PHARMACOLOGY
Pharmacology
- most simply defined as study of drug.
Fundamentals of
Pharmacology
1. Pharmacokinetics
- study of drug’s changes as it enters and
passes through the body.
a. absorption
b. distribution
c. biotransformation
d. excretion
2. Pharmacodynamics
- mechanism by which drugs produce
changes in body tissue.
a. desired effect - intended action of drugs
b. adverse effect - harmful unintended reactions
c.
side effects – consequence reactions
d.
toxicity – the degree which something is poisonous
digoxin = 0.5 – 2.0 ng/mL
lithium
= 0.5 – 1.5 mEq/L
Safety
and Efficacy
Nursing
Principles :
1. Always verify the Five Rights .
a. the right medications
b. the right client
c. the right dosage
d. the right form, route and
technique
e. the right time
2. Chart drug administration only after its
been given, never before.
3. Never leave the medication on cart or tray
unattended.
4. Chart observed therapeutic and adverse
effects accurately and fully.
5. Check history for allergies and potential
drug interactions before administering a
newly ordered drug.
6. Inform the prescribing physician of any
observed adverse effects; if cannot be
located, inform the nursing supervisor
7. Question drug orders that are unclear, that
appear to contain errors, or that have
potential to harm.
8.
Take the following actions if an error occurs :
a. immediately notify the nursing
supervisor, the prescribing physician, and the
pharmacist.
b. assess the client’s condition and
provide any necessary care.
9.
For postpartum women, advice to take drugs
after breastfeeding.
Administration of Drugs :
Routes and Nursing considerations:
1. Enteral – oral, sublingual,
rectal, gastric tubes
- capsulated pill,
sustained release and enteric coated should not be crushed.
2. Parenteral – IV, IM, SQ, ID, IT, IA,
epidural.
- vastus lateralis (safest site for IM)
3. Topical – skin, inhalants, mucus membrane.
Eye medications :
- administer eyedrops first then ointment.
- use a separate bottle for each client.
- instruct the client to tilt the head
backward, open eyes and look up.
- avoid contact of medication bottle to the
eyeball.
- place prescribed dose in the lower
conjunctival sac.
- instruct the client to press the inner canthus for 30-60 seconds.
- instruct the client to close the eye
gently.
Ear drops
- in infant and children younger than 3 y.o,
pull pinna downward and backward.
- in older children and adult, upward
and backward.
- direct the solution on the wall of the ear
canal, not directly on the ear drum.
CLASSIFICATIONS
OF DRUGS
DRUGS AFFECTING THE CENTRAL AND
AUTONOMIC SYSTEM
Cholinergic Agents (Parasympathomemitics)
Prototype :
-
synthetic acetylcholine, pilocarpine, carbachol, bethanecol
(Urocholine),
edrophonium
(Tensilon), neostigmine (Prostigmine), pyridostigmine (Mestinon).
Mechanism of action :
- stimulates cholinergic receptors by
mimicking acetylcholine or inhibition of
enzyme cholinesterase.
Indications :
- glaucoma, urine retention, Myasthenia
Gravis
- antidote to neuromuscular blocking agents
: tricyclic antidepressants and
atropine
Adverse effects :
- blurring of vision, miosis
- increase in salivation, intestinal cramps
- bronchoconstriction, wheezing, DOB
- hypotension and bradycardia
Nursing considerations :
1. Warn & monitor clients of the side
effects.
2. Have atropine available for use as
antidote.
Cholinergic
Blocking Agents (Parasympatholytics,
Anticholinergics)
Prototype :
-
atropine,
scopalamine (Triptone), dicyclomine (Bentyl),
propantheline
(Pro-Banthine).
Mechanism of actions :
-
block
the binding of acetylcholine in the receptors of parasympathetic nerves.
Indications :
- use preoperatively to dry up secretions.
- treat spasticity of GI or urinary tract.
- use for treatment of bradycardia,
asthma, parkinsonism.
- use for antidote in organophosphate poisoning.
Adverse effects :
- dry mouth , dilatation of pupils,
tachycardia
- urinary retention, ileus, heat stroke
Nursing considerations :
1. Keep client’s in cool environment.
2. Watch out for signs of heatstroke and
dehydration.
3. Encourage clients to increase fluid intake
and use of sugarless gum/candy for dry
mouth.
4. For GI spasticity, administer 30 minutes
before meals and at bed time.
Adrenergic Agents (Sympathomimetics)
Prototype :
- epinephrine, norepinephrine, ephedrine,
dopamine, dobutamine, phenylephrine,
terbutaline, albuterol, isoproterenol.
Mechanism of actions :
- stimulate alpha and beta adrenergic
receptor directly or trigger the release
of
catecholamines indirectly causing
sympathetic effects.
Indications :
- cardiopulmonary arrest, hypotension
- COPD and asthma, nasal congestions
- allergic reaction, anaphylactic shock
Adverse effects :
- restlessness, insomnia, tremors, nausea
- palpitations, angina, tachycardia, HPN
Nursing considerations :
1. Contraindicated in clients w/
hyperthyroidism,
pheochromocytoma & cardiovascular
disease.
2. Monitor vital signs and advice precautions.
3. Should be taken with food.
ADRENERGIC
BLOCKING AGENTS
Prototype :
a. Alpha blockers
- phentolamine (Regintine), phenoxybenzamine,
prazosin (Minipress),
reserpine (Serpasil), terazosin (Hytrin)
- clonidine (Catapress), methyldopa
(Aldomet)
b. Beta blockers
- atenolol (Tenormin), esmolol (Brevibloc),
metoprolol (Lopressor), nadolol (Corgard),
propanolol (Inderal), timolol ( Blocadren)
Mechanism
of actions :
a. alpha blockers
- inhibits action of a-receptors in
vascular smooth muscle to cause vasodilatation.
b. beta blockers
- compete with epinephrine in
b-receptors in heart, pulmonary airways,
peripheral
circulation and CNS.
