PHARMACOLOGY

STUDENTSNOTES/WORKBOOK

I
. Cour
seCode:
NCM 106

I
I. Cour
seTi
tl
e:PHARMACOLOGY

I
II
. Cr
edi
tUni
ts:
3uni
tsl
ect
ure(
54Hour
s)

I
V.Cour
seDescr
ipt
ion:

CHAPTER3:DRUGSAFFECTI
NGTHEBODYSYSTEM

 DRUGSACTI
NGONTHENERVOUSSYSTEM

CENTRALNERVOUSSYSTEM –i
sthebody
’spr
imar
yner
voussy
stem.

Component s:
1.Brain
2.SpinalCor
d

PERI
PHERALNERVOUSSYSTEM( PNS)-isl
ocat
edoutsi
dethebrai
nandspinalcord.
- Afteri
nterpr
etati
onbyt
heCNS, t
hePNSrecei
vesst
imuli
andini
ti
atesresponsest
o
thosestimuli.
Components/Divi
sions:

1.Autonomi cNer v ousSy stem (ANS) /Vi sceralSy st

em
- I nnervatesoract sinsmoot hmuscl esandgl ands;i
sinv
oluntar
yoverwhichtheperson
hasli
ttleornocont rol.E.g.hear t
beat ,peri
stalt
icacti
on.
Funct i
on:cont rolandr egulationoft hehear t,respir
ator
ysystem,GIT,
bladder
,eyesand
glands.
Set
sofNeur onsi nt heANS:
A.Af ferent /Sensor yNeur ons–sendsi mpul sestotheCNSwher etheyareint
erprt
eted.
B.Ef ferent /Mot orNeur ons–r eceivest heimpulsesfr
om thebrai
nt hr
oughthespinal
cordt ot heef fectoror gan.
Branches:
a. Sy mpat het i
cNer vousSy stem
b. Par asympat heti
cner vousSy stem
2.Somat i
cNer voussy stem

1|Page
 - I
sav
olunt
arysy
stem unl
i
keANS;
inner
vat
esskel
etal
muscl
esov
erwhi
cht
her
eiscont
rol
.

SYMPATHETI CNERVOUSSYSTEM
- IsalsocalledADRENERGI CSYSTEM becauseatonet
ime,i
twasbel
i
evedt
hatadr
enal
i
n
wast heneurotr
ansmi
tt
erthatinnerv
atedt
hesmoothmuscl
e.Not
e:t
he
neurotr
ansmi t
teri
sNorepinephr
ine.
ReceptorSit
es:
1.Al pha1
2.Al pha2
3.Bet a1
4.Bet a2

PARASYMPATHETI CNERVOUSSYSTEM
- Isalsocall
edCHOLI NERGICSYSTEM becauset heneurotr
ansmit
teratt
heendoft he
neuronthatinnervat
esthemuscleisAcety
lcholine.
I
mportantConsiderat
ions:
1.Drugsthatmi micstheneur
otr
ansmi t
ter
snorepinephri
neandacetyl
choli
ne pr oduces
responsesoppositetoeachotheri
nthesameor gan.
2.Drugsthatmi micsthesympat
heticnerv
oussy stem cancausesi
milarr
esponsesinthe
organ.

EFFECTSONBODYORGANS/
STRUCTURES:

BodyOrgan/
Str
uct
ure Sympatheti
c Parasy mpathetic
1.Eyes dil
atespupil
s const ri
ctspupils
2.Lungs di
l
atesbronchi
oles const ri
ctsbronchiol
esand
Increasessecr eti
ons
3.Heart i
ncreaseHR decreaseHR
4.Bloodvessels constri
cti
on dil
ation
5.GIT rel
axessmoot hmuscl
es i
ncreaseper i
stalsi
s
6.Bladder r
elaxesbladdermuscl
e const r
ict
sbladder
7.Uterus r
elaxesuteri
nemuscle -
8.Sali
varyGlands - increasesalivat
ion

DRUGACTI
ONS:

I.Sy mpat heticStimulants/Sympathomimet i

cs(adr energics,adrenomimeti
cs, adrenergic
agoni sts)
1.I ncreaseBP 4.Dil
at espupi l
s
2.I ncreaseHR 5.Rel axut eri
nemuscl es
3.Rel axbr onchiol
es 6.Incr easebl oodsugar
II.Sympat heti
cDepr essants/Sympatholy
tics(adr energicblockers,adr
enolyti
cs,adrenergi
c
agoni sts)
1.Decr easePR
2.Decr easeBP
3.Const ri
ctsbronchiol
es
III.Parasympat heticStimulants/Di
rect
-Act i
ngPar asy mpat heti
cs(choli
nergicorchol i
nergic
agoni sts)
1. Decr easeBP 4.Const ri
ctspupils
2.I ncreaseHR 5.Incr easedur i
narycontract
ion

2|Page
 3.Const ri
ctdbronchiol
es 6.Increasedperist
alsi
s
I
V.Par
asy mpatheticDepressant
s/Par asy
mpat
holyti
cs
1.IncreasedPR 4.Increasedurinaryret
ent
ion
2.Decr easedmucussecr et
ions 5.Dil
atepupil
s
3.Decr easedgastri
cmotili
ty

 CENTRALNERVOUSSYSTEM DRUGS

I
. ADRENERGICSANDADRENERGI
CBLOCKERS–ar
edr
ugst
hataf
fect
sthesy
mpat
het
ic
ner
voussy
stem.

A.ADRENERGICS(Sympathomimeti
csorAdrenomimetics)–aredrugsthatst
imul
atethe
sympat
het
icnerv
oussyst
em; t
heymimictheneurot
ransmitt
erNorepi
nephri
ne.Theyacron
doneormoreadr
ener
gicr
eceptorsi
tesl
ocatedonthecell
sofsmoot hmuscles.

Ef
fect
satRecept
orSi
tes:

1.Alpha1–l ocat edi nt hev ascul art i

ssuesofsmoot hmuscl es.
a.I ncr easesf orceofhear tcont raction
b.Vasoconst rictionincr easesBP
c. My dr i
asis
d.Decr easedsal ivarysecr et ions
e. I ncr easedcont racti
onandej acul ati
onofbl adderandpr ostati
ccapsule.
Not e:WhenAl pha1i shy per stimul at ed, bloodflowi sdecreasedi nvi
talor gans.
2.Alpha2–l ocat edi nt hepost gangl ionicsy mpat heticner veendings.
a.I nhi bitsreleaseofnor epi nephr inel eadst ov asoconstrict
ion.
b.Di l
at esbl oodv essels.
c. Decr easeBP.
d.Decr easeGI Tmot il
ityandt one.
3.Beta1–l ocat edpr imar il
yint hehear t
a.I ncr easeHRandf orceofcont raction
b.I ncr easer enni nsecr et i
ont hati ncreasesBP
4.Beta2–l ocat edi nthesmoot hmuscl esoft hel ungs,arteri
olesofskeletalmuscl esandthe
uter
inemuscl es.
a.Di l
at esbr onchi oles.
b.Pr omot esGI Tandut eriner el axat i
on.
c. Pr omot esi ncreasei nbl oodsugart hroughgl ycogenolysisinthel
iver.
d.I ncr easedbl oodf lowi nt heskel etal muscles.
5.Dopami ner gi cRecept or-l ocat edi nt her enal ,mesent eri
c,coronaryandcer ebralart
eri
es.
a.Di latesbl oodv essels.
b.I ncr easedbl oodf low.
Note:Onl yDopami necanact ivatet hi sr ecept or.

I
NACTI VATI ONOFNEUROTRANSMI TTERS:
Note:Af t
ert heneur otr
ansmi t
tershaveperformeditsfunct
ion,
theact
ionmustbest
oppedt
o
preventprolongingt heeffect.
1.Re- upt akeoft hetransmi t
terbackint
ot heneuron.
2.Enzy mat i
ctransformat i
onordegr edati
on.
3.Di ffusionawayf r
om t hereceptor.
Enzymesr esponsi bleforthedegr edation:

3|Page
 1.Monoami neOxidase(MAO)
2.Cat hecol-O-Methylt
ransferase(COMT)
Drugscanst opt heterminati
onoft heneur otransmitt
er sby:
1.I nhibiti
ngt henorepi
nephr i
ner e-
uptake.
2.I nhibiti
ngt hedegredati
onoft henor epinephri
nebyenzy meact ion.
CLASSIFICATI ONOFADRENERGI CS:
1.Di rect -
Act i
ngSy mpathomi metic-dir
ect l
ysti
mul atetheadrenergicreceptors.E.
g.
epinephr i
ne, nor
epinephri
ne
2.I ndirect-Act i
ngSy mpathomi metics–st i
mulatesthereleaseofnor epinephri
nefrom the
termi nalnerveendings.
3.Mi xed-Act i
ngSy mpatomi metics-bot hdi r
ectandi ndi
rectacti
ng; st
imulatesadrenergic
recept orsitesandstimulatesther el
easeofnor epinephrinefr
om t heterminalnerve
endings.

CATECHOLAMI NES–ar ethechemi calstruct

uresofasubst anceeit
herendogenousor
synt
het
ict
hatcanpr oduceasy mpathomi meti
cr esponse.
Examples:
1.ENDOGENOUS
a.Epi nephr ine
b.Nor epi nephrine
c. Dopami ne
2.SYNTHETIC
a.Isopr oterenol
b.Dobut ami ne
NON-CATHECOLAMI NES
- sti
mulatestheadr energi
creceptors;havelongerdurati
onofacti
onthancat hecol
amines.
Examples:
a.pheny l
ephr i
ne
b.met aproter enol
c. al
buterol
NOTE: Manyoft heseadrenergi
cdr ugsstimulat
emor ethanonereceptorsit
es.

ADRENERGI
CDRUGS:

1.EPINEPHRI NE(Tr adeName:Adr enali

n)
- I sanon- select
iveadrener
gicdrugt hatstimulat
esmor ethanonerecept
orssi
tes.
- Act sonAl pha1, bet
a1andbet a2r eceptorsit
es.
- Responseofst i
mulationr
esultsto:
a.I ncreasedBP c.Incr
easedHR
b.Pupil dil
atat
ion d.Bronchoconst
ri
ction
-Duri
ngshock, i
tisusef ul
becauseitincreasesBP, HRandai r
fl
owt hr
uthelungsthr
u
br
onchodil
at i
on.
ROUTES:
a.SubQ c.Topi
cal
b.IV d.I
nhalat
ion

Not
e:itshoul
dnotbegivenoral
lybecausei
tisr
api
dlymet
abol
izedi
ntheGI
Tandl
iv
er;
thus
i
nadequateser
um l
eveloccur
s.

2.ALBUTEROL(Pr
ovent
il
,Sal
but
amol
,Vent
oli
n)

4|Page
 - Isselect
iveforbeta2adr ener gicreceptors,sot heresponsei spurelybronchodial
ti
on.
- IswellabsorbedintheGI Tandi sextensivelymet abol
izedint heli
ver.
3.ISOPROTERENOLHCl(I supr el)
- Acti
vatesbeta1andbet a2r ecept orsit
es.
- Ismor especifi
cthanepi nephr inebecausei tactsontwodi fferentadr
ener gi
creceptors
butisnotcompl etel
ysel ecti
v e.
- Theresponset obeta1andbet a2st imulationisbronchodilationandincreasedHR.
- Whenusedexcessi vel
y,sev ert achycardi
acanr esult
.
4.CLONIDI
NE( Catapres)ANDMETHYLDOPA( Aldomet )
- Areselecti
vealpha2adr ener gicdr ugsthatar eusedpr i
mar i
lytot r
eatHPN.
- Regulatethereleaseofnor epi nephrinebyi nhibi
ti
ngitsrelease.
- Producescar di
ovasculardepr essionbyst i
mul ati
ngalpha2r eceptorsintheCNSl eading
todecreasedBP

B.ADRENERGICBLOCKERS/ANTAGONI
STS–ar
edr
ugst
hatbl
ockt
heef
fect
soft
he
adr
ener
gicneur
otr
ansmi
tt
ersby:

1.DI
RECTLY–occupyi
ngtheal
phaorbetarecept
orsit
es;
2.I
NDIRECTLY–i
nhibi
ti
ngther
eleaseoft
heneurotr
ansmit
ter
s.

ReceptorSi
tes:
1.Al pha1
2.Bet a1
3.Bet a2

ADRENERGI
CBLOCKERAGENTS:

1. ALPHA- ADRENERGI CBLOCKERS( AlphaBl ockers)

- Aredr ugsthatbl ockori nhi bitar esponseatt heal pha-adr energi
creceptorsi
tes.
- Promot esv asodilati
ont huscausi ngdecr easedBP.
- I
tcanbeusedt otreatper ipher alvasculardi sease.
2.BETA- ADRENERGI CBLOCKERS( Bet a-
Blocker s)
- DecreasesHRr esulti
ngt odecr easedBPandbr onchodi altion.
- Somear enon- selective, blockingbot hbet a1andbet a2r eceptorsi
tes.
Int
ri
nsi cSy mpat homi met icAct i
vity(I
SA)
- Causespar t
ialstimul ationofbet ar eceptor s.
Non-selectiveBet aBl ocker s:
1.Car t
eolol
2.Car vedil
ol
3.Penbut olol
4. Pi ndolol
Propanol olHcl( I
nder al)
- Wast hef ir
stbet ablockerpr escri
bedot reatangi na, cardiacdy sr
hythmiasandHPN.
3.ADRENERGI CNEURONBLOCKERS
- Arethedr ugst hatbl ockt her eleaseofnor epinephr i
nef rom t hesympatheti
cterminal
neurons.
- Areusedt odecr easeBP.
EXAMPLES:
1.Guanet hidi
nemonosul fate( I
smel i
n)
2.Guanadr el
So4( Hy lorel)

5|Page
I
I. CHOLI NERGI CS( Parasympat homimeti
cs)
- Aredrugst hatst i
mulatethepar asy
mpathet
icnerv
oussyst
em,becauset
heymimicthe
parasympat heti
cneur otr
ansmi tt
erACETYLCHOLINE.
Receptors:
1.Muscar inicRecept or
s
- Locatedint hesmoot hmuscl esoft heGI
T,GUT,gl
andsandhear
t;st
imul
atessmoot
h
musclesandsl owsHR.
2.Ni cotini
cRecept or s(Neuromuscular
)
- Aff
ectst heskel et
almuscl es

A.CHOLI
NERGI
CAGENTS:

1.Direct -Act ingChol iner gi cDr ugs

- Aredr ugst hatr esembl eacet ylchol i
neandactdi rectlyont her eceptor ;arepr i
mar i
ly
select ivet ot hemuscar i
nicr ecept orsbutar enon- speci f
ic.
Exampl es:
a.Bet hanecol( Ur echol ine)–act sont hemuscar i
nicrecept or,usedpr i
mar i
lyt o
incr easeur i
nat ion.
b.Met ocl opr omi deHcl( Regl an)–i susedt otreatgast ro-esophageal reflux( GERD)
andi ncr easegast ricempt yingt ime.
c. Pi l
ocar pine–const ri
ctspupi ls;isusedt ot r
eatgl aucomabyr li
ev i
ngf luidbyopeni ng
thecanal ofSchl emm t opr omot edr ai nageofaqeoushumor .
2.Indirect -Act i
ngChol iner gics
-inhibit stheact ionoft heenzy meschol inesterasebyf or mingachemi cal compl ex,
thusper mi ttingacet ylchol i
net oper si standat tacht ot her eceptor .
-donotactonanyr ecept orsi tebutonl yinactivateschol inesteraseper mitting
acet yl
chol inet oaccumul at eatt her ecept orsite.
TypesofI ndi rect -Act i
ngChol iner gics:
a.Rev ersibleChol inest eraseI nhibi t
or s–pr oducepapi l
laryconst ricti
oni nt het er
minal
glaucomaandi ncr easemuscl estrengt hinMy estheniaGr avis.
Exampl es:
1.Neost igmi ne( Prost i
gmi ne)
2.Py ri
dost igmi neBr omi de( Mest inon)
3.Ambenoni um Chl oride(My tel
ase)
4.Edr ophoni um Chl oride(Tensi lon)
b.I rrev ersibleChol inest eraseI nhibitor s–ar epot entagent sbecauseoft heirlong
last i
ngef fect ;usedt opr oducepapi llaryconst ricti
onandmanuf acture
or ganophosphat ei nsect i
ci des

B.ANTI -CHOLI NERGICS(Par asympat holyti

cs)-ar edrugst hatinhi
bitt
heacti
onoft he
acety
lcholi
nebyoccupy i
ngt heacetylcholiner ecept
or s.
Types:
1.ATROPI NE( AtropineSO4)-f i
rstderiv
edf rom thebel ladonnapl antandpur
if
iedin1831; i
s
aclassi
canticholi
nergicormuscar ini
cant agonistdr ug.Itactsont hemuscari
nicreceptor
buthaveli
tt
leef f
ectont henicotini
crecept orsite.
USES:
a.Pr e-opmedi cati
ont odecr easesal iv
ar ysecretion.
b.Ant i-
spasmodi ctot reatpepti
cul cersbecausei trel
axessmoot hmusclesofthe
GITandper i
stal
sis.

6|Page
 c. Agentt oincreaseHRwhenbr adycardi
aispr esent
.
d.Ant idoteformuscar i
nicagonistpoisoni
ng.
2.ANTI
-PARKINSON-ANTI CHOLI NERGI CDRUGS
EXAMPLE:Tr ihexy phenidyl-iswellabsorbedf r
om theGIT;decr
easeinvol
unt
ary
mov ement sanddi mi ni
shessignsandsy mpt omsoft remorsandri
gidi
ty
thatoccur si
nPar kinson’sdisease.
3.ANTI
HISTAMI NESFORTREATI NGMOTI ONSI CKNESS
a.Scopol amine–av ai
lableinpatchbehindt heear.
b.Di menhy drinate(Dramami ne)
c. Mecl izi
neHcl (Bonami ne)
d.Cy cline(Mar ezine)

 NEUROLOGI
CANDNEUROMUSCULARAGENTS

I
. CENTRALNERVOUSSYSTEM STI
MULANTS

1.AMPHETAMINES–sti
mulat
ether
eleaseoftheneur
otr
ansmi
tt
ersnor
epi
nephr
ineand
dopami
nef
rom t
hebrai
nandsy
mpathet
icnervoussyt
em.
Ef
fect
s:
a.Euphor
iaandal
ert
ness e.i
ncr
easedHR
b.Sl
eepl
essness/l
nsomni
a f
.pal
pit
ati
ons
c.Rest
lessness g.car
diacdy
srr
hyt
hmi
as
d.Tremor s h.incr
easedBP
e.Ir
ri
t abi l
it
y
Exampl es:
a.Amphet amine( Adder al)
b.Dext roamphet ami ne( Dexedr ine)
c.Met amphet ami ne( Desoxy n)
AMPHETAMI NE-LI KEDRUGSTOTREATADHDANDNARCOLEPSY
a.Met hy l
phenidat e( Rit
alin)
b.Dexmet hyl
pheni dat e(Focal i
n)
c. Pemol i
ne( Cylert)
d.Modaf i
nil(Prov igil)
Mechani sm ofAct i
on:
a.I ncr easechi l
d’sat t
ent ionspanandcogni t
iveper
f or
mance.
b.Decr easesimpul siveness, hyperacti
vit
yandr est
lessness.
c. Tr eat snarcolepsy .
I
mpor tantConsi der at i
ons:
a.Pemol i
neshoul dnotbeconsi deredafirst
-l
inedrugforADHD.
b.Ther eislesspot ential abuseofPemol inethanMet hyl
phenidat
e(Ri
tal
i
n)t
husi
s
classi fi
edasschedul edsubst ance.
c. Theseshoul dnotbet akenintheev eni
ng.

2.ANOREXI
ANTS (
Appet
it
eSt
imul
ant
s)–t
otr
eatobesi
ty.
Exampl
es:

7|Page
 a.Benzphet ami neHcl (
Didr ex)
b.Dext roamphet ami neSO4( Dexedri
ne)
c. Diethylpropi onHCl (
Dospon, Tenuat e,Tenapil,Nobesi ne)
d.Phent ermi neHCl (
Fastin,Ionami n,Zant r
yl,
AdipexP, Obe-ni
x30)
e. WithoutPr opanol ami neHCl :Acutrim, Control
, Dexat ri
m,Dexatri
neNat ur
al,Prot
amine
I
mportantConsi der ations:
1.Amphet ami nesar erecommendedasanof exiant sforSHORTt erm useonly(412
weeks)ornotatal l.
2.FDAor der edt heremov alofpheny lpropanolami nef roOTCdr ugs,weightlossdrugs
andcol dr emedi es.
3.St udiesshowedt hatyoungwomenwhot ookpr opanolamineaddedwei ghtloss
drugshasi ncreasedr iskf orHPN, st r
oke,renal fail
ure,psychosisandcardiac
dysrhy t
hmi as.
4.Ex ercise, dietandl if
est ylemodi fi
cat i
onisst i
l
l thebestwei ghtlossmanagement .

3.ANALEPTI CS–i saCNSstimulantt

hataff
ectst
hebrainstem andspi
nalcor
dbutmayal
so
af
fectthecerebr
al cor
tex.
Acti
on:sti
mulatesrespir
ati
on
Examples:
a.Met hyl
xanthines–caffei
neandtheophy
ll
inearethemaindrugs
b.Doxapr am HCl (
Dopram)-respi
rat
orysti
mulant

4.RESPI
RATORYNERVOUSSYSTEM STI
MULANTS

Doxapr am (
Dopr am)–isaCNSandr espir
ator
ystimul
antusedtotr
eatrespi
rator
ydepression
causedby :
a.Dr ugov er
dose
b.Pr eandpostopanestheti
cr espi
rator
ydepressi
on
c. COPD
Not e:shouldbeusedwithcaut
ionf orthetr
eatmentofneonat
alapneaandov erdosageleads
toHPN, t
achycardi
aandconvul
sion.

