Nursing Pharmacology

Florence B. Grageda, M.D.

Reviewer

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 Learning objectives

• At the end of this unit the students are expected to;

1. Define the basic concepts of pharmacology
a. Review of Pharmacodynamics
b. Review of Pharmacokinetics
2. Review the anatomy and physiology of the ANS
3. Review the different drugs affecting the autonomic
nervous system (ANS)
a. Adrenergic agonists
b. Adrenergic antagonists
Basic Concepts of Pharmacology

C
Pharmacodynamics
DRUG BODY
CELL

Pharmacokinetics

LIBERATION
ABSORPTION
DISTRIBUTION
METABOLISM
EXCRETION
 Pharmacodynamics

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 Pharmacodynamics
§ ACTION of DRUG

§Replace a missing substance

§Increase cellular activities

§Depress cellular activities

§Interfere with the growth of a foreign cell

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 Pharmacodynamics
§ Drug Actions maybe through;

1. Receptors

2. Enzymes

3. Pumps

4. Chemical interaction

5. Altering metabolic process

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 I. DRUG-RECEPTOR INTERACTIONS.

A
§ AGONISTS CE
LL

§ ANTAGONISTS

C
§ Competitive Antagonist

C
EL
L
D
E

§ Non Competitive Antagonist CE

LL
F
 ADRENERGIC RECEPTORS

ALPHA (a ) BETA ( b )

a1 a2 b1 b2

I. DRUG-RECEPTOR INTERACTIONS
§ Example: Autonomic Drugs

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II. DRUG-ENZYME INTERACTIONS

§ Example: Cholinesterase Inhibitors

BREAKSDOWN ACETYLCHOLINE ( Ach )

 IMPULSE
§ Example:
Drug-Enzyme Interactions PRESYNAPTIC NERVE

BREAKDOWN AXON
TERMINAL
AACh
CH

CHO
LIN
EST
ERA
NEOSTIGMINE SE
ACh
receptor
EFFECTOR CELLS
MUSCLE

CONTRACTION
RELAXATION

10
§ Example: IMPULSE

Reuptake Inhibitors PRESYNAPTIC NERVE

REUPTAKE
5HT
5HT AXON
TERMINAL
SSRI

5HT
receptor
EFFECTOR CELLS
NERVE

11 IMPULSE
transmission
 Pharmacokinetics

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 Pharmacokinetics

drug enters body

release of active ingredient

1. LIBERATION
 Pharmacokinetics
Movement of drug particles from GIT à blood:

1. LIBERATION

2. ABSORPTION

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 Pharmacokinetics

1. LIBERATION
= drug enters body &
releases active ingredient

2. ABSORPTION
= blood
3. DISTRIBUTION

CELL
C

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 Pharmacokinetics

1. LIBERATION 4. METABOLISM
= drug enters body &
releases active ingredient
2. ABSORPTION
= blood
3. DISTRIBUTION

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 Pharmacokinetics
• Dose
à amount of drug

• Schedule
à TIME, frequency

• Recommended dose
à the amount of drug administered to reach the
critical concentration
à RIGHT DOSE + RIGHT TIME
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 Pharmacokinetics
• Critical concentration
à level of drug in the blood which produces a
therapeutic effect

• Therapeutic effect
à favorable response after a treatment of any
kind
à CURE

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 Pharmacokinetics
• Loading dose
à initial dose, immediate
response

• Half Life
à time it takes for a drug
to become half of its
previously peaked level

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 Pharmacokinetics
LOADING DOSE
THERAPEUTIC EFFECT

CRITICAL CONCENTRATION
1000

750

500
250 DOSE
125
RECOMMENDED
mg
DOSE
0 8 16 24 32 40 48 56 64 72 80 86 168 SCHEDULE
HOUR
 Pharmacology tip

remembering
Medications and the Body
System affected…
 review the
Sympathetic and Parasympathetic nervous
system
 § THE
NERVOUS SYSTEM

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 NEURON
How do neurons NEURON è Functional Unit of
the Nervous System
communicate ?

IMPULSE

synapse

INFORMATION
( Message )

EFFECTOR CELL
24
 Neurotransmitters
à body’s chemical “messengers”

§ Acetylcholine ( ACh )

§ Norepinephrine and Epinephrine ( NE / E )

§ Dopamine ( Dopa )

§ Serotonin ( 5HT )

§ Gamma Amino Butyric Acid ( GABA )

25
 Autonomic Nervous System
§ Two branches :
§Sympathetic nervous system
§Neurotransmitter:
§ NOREPINEPHRINE (NE)

§Parasympathetic nervous system

§Neurotransmitter:
§ ACETYLCHOLINE (ACh)

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 GANGLION

Preganglionic nerves
Postganglionic nerves
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 Autonomic Nervous SYMPATHETIC PARASYMPATHETIC
System
General Response “ fight or flight ” “ rest and digest “

Origin thoracolumbar craniosacral

Preganglionic Nerve SHORT LONG

Neurotransmitter
ACh ACh
Postganglionic Nerve
LONG SHORT
Neurotransmitter
NE ACh
Termination of Impulse MAO
CHOLINESTERASE
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 Autonomic Nervous SYMPATHETIC PARASYMPATHETIC
System
Response to:
HEART

LUNGS,
BRONCHUS

PUPILS

GIT
( blood flow, motility, secretions )

KIDNEY
• blood flow

URINARY BLADDER
• sphincter
• detrusor muscle
BLOOD VESSELS
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( smooth muscle )
 Drill !
Drill !
Drill !

