PHARMACOLOGY NCMA 216 3.

Bisoprolol – B1 selective blockers

4. Pindolol, Acebutolol – a partial agonist
MIDTERMS
beta blockers w/ some intrinsic
CARDIOVASCULAR sympathomimetic activity, This drugs a
particularly beneficial for patients
 Inherent rate w/bradythimias or periperhal vascular
 SA node 60-1000 BPM disease
 AV node 40-60 BPM
 BUNDLE OF HIS 40-60 BPM PRECAUTIONS: not given to patients w/ Hearth
 LEFTA DND RIGHT BUNDLE BRANCHES blick, Bradycardia, CHN, COPD
20-40 BPM Side effects: Bradycardia, Hypotension,
 PURKINJE FIBERS 20-40 BPM Rebound hypertension, ( be cautious when
 ELECTRICAL CONDUCTION OF THE abruptly stopped) impotent when use w/
HEART Inderal
 ANTI-HYPERTENSIVE DRUGS
 Idiopathic/ essential/primary ALPHA & BETA BLOCKERS
Hypertension
1. LABETELOL
 >90%, 15-40 YRS
2. CARVEDILOL - Have both beta blocking
Secondary Hypertension and vasodilating effects
3. NEVIVOLOL
 Renal Arttery Diesease 4. ESMOLOL - B1 selective blocker that is
 Pheochromocytoma rapidly metabolized via hydrolysis by
 Renal parenchymal disease RBC. Used for management of intra and
 Toxemia of pregnancy post operative hypertension and
sometimes for hypertensive
emergencies. Particularly when HTN is
assiociated w/ Tachycardia.
Pgarmacodynamics: /block both the
alpha and beta receptors of the
sympathetic nervous system
Indications:/ Adjuct in the treatment of
hypertension
Nursing Consideration:
/ monitor for adverse effects complain
of fatigue, loss of libido, inabilioty to
sleep, and GI and genitourinary
disturbances
B- Blockers ( ends with – OLOL)
OTHER BETA BLOCKERS Action- Block Beta Recebtors in the
heart causing:
1. Nanolol – non selective beta receptors/
2. Carteolol Block B1 &B2 receptor site  Hearth rate
  Force of contraction 1. CAPTOPRIL (CAPOTEN) Usually
 Rate of AV conduction tolerated by bost of patient
2. ENALAPRIL ( VASOTEC)
Side effects 3. LISINOPRIL ( ZESTRIL)
4. RAMIPRIL ( ALTACE)
 Bradycardia
5. – is not given to patient w/ renal
 Lethargy
dysfunction because this drugs may
 GI disturbances
cause further decrease in renal blood
 CHF
flow
 Low BP
 Depression WOF: Hypotension, Hyperkalemia

AE: reflex tachycardia, cough, dizziness

Better to give on empty stomach for absorption

ADVANTAGES:

1. no postural hypotension
2. Safe in asthmatic patient DM and
peripheral vascular disease
3. Long term has potential to reduce
incidence of type 2 DM
4. No rebound hypertension on
withdrawal
ROLE OF RAAS IN CONTROL OF BP
ANGIOTENSIN ANTAGONIST/ ANGIOTENSIN
 Kidney Protection
RECEPTOR BLOCKERS
 Cardio Protection
 Vascular Protection 1. LOSARTAN- high first pass metabolism
2. CANDESARTAN
ACE Inhibitors ( ends with PRIL)
3. VALSARTAN- absorption is affected by
Recommended as first line treatment of food
hypertension in patients w/ a variety of 4. TELMISARTAN
compelling indication including high coronary 5. OLMESARTAN no dose adjustment
disease risk or history of DM, stroke, heart 6. IRBESARTAN
failure, MI
ARBS produce arteriolar and venous dilatation
It dilates arterioles which improves renal blood and block aldosterone secretion, has lowering
flow and decrease blood fluid volume BP and decreasing salt and water retention

Reduce both cardiac preload and afterload AE: Hyperkalemia

thereby decreasing cardiac work
WOF: Hypotension
CI: 1. Teratogenicity) pregnant women

