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PHARMACOLOGY: A REVIEW f. Right Documentation

g. Right Assessment
h. Right Education
PHARMACOLOGY i. Right Evaluation
- most simply defined as study of drug. j. Right to Refuse to Medication
Fundamentals of Pharmacology 2. Chart drug administration only after it has been given, never before.
1. Pharmacokinetics 3. Never leave the medication on cart or tray unattended.
- study of drug’s changes as it enters and passes through the body. 4. Chart observed therapeutic and adverse effects accurately and fully.
a. absorption 5. Check history for allergies and potential drug interactions before
b. distribution administering a newly ordered drug.
c. biotransformation 6. Inform the prescribing physician of any observed adverse effects; if cannot be
d. excretion located, inform the nursing supervisor
2. Pharmacodynamics 7. Question drug orders that are unclear, that appear to contain errors, or that
- mechanism by which drugs produce changes in body tissue. have potential to harm.
a. desired effect - intended action of drugs 8. Take the following actions if an error occurs: immediately notify the nursing
b. adverse effect - harmful unintended reactions supervisor, the prescribing physician, and the pharmacist. Assess the client’s
c. side effects – consequence reactions condition and provide any necessary care.
d. toxicity – the degree which something is poisonous 9. For postpartum women, advice to take drugs after breastfeeding.
 Digoxin = 0.5 – 2.0 ng/mL
 Lithium = 0.5 – 1.5 mEq/L Administration of Drugs
 Digoxin Toxicity: nausea, vomiting, anorexia, diarrhea, halo vision Routes and Nursing Considerations:
1. Enteral – oral, sublingual, rectal, gastric tubes
SAFETY AND EFFICACY -capsulated pill, sustained release and enteric coated should not be crushed.
Nursing Principles 2. Parenteral – IV, IM, SQ, ID, IT, IA, epidural.
1. Always verify the Five Rights  Vastus lateralis (safest site for IM)
a. Right Medication  Deltoid- less than 2ml
b. Right Amount  Dorsogulteal (gluteus maximus)- not use for patient less than 3 years old
c. Right Patient 3. Topical – skin, inhalants, mucus membrane.
d. Right Manner and Route Eye medications
e. Right Time o administer eyedrops first then ointment.
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o use a separate bottle for each client. -bronchoconstriction, wheezing, DOB

o instruct the client to tilt the head backward, open eyes and look up. -hypotension and bradycardia
o avoid contact of medication bottle to the eyeball. Nursing considerations
o place prescribed dose in the lower conjunctival sac. 1. Warn & monitor clients of the side effects
o instruct the client to press the inner canthus for 30-60 seconds. 2. Have atropine available for use as antidote
o instruct the client to close the eye gently. Cholinergic Blocking Agents (Parasympatholytics, Anticholinergics)
Ear drops Prototype
o in infant and children younger than 3 y.o, pull pinna downward and -atropine, scopalamine (Triptone), dicyclomine (Bentyl), propantheline (Pro-
backward. Banthine).
o in older children and adult, upward and backward. Mechanism of actions
o direct the solution on the wall of the ear canal, not directly on the ear drum. -block the binding of acetylcholine in the receptors of parasympathetic nerves.
Indication
CLASSIFICATIONS OF DRUGS -use preoperatively to dry up secretions.
-treat spasticity of GI or urinary tract.
A. DRUGS AFFECTING THE CENTRAL AND AUTONOMIC SYSTEM -use for treatment of bradycardia, asthma, Parkinsonism.
Cholinergic Agents (Parasympathomemitics) -use for antidote in organophosphate poisoning.
Prototype Adverse effects
-synthetic acetylcholine, pilocarpine, carbachol, bethanecol (Urocholine), -dry mouth, dilatation of pupils, tachycardia
edrophonium (Tensilon), neostigmine (Prostigmine), pyridostigmine -urinary retention, ileus, heat stroke
(Mestinon). Nursing considerations
Mechanism of action 1. Keep clients in cool environment.
