Pharmacology Outlines - Final Edition - Asad Al-Salti

Unit 3: Peripheral Nervous System Drugs
Drug Epinephrine/Norepinephrine Dopamine Dobutamine

Stimulates all adrenergic
receptors, particularly those of the
Used to treat the
cardiovascular and central Short-term treatment and
hypotension resulting from
nervous systems support of patients
shock because it stimulates
experiencing cardiac
alpha and beta-receptors to
Treats shock (supplied on crash decompression.
increase cardiac output,
Indications cart), cardiac emergencies,
blood pressure, and renal
asthma, COPD, glaucoma, and Atrial fibrillation and a rapid
perfusion.
Anaphylactic reaction. ventricular rate: manage first
with Digoxin THEN Dobutamine
Correct hypovolemia
Norepinephrine (NE): management (protect ventricle)
before administering.
of hypotension, shock, ventricular
fibrillation and cardiac arrest.
Classification Non selective adrenergic agonist Beta-1 adrenergic agonists Beta-1 adrenergic agonists
Does not produce the
It stimulates alpha-1 and
increased renal output that
Acts directly on the postsynaptic beta-1 receptors through
dopamine does
adrenergic receptors direct methods and indirectly
Dobutamine always increases
Positive inotropic: increase cardiac through the release of stored
peripheral resistance, whereas
Mechanism contractility (in heart) epinephrine.
dopamine may increase or
of Action Positive chronotropic: increase HR -dopaminergic effects:
decrease peripheral resistance.
Overall effects: increase systolic Beta-1 stimulation produces
pressure and slightly decrease increased cardiac output by
Does not cause the release of
diastolic pressure, bronchodilation increasing the force of
endogenous norepinephrine
contraction and heart rate.
that dopamine causes.
Hypersensitivity, during active
Pheochromocytoma,
labor, closed-angle glaucoma,
Major contra- uncorrected tachy- Idiopathic hypertrophic
general anesthesia, severe organic
indications arrhythmias, and ventricular sub-aortic stenosis
cardiac disease, and shock states
fibrillation
other than anaphylaxis
Ectopic beats, nausea
Most and vomiting, tachycardia, Nausea, headache, anginal
common Fatigue, sleep disturbances, angina, palpitations, pain, nonspecific chest pain,
adverse tremor, weakness, dizziness dyspnea, headache, palpitations, and shortness of
effects hypotension, and breath.
vasoconstriction
May cause or exacerbate
Most serious
ventricular ectopic beats,
adverse Cardiovascular stimulation Ventricular arrhythmias
although ventricular
effects
tachycardia is rare.
Maximizing Use infusion pump, titrate -Continuous cardiac monitoring
Monitor cardiovascular
therapeutic drug until desired effect is while receiving the drug.
status closely.
effects obtained. -BP is checked frequently.
Schedule doses to minimize Monitor BP, urinary output, Large vein is chosen to
Minimizing
sleep disruption and allow cardiac output, and minimize the patient’s risk
adverse
appetite and meal times to pulmonary wedge pressure for developing IV
effects
coincide. throughout therapy. complications.
Most
Reassure patient that close Reassure patient that close
important
Use of inhalers and nebulizers monitoring will be monitoring will be
patient
maintained. maintained.
education
Require continuous cardiac
monitoring while receiving the
Nursing Alert Important drug–drug
drug.
(Black Box interaction: monoamine
BP is checked frequently .
Warning) oxidase inhibitors
Pulmonary wedge pressure
and cardiac output.
Prepared by: Asad AlSalti Unit 3: Peripheral Nervous System drugs AY 2018-2019
Drug Clonidine Phenylephrine
Use is for the treatment of hypertension.

Off-label uses: preventing symptoms of
alcohol, methadone, or opiate Vasopressor (constricts blood vessels,
withdrawal during detoxification raises blood pressure)
(perhaps the most common current use for
Indications
the drug); Treats hypotension, shock related to
Reduction of allergen-induced vascular failure, nasal congestion; also
inflammatory reactions in patients with used during anesthesia
extrinsic asthma; smoking cessation;
and ulcerative colitis.
Classification Alpha-2 adrenergic agonist Alpha-1 adrenergic agonist (Vasopressor)

Stimulating alpha-1 vascular receptors and
Clonidine’s alpha-2 stimulation results in
thus causes vasoconstriction. As a result,
Mechanism decreased heart rate, decreased blood
of Action
renal perfusion and cardiac output are
pressure, decreased vasoconstriction, and
decreased, and blood pressure is increased
decreased renal vascular resistance.
by the heightened peripheral resistance.
Hypersensitivity, severe hypertension,
Major contra-
indications
Hypersensitivity ventricular tachycardia, and closed-angle
glaucoma
Dry mouth, drowsiness, dizziness, sedation,
Most and constipation, are common.
common
adverse
Hypertension, headache, sleep disturbances
effects Dry mouth and drowsiness frequently occur
when is administered transdermally.
Most serious
adverse Erythema Reflex bradycardia
effects
Maximizing
Possible life-threatening interaction with
therapeutic
effects monoamine oxidase inhibitors
Minimizing
Instill eye drops in Conjunctival Cul-De-
adverse
effects Sac.
When administered transdermally, drug

Most is released at a constant rate for 7 days.
important Avoid situations that increase
patient blurred vision.
education Pts need to be taught how to apply the
patch and how to safely dispose of it.
-Because clonidine can be used to prevent

the symptoms of narcotic withdrawal
nurse should be alert to patients returning
for a duplicate prescription of clonidine,
Nursing Alert
claiming to have lost the original shortly
(Black Box Stress safety related to blurred vision.
Warning) after it was prescribed <<This indicate the
patient has sold or stored the prescription.
-Rebound hypertension may occur if the

drug is discontinued abruptly.
Drug Prazosin Metoprolol
Treats hypertension, angina, chronic heart

Treats hypertension, Raynaud failure, cardiac arrhythmias, post-MI
Indications syndrome, prostatic obstruction,
PTSD -Decreases heart rate and contractility, slows
conduction, suppresses automaticity
Alpha-adrenergic antagonists / Beta-adrenergic antagonists (Selective Beta-2

Classification
Vasodilator blocker)
-Beta-1 blockade decreases heart rate and

myocardial contractility during periods of high
sympathetic activity (such as during physical
exercise), which results in decreased cardiac
output. As cardiac output decreases, so does blood
Selectively and competitively blocks pressure.
postsynaptic alpha-1 adrenergic
receptors, decreasing sympathetic tone -In cardiac conduction tissue, beta blockade results
Mechanism
of Action
of the vasculature, dilating arterioles in slowing of atrioventricular conduction and
and veins, resulting in decreased suppression of automaticity. These actions result in
peripheral resistance, decreased decreased oxygen demand, thus suggesting its use
supine, and standing blood pressure. as an antianginal agent.
-As metoprolol decreases cardiac output, it may

seem contradictory for it to be used in heart failure,
where typically the left ventricle does not have the
normal ejection fraction.
Cardiovascular abnormalities (e.g., bradycardia,

Major contra-
indications
Hypersensitivity complete heart block, cardiogenic shock,
uncompensated cardiac failure).
Most
Lightheadedness, dizziness, headache,
common Cardiac (hypotension, bradycardia, heart block,
adverse
drowsiness, weakness, lethargy,
worsening of heart failure), depression
effects nausea, and palpitations
Most serious
adverse “First dose syncope” Heart block, bronchoconstriction/bronchospasm
effects
Maximizing
Refrain from administering any OTC Take the medication exactly as prescribed, never
therapeutic
effects drug in combination with Prazosin. double a dose.
-Stress safety issues regarding CNS
Minimizing -Assess pulse and BP before giving a dose.
effects.
adverse
effects -Assess for weight increases and fluid retention
-Check drug interactions.
-To never abruptly stop taking the medication.
Most Safe ways to cope with postural
important -How to check their own pulse and BP.
patient
hypotension; use caution driving or
education using heavy machinery.
-To monitor for weight gain or swelling in
extremities, or worsening of CHF symptoms.
Nursing Alert
Suddenly stopping metoprolol can exacerbate
(Black Box
Warning) angina and may lead to myocardial infarction.
Drug Pilocarpine Neostigmine Atropine

Myasthenia gravis (main).
Used for simple and acute
glaucoma (Open-angle Sever bradycardia or during
-Urinary retention and
glaucoma), preoperative and CPR, Used routinely as a
paralytic ileus.
Indications postoperative intra-ocular pre-operative medication to
tension, mydriasis, and reduce intraoperative
-Antidote for non
xerostomia, Dry mouth from pulmonary secretions
depolarizing neuromuscular
chemotherapy
blocking agent.
Direct-acting muscarinic An indirect-acting
Classification Anti-cholinergic
agonist cholinoceptor agonists
-Bind to the muscarinic

receptors located in various
tissues and organs throughout Reversible inhibitor of
the body. postsynaptic cholinesterase
Mechanism Inhibit the action of
of Action
Acts as a cholinergic agent
acetylcholine.
-Elicits a response that by increasing the synaptic
resembles the action of the presence of acetylcholine
parasympathetic nervous
system.
(Ophthalmic): hypersensitivity,
History of retinal detachment,
GI obstruction or ileus, Hypersensitivity to sulfites,
Major contra- and acute iritis.
indications
urinary tract obstruction, myasthenia gravis, acute
peritonitis myocardial infarction
(Oral): hypersensitivity, severe
Respiratory diseases.
Nausea or vomiting,
Most
diarrhea, abdominal pain,
common Blurred vision, constipation,
adverse
Blurred vision, myopia miosis, salivation,
dry mouth, urinary retention
effects diaphoresis,
sinus bradycardia
Most serious
Cholinergic crisis, Cholinergic crisis,
adverse Cardiac arrhythmias
effects bronchospasm cardiac arrest
Administer at regular
Maximizing Take the medication
Administer ophthalmic solution intervals throughout the
therapeutic exactly as prescribed and at
effects into the conjunctival cul-de-sac. day to ensure adequate
the required dosage
blood levels
Minimizing Availability of antidote, Availability of Atropine,

Good oral hygiene,
adverse aseptic technique for the antidote for
effects fluid replacement
ophthalmic administration cholinergic crisis
Safety issues for blurred

Most Symptoms of cholinergic
Symptoms of cholinergic vision; Avoid OTC and
important crisis and need for
patient
crisis and need for immediate herbal medications without
immediate medical
education medical attention the direct approval of the
attention
health care provider.
Nursing Alert Differentiate between
(Black Box cholinergic crisis and
Warning) myasthenic crisis
Life span Nighttime driving, elderly and
Alert those with opaque lenses
Unit 4: Central Nervous System Drugs
Drug Phenytoin Ethosuximide Diazepam
-Used in convulsive disorders.
-First choice to treat status
epilepticus and for myoclonic and
Used to treat Generalized Tonic Clonic
atonic seizures, partial and
(Grand Mal) and other Psychomotor
generalized tonic-clonic seizures.
Seizures; Status Epilepticus.
Used to treat Absence
Indications Seizure (Petit Mal). -Used to treat anxiety, as a muscle
-Trigeminal Neuralgia
relaxant in the treatment of acute
alcohol withdrawal, and as Pre-op
-Off-label use: anti-arrhythmic drug.
Med to reduce anxiety, tension,
and recall of events.
-Off-label use: panic attacks.
Anti-epileptic drug that decrease sodium Anti-epileptic drug that Antiepileptic drug that increase the
Classification
influx decrease calcium influx effects of GABA (Benzodiazepines)
Binds to receptors on sodium channels,
Works by inhibiting
keeping the channels in a closed position Works like all benzodiazepines by
Mechanism the influx of calcium
longer, and preventing influx of sodium increasing the effectiveness of
of Action ions through T-type
ions and excessive firing of the cell, which GABA.
calcium channels
decreases seizure activity.
Sinus bradycardia, sinoatrial block,
Major contra-
second- and third degree AV block, and Hypersensitivity Hypersensitivity
indications
Adams Stokes syndrome
Most
Drowsiness, dizziness,
common CNS (dizziness, ataxia, blurred vision), Mild drowsiness, ataxia, confusion
Lethargy, nausea and
adverse nausea, and gingival hyperplasia
vomiting
effects
Life-Threatening Dermatologic
Most serious Reactions, Liver Damage, And Blood Blood Dyscrasias,
adverse Dyscrasias. Systemic Lupus CNS depression
effects -Cardiovascular Collapse If Given Too Erythematosus
Rapidly by IV Push
Maximizing -Monitor for therapeutic blood level,
therapeutic -Avoid Co-administration with enteral tube Monitor serum levels. Monitor serum levels.
effects feedings
-Change dose upward or downward in
small increments. -Monitor CBC, Serum
-Monitor blood levels when dosage is Levels. -Monitor CBC, Serum Levels.
Minimizing changed or if symptomatic of adverse
adverse effects. -Assess mood. -Assess mood.
effects -Give IV push very slowly during
status epilepticus. -Assess for suicidal -Assess for suicidal tendencies.
-Vitamin k before date of delivery. tendencies.
-monitor mood.
-Notify the physician
-Be careful driving or operating of skin rash, joint
Most machinery until effects of drug are pain, signs of
important known. infection, unusual -May increase suicidal thoughts or
patient -Potential risks to fetus if patient bleeding or bruising, actions.
education becomes pregnant. or pregnancy.
-May increase suicidal thoughts. -May increase suicidal
thoughts.
-The small veins in the dorsum of the
Nursing Alert
hand or the wrist should be avoided.
(Black Box Must be administered very slowly IV
-Should be injected very slowly, no
Warning)
faster than 5 mg in 1 minute.
Cause Fetal Hydantoin Syndrome, infant
death from neonatal hemorrhage, and
Life span decreased effectiveness of hormonal
Alert contraceptives; circulating level will
decrease during pregnancy, increasing risk
for seizures.
Prepared by: Asad AlSalti Unit 4: Central Nervous System drugs AY 2018-2019
Drug Isoflurane Propofol Lidocaine
A parenteral anesthetic Used for infiltration

used in the management anesthesia, regional
A potent inhalation of general anesthesia, blocks, nerve blocks,
Indications
anesthetic sedation induction or ophthalmic anesthesia,
maintenance, and status obstetric anesthesia, or
epilepticus dental anesthesia
Classification General anesthetic agent General anesthetic agent Local anesthetic agent
Reversible nerve
Theory: through physico-
conduction blockade,
chemical properties of the
Theory: which diminishes the
gases (lipid solubility, oil-gas,
nerve membrane’s
and blood-gas partition
Mechanism Mediate activity of the permeability to sodium.
of Action
coefficients), rather than
inhibitory gamma This action decreases the
through specific binding with
aminobutyric acid (GABA) rate of membrane
receptors or through
receptors. depolarization, thereby
potentiation or inhibition of
increasing the threshold
specific neurotransmitters.
for electrical excitability.
Hypersensitivity to amide
Hypersensitivity to local anesthetics, sulfites,
Hypersensitivity to
Major contra- halogenated Compounds, or methyl paraben;
indications soybean oil, glycerol, or
predisposition to malignant infection or inflammation
egg phosphatide
hyperthermia at the site of
administration
Most Minimal adverse reactions
common Hypotension, hypothermia, Nausea, vomiting, Unless accidental
adverse Nausea, or vomiting involuntary movements intravascular or intrathecal
effects injection occurs
Most serious
adverse Respiratory depression Apnea and Anaphylaxis Allergic Reactions
effects
Maximizing Low-stimulus environment,
therapeutic Pre-op teaching regarding Low stimulus environment Calm reassurance by staff
effects anesthetic induction
Read labels carefully. Be
Minimizing Time the administration
Monitor need for respiratory sure to use the right
adverse to avoid potential
effects support. preparation for the right
bacterial growth.
procedure.
Most Preoperative teaching Reassure the patient
important Safety due to lack of
patient regarding anesthesia and that he or she is being
Sensation
education surgical procedures constantly monitored.
Nursing Alert
(Black Box
Warning)
Life span
Alert
Drug Vecuronium Succinylcholine
Used to facilitate endotracheal

Used to facilitate endotracheal
intubation and short procedures
Indications intubation and mechanical
such as endoscopy or
ventilation
electroconvulsive therapy
Non-Depolarizing
Depolarizing Neuromuscular
Classification Neuromuscular Junction
Junction Blocking Agent
Blocking Agent
An agonist at the cholinergic nicotinic
Antagonists of acetylcholine;
receptors of the motor end plate. Like
block the normal breakdown of
the usual neurotransmitter
Mechanism acetylcholine at the motor end
of Action acetylcholine, it depolarizes the
plate, causing the
postsynaptic membrane, producing
neurotransmitter to accumulate
repetitive excitation of the motor end
and returning muscle stimulation.
plate.
Hypersensitivity, History Of Malignant

Major contra- Hyperthermia, Familial Plasma
indications Hypersensitivity
Pseudo-Cholinesterase Disorders, And
Narrow-Angle Glaucoma
Most
common Increased Ocular Pressure, Histamine
adverse Release, Muscle Pain
effects
Most serious
adverse Prolonged Paralysis, Apnea Prolonged Paralysis And Apnea
effects
Maximizing
therapeutic Decrease anxiety and fear. Decrease anxiety and fear.
effects
Minimizing Have resuscitation equipment

