INTRODUCTION TO THE IMMUNE RESPONSE AND INFLAMMATION

Mucous Body Defenses

1. Mechanical and Chemical Barrier Defenses/ First Line of Defense
Skin
s Membranes
Secretions
Gastric Acid
Major Histocompatibility Complex (MHC)

2. Second line of defense (inflammatory responses, phagocytosis, NK cells lysis,

biologic response modifiers- interferon, complement)
Cellular Defenses
Neutrophils- Respond to a bacterial infection (pyogenic infection), acute inflammation,
heart attack, or burn
Basophils- The substances include histamine, heparin, and other chemicals used in
the inflammatory response.
Eosinophils- Respond to parasitic infection, allergic reaction, cancer
Monocytes/Macrophages- Remove foreign material from the body, including
pathogens, debris from dead cells, and necrotic tissue from injury sites

The Inflammatory Response- The inflammatory response is the local reaction of the
body to invasion or injury. Any insult to the body that injures cells or tissues sets off a
series of events and chemical reactions.
Kinin System
Histamine Release
Chemotaxis
Clinical Presentation

Five (5) Different Types of Immunoglobulins

1) IgM—the first immunoglobulin being released, which contains the antibodies
produced at the first exposure to the antigen.
2) IgG—another form of immunoglobulin, contains antibodies made by the memory
cells that circulate and enter the tissue; most of the immunoglobulin found in the serum
is IgG.
3) IgA—is found in tears, saliva, sweat, mucus, and bile. It is secreted by plasma cells
in the GI and respiratory tracts and in epithelial cells. These antibodies react with
specific pathogens that are encountered in exposed areas of the body.
4) IgE—is present in small amounts and seems to be related to allergic responses and
to the activation of mast cells.
5) IgD—is another identified immunoglobulin whose role has not been determined.

ANTI-INFLAMMATORY AGENTS
CORTECOSTEROIDS
Normally released by the adrenal glands
- mimics action of steroid hormone

MINERALOCORTICOID: Aldosterone-like actions and balances electrolytes through

Na and water reabsorption.

GLUCOCORTICOID: regulates CHON, carbo, and fat metabolism; affects metabolism.

Promotes antibodies, does not produce insulin

INDICATIONS
Long-term management of chronic inflammatory diseases: Rheumatoid arthritis, SLE,
and asthma.
Short-term management of acute dermatitis, bronchitis, and inflammation associated
with infectious diseases.
Traumatic injuries: Head trauma, SCIs.
Suppression of inflammatory responses during organ transplantation.
SIDE/ADVERSE EFFECTS
Resp: Oral candidiasis and dysphonia (inhaled steroids)
Renal: Hypokalemia, alkalosis, weight gain, edema.
GI: PUD, GI bleeding.
SKIN: Facial erythema, delayed wound healing.
ENDO: CUSHING’s Syndrome, menstrual irregularities, growth suppression in
children.

NURSING MANAGEMENTS
1. Taper dose. DO NOT discontinue suddenly because this may lead to Addisonian
state which is life-threatening.
2. “If you have a headache, do what it says in the aspirin bottle: Take two, and keep
away from children.”
3. Monitor for steroid withdrawal: lassitude/ lethargy, fever and diffuse
musculosketal pain. These effects are life threatening and permanent.
COMMON CORTECOSTEROIDS
PO and Parenteral
a. prednisone (Deltasone)
b. dexamethasone
c. methylprednisolone (Medrol)
d. prednisolone (Prednisol, Delta-Cortef)
e. hydrocortisone ( Solu-cortef)
f. betamethasone ( Celestone)

Inhaled Agents
b. dexama. beclomethasone (Beclovent)
athesone (Decadron)
Opthalmic Solutions/Ointments
a. dexamethasone (Decadron)
b. flouromethalone (Flarex)
Topical Creams
a. betamethasone dipropionate (Diprolene)

NSAIDS
- The most widely used non –narcotic agent. Available OTC
- Has analgesic, anti-inflammatory, antipyretic effects
-Should be given on full stomach
SIDE/ADVERSE EFFECTS:
GI: Most frequent- dyspepsia, heartburn, epigastric distress, nausea.
misoprostol (Cytotec) successful in preventing gastric ulcers and hence GI bleeding
due to NSAID use.
Less frequent- vomiting, anorexia, abdominal pain, GI bleeding, mucosal erosions or
ulcerations.
HEPA: acute reversible hepatotoxicity.
RENAL: altered creatinine clearance, ATN, ARF
OTHER: rashes, tinnitus, hearing loss.

