DRUGS

SUPPLEMENTALS ON PHARMACOLOGY

BULLETS

SALICYLATE POISONINGTINNITUS,NAVDA,LETHARGY/EXCITABILITY, HYPERVENTILATION AND HYPERTHERMIA,METABOLIC ACIDOSIS LIDOCAINE TOXICITY

SLURRED SPEECH ALTERED CNS MUSCLE TWITCHING SEIZURES

TOXIC LEVEL
LITHIUM 2.0 MeQ/l DIGOXIN 2.0 NG/ML THEOPHYLLINE 20 MCG/ML

THIS DRUGS CAN INTERACT

THEOPHYLLINE,DILANTIN,COUMADIN,ILO SONE

TETRACYCLINE AND QUINOLONES-NO TO PREGNANCY AMINO GLYCOSIDE TOXICITY

OTOTOXICITY AND NEPHROTOXICITY

PEAK 1 HOURS AFTER ADMINISTRATION TROUGH 30 MINUTES PRIOR TO THE NEXT DOSE ORAL BIRTH CONTROL PILLS-COMP.

ABDOMINAL PAIN CHEST PAIN-SOB HEADACHES AND HYPERTENSION EYE PROBLEMS SEVERE LEG PAIN

LEADS EMERGENCY DRUGS BETA BLOCKER ACTIONS

BETA 1 HEART BETA 2 LUNGS

SIDE EFFECTS OF ADRENERGIC ANTAGONIST BETA BLOCKERS

HYPOTENSION DROWSINESS/DEPRESSION SYMPTOMS OF CHF BRADYCARDIA

EXAMPLES

PROPANOLOL,TENORMIN,LOPRESSOR

SIDE EFFECTS OF ADRENERGIC ANTAGONIST ALPHA BLOCKERS

SEXUAL DYSFUNCTION TACHYCARDIA ORTHOSTATIC HYPOTENSION VERTIGO

DOXAZOSIN

( CARDURA) PRAZOSIN (MINIPRESS) METHYLDOPA ( ALDOMET)

CALCIUM ANTAGONISTS VERY NICE DRUGS BLOCKS CALCIUM ACCESS TO CELLS CAUSING DECREASED COTRACTILITY,CONDUCTIVITY OF THE HEART AND DEC. FOR OXYGEN DEMAND SIDE EFFECTS:HYPOTENSION,BRADYCARDIA(AV BLOCKPRECIPITATES)HA,ABDL.DISC,PERIPHERAL EDEMA EXAMPLES:

VERAPAMIL NIFEDIPINE DIALTIZEM VERY NICE DRUGS

DRUGS FOR BRADYCARDIA

ISOPROTERINOL DOPAMINE EPINEPHRINE ATROPHINE

ANTIHYPERTENSIVE DRUGS ACE INHIBITORSCAPOTEN/CAPTOPRIL,VASOTEC/ENAL APRIL,LOTENSIN/BENZAPRIL) BETA BLOCKERSINDERAL/PROPANOLOL, TENORMIN/ATENOLOL CALCIUM ANTAGONIST- CALAN ISOPTIN/VERAPAMIL, CARDIZEM/DIALTIZEM, PROCARDIA/ NIFEDIPINE

ACE INHIBITORS

SIDE EFFECTS-DIZZINESS ORTHOSTATIC HYPOTENSION GI DISTRESS COUGH HEADACHE

ACTIONS- DECREASED PERIPHERAL VASCULARRESISTANCE WITHOUT INCREASED CARDIAC OUTPUT,CARDIAC RATE AND CARDIAC CONTRACTILITY

B-BLOCKERS
ACTION BLOCKS BETA RECEPTORS IN THE HEART CAUSING DECREASED HEART RATE, FORCE OF CONDUCTION AND RATE OF AV CONDUCTION SIDE EFFECTSBRADYCARDIA,LETHARGY,GI DIST. CHF ,HYPOTENSION,DEPRESSION

ANTI-CANCER DRUGS-ADVERSE REACTIONS AND PRECAUTIONS

NAVDA BONE MARROW SUPPRESSION ALOPECIA (AVOID PREGNANCY)

