Drugs acting on the

Autonomic Nervous
System
KATRINA P. COLO, RN, MAN(c)
• Sympathetic: alertness (“flight or fight response”)
transmitter: norepinephrine
ex: pupil dilation, increased HR, diaphoresis

• Parasympathetic: relaxation (“rest and digest”)

• transmitter: acetylcholine
• ex: pupil constriction, decreased HR, increased salivation
 Adrenergics/ Sympathomimetics
Stimulates the effecf of the SNS, commonly used for tx of
glaucoma, shock, shock-like sx
Alpha & Beta Alpha Specific Beta Specific
Dopamine, Dobutamine, Clonidine, Midodrine, Phenylephrine Albuterol, Salmeterol, Terbutaline
Norepinephrine Route: SL/ PO Route: INH/PO/SQ
Route: IV drip/ IVTT,/SQ BP, vasoconstriction HR, bronchodilation, vasodilation
HR, bronchial activity, IOP Uses/action: Uses/action:
Uses/action: Phenylephrine: colds Respiratory diseases (asthma, COPD)
Dopamine: DOC for shock Midodrine: orthostatic HPN Contraindications & caution:
Dobutamine/Ephedrine: failure Clonidine: HPN, cancer pain Pulmonary HPN
Phenylephrine: colds Pxs w/ thyrotoxicosis
Adverse rxns: Eclampsia (maternal HPN)
piloerection, extravasation
WOF: paradoxical HPN in pxs taking
Propanolol
 Alpha & Beta
Nursing Management:
V/S monitoring (ECG, urine output)
Hand hygiene for opthalmic solutions
Frequent monitoring for
extravasation
if extravasation occurs, administer
phentolamine (10ml NSS: 5-10mg)
counteracts the effect of
vasoconstrictive agents
Alpha Specific
Nursing Management:
Drug titration: prevent rebound HPN
V/S (BP, ECG)
Phentolamine on standby (for pxs on
Clonidine infusion)
Px education and safety
Beta Specific
Nursing Management:
V/S (BP, HR,RR)
Advise px to gargle every after
administration of medications
especially if therapy is combined with
steroids
Beta-blockers (Propanolol,
Metoprolol) for severe reactions on
pxs undergoing isoproterenol
therapy.
 Adrenergic Antagonists/ Blockers
Blocks the responses of the SNS without activating them
Main action: BP ; Route:PO
Non-Selective Non-Selective Alpha Alpha 1-Selective Non-Selective Beta Beta Selective
Blockers Blockers Blockers Blockers Blockers