2. Bilateral renal artert stenosos

Interacts: K. sparing diuretics VASODILATORS

DIURETICS Direct acting antihypertensive drugs

Thiazide diuretics: Thiazide diuretics, such as NITRATES

hydrochlorithiazede and chlortalorthiazede,
lower blood pressure initially by increasing -reduce venous tone, w/c decrease the
soudium and water excretion. Thiazide diuretics workload of the heart and promotes
can induce hypokalemia , hyperuricemia and to vasodilation
a lesser extent, hyperglycemia in some patients - relax vascular smooth muscle
Loop diuretics- the loop diuretics act promptly - causes general vasodilation
by blocking sodium and chloride reabsorption in
the kidneys, even in patients with poor renal INICATION: acute or chronic anhina attacks
function or those who have not responded to
Nitrates cause the smooth muscle of the veins,
thiazide diuretics. Loop diuretics cause decresed
and to lesser extent the arteries to relax and
renal vascular resistance and increased renal
dilate
blood flow
FORMS OF NITRATES
K Sparing- potassium-sparing
diuretics( spironolactone and eplerenone) are 1. Sublingual – Isosorbide Binitrates ( SL.
competitive antagonsut that either compete Chewable)
with aldosterone, or directly block epithelial Pharmacokinatics taken SL absorbed
sodium channel( amiloride) rapidly and directly into JV and Right
atrium
ANTI-ANGINA DRUGS
- Can repeat dose if pain is not
Angina- a condition of acute cardiac pain caised relieves within 5 mins but do not
by inadequare blood flow to the mycocardium give more than 3 tabs
due to either 1. Plaque occlusion 2. Spasm of 2. Topical- ointment and ( transdermal
other coronary arteriws patch- longer acting nitrates)
- Should not removes w/ bare hands
Characteristic of pain: - Do nor sefib when tere is
1. Tightness, pressure in the center of the nitroglycerin patch
chest and pain aradiating in the left arm 3. Translingual, oral extended- Isosotbide
2. Pain last for a minuite mononitrate
- Release capsule and sustained
release tablet or capsule

SE: 1. Headeache, dizziness, hypotension,

weakness
Reflex tachycardia. May occur of nitrates are  Action: blocks calcium access to cells
given to rapidly causing:
- Contractility
Drug Interactions:
- Conductivity of the heart
1. Betablockers, calcium channel blockers - Demand of oxygen
 Side effects:
2. Alcohol can enhance the hypotensive - Low BP
effect of the nitrates - Bradycardia
- May precipitate AV blockers
BETA- ADRENERGIC ANTAGONIST/BETA
- Headache
BLOCKERS
- Abdominal discomfort
 ATENOLOL - (constipation, nausea)
 CARVEDILOL - Peripheral edema
 METOPROLOL TARTRATE
ANTIDYSRYTHIMIC DRUGS
 NADOLOL
 PROPRANOLOL HYDROCHLORIDE Cardiac Dysrhythmias/ Arrhythmia- abnormal
beats
CLASSIFICATION OF CCB
4 things happens:
Indirect acting vasodilators/ calcium channel
blockers ( ends with DIPINE) 1. Heart beats faster
2. Heart beats slow
1. Relax the coronary artery spasm in 3. Heart will respond to other impulses
variant angina, relax peripheral generated by the cardiac cell( other
arterioles in stable angina which than SA node)
decrease O2 demand 4. Heart will respond to impulses
2. Decrease the cardiac contractility, travelling the extra pathways
afterload and peripheral resistance this
decreasing the workload of the heart MOA:
3. Reduce the force contraction of the
1. Block the adrenergic stimulation of the
heart
heart
2. Depress the myocardial exitability and
contractility
3. Decrease conduction velocity in cardiac
tissue
4. Increase recovery time( repolarization/
resting)

RATE: RR Interval

RHYTHM: R to R interval

CALCIUM CHANNEL BLOCKERS

PWAVE: Atrial depolarization/ Ventricular
activity/ Ventricular contraction

Atrial repolarization/ resting

QRS COMPLEX: ventricular depolarization/

ventricular activity/ ventricular contraction

TWAVE: ventricular repolarization/ resting

ST SEGMENT: should be that

Indicative of ischemia, infraction, strain FOR HEARTH BLOCKS

ATROPHINE – a prototype antimuscarinic frugs

Atrophine is a naturally occuring” belladonna

alkoid” that can be extracted from plants such
as deadly nightshade (astropa belladonna),
jimson weed & mandrake. It is a competitive
antagonist of all five known muscarinic
receptors ( m1-m5)) and when administered
systematically. It has numerus medical uses,
including temporary relief from bradycardia or
AV block as an antidote for cholinesterase
poisoning of poisoning by mushrooms
containing muscarine,