Indications :
- Raynaud’s disease, hypertension, pheochromocytoma.
- angina, arrhythmias, mitral valve prolapse,
glaucoma
Adverse
effects :
- orthostatic hypotension, bradycardia, CHF
- depression, insomnia and vertigo
- bronchospasm and dyspnea, nasal stuffiness,
cold extremities
Nursing considerations :
1. Administer oral alpha-blockers with milk
to minimize GI side effects.
2. Administer oral beta-blockers before meals
and at a.m. if insomnia occurs.
3. Check client’s apical pulse rate before
drug administration, refer if below 60 bpm.
4. Hypotensive precautions.
5. Warn clients not to drive or operate dangerous machinery until he/she has
adjusted to medications.
Skeletal
Muscle Relaxants Agents
Prototype :
-
methacarbamol (Robaxin), baclofen (Lioresal), dantrolene
(Dantrium),
metaxalone (Skelaxin), orphanedrine (Norgesic), chlorzoxazone
Mechanism of actions:
- depress CNS
- inhibit calcium ion release in the muscle
- enhance the inhibitory action of GABA (gamma-amino butyric acid)
Indications :
- for acute musculoskeletal pain
- for muscle spasticity associated with
multiple sclerosis, cerebral palsy, CVA,
and
spinal cord injury.
Adverse effects :
- hypotonia, ataxia, hypotension, drowsiness
- blurred vision, bradycardia, depression,
urine retention
Nursing considerations :
1.
Caution clients that mental alertness may be
impaired.
2.
Monitor neuromuscular status, bowel and
bladder functions.
3.
Inform clients that maximum benefit of baclofen
is attained for 1-2 months.
4.
Reduce baclofen dosage gradually because of associated withdrawal symptoms :
Confusion, hallucinations, paranoia &
rebound spasticity.
ANTICONVULSANTS
Prototype :
a.
Hydantoins - phenytoin (Dilantin)
b. Barbiturates
- phenobarbital ( Luminal)
c.
Miscellaneous
- carbamazepine (Tegretol), diazepam, clorazepate
(Tranxene),
valproic acid (Dapakene),
ethosuximide (Zarontin).
Mechanism of action :
-
treat
seizures by depressing abnormal neuronal
activity in motor cortex.
Adverse effects :
- sedation & drowsiness, gingival
hyperplasia
- diplopia, nystagmus, vertigo,
dizziness
- thrombocytopenia,
aplastic anemia
Nursing considerations :
1. Advise female clients to use
contraceptives.
2. Inform clients taking phenytoin that
harmless urine discoloration is common.
3. Warn clients with diabetes that hydantoins may increase blood sugar level and that
valproic acid may produce a false
positive result in urine ketone test.
4. Teach clients receiving carbamazepine
to identify symptoms of bone marrow
depressions.
5. Reassure that barbiturates are not
addictive at a low dosage.
6. Avoid taking alcohol with barbiturates.
7. Administer IV phenytoin slowly to avoid
cardiotoxicity.
8. Avoid mixing other drugs in same syringe
with phenytoin.
ANTIPARKINSONIAN
AGENTS
Prototype :
a. Anticholinergic agents
- trihexyphenidyl (Artane), benztropine (Congentin)
b. Dopaminergic agents
- Levodopa, carbidopa-levodopa
(Sinemet), amantidine (Symmetrel),
pergolide (Permax), selegiline
(Eldepryl), bromocriptine.
Mechanism of actions :
a. anticholinergic agents
- inhibit cerebral motor centers.
b. dopaminergic agents
- increasing dopamine concentrations or
enhancing neurotransmitter
functioning.
Adverse effects of dopaminergic agents:
a. levodopa – nausea, vomiting, anorexia, orthostatic
hypotension,
dark-colored urine
and sweat
b. amantidine – ankle edema, constipation
c. bromocriptine – palpitations,
tachycardia
Nursing
considerations :
1. Give dopaminergic agents after meals
to reduce GI symptoms.
2. Reassure client that levodopa may cause
harmless darkening of urine and sweat.
3. Avoid taking Vit B6 (pyridoxine) with
levodopa because it speed up metabolism.
4. Educate clients to minimize orthostatic
hypotension.
5. Elevate leg to reduce ankle edema.
CENTRAL
NERVOUS SYSTEM STIMULANTS
Prototype :
- amphetamines, methylphenidate (Ritalin)
Mechanism of actions :
- increase excitatory CNS neurotransmitter
activity and blocks inhibitory impulses.
Indications :
- for obesity (amphetamines)
- attention deficit hyperactivity disorders
- narcolepsy
- drug-induced respiratory depressions.
Adverse effects :
- nervousness, insomnia, restlessness
- hypertension, tachycardia, headache
- anorexia, dry mouth.
Nursing considerations :
1. Should be given at morning.
2. Don’t stop amphetamine abruptly to avoid
withdrawal symptoms.
3. Monitor blood pressure and pulse.
4. Ice chips or sugarless gum for dry mouth.
5. Watch out for growth retardation in
children taking methylphenidate.
DRUGS
AFFECTING MENTAL FUNCTIONING
Sedatives, Hypnotics, and Anxiolytics
Prototype :
a.
