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PHARMACOLOGY a.

immediately notify the nursing


supervisor, the prescribing physician,
Pharmacology and the pharmacist.
- most simply defined as study of drug. b. assess the client’s condition and provide
any necessary care.
Fundamentals of Pharmacology 9. For postpartum women, advice to take drugs
1. Pharmacokinetics - study of drug’s after breastfeeding.
changes as it enters and passes through
the body. Administration of Drugs :
a. absorption Routes and Nursing considerations:
b. distribution 1. Enteral
c. biotransformation - oral, sublingual, rectal, gastric tubes
d. excretion - capsulated pill, sustained release and
2. Pharmacodynamics - mechanism by which enteric coated should not be crushed.
drugs produce changes in body tissue. 2. Parenteral
a. desired effect - intended action of drugs - IV, IM, SQ, ID, IT, IA, epidural.
b. adverse effect - harmful unintended - vastus lateralis (safest site for IM)
reactions 3. Topical
c. side effects - consequence reactions - skin, inhalants, mucus membrane.
d. toxicity - the degree which something is
poisonous Eye medications:
digoxin = 0.5 – 2.0 ng/mL - administer eyedrops first then ointment.
lithium = 0.5 – 1.5 mEq/L - use a separate bottle for each client.
- instruct the client to tilt the head backward,
Safety and Efficacy open eyes and look up.
Nursing Principles : - avoid contact of medication bottle to the
1. Always verify the Five Rights . eyeball.
a. the right medications - place prescribed dose in the lower
b. the right client conjunctival sac.
c. the right dosage - instruct the client to press the inner cantus
d. the right form, route and technique for 30-60 seconds.
e. the right time - instruct the client to close the eye gently.
2. Chart drug administration only after its been
given, never before. Ear drops:
3. Never leave the medication on cart or tray - in infant and children younger than 3 y.o,
unattended. pull pinna downward and backward.
4. Chart observed therapeutic and adverse - in older children and adult, upward and
effects accurately and fully. backward.
5. Check history for allergies and potential drug - direct the solution on the wall of the ear
interactions before administering a canal, not directly on the ear drum.
newly ordered drug.
6. Inform the prescribing physician of any
observed adverse effects; if cannot be
located, inform the nursing supervisor
7. Question drug orders that are unclear, that
appear to contain errors, or that have
potential to harm.
8. Take the following actions if an error occurs :
CLASSIFICATIONS OF DRUGS - use for antidote in organophosphate
poisoning.
DRUGS AFFECTING THE CENTRAL AND  Adverse effects :
AUTONOMIC SYSTEM - dry mouth , dilatation of pupils,
Cholinergic Agents tachycardia
(Parasympathomemitics) - urinary retention, ileus, heat stroke
 Prototype:  Nursing considerations :
- synthetic acetylcholine, pilocarpine, 1. Keep client’s in cool environment.
carbachol, bethanecol (Urocholine), 2. Watch out for signs of heatstroke
edrophonium (Tensilon), and dehydration.
neostigmine (Prostigmine), 3. Encourage clients to increase fluid
pyridostigmine (Mestinon). intake and use of sugarless
 Mechanism of action: gum/candy for dry mouth.
- stimulates cholinergic receptors by 4. For GI spasticity, administer 30
mimicking acetylcholine or inhibition minutes before meals and at bed
of enzyme cholinesterase. time.
 Indications: Adrenergic Agents (Sympathomimetics)
- glaucoma, urine retention,  Prototype :
Myasthenia Gravis - epinephrine, norepinephrine,
- antidote to neuromuscular blocking ephedrine, dopamine, dobutamine,
agents : tricyclic antidepressants phenylephrine, terbutaline, albuterol,
and atropine isoproterenol.
 Adverse effects :  Mechanism of actions :
- blurring of vision, miosis - stimulate alpha and beta adrenergic
- increase in salivation, intestinal receptor directly or trigger the
cramps release of
- bronchoconstriction, wheezing, DOB - catecholamines indirectly causing
- hypotension and bradycardia sympathetic effects.
 Nursing considerations : - Indications :
1. Warn & monitor clients of the side - cardiopulmonary arrest, hypotension
effects. - COPD and asthma, nasal
2. Have atropine available for use as congestions
antidote. - allergic reaction, anaphylactic shock
Cholinergic Blocking Agents  Adverse effects :
(Parasympatholytics, Anticholinergics) - restlessness, insomnia, tremors,
 Prototype : nausea
- atropine, scopalamine (Triptone), - palpitations, angina, tachycardia,
dicyclomine (Bentyl), HPN
propantheline (Pro-Banthine).  Nursing considerations :
 Mechanism of actions : 1. Contraindicated in clients w/
- block the binding of acetylcholine in hyperthyroidism, pheochromocytoma
the receptors of parasympathetic & cardiovascular disease.
nerves. 2. Monitor vital signs and advice
 Indications : precautions.
- use preoperatively to dry up 3. Should be taken with food.
secretions.
- treat spasticity of GI or urinary tract.
- use for treatment of bradycardia,
asthma, parkinsonism.
