UNIT 1:

FOUNDATIONS OF PHARMACOLOGY
2. GLYCOSIDES
compounds that consist of sugar units,
Pharmacology
usually glucose, & a nonsugar
component called AGLYCONE
 derived from Greek word “pharmakon” – drugs, Example: Digitalis – Digoxin
medicine, poison; “logos” – science
 the science that deals with the origin, nature,
3. VOLATILE OIL
chemistry, effects & uses of drugs.
 may be used as aromatics & as
 it includes:
flavoring agents -peppermint,
menthol, cinnamon
PHARMACOGNOSY
 wintergreen oil -antiseptic & for rubs
 branch of pharmacology dealing with
natural drugs & their constituents
 deals with the sources, procurement & 4. RESINS
chemistry of natural products.  are complex substances of plant origin
that are amorphous in structure &
PHARMACOKINETIC insoluble in water but mostly soluble
 the study of the movement of drugs in the in alcohol
body, including the processes of
absorption, distribution, localization in Ex: Podophyllum
tissues, biotransformation, & excretion (mandrake) – laxative
Peruvian balsam
PHARMACODYNAMICS – astringent used in
 the study of the biochemical & Hemorrhoidal prep
physiological effects of drugs & the 5. GUMS
mechanisms of their actions, including the  translucent, amorphous,
correlation of their actions & effects with hydrocolloidal masses
their chemical structure. Ex: karaya, agar, carrageenan
– bulk laxatives
PHARMACOTHERAPEUTICS
 treatment of diseases with medicines
6. TANNINS
TOXICOLOGY their presence in many herbal teas as
 study of poisons well as ordinary tea has been linked to
ocurrence of esophageal cancer.
Drugs Tannic Acid – used as antiseptic &
 derived from Dutch word “droog” – dry astringent for bed sores
 any chemical compound used in the
diagnosis, treatment, or prevention of B. Animals
disease or other abnormal condition - liver
- thyroid
- insulin
Sources of Drugs - cortisone

I. NATURAL SOURCES C. Mineral Products

A. Plants 1. Elementary substances

 parts are processed -----> Crude Drugs a. oxygen
------> Active Principles: b. iodine
c. iron
1. ALKALOIDS 2. Free acids
o are a diverse group of bitter-tasting, a. Boric acid
organic, basic substances found in b. Hydrochloric Acid
plants 3. Metallic hydroxide
o generally given names that end in a. Aluminum hydroxide
“INE”
4. Salts
Examples: Morphine
Cocaine a. Magnesium sulfate
Atropine - Epsom salt
Quinine - as a cathartic
Nicotine b. Magnesium trisilicate
Caffeine - gastric antacid

II. SEMI-SYNTHETIC
 derived by chemical modification of
natural substances
 Genetic Eng’g – a new method of
drug production based on
recombinant DNA tech.
III. SYNTHETIC
 made in the laboratory
 pure chemicals
 Medicinal Chemistry – branch of the
pharmaceutical science most directly
concerned with the synthesis of new drug
substances.
Examples: hematropine
barbiturates
sulphonamides
FORMS/PREPARATIONS OF DRUGS
A. TOPICALS
1. CREAMS – are water soluble prep’n
usually applied by rub’g into
the skin
- often used as moisturiz’r
2. OINTMENT – oily or fatty suspens’n of
drugs
- most commonly used ointment
bases are petrolatum & lanolin
- not easily washed away by
water or sweat
3. PASTES – ointments that are esp. thick
& viscous & that don’t soften
substantially from body heat
4. GELS - aqueous suspensions of hydrated
particles
5. LOTIONS – aqueous suspensions of drugs
& should be dabbed, not
rubbed
6. LINIMENTS - thinner than ointm’t,
consisting of fluid mixture
of drugs w/ water, oil, soap
& other constituents
- applied by rubbing
7. PLASTERS – are solid dosage forms
- usually have a rubber
mixture as their base
8. POWDERS – usually consist of fine mineral
dusts, such as talc & are
applied by dusting.
- used to absorb moist’re from
the skin thereby altering
conditions favor’le to growth of
microbes.
9. PATCHES – used to provide gradual
transfer of drug from the
patch to the skin, usually
for drugs that’ll be absorbd
through the skin to provide
systemic effects
10. TINCTURES – solutions of drugs in
alcohol; often applied
by fainting
11. AEROSOLS – used for topical applicat’n
of drugs to both the skin
& the respiratory tract
- consist of liquids applied
under air pressure as
sprays
12. FOAMS – aerated semisolid preparat’n
applied under pressure in a
manner similar to aerosol.
13. BATHS & SOAKS – provide thorough &
direct contact of the
skin w/ water or
other fluids for a
limited time period
B. MUCOSAL MEMBRANES
- ointment, creams, drops
- urethra, vagina, conjunctiva, nose,
throat, rectum, mouth
- readily absorbed – both local & systemic
1. GARGLES – oral membrane
2. LOZENGES – flat disk containing a
medicinal agent in a
suitable flavoured base
- held in the mouth to
dissolve slowly
3. VAGINAL SUPPOSITORY
- is usually supplied with an
applicator to facilitate easy &
effective insertion
- wipe away excessive vaginal
discharge & use sterile technique
- lie flat for 15 mins
C. INHALATION/INSUFFLATION
1. INHALATION
- drugs can be administered to the
RT for either topical or systemic
purpose.
- both liquid & gases can be
administered.
2. INSUFFLATION
 - fine powders administered to the
RT by blowing or spraying into the
nose.
D. OCULAR INSTILLATION
1. DROPS – solutions, or less commonly,
suspensions, that are instilled in
the eye by the use of a dropper
- should be kept sterile
2. OINTMENT – usually placed on the inner
mucosal surface of the
lower eyelid or in the
conjunctival sac in the
inner canthus
E. EAR DROPS
1. DROPS – labelled as otic
F. ENTERAL ADMINISTRATION
- alimentary tract
- oral, rectal, sublingual, buccal routes
- systemic effects
F1. ORAL ROUTE
- most convenient, frequently used
route
a) TABLETS – dried powdered drug that
has been compressed into
small disks.
- sometimes “scored” to aid in
subdividing them.
- some are “enteric coated”
 resist dissolution in the
acid medium of the
stomach
 don’t chew
b) CAPSULES – consist of powders or
liquids in a gelatin container
- don’t require color or
additives to improve taste
c) TIMED-RELEASE CAPSULE
- granules w/in the capsule dissolve
at different rates
G. PARENTERAL ADMINISTRATION
d) SOLUTIONS – consist of substances
dissolve in water
e) SYRUPS – are sugar solutions used
as vehicles for various drugs
f) SUSPENSIONS – consist of fine drug
particles suspended in
a liquid vehicle
- shake well to ensure
thorough mixing
g) EMULSIONS – consist of a lipid
substance dispersed in
water by the action of an
emulsifying agent
h) MAGMAS – often called milk, are
thick suspensions of
white particles in water
ex. Milk of magnesia (MOM)
i) GELS – aqueous suspensions of
hydrated particles
j) ELIXIR – are vehicles containing
alcohol, sugar, & water
- used primarily when the drug
will not dissolve in water
k) SPIRITS – alcohol solutions of
volatile substances
l) TINCTURES – consist of drugs
dissolved in alcohol or
alcohol & water
F2. SUBLINGUAL/BUCCAL ADM
a) NITROGLYCERIN – placed under the
tongue  rapidly
disintegrate 
absorbed thru
thin epithelium
into the blood
vessels
F3. RECTAL SUPPOSITORY
- mixture of drugs in a base, e.g. cocoa
butter, that is solid at room temp. but
which melts at body temp & dissolves
in the body fluids.
- suitable substitute for oral adm in
comatose patients
- evacuate the rectum by enema
before administration
BOUGIES – small supp. inserted into
the urethra
1. AMPULES – glass containers that usually
contain a single dose of med.
- may be scored or have a
darkened ring around neck
2. VIALS – are glass containers that contain
1 or more doses of a sterile med
- may be a solution or it may be a
sterile powder to be reconstitutd
before the time of administration
3. MIX-O-VIALS – glass containers with 2
compartments
- lower chamber contains
 the solute; upper *should not be given to children below 4 years old.
chamber contains a
sterile diluent.
- in between the chambers
is a rubber stopper
4. PREFILLED SYRINGE
- premeasured amount of meds in a
disposable cartridge-needle unit 6. Bayabas (Psidium guajava)
- cartridge is in a sealed unit  Guava
- drug name, concentration, &  INDICATIONS:
volume are clearly printed in the a. Used to wash wounds
cartridge b. For diarrhea.
- time saving, diminished chance of
c. Used as a gargle to relieve toothache.
contamination

7. Akapulko (Cassia, alata L.)

COMMON HERBAL PLANTS by DOH  Ringworm bush or shrub
 INDICATIONS:
a. Anti-fungal
1. Lagundi (Vitex Negundo)
 5 leaves chaste tree
 INDICATIONS:
8. Ulasimang Bato (Peperonia pelluida)
a. Asthma, cough & fever  Pansit-pansitan
b. Dysentery, colds and pain in any part of the body as  INDICATION:
in influenza. a. Lowers uric acid (rheumatism and gout).
c. Skin diseases (dermatitis, scabies, and ulcer
eczema) and wounds. 9. Bawang (Alium sativum)
d. Headache  Garlic
e. Rheumatism, sprain, contusions, insect bites.  INDICATIONS:
f. Aromatic bath for sick patients. a. Hypertension- lower cholesterol level in blood
b. Toothache
2. Yerba (Hierba) Buena (Mantha Cordifelia)
 Peppermint 10. Ampalaya (Mamordica charantia)
 INDICATIONS:  Balsam apple, Balsam pear, Bitter Gourd
a. For pain (headache, stomach-ache).  INDICATIONS:
b. Rheumatism, arthritis, and headache. a. Lowers blood sugar level.
c. Cough and colds. b. DM (Mild non-insulin dependent)
d. Swollen gums.
e. Tooth-ache. SIGNIFICANT PERSONALITIES IN THE
f. Menstrual and gas pain. HISTORY OF PHARMACOLOGY
g. Nausea and fainting. 1. HIPPOCRATES (400 BC)
h. Insect bites. - father of medicine
- freed medicine from mysticism &
i. Pruritis
philosophy

3. Sambong (Blumea balsamifera) 2. FRIEDRICH SERTURNER (1805)

 Camphor - he isolated the first alkaloid from
 INDICATIONS: opium which was then named
a. Anti-edema-diuretic morphine
b. Anti-urolithiasis
3. OSWALD SCHMIEDEBERG (1869)
- founder of modern pharmacology
4. Tsaang Gubat (Carmona retusa) - he studied the pharmacology of
 Kalimunog, Talibunog, Tsa, Taglokot (TAG) chloroform & chloral hydrate
 INDICATIONS: - showed that muscarin evoked the
a. Diarrhea same effect on the heart as electrical
b. Stomach ache stimulation of the vagus nerve.
- he introduced urethane as hypnotic.

5. Niyug-Niyogan (Quisqualis indica L.) 4. JOHN JACOB ABEL (1890)

 Burma creeper, Chinese honey suckle - isolated epinephrine from adrenal
 INDICATIONS: extracts
a. Anti-helminthic
 5. REID HUNT (1906))
- discovered acethylcoline in adrenal
extracts
6. Sir JOHN VANE (1971)
- discovered action of aspirin
- Nobel Prize for Medicine in 1981
LEGAL ASPECTS & DRUG
LEGISLATIONS
NURSE PRACTICE ACT OF 2002
– Understanding of the NPA & the rules &
regulations established by the BON is a
solid foundation for a beginning nurse to
practice its profession
– the nurse must understand the individual
patient's diagnosis & symptoms that
correlated with the rationale for drug use
– the first legal responsibility of a nurse in
drug therapy is to administer medications
safely & accurately. The nurse is held
liable if this aspect is not carried out.
PURE DRUG ACT OF 1906
– an act for preventing the manufacture,
sale or transportation of adulterated or
misbranded or poisonous or deleterious
foods, drugs, medicines, & liquors, & for
regulating traffic therein, & for other
purposes
– all drugs sold had to meet strength &
purity standards
FEDERAL FOOD, DRUG & COSMETIC ACT OF 1938
– extending control to cosmetics &
therapeutic devices
– requiring new drugs to be shown safe
before marketing
– providing that safe tolerances be set for
unavoidable poisonous substances
– authorizing standards of identity, quality,
& fill-of-container for foods
– authorizing factory inspections
DURHAM-HUMPHREY AMENDMENT OF 1951
– until this law, there was no requirement
that any drug be labelled for sale by
prescription only. The amendment defined
prescription drugs as those unsafe for self-
medication & which should therefore be
used only under a doctor's supervision
– 1st law to recognize class of drugs that
could be sold OTC
KEFFAUVER-HARRIS DRUG AMENDMENTS OF
1962
– tighten control over drugs
– before marketing a drug, firms now had to
prove not only safety, but also
effectiveness for the product's intended
use
– firms were required to send adverse
reaction reports to FDA, & drug advertising
in medical journals was required to
provide complete information to doctors
--- the risks as well as the benefits
CONTROLLED SUBSTANCES ACT OF 1970
– is designed to limit & control access to
drugs that can make you “high” or
intoxicated in a pleasant way, & also is
now used to control certain other drugs of
abuse such as anabolic steroids used by
athletes to increase muscle mass.
– Replaced the Harrison Narcotic Act
HARRISON NARCOTIC ACT
– first federal law aimed at curbing drug
addiction & dependence
– established the word narcotic as a legal
term
DRUG REGULATION & REFORM ACT OF 1978
– it amplifies & redefines the investigative
process to facilitate & promote research
while protecting patient's rights. It also
divides the commercial investigation
process into 2 phases: drug innovation
investigations & drug development
investigations
ORPHAN DRUG ACT OF 1983
– “orphans” are drugs & other products for
treating rare diseases. They may offer
little or no profit to the manufacturer, but
may benefit people with the rare diseases.
To foster orphan product development,
this law allows drug companies to take tax
deductions for about 3 quarters of the cost
of their clinical studies
– firms also are given exclusive marketing
rights for 7 years for any orphan products
that are approved
RA 6675 ( Generics Act of 1988 )
– states that only validly registered medical,
dental, & veterinary practitioners whether
in private institution or in the government
are authorized to prescribe drugs.
– An act to promote, require & ensure the
production of an adequate supply,
distribution, use & acceptance of drugs &
medicines identified by their generic
names
RA 2382 ( Medical Act of 1959 )
– this act provides for & shall govern
a) the standardization & regulation of
medical education
b) the examination for registration of
physicians
c) the supervision, control & regulation
of the practice of med. in the Phils.
RA 4419 ( Dental Act of 1965 )
– this act provides for
a) the regulation, control & supervision of
the practice of dentistry in the Phils.
b) the giving of licensure exam to
graduates of recognized dental schools for
the purpose of registration
 c) the regulation & standardization of
dental education
d) promotion & dev't of dental research
in the country
RA 382 ( Veterinary Act )
– regulating the practice of veterinary
medicine & surgery
RA 5921 ( The Pharmacy Act )
– an act regulating the practice of pharmacy
& setting standards of pharmaceutical
education in the Phils.
RA 3720 ( Food, drug, & Cosmetic Act )
– an act to ensure the safety & purity of
foods, drugs, & cosmetics being made
available to the public by creating the
food & drug administration which shall
administer & enforce the laws pertaining
thereto.
FDA PREGNANCY CATEGORIES
Category A:
 adequate studies in pregnant women have not
demonstrated a risk to the fetus in the first
trimester of pregnancy, & there is no evidence
of risk in later trimester.
Category B:
 animal studies have not demonstrated a risk to
the fetus but there are no adequate studies in
pregnant women, or animal studies have
shown an adverse effect, but adequate studies
in pregnant women have not demonstrated a
risk to the fetus during the first trimester of
pregnancy, & there is no evidence of risk in the
later trimester.
Category C:
 animal studies have shown an adverse effect on
the fetus but there are no adequate studies in
humans; the benefits from the use of the drug
in pregnant women may be acceptable despite
its potential risks, or there are no animal
reproduction studies & no adequate studies in
humans
Category D:
 there is evidence of human fetal risk, but the
potential benefits from the use of the drug in
pregnant women may be acceptable despite its
potential risks.
Category X:
 studies in animals or humans demonstrate fetal
abnormalities or adverse reaction; reports
indicate evidence of fetal risk. The risk of use in
a pregnant woman clearly outweighs any
benefit.
NOTE: regardless of the designated
Pregnancy Category or presumed
safety, NO DRUG should be
administered during pregnancy unless
it is clearly needed.
DEA SCHEDULES
OF CONTROLLED SUBSTANCES
The Controlled Substances Act of 1970 regulates the
manufacturing, distribution, & dispensing of drugs that are
known to have abuse potential. The Drug Enforcement
Agency is responsible for the enforcement of these
regulations. The controlled drugs are divided into 5 DEA
schedules based on their potential for abuse & physical &
psychological dependence.
Schedule I ( C-I )
 high abuse potential & no accepted
medical use
 ex. heroin, marijuana, LSD
Schedule II ( C-II )
 high abuse potential with severe
dependence liability
 ex. narcotics, amphetamines, barbiturates
Schedule III ( C-III )
 less abuse potential than schedule II drugs
& moderate dependence liability
 ex. nonbarbiturate sedatives,
nonamphitamines stimulants
Schedule IV ( C-IV )
 less abuse potential than C-III & limited
dependence liability
 ex. sedatives, antianxiety agents,
nonnarcotic analgesics
Schedule V ( C-V )
 limited abuse potential. Primarily small
amounts of narcotics (codeine) used as
antitussive or antidiarrheals. Under federal
law, limited quantities of certain schedule
V drugs may be purchased without a
prescription directly from a pharmacist.
The purchaser must be at least 18 years
of age & must furnish suitable
identification. All such transactions must
be recorded by the dispensing pharmacist.
DRUG DISTRIBUTION SYSTEM

