PHARMACOLOGY a.
immediately notify the nursing
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 :
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 cantus
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
6. 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
3. benzodiazepines.
4. Warn clients not to discontinue
medications abruptly without consulting
a physician.
5. 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 :
 lip smacking
 fine wormlike tongue movement
 involuntary movements of arms
and leg.
- Neuroleptic malignant syndrome
 fever, tachycardia, tachypnea,
diaphoresis, cardiovascular
collapse
 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
narcoticsabruptly 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
3. weight gain.
4. Watch out for signs of lidocaine toxicity :
5. confusion and restlessness
 ANTILIPEMICS  Adverse effects :
 Prototype : - bradycardia, hypotension, headache
a. cholesterol-lowering agents - reflex tachycardia, constipation
- cholestyramine, colestipol, lovastatin  Nursing considerations :
b. triglyceride-lowering agents - Administer between meals to enhance
- gemfibrozil, clofibrate absorption.
 Mechanism of actions : - Take client’s pulse rate before each dose,
- interfere with cholesterol synthesis as withhold if pulse is below 60 bpm.
well as decreasing lipoprotein & - Refer for signs of congestive heart failure.
triglyceride synthesis.
 Nursing considerations : DIURETICS
- monitor liver functions while using (usually given at morning)
statins. CARBONIC ANHYDRASE INHIBITORS
- prevent constipation, flatulence, - Acetazolimide (Diamox)
cholelithiasis - increase Na+, K+, & HCO3 secretion,
- encourage increase fluid and fiber along with it is H2O
intake. - metabolic acidosis
OSMOTIC DIURETIC
ANTI – HYPERTENSIVE - Mannitol
Angiotensin-Converting Enzyme (ACE) - Increase osmotic pressure of the
Inhibitors glomerular filtrate.
 Prototype: - hypotension
- captopril (Capoten), enalapril (Vasotec), THIAZIDE DIURETICS
quinapril, lisinopril - hydrochlorothiazide
 Mechanism of actions: - blocks Na and K reabsorption; reabsorb
- prevent peripheral vasoconstriction by Ca
blocking conversion of angiotensin I to - hypercalcemia
angiotensin II decreasing peripheral LOOP DIURETICS
resistance. - Furosemide (Lasix)
 Adverse effect: - blocks Na, K, and Ca reabsorption
- it cause hyperkalemia - hypocalcemia
- induce chronic cough POTASSIUM SPARING DIURETICS
 Nursing considerations: - Spironolactone (Aldactone)
- not to discontinue medications because it - excrete Na and water but it reabsorb K
can cause rebound hypertension. - hyperkalemia
- avoid using K+ sparing diuretics.
CALCIUM-CHANNEL BLOCKERS RESPIRATORY MEDICATIONS
 Prototype : Bronchodilators
- Nifedipine (calcibloc, adalat),  Prototype :
Amlodipine (norvasc), Felodipine Symphatomimetic Xanthines
(Plendil), Verapramil (Isoptin) - albuterol, salbutamol - aminophylline
 Mechanism of action : - isoproterenol, salmeterol - theophylline
- decrease cardiac contractility and the - terbutaline
workload of the heart, thus decreasing  Mechanism of actions:
the need for O2. - sympathomimetic (b-receptor agonist)
- it also promote vasodilatation of the bronchodilators, dilate airways.
coronary and peripheral vessels. - xanthine bronchodilators, stimulate CNS
 Indications : for respiration.
- hypertension, angina, arrhythmia  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 riggering 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
histaminein 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-
- Streptomycin 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.
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 PARATHYROID AGENTS
diarrhea.  Prototype :
- Monitor atropine toxicity with diphenoxylate. a. calcitonin (Calcimar), etidronate
- Clay, white or pale stool is common with (Didronel),
kaopectate. b. calcitrol (Rocaltrol), calcifediol
Laxatives (Calcedrol)
a. lactulose (Cephulac), Na biphosphate  Mechanism of action :
(Fleet enema) & magnesium salt (Milk of a. reduce bone resorption
Magnesia) b. promotes calcium absorption
- retain fluid and distend intestine  Nursing considerations :
b. ducosate (Dialose) - Monitor signs of calcium imbalance
- emulsify fecal fat and water - Report for bone pains.
c. bisacodyl (Dulcolax) & senna (X-prep) - Remain sitting upright after taking
- irritates intestinal mucosa and etidronate.
stimulate intestinal smooth muscles
d. bulk-forming laxative (Metamucil) Oral Hypoglycemic Agents (OHA)
- increase fecal bulk and water content 1. Sulfonylureas
e. mineral oil - stimulate insulin secretions and
- lubricates & prevent colon absorption increase tissue sensitivity to insulin.
