PHARMACOLOGY

TERMS AND DEFINITION

Pharmacology
❖ It is the study of drugs, their origin, nature, properties and their effects upon living organism
Pharmacotherapy
❖ It is the use of drugs to prevent, diagnose, or treat signs, symptoms and disease process.
Pharmacodynamics
❖ What the drug does to the body
❖ Involves drug actions on target cells and the resulting alterations in cellular biochemical reactions and functions
Pharmacokinetics
❖ What the body does to the drug
❖ Involves drug movement through the body to reach sites of action, metabolism and excretion.

PROCESS OF DRUG TRANSPORT (ADME)

1. Absorption
❖ Occurs from the time a drug enters the body to the time it enters the bloodstream to be circulated.
Factors Influencing Drug Absorption
Dosage form
Route of administration
Blood flow
GI function
Presence of food or other drugs

2. Distribution
❖ Transport of drug molecules within the body.
3. Metabolism
❖ Also known as Biotransformation
❖ Method by which drugs are inactivated by the body.
4. Excretion
❖ Refers to the elimination of a drug from the body
❖ Kidneys, bowel, lungs and skin
❖ Enterohepatic recirculation
THERAPEUTIC INDEX
Side effects
❖ Physiologic effects not related to desired drug effects
❖ Expected and normal
Adverse reactions
❖ Any undesired responses to drug administration
❖ More severe than side effects
❖ Abnormal and reportable
Toxic effects
❖ Life-threatening effects, emergency
❖ Result from excessive amounts of drug and
may cause reversible/irreversible damage to body tissues

NURSING RESPONSIBILITIES IN MEDICATION ADMINISTRATION

OBSERVE THE TEN RIGHTS OF MEDICATION
Right route Right to refuse
Right time & frequency Right drug-drug interaction
Right of the patient Right education and information
Right drug Right history and assessment
Right dose Right documentation
Be familiar with the medication
❖ The reason it is being administered
❖ Desired effect, side effects and adverse effects
❖ Typical dose and range of safety, if applicable
❖ Specific safety regulations before administration
❖ Check the compatibility of the medication with the other drugs and infusions the patient is receiving.
❖ Do not administer any medication that you did not prepare.
Assess the patient
❖ Food or drug allergies
❖ Past medical history and present condition
❖ Knowledge deficit and health teaching needed
Evaluate Responses
❖ Evaluate patient for his or her response to the medication, and document if appropriate
❖ Report any unfavorable or unexpected response
ALLERGIC RESPONSES
Difficulty of breathing
Rashes /pruritus
Nausea / vomiting
Wheezing
Palpitations

TESTING & CLINICAL TRIALS OF DRUGS

❖ Testing process begins with animal studies. Next step involves Food & Drug Administration (FDA) to review
the data obtained in animal studies.
PHASE I Determine safe dosage, scheduling, and toxicity.
PHASE II Determine effectiveness with specific diseases.
PHASE III Establish if new drug is more effective than the standard drug.
PHASE IV Drug marketed for general use.
Continuous monitoring and further testing of drug

Nursing Considerations in Drug Administration

❖ Generally, the client should not take an antacid with medication or with milk because the antacid will affect the
absorption of the drug.
❖ Enteric-coated and sustained-release tablets should not be opened.
❖ Capsules should not be opened.
❖ Never adjust or change medication dose or abruptly stop taking the medication without physician’s order.
❖ Avoid taking any OTC (over-the-counter drug) or any other herbal reparations unless they are approved.
❖ Avoid smoking and drinking alcoholic beverages while taking specific drug.

❖ Never administer medication if the order is difficult to read or the dose is not within therapeutic range.

Hepatotoxic drugs Acetaminophen Ototoxic drugs Aminoglycosides

Erythromycin Aspirin
Iron overdose Chloroquine
Isoniazid Loop diuretics
Rifampicin Drug that can be Macrodantin
Sulfonamides cause staining Iron
Nephrotoxic drugs Acetaminophen Lugol’s solution
Acyclovir Tetracycline
Aminoglycosides Teratogenic Fluoroquinolones
Amphotericin B Aminoglycosides
Ciprofloxacin Tetracycline
Rifampicin Ace inhibitor
Sulfonamides Lithium
Tetracycline Oral hypoglycemic
Contrast medium Agents
 Disulfiram reaction Metronidazole
Cephalosporins
Oral hypoglycemic Agents

AUTONOMIC NERVOUS SYSTEM (ANS) AGENTS

ORGAN SYMPA PARASYMPA

Eye Mydriasis Miosis
Bronchioles Bronchodilate Bronchoconstrict
Heart Inc. HR Dec HR
Blood vessel Vasoconstriction Vasodilation
GI tract Dec. Peristalsis Inc. Peristalsis
Urinary Bladder Bladder Relaxation Bladder Contraction
Contracts Sphincter to Prevent Urination Relaxes Sphincter to Permit Urination
Sweat glands Inc. Secretion None
Salivary glands Dec. Secretion Inc. Secretion
Adrenal glands Inc. Secretion of Epinephrine & None
Norepinephrine

SYMPATHETIC NERVOUS SYSTEM

❖ Also termed as adrenergic thoracolumbar system
❖ Fight or flight system
❖ Responsible for preparing the body to respond to stress
❖ Epinephrine and norepinephrine are the major neurotransmitters
Adrenergic receptor organ cells
❖ Alpha 1
• Found in the blood vessels, iris and urinary bladder
❖ Alpha 2
• Found on nerve membranes and act as modulator of NE release
❖ Beta 1
• Cardiac tissue
❖ Beta 2
• Bronchi, smooth muscles in the blood vessels, uterine muscles
Drug that mimic the effect of the norepinephrine
❖ Sympathomimetics
❖ Adrenergic agonists
Drug that block the effect of norepinephrine
❖ Sympatholytics
❖ Adrenergic Antagonist

PARASYMPATHETIC NERVOUS SYSTEM

❖ Also termed as cholinergic/ craniosacral system
❖ Acetylcholine is the major neurotransmitter
Drugs that mimic acetylcholine
❖ Parasympathomimetics
❖ Cholinergic agonists
drugs that block acetylcholine
❖ Parasympatholytics
❖ Cholinergic anatagonists

COMPARISON BETWEEN SYMPATHETIC AND PARASYMPATHETIC RESPONSES

SYMPATETIC PARASYMPA RESPONSE

Sympathomimetic Parasympathomimetic Opposite

Sympatholytic Parasympatholytic Opposite

Sympathomimetic Parasympatholytic Similar

Sympatholytic Parasympathomimetic Similar

Adrenergic Drugs
❖ Epinephrine
• Used in emergencies
• Treats Allergic reaction, anaphylaxis, bronchospasm & cardiac arrest
• Potent inotropic drug
❖ Norepinephrine
• Potent vasoconstrictor that increases BP and cardiac output
❖ Albuterol
• Selective for beta-2 adrenergic receptors
• Response: bronchodilation
• Used to treat bronchospasm, asthma: bronchitis
• Should not be given with MAOI (can cause hypertensive crisis)
❖ Isoproterenol
• Acts on B1 & B2 receptors
• Response: bronchodilation
❖ Ephedrine
• Used to treat hypotensive state, bronchospasm
• Relief of hay fever, sinusitis and allergic rhinitis
❖ Clonidine
• Selective Alpha 2 adrenergic drug
• Used to treat hypertension
❖ Dopamine
• Drug of choice for shock
❖ Dobutamine
• Used in treatment of CHF as it increased contractility without changes in rate or increase in O2 demand