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 AUTONOMIC NERVOUS SYSTEM
DRUGS

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 3 Important Components to Know & Remember

• Receptors

• Agonist OR antagonist

• Location of the expected response

 ANS DRUGS: _____________________
1. ADRENERGIC AGONISTS
a. Epinephrine
= CPR, Shock
a. Dobutamine
= CHF
a. Dopamine
= CHF, Cardiogenic Shock
a. Norepinephrine
= cardiac arrest

2. ALPHA ADRENERGIC AGONISTS

a. Midodrine
= orthostatic hypotension
 ANS DRUGS: __________________________
3. ALPHA 2 ADRENERGIC AGONISTS
a. Clonidine ( Catapres )
= found in CNS neurons
= Hypertension

4. BETA 1 ADRENERGIC AGONIST

a. Dobutamine
= CHF

5. BETA 2 ADRENERGIC AGONISTS

a. Albuterol / Salbutamol
b. Isoproterenol
c. Terbutaline
d. Isoxsuprine

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 ADRENERGIC ANTAGONISTS: ___________________

1. ALPHA and BETA ADRENERGIC ANTAGONISTS

a. Carvediol
b. Labetalol
= hypertensive crisis due to pheochromocytoma

2. ALPHA ADRENERGIC ANTAGONISTS

a. Phentolamine
= hypertensive crisis due to pheochromocytoma but with lesser SE

3. ALPHA 1 ADRENERGIC ANTAGONISTS

a. Prazosin = HPN
b. Doxazosin = HPN and BPH causing urinary retention
c. Terazosin = HPN and BPH causing urinary retention
d. Alfuzosin = BPH
e. Tamsulosin = BPH
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 ADRENERGIC ANTAGONISTS :
___________________

4. BETA ADRENERGIC ANTAGONISTS “ olol “

a. Propranolol
b. Pindolol
c. Timolol

5. BETA 1 SPECIFIC ADRENERGIC ANTAGONISTS

a. Betaxolol Bisoprolol
b. Esmolol
c. Atenolol Acebutolol
d. Metoprolol

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 ANS DRUGS : NURSING CONSIDERATIONS

1. Avoid sudden withdrawal of the drug.

2. Monitor vital signs.

3. Provide comfort measures.

4. Provide adequate health teaching on the name of drug, prescribed

dosage, effects and adverse effects.

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 ADRENERGIC
RECEPTORS

ALPHA (a ) BETA ( b )

a1 a2 b1 b2
U. BLADDER SPHINCTER
CNS
closes: retention NERVE MEMBRANE
BLOOD VESSELS bronchodilation
↓ NE release
vasoconstriction ↑ HR, UTERUS
↑ contractility
IRIS weakens sns
relaxation
K+ enters cell
dilation: mydriasis PSNS BLOOD VESSELS
KIDNEY
PANCREAS vasodilation
é renin release LIVER
↓ insulin release
glycogenolysis
hyperglycemia
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38
ADRENERGIC AGONISTS
ADRENERGIC
RECEPTORS

ALPHA (a ) BETA ( b )

a1 ALPHA 1 ADRENERGIC AGONIST

U. BLADDER SPHINCTER
PHENYLEPHRINE Chlorpheneramine+Paracetamol
=Neozep Bioflu
CLOSES: RETENTION
Vasopressor=vasoconstriction=increase SVR= increase BP= Hypotension

Nasal decongestant
BLOOD VESSELS HTN+Colds =give SINUPRET FORTE tid =vasoconstriction=cell shrink
BP=HR x Stroke Volume (SV) x Systemic Vascular resistant (SVR)

VASOCONSTRICTION

IRIS
dilation: MYDRIASIS

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ADRENERGIC AGONISTS
ADRENERGIC
RECEPTORS

ALPHA (a ) BETA ( b )

a2 ALPHA 2 ADRENERGIC AGONIST

CNS CLONIDINE
NERVE MEMBRANE

↓ NE RELEASE

weakens SNS

PSNS METHYLDOPA
PANCREAS

↓ INSULIN RELEASE

HYPERGLYCEMIA 40
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ADRENERGIC AGONISTS
ADRENERGIC
RECEPTORS

ALPHA (a ) BETA ( b )

a1 a2 b1 b2
U. BLADDER SPHINCTER
CNS
closes: retention NERVE MEMBRANE ADRENERGIC AGONIST
BLOOD VESSELS
NOREPINEPHRINE
=non selective
↓ NE release =Alpha and Beta
vasoconstriction =Vasopressor; inotrope
=Used for hypotension, cardiac arrest

IRIS weakens sns

dilation: mydriasis PSNS

PANCREAS

↓ insulin release
hyperglycemia 41
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ADRENERGIC AGONISTS
ADRENERGIC
RECEPTORS

ALPHA (a ) BETA ( b )

a1 a2 b1 b2
U. BLADDER SPHINCTER
CNS
closes: retention NERVE MEMBRANE ALPHA ADRENERGIC AGONIST
BLOOD VESSELS

vasoconstriction
↓ NE release
MIDODRINE ( alpha 1 )
IRIS weakens sns =used for chronic orthostatic hypotension
Side effect= hypertension

dilation: mydriasis PSNS

PANCREAS

↓ insulin release
hyperglycemia 42
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ADRENERGIC AGONISTS
ADRENERGIC
RECEPTORS

ALPHA (a ) BETA ( b )

