Pharmacology

Pharmacology o Only 2 cheeses w/o thyramine – cottage cheese

and cream cheese
5R’s of Medication Error - Impact of food on drug action – Vit K, NOT POTASSIUM,
(green leafy vegetables) can reduce effects of
- Right Patient – ask their name, birthday (two-patient coumadin
identifier) - Drug to Drug interaction
- Right Drug – clarify the order with doctor; avoid o Additive effect – 1+1 =2
abbreviations  Note herbal medications
o MSO4 –morphine sulfate  DOH Herbal Medications
o MgSO4 – magnesium sulfate  Santalubi
- Right Dose  Sambong - diuretic
o Need for conversion when preparing a dose of  Akapulko
medication  Niyog-niyogan
- Right Route – not everything comes in oral, parenteral.  Tsaang Gubat
You can have topical, nasal spray.  Ampalaya
o Insulin – not given oral  Lagundi
 There are a lot of drugs inactivated by  Ulasimang bato
gastric juices  Bawang
 Hepatic First Pass – inactivated in liver  Bayabas
- Right Time - leeway of 30 minutes; specific time  Yerba Buena
o Antagonistic - counteracting
Ischemia – lack of blood supply – dec. oxygen o Potentiating – strengthens the other drug
Infarction – absence of blood supply – necrosis  CoAmoxyclav
The one of produces cholesterol internally is our liver - Creation of unique response
Cholesterol in our level is produced in liver – 10pm until 2am – statin o Drugs combined in IV solution can form
- Give statin at night – 9pm precipitate (crystallization)
Steroids – produced ¾ in morning (4-8am), ¼ in the afternoon (1- o Do not give with dextrose solution – Mannitol
5pm) and Pheytoin (NSS only)
- No one will drink a medication at 4am
- Steroids are gastric irritant VITAMINS AND MINERALS
- given 8am with breakfast - Fat soluble vitamins – needs bile (produced in liver)
o If problem with liver, problem with ADEK
Assess for allergies o Risk for hypervitaminosis
- drug of choice for anaphylactic shock is epinephrine = o Vit A
vasoconstrictor, bronchodilator  integumentary and eye sight
 excessive doses can be toxic
DO NOT GIVE especially in pregnancy
- If systolic pressure is below 90mmHg; affect perfusion (hypervitaminosis)
- If HR is 60bpm; when 60 exactly do not give it.  may have alopecia, yellow sclera
- If RR is less than 12bpm o Vit D
 Calcium absorption
Go for apical, 2nd na lang yung radial o
If pedia, adjust values, do not follow cutoff - Water soluble vitamins – excreted in body – stool and
urine
Orthostatic Hypotension o No hypervitaminosis
- Get 3 sets – lying down, sitting, standing (5 mins interval) o Vit C
- A drop of 20-30 mmHg in BP when lying to standing  Diarrhea and GI upset when excess
*Whatever the doctor writes, if you give it, you will be liable o B Vitamins
 Important in synthesis of DNA
Safety Issues  Important in blood production – RBC
- Adults – computed based on weight and height  Formation of nervous system;
- Pediatric – adjusted to size but should not reach adult regeneration of nerve cells
those since organ immature  Not absorbed if you drink alcohol!
- Geriatic – degenerate organs; decrease dosage  Folic acid – green leafy vegetables
- Nephrotoxic – monitor BUN (10-20) and Crea (nervous system dev’t – dec. neural
o Streptomycin tube defect – spina bifida);
- Hepatotoxic – ALT, AST 400mcg/day
 B12(cyanocobalamin) – meat
Medication Interaction products; organ meats;
- can result in toxicity or therapeutic failure  IM once a month. Once a
- you have take medicines on an empty stomach except if week for 1st month, then once
food is gastric irritant – food delays absorption a month for the rest of the life
- Iron  Needs intrinsic factor
o “best absorbed” – without food , “how produced in stomach!
administered” – w/food  Problem with gastrectomy
- MAOIs – antidepressant  Deficient in vegetarian –
o Thyramine rich foods – high BP (Hypertensive pernicious anemia
Crisis)
Megaloblastic Anemia

