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VITAL ESSENTIAL

AND NECESSARY
DRUGS (VEN) LIST
CLASSIFICATION OF
DRUGS
By Samantha McIntosh
OBJECTIVES
O DRUGS USED IN THE DISORDER OF EACH
SYSTEM:
O CARDIOVASCULAR SYSTEM
O CENTRAL NERVOUS SYSTEM
O DERMATOLOGY
O EAR, NOSE AND OROPHARYNX (ENT)
O ENDOCRIME SYSTEM
O GASTROINTESTINAL SYSTEM
O RESPIRATORY SYSTEM
O MUSCULOSKELETAL SYSTEM AND JOINT
DISEASES
O GENITO-URINARY TRACT

O DRUGS USED IN THE TREATMENT OF
THE FOLLOWING:
O INFECTIONS
O MALIGNANT DISEASES AND FOR
IMMUNOSUPPRESSION
O STDs
o DRUGS USED IN OPTHALMOLOGY
o DRUGS USED IN ANNAESTHESIA
o VACCINES
o ANTIDOTES AND OTHER SUBSTANCES
USED IN POISONING

CARDIVASCULAR SYSTEM

1. Diuretics
2. Cardiac glycosides
3. Anti-arrhythmic drugs
4. Anti-hypertensive therapy
5. Angiotensin converting enzymes (ACE) inhibitors
6. Angiotensin II receptor antagonists
7. Anti-anginal
8. Sympathomimetics
9. Anti-coagulant and anti-platelet
10. Homeostatics
11. Lipid lowering
12. Fibrinolytic



DIURETICS

O Drugs that modify renal function to induce diuresis.
Mainly used in the treatment of heart failure, HTN
and oedema.
O Examples:
O Furosemide (Lasix) sulfonamide Loop diuretic and
antihypertensive.
O hydrochlorothiazide (HTCZ) thiazide diuretic
O Mannitol osmotic diuretic
O Indapamide SR (electrolytic & water balancing
agent; diuretic) thiazide-like diuretic
O Spironolactone potassium-sparing diuretic
O Metolazone, Bendrofluazide.
CARDIAC GLYCOSIDES

O Drugs used to increases contractility of the heart
muscles.
O Digoxin (Lanoxin) Inotrope/cardiac glycoside
(Antiarrhythmic effect)
O (Check apical pulse for 1 full minute before
administration if apical pulse is below 60 withhold
drug )

Also used in the treatment of Congestive heart failure and
Cardiac Arrhythmia.
INOTROPES
O Strengthen myocardial contractility.

O Agents that alters the force or energy of muscular
contractions.

O Negatively inotropic agents weaken the force of
muscular contractions.

O Positively inotropic agents increase the strength of
muscular contraction.
ANTI-ARRHYTHMIC DRUGS

O 4 Classes
O Class 1B Antiarrhythmic
Lignocane (Lidocaine)
Class 2 (beta- Adrenergic Blocking Drugs have a
negative inotropic action)
Atenolol, Bisoprolol, propranolol.
Class 3 - Antiarrhythmic
Amiodarone, Adenosine
Class 4 (Calcium Channel blockers)
Verapamil

Antiarrhythmic drugs are used to treat abnormal heart
rhythms resulting from irregular electrical activity of the
heart.
CLASS I B
O LIDOCAINE suppresses automaticity in His-
Purkinje system of the heart and elevates
electrical stimulation threshold of ventricle
during diastole.

O Rapid control of ventricular arrhythmias
occurring during acute MI, cardiac surgery and
cardiac catheterization and those caused by
digitalis intoxication.
CLASS II
Beta- adrenergic blocking antagonist
Atenolol, propranolol, Bisoprolol
Antihypertensive & Antianginal effects

Reduces rate and force of cardiac contractions
(negative inotropic action): cardiac output is
reduced as well as systolic and diastolic blood
pressure.

Atenolol decreases peripheral vascular
resistance both at rest and with exercise.
ATENOLOL
O Measure BP before administration and
monitor throughout.

O Monitor diabetics for loss of glycaemic
control. Drug may mask symptoms of
hypoglycaemia.

CLASS III
O Amiodarone hcl antiarrhythmic
O Class III Antiarrhythmic drugs that has antianginal
and antiadrenergic properties.
O Acts directly on all cardiac tissues by prolonging
duration of action potential & refractory period.
O Slows conduction time through the AV node & can
interrupt the re-entry pathways through the AV
node.
Nursing implications for
Amiodarone
O Check patient pulse daily once stabilized & report
pulse lower then 60 bpm.
O Avoid grapefruit while taking drug.
O Avoid exposure to sunlight drug may cause
photsensitivity.
CLASS IV
O Calcium Channel Blockers
O Verapamil
O Decrease angina attacks by dilating coronary
arteries and inhibiting coronary vasospasms.
O Decreasing nodal (SA & AV) conduction, resulting in
an antiarrhythmic effect.
O Decrease total peripheral vascular resistance; &
therefore reduce blood pressure
CALCIUM CHANNEL
BLOCKERS primarily have 3
effects:

O Acting on vascular smooth muscle they reduce
contraction of the arteries and cause an increase in
arterial diameter, a phenomenon called vasodilation
(CCBs do not work on venous smooth muscle)
O Acting on cardiac muscles (myocardium), they
reduce the force of contraction of the heart
O Slowing down the conduction of electrical activity
within the heart, they slow down the heart beat.

ANTI-HYPERTENSIVES
O Vasodilators -
O reduces Bp by direct effect on smooth muscles of
arterial-resistance vessels, resulting in vasodilation.