BETA 2 ADRENERGIC AGONISTS b2

ALBUTEROL / SALBUTAMOL (Ventolin) Dobutamine
=Synthetic dopamine
=bronchoconstriction=asthma and COPD
=SABA-onset : 5min, duration : 6h (drug of choice for acute attacks of asthma =Used for HR, shock(decrease HR, RR, BP
=Hyperkalemia
=Side effect: palpitation and Tremors
Side effect: Tachycardia, Hypertension BRONCHODILATION
TERBUTALINE
=asthma, COPD UTERUS
=SABA - onset : 5 min, duration:
6h
= TOCOLYTIC RELAXATION
=used for premature labor

ISOXSUPRINE BLOOD VESSELS

=TOCOLYTIC
=Preterm labor
=Dysmenorrhea
VASODILATION
FORMOTEROL =prophylaxis for future attacks
-onset: <3 min, duration 12h LIVER
SALMETEROL =LABA GLYCOGENOLYSIS
HYPERGLYCEMIA
43
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ADRENERGIC ANTAGONISTS ADRENERGIC
RECEPTORS

ALPHA (a ) BETA ( b )

a1 a2
U. BLADDER SPHINCTER
ALPHA ADRENERGIC ANTAGONIST
CNS
CLOSES: RETENTION NERVE MEMBRANE PHENTOLAMINE = Drug of choice for HT've crisis due to;

BLOOD VESSELS

VASOCONSTRICTION
↓ NE RELEASE
= used in extravasation of adrenergic
IRIS weakens SNS drugs
> Dopamine
>Epinephrine

dilation: MYDRIASIS PSNS Vasodilation-> decrease SVR -> decrease in

BP
PANCREAS

↓ INSULIN RELEASE

HYPERGLYCEMIA 44
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ADRENERGIC ANTAGONISTS ADRENERGIC
Sympatholytic=PNS
RECEPTORS

ALPHA (a ) BETA ( b )

a1 ALPHA 1 ADRENERGIC ANTAGONIST

U. BLADDER SPHINCTER PRAZOSIN -> blood vessel-> vasodilation -> decrease SVR-> decrease BP
=HTN

CLOSES: RETENTION -> blood vessels -> vasodilation -> decrease TPR -> HTN

BLOOD VESSELS DOXAZOSIN -> urinary bladder -> emptying the bladder -> BPH ( BENIGH PROSTATIC
HYPERPLASIA)
-> Obstruction in the flow of urine and semen
-> dribbling, blood- streaked semen, urine stasis
VASOCONSTRICTION
TERAZOSIN -> Urinary bladder-> Emptying of bladder ->
IRIS BPH

dilation: MYDRIASIS
ALFUZOSIN -> urinary bladder -> emptying the bladder ->
HPH

TAMSULOSIN
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 ADRENERGIC
RECEPTORS
ADRENERGIC ANTAGONISTS

BETA ADRENERGIC BLOCKERS BETA ( b )

PROPRANOLOL == tachycardia
Stage fright
in hyperthyroidism

b1 b2
Side effects:
= Prophylaxis for migraine 1. Bradycardia
Contraindications & Nursing Considerations
2. Hypotension
1. Bradycardia- monitor HR, BP, Hold if HR < 60 BPM
3. Bronchoconstrict
2. Hypotension- hold if BP< 90/60 mmHG
4. Hypoglycemia
3. asthma, COPD
5. Erectile
4. CAUTION IN PATIENTS WITH DM= May cause the hypo glycemia
dysfunction
(Impotence)

TIMOLOL =open angle glaucoma by decrease production of

acqeous fluid
= Decrease IOP bronchodilation
= Prophylaxis for migraine (eye drops)
↑ HR,
↑ contractility
UTERUS

NADOLOL = Drug of Choice in angina + HTN

K ENTERS CELL
RELAXATION
BLOOD VESSELS
KIDNEY
LABETALOL = most used in pregnancy for BP VASODILATION
= Has alpha receptor effect increase placental blood é RENIN RELEASE
flow LIVER
GLUCONEOGENESIS
HYPERGLYCEMIA
46
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ADRENERGIC ANTAGONISTS ADRENERGIC
RECEPTORS

ALPHA (α ) BETA ( β )
BETA 1-SELECTIVE
ADRENERGIC BLOCKERS β1
BISOPROLOL, BETAXOLOL

ESMOLOL
↑ HR,
↑ contractility
ACEBUTOLOL, ATENOLOL
K ENTERS CELL

METOPROLOL KIDNEY

RENIN RELEASE

47
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 CHOLINERGIC
Parasympathetic
RECEPTORS

MUSCARINIC NICOTINIC
Muscarinic agonist to pupils= miosis
Antimuscarinic to bladder = retention of urine
Nicotinic Antagonist to fit = constipation

48
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 CHOLINERGIC
RECEPTORS

MUSCARINIC NICOTINIC

M1 M2 M3 M4 M5 N1 or NM N2 or NN

SMOOTH
CNS MUSCLE CNS CNS NMJ AUTONOMIC
GANGLIA

GASTRIC
PARIETAL CNS
CELLS

ADRENAL MEDULLA
AUTONOMIC
GANGLIA

49
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 Nursing pharmacology
102
Florence R. Benavidez-Grageda, M.D.

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 Learning objectives
• At the end of this unit the students are expected to;
1. Review the different drugs affecting the autonomic nervous system
(ANS)
a. Cholinergic agonists
i. Drugs used for Myasthenia gravis
ii. Drugs used for Alzheimer’s disease
b. Cholinergic antagonists
2. Review the Drugs affecting the Central Nervous System
i. Drugs used for Parkinson’s disease
ii. Anxiolytics
iv. Anticonvulsants
3. Drugs Used for Respiratory System
i. Agents used for Upper Respiratory Tract
ii. Agents used for Asthma
 • MYASTHENIA
GRAVIS

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 PRESYNAPTIC N.
PHYSIOLOGICAL
Drug-Enzyme Interactions IMPULSE
AXON
TERMINAL

BREAKDOWN

ACH

CHO
LIN
EST
ERA
SE
receptor
EFFECTOR CELLS
MUSCLE

CONTRACTION
RELAXATION
54
 MYASTHENIA GRAVIS PRESYNAPTIC N.