Adrenergic Drugs Nursing Responsibilities

❖ Record baseline VS
❖ Assess other drugs' that the client is taking to avoid drug-to-drug interaction
❖ Check urinary output and assess for bladder distention
❖ Phentolamine mesylate = antidote for NE and dopamine overdose

Adrenergic Blockers
❖ Inhibit or block stimulation of the sympathetic nervous system
1. Alpha Adrenergic Blockers
❖ Drugs that block or inhibit a response at the alpha-adrenergic receptor sites

Non-selective Alpha Blockers (Al, A2)

❖ Phentolamine

Selective Alpha Blockers (A1)

❖ Doxazosin
❖ Prazosin

2. Beta-adrenergic Blockers
Non-selective Beta-adrenergic Blockers
❖ Propranolol
❖ Nadolol
❖ Timolol
Caution when giving Non-selective Beta-Adrenergic Blockers:
❖ COPD
❖ Bronchial Asthma
❖ DM
Undesirable effects
❖ Bradycardia
❖ Bronchospasm
❖ Peripheral vascular constriction
❖ Exhaustion
❖ Emotional Depression
❖ Decrease libido
Selective Beta-1 Blockers
❖ Metoprolol
❖ Atenolol
❖ Acebutolol
❖ Betaxolol
❖ Esmolol

Cholinergic Agonists
❖ Drugs that stimulate the parasympathetic nervous system
2 Type of Cholinergic Receptors
❖ Muscarinic Receptors
❖ Stimulate smooth muscles & slows heart rate
❖ Nicotinic Receptors
• Skeletal muscles
Direct -acting Cholinergic Agonist
❖ Bethanechol (Urecholine)
• Used to treat urinary retention and abdominal distention
❖ Metoclopramide (Plasil)
• Used to treat GERD
• Increased gastric emptying time
❖ Pilocarpine
• Constricts the pupil of the eye
• Treatment of glaucoma

SIGNS OF OVERDOSE
• Salivations
• Sweating
• Abdominal cramps
ATROPINE SULFATE = antidote for cholinergic overdose
Indirect - acting Cholinergic Agonists
❖ Reversible Cholinesterase
• Physostigmine
• Neostigmine
• Pyridostigmine
❖ Irreversible Cholinesterase
• Potent agents
• Has long-lasting effect
• PRALIDOXIME = antidote for irreversible acetylcholinesterase-inhibiting drugs
Drug Effects of Cholinergic Agents "SLUDGE"
S - alivation
L - acrimation
U - rinary incontinence
D - iarrhea
G - astrointestinal cramps
E – mesis

Anti-Cholinergic Drugs
❖ Drugs that inhibit the action of acetylcholine by occupying the receptors
Examples
❖ Atropine
• May be used as an antidote for muscarinic agonist poisoning
 ❖ Scopolamine
❖ Propantheline bromide
❖ Dicyclomine
❖ Tropicamide

NEUROLOGIC DRUGS
1. ANTI-CONVULSANTS
❖ Modify bioelectric activity at subcortical and cortical areas
Examples
• Diazepam (Valium)
• Phenytoin (Dilantin)
• Phenobarbital (Luminal)
Indication: Prevents seizures
Adverse Effects
• Blood dyscrasias
• Nausea and vomiting (N/V)
• Dizziness/Drowsiness
• Phenytoin: ataxia, hirsutism, hypotension

Nursing Interventions
• Give medication with food
• Phenytoin
✓ Monitor condition of oral mucosa (S/E: gingival hyperplasia)
✓ Don't mix with other IV fluids
✓ Monitor blood laboratory results
Health Teaching
• Avoid alcohol
• Notify physician of unusual symptoms
• Carry medical alert information
• Take medication on schedule
• Avoid driving and other potentially hazardous machinery
• Phenytoin: good oral hygiene, frequent dental visits

2. ANTI-PARKINSON AGENTS
Dopaminergics
❖ Levodopa
• Most effective drug for symptoms of Parkinson's disease
Fact: dopamine cannot cross blood brain barrier
• 1% of administered dopamine dose reaches the brain
• Must be given in large doses
Carbidopa
• Inhibits the enzyme dopa decarboxylase
❖ Levodopa + Carbidopa
• Levodopa is converted to dopamine by the enzyme dopa decarboxylase.
• This enzyme is present in the peripheral nervous system
• Because of its presence, 99% of the levodopa drug is converted into dopamine before it reaches the brain.
PRECAUTIONS IN ANTI-PARKINSONIAN DRUGS
Anticholinergics Dry mouth
Urinary retention
Constipation Blurred vision Tachycardia Glaucoma
COPD
Levodopa Nausea
Vomiting
Dyskinesia
Orthostatic hypotension
Selegiline Insomnia
Meperidine (drug-to-drug interaction)
3. ACETYLCHOLINESTERASE INHIBITORS
• Prevent breakdown of acetylcholine at nerve endings
• Facilitate transmission of impulses across myoneural junction
• Strengthen muscle contractions including respiratory muscles
Drugs
• Edrophonium chloride (diagnostic purposes)
• Pyridostigmine
• Neostigmine bromide
• Ambenonium
Indication: Treat MYASTHENIA GRAVIS
Adverse Effects:
• N/V
• Diarrhea
• Hypersalivation
• CNS disturbances
• Toxicity: Pulmonary edema, respiratory failure, bronchospasm
Contraindications:
• Intestinal obstruction
• Renal obstruction
• Peritonitis
Nursing Interventions
• Keep Atropine sulfate available for overdosage (cholinergic crisis)
• Monitor V/S during period of dosage adjustment
• Administer medication with some food (S/E: gastric upset)
• Administer medication 30 minutes to 1 hour before meals.
• Health Teaching
✓ Wear medic alert jewelry and ID
✓ Change position cautiously

4. ANTIDEPRESSANTS
❖ Increase norepinephrine levels at subcortical neuroeffector sites
Drugs
❖ Tricyclic Antidepressants (TCA)
• Amitriptyline (Elavil)
• Imipramine (Tofranil)
• Amoxapine (Asendin)
• Nortriptyline (Aventyl)

❖ Selective Serotonin Reuptake Inhibitors (SSRI)

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)

❖ Monoamine Oxidase Inhibitors (MAOI)

• Tranylcypromine (Parnate)
• Isocarboxazid (Marplan)
• Phenelzine sulfate (Nardil)

Use: Treat depression

Adverse Effects
TCA
• Orthostatic hypotension
• Drowsiness
• Dizziness
• Confusion
• CNS stimulation
SSRI
• May interact with tryptophan
• Insomnia
• Headache
• Sexual dysfunction
• Gastric irritation
MAOI
• Potentiate alcohol, barbiturates, and antihistamines
• Hypertensive crisis with ingestion of foods high in tyramine (beer, wine, chocolate)

Nursing Interventions
• Maintain suicide precautions especially as depression lifts.
• Give SSRI in morning, TCAs at bedtime.
• Health Teachings:
✓ Do not take OTC medications without physician's approval
✓ Avoid hazardous activities
✓ Effect of medication may take up to 2 to 4 weeks
✓ SSRIs and MAOls should not be given concurrently or close together
✓ MAOI: Avoid food containing tyramine
o Give Phentolamine in case of hypertensive crisis.