O Improves cardiac output, renal and cerebral blood flow.
O Hydralazine Nonnitrate vasodilator, antihypertensive
(monitor pt for edema)
O sildenafil Citrate pulmonary antihypertensive


O Centrally Acting Alpha-Agonist -
reduces renal vascular resistance;
maintain cardiac output, slow heart rate,
supports sodium retention.
O Methyldopa

ANGIOTENSIN CONVERTING
ENZYME (ACE) INHIBITORS
O ACE inhibitors decreases angiotensin II levels, thus
decreasing vasopressor activity and aldosterone
secretions.
O Suppress the RAAS system
O Reduce peripheral and arterial resistance.
O Lowers Bp.
O Improve cardiac output results in increased
exercise tolerance.
O Captopril, enalapril

O ACE inhibitors is an enzyme that
catalyzes the conversion of angiotensin I
to angiotensin II, a vasoconstrictor
substance.
ANGIOTENSIN II RECEPTOR
ANTAGONIST
O Antihypertensive effect due to vasodilation
and inhibition of aldosterone effects on
sodium and water retention.
O Losarton
ANTI-ANGINAL
O Nitrates
O Calcium Channel Blockers
O Beta-Adrenergic Blockers


ANTI-ANGINAL
O NITRATES Has anti-anginal effects as a result of
vasodilation of the coronary arteries.

O Relaxes vascular smooth muscle with resulting vasodilation.

O Dilation of peripheral blood vessels tends to cause peripheral
pooling of blood, decrease venous return to heart, & decrease
left ventricular end diastolic pressure, with consequent
reduction in myocardial oxygen consumption.

O Isosorbide Dinitrate nitrate, vasodilator
O Glyceryl Tinitrate
ANTI-ANGINAL
O Calcium Channel Blockers Blocks selectively blocks
calcium influx across cell membranes of cardiac and vascular
smooth muscle without changing serum calcium
concentrations.
O It reduces coronary vascular resistance and increases coronary
blood flow.

O Amlodipine decrease peripheral vascular resistance,
increase oxygen delivery to the myocardial tissues &
increase cardiac output.
O Reduce systolic, diastolic & mean arterial blood pressure.
It decrease pain due to angina.
O Used in mild to moderate HTN & stable angina
O Nifedipine

ANTI- ANGINAL
O Beta-Adrenergic Blockers contributes to BP reduction.
Peripheral vasodilation & therefore, decrease peripheral
resistance results from alpha1- blocking activity.

O Carvedilol an effective antihypertensive agent
reducing BP to normotensive range and useful in
managing some angina, dysrhythmias, & CHF by
decreasing myocardial oxygen demand & lowering
cardiac workload.

O Metaprolol

SYMPATHOMIMETICS
O Sympathomimetic drugs mimic the effects of sympathetic
activation on the heart and circulation.
O Like the sympathetic nerves innervating the heart,
sympathomimetics stimulate the heart through activation.
O Sympathomimetics cause vascular smooth muscle contraction
and vasoconstriction through activation.
O INJECTIONS
O Adrenaline Chloride (Epinephrine hcl) reverses
analphylactic reactions & provide temporary from acute
asthmatic attach. Restores normal cardiac rhythm.
O Dopamine -
O Dobutamine

ANTI-COAGULATED
ANTIPLATELET
O Heparin inhibits formation of new clots.
O Has rapid anticoagulant effects.
O Does not lyse existing thrombi but may prevent their
extension & propagation.
O Warfarin deters further extension of existing thrombi &
prevents new clots from forming.

O Aspirin (analgesic, antiplatelet, antipyretic)- Inhibits platelet
aggregation.
O Impair hepatic synthesis of blood coagulation factors VII, IX
& X.

O Inhibits platelet aggregation, reducing ability of blood to clot
HAEMOSTATICS
O Agents acting to conserve blood but have differing sites of action in
the complex pathways determining coagulation and fibrinolysis.
O Absorbable haemostatics arrest bleeding either by the formation
of an artificial clot or by providing a mechanical matrix that
facilitates clotting when applied directly to the bleeding surface.
O These agents function more at the capillary level and are not
effective at stemming arterial or venous bleeding under any
significant intravascular pressure.
O Inhibit the activation of plasminogen to plasmin, prevent the
break-up of fibrin and maintain clot stability.

O Aminocaproic acid (coagulator; systemic haemostatic) inhibits
plasminogen activator substance, and to a lesser degree
plasmin (Fribrinolysin) which is concerned with destruction of
clots.
O Acts as an inhibitor of fribrinolytic bleeding.
LIPID LOWERING DRUGS
O ANION EXCHANGE RESINS Cholestyramine or
Questran (antilipemic; bile acid sequestrant)
O increases faecal loss of bile acids.
O Leading to lowered serum total cholesterol by decreasing (LDL)
cholesterol.
O Serum triglycerides levels may increase or remain unchanged.

O STATINS Simvastatin or Lovastin (antihyperlipemic)
O decreases serum triglycerides, decreases LDL, cholesterol &
modests increase in HDL cholesterol.
FIBRINOLYTIC
O Streptokinase Injection (used intracoronary on IV)-
Streptokinase is used to dissolve blood clots that have formed in
the blood vessels.
O It is used immediately after symptoms of a heart attack occur
to improve patient survival.
O May also be used to treat blood clots in the lungs (pulmonary
embolism) and in the legs (deep venous thrombosis)
O Also used to dissolve blood clots in tubes (catheters) that are
inserted in blood vessels.

FRIBRINOLYTIC
O Tissue Plasminogen Activator -
O Is a protein involved in the breakdown of blood clots.
O It is a serine protease found on endothelial cells, the cells
that line the blood vessels.
O As an enzyme, it catalyses the conversion
of plasminogen to plasmin.
O the major enzyme responsible for clot breakdown.
O it works on the clotting system. tPA is used in clinical
medicine to treat embolic or thrombotic stroke.
O Use is contraindicated in haemorrhagic stroke and head
trauma.
CENTRAL NERVOUS SYSTEM

O Anticonvulsants
O Anxiolytics
O Antidepressants
O Antipsychotics
O Sedatives
O Drugs used in Vertigo and Nausea
O Analgesics, Anti-inflammatory & Anti-pyretic
O Drugs used in Parkinsonism & Related Disorders
O CNS Stimulants
O Acetylcholinesterase Inhibitor
ANTICONVULSANTS
O Phenytoin inhibits seizure activity by reducing voltage,
frequency & spread of electrical discharges within the motor
cortex.
O Not effective for absent seizures.
O Effective to prevent or treat seizures occurring during or after
neurosurgery & after head trauma.
O Control tonic-clonic seizures.
O Used in treatment of trigeminal neuralgia.
O Gabapentin used in conjunct with other anticonvulsants.
O Effective in controlling painful neuropathies.
O Carbamazepine inhibit sustained repetitive impulses.
O Reduces post-tetanic synaptic transmission in the spinal
cord.
O Limits the spread of seizure activity.
O Provides relief in trigeminal neuralgia by reducing synaptic
transmission within trigeminal nucleus.