ADRENERGIC BLOCKING AGENTS SKELETAL MUSCLE RELAXANTS
 Prototype : AGENTS
a. Alpha blockers  Prototype :
- phentolamine (Regintine), - methacarbamol (Robaxin), baclofen
phenoxybenzamine, prazosin (Lioresal), dantrolene (Dantrium),
(Minipress), metaxalone (Skelaxin), orphanedrine
- reserpine (Serpasil), terazosin (Norgesic), chlorzoxazone
(Hytrin)  Mechanism of actions:
- clonidine (Catapress), methyldopa - depress CNS
(Aldomet) - inhibit calcium ion release in the muscle
b. Beta blockers - enhance the inhibitory action of GABA
- atenolol (Tenormin), esmolol (gamma-amino butyric acid)
(Brevibloc), metoprolol (Lopressor),  Indications :
nadolol (Corgard), propanolol - for acute musculoskeletal pain
(Inderal), timolol ( Blocadren) - for muscle spasticity associated with
 Mechanism of actions : multiple sclerosis, cerebral palsy,
a. alpha blockers CVA, and spinal cord injury.
- inhibits action of a-receptors in  Adverse effects :
vascular smooth muscle to cause - hypotonia, ataxia, hypotension,
vasodilatation. drowsiness
b. beta blockers - blurred vision, bradycardia, depression,
- compete with epinephrine in b- urine retention
receptors in heart, pulmonary  Nursing considerations :
airways, peripheral circulation and 1. Caution clients that mental alertness
CNS. may be impaired.
 Indications : 2. Monitor neuromuscular status, bowel
- Raynaud’s disease, hypertension, and bladder functions.
pheochromocytoma. 3. Inform clients that maximum benefit of
- angina, arrhythmias, mitral valve baclofen is attained for 1-2 months.
prolapse, glaucoma 4. Reduce baclofen dosage gradually
 Adverse effects : because of associated withdrawal
- orthostatic hypotension, bradycardia, symptoms: Confusion, hallucinations,
CHF paranoia & rebound spasticity.
- depression, insomnia and vertigo
- bronchospasm and dyspnea, nasal ANTICONVULSANTS
stuffiness, cold extremities  Prototype :
 Nursing considerations : a. Hydantoins - phenytoin (Dilantin)
1. Administer oral alpha-blockers with milk b. Barbiturates - phenobarbital ( Luminal)
to minimize GI side effects. c. Miscellaneous - carbamazepine
2. Administer oral beta-blockers before (Tegretol), diazepam, clorazepate
meals and at a.m. if insomnia occurs. (Tranxene), valproic acid (Dapakene),
3. Check client’s apical pulse rate before ethosuximide (Zarontin).
drug administration, refer if below 60  Mechanism of action :
bpm. - treat seizures by depressing abnormal
4. Hypotensive precautions. neuronal activity in motor cortex.
5. Warn clients not to drive or operate  Adverse effects :
dangerous machinery until he/she has - sedation & drowsiness, gingival
6. adjusted to medications. hyperplasia
- diplopia, nystagmus, vertigo, dizziness
- thrombocytopenia, aplastic anemia
 Nursing considerations :  Nursing considerations :
1. Advise female clients to use 1. Give dopaminergic agents after meals to
contraceptives. reduce GI symptoms.
2. Inform clients taking phenytoin that 2. Reassure client that levodopa may
harmless urine discoloration is cause harmless darkening of urine and
common. sweat.
3. Warn clients with diabetes that 3. Avoid taking Vit B6 (pyridoxine) with
hydantoins may increase blood sugar levodopa because it speed up
level and that valproic acid may metabolism.
produce a false positive result in urine 4. Educate clients to minimize orthostatic
ketone test. hypotension.
4. Teach clients receiving carbamazepine 5. Elevate leg to reduce ankle edema.
to identify symptoms of bone marrow
depressions. CENTRAL NERVOUS SYSTEM
5. Reassure that barbiturates are not STIMULANTS
addictive at a low dosage.  Prototype :
6. Avoid taking alcohol with barbiturates. - amphetamines, methylphenidate
7. Administer IV phenytoin slowly to avoid (Ritalin)
cardiotoxicity.  Mechanism of actions :
8. Avoid mixing other drugs in same - increase excitatory CNS
syringe with phenytoin. neurotransmitter activity and blocks
inhibitory impulses.
ANTIPARKINSONIAN AGENTS  Indications :
 Prototype : - for obesity (amphetamines)
a. Anticholinergic agents - attention deficit hyperactivity disorders
- trihexyphenidyl (Artane), - narcolepsy
benztropine (Congentin) - drug-induced respiratory depressions.
b. Dopaminergic agents  Adverse effects :
- Levodopa, carbidopa-levodopa - nervousness, insomnia, restlessness
(Sinemet), amantidine - hypertension, tachycardia, headache
(Symmetrel), pergolide (Permax), - anorexia, dry mouth.
selegiline (Eldepryl),  Nursing considerations :
bromocriptine. 1. Should be given at morning.
 Mechanism of actions : 2. Don’t stop amphetamine abruptly to
a. anticholinergic agents avoid withdrawal symptoms.
- inhibit cerebral motor centers. 3. Monitor blood pressure and pulse.
b. dopaminergic agents 4. Ice chips or sugarless gum for dry
- increasing dopamine mouth.
concentrations or enhancing 5. Watch out for growth retardation in
neurotransmitter functioning. children taking methylphenidate.
