Mindanao State University

Department of Nursing

Course Module
Subject Code: Nursing 105 Credits: 3 units

Subject: Pharmacology for Nursing Year &Section : 3A

Instructor: Kamala A. Sangkula-Elam,RN,MPA,MAN (C)

University E-mail address: kamala.elam@msusulu.edu.ph

Class schedule: Monday & Tuesday& Wednesday 3:00-400 pm NR 03

PHARMACOLOGY FOR NURSING

PHARMACOLOGY – The science that deals with the origin, nature, chemistry, effects, and
uses of drugs.

Concepts in pharmacology:

1. Pharmacodynamics – Refers to the mechanisms by which drugs produce biochemical and

physiologic changes in the body.

2. Pharmacokinetics – Refers to the movement of drugs across body membranes to reach its
target organ.
- It involves four stages of drug movement: absorption, distribution, metabolism,
and
excretion.

Absorption- Refers to movement of drug from its administration site through or across
tissue into the systemic circulation.

Distribution- Refers to movement of a drug from the systemic circulation into the tissues.

***Blood-brain barrier- refers to limited distribution of drugs into the central

nervous system; only highly lipid-soluble
drugs.

Metabolism- Refers to alteration of a drug from its dosage form to a more water-
soluble form that can be excreted.
- It usually occurs in the liver; may also occur in plasma, kidneys, or intestinal
membranes.

Excretion- Refers to elimination of a drug from the circulation.

- major excretion routes: kidneys via urine
liver via bile, then in feces
lungs via exhaled air
 breastmilk
- minor excretion routes: saliva, tears, sweat

3. Pharmacotherapeutics- Refers to the use of drugs to treat a specific disease or

produce a desired effect.

4. Loading dose- Refers to administration of one or more doses at the onset of therapy to
quickly reach the therapeutic blood level and
hasten a therapeutic effect.

5. Drug efficacy- Refers to a drug’s maximal effectiveness.

- May be measured by the patient’s vital signs, body weight, and easing of
symptoms that the drug is expected to
relieve.

6. Therapeutic drug levels- Refer to drug levels that provide adequate action but minimal
effects.

7. Adverse reactions- Refers to unwanted or potentially harmful

drug effects Types of adverse reactions:

1. Dose-related reactions- reactions to the drug’s primary effect (such as

bleeding from anticoagulants) or secondary
effect (such as drowsiness after taking antihistamines) and overdose.

2. Sensitivity-related reaction- Reaction due to hypersensitivity or allergy.

3. Iatrogenic effect- Reaction that mimics a pathologic condition such as when

GI aspirin cause
irritation.

4. Toxicity- Reaction when drug levels exceed the therapeutic range.

5. Idiosyncrasy- An unexpected or peculiar response to a drug.

- Example: diphenhydramine (Benadryl) may cause hyperexcitability in
children.

6. Miscellaneous reactions- Include blood dyscrasias, nephrotoxicity, hepatic

toxicity,
carcinogenicity, teratogenicity
(abnormal), photosensitivity, and disease-related effects.

8. Interactions- Refers to alterations of the pharmacokinetic, pharmacodynamics, or

pharmacotherapeutic characteristics of drugs, which affect overall therapeutic effects.

9. Additive effect- Combining two or more drugs to cause an effect equal to the sum of
their separate effects.
- Example: aspirin and codeine may be combined to increase pain relief.

10.Synergism- Combining two or more drugs to cause an effect greater than the sum of
their separate effects.
- Example: Administration of promethazine (Phenergan) and meperidine (Demerol)
provides greater pain relief than meperidine alone.
11.Potentiation- Type of synergism in which one of two or more combined drugs exerts an
action greater than if it were given alone.
- Example: vitamin D helps with the absorption and the action of calcium in the body.

12.Antagonistic effect- Combining two or more drugs to produce an effect less than the
sum of their separate effects.
- Example: a drug antidote.