Have resuscitation equipment at the
adverse and cholinesterase inhibitor
effects bedside.
antidote at the bedside.
Most
important Reassure the patient that he is Reassure the patient that he is being
patient being constantly monitored. constantly monitored.
education
Nursing Alert
(Black Box
Warning)
Life span
Alert
Drug Baclofen Gapentin Dantrolene
-Used to treat neuropathic pain

associated with postherpetic -Used for muscle spasms or
neuralgia and peripheral diabetic spasticity.
Used for muscle spasms or neuropathy.
Indications
spasticity. -off-label use: managing spasticity -Drug of choice for preventing
associated with MS, amyotrophic or treating malignant
lateral sclerosis, bipolar disorder, and hyperthermia
prophylaxis for migraine headaches
Spasmo-lytic (Centrally acting) / Spasmo-lytic (Peripherally

Classification Spasmo-lytic (Centrally acting)
Miscellaneous Anti-Epileptic acting)
Reduces the force of
contraction of skeletal muscle
inhibiting the RYR receptor,
Inhibits transmission of reflexes at Theory: interact with voltage-gated which in turn reduces the
Mechanism
spinal cord level which Relieves calcium channels to decrease pain amount of Ca2+ released from
of Action
muscle spasticity. and spasticity. the sarcoplasmic reticulum,
thereby uncoupling (relaxing)
muscle contraction from
excitation.
Patients who use spasticity to
Maintain posture or balance
Major contra- Patients who use spasticity to
Hypersensitivity (such as patients with cerebral
indications maintain posture or balance
Palsy) or who have active
hepatic disorders
Drowsiness, Blurred Vision.
Patients Older Than 12 Yrs:-
Cns Effects: Somnolence, Dizziness,
Ataxia, Fatigue, And Nystagmus.
Most Neuropsychiatric: Behavior Problems,
common Sedation; Safety Is A Nursing Aggressive Behavior, Thought
Muscle Weakness
adverse Priority Disorders With Trouble Concentrating
effects Or Changes In School Performance,
Restlessness, And Hyperactivity.
Children Between (3-12) Yrs :
Viral Infection, Fever, Nausea And
Vomiting, Somnolence, And Hostility.
Occur with abrupt withdrawal
Most serious and include agitation, auditory Fatal hepatitis, especially in
adverse or visual hallucinations, Women older than 35 years
effects seizures, or psychotic who are taking estrogens
symptoms
Maximizing -Monitoring renal function
Administer at evenly spaced Give with food or milk to
therapeutic -Should be administered at least 2
intervals. decrease GI distress.
effects hours after antacids are given
-Assist in changing positions
Minimizing
slowly. Withdrawn slowly and gradually to
adverse Safety is a nursing priority
-Withdraw the medication over prevent the onset of seizures.
effects
2 week period.
Most
important Never abruptly stop May increase suicidal thoughts or
Assist with ambulation.
patient medication. actions.
education
Advice patients of symptoms
Nursing Alert Patients with renal failure or renal
of hepatitis and the importance
(Black Box disease may have additional risks of
of notifying the prescriber
Warning) adverse effects from the drug.
should any occur.
The dose should be increased
Older patients are more prone to
Life span gradually in older pts, because of
sedation and other effects on the
Alert age-related kidney function
central nervous system.
Deterioration.
Drug Carbidopa-Levodopa Neostigmine
-Myasthenia gravis (main indication!).

-Urinary retention and paralytic ileus.
Indications Treat Parkinson disease
-Antidote for non-depolarizing
neuromuscular blocking agent.
Dopamine-rgic agent /Anti- An indirect-acting cholinoceptor

Classification
parkinsonian agonists
Diffuses levodopa into the central nervous

system (CNS), where it is converted to
dopamine. Reversible inhibitor of postsynaptic
cholinesterase
Mechanism
The resulting change in Acts as a cholinergic agent by
of Action
dopamine–acetylcholine balance is increasing the synaptic presence of
believed to improve nerve impulse control acetylcholine
and to form the basis of the drug
antiparkinsonian activity.
Known Hypersensitivity, Allergy To

Major contra- GI Obstruction Or Ileus, Urinary
Tartrazine, Melanoma, Closed-Angle
indications Tract Obstruction, Peritonitis
Glaucoma, Or Breast-Feeding
Most
Nausea Or Vomiting, Diarrhea,
common Abnormal Movements, Orthostatic
Abdominal Pain, Miosis, Salivation,
adverse Hypotension, GI Effects
Diaphoresis, Sinus Bradycardia
effects
Neuroleptic Malignant Syndrome —
Most serious Common With Abrupt Cessation Of Drug;
adverse Precautions With Cardiac, Pulmonary, Cholinergic Crisis, Cardiac Arrest
effects And Peptic Ulcer Diseases, Diabetes
Mellitus, Psychosis And Pregnancy
Maximizing Administer At Regular
-Take Drug On Empty Stomach
therapeutic Intervals Throughout The Day To
-Reduce Protein In Diet
effects Ensure Adequate Blood Levels
Minimizing Titrate Drug Upward To Avoid

Availability Of Atropine, The
adverse GI Effects, Titrate Drug Downward To
Antidote For Cholinergic Crisis
effects Avoid Neuroleptic Malignant Syndrome
Most
Symptoms Of Cholinergic Crisis And
important Caution About Hypotension And
Need For Immediate Medical
patient “On-Off Syndrome”
Attention
education
Nursing Alert
Differentiate between cholinergic crisis
(Black Box
and myasthenic crisis
Warning)
Life span
Alert
Unit 5: Analgesic and anti-inflammatory Drugs
Drug Morphine Codeine
Used in Moderate to Severe pain (LVF, MI,

Pulmonary edema, etc…)
Treat Mild to Moderate pain and as a Cough
Indications
Suppressant
Standard against which all other narcotic
analgesics are measured for effectiveness
Classification Narcotic analgesics (Strong Narcotic Agonist) Narcotic analgesics (Mild Narcotic Agonist)
Reduce the release of neurotransmitters in the

Mechanism Act at specific opioid receptors in the CNS to
presynaptic space and produce hyperpolarization
of Action produce analgesia, euphoria and sedation
of postsynaptic dorsal horn neurons.
Major contra- Significant respiratory depression, increased Same as for all narcotics (e.g., respiratory
indications intracranial pressure, and CNS depression depression, use of other CNS depressants)
-as a Cough Suppressant—drowsiness,

Most sedation, dry mouth, nausea and vomiting, and
common Light-headedness, dizziness, sedation, nausea, constipation (all incidence is low at this dose);
adverse and vomiting
effects -as an Analgesic— similar to those of
morphine, although less severe
Most serious
adverse Respiratory depression Respiratory depression (in overdoses)
effects
Maximizing Assess pain thoroughly before and during therapy Assess pain thoroughly before and during
therapeutic and titrate the dose until the desired pain-relieving therapy and titrate the dose until the desired
effects effect is achieved. pain-relieving effect is achieved.
-Individualize dose based on patient-related

variables. Avoid use if patient’s health status requires
Minimizing a strong cough;
adverse -Monitor vital signs, especially respiratory rate,
effects frequently. Other considerations are the same as for
morphine.
-Have the antidote, Naloxone, on hand.
For long-term use in cancer pain, physical

Most
dependency will develop.
important Provide general information on pain
patient management, as for all other narcotics
This is not the same as addiction and not an
education
appropriate reason to withhold the drug.
-Check, dose and patient status carefully; adverse

Nursing Alert effects and medication errors are common.
Monitor patient closely, because fall risk is
(Black Box
increased.
Warning) -Monitor patient closely, because fall risk is
increased.
Life span Avoid use in premature infants or during labor Avoid use in premature infants or during labor
Alert when delivery of premature infant is expected. when delivery of premature infant is expected.
Prepared by: Waheiba AlWaheibe Unit 5: Analgesic and anti-inflammatory Drugs AY 2018-2019
Drug Naloxone Pentazocine
-Used in Moderate to Severe pain

-Narcotics Antidote
-Is an agonist at some opioid receptors and a weak
-Used to reverse the effects of opiates antagonist at others
(e.g., respiratory depression) if the dose is
Indications
sufficient and to treat opioid overdose. -Precipitates withdrawal in patients physically
dependent on narcotics.
-Precipitates withdrawal in patients
physically dependent on narcotics. -Abused on the street (known as “T’s and
Blues”)
Narcotic analgesics (narcotic agonist

Classification Narcotic Antagonist
antagonists)
Mechanism of Antagonize the effects of narcotics by Stimulate kappa receptors also inhibits weak
Action competing for opioid receptor sites. antagonist effect at the mu receptors.
Major contra- Respiratory depression, use of other CNS

indications depressants
Most common Nausea, Vomiting, Sweating, Tachycardia, Nausea, vomiting, dizziness, light-headedness, and
adverse effects Increased Blood Pressure, and Tremors. euphoria
Most serious Respiratory depression and circulatory

adverse effects depression
Maximizing The most rapid onset is achieved with IV use Assess pain thoroughly before and during therapy
therapeutic (2 min), and this route is recommended in and titrate the dose until the desired pain-relieving
effects emergencies. effect is achieved.
-Individualize dose based on patient-related

-Careful monitoring of the patient beyond variables.
initial response is warranted because the
Minimizing
duration of action of the narcotic agonist -Monitor vital signs, especially respiratory rate,
adverse effects
may be longer than the duration of frequently.
naloxone, then the patient may relapse
into respiratory arrest or depression. -Have the antidote, Naloxone, on hand.
Most important
Avoid alcohol and CNS depressants while taking
patient
drug.
education
Nursing Alert
-Repeated doses may be necessary to Monitor patient closely, because fall risk is
(Black Box
maintain reversal of the opiate’s effects. increased.
Warning)
Naloxone can be used in adults, children,

Life span Alert
and neonates.
Drug Aspirin Ibuprofen
Used for its analgesic, antipyretic, anti- Used for its anti-inflammatory, analgesic,
Indications inflammatory, and antiplatelet effects; irreversibly and antipyretic effects; reversibly inhibits
inhibits cyclooxygenase (COX) cyclooxygenase (COX)
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)-

Classification (NSAIDs) - para aminophenol derivatives
Salicylates
Antipyretic effects: inhibit PGE2 synthesis in the

hypothalamus.
Mechanism of Inhibit the synthesis or release of
Anti-inflammatory action: inhibit prostaglandin.
Action prostaglandin.
Antiplatelet action: irreversible inhibition of
thromboxane.
Active GI Diseases; Used With Caution In

Peptic Ulcer Disease, Gout, Renal Or Hepatic Patients With Renal or Hepatic Impairment,
Major contra-
Impairment, Bleeding Disorders, And Patients Already Hemopoietic Dysfunction, Pre-Existing
indications
On Anticoagulation Therapy Coagulopathy, Cardiac Impairment, and Age
Greater Than 60 Years
Most common
GI distress GI related
adverse effects
Most serious Renal Impairment, Gastric Ulceration, and
Hepatic and Renal Toxicity
adverse effects GI Bleeding
Maximizing
Give with milk or food to decrease gastric distress, as Give with milk or food to decrease gastric
therapeutic
needed. distress, as needed.
effects
Anticipate the use of proton pump inhibitors or Anticipate the use of proton pump inhibitors
Minimizing
misoprostol in combination, to decrease the or misoprostol in combination, to decrease
adverse effects
potential for adverse effects. the potential for adverse effects.
-Encourage patients to take the drug exactly as -Encourage patients to take the drug exactly
prescribed to avoid adverse effects or overdose of as prescribed to avoid adverse effects or
aspirin. overdose of aspirin.
Most important
patient
-Advise patients to avoid drinking alcohol and -Advise patients to avoid drinking alcohol
education
smoking when taking aspirin because these and smoking when taking aspirin because
activities can increase the risk of gastric irritation these activities can increase the risk of
and bleeding. gastric irritation and bleeding.
Nursing Alert All NSAIDs, including ibuprofen, have an

-Caution patients to contact the prescriber in the event
(Black Box increased risk of inducing MI or stroke. The risk
of persistent nausea or vomiting to avoid fluid loss.
Warning) escalates the longer the duration of therapy
-Aspirin should not be given to children with varicella-

or flu-like illness.
-it should not be given during pregnancy, especially

during the third trimester. Ibuprofen is in pregnancy category D in the
Life span Alert third trimester; monitor patients over the age of
-monitor patients older than 60 years carefully. 60 years carefully.
-Low-dose aspirin therapy is routinely given to healthy

adults older than 40 years age to prevent MI and
stroke.
Drug Acetaminophen (Paracetamol) Sumatriptan
Used for mild to moderate pain and fever.

Used for treatment of acute migraine or
Indications
cluster headache
-Has no anti-inflammatory effect
Classification (NSAIDs)-Serotonin-selective agonists (NSAIDs)-Serotonin-selective agonists
-It is centrally acting has no effects on platelet

aggregation.
-Analgesic effect: inhibit prostaglandin synthesis Stimulate 5 HT receptors located on cranial

Mechanism of in CNS blood vessels & trigemino-vascular system
Action result in vasoconstriction inhibition of
-Antipyretic activity: inhibit prostaglandin proinflamatory neuropeptides release.
synthesis in CNS = hypothalamus produce
vasodilation=increase blood flow = sweating =
heat loss.
Major contra-
Hepatic Disease, Viral Hepatitis, and Alcoholism Cardiovascular and Cerebrovascular Disorders
indications
Flushing, Dizziness, Weakness, Nausea,

Most common
Rash, Urticaria, and Nausea Drowsiness, Stiffness, or Feelings of Tingling,
adverse effects
Heat, Fatigue
Vasospasm resulting in ischemic events to

Most serious Acetaminophen may cause hepatic or renal
the cardiovascular and cerebrovascular
adverse effects toxicity in susceptible patients
systems
Maximizing
Acetaminophen can be administered without Administer only to patients with documented
therapeutic
regard to meals. migraine or cluster headaches.
effects
-Avoid administration to patients with

-Assess patients for medical conditions that
cardiovascular or cerebrovascular
contradict the use of acetaminophen.
Minimizing disorders.
adverse effects
-Overdose is treated with the antidote,
-Do not administer to patients with atypical
Acetylcysteine orally or IV.
headaches.
-Remind patients that the maximum adult dose

Most important -Teach signs and symptoms of ischemic
is 4g in 1 day, and that exceeding this dose
patient events and importance of seeking medical
may cause acute liver disease or kidney
education care should any occur.
disease.
-Acetaminophen overdose is potentially fatal.

-Sumatriptan should also be used with care in
Nursing Alert -The patient must receive treatment in an acute
patients with a history of seizures because it
(Black Box care facility.
may induce them.
Warning) -Anticipate the use of Acetylcysteine as an
antidote.
-Acetaminophen is the drug of choice for infants Sumatriptan is embryo lethal in rabbits. Do not
Life span Alert and children with flu or flu-like symptoms; administer to pregnant women unless the
-analgesic of choice during pregnancy or lactation. benefit to the fetus outweighs the risk.
Drug Methothrexate Etanercept
Disease-modifying Anti-Rheumatic drug

Disease-modifying Anti-Rheumatic drug
(DMARD) used as monotherapy or in
(DMARD) used in combination with
Indications combination with glucocorticoid steroids,
methotrexate to decrease the progression of
NSAIDs, or other DMARDs to decrease the
RA
progression of RA
Disease-Modifying Anti-rheumatic Drugs

Classification Tumor Necrosis Factor Inhibitors (TNF)
(DMARDs)
Activated T cells release inflammatory

mediators called cytokines, including
Inhibiting the replication and function of T
interleukins and tumor necrosis factor. TNF
Mechanism of lymphocytes that stimulate the production of
Action
binds to TNF receptors on cellular
cytokines, in particular interleukin-1 (IL-1),
membranes and triggers a cascade of
IL-6, and IL-8, as well as TNF-alpha.
inflammatory events that results in increased
inflammation of the synovial membrane
Major contra- Immunosuppression, Blood Dyscrasias, Immunosuppression, Blood Dyscrasias,

indications Pregnancy Infections
Most common Nausea, Headache, Stomatitis, Gingivitis, Nausea, Headache, Upper Respiratory
adverse effects Alopecia Infections, Injection Site Reactions
Most serious
adverse effects
Depressed Bone Marrow Function Severe Infections, Blood Dyscrasias
Maximizing
-Rotate Site of Injection
therapeutic Remain Hydrated
effects -Avoid areas that are tender, red, and hard.
-Take vitamin B, 5 mg every day. -Use aseptic technique for injections.

