 Synthetics

- Make drugs to market for human consumption.

- The synthetic (manufactured) sources evolved with human skills in
laboratories and advanced understanding of chemistry.
 Cheminformatics
Rizalyn Mae M. Faminial - A process by which use of computer technology is used to screen
drugs.
Ex. Antibiotics
 DNA
- Genetic engineering of drugs and the recently developed technique
of recombinant DNA technology has allowed the production of
biologically active substances that are present in the body and that
Pharmacology can be used to treat certain diseases.
- It is the study of drugs and their interactions with living systems. Ex. Insulin, hepatitis B vaccine
 Pharmacos - drug or poison
 Lohiya - study Information Associated with Drug Classification:
Drug o Therapeutic Uses
- Substance or chemical capable of altering a biochemical or o Most Common side effects
physiological process in the body. o Precautions to be used
o Contraindications
Therapeutic Objective o Interactions
- Provide maximum benefit with minimum harm. o Names, dosages, comments on administration

Sources of Medication Legal Terms Referring to Drugs

 Plants  Over the counter (OTC)
- Primary source of drug - No purchasing restrictions
- Berries, bark, leaves, resin from trees, roots were found to aid the  Prescription Drug (Legend Drug)
body - Determined unsafe for OTC purchase because of possible harmful
Ex. Cinchona bark - quinidine - Antiarrhythmic side effects if taken indiscriminately.
Poppy Plant - morphine - Analgesic  Controlled Substance
 Minerals - Drug controlled by strict prescription requirement because of danger
- Minerals from the earth also found their way into human use as of addiction or abuse.
drugs.
Ex. Magnesium - milk of magnesia - Antacid
 Animals
- Substance lacking in the body can replaced by similar substance
obtained from the gland, organ, tissues
Ex. Thyroid gland of animals - thyroid – Hormone
Identifying Names
 Generic Name
- Common or general name assigned to the drug regardless of the
manufacturer.
Ex. Ampicillin, paracetamol, ibuprofen, toothpaste
 Brand / Trade Name
- Propriety or trade name
- Name by which a pharmaceutical company identifies its products
- Initial letter in capital letter
- Often shown of labels and references with the symbol ®
Ex. Alaxan FR®, Advil®, Allerkid®, Colgate
 Chemical Name
- The exact molecular formula of the drug
- Designated according to rules of nomenclature of chemical
compounds (IUPAC)
Ex. (RS)-2-(4-(2-methylpropyl)pheny)propanoic acid

Pfizer, Unilab – Manufacturer

Philippine Laws Governing Drugs

RA 9165 - Dangerous Drug Act
RA 3720 - Food, Drug and Cosmetic Act
RA 9502 - Cheaper Medicines Act
RA 10918 - Philippine Pharmacy Act
 o Food may interfere with dissolution and absorption, some drugs irritate
the lining of the GIT thus it is best taken with food to dilute drug
concentration and to act as protectant.

Pharmacokinetic Phase
- Process of drug movement to achieve drug action
Rizalyn Mae M. Faminial
Four Processes
 Absorption
 Distribution
 Metabolism/Biotransformation
 Excretion
The Drug Action: Pharmaceutic, Absorption
Pharmacokinetics and Pharmacodynamics - Passage of a substance through a membrane into the bloodstream
Site: mouth, mucosa of stomach, small intestine, rectum,
dermal layers of the skin
Pharmaceutic Phase - Condition may alter the process: incorrect administration of drug
- First phase of drug action - Absorption of oral drugs varies according to the physical properties
of each drug: Ph, Lipid(fat) solubility, Presence/absence of food in the
Excipients stomach
- An active substance that serves as the vehicle or medium for a drug Liver - drug passes first
or other active substance. - Drugs maybe metabolized to an inactive form which may then be
- Fillers and insert substances used in drug preparation that allow the excreted
drug to have a particular size & shape. Bioavailability - percentage of drug dose that reaches the
systemic circulation
Tablet Oral: less than 100%
to IV: always 100%
Disintegration - breakdown into smaller products
to Factors that Alter Bioavailabity
Dissolution - dissolving of small particles o Drug form
o Route of administration
o Drugs in liquid form are rapidly absorb o GI mucosa and motility
o Drugs are generally absorbed faster in acidic fluids o Food and other drugs
o Young and elderly less gastric acidity, slower absorption o Changes in liver metabolism caused by liver dysfunction or a decrease
o Enteric coated drugs disintegrate in the small intestine; crushing it may in hepatic blood flow - less drug is destroyed I the presence of liver
alter the place and time of absorption. disorder.
Distribution Pharmacodynamics Phase
- Process by which drug is delivered to tissues and fluids of the body - Study of drug concentration and its effects on the body
- Influenced by blood flow  Drug Effect
- May be influenced by drugs ability to cross a lipid membrane (blood- - body response resulting from drug action
brain barrier and placental barrier)  Dose Response
Metabolism/Biotransformation - Relationship between the minimal versus the maximal
- Primarily takes place in the liver amount of drug dose needed to produce the desired drug
- Body's ability to change a drug from its dosage form to a more water response
soluble form (metabolites) that can then be excreted  Maximal Efficacy
Excretion - Maximum drug effect
- Elimination of drugs from the body
- Mainly excreted by kidneys (urine) Categories of Drug Action:
- Routes: sweat glands, Lungs, Rectum Stimulation or Depression
Creatinine Clearance Most accurate test to determine renal function - Stimulates rate of cell activity; gland secretion increases.
Normal Values: 85-135 mL/min Ex. Epinephrie
- 12/24 hours’ urine collection, blood sample Replacement
- Replace essential body compounds
Other Variables Affecting Drug Action Ex. Insulin
o Age Inhibition or Killing if Microorganisms
o Weight - Interfere with bacterial growth
o Gender Ex. Antibiotics
o Psychological State Irritation
Placebo Effect - Inactive substance that resembles a medication, - Act by mechanism of irritation
although no drug is present. Used in blind study experiments. Ex. Laxatives

Drug Interaction: Peak and Trough Drug Levels:

Synergism Peak Drug Level
- The action of 2 drugs working together in which one helps the other - Highest plasma concertation of drug at a specific time
simultaneously for an effect that neither could produce alone. - Indicate level of absorption
(1+1=3) Route: Oral - 1-3 hours
Potentiation : IV - 10 minutes
- The action of 2 drugs in which one prolongs or multiples the effect Trough Drug Level
of the other. - Lowest plasma concentration of a drug before the next drug is
(1+0=2) administered
Antagonism - Measure the rate at which the drug is eliminated
- The opposing action of 2 drugs in which one decreases or cancels
out the effect of the other. Peak - rate of absorption of the drug
(1+1=0) Trough - rate of the elimination of the drug
Parameters of Drug Action: Therapeutic Effects of Drugs:
Onset of Action (T0 - T1) Curative
- Time it takes to reach the minimum effective concentration after a - Cures a disease or condition
drug is administered Ex. Penicillin for infection
Peak Action (T0 - T2) Supportive
- Occurs when drug reaches its highest blood or plasma - Supports body function until other treatment or the body's
concentration response can take over
Duration of Action (T1-T3) Ex. Aspirin for high blood temperature
- The length of the time the drug has a pharmacologic effect Substitutive
- Replace body fluids or substances
Dosages: Ex. thyroxine for hypothyroidism, insulin for DM
Minimum Dose Chemotherapeutic
- Smallest amount of drug that will produce a therapeutic effect. - Destroys malignant cells
Maximum Dose Ex. busulfan for leukemia
- Largest amount of a drug that will produce desired effect without Restorative
producing symptoms of toxicity. - Returns body for health
Loading Dose Ex. Vitamin, mineral supplements
- Initial High dose (often maximum dose) used to quickly elevate the Palliative
level of the drug in the blood. - Relieves symptoms
Maintenance Dose Ex. Aspirin for pain
- Dose required to keep the level of the drug in the blood at a steady
state to maintain the desired effect. Effects of Drugs:
Toxic Dose Skin rash
- Amount of a drug that will produce harmful side effects or - Intra-epidermal vesicle rash
symptoms of poisoning. Pruritus
Lethal Dose - Itching of the skin
- Dose that can cause death Angioedema
Therapeutic Dose - permeability of blood capillaries
- Dose that is customarily given; adjusted according to variations Rhinitis
from the norm. - Excessive watery discharge from the nose
Lacrimal tearing
Nursing Responsibilities: - Excessive tearing
o Administering drugs Nausea, vomiting
o Assessing drug effects - Stimulation of centers in the brain
o Intervening to make the drug regimen more tolerable Wheezing and Dyspnea
o Providing patient teaching about drugs and the drug regimen - Accumulated fluids and swelling of respiratory tissue
o Monitoring the overall patient care plan to prevent medication orders Diarrhea
- Irritation of the mucosa of large intestine
Unexpected Effects of Drugs:
Side effects
- Unintended or secondary effects can be harmless or potentially
harmful.
Adverse effects or reaction
- More severe side effects
- When side effects cause harm to the functioning of the body system.
Drug toxicity
- Results from over dosage, ingestion of a drug intended for external
use, and buildup of the drug in the blood because of impaired
metabolism or excretion.
Drug Allergy / Hypersensitivity
- Immunologic reaction to a drug
- Drug acts as an antigen which causes antibodies to be produced
Anaphylactic Reaction
- Severe, fatal allergic reactions usually occur immediately after the
administration of the drug.
Drug Tolerance
- Unusually low physiologic response to a drug after repeated doses
are given
Cumulative Effect
- Increasing response to repeated doses of a drug that occur when the
rate of administration exceeds the rate of metabolism or excretion.
Iatrogenic Disease
- Disease caused unintentionally by medical therapy
Ex. Renal damage, liver damage
Idiosyncratic Reactions
- Unusual, unique and unexpected response to a drugs wherein the
client may overreact or underreact to a drug.
Teratogenic Effect
- Effect from maternal drug administration that causes physical
defects in the fetus.
Paradoxical Effect
- Opposite effect from the expected.
  Sustained Release or Capsule or Tablet
- Capsule or tablet containing drug particles that have various
coatings that differ in the amount of time required before
the coating dissolve.
 Lozenge
- Tablet containing palatable flavoring, intended for a local
Rizalyn Mae M. Faminial effect on mouth or throat.
- Should not be swallowed and be taken with drinks for 15
minutes of administration.
 Suspension
- Liquid form of medication that must be shaken well before
Medication Preparation and Supplies administration because then particles settle at the bottom
of the bottle.
Drug Form or Drug Preparation
 Elixir
- Refers to the type of preparation in which a drug is supplied. - Liquid drug forms in alcohol base. Should be tightly capped
May be administered through GI Tract (oral, nasogastric, to prevent evaporation.
gastrostomy, rectal) and parenterally (IV, IM, ID, SQ).  Syrup
- Sweetened, flavored liquid drug form. Most commonly used
Oral Drug Form in children.
 Tablet  Buccal Tablet
- Are disk of compressed drug - Tablet being absorbed in the buccal mucosa in the mouth.
- Different shapes and sizes and colors Should not be swallowed.
- Maybe scored (evenly divided in halves/quarters).  Sublingual Tablet
 Enteric Coated Tablet - Tablet that being absorbed via the mucosa under the
- Tablets with special coating that resists disintegration by tongue. Should not be swallowed; has sting effect.
gastric juices.
- The coating must not be destroyed by chewing or crushing Oral Form Advantages
when administered o Easiest way
 Capsule o Cheapest
- Drug contained within a gelatin-type container. Double Oral Form Disadvantages
chamber can be pulled apart for easy swallowing. o Not the route of choice during emergency, acute pain, NPO, unable
 Emulsion to swallow.
- Liquid drug preparation that contains oils and fats in water.
Rectal Drug Forms:  Intramuscular
 Suppository - Injected to the muscle at 90-degree angle. Absorption is fairly
- Can also be a vaginal or rectal sup rapid due to vascularity in muscle.
- Drug suspended in a substance that melts at body Ex. Vaccines, antibiotics
temperature  Subcutaneous
 Enema - Injected into the fatty layer of tissue the skin at 45-degree angle.
- Drugs may be in a suspension or solution given via rectal Ex. Vaccines, insulin, heparin
route.  Intradermal
- Injected just beneath the skin by positioning the needle bevel up
and 10-15-degree angle from the skin.
Injectable Drug Forms:
Ex. Vaccines, TB, Skin Testing or allergy
 Liquid
- Drug suspended or dissolved in a sterile solution. Often have a  Epidural
sterile water base and referred as aqueous solutions. - Injected into a catheter that has been placed by an
- Sometimes they are oil-based, which tends to cause a more anesthesiologist in the epidural space of the spinal canal.
prolonged absorption time.  Intraosseous
 Powder - Injected directly into the marrow of long bones.
- Dry particles of the drug Ex. Cardiac arrest
- Powder itself cannot be injected  Intraspinal
- Must be mixed with sterile water/saline solution to render an - Injected into the subarachnoid space, which contains the CSF
injectable solution, called reconstitution. that surrounds the spinal cord. Usually route of choice for
anesthetics.
Parental Route:
 Intravenous Topical Forms:
- Directly into the vein  Cream or Ointment
- Immediate absorption - A semisolid preparation containing the drug for external
- 100% bioavailability application.
o IV Push Cream - wet wounds
- Small volume of drug injected to the peripheral lock Ointment - dry wounds
o IV Drip  Lotion
- Large amount of the fluids with drugs added that - A liquid preparation for external use that is patted onto skin.
infuses continually into a vein.  Transdermal Patch
o IV Piggyback - Skin patch contains drug molecules that can be absorbed through
the skin at a varying rates to promote a consistent blood level of
- Drug diluted in moderate amount for intermittent
the drug between application times.
infusion at specified intervals.
Other Forms 10 RS of Drug Administration:
 Eye, Ear, Nose Drops  Right Patient
- Drugs in sterile liquids to be applied by drops. - Ask the name of the patient
Eye - Inner Canthus - Best way: ask the patient/caregiver
Ear - 3 years old below, pull pinna down and back - Bed ID
- ID Band
 Vaginal Creams - Identity their age group
- Medicated creams that are inserted vaginally with the use of
 Right Drug
special applicator.
- Know what the drug is typically used for. If it’s therapeutic effect
 Douche Solution
does not match the diagnosis, verify the order or at least further
- Sterile solution, often an antiseptic such as povidone-iodine
investigate. You may see generic and trade names. Double check
solution and water, used to irrigate vaginal canal.
the MD order.
 Spray or Mist - Beware of look-alike and sound-alike medication names.
- Very fast acting and effective route for delivering humidification
 Right Dose
and medication directly to the respiratory system.
- The amount of drug being given to the patient
Pedia: the dosage of medicine depends on the weight of the
Supplies child
 Medication Cup 1.25mg vs. .125mg is significant
- for oral type of medication
 Right Route
 Ampule - Oral? I.V? The doctor makes that call but you might request to
- Glass form, need to tap and twist
change the order depending on other factor
 Vial
- Glass form with rubber, need needle Ex. Swallowing pills, a common issue with children and teens.
 Needle  Right Time or Frequency
14G - Orange - Typically, you have 30 minutes before 30 minutes after
16G - Gray prescribed administration time. You'll need extra time when you
18G - Green are looking up all those medications. Start 1/2 hour early if you
20G - Pink need to. For a PRN med, make sure enough time has passed since
22G - Blue their last dose.
24G - Yellow - Take note of the frequency, this is a common medicine error.
 Syringe  Right History/Assessment
- History of allergy to the medication, contraindications,
pregnancy.
- How about pre-medication assessment? Check to see if the med
should be held if pulse or BP is too high or too low.
  Right Education Digoxin, maintain blood level of 0.5-2 mg/ml
- Educate the patient/family about the meds they are taking.  One time or Single orders
Inform them of the expected therapeutic and side effects and ask - Given once and usually at a specific time
if they have any questions. Ex. Versed 2 mg IM at 7 AM on 12/5/10
 Right to Refuse
- People taking medications have the right to refuse medications.  PRN orders
- Given at the client's request and nurse's judgement concerning
- Nurses must legally document a refusal of medication.
need and safety
 Right Evaluation
- Review any medications previously given or the diet of the Ex. Tylenol 650 mg q3 to q4 PRN for headache
patient that can yield a bad interaction to the drug to be given.  STAT order
Check also the expiry date of the medication given. - Given once and immediately
 Right Documentation Ex. Morphine sulfate 2 mg IV STAT
- Golden Rule: What is not written, is not done. Demerol 100 mg IM STAT

Ways to prevent Drug Administration Error: Guidelines for Correct Drug Administration
o Read drug labels carefully.
Preparation
o Question the administration of multiple tablets or vials for a single o Wash hands
dose. o Check for drug allergies
o Beware of drugs with similar names.
o Check medication order
o Check the decimal points.
o Check label on drug container three times
o Question abrupt and excessive increases in dosage.
o Check expiration date
o When a new order or unfamiliar drug is ordered, consult a resource.
o Recheck drug calculation
o Do not administer a drug ordered by a nickname.
o Verify doses of drugs that are potentially toxic
o Do not attempt to decipher illegible writing.
o Open packet at bedside after verifying patient
o Know patients with the same last names.
o Do not confuse equivalents
Administration
o Administer inly drugs that you have prepared
Categories of Drug Order: o Identify client
 Standing Orders o Assist the client to an appropriate position
- May be an ongoing order or may be given for a specific number o Offer ice chips when giving bad tasting drugs
of doses or days. o Give bad tasting drugs first followed by a pleasant tasting liquids
- May have special instructions to base administration on o Stay with the client until the medications are taken
laboratory values o When giving drug to a group of clients, give drugs last to clients
- May include PRN orders who need extra assistance
Ex. Multivitamins PO daily o Discard needles and syringe in appropriate store drugs
 o Write date and time opened and your initials on label o Any special instructions for withholding or adjusting dosage based in
o Keep narcotics in a double-locked drawer or closet nursing assessment, drug effectiveness or laboratory results.
o Physician or other health care provider's signature or name if TO or
Recording VO
o Report drug error immediately o Signature of licensed practitioners taking TO or VO
o Charting: record drug given, dose, time, route ad initials
o Record drugs promptly, especially STAT orders Nursing Implications
o Report drugs that were refused with reason for refusal o Check that then medication order is complete and legible
o Record amount of fluid taken with medications o Know the reason the client is to receive the medication
o Check the drug label three times before administration
Behaviors to Avoid during Medication Administration o Know the date the medication was ordered and any ending date
o Do not be distracted when preparing medications.
o Do not give drugs poured by others.
o Do not pour drugs from container that are difficult to read or whose
labels are partially removed or have fallen off.
o Do not transfer drugs from one container to another.
o Do not pour drugs into the hand.
o Do not give medications for which the expiration date has passed.
o Do not guess about drugs and drug doses. Ask when in doubt.
o Do not use drugs that have sediment, are discolored, or are cloudy.
o Do not leave medications by the bedside or with watchers or
visitors.
o Do not leave prepared medications out of sight.
o Do not give drugs if the pt claims of allergies to the drug or drug
group.

