PHARMACOLOGY IN NURSING

Prof. Ayesha C. Penuela, MAN, LPT

PHARMACOKINETICS – movement of medications Antibiotics (erythromycin, penicillin) – citrus fruits, colas

molecules in the body and any food
Absorption Tetracycline - calcium
Distribution Anticoagulants (warfarin) – Vitamin K
Metabolism MAO inhibitors - Tyramine
Excretion
DRUGS THAT CAN CAUSE NEPHROTOXICITY
PHARMACODYNAMICS – (mechanism of action), Acetaminophen (high doses, acute)
interaction between medications and target cells, body Acyclovir, parenteral (zovirax)
system, and organs to produce an effect Aminoglycosides
Amphotericin B, parenteral (Fungizone)
Concepts: Analgesic combinations cont. acetaminophen, aspirin, or
Children- safety other salicylates in high doses, chronically
Observe, report, teach undesirable effects Ciprofloxacin
Meds – no OTC w/o consultation Cisplatin (platinol)
Pregnancy/lactating are out w/ meds Methotrexate (high doses)
Liver must be intact NSAID’s
Interactions –pharmacological, assess & teach Rifampin
Allergies- assess; Do not administer if allergic Sulfonamides
Nutrition must be considered; Tetracyclines(except doxycycline & minocycline)
Compliance w/ time & taking full course Vancomycin, parenteral (Vancocin)
Elderly- safety, evaluate outcomes for all meds
DRUGS THAT CAN CAUSE HEPATOTOXICITY
Drug nomenclature ACE inhibitor
Chemical name Acetaminophen
Brand/ trade/proprietary name Alcohol
Generic name Iron overdose
Official name Erythromycins
Example: Estrogens
Chemical name- C6 H8 O6 Fluconazole (Diflucan)
Brand name- Cecon Isoniazid (INH)
Generic name- Ascorbic Acid Itraconazole (Sporanox)
Official name-Ascorbic/official monograph Ketonazole (nizoral)
USP 23 NSAID’s
Phenothiazines
References on drugs standards: Phenytoin (Dilantin)
 Phamacopoeia- (USP) Rifampin (Rifadin)
 Formulary- (NF) Sulfamethooxazole & trimethoprin (bactrim, septra
 Philippine national drug formulary (PNDF) Sulfonamides
 Essential Drugs List (EDL)
 Medimedia index of medical specialties (MIMS) DRUGS THAT CAN CAUSE OTOTOXICITY
Aminoglycosides
Drugs according to use/purpose: Bumetanide, parenteral (Bumex)
 Hygienic / prophylactic- application of a drug with Cisplatin
the purpose of preventing the disease when the Erythromycin (renal impairment & high doses )
disease is greatly anticipated Ethacrynic acid (Edecrin)
 Palliative-relieves the symptoms of a disease but Furosemide (Lasix)
does not affect the disease itself Hydrochloroquine (Plaquenil)
 Specific / curative- treats a disease condition NSAID’s
 Supportive /supplementary / restorative-prevents Salicylates (chronic high doses, overuse)
development of deficiency state and sustains Vancomycin, parenteral (high doses & renal impairment)
body functions
 Chemotherapeutic-destroys malignant cells ANTI- INFECTIVE AGENTS - ANTIBIOTICS
 Diagnostic-a medium use for visualization of body Monitor superinfections.
organ to recognize abnormalities and cause of a Evaluate renal/liver functions.
disease condition Diarrhea- take yogurt.
Inform provider prior to taking other meds.
DRUG-DRUG INTERACTIONS Cultures prior to initial dose.
Tricyclic antidepressants Alcohol is out, ask about allergy.
Histamine antagonist (Tagamet) Take full course (of pills).
Ethanol; Erythromycin Evaluate cultures, WBC, blood test
MAO inhibitors
Aminophylline; Aspirin Terms:
Digoxin; Dilantin; Diuretics  Culture and sensitivity testing
Warfarin  Resistance
Azole (antifungal); Antacids  Broadspectrum /narrowed spectrum
Rifampin  Superinfection
 Prophylaxis
FOOD-DRUG INTERACTIONS DRUG  Sensitivity testing
Antacids (Calcium carbonate) – bran and whole grain  Teratogenic
breads
AMINOGLYCOSIDES Doxycycline
Gentamycin Minocycline
Amikacin Oxytetracycline
Kanamycin Lincosamides
Neomycin Clindamycin
Strepnomycin Lincomycin
Tobramycin
GI effect- nausea,vomiting,diarrhea GI effects
CNS effect-dizziness,confusion CNS effect
One can’t feel. .neurotoxicity Similar to macrolides but more toxic
One can’t hear..ototoxicity Bone marrow depression
One can’t pee..nephrotoxicity Pain on injection site / Abscess at injection site
Monobactam
CEPHALOSPORINS Aztreonam
*1st generation - Cefalexin,Cephradine,Cephazolin GI. Effects
*2nd generation - Cefaclor,Cefoxitin,Cefuroxime Hepatotoxic
*3rd generation - Cefdinir,Cefotaxime,Ceftriaxone Inflammation, phlebitis and discomfort at injection site
*4th generation - Cefepime,Cefditoren
ANTITUBERCULARS
GI Effects -nausea, vomiting, diarrhea First- line drug: ISONIAZID
CNS effects-headache, dizziness,lethargy L iver enzymes-monitored
Nephrotoxicity U se cautiously w/ renal dysfunction
Bone Marrow Depression - similar structure with No alcohol
Penicillins Give pyridoxine-prevent peripheral neuropathy
S hould take on empty stomach
FLUOROQUINOLONES Screen vision
Ciprofloxacin
Gemifloxacin First -line drug: RIFAMPIN
Levofloxacin Many Drug - drug interactions
Norfloxacin Do not take alcohol.
