CONCEPT: PHARMACOLOGY

NERVOUS SYSTEM

The Nervous System

CNS PNS

TYPE MECHANISM OF PHYSIOLOGIC EFFECTS

ACTION

Dopamine Inhibitory Affects behavior (attention,

emotions)
Fine movement
Acetylcholine Excitatory Parasympathetic effects sometimes
inhibitory
Serotonin Inhibitory Control mood and sleep
Inhibits pain pathways
Norepinephrine Excitatory Mood and overall activity

Gamma-Amino Inhibitory Regulates other neurotransmitters

Butyric Acid
(GABA)

“Everything comes to you in the right moment. BE PATIENT.”

 “TOO LITTLE” “TOO MUCH”
Neurotransmission Neurotransmission

DEPRESSION MANIA

ANXIETY SEIZURE

MYASTHENIA GRAVIS PSYCHOSIS

PARKINSON’S DISEASE SCHIZOPHRENIA

ALZHEIMER’S DISEASE

DEPRESSION

CAUSE: THERAPEUTIC GOAL:

ASSOCIATED DISORDERS: EATING DISORDERS

ANOREXIA NERVOSA

BULIMIA

ANTIDEPRESSANTS
1. TCAs 2. SSRIs

Prototype Drugs: Prototype Drugs: Therapeutic Effect:

AmitripTYLINE HCl (Elavil)
NortripTYLINE HCl
(Pamelor, Aventyl)
ProtripTYLINE (Vivactyl)
ClomiPRAMINE HCl
(Anafranil)
ImiPRAMINE HCl
(Tofranil)
CitaloPRAM (Celexa)
Side Effect:
FluoxetINE(Prozac)
WOF:
SertralINE HCl (Zoloft)
Paroxetine (Paxil) 1.
2.
Atypical Reuptake Inhibitors: 3.
Mertazapine (Remeron)
Bupropion (Wellbutrin)
Trazodone (Desyrel)

NorPRAMINE
*Avoid Alcohol and Antihistamines
Amoxapine (Asendin) *can be taken in the AM
Doxepin HCl (Sinequan)

“Everything comes to you in the right moment. BE PATIENT.”


3. MAOIs
Prototype Drugs:
Tranylcypromine sulfate (PArnate)
Phenelzine sulfate (NArdil)
Isocarboxazid (MArplan)
Moclobemide (MAnerix)
4. Herbal Medication
St. John’s Wort
s-adenosyl methionine (sAME)
CAUSE:
ANTI-PARKINSON DRUGS
1. Dopaminergics
Levodopa (Larodopa, Dopar)
Carbidopa-Levodopa (Sinemet)
Amantadine (Symmetrel)
Bromocriptine (Parlodel)
Pergolide mesylate (Permax)
Pramipexole (Mirapex)
CAUSE:
“Everything comes to you in the right moment. BE PATIENT.”
Nursing Considerations
Therapeutic Effect:
Common Side Effects:
* interacts with food and drugs with
TYRAMINE (potent vasoconstrictor)
Wash out period: the time allowed for the medication to be eliminated from the body
MAOI-SSRI
SSRI-MAOI
Specific for St. John’s Wort:
For both: Do not use in conjunction with other prescribed anti-depressants
PARKINSON’S DISEASE
THERAPEUTIC GOAL:
2. Anticholinergics Nursing Considerations:
Common Side Effect:
Benztropin mesylate (Cogentin)
Trihexyphenidyl HCl (Artane) ANTICHOLINERGIC SIDE EFFECT
Diphenhydramine HCl (Benadryl)
Biperiden HCl (Akineton)
ALZHEIMER’S DISEASE
THERAPEUTIC GOAL: MECHANISM OF ACTION:
Block Acetylcholinesterase
Block Cholinesterase
ANTI-ALZHEIMER’S DRUGS
Cholinesterase Inhibitors
Mechanism of Action: Elevate acetylcholine concentration in cerebral cortex by slowing degradation of acetylcholine released in
cholinergic neurons
Drugs: Nursing Considerations:

Donepezil HCl (Aricept)