Minimizing
adverse effects -Remind the patient that Methothrexate -Do not administer if the drug solution is
can cause photosensitivity. discolored, cloudy, or contains particles.
-Substantial adverse effects may occur. -High risk for severe infection.
Most important
patient
education -Be sure to contact the health care -Be sure to contact the health care
provider if they occur. provider if they occur.
-Deaths have been reported with the use of

MTX in the treatment of malignancy, -Risk/benefit ratio due to serious infections
Nursing Alert psoriasis, and RA. and malignancies.
(Black Box
Warning) -Patients should be closely monitored for -Increased risk for lymphoma with children
bone marrow, liver, lung, and kidney and adolescents
toxicities.
Life span Alert
Drug Colchicine Allopurinol
Decreases the inflammatory reaction of

Indications Used for the management of chronic gout
acute gout
Classification Anti-gout Anti-gout
Decrease the production of uric acid by

Mechanism of Inhibiting the activity of leukocyte inhibiting the action of xanthine oxidase, an
Action Prevent release of glycol-protein enzyme that converts hypoxanthine to
xanthine to uric acid.
Major contra- Severe Cardiac, Hepatic, or Renal Co-administration with drugs that induce
indications Diseases myelosuppression.
Pruritus, Maculopapular Rash, Nausea And

Most common
adverse effects
Related To Gastrointestinal System Vomiting, Elevated Liver Function Test
Values, And Acute Gout Symptoms
Most serious Blood Dyscrasias, Including Bone Blood Dyscrasias, Severe Dermatologic
adverse effects Marrow Suppression Disorders
Maximizing
Adherence to diet and alcohol restrictions to
therapeutic Adhere to diet that limits uric acid production
effects reduce hyperuricemia
-Take colchicine at the first sign of an

attack, then only until the symptoms
start to resolve. -Ingest 2.5 to 3 L of fluid daily
Minimizing
adverse effects -Closely monitor patients with pre- -Administer after meals to decrease
existing medical conditions or those on nausea or vomiting
drug therapy that may interact with
colchicine
-Teach about diet and alcohol

-Any rash must be evaluated by the
restrictions.
health care provider.
-Advise patients not to take colchicine if
Most important -Advise patients that allopurinol can
they have severe cardiac disease,
patient cause minor adverse effects, such as
education hepatic disease, or renal disease.
nausea, vomiting, and pruritus.
-Administer intravenous colchicine
-Emphasize the need to follow the health
cautiously and monitor frequently for
care provider’s dosage instructions.
signs of extravasation.
Nursing Alert Colchicine should be used cautiously in

Many drugs increase the incidence of
(Black Box patients with pre-existing GI disease or
Warning) hypersensitivity that is potentially fatal.
depressed bone marrow function.
Life span Alert
Unit 7 - Hematopoietic, Cardiovascular and Renal Drugs
Drug Captopril Valsartan Labetalol
Used for treating hypertension,
-Administered orally to lower blood pressure
usually with other agents, especially
in hypertensive patients. used in treating Used to treat hypertension and
thiazide and loop diuretics,
CHF (usually in combination with kidney damage in people with
although it may be used alone.
diuretics, beta blockers, and digitalis) type 2 diabetes
Used to manage acute, severe
- treating diabetic nephropathy and left
Indications ventricular dysfunction after MI. Additionally labeled for use in MI
hypertension that occurs after an
acute ischemic stroke and used in
but not for diabetic nephropathy.
clonidine-withdrawal hypertension
- Unlabeled uses: treating hypertensive
crisis, neonatal and childhood hypertension, Does not produce ACE cough
Unlabeled uses: include lowering
non-diabetic kidney disease, kidney
hypertension associated with
imaging in Reno-Vascular hypertension
encephalopathy.
Anti-hypertensive (Angiotensin
Classification Anti-hypertensive (ACE inhibitor)
II receptor blocker "ARBs"(
Alpha-Beta blockers
1- Inhibits the angiotensin-converting

enzyme (ACE) needed to change
angiotensin I (inactive) to angiotensin II
(active). Angiotensin II is a potent
vasoconstrictor, so that less angiotensin II Blocks vasoconstricting and
means less vasoconstriction. aldosterone-secreting Reduces blood pressure while
Mechanism
2- Decreased angiotensin II also decrease effects of angiotensin II by maintaining glomerular filtration rate
of Action secretion of aldosterone, which thus preventing angiotensin II from and renal blood flow.
prevents retention of sodium and water binding to receptor sites
3- Lowers blood pressure by decreasing
peripheral vascular resistance; smaller anti-
hypertensive response (monotherapy) in
African Americans than whites
Major contra- Hypersensitivity to any

Hypersensitivity to drug, pregnancy. Hypersensitivity to drug
indications component of the drug.
Most
common Upper Respiratory Infections,
Chronic Cough and Rash Depression
adverse Dizziness, and Diarrhea
effects
Most serious
No Serious Adverse Effects In
adverse Angioedema and Neutropenia
Normal Dosing
effects
Maximizing
Administer captopril 1 hour before meals
therapeutic because food decreases absorption.
Continue with lifestyle changes.
effects
-Assess patients carefully for a
history of depression, suicidal
Monitor blood pressure for 2 hours after
Minimizing ideation, or attempted suicide
initial dose until stabilized, and monitor Assist patient out of bed and
adverse patient’s blood pressure throughout with ambulation.
effects -Sudden discontinuation of the
therapy.
drug may create rebound
hypertension.
-Teach your patients not to stop
-Use caution until it is known taking their medication on their
whether drug will cause own and to be certain not to allow
Most their prescriptions to run out.
Urge continuation of lifestyle changes dizziness;
important - Teach your patients or their
while on drug therapy, and teach the -avoid OTC potassium
patient signs and symptoms of hypotension. supplements and salt families how to check their
education substitutes containing pulse and blood pressure at
potassium. home, and what to do if there is
a problem.
Nursing Alert Captopril can cause injury and death to a Can cause injury and death to a
- Do not administer the dose if the
(Black Box developing fetus during the second and developing fetus during the
patient is bradycardic or hypotensive.
Warning) third trimesters. second and third trimesters.
Life span Avoid use during second and third Do not give to women who are
Alert trimesters of pregnancy. pregnant or breast-feeding.
Prepared by: Asad AlSalti Unit 7 - Hematopoietic, Cardiovascular and Renal Drugs AY 2018-2019
Drug Hydralazine Nitroprusside
-Used as an adjunct to other anti-hypertensive, perhaps as the

third or fourth drug in a therapeutic regimen. -Drug of choice for hypertensive crisis when
blood pressure must be reduced immediately
Parenteral form is used for severe hypertension when the need
to reduce the blood pressure is urgent or the patient cannot take - Reducing bleeding during surgery
Indications through the production of a controlled
oral drugs.
hypotensive state.
-Unlabeled Use: used following valve replacement, for
treating severe aortic insufficiency, and for reducing - Used for treating acute HF.
afterload to manage CHF.
Classification Direct-acting vasodilator Drugs Used In Hypertensive Crisis
-Produce smooth muscle relaxation of arterioles.

-Directly relaxes vascular smooth muscle,
allowing dilation of peripheral arteries and veins.
- Peripheral vasodilation results, decrease in arterial blood
Mechanism pressure and decreased peripheral resistance.
-This effect decreases venous return to the heart,
of Action reducing left ventricular end-diastolic pressure
- Increases plasma renin activity, leading to production of
and pulmonary capillary wedge pressure
Angiotensin II. Angiotensin II increases aldosterone production,
(preload).
which increases sodium and water retention.
compensatory hypertension resulting from aortic

Major contra- coarctation or arteriovenous shunting, and
Coronary artery disease and mitral valvular rheumatic disease.
indications surgical procedures on patients with inadequate
cerebral circulation
Most
common Sodium and water retention, palpitations, tachycardia, angina,
Hypotension from too-rapid infusion
adverse anorexia, nausea, and vomiting.
effects
Most serious Symptoms of systemic lupus erythematosus (SLE), an
adverse autoimmune disease, such as arthralgia, dermatoses, fever, Severe hypotension and cyanide poisoning
effects splenomegaly, and glomerular nephritis.
Maximizing
Wrap diluted bag of drug in an opaque sleeve or
therapeutic Administer with meals consistently to enhance absorption
aluminum foil to protect from light.
effects
-Always use an IV pump to regulate infusion.

-Because of the increases in sodium and water retention,
hydralazine is co-administered frequently with a diuretic -Start the infusion at a low dose and slowly
Minimizing increase.
-Monitor lab result of Complete blood counts (CBCs) and
adverse anti-nuclear antibody titer -Once the maximum infusion rate has been
effects achieved, do not continue for more than 10
-Assess for signs of peripheral neuritis (numbness, tingling minutes.
in hands and feet).
-Monitor blood pressure throughout therapy.
Most Explain to patient and family that the drug is

important The drug needs to be discontinued because of adverse given to lower blood pressure quickly and
patient effects. that blood pressure will be monitored
education constantly
-Consult with the physician or nurse practitioner if these drugs are

-Not suitable for direct injection after initial
not currently ordered.
reconstitution but must be further diluted.
Nursing Alert -It should be administered cautiously to patients with advanced
renal damage, cerebral vascular accidents, suspected coronary
(Black Box artery disease, pulmonary hypertension, and sensitivity
-Can cause sudden substantial decreases in
Warning) blood pressure.
-If signs of peripheral neuritis are present, seek an order to
administer pyridoxine (a B vitamin) because the neuritis may be
-Can cause cyanide toxicity, which can be lethal.
caused by the anti-pyridoxine effect of drug therapy.
Drug Hydrochlorothiazide Spironolactone Furosemide
-Used as an adjunct therapy to

treat hypertension and edema
associated with CHF, Nephrosis,
and cirrhosis.
-Used in preventing or treating

hypokalemia in high-risk -A potent diuretic used to treat
patients, particularly those edema from CHF, pulmonary
Widely used alone or with other agents to patients also taking Digitoxin for edema, and in hepatic and renal
reduce blood pressure; also cardiac disease or those disease; may be used as an
patients with cardiac antihypertensive
Indications -used to treat edema from CHF, from arrhythmias.
hepatic or renal disease, or secondary to -First-choice diuretic for treating
drug use -Major use is in diagnosing and hypertension with preexisting renal
treating primary disease
hyperaldosteronism.
- Unlabeled uses: treatment of

hirsutism, familial male
precocious puberty, symptoms
of premenstrual syndrome, and
acne vulgaris (short-term use).
Drugs Producing Diuresis

Drugs Producing Diuresis (Thiazide Drugs Producing Diuresis (Loop
Classification diuretic)
(Potassium-sparing diuretics /
diuretics)
Anti-aldosterone )
Works in the distal tubule to promote Works in the distal tubule to Works in the loop of Henle to promote
Mechanism
excretion of sodium, chloride, potassium, increase sodium and water loss excretion of large amounts of sodium,
of Action and water and to retain potassium. chloride, potassium, and water
Major contra-
Severe renal disease Hypersensitivity to drug Anuria in Chronic Renal Failure
indications
Most
Related to fluid and electrolyte loss
common Related to fluid and electrolyte loss,
(dizziness, light-headedness, vertigo, Related to fluid and electrolyte loss
adverse especially potassium loss
nausea, and vomiting)
effects
Most serious Significant hypokalemia,
Aplastic anemia and thrombocytopenia
adverse (although not normally life- threatening)
permanent deafness, and
effects activation or exacerbation of SLE
Maximizing Administer in the morning so that
Administer in the morning so that the Administer in the morning so that the
therapeutic diuretic effect does not disturb sleep
the diuretic effect does not disturb
diuretic effect does not disturb sleep
effects sleep
Administer IV push slowly, and

Minimizing Monitor blood pressure, weight,
Monitor blood pressure, weight, intake monitor blood pressure, edema,
intake and output, and serum
adverse and output, and serum electrolyte levels
electrolyte levels during therapy
breath sounds, weight, intake and
effects during therapy with this drug. output, and serum electrolyte
with this drug.
levels while therapy continues.
-Helping the patient understand

and cope with such adverse
Most effects as impotence, menstrual
irregularities, and
important Explain the importance of periodic blood Explain the importance of periodic
gynecomastia.
patient work to monitor electrolytes. blood work to monitor electrolytes.
education -Teach the about the drug
interaction with salicylates,
such as aspirin, which decrease
the diuretic effect of therapy.
Life span Older adults are more sensitive to
Alert effects of rapid fluid loss.
Drug Mannitol Tolterodine
Used to treat overactive bladder,

-Treats acute renal failure, increased intracranial controlling symptoms of urinary
Indications
pressure, and increased intraocular pressure frequency, urgency, or urge
incontinence
Drugs That Affect Bladder Contraction

Classification Drugs Producing Diuresis (Osmotic diuretics)
(Anti-cholinergic)
A sugar that draws water into the vascular space Blocks cholinergic muscarinic receptors
Mechanism
of Action
through osmosis. Freely filtered but not reabsorbed; in the bladder, decreasing bladder
thereby causes diuresis function
Major contra- Anuria due to severe renal disease, pulmonary urinary retention, gastric retention, and
indications edema, and intracranial bleeding uncontrolled narrow-angle glaucoma
-Dry Mouth and Headache

Most
-Anti-Muscarinic (Anti-Cholinergic)
common
adverse
Dizziness and GI Problems Effects: Constipation, Abnormal Vision
effects (Accommodation Abnormalities),
Urinary Retention, and Xerophthalmia
(Conjunctival Dryness).
Most serious -Worsening of CHF

adverse -Serious imbalances of fluid and electrolytes
effects -Obscure or worsened hypovolemia
Maximizing Warm the drug vial in water before using if crystals

Administer the drug on a regular
therapeutic are seen, and administer no warmer than body
effects prescribed basis.
temperature, using an in-line filter.
-Give a test dose for patients with marked oliguria

or inadequate renal function. If urine output does
Minimizing not increase after two test doses, discontinue
Decrease the dose if patient has
adverse use.
effects renal or liver disease.
- Monitor the patient’s hourly urine output.
Accuracy is essential.
-Urinary retention, GI retention, or

-Explain the purpose of mannitol therapy.
visual changes such as blurred
Most vision may occur and need to be
-Urge to report any difficulty breathing, chest
important reported.
patient
pain, or peripheral swelling (edema).
education -Tell pts whom having dry mouth to
-Tell that blurred vision or a runny nose (if occur)
suck on hard candies or ice chips to
should subside when therapy is discontinued.
relieve the dryness.
Drug Atorvastatin Fenofibrate Cholestyramine
-Used to treat hyperlipidemia.

-Used to treat -Used to reduce elevated serum
hyperlipidemia. cholesterol levels in patients with
-Used alone & in combination primary hypercholesterolemia Who
Indications Used to treat hyperlipidemia.
with statins. have not responded to other drug
-drug of choice for diabetes therapy.
or metabolic syndrome. -Used to relieve pruritus associated
with partial biliary obstruction.
Anti-hyperlipidemics (Fibric Anti-hyperlipidemics (Bile acid

Classification Anti-hyperlipidemics (statin)
acid derivatives) (Fibrates) sequestrants)
-Fenofibric acid lowers

plasma triglycerides
-Promote the oxidation of cholesterol
apparently by inhibiting the
to bile acids.
synthesis of triglycerides,
which reduces the amount of
Mechanism It lowers LDL, triglycerides, and total -The decrease in available bile acid
VLDL released into the
of Action cholesterol, and raises HDL. causes the body to increase the
circulation.
oxidation of cholesterol to bile acids,
which in turn decreases the LDL and
-It also stimulates the
serum cholesterol levels.
catabolism of triglyceride-rich
VLDL.
Hepatic or severe renal

Dysfunction (including
primary biliary cirrhosis and
Active liver disease, unexplained
Major contra- patients with unexplained
persistently elevated liver function test
indications persistent liver function
results, and pregnancy
abnormality), preexisting
gallbladder disease, and
hypersensitivity.
Constipation, which lead to fecal
impaction, abdominal pain, distention,
Most -Rash
cramping, GI bleeding, belching,
-Gastrointestinal problems
common bloating, flatulence, nausea, vomiting,
Elevated liver enzyme levels such as diarrhea, flatulence,
adverse diarrhea, loose stools, indigestion,
and nausea and vomiting;
effects heartburn, anorexia, steatorrhea,
and myalgia.
prolonged bleeding resulting from
vitamin K deficiency.
Most serious
Pancreatitis, hepatotoxicity,
adverse Rhabdomyolysis and Myopathy Hyper-chloremic acidosis
and rhabdomyolysis.
effects
-Administered before a meal
Maximizing Is most effective when administered in the -Before starting therapy determine
therapeutic evening, possibly because evening is also whether both the patient’s serum
effects when most cholesterol synthesis occurs. cholesterol and triglyceride levels are
elevated.
Minimizing Monitor liver enzyme levels
Monitor liver enzyme levels for at least Monitor liver enzyme levels for at
adverse for at least first year of
first year of therapy. least first year of therapy.
effects therapy.
Teach patients to continue

Most Teach patients to continue on a low-fat Teach patients to continue on a
on a low-fat diet and to
important diet and to report any unexplained low-fat diet and to report any
report any unexplained
patient muscle pain, tenderness, or weakness unexplained muscle pain,
muscle pain, tenderness, or
education at once. tenderness, or weakness at once.
weakness at once.
-Pregnancy category C drug

-Pregnancy category X. -Younger and smaller patients are risk
Life span -Avoid lovastatin if the patient is breast- for hyper-chloremic acidosis.
Alert feeding. -Older than 60 years, constipation is
-Older adults are More likely to have drug more likely to develop with ongoing
interactions. cholestyramine therapy.
Drug Digoxin Nitroglycerine
-Used in treating CHF and atrial fibrillation -Used in treating angina; IV route is used to
-Can cause the same arrhythmias it is used to treat decrease blood pressure (BP)
Indications
-Antidote for digoxin overdose is digoxin immune -Usually given sublingually or topically,
Fab. sometimes IV in acute care setting
Classification Cardiac Glycoside Nitrates / Anti-Angina
Direct effect is to strengthen force of cardiac contraction