NSAIDS and their STRUCTURAL GROUPS

ACETIC ACIDS
indomethacin (INDOCIN)
diclofenac sodium (VOLTAREN)
CARBOXYLIC ACIDS (SALICYLATES)
aspirin (many)
sodium salicylates (many)
ENOLIC ACIDS
piroxicam (FELDENE)

FENAMIC ACIDS
mefenamic acid (DOLFENAL, GARDAN, PONSTAN)
NONACIDIC COMPOUNDS
nabumetone (REFALEN)
PROPIONIC ACIDS
ibuprofen (MOTRIN, ADVIL)
ketoprofen (ORUDIS)
naproxen (NAPROSYN, FLANAX)

COMMON NSAIDS
1. indomethacin (Indocin)
RA, GA, closure of patent ductus arteriosus in infants.
Prescribed drug. Not for long term therapy.
Oral, rectal, IV prep.
Monitor for bleeding and hearing loss.
2. diclofenac sodium (VOLTAREN)
Analgesic, dysmenorrhea.
Instruct client on sun exposure.
3. aspirin
Primary drug in the treatment of MI.
Contraindicated in hypersensitivity.
Give with food or large amount of water.
Instruct client to stop taking ASA 7 days before surgery.

4. ibuprofen (MOTRIN and others)

Dental pain, arthritis and musculoskeletal disorders.
Therapeutic effect for arthritis will be observed in 2-4 weeks
Do not exceed 3.2 grams daily.
Not for children < 12 years old.
Not to be used for >3 days for fever and >10 days for management of pain without
consulting prescriber.
No alcohol= increases bleeding

COX-2 INHIBITORS
- Have same effects of NSAIDSbut have little to no effect on platelet aggregation
- causes fewer GI effect but not GI toxicity
-Should be given on full stomach
SIDE/ADVERSE EFFECTS:
Fatigue, dizziness, LE edema, HPN, dyspepsia, nausea, heartburn.
COMMON COXIBs
1. celecoxib (CELEBREX)
2. etoricoxib (ARCOXIA)
3. rofecoxib (VIOXX)
4. meloxicam (MOBIC)
SKELETAL MUSCLE RELAXANTS
- Used in the management of spasticity associated with severe chronic disorders such
as Multiple Sclerosis, Cerebral Palsy, Rheumatic Disorders.
SIDE/ADVERSE EFFECTS:
Fatigue, dizziness, LE edema, HPN, dyspepsia, nausea, heartburn.
COMMON COXIBs
1. baclofen (Lioresal)
2. chlorzoxazone (Paraflex)
3. diazepam (Valium)
4. dantrolene (Dantrium)
5. butolinum Toxin Type B (Myoblock)
6. pancuronium Bromide (Pavulon)

ANTI-HYPERTENSIVE DRUGS
HYPERTENSION
A common, often asymptomatic disorder in which blood pressure persistently exceeds
140/90 mmHg

Joint National Committee (JNC) on the detection evaluation and treatment of high
blood pressure introduce a more individualized therapy

I. ADRENERGIC AGENTS
Indicated for HPN, prophylaxis for migraine headaches, treatment of severe
dysmenorrhea or menopausal, glaucoma
SIDE EFFECTS: dry mouth, drowsiness, sedation and constipation, impotence.
WOF: ORTHOSTATIC HYPOTENSION
COMMON DRUGS: reduces peripheral vascular resistance and BP by dilating arterial
and venous blood vessels
-prazosin (Minipress)
-clonidine (Catapres)
-reserpine (Serpasil)
-methyldopa (Aldomet)