 Adverse effects of dopaminergic
agents: DRUGS AFFECTING MENTAL
a. levodopa FUNCTIONING
- nausea, vomiting, anorexia, Sedatives, Hypnotics, and
orthostatic hypotension, dark- Anxiolytics
colored urine and sweat  Prototype :
b. amantidine a. Benzodiazepines
- ankle edema, constipation - diazepam (Valium), lorazipam
c. bromocriptine (Ativan), alprazolam (Xanax),
- palpitations, tachycardia flurazepam (Dalmane)
b. Barbiturates  Mechanism of actions :
- amobarbital, phenobarbital, a. Tricyclic antidepressants
secobarbital - increase receptor sensitivity to
c.Miscellaneous serotonin and/or norepinephrine.
- chloral hydrate (Noctec), buspirone b. MAO inhibitors
(Buspar), paraldehyde (Paral) - inhibit the enzyme MAO that
 Mechanism of actions : metabolize the neurotransmitters
a. Benzodiazepines norepinephrine and
- increase the effect of inhibitory serotonin.
neuro transmitter GABA (gamma- c. Second-generation antidepressants
amino butyric acid) - inhibits the reuptake of serotonin.
b. Barbiturates and Miscellaneous agents d. Lithium
- depress CNS - increase serotonin & norepinephrine
 Indications : uptake
- induce sleep, sedate and calm clients  Adverse effects :
 Adverse effects : - dry mouth, blurred vision, urine
- hangover-effect, dizziness, CNS retention, constipation (anticholinergic
depression effects)
- respiratory depression, drug- - orthostatic hypotension, insomnia
dependence - hypertensive crisis (MAO)
 Nursing considerations : - dehydration (Lithium).
1. Warn clients of injuries and falls.  Nursing considerations :
2. Brief period of confusion and excitement 1. Caution client to rise slowly to reduce
upon waking up is common with the effects of orthostatic hypotension.
3. benzodiazepines. 2. Take antidepressant with food to
4. Warn clients not to discontinue enhance absorption
medications abruptly without consulting 3. Explain to client that full response may
a physician. take several weeks (2 weeks).
5. Avoid alcohol while taking these drugs. 4. Assess client for constipation resulting
6. Rotate and don’t shake the ampules of from tricyclic antidepressant use.
barbiturates. Don’t mix with other drugs. 5. Client taking MAO inhibitors should
7. Warn female clients that diazepam is avoid tyramine-rich foods to avoid
associated with cleft lip. hypertensive crisis.
 aged cheese, sour cream, yogurt,
ANTIDEPRESSANTS AND MOOD beer, wine, chocolate, soy sauce
DISORDER DRUGS and yeast
 Prototype :  pentholamine (Regintine) is the drug
a. Tricyclic antidepressants of choice for hypertensive crisis.
- amitriptyline (Elavil), protriptyline 6. Inform physician and withhold fluoxetine
(Vivactil), if client develop rashes.
- imipramine (Tofranil), desipramine 7. Take lithium with food to reduce GI
b. MAO (monoamine oxidase inhibitors ) effects
- isocarboxazid (Marplan), phenelzine  >1.5 mEq/L blood level may cause
(Nardil), tranylcypromine (Pernate) toxicity manifested by: confusion,
c. Second-generation antidepressants lethargy, seizures,hyperreflexia.
- fluoxetine (Prozac), trazodone  maintain salt and adequate fluid
(Desyrel) intake
d. Lithium  tremors may occur but it is
temporary
 monitor white blood cell count DRUGS USED IN PAIN MANAGEMENT
(increase). General Anesthetics
 Prototype :
ANTIPSYCHOTIC DRUGS (NEUROLEPTICS) a. Inhalation anesthetics
 Prototype : - enflurane (Ethrane), halothane
a. Phenothiazines - isoflurane (Forane), nitrous oxide
- chlorpromazine (Thorazine), b. Injection anesthetics
- trifluoperazine (Stelazine), - fentanyl (Sublimaze), ketamine
- thioridazine (Mellaril) (Ketalar), thiopental Na (Penthotal),
b. Other Agents etomidate (Amidate)
- clozapine (Clozaril), haloperidol (Haldol)  Mechanism of actions :
 Mechanism of action : - cause CNS depression, by producing
- block dopamine receptor in the loss of consciousness,
limbic system, hypothalamus, and unresponsiveness to pain stimuli, and
other regions of the brain. muscle relaxation.
 Adverse effects :  Nursing considerations :
- Extra pyramidal symptoms such as 1. Instruct client NPO for 8 hours before
dystonia, pseudoparkinsonism, and administration.
an irreversible tardive dyskinesia as 2. Monitor cardio pulmonary depression
manifested by : and hypotension.
 lip smacking 3. Monitor urinary retention.
 fine wormlike tongue movement 4. Monitor body temperature
 involuntary movements of arms - malignant hyperthermic crisis :
and leg. - dantrolene (antidote)
- Neuroleptic malignant syndrome 5. Avoid alcohol or CNS depressants for
 fever, tachycardia, tachypnea, 24 hours after anesthesia.
diaphoresis, cardiovascular 6. In patient who received halothane,
collapse monitor signs of hepatic fatal side
 muscle rigidity, seizures. effects :
- orthostatic hypotension - rash, fever, nausea, vomiting
 Nursing considerations : - jaundice and altered liver
1. Teach family members the signs of EPS function.
and NMS, and report to physician
immediately. LOCAL AND TOPICAL ANESTHETIC
2. Normalization of symptoms may not  Prototype:
occur for several weeks after beginning - Local: bupivacaine, lidocaine, tetracaine,
of therapy procaine, mepivacaine, prilocaine
3. Avoid administering haloperidol - Topical: benzocaine, butacaine,
intravenously dibucaine,lignocaine
4. Watch out of neutropenia with  Mechanism of action :
clozapine. - block transmission of impulses across
5. Watch out for orthostatic hypotension nerve cell membrane.
and photosensitivity with phenothiazine.  Adverse effects :
6. Be sure that oral doses are swallowed, - cardiac dysrhythmias
and not hoarded.  Nursing considerations :
- lignocaine + prilocaine (EMLA cream)
should be applied topically 60 minutes
before procedure.
