BROAD DRUG CLASSIFICATION

APPLIED PHARMACOLOGY
HBNC 6420405
Ms NORALENE OSMAN
Learning Objectives
At the end of learning sessions, the students able
to:
1. List types of medications
2. Define, list and give example of medications.
3. State the routes of administration, dosage and
indications
4. Describe the side-effects and contraindications
of drugs
5. Describe the nursing interventions related to
drugs
 Drug group / classification
1. Anticoagulant
2. Antacid
3. Diuretic
4. Antipyretic
5. Analgesic
6. Antihypertensive
7. Antiarrhythmics
8. Antiemetic
9. Nitrates
10. Bronchodilator
11. Others
Anticoagulant drug type :
A) Parenteral anticoagulant

B) Oral anticoagulant
A) Parenteral anticoagulant

Drug action :
• Prevent thrombosis occurs in the heart
or blood vessels to prevent blood clots
against thromboplastin
• Thus preventing the conversion of
prothrombin to thrombin and fibrinogen
can not be turned into a fibrin for blood
clotting

• Example: Heparin
• HEPARIN

• Indication :
1.Pulmonary / peripheral arterial
embolism
2.Venous thrombosis
3.Atrial fibrillation with embolization
4.Intravascular coagulation
 Contraindication :

1.Active bleeding
2.Blood dyscrasias – component of
blood e.g. hemophilia
3.Hypoprothrombinemia-factor II
level low
 Route of drug administration and
dosage :

• Parenteral - Deep SC
Dosage : 8,000 – 10,000 units tds /
15,000 – 20,000 units bd

• Parenteral – IV
Dosage : 5,000 – 10,000 units in
24 hours
 Side-effects :

1.Thrombocytopenia (low level of

platetelet)
2.Hypersensitivity like fever, urticaria,
chills
3.Hematuria
4.Shock
• Nurse’s responsibilities

1. Check prothrombin time (PTT) and blood

clots (CBC) every day
2. Ask patient if having bleeding e.g. gums,
urine, stool or vomitus
3. Taking vital signs and observation of the
patient's neurological status
4. Administration through subcutaneous,
advise patients do not massage
• Oral anticoagulant
• Drug action :
Anticoagulants achieve their effect by
suppressing the synthesis or function of
various clotting factors that are normally
present in the blood. 
Example: Tab. Warfarin
• WARFARIN
Route of administration : Oral
• Starting dosage: 10 – 15 mg
• Maintenance dosage: 2 – 15 mg /day
Indications :
1.Venous thrombosis
2.Atrial fibrillation
3.Pulmonary embolism

• Contraindication: Lactation
Side-effects :
1.Bleeding
2.Diarrhea
3.Anorexia
4.Abdominal cramping
5.Effects on skin e.g. dermatitis, urticaria,
alopecia
Nursing interventions :

1. Ask the patient about bleeding in

gums, urine, stool, vomit or signs of
bleeding in the skin
2. Check PT time ( Prothrombin time )
or INR (international normalized ratio)
3. Check the urine for RBC every day
4. Hear complaints from patients such as
pain in the lumbar to show there is
bleeding in the retroperitoneal area
 2. ANTACID
Definition:
• Medicines used to relieve pain due to
gastritis or peptic ulcers
Drug action :
i. Reduce or neutralize acidity in gastric acid.
The effect reduces inflammation of the
lining of the gastric mucosa
ii. Buffering and protect the mucosa layer.
This provides the opportunity for the
injured mucosa to heal
Types of antacid :
i) Simple antacids
ii) Compound antacids

i) Simple antacids
Example :
• Magnesium Trisilicate ( MMT )
• Sodium Bicarbonate ( NaHC3 )
• Calcium Carbonate ( CaCO3 )
MAGNESIUM TRISILICATE ( MMT )

Route of drug administration :

• Oral ( Mixture dan powder)
• Dosage 15 ml tds ( after food)

Side effects :
Diarrhea
• Nursing interventions
1. Give ½ - 1 hour after meals and at
bedtime
2. Drugs that can not be taken with
antacids as influencing actions such as
tetracycline, indocid and digoxin
3. Avoid foods that are rich in protein
because
it can increase the level of acid in the
stomach
• SODIUM BICARBONATE (NAHC)3
Route of drug administration :
Orally and after food
Dosage:
Tablet : 0.325 – 2 g, 1 - 4 times per day
Oral powder: ½ teaspoon in a glass of
water
 Indications :
1. Hyperacidity
2. Severe diarrhea
3. Acute mild and moderate metabolic