-stimulates cholinergic receptors by mimicking acetylcholine or inhibition of 2. Watch out for signs of heatstroke and dehydration.
enzyme cholinesterase 3. Encourage clients to increase fluid intake and use of sugarless um/candy
Indications for dry mouth.
-glaucoma, urine retention, Myasthenia Gravis 4. For GI spasticity, administer 30 minutes before meals and at bed time.
-antidote to neuromuscular blocking agents : tricyclic antidepressants and Adrenergic Agents (Sympathomimetics)
atropine Prototype
Adverse effects -epinephrine, norepinephrine, ephedrine, dopamine, dobutamine,
-blurring of vision, miosis henylephrine, terbutaline, albuterol, isoproterenol.
-increase in salivation, intestinal cramps Mechanism of actions
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-stimulate alpha and beta adrenergic receptor directly or trigger the release of Indications
catecholamines indirectly causing sympathetic effects. -Raynaud’s disease, hypertension, pheochromocytoma.
Indications -angina, arrhythmias, mitral valve prolapse, glaucoma
-cardiopulmonary arrest, hypotension Adverse effects
-COPD and asthma, nasal congestions -orthostatic hypotension, bradycardia, CHF
-allergic reaction, anaphylactic shock -depression, insomnia and vertigo
Adverse effects -bronchospasm and dyspnea, nasal stuffiness, cold extremities
-restlessness, insomnia, tremors, nausea Nursing considerations
-palpitations, angina, tachycardia, HPN 1. Administer oral alpha-blockers with milk to minimize GI side effects.
Nursing considerations 2. Administer oral beta-blockers before meals and at a.m. if insomnia occurs.
1. Contraindicated in clients w/ hyperthyroidism, pheochromocytoma & 3. Check client’s apical pulse rate before drug administration, refer if below 60
cardiovascular disease. bpm.
2. Monitor vital signs and advice precautions. 4. Hypotensive precautions.
3. Should be taken with food. 5. Warn clients not to drive or operate dangerous machinery until he/she has
Adrenergic Blocking Agents adjusted to medications.
Prototype Skeletal Muscle Relaxants Agents
a. Alpha blockers Prototype
-phentolamine (Regintine), phenoxybenzamine, prazosin (Minipress), -methacarbamol (Robaxin), baclofen (Lioresal), dantrolene (Dantrium),
reserpine (Serpasil), terazosin (Hytrin) metaxalone (Skelaxin), orphanedrine (Norgesic), chlorzoxazone
-clonidine (Catapress), methyldopa (Aldomet) Mechanism of actions
b. Beta blockers -depress CNS
-atenolol (Tenormin), esmolol (Brevibloc), metoprolol (Lopressor), nadolol -inhibit calcium ion release in the muscle
(Corgard), propanolol (Inderal), timolol ( Blocadren) -enhance the inhibitory action of GABA (gamma-amino butyric acid)
Mechanism of actions Indications
a. alpha blockers -for acute musculoskeletal pain
-inhibits action of a-receptors in vascular smooth muscle to cause -for muscle spasticity associated with multiple sclerosis, cerebral palsy, CVA,
vasodilatation. and spinal cord injury
b. beta blockers Adverse effects
-compete with epinephrine in b-receptors in heart, pulmonary airways, -hypotonia, ataxia, hypotension, drowsiness
peripheral circulation and CNS. -blurred vision, bradycardia, depression, urine retention
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Nursing considerations 8. Avoid mixing other drugs in same syringe with phenytoin.