University of Santo Tomas – College of Nursing / JSV

 Pharmacology
- Big and immature RBC - Hypokalemia
- Cannot carry oxygen since it’s abnormal o Inadequate source, dieresis, diarrhea
- Folic Acid and Vit B12 o Oral (gastric irritant - ), IV (vein irritant – do not
Mineral give IV push or bolus, give in infusion over 1 hour
Iron – painful and arrhythmia which may lead to
- For hemoglobin regeneration cardiac arrest)
- Teratogenic in megadoses in 1st trimester - Hyperkalemia
- Causes GI discomfort o Most common in CRF, burns, chemotherapy
- Increased demands in menstruating women, children, (tumor lysis syndrome)
pregnant, alcoholics o Kayexelate (sodium polystyrene) – diarrhea to
- Vit C increases absorption excrete potassium if renal cannot excrete.
- Taken in tablet and liquid (drink with straw since it stains Monitor bowel movement
teeth), IM (Z track method –deep IM to dorso gluteal or o Diuretics if renal system is working
ventro gluteal to prevent staining)
- Black stools Ca
- 99% in bones
FLUID AND ELECTROLYTES - 1% in blood
- Water is affected by gender and age - Blood clotting and muscle contraction
- 70-80% water – infant - Dairy products
- 60-70% - water in males; women have water - Lactose intolerant – small fish whose bones are intact -
- 40-50% - elderly anchovies
- Very young and very old are most affected by fluid - Hypercalcemia
shifting o High in blood
o Calcitonin – comes form thyroid gland to bring
Fluid Composition back s.calcium in blood
- IC - 70%  No.1 drug for osteoporosis
o K o Prone to fracture
- EC – 30% o Bone cancer – bone breakdown
o IV (Blood) -5% o Can lead to kidney stones
 H20 + solutes Electrolytes (Na) o Diuretics – drink lots of water to flush stones
o IT – 25% o Dialysis
- Hypocalcemia
Diffusion – movement of solutes - higher to lower o High in bones
Osmosis – movement of solvent - lesser to grater o Parathormone – from parathyroid – inc. serum
calcium
Where solutes go, water follows o Thyroidectomy, sometimes parathyroid is
Increase volume, increase pressure removed – prepare CALCIUM GLUCONATE to
o Tetany – muscle spasm
Na  Chovstek’s – tap below earlobe
- Hypernatremia  Trosseau’s – BP pressure bring up 20
o Cell shrinks – dehydrates the cell plus above systolic then monitor for
o Fluid shifts from IC to IV carpal spasm
o Increases IV volume – Inc. BP can cause Mg
aneurysm – maintain BP - Muscle relaxant
o IV - Anticonvulsant (tocolytic and ecclampsia in OB)
- Sister cation of Potassium; same sources
- Hyponatremia - Infused in an hour: same with K
o Edema – IV to Interstitial/ IC - Hypomagnesemia
o Swelling of cell o Neutromuscular irritability – tetany
o Sodium tablet o Dysrythmnia

If solution contains more water – Hypotonic - Hypermagnesemia (Mag toxicity)

If solution contains more solute – Hypertonic o Muscle relaxation except for heart
Equal solute and solvent – Isotonic o Loss of DTR
o Do not give when dec. urine, BP, RR, and loss of
Anything more than 0.9 NaCl – is hypertonic DTR
Anything more than D5 (isotonic) – hypertonic o Give calcium gluconate
LRS – isotonic
AUTONOMIC NERVOUS SYSTEM
* D5 becomes hypotonic when inside the body since glucose is - Sympathetic Nervous System (Adrenergic)
metabolized by the body o Every time stressed, stimulated, excited
* All electrolytes are important for nerve impulse transmission –  Epinephrine (Adrenaline)
weakness of muscles  Norepinephrine
 Dopamine
K  If it doesn’t attach to a
- 80 % excreted in kidneys receptor, it is useless
- 20 % excreted in GI - Amount of blood to go to GI and GU decreases and goes
- Sources: All fresh fruits and vegetables; the drier the fruit, to more important organs; decreases secretions
the higher the content - Receptors

University of Santo Tomas – College of Nursing / JSV

 Pharmacology
o Alpha1 – vasoconstriction to increase BP o Antidote to cholinergic crisis
o Alpha2 – vasodilation to decrease BP o For symptomatic bradycardia
o Beta1 – 1 heart – Inc. heart rate
o Beta2 – 2 lungs – bronchodilation (Salbutamol- *Antihistamine have cholinergic properties
asthma) + relaxation of uterine muscles Benadryl
(Terbutaline - premature labor) Scopolamine – motion sickness