ANXIOLYTICS
O Alprazolam or Xanax (sedative hypnotic,
benzodiazepine) a CNS depressant that appears to act at
the limbic, thalamic & hypothalamic levels of the CNS.
O Alcohol withdrawal.
O Diazepam or Valium- sketal muscle relaxation properties.
O Larazepam

ANTIDEPRESSANTS
O Amitriptyline HCL interference with the reuptake of
serotonin & norepinephrine from the synaptic gap. Restores
the levels of these neurotransmitters .
O Also used as a prophylaxis for cluster migraine &chronic
tension headaches .

O Fluoxetine HCL or Prazac selective serotonin reuptake
inhibitor.
O Inhibition of CNS neuronal uptake of serotonin, a neural
transmitter.
SEDATIVES
O Sedatives work by slowing down brain activity resulting in
drowsiness or relaxation.
O Sedatives are central nervous system (CNS) depressants, a
category of drugs that slow normal brain function.
O There are various kinds of CNS depressants, most of which act
on the brain by affecting the neurotransmitter gamma-
aminobutyric acid (GABA)
O Sedatives are central nervous system (CNS) depressants, a
category of drugs that slow normal brain function.
O There are various kinds of CNS depressants, most of which act
on the brain by affecting the neurotransmitter gamma-
aminobutyric acid (GABA)

O Phenobarbital interference with impulse transmission of cerebral
cortex by inhibition of reticular activating system.
O Limiting spread of seizure activity results by increasing the threshold for motor
cortex stimulation.
O Effective as a sedative, hypnotic and an anticonvulsant with no analgesic effect.

O Drugs used in diabetes
O Thyroid and Anti-thyroid drugs
O Corticosteroids
O Hormones
O Contraceptives

DRUGS USED IN DIABETES
O Insulin
O Biguanides / Metformin
O Sulphonylureas
O Meglitinides / Prandial glucose regulator /
Glinides
O Alpha-glucosidase inhibitors
O Thiazolidinedione / Glitazones
O DPP-4 inhibitors / Gliptins
O Incretin mimetics / GLP-1 analogues
O Amylin analogues
INSULINS
O Insulin is a hormone which helps to regulate blood
sugar.
O Insulin is prescribed for people with type 1 diabetes
and for people with type 2 diabetes who have not
responded so well on oral medication (tablets).
O There are 4 types of insulin, based on how soon the
insulin starts working (onset), when it works the
hardest (peak time) and how long it lasts in your
body (duration).
O However, each person responds to insulin in his or
her own way.


TYPES OF INSULIN
O Rapid-acting insulin (Lispro) Onset 15 minutes after
injection.
O It peaks 30 to 90 minutes later and may last as long as 5 hours.
O Short-acting (regular) - Onset 30 minutes after injection.
O It peaks 2 to 4 hours later and stays in the blood for about 4 to 8
hours.
O Intermediate acting (NPH and lente) - Onset 2 to 6 hours after
injection.
O They peak 4 to 14 hours later and stay in the blood for about 14 to
20 hours.
O Long acting (ultralente) - Onset 6 to 14 hours to start working.
O It has no peak or a very small peak 10 to 16 hours after injection.
O It stays in the blood between 20 and 24 hours.


O http://www.diabetes.co.uk/about-insulin.html
STORAGE & SAFETY OF
INSULIN
O Using cold insulin can make your shot more painful.
O You can warm an insulin bottle by gently rolling it between
your hands before you fill your syringe.
O Store extra bottles in the refrigerator until ready to use.
O Never store insulin at very cold or very hot temperatures
as extreme temperatures destroy insulin.
O Do not put insulin in the freezer or in direct sunlight.
O Insulin may lose some potency if the bottle has been
opened for more than 30 days.
O Look at the bottle closely to make sure the insulin looks
'normal'. For example, if you use regular insulin, it should
be perfectly clear - no floating pieces or colour.
O Do not use insulin past the expiration date.

O http://www.diabetes.co.uk/about-insulin.html

BIGUANIDES
O Biguanides prevent the liver from producing glucose and helps to
improve the bodys sensitivity towards insulin.

O Metformin is commonly used as a first line treatment for type 2
diabetes and may occasionally be prescribed, in combination
with insulin, for people with type 1 diabetes.

O Metformin - only available diabetes medication in the biguanides
class of drugs.

O Metformin is sold both under brand names, and also as a generic
drug. Common brand names include: Glucophage,
Riomet,,Fortamet, Glumetza, Obimet, Dianben, Diabex,
Diaformin.
SULPHONYLUREA
O Sulphonylureas are the class of antidiabetic drug for
type 2 diabetes that tends to include those drugs
which end in ide.
O Glibenclamide also known as Glyburide (Daonil), Glipizide
(Glucotrol), Gliquidone (Glurenorm), Glyclopyramide (Deamelin-
S), Glimepiride (Amaryl), Gliclazide (Diamicron)
O Sulphonylureas work by increasing the amount of
insulin the pancreas produces and increasing the
working effectiveness of insulin.
O The mode of action of sulphonylureas means that
hypoglycemia and weight gain can be relatively
common side effects.
MEGLITINIDES
O Prandial glucose regulator / Glinides.
O The glinides are a class of drug which have a similar
response as sulphonylureas but act for a shorter time.
Meglitinides are prescribed to be taken by people with
type 2 diabetes within half an hour before eating. As
the drugs act for a shorter period than
sulphonylureas, the side effects of hypoglycemia and
weight gain have a smaller likelihood.
O Examples of prandial glucose regulators are (brand
names in brackets):
O Repaglinide (Prandin)
O Nateglinide (Starlix)
ALPHA GLOCSIDASE
INHIBITORS
O Alpha-glucosidase inhibitors,

O such as Acarbose (marketed as Precose or Glucobay) or
Miglitol (branded as Glyset) are drugs for type 2 diabetes.

