Nursing Pharmacology

Legal Regulation of Drugs
1. RA 6425: 2. RA 9165: 3. RA 6675: 4. RA 8203: Dangerous Drug Act of 1972 Comprehensive DDA of 2002 Generics Act of 1988 Special Law on Counterfeit Drugs

Narcotics 
Any drug which produces:  Insensibility, stupor, melancholy, or dullness of mind with delusions  May be habit-forming  Include opium & opium derivatives, and synthetic opiates

Dangerous Drugs
1. Prohibited Drugs  Opium (e.g. heroine, morphine)  Cocoa leaf (e.g. cocaine)  and eucaine  Hallucinogenics (e.g. mescaline, LSD)  Indian hemp

Dangerous Drugs
2. Regulated Drugs  Sedatives (e.g. phenobarbital, barbituric acid salts)  Amphetamines (e.g. benzedrine, dexedrine)  Hypnotics (e.g. methaqualone)

Exempt Preparations 
Preparations described in Sec. 7 of the Narcotic Drugs Law (R.A. 953)  Contains NOT MORE THAN:  2 grains of opium, or  ¼ grain of morphine, or  1/8 grain of heroine, or  1 grain of codeine, or  1 fluid oz. of above derivatives, or  1 avoirdupois oz. of above derivatives

Nurses & Narcotics 
Nurses can handle narcotics, in the course of their professional practice, only as agents of practitioners of institutions under whose direction or supervision their duties are performed.

Pharmacokinetics 
How the body acts on the drug  Involves absorption, distribution, biotransformation, & excretion of drugs  Include the onset of drug action, drug half-life, timing of the peak effect, duration of drug effects, drug metabolism, and site of excretion

Absorption 
Refers to what happens to the drug from the time it is introduced to the body until it reaches the circulating fluids and tissues.  A large percentage of the oral dose of the drug is destroyed by liver enzymes and never reaches the tissues.

Distribution 
Involves the movement of a drug to the body¶s tissues  Factors affecting distribution include the drug¶s lipid solubility and ionization, and the perfusion of the reactive tissue.  Many drugs are bound to proteins and are not lipid soluble.

Biotransformation 
The liver is the single most important site where drugs are detoxified into less active chemicals that are more easily excreted.  Some drugs cannot be taken together effectively. The presence of one drug can speed up the metabolism of other drugs, preventing them from reaching therapeutic levels.

Excretion 
The removal of the drug from the body through the skin, saliva, the lungs, bile, and feces  The kidneys play the most important role in drug excretion.  The half-life of the drug is the time it takes for the amount of drug in the body to decrease to ½ of the peak level.

Pharmacodynamics 
How the drug affects the body  Deals with interactions between chemical components of living systems and the drugs that enter those systems

Drug-Drug Interactions 
When 2 or more drugs are taken together, there is a possibility that these drugs will interact with each other to cause unanticipated effects in the body.

Factors Influencing Drug-Drug Interactions
1. Intestinal Absorption 2. Competition for plasma protein binding 3. Drug metabolism 4. Action at the receptor site 5. Renal elimination 6. Electrolyte imbalance

Drug-Food Interactions
‡ Occurs when the drug and the food are in direct contact with the stomach ‡ Some foods increase acid production, speeding up the breakdown of the drug and preventing absorption and distribution. ‡ Oral drugs are best taken on an empty stomach

Drug-Food Interactions
1. Antacid vs. Bran & Whole Grain bread 2. Antibiotics vs. Citrus Fruit & Caffeine 3. Tetracycline vs. Calcium-rich foods 4. Anticoagulants vs. Vitamin K-rich foods 5. MAO Inhibitors vs. Tyramine-rich foods

Hepatotoxic Drugs
‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ACE Inhibitors Acetaminophen & NSAIDS Alcohol, Phenytoin Iron Erythromycin, Trimethoprim-SMZ Estrogens Fluconazole & Ketoconazole Isoniazid, Rifampin, Sulfonamides

Nephrotoxic Drugs
‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Acyclovir Acetaminophen, NSAIDS Aminoglycosides, Vancomycin Amphotericin B Ciprofloxacin Cisplatin Methotrexate Rifampin, Tetracycline, Sulfonamides