Assessment for drug administration:

- Determine food or drug allergies
- Obtain a drug history
- Obtain a medical history
- Perform a physical examination

Six rights of drug administration:

1. Right drug
2. Right route
3. Right dose
4. Right time
5. Right patient
6. Right documentation

Key medication guidelines:

- Never give a drug poured or prepared by someone else.
- Never allow the medication cart or tray out of your sight once you have prepared a dose.
- Never leave a drug at a patient’s bedside; rather watch the patient swallow the drug.
- Never return unwrapped or prepared drugs to the stock supply; instead, dispose of the
medication and notify the pharmacist.
- Keep the medication cart locked at all times.
- Take care to avoid medication errors that can easily be caused by similar sounding
drug names, unclear orders, wrong route of administration, and miscalculation of dosages.

DRUG NAME

Chemical name
Gives the exact chemical makeup of the drug and placing of the atoms or molecular
structure; it is not capitalized.

Example: ethyl 4-(8-chloro-5,6-dihydro-11H-benzo[5,6] cycloheptal[1,2-b]-pyridin-11-ylidene)-

1- piperidinecardisplayylate

Generic name
Name given to a drug before it becomes official; may be used in all countries, by all
manufacturers; it is not capitalized.

Example: loratadine

Official name
Name listed in The United States Pharmacopeia-National Formulary; may be the same
as the generic name.

Example: loratadine

Trade name (brand name)

 Name that is registered by the manufacturer and is followed by the trademark
symbol; the name can be used only by the manufacturer; a drug may have several
trade names, depending on the number of manufacturers; the first letter of the
name is capitalized.

Example: Claritin©

Dosage Calculations:

Example: You have an order to administer meperidine (Demerol) 75 mg I.M. taken

from a 1 ml prefilled syringe containing 100 mg of Demerol.

You can calculate the ordered dose in one of two ways.

1. Ration and Proportion Method

The ration for this calculation would be 75 mg is to X ml as 100 mg is to 1 ml;

the equation would read as follows:
75 mg : X :: 100 mg : 1

ml 75 mg x 1 ml = 100

mg x X

Solve for X:

X = 75/100 or X = 0.75 ml
2. Dose Desired versus Dose on Hand Method

Alternatively, you may use the dose desired/dose on hand x ml method. The
equation using this method would be:

75/100 x 1 ml = 0.75 ml

Calculation for drop factor:

Volume of infusion (in millilitres) Drop Factor (in drops per millilitre) = Infusion (drops per min)
Time of infusion (in minutes)

***Macrodrip delivers 10, 15, or 20

gtt/ml Microdrip delivers 60

gtt/ml

Example:
500 ml X 15gtt/ml
= ? 8 hrs
(480 min)

1.04 min X 15gtt = 15.6 gtt/min or 16 gtt/min

Celsius and Fahrenheit Conversion

OF to OC OC to OF

OF – 32 x 5/9 OC x 9/5 + 32
When to question a medication drug?

- When handwriting is difficult to read

- When the drug’s use in the patient’s condition is questionable
- When dosages are unclear
- When drug incompatibilities or interactions may occur

Drug Administration Routes

1. Oral administration

- Most medications delivered orally, safe, convenient, and least expensive

- May be necessary to administer oral drugs at higher doses than their parenteral
equivalents because of first-pass metabolism
- Can sometimes be mixed with juice or foods if the patient has difficulty taking
medications

2. Buccal and Sublingual Administration

- Buccally administered medications are placed between the cheek and the teeth.
- Sublingually administered medications are placed under the tongue
- These drugs bypass the digestive tract and are immediately absorbed into systemic
circulation
- Can’t be swallowed because involving the digestive tract in absorption eliminates
immediate absorption

3. Parenteral Administration
a. Intravenous: deposits drug directly into the systemic circulation
b. Intramuscular: deposits drug into

the muscle IM injection sites:

1. Deltoid
2. Dorsogluteal
3. Ventrogluteal
4. Vastus Lateralis

c. Subcutaneous : deposits drug directly into fatty tissue

d. Intradermal : deposits drug into corium (a skin layer consisting of dense vascular
tissue)

4. Topical administration
- Lotions, creams, ointments, drops, and transdermal patches applied directly to the skin
- When applying, never place a heating pad over the application site
- Never place a defibrillator paddle over a transdermal patch.