Labetatol, Carvedilol Phentolamine Prazosin, Propanolol, Atenolol, Metoprolol,

renal output HR Tamsulosin, Nebivolol, Timolol Esmolol
Uses/action: Uses/action: Doxazosin Aids in Uses/action:
Essential HPN w/ Dopamine/ Does not affect HR bronchodilation D/O, glaucoma
combination of Norepinephrine and cardiac output Uses/action: Contraindications
diuretics extravasation Uses/action: HPN, situational and cautions:
Amiodarone (IVTT): WOF: pxs with Tx of BPH anxiety, migraines, failure,
DOC for arrythmias alcoholism and Lower cholesterol angina (in controlled cardiogenic shock,
Contraindications & hypotension levels doses) bradycardia
cautions: HPN reduce IOP in
Bradycardia, blocks Adverse effects: glaucoma
Shock, failure Eye and nose Contraindication &
Pxs on Carvedilol: risk disturbances, caution:
for hepatotoxicity
priapism Pxs w/ thyrotoxicosis
 Non-Selective Non-Selective Alpha Alpha 1-Selective Non-Selective Beta Beta Selective
Blockers Blockers Blockers Blockers Blockers
Nursing Management: Nursing Management: Nursing Management: Nursing Management: Nursing Management:
Drug titration (for 2 Px safety & education V/S monitoring Drug titration Administer Metoprolol
weeks) Constant extravasation Drug titration Px safety & education PO w/ food to facilitate
V/S monitoring (ECG) monitoring Px safety (for CNS Diet & lifestyle absorption
Diet & lifestyle V/S monitoring effects); education modifications Px safety & education
modifications Diet & lifestyle Diet & lifestyle
Px safety & education modifications modifications
Cholinergics/Parasympathomimetics
Direct Acting
Bethanecol, Pilocarpine
Route: SQ/Ocular
HR, vasodilation, bronchoconstriction, GI &
bladder relaxation, miosis
Uses/action:
Carbachol (ocular): DOC for ocular HPN
Bethanecol (SQ): for neurogenic bladder;
approved for use in children 8 y/o above
Cevimeline & Pilocarpine (PO): dry mouth
Pyridostigmine (Mestinon): M. Gravis
Endrophonium (Tensilon): Dx for M. Gravis
Contraindications and Cautions:
Bladder obstruction, GI bleed
Adverse effect:
salivation, urinary frequency
Indirect Acting (Acts on acetylcholinesterase)
Neostigmine, Donepezil
Route: IV/IM/SQ/PO
Acts for longer periods of time
Uses/action:
Neostigmine (IM/PO): M. Gravis
Donepezil (PO): DOC for Alzheimer’s Disease
Nursing Management:
Px safety- choking hazards = aspiration
Maintain skin integrity
Px education (compliance, food choices)
Administer PO meds on an empty stomach
Anti-cholinergics/Parasympatholythics
Blocks the responses of the PNS
Meclizine, Scopalamine, Ipratropium, Atropine (most used anti-
cholinergic)
Route: PO/IM/IV/SQ/INH
Depress salivation and bronchial secretions through bronchodilation
Uses/action:
Atropine & Scopalamine: block muscarinic effectors ( HR, secretions,
etc.)
Meclizine (PO): motion sickness
GI ulcerations/IBS: HCL secretions, before anesthesia induction
Contraindications & Cautions:
Pxs with glaucoma, paralytic ileus, GI obstructions
Adverse reactions:
photophobia,cycloplegia