Decrease cardiovascular response to vagal

stimulation resulting in tachycardia

HEART FAILURE

CONDITION IN WHICH THE HEART CAN’T PUMP

ENOUGH BLOOD TO MEET THE BODY’S NEED.
Heart failure does not mean that your heart has
stopped or is about to stop working. It means SE: Digitalis toxicity
that your heart is not able to pump blood the
way it should. IT can affect one or both sides of Nursing Consideration: Less than 60PR don’t
the heart. give ANTIDOTE: Digoxin immune fab

LEFT SIDED DRUGS AFFECTING THE RESPIRATORY SYSTEM

TIMEBAND: Within 90 minuets

 When the left ventricle does not
contract sufficiently to pump the blood NON-SEPARATION OF NEWBORN FROM
that returned from the lungs and left MOTHER FOR EARKY BREASTFEEDING
atrium out through the aorta into
peripheral circulation a) Weighting, bathing, eye care,
 Causes excessive amount of blood back examinations, injections (hepatitis B,
up to the lungs BCG, VIT. K) should be done after the
 Shortness of breath first full breastfeed is completed
b) Postpone washing until 6 hours
RIGHT SIDED
DRUGS FOR UPPER RESPIRATORY INFECTION
 When the heart does not sufficiently
pump the blood returned into right COMMON COLD- the most prevlent type of URI
atrium from the systemic circulation
- Adult have an average of 2 to 4
 Blood backed up in the peripheral tissue
colds per year
causing peripheral
- Children have an average of 4 to
edema(abdomen/legs/feet)
cold 12 per year
 Swelling
- Not considered as a life-threatening
S/SX: fatigue, irregular heartbeat, reduce ability illness but it does cause physical
to exercise rapid weight gain, chest pain and mental discomfort
- Caused by rhinovirus and affects
CARDIAC GLYCOSIDES the nasopharyngeal tract

DIGITALIS – began being used as early as Although many type of viruses can cause a
1200AD making it as one of the oldest drugs common cold, rhinoviruses are the most
common culprit,
Effects
A cold virus enters your body through your
1. Inotropic action increasing myocardial
mouth, eyes. Or nose. The virus can spread
contraction stroke volume
through droplets in the air when someone who
2. Chronotropic action decreasing the
is sick cough, sneezes or talk
heartrate
3. Drimotropic action decreasing the Acute Rhinitis- Inflammation of the mucous
conduction of the heart cells membranes of the nose, usually accompanies
the common cold
Therapeutic level of Digoxin: 5-2.0
nanogram/ml
Allergic Rhinitis- often called hay fever, caused
by pollen or foreign substance such as animal
dender.

DRUGS FOR COMMON COLDS

1. Antihistamine- are H1 blockers or H1

antagonist
Action: It competes w/ histamine for
receptor site and prevent a histamine
response

