PHARMACOLOGY f) AVOID caffeine (it increases

⮚ Study of the drug & its interaction within HR)

the body. ❒ Coffee & Tea
❒ Cola, Energy drinks
PHARMACOKINETICS: ❒ Chocolates (dark)
⮚ Study of the drug movement through g) Given:
the body. ❒ Early AM (it can cause
⮚ ADME Study = Absorption, insomnia)
Distribution, Metabolism, Excretion ❒ BEST: PRN
1) ABSORPTION 1) Beta-Adrenergic/AGONIST(“-ol”
❒ Site of administration to the Drugs)
bloodstream. ❒ EXAMPLES:
2) DISTRIBUTION a) Metaproterenol (Alupent)
❒ Transportation of the medication b) Albuterol (Proventil)
from the bloodstream to the c) Salbutamol (Ventolin)
specific cells, organs or d) Salmeterol (Serevent)
receptors. 2) Xanthine-Derivatives (“-phylline”
3) METABOLISM Drugs)
❒ Chemical transformation of ❒ EXAMPLES:
drugs from organ to the liver. a) Theophylline (Theodur)
❒ MAIN ORGAN: Liver b) Aminophylline (Phyllocontin)
4) EXCRETION 3) Mast Cell Stabilizers
❒ Process of elimination ❒ ACTION: inhibit histamine release
❒ MAIN ORGAN: Kidneys (prevent asthma attacks)
❒ ROUTE:
RESPIRATORY DRUGS a) Inhalation: Metered Dose
Inhalers (MDI)
I. ANTIASTHMATICS ❒ Given:
A. Bronchodilators a) BEFORE/PRIOR to
❒ ACTION: relaxes the bronchus asthma attack
(bronchodilation) b) BEFORE meals
❒ EFFECTIVENESS: c) Bedtime (HS)
a) Easy breathing ❒ NURSING MANAGEMENT:
b) (-) DOB a) Use as PROPHYLAXIS
c) (N) RR (not used as treatment
d) (-) wheezing but prevent asthma
❒ SIDE EFFECTS: attacks)
a) Tachycardia/Palpitations ❒ EXAMPLES:
✔ Nursing Mgt.: Check a) cromolyn (Intal)
HR!
b) Agitation II. NASAL DECONGESTANTS
c) Nervousness (“-propanolamine” Drugs)
❒ (N) SERUM LEVEL: 10-20 ❒ ACTION: promotes nasal
mcg/mL (xanthines) vasoconstriction (relieves
❒ >20 mcg/mL = TOXIC! congestion)
❒ INDICATIONS:
a) Rhinitis
❒ NURSING MANAGEMENT: b) Nasal congestion/Runny
a) Check Vital Signs: HR nose
b) If checking of effectiveness: ❒ CONTRAINDICATIONS:
Check RR a) Hypertensive Crisis
c) Give FIRST: Bronchodilators b) Dysrhythmias
(it opens airway) c) Glaucoma (increased IOP)
d) Give LAST: Steroids ❒ SIDE EFFECTS:
e) Used as RESCUE inhaler: a) SNS S/E:
Albuterol (it is a short-acting)
 ✔ Increased BP c) STOP smoking (causes
✔ Increased HR bronchoconstriction)
❒ EXAMPLES:
a) Phenylpropanolamine V. ANTITUSSIVES (“-ate” Drugs)
(Decolgen, Neozep) ❒ ACTION: inhibits/suppresses the
b) Pseudoephredine cough reflex
(Sinuzip) ❒ EFFECTIVENESS:
❒ NURSING MANAGEMENT: a) Decrease frequency of
a) Check Vital Signs: BP cough
b) LIMIT caffeine ❒ INDICATIONS:
c) AVOID overuse (to prevent a) Dry cough/Unproductive
rebound congestion) cough
❒ SIDE EFFECTS:
III. MUCOLYTICS (“-cysteine” or a) CNS depression
“-solvon/-solvan” Drugs) b) Sedation
❒ ACTION: loosens/thins the c) Drowsiness
secretions (prevent thickening of d) Fatigue
secretions) e) Lethargy
❒ INDICATIONS: ❒ EXAMPLES:
a) Bronchitis a) Benzonatate (Tessalon)
b) Productive cough b) Butamirate (Sinecod Forte)
❒ NURSING MANAGEMENT:
a) Increase fluids (best ❒ NURSING MANAGEMENT:
natural mucolytic) a) Increase fluids
b) Bedside equipment: b) PRIORITY: Safety
suction machine ✔ side rails up
✔ Assist in
❒ EXAMPLES: ambulation
a) Acetylcysteine (Mucomyst) ✔ AVOID driving
✔ Used as antidote ✔ AVOID operating
for Tylenol machines
overdose
✔ ROUTES: VI. ANTITUBERCULARS (RIPE)
⮚ Inhalation ❒ ACTION: kills microorganisms
⮚ Oral (Mycobacterium tuberculosis)
⮚ NGT ❒ GENERAL MANAGEMENT:
✔ If Tylenol a) Prevent RESISTANCE:
overdose: the drug Multi-drug therapy
must be DILUTED b) Duration: 6-12 months
with water or juice c) NOT CONTAGIOUS if:
(acetylcysteine has after 2 weeks of
a rotten egg flavor) continuous drug therapy.