Benzodiazepines
-
diazepam (Valium), lorazipam (Ativan),
alprazolam (Xanax), flurazepam (Dalmane)
b.
Barbiturates
-
amobarbital, phenobarbital, secobarbital
c.
Miscellaneous
- chloral
hydrate (Noctec), buspirone (Buspar),
paraldehyde (Paral)
Mechanism of
actions :
a.
Benzodiazepines
- increase the effect of
inhibitory neuro transmitter GABA
(gamma-amino butyric acid)
b. Barbiturates and Miscellaneous agents
- depress CNS
Indications :
- induce sleep, sedate and calm clients
Adverse effects :
- hangover-effect, dizziness, CNS
depression
- respiratory depression, drug-dependence
Nursing
considerations :
1. Warn clients of injuries and falls.
2. Brief period of confusion and excitement upon waking up is common with
benzodiazepines.
3. Warn clients not to discontinue
medications abruptly without consulting
a physician.
4. Avoid alcohol while taking these drugs.
6. Rotate and don’t shake the ampules of barbiturates.
Don’t mix with other drugs.
7. Warn female clients that diazepam is
associated with cleft lip.
ANTIDEPRESSANTS
AND MOOD DISORDER DRUGS
Prototype :
a. Tricyclic antidepressants
-
amitriptyline (Elavil), protriptyline (Vivactil),
- imipramine
(Tofranil), desipramine
b. MAO (monoamine
oxidase inhibitors )
- isocarboxazid
(Marplan), phenelzine (Nardil), tranylcypromine (Pernate)
c.
Second-generation antidepressants
- fluoxetine
(Prozac), trazodone (Desyrel)
d. Lithium
Mechanism of actions :
a. Tricyclic antidepressants
- increase receptor sensitivity to
serotonin and/or norepinephrine.
b. MAO inhibitors
- inhibit the enzyme MAO that metabolize
the neurotransmitters norepinephrine and
serotonin.
c. Second – generation antidepressants
- inhibits the reuptake of serotonin.
d. Lithium
- increase serotonin & norepinephrine
uptake
Adverse effects :
- dry mouth, blurred vision, urine
retention, constipation (anticholinergic effects)
- orthostatic hypotension, insomnia
- hypertensive crisis (MAO)
- dehydration (Lithium).
Nursing considerations :
1. Caution client to rise slowly to reduce
the effects of orthostatic hypotension.
2. Take antidepressant with food to enhance absorption
3. Explain to client that full response may
take several weeks (2 weeks).
4. Assess client for constipation resulting
from tricyclic antidepressant use.
5. Client taking MAO inhibitors should
avoid tyramine-rich foods to avoid
hypertensive crisis.
-
aged cheese, sour cream, yogurt, beer, wine, chocolate, soy sauce and
yeast
-
pentholamine (Regintine) is the drug of choice for hypertensive crisis.
6. Inform physician and withhold fluoxetine if
client develop rashes.
7. Take lithium with food to reduce GI effects
- > 1.5 mEq/L blood level may cause
toxicity manifested by:
confusion, lethargy, seizures,hyperreflexia.
- maintain salt and adequate fluid intake
- tremors may occur but it is temporary
- monitor white blood cell count
(increase).
ANTIPSYCHOTIC
DRUGS
(NEUROLEPTICS)
Prototype :
a. Phenothiazines
-
chlorpromazine (Thorazine),
-
trifluoperazine (Stelazine),
-
thioridazine (Mellaril)
b. Other Agents
- clozapine (Clozaril), haloperidol
(Haldol)
Mechanism of action :
-
block
dopamine receptor in the limbic system, hypothalamus, and
other regions of the brain.
Adverse effects :
-
Extra
pyramidal symptoms such as dystonia, pseudoparkinsonism, and
an irreversible tardive dyskinesia as manifested by :
a. lip smacking
b. fine wormlike tongue movement
c. involuntary movements of arms and
leg.
- Neuroleptic malignant syndrome
a. fever, tachycardia, tachypnea,
diaphoresis, cardiovascular collapse
b. muscle rigidity, seizures.
- orthostatic hypotension
Nursing considerations :
1. Teach family members the signs of EPS and
NMS, and report to physician
immediately.
2. Normalization of symptoms may not occur
for several weeks after beginning of
therapy .
3. Avoid administering haloperidol
intravenously
4. Watch out of neutropenia with clozapine.
5. Watch out for orthostatic hypotension and
photosensitivity with phenothiazine.
6. Be sure that oral doses are swallowed,
and not hoarded.
DRUGS USED IN PAIN MANAGEMENT
General
Anesthetics
Prototype :
a. Inhalation anesthetics
- enflurane (Ethrane), halothane
- isoflurane (Forane), nitrous oxide
b. Injection anesthetics
- fentanyl (Sublimaze), ketamine
(Ketalar),
thiopental Na (Penthotal), etomidate (Amidate)
Mechanism of actions :
- cause CNS
depression, by producing loss of
consciousness, unresponsiveness to pain
stimuli, and muscle relaxation.
Nursing considerations :
1. Instruct client NPO for 8 hours
before administration.
2. Monitor cardio pulmonary depression
and hypotension.
3. Monitor urinary retention.
4.
Monitor body temperature
- malignant
hyperthermic crisis :
dantrolene (antidote)
5. Avoid alcohol or CNS depressants for 24
hours after anesthesia.
6. In patient who received halothane, monitor signs
of hepatic fatal side effects :
- rash, fever, nausea, vomiting
- jaundice and altered liver
function.