Components of a Drug Order

o Full name of the patient
o Date and time the order is written
o Name of the drug to be administered
o Dosage of the Drug
o Frequency of administration
o Route of Administration
 Formula
Amount of Drug
D - desired amount or prescribe amount
A - available dosage
Q - quantity
Rizalyn Mae M. Faminial
D / A X Q = Amount

(Note D: 100mg/2ml, give 3ml)

: divide and times
: 100mg/mg, give 3ml
Common Conversion : times
1 kg 1000 g (Note A: kapag merong ":" just add )
: Kapag “in” wag pakialaman
1g 1000 mg
1L 1000 mL
Intravenous Meds
1 mg 1000 mcg
Macrodrip Set
1 gr 60 mg
Abbott - 15gtts/min
1/2 gr 30 mg
Baxter - 20gtts/min
1/4 gr 15 mg Microdrip Set - 60ugtts/min
1 measuring cup 8 oz
1 coffee cup 6 oz Drops per Minute (Gtts/Min)
1 oz 2 tbsp ( vol. of IVF ) ( drop factor )
1 tbsp 3 tsp ( # of hrs. ) (60 min)
1 tsp 60 drops
1 kg 2.2 lbs cc per hour
1 cc 1 mL vol of IVF
1 in 2.54 cm # of hrs.
1 ft 12 in
1 tbsp 15 mL, 3 tsp Number of Hours To Run
2 tbsp 3O mL, 6 tsp ( vol left ) ( drop factor )
1 tsp 5 mL ( # of gtts/min ) ( 60 min )
1 glass 240 mL, 8 oz
1 cup 180 mL, 6 oz
1 oz 30 mL
 1/2 grain - 30 mg
1/4 grain 15 mg
 Household
- Not as accurate as the metric because of the lack of
standardization of spoons, cups and glasses
- Measure re approximate
Household in Volume
Rizalyn Mae M. Faminial 1 measuring cup - 8 ounces
1 coffee cup - 6 ounces
1 ounce - 2 tablespoons
1 tablespoon - 3 teaspoons
1 teaspoon - 60 drops

Medications and Calculations Most Common

Weight (kg – lbs)
1 kg = 2.2 lbs
Recommendation for Safe and Correct Drug Preparation
o Think
o Read Accurately
Volume (cc – ml)
o Picture the Problem
1 cc = 1 ml
o Seek to understand the problem
Height
1 in = 2.54 cm
1 ft = 12 inches
System of Measurement
Tablespoon = ml = teaspoon
 Metric
1 tbp = 15 ml = 3 tsp
- Logically organized
2 tbp = 30 ml = 6 tsp
- Easy to compute and convert
1 tsp = 5 ml
Metric Units
-
1 kg - 1000g
1 glass = 240 ml = 8 oz
1 g - 1000mg
1 cup = 180 ml = 6 oz
1 L - 1000ml
1 oz = 30 Ml
1 mg - 1000 mcg
 Apothecary
- Older system of measurements
- Uses Roman numeral to express the quantity
Basic Units
Weight - grain
Volume - ounce, dram, minim
1 grain - 60 mg
Quantity
 For oral/supp Solid
o Tab, cap, EC tab, EC cap
o Vaginal supp, rectal supp
 For oral Liquid
o Volume of dilute used
 For IV medications
o Liquid form - volume of diluent used
o Powder - depends on the amount of diluent that will be
given

Right Dose
- The right amount being given to the patient

Steps in Solving
1. Analyze
2. Check
3. Compute

Amount of Drug
 Administration Measurements Administration Route

cc cubic centimeter AD right ear Q1 every 1 hour

g or gm gram AS Left ear STAT immediately at once
gr grain AU both ears TID three times a day
gtts drops HHN hand held nebulizer amp ampoule
IU international units ID intradermal route cap capsule
kg kilogram IM intramuscular route DS double strength
mcg microgram IT intrathecal route elix elixir
mg milligram IV intravenous route LA long-acting
mEq Milli-equivalent IVP intravenous push liq liquid
mL milliliter IVPB intravenous piggyback sol solution
mn or m minim NGT nasogastric tube supp suppository
oz ounce OD right eye SR sustained release
ss one half OS left eye susp suspension
sliver one half of a suppository OU both eyes syr syrup
tbsp tablespoon PO by mouth tab tablet
tsp teaspoon PR by rectum tinct tincture
U unit SQ subcutaneous route ung ointment
L liter SL sublingual route QD everyday
AMA against medical advice S&S swish and swallow QID four times a day
C with V/VP vaginal route QOD every other day
DC discontinue ac before meals
G gauge ad lib as desired
KVO keep vein open ASAP as soon as possible
NKA no know allergies BID twice daily
NPO nothing by mouth HS at bedtime
OTC over the counter NOC night time
Rx prescription PC after meals
s without PRN as needed
TO telephone order Q every
VO verbal order q AM every morning
Q hr every hour
 Second Generation
Drug Name:
- Cetirizine, levocetirizine, loratadine
Action:
- Selective histamine receptor antagonist that have fewer CNS
effects and less anticholinergic effects
Uses:
Rizalyn Mae M. Faminial - Symptomatic relief of seasonal allergic rhinitis
Side Effects:
- Headache, dizziness, fatigue, drowsiness (cetirizine)
Nursing Consideration:
- No self-medications
- Taking care in driving or operating machinery because of
Respiratory Drugs sedative effect
Antihistamine Sympathomimetic
Action: Drug Name:
- Compete with histamine response – when H1 receptor is - Albuterol, salbutamol, salmeterol
stimulated, the extravascular smooth muscles, including those lining Action:
the nasal cavity, are constricted. - Stimulates beta receptors in the lungs causing it to relax bronchial
smooth muscle, increasing vital capacity and decrease airway
First Generation resistance
Drug Name: Uses:
- diphenhydramine (Benadryl) - Asthma, bronchitis, emphysema
Uses: Side Effects:
- antitussive, sleep aid, antiemetic, anaphylactic reactions - Nervousness, tremors, restlessness, headache, tachycardia,
irregular heartbeat, hypertension
Side Effects: Nursing Consideration:
- Anti-cholinergic Effects – dry mouth, tachycardia, - Monitor breath sounds, sensorium levels for confusion and
hypotension, sedation, urinary retention, constipation restlessness due to hypoxia, and vital signs
Nursing Consideration: - Caution against overuse
- Avoid prolonged use of antihistamines - Demonstrate correct use of inhalers
- No self-medication in patients with COPD, BPH - When 2 puffs are needed 1 to 3 minutes should lapse between 2
- Taking care in driving or operating machinery because of puffs
sedative effect.
- Offer gum or hard candy to promote salivation
To use a Metered Dose Inhaler (MDI) Side Effects:
1. Shake the inhaler well before use (3 to 4 shakes) - headache, dizziness, nasal congestion, nausea, behavioral changes,
2. Remove the cap suicidal ideations
3. Breathe out, away from your inhaler Nursing Consideration:
4. Bring the inhaler to your mouth. Place it in your mouth between - monitor breath sounds and for gastric distress
your teeth and close your mouth around it.
5. Start to breathe in slowly. Press the top of you inhaler once and Corticosteroids
keep breathing in slowly until you have taken a full breath. Use:
6. Remove the inhaler from your mouth, and hold your breath for - To relieve inflammation, reduce swelling, decrease bronchial hyper-
about 10 seconds, then breathe out. responsiveness to triggers, and suppress symptoms in acute d
chronic reactive airway disease. Must be administered for short-
Xanthine term bursts during exacerbations until controlled
Drug Name: o inhaled
- theophylline o intranasal spray
Action: Side Effects:
- It causes smooth muscle relaxation (ex. bronchodilation) by - throat irritation and dry mouth, hoarseness, oral fungal infections,
phosphodiesterase inhibition and suppression of the response of immune suppression
the airways to stimuli (ex. Prophylactic effects). Nursing Consideration:
Uses: - Advise to rinse mouth with water after use
- COPD patients who do to respond to long acting broncho dilators. - Follow exact dosage and administration orders
Side Effects: - Dangers of infection may happen in prolonged use
- GI distress, CS stimulation, palpitations, tachycardia, arrhythmias,
diuresis, hyperglycemia Mucolytic Agents and Expectorants
Nursing Consideration: Action:
- May be taken with food to prevent gastric irritation - Used to liquefy secretions in the respiratory tract, thus producing a
- Reiterate importance of smoking cessation productive cough
- Watch closely for cardiac irregularities Mucolytic – act directly to break up mucus plugs in the
tracheobronchial passages allowing easier elimination.
Leukotriene Receptor Antagonist Expectorant – acts indirectly to liquefy mucus by increasing
Drug Name: respiratory tract secretions via oral absorption to clear
- Montelukast, zafirlukast mucus out of airways easily. It is drier to productive cough
Action: Drug Name:
- Blocks the receptor that inhibits leukotriene formation, preventing - Mucolytic: N-acetylcysteine (Fluimucil), carbocisteine (solmux)
the many signs of asthma - Expectorant: guaifenesin (Robitussin)
Uses: Nursing Consideration:
- prevention and long-term control of mild asthma and for treatment - Assess respiratory status
of allergic rhinitis - Promote adequate fluid intake
- Encourage coughing and deep breathing
 - Avoid administering fluids immediately after taking expectorant Nursing Consideration:
- Have suction apparatus available - Using decongestants for a few days only (3 days for nasal; 7 days for
- Evaluate client’s response to medication and understanding of oral) to avoid rebound congestion
teaching - Avoid when cardiac or thyroid conditions or diabetes are present
- Increase oral fluid intake
Antitussives
Drug Name:
- butamirate citrate (siecod)
Action:
- Act on the cough- control center in the medulla to suppress the
cough reflex or by indirect action peripherally on sensory nerve
endings. They are typically used to treat dry, non-productive
coughs.
Side Effects:
- Respiratory depression, constipation, urinary retention, sedation
and dizziness
Nursing Consideration:
- Provide adequate fluid intake
- Avoid administering fluids immediately after liquid preparations
- Encourage high-fowlers position

Decongestant
Drug Name:
- Phenylephrine, pseudoephedrine
Action:
- Constricts blood vessels in the respiratory mucous membrane and
helping to open nasal airway passages
Note: when taken orally, the systemic decongestants are absorbed
readily from the GI tract and widely distributed throughout the body
into various tissues and fluids including cerebrospinal fluid, placenta and
breast milk
Side effects:
- Anxiety, nervousness, palpitations, tachycardia, hypertension,
headache, cerebral hemorrhage, reduced cardiac and urine output
 Vital functions of the Kidney
1. Removal of water and waste products from the blood in the form of
urine
2. Keeping a stable of balance of salts ad other substances in the body
3. Releasing of hormones that helps maintain the normal number of
RBC and regulate PB through RAAS
Rizalyn Mae M. Faminial Nephrons
- Functional and structural units of the kidney
- Each kidney contains about 1.25 million nephrons
o Bowman’s Capsule
- Encloses a bundle of tiny capillaries called the
glomerulus
Renal Drugs - Where actual sifting or filtering of blood
occurs.
o Network of Convoluted Tubules
Kidney
 Proximal convoluted tubules
- Are two bean-shaped organs about the size of clenched
- Reabsorption of nutrients and substances
3 Regions
that the body needs
o Renal Cortex
 Henle’s loop
- Outer most region
- controls the concentration of urine
o Renal Medulla
- Middle region  Distal convoluted tubule
- Regulation of sodium potassium or pH
- Which consists of collecting ducts that carry the
urine  Collecting tubule
o Renal Pelvis - regulates sodium reabsorption
- Inner region - receives the nitrogen waste from many
- A cavity connected to the ureter, into which the nephrons
urine drains
Renal Artery Circulation
- Delivers oxygenated blood to the kidney o Impure blood enters the kidney through the renal artery
Renal Vein o Purified blood exist the kidneys through the renal vein
- Receives deoxygenated blood from the peritubular
veins within the kidney
Drugs involve in the Renal System: Uses:
Diuretics - Edema, Hypertension, Prophylaxis of calculus
- Drugs that act to increase urine excretion Side Effects:
Indications: to reduce the circulating fluid volume to help treat - Hypokalemia, hyponatremia, postural hypotension, vertigo,
edema and hypertension headache, hyperglycemia and increased uric acid level
- Water pills Nursing Consideration:
- Most commonly used drugs influencing the function of the urinary - Include potassium-rich food in the diet
tract - Low sodium diet if prescribed from hypertension
Classes of Diuretics - Administration in the morning to prevent disruption of sleep from
- Thiazides and thiazide-like frequent urination
- Loop diuretics - Rising slowly from a reclining position to counteract postural
- Potassium-sparing hypotension
- Carbonic anhydrase inhibitors - Necessity for regular blood test to monitor electrolyte levels
- Osmotic diuretics - Precaution to patient who are at high risk of developing diabetes, as
this may cause hyperglycemia
Diuretic Class Major site of Action Special Side Effects - Monitor intake and output
Carbonic anhydrase
Proximal tubule Acidosis
inhibitor Carbonic Anhydrase Inhibitors
Hypokalemia Drug Name:
Loop diuretics Loop of Henle - acetazolamide
Ototoxicity
Thiazide and thiazide Hyperuricemia Action:
Distal tubule - Inhibit the enzyme carbonic anhydrase in the kidney, brain and eye.
like Hypokalemia
Potassium sparing Distal tubule Hyperkalemia - It promotes the excretion of sodium, potassium, water and
Hypovolemia bicarbonate
Osmotic diuretic glomerulus Uses:
hypotension
- Increased intraocular pressure
Thiazides
Drug Name: hydrochlorothiazide Loop Diuretics
1. bendroflumethiazide Drug Name: furosemide (Lasix)
2. benthiazide 1. bumentanide
3. chlorothiazide 2. torsemide
4. hydroflumethiazide Action:
5. methylclothiazide - inhibit sodium, chloride and water reabsorption in the proximal
6. trichlormethiazide portion of the ascending loop of Henle
Action: Uses:
- Block the chloride pump, keeping the chloride, sodium and - Edema, pulmonary edema, ascites caused by malignancy or
potassium in the distal tubule to be excreted into the urine. cirrhosis, hypertension
Side Effects: Osmotic Diuretic
- Hyperglycemia, hypotension, blurred vision, headaches, dizziness, Drug Name:
lightheadedness, anorexia, nausea, diarrhea, dehydration, muscle - mannitol
cramp, ototoxicity. Action:
- Increases osmotic pressure of glomerular filtrate, thus preventing
Nursing Consideration: reabsorption of water
- Monitor serum glucose and electrolytes - Increase excretion of sodium and chloride
- Report changes in hearing, irritability, vomiting, anorexia, nausea, - Reduce intracranial pressure by creating an osmotic gradient and
diarrhea, twitching or tetany decreasing cerebral edema
- Instruct patient taking furosemide to limit sunlight exposure due to Side Effects:
photosensitivity - Dry mouth, thirst, nausea, vomiting, blurred vision, headache,
- Monitor intake and output dizziness, fluid and electrolyte imbalance
Nursing Consideration:
Potassium Sparing Diuretics - Monitor renal function tests, serum and urine potassium and
Drug Name: sodium levels
- spironolactone (Aldactone), triamterene (Dyrenium) - IV solution may crystallize never give solutions with crystals.
Action: Solution given IV only via an in line filter
- Promotes excretion of sodium and water, but retains potassium in - Intraocular pressure is closely monitored by the primary care
the distal renal tubule provider
Indication: - Monitor intake and outtake
- Increased ICP
Side Effects: O – Oliguria, edema
- Nausea, diarrhea, dizziness, headache, dry mouth, rash, S – Stops reabsorption of water
photosensitivity, hyperkalemia result in peaked T waves on ECG M – Mannitol
Nursing Consideration: O – Output of urine, electrolytes – monitor
- Inform client that maximum hypotensive effect may not be seen in T – Tissue dehydration
2 weeks. I – increased frequency
- Advice client to avoid citrus juices, colas, salt and salt substitutes C – Circulatory overload
- Monitor potassium levels
- Monitor intake and output Treatment of Gout:
L – Low Na+ Gout
E – Elevated T waves from increased k+ o Form of arthritis and metabolic disorder characterized by
A – Agranulocytosis with triamterene accumulation of uric acid crystals in various joints, tissue and
K – K+ level must be monitored sometimes the kidneys
Colchicine Side Effects
Action: - Rash, allergic reactions, fever, chills, nausea and vomiting, diarrhea,
- Used to relieve inflammation in acute gouty arthritis and chronic vertigo
management of gout Nursing Consideration:
Side Effects: - Increase fluid intake
- Rash, alopecia, GI upset, blood disorder and bone marrow - Administer with food
suppression - Avoid purine-rich foods (liver, kidney, shell fish, red meat)
Nursing Consideration:
- Instruct patients to increase fluid intake to facilitate excretion of Bladder Problems:
uric acid crystals Cholinergic
- Instruct patients to avoid alcohol Drug Name:
- bethanecol (Urecholine)
Uricosuric Agents Action:
Drug Name: - Stimulate parasympathetic nerves to bring about contraction of the
- probenecid urinary bladder in cases of non-obstructive urinary retention,
Action: usually post operatively or postpartum
- Block reabsorption and promotes urinary excretion of uric acid in Indication:
the kidneys - Urolithiases, with full bladder but no urine output
- This has o anti-inflammatory or analgesic effect
- May be given with penicillin Side Effects:
Side Effects: - GI cramping, diarrhea, sweating and salivation, headache and
- Headache, nausea and vomiting, kidney stones bronchial constriction, tachycardia, hypotension, urinary urgency
Nursing Consideration:
- Advise to increase fluid intake Treatment of UTI’s
- Administer with food - Urinary tract infections are characterized by symptoms of increased
- Report rash immediately frequency of urination or sudden urge to urinate, burning while
urinating, cloudy or strong smell of urine, pain in the lower
Xanthine Oxidase Inhibitors abdomen area
Drug Name: - Most common in female than male
- allopurinol Treatment:
Action: - Antibiotics, usually with trimethoprim-sulfamethoxazole,
- Inhibit xanthine oxidase, an enzyme in the purine catabolism ciprofloxacin and nitrofurantoin for 7-14 days.
pathway that converts hypoxanthine to xanthine to uric acid Nursing Consideration:
Uses: - Importance of compliance to treatment
- Aside from chronic gout, used for prevention of renal calculi in - Proper hygiene
patients with hyperuricemia and stone formation during
radiation/chemotherapy in tumors Treatment of Benign Prostatic Hyperplasia:
Antiandrogens
Drug Name:
- finasteride (Proscar), dutasteride (Avodart)
Action:
- Inhibit enzymatic action of converting testosterone to 5a-
dihydrotestosterone (DHT), which is the androgen primarily
responsible for the initial development and subsequent
enlargement of the prostate Gland