5.HEADACHES:MI
GRAI
NEANDCLUSTER

Migrai
neHeadaches–arecharact
eri
zedbyuni
l
ater
alt
hrobbi
ngheadpai
naccompani
edby
nauseaandvomit
ingandphot
ophobia.

CAUSE:i
nfl
ammat
ionanddi
l
atat
ionofbl
oodv
essel
sint
hecr
ani
um.

TYPES:
a.Classi
cMi
grai
nes–areassoci
atedwi
thanaur
athatoccur
smi
nut
est
oonehourbef
ore
onset.
b.CommonMi gr
aines–ar
enotassoci
atedwi
thanaura.

ClusterHeadaches-ar echar
acter
izedbyasever eunil
ateral
,non-t
hrobbi
ngpainusual
l
y
l
ocat4dar oundt heeye.Theyoccurinseri
esofclusterat
tacksandarenitassoci
atedwi
than
aura;donotcausenauseaandv omi t
ing;
menar emor eaffected.
TREATMENT:
A.PREVENTI VE
1.Beta-adrenergi
cblocker
s

8|Page
 2.Anticonvulsants
3.Tri
cy cl
icant i
depr
essants
B.TREATMENTOFACUTEATTACK
MI LD
1.Aspirin
2.Acet ami nophen
3.NSAI DS
4.Meper idi
neHCl
5.Butorphanol NasalSpray(Stadol
NS)
MODERATE
1.Ergotami neTartr
ate
2.Dihy droergotamine
ACUTEATTACKS
1.Tr iptans(5- HT<receptoragoni
st)

I
I. CENTRALNERVOUSSYSTEM DEPRESSANTS

1.SEDATI VEHYPNOTI CS–i st hemi l

destf or
m ofCNSsedat i
onwhi chdiminishesphy sicaland
mentalresponsesatl owerdosages; i
ncr easingt hedr ugdosecanpr oducehy pnoticeffectbut
nothypnosi s,instead,nat uralsleep.
A.Barbitur ates–wer ei ntroducedasasedat i
v eintheear ly1900s.
a.Long- Acti
ngBar bi turates-i susedt ocont rolseizuresi nepil
epsy .
e.g.Phenobar bit
al, Mephobar bital
b.I ntermedi ate–Act ingBar bit
ur ates–i susedassl eepsust ainersf ormaintaini
ngl ong
periodsofsl eep.
Exampl es:Amobar bi
tal(Amy tal)
,Apr obarbit
al (Al
ur at
e),Butabarbi
t al
(But isol)
c. Shor t-Acti
ngBar biturates–ar eusedt oinducesl eepf orthosewhohav ediffi
culty
fal
lingasl eep; maycauseper sont oawakenear l
yint hemor ning.
Exampl es:Secobar bit
al(Seconal )
,Pent obarbital(Nembut al
)
d. Ult ra–Shor tActingBar biturates–i susedasgener al anesthesia.
Exampl e: Thiopent al Na( Pentothal)
NOTE:Bar bi t
ur at
esshoul dber estrictedt oshor t
-t
erm use(2weeksorl ess)becauseoft hei
r
numeroussi deef fectsincl udingdr ugt olerance.

B.Benzodiazepi nes–ar eorderedassedative-

hypnoti
csforinducingsleep;
incr
easest
he
act
ionofthei nhibi
tor
yneurotransmit
terGABAt otheGABAr eceptors.
Exampl es:
a.Fl urazepam (Dalmane) e.Quazepam (Doral)
b.Temazepam ( Restr
il
) f.Lorazepam (At
ivan)
c. Triazolam (Halci
on) g.Diazepam (Val
ium)
d.Est azolam (Prosom)

Fl
umazeni
l–i
stheant
idot
eforBenzodi
azepi
neov
erdosage.

C.Non- Benzodiazepines–i ntr

oducedin1960;i
susedforshort
-termt r
eat
mentofinsomnia
(10daysonl y)
Exampl e:Zolpi
dem (Ambion)
D.Piperidi
nedimes–i nt
roducedmid1950s;resembl
ebenzodiazepinewitheff
ect
ssimil
arto
shrt
-acti
ngbar bi
turat
es.Itcanbeaddicti
veandcancausesev er
er ect
ions.
E.ChloralHydrate–wasi nt
roducedin1860s;i
susedtoinducesleepandt odecr
ease

9|Page
noct
urnalawakeni
ngs.I
tcanbegivenwit
hcl
i
entswit
hmi
l
dli
verdy
sfunct
ionbutshoul
dbe
avoi
dedifsever
eli
verorrenal di
sor
deri
spr
esent
.

2.ANESTHETI CS–ar eclassi

fi
edasl ocalorgeneral
.
Gener alAnesthesia–depresstheCNS, all
evi
atepainandcauseal ossofconsci
ousness.
Nitr
ousOxi de( “
LaughingGas”)–wast hefi
rstanest
hesiausedforsurger
yin1800s;i
tissti
l
l
aneffecti
veanestheticandisfr
equentlyusedindentalsur
gery.
EtherandChl oroform –wasintroducedinthemid1800s; buti
snowNOTUSED.

STAGESOFANESTHESI
A:

A.Anal gesia(Inducti
onSt age)–begi nswi t
ht heconsciousnessandendswi t
hthelossof
consciousness; speechisdi ff
icul
t,sensati
onsofsmel l
andpai nar
el ost
;dreamsandssuditory
andv i
sual hall
ucinati
onsmayossur .
B.Exci t
ementandDel ir
ium-pr oducesal ossofconsci ousnesscausedbydepr essi
onofthe
cerebralcortex;confusi
on, excit
ementordel i
rium mayoccur ;shor
tinducti
ont i
me.
C.Sur gical–sur gi
calprocedurei sperf
ormeddur i
ngthisstage;
asanest hesi
adeepens,the
respi
rationbecomesshal l
owandRRi ncreased.
D.Medul l
aryPar al
ysi
s(Toxi cStage)–r espirati
onsarelostandcircul
atorycoll
apseoccurs;
venti
latorassistanceisnecessar y.

TYPESOFANESTHESI
A:

1. I
nhalati
onAnest hetics–areusedt odel
iv
eranesthesiaduri
ngthethi
rdstageof
anesthesi
a.Itprovidessmoot hinduct
ionandrecoveryofconsci
ousnessoccursaf
ter1
hourormi nutes.Areusuallymixedwithbarbi
tur
ates,str
onganalgesi
csandamuscl e
rel
axantforsurgicalprocedur
es.

Exampl es:
a.Desf lurane e.Hal ot
hane
b.Cy cl
opr opane f.Cy cl
opropane
c.Met hoxy f l
ur ane g.Met hoxyflur
ane
d.Sev of l
urane h.Sevoflurane
SideEffects:
a.Respi rat orydepr ession
b.Hy pot ewnsi on
c. Dy srhy thmi as
d.Hepat icdy sfunction
e. Hy per ther mi a
f.
2.I ntr
avenousAnest het i
cs–may beusedf orgener
alanest
hesi
aorf
ort
hei
nduct
ionof
anesthesia;hav er api donsetandshor tdurati
onofacti
on.
Exampl es:
a.Thi opent al Na(Pent othal)
b.Dr oper idol (Innovar )
c. Et omi dat e( Ami date)
d.Ket ami neHCl (
Ket al
ar)
e. Mi dazol am ( Versed)
f. Pr opof ol (Di pr
ivan)
Adv erseEf fects:

10|Page
 a.Respir
ator
ydepressi
on
b.Cardi
ovascul
ardepression
c. Maysuppor
tmicrobialgrowt
handmayi
ncr
easer
iskofbact
eri
ali
nfect
ion.

3.TopicalAnesthet
ics–isli
mitedtomucusmembr anes,
brokenorunbrokenski
nsurf
aces
andbur ns.I
tdecr
easesthesensit
ivenerveendingsoftheaffect
edarea.Itmaycomein
di
fferentfor
mssuchassol ut
ions,l
iqui
d,spray
,ointment,cr
eam andgel.

4.LocalAnest het i
cs–bl ockspai natthesitewherethedrugisadminist
eredall
owing
consciousnesst obemai ntained.
Uses:
a.Per formi ngdent alprocedures.
b.Sut uri
ngski nlacerati
ons
c. Per formi ngshor t-
ter
m sur geryatalocal
izedarea.
d.Bl ocki ngner v
ei mpulsesbelowt heinser
ti
onofaspi nalanest
hesia.
e. Per formi ngdi agnosti
cpr ocedures.
Exampl es:
a.Cocai neHCl
b.Pr ocai neHCl
c. Lidocai neHCl
d.Pai nf reePumpSy st em
5.SpinalAnest hesia–r equiresthatalocalanest
heti
cbei nj
ectedinthesubarachnoi
dspace
betweenL3andL4.

Si
tes:
a.Spi nalBl ock–i st hepenet rationoft heanest heticintot hesubar achnoid
membr ane
b.Epi duralBl ock–i st hepl acementoft hel ocal anest heticintheout ercov er
ingof
thespi nal cor d.
c. Saddl eBl ock–i sgi venatt hel owerendoft hespi nal columnt oblockt heperineal
area.Itisf requent l
yusedf orwomeni nl abordur ingchi l
dbir
th.
I
mpor t
antConsi der at i
ons:
a.I fthelocal anest hesi aisgi vent oohi ghi nt hespi nal column, therespiratory
muscl escoul dbeaf fectedandr espi ratorydi stresscoul dresult.
b.Headachesmi ghtr esultfollowi ngspi nal anest hesi aduet oadecr easeintheCSF
pressur ecausedbyt heleakoff l
uidatt heneedl ei nser t
ion.
c. Encour agecl ientt oremai nFLATf ollowi ngsur gerywi t
hspinal anesthesiaand
takeincr easedf l
uids.
d.Hy potensi oncanoccurf ollowi ngspi nal anest hesi a.
e. BPshoul dbemoni tor eddur ingadmi nistrationoft heset ypesofanest hesia
becauseadecr easei nBPr esul ti
ngf rom t hedr ugmi ghtoccur .
f. Prepar ethecl ientf orsur gerybyexpl ainingt hepr epar ati
onsandcompl eti
ngthe
pre-opmedi cat i
onst oenhancesaf etyandef fectivenessofanest hesiaand
surgery.

I
II
.DRUGSFORPAI
NMANAGEMENT:NON-
NARCOTI
CANDNARCOTI
CANALGESI
C

1.NARCOTI CANALGESIC–ar enotaddict

iveandarelesspotentt
hannar
coti
canal
gesi
cs;
it
act
satthePNSatt hepai
nreceptorsit
es.Theyareusedtotreatmil
dtomoderat
epai
nand
maybepurchasedover
-t
he–count er
.

11|Page
 A.Sal i
cy latesandNon- Ster oi
dal Anti-
Inf l
ammat oryDr ugs( NSAI Ds)–hav eananal gesi c
effectaswel l asant ipy reti
candant i
-infl
ammat or yact ion.
Exampl es:
a.Aspi rin( ASA)
b.I bupr of en
c. Napr oxen
B.Acet ami nophen-i sapopul arnon- prescr ipti
ondr ugt akenbyi nfant s,chi l
drenand
adul tsandol deradul tst oreliev epain, discomf ortandf ev er.Itisanon- nar coticdr ug
buti snotanNSAI D.I tdoesnothav eanyant i-i
nf l
ammat or yeffect.
Exampl es:
a.Ty lenol
b.Panadol
c. Tempr a
d.Excedr in
2.NON- NARCOTI CANALGESI CS/NARCOTI CAGONI STS–ar epr escr i
bedf ormoder ateand
severepain.I tact smost lyont heCNS.I tdoesnotonl ysuppr esspai nimpul sesbutal so
suppressrespi rationsandcoughi ngbyact ingont herespi rator yandcoughcebnt ersint he
medullaandbr ainst em.I thasal soanant i
tussiveandant i-diar rheal eff
ect.
A.Opi um -wasusedasear lyas350B. C.t or el
iev epai n.
B.Mor phi ne–i sanext ractionf rom opi um, isapot entnar cot icanal gesi c.Itisusedf or
acut epai nr esul ti
ngf rom acut eMI ,
canceranddy spneaf rom pul monar yedema.I tis
alsoapr e- opmedi cation
Adv er seReact ions:
a.Respi rat or ydepr essi on
b.Or thost at ichy potensi on
c. Mi osis
d.Ur inar yr et ent i
on
e. Const ipat ionduet odecr easedbowel mot ili
ty .
f. Coughsuppr ession
C.Meper idine-hasashor terdur ationofact iont hanmor phi neandi t
spot encyv ar i
es
accor dingt ot hedosage, iti
sef fect
ivei nGIpr ocedur es.I tispr eferredov ermor phine
duringpr egnancybecausei tsoesnotdi mi nishut erinecont racti
onsandcausel esser
neonat al respi ratorydepr ession.I tshoul dnotbepr escr ibedf orlong- term use.
D.Hy dr omor phone( Dilaudi d)–i sasemi synt hetic nar cot i
csi mil
art omor phine.The
anal gesi cef fecti s6Xmor epot entt hanmor phinewi thf ewerhy pnot icef fectsandl ess
GIdi st ress.I thasaf asteronsetandshor terdur at i
onofact ionthanmor phine.Iti sgi v
en
orally, rectal ly, subQ, IM andI Vandmay beadmi nist eredbyPCA.
E.Combi nat iondr ugs(Anal gesic+Nar coticAnal gesi c)–i susedt otr eatmoder atet o
sev erepai n.I thel pst odecr easedr ugdependencyt hatmayr esultfrom possi blel ong-
timeuseofanar coticagent .
Exampl e:
a.Hy drocodone+I bupr of
en
b.Acet ami nophen+Codei ne
F.Tr ansder malOpi oidAnal gesics–pr ov i
deacont inuous“ round- the-clock”pai ncont rol
thati shel pf ul tocl i
ent swhosuf ferfrochr onicpai n.I tisnotusef ul foracut epost -
op
pain.
Exampl e:Fent any l(Dur agesic)

3.NARCOTICAGONIST-ANATAGONI
ST(MixedNarcot
ic-
Agoni
stAntagonist
)-i
samixt
ureof
agoni
st-
ant
agoni
stwer
edevel
opedi
nhopesofdecr
easi
ngnarcot
icabuse.Thesear
e

12|Page
consi deredsaf ef orusedur inglabor ;howev er,
theirsaf etywhent akendur ingpregnancyhasnot
yetbeenest ablished.
Exampl es:
a.Nal oxone( NAr can)
b.Pent azoci ne( Tal win)
c. But orphanol t
ar trate( Stadol)
d.Bupr enor phine( Bupr enex)
e. Nal buphineHCl (Nubai n)
4.NARCOTI CANTAGONI STS–ar eant i
dot esforov erdosesofnar coticanalgesics.Itblocks
ther ecept oranddi spl acesanynar cot icthatwoul dnor mal lybeatt her eceptor,t
hus,inhibit
ing
thenar coticact ion.
Exampl es:
a.Nal oxone(NAr can)
b.Nal tr
exoneHcl (ReVi a)
c. Nal mef ene( Rev ex )
METHADONETREATMENTPROGRAM –i sthetreatmentf ornarcot i
caddi ct
edper sons.It
wor ksbyr eplaci ngt henar coticswithmet hadone, alsoanar cot
icbutcausesl essdependency
thannar coticitr eplaces.Thehal f-
li
fei slongert hanmostoft henar cot i
cssoi ti
sgi v
enOD.The
dosagei s15- 40mg/ day ,amaxi mum of120mg/ day.
Ty pes:
1.Weani ngPr ogr am –t heper sonr eceivesadosef ort hef irst2day sthatisapproximat el
yt he
sameast hedoseoft he“ street”drugt owhi chhei saddi cted.Af ter2day s,t
hedosemay be
decr easedby5- 10mgdai lyorasi ndicatedunt i
ltheper soni sweanedf rom themet hadone.
2.Mai ntenancePr ogr am –t heper soni sgiventhesamedoseev eryday .Thedosemay beless
thant hatoft he“ street ”dr ug,butitremai nsconsi stentt hroughoutt hecour seofthet reatment.

IV.ANTI -
CONVULSANTS/ANTI -EPI LEPTI CS-aredr ugsusedf orepi l
epti
csei zures.It
suppressest heabnor mal electri
cal impul sesfr
om t hesei zurefocust oot hercor ti
calar eas,thus,
preventingt hesei zur ebutnotel iminat i
ngt hecauseoft hesei zure.Theyar eusual lytaken
throughoutt heper son’ sl i
fet
imebuti nsomecases, itmi ghtbedi scont i
nuedi ftherehasnot
beenasei zur ef or3- 5y ears.
1.Hy dant oi ns( Pheny t
oin)-wast hef i
rstanti
conv ulsantusedt otreatseizures.Ithast he
leastt oxi cef f
ect s,hasasmal leffectongener al sedationandi snon- addicting.Howev er.It
hasahi ght er
at ogeni ceffect .
2.Bar bi
tur at es( Phenobar bital)–i sal ong-acti
ngbar bit
urateusedt otreatgrandmal seizures
andacut eepi sodesofst atusepi l
epticus,meningi ti
s,toxicreactionsandecl ampsi a.
Teratogeni cef fect sandot heref fectsar el
esser .NOTE:di scont i
nuegr aduallytoav oid
recurrenceofsei zures.
3.Succi nami des–ar eusedt ot r
eatabsenceofpet itmal seizures.Theymay beusedwi t
h
combi nat ionwi thot herant i
-conv ulsantstotreatsei zures.
Exampl es:
a.Et hosuxi mi de(Zaront i
n)
b.Met hsuxi mi de( Celontin)
c. Phensuxi mi de( Milontin)
4.Oxal i
di nes/ Oxazol i
dinedones–ar ealsousedt ot reatpetitmal sei
zures.Ther ear emany
sev er
esi deef fect sassoci atedwi t
ht hisdr
uggr oup.
Exampl es:
a.Tr imet hadi one
b.Par amet hadione
5.Benzodi azepi nes

13|Page
 Exampl es:
a.Cl orazepam
b.Cl orazepatdipot assium
c. Diazepam
6.Iminostil
benes(Car bamazepi ne)-i seffecti
veintreatingr efr
actor
yseizuredisordersthat
haveni tr
espondedt oot herant iconvulsants.I
tisusedt ocont r
olgrandmal seizuresanda
combi nati
onofthisseizur es.Iti
sal sousedf orpsychiatricdisorder
s.
Note:Aninter actionmayoccurwi thgrapefruitjuicecausingpossibletoxicit
y.
7.Valproate(Valproi
cAci d)–i susedf orpetitmalseizure, grandmal sei
zureandmi xed
typesofseizures.Cautionwhenadmi ni
steri
ngwi t
hy oungchi l
drenandcli
entswi thliv
er
disease.

V.DRUGSFORNEUROLOGI CDI SORDERS:Par kinsoni sm andAl zhei mer ’sDi sease

PARKI NSONI SM -i sachr onicneur ologi cdi sor dert hataf fect st heext rapy r
ami dal tr
act .I
tis
consideredasy ndr omebecauseofi tsTHREEMAJORFEATURES:
1.Ri gidi ty
2.Br ady kinesia
3.Tr emor s
ANTI -PARKI NSONDRUGS:
1.Anti-Chol iner gics-r educest her i
gidit yandsomeoft het r emor schar act eristicof
Parki
nsoni sm buthav emi ni mal ef f
ect sonbr ady kinesi a.
Exampl es:
a.Tr ihexy pheni dy l)Ar tane)
b.Benzt ropi ne(Cogent i
n)
c. Bi per i
den( Aki neton)
d.Pr ocy clidine(Kemadr ine)
e. Et hopr opazi ne(Par sidol)
f. Or phenadr ine(Nor flex)
g.Di phenhy dr ami ne( Benadr yl)
2.Dopami ner gics
Exampl es:
A.Lev odopa- -i st hef irstdopami ner gicdev el opedandi nt r
oducedi n1961.I tisthemost
effect ivedr ugf ordi minishi ngt hesy mpt omsofPar kinsoni sm.I t’
smaj orbenef itis
MOBI LITY.I ti si niti
allyadmi nister edi nl owdosesf oroneweekandt hengr adual l
y
i
ncr easedov eraper iodofweeks.
B.Car bidopaandLev odopa(1par tCar bi
dopa: 10par tsLev odopa)
a.Mor edopami ner eachest hebasal gangl i
a.
b.Asi ngl edoseperdayi sadmi nist er edinst eadofmul ti
pledoses.
c. Smal l
erdosesofl evodopaar er equi redt oachi evet hedesi redef fect .
3.Dopami neAgoni st s-st imul atest hedopami ner ecept or s.
A.Amant adi neHCl(Sy mmet rel)–i sanant iv i
ralagentt hatact sont hedopami ne
recept ors.I ti sal sousedt ot r
eatdr ug- inducedPar kinsoni sm.I tmay begi venal oneorin
combi nat i
onwi thlev odopaoranyant i
-chol i
nergicdr ug.
B.Br omocr i
pt inemesy l
at e(Par lodel )–act sdi r
ect l
yont hedopami ner ecept orsi nt he
CNS, cardiov ascul arsy stem, andGI T.Iti smor eef fect ivet hanamant adineandt heanti
-
chol inergi cs; howev er,isnotasef fect i
v easl ev odopai ntreat i
ngPar ki nsoni sm.
4.MAO- BI nhi bitor( Mono- ami neBOxi daseI nhi bi tor)–causescat abolism ofdopami ne.
*Sel egi l
ine -i nhibitsMAO- Bt huspr olongi ngt heact ionofl ev odopa.Lar gedosesmay
i
nhi bi tMAO- A.
5.COMTI nhi bitor s(Cat echol -O-Met hy ltransf er ase)¬–i nact ivatesdopami ne.Whent aken

14|Page
wi
thl
evodopa,i
nincr
easest heamountoflevodopaconcent rati
oninthebrain.
A.Tolcapane(Tasmar )-wast hefir
stCOMTi nhibitortakenwit
hlevodopaforadv
anced
Par
kinson’
sdisease.Itcanaff
ectl
ivercel
lfunction; t
hus,ser
um li
verenzymesshoul
dbe
cl
oselymonit
ored.
B.Entacapone(Comt an)-i st
henewestCOMTi nhibit
orapprovedbyt heFDA.