1. Floor or Ward System
all but the most dangerous or rarely
used medications are stocked at the
nursing station in stock containers
this system has been used most often
in a very small hospital & hospitals
where there are no charges directly to
the patient for medications.
Advantages:
– ready availability of most drugs
– fewer inpatient prescription orders
– minimal returns of medications
Disadvantages:
– increased potential for medication
errors
– increased danger of unnoticed
drug deterioration
– need for larger stocks & frequent
total drug inventories
– storage problems on the nursing
units in many hospitals
2. Individual Prescription System
in this system, medications are
dispensed from the pharmacy on
receipt of a prescription or drug order
on individual patient
Advantages:
- provides greater patient's safety
- less danger of drug deterioration
- easier inventory control
Disadvantage:
– time consuming procedures used to
schedule, prepare, administer,
control & record the drug distribution
& administration process.
3. Computer-controlled Dispensing
System
is the safest & most economical
method of drug distribution in
hospitals & long- term care
facilities today.
the system provides detailed listing
of all medications administered to
a patient & charges the patient for
the medication as well.
controlled drug are kept in this
cart, & the system provides a
detailed record of the controlled
substance dispensed including
date, time, & by whom it was
accessed.
4. Unit-dose System
use single packages of drugs
dispensed to fill each requirement
as it is ordered.
each package is labelled with
generic & brand name,
manufacturer, & expiry date
DRUG DEVELOPMENT
A. Pre- CLINICAL RESEARCH
 begins with discovery, synthesis, & purification
of the drug.
 The goal of this stage is to use laboratory
studies to : 1) to determine whether they have
the presumed effects in living tissue, & 2) to
evaluate any adverse effects.
 Animal testing is important because unique
biological differences can be found only in living
organisms, so computer-generated models
alone are often inadequate.
 The data collection in this phase may require 1-
3 years, although the average length of time is
18 months.
 At the end of preclinical trials, some chemicals
are discarded for the following reasons:
a) the chemical lacks therapeutic activity
when used with living animals.
b) the chemical is too toxic to living animals
to be worth the risk of develop’g into
drugs.
c) the chemical is highly teratogenic
d) the safety margins are so small that the
chemical would not be useful in the
clinical setting
 some chemicals, however, are found to have
therapeutic effects & reasonable safety
margins. This means that the chemicals are
therapeutic at doses that are reasonably
different from doses that cause toxic effects.
Such chemicals will pass the clinical trials &
advance to Phase I studies.
B. CLINICAL RESEARCH &
DEVELOPMENT
STAGE
 the testing in human stage
 use human volunteers to test the drugs. These
studies are more tightly controlled & are
performed by specially trained clinical
investigators.
Phase I
 determine an experimental drug's
pharmacologic properties
 usually requires 20-100 subjects who
are treated for 4-6 weeks
 investigators scrutinize the drug being
tested for effects in human. They also
look for adverse effects & toxicity
 at the end of this, many chemicals are
dropped from the process for the
 following reasons: NEW DRUG APPLICATION REVIEW
a. they lack therapeutic effect in
humans the review takes 24 months
b. they cause unacceptable adverse once a drug is approved by the FDA, it is the
effects manufacturer's decision as to when to bring a
c. they are highly teratogenic product to the market place.
d. they are too toxic When sufficient data have been collected to
demonstrate that the experimental drug is
both safe & effective, the investigator submits
Phase II
a new drug application to the FDA, formally
this phase needs a larger population of requesting approval to market a new drug for
patients. human use.
Studies conducted to determine the An approved drug is given a brand name (trade
success rate of a drug for its intended name), generic name, chemical name.
use.
Allow clinical investigators to try the
drug in patient who have the disease
POST-MARKETTING SURVEILLANCE
that the drug is meant to treat.
Usually, the phase II studies are  it consists of an ongoing review of adverse
performed at various sites across the effects of the new drug, as well as periodic
country – in hospitals, clinics, & doctors' inspections of the manufacturing facilities &
office & are monitored by products.
representatives of the pharmaceutical  Prescribers are obligated to report to the FDA
company studying drugs any untoward or unexpected adverse effects
at the end of phase II studies, a drug associated with the drug they are using, & the
may be removed from further FDA continually evaluates this information
investigation for the following reasons:  health care practitioners make a significant
a. it is less effective than contribution to the knowledge of drug safety by
anticipated reporting adverse effects of the drugs to the
b. it is too toxic when used with FDA
patients
c. it produces unacceptable
adverse effects
d. it has a low benefit -to-risk
ration, meaning that the
therapeutic benefit it
provides does not outweigh
the risk of potential adverse
effects that it causes.
e. it is no more effective than
other drugs already on the
market, making the cost of
continued research &
production less attractive to
the drug company.

Phase III
 provides additional information on
proper dosing & safety
 involve use of the drug in a vast clinical
market. Prescribers are informed of all
the known
reactions to the drug & precautions
required for its safe use.
 Prescribers then evaluate the reported
effects to determine whether they are
caused by the disease or by the drug.
This information is collected by the
drug company that is developing the
drug & is shared with the FDA.
 A drug that produces unacceptable
adverse effects or unforseen reactions
is usually removed from further study
by the drug company. In some cases,
the FDA may have to request that a
UNIT II : THE NURSING PROCESS &
drug be removed from the market. DRUG ADMINISTRATION
NURSING PROCESS
 A goal-directed series of activities
whereby the practice of nursing is
approached in a systematic & orderly
way.
 goal of the NP is to alleviate, minimize, or
prevent actual & potential health
problems
5 SEQUENCIAL & CYCLICAL PHASES
1. ASSESSMENT
 is the collection of relevant information
that defines the current health situation
for the particular client
 it encompasses the client’s medical &
drug history, physical examination,
psychological, social, cultural, &
environmental factors, laboratory tests &
current drug & nondrug orders &
interventions
2. ANALYSIS/DIAGNOSIS
 is the critical study of the assessment
data for the purposes of studying the
client’s needs & establishing nursing
goals.
 includes the determination of appropriate
nursing diagnoses & identification of
requirements for referral to other HCP
 NURSING DIAGNOSES – are those
problems for which nurses can legally
prescribe interventions independently
Ex. Anxiety r/t insufficient knowledge
regarding surgical experience
3. PLANNING
 is the designing of strategies, in
cooperation with the client or those
responsible for the client, that will help to
achieve the established the nursing goals.
 includes setting priorities & determining
nursing interventions
 plans are individualized to the unique
requirements & capabilities of each client
 plans are also dynamic – require frequent
adjustments as the client condition
changes.
4. IMPLEMENTATION
 is the initiation & completion of the
strategies developed during the planning
stage
5. EVALUATION
 is the process of determining the effects
of the plan of care, both the extent to
which the goals have been achieved &
the occurrence of any unfavorable
consequences.
 nurses observe & measure the extent to
which a client is responding to drug
treatment, any side effects the client may
be experiencing, & any changes in
physiological or psychological functioning
ADMINISTERING MEDICATIONS
(10 RIGHTS)
1. Right Assessment
 before any medication is administered to
the client, it is important for the nurse to
conduct a thorough assessment of the
client.
a). take a medication history
- prescription, otc, herbals, alcohol
- adverse drug effects experienced
b). assess the client’s understanding
about illness, including past experience
- What do you believe to be the cause
of your illness?
- What do you know about your
condition?
c). conduct a physical assessment
- provides baseline info on height,
weight, BP, temp., PR, RR
- also provides general health &
nutrition & about physical condit’n.
d). obtain information about social
networks & resources
- these factors influence whether
individuals will have prescriptions
filled & will comply with the
treatment program.
Nursing Diagnosis
 a number of nursing diagnoses may be
useful in guiding planning &
implementation. These may include:
 state relevant nursing diagnoses
a) ineffective health maintenance
b) risk for injury
c) noncompliance r/t drug regimens
d) deficient knowledge (illness & its Tx)
e) ineffective mgt of the therapeutic
regimen
Planning
 once the assessment has been completed
& the nursing diagnoses made, the nurse
engages in identifying desired outcomes of
nursing intervention & in planning
 appropriate nursing actions to achieve OCTOR on call to operating rm.
these outcomes O.S. left eye
 focus on: o.u. both eyes
(a) Why the drug is needed p after
(b) How the drug will be administered p.c. after meals
(c) Common indications of adverse p.o, by mouth
effects p.r.n., PRN as the occasion rises,
(d) other nursing measure that will q every
enhance the likelihood of achiev’g q.h. every hour
desired outcomes q2h every 2 hours
q.s. a sufficient quantity
Implementation q.i.d 4x a day
s without
 in preparing to administer medications, it is S.C., sub q subcutaneously
important for the nurse to ensure S.L. sublingually
cleanliness of all materials used sol. solution
 ensure availability of supplies ss one-half
 ensure adequate lighting stat immediately
 decrease environmental distractions susp. suspension
 verify the prescription for the medication to tab’ tablet
be administered (date, time, drug name, TID three times a day
dosage, route, frequency, & duration of TPN total parenteral nutrition
administration, & required signature by the tr. tincture
prescriber tsp. teaspoon

NOTE: prescription must always be written

except in some emergency situations. Once 2. The Right Drug
emergency has been controlled, written - read label 3x (nonunit dose)
prescription must be obtained. a) when taking the container
from its location
PRESCRIPTIONS FREQUENTLY CONTAIN b) when removing the drug from
ABBREVIATIONS its container
c) when returning the container
aa of each to its storage place
ad lib freely, as desired
a.c. before meals - three checks be carried out (unit dose)
b.i.d, BID twice a day a) when removing it from its
c with location in the drawer/ref.
caps. capsule b) when comparing it with the
dl, dL deciliter client’s medication administ’n
elix. elixer record
ext. extract c) before administering it
g gram
gr grain NOTES:
gtt drop - carefully check the prescription
h hour - check the medication against the
H.S., h.s. at bedtime or hr of sleep prescription
ID intradermal - do not administer a medication
Im intramuscular someone else has prepared
inj. by injection - if using a unit dose system, do not
IV or I.V. intravenously open the unit packaging until you are
IVPB intravenous piggyback at the client’s bedside.
kg kilogram - ask if this drug is “right” for the client.
kvo keep vein open (e.g. allergy)
L liter - never leave medications unattended
mcg microgram
mEq milliequivalents 3. In the Right Dose
mg milligram a) be familiar with the various measur’t
ml, mL milliliter systems & the conversion from one
NGT nasogastric tube system to another
O.D. right eye b) always use the appropriate measur’g
 device & read it correctly
c) shake all suspensions & emulsions
d) when measuring drops of medicat’n
with a dropper, always hold the
dropper vertically & close to the
medication cup
e) when removing a drug from a
multiple –dose vial, inject an amount
of air equal to the amount of fluid to
be withdrawn
f) do not attempt to divide unscored
tablets & do not administer tablets
that have been broken unevenly
along the scoring
4. To the Right Client
a) check the tag on the client’s bed
b) check the client’s ID band
c) ask the client to state his name
d) ask parents to tell you the name of
their child
e) always double-check a prescription
that the client questions.
5. At the Right Time
a) to achieve maximum therapeutic
effectiveness, medications are
scheduled to be administered at
specific times
b) the nurse should adhere, as closely
as possible. to the scheduled time
of administration
NOTE: as a general rule, the nurse should always
be certain that a medication is administered within
half an hour of the time it is ordered to be given
6. By the Right Route
- the method by which a drug is
administered affects such factors as
the absorption, speed of onset, dose,
side effects & adverse effects
a) be sure you know the prescribed route
by which a medication is to be given
b) if no route is specified in the health
care provider’s prescription, the MD
should be questioned about the
intended route
c) always gain the client cooperation
before attempting to administer a dos
of drug
d) consider the client’s developmental
level during adm. of medications
e) The nurse must know what vehicles
may be used with various drugs
f) to achieve maximum effectiveness &
client well-being, it is important to plan
the order in which meds are administ’rd
Correct Sequence of Oral Medications
1. drugs that require special assessments
such as those for which an apical pulse
or BP is required
2. other tablets & capsules
3. liquid preparations except for syrups
intended for local soothing or
anesthetic actions
4. sublingual preparations
5. antacids & liquid preparations intended
for local soothing or anesthetic actions
that are given with instructions not to
eat or drink fluids for 20-30 mins.
7. Right Documentation
a) be sure to document the medication &
time administered on appropriate
facility document.
b) document site location after
administering ID, SC, or IM inj
c) document if client refuses medication,
client’s reason, & reporting of refusal
to health care provider
 the right documentation is not only
a legal requirement, but also a safety
responsibility of the nurse.
 ‘if it isn’t documented, it wasn’t done”
 an inappropriate & illegal practice is
for the nurse to “borrow” a drug from
client”A” to give to client “B” with the
intent of replacing it later.
8. Client’s Right to Refuse
a) be sure to assess client’s reason for
refusing medication
b) if knowledge deficit underlies client’s
reason for refusal, provide appropriate
explanation for why medication is
prescribed, what medication does, &
the importance of medication for
treatment of client’s health alteration.
c) Document refusal
9. Right Evaluation
 Is the comparison of actual client
outcomes with expected outcomes.
 Includes assessing the effectiveness of the
medication in alleviating s/s of illness,
determining adverse effects that result
from the use of the drug, & determining
the client’s ability to self-administer
medication
10. Right Education
CLASSIFICATIONS OF DRUGS ACC’G TO USE
A. THERAPEUTIC AGENTS
 Do any of the following actions
 1) Maintain Health
 Vitamins & minerals to
regulate metabolism
 ASA for baby at risk for
heart attack
2) Relieve Symptoms
 Anti-inflammatory like
ibuprofen
 Narcotics – severe pain
 Diuretic – control excess
fluids
3) Combat Illness
 Antibiotics to cure
pneumonia, strep throat
4) Reverse Disease Processes
 Drugs to control
depression, BP,
cholesterol or diabetes
B. PHARMACODYNAMIC AGENTS
 Alter bodily functioning in a desired
way
 Muscle relaxant
 Pupil dilator/constrictor
 Increase/decrease BP
 Contraceptives
 Anesthetics
C. DIAGNOSTIC AGENTS
 Facilitate an exam or conclusion as
to the nature or extent of a disease
condition
 Radioisotopes (technetium/iodine)
– PET
D. PROPHYLACTIC AGENTS
 Prevent illness or disease from
occurring
 IODINE – prepare skin
preoperatively
 VACCINE
E. DESTRUCTIVE AGENT
 Has a –cidal action; kills bacteria,
fungi, virus,or even normal cells or
abnormal cells
 Antineoplastic drugs
ADDENDUM:
1. CHEWABLE TAB
Contain a base that is
flavoured/colored
Preferred for antacids,
antiflatulence, vitamins
2. EFFERVESCENT TAB
Granular salts that release gas
& so disperse active ingredients
into solution when placed in
water or juice
ALKA-SELTZER – relieve
headache or hangover
3. BUCCAL TAB
Placed on the buccal pouches
4. SUBLINGUAL TAB
Dissolved under the tongue &
absorbed
Nitroglycerin
5. VAGINAL TAB
Placed by means of an
applicator
Less messy than equivalent
cream formulations
UNIT THREE: DRUG CALCULATIONS
A. NONPARENTERAL MEDS
Capsules and unscored tablets are rounded to the
nearest whole tablet. Scored tablets are rounded
to the nearest 1/2 tablet. Liquid medications are
rounded to one decimal place (tenths).
The dosage in which the drug is manufactured is
considered a conversion factor; such as 1 tablet
= 0.5 mg is 0.5 mg/tablet.
1. RATIO & PROPORTIONS
 Ratios indicate a relationship between two
numbers with a colon between the numbers.
The colon represents division. For example
3:4 = 3/4.
 Proportions are equations containing ratios
of equal value.
For example 3:4 = 6:8. This may also be
written as fractions, 3/4=6/8.
Means are the two inner numbers, in this case 4 & 6.
Extremes are the two outer numbers, 3 and 8.
3:4=6:8
The product of the means (4 X 6) must equal the product
of the extremes (3 X 8).
Therefore when you do not know one value (x), you can
determine it, if the other three values are known.. When
setting up a ratio, the known factor (on hand) is stated
first, the desired is stated second. H = D x
3:4=x:8 multiply the means and Example: Order: Potassium Chloride 20 mEq added
4x = 3 X 8 the extreme to the IV
4x = 24 Available: 40 mEq per 10cc.
x= 24  4 = 6 How much potassium will you add?
D = 20 mEq H = 40 mEq Q = 10 cc
If you set this up as a fraction: 20 mEq X 10 cc = X
40 mEq
3=x cross multiply to obtain 0.5 X 10 = X = 5 cc
4 8 the product of the means
4x = 3 X 8 = 24 and extremes Points to remember:
x = 24  1. The maximum number of tablets and capsules
administered to achieve a desired dose is usually
3.
2. No more than 10% variation should exist
between the dose ordered and the dose
administered.

3. Make sure your answer seems reasonable. Think

about whether the dose should be larger or
smaller than what is available.
Example: Ordered: 600,000 units of penicillin po
q6h
EXERCISES:
Available: 400,000 units per scored
tablet
1. A client is ordered 50 mg of Amitriptyline.
25 mg tablets are available. How many tablets
How many tablets will you administer? will you give?
400,000 units : 1 tablet = 600,000 units : x
600,000 = 400,000x 50 mg/25 mg = 2 tabs
600,000 = x = 1.5 tablets
400,000 antidepressant

OR set it up as a fraction
400,000 = 600,000
1 x 2. A client is ordered 0.5 mg of Digoxin.
250 mcg tablets are available. How many tablets
400,000x = 600,000
will you give?
x = 600,000 = 1.5 tablets
400,000
0.5 mg/0.25 mg = 2 tabs
 When working with a complex fraction -
either a fraction in the numerator or
denominator - it helps to simplify the
fraction. When dividing by a fraction, 3. A client is ordered 1 mg of Diazepam.
remember to invert and multiply. 2 mg tablets are available. How many tablets will
you give?

2. THE FORMULA METHOD: 1 mg/2 mg = ½ tab

D/H x Q = X

D - dosage desired or ordered

H - what is on hand (available)
Q - unit of measure that contains the available dose. 4. A client is ordered 2.5 grams of Neomycin
sulphate. 500 mg tablets are available. How
many tablets will you give?
When using solid products (tabs, caps) Q is
always 1 and can be eliminated.
Q varies when using liquid measure. 2.5 g/0.5 g = 5 tabs

X - the unknown dosage you need to administer Topical antibiotic


5. A client is ordered 1.25 mg of Clonazepam. 0.5
mg tablets are available. How many tablets will
you give?
1.25 mg/0.5 mg = 2 ½ tabs
Anxiolytic, anticonvulsant
6. Order: Codeine gr. I, PO, STAT
Available: 30 mg
1 gr (60mg)/30 mg = 2 tabs
Analgesic, antidiarrheal, antitussive
7. A client is ordered 35 mg of Codeine phosphate
by subcutaneous injection.
50 mg in 1 mL of liquid for SC Injection is
available. How many mL will you administer?
35 mg/50 mg x 1 mL = 0.7 mL
8. A client is ordered 22 mg of Gentamicin sulphate
by intramuscular injection. 20 mg in 2 mL of
liquid for IM Injection is available. How many mL
will you administer?
22 mg/20 mg x 2mL = 2.2 mL
9. A client is ordered 200 mg of Amoxicillin
trihydrate orally. 250 mg in 5 mL of Syrup is
available. How many mL will you administer?
200mg/250mg x 5 mL = 4 mL
10. Order: Atropine 0.3 mg IM now
Label: Atropine 400 mcg/mL
How many mL would be administered?
0.3 mg/ 0.4 mg/mL = 0.75 mL
11. Order: Chloromycetin 800 mg IV q8h.
The vial reads: 1g per mL. How many cc would
you give?
800mg/1000 mg/mL = 0.8 mL
B. PARENTERAL MEDICATIONS
 Injectable medication guidelines:
1. Intradermal - the volume to be administered
is 0.1 ml or less
2. Subcutaneous - the volume to be administer
is 1.0 ml or less
3. Intramuscular - depends upon the size of the
person
a. A healthy well developed person can
tolerate 3.0 ml in large muscles - this does
NOT include the deltoid.
b. For elderly, thin clients or children the
total amount should not exceed 2.0 ml.
c. No more than 1.0 ml should be given to
young children and older infants.
 Calculating dosages in units (insulin, heparin,
pitocin, vitamins, some antibiotics)
Ex: Ordered: Heparin 8000 units sq q12h
Available: Heparin 10,000 units/ml
How much will you administer?
Formula: 8000 units X 1 ml = 0.8 ml
10,000 units
Ratio: 10,000 units : 1 ml = 8000 units : x
8000 units X 1 ml = 10,000 units x
8000 / 10,000 = x
0.8 ml = x
If the answer is greater than 1, you probably calculated
the problem incorrectly. Rarely, the desired dose is large
and you will have to administer it in more than one site.