1. Caution clients that mental alertness may be impaired. Antiparkinsonian Agents
2. Monitor neuromuscular status, bowel and bladder functions. Prototype
3. Inform clients that maximum benefit of baclofen is attained for 1-2 months. a. Anticholinergic agents
4. Reduce baclofen dosage gradually because of associated withdrawal -trihexyphenidyl (Artane), benztropine (Congentin)
symptoms: Confusion, hallucinations, paranoia & rebound spasticity. b. Dopaminergic agents
Anticonvulsants -Levodopa, carbidopa-levodopa (Sinemet), amantidine (Symmetrel),
Prototype pergolide (Permax), selegiline (Eldepryl), bromocriptine.
a. Hydantoins-phenytoin (Dilantin) Mechanism of actions
b. Barbiturates-phenobarbital ( Luminal) a. anticholinergic agents
c. Miscellaneous -inhibit cerebral motor centers
- carbamazepine (Tegretol), diazepam, clorazepate (Tranxene), valproic acid b. dopaminergic agents
(Dapakene), ethosuximide (Zarontin) -increasing dopamine concentrations or enhancing neurotransmitter
Mechanism of action functioning.
-treat seizures by depressing abnormal neuronal activity in motor cortex Adverse effects of dopaminergic agents
Adverse effects a. levodopa–nausea, vomiting, anorexia, orthostatic hypotension, dark-colored
-sedation & drowsiness, gingival hyperplasia urine and sweat
-diplopia, nystagmus, vertigo, dizziness b. amantidine–ankle edema, constipation
-thrombocytopenia, aplastic anemia c. bromocriptine–palpitations, tachycardia
Nursing considerations Nursing considerations
1. Advise female clients to use contraceptives. 1. Give dopaminergic agents after meals to reduce GI symptoms.
2. Inform clients taking phenytoin that harmless urine discoloration is 2. Reassure client that levodopa may cause harmless darkening of urine and
common. sweat.
3. Warn clients with diabetes that hydantoins may increase blood sugar level 3. Avoid taking Vit B6 (pyridoxine) with levodopa because it speed up
and that valproic acid may produce a false positive result in urine ketone test. metabolism.
4. Teach clients receiving carbamazepine to identify symptoms of bone 4. Educate clients to minimize orthostatic hypotension.
marrow depressions. 5. Elevate leg to reduce ankle edema.
5. Reassure that barbiturates are not addictive at a low dosage. Central Nervous System Stimulants
6. Avoid taking alcohol with barbiturates. Prototype
7. Administer IV phenytoin slowly to avoid cardiotoxicity. -amphetamines, methylphenidate (Ritalin)
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Mechanism of actions a. Benzodiazepines

-increase excitatory CNS neurotransmitter activity and blocks inhibitory -increase the effect of inhibitory neuro transmitter GABA (gamma-amino
impulses butyric acid)
Indications b. Barbiturates and Miscellaneous agents
-for obesity (amphetamines) -depress CNS
-attention deficit hyperactivity disorders Indications
-narcolepsy -induce sleep, sedate and calm clients
-drug-induced respiratory depressions. Adverse effects
Adverse effects -hangover-effect, dizziness, CNS depression
-nervousness, insomnia, restlessness -respiratory depression, drug-dependence
-hypertension, tachycardia, headache Nursing considerations
-anorexia, dry mouth 1. Warn clients of injuries and falls.
Nursing considerations 2. Brief period of confusion and excitement upon waking up is common with
1. Should be given at morning. benzodiazepines.
2. Don’t stop amphetamine abruptly to avoid withdrawal symptoms. 3. Warn clients not to discontinue medications abruptly without consulting a
3. Monitor blood pressure and pulse. physician.
4. Ice chips or sugarless gum for dry mouth. 4. Avoid alcohol while taking these drugs.
5. Watch out for growth retardation in children taking methylphenidate 5. Rotate and don’t shake the ampules of barbiturates. Don’t mix with other
drugs.