LOCAL AND TOPICAL ANESTHETIC
Prototype :
local :
bupivacaine, lidocaine, tetracaine, procaine, mepivacaine, prilocaine
topical : benzocaine,
butacaine, dibucaine,lignocaine
Mechanism of action :
- block transmission of impulses across
nerve cell membrane.
Adverse effects :
- cardiac dysrhythmias
Nursing considerations :
-
lignocaine + prilocaine (EMLA cream) should be
applied topically 60 minutes before
procedure.
-
administer cautiously to the areas of large broken skin.
-
observe for fetal bradycardia in
pregnant clients.
ANALGESICS
Prototype :
a. Narcotic analgesics
-
codeine, meperidine (Demerol) morphine,
butorphanol (Stadol)
nalbuphine (Nubain)
b. Non – narcotic analgesic
NSAIDs – aspirin (aminosalicylic
acid), mefenamic acid (Ponstan),
ibuprofen
(Motrin), naproxen, ketoprofen (Orudis), ketorolac.
paracetamol and
acetaminophen (Tylenol)
Mechanism of actions :
a. Narcotic analgesics
-
alter pain perception by binding to opiod receptors in CNS.
b. Non- narcotic analgesic
- relieves pain and fever by inhibiting
the prostaglandin pathway.
Nursing considerations :
1. Monitor respiratory depression &
hypotension in clients taking narcotic analgesic.
2. Injury and accident precautions in clients
taking narcotic analgesic.
3. Warn clients about possibility of
dependency,and do not discontinue narcotics
abruptly in the narcotic-dependent
clients.
4. Naloxone is antidote for narcotic overdose.
5. Advice clients to take NSAIDs with food and
monitor bleeding complications.
6. Aspirin is contraindicated in clients below 18 years old with flu-like symptoms.
7. Monitor hearing loss in clients taking
aspirin.
8. Monitor liver function in clients
taking acetaminophen.
9. N-acetylcysteine is antidote for
paracetamol overdose.
DRUGS
AFFECTING THE CARDIOVASCULAR SYSTEM
ANTICOAGULANTS
Prototype :
-
Heparin (SQ and IV)
Warfarin (Orally)
Mechanism of actions :
a. Heparin
- prevents thrombin from
converting fibrinogen to fibrin.
b. Warfarin
- suppress coagulation by acting as
an
antagonist of vitamin K after 4-5 days.
Indications :
- thrombosis, pulmonary embolism,
myocardial infarction
Adverse effect :
- bleeding
Nursing considerations :
1. HEPARIN
sodium
- if given SQ don’t aspirate or rub the
injection site (above the scapula - best site).
- therapeutic level 1.5-2.5 times normal
PTT;
normal PTT is 20-35 sec. = 50-85 sec.
- antidote : (protamine sulfate)
2. WARFARIN sodium (coumadin)
- warfarin is used for long-term .
-
onset of action is 4-5 days.
- therapeutic level is 1.5-2.5 times
normal PT;
normal PT = 9.6 -11.8 sec. = 25 - 30
sec.
INR = 2 - 3
- should be taken at the
same time of the day to maintain at therapeutic level.
- reduce intake of green leafy vegetables.
- antidote : Vitamin K ( Aquamephyton)
THROMBOLYTICS
Prototype :
Streptokinase, Urokinase
Mechanism of actions :
-
activates plasminogen to generates
plasmin (enzyme that dissolve clots).
Indications :
-
use early in the course of MI
(within 4-6 hours of the onset)
Nursing considerations :
-
monitor bleeding
-
antidote : Aminocarpic acid
Antiplatelet
Medications
Prototype: aspirin, Dipyridamole (Persantin)
Clopidoigrel (Plavix),
Ticlopidine
Mechanism of action :
- inhibit the aggregation of platelet
thereby prolonging bleeding time.
Indications :
- used in the prophylaxis of long-term complication
following M.I, coronary
revascularization, and thrombotic CVA.
Nursing considerations :
- Monitor bleeding time ( NV = 1-9 mins)
- Take the medication with food.
CARDIAC
GLYCOSIDES
Prototype:
- digoxin (Lanoxin) and digitoxin
(Crystodigin)
Mechanism of actions :
- increase intracellular calcium, which
causes the heart muscle fibers to
contract more
efficiently, producing positive inotropic
& negative chronotropic action.
Indications :
- use for CHF, atrial tachycardia and
fibrillation
Nursing
considerations :
-
Monitor for toxicity as evidence by :
nausea, vomiting, anorexia, halo
vision, confusion, bradycardia and heart blocks .
- Do not administer if pulse is less than 60
bpm.
- Should be caution in patient with hypothyroidism
and hypokalemia.
- Antidote : Digi-bind
- Phenytoin is the drug of choice to manage
digitalis-induced arrhythmia.
Nitrates
Prototype :
- isosorbide dinitrate (Isordil)
- nitroglycerine (Deponit, Nitrostat)
Mechanism of action :
-
produce vasodilatation including coronary artery.
Indications :
- angina pectoris, MI, peripheral
arterial occlusive disease.
Adverse effects:
- headache, orthostatic hypotension .
Nursing
Considerations :
1. Transdermal patch
- apply the patch to a hairless area using
a new patch and different site each
day.
- remove the patch after 12-24 hours,
allowing 10-12 hours “patch free” each day to
prevent tolerance.
2. Sublingual medications :
- note the BP before giving the medication.
- offer sips of water before giving because
dryness may inhibit absorption.
- one
tablet for pain and repeat every 5 mins.
for a total of three doses; if not relieved
after 15 mins., seek medical help.
-
stinging or burning sensation indicates that
the tablet is fresh.