Ofloxacin Don’t stop taking (6 months to 2 years)
Maxifloxacin Dizzy – don’t drive.
Theophylline Does havoc the liver.
Anticoagulant Dyscrasias
Digoxin Red Orange colored urine /body fluids
TAD may result in drug toxicity when taken w/ the
fluoroquinolones. Second- line drug: Ethambutol
Vision loss and loss of color discrimination
GI. Effects -nausea, vomiting, diarrhea GI effects
CNS effects-headache, dizziness,lethargy CNS effect
Nephrotoxicity
Bone Marrow Depression Second-line drug: Pyrazinamide
Photosensitivity Leprostatic: Dapsone
GI. effects
MACROLIDE CNS effects
AZITHROMYCIN - Clarithromycin, Dirithromycin, Hepatotoxic
Erythromycin Nephrotoxic
(MACROLIDE GIRL) Complete therapy
GI disturbances
IV site-check for irritation ANTIFUNGAL:
Reduces activity of med if given with acids (fruit juices) or Systemic: amphotericin B, Fluconazole, Ketoconazole
food Topical: Clotrimazole, Miconazole, Ketoconazole
Liver function tests Z OLE – many drug interactions can occur
O bserve hygiene measures to control infection
PENICILLINS L iver Function Tests – monitor
Penicillins G benzathine E ducate to take with food.
Penicillin V *Topical-local irritation /burning
*Extended -Spectrum Penicillins * - Amoxicillin, Ampicillin, *Systemic-Phlebitis
Carbenicillin
*Penicillin –Resistant Antibiotics * - Nafcillin, Oxacillin ANTIPROTOZOAL AMEBICIDE: Metronidazole (Flagyl)
F lushing
PENICILLINS A LCOHOL will cause these effects
GI. Effects -nausea, vomiting, diarrhea I ncreased vomiting-unpleasant taste
CNS effects-headache, dizziness, lethargy N ausea
Nephrotoxicity T achycardia
Bone Marrow Depression
Similar structure - CEPHALOSPORINS If Flagyl is mixed w/ alcohol, there will be a disulfiram-like
reaction
SULFONAMIDES(SULFA)
Sulfadiazine ANTIPROTOZOAL
Sulfisoxazole Antimalarial:Chloroquine,Quinine
Sulfasalazine Cinchonism-nausea,vomiting,tinnitus,vertigo
GI effects
TETRACYCLINES (TETRA “CYCLINES”) Dermatological effects-rash,pruritus,loss of hair
Demeclocycline Visual changes-blindness related to retinal damage
CNS effects-headache.dizziness,shaking,chills S E: “BIRTH” (bone marrow depression, Incresased GI
distress, renal toxicity, tinnitus & hepatotoxicity)
ANTIVIRALS A spirin sensitivity- do not give
Acyclovir (Zovirax)-herpes virus I nhibits prostaglandins
Famciclovir (Famvir)-CMV retinitis D o take w/ food
Valacyclovir (Valtrex)-herpes virus S top 5-7 days before surgery
GI effects
CNS effects ANTIGOUT: ALLOPURINOL (ZYLOPRIM)
Wear protective gloves when applying topical drug G ulp 10-12 glasses (8oz) of fluid daily
Teratogenic I distress- UE
O utput & input- monitor closely
ANTHELMINTIC U ric acid production decreased
Mebendazole se no alcohol
Pyrantel T ake after meals
Praziquantel
Treatment: pinworms, roundworms, whipworms, ANTACIDS
hookworms ALUMINUM MAGNESIUM
GI effects Calcium Bicarbonate
CNS effects Sodium Bicarbonate
**Strict handwashing and hygiene (daily laundering of Aluminum & Magnesium Hydroxide (Maalox)
underwear, bed linens, disinfection of toilet facilities and Neutralize Stomach Acids
bathroom floors Watch Out for: Constipation /Diarrhea/ Acid Rebound
Monitor electrolyte :
ANTINEOPLASTIC AGENTS Hypermagnesemia,
UNDESIRABLE EFFECTS FROM ANTICANCER Hypophosphatemia,
DRUGS Hypernatremia
B one marrow depression
A lopecia ANTI-ULCER MEDICATIONS: H2 HISTAMINE
R etching- nausea/vomiting ANTAGONISTS
F ear and anxiety CIMETIDINE
S tomatitis FAMOTIDINE
NIZATIDINE
C BC, platelets- monitor RANITIDINE
A ntiemetics before drug *Blocks the release of acid*
N ephrotoxicity- UE D on’t take w/ antacids
C ounseling regarding reproduction issues I nform provider of bleeding
E ncourage handwashing, avoid crowds N o smoking, alcohol or NSAIDs
R ecommend a wig for alopecia E levate head of bed
*Give drugs with or before meals and at bedtime *
ALKYLATING AGENTS(NITROGEN MUSTARD)
Chlorambucil Proton Pump Inhibitors
Cisplatin Omeprazole
Carboplatin Pantoprazole
Busulfan Omeprazole
*suppress Gastric Acid secretion*