B. DRUGS AFFECTING MENTAL FUNCTIONING 6. Warn female clients that diazepam is associated with cleft lip.
Sedatives, Hypnotics, and Anxiolytics Antidepressants and Mood Disorder Drugs
Prototype Prototype
a. Benzodiazepines a. Tricyclic antidepressants
-diazepam (Valium), lorazipam (Ativan), alprazolam (Xanax), flurazepam -amitriptyline (Elavil), protriptyline (Vivactil), imipramine (Tofranil),
(Dalmane) desipramine
b. Barbiturates b. MAO (monoamine oxidase inhibitors)
-amobarbital, phenobarbital, secobarbital -isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Pernate)
c. Miscellaneous c. Second-generation antidepressants
-chloral hydrate (Noctec), buspirone (Buspar), paraldehyde (Paral) -fluoxetine (Prozac), trazodone (Desyrel)
Mechanism of actions d. Lithium
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Mechanism of actions -tremors may occur but it is temporary

a. Tricyclic antidepressants -monitor white blood cell count (increase)
-increase receptor sensitivity to serotonin and/or norepinephrine. Antipsychotic drugs (Neuroleptics)
b. MAO inhibitors Prototype
-inhibit the enzyme MAO that metabolizes the neurotransmitters a. Phenothiazines
norepinephrine and serotonin. -chlorpromazine (Thorazine),
c. Second – generation antidepressants -trifluoperazine (Stelazine),
-inhibits the reuptake of serotonin. -thioridazine (Mellaril)
d. Lithium b. Other Agents
-increase serotonin & norepinephrine uptake -clozapine (Clozaril), haloperidol (Haldol)
Adverse effects Mechanism of action
-dry mouth, blurred vision, urine retention, constipation (anticholinergic -block dopamine receptor in the limbic system, hypothalamus, and other
effects) regions of the brain.
-orthostatic hypotension, insomnia Adverse effects
-hypertensive crisis (MAO) -Extra pyramidal symptoms such as dystonia, pseudoparkinsonism, and an
-dehydration (Lithium) irreversible tardive dyskinesia as manifested by :
Nursing considerations a. lip smacking
1. Caution client to rise slowly to reduce the effects of orthostatic hypotension. b. fine wormlike tongue movement
2. Take antidepressant with food to enhance absorption c. involuntary movements of arms and leg.
3. Explain to client that full response may take several weeks (2 weeks). -Neuroleptic malignant syndrome
4. Assess client for constipation resulting from tricyclic antidepressant use. a. fever, tachycardia, tachypnea, diaphoresis, cardiovascular collapse
5. Client taking MAO inhibitors should avoid tyramine-rich foods to avoid b. muscle rigidity, seizures.
Hypertensive crisis. -orthostatic hypotension
-aged cheese, sour cream, yogurt, beer, wine, chocolate, soy sauce and yeast Nursing considerations
-pentholamine (Regintine) is the drug of choice for hypertensive crisis. 1. Teach family members the signs of EPS and NMS, and report to physician
6. Inform physician and withhold fluoxetine if client develop rashes. immediately.
7. Take lithium with food to reduce GI effects 2. Normalization of symptoms may not occur for several weeks after beginning
->1.5 mEq/L blood level may cause toxicity manifested by: confusion, of therapy.
lethargy, seizures,hyperreflexia. 3. Avoid administering haloperidol intravenously
-maintain salt and adequate fluid intake 4. Watch out of neutropenia with clozapine.
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5. Watch out for orthostatic hypotension and photosensitivity with Mechanism of action
phenothiazine. -block transmission of impulses across nerve cell membrane.
6. Be sure that oral doses are swallowed, and not hoarded. Adverse effects
-cardiac dysrhythmias
C. DRUGS USED IN PAIN MANAGEMENT Nursing considerations
General Anesthetics 1. lignocaine + prilocaine (EMLA cream) should be applied topically 60
Prototype minutes before procedure.
a. Inhalation anesthetics 2. administer cautiously to the areas of large broken skin.
-enflurane (Ethrane), halothane 3. observe for fetal bradycardia in pregnant clients.