O These drugs slow down the digestion of carbohydrates in the small
intestine and therefore can help to reduce after meal blood sugar
levels.

THIAZOLIDINEDIONE/
GLITAZONES

O Medication use in treatment of type 2 diabetes which help to
improve insulin sensitivity and have been found to help decrease
triglyceride levels.
O Decrease hepatic glucose output & increase insulin-dependent
muscle glucose uptake in skeletal muscles & adipose tissue.
O Enhance insulin sensitivity of cells without stimulating pancreatic
insulin secretion.

O In September 2010, the most popularly prescribed drug in this
class rosiglitazone (Avandia) was banned for use by the
European medicines Agency over heart attack concerns.
http://www.diabetes.co.uk/Diabetes-drugs.html

O Pioglitazone (Actos) has also made the news in connection with
instances of bladder cancer, however, the danger has not been
deemed sufficient to need to ban the drug in the UK.
http://www.diabetes.co.uk/Diabetes-drugs.html
DDP-4 INHIBITORS/
GLIPTINS
O Class of drug which help to stimulate the production of insulin
and reduce the production of glucagon, particularly during
digestion.

O DPP-4 inhibitors are usually prescribed for people with type 2
diabetes who have not responded well to drugs such as
metformin and sulphonylureas.

O This drug class includes following medications (trade names in
brackets):
O Sitagliptin (Januvia)
O Vildagliptin (Galvus)
O Saxagliptin (Onglyza)
O Linagliptin (Tradjenta) approved for use in the USA
http://www.diabetes.co.uk/Diabetes-drugs.html
INCRETIN MIMETICS/
GLP-1ANALOGUES
O These are injectable treatment for type 2 diabetes.
O Incretin mimetics mimics the effect of a group of hormones
called incretins which increase the production of insulin and
decrease the release of glucagon in a relatively similar way
DPP-4 inhibitors.

O GLP-1 analogues have been found to be particularly effective in helping to
improve blood glucose levels and helping with weight loss.

O The following GLP-1 analogues are prescribed in the UK:
O Exenatide (Byetta) improves glycemic control by reducing
fasting & post-prandial glucose concentrations in type 2
diabetes.
O Liraglutide (Victoza)
AMYLIN ANALOGUES
O Amylin is a hormone produced by the pancreas and released at
the same time as insulin, but in much smaller quantities (about
1% compared with insulin).
O Amylin helps to suppress glucagon release and therefore
reduce post meal blood glucose levels.

O Pramlintide acetate (marketed as Symlin) is an injectable drug
for the treatment of both type 1 and type 2 diabetes.

O The use of amylin with insulin can carry an increased chance of
hypoglycemia.
THYROID & ANTI-THYROID
O Thyroid hormone replacement (Levothyroxine
sodium T4) replaces decreased or absent thyroid hormone.
O Restoring metabolic rate of a hypothyroid Individual.
O Increase diuresis, loss of weight & puffiness.
O Increase a sense of well-being & activity tolerance plus rise of
T3 & T4.
O Anti-thyroid hormone (Propylthiouracil (PTU))
Interferes with the use of iodine & blocks synthesis of Thyroxine
(T4), & Triiodothyroxine (T3)

CORTICOSTEROIDS/
STEROIDS
Corticosteroids are man-made drugs that closely
resemble cortisol, a hormone that your adrenal glands
produce naturally.
Steroids work by decreasing inflammation and
reducing the activity of the immune system. (Inhibits
Phagocytosis)
O Steroids reduce the production of inflammatory
chemicals in order to minimize tissue damage.
O Dexamethasone (Adrenal corticoid & Gucocorticoid)
has both anti-inflammatory & immunosuppression properties.
O Methyl prednisolone -

HORMONES
O Hormones are chemical messengers or
substances generated in one organ & carried by
the blood to another, in which it excites activity.
(Baillieres)


O Estradiol Valerate or acetate -
O Oxytocin initiate an improve uterine
contraction at term.
CONTRACEPTIVES
O Hormonal contraceptives work by inhibiting
ovulation and fertilization.
O Changes in the cervical mucus that inhibit sperm
penetration.
O Depo-provera slows release of luteinizing
hormone (LH) preventing follicular maturation &
ovulation.

O Levonorgestrel Implant (Norplant)
O Low Dose Perle Tablets
O Lofeminal Tablets
O Levonorgestrel Tablets 750 mcg
GASTROINTESTINAL
O Antacids
O Antispasmodics & other drugs altering gut
motility
O Drugs used to treat diarrhoea
O Ulcer healing drugs
O Laxatives/Bowel cleansing solutions

ANTACIDS
O Antacids perform a neutralization reaction, (buffer
gastric acid), raising the pH to reduce acidity in the
stomach.
O When gastric hydrochloric acid reaches the nerves in the
gastrointestinal mucosa, they signal pain to the central nervous
system. This happens when these nerves are exposed, as in
peptic ulcers. The gastric acid may also reach ulcers in the
esophagus or the duodenum.
O Antacids also alter the profile of prostaglandins
produced by gastroduodenal mucosa and this may
promote mucosal healing and be related to its therapeutic
effect.
O Alka- Selter, Maalox, Milk of magnesia, Tums, Pepto-bismol,
Andrews.
O Aluminium Hydroxide 250 mg/
O Magnesium Hydroxide 500mg/5ml Susp.
O Bismuth Subsalicylate Suspension
ANTISPASMODICS & OTHER
DRUGS ALTERING GUT MOTILITY