Compound w/c is release by cells in

response to injury and in allergic and
inflammatory reaction

NURSING CONSIDERATION
Beathing and coughing techniques
Relaxation techniques
Evaluate heart rate and BP
Appropriate positioning
Tremors
Have 8 or more glass of fluid
Emphasize NO SMOKING
NURSING CONSIDERATION  This drug isn’t indicted for reversing
bronchospasm in acute asthma attack
 DO NOT use during acute attacks
 Give cautiously to elder patients and
 Use bronchodilator before those with hepatic impairment
corticosteroid aerosol
 Drug absorption is decreased by food
 Hold the inhaled drug for a few seconds give the drug 1 hour before or 2 hours
before exhaling after meal
 Allow 1-3 minutes to elapse between
each inhalation Montelukast has a rapid absorption from the GI
 Rinse mouth with water after tract and may be given with food
 Notify provider if sore throat or sore
mouth occurs, do not stop abruptly
 Must taper of gradually under provided GASTROINTESTINAL TRACT
supervision
HISATIME 2 RECEPTOR ANTAGONIST
ANTI ASTHMA DRUGS
 Block the receptor for histamine 2 in
LEUKOTRIEN RECEPTOR ANTAGONIST the parietal cells to stop release of
hydrochloric acid from parietal cells
MONTELUKAST
( cures hyperacidity)
MAST CELL STABILIZER
Pharmacokinetics: readily absorbed after
CROMOLYN SODIUM oral administration, liver metabolized the
drug and excreted in the urine
LEUKOTRIENE MOMDIFIERS
Contraindications and Cautions:
Leukotriene modifiers are used for the Contraindicated to clients with known
prevention and long-term control of mild allergy to the drug. Pregnancy and lactation
asthma
Adverse effects: drugs may cause diarrhea
There are two types: or constipation, dizziness, insomnia,
gynecomastia and impotence
1. Leukotriene receptor antagonist include
zafirlukast and Montelukast Drug- drug interactions: these drugs may
2. Leukotriene formation inhibitors slow doesn’t metabolism of some drug
include zileuton blockers, theophylline, nifedipine,
phenytoin and alcohol
Zafirlukast Actions
Examples: ranitidine, cimetidine, famotidine
 Selectively competes for leukotriene
receptor sites, blocking inflammatory Proton- pump Inhibitor (PPI)
action and indication
 Prophylaxis and long-term management Suppress gastric acid secretion by
of asthma specifically inhibiting the hydrogen-
 Nursing considerations postpartum adenosine triphosphate
 enzyme system on the secretory surface of disturbances of the middle ear that
the parietal cells hence decreasing affects the equilibrium
hydrochloric acid secretion.
Non pharmacological measures should be used
The classification is now the drug of choice first when vomiting occurs:
for treatment of PUD, gastritis and GERD.
Tea, gelatin, Gatorade, Pedialyte crackers and
Adverse effects: dizziness, headache, dry toast maybe helpful
vertigo, insomnia, GI effects like diarrhea,
nausea and vomiting, respiratory symptoms MECHANISM OF ACTION
like cough, hoarseness and epistaxis  5HT3 antagonist: they block serotonin
Examples: Omeprazole, Esomeprazole, receptors in CNS and Gastrointestinal
Pantoprazole tract so it can be used to treat post
operative and cytotoxic
ANTACIDS ( Chemotherapy) drugs nausea/
vomiting.
Neutralize acidity to decrease symptoms of
 Prokinetics (Dopamine Antagonist):
pyrosis or heartburn. Antacids do not cure PUD
They block the dopamine
or gastritis but help decrease symptoms.
neurotransmitter also they promote
The best form of antacids is liquid form, taken gastrointestinal motility & quicken
1-2 hours after eating to maximize therapeutic gastric emptying
effect of drugs.  Antihistamines: They block the
histamine neurotransmitter and they
Examples: magnesium aluminum hydroxide, act by an effect on vomiting center and
calcium salts by producing sedation.
 Anticholinergics: an anticholinergics
DRUGS OF THE GI TRACT
agents block the neurotransmitter
ANTI-EMETIC DRUGS acetyl choline in central and peripheral
nervous system.
Vomiting/emesis- expulsion of gastric contents
or removal of non-toxic or harmless substance NON-PRESCRIPTION ANTI EMETICS
from the body after ingestion
Usually used to prevent motion sick ends
2 CAUSES but have minimal effect on controlling
severe vomiting resulting from
1. Due to GI illness – either by obstruction antineoplastic agent, radiation and toxins
or gastroenteritis
2. Secondary cause – either: When use for motion sickness- should be
 Severe visceral pain taken 30 mins before travel
 Severe systematic illness
1. SELECTIVE ANTIHISTAMINE ANTI-
 Specific condition such as pregnancy,
EMETICS/H1 RECEPTOR ANTAGONIST
increased ICP toxins, chemotherapy
DRUGS:
sessions or effect of selected medicines
  cyclizine Hcl 7. Cannabinoids
 promethazine Side effects:
 dimenhydrinate  Mood changes
 meclizine Hcl  Euphoria
 diphenhydramine hcl  Drowsiness
 Nightmare
Use: It inhibits vestibular stimulation in the  Depersonalization
middle ear
NURSING RESPONSIBILITIES
SE: similar to those of anti cholinergic
( drowsiness, dryness of the mouth,  Monitor I and O
constipation  For patients taking cannabinoids WOF:
drugs that increase its toxic effect
Nsg Responsibilities:
 Collect data regarding emesis (amount,
 not to use alcohol type and frequency)
 not to operate machine or drive  Monitor vitals
 Monitor the electrolytes
PRESCRIPTION ANTI-EMETICS  Know the causes of vomiting