-isoflurane (Forane), nitrous oxide
b. Injection anesthetics
-fentanyl (Sublimaze), ketamine (Ketalar), thiopental Na (Penthotal),
etomidate (Amidate)
Mechanism of actions
-cause CNS depression, by producing loss of consciousness, unresponsiveness
to pain stimuli, and muscle relaxation
Nursing considerations
1. Instruct client NPO for 8 hours before administration.
2. Monitor cardio pulmonary depression and hypotension.
3. Monitor urinary retention.
4. Monitor body temperature
-malignant hyperthermic crisis: dantrolene (antidote)
5. Avoid alcohol or CNS depressants for 24 hours after anesthesia
6. In patient who received halothane, monitor signs of hepatic fatal side effects:
-rash, fever, nausea, vomiting
-jaundice and altered liver function
Local and Topical Anesthetic
Prototype
Local: bupivacaine, lidocaine, tetracaine, procaine, mepivacaine, prilocaine
Topical: benzocaine, butacaine, dibucaine,lignocaine
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Analgesics Prototype
Prototype -Heparin (SQ and IV), Warfarin (Orally)
a. Narcotic analgesics Mechanism of actions
-codeine, meperidine (Demerol) morphine, butorphanol (Stadol) a. Heparin
nalbuphine (Nubain) -prevents thrombin from converting fibrinogen to fibrin.
b. Non – narcotic analgesic b. Warfarin
NSAIDs – aspirin (aminosalicylic acid), mefenamic acid (Ponstan), -suppress coagulation by acting as an antagonist of vitamin K after 4-5 days.
ibuprofen (Motrin), naproxen, ketoprofen (Orudis), ketorolac. paracetamol Indications
and acetaminophen (Tylenol) -thrombosis, pulmonary embolism, myocardial infarction
Mechanism of actions Adverse effect
a. Narcotic analgesics -bleeding
-alter pain perception by binding to opiod receptors in CNS Nursing considerations
b. Non- narcotic analgesic 1. HEPARIN sodium
-relieves pain and fever by inhibiting the prostaglandin pathway. -if given SQ don’t aspirate or rub the injection site (above the scapula - best
Nursing considerations site).
1. Monitor respiratory depression & hypotension in clients taking narcotic -therapeutic level 1.5-2.5 times normal PTT; normal PTT is 20-35 sec. = 50-
analgesic. 85 sec.
2. Injury and accident precautions in clients taking narcotic analgesic. -antidote: (protamine sulfate)
3. Warn clients about possibility of dependency, and do not discontinue 2. WARFARIN sodium (coumadin)
narcotics abruptly in the narcotic-dependent clients. -warfarin is used for long-term
4. Naloxone is antidote for narcotic overdose. -onset of action is 4-5 days.
5. Advice clients to take NSAIDs with food and monitor bleeding complications. -therapeutic level is 1.5-2.5 times normal PT; normal PT = 9.6 -11.8 sec. =
6. Aspirin is contraindicated in clients below 18 years old with flu-like 25 - 30 sec; INR = 2 – 3
symptoms. -should be taken at the same time of the day to maintain at therapeutic level.
7. Monitor hearing loss in clients taking aspirin. -reduce intake of green leafy vegetables.
8. Monitor liver function in clients taking acetaminophen. -antidote: Vitamin K (Aquamephyton)
9. N-acetylcysteine is antidote for paracetamol overdose.

D. DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM

Anticoagulants
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Hemostasis: 1. monitor bleeding

2. antidote : Aminocarpic acid
Bleeding/injury Antiplatelet Medications
I Prototype
Vasoconstriction Plasminogen Aspirin, Dipyridamole (Persantin), Clopidoigrel (Plavix), Ticlopidine
I I Mechanism of action
Platelet aggregation Plasmin -inhibit the aggregation of platelet thereby prolonging bleeding time.
(temporary plug) I Indications
I I -used in the prophylaxis of long-term complication following M.I, coronary
Clotting factor activation ---------------------------- I revascularization, and thrombotic CVA.
I I II Nursing considerations
Intrinsic pathway (8, 9, 10, 11, 12) Extrinsic pathway (3, 7, 10) I 1. Monitor bleeding time (NV = 1-9 mins)
I I I 2. Take the medication with food.