II. ACE INHIBITORS

Inhibits angiotensin- converting enzyme which is responsible for converting angiotensin
1 to angiotensin 2, the latter a potent vasoconstrictor and stimulator of aldosterone.
Aldosterone Stimulates sodium and water resorption.
SIDE EFFECTS: Fatigue, dizziness, mood changes, and headache
They are usually combined with diuretics in the control of HPN
COMMON DRUGS:
-captopril (Capoten)
-enalapril (Vasotec)
 -lisinopril (Zestril)

III. ANGIOTENSIN 2 RECEPTOR BLOCKERS

One of the newest classes of antihypertensives. Does not cause cough.
Angiotensin 2 Stimulates production of aldosterone causing increase BP
ARBS/ARTANS COMMON DRUGS:
-lozartan (Cozaar)
-valsartan (Diovan)
-telmisartan (Micardis)

IV. CALCIUM CHANNEL BLOCKERS

First line agents for HPN. This is also for ANGINA
CCB are a class of drugs and natural substance with effect on many excitable cells like
heart, smooth muscles of the vessels or neuron cells
Has negative inotropic effect, negative dromotropic effect, negative chronotropic effect
WOF : Increase calcium in the brain
Increase calcium in the heart
COMMON DRUGS:
-nifedipine (Adalat, procardia)- the most potent smooth muscle dilator and
common agent used for severe HPN and HPN crisis
-verapamil (Isoptin) -amlodipine (Norvase)
-diltiazem (Cardizem)
-felodipine (Plendil)

V. BETA ADRENERGIC –Olols-

Used to improve cardiac function by blocking the action of epinephrine
This is best for HPN, MI, Angina
Reduction of intraocular pressure
WOF : THE 4 C’s of HPN
C-oronary Artery Disease
C-oronary Rheumatic Fever
C- ongestive Heart Failure
C- ardio Vascular Accident
COMMON BETA BLOCKER DRUGS:
-propranolol (Inderal) -hydralazine (Apresoline) for PIH every 5 min 3 doses
max
-atenolol (Tenormin) -nadolol (Corgard)
-esmolol (Brevibloc)
-metoprolol (Lopressor)
-timolol maleate (Timoptic) Lowers IOP in glaucoma

ANTI-HYPOTENSIVE DRUGS
Anti-hypotensive are primarily used to treat hypotension which may be a manifestation
of a shock state.
Also known as CARDIOSELECTIVE SYMPATHOMIMETICS
Know that the client receiving anti-hypotensive is either an ER or on the way to a
critical unit.
Continuously monitoring the heart rate and rhythm with a cardiac monitor. Monitor BP
through an arterial line.
INDICATION: Life-threatening hypotension , shock or cardiac arrest not caused by
hypovolemia
SIDE EFFECTS:
Headache
Tachycardia
Vasoconstriction
Hypertension
Restlessness
Euphoria
Excitement
Insomnia
palpitation

DRUGS FOR BRADYCARDIA AND LOW BP:

IDEA
I- Isoproterenol
D- Dopamine
E- Epinephrine
A- Atropine Sulfate

ANTI-HYPOTENSIVE DRUGS
1.epinephrine (Adrenalin)
- management of profoundly symptomatic bradycardia or cardiac arrest, status
asthmaticus and anaphylaxis
- cannot be used as a substitute for fluid volume replacement for hypotension and
bradycardia resulting from hypovolemia
2. norepinephrine (Levophed)
- indicated for septic and neurogenic shock
3. isoproterenol (Isuprel)
- has a potent inotropic and chronotropic properties
- contraindicated in routine treatment of cardiac arrest; atropine, pacing , dopamine,
and epinephrine. Should be used in bradycardia before Isuprel
4. dopamine (Intropin)
- increase force of cardiac contraction and increases cardiac output with minimal
increase in heart rate, thus producing less myocardial O2 demand
- INDICATIONS: Early renal failure, chronic congestive HF, symptomatic hypotension,
in the absence of hypovolemia.
-After resuscitation, higher doses may be given to foster cerebral perfusion
- Never use peripheral line unless absolutely necessary
- Do not mainline
5. dobutamine (Dobutrex)
-treatment of pulmonary congestion with low cardiac output, septic shock, CHF, used
with dopamine for the treatment of cardiogenic shock