Ototoxic Drugs
‡ Aminoglycosides: Vancomycin, Erythromycin, ‡ Bumetanide ‡ Cisplatin ‡ Ethacrynic Acid ‡ Furosemide ‡ NSAIDs, ASA ‡ Hydroxychloroquine

Common Antibiotics
1. Aminoglycosides (Bactericidal) ± for Gram (-) infections 2. Cephalosporins (Bactericidal / Bacteriostatic) ± for G(+) & G(-) infections 3. Fluroquinolones (Bactericidal) ± for G(+) & G(-), UTI, bone & joint infections 4. Macrolides (Bacteriostatic) ± For G(+) & G(-); allergy to penicillin

Common Antibiotics
5. Penicillins (Bactericidal) ± for G(+) & G(-), UTI, RTI, syphilis, meningitis, & skin infections (Ox, Clox, DiClox & Naf) 6. Sulfonamides (Bacteriostatic) ± for G(+) & G(-), UTI, RTI, acute OM 7. Fluroquinolones (Bactericidal) ± for Gram (+) & Gram (-) infections

Common Antibiotics
8. Tetracycline (Bacteriostatic) ± For G(+) & G(-) aerobes & anaerobes, skin infections, chlamydia, syphilis, Lyme dse 9. Vancomycin HCl (Bactericidal) ± Antibiotic-associated pseudomembranous infections. 10.Antimycombacterials a. Rifampin ± Impairs RNA Synthesis b. Isoniazid ± Impairs DNA Synthesis

Antibiotics: MEDICATE
1. Monitor for superinfections. 2. Evaluate liver & renal functions. 3. Diarrhea 4. Inform provider prior to taking others. 5. Culture prior to initial dose. 6. Alcohol is out. Ask about allergies. 7. Take the FULL course of the drug. 8. Evaluate culture, WBC, temp, etc.

Antifungals
‡ Increases fungal cell membrane permeability causing cell death ‡ Systemic fungal infections ‡ Infusion-related reactions, drying of skin, pruritus, nephrotoxic ‡ Steroids increase risk of hypoK ‡ Increases digoxin toxicity ‡ Ampho-B

Antiprotozoals
1. Metronidazole ‡ For trichomoniasis, amoebiasis, & gardnerella vaginalis infections. ‡ WOF: HA, dizziness, ataxia, anorexia, N & V, diarhea, metallic taste, and superinfections like candidiasis ‡ Flagyl

Antiprotozoals
2. Antimalarials ‡ Interrupts plasmodial reproduction & protein synthesis ‡ WOF: HA, dizziness, N & V, diarrhea, alopecia, blindness, hepatotoxicity ‡ Chloroquine

Antivirals
1. For Influenza A & respiratory viruses ± WOF: lightheadedness, insomnia, nausea, orthostatic hypotension, urinary retention ± Amantadine, Ribavirin, Wirazole, Flumadine

Antivirals
2. For Herpes & CMV ± Inhibits viral DNA replications ± WOF: N & V, HA, insomnia, rash, hair loss ± Acyclovir

Antivirals
3. For HIV and AIDS ± inhibits viral replication ± HA, dizziness, myalgia, N & V, flu-like symptoms, rash, BM depression ± Lamivudine, Indinavir, Zalcitabine, Zidovudine

Antineoplastic Drugs: CANCER
1. CBC/platelet monitoring 2. Antiemetics before drug 3. Nephrotoxicity 4. Counseling about reproduction issues 5. Encourage handwashing, avoid crowds 6. Recommend a wig for the alopecia

Alkylating Agents
‡ Cell death/mutation of malignant growth ‡ CLL, malignant lymphomas, Hodgkin¶s disease, breast, lung & ovarian CA ‡ Adverse Effects (BAD): ± Bone marrow suppression ± Anorexia & Alopecia ± Distressful N & V ‡ Busulfan, Carboplatin, Carmustine

Antimetabolites
‡ Interferes with the building blocks of DNA synthesis ‡ For myelocytic leukemias, breast, cervical, colon, liver, ovarian pancreatic, gastric, & rectal CA ‡ AE: GI disturbance, oral & anal inflammation, BM depression, alopecia, renal dysfunction, thrombocytopenia ‡ Capecitabine, Cytarabine, Floxuridine