B one marrow depression (leukopenia,thrombocytopenia)
A norexia/alopecia GI effects-Diarrhea
D istressful nausea & vomiting Give the drug before meals
@ destroying malignant neoplasm CNS effects

ANTIMETABOLITES ANTIPEPTIC
Methotrexate Sucralfate (Carafate)
Fluorouracil *Protect the eroded ulcer site from further damage by
Mercaptopurine acid*
Give drug on an empty stomach
M onitor CBC & platelets weekly Give antacids between doses of sucralfate not within 30
E valuate renal function tests mins
T emp assessment q 4-6 hrs CNS effects
A sepsis- strict Mouth care/sugarless lozenges
B leeding, anemia, & nausea- report
O ral hygiene- brush w/ soft toothbrush ANTIDIARRHEAL: Loperamide
L ots of fluids (2-3L/day) D rowsiness, dizziness, dry mouth,
I ntake & output, nutritional intake- monitor I nhibits gastric mobility
T he Protocols for handling & administering- follow A lcohol is out
E mphasize protective Isolation R eport if there is a narcotic drug Hx
R esponse of a drug determined prior to driving
NONSTEROIDAL ANTI-INFLAMMATORY DRUGS H abit forming- only take prescribed dose
(NSAID’s) E lectrolytes- monitor w/ severe diarrhea; encourage clear
Ibuprofen liquids
Mefenamic acid A ssess frequency of BM; bowel sounds
Naproxen
Celecoxib BULK FORMING Laxative:
Diclofenac Antiemetics
Metoclopramide
N o alcohol Meclizine
Buclizine ANTIDIABETIC: Sulfonylureas
*Suppress vomiting center* First generation: Chlorpropamide, Tolbutamide
CMS effects (dizziness, weakness & hypotension) Second generation: Glyburide, Glipizide, Glimepiride
Photosensitivity
Dehydration (avoid excessive heat exposure) GI. effects –nausea ,vomitng
Hypoglycemia- Monitor Blood Glucose
ENDOCRINE AGENTS Increased risk of Cardiovascular Disease- 1st gen
CORTICOSTEROIDS Hepatotoxic
Prednisone Teratogenic
Hydrocortisone
Betamethasone ANTIDIABETIC DRUGS: NONSULFONYLUREAS
Cortisone Metformin (glucophage)
Rosiglitazone (Avandia)
C ushing-like Sx Monitor Blood Glucose Level / Liver Enzymes
bU ffalo hump Switch to insulin coverage as needed during times of
S odium increase ; Sweating, trauma,pregnancy, or severe stress
H eadache; Hyperglycemia Hypoglycemia
I ncrease in BP, HR appetite GI effects
N ot healing quickly
G I upset Glucose- elevating agent: GLUCAGON
*For severe hypoglycemia reactions*
CORTICOSTEROIDS
some people get Cold Monitor glucose level
Na+ up Insulin on standby (hyperglycemia)
K+ down GI.effects nausea and vomiting
Glucose up Hypotension
Ca+ down
Treatment: allergic & inflammatory disorder, bronchial INSULIN
asthma *Lowers serum glucose level*
Hypothyroidism –Bradycardia, hypotension, low body
temp, menorrhagia, habitual abortion, weight gain RAPID ACTING: CLEAR
*Take single daily dose before breakfast * Regular
Humulin R
THYROID PREPARATIONS Semilente
Levothyroxine Actrapid
Liothyronine Crystalline Zinc
*for Hypothyroidism* Peak: 2-4 H
T SH, T3, T4- monitor
H ypo/Hyperthyroidism- monitor INTERMEDIATE ACTING: CLOUDY
R eview how to take a pulse NPH
O bserve clinical improvement in 3-4 days Humulin N
I ncrease metabolic rate- action Lente
D o not change brands of drug Monotard
Peak: 6-8 H
ANTITHYROID INSULIN
Propythiouracil (PTU)
Strong iodine solution LONG ACTING: CLOUDY
Radioactive iodide I 131 Ultralente
*Hyperthyroidism* Peak: 16-20 H
Everything is running EXCEPT my periods! SC; DO NOT shake (gently rotate vial ),DO NOT
B leeding (bone marrow depression) massage the site,rotate the site
I nfection Do not inject a cold insulin, never IM
G ive w/ food (GI effect –PTU ) Hypoglycemia / Hyperglycemia
Monitor Glucose level
HYPOGLYCEMIA
Blood sugar conc. < 30mg/dl CENTRAL NERVOUS SYSTEM AGENTS
T remors; Tachycardia NARCOTIC ANALGESICS
I rritability Morphine
R estless Meperidine (Demerol)
E xcessive hunger Codeine
D iaphoresis; Depression * Alter perception of PAIN*
D epressed respirations
Hot & dry - sugar’s high D izzy
Cold & clammy - need some candy, D rowsy
DIABETES D rug dependence
D iet, wt.loss, exercise D ecreased BP