5. ANTI-MANIC AGENTS/ MOOD STABILIZERS

❖ Reduce adrenergic neurotransmitter level in cerebral tissue
Drugs
• Lithium carbonate
• Carbamazepine
• Clonazepam
Use: Control of manic phase of mood disorders; bipolar disorder

Adverse Effects
• Metallic taste
• Hand tremors
• Excess voiding & extreme thirst
• Slurred speech
• Disorientation
• Cogwheel rigidity
• Renal failure
• Respiratory depression

Nursing Interventions
• Monitor blood levels regularly (Normal Lithium: 0.5-1.5 mEq/L).
• Avoid concurrent administration of adrenergic drugs.
• Evaluate client's response to medication.
• Health Teaching:
✓ Effect of medication may take several weeks
✓ High intake of fluids and normal sodium
✓ Toxicity signs: nausea, vomiting, diarrhea, weak muscles, confusion
✓ Take medication with meals.

6. ANTI-PSYCHOTICS/NEUROLEPTICS
❖ Block Dopamine receptors in the CNS and sympathetic nervous system.
Drugs
Typical
• Chlorpromazine (Thorazine)
• Haloperidol (Haldol)
• Thioridazine (Mellaril)
• Fluphenazine (Prolixin)
Atypical (CROQZ)
• Clozapine (Clozaril)
• Risperidone (Risperdal)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Ziprasidone (Geodon)

Use: Treatment of psychotic symptoms in schizophrenia, psychosis, Tourette's syndrome

Adverse effects
• Excessive sedation
• Jaundice
• Orthostatic hypotension
• Urinary retention
• Anorexia
• Dry mouth
• Extrapyramidal side effects (EPS)
o Acute dystonia
o Pseudoparkinsonism
o Akathisia
o Tardive dyskinesia

Nursing Interventions
• Assess client's response to therapy
• Monitor for signs of infection, liver toxicity, extrapyramidal symptoms
• Monitor V/S
• Give medication at bedtime
• Health Teaching
✓ Avoid alcohol use
✓ Avoid driving or other hazardous activities
✓ Avoid exposure to direct sunlight
✓ Good oral hygiene
✓ Report extrapyramidal symptoms or signs of infection

7. HYPNOTICS/SEDATIVES
❖ Depress CNS
Drugs
• Pentobarbital
• Phenobarbital
• SecobarbitaI
Use: INSOMNIA / SEDATION

ADVERSE REACTIONS

ADVERSE REACTIONS
Hypertension
Pulmonary constriction
Cold and clammy skin
BARBITURATE
Cyanosis of lips
TOXICITY
Insomnia
Hallucination
Delirium
Contraindications
• Hypersensitivity
• Pregnancy
Nursing Interventions
• Monitor client's response to medication
• Health Teaching
✓ Take medication exactly as prescribed.
✓ Avoid alcohol.
✓ Avoid driving and other hazardous activities.

8. ANTI-ANXIETY/ANXIOLYTICS
Drugs
Benzodiazepines
• Alprazolam (Xanax)
• Diazepam (Valium)
• Chlordiazepoxide (Librium)
Azapirone
• Buspirone (Buspar)

Uses:
• Anxiety
• Sleep disorders

ADVERSE REACTIONS
Dizziness
Drowsiness
Lethargy
Orthostatic hypertension
Skin rash
Blood Dyscrasias

Contraindications
• Hypersensitivity
• Acute narrow glaucoma
• Liver disease
Nursing Interventions
• Notify health care provider if systolic BP drops 20 mmHg.
• Administer with food or milk.
• Health Teaching
✓ Do not take OTC medication without health care provider's approval.
✓ Use caution when driving or hazardous.
✓ Action potentiated with alcohol or sedatives.
✓ Never abruptly stop the medication.
✓ Librium = Avoid excessive sunlight

9. GENERAL ANESTHETICS
❖ Depress the CNS through a progressive sequence
Drugs
❖ Inhalation Anesthetics
• Cyclopropane
• Enflurane
• Ether
• Nitrous oxide
❖ IV Barbiturates
• Thiopental (Pentothal)
• Methohexital sodium (Brevital)
❖ IV & IM Non-barbiturates
• Midazolam (Versed)
• Ketamine (Ketaject)
• Propofol (Diprivan)
 ADVERSE REACTIONS
Excitement
Inhalation Anesthetics Restlessness
Nausea
Vomiting
Respiratory distress
Respiratory distress
IV barbiturates Hypotension
Tachycardia
Laryngospasm
Respiratory failure
IV & IM Non-barbiturates Hyper/hypotension Rigidity
Psychiatric disturbance

Contraindications
• CVA
• Increased ICP
• Severe hypertension
• Cardiac decompensation

Nursing Interventions
• Have O2 and emergency treatment available
• Monitor V/S
• Use precautions if agent is flammable
• Safety precautions

10. LOCAL ANESTHETICS

❖ Decrease nerve membrane permeability to sodium ion influx
Drugs
❖ Topical
• Benzocaine (Orajel)
• Cocaine
• Lidocaine (Xylocaine)

❖ Spinal
• Dibucaine (Nupercaine)
• Procaine (Novocaine)

❖ Nerve block
• Bupivacaine (Marcaine)
• Mepivacaine (Carbocaine)

Use: PAIN CONTROL while the client is conscious

Adverse Effects
• Allergic reactions
• Respiratory arrest
• Arrhythmias / Cardiac arrest
• Convulsion
• Hypotension
Nursing Interventions
• Have oxygen and emergency equipment available
• Monitor V/S during local anesthesia
• SPINAL ANESTHESIA: keep the client flat for 6-12 hours to prevent spinal headache.
MUSCULOSKELETAL DRUGS
1. SKELETAL MUSCLE RELAXANTS
Uses
• Relax muscles
• Treat spasm disorders
Drugs
❖ Central
• Cyclobenzaprine (Flexeril)
• Diazepam (Valium)
• Orphenadrine (Norflex)
❖ Peripheral
• Gallamine triethiodide (Flaxedil)
• Succinylcholine (Anectine)

CENTRAL PERIPHERAL
Use Relief of muscle spam and pain Facilitation of endotracheal intubation;
orthopedic manipulation
Action Depress CNS, leading to relaxation of Block nerve impulses at the myoneuraI
voluntary muscles junction
Adverse effects Tachycardia Dizziness Drowsiness Hypotension
Dry mouth Angioedema Respiratory depression
Dysrhythmias
Nursing Monitor client for safety precautions Have resuscitation equipment available
Interventions Teach client to avoid alcohol and hazardous Monitor VS
activities Withhold medication and call care provider if
Administer with meals client shows signs of allergic reaction.
Fluids for dry mouth
Do not discontinue abruptly

2. NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs)

❖ Interfere with prostaglandin synthesis
Drugs
COX-1 Inhibitors
❖ Ibuprofen (Motrin)
❖ Indomethacin (Indocin)
❖ Salicylates (Aspirin)
COX-2 Inhibitors
❖ Celecoxib (Celebrex)
❖ Valdecoxib (Bextra)
Uses
❖ Rheumatoid arthritis
❖ Osteoarthritis
❖ Dysmenorrhea
Adverse Effects
COX-1 Inhibitors:
❖ Gastric disturbances
❖ Skin rash
❖ Blood dyscrasias/bleeding
❖ CNS disturbances
❖ Nephrotoxicity
COX-2 Inhibitors:
❖ CNS disturbances
❖ Nephrotoxicity
❖ Myocardial infarction
❖ Stroke
Contraindications
❖ Hypersensitivity
❖ Asthma
 ❖ Renal disease
❖ Liver disease
Nursing Interventions
❖ Administer one hour before or two hours after meals.
❖ Monitor VS.
❖ Monitor response to medication.

3. ANTI-GOUT AGENTS
❖ Increase excretion of uric acid and decrease uric acid formation
Drugs
• Allopurinol (Zyloprim)
• Colchicine (Novocolchine)
• Probenecid (Benemid)
Use: Prevents GOUT ATTACKS
Adverse Effects
• N/V
• Indigestion
• Blood dyscrasias
• Liver damage
• Skin rash
• GI disturbances
Nursing Interventions
• Increase OH to prevent renal calculi
• Monitor I & O
• Administer with meals
• Monitor blood work, including serum uric levels, and electrolyte levels
• Health Teaching
✓ Lose weight if needed.
✓ Avoid high purine foods (organ meats, sardines, shellfish, etc.).
✓ Avoid fermented beverages such as beer, ale, wine.

GASTROINTESTINAL DRUGS
1. ANTI-EMETICS
❖ Prevent expulsion of stomach contents by decreasing stimulation of either the chemoreceptor trigger zone, near
the medulla, or the vomiting center in the medulla
DRUGS
Antihistamines Dramamine
Phenergan
Anticholinergic Scopolamine
Phenothiazines Thorazine
Serotonin receptor antagonist Granisetron Ondansetron

Use: Prevent NAUSEA & VOMITING

Adverse Reactions
• Tachycardia
• Hypotension
• Dry mouth and eyes
• Blurred vision
• Constipation
• Sedation
• Drowsiness
Contraindications
• Narrow-angle Glaucoma
• Liver disease
• Intestinal obstruction
• Depression
Nursing Interventions
• Use non-pharmacologic measures first
✓ Dry toast
✓ Tea
✓ Crackers
✓ Monitor VS
• Monitor for signs and symptoms of vomiting is severe.
• Monitor bowel sounds.
• Provide mouth care after vomiting.
• Health Teaching
✓ Store drug in tight, light-resistant container.
✓ Avoid OTC drugs.
✓ Avoid alcohol.
✓ Avoid during 1st trimester of pregnancy.

2. ANTACIDS
❖ Neutralize gastric acid
Drugs
• Aluminum hydroxide (AlOH) gel (Amphogel)
• Magnesium hydroxine (MgOH) (Milk of Magnesia
• AlOH + MgOH (Maalox/Magaldrate)

Uses: Peptic ulcers, reflux esophagitis, hiatal hernia

Adverse Reactions
• Aluminum compounds = constipation, intestinal obstruction
• Magnesium compounds = diarrhea
• Reduced absorption of Ca & Fe Nursing Interventions

Nursing Interventions
• Shake oral suspension well
• Monitor client's response to treatment
• Administer with 8 oz glass of water
• Health Teaching
✓ Avoid overuse of antacid
✓ Dietary restrictions for ulcers
✓ Diet: High in Ca & Fe
✓ For clients on low sodium diet

3. ANTI-PEPTIC ULCER DISEASE (PUD)

❖ Decrease acetylcholine release
❖ Block release of histamines
❖ Inhibit secretion of pepsin
❖ Inhibit proton pump
Drugs
❖ Proton-pump Inhibitor (PPI)
• Omeprazole (Prilosec)
• Lansoprazole (Prevacid)
❖ H2-receptor Blockers
• Cimetidine (Tagamet)
• Ranitidine (Zantac)
• Famotidine (Pepcid)
❖ Cytoprotective agent
• Sucralfate (Carafate)
• Misoprostol (Cytotec)
❖ Anti-cholinergics
• Chlordiazepoxide (Librax)
• Atropine sulfate
Uses: Management of peptic ulcer disease, GERD; protects gastric mucosa from hydrochloric acid production

Adverse Reactions
• Dry mouth
• Decreased secretions
• Constipation
• Tachycardia
• Urinary retention
• Headache
• Dizziness
• Constipation
• Pruritus
• Impotence
Contraindications
• Anti-cholinergics (narrow-angle glaucoma)
• Renal failure
• Liver disease
Nursing Interventions
• Administer on an empty stomach
• Avoid antacids within 30 minutes of sucralfate
• Avoid antacids within one to two hours of other anti-ulcer drugs
• Administer other drugs one to two hours after sucralfate
• Health Teaching
✓ Avoid alcohol, spicy food and caffeinated beverages.
✓ Eliminate smoking.
✓ Increase fluid intake.
✓ Medication can take up to two weeks for full effect.

4. ANTI-DIARRHEAL
❖ Forms the stool
Use: Treatment of diarrhea
Drugs
❖ Fluid absorbents (Decrease fluid content)
• Kaolin and Pectin
❖ Motility Suppressants (Decrease GI motility)
• Diphenoxylate hydrochloride (Lomotil)
• Loperamide hydrochloride (Imodium)
❖ Enteric bacterium replacements
• Lactobacillus acidophilus (Bacid)

ADVERSE REACTIONS

Fluid absorbents Gastric disturbances CNS toxicity

Enteric bacterium Excessive flatulence abdominal cramps

replacements
Motility Urinary retention
suppressants Tachycardia Sedations
Paralytic ileus
Respiratory depression
Contraindications
• Ulcerative colitis
Nursing Interventions
• Monitor the effect of medication
• Assess for fluid and electrolyte imbalance
• Assess for cause of diarrhea
• Motility suppressants may cause physical dependence, may impair ability to perform hazardous activities

5. LAXATIVES
❖ Agents which facilitate defecation, and treat constipation
❖ Increase bulk within the bowel
❖ Lubricate the intestinal walls
❖ Increase peristalsis
Drugs
• Mineral oil
• Colace
• Metamucil
• Dulcolax
• Milk of magnesia
Use: To treat CONSTIPATION

Adverse Reactions
• Nausea
• Cramping
• Diarrhea
• Dependence with long-term use
• Intestinal lubricants inhibit absorption of fat-soluble vitamins
• Saline cathartics: dehydration, hypernatremia