Guidelines for Antimetabolites
1. Monitor CBC & platelets weekly. 2. Evaluate renal function. 3. Temperature assessment q4 ± 8 hours 4. Asepsis (strict) 5. Bleeding, anemia, infection, nausea 6. Oral hygiene (use soft toothbrush) 7. Lots of fluids (2 ± 3 L/day) 8. Intake & Output monitoring 9. Teach protocols for handling & administering 10.Emphasize protective isolation

Immune System Drugs
1. NSAIDs ‡ Analgesic, anti-inflammatory, antipyretic 2. Salicylates: anti-inflammatory 3. Immune Modulators a. Immune Stimulants ‡ Inhibit tumor growth and replication; prevent virus particles from replicating inside other cells b. Immune Suppressants: Transplant rejection

Immune System Drugs
4. Vaccines ‡ Stimulate active immunity 5. Sera & Antitoxins ‡ provides passive immunity

Drugs Acting on the CNS & PNS
A. Antidepressants (DEPRESSION) 1. SSRIs (CNS) ‡ Selective inhibition of serotonin 2. Tricyclic Antidepressants (HATS) ‡ Blocks re-uptake of norepinephrine and serotonin 3. Monoamine Oxidase Inhibitors ‡ Inhibits the enzyme (MAO) that breaks down norepinephrine

Drugs Acting on the CNS & PNS
B.Psychotherapeutics 1. Antipsychotics ‡ Blocks dopamine receptor sites 2. Antiepileptics a. For Tonic-Clonic Seizures ‡ Reduce motor cortex activity by altering transport of ions

Drugs Acting on the CNS & PNS
b. For Partial Seizures ‡ Prevent polysynaptic responses & inhibit post-tetanic potentiation 3. Anti-anxiety Drugs a. Benzodiazepines (ANXIETY) ‡ Enhance the action of GABA, which inhibits the transmission of nerve impulse; depress the limbic & subcortical CNS

Drugs Acting on the CNS & PNS
4. Antiparkinsonism Agents a. Dopaminergics ‡ Helps restore balance between the inhibitory and excitatory neurons

Drugs Acting on the CNS & PNS
B.Psychotherapeutics (cont¶d) 5. Muscle Relaxants a. Centrally-acting ‡ Interfere w/ reflexes causing the muscle spasm (spasmolytics) b. Direct-acting ‡ Reduces muscle action potentialinduced release of calcium into the SR limiting the cross-bridging

Drugs Acting on the CNS & PNS
6. Narcotics & Antimigraine Agents a. Narcotic Agonists ‡ Acts at specific opioid receptor sites in the CNS to produce analgesia, sedation and sense of well being b. Narcotic Agonist-Antagonists ‡ Acts on opioid receptor site ‡ Blocks opioid receptors

Drugs Acting on the CNS & PNS
6. Narcotics & Antimigraine Agents c. Narcotic Antagonists ‡ Blocks opioid receptors and reverses the effects of opioids d. Anti-migraine Drugs ‡ Ergot derivatives: Blocks alpha adrenergic & serotonin receptor sites; Triptans: Bind to selective serotonin receptor sites

Drugs Acting on the CNS & PNS
7. Anesthetics a. General ‡ Depresses the reticular activating system and the cerebral cortex b. Local ‡ Blocks nerve depolarization throughout the system

Drugs Acting on the CNS & PNS
8. Neuromuscular Junction Blocking Agents ‡ Cause prolonged depolarization that first causes muscle contraction and then flaccid paralysis ‡ Serve as adjuncts to general anesthetics during surgery and facilitate mechanical intubation

Drugs Acting on the ANS
A. Adrenergic Agents/Sympathomimetics ‡ Hypotension, shock, bronchospasm, asthma; used to block nerve impulse conduction; for spinal anesthesia and relief of local pain B. Adrenergic Blocking Agents ‡ Hypertension, diagnosis and management of pheochromocytoma, BPH, chronic angina, used in reducing anxiety and intraocular pressure, PVC and arrhythmias