I dentification- medical alert bracelet D ecreased GI peristalsis & UO
A void alcohol & other meds *Teach client to avoid activities that require
B lood sugar & urine sugar ALERTNESS*
E d.about antidiabetic agents
T herapy decreases signs, not a cure NARCOTIC ANTAGONISTS
E d. foot care, no smoking, stressors Naloxone
S igns & Sx of hyper/Hypoglycemia; skin care Nalmefene
Naltrexone
P erspiration increase
P ulse increase SELECTIVE SEROTONIN REUPTAKE INHIBITORS
P ain increase (SSRIs)
P ressure increase Fluoxetine
Paroxetine
*Narcotic free for 7 to 10 days- withdrawal syndrome Sertraline
(nausea, vomiting, tachycardia, hypotension)* Fluvoxamine
Provide comfort and safety measure Duloxatine
*Blocks the reuptake of serotonin*
ANTICONVULSANT: Phenytoin (DILANTIN) Do not have the many side effects of TCAs & MAOIs
Gingival hyperplasia Give drug in AM OD, 4 weeks for therapeutic effects
U se alternate birth control C NS system stimulation; nervousness, headache
M outh care- dental check-up N ausea, anorexia, vomiting
S oft toothbrush, don’t stop abruptly S kin rash; Sexual dysfunction

ANTIEPILEPTIC AGENT: MONOAMINE OXIDASE INHIBITOR (MAOI)

Gabapentin (Neurontin) Phenelzine
Carbamazepin (Tegretol) Isocarboxacid
(CAESAR) Tranylcypromine
C NS: dizziness, insomnia-UE *Acts on CNS by increasing the concentration of
Antacids decrease norepinephrine, serotonin and dopamine thereby
Eat food with drug (nausea,vomiting,anorexia) reducing depression elevation*
Support group for epileptics *2 to 4 weeks therapeutic effects
Alert tag indicating specific drug *Monitor BP and orthostatic BP
Report U E (hepatotoxic,teratogenic) *Phentolamine on standby –severe hypertension
*Diet LOW in TYRAMINE- containing foods
ANXIOLYTICS, ANTIDEPRESSANTS, AND
ANTIPSYCHOTIC AGENTS Foods high in TYRAMINE
Aged cheeses: cheddar ,blue,Swiss
ANTI-ANXIETY: BENZODIAZEPINES Aged or fermented meats, fish, poultry
Diazepam Red wines: burgandy, cherry
Lorazepam Smoked or Pickled meats ,fish or poultry ,sausage,
Alprazolam corned beef, salami, pepperoni
Clonazepam
* Antidote: Flumazenil * ANTIMANIC MEDICATION
A void abrupt discontinuation after prolonged use L evel – therapeutic (0.5-1.5 mEq/L)
N ot give if increase BP renal/hepatic dysfunction or I ncreased urination
history of drug abuse T hirst increased
X anax, Ativan, Serax-a few examples H eadache; Hand tremors
I ncrease in 3D’s-drowsiness, dizziness, decreased BP I ncrease fluids
E nhances action of GABA (inhibitory transmitter) U nsteady
T each to rise slowly from supine M orton’s Salt-adequate intake
Y es,alcohol should be avoided
*Alters NA transport in nerve and muscles cells
CONCEPT: DEPRESSION *Inhibits the release of norepinephrine and dopamine but
(ANTIDEPRESSANTS) not serotonin in CNS thereby affecting emotional
D riving is out until response to drug has been achieved response*
E ffect has a delayed onset of 7-21 days 10 to 14 days therapeutic effects
P lanning Px- consult w/ provider of care 0.5 to 1.5 mEq/L serum therapeutic level
R elieves Sx , not a CURE Above 1.5 mEq/L : Toxic
E valuate V/S 2.0 mEq/L: Lethal
S topping drug abruptly is OUT! Diuretics increase the risk of Lithium toxicity
S afety measures (i.e., change position slowly)
I nstruct client to report UE ANTIPSYCHOTICS
O bserve for suicidal tendencies Chlorpromazineava(Thorazine)
N o alcohol or CNS depressants Clozapine (Clozaril)
Thioridazine (Mellaril)
TRICYCLIC ANTIDEPRESSANTS Haloperidol (Haldol)
T rimipramine H ypotension Thiothixine (Navane)
I mipramine A nticholinergic Fluphenazine (Prolixin)
N ortriptyline T achycardia
A mitriptyline Sedation S edation; Sunlight sensitivity
T ardive dyskinesia; Tachycardia; Tremors
TRICYCLIC ANTIDEPRESSANTS A nticholinergic; Agranulocytosis
Imipramine N euroleptic malignant syndrome
Amitriptyline C ardiac arrhythmias (orthostatic hypotension)
Amoxapine E xtrapyramidal (akathesia); Endocrine (change in libido)
Clomipramine
Nortriptyline Dystonia-spasm of the tongue,neck, back and neck .