Emetics  First Generation:
 Prototype: ipecac syrup, apomorphine Chlorpropamide (Diabenese)
 Mechanism of actions: - disulfiram precaution
- induce vomiting through stimulation of Tolbutamide (Orinase)
vomiting center of medulla. - congenital defect
 Indications:  Second Generation:
- ingestion of poisonous or toxic Glypizide, Glymepiride
substances. 2. Biguanides
 Nursing considerations: - facilitates insulin action on the
- Consult poison control center before peripheral receptor site.
induction of vomiting. - Metformin and Glucophage
- Administer ipecac syrup with large (Glucovance)
amount of fluid. - side effect is lactic acidosis
3. Alpha-glucosidase inhibitors
DRUGS AFFECTING THE ENDOCRINE - delay carbohydrate absorption in the
SYSTEM intestinal system.
THYROID AGENTS - Acarbose (Precose) – side effect is
 Prototype : diarrhea
- Proloid (thryroglobulin ) 4. Thiazolinidine
- Synthroid (levothyroxine) - increase tissue sensitivity of insulin.
- Cytomel ( liothyronine). - Rosiglitazone (Avandia)
 Mechanism of action : 5. Meglitinides
- Function as natural or synthetic - stimulate insulin release in pancreatic B-
hormones. cells.
 Nursing considerations : - Repaglinide (Prandin)
- Taken in the morning.  Nursing considerations :
- Caution with coronary artery disease. - Effective only for type II DM.
- Monitor for signs of hyperthyroidism and - Contraindicated to pregnant &
refer for decreasing the dose. breastfeeding.
- Given before meals.
- Monitor for signs of hypoglycemia.
 Insulin ESTROGENS AND PROGESTINS
Insulin Onset Peak Duration  Prototype :
Immediate- - conjugated estrogen (Premarin), estrone
acting 0.15hr 0.5-1hr 5hr (Bestrone), estradiol (Estrace),
(lLispro) diethylstilbestrol (DES).
Short-acting  Indications :
(regular, 0.5-1hr 2-4hr 5-7hr - prostate cancer, contraceptions
semilente) - estrogen replacement
Intermediate-  Adverse effects:
acting (NPH, 1-3hr 6-12hr 18-24hr - estrogen - endometrial CA, gallbladder
Lente) disease, HPN, migraine, breast
Long-acting tenderness
4-6hr 10-30hr 24-36hr - progesterone - altered menstrual flow,
(Ultralente)
Mixed risk of thrombo embolism
(regular  Nursing considerations :
0.5hr 4-8hr 25hr 1. Mix estrogen or progestins prior to IM
30%,NPH
70%) administration by rolling vials between
 Nursing considerations : palms.
- Usually given before meals. 2. Monitor blood pressure
- Roll the bottle in palm of hands, don’t 3. Teach patient how to perform BSE.
shake. 4. Regular follow-up examination is
- Inject amount of air that is equal to each required to detect associated risk of
dose into the bottle – short acting last acquiring CA
(clear).
- Aspirate short acting first, then long or DRUGS AFFECTING LABOR and
intermediate (cloudy). LACTATION
- Alcohol is recommended for cleansing Uterine Stimulating Agents
bottle but not with skin.  Protoytpe :
- Pinch skin, avoid I.M, don’t aspirate. a. Oxytocin (Pitocin), ergonovine
- Rotate the injection site an inch a part. (Ergotrate), methylergonovine
- Prefilled syringes are stored vertically, (methergine)
needle-up. b. carbopost (Prostin), dinoprostone
- May increase dose during illnesses. (Prostin E2)
- Used bottles stored in room temperature,  Mechanism of actions :
unused bottle stored in refrigerator. a. stimulates uterine smooth muscles
- Monitor for acute hypoglycemia : b. ripening of cervix
 3-4 commercially prepared glucose  Adverse reactions :
tablet - fetal bradycardia (oxytocin),
 4-6 ounce of fruit juice or regular soda - hypertension (ergonovine), palpitations
 2-3 teaspoon or honey - allergic reactions (Prostaglandins)
 Glucagon 1 gm SQ or IM Uterine Inhibiting Agents (Tocolytic)
 D50-50 IV.  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 :
- Aminoglycoside - nephrotoxicity &
ototoxicity
- Sulfonamides - Steven-Johnson’s
syndrome, photosynsetivity
- Quinolones - insomnia
- Tetracyclines - bone problems
- Chloramphenicol - Gray syndrome, bone
marrow depression
- 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. flourouracil – phototoxicity reaction
and cerebellar dysfunctions
c. 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.