5. Ophthalmic administration
- Ointments or drops used for local effects within the eye
- Absorbed into mucus membrane
- Place the patient in a supine position, and tilt his head back and toward the affected eye
- Gently pull down the lower lid of the affected eye, and instill the drops or
ointment into the conjunctival sac
- When administering, never instill the drug directly onto the eyeball.
- Never touch the eye or lid with applicator tip
6. Otic administration
- Drugs administered to the ear to treat local infection and inflammation
- Soften cerumen and provide local anesthesia
- Have the patient lie on the side opposite the affected ear.
- When administering, straighten the patient’s ear canal:
- In adults, gently pull the auricle up and back
- In infants or children younger than age 3, gently pull the auricle down and
back
- Gently massage the anterior area of the ear, and instruct the patient to remain on his
side for an additional 5 minutes
- If ordered, insert a cotton ball into the external ear and observe for reactions.

7. Inhalation administration
- Topical medications delivered into the respiratory tract by inhaler or nebulizer
- Lung’s mucosal lining absorbs the drug almost immediately

8. Vaginal Administration
- Topical treatments used to treat vaginal infections and inflammation
- Includes suppositories or creams

9. Rectal administration
- Drugs administered rectally to treat constipation, nausea and vomiting, haemorrhoids,
colitis, and
pai
n - Used when other routes aren’t available
- Absorbed into the large intestine

Drugs and the Autonomic Nervous System

Anatomy and Physiology Highlights

-The ANS consists of the sympathetic nervous system (adrenergic system), the
parasympathetic nervous system (cholinergic system), and the enteric nervous system
(usually not discussed).

- ANS pathways consist of two neurons which transmit information to the effector organs:

1. Preganglionic neuron – extends from the CNS to a ganglion

2. Postganglionic neuron – extends from the ganglion to the effector organ or gland

- The ANS controls involuntary body functions, glands, and organs

- The sympathetic system helps the body cope with external stimuli and functions during
stress (triggers “fight or flight” response)

- “Fight or flight” response (vasonconstriction, increased heart and respiratory rate, cold,
sweaty palms, and pupil dilation)

- The parasympathetic system works to save energy, aids in digestion, and supports
restorative resting body functions (decreased heart rate, increased GI tract tone and
peristalsis, urinary sphincter relaxation, and vasodilation)

- Adrenergic receptors are divided into alpha and beta receptors:

 1. Alpha1 receptors – produces contractions (vasoconstriction of smooth muscle
walls of blood vessels

2. Alpha2 receptors – inhibits norepinephrine release

3. Beta1 receptors – (found mostly in the heart)

- causes the heart to beat faster and more forcefully

4. Beta2 receptors – (found mostly in smooth muscles of the bronchial walls and blood
vessels)
- dilates bronchi and relaxes blood vessels

5. Dopamine – Increases renal blood flow

- Increases cardiac output
- Elevates blood pressure

ANS neurotransmitters

1. Acetylcholine

- Is released in response to a stressful event

- Helps neurons transmit impulses in the CNS
- Stimulates postganglionic neurons, causing epinephrine and norepinephrine release
- Is inactivated by cholinesterase

2. Norepinephrine

- Causes sympathetic stimulation by triggering release of epinephrine and norepinephrine

- Combines with adrenergic receptors on effector organs

OK!

CHOLINERGICS

1. Cholinergic Agonists

- Directly stimulate cholinergic receptors, mimicking the action of acetylcholine.

