Professional Documents
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Pharmacology HESI Review
Pharmacology HESI Review
ANTIPARKINSONIAN AGENTS
Prototype :
a. Anticholinergic agents - trihexyphenidyl (Artane), benztropine (Congentin)
b. Dopaminergic agents - Levodopa, carbidopa-levodopa (Sinemet), amantidine (Symmetrel)
Adverse effects of dopaminergic agents:
a. levodopanausea,
vomiting,
anorexia,
orthostatic
hypotension,
dark-colored
urine and sweat
b. amantidine ankle edema, constipation
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) because it reverses effects of levodopa.
4. Change positions slowly to avoid orthostatic hypotension.
5. Elevate leg to reduce ankle edema.
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 ampoules of barbiturates. Dont mix with other drugs.
7. Warn female clients that diazepam is associated with cleft lip.
ANTIPLATELET MEDICATIONS
Prototype: aspirin (ASA), Dipyridamole (Persantin), Clopidogrel (Plavix)
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 &
thrombotic CVA
Nursing considerations:
- Monitor bleeding time ( NV = 1-9 mins)
- Take the medication with food.
CARDIAC GLYCOSIDES
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, 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 10
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 crushed
- protect the pills from light
ANTI HYPERTENSIVES
ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS (DRUG NAMES END IN WITH -PRIL)
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 :
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- hyperkalemia
- induce chronic dry 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), Verapramil (Isoptin)
Mechanism of action:
- decrease cardiac contractility and the workload of the heart, thus decreasing the need for O 2
- it also promotes 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
Thiazides - hydrochlorothiazide
- blocks Na and K reabsorption; reabsorb Ca
- hypercalcemia
Loop diuretics - furosemide (Lasix)
- blocks Na, K, and Ca reabsorption
- hypocalcemia
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Potassium sparing diuretics - Spironolactone (Aldactone)
- excrete Na and water but it reabsorbs K
- hyperkalemia
RESPIRATORY MEDICATIONS
BRONCHODILATORS
Prototype :
Symphatomimetic
Xanthines
- albuterol, salbutamol
- aminophylline
- isoproterenol, salmeterol - theophylline
- terbutaline
Mechanism of actions:
- sympathomimetic ( -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 in hyperthyroidism, cardiac dysrhythmia, or uncontrolled seizure disorder.
- Should be used with caution in patients with HPN and narrow-angle glaucoma.
GLUCOCORTICOIDS (Corticosteroids)
Prototype:
- prednisone
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 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 NSAIDs while taking steroids.
- Take inhaled bronchodilators first before taking inhaled steroids, and rinse mouth after using.
Nursing Considerations :
- Administer with food and drink.
- Precautions in handling machinery and driving while taking these drugs.
- Ice chips or candy for dry mouth
DECONGESTANTS
-
Mechanism of action:
- coats the mucosa to prevent ulcerations.
Nursing consideration:
- Given before meals.
- Misoprostol is contraindicated for pregnants.
- Sucralfate cause constipation.
ANTII-EMETICS (ANTI-VOMITING)
-
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. Osmotic : lactulose (Duphalac), Na biphosphate (Fleet enema) & magnesium salt (Milk of
Magnesia)
- retain fluid and distend intestine
b. Fecal softeners : ducosate (Dialose)
- emulsify fecal fat and water
c. Stimulant : bisacodyl (Dulcolax) & senna (X-prep)
- irritates intestinal mucosa and stimulates intestinal smooth muscles
d. bulk-forming laxative (Metamucil)
- increase fecal bulk and water content
e. Emollient/Lubricant : mineral oil
- lubricates & prevent colon absorption
ANTIDIABETICS
ORAL HYPOGLYCEMIC AGENTS (OHA)
1. Sulfonylureas
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stimulate insulin secretions and increase tissue sensitivity to insulin.
First Generation: Chlorpropamide (Diabenase) - disulfiram precautions
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; e.g Rosiglitazone (Avandia) already discontinued
Nursing considerations:
- Effective only for type II DM
- Contraindicated to pregnant & breastfeeding.