Side Effects:
- Impotence, decreased libido, decrease ejaculate, gynecomastia

Alpha Blockers
Drug Name:
- tamsulosin (Flomax), doxazosin (Cardura), terasozin (Hytrin)
Action:
- It is a selective a1 receptor antagonist that has preferential
selectivity for the a1a receptor I the prostate versus the a1b
receptor I the blood vessels causing muscle relaxation
Side Effects
- Dizziness, headache, nasal congestion, orthostatic hypotension,
palpations, ejaculation dysfunction, decreased libido, impotence

Phosphodiesterase (PDE) Inhibitors

Drug Name:
- tadalafil (Cialis)
Action:
- Work by increasing the levels of a chemical called cyclic guanosine
monophosphate, or cGMP. This chemical increases blood flow to
the penis. The chemical also relaxes muscle cells in the bladder and
prostate. This may be why it eases the urinary symptoms of BPH.
Side Effects:
- Headache, stomach upset, back pain, muscle pain, stuffy nose,
flushing, or dizziness
Nursing Consideration:
- Sexual precautions
- Should not be taken without prescription, especially to cardiac
patients
 Antacids
Drug Name:
- Aluminum magnesium hydroxide (Maalox)
- calcium carbonate (Tums)
- sodium alginate + sodium carbonate + calcium carbonate(Gaviscon)
Action:
- Works locally in the stomach by neutralizing gastric hydrochloric
Rizalyn Mae M. Faminial acids; eliminated primarily in feces
- Antacid products may contain aluminum, calcium carbonate,
magnesium, either individually or combination
Uses:
- Treatment of pyrosis (heartburn),
- dyspepsia (acid indigestion),
Gastro Intestinal Drugs - sour stomach
Function of the GI System Side Effects:
o Referred as the second brain - Constipation (aluminum and calcium carbonate)
o May biochemical messages be affecting different body systems - diarrhea (magnesium)
comes from enteric nervous system of the digestive system - renal calculi, osteoporosis (aluminum)
o Produces transmitters such serotonin that affect mode or well being Precaution/Contraindications:
o It is a key component in body’s immune defenses against infection, - HF, CKD or real calculi, cirrhosis of the liver, dehydration or
bacteria, viruses, and fungi and other microorganism electrolyte imbalance.
o It is responsible for transfer of nutrients to the body. Nursing Considerations:
- Antacids may either increase/decrease absorption of other
Classifications of Tracts medications, give at least 2 hours’ allowance before administering
o Antacids medications. (antibiotics, digoxin, salicylates, thyroid hormones)
o Drugs for treatment of ulcers ad gastroesophageal reflux disease - Instruct to shake suspension well before taking
(GERD) - Take 1 to 3 hours after meal
o GI antispasmodics - Do not take large amounts of caffeine or alcohol
o Antiflatulent - Take calcium carbonate with large amount of water
o Laxatives and cathartics - Advise client to avoid foods or liquids that can cause gastric
o Antiemetic irritation
Aunt Acids Family – AI’s problem is constipation; Mag has a problem with
diarrhea
H₂ Blockers Proton Pump Inhibitors (PPIs)
Drug Name: Drug Name:
o Cimetidine, famotidine, ranitidine - Omeprazole, pantoprazole, Iansoprazole, esomeprazole,
Action: rabeprazole
- Histamine2 receptor antagonists block histamine from stimulating Action:
the acid-secreting parietal cells of the stomach, thereby reducing - It in inhibit the parietal cell H+ / K+ ATP pump, the final step of acid
acid secretion to promote healing of ulcers. production. I turn, suppress gastric basal and stimulated acid
Uses: secretion.
- Used for short term relief Uses:
- GERD, esophagitis, prevention of duodenal ulcer recurrence - Long term treatment of GERD, ulcer, esophagitis, hyper-secretory
Side Effects: conditions.
- Diarrhea, dizziness, rash and headache Side Effects:
Precaution/Contraindications: - Diarrhea, constipation, nausea, vomiting, abdominal pain, increased
- Renal disease, pregnancy and lactation risk for pneumonia or intestinal C difficile infection
Nursing Considerations: Nursing Considerations:
- Advise to take with meals - Eso, lanso, ome - empty stomach
- To assist in decrease in acid reflux advise the client t elevate the - Rabe, panto – no regards to meals
head of bed during sleep - Regular medical flow ups are important for evaluation
- No meal intake 2 hours before hour sleep - Slow release (SR) capsule must not be crushed, chewed or broken. It
- Eliminate caffeine, alcohol, harsh spices, chocolate and peppermint may be opened and sprinkled on applesauce or yogurt, given with
form the diet fruit juices
- Stop smoking
- No aspirins or NSAIDS Pepsin Inhibitors
- Notify medical provider of blood in emesis or stool or an increase in Drug Name:
abdominal pain. - Sucralfate (Carafate)
Action:
D - Don’t take with antacids - It dissociates in the acid environment of the stomach to its anionic
I – Inform provider of bleeding form, which binds to the ulcer base. This creates a protective barrier
N – No smoking, alcohol or NSAIDs to pepsin and bile and inhibits the diffusion of gastric acid (localized
E – Elevate head of bed effect)
Side Effects:
- constipation
Nursing Considerations:
- Monitor the characteristics of the abdominal pain, renal function,
fluid and electrolytes and gastric pH
- Instruct to administer drug on an empty stomach and not within 2h
of any other medicine
 - Tell the client that it usually takes 4 to 8 weeks for optimal ulcer - Advise to be on Bland diet
healing - Encourage to increase oral fluid intake
- Monitor intake and output (C.O.C.A)
GI Antipasmodic/Anticholonergic
Drug Name:
- Hyoscine N-butyl bromide (Buscopan) Antidiarrheal – Opiate Agonist
Action: Drug Name:
- An anticholonergic and antimuscarinic agent used for treatment of - loperamide
irritable bowel syndrome and other functional disturbances of GI Action:
motility. GI anticholinergic work by decreasing motility (smooth - Inhibits gastric motility, thus allowing for more reabsorption of fluid.
muscle tone) in the GI tract Side Effects:
Side Effects: - drowsiness, dizziness, constipation, dry mouth
- Dry mouth, constipation, blurred vision, dizziness, drowsiness, Precaution/Contraindications:
urinary retention, tachycardia, palpitation, confusion - During the history determine the cause of diarrhea
Precaution/Contraindications: - Monitor stools for frequency and consistency
- Glaucoma, ulcerative colitis, obstructive uropathy Myasthenia - Monitor intake and Output and vital signs
gravis, lactation - Evaluate hydration especially in the very young and very old
Nursing Considerations: - Instruct to not exceed recommended dosages; short term (48h) only
- Swallow the Tablet. Do not crush/chew D – Drowsiness, dizziness, dry mouth, dehydration
- Do not double the dose to make up for the missed dose I – inhibits gastric mobility
A – Alcohol id out
Anti-Diarrheal R – Report if there is a narcotic drug history
Drug Name: R – Response if drug determined prior to driving
- Bismuth subsalicylate (Pepto-bismol) H – Habit forming – only take prescribed dose
Action: E – Electrolytes – monitor with severe diarrhea; encourage clear liquids
- An anti-nausea and antiulcer agent that absorbs water and toxins in A – Assess frequency of bowel movements: bowel sounds
the large intestine and forms a protective coating in the intestinal
mucosa. Also possesses antisecretory and antimicrobial effects. Probiotics
Therapeutic Effect: Prevents diarrhea Drug Name:
Side Effects: - Lactobacillus clausii (Erceflora), Saccharomyces boulardii
- Transient/ocassional constipation, discoloration of tongue and stool Action:
(black color), ringing in the ear - Enhancement of the epithelial barrier, increased adhesion to
Precaution/Contraindications: intestinal mucosa, and concomitant inhibition of pathogen
- Salicylate hypersensitivity, children <12yy/o recovering from adhesion, competitive exclusion of pathogenic microorganisms,
chickenpox/influenza, pregnancy and lactation, ulcers production of anti-microorganism substances and modulation of the
Nursing Considerations: immune system
- Advise to avoid self-medication for longer than 48 hours or if ever Side Effects:
develops - Mild and digestive (bloating, gas) in nature
Precaution/Contraindications: - Abdominal cramps, loss of normal bowel function with prolonged
- Anyone with high fever, lactose intolerant, long term use, with use, electrolyte imbalance and dehydration with prolonged use,
prosthetic heart valves (prone to bacteremia) discoloration of urine in senna.
Nursing Considerations:
Antiflatulents - Strong warnings to prolonged use because of dangers of
Drug Name: dependence and loss of normal bowel function
o simethicone o Bisacodyl tabs must not be crushed or taken within 1hafter milk or
Action: antacids due to gastric irritation
o Is a silicone compound that functions as a non-systemic surfactant,
decreasing the surface tension of gas bubbles in the GI tract. Stool Softener/Surfactant
o This action results in coalescence and dispersion of the gas bubbles Drug Name:
allowing their removal from the GI tract as flatulence or belching - docusate
Action:
Laxative: - soften stool materials by absorbing water and lipids
Bulk Forming Uses:
Drug Name: - post-op patients, MI patients
- Calcium polycarbophil, psyllium mucilloid Side Effects:
Action: - abdominal cramps, diarrhea
- Works by absorbing water to form a bulky emollient gel that Precaution/Contraindications:
distends the colon and promotes peristalsis - avoid stool softeners containing stimulant laxatives
Uses: Nursing Considerations:
- Treatment of chronic constipation, diverticulosis - discontinue with adverse effects
Nursing Considerations: - Avoidance of prolonged use
- Basic assessment on abdomen and bowel pattern - Take large amount of fluid to soften stool
- Should be administered orally after powder form has been
completely dissolved into 1 glass of water Osmotic
Drug Name:
Stimulant - Glycerin. Lactulose, polyethylene glycol (PEG), sorbitol
Drug Name: Action:
- Bisacodyl, castor oil, senna - Draws water from the tissue into the feces ad reflexively stimulates
Action: evacuation
- Cathartic in action, producing strong peristaltic activity, and may Uses:
also either intestinal secretions in several ways. - Colonoscopy preparation, purging toxins from the body, treatment
Uses: of encephalopathy
- “bowel prep” prior to bowel procedures, examinations and Side Effects:
surgeries - Abdominal cramping, diarrhea
Side Effects: Nursing Considerations:
 - Caution to prolonged use or avoid by elderly due to potential for Side Effects:
dehydration and electrolyte imbalance - Confusion, anxiety, restlessness, sedation, drowsiness, vertigo,
- Adequate fluid intake headache, diarrhea, dry mouth, blurred vision, extrapyramidal
reactions (involuntary movements) esp. in children and elderly,
Antiemetic: cardiac arrhythmias
Anticholinergic Precaution/Contraindications:
Drug Name: - Pregnancy and lactation, angle-closure glaucoma, hypertension,
- Meclizine Hcl (Bonamine) seizure disorders
Action: Nursing Considerations:
- Central anticholinergic actions that diminish vestibular stimulation - Determine the cause of nausea and vomiting
ad depresses labyrinthine function - Administer only as directed
Uses: - Medications should not be combined with any other CNS
- Treatment of nausea, vomiting and/or vertigo caused by motion depressants, SSRI antidepressants alcohol, or muscle relaxants
sickness, children with motion sickness unless prescribed by the doctor
Side Effects: - Monitor intake and output
- Drowsiness, dry mouth, confusion, urinary retention -
A – Assess bowel sounds
Antidopaminergic N – No alcohol or other CNS depressants
Drug Name: T – Take prophylactically
- Promethazine (Phenergen), metoclopramide I – Interacts with medications
Action: E – Evaluate for changes (hypovolemia, hypotension, dry mouth, oliguria,
- Dopamine-receptor antagonist interferes with the stimulation of dry eyes)
the chemoreceptor trigger zone in the brain, thereby blocking M – Monitor for mental changes
messages to the GI tract
Uses:
- Pre-operative/postoperative treatment of nausea and vomiting
(Phenegan)
Side Effects:
- Tremors, difficulty walking, muscular rigidity (extrapyramidal
effects), induced nausea and vomiting

Serotonin Receptor Antagonist

Drug Name:
- Ondansetron, dolasetron
Action:
- Serotonin receptor antagonist
 Generic Name:
Rizalyn Mae M. Faminial
Musculoskeletal and Anti-inflammatory
Drugs
Muscle Relaxants
Action:
- Affect the central nervous system (spinal cord and brain), with no
direct effects on the skeletal muscle that results in reduced muscle
spasm, causes alterations in the perception of pain, and produce a
sedative effect, promoting rest and relaxation of the affected part.
Uses:
- Acute painful musculoskeletal conditions
Side Effects:
- Drowsiness, dizziness, dry mouth, weakness, tremors, seizures,
headache, confusion, hypotension, GI symptoms, urinary problems,
Nursing Consideration:
hypersensitivity reaction, respiratory depression
Precaution/Contradiction:
- Hypersensitivity to muscle relaxant, pregnancy and lactation, history
of drug abuse, impaired kidney function, liver disorders, blood
dyscrasias, COPD, cardiac disorders, older adult, abrupt
discontinuation, closed-angle glaucoma
Interaction:
- Alcohol, analgesics, psychotropic medications, antihistamines
1. baclofen
Dosage: PO 10mg – 20 mg, 3-4x a day; intrathecal 300-800
mcg
Comments: for spasticity with spinal cord injury or spinal
cord diseases
2. carisoprodol
Dosage: PO 250 mg – 350 mg, 3-4x a day
Comments: Caution with asthma; watch for abuse potential
3. cyclobenzaprine
Dosage: PO 5mg-10mg 3x a day
Comments: Strongly anticholinergic side effects
4. dantrolene
Dosage: PO 25mg-100mg 2-4x a day (titrate to lowest
effective dose)
Comments: for multiple sclerosis and cerebral palsy, not for
trauma or rheumatic disorders
5. methocarbamol
Dosage: 4g-8g PO in divided doses also in IM and IV
Comments: for acute painful, musculoskeletal conditions
6. tizanidine
Dosage: PO 2mg-8mg 1-3x a day (6-8 hours interval)
Comments: for increased muscle tone associated with
spasticity
Ex. Multiple sclerosis or spinal cord trauma
- Take the medication only as long as absolute necessary and
observing caution regarding prolonged use, which could lead to
physical or psychological dependence and withdrawal symptoms.
- Precaution when driving or operating until the side effects subside
- Avoidance of other CNS depressants at the same time (tranquilizers,
antihistamine, alcohol) which can cause serious CNS depression
- Importance of the following physician’s order regarding rest,
physical therapy and exercises as prescribed to strengthen weak
muscles
 - RICE (rest, ice, compression, elastic bandage) represents initial care Uses:
for musculoskeletal injuries - Postoperative pain, menstrual pain, myalgia/neuralgia,
headache/backache, pyrexia (fever), osteoarthritis, rheumatoid
arthritis, anti-platelet
Muscle Relaxant:
Neuromuscular Blocking Agents Functions of Prostaglandins
Drug Name: o Directly cause pain
- Succinylcholine, rocuronium (Zemuron) o Enhances pain including effects of Bradykinin
- Used during surgical, endoscopic or orthopedic procedures. o Induces fever
These drugs are potentially very dangerous and can result in Functions of Thromboxane
respiratory arrest because of potential to paralyze the o cause platelets to aggregate
major muscle of ventilation, the diaphragm. o causes vasoconstriction
- Only administered by anesthesiologists in intubation, o enhances function of inflammatory cells
medically induced paralysis, and resuscitation Functions of Histamines
- Patients can still feel pain o causes tissue congestion and swelling
o causes bronchoconstriction
Anti-inflammatory Drugs o causes sneezing, watery eyes, itching
- Are used to treat disorders in which the musculoskeletal system is o causes pressure and pain
of functioning properly because of inflammation. Functions of Leukotrienes
Condition: o Increases vessel permeability and keajiness
- Arthritis, bursitis, spondylitis, gout and muscle strains and o Stimulates platelet aggregation
sprains, can cause swelling, redness, heat, pain and limited
muscle and joint mobility. Pain and fever during inflammation pain: PG sensitize nerve terminal to
Treatment: release bradykinin, PG, histamine and other local mediators released which
- Corticosteroids and NSAIDS. cause inflammation and pain