Autoimmune IMPULSE
AXON
Self Antibody-> antigen (foreign body TERMINAL
Destroys receptor

= women, 20 – 40 y/o,
= unknown cause or idiopathic
ACh
= descending muscle weakness

= ascending muscle weakness ?

Gullain Barre Syndrome receptor

MUSCLE

RELAX
PARALYSIS
55
 MYASTHENIA GRAVIS PRESYNAPTIC N.

AXON
TERMINAL

BREAKDOWN

ACh

CHO
LIN
EST
ANTICHOLINESTERASE
ERA
SE
Goal: increase the TONE of muscle, ACh
receptor
temporary(contraction)
MUSCLE

CONTRACTION
RELAX

56
MYASTHENIA GRAVIS PRESYNAPTIC N.

Promotes
AXON acytylcholine
TERMINAL
§ NEOSTIGMINE
à treatment
§ PYRIDOSTIGMINE
ACh à treatment
CHO § PHYSOSTIGMINE
LIN à treatment
EST
ANTICHOLINESTERASE
ERA
SE § EDROPHONIUM
ACh
receptor ( Tensilon )
Anticholinergic Cholinergic MUSCLE à diagnostic
-> short acting,

§ Pharmacodynamics:
10 mins.

§ anticholinesterase
Blocks cholinesterase (
CONTRACTION
RELAX ANTINESTERASE)

57
 CHOLINERGIC AGONISTS
q Pharmacodynamics:
Expect:
Diarrhea
Increase UO

à Hypersalivation
Bradycardia

§ NEOSTIGMINE - Long term

- Increase Acetylcholine -receptor binding

Cholinergics
§ PYRIDOSTIGMINE 1st line drug for MG
Drug of Choice for Atropine (anticholinergic) Toxicity

§ PHYSOSTIGMINE
§ EDROPHONIUM CHLORIDE
Corticosteroids:
- to suppress immune response
- DECADEON ( DEXAMETHASONE)

60
 Myasthenia Gravis

• Nursing PRIORITY / PRIORITIES ?

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 Myasthenia Gravis
Diagnosis in 2 types of Crisis: TENSILON
• Monitor for crisis TEST= Cholinergic drug
Myasthenic Crisis: improvement of paralysis
1. Monitor for 2 Types of Crisis: Cholinergic Crisis: worsening of paralysis
Myasthenic Crisis
S/ss: Weakness & Paralysis
Cause: UNDERDOSE of Cholinergic Drugs, Stress, Infection When preparing for TENSILON TEST
Treatment: CHOLINERGIC DRUGS(Pyridosrigmine, always remember to prepare
Physostigmine) ATROPINE

Cholinergic Crisis
S/ss: Weakness & Paralysis
Cause: OVERDOSE of Cholinergic Drugs
Treatment: ANTICHOLINERGIC DRUGS (Atropine)
• Slow IV adminstration
= to avoid severe cholinergic effects
- diarrhea, increase urine output, miosis
-bradycardia, hypotension
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 • ALZHEIMER’S
DISEASE

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 PRESYNAPTIC N.
ALZHEIMER’S DISEASE
IMPULSE
=Degeneration of Cholinergic nerves

S/SS:AAA
-Amnesia-loss of memory
-Apraxia-unable to determine function&purpose of
object
-Agnosia- unable to recognize familiar object ACh
-Aphasia- Language Disorder:
1. Expressive- unable to say something(frontal lobe,
Broca's area)
2. Receptive -unable to understand spoken
words(temporal lobe, Wernicke's area)
3. Global/Mixed(Both) receptor
EFFECTOR CELLS
COMMON TO ALZHEIMER: RECEPTIVE NERVE CELL
APHASIA

MEMORY
ALZHEIMER’s DISEASE PRESYNAPTIC N.
IMPULSE
AXON
TERMINAL

BREAKDOWN
§ RIVASTIGMINE (Exelon)
ACh
§ DONEPEZIL (Aricept)
CHO
LIN
EST
ANTICHOLINESTERASE
ERA
SE § TACRINE
ACh
receptor

NERVE CELL § Pharmacodynamics:

§ anticholinesterase
Cholinergic Drugs

memory

Note: drugs will not cure the disease 66

 CHOLINERGIC AGONISTS : ___________________
Parasympathomimetic

1. BETHANECOL
= selectively activates bladder muscarinic receptor
= emptying of the bladder
= Use:
ü relief of urinary retention
ü post partum
ü neurogenic atony of bladder
= SE:
ü Asthma o constrict airways Bronchoconstriction
ü Cardiac problems o slows HR Bradycardia
ü Peptic ulcer o Inc GI activity Increase secretions, motility
ü Intestinal obstruction

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 CHOLINERGIC ANTAGONISTS

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 Parasympatholytic Anticholinergics
CHOLINERGIC ANTAGONISTS : ______________________

1. ATROPINE
= antidote to cholinergic Crisis
= Pre-op -> decrease secretions-> decrease risk of aspiration

Side effect: dryness of mouth, retention of urine,

mydriasis in cataract symptom, tachycardia,
constipation
2. DICYCLOMINE
=antispasmodic, antimuscarinic,
=For hyperactive bowel in adults

3. SCOPOLAMINE ( Hyoscine butylbromide )

= motion sickness
= Decrease secretions
=Pupil dilation
= Post operation Nausea and Vomiting