- Relaxes smooth muscles and dilates vascular
(Positive inotropic effect).
beds
Mechanism
of Action -Indirect effect is to depress the SA node and slow
- Relaxes vascular smooth muscle and dilates
conduction to the AV node (negative dromotropic effect),
both arterial and venous vessels.
thus slowing heart rate (negative chronotropic effect).
Use of phosphodiesterase inhibitors

Heart Block, Ventricular Fibrillation, Certain Cases Of (drugs to treat erectile dysfunction)
Major contra-
Ventricular Tachycardia, Some Cases Of Sick Sinus -Hypersensitivity or idiosyncratic reactions to
indications
Syndrome, And Digitalis Toxicity nitrates or to adhesives (transdermal patches
only), severe anemia, orthostatic hypotension
Most
common Cardiac Toxicity, Hypokalemia, Hypomagnesemia, And
Headache followed by hypotension
adverse Hypercalcemia Increase The Risk Of Toxicity
effects
Most serious
adverse Ventricular Fibrillation Hypotension
effects
Keep tablets out of:

1- sunlight (keep in original dark bottle),
Maximizing 2- moisture (keep cap sealed tightly when drug
Achieve rapid onset of therapeutic effects with a loading
therapeutic not in use), excessive heat;
dose (“digitalization”).
effects -Give one tablet every 5 minutes, up to 3 in 15
minutes; and have patient rest or lie down
during anginal attacks.
-Monitor serum digoxin levels,

Take BP before and during therapy; to
Minimizing -Assess for bradycardia (take apical pulse for 1
prevent orthostatic hypotension, keep the
adverse minute before giving drug),
patient lying down during therapy.
effects -Monitor and correct electrolyte imbalances, and
assess for non-cardiac signs of digoxin toxicity.
If three sublingual tablets do not alleviate

Most -Teach how to take pulse and to avoid taking the pain, seek immediate emergency medical
important dose if pulse is below 60. treatment; use prophylactic doses before
patient activities that may precipitate angina; and
education -Keep digoxin out of the reach of children. remove patches or ointment for 10 or 12
hours out of every 24 to prevent tolerance.
Nursing Alert Avoid using drugs to treat erectile dysfunction

(Black Box (e.g., sildenafil) as severe hypotension can
Warning) occur
-Older adults tend to have increased risk for adverse

Life span effects due to decreased renal function.
alert
-Children Are often poisoned accidentally by digoxin.
Drug Amiodarone Verapamil
-Antiarrhythmic uses: controls

ventricular rate in chronic atrial flutter
-Used to treat life-threatening ventricular or fibrillation; used prophylactically
arrhythmias and prevent their recurrence with digoxin for repetitive paroxysmal
supraventricular tachycardia;
Indications
-Has properties of Classes I, II, and IV
-treat Supraventricular
-Has extremely long half-life Tachyarrhythmias IV
-Also used in angina and hypertension
Class IV Anti-arrhythmics
Classification Class III Anti-arrhythmics
(Calcium Channel Blockers)
1-Produces prolonged phase of repolarization -Inhibits movement of calcium ions across

(phase 3) the cardiac and arterial muscle cell
or membrane
Mechanism
of Action
1-prolongation of the refractory period, -Slows conduction, depresses
2-non-competitive alpha- and beta-adrenergic automaticity, depresses myocardial
inhibition. contractility, and dilates coronary arteries
and peripheral arterioles
significantly depressed cardiac function,

including second- or third-degree heart
Major contra- severe sinus bradycardia and
indications
block, severe hypotension, severe left
second- or third-degree atrioventricular heart block
ventricular dysfunction, severe chronic
heart failure, or cardiogenic shock
central nervous system effects (e.g., malaise,
Most
dizziness, paresthesia, tremor, headache, and
common
adverse
insomnia); constipation
effects GI effects (e.g., nausea and vomiting);
photosensitivity; and hypotension (IV use)
Most serious
adverse pulmonary toxicity and cardiac arrhythmias ventricular arrhythmias
effects
Maximizing -Shield drug solution from light;
therapeutic Use a loading dose. -give with digoxin for additive effect of
effects slowing at the atrioventricular node.
Correct pre-existing electrolyte imbalances

before giving the drug Monitor electrocardiogram and blood
Minimizing
-adjust IV dose to control ventricular arrhythmia; pressure constantly while on IV, and
adverse
effects -monitor blood pressure (IV dosing); monitor periodically throughout oral
-monitor electrocardiogram for changes therapy.
-assess for respiratory changes.
Most Take with food to minimize GI distress and

important
patient
notify the physician if cough or shortness of Techniques to prevent constipation
education breath develops.
IV routes are contraindicated in neonates
Life span -Drug is in pregnancy category D and infants, and older adults are more
alert -Use only if benefit outweighs risk. sensitive to hypotensive effects.
Drug Heparin Warfarin Clopidogrel
-Used to prevent the extension of a -Used to complete

blood clot, particularly in patients treatment with heparin
with DVT or PE. after clot formation; is Used to prevent atherosclerotic
-Used prophylactically with short- used prophylactically in events in patients who have had
term increased risk of thrombus patients at high risk of myocardial infarction or stroke,
Indications
formation, such as in the thrombus formation or who are at risk for having
postoperative period after a total hip -Administered orally these events
replacement. -May be given with heparin
-Used to treat DIC until therapeutic level of
-Parenteral administration (IV or SC) warfarin is obtained
Hypercoagulation (Direct
Classification Hypercoagulation (Anticoagulants) Hypercoagulation (Anti-platelets)
thrombin inhibitors)
Promotes the inactivation of factor X,

which, in turn, prevents the conversion Works by competitively
Mechanism Prevents platelet aggregation and
of prothrombin to thrombin. Also has an blocking vitamin K at its sites
of Action prolongs bleeding time
effect on fibrin, limiting the formation of of action.
a stable clot.
Active Bleeding, Ulcerations

Major contra- Thrombocytopenia, Bleeding Disorders,
of The GI Tract, or Bleeding Active Bleeding Disorders
indications and Active Bleeding Other Than DIC
Disorders
Most
Bleeding (Vitamin K Is The
common Bleeding (Antidote For Heparin
Antidote For Warfarin GI Distress
adverse Overdose Is Protamine Sulfate)
Toxicity)
effects
Most serious
adverse Thrombocytopenia Fetal Warfarin Syndrome Bleeding
effects
-Monitor PT for therapeutic
Maximizing -Monitor APTT for therapeutic range
range.
therapeutic -Adjust dose until therapeutic range Administer regularly.
-Adjust dosage until
effects achieved.
therapeutic range is attained.
-Take with food to decrease

Minimizing -Use IV pump
Monitor for signs of GI distress.
adverse
bleeding. -Assess for risk for falls and
effects -Assess for signs of bleeding.
injuries.
-Avoid activities that increase

Teach patients to monitor risk for falls or injury, remove
Most
Instruct patients to report any blood for bleeding, to modify scatter rugs or other hazards that
important
in urine or stools or bleeding from behavior to avoid injuries, may contribute to falls in the
patient
gums, nose, vagina, or wounds. and to avoid greatly home;
education
increased vitamin K intake. -Apply pressure to any bleeding
cut.
-This drug relies on metabolism

-Check concentration of heparin via CYP2C19 to become active.
carefully. -Loss of therapeutic effect in
Nursing Alert
-Use of the wrong concentration for the poor metabolizers.
(Black Box
route of administration is a common -Genetic test required to
Warning)
medication error with serious/potentially determine therapeutic dose.
life-threatening ramifications. -Consider alternative therapy in
poor metabolizers.
Warfarin is not for use in
Life span Heparin is the anticoagulant that can
pregnancy because it causes
Alert be used during pregnancy.
fetal defects.
Drug Alteplase, recombinant Streptokinase Anti-hemophilic factor
Provides factor VIII for

Used to break up blood clots Used in treating acute evolving
those with hemophilia;
posing acute medical MI, pulmonary embolism DVT,
made from
emergencies such as acute arterial thrombosis, or
Indications pooled human sources
myocardial infarctions, acute embolism, and to open
ischemic strokes, and pulmonary occluded arteriovenous
Dosage is individualized to
embolus cannulas
needs of patient
Hypercoagulation Hypocoagulation (Clotting
Classification Hypercoagulation (Thrombolytics)
(Thrombolytics) factors)
Works by attaching to the fibrin in

Works by binding to the fibrin in a
a thrombus and converting the Temporarily meets needs for
Mechanism clot and converting the trapped
trapped plasminogen to plasmin, clotting factor to prevent or
of Action plasminogen to plasmin. Fibrinolysis
streptokinase works indirectly to stop bleeding
then occurs.
activate plasminogen.
-Current internal bleeding, especially

intracranial;
-Recent surgeries or medical events
Major contra- in which patient bled or which put Hypersensitivity To Mouse
Hypersensitivity
indications patient at increased risk for bleeding Protein
now
-Seizure at onset of stroke; or
severe uncontrolled hypertension
Most
common Allergic reactions: Fever and chills
Bleeding No common adverse effects
adverse Hypotension
effects
Most serious Slight risk of hemolytic
adverse Bleeding Bleeding anemia and transmission
effects of hepatitis or HIV
-Avoid vigorous shaking or agitation -Avoid vigorous shaking or
Maximizing
when reconstituting; agitation when reconstituting; Refrigeration is required for
therapeutic
-Administer IV over 90 Minutes to 3 -Administer IV over 90 Minutes to AHF until it is used.
effects
hours. 3 hours.
-Monitor for bleeding;

-Monitor for bleeding;
-Avoid venipuncture and
-Avoid venipuncture and arterial
arterial puncture if possible,
puncture if possible, use pressure
Minimizing use pressure dressings when Monitor hematocrit and
dressings when needed;
adverse needed; Coombs test result
effects
-Handle patient gently;
-Handle patient gently; (hemolytic anemia)
-When treating ischemic stroke,
-When treating ischemic stroke,
give within 3 hours of onset of
give within 3 hours of onset of
symptoms.
symptoms.
Teach patients to avoid

Most
injury to prevent bleeding,
important Need for frequent assessment Need for frequent assessment
and to carry or wear
patient and limitations on activity and limitations on activity
education identification of the
disease.
-Current pregnancy or delivery of
a child within the last 10 days
Life span
increases risk for bleeding;
Alert
-Older adults are more likely to have
intracranial bleeding.
Drug Epoietin Alpha / Erythropoietin Filgrastim
- Used in patients with cancer to increase
Used to treat anemia in chronic kidney disease, HIV
their neutrophil counts and to support
infection (when zidovudine is used), and cancer
stem cell harvest
Indications (when chemotherapy is used), and in preoperative
anemic patients (when high blood loss and
-Administered by IV infusion or daily SC
transfusion are anticipated)
injections
Classification Erythropoiesis Stimulants Colony-Stimulating Factors
A DNA recombinant granulocyte colony-
Recombinant human erythropoietin works exactly as
Mechanism stimulating factor (G-CSF) that stimulates
endogenous erythropoietin; it stimulates the production of
of Action white blood cell development just as
RBCs (erythropoiesis)
endogenous G-CSF does
Major contra-
uncontrolled hypertension Hypersensitivity
indications
-hypertension (in chronic kidney disease [CKD]);
Most -fever (all other uses);
common -nausea and vomiting (surgical patients)
medullary bone pain; nausea and vomiting
adverse - Difficult to determine true adverse effects, because
effects those reported are also present in disease process or
post procedure
Most serious
thrombotic effects (in CKD, and preoperative
adverse none
patients)
effects
-Do not dilute in saline use D5W;

-Avoid shaking;
-Consult with prescriber about dose adjustment and
Maximizing -Do not use 24 hours pre- or post-
verify iron availability;
therapeutic chemotherapy;
-Monitor hemoglobin levels in CKD patients; do not shake
effects -Administer with the first cycle of
vial.
chemotherapy in those at high risk for febrile
neutropenia, including older adults.
-Do not decrease the dose before the

expected neutrophil nadir;
Minimizing -Monitor hemoglobin;
adverse
-Keep refrigerated and use aseptic
effects -Do not use high target levels for hemoglobin.
technique to minimize risk of bacterial
growth.
Most
important Advise patients of the need for follow-up blood work
how to decrease risk of infection
patient and the importance of dietary iron.
education
-Attempting to raise the Hb level to typical normal levels
increases the risk of cardiovascular complication;
-raising the Hb level too quickly can result in seizures,
doses should be individualized and the lowest effective
dose should be used.
- Renal failure patients experienced Greater risks for
Nursing Alert death and serious cardiovascular events if hemoglobin
Patients have a high risk of infection until
(Black Box level raised too high;
neutropenia is corrected.
Warning) -Treatment goal should be 10 to 12 g/dL only.
- Cancer patients may shorten overall survival and/or
increased the risk of tumor progression or recurrence;
-Use the lowest ESA dose needed to avoid red blood cell
transfusion.
- For pre-operative use, administer anticoagulants to
prevent DVT.
-Older adults are more at risk from
Life span complications with neutropenia;
alert -prophylactic use of G-CSF is usually
appropriate.
Unit 9: Respiratory System Drugs
Drug Dextromethorphan Cetirizine
Chronic idiopathic urticaria,

Indications Non-productive cough. perennial allergic rhinitis, and
seasonal, Allergic rhinitis.
Classification Anti-tussive Anti-histamine
Selectively blocks the effects of

Mechanism of Directly affects the cough center
histamine at H1-receptor sites,
Action in the medulla.
decreasing the allergic response.
Chronic coughs resulting from

emphysema and asthma. -Hypersensitivity
Major contra-
indications Caution in patients with hepatic -Use in children younger than 12
impairment and during years old
pregnancy.
Most common Flu-like symptoms, nausea and

adverse Nausea, Vomiting, and Irritability vomiting, dysmenorrhea, and
effects drowsiness
Most serious
Potential for QT-interval
adverse Drowsiness and Dizziness
prolongation
effects
Maximizing
Administer at evenly spaced Use a humidifier and increase fluid
therapeutic
intervals throughout the day intake.
effects
Minimizing Institute precautions to ensure

adverse safety during potential Adhere to safety precautions.
effects drowsiness or dizziness
-Use for symptoms R/T allergic

Most disorders.
Advise the patient to seek
important
medical attention if cough
patient -Do NOT use for symptoms R/T
does not resolve.
education common viral illness, such as
colds and flu.
Nursing Alert
(Black Box
Warning)
a pregnancy category C a pregnancy category B

Life span Alert not indicated for use in children Approved for use in children as
younger than 2 years old young as 6 months of age.
Prepared by: Asad Al Salti Unit 9: Respiratory System Drugs AY 2018-2019

Drug Acetylcysteine Albuterol Ipratropium Bromide
Acute and chronic
Used to liquefy thick, Therapy of CAL or
Indications management of CAL and
tenacious secretions asthma
asthma
Bronchodilators
Classification Mucolytic Bronchodilators (Beta agonists)
(Anti-cholinergenics)
stimulates receptors of smooth
muscle in the lungs,
Blocking muscarinic
The uterus and the vasculature
cholinergic receptors.
Affects the mucoproteins in that supplies skeletal muscle.
Blockade of
the respiratory secretions. It The main result is to bind beta-2
these cholinergic receptors
splits disulfide bonds that are receptors in the lungs is
decreases the formation of
responsible for holding the relaxation of bronchial smooth
Mechanism cyclic guanosine
mucous material together. The muscles.
of Action monophosphate, resulting
result is a decrease in the This relaxation of bronchial
in decreased
tenacity and viscosity of the smooth muscle relieves
contractility of smooth
secretions. bronchospasm,
muscle and thereby
Reduces airway resistance,
reducing
facilitates mucus drainage, and
Bronchospasm.
increases vital capacity.
Hypersensitivity to
Major contra- fluorocarbons
Hypersensitivity Hypersensitivity
indications Or legumes, such as
soybeans or peanuts
Most Throat irritation, Cough, hoarseness,
common Nausea, vomiting, and Palpitations, tachycardia, Throat irritation,
adverse Rhinorrhea anxiety, tremors, and dysgeusia, and
effects Increased blood pressure anticholinergic effects
Most serious
bronchospasm and bronchospasm, urticaria, bronchospasm and
adverse
bronchoconstriction and angioedema anaphylaxis
effects
Administer the
Maximizing
Refrigerate the solution Ensure correct use of Medication daily, despite
therapeutic
And use it within 96 hours. Inhalation device. the absence of symptoms.
effects
Minimizing Use only as directed to

Keep suction equipment Do not use more than
adverse Decrease potential
Close by. Prescribed.
effects systemic absorption.
Most This rescue drug should be

important Correct use of special used first for all acute This drug will not Abort
patient equipment symptoms of shortness of an acute asthma attack.
education breath, wheezing.
Life span Pregnancy class c, not for

Pregnant or breast-feeding Pregnancy category b
Alert children younger than 6 years

Drug Theophylline Flunisolide
Symptomatic relief of
Indications Broncho-constriction and Treatment of CAL and asthma
Broncho-spasm
Classificati Anti-Inflammatory Agents (Inhaled

Bronchodilators (Xanthine derivatives)
on glucocorticoid Steroids)
Inhibit the production of leukotrienes and

prostaglandins through interference with
Direct effect on the smooth muscles of arachidonic acid metabolism, reduce
Mechanism the respiratory tract, both those in the migration and activity of the inflammatory
of Action bronchi and those in the blood cells, increase the number of Beta-
vessels. receptors, enhance the responsiveness of
beta receptors in airway smooth muscle,
and decrease the production of mucus.
Major
contra- Status Asthmaticus and Peptic Ulcer Active Respiratory Infection
indications
Most
common Nausea, Vomiting, Headache, and
Dry Mouth, Dysphonia
adverse Insomnia
effects
Most
serious
Seizures And Arrhythmias Oral Candidiasis, Systemic Absorption
adverse
effects
Maximizing Evaluate patient care variables if
Administer the drug Daily, despite the
therapeutic serum concentration not stable.
absence of symptoms.
effects
Minimizing
Monitor serum theophylline levels
adverse Use a spacer device.
periodically.
effects
Most
important Take the drug exactly as prescribed
This drug will not abort an acute attack.
patient to avoid adverse effects.
education
Life span Approved for use in children older than 6

pregnancy and lactation
Alert years.