- Alpha and Beta Adrenergic Agonists Parkinsons’ Disease

o Epi, Norepi, Dopa - Decrease dopamine, inc. acetylcholine, degenerative,
o stimulates Alpha 1, Beta 1, Beta 2 decreases substantia nigra
o inc. metabolism – energy – inc. blood glucose – - NO DIAGNOSTIC TEST, NO CURE
DO NOT REPORT if less than 200, but if higher - 3 cardinal symptoms
report for possible management o Tremors at rest
 Epi – shock, bronchospasm, glaucoma, o Muscle rigidity
cardiac arrest o Bradykinesia
 Norepi- shock and cardiac arrest - Levadopa – precursor of dopamine; becomes dopamine
 Dopamine – drug of choice for shock; o Converted to dopamine – has receptors in Brain,
titration heart, GI, GU
 Low dose – vasodilation - Carbidopa – allows more dopamine to go to the brain
 High dose – vasoconstriction - Carbidopa-Levodopa (Synemet)
- Phenylephrine (Neosynephrine/Phenylpropanolamine) –
Alpha 1 agonist; no beta effect MAO
o If hypertensive, do not drink Neozep since it - Enzyme that destroys epi,norepi,dopa
causes inc. alpha 1 sti. - Give MAOI (Selegiline, Anti-cholinergics, antihistamine)
- Clonidine (Catapres) – stimulates alpha 2 agonist - Also used for parkinson’s
o Antihypertensive
- Isoproterenol – stimulates beta 1 and 2 Pseudoparkinsonism
o Do not give if increased HR but causes - Given a medication that blocked dopamine
bronchodilation - Parkinson itself is degenerative
- Salbutamol – stimulates only Beta 2
o Bronchodilation only Glaucoma
Agonist – stimulates - Increase IOP
Antagonist/Blockers – stoped - Open angle
Mydriasis – pupil dilation o Overproduction of aqueous humor; obstruction
o Inc. volume, inc. pressure
Block beta – olols o Pressure on optic nerve
Block alpha – zozin o Carbonic anhydrase inhibitors (Acetazolamine)
– diuretic, eye drops, press nasolacrimal duct for
Increase in heart rate = increased oxygen demand 2- to prevent systemic absorption
o Mannitol –eyedrops
- Parasympathetic Nervous System (Cholinergic) o Ciliary body – aquaeous body -. Posterior
o opposite of SNS chamber -> anterior chamber trabecular
o Acetylcholine meshwork in the canal of Schlemm =
- Cholinergics trabeculoplasty
- Increase acetylcholine (Myesthenia Gravis) - Closed/Narrow angle – more dangerous
o Neostigmine (Prostigmine) - The more dilated the pupils are, the more obstruction
o Edrophonium (Tensilon) - Pilocarpine – miotic – PNS/ cholinergic to decrease pupils
- Promote peristalsis
- Treat urinary retention Eye Medication
o Urecholine (Bethanicol) – dieresis, non- - OD – right eye
obstructive urinary retention - OS – Left eye
- OU –both eyes
Myesthenia Gravis - Pressure on inner canthus
- Decreased acetylcholine = muscle weakness (ptosis, - Wait 5 mins per each drug
DOB, drooling) - Drops – lower conjunctival
- Tensilon (Edpronium chiloride) – short acting, works in 5 - Ointment – inner to outer
mins, gone in 20 mins
o Remove symptoms, (+) tensilon test
o Diagnostic drug ANTIANEMICS
- Neostigmine – long acting cholinergic Normal neutrophil count: neutropenic diet
- Myasthenic Crisis – underdosing muscle Erythropoetin (Epogen) – low in CRF; stimulate RBC production
weakness = same symptoms Philgrastim (Nupogen) – stimulates neutrophil production; given
- Cholinergic Crisis – overdosing subcutaneous, do not shake and refrigerate; common in
o Antidote is anticholinergic – atrophine sulfate chemotherapy
Acetylcholine - important for nerve impulse transmission CARDIAC MEDICATIONS
ANTICHOLINERGIC Ischemia – dec. blood supply
- Same effect as adrenergic Decrease heart rate in cardiovascular disorders
- Atrophine sulfate - SFF, no exercises
o Dec secretion prior to OA

University of Santo Tomas – College of Nursing / JSV

 Pharmacology
Nitrates
- Oral, sublingual (fastest at home 3 times, 5 mins. Interval;
after 2 mins before it takes effect), IV (fastest in hospital),
patch (doesn’t matter where you place it; do not touch;
headache – say it is normal but give analgesic)
- Vasodilator; increases blood supply
- Potency is decreased when exposed to sunlight
- Tolerance (Ceiling effect) – inc. dosage
- Never give nitrate in patients who had Viagra and other
drugs for ED
- Antidone to Viagra is epinephrine
- If erection lasts for 4 hours, go to Emergency Room
- Warfarin – PT (Control value = 10-15 secs; therapeutic
value = 1.5-2.5xCV) and INR = 2-3; must be checked every
2 weeks for the rest of your life to maintain the level
o Potent drugs; prone to bleeding
- Heparin – aPTT (Control value = 30-45 secs)
- Warfarin - If high therapeutic value, give Vit K
- Heparin – protamine sulfate
Warfarin takes 2-3 days before it can take effect so Heparin and
Warfarin can both be used
- Electric razon, soft bristled toothbrush
- Antidote is Vit K

All drugs in a patch are placed on 12 hours only to prevent Prone to bleeding, do not do IM, SQ instead!
tolerance
Patch are needed in the morning THROMBOLYTICS