Anti-inflammatory: Fever: pyrogenic, cytokines (WBC) and chemical mediators are activated
Non-Steroidal Anti-inflammatory Drug (NSAID) during inflammation, infection and diseases condition which stimulate PG
o are drugs that reduce inflammation, pain and fever by inhibiting the synthesis in hypothalamus and temperature set up point is raised
synthesis of prostaglandins and related compounds
o NSAID inhibits COX (cyclooxygenase) 1 or 2 or both enzymes Analgesic, Anti-pyretic and Anti-inflammatory Action: NSAID is due to
NSAIDS have three major actions: inhibition of inflammatory mediators, prostaglandins, histamines,
 Analgesic thromboxane and leukotrienes
 Antipyretic
 Anti-inflammatory
COX-2 Inhibitor - Anti-hypertensive
Drug: - Methotrexate (potentiates and increases the risk of methotrexate
- Celecoxib toxicity)
- Selectively inhibiting COX2 prostaglandins synthesis, therefore
does not inhibit platelet aggregation (clotting) or inhibit the Nonselective (traditional) NSAIDs
production of mucosal-protective prostaglandins. Consequently, - Diclofenac
does not pose the bleeding risks of the other NSAIDs described - Ibuprofen
previously - Indomethacin
- Selective COX-2 inhibitor shuts down only the “good - Ketorolac
prostaglandin”, raising the risk for hypertension, atherosclerosis - Naproxen
and clotting - Oxaprozin
Side Effects pf NSAIDs: Partially Selective NSAIDs
- GI ulceration and bleeding - Etodolac
- Epigastric pain, nausea, heartburn, and GERD - Meloxicam
- MI, thromboembolism, stroke, hypertension, HF - Nabumetone
- Fluid retention and edema Selective COX-2 inhibitor
- Constipation - Celecoxib
- Tinnitus and hearing loss Nursing Consideration
- Headache or dizziness - Administer the medication with food to reduce gastric irritation
- Visual disturbance - Caution with dosage
- Hematuria and albuminuria - Discontinue drug and reporting to physician any sign of abnormal
- Rash, hypersensitivity reaction (esp with aspirin) bleeding (gums, stool, urine, bruising), epigastric pain, ringing in the
- Blood dyscrasias, anemia, liver toxicity ear, rash, edema
Precaution/Contraindication: - Avoid taking any other drugs without checking first with the doctor
- Asthma - The danger of GI ulceration without previous warning signs and
- Cardiovascular disorders symptoms
- Kidney disease, Liver dysfunction - Discontinue NSAIDs (esp aspirin) before elective surgery or dental
- History of GI ulcer procedures to reduce risk of bleeding
- Blood dyscrasia, GERD - Checck allergy history of patients first-not taking Celebrex if patient
- Pregnancy and lactation has history of allergy to Sulfonamides
- Children with viral infections (danger of Reye’s syndrome with
salicylates)
- Hypersensitivity to aspirin and NSAID
Interaction:
- Alcohol (potentiates the possibility of GI bleeding)
- Anticoagulants (potentiate the possibility of bleeding)
- Aspirin (increase adverse GI effects and diminishes the risk reducing
effects of COX-2 inhibits in the GI tract)

Rizalyn Mae M. Faminial
Autonomic Drugs
Compare and contrast the Central and Autonomic Nervous System
- CNS (central nervous system) and ANS (autonomic nervous system)
are two divisions of the nervous system. Generally, they are
responsible for regulating the functions of the body by responding
to both internal and external stimuli. The main function of CNS is to
receive sensory output from the PNS, process and send necessary
information to the various parts of the body through the PNS while
the main function of the ANS is to control involuntary functions of
the body including the heart rate, digestion, respiratory
rate, pupillary response, urination, and sexual arousal.
Autonomic Nervous System
Adrenergic receptors:
Alpha1
Action: promotes smooth muscle contraction, vasoconstriction, and sweat
secretion
Function: Associated with vascular smooth muscle are a large number of
alpha1 receptors relative to beta2 receptors. Activation of these receptors
by sympathetic nervous system transmission or drugs will result in
vasoconstriction and an increase in peripheral resistance and systemic
arterial blood pressure.
Alpha2
Action: increases the blood’s clotting tendency, decreases the release of
insulin, and decreases vascular resistance in the peripheries.
Function: Alpha2 receptors also exist presynaptically associated with nerve
terminals. Activation of these receptors inhibits the release of
norepinephrine. Norepinephrine acts at presynaptic alpha2 receptors to
inhibit its own release.
Beta1
Action: increases contractility, cardiac output, renin secretion, and heart
rate
Function: Activation of the beta1 receptor leads to increases in contractile
force and heart rate. Drugs that activate the beta1 receptor can be used in
heart failure to improve the contractile state of the failing heart. Drugs that
activate the beta1 receptor also increase heart rate. Indeed, excess
stimulation the beta1 receptor can induce significant increases in heart rate
and arrhythmias. Arrhythmias are a major concern with drugs such as
epinephrine that can be absorbed systemically after intra-oral injection.
Beta2
Action: promotes arterial dilation, smooth muscle relaxation, skeletal
muscle anabolism, and insulin secretion
Function: Activation of the beta2 receptor leads to vascular and nonvascular
smooth muscle relaxation. Drugs that activate the beta2 receptor can be
used to treat as asthma (by relaxing airway smooth muscle) and premature
labor (by relaxing uterine smooth muscle).
Four categories of autonomic nervous system drugs: - Seeking immediate medical attention after injection because the
Adrenergics effects of this medication are rapid but not long-lasting
Actions: - Recognizing situations where a second dose is needed such as a
- Cardiac stimulation patient not responding or not receiving the full initial dose because
- Increased blood flow to skeletal muscles of user error (rushed or panicked situation)
- Peripheral vasoconstriction
- Bronchodilation Adrenergic blockers
- Dilation of the pupils (mydriatic action) Actions:
Uses: - Block the action of the sympathetic nervous system
- Restoring rhythm Uses:
- Elevating blood pressure in shock - Hypertension
- Constricting capillaries - Cardiac arrhythmias
- Dilating bronchioles in acute asthmatic attacks, bronchospasm, or - Angina pectoris
anaphylactic reaction - Migraine headache
- Ophthalmic procedures - Tremor
Side Effects: Side Effects:
- Palpations - Hypotension
- Nervousness or tremor - Bradycardia
- Tachycardia - Fatigue or lethargy
- Cardiac arrhythmias - Bronchospasm
- Anginal pain - Nausea and vomiting
- Hypertension - Hypoglycemia
- Hyperglycemia Contraindication:
Contraindication: - Digoxin (frequently used together; monitor for bradycardia)
- Agina - Insulin or oral antidiabetic agents
- Coronary insufficiency - Theophylline
- Hypertension - MAOIs and tricyclic antidepressants
- Cardiac arrhythmias - Epinephrine
- Angle-closure glaucoma - Phenothiazine
- Organic brain syndrome Nursing Consideration:
- Hyperthyroidism - Rising slowly from the reclining position to avoid postural
Nursing Consideration: hypotension
- Keeping the product near you at all times - Reporting possible slow heartbeat and dizziness, difficulty
- Learning in advance how to properly inject this medication in the breathing, or excessive weakness to the physician
thigh area only (epinephrine training injectors are available) - If you have diabetes, checking with your health care professional
- Teaching a family member or caregiver what to do if you cannot before changing diet or the dose of your diabetic medication
inject the medication yourself - Avoiding alcohol, antihistamines, muscle relaxants, tranquilizers,
and sedatives because they potentiate CNS depression and sedation
 - Reporting sexual dysfunction or depression to the physician for
possible dosage regulation of change to different medication
- Not discounting the medication abruptly, expect on advice of the
physician
- Consulting a physician or pharmacist before using over-the-counter
cold preparations
Nursing Consideration:
- Reporting immediately to physician or an emergency room any
symptoms of prolonged GI distress, excessive perspiration, slow
heartbeat, or depressed respiration
- Avoiding combination of cholinergic medications with heart
medications or cholinergic blockers

Cholinergic Cholinergic blockers

Actions: Actions:
- Increased gastrointestinal peristalsis - Block the action of the parasympathetic nervous system
- Increased contraction of the urinary bladder Uses:
- Increased secretions - Antispasmodic and anti-secretory for GI or GU hypermortilty
- Increased skeletal muscle strength - Preoperative and preanesthetic uses
- Lowered intraocular pressure - Antidote for insecticide poisoning, cholinergic crisis, or mushroom
- Constriction of the pupils poisoning
- Slowing of the heart - Emergency treatment of bradycardia and atrioventricular heart
Uses: block with hypotension
- Non-obstructive urinary retention (bethanecol) - Dilation of the pupils (mydriatic)
- Neuromuscular blockade reversal (neostigmine) - Prevention and treatment of bronchospasm
- Myasthenia gravis (pyridostigmine) - Hydrofluroalkaline HFA inhaler
- Xerostomia (dry mouth) Side Effects:
- Open-angle glaucoma (pilocarpine) - Fever or flushing
Side Effects: - Blurred vision and headache
- Nausea, vomiting and diarrhea - Dry mouth, constipation, and urinary retention
- Muscle cramps and weakness - Falls, delirium, and cognitive impairment, especially in older adults
- Slowing of the heart and hypotension - Palpations and tachycardia
- Sweating, excessive salivation, lacrimation and flushing Contraindication:
- Respiratory depression and bronchospasm - Asthma and other COPD – atropine type inhalations of aerosols are
Contraindication: recommended rather than oral or parenteral administration, which
- Benign prostatic hyperplasia (BPH) can reduce and dry bronchial secretions and obstruct air flow.
- GI disorders (ulcer and obstruction) - Angle-closure glaucoma
- Asthma - GI an GU obstruction
- Cardiac disorder - Cardiac arrhythmias
- Hyperthyroidism - Hypertension
- Hypothyroidism and hepatic or renal disease
Nursing Consideration: - Corn hypersensitivity and sulfite hypersensitivity
- Dried secretions
- Possible blurring of vision Epinephrine
- Reporting fast heartbeat of palpations, feeling faint or falls, or Action:
trouble passing urine - Secreted by the adrenal glands increasing vascular smooth muscle
- Avoiding oral anticholinergics with chronic obstructive lung disease contraction, pupillary dilator muscle contraction, increasing blood
and asthma and using inhalants only as prescribed, never OTC pressure
Use:
Most common drugs: - Response to strong sympathetic stimulations, for bronchospasm,
Dopamine asthma, cardiac arrest
Action: Effects:
- Procedures positive chronotropic and inotropic effects on the - Increased BP, increased heart rate, dilation of the pupils
myocardium that leads to increased heart rate and cardiac -
contractility
Use:
- To raise blood pressure
- Cardiotonic
Effects:
- Tachycardia
- Cardiac arrhythmias
- Anginal pain
- Hypertension

Dobutamine
Action:
- is a direct-acting inotropic agent and an adrenergic agonist that
stimulates primarily the beta-1 adrenoceptor, with lesser effect on
beta-2 or alpha receptors.
Use:
- to stimulate your heart muscle and improves blood flow by helping
your heart pump better.
- short-term to treat cardiac decompensation due to weakened heart
muscle.
- after other heart medicines have been tried without success.
Effects:
- Increase in Heart Rate or Blood Pressure
- Ectopic Activity
- Hypersensitivity
 Thyroid Gland
- Located anterior to the trachea, the thyroid gland has 2 lobes that
are connected by a bridge of thyroid issue.
Thyroid Gland Secretes Hormones
1. Thyroxine (T4)
2. Triiodothyronine (T3)
3. Thyracalcitonin
Rizalyn Mae M. Faminial
Parathyroid Glands
- There are 4 parathyroid glands (2pairs) that lie on the dorsal surface
of the thyroid gland.
- The parathyroid gland secretes parathyroid hormone (PTH) which
regulates calcium level in the blood.
Endocrine System Drugs
 The endocrine system consists of ductless glands that secrete Adrenal Glands
hormone into the bloodstream. - The adrenal glands, located at the top of each kidney, consist of 2
 HORMONE is a chemical messenger which have specialized separate sections- the adrenal medulla and the adrenal cortex.
functions in regulating the activities of specific cells or organs as - The adrenal medulla releases catecholamine, epinephrine, and
they travel into the bloodstream to their targets. norepinephrine.
- The adrenal cortex produces 2 major types of hormones the
Pituitary Gland glucocorticoids and the mineralocorticoids.
- is located at the base of the brain. - The adrenal cortex also produces small amounts of androgen,
- also called the “master gland” because it secretes hormones that estrogen, and progestin.
stimulates the release of other hormones.
Anterior Pituitary Hormones are: Pancreas
1. Thyroid stimulating hormone (TSH) - located to the left and behind the stomach, is both an exocrine and
2. Adrenocorticotropic hormone (ACTH) endocrine gland.
3. Gonadotropins - The exocrine section of the pancreas secretes digestive enzymes
a. Luteinizing hormone (LH) into the duodenum.
b. Follicle stimulating hormone (FSH) - The endocrine section has cell clusters called islets of Langerhans.
4. Growth hormone (GH) The alpha islet cells produce glucagon, which breaks in glycogen
5. Prolactin (PL) down to glucose in the liver and the beta cells secrete insulin, which
6. Melanocyte - stimulating hormone regulates glucose metabolism.