Drug Cromolyn sodium Montelukast
Used for prophylaxis of allergic

Indications Asthma
symptoms, including Asthma
Anti-Inflammatory Agents Anti-Inflammatory Agents

Classification
(Mast cell stabilizers) (leukotriene receptor Antagonists)
Works at the surface of the mast cell Blocks receptors for the
to inhibit mast cell rupture and leukotrienes, bound to the amino
degranulation after contact with an acid cysteine.
Mechanism of antigen. To prevent the release of
Action histamine and SRS-A, mediators of Broncho constrictor, by blocking
type I allergic reactions. Also may their receptors, Which mediate
reduce the release of inflammatory bronchoconstriction, vascular
leukotrienes. permeability, and mucous
secretion.
Major contra-
Hypersensitivity, acute symptoms Hypersensitivity. Breast-feeding.
indications
Most common
Headache, gastritis, pharyngitis,
adverse Dry Throat, Cough, and Wheezing
and rhinitis
effects
Most serious
Hepatic failure and Churg-
adverse Bronchospasm and Anaphylaxis
Strauss syndrome
effects
Maximizing
Administer the drug daily, despite
therapeutic Teach use of delivery systems.
the absence of symptoms.
effects
Minimizing
adverse Use only as directed. Take the drug only as prescribed.
effects
-Take the medication Daily,

Most despite the absence of symptoms.
important This drug will not abort an acute
patient -Drug is to be used only for attack.
education prophylaxis and not as a “rescue”
drug.
Nursing Alert
(Black Box
Warning)
Use children 2 years of age and
Life span Alert Pregnancy category B
older

Unit 10: Gastrointestinal Tract Drugs
Drug Omeprazole Ranitidine Aluminum hydroxide
Used for gastroesophageal

Treat peptic ulcers resulting reflux disease (GERD),
from H. pylori, GERD, erosive duodenal ulcer, gastric ulcer, Hyperacidity and its symptoms
Indications esophagitis, and chronic hyper pathologic hyper secretory in GERD and peptic ulcers;
secretory conditions (e.g., conditions; to prevent upper GI prevents stress ulcer bleeding
Zollinger-Ellison syndrome) bleeding; and for heartburn
and acid indigestion (OTC
strength only)
Classification Proton Pump Inhibitors H2 Receptor Antagonists Antacids
Raises the gastric pH in the
Suppresses the last phase of
stomach, inhibits pepsin’s
gastric acid production by
proteolytic activity and increases
suppressing the H+/K+ ATPase
Inhibits both daytime and the tone of the lower esophageal
enzyme system. Intragastric pH is
nocturnal basal gastric acid sphincter. Inhibits gastric
Mechanism of therefore elevated, and as a result,
secretions as well as gastric acid emptying by inhibiting contraction
Action blood flow in the antrum, pylorus,
secretion stimulated by food, of the smooth muscle of the
and duodenal bulb is decreased.
betazole, and pentagastrin. stomach. The aluminum in the
Omeprazole increases serum
drug binds with phosphate in the
pepsinogen levels and decreases
GI tract and can lower phosphate
pepsin activity.
levels effectively.
Major contra- May interact with other drugs Avoid use in chronic renal failure
Hypersensitivity
indications metabolized by CYP 450 (multiple doses).
constipation (aluminum antacids)
and diarrhea (magnesium
Most common
headache and diarrhea Headache, sometimes severe antacids); combination usually
adverse effects
negates the adverse effect of
each, although either may occur
neutropenia, agranulocytosis,
Most serious thrombocytopenia, potential electrolyte
adverse effects autoimmune hemolytic or imbalance
aplastic anemia
Liquid preparations are usually
preferred, tablets are used, and
Give ranitidine at least 2 hours they must be chewed thoroughly
administered for the recommended
Maximizing apart from antacids. before swallowing and followed
time
therapeutic If administration is intramuscular, with a glass of water.
Be sure the patient does not crush
effects inject undiluted ranitidine into a Tablets should be administered 1
or chew the capsule.
large muscle. to 3 hours after meals and at
bedtime for the best therapeutic
effects.
Monitor serum trough levels
Administer IV ranitidine slowly
Monitor the patient for the to prevent hypotension and Administer 2 hours after other
development of diarrhea cardiac arrhythmias. drugs to prevent drug
Minimizing
Suggest calcium citrate important to administer single interactions.
adverse effects
supplementation IV push doses, diluted in 20 mL Monitor for signs of acid
divided doses of normal saline or other rebound
compatible solution, over at
least 2 minutes
-Do not substitute this drug for
prescription drugs to treat
Do not substitute OTC drug for
Take omeprazole before meals; peptic ulcer disease
prescription drug nor add OTC
do not crush or chew drug. -Caution patients not to take
drug to prescribed drug
Most important Encourage calcium citrate the maximum dose for longer
therapy.
patient supplementation for patients than 2 weeks unless directed
Discuss potential adverse
education Avoid driving if dizziness by the prescriber.
effects and interventions.
occurs. • Ensure adequate -Teach patients to take the
Avoid driving if dizziness
nutrition antacid 2 hours after other
occurs.
drugs and 1 hour after meals
and at bedtime.
pregnancy category C , use not
recommended during breast-
Life span Alert pregnant or breast-feeding
feeding
Prepared by: Asad Al Salti Unit 10: Gastrointestinal Tract Drugs AY 2018-2019
Drug Metoclopramide Pancrelipase Ondansetron
Used as a GI stimulant in diabetic Used as enzyme replacement Used to prevent nausea and
gastric stasis, and GERD; as an therapy for patients vomiting associated with cancer
Indications
antiemetic post surgery and with deficient in this pancreatic chemotherapy, radiation, and
chemotherapy for cancer enzyme certain postoperative states
Classification Prokinetic Agents Digestive Enzymes Anti-emetics
Responsible for the final phase
of digestion. During this phase, Serotonin receptors of the 5-HT3
Metoclopramide increases peristalsis fats are hydrolyzed to fatty type are located peripherally on
of the duodenum and jejunum, thus acids, proteins to proteoses the vagal nerve terminal and
shortening the transit time through and derived substances, and centrally in the CTZ. During
Mechanism of the stomach and small intestine. It starches to sugars and dextrins chemotherapy, special mucosal
Action also increases the tone of the lower so that they can be absorbed cells in the small intestine release
esophageal sphincter, increases in the small intestine. serotonin, which stimulates these
gastric contractions, and relaxes the Pancreatic enzymes normally receptors Ondansetron blocks
pyloric sphincter. exert their effects in the these receptor sites, thus
duodenum and in the first part preventing nausea and vomiting.
of the jejunum
Acute pancreatitis or acute
Major contra- When stimulation of GI motility might
exacerbations of chronic Hypersensitivity
indications be dangerous
pancreatitis, Hypersensitivity
Most
common Nausea, abdominal cramps, Headache, constipation, and
CNS complaints
adverse and diarrhea at large doses malaise
effects
Most serious
Tardive dyskinesia and severe Arrhythmias, hypotension, and
adverse
depression extrapyramidal effects
effects
Give metoclopramide 30 min before Administer 30 minutes before
Maximizing meals or chemotherapy. Brands of Pancrelipase should treatment.
therapeutic Administer IV metoclopramide over at not be changed without Infusions should be given over 15
effects least 15 minutes, 30 minutes before consulting the prescriber minutes. Additional doses are
the start of chemotherapy used after chemotherapy
Monitor for depression, Parkinson-

-IV administration, dilute
like symptoms, extrapyramidal
ondansetron in 50 mL of 5%
effects, and tardive dyskinesia; Be sure to administer or
dextrose or 0.9% sodium
Minimizing hold further drug administration make sure the patient is
chloride.
adverse and contact the prescriber if administering Pancrelipase
effects noted. exactly as prescribed to
-Do not mix with alkaline
prevent excessive dosing.
solutions. Administer slowly
Monitor for evidence of depression
over 15 minutes
and report positive findings to the
prescriber
-Notify the nurse if any adverse

effects occur.
-Teach patient to recognize signs Do not crush or chew -Explain the purpose of the
of serious adverse effects; to call tablets; take before or with drug.
prescriber at once when noted. meals; avoid breathing -Advise patients to take
Most
powder and skin contact. ondansetron every 8 hours for 1
important
-Tell patients to take 30 minutes to 2 days after chemotherapy or
patient
before meals. Tell patients to take the drug radiation therapy to maximize
education
every time they eat, either prevention of nausea and
-Caution patients to prevent injury before or with meals and vomiting.
by avoiding activities snacks. -Teach patients to change
positions slowly to avoid
weakness or dizziness.
Nursing Alert
May cause tardive dyskinesia in the
(Black Box
elderly, especially in women.
Warning)
Older women are more likely to
Life span
experience tardive dyskinesia as an pregnancy category C pregnancy category B
Alert
adverse effect.
Drug Simethicone Loperamide Mesalamine
Used for chronic as well as

Relieves the pain of excess gas
acute diarrhea.
in the GI tract; antifoaming
Indications action changes surface tension Used to treat IBD
Used to treat diarrhea not
of gas bubbles, causing them to
responsive to symptomatic
coalesce and pass more easily
and supportive treatment
Drugs Used to Treat

Classification Anti-flatulent Anti-diarrheal
Inflammatory Bowel Disease
Action that alters the surface The action of Mesalamine is
tension of gas bubbles. As the unknown. Mucosal production of
surface tension is changed, gas arachidonic acid metabolites is
bubbles unite, forming larger gas Acts on the smooth muscle of the increased in patients with IBD
bubbles that are eliminated more intestine to slow intestinal motility through both the cyclooxygenase
Mechanism of
easily by belching or expulsion as and prolong intestinal transit and lipoxygenase pathways.
Action
flatus. It also is combined with time, allowing for the Mesalamine is thought to inhibit
antacids to decrease flatulence, reabsorption of fluid. these pathways, thereby
but it has no antacid properties. An decreasing the production of
off-label use is treating the prostaglandins, leukotrienes, and
symptoms of infant colic. hydroxyeicosatetraenoic acids.
Diarrhea associated with
Major contra- No contraindications or organisms that penetrate Hypersensitivity to salicylates or
indications precautions. intestinal mucosa; pseudo- with active peptic ulcer disease
membranous enterocolitis
No substantial adverse reactions
Most common Drowsiness, dizziness, and dry
have been reported with the use of gi effects and headache
adverse effects mouth
Simethicone
blood dyscrasias, exacerbation
Most serious
of colitis, pericarditis, renal
adverse effects
impairment, and hepatotoxicity
Maximizing Should be given after meals and at
assist the patient into a side-lying
therapeutic bedtime to increase its
position on his or her left side
effects effectiveness.
-Decrease the dose when Ensure the oral formulation is

diarrhea becomes less swallowed completely.
frequent Administer the oral medication
Minimizing
at even intervals throughout
adverse effects
-Monitor for signs of atropine the day. Be sure the patient
overdose (in children) and does not crush or chew the
toxic mega-colon. capsules or tablets.
-Teach patients to take

Simethicone after each meal
and at bedtime
Contact the health care
provider if fever or rash occurs.
-Tell patients to expect to pass
Most important Educate patients about the
gas and have increased Do not exceed the prescribed
patient potential adverse effects of
belching after taking this drug. dose.
education Mesalamine.
Instruct patients to stop taking
-Caution patients not to
the drug if fever or rash occurs.
increase the dosage unless
instructed to do so by the
prescriber.
Children are more likely to have

adverse effects from atropine,
especially if they have Down
Life span Alert pregnancy category B drug
syndrome; variable response in
children; avoid use if patient is
less than 2 years old.
Unit 12: Antimicrobial Drugs
Drug Penicillin G Meropenem
Used to manage abdominal infections, such as

Used for infections caused by gram-positive
appendicitis and peritonitis, and bacterial
bacteria, anaerobes, and spirochetes.
meningitis.
Indications
Also used as prophylaxis to prevent bacterial
Used to manage nosocomial infections that are
endocarditis.
resistant to other antibiotics.
Classification Anti-biotic (Cell Wall) (Penicillins) Anti-biotic (Cell Wall) (Carbapenems)

Mechanism
Binds to bacterial cell wall, causing cell death. Binds to bacterial cell wall, causing cell death.
of Action
Major contra- Hypersensitivity to penicillin, cephalosporins, or
Hypersensitivity
indications imipenem
Most
GI distress, superinfections such as candidiasis,
common
Nausea, vomiting, diarrhea injection-site reactions, phlebitis, and elevations of lft,
adverse
bun, and creatinine.
effects
Most serious
Seizures, pseudomembranous colitis, and blood
adverse Hypersensitivity
dyscrasias, seizures are less likely to occur
effects
-Oral preparations should be given on an empty

stomach.
Maximizing
therapeutic
-When using for gram-negative infections, be
effects
sure culture and sensitivity tests are done before
administration.
-Monitor intake and output because it may be

Minimizing the first sign of kidney dysfunction.
-Monitor intake and output because it may be the
adverse
first sign of kidney dysfunction.
effects -Blood levels may become toxic if the kidneys
cannot excrete penicillin.
-Take the medication exactly as prescribed

-Take the medication exactly as prescribed until
until the entire prescription is completed,
Most the entire prescription is completed, despite the
despite the absence of symptoms.
important absence of symptoms.
patient
-Monitor for signs and symptoms of allergic
education -Monitor for signs and symptoms of allergic
response and stop the medication if any
response and stop the medication if any occur.
occur.
-Penicillin G has three formulations— penicillin G

aqueous, penicillin G procaine, and penicillin G
Nursing Alert Meropenem may interact with valproic acid; thus,
benzathine.
(Black Box patients receiving valproic acid should be monitored to
Warning) ensure that their treatment is effective.
-Only penicillin G aqueous may be given
intravenously.
Life span Elderly patients may need reduced dosage

Alert because of decreased kidney function.
Prepared by: Waheiba AlWaheibe Unit 12: Antimicrobial Drugs AY 2018-2019

Drug Cefazolin Vancomycin
Used for infections caused by gram-positive Used for serious gram-positive infections,
bacteria, anaerobes, and spirochetes. especially Clostridium difficile and
Indications
Also used as prophylaxis in patients having methicillin-resistant
GI or GU surgery. Staphylococcus aureus (MRSA).
Classification Anti-biotic (Cell Wall) (Cephalosporins) Anti-biotic (Cell Wall) (Vancomycin)

Mechanism
of Action
Binds to bacterial cell wall, causing cell death. Binds to bacterial cell wall, causing cell death.
Major contra-
indications
Hypersensitivity to cephalosporins or penicillin Hypersensitivity and pregnancy
Most
common Histamine release resulting in “red-man”
adverse
Nausea, vomiting, diarrhea
syndrome
effects
Most serious
adverse Hypersensitivity Ototoxicity and nephrotoxicity
effects
Maximizing When using for gram-negative infections, be
Obtain culture and sensitivity report before
therapeutic sure culture and sensitivity tests are done
effects administration.
before administration.
-Inject IM preparations into a large muscle

mass.
Minimizing
adverse Administer over 60 minutes.
effects -Be sure IV preparations are administered
according to the health care prescriber’s
orders, either IV push or IV piggyback.
-Take the medication exactly as prescribed

until the entire prescription is completed, -Need for periodic CBC when taking for
Most despite the absence of symptoms. prolonged period or high doses.
important
patient
education -Monitor for signs and symptoms of -Need to advise the health care team for
allergic response and stop the medication changes in hearing.
if any occur.
-The generic names of the cephalosporins are

Nursing Alert very similar.
(Black Box
Warning) -Triple-check the order before administering
the medication.
Elderly patients may need vancomycin

Cefazolin should be used cautiously and the Concentration monitoring because of a higher
Life span
Alert
dosage adjusted in elderly patients who have risk of toxicity and drug accumulation
any degree of renal insufficiency. secondary To age-related decreases in renal
function.