CONGESTIVE HEART FAILURE AND CARDIAC DYSRYTHMIAS

Heart failure: pathologic state in which the heart is unable to pump blood in sufficient
amount from the ventricles to meet the body’s metabolic needs

CHF: the overworked, failing heart cannot meet the demands placed on it and blood is
not ejected efficiently from the ventricles
DIGITALIS GLYCOSIDES- digoxin (Lanoxin)
: one of the highly interactive drugs
: derived from the leaves of the digitalis purpurea lanata plant. (Purple foxglove)
: POSITIVE INOTROPIC: Increases myocardial contractility increasing Cardiac Output,
alleviating symptoms of CHF
: NEGATIVE CHRONOTROPIC: decrease ventricular rate
INDICATIONS: treatment of CHF, atrial tachy-arrythmias, cardiogenic and thyrotoxic
shock states, dysrethmias in children
CONTRAINDICATIONS: Renal failure due to decrease renal excretion which may
cause toxicity
: Pregnancy and lactation
DRUG INTERACTION:
Increased Toxicity: captopril, diltiazem, ibuprofen, nifedipine, diuretics, veramapil
Decrease Absorption: antacid, laxative, oral aminoglycosides, nifedipine, diuretics,
veramapil
NURSING MANAGEMENT:
Assess Cardiac output
know the therapeutic range
Prevention of toxicity by knowing and monitoring serum level

ANTIDOTE:
digoxin immune fab (Digibind): withhold drug if the pulse is below 60 beats per minute
(Adults) because digoxin could lower heart rate to dangerous levels and when PR is
above 120 bpm because it could indicate toxicity

ANTIDYSRHYTHMIC AGENTS
prevents abnormal heart rhythms.
: the etiology and type of dysrhythmia present will dictate the choice of drug
DYSRHYTHMIA: any deviation from the normal rhythm of the heart
ARRYTHMIA: also used to refer to these deviations literally means no rhythm.
Asystole or no heart beat
INDICATIONS: treatment of cardiac dysrhythmias. The goal is to decrease
symptomology and improved hemodynamics

NURSING MANAGEMENT: monitor vs, ECG, neurologic functioning, and

hemodynamics to determine the need for the effectiveness

COMMON ANTIDYSRYTHMICS:
1. quinidine (Cardioquin, Quinora): Therapeutic Blood Level: 2-6 mcg/ml; 50% increase
for digoxin
2. lidocaine (Xylocaine): suppression, prevention and acute treatment of premature
ventricular contraction; Therapeutic Blood Level: 1.5-5 mcg/ml
3. procainamide hydrochloride (pronestyl)
4. dysopyramide (Norpace)
5. amniodarone (Cordarone)
6. Bretylium tosylate (Bretylol)
7. diltiazem (Cardizem)
8. verapamil (Isoptin)

UNCLASSIFIED ANTIARRYTHMIC

Adenosine (Adenocard)- indicated for first line therapy in ACLS for paroxysmal
supraventricular tachycardia
: Flush it with 10 mL and raise hand

3. ANTIARRHYTHMIC AGENTS (lidocaine)

Mechanism of Action
• local anesthetic
• antiarrhythmic agent
• suppresses ventricular arrhythmias by decreasing automaticity
Indication
• Vtach, Vfib, Cardiac arrest
Dosage
• bolus: 0.5 -3 mg/kg
• drip: 2 – 4 mg/min