ALZHEIMER’SDISEASE-i sani
ncur
abl
edementiai
ll
nesschar
acter
izedbychroni
c,pr
ogr
essi
ve,
neur
odegenerat
ivecondi
ti
onswi
thmarkedcogni
ti
vedysf
uncti
on.Theonsetoccur
sbetween
ages45and65.

Causes:
1.Degener ationoft hechol i
ner gicneur onanddef iciencyi nacet y
lchol ine.
2.Neur iticpl aquest hatf or
m mai nlyout sidet heneur onsandi nt hecer ebr al cortex.
3.Apol ipopr oteinE4( ApoE4)t hatpr omot esf ormat ionofneur iti
cpl aqueswhi chbi nds
beta- amy loidi nt hepl aques.
4.Bet a- amy loidpr otei naccumul ationi nhi ghl ev elst hatmaycont ri
but et oneur onal i
njur
y.
5.Pr esenceofneur f
ibr i
ll
aryt angl eswi t ht wi stsi nsidet heneur ons.
Stages:
1.Mi l
d( Ear l
yConf usion)–cogni ti
v edecl inei noneormor ear eas, memor yl oss,
decr easedabi l
ityt of unctioni nwor ksi tuat ion, namef i
ndi ngdef i
cit, somedecr easedin
social funct ioning, recalldiffi
cul tyandanxi ety .
2.Moder ate–unabl et oper form compl ext askssuchasmanagi ngper sonal f
inances.
Unabl et oconcent rateandnoknowl edgeofcur r
entev ents.
3.Moder atel ySev ere(Ear lyDement ia)¬–usual lyneedsassi stancef orsur vival.Need
remi nder si nbat hingandneedshel pi nsel ectingcl othesandot herdai lyf unct i
ons.
May bedi sor i
ent edast otimeandr ecentev ent sal thought hiscanf l
uct uat e.May
becomet ear ful.
4.Sev er e( Dement i
a)–needsassi stancewi thdr essi ng,bat hingandt oi l
etf unct i
ons.May
forgetspouse.Fami lyandcar egivers’ names, det ailsoft heirper sonal l
ife.Gener al
ly
unawar eoft hei rsur roundi ngs.Hasf ecal andur inei ncont inenceandi ncr easedCNS
distur bance.
5.Ver ySev er e(Lat eDement i
a)–unabl et ospeak, mayscr eam ormakesounds.Unabl e
toambul at e, situp, smi l
eorf eedsel f.Unabl et ohol dheader ectandwi llul t
imat elysli
p
intost uporandcoma.
Treatment :
1.Er gol oidmesy lat e( Hy dergine)–hasnotbeensuccessf ulint r
eat ingmemor yloss.
2.Tacr ine(Cognex)-i mpr ov escogni t i
v ef unct ionf orcl ientswi thmi l
dt omoder ate
Alzhei mer ’sdi sease.I tincreasest heamountofAchatt hechol iner gicsy napsesand
tendst osl owt hedi seasepr ocess.
3.Donepezi l( Ar i
cept )
4.Ri vast igmi ne( Exel on)–per mi tsmor eacet ylchol i
nei ntheneur onr ecept ors.Ithasan
effect ivepenet rationi ntot heCNS, t
huschol i
ner gi ctransmi ssioni si ncr eased.

VI
.DRUGSFORNEUROMUSCULARDI
SORDERS:My
est
heni
aGr
avi
s,Mul
ti
pleScel
ori
sAnd
Muscl
eSpasms

A.My estheni
aGr avi
s(MG)–isalackofner
vei
mpulsesandmuscler
esponsesatthe
myoneuralner
vejuncti
onscausesf
ati
gueandmuscul
arweaknessofr
espi
rator
ysystem,
faci
al
muscl
esandext r
emi t
ies.

15|Page
Cause:-i
nadequatesecret
ionofacet
ylchol
ine(
Ach)oralossofAchbecauseofani
ncr
easei
n
t
heenzymecholinest
erase,whi
chdestroysAchatt
hemy oneur
aljunct
ion.

Tr
eatment :
1.Neost igmine(Pr ost
igmine)–i sthef i
rstdr
ugusedt omanageMG.i ti
sashor tacti
ng
acety
lcholi
nesteraseinhibi
torandhasahal f-
li
feof0.5-1hour .Iti
sgivenevery2-4hours
andmustbegi v enont i
met opr eventmuscleweakness.
2.Py ri
dostigminebr omide( Mesti
non)–hasani nt
ermedi ateact i
on.Givenevery3-6hours.
3.Ambenoni um Cl(My t
elase)–isal ongacti
ngAChEi nhi bi
tor.Itisusual
lyprescr
ibedwhen
thecli
entdoesnotr espondt oneost i
gmineorpyri
dostigmi ne.

B.Mul t i
pleScl
erosis(MS)-isanaut oi
mmunedi sorderthatatt
ackst hemyeli
nsheathof
nervefibersinthebrai
nandspi nal cor
d,causinglesi
onst hatarecall
edPLAQUES.Theonsetis
usuall
ysl owandi sdif
ficul
ttodiagnosebecauset hereisnospeci f
icdiagnosti
ctest
.Iti
sa
condit
ioni nwhichthereisremissionsandex acerbati
onsofmul ti
plesympt omssuchas
di
plopia,weaknessi ntheextremiti
esorspast i
cit
y.

PhaseswithCor respondi ngTr eatment :

1.AcuteAt t
ack–f ati
gue, mot or,opticneurit
is.
Treatment :
a.Taper i
ngcour seofgl ucocor ti
coids(Prednisone)
b.Adr enocorti
cot rophicHor mone( ACTH)
c. 6-alphamet hylprednisoloneNaSucci nate
2.Remissi on-exacer bat i
on–r ecurrenceofcl i
nicalMSsymptoms,spasti
cit
y.
Tr
eatment :
a.Bi ologic(immune)r esponsemodi fi
ers(BRM)
InterferonB( I
FNB)–i treducesspast i
cit
yandimprovesmusclemovement
.
b.Immunosuppr essantDr ug
Azat hioprine( I
mur an)–r educesexacerbati
on/r
elapses;
usedtodecr
ease
steroiduse.
3.ChronicPr ogressi v
e-pr ogressiveMSsy mpt oms.
Tr eatment :Cy clophosphami de(Cy t
oxan)

C.Muscul arSpasms–hav ev ariouscausesi ncl

udingi nj
uryormot orneurondi sorderresul
ti
ng
i
nt hefol
lowi ngcondi tions:1)Cer ebral Pal
sy ;
2)MS; 3)CVA; 4)Hemi pl
egia.
Treatment:
Muscl eRel axant s¬–r el
i
ev esmuscul arspasm andpai nassociat
edwi thtraumat i
cinjuri
esand
spasti
cit
yf rom chr onicdebi li
tatingdi sorders.
Types:
1.Anxi olytics
a.Di azepam ( Valium)
b.Mepr obanat e(Equani l
,Mi ltown)
2.Cent rally-Act i
ngMuscl eRel axant s(Spasti
city)
a.Bacl ofen(Li oresal) f.CyclobenzapdineHCl(Flexeri
l,Cyclofl
ex)
b.Ti zani dine(Zanaf l
ex ) g.Met hocarbamol (Robaxin,Mar baxin)
c. Dant r
oleneNa( Dant ri
um) h.Orphenadr i
neCi tr
ate(Nirfl
ex,Flexon)
d.Car isopr adol(Soma)
e. Chlor zoxazone(Par saflex ,
Par afonFor t
e)
3.Depol ari
zingMuscl eRel axant s

16|Page
 a.Pancuronium bromide(Pavulan)
b.Seccynil
cholinebromide(Norcur
on)
c.Vecuroni
um br omide(Nir
curon)
d.TubocurarineChlori
de

 PSYCHI
ATRI
CAGENTS

I
.ANTI
PSYCHOTI
CS ANDANXI
OLYTI
CS

A.Anti
-Psychot
icAgents-blockst
heact
ionsofdopami
neandt
husmaybecl
assi
fi
edas
dopaminergi
cantagoni
st.

Cat
egori
es:
1.Typi
cal/Tr
adi t
ional
a.Phenothiazines-bl ocksnorpinephr i
ne,causi
ngsedat i
veandhy potensiveef f
ectsearly
intr
eatment .
Types:
 Al ipathicphenothi
azines–pr oduceast r
ongsedati
veefect,decreasedBPand
maycausemoder ateEPS( pseudoparkinsoni
sm)Exampl e:Chlorpromazi ne
(Thorazine)
 Pi perazinePhenot hi
azines–pr oduceal owsedati
veandst r
ongant i-
emet ic
effectandhav eali
ttl
eef fectont heBP.Example:Fluphenazine(Per phenazine)
(Tril
afon)
 Pi peridinePhenothiazines-hav eastrongsedati
veeffect,causef ewEPS,
hav elowt omoder at
eef fectonBPandhav enoanti
-emet i
ceffect.
Exampl e:
Thioridazine(Mell
ari
l)

b.Non- Phenot hi
azines
Types:
 But yr
ophenone–bl ocksonl ythedopami neneurotr
ansmit
ter.
Exampl e:Haloper i
dol(Haldol)
 Di benzoxazepi neEx ample: Loxapi ne(Loxi
tane)
 Di hypdroindolone;Exampl e:Mol i
ndoneHCl Acid(Moban)
 Thi oxanthenes; Example:Thi othixene( Navane)
2.Atypi
calantipsychoti
cs( Serotonin/Dopami neAnt agonist)–areeff
ecti
veint
reat
ingbot
h
posi
ti
veandnegat i
vesy mpt om ofschizophrenia.
a.Cl ozapine(Clozar i
l) d.Quet iapine(Seroquel)
b.Ri speri
done( Risperdal
) e.Zi prasidone(Geodon)
c. Olanzapine(Zy prexa) f.Aripiprazole(Abil
ity
)

B.ANXIOLYTICS/ANTIANXI ETYDRUGS–ar epri

mar i
lyusedt ot
reatanxiet
yandi
nsomni
a.
1.Benzodiazepines
USES:
a.Ant iconvulsant
s c.Pre-
0pdrug
b.Sedat ive-hypnoti
cs d.Anxi
oly
tics
Examples:
a.Chl ordiazepoxi
de(Libr
ium) e.Al
prazolam (Xanax)
b.Di azepam (Valium) f.Prazepam (Centr
ax)
c. Lorazepam (At i
van) g.Halazepam (Paxipam)

17|Page
 d.Clorazepat
e dipotassi
um (Tranxene)
2.Miscel
l
aneousAnxiolyt
ic;Buspir
oneHCl (Buspar
)

II
.ANTIDEPRESSANTSANDMOODSTABI LIZERS
Antidepr
essants/MoodEl evat
ors–ar eusedfordepr
essi
veepi
sodest
hatar
eaccompani
ed
byfeeli
ngsofhopelessnessandhelpl
essness.

TREATMENT
1.Electroconvul
siveTherapy( ECT)-wasusedt otreatpsychosisanddepr essionbefor
e
thintroduct
ionofantipsychot i
csandantidepressants.I
tisusedf orcl
ientswhoar e
extremely depr essed,suicidalordonotrespondt oantidepr
essanttherapy.Itdoesnot
affecttheperson’
sintell
ectual f
uncti
onandmayaf fectshort-
ter
m memor yloss.

2.Herbalsuppl
ements
a.St.John’
sWor t
h–decreasere-
uptakeoftheneur
otr
ansmi
tt
ers.
b.GingkoBiloba–formi
l
ddepressi
ononly.

3.Ant
i-
Depr
essantAgent
s

A. Tri
cycli
cAnt idepr esants( TCAs)–ar eusedtot r
eatmaj ordepressi
onbecausethey
areeffecti
veandl essexpensi v
ethanSSRI’sandot herdrugs.Itbl
ockstheuptakeof
theneurotransmi t
tersepi nephri
neandserotoni
ni nthebr ai
n.Thecli
nical
response
occursaf t
er2-4weeks; i
fnoi mprovementoccurs,iti
sslowl ywit
hdrawnand
anotherant i
depr essanti sprescri
bed.NOTE:Pol ydr
ugt herapyshouldbeavoided
duet oserioussi deef fects.
Examples:
a.Ami ptri
ptyli
ne(El avi
l) e.Desipr
ami ne
b.Imiprami neHCl (Tof ranil
) f
.Nor tr
iptyl
ine
c. Tri
miprami ne( Surmont il) g.Pr optypli
ne
d.Doxepi ne(Si nequan)

B. Sel ecti
v eSerotoninReupt akeInhi
bitors(SSRI)-wast hef i
rstclassi
fi
edassecond
generationantidepressants.Theyblockther euptakeofserotoninintothener
ve
ter
mi naloftheCNS, therebyenhancingitstr
ansmi ssi
onatt heserotogenicsy
napse.
Exampl es:
a.Fl uoxet i
ne(Pr ozac) d.Par oxet
ine(Paxil)
b.Fl uvoxami ne(Luv ox ) e.Ci t
alopram (Cel
exa)
c. Ser t
rali
ne(Zol oft) f.Escital
opram (Lexapro)

C.At ypicalAnt idepressant s/Het erocycli

cAnt i
depr essants/Second-generat
ion
Antidepressant s-ar eusedf ormaj ordepression, r
eacti
vedepr essi
onandanxiet
y.
Theyaf fectoneort wooft hethreeneur ot
ransmi t
ters:serotoni
n,norepi
nephri
ne
anddopami ne.
Exampl es:
a.Amoxapi ne( Asendi n) e.Trazadone(Desy r
el)
b.Bupr opion( Wellbutrin) f
.Mi t
razapine(Remer on)
c. Mapr ot i
l
ine(Ludi omi l
) g.Venl adaxine(Ef exor)
d.Nef azodone( Serzone) h.Reboxetine(Vest ra)
NOTE:theyshoul dnotbet akenwi thMAOI ’sandshoul dnotbeusedwi t
hin14daysaf t
er
di
scont
inui
ngMAOI ’s

18|Page
 D.MonoamineOxi
daseInhi
bitor
s(MAOI’s)–inhibi
tstherel
easeoftheenzyme
monoamineoxi
dasel
eadingtothei
ncreasedlevel
softheneurot
ransmitt
ers
nor
epi
nephri
ne,
dopamine,epi
nephr
ineandser ot
onin.

Examples:
a.Tr any
lcypromineSO4( Par
nat
e)
b.Isocarboxacid(Marpl
an)
c. Phenelzi
neSO4(Nar dil
)

Impor t
antConsi derations:
1.MAOI ’
sareasef f
ectiveasTCA’ sfort r
eatingdepr essi
on, butbecauseofadv er
seef fects,
only
1%ofcl i
entstakeMAOI .
2.MAOI ’
sareNOTt heant idepr
essantofchoi ce; butmay begi venformildanxiety,reacti
veand
atypi
caldepression.
3.MAOI ’
sareussual lyprescri
bedwhent hecl ientdoesnotr espondt oTCA’ sorsecond
generati
onantidepressant s.
4.MAOI ’
sandTCA’ sshoul dNOTbet akent oget herwhent r
eatingdepression.
MoodSt abil
izers
Lit
hium –wasf i
rstusedasasal tsubstit
utei nt he1940’ s,butbecauseofl i
thium toxici
ty,
itwas
bannedf r
om themar ket.I
tisusedtot reatbipol arafectivedisorder
.Ithasacal mingef fect
withouti
mpai r
ingintell
ectualacti
vit
y.Itcont rolsanyev i
denceoff li
ghtofidesandhy peracti
vit
y.
Iti
sanexpensi vedrugandmustbemoni t
ored.

 I
MMUNOLOGI
CAGENTS

I
.HI
VANDAI
DS-
RELATEDAGENTS

A.Antiretr
ovir
alTher apy
GOALS:
1.Suppr essv i
ral repli
cationt osl owt hedecl inei nt henumberofCD4+cel ls.
2.Suppr essv i
ral repli
cationt oundet ect ablel evels.
3.Reducet hei nci denceandsev ei t
yofoppor tunisticinfections.
4.Mi ni
mizeadv erseef fect sofant i
retrov i
raldr ugs.
5.I mprovequal i
tyofl if
e.
6.I mprovesur vi
v alandr educemobi l
ity.
ANTIRETROVI RALAGENTS:
a.Nucl eosideRev erseTr anscr iptaseI nhi bi
t or s
 Zi dov udine( AZT, ZDV, Retrov i
r)–i mpr ovesCD4+count s,
impr ov esur v
ival
rat esandsur viv al ti
mesanddecr easespr ogr ession.Itpenetratest heCNSand
may beusef ulint het reatmentofdement i
aandt hrombocy topeni a.Itiseffcti
ve
inpr ev entinginf ect ionofi nf ants,bot hi ntheut er oanddur i
ngdel i
veryf r
oHI V
infect edwomen.I tisabsor bedr api dlyint heGI T;peaki n30–90mi nutes.Itis
wi delydi stri
but edandcancr osst hbl ood-br ai
nbar r
ier
.Thet abletsar etakenon
anempt ystomachandswal lowedwhol ewi t
hpl entyofwat er;capsul escanbe
takenwi thorwi thoutf ood; IVadmi ni
strationat l
east60mi nutes.
b.Non- nucleosi deRev erseTr anscr iptaseI nhi bitors( NNRTI ’s)
 Ef avirenz( Sust iva)–i mpr ov esCD4+count sandr educesv ir
al l
oad( VL).I
t
shoul dbeusedonl yincombi nationwi that l
eastoneot hernucleosi deanal ogue.

19|Page
 Itisreadi lyabsor bedf oll
owi ngor al admi nist
ration.Absor ptionisi ncr easedin
fattymeal s.Thepeakconcent rati
onoccur si n3- 8hour s.Itisbestt akenwi than
empt yst omach.I ti swidelydi str
ibut edwi t
hl evelsint heCSF, met abol i
zedi n
theliv erandexcr etedi nthef ecesunchangedandi nt heur ineasmet aboli
te.
c. Pr
ot easeI nhi bitors
 Lopi nav ir/Ri tonav ir(Kalet ra)-i sused pr i
mar i
lyfori t
sant i
retrov ir
al acti
vi
ty.
Itblockpr ot ease.I treducesv i
ralplasmal evel,slowsHI Vr eplicationand
reducest hepr ogr essionofhI Vi nfect ion.I
tmustbeusedi ncombi nation
therapyandbestt akenwi thf ood.
d.Ant ir
etrov ir
alCombi nat i
ons/Fusi onI nhibitor s
 Combi vi
r(Lami vudi neandZi dovudi ne)-gi veni ncombi nat i
onandnev era
monot herapy .
 Tr izivir(Abacav ir,Lami vudi neandZi dovudine)-may beusedal oneori n
combi nat ionwi thot herant i
r etroviral agents.
TheNurses’Rol ei nAnt i
viral Ther apy :
1.Thor oughassessmentoft heclient ’sphy si ologi
candpsy chosoci al healthneeds.
2.Anal y sisoft hepat ient’scondi tion.
3.Faci li
tat eadher encet ot herapy.
4.Educat eclientr egar dingt herapy .
5.I dentifythepr obl emst hatr equireaddi t
ional i
nvestigationandr esear ch.

B.Ot
herDr
ugsf
orHI
V

1.Hy doxy urea(Hy dra)–i susedf orsicklecelldisease andi sNOTFDAappr ov

edf or
HIV, butiscur rentlythoughtofasapossi bledr ug.
2.Adef ovirdi pi
v oxil(Pr eveon)–i sanNRTIt hatisav ailablet ocli
entsinwhom at least
NRTI ’sandonepr oteasei nhibi
torhav efail
ed.
3.Tenof ov i
r(Vi r
ead)–i spot entinhibitorofHI Vr epli
cation.
4.Enf uv ir
tide( Fuzeon)–Fusi onInhibitors–bi ndst ov i
ral parti
clesandpr events
adhesi ont oCD4+cel ls.Itisadmi nister
edt wicedai lyasasubcut aneousinjenct
ion.
5.Atazanav ir(Rey ataz)–i saonce- adaypr oteasei nhibitor.Theadv antageov erother
prot easei nhibitorisitdoesnoti ncreasetheLDLor“ badchol esterol
”.
6.Emt rici
tabi ne(Emt ri
va)-isaonce-adayNRTIandi ssimi lartoLAmi vudine.
7.Fosampr enav i
r( Lexiva)-i saphosphat eest erpr o-
drugofampr enavir
.

