Drugs affecting the ● Support group for epileptics

1. CNS ● Report adverse effects – report to the doctor

2. Respiratory
3. Cardiovascular Cardiovascular
4. GIT 1. Anti-hypertensive
5. Endocrine 2. Cardiac Glycosides
3. Anti-anginal drugs
4. Anti-arrhythmic drugs
CNS Depressants
Common Drugs: Angiotensin antagonist (Angiotensin converting
enzyme inhibitor or ACEI)
Sedative-hypnotics - Common Drugs: ● PRILS
Benzodiazepine – action – increase GABA – calming ● enalapril
effect ● lisinopril
Anesthetics ● captopril
Analgesics
Anticonvulsants Angiotensin II receptor blockers
Anxiolytics - Increase in 3Ds - drowsiness, dizziness, ● The “sartans”
and decrease in BP ● Losartan
● Valsartan
Antidepressants – TCA, MAOI, SSRI ● newest group, may only be indicated when ACEI
Analgesic - drugs that relieve the sensation of pain are intolerable, mostly free of side effects but
● Non-narcotic analgesics very costly.
○ Salicylates – aspirin (analgesic, ● Decrease blood pressure.
antipyretic, anti-inflammatory, decreases
platelet aggregation) Beta blockers - block the effects of
○ NSAID – meloxicam (analgesic, anti- epinephrine/adrenaline.
inflammatory) Reduces sympathetic stimulation in cardiac muscle.
○ Para aminophenol – acetaminophen Causing the heart to beat more slowly and with less
(analgesic) force, which lowers blood pressure.
● Narcotic analgesics Beta blockers also help open veins and arteries to
improve blood flow. Increase blood flow to the kidney.
Nursing Implications
-Assess respiratory status – Naloxone (Narcan) for opiod Calcium Channel Blockers
toxicity ● They work by slowing the movement
-Assess for hypotension of calcium into the cells of the heart and blood
-Monitor bowel elimination vessel walls, which makes it easier for the heart
-Evaluate pain response to medication to pump and widens blood vessels.
● Examples of calcium channel blockers
Antidepressant include:
● TCA – tricyclic antidepressants - increases ● Amlodipine (Norvasc)
neurotransmitter concentration levels of NE and ● Diltiazem (Cardizem, Tiazac, others)
serotonin. ● Nicardipine.
● - Anticholinergic effect ● Nifedipine (Adalat CC, Procardia)
● MAOI – mono amine oxidase inhibitors – inhibit
MAO enzyme that metabolizes NE and Cardiac Glycosides
serotonin ● digoxin (Lanoxin)
● - Hypertensive crisis – avoid eating tyramine rich ● digitoxin (Crystodigin)
foods like dairy products Effects:
● SSRI – Serotonin Reuptake Inhibitors - inhibit ● positive inotropic effect – increase force of
the serotonin uptake. contraction
● - administer with meals to reduce nausea. ● Negative chronotropic effect - decrease heart
rate
Anti-convulsant - substance that prevents, reduces, ● Adverse reactions: digitalis toxicity –
or stops the severity of epileptic or other convulsive heart/pulse rate less than 60.
disorders. ● Therapeutic level is 0.5 to 2.0 nanograms/mL)
● Antidote: digoxin immune fab (Digibind)
Nursing Consideration
● CNS: dizziness
● Eat food with drug – causes gastric irritation
● Antacids decrease – it will delay the absorption
of anti-epileptic drugs
Antianginal Drugs
● Nitrates – relaxes vascular smooth
muscles, decrease arterial BP, decrease
left ventricle workload. VASODILATION
● Beta-blockers – DECREASE HEART
RATE
● Calcium-channel blockers –
DECREASE FORCE OF
CONTRACTION
Rapidly acting agents
● E.g., nitroglycerine (Nitrostat, Transderm Nitro)
● Usually given sublingually -
● Used to terminate acute attack of angina
● If chest pain persists for more than 5 minutes,
hospital consultation should be done
immediately.
GIT
Peptic Ulcers
● Acid-suppressing drugs
● Antacids
● H2 receptor antagonists
● Proton-pump inhibitors
● Mucosal protective agents
● Sucralfate
● Prostaglandin analogue
● Bismuth-containing compounds
● Antacids – neutralize secreted acid.
Side effect: rebound acidity: stomach produces more
acid in response to an alkaline environment
● H2 receptor antagonist - selectively block
specific histamine receptor sites leading to a
reduction in gastric acid secretion.
● Cimetidine (Tagamet) – side effect: androgenic
antagonist
● Proton-pump inhibitors - inhibit the hydrogen-
potassium-ATPase enzyme system located in
the gastric parietal cells.
● Mucosal protective agents
● Sucralfate (Carafate) Protect the lining of the
gastrointestinal tract from
harmful stomach acid.