b) Carbocysteine (Solmux, d) TOXICITY: Hepatotoxic
Loviscol) ✔ Jaundice
c) Bisolvon (Bromhexine) ✔ Clay-colored stool
✔ Increased ALT/AST
IV. EXPECTORANTS (“-sin” Drugs) ✔ AVOID alcohol
❒ ACTION: expel secretions (acts ✔ Check labs:
as lubricant) − ALT (SGPT)
❒ EXAMPLES: − AST
a) Guaifenesin (Robitussin) (SGOT)
❒ NURSING MANAGEMENT: ❒ RIFAMPICIN:
a) Increase fluids ⮚ TAKEN: EMPTY stomach (to
b) Taken with a glass of water increase absorption)
 ⮚ Urine color: ORANGE/RED a) Liver diseases
ORANGE color ❒ CHECK for ALT/AST levels
❒ ISONIAZID: 1) STATINS (Hydroxymethylglutaryl
⮚ Most common TB drug Coenzyme A Reductase Inhibitors)
⮚ Used as PROPHYLAXIS ❒ TAKEN: Bedtime
(prevention for those exposed) ❒ ACTION: prevent cholesterol
⮚ S/E: synthesis (decreases serum
a) Peripheral neuritis cholesterol)
b) Tingling or Prickling ❒ EXAMPLES:
sensation a) Atorvastatin (Lipitor)
c) Pins & needles b) Lovastatin (Mevacor)
d) Paresthesia c) Simvastatin (Zocor)
e) Numbness 2) FIBRIC ACIDS (“-fibrate” Drugs)
⮚ TREATMENT: Vitamin B6 (B ❒ ACTION: Decreases/Reduces
vitamins) cholesterol level
❒ PYRAZINAMIDE: ❒ EXAMPLES:
⮚ S/E: a) Clofibrate (Atropid)
a) Increased uric acid b) Fenofibrate (Tricor)
(gouty) c) Gemfebrozil (Lopid)
⮚ CONTRAINDICATIONS: 3) BILE ACIDS SEQUESTRANTS
a) Pregnant women (“-fibrate” Drugs)
❒ ETHAMBUTOL: ❒ ACTION: Binds cholesterol with
⮚ S/E: the bile and excretes through the
a) Optic neuritis (unable stool
to differentiate red or ❒ NURSING MANAGEMENT:
green color) a) Needs a HEALTHY liver:
⮚ AVOID: <6 years old ✔ Check ALT/AST
levels
CARDIOVASCULAR DRUGS ❒ EXAMPLES:
I. ANTILIPIDS a) Cholestyramine (Questran)
❒ GENERAL MANAGEMENT: ✔ TAKEN: BEFORE
a) Determine meals
EFFECTIVENESS: ✔ PREPARATION
decreased serum level of (powdered):
LDLs (bad cholesterol) & Dissolve in liquid
triglycerides. with fruit juice
❒ SIDE EFFECTS: b) Colestipol (Colestid)
a) Constipation
b) Cataracts (blurred vision) II. ANTIANGINALS
c) Headache ❒ ACTION: vasodilation of
❒ ADVERSE EFFECTS: coronary arteries (increased
a) Myopathy blood circulation and O2 supply
✔ S/Sx: to heart muscles) and the veins
a. Muscle Weakness (decreased venous return and
b. Gray-bronze skin cardiac workload that decreases
(rhabdomyolysis) O2 demand)
✔ Nursing Mgt: NOTIFY ❒ EFFECTIVENESS: relieve of
physician chest pain
b) Photosensitivity ❒ SIDE EFFECTS:
❒ DIET: a) Orthostatic hypotension
a) High fiber diet (fruits & (Safety precautions!)
vegetables, papaya, b) Headache (MOST
oatmeal, wheat bread, COMMON)
legumes & corn) ❒ NURSING MANAGEMENT:
❒ CONTRAINDICATIONS:
 a) ROUTES: d) Melena (Upper GI
Sublingual/Patch bleeding)
b) Potency sign: burning e) Hematochezia (lower GI
sensation under the bleeding)
tongue f) Hematuria
c) Storage: g) Internal bleeding (bruises,
dark-closed/brown ecchymosis, petechiae,
container (drug is purpura)
photosensitive)
d) Shelf-life: 6 months
✔ If more than 6 months: ❒ NURSING MANAGEMENT:
DISCARD! Heparin Warfarin
e) ONSET: 2-3 minutes ROUTE SQ/IV ORAL
f) DOSAGE: 3 doses (maintenance)
g) INTERVAL: 1 dose every AVOID IM
5 minutes
ANTIDOTE Protamine Vitamin K
h) PROPHYLAXIS: before
sulfate (Aquamephyto
activity or sex
n)
i) AVOID sildenafil (Viagra)
✔ It promotes vasodilation LABS Partial Prothrombin
+ NTG = further Thromboplasti Time (PT):
vasodilation causing fatal n Time (PTT): 11-13
hypotension 60-90 seconds seconds
❒ For NTG patches:
a) ROTATE site (to prevent Active Partial Internal
irritation) Thromboplasti Normalized
b) EFFECTIVE site: n Time (aPTT): Ratio (INR):
non-hairy/hairless CHEST 30-45 seconds 2-3 seconds
(increase absorption)
c) DURATION: 12-14 hours THERAPEUTI X2 X2
(to prevent tolerance) C LEVEL If patient is If patient is
d) WEAR gloves (to prevent taking this taking this
systemic reaction) medication, medication, PT
❒ EXAMPLES: PTT and aPTT and INR
a) Nitroglycerine normal levels normal levels
(Nitrolingual) must be must be
b) Nitroglycerine (Nitrobid) DOUBLED. DOUBLED.
PREGNANCY OK! AVOID!
III. ANTICOAGULANTS (“-rin” Drugs) (Heparin has (Teratogenic)
❒ ACTION: inhibits synthesis of large
clotting factors (prevent molecules,
development of clots) does not cross
✔ NO placental
prothrombin-to-thrombin barrier)
conversion
❒ INDICATIONS: ❒ EXAMPLES:
a) MI a) Heparin (Liquaemin)
b) CVA/Stroke b) Enoxaparin (Lovenox)
c) DVT c) Warfarin (Coumadin)
❒ S/E: High risk of bleeding ✔ ONSET: 3-4 days
a) Epistaxis ✔ After giving Warfarin
b) Hematemesis PO to the patient,
c) Hemarthrosis (bleeding administer also
joints) Heparin IV (due to
immediate effect of
heparin while waiting
 for the effect of V. CARDIAC GLYCOSIDES
warfarin for 3-4 days ❒ ACTION:
onset) ✔ (+) inotropy: increase force
✔ AVOID: Vitamin K of contraction (increases
− Green leafy CO)
vegetables ✔ (-) chronotropy: decrease
− Spinach HR
− Camote tops ❒ EFFECTIVENESS:
− Cabbage a) Increase urine output
− Lettuce (UO is dependent on CO)
− Malunggay ❒ INDICATIONS:
− Brussel sprouts a) CHF
− Bokchoy ❒ (N) serum level: 0.5-2 ng/mL
− Asparagus ❒ TOXIC signs: >2 ng/mL (NOTIFY
✔ Hep Lock: doctor!)