ANTIANGINAL AGENTS
The heart is a very efficient organ but very demanding of oxygen
O2 supply is delivered via the coronary artery
Decreased O2 leads to angina pectoris (Chest pain)
Poor Blood supply will lead to ischemia (MI)
CAD results from atherosclerotic plaques in the vessels
IHD results from poorly Oxygenated heart muscles

THREE TYPES OF ANGINA

1. Chronic Stable Angina
- Atherosclerosis is the primary cause (Fat deposits)
-Classic Angina or Effort Angina (triggered by activity)
-Triggered by stress
- Exacerbated by alcohol intake, smoking, coffee and some drugs
- Pain is intense but subsides within 15 minutes with drug therapy
2. Unstable Angina
- The early stage of progressive CAD often ends in MI
-Pre infarction angina or crescendo angina (increasing pain)
-In later stages, pain may occur even if at rest.
3. Vasospastic Angina
- Results from spasms of the smooth muscles that surround the atherosclerotic
coronary arteries
-Pain happens without precipitating cause
-Follows a regular pattern, occurring at the same time of the day
-Prinzmetal’s angina or variant angina

NITRATES/NITRITES
- Main stay of both prophylaxis and treatment for angina and other cardiac problems
-Available in: SL, buccal, chewable, oral tablets, capsule, ointment, patches, inhalable
sprays and IV solution.
SIDEEFFECTS: Headache, tachycardia, postural hypotension

RAPID-ACTING AGENTS
Amyl nitrate
Nitroglycerin
LONG-ACTING AGENTS
Isosorbide dinitrate
Isosorbide mononitrate

COMMON NITRATES
isosorbide dinitrate (Isordil)- organic nitrates and therefore a powerful explosive
For acute relief of angina pectoris
For prophylaxis in situations likely to provoke angina attacks
Long term prophylaxis
2. nitroglycerine drip (Nitro-bid, Nitro-stat, Nitrong)- Traditionally, the most
important drug used in the symptomatic treatment of ischemic heart conditions such as
angina.
3 maximum you can take
Check BP and PR pre-administration
May give lingual spray SL

COAGULATION MODIFIERS
Homeostasis: the process that halt the bleeding after an injury to a blood vessel
ANTIPLATELET DRUGS: prevent platelet plugs from forming by inhibiting platelet
aggregation, which can be beneficial in preventing attacks and strokes
THROMBOLYTIC DRUGS: lysis/dissolves clots.
ANTIFIRINOLYTICS: drug that prevents lysis of fibrin and in doing so, it promotes clot
formation.
ANTICOAGULANTS: inhibit the development and enlargement of blood clots
HEMOSTATIC AGENTS: Have the opposite effects of these other classes of agents; it
promote blood coagulation and are helpful in the management of excessive bleeding.

I. ANTICOAGULANTS
Blood thinners
Does not dissolve existing clots. They prevent formation of new ones
Are given prophylactically
INDICATIONS: MI, unstable angina, atrial fibrillation, mechanical heart valves,
conditions in which blood flow may be slowed and blood may pool such as major
orthopedic surgery.
CONTRAINDICATIONS: condition in which the threat of bleeding is present:
hemorrhagic disorders, GI ulcers, uncontrolled HPN, severe trauma, aneurysm, IFCs,
pregnancy, abortion, surgeries, postpartum states, lactation, menstruation
SIDE EFFECTS: Bleeding

COMMON ANTICOAGULANTS
1. heparin- in units (Hep-lock, Liquaemin, Hepalean)- Half-life is 1 hour
Found in lungs, intestinal mucosa, liver of sheep and cows
Administered IV or SC
If given IV, a large bolus is administered followed by a continuous drip
If Sub cutaneous use gauge 25-28 ½ to 5/8 inch needles. Do not inject within 2 inches
on of umbilicus.
Apply pressure to injection site for 5-10 seconds after injection
Do not rub and aspirate
Rotate injection site to prevent lipodystrophy
Mix heparin with PNSS for infusion . Use infusion pump generally followed by
anticoagulants