Posterior Pituitary Gland

Posterior Pituitary Hormones Are:
1. Oxytocin
2. Antidiuretic Hormone (ADH)
Medication Affecting the Pituitary Gland:
Growth Hormone (GH)
Action:
- determines adult physical size by regulating growth of organs and
tissues, specifically length of long bones.
Use:
- approved only for use in children to treat growth hormone
deficiency or in adequate growth hormone secretion related to
documented lack of growth hormone.
Administration Considerations:
- Only given parenterally (IM or SQ); oral route is inactivated by
digestive enzymes.
- Rotate IM sites and use appropriate needle length.
Contraindications:
- To stimulate growth in children who are short unrelated to growth
hormone deficiency.
- Use cautiously if there is diabetes or family history of same,
hypothyroidism, or concurrent or previous use of thyroid or
hormones in males before puberty.
- Known sensitivity to benzyl alcohol; preferred diluent is sterile
water especially for newborns.
Significant Drug Interactions:
- Adrenocorticotropic hormone (ACTH) or corticosteroids may slow
the action of the growth hormone.
- Thyroid hormone, anabolic steroids, androgens, or estrogens may
hasten closure of epiphyseal plates of long bones.
Side Effects:
- Metabolic: glucose intorelance, ACTH deficiency, or hypothyroidism
- Renal: hypercalciuria during first 2-3 months of treatment; risk of
renal calculi with complaints of flank pain, colic, GI upset, urinary
frequency, chills, fever, and hematuria.
Adverse Effects/ Toxicity:
- Local allergic reaction: pain and edema at injection site
- Systemic allergic reaction: peripheral edema, headache, myalgia,
and weakness
- Excess dosage: diabetes mellitus, atherosclerosis, enlarged organs,
hypertension, and feature related acromegaly.
Nursing Considerations:
- Make sure there is documentation of growth rate for at least 6-12
months prior to irritating treatment.
- Assess client for any adverse effects or toxicities related to drug
administration
- Make sure annual bone age assessments are performed, especially
for clients undergoing thyroid, androgen or estrogen replacement
Client Education:
- Advise parents or caregivers to have regular bone age assessment
done at specific times.
- Tell parents or caregivers that a 3-5-inch growth rate is expected in
the 1st year and less in the 2nd year and SQ fat is diminished during
treatment, but will return later.
- Teach parents or caregivers how to accurately document monthly
height and weight measurements and to report any less than
expected growth to the physician.
- Advise parents or caregivers that treatment is discontinued when
adequate adult height is reached, when epiphyseal plates are fuse,
on what client fails to respond to growth hormone.
Antidiuretic Hormone (Adh)
- pitressin, desmopressin, lypressin (IN)
Action:
- acts on renal tubules to promote reabsorption of water;
vasopressor effect due to constriction of smooth muscle
Use:
- diabetes insipidus
*infusion pump is needed for intravenous or intra-arterial routes
Nursing Considerations:
- Check vital signs (BP and pulse) before giving by the IV and SQ
routes
- Assess client for mental status charges such as disorientation,
lethargy, and behavioral changes related to fluid overload.
- Measure daily I&O to monitor water retention and sodium
depletion; assess edema in extremities
- Weigh daily to monitor water retention
 - For nasal spray make sure nasal mucosa is intact by inspecting prior h) Organ transplant, to prevent rejection
to dose
- IV dose may be given undiluted over one minute Side Effects:
Contraindication: - Delayed wound healing
- client with coronary artery or vascular disease, blood pressure - Inceased susceptibility to infection, Osteoporosis
elevation is caused by vasoconstriction - Cushing’s syndrome such as moon face, acnem hirsutism,
Side Effects: amenorrhea and hyperglycemia
CNS: drowsiness, headache, lethargy - Gastric/esophageal irritation, ulceration and hemorrhage
EENT: nasal congestion and irritation, rhinitis - Fluid retention
GI: abdominal cramps, nausea and heartburn - Weight gain
CV: elevated BP - Hypokalemia
Adverse Effects/Toxicity Precautions/Contraindications:
- IV route may cause anaphylaxis - Long term use
- Overdose may produce symptoms of water intoxication. - hypothyroidism or cirrhosis
Client Education: - hypertension or HF
- Avoid over-the-counter medicines containing epinephrine that can - patients with psychosis or emotional instability
decrease drug’s action - DM
- Avoid alcohol use when taking drug - Glaucoma
- Do not double dose if dose is missed; may take skipped dose up to - Cataract
one hour before the next dose - Hx of gastric/ esophageal irritation
- Children
Adrenal Corticosteroids - Pregnancy and lactation
- cortisome, dexamethasone, methylprednisolone, prednisone Nursing Considerations:
Action: - Monitor VS, Sugar levels, electrolytes
- suppress the body’s response to infection or trauma. Relieve - Follow exact dosage and administration
inflammation, reduce swelling, suppress symptoms in acute - Instruct to be taken with meals
conditions. - Protect patient from infection
Uses: - Side effects to expect when in long term uses
1. Replacement therapy when deficient (Addison’s Disease) - Inform dangers of infection- delayed wound healing, osteoporosis,
2. Anti- inflammatory/ suppressant agent mental disorders
3. Supportive therapy with other medications
a) Allergic reactions Diabetes:
b) Acute flare ups of rheumatic or collagen disorders Type 1 Diabetes
c) Acute flare ups of severe skin conditions - your body is no longer able to produce insulin
d) Acute respiratory orders - usually develops during childhood, but can develop at any age
e) Long term prevention in asthma/COPD - Risk factor: family history
f) Malignancies
g) Cerebral edema
 - Symptoms: bed wetting, blurry vision, frequent urination, increased - Use syringes calibrated for the particular concentration of insulin
appetite and thirst, mood changes and irritability, tiredness and administered. If through IV, use infusion pumps.
weakness, unexplained weight loss. - Always check the expiration date on the vial/flex pens.
- no known prevention methods - Avoid insulin that changes color or becomes clumped or granular in
- Treatment: injections appearance. (gluisine, lispro-clear, NPH- cloudy)
- Dosage may vary with activities, diet, or stress.
Type 2 Diabetes - Chart and rotate injection sites. Upper outer arms, abdomen,
- Your body still produces insulin but it doesn’t make enough of it or buttocks, upper outer thighs
it doesn’t use it efficiently. - store in refrigerator
- can develop at any age but is most common in adult over 45 Biguanides
- Risk factor: overweight and/ or inactive, family history, high blood - Metformin (Glucophage)
pressure Action:
- Symptoms: increased appetite and thirst, dark patches on armpit/ - decrease hepatic glucose production and intestinal absorption of
neck, frequent urination, blurry vision, tiredness and weakness, glucose; increase peripheral insulin uptake and utilization.
unexplained and weight loss Side Effects:
- Prevention: healthy lifestyle - anorexia, abdominal gas or pain, headache, nausea, vomiting,
- Treatment: healthy living, possible insulin support possible metallic taste, hypoglycemia
Interventions:
A. Medications to Treat DM - Monitor CBC, blood & urine for glucose.
Insulin - Monitor renal function prior to therapy and at least annually to
Action: determine normal renal function.
- reduces blood sugar level by increasing glucose transport across Education:
muscle and fat cell. Promotes conversion of glucose to glycogen. - Instruct to take with meals and encourage adequate hydration.
2 Types:
- Biosynthetic- “Human” Sulfonylureas
- Analog- aspart, detemir, glargine, glulisine, lispro - 1ST gen: chlorpropamide, tolbutamide
Use: - 2nd gen: glipizide, glyburide
- Treatment of DM type 1 &2 Glimpiride lipizide is better for grandmother
- *table 23-4 page 448 Action:
Side Effects: - work by increasing insulin production from the pancreas and by
- Hypoglycemia, tremors, tachycardia, irritability, restlessness, improving peripheral insulin activity.
excessive hunger, diaphoresis, depression, rebound hyperglycemia Side Effects:
(somogyi effect) redness, irritation, flushing, urticaria, - nausea, vomiting, diarrhea, rash, pruritus, headache, hypoglycemia
lipodystrophy. Interventions:
- NURSING CONSIDERATIONS: - Monitor VS, BUN, serum creatinine, liver function tests, blood &
- Monitor VS, blood & urine glucose levels. urine glucose.
- Normal blood glucose level: adult- 70-110 mg/dl - Monitor elderly for hypersensitivity.
- Drug may accumulate in clients with renal insufficiency.
Education: Thyroid Hormone
- Instruct client to take with food. Discuss importance of eating meals - Levothyroxine (Synthroid)
on schedule since missing a meal can result in hypoglycemia Action:
- replaces the thyroid hormones in the body by increasing the
A. Medication Affecting the Thyroid Gland metabolic rate, oxygen consumption, and body growth
Anti- Thyroid Toxic Effects:
- Methimazole, propylthiouracil (PTU) - diarrhea, weight loss, tachycardia, palpitations, angina,
Action: nervousness, tremors, irritability, insomnia, menstrual irregularities,
- inhibits the synthesis of thyroid hormones sweating heat intolerance, exopthalmos
Use:
- Grave’s disease or hyperthyroidism, Thyroiditis MORBID MATILDA
Side Effects: T- SH, T3, T4- monitor
- paresthesia, neuritis, drowsiness, vertigo, nausea, vomiting, H- Hypo/hyperthyroidism- monitor
agranulocytosis, skin rash. R- Review how to take a pulse
Precaution/Contraindications: O- Observe clinical improvements in 3-4 days
- prolonged use, patient older than 40 y/o, pregnancy and lactation, I- Increased metabolic rate- action
hepatic disorder D- Do not change brands of drugs
Interventions: Intervention:
- Regular blood tests to monitor TSH, T3, T4 levels and bone marrow - Monitor serum T3, T4 & TSH levels.
depression and bleeding tendencies. - Obtain baseline VS & weight to compare with future assessments.
- Assess for signs and symptoms of thyroid crisis. - Levothyroxide has a NTI- careful in dosage administration.
- Monitor VS Education:
Education: - Advise client that within 3-4 days there should be improvement and
- Instruct to Take the Drug with Meals; Take 3 Equal Doses at 8hour the maximum effect is usually 4-6 weeks.
Intervals Around the Clock; Do Not Abruptly Stop. - Teach to take prescribed dose daily CONSISTENTLY.
- Food Containing Iodine May Be Restricted. - Take on an empty stomach (30-60 mins pre breakfast)
- Advise Client That Signs and Symptoms Should Be Alleviated in 1-3 - Do not discontinue without consulting the medical provider.
Weeks. - Instruct to take pulse and to hold medication if more than 100.
- Importance of reporting symptoms of overdose (palpitations,
Go getter Gertrude nervousness, excessive sweating, unexplained weight loss).
Everything is running EXCEPT my periods.
I need PTU with my BIG thyroid!
Bleeding
Infection
Give with food