Calcium channel blockers Mas matagal, mas matigas

- dec. heart rate/ check HR Mas matigas, mas mahirap tunawin
- also vasolators/ monitor BP
- the more the calcium, the more contraction, the more HR - Given as soon as possible; 4-6 hours from the onset of
and oxygen symptoms of MI
o Verapamil - Ischemic Stroke – must be given 3-4 hours. NOT
o Nifedipine HEMORRHAGIC STROKE
o Diltiazem o CT Scan without contrast
o –dipine - Tissue Plasminogen Activator (Alteplase), Streptokinase,
- ER Door-to-Drug – 90 mins but still must conform to the 4-6
Beta-blockers hours limit
- dec. heart rate
- olol CARDIAC GLYCOSIDES
Digoxin
ANTIARRYTHMICS - increase force of contraction; the more you squeeze the
- Drugs depend on type of arrhythmia more ineffective the contraction; dec. heart rate
- Rate problem - 0.5-2ng/ml
o Symptomatic bradycardic – atropine sulfate - Given to patients with diuretic
o Tachydardia – beta blocker, calcium channel - Hypokalemia predisposes you to digoxin toxicity
blockers - BANDAV – bradycardia, Anorexia, Nausea, Diarrhea,
- Rhythm problem Abdominal pain, visual illusions , males (gynecomastia)
o Atrial - quinidine - Antidote: digibind
o Ventricular tachycardia – 200-300bpm -
Lidocaine DIURETICS
- Diamox/Mannitol – open angle glaucoma; not given as
P – atrial depolarization (stimulates muscles) – made by SA node – antihypertensives
initial pacemaker - Mannitol – ICP
- Atrial arrhythmia - Furosemide (Lasix)-fast acting drug (oral – 30 mins, venous
SA-AV node – PR interval (0.12-0.20 secs)- to allow filling – 5 mins) for CHF; not given as antihypertensives since it
Bundle of His will trigger the RAAS system -> rebound hypertension
Purkinje Fibers – QRS – Ventricular depolarization (0.04-0.12 secs) - Thiazides – antihypertensives; gradual diuretics
- Ventricular arrhythmia - Spirinolactone – potassium sparing diuretic (Aldactone);
mild
Adenosine – supraventricular tachycardia o Liver cirrhosis
- Half life is 6 seconds – time it take for half of the drug to - Ascites – high Na, low K – so potassium sparing
be excreted - Monitor for orthostatic hypertension
- Follow with bolus 10-20 cc NSS
ANTIHYPERTENSIVES
- Alpha Blockers
Myocardial Infarct - Alpha 2 agonists – catapres
M - Morphine - Nitroglycerin
O - Oxygen - Calcium channel blockers
N – Nitroglycerin – patch/IV - Beta blockers
A – aspirin (ANTIPLATELET) Ticlobidine – alternative if with - Vasodilators
allergy

- Must have maintenance aspirin or anticoagulant - ACE Inhibitors

(Heparin & Warfarin – IV, SQ while the other one is oral)
- Enoxaparin (Lovenox) – low molecular weight, less o Rennin – angiotensin I -> angiotensin II ->
systemic bleeding, anticoagulant vasoconstrictors
o Monitor for bleeding o -pril
o Side effect: dry cough

University of Santo Tomas – College of Nursing / JSV

 Pharmacology
- Angiotensin II Receptor Blockers
o –sartan
o Most expensive but newest
o Telmisartan, irbesartan, losartan
o No dry cough effect
o Covalsartan – thiazide(diuretic) and sartans
- Antilipemics
o Internal production – statin
o Cholesterol is made in liver so…
o Hepatotoxic
- Bile Acid Sequestrants
o Binds with external fats so that it can bind
o Cholestyramine (Questran)
o Orlistat (Xenical/Lesofat) – steatorrhea
 Vit ADEK Deficiency since it cannot be
absorbed
RESPIRATORY DRUGS
- Injury -> broken skin -> inflammatory response ->mast cells
(chemical mediators – histamine, kinins, leukotrienes) ->
blood -> cell effect
o Histamine – vasodilator, inc. capillary
permeability -> edema
Oral Decongestants
- Nasal Congestion (vasodilation) - Adrenergics –
vasoconstriction
- Anti-inflammatory
- No rebound congestion (oral)
- Ex. phenylpropanolamine (Neozep), phenyleprine
(Neosynephrine)
Topical Decongestants
- Topical – adrenergic and steroids –the more you use it
rebound congestion (rhinitis medicamentosa)
Decongestants are stimulants. May cause hypertension,
palpitation, and CNS stimulation
Cough
- Dry cough
o Antitussive (cough suppressant) – opiods
 Opioids – CNS Depressants
 Drowsy; do not do activities
requiring mental alertness
 Can suppress respiration
 Robitussin with codeine
 Reduced peristalsis
 Prescription
o Robitussin with dextrometorphan – no sleep
- Productive cough
o Expectorants – plain Robitussin
 Reduce the viscosity of secretions
 Disintegrate and thin secretions
 Thinner mucus that is easier to remove
 Acetylcysteine (Fluimucil, Mucomyst) –
antidote to Tylenol
(Paracetamol)overdose,
Carbocysteine
o Mucolytics
Any drug that affects CNS may be potentially addictive
COPD
- Chronic bronchitis – treat the cause
University of Santo Tomas – College of Nursing / JSV
o Anti-inflammatory
- Emphysema
o Alveoli filled with air – bullae – may lead to
spontaneous pneumothorax - bullectormy
- Asthma
o Triggered by environment and other allergens
o Hypersensitivity reaction
o Edema of bronchioles
o Leukotrienes- bronchoconstriction, tighten up
muscles
o Oxygen does not really help
o Salbutamol – beta 2 only; bronchodilators
o Xanthenes – aminophylline and theophylline (10-
20mcg/ml)
 Belong to same family as caffeine
o Generally, all bronchodilators will increase HR
Techniques in Administration (Inhaler)
- Inhaler must be 1-2 inches away because if directly done
corticosteroid can kill normal flora which may predispose
to oral thrush (candidiasis), rinse mouth with water after
- Hold your breath for 5- 10 seconds
- Use spacer to prevent staying
- If disk type (powder), it must be in contact with mouth
Long Term Steroids
- Inhaled long-acting beta-2 agonists
o Salmetrol (Severent diskus)
- Leukotriene antagonist
o Montelukast (singulair) – avoid bronchospasm
- Mast cells stabilizer
o Cromolyn Na – maintenance
o AE: bronchospasm
ANTITUBERCULOSIS
- Airborne/ droplet
- 6-9 months treatment
Rifampicin
- reddish orange secretion; hepatotoxic
INH
- LFT, pyridoxine (b6), to prevent peripheral neuritis
- No.1 drug for TB
PZA
- Raises uric acid, monitor LFT
Ethambutol
- Optic neuritis
Streptomycin
- Ototoxic, nephrotoxic
Multi-drug therapy – combination to decrease tolerance
Family member – INH/ 1-3 months
Multi-drug Resistant
- Quinolones – -floxacin
GASTRIC MEDICATIONS
Ulcers- may perforate the organ and cause peritonitis
1. Increased amount of acid
2. Decreased amount of mucus
- Food acts as a buffer that protects GI lining
- Stress can increase chances of ulcer
- Gastric ischemia – dec. blood supply
- Bacterial infection – Helicobacter pylori – no. 1 cause
since it stimulates parietal cells which stimulate gastric
acid production
o Antibiotic is best medication
o Proton pump inhibitors
- Burns – curling’s ulcer
 Pharmacology
- Neurological – cushing’s ulcer *Increase fiber plus water in constipation!