CHOLINERGIC CRISIS- (WEAKNESS)

SALIVATION LACRIMATION URINATION DEFECATION

SYMPATHETIC/ANTI CHOLINERGIC/ADRENERGICFIGHT/FLIGHT PARASYMPATHETIC-REST AND DIGEST

STEROIDS- (ENDS IN ONE) ANTIINFLAMMATORY INH INCREASE B6 LEVODOPA DECREASE B6 MAO-NO PICKLES,WINE,CHEES,BARBITURATES ,TRICYCLIC ANTIDEPRESSANTS,ANTIHISTAMINES, ANTIHYPERTENSIVES,OTC COLD MEDS

SWEATING,TREMORS,HYPERTHERMIA,HPN,

BOUNDING HEART

Basic pharmacological classification

Action and indication Bad effects adverse reaction /side effect Considerations Drug examples

SAMPLE DISCUSSION

PHARMACOLOGY DETAILED DISCUSSION

ANTI BIOTICS

PENICILLINS-amoxicillin,ampicillin,penicillin CEPALOSPORINS- cefazolin Na, cephalexin-1st

cefaclor, cefamandole(Mandol)-2nd cefatoxime Na,Moxam- 3rd

ERYTHROMYCIN- clindamycin , erythromycin TETRACYCLINE- doxycycline(Vibramycin) AMINOGLYCOCIDES-streptomycin, kanamycin,gentamycin(Garamycin), tobramycin , neomycin POLYMYXIN CHLORAMPHENICOL- chloromycetin

ANTI BIOTICS

SIDE EFFECTS

ALLERGIC REACTIONS NAVDA SUPERINFECTION

TETRACYCLINES- HEPATOTOXICITY

PHOTOTOXICITY HYPERURECEMIA ENAMEL HYPOPLASIA,DENTAL CARRIES AND BONE DEFECTS ( DRUG BINDS TO CALCIUM IN TISSUE)

ANTI BIOTICS

AMINOGLYCOSIDES
OTOTOXICITY
LEUKOPENIA THROMBOCYTOPENIA HEADACHE

AND CONFUSION PERIPHERAL NEUROPATHY (NEUROTOXIC) OPTIC NEURITIS

ANTI BIOTICS

CHLORAMPHENICOL
BLOOD

DYSCRASIAS(BONE MARROW DEPRESSION) FEVER RASH , URTICARIA(HYPERSENSITIVITY JAUNDICE(HEPATOXOCITY)

ANTI BIOTICS

NURSING CARE
ASSESS

DRUG HISTORY MONITOR FOR ADVERSE REACTIONS AND SUPERINFECTIONS; SUGGEST YOGURT OR FOOD SUPPLEMNETS CONTAINING LACTOBACILLUS EMPHASIZE STRICT COMPLIANCE AND TIMING EVALUATE RESPONSE

CEPHALOSPORINS FALSE POSITIVE URINE GLUCOSE TETRACYCLINES-AVOID DURING LAST HALF OF PREGNANCY OR BY CHILDREN YOUNGER THAN 8 YEARS. POTENTIATES ANTI COAGULANTS, AVOID SUNLIGHTDAIRY PRODUCTS , ANTACIDS OR IRON PREPARATION( REDUCE EFFECTIVENESS) AMINOGLYCOSIDES- ASSESS FOR POTENTIATION OF NEUROMUSCULAR BLOCKING AGENT / GENERAL ANESTHETIC OR MAGNESIUM CHLORAMPHENICOL B;LOOD WORK ASSESSMENT BEFORE AND DURING POTENTIATION OF PHENYTOIN, OHAS, ANTICOAGULANTS

ANTIVIRALS
PROVIDE PROPHYLAXIS WHEN EXPOSURE TO VIRAL INFECTION HAS OCCURRED Acyclovir sodium (Zovirax) Amantadine Hcl (Symmetrel) Interferon(Roferon A) AZT Idoxuridine ( Stoxil)