1) Saline Flush a) Visual Disturbances:
2) Administer ✔ Blurred vision
Drug ✔ Yellow vision
3) Saline Flush (xanthopsia)
4) Heparin b) Abdominal Cramps
IV. THROMBOLYTICS (“-ase” Drugs) c) Diarrhea
❒ ACTION: dissolve clots d) Nausea & Vomiting
❒ NURSING MANAGEMENT: e) Anorexia
a) GIVEN: within 3-6 hours of f) Bradycardia
MI or CVA attack (More ❒ NURSING MANAGEMENT:
effective) a) V/S: HR (apical pulse) in 1
❒ ANTIDOTE: Aminocaproic acid full minute
(Amicar) b) ELECTROLYTES:
❒ CAUTION: High risk of Bleeding Potassium (hypokalemia
❒ EXAMPLES: increases digoxin toxicity)
a) Urokinase (Abbokinase) c) WITHHOLD:
b) Streptokinase ✔ if <60 HR
(Streptokinase) ✔ if <3.5 mEq/L
c) Alteplase (TPA) Potassium
d) DOSAGE:
✔ 0.25 mg (ADULT)
GENERAL GUIDELINES FOR ✔ 0.05 mg (INFANT)
ANTICOAGULANTS/THROMBOLYTICS e) ANTIDOTE: Digoxin
1) BLEEDING PRECAUTIONS Immune Fab (Digibind)
a) Use soft toothbrush ❒ ANTIDOTE: Aminocaproic acid
b) Use electric razor (AVOID using (Amicar)
blade razor) ❒ CAUTION: High risk of Bleeding
c) AVOID contact sports (boxing, ❒ EXAMPLES:
basketball, wrestling, a) Digoxin (Lanoxin)
taekwondo) b) Digitoxin (Crystodigin)
d) ALLOWED sports:
❒ Swimming
❒ Chess
❒ Bowling
❒ Board & Card games
e) AVOID rectal procedures
❒ Health teaching: AVOID
anal sex (rectum is VI. ANTIHYPERTENSIVES
highly vascular) 1) ACE INHIBITORS (“-pril” Drugs)
 ❒ ACTION: inhibits
Angiotensin-Converting enzyme
(no conversion of Angiotensin I to
Angiotensin II)
✔ No vasoconstriction
(vasodilation)
✔ No water and sodium
retention (decrease blood
volume)
✔ Decrease BP
❒ RAAS Activation: ..\ncm 118
(critical care nursing)\chf, ekg
interpretation & ecg leads 1.docx
❒ S/E: Persistent Cough
❒ INDICATIONS: CHF
❒ EXAMPLES:
a) Captopril (Capoten)
b) Enalapril (Vasotec)
c) Lisinopril (Prinivil)
d) Ramipril (Altace)
2) BETA BLOCKERS (“-olol” Drugs)
❒ ACTION: blocks Beta 1 (heart)
✔ Decreased HR and
decreased BP
❒ EXAMPLES:
a) Metoprolol (Lopressor)
b) Atenolol (Tenormin)
c) Propanolol (Inderal)
d) Betaxolol (Betoptic)
e) Nadolol (Corgard)
3) CALCIUM CHANNEL BLOCKERS
(“-dipine” Drugs)
❒ ACTION: blocks calcium entrance
to the heart cells
✔ relaxes the heart muscle
then decreases contraction
and BP
✔ relaxes the blood vessels
(artery) then decrease
spasm and decrease
vasodilation
✔ decrease BP
❒ INDICATIONS:
a) Vasospasms (Raynaud’s
Disease)
❒ EXAMPLES:
a) Nifedipine (Procardia)
b) Felodipine (Plendil)
c) Amlodipine (Norvasc)
d) Nicardipine (Cardene)
e) Verapamil (Calan, Isoptin)
f) Diltiazem (Cardizem)
GENERAL MANAGEMENT FOR
ANTIHYPERTENSIVES
1) S/E:
a) Orthostatic/Postural
Hypotension
b) Dizziness
c) Drowsiness
d) Sedation
e) Fatigue
f) Impotence
2) CHECK V/S: Check BP BEFORE
(baseline data) and AFTER (evaluation
for effectiveness) taking medication
3) WITHHOLD: if 90/60 or 100/60 mmHg
4) DIET: Low Sodium Diet
a) AVOID processed foods (has
high sodium that causes sodium
retention)
5) AVOID sudden discontinuation (prevent
rebound hypertension)
6) PRIORITY: SAFETY
✔ ASSIST IN: Ambulation
✔ CHANGE POSITION: Gradually
✔ AVOID hot baths (causes
vasodilation)
URINARY SYSTEM DRUGS
I. DIURETICS
1) LOOP DIURETICS (“-mide” Drugs)
❒ MOST POTENT diuretic
❒ ACTION: No water reabsorption
on the site of loop of Henle
✔ Increase excretion of water
❒ EFFECTIVENESS: increase U/O
❒ ADVERSE EFFECTS:
a) Ototoxicity
✔ Tinnitus
✔ Hearing loss
✔ Vertigo
❒ EXAMPLES:
a) Furosemide (Lasix)
b) Ethacrynic Acid (Edecrin)
c) Torsemide (Demadex)
2) THIAZIDE DIURETICS (“-thiazide”
Drugs)
❒ ACTION: No water reabsorption
on the site of the distal tubule
✔ Increase excretion of water
❒ EFFECTIVENESS: increase U/O
❒ EXAMPLES:
a) Chlorothiazide (Diuril)
b) Hydrochlorothiazide
(HydroDIURIL)
c) Benzthiazide (Exna)
3) OSMOTIC DIURETICS
 ❒ ACTION: draws fluid from the cell a) Hyperkalemia in Renal
out to the blood Failure
✔ Fluid goes to the bloodstream ❒ S/E:
❒ EFFECTIVENESS: increase U/O a) Diarrhea
❒ INDICATIONS: ❒ ROUTES:
a) Cerebral Edema a) ORAL
b) Increased ICP b) Through ENEMA (rectal)
❒ ROUTE: IV ✔ There will be retention
❒ RISK: Crystallization of the drug for 30
