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     


  Dangerous Drug Act of 1972

  Comprehensive DDA of 2002
  Generics Act of 1988
  Special Law on Counterfeit
Drugs
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þ 
!"
  
nsensibility, stupor, melancholy, or
dullness of mind with delusions
May be habit-forming
nclude opium & opium derivatives,
and synthetic opiates
  
 

 
# 

mpium (e.g. heroine, morphine)
Cocoa leaf (e.g. cocaine)
ǹ and ȕ eucaine
Hallucinogenics (e.g. mescaline, LSD)
ndian hemp
  
 

    

Sedatives (e.g. phenobarbital,
barbituric acid salts)
Amphetamines (e.g. benzedrine,
dexedrine)
Hypnotics (e.g. methaqualone)
 O
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þ ?reparations described in Sec. 7 of the
Narcotic Drugs Law (R.A. 953)
þ Contains Nm MmRE HAN:
2 grains of opium, or
¼ grain of morphine, or
1/8 grain of heroine, or
1 grain of codeine, or
1 fluid oz. of above derivatives, or
1 avoirdupois oz. of above derivatives
c
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þ Nurses can handle narcotics, in

the course of their professional
practice, only as agents of
practitioners of institutions under
whose direction or supervision
their duties are performed.


% 

þ How the body acts on the drug

þ nvolves absorption, distribution,
biotransformation, & excretion of drugs
þ nclude the onset of drug action, drug
half-life, timing of the peak effect,
duration of drug effects, drug
metabolism, and site of excretion
#
"

þ Refers to what happens to the drug from

the time it is introduced to the body until
it reaches the circulating fluids and
tissues.
þ A large percentage of the oral dose of
the drug is destroyed by liver enzymes
and never reaches the tissues.

# 

þ nvolves the movement of a drug to the

body¶s tissues
þ Factors affecting distribution include the
drug¶s lipid solubility and ionization, and
the perfusion of the reactive tissue.
þ Many drugs are bound to proteins and
are not lipid soluble.
ÿ



þ he liver is the single most important
site where drugs are detoxified into less
active chemicals that are more easily
excreted.
þ Some drugs cannot be taken together
effectively. he presence of one drug
can speed up the metabolism of other
drugs, preventing them from reaching
therapeutic levels.
O 

þ he removal of the drug from the body
through the skin, saliva, the lungs, bile,
and feces
þ he kidneys play the most important role
in drug excretion.
þ he half-life of the drug is the time it
takes for the amount of drug in the body
to decrease to ½ of the peak level.


 


þ How the drug affects the body

þ Deals with interactions between
chemical components of living systems
and the drugs that enter those systems

&
'


þ -hen 2 or more drugs are taken

together, there is a possibility that
these drugs will interact with each
other to cause unanticipated effects in
the body.
 è 
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1. ntestinal Absorption
2. Competition for plasma protein binding
3. Drug metabolism
4. Action at the receptor site
5. Renal elimination
6. Electrolyte imbalance
 
&è '

D mccurs when the drug and the food
are in direct contact with the stomach
D Some foods increase acid production,
speeding up the breakdown of the
drug and preventing absorption and
distribution.
D mral drugs are best taken on an empty
stomach

&è '


1. Antacid vs. Bran & -hole Grain bread

2. Antibiotics vs. Citrus Fruit & Caffeine
3. etracycline vs. Calcium-rich foods
4. Anticoagulants vs. Vitamin K-rich foods
5. MAm nhibitors vs. yramine-rich foods
 w "  

D ACE nhibitors
D Acetaminophen & NSADS
D Alcohol, ?henytoin
D ron
D Erythromycin, rimethoprim-SMZ
D Estrogens
D Fluconazole & Ketoconazole
D soniazid, Rifampin, Sulfonamides
 c "
 

D Acyclovir
D Acetaminophen, NSADS
D Aminoglycosides, Vancomycin
D Amphotericin B
D Ciprofloxacin
D Cisplatin
D Methotrexate
D Rifampin, etracycline, Sulfonamides
 m 

D Aminoglycosides: Vancomycin,
Erythromycin,
D Bumetanide
D Cisplatin
D Ethacrynic Acid
D Furosemide
D NSADs, ASA
D Hydroxychloroquine
 ë