1. anti-histamine -scopolamine (L-

hyoscines)
2. Anti cholinergic- anticholinergic
antiemetics are agents that block
muscarinic receptors and inhibits
cholinergic transmission from the
vestibular nuclei to the vomiting center.
Anticholinergic antiemetics are mainly EMETICS -emetics are drugs which produce
used to prevent or treat motion vomiting
sickness
Mechanism of action – they stimulate the
Ex. Meclizine, Diphenhydramine
chemoreceptor trigger zone and gastric mucosa
3. Dopamine antagonist- metoclopramide,
to induce vomiting
domperidone, haloperidol
4. Benzodiazepines- combination effect of
sedation. Reduction of anxiety or
possibly depression of vomiting center.
EX. Lorazepam
5. Serotonin Antagonist- found to be
highly effective for treatment of N/V w/
fewer side effects
6. Glucocorticoids - suggested as the first
line drug for low level emetogenic
chemo and radiation therapy ex.
Dexamethasone
Indication / uses  Drug therapy

 To induce vomiting
 To treat poisoning
 Treatment of overdose of drugs

Contraindication/ precautions

 History of seizures
 Semi-comatose or unconscious patient,
 Ingested caustic substance or
petroleum products.

DRUGS FOR DIARRHEA

ABSORBENTS ANTI-DIARRHEA
Diarrhea – frequent liquid stool w/c is a
symptom of intestinal disorder, loose, watery, Decrease absorption of many agents including
bowel movements Digoxin, clindamycin, Quinidine and OHA

CAUSES: Acts by coating the wall of GI tract and

absorbing bacteria or toxins that causes
 Food diarrhea
 Fecal inaction
 Bacteria
 Toxins
 Drug reaction
 Laxative abuse
 Stress anxiety

CLASSIFICATION:

 Acute – sudden onset, last than 2 days

 Chronic - 2 weeks or longer Mechanism of action

DRUGS CAUSING DIARRHEA:  Osmotic laxatives (Magnesium

hydroxide) draw water into the
 Magnesium antacids intestine to increase the mass of stool ,
 Antibiotics trenching musculature to increase the
 Quinidine mass of stool, stretching musculature
 GI prokinetic drugs which result in peristalsis.
 Stimulant laxative result in stimulation
PRINCIPLES OF TREATMENT:
of intestinal peristalsis
 REHYDRATION – ORS, probiotics  Lubricant laxatives increase water
- IV therapy (LR) retention in the stool, prevent water
 Nutrition
 absorption from the stool, and lubricate  TSH
as well as soften intestinal contents,  ACTH
 Stool softener allow more fluid are fat  Gonadotropic
to penetrate the feces, producing a
after fecal mass. NON- TROPIC

 GH
 MSH
 PROLACTIN

Indication/ Uses

 To treat or prevent constipation

 To prepare the bowel for radiologic or
endoscopic procedures,
 Short term treatment of constipation
caused high dose of ooid use,
 Osmotic laxative are used to rapid
evacuation of the bowl offer ingestion
of poison or following anti helminthic
therapy to rid of the body from dead
parasites.
 Methyl cellulose and psyllium are used
to many chronic diarrhea

CONTRAINDICATION/ Precautions

Contraindicated if patient with parasites, or

BIOLOGOCAL RHYTHM
severe abdominal pain of unknown cause
 Circadian rhythm: the 24- hour cycle
DRUGS AFFECTING THE ENDOCRINE SYSTEM that includes physiological and
behavioral rhythms like sleeping
ADH and acytocin are released by the posterior  Diurnal rhythms: the circadian rhythm
pituary gland is what structure are they synced with day
produced:  Ultradian rhythms: biological rhythms
with a shorter period and higher
TROPIC
frequency than circadian rhythms
  Infradian rhythms: biological rhythms TARGET ACTION
that last more than 24 hours, such as a Thyroxine most cells High BMR
menstrual cycle triiodothyronin
e
 Nocturnal rhythms: pattern of hormone
Calcitonin Mostly bone Lower
releasing in the evening
calcium
HOW METABOLISM IS CONTROLLED AND
MEDIATED BY HORMONES PANCREAS
 Many disorder are due to either over or TARGET ACTION
under secretion of a hormones Glucagon Liver High glucose
Insulin General Low glucose
ENDOCRINOLOGY – can potentiate normal
ADRENAL MEDULLA
hormonal action
TARGET ACTION
Norepinephrin Hearth blood Prolongs SNS
e vessels, liver effects
ADRENAL CORTEX

TARGET ACTION
Aldosterone Kidney High sodium
NA
reabsorption
high water
retention
Cortisol Most tissue High and low
glucose
inflammation