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 CENTRAL NERVOUS
SYSTEM DRUGS

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 • PARKINSON’s
DISEASE
Progressive disorder
Degeneration of dopaminergic
neurons

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 Parkinson’s Disease

( ---- )

Dopa ACh Dopa

Dopaminergics
ACh Contracts

Fine movements Anticholinergics

Normal
SUBSTANCIA NIGRA PARKINSON’s
IN MIDBRAIN
disease
72
 Classes of Anti-Parkinson Agents
Goal:
Improve motor control
§ ANTICHOLINERGICS : Improve quality of life
Increase dopamine or decrease Ach
action

§ BIPERIDEN (AKINETON)
§ TRIHEXYPHENIDYL (ARTANE)
§ DIPHENHYDRAMINE (BENADRYL)
§ BENZTROPINE (COGENTIN)

73
 Classes of Anti-Parkinson Agents

§ DOPAMINERGIC AGENTS
Carbidopa- blocks the decarboxylase hence more Levodopa is available in
brain to be converted to dopamine

§ DOPAMINE PRECURSORS
L-dopa (Levodopa): mainstay in treatment of Parkinson's disease
=Increases available dopamine in the brain
Side effects: many
Nursing Considerations= avoid Vitamin B6(reverses the action of Levodopa, advice Low
protein Diet

§ DOPAMINE RECEPTOR AGONISTS

§ MAO-B INHIBITORS
§ CATECHOL-O-METHYL TRANSFERASE
( COMT ) INHIBITORS

74
 RESPIRATORY DRUGS
Upper Respiratory Tract

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INFLAMMATORY RESPONSE = normal response of a vascularized tissue to injury
= destroys pathogen, promotes healing
BRONCHOCONSTRICTION
E
NAS
GE
OXY
LIP LEUKOTRIENE CHEMOTAXIS healing

Broncocorticoids
Arachidonic Acid
DOLOR
I Pain MUCUS
N CY
CL BICARBONATE
OO PROSTAGLANDIN STOMACH
J XY
G
OX ENAS
(C HCl ACID
U 2) E2 FEVER
R
Y
THROMBOXANE A2 CLOTTING

BLOOD FLOW TO
KIDNEY

Antihistamine VASODILATION BLOOD FLOW RUBOR Redness

HISTAMINE
CALOR Warmth/heat
Glucocorticoids Swelling
CAPILLARY LEAK OF PLASMA TUMOR
PERMEABILITY PROTEIN
 UPPER RESPIRATORY TRACT DRUGS
• Upper respiratory tract

• DRUGS to treat ALLERGIC RHINITIS:

• Antihistamine Oral intranasal

• Glucocorticoids Intranasal
• Sympathomimetic Decongestants

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 I. MEDICATIONS TO TREAT ALLERGIC RHINITS
I. ANTIHISTAMINE:
Pharmacodynamics: Blocks Histamine 1 receptors
Anticholinergic

A. First Generation:
a. Diphenhydramine C. Intranasal antihistamines
Side effects: drowsiness
Take at hs avoid driving and operating big
a. Azelastine
B. Second Generation
machineries

a. Cetirizine
Non-drowsy

b. Loratadine
c. Desloratadine
 I. MEDICATIONS TO TREAT ALLERGIC RHINITS

II. INTRANASAL GLUCOCORTICOIDS

Antiinflammatory
A. First Generation
a. Beclomethasone
b. Budesonide
c. Triamcinolone

B. Second Generation
a. Fluticasone propionate
b. Ciclesonide
 I. MEDICATIONS TO TREAT ALLERGIC RHINITS

III. SYMPATHOMIMETICS:
Pharmacodynamics:
à Vasoconstriction -> shrink
membranes
A. Phenylephrine
à Nasal spray or oral

B. Pseudoephedrines
à Oral
Use with caution in CV patients
Shrinks swollen membranes -> ease
breathing
Ingredient in crystal meth
Wean intranasal spray
-> rebound congestion
 I. MEDICATIONS TO TREAT COUGH
• I. COUGH SUPPRESSANTS: Antitussive
Pharmacodynamics: CNS
=suppress the cough reflex in the

==Non productive cough

§ DEXTROMETHORPHAN ROBUTUSSIN DM
Opiod derivative without euphoria in normal
= dose
Found in combination with other cold meds

§ CODEINE
Opiod derivative with euphoria
Most effective for treating cough
1/10th the dose used for pain
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 I. MEDICATIONS TO TREAT COUGH

II. MUCOLYTIC III. EXPECTORANTS

Pharmacodynamics: Pharmacodynamics :
= Decrease viscosity of secretions = Reduce adhesiveness and surface
Protects liver cells from acetaminophen tension of URT
Productive cough Facilitates the removal of viscous mucus
Take in the morning
Nursing Considerations: drink plenty of
fluid
Acetylcysteine Guiafenesin
Ambroxol Robitussin Expectorant
S-Carboxymethyl Carbocisteine
Dornase Alfa
 UPPER RESPIRATORY TRACT DRUGS
IV. ANTIHISTAMINE: V. ANTITUSSIVE
Pharmacodynamics: Pharmacodynamics:
= =

A. First Generation:
a. Diphenhydramine a. Dextromethorphan
b. Chlorpheniramine
c. Hydroxyzine b. Benzonatate

B. Second Generation c. Codeine

a. Cetirizine
b. Loratadine
c. Desloratadine
 RESPIRATORY DRUGS
Lower Respiratory Tract
Drugs for Asthma and
COPD

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 Medications TO TREAT BOTH ASTHMA AIRWAY
PROBLEMS

• Problem ? • GOAL ?