Nursing Management:
V/S monitoring (ECG, urine output)
Provide comfort measures (adequate lighting, small frequent
meals, etc,)
Px education and safety
Drugs acting on the
Endocrine System
KATRINA P. COLO, RN, MAN(c)
 The Pituitary Gland
Anterior Posterior
• Adrenocorticotropic Hormone • Antidiuretic Hormone(ADH or
(ACTH): cortisol vassopressin): water-sodium balance
• Follicle-stimulating hormone (FSH): • Oxytocin: uterine contraction
HCG (Human Chorionic Gonadotropin)
• Growth hormone (GH)
• Luteinizing hormone (LH): stimulates
ovulation & testosterone production
• Prolactin: milk production in women
• Thyroid-stimulating hormone (TSH):
stimulate different thyroid hormones
for body metabolism, energy levels
and nervous system
 Growth Hormones
Agonists
(Hypopituitarism)
Genotropin, Serostim, Zomacton
Route: SQ/IM
Stimulate skeletal & internal organ growth,
protein synthesis by replacing the human GH
Uses/action:
Pxs with dwarfism, Somatotropin Deficiency
Syndrome, Turner Syndrome, cachexia
Contraindications & cautions:
Cranial lesions and pxs with TBI
Abdominal surgery and acute illness secondary
to complications of heart surgery
Adverse Effects:
GH antibody development
Autoimmune type of reactions, inflammation
Hypothyroidism, insulin resistance
Antagonists
(Hyperpituitarism)
Bromocriptine, Octreotide, Lantreotide
Route: SQ/IM
Inhibits GH secretion
Uses/action:
Tx of Parkinson’s Disease, hyperprolactinemia,
acromegaly; gigantism
short term: amenorrhea,galactorrhea
Contraindications and cautions:
Pxs with diabetes and thyroid D/O
Pxs taking the ff medications:
Erythromycin: toxicity w/ Bromocriptine
WOF: jaundice in pxs taking
Octreotide/Lantreotide
Adverse effects:
Inflammation at injection site
 Agonists
(Hypopituitarism)
Nursing Responsibilities:
Monitor thyroid function, glucose levels
periodically
Px education (proper administration,
medication compliance)
Antagonists
(Hyperpituitarism)
Nursing Responsibilities:
Monitor thyroid function, glucose levels
periodically
Px education (proper administration,
medication compliance)
Baseline & periodic ultrasounds of the
gallbladder
 Drugs affecting Posterior
Pituitary Hormones
ADH- has hemostatic, antidiuretic, and vasopressor properties; the
hormone affected in pxs with Diabetes Insipidus & Hemophilia A
(Conivaptan, Desmopressin, Tolvaptan)
Route: IV drip/Intranasal/PO
Uses:
Increase H2O absorption, decrease urine formation, increase levels of
clotting factor VIII
Adverse effect: water intoxication (s/sx: altered LOC, nausea,vomiting)
WOF: Hyponatremia
Nursing management:
Monitor fluid intake and output
Px education (compliance)
 The Thyroid Gland
Produces three hormones: Triiodothyronine (T3), tetraiodothyronine/thyroxine
(T4), and calcitonin
Iodine: one of the main building blocks of both T3 & T4 hormones
Goiter: a disease caused by lack of iodine
Hyperthyroidism: excessive thyroid hormones
Hypothyroidism: less thyroid hormones, most common type of thyroid
dysfunction
Euthyroidism: thyroid levels are at normal ranges
 Hyperthyroidism
(Anti-Thyroid agents)
Propylthiouracil (PTU), Methimazole
Work by inhibiting or suppressing the
synthesis of thyroid hormones or decreasing
thyroid hormone activity
Route: PO/IV drip
Uses/action:
Tx of hyperthyroidism
Blocks thyroid from radiation
Contraindications & cautions:
Pxs with CA
Adverse effects:
Methimazole: bone marrow suppression
Iodine: metallic taste, staining of teeth
Nursing Management:
V/S (including ECG)
Administer PTU TID RTC
Administer Iodine through a straw
Periodic thyroid diagnostics
Px education (compliance)
Hypothyroidism
(Thyroid agents)
Levothyroxine (Synthroid)
Suppress overproduction of TSH by the pituitary
glands; replace low or absent levels of natural TH
Route: PO/IM/IVTT
Uses/action:
O2 consumption, HR,growth &
maturation,metabolism of fats,carbs,and protein
Contraindications & cautions:
Pxs with thyrotoxicosis
Adverse effects:
Alopecia
Hyperthyroidism symptoms
Nursing Management:
V/S (including ECG)
Administer daily before breakfast
Periodic thyroid diagnostics
Px education (compliance)
 Parathyroid Agents
Drugs used to treat D/O that affect calcium levels
Anti-hypocalcemics Anti-hypercalcemics
Vitamin D compounds, Teriparatide Alendronate (Fosamax), Calcitonin salmon
(FORTEO) Route: PO/IM/SQ
Route: PO/SQ Uses/action:
Uses/action: Treat excess levels of PTH
Treat deficient levels of PTH Contraindications & cautions:
Vitamin D: facilitates absorption of Ca Pxs with hypocalcemia, upper GI disease
Teriparatide: increase bone strength and Adverse effects:
density Skin flushing/local inflammation at injection
WOF: Pxs taking antacids containing site
Magnesium Nursing Management:
Adverse effects: Monitor Ca levels (N: 8.6 to 10.3 mg/dL)
Metallic taste, dry mouth Rotate injection sites to prevent irritation &
Nursing Management: skin breakdown
Monitor Ca levels (N: 8.6 to 10.3 mg/dL) Px safety & education (compliance)
Px safety & education (compliance)
 Adrenocortical Agents
Glucocorticoids
Methylprednisolone, Dexamethasone,
Prednisone
Route: PO/IV
Uses/action:
Reduce inflammation, pain reduction
Contraindications & cautions:
Pxs with infections, D. Mellitus
Adverse effects:
Burning/pain at injection site
Methylprednisolone toxicity
Nursing Management:
Drug titration
Dosage spacing: to achieve
homeostasis
Px safety & education
Mineralocorticoids
Aldosterone
Route: PO/IV
Uses/action:
Increase sodium reabsorption leading
to water-sodium retention
Tx of hypotension
Replacement therapy of
adrenocortical insufficiencies
Contraindications & cautions:
Pxs with HPN, cardiac disorders
Adverse effects:
Possible hypernatremia, hypokalemia
Nursing Management:
Periodic electrolyte monitoring, V/S
D/c if px is showing signs of overdose
(edema, weight gain,HPN)
Px education & safety
Androgens
Testosterone (Testim)
Route: PO/IV/IM
Uses/action: stimulate the
development of male sexual
characteristics and development of
male sex organs.
Contraindications & cautions:
Hx of breast CA, prostate CA, Heart
failure
Adverse effects:
Hirsutism,edema, acne
Nursing Management:
Assessment (health hx, usage of
other hormonal products)
Px education (compliance)
 Anti-Diabetic Drugs
Type 1 DM
Also referred as IDDM
Pancreas cannot produce enough
insulin
Develops at a young age
Insulin therapy (SQ)
Type 2 DM
Also referred as NIDDM
Insulin resistance
Onset is usually at adulthood
Oral anti-hypoglycemics/insulin
Biguanide Metformin- common oral anti-
hypoglycemic prescribed