Reconstituting powdered drugs:

Read the label for the amount of fluid to add, the type of
fluid and the final concentration of the reconstituted
fluid. The label will also tell you how long the mixture
may be stored and what conditions are required for
storage. The final volume will be larger than the amount
of fluid you add because the powder will take up some
room when diluted. If you are not given a final volume
calculate the concentration based on the amount of fluid
you added. You will calculate the amount to administer
from the final concentration.

Insulin

Insulin is administered only using an insulin syringe.

Most insulin vials contain 100 units/ml. Insulin may be
administered subcutaneously, intramuscularly (rarely
used) and intravenously.
Regular insulin is the only type that may be given IV
since it does not contain any additives to prolong the
action. Regular insulin is clear. If the vial is cloudy, it
has been contaminated and should be discarded.
Longer acting insulin is cloudy and may have a
precipitate on the bottom of the vial. Be sure to mix the
vial well by rotating it between the hands.
Mixing regular insulin and a longer acting insulin in the
same syringe.
 Inject air into the longer acting insulin vial
first - don't let the tip of the needle touch the
surface of the fluid.
 Using the same syringe, inject air into the
regular insulin then invert the bottle and
withdraw the correct amount of regular
insulin. Remove air bubbles.
 Still using the same syringe, withdraw the
correct amount of the longer acting insulin.
You cannot return any extra fluid withdrawn.
Ex: Ordered: D5W 1000 ml to infuse in 6 hours.
If you withdraw too much, you must start
over.
Intravenous calculations
Drop factor - IV tubing has a drip chamber
that is used to count drops (gtts) per minute.
Each tubing is labeled with the number of
drops per milliliter (drop factor).
Macrodrop tubing - has a drop factor of 10, 15
or 20 gtts/ml (drops per milliliter).
Microdrip tubing - has a drop factor of 60
gtts/ml.
FLOW RATE FORMULA:
R= V x DF
T
Where:
R = rate ; expressed in gtts/min
V = volume ; amount to be infused
expressed in mL or cc
DF = drop factor; expressed in gtts/mL ;
either macro (10,15,20) or
micro (60)
T = time or duration of infusion ;
expressed in minutes
The DF of your tubing is 10 gtts/ml.
How many gtts/min will you infuse?

R = 1000 mL x 10 gtts/mL
6 hr or 360 mins

= 10000 gtts
360 mins
 = 27.77 gtts/min
= 27.8 gtts/min
R= 27-28 gtts/min

The same formula may be used to calculate drop

rates for fluids administered in less than 1 hour:

Ex: Ordered: Gentamycin 40 mg/100 ml IVPB q 6h

Drop factor 15 gtts/ml
Your drug book says you can give this
in 45 min
How many gtts/min will you infuse
the Gentamycin?

R = 100 mL x 15 gtts/mL
45 mins
R = 15000gtts
45 mins
R = 33 gtts/min or 32 – easier to count: 8/15 sec

When using an IV pump, the rate is in ml/hr.

Therefore, you do not need to determine a drop factor. EXERCISES:

Example: 1. Calculate the drip rate for 100 mls of IV Fluids to

Infuse Ancef 1 g/50 ml IVPB q6h. The IV be given over a half hour via a giving set which
handbook states this can be given in 20 minutes. delivers 10 drops/ml.

What rate will you set on the IV pump?

R = 33.33 0r 33-34 gtts/mL
 50 ml X 60 min = 50 X 3 = 150 ml/hr
20 min 1 hr
 You need to give 50 ml in 20 minutes. But you
have to convert the minutes to hours.

2. Calculate the drip rate for 500 mls of Normal

OTHER FORMULA: Saline to be given over 4.5 hours via a giving set
T = V x DF which delivers 15 drops/ml.
R

R = 27.77 or 27-28 gtts/mL

V = RxT
DF

DF = R x T
V
3. Three litres of Hartmans (Lactated Ringer's) is
charted over 12 hours. The drop factor is 15.
The IV has been running for 9 hours. 800 mls
remain. How many drops per minute are needed
so that the IV finishes in the required time?

800 x 15 / 180 = 66-67 gtts/mL


4. Ordered : 1000mL of D5W to infuse over 12h
Available: macrodrip set with 10 gtts/mL & a
microdrip set with 60 gtts/mL
a) Would you use macro or micro IV set?
b) Calculate the IV flow rate in gtts/min
according to IV set you selected
1000 mL x 10 gtts/mL / 720 mins = 13-14gtts/mL
or
1000 mL x 60 gtts/mL / 720 mins = 83-84 gtts/mL
Uses
1. Adult I.V. solution to keep vein open.
2. Vehicle for mixing medications for I.V. delivery for all
age groups.
3. It may be the primary adult I.V. fluid for medical
emergencies, though many services use only L.R. or
N.S.
The fluid is isotonic when in the container. After
administration, the dextrose is quickly metabolized in
the body, leaving only water - a hypotonic fluid.
5. Ordered: 250 mL of D5W to KVO, 10 gtts/mL
a) What type of IV set would you use?
Why?
b) Determine how many gtts/min the client
should receive.
6. A D10W IVF regulated at 24 gtts/min was
hooked to an adult client at 1 PM yesterday.
How much fluid would the patient consume until
tomorrow at 3 PM? Express your answer in
liters.
V= R x T/df
24gtts/min x 26 hrs or 3000 mins / 15
gtts/mL
A = 4.8L
7. How long will it take for a 750 mL IVF to be
consumed if it is infusing at 33 gtts/min. The
client is a preschooler suffering from mild
dehydration related to diarrhea secondary to
ingestion of contaminated “tokneneng”. The IVF
was started 30 minutes before the 3-11 shift.
Find out when a follow-up IVF is to be given.
T = V x df / R
750 mLx 60 gtts/mL / 33 gtts/min
1363.6 mins or 22.7 hrs or 22 hrs& 42min
FOLLOW UP = 1:12PM
8. One litre of Dextrose 5% in water is charted
over 8 hours. The drop factor is 10. Calculate
the number of drops per minute
R = V x DF/ T
1000mL x 10gtts/mL / 480 mins
20.8 or 21 gtts/min
9. Calculate the drip rate for 100 mls of IV Fluids to
be given over 2 hours via a giving set which
delivers 60 drops/ml.
R = V x df / T
100mL x 60 gtts/mL / 120 mins
50 gtts.min
PEDIATRIC CALCULATIONS
Accurate doses are especially important in giving
medications to infants and children because even small
errors can be dangerous due to their small body size.
Two methods are used to calculate pediatric dosages:
According to the weight in kilograms (kg)
According to the child's body surface area (BSA)
A. BASED ON BODY WEIGHT
1. The first step is to convert the child's body
weight into kg. The formula is 2.2 lb. = 1 kg.
2. The second step is to calculate the medication dose.
a. Calculate the daily dose
b. Divide the daily dose by the number of doses to
be administered
c. Use either the ratio-proportion or formula
method
to calculate the number of tablets/capsules or
volume to be administered with each dose.
Example: A child weighing 76 lbs. is ordered to receive
150 mg of Clindamycin q6h. The pediatric drug
handbook states the recommended dose is 8-20
mg/kg/day in four divided doses. The Clindamycin is
supplied in 100 mg scored tablets.
1. What is the weight in kg?
76 lbs. 2.2kg/lb. = 34.5 kg
2. What is the safe total daily dose?
Minimum: 8 mg/kg/day X 34.5 kg = 276
mg/day
Maximum: 20 mg/kg/day X 34.5 kg = 690
mg/day
3. Is this a safe dose?
150 mg/dose X 4 doses/day = 600 mg/day
Yes this is within the recommended safe range.
4. Calculate the number of tablets to give.
100 mg : 1 tablet = 150 mg : x
100 x = 150
x = 1.5 tablets
C. BASED ON BODY SURFACE AREA
BSA is determined from a nomogram using the child's
height and weight.
When you know the child's BSA the dosage is
determined by multiplying the BSA by the
recommended dose.
To determine whether the dose is safe, compare the
ordered dose and the calculation based upon the BSA.
The formula for calculating child's dosage is
Child's BSA X adult dosage
1.7 M2
Example: The child has a BSA of 0.67 M2. the adult
dose is 40 mg. The physician ordered 8 mg. Is the
dosage correct?
0.67 X 40 = 26.8 = 15.8 mg No, the dose is
1.7 1.7
OTHER FOMULA:
1. FRIED’S RULE – below 1 yr
Dose = age in months X average adult dose
150 months
The adult dose of tincture of digitalis is 1 mL. What should a
10 month old child receive?
10/150 x 1mL = 0.07 mL
2. YOUNG’S RULE – 1 to 12 yrs
Dose = age in years X average adult dose
age in years + 12
An adult dose of drug is 500mg, what is
the dose for a 2-year old child ?
2/2+12 x 500 mg = 71.4 or 70 mg
3. CLARK’S RULE
Dose = weight in pounds X average adult dose
150 lbs
If an adult dose of drug is 750mg, what
is the dose for child weighing 20 lbs ?
20/150 x 750 mg = 100mg
Conversion Guide
* 1 Kilogram = 1000 grams
* 1 Gram = 1000 milligrams = 15 grain
60 mg = 1 grain
* 1 Milligram = 1000 micrograms
* 1 Microgram = 0.001 milligrams
* 1 Milligrams = 0.001 grams
* 1 Microgram = 10 -6 grams
* 1 Nanogram = 10 -9 grams
* 1 Grain = 65 milligrams
too small.
60 Grain = 1 dram
8 dram = 1 oz
1 fluid dram = 60 minim
1 cc = 15-16 min
1 min = 0.06 cc
8 fluid dram = 1 fluid oz
2 fluid dram = 8 cc
 240 cc = 8 fluid oz (f oz viii)

30 cc = 1 fluid oz (f oz i) = 2 tbsp

15-16 cc = 4 oz = 3 tsp = 1 tbsp

* 1 Litre = 1000 cc

* 1 OZ = 30 cc

* 16 OZ = 480 cc = 1 Pint

16 oz = 1 lb

* 1 Pint = 480 cc

* 1 Quart = 960 cc = 2 Pints

* 1 Gallon = 3840 cc = 4 Quarts = 8 Pints

UNIT 1V: DRUG ACTION – PHARMACEUTIC,
* 2.2 lbs = 1 kg PHARMACOKINETIC,
PHARMACODYNAMIC
* 1 Teaspoonful = 5 cc = 60 gtts
I. PHARMACEUTIC PHASE
 The science of formulating drug
* 1 Tablespoonful = 15 cc products & the study of the influence of
formulation characteristics on the
* 1 Teacupful = 120 cc ability of an administered drug product
to be dissolved in a body fluid
A. Disintegration
* 1 Wineglassful = 60 cc
 The breaking up of a solid oral
medication into small fragments
* 1 Tumblerful = 240 cc  Enteric-coated drugs resist
disintegration in gastric acid.
- should not be used when
immediate effect is
desired

B. Dissolution
 The rate that a drug enters into
a solution
 The dispersal of the substance
as solute particles in the body
fluid with which the drug is in
contact
 Liquid drugs – immediately
available for absorption
 Capsule – dissolve rapidly;
absorption nearly as quickly as
liquid drugs
 Tablets – absorbed least rapidly
 Sustained-Release – requires
varying amounts of time to be
dissolved; absorbed over 8-12
hrs

C. Rate limiting
  The step leading up to
bioavailability that occurs most
slowly for a given drug product
will determine the overall rate @
which the drug becomes
bioavailable
II. PHARMACOKINETIC PHASE
 larger molecules & particles
can be brought across lipid
membranes through this
process
 the engulfment by a cell of a
droplet of the surrounding
fluid, complete with all its
contents

A. Absorption a) Pinocytosis
 The act of the drug reaching the - a nonselective process by
circulating fluids & tissues from which membranes trap a
outside of the body small quantity of adjacent
 Oral doses absorbed via small fluid.
intestines (3-4 hrs) - The membrane invaginates
 Mucus membrane, skin, lungs, to form a pocket & then
muscles, & subcutaneous fats closes to engulf a bead of
also allow for absorption fluid complete with
whatever solutes it might
 Massage or heat can be used to
contain
hasten absorption
1. PASSIVE ABSORPTION/DIFFUSION
 the random movement of
b) Receptor-mediated endocytosis
chemicals from an area of
- similar in appearance
higher concentration to an
to pinocytosis but is
area of lower concentration
highly specific
across a semi-permeable
- the receptors,
membrane until equilibrium is
consisting of
reached
membrane proteins,
 requires no energy
cluster in pits in the
membrane & bind a
2. FACILITATED DIFFUSION
specific substance
 the use of a carrier,
(ligand) from the
sometimes a hormone ,
surrounding fluid
enzyme or a protein, to move
- once inside the cell, the
a chemical across a semi-
ligand is released from
permeable membrane
the receptor & the
 the carrier moves across the
receptor is recycled for
membrane by passive
additional activity.
diffusion
 the chemical cannot move
5. LIPID SOLUBILITY
across the semi-permeable
 drugs that have high lipid
membrane w/o attaching itself
solubility are absorbed more
to the carrier
rapidly than those soluble in
 requires no energy
water because the
 selective & saturable
penetration barriers are
largely composed of lipids
3. ACTIVE TRANSPORT
 Neomycin is a highly water
 also requires a carrier, usually
soluble antibiotic that can be
an ion or protein, to move
used in the treatment of
across a semi-permeable
intestinal bacterial infection
membrane
 the chemical cannot move
6. BIOAVAILABILITY
across the semi-permeable
 an important factor in the
membrane w/o attaching itself
effectiveness of a drug
to the carrier
product
 requires energy
 absorption efficiency of a drug
 selective & saturable
 bioavailability of a drug is
 limited to substances of small
influenced by its
to moderate size
pharmaceutical composition
4. ENDOCYTOSIS
  plasma level of a drug are
commonly accepted as an
approximate measure of
bioavailability
B. Distribution
 the act of the drug being
transported via circulation to
the tissues
 most drugs distributed while
bound w/ protein
 some drugs tightly bound –
slow release & excretion
 some drugs loosely bound –
rapid release & excretion
WHY IS UNIFORM DISTRIBUTION UNLIKELY
IN ALL PARTS OF THE BODY?
a) differences in permeability of
various penetration barriers
b) regional variations in pH &
perfusion
c) differences in solubility of the
drug in blood & various tissues
d) sequestering of drug by protein
binding or carrier-mediated
transport into specific tissues
1. Apparent Volume of Distribution
 a measure of the extent to
which a drug can penetrate
into various fluid & tissue
compartments
 influenced by body mass, &
drug dosage therefore be
adjusted in relation to body
mass
2. Protein Binding
 occurs in plasma esp. to
albumin proteins
 for such drugs, a fraction of
the total plasma conc. is
bound to proteins & the
remainder is unbound or free.
 protein binding slows
absorption of a drug out of
the plasma into tissues
by reducing the effective
conc. of the drug
 only unbound fraction is
immediately available for
further distribution into
tissues by passive diffusion
 as free drug is removed from
the circulation by absorption
into tissues
or elimination, some of the
bound drug is released to
restore equilibr’m.
 one factor that influences
protein binding of drug is
competitive displacement – a
common type of drug-drug
interaction that occurs
whenever 2 drugs capable
of protein binding are given
concurrently.
** the effect is most
significant for drugs tha
are highly bound & that
have low therapeutic
indexes – warfarin &
digitoxin
C. Metabolism
 the breakdown of a substance
through chemical reactions
that are controlled by
enzymes
 the chemical process of
changing a toxin (drug) to a
non-toxic chemical
 liver the single most
important site
 more often than not, hepatic
metabolism decreases the
activity of drug
Hepatic First-Pass Effect
- newly absorbed substances
initially pass to the liver before
entering the systemic circulation
thru enterohepatic portal
circulation
- drugs that are largely cleared by
first-pass extraction have short
durations of action.
 Enzyme Induction
- occurs with chronic use of
many drugs, typically after a
period of a few days.
- inducers include: alcohol,
barbiturates, hypnotics,
analgesics, steroids,
antihistamines, etc….
 Half-Life
- the time it takes for the
amount of drug in the body
to be decreased to ½ of the
peak level it previously
achieved
 - this info is important in
determining the appropriate
timing for a drug dose or
determining the duration of a
drug’s effect in the body
D. Excretion
 the kidneys rapidly excrete most of
the products of liver metabolism
that have been reabsorbed into the
blood, but they also excrete many
drugs unchanged.
1. Filtration
- small molecules pass by
passive diffusion from the
blood vessels in the kidney
into the tubule that collects
the materials that ultimately
form the urine.
2. Active Secretion
- is the energy-dependent
removal of a drug from the
renal circulation into the
tubule
III. PHARMACODYNAMIC PHASE
 the physiological & biochemical
operation of a drug on the body.
 drugs can inhibit a process, activate a
process, or they can replace a missing
element.
1. Physiochemical influences
 osmotic diuretics act to increase
the osmolarity of filtrate in the
nephron, holding water in the
tubule & ultimately enhancing
formation of urine.
 antacids produce a chemical
neutralization of acid, thereby
raising pH.
2. Receptor theory
 receptors are cellular components
with which the body’s own hormones
(sometimes drugs) interact to
produce characteristic effects
 the body of knowledge & hypothesis
concerning interactions between
drugs & receptors is called receptor
theory
 receptors exhibit specificity
 drugs interact with receptors in either
of 2 different ways:
a) AGONISTS
- also called activators
- bind to receptors &
modify it to produce a
pharmacologic effect
b) ANTAGONISTS
- bind to the receptor &
prevent it from
producing an effect
3. Dose-Response Relationship
 a drug that produces a greater effect
at a lower dose than another is said to
have a greater potency
 the intensity of a biological response
to a drug is presumed to be related
either to the number of activated
receptors or the rate of their
activation.
 the concentration of the drug in the
vicinity of the receptor as well as the
number, affinity, & sensitivity of the
receptors themselves will determine
the magnitude of the response
 THERAPEUTIC INDEX =
lethal dose/effective dose
 general indicator of the margin of
safety for a drug
 a large TI is favorable
4. Client Variable to Drug Action
a) AGE
- primarily a factor in pediatrics &
geriatrics
- inability or less efficient at
absorb’g, transport’g,metaboliz’g
& excrete’g drugs
b) BODY WEIGHT
- more tissue means more of the
drug is needed
- normal doses may cause toxic
effects on the small
c) GENETIC & ETHNIC CHRACTERISTICS
- enzyme characteristics vary
slightly amongst diff. Cultural
backgrounds
- variances can lead to altered drug
response
d) GENDER
- drugs may have different effects
dependent on gender
- males have more vascular
musculature resulting in faster
absorption & transport
- females have higher conc. of fat
cells
e) DISEASE ENTITIES
- affect the chemical make-up of
 the system & therefore may alter
the therapeutic effect of drugs
factors contributing to altered
effects
 acid-base balance
 electrolyte levels
 hydration
 diurnal rhythm of nervous
system & endocrine system
 malabsorption
 distribution disturbances
 metabolic interference
 malexcretion
f) DRUG TAKING COMPLIANCE
- the individual’s attitude affects
the effectiveness of drugs
- the placebo effect
- those who trust the system
- those in-between
5. Adverse Drug reactions
 covers a host of undesirable
effects of drugs
 in assessing whether an observed
symptom is an adverse drug
reaction or is due to some other
cause, the nurse should be
guided by the following
considerations:
a) is the observed symptom
known to be a potential rxn
to a drug being used by the
client?
b) did the symptom develop
after addition of a new drug
to the regimen or an
increase in dosage of an
existing treatment?
c) did the adverse event
subside when the drug was
discontinued or the dosage
reduced?
d) did the symptom reappear
when the drug was
reintroduced?
e) are there alternative
possible etiologies?
f) has the client had similar
reactions to the drug or
related drugs in the past?
PREDICTABLE,ACUTE ADVERSE DRUG RXNs
 Side effects
- are predictable ADR that
occur within the normal range
of therapeutic doses for a
given drug
- identification is a major part
of the nurse’s role
 Overdose toxicity
- predictable consequence of
excessive drug effect due to
administration of doses above
the normal limit
 Functional overdose
- is one produced when the
dose administered is within
the normal range, but when
unusual pharmacokinetics
produce a higher than normal
plasma conc.
 Cumulative toxicity
- occurs when repeated dosing
is used & drug elimination
between doses is less than
the drug made available from
each additional dose
UNPREDICTABLE, ACUTE ADVERSE DRUG RXNs
 Hypersensitivity
Rxns
- drugs can function as
antigens themselves or they
can function as haptens,
binding to endogenous
proteins to create antigenic
complexes
- Skin Testing – preventive
 Idiosyncratic
Rxns
- are reactions of unusual
intensity in an individual
client, outside of the normal
range of responses
- usually genetically
determined.
CHRONIC ADVERSE DRUG REACTIONS
 tolerance &
dependence
- seldom develop in less than
a few months of regular drug
use
 iatrogenic
diseases
- are disease caused by drugs
that are part of medical
treatment
FIVE MOST COMMON
1. blood dyscrasias
2. liver damage
3. kidney damage
4. teratogenic effects
5. skin eruptions

