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Pharmacology Notes
Pharmacology Notes
Pharmacology Notes
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.
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 clients 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.
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.
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 dont shake the ampules of barbiturates. Dont mix with other drugs.
7. Warn female clients that diazepam is associated with cleft lip.
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.
Hemostasis :
Bleeding/injury
I
Vasoconstriction
Plasminogen
I
I
Platelet aggregation
Plasmin
( temporary plug)
I
I
I
Clotting factor activation -------------I
I
I
I
Intrinsic pathway (8,9,10,11,12) Extrinsic pathway (3,7,10) I
(PTT )
(PT) Vit K dep.
I
I
I
I
I Prothrombin activation I
I
I
I
Thrombin
I
I
I
Fibrinogen ------------Fibrin threads ------------- Fibrin split products
(coagulation)
( Removed by liver & spleen )
Indications :
- thrombosis, pulmonary embolism, myocardial infarction
Adverse effect :
- bleeding
Nursing considerations :
1. HEPARIN sodium
- if given SQ dont 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 clients 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 :
- Cushings 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.
Anti-tuberculosis
Prototype :
First line
- Isoniazid (INH)
- Rifampicin (Rifadin)
- Ethambutol
- Pyrazinamide
- Streptomycin
Second line
- Cycloserine
- Kanamycin
- Ethonamide
- Para-aminosalicylic acid
- 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.
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.
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.
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.
Insulin
Insulin
Immediate-acting
(lispro)
Short-acting
(regular, semilente)
Intermediate-acting
(NPH, lente)
Long-acting
(ultralente)
Mixed
(regular 30%, NPH 70%)
Onset
Peak
0.15h
0.51h
5h
0.5-1 h
2-4 h
5-7h
1-3 h
6-12 h
18-24 h
4-6h
10-30 h
0.5 h
4-8 h
Duration
24-36 h
25 h
Nursing considerations :
- Usually given before meals.
- Roll the bottle in palm of hands, dont 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, dont 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.
Lactation Suppressants
Prototype :
- bromocriptine (Parlodel)
Mechanism of action :
- decrease serum prolactin levels
Adverse effects :
- drowsiness, headache, nausea, palpitations
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.
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