• BRONCHOCONSTRICTION •bronchoDILATION
• INFLAMMATION
• BLOCKS THE
INFLAMMATION
 PROBLEM: 1. BRONCHOCONSTRICTION FORMOTEROL
SALMETEROL

ALBUTEROL •SABA(Short
SABAacting Beta 2 agonist • LABA
LABA (Long acting Beta 2 agonist)

LEVALBUTEROL ( Short- ( Long-

TERBUTALINE acting Beta Long-term Inhalers acting Beta
2-Agonist ) Emergency Rescue
Emergency 2-Agonist )
Long-Term
Inhalers
Rescue
Inhalers
Inhalers

Xanthines
Anti-
Anti-cholinergic IPRATROPIUM
Xanthines cholinergic
Anti-cholinergic blocks the muscarinic
CAFFEINE receptors in the lungs
• Blocks the
AMINOPHYLLINE • Directly relax
the smooth muscarinic
THEOPHYLLINE receptors in
muscle lungs
 LOWER RESPIRATORY TRACT DRUGS

I. BRONCHODILATORS : ( Antiasthmatics )
Pharmacodynamics:
Dilate airways-> facilitate respirations
= Indications: Asthma, COPD

a. SYMPATHOMIMETICS
Pharmacodynamics:
= Reacts at alpha

EPINEPHRINE
ALBUTEROL
TERBUTALINE
FORMOTEROL
SALMETEROL
 LOWER RESPIRATORY TRACT DRUGS
I. BRONCHODILATORS : ( Antiasthmatics )
Parasympatholytic
b. ANTICHOLINERGICS
= Blocks the muscarinic receptors in the lungs
Reduce vagal cholinergic tone
Reduces mucus hypersecretion
Off label use for asthma
More use with COPD
S/E: dry mouth, irritation of pharynx

IPRATROPIUM
TIOTROPIUM
I. BRONCHODILATORS : ( Antiasthmatics )

C. METHYLXANTHINES
Pharmacodynamics:
= Directly relaxes bronchial smooth muscles, increase vital capacity
Less effective than beta 2 agonist but longer duration
Narrow therapeutic window: target 5-15 mcg/ mL
Nursing Considerations:
1. Administer oral drug with food or milk
2. Monitor for side effects(palpitation and Tremors)
3. Dietary control of caffeine( coffee, soda, tea)
4. Monitor serum theophylline levels
>20 mcg/ ml= Nausea (1st sign)
> 30 mcg/ ml = tremors (later signs)
5. Serious SD: Dysrhythmia, convulsions
6. Antidote: NONE
INFLAMMATORY RESPONSE = normal response of a vascularized tissue to injury
= destroys pathogen, promotes healing
BRONCHOCONSTRICTION
E
NAS
GE
OXY
LIP LEUKOTRIENE CHEMOTAXIS healing

Arachidonic Acid
DOLOR
I MUCUS
N CY
CL BICARBONATE
OO PROSTAGLANDIN STOMACH
J XY
G
OX ENAS
(C HCl ACID
U 2) E2 FEVER
R
Y
THROMBOXANE A2 CLOTTING

BLOOD FLOW TO
KIDNEY

VASODILATION BLOOD FLOW RUBOR

HISTAMINE
CALOR

CAPILLARY LEAK OF PLASMA TUMOR

PERMEABILITY PROTEIN
 PROBLEM: 2. INFLAMMATION

GLUCOCORTICOIDS
Produced by the adrenal Cortex in
body
Can be given as meds by; inhaled,
oral, IV
Uses: prevent asthma attacks
Given on fixed schedules, NOT PRN
Suppress inflammation
Nursing Considerations:
Not used during acute attacks
Use bronchodilator before
corticosteroids aerosol
Hold the inhaled drug for a few
seconds before exhaling
Allow 1-3 minutes to elapse between
each inhalition
Rince mouth with water after-
destroys normal flora- stomatitis
Notify provider if sore throat or sore
mouth occurs (signs of infection)
Do not stop abrubtly(Addisonian
Crisis)
Nursing Considerations : CORTICOSTEROIDS

1.NOT used during acute attacks.

2.Use bronchodilator before corticosteroid aerosol.
3.Hold the inhaled drug for a few seconds before exhaling.
4.Allow 1-3 minutes to elapse between each inhalation.
5.Rinse mouth with water after.
6.Notify provider if sore throat or sore mouth occurs
7.Do not stop abruptly.
8.Must taper off gradually under provided supervision.
 PROBLEM: 2. INFLAMMATION

MAST CELL STABILIZERS

Inhaled meds
Mast cell stabilize
Suppresses inflammation (not relieve
bronchoconstriction)
 PROBLEM: 2. INFLAMMATION

LEUKOTRIENE INHIBITORS
MONTELUKAST
 Nursing pharmacology
103
Florence R. Benavidez-Grageda, M.D.