O Drugs that suppresses muscle spasms.
O Antispasmodics is used for smooth muscle contraction,
especially in tubular organs of the gastrointestinal tract.
O The effect is to prevent spasms of the stomach, intestine or
urinary bladder.
O Dicyclomine and Hyoscyamine are antispasmodic due to their anticholinergic action. Both
of these drugs are specific to the smooth musclesand have general side effects and can
worsen gastroesophageal reflux disease
O Buscopan (hhyoscine) is known as an anticholinergic
medicine.
O It relieves the pain of stomach and bowel cramps by helping
your digestive system to relax.
O Hyoscine is used to relieve smooth muscle spasms (cramps)
in the stomach and intestines and in the bladder and urethra.
O Metoclopramide Hydrochloride (antiemetic, Gi stimulant)
ANTI-DIARRHEAL
O Oral rehydration salts -
O Will be explained later.
ANTI-ULCERS
O Antiulcer drugs are a class of drugs, exclusive of the
antibacterial agents, used to treat ulcers in the
stomach and the upper part of the small intestine.
O Omeprazole or prilosec proton pump inhibitor; anti-secretory.
(suppress gastric acid secretion).
O Ranitidine Hydrochloride or Zantac H2receptor antagonist or
H2 blocker; anti-secretory. (blocks daytime & night time gastric
secretion stimulated by histamine & reduces gastric acid
release in response to food, caffeine.
O Prescription forms:
O Tagamet (cimetidine)
O Pepcid (famotidine)

H2 BLOCKERS
PROTON PUMP
INHIBITORS
O Suppress gastric
secretions
O block one of the first
stimuli for acid
production
O blocking the histamine
receptors in acid
producing cells in the
stomach
O begin working within
an hour
O usually only work up
to 12 hours.


O Suppress gastric
secretions

O block the final step in the
pathway of acid secretion
in the stomach
O shut down the proton
pumps in the stomach


O have a delayed onset of
action

O work for a longer period of
time; most up to 24 hours
and the effects may last up
to three days.
O Recurrent gastric and duodenal ulcers are caused
by Helicobacter pylori infections, and are treated
with combination treatments that
incorporate antibiotic therapy with gastric acid
suppression.
O The primary class of drugs used for gastric acid
suppression are the proton pump
inhibitors, omeprazole, lansoprazole, pantoprazole
and rabeprazole.
O The H-2 receptor blocking
agents, cimetidine, famotidine, nizatidine, and
ranitidine have been used for this purpose, but are
now more widely used for maintenance therapy
after treatment with the proton pump inhibitors.

LAXATIVES & BOWEL
CLEANSERS
Laxatives (purgatives, aperients) are foods, or drugs taken
to loosen the stool, most often taken to treat constipation.
Laxatives work to increase the movement of faeces along
the colon.
Laxatives may be oral and/or in suppository form.
O Bisacodyl Tablets or Suppositories induces peristaltic
contractions by direct stimulation of sensory nerve endings in
the colonic wall.
O Glycerine Suppositories (paediatric & adult) hyperosmotic
laxative relieves constipation by absorption of water &
stimulation of peristalsis.
O Fleet Enema
O Mineral oil

MUSCULOSKELETAL &
JOINTS

O Non-steroidal Anti-inflammatory (Nsaids) Drugs
O Corticosteroids
O Immunosuppressant
O Antibiotics
O Neuromuscular drugs

NSAIDS
O These are a class of drugs that provide analgesic and
antipyretic (fever-reducing) effects, and, in higher doses,
anti-inflammatory effects.
O The term nonsteroidal distinguishes these drugs from
steroids, which, among a broad range of other effects,
have a similar eicosanoid-depressing, anti-inflammatory
action.

O The most prominent members of this group of drugs are:
O Aspirin (anti-platelet, salicylate, antipyretic & nonnarcotic
analgesic)- inhibits prostaglandin synthesis thus reducing
inflammation (also in or near the hypothalamus thus
reducing temperature).
O Direct effects on the CNS causing pain relief.

O ibuprofen, and naproxen
CAUTION!!!!
O Aspirin has been linked with Reye's syndrome, so use
caution when giving aspirin to children or teenagers.

O Children and teenagers recovering from chickenpox or flu-
like symptoms should never take aspirin.
O Reye's (Ryes) syndrome is a rare but serious condition that
causes swelling in the liver and brain.
O Reye's syndrome most often affects children and teenagers
recovering from a viral infection and who may also have a
metabolic disorder.
O Signs and symptoms such as confusion, seizures and loss of
consciousness require emergency treatment.
O Early diagnosis and treatment of Reye's syndrome may improve
prognosis.
O mayoclinic.com
IMMUNOSUPPRESSANTS
Immunosuppressive drugs or immunosuppressive agents
are drugs that inhibit or prevent activity of the immune
system.
They are used in immunosuppressive therapy to:
Prevent the rejection of transplanted organs and tissues
(e.g., bone marrow, heart, kidney, liver)
Treat autoimmune diseases or diseases that are most
likely of autoimmune origin (e.g., rheumatoid arthritis,
multiple sclerosis, myasthenia gravis, systemic lupus
erythematosus, sarcoidosis, focal segmental
glomerulosclerosis, Crohn's disease, Behcet's Disease,
pemphigus, and ulcerative colitis).
Treat some other non-autoimmune inflammatory diseases
(e.g., long term allergic asthma control).
O IMMUNOSUPPRESSANT CAN BE CLASSIFIED INTO 5
GROUPS:

O Glucocorticoids
O Immunosuppressive mechanism
O Antiinflammatory effects
O Cytostatics
O Alkylating agents
O Antimetabolites
O Antibodies
O Polyclonal antibodies
O Monoclonal antibodies
O Drugs acting on immunophilins
O Ciclosporin
O Tacrolimus
O Sirolimus
O Other drugs
O Interferons
O Opioids
O TNF binding proteins
O Mycophenolate
O Small biological agents

O Immunosuppressive drugs can be classified into five
groups:
O Glucocorticoids - glucocorticoids are used to suppress
various allergic, inflammatory, and autoimmune disorders.
O They are also administered as posttransplantory
immunosuppressants to prevent the acute transplant rejection and
graft-versus-host disease.
O Do not prevent an infection and also inhibit later reparative
processes.