Contraindications :
1. Hypertension
2.Congestive Heart Failure,
3.Convulsion
Side-effects :

1.Hypercalcemia
2.Metabolic alkalosis ( dizziness, cramps,
thirst, anorexia, tetany)
3.Hyperirritability
• Nursing interventions
1. Make observations of the patient's skin
and dry mucous membranes,
polydipsia, polyuria or thirst because it
showed symptoms of metabolic
acidosis
2. Monitor the quality and consistency of
stool during the therapy given

3. Do not give medications with enteric -

CALCIUM CARBONATE ( CACO3 )

Route of drug administration:

• Oral
Medicine in tablet form (can be chewed)
tablet, suspension and lozenges
Dosage : 0.5 – 1.5 g

Indications :
• Mild hypocalcemia
1.Heartburn
2.Antihyperphosphatemic
 Contraindication :
Severe renal disease

Nursing intervention:
1. Observe patients for signs of
hypercalcemia such as depression and
bradycardia
ii) Compound antacids

Example :
• Gelusil Tablet (magnesium trisilicate
500 mg + alumunium hydroxide 250
mg )
• Actal Tablet(alexitol sodium 360 mg)
 3. DIURETIC
Definition :
• The drug can increase the urine
production

• Types of diuretic :
1.Thiazide diuretics
1.Loop Diuretics
2.Potassium - Sparing Diuretics
3.Osmotic Diuretics
 1. Thiazide diuretics
Action :
i) Prevent reabsorption of sodium ions,
potassium and water in the distal
convoluted tubule in the renal
ii) It reduces blood volume and lower blood
pressure
ii) Urine output increased. Action drugs
cause loss of potassium
Example :

• Chlorothiazide 0.5 – 2 g / day

( Tab., IV )
• Tab. Metolazone 2.5 – 20 mg / day
• Tab. Methyclothiazide 2.5 – 10 g/day
• Tab. Indapamide 2.5 mg / day
 CHLOROTHIAZIDE
Route of drug administration :
• Oral
• IV
Dosage : 0.5 – 2 g/day

Indications :
1. Congestive heart failure
2. Hypertension
3. Nephrotic syndrome
4. Cirrhosis Liver
Side-effects :
• Disturbances of the digestive tract
• Pain and dizziness
• Weak
• Jaundice
• Postural hypotension
• Blood disorders such as
thrombocytopenia, aplastic anemia
• Electrolyte imbalance
• Visual disturbances
 Nursing interventions :
1.Medications taken with or after food to
reduce the feeling of nausea
2.Advise patients taking potassium-rich
foods such as fruits of citrus, bananas
and apricots
3. Medication should be given at the time
of the day to avoid nocturia
4. Tell the patient that he will pass a lot of
urine
5.To monitor Intake /Output chart
6. Take blood pressure while sitting and
standing to detect postural hypotension
7. Take daily weight of patients
8.Monitor potassium levels and watch for
the sign - a sign of hypokalemia such
as muscle cramps and weakness
2. Loop Diuretics
Action :
1. Prevent reabsorption of sodium ions,
potassium and water in the Loop of Henle
in the renal

2. It reduce blood volume and lower blood

pressure

3. Increased urine output and cause loss of

potassium
Example:
FUROSEMIDE
Route of drug administration :
• Oral
• Parenteral – IV, IM
Dosage :
• Adult : 20 – 80 mg/day
• Infant and children : 2 mg/kg per dose
• Indications :

1. Congestive Heart Failure

2. Nephrotic Syndrome
3. Hepatic Cirrhosis
4. Ascites
5. Acute Pulmonary Edema
6. Hypertension
• Contraindications :

1. Anuria
2. Hypersensitivity to drug
3. Severe renal Disease
4. Hepatic coma
5. Lactation
Side-effects :
1.Cardiovascular disturbances such as
orthostatic hypotension,
thromboplebitis, chronic aortitis
2. Hematologic disturbances such as
anemia, thrombocytopenia,
neutropenia, purpura
3.Disturbance of the digestive tract such
as nausea, vomiting, anorexia,
constipation, cramps
5. Rashes
• pruritis, urticaria
• CNS such as vertigo, headache,
dizziness, blurred vision
• Electrolyte imbalance such as
dehydration, hypovolemia,
hypokalemia