CHOLINERGIC SIDE EFFECT:
Tacrine (Cognex)
S

MANIA

CAUSE: THERAPEUTIC GOAL:

MOOD STABILIZERS
1. Lithium Preparations
Mechanism of Action: Correct an ion exchange abnormality
Nursing Considerations:
Therapeutic level: 0.6 to 1.2 mEq/L

Lithium carbonate (Eskalith, Lithane, Lithobid) Avoid:

1.
Lithium citrate (Cibalith-Si) 2.

Maintain:

Lithium toxicity Effects:

V

Note: DO WEEKLY MONITORING OF BLOOD TESTS N

“Everything comes to you in the right moment. BE PATIENT.”

 ANTICONVULSANTS

Mechanism of Action: Unknown, enhancement of GABA neurotransmission postulated

Carbamazepine (Tegretol)

Lamotrigine (Lamictal)

Phenytoin (Dilantin)

Oxcarbazepine (Trileptal)
Divalproex sodium (Depakote)
Gabapentin (Neurontin)
Topiramate (Topamax)

PSYCHOSIS/ SCHIZOPHRENIA
CAUSE: THERAPEUTIC GOAL:

P–

S–

Y–

C–

H–

O–

ANTIPSYCHOTICS/NEUROLEPTICS
Mechanism of Action: Block dopamine in the post synapse
Classification Generic Name Adult Daily Therapeutic Notes
(Trade Name) Dosage Range
Phenothiazines Chlorpromazine 30-2000 mg Potent hypotensive effect
(Thorazine)
Thioridazine 150-800 mg May cause retinitis pigmentosa in doses above 800 mg
(Mellaril)
Mesoridazine 30-400 mg
(Serentil)
Trifluoperazine 12-64 mg
(Stelazine)

“Everything comes to you in the right moment. BE PATIENT.”

 Fluphenazine 1-40 mg Available in long acting form; may be used in clients with a history of
(Prolixin) noncompliance
Thioxathenes Thiothixene 8-30 mg
(Navane)
Butyrophenone Haloperidol 1-100 mg Available in long acting form; may be used in clients with a history of
(Haldol) noncompliance
Dihydroindolone Molindone 15-225 mg
(Moban)
Dibenzoxazepine Loxapine 20-250 mg
(Loxitane)
Dibenzodiazepine Clozapine 300-900 mg Increased risk for agranulocytosis; higher incidence of seizures reported
(Clozaril)
Benzisoxazole Risperidone 2-6 mg
(Risperdal)
Thienobenzodia- Olanzapine 5-20mg
Zepine (Zyprexa)

ATYPICAL ANTIPSYCHOTICS

Aripiprazole (Abilify) Olanzapine (Zyprexa) Ziprasidone (Geodon)

Clozapine (Clozaril) Quetiapine (Seroquel)
Loxapine (Loxitane) Risperidone (Risperdal)

Advantages: Disadvantages:
Less EPSE Agranulocytosis
Fast acting Seizure

Side Effects and Nursing Interventions

Side Effect Nursing Intervention

Anticholinergic Symptoms
Dry mouth Encourage frequent sips of water, good oral hygiene, chew
sugarless gum
Blurred vision Reassure client of transient nature of blurred vision

Retinitis pigmentosa Notify physician

Urinary retention or hesitancy I&O, notify physician
Constipation High fiber diet, increase fluid intake and exercise

Paralytic ileus Notify physician

Sedation Client teaching regarding need to restrict driving or operation of
machinery
Orthostatic hypotension Instruct client to rise slowly from a lying or sitting position

“Everything comes to you in the right moment. BE PATIENT.”