II
.VACCI NESANDI MMUNI ZATI
ONS
Ty pesofI mmunit y:
1.Act iveImmuni ty–occur sasapar tofthehumanr esponse, whichi sactivatedwhena
pathogeninv adest hebody ;ormay bepr ovokedbyani mmuni zation.
VACCI NATI ON–i nvolvest headmi nist5ati
onofasmal lamountofant igen,which,alt
hough
capableofst i
mulat i
ngani mmuner esponse, doesnott y
picallypr
oduceadi sease.
Types:
a.I nacti
vated/Ki lledmicroor ganisms
b.At tenuatedv ir
uses
c. Toxoids
d.Conj ugatev accines
e.Recombi nantsubuni tvacci nes
2.Passi veImmuni ty–occur swhenani ndi v
idualr
eceivesantibodiesagai nstapar t
icular
pathogenfrom anot hersource; ormay beacqui r
edv i
at headminist r
ati
onofant i
bodies
pooledfrom sev eral humanorani mal sourcesthahav ebeenexposedt odi sease-causi
ng

20|Page
 pathogens.
AGENTSUSEDI NPROVI DINGPASSI VEI MMUNI TY:
1.ImmuneSer ums
a.Cy tomegal ov i
rus( CMV)I mmuneGl obul inI ntr
av enous, Human-i susedi nt he
pr ev entionofCMVi ncl ient sr eceiv ingki dneyt ranspl ant .
b.Hepat it
isBI mmuneGl obul i
n-pr ov idespassi v ei mmuni t
yf orper sonsexposedt o
HepaB.
c. ImmuneGl obul inI ntrav enous–pr ov idesr apidi ncr easei ni nt rav ascul ar
immunogl obul inlev elsi ncl i
ent swi thi mmune- def iciencysy ndr ome.
d.I mmuneGl obul inI M, gammagl obul in–f orthepr ev entionormodi ficationofHepaA,
measl esi nsuscept i
bl econt acts.
e.Ly mphocy teI g, Ant ihymocy tegl obul i
n- fort hemanagementofal l
ogr aftr eject i
oni n
renal t
ranspl ant s.
f. Respi r
at orySy ncy ti
al Vi rus( RSV)I g–pr eventsser iousr espi rator yt r
acti nf ect i
ons
causedbyRSVi nchi l
dr enl esst han24mont hswi thbr onchopul monar ydy splasi a.
g.Rho( D)I g- isusedf ort hesuppr essi onoft hei mmuner esponseofnonsensi tized
Rho( D)negat i
veper sonswhor ecei v eRho( D)posi tivebl ood.I tisal sousewdf ort he
pr ev entionofsensi t
izat iont ot heRho( D)f actori nRH- negat ivewomenwhohav eended
apr egnancywi thanRH- posi tivef et usornewbor n, thuspr ev ent inghemol y ti
canemi aof
thef etusi nt hesubsequentpr egnancy .Exampl e: RhoGam
h.Tet anusI g¬–pr ov i
despassi v eimmuni tyi nper sonsnotact ivelyi mmuni zedagai nst
tet anusorwhosei mmuni tyst atusi sunknown.
i. Var icella-Zost erI g-pr ov idespassi vei mmuni zat ionofsuscept ible
immunodef icientchi ldrenaf terexposur et ov aricel la.
2.Ant i
toxinsandAnt iv enins
a.Ant iveni n( Crtot alidaepol yv alent )–cont ainspr ot ectiv esubst ancesagai nstt he
venomsoft hecr otalids( pitv iper s)i ncludi ngr at tl
esnakes, cot tonmout hs,
copper headsandmoccasi ns.
b.Ant iveni n( Mi crur usf ul vius) -fort het resat mentofNor thAmer icancor al snakebi tes.
c. Bl ackWi dowSpi derSpeci eAnt iveni n( Lact rodect usmact ans) -f orthet r
eat mentof
blackwi dowspi derbi tes.
d.Di pht her iaAnt itoxin-f ort hepr ev ent ionort reat mentofdi pht her ia.
e.Tet anusAnt i
toxi n-f ort hepr event ionoft etanus; usedonl ywhent etanusi mmune
globul ini snotav ailable.
AGENTSUSEDFORACTI VEI MMUNI ZATI ON
1.Bact erialVacci nes
a.BCGVacci ne( Ti ceVacci ne)–i susedf orTBpr ophy laxisi nper sonswi tht uber culi
n
negat iv eski nt est sexposedt oTB.
b. Hemophi lusbConj ugat eVacci ne–f ori mmuni zat ionofchi l
dr en2mont hst o6
year sofagecausedbyh.i nf l
uenzab.
c. Meni ngococcal (Qadr ivalent )–f ort hepr ophy laxi sofmeni ngi ti
si nhi gh- r
isk
popul at ions.
d.Mi xedRespi rator yVacci ne( MRV)–i susedf ordesensi tizat i
ont ocommonbact eri
al
organi smspr esenti nt her espi rator ysy stem.
e.PneumococcalVacci ne, pol y
v alent( Pneumov ax23)–i susedf ort hepr otect ion
agai nstt hemostcommont ypesofpneumococci forhi ghr iskper sons ,
i
ncl udi ngt hosewi thachr oni cillness, thosei nchr oniccar ef aciliti
es, conv al escing
clientsand50y earsofageandabov e.
f. Ty phoi dVacci ne–f ort hepr oduct ionofact i
v ei mmuni zat ionagai nstt y phoi df or
per sonsexposedt ot y phoi dcar riersandt hoset rav ellingt oar easwher et yphoi di s

21|Page
 endemi c.
2.Vi
ralVacci nes
a.HepaAVacci nes( Hav ri
x, Vaqt a)
b.HepaAandB( Twi nr i
x)
c. HepaBVacci ne( Hept avax)
d.I nfl
uenzaVi rusVacci ne(I nf l
uenzaVi rusTr ivalent ,YpesAandB, Fluzone, Flumi st)
-
fort hepr otect ionagai nstst rainsofi nfluenzav i
rusescont ainedi nv acci neand
closel yr elatedst rains.Annual vacci nat i
onr ecommendedf orper sonsati ncreased
riskf oradv erseconsequencesf r
om l owerr espirator ytractinf ect i
ons.
e.JapaneseEncephal iti
sVi rusVacci ne( Je- Vax)–f ortheact i
v ei mmuni zat i
on
agai nstJapaneseencephal i
t i
sf orper sonsov eroney earofage.
f. Measl es, MumpsandRubel laVacci ne, li
v e( MMRI I)-st i
mul atei mmuni zati
on
agai nstmeasl es, mumpsandr ubel l
ai nchi l
dr enf rom 15mont hst opuber t
y.
g.Measl es( Rubeol a)Vi rusVacci ne, l
ive, attenuat ed( Attenuv ax) -act i
vei mmuni zation
ofchi ldr en15mont hsofageorol deragai nstmeasl es.
h.MumpsVi rusVacci ne,li
ve(Mumpsv ax)–f orthei mmuni zat ionagai nst mumps
i
nchi ldren12mont hsorol der.
i
. Pol iov irusVacci ne, i
nact i
vat ed( IVP)–f ort heact i
v eimmuni zat ionagai nst
poliomy elitis.
j
. Rubel l
aandMumpsVi rusVacci ne, li
v e(Bi av axI I
)-fort hesimul taneous
i
mmuni zationagai nstr ubellaandmumpsi nchi ldrenf rom 12mont hsofaget o
puber t
y .
k. Rubel l
aVi rus, liv
e( Mer uvaxI I
)–f ort hei mmuni zationagai nstr ubellai nchi l
dren
from 12mont hsofaget opuber t
y.Itmayal sobeusedt ocont rol r
ubel laout break.
l
. Var i
cel laVacci ne–l i
ve,attenuat edv acci nef oract i
v eimmuni zat ionf orheal thy
childrenov erage12mont hsandadul ts.Al soef fect i
vei nchi ckenpoxandshi ngles.
m.Yel lowFev erVacci ne( YF-Vax)–f ort heact iveimmuni zationoft ravel erst o
count r
iesr equi ri
ngv accinat i
on; f
orusei nper sons6mont hsandol der .

3.Toxoids
a.Di pht heriaandTet anusToxoi dsandPer tussisVacci ne( DTaP)-f ortheactiv
e
immuni zati
onofi nfantsov er2mont hsandchi l
drenunder7y earsofageagai nst
dipht heri
a,tetanusandper tussi s.
b.Di pht heriaandTet anusToxoi dsandAcel lul
arPer tussisVacci ne(Datpacel)–for
he4 or5h
t
h t
theact iveimmuni zat i
onagai nstdi pht heria,t
etanusandper t
ussisast
dosei nchil
drenf rom 15mont hst o7y earsofage.
c. Tet anusToxoi d( Tetanust oxodf l
uid; tet
anust oxoidadsor bed)–f ortheact i
ve
immuni zati
onagai nsttetanusf oradul tsandchildren.
NURSINGRESPONSI BILITIESTOWARDSVACCI NEADMI NISTRATI ON:
1.Obtainhistoryofal l
ergybef oreadmi ni steri
nganyagentaf fecti
ngi mmuni ty.
2.Donotuseagent sbey ondt hei
rexpi rationdat e.
3.Alwaysadmi nist
ertheseagent sinset tingswher el i
fesuppor tequipmenti savail
able.
4.Epinephri
nei njecti
on1: 1,000musti mmedi at elybeav ai
lablefort hetreat
mentof
anaphylacticreacti
ons.
5.Observeclient’sreactiont ot hedrugf or20- 30mi nutesbeforedi scharge.
6.Updateclient ’
simmuni zationrecor d.

 ANTI
-I
NFLAMMATORYANDANTI
-I
NFECTI
VES

I
.ANTI
-I
NFLAMMATORYAGENTS

22|Page
 Eff
ects/
Pr opert
ies:
a.Anal gesic
b.Ant i
py r
eti
c
c. Anti
coagulation

A.Non-St
eroi
dalAnti
-I
nfl
ammat or
yDrugs(NSAIDs)–inhi
bit
stheenzymeCYCLO-
OXYGENASE( COX).Al
socall
ed“Pr
ostagl
andi
nInhi
bitor
s”whichar
eusedpri
mar
il
yasan
ant
i-
inf
lammatoryagentt
oreli
evei
nfl
ammat i
onandpain.

The7Gr
oups:

1.Salicy l
at esr elat edt oAspi rin
ASPI RI N( ASA-Acet ylSal icy li
cAci d)–i sapr ostagl andi ninhi bitort hatdecr easesthe
infl
ammat or ypr ocess.I talsodecr easespl ateletaggr egationdecr easingbl oodclotti
ng.
Iti
st hedr ugofchoi cef oral leviatingi nflammat i
onandpai ni nar t hri
ticcondi t
ions,but
whengi veni nhi ghdoses, GIpr obl emscoul doccur .
2.Par a-Chl or obenzoi cAci d
a.I ndomet haci n(I ndoci n)–i sapot entpr ostagl andi ninhi bitorusedf orrheumat oi
d
arthr itis, gout yar thritisandost eoar thr iti
s.I tishi ghl ypr ot ein-boundanddi spl
aces
otherpr ot ein-bounddr ugsr esul tingt opot ential toxici
ty .Ithasamoder atehalf-
li
fe
andi sv eryi rri
tat i
ngt ot hest omach.
b.Sul indac( Cl i
nor il
)
c. Tol met in(Tol ect i
n)
3.Pheny lacet icAci dDer i
v at i
v es
a.Di clof enacNa(Vol taren)–i si ndicat edf orr heumat oi dar thr i
tis,osteoarthri
ti
s,
anky losi ngspondy liti
s.
b.Ket or ol ac(Tor adol )–i sadmi nister edI M q6hour sat30- 60gr ams, i
sthef i
rst
inject abl eNSAI D.I ti nhibitspr ost agl andi nsy nt hesi s,buthasgr eateranalgesic
pr oper tiest hanot herant i
-inflammat or yagent s.I tisrecommendedf orshort-
term
managementofpai n.
4.Propi oni cAci dDer ivatives- areaspi rin-likebuthav est r
ongeref f ectsandcr eatesless
GIirritation.
a.I bupr of en( Mot ri
n) e.Ket opr ofen(Or udi s)
b.Fenopr of enCa(Nal fan) f.Fl ur biprof en(Ansai d)
c. Napr oxen(Napr osy n) g.Oxapr ozin(Day pro)
d.Supr of en(Pr ofenal )
5.Fenamat es–ar eusedf orchr oni car thriti
ccondi ti
ons.
a.Mecl of en–amat eNamonohy dr at e(Mecl omen)
b.Mef enami cAci d( Ponst el )
6.Oxicams
Pi r
oxi cam (Fel dene)–i si ndicatedf orl ong- term ar thri
ti
ccondi t i
onssuchas
r
heumat
oidar thr itisandost eoar thr i
tis.
7.Select iveCOX- 2Inhi bitor s(Second- gener ationNSAI Ds)–decr easesi nfl
ammat i
on
andpai n.Thesear et hedr ugofchoi cef orcl i
ent swi thsev er ear thr i
ticcondi ti
onswho
needhi ghdosesofant i-inf l
ammat or ydr ugs.
a.Cel ecoxi b(Cel ebr ex)
b.Nabumet one( Rel af en)

B.Corti
coster
oids-areusedasant
i-
infl
ammatoryagents.Theycont
roli
nfl
ammat ionby
suppressi
ngorprev
enti
ngmanyoft hecomponentsoftheinfl
ammatoryprocessatthe

23|Page
 i
njur
edsite.I
thasalonghal
f-
li
feandi
sadmi
nist
eredi
nceadayi
nlar
gepr
escr
ibeddoses.
a.Pr edni
sone
b.Pr edni
sol
one
c. Dexamethasone

C.Disease-ModifyingAnt i-Rheumat i
cDr ugs(DMARDS)–ar eusedwhenNSAI Ddonot
controli
mmune- medi atedar thri
ti
cdi seasesuf fi
cientl
y.Al t
houghmor etoxi
c,t
heyal t
erthe
diseaseprocess.
1.Gol dDr ugTher apy-i susedt oar restt heprogressionofr heumat i
carthr
it
isandt o
preventdefor mi ti
escausedbyt hedi sease.Itdepr essest hemi grati
onofleukocytes
andsuppr essespr ost aglandinact i
vit
y .Iti
nhibit
s dest ructiv
el ysosomal enzymes
thatarecont ainedi nl eukocytes whi char er el
easedi njoints.
 Aur aofin(Ri daur a)
 Aur othiogl ucose(Sol ganal )
 Gol dNat hi omel ate(My ochr ysine)
2.I mmunosuppr essiv eAgent s–ar eusedt otreatrefractoryrheumat oidar
thri
tis.
 Azat hiopr ine(I mur an)
 Cy clophosphami de(Cy toxan)
 Met hot rexat e(Mexat e)
3.I mmunomodul ators–t r
eatmoder atet osev ererheumat oidar thri
ti
sbydi srupt
ing
theinfl
ammat or ypr ocessanddel ay i
ngdi seasepr ogression.

Gr
oupofI
mmunomodul
ator
s:

a.I nt
erleukin(I l-
1)Recept orAntagoni st
ANAKI RA( KINERET)–bl ockst heact i
vit
yofI L-1byi nhi
biti
ngIl-
Ifrom bi
ndi
ngt
i
nter
leuki
nr eceptorslocat edinthecar t
ilageofbone.I tisadmi nisteredsubQ.
b.TumorNecr osisFactorBlocker s–bi ndstot heTNFandbl ocksitfr
om att
aching
toTNFr eceptorsont hesy novial cel
lsurf
aces.
 Et aner cept(Enbr el)
-isadmi nist
eredsubQ
 I nfli
ximab(Remi cade)
 Adal imumab(Humi r
a)
 Lef l
unomi de(Arava)
4.Ant i
-Malarials–may beusedt otreatrheumat oidarthrit
iswhenot hertr
eatment
met hodf ail
s.Theyar eusual l
yusedi ncombi nati
onwi thNSAI Dswhosear thr
iti
sis
notundercont rol.

D.Ant
i-
GoutDr
ugs

1.Col chicines–i nhi bitthemi grati

onofl eukocy testotheinflamedsi te.Iti
seffecti
vein
all
eviatingacut esy mpt omsofgout ,buti snotef f
ecti
veindecr easi ngi nf
lammat i
on
occurringinot heri nfl
ammat orydisorders.Itdoesnoti nhibituricaci dsynthesi
sand
doesnotpr omot eur icacidsecr eti
on.Itshoul dnotbeusedi ft
hecl ienthasasev ere
renal,cardi
acorGIpr oblem.
2.Ur icAci dInhibitor
Al
lopuri
nol(Zylopr i
m) -i
snotanant i-
infl
ammat orydr ugbutitinhibi
tst hefinalst epsofuricaci
d
bi
osynthesi
sandt hereforel owersser um uricacidl evelspreventi
ngt hepr ecipitati
onofan
at
tack.Iti
susedasapr ophy l
acti
c topr eventgout .I
tisthedr ugofchoi ceforcli
ents
wi
thchr oni
ctophaceousgout .Itisalsoi ndi
catedf orclientswhohav egoutandr enal

24|Page
i
mpairments.
3.Uri
cosori
cs–i ncreaset her ateofur icaci dexcreti
onbyinhibi
ti
ngitsreabsor pt
ion.
Theyareeff
ecti
veinalleviati
ngchr oni cgout ,buttheyar eNOTt obeusedinacuteat tacks.
a.pr obeneci d(Benemi d)–bl ockst her eabsorpti
onofuricaci
dandpr omot esi
ts
excreti
on.I tcanbet akenwi thcol chicines.I
tshouldbetakenwithmeal sif
gastri
cirrit
ation occur s.
b.Sul fi
npy r
azone( Antur ane)-isamet abol i
teofphenyl
butazoneandi smor e
potentthanpr obeneci d.I
tshoul dbet akenwi t
hmealsorwi t
hant aci
dst o
preventgast ri
ci r
rit
ation.Sev erebl ooddy scrasi
asmightoccurespeci al
lyin
cli
entswi thahi storyofbl ooddy scrasia.

I
II
. ANTI
-BACTERI
ALS/ANTI
BIOTI
CS

MechanismsofAct i
on:
1.Inhibiti
onofbacter
ialcell
-wall
synthesi
s.
2.Al t
erati
onofmembr anepermeabil
ity.
3.Inhibiti
onofprot
einsy nt
hesis.
4.Inhibiti
onofbacter
ialRNAandDNAsy nt
hesi
s.
5.Interferencewi
thmet abol
ism wit
hinthebact
eri
alcel
l
.

A.PENICI LLINS/BETALACTAM ANTI BIOTI CS-ar enat ural antibact erialagent sf rom the
moldgenus“Peni cill
ium” .I tinterfereswi thbact erialcell wal lsynthesi sbyi nhi biti
ng
thebact erial enzy met hati snecessar y f orcel ldi
visionandcel lularsy nthesi s.Itcan
bebot hbact er iostat i
candbact eri
cidal dependi ngont hedr ugdosage.
1.PenG-wast hef ir
stpeni ci l
li
nadmi ni steredor allyandbyi njection.Becauseofi ts
poorabsor ption, itisgi venbyI M orI Vi smor eef fectivei nachi ev i
ngt he
ther apeut icl ev el
.
2.PenV–i sl esspot entt hanPenG.I ti sef fectiv
eagai nstmi l
dt omoder ate
i
nf ectionsi ncl udingant hrax .
3.Ami nopeni cilli
ns/br oad-spect rum peni cil
li
ns- ar eusedt otreatbot hgr am
posi ti
v eandgr am negat ivebact eria.Thesear enotpeni cil
li
naser esistanthowev er
.
a.Ampi cill
in
b.Amoxi cill
in
c. Bacampi cill
in
4.Ant istaphy lococcalPeni cilli
n/Peni cilli
nase–r esistantPeni cil
li
ns–ar eusedt o
treatpeni ci l
li
nasepr oduci ngst aphy lococcusAur eus.
a.Cl oxaci lli
n d.Oxaci l
li
n
b.Di cloxaci llin
c. Naf ci ll
in
5.Ant ipseudomonalPeni cil
lins/Ext ended- Spect rum Peni cill
ins-isef fectiveagai nst
pseudomonasaer ugi nosa.Theyar eal soef f
ect i
veagai nstmanygr am- negat ive
organi sms.Theyar enotpeni cil
linaser esistantandt heact ioni ssimi l
art o
ami nogl y cosi des, butt heyar elesst oxi c.
6.Bet a-lact amaseI nhi bitors–ar ecombi nat i
onofabr oadspect rum ant ibioticwitha
bet a-l
act amasei nhibitor.Itinhibitst hebact eri
al beta-lactamase maki ngt he
ant i
biot i
cef fect i
v eandext endingi tsant imicrobial effect.
a.Amoxi cill
in-clauv inicaci d
b.Ampi cill
in-sul bact am
c. Pi per acin-t azobact am
d.Ti car cil
li
n- clavulani caci d

25|Page
 B.CEPHALOSPORI NS-i sder iv edf rom t hef unguscephal ospor ium acr emoni um.I tis
activeagai nstgr am- posi t
iveandgr am negat iv ebact eriaandr esist antt obet a-
l
act amase.I thasabet a- l
act am st ruct ureandact sbyi nhi bi ti
ngt hebact erial enzyme
thati snecessar yf orcel lwal l sy nthesi s.
1.Cephal exins( Kef l
ex ) 6.Cef ur oxi meNa(Zi nacef )
2.Cef adr oxi l(Dur icef ) 7.Cef clinir(Omni cef )
3.Cephadr ine( v elosef ) 8.Cef ti
but en(Cedax)
4.Cef acl or(Cecl or ) 9.Cef i
xi me(Supr ax)
5.Cef ur oximeaxet i
l (Cef t
in) 10.Cef azol inNa(Ancef , Kef zol
)
C.MACROLI DES–ar eact iv eagai nstmostgr am posi tivebact er i
aandmoder atelyactive
againstsomegr am negat i
v ebact eria.Theyar eusedt ot reatmi ldt omoder ate
i
nf ect i
onsoft her espi rator yt ract ,sinuses, GI T, ski nandsof ttissuesaswel las
dipht her i
a, i
mpet i
goandcont agiosaandSTDs.
1.Azi thromy ci n( Zithromax )
2.Cl ar it
hr omy cin( Biaxi n)
3.Di rithromy cin(Dy nabac)
4.Er y thromy ci n(E- my cin)
D.LI NCOSAMI DES–i nhi bitbact erialpr oteinsy nt hesi sandhav ebot hbact eriost at
ic,
bact ericidal act ions, dependi ngondr ugdosage.
1.Cl indamy ci n(Cl eoci n)
2.Li ncomy cin(Li ncoci n)
E.VANCOMYCI N( Vancoci n) -ISUSEDAGAI NSTDRUGRESI STANTs. Aur eusAndi n
cardiacsur gical pr ophy laxisf ori ndiv i
dual swi thpeni cil
linal l
er gies.I t’
susewasal most
abandonedduet osi deef fect sofnephr otoxici tyandot otoxi ci ty.
F.KETOLI DES-ar enewcl assi ficat i
onofant i
biot icswhi char est ruct urallyrelat edto
macr olides.
Tel i
thromy cin( Ket ek)–i susedf oradul ts18andabov ef ort het reatmentof
chr onicbr onchi tis.
G.TETRACYCLI NES–i si sol at edf rom st r
ept omy cesaur eof aci ensi n1948.Theywer ethe
fi
rstbr oad- spect r
um ant ibiot icsef fect i
veagai nstgr am posi tiveandgr am negat i
ve
bact eria.Theyar enotef fect iv eagai nstS.aur eus, pseudomonasorpr oteus.Theyar e
frequent l
ypr escr ibedf oror al use, althoughal soav ailabl ei nI M andI V.
H.AMI NOCLYCOSI DES–actbyi nhibitingbact er ial pr oteinsy nt hesi s.I tisusedagai nst
gram- negat ivebact er iasuchasE. col i.i
tact sf orser i
ousi nf ect ions.
1.St rept omy ci n 4.Ami kaci n
2.Gent amy cin 5.Net il
mi ci
n
3.Tobr amy cin
I. FLIUROQUI NOLONES( QUI NOLONES) -interfer eswi tht heenzy meDNAgy rasewhi chis
neededt osy nt hesi zebact er ial DNA.I tki l
lsbot hgr am- posi ti
v eandgr am negat i
ve
organi sms.
1.Nal idixicAci d( Negr am) 5.Lev of l
oxaci n(Lev aqui n)
2.Ci noxaci n(Ci nobac) 6.Spar floxaci n(Zagam)
3.Ci pr of l
oxaci n(Ci pr o) 7.Tr ov af l
oxaci n(Tr ivan)
4.Nor floxaci n(Nor oxi n)
J.SULFONAMI DES–ar enotcl assi fiedasant ibiot icbecauset heyar enotobt ainedf rom
biologi csubst ances.Theyar ebact er i
ost aticbecauset heyi nhi bitbact erial synthesisof
foli
caci d,whi chi sessent i
al f orbact er i
algr owt h.Theyar enotef fect i
veagai nstv ir
uses
andf ungi .
1.Sul fi
soxazol e(Gant risin) 4.Sul famer azi ne
2.Sul famet hoxazol e(Gant anol ) 5.Sul famet hazi ne

26|Page
 3.Sul fadi azine
K.TRI
METHROPRI M ANDCO- TRI MOXAZOLE
1.Tr imet hropr im (Pr olopr im,Tri
mpex)-i sanant ibacter i
alagentt hatinterfer
es
withbact erialfolicacidsy nt
hesissi mil
arlytosul fonami des.Itisclassi fi
edas
urinar ytractant i-
infectivesthatmay beusedal onef orcompl icatedUTI .
2.Tr imet hropr im-sul famet hoxazole(CO- t
rimoxazl oe, BActrim,Sept ra)
L.UNCLASSI FIEDANTI BACTERI ALDRUGS
1.Chl orampheni col(Chl or omycetin)–i sbact eri
ost at
ic; i
nhibi
tsbact eri
al prot
ein
synt hesi s.Itisusedonl yt otr
eatsev er
einfections.
2.Spect i
nomy cinHCl( Trobi ci
n)–f orN. gonor r
heaandf orpersonsal lergicto
peni cil
lin, cephal osphor insandt etracycli
ne.
3.Qui nupr ist i
ne/dal f
opr istin(
Syner cid)–ef fecti
vef ort r
eati
ngv ancomy ci
n
resistantmi croor ganism.