Drug Gentamycin Clindamycin Erythromycin
Used for serious

infections caused by Used for infections caused
Used for serious gram-negative gram-positive cocci and by gram-positive organisms.
Indications
infections. both gram-positive and Less effective for gram-
gram-negative negative organisms
anaerobes.
Antibiotics affecting protein

Anti-biotic (Protein Synthesis) Antibiotics affecting protein
Classification synthesis(Macrolide
(Amino-glycosides) synthesis (lincosamides)
antibiotics)
Enters the bacterial cell

wall and binds to bacterial Inhibiting RNA dependent
Mechanism Inhibit bacterial growth by ribosomes, suppressing protein synthesis, suppressing
of Action disrupting protein synthesis. protein synthesis and protein synthesis and leading
leading to bacterial cell to bacterial cell death.
death
Hypersensitivity,
Major contra- Hypersensitivity, pregnancy, pregnancy, breast-feeding,
indications
Hypersensitivity
and breast-feeding and renal or hepatic
dysfunction
Most
Nausea, vomiting,
common Nausea, vomiting, diarrhea,
adverse
abdominal pain, rash, and Gi distress
and weight loss
effects pruritus
Hepatotoxicity,
Most serious Neurotoxicity, nephrotoxicity,
Pseudomembranous Qt prolongation,
adverse ototoxicity, and neuromuscular
effects colitis pseudomembranous colitis,
blockade
and ventricular tachycardia
Maximizing Administer at least 2 hours before Administer on an empty

Administer at evenly
therapeutic or after extended infusions of stomach, unless GI distress is
effects spaced intervals.
penicillins. pronounced
Minimizing
Monitor peak and trough levels Give with food to Provide small, frequent
adverse
effects throughout therapy. minimize GI distress. meals.
-Teach the patient the

-Teach the patient the signs and signs and symptoms of
symptoms of both superinfection, especially
Most nephrotoxicity and ototoxicity. pseudomembranous
Complete the entire course
important colitis.
of medication, even when
patient - Explain the importance of
education feeling better.
contacting the health care -Explain the importance
provider immediately if any of contacting the health
symptoms should occur. care provider
immediately if any
symptoms occur.
Nursing Alert neurotoxicity, nephrotoxicity, Pseudomembranous colitis:
(Black Box ototoxicity, and neuromuscular May range from severe to
Warning) blockade mild to life threatening.
Life span
Alert

Drug Mupirocin Tetracycline Chloramphenicol

Used for Rickettsia, Used for serious gram-
Used to treat impetigo and other
Mycoplasma positive or gram-negative
Indications minor skin infections due to
pneumoniae, chlamydia, infections, especially brain
Staph aureus or Strep pyogenes
and acne abscesses or meningitis
Antibiotic affecting protein
Anti-biotic (Protein Synthesis) Antibiotic affecting protein synthesis (Miscellaneous
Classification
Topical drugs synthesis (Tetracycline) antibiotics that affect protein
synthesis)
Inhibit the growth of
Mechanism Inhibit bacterial growth by Inhibit the protein synthesis of
of Action
bacteria but do not kill
disrupting protein synthesis. bacterial cell
them.
Pregnancy, breast-feeding,
Major contra- Hypersensitivity and
indications
Hypersensitivity and in children younger
breastfeeding
than 8 years of age
Most
Discoloration of teeth,
common Headache, nausea, vomiting,
adverse
Hypersensitivity nausea, vomiting, and
and diarrhea
effects photosensitivity
Most serious
Blood dyscrasias,
adverse Azotemia
effects “Graybaby” syndrome
Maximizing Administer at evenly
Administer oral preparations
therapeutic spaced intervals on an
effects on an empty stomach.
empty stomach.
Minimizing Give frequent small meals
Monitor peak and trough levels
adverse and increase mouth care
effects throughout therapy.
when GI distress is present
-Take the medication exactly as

-Teach the patient to
prescribed until the entire Teach the patient the signs
complete the entire
prescription is completed, and symptoms of bone
course of medication,
Most despite the absence of marrow suppression.
despite feeling better.
important symptoms.
patient - Explain the importance of
education -Teach the patient to
- Explain the importance of contacting the health care
keep medication out of
contacting the health care provider immediately if any
the reach of children.
provider immediately if any symptoms should occur.
symptoms should occur.
Serious and fatal blood

Nursing Alert dyscrasias including aplastic
(Black Box anemia, hypo-plastic anemia,
Warning) thrombocytopenia, and
granulo-cyto-penia
Life span
Alert

Drug Sulphamethoxazole-trimethoprim (SMZ-TMP) Nitrofurantoin
Highly effective against gram-negative and

gram-positive organisms in the urinary
Used for UTI, prophylaxis and treatment of
system because high concentrations are
Pneumocystis jiroveci pneumonia, and
found in urine.
Indications infection by Legionella, Shigella, or
Salmonella species; Haemophilus
Resistant microbes include Entero-bacter,
influenzae; or Streptococcus pneumoniae
Klebsiella, Proteus, and Pseudomonas
species.
Anti-biotic (Urinary Tract Infection)

Classification Anti-biotic (Urinary Tract Antiseptic)
(Sulfonamides)
Inhibits with bacterial enzyme systems,

Mechanism
Blocks bacterial folic acid synthesis and growth. interfering with metabolism and cell wall
of Action
synthesis.
Hypersensitivity, deficiencies in G6PD or other Patients with renal impairment, in infants

Major contra- folates, porphyria, urinary obstruction, younger than 1 month because of the
indications term pregnancy just ready to deliver, and age possibility of hemolytic anemia, and in pregnant
less than 2 months old. women at term.
-Anorexia, nausea, and vomiting. Abdominal

Most pain, diarrhea, parotitis, and pancreatitis.
common -Cause Hepatic reactions & hematopoietic
Nausea, vomiting, diarrhea
adverse effects in patients with folate deficiency.
effects -Sudden onset of fever, cough, chills, myalgias,
and dyspnea.
Most serious
Hematopoietic effects, crystalluria, Stevens-
adverse
Johnson syndrome
effects
Maximizing
Administer 1 hour before or 2 hours after a
therapeutic
meal.
effects
Minimizing
Increase fluids by 1.5 L/d to avoid
adverse
crystalluria.
effects
Most
Teach the patient strategies to avoid
important
disulfiram-like reactions, photosensitivity,
patient
and crystalluria.
education
Nursing Alert
(Black Box
Warning)
To avoid inducing kernicterus, this drug should

Life span
not be given to pregnant or breast- feeding
Alert
women or to infants younger than 2 months old.

Drug Isoniazid Ethambutol Pyrazinamide
More effective and less toxic than

Used for prophylaxis and
other anti-tubercular drugs.
management of tuberculosis and for Only for use in treating M.
Indications
other susceptible mycobacterial tuberculosis.
Effective against INH and
infections.
rifampin-resistant bacilli.
Anti-biotic (Mycobacterium)
Classification Anti-tubercular Anti-tubercular
Anti-tubercular
Inhibiting the synthesis of certain

Mechanism Disrupting the synthesis of the bacterial metabolites, with subsequent
Exhibits bacteriocidal action.
of Action cell wall. impairment of cell metabolism
leading to cell death.
Major contra-
Acute hepatic diseases hypersensitivity Hypersensitivity
indications
Arthralgia, gi disturbances,
and photosensitivity.
Non-gouty arthritis may occur

Most because pza inhibits urate
common Peripheral neuropathy, excretion, resulting in
Optic neuritis.
adverse elevated liver enzyme levels hyperuricemia.
effects
Rarely, hematopoietic effects,
such as thrombocytopenia and
sideroblastic anemia, may
occur.
Most serious Hepatotoxicity, peripheral

Hepatotoxicity, liver atrophy
adverse Hepatotoxicity, optic neuritis neuropathy, and blood
and fatalities have occurred.
effects dyscrasias.
Maximizing
Administer on an empty stomach,
therapeutic
unless GI distress occurs.
effects
-May also cause hyperuricemia

Minimizing Promptly identify signs and Periodically tests include a
-Patients with a history of gout
adverse symptoms of potential adverse CBC, liver and renal function
should be closely monitored for
effects effects, especially hepatitis. tests, and uric acid level.
exacerbations.
Most
Teach patients about the role of
important
adherence in avoiding drug
patient
resistance.
education
Patients with pre-existing ocular
disease should have a baseline
Nursing Alert
ophthalmologic examination and
(Black Box Hepatotoxicity
be closely monitored for changes
Warning)
in visual acuity and color
discrimination.
Patients over the age of 35 years have The drug should not be used in
Life span
an increased risk for isoniazid-induced children whose visual acuity
Alert
hepatic dysfunction. cannot be adequately assessed.

Drug Ciprofloxacin Rifampin
Used to manage acute TB and leprosy; also

Used for infections caused by aerobic
Indications used to manage other mycobacterial
gram-negative organisms
infections
Miscellaneous Antibiotics ( Quinolones Drugs Treating Mycobacterial Infections

Classification
/Fluoroquinolones) (Drugs for Treating M. leprae )
Inhibits deoxyribonucleic acid (DNA) gyrase, Blocking initiation of RNA transcription by

Mechanism
of Action
an enzyme needed for bacterial DNA inhibiting bacterial DNA-dependent RNA
replication. polymerase.
Major contra- Hypersensitivity, children younger than 18

indications
Hypersensitivity
years, pregnancy, or breast-feeding
Most
common GI: nausea and vomiting, diarrhea, and
adverse
Discoloration of body fluids, GI disturbances
abdominal pain.
effects
Most serious
Arthropathy (in children younger than 18
adverse Hepatotoxicity
effects years)
Maximizing
therapeutic Complete the full course of antibiotic therapy. Administer on an empty stomach.
effects
Minimizing
Provide small, frequent meals for GI Evaluate the patient for potential drug–drug
adverse
effects distress. interactions.
-Teach patients the role of adherence in

Most -Importance of completion of therapy preventing resistance
important
patient -for women, use of a backup method of -Explain the importance of contacting the
education contraception prescriber if any signs of hepatic
dysfunction occur.
Nursing Alert
(Black Box Increased risk of tendinitis and tendon rupture.
Warning)
Life span
Alert

Drug Amphotericin B Fluconazole Griseofulvin
Used to treat candidiasis
Used to treat superficial
and prophylaxis for fungal
Used for Severe fungal, dermatophytic infections,
Indications diseases in
Protozoal infection such as ringworm and
immunocompromised
tinea.
patients
Anti-biotic (Anti-fungal) Anti-biotic (Antifungal Agents) Anti-biotic (Antifungal Agents)
Classification
(Polyene) - Azole antifungal drugs -Miscellaneous antifungal
Works directly by altering the

fungal cell membrane.
Kill or stop growth of susceptible Fluconazole inhibits synthesis works by disrupting the mitotic
Mechanism fungi by affecting the permeability of ergosterol. Inhibition of spindle structure of the fungal
of Action of the fungal cell membrane or ergosterol synthesis results in cell, thereby stopping cell
protein synthesis increased cellular division
permeability, causing leakage
of cellular contents.
Major contra- Pregnancy and breast-

indications
Hypersensitivity Hypersensitivity
feeding.
GI: Nausea, vomiting,
flatulence, and epigastric
Most
Nausea, vomiting, diarrhea, distress.
common Infusion reactions, electrolyte
adverse
abdominal pain, headache, CNS: headache, fatigue,
abnormalities, and anemia
effects and dizziness dizziness, insomnia,
confusion, psychotic
symptoms
Most serious
adverse Nephrotoxicity Stevens-Johnson syndrome Hypersensitivity
effects
Prepare the patient for the
Maximizing Administer adjunct
possibility of an infusion reaction
therapeutic medications for nausea and
effects so that the patient does not cease
diarrhea.
therapy.
Minimizing Do not administer with other Do not give with any drugs Do not give with any drugs
adverse nephrotoxic drugs to minimize that increase the potential that increase the potential
effects the potential for nephrotoxicity. for adverse effects for adverse effects
Watch for signs and

Most Discuss the potential for an Advise women taking birth
symptoms of adverse
important infusion reaction and the need control pills to use another
effects and call the
patient to monitor the hematopoietic method of contraception
education prescriber immediately if
and renal systems closely. during griseofulvin therapy.
any occur.
-Amphotericin B deoxycholate
should only be used for life-
threatening systemic fungal
infections.
Closely monitor prothrombin
Nursing Alert
time if griseofulvin is either
(Black Box -There are four formulations of
Warning) added to or discontinued from
amphotericin B.
warfarin therapy.
-Use caution to administer the
correct formula at the correct
infusion rate.
Life span
Alert
Drug Acyclovir Oseltamivir
Used for the management of herpes simplex

Manage infection with influenza A or B
Indications virus, herpes zoster virus, Epstein-Barr
virus
virus, and cytomegalovirus
(Antiviral Agents)-Purine nucleoside

Classification (Antiviral Agents)- Drugs for influenza
analogue drug
Inhibit the release of viruses from infected

Mechanism cells, thus reducing spread to adjacent cells
of Action
Prevent replication of the virus.
and limiting tissue damage and the duration
of symptoms.
Major contra- Hypersensitivity or cross-sensitivity to

indications
Hypersensitivity
ganciclovir
Most
common Nausea, vomiting, anorexia, light-headedness, Nausea and vomiting, bronchitis, insomnia,
adverse abdominal pain, and headache and vertigo.
effects
Most serious
Hallucinations, delirium, and abnormal
adverse Seizures and renal dysfunction
effects behavior.
Maximizing
Administer the medication directly in the
therapeutic Administer the drug at regular intervals.
effects mouth–do not mix with any liquid.
Minimizing Nausea and vomiting can be reduced by

adverse Ensure hydration to avoid nephrotoxicity. administration with milk, a snack, or a
effects meal
-Acyclovir treats the symptoms of the

Most disease. -Encourage the patient to take the
important
patient
medication for the full course of therapy
education -It does not cure the disease or prevent its as prescribed
transmission to another person.
Nursing Alert
(Black Box
Warning)
Life span
Alert

Drug Zidovudine Efavirenz indinavir
Used for management of HIV Used for the management of

Indications Treating HIV infection.
and AIDS HIV infection and AIDS
For HIV and AIDS (Nucleoside / Treating HIV Infection and AIDS Drugs Treating HIV
Classification Nucleotide Reverse (Nonnucleoside Reverse Infection and AIDS (
Transcriptase Inhibitors) Transcriptase Inhibitors) Protease Inhibitors)
Inhibits HIV reverse

Zidovudine inhibits the synthesis transcriptase. It binds directly to
Inhibitor of HIV protease,
Mechanism of DNA by reverse transcriptase the active site on reverse
of Action
an enzyme required for HIV
(the viral enzyme that copies transcriptase, resulting in the
replication.
viral RNA into DNA). inability to change viral RNA into
DNA.
Hypersensitivity and taking

Major contra- Hypersensitivity, first 14 weeks of Hypersensitivity, age less
indications
midazolam or triazolam, ergot
pregnancy than 16 years
derivatives, or voriconazole
Nausea, headache, fatigue,

Most Dizziness, impaired
abdominal pain, vomiting,
common Nausea, headache, rash, fever, concentration, insomnia,
adverse
rash, and dry skin,
and abdominal pain abnormal dreams, hallucinations,
effects paronychia, severely dry
and rash
skin, or cracked lips.
Anemia, granulo-cyto-penia,
Kidney stones, elevated
Most serious and thrombocytopenia; Stevens-johnson syndrome,
liver enzymes, and
adverse suppression of bone marrow hepatotoxicity, and psychiatric
effects worsening of preexisting
function; lactic acidosis; and disorders
thrombocytopenia.
hepatomegaly with steatosis
Maximizing Administer with other
take on an empty stomach
therapeutic Administer 1 hour before meals. antiretroviral agents—never as
effects for best absorption.
monotherapy
To decrease the potential
for kidney stones,
Minimizing instruct the patient to
Avoid IM injections because of Administer at bedtime to
adverse drink at least 1 to 2 L of
effects thrombocytopenia. decrease CNS adverse effects.
water a day especially
during hot days or
episodes of diarrhea.
Most signs and symptoms of Explain the importance of Instruct the patient to
important anemia and importance of laboratory follow-up to monitor avoid St. John’s wort,
patient notifying the prescriber for hepatotoxicity and lipid garlic, and high doses of
education immediately abnormalities. vitamin C.
Patients with pre-existing

hepatic dysfunction or
Neutropenia and severe anemia,
Nursing Alert thrombocytopenia should
myopathy with prolonged use,
(Black Box be monitored closely, and
Warning) and potential for lactic acidosis
appropriate laboratory
and hepatomegaly
testing should be
scheduled regularly.
Life span
Alert
Drug Chloroquine Metronidazole
Used primarily for malaria; secondarily for Used for Trichomonas vaginalis,
Indications amebiasis, rheumatoid arthritis, and amebiasis, giardiasis, and anaerobic
lupus infections
Classification Treating Parasitic Infections (Anti-malarial) Parasitic Infections (Anti-protozoans)
Increase blood pH and upset phospholipid

Metronidazole acts against anaerobic
Mechanism metabolism in the parasite, thereby
of Action bacteria by inhibiting DNA synthesis,
interrupting the synthesis of ribonucleic acid
which causes bacterial cell death.
(RNA) and deoxyribonucleic acid (DNA).
Major contra-
indications Pre-existing eye diseases Alcohol dependency and pregnancy
Most
common Hypotension, Nausea, Vomiting, Diarrhea, Nausea, Vomiting, Xerostomia, And
adverse And Abdominal Pain Dysgeusia
effects
Most serious
adverse Retinopathy and aplastic anemia Blood dyscrasias
effects
Maximizing
Administer medication on the same day
therapeutic Treat both partners at the same time.
effects each week.
Minimizing
Administer with meals to decrease
adverse Assess alcohol intake closely.
effects potential GI effects.
Most Begin prophylaxis 2 weeks before

important entering any area where malaria is Reinforce the need to refrain from
patient endemic and continue for 4 to 6 weeks alcohol intake during therapy.
education after leaving the area.
Nursing Alert
Administer only for treatment of malaria and Carcinogenic in rodents – avoid
(Black Box
Warning) extra-intestinal amebiasis unnecessary use.
Life span
Alert

Drug Mebendazole Permethrin
Used for management of helminthic

Indications Used for scabies and pediculosis
infections
Classification Parasitic Infections (Anti-helminthic) Parasitic Infections (Anti-ecto-parasitic)
Disrupts the parasite’s nerve cell membrane,

Mechanism Damages cytoplasmic microtubules in the resulting in paralysis and death. Also exhibits
of Action absorptive and intestinal cells of the helminth. residual ovicidal activity for approximately 2
days.
Major contra-
indications
Hypersensitivity Hypersensitivity to household insecticides
Most
Burning, itching, numbness, rash, redness,
common Abdominal pain, diarrhea, dizziness, and
adverse
stinging, swelling, or tingling of the scalp,
headache
effects pruritus, edema, and erythema
Most serious Inhaling substantial quantities of

adverse Blood dyscrasias permethrin can aggravate bronchial
effects asthma.
Maximizing
therapeutic Treat all family members at the same time. Apply only as directed
effects
Minimizing
adverse Small, frequent meals to decrease GI effects Keep out of reach of children.
effects
-To minimize the risk for systemic

Most absorption,
important Wash all clothing and bed linens at the same
patient time the whole family is being treated.
education -Do not leave on the scalp or body for
longer than the recommended time.
Nursing Alert
(Black Box
Warning)
Life span
Alert

Unit 14: Endocrine Drugs
Drug Prednisone Fludrocortisone
Anti-inflammatory or immunosuppressive therapy.