Nursing responsibilities:
Periodic blood glucose monitoring
Rotation of injection sites
Diet and lifestyle modifications
Px education & compliance
Drugs acting on the
Cardiovascular System
KATRINA P. COLO, RN, MAN(c)
 Hypertension: A disease that causes an increase in blood pressure
due to increase in the pressure of the blood vessels.
• The leading cause of mortality in the Philippines.
• Increases the risk of heart, brain & other diseases.
2 types
Essential HPN: Usually exhibit no symptoms; “the silent killer”
Secondary HPN: Due to a known cause (ex: pheochromocytoma)

Categories
Normal: 120/80mmHg
Elevated: 120-129/less than 80mmHg
Stage 1 HPN: 130-139/80-89mmHg
Stage 2 HPN: 140/90mmHg (or more)
Nursing responsibilities for patients on cardiovascular drugs:
• Monitor vital signs & serum electrolyte levels
• Provide small frequent meals
• Monitor fluid intake & output
• Obtain baseline weight
• Observe for s/sx of toxicity
• Promote lifestyle & diet modification
• Teach px and SOs about drug dosing & frequency. Stress the
importance of medication compliance
 Antihypertensives
ACE Inhibitors Angiotensin II Receptor Calcium Channel Vasodilators
Blockers Blockers
Captopril, Enalapril Telmisartan, Losartan Amlodipine, Nicardipine Nitroprusside,
Vasoconstrictor, K with Route: PO Route: PO/IV drip Hydralazine
some Na loss Uses/actions: Uses/actions: Vasodilation & muscle
Route: PO Tx of HPN combined with Tx of angina, HPN & HPN relaxation
Uses/actions: other anti-HPN drugs comnined with other anti- Route: PO/IV drip/IM
failure, L ventricular HPN drugs Uses/actions:
dysfunctions, Diabetic Contraindications & Used if previous drugs were
nephropathy cautions: not effective
Tx of HPN combined with Grapefruit juice: serum Caution: Nitroprusside
other anti-HPN drugs levels and Ca toxicity toxicity/cyanide toxicity
s/sx: dyspnea, ataxia, dilated
pupils, distant sounds
Nitroprusside suppresses
iodine which leads to
hypothyroidism
 Cardiotonic agents
Increases the contractility of the heart; commonly used in pxs with heart failure.
Heart failure can be:
Left sided: Left ventricle is affected; s/sx: pulmonary sx , tachycardia
Right sided: Right ventricle is affected; s/sx: distended neck veins, organ enlargement
(ex: hepatomegaly,spleenomegaly) due to blood congestion
Cardiac Glycosides Phosphodiesterase Inhibitors
Digitoxin, Digoxin Cilostazol, Inocor
heart muscle contractility; relieves heart force of myocardial contractility
failure, atrial flutter, fibrillation 3 major effects: vasodilation, O2 consumption,
Route: PO/IV arrythmias
WOF: Digitalis toxicity (s/sx: tremors, Route: PO/IV
diaphoresis, Uses/action:
antidote: Digibind LOC) Short-term tx for pxs not responding to glycosides
Caution:
Pxs taking K+ wasting diuretics: risk for Caution:
arrythmia Conditions w/ fluid vol. deficit (exacerbated by
renal perfusion which leads to urine output)
 Anti-arrythmics
• Drugs that address arrythmias by altering cells’ automaticity
& conductivity
• Arrythmia : a condition which causes heart rate disturbances
caused by certain factors (pre-existing disease, electrolyte
imbalance, etc.)
• DOC: Amiodarone (IVTT/IV infusion/PO)
Heart Rhythms
Sinus rhythm
The normal heart rhythm