- administer cautiously to the areas of
large broken skin.
- observe for fetal bradycardia in pregnant DRUGS AFFECTING THE
clients. CARDIOVASCULAR SYSTEM
ANTICOAGULANTS
ANALGESICS  Prototype :
 Prototype : - Heparin (SQ and IV)
a. Narcotic analgesics - Warfarin (Orally)
- codeine, meperidine (Demerol)  Mechanism of actions :
morphine, butorphanol (Stadol), a. Heparin
nalbuphine (Nubain) - prevents thrombin from converting
b. Non – narcotic analgesic fibrinogen to fibrin.
- NSAIDs – aspirin (aminosalicylic acid), b. Warfarin
mefenamic acid (Ponstan), ibuprofen - suppress coagulation by acting as an
(Motrin), naproxen, ketoprofen antagonist of vitamin K after 4-5 days.
(Orudis), ketorolac, paracetamol and  Indications :
acetaminophen (Tylenol) - thrombosis, pulmonary embolism,
 Mechanism of actions : myocardial infarction
a. Narcotic analgesics  Adverse effect :
- alter pain perception by binding to opiod - bleeding
receptors in CNS.  Nursing considerations :
b. Non- narcotic analgesic 1. HEPARIN sodium
- relieves pain and fever by inhibiting the - if given SQ don’t aspirate or rub the
prostaglandin pathway. injection site (above the scapula - best
 Nursing considerations : site).
1. Monitor respiratory depression & - therapeutic level 1.5-2.5 times normal
hypotension in clients taking narcotic PTT;
analgesic. - normal PTT is 20-35 sec. = 50-85
2. Injury and accident precautions in sec.
clients taking narcotic analgesic. - antidote : (protamine sulfate)
3. Warn clients about possibility of 2. WARFARIN sodium (coumadin)
dependency,and do not discontinue - warfarin is used for long-term.
narcoticsabruptly in the narcotic- - onset of action is 4-5 days.
dependent clients. - therapeutic level is 1.5-2.5 times
4. Naloxone is antidote for narcotic normal PT; normal PT = 9.6 -11.8 sec.
overdose. = 25 - 30 sec. INR = 2 – 3
5. Advice clients to take NSAIDs with food - should be taken at the same time of
and monitor bleeding complications. the day to maintain at therapeutic level.
6. Aspirin is contraindicated in clients - reduce intake of green leafy
below 18 years old with flu-like vegetables.
symptoms. - antidote : Vitamin K ( Aquamephyton)
7. Monitor hearing loss in clients taking THROMBOLYTICS
aspirin.  Prototype:
8. Monitor liver function in clients taking - Streptokinase, Urokinase
acetaminophen.  Mechanism of actions:
9. N-acetylcysteine is antidote for - activates plasminogen to generates
paracetamol overdose. plasmin (enzyme that dissolve clots).
 Indications:
- use early in the course of MI (within 4-
6 hours of the onset)
 Nursing considerations: monitor bleeding
antidote : Aminocarpic acid
Antiplatelet Medications  Indications :
 Prototype: - angina pectoris, MI, peripheral arterial
- aspirin, Dipyridamole (Persantin), occlusive disease.
Clopidoigrel (Plavix), Ticlopidine  Adverse effects:
 Mechanism of action: - headache, orthostatic hypotension .
- inhibit the aggregation of platelet  Nursing Considerations :
thereby prolonging bleeding time. 1. Transdermal patch
 Indications: - apply the patch to a hairless area using a
- used in the prophylaxis of long-term new patch and different site each day.
complication following M.I, coronary - remove the patch after 12-24 hours,
revascularization, and thrombotic allowing 10-12 hours “patch free” each day
CVA. to prevent tolerance.
 Nursing considerations: 2. Sublingual medications:
- Monitor bleeding time ( NV = 1-9 mins) - note the BP before giving the medication.
- Take the medication with food. - offer sips of water before giving because
CARDIAC GLYCOSIDES dryness may inhibit absorption
 Prototype: - one tablet for pain and repeat every 5
- digoxin (Lanoxin) and digitoxin mins. for a total of three doses; if not
(Crystodigin) relieved after 15 mins., seek medical help.
 Mechanism of actions : - stinging or burning sensation indicates
- increase intracellular calcium, which that the tablet is fresh.
causes the heart muscle fibers to - instruct patient not to swallow the pill
contract more efficiently, producing - sustained release medications should be
positive inotropic & negative swallowed and not to be crush
chronotropic action. - protect the pills from light.
 Indications : ANTI-ARRHYTHMIC DRUGS
- use for CHF, atrial tachycardia and  Class I (block Na channels)
fibrillation  IA - quinidine, procainamide
 Nursing considerations :  IB - lidocaine
- Monitor for toxicity as evidence by:  IC - flecainamide
 nausea, vomiting, anorexia, halo  Class II (Beta-blockers)
vision, confusion, bradycardia and  propanolol, esmolol
heart blocks .  Class III (block K channels)
- Do not administer if pulse is less than 60  amiodarone, bretylium
bpm.  Class IV (block Ca channels)
- Should be caution in patient with  verapramil, diltiazem
hypothyroidism and hypokalemia.  Nursing considerations :
- Antidote : Digi-bind 1. Watch out for signs of CHF.