Drugs Acting on the ANS
C.Cholinergic Agents ‡ o activity of Ach receptor sites throughout the body to counter the action of some muscle-relaxing drugs D.Anticholinergic Agents ± Blocks cholinergic receptor sites so response to acetylcholine is ¡; for bradycardia & heart block; Parkinson's disease; preoperatively, to ¡ secretions & vagal stimulation

Endocrine System Drugs
A.Anterior Pituitary Hormones 1. Growth Hormone 2. Growth Hormone Antagonist B.Posterior Pituitary Hormones 1. Antidiuretic Hormone 2. Oxytocin

Endocrine System Drugs
C.Adrenocortical Agents 1. Glucocorticoids ‡ Anti-inflammatory and immunosuppressive effects ‡ Administer the drug daily around 8 to 9 a.m. to mimic normal peak diurnal concentration levels

Endocrine System Drugs
C.Adrenocortical Agents 2. Mineralocorticoids ‡ o reabsorption in renal tubules ‡ o potassium & hydrogen excretion

Endocrine System Drugs
D.Thyroid Hormones 1. Thyroid Hormone ‡ Ÿ metabolic rate, O2 consumption; body growth 2. Anti-thyroid Hormone ‡ Inhibits Thyroid Hormone synthesis

Endocrine System Drugs
E.Parathyroid Hormones 1. Anti-hypocalcemic Agents ‡ Vit. D regulates Ca intestinal absorption 2. Anti-hypercalcemic Agents ‡ Calcitonin directly acts on serum calcium levels

Endocrine System Drugs
F. Antidiabetic Agents 1. Metformin ‡ ¡ hepatic glucose production ‡ Ÿ insulin uptake 2. Sulfonylureas ‡ Stimulates insulin release ‡ Ÿ peripheral sensitivity

Endocrine System Drugs
F. Antidiabetic Agents 3. Insulin ‡ Ÿ glucose transport ‡ Rapid-Acting: Regular, Humulin-R ‡ Intermediate-Acting: Humulin ‡ Long-Acting: Humulin-L

Female Reproductive System Drugs
A.Estrogen  affects the release of pituitary gonadotropins; promotes bone formation B.Oxytocin  Stimulates contraction of uterine muscle fibers

Male Reproductive System Drugs
A.Androgen  o the retention of N, Na, K, & phosphorus, & urinary excretion of Na. o protein anabolism & production of RBC & protein catabolism

Male Reproductive System Drugs
B. Erectile Dysfunction Drugs  Relaxes vascular smooth muscles & blood flow into the corpus cavernosum causing erection

Cardiovascular System Drugs
A.Cardiac Glycosides ‡ increases the force of myocardial contraction B.Antianginal Drugs ‡ Relaxes vascular smooth muscles C.Antiarrythmic Drugs ‡ q cardiac excitability

Cardiovascular System Drugs
D.Antihypertensives 1. ACE Inhibitors ‡ blocks conversion of angiotensin I to angiotensin I 2. Beta Adrenergic Blockers ‡ Binds to Beta-1 (cardiac) & Beta-2 (lungs) adrenergic sites that prevents catecholamine release

Cardiovascular System Drugs
D.Antihypertensives 3. Calcium Channel Blockers ‡ Blocks calcium access to the cells causing a q in contractility, q arteriolar constriction 4. Centrally Acting Alpha-2 Agonists ‡ Decrease the release of adrenergic hormones

Vasodilators
‡ Directly acts on vascular smooth muscle causing vasodilation ‡ Increased renal and cerebral blood flow ‡ Lupus-like reaction (fever, facial rash, muscle and joint ache, splenomegaly) ‡ Assess for peripheral edema ‡ Take with food ‡ Other Adverse effects - Headache, dizziness, anorexia, tachycardia and Hypotension ‡ Review BP

Diuretics
1. Loop Diuretics ‡ Inhibits sodium, chloride & water reabsorption in the proximal portion of the ascending L of H. 2. Thiazides ‡ inhibiting reabsorption of Na, Cl & water in the distal portion of the ascending L of H. 3. Osmotic Diuretics: osmotic pressure of glomerular filtrate

Anticoagulants
1. Warfarin ‡ Check VS, platelete count, PT ‡ Observe for bleeding ‡ Review bleeding protocol (i.e. electric razors, soft toothbrushes, etc.) ‡ Avoid ASA, may use Acetaminophen