Contraindications
• GI obstruction
• Suspected appendicitis
• Abdominal pain
•
Nursing Interventions
• Monitor effects of medication
• Health Teaching
✓ Dietary considerations (Inc. fiber and fluid intake)
✓ Maintain/increase activity level
✓ Caution regarding overuse of laxatives

CARDIO DRUGS
1. CARDIAC GLYCOSIDES
❖ Make heart beat slower but stronger
❖ Improve pumping ability of heart
❖ Increase force of heart's contraction
❖ Decrease rate of contraction
❖ Increases cardiac output
Drugs
• Digoxin (Lanoxin)
• Digitoxin (Crystodigin)
✓ (+) inotropic (Increased heart contractility)
✓ (-) chronotropic (Decreased heart rate)
Uses
• Congestive Heart Failure
• Atrial flutter
 • Atrial fibrillation

Contraindications
• Ventricular tachycardia
• Ventricular fibrillation
• Second and third degree heart block
Adverse Effects
• Vision changes: yellow-green halos
• N/V
• Diarrhea
• Anorexia
• Bradycardia
• Xanthopsia
• Muscle weakness
• Dysrhythmia
Nursing Interventions
• Before giving glycosides, check apical pulse and heart rhythm. Report if <60 bpm (adult); <90 bpm (infants)
• Monitor digoxin levels for possible toxicity
(therapeutic range = 0.5 to 2.0 mg/mL)
• Antidote: DIGOXIN IMMUNE FAB (Digibind)
• Monitor intake and output
• Health teaching
✓ Take medications as prescribed
✓ Teach client how to take and record pulse daily
✓ Identify and report signs of toxicity
✓ Daily weights: Report two-pound increase

2. ANTI-HYPERTENSIVES
❖ Dilate peripheral blood vessels
❖ Prevent hypertension
Drugs
❖ Angiotensin-converting Enzyme Inhibitors (ACE-I)
• Captopril
• Enalapril
❖ Angiotensin II Receptor Blockers (ARBs)
• Losartan
• Telmisartan
• Irbesartan
❖ Calcium Channel Blockers (CCB)
• Verapamil
• Diltiazem
• Nifedipine
• Nicardipine
❖ Other Drugs
• Hydralazine hydrochloride (Apresoline)
• Reserpine (Serpasil)
• Prazosin hydrochloride (Minipress)
• Methyldopa (Aldomet)
• Clonidine (Catapres)

Use: Treat hypertension

Adverse Reactions
• Orthostatic hypotension
• Dizziness
• bradycardia/Tachycardia
• Sexual dysfunction
• Deterioration in renal function
Nursing Interventions
• Monitor VS and blood pressure (sitting and standing)
• Monitor for hearing changes
• Monitor renal functioning
• Closely monitor client if hypotensive
• Encourage intake of foods high in Vitamin B
• Health Teaching
✓ Low sodium diet
✓ Change positions slowly
✓ Take medication as instructed
✓ Avoid hazardous activities
✓ Protect medication from heat and light

3. THROMBOLYTICS
❖ Binds with plasminogen to dissolve thrombi (clots) in coronary arteries
❖ Activates conversion of plasminogen to plasmin
❖ Plasmin is able to break down clots (fibrin)
Drugs
• Streptokinase (Streptase)
• Urokinase (Abbokinase)
Use
• Myocardial Infarction
• Deep vein thrombosis
• Pulmonary emboli
Contraindications
• Active bleeding
• Cerebral embolism/hemorrhage
• Recent intra-arterial diagnostic procedure or surgery
• Recent major surgery
• Severe hypertension
Adverse effects
• Urticaria
• Itching
• Flushing
• Headache
Nursing Interventions
• Monitor for bleeding times
• Monitor coagulation studies
• Monitor for allergic reactions
• Antidote: Aminocaproic acid (Fibrinolysis Inhibitors)

4. ANTI-LIPEMIC
❖ Lower LDL levels by reducing the synthesis of cholesterol and/or triglycerides
Uses
• Primary hypercholesterolemia
Drugs
HMG-CoA Reductase Inhibitors
• Atorvastatin (Lipitor)
• Simvastatin (Afordel)
Bile Acid Sequestrants
• Colestipol (Colestid)
• Cholestyramine (Questran)

Contraindications
• Hypersensitivity
• Pregnancy/Lactation
 • Active Liver Disease

Adverse Reactions
• Skin flushing
• Gastric upset
• Reduced absorption of fat-soluble vitamins
• Disruption of liver function
• Muscle tenderness or weakness
Nursing Interventions
• Monitor cholesterol levels
• Monitor liver function test
• Health Teaching
✓ Blood work and eye exams will be necessary during treatment
✓ Report: blurred vision, severe GI symptoms, or headache, muscle tenderness or weakness
✓ Diet: low cholesterol; high-fiber

5. ANTI-ANGINALS

Nitrates
❖ Dilate arterioles which lowers peripheral vascular resistance (afterload)
Drugs
• Nitroglycerin
• Isosorbide dinitrate (Isordil)
• Isosorbide mononitrate
Types
❖ Sublingual Medications
• Offer sips of water before giving. Dryness may inhibit absorption
• Instruct to put under the tongue and leave until fully dissolved
❖ Translingual Medications (tongue spray)
• Instruct the client to spray directly against the oral mucosa.
• Avoid inhaling the spray.
❖ Transmucosal-Buccal Medications
• Instruct the client to put between the upper lip and gum or in the buccal area between the cheek and
gum.
• Medication will adhere to the mucosa and slowly dissolve
❖ Transdermal Patch
• Instruct the client to apply the patch over a hairless area, using a new patch and a different site each day.
• Instruct the client to remove the patch after 12-14 hours, allowing 10-12 "patch-free" hours to avoid
tolerance
❖ Topical Ointments
• Instruct the client to remove the ointment on the skin from the previous dose
• Avoid hairy areas. Cover with plastic wrap. Rotate sites.
•
Use: Treatment and prevention of acute chest pain caused by Myocardial Ischemia

Adverse Effects
• Postural hypotension
• Headache
• Flushing
• Dizziness
Contraindications
• Hypersensitivity
• Severe anemia
• Hypotension
• Hypovolemia
Nursing Interventions
• Monitor for orthostatic hypotension
• Monitor for tolerance with long — term use
 • Administer every 5 minutes but not more than three tablets

• If pain is not relieved after 15 minutes and

• three tablets, notify physician immediately
• Instruct client:
✓ Take pulse before taking medication
✓ Take oral preparations without food
✓ When to seek medical attention
✓ Not to chew or swallow sublingual tablets
✓ Make position changes slowly
✓ Carry drug so that it is always within reach but avoid exposure to body heat and light
✓ Replace drug approximately every six months
✓ Avoid alcohol ingestion

Beta-adrenergic blocking agents

❖ Inhibit sympathetic stimulation of beta-receptors in the heart

❖ Decrease heart rate and force of myocardial contraction thus decreasing myocardial oxygen consumption
Use
• Reduces frequency and severity of acute anginal attacks, dysrhythmias
Drugs
• Propranolol (Inderal)
• Metoprolol (Lopressor)
• Nadolol
• Timolol
• Acebutolol
• Betaxolol
• Esmolol
• Pindolol
• Penbutolol