Drug examples:
- bethanechol (Duvoid)
- pilocarpine (Pilocar)

Indications:
- Treat atonic bladder conditions, postoperative/postpartum urine retention
- Treat GI disorders (such as postoperative abdominal distention and GI atony)
- Decrease eye pressure in patients with glaucoma (increased IOP) and during eye
surgery
- Treat salivary gland hypofunction caused by radiation therapy

Nursing actions:
- Assess urinary status
- Assess bowel sounds and abdomen
- Administer by mouth or subQ
- Never give IV or IM
 - Observe patient for 20 to 60 minutes after subQ administration
- Monitor for toxicity (urinary urgency, excessive secretion, respiratory depression or
spasm)
- Administer atropine as an antidote as prescribed

2. Alzheimer’s treatment drugs

- Slowing the neuronal degradation that occurs in Alzheimer’s

disease Drug examples:

- donepezil (Aricept)
- galantamine (Razadyne)
- memantine (Namenda)

Indications:
- Treat mild to moderate dementia of the Alzheimer’s type
- Treat moderate to severe dementia of the Alzheimer’s type (memantine)

Nursing Actions:
- Notify the surgeon about the use of Alzheimer’s treatment drugs if surgery is
planned.
- Teach the patient that these drugs won’t cure Alzheimer’s, only slow its progression
- Administer donepezil daily at bedtime

3. Anticholinergics

- Interrupt parasympathetic nerve impulses in the CNS and ANS

- Prevents acetylcholine from stimulating cholinergic receptors
- Also referred to as cholinergic blockers

Drug examples:
- atropine
- glycopyrrolate (Robinul)
- benztropine (Cogentin)

Indications:
- Reduce oral, gastric, and respiratory secretions, especially preoperatively

Nursing Actions:
- Administer before meals
- Teach the patient to consult the practitioner before taking non-prescription drugs
- Advise the patient on how to reduce xerostomia and constipation
- Monitor I and O

ADRENERGIC AGONISTS

1. Catecholamines

- Stimulate nervous system by combining with either alpha-adrenergic or beta adrenergic

receptors

Drug examples:
- dobutamine (Dobutrex)
- dopamine (Intropin)
- epinephrine (Adrenalin)
- isoproterenol (Isuprel)
 - norepinephrine (Levophed)

Indications:
- Treat bradycardia, heart blocks, and decreased cardiac output
- Treat bronchodilation in acute and chronic bronchial asthma
- Treat acute drug-induced allergic reaction
- Treat mild renal failure caused by decreased cardiac output (dopamine, which
dilates renal arteries in low doses)
- Stimulate the heart in cardiac arrest
- Increase blood pressure through vasoconstriction in acute hypotension and shock
- Increase myocardial force and cardiac output in patient with acute heart failure

Nursing actions:
- Monitor ECG, VS, urine output
- Correct hypovolemia
- Administer through a large vein to prevent extravasation
- Monitor for a sudden drop in BP after stopping the drug

2. Noncatecholamines

- Stimulate sympathetic nervous system by directing stimulating alpha or beta 2

receptors. Drug examples:

- albuterol (Proventil, Ventolin)
- metaproterenol (Alupent)

Indications:
- Treat hypotension and severe shock
- Stop preterm labor (terbutaline)
- Treat bronchodilation (albuterol and metaproterenol)
- Treat nasal congestion (ephedrine and phenylephrine)

Nursing action:
- Monitor respiratory status

Drugs and the Central Nervous System

A&P Highlights:

CNS:
- Spinal cord : carries messages from the body to the brain
: protected by vertebrae and cerebrospinal fluid

- Brain : receives message, analyses and interprets it, and sends a

response message through the spinal cord to the
rest of the body.
: protected by skull and membranous meninges

- Neuron : the basic functional unit of the CNS

Function of the CNS

- Relays messages
- Processes, compares, and analyses information
 CNS neurotransmitters
- Help neuron transmit impulses in the CNS
- Include acetylcholine, norepinephrine, serotonin, dopamine, and
gamma- aminobutyric acid (GABA)