Nursing intervention :
• Same as Chlorothiazide
3) Potassium - Sparing Diuretics

Drug interaction :
i) Respond to Aldosterone hormone
When a diuretic is inhibited against
aldosterone, it will increase the absorption of
sodium and lower potassium excretion
• Thus, it reduces blood volume and lower
blood pressure
• Increased urine production
 Example :

• Spironolactone ( Aldactone ) by oral

Adult dosage : 25 – 200 mg /day
Children dosage : 1-3.3 mg/kg/day

• Triamterene by oral
Dosage : 100 mg twice daily after meals
Maximum 300 mg/day
• Indications :

1.CHF
2.Cirrhosis of liver
3.Nephrotic syndrome
4.Essential Hypertension
5.Primary hyperaldosteronism
 Contraindications :

• Acute renal insufficiency

• Renal Failure
• Hyperkalemia
• Anuria
• Patients who receive treatment such as
amiloride or triamterene
 Side-effects :
1. Electrolyte imbalance such as lethargy, dry
mouth and thirst
2. GI disturbances such as diarrhea, cramps, ulcers,
gastritis and vomiting
3. CNS disturbances such as drowsiness, ataxia,
lethargy, confusion, headache
4. Endocrine system disturbances such as
gynecomastia, irregular period
5. Skin disturbances such as urticaria
 Nursing interventions:

1. Just like Chlorothiazide

• Advise patients avoid eating foods high in
potassium

2. Medications taken with food or immediately

eat to increase absorption
• Example : Mannitol, IV. 20 – 200g/daily
Glycerin by oral - 1.5 g/kg
Drug interaction:
• Reducing the water content in the body by
inhibiting the reabsorption of sodium ions and water
in the proximal convoluted tubule
• These drugs also drain the liquid that accumulates
in the peripheral
• It reduces blood volume and lower blood pressure
• Increased urine production
 Indication :
1. Acute Renal Failure
2. Cerebral edema
3. Reduce intracranial pressure
4. Reduce intra ocular pressure such as
Acute Glaucoma before surgery
5. Barbiturate, salicylate & bromide poisoning

Contraindication :
1. Anuria
2. Pulmonary edema
3. Severe dehydration
4. Active intracranial bleeding
 Side-effects :

1. Fluid and electrolyte imbalance, acidosis, and

dehydration
2. The disturbance in digestive system such as
nausea, vomiting, dry mouth, diarrhea, thirst
3. The disturbance in cardiovascular system such as
edema, hypotension or hypertension
4. CNS disturbance such as dizziness, headache,
blurring of vision
5. Rhinitis, chills, fever, urticaria
 Nursing interventions
1. Monitor the intake / output chart (I/O chart)

2. Monitor vital signs especially during infusion

3. Detect dehydration signs and report if there is any

 4. ANTIPYRETIC
Definition :
• Medicines / drugs that can lower high temperature /
reduce fever
Drug interaction :
• Act on Regulating heat center in the brain and cause
peripheral dilatation / dilating blood vessels in the
skin and the temperature will drop through sweating
• Antipyretic drugs usually are analgesics drugs
 Example :
• Paracetamol 500 mg – ( adult: 1g and
cannot exceed 4g)
• Acetylsalicylic acid ( Aspirin ) 300 – 900
mg daily

Indication :
1. Relief mild to moderate pain
2. Fever
 Contraindications :

1. Alcoholism
2. Hepatic diseases
3. Renal function impairment
4. Viral hepatitis

Side-effects :
• skin rashes
 5. ANALGESIC
Definition :
• Drugs / medications that can relieve pain without
disrupting consciousness / awareness
Drug interaction:
• Reacting with reducing a person's ability to receive
sensory emotional pain and alter the action of the
senses
• Acting on a receptor that is responsible for sensory
pain selectively. These receptors are found in the
nerve endings acting stimulation
 Analgesics are classified based on the
potential and strength :