Adverse Effects
• Blood dyscrasias
• Hypotension
• GI disturbances
• Flushing of the skin
Contraindications
• Hypersensitivity
• Cardiogenic shock
• Cardiac failure
Nursing Interventions
• Weigh daily. Report weight gain of 5 lbs. or greater
• Monitor ECG if using for dysrhythmia
• Administer on an empty stomach
• Protect injectable solution from light
• Instruct client
✓ Take pulse before taking the drug
✓ Not to discontinue the drug abrupt
✓ Avoid hazardous activities if drowsiness occurs
✓ Make position changes slowly
✓ Take drug at same time each day

Calcium-Channel Blockers
❖ Prevent the movement of extracellular calcium into the cell resulting in coronary and peripheral artery dilation
❖ Decrease cardiac contractility
Uses
• Stable angina
• Dysrhythmias
 • Hypertension

Drugs
• Verapamil
• Nifedipine
• Diltiazem
• Nicardipine
• Felodipine
Adverse Effects
• Headache
• Drowsiness
• Dizziness
• GI disturbances
• Flushing of the skin
Contraindication
• Hypersensitivity
Nursing Interventions
• Monitor chest pain
• Monitor ECG if used for dysrhythmias
• Administer with food
• Instruct the client:
✓ Increase fluids to counteract constipation
✓ Take pulse before taking drug
✓ Avoid hazardous activities until stabilized on drug
✓ Limit caffeine consumption
✓ Avoid alcohol
✓ Change position slowly

6. MEDICATIONS FOR HYPOTENSION & SHOCK

❖ Adrenergic agonists
❖ Mimics the action of the sympathetic nervous system
❖ Increases the cardiac output, (+) inotrope, (+) chronotrope
o Inotrope: Increases cardiac contractility
o Chronotrope: Increases heart rate
o Dromotrope: Increases AV conduction

Drugs and Uses

• Dopamine & Dobutamine: hypovolemic and cardiogenic shock
• Epinephrine: anaphylactic shock

Adverse Effects
• Dysrhythmias
• Tissue necrosis (extravasation)
• Tremors
• Anxiety
• Dizziness (epinephrine)
Contraindications
• Hypersensitivity
• Ventricular fibrillation
• Tachydysrhythmias
Nursing Interventions
• Correct hypokalemia before administering
• Monitor vital signs frequently
• Monitor ECG continuously during administration
• Administer with infusion pump
• Start drug slowly and increase according to health care provider's orders
• Monitor injection site for extravasation
• Protect solution from light
 • Do not use discolored solution

• Stop the drug gradually

7. ANTICOAGULANTS
❖ Disrupt the blood coagulation process,
Thereby suppressing the production of fibrin
Drugs
• Heparin
• Warfarin
Uses
• Pulmonary embolism
• Deep vein thrombosis
• Myocardial infarction
• Atrial fibrillation

Adverse Effects
• Allergic responses (chills, fever, urticarial)
• Use cautiously if client tends to bleed (hemophilia, peptic ulcer)
• N/V
• Diarrhea
• Abdominal cramps
Contraindications
• Hemophilia
• Leukemia
• Peptic ulcer
• Blood dyscrasias
Nursing Interventions
• Heparin: Monitor aPTT (activated partial thromboplastin time)
✓ Therapeutic levels: aPTT increase by a factor of 1.5 to 2.5 (25 to 38 seconds)
• Parenteral (SQ) Coumadin: Monitor PT (Prothrombin time)
✓ INR: 2.0 to 3.0
✓ Oral
• Do baseline blood studies before therapy
• Have antidote ready:
✓ Heparin: Protamine sulfate
✓ Coumadin: Vitamin K
• Monitor client for symptoms of hemorrhage (INC. PR, Dec, BP)
• Avoid salicylates (Aspirin)
• Avoid IM injections
• Teach client
✓ Take medication at same time every day
✓ Wear medical alert jewel
✓ Use of soft toothbrush
✓ Report and signs of bleeding, red of black bowel movement, headaches, rashes, red or pink-tinged urine,
sputum
✓ Avoid trauma
8. ANTI-DYSRHYTMICS
❖ Prevent abnormal heart rhythms
DRUGS

Quinidine
Class I (Sodium Channel Procainamide
Blockers) Lidocaine
Flecainide

Acebutolol
Class II (Beta Blockers) Propranolol
Esmolol

Class III (Conduction Bretylium

Delayers) Amiodarone

Verapamil
Class IV (Calcium – channel
Diltiazem
Blockers)
Nifedipine

Use: Treat abnormalities in cardiac rate and rhythm

Adverse Effects
• Hypotension
• N/V
• Blood dyscrasias
• Diarrhea

Nursing Interventions
• Monitor Cardiac Rhythm
• Monitor blood levels
• Monitor for blood dyscrasias
• Administer oral preparation with meals
• Monitor ECG
• Use infusion-control devices for IV administration
• Health teaching
✓ Report changes in heart rate and/or rhythm
✓ Report any side effects
RESPIRATORY DRUGS

1. BRONCHODILATORS
❖ Dilates air passages in the lungs, specific action dependent on type of drug
DRUGS
Albuterol/Salbutamol
Beta-adrenergic Terbutaline
Epinephrine
Aminophylline
Xanthine derivative
Theophylline
Ipratropium Bromide
Uses
• Bronchospasms
• Asthma

Adverse Effects
• Dizziness
• Tremors
• Anxiety
• Palpitations
• GI disturbances
• Headaches
• Tachycardia
• Dysrhythmia

Contraindications
Anticholinergic
• Hypersensitivity
• Narrow angle glaucoma
• Severe cardiac disease

Nursing Intervention
• Monitor theophylline levels
(N: 10 to 20 mcg/dL)
• Monitor I & O and VS
• Health Teaching
✓ Take medication as
prescribed only
✓ Report adverse effects
✓ Stop smoking during
therapy
✓ Take with meals
✓ Avoid OTC drugs

2. MUCOLYTICS / EXPECTORANTS

Mucolytics: act by dissolving chemical bonds within the mucus, causing it to separate and liquefy, thereby reducing
viscosity
Expectorants: stimulate a gastric mucosal production of lung mucous
 DRUGS

Acetylcysteine
Mucolytics
(Mucomyst)

Guaifenesin
Expectorants
(Robitussin)

Uses
• Asthma
• Acute / Chronic broncho – pulmonary disease
• Cystic fibrosis
• N-acetylcysteine: Acetaminophen toxicity

Adverse Reactions
• Oropharyngeal Irritation
• Bronchospasm
• Gastric effects
• N/V

Contraindications
• Increased intracranial pressure
• Status asthmaticus

Nursing interventions
• Monitor respiratory status
• Health Teaching
✓ Take no fluids directly after oral administration
✓ Increase oral fluid intake
✓ Encourage coughing and deep breathing, especially before treatment