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REVIEW
ACADEMY
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 Learning objectives
• At the end of this unit the students are expected to;
1. Review the different drugs affecting the
Cardiovascular System
a. Coronary Artery Disease
i. Angina
ii. Myocardial Infarction
b. Drugs affecting blood coagulation
b. AntiHypertensive Drugs
c. Agents used for Heart Failure
 CARDIOVASCULAR
DRUGS

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 The Heart and Blood Pressure

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ANGINA
Drugs FOR ANGINA PECTORIS
 Drugs FOR ANGINA PECTORIS
• Nitrates
NITROGLYCERINE
ISOSORBIDE MONONITRATE
ISOSORBIDE DINITRATE

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 Drugs FOR ANGINA PECTORIS
• Calcium Channel Blocker
VERAPAMIL
NIFEDIPINE
AMLODIPINE
FELODIPINE
DILTIAZEM

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 Drugs FOR ANGINA PECTORIS
• Beta Adrenergic Blocker
METOPROLOL
NADOLOL

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 Drugs Affecting Blood Coagulation
• Antiplatelets • Antifibrinolytic
Aspirin Aminocaproic acid
Clopidogrel Tranexamic acid
• Anticoagulants • LOW-MOLECULAR
Warfarin WEIGHT HEPARINS
Heparin • DEAKTEOARUB
• Thrombolytics • ENOXAPARIN
Alteplase • ANTICOAGULANT
Streptokinase ADJUNCTIVE THERAPY
Reteplase • VITAMIN K
Urokinase • LEPIRUDIN
• PROTAMINE SULFATE
 Drugs Used for MYOCARDIAL INFARCTION

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COAGULATION CASCADE fibrinolytic CASCADE
INJURY

vasoconstriction
Plasminogen ( liver )
formation of platelet plug

intrinsic pathway extrinsic pathway

Plasmin
liver Vit. K
Prothrombin Thrombin

Fibrinogen Fibrin

CLOT
 Drugs Used for MYOCARDIAL INFARCTION
• ANTIPLATELETS:
ASPIRIN
CLOPIDOGREL

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 Drugs Used for MYOCARDIAL INFARCTION
• ANTICOAGULANT:
WARFARIN

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 Drugs Used for MYOCARDIAL INFARCTION
• ANTICOAGULANT:
HEPARIN

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 Drugs Used for MYOCARDIAL INFARCTION
• THROMBOLYTICS:
HEPARIN

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 ANTIHYPERTENSIVE DRUGS

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 BP = CO x TPR
Amount of blood
ejected per STROKE TOTAL PERIPHERAL RESISTANCE/
or BEAT SYSTEMIC VASCULAR RESISTANCE
HEART RATE
STROKE VOLUME

BP = HR X SV X TPR/SVR
CARDIAC
OUTPUT CO
Amount of blood
ejected per MINUTE

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 How to compute MAP ?
MAP = SBP + 2 (DBP)
3

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 ANTIHYPERTENSIVE DRUGS
ACTING ON
RAAS
§ Drug acting on RENIN
§ Drug acting on ACE receptor
§ Drug acting on the Angiotensin 2 receptors
§ Drug acting on ALDOSTERONE

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 ANTIHYPERTENSIVE DRUGS
ACTING ON
ANS RECEPTORS
§ Drugs acting on ALPHA 1 ADRENERGIC receptors
§ Drugs acting on the CNS ( ALPHA 2 receptors )
§ Drugs acting on BETA ADRENERGIC receptors

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 VASODILATOR
ANTIHYPERTENSIVE DRUGS

§ Indirect Acting Vasodilators

§ Calcium Channel Blockers
§ Direct Acting Vasodilators
§ Vasodilators

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 ANTIHYPERTENSIVE DRUGS
§ ANGIOTENSIN CONVERTING ENZYME ( ACE ) INHIBITORS. “ pril "
§ CAPTOPRIL Adverse Effects:
§ ENALAPRIL ü Kidney damage in
px with prior
§ ANGIOTENSIN 2 RECEPTOR BLOCKER ( ARB ) “ sartan ” damage
§ LOSARTAN ü X’s drop in BP
§ VALSARTAN

§ ALPHA 1 ADRENERGIC ANTAGONISTS “ zosin ”

§ PRAZOSIN
§ DOXAZOSIN
§ TERAZOSIN

§ ALPHA 2 ADRENERGIC AGONIST

§ CLONIDINE
§ METHYLDOPA
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 ANTIHYPERTENSIVE DRUGS

§ BETA ADRENERGIC BLOCKERS “ olol ”

§ PROPRANOLOL

§ BETA1 - SPECIFIC ADRENERGIC BLOCKERS “ olol ”

§ BETAXOLOL BISOPROLOL
§ ESMOLOL
§ ACEBUTOLOL ATENOLOL
§ METOPROLOL

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 ANTIHYPERTENSIVE DRUGS
§ DIURETICS
§ THIAZIDE
§ HYDROCHLOROTHIAZIDE

§ LOOP DIURETIC
§ FUROSEMIDE ( LASIX )

§ POTASSIUM-SPARING
§ SPIRONOLACTONE
§ AMILORIDE
§ TRIAMTERENE

§ OSMOTIC DIURETICS
§ MANNITOL

§ CARBONIC ANHYDRASE INHIBITORS ( CAH INHIBITORS )

§ ACETAZOLAMIDE ( DIAMOX )
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 ANTIHYPERTENSIVE DRUGS

§ VASODILATORS:
§ INDIRECT – ACTING: § DIRECT – ACTING:

§ CALCIUM CHANNEL BLOCKERS § VASODILATORS

§ VERAPAMIL § HYDRALZINE ( APRESOLINE )
§ NIFEDIPINE § NITRATES
§ NICARDIPINE § NITROGLYCERINE
§ AMLODIPINE § ISOSORBIDE DINITRATE or
§ FELODIPINE MONONITRATE
§ DILTIAZEM § NITROPRUSIDE
§ MINOXIDIL

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 Drugs USED FOR HEART FAILURE

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 CARDIAC GLYCOSIDE:
DIGOXIN

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 BETA 1 ADRENERGIC AGONIST:
DOPAMINE

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 Nursing pharmacology
104
Florence R. Benavidez-Grageda, M.D.