- Phenytoin is the drug of choice to 2. Have client weigh themselves and
manage report
- digitalis-induced arrhythmia. 3. weight gain.
NITRATES 4. Watch out for signs of lidocaine toxicity :
 Prototype : 5. confusion and restlessness
- isosorbide dinitrate (Isordil)
- nitroglycerine (Deponit, Nitrostat)
 Mechanism of action :
- produce vasodilatation including coronary
artery.
ANTILIPEMICS  Adverse effects :
 Prototype : - bradycardia, hypotension, headache
a. cholesterol-lowering agents - reflex tachycardia, constipation
- cholestyramine, colestipol, lovastatin  Nursing considerations :
b. triglyceride-lowering agents - Administer between meals to enhance
- gemfibrozil, clofibrate absorption.
 Mechanism of actions : - Take client’s pulse rate before each dose,
- interfere with cholesterol synthesis as withhold if pulse is below 60 bpm.
well as decreasing lipoprotein & - Refer for signs of congestive heart failure.
triglyceride synthesis.
 Nursing considerations : DIURETICS
- monitor liver functions while using (usually given at morning)
statins. CARBONIC ANHYDRASE INHIBITORS
- prevent constipation, flatulence, - Acetazolimide (Diamox)
cholelithiasis - increase Na+, K+, & HCO3 secretion,
- encourage increase fluid and fiber along with it is H2O
intake. - metabolic acidosis
OSMOTIC DIURETIC
ANTI – HYPERTENSIVE - Mannitol
Angiotensin-Converting Enzyme (ACE) - Increase osmotic pressure of the
Inhibitors glomerular filtrate.
 Prototype: - hypotension
- captopril (Capoten), enalapril (Vasotec), THIAZIDE DIURETICS
quinapril, lisinopril - hydrochlorothiazide
 Mechanism of actions: - blocks Na and K reabsorption; reabsorb
- prevent peripheral vasoconstriction by Ca
blocking conversion of angiotensin I to - hypercalcemia
angiotensin II decreasing peripheral LOOP DIURETICS
resistance. - Furosemide (Lasix)
 Adverse effect: - blocks Na, K, and Ca reabsorption
- it cause hyperkalemia - hypocalcemia
- induce chronic cough POTASSIUM SPARING DIURETICS
 Nursing considerations: - Spironolactone (Aldactone)
- not to discontinue medications because it - excrete Na and water but it reabsorb K
can cause rebound hypertension. - hyperkalemia
- avoid using K+ sparing diuretics.
CALCIUM-CHANNEL BLOCKERS RESPIRATORY MEDICATIONS
 Prototype : Bronchodilators
- Nifedipine (calcibloc, adalat),  Prototype :
Amlodipine (norvasc), Felodipine Symphatomimetic Xanthines
(Plendil), Verapramil (Isoptin) - albuterol, salbutamol - aminophylline
 Mechanism of action : - isoproterenol, salmeterol - theophylline
- decrease cardiac contractility and the - terbutaline
workload of the heart, thus decreasing  Mechanism of actions:
the need for O2. - sympathomimetic (b-receptor agonist)
- it also promote vasodilatation of the bronchodilators, dilate airways.
coronary and peripheral vessels. - xanthine bronchodilators, stimulate CNS
 Indications : for respiration.
- hypertension, angina, arrhythmia  Indications :
- bronchospasm, asthma, bronchitis, COPD.
 Adverse effects : - Drink a few sips of water before & after
- palpitations and tachycardia inhalation to prevent cough &
- restlessness, nervousness, tremors unpleasant taste
- anorexia, nausea and vomiting, - Assess for lactose-intolerance.
headache, dizziness.
 Nursing considerations : ANTI-HISTAMINES (H-1 BLOCKERS)
- Contraindicated hyperthyroidism,  Protoytype :
cardiac dysrhythmia, or uncontrolled - Astemizole (Hismanal), Loratidine
seizure disorder. (Claritin), Brompheniramine (Dimetapp),
- Should be used with caution in patient Diphenhydramine (Benadryl), Cetirizine
with HPN and narrow-angle glaucoma. (Iterax), Celestamine (Tavist).
GLUCOCORTICOIDS  Mechanism of action :
(CORTICOSTEROIDS) - decrease nasopharyngeal secretions and
 Prototype : decrease nasal itching by blocking
- dexamethasone, budesonide, histaminein H1-receptor.
fluticasone, prednisone,  Indications :
beclomethasone. - common colds, rhinitis, nausea and
 Mechanism of actions : vomiting, urticaria, allergies and as sleep
- act as anti-inflammatory agents and aid.
reduce edema of the airways, as well  Nursing Considerations :
as pulmonary edema. - Administer with food and drink.
 Adverse effects : - Given IM via Z-track method or orally.
- Cushing’s syndrome, neutropenia. - Precautions in handling machine and
- osteoporosis driving while taking these drugs.
 Nursing considerations : - Ice chips or candy for dry mouth
- Take drugs at meal time or with food.