Trimipramine May cause abnormal eye movements and excessive
*Blocks the reuptake of norepinephrine and serotonin salivation
into the nerve endings * Akathisia-continous restlessness, inability to sit still with
*4 to 8 weeks therapeutic effects constant hand moving and foot tapping
*Anticholinergic effects Tardive dyskinesia-abnormal muscle movements such as
lip smacking,tongue darting
Pseudoparkinsonism-muscle tremors, drooling,shuffling
gait,slow movements CARDIAC GLYCOSIDES ( DIGOXIN)
D- dig level 0.5 - 2ng/ml
ANTIPARKINSONISM I- increases myocardial contractility
Benztropine (cogentin) G- GI or CNS sign indicate adverse effects
Biperiden(Akineton)
Procyclidine(Kemadrin) Digoxin Antidote- digoxin immune Fab
Trihexyphenidyl (Artane) Check for headache,weakness,drowsiness & vision
*blocks the action of acetylcholine in the CNS to help changes(a yellow halo around objects)
normalize the acetylcholine-dopamine imbalance Check apical pulse for 1 full min
*anticholinergic effects-dry mouth,urinary
retension,tachycardia,constipation,blurred vision ANTIANGINAL AGENTS
*Dizziness,confusion,depression,disorientation Nitroglycerin
*Adm before meals –dry mouth, after meals-if drooling Amyl nitrate
Isosorbide dinitrate
DOPAMINERGICS Isosorbide mononitrate
Levodopa Relaxes vascular smooth muscle
Amantadine Decreases venous return
Bromocriptine Decrease arterial BP
*Avoid –Vit B6 (grains & Brans)- Speeds up conversion Decreases L ventricular workload
of levodopa to dopamine Decreases myocardial O2 consumption
*Carbidopa—Levodopa combination *
*Works by increasing the level of dopamine* *Ask the patient if the tablet SL “fizzles” or burns,indicates
Give drug with meal potency
Urinary retension *Give SR forms with water and caution not to chew or
Constipation crush tablet
CNS effects *Rotate the sites of topical forms and monitor for skin
Tachycardia, increased sweating,flushing breakdown
*Taper the dose gradually ( over 4 to 6 weeks) after long
GENERAL AND LOCAL ANESTHETIC AGENTS –term therapy---severe reaction MI
Balance Anesthesia *CNS effects- headache,dizziness & weakness
*Pre-op meds-anticholinergics *GI effects – nausea, vomiting
*Sedative-hypnotics *CV effects- hypotension,reflex tachycardia,syncope
*Antiemetics *Transdermal prep-risk of contact dermatitis
*Antihistamine
*Narcotics Lidocaine (Xylocaine)
Propanolol
General Anesthetics Procainamide hydrochloride
Adverse effects Quinidine
Respiratory depression,Hypotension
Bronchospasm,GI slowdown *Arrhythmias –disturbances in the normal electrical
Malignant hyperthermia ( Dantrolene ) conduction of the heart
Monitor: T , PR , BP , RR * Action : Decreases cardiac conduction
*Adverse effects
Anesthetic Gases Sedation
Nitrous oxide (Blue cylinder) hypotension
Cyclopropane (Orange cylinder) cardiac arrhythmias -Bradycardia /Tachycardia
Ethylene (Red cylinder) respiratory depression
*hypoxia,nausea,vomiting
headache,delirium* PRESSURE
Pressure (blood) monitor
Volatile Liquids Rise slowly to reduce orthostatic hypotension
Halothane Eating must be considered
Isoflurane Stay on medications
Desflurane Skipping or stopping is a no-no
Enflurane Undesirable responses
*depresses the CNS,causing anesthesia Remind to exercise, decrease alco
*Drowsiness,sedation,disorientation, Eliminate smoking; educate
incontinence,urenary retension,restlessness
bradycardia,tachycardia,constipation ACE INHIBITORS ( Pril )
Captopril
Local Anesthetics Enalapril
Spinal anesthesia-remain lying down for 12 hrs after Benazepril
anesthesia to minimize headache Lisinopril
Establish safety precautions *Blocks conversion of angiotensin I to angiotensin II
Adverse effects : Best taken on an empty stomach
Respiratory depression,hypotension Adverse effect – hypotension,cardiac arrhythmias,
GI upset cough ,renal dysfunction
Local Anesthetics Lifestyle changes-weight loss,smoking
Lidocaine (Xylocaine) cessation,decreased alcohol & salt and increased
Benzocaine Procaine exercise