 ANTI
-CANCERAGENTS

I
. ALKYLATI NGDRUGS-causecr ossl inkingofDNAst rands, abnor malbasepai r
ingor
DNAst randbr eakspr ev ent i
ngt hecel lfrom div iding.Itkillscellsinvari
ousandmul ti
ple
phasesoft hecel l cy cle.
1.Cy clophosphami de(Cy toxan)
2.Mechl or ethami ne(Ni trogenmust ard,Must argen)
I
I. ANTI -METABOLI TES–di sruptt hemet abol icpr ocessandsomeort heagent sinhibit
s
enzy mesy nthesi s.I tiscl assi fiedaccor dingt ot hesubst anceswi t
hwhi cht heyinterfer e
andi ncludef olicaci dant agoni sts.Theyar eusedt ot reatacut eleukemia, breastcancer
andheadandneckcancer ,l
ungcancer , osteosar comaandnon- Hodgkinsl ymphoma.
1.Met hot rexat e( MTX) -i saf oli
cant agoni stusedf ort hetreatmentofbot h
cancer ousandnon- cancer ouscondi ti
ons.I tact sasasubst it
uteoff oli
caci d
neededf ort hesy nthesi sofpr oteinsandDNA.
2.Fl uor our aci l( 5FU)–i sadmi nisteredI Vf orsol idt umor sandtopicall
yf or
super f i
ci albasal cel lcar cinoma.I tbl ockst heenzy meact i
onnecessar yforDNA
andRNAsy nt hesi s.
I
II
. ANTI -TUMORANTI BI OTI CS–i nhibitsRNA sy nt hesisandbi ndsDNAcausi ng
fragment ation.
1.Bl eomy cin(Bl enoxane) 4.Mi tomy cin(Mut acy n)
2.Dact i
nomy cin(Act i
nomy cin) 5.Pl imy cin(Mi thracin)
3.Doxor ubi cin(Adr i
amy ci n
I
V. MI TOTI CI NHI BI TORS–ar epl antal kaloidsandot hercompoundsder i
vedf rom nat ural
product st hatbl ockscel l division.
1.Vi nbl ast inSO4(Vel ban) 4.Docer axel (Taxot ene)
2.Vi ncr ist i
neSO4(Oncov in) 5.Pacl itaxel (Taxol )
3.Vi ner ol bine(Nav elbine)
V. TARGETEDCANCERTHERAPI ES–i nterfereswi thcancercel l
growt handdi visionin
differ
entway sandatv ar iouspoi ntsint hedev elopment ,
gr owthandspr eadofcancer .It
mayi nt erfer ewi thpr otei nsorenzy mesi ncancercel lsleadi ngtoapopt osis. By
blockingt hesi gnal st hatt ell cancercel lst ogr owanddi vi
deuncont rol
lably,itcanst op
thegr owt handdi visionofcancercel ls.
1.Topoi somer aseII nhi bitors/Campt ot hecins-i nterfereswi ththeact i
onof
Topoi somer aseEnzy mes(IandI I)t odest royt hest ructureoftheDNAt hatis

27|Page
 neededf orr epl i
cat i
on.
a.I ri
notecan c.Teniposide
b.Topot ecan
2.ProteinTy rosineKi nases(PTKs)- areenzy mest hatregulatesignalingpat hway si
n
cell
sandr egul atecel lprol
iferati
on,di
fferentiat
ionandant iapoptoticsignals.
a.Gef initi
b(I ressa)
b.I matinibmesy l
ate(Gl eevec)
3.ProteasomeI nhibi t
ors-pr eventt hebreakdownofcer tainproteinsandt ranscripti
on
factorsandi nact iv egenesandpr otei
nst hathelpcancercel lssur v
iveantineoplastic
therapy,causi ngcancercel ldeath.
Exampl e: Bortezomi b(Vel cade)
4.Monocl onalAnt ibodi es(Moabs, mAbs)–r ecognizeproteinsinspeci f
iccancercel ls.
Itcanbeusedal oneorcanbeusedasv ehiclestodeli
v erdrugs,toxinsorr adioacti
ve
mat eri
altot umorsi t
e.
(
a)Exampl e: Trastuz2mab(Her ceptin)

VI.LI
POSOMALCHEMOTHERAPY -i sanewappr oacht
odeli
ver chemot
her
apythati
nvol
ves
theuseofanti
cancerdrugst
hahav
ebeenpackagedinsi
desy
nthet
icf
atgl
obul
escal
led
LIPOSOMES.
1.Doxorubici
n
2.Daunorubici
n
3.Vincri
sti
ne

VI
. HORMONALAGENTS–sev
eral
classesofhor
monal
agent
sar
eusedi
nthet
reat
mentof
cancer
.

1. Cor t
icoster oids- ar eant i
-infl
ammat oryagent sthatsuppr essthei nflammat ory
processt hatoccur sasar esultoft umorgr owth.Thesebl ocksst eroid-speci f
ic
recept orsont hecel lsur f
aces.
Exampl es:
a.Pr edni sone c.Hy drocortisone
b.Dexamet ahsone d.Cor t
isone
2.SexHor mones(Est rogen, Andr ogen)–sl owt hegr owt hofhor mone- dependentt umor s.
A.Est rogenTher aphy–i sapal li
ati
v et r
eatmentusedt odecr easethepr ogressionof
prost ati
ccanceri nmenandt osl owt hegr owt hofhor mone- dependentbr eastcanceri n
women.I tsuppr esst umorgr owt handt hedr ugpr omot esr emissionoft hecancerf orup
toay ear.
Exampl es
a.Diethylsti
lber ol(DES<St i
lber ol
) c.Chl or
ot ri
anase
b.Et hynilEstradiol (Est ryl
) d.Conjugat edest rogens(Pr emar in)
B.Pr ogestins-i susedt ot r
eatbr eastcancer ,endomet r
ialcancerandr enalcancer .I
tact sby
shrinki
ngt hecancert issues.
Exampl es:
a.Hy droxy progest eronecapr oat e(Dur alutin)
b.Medr oxypr ogest eroneacet ate(Depo- pr overa)
c.Megest rolacet ate(Meagcel )
C.Andr ogens–ar egi vent otreatadv ancedbr eastcanceri npremenopausal women.I t
promot esr egressi onoft hetumor .
D.Ant i
-Est rogens-ar eusedt otreatbr eastcancert hatareest rogenr eceptorposi t
ive.
Exampl es:a.Tamoxi fen( Nolv adex) ;b.Ral oxifene(Ev i
sta)

28|Page
E.Gonadot ropin-ReleasingHor mone-suppr esst hesecretionofFSHandLHf r
om thepitui
tar
y.
Ini
ti
al ly,anincreasei ntestoster onel eveli
sseen.Wi t
hcont inueduse, t
hepi t
uitarygl
ands
becomei nsensitiv
et othisstimul ationwhi chleadst oar educti
oni nt heproduct i
onof
andr ogensandest rogens.
Exampl es:a.Leupr oli
de(Lupr an);b.Goser eli
n(Zoldex)
F.Ant i
-Andr ogens–ar eusef ul i
nt reati
ngcl i
entsormenwi t
hhor mone- responsiveprostate
cancert hathasmet astasized.Itbi ndst oandrogen- r
eceptorsandbl ockst heeffectof
dihydr otestosteroneont hepr ost atecancercel ls.
Exampl es: a.Dlutamide(Eul exin);b.Ni l
utami de(Nilandron);c.Bi cal
utami de(Casodex)
G.Ar omat asei nhibi
tors–bl ockt heper i
pheral conver
sionofandr ogenst oestrogen,t
hus
suppr essingpost menopausal sy nthesisofest r
ogenandsl owingtumorgr owt h.Theyareused
i
nt het r
eat mentofhor monal l
ysensi ti
vebr eastcancerinpost menopausal womenwhohad
theirov ariesremov ed.
Exampl es: a.Anast r
ozole( Ar imidex);b.Letrozole(Femor a);c.Exemest ane(Ar omasin)
H.Mi scellaneousAgent s:a.L-aspar ginase(El spar;b.Pegaspar gase

VII
I. BI OLOGI CRESPONSEMODI FI
ERS( (BRM) -ar ecompl expr ot einspr oducedbyt hecells
ofthei
mmunesy st em.
Funct ions:
1.Enhancehosti mmunol ogicf unction.
2.Dest royori nter fer ewi thtumoract i
v i
ties.
3.Pr omot edi fferent iationofst em cel l
s.
2.I nter fer ons–ar ef ami lyofnat iral
lyoccur ingpr ot einsdi scov eredi n1950’s.
Interfer on–a( IFN- a)–i spr oducedbyB-cel l
s, Tcel ls,macr ophagesand nul ldell
sin
responset ot hepr escenceofv irusesort umor .
Act i
ons:
a.i nhi bit sint racel lularr epli
cat i
onoft hev i
ralDNA.
b.I nter fer eswi tht umor cel lgrowt h.
c. Enhancesnat ural kill
ercel l.
Exampl es:Rof eron- A,I ntronA
1.Col ony -St i
mul at i
ngFact ors-ar eprot einst hatst imul ateorr egulatethegr owt h,
mat ur at ionanddi f
fer entiati
onofbonemar rowst em cel l
s.
Act ions:
a.Decr easet hel engt hofpostt r
eat mentneut ropeni ar educi ngt heincidenceand
dur at ionofi nf ect i
on.
b.Per mi tsthedel iveryofhi gherdosesofdr ugs.
c. Reducebonemar rowr ecov eryt i
meaf tertranspl ant at i
on.
d.Enhancemacr ophageorgr anulocy tet umorv i
rusandf ungusdest royi
ngabi l
i
ty.
e.Pr ev entsev eret hr ombocy topeni aaf termy elosuppr essi onchemot her apy .
A.Er yt hr opoi et i
n( EPO)( Proct i
l)-i sagl ycoprot einpr oducedbyt heki dneyt hat
st i
mul atesRBCpr oduct ioni nresponset phy poxi a.Itst imul atesthedi visionand
di f
f erent i
at i
onofcommi tedRBCpr ogei torsi nt hebonemar row.
B.Gr anul ocy teandPel fil
grast i
m( Neul asta)Col ony -St i
mul ati
ngFact or–ar ehuman
gr anul ocy tecol ony -stimul ati
ngf act orpr oducedbyr ecombi nantDNAt echnol ogy.
C.Gr anul ocy teMacr ophage-Col onySt imul atingFact or–bel ongst oagr oupof
gr owt hf act or st hatsuppor tsurvival, cl
onal expr essi onanddi ff
erentiat
ionor
mat urat ionofhemopoet icpr ogeni t
orcel l
s.Iti nducespar t
iall
ycommi t
ted
pr ogeni t
orcel lst odi v i
deanddi fferent i
at eint hegr anul ocy temacr ophage-
pat hway .
2.I nterleuki ns/Ly mphocy tes–ar egr oupofpr oteinspr oducedbyt hebody ’
sWBC.

29|Page
 Example:Aldesleukin(Pr ol
eukin)
3.MonoclonalAntibody–ar eengineer edi
nthelabor
ator
ywi t
hthespeci
fi
cpurposeof
tar
geti
ngantigensandr eceptorsthatareexpr
essedmostf r
equent
lyoncancercel
l
s.
Examples:
a. Gefi
ini
ti
b(I ressa) d.Bevaci
zumab(Av asti
n)
b.Cetuximab(Er bi
tux) e.Rit
uxi
mab(Ri t
uxan)
c. Tr
astuzumab(Her cepti
n)

 GASTROI
NTESTI
NALAGENTS

A.DRUGSFORGI
TDI
SORDERS

A.Vomi t
ing(Emesi s)
Non-phar macol ogicMeasur es:
1.Admi ni strat i
onofweakt ea,car bonat edbev erageandgel atin.
2.Gat or adeandpedi aly tef orchi l
dren.
3.Cr acker sanddr yt oast .
4.IVFi fcondi tioni ssev eret or estor ebodyf l
uidbal ance.
Non-Pr escr iptionAnt i-emet i
cs:
1.Di menhy dr i
nat e(Dr amami ne)
2.Cy clizineHCl (Mar ezine)
3.Mecl izineHCl (Ant iver t)
4.Di phenhy drami neHCl (Benadr yl)
Pr
escr i
pt i
onAnt i
-emet ics
1.Ant ihist ami nesandAnt icholinergics–act spr i
mar ilyont hev omit
ingcenter.Ital
so
actbydecr easi ngst imul astionoft hechemor eceptort ri
ggerzone(CTZ)and
vest ibul arpat hway s.
Ex ampl es: Hy droxy zine(Vi staril
,At arax ),Pr omet hazi ne(Phener gan)’
Scopol ami ne(Tr ansder m-Scop)
2.Dopami neAnt agoni sts–suppr essemesi sbybl ocki ngdopami nereceptorsinthe
CTZ.
Exampl es: Phenot hiazi nes:Chl orpromazi ne(Thor azi ne),Pr ochl
orperazi
ne
edi
syl
ate (Compazi ne)Pr omet hazine(Phener gan)
3.Benzodi azepi nes–i ndi rectlycont rol nauseaandv omi ti
ngt hatmayoccurwi thcancer
chemot her apy .Exampl e:Lor azepam (At ivan) ,Di
azepam (Val i
um)
4.But y rophenones-bl ockst hedopami ner ecept orsint hechemor eceptortr
iggerzone.
Theyar eusedt ot reatpost -oper ati
v enauseaandv omi ti
ngandemesi sassociated
wi tht oxi ns, cancerchemot her apyandr adiationt her apy .
Exampl es: Haloper idol (Hal dol),Dr oper idol (Inapsi ne)
5.Met ochopr ami de(Regl an)–suppr essemesi sbybl ocki ngt hedopaminei ntheCTZ.
Itisusedi nt het east mentofpost -
oper at i
v enausea, cancerchemot her
apyand
radi ationt herapy .
6.Ser ot oni nRecept orAnt agoni sts–suppr essnauseaandv omiti
ngbybl ocki
ngt he
ser otoni nr ecept orsandt hev agal ner vet ermi nalsint heupperGI T.
Exampl es:
a.Ondansent ron(Zof r
an)
b.Gr ani setron(Ky tril)
c. Dol aset ron(Anzer net)
d.Pol anoset ron(Al oxil)

30|Page
 7. Gl ucocorti
coids(Cor ticosteroids)
-suppr essvomi t
ingassociatedwit
h
chemot herapy.
Exampl e:Dexamet hasone(Decadr on),Methyl
prednisol
one(Sol uMed)
8. Cannabi noids-alleviatesnauseaandv omi t
ingfr
om cancert reatment
.Iti
susedas
appetit
est i
mul antsf orpat i
entswi t
hAI DS.Itisprescri
bedf orthosewhodonot
respondt oorunabl etot akeot heranti-
emet i
cs.
Exampl e:Dr onabi nol(Mar inol
9.Mi scel
laneousAnt i-
emet i
cs–
Exampl e:Diphenidol (Vont rol
),Tr imethobenzami de(Tigan)
Emet ics-aredr ugsusedt oinducev omi t
ingtoexpel thesubstancebeforeabsor
pti
on
occurs.Exampl e:Ipecac

B. Diar rhea
TREATMENT:
1.Opiates–decr easei nt
estinalacti
v i
tyt
herebydecr easingperistal
sis.
Exampl es:Codei ne,Di phenoxy l
ate(Lomot i
l),Difenoxin(Mot ofen),Loperamide( I
modium)
2.Somat ostati
n–i nhibit
sgast ri
c acid,pepsinogen, gastr
in.cholecystoki
ni,
andser otoni
n
secret
ionsandi nt
estinalfl
uids.Itdecreasessmoot hmuscl econtractil
i
ty.I
tisusuall
y
prescr
ibedf orsever
edi arr
hear esult
ingfrom met astati
ccancer .Exampl e:Octreoti
de
(Sandost atin)
3.Adsor bent s–actbycoat ingthewal l
oftheGI Tandadsor bingthebacteriaortoxinsthat
causedi arrhea. Exampl es:Kaol in,Pect
in,Bi
smut hsal t
s,Calesti
pol,Cholestyr
amine
(Questran)

C.Constipation–i st heaccumul ati

onofhar df ecalmat er
ialsinthel argei nt
estines.
TREATMENT:Laxat ivesandCat hartics
TypesofLaxat ives:
1.Osmot ic(Sal ine)Laxat i
ves/Hy per osmol arLaxat i
ve–i ncludessal inepr oductsLact ul
ose
andGl ycerin.Itpul lswat eri ntothecol onandi ncreasewat eri nthef ecest oincreasebulk
whichst i
mul atesper istalsis.
2.St imul ant(Cont act ,
Irrit
ant )Laxat i
v es–i ncreaseper i
stalsisbyi rr
itati
ngsensor ynerve
endingsi nthei ntest i
nal mucosa.Exampl es:Bi sacody l(Dul colax),Senna(Senokot ),
Cast oroi l
3.Bul k-for mingLaxat ives-ar enat uralfibroussubst ancesthatpr omot elarge,softstoolsby
absor bingwat eri ntot heint esti
nes, increasi ngfecalbulkandper i
stalsi
s.Exampl es:
Calcium pol y
car bophi l(Fibercon), Met hy l
cell
ulose(Ci tr
ucel) .
4.Emol li
ent s(St oolSof teners) -arest ool softenersandl ubricant susedt opr event
const i
pat ion,decr easest rainingdur ingdef ecati
on.Itlower st hesurfacet ensionand
promot eswat err etentioni nthei ntestinesandst ool.Exampl es:Docusat eCa(Sur f
ak),
Docusat eK(Di al ose) ,Docusat eNa(Col ace)

I
II
. ANTI
-ULCERDRUGS

7GROUPS:
1.Tranquili
zers–hav eami ni
mal ef
fecti
npreventi
ngandt r
eat i
ngulcer
s;however,
they
reducev agalsti
mulationanddecr easeanxiety
.Example: Libr
ax
2.Anticholi
nergics–relievepainbydecr easi
ngGImot i
li
tyandsecr eti
ons.Theyactby
i
nhibiti
ngacet yl
chol
ineandbl ocki
nghistamineandHCl acid.Theydelaygast
ri
cemptying,
sotheyar eusedmor efrequentlyforduodenalul
cer
sthanf orgastri
culcer
s.Example:
Propantheli
nebr omine(Pr o-Banti
ne)

31|Page
3.Ant acids–pr omot eul cerheal ingbyneut ral
izingthehCl aci dandr educingpepsi nacti
vit
y.
a.Sy stemi cAnt acids–ar esy st emi cal
lyabsor bedant acid.Exampl e: NaBi carbonat e(Alka-
seltzer)
b.Non- Sy stemi cAnt acids–hasasmal ldegr eeofabsor ption.Exampl e: AlMghy droxi
de
(Maal ox
4.Hi st ami ne2Bl ocker s(H2Recept orAnt agoni st
)–pr eventaci drefluxint heesophagus.
Itbl ockst heH2r eceptoroft hepar ietalcell
si nthest omach, thusr educing gast ri
caci d
secr eti
onandconcent rat i
on.I ti susedt ot r
eatal lergi
creact i
ons.Exampl es:Ci metidine
(Tagamet ),r ani ti
dine(Zant ac) ,Famot i
dine(Pepci d)
,Ni zatidine(Axi d)
5.Pr otonPumpI nhibitors(Gast ricAci dSecr etionInhibitors, Gast ri
cAci dPumpI nhibit
ors)-
-suppr essgast r
icaci dsecf etionbyi nhibiti
ngt hehy drogen/pot assium adenosi ne
tri
phosphat e( ATPase)enz y mel ocat edi nthegast ri
cpar i
et alcells.Exampl e:Omepr azole
(PRisloec) , Lansopr azole(Pr ev acid)
6.Pepsi nI nhibitor(Mucosal Protect i
veDr ug)–i snon-absor banleandcombi neswi thprotei
n
tofor m av iscoussubst ancet hatcov erstheul cerandpr otectsi tfrom aci dandpepsi n.
Exampl e:Secr alf
ate(Car af ate)
7.Pr ost agl andi nAnal ogueAnt iUlcerDr ug
Exampl e:Mi sopr ost ol–suppr essgast ri
caci dsecr eti
onandi ncreasecy toprotectivemucus
i
nt heGI T.