Sinus tachycardia
Sinus bradycardia

Ventricular tachycardia

Most serious and fatal

DOC: Amiodarone (IVTT)
Mgt: Cardioversion

Ventricular fibrillation
 Atrial fibrillation
DOC: Beta-blockers
(Atenolol, Verapamil)
Mgt: Cardioversion

Supraventricular tachycardia
Not life-threatening; lasts a
few seconds to hours
Happens due to oxer exertion

Asystole
DOC: Epinephrine (IVTT)
Mgt: CPR, defibrillation
Nursing Responsibilities:
• Monitor v/s (ECG, BP, HR)
• Obtain baseline ECG
• Attach px to cardiac monitor at all times
• Pxs room should preferably be near the nurses’ station
• O2 therapy
Before cardioversion/defibrillation During After
• Let the px sign a consent/waiver • Medical staff must be by • V/s monitoring
• Obtain baseline ECG the px’s bed side (q15,q30,qhourly until stable)
• Emergency cart, O2 & suction • Ecart, O2 & suction should • Px must be attached to the
machine must be on standby be at reach cardiac monitor
• Prepare epinephrine/amiodarone • Ensure that the defib device • Ecart on standby
• Ensure px has no metallic is functional
objects/metallic devices (ex: • Avoid touching the px or
coins/belt, pacemaker) side rails prior to
cardioversion/defibrillation
• Documentation
 Anti-anginals
• Drugs that balance O2 supply and demand of the heart
• Dilates the heart vessels to O2 in ischemic regions

Coronary Artery Disease: blood vessel narrowing due to atherosclerosis

narrowed vessels = O2 supply to the heart
• s/sx: hypoxia, pain/ angina Stable: Classic angina; caused by physical activity

Precipitating factors:
4 Es
Unstable: Vasospastic, Prinzmetal’s
• Emotion
Unpredictable, occurs even at rest
• Exertion
• Eating
• Extreme temperature
 Nitrates & Nitrites
Isordil, Nitroglycerin
Fast acting; directly relaxes
smooth muscles & depresses
muscle tone thereby increasing
blood flow to healthy arteries
Route: SL
Caution:
Pxs with anemia, head
injuries/cerebral hemorrhage
Beta Adrenergic Blockers
Nadolol, Propanolol
Route: PO/IV
Uses/action:
Nadolol: DOC for px with angina
and HPN; chronic angina
Propanolol: angina with syncope
Ca Channel Blockers
Amlodipine, Nicardipine
Route: PO/IV drip
Uses/action:
Tx for both stable and unstable
angina