Rizalyn Mae M. Faminial
Anti-Infective
- Anti-infective agents are drugs that are designed to act selectively
on foreign organisms that have invaded and infected the body
- Anti-infective range from antibiotics, antifungals, antiprotozoals,
antihelmintics, antivirals and antimycobacterial.
Selection of anti-infective are based on the following factors:
 Site of the infection
- his helps determine the initial empiric anti-infective
regimen
 Status of hepatic and/or renal function
- Lower doses or alternative drugs might be indicted with
impairment.
 Age of the patient
- Some anti-infectives are more toxic to children or older
patients. Lower doses or alternative drugs might be
indicated.
 Pregnancy or lactation
- Some anti-infectives can cross the placenta and can cause
damage to the fetus, like tetracycline or streptomycin.
Others can be carried in the breast milk and can cause
toxicity to the infant.
 Likelihood of organism developing resistance.
- Sometimes a combination of drugs is used to decrease the
chance of organism developing resistance to single drug.
*Organisms build up RESISTANCE to drugs that have used too frequently or
improperly that makes the drug non-effective. Sample organisms that are
resistant to most antibiotics: methicillin resistant Staphylococcus aureus
(MRSA), Vancomycin Resistant enterococci (VRE).
Known allergy to the anti-infective drug.
General Mechanisms of Section of Anti-infective
 Some interfere with the biosynthesis of bacterial cell WALL
 Some inhibit protein synthesis
 Some change the cell membrane permeability
 Some inhibit DNA synthesis
Spectrum of activity of Anti-infective
 Narrow spectrum anti-infective affect only a few bacterial types.
The early penicillin drugs are examples.
 Broad-spectrum anti-infective affect many bacteria. Meropenem is
an example. Because narrow spectrum antibiotics are selective,
they are more active against those single organisms than the broad
spectrum antibiotics.
 Anti-infective that interfere with o cell to reproduce/replicate
without killing them are called BACTERIOSTATIC drugs. Tetracycline
is an example.
 Antibiotics that can aggressively because bacterial death are called
BACTERICIDAL. These properties (-cidal and –static) can also depend
on the antibiotic concentration in the blood.
Common Adverse Reactions to Anti-infective Therapy
The most common adverse effects are due to the direct action of the drugs
in the following organ system- Neuro, nephro and GI system
1. Nephrotoxicity
- Antibiotics that are metabolized and excreted in the kidney most
frequently cause kidney damage.
2. Gastro-intestinal toxicity
- Direct toxic effect to the cells of the GI tract can cause nausea,
vomiting, stomach pain and diarrhea. Some drugs are toxic to liver
cells and can cause hepatitis or liver failure.
3. CNS toxicity Penicillin
- When drugs can pass through the brain barrier and accumulate in - Penicillin is a beta-lactam drug, with a beta-lactam ring. The group
the nervous tissues, they can interfere with neuronal function. of penicillin’s is called beta lactam antibiotics.
4. Hypersensitivity
- Most protein antibiotics can induce the body’s immune system to Pharmacodynamics:
produce allergic responses. Drugs are considered foreign substances  The penicillin and penicillinase
and when taken by the individual, it encounters the body’s immune - resistant penicillins produce BACTERICIDAL effects by
cells. interfering with the ability of susceptible bacteria from
5. Superinfections biosynthesizing the framework of the cell wall.
- Opportunistic infections that develop during the course of antibiotic  The bacterium will have weakened cell wall, will swell and then
therapy are called SUPERINFECTIONS. burst from the osmotic pressure within the cell.
Therapeutic Indications
The Penicillins  The penicillin is indicated for the treatment of streptococcal
Narrow spectrum penicillins infections.
 Penicillin G Adverse Effects
 Penicillin V  GI system effects
Broad Spectrum Penicillins (aminopenicillin) - the major adverse effects of penicillin therapy involve the
 Amoxicillin GIT. Nausea, vomiting, diarrhea, abdominal pain, glossitis,
 Ampicillin stomatitis, gastritis, sore mouth and furry tongue.
 Bacampicillin  The reason for some of these effects (superinfection) is associated
Penicillinase-resistant Penicillin (anti-staphyloccocal penicillins) with the loss of bacterial flora.
 Cloxacillin  Hypersensitivity reactions
 Nafcillin - rashes, pruritus, fever. These indicate mild allergic reaction.
 Methicillin Wheezing and diarrhea may also occur. Anaphylaxis can
 Dicloxacillin also happen leading to shock or death. It occurs in 5-10% of
 Oxacillin those receiving penicillin.
Extended-Spectrum penicillins (Anti-pseudomonal penicillins)  Pain and inflammation on injection sites
 Carbenicillin Nursing consideration
 Mezlocillin  Obtain culture and sensitivity testing results to check if penicillin is
 Piperacillin the drug of choice
 Ticacillin  Monitor the renal status and function regularly
Beta-lactamase inhibitors  Administer the correct dosage and stress the importance of
 Clavulanic acid completing the full course and duration of therapy even though the
 Sulbactam patient experiences relief earlier in the treatment
 Tazobactam  Monitor the site of injection and the signs and symptoms related to
the drug administration
  Provide small frequent meals, frequent mouth care, ice chips or - Cefoxitin
sugarless candy to suck if stomatitis and sore mouth occurs. - Cefmetazole
 Provide patient teaching. Tell the patient to drink a lot of fluids and - Ceefprozil
eat nutritious foods. Advise to report difficulty of breathing, severe - Cefuroxime
diarrhea, dizziness, weakness and vaginal itching. Third Generation
 Monitor patient response to therapy - Cefridir
 Monitor for adverse effects and evaluate the effectiveness of health - Cefixime
teaching - Cefoperazone
 Monitor the effectiveness of comfort and safety measures - Cefotazime
- Cefpodoxime
The Cephalosporins - Ceftazidime
 First Generation cephalosporins - Ceftibuten
- are largely effective against the same gram-positive - Moxalactam
organisms affected by penicillin. Fourth Generation
 Second generation cephalosporins - Cefepime
- are effective against those strains as well as Haemophilus Pharmacodynamics
influenza, Enterobacter aerogenes and Nesseria sp. These - The cephalosporin is primarily BACTERICIDAL. They interfere with
drugs are less effective against gram positive bacteria the cell-wall building ability of bacteria when they divide. They
 Third Generation cephlosporins prevent the bacteria from biosynthesizing the framework of their
- are relatively weak against gram-positive bacteria but more cell wall. The weakened cell wall will swell and burst causing cell
potent against gram-negative bacteria, to include Serratia death.
marcescens. Pharmacokinetics
 Fourth generation cephalosporins - Only a few cephalosporin is administered orally, most are
- are developed to fight against the resistant gram-negative administered parenterally. Their half-lives are short and they are
bacteria. The first drug is cefepime. excreted mainly in the urine.
First Generation Contraindications and Precautions
- Cefadroxil - The drugs are contraindicated in patients with known allergies to
- Cefazolin cephalosporin and penicillin.
- Cephalexin Adverse Effects
- Cephalotin  GI system
- Cephapirin - Nausea, vomiting, diarrhea, anorexia, abdominal pain and
- Cephadrine flatulence are common effects.
Second Generation  CNS
- Cefaclor - headache, dizziness, lethargy and paresthesia have been
- Cefamandole reported.
- Cefonizind  Renal system
- Cefatetan - nephrotoxicity in individuals with pre-existing renal disease
Drug-Drug interactions  Take medication with food if gastric irritation occurs.
 Aminoglycosides  Monitor patient response to the drug regimen
- if given with cephalosporins may increase the risk of kidney  Monitor for adverse effects and evaluate the effectiveness of
toxicity comfort and safety measures
 Anti-coagulants
- may experience increased bleeding tendencies The Aminoglycosides
 Alcohol  gentamycin
- many patients experience a disulfiram-like reactions when taken  tobramycin
with some specific cephalosporins ( cefamandole, cefoperazone  amikacin
or moxalactam). The patient may experience flushing, headache,  netilmicin
nausea, vomiting and muscular cramps. This may occur even up  kanamycin
to 72 hours of cephalosporin discontinuance. Pharmacodynamics
Nursing consideration  These are BACTERICIDAL. They inhibit protein synthesis in
 Patient History susceptible strains of gram-negative bacteria, leading to loss of
- The ensure must assess for cephalosporin and penicillin functional integrity of the bacterial cell membrane, which causes
allergies. Pregnancy, lactation and kidney status must also cell death.
be ascertained Therapeutic Use
 Physical Examination  These drugs are used to treat serious infections caused by gram-
- baseline data for evaluation. Renal function should be NEGATIVE bacteria.
checked by obtaining BUN and Creatinine levels, urine Contraindications and Precautions
output monitoring and temperature monitoring.  These drugs are contraindicated in known allergies to
 Check the culture and sensitivity results to determine if aminoglycosides, in patients with renal failure, hepatic disease,
cephalosporin is the drug of choice pre-existing hearing loss, myasthenia gravis, Parkinson’s,
 Monitor renal function test prior to and periodically during therapy pregnancy and lactation.
 Ensure that the patient receives the full course of cephalosporin as Adverse Effects of Aminoglycosides
prescribed for the duration specified. Advise the patient to consume  CNS
all the drugs even though signs/symptoms may resolve earlier in the - irreversible deafness, vestibular paralysis, confusion,
course. depression, disorientation, numbness, tingling and
 Provide small frequent meals as tolerated, mouth care, ice chips if weakness related to drug effects.
stomatitis occurs.  Kidney
 Provide safety measures including safety side-rails, adequate - renal toxicity, which may progress to renal failure caused by
lighting and assistance with ambulation. the direct toxicity of the aminoglycosides.
 Provide heath teaching and advise the patient to take safety  Hema
precaution in changing positions carefully, avoid driving and - bone marrow depression resulting from direct drug effect
hazardous tasks, drink fluids liberally, report severe reactions to the may lead to immune suppression and superinfection.
drug and AVOID alcoholic beverages for 72 hours after completing
the drug.
  GI system
- nausea, vomiting, diarrhea, weight loss, stomatitis and
hepatic toxicity. The effects are due to the direct GI
irritation, loss of bacterial flora and toxicity to mucus
membrane and liver as the drugs are metabolized.
 Skin effects
- photosensitivity, purpura, rash, urticaria and exfoliative
dermatitis
 Cardiac
- palpitations, hypotension or hypertension
Drug to drug interactions
 Diuretics
- increased incidence of ototoxicity, nephrotoxicity and
neurotoxicity.
 Anesthetics and neuromuscular blockers- increased neuromuscular
blockage and paralysis may be possible
o Penicillin- synergistic action
Nursing consideration
 Patient History
- the nurse assesses the allergy to aminoglycosides, history of
renal and hepatic disease, parkinsonism, myasthenia gravis,
existing hearing loss, active herpes infection, current
pregnancy and lactation.
 Physical examination
- baseline data should be obtained. Auditory and CNS
assessment must be done prior to therapy. Culture and
sensitivity specimen must be sent to laboratory. Renal and
hepatic function tests should be checked.
 Check the culture and sensitivity results to determine if
aminoglycosides are the drug of choice.
 Monitor the course of therapy. Ensure that the patient receives the
correct dose and duration of treatment.
 Monitor the patient regularly for signs of nephrotoxicity,
neurotoxicity, ototoxicity and bone marrow depression to
effectively arrange for discontinuation of drug or decreased dosage
as appropriate
 Provide safety measures to protect the patient if CNS effects occur.
 Provide small, frequent meals as tolerated, frequent mouth care
and ice chips or sugarless and to provide relief and maintain
nutrition
 Ensure that patient is hydrated at all times during the drug therapy
to minimize renal toxicity
 Provide teaching to the patient to take safety precaution such as
changing position slowly and avoiding driving/hazardous tasks,
drink liberal amounts of fluids, avoid exposure to other infections,
and to report severe reactions.
 Monitor patient response to the drug, adverse effects and
effectiveness of comfort measures
 Evaluate the effectiveness of teaching and compliance to regimen.
The Macrolides
 Azithromycin
 Clarithromycin
 Dirithromycin
 Erythromycin
Pharmacodynamics
 The macrolides are primarily BACTERICIDAL and sometimes
bacteriostatic. They exert their effect by binding to the bacterial cell
ribosomes and changing or altering protein production/function.
This will lead to impaired cell metabolism and division.
Pharmacokinetics
 Erythromycin is destroyed by the gastric juice, which is why slats are
added to stabilize the drug. Food does not interfere with the
absorption of the macrolides.
Therapeutic Use of Macrolides
 These are indicated for the treatment of the following conditions:
Streptococcal infection, Mycoplasma infection, Listeria infection and
group A beta hemolytic strep infection.
Contraindications and Precautions in the Use of Macrolides
 These agents are contraindicated in the presence of known allergy
to any macrolide, because cross-sensitivity occurs. Caution should
be used in patients with hepatic dysfunction that could alter the
metabolism of the drug; in lactating women because of drug
 excretion in breast milk and in pregnant women because potential  Provide small, frequent meals as tolerated, provide mouth care and
adverse effects on the developing fetus. ice chips
Adverse Effects of Macrolides  Provide safety measures to protect patient if CNS effects occur
 GI system  Provide health teaching and emphasize that the patient should take
- abdominal cramping, anorexia, diarrhea, vomiting and safety precautions including changing position slowly, drinking
pseudomembranous colitis. HEPATOTOXICITY can occur if liberal amounts of fluids, and reporting severe reactions.
the drug is taken in high doses with other hepatotoxic  Monitor patient response to the drug and adverse effects
drugs.  Evaluate the effectiveness of comfort and safety measures and the
 CNS effectiveness of health teaching
- confusion, abnormal thinking and uncontrollable emotions.
 Hypersensitivity reactions The Lincosamides
 Clindamycin
Drug-Drug Interactions  lincomycin
 Digoxin These agents are similar to the Macrolides but are more toxic. They are
- increased level of dioxin can occur bactericidal and bacteriostatic depending on the dose.
 Anticoagulants, theophyllines and corticosteroids Pharmacodynamics
- increased effects of these drugs due to impaired hepatic  These agents penetrate the cell membrane and bind to the
metabolism ribosome in the bacterial cytoplasm to prevent the protein
 Astemizole production
- when used with macrolides, will cause fatal cardiac Side effects and Adverse Reactions
arrhythmias  GIT
 Clindamycin or lincomycin - GI irritation, nausea, vomiting and stomatitis
- should not be given with erythromycin because they  Allergic reactions
compete for receptor sites. Drug Interactions
Nursing Consideration  Lincomycin and clindamycin are incompatible with aminophylline,
 Patient History phenytoin, barbiturates and ampicillin.
- the nurse should obtain history of allergy, current
pregnancy or lactation before administering the drug The Tetracyclines
 Physical Examination Short-acting tetracyclines
- Assess baseline data and perform C/S before instituting  tetracycline
therapy. The nurse then obtains information about the  oxytetracycline
status of the liver and kidney, skin and GI system. Intermediate acting tetracyclines
 Check culture and sensitivity results to ensure that macrolides are  demeclocycline
the drug of choice  methacycline
 Monitor hepatic function test prior to therapy Long acting tetracyclines
 Ensure that patients receive the full course of therapy  doxycycline
 Monitor signs and symptoms of adverse reactions  Minocycline
These agents were first isolated from Streptomyces aureofaciens  Digoxin
Pharmacodynamics - digoxin toxicity rises when tetracyclines are used together
 The tetracyclines inhibit protein synthesis in susceptible bacteria Drug-Food Interaction
leading to the inability of the bacteria to multiply.  Dairy products
Therapeutic indications - can complex with tetracycline and render unabsorbable.
 Tetracyclines are effective against a wide range of bacteria. They are Tetracyclines should then be given on an EMPTY stomach 1
primarily BACTERIOSTATIC. hour before meals or 2-3 hours after any meal or other
Contraindications and Precautions medications.
 These agents are contraindicated in the presence of known allergy Adverse Effects of the Tetracycline
to tetracyclines and the tartrazine dye. It is not recommended for  GI system
use in pregnancy and lactation because the drug can affect the - nausea, vomiting, diarrhea, abdominal pain, glossitis and
bones and teeth, causing permanent discoloration and sometimes dysphagia. Fatal hepatotoxicity related to tetracycline’s
arrest of growth. Tetracyclines are also avoided in children less than irritating effect on the liver cells has been reported.
8 (eight) years of age because of the potential damage to the bones  Musculoskeletal-
and permanent discoloration of the teeth. - Tetracyclines have an affinity for teeth and bones; they
Adverse Effects of the Tetracycline accumulate there, leading to weakening of the bone/teeth
 GI system and permanent staining and pitting.
- nausea, vomiting, diarrhea, abdominal pain, glossitis and  Skin
dysphagia. Fatal hepatotoxicity related to tetracycline’s - photosensitivity and rash are expected.
irritating effect on the liver cells has been reported.  Less frequent
 Musculoskeletal - bone marrow depression, hypersensitivity, super infections,
- Tetracyclines have an affinity for teeth and bones; they pain and hypertension
accumulate there, leading to weakening of the bone/teeth Drug-Drug Interactions
and permanent staining and pitting.  Penicillin
 Skin - if taken with tetracyclines, will decrease the effectiveness of
- photosensitivity and rash are expected. penicillin.
 Less frequent  Oral contraceptives
- bone marrow depression, hypersensitivity, super infections, - if taken with tetracycline, will have decreased effectiveness.
pain and hypertension Nurse must advise alternative methods of contraception
Drug-Drug Interactions  Digoxin
 Penicillin - digoxin toxicity rises when tetracyclines are used together
- if taken with tetracyclines, will decrease the effectiveness of Drug-Food Interaction
penicillin.  Dairy products
 Oral contraceptives - can complex with tetracycline and render unabsorbable.
- if taken with tetracycline, will have decreased effectiveness. Tetracyclines should then be given on an EMPTY stomach 1
Nurse must advise alternative methods of contraception hour before meals or 2-3 hours after any meal or other
medications.
Nursing Consideration
 Patient History
- The nurse screens the patient for allergy to tetracyclines
and tartrazine. She should elicit history of renal and liver
diseases, pregnancy, lactation, and AGE. Tetracyclines have
adverse effects on the bones and teeth.
 Physical Examination
- this should be performed to establish baseline data for
monitoring. Culture and sensitivity tests should be done and
evaluation of kidney and liver status should be done.
 Check the culture and sensitivity results to ensure that tetracyclines
are the drug of choice
 Monitor renal and liver status/function tests periodically
 Emphasize the need to complete the recommended duration of
therapy
 Provide small frequent meals if tolerated only
 Protect the patient from exposure to the sun with adequate
clothing and sunscreen
 Instruct the patient to take the meds without food, with full glass of
water, adequate fluid intake, avoidance of exposure to other
infections and to report severe drug reactions
 Provide information of alternative contraceptive methods during
the course of therapy
 Monitor response to tetracycline and adverse effects
 Monitor Intake and Output
 Evaluate the effectiveness of teaching a comfort
The Fluoroquinolones
 nalidixic acid
 ciprofloxacin
 oxacillin
 norfloxacin
 levofloxacin
 sparfloxacin
The fluoroquinolones are broad-spectrum antibiotics. They are usually
manufactured synthetically and are associated with mild adverse reactions.
Pharmacodynamics
 These agents enter the bacterial cell by diffusion through cell
channel. Once inside they interfere with the action of DNA enzymes
(DNA gyrase) necessary for the growth and reproduction of the
bacteria. This will lead to cell death.
Therapeutic Use
 These agents are indicated for the treatment of infections caused by
susceptible strains of gram-negative bacteria including E. coli.,
Proteus, pseudomonas, Strep and Staph spp.
Contraindications and Precautions
 Known drug allergy to these agents contraindicate their use.
Pregnancy and lactation are also contraindications. These agents
are found to cause significant damage to the cartilages such that
they are given cautiously to growing children and adolescents less
than 18 years of age.
 Adverse Effects of the Fluoroquinolones
 CNS
- dizziness, insomnia, headache, and depression related to
possible effects on the CNS membrane.
 GI system
- nausea, vomiting, diarrhea and dry mouth related to the
direct effect on the GIT
 Hema
- bone marrow depression related to the direct effect of the
drug on the cells of the bone marrow that rapidly turn over.
 Other effects
- skin reactions, rash, fever and photosensitivity
Drug-Drug Interaction
 Iron salts, Sucralfate, mineral supplements and antacids
- all of these will decrease the effectiveness of the
fluoroquinolones
 Quinidine, Procainamide, terfenadine, henothiazines
- can prolong the QT interval and when used with the
fluoroquinolones
The Sulfonamides
 Sulfazalazine
 Sulfamethoxazole
 Sulfadiazine
 Sulfixoxazole
These are called sulfa drugs that inhibit folic acid synthesis. Folic acid is
necessary for the synthesis amiof purine and pyrimidine precursors of DNA
and RNA. Humans cannot produce folic acid and must obtain it form the
diet. While bacteria need to manufacture their own folic acid inside their
cell structure.
PharmacodynamicsThe sulfa drugs competitively block the para-amino
benzoic acid to prevent the synthesis of folic acid in susceptible bacteria
that synthesize their own folates for the production of RNA and DNA.
Therapeutic indications
 The spectrum of activity includes the following bacteria- Chlamydia,
Nocardia, Haemophilus, E, coli and Proteus. Sulfa drugs are used to
treat trachoma and brain abscess.
Contraindications and precautions
 These agents are contraindicated to patients with known allergy to
sulfa drugs, sulfonylureas and thiazide diuretics because they share
similar structures. It is not recommended for use in pregnancy
because it can cross the placenta and cause birth defects and
kernicterus. Lactating women who take these drugs will excrete
them in the breast milk potentially causing kernicterus, diarrhea and
rash in the newborn.
Adverse Effects of the Sulfonamides
 GI system- nausea, vomiting, diarrhea, abdominal pain, anorexia,
stomatitis and hepatic injury, which are all related to the direct
irritation of the GIT and death of normal flora.
 Renal system- crystalluria, hematuria and proteinuria which can
progress to a nephrotic syndrome.
 CNS- headache, dizziness, vertigo, ataxia, convulsions and
depression related to drug effects on the nerves
 Hema- bone marrow depression related to drug effects on the cells
of the bone marrow that turn over rapidly.
 Dermatologic effects- photosensitivity and rash and hypersensitivity
Drug-Drug Interaction
 Tobultamide, tolazamide, glyburide, glipizide, acetohexamide or
chlorpropamide (all are oral Anti-diabetic agents) can increase the
risk of hypoglycemia if taken with the sulfa drugs
Nursing consideration
 Patient History- The nurse screens for known allergy to
sulfonamides, sulfonylureas and thiazide diuretics because of cross
sensitivity. Elicit history of renal disease and current
pregnancy/lactation
 Physical Examination- PE should be performed to establish baseline
data for assessing the drug effectiveness. Culture and sensitivity
should be performed before instituting therapy. The nurse should
also monitor the renal status. CBC should be performed to establish
a baseline data to monitor for adverse effects.
 The nurse checks the culture and sensitivity results to ensure that
sulfa drugs are the drug of choice
 Monitor renal functions test periodically. Discontinue drug if
hypersensitivity reaction occurs.
 Administer the drug on an EMPTY stomach 1 hour before or 2 hours
after meals with full glass of water to ensure adequate drug
absorption
 Provide mouth care if with stomatitis or mouth problems occur
 Monitor CBC and urinalysis periodically.
 Implement health teaching. Emphasize that the patient should
avoid operating dangerous machinery, drinking liberal amount of
fluids, maintain nutrition and to report severe drug reactions.
 Monitor patient response to the drug. Monitor for adverse effects
 Evaluate effectiveness of the teaching plan and monitor the
effectiveness of safety and comfort measures
Anti-Fungals  Monitor nutrition. Offer small frequent feedings.
 Amphotericin B  Ketoconazole– must be given on an empty stomach.
 Fluconazole
 Ketoconazole
 Nystatin
 Posaconazole
Mechanism of action
 Act by binding to sterols, increasing the permeability of the fungal
cell wall, causing the leakage of cellular components, death of the
cell and failure of the cell to reproduce.
Therapeutic Use
 Fungal infections of the system, skin and mucous membranes.
Precaution and Contraindications
 Hypersensitivity to drug, lactation, and Liver or kidney disease.
Adverse effects
 Headache, visual problems, peripheral neuritis, dizziness, seizures
insomnia, tachycardia, hypertension, photosensitivity, hives,
endocrine dysfunction, transient hearing loss, nausea, vomiting
Drug-Drug Interactions
 Amphotericin B increases toxicity of flucytosine.
 Amphotericin B and furosemide, corticosteroids and cyclosporine-
hematologic and renal adverse effects, hypokalemia
 Ketoconazole and h2 antagonists and PPIs- decreased bioavailability
Nursing consideration
 Patient History
- The nurse screens for known allergy to antifungals.
 Physical Examination
- PE should be performed to establish baseline data for
assessing the drug effectiveness.
 Reiterate importance of compliance to treatment.
 Report when patient experience symptoms such as fever, chills,
abdominal pain and skin rash
 Lactating women should not breastfeed their infants while taking
antifungals
 Anti-fungal given through IV route- infuse medication slowly (2-4
hours) and observe for phlebitis
 Monitor patient’s kidney and liver lab studies
 Digoxin is considered as narrow therapeutic index (NTI)
Therapeutic Level: 0.5-2.0 ng/ml
Antidote: digibind or digitab – overdose
Side Effects:
- Anorexia, vomiting, nausea
- Headache, fatigue, lethargy, muscle weakness
- Vertigo, restlessness, irritability, tremors
Rizalyn Mae M. Faminial - Visual disturbances such as diplopia, halos
- Cardiac arrhythmias
- Electrolyte imbalance esp. Potassium
- Insomnia, confusion, mental disorders
Contraindication:
- Severe pulmonary disease
Cardio Vascular System Drugs - Hypothyroidism
 Include medications that affect the HEART and BLOOD VESSELS - Acute MI, myocarditis, severe HF
categories - Impaired renal function
- Cardiac glycosides - Arrhythmias NOT caused by HF
- Antiarrhythmic Agents - Pregnancy and lactation
- Antihypertensive Drug Interaction:
- Vasodilator - Antacids, cholestyramine, neomycin and rifampin (reduce the
- Antilipemic agents absorption of digoxin)
- Anticoagulant - Diuretics, calcium, corticosteroids (increase arrhythmias)
- Macrolides, anti-arrhythmic (potentiate digoxin toxicity)
Functions of The Heart and Blood Vessels: - Adrenergic (epinephrine) (increased risk for arrhythmias)
- Pumps blood throughput the body via the blood vessels Nursing Management:
(circulatory system) - Careful monitoring of cardiac rate and rhythm with EKG, cardiac
- Supply oxygen and nutrients to the tissues function, side effects and serum digoxin levels.
- Remove carbon dioxide and other wastes - CHECK PULSE! If apical is less than 60, do not administer and refer
to physician.
Classification: Cardiac Glycosides
Digoxin Classification: Anti Arrhythmic Agents
Action: Arrhythmia
- Increase the force of myocardial contractions without increasing - Refers to any change from normal sequence of electrical impulses of
oxygen consumption, thereby increasing cardiac input. the heart.
- Lower norepinephrine levels - It could be too fast (tachycardia), too slow (bradycardia) or erratic
Indication: (fibrillation).
- Heart failure - Most anti-arrhythmic have the potential for hypotension and
- Atrial fibrillation - irregular and often rapid heart rate bradycardia
 - The role of the nurse is to have an accurate and TIMELY reporting of Lidocaine
vital signs, pertinent observations regarding the effectives of - Local anesthetic that has antiarrhythmic effects and membrane
medications and adverse side effects and modification of stabilizing action.
precipitant causes. Indication:
- ventricular arrhythmia
Adenosine Side Effects:
Action: - CNS symptoms, hypotension, bradycardia, dyspnea, respiratory
- it restores normal sinus rhythm in supraventricular tachycardia by arrest
slowing conduction time through the AV node. It also has Precaution/ Contraindication:
vasodilator, antiadrenergic, and negative chronotropic (decrease in - heart block and respiratory depression, pregnancy and lactation
rate) properties, which act to decrease cardiac oxygen demand. children
Side Effects:
- facial flushing, light headedness, headache, dyspnea, chest Procainamide
pressure. Action:
Contraindication: - they act by decreasing myocardial excitability, inhibiting conduction,
- 2nd / 3rd degree heart block or symptomatic bradycardia and may depress contractility, possess anticholinergic properties.
Use:
Amiodarone - alternative (to amiodarone) for ventricular tachycardia: used orally
- Oral and injectable antiarrhythmic agent approved for the primarily as prophylaxis to maintain NR
treatment of refractory life-threatening ventricular arrhythmias. Side Effects:
- Also relaxes both smooth and cardiac muscle, causing decreases in - diarrhea, abnormal pain, N and V, tachycardia, QT prolongation,
coronary and peripheral vascular resistance and systolic blood hypotension, anticholinergic effects- dry mouth, blurred vision,
pressure. urinary retention
- Used for recurrent atrial fibrillation Contraindications:
Side Effects: - HF, AV blocks, digoxin toxicity, electrolyte imbalance
- pulmonary fibrosis, cardiac arrhythmias, hypotension, induction or
worsening of HF, nausea and vomiting, hepatitis, Propafenone
hypo/hyperthyroidism, neurotoxicity, visual disturbances, Use:
dermatological reactions esp. Photosensitivity. - symptomatic/severe supra ventricular arrhythmias and atrial
Precaution/Contraindication: fibrillation conversion to NSR.
- Patients with 2nd / 3rd degree heart block, sinus bradycardia - Has local anesthetic effect, directly stabilizing action on myocardial
- Patient with thyroid disease (because of large amount of iodine) membranes and beta blocking properties.
- Iodine hypersensitivity Side Effects:
- Older adults - dizziness, NV, angina, heart failure, palpitations, arrhythmia, fatigue,
weakness, rash
Contraindication:
- Asthma or acute bronchospasm, marked hypotension and
electrolyte imbalance
Nursing Consideration: o Instruct the client that NTG degrades in heat, light or moisture
1. Careful assessment prior to administration (BP and HR) so the medication should be stored in the original container.
2. Advise to rise slowly from reclining position prevent postural o Nitroglycerine drips are often ordered to control or treat the
hypotension client’s chest pain; the nurse should titrate the medication as
3. Modification of lifestyle advised- regular mild- exercise, low ordered.
cholesterol, low sodium diet o Monitor BP and HR every 15 minutes when using IV form of
4. Not to DC the medicine even if the patient feels well NTG and titrating the medication.
5. Taking the medicine 1 hrs. before or 2 hrs. after meals to increase o Wear gloves when applying NTG paste to the client’s skin
absorption o Rotate the location of NTG paste or patch
Nursing Consideration
Nitrate and Nitrites o Ensure that the client is sitting or lying down when taking NTG
Action: to prevent dizziness or fainting.
- it increases the oxygenated blood flow to the myocardium by o Allow the tablet to dissolved naturally under the tongue; if
dilating the coronary and systemic blood vessels; it commonly mouth is dry instruct the client to take a sip of water before
prescribes to treat angina placing the tablet under the tongue
Preparations of Nitrates o If using NTG paste or patch do not apply it to areas with
All Absorbed excessive hair or scar tissue; appropriate areas are chest,
- Sublingually (under the tongue) abdomen, anterior thigh or upper arm
- Bucally (in the pocket of the cheek) o Remove the patch each day at the designated time before
- Chewable tablets applying additional medication.
- Lingual aerosols (sprayed into or under the tongue) Client Education:
- Via inhalation o Instruct patient that all form of NTG might cause dizziness and
*absorbed almost completely because of the rich blood supply of the headache
mucous membranes of the mouth. o If pain persist after 3 NTG tabs at 5 mins. Interval physician
Half Absorbed should be notified immediately
o Swallowed nitrate capsule- through the mucous membranes of the o Advice to change position slowly to avoid postural hypotension
GI tract, only 1/2 the dose enters circulation. and fall
o Transdermal nitrates (patch or ointment)- absorbed slowly and in o Advice that the patient can swim or bath with an NTG patch in
varying amounts, depending on the quantity if drug applied, the place
location where it is applied, the surface area of skin is used, and the
circulation to the skin. Antihypertensive
Not Absorbed - HYPERTENSION is wide spread epidemic
o IV nitroglycerin- doesn’t need to be absorbed, it goes directly into - it is defined as SBP of > or = to 140mmHg and DPB of > or =
the circulation 90mmHg
Administration Consideration: - There is a strong relationship between BP and cardiovascular
o Instruct client to take no more than 3 NTG tablets. disease, it increases the risk of angina, MI, HF, stroke, peripheral
o Instruct the client that it should produce a slight stinging or arterial disease, kidney disease, thus needs aggressive treatment
tingling sensation when placed under the tongue. - Anti-hypertensive do not cure hypertension; they control it.
Usual Side Effect:
- Hypotension and bradycardia (except for hydralazine: tachycardia)
 Alpha Adrenegic Blocker
o blocks the alpha effects from nervous system of
vasoconstriction therefore causing vasodilation. Example
drug prazosin (Minipress)
 Peripheral Vasodilator
o cause smooth muscle relaxation pf arterioles causing direct
vasodilation; example of drug hydralazine
Side Effects:
- Tachycardia, palpitations, headache and flushing, orthostatic
hypotension, edema and weight gain
Precaution/ Contraindication:
- Systemic lupus erthematosus (SLE), renal disease, CAD and
rheumatic heart disease.
 Calcium Channel Blocker
o blocks calcium ion channels needed for smooth muscle
contraction and therefore causes smooth muscle relaxation
and resulting vasodilation
o example drugs; amlodipine (Norvasc) and verapamil (Calan)
 Beta Adrenergic Blocker
o reduces cardiac output by decreasing heart rate and force
of contraction
o example drugs; carvedilol (Coreg) and metoprolol (
Lopressor)
Beta1 - increases myocardial contractility and heart rate
Beta2 - causes
1. Relaxation of smooth muscles of the lungs resulting in
bronchodilation
2. Increased in blood flow to the skeletal muscles
3. Relaxation of the uterine muscle
 Beta blockers
Non Selective
o have equal affinity to beta 1 and 2, they inhibit both.
Example. Propanol, nadolol, penbutulol, timolol
Selective Beta 1
o exhibits action against beta 1 but DO NOT affect beta 2
receptors of the bronchi.
Example; atenolol, bisoprolol, esmolol, metropolol
Beneficial to patients with bronchospasm
 Ace Inhibitors (ACEi’s)
o Block formation of angiotensin II from causing vasoconstriction,
therefore causing vasodilation; also blocks aldestosterone
secretion thereby causing increased urine output;
o example drugs; linisipril (Prinivil) and enalapril (Vasotec)
 Angiotensin Receptore Blockers (ARB’s)
o prevents angiotensin II from reaching receptors and therefore
causes vasodilation;
o example drugs; losartan (Cozaar) and valsartan (Diovan)
LEARNING HINT!
Beta adrenergic blockers - lol
Ace inhibitors- pril
Angiotensin receptor blocker- sartan
Nursing Intervention for Anti- Hypertensive Drugs
- patient techniques include:
1. Routinely monitor BP at home, keeping a log of thir BP readings
2. Immediate reporting of any adverse effects such as Brady/Tachy
cardia, dizziness, weakness, breathing difficulty, gastric distress,
numbness and swelling of extremities.
3. Reiterate importance of drug compliance
4. Avoid GRAPEFRUIT JUICE while taking Calcium Channel Blockers
which can increase hypotension or any cardiac adverse effects
Classification: Anti-Lipemic Agents Fibric Acid Derivatives (Fibrates)
Statins - Fenofibrate (TriCor) and gemfibrozil (Lopid) is indicated for patients
- artovastatin, simvastatin who have extremely high TG levels and elevated cholesterol levels,
Action: and in patients with combined forms of hyperlipedemia. They
- HMG-CoA reductase inhibitors(statins) inhibit the enzyme for improve GLUCOSE TOLERANCE for diabetic patients.
cholesterol synthesis. It is effective in lowering LDL levels and Side Effects:
modestly effective in reducing TG levels, and increasing HDL levels. - GI complaints
Indication: - Cholelothiasis
- hyperlidemia - Increases risk for pulmonary emboli
Administration Consideration:
- Best given at night time to provide optimal decrease in LDL levels Cholesterol Absorption Inhibitor
- Ezetimibe (Zetia) moderately reduces LDL levels by inhibiting
Side Effects: intestinal absorption of both dietary and biliary cholesterol, blocking
- Myalgia and muscle weakness its transport in the small intestine.
- Rhabdomyolysis Side Effects:
- Elevated liver enzymes - Abdominal pain, back pain and arthralgia
Precaution/ Contraindications: Contraindication:
- Hepatices/ renal disease - Patients with gall bladder disease and moderate-severe hepatice
- pregnancy and lactating insufficiency
- children - Administer ezetimibe at least 1-2 hrs before or 2-4h after
administering antacids a bile sequestrants.
Bile Acid Sequestrants - Avoid use with fibrates (increased risk for cholelithiasis)
- Cholestyramine (Questran), colesvelam(WelChol), which are not
absorbed from the GI tract, bind bile acids in the intestine, Omega- 3 Fatty Acids
interrupting the process by which bile acids are returned to the liver - Include eicosapentaenoic acia (EPA) and docosahexaenoic acid
for reuse. Because bile acids are formed from cholesterol, (DHA) found in fatty clodwater fish, and alpha-linolenic acid found
sequestrants reduce total body cholesterol. This can be used as in flaxseed, tofu, soybean, canola oil and nuts. These substances
monotheraphy when moderate reduction in LDL levels are required may have a role in prevention of heart disease and reduces TGs.
or as an add-on therapy to statins. Side Effects:
Side Effects: - nausea, heartburn, diarrhea
- constipation, gas cramps, heartburn, nausea, anorexia, abdominal Education:
pain, and bloating - Continue low fat, low cholesterol diet
Precaution/Contraindication: - Report side effects to the physician esp. muscle pain, tenderness,
- Biliary cirrhosis and obstruction weakness, dark colored urine or bleeding.
- GI obstruction or fecal impaction - Take statins in the evening (body synthesizes most cholesterol at
night)
- It is important to take liver function test first before therapy
Classification: Anti Thrombotis Agents
Anticoagulants
- prevent the formation of fibrin clot by interfering with one of the
steps leading to fibrin formation.
2 groups: oral (coumarins) and injectables (heparins)