(PTT) (PT) Vit K depletion I Cardiac Glycosides
` I I I Prototype
Prothrombin activation I -digoxin (Lanoxin) and digitoxin (Crystodigin)
I I Mechanism of actions
Thrombin I I -increase intracellular calcium, which causes the heart muscle fibers to
I I contract more efficiently, producing positive inotropic & negative
Fibrinogen ------------Fibrin threads ------------- Fibrin split chronotropic action.
products Indications
(Coagulation) (Removed by liver & spleen) -use for CHF, atrial tachycardia and fibrillation
Thrombolytic Nursing considerations
Prototype 1. Monitor for toxicity as evidence by : nausea, vomiting, anorexia, halo vision,
Streptokinase, Urokinase confusion, bradycardia and heart blocks .
Mechanism of actions 2. Do not administer if pulse is less than 60 bpm.
-activates plasminogen to generates plasmin (enzyme that dissolve clots). 3. Should be caution in patient with hypothyroidism and hypokalemia.
Indications 4. Antidote : Digi-bind
-use early in the course of MI (within 4-6 hours of the onset) 5. Phenytoin is the drug of choice to manage digitalis-induced arrhythmia.
Nursing considerations Nitrates
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Prototype propanolol, esmolol

-sosorbide dinitrate (Isordil) Class III (block K channels)
-nitroglycerine (Deponit, Nitrostat) amiodarone, bretylium
Mechanism of action Class IV (block Ca channels)
-produce vasodilatation including coronary artery. verapramil, diltiazem
Indications Nursing considerations
-angina pectoris, MI, peripheral arterial occlusive disease 1. Watch out for signs of CHF.
Adverse effects 2. Have client weigh themselves and report weight gain.
-headache, orthostatic hypotension 3. Watch out for signs of lidocaine toxicity: confusion and restlessness
Nursing Considerations Antilipemics
1. Transdermal patch Prototype
-apply the patch to a hairless area using a new patch and different site each a.cholesterol-lowering agents
day. -cholestyramine, colestipol, lovastatin
-remove the patch after 12-24 hours, allowing 10-12 hours “patch free” b.triglyceride-lowering agents
each day to prevent tolerance. -gemfibrozil, clofibrate
2. Sublingual medications Mechanism of action
-note the BP before giving the medication -interfere with cholesterol synthesis as well as decreasing lipoprotein &
-offer sips of water before giving because dryness may inhibit absorption triglyceride synthesis.
-one tablet for pain and repeat every 5 minutes for a total of three doses; if Nursing considerations
not relieved after 15 minutes seek medical help. 1. monitor liver functions while using statins.
-stinging or burning sensation indicates that the tablet is fresh. 2. prevent constipation, flatulence, cholelithiasis
-instruct patient not to swallow the pill 3. encourage increase fluid and fiber intake.
-sustained release medications should be swallowed and not to be crush
-protect the pills from light E. ANTI – HYPERTENSIVE MEDICATIONS
Anti-arrhythmic Drugs Angiotensin-Converting Enzyme (ACE) Inhibitors “PRIL”
Class I (block Na channels) Prototype
IA - quinidine, procainamide captopril (Capoten), enalapril (Vasotec), quinapril, lisinopril
IB – lidocaine Mechanism of actions
IC - flecainamide -prevent peripheral vasoconstriction by blocking conversion of angiotensin I to
Class II (Beta-blockers) angiotensin II decreasing peripheral resistance
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Adverse effect Osmotic Diuretic

-it cause hyperkalemia -Mannitol
-induce chronic cough -Increase Osmotic Pressure Of The Glomerular Filtrate.