POSTERIOR PITUARY ADDISON DISEASE(PRIMARY ADRENAL

INSUDDICIENCY)
TARGET ACTIONS
OXYTOCIN Uterus High This is a rare autoimmune disease that causes
Mammary contraction your adrenal glands to produce lower-than-
High milk
normal levels of cortisol and aldosterone.
letdown
ADH Kidneys High water CUSHING’s Syndrome- This condition happens
reabsorption
when your adrenal glands produce too much
ANTERIOR PITUARY
cortisol. Its usually caused by a tumor or certain
TARGET ACTION medications
Prolactin Mammary Milk
gland production HIRSUTISM – this condition happens when
women develop excessive hair growth due to
high levels of androgen.
THYROID
  Intramuscular or Subcutaneous
administration for appropriate
distribution of the drug
 Monitor closely for response to
treatment
 Monitor other r hormone function
because they may be affected like
thyroid function and glucose tolerance
 Monitor closely to adverse effect like
hypothyroidism, glucose intolerance
and nutritional imbalance
 Provide health teaching about the drug,
prescribe dosage, therapeutic and
adverse effects to increase client’s and
HYPOPITUARAISM guardian’s understanding and promote
compliance
PITUARY DWARFISM – is a disor=der
characterized by hypersecretion of the pituary HYPERPITUITARISM ( GIGANTISM,
gland, usually it causes congenita, circulatory ACROMELAGY)
disturbances. Inflammation, tumour in the
- Acromelagy Palapad, giantism,
pituary gland. Lack of growth hormone, to fix
patangkad ang paglaki, high level of
this is they need to replace their growth
growth hormone in the body
hormone which is somatropin.
(kabaliktaran ng dwarfism
SOMATROPIN, SOMATREM
OCTREOTIDE, PEGVISOMANT, BROMOCRIPTINE-
Somatropin and somatrem are hormones of drugs are growth hormone antagonist
recombinant DNA origin that are equivalent to
Octreotide ( sandostatin) inhibits GH release
human GH. Somatrem is indicated only for the
with less inhibitory effect on insulin release.
treatment of children with growth failure due to
lack of endogenous GH. Somatropin is indicated Pegvisomant (somavert) is a GH analog, it binds
or the treatment of growth failure due to lack of to GH receptors on cells inhibiting GH effects, It
GH or to chronic renal failure, for treatment of mus be given daily subcutaneous injection.
short stature associated with Turner’s
syndrome Bromocriptine ( parlodel) is a dopamine agonist
inhibiting GH secretion in patients with
Nursing Considerations acromegaly; opposite effects occur in normal
individuals
 Individual products vary so follow
strictly the manufacturer’s direction FOLLOW STRICTLY THE MANUFACTURER’S
before use. DIRECTION FOR USE

 Monitoe patients response to the drug

  Monitoe for adverse effects like ACTIONS – stimulates metabolism of all body
hypothyroidism, gucose intolerance, tissues by accelerating the rate of cellular
nutritional imbalance, GI disturbances, oxidation
dizziness headache and cholecytitis
INDICATIONNS
 Provide comfort measures
* cretinism
 Health teaching about drug actions and
adverse effects to increase client’s and Myxedema coma
guardian’s understanding
Thyroid hormone replacement
DRUGS AFFACTING THYROID GLAND
Nursing Considerations
- Thyroid gland produces hormones
Thyroxine and triiodthitinine which  Monitor the patient for adverse effects,
influence growth, development and such as nervousness, insomnia, tremor
metabolism. trachycardia, palpitations, angina,
arrythmias and cardiac arrest,
HYPERTROIDISM (THYROTOXICOSIS)  Levothyroxine is prescribed in
micrograms; medication errors can
 Overproduction of thyroid hormone
occur in written in another unit. Verify
 Graves disease is an example of
dose and order or avoid error.
hyperthyroidism. More common in
 Use with extreme caution in elderly
women than in men and occurs
patients and in patients with
between 20-40 years of age and often
cardiovascular disorders.
arises after emotional or physical stress
ir infection ANTI-THYROID DRUGS
SYNTHETIC THYROID DRUGS ACTUALLY ARE THE  A number of drugs act as an hydroid
SODIUM SALTS OF THE L-ISOMERS OF THE drugs, or thyroid antagonists,
HORMONES.  Used for patients with hyperthyroidism,
which includes propylthiouracil and
These synthetic hormone include:
methimazole,
 Levothyroxine sodium, which contains
T4
 Liothyronine sodium, which contains T3
 Liotrix, which contains T3 and T4

Thyroid hormones are absorbed variably from

the GI tract, distributed in plasma, and bound to
serum proteins. They’re metabolized through
deiodination, primarily in the liver, and excreted
unchanged in feces.

