STORED IN ROOM TEMPERATURE
NSG CONSIDERATIONS
üUNUSED BOTTLE STORED IN THE REFRIGIRATOR
üMONITOR FOR ACUTE HYPOGLYCEMIA
ü3-4 COMMERCIALYLY PREPATED GLUCOSE TABLET
ü4-6OZ OF FRUIT JUICE OR REGULAR SODA
ü2-3 TEASPOOM OF HONEY
üGLUCAGON 1G SQ OR IM
üD50-50 IV