O Cytostatics - Cytostatics inhibit cell division. In
immunotherapy, they are used in smaller doses than in the
treatment of malignant diseases.
O They affect the proliferation of both T cells and B cells. Due to
their highest effectiveness, purine analogs are most frequently
administered.
O Dactinomycin is the most important. It is used in kidney
transplantations. Other cytotoxic antibiotics are anthracyclines,
mitomycin C, bleomycin, mithramycin.
O Antibodies :
O Antibodies are sometimes used as a quick and potent
immunosuppressive therapy to prevent the acute rejection
reactions as well as a targeted treatment of lymphoproliferative
or autoimmune disorders .
O Drugs acting on immunophilins :
O Ciclosporin - Ciclosporin is thought to bind to the cytosolic
protein cyclophilin (an immunophilin) of immunocompetent
lymphocytes, especially T-lymphocytes.
O This complex of ciclosporin and cyclophilin inhibits the
phosphatase calcineurin, which under normal circumstances
induces the transcription of interleukin-2.
O The drug also inhibits lymphokine production and interleukin
release, leading to a reduced function of effector T-cells.
O Other drugs:
O Interferons - IFN- suppresses the production of Th1 cytokines
and the activation of monocytes. It is used to slow down the
progression of multiple sclerosis. IFN- is able to trigger
lymphocytic apoptosis.
O Opiods - Prolonged use of opioids may cause
immunosuppression of both innate and adaptive immunity.
O Decrease in proliferation as well as immune function has been
observed in macrophages, as well as lymphocytes.
NEUROMUSCULAR
O Drugs acting on immunophilins- Like tacrolimus,
ciclosporin (Novartis' Sandimmune) is a calcineurin
inhibitor (CNI). It has been in use since 1983 and is one
of the most widely used immunosuppressive drugs. It is
a cyclic fungal peptide, composed of 11 amino acids.
O Ciclosporin is thought to bind to the cytosolic protein

O Other drugs - Prolonged use of opioids may cause
immunosuppression of both innate and adaptive
immunity.
O Decrease in proliferation as well as immune function has
been observed in macrophages, as well as lymphocytes.
O It is thought that these effects are mediated by opioid
receptors expressed on the surface of these immune cells
DRUGS AFFECTING
NUTRITION & BLOOD
O Drugs affecting:
O Nutrition
O Fluid and Electrolytes
O Intravenous infusions
O Blood
O Other (water irrigation)


DRUGS AFFECTING NUTRITION
O Vitamins
O Any group of substance that are required, in very small amount, for
healthy growth and development. They are also required for
nucleoprotein synthesis and maintenance of normal erythropoiesis.
O Examples are:
O Ascorbic acid (vitamin C) needed for healing wounds, and for
repairing and maintaining bones and teeth.
O Vitamin B complex
O Cyanocobalamin (B12) essential to cell growth and reproduction,
nucleoprotein and myelin synthesis, and has been associated with fat
and carbohydrate metabolism and protein synthesis.
O Folic acid (B9) Used to treat megaloblastic anemias due to sprue,
nutritional deficiency, infancy and childhood. It is also essential in
pregnancy to help prevent congenital birth defects.
O Multivitamin Syrup
O Pyridoxine Injection
O Thiamine Hydrochloride
O Hydroxocobalamin
FLUID & ELECTROLYTES
O Fluids
are liquids originating from inside the bodies of living people.
The main purposes are regulate body temperature, blood
circulation, remove toxins, keep the skin moist and help the
digestive process.
O Electrolytes
electrolytes are substances that become ions in solution and
acquire the capacity to conduct electricity. Electrolytes are
present in the human body, and the balance of the electrolytes
inside the body is essential for normal function of cells and
organs.
Examples of electrolytes are:
Sodium: Regulates fluid balance
Potassium: Regulates metabolism
Magnesium: Regulates the levels of other electrolytes
Calcium: Regulates muscle contraction and heart rhythm
FLUID & ELECTROLYTES
CONTINUED
O Fluid and electrolytes
O To control fluid passage across cell membranes, cells
regulate the movement of electrolytes into and out of
them, which causes water to follow the charged
particles around wherever they go. Some examples
include:
O Calcium Chloride
O Calcitriol Injection
O Potassium Chloride tablet or injection
O Oral rehydration salt