Dermatologic Effects
Photosensitivity Instruct the client to wear protective sunscreens, clothing and
sunglasses, and to limit exposure time in the sun

Hormonal Effects
Decreased libido Explain that this may be transient
Amenorrhea Explain that this is reversible
Instruct client not to discontinue the use of birth control as
ovulation is continuing and pregnancy is possible

Weight gain Encourage proper diet and exercise

EXTRAPYRAMIDAL SIDE EFFECTS

Dystonia (involuntary muscular movements of face, Notify physician
arms, legs, and neck) Antiparkinsonian Drug

Oculogyric crisis (uncontrolled rolling back of the Notify physician

eyes) Antiparkinsonian Drug
Anticipate need for respiratory/ emergency support PRN
Akinesia (muscular weakness and fatigue-like Notify physician
symptoms) Antiparkinsonian Drug

Akathisia (restlessness, fidgeting, pacing beyond the Notify physician

conscious control of the client Antiparkinsonian Drug

Pseudo parkinsonism Notify physician

Antiparkinsonian Drug

Tardive dyskinesia (bizarre facial and tongue Notify physician

movements, stiff neck, difficulty swallowing) Antipsychotic may be discontinued or changed

Neuroleptic Malignant Syndrome (NMS) Withhold antipsychotic medication until discussion with physician
HYPERTHERMIA Monitor VS
Initiate supportive measures to lower temperature
ALTERED LEVEL OF CONSCIOUSNESS

MUSCLE RIGIDITY

“Everything comes to you in the right moment. BE PATIENT.”

 ANXIETY
CAUSE: THERAPEUTIC GOAL:

ASSOCIATED DISORDERS:
1.PHOBIA –irrational fear of something that poses little or no risk of danger.
2.Obsessive Compulsive Disorder (OCD) - excessive thoughts that lead to repetitive behaviors.
3.PANIC – sudden sensation of fear, making one illogical or irrational.

ANXIOLYTICS AND SEDATIVES

1. Benzodiazepines (BZs) 2. Barbiturates 3. Nonbenzodiazepines/Nonbarbiturates
AlprazoLAM (Xanax) PhenoBARBITAL (Luminal) Buspirone (Buspar)
MidazoLAM (Versed)
DiazePAM (Valium)

SecoBARBITAL (Seconal) Zolpidem (Ambien)

Chlordiazepoxide (Librium)

ADHD – ATTENTION DEFICIT HYPERACTIVITY DISORDER

Inattention - not paying attention
Hyperactivity - shifting from one uncompleted activity to another
Impulsivity - no regard/not considering consequences

MEDICATIONS TO TREAT ADHD

CNS Stimulants

Drugs: Nursing Considerations:

Amphetamine S/E: Decreased appetite and sleep
Atomoxetine (Strattera) Headache
Dextroamphetamine (Dexedrine, Adderall) N&V
Methamphetamine (Desoxyn)
Methylphenidate HCl (Ritalin) Growth retardation:
Pemoline (Cylert) “Drug Holiday” – patient stops taking the medication for a period of
time as advised by the physician.

Rapid, repetitive ticks

Hyperactivity
MEDICATION ADMINISTRATION:

“Everything comes to you in the right moment. BE PATIENT.”

 NEUROLOGICAL AND MUSCULOSKELETAL MEDICATIONS
MYASTHENIA GRAVIS

Drugs: Nursing Considerations:

Feature:
EdrophONIUM chloride (Tensilon)
Initial signs and symptoms:

PyridosTIGMINE bromide (Mestinon)

Diagnostic Test:

Result:
NeosTIGMINE bromide (Prostigmine)
AmbenONIUM chloride (Mytelase)
BEST TIME TO TAKE MEDICATIONS:
CENTRALLY ACTING MUSCLE RELAXANTS

Mechanism of Action: Decrease synaptic responses at neurotransmitters to decrease frequency of spasms.

Drugs: Nursing Considerations:
Baclofen (Lioresal)
Dantrolene sodium (Dantrium) Common side effect:
Carisoprodol (Soma)
Cyclobenzaprine HCl (Flexeril) Action:

Methocarbamol (Robaxin) CONTRAINDICATED:

OSTEOPOROSIS
Cause: Bone demineralization and decalcification
Mechanism of Action: Improve bone mineralization.
Drugs: Nursing Considerations:
Calcium and Vit. D supplements

Estrogen replacement

Calcitonin (Calcimar, Miacalcin)

Biphosphonates: Guideline:

AlenDRONATE (Fosamax)
Ibandronate (Boniva)
RIsedronate (Actonel)

“Everything comes to you in the right moment. BE PATIENT.”