ANTIVIRALS
cns stimulation and orthostatic hypotension, nephrotoxicity, dizziness and constipation Nsg. Consideration: support natural defense encourage high fiber foods evaluate response

Sulfonamides
treat UTI sulfamethazole(Gantanol) Sulfixazole(Gantrisin) sulfazaline( Azulfidine) sulfamethazole and trimethoprim(Bactrim and Septra)

Sulfonamides

S/E; nausea and vomiting (gastric irritation) decreased absorption of folacin rash malaise blood dyscrasias crystaluria(drug precipitation in acidic urine) stomatitis , hypersensitivity and photosensitivity

Sulfonamides

I;
increase OFI maintain alkaline urine moniotr blood work megaloblastic anemia(dec. folacin) potentiates anticoagulant and oral hypoglycemic effects

Anti Tuberculars

administered in combination over a prolonged time period to decrease the possibility of mycobacterial drug resistance first line :

ethambutol-mycobacterial RNA Isoniazid mycobacterial cell wall Paraaminosalicylic acid preparation(PAS)mycobacterial folic acid synthesis Rifampin-interferes with mycobacterial RNA Streptomycin sulfate inhibits mycobacterial protein synthesis pyrazinamide ethionamide capriomycin

second line:

Anti Tuberculars

S/E:

GI irritation suppressed absorption of fat and B complex , spec. folacin and B12, depletion of B6 by isoniazid dizziness,CNS and liver disturbances blod dyscrasias streptomycin : ototoxicity( direct auditory{eight cranial nerve}toxicity) ethambutol: visual disturbances ( direct optic nerve toxicity)

Anti Tuberculars

nursing care:

support defense mechanisms obtain sputum specimens for acid fast bacillus monitor blood work enforce compliance , avoid alcohol instruct regarding nutriitonal deficits Rifampin urine dark orange Streptomycin: auditory exams Ethambutol visual exams PZA liver functions

Anti fungals
used to treat sytemic and localized fungal infections Amphotericin ( Fungizone) Fluconazole (Diflucan ) Griseofulvin ( Grisactin ) Nystatin ( Mycostatin, Nilstat )

Anti - fungals

nausea and vomiting( gastric irritation) headache( neurotoxicity) fever and chills ( blood dyscrasias ) paresthesia( neurotoxicity) review proper method of application assess vital signs, throughout course of therapy evaluate clients response

Anti fungals

Amphotericin B

use infusion control device and protect from light monitor blood works-hypokalemia and hypomagnesemia
Griseofulvin assess for antagonism if patients are taking anti coagulants. avoid sunlight topical prep- wash drug stained clothing with soap and water., report signs of local irritation

Anti parasitics

interfere with parasite metabolism and reproduction, helminthic as well as protozoal infestations respond to this class of drugs
Antihelmithic Mebendazole ( Vermox) Piperazine ( Vermazine ) Pyrivinium Pamoate ( Povan) Amebicides Chloroquine HCl ( Aralen) Emetine Hcl Metronidazole ( Flagyl) Antimalarials Chloroquine HCl ( Aralen) Hydroxychloroquine SO4 ( Plaquenil) Pyrimethamine ( Darapime) Primaquine PO4

Anti parasitics
antihelminthics-GI irritation, CNS disturbance, skin rash amebicides GI iiritation, blood dyscrasias, skin rash, headache, dizziness Antimalarials-nausea and vomiting, blood dyscrasias, visual disturbances

Anti parasitics
administer drug with meals and assess VS monitor blood works and instruct client about proper hygiene use safety prec if CNS effects are manifested antimalarials frequent visual examinations evaluate response to treatment and understanding of therapy

pharmacology related to peri-operative care

general anesthetics local anesthetics sedatives / hypnotics analgesics

general anesthetics

used in balanced combination o produce loss of consciousness , pain control and skeletal muscle relaxation acts by depressing CNS throught the following progressive sequence stage 1 euphoria, gradual LOC stage 2- hyperexcitement,hyperactive reflexes, pupil dilation stage 3 depression of corneal reflex and pupillary response to light, absence of voluntary control, decreased muscle tone, stage of surgical anesthesia stage 4 medullary paralysis( respiratory / cardiac failure) death

general anesthetics

inhalation

Halothane(Entrane) Cyclopropane Ether Methoxyflurane ( Penthrane) Nitrous Oxide

IV barbiturates-prompt effect on cerebral tissue

Methohexital Na ( Brevital) Thiopental Na (Penthotal ) Thiamylal Na ( Surital) Ketamine HCl ( Ketaject) Midazolam ( Versed)