Warfarin (Coumadin)
- alters the synthesis of blood coagulation factors in the liver by
interfering with the action of vitamin K.
Antidote: FFP and Vitamin K
Heparin
- 2 TYPES standard or unfractionated tyoe (UFH) and low-molecular-
weight heparin (LMWH)
- UFH- IV or SQ only
- LMWH- SQ but may be given as IV
Action:
- Acts on thrombin inhibiting the action of fibrin in clot formation.
Antidote: protamine sulfate
Side Effects for Anticoagulants
- major hemorrhage
- thrombocytopenia
- Hematuria or melena
- osteoporosis in long term use
Contraindications for Anticoagulants:
- GI disorders or ulcerations
- Hepatic and renal dysfunction
- Blood dyscrasia
Education:
1. Reiterate importance of compliance
2. That it does not dissolve clot but decrease the clotting ability,
formation of harmful blood clots
3. Avoid eating grapefruit juice
4. Avoid contact sports that may cause injury, cuts, or bruises
5. Use of bristle toothbrush- prevent from injury
6. Report unusual bleeding

Rizalyn Mae M. Faminial
Chemotherapeutic Drugs
Cancer is a group of more than 100 different diseases that are characterized
by uncontrolled cell growth, local tissue invasion, and distant to the site of
original growth (metastases)
Tumors can be benign, malignant or cancerous
Antineoplastic
- Refers to an agent that counteracts the development, growth, or
spread of malignant cells and therefore treat various types of
cancer.
- Treatment of cancer often requires a combination of radiation,
surgery, chemotherapy, targeted drug therapy and biologic therapy
- Chemotherapy can be as palliative or for long term or complete
remission
- Antineoplastic are cytotoxic especially to those that grow rapidly.
Cytotoxic means destructive to cells also normal cells
- Antineoplastic possess immune-suppressive properties.
- Antineoplastic are frequently administered in high doses in
intermittent schedule
- Chemotherapy is individualized and frequently modified according
to patient’s response to treatment
- The treatment of cancer is highly complex
Drug Therapy for Cancer
Goal:
- Give large dose enough to be lethal (cytotoxic) to the cancer cells
but small enough to be tolerable by normal cells
- Control of disease
- Palliation of symptoms
- Prophylactic purposes
- Uses combination therapy to allow cell death during different
phases of the cell cycle
- The choice of chemo drugs depends on the type of tumor cells, rate
growth, and the size of the tumor
Cell Cycle
- process which cells replicate and make new cells
G1 - cell preparing to divide, resting phase
S (synthesis) – cell copies all the DNA. replication
G2 - organizes and condenses the genetic material, resting phase
M (mitosis) – where cell partition the two copies of genetic materials into
two daughter cells, division
- After, the m phase completes cell division occur and two cell are
left, and the cell cycle ca begin again.
Alkylating Agents
Drugs: ifosfamide, cisplatin, cyclophosphamide
- Bond with DNA molecules which prevent the separation of the
double-coiled DNA molecule that is necessary for cell division
- They are capable of combining with cellular components at any
phase of the cell cycle.
- They can cause long term damage to bone marrow, that can
eventually lead to acute leukemia 5-10 years after treatment
Side Effects:
- Nausea, vomiting, diarrhea
- Mucosal ulceration; bone marrow suppression, leukopenia, anemia,
thrombocytopenia
- Neurotoxicity, headache, vertigo, seizure
- Rash and alopecia
- low of tissue if IV drug solution infiltrates into tissues
Contraindication: - Vinorelbine (Navelbine), semi synthetic derived from vinblastine, is
- Pregnancy the treatment of choice for lung cancer in older patients.
- Renal disease Side Effects:
- Debilitated patients - Neurotoxicity, numbness, tingling, foot drop, pain in jaw and
Anti-Metabolites extremities, visual disturbances
Drugs: methotrexate, fluorouracil, gemcitabine - Severe constipation or diarrhea, nausea and vomiting
- Sub-classified as folic acid, purine and pyrimidine antagonists - Oral or GI ulceration
- Inhibit key enzymes in biosynthesis pathways of DNA and RNA - Rash, alopecia
synthesis. These agents interfere with the ability of neoplastic cell to - Leukopenia with vinblastine
multiply - Necrosis of tissue if IV drug solution infiltrates into the tissues
- Most of this are cell-specific during the S phase of cell maturation Contraindications/Precautions:
- All kills normal cells, such as bone marrow cells and hair follicle cells - Pregnancy
Side Effects: - Hepatic dysfunction
- Anorexia, nausea, vomiting, diarrhea - Infection
- Oral mucosa and GI tract ulceration - Geriatric patients
- Bone marrow suppression leukopenia; thrombocytopenia with
hemorrhage Taxanes
- Rash, itching, photosensitivity and scaling - Paclitaxel – originally extracted from the bark of western yew
- Alopecia - Used as second line or subsequent therapy in patients with
Contraindications/Precaution: metastatic cancer or ovarian carcinoma refractory to conventional
- Renal and hepatic disorder chemotherapy
- Pregnancy - Because of severe adverse reaction, this is only administered only
- GI ulcers by IV under constant supervision of oncologist
Side Effects:
Methotrexate - Bone marrow suppression-neutropenia, leukopenia,
- Are only dosed once weekly; generally given as multiple 2.5 mg tabs thrombocytopenia, anemia
on the same day of the week - Hypersensitivity reactions
- Often given with folic acid during the time patient is not taking - Peripheral neuropathy
methotrexate - Nausea, vomiting, diarrhea, mucositis
- Alopecia
Natural Products (Mitotic Inhibitors) - Necrosis of tissue due to IV infiltration
- derived from living tissue that block the formation of the mitotic Contraindication/Precautions:
spindle during mitosis, thus inhibiting cell division - Pregnancy
- Plant alkaloids and taxens - Hepatic dysfunction
- Infection
Plant Alkaloids - Cardiac disease
- Vincristine or vinblastine – derived from periwinkle plant in
combination with other chemo drugs to treat malignancies
Antineoplastic Antibiotics
- Bind to DNA, inhibiting DNA or RNA synthesis, which eventually
inhibits protein synthesis, preventing cell replication
Doxorubicin – most active therapeutic agent and is a critical component in
the treatment protocols of breast, lungs, gastric, ovarian lymphoma. Can
permanently damage the heart if maximum lifetime dose is reached
Daunorubicin – used for acute leukemia because of lower incidence of
cardiotoxicity
Other Drugs: bleomycin, mitomycin
Side Effects:
- Bone marrow suppression
- Cardio toxicity including arrhythmias, CHF, cardiomyopathy
- Pneumonitis and dyspnea
- Anorexia, nausea, vomiting, diarrhea, alopecia
- Oral and GI ulceration
- Necrosis of tissue due to IV infiltration
Contraindications/Precaution:
- Precaution
- Liver disorders
- Cardiac disease, esp CHF
Hormones
Corticosteroids – beneficial in lymphomas
- Ability to suppress mitosis in lymphocytes
- Helps reduce inflammation and edema (brain tumors)
- Restore weight, appetite and strength
Estrogens and Androgens – for malignancies of sexual organs
Antiestrogens
- A non-steroidal agent to a class of drugs called selective estrogen-
receptor modifier (SERM), tamoxifen, which binds to estrogen
receptors in various tissues. Letroxole and anastrozole, inhibits the
final step in estrogen production
- Used as treatment for breast cancer
Antiandrogens
- Include leuprolide acetate, which suppresses testosterone
production for prostate cancer
- Used as hormonal therapy for endometriosis
- Bicalutamide, which interfere with the binding of testosterone to
androgen receptors in the prostate, used in the treatment of
metastatic prostate cancer
Biologic Therapies
- Designed to repair, stimulate or enhance cancer patient’s natural
immune systems to more effectively recognize and attack cancer
cells
- Active or direct type - stimulate the body’s own immune system to
fight the disease
- Passive or indirect type - uses immune system components created
outside the body.
Interferons
- Interferons alfa (Intron A), type most widely used in cancer
treatments, is a complex combination of many proteins that boost
immune system response
- Used in the treatment od certain leukemia, melanoma, Kaposi’s
sarcoma, Non-Hodgkin lymphoma
Side Effects:
- Flulike symptoms – fever, fatigue, chills, headache, muscle aches
- GI symptoms – anorexia, nausea, vomiting, diarrhea, dry mouth
- Nervous system effects – sleep disturbance, depression, neuropathy
- Hematology – leukopenia, anemia
- Alopecia
- Dyspnea, cough, nasal congestion, pneumonia
Monoclonal Antibodies
- Are exogenous antibodies genetically engineered in the laboratory,
which are designed to target only cancer cells, thereby sparing
normal tissues
- Angiogenesis inhibitors prevent the formation of new blood cells
that tumor need to grow and invade nearby tissue.
- Bevacizumab, combined with other agents, is used as first line
treatment for metastatic carcinoma of colon, lung, kidney. IT may
only stop or slow down the cancer, but not eradicate it.
- Trastuzumab, combined with paclitaxel, indicated for 1st line
treatment of metastatic breast Ca
- All mabs are administered intravenously
Side Effects: 3. IV fluids containing antineoplastic agents should not be allowed to
- Fever, chills, headache, dizziness get on the skin or into the eyes of patient/nurse
- Nausea and vomiting 4. Antiemetics should be immediately available and administered as
- Itching, rash, generalized pain prescribed to prevent N/V
Severe Reactions 5. Advice patient to do careful and frequent oral hygiene to minimize
- Angioedema, hypotension, dyspnea, bronchospasm discomfort and ulceration
- Hypersensitivity recation 6. Advise patient to eat soft food/ cool liquids
- Cardiac dysrhythmias, HF, angina 7. Accurate intake and output is required
- Acute renal failure 8. Careful observation and reporting of symptoms and side effects is
- GI perforation, bleed an essential part of chemotherapy
9. Aseptic technique is advised in preparation of chemo drugs
Targeted Therapies 10. Careful assessment of VS is important
- Drugs and other substances that block the growth and spread of
cancer by interfering with specific molecules involved in tumor Nursing Implications
growth and progression. 1. Assessment
- Signal Transduction Inhibitors - Demographics – gender, age
- Block specific enzymes and growth factor receptors that signal - Job related exposure to chemical carcinogens
cancer cell proliferation. - Exposure to tobacco
- Imatinib (Gleevec) used as treatment for Chronic Myelogenous - Pharmacologic agents known to be carcinogens
leukemia and some rare cancer - Treatment with radiation
2. Dietary Habits
Vaccines - Eating pattern
- Medicines that boost the immune system’s natural ability to protect - Symptoms associated with nutrition
the body against foreign invaders - Height and weight
- Preventive 3. Pre-existing health problems
- Treatment
- Gardasil and Cervarix – preventive for HPV Symptoms of pharmacologic effects:
- Provenge – treatment for metastatic prostate cancer. Made from - Sexual assessment- use of birth control and reproductive
patient’s WBC to stimulate the patient’s immune system against counselling
cancer and manufactured for each patient individually. - Smoking
- Pain control
Safety when using Chemotherapy - Infection – reverse isolation
1. All medications should be given on time and exactly as prescribed to - Nausea and vomiting – monitor I and O
keep the patient as comfortable as possible and maximize the - Positioning – prevent alteration in skin integrity
efficacy and safety of the medication - Diarrhea and constipation – monitor I and O; modify diet
2. IV site used must newly inserted line, with big veins. It must be - Stomatitis – meticulous oral hygiene
checked regularly. - Bleeding – encourage rest. Avoid physical activities
- Neurotoxicity – LOC
 - Anxiety

