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FACTORS AFFECTING DRUG ACTION

1. Absorption • Route of administration • Perfusion status • GI motility 1. Distribution • Plasma protein binding • Lipid solubility Perfusion status • Barriers (BBB, placenta) • Obesity

FACTORS AFFECTING DRUG ACTION
1. • • • 6. • • • Metabolism Age Drugs Liver disorders Excretion Drug-drug interaction Blood concentration levels Renal status

NONNARCOTIC ANALGESICS AND ANTIPYRETICS
1. ASA Action • Analgesia • Antipyretic • Anti-inflammatory • Antiplatelet 2. NSAIDs (ibuprofen, naproxen, piroxicam, indomethacin, ketorolac)
Adverse Effects • Salicylism • Drowsiness • Bleeding • Edema • Hypertension • Gastritis • N and V • Hypoglycemia Respiratory alkalosis/metabolic acidosis • Reye’s syndrome

NONNARCOTIC ANALGESICS AND ANTIPYRETICS
Nursing Implications • Monitor CBC, PT, kidney and liver function studies • Additive effects if with use with anticoagulants • Drink plenty of fluids • Take with food or fluids. • Never given with children/adolescents with flu • Don’t crush enteric-coated tablets. • Avoid intake of alcohol

NONNARCOTIC ANALGESICS AND ANTIPYRETICS
2. Acetaminophen • Analgesic and antipyretic Adverse effects: • Rash • Thrombocytopeni a • Liver toxicity Nursing Considerations: • Monitor liver and kidney function and CBC • Antidote: Nacetylcysteine (Mucomyst)

ANTIPSYCHOTIC MEDICATIONS
1. • • • • • Phenothiazines Thioridazine Haloperidol Thorazine Promethazine Fluphenazine Adverse Effects: • EPS (dystonia, parkinson’s, tardive dyskinesia, akathisia) • Dizziness, sedation • Orthostatic hypotension • Anticholinergic affects • Photosensitivity • Neuroleptic malignant syndrome • Agranulocytosis • Hyperprolactinemia • Hypersensitivity (obst. Jaundice)

Action: • Blocks dopamine receptors • Anticholinergic, antihistamine, antiadrenergic effects • Antiemetic

ANTIPSYCHOTIC MEDICATIONS
Nursing Implications • Wear gloves when handling parenteral or liquid forms. • Give deep IM injection into gluteal muscle and massage well. Store in cool, dark place. • Monitor for EPS. • Take with food or milk. • Take at bedtime. • Advise not to drive or do activities that require attention. • Change position gradually • Report fever and sore throat to physician • Wear protective clothings. • Never abruptly withdraw drug • Avoid smoking

ANTIMANIC MEDICATIONS
Lithium

Nursing Implications: Adverse effects: • Monitor serum • Confusion lithium levels • Restlessness monthly • Fatigue • Monitor for lithium • Hand tremors toxicity. • Arrythmias • Hypotension • Teach patient to increase fluid intake. • BOV • Maintain sodium • Weight gain intake of 6-10 g/day. • N and V • hypothyroidism• Take with food.

ANTIDEPRESSANT DRUGS
1. Tricyclic antidepressants • Nortryptyline • amitriptyline • Imipramine Adverse Effects: • Sedation • Confusion • Anticholinergic effects • Orthostatic hypotension • Arrythmias • Blood dyscrasia

Nursing Implications: • Takes 2-4 weeks to take effect. Monitor for suicidal tendencies. • Monitor CBC. • Drug therapy disconitued gradually. • Taken with food • Monitor for toxicities (seizures,coma.arryt

ANTIDEPRESSANT DRUGS
1. MAO Inhibitors • Phenelzine • Tranylcypromine Adverse Effects: • Orthostatic hypotension • Anticholinergic effects • Hypertensive crisis • Leukopenia

Nursing Implications: • Protect patient from injury • Monitor I and O • Inform patient to avoid foods and fluids high in tyramine • Monitor CBC and liver function tests.