- Eat foods high in potassium, low in ANTI-TUBERCULOSIS
sodium.  Prototype :
- Instruct client to avoid individuals with First line Second line
RTI. - Isoniazid (INH) - Cycloserine
- Instruct client not to stop medication - Rifampicin (Rifadin) - Kanamycin
abruptly, it should be tapered to prevent - Ethambutol - Ethonamide
adrenal insufficiency - Pyrazinamide - Para-
- Avoid taking NSAID while taking - Streptomycin aminosalicylic
steroids. acid
- Take inhaled bronchodilators first before - active tuberculosis are treated with drug
taking inhaled steroids, and rinse mouth combination for 6-9 mos.
after using. - multidrug-resistant strain (MDR-TB) are
MAST CELL STABILIZERS medicated for 1 year up to 2 years
 Prototype: cromolyn sodium (Intal) - given before meals
 Mechanism of action : Isoniazid
- stabilize mast cells that release - should be given 1 hr before or 2 hrs
histamine riggering asthmatic attacks. after meals because food may delay
 Nursing Consideration: absorption.
- Should be given before asthmatic - should be given at least 1 hr before
attacks. antacids.
- Administer oral capsule at least 30 mins - instruct to notify physician for signs of
before meals for better absorption. hepatoxicity (jaundice), and
neurotoxicity
- numbness of extremities.
- administer with Vitamin B6 to counteract  Nursing considerations :
the neurotoxic side effects. - Give 1 hr after meals.
- avoid alcohol. - Avoid giving medications within 1-2 hrs
Rifampicin of antacid administration (decreases
- given on an empty stomach with 8 0z. of absorption).
water, 1 hour before or 2 hours after - Take fluids to flush after intake of
meals antacid suspensions.
- and avoid taking antacids with - Monitor for changes of bowel patterns.
medications. HISTAMINE – 2 BLOCKERS
- hepatotoxic thus avoid alcohol.  Prototype :
- instruct the client that urine, feces, - cimetidine (Tagamet), ranitidine
sweat, and tears will be red-orange in (Zantac), famotidine (Pepcid),
color. nizatidine (Axid).
Pyrazinamide  Mechanism of action:
- given for 2 months. - blocks H2 receptors in the stomach,
- increase serum uric acid and cause reducing acid secretions.
photosensitivity.  Nursing considerations :
Ethambutol - Given before or with meals
- contraindicated in children under 13 - Avoid giving other drugs with cimetidine
years old. - Gynecomastia may developed with
- obtain a baseline visual acuity because chronic use of cimetidine.
it can cause optic neuritis. Proton – Pump Inhibitors (PPI)
- Instruct the client to notify the physician Prototype :
immediately if any visual problems - omeprazole (Losec), Lansoprazole (Lanz),
occurs. pantoprazole (Pantoloc).
Streptomycin Mechanism of action :
- aminoglycoside antibiotic given IM. - inhibit the proton H+ to combine with Cl-
- nephrotoxic and ototoxic. toform hydrochloric acid.
- obtain baseline audiometric test and Nursing considerations :
repeat every 1-2 months because the - Given before meals preferably at morning.
medications impairs the CN VIII. Mucosal Barriers
 Prototype :
DRUGS AFFECTING GASTROINTESTINAL - sucralfate (Carafate), misoprostol (Cytotec).
SYSTEM  Mechanism of action :
Antacids - coats the mucosa to prevent ulcerations.
 Prototype :  Nursing consideration :
- - aluminum/magnesium compounds - Given before meals.
(Maalox) - Misoprostol is contraindicated for
- - sodium bicarbonate (Alka-Seltzer) pregnants.
- calcium carbonate (Tums) - Sucralfate cause constipation.
- magnesium hydroxide (Milk of Anti-diarrheal Agents
Magnesia).  Prototype :
 Mechanism of actions : - diphenoxylate (Lomotil), loperamide
- neutralize the stomach acidity. (Imodium), kaolin/pectin mixture
 Adverse effects : (Kaopectate).
- metabolic alkalosis, stone formation  Mechanism of actions :
- electrolyte imbalance - decrease stomach motility and peristalsis.
- diarrhea (magnesium), constipation  Nursing considerations :
(aluminum). - Monitor for rebound constipation.
- Be cautious taking if with infectious PARATHYROID AGENTS
diarrhea.  Prototype :
- Monitor atropine toxicity with diphenoxylate. a. calcitonin (Calcimar), etidronate
- Clay, white or pale stool is common with (Didronel),
kaopectate. b. calcitrol (Rocaltrol), calcifediol
Laxatives (Calcedrol)
a. lactulose (Cephulac), Na biphosphate  Mechanism of action :
(Fleet enema) & magnesium salt (Milk of a. reduce bone resorption
Magnesia) b. promotes calcium absorption
- retain fluid and distend intestine  Nursing considerations :
b. ducosate (Dialose) - Monitor signs of calcium imbalance
- emulsify fecal fat and water - Report for bone pains.
c. bisacodyl (Dulcolax) & senna (X-prep) - Remain sitting upright after taking
- irritates intestinal mucosa and etidronate.
stimulate intestinal smooth muscles
d. bulk-forming laxative (Metamucil) Oral Hypoglycemic Agents (OHA)
- increase fecal bulk and water content 1. Sulfonylureas
e. mineral oil - stimulate insulin secretions and
- lubricates & prevent colon absorption increase tissue sensitivity to insulin.