 ARTHRITIS - Goal of Treatment: Decrease inflammation and pain

RHEUMATOID OSTEOARTHRITIS GOUTY

Autoimmune Degeneration Faulty purine metabolism

“wear and tear”

Feature: Feature:

Management: Management:

Feature:

Management:

Nonsteroidal Anti-inflammatory Drugs Other NSAIDs

Fenoprofen (Nalfon) Diclofenac (Voltaren)

Ibuprofen (Motrin) Diflunisal (Dolobid)
Ketoprofen (Orudis) Indomethacin (Indocin)
Naproxen (Naprosyn) Ketorolac (Toradol)
Meloxicam (Mobic)
Cyclooxygenase-2 Inhibitor Piroxicam (Feldene)
Celecoxib (Celebrex) Sulindac (Clinoril)
Etoricoxib (Arcoxia)

GOUT
Common side effect: GI upset

Drugs: Nursing Considerations:

Colchicine
Prevents deposition of Uric Acid into joints

Allopurinol (Zyloprim)
Prevents synthesis of Uric Acid

Probenecid (Benemid)
Promotes Uric Acid excretion

“Everything comes to you in the right moment. BE PATIENT.”

 CARDIOVASCULAR MEDICATIONS
HEART FAILURE

CAUSE: THERAPEUTIC GOAL:

Decrease contractility Increase contractility
Increase heart work load Decrease heart work load

Drugs: Nursing Considerations:

Digoxin (Lanoxin) Therapeutic level: 0.5 to 2 ng/mL

Digitoxin (Crystodigin)
WOF:

NOTE:

DIGOXIN TOXICITY: V

A
ANTIDOTE:

***HYPOKALEMIA can cause digoxin toxicity

DIURETICS
POTASSIUM WASTING POTASSIUM SPARING

EXAMPLES: EXAMPLES:

F S

B E

Ma A

D T

WOF: WOF:

MANAGEMENT DRUG OF CHOICE:

WOF:

“Everything comes to you in the right moment. BE PATIENT.”

 HYPERTENSION
CAUSE: THERAPEUTIC GOAL:
INCREASE CARDIAC OUTPUT DECREASE HEART WORKLOAD
DECREASE HEART CONTRACTILITY

Central anti-adrenergics Clonidine (Catapress) Side effect:

Methyldopa (Aldomet) Hypotension
Bradycardia
Beta-adrenergic blockers Contraindicated:
Asthma
Heart Block

Calcium-channel blockers Side effect:

-St. john’s wort Hypotension
-Orange juice Bradycardia
-Grapefruit juice Contraindicated:
Heart block

CAUSE: THERAPEUTIC GOAL: MECHANISM OF ACTION:

Vasoconstriction Vasodilation Direct acting vasodilator

Alpha-adrenergic blockers
PraZOSIN (Minipress), Terazosin (Hytrin)
ACE Inhibitors
CaptoPRIL (Capoten)

ANGIOTENSIN CONVERTING ENZYME INHIBITORS (ACE INHIBITORS)

Action: Inhibits the conversion of Angiotensin I to Angiotensin II

Examples:

Angiotensin II Antagonists
LoSARTAN (Cozaar), Candesartan (Atacand)
Direct-acting vasodilators Hydralazine (Apresoline)
Nitroprusside (Nipride)

“Everything comes to you in the right moment. BE PATIENT.”

 ANGINA PECTORIS
VASODILATORS
Drugs: Nursing Considerations:
Nitroglycerin (Nitrostat)

Isosorbide mononitrate (Imdur)

Isosorbide dinitrate (Isordil)

VASCULAR OCCLUSION
Cause: Increased cholesterol
Therapeutic Goal: Decrease cholesterol

ANTIHYPERLIPIDEMICS
1. HMG-CoenzymeA reductase inhibitors
Nursing Considerations:

AtorvaSTATIN (Lipitor)
T
RosuvaSTATIN (Crestor)
A
SimvaSTATIN (Zocor)

“Everything comes to you in the right moment. BE PATIENT.”