ANTIDEPRESSANT DRUGS
1. SSRI • Sertraline • Fluoxetine Uses: • Major depression • ObsessiveCompulsive D/O
Adverse Effects: • CNS stimulation • Sexual dysfunction • N & V, anorexia • Weight loss Nursing Implications: • Interacts with warfarin. • Cannot be combined with MAOI. • Taken in the morning • Report immediately if with rashes

ENDOCRINE DRUGS
ANTIDIABETIC AGENTS 2. Insulin Adverse Effects: • Allergy • Hypoglycemia • Lipodystrophy Nursing Implications: • Do not inject cold insulin. • Discard discolored solutions or those with precipitates. Do not shake vial. • Draw up clear insulin first. • Rotate injection sites • Monitor blood glucose levels regularly. • Inform patients regarding signs of hypoglycemia and appropriate treatment. • If ill continue taking insulin and drink freely nancaloric liquids. • Inform regarding avoidance of smoking.

Type

Rapid-acting •Regular •Clear insulin •Semilente insulin Intermediat e acting •NPH •Lente Long-acting •ultralente

Appearanc Onse peak Duratio e t n ½-1 ½-1 2-4 4-6 6-8 12-16

•cloudy

•cloudy

1-1 ½ 8-12 1-1 1/2 8-12 1620

18-24 18-24 30-36

•Cloudy

4-8

Insulin
1. Drugs that increase effect of insulin • Aspirin • Oral anticoagulants • Beta blockers • TCAs 6. Drugs that decrease insulin effect • Glucocorticoids • Thiazide diuretics • OCP • Thyroid agents

Oral Hypoglycemic agents
a. Sulfonylureas
– promotes inc. insulin secretion from pancreatic beta cells through direct stimulation (requires at least 30 % normally functioning beta cells) – First-Generation Agents: • Tolbutamide, Acetohexamide, Tolazamide, Chlorpropamide – Second-Generation Agents • Glypizide, Glyburide

Oral Hypoglycemic agents
b. Biguanides – reduces hepatic production of glucose by inhibiting glycogenolysis – decrease the intestinal absorption of glucose and improving lipid profile – Agents •Phenformin , Metformin , Buformin

Oral Hypoglycemic agents
c. Alpha-glucosidase inhibitors
– Inhibits alpha-glucosidase enzymes in the small intestine and alpha amylase in the pancreas – Decrease rate of complex carbohydrate metabolism resulting to a reduced rate postprandially. – Agents
• Acarbose (precose), Miglitol (glyset)

Oral Hypoglycemic agents
d. Thiazolidinediones – Enhances insulin action at the cell and post-receptor site and decreasing insulin resistance – Agents • Pioglitazone (Actos), Rosiglitazone (Avandia)

Adverse Effects: • Nausea and vomiting • Hypoglycemia • Hemolytic anemia • Allergy • Photosensitivity Nursing implications: • Tablets should not be crushed • Monitor for signs of hypoglycemia

• Use other forms of contraception aside from OCPs • Alcohol can trigger a hypoglycemic effect. • Cover body is sunshine. Use of sunscreen. • Sulfonylureas are best taken before meals • Monitor for drug to drug interactions.

Oral Hypoglycemic agents
Drugs that reduce hypoglycemic effects: • Diuretics • Steroids • OCPs Drugs that potentiates hypoglycemic effects: • Sulfonamides • MAOI • Coumarin • Salicylates • Probenecid • propranolol

CORTICOSTEROIDS
• Cortisol, hydrocortisone, prednisone, prednisolone, methylprednisone, triamcinolone, dexamethasone • Mineralocorticoid (fludrocortisone) Uses: • Replacement therapy for adrenocortical insufficiency • Anti-inflammatory agent

Adverse effects: 1. Altered protein metabolism • Muscle wasting • Osteoporosis • Easy bruisability 2. Altered fat metabolism • Moon facies • Buffalo hump • Truncal obesity • hyperlipidemia 3. Altered carbohydrate metabolism • Hyperglycemia