Nursing responsibilities:
• Monitor v/s
• Observe proper administration of the drug
• Educate pc and SOs about the importance of medication compliance and when to seek help
• Ensure px safety
• Diet and lifestyle modifications
 Anti-Lipidemics
• Drugs that decrease cholesterol levels, prevent or minimize the build-up of
plaque in the blood vessels (atherosclerosis)
• Hyperlipidemia: lipid levels
Bile Acid Sequestrants HMG--CoA Reductase Fibrates Vitamin B Omega 3
Inhibitors
Colestipol, -statins (ex. Atorvastatin) Fenofibrates Biotin, Niacin Lovaza, Vascazen
Cholestyramine Increases cell absorption Drugs used to lower Plays a major role in A supplement to aid
Normalize cholesterol of LDL = slight increase triglyceride levels cholesterol maintenance with cholesterol control,
levels in HDL HDL Triglycerides used often together with
Uses: Administer @ HS: peak LDL = risk for heart other anti-lipidemics
Tx for primary of cholesterol synthesis diseases/stroke
cholesterolemia is 12MN--5am
 Cholesterol Absorption Inhibitors
• New class of drugs approved for use (established 2003)
• Blocks the absorption of dietary cholesterol so less cholesterol goes to
the liver, promoting increased cholesterol clearance levels
• Ezetemibe: the first clinically approved CAI
Nursing responsibilities:
• Monitor v/s
• Obtain baseline weight
• Observe proper administration of the drug
• Educate pc and SOs about the importance of medication compliance
and when to seek help
• Ensure px safety
• Diet and lifestyle modifications
Drugs affecting blood coagulation
Anti-platelet Anti-coagulant Thrombolytic
Aspirin, Clopidogrel Heparin, Warfarin Streptokinase, Urokinase
• Prevents platelet clumping • clotting process • Dissolve clots/ break down
• Taken by pxs with heart • “blood thinner” clots
attack or stroke • WOF: Heparin & Warfarin • Used in MI, embolisms
toxicity

s/sx:
Hematochezia/melena
s/sx: WOF: BLEEDING
Red rash-like spots
Hematuria
Heavy bleeding
Hematemesis
Severe headache and dizziness
Epistaxis
antidote: Vit. K/Phytomenadione
antidote: Protamine Sulfate
 Drugs to control bleeding
• Agents used in the prevention & control of hemorrhagic
episodes
Anti-hemophilics Hemostatics
Route: IVTT/PO Devices/agents used to
Hemofil-M control/prevernt/stop bleeding
Tranexamic Acid (fibrinolytic agent): Ex: Hemo-Lock/Ligature Lock
commonly used Cauterization
Hemo Gel (Hemostatic Gel)
 Drugs for Anemia
Epoetin Alfa, Eposino, Erythropoetin
Route: SQ/IV
• Used in pxs with anemia due to renal dysfunction, chronic renal failure
(hemodialysis pxs)
Folic Acid
Route: PO
• Commonly used together with Vitamin C during pregnancy to prevent the
fetus from neural tube defects like myelomeningocele (spina bifida).
Vitamin B12
Route: PO
• Aids in production of red blood cells
 Sickle Cell Anemia
An inherited blood disorder marked by defective hemoglobin. · It inhibits the ability of
hemoglobin in red blood cells to carry oxygen.
S/sx:
• Frequent infections
• Pain crises (Crezanlizumab (IV infusion), Hydroxyurea (IV infusion))
• Swelling of upper & lower extremities
• Vision problems
Tx:
• Blood & bone marrow transplant
Nursing management:
• Ensure px safety
• Obtain baseline & periodic blood tests
• Observe proper aseptic techniques when doing px procedures
Drugs acting on the Renal
System
KATRINA P. COLO, RN, MAN (c)
Chronic Kidney Disease - caused by renal insufficiency
(defective kidneys) caused by a certain disease condition/electrolyte
imbalance.