Nursing considerations -Hypotension
1. not to discontinue medications because it can cause rebound hypertension. Thiazide Diuretics
2. avoid using K+ sparing diuretics. -Hydrochlorothiazide
Calcium-Channel Blockers -Blocks Na and K Reabsorption; Reabsorb Ca
Prototype -Hypercalcemia
-Nifedipine (calcibloc, adalat), Amlodipine (norvasc), Felodipine (Plendil) Loop Diuretics
Verapramil (Isoptin) -Furosemide (Lasix)
Mechanism of action -Blocks Na, K, and Ca Reabsorption
-decrease cardiac contractility and the workload of the heart, thus decreasing -Hypocalcemia
the need for O2. Potassium Sparing Diuretics
-it also promotes vasodilatation of the coronary and peripheral vessels. -Spironolactone (Aldactone)
Indications -Excrete Na and Water but it reabsorbs K
-hypertension, angina, arrhythmia -Hyperkalemia
Adverse effects
-bradycardia, hypotension, headache F. RESPIRATORY MEDICATIONS
-reflex tachycardia, constipation Bronchodilators
Nursing considerations Prototype:
1. Administer between meals to enhance absorption. Symphatomimetic Xanthines
2. Take client’s pulse rate before each dose, withhold if pulse is below 60 bpm. -albuterol, salbutamol -aminophylline
3. Refer for signs of congestive heart failure. -isoproterenol, salmeterol -theophylline
-terbutaline
F. DIURETICS Mechanism of actions:
-usually given at morning -sympathomimetic (b-receptor agonist) bronchodilators, dilate airways.
Carbonic Anhydrase Inhibitors -xanthine bronchodilators, stimulate CNS for respiration.
-Acetazolimide (Diamox) Indications:
-Increase Na+, K+, & Hco3 Secretion, Along With It Is H2o -bronchospasm, asthma, bronchitis, COPD
-Metabolic Acidosis Adverse effects:
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-palpitations and tachycardia Nursing Consideration:

-restlessness, nervousness, tremors 1. It should be given before asthmatic attacks.
-anorexia, nausea and vomiting, headache, dizziness 2. Administer oral capsule at least 30 mins before meals for better absorption.
Nursing considerations: 3. Drink a few sips of water before & after inhalation to prevent cough &
1. Contraindicated hyperthyroidism, cardiac dysrhythmia, or uncontrolled unpleasant taste
seizure disorder. 4. Assess for lactose-intolerance.
2. It should be used with caution in patient with HPN and narrow-angle Anti-histamines (H-1 blockers)
glaucoma. Prototype:
Glucocorticoids (Corticosteroids) -Astemizole (Hismanal), Loratidine (Claritin), Brompheniramine (Dimetapp),
Prototype: Diphenhydramine (Benadryl), Cetirizine (Iterax), Celestamine (Tavist)
-dexamethasone, budesonide, fluticasone, prednisone, beclomethasone
Mechanism of actions:
-act as anti-inflammatory agents and reduce edema of the airways, as well as
pulmonary edema.
Adverse effects:
-Cushing’s syndrome, neutropenia. osteoporosis
Nursing considerations:
1. Take drugs at meal time or with food.
2. Eat foods high in potassium, low in sodium.
3. Instruct client to avoid individuals with RTI.
4. Instruct client not to stop medication abruptly, it should be tapered to
prevent adrenal insufficiency
5. Avoid taking NSAID while taking steroids.
6. Take inhaled bronchodilators first before taking inhaled steroids, and rinse
mouth after using.
Mast Cell Stabilizers
Prototype:
-cromolyn sodium (Intal)
Mechanism of action:
-stabilize mast cells that release histamine triggering asthmatic attacks.
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Mechanism of action: Rifampicin

-decrease nasopharyngeal secretions and decrease nasal itching by blocking -given on an empty stomach with 8 0z. of water, 1 hour before or 2 hours
histamine in H1-receptor. after meals and avoid taking antacids with medications.
Indications: -hepatotoxic thus avoid alcohol.
-common colds, rhinitis, nausea and vomiting, urticaria, allergies and as sleep -instruct the client that urine, feces, sweat, and tears will be red-orange in
aid color.
Nursing Considerations: Pyrazinamide
1. Administer with food and drink. -given for 2 months.
2. Given IM via Z-track method or orally. -increase serum uric acid and cause photosensitivity.
3. Precautions in handling machine and driving while taking these drugs. Ethambutol
4. Ice chips or candy for dry mouth -contraindicated in children under 13 years old.
Anti-tuberculosis -obtain a baseline visual acuity because it can cause optic neuritis.