1. Altered immune response 2. Sodium and water retention 3. Hypertension 7. Hypokalemia, metabolic alkalosis 8. Emotional instability 9. Excessive androgen activity 10. Gastric irritation

Nursing Implications: • Review patient’s medical history prior to giving the drug • Administer in light-resistant containers • Observe for mental changes. • Monitor for BP, weight, I and O, glucose, electrolytes. • Take with food or milk. • Take drug before 9 AM. • Never abruptly stop taking the drug • Teach patient ways to prevent infection. • Restrict sodium, alcohol and caffeine intake. • Increase intake of foods high in potassium. • Rinse mouth after using inhaled steroids • Teach patient to avoid strenous activities

ANTITHYROID DRUGS
• Propylthiouracil (PTU) and methimazole • During pregnancy PTU, is the preferred therapy • A few of the infants born to mothers receiving antithyroid medication will be hypothyroid. • Mechanism of action – Blocks thyroid hormone synthesis

Propylthiouracil (PTU) and methimazole
Adverse effects: • Skin rash • Urticaria • Agranulocytosis • Hepatitis • Myalgia • Headache • Hypoprothrombinemia • hypothyroidism

Nursing considerations • Give the drug with meals to reduce GI effects • Watch for signs of hypothyroidism • WOF: Agranulocytosis • Instruct patient to report for skin eruptions • The drug should be stopped if severe rash develops or cervical lymph nodes become enlarged • Advise patient to avoid foods high in iodine or potassium • Warn the patient against the use of the over-the-counter medication • Store the drug in a light-resistant container • Monitor for weight and PR regularly.

PTU/Methimazole

SSKI/Lugol’s solution
Potassium or sodium iodide (potassium iodide SSKI), strong iodine solution (Lugol’s solution) • Treatment for thyrotoxic crisis • Mechanism of action:
– Inhibits the release and synthesis of thyroid hormones – Decreases the vascularity of the thyroid gland – Decreases thyroidal uptake of radioactive iodine following radiation emergencies or administration of radioactive isotopes of iodine

SSKI/Lugol’s solution
Adverse Effects: • Unpleasant tase • Hypersalivation • Acne • Rashes • angioedema • Burning sensation

SSKI/Lugol’s solution
Potassium or sodium iodide, (potassium iodide solution, SSKI), strong iodine solution (Lugol’s solution) • Dilute oral doses in water or fruit juice and give with meals. • Warn the patient that sudden withdrawal may precipitate thyrotoxicosis • Store in a air-tight and light-resistant container. • Give iodides through a straw to avoid tooth discoloration • Force fluids to prevent fluid volume deficit

Radioactive iodine (sodium iodide or 131I )
• Food may delay absorption. The patient should fast overnight before administration • After dose for hyperthyroidism, the patient’s urine and saliva are slightly radioactive for 24 hours; vomitus is highly radioactive for 6 to 8 hours. • Institute full radiation precautions during this time • Instruct the patient to use appropriate disposal methods when coughing and expectorating.

Radioactive iodine (sodium iodide or 131I )
– The patient should drink as much fluid as possible for 48 hours after drug administration to facilitate excretion. – Limit contact with the patient to 30 minutes per shift per person the 1st day; may increase time to 1 hour on 2nd day and longer on 3rd day.

THYROID HORMONES
• Levothyroxine • Liothyronine • Thyroglobulin (Proloid) Adverse Effects: • Signs of hyperthyroidism

THYROID HORMONES
Nursing Implications: • Different brands of levothyroxine may not be bioequivalent. • Warn the patient (especially the elderly) to tell the doctor if with signs of hyperthyroidism • Instruct the patient to take thyroid hormones at the same time each day to maintain constant hormone levels. • Medications taken in the morning. • Monitor apical pulse and blood pressure. If pulse is >100 bpm, withhold the drug. • Store in air-tight and light-resistant containers. • Monitor prothrombin time; a patient taking these hormones usually requires less