-
instruct patient not to swallow the pill
- sustained release medications should be
swallowed and not to be crush.
-
protect the pills from light.
ANTI-ARRHYTHMIC
DRUGS
Class I
(block Na channels)
IA - quinidine, procainamide
IB - lidocaine
IC - flecainamide
Class
II (Beta-blockers)
propanolol, esmolol
Class
III (block K channels)
amiodarone, bretylium
Class
IV (block Ca channels)
verapramil, diltiazem
Nursing considerations :
1. Watch out for signs of CHF.
2. Have client weigh themselves and report
weight gain.
3. Watch out for signs of lidocaine toxicity
:
- confusion and restlessness
ANTILIPEMICS
Prototype :
a. cholesterol-lowering agents
- cholestyramine, colestipol,
lovastatin
b. triglyceride-lowering agents
- gemfibrozil, clofibrate
Mechanism of actions :
- interfere with cholesterol synthesis as well
as
decreasing lipoprotein & triglyceride
synthesis.
Nursing considerations :
- monitor liver functions while using
statins.
- prevent constipation, flatulence,
cholelithiasis
- encourage increase fluid and fiber intake.
ANTI
– HYPERTENSIVE
Angiotensin-Converting
Enzyme (ACE) Inhibitors
Prototype :
captopril (Capoten), enalapril (Vasotec),
quinapril, lisinopril
Mechanism of actions :
- prevent peripheral vasoconstriction by
blocking conversion of angiotensin I to
angiotensin II decreasing
peripheral resistance.
Adverse effect :
- it cause hyperkalemia
- induce chronic cough
Nursing considerations :
- not to discontinue medications because
it can cause rebound hypertension.
- avoid using K+ sparing diuretics.
CALCIUM-CHANNEL
BLOCKERS
Prototype :
-
Nifedipine (calcibloc, adalat), Amlodipine (norvasc), Felodipine
(Plendil)
Verapramil (Isoptin)
Mechanism of action :
- decrease cardiac contractility and
the workload of the heart, thus
decreasing the
need for O2.
- it also promote vasodilatation of the
coronary and peripheral vessels.
Indications :
- hypertension, angina, arrhythmia
Adverse effects :
-
bradycardia, hypotension, headache
- reflex tachycardia, constipation
Nursing considerations :
- Administer between meals to enhance absorption.
- Take client’s pulse rate before each dose,
withhold if pulse is below 60 bpm.
- Refer for signs of congestive heart
failure.
DIURETICS
- usually given at morning
CARBONIC ANHYDRASE INHIBITORS
- Acetazolimide (Diamox)
- increase Na+, K+, & HCO3 secretion, along
with it is H2O
- metabolic acidosis
OSMOTIC
DIURETIC
- Mannitol
- Increase osmotic pressure of the
glomerular filtrate.
- hypotension
THIAZIDE
DIURETICS
- hydrochlorothiazide
- blocks Na and K reabsorption; reabsorb Ca
- hypercalcemia
LOOP
DIURETICS
- Furosemide (Lasix)
- blocks Na, K, and Ca reabsorption
- hypocalcemia
POTASSIUM
SPARING DIURETICS
- Spironolactone (Aldactone)
- excrete Na and water but it reabsorb
K
- hyperkalemia
RESPIRATORY
MEDICATIONS
Bronchodilators
Prototype :
Symphatomimetic Xanthines
- albuterol, salbutamol - aminophylline
- isoproterenol, salmeterol - theophylline
- terbutaline
Mechanism of actions:
- sympathomimetic (b-receptor agonist) bronchodilators, dilate airways.
- xanthine bronchodilators, stimulate CNS
for respiration.
Indications :
-
bronchospasm, asthma, bronchitis, COPD.
Adverse effects :
- palpitations and tachycardia
- restlessness, nervousness, tremors
- anorexia, nausea and vomiting, headache,
dizziness.
Nursing
considerations :
- Contraindicated hyperthyroidism, cardiac
dysrhythmia, or uncontrolled seizure
disorder.
- Should be used with caution in patient
with HPN and narrow-angle glaucoma.
GLUCOCORTICOIDS (CORTICOSTEROIDS)
Prototype :
- dexamethasone, budesonide,
fluticasone, prednisone, beclomethasone.
Mechanism of actions :
-
act
as anti-inflammatory agents and reduce
edema of the airways, as well as
pulmonary
edema.
Adverse effects :
-
Cushing’s syndrome, neutropenia. osteoporosis
Nursing
considerations :
- Take drugs at meal time or with food.
- Eat foods high in potassium, low in sodium.
- Instruct client to avoid individuals with
RTI.
- Instruct client not to stop medication abruptly,
it should be tapered to prevent
adrenal insufficiency
- Avoid taking NSAID while taking steroids.
- Take inhaled bronchodilators first before
taking inhaled steroids, and rinse mouth
after using.
MAST
CELL STABILIZERS
Prototype :
cromolyn
sodium (Intal)
Mechanism of action :
- stabilize mast cells that release histamine
triggering asthmatic attacks.
Nursing Consideration:
- Should be given before asthmatic attacks.
- Administer oral capsule at least 30 mins before
meals for better absorption.
- Drink a few sips of water before & after inhalation
to prevent cough & unpleasant taste
- Assess for lactose-intolerance.
ANTI-HISTAMINES (H-1 BLOCKERS)
Protoytype :
- Astemizole (Hismanal), Loratidine
(Claritin),
Brompheniramine (Dimetapp),
Diphenhydramine (Benadryl),
Cetirizine (Iterax), Celestamine (Tavist).