2. warfarin sodium (Coumadin)- only oral in mg

Most commonly prescribed anticoagulant works within 48-72 hours
Long term prevention of DVT
Given per orem, once a day in milligram
INSTRUCT CLIENT TO:
Use soft bristle toothbrush/toothettes
Shave with electric razor
Tell dentist if he is on warfarin
For children: wear helmet, elbow and knee pads
Avoid venous stasis and vitamin K rich food

3.enoxaparin (Lovenox)- only oral in mg

Prevention and treatment of DVT which may lead to pulmonary embolism after knee or
hip replacement therapy

II. THROMBOLYTICS
These agents are quite toxic and generally are given only when life is jeopardized by
the presence of an intravascular clot.
Clot busters
Destroy life threatening thromboemboli and accelerate clot resolution
Reestablishes blood flow
BLEEDING PRECAUTIONS:
B- Bleeding precautions
L- Let pt use soft toothbrush
E- Educate on S/S of unusual bleeding
E- Eliminate ASA, NSAID
D- Dx for clotting (aPTT- hep, PT- war)
E- Examine blood in urine and stool
R- Require application of pressure= IV site
S- Secure antidotes

COMMON THROMBOLYTICS

1.alteplase, recombinant (Activase, TPA)- clot specific and does not produce a
systemic lytic state
-For Acute MI, Pulmonary embolism, Acute ischemic stroke
2.(Streptase)- From Beta-Hemolytic streptococci, first used in to dissolve hemothorax,
eventually for MI. Since it is made from non- human resource, It may provoke allergic
reaction
3.urokinase (Abbokinase)

III. ANTIFIBRINOLYTICS
Prevent lysis of fibrin, the substance that helps make the platelet plug insoluble and
anchors the clot to the damaged blood vessels
Promotes clot formation
Prevention and treatment of excessive bleeding
COMMON ANTIFIBRINOLYTICS:
aminocaproic acid (Amicar)
desmopressin (DDVAP)
tranexamic acid (Hemostan)
protamine sulfate (heparin antagonist)

LIPID LOWERING AGENTS

Lower serum levels of cholesterol and various lipids.
These include bile acid sequestrants and a cholesterol absorption inhibitor.
1.Bile Acid Sequestrants
▪ Used to decrease plasma cholesterol levels.
▪ cholestyramine (Questran), colestipol (Colestid), and colesevelam (WelChol)
2. HMG-CoA Reductase Inhibitors
▪ atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor),
pitavastatin (LIvalo), pravastatin (Pravachol), rosuvastatin (Crestor), and simvastatin
(Zocor)
3. Cholesterol Absorption Inhibitors
▪ ezetimibe (Zetia)

Contraindications and Cautions

▪ Allergy.
▪ Active liver disease or a history of alcoholic liver disease
▪ Pregnancy or lactation
▪ Caution should be used in patients with impaired endocrine
function.
Adverse Effects
▪ GI system effects: flatulence, abdominal pain, cramps, nausea,
vomiting, and constipation.
▪ CNS effects can include headache, dizziness, blurred vision,
insomnia, fatigue, and cataract development.
▪ May reflect changes in the cell membrane and synthesis of
cholesterol.
DRUGS USED TO TREAT ANEMIA

Erythropoesis-Stimulating Agents
epoetin alfa (Epogen, Procrit) and darbepoetin alfa (Aranesp)
Therapeutic Actions and Indications
▪ Epoetin alfa acts like the natural glycoprotein erythropoietin to
stimulate the production of RBCs in the bone marrow.
Contraindications and Cautions
▪ Presence of uncontrolled hypertension
▪ With known hypersensitivity to any component of the drug
▪ Lactation
▪ Use caution when administering any of these drugs to patients
with normal renal functioning and adequate
▪ levels of erythropoietin and when administering them to a patient
with anemia and normal renal function.