OXYTOCIN
Uses: • Promotion of uterine contractions • Control of bleeding • Release of milk from breast Oxtocin-related drugs: • Methergine • ergonovine

Adverse Effects: • Hypotension • Tachycardia • Water intoxication • Uterine rupture • Nausea and vomiting • Cardiovascular collapse • Anaphylaxis • Hypertension (oxytocin-related

Nursing Implications: • Use infusion pump for administration. Never give IM • Monitor BP, heart rate and I and O. • Regularly monitor for uterine contractions and FHR. • Discontinue if:  With note of tetanic uterine contractions.  Signs of fetal distress  Urinary flow is less than 30 ml/hour  Signs of abruptio placenta and uterine rupture • For ergonovine/methergine- C/I for patients with vascular, renal and

OXYTOCIN

ANTIASTHMA DRUGS
• Beta adrenergic agonists • Anticholinergic drugs • Methylxanthines • Mast Cell stabilizers • Leukotriene inhibitors • Cortocosteroids

Methylxanthines
• • • Theophylline Aminophylline Theo-dur Adverse Effects: • CNS stimulation • Tachycardia, hypotension, palpitations • Nausea and vomiting • Rectal irritation with suppository

Action: • Bronchodilator • CNS stimulant • Increased renal blood flow

Methylxanthines
Nursing Implications: • Monitor theophylline levels. • Monitor VS, I and O and symptoms of toxicity • Avoid smoking and use of marijuana. • Administer with milk if with GI distress, otherwise take before meals with water. • Avoid excessive caffeine use • Do not crush or chew time-release or enteric coated tablets

Mast Cell Stabilizer
• Cromolyn sodium • Nedocromil Actions: • Prophylaxis against asthma attacks • Allergic rhinitis Adverse Effects: • Bronchoconstriction • Cough • Nasal congestion • rash

Mast Cell Stabilizer
Nursing Implications: • Teach patient to use before exercising. • Teach about proper use of inhaler
     With spinhaler place capsule in container and exhale fully. Place mouthpiece between lips. Tilt head back and inhale fully. Remove inhaler, Hold breath Exhale slowly

• Rinse to reduce irritation in the mouth. • Discontinue use if an allergic reaction occurs.

ANTINEOPLASTIC AGENTS
• • • • • • • A. General Adverse Effects GI symptoms alopecia BM depression hepatotoxicity ↑ uric acid fatigue

• B. Prototype – Cyclophosphamide(Cytoxan) 1. Action. Produces cytoxic effects by damaging DNA • and interfering with cell replication. 2. Adverse Effects. Hemorrhagic and nonhemorrhagic • cystitis • ANTIMETABOLITES • Prototype – Methotrexate with leucovorin rescue
– 5-Fluorouracil (5-FU) – Mercaptopurine (Purinethol) – Cytarabine (Cytosar-U)

• Action. Leucovorin calcium is a folic acid analog that interferes with mitotic process by blocking folinic acid.

• • •

ANTIBIOTIC ANTINEOPLASTIC AGENTS

Action. Attaches to DNA and prevents DNA synthesis in vulnerable cells. Adverse Effects.
– – – hyperuricemia cardiotoxic BM depression

Prototype – Dactinomycin and Doxorubicin HCl (Adriamycin)

• • • •

VINCA ALKALOIDS Prototype – Vincristine (Oncovin) and Vinblastine
– –

MISCELLANEOUS ANTINEOPLASTIC AGENTS L-Asparaginase (Elspar)
– – –

Action. Acts on cells undergoing mitosis, thus stopping cell division. Adverse Effects. Neuropathy and neurotoxic

Hydroxyurea (Hydrea)

Action. Enzyme that destroys asparagines, an amino acid necessary for protein synthesis of leukemia cells. Adverse Effects. Azotemia, hemorrhagic pancreatitis, hyperglycemia, hepatotoxicity Action. Urea derivative that kills granulocytes