Location:
- Gastric LAXATIVES
o Normal to hypo secretion of mucus - For constipation
o May have abortifacient effect 1. Bulk forming agents– increase water
o Cytotec(Misoprostol) 2. Gastric Stimulant
 Increase production a. Stimulate peristaltic activity
 causes uterine contractions b. Cramps
o Do no give proton pump or H2 blockers 3. Stool softeners – not with MI, inc ICP
- Duodenal 4. Lubricants – Lactulose – to decrease ammonia in Liver
o Hyperacidity - hypersecretion CIrrosis
o more common
o Decrease acid production CHO -> Glucose -> ATP
 Proton pump inhibitors - prazole Fats -> fatty acids
 H2 blockers – rantidine CHON -> ammonia -> urea -> kidneys

Antacids – for neutralization (magnesium, aluminum, calcium) Hepatic encephalopathy – cannot convert urea; ammonia build
- Magnesium SE: Diarrhea up which is toxic to brain
- Aluminum, Calcium SE; Constipation
- Maalox – Magnesium-Aluminum – SE depends on patient ANTIDIARRHEA
- If cause of diarrhea is bacteria/toxin/poison, do not drink
Provide protective coating over ulcerated site these medicines since it will counteract with
o Sucralfate – coats the ulcer compensatory mechanisms
- If other reason, drink medicines
EMETICS AND ANTI-EMETICS 1. Opiods
a. Decrease intestinal motility and peristalsis
Vomiting – causes b. Can cause drowsiness
o Obstruction c. Depress breathing
o Trigger of vomiting center (medulla oblongata)
o Chemical imbalance ENDOCRINE MEDICATIONS
 acetylcholine increase Pituitary Gland – master gland, common site of tumors
 Inc Epi, NE, Dopa (mostly manipulated) - If you have pituitary gland, you can have brain tumor –
– Dopamine antagonist Inc. ICP
 Block dopa – EPS - Last option = remove pituitary gland (hypophysis) –
o Akthesia hypophysectomy
o Acute dystonia - Tumor = excessive disorder
o Pseudoparkinsonism - Anterior Pituitary
o Tardive dyskinesia o FSH
 Block serotonin – no EPS o LH
o Atyptical o Growth Hormone
antipsychotics  Growth of long bones – epiphyseal
Endogenous Depression – depression due to chemical imbalance plate closes at 18 for women, 21-24 for
males
Many SNS - Psychotic  Growth of cells and tissues
Decreased PNS - Depressed  Decreased GH – Dwarfism
All anticholinergic are antihistamines  Somatropin – do not inject if
All antipsychotics are antiemetics epiphysis is closed
 SQ injection; anabolic – builds
up
- Serotonin antagonists (Atypical Antipsychotics) – block  SE: fluid retention and
serotonin receptors myalgia
 Anabolic substance
Increase Dopamine nandroxone and
- TCA oxandrolone – stimulates
- MAOI – breaks down dopamine protein synthesis, inc.
Increase Serotonin cartilage, and bone growth
- SSRI  May have cardiac arrest
 Increased GH if open epiphysis –
Gigantism
EMETICS  Somatostatin analogs
- Syrup of ipecac  Sandostatin (Octreotide
o For overdose and poisoning Acetate)
o Do not induce vomiting if corrosive substance o Anti GH
(petroleum) or unconscious (aspiration) o SQ 3x/week IM 2-4
o Activated Charcoal/Gastric lavage – if corrosive weeks
o But if with antidote, give it!  Dopamine agonists
- Ipecac syrup – more concentrated o Bromocriptine
(Parlodel)