TOPRANK
REVIEW
ACADEMY
TOPRANK | Nursing
 Learning objectives

• At the end of this unit the students are expected to;

1. Review the different agents affecting the
Gastrointestinal Tract
2. Review the agents affecting the Endocrine system
a. Diabetes Mellitus
b. Thyroid Diseases
3. Review of Antimicrobial Agents
4. Analgesics and Antiinflammatory Drugs
5. Dosage and Calculation
 Gastrointestinal drugs

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 § DRUGS AFFECTING GASTRIC SECRETIONS

§ Drugs for PUD, GERD and Gastritis

§ Antacids
§ H2 Receptor Blockers
§ Proton Pump Inhibitors
§ GI Protectives
§ Sucralfate
§ Prostaglandin
§ a. Misoprostol
 Drugs Used for PUD, GERD and GASTRITIS
• ANTACIDS:
ALUMINUM HYDROXIDE
MAGNESIUM HYDROXIDE
MILK OF MAGNESIUM

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 Drugs Used for PUD, GERD and GASTRITIS
• HISTAMINE 2 ANTAGONISTS:
CIMETIDINE
RANITIDINE

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 Drugs Used for PUD, GERD and GASTRITIS
• PROTON PUMP INHIBITORS:
OMEPRAZOLE
LANZOPRAZOLE

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 Drugs Used for PUD, GERD and GASTRITIS
• CYTOPROTECTIVE:
SUCRALFATE

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 Drugs Used for PUD, GERD and GASTRITIS
• PROSTAGLANDIN AGONIST:
MISOPROSTOL

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 Endocri ne dr ug s

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 DRUGS TO CONTROL BLOOD
GLUCOSE

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 ORAL HYPOGLYCEMIC AGENTS
1. Sulfonylureas 3. THIAZOLIDINEDIONES
• First-Generation Sulfonylureas (GLITAZONES)
– chlorpropamide pioglitazone
– tolazamide
4. BIGUANIDES
– Tolbutamide (Orinase)
• Second-Generation metformin
Sulfonylureas 5. ALPHA-GLUCOSIDASE
– glimepiride INHIBITORS
– glipizide acarbose, miglitol
– glyburide
2. Meglitinides (Glinides)
Nateglinide, Repaglinide
 ORAL HYPOGLYCEMIC AGENTS: ( oha )
Pharmacodynamics
• SULFUNYLUREAS
• more insulin production
• MEGLITINIDES
• more insulin secretion
• THIAZOLIDINEDIONES “glitazones”
• dec. hepatic glucose production
• BIGUANIDES
• suppresses hepatic production of glucose and increases insulin
sensitivity
• ALPHA-GLUCOSIDASE INHIBITORS
• delay absorption of ingested cho
 INSULIN

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 Type Example Onset Peak Duration
HYPOGLYCEMIA

Rapid Acting Lispro (Humalog)

Aspart (Novalog)

Regular
Short (Humulin R)
(Novolin R)

Intermediate NPH

Long acting Glargine (Lantus)

Detamir (Levamir)
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 HYPOGLYCEMIA
• GLUCAGON

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 G t he
FECTIN
G A F
D R U
THYROID GLAND

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 THYROID DISEASE : HYPOTHYROIDISM
§LEVOTHYROXINE ( SYNTHROID )
§LIOTHYRONINE ( TRIOSTAT )
§LIOTRIX
§THYROID HORMONE

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 THYROID DISEASE : HYPERTHYROIDISM
I. THIONAMIDES
§ PROPYLTHIOURACIL ( PTU )
§ METHIMAZOLE

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 THYROID DISEASE : HYPERTHYROIDISM
II. IODIDE SALTS:
§ LUGOL’s Solution

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 THYROID DISEASE : HYPERTHYROIDISM
III. RADIOACTIVE IODINE:
§ 131 I

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 ANTIMICROBIALS

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ANTIMICROBIALS CLASSIFICATION ACCORDING TO
SITE OF ACTION
§ BLOCKS CELL WALL SYNTHESIS
§BETA LACTAMS
§PENICILLINS
§CEPHALOSPORINS
§CARBAPENEMS
§MONOBACTAM
§ GLYCOPEPTIDES
§ VANCOMYCIN
 ANTIMICROBIALS CLASSIFICATION ACCORDING TO
SITE OF ACTION

§BLOCKS PROTEIN SYNTHESIS

§ MACROLIDES
§ CHLORAMPHENICOL
§ LINCOSAMINES
§ AMINOGLYCOSIDES
§ TETRACYCLINES
ANTIMICROBIALS CLASSIFICATION ACCORDING TO
SITE OF ACTION

§FOLIC ACID SYNTHESIS INHIBITOR

§SULFONAMIDES
§TRIMETHOPRIM

§ NUCLEIC ACID SYNTHESIS INHIBITOR

§FLUOROQUINOLONES
 Dosage
AND c a l c u l a ti o n

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Formula in computing for Drug Dosages
Order: Tempra 250 mg every 4 hours for fever prn.
Supply:
Tempra 100 mg / ml
D Tempra 125 mg / 5 ml
------ x Q = a Tempra 250 / 5 ml
S Tempra 250 mg cap
Tempra 500 mg cap
A = amount
D = Desired dose
S = stock
Amount/Dose?
Q = quantity 250 mg per dose
----------------------- X 5 ml
125 mg
 FORMULA in Computing for the FLUID FLOW RATE

amount to be infused drop factor

------------------------------- x ----------------- = rate
hour of infusion 60 mins/h

ml gtts/ml
----- x -------- = gtts/min
h 60 min/h
TOPRANK | Nursing
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