Emetics  First Generation:
 Prototype: ipecac syrup, apomorphine Chlorpropamide (Diabenese)
 Mechanism of actions: - disulfiram precaution
- induce vomiting through stimulation of Tolbutamide (Orinase)
vomiting center of medulla. - congenital defect
 Indications:  Second Generation:
- ingestion of poisonous or toxic Glypizide, Glymepiride
substances. 2. Biguanides
 Nursing considerations: - facilitates insulin action on the
- Consult poison control center before peripheral receptor site.
induction of vomiting. - Metformin and Glucophage
- Administer ipecac syrup with large (Glucovance)
amount of fluid. - side effect is lactic acidosis
3. Alpha-glucosidase inhibitors
DRUGS AFFECTING THE ENDOCRINE - delay carbohydrate absorption in the
SYSTEM intestinal system.
THYROID AGENTS - Acarbose (Precose) – side effect is
 Prototype : diarrhea
- Proloid (thryroglobulin ) 4. Thiazolinidine
- Synthroid (levothyroxine) - increase tissue sensitivity of insulin.
- Cytomel ( liothyronine). - Rosiglitazone (Avandia)
 Mechanism of action : 5. Meglitinides
- Function as natural or synthetic - stimulate insulin release in pancreatic B-
hormones. cells.
 Nursing considerations : - Repaglinide (Prandin)
- Taken in the morning.  Nursing considerations :
- Caution with coronary artery disease. - Effective only for type II DM.
- Monitor for signs of hyperthyroidism and - Contraindicated to pregnant &
refer for decreasing the dose. breastfeeding.
- Given before meals.
- Monitor for signs of hypoglycemia.
Insulin ESTROGENS AND PROGESTINS
Insulin Onset Peak Duration  Prototype :
Immediate- - conjugated estrogen (Premarin), estrone
acting 0.15hr 0.5-1hr 5hr (Bestrone), estradiol (Estrace),
(lLispro) diethylstilbestrol (DES).
Short-acting  Indications :
(regular, 0.5-1hr 2-4hr 5-7hr - prostate cancer, contraceptions
semilente) - estrogen replacement
Intermediate-  Adverse effects:
acting (NPH, 1-3hr 6-12hr 18-24hr - estrogen - endometrial CA, gallbladder
Lente) disease, HPN, migraine, breast
Long-acting tenderness
4-6hr 10-30hr 24-36hr - progesterone - altered menstrual flow,
(Ultralente)
Mixed risk of thrombo embolism
(regular  Nursing considerations :
0.5hr 4-8hr 25hr 1. Mix estrogen or progestins prior to IM
30%,NPH
70%) administration by rolling vials between
 Nursing considerations : palms.
- Usually given before meals. 2. Monitor blood pressure
- Roll the bottle in palm of hands, don’t 3. Teach patient how to perform BSE.
shake. 4. Regular follow-up examination is
- Inject amount of air that is equal to each required to detect associated risk of
dose into the bottle – short acting last acquiring CA
(clear).
- Aspirate short acting first, then long or DRUGS AFFECTING LABOR and
intermediate (cloudy). LACTATION
- Alcohol is recommended for cleansing Uterine Stimulating Agents
bottle but not with skin.  Protoytpe :
- Pinch skin, avoid I.M, don’t aspirate. a. Oxytocin (Pitocin), ergonovine
- Rotate the injection site an inch a part. (Ergotrate), methylergonovine
- Prefilled syringes are stored vertically, (methergine)
needle-up. b. carbopost (Prostin), dinoprostone
- May increase dose during illnesses. (Prostin E2)
- Used bottles stored in room temperature,  Mechanism of actions :
unused bottle stored in refrigerator. a. stimulates uterine smooth muscles
- Monitor for acute hypoglycemia : b. ripening of cervix
 3-4 commercially prepared glucose  Adverse reactions :
tablet - fetal bradycardia (oxytocin),
 4-6 ounce of fruit juice or regular soda - hypertension (ergonovine), palpitations
 2-3 teaspoon or honey - allergic reactions (Prostaglandins)
 Glucagon 1 gm SQ or IM Uterine Inhibiting Agents (Tocolytic)
 D50-50 IV.  Prototype :
- ritodrine (Yutopar), terbutaline (Brethine)
 Mechanism of actions :
- relaxes the uterus by stimulating the B2-
adrenergic receptors
 Adverse effects :
- tremors, nausea, vomiting and
tachycardia
Lactation Suppressants Antiviral Agents
Prototype :  Prototype :
- bromocriptine (Parlodel) - acyclovir (Zovirax), ganciclovir
Mechanism of action : (Cytovene), vidarabine (Vira-A),
- decrease serum prolactin levels amantidine (Symmetrel), ribavirin
Adverse effects : (Virazole), zidovidine (Retrovir).
- drowsiness, headache, nausea, palpitations  Mechanism of actions :
- inhibits virus specific enzymes involve in
DRUGS FOR TREATING INFECTION DNA synthesis. They only control the
Antibacterial Agents growth of virus but it does not cure.
1. Cell wall inhibitors  Adverse effects :
a. penicillins - pen G, amoxicillin, cloxacillin - granulocytopenia, thrombocytopenia,
b. cephalosphorins - cephalexin, cefaclor nausea, nervousness, headache,
c. glycopeptide - vancomycin nephrotoxicity.
2. Protein synthesis inhibitors  Nursing consideration :
a. aminoglycosides - amikacin, gentamycin - Pregnant and breastfeeding
b. macrolide - erythromycins, roxithromycin precautions.
c. lincosamides - clindamycins - Administer IV antivirals to avoid
d. chloramphenicol, tetracyclines crystallization in renal tubules.