Prototype: -instruct the client to notify the physician immediately if any visual problems
First line Second line occurs.
-Isoniazid (INH) -Cycloserine Streptomycin
-Rifampicin (Rifadin) -Kanamycin -aminoglycoside antibiotic given IM
-Ethambutol -Ethonamide -nephrotoxic and ototoxic
-Pyrazinamide -Para-aminosalicylic acid -obtain baseline audiometric test and repeat every 1-2 months because the
-Streptomycin medications impairs the CN VIII
-active tuberculosis is treated with drug combination for 6-9 mos.
-multidrug-resistant strain (MDR-TB) are medicated for 1 year up to 2 years G. DRUGS AFFECTING GASTROINTESTINAL SYSTEM
-given before meals Antacids
Isoniazid Prototype:
-should be given 1 hr before or 2 hrs after meals because food may delay -Aluminum/magnesium compounds (Maalox)
absorption. -Sodium bicarbonate (Alka-Seltzer)
-should be given at least 1 hr before antacids. -Calcium carbonate (Tums)
-instruct to notify physician for signs of hepatoxicity (jaundice), and -Magnesium hydroxide (Milk of Magnesia).
neurotoxicity, numbness of extremities. Mechanism of actions:
-administer with Vitamin B6 to counteract the neurotoxic side effects. -neutralize the stomach acidity.
-avoid alcohol. Adverse effects:
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-metabolic alkalosis, stone formation

-electrolyte imbalance
-diarrhea (magnesium), constipation (aluminum)
Nursing considerations:
1. Give 1 hr after meals.
2. Avoid giving medications within 1-2 hrs of antacid administration
(decreases absorption).
3. Take fluids to flush after intake of antacid suspensions.
4. Monitor for changes of bowel patterns.
Histamine – 2 blockers
Prototype:
-cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), nizatidine
(Axid)
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Mechanism of action: 2. Be cautious taking if with infectious diarrhea.

-blocks H2 receptors in the stomach, reducing acid secretions 3. Monitor atropine toxicity with diphenoxylate.
Nursing considerations: 4. Clay, white or pale stool is common with kaopectate.
1. Given before or with meals Laxatives
2. Avoid giving other drugs with cimetidine A. lactulose (Cephulac), Na biphosphate (Fleet enema) & magnesium salt (Milk of
3. Gynecomastia may develop with chronic use of cimetidine. Magnesia)
Proton – Pump Inhibitors (PPI) -retain fluid and distend intestine
Prototype: B. ducosate (Dialose)
-omeprazole (Losec), Lansoprazole (Lanz), pantoprazole (Pantoloc). -emulsify fecal fat and water
Mechanism of action: C. bisacodyl (Dulcolax) & senna (X-prep)
-inhibit the proton H+ to combine with Cl- toform hydrochloric acid. -irritates intestinal mucosa and stimulate intestinal smooth muscles
Nursing considerations: D. bulk-forming laxative (Metamucil)
1. Given before meals preferably at morning -increase fecal bulk and water content
Mucosal Barriers E. mineral oil
Prototype: -lubricates & prevent colon absorption
-sucralfate (Carafate), misoprostol (Cytotec). Emetics
Mechanism of action: Prototype:
-coats the mucosa to prevent ulcerations -ipecac syrup, apomorphine
Nursing consideration: Mechanism of actions:
2. Given before meals -induce vomiting through stimulation of vomiting center of medulla.
3. Misoprostol is contraindicated for pregnants. Indications:
4. Sucralfate cause constipation. -ingestion of poisonous or toxic substances
Anti-diarrheal Agents Nursing considerations:
Prototype: 1. Consult poison control center before induction of vomiting.
-diphenoxylate (Lomotil), loperamide (Imodium), kaolin/pectin mixture 2. Administer ipecac syrup with large amount of fluid.
(Kaopectate)
Mechanism of actions:
-decrease stomach motility and peristalsis
Nursing considerations:
1. Monitor for rebound constipation.