Using the Drug Monographs
The following components are described in the order in
which they appear in the monographs. All components
may not appear in each monograph but are represented
where appropriate and when information is available.
1. Drug Name: The generic drug name is the
first item in the name block
2. Phonetic Pronunciation: Pronunciation guide
for generic name to assist in mastering
often complex names.
3. Classifications: Defines the type of drug or
the class under which the drug is listed. A
classification or descriptor is provided for
each drug name.
4. Pregnancy Category: List the FDA pregnancy
category (A, B, C, D, or X) assigned to the
drug.
5. Trade name: Trade names are identified as
Rx (prescription) or OTC (over the counter,
no prescription required). If numerous forms
of the drug are available, the trade names
are identified by form.
6. Controlled Substance: If the drug is controlled
by the U.S Federal Controlled Substances
Act, the schedule in which the drug is
placed follows the trade name listing (C-1,
C-11, C-111, C-1V, and C-V).
7. Combination Drug: The heading at the top of
the name block indicates that the drug is a
combination of two or more drug in the
same product.
8. General Statement: Information about the
drug class and/or anything specific or
unusual about a group of drugs is
presented. Information may also be
presented about the disease(s) or
condition(s) for which the drugs are
indicated.
9. Action/ Kinetics: Critical information about
the rate of drug absorption, distribution, time
for peak plasma levels or peak effect,
minimum effective serum or plasma level,
duration of action, metabolism, and
excretion route(s). Metabolism and
excretion routes maybe important for clients
with systemic liver disease, or both.
10. Uses: Approved therapeutic uses for the
drug are listed.
11. Contraindications: Disease states or
conditions in which the drug should not be
used are noted
12. Special Concerns: When appropriate, the FDA
Black Box Warning is included.
Considerations for use with pediatric,
geriatric, pregnant, or lactating clients.
Situations and disease states when the drug
should be used with caution are also listed.
13. Side Effects: Listed by the body organ or
system affected. Usually presented with the
most common side effects first in
descending order of incidence. If potentially
life-threatening, the side effect is bold –
italic.
14. Overdose Management: Symptoms observed
following an overdose or toxic reaction and
treatment approaches and/or antidotes for
the overdose.
15. Drug Interactions: Alphabetical listing of
drugs and herbals that may interact with the
drug. Increase, Decrease, leading
to.
16. Laboratory Test Considerations: The manner
in which the drug may affect laboratory test
values is presented as increased values ( ),
false positive values ( + ), decreased values
( ), or false negative values ( -) . Also
included, when available, are drug-induced
changes in blood or urine levels of
endogenous substances.
17. How Supplied: Dosage forms and amounts
of the drug in each of the dosage forms.
One dosage form may be more appropriate
for a client than another. This information
also allows the user to ensure the
appropriate dosage form and strength is
being administered.
18. Dosage: The dosage form and/or route of
administration is followed by the disease
state or condition (in italics) for which the
dosage is recommended.
19. Nursing Considerations: Guidelines to help
the practitioner in applying the nursing
process to pharmacotherapeutic s to ensure
safe practice and patient safety.
20. Sound Alike Warnings
21. Administration Storage: Guidelines for
preparing medications for administration,
administering the medication, and proper
storage and disposal of the medication.
Guidelines for administration by IV are
indicated by an icon IV.
22. Assessment: Guidelines for
monitoring/assessing client before, during,
and after prescribed drug therapy.
23. Client/Family Teaching: Guidelines to
promote education, active participation,
understanding, and adherence to drug
 therapy by the client and/or family
members. Precautions about drug therapy
are also noted for communication to the
client/family.
24. Outcomes/Evaluate: Desired outcomes of the
drug therapy and client response.
25. Interventions (For selected Drugs): Guidelines
for specific nursing actions related to the
drug being administered.
UNIT FIVE : DRUGS AFFECTING THE
DIFFERENT SYSTEMS
ANTI-INFECTIVE AGENTS
Definition: Drugs that are designed to act selectively on
foreign organisms that have invaded &
infected the body of a human host
Goal: To reduce microbes to a point at which the human
immune response can take care of the infection.
Drug Therapy Across the Lifespan:
CHILDREN
 Use with caution – early exposure can lead to early
sensitivity
 Monitor nutritional & hydration status
ADULTS
 Drug allergies & emergence of resistant strains can
be a big problem
 Pregnant & nursing women – cautious
OLDER
 C&S tests are important to determine the type &
extent of many infections – often do not present s/s
seen in younger people
 Monitor nutritional & hydration status
 Hepatotoxic & nephrotoxic drugs be used with
caution – decreased organ function
Mechanisms of Action:
1. Interfere with biosynthesis of the bacterial cell wall
Ex. Penicillins
2. Prevent the cells of the invading microbes from using
substances essential to their growth & development,
leading to an inability to divide & eventually cell death
Ex. Sulfonamides, anti-TB drugs, Trimethoprim
3. Interfere with the steps involved in protein synthesis
Ex. Aminoglycosides, Macrolides, Chloramphenicol
4. Interfere with. DNA synthesis in the cell, leading to
inability to divide & cell death
Ex. Fluoroquinolones
5. Alter the permeability of the cell membrane to allow
essential cellular components to leak out, causing cell
death
Anti-infective Activity
a) NARROW SPECTRUM
 Effective against only a few
microbes with a very specific
metabolic pathway or enzyme
 Spectinomycin (Trobicin)
- interferes with protein
synthesis only in susceptible
strains of Neisseria
gonorrhoeae
b) BROAD SPECTRUM
 Interfere with biochemical reactions in
many different kinds of microbes, making
them useful in the treatment of a wide
variety of infections
c) BACTERICIDAL
 They cause the death of the cells they
affect
d) BACTERIOSTATIC
 They interfere with the ability of the
microbes to reproduce or divide
Human Immune Response
 Involves a complex interaction among
chemical mediators, leukocytes,
lymphocytes, antibodies, & locally
released enzymes & chemicals
 If immunocompromised (malnutrition,
age, AIDS, immunosuppresant drugs), the
system may be incapable of dealing
effectively with the invading microbes
 WHY Tx IS SOMETIMES DIFFICULT:
(1) drugs cannot totally eliminate the
pathogen without causing severe toxicity
in the host.
(2) patients do not have the immune
response in place to deal with even a few
pathogens
Resistance:
 Because anti-infectives act on specific enzyme
systems or biological processes, many microbes that
do not use that system or process are not affected by
a particular drug.
  VANCOMYCIN – interferes with cell wall
synthesis
- used both in patients who are
intolerant to or allergic to
penicillin/cephalosporins
- prophylaxis against bacterial
endocarditis
- may be highly toxic : renal
failure, ototoxicity,
superinfections, “red man
syndrome” – sudden, severe
hypotension, fever, chills,
paresthesia, erythema of neck &
back
Acquiring Resistance:
(3) NEUROTOXICITY
 Can damage or interfere with the function of
nerve tissue, usually in areas where drugs tend to
accumulate in high concentrations
 Ex. aminoglycosides – collect in the 8th CN 
dizziness, vertigo, loss of hearing
 Ex. Chloroquine for malaria – can accumulate in
the retina & optic nerve  blindness
(4) HYPERSENSITIVITY Rxns
 Induce antibody formation in susceptible people
(5) SUPERINFECTIONS
 Destruction of normal flora – broad spectrum
 Opportunistic pathogens have the opportunity to
invade tissues & cause infections
 Ex. vaginal or GI yeast infections

1. Producing an enzyme that deactivates the drug

Ex. penicillinase
ANTIBIOTICS

2. Changing cellular permeability to prevent the drug A. AMINOGLYCOSIDES (Mycins)

from entering the cell or altering transport systems to  Group of powerful antibiotics used to treat serious
exclude the drug from active transport into the cell. infections caused by gram-negative aerobic bacilli
a) Pseudomonas aeruginosa
3. Altering binding sites on the membranes or ribosomes, b) E. coli
which then no longer accept the drug. c) Proteus species
d) Klebsiella-Enterobacter-Serratia group
4. Producing a chemical that acts as an antagonist to the e) Staphylococcus
drug f) Citrobacter species
 Bactericidal – inhibit protein synthesis
Preventing Resistance:  Poorly absorbed from GIT; rapidly absorbed after IM
inj
1. doses should be high enough & long enough to  Most of these drugs have potentially serious adverse
eradicate even slightly resistant microbes. effects
2. correct timing – maintain a constant therapeutic level
3. avoid indiscriminate use of anti-infectives – identify 1. amikacin (Amikin) – nephro/ototoxicity is high
first the causative organism 2. gentamycin (Garamycin) – available in many
forms
Combination Therapy: 3. kanamycin (Kantrex) – used to Tx hepatic
(1) smaller dosage of each drug is used  fewer coma when ammonia-
adverse effects producing bacteria in
(2) synergism – more powerful when given in the GIT cause serious
combination illness
(3) more than one pathogen - not to be used longer than 7
(4) delay the emergence of resistant strains – TB –10 days  renal damage,
BMD, GI
Adverse Reactions to Infective Therapy: 4. neomycin (Mycifradin) – used to suppress GI
(1) KIDNEY DAMAGE bacteria preoperatively;
 most frequently with drugs that are metabolized wounds
& excreted by the kidney 5. streptomycin – very toxic to 8th CN & kidney
 Ex. aminoglycosides - today, used as the 4th drug in
 Stay well hydrated throughout the course of combination therapy for TB
therapy 6. tobramycin (Tobrex) – also available in ophtha
form
(2) GI TOXICITY
 N/V, stomach upset, diarrhea Nursing Responsibility:
 Ex. Meropenem – used to Tx intraabdominal monitor for ototoxicity, renal toxicity, GI
infections & some cases of meningitis disturbances, BMD, superinfections

B. CEPHALOSPORINS
 first introduced in the 1960s
 similar to penicillin in structure and action
 4 GENERATIONS
(a) FIRST Generation
 effective against gram+ that are affected by
pen G, as well as the gram- bacteria :
Proteus mirabilis, E coli., & Klebsiella
pneumonia - PEcK
1. cefadroxil (Duricef) – UTI, pharyngitis,
tonsil’s
2. cefazolin (Ancef) – RTI, GUI, bone/joint
infxn
3. cephalexin (Keflex) – RTI, SSTI, GUI, OM
(b) SECOND Generation
 effective against PecK & Hemophilus
influenzae, Enterobacter aerogenes,
Neisseria species – HENPEcK
 less effective against gram+
1. cefaclor (Ceclor) – RTI, SSTI, UTI, OM,
TY
2. cefprozil (Cefzil) – s/a, pharyngitis,
tonsillitis
3. cefuroxime (Zinacef) – s/a
4. loracarbef (Lorabid) – s/a
(c) THIRD Generation
 relatively weak against gram+ but are more
potent against the gram- bacilli as well, as
Serratia marcescens – HENPEcKS
1. cefdinir (Omnicef) – s/a
2. ceftazidime (Tazicef)
3. cefixime (Suprax)
4. ceftriaxone (Rocephin) – s/a; PID,
intraabdominal infections, peritonitis,
septicemia, bone infections, etc
5. ceftazidime (Fortum) – with
antipseudomonal activity
(d) FOURTH Generation
 extended-spectrum agents with similar
activity
against Gram-positive organisms as first-
generation cephalosporins
 Many can cross the blood-brain barrier and
are
effective in meningitis. They are also used
against Pseudomonas aeruginosa.
1. cefepime (Maxipime)
2. cefpirome (Cefrom)
3. cefclidine
4. cefoselis
(e) FIFTH Generation
 Ceftobiprole has been described as "fifth
generation",though acceptance for this
terminology is not universal.
 has powerful antipseudomonal
characteristics
and appears to be less susceptible to
development of resistance.
Nursing Responsibility:
monitor for GI upsets & diarrhea,
pseudomembranous colitis, headache,
dizziness & superinfections
C. FLUOROQUINOLONES
 relatively new class of antibiotics with a broad
spectrum of activity
 all made synthetically but with relatively mild
adverse reactions
1. ciprofloxacin (Cipro)
- most widely used; effective against
gram-
- approved in 2001 for Px of anthrax
- also effective against TY
2. levofloxacin (Levaquin)
- use for RTI, UTI, SSTI, sinus infxn, etc
- may be preferred for severe infections &
when patients can not take oral drugs
3. ofloxacin (Floxin) – also in ophthalmic form
4. sparfloxacin (Zagam) – CAP, A. bronchitis
5. moxifloxacin (Avelox) – sinusitis, bronchitis,
pneumonia in adults
Nursing Responsibility:
monitor for headache, dizziness, GI
upsets & BMD
caution about the risk of
photosensitivity reactions
D. MACROLIDES
 interfere with protein synthesis
1. erythromycin (E-mycin)
- 1st to be developed
- DOC for Legionnaire’s disease,
infections caused by Corynebacterium
diptheriae, urea-plasma, SY,
mycoplasmal infection, chlamydial
infections
2. clarithromycin (Biaxin)
- RTI, SSTI, sinus & maxillary infxn
- also effective against mycobacteria
3. azithromycin (Zithromax)
- mild to moderate RTI & urethritis in
adults
- OM, tonsillitis & pharyngitis in children
Nursing Responsibility:
monitor for N/V, diarrhea,
dizziness, & other CNS effects
E. LINCOSAMIDES
similar to the macrolides but are more toxic
1. clindamycin (Cleocin)
- treatment of severe infections when
penicillin or other less toxic antibiotics
cannot be used
 needed
2. lincomycin (Lincocin) 3. oxacillin – DOC if switch to oral form is
- s/a needed
- stop the drug at first sign of bloody
diarrhea I. SULFONAMIDES
 sulfa drugs inhibit folic acid synthesis
Nursing Responsibility:  folic acid is necessary for the synthesis of purine &
monitor for pseudomonas colitis, BMD, pyrimidines, which are precursors of DNA & RNA
pain, CNS effects  not used much anymore, however, they remain
inexpensive & effective for UTI.