*Headache, backache, hypotension, urinary retention,
pruritus, seizures ANGIOTENSIN II RECEPTOR BLOCKERS (ARBS)-
Respiratory depression Sartan
*locally applied- burning, stinging, swelling, tenderness Candesartan Eprosartan Irbesartan
Losartan Telmisartan Valsartan Lupus-like rxn (fever, facial rash, mm & joint ache,
splenomegaly)
Administer without regard to meals Assess for peripheral edema of hands & feet
Renal function test- review Take with food
Blocks vasoconstriction effect of renin- angiotensin Other- headache, dizziness, anorexia, tachycardia,
system hypotension)
Salt substitution or K+ supplements- do not use Review BP

ALPHA 1 ADRENERGIC BLOCKERS -Sins DIURETICS

Prazosin Diet- inc K+ for all except aldactone
Terazosin Intake & output daily wt.
Doxazosin Undesirable effects: F&E imbalance
Syncope; Sexual dysfunction Review HR, BP, & electrolytes
Increased drowsiness, orthostatic hypotension, HR Elderly- careful
Need to be recumbent for 3-4 hours after initial dose Take w/ or after meals & in am
Increase risk of orthostatic hypotension; move slowly
BETA BLOCKERS ACTIONS Cancel alcohol
Acebutolol
Atenolol LOOP DIURETICS
Nadolol Furosemide
Metoprolol Bumetanide
Propranolol Ethacrynic acid
Pindolol *most potent (high –ceiling diuretics)
Bradycardia *Increase excretion of sodium and water
Lipidemia (inc); Libido (decrease) *Adverse effects-Fluid & electrolyte imbalances
brOnchospasm hypokalemia(eat foods high in K),dizziness
CHF; Conduction abnormalities *Weigh daily (dehydration) ,MIO-Report loss or gain of 3
Konstriction peripheral vascular lbs/day , NO ALCOHOL
Exhaustion; Emotional depression *Increased thirst (maintain usual fluid intake)
Reduces recognition of hypoglycemia *Hypotension,ototoxic

CENTRAL ALPHA2 AGONISTS Carbonic Anhydrase Inhibitors

Clonidine (Catapres) Azetazolamide
*hypotension, hepatotoxicity *mild diuretics-use to treat glaucoma*
*transient drowsiness /dizziness *Decreased secretion of aqueous humor of the eye
*arterial Pressure all over the body is lowered *Hypokalemia,tingling of the extremities,drowsiness,
*paradoxical HPN w/ propanolol confusion
*record V/S
*evaluate liver function OSMOTIC DIURETICS
*the drugs should be slowly tapered down & not stopped Mannitol (Osmitrol)
suddenly Oliguria, edema, inc. ICP- indications
Stops reabsorption of water
CALCIUM CHANNEL BLOCKERS Output of urine, electrolytes- monitor
Amlodipine Tissue DHN- UE
Nifedipine Increased frequency/volume of urination
Felodipine Circulatory overload- UE
Diltiazem
Verapamil K+ SPARING DIURETICS
Nicardipine Spironolactone (Aldactone)
*interferes with the ability of muscles to contract which Triamterene
leads to vasodilation and decrease peripheral resistance Amiloride
*NO grapefruit juice- inc concentration of the drug *retain K instead of wasting it
*CNS effects- dizziness,light headedness, Low Na+
headache,fatigue
*CV effects- hypotension,bradycardia, syncope peripheral Elevated T waves from hyperkalemia (lethargy,muscle
edema cramps,confusion,cardiac arrhythmias)
Agranulocytosis w/triamterene
VASODILATORS K+ level must be monitored
Diazoxide
Hydralazine ANTICOAGULANT - Warfarin (Coumadin)
Nitroprusside *Interferes with thrombin formation
Minoxidil *Antidote Vit K
Check VS. platelet ct., PT(1.5 to 2.5x control)
*CNS effects-dizziness, anxiety & headache ,reflex Observe for bleeding,(petechiae,bleeding gums) NO
tachycardia,hypotension IM,do not rub Sub-Q injection site
*Abnormal hair growth with –Minoxidil Review bleeding protocol (i.e. electric razors, soft
*Cyanide toxicity toothbrushes,avoidance of contact sports)
(dyspnea,headache,vomiting,dizziness,ataxia,loss of Avoid ASA, may use acetaminophen
consciousness,dilated pupil,pink color,shallow
breathing,suppresses iodine uptake- hypothyroidism ANTICOAGULANT - Heparin
Antidote- Protamine Sulfate
VASODILATORS Monitor partial thromboplastin time (PTT)
Directly acts on vascular smooth mm, causing If PTT is >1.5-2.5 x control
vasodilation pt. may bleed too freely.