IV and IM non Barbiturates

general anesthetics- major s/e

inhalation

excitement and restlessness nausea and vomiting respiratory distress

IV Barbiturates

respiratory depression hypotension and tachycardia laryngospasm

respiratory failure changes in blood pressure rigidity psychic disturbances

IV and IM non barbiturates

general anesthetics- nursing care

assess for allergies and other medical problems have O2 and emergency resuscitative equipment available safety prec.-flammable and protect client during post-anesthetic period- decreased sensory awareness evaluate response

Local Anesthetics

pain control without rendering the client unconscious block nerve impulse conduction in sensory , motor and autonomic nerve cells major side effects:

anaphylaxis respiratory arest dysrhythmias and cardiac arrest convulsions hypotension

Local Anesthetics

Topical : local infiltration of tissue

lidocaine HCL ( Xylocaine), also used for nerve block Dibucaine ( Nupercainal) Piperocaine HCl ( Metylcaine ) Tetracaine HCl ( Pontocaine ) also used for spinal anesthesia an nerve block

Spinal: injected into the spinal subarachnoid space

Lidocaine HCl Procaine HCl ( Novocain)-also used for nerve block

Local Anesthetics

Epidural : injected into the epidural space of the of the spinal column

Bupivacaine HCl ( Sensorcaine) Lidocaine ( Xylocaine) Mepivacaine ( Carbocaine )

Nerve Block injected at perineural site distant from desired anesthesia site

Bupivacaine Chloroprocaine HCl ( Nesacaine) Mepivacaine

Local Anesthetics nursing care assess for allergies and other medical

problems have o2 and emergency resuscitative equipment monitor vital signs protect anesthetized body parts from mechanical or thermal injuries keep client flat for a specified period ( usually 6 12 hours ) after spinal anesthesia to prevent sece3re headache, avoid pillows and monitor for hypotension maintain side lying after general anesthesia and restrict fluids until after gag returns

Sedatives ad Hypnotics

produce sedation in small doses and sleep in large doses, acts by depressing CNS barbiturates:

Butabarbital Na ( Butisol) Pentobarbital Na ( Nembutal) Phenobarbital ( Luminal) Secobarbital ( Seconal)

non-barbiturates:

Chloral hydrate ( Noctec) Flurazepam HCl ( Dalmane) Glutethimide ( Doriden ) Methyprylon ( Noludar)

Sedatives ad Hypnotics

S/E:
drwsiness\hypotension dizziness GI irritation Skin rash blood disorders dependence Barbiturates

hangover photosensitivity paradoxic reacion(excitement)

Sedatives ad Hypnotics
avoid administration with other depressants caution patient to avoid activities that require alertness and avoid alcohol assess for signs of dependence supportive measures to promote sleep administer controlled substances according to appropriate schedule restrictions

Analgesics

used to relieve pain non narcotics-mild to moderate pain

peripheral mechanism, inhibiting prostaglandin and other chemical mediators exert antipyretic activity salicylates- analgesic, antipyretic, anti inflammatory, uricosuric anti platelet-aggregating efects blocks opioid receptors in the CNS, altering awareness of pain depress CNS and produce effects on multiple body system,produce euphoria and are addicting

narcotics moderate to severe pain

Analgesics

Nonnarcotics ( Salicylates)

Aspirin (ASA , Ecotrin) Magnesium salicylate ( Magan) acetaminophen ( Tylenol, Datril) Diflunisal ( Dolobid) codeine sulfate meperidine HCL ( Demerol) Morphine Sulfate Oxycodone ( Percodan) Pentazocine HCl( Talwin) Propoxyphene HCl ( Darvon) Nalbuphine HCL ( Nubain)