LEVETHYROXINE
GLUCOCORTICOIDS

 Classified according to their duration of INSULIN, A pancreatic hormone, and oral

action antidiabetic drugs
 Increases blood glucose, mobilizes fats,
 Are classifed as hypoglycemic drugs
stimulates protein catabolism,
because they lower blood glucose
depresses immunity, and inflammatory
levels.
responses.
 Glucagon, another pancreatic hormone,
 Natural = Hydrocortisone
is classified as a hyperglycemic drug
 Synthetic = All others, prednisone
because it raises blood glucose levels
DRUGS USED IN DISORDERS OF THE PANCREAS
Low Insulin = high glucose
 When the pancreas no longer secrete
Diabetes mellitus, known simply as
sufficient effective insulin the glucose
diabetes, is a chronic disease of insulin
cannot enter the cells.
deficient or resistance. It’s characterized by
 NIDDM, IDDM, Glucogon.
disturbances in carbohydrate, protein and
 Glucagon acts on the liver to increase
fat metabolism.
blood glucose levels by stimulating the
breakdown of glycogen into glucose and This leads to elevated glucose levels in the
amino acids and free fatty acids body.

The disease come in two primary dorm that

are recognized by the American diabetes
association (ADA): Type 1, reffered to as
insulin dependent diabetes mellitus, Type 2,
previously reffered to as non-insulun
dependant diabetes mellitus
 respiratory depression that this is not
primarily used for anxiety today
Ex. Phenobarbital, Secobarbital,
Amobarbita
 Benzodiazepines – drug action is to
enhance GABA effect to cause inhibition
of impulse transmission.
• Examples: Diazepam, Lorazepam,
Clonazepam, Chlordiazepoxide
 Non – Benzodiazepines
• Paraldehyde, Meprobamate, Chloral
hydrate, Zolpidem, Diphenhyramine

ANXIOLITOC HYPNOTIC DRUGS

NEUROPHARMACOLOGY
Nursing Considerations
• REVIEW ON NEUROPHYSIOLOGY
 Avoid abrupt discontinuation after
• NEURONS AND NERVE ACTION POTENTIAL prolonged use
 Not given if BP is elevated, with
• ELECTRICAL NATURE renal/hepatic dysfunction, or history of
drug abuse
• CHEMICAL NATURE
 Xanax (Alprazolam), Ativan
• NEUROTRANSMITTERS (Lorazepam), Serax ( Oxazepam ) -
examples with brand names
• EXCITATORY NEUROTRANSMITTERS
 Increase in 3Ds - drowsiness, dizziness,
• INHIBITORY NEUROTRANSMITTERS and decrease in BP
 Enhance action of GABA
ANXIOLITIC DRUGS  Teach to rise slowly from supine
 Yes, alcohol and caffeine should be
SEDATIVE HYPNOTIC
avoided
• Mechanism of action – to enhance the effect
ANTIPSYCHOTIC DRUGS
of GABA (Gamma Amino Butyric Acid), an
inhibitory neurotransmitter to decrease • TYPICAL ANTIPSYCHOTIC DRUGS - block
impulses in the synapses of the brain, therefore Dopamine receptors in the limbic system, in the
decreasing conduction of rapid impulses causing reticular activating system and the brain. This
symptoms of anxiety. group of antipsychotic may block all dopamine
receptors including those not associated with
 Barbiturates – drug action is to enhance
psychoses
GABA effect. This is used to be the drug
of choice to manage anxiety but its • ATYPICAL ANTIPSYCHOTIC DRUGS – block
depressant effect may cause severe Dopamine and Serotonin receptors. This group
will lock only the receptors of Dopamine and • Typical Antipsychotic drugs: Older drugs, they
Serotonin which are responsible for occurrence are less potent and associated with more
of psychosis making them more specific drugs adverse effects
for Psychotic disorders DOPAMINE REC
• Examples: Chlorpromazine, Fluphenazine,
Thioridazine, Haloperidol