University of Santo Tomas – College of Nursing / JSV

 Pharmacology
 GH receptor antagonists
o Pegvisomant
(Somavert)
 Increased GH if closed epiphysis –
Acromegaly
 Prognatism – enlarged jaw
o TSH -. Thyroid glant to produce T3 and T4
 Needs iodine to produce
 T3 – Triiodoformin (?)
 T4 Thyroxine
 Mental and growth capacity
 Who do not have sources of iodine
 Mountain – Highlanders
 Goitrogenic – interfere with
iodine synthesis
o Cabbage, broccoli,
cauliflower,
chopsuey!
o Metabolism = SNS
 Severe Hypothyroidsm (Myedema)
 Children without Thyroid gland
(cretinism)
 Mentally retarded
 Thyroid hormones
 Levothyroxine (Synthroid) – T4
 Liothyronine (Cytomel) – T3
 Liotrix (Euthyroid) –
combination
 Thyroidectomy – no frequent
swallowing is at the neck; bleeding at
neck
 Shrink and reduce vascularity
of the thyroid gland before
throidectomy with
SSKI/Lugol’s solution
o ACTH – targets adrenal glands: cortex and
medulla
 Cortex
 Glucocorticoids
(Cortisol/Steroids)
o Catabolic –
breakdown CHON,
CHO, Fats -> high
glucose -> CHON
breakdown (fluid
shifting) -> edema,
muscle wasting,
osteoporosis, stretch
marks,
immunosuppressant
(antibodies are
made of proteins) ->
fat breakdown ->
central (truncal)
obesity
o Buffalo hump
o Anabolic steroids –
pure androgen;
used by athletes
 Mineralocorticoids
(Aldosterone)
o Retains Na and
water
 Androgens (secondary male
characteristics)
o Hirsutism
University of Santo Tomas – College of Nursing / JSV
o Stimulation of
sebaceous glands
 High GMA – Cushing’s
Disease
o High water and
sodium; low
potassium
o SIADH – no high
sodium
o If secondary to
medicine –
Cushing’s Syndrome
 Low GMA – Addison’s
o Steroids
o Addisonian(Adrenal)
Crisis – do not stop
abruptly
 Taken with
meals
 Medulla: E, NE
 Pheochromocytoma – more
E,NE due to tumor
o Antihypertensive
o Remove adrenal
gland
(adrenelectomy)
ANTI THYROID MEDICATIONS
- PTU(Propythiouracil)
o Prevent the formation of thyroid hormone
o Not for pregnant women – cretinism
o SE: Aggranulocytosis – monitor for signs of
infection
o Tapazole (Methimazole)
Tonsillectomy – frequent swallowing
Hyper = increase
Hypo = decrease
- Posterior Pituitary
o Oxytocin
o ADH (vasopressin) – water
retention/reabsorption
 Inc. ADH – SIADH
 High BP, edema
 Fluid restriction
 Diuretics
 Dilutional hyponatremia
o 3% NaCl
 Dec. ADH – Diabetes Insipidus
 Polyuria
 Dehydration -> polydipsia
 Fluid Deprivation Test
o Even if deprived for
10 hours, urinate
o 1kilo – 1 L
 Give vasopressin (Pitressin,
Lypressin; nasal,
Desmopressin: oral IV, nasal
spray)
INSULIN
- Type 1 – No Insulin
- Type 2 – With less functional insulin
1. Rapid Acting: Lispor (Humalog)
a. 10-15 mins, 1 hour peak, duration 3 hours
2. Short acting: Regular
a. O 30 mins-1hr P 2-4 hrs, D 6-8 hrs
 Pharmacology
3. Intermediate acting: NPH and Lente o Monitor for elevate K and for tumor lysis
a. O 2-4 hrs P 8-12 D 12-16 hrs syndrome
4. Long acting insulin o Affects the normal and abnormal cells
5. Glargine (Lantus) – no peak; no hypoglycemia; 24 hour o Serotonin antagonist – zetron, no dopamine
insulin antagonist
o Chemo = massive cell destruction
*Peak action is the time when you experience hypoglycemia –  Hyperuricemia and hyperkelmia
Regular and NPH  Allopurino – preventive
 Increase hydration
Regular insulin is SQ and IV