#
 
   (Bactericidal) ± for
Gram (-) infections
 ë " "
 (Bactericidal /
Bacteriostatic) ± for G(+) & G(-)
infections
 è
(    (Bactericidal) ± for
G(+) & G(-), U , bone & joint infections
 ) 
   (Bacteriostatic) ± For G(+) &
G(-); allergy to penicillin
 ë

#
    (Bactericidal) ± for G(+) &
G(-), U , R , syphilis, meningitis, &
skin infections (mx, Clox, DiClox & Naf)
 * 
  (Bacteriostatic) ± for G(+)
& G(-), U , R , acute mM
 è
(    (Bactericidal) ± for
Gram (+) & Gram (-) infections
 ë

#
 + 
  (Bacteriostatic) ± For G(+)
& G(-) aerobes & anaerobes, skin
infections, chlamydia, syphilis, Lyme dse
9. Vancomycin HCl (Bactericidal) ± Anti-
biotic-associated pseudomembranous
infections.
10.Antimycombacterials
a. Rifampin ± mpairs RNA Synthesis
b. soniazid ± mpairs DNA Synthesis
 #)O'ë+O
 )onitor for superinfections.
 Ovaluate liver & renal functions.
 iarrhea
 'nform provider prior to taking others.
 ëulture prior to initial dose.
 lcohol is out. Ask about allergies.
 +ake the FULL course of the drug.
 Ovaluate culture, -BC, temp, etc.
   
D ncreases fungal cell membrane
permeability causing cell death
D Systemic fungal infections
D nfusion-related reactions, drying of skin,
pruritus, nephrotoxic
D Steroids increase risk of hypoK
D ncreases digoxin toxicity
D Ampho-B
 "
, 

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 ,
D For trichomoniasis, amoebiasis, &
gardnerella vaginalis infections.
D -mF: HA, dizziness, ataxia, anorexia,
N & V, diarhea, metallic taste, and
superinfections like candidiasis
D Flagyl
 "
, 

 

 
D nterrupts plasmodial reproduction &
protein synthesis
D -mF: HA, dizziness, N & V, diarrhea,
alopecia, blindness, hepatotoxicity
D Chloroquine
 -


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± -mF: lightheadedness, insomnia,
nausea, orthostatic hypotension,
urinary retention
± Amantadine, Ribavirin, -irazole,
Flumadine
 -


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± nhibits viral DNA replications
± -mF: N & V, HA, insomnia, rash,
hair loss
± Acyclovir
 -


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± inhibits viral replication
± HA, dizziness, myalgia, N & V, flu-like
symptoms, rash, BM depression
± Lamivudine, ndinavir, Zalcitabine,
Zidovudine
  " 
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 ëBC/platelet monitoring
 ntiemetics before drug
 cephrotoxicity
 ëounseling about reproduction issues
 Oncourage handwashing, avoid crowds
 ecommend a wig for the alopecia
  %  
D Cell death/mutation of malignant growth
D CLL, malignant lymphomas, Hodgkin¶s
disease, breast, lung & ovarian CA
D Adverse Effects (BAD):
± ÿone marrow suppression
± norexia & Alopecia
± istressful N & V
D Busulfan, Carboplatin, Carmustine
 
 #  
D nterferes with the building blocks of
DNA synthesis
D For myelocytic leukemias, breast,
cervical, colon, liver, ovarian pancreatic,
gastric, & rectal CA
D AE: G disturbance, oral & anal
inflammation, BM depression, alopecia,
renal dysfunction, thrombocytopenia
D Capecitabine, Cytarabine, Floxuridine
 °   

 #  
 )onitor CBC & platelets weekly.
 Ovaluate renal function.
 +emperature assessment q4 ± 8 hours
 sepsis (strict)
 ÿleeding, anemia, infection, nausea
 mral hygiene (use soft toothbrush)
 ots of fluids (2 ± 3 L/day)
 'ntake & mutput monitoring
 +  protocols for handling & administering
Omphasize protective isolation
 '

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D Analgesic, anti-inflammatory, antipyretic
 *   anti-inflammatory
 '