Increases renal & cerebral blood flow Normal PT—10 to 14 sec
Normal PTT--- 30 to 45 sec *decrease nasal congestion-common colds,allergic
rhinitis,relief of pain and congestion of otitis media
ANTIPLATELET: ASPIRIN *promotes drainage of secretions and improved airflow
Clopidogrel (Plavix) *sympathomimetics-cause local vasoconstriction-
Dipyridamole (Persantine) decreased edema and inflammation of the nasal
Ticlopidine (Ticlid) membrane
Cilostazole (Pletal) *caution not to use drug for longer than 5 days
*Inhibits platelet aggregation---BLEEDING *measures to help relieve discomfort of congestion
Inflammation,fever,pain--aspirin -- increased fluid intake
Reduces TIAs due to fibrin platelet embolus -- cool environment,humidity
Eliminates (reduces) death with hx of MI *Dizziness or sedation
GI effects- stomach irritation *Topical - local burning /stinging
Caution: bleeding disorder,recent surgery, *Adrenergic effects- inceased pulse,blood
pressure,urinary retension, cool and clammy skin
THROMBOLYTIC AGENTS
Streptokinase EXPECTORANT
Urokinase Guaifenesin
Alteplase *liquefy lower resp tract secretion and facilitating the
*dissolves the CLOT in a blood vessel. removal of viscous mucus
Institute tx within 6 hrs after the onset of acute MI *Caution -not to use longer than 1 week
CBC, hgb, hct- monitor *Drowsiness,dizziness
Look for dysrythmias *Nausea, vomting
Observe for bleeding
The V/S must be monitored MUCOLYTICS
Lipid- Lowering Agents Acetylcysteine
*break down mucus to aid pt in coughing up
BILE- ACID SEQUESTRANT thick,tenacious secretions
Cholestyramine *Antidote for acetaminophen toxicity
Cholestipol *nausea,stomatitis rhinorrhea,bronchospasm,rash
*Binds with bile acids leading to their excretion in the
feces.Bile acids contain Cholesterol . DRUGS USED TO TREAT OBSTRUCTIVE
LDL is low 15-30% PULMONARY DISORDER
Increase fluids & fiber
PT monitoring (decreased absorption of Vit K) BRONCHODILATORS/antiasthmatics
Increase in GI distress- constipation Breathing & coughing techniques
Decreases absorption of many meds(Fat soluble Vit) Relaxation techniques
Evaluate HR & BP
HMG CoA INHIBITORhydroxymethylglutaryl-coenzyme A Arm identification
Simvastatin Tremors
Lovastatin Have 8 or more glasses of fluids
Atorvastatin Emphasize no smoking
*blocks HMG CoA reductase from completing the Xanthines
synthesis of cholesterol Aminophylline
*Adm at bedtime (Cholesterol synthesis-midnight) Theophylline
*Monitor serum cholesterol and LDL level *Admin with empty stomach
*Monitor liver function *GI effects-nausea,vomiting,heartburn
*Teratogenic *nervousness,restlessness, headache difficulty in
*ophthalmic examination for Cataract development\ sleeping (avoid caffeine,cola,tea,chocolate )
*Encourage lifestyle changes *therapeutic levels- 10 to 20 mcg/ml
*tachycardia to seizures,brain damage and even death
DRUGS ACTING ON THE UPPER RESPIRATORY (>30 to 35mcg/ml)
TRACT
ANTITUSSIVES ANTIHISTAMINES
Dextromethorphan CLARITIN + ALCOHOL + CNS depressant= SLEEP
Codeine CLARITIN + MAOIs = DRYNESS
*suppress cough reflex Antihistamines (Claritin) combined w/ alc & CNS
*contra-post op pt- abdominal surgery depressant may result to sleep. Antihistamines & MAOIs
*CNS effects drowsiness, sedation, respiratory may result in dryness.