Mechanism of action :
- decrease nasopharyngeal secretions and
decrease nasal itching by blocking histamine
in H1-receptor.
Indications :
- common colds, rhinitis, nausea and
vomiting, urticaria, allergies and as
sleep aid.
Nursing Considerations :
- Administer with food and drink.
- Given IM via Z-track method or orally.
- Precautions in handling machine and
driving while taking these drugs.
- Ice chips or candy for dry mouth
ANTI-TUBERCULOSIS
Prototype :
First line Second line
- Isoniazid (INH) - Cycloserine
- Rifampicin (Rifadin) - Kanamycin
- Ethambutol - Ethonamide
- Pyrazinamide - Para-aminosalicylic acid
- Streptomycin
-
active tuberculosis are treated with
drug combination for 6-9 mos.
- multidrug-resistant strain (MDR-TB)
are medicated for 1 year up to 2 years
-
given before meals
Isoniazid
- should be given 1 hr before or 2 hrs after meals because food may delay absorption.
- should be given at least 1 hr before
antacids.
- instruct to notify physician for signs of
hepatoxicity (jaundice), and neurotoxicity
numbness of extremities.
- administer with Vitamin B6 to counteract
the neurotoxic side effects.
- avoid alcohol.
Rifampicin
- given on an empty stomach with 8 0z. of water, 1 hour
before or 2 hours after meals
and avoid taking antacids with
medications.
- hepatotoxic thus avoid alcohol.
- instruct the client that urine, feces,
sweat, and tears will be red-orange in
color.
Pyrazinamide
- given for 2 months.
- increase serum uric acid and cause
photosensitivity.
Ethambutol
- contraindicated in children under 13 years
old.
- obtain a baseline visual acuity because it can cause optic
neuritis.
- Instruct the client to notify the physician immediately if any
visual problems occurs.
Streptomycin
- aminoglycoside
antibiotic given IM.
-
nephrotoxic and ototoxic.
-
obtain baseline audiometric test
and repeat every 1-2 months because the
medications impairs the CN VIII.
DRUGS AFFECTING GASTROINTESTINAL SYSTEM
Antacids
Prototype :
- aluminum/magnesium compounds
(Maalox)
- sodium
bicarbonate (Alka-Seltzer)
- calcium carbonate (Tums)
- magnesium hydroxide (Milk of Magnesia).
Mechanism of actions :
- neutralize the stomach acidity.
Adverse effects :
- metabolic alkalosis, stone formation
- electrolyte imbalance
- diarrhea (magnesium), constipation
(aluminum).
Nursing considerations :
- Give 1 hr after meals.
- Avoid giving medications within 1-2 hrs of antacid administration
(decreases absorption).
- Take fluids to flush after intake of
antacid suspensions.
- Monitor for changes of bowel patterns.
HISTAMINE – 2 BLOCKERS
Prototype :
- cimetidine (Tagamet), ranitidine (Zantac),
famotidine (Pepcid), nizatidine (Axid).
Mechanism of action:
- blocks H2 receptors in the stomach,
reducing
acid secretions.
Nursing considerations :
- Given before or with meals
- Avoid giving other drugs with cimetidine
- Gynecomastia may developed with chronic
use of cimetidine.
Proton – Pump Inhibitors (PPI)
Prototype :
- omeprazole (Losec), Lansoprazole (Lanz),
pantoprazole (Pantoloc).
Mechanism of action :
- inhibit the proton H+ to combine with Cl-
toform hydrochloric acid.
Nursing considerations :
- Given before meals preferably at morning.
Mucosal Barriers
Prototype :
- sucralfate (Carafate), misoprostol
(Cytotec).
Mechanism of action :
- coats the mucosa to prevent ulcerations.
Nursing consideration :
- Given before meals.
- Misoprostol is contraindicated for
pregnants.
- Sucralfate cause constipation.
Anti-diarrheal Agents
Prototype :
- diphenoxylate (Lomotil), loperamide
(Imodium), kaolin/pectin mixture (Kaopectate).
Mechanism of actions :
- decrease stomach motility and peristalsis.
Nursing considerations :
- Monitor for rebound constipation.
- Be cautious taking if with infectious
diarrhea.
- Monitor atropine toxicity with
diphenoxylate.
- Clay, white or pale stool is common with
kaopectate.
Laxatives
a. lactulose (Cephulac), Na biphosphate
(Fleet
enema) & magnesium salt (Milk of
Magnesia)
- retain fluid and distend intestine
b. ducosate (Dialose)
- emulsify fecal fat and water
c. bisacodyl
(Dulcolax) & senna (X-prep)
- irritates intestinal
mucosa and
stimulate intestinal smooth muscles
d.
bulk-forming laxative (Metamucil)
- increase fecal bulk and water
content
e.
mineral oil
- lubricates & prevent colon
absorption
EMETICS
Prototype : ipecac syrup, apomorphine
Mechanism of actions :
- induce vomiting through stimulation
of vomiting center of medulla.
Indications :
- ingestion of poisonous or toxic
substances.
Nursing considerations :
- Consult poison control center before
induction of vomiting.
- Administer ipecac syrup with large amount of fluid.
DRUGS AFFECTING THE ENDOCRINE SYSTEM
THYROID AGENTS
Prototype :
- Proloid (thryroglobulin )
- Synthroid (levothyroxine)
- Cytomel ( liothyronine).
Mechanism of action :
- function as natural or synthetic
hormones.
Nursing considerations :
- Taken in the morning.
-
Caution with coronary artery disease.
-
Monitor for signs of hyperthyroidism and refer for decreasing the dose.