✔ Place warm water to minutes
de-crystallize ❒ EXAMPLES:
❒ EXAMPLES: a) Polysterene sulfonate
a) Mannitol IV (Osmitrol) (Kayexalate)
4) POTASSIUM SPARING DIURETICS
❒ ACTION: excretes sodium and III. ERYTHROPOIETIN (EPOGEN)
water ❒ ACTION: stimulates RBC
✔ Conserves potassium (risk for production
hyperkalemia) ❒ EFFECT: increases Hgb and Hct
❒ Bedside equipment: levels
cardiac/EEG monitor ❒ INDICATIONS:
❒ RISKS FOR HYPERKALEMIA: a) Anemia in renal failure
a) Dysrhythmias ❒ S/E:
✔ Tall tented T-wave a) Hypertension
❒ EXAMPLES: ❒ MANAGEMENT:
a) Spironolactone b) ROUTE: SQ
(Aldactone) c) AVOID oral (degraded in
b) Amiloride (Midamor) GIT)
c) Triamterene (Dyrenium) d) ONSET: 2-6 weeks
e) STORAGE: refrigerated
(body)
GENERAL MANAGEMENT FOR DIURETICS ✔ AVOID freezer
1) S/E: GASTROINTESTINAL SYSTEM DRUGS
a) Hypotension
I. ANTIULCERS
b) Hypokalemia (except K+
1) ANTACIDS
sparing diuretics)
❒ ACTION: neutralizes HCl
2) CHECK V/S: BP
❒ EFFECTIVENESS:
3) GIVEN: AM (8 AM) – to prevent sleep
a) Decrease or relief of
pattern disturbances
heartburn or gastric pain
4) MONITOR: WEIGHT (best indicator of
❒ NURSING MANAGEMENT:
fluid status) 🡪 1 kg = 1 L gain
a) GIVEN: AFTER meals
5) DIET: High Potassium Diet (except b) CHEW drug (to increase
K+ sparing diuretics) absorption/to dissolve
6) Ca+ Sparing: THIAZIDES (AVOID in medication before entering
hypercalcemia) small intestine)
c) DRUG INTERVAL: 2
II. ANTIHYPERKALEMIA hours (at least 1-2 hours)
❒ ACTION: binds K+ ions with Na+ A. ALUMINUM-BASED
ions ❒ S/E:
✔ Moves potassium back to a) Constipation
the cell ❒ EXAMPLES:
✔ Excretes potassium a) Aluminum hydroxide
through the stool (Amphojel)
❒ EFFECT: to decrease serum ✔ INDICATIONS:
potassium − Hyperphosphate
❒ INDICATION: mia in renal
 failure (it binds a) GERD
excess phosphorus ❒ NURSING MANAGEMENT:
and excretes it a) GIVEN: BEFORE meals
through the stool) b) AVOID chewing or crushing
b) Aluminum carbonate (to increase absorption)
(Basaljel) c) INTERVAL WITH ANTACIDS:
B. MAGNESIUM-BASED 2 hours (at least 1-2 hours)
❒ S/E: ❒ AVOID smoking
a) Diarrhea ❒ EXAMPLES:
❒ EXAMPLES: a) Esomeprazole (Nexium)
a) Magnesium hydroxide (Milk b) Omeprazole (Prilosec)
of Magnesia) c) Lansoprazole (Prevacid)
C. CALCIUM-BASED 4) CYTOPROTECTIVES
❒ EXAMPLES: ❒ ACTION: coats the ulcer
a) Calcium carbonate (Tums, (hole/lesions)
Rolaids) ❒ NURSING MANAGEMENT:
D. MAGNESIUM-ALUMINUM a) GIVEN: BEFORE meals
COMBINATION b) INTERVAL: 2 hours (at least
❒ EXAMPLES: 1-2 hours)
a) Magnesium aluminum ❒ EXAMPLES:
(Maalox, Mylanta) a) Sucralfate (Carafate)
b) Magnesium Aluminum b) Misoprostol (Cytotec)
trisilicate (Gaviscon, 2) Abortifacient drug
Kremil-S) (AVOID to pregnant
c) Magaldrate (Riopan): women)
✔ Has less sodium
✔ INDICATIONS: II. LAXATIVES
− CHF 1) STIMULANT LAXATIVES
2) HISTAMINE 2 BLOCKERS (“-tidine” ❒ ACTION: stimulates peristalsis (to
Drugs) promote bowel movement)
❒ ACTION: decreases/reduces HCl ❒ S/E:
production a) Abdominal cramps
❒ NURSING MANAGEMENT: b) Nausea
a) GIVEN: Bedtime (if single c) Diarrhea
dose) ❒ TAKEN: BEFORE meals
b) INTERVAL WITH ANTACIDS: ❒ EXAMPLES:
2 hours (at least 1-2 hours) a) Bisacodyl (Dulcolax)
c) AVOID smoking (nicotine b) Cascara sagrada
increases HCl) c) Castor oil (Neoloid, Emulsoil)
d) TREATMENT COURSE: 4-6 d) Senna (Senokot)
weeks 2) BULK-FORMING LAXATIVES
❒ EXAMPLES: ❒ SAFEST laxative
a) Cimetidine (Tagamet) ❒ ACTION: increases bulk of the
1) S/E (CAUTION for stool (increase peristalsis to
elderly): promote bowel movement)
− CNS problems ❒ TAKEN: with water (prevent stool
− Gynecomastia impaction)
b) Famotidine (Pepcid) ❒ EXAMPLES:
c) Ranitidine (Zantac) a) Methylcellulose (Citrucel)
3) PROTON PUMP INHIBITORS b) Psyllium (Metamucil)
(“-prazole” Drugs) 3) HYPEROSMOTIC LAXATIVES
❒ ACTION: inhibits HCl production ❒ ACTION: draws water into colon
❒ EFFECTIVENESS: relief of to distend the bowel (to promote
heartburn bowel movement)
❒ INDICATIONS: ❒ EXAMPLES:
 a) Lactulose (Cephulac) ❒ EXAMPLES:
b) Glycerin (Glycerol) a) Ferrous sulfate (Oral)
c) Magnesium citrate (Citroma) b) Iron dextran IM (Imferon)