i. Minor analgesic/ non narcotic –for mild and

moderate pain

ii. Narcotic analgesic –for stronger pain

 i) Minor analgesic / non narcotic –for mild
and moderate pain

Drug interaction :
1. Eliminate pain
2. Body feel warmth
3. Swelling and stiffness in the joints of the bones
Example :
• Acetylsalicylic acid ( Aspirin ) 300 – 900 mg daily
• Paracetamol 0.5 g – 1 g, maximum 4 g
 ACETYLSALICYLIC ACID
(ASPIRIN )
Route of drug administration : Oral
• Dosage : 300 – 900 mg daily
Contraindications :
1. Gastritis
2. Peptic ulcer
3. Patient with bleeding disorder
4. Patient with kidney disease
5. Patient with asthma or hypertension
6. Patient who receiving anticoagulant drug
• Side-effects :
1.Irritation on the gaster membrane mucosa
2.Nausea and vomiting
3.Urticaria
Toxic effects :
4.Reyes Syndrome if given to children
• Nursing interventions:
Patients are given milk when taking aspirin
and advised to take the medication with food
to reduce irritation
ii) Narcotic analgesic – for severe pain

Drug interaction :
1. Act on central nervous system by
changing the acceptance of pain stimuli in
the brain so that pain can not be felt
2. Depress the respiratory centre, coughing
and vomiting
3. Will cause addiction
Example :
• Morphine sulfate
• Pethidine

MORPHINE SULFATE
Route of drug administration :
• Oral, IV, IM, SC, Epidural, intrathecal,
Rectal suppositories
 Dosage :
• Oral : 10 – 30 mg every 4 hours
• IM , SC : Adult : 10 mg every 4 hours
• IV : 0.5 – 3 mg / kg
• Rectal : 10 – 30 mg every 4 hours
• Intrathecal : 0.2 – 1 mg as a single daily
Contraindications:
1. Asthma with respiratory depression
2. Increased intracranial pressure
3. Shock
 Side-effects
1. Anorexia
2. Nausea, vomiting
3. Constipation
4. Drowsiness
5. Dizziness, sedation
6. Confusions
7. Urine retention
8. Rashes
9. Blurring of vision
10. Bradycardia
11. Pruritis
• Nursing interventions:
1. Monitoring vital signs especially breathing (
this drug will depress the breathing system)
If the respiration rate less than 10/min, this
shows respiratory distress
2. Monitor patient’s urine output, normal urine
output is 30ml / hours
3. Check pupil reaction ( eye ) If the pupil
reaction is pinpoint, this shows morphine
overdose. Inform to the doctor immediately
 PETHIDINE ( Meperidine HCL )
Route of administration : Oral, IM, IV
Dosage:
Adult : 50 – 100 mg every 3 – 4 hours
Children : 1-2 mg / kg every 3 – 4 hours
Contraindication:
1. Nausea, vomiting 2.Constipation
3. Headache 4.Hypotension
5. Sedation 6.Confusion
7. Abdominal cramps 8.Euphoria
9. Rashes 10. Tremor
 Nursing interventions :

1.Monitor vital signs

- Blood pressure due to the it’s side-
effects - hypotension. Compare with
baseline blood pressure.
- Observe breathing pattern

2.Monitor urine production and bowel

sound.
- The drug ‘s effect can cause urinary
retention and constipation. Normal
urine production for 1 hour is 30 ml.
 6. ANTIHYPERTENSIVE

Definition :
• Drugs use for hypertension treatment

Drug action
• Depends on the type of hypertensive
drugs
Type of anti-hypertensive drugs:

a) Beta Blocker
b) Centrally acting drugs
c) Vasodilator
d) Diuretic
 a) Beta Blocker

Drug action :
• Reduce sympathetic stimulation on the
heart
• It reduces cardiac output and reduce the
resistance of peripheral blood vessels
 Example :
• Propranolol ( Inderal ) 40 mg twice
daily or 80 mg once daily
• Pindolol
Initially 5 mg twice daily, dosage may
be gradually increased to maximum of
60 mg daily
• Nadolol 40 – 320 mg/day
• Timolol maleate 10 – 40 mg / day
 PROPRANOLOL ( INDERAL )
• Route of drug administration : Oral
• Dosage : 40 mg twice daily or 80 mg
once daily
• Indications :
1.Hypertension
2.Angina Pectoris
3.Miocardial infarcation ( MI )
4.Cardiac arrhythmias
5.Hypertrophic subaortic stenosis
• Contraindications :