1. cotrimoxazole (Septra, Bactrim)

- a combination drug that contains
F. MONOBACTAM ANTIBIOTICS sulfamethoxazole & trimethoprim
1. aztreonam - effective in OM, UTI, bronchitis,
- the only monobactam antibiotic currently pneumonitis
available
- effective against gram – enterobacteria 2. sulfadiazine
- no effect on gram+ or anaerobic - with broad use in infections
- disrupts cell wall synthesis which
promotes leakage of cellular contents 3. sulfisoxazole (Gantrisin)
- UTI, SI, intra-abdominal infxnz. - includes various STDs

Nursing Responsibility: Nursing Responsibility:

monitor for GI problems, liver toxicity, monitor for CNS toxicity, N/V, diarrhea,
pain at the injection site liver injury, renal toxicity, BMD

G. PENICILLINS J. TETRACYCLINES
1. penicillins G benzathine developed as semisynthetic antibiotics based
- SY & erysipeloid infections on the structure of a common soil mold
inhibit protein synthesis
2. penicillin G potassium composed of four rings
- severe infections
1. doxycycline (Periostat)
3. penicillin G procain - recommended for traveller’s diarrhea,
- moderately severe infections periodontal disease, acne, some STDs
4. penicillin V 2. minocycline (Minocin)
- prophylaxis for bacterial endocarditis - DOC in treating meningococcal carriers
- Lyme disease, UTI
3. oxytetracycline (Terramycin)
EXTENDED-SPECTRUM PENICILLIN - also used as an adjunctive therapy in
1. amoxicillin acute intestinal amoebiasis.
- broad spectrum of uses for adults &
Children 4. tetracycline (Sumycin)
- oral & topical & opthalmic
2. ampicillin - acne vulgaris & minor skin infections
- switch from parenteral to oral
- monitor for nephritis Nursing responsibilities:
monitor for GI effects, BMD, rash,
3. carbenicillin superinfections
- UTI in adults caution women that these may make
- not used in children oral contraceptives ineffective
Nursing Responsibility: K. ANTI-MYCOBACTERIAL
monitor for N/V, diarrhea,
superinfections, hypersensitivity
reactions
ACID-FAST BACTERIA
have the ability to hold a stain even in the
presence of a “destaining” agent such as acid
H. PENICILLINASE-RESISTANT antibiotics
1. dicloxacillin – must be taken x 10 days RTC
2. nafcillin – DOC if switch to oral form is
 have an outer coat of mycolic acid – protects occurs after treatment of
from disinfectants & allows them to survive leprosy
for long periods in the environment
Mycobacterium leprae – causes leprosy-
Hansen’s disease – disfiguring lesions & ANTIVIRAL AGENTS
destructive effects on the RT
Viral Overview:
 Made of DNA or RNA inside a protein coat
 Metabolic processes & replication are done inside a
host cell – dictates the cell for its survival
 Difficult to treat because they are hidden inside the
1. ANTI-TB drugs cell
 INTERFERONS – released by the host in response to
1st – line drugs
invasion  replication prevented
(a) INH (Nydrazid) – affects the
mycolic acid
A. DRUGS for INFLUENZA A & RESPIRATORY
(b) rifampin (Rifadin, Rimactane) –
VIRUSES
alters DNA & RNA act.
These viruses including RSV invade the RT
(c) ethionamide (Trecator SC) – Px cell
& cause the s/s of “flu”
divis’n
(d) rifapentine (Priftin) – alters DNA &
1. Amantadine (Symmetrel)
RNA
 Originally for Parkinson’s disease
2nd-line drugs
2. Oseltamivir (Tamiflu)
(a) ethambutol (Myambutol) – inhibits
 Uncomplicated influenze
cellular metabolism
(b) pyrazinamide (generic) –
3. Ribavirin (Rebetron; Virazole)
bactericidal and bacteriostatic
 Effective against influenza A, RSV,
herpes virus
3rd-line drugs
 Rebetron for chronic HepaC
(a) capreomycin (Capastat) – MOA
 Teratogenic
unknown
(b) cycloserine (seromycin) – inhibit
4. Rimantadine (Flumadine)
cell wall synthesis
 Px & Tx of influenza A
2. LEPROSTATIC drugs
5. Zanamivir (Relenza)
a) dapsone – mainstay of leprosy
 Uncomplicated influenza
treatment for many years
- inhibits folate synthesis
B. AGENTS FOR HERPES & CMV (clovir)
- also used to treat PCP
Herpes cause cold sores, encephalitis,
shingles, genital infections
b) clofazimine (Lamprene) – binds to
CMV can affect the eye, RT, liver
bacterial DNA sites & causes cell death
- useful in the treatment of
1. Acyclovir (Zovirax)
dapsone-resistant leprosy
 Specific for herpes virus
- initial treatment
2. Cidofovir (Vistide)
c) thalidomide (Thalomid)
 CMV retinitis in AIDS
- hypnotic drug
 Always given with probenecid to
- was approved for use in a
increase renal clearance
condition that occurs after
treatment for leprosy
3. Famciclovir (Foscavir)
- 1950 > serious abnormality –
 Most effective inTx herpes
lack of limb or defective
infections
limbs
- 1998 > approved by FDA for
4. Ganciclovir (Cytovene)
the treatment of erythema
 Long-term Tx of CMV
nodosum leprosum – a
painful inflammatory
5. Valacyclovir (Valtrex)
condition r/t an immune
 H. zoster & recurrent genital herpes
reaction to dead bacteria that
 6. Valgancyclovir (Valcyfe)
 CMV retinitis in AIDS
Fungal Overview:
C. HIV & AIDS Drugs
HIV attacks helper T cells  loss of monitor
that propels the immune recation into full
force  AIDS  opportunistic infections
Difficult to Tx : (a) length of time the virus
can remain dormant within the T cells, (b)
adverse effects of potent drugs  further
immune system depression
Attack virus at various points in its life cycle
1. REVERSE TRANSCRIPTASE INH’R
 Bind to HIV reverse transcriptase 
prevent transfer of info necessary for
growth & reproduction
a) Delavirdine ((rescriptor)
b) Efavirenz (sustiva)
c) Emtricitabine (emtriva)
d) Neviraoine (viramune0
2. PROTEASE INHIBITORS (navir)
 Block protease activity within the virus
– essential for maturation 
noninfective
a) Amprenavir (agenerase)
b) Atazanivir (reyataz)
c) Fosamprenavir (lexiva)
d) Indinavir (crixivam)
e) Lopinavir (kaletra)
f) Nelfinavir (viracept)
g) Ritonavir (norvir)
h) Saquinavir (fortovase)
 Nonteratogenic
3. NUCLEOSIDES
Inhibit cell wall synthesis cell
death
a) Abacavir (ziagen)
> Fatal hypersensitivity rxn – stop
immediately the drug
b) Didanosine (videx)
c) Lamivudine (epivir)
d) Stavudine (zerit)
e) Tenafovir (viread)
f) Zalcitabine (hivid)
g) Zidovudine (retrovir)
 One of the first drugs
 For symptomatic dz
 Px maternal transmission
4. FUSION INHIBITORS
Prevents fusion of the virus with
the human cellular membrane
a) Enfuvirtide (Fuzeon)
ANTIFUNGAL AGENTS
 The infection is called MYCOSIS
 Has a rigid cell wall – chitin & ergosterol  resistant
to antibiotic
A. SYSTEMIC ANTIFUNGALS
Can be toxic to the host – culture is needed
1. Amphotericin B (amphotec, fungizone)
- IV form; potent but with many unpleasant
effects like renal failure
- Reserved for fatal infections
- Aspergillosis,leishmaniasis, cryptococcosis,
blastomycosis, moniliasis,
coccidioidomycosis, histoplasmosis,
mucormycosis
2. Caspofungin (Cancidas)
- Invasive aspergillosis
- Hepatotoxic
3. Flucytosine (Ancobon)
- Ncandidial & cryptococcal infection
4. Nystatin (Mycostatin)
- Intestinal candidiasis
The AZOLES
Less toxic than ampothericin B but less
effective
5. Ketoconazole (Nizoral)
- Orally treat mycoses as ampothericin B
- Block the activity of a steroid in the fungal
wall & has the side effect of blocking the
activity of human steroids – testosterone &
cortisol – not for patient with endocrine &
infertility probs.
6. Fluconazole ((Diflucan)
- Candidiasis, cryptococcal meningitis
7. Itraconazole (Sporanox)
- Assorted systemic mycoses
8. Voriconazole (Vfend)
- Newest antifungal
- Invasive aspergillosis
9. Terbinafine (Lamisil)
- A similar drug that blocks the formation of
ergosterol
- For onychomycoses of the nails
B. TOPICAL ANTIFUNGALS
Fungi that cause infections of the skin & mucous
membranes are called DERMATOPHYTES
Tinea infections – ringworm
 Tinea pedis – athlete’s foot  Gastric acid secretion
Tinea cruris – jock itch
Yeast infections: candidiasis ANTIHISTAMINES
1. Gentian violet  Agents which do not affect the release of
- Toxic when absorbed – don’t used near histamine but act primarily to block the
active lesions action of histamine at it usual receptor site
2. Butenafine ((mentax)  Aka histamine antagonists
- Tinea infections  H2 blockers is discussed under GIT drugs
3. Butoconazole (Gynazole I)
H1 – BLOCKERS EXAMPLES
- Vaginal candidiasis
1. diphenhydramine
4. Ciclopirox (Loprox)
2. chlorpheniramine
- Tinea infections
3. fexofenadine
5. Clotrimazole (lotrimin)
4. loratadine – non sedating
- Oral & vaginal candidiasis
5. cetirizine – non sedating
- Tinea infections
Nasal allergies
6. Econazole (Spectazole)
Colds
- Tinea infections
Rhinitis
- Intense, local burning sensation
Allergic reactions
7. Haloprogin (Halotex)
Motion sickness
- Athlete’s foot, jock itch, ringworm
Parkinson’s disease –
8. Ketoconazole (Nizoral)
- Tinea corporis anticholinergic effect
9. Miconazole (fungoid), Monistat) Vertigo
-athlete’s foot Sleep aid
10. Naftifine (naftin)
- Don’t use for more than 4 weeks DECONGESTANTS
11. Oxiconazole (oxistat)  Agents which constrict dilated blood
-can be used for up to 1 month vessels in the nasal mucosa by stimulating
12. Terbinafine (lamisil) nerve receptors in vascular smooth
- Stop when condition alrdy improved muscles  reduced blood flow to
13. Tolnaftate (tinactin) edematous area; slowed mucus formation;
- Good for athlete’s foot better drainage  relief
14. Undecyclinic acid (pedi-dri)  REBOUND CONGESTION (topical)
- Athlete’s foot, jock itch, diaper rash, burning - Excessive use causes local
& chafting in the groin area ischemia & irritation of mucosa 
extensive vasodilation &
congestion
NASAL CONGESTION
RESPIRATORY DRUGS  Due to excessive nasal secretions &
inflamed & swollen nasal mucosa
ANTIHISTAMINES 3 groups of DRUGS
HISTAMINE 1. ADRENERGICS (sympathomimetics)
 A bodily substance that performs many  Constrict small arterioles  better
functions: drainage
 Nerve impulse transmission in the a) naphazoline HCl (Privine)
CNS b) oxymethazoline (Afrine)
 Dilation of capillaries
 Contraction of smooth muscles 2. ANTICHOLINERGICS (parasympathomimetics)
 Stimulation of gastric secretion a) ipratropium bromide (atrovent)
 Acceleration of HR
 Major inflammatory mediator of many 3. CORTICOSTEROIDS
allergic disorders eg. Allergic Rhinitis  Anti-inflammatory effect
 TWO types of cellular histamine receptors: a) dexamethasone NaPO4
b) beclomethasone dipriopionate
a) H1 receptors
 Mediate smooth muscle
contraction
 Dilation of capillaries ANTITUSSIVES
 Cough suppressant
b) H2 receptors
 Acceleration of HR
  Advised only when it serves a useful
purpose and causes respiratory discomfort
and/or sleep disturbance
CATEGORIES
A. NARCOTIC
Suppress cough reflex by a direct
effect on the cough center in the
medulla oblongata
Drawback is dependence,
respiratory depression, bronchial
constriction, CNS depression,
constipation
Ex. CODEINE
HYDROCODONE
B. NON-NARCOTIC
Less effective
No analgesic properties
Dextromethorphan
Benzonatate
EXPECTORANTS
o Aid in the expectoration of excessive
mucus by breaking down & thinning out
the secretions
o Clinical effectiveness is somewhat
questionable – absence of data to
substantiate reduction of sputum viscosity
as compared to placebo
Examples:
1. Guiafenesin – most popular
2. Ammonium Cl – serious adverse effects
3. Iodides – hypersensitivity issues
BRONCHODILATORS
 Pharmacotherapy for all COPDs
 Relax bronchial smooth muscle bands to
dilate the bronchi & bronchioles that are
narrowed as a result of the disease
process
THREE CLASSES
1) Beta – agonist
Commonly used during acute phase of
asthmatic attack to quickly reduce
constriction & restore airflow to normal
Imitate the effects of NE
a. albuterol (ventolin)
b. epinephrine
c. terbutaline
2) Anticholinergic
 Blocks Ach receptors to prevent
bronchoconstriction – indirectly
causing airway constriction
 Actions are slow & prolonged – used
for prevention of bronchospasm
associated with chronic bronchitis or
emphysema
 a) ipratropium (Atrovent) – similar
to atropine
b) tiotropium (Spiriva)
3) Xanthine derivative
 cause bronchodilation by increasing
the levels of the energy-producing
substance cAMP
 a) aminophylline
b) theophylline
NONBRONCHODILATORS –
ANTILEUKOTRIENE
 LTs cause inflammation,
bronchoconstriction, & mucus production
in people with asthma  cough, sneeze,
SOB
 Prevent LTs from attaching to receptors
located on circulating immune cells within
the lungs
 a) montelukast (singulair)
b) zaforlukast (accolate)
c) zileuton (Zyflo)
CARDIOVASCULAR DRUGS
I. CARDIOTONIC DRUGS
A. USES
 For CHF & cardiac arrhythmia
(atrial fibrillation or flutter)
B. ACTION
 inhibit the membrane bound Na+-
K+-ATPase pump responsible for
Na+-K+ exchange  more Ca
intracellularly  improved
myocardial contraction 
increased blood flow to organs
including kidney (better diuresis)
 They have an antiarrhythmic
effect by prolonging the refractory
period of the AV node , reducing
the number of impulses reaching
the ventricles. Cardiac output is
restored but atrial fibrillation or
atrial flutter are not abolished.
C. EXAMPLES
1. Digoxin (lanoxin) – Onset 15-30
M; Peak 1.5-5 h ; HL – 36 h
2. Digitoxin – Onset 25 – 120 M; Peak
4-12 h; HL – 4-6 D
3. Acetyldigoxin
 4. Lanatoside C
5. G-strophanthin
D. ADMINISTRATION
Digitalizing dose – IV or PO –
quickly raise the serum drug level
to therapeutic level
Maintenance dose is 0.125 to 0.5
mg PO daily
E. GUIDELINES FOR ADMINISTRATION
a) Slows but strengthens heart
b) Loading dose higher than
maintenance dose
c) ECG done before digitalizing
d) Withhold if apical pulse is <60 ,>
90 or 100; <90-110 for child.
e) IV digoxin is given in ICU – not
much in other units; may be given
by a doctor
f) Assess for digitalis toxicity
F. DIGITALIS TOXICITY (above 2.0 ng/mL)
1. Causes:
a) Overdose
b) Drug interaction – quinidine,
verapamil, amiodarone
c) Diuretics – cause K loss 
increased risk
d) Hypomagnesemia - needed
II.
for the adequate function of
the Na+/K+-ATPase pumps in
the cells of the heart; inhibits
release of potassium, a lack of
magnesium increases loss of
potassium. Intracellular levels
of potassium decrease and
the cells depolarise. Digoxin
increases this effect. Both
digoxin and hypoMg inhibit
the Na-K-pump resulting in
decreased intracellular
potassium
e) Decreased kidney function
2. Symptoms:
a) Visual changes
 Halos or rings around
objects
 Seeing lights or bright
spots
 Changes in color
perception
 Blind spots in vision
 Blurred vision
b) Confusion
c) LOA
d) N/V, diarrhea
e) Palpitations
f) Irregular pulse
g) Decreased urine output 
overall swelling 
orthopnea
3. Tests
a) Blood chem. – K & Mg
level
b) BUN, creatinine – kidney
function
4. Treatment – depends on the
cause
Activated charcoal
Lavage
DIGIBIND – antidote for life
threatening intoxication
G. NOTE: don’t adjust dose to obese
because fats don’t absorb the
drug.......base dose on ideal body
weight
ANTIANGINAL DRUGS
A. How do antianginal drugs affect
myocardial oxygen supply and
demand, and how do these actions
reduce chest pain?
 Angina results from a reduction
in the oxygen supply/demand
ratio. Therefore, in order to
alleviate the pain, it is
necessary to improve this ratio.
This can be done either by
increasing blood flow (which
increases oxygen delivery or
supply), or by decreasing
oxygen demand (i.e., by
decreasing myocardial oxygen
consumption).
 Pharmacologic interventions
that block coronary vasospasm
(coronary vasodilators) or
inhibit clot formation are used
to treat variant and unstable
angina, respectively. These
drugs act by increasing
coronary blood flow and oxygen
supply, or by preventing
vasospasm and clot formation,
and associated decreases in
blood flow. Drugs that reduce
myocardial oxygen demand are
also given to patients with
 these two forms of angina to  PREPARATIONS : topical,
reduce oxygen demand and transdermal, sublingual,
thereby help to alleviate the capsule, aerosol, tablet
pain. SR,
ointment, IV
 Drugs that reduce myocardial  Sublingual nitro may be
oxygen demand are commonly given every 5 mins for a
used to prevent and treat total of THREE DOSES
episodes of ischemic pain only – if no relief – call
associated with fixed stenotic MD – might be MI
lesions (i.e., chronic stable already
angina). Some of these drugs  Store in a dark, glass
reduce oxygen demand by container – cool place ;
decreasing heart rate shelf life is 3-6 mos.
(decreased chronotropy) and  OINTMENT PREP
contractility (decreased guidelines:
inotropy), while other drugs a) Apply to hairless
reduce afterload and or preload area
on the heart. Afterload and b) New site per new
preload reducing drugs act by dose
dilating peripheral arteries and c) Use the provided
veins. Direct vasodilation of the ruled applicator –
coronary arteries is ineffective accurate dosing
as a therapeutic approach and d) Leave applicator
may actually worsen the paper on the site
ischemia by producing coronary e) Cover applicator
vascular steal. paper with plastic
B. ANTIANGINAL DRUGS are classified wrap, secure it with
as coronary vasodilators – used to tape
reduce pain of angina. ALL
VASODILATORS DILATE CEREBRAL isosorbide dinitrate (ISORDIL)
& PERIPHERAL ARTERIES AS WELL  have a longer onset of
AS CORONARY ARTERIES  action and duration of
HEADACHE & HYPOTENSION action than
nitroglycerin
C. EXAMPLES  more useful than short-
1. NITRODILATORS acting nitroglycerin for
nitroglycerin the long-term
 commonly used - very prophylaxis and
fast acting (2 to 5 management of
minutes) sublingually. coronary artery disease
 Its effects usually wear
off within 30 minutes - sodium nitroprusside
useful for preventing or  used to treat severe
terminating an acute hypertensive
anginal attack. emergencies and
 Longer-acting severe heart failure,
preparations of has a rapid onset of
nitroglycerin (e.g., action. It is only
transdermal patches) available as an
have a longer onset of intravenous
action (30 to 60 preparation, and
minutes), but are because of its short
effective for 12 to 24 half-life, continuous
hours. infusion is required.
 Intravenous nitroglycerin
is used in the hospital erythrityl tetranitrate
setting for unstable pentaerythritol tetranitrate
angina and acute heart
failure.
2. CALCIUM CHANNEL BLOCKERS
  The anti-anginal effects of
CCBs are derived from their
vasodilator and
cardiodepressant actions.
Systemic vasodilation
reduces arterial pressure,
which reduces ventricular
afterload (wall stress)
thereby decreasing oxygen
demand. The more
cardioselective CCBs
(verapamil and diltiazem)
decrease heart rate and
contractility, which leads to a
reduction in myocardial
oxygen demand, which
makes them excellent
antianginal drugs. CCBs can
also dilate coronary arteries
and prevent or reverse
coronary vasospasm (as
occurs in Printzmetal's
variant angina), thereby
increasing oxygen supply to
the myocardium.
 CARDIAC EFFECTS
a) Decreased contractility
– negative inotropy
b) Decreased Hr –
negative chronotropy
c) Decreased conduction
velocity – negative
dromotropy
 VASCULAR EFFECTS
a) Smooth muscle
relaxation –
vasodilation
DIFFERENT CLASSES OF CCB
A. Dihydropyridines
 Because of their high vascular
selectivity, these drugs are primarily
used to reduce systemic vascular
resistance and arterial pressure, and
therefore are primarily used to treat
hypertension. They are not, however,
generally used to treat angina
because their powerful systemic
vasodilator and pressure lowering
effects can lead to reflex cardiac
stimulation (tachycardia and
increased inotropy), which can
dramatically increase myocardial
oxygen demand. Note that
dihydropyridines are easy to
recognize because the drug name
ends in "pine."
 Given PO only:
1. amlodipine - Norvasc
2. felodipine - Plendil
3. isradipine - DynaCirc
4. nicardipine - Cardene
5. nifedipine - Procardia
6. nimodipine - Nimotop
7. nitrendipine
B. Nondihydropyridines
Given IV and PO
8. Verapamil – Calan, Isoptin
 selective for the
myocardium, and is
less effective as a
systemic vasodilator
drug
 reducing myocardial
oxygen demand and
reversing coronary
vasospasm
9. Diltiazem – Cardizem
 intermediate between
verapamil and
dihydropyridines in its
selectivity for vascular
calcium channels.
 both cardiac depressant
and vasodilator actions,
- able to reduce arterial
pressure without
producing the same
degree of reflex cardiac
stimulation caused by
dihydropyridines.
III. PERIPHERAL VASODILATORS
A. Definition
 is a drug or chemical that
relaxes the smooth muscle in
blood vessels, which causes
them to dilate. Dilation of
arterial blood vessels (mainly
arterioles) leads to a
decrease in blood pressure.
B. Therapeutic Uses
 Hypertension
 Angina
 CHF
 Raynaud’s disease – primary
or idiopathic vasopastic
disorder char by cyanosis of
fingers, or feet, or nose,
cheek, chin
 Buerger’s disease - TAO
C. Examples
Cyclandelate - cyclospasmol
Isoxsuprine HCl - vasodilan
Papaverine HCl – pavabid,
 vasospam
NOTE: some spasm & vaso in
some trade names
IV. ANTIHYPERTENSIVES
Definition: medicines that lower BP
A. DIURETICS
Increase the excretion of Na &
water  decreased blood
volume
Edema , CHF
can disturb electrolytes & acid-
base balance – monitor serum
electrolytes
can cause orthostatic
hypotension – change position
slowly
monitor output, weight
TYPES of diuretics
1. POTASSIUM-SPARING DIURETICS
 Used for patients at high risk of
hypokalemia associated with
diuretics use (digitalis-taking
patients, arrhythmic patients)
 Not as powerful as loop diuretic
but they retain K instead of
wasting it
a) Amiloride (Midamor)
b) Spironolactone (aldactone) –
can be used by children
c) Triamterene (dyrenium)
2. OSMOTIC DIURETICS (not for HPN)
 Pull water into the renal tubule
(PCT & DLoH) without Na loss
 Diuretics of choice in cases of
increased ICP or IOP or ARF d/t
shock, drug overdose or trauma
 Ex. Mannitol (Osmitrol)
3. LOOP DIURETICS
 that act on the ascending loop of
Henle in the kidney
 also cause vasodilation of the
veins and of the kidney's blood
vessels, mechanically causing a
decrease in blood pressure.
a) Bumetanide
b) Ethacrynic acid
c) FUROSEMIDE
d) Torsemide
4. THIAZIDE/LIKE DIURETICS
 help reduce the amount of water
in the body by increasing the flow
of urine.
 may cause your skin to be more
sensitive to sunlight than it is
normally. Exposure to sunlight,
even for brief periods of time, may
cause a skin rash, itching, redness
or other discoloration of the skin,
or a severe sunburn.
 Chlorothiazide, hydrochlothiazide,
chlorthalidone, metolazone
5. CARBONIC ANHYDRASE INHIBITORS
(ZOLAMIDE)
What is carbonic anhydrase? -
enzymes that catalyze the rapid
conversion of carbon dioxide to
bicarbonate and protons.
The reaction catalyzed by carbonic
anhydrase is:
CO2 + H2O  CAh HCO3- + H+
(in tissues - high CO2 conc.
Acetazolamide - It can act as a
mild diuretic by reducing NaCl and
bicarbonate reabsorption in the
proximal tubule. However, the
distal segment partially
compensates for the sodium loss,
and the bicarbonaturia will
produce a metabolic acidosis,
further reducing the effect.
Methazolamide-. It is longer-acting
than acetazolamide and has less
effect on the kidney
Dorzolamide - ocular hypertension
and who are insufficiently
responsive to beta-blockers
B. SYMPATHETIC NS DRUGS
 The part of ANS originating in
the thoracic and lumbar regions
of the spinal cord that in
general inhibits or opposes the
physiological effects of the PNS,
as in tending to reduce
digestive secretions, speeding
up the heart, and contracting
blood vessels.
1. BETA-BLOCKERS (olol)
 block the action of endogenous
catecholamines (epinephrine
(adrenaline) and NE
(noradrenaline)) in particular),
on β-adrenergic receptors, part
of the SNS which mediates the
"fight or flight" response.
 Aka SYMPATHOLYTIC drugs
 Block beta-receptors in the
heart and kidney (JGA)
 Decreased HR, contractility,
excitability  decreased
arrythmias, workload, oxygen
demand
 a) Carteolol (cartrol)
b) Nadolol (corgard)
c) Penbutolol (levator)
d) Pindolol (visken)
e) PROPRANOLOL (INDERAL)
f) Sotalol (betapace)
g) TIMOLOL (timoptic)
h) Acebutolol (sectral)
i) ATENOLOL (tenormin)
j) Betaxolol (kerlone)
k) Bisoprolol (zebeta)
l) ESMOLOL (brevibloc)
m) METOPOLOL (lopressor)
2. ALPHA-BETA ADRENERGIC BLOCKERS
 Block all adrenergic receptor 
NE is blocked  no sympathetic
stress reaction lower BP, PR,
increased renal perfusion with
decreased renin levels
a) Carvedilol (coreg)
b) Guanadrel (hylorel)
c) Guanethidine (ismelin)
d) Labetalol (trandate)
3. ALPHA-adrenergic blockers
Some blockers have a specific
affinity for alpha-receptor sites
 limited use only
PHENTOLAMINE (regitine) – only
the one in use today
 Useful in diagnosing
pheochromocytoma
4. ALPHA1 – selective adrenergic blocker
(ZOSIN)
 Have a specific affinity for
alpha1 receptors
 Block the post-synaptic alpha1
receptor sites  decreased in
vascular tone & vasodilation 
fall in BP
a) Alfuzosin (uroxatral)
b) Doxazosin (cardura)
c) PRAZOSIN (minipress)
d) Tamsulosin (flomax)
e) TERAZOSIN (hytrin)
5. ALPHA2-AGONISTS
Stimulates alpha2-
adrenoceptors in the brain
stem, thus activating an
inhibitory neuron, resulting in
reduced sympathetic outflow
from the CNS, producing a
decrease in peripheral
resistance, renal vascular
resistance, HR, and BP
a) Clonidine (catapress)
b) Guanfacine
c) Methyldopa
C. ACE INHIBITORS (acePRIL)
 Blocks the conversion of AI to AII in
the lungs
 The RAAS plays an important
role in regulating blood volume
and systemic vascular
resistance, which together
influence cardiac output and
arterial pressure.
 Renin is a proteolytic enzyme
that is released into the
circulation primarily by the
kidneys. Its release is stimulated
by
1) sympathetic nerve activation
2) renal artery hypotension
(caused by systemic
hypotension or renal artery
stenosis)
3) decreased sodium delivery to
the distal tubules of the
kidney.
 Most common adverse effects :
r/t vasodilation & altered blood
flow – reflex tachycardia,
angina, CHF, arrhythmias
 Take them with empty stomach
a) Benazepril (lotensin)
b) CAPTOPRIL (CAPOTEN)
c) ENALAPRIL (VASOTEC)
d) Fosinopril (monopril)
e) Lisinopril (prinivil, zestril)
f) MOEXIPRIL (UNIVASC)
g) Perindopril (aceon)
 h) QUINAPRIL (ACCUPRIL)
i) RAMIPRIL (ALTACE)
j) Trandolapril (mavik)
D. ANGIOTENSIN RECEPTOR
BLOCKERS (arbSARTAN)
Bind the AII receptors in blood
vessels to prevent
vasoconstriction & in the
adrenal cortex to prevent the
release of aldosterone that is
caused by reaction of these
receptors with AII
a) Candesartan (atacand)
b) Eprosartan (teveten)
c) Irbesartan (avapro)
d) LOSARTAN (COZAAR)
e) Telmisartan (micardis)
f) Valasartan (diovan)
Adverse effects: headache,
dizziness, syncope, weakness 
drop in BP
Preclinical trials – associated
with development of cancers
E. CALCIUM-CHANNEL BLOCKERS
(PINE)
 Flodipine, nefidipine,
amlodipine, nicardipine
(diltiazem, verapamil)
F. VASODILATORS
 If other drugs don’t seem to
cause effect, direct vasodilator
may be necessary
 Produce a relaxation of the
vascular smooth muscle
decreased peripheral resistance
 reduced BP
 Reserve for use in severe
hypertension
a) Diazoxide (HYPERSTAT) –
increase blood glucose by
blocking insulin release –
caution with functional
hypoglycemia
b) HYDRALAZINE
(APRESOLINE)
c) MINOXIDIL (LONITEN)
d) NITROPRUSSIDE
(NITROPRESS)
G. Other antiHPN
 Mecamylamine (Inversine) – a
ganglionic blocker that occupies
cholinergic receptor sites of
autonomic neurons, blocking
effects of acetylcholine
ADVERSE EFFECTS/NURSING CARE
1. Orthostatic hypotension & dizziness
a. BP should be taken both supine
& upright
b. Change positions slowly
c. Avoid very hot baths
d. Avoid alcohol
2. Rebound hpn when discontinued
abruptly
3. Report adverse reactions
4. Avoid OTC drugs esp cold
medications
V. ANTIHYPOTENSIVE AGENTS
FIRST CHOICE IS
SYMPATHOMIMETIC DRUGS – react
with sympathetic adrenergic
receptors to cause the effects of a
sympathetic stress response :
increased BP, BV,cardiac muscle
contraction  increased BP
MIDODRINE (proamatine) –
orthostatic hypotension
Dobutamine, dopamine,
ephedrine, epinephrine,
isoproterenol, metaraminol
VI. ANTIARRHYTHMIAS
Causes of arrhythmias:
1. Electrolyte disturbances that alter
the action potential
2. Tissue hypoxiaaltered action
potential activity
3. Structural damage  altered
conduction pathway
4. Acidosis or waste products
accumulation alters action
potential
PHASES of ACTION POTENTIAL
(cardiac muscle)
1. Phase 0
 Occurs when the cell reaches a
point of stimulation
 Na gates open Na gets into
the cell  positive flow of
electrons  electrical potential
-DEPOLARIZATION
2. Phase 1
 Short period only
 Na ion equalizes inside &
outside
3. Phase 2
Plateau stage
Cell membrane becomes less
permeable to Na  Ca slowly
 enters the cell as K begins to
leave
Cell membrane is trying to
return to its resting state -
REPOLARIZATION
4. Phase 3
 Time of rapid repolarization
 Na gates are closed; K flows out
of the cell
5. Phase 4
 Cell comes to rest
 K-pump returns membrane to
its resting membrane potential
– spontaneous depolarization
begins again
ANTIARRYTHMIC DRUGS
Affect the action potential of
cardiac cells, altering their
automaticity, conductivity, or both
– can also produce new
arrhythmias (proarrythmic)
TYPES
1. CLASS 1
 block the Na channels
during action potentials
 Local anesthetics or
membrane-stabilizing agents
 Stabilize the membrane by
binding to Na channels
 Preferable in tachycardia
a) Class Ia – depress phase 0 &
prolong the duration of action
potential
1. Disopyramide (NORPACE)
2. Moricizine (ethmocine)
3. PROCAINAMIDE
(pronestyl)
4. QUINIDINE (QUINAGLUTE)
b) Class Ib – depress phase 0
somewhat & actually shorten the
duration of AP
1. LIDOCAINE (XYLOCAINE) –
most frequently used
2. Mexiletine (mexitil)
c) Class Ic – markedly depress phase
0, with a resultand slowing of
conduction
- Have little effect on the
duration of AP
1. Flecainide (tambocor)
2. Propafenone (rythmol)
2. CLASS 2
 Are beta-adrenergic blockers
that block beta receptors
causing a depression of phase 4
of the AP  slow the recovery
of the cells slowed conduction
& decreased automaticity
a) Acebutolol (spectral)
b) Esmolol (BREVIBLOC)
c) Propranolol (INDERAL)
3. CLASS 3
 Block K channels, prolonging
phase III of the AP, which
prolongs repolarization & slows
the rate of conduction of the
heart
 All of these are proarrythmic
a) Amiodarone (cordarone)
b) Bretylium (genric)
c) Dofetilide (tikosyn)
d) Ibutilide (corvert)
e) Sotalol (betapace)
4. CLASS 4
Block Ca channel in the cell
membrane  depression of
depolarization & prolongation of
phase 1 & 2 of repolarization 
slows automaticity & conduction
CCB – diltiazem (cardizem);
verapamil (calan)
5. Other antiarrythmic drugs
a) Adenosine (ADENOCARD)
 Used to convert
supraventricular tachycardia
(DOC) to sinus rhythm if vagal
maneuvers have been
ineffective
 Slows conduction through AV
node
 Decreases automaticity in AV
node
b) Digoxin
Also used at times
Slows calcium from leaving
the cell, prolonging action
potential, & slowing
conduction
DRUG OF CHOICE FOR SPECIFIC TYPES OF
ARRYTHMIAS (underlined ones)
1. Atrial flutter/fibrillation
 Quinidine – long term
 Ibutilide – recent onset;
dofetilide – maintenance
2. Paroxysmal atrial tachycardia (PAT)
 Digoxin
3. Supraventricular tachycardia (SVT)
 Flecainide, propafenone
 Esmolol, propanolol
 Diltiazem, verapamil
  adenosine 5. Offer sugar-free chewing gum or hard candy
4. PVC > lidocaine, acebutolol to promote salivation
6. Instruct client to change positions slowly
5. VTac or VFib > lidocaine, bretylium
6. Life-threatening ventricular
arrhythmias
EMETICS
 Disopyramide, moricizine,
procainamide A. Description
 Mexilitine  Stimulate the vomiting center &
 Flecainide, propafenone induce vomiting
 Amiodarone, sotalol  Used to treat acute poisoning