Regular first. Clear then cloudy. Rotate sites (1 in apart) to prevent Neutropenic Precautions
lipodystrophy - NO
o Fresh flowers, fruits, or vegetables
DO NOT MIX LANTUS o Visitors with infection
- Oral Antidiabetic – must have functioning beta cells (Type o Rectal temps, suppositories, enema
2) o Catheters
- Administer all insulin SQ, only regular for IV - YES
- DKA – Type 1; HHNKS – Type 2 o Handwashing
- Abdomen fastest route, then arms o Mask and gloves
- Do not inject cold insulin (lipodystrophy) o Watch for signs of infection
- Store in room temp (1 month), refrigerator (3 months)
Bleeding Precautions
INSULIN PUMP - Soft bristled toothbrush
- Pump that secretes insulin continuously - Electric toothbrush
- Mimics pancreatic functioning
- Needle is changed only 3 days; embedded; not Drugs:
changing everyday - Hormonal
o For hormone dependent hormones
Hyperglycemic Agents o Signs and symptoms for
- Choose liquid first since it’s fast absorbed! o Estrogen, tamoxifen (antiestrogen
- Unconscious - Corticosteroids/Predisone
o Dextrose 50% IV (unconscious IV access) o Don’t withraw abruptly
o Very concentrated o predisone
o If without IV access, glucagon SQ/IM - Antibiotics
o Doxorubicin – cardiotoxic
CANCER o Bleamomycin – pulmonary toxi
- Antimetabolite
Cell Cycle o S phase
- G0 – cell is resting; no replication; even if you give chemo, o If given much, give
no effect o Leucovorin (folicinic acid)- antidote
- G1 – preparatory phase; needs protein based o 5FU, cytosine, methotrexate
o By product of protein is uric acid - Alkyating Agent
- S – DNA synthesis o Cyclophosphamide (Cytoxan)
- G2 – RNA and other enzymes needed o Hemorrhagic cystitis
- M – division; mitosis - Vinca Alkaloids
o Stops mitosis
Antineoplastic Agents o Vincristine, Vinblastine
- Cell division gone wild!
- Acts on cell cycle Major component of a cell is folic acid
- Chemotherapy – interferes with cell division Do not use small veins since chemotherapy are vesicants
- Cannot be done consecutively - Infliltration - NR
- CCS (Cell Cycle Specific), CCNS (Cell Cycle Non Specific) - Extrasavation - strong concentrated chemical
- Mitotic Inhibitors (vin-) and Antimetabolites (S) – o Chemical
methotrexate  Wash and run in water 15-30 mins.
- Chemotherapy in cycle – kills cells; done repeatedly to o Can have either warm or cold compress
avoid G0 phase depending on drug
- 1cycle =5 sessions
- SE: ANTIBIOTICS
o Bone marrow depression (40-70% neutrophil) Reasons for Resistance
 If lower, neutropenia - Takes it for long time
o Alopecia – will grow back again - Take antibiotic but does not complete it
o Muscous membranes affected (stomatitis) – do o Some antibiotics are just bacteriostatic not
not use anything that is alcohol based bacteriocidal
o Nausea/Vomiting – - Large doses of antibiotic
o Antiemetics given 30 to 1 hour before and after
surgery If admitted with fracture, give broad spectrum
o Vomiting center is medulla
o Elevates uric acid Superinfection – infection due to decrease in normal flora