PARATHYROID AGENTS
Prototype :
a. calcitonin (Calcimar), etidronate
(Didronel),
b. calcitrol (Rocaltrol), calcifediol
(Calcedrol)
Mechanism of action :
a. reduce bone resorption
b. promotes calcium absorption
Nursing considerations :
- Monitor signs of calcium imbalance
- Report for bone pains.
- Remain sitting upright after taking
etidronate.
Oral
Hypoglycemic Agents (OHA)
1.
Sulfonylureas
-
stimulate insulin secretions and
increase tissue sensitivity to insulin.
First Generation :
Chlorpropamide (Diabenese)
-
disulfiram precautions
Tolbutamide (Orinase)
-
congenital defect
Second Generation :
Glypizide, Glymepiride
2.
Biguanides
- facilitates insulin action on
the peripheral receptor site.
Metformin and Glucophage (Glucovance)
- side effect is lactic acidosis
3.
Alpha-glucosidase inhibitors
- delay carbohydrate absorption in the
intestinal system.
Acarbose (Precose) – side effect is
diarrhea
4.
Thiazolinidine
- increase tissue sensitivity of insulin.
Rosiglitazone (Avandia)
5. Meglitinides
- stimulate insulin release in
pancreatic B-cells.
Repaglinide (Prandin)
Nursing
considerations :
- Effective only for type II DM.
- Contraindicated to pregnant &
breastfeeding.
- Given before meals.
- Monitor for signs of hypoglycemia.
Insulin
Insulin Onset Peak
Duration
Immediate-acting 0.15h
0.5–1h
5 h
(lispro)
Short-acting 0.5-1
h 2-4 h 5-7h
(regular, semilente)
Intermediate-acting 1-3 h
6-12 h 18-24 h
(NPH,
lente)
Long-acting 4-6h
10-30 h 24-36 h
(ultralente)
Mixed 0.5 h 4-8 h 25 h
(regular 30%, NPH 70%)
Nursing
considerations :
- Usually given before meals.
- Roll the bottle in palm of hands, don’t
shake.
- Inject amount of air that is equal to each
dose
into the bottle – short acting last
(clear).
- Aspirate short acting first, then long
or intermediate (cloudy).
- Alcohol is recommended for cleansing bottle
but not with skin.
- Pinch skin, avoid I.M, don’t aspirate.
- Rotate the injection site an inch a part.
- Prefilled syringes are stored vertically,
needle-up.
- May increase dose during illnesses.
- Used bottles stored in room temperature,
unused bottle stored in refrigerator.
- Monitor for acute hypoglycemia :
a.
3-4 commercially prepared glucose tablet
b. 4-6 ounce of fruit juice or regular
soda
c.
2-3 teaspoon or honey
d. Glucagon 1 gm SQ or IM
e. D50-50 IV.
ESTROGENS
AND PROGESTINS
Prototype :
- conjugated estrogen (Premarin),
estrone (Bestrone), estradiol (Estrace),
diethylstilbestrol (DES).
Indications :
- prostate cancer, contraceptions
- estrogen replacement
Adverse effects :
estrogen - endometrial CA, gallbladder
disease, HPN, migraine, breast tenderness
progesterone - altered menstrual flow, risk
of thrombo embolism
Nursing considerations :
1. Mix estrogen or progestins prior to IM administration
by rolling vials between palms.
2. Monitor blood pressure
3. Teach patient how to perform BSE.
4. Regular follow-up examination is required
to detect associated risk of acquiring CA
DRUGS
AFFECTING LABOR and LACTATION
Uterine
Stimulating Agents
Protoytpe :
a. Oxytocin (Pitocin), ergonovine (Ergotrate),
methylergonovine (methergine)
b. carbopost (Prostin), dinoprostone (Prostin
E2)
Mechanism of actions :
a. stimulates uterine smooth muscles
b. ripening of cervix
Adverse reactions :
- fetal bradycardia (oxytocin),
- hypertension (ergonovine), palpitations
- allergic reactions (Prostaglandins)
Uterine Inhibiting Agents (Tocolytic)
Prototype :
- ritodrine (Yutopar), terbutaline
(Brethine)
Mechanism of actions :
- relaxes the uterus by stimulating the B2-
adrenergic receptors
Adverse effects :
-
tremors,
nausea, vomiting and tachycardia
Lactation Suppressants
Prototype :
- bromocriptine (Parlodel)
Mechanism of action :
- decrease serum prolactin levels
Adverse effects :
- drowsiness, headache, nausea, palpitations
DRUGS
FOR TREATING INFECTION
Antibacterial Agents
1. Cell wall inhibitors
a. penicillins - pen G, amoxicillin,
cloxacillin
b. cephalosphorins - cephalexin, cefaclor
c. glycopeptide - vancomycin
2. Protein synthesis inhibitors
a. aminoglycosides - amikacin, gentamycin
b. macrolide - erythromycins,
roxithromycin
c. lincosamides - clindamycins
d. chloramphenicol, tetracyclines
3. Antimetabolites - blocks folic acid
synthesis
a. Sulfonamides - cotrimoxazole
4.
DNA synthesis inhibitors
a. quinolones - ciprofloxacin, ofloxacin
b. metronidazole
Adverse effects :
1. Aminoglycoside - nephrotoxicity &
ototoxicity
2. Sulfonamides - Steven-Johnson’s syndrome,
photosynsetivity
3. Quinolones - insomnia
4. Tetracyclines - bone problems
5. Chloramphenicol - Gray syndrome, bone marrow depression
6. Erythromycin - hepatitis
Nursing considerations :
1. Collect appropriate specimen for C & S
before starting antibiotics.