Nonnarcotic ( non salicylates)

Narcotics

Non narcotics(salicylates)

Analgesics

gastric irritation visual disturbances prolonged bleeding time tinnitus sore,throat and fever skin rash hepatotoxicity

Non-narcotics(Non-salicylates)

Narcotics

respiratory depression hypotension constipation and euphoria urinary retention and miosis

Analgesics

administer medication before pain becomes severe assess for covert signs of pain( VS and Non verbal cues) evaluate response and understanding of teaching administer narcotics as ordered:

do not adm. if RR , 12/min have Naloxone ( Narcan ) available observe for overdosage triad ( respiratory depression, pinpoint pupils and coma) avoid adm. w/ CNS depressants/ head injuries

SAMPLE DISCUSSION

FOCUSSED PHARMACOLOGY

SLECTED DRUGS
C LASSIFICATION HOW TO ASSESS FOR EFFECTIVENESS EXACT TIME CLIENT TEACHING TIPS KEYS IN SAFETY

ANTABUSE

CAUSES AN UNPLEASANT REACTION WHEN COMBINED WITH ALCOHOL PATIENT AVOIDS ALCOHOL BEST TAKEN AFTER ABSTAINING ALCOHOL FOR 12 HOURS INSTRUCT PATIENT TO AVOID ALCOHOL BASED SUBSTANCES INSPECT PATIENTS BELONGINGS AND CONFISCATE ALCOHOLIC SUBSTANCES, MONITOR lftS

APRESOLINE -HYDRALAZINE
ANTI HYPERTENSIVE DECREASED BP BEST TAKEN WITH FOOD RISE SLOWLY MONITOR FOR ORTHOSTATIC HYPOTENSION AND HR FOR TACHYCARDIA

ATROPHINE SULFATE
ANTICHOLINERGIC, VAGOLYTIC DRYING AGENT INCREASES HEART RATE IN A CLIENT WITH HEART BLOCK, USED PRE-OPERATIVELY TO DECREASE SECRETIONS BEST TAKEN 30 MINUTES BEFORE MEAL MAY CAUSE FACIAL FLUSHING, AVOID TASKS THAT REQUIRE ACUTE VISION AVOID HOT ENVT. CHECK BP, CAUSES HYPOTENSION, CONSTIPATION AND DRYMOUTH

CELESTONE(BETHAMETHASONE)
STEROID,STIMULATES LUNG MATURITY IN INFANTS - RESP DISTRESS GIVEN WITH FOOD REPORT SIGNS OF INFECTION MONITOR WEIGHT , GIVE ONCE A DAY DOSE IN THE MORNING TO AVOID INSOMNIA GIVEN 48 HOURS BEFORE DELIVERY

CLOZARIL-CLOZAPINE

ANTIPSYCHOTIC DECREASED DELUSION,HALLUCINATIONS AND LOOSENESS OF ASSOCIATION BEST TAKEN AFTER MEALS REPORT SORETHROAT AND AVOID EXPOSURE TO SUNLIGHT CHECK BP CAUSES HYPOTENSION, ASSESS FOR AKATHISIA, TARDIVE DYSKENISIA-TONGUE TWITCHING AND LIP SMACKING

LIBRIUMCHLORDIAZEPOXIDE
ANTIANXIETY-BENZODIAZEPINES DECREASED ANXIETY AND INC. RELAXATION WITH FOOD OR MILK NO ACTIVITY REQUIRING ALERTNESS , SUGARLESS GUM HOLD DRUG IF BP DROPS MORE THAN 20 MMHG , WATCH OUT FOR ECG CHANGES AND TACHYCARDIA-REFER

GARAMYCIN(GENTAMYCIN)
AMINOGLYCOSIDE,BACTERICIDAL - INFECTION NO SPECIFIC TIME INCREASE FLUID INTAKE, TINNITUS INDICATES OTOTOXICITY MONITOR FOR SIGNS AND SYMPTOMS OF OTOTOXICITY, NEPHROTOXICITY AND NEUROTOXICITY