● Nursing considerations:
● Evaluate the effectiveness of the medications if
the client states relief from abdominal pain
caused by hyperacidity.
● Side effects of antacids:
● rebound acidity: stomach produces more acid in
response to an alkaline environment
● constipation: if aluminum products are used
● diarrhea: if magnesium product used
● fluid retention if sodium bicarbonate products
are used
● milk-alkali syndrome (alkalosis, renal calcium
deposits, severe electrolyte disorders): if calcium
salts are used
Anti-emetic drug – prevent vomiting
● Antihistamine - meclizine
● Anticholinergics – scopolamine, transderm
scoop (applied behind the ear)
● Dopamine antagonists - metoclopramide
● Serotonin receptor antagonists - ondansetron
Anti diarrheal drug
Adsorbents: kaolin pectin (kaopectate)
Loperamide - direct muscles of the GI tract to slow
activity and allow increased time for absorption of fluid
and electrolytes.
Laxatives
Bulk forming
▪ natural fibrous, non-absorbable substances
Action: fluid in the intestinal contents →enlarges bulk →
stimulates local stretch receptors→ GI motility
Common drugs: methycellulose (Cologel)
psyllium (Metamucil)
dietary fiber (Fibrosine)
lactulose (Duphalac)
Respiratory
● Upper Respiratory Agents
● Antihistamine
● Decongestants
● Expectorants
● Antitussives
● Lower Respiratory
● Bronchodilators
● Anti-inflammatory
Antihistamine – blocks H1 receptors thereby
decreasing allergic response.
● Allergic responses like itchy, watery
eyes, rhinitis.
● Benadryl AH, Dimetapp
Decongestants – eliminate or reduce congestion or
swelling.
● Common drugs – pseudoephedrine,
phenylephrine
● limit 5-7 days to prevent rebound nasal
congestion.
Expectorant – liquefy secretions by enhancing the
output of respiratory fluid reducing the viscosity of
secretions and decreasing its adhesiveness.
● Guafenesin – loosen bronchial
secretions for effective coughing.
● Benadryl, Robitussin
● Increase water intake.
Antitussives – supress the cough reflex. Non-
productive cough.
● dextromethorphan (Robitussin DM)
● reduce the frequency of cough.
Lower Respiratory Tract disorder
Common disorder:
● Bronchial asthma - Reversible airway
obstruction that is characterized by
hyperirritability and inflammation of the airways.
Main problems – bronchoconstriction and
inflammation
Medications: Bronchodilators
● 1. Sympathomimetic
● 2. Xanthine derivatives – methylxanthines –
Aminophylline-Theophylline
Side effects: Cardiac stimulation:
tachyarrhythmias, tachycardia
● 3. Anticholinergics (parasympatholytic)
Medication: Anti inflammatory
● 1. Glucocorticoids - decreasing the inflammatory
response and reduce mucus plugs and edema
secondary to vascular permeability.
● 2. Leukotriene receptor antagonist – Zafirlukast,
Montelukast
Nursing considerations:
● assess respiratory status
● assess liver function tests
● medication does not treat acute asthma attacks
Endocrine
● Anti-Diabetic Drugs
Insulin - increases glucose transport into cells and
promotes conversion of glucose to glycogen decreasing
serum glucose levels
Normal glucose level - 4.2 – 6.4 mmol/L (75 – 115
mg/dL)
Oral Hypoglycemic Agents – OHA
Sulfonylureas
MOA: stimulates the beta cells secrete more insulin →
insulin cell receptors → inc. ability of cells to bind insulin
for glucose metabolism
Alpha-glucosidase inhibitors
MOA: inhibits the digestive enzyme (alpha-glucosidase)
in the small intestine (responsible for the release of
glucose from the complex carbohydrates (CHO) in the
diet) → CHO cannot be absorbed → CHO passed into
the large intestine.
It stimulates the pancreas to produce insulin and
increases peripheral receptors sensitivity to insulin
decreasing serum glucose levels.
3. Biguanides
● Drugs: phenformin, metformin (Humamet,
Glucophage, Avandamet, Glucovance)
4. Thiazolidinediones
● Used for decreased insulin-stimulated glucose
uptake
● Improve the response of muscle and adipose
tissue to insulin in patients who are otherwise
relatively unresponsive, notably the extremely
obese
● Decrease insulin resistance
Drugs:
● Rosiglitazone (Avandia,
Avandament)
● piolitazone (Actos)
● Best suited for patient who are obese or
insulin-resistant
5. Meglitinides
● Drugs: Repaglinide (NovoNorm) Nate glinide
(Starlix)
● Stimulate the beta cells to release insulin
● Should not be prescribed for client with liver
dysfunction
● May cause hypoglycemic reaction
● Best suited for patients with recently diagnosed
type diabetes who have high postprandial
glucose levels