B. Examples
1. Apomorphine
Controlled substance
GIT DRUGS Given subq
Emesis occurs 5-15 mins after
ANTIEMETICS subq. adm’n
DO NOT GIVE to patients who
A. Description are allergic to morphine or other
1. Diminish the sensitivity of the chemoreceptor opiates
trigger zone (CTZ) to irritants. AE: depression, euphoria,
2. Alleviate nausea and vomiting respiratory depression,
3. Prevent and control emesis and motion ortho. hypotension
sickness
4. Available in oral, parenteral (IM, IV), rectal, 2. Ipecac syrup
and transdermal preparations  30 cc or less cause no systemic,
adverse effects
B. Examples  Emesis occurs after 20-30 mins
 200-300 mL of water may
1. Centrally-acting agents: ondansetron HCl facilitate the emetic action
(Zofran); prochlorperazine (Compazine);  DO NOT GIVE to patients who:
trimethobenzamide HCl (Tigan) a) Have altered LOC
2. Agents for motion sickness control: b) Have seizures
dimenhydrinate (Dramamine); mechlizine HCl c) Ingested corrosives
(Antivert, Bonine); promethazine HCl d) Ingested petroleum
(Phenergan) distillates
3. Agents that promote gastric emptying:
ANOREXIANTS
cisapride (ProPULSID); metoclopramide
(Reglan)
A. Description
C. Major side effects: drowsiness (CNS
depression); hypotension (vasodilation via 1. suppress the desire for food at the
central mechanism); dry mouth (decreased hypothalamic appetite centers; generally
salivation from anticholinergic effect); in produce CNS stimulation
coordination (an extrapyramidal symptom due 2. Available in oral preparations
to dopamine antagonism)
B. Examples:
D. Nursing Care 1. amphetamine sulphate (Bezedrinea)
2. dextroamphetamine sulphate (Dexedrine)
1. Observe occurrence and characteristics of
vomitus C. Major side effects: nausea, vomiting (irritation
2. Eliminate noxious substances from the diet of gastric mucosa); constipation (delayed
and environment passage of stool in GI tract); tachycardia
3. Provide oral hygiene (sympathetic stimulation); CNS stimulation
4. Caution client to avoid engaging in hazardous activation
activities
D. Nursing care
1. Educate client regarding:
a. Drug misuse(controlled substances)
b. Concurrent exercise and diet therapy
c. Need for medical supervision during therapy
d. Possibility of affecting ability to engage in
hazardous activities
2. Caution client on a sodium-restricted diet that
many antacid contains sodium
3. Shake oral suspensions well before
administration
4. Administer with small amount of water to
ensure passage to stomach
5. Can interfere with sucralfate

2. Monitor weight

ANTACID ANTICHOLINERGICS
A. Description A. Description

1. Provide a protective coating on the stomach
lining and lower the gastric acid level; allows
more rapid movement of stomach contents
into the duodenum
2. Inactivate pepsin & enhance mucosal
protection but do not coat the ulcer crater
3. Neutralize gastric acid; effective in the
treatment of ulcers
4. Available in oral preparations
B. Examples:
1. aluminum hydroxide gel (Amphojel)
2. Al & MgOH (Maalox)
3. Aluminum phosphate gel (Phosphaljel)
4. sodium bicarbonate - may cause alkalosis; 5.
Calcium carbonate (Tums) – may cause
hypercalcemia & hypophosphatemia
6. MOM
C. Major side effects
1. Constipation (aluminum compounds)
(aluminum delays passage of stool in GI tract)
2. Diarrhea (magnesium antacid) magnesium
stimulates peristalsis in GI tract
3. Alkalosis (systemic antacids) (absorption of
alkaline compound into the circulation)
4. Reduce absorption of calcium and iron
(increase in gastric pH)
D. Nursing care
1. Inhibit smooth muscle construction in the GI
tract
2. Alleviate pain associated with peptic ulcer
3. Available in oral and parenteral (IM, SC, IV)
preparations
B. Examples:
1. atropine sulphate
2. dicyciomine HCI (Bentryl)
3. glycopyrrolate (Robinul)
4. propantheline bromide (Pro-Banthine)
5. methaneline bromide (Banthine)
6. Belladona
C. Major side effects (all related to decreased
parasympathetic stimulation)
1. Abdominal distention and constipation
(decrease peristalsis)
2. Dry Mouth (decreased salivation )
3. Urinary retention (decreased parasympathetic
stimulation)
4. CNS disturbances (direct CNS toxic effect) –
confusion
5. Blurred vision
D. Nursing care
1. Provide dietary counseling with emphasis on
bland foods
2. Provide oral hygiene