ANTIPSYCHOTIC DRUGS

Adverse Effects

 Sedation/Sunlight sensitivity
 Tardive dyskinesia, Tachycardia, and
Tremors Anticholinergic,
Agranulocytosis, Addiction
 NMS ( Neuroleptic Malignant Syndrome
) Cardiac symptoms (orthostatic
hypotension), EPS ( Extra pyramidal
syndrome )
 Endocrine (change in libido)

TYPICAL ANTIPSYCHOTIC DRUGS

• Typical Antipsychotic drugs: Older drugs, they

are less potent and associated with more
adverse effects

• Examples: Chlorpromazine, Fluphenazine,

Neuroleptic Malignant Syndrome

 Rigidity
Thioridazine, Haloperidol
 High fever
ATYPICAL ANTIPSYCHOTIC DRUGS  Autonomic instability
 Unstable BP
 Diaphoresis
 Pallor
  Delirium Nursing Considerations
 Elevated enzymes:
• CNS: dizziness, insomnia
 creatinine and phosphokinase
• Antacids decrease
 Mute
• Eat food with drug
 Agitation to stupor
• Support group for epileptics
MNEMONICS • Alert tag indicating specific drug
• Report adverse effects
 F – FEVER
 E – ENCEPHALPATHY ANTI PARKINSONS DRUG
 V – VITALS UNSTABLE
• Dopaminergic drugs – increase the effect of
 E – ELEVATED ENZYME (CPK)
Dopamine at the receptor sites by increasing
 R – RIGIDITY OF MUSCLE
the levels of dopamine in the substantia nigra or
TREATMENT directly stimulating the receptors

- Stop all antipsychotic agents • Levodopa with Carbidopa, Amantadine,

- Supportive medical care Bromocriptine ANTICHOLINERGIC DRUGS

ANTI SEIZURE DRUGS • oppose the effects of acetylcholine at

receptor sites in the substantia nigra. These
• Mechanisms of Action anticholinergic drugs have greater affinity with
• Suppressing sodium influx or the receptors of acetylcholine in the CNS than
deporalarization in the neuron those in the periphery. However, they still block
• Suppressing calcium influx, preventing some receptors at the autonomic nervous
electric current generated by calcium system. Blocking the acetylcholine effect help to
ions normalize the dopamine – acetylcholine
• Increasing the action of the Gamma imbalance in the basal ganglia.
Amino Butyric Acid ( GABA ) an
inhibitory neurotransmitter in the brain • Diphenhydramine ( Benadryl ), Benztropine
( Cogentin ), Biperiden ( Akineton )
Trihexyphenidyl ( Artane ) ANTI PARKINSON’S
DRUGS

Dopaminergics

Levodopa
Nursing Considerations

• Give the drug with meals

• Monitor bowel function
• Instruct to void before taking the drug
• Inform about relapse
ANTI PARKINSON’S DRUGS

• Anticholinergics
• Benztropine (Cogentin)
• Biperiden (Akineton)
• Trihexyphenidyl (Artane)

Nursing Considerations:

Avoid alcohol, eat sugarless candy, use

sunglasses
SPASMOLYTICS •
Dopamine Agonists
1. CENTRALLY – ACTING MUSCLE RELAXANTS
• Amantadine (Symmetrel)
2. DIRECT ACTING SKELETAL MUSCLE
• Bromocriptine (Parlodel) RELAXANTS CENTRALLY – ACTING MUSCLE
RELAXANTS
• Pergolide (Permax)
DIRECTLY SUPPRESS MOTOR NEURONS IN THE
Nursing Considerations: CNS
Slowly rise from supine to standing position, • BACLOFEN, ORPHENADRINE,
avoid alcohol TIZANIDINE
MUSCLE RELAXANT DIRECT ACTING SKELETAL MUSCLE RELAXANT

• DECREASE THE RELEASE OF CALCIUM

THE SKELETAL MUSCLES
• DANTROLENE, BOTULINUM TOXIN B
SPASMOLYTICS

Centrally-acting Muscle Relaxants

• Baclofen (Lioresal)

Nursing Consideration:

NMJ BLOCKERS • • Monitor respiratory status

1. NON DEPOLARIZING NMJ BLOCKERS NO ALCOHOL SPASMOLYTICS

2. DEPOLARIZING NMJ BLOCKERS
• Direct Acting Skeletal Muscle Relaxants
Dantrolene sodium (Dantrium)

Nursing Consideration:

• STOP if diarrhea becomes severe