d) Magnesium hydroxide (Milk of
Magnesia) ENDOCRINE SYSTEM DRUGS
4) STOOL SOFTENER I. ANTIDIABETIC AGENTS
❒ ACTION: promotes water 1) INSULIN
absorption into the stool (softens SHORT INTERMEDIA LONG
the stool) ACTING TE ACTING ACTING
❒ INDICATIONS:
a) Cardiovascular problems (to ❒ Semilent ❒ Lente ❒ Ultralent
decrease BP)
e ❒ NPH e
❒ EXAMPLES:
a) Docussate sodium (Colace) ❒ Regular insulin ❒ Humulin
b) Docussate potassium ❒ Humulin ❒ Humulin N U
(Dialose) R
c) Docussate calcium (Doxidan) ❒ Novolin
R
GENERAL MANAGEMENT FOR LAXATIVES 30 2-4 hours 6-8 hours
1) ROUTES: minutes-1
a) ORAL hour
b) RECTAL
2) AVOID everyday use (prevent
dependence)
✔ RISK: Rebound
Constipation
3) AVOID long term use 2-4 hours 6-8 hours 18-24 hours
✔ RISK: Rebound
Constipation HIGH RISK: HIGH RISK: HIGH RISK:
Hypoglyce Hypoglycemi Hypoglyce
III. ANTIANEMICS mia a mia
❒ ACTION: promotes Hgb synthesis
❒ INDICATIONS:
a) Iron Deficiency Anemia 6-8 hours 18-24 hours 36-72 hours
❒ S/E:
a) Black/greenish-black colored
stool
b) Skin Staining (via IM)
c) Teeth staining (via PO liquid)
d) Stool: Constipation
❒ NURSING MANAGEMENT:
a) PROMOTE absorption:
✔ give with orange/citrus
juices (Vitamin C) ❒ ACTION: transport glucose and
✔ EMPTY stomach potassium into the cell
(BEFORE meals) ❒ EFFECTIVENESS: decrease serum
✔ AVOID milk glucose
b) ROUTE: ❒ S/E:
✔ IM in Z-track method a) Hypokalemia
(to avoid skin staining) b) Hypoglycemia
✔ PO in liquid: USE ❒ INDICATIONS:
STRAW a) DM Type 1
c) ANTIDOTE: Deferoxamine b) Hyperkalemia in renal failure
(Desferal) c) GDM
❒ MANAGEMENT:
 a) ROUTE: SQ in abdomen
(more rapid absorption)
b) ANGLE:
✔ Average/Thin: 45
degrees II. ORAL HYPOGLYCEMIC AGENTS (OHAs)
✔ Obese: 90 degrees (“-ide” Drugs)
✔ Prefilled: 90 degrees 1) SULFONYLUREAS
c) INSTRUCTIONS: ❒ ACTION: promotes/stimulates
✔ DO NOT aspirate insulin secretion by the pancreas
✔ DO NOT massage (softens the stool)
✔ Rotate sites (prevent ✔ Stimulates binding of
lipodystrophy🡪decrease glucose into cell receptors &
s absorption) insulin sensitivity to cells
✔ DISTANCE: 1 inch (2.5 ❒ S/E:
cm) a) Hypoglycemia
✔ Only IV INSULIN: ❒ A/E:
REGULAR a) Agranulocytosis (decreased
❖ DOC for DKA WBC)
❒ STORAGE: ✔ Sore throat
a) If CLOSED: Refrigerator ✔ Fever
✔ AVOID freezer b) Photosensitivity (rashes)
✔ If FROZEN: DISCARD ❒ MANAGEMENT:
b) If OPENED: Room a) AVOID exposure under the sun
Temperature (before ❒ EXAMPLES:
injection) a) Chlorptoptamide (Diabenese)
✔ AVOID cold insulin (can b) Glipizide (Glucotrol)
cause lipodystrophy) ✔ GIVEN: BEFORE breakfast
❒ MIXING 2 INSULINS: c) Glyburide (Diabeta)
a) Inject air to: NPH vial 🡪 d) Tolbutamide (Orinase)
Regular vial (N🡪R) 2) ORAL BIGUANIDES
b) Withdraw to: Regular vial 🡪 ❒ ACTION: decrease glucose
NPH vial (R🡪N) production in the liver
✔ This is to prevent ❒ S/E:
contamination of the a) GI disturbances
clear insulin (Regular) ✔ Nausea & Vomiting
to cloudy insulin (NPH) ✔ Diarrhea
c) ROLL gently between ✔ Abdominal cramps
palms ❒ EXAMPLES:
d) AVOID shaking a) Metformin (Glucophage)
e) NPH: 70%
f) REGULAR: 30%
❒ PREVENT HYPOGLYCEMIA GENERAL MANAGEMENT FOR OHAs
a) RISK: during PEAK 1) GIVEN: AM with breakfast
b) DURING PEAK: AVOID 2) ASSESS allergy: SULFUR
exercise a) Sulfur-based soaps
c) BRING SNACKS: simple 3) AVOID sun exposure (drug can cause
CHO photosensitivity)
✔ Orange juice 4) AVOID alcohol (risk of hypoglycemia)
✔ Crackers 5) AVOID in pregnant women (it is
✔ Candies teratogenic)
d) AVOID alcohol (increases 6) In GDM: GIVE INSULIN!
hypoglycemia)
III. PITUITARY HORMONES
1) ANTIDIURETIC HORMONE (ADH)
(“-pessin” Drugs)
 ❒ ACTION: promotes water retention ✔ Diarrhea
❒ EFFECTIVENESS: 4. Increased cell activity
a) decrease U/O ✔ Increased V/S
b) (N) specific gravity ✔ Exophthalmos
(1.010-1.030) ✔ Amenorrhea
❒ INDICATIONS: ❒ MANAGEMENT:
a) Diabetes Insipidus (decreased a) GIVEN: AM 🡪 BEFORE
ADH) breakfast (prevent insomnia)
✔ Polyuria b) CHECK V/S: HR or APICAL
✔ Decreased specific pulse (priority)
gravity c) DOSAGE: 0.1-0.2 mg
❒ S/E: d) INSTRUCTIONS: LIFETIME
a) Hypertension USE!