1.Bronchial Asthma
2.Bronchospasm
3.Severe COPD
4.Congestive heart failure
5.Secondary heart block
6.Cardiogenic shock
• Side-effects :

1.Bradycardia
2.Confusion
3.Drowsiness
4.Fatigue
5.Vertigo
6.Pruritis
7.Dry mouth
• Nursing interventions :

1. Check your blood pressure before

giving medication and take the blood
pressure after 30 minutes of taking
drugs

2. Monitor the patient's breathing patterns

and pulse. Monitor apical pulse before
giving medications. If pulse> 100 / min
and <60 min, inform doctor.
 NADOLOL
• Route of drug administration : Oral
• Dosage: 40 - 320 mg/day
• Indications : Hypertension
• Contraindications :
1. Bronchial asthma
2. Bronchospasm
3.COPD
Side-effects and nursing interventions:
Same as Propranolol
LABETALOL (TRANDATE)
Route of drug administration: Oral,
IV
Dosage:
Oral: Initially 100 mg twice daily
Maintenance doses; 200 – 400 mg twice
dly
IV : 30 – 300mg
• Indications :
1.Hypertension

• Contraindications :
1. Cardiogenic shock
2. Cardiac Failure
3. Severe bradycardia
4.Bronchial Asthma

• Side-effects: Same as Propranolol

• Nursing interventions: same as
Propranolol
 METOPROLOL TARTRATE
( BETALOC )

• Route of drug administration : oral

• Dosage : 100 - 450 mg/day

Indications :
1. Hypertension
2. Acute MI
3. Angina Pectoris
 Contraindications :

1. Cardiac failure
2. Second or third degree heart block
3. Myocardial infarction with heart rate <
45/min

• Side –effects & nursing

interventions same as Propranolol
 b) Centrally acting drugs
Drug action :
• Act on the brain to reduce vasomotor
sympathetic action to the heart and
blood vessels
• Thus reducing cardiac output and reduce
the impact on the blood vessels
sympathetic
• Vasodilation will occurs and lowers
the blood pressure
 Example :
1. Methyldopa ( Aldomet )
2. Prazosin HCl ( Minipress )

• METHYLDOPA ( ALDOMET )
• Route of drug administration : Oral, IV
• Dosage : Oral : 0.5 – 3 g/day
IV : 0.25 – 0.5 g every 6 hours
• Indications :
1. Severe hypertension
2. Impaired Renal function

• Contraindications :
1. Pregnancy
2. Active hepatic disease ( acute
hepatitis, active cirrhosis )
3. Phaeochromocytoma
 Side-effects :

1. Headache
2. Dizziness
3. Paresthesias
4. Bradycardia, orthostatic hypotension
5. Abdominal distension, diarrhea atau
constipation
6. Edema, weight gain
 PRAZOSIN HCL ( MINIPRESS )
Route of drug administration : Oral
Dosage :
Initial dose : 1 mg 2 - 3 times/day,
gradual increase to 3 – 20 mg/day given
in 3 divided doses

Indications :
• Mild or moderate hypertension
Contraindication :
• Renal disease
 Side-effects:
1.Dizzyness
2.Drowsiness
3.Headache
4.Nausea, vomiting
5.Diarrhea or constipation
6.Vertigo
7.Urinary frequency
8.Tinnitus, dry mouth
9.Abdominal discomfort
10.Incontinence
 Nursing interventions

• Monitor vital signs. To take blood

pressure in lying and standing
position. To recheck the blood
pressure after 30 minutes taken the
drugs.
 VASODILATORS
Types of vasodilators
a) Calcium channel agents / blocker
b) Angiotensin – converting enzyme
inhibitor ( ACE inhibitor)
c) Alpha blocker / sympathetic blocker /
sympatholytic
a) Calcium channel agents / blocker
Drug action :
1. Prevent the movement of calcium in
muscle blood vessel’s muscle so that
his muscles will not constricting
2. Thus, dilatation of blood vessels
occurs and blood pressure is lowered
3. Calcium channels agents also used for
the treatment of Angina Pectoris
 Example :

1.Nifedipine ( Adalat ) by oral – initially

30 – 60 mg once daily increase
gradually to 120 mg daily if needed

2.Verapamil ( Isoptin ) by oral – initially

80 mg 3 times daily Increased to 360
mg daily if required
3. Felodipine ( Plendil ) by oral -
initially 5 mg once daily, increased to
10 mg once daily if needed