• Normal creatinine lab values: 0.7-1.3mg/dl

• Creatinine clearance: accurate test for renal function
• Common diuretic DOC: Furosemide
• Na & K electrolyte levels are the most affected
 Main routes: PO/IVTT
Thiazide-Thiazide Loop Diuretics/ K+ Carbonic Anhydrase K+ Sparing Osmotic
like Wasting
• Mild, first line drugs Furosemide • Mild; commonly Aldactone Mannitol
for essential HPN • Used for acute HF & used for glaucoma • Safe for use in • A kind of diuretic
• urination (Na & Cl) pulmonary edema, children that can cross the
HF with renal and/or • Na K+ blood-brain barrier
hepatic disorders • Na
• Na K+

Nursing responsibilities:
• Obtain baseline weight
• Monitor serum electrolyte levels
• Monitor fluid intake & output
 Parenteral Fluids/ Solutions
Solutions that contain certain compounds/electrolytes
• Isotonic: normal cell concentrations; most preferred fluids for
resuscitation, hemorrhage,dehydration, burns
(ex.: PNSS, PLR,D5W)
• Hypotonic: concentrations of Na (ex.: 0.25%Nacl, 2.5% Dextrose),
used commonly for pxs with hypernatremia, dextrose
supplementation
• Hypertonic: concentrations of Na (ex: D5LR, D5NSS), used to
manage severe hyponatremia & cerebral edema
Drugs acting on the
Respiratory System
KATRINA P. COLO, RN, MAN (c)
 Upper Respiratory System
Main Route: PO
Antitussive Decongestant Antihistamine Expectorant Mucolytic
Dextromethorphan Phenylephrine Cetirizine, Loratadine Guaifenesin NAC, Carbocisteine
(Vicks Formula 44) swelling, Blocks allergic (Robitussin) Promote thinning
coughing reflex inflammation of the responses viscoscity of of
nasal mucosa, mucus/phlegm mucus/secretions
bronchi,bronchioles
which leads to easy
expectoration
 Lower Respiratory System
Bronchodilators
Albuterol, Budesonide
Dilates the bronchi & bronchioles = O2
delivery to the lungs
Xanthines
Theophylline, Aminophylline
Relieves bronchospasms

Nursing responsibilities:
• Ensure patient has a gag reflex
• Encourage chest tapping/cupping to promote expectoration
• Monitor v/s esp. O2 saturation
• Suction secretions PRN
• Instruct patient to gargle every after inhalation (to prevent oral candidiasis)
 Drugs acting on the
Gastrointestinal System
KATRINA P. COLO, RN, MAN (c)
Main route/s: PO/IVTT
Histamine 2 Antacids Proton Pump Inhibitors Antiemetics
Antagonists
Ranitidine Aluminum Hydroxide, Pantoprazole, Metoclopromide,
Blocks the release of Gaviscon Omeprazole Ondansetron
HCL Neutralizes gastric acids Suppress gastric acid Suppresses the vomiting
Uses/actions: Uses/actions: secretion reflex, either GI or CNS
Short term tx for active PUD. gastric ulcerations, Uses/actions: induced
duodenal ulcers, benign hyperacidity GERD, H.Pylori infxns Uses/actions:
gastric ulcers, Zollinger- Side effects: Contraindications & GI ulcerations
Ellison Syndrom Constipation/diarrhea cautions: CNS disturbances ( ICP,
Relief of heartburn, Adverse effects: Pxs taking clopidogrel tension headaches, etc.)
GERD, acid indigestion Electrolyte imbalances, Adverse effect: Pxs taking
Adverse effect: gastric ruptures, tetany Respiratory infections chemotherapy
Gynecomastia
Nursing responsibilities:
• Monitor serum electrolyte levels
• Ensure proper medication administration
(route,dosage,etc.)
• Assess nutritional status/ fluid volume alterations
• Px education (compliance)
• History of drug usage, indication/ hx taking
• Pregnancy and other related symptoms
 Drugs acting on the
Reproductive System
KATRINA P. COLO, RN, MAN (c)
 Drugs acting on the Female Reproductive
System
Drug
Estrogen (Premarin)
Progestin (Aygestin)
Pregnyl(HCG)
Methylergonovine (Methergine)
Oxytocin (Pitocin)
Abortifacients (Misoprostol)
Route Indication
SQ/IM/PO/Intravaginally Development of female sex
characteristics
SQ/IM/PO/Intravaginally Contraceptive effects,
suppresses ovulation
SQ/IM Helps in thickening the uterine
lining during pregnancy
IM Vasoconstrictor, controls
IM bleeding
Stimulates uterine
PO contractions/controls bleeding
Assist in expelling fetal
products/by products of
conception
 Drug
Estrogen (Premarin)
Progestin (Aygestin)
Pregnyl(HCG)
Methylergonovine (Methergine)
Oxytocin (Pitocin)
Abortifacients (Misoprostol)
Route Indication
SQ/IM/PO/Intravaginally Development of female sex
characteristics
SQ/IM/PO/Intravaginally Contraceptive effects,
suppresses ovulation
SQ/IM Helps in thickening the uterine
lining during pregnancy
IM Vasoconstrictor, controls
IM bleeding
Stimulates uterine
PO contractions/controls bleeding
Assist in expelling fetal
products/by products of
conception
Drugs acting on the Male Reproductive
System Drug Route Indication
Androgen (Danazol) SQ/IM/PO A hormone crucial in the
development of sex
characteristics (hirsutism in
females, deepening of voice),
AV: phallic enlargement in men,
loss of libido, continual penile
erection (in males)