INDERAL -PROPANOLOL

ANTI ANGINAL, ANTIARRYTHMIC, ANTIHYPERTENSIVE,REDUCES PORTAL PRESSURE AND DECREASES THE RISK OF BLEEDING FROM ESOPHAGEAL VARICES DECREASED BP BEST TAKEN WITH MEALS AVOID DRIVING , DO NOT DISCONTINUE ABRUPTLY CHECK BP CAUSES HYPOTENSION

ISORDIL
ANTIANGINAL/RELAXES SMOOTH MUSCLES DECREASED BP BEST TAKEN ON EMPTY STOMACH CHANGE POSITION SLOWLY, CAUSES FACIAL FLUSHING CHECK BP, DO NOT CHEW SUSTAINED RELEASE FORM

LEVODOPA
ANTIPARKINSONISM MUSCLES BECOME LESS STIFF BEST TAKEN WITH MEALS AVOID FOODS CONTAINING B6 OR CHON RICH FOODS-DECREASES ABSORPTION ENSURE PATIENT VOIDS-MAY CAUSE URINARY RETENTION

LITHIUM CARBONATE

ANTIMANIC DECREASED HYPERACTIVITY BEST TAKEN AFTER MEALS INCREASE OFIS 3 L/D AND Na 3 GM./DAY AVOID ACTIVITIES THAT INCREASE PERSPIRATION TAKES 10-14 DAYS BEFORE THERAPEUTIC EFFECT BECOMES EVIDENT.ANTIPSYCHOTIC GIVEN DURING THE FIRST TWO WEEKS TO MANAGE ACUTE SYMPTOMS MONITOR SERUM LEVEL , NAVDA-INDICATES TOXICITY, MANNITOL - ANTIDOTE

DRUGS AND DRUG CLASSIFICATIONS COMMONLY ASKED

DOPAMINE AND DOBUTAMINE ADRENALIN

LIBRIUM VALIUM ATARAX

AMPHOGEL MAALOX

LIDOCAINE

AMINOGLYCOSIDES CEPHALOSPORINS

ERYTHROMYCIN PENICILLINS SILVADENE

NITROFURANTOIN PYRIDIUM HEPARIN COUMADIN

PROBANTHINE

DILANTIN VALIUM PHENOBARBITAL MAGNESIUM SULFATE TEGRETOL AND CLONAZEPAM

MAO TRICYCLICS-E.G.TOFRANIL/ELAVIL SSRI-FLOUXETINE

INSULIN OHA GLUCAGON COMPAZINE / DRAMAMINE COLCHICINE PROBENECID ALLOPURINOL

LOMOTIL / IMMODIUM

AMPHOTERICIN

BENADRYL

QUESTRAN

ANTIHYPERTENSIVES
LITHIUM ANTINEOPLASTIC AGENTS

ANTIPARKINSONIAN

AGENTS

ASA

ANTIPSYCHOTICS

TYLENOL AND PARACETAMOL ANTI-THYROIDS THYROID REPLACEMENTS ANTI TUBERCULAR MUCOLYTIC,EXPECTORANTS BRONCHODILATORS ANTIVIRAL

RITALIN

, CYCLERT

DIAMOX PILOCARPINE DIGOXIN

TENSILON MESTINON AND PROSTIGMIN

DIURETICS

ELECTROLYTE REPLACEMENT EYE MEDICATIONS STEROIDS H2-RECEPTOR BLOCKERS IMMUNOSUPRESSANTS LAXATIVES AND STOOL SOFTENERS MIOTICS AND MYDRIATICS

 MORPHINE
DEMEROL

SULFATE

NITROGLYCERIN
ISORDIL

NSAIDS STREPTOKINASE

 ENDURANCE

DEVELOPS EVERYTIME YOU DEFEAT THE TEMPTATION TO GIVE UPQUITTERS NEVER LOSE BUT THEY NEVER WIN. REST IF YOUMUST. BUT DONT QUIT