4. Diltiazem ( Herbesser ) by oral –

initially 60 – 120 mg twice daily,
increase to 240 – 360 mg daily if
needed
1. Nifedipine ( Adalat )
Route of drug administrations: oral
initially 30 – 60 mg once daily increase
gradually to 120 mg daily if needed
Indications:
1.Vasospastic
2. Stable Angina
3. Essential hypertension
Contraindications:
2. Hypersensitivity
3. Lactation
• Side-effects
1. Cardiovascular disturbances like
pulmonary edema, hypotension,
palpitation, syncope, tachycardia
2. Digestive system disturbances such as
nausea, diarrhea, constipation,
vomiting
3. Central nervous system disorder such
as giddyness, nervousness, sleep
disturbance, depression, migrane
4. Skin – rashes, urticaria, pruritis
5. Fever, chills, sweating, hematuria
Nursing interventions :

1. Medicines should not be smoked or

chewed or crushed
b) Angiotensin – converting enzyme
inhibitor ( ACE inhibitors )
• Drug actions :

1. Inhibit the angiotensin enzyme

converting enzyme from turning
angiotension 1 to angiotension II
2. Thus the blood vessels will be dilated
and blood pressure is lowered
 Drug example:
1.Captopril ( Capoten ) by oral, 25 – 150 mg 3
times daily

2.Enalapril maleate ( Vasotec) by oral, 2.5 –

40 mg daily as a single or divided dose

3.Quinapril (Accupril) by oral, initially 10 mg

once daily, increase gradually at 2 week
intervals to 20 – 80 mg daily

4.Ramipril (Altace) by oral, initially 2.5 mg

once daily, may gradually be increased to as
high dose as 20 mg daily if needed
 CAPTOPRIL ( CAPOTEN )

• Route of drug administration : Oral

• Dosage : 25 – 150 mg 3 times daily

Contraindication :
Heart block
• Side-effects:
1. Skin disorder such as rashes
2. Digestive system disorders such as
anorexia, abdominal pain and gastric
irritation
3. Central nervous system disorders such as
headache, dizziness, insomnia, malaise and
fatigue
4. Cardiovascular disorders such as
hypotension, angina
5. Breathing system disorders such as cough,
dyspnea
6. Others such as loss sense of taste, syncope,
fever, blurred vision
 Nursing interventions :
1. Give medication 1 hour before eating
or 2 hours after a meal because food
interferes with the absorption of drugs.

2. Avoid foods that are high in potassium.

3. Monitor vital signs. Take blood

pressure before and 30 minutes after
drug administration.
c) Alpha blocker / sympathetic
blocker / sympatholytics
Drug actions :
1. Block adrenergic transmitter / nerve
signal / sympathetic receptor
stimulating the constricting blood
vessels and will dilate the blood vessels
2. Therefore, the blood pressure will drop
Drug example :
• Prazosin ( Minipress ) by oral, 1-20
mg daily
d) Diuretic
Type diuretic used for the treatment of
hypertension
Example:

i) Thiazide diuretic
ii) Loop diuretic
i) Thiazide diuretic
Drug action :

• Prevent reabsorption of sodium ions,

potassium and water in distal convoluted
tubule
• Thus it reduces blood volume and lower
blood pressure

Drug example :
• Chlorothiazide by oral
b) Loop diuretic
Drug action :
1. Prevent reabsorption of sodium ions,
potassium and water in the Loop of
Henle in the renal
2. Thus, it reduces blood volume and
lower blood pressure
3. Urine production will increase
Drug example :
• Frusemide ( Lasix )
 7. ANTIARRHYTHMIC
Definition
• Drug to treat arrhythmias
Antiarrhythmic drugs
a) Digitalis
b) Beta Blocker
c) Calcium channel blocker
 a) Digitalis

Drug action :
1. Stimulate the myocardium by
increasing the strength and rate of
contraction of the heart

2. Reducing the speed of contraction of

the heart ventricles is too high
 DIGITOXIN

Route of administration : Oral, IV

Dosage :
• Oral and IV : 0.6 mg initially followed
by 0.4 mg and then 0.2 mg at 4 - 6 hour
• Maintenance dose 0.05 – 0.3 mg daily
• Children 0.3 – 0.45 mg/kg