✔ Increased blood volume ❒ EXAMPLES:
✔ Vasoconstriction a) Levothyroxine (Synthroid): DOC
❒ MANAGEMENT: b) Liothyronine sodium (Cytomel)
a) CHECK V/S: BP
❒ EXAMPLES: V. ANTITHYROIDS
a) Vasopressin (Pitressin) 1) THIOAMIDES
✔ ROUTE: IM ❒ ACTION: blocks T3 & T4 production
b) Desmopressin (DDAVP) (decreases T3 & T4 in the blood)
✔ ACTION: stimulates ❒ EFFECTIVENESS: Adequate sleep
factor VIII ❒ INDICATIONS:
✔ ROUTE: Intranasal a) Hyperthyroidism
❒ S/E:
IV. THYROID HORMONES a) Hypothyroidism S/Sx: ALL are
❒ ACTION: replaces T3 and T4 DECREASED except the
(increases T3 & T4 levels in the blood) weight & menstruation
❒ EFFECTIVENESS: increase physical ❒ A/E:
and mental alertness a) Agranulocytosis (decreased
❒ INDICATIONS: WBC)
a) Hypothyroidism (decreased T3 ✔ Sore throat
& T4) ✔ Fever
❒ S/E: ❒ LABS: CHECK CBC (decreased
a) Hyperthyroidism S/Sx: ALL WBC)
INCREASE except weight & ❒ MANAGEMENT:
menstruation a) GIVEN: AM 🡪 WITH breakfast
1. Increased O2 (prevent insomnia)
consumption b) AVOID in pregnant women
✔ Hyperactivity ✔ ASSESS FIRST: ask for
✔ Insomnia LMP
✔ Irritability ✔ If NEEDED: give PTU
✔ Tremors (adjusted to
✔ Nervousness safest/lowest effective
2. Increased body heat dose)
production ❒ EXAMPLES:
✔ Heat intolerance a) Propylthiouracil (PTU)
✔ Hyperthermia b) Methimazole (Tapazole)
✔ Diaphoresis 2) IODIDES (“solution” Drugs)
✔ Warm and moist ❒ ACTION: suppress T3 & T4 release
skin ✔ Decreases vascularity (to
3. Increased metabolism decrease bleeding
✔ Increased tendencies during
appetite thyroidectomy)
✔ Weight loss ❒ GIVEN: BEFORE surgery
 ❒ S/E: ✔ Alcohol
a) Iodism S/Sx: ❖ CONSIDERED AS
✔ Metallic/Brassy taste DIURETIC!
❒ A/E: ❖ RISK FOR
b) Agranulocytosis (decreased HYPOKALEMIA!
WBC) d) INSTRUCTIONS: LIFETIME
✔ Sore throat USE! (ONLY for Addison’s
✔ Fever disease!!!)
❒ LABS: CHECK CBC (decreased e) COMMON
WBC) COMPLICATIONS:
❒ MANAGEMENT: ✔ Cataracts
a) GIVEN: AFTER meal 🡪 MIXED ✔ DM
with fruit juices (due to metallic ✔ In CHILDREN: stunted
taste) growth
b) PREVENT TEETH STAINING: ✔ In ELDERLY:
Use straw osteoporosis (increase
❒ EXAMPLES: brittleness of bone)
a) Lugol’s solution f) PREVENT infection
b) Saturated solution potassium g) AVOID sudden
iodide (SSKI) discontinuation (to prevent
Addisonian Crisis)
VI. CORTICOSTEROIDS (“-sone/one” Drugs) ❒ EXAMPLES:
❒ ACTION: reduces inflammation a) Prednisone (Deltasone)
✔ Suppresses autoimmunity b) Hydrocortisone (Cortisol)
✔ Increases GMA: c) Dexamethasone (Decadron) –
a) Glucocorticoids (Cortisol = direct IV
Sugar) ✔ ONLY steroid that can
b) Mineralocorticoids pass blood brain
(Aldosterone = Salt) barrier
c) Androgen (Sex hormones) ✔ INDICATION: cerebral
❒ INDICATIONS: edema
a) Addison’s Disease d) Methylprednisolone
(decreased GMA) (Solu-medrol)
❒ S/E: e) Betamethasone (Celestone)
a) Hyperglycemia ✔ INDICATION: For fetal
b) Hypernatremia lung maturity
c) Hypervolemia (Increased BP) f) Prednisolone (Delta-Cortef)
d) Hypokalemia g) Fudrocortisone (Florinef)
e) Hirsutism
f) High risk for infection
g) High risk for GI irritation CENTRAL NERVOUS SYSTEM
❒ MANAGEMENT: SYMPATHETI PARASYMPATHET
a) GIVEN: C NERVOUS IC NERVOUS
✔ AM (to mimic the normal SYSTEM SYSTEM (PNS)
release of hormones) (SNS)
✔ WITH MEALS (to prevent GI RESPONSE FIGHT or REST & DIGEST
irritation) FLIGHT
b) DIET: NEUROTRANSM Epinephrine Acetylcholine
✔ LOW carbohydrate diet ITTER (Adrenaline)
✔ HIGH protein diet PRINCIPLES
✔ HIGH potassium diet 1) SYSTEM INCREASE DECREASE
c) AVOID:
✔ Caffeinated foods & 2) GIT/URI DECREASE INCREASE
drinks
✔ Carbonated drinks
3) BLOOD VASO-CONS VASODILATI PUPIL DILATION PUPIL CONSTRI
VESSELS TRICTION
EJACULATION ERECTION
4) PUPIL & DILATED CONSTRICT
BRONCHUS

ACTIONS

SYMPATHETIC NERVOUS PARASYMPATH SYMPATHETIC NERVOUS SYSTEM DRUGS

SYSTEM SYST I. ADRENERGICS
1) ALPHA & BETA AGONISTS
❒ ACTION: Stimulates:
STIMULATES: BLOC ✔ Alpha 1:
Vasoconstriction
a) Alpha 1 (Blood vessels): a) Alpha 1 (Bloo (Increased BP)
❖ Vasoconstriction ❖ Vasodilati ✔ Beta 1: Increases HR
(Increase BP) BP) and BP
✔ Beta 2: Bronchodilator
(fast onset)
b) Beta 1 (Heart): b) Beta 1 (Heart) ❒ S/E: SNS S/Sx
❖ Increase HR & BP ❖ Decrease ❒ INDICATIONS:
a) Shock
b) Anaphylaxis (risk for
c) Beta 2 (lungs/smooth c) Beta 2 bronchoconstriction)
muscles): c) Cardiac Arrest
❖ Relaxation of smooth (lungs/smooth m d) Status asthmaticus (asthma that
❖ Contractio does not respond to treatment)
muscle
muscle ❒ MANAGEMENT:
a) CHECK V/S: BP & HR
b) ANTIDOTE: Phentolamine
LUNGS Bronchodilation
LUNGS Bronc (Regitine)
c) ROUTES:
Eye Pupil Dilation ✔ IV = if hospital
muscles Eye Pup
muscles ✔ SQ = if community
Female Uteri DRUG OF CHOICE:
Female Uterine organs
organs relaxation ANAPHYLAXIS
EPINEPHRIN
BRONCHOSPAS E
M

SIDE EFFECTS STATUS

ASTHMATICUS
DRY MOUTH INCREASED S
SALIVA ❒ EXAMPLES:
a) Epinephrine (Adrenaline Cl)
CONSTIPATION DIARR b) Norepinephrine (Levophed)
2) ALPHA AGONISTS
URINARY RETENTION INCREASED U/ ❒ ACTION: Stimulates:
INCREASED V/S DECREA ✔ Alpha 1:
Vasoconstriction
BRONCHODILATION BRONCHOCO (Increased BP)
✔ Relieves nasal
decongestion
 ❒ S/E: SNS S/Sx ❒ REFER to Beta Adrenergic &
Bronchodilator in RESPIRATORY
❒ MANAGEMENT: DRUGS (p. 1)!