3. ANTI-TUSSIVES
❖ Acts on the cough control center in the medulla to suppress the cough reflex
DRUGS

Codeine
Narcotic Hydrocodone bitartrate

Non-Narcotic Dextromethorphan

Uses
• Colds
• Respiratory congestion
• Pneumonia
• Bronchitis
• Cystic Fibrosis

• Emphysema
• Cancer-induced cough

Adverse Effects
• Drowsiness
• Nausea
• Dry mouth
• Dizziness
• Constipation (codeine)

Contraindications
• Hypothyroidism
• Iodine sensitivity

Nursing Intervention
• Monitor blood counts with long term therapy
• Increase fluid intake humidify client’s room
• Avoid driving and other hazardous activity especially if taking narcotic type
• Antitussives add to the effects of alcohol

4. ANTIHISTAMINES
❖ Blocks histamine at receptor sites

Drugs
• Promethazine HCl (Phenergan)
• Chlorpheniramine maleate
• Diphenhydramine
• Loratadine
• Cetirizine

Uses
• Relieves symptoms of allergies, colds, pruritus
• Prevents problems in blood transfusions and drug reactions

Adverse Reactions
• Drowsiness
• Gastric effects
• Dry Mouth
• Headache
• Thickening of bronchial secretion

Contraindications
• Acute Asthma
• Lower respiratory
• Narrow angle glaucoma

Nursing Intervention
• Discontinue four days before skin testing for allergies
• Avoid interaction with CNS depressants
• Health Teaching
• Avoid driving and hazardous activities
 • Take antihistamines with food

• Additive effects with alcohol

• Additive effect with alcohol and other CNS depressants

5. ANTI-INFLAMMATORY DRUGS
❖ Stabilize mast cells so chemical mediators are not released easily
❖ Decrease bronchial hyperactivity
❖ Decrease airway inflammation

DRUGS
Mast Cell Stabilizer Cromolyn Sodium

Beclomethasone
Budesonide
Corticosteroids Mometasone
Fluticasone
Triamcinolone

Leukotriene
Montelukast
Receptor
Zafirlukast
Antagonist

Immunomodulators Omalizumab

Use: Prevent asthma attacks; exercise-induced bronchospasm

Adverse Effects
• Cough
• CNS Disturbances
• Burning, stinging eyes
• Throat irritation
• Headache

Contraindicators
• Status asthmaticus
• Hypersensitivity

Nursing Intervention
• Give bronchodilators first before steroids
• Monitor eosinophil count
• Monitor respiratory status
• Store in highly closed light-resistant container
• Health Teaching
✓ How to use inhaler
✓ Rinse mouth after using steroid inhaler
✓ When to call health care provider if medications are not effective
✓ Therapeutic effect may take up to four weeks
ENDOCRINE DRUGS

1. ANTI-DIABETIC AGENTS
❖ Provide insulin to promote transport of glucose
Drugs
❖ First-generation Sulfonylureas
• Acetohexamide
• Chlorpropamide
• Tolazamide
• Tolbutamide
❖ Second-generation Sulfonylureas
• Glipizide
• Glyburide
• Glimepiride
❖ Biguanide
• Metformin
❖ Alpha Glucosidase inhibitors
• Acarbose
❖ Thiazolidinediones
• Pioglitazone
• Rosiglitazone
❖ Meglitinides
• Repaglinide
• Nateglinide

Adverse Effects
• Hypoglycemia
• Irritability
• Confusion
• Convulsions
• Tachycardia
• Tremors
• Moist skin
• Headache
• Nausea
• Bloating
• Diarrhea

Contraindications
• Adrenal insufficiency
• Myocardial infarction
• Thyrotoxicosis

Nursing Intervention
• Monitor client’s response to medication
• Health Teaching
✓ Usually life-long therapy
✓ Take medication same time each day
✓ Monitor pulse rate; report pulse rate over 100
✓ Report signs of toxicity (chest pain, palpitations, nervousness)
 ✓ Wear medic alert jewelry/ID

✓ Avoid OTC medication unless approved by health care provider

✓ Continue medical supervision

3. ANTI-HYPERTHYROID AGENTS
❖ Blocks synthesis of thyroid hormone
Drugs
• Iodine (Lugol’s Solution)
• Methimazole (Tapazole)
• Propylthiouracil (PTU)

Adverse Effects
• Agranulocytosis
• Skin Disturbance
• Decreased metabolism
• Gastric disturbance
• Iodine: stains teeth, bitter taste

Contraindicators
• Hypersensitivity

Nursing Interventions
• Administer iodine preparations through straw
• Monitor effects of medication
• Instruct the client
✓ Report side effects
✓ Avoid OTC drugs containing iodine
✓ Carry medic alert jewelry

4. ANTERIOR PITUITARY: GROWTH HORMONE

❖ Stimulates the growth of practically all organs and tissues
Drugs
• Somatrem (Protropin)
• Somatropin (Humatrope)
• Sandostatin (Octreotide)

Use: Treat Dwarfism

Adverse Effects
• Hyperglycemia
• Hypothyroidism
• Interaction with glucocorticoids

Contraindicators
• Hypersensitivity to benzyl alcohol
• Closed epiphyses
• Intracranial lesions

Nursing Interventions
• Monitor diabetic client closely
• Instruct client
✓ Record height measurements at regular intervals
 ✓ Report to physician if growth is less than expected

5. ANTI-DIURETIC HORMONE (ADH)

❖ Helps distal renal tubules reabsorb water

Drugs
• Lypressin (Diapad)
• Vasopressin (Pitressin)

Use: Treatment of Diabetes Insipidus

Adverse Effects
• Gastric disturbances
• Hyponatremia
• Water intoxication
• Cardiac disturbances

Nursing Interventions
• Monitor response to therapy: I&O, blood pressure
• Assess for dehydration

GENITOURINARY DRUGS

1. DIURETICS
❖ Interfere with sodium reabsorption

DRUGS

Hydrochlorothiazide
THIAZIDES
Chlorothiazide

Bumetanide (Bumex)
LOOP
Furosemide (Lasix)

Mannitol
OSMOTIC
Urea

CARBONIC
Acetazolamide
ANHYDRASE

POTASSIUM Spironolactone
SPARING Triamterene

Uses: Hypertension, edema

Adverse Reaction
• GI irritation
• Orthostatic hypotension
• Dehydration
• Electrolyte imbalance: hyponatremia, hypokalemia (except for potassium-sparing)
Contraindicators
• Electrolyte imbalances
• Dehydration

Nursing Interventions
• Monitor weight, intake and output, vital signs
• Give medication in morning
• Monitor client for fluid and electrolyte imbalance
• Health Teaching
✓ Change positions slowly
✓ Report changes in hearing
✓ Diabetic clients: closely monitor glucose levels

2. SULFONAMIDES

Drugs
• Succinylsulfathiazole (Sulfasuxidine)
• Sulfisoxazole (Gantrisin)
• Trimethoprim-Sulfamethoxazole (Bactrim)

Use: Urinary tract Infection

Adverse Effects
• Gastric Irritation
• Rash
• Malaise
• Blood dyscrasias
• Crystalluria
• Photosensitivity
• Allergic response