1. Instruct the client regarding

ANTISECRETORY AGENTS
a. Prevention of overuse of antacids which can
result in rebound hyperacidity A. Description
b. Need for continued supervision
c. Dietary restrictions related to gastric distress 1. Inhibit gastric acid
d. Foods high in calcium and iron secretion
 2. Act at the H2 SUCRALFATE (Carafate)
receptors of the stomach parietal cells to limit  Forms a highly-condensed, paste-like
gastric secretion (H2) antagonists) substance after reacting with gastric acid
3. Inhibit hydrogen/ that binds to gastric & duodenal ulcers,
potassium ATPase enzyme system to block forming a protective barrier to pepsin, acid,
acid production (proton pump inhibitors) bile – allowing ulcers to heal
4. Available in oral and  Wait for 2 hrs after other drugs
parental (IM, IV) preparations

ANTIDIARRHEALS

A. Description

1. Promote the formation of formed stools

2. Alleviate diarrhea
B. Examples 3. Available in oral and parental (IM)
preparations
1. H2 antagonists
a) famotidine (Pepcid)
b) ranitidine (Zantac)
c) cimetidine (Tagamet) B. Examples
d) nizatidine (Axid) – for GERD
2. Proton pump inhibitors 1. Fluids adsorbents: decrease the fluid
a) omeprazole (Prevacid) – for content of stool: bismuth carbonate; kaolin
esophagitis, GERD, ulcer and pectin (Kaopectate)
3. misoprostol (Cytotec) – suppresses
gastric acid secretion; promotes 2. Enteric bacteria replacements: enhance
secretion of HCO3 & cytoprotective production of lactic acid from carbohydrates in
mucus; maintains submucosal blood intestinal lumen; acidity suppresses
flow through vasodilation pathogenic bacterial over growth:
Lactobacillus acidophilus (Bacid);
C. Major side effects Lactobacillus bulgaricus (Lactin-ex)
1. CNS disturbances
(decreased metabolism of drug because of 3. Motility suppressants: decrease GI tract
liver or kidney impairment) motility so that more water will be absorbed
2. Blood dyscrasias from the large intestine: diphenoxylate HCI
(decreased RBCs, WBCs , platelet synthesis) (Lomotil); Loperamide HCI (Imodium)
3. Skin rash
(hypersensitivity) C. Major side effects

D. Nursing care 1. Fluid adsorbents: GI disturbance (local

effect); CNS disturbance (direct CNS toxic
1. Do not administer at effect)
the same time as antacids; allow 1 to 2 hour
between drugs 2. Enteric bacteria replacements: excessive
2. Administer oral flatulence (increased microbial gas
preparation with meals production); abdominal cramps (increased
3. Assess for microbial gas production)
potentiation of oral anticoagulant effect
4. Instruct client to 3. Motility suppressants: urinary retention
follow prescription exactly (decreased parasympathetic stimulation);
5. Administration tachycardia (vagolytic effect on cardiac
should not exceed 8 weeks without medical conduction); dry mouth (decreased salivation
supervision from anticholinergic effect); sedation (CNS
depression); paralytic ileus (decreased
 peristalsis); respiratory depression
(depression of medullary respiratory center)
D. Nursing care
1. Monitor bowel movement for color,
characteristics, and frequency
2. Assess for fluid/electrolyte imbalance
3. Assess and eliminate cause of diarrhea
4. Motility suppressants
a. Warn client of interference with ability to
perform hazardous activities and risk of
physical dependence with long-term use
b. Offer sugar free chewing gum and hard
candy to promote salivation
CATHARTICS/LAXATIVES
A. Description
1. Alleviate or prevent constipation and promote
evacuation of stool
2. Available in oral and rectal preparations
B. Examples
1. Intestinal lubricants: decrease dehydration
of feces, lubricate intestinal tract: mineral oil;
olive oil
2. Fecal softeners: lower surface tension of
feces, allowing water and fats to penetrate;
dicotyl calcium sulfosuccinated (Surfak);
dicotyl sodium (Colace)
3. Bulk – forming laxatives: increase bulk in
intestinal lumen, which stimulates propulsive
movements by pressure on mucosal lining:
methylcellulose (Cellothyl); psyllium
hydrophilic mucilloid (Metamucil)
4. Colon irritant: stimulate peristalsis by
reflexive response to irritation of intestinal
lumen bisacodyl (Dulcolax); senna (Senokot)
5. Saline cathartics: increase
osmotic pressure within intestine, drawing
fluid from blood and bowel wall, thus
increasing bulk and stimulating peristalsis:
effervescent sodiumphosphate (Fleet
Phospho-Soda); magnesium citrated solution;
Milk of Magnesia
C. Major side effects
1. Laxative dependence with long term use (loss
of normal defecation mechanism)
2. GI disturbances (local effect)
3. Intestinal lubricants: inhibit absorption of fat
soluble vitamins A, D, E, K; can cause anal
leaking of oil (accumulation of lubricant near
rectal sphincter)
4. saline cathartics: dehydration (fluid volume
depletion resulting from hypertonic state in GI
tract); hypernatremia (increased sodium
absorption into circulation; shift of fluid from
vasculature to intestinal lumen)
D. Nursing care
1. Instruct the client regarding:
overuse of cathartics and intestinal lubricants;
increasing intake of fluids and dietary fiber;
increasing activity level; compliance with
vowel-retraining program.
2. Monitor bowel movements for consistency
and frequency of stool
3. Intestinal lubricants: use peripad to protect
clothing
4. Bulk-forming laxatives: mix thoroughly in 8
oz of fluid and follow with another 8 oz of fluid
to prevent obstruction
5. administer at bedtime to promote defection in
the morning
PANCREATIC ENZYMES
A. Description
1. Replace natural endogenous pancreatic
enzymes (protease, lipase, amylase);
promote the digestion of proteins, fats and
carbohydrates
2. Available in oral preparations
B. Examples: pancreatin (donnazyme);
pancrelipase (Cotazym, Pancrease, Viokase)
C. Major side effect: nausea and diarrhea (GI
irritation)
  Constipation
D. Nursing care  Rash
 Euphoria
1. Administer with meals  dizziness
2. Avoid crushing preparations that are enteric C. Examples
coated
1. HNBB - Buscopan
3. Provide a balanced diet to prevent indigestion

BILE ACID SEQUESTRANTS ANTIHELMINTHICS

A. Description
 Treat pruritus associated with biliary
disease
 Act by absorbing & combining with
intestinal bile salts – secreted in the
feces
 Take with flavored products or juice to
mask bad taste
 Abate GI effects through stool softeners
B. Examples
1. Cholestyramine (Questran, Prevalite)
2. Colestipol (Colestid)
Medicines that rid the body of parasitic
worms
The body has no natural means of getting
rid of parasitic worms – antihelminthics do
the job
Kill, starve, or paralyze
Can be transferred from person to person
through contaminated food, drinking
glasses, clothing or linens – pinworms
May be present in undercooked meat or
fish – tapeworm
TYPES:
A. INTESTINAL WORMS
I. NEMATODES/ROUNDWORMS

C. Side effects 1. PINWORMS

1. Constipation Perianal/vaginal itching
2. Bloating Most common among school-age
3. Flatulence children
2. WHIPWORMS
4. Nausea o Attach to colon wall
5. Decreased vitamin absorption o Cause colic & bloody diarrhea
o Intestinal prolapsed & anemia
due to blood loss
HEPATIC ENCEPHALOPATHY 3. THREADWORMS
 Burrow itself in the wall of SI
A. Lactulose (Duphalac) lay eggs  invade tissues –
lungs, liver, heart  death
 Reduces ammonia level 4. ASCARIS
 Improves protein tolerance in clients  May reach the lungs  cough &
with advanced hepatic cirrhosis fever
 Lowers colonic pH from 7 t0 5:  May grow in the intestine to as
acidification pulls ammonia into the big as earthworm
bowel to be excreted in the feces, thus  Abdominal distention, pain,
lowering the ammonia level obstruction
5. HOOKWORMS
Suck blood from the walls of the
B. Neomycin (Mycifradin) intestines  anemia,
Reduces the number of colonic bacteria malabsorption
that normally convert urea & amino
acids into ammonia II. FLATWORMS

ANTISPASMODICS 1. CESTODES/TAPEWORMS
o Segmented with a head or scolex
o Grow yards long
A. Description o May come out the mouth or nose
 Relax smooth muscle of the GI
B. Side effects 2. FLUKES/SCHISTOSOMES

B. TISSUE-INVADING WORMS
1. TRICHINOSIS
 Caused by ingestion of Trichinella spiralis
present in undercooked meat
 Larvae pass into the blood stream 
skeletal muscle, cardiac muscle, brain 
inflammatory reaction
 Fatal pneumonia, heart failure,
encephalitis
 Prevention is the best treatment
2. FILARIASIS
 Infection of blood & tissues  skin
bites  inflammatory reactions 
swelling of hands, feet, scrotum, arms,
legs, breast
 elephantiasis
3. SCHISTOSOMIASIS
 Infection by a fluke carried by a
snail
 Larvae skinbloodstream &
lymphatics  lungs & liver 
mature & mate  migrate to
intestine & urinary bladder 
urine & feces..........
 s/s : Swimmer’s itch, fever, chills,
h/a, abdominal pain, diarrhea,
spleen & liver enlargement
AVAILABLE DRUGS:
1. PYRANTEL (Antiminth)
 Single oral dose
 Pinworms & roundworms
2. THIABENDAZOLE (Mintezol)
 Roundworm, hookworm,
pinworm
 Not as effective as others & has
more adverse effects
3. ALBENDAZOLE (Albenza)
Effective against active lesions
caused by pork tapeworm &
cystic disease of the liver,
lungs, & peritoneum caused by
dog tapeworm
RF & BMD – adverse effects
4. IVERMECTIN (Stromectol)
 threadworm
5. PRAZIQUANTIL (Biltricide)
 Schistosomiasis & flukes
 3 doses with 4-6 hours interval
ANTIPROTOZOAL AGENTS
 Infections caused by insect bites (malaria,
trypanosomiasis, leishmaniasis)
 Infections caused by ingestion or contact
with the causal organism (amoebiasis,
giardiasis, trichomoniasis)
MALARIA
 Spread via the bite of Anopheles mosquito
 The plasmodium parasites:
1. P. Falciparum
- Most dangerous
- Fever, hypotension,swelling, of
limbs, RBC loss, death
2. P. Vivax
- Milder & seldom results in
death
3. P. Malariae
- Very mild s/s
- Acute disease in travellers to
endemic areas
4. P. Ovale
- Rare; on the verge of
eradication
 Combination of drugs attack the
plasmodium at various stages
a) QUININE – first to be discovered
- Reserved for chloroquine
resistant infections
- May lead to severe diarrhea &
CINCHONISM (n/v, tinnitus,
vertigo)
b) CHLOROQUINE (Aralen)
- Mainstay of antimalarial
therapy
- Hepatotoxic, eye damage,
blindness
c) HYDROXYCHLOROQUINE (Plaquenil)
- Combined with PREMAQUINE
for greater effectiveness
d) PRIMAQUINE
- Prevent relapse of vivax &
malariae infections
e) MEFLOQUINE (Lariam)
- Prevention & treatment
f) PYRIMETHAMINE (Daraprim)
- Combined with other drugs
AMEBIASIS
 Caused by Entamoeba histolytica
 Aka amebic dysentery
 Transmitted while in the cystic stage in
fecal matter  water, ground
 Ideal environment is large intestine –
TROPHOZOITE
  Eat away tissues vascular area  liver, a. Acts to facilitate the transport of glucose
lungs, heart, etc.. across the cell membrane and to promote
glycogenesis.
LEISHMANIASIS b. Available in three forms: human, beef, and
 Passed from sand flies to humans pork; human and purified pork insulins are
 Can cause serious lesions in the skin, less antigenic; administered parenterally;
viscera, mucous membranes brands and forms should not be substituted
without medical supervision.
TRYPANOSOMIASIS c. Available in rapid-acting, intermediate-
 African sleeping sickness – tsetse fly – acting, and long-acting forms; rapid-acting
lethargy, prolonged sleep, death and intermediate-acting forms are available
 Chaga’s disease – cardiomyopathy in mixed preparations (e.g., Humulin 70/30,
TRICHOMONIASIS which contains 70% NPH and 30% regular
 Spread during sexual intercourse by insulin).
asymptomatic men to women vaginitis –
reddened, inflamed, itching, burning, 4. Oral antidiabetics
yellowish-green discharge
a. Require some functioning beta cells.
GIARDIASIS b. Lower serum glucose in variety of ways
 Most common intestinal parasite in the US depending on the drug.
 Contaminated water or food
 Diarrhea, rottenegg-smelling stool, pale-
B. Examples
mucoid stool
1. Insulin: regular (Humulin R, Novolin R);
PNEUMOCYSTIS CARINII PNEUMONIA
isophane suspension (Humulin N, Novolin N);
 PC does not usually cause illness in
insulin zinc suspension (Humulin L, Novolin
humans
N).
 Most common opportunistic infection in
AIDS patient
2. Oral antidiabetics
DRUGS AVAILABLE:
1. ATOVAQUONE (mepron) a. Sulfonylureas: stimulate pancreatic beta
- Active against PCP cells to produce insulin: glipizide (Glucotrol);
2. METRONIDAZOLE (flagyl) chlorpropamide (diabenese); glyburide
- Amebiasis, trichomoniasis, (Micronase).
giardiasis b. Other: acarbose (Precose); delays
3. PENTAMIDINE (Pentam 300) digestion of carbohydrates; metformin
- Inhalation agent for PCP (Glucophage) and troglitazone (Rezulin);
4. TINIDAZOLE (Tindamax) increase sensitivity to insulin and inhibit
- Amebiasis, trichomoniasis, hepatic glucose production.
giardiasis
C. Major side effects

1. Insulin: irritability, tremor (hypoglycemia);

ENDOCRINE DRUGS headache; confusion, convulsion
(hypoglycemia); tachycardia (hypoglycemia);
moist skin (hypoglycemia); hunger
ANTIDIABETIC AGENTS (hypoglycemia).

A. Description 2. Oral antidiabetics: hypoglycemia; skin rash,

allergic reactions, pruritus (hypersensitivity);
1. Used to treat diabetes mellitus jaundice (hepatic alterations);
2. Classified into two types: insulin for parenteral thrombocytopenia (glucophage).
use and oral antidiabetics
3. Insulin D. Nursing care

1. Assess client for signs of hypoglycemia.

 2. Instruct client to: Humulin Lente)

a. Use proper medication administration

procedure.
b. Comply with dietary program, including * Long-acting 6-8 12-16 20-30
snacks. Insulin (Humulin hours hours hours
c. Avoid alcohol, especially when taking Ultralente)
Diabenese and Glucophage.
d. Perform blood glucose solution, hard candy,
orange juice, glucagon)
Premixed 1 hour 2-12 18-14
3. Administer insulin Insulin hours hours
(70%NPH +
a. Administer all forms of insulin 30% regular)
subcutaneously.
b. Use only regular insulin for IV
administration.
c. If premixed insulin is not prescribed and two *1st generation *2nd Generation
forms are to be mixed, draw up regular Sulfonyllureas Sulfonylureas
insulin first.
d. Abdomen is preferred site because it is not Glipizide (Glucotrol,
influenced by exercise. Glucotrol XL)
e. Slight dosage adjustment may be necessary * Short Acting
when switching from one form of insulin to Glyburide (Dia Beta,
another because of different Tolbutamide (Orinase)
Micronase, Glynase)
pharmacokinetics.
Glimeperide (Amaryl)
4. Offer emotional support to client; therapy is
lifelong.

* Intermediate Acting Non Sulfonylureas

Acetohexamide (Dymelor) Meiformin

(Glucophage)
Common Onset Peak Duration Tolazamide (Tolinase)
Types of Acarpos (Precose)
Insulin
Miglitol (Glysey)
*Long Acting
Troglitazone (Kezulin)
* Rapid-acting 10-15 1 hour 3 hours Chlorpropamide
Insulin (Lispro, mins (Diabenase) Rosiglitazone
Humalog) (Aranida)

Rapaglinide (Prandin)

* Short acting 1 hour 2-3 4-6 hours

insulin (Humulin hours THYROID ENHANCERS
Regular)
The thyroid hormones, thyroxine (T4) and
triiodothyronine (T3), are tyrosine-based hormones
produced by the thyroid gland. An important
* Intermediate- 3-4 4-12 16-20 component in the synthesis of thyroid hormones is
acting Insulin hours hours hours iodine. The major form of thyroid hormone in the
(Humulin NPH, blood is thyroxine (T4), which has a longer half life
than T3. The ratio of T4 to T3 released in the blood is
roughly 20 to 1. Thyroxine is converted to the
active T3 (three to four times more potent than T4)
within cells by deiodinases (5'-iodinase). These are
further processed by decarboxylation and
deiodination to produce iodothyronamine (T1a) and
thyronamine (T0a).
2. Assess client for potentiation of anticoagulant
effect.
3. Offer emotional support to client; therapy may
be lifelong.
4. Assess client for signs of hyperthyroidism.

Effects of thyroxine
THYROID INHIBITORS
 Increases cardiac output
 Increases heart rate
A. Description
 Increases ventilation rate
1. Interfere with the synthesis and release of
 Increases basal metabolic rate thyroid hormone; inhibit oxidation of iodides to
prevent their combination with tyrosine in
 Potentiates the effects of catecholamines (i.e formation of thyroxine.
increases sympathetic activity) 2. Treat hyperthyroidism.
3. Available in oral and parenteral (IV)
 Potentiates brain development preparations.