a) AVOID IV overdose (risk for
rebound congestion) II. ANTICHOLINERGICS
b) CAUTION: ❒ ACTION: blocks acetylcholine (SNS
✔ Hypertensive crisis effect)
✔ Dysrhythmias ❒ EFFECTIVENESS:
✔ Glaucoma a) Pupil dilation 🡪 for eye
❒ EXAMPLES: examination
a) Phenylephrine b) Decreases gastric secretions
(Neo=Synephrine) (HCl) 🡪 for PUD
b) Methoxamine (Vasoxyl) c) Decreases oral secretions (dry
3) BETA 1 & 2 AGONISTS mouth) 🡪 for pre-op
(NONSELECTIVE) medications (preventing
❒ ACTION: Stimulates: aspiration)
✔ Beta 1: Increases HR ❒ S/E: SNS S/Sx
and BP ❒ MANAGEMENT:
✔ Beta 2: Bronchodilator a) GIVEN: BEFORE surgery
❒ S/E: SNS S/Sx (prevent aspiration)
❒ EXAMPLES: b) CONTRAINDICATED IN:
a) Isoproterenol (Isuprel) Glaucoma
b) Isoxsuprine HCl (Vasodilan) c) DIET: HIGH fiber
c) Ritrodine (Yutopar) ❒ EXAMPLES:
✔ DOC: for uterine a) Atropine sulfate
contraction (pre-term ✔ DOC: for bradycardia
labor) b) Scopolamine
4) BETA 1 AGONISTS (SELECTIVE) c) Glycopyrrolate (Robinul)
❒ ACTION: Stimulates:
✔ Beta 1: Increases HR
and BP
PARASYMPATHETIC NERVOUS SYSTEM
✔ Increases CO
DRUGS
❒ S/E: SNS S/Sx
❒ INDICATIONS: I. ADRENERGIC BLOCKING AGENTS
a) CHF 1) ALPHA BLOCKERS
b) Shock (Cardiogenic Shock) ❒ ACTION: Blocks:
❒ MANAGEMENT: ✔ Alpha 1: vasodilation
a) CHECK V/S: BP & HR (regular (Decreases BP)
monitoring) ❒ S/E: PNS S/Sx
b) For accuracy: use infusion ❒ INDICATIONS:
pump a) Hypertension
c) ANTIDOTE: Phentolamine b) Hypertensive Crisis
(Regitine) c) Angina Pectoris
d) PREVENT extravasation: (+) d) MI
leakage ❒ MANAGEMENT:
✔ use LARGE VEIN a) CHECK V/S: BP
✔ use MINIDRIP tubing b) REFER to Antihypertensives
✔ if (+) extravasation: in CARDIOVASCULAR
STOP INFUSION DRUGS (p.6)!
❒ EXAMPLES: ❒ EXAMPLES:
a) Dopamine HCl (Intropin) a) Phentolamine (Regitine)
b) Dobutamine (Dobutrex) b) Ergotamine tartrate (Ergomar)
5) BETA 2 AGONISTS (“-ol” Drugs) ✔ CONTRAINDICATED: in
pregnant women (can
cause uterine
contraction)
 6) BETA BLOCKERS (“-olol” Drugs) ❒ Dx Drug: Edrophonium Cl
❒ ACTION: BLOCKS: (Tensilon)
✔ Beta 1: Decreases HR a) ROUTE: IV/IM
and BP b) ONSET: 1 minute
❒ REFER this to c) (+) MG: sudden increase in
CARDIOVASCULAR DRUGS (p. muscle strength upon
6)! Tensilon injection
d) DURATION: 5-20 or 3-5
II. CHOLINERGICS minutes (Short duration)
❒ ACTION: Stimulates PNS e) NOT USED as
❒ EFFECTIVENESS: maintenance!
a) Pupil constriction 🡪 DOC for f) If DIAGNOSED ALREADY:
glaucoma ✔ Tensilon is still injected
b) Increase gastric secretions for differentiation of
(HCl) myasthenic crisis
❒ S/E: PNS S/Sx versus cholinergic
❒ MANAGEMENT: crisis.
a) ANTIDOTE: atropine sulfate
(anticholinergic) MYASTHENIC CHOLINERGIC
b) If GIVEN for glaucoma: CRISIS CRISIS
LIFETIME USE! CAUSE UNDER OVER
c) GLAUCOMA: medication medication
⮚ MIOTICS S/Sx ❒ Weakness ❒ Weakness
✔ A cholinergic:
pilocarpine GIVE INCREASE WORSENS
✔ An optic beta blocker: Tensilon muscle strength weakness
timolol
⮚ CARBONIC ANHYDRASE ❒ MANAGEMENT:
INHIBITOR a) GIVEN: BEFORE meals (30
✔ Diamox: inhibits minutes BEFORE meals)
aqueous humor ✔ This is to give more
production (decreases energy in eating meals.