Contraindications
• Hypersensitivity
• Infants <2 months old
• Pregnancy at term

Nursing Interventions
• Check if the client has history of allergies
• Monitor client’s response to treatment
• Monitor vital signs and blood work
• Health Teaching
✓ Increase OFI
✓ Take medication as prescribed
✓ Avoid OTC medication unless approved by health care provider
✓ Avoid direct sunlight

3. IMMUNOSUPPRESSANTS

Drugs
• Cyclosporine (Sandimmune)
Uses
• Prevent organ rejection in transplant patient
• Treat autoimmune disorders

Adverse Effects
• Nephrotoxicity
• Infection
• Hypertension
• Tremor
• Hirsutism

Contraindications
• Hypersensitivity

Nursing intervention
• Monitor BUN and creatinine (liver function test)
• Health Teaching
✓ Report early signs of infection (fever, sore throat)
✓ Medication may be taken with meals
✓ Hirsutism is reversible when the treatment stops

4. ANTI-INFECTIVE
❖ Interferes with several bacterial enzyme system

Drugs
• Nitrofurantoin (Furadantin)
• Methenamine (Hiprex)

Uses
• Pyelonephritis
• Pyelitis
• Cystitis

Adverse Effects
• Anorexia
• N/V
• Methenamine (crystalluria, bladder irritation)
• Nitrofurantoin (exfoliative dermatitis, interstitial nephritis, necrosis)

Contraindications
• Hypersensitivity
• Anuria
• Severe renal disease

Nursing Interventions
• Monitors intake and output
• Health teaching
✓ Take medication as prescribed
✓ Increase OFI
✓ Take medication with food or milk
✓ Nitrofurantoin
 ➢ Do not crush pill because it stains teeth: dilute oral suspension and rise mouth after taking

➢ Report muscle weakness, tingling or numbness

➢ Urine may look brown or rust yellow
➢ Avoid alcohol
OTHER DRUGS

Antibiotics
Action
• Destroy or inhibit bacteria

Drugs
❖ Penicillin
• Ampicillin
• Penicillin G
• Penicillin V
❖ Cephalosporins
• First Generation
✓ Cephalexin
✓ Cefadroxil
✓ Cefradine
✓ Cephazolin
✓ Cephalothin
✓ Cephapirin
• Second Generation
✓ Cefaclor
✓ Cefprozil
✓ Cefuroxime
✓ Cefamandole
✓ Cefotetan
✓ Cefoxitin
✓ Cefmetazole
• Third Generation
✓ Cefdinir
✓ Cefixime
✓ Cefpodoxime
✓ Cefotaxime
✓ Ceftazidime
✓ Ceftriaxone
✓ Cefoperazone
• Fourth Generation
✓ Cefepime
❖ Macrolides
• Erythromycin
• Clarithromycin
• Azithromycin
❖ Tetracycline
• Oxytetracyline
• Doxycycline
• Minocycline
• Aminoglycosides
 • Amikacin

• Gentamicin
• Netilmicin
• Streptomycin
• Tobramycin
• Kanamycin
• Neomycin

Use: Treat bacterial infection

Adverse Effects
• Gastric disturbance: N/V, poor appetite, diarrhea
• Allergic reactions
• Loss of water-soluble vitamins and minerals
• Tetracyclines: Hepatotoxicity, phototoxicity, hyperuricemia, tooth enamel hypoplasia, and bone defects in children
under eight years of age
• Fluroquinolones: Photosensitivity
• Aminoglycosides: Ototoxicity, leukopenia, thrombocytopenia, headache, confusion, peripheral neuropathy, optic
neuritis, nephrotoxicity

Contraindications
• Hypersensitivity
• Pregnancy
✓ Tetracyclines
✓ Fluoroquinolones
✓ Aminoglycosides
• Fluoroquinolones: children < 18 years of age

Nursing Interventions
• Monitor client for allergies
• Monitor client’s response to treatment
• Teach client
• Take all prescribed medication
• Symptoms of allergic response
• If taking a liquid (suspension), shake it first
• Take medication before meals
• Tetracyclines
✓ Not for young children or in last half of pregnancy
✓ Possible oral anticoagulant effects
• Fluoroquinolones: Avoid hazardous activities; avoid sunlight
• Aminoglycosides: may potentiate neuromuscular blocking agents, general anesthesia or magnesium effects

ANTIVIRALS

Action
• Interfere with DNA synthesis needed for viral replication
Drugs
• Acyclovir sodium
• Valacyclovir
• Amantadine
• Rimantadine
 • Oseltamivir

• Foscarnet
• Vidarabine
• Ribavirin
Use:
• Viral infections
Adverse Effects
• Orthostatic hypotension
• Dizziness
• GI disturbance
• Nephrotoxicity
• Blood dyscrasias
Contraindication
• Hypersensitivity
• Immunosuppression
Nursing Intervention
• Monitor vital signs during antiviral therapy
• Monitor effect of therapy
• Increase fluid intake
• Monitor for signs of superinfection: sore throat, fever, fatigue

ANTIFUNGALS

Action
• Destroy fungal cells or inhibits their reproduction

Drugs
• Amphotericin B
• Nystatin
• Fluconazole
• Ketoconazole
• Miconazole
• Voriconazole
• Posaconazole
• Griseofulvin

Use
• Treat local and systemic fungal infections

Adverse Effects
• Gastric irritability: Nausea & Vomiting
• Headache
• Fever & Chills
• Paresthesia
• Renal Impairment

Contraindications
• Hypersensitivity
• Severe bone marrow depression

Nursing Intervention
• Monitor vital signs and I & O during therapy
• Amphotericin B

✓ Protect IV solutions from light

✓ Monitor blood work
✓ Use infusion device for IV administration
• Griseofulvin
✓ Instruct the client to avoid sunlight

ANTIPARASITICS

❖ Interfere with parasite metabolism and reproduction

Drugs
❖ Anti-helminthic
• Albendazole
• Mebendazole
• Piperazine
❖ Amebicides
• Chloroquine
• Metronidazole (Flagyl)
❖ Antimalarials
• Chloroquine
• Quinine sulfate

Use
• Kill parasites, helminths and protozoa

Adverse Effects
• Anti-helminthic
✓ GI upset
✓ CNS disturbance
✓ Skin rashes
✓ Headache
• Amebicides
✓ GI upset
✓ Blood dyscrasias
✓ Skin rash
✓ CNS disturbances
• Antimalarials
✓ GI upset
✓ Blood dyscrasias
✓ Visual disturbance

Nursing Intervention
• Administer medication with food
• Monitor vital signs, blood work during therapy
• Use safety precautions if CNS disturbances manifested
• Teach client to prevent further infection
• Antimalarials: Frequent visual examinations; urine may turn rust colored
References:
National Council of State Boards of Nursing (NCSBN) Comprehensive Review Class

Smeltzer, Suzanne & Bare Brenda (2010) Brunner and Suddarth’s Textbook of Medical-Surgical Nursing (12th Edition).
Philadelphia: Lippincott Williams & Wilkins.

Huttel, Ray H. Pharmacology Success. F.A Davis Company, 2008.