2. Fibric Acid Derivatives
Clofibrate (Atromid-S)
Fenofibrate (Tricor)
Gemfibrozil (Lopid)
Nursing Considerations:
LOWERS BLOOD TRIGLYCERIDE
S/E: V A N D A

A/E: Rash

ANTICOAGULANTS
Drugs: Nursing Considerations:

Coumadin

HePARIN

EnoxaPARIN (Lovenox)

Danaparoid (Orgaran)

ANTIPLATELET AGENTS
Drugs: Nursing Considerations:

Aspirin
Clopidogrel bisulfate (Plavix)
Dipyridamole (Persatine)
Eptifibatide (Integrilin)
Ticlopidine (Ticlid)
Tirofiban (Aggrastat)

Abciximab(Reopro)

FIBRINOLYTICS
Drugs:

Urokinase (Abbokinase)
StreptoKINASE (Streptase)
AltePLASE (Activase)

“Everything comes to you in the right moment. BE PATIENT.”

 MALE REPRODUCTIVE DRUGS

BEST TIME TO TAKE AVOID NORMAL TO NOTIFY THE DOCTOR

EXPECT

RESPIRATORY MEDICATIONS

BRONCHODILATORS
BETA ADRENERGIC AGONISTS/ METHYLXANTHINES ANTICHOLINERGICS
SYMPATHOMIMETICS

Albuterol (Proventil) AminoPHYLLINE (Truphylline) IpraTROPIUM bromide (Atrovent,

Epinephrine (Adrenalin) TheoPHYLLINE (Theo-dur) Combivent)
Isoproterenol (Isuprel) Tiotropium (Spiriva)
Terbutaline sulfate (Brethine)

TO PROVIDE RELIEF FOR INFLAMMATION

CORTICOSTEROID INHALED
BeclomethasONE (Beclovent)
BudesonIDE (Pulmicort)
Flunisolide (Aerobid-M)
Fluticasone propionate (Flovent)
Triamcinolone acetonide
(Azmacort)
MAST CELL STABILIZERS LEUKOTRIENE ANTIHISTAMINES
MODIFIERS
Cromolyn (Intal) MonteLUKAST First Generation
Nedocromil (Tilade) (Singulair) Diphenhydramine (Benadryl)
ZafirLUKAST (Accolate) Hydroxyzine (Atarax)
Second Generation
Loratadine (Claritin)
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Astemizole (Hismanal)

GENITOURINARY MEDICATIONS

URINARY ANTI-INFECTIVES URINARY ANALGESIC ANTISPASMODIC CHOLINERGIC AGENTS

Methenamine (Hiprex, Phenazopyridine Hyoscyamine
Mandelamine) (Pyridium) (Cystospaz)
- Avoid milk Tolterodine tartrate Bethanechol chloride
-To decrease pain upon (Detrol) (Urecholine)
urination Oxybutynin chloride
Nalidixic acid (Negram) (Ditropan) -Promotes urination
Flavoxate (Urispas) -Increases bladder muscle tone

“Everything comes to you in the right moment. BE PATIENT.”

 Nitrofurantoin (Macrodantin)
-Take it with meals
-Drug of choice for Urinary
Tract Infection

Sulfisoxazole (Gantrisin)
-Avoid urine acidifying
substances

TMP-SMZ (Bactrim)

GASTROINTESTINAL MEDICATIONS

MEDICATIONS ACTION BEST TIME EXAMPLES SIDE EFFECTS

TO TAKE
ANTACIDS
Neutralizes the acid Constipation
Diarrhea

H2 RECEPTOR Vomiting
BLOCKERS Decreases the acid Anorexia
“TIDINE” production Nausea
Diarrhea
Abdominal cramps

A/E: Anxiety
Psychosis

PROTON PUMP
INHIBITORS Vomiting
Decreases the acid Anorexia
“PRAZOLE” production Nausea
Diarrhea
Abdominal cramps

SUCRALFATE Sucralfate
Coats the ulcer (Carafate) Constipation

CYTOTEC Increases mucous Cytotec Abortion

lining protection (Misoprostol) Birth defects

TREATMENT REGIMEN FOR H.PYLORI  Lansoprazole, amoxicillin, clarithromycin (Prevpak)

 Bismuth subsalicylate, metronidazole, tetracycline
 Omeprazole, clarithromycin
 Ranitidine, bismuth citrate, clarithromycin
 Lansoprazole, amoxicillin

“Everything comes to you in the right moment. BE PATIENT.”