2. Check client’s history of allergies.
3. Avoid administering erythromycin and quinolones with food.
4. Pregnant precautions.
5. Report for diarrhea -
pseudomembranous colitis (clindamycin)
6. Monitor adverse effects.
Antiviral Agents
Prototype :
- acyclovir (Zovirax), ganciclovir
(Cytovene),
vidarabine (Vira-A), amantidine
(Symmetrel),
ribavirin (Virazole),
zidovidine (Retrovir).
Mechanism of actions :
- inhibits virus specific enzymes involve
in DNA
synthesis. They only control the growth of
virus but it does not cure.
Adverse effects :
- granulocytopenia, thrombocytopenia,
nausea,
nervousness, headache, nephrotoxicity.
Nursing
consideration :
- Pregnant and breastfeeding precautions.
- Administer IV antivirals to avoid
crystallization in renal tubules.
- Give ribavirin only with aerosol generator.
- Monitor CBC and creatinine level.
- Refer for signs of bleeding.
- Take amantidine after meals.
Antifungal Agents
Prototype :
- amphotericin B (Fungisone), nystatin,
fluconazole (Diflucan), ketoconazole
(Nizoral).
Mechanism of actions :
- inhibit the synthesis of fungal sterol.
Adverse effects :
- nephrotoxicity and neurotoxicity
- bone marrow depression
- chills, fever, joint pains, abdominal pain
and headache.
Nursing considerations :
- Dilute amphotericin B with sterile water solution
not with electrolyte solution.
- Tell clients that fever, chills, GI upset,
joint and muscle pain will subside as
amphotericin B continues.
- With oral candidiasis, let nystatin tablet dissolve
in mouth rather than swallowing it.
- Refrain ketoconazole with antacids.
- Report for signs of bleeding, infection
& fatigue.
ANTIPARASITIC AGENTS
Prototype :
a. Antimalarial
- chlroquine, mefloquine, primaquine,
quinine, pyrimethamine
b. Antiamebiasis
- metronidazole (Flagyl), iodoquinol,
furozolidone (Furoxone).
Mechanism of actions :
a. antimalarial – alters protozoal DNA,
depleting folates, & reducing
nucleic acid
production
b. antiamoeba – block protein synthesis.
Nursing considerations :
1. Administer anti-malarial drugs with food.
2. Take seizure precautions while
administering
antimalarial drugs.
3. Refer cinchonism during quinine treatment:
- tinnitus, headache, vertigo, fever,
and visual changes.
4. Inform clients that iodoquinol falsify
thyroid function test for up to 6 months.
ANTIHELMINTIC
Prototype :
- mebendazole (Vermox), thiabendazole,
niclosamide (Niclocide), piperazine
(Antepar),
praziquantel (Biltricide).
Mechanism of actions :
- paralyze larva and adult helmints by
acting on parasite microtubules.
Adverse effects :
- GI upset, urinary odor (thiabendazole)
-
headache, dizziness, fatigue
Nursing considerations :
1. Treat all the family members for nematodes
infection to prevent recurrence.
2. Praziquantel must swallowed rapidly because of its bitter taste to avoid gagging.
3. Other antihelmintics should be chewed.
ANTI-NEOPLASTIC
DRUGS
General considerations :
- kills or inhibit the reproduction of
neoplasmic cells but as well as normal
cells.
- it could be cell cycle phase specific or
cell cycle non-specific.
- preferably given through IV route.
Prototype :
1. Alkylating Agents
- inhibits cell production by
causing cross linking of DNA
a. Busulfan – hyperuricemia
b. Chlorambucil – gonadal suppression
c. Cisplatin – ototoxicity and nephrotoxicity
d. Cyclophosphamide – hemorrhagic
cystitis.
2. Antitumor Antibiotic Agents
- interfere in DNA and RNA synthesis
a. Plicamycin – affects bleeding time
b. Doxurubicin – cardiotoxicity
c. Bleomycin – pulmonary toxicity.
3. Antimetabolites
- replace normal proteins required for
DNA synthesis by inhibiting the S phase
a. Cytarabine – hepatotoxicity
b. 5-flourouracil – phototoxicity reaction
and cerebellar dysfunctions
c. 6-marcaptopurine – hyperuricemia
d. Methotrexate – photosensitivity
- given with leucoverin to lessen its
toxicity.
4. Mitotic Inhibitors (Vinca Alkaloids)
- prevent mitosis acting on the M
phase causing cell death
a. Vincristine sulfate – neurotoxicity,
numbness
5. Hormonal Medications and Enzymes
- block the normal hormones in hormone
sensitive tumors
a. Tamoxifen citrate – visual problems
– elevate cholesterol &
triglycerides level
b. Diethylstilbestrol – impotence and
gynecomastia in men.
Side
Effects:
stomatitis
- bland diet, avoid strong mouthwash
- soft tooth brush, ice chips
diarrhea, nausea and vomiting
- anti-emetic, replace fluids and
electrolytes
alopecia
- reassure that it is temporary
- encourage o wear wigs, hats and head
scarf
skin pigmentation
- inform that it is only temporary
tumor lysis syndrome
- hyperuricemia & hyperkalemia
- force fluids
infection
- notify physician if WBC is <2000/mm3
- monitor for signs of infection
- reverse isolation
- low bacteria diet
anemia
- iron, B-12, folic acid rich food
- provide rest periods
bleeding
- avoid NSAIDs
- minimize invasive procedures
- use soft toothbrush and electric razor
menstrual changes
- reassure that menstruation will
resume.
THE END
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