* Long-acting Digitalis
DIGOXIN (LANOXIN)
Route of administration: Oral, IV
Dosage : Oral: o.25 – 0.5 mg every 6 – 8
hrs.
IV : 0.25 mg every 4 – 6 hrs
0.125 – 0.5 mg daily (Maintenance dose)
Indications:
1. CHF
2. Ventricular arrhythmia
3. Sinus tachycardia
4. Cardiogenic shock
Contraindication:
• Ventricular fibrillation
• Side-effects:

1. Anorexia
2. Nausea , vomiting
3. Headache
4. Blurred vision
5. Diplopia
6. Photophobia
7. Drowsiness, fatigue, confusion
Nursing interventions

1. Take apical pulse rate / apex beat

before drug administration such as
Digoxin. Count apical pulse rate for
1 minute. If irregular or bradycardia
or tachycardia, inform the doctor

2. Monitor patient’s body weight by

taking weight at least once in a week
to detect the edema
3. Monitor serum digoxin level to
detect the symptom of toxicity.
(Normal digoxin level : 0.5 – 2.0
mg/mL )

4. Advise the patient to take food rich

in potassium. Take fresh food from
the source of fresh fruits and
vegetables, especially banana.
 Drug example :
1.Propranolol ( Inderal ) by oral : 10 – 30
mg 3 - 4 times daily before meals and
the bedtime

2.Metoprolol ( Betaloc ) by oral, 50 –

200 mg daily in divided dose as ordered
by the doctor.
b) Beta Blocker
Drug action :
1. Reduce sympathetic stimulation on
the heart

2. Therefore, it will reduce cardiac

output

3. Also reduce the resistance of

peripheral blood vessels
c) Calcium channel blocker
Drug action :
1. Prevent the movement of calcium in
muscle blood vessels so that his
muscles will not constrict

2. Thus, dilatation of blood vessels

occurs, the blood pressure will be
lowered
 8. ANTI EMETIC
Definition :
• Medicines used to relieve nausea and
vomiting

Drug action :
• acting on the vomiting center in the brain
 Drug example:

1.Prochlorperazine ( Stemetil ) 5 mg
TDS by oral
2.Promethazine theoclate ( Avomine ) 25
mg TDS by oral
3.Meclozine ( Ancoloxin ) 25 mg TDS by
oral
4.Metoclopramide ( Maxolon ) 10mg
TDS by oral
 9. NITRATES
Drug action:
• Dilate vessel
– Blood
– Response after 1 hour and it
– Effective for 5 hours
Drug example :
• Isosorbide dinitrate ( Isordil )
sublingual : 2.5 – 5 m
oral : 5 – 40 mg qid
• Pentaerythritol tetranitrate by oral
: 10 – 40 mg qid
10. BRONCHODILATORS

Definition :
Drugs used in the treatment of asthma to
develop / relieve the narrow airways
• Drug action:

1. Can relax the smooth muscles in the

bronchial
2. Therefore, the narrowing caused
bronchial smooth muscle spasm or
restrictions of thick phlegm or
blockage by swelling in the mucous
layer can be reduced
3. Dilate the airway
 Drug example :

• Salbutamol ( Ventolin ) : oral 4 mg tds

Aerosol inhalation : 100 – 200
microgram / 1-2 puffs 3 - 4 kali daily

• Terbutalline ( Bricanyl )
• by oral : 2.5 – 5 mg tds
Aerosol inhalation : 1 - 2 puffs 3 – 4
times daily
 Aminophylline
• by oral : 200 mg 3 - 4 times daily
by rectal : 250 – 500mg 3 - 4 time daily

Theophylline
• by oral
• by inhaler-ipratropium bromide
(Atrovent)
a) TERBUTALLINE ( BRICANYL )
Route of administration: oral, SC,
inhalation
• Dosage : Oral: 2.5 – 5 mg 3 times daily,
not exceed 15 mg /day
SC : 0.25 mg ( into lateral deltoid area )
Inhalation : 2 inhalations every 4 – 6
hours
• Indications :
1. As a prophylaxis and treatment of
bronchial asthma
2.Reversible bronchospasms associated with
chronic bronchitis, emphysema and COPD
• Contraindications :