 ) 

a. mmune Stimulants
D nhibit tumor growth and replication;
prevent virus particles from replicating
inside other cells
b. mmune Suppressants: ransplant rejection
'

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D Stimulate active immunity
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D provides passive immunity
 
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1. SSRs (CNS)
D Selective inhibition of serotonin
2. ricyclic Antidepressants (HA S)
D Blocks re-uptake of norepinephrine and
serotonin
3. Monoamine mxidase nhibitors
D nhibits the enzyme (MAm) that breaks
down norepinephrine
 
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1. Antipsychotics
D Blocks dopamine receptor sites
2. Antiepileptics
a. For onic-Clonic Seizures
D Reduce motor cortex activity by
altering transport of ions

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b. For ?artial Seizures
D ?revent polysynaptic responses &
inhibit post-tetanic potentiation
3. Anti-anxiety Drugs
a. Benzodiazepines (ANXE
)
D Enhance the action of GABA,
which inhibits the transmission of
nerve impulse; depress the limbic
& subcortical CNS

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a. Dopaminergics
D Helps restore balance between
the inhibitory and excitatory
neurons
 
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D nterfere w/ reflexes causing the
muscle spasm (spasmolytics)
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D Reduces muscle action potential-
induced release of calcium into
the SR limiting the cross-bridging

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D Acts at specific opioid receptor
sites in the CNS to produce
analgesia, sedation and sense of
well being
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D Acts on opioid receptor site
D Blocks opioid receptors

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D Blocks opioid receptors and
reverses the effects of opioids
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D Ergot derivatives: Blocks alpha
adrenergic & serotonin receptor
sites; riptans: Bind to selective
serotonin receptor sites

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a. General
D Depresses the reticular activating
system and the cerebral cortex
b. Local
D Blocks nerve depolarization
throughout the system

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D Cause prolonged depolarization
that first causes muscle
contraction and then flaccid
paralysis
D Serve as adjuncts to general
anesthetics during surgery and
facilitate mechanical intubation
 
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D Hypotension, shock, bronchospasm,
asthma; used to block nerve impulse
conduction; for spinal anesthesia and relief
of local pain
ÿ 

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D Hypertension, diagnosis and management
of pheochromocytoma, B?H, chronic
angina, used in reducing anxiety and
intraocular pressure, ?VC and arrhythmias

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C.Cholinergic Agents
D à activity of Ach receptor sites
throughout the body to counter the
action of some muscle-relaxing drugs
D.Anticholinergic Agents
± Blocks cholinergic receptor sites so
response to acetylcholine is ; for
bradycardia & heart block; ?arkinson's
disease; preoperatively, to
secretions & vagal stimulation
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1. Growth Hormone
2. Growth Hormone Antagonist
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w

 
1. Antidiuretic Hormone
2. mxytocin
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D Anti-inflammatory and
immunosuppressive effects
D Administer the drug daily
around 8 to 9 a.m. to mimic
normal peak diurnal
concentration levels
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D à reabsorption in renal tubules
D à potassium & hydrogen
excretion
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D † metabolic rate, m2
consumption; body growth
 &
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D nhibits hyroid Hormone
synthesis
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D Vit. D regulates Ca intestinal
absorption
 &"
 
 
D Calcitonin directly acts on serum
calcium levels
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D hepatic glucose production
D † insulin uptake
 * 

D Stimulates insulin release
D † peripheral sensitivity
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D † glucose transport
D Rapid-Acting: Regular, Humulin-R
D ntermediate-Acting: Humulin
D Long-Acting: Humulin-L
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þ affects the release of pituitary
gonadotropins; promotes bone
formation
ÿm 
þ Stimulates contraction of uterine
muscle fibers
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 - *




 
þ à the retention of N, Na, K, &
phosphorus, & Ļ urinary
excretion of Na. à protein
anabolism & production of RBC
& Ļ protein catabolism
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 - *



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þ Relaxes vascular smooth
muscles & Ĺ blood flow into the
corpus cavernosum causing
erection
 ë
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D increases the force of myocardial
contraction
ÿ  

D Relaxes vascular smooth muscles
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D  cardiac excitability
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D blocks conversion of angiotensin 
to angiotensin 
 ÿ  

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D Binds to Beta-1 (cardiac) & Beta-2
(lungs) adrenergic sites that
prevents catecholamine release
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D Blocks calcium access to the cells
causing a  in contractility, 
arteriolar constriction
 ë 
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D Decrease the release of adrenergic
hormones
.   