2. Agents used for Iron Deficiency Anemia

Contraindications and Cautions
▪ With known allergy to any of these preparations
▪ Hemochromatosis (excessive iron)
▪ Hemolytic anemias
▪ Normal iron balance
▪ Peptic ulcer, colitis, or regional enteritis
Adverse Effects
▪ GI irritation: GI upset, anorexia, nausea, vomiting, diarrhea, dark
stools, and constipation.
▪ With increasing serum levels, iron can be directly toxic to the CNS,
causing coma and even death.
▪ Parenteral iron is associated with severe anaphylactic reactions,
local irritation, staining of the tissues, and phlebitis.
▪ Ferumoxytol is a supermagnetic iron oxide that can alter MRI
images.

Agents for Megaloblastic Anemias

- Folic acid derivatives include folic acid (Folvite), leucovorin (Wellcovorin). ▪ Vitamin
B12 includes hydroxocobalamin (Hydro-Crysti-12), and cyanocobalamin (Nascobal).
Therapeutic Actions and Indications
▪ Folic acid and vitamin B12 are essential for cell growth and
division and for the production of a strong stroma in RBCs.
▪ Vitamin B12 is also necessary for maintenance of the myelin
sheath in nerve tissue.
▪ Both are given as replacement therapy for dietary
deficiencies, as replacement in high-demand states such as
pregnancy and lactation, and to treat megaloblastic anemia.

Agents for Sickle Cell Anemia

▪ hydroxyurea (Droxia)—is a cytotoxic antineoplastic drug that
is also used to treat leukemia, ovarian cancer, and melanoma.
Therapeutic Actions and Indications
▪ Hydroxyurea, taken for several months, increases the amount
of fetal hemoglobin produced in the bone marrow and dilutes
the formation of the abnormal hemoglobin S in adults who
have sickle cell anemia.

DRUGS ACTING ON THE RENAL SYSTEM

KIDNEY FUNCTION
It filters out waste products from the blood
Nephron is the main structural element of the kidney where diuretics exert their effects
GFR- The rate at which filtration occurs, used to gauge of how well the kidneys are
functioning as filters
An approximately 180 liters of blood is filtered per day
DIURETICS
Drugs or other substance that tends to promote the formation and excretion of urine
Accelerates the rate of urine formation and results in the removal of sodium and water
in the body
INDICATIONS:
Prevention and treatment of EDEMA associated with HPN, CHF, cirrhosis and
endocrine diseases
NURSING MANAGEMENT:
Monitor Urine output
Assess Breathing
Informed client about increased urine output and frequency
For immobile patients, ensure that urinal/bedpan is within reach
Weigh client daily at the same time each day, report weight loss of greater than 3
pounds per day
Maintain sodium in the diet: 3000 mg daily/ 1 teaspoon
Do not administer at night
WOF tinnitus and weakness

I. CARBONIC ANHYDRASE INHIBITORS

Mainly used as an adjunct in the management of open angle glaucoma and CHF
Chemical derivative of sulfonamide antibiotic
COMMON CAI
azetazolamide (Diamox)
II. OSMOTIC DIURETICS
Indicated for reduction of ICP cerebral edema, IOP
CONTRAINDICATION: dehydration
COMMON OSMOTIC DIURETIC:
mannitol (Osmitrol)
NURSING MANAGEMENT:
Monitor urine output
Do not give with blood
Do not refrigerate
Give infusion through a filter
III. LOOP DIURETICS
Very useful when rapid diuresis is desired because their onset of action is rapid
Very potent, works in the loop of henle where the most of the sodium is restored
Excretion of large quantities of urine with high levels of NaCl, K, Mg, Ca
INDICATIONS: CHF, Pulmonary Edema
COMMON LOOP DIURETIC:
furosemide (Lasix)
IV. THIAZIDE and THIAZIDE-LIKE DIURETICS
Has antihypertensive effects
Causes water, NaCl, and K loss
NURSING MANAGEMENT:
Monitor serum potassium level
Administer potassium supplements if indicated (Kalium durule)
COMMON THIAZIDE:
hydrochlorothiazide (Esidrix, HydroDIURIL)
chlorothiazide (Diuril)
chlorthalidone (Hygroton)
SIGNS AND SYPTOMS OF INCREASED SERUM POTASSIUM