 ENDOCRI
NEAGENTS

I
. PI
TUI
TARYGLAND(Hy
pophy
sis)

LOBES:
1.Ant eriorPituit
ar y(Adenohy pophy sis)–secr et est hefollowingv ari
oushormonest hat
tar
gettissuesandgl ands.
A.Gr owthHor mone
B.Thy roidst i
mul ati
nghor mone
C.Adr enocor ticot r
opi chor mone
D.Gonadot ropi ns
DRUGTHERAPY:
A.Growt hHor moneDef i
ciency -Somat r
en( Protropin);Somat r
opin(Humat r
ope)
B.Growt hHor moneExcess-Oct reotide(Sandost atin)
C.ThyroidSt i
mul atingHor mone–st imulatest het hyroidglandt or el
easeTHYROXI NE(T4)AND
TRII
ODOTHYRONI NE( T3)orLI OTHYRONI NE.Excesssecr et i
oncancausehy pert
hyr
oidism;
defi
ci
tcancausehy pothy roidism.Exampl e:Thr y otropin(Thy tr
opar)
D.Adrenocor t
icotropi cHor mone(ACTH)-st imul atesther eleaseoft hefol
l
owi nghormones:
1.Glucocor t
icoi ds(Cor tisol)
2.Mi neralocor tocoi ds(Al dosterone)
3.Andr ogen(Andr ogen)
Exampl e:Act har
2.PosteriorPituit
ar yGl and(Neur ohy pophy si
s)-secr etest hef ol
lowinghormones:
A.Ant i
-diureticHor mone( ADH)
B.Oxy t
oci n
Exampl es:Vasopr essin(Pi tressin)
; Desmi pressi n(DDAVP)
3.ThyroidGl and–secr et esthef ollowinghor mones:Thy roxi ne(T4)andTr ii
odothyronine(
T3)
Funct
ions:

32|Page
 1.Regul
atepr
otei
nsynthesis.
2.Regul
ateenzymeactivi
ty.
3.Sti
mulatemit
ochondri
aloxidat
ioi
n.

Thy
roi
dGl
andDi
sor
der
s:

A.Hypothyroidi
sm
DRUGTHERAPY:
a.Lev othyroxineNa(Lev othroid,Synthroid)–isthedrugofchoi
ceforrepl
acement
ther
apyfortreatment.ItincreaseT3andT4l evels.
b.Liot
hyroxine( Cy t
omel)–i sasy ntheti
cT3t hathasashorthal
f-
li
feanddurat
ionof
acti
on.I
tisbetterabsor bedint heGI
Tt hanlevothyroxine.
c.Liotr
ix(Eut hroid,Thyr
olar)–isami xtureoflev
othy
roxi
nenaandl i
othyr
oni
ne.

C.Hy
per
thy
roi
dism

Grave’sDi sease–i sthemostcommont ypeofhy perthyroidi

sm causedbythehy per
functionoft het hyroidglands.
Treatment :
a.Subt otal Thyroidectomy
b.Radi oact i
veI odineTher apy
c.Dr ugTher apy-i nhi
bit
seitherthesynthesi
sort hereleaseoft hyr
oidhormone.The
purposei stor educet heexcessivesecreti
onofthyroi
dhor monepr oducti
on.
1.Thi omi des-ar ethedrugofchoi ceusedtodecr easehor monepr oducti
on.Iti
nter
feres
withsy nt
hesi soft hy r
oidhormone.EXAMPLES:Pr opylt
hiouracil(RTU),Methi
mazol e(
Tapazole)
2.Lugol ’sSol uti
on–suppr essesthyr
oidfuncti
onf orclient
swhohav eundergonesurgery
duet oGrav e’sDi sease.

4.Parat
hyroi
dGl ands–secr etesparathyr
oidhormones( PTH)whi
chr
egul
atescal
cium l
evel
sin
thebl
ood.Iti
ncreasescal cium by:
a.mobili
zi
ngcal ci
um f r
om thebone.
b.promotingcalcium absorptionfrom thei
ntesti
nes.
c.pr omotingcalcium reabsorpti
onf r
om therenaltubul
es.

CALCITONIN–isahor moneproducedprimari
lybythet hy
roidgl
andsandtol esserext
entby
thepar
athy
roi
dglands.Iti
nhi
bit
scalci
um reabsorpti
onbyt heboneandincr
easesr enal
excr
eti
onofcal
cium.
CALCITROL-isav i
taminanal
oguethatpromot escalci
um absorpt
ionf
rom theGI Tand
secr
eti
onofcal
cium fr
om bonetotheblood.

5.AdrenalGl ands -arepairedglandsconsi st

ingoft
headr enalmedul
laandadrenalcort
ex.
AdrenalCor tex–pr oducestwohor moneorcorti
coster oi
ds:GLUCOCORTI COIDSAND
MINERALOCORTI COI DS
AdrenalGl andDi sor
ders:
A.Addison’ sDisease–i sadi sorder duetodecr easedsecret
ionoradrenal
hyposecret
ionofi nsuff
ici
ency.
B.Cushi ng’sSyndrome–i sadi sorderduetoanincreasei ncor
ti
coster
oidsecret
ionor

33|Page
adr
enal
hyper
secr
eti
on.

DRUGTHERAPY:

1.Glucocorticoids-ar eusedtotreatmanydi seasesandheal thprobl

emsi ncluding
i
nflammat ory, al
lergicanddebi l
it
atingcondi tions.
a.Cor t
isol_i sthemai nglucocorticoid,hasanaant i-i
nflammat or
y,anti
-all
ergicandanti-
str
ess
eff
ect.
b.Dexamet hasone–i susedforsev ereinflammat oryresponseasar esultofheadt r
aumaor
all
ergi
cractions.
c.Prednisone–i sanexpensi v
egl ucocor t
icoid.
2.GlucocotricoidI nhibitors
a.Ket okonazol e(Ni zoral
)–isef fectivei
nt r
eatingclientswithCushing’sSy ndromeandalso
i
sedasanadj unctt osur ger
yandr adiation.
b.Mi t
otane( Lysedr en)–i sanant i-
neoplast i
chor moneant agoni
st.
¬c.Ami noglut ethimide(Cy t
adren)–i nhibitglucocr t
icoidsynthesi
s.
4.Mi neralocor ti
coids–secr et
esal doster
one.

 ANTIDIABETI
CAGENTS
- Areusedpri
mari
l
ytocont
rol
diabet
esmel
l
itus.
1.I
nsul
in

2.Or
alAnt
i–di
abet
icDr
ugs(Or
alHy
pogl
ycemi
cDr
ugs)

A.Fi
rstandSecondGener at
ionSul fonylureas–ar echemicall
yr elat
edt osulfonami desbut
l
acksant ibacterialacti
v i
ty.Theyst i
mul atebet acel l
stosecr etemor einsulin.They
i
ncreasesi nsulincel l
receptor sthusi ncr easingt heabi
li
tyoft hecel l
st obindinsul i
nfor
gl
ucosemet abolism.
a.Fi rstGener ationSulfony lureas–coul dbeshor t-
acting, i
ntermediat
eact ingand
l
ong- acti
ngant i
diabetics.EXAMPLE:Acet ohexamide(Dy mel or
).
b.SecondGener ati
onSuf onylureas–i ncreasesthetissuer esponsetoi nsulinand
decr easegl ucoseproduct i
onbyt hel iver.Theyhasagr eaterhypogly
cemi cpotncy
thanf i
rstgener ati
ons.Theyhasl essdi splacementpot entialfr
om proteinbinding
sit
esorhi ghl yprotei
n-bound.EXAMPLES:Gl iomepr i
dine(Amar yl
);Gli
pizide
(Gl ucot r
ol)

B.Non-sulf
oy l
ureas–doesnotenhancei nsul i
nr eleaseandr ecept orinteractionsbut
af
fectthehepat i
candGIpr oductionofgl ucose.
a.Mel formin(Gl ucophage) -decr easeshepat i
cpr oduct ionofgl ucosef rom stored
fats.Itdiminishest heincreasei nser um gl ucosef ollowingameal .Itdecreases
glucoseabsor ptionfrom thesmal lintesti
nes.i tincreasesi nsul i
nreceptor
sensi t
ivit
yandper i
pheralglucoseupt akeatt hecel l
ularlevel.
b. Acar bose(Pr ecose)andMi gitol(Gl ycoset )–i nhibitthedi gestiveenzymei n
thesmal li
ntestineresponsi bl
ef ort hereleaseofgl ucosef r
om t hecompl ex
carbohy dratesfrom t hediet.
c. Megl i
ti
nides; examples:Repagl i
nide(Pr andin)andNat eglinide(Starli
x)-
stimiulatesbet acellstoreleasei nsulin.Isusedf orty pe2di abet esandar eshort-
acting.

34|Page
Gui
del
ines f
orOr alAnt i
diabeticTherapy(Ty pe2-NIDDM)
1.Onsetmustbeatage40.
2.Diagnosi sofdi abetesforlessthan5years.
3.Nor mal wei ghtorov er
weight.
4.FBS-equal toorl essthan200mg/ d
5. Lesst han40“ u” ofi nsuli
nrequir
edperday.
6.Nor mal renal andhepaticf uncti
ons.
C.Hy per
glycemicDr ugs

A.Glucagon–i sahy perglycemichor monesecr etedbyt healphacel l

soft heisletsof
langerhans.I tincreasesbl oodsugarbyst i
mul ati
ngGLYCOGENOLYSI Si ntheliver.I
t
protectst hebodycel ls,especiallythoseinthebr ainandr eti
na,byprov i
dingt he
nutrientsandener gyneededt omai ntainbodyf uncti
on.Itisusedt otreatinsulin-
inducedhy pogl y
cemi awhenot hermet hodsofpr ovi
dingglucosear enotav ai
lable.I
t
isav ai
lablef orparenter aluse.Recent ly,I
Vglucagoni susedi ntheacut et r
eatment
ofbet a-bl
ockerov erdoseandpr ofoundshock.
B.Diazoxide(Pr oglycem)–i ncreasesbl oodsugarbyi nhibiti
nginsuli
nr el
easef r
om
thebet acel lsandst imul ati
ngr eleaseofepinephr i
nef r
om theadr enalmedul l
a.
D.Ot
herAnt -Diabet i
cs
A.Exenat ide(By etta)–i mpr ov esbetacellresponsivenessimpr ovingglucose
control i
npeopl ewi thNI DDM.
B.Pr aml inti
deacet at e(Sy mlin)–f oradultswi thtype1and2Dm t oimpr ove
postprandi alglucosecont rol indiabeti
cswhoar eusinginsuli
nbutar eunabl eto
achieveormai ntaingl ucosecont rol.

 CARDI
OVASCULAR AGENTS

I
. CARDI
ACGLYCOSI
DES,
ANTI
-ANGI
NALS,
ANDANTI
-DYSRRHYTMMI
CS

A. Car diacGl ycosi des(Di gitalisGl y

cosi des)-i
nhibit
st heNa-Kpump; thusincreasing
intracell
ularcal cium causi ngt hecar di
acmuscl efi
ber st
ocont r
act .
Ef f
ectofDi gitalist otheHear t:
a. Aposi tivei notr
opicact ion.
b.Anegat ivechr onotropi cact i
on.
c. Anegat ivedr omotropi cact i
on
NOTE:
a.t heincr easei nmy ocardi alcont r
acti
li
tyincreasescardiac,peri
pher al
andki dney
functionby :
 i ncr easi ngcar di
acout put.
 Decr easi ngpreload
 I mpr ov i
ngbl oodf lowt otheper ipheryandki dneys.
 Decr easi ngedema.
 I ncr easi ngf l
uidexcr eti
on.
b.Theyar eal sousedt ocor r
ectat ri
alfi
bri
ll
ationandat r
ialfl
utterthruchronotropic
effectsandnegat i
vedr omot ropiceffects.
A.DI GOXI N( Lanoxi n)-isacar diacgl ycosideusedt otreatCHF, atr
ialtachycardia,
flut
teror
fibril
lati
on.Iti nhibitstheNa- K ATPaset huspr omotingincreasedf orceofcar di
ac
cont racti
on, car diacout putandt i
ssueper fusion.I
tdecreasesv entri
cularrate.

35|Page
Di
gital
isToxici
ty–occur
swithover
dosageoraccumul
ati
onofdiogoxi
n.
Note:Cardi
otoxi
cit
yisaser
iousadver
sereact
iontodi
goxi
nleadingtovent
ri
cul
ar
dysrr
hythmias.

ANTI
DOTETODI GI
TALI
STOXICITY:
1.Phenytoi
nandLi
docai
ne
2.Digoxi
nimmuneFab(Ov i
ne,Di
gibi
nd)

B.PHOSPHODI ESTERASEI
NHIBITORS-isusedt otr
eatacut
eCHF orwhent her
eisno
responsetot
heuseofot
heragents.I
tinhi
bit
’stheenzymePhosphodi
est
erase
promotingaposi
ti
vei
not
ropi
cresponse.
C.OTHERAGENTSUSEDTOTREATHEARTFAI LURE

1.Vasodi lators–decr easev enousbl oodr et urnt ot hehear tresul t

ingto:
a.Decr easei ncar diacfill
ing.
b.Decr easedv entri
cularst ret ching.
c. Decr easedO2demand.
Act ions:
1.Reducescar diacaf t
erloadi ncr easi ngcar diacout put .
2.Di l
at ear teriolesofki dney si mpr ov i
ngr enal perf usi onandi ncreasef luidloss.
3.I mpr oveci rculati
ont ot heskel et al muscl es.
2.Angi ot ensi n-Conv ertingEnzy meI nhi bitors( ACE) -di l
atev enul esandar teri
oles
i
mpr ov ingr enal bloodf lowdecr easi ngbl oodv olume.
3.Di uret ics(Thi azides, Furosemi des)–ar et hef i
rstl inedr ugsf orreduci ngf l
uidv olume
fr
equent lypr escribedwi thdigoxi norot heragent s.
4.Spi ronol act one(Al dact one)–i sapot assi um- spar ingdi ur eticusedt ot reatmoder ate
tosev er eCHF.I timpr oveshear tr atev ar i
abi li
tyanddecr easesmy ocardial f
ibrosis.
Not e:Al dost eronesecr eti
onsar ei ncreasedi nCHFpr omot ingbodyl ossofpot assi um
and magnesi um neededbyt hehear t .
5.Bet a- blocker s–ar eusual lycont rai ndicat edf orcl ient swi t
hhear tf
ai l
urebecauset hi s
drugcl assr educescar diaccont ract il
i
ty; howev er, somehav eshownt oimpr ov ecar di
ac
perfor mance.
Exampl es:Car v
edi lol(Cor eg) ,Met ropol olt artrat e(Tr opol–XL)
6.Nesi ritide(NAt r
ecor )–i sanat rial natriur eticpept i
dehor monet hatinhibitsant i-
diureti
c
hormone(ADH)byi ncreasingNal oss.I tisusedi ncor rect ingCHFbypr omot ing
vasodi lat i
on, ntriurei sanddi eresi s.I tisusef ulfort r
eat ingcl ientswhohav eacut e
decompensat edCHFwi thdy spneaatr estorwhohav edy spneawi thli
ttlephy sical
mov ement .
7.Bi dil–i sacombi nat ionofhy dral azi neandi sosor bide.

B.Ant
i-
Anginals– -ar eusedt otreatangi napect ori
s.
1.Ni t
rates–causegener al
alizedv ascularandcor onaryvasodi l
ation,i
ncreasi
ngblood
fl
owt hruthecor onaryaretiest omy ocardialcells.
a.Subl i
ngual(SL)Ni t
rogly cerin–isnotswal lowedbecausei tundergoesf i
rst
-
passef fectbyt heli
verdecr easingeffectiveness.Itisplacedundert heoungefor
fasterabsorpt i
on.
b.I sosorbideDi ni
trat
e(I sor dil
,Sorbit
rate)–canbeadmi nisteredbySLbyt abl
ets
andor all
ybychewabl et ablets,
immedi ate-releasetablets,sustai
nedr el
ease
tabletsandcapsul es.
c. IsosorbideMononi t
rate(Monot el
,Imdur )
-canbegi venor allybyimmediate

36|Page
 releaseandsust ainedr eleaset ablet s.
2.Bet a-bl ocker s-decr easeheef fect soft hesy mpat heticner voussy stem bybl ocking
theact ionoft hecat echol ami neepi nephr ineandnor epinephr i
ne, t
herebydecr easing
HRandBP.Theyar eef fect iveasanant i-angi nal sbecausebydecr easingt heHR
andmy ocar dialcont ract i
lity,ther educeneedf orO2consumpt ionandconsequent ly
,
reduceangi napai n.
Exampl es:Pr opanol ol (Inder al ),Nadol ol(Cor gar d),Pindolol(Visken) ,
At enol ol(Tenor mi n) ,Met ropol ol (Lopr esor ,Topr ol-
XL)
3.Cal ci um ChannelBl ocker s/Cal cium Bl ocker s
Act ions:
a.Decr easecar di accont ract il
ity.
b.Decr easeaf terload.
c. Decr easeper ipher al resist ance
d.Reducewor kl oadoft hehear t.
e. Decr easet heneedf orO2.
Exampl es:Aml odi pi ne(Nor v asc) ,Bepr i
di lHCl (Vascor ),Dil
tiazem
HCl (Car dizem) , Fel odi pine(Pl endi l
), Isr adipine(Dy naciro)
C.Anti
dysrhy thmi cs–ar eusedt or est oret hecar di acr hy thm t onor mal .
1.Fast( Na)Channel Blocker s–decr easet hef astNai nf l
uxt ot hecardiaccel l
s.
Subgr oups:
a.I -
A–sl owsconduct i
onandpr olongsr epol ar i
zation.
b.I -
B-sl owsconduct ionandshor tensr epol arization.
c. I -
C-pr olongsconduct i
onwi thl i
ttlet onoef fectt orepolar i
zati
on.
2.Bet a-bl ocker s–decr easeconduct i
onv el oci t
y,aut omat i
cityandr ecov erytime.
3.Pr ol ongRepol ar i
zat ion–ar eusedi nt heemer gencyt reatmentofv ent r
icular
dysr hy thmi aswhenot herant idy srhy thmi asar ei neffective.Theyi ncreaset he
refract or yper i
odandpr olongt heact i
onpot ential durat i
on.
Exampl es:Br et yli
um (Br etylol ),Ami odar one(Cor darone)
4.Sl ow Cal cium ChannelBl ocker s–bl ockscal cium i nfluxther ebydecr easingthe
exci tabi l
ityandcont ract ili
tyoft hemy ocar dium.I tincreasest her efractoryperiod
oft hAVnodewhi chdecr easesv ent ri
cul arr esponse.
Exampl es:Ver apami l(Cal an,I sopt in), Dilti
azem (Car dizem)

I
I. DIURETI CS–pr oducei ncreasedur inef lowbyi nhibi
tingNaandwat erreabsor ption
fr
om t heki dneyt ubul es.Itisusedt odecr easeHPNandper ipheraland pul monar y
edema.
5Cat egor ies:
1.Thi azideandt hiazi de-l
ikeDi ur etics-act sont hedisatal conv olut
edr enalt ubule
bey ondt hel oopofHenl et hopr omot eNa, ClandH2Oexcr eti
on.Theyar eusedt o
treatHPNandper ipheral edemaandar eprimarilyusedf orclient
swi t
hnor mal
renal funct i
on.Itcausesal ossofNa, K,andmagnesi um butpr omot scalci um
absor ption.Itaf fectsgl ucoset oler ance,thushy perglycemi acanoccur .Not e:I
tis
notef fect i
vef ori mmedi atedi uresi s.
Exampl es:Chl orthiazide(Di ur i
l),Indapami ne(Lozol )
2.Loop(Hi gh-Cei l
ing)Di uretics–act sont heascendi ngl oopofHenl ebyinhbi ti
ng
chl ori
det ranspor tofNai ntot heci rculati
on.Itcanaf fectbl oodsugarandi ncease
thur i
caci dl evel.Itiscal l
ed“ high- ceil
ing”becauset heef fectisdoser elated.
Exampl es:Et hacr ynicAci d(Edecr in),Furosemi de(Lasi x),Bumet anide(Bumex)
3.Osmot icDi uretics–i ncreaset heosmol ali
tyofthepl asmaandf luidsinther enal
tubul es.I tisusedt odecr easei ntracranialpressure,prev entrenal fail
ureand