INTRAVENOUS INFUSIONS
O Intravenous infusions
The slow injection of substances into a vein. A common
method for replacing fluid and electrolytes and
continuous administration of drug.
Solutions used for IV infusion can be:
O Isotonic- a solution having the same osmotic
pressure as blood.
O Hypotonic- a solution that pushes fluid into a
cells.
O Hypertonic-a solution that pulls fluid from cells.
SOLUTIONS
INTRAVENOUS INFUSIONS
CONTINUED
Examples of intravenous infusions are:
O Normal Saline (Sodium Chloride) is a sterile,
nonpyrogenic solution for fluid and electrolyte
replenishment for intravenous administration. It contains
no antimicrobial agents. The nominal pH is 5.5 (4.5 to
7.0).
O 0.45% Sodium Chloride Injection, contains 4.5 g/L Sodium
Chloride (sodium chloride injection) , It contains 77 mEq/L
sodium and 77 mEq/L chloride
O 0.9% Sodium Chloride Injection, USP contains 9 g/L Sodium
Chloride (sodium chloride injection). It contains 154 mEq/L
sodium and 154 mEq/L chloride.
INTRAVENOUS INFUSIONS
CONTD
O Dextrose is another name for glucose, a type of sugar; dextrose IVs are
sometimes referred to as sugar water. As with every other form of
sugar, prolonged or incorrect use of dextrose can cause hyperglycemia.
O Dextrose IVs contain combinations of dextrose and water, in differing
concentrations
O Dextrose 2.5%: Dextrose 2.5%, or D2.5W, is a dextrose IV that contains 2.5
grams of dextrose per 100 ml of water. D2.5W is used to dilute other IV
solutions or to supply the patient with water and calories.
O Dextrose 5% (D5W): used to hydrate patients or to dilute other IVs and
medications. D5W keeps the body from using up protein and muscle mass by
giving it carbohydrates and can decrease sodium and potassium levels.
D5W quickly becomes hypotonic, having a lower salt concentration than the
blood or other cells in the body, and hence is not used for resuscitation like
some other solutions with similar chemical makeup, such as normal saline.
It is used as source of free water and to prevent cell dehydration
INTRAVENOUS INFUSIONS
CONTD
O Dextrose 10 % and 20% (D10W and D20W): Dextrose 10%
is a more concentrated form of dextrose IV fluid. Its usually
used to counterattack hypoglycemia. D20W can also provide
more nutrition to the patient in the long term.
O Dextrose 50% (D50W): Along with dextrose 20%, it is used
for more long-term IVs since it can provide more nutrition to
the body. But dextrose IVs used for too long can result in a
number of negative side effects. Any dextrose IV therapy can
cause hypokalemia (a drop in potassium levels) and
hyponatremia, a condition in which there is not enough
sodium in the body outside of the cells. This is a very serious
condition that can lead to brain damage and death.
INTRAVENOUS INFUSIONS
CONTD
O Gelofusine is a volume expander that is used as a blood plasma
replacement if a significant amount of blood is lost due to
extreme hemorrhaging, trauma or dehydration. It behaves
similar to blood filled with albumins thus resulting in an
increase blood volume, blood flow, cardiac output, and oxygen
transportation.
O Fractionated Ovolecithin
O Fractionated Soya Oil
O Glycerol
O Hemodialysis Solution
O Mannitol
O Peritoneal Dialysis Solution
O Sodium Bicarbonate 8.4
DRUGS AFFECTIONG BLOOD
O Iron Preparations
The therapeutic action of iron preparation is to
elevate the serum iron concentration, and is then
converted to Hgb or trapped in the
reticuloendothelial cells for storage and eventually
converted to usable form of iron.
Some examples are:
O Ferric Ammonium Citrate Compound
O Ferrous Fumarate Tablets
O Ferrous Sulphate
O Iron - Dextran Complex
O Iron and Multivitamin
O Iron Sucrose Injection
DRUGS AFFECTIONG BLOOD
CONTD
O Haemostatics
O The therapeutic action of systemic drug is to inhibit
fibrinolysis by inhibiting plasminogen activator substances
and by plasmin activity; this action prevents the
breakdown of clots, the following are examples:
O Aminocaproic Acid Injection
O Aminocaproic Acid Syrup
O Phytomenadione Injection
O Phytomenadione Tablets
O Tranexamic Acid Tablet
O Tranexamic Acid Injection
WATER IRRIGATION
O Sterile Water for Irrigation is a sterile, hypotonic,
nonpyrogenic irrigating fluid or pharmaceutic aid
(solvent) entirely composed of Sterile Water for
Injection USP. It is prepared by distillation and
contains no antimicrobial or bacteriostatic agents or
added buffers. The pH is 5.7 (5.07.0).
DRUGS USED IN TREATMENT
OF RESPIRATORY SYSTEM
O Bronchodilators
O Corticosteroids
O Antihistamines
O Anti-infectives (Antibiotics)
O Expectorants and Cough Suppressants
O Respiratory Stimulants

Pulmonary surfectant
Oxygen
Aromatic Inhalations
Nasal decongestants (ENT)

BRONCHODILATORS
O Bronchodilators relaxes bronchial smooth muscle, causing
bronchodilation and increasing vital capacity, which has
been impaired by bronchospasm and air trapping; in higher
concentration, it also inhibits the release of slow-reacting
substances of anaphylaxis and histamine and suppresses
the response of airways to stimuli.
O Examples of bronchodilators are:
O Ipratropium Bromide Inhaler (Atrovent)
Atrovent causes dilates the bronchial airway and inhibits secretion
from serous and seromucous gland lining the nasal mucosa; it also
has anticholinergic effects. Used in maintenance treatment foe
COPD, chronic bronchitis and emphysema. Relieves symptoms of
rhinorrhea, common cold and rhinitis.
BRONCHODILATORS CONTD
O Albuterol (Ventolin)
in low does it acts relatively selective at beta2-
adrenergic receptors to cause dilation of bronchial
airway and vasodilation; it higher doses beta2
selectivity is lost, and the drug acts beta2 receptors to
cause typical sympathomimetic cardiac effects

O Other examples of bronchodilators continued:
O Aminophylline Injection
O Formoterol 160mcg/Budesonide
O Metered Dose Inhaler (MDI)
O Ipratropium Bromide Nebuliser Solution
O Salbutamol Inhaler, nebuliser, syrup, tablet and expectorant
ANTIHISTAMINES
O Antihistamines completely blocks the effects of
histamine at peripheral H
1
receptor sites, and also
has anticholinergic and antipruritic effects.
O Types of antihistamines are:
O Diphenhydramine Hydrochloride elixir or capsules
(DPH)
DPH is an antihistamine drug with several other effects,
these include: antipruritic sedative, cough suppressant, and
anti-motion-sickness effects. This drug is commonly used in
mental health facilities to counteract the side effects of
parkinsonism.
ANTIHISTAMINES CONTINUED
O Loratidine Tablets or syrup(Claritin)
Non sedative type of histamine; used to treat the
symptoms of seasonal allergies, such as sneezing,
watery eyes, and runny nose and itching of the nose
and throat. Claritin is also used
O Some other example of antihistamine continued:
O Chlorpheniramine Syrup
O Clemastine Fumarate Tablets
O Diphenhydramine Hydrochloride Injection
O Ketotifen Elixir
O Promethazine Hydrochloride Tablets
EXPECTORANTS & COUGH
SUPPRESSANTS
O Expectorants
Drugs that increase the bronchial secretion and enhance the
expulsion of mucus by air passages of the lungs. This makes it
is easier to cough up the phlegm or sputum. Expectorants are
used in cough mixtures for chesty coughs. Some examples are:
O Bromhexine Hydrochloride Elixir (Bisolvant)
Bisolvin Elixir is for conditions where breathing is difficult
due to a lot of secretions (mucus) in the air passages. Such
conditions include bronchitis and emphysema.
O Guaifenesin (Ributussin)
Sypmtomatic relieve of respiratory conditions characterised
by dry, non-productive cough and when there is mucus in
the respiratory tract
EXPECTORANTS & COUGH
SUPPRESSANTS
O Cough suppressants
Cough suppressants, also known as antitussives, are a
class of cough medication that are intended to suppress
(stop) a cough. They Control cough spasm by
depressing the cough center in the medulla.
O Dextromethorphan
Controls non-productive coughs but will not treat a
cough that is caused by smoking, asthma, or
emphysema.

