CHAPTER 6

Focus on Nursing Pharmacology

Drug Therapy in the 21st Century

Consumer Awareness
● Media Influence
● The Internet
● OTC Drugs
Health Care Crisis
● HMOs and Regulations
● Cost Considerations
● Off-label Uses
● Home Care
 CHAPTER 7
Focus On Nursing Pharmacology
Introduction to Cell Physiology
The Cell
šThe cell is the basic structural unit of the
body
šThe cells that make up living organisms,
which are arranged into tissues and organs,
all have the same basic structure
The Cell Membrane
šThe cell membrane is a lipoprotein structure
that separates the interior of a cell from the
external environment; regulates what can
enter and leave a cell
Cytoplasm
šMitochondria: rod-shaped organelles; produce ATP for
energy within the cell
šEndoplasmic Reticulum: network of interconnected
channels
šFree Ribosomes: free floating ribosomes that produce
proteins
šGolgi Apparatus: structure that prepares hormones or other
substances for secretion; produces lysosomes and stores
other synthesized proteins and enzymes
šLysosomes: encapsulated, digestive enzymes found within
a cell; digest old or damaged areas of the cell and are
responsible for destroying the cell when the membrane
ruptures and the cell dies
Osmosis
The Cell Cycle
CHAPTER 8
Focus On Nursing Pharmacology

Anti-infective Agents
Culture
Sample of the bacteria (eg., from sputum, cell
scrapings, urine) to grow in a laboratory to
determine the species of bacteria that is
causing an infection
Prophylaxis
Treatment to prevent an infection before it
occurs, as in the use of antibiotics to prevent
disease such as bacterial endocarditis or
antiprotozoals to prevent malaria
Resistance
Ability of bacteria over time to adapt to an
antibiotic and produce cells that are no longer
affected by the drug
Sensitivity Testing
Evaluation of bacteria obtained in a culture to
determine to which antibiotics the organisms
are sensitive and which agent would be
appropriate for treatment of a particular
infection
Spectrum
Range of bacteria against which an antibiotic
is effective (eg., broad-spectrum antibiotics
are effective against a wide range of bacteria)
Treatment Of Systemic Infections
Identification of the pathogen

Sensitivity of the pathogen

Combination therapy
Adverse Reactions To Anti-Infective Therapy

Kidney Damage
GI Toxicity
Neurotoxicity
Hypersensitivity Reactions
Superinfections
Antibiotics
Definitions
Antibiotic: chemical that is able to inhibit the growth
of specific bacteria or cause the death of susceptible
bacteria
Bactericidal: substance that causes the death of
bacteria, usually by interfering with cell membrane
stability or proteins or enzymes necessary to
maintain the cellular integrity of the bacteria
Bacteriostatic: substance that prevents the
replication of bacteria, usually by interfering with
proteins or enzyme systems necessary for
reproduction of the bacteria
Bacteria
Aerobic: bacteria that depend on oxygen for survival
Anaerobic: bacteria that survive without oxygen,
which are often seen when blood flow is cut off to an
area of the body
Gram-negative: bacteria that accept a negative stain
and are frequently associated with infections of the
GU or GI tract
Gram-positive: bacteria that take a positive stain and
are frequently associated with infections of the
respiratory tract and soft tissues
Preventing The Development Of Resistance

-Identify bacteria
-Correct drug choice
-Full course of therapy
-Avoid inappropriate use
Aminoglycosides
-Bactericidal

-Effective against gram-negative bacteria

-Serious adverse effects - CNS, GI, Renal,

Cardiac, Bone marrow
Examples: Gentamycin, Streptomycin
Cephalosporins
-Bactericidal and Bacteriostatic

-Numerous sensitive bacteria

-GI effects including Pseudomembranous

Colitis
Fluoroquinolones
-Bactericidal and Bacteriostatic
-Effective against gram-negative bacteria
-Adverse effects include headache, dizziness,
GI upset, and photosensitivity, which can be
severe
Example: Ciprofloxacin
 Macrolides
-Bactericidal or Bacteriostatic
-Effective against many sensitive organisms and
intestinal amebiasis
-Severe GI upset, can cause pseudomembranous
colitis
Example: Erythromycin
Lincosamides
Similar to macrolides

Associated with severe toxicity

Example: Clindamycin
Monobactam Antibiotic
-Bactericidal
-Effective against gram-negative
enterobacteria
-Used for patients allergic to Penicillins or
Cephalosporins
-Only one available - Aztreonam (Azactam)
Penicillins
-Bactericidal

-Effective against gram-positive bacteria

-GI upset, allergy

Example. Amoxicillin
 Sulfonamides
-Bacteriostatic
-Effective against gram-negative and
-gram-positive bacteria
-Many resistant strains
-GI effects common
Example: Sulfamethoxazole
 Tetracyclines
-Bacteriostatic

-Effective against a wide range of bacteria

-Potential bone and teeth damage in children

under 8 years
Examples: Doxycycline
 Antimycobacterials
-Tuberculosis
-Leprosy (Hansen’s Disease)
-Bactericidal
-Long term therapy
Examples: Rifampicin, Isoniazid, Pyrazinamide,
Ethambutol, Streptomycin
CHAPTER 10
Focus On Nursing Pharmacology

Antiviral Agents
Agents For Influenza A And Respiratory Viruses

Amantadine- blocking the un-coating

Ribavirin- nucleoside inhibitor
Rimantadine- blocking the un-coating
Oseltamivir- neuraminidase enzyme inhibitor
Zanamivir- neuraminidase enzyme inhibitor
 Agents For Herpes And CMV
Acyclovir-nucleoside analog that selectively inhibits the replication
of herpes simplex virus
Cidofovir-competitive inhibitor and an alternate substrate for
cytomegalovirus (CMV) DNA polymerase
Famciclovir- inhibits viral DNA polymerase
Foscarnet-selectively inhibits the pyrophosphate binding site on
viral DNA polymerases
Ganciclovir-triphosphate is a competitive inhibitor of
deoxyguanosine triphosphate (dGTP) incorporation into DNA and
preferentially inhibits viral DNA polymerases
HIV And AIDS
-Human Immunodeficiency Virus (HIV): retrovirus
that attacks helper T cells, leading to a decrease
in immune function and AIDS or ARC
-AIDS-Related Complex (ARC): diseases that are
characterized by the emergence of a variety of
opportunistic infections and cancers that occur
when the immune system is depressed and
unable to function properly
Agents For HIV and AIDS
-Reverse Transcriptase Inhibitors- zidovudine (Retrovir)
lamivudine (Epivir)

-Protease Inhibitors-ritonavir (Norvir),darunavir (Prezista)

-Integrase inhibitors- raltegravir (Isentress), dolutegravir (Tivicay)

*Always used in combination

Favipiravir (Avigan, Avifavir, Coronavir; Fujifilm
Pharmaceuticals; Appili Therapeutics) is an oral antiviral
approved for treatment of influenza in Japan. It is approved in
Russia for treatment of COVID-19. Favipiravir selectively
inhibits RNA polymerase, which is necessary for viral
replication.

Remdesivir (GS-5734- the broad-spectrum antiviral agent

Gilead Sciences, Inc) is a nucleotide analog prodrug. On May 1,
2020, The US FDA issued EUA of remdesivir to allow emergency
use of the agent for severe COVID-19 (confirmed or suspected) in
hospitalized adults and children.