-for Adrenal insufficiency (Addison
-Hepatic dysfunction may impair prednisone conversion disease)
into active prednisolone.
Indications -may cause HRA axis suppression if
-may cause HPA axis suppression if given for more than given for more than 2 weeks and
2 weeks and then withdrawn too abruptly, placing the withdrawn too abruptly; abrupt withdrawal
patient at risk for acute adrenal insufficiency. places the patient at risk for acute adrenal
insufficiency.
Steroid Hormone Agonists

Classification Steroid Hormone Agonists (Glucocorticoids)
(Mineralocorticoids)
Metabolic:
-Increased glycogeno-lysis and gluconeo-genesis
-Increased protein catabolism and decreased protein
synthesis
-Decreased gastrointestinal absorption of calcium
-Decreased secretion of thyroid-stimulating hormone Acts on the distal renal tubule to enhance
Mechanism (TSH) the reabsorption of sodium and to increase
of Action -Decreased activity and formation of osteoblasts the urinary excretion of both potassium
and hydrogen ions
Anti-inflammatory (systemic and local effects):
-Decreased production of prostaglandins, cytokines, and
interleukins
-Decreased proliferation and migration of lymphocytes and
macrophages
Hypersensitivity to fludrocortisone;
Major contra-
Hypersensitivity to prednisone; systemic fungal infections conditions not requiring intense
indications
mineralocorticoid activity
Most
CNS complaints of euphoria, headache, and vertigo; GI
common Sodium retention and increased urinary
complaints of nausea, vomiting, increased appetite, weight
adverse potassium excretion
effects
gain, edema and hypertension and dyspepsia
Most serious
Acute adrenal insufficiency due to HPA axis Chronic heart failure, cardiomegaly, and
adverse
effects
suppression following prednisone withdrawal hypokalemic alkalosis
-Administer prednisone according to established schedule

(preferably one that follows the normal diurnal pattern of
Maximizing
cortisol secretion). Increase the dosage in times of stress to
therapeutic
prevent drug-induced adrenal insufficiency.
effects
-Increase the dosage in times of stress to prevent drug-
induced adrenal insufficiency.
Minimizing
adverse Give prednisone with meals and/or antacids. Monitor fluid balance.
effects
Most
Advise the patient to wear medical identification so
important Eat potassium-rich foods and moderate
that any emergency medical personnel will know
patient sodium intake
education about this drug therapy
Nursing Alert
(Black Box
Warning)
Life span
Alert
Prepared by: Waheiba AlWaheibe Unit 14: Endocrine Drugs AY 2018-2019

Drug Regular insulin Glucagon
Used primarily to treat type 1 diabetes

Used in unconscious patients with diabetes to
mellitus; only type of insulin used for
reverse the severe hypoglycemia resulting
Indications intravenous administration, in external
from insulin over-dosage.
insulin pumps, and for “sliding scale”
coverage for hypoglycemia
Classification Insulins Glucose-Elevating agent
Insulin increases the cell membrane

Glucose-elevating agent that accelerates
Mechanism permeability to glucose, amino acids, and fatty
of Action
hepatic Glyconeo-genesis, increasing blood
acids and maintains a constant glucose level by
glucose levels
changing glycogen into glucose.
Major contra-
indications
Hypersensitivity Insulinoma and pheochromo-cytoma
Most Nausea, vomiting, generalized allergic
common
adverse
Hypoglycemia reactions, including urticaria, respiratory
effects distress, and hypotension
Most serious
adverse Anaphylaxis and hypersensitivity Hypo-Kalemia
effects
-Use the diluent provided in preparation of

glucagons for parenteral injection (SC, IM, IV).
-Reconstituted glucagons should be clear,
Maximizing watery, and used immediately.
Protect insulin from excessive heat and light to
therapeutic -Any unused portion should be discarded.
effects avoid deterioration
-Provide supplemental carbohydrates as soon
as possible after drug injection to restore liver
glycogen and prevent secondary
hypoglycemia.
Use the same type and brand of syringe to

Minimizing Teach the patient and family members
avoid dosage errors; rotate injection sites to
adverse preparation and administration techniques
effects prevent tissue damage; have second nurse
for glucagons before an emergency arises.
check dose; read labels carefully.
Teaching Regarding Dosage, Administration

Techniques For Subcutaneous Injection, Teach the patient and family members
Most Delivery Devices, Diet and Exercise, and measures to prevent hypoglycemic
important Capillary Blood Glucose Testing. reactions due to insulin.
patient
education Wear Medical Alert Tag Identifying Diabetic -Convey importance of early recognition
Condition Treated With Insulin To Alert and treatment of hypoglycemic episodes.
Emergency Medical Personnel.
Nursing Alert Sound-alike names for various types of insulin

(Black Box and the high potency of insulins are both
Warning) common sources of medication errors
Life span .
Alert

Drug Metformin Glimepiride
Oral hypo-glycemic used as adjunct with

Oral anti-hyperglycemic available
dietary restrictions to treat type 2 diabetes
commercially, combined with glyburide, to
Indications mellitus; is available commercially,
manage type 2 diabetes (e.g., Glucovance)
combined with metformin, to manage type 2
diabetes (e.g., Glucovance)
Non-Insulin Anti-diabetics (Biguanides)

Classification Non-Insulin Anti-diabetics (Sulfonylureas)
(Non-Sulfonylurea)
Increases peripheral tissue sensitivity to the

Mechanism Stimulates insulin release and increases
effects of insulin and decreases hepatic glucose
of Action peripheral tissue sensitivity to insulin effects
production.
Major contra- Severe hepatic or renal impairment; allergy

Serious hepatic or renal function impairment
indications to sulfa drugs
Most
common Nausea, diarrhea, abdominal bloating,
Nausea, epigastric fullness, heartburn
adverse flatulence, and anorexia
effects
Most serious
adverse Lactic acidosis and hypoglycemia Hypoglycemia
effects
Maximizing Individualize the dosage on the basis of both Daily dosage of greater than 10 mg should
therapeutic effect and tolerance, while not exceeding the be divided into two doses and taken 30
effects maximum recommended daily dose minutes before the meal.
Daily dosage of greater than 2g should be Avoid taking with certain alternative
Minimizing
divided into three doses taken at each meal; dietary therapies, supplements, or herbs
adverse
the drug should be taken with food to because of increased risk for
effects
decrease adverse GI effects. hypoglycemia
-Signs and symptoms of out-of-control

Most diabetes, such as hyperglycemia,
important Dietary restrictions for serum glucose polydipsia, polyphagia, and polyuria.
patient control and weight loss
education -Dietary restrictions for serum glucose
control and weight loss
Nursing Alert
(Black Box
Warning)
Older adults may be at greater risk for

Older adults may be at greater risk for lactic
Life span hypoglycemia related to drug accumulation
acidosis from age-related decline in renal
Alert from age-related decline in hepatic and renal
function
functions.

Drug Somatropin Desmopressin
Genetically engineered (recombinant DNA)

human growth hormone used for long-term Treatment of neurogenic diabetes
Indications
treatment of children with deficient insipidus
endogenous growth hormone
Classification Growth hormones Posterior Pituitary hormone Regulators
Stimulates cell growth and cellular mitosis, The naturally occurring posterior pituitary
Mechanism facilitates cellular uptake of amino acids for hormone, vasopressin (ADH), and its
of Action protein synthesis, and promotes use of fatty synthetic analogue (desmopressin) interact
acids for energy with V1 and V2 receptors
Major contra- Presence of hemophilia a with factor viii

Closed epiphyses and cranial lesions
indications levels 5% or less
Most -Localized erythema with intranasal

common administration
Joint and muscle pain
adverse
effects -Burning pain with parenteral injection
Most serious Development of antibodies to growth

adverse hormone, hypothyroidism, and insulin
effects resistance
Maximizing
Reconstitute drug according to Keep solutions (nasal, parenteral)
therapeutic
manufacturer’s directions. refrigerated.
effects
Monitor urine volume/osmolality, plasma

osmolality.
Minimizing Periodic testing of glucose tolerance,
adverse thyroid function, and presence of growth
-Pts with conditions associated with
effects hormone antibodies
fluid/electrolyte imbalances are prone to
hyponatremia.
Inform patients that medication bottle

accurately delivers 25 to 50 doses and
Most -Proper preparation and storage of any solution remaining after 25 to 50
important medication doses should be discarded because the
patient amount delivered thereafter may be
education -Proper SC or IM injection technique substantially less than prescribed. The
remaining solution should not be
transferred to another bottle.
Nursing Alert
(Black Box
Warning)
Infants, children, and the elderly require

Life span careful fluid intake restriction to prevent
Alert possible HypoNatremia and water
intoxication

Drug Levothyroxine Propylthiouracil
used for palliative treatment of
Replacement therapy in hyperthyroidism
hyperthyroidism, As an adjunct in
except in transient hyperthyroidism during
Indications preparation for surgery (thyroidectomy) or
the acute phase of subacute thyroiditis,
radioactive iodine therapy, or to manage
treat myxedema coma
thyrotoxic crises.
Classification Thyroid hormones Anti-Thyroid agent
Act as replacement for natural thyroid

hormone. Increase o2 consumption, RR, Inhibits the synthesis of thyroid hormones
Mechanism
HR, protein and carbohydrate metabolism (T4 & T3); hence, new T3 and T4 are not
of Action
occur secondary to increase in basal produced.
metabolic rate.
Major contra- Acute myocardial infarction, thyrotoxicosis; Sensitivity to the drug; breast-feeding, because
indications use cautiously in hypo-adrenalism the drug is excreted in breast milk
Most
common Symptoms of hyperthyroidism, alopecia GI (nausea, vomiting, epigastric pain), itching,
adverse with initial therapy (particularly in children) rash, hives, and arthralgia
effects
Agranulocytosis, liver damage, aplastic

Most serious
anemia, and vasculitis. Most adverse
adverse
effects resolve spontaneously with
effects
discontinuation of the drug.
-Monitor drug response carefully at the start

Maximizing of therapy. Administer drug around the clock at 8-hour
therapeutic intervals, although it can be given in a single
effects -Administer oral drug as a single daily dose daily dose.
before breakfast.
Minimizing Monitor cardiac response, as increased

Periodic blood tests to assess bone marrow
adverse basal metabolic rate may exacerbate
function and bleeding tendencies
effects angina pectoris.
-Drug must be taken for a prolonged period

Most
Have patient wear medical ID (tag or (months) to achieve the desired effects.
important
bracelet) to alert emergency medical
patient
personnel of drug therapy. -Report fever, sore throat, unusual bleeding
education
or bruising, and malaise.
Nursing Alert
(Black Box Not for use for obesity or weight loss
Warning)
Life span
Alert

Drug Calcitonin Calcitriol
regulator used to treat postmenopausal Vitamin D; management of hypocalcemia

Indications osteoporosis, Paget disease, and resultant bone disease in patients
hypercalcemia undergoing chronic renal dialysis
Classification Anti-hyper-calcemic Anti-hypo-calcemic

It increases calcium absorption from the
It plays a role in the regulation of calcium
Mechanism intestine, thereby increasing serum calcium
and bone metabolism and has direct renal
of Action levels. It decreases alkaline phosphatase and
effects and actions on the GI tract.
possible PTH levels
Hyper-calcemia, hyper-vitaminosis d,
Major contra-
Hypersensitivity to fish products malabsorption syndrome, and decreased renal
indications
function
Most
Weakness, headache, somnolence, nausea,
common
Nausea, vomiting, and diarrhea vomiting, dry mouth, constipation, muscle or
adverse
bone pain, and metallic taste
effects
Chronic hypercalcemia can lead to
Most serious
generalized vascular calcification,
adverse
nephrocalcinosis, and other soft tissue
effects
calcifications
-Patients with normal renal function taking

calcitriol should maintain adequate fluid intake
Store unopened bottle and avoid dehydration.
Maximizing
(nasal drug formulation) in the refrigerator -Periodically monitor serum calcium,
therapeutic
between 36° and 43°F; once the pump has phosphate, magnesium, alkaline phosphatase,
effects
been activated, store at room temperature. and 24-hour urinary calcium and phosphate,
especially in hypo-parathyroid and dialysis
patients.
-Periodically examine urine sediments of

Minimizing patients on chronic therapy.
Maintain serum calcium levels between 9
adverse -coarse granular casts and renal tubular
and 10 mg/dL.
effects epithelial cell casts result from therapy
and may cause renal calculi.
-Adequate dietary calcium is necessary for

-With intranasal dosing, alternate a clinical response to vitamin D therapy.
Most
nostrils daily. -Compliance with dosage instructions, diet,
important
phosphate-binder use, and calcium
patient
-Notify health care provider if significant supplementation is essential.
education
nasal irritation occurs. -Avoid use of nonprescription drugs,
including magnesium-containing antacids.
Nursing Alert
(Black Box
Warning)
Use caution in elderly patients, especially

Life span Children - safety and efficacy not
those with coronary disease, renal function
Alert established
impairment, and arteriosclerosis

Unit 15: Immune system and Cancer chemotherapy Drugs
Drug Interferon Alfa-2A Cyclosporine Thalidomide
Used as primary therapy for

newly diagnosed or relapsed
Used as an adjunct treatment to
multiple myeloma,
prevent rejection in solid organ
Used to treat some types of myelodysplastic syndrome,
transplantation and to prevent
Indications leukemia, AIDS-related Kaposi follicular and diffuse large
Graft-versus-host disease in
sarcoma, and various cancers cell lymphoma, erythema
allogeneic bone marrow or stem
nodosum leprosy, and
cell transplant recipients.
refractory rheumatoid
arthritis.
Classification Cytokines Immune Modulators Anti-angiogenic
Has immunomodulatory,
Inhibits growth of tumor cells,
Anti-inflammatory, and anti-
prevents their multiplication, and
Immunosuppressant that inhibits T- angiogenic properties thought to
heightens the host immune
Mechanism lymphocytes by causing be related to suppression of
response to help protect the body
of Action cytotoxicity during the G0 and G1 tumor necrosis factor alpha
from tumor cells. Blocks specifically
phase. production and down-regulation
viral infection by preventing viral
of surface adhesion molecules
replication.
involved in leukocyte migration.
It is essential for patients

receiving thalidomide to avoid
becoming pregnant or
Major contra- Hypersensitivity to impregnating another for four
Hypersensitivity
indications poly-oxyethylated castor oil weeks prior to and after
concluding therapy due to the
certain teratogenic effects of the
medication.
Most Drowsiness, neutropenia,