 POINTS TO REMEMBER:

ANTIBIOTICS
AMINOGLYCOSIDE PENICILLIN CEPHALOSPORIN

Gentamicin Amoxicillin Cephalexin

Amikacin Ampicillin Cefuroxime
Neomycin Oxacillin Ceftriaxone
Tobramycin Ticarcillin Cefepime
Streptomycin

Toxicity: WOF: WOF:

Ototoxicity Anaphylaxis Anaphylaxis
Nephrotoxicity

Nursing Consideration: Note: Note:

Ticarcillin – decreases platelet Cross allergies exist between Penicillin
Avoid in pregnant woman adhesion and Cephalosporin
Assess peak and trough level Cross allergies exist between
Penicillin and Cephalosporin

TETRACYCLINE MACROLIDE QUINOLONE

Demeclocycline Azithromycin Ciprofloxacin

Doxycycline Clarithromycin Ofloxacin
Tigecycline Erythromycin Norfloxacin

Nursing Consideration: WOF: Nursing Consideration:

Photosensitivity Fatal Dysrhythmias Photosensitivity
Avoid in pregnant women Avoid in pregnant women
Dairy products and Antacids may Nursing Consideration: Dairy products and Antacids may
decrease absorption Avoid in pregnant women decrease absorption

Note:
Do not use in children under 8 years
old. Enamel hypoplasia and tooth
discoloration may occur.

Other Antibiotics
Chloramphenicol
WOF: Irreversible fatal bone marrow depression
Nursing Consideration: Monitor CBC

Metronidazole (Flagyl)
Nursing Consideration: Avoid in pregnant women
Dark urine expected
Vancomycin
Drug of choice for MRSA
WOF: Red man syndrome (Continuous rashes and facial flushing)
Management: slow the rate of infusion

“Everything comes to you in the right moment. BE PATIENT.”

 ANTIVIRAL ANTIFUNGAL

Acyclovir (Zovirax) Nystatin (Mycostatin)

Oseltamivir (Tamiflu) -For oral fungal infection
-Liquid form: Swish and swallow

Zidovudine (Retrovir) Griseofulvin (Grisactin)

WOF: Bone marrow depression Photosensitivity
Monitor: CBC

Chemotherapy
1. Alkylating agent
> cell-cycle nonspecific; toxic to hematologic cells
a. Cyclophosphamide (Cytoxan)
b. Cisplatin (Platinol)
SE: alopecia/ gonadal suppression/nephrotoxicity
d. Busulfan (Myleran)
SE: pulmonary fibrosis
2. Antimetabolites
> cell-cycle specific; toxic to
hematologic cells
a. Methotrexate (Rheumatrex)
SE: alopecia/stomatitis/hyperuricemia/
hepatotoxicity antidote: Folinic acid
(“Leucovorin rescue”)
b. Cytarabine (Ara-C)
SE: Conjunctivitis with high doses
c. Mercaptopurine (6-MP)
SE: hyperuricemia/hepatotoxic
d. 5 FU(fluoro-uracil)
SE: alopecia/stomatitis/diarrhea/photosensitivity
3. Plant alkaloids
> cell-cycle specific; inhibit mitosis
a. Vinca alkaloids : Vinblastine (Velban) / Vincristine (Oncovin)
SE: neuropathy/ neurotoxic/ numbness/ paresthesia/ constipation / phlebitis at IV site

Antitumor Antibiotic
> cell-cycle nonspecific
b. Doxorubicin (Adriamycin)/ Daunarubicin (Daunomycin)
SE: Irreversible cardiomyopathy
c. Dactinomycin (Actinomycin D): extensively used for pediatric sarcomas
d. Bleomycin
SE: pulmonary fibrosis

“Everything comes to you in the right moment. BE PATIENT.”