1. Peptic ulcer
2. Hypotension
3. Angina Pectoris
• Side-effects
1. Digestive system disorder such as nausea,
vomiting, diarrhea, anorexia, epigastric
pain, hematemesis, dyspepsia, rectal
bleeding
2. CNS disturbance such as headache,
insomnia, irritability, fever, dizziness,
vertigo
3. Cardiovascular ( CV ) disorder such as
Hypotension, palpitation, tachycardia
4. Renal disorder such as proteinuria,
dehydration
5. Others such as tachypnea, flushing, rash,
alopecia
• Nursing interventions
1. Route of drug administration
• Through subcutaneous – deltoid
muscle is the muscle involved
• Through oral – if the patient
experienced digestive system
disturbance are advised to take food
first
• Through inhalation – taught the proper
way to inhale. Only 2 inhalation for 60
seconds every 4-6 hours
2. Assess the side-effects especially
cardiovascular system due to faster
effect in this system and if given
through subcutaneous
3. Monitor vital signs such as blood
pressure, pulse, temperature and
respiration to detect any abnormalities.
Report if any
4. Nurse to avoid using perfumes or
colognes when providing treatment for
patients especially having breathing
disturbances.
5 Advised of patients do not use the
powder as this exacerbates the patient's
condition
6. Monitor patient closely when on
bronchodilator treatment because the
drugs from this group can cause
tachycardia, cardiac arrhythmias and
gastrointestinal symptoms
7. Give health education to the patient :
• Avoid taking food or drinks that contains
high caffeine ( chocolate, coffee ) due to
worsened side-effects
• If the secretion is thick and concentrated, tak
plenty of warm water to facilitate drainage of
secretion. Avoid taking a milky drink during
this period.
• Avoid / reduce perform strenuous activities th
may cause the patient to experience difficulty
in breathing example: exercise, jogging
 b) Anticholinergic

Drug action :
• Blocks the action of neurotransmitters
that cause muscle contraction

• Thus the airway dilates and less

resistance to the incoming air
Drug example :
• ipratropium bromide ( atrovent )
• nebulizer : 100 – 500 microgram 4 times
daily
c) Xanthine bronchodilators

Drug action:

• Acting on the bronchioles - relax smooth

muscles in the bronchial

• Thus it will enlarge the airway

• Drug example :

Aminophylline
• By oral: 200 mg 3 - 4 times daily
By rectal : 250 – 500 mg 3-4 times daily
By IV : loading dose of 6 mg/kg followed by
a continuous infusion of 0.5 – 0.7 mg/kg/hr
• Dyphylline
By oral : up to 15 mg/kg 4 times daily (adult
By IM ( adult ) : 250 – 500 mg
injected slowly every 6 hours
d) Corticosteroid
Drug action :
• Reduce inflammation at the mucosa membrane
in the airway that cause bronchiole narrowing
• Thus enlarged airways and reduce air resistance
entry
• If used as a inhalation, it has a topical effect on
the lungs without systemic effects
Drug example :
• Beclomethasone dipropionate ( Becotide )
By puff : 100 microgram tds
11.ANTIHISTAMINE
- Reduce allergy ( Piriton )

12. ANTIHELMINTHIC
- Treating of intestinal parasites (worms)
infestation
- Vermox, Albendazole.
13. ANTICONVULSANT
- Drugs to prevent epilepsy
- Dilantin (Tablet) , Epilim (Syrup)

14. ANTITOXIN
- Materials in serum given to the reaction
against toxins in the blood
( ATT-Attenuated Tetanus Toxoid )

15. ANTIVENOM
- A poison antidote serum against snakebites
16. ANTISPASMODIC
- Reduce intestinal muscle‘spasm’in abdomen
blood vessel
( GTN,Atropine )

17. ANTIFUNGAL
- Kill fungus ( Nystatin )

18. ANTISEPTIC
- Prevent bacterial growth
( Lotion Hibitane 1:2000 in aqueous,
Lotion Flavine )
19. EXPECTORANT
- Dilute phlegm and promote excretion of
secretion
( Benadryl, Mist. Expectorant )

20. HYPOGLYCAEMIC AGENT – learn

more next slide
- Reduce glucose level in the blood
( Daonil, Glucophage, Insulin )
21. LAXATIVE
- Encourage the removal of feces ( Ducolax )

22. CARMINATIVE
-Producing gas from the gastrointestinal
(Mixt. Carminative)
• THANK YOU