Dizziness, confusion, lethargy, flu- Renal dysfunction, tremor,
common constipation, peripheral
like symptoms, anorexia, nausea, hirsutism, hypertension, and gum
adverse neuropathies and venous
and altered taste hyperplasia.
effects thromboembolism.
Most serious
Renal toxicity and hepatic
adverse Depression and suicidal ideation Human teratogenecity
toxicity
effects
High fat meals or snacks taken

with thalidomide may prolong
the time to peak drug
Maximizing
Reconstitute and store following Start as soon after transplantation concentrations, so this
therapeutic
manufacturers’ instructions. as possible. medication should be taken
effects
orally with water, preferably at
bedtime and at least two hours
after the evening meal.
Use cautiously with

medications that also cause
somnolence, peripheral
Minimizing Pre-medicate patient with other
neuropathies or neutropenia,
adverse drugs to reduce the flu-like Monitor blood work
as these effects will be
effects adverse effects.
enhanced by combination
agents with these adverse
effects.
Most
Teach patients about the
important Teach patients about the 1-The importance of effective
importance of preventing
patient importance of avoiding infection. contraception and prevention
infection.
education of pregnancy.
Prepared by: Waheiba AlWaheibe Unit 15: Immune system and Cancer chemotherapy Drugs AY 2018-2019
2-The teratogenic effects are
well documented and
consistent .
3-Patients are also advised to

monitor for the presence of
drowsiness or sedation and
modify their activities
accordingly, and drink plenty
of fluids or take mild laxatives
to reduce the incidence or
severity of constipation .
4-Since many patients

experience a safety risk due
to drowsiness, peripheral
neuropathies or neutropenia,
precautions to prevent injury
are emphasized.
-This medication is teratogenic

and should never be
administered to an individual
This medication produces extreme who is or could become
immune suppression and only pregnant.
-Associated with serious or fatal prescribers experienced in
neuropsychiatric, autoimmune, management of patient who have -Black box warning provide
ischemia and infectious disorders. medical conditions requiring extensive
therapeutic immune suppression Advisement to prevent infection
-Patients must be closely and in facilities which are equipped And avoid medications that
Nursing Alert
monitored and withdrawal of to evaluate and treat serious life- could interfere with
(Black Box
medication is indicated with threatening infections if they should contraception.
Warning)
persistently severe or worsening occur.
signs and symptoms. -The Risk for venous thrombo-
Monitoring for secondary embolism is as high as 22.7%
-Symptom resolution will occur in malignancies should also be and also outlines in the black
many, but not all cases of toxicity. incorporated into the patient’s plan box warning. Clinicians should
of care. be observant for signs and
symptoms of venous
thromboembolism and provide
concurrent prophylactic
anticoagulation.
-Teratogenecity is of such
high risk that and male or
female of childbearing age must
be enrolled in the S.T.E.P.S.
counseling.
-Always use contraception

-Children may need higher doses
with a latex condom while on
Life span Generally, avoid during
therapy and for four weeks
Alert pregnancy and breast-feeding. -therapy usually avoided during
after treatment conclusion.
pregnancy.
-Additionally, consult the
prescriber who is counseling
the patient on the S.T.E.P.S.
program for any medication
changes that may influence the
efficacy of contraception.
Drug Rituximab Imatinib
A tyrosine kinase inhibitor that targets

special mechanisms of cancer cell
growth.
Indications Used in non-Hodgkin’s lymphoma (NHL)
Used in the treatment of GI stromal
tumor, Philadelphia chromosome
positive chronic myeloid leukemia,
and acute lymphoblastic leukemia.
Classification Antibodies Kinase inhibitors
-Inhibit Bcr-Ab1 tyrosine Kinase created

by Philadelphia chromosome
Mechanism of Binds specifically to CD20 antigen on the surface of abnormality.
Action malignant B lymphocytes and causes cell lysis.
-Inhibitor of platelet-derived growth
Factor, c-kit, and stem cell factor (SCF)
Major contra- Patients with hepatitis C, major infection, JC virus,

indications renal dysfunction, or cardiac dysrhythmias
Most common Infusion-related effects (fever, flushing, chills,

Fluid retention and myelo-suppression
adverse effects rigors)
Most serious Respiratory distress and hypotension (more Heart failure and left ventricular
adverse effects common when tumors are larger than 10 cm) dysfunction
Maximizing Administer in saline or dextrose stored in plastic Take orally with food and a large glass of
therapeutic effects bags, not glass water
.
-Assess for fluid overload and heart
failure
Minimizing
Pre-medicate patient with other drug therapies.
adverse effects
-Monitor complete blood count
regularly
-Teach to monitor for signs/symptoms

of fluid overload (e.g., weight gain,
dyspnea, shortness of breath,
Most important Instruct patient to notify nurse of adverse edema).
patient education effects.
-Teach to avoid infections and report
any low grade fever (greater than
100.5°)
-Fatal infusion reactions have been reported and it

is unclear if this relates to hypersensitivity or acute
tumor lysis.
-Rituximab may be resumed after additional pre-

medications and slowed infusion rate.
-When acute reactions including angioedema,

hypotension, bronchospasm, or respiratory distress
occur, the infusion should be immediately stopped
and supportive measures instituted.
Nursing Alert
(Black Box -Severe Mucocutaneous reactions such as
Warning) Stevens-Johnson syndrome have been reported.
-Severe skin reactions warrant immediate

discontinuation of the drug.
-Progressive Multifocal leukoencephalopathy (PML)

is a rare but potentially fatal neurologic infiltration
with lymphocytes.
-Neurologic Symptoms indicate the need to

discontinue the drug until diagnostic tests can
validate PML.
-Use birth control during therapy and for 1 year

afterward and avoid breast-feeding during this time.
Life span Alert
-Use with caution in older adults.
Drug 5-fluouracil Hydroxyurea
Managing acute leukemia with blasts. Also

Indicated for treating carcinoma of the colon, rectum, breast, indicated for Head and neck cancer,
Indications stomach, and pancreas malignant melanoma, cervical cancer and
sickle cell disease
Classification Anti-metabolites Miscellaneous cell cycle-specific drugs
Acts as a “false” antimetabolite, causing a thymine Deficiency.

Mechanism This deficiency deprives the cell of DNA and
Inhibit DNA synthesis.
of Action RNA, which are essential for cell division and growth.
The Result is unbalanced growth and death of the cell.
Major
Poor nutritional status, decreased bone marrow reserve, or a Depressed bone marrow reserve, except in
contra-
potentially serious infection blast crisis of acute leukemia
indications
Most
Gastrointestinal effects manifested by
common Mucositis, diarrhea, alopecia and other cutaneous changes, such
anorexia, nausea and vomiting, stomatitis, and
adverse as photosensitivity and increased pigmentation of the skin
diarrhea or constipation
effects
Depression of bone marrow function,

Most serious Dose-limiting effects: mainly on the bone marrow, manifested by including leukopenia, anemia, and
myelo-suppression, and the gastrointestinal mucosa, causing thrombocytopenia. Rapid decrease in white
adverse blood cell counts may occur within a short
nausea, vomiting, diarrhea, and stomatitis
effects period, which is the desired effect for
leukemia patients.
Maximizing
Potentiate antineoplastic activity of 5-FU by the addition of reduced
therapeutic folates, such as leucovorin calcium.
effects
-Monitor the patient’s blood count before,

during, and after treatment.
Minimizing - If anemia occurs, the patient may receive

Monitor CBC and assess for signs and symptoms of
adverse myelo-suppression, which include infection and bleeding.
blood transfusion without interrupting
effects treatment cycles.
-Pre-medicate the patient with the

appropriate antiemetic regimen.
-Hydroxyurea is administered orally, take

with or without food.
Most -Teach patient good oral care and to monitor for signs and
-If unable to vomiting occurs after taking
symptoms of mucositis and infection.
important hydroxyurea notify prescriber immediately.
patient -Advice patient of the possibility of transient alopecia, which
education -Advise the patient on careful handling of a
will reverse after chemotherapy is finished.
cytotoxic agent, particularly to avoid
contact with the skin or mucous
membrane.
-Advise women of child-bearing age of the potential for harm to the

Life span fetus so that they practice contraception.
Alert
-It is not known Whether the drug is excreted in breast milk and
explain that breast-feeding is not advised.
Drug Vincristine Etoposide Paclitaxel
Primarily indicated for acute leukemia Indicated for patients who breast
Treatment of testicular
and for other cancers such as Hodgkin’s and ovarian cancer, Kaposi
Indications carcinoma, small-cell and non–
disease, breast cancer, neuroblastoma, sarcoma, and non-small cell lung
small-cell lung cancer
and multiple myeloma cancer.
Mitotic inhibitors
Classification Mitotic inhibitors (Vinca alkaloids) Mitotic inhibitors (Taxanes)
(PodoPhyllotoxins)
Inhibits DNA synthesis in the
Attributed to mitotic inhibition, which
Mechanism S and G2 phases so that cells Arrest cell mitosis causing cell
arrests cell division in the metaphase
of Action do not enter mitosis and death.
stage of mitosis.
prophase.
Hypersensitivity to Cremophor
Major Known hypersensitivity to
Demyelinating form of El, baseline neutropenia of less
contra- etoposide or to any
indications
Charcot-Marie-Tooth syndrome than 1,500/mm3, pregnancy
podophyllotoxin derivative
and lactation
Most
common Tissue necrosis if the drug, which is a Nausea, vomiting, alopecia,
adverse vesicant, accidentally extravasates and joint pains
effects
Neurotoxic deficits manifested by Hypersensitivity or anaphylaxis
Severe hypersensitivity reactions
Most serious paresthesias, myalgias, loss of deep evidenced by orthostatic
(anaphylaxis), which occur during
adverse tendon reflexes, and jaw pain. Paralytic hypotension, chills, dyspnea, or
the first 10 to 15 minutes of drug
effects ileus as evidenced by constipation may bronchospasm (wheezing)
infusion.
also occur. when given rapidly.
-The drug is light sensitive; protect it from Use glass or polyolefin containers,
Maximizing Always infuse slowly (over 30 to
light. non-DEHP administration sets, and
therapeutic 60 minutes or slower), never by
-Infuse it slowly over approximately 1 in-line filtration for drug
effects IV push.
minute. administration.
-Monitor results of complete -Administer paclitaxel first when
-Always assess bowel elimination blood count before given in combination with
pattern because of the danger of chemotherapy and at expected cisplatin or carboplatin to prevent
paralytic ileus. nadir, approximately 10 to 14 profound myelosuppression.
Minimizing
days after the drug dose.
adverse
-Ensure good vascular access and -Pre-medicate patients with a
effects
monitor for signs and symptoms of -Monitor for signs and corticosteroid, diphenhydramine,
extravasation. symptoms of myelo- and an H2-antagonist IV 60
suppression, which include minutes before paclitaxel to avoid
infection and bleeding. anaphylactic reactions.
If the physician prescribes the
corticosteroid premedication
Forewarn the patient that the
Most regimen to be started at home,
Instruct the patient to obtain a infusion causes a metallic taste.
important ensure that patient understands
prescription for a prophylactic stool Advise the patient that sucking
patient the importance of complying with
regimen on hard candy may alleviate the
education the dosing schedule and will have
metallic taste.
enough medications
(dexamethasone) at home.
Nursing
Dose-limiting effect: depression of
Alert (Black Dose-limiting effect:
Vincristine is fatal if given intra-thecally. bone marrow function,
Box myelosuppression
particularly neutropenia
Warning)
-Caution elderly patients regarding the
Radiation recall may occur.
potential for motor and sensory deficits
Life span that may compromise their safety and
The safety and efficacy of VP-16
Alert sensory acuity.
have not been established in
-Vincristine may cause fetal harm or risk
children
to mothers who are breast-feeding.
Drug Cyclophosphamide Lomustine
Commonly used in brain tumors

Indications For testicular, ovarian, and bladder cancers
and Hodgkin’s lymphoma
Classification Alkylating agents Nitrosureas

Mechanism Creates a by-product that prevents
of Action
Causes DNA breakage leading to cell death
normal DNA function
Major severe depression of bone marrow function,

contra- serious infections, nursing mothers, and women
indications and men with reproductive potential
Most
Acute nausea usually occurs 3 to 6
common
adverse
hemorrhagic or non-hemorrhagic cystitis hours after an oral dose and
effects usually lasts about 24 hours
Most serious
adverse Liver toxicity
effects
Maximizing
Ensure that patient has adequate bone marrow Administered on an empty
therapeutic
effects reserve and good renal function. stomach.
Minimizing Promote vigorous hydration and diuresis, and

adverse administer mesna, if indicated, to prevent
effects hemorrhagic cystitis.
Most
Patients should be carefully
important Instruct the patient to drink plenty of fluids
patient
instructed on proper
and empty the bladder every 2 hours.
education administration to ensure safety.
Obtain a current and accurate height and weight

in order to calculate the body surface area.
These numbers should be independently verified

Life span and not obtained from another provider’s stated
Alert measurements to ensure that the proper dose of
cyclophosphamide is administered.
Death can result if inappropriate doses are

administered
.
Drug Doxorubicin HCl Tamoxifen
Indicated for advanced breast

Indicated for treating acute leukemia, soft-tissue
cancer in postmenopausal women
and bone sarcoma, Hodgkin and non-Hodgkin
Indications and cancers of tissues having
lymphoma, breast and ovarian cancers,
specific hormone receptors, such
bronchogenic carcinoma.
as the prostate gland.
Classification Anti-tumor Anti-biotic Anti-estrogens
Acts mainly by intercalation between specific base

Deprives estrogen-sensitive tumors of
Mechanism pairs within the cancer cell’s DNA.
estrogen
of Action This action results in blocking the synthesis of new
RNA or DNA
Major
Allergy to the drug, pregnancy, and
contra- Severe depression of bone marrow function
lactation
indications
Most
common Occurrence of hot flashes, especially
Alopecia and nausea with vomiting
adverse among premenopausal women
effects
Most serious Risk of endometrial cancer and
Cardiac damage, bone marrow depression, and
adverse thromboembolic events associated
extravasation
effects with long-term therapy
Instruct the patient to take his/her pills

Maximizing bid, in the morning and evening.
Administer dexrazoxane cardio-protectant therapy, if
therapeutic
indicated. Drug should not be discontinued
effects
without consulting the physician or
nurse.
Teach the patient to regulate the

home environment to a cooler
temperature.
To wear loose, cotton, layered

clothing (for hot flashes).
Minimizing -Maintain maximum lifetime dose of 550 mg/m2
To eat small, frequent meals and to
adverse
-if patient is receiving radiation or concurrent stay away from spicy foods (for
effects myelo-toxic therapy, dose is 400 mg/m2 nausea and vomiting).
To notify the physician

immediately if symptoms of muscle
weakness, pain and swelling of
legs and ankles, mental confusion,
and constipation are noted.
Most Counsel women about the possible

Warn patient of the appearance of red urine
important risks of endometrial cancer and to
discoloration (harmless) after administration and
patient have regular gynecologic
of alopecia, which is reversible.
education checkups.

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Unit 3: Peripheral Nervous System Drugs

Drug Epinephrine/Norepinephrine Dopamine Dobutamine

Use is for the treatment of hypertension.

Classification Alpha-2 adrenergic agonist Alpha-1 adrenergic agonist (Vasopressor)

When administered transdermally, drug

-Because clonidine can be used to prevent

-Rebound hypertension may occur if the

Drug Prazosin Metoprolol

Treats hypertension, angina, chronic heart

Alpha-adrenergic antagonists / Beta-adrenergic antagonists (Selective Beta-2

-Beta-1 blockade decreases heart rate and

-As metoprolol decreases cardiac output, it may

Cardiovascular abnormalities (e.g., bradycardia,

Drug Pilocarpine Neostigmine Atropine

-Bind to the muscarinic

Minimizing Availability of antidote, Availability of Atropine,

Safety issues for blurred

Drug Isoflurane Propofol Lidocaine

A parenteral anesthetic Used for infiltration

Drug Vecuronium Succinylcholine

Used to facilitate endotracheal

Hypersensitivity, History Of Malignant

Minimizing Have resuscitation equipment

-Used to treat neuropathic pain

Spasmo-lytic (Centrally acting) / Spasmo-lytic (Peripherally

Drug Carbidopa-Levodopa Neostigmine

-Myasthenia gravis (main indication!).

Dopamine-rgic agent /Anti- An indirect-acting cholinoceptor

Diffuses levodopa into the central nervous

Known Hypersensitivity, Allergy To

Minimizing Titrate Drug Upward To Avoid

Used in Moderate to Severe pain (LVF, MI,

Reduce the release of neurotransmitters in the

-as a Cough Suppressant—drowsiness,

-Individualize dose based on patient-related

For long-term use in cancer pain, physical

-Check, dose and patient status carefully; adverse

-Used in Moderate to Severe pain

Narcotic analgesics (narcotic agonist

Major contra- Respiratory depression, use of other CNS

Most serious Respiratory depression and circulatory

-Individualize dose based on patient-related

Naloxone can be used in adults, children,

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)-

Antipyretic effects: inhibit PGE2 synthesis in the

Active GI Diseases; Used With Caution In

Nursing Alert All NSAIDs, including ibuprofen, have an

-Aspirin should not be given to children with varicella-

-it should not be given during pregnancy, especially

-Low-dose aspirin therapy is routinely given to healthy

Used for mild to moderate pain and fever.

Classification (NSAIDs)-Serotonin-selective agonists (NSAIDs)-Serotonin-selective agonists

-It is centrally acting has no effects on platelet

-Analgesic effect: inhibit prostaglandin synthesis Stimulate 5 HT receptors located on cranial

Flushing, Dizziness, Weakness, Nausea,

Vasospasm resulting in ischemic events to

-Avoid administration to patients with

-Remind patients that the maximum adult dose

-Acetaminophen overdose is potentially fatal.

Disease-modifying Anti-Rheumatic drug

Disease-Modifying Anti-rheumatic Drugs

Activated T cells release inflammatory

Major contra- Immunosuppression, Blood Dyscrasias, Immunosuppression, Blood Dyscrasias,

-Take vitamin B, 5 mg every day. -Use aseptic technique for injections.