Sildenafil PO For erectile dysfunction

WOF: bleeding disorders, hypovolemic shock, active bleeding

Nursing Responsibilities
Provide privacy and comfort
Assess patient’s mental status
Obtain a thorough health history (especially for female teenagers), assess for current diseases.
Encourage participation in counsellings, regular check ups (for those undergoing hormone therapy).
Emergency Drugs
KATRINA P. COLO, RN, MAN (c)
 Drug Name Route Indication
ATROPINE SULFATE IVTT antidote for cholinergic toxicity
MORPHINE SULFATE IVTT opioid antagonist; pain reliever;
antidote: Naloxone (Narcan)
NITROGLYCERIN SL DOC for angina
EPINEPHRINE IVTT common cardiac drug for resuscitation
FUROSEMIDE IVTT edema, CHF, renal failure, CKD
ACTIVATED CHARCOAL PO/NGT poisoning
IPECAC PO induce vomiting
DOPAMINE, DOBUTAMINE, IV drip/infusion vasopressors, BP, HR
NOREPINEPHRINE
DIPHENHYDRAMINE IVTT/IM/PO allergic reactions
FLUMAZENIL IVTT antidote for benzodiazepine toxicity
NICARDIPINE IV drip/infusion BP
D50W IVTT rapid acting glucose for severe
hypoglycemia
GLUCAGON IVTT prevent glucose levels dropping too low
VOLUVEN IV infusion blood alternatives during emergency
situations
VITAMIN K/PHYTOMENADIONE IVTT antidote for warfarin toxicity
Difference between IVTT/IV and IV
IVTT
drip/infusion IV Drip/infusion

Ref: google.com/intravenousinfusions
 EXTRAVASATION
Caused by erosive agents like IV infused/IVTT medications which leads
to tissue/cell necrosis or death.

Ref: google.com/images/extravasation
 HYPOVOLEMIC SHOCK
Causes:
• profused bleeding
Tachycardia Tachypnea • trauma/injury
• ruptured aneurysms/ectopic pregnancy
S/sx:
• cool, clammy skin
• pallor
• diaphoresis
• oliguria/anuria
• decreased LOC
Tx/Management:
• Fluid resuscitation (PNSS, large bore
cannula)
• Epinephrine, Norepinephrine, Dopamine,
Hypotension Dobutamine infusions
• Voluven - restores blood volume
 CARDIOGENIC SHOCK
Causes:
Tachycardia Tachypnea • bradycardia, heart blocks
• Vtach,Vfib,SVTach
• Myocardial infarction, ischemia, heart attacks (ex: Stress
Cardiomyopathy)
• Heart muscle tears (chordae tendineae)
S/sx:
• chest pain
• oliguria
• diaphoresis
• shortness of breath
• decreased level of consciousnes
Tx/Management:
• Dopamine, Dobutamine, Epinephrine, Norepinephrine
• cardioversion; angioplasty;pacemaker
Hypotension