Anticoagulants
2. Heparin Sodium ‡ Combines with antithrombin III to retard thrombin activity ‡ o effect with aspirin, alcohol and antibiotics; q effect with digoxin (Lanoxin), antihistamines, and nitroglycerin products; o risk of bleeding with chamomile, garlic, ginger, ginkgo

Anticoagulants
3. Antiplatelets ‡ inhibits platelet synthesis of thromboxane A2, a vasoconstrictor and inducer of platelet aggregation

Anticoagulants
3. Thrombolytics ‡ Binds with plasminogen causing conversion to plasmin which dissolves blood clots

Cardiovascular System Drugs
G.Antilipemics 1. Bile Acid Sequestrants ‡ Combines with bile acids in the intestine resulting in excretion in the feces 2. HMG CoA Inhibitors ‡ competitive inhibitors of HMGCoA reductase (for cholesterol biosynthesis in the intestines & liver

Respiratory System Drugs
A.Antihistamines ‡ Blocks histamine release at H1 receptors B.COPD Drugs 1. Xanthines ‡ Inhibits phosphodiesterase (breaks down cyclic AMP) resulting in bronchodilation & reducing airway resistance

Respiratory System Drugs
B.COPD Drugs (cont¶d) 2. Corticosteroids ‡ inflammation and edema, bronchoconstrictions and secretion of mucus 3. Leukotriene Receptor Antagonists ‡ Blocks the receptor that inhibits leukotriene formation

Gastrointestinal System Drugs
A.GI Secretion Drugs 1. Antacids ‡ Neutralizes gastric acid; decreases pepsin activity 2. H2 Antagonists ‡ prevents histamine-induced acid release by competing with histamine for H2 receptors

Gastrointestinal System Drugs
A.GI Secretion Drugs 3. Carafate ‡ Forms a protective covering on the ulcer surface and also inhibits pepsin activity in gastric juices 4. PPI ‡ increases gastric pH ‡ reduces gastric acid production

Gastrointestinal System Drugs
B.Antidiarrheal Drugs ‡ Inhibits gastric motility C.Emetics and Antiemetic Agents 1. Emetic Agents - Ipecac ‡ Irritates the GI mucosa locally which stimulates the CTZ to induce vomiting within 20 minutes

Gastrointestinal System Drugs
C.Emetics and Anti-emetic Agents 2. Anti-emetic Agents ‡ Locally these drugs decrease the local response to stimuli that is being sent to medulla to induce vomiting. ‡ Centrally, these drugs directly block the CTZ or suppress the vomiting center

Gastrointestinal System Drugs
D.Gallstone Solubilizers ‡ Suppress the synthesis of cholesterol and cholic acid by the liver ‡ Contraindicated in patients with calcified stones which are not dissolved; and in billiary tract obstruction

Nursing Interventions
‡ ‡ ‡ ‡ ‡ ‡ Obtain baseline data & VS Determine allergies Determine hepatic/renal dysfunctions Monitor px¶s reaction to drugs Determine Drug-Drug Interactions Conduct serum/electrolyte analysis & hepatic & renal function during therapy ‡ Provide patient education ‡ Provide safety/comfort measures

Formulas for Dosage Computation
A.Oral / Parenteral Medications 1. Solids ‡ Q = Desired dose / Stock 2. Liquids ‡ Q = (Desired dose / Stock) x dilution

Formulas for Dosage Computation
B.IV Fluid Flow Rate 1. Gtts/min = Volume in cc x gtt factor no. of hours x 60 min. 2. cc/hr = Volume in cc / no. of hours = gtts / min x 4

Formulas for Dosage Computation
B.Temperature conversion 1. °C to °F = (°C x 1.8) + 32 2. °F to °C = (°F ± 32) (0.55)

Formulas for Dosage Computation
C.Pediatric Doses 1. Clark¶s Rule ‡ (Wt in lbs/150) x adult dose 2. Freid¶s Rule ‡ (Age in mos/150) x adult dose 3. Young¶s Rule ‡ Age (yrs)/Age (yrs)+12 (adult dose)

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