depression Inhaled Steroids: Budesonide, beclomethasone,
*drying effects-nausea ,constipation, dry mouth fluticasone
*Decrease inflammatory response in the airway
DECONGESTANTS *sore throat,coughing, dry mouth,pharyngeal and
Topical –ephedrine phenylephdrine laryngeal fungal infection
Oral-Pseudoephedrine
*nasal irritation Zafirlukast
*Assess for temp,blood pressure,pulse, respiration *blocks many signs ang symptoms of asthma
*for prophylaxis and chronic treatment of bronchial
CORTICOSTEROID INHALERS (AZMA) asthma
ACTION= decreased respiratory tract edema *Admin with an empty stomach
Zero improvement- contact provider *dizziness,headache,nausea,myalgia
Must taper off gradually

Asthma control REPRODUCTIVE AND WOMEN’S HEALTH-RELATED

LEUKOTRIENE RECEPTOR ANTAGONIST AGENTS
Montelucast (singulair)
OXYTOCICS *BLOCK PIH & SEIZURES
Oxytocin (Pitocin, Syntocinon) A CNS depressant reduces or “stops” convulsions in the
Methyergonovine(Methergine) OB client.
*Stimulate uterine contraction* MAG SULFATE
*Stimulate milk “let down” in lactating women Decreased BP
Decreased Pee Pee
P ressure is elevated Drop in RR
I ntoxication w/ H2O Patellar reflex there ain’t
T itanic contractions Give antidote calcium gluconate
O xygen decrease in fetus Normal Mg level- 3 to 5 mEq/L
C ardiac arrhythmia
I rrenegularity in fetal heart rate SELECTIVE ESTROGEN RECEPTOR MODULATOR
N ausea and vomiting (SERM)
Raloxifene (Evista)
FETILITY DRUGS *prevent osteoporosis in postmenopausal women.
Clomiphene (Clomid) Menotropins (Pergonal) *no increased risk of breast or endometrial CA.
*Stimulate follicle development and ovulation in *Teratogenic
functioning ovaries * *Caution (thrombosis,smoking)
*Risk hazard of multiple births and birth defects *GI effects –nausea ,vomiting
*Risk of ovarian overstimulation(abdominal *headache,dizziness,hot flashes,vaginal bleeding
pain,distention,ascites,nausea ,bloating,uterine bleeding,
ovarian enlargement) DRUGS FOR TREATING PENILE ERECTILE
Provides instructions on when intercourse should occur DYSFUNCTION
Sildenafil (Viagra) – 4hrs duration
MAGNESIUM SULFATE - (BLOCK PIH & SEIZURES) Alprostadil (Caverject)
Magnesium SO4, a CNS depressant reduces or “stops”
convulsions in the OB client. *Promotes blood flow into the corpus
MAG SULFATE cavernosum,resulting in penile erection
Decreased BP *Dizziness, headache, flushing, hypotension or severe
Decreased Pee Pee hypertension
Drop in RR *Pain on the injection site,Priapism
Patellar reflex there ain’t
Give antidote calcium gluconate SOURCES OF DRUGS
 Plants-are source of chemicals developed into
ABORTIFACIENTS drugs Sambong( Blumea balsamifera)-
Dinoprostone antiurolithiases
Carboprost  Lagundi (vitex negundo)- cough
*Stimulate intense uterine contractions to evacuate the  Ampalaya (Momordika charantia)-Diabetes
uterus * Mellitus
Terminate pregnancy 12 to 20 weeks  Animals-are used to replace human chemicals
Confirm that uterine evacuation is complete that are not produced because of disease or
Monitor BP- hypotension ,and the amount of bleeding genetic problems
 Insulin (cow & pig pancreas tissue)-Diabetes
TOCOLYTICS Mellitus
Terbutaline Sulfate (Bricanyl)  Animal thyroid-use as thyroid drugs
Ritodrine (Yutopar)  Minerals-salts of various elements can have
Relax the uterine smooth muscle therapeutic effects in the body
Stop premature labor after 20 weeks gestation o Aluminum-Antacids
Monitor BP- Hypotention/Hypertension o Iron- Iron deficiency anemia
Monitor maternal heart rate and fetal heart rate  Synthetic Sources-use genetic engineering to
produce chemicals that are therapeutic
Rho (D) Immune Globulin (Human) o Synthetic insulin
Rho Gam Gamulin Rh Micro Gam
* Use to prevent RH Immunization of the RH – negative Philippine Laws
Patient exposed to RH- Positive Blood  RA 6675-known as the Generic act of 1988 - An
*Localized tenderness on injection site act to promote, require and ensure the production
*hypotension of an adequate supply, distribution, use and
*prevention of RH hemolytic disease of the newborn acceptance of drugs and medicines identified by
(Erythroblastosis) their generic names.
*never adm IV  RA 9165- Comprehensive Dangerous Drugs Act
*never adm to neonate of 2002 repealing R.A. no 6425 known as
*never adm to an RH negative pt who has been Dangerous Drugs Act of 1972
previously sensitized to the RH antigen  RA 9503 - Universally Accessible Cheaper and
Confirm that the mother is RH negative and the neonate Quality Medicines Act of 2008
is RH positive with a negative Coomb’s test  RA 10918 – Philippine Pharmacy Act

ANTICONVULSANTS
Magnesium sulfate