37|Page
 decreaseintraocularpressure.
Exampl es:Manni t
ol,Ureaphi l
4.CarbonicAnhy dr aseInhibi
tors–bl ockst heactionoft heenzy mecar bonic
anhydrase.Itisusedpr imarilytodecr easei
ntraocularpressure(IOP)i ncli
ents
wit
hopen- anglegl aucoma.I tisalsousedf ordieresis,
managementofepi lepsy
andt r
eatmentofhi ghal t
it
udeoracut emount ainsickness.
5.Potassium-Spar i
ngDi uret
ics-areusedasmi lddiureti
csori ncombi nat i
onwi t
h
anotherdiureti
c.Itactspr i
mar i
lyont hecoll
ectingductr enaltubulestopr omote
Naandwat err etenti
on.
Exampl es:Spi ronolactone(Al dactone),Tri
amt erene(Dy r
enium)Ami lori
de
(Midamor )

I
II
. ANTI-HYPERTENSI VES
1.Diuret i
cs–pr omot eNadepl eti
onwhi chdecr easesdext racel l
ularfluid
volume(ECFV)t heyar eef fectiveasf irst-li
nedr ugsf ortreat ingmi ldHPN.
Exampl e: Hydr ochl or thiazide(Hy drodi uril
)
2.Sy mpat holyt
ics(Sy mpat het icDepr essant s)
a.Bet a-adrener gi cbl ocker s c.alphaadr energicbl ocker s
b.Cent rall
yact ingal phaagoni sts d.adr ener gicneur onbl ocker s
3.Direct-Act i
ngAr teiolarVasodi lators-actbyr elaxingt hesmoot hmuscl esoft he
bloodv esselscausi ngv asodi l
at i
on.I tpr omot esani ncreasei nbloodf lowt ot he
kidney sandbr ain.Wi thv asodi l
at i
on, BPdecr easesandNaandwat erar er tai
ned
resul t
ingper ipher aleema, r efl
ext achy cardiai scausedbyt hev asodi altor sand
decr easei nBP.
Exampl es:Hy dr alazine, Minoxi dil
4.Angi otensi nAnt agoni st(angi otensi n-conv erti
ngenzy me[ ACE]I nhibitor s)–
inhibitsACEwhi chi nt urni nhibitst hef ormat i
onofAnhi ot ensinI Iandbl ockst he
relaseofal dost er one.
Exampl es:Capt opr il(Capot en) ,Benazepr il(Lot ensin),Enal aprilmal eat e
(Vasot ec),Fosi napr i
l(Monopr i
l)Li si
nopr i
l(Pr i
nivil
,Zest ril)
, Moexi pril(Uni vasc)
Per i
ndopr i
l(Aceon) ,Qui napr il(Accupr i
l),Rami pril(Al t
ace), Trandopr i
l(Mav i
k)
5.Angi otensi nIIr ecept orAnt agoni sts(A- IIblocker sorARB)–i ssi milart oACE
inhibitorsint hatt heypr ev entt her eleaseoft heal dost erone.I tact sont her ennin-
angi otensinsy stem.
Exampl es: Lorasar tan(Cozaar ), Valsar tan(Di ov an),Irbesar tan(Av apro),
Candesar t
anci lexet il(At acand)
6.Caci um ChannelBl ocker s(Cal cium Ant agoni sts)–decr easecal cium l evels
andpr omot ev asodi lation.Theyar ehi ghl ypr otein-boundandhav eashor thalfl
if
e.
Exampl es: Ver apami l(Cal an) ,Ni fedipine(Pr ocar dia),Aml odipine(Nor vasc)

I
V. ANTI-
COAGULANTS, ANTI-PLATELETSANDTHROMBOLYTI CS
A.Anti-coagulants–areusedt oinhibi
tclotformation,butdonotdi ssolveclot
s
thathav ealreadyfor
med.
1.Hepar i
n–i sanaturalsubst
ancei ntheliv
ert hatpreventsclotfor
mat i
on.Itis
usedinopenhear tsurgeryt
opr eventbloodf rom cl
ottingandinthecriti
call
y
i
llcl
ientswithDIC.I
tisprimaril
yusedt opr ev
entv enoust hr
ombosi s,
which
canleadt opul
monar yembolism orstroke.Itisnotgi venorall
ybecausei ti
s
poorlyabsorbedintheGI Tandi sdestroyedbyhepar i
nase,anenzy mei nthe

38|Page
 l
iv er .
2.Or alAnt i
coagul ant s–i nhi bithepat i
csy nthesi sofv itK, thusaf fect ingthe
clot ti
ngf act orsI I,VI I,IXandX.Theyar eusedpr imar ilyt opr ev ent
thromboembol iccondi ti
onsandt opr olongcl ottingt ime.
Exampl es:War far in( Coumadi n)
, Dicumar ol ,Ani sindione(Mi radon), .
Par ent eral Ant icoagul ant s:Ar gatroban(Acov a),Bival i
rudi n(Angi omax) ,
Lepi r
udi n(Ruf ludan)
Filmt abl etten(Exant ha) -wasr ecent lydv l
opedt odecr easet her i
skofbl ood
clot sandst roke.i tisusedf orcl i
ent swi thbl eedi ngpr oblemsr elatedt o
war farin.
Vit .K1( Phy tonadi one)–i stheant idot ef orwar farinov erdoseor
uncont rol l
abl ebl eedi ng.I fbleedingi snotcont rolled, freshwhol ebl oodor
freshf rozenpl asmaorpl ateletsar egener allyar egi ven.
B.Anti-Pl atel etDr ugs-ar eusedt opr eventt hrombosi si nar ter i
esbysuppr essing
plateletaggr egat ion.Theyar eusedmai nlyf orpr ophy l
acticuse:
a.Pr ev ent ionofmy ocar dial infarcti
onorst r
okef orcl i
ent swi thf ami l
ial hi
story.
b.Pr ev ent ionofar epeatMIorst roke.
c. Pr ev ent ionofst r
okei ncl ient shav ingt ransi entat tacks.
Exampl es:Aspi rin, Cilost azol (Pletal),Cl opi dogr el(Pl avix), Dipyradamol e
(Persant ine)
C.Thrombol ytics-ar eusedt ipr omot eFibr i
nol y ti
cMechani sm.(t heconv ersionof
plasmi nogent opl asmi n,whi chdest roy st hef ibr ini nt hebl oodcl ot s.)
Not e:
1.Thet hrombusorbl oodcl otsdi si
nt egrat ewhenat hrombol yticdr ugi s
admi ni ster edwi t
hi n4- 6hour s af teranacut eMI .
2.Theneedf oracar iacby passorcor onar yangi opl astycanbeev aluat edsoon
aftert hrombol ytict reatment .
3.I tshoul dbeadmi ni steredwi thin3hour soft hrombol y ti
cst roke.
4.Theyar eal sousedf orpul monar yembol i
sm, non- cor onar yar ter i
al occlusion
from anacut et hromboembol i
sm amdt hrombol icst roke.
Exampl es:St r ept oki nase, Uroki nase, TissuePl asmi nogenAct i
v ator
(TPA, Al tept ase) , Ani soy latedPl asmi nogenSt r ept okinaseAct i
vat orCompl ex
(APSAC)Ret epl ase(Ret av ase) ,Tenecl ept ase(TNkase)

V. Ant
i-
Lipi
demi
csandPer
ipher
alVasodi
lat
ors

A.Ant
i-
Lipi
demi
cs–l
owerabnor
mal
li
pidl
evel
s.

Ty
pes:
1.Chol est yr
ami ne(Quest ran)–i sar si
nt hatbindswi thbileacidsinthe
i
ntestines.ItcomesI nagr i
ttypowderwhi chi
smi xedt horoughl
yinwateror
j
uice.
2.Col estipol(Colestid)–i saresinant i
l
ipidemicsimi l
art ocholestyr
amine.It
l
ower schol esterollevel
.
3.Cl ofi
br at
e(At r
omi d-S)}
-ar ehighlyproteinboundandshoul dnotbetaken
withan
4.Gemf ibrozil(
Lopi d) } ant i
coagulant.
5.St ati
nsar ealsocal ledHMGCoAReduct aseInhibitors.Iti
nhibi
tschol
esterol
synthesisinthel iverdecreasingtheconcent r
ationofchol est
eroland
decreasest heLDLandsl i
ghtlyincr
easingHDL.Not e:reducti
onisseenin2

39|Page
 weeks.
Exampl es:At rov astati
nCa(Li pitor
),Fl
uvastat i
n(Lescol ),Lovast
ati
n
(Mev acor),Prav astati
nNa(Pr avachol)
,Simv ast ati
n(Zocor ),
Rosuvastat
in
Na(Cr estor)
B.Peri
pheralVasodi lators–i ncreasebloodf l
owt ot heext remiti
es.Theyareused
i
nper i
pheralvascul ardisordersofv enousandar terialvessels.
Examples:Tol azoline(Pr iscoli
ne),I
soxsupri
ne(Vasodi l
an),Nicoti
nylal
cohol,
Papaveri
ne(Cer espan, Genabid),Pr
azosin(Minipres) ,Nif
edipine(Procar
dia),
Pentoxi
fyll
i
ne( Trent al)

 DRUGSACTI
NGONTHERESPI
RATORYSYSTEM

I
. DRUGSFORTHECOMMONUPPERRESPI
RATORYTRACTDI
SORDERS(URI
’
s)

A.Ant i
-Histamines(H1bl ocker sorH1Ant agonists)–compet ewithhistami neforrecept
or
sitesthuspr eventinghist amineresponse.Theydecr easenasopharyngeal secreti
onsby
blockingH1r eceptorsites.Theyar er api
dlyabsor bedin15mi nutes;butisnotf i
tfor
anaphy laxi
s.
1.Fi rstGener ationAnt ihistamines–causesdr owsi ness,dr
ymout handot her
anti
cholinergi
csy mpt oms.
Exampl e:Di phenhy dramine(Benadr yl
)
2.SecondGener ationAnt i
hist
ami nes-causesf eweranti
choli
nergiceffect s.
Exampl e:Cet ri
zine(Zy rt
ec),Fexofenadine(Al l
egr
a),Loratadi
ne(Cl ari
ti
n),
Azel
astatine(Ast eli
n,Opt i
var)

B.NasalandSy st
emi cDecongest ants(Sy mpat homimet icAmi nes) -stimul at etheal pha
adr ener gicr eceptors,thuspr oduci ngv asoconst ri
cti
onoft hecapi ll
ari
eswi thi nthenasal
mucosa.Theyar epr i
mar i
lyadmi nisteredbynasal sprayordr ops, orint ablet, capsuleor
l
iqui df orm.Theyar eusedpr i
mar i
lyforal l
ergicrhini
ti
s, i
ncludi nghayf ev erandacut e
cor yza.
Exampl es:Ephedr i
ne, Pheny lephr ine(Neo-Sy nephrine),Pseudoephedr ine(Sudaf ed)
C.I ntranasal GlucocorticoidsorSt eroids–ar eeffecti
vef ort reatingal l
er gicr hinit
is.
Becauset heyar esteroids, theyhav eant i-infl
ammat oryef fect, t
husdecr easi ngthe
all
er gicr hiniti
ssy mpt omsorr hinor r
hea, sneezingandcongest i
on.I tmay beusedal oneor
i
ncombi nat i
onwi thH1ant i
histami ne.
Exampl es:Beclomet hasone(Beconase, Vancenase, Vancer i
l),Budesoni de
(Rhinocor t),Dexamet hasone( Decadr on) ,Fl unisol i
de(NAsalide),Fl uti
casone(Fl onase) ,
Tri
amci lone(Nasacor t)
D.Ant itussiv es–actont hecoughcont rolcent erinthemedul lat osuppr esst hecough
reflex.Iti susedonl yifthecoughi snon- pr oductiveandi r
r i
tatingt hatcausesasor e
throat .Not e:A coughi sapr otectivemechani sm thatcl ear stheai r
wayofsecr eti
onsor
anycol lect edmat erial.
Exampl e:Dext romet hor phan(Robi tussi n)
E.Expect orant s–l oosenbr onchi al secret i
onssot heycanbeel imi natedbycoughi ng.Itcan
beusedwi thorwi thoutot herphar macol ogicagents.
Exampl e:Guai fenesi n

I
I. DRUGSFORACUTEANDCHRONI CLOWERRESPI RATORYDI SORDERS
1.Sympathomimetics:Al
p[ha&Beta2Adrener
gicAgonist
s
a.Albut
erol–iseff
ecti
vefortr
eat
mentandcontrolofasthmabycausi
ng

40|Page
 bronchodi l
at ionwi thl ongdur ati
onofact ion.
b.Met apr ot erenol–canbeadmi nister edor all
yorbyi nhal ati
onwi thamet ered
dosei nhal eroranebul izer;butisf r
equent l
yadmi nisteredbyi nhalation.
c.Isopr oter enol (Isupr el)–i susedf orbr onchospasms.
d.Aer osolI nhal er
2.Ant ichol iner gics
a.I pratropi um br omi de( At rov ent)–t reatast hmat i
ccondi tionsbydi al
tingt he
bronchi ol es.
b.Combi v ent( Iprat r
opi um br omi de+Al but erolSo4)–t reatchr onicbronchi t
is.
3. Met hylxant hine( Xant hi ne)Der i
v at
ives–i susedt otreatast hma.Theyst i
mul atethe
CNSandr espi ration, dilatecor onar yandpul monar yvessel sandcausedi eresis.
a.Theophy ll
ine–r elaxessmoot hmuscl esoft hebr onchi andbr onchi
ol es.
b.Ami nophy ll
ine
c. Caf feine
4.Leukot rieneRecept orAnt agoni stsandSy nt hesi sInhibitors( LT)-isachemi cal
medi atort hatcancausei nflammat or ychangesi nthel ungs.Theyar eusedf orexer ci
se
inducedast hma.
Exampl es:Zaf i
rlukast(Accol at e),Zil
eut on(Zy f
lo),Mont elukast(Singulair)-r educes
t
hei
nflammat orypr ocessanddecr eaebr onchoconst r i
ction.
5.Cr omol ynandNedocr omi l
Exampl e:Cr omol ynNa–i susedf orpr ophy lactictreatmentofbr onchialast hmaand
t
her
eforemustbet akendai ly.
6.Mucol yti
cs–actl ikedet ergent sbyl i
quef yingandl ooseni ngt hickmucussecr eti
onsso
theycanbeexpect or ated.
7.Ant imi crobi als–ar eusedonl yifani nfect i
onr esultsfrom r etainedmucussecr eti
ons.

 DRUGSFORURI
NARYTRACTDI
SORDERS

I
. Urinar yAnt i
sept ics/ant i-i
nfectivesandAnt i
bioti
cs–ar eli
mi tedf ortreatmentofUTI ’
s.
theact i
onoccur si nther enal t
ubul esandbl adderandt husisef fect i
veinr educing
bact erialgr owt h.
1.Ni trof urant oin(Fur alan, Macr odant i
n)i sthebact eri
ostat i
candbact eri
cidal
dependi ngont hedosage.I tiseffecti
v eagainstmanygr am posi ti
veandgr am
negat ivebact eri
aesp.E.col i.
2.Met hanami ne(Hi prex,Mandel amine) -producesbact erialeffectwhnt heur inepHis
l
esst han5. 5.
3.Tr imet hopr im( Proloprim, Trimpex)andTr imet hopri
m-Sul famet hoxazol e–i sused
fort het reatmentandpr eventionofacut eandchr onicUTI .
4.Fl our oqui nolones(Qui nolones)ar eeffecti
v eagainstlowerUTI ’
s.
Exampl e:Nal i
dixicAci d(Negr am), Norfloxacin(Nor oxin)Ci profl
oxaci nHCl
(Ci pro), Ofloxacin,lomef loxacin
I
I. Urinar yAnal gesi cs
Phenazopy ri
dineHCl( Py ri
dium)–i susedt oreli
evepai n,bur ningsensat i
onandt he
urgencyandf r
equencyofuer iant
iont hataresy mpt omat i
cofl owerUTI .
I
II
. Urinar yAnt i-
Spasmodi cs/Ant imuscar inics- t
reatsurinaryspasmsr esulti
ngf ro
i
nf ectionori njury .
Exampl es:Oxy butin(Di tr
opan) ,Flavoxate(Ur i
spus)

41|Page
  REPRODUCTI
VEANDGENDER-
RELATEDAGENTS

I
. DrugsAssoci atedwi ththeFemal eRepr oduct i
veCy cl
eI :PregnancyandPr eterm Labor
A.Tocol yticTher apy–i susedt odecr easeuter i
necont racti
ons.Exampl es:Terbutali
ne
(Bret hrine) ,MgSO4
Goal s:
a. Toi nt er r
uptoronhi bi
tuteri
necont ractionstocr eate4addi ti
onalti
mef ortheutero-
fet al mat ur ation.
b.Todel aydel i
v erysoant enatalcortoecosteroidscanbedel iv
eredtofacili
tat
elung
mat urat ion.
c. Toal lowsaf etransportoft hemot hert oanappr opr i
atef aci
li
ty.
B.Corticost er oidTher apy–accel erateslungmat urati
onwi thr esul
tantsurf
actant
developmenti nt hef etusinutero,therebydecr easingt heincidenceandsev eri
tyif
Respi rator yDi stressSy ndr
ome( RDS)wi thincreasedsur vivalofpreterminfants.
Exampl es:Bet hamet hasone(Cel estone),Dexamet hasone
C.Drugsf orPI H
a.Met hy ldopa(Al domet)
e.Pr azosi ne
b.Hy dr alazi ne(Apr esoli
ne)
f.Ni fedi pine
c. Labet al ol (Trandat e)
g, Cl oni di ne
d.Bet abl ocker s

I
I. Dr
ugsAssoci
atedwi
tht
heFemal
eRepr
oduct
iveCy
cleI
I:Labor
,Del
iv
eryandt
he
Pr
eter
m Neonate

A.Analgesia
1.Sedat ive-Tranquil
izerDrugs–pr omot erestandr el
axat i
onanddecr easefearand
anxiety, buttheydonotpr ovi
depai nrelief
.
Exampl es:Secobarbit
alNa(Seconal ) ,Pentobarbit
al Na(Nembut al)Pr omethazine
(Phener gan)
2.Nar coticAgoni st
s–i nterf
erswi t
hpai nimpul sesatthesubcor t
icallevelofthebrain.
Exampl es:MorphineSO4,Meper idineHCl (Demer ol),Fent
any l(Sublimaze)
3.Mi xedNar coti
cAgoni st
-Antagonist–exer ttheireff
ectatmor et hanonesi t
e,oftenan
agoni statonesi deandanant agonistattheot her.
Exampl es:BUtorphanoltart
rate(St adol)
,Nal buphineHCl (Nubai n)

B.Anest
hesi
a(Regi
onalandGener
al)

RegionalAnesthesia–achiev
spai nrel
iefduri
nglaboranddel
iver
ywithoutl
ossof
consciousness.I
nject
edlocalanesthet
icstempor
aril
yblockconduct
ionofpaini
mpul
sesal
ong
sensorynervepathwaystothebrain.

1.LocalInfil
trat
ion-canbeusedf orper
formingandrepairi
ngepisiot
omi esaswell
as
l
acer at
ions.
2.Pudendal Block–bl ocksst
imulusalongpudendalnerve.Itisgi
ventransvagi
nal
l
y
behindeachsacr ospinousl
igamenttoblockpudendalnerv es.
3.ParacervialBlock-isthetr
ansvaginali
nject
ionofananest heri
csoluti
ononeachside
ofthecer vi
x.

42|Page
 4.Subar
achnoi
dBlock/Spi
nalAnesthesi
a/SpinalBlock¬–pr
ovokesapai
nlessdel
i
ver
y
anddoesnoti
nter
fer
ewithuter
inecontract
ions.

C.Dr
ugst
hatEnhanceUt
eri
neMuscl
eCont
ract
il
it
y

1.Oxytocin–i susedf orl abori

nductionandaugment at
ion.Itfaci
li
tat
essmoot hmuscle
contract
ioni ntheut erusi nacli
entwi t
hinadequat euter
inecont r
acti
li
ty.
2.ErgotAlkaloids–actbysmoot hmuscl ecel lr
eceptorstimulati
on.Theyar eusedaf t
er
deli
veryforthepr event ionorcontrol ofpostpartum hemor rhageandpr omotionof
uter
ineinvolution.
Exampl es:Er gonovi
neMal eate(Er gotrat
e),Met hyler
gonovinemal eate
(Met her gi
ne)
D.Sur
factantTher apyi nPr eterm Bi
rt
h
SyntheticSur factant–i susedt opreventRespirat
oryDi st
ressSy ndrome( RDS);
tomai ntaindistent i
onofalveol isacs.
Exampl es:Ber actant(Survant a),Calfactant(I
nfasur f
),Poract
antal f
a
(Curosur f)

I
II
. Dr
ugsAssoci
atedwi
tht
hePost
par
tum andt
heNewbor
n

Nurses’ Rolei nPost partalTher apy :

1.Toassesandpr ovi
depost par tal physicalchangesandpai nmanagementwi ththe
cli
entt odet erminebot hheal ingpr ogresswi t
hinast andar dandef fectivenessof
medi cat ions.
2.Tot eacht hecl i
entandadmi nisterpost partalmedi cations.
3.Tot eacht hecl i
entandadmi nisternarcot i
canal gesicspr escri
bedwhenpai ncontr
ol
bynar cot i
cpr oductsisineffect i
ve.
A.PainRel ieff orUt eri
neCont raction:i bupr ofen,Mot rin,Ket orol
ac
B.PainRel ieff orPer i
neal WoundsandHemor rhoids:Hazel ,NUpr ecainalointment
C.Promot ionofBowelFunct i
on:Docusat eNa(Col ace) ,Bicasody lsupposi tories
(Dulcolax ),Magnesi um hydroxide(Mi l
kogMagnesi a),Senna(Senokot ),Mi ner al Oi
l.
D.I
mmuni zat ionsoft hemot her:
a.Rho( D)I mmuneGl obulin:Rhogam,RhoD
b.Rubel l
aVacci nes-ifanon- i
mmuni zedcont ract sthev irusduringthef irstt ri
mest er
,a
highr ateofabor ti
onandneur ologicdev el
opment alsequal eassoci atedwi t
h
congeni t alrubell
asy ndrome.
E.Drugsadmi ni steredt otheNewbor naf terdel i
very:
a.Er yt hromy cinopht halmi coint ment-t opr ovidepr ophy l
axisagai nstey ei nfecti
ons.
b.Vi t.K¬–t opr eventhemor rhagi cdi seaseoft henewbor n.
c. Ant i-i
nf ect i
ves
d.I mmuni zat i
onbef oredi schar ge

 NUTRI
TIONALSUPPORT

ROUTESOFADMI NISTRATION:
1.Enter
alNutr
it
ion(NGT, OGT)-inv
olv
estheGIT,canbegivenoral
l
yorbyf eedingtubes.
Nursi
ngResponsibili
ti
es:
a.Besur ethatthereisadequat
esmallbowelfunct
ionwit
hdigest
ion,absorpti
on
andGImot i
li
ty.
b.Assessf orabdomi nal
dist
enti
onanddecreaseorabsenceofbowel sounds.