3. Antimetabolites - Give ribavirin only with aerosol
- blocks folic acid synthesis generator.
a. Sulfonamides - cotrimoxazole - Monitor CBC and creatinine level.
4. DNA synthesis inhibitors - Refer for signs of bleeding.
a. quinolones - ciprofloxacin, ofloxacin - Take amantidine after meals.
b. metronidazole Antifungal Agents
 Adverse effects :  Prototype :
- Aminoglycoside - nephrotoxicity & - amphotericin B (Fungisone), nystatin,
ototoxicity fluconazole (Diflucan), ketoconazole
- Sulfonamides - Steven-Johnson’s (Nizoral).
syndrome, photosynsetivity  Mechanism of actions :
- Quinolones - insomnia - inhibit the synthesis of fungal sterol.
- Tetracyclines - bone problems  Adverse effects :
- Chloramphenicol - Gray syndrome, bone - nephrotoxicity and neurotoxicity
marrow depression - bone marrow depression
- Erythromycin - hepatitis - chills, fever, joint pains, abdominal pain
 Nursing considerations : and headache.
1. Collect appropriate specimen for C & S  Nursing considerations :
before starting antibiotics. - Dilute amphotericin B with sterile water
2. Check client’s history of allergies. solution not with electrolyte solution.
3. Avoid administering erythromycin and - Tell clients that fever, chills, GI upset,
quinolones with food. joint and muscle pain will subside as
4. Pregnant precautions. - amphotericin B continues.
5. Report for diarrhea - - With oral candidiasis, let nystatin tablet
pseudomembranous colitis dissolve in mouth rather than swallowing
(clindamycin) it.
6. Monitor adverse effects. - Refrain ketoconazole with antacids.
- Report for signs of bleeding, infection &
fatigue.
ANTIPARASITIC AGENTS ANTI-NEOPLASTIC DRUGS
 Prototype :  General considerations :
a. Antimalarial - kills or inhibit the reproduction of neoplasmic
- chlroquine, mefloquine, primaquine, cells but as well as normal cells.
quinine, pyrimethamine - it could be cell cycle phase specific or cell
b. Antiamebiasis cycle non-specific.
- metronidazole (Flagyl), iodoquinol, - preferably given through IV route.
furozolidone (Furoxone)  Prototype :
 Mechanism of actions : 1. Alkylating Agents
a. antimalarial – alters protozoal DNA, - inhibits cell production by causing
depleting folates, & reducing nucleic cross linking of DNA
acid production a. Busulfan – hyperuricemia
b. antiamoeba – block protein synthesis. b. Chlorambucil – gonadal suppression
 Nursing considerations : c. Cisplatin – ototoxicity and
1. Administer anti-malarial drugs with food. nephrotoxicity
2. Take seizure precautions while d. Cyclophosphamide – hemorrhagic
administering antimalarial drugs. cystitis.
3. Refer cinchonism during quinine 2. Antitumor Antibiotic Agents
treatment: - interfere in DNA and RNA
 tinnitus, headache, vertigo, fever, synthesis
and visual changes. a. Plicamycin – affects bleeding time
4. Inform clients that iodoquinol falsify b. Doxurubicin – cardiotoxicity
thyroid function test for up to 6 months. c. Bleomycin – pulmonary toxicity.
ANTIHELMINTIC 3. Antimetabolites
 Prototype : - replace normal proteins required
- mebendazole (Vermox), thiabendazole, for DNA synthesis by inhibiting
niclosamide (Niclocide), piperazine the S phase
(Antepar), praziquantel (Biltricide). a. Cytarabine – hepatotoxicity
 Mechanism of actions : b. flourouracil – phototoxicity reaction
- paralyze larva and adult helmints by and cerebellar dysfunctions
acting on parasite microtubules. c. marcaptopurine – hyperuricemia
 Adverse effects : d. Methotrexate – photosensitivity
- GI upset, urinary odor (thiabendazole)  given with leucoverin to lessen
- headache, dizziness, fatigue its toxicity.
 Nursing considerations : 4. Mitotic Inhibitors (Vinca Alkaloids)
1. Treat all the family members for - prevent mitosis acting on the M
nematodes infection to prevent phase causing cell death
recurrence. a. Vincristine sulfate – neurotoxicity,
2. Praziquantel must swallowed rapidly numbness
because of its bitter taste to avoid 5. Hormonal Medications and Enzymes
gagging. - block the normal hormones in
3. Other antihelmintics should be chewed. hormone sensitive tumors
a. Tamoxifen citrate – visual problems
 elevate cholesterol &
triglycerides level
b. Diethylstilbestrol – impotence and
gynecomastia in men.
 Side Effects:
 stomatitis
- bland diet, avoid strong mouthwash
- soft tooth brush, ice chips
 diarrhea, nausea and vomiting
- anti-emetic, replace fluids and electrolytes
 alopecia
- reassure that it is temporary
- encourage o wear wigs, hats and head
scarf
 skin pigmentation
- inform that it is only temporary
 tumor lysis syndrome
- hyperuricemia & hyperkalemia
- force fluids
 infection
- notify physician if WBC is <2000/mm3
- monitor for signs of infection
- reverse isolation
- low bacteria diet
 anemia
- iron, B-12, folic acid rich food
- provide rest periods
 bleeding
- avoid NSAIDs
- minimize invasive procedures
- use soft toothbrush and electric razor
 menstrual changes
- reassure that menstruation will resume.