IOP) ✔ GIVEN ON TIME (to
❒ EXAMPLES: maintain therapeutic
a) Pilocarpine (Akarpine) level)
✔ DOC: for glaucoma ✔ If EARLY: cause
b) Bethanecol Cl (Urecholine) cholinergic crisis
✔ DOC: for urinary ✔ If LATE: cause
retention myasthenic crisis
c) Acetylcholine Cl (Miochol) b) ANTIDOTE: Atropine sulfate
(anticholinergic)
III. ANTICHOLINESTERASE ✔ Must be on
(“-tigmine” Drugs) BEDSIDE
❒ ACTION: blocks cholinesterase (to ❒ EXAMPLES:
increase acetylcholine) a) Neostigmine (Prostigmin)
❒ EFFECTIVENESS: Increase b) Pyridostigmine (Mestinon)
muscle strength c) Edrophonium Cl (Tensilon)
a) Increase chewing ✔ DIAGNOSTIC test for
b) Louder speech Myasthenia gravis
❒ INDICATIONS:
a) Myasthenia Gravis (decrease
acetylcholine) III. ANTIALZHEIMERS
✔ Classical sign: muscle ❒ ACTION: increases acetylcholine
weakness (to prevent progress of the disease)
❒ S/E: PNS S/Sx ❒ S/E: PNS S/Sx
 ❒ MANAGEMENT: ❒ ACTION: stimulates dopamine
a) GIVEN: BEDTIME production
b) 1st drug: Tacrine (Cognex) ❒ EFFECTIVENESS:
✔ S/E: Hepatotoxic ❒ MANAGEMENT:
✔ CHECK LABS: ALT/AST a) GIVEN: WITH meals (to
c) DOC: Donepezil (Aricept) avoid GI irritation)
❒ EXAMPLES: b) INSTRUCTIONS: LIFETIME
a) Tacrine (Cognex) USE!
b) Donepezil (Aricept) c) URINE COLOR: Dark/Brown
c) Galantamine (Reminyl) d) AVOID Vitamin B6
d) Rivastigmine (Exelon) ✔ Root crops
✔ Cereals
✔ Egg yolk
IV. ANTIPARKINSON AGENTS e) AVOID/DECREASE protein
1) DOPAMINERGICS (“-dopa” Drugs) intake (decreases
❒ ACTION: increases dopamine level absorption of levodopa)
in the brain ❒ EXAMPLES:
❒ EFFECTIVENESS: a) Amantadine (Symmetrel)
a) Decreases tremors b) Ropinirole (Requip)
b) Decreases Rigidity c) Bromocriptine (Parlodel)
❒ S/E:
a) Postural hypotension V. ANTICONVULSANTS
(COMMON) ❒ ACTION: Slows nerve transmission
b) Anorexia 1) BARBITURATES (“-bital” Drugs)
c) Nausea & Vomiting ❒ S/E: CNS Suppressant
d) Gastric irritation a) Sedation
❒ MANAGEMENT: b) Drowsiness
a) GIVEN: WITH meals (to c) Dizziness
avoid GI irritation) d) Lethargy
b) INSTRUCTIONS: LIFETIME ❒ MANAGEMENT:
USE! a) PRIORITY: SAFETY
c) URINE COLOR: Dark/Brown ❒ EXAMPLES:
d) AVOID Vitamin B6 a) Phenobarbital sodium
✔ Root crops (Luminal)
✔ Cereals ✔ DOC: for epilepsy
✔ Egg yolk b) Amobarbital sodium
e) AVOID/DECREASE protein (Amytal)
intake (decreases c) Pentobarbital sodium
absorption of levodopa) (Nembutal)
❒ EXAMPLES: d) Secobarbital sodium
a) Levodopa (Larodopa) (Seconal)
b) Carbidopa/levodopa 2) HYDANTOINS (“-toin” Drugs)
(Senemet) ❒ ACTION:
❒ (N) serum level: 10-20 mcg/mL
❒ TOXIC SIGNS:
a) Sedation
b) Slurred Speech
c) Ataxia (uncoordinated
movements)
d) Nystagmus (jerking
movement of eyes)
❒ S/E: Gingival Hyperplasia (gums
are bigger)
2) DOPAMINE AGONIST ❒
❒ MANAGEMENT:
 a) HYGIENE: Oral
✔ Dental check-up
(every 6 months)
✔ Use soft toothbrush
✔ Gentle massage
b) URINE COLOR: pink/brown
c) PREVENT precipitation:
✔ ROUTE: IV
✔ FLUSH: NSS (NaCl
0.9%)
✔ Infuse Slowly: 90
minutes
❒ EXAMPLES:
a) Phenytoin (Dilantin)
✔ DOC: for grand mal
seizures
b) Ethotoin (Peganone)
c) Mephentoin (Mesantoin)
3) OTHER CONVULSANTS
❒ EXAMPLES:
a) Carbamazepine (Tegretol)
✔ DOC: for Tic
Douloureaux
(Trigeminal
neuralgia)
b) Valproic acid (Depakene)

GENERAL MANAGEMENT FOR

ANTICONVULSANTS
1) AVOID: activities require alertness
✔ Driving
✔ Operating machines
2) TAPER: gradual discontinuation (to
prevent status epilepticus)
3) EPILEPSY (chronic recurrent seizures)
✔ DOC: phenobarbital (Luminal)
4) Grand mal Seizures/Tonic-clonic
Seizures
✔ DOC: phenytoin (Dilantin)
5) Status Epilepticus (continuous
uninterrupted seizures)
✔ DOC: Diazepam (Valium)
6) Tic Douloureaux (trigeminal neuralgia:
nerve pain)
✔ DOC: Carbamazepine
(Tegretol)