43|Page
 c. Thismet hodi susedonl yforclient swi thintactgast r
icemptyingti
meand
decreasedr i
skofaspi rati
on.
Component s:
a.Car bohy dratesinthef orm ofdext rose, sucrose,lactose,st
archordext
rin.
b.Pr oteini nt heform ofintactpr oteins, hydrolyzedpr otei
nsorfreeaminoacids.
c. Fatinthef or
m ofcor noi lorsoy beanoi l.
2.Ent
eralMedi cat ion: Pr ecreat i
n(Cr eon) ,Pancr eli
pase(Vi okase)
3.Tot
alPar enteralNut r
iti
on(TPN)orI VHy peralimant ati
on( IVH)–ist hepr
imarymet hod
Forprovidingcompl etenut ri
entsbyt hepar enteralorIVr out
e.
Note:enter al nutri
ti
onshoul dbeconsi deredbef oreTPN.
 DRUGANDALCOHOLABUSE

I. DrugAbuseandDependence
DrugAbuse–i nv ol vesaper sistentandexcessi ve, non- medi calornonpr escr i
pti
onuseof
chemi cal substances.
DrugDependence–i sacompl exphenomenoni nv olv i
ngsoci al
,per sonal andphar macol ogical
factors.
TypesofDr ugDependence:
1.Nar coti
cDr ugDependence( Heroin,Mor phine)
Treatment :
a.Met hadonet herapy
b.Nal oxone
c. Compl eteabst i
nence
2.Bar bi t
urateDr ugDependence–al t
houghbar bitur atesmay beusedf ori nducingsleepov era
periodoft i
mewi thoutcausi ngmor ethanhabi tuat ion, theyal socauseaddi cti
on.
SignsandSy mpt omsofaddi ction:
a.Dr owsiness e.ny st agmus
b.Poorj udgment f.tremor s
c. Emot i
onal l
abi li
ty g.st agger i
nggai t
d.Sl urr
edspeech
Wi thdrawalSy ndr omes:
a.Appr ehensi on f.distur bancesi ncar diovascul arfuncti
on
b.Weakness g.t remul ousness
c. Anor exia h.i nsomni a
d.Nausea i.maj ormot orconv ulsions
e. Vomi t
ing j.del iri
um
Treat ment :
a.Hospi talizat i
on
b.Psy chot her apy
3.Sedat iv
e-Hy pnot i
cAbuse(Met haqualone, Mepr obamat e,Gl uthethimi de,Ethinami de)
4.Dr ugDependencewi thCNSSt imulants (Amphet ami nes,Cocai ne)
5.Dr ugDependencewi thHal l
ucinogent ypes:
a.LSD(Ly sergicaciddiethy l
ami de) -i susual l
ytakenor al lyasat ablet.I tisa
crystalli
nepowderoral iquidthatcanbedeposi t
edonsugarcubes, cookies
orot herf oods.
b.Mescal i
ne–i susual l
yingestedor ally
, hasabi ttertast e.I ti
ncreasessensor y
awar eness, v i
sualimager y,anxiety ,nauseaandi mpai redcoor dination.
c. Psi locy bin–obt ai
nedf r
om cer tainmushr oomsf roCent ralAmer ica; same
effectswi t
hMescal i
ne.
d.DMT( Di met hylt
ryptamine)-obt ainedf rom acer tai
npl antf oundint heWest

44|Page
 Indi
es.Sameef fectwit
hLSD.
e.STP(Di methoxamphet ami
ne)
-isasy
nthet
icamphet
ami
ne;
mor
epower
ful
andlongeracti
ngt hanLSD.
f. Marij
uana
g.Met amphet amineHCl

APPROACHESTOTHEDRUGABUSEPROBLEMS:
1.Preventitsoccur r
encethr
upr opereducation.
2.All
eviat
esoci alandeconomi cf act
orsthatareassoci at4edwithdrugabuse.
3.Rehabili
tati
on.
4.Avoidinjudici
oususeofPRNnar coti
cs,hypnotics,
sedat iv
esandot herdependence-
producingagent s.
5.Nursinginterventi
onsshouldbedi rect
edtowar dspr ovi
dingeachpat i
entconfortand
supportsot hattheneedfordr ugscanber educedorel iminat
ed.
6.Carefuldestructi
onofusedsy ringesandneedl estopr eventre-
use.

I
I. ALCOHOLUSEANDABUSE
Benef
icialEf f
ectsofAl cohol:
1.IncreaseHDLi nt heblood.
2.Decr easeriskofCor onaryArter
yDisease(CAD)
HarmfulEf f
ects:
1.CNsdepr essionr emov esinhibi
ti
onproduci
ngeuphor i
a.
2.Impai rmentoft heabi li
tytoperf
ormf i
nemot ormovements.
3.Itdullsmemor y,discriminat
ion,i
nsi
ghtandconcentrati
on.
4.Unconsci ousness.
5.Decr easedbloodsugar .
6.Nausea
7.Vomi t
ing
8.Dizziness
9.Gast ri
cirri
tat
ion
Note: drugandalcoholabuseanddependencear enotr el
atedmerelyt
oafew,
speci
fi
c,
chemicalcompounds; butawi dev ari
etyofsubstancesareinvol
ved.

TOXICOLOGY--i
sabr anchofmedi
cinet
hatdeal
swi
tht
henat
ure,
proper
ti
es,
eff
ect
sand
det
ecti
onofpoi
sons.

Ty
pesofPoi
soni
g:

1.AcutePoi soning–occur sexposuretothenoxioussubstancei ssuddenandsev ere.

Sympt omsdev el
opinashor tperi
odoftimeanddeat hmayf ol
lowrapidl
y.I
tisusuall
y
causedbyasi ngledoseofasubst ancethatisreadi
lyabsorbedandhast heabili
tyto
damageoneormor evit
albodyprocesses.Recoveryfr
om acut epoisoni
ngmay be
fol
lowedbyl at
erdev el
opmentofser i
oussy mptoms.
2.Sub-acutePoi soning–r esul
tfr
om thefrequentexposuretoapoi sonoveraperiodof
severalhoursorday s.
3.ChronicPoi soning–occur sfr
om repeatedexposureoveral ongper i
odoft
imeofa
substancet hathastendencytoaccumul ateint
hebody .

Gener
alActi
onOfPoisons:
1.Local-i
rr
it
ati
onordest
ruct
ionoft
issues.

45|Page
 2.Sy stemi c–absor bedi ntot hebl oodi nt
othet argetti
ssues.
3.
Emer
gencyTr eatment :
1.Cal laphy sici
anorpoi soncont rolimmedi ately.
2.At temptt oidentif
yt hepoi son.
3.I mplementf i
rstaidmeasur es:
a.Del ayabsor ptionbyor al i
ngestionofmi lk,eggwhi t
esorchar coal.
b.I nduceemesi swi t
hi pecacxsy r
up.Tepi dsaltwater,soapsudsol ut
ionorsi
mply
t
ouchi ngt hebackoft het hroatwi thaf i
nger.
4.Ef fectchemi calalterationsoft heingestedsubst ancebyadmi nisteri
ngaweakal kal
i
suchasmi lkofmagnesi af oracidicsubst ances;orvinegari
falkalinesubst
ancehave
beeni ngest ed.
5.Gi vespeci f
icantidot es.
6.Pr ovidesuppor ti
vecar e.
a.Mai ntai
nnor mal bodyt emper ature.
b.Gi vear t
ifi
cialr espirationwhenr equi
red

 DRUGNAMEENDI
NGS

- cai
ne Local
anest
het
ics
-
cil
l
in Ant
ibi
oti
cs
-
my ci
n/mi
cin
-
dine Ant
iul
ceragent
-
done Opi
odAnal
gesi
c
-
ide Or
alHy
pogy
lcemi
cs

-
lam Ant
ianxi
ety
-
pam
-
mi de Di
eur
eti
cs
-
zide
-
olol Bet
aBl
ocker
s
-
pri
l ACEi
nhi
bit
ors

-
sone St
eroi
ds

CHAPTER4:APPROPRI
ATECOMMUNI CATI
ONTECHNIQUESONTHE
PHARMACODYNAMICS/PHARMACOKINETI
CSOFSPECI
FIEDDRUGSPRESCRI
BETO
CLI
ENTS

46|Page
DRUGADMI
NISTRATI
ONTHROUGHOUTTHELI
FESPAN

I
mpor t
antConsiderations:
1. Heal
thcarepr ov i
dersmustunder st
andnor mal gr
owt handdev elopmentpat ternsto
provideopti
mum car e.
2. Thedevelopmentofaper sonisacompl exprocessinterweavingt hebiophysical
withthebiopsychosoci al,ethnoculturalandspiri
tualcomponent stomakeeachi ndi
v i
dual a
uniquehumanbei ng.
A. DRUGADMI NISTRATI ONDURI NGPREGNANCYANDLACTATI ON
1. Thef ocusmustbet oeli
mi nat
epot enti
all
ytoxicagentsthatmayhar mt he
mot herort heunbor nchil
d.
2. Duringal lstagesofpr egnancy ,
thenur seshouldhelpthemot hertoassessal l
medi cationsordi etarysupplement stodetermineiftheyar enecessar y.
3. Memor izet hedrugpr egnancycat egoriesformedicati
onscommonl ypr escr
ibed
fortheirpat i
ents.
FDA PREGNANCYCATEGORI ES:

CATEGORYA–havenotshownani
ncr
easedr
iskoff
etal
abnor
mal
i
ties.E.
g.FeSo4
CATEGORYB-noev idenceofhar mt othef etusofani mal sbasedonani mal study;butno
adequat e, well-cont rolledst udi esinpr egnantwomen.E. g.Cef aclor
CATEGORYC-ani mal studi eshav eshownanadv er seef fect andt her earenoadequat e,
well
-cont roll
edst udi esi npr egnantwomen.E. g.Ni fedipine
CATEGORYD–st udi esdemonst ratedr i
skt ot hef et us,howev er
, t
hebenef it
soft herapymay
outweight hepot ent ial risk.E. g.Al prazolam, Di azepam
CATEGORYX–st udi eshav edemonst r
atedposi tiveev idenceoff et alabnor mal it
ies.Theuseof
thi
sproducti scont rai ndi cat edi nwomenwhoar eormaybecomepr egnant .
B. DRUGADMI NI STRATI ON DURI NGI NFANCY(0- 12mont hs)
1. Phar macot her apyi sdi r ectedt owards:
a. Saf etyoft hei nf ant.
b. Pr operdi sposi ngofpr escr i
beddr ugs.
c. Teachi ngpar ent showt oadmi nist ermedi cat i
onspr oper l
y.
2. Or almedi cat i
onsshoul dbeadmi nist eredsl owl yt oav oidaspi rati
on.
3. Forr ect al supposi tor ies, t
hebut tocksshoul dbehel dt ogetherf or5- 10mi nutes.
4. Thev ast usl ater alisi st hepr eferr
edsi tef orI Mi nject i
ons.
5. Thegl uteal sitei scont raindicatedbecauseoft hepot entialdamaget othesci ati
cnerves.
6. Medi cat ionsar eof tenpr escr i
bedi nmg/ kg/ dayr at hert hanaccor dingt othebaby ’sage
i
nweeksori nmont hs.
7. Becauset hel i
v erandki dney sofi nfant sar ei mmat ure, drugswi llhaveagr eaterimpact
duet ot hepr ol ongeddur ationofact i
on.
8. Consi derageandsi zei ndet erminingsaf edosagesofmedi cationsf orinfants.
C. PHARMACOLOGYOFTODDLERS(1–3Year s)
Note:t hechi ldi scur iousandbegi nst oexpl oreandt endst oputev erythingi nthemout h.
1. Teachpar ent st hatpoi sonscomeouti nal lshapes, sizesandf ormsandi ncludes
medicat i
ons.
2. Or almedi cat i
onst hatt ast ebadshoul dbemi xedwi thav ehiclesuchasj am, sy r
upor
fruitj
ui cei fpossi bl e.
3. IMi nject i
onsf ort oddl er smay begi veni ntot hev ast usl at
er alis.
4. IVi nj
ect ionsmayusescal porf eetv eins.
5. Supposi tor iesmay bedi ffi
culttoadmi nisterduet ot her esist anceoft hechi l
d.Hav i
nga

47|Page
 parenti
nclosepr
oxi
mit
ywi
l
lusual
l
yreducet
het
oddl
er’
sanxi
etyandi
ncr
ease
cooperat
ion.

D. PHARAMCOTHERAPYOFPRE- SCHOOLERS(3- 5YEARS)ANDSCHOOL- AGE

CHILDREN( 6-
12YEARS)
1. Theymaycooper ateint
akingoral
medicati
onsi
ftheyarecrushedormixedwit
hfoodor
otherfl
avoredbever
ages.
2. I
Mi nject
ionsaregiv
enatthedorsogl
utealmuscl
eafterachil
diswalki
ngforabouta
year
.
3. Peri
pheralvei
nsareusedforIVinj
ecti
ons.
4. Expl
ainproceduretogai
ntrust
.
5. Schoolagechil
drenmaytakechewabletablet
sandswall
owtablet
sorcapsul
es.
6. Administ
erparenter
almedicat
ionsqui
cklyandcompassi
onat
ely
.

E. PHARMACOLOGYOFADOLESCENTS( 13–16YEARS)
1. Thereisanincreasedneedf orcont r
aceptiv
einf
ormat i
onandcounsel i
ngwithsexual
l
y
rel
atedhealt
hpr oblems.
2. Educatethem aboutt hehazardsoft obaccouseandi l
li
citdrugs.
3. Theadolescenthasaneedf orprivacyandcontrolindrugadmi nist
rat
ion.
4. Explai
ntheimpor tanceofmedi cati
onsandt hei
radv er
seef f
ects.
5. Besensiti
vetot heirneedforself
-expressi
on,pr
ivacyandi ndivi
dual
ity
,part
icul
arl
ywhen
parent
s,sibl
i
ngsorf ri
endsarepresent .

F. PHARAMCOTHERAPYFORADULTS
1. Thehealthstatusofyoungeradult
s( 18-40y ear
s)isgener
allygood;absorpt
ion,
metaboli
cexcreti
onmechani smsareatt heirpeak.
2. Thereisminimalneedforprescr
ipti
ondr ugsunlesschroni
cdi seasessuchasdiabetes
ori
mmuner el
atedcondit
ionsexist
.
3. Theuseofv it
amins.Mineral
sandher bal r
emediesar epr
evalent.
4. Medicati
oncompl i
ance isposit
iveast hereisclearcomprehensionofbenefi
tinter
ms
ofl
ongev i
tyandfeel
ingwel l
.

G. PHARMACOLOGYFORTHEELDERLY
Changest hataf fectsphar macot herapyi nt heelder l
y:
1. IncreasedpHanddecr easedper istalt
ic r ateaffectsmedi cationabsor pt
ion.
2. Thel iver’
spr oductionofenzy mesdecr eases, r
esulti
ngi nreducedhepat i
cdrug
metabolism.
3. Theagi ngl i
v erreducesal bumi npr oduct ion,resulti
ngt odecr easedpl asmapr otei
n
bindingandi ncreasedl evelsoff reedr ugi nthebl oodstream, thusi ncreasingthe
pot enti
al fordr ug-to-
drugi nteraction.
4. Reducedbl oodf l
owt ot hekidney sanddecr easednephr onf unctionr educedrug
eliminat i
on, whi chincreasesser um dr ugl evel
sandt hepot enti
alfort oxici
ty.
5. Theper cent ageofbodywat erdecr eases, maki ngtheef fectsofdehy drati
onmor e
dr
amat i
c.
a. Riskf ortoxi cit
yi sboost edbyf luiddef ici
t.
b. Elderlypat ientswhohav ereducedbodyf lui
dsexper iencemor eor thostati
chypotensi
on.
6. Ther at
ioofbodyf attowat erincreased, enhanci ngst orageoff at-solubledrugsand
vi
tamins.

48|Page
7. Theagingcar
diovascularsyst
em hasdecreasedcar
diacoutputandlesseff
icientbl
ood
ci
rcul
ati
onwhichslowsdr ugabsor
ption.
NOTE:
Immunef unct
iondiminisheswit
haging,soautoi
mmunedi seasesandinfect
ionsoccur
moref
requent
lyinel
derl
ypatients.

CHAPTER6:
CURRENTTRENDSANDCLI
NICALALERTSI
NNURSI
NGPHARMACOLOGY

MEDI
CATI
ONERRORSANDRI
SKREDUCTI
ON

_
___
___
_ ______
_____
_______
______
_ _
__
- Isanypr ev
entableeventthatmaycauseorl eadt oinappr
opri
atemedicati
onuseor
patienthar
m whi l
ethemedi cat
ionisincontrol
oft hehealt
hcareprofessi
onal
,pati
entor
consumer .
- Iti
mpedesphar macot her
apeuticoutcomesandcancauseser iousil
l
nessordeath.
- Itcanleadtolit
igati
onagainstthenurse,physi
cianorhealthcareagency.

Fact
orsLeadi
ngt
oMedi
cat
ionEr
ror
:
1. Omi ssionoft het enr i
ghtsofdr ugadmi nistrat
ion;especial
lyt
hefirstfi
ve.
2. Failur etoper form asy stem checkwi thi
nanagency .
3. Failur etot akeintoaccountpat ientv ar i
ables,suchasr ecentchangesi nrenal
orhepati
c
funct ion.
4. Giv i
ngmedi cati
onsbasedonv er bal ortelephoneor dersoratbedsi dethatmaybe
mi sinterpretedorundocument ed.
5. Giv i
ngmedi cati
onsoni ncompl eteor der s,orani l
l
egibleorder
,wher ethenurseisunsur
e
oft hecor r
ectdr ug, dosageoradmi nistrati
on.
6. Increasei nthenumberofdr ugsi nth4mar ket.
7. Lackofdr ugknowl edge, memor yl apses, transcri
pti
onofor ders,
dispensingofdrugsor
deliver yproblems.
8. Inadequat emoni t
or i
ngofst aff
.
9. Distr actionofst affwhi l
eprepar ingt hedr ug.
10. Ov erwor kedst aff.
11. Lackofst andardizat i
on.
12. Conf usingpackagi ngpr escri
ption.
13. Equi pmentf ail
ures.
14. Inadequat eclienthistory.
15. Poori nterdepartment alcoordinat i
on.

AMedi
cat
ionEr
rorMayI
nvol
veOneorMor
eoft
heFol
lowi
ng:
1. Administr
ationofthewr ongmedi cati
onorI
VF.
2. Theincorrectdoseorr ate.
3. Administr
ationtothewr ongclient
.
4. I
ncorrectrouteandschedulei nter
val.
5. Administr
ationofall
ergicdrugorI VF.
6. Omissionofdoseordi scontinuati
onofmedicat
ionori
VFt
hatwasnordi
scont
inued.

REDUCI
NGMEDI
CATI
ONERRORS:

49|Page
1. BarCoding–pr oposedbytheFoodandDr ugAdmini
str
ati
on(FDA)in2002;whi
ch
uni
quel
yi denti
fi
esthedrug,it
sstrengt
handdosagef
orm.
2. ComputerizedPrescr
iberOrderEntry(
CPOE)-isasy
stem underbarcodi
ngwhich
i
nter
actswi tht
helaborator
y,pharmacyandcl
i
entdat
a.

NURSES’
RESPONSI
BILI
TIESI
NREDUCI
NGMEDI
CATI
ONERRORS:

I
. ASSESSMENT
1. Askt hepat ientaboutal lergi est of oodandmedi cations,currenthealthconcer ns,useof
OTCdr ugsandher bal suppl ement s.
2. Ensur ethatt hepat ientisr ecei vingther i
ghtdoseatt herightti
meandbyt herightroute.
3. Assessr enal andl iverf unct i
onandf orimpair
ment sofotherbodysy stemsthatmay
haveani mpactonphar macot her apy .
I
I. PLANNI NG
1. Hav et hepat ientst atet hepr escr i
bedout comeoft hemedi cati
on,includingther i
ghttime
totakethemedi cationandt her ightdose.
I
II. I MPLEMENTATI ON
1. Adv iset hecl ientt ot aket hemedi cati
onaspr escribedandt oquestiont henursei f
medications“ lookdi ff erent ”.
2. Usedr ugr efer encesr egul ar l
y.
3. Cont actheal thcar epr ov i
der ;donotguessaboutt heor der.DOCUMENTCLARI FICATION.
4. Doubl echeckal l calculateddose.
5. Usel eadingzer o( 0.5);donotuset rail
ingzero(5.0).
6. Av oidv erbal or der s; i
fneeded, repeatitaloudtoconf i
rm.
7. Scanbarcodeatpoi ntofcar e.
8. Includephar maci stoncl ientr ounds.
9. Useacomput erizedor derent ry( CPOE) .
10. Av oiddanger ousabbr ev i
at ions.e. gHCT–i sithy drocorti
soneorhy drochl
orthiazi
de?
Note:alway st hi
nkcr itically.
I
V. EVALUATI ON
1. Assesswhet hert heexpect edout comesofphar macot herapyhav ebeenachi ev edand
whethert hepat ientencount eredadv er sereact i
ons.

50|Page