M-U-R-D-E-R
M-uscle weakness
U-rine , oliguria, anuria
R-espiratory distress
D-ecreased cardiac contractility
E-CG changes
R-eflexes, hyperflexia, areflexia (Flaccid)
V. POTASSIUM SPARING DIURETICS
When used alone, they are not potent diuretics and cause HYPERKALEMIA.
Adjunctive therapy with other diuretics to minimize K loss
COMMON K-SPARING DIURETICS
amiloride (Midamor)
spiral naloctone (Aldactone)

NURSING MANAGEMENT
Monitor hyperkalemia
Instruct client to avoid, potassium rich foods

CEREBRAL AND PERIPHERAL VASODILATORS

Used to treat cerebral or peripheral vascular obstructive disease
VASODILATORS: Relaxes smooth muscles
INDICATIONS:
Vasoconstriction due to hypertension
Atherosclerotic obstruction of coronary or cerebral arteries
Excessive vasoconstriction in the peripheral arteries of the extremities
Treatment of Heart failure
5 Ps of Circulatory Check:
P- Pain
P- Paresthesia
P- Paralysis
P- Pulse
P- Pallor
COMMON VASODILATORS

isoxsuprine (Duvadilan)- decrease uterine contraction

pyridamole (persantin)- prevent reinfarction, adjunct to coumarin, anticoagulants during
valve replacement
pentoxyfilline (Trental)- only hemorrheologic agent that affects blood viscosity,
increase capillary blood blow,

NURSING MANAGEMENT
Must be taken long term- it improves circulation in conjunction
Check extremities daily , pulse, temperature, movement, color and cuts
May cause orthostatic hypotension
Proper foot care

CHOLINERGICS, ANTICHOLINERGICS, ADRENERGICS, ADRENERGIC-

BLOCKERS
These drugs influence the activity of autonomic nervous system
They facilitate or block the effects of neurotransmitters as they act on the body cells
ANS- is a part of the peripheral nervous system that acts as control system maintaining
homeostasis in the body. It affects heart rate, digestion, respiration rate, salivation,
perspiration, diameter of the pupil, micturition and arousal
I. ADRENERGIC DRUGS
Stimulate the sympathetic nervous system
Also known as adrenergic agonist or sympathomimetics
COMMON ADRENERGIC AGENTS:
BRONCHODILATORS: very effective as anti-asthmatic agents and used in
management of acute attacks
albuterol sulfate (Salbutamol, Ventolin)
metaproterenol (Alupent)
terbutaline sulfate (Brethine)- 10-20 mg/dl used to suppress premature labor
epinephrine (Adrenalin)- DOC for status asthmaticus and treatment of anaphylaxis
B. NASAL DECONGESTANTS: causes vasoconstrictions in the nasal mucosa
promoting easier nasal breathing
REBOUND PHENOMENON: greater congestion due to excessive use and when
treatment is stopped
DOC- pseudoepinephrine (Sudafed)
C. OPTHALMIC DECONGESTANTS: causes constriction and relieves conjunctival
congestion, thus decreasing redness in the eyes
- tetrahydrozoline (Visine, Murine)
D. VASOACTIVE ADRENERGICS
- dobutamine (Dobutrex)
- dopamine (Intropin)
- epinephrine (Adrenalin)
-isoproterenol (Isuprel)
-norepinephrine (Levophed)

II. ADRENERGIC BLOCKERS

highly effective pharmaceuticals that are used broadly in treatment of cardiac diseases.
Their physiological effects include the dilation of blood vessels, which lowers blood
pressure and slows heart rate.
COMMON DRUGS
- ergotamine tartrate (Ergostat)
- prazosin (Minipress)
- nadolol (Corgard)
- propanolol (Inderal)
-atenolol (Tenormin)
-esmolol (Brevibloc)
- metropolol (Lopressor)