D irectly acts on vascular smooth muscle
causing vasodilation
D 'ncreased renal and cerebral blood flow
D upus-like reaction (fever, facial rash, muscle
and joint ache, splenomegaly)
D ssess for peripheral edema
D +ake with food
D mther Adverse effects - Headache, dizziness,
anorexia, tachycardia and Hypotension
D eview B?


 "

D nhibits sodium, chloride & water
reabsorption in the proximal
portion of the ascending L of H.
 + , 
D inhibiting reabsorption of Na, Cl &
water in the distal portion of the
ascending L of H.
 m

 Ĺ osmotic
pressure of glomerular filtrate
  

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D ëheck VS, platelete count, ?
D mbserve for bleeding
D eview bleeding protocol (i.e. electric
razors, soft toothbrushes, etc.)
D void ASA, may use Acetaminophen
  
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* 

D Combines with antithrombin  to

retard thrombin activity
D à effect with aspirin, alcohol and
antibiotics;  effect with digoxin
(Lanoxin), antihistamines, and
nitroglycerin products; à risk of
bleeding with chamomile, garlic,
ginger, ginkgo
  

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D inhibits platelet synthesis of
thromboxane A2, a
vasoconstrictor and inducer of
platelet aggregation
  

 +

# 
D Binds with plasminogen
causing conversion to plasmin
which dissolves blood clots
ë
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D Combines with bile acids in the
intestine resulting in excretion in
the feces
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D competitive inhibitors of HMG-
CoA reductase (for cholesterol
biosynthesis in the intestines &
liver
 "

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D Blocks histamine release at H1
receptors
ÿëm

 5  
D nhibits phosphodiesterase
(breaks down cyclic AM?)
resulting in bronchodilation &
reducing airway resistance
 "

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D Ļ inflammation and edema, Ļ
bronchoconstrictions and secretion
of mucus
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D Blocks the receptor that inhibits
leukotriene formation
° 
  *


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D Neutralizes gastric acid;
decreases pepsin activity
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D prevents histamine-induced acid
release by competing with
histamine for H2 receptors
° 
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3. Carafate
D Forms a protective covering on
the ulcer surface and also
inhibits pepsin activity in gastric
juices
4. ??
D increases gastric pH
D reduces gastric acid production
° 
  *


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D nhibits gastric motility
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D rritates the G mucosa locally
which stimulates the C Z to
induce vomiting within 20
minutes
° 
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 &
 
D Locally these drugs decrease
the local response to stimuli
that is being sent to medulla to
induce vomiting.
D Centrally, these drugs directly
block the C Z or suppress the
vomiting center
° 
  *



°  * # ,

D Suppress the synthesis of
cholesterol and cholic acid by
the liver
D Contraindicated in patients with
calcified stones which are not
dissolved; and in billiary tract
obstruction
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D mbtain baseline data & VS
D Determine allergies
D Determine hepatic/renal dysfunctions
D Monitor px¶s reaction to drugs
D Determine Drug-Drug nteractions
D Conduct serum/electrolyte analysis &
hepatic & renal function during therapy
D ?rovide patient education
D ?rovide safety/comfort measures
è


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1. Solids
D = Desired dose / Stock
2. Liquids
D = (Desired dose / Stock) x dilution
è


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ÿ'.è  è ! 
1. Gtts/min = Volume in cc x gtt factor
no. of hours x 60 min.

2. cc/hr = Volume in cc / no. of hours

= gtts / min x 4
è


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1. °C to °F = (°C x 1.8) + 32

2. °F to °C = (°F ± 32) (0.55)

è


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1. Clark¶s Rule
D (-t in lbs/150) x adult dose
2. Freid¶s Rule
D (Age in mos/150) x adult dose
3.
oung¶s Rule
D Age (yrs)/Age (yrs)+12 (adult dose)