- Given before meals
- Monitor for signs of hypoglycemia.
Insulin
Type of Insulin
& Brand
Names
Rapid-Acting
Humalog or
lispro
Novolog or
aspart
Apidra or
glulisine
Onset
Peak
15-30 min.
30-90 min
3-5 hours
10-20 min.
40-50 min.
3-5 hours
20-30 min.
30-90 min.
1-2 hours
2-5 hours
5-8 hours
2-3 hours
2-3 hours
4-12 hours
18-24 hours
3-10 hours
18-24 hours
Short-Acting
Regular (R)
humulin or
30 min. -1 hour
novolin
Velosulin (for
use in the
30 min.-1 hour
insulin pump)
Intermediate-Acting
NPH (N)
1-2 hours
Lente (L)
1-2 hours
Duration
Intermediate-acting
insulin covers insulin
needs for about half
the day or overnight.
This type of insulin is
often combined with
rapid- or short-acting
insulin.
10
Long-Acting
30 min.-3
hours
10-20 hours
20-36 hours
Lantus
(Glargine)
1-1 hour
No peak time;
insulin is
delivered at a
steady level
20-24 hours
Levemir or
detemir
1-2 hours
6-8 hours
Up to 24 hours
Ultralente (U)
Long-acting insulin
covers insulin needs
for about one full day.
This type of insulin is
often combined, when
needed, with rapid- or
short-acting insulin.
* Cannot mix these
with other insulins in
the same vial. Have to
give two separate
injections.
Pre-Mixed*
Humulin 70/30
30 min.
2-4 hours
14-24 hours
These products are
Novolin 70/30
30 min.
2-12 hours
Up to 24 hours generally taken twice
Novolog 70/30
10-20 min.
1-4 hours
Up to 24 hours a day before
mealtime.
Humulin 50/50
30 min.
2-5 hours
18-24 hours
Humalog mix
30 min.-2
15 min.
16-20 hours
75/25
hours
*Premixed insulins are a combination of specific proportions of intermediate-acting and shortacting insulin in one bottle or insulin pen (the numbers following the brand name indicate the
percentage of each type of insulin).
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; treat with:
a. 3-4 commercially prepared glucose tablet
b. 4-6 ounce of fruit juice or regular soda
c. 2-3 teaspoons of honey
d. Glucagon 1 gm SQ or IM
e. D50-50 IV.
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c. tetracyclines
3. Antimetabolites - blocks folic acid synthesis
a. Sulfonamides cotrimoxazole
4. DNA synthesis inhibitors
a. quinolones - ciprofloxacin, norfloxacin
b. metronidazole (Flagyl)
Adverse effects :
1. Aminoglycoside - nephrotoxicity & ototoxicity
2. Sulfonamides - Steven-Johnsons syndrome, photosensitivity Quinolones - insomnia
3. Tetracyclines - bone problems
4. Erythromycin - hepatitis
Nursing considerations:
1. Collect appropriate specimen for C & S before starting antibiotics.
2. Check clients history of allergies.
3. Monitor adverse effects: ALL antibiotics can cause nausea, vomiting & diarrhea
Prototype: atropine
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 (insecticide)
Adverse effects:
- dry mouth , dilatation of pupils, tachycardia
- urinary retention, ileus, heat stroke
Nursing considerations:
1. Keep clients 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 bedtime.
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Nursing considerations:
1. Contraindicated in clients w/ hyperthyroidism, pheochromocytoma & cardiovascular disease.
2. Monitor vital signs and advice precautions
MISCELLANEOUS DRUGS
ANTI-GOUT
-
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Digoxin Digibind
Heparin/Lovenox - Protamine Sulfate
Morphine sulfate - Naloxone Hydrochloride
Warfarin/Coumadin- Vitamin K
Acetaminophen - Acetylcycteine
Benzodiazepine - Flumazenil
Penicillin Epinephrine
Anticholinergic poisoning - Physostigmine