RESPIRATORY STIMULANTS
O Ammonia Spirit (aromatic ammonia spirit)
O Respiratory stimulant used as a smelling salts to treat or prevent
fainting.
O For preventing or treating fainting:
O For inhalation dosage form (inhalants):
O Adults and teenagersThe inhalant should be held away from the face
and crushed between the fingers. The inhalant should then be held about
four inches away from the nostrils, and the vapor slowly inhaled until the
patient awakens or no longer feels faint.
O ChildrenUse and dose must be determined by your doctor.
O For inhalation dosage form (solution):
O Adults and teenagersAfter the top is taken off the container, the vapor
may be slowly inhaled until the patient awakens or no longer feels faint.
O ChildrenUse and dose must be determined by your doctor.
PULMONARY SUFECTANTS
O Pulmonary surfactant is a surface-active lipoprotein
complex (phospholipoprotein) formed by type II
alveolar cells. It reduces the surface tension of the
alveolar air-liquid interface, thereby providing
mechanical stability and preventing alveolar
atelectasis
O Beractant Suspension (Survanta)
a sterile, non-pyrogenic pulmonary surfactant intended
for intratracheal use only. It is a natural bovine
compound containing lipids and apoproteins that reduce
surface tension and allow expansion of the alveoli;
replaces the surfactant missing in neonates siffering from
respiratory distress syndrome(RDS).


OXYGEN
O Oxygen therapy : a treatment that provides extra oxygen, a gas
that the body needs to work well. Normally, the lungs absorb
oxygen from the air. However, some diseases and conditions can
prevent the consumption of enough oxygen.

O Oxygen flows through a tube and is delivered to the lungs in one of
the following ways:
O Through a nasal cannula, which consists of two small plastic tubes,
or prongs, that are placed in both nostrils.
O Through a face mask, which fits over your nose and mouth.
O Through a tracheostomy tube (small tube inserted into your
windpipe through the front of your neck). A needle or small incision
can be used to place the tube. Oxygen delivered this way is called
transtracheal oxygen therapy.
AROMATIC INHALATIONS
O Menthol Crystals are clear, colorless, crystals that are
obtained from steam distilled peppermint oil. They are
formed when peppermint oil is distilled by steam. They can
be used to alleviate a variety of aches, pains and other
ailments.

O Menthol crystals provide relief for symptoms of congestion,
upper respiratory problems, sore throat and coughs. Most
lozenges, cough drops, and respiratory balms will list menthol
as the chief ingredient. For congested, after inhaling the scent
of menthol crystals, the menthol vapors attacking and breaking
up lung congestion, giving a cooling and soothing sensation
can be very relieving.

AROMATIC INHALATIONS
CONTINUED
O Tincture Benzoin Compound
O Plain Tincture of Benzoin can be inhaled in steam as
a treatment for various conditions including
bronchitis and colds
VACCINES

VACCINES
O A preparation of a weakened or killed pathogen,
such as a bacterium or virus, or of a portion of
the pathogen's structure that upon
administration stimulates antibody production or
cellular immunity against the pathogen but is
incapable of causing severe infection.

VACCINES CONTINUED
O Common vaccines used are:
O BCG protects against tuberculosis
O DPT protects against diphtheria,
pertussis and tetanus
O MMR protects against measles
mumps and rubella
O OP/IPV protects against
(oral/injectable polio) poliomyelitis
VACCINES CONTINUED
O Hep B protects against hepatitis
B
O HIB protects against
Haemophilus influenzae
ANTIDOTES & SUBSTANCES
USED IN POISONING
O Specific
O Non-specific
SPECIFIC
O Acetylcysteine Injection 200 mg/ml
O Desferrioxamine Injection 500 mg
O Dimercaprol Injection 50 mg/ml
O Flumazenil Injection 0.1 mg/ml
O Glucagon Injection 1 mg/ml
O Naloxone HCl Injection 400 mcg/ml
O Pralidoxime Mesylate Injection 200 mg/ml
O Protamine Sulphate Injection 50 mg/ml
O Sodium Calcium Edetate Injection 200mg/ml
NON-SPECIFIC
O Activated Charcoal Powder
O Adrenaline Injection 0.1%
O Atropine Sulphate Injection 1 mg
O Calcium Gluconate Injection 100 mg/ml
O Diazepam Injection 5 mg/ml
O Fuller's Earth (Bentonite)
O Ipecacuanha Syrup 14 mg/10ml
SOME COMMON DRUGS
O Morphin , pethidine Naloxone or Narcan
O Heparin protamine sulfate
O Warfarin Vitamin K
O Digoxin Digibind
O Paracetamol - acetylcysteine
REFERENCES
O Diabetes drugs classification retrieved September 14, 2013 from
www.diabetes.co.uk
O Porth, C. Essential of Pathophysiology. 3
rd
edition. Lippincott
Williams & Wilkins 2001 Market Street, PA 19103 USA.
O Wilson, B. Pearson Nurses Drug Guide. 2013. Pearson
Education, Inc. Upper Saddle River, NJ 07458.
O Weller,. B. Baillieres Nurses Dictionary . 3
rd
edition. RCN
Publishing Company.