Dangers to Health Professionals

Safe handling involves 4 broad goals:
- Protect ad secure packages of hazardous drugs. Store them
separately from non-hazardous drugs
- Inform and educate all involved personnel about hazardous and
train them in handling
- Do not let the drug escape from containers when they are
manipulated (dissolved, transferred, administered, discarded)
- Eliminate the possibility of inadvertent ingestion or inhalation and
direct skin and eye contact with the drugs.
 4. If the patient is unconscious, severely inebriated, in shock, convulsing, or
emw has no gag reflex.
5. If patient is less than one-year-old.
6. If patient has cardiac or vascular disease.
**If any of these conditions exist, the patient should be transported
immediately to an emergency care facility. Trained personnel can remove
the stomach contents by gastric lavage, if appropriate, and administer
Rizalyn Mae M. Faminial antidotes as indicated.

Toxins Antidotes
Acetaminophen Acetylecysteine
Salicylates Alkalinize urine, Dialysis
Toxins and Antidotes Beta Blockers Glucagon
Poison Iron (Ferrous Sulfate) Deferoxamine
- substance taken into the body by ingestion, inhalation, injection, or Anticholinergics Physostigmine
absorption that interferes with normal physiological functions. Benzodiazepines Flumazenil
Emetic Calcium Channel Blockers Glucagon
- substance given to induce vomiting.
Coumadin/Warfarin Vitamin K, Fresh Frozen Plasma
Ingestion
Cyanide Sodium Nitrate
- type of poisoning that is most common. Children between 1-5 are
Heparin Protamine Sulfate
most at risk for poisoning.
Insulin Reaction Glucose (Dextrose 50%)
Antidote
Potassium Insulin + Glucose
- Substance that counteracts a form of poisoning.
Magnesium Sulfate Calcium Gluconate
Routes how poison may take in to the body: Lead Dimercaprol, Succimer, Penicillamine
o Ingestion Copper, Arsenic, Gold Penicillamine
o Inhalation Carbon Monoxide 100% O2, Hyperbaric O2
o Injection Heparin Protamine Sulfate
o Absorption Isoniazid Vitamin B6
Morphine Sulfate Naloxone
Conditions when vomiting could be injurious and should be avoided if Penicillin Epinephrine
possible: Heroin Naloxone
1. Ingestion of corrosive substances such as mineral acids or caustic alkalis
(e.g. carbolic acid, ammonia, drain cleaners, oven cleaners, dishwasher Personnel caring for poisoning victim should observe for the following
detergents, lye) cautions:
2. Ingestion of volatile petroleum products (gasoline, kerosene, benzene) 1. Be sure to save emesis. It may be necessary to send it to laboratory to
3. ingestion of consultants (strychnine or iodine). determine the type of poison.
2. closely monitor vital signs of the patients who have taken poison at any
kind.
3. Observe closely for possible confusion, tremors, convulsions, visual
disturbances, loss of consciousness, respiratory distress or cardiac
arrhythmias.
 Vitamins: Functions, Suggested Food Sources, and Selected Deficiency Functions as a
Conditions building block of
nucleic acids & Gastrointestinal
B12 Liver, kidney,
Deficiency to form RBC’s. disorders, poor
Vitamin Function Food Sources (Cobalamin) fish, milk
Conditions Facilitates growth, anemia
Helps form and functioning of
maintain healthy Whole milk, nervous system
Dry skin, poor
teeth, skeletal butter, eggs, Helps in
tooth
A and soft tissue, leafy green & formation of
development,
mucous yellow vegies & genetic materials Decreased WBC
night blindness Leafy green
membranes and fruits & proteins for count & clotting
vegies, yellow
skin the cell nucleus. factors, anemia,
Folic Acid fruits & vegies,
Helps the body Assists with intestinal
yeast, organ
cells convert intestinal disturbances,
meats
carbs into functioning, depression
Sensory
energy. It is also Enriched bread prevents
disturbances,
B1 (Thiamine) essential for the & cereals, yeast, selected anemia
retarded growth,
functioning of liver, fish, milk Promotes body’s
fatigue, anorexia
the heart, use of carbs, fats
muscles & & proteins.
Eggs, leafy
nervous system Essential for
Pantothenic green vegies, Deficiency
Works with formation of
Acid nuts, liver, skim unknown
other B vitamins Milk enriched Visual defects specific
milk
to promote breads & such as blurred hormones &
B2 healthy growth cereals, liver, vision & nerve regulating
(Riboflavin) and tissue repair lean meat, eggs, photophobia, substances
& helps release leafy green numbness of In all body
energy from vegies extremities tissues. Retarded growth,
Eggs, meat,
carbs Necessary for headache,
liver, beans,
Important in Niacin energy memory loss,
Lean meat, leafy peas, enriched
metabolism, producing anorexia,
green vegies, Convulsions, bread, cereals
B6 synthesis of reactions. Assists insomnia
whole-grain dermatitis,
(Pyridoxine) proteins & nervous system
cereals, yeast, anemia,
formation of red Synthesis of fatty
bananas Eggs, milk, leafy
blood cells acids & energy Deficiency
Biotin green vegies,
production from unknown
liver
glucose
 Helps tissue
Citrus fruits, Poor wound
repair and
tomatoes, leafy healing, bleeding
C (Ascorbic growth.
green vegies, gums,
Acid) Required in
potatoes, predisposition to
formulation of
strawberries infection
collagen
Promotes use of
phosphorus and Vitamin D Rickets, deficit of
calcium. fortified milk, phosphorus &
D (Calciferol)
Important for egg yolk, tuna, calcium in the
strong teeth and salmon blood
bones
Protects fatty
Whole grain
acids &
cereals, wheat
promotes the
germ, vegetable
formation & Breakdown of
E oil, lettuce,
functioning of RBC’s
sunflower
red blood cells,
seeds, milk,
muscle & other
eggs, meat
tissue
Leafy green Increased clotting
vegies, liver, time, leading to
Essential for
K cheese, egg increased
blood clotting
yolk, vegetable bleeding &
oil, tomatoes hemorrhage

emw
Rizalyn Mae M. Faminial
Nutrition, Herbal and Dietary
Supplement
Nutritional Pharmacology- is the use of minerals, vitamins, plant or herbal
derived botanical and phytochemicals as nutritional supplements
Nutritional Support
Enteral Nutrition is given in different types of formula, in different routes
with different gastrointestinal tubes
1. Nasogastric- nose to stomach
2. Nasoduodenal/ Nasojejunal – pass through the nose into the
duodenum or jejunum
3. Gastrostomy (opening) –through temporary or permanent opening
in the abdominal wall (stoma) into the stomach
4. Jejunostomy –passed through a stoma directly into the jejunum
Parenteral Nutritional
Total parenteral Nutrition is the primary method for providing complete
nutrients by the parenteral or IV route.
Commonly Used Herbal Remedies
1. Aloe Vera – Indications: for constipation, to relieve pain and
promote healing of burns, wounds, sunburn and psoriasis.
Preparation: remove the outer layer of the leaf then make it as gel
2. Bilberry- Indication: fruit may promote healthy vision and decrease
diarrhea in children while the leaf is used for diabetes, arthritis,
dermatitis and gout.
Preparation: decoction of dry leaves for diarrhea; consume the fruits
3. Chamomile –Indication: stimulates normal digestion, anti-
inflammatory, anti-spasmodic, mild sedative, mild diuretic.
Preparation: decoction as tea
4. Cranberry –Indication: prophylaxis of urinary tract infections and
urinary stones.
Preparation: eat as fruit; juice.
5. Garlic- Indication: detoxifies body and increases immune function,
decreases platelet aggregation, used for hypercholesterolemia, mild
hypertension, colds and flu.
Preparation: taken as fruit.
6. Ginger –indication: stimulates digestion, decreases absorption and
increase excretion of cholesterol, antioxidant, for nausea and
motion sickness.
Preparation: decoction as tea.
7. Milk Thistle –Indication: hepatoprotective and antihepatotoxic
actions over liver toxins. Silymarin is from the seeds of milk thistle.
Preparation: seed and leaves are made as a tea/ extract. It is food
for the liver.
8. Ginkgo Biloba –Indication: arterial and venous vasoactive changes
that increases perfusion and cerebral blood flow and acts as anti-
oxidant.
Preparation: extract; decoction. *Pampatalino
Advised – do not take the home remedies without consulting a doctor.
Especially patients who are taking maintenance drugs.
Drugs of Abuse
Drug Abuse is also called substance abuse or chemical abuse. It is also a
disorder that is characterized by a destructive pattern of using a substance
that leads to significant problems or distress.
Drug Addiction is also called substance dependence or chemical
dependency. It is a disease that is characterized by a destructive pattern of
drug abuse that leads to significant problems involving tolerance to or
withdrawal from the substance.
Alcohol Effect sought: relaxation, euphoria, increased perception
Medical name: ethyl alcohol Over dosage: fatigue, paranoia, possible psychosis
Slang name: booze Long term: respiratory difficulties, lung cancer, interference with physical
Form: liquid and emotional development
Method of admin: swallow
Effect sought: sense alteration, anxiety reduction Cocaine
Over dosage: total loss of coordination, nauseam unconsciousness and Medical name: cocaine
possible death Slang name: Coke, rock, crack
Long term: dependency, toxic psychosis, neurologic damage Form: powder, rock
Method of admin: inject, smoke, inhale
Amphetamine Effect sought: excitation, euphoria
Medical name: Dexedrine, Benzedrine Over dosage: agitation, seizure, hallucination, death
Slang name: speed, pep pills, Meth Long term: dependency, depression, paranoia, convulsions
Form: cap, tab, liquid, powder
Method of admin: inject, swallow, inhale Ecstacy
Effect sought: alertness, activeness - in overdose it can increase body temperature to the point of being fatal.
Over dosage: agitation, SEIZURE, HALLUCINATION, DEATH
Long term: severe withdrawal, toxic psychosis, advanced tooth decay Inhalants
Medical name:
Anabolic steroids Slang name: rugby
- substances abused by body builders and other athletes, this can lead to Form: solvent, aerosol
terrible psychological effects like aggression and paranoia as well as Method of admin: inhale
devastating long-term physical effects like infertility and organ failure. Effect sought: relaxation
Over dosage: heart failure, unconsciousness, asphyxia, possible death
Caffeine Long term: impaired perception, coordination and judgment, neurologic
Medical name: caffeine damage
Slang name: Java, cup of joe, morning thunder
Form: chocolate, tea, soft drinks, coffee Nicotine
Method of admin: swallow Medical name: nicotine
Effect sought: alertness Slang name: yosi, smoke, cig
Over dosage: Irritability Form: tobacco, cigarette
Long term: dependency Method of admin: sniff, shew, smoke
Effect sought: relaxation
Cannabis Over dosage: none
Medical name: tetrahydrocannabinol Long term: dependency, lung cancer, heart attacks, respiratory ailments
Slang name: pot, dope, weed
Form: plant particles
Method of admin: smoke, swallow
Sedative, Hypnotic or Antianxiety Drugs Drugs for Elderly
Medical name: phenobarbital, Valium Physiologic Changes in The Elderly
Slang name: downers Effect On Drug
System Physiologic Change
Form: caps, tabs, powder Administration
Method of admin: inject, swallow Increased pH gastric Slower absorption of
Effect sought: anxiety reduction, euphoria, sleep secretion, decreased oral drugs
Over dosage: cold clammy skin, dilated pupils, shallow respiration, weak Gastrointestinal peristalsis with
and rapid pulse, coma, death delayed intestinal
Long term: dependency, severe withdrawal, possible convulsion, toxic emptying time
psychosis Decreased cardiac Impaired circulation
Cardiac and output and decreased can delay
Drugs in Pregnancy and Lactation Circulatory blood flow transportation of
Oxytocin drugs to the tissues
Action: stimulates contractions of the uterine muscle fibers Decreased enzyme Drugs metabolized
Nursing management: Hepatic function and more slowly and less
1. Never leave patient receiving oxytocin infusion unattended. Use decreased blood flow completely
infusion pump. Decreased blood flow, Drugs excreted less
2. Monitor vs, uterine contractions, PHR and rhythm. decreased functioning completely
3. Check amount and characteristics of vaginal discharge of nephrons and
Renal
decreased GFR
Magnesium Sulfate (Glomerular Filtration
Action: reduces striated muscle contractions due to the depressant effect Rate)
on the CNS. Blocks neuromuscular transmission. It reduces or stop BARRIERS TO EFFECTIVE MEDICATION USE BY ELDERLY
convulsions in the hypertensive OB client Causes Nursing Actions
Taking too many medications at Develop a chart indicating time to
Estrogen different times take drugs
Action: development and maintenance fir adequate functioning of female Failure to understand purpose or Explain purpose, drug action, and
reproductive system; affects release of pituitary gonadotropins; promotes reason for drug importance of medication
adequate use in bone structures. Impaired memory Advice family members or friends
to monitor drug regimen
Decreased mobility Advice significant others to make
drugs and water accessible and
assist as needed
Visual and hearing disturbances Suggest eye and ear examinations
Side effects or adverse reactions Educate client and family about
from the drug side effects to report to health care
provider