University of Santo Tomas – College of Nursing / JSV

 Pharmacology
Opportunistic infection
The more broader the antibiotic, the more prone to superinfection
Diarrhea due to bacteria – pseudomembranous colitis
Narrow spectrum – either gram negative, gram positive
Medications
- Penicillin
o GI symtoms; hypersensitivity reaction
o “miracle drug”
o No. 2 drug for syphilis
o Not effective for gonorrhea
- Cephalosporins
o Same chemical structure as PCN (beta-lactom) ;
more prone to infection (broad specturm)
o Chemically related – cross resistance and cross
allergy with penicillin
o More broad spectrum; more prone to
superinfection
- Tetracycline
o yellow discoloration of teeth photo sensitivity (do
not use for last half of pregnancy until 8 years o
age)
o Yellow teeth, yellow sun
o Not allowed to children
- Aminoglycosides
o Nephrotoxic, ototoxic (VIII) – vertigo and tinnitus
o -mycin
o Neomycin is a prophylactic antibiotic, given for
liver cirrhosis – bacteria increases ammonia
conversion
- Quinolones
o Drug of choice in MDR TB, UTI, RTI
o Crytalluria; photosensitivity
o –floxacin
- Macrolides
o Good for RTI
o Extremely GI irritant; take with food
o Erythromycin, azithromycin (only drug for 3 days
for CAP), once a day
o MRSA - Vancomycin (antibiotic of choice)
o RED – Red Man’s Syndrome – causes redness
from neck to below due to fast administration –
vasodilation, dec. BP, not an allergic response –
infused in 1-2 hours
- Sulfonamides
o First antibiotic; for UTI, skin infections, burns
o Crystalluria, photosensitivity, Steven Johnson
syndrome – derma condition which looks like a
second degree burn, blisters
o Sulfa-, cotrimoxazole
o Yeilds sulfuric acid which can cause metabolic
acidosis
Pyridium – urinary analgesic for dysuria; not an antibiotic, causes
redish-orange urine; give with other antibiotics
ANTIFUNGALS
Systemic – Ampothericin B (Fungizone)
- Shake and Bake syndrome
- Seizure and pyrexia - antipyretics
University of Santo Tomas – College of Nursing / JSV
Local
Oral Candidiasis
- Nystatin (Mycostatin)
- Oral suspension: swish and spit (mouth)/ swish and
swallow (lower GI)
Yeast infection (Vaginal candidiasis)
- Cheesy drainage, foul smelling
- Nystatin – tablet/ suppository
Candidiasis can occur in moist areas in body
- Nystatin power/ointment
Ringworm (Tinea)
- Capitis
- Corporis
- An an, buni, had had
- -azole
ANTIHELMINTHICS
Lindane – for pediculosis
- Head – Quel – neurotoxic so wash away
- Corporis – leave Quel to 12 to 24 hours
Mebendzaole - deworming
Quinine – antimalarial; may be used for prophylaxis 2 weeks before
and 2 weeks after, same time for one week
ANTIVIRAL
- ALL ARE NEPHROTOXIC, drink lots of water
ANTIGOUT
- Hyperuricemia
o eating high foods in purine which yield uric acid
o shellfish, legumes in general, nuts and oats
o Kidneys excrete uric acid; kidney dysfunction
impairs excretion which may cause uric acid
stone or may deposit in the big toes (tophi)
o Colchicine – for pain and inflammation
o Allopurinol – preventive and maintenance,
reduces production
o Probenecid - Uricosuric – secretes uric acid
ANALGESICS
Opiod
- Suppresses respiration and cough (Antitussive)
- Constipation
- Morphine – one of the best drugs for MI
ASA, NSAID, Paracetamol – stops the inflammatory process; blocks
prostaglandins
- ASA – most effects; analgesic, antipyretic,
antiinflammatory, antiplatelet
o Can cause bleeding
o Ototoxic (tinnitus)
o Reye’s Syndrome – not given to children
younger than 15. NOT GIVEN IF only manifesting
viral symptoms, causes liver damage
- NSAID - analgesic, antipyretic, anti-inflammatory
o Gastric irritants
o COX 2 – not so much gastric irritants
 Pharmacology
o Ibuprofen, advil, ponstan, mefenamic acid, - Pseudoparkinsonism – tremors, rigidity and bradykinesia
ketorolac - Tardive dyskinesia
- Paracetamol (Tylenol) - analgesic, antipyretic o Needs to be stopped when this happens
o Neoaspilet (Neokiddielets) o In many patients, it is irreversible
o Hepatotoxic o Bizarre face and tongue movements
o MAXIMUM DOSE: 4g/day - STOP THE MEDICINE IF IT OCCURS
o Antidote: Acetylcysteine (Fluimucil/Mucomyst) - Tx: Antichoinergic drugs
- Benzotropine (Cogentin), trihexyphenidyl (Artane),
Diphenhydramine (Benadryl)
CNS STIMULANTS - Neuroleptic Malignant Syndrome- NOT AN EPS
Amphetamine – aceepted; methampethamine – not accepted o High temp and seizures
- Pupils is the test for addiction – dilated in addicts
Caffeine – addictive substances Typical Antipsychotic - Block dopamine (+ symptoms)
- Haldol, thorazine
*For narcolepsy, ADHD (more focused/paradoxical effect) - May cause EPS
Atypical Antipsychotic - Block serotonin (- symptoms)
- Usually mixed with dietary pills to increase metabolism; - Few or no EPS
only good for 6 weeks - Clozapine (Clozaril), risperidone (Risperidal), olanzapine
- May cause cardiac arrest (Zyprexa)
- Blood dyscrasias - agranulocytosis (Clozapine)
CNS DEPRESSANTS, SEDATIVE, ANXIOLYTICS Lithium
Barbiturates – barbi - Controlling the manic phase
- Calming effect without impairing intellectual activity
All CNS depressants are used for anesthesia; may cause respiratory - Controls flight of ideas an hyperactivity
depression - TE: 0.6-1.2mEq/L
- 1.5-2mEq/L – TOXIC
ANTICONVULSANTS - Monitor for every month or two
Anticonvulsants are CNS depressants - Serum Na levels needs to be monitored – lithium tends to
Phenobarbital – long acting barbiturate (anticonvulsant) deplete Na – adequate sodium intake, increase fluid
- Tonic clonic intake
- partial - Review mild, moderate, severe
- No 1 cause of death - dehydration
Bendzodiazepin – Valium (IV)
- status epilepticus – continuous seizure activity
- cerebral hypoxia – damage
- Antidote: Flumazenil
Hydantoin
- Phenytoin (Dilantin)
- Gingival hyperplasia – increase number of cells, can be
lessened by massaging the gums, soft bristled toothbrush
- Monitor serum level NV; 10-20mcg/ml
- Can cause redish brown urine (NORMAL)

ANTIDEPRESSANTS
* Effects can be seen after 2-4 weeks
- TCA (Amitriptyline-Elavil)
o Sedating, orthostatic hypotension, palpitations
o Give in evening
o Palpitation – Cardiac Arrest
- MAOI
o Last option to be given
o Hypertensive crisis
o Avoid tyramine rich foods
o MAO – destroys E,NE,D
o MAOI – increases E, NE,D
o PArnate,MArplan,NArdil
- SSRI (Fluxetine-Prozac)
o First drug
o Give in morning since may cause insomnia,
anxiety

ANTIPSYCHOTICS
- Block dopamine receptors in brain
- EPS results
- Acute dystonia – oculogyric crisis – occurs early in the
treatment acute muscle spasms, opisthotonus (back
muscle), torticollis (neck)
- Akathisia – develops in 1st 2 months – uncontrolled need
to move-foot tapping and pacing

University of Santo Tomas – College of Nursing / JSV