 Thickens endometrium in females B. Examples: iodine (Lugol’s solution);

methimazole (Tapazole); Propylthiouracil (PTU)

C. Major side effects: agranuclocytosis

A. Description (decreased WBCs); skin disturbances
(hypersensitivity); nausea, vomiting (irritation of
1. Regulate the metabolic rate of body cells; aid gastric mucosa); decreased metabolism
in growth and development of bones and (decreased production of serum T3, T4); iodine:
teeth; and affect protein, fat, and (bitter taste, stains teeth because of local oral
carbohydrate metabolism. effect on mucosa and teeth).
2. Replace thyroid hormone in clients
experiencing a reduction in or absence of
thyroid gland functions. D. Nursing care

B. Examples: levothyroxine sodium (Synthroid); 1. Instruct client to:

Iothyronine sodium (Cytomel); Thyroid (Thyrar)
a. Report the occurrence of any side effects to
C. Major side effects: increased metabolism physician, especially sore throat and fever.
(increased serum T3, T4); hyperactivity b. Avoid crowded places and potentially
(increased metabolic rate); cardiac stimulation infectious situations.
(increased cardiac metabolism).
2. Administer liquid iodine preparations diluted in
D. Nursing care beverages of choice; use a straw.
3. Assess client for signs of hypothyroidism.
1. Instruct client to:

a. Report the occurrence of any side effects to ADRENOCORTICOIDS

the physician immediately.
b. Take medication as scheduled at the same A. Description
time daily; d0 not stop abruptly.
c. Take radial pulse; notify physician if greater 1. Interfere with the release of factors important
than beats/minute. in producing the normal inflammatory auditory
d. Carry medical alert card. immune responses.
e. Keep all schedule appointments with 2. Increase glucose and fat formation and
physicians; medical supervisio0n is promote protein breakdown.
necessary. 3. Used for hormonal replacement therapy.
 4. Available in oral, parenteral (IM, IV), and increased muscle tone of the bladder, GI
inhalation, intraarticular, and topical, including tract, uterus, and blood vessels.
ophthalmic, preparations. 2. treatment for diabetes insipidus
3. Available in parenteral (IM, SC) or nasal
B. Examples: dexamethasone (Decadron); preparation
hydrocortisone succinate (Solu-Cortef);
prednisone (Deltasone). B. Examples:
1. Lypressin (Diapid) for intranasal adm.
C. Major side effects 2. vasopressin (Pitressin)

1. Cushing-like symptoms (increased C. Major side effects

glucocorticoid activity)
2. Hypertension (promotion of sodium and water 1. Increased intestinal activity (direct peristaltic
retention) stimulant)
3. Hyperglycemia (increased carbohydrate 2. Hyponatremia (promotion of water
catabolism; gluconeogenesis) reabsorption)
4. Mood changes (CNS effect) 3. Pallor (hemodilution)
5. GI irritation and ulcer formation (local GI 4. Water intoxication (promotion of water
effect) reabsorption)
6. Cataracts (hyperglycemia) 5. Cardiac disturbances (Fluid/electrolyte
7. Hypokalemia (promotion of potassium imbalance)
excretion) 6. Nasal irritation (lypressin has local effect on
nasal mucosa)

D. Nursing care

D. Nursing care 1. Assess client for signs of dehydration during

1. Administer oral preparations with food milk or
antacid.
2. Monitor client’s weight, blood pressure, and
serum electrolytes during therapy.
3. Avoid placing client in potentially infectious
situations.
4. Assess for GI bleeding; monitor blood glucose
in people with diabetes.
5. In addition to carrying a medical alert card,
instruct client to:
a. Avoid exposure to infections; notify
physician if fever or sore throat occurs;
avoid immunizations during therapy.
b. Avoid using salt; encourage foods high in
potassium.
c. Avoid missing changing, or withdrawing
drug suddenly.
6. Withdraw drug therapy gradually to permit
adrenal recovery.
ANTIDIURETIC HORMONE
A. Description
1. Promotes water reabsorption by the distal
renal tubules and causes vasoconstriction
therapy, monitor intake and output.
2. Assess vital signs, especially blood pressure
3. If drug is administered to improve bladder or
bowel for continence or passage.
PSYCHIATRIC MEDICATIONS
SELECTIVE SEROTONIN INHIBITORS
What is SEROTONIN?
 A hormone & neurotransmitter found in many
tissues, including blood platelets, intestinal
mucosa, pineal body, & CNS
 Inhibits gastric secretion, stimulation of smooth
muscles, production of vasoconstriction
 May play a role in sleep & arousal, libido,
appetite, mood, aggression, pain perception,
coordination, and the ability to pursue goal-
directed behaviour
 Catabolized by MAO
A. DESCRIPTION:
1. Inhibit serotonin reuptake
2. Produce an antidepressant response
B. EXAMPLES:
1. Fluoxetine (PROZAC)
2. Sertraline Hcl (ZOLOFT)
 3. Citalopram (Celexa) 4. Desipramine HCl (Norpramin)
4. Escitalopram (Lexapro) 5. Doxepine HCl (Sinequan)
5. Fluvoxamine (Luvox) 6. Amoxapine (Asendin)
6. Paroxetine HCl (Paxil) 7. Trimipramine maleate (SURMONTIL)
7. Bupropion HCl (Wellbutrin) 8. Trazodone (Deyserel)
8. Venlafaxine HCl (Effexor) 9. Protriptyline HCl (Vivactyl)
10. Nortriptyline HCl (Aventyl)
C. SIDE EFFECTS:
1. N/V, cramping, diarrhea C. SIDE EFFECTS:
2. Dry mouth 1. Anticholinergic eefects
3. CNS stimulation 2. Dry mouth
4. Photosensitivity 3. Decreased GI motility & constipation
5. Insomnia/somnolence 4. Difficulty voiding
6. Nervousness 5. Dilated pupils & blurred vision
7. Headache, dizziness 6. Photosensitivity
8. Seizure activity 7. Cardiovascular disturbances - dysrhythmias
9. Weight loss/gain 8. Ortho hypo
9. Sedation
D. INTERVENTIONS: 10. Weight gain
1. Monitor VS & weight 11. Anxiety, restlessness, irritability
2. Initiate safety precautions 12. Decreased or increased libido with ejaculatory &
3. Administer with food – reduce risk of dizziness erection disturbances
4. Monitor the suicidal client, especially during
improved mood & increased energy levels D. INTERVENTIONS:
5. Prozac be taken early in the day – avoid 1. Instruct about delayed effects – 2 to 4 weeks
interference with sleep 2. Monitor the suicidal client
6. Monitor liver/renal function tests – long term Tx 3. Change position slowly
7. If PRIAPISM occurs, discontinue immediately 4. Monitor pattern of daily bowel activity
8. Inform possibility of decrease in libido 5. Assess for urinary retention
9. Change position slowly 6. If GI distress occurs, administer it with food
10. Report visual changes 7. Dose given preferably at bed time
8. Discontinuation should be tapered gradually
MONOAMINE OXIDASE INHIBITORS
TRICYCLIC ANTIDERESSANTS
What is MONOAMINE OXIDASE?
What is NOREPINEPHRINE?  A copper-containing enzyme that deaminates
 A neurotransmitter that produces activity at the monoamines such as dopamine, epinephrine, NE,
sympathetic postsynaptic nerve terminals in the ANS & serotonin
resulting in the “fight or flight” responses in the
effector organs A. DESCRIPTION:
 Metabolized by MAO & catechol-O-methytransferase 1. Inhibit the enzyme, MAO, which is present in the
brain, blood platelets, liver, spleen, & kidneys
A. DESCRIPTION: 2. Inhibition of MAO metabolizes amines
1. Block the reuptake of NE & serotonin at the 3. Used for DEPRESSION in patients unresponsive
presynaptic neuron to other drug therapies, including ECT
2. Used to treat DEPRESSION 4. Hypertensive crisis may result if taken along with
3. May reduce seizure threshold : amphetamines, dopamine, epinephrine,
4. May reduce effectiveness of antihypertensive guanethidine, levodopa, methyldopa, nasal
agents decongestants, NE, reserpine, TYRAMINE-
5. Cause CNS depression if used with alcohol or containing foods, & vasoconstrictors
antihistamines 5. If used with narcotic analgesics –
6. HYPERTENSIVE CRISIS may result if used with hypo/hypertension, coma, seizures
MAOIs
B. EXAMPLES:
B. EXAMPLES: 1. Phenelzine sulphate (NARDIL)
1. Amitriptyline HCl (ELAVIL) 2. Isocarboxasid (Maplan)
2. Clomipramine (ANAFRANIL) 3. Tranylcypromine sulphate (Parnate)
3. Imipramine HCl (TOFRANIL)
C. SIDE EFFECTS: 2. Concurrent use with diuretics, Prozac,
1. Ortho hypo methyldopa, or NSAIDs increases lithium
2. Restlessness reabsorption by the kidneys  lithium toxicity
3. Insomnia 3. Acetazolamide, Aminophylline, Phenothiazines,
4. Dizziness Na bicarb – increase renal excretion of lithium
5. Lethargy, weakness  reduced effectiveness
6. GI upset 4. Therapeutic dose (0.6 to 1.2 mEq/L) is slightly
7. Dry mouth lower than toxic dose
8. Weight gain 5. Causes of an increase Lithium level: decreased
9. Peripheral edema Na intake, illness, overdose, fluid & electrolyte
10. CNS stimulation : anxiety, agitation, mania loss
11. Delay in ejaculation 6. Blood samples for serum lithium level be drawn
in the morning, 12 hours after last dose
D. HYPERTENSIVE CRISIS:
1. Hypertension B. EXAMPLES:
2. Occipital headache radiating frontally 1. Lithium carbonate (ESKALITH, Lithane, Lithobid)
3. Neck stiffness & soreness 2. Lithium citrate (Cibalith-Si)
4. N/V 3. Carbamazepine (TEGRETOL)
5. Sweating, fever, chills 4. Divalproex Na (DEPAKOTE)
6. Clammy skin 5. Gabapentin (Neurontin)
7. Dilated pupils 6. Lamotrigine (LAMICTAL)
8. Palpitations, tachycardia, or bradycardia 7. Oxcarbazepine (Trileptal)
9. Constricting chest pain 8. Topiramate (Topamax)
10. ANTIDOTE: phentolamine (REGITINE) 5-10 mg IV
C. SIDE EFFECTS:
E. INTERVENTIONS: 1. Polydipsia, polyuria, dry mouth, anorexia,
1. Monitor BP nausea
2. Monitor for signs of H. CRISIS 2. Weigh gain, bloating, diarrhea
3. Discontinue meds & notify MD if palpitations & 3. Hand tremors, inability to concentrate
headache occurs 4. Muscle weakness, lethargy, fatigue, headache
4. Give with food if with GI upsets 5. Hair loss
5. Effect may be noted during the first week,
maximum effect may take up to 3 weeks D. INTERVENTIONS:
6. Change position slowly 1. Monitor suicidal client of improved mood
7. Avoid caffeine or OTC drugs 2. Administer with food
8. Avoid giving the drug at night – insomnia 3. Maintain fluid intake of 6-8 glassess
9. Should be tapered & discontinued 7-14 days 4. Avoid excessive amounts of caffeinated drinks –
before surgery diuretic effect
10. Avoid tyramine-containing foods 5. Maintain adequate salt intake
6. No to diuretics while on lithium
F. FOODS CONTAINING TYRAMINE 7. Missed dose may be taken within 2 hours only
1. Avocado, banana, papaya, overripe fruits 8. Educate client about s/s of toxicity
2. Liver, meat extracts & tenderizers 9. Therapeutic response is noted in 1-3 weeks
3. Brewer’s yeast, broad beans, caffeine
4. Cheese esp aged except cottage E. LITHIUM TOXICITY
5. Raisins,yogurt, sour cream, red wine
6. Soy sauce, figs 1. Description
7. Sausage, bologna, pepperoni, salami a. Occurs when ingested lithium cannot be
detoxified & excreted by the kidneys
b. Symptoms begin to appear when lithium
MOOD STABILIZERS level is at 1.5-2 mEq/L

A. DESCRIPTION: 2. Mild Toxicity

1. Affect cellular transport mechanism, alter the a. Level at 1.5
presynaptic & postsynaptic events affecting b. Apathy
serotonin, & thus enhance serotonin function c. Lethargy
d. Diminished concentration
e. Mild ataxia
f. Coarse hand tremors
 g. Slight muscle weakness C. SIDE EFFECTS:
1. Daytime sedation
3. Moderate toxicity 2. Ataxia
a. 1.5 to 2.5 3. Dizziness, headache
b. N/V 4. Blurred/double vision
c. Severe diarrhea 5. Hypotension,tremor
d. Ataxia – mild to oderate 6. Amnesia
e. Slurred speech 7. Slurred speech
f. Tinnitus 8. Urinary incontinence
g. Blurred vision 9. Constipation
h. Muscle twitching
i. Irregular tremor D. ACUTE TOXICITY:
1. Somnolence – drowsiness or sleepiness
4. Severe Toxicity 2. Confusion
a. Above 2.5 3. Diminished reflexes & coma
b. Nystagmus 4. Flumazenil (Romazicon), benzo antagonist
c. Muscle fasciculations administered IV will reverse benzo intoxication
d. Deep tendon hyperreflexia in 5 minutes
e. Visual or tactile hallucination 5. When treated for an overdose : agitation,
f. Oliguria or anuria restlessness, discomfort, anxiety
g. Impaired LOC
h. Tonic-clonic seizures or coma o death E. WITHDRAWAL:
1. Dosage should be tapered gradually over 2-6
5. Interventions weeks
a. Hold lithium & notify MD 2. Abrupt or too rapid may result in the following;
b. Monitor VS & LOC a. Restlessness
c. Monitor cardiac status b. Irritability
d. Prpepare to obtain lithium level c. Insomnia
e. Monitor for suicidal tendencies & insititute d. Hand tremors
suicide precautions e. Abdominal or muscle cramps
f. Sweating
g. Vomiting
ANTIANXIETY/ANXIOLYTIC DRUGS h. seizures
F. INTERVENTIONS:
What is ANXIETY? 1. Monitor for motor responses such as agitation,
 Vague diffuse apprehension that is associated with trembling & tension
feelings of uncertainty & helplessness 2. Monitor for autonomic responses such as cold
clammy hands & sweating
A. DESCRIPTION: 3. Monitor visual disturbances – can worsen
1. Depress the CNS, thereby increasing the effects glaucoma
of GABA, which produces relaxation & may 4. Initiate safety precautions
depress the limbic system 5. Instruct client that drowsiness usually
2. Benzodiazepines have anxiety-reducing, disappears during continued therapy
sedative-hypnotic, muscle-relaxing, & 6. Don’t stop abruptly
anticonvulsant actions
MEDICATIONS FOR INSOMNIA & ANXIETY
B. EXAMPLES:
1. Alprazolam (XANAX) A. DESCRIPTION:
2. Chlordiazepoxide (LIBRIUM) 1. Depress the reticular activating system by
3. Clonazepam (KLONOPIN) promoting the inhibitory synaptic action of
4. Clorazepate (TRANXENE) GABA
5. DIAZEPAM (VALIUM) 2. Used for short-term treatment of insomnia or
6. LORAZEPAM (ATIVAN) for sedation to relieve anxiety, tension, &
7. Halazepam (Paxipam) apprehension
8. Oxazepam (Serax)
9. Prazepam (Centrax) B. EXAMPLES :
10. Triazolam (Halcion) 1. Barbiturates
a. Amobarbital (AMYTAL)
 b. Secobarbital (SECONAL) 2. Block dopamine receptors in the brain, thereby
c. Phenobarbital (LUMINAL) reducing the psychotic symptoms
d. Aprobarbital (Alurate) 3. Block the chemoreceptor trigger zone &
e. Pentobarbital (Nembutal) vomiting center in the brain, producing an
f. Butabarbital (Butisol) antiemetic effect
4. Phenothiazines lower the seizure threshold
2. Sedative-hypnotic anxiolytics 5. Should not be given with other antipsychotic
a. Buspirone (BuSpar) drugs or antidepressants
b. Hydroxyzine HCl (ATARAX)
c. Chloral hydrate (Noctec) B. EXAMPLES:
d. Zaleplon (Soanata) 1. Typical antipsychotics
e. Zolpidem tartrate (Ambien) a. Chlorpromazine HCl (THORAZINE)
b. Thioridazine HCl (MELLARIL)
C. SIDE EFFECTS: c. Trifluoperazine (STELAZINE)
1. Confusion d. Fluphenazine HCl (Prolixin)
2. Irritability e. Perphenazine (Trilafon)
3. Allergic reactions f. Thiothixene HCl (Navane)
4. Agranulocytosis g. Triflupromazine HCl (Vesprin)
5. Thrombocytopenia purpura
6. Megaloblastic anemia 2. Atypical antipsychotics
a. Haloperidol (HALDOL)
D. OVERDOSE: b. Clozapine (CLOZARIL)
1. Tachycardia c. Risperidone (RISPERDAL)
2. Hypotension d. Aripiprazole (Abilify)
3. Cold & clammy skin e. Loxapine (Loxitane)
4. Dilated pupils f. Molindone HCl (Moban)
5. Weak & rapid pulse g. Olanzapine (Zyprexa)
6. Signs of shock h. Quetiapine (Seroquel)
7. Depressed respirations i. Ziprasidone (Geodon
8. Absent reflexes
9. Coma & death C. SIDE EFECTS:
1. Anticholinergic effects
E. WITHDRAWAL: 2. Dry mouth
1. Begin within 24 hrs after discontuation 3. Increased HR
2. Gradual withdrawal is used to detoxify a 4. Urinary retention
dependent person 5. Constipation
3. Anxiety 6. Hypotension
4. Insomnia 7. Drowsiness
5. Nightmares 8. Blood dyscrasias agranulocytosis
6. Daytime agitation 9. Pruritus
7. Tremors 10. Photosensitivity
8. Delirium
9. Tremors D. EXTRAPYRAMIDAL SYNDROME:
1. Parkinsonism
F. INTERVENTIONS: a. Tremors
1. Administer lower doses as prescribed b. Masklike facies
2. Maintain safety c. Rigidity
3. Avoid driving or hazardous activities d. Shuffling gait
4. Insomniac – take drug 30 mins before bedtime
5. A hangover effect may occur in AM 2. Dystonia
6. Don’t discontinue meds abruptly a. Facial grimacing
b. Abnormal or involuntary eye movements
ANTIPSYCHOTIC MEDICATIONS
3. Akathisia
A. DESCRIPTION: a. Restlessness
1. Improve the thought processes & the behavior b. Constant moving about
of the client with psychotic symptoms, esp the
client with schizophrenia 4. Tardive dyskinesia
a. Protrusion of the tongue
 b. Chewing motion 5. Monitor LOC
c. Involuntary movement of the body & 6. Antipyretics prn
extremities 7. Cooling blanket to lower temp
8. Monitor electrolytes & administer IV as
E. INTERVENTIONS: prescribed
1. Monitor VS
2. Monitor for EPS
3. Monitor for symptoms of neuroleptic malignant
syndrome
4. Monitor urine output, serum glucose
5. Administer with food
6. Avoid skin contact with liquid concentrate to
prevent contact dermatitis
7. Protect liquid from light
8. Dilute liquid with juice
9. Therapeutic response may be apparent after 7-
10 days but full effect is in 3-6 weeks
10. Phenothiazines may produce a harmless urine
color of pinkish to red-brown
11. Sun protection
12. Gradual discontinuation

NEUROLEPTIC MALIGNANT SYNDROME

A. DESCRIPTION:
1. A potentially fatal syndrome that may occur at
any time during therapy with neuroleptics
2. Rare but commonly occurs at the initiation of
therapy, after client is changed from one drug to
another, after a dosage increase, or when
combination of drugs is used.

B. ASSESSMENT:
1. Dyspnea or tachypnea
2. Tachycardia or irregular pulse
3. Fever
4. High or low BP
5. Increased sweating
6. Loss of bladder control
7. Skeletal muscle rigidity
8. Pale skin
9. Excessive weakness or fatigue
10. Altered LOC
11. Seizures
12. Severe EPS effects
13. Dysphagia
14. Excessive salivation
15. Oculogyric crisis
16. Dyskinesia
17. Elevated WBC
18. Elevated liver function tests
19. Elevated CPKlevel

C. INTERVENTIONS:
1. Notify MD
2. Monitor VS
3. Initiate safety & seizure precautions
4. Discontinue drug