1. CNS Stimulants
- Increase neurotransmitter levels in the CNS
- Metabolized by the liver
- Excreted in urine

Drug examples:
- amphetamine-dextroamphetamine (Adderall)
- dexmethylphenidate (Focalin)
- methylphenidate (Ritalin)

Indications:
- Increase mental alertness and respiratory rate
- Treat attention deficit hyperactivity disorder (ADHD)
- Treat respiratory stimulation after anesthesia (doxapram)

Nursing Actions:
- Assess patient’s behaviour to determine drug effectiveness.
- Monitor growth in a child receiving long-term therapy.
- Instruct patient to take last daily dose 6 hours before bedtime to prevent insomnia
- Instruct patient to avoid caffeine.
2. Anticonvulsants

a. Hydantoins – Inhibit seizure activity

- Metabolized in the liver
- Excreted in urine

Drug examples:
- ethotoin (Peganone)
- fosphenytoin (Cerebyx)
- phenytoin (Dilantin, Phenytek)

Indications:
- Treat tonic-clonic (grand mal) seizures and complex partial seizures
- Short-term control of general convulsive status epilepticus (fosphenytoin
given IV)
Status epilepticus: a continuous series of generalized tonic-clonic
seizures without return to consciousness between them.

Nursing actions:
- Monitor for signs and symptoms of toxicity (ataxia, nystagmus,
dysarthria) Ataxia: The inability to coordinate the
movements of muscles
Nystagmus: An involuntary rhythmic movement of the eyes, usually
form side to side, caused by some illness that affect the
nerves and muscle behind the eyeball.
Dysarthria: Difficulty in speech articulation caused by a lack of muscle
control resulting from damage to the CNS.
- If GI upset occurs, administer drug with food.
 - Monitor VS, BP, and ECG during IV administration

b. Barbiturates – Depress the sensory cortex and motor activity and alter cerebellar
function.
- Causing drowsiness, sedation, and hypnosis.
- Metabolized by the liver
- Excreted in urine

Drug examples:
- mephobarbital (Mebaral)
- phenobarbital (Luminal)

Indications:
- Treat tonic-clonic seizures, partial seizures, and febrile seizures
- Adjunct to anesthesia, may be used as an emergency control for acute
convulsive Episodes
- Treatment of choice for chronic epilepsy (primidone)

Nursing Actions:
- Assess respiratory status before and during drug therapy
- Discourage alcohol use during drug therapy
- Notify practitioner immediately if patient develops fever, sore throat,
mouth sores, bruising, bleeding or tiny broken blood vessels
under the skin during drug therapy
- Monitor for withdrawal symptoms:
- anxiety
- muscle twitching
- hand and finger tremors
- weakness
- dizziness
- nausea and vomiting
- convulsions
- delirium: temporary mental disturbance;
: A state marked by extreme restlessness, confusion,
and sometimes hallucinations caused by fever,
poisoning or brain injury.

c. Benzodiazepines – Depress the CNS, suppressing seizure activity; action is poorly

understood
- Metabolized by the liver
- Excreted in the urine

Drug examples:
- clonazepam (Klonopin)
- clorazepate (Tranxene)
- diazepam (Valium)
- lorazepam (Ativan)

Indications:
- Long-term treatment of epilepsy (clonazepam only)
- Adjunctive treatment of partial seizures and treatment of acute alcohol
withdrawal (clorazepate)
- Treat anxiety and skeletal muscles spasm (diazepam)
- Treat acute status epilepticus (I.V. lorazepam is drug of choice)
 Nursing Actions:
- Caution patient not to stop drug abruptly (could produce status
epilepticus or worsen disorder)
- Administer I.V diazepam no faster than 5mg/minute in adults; at least 3
minutes in children.
- Don’t mix I.V. diazepam with other drugs in same syringe.

3. Antiparkinsonians

a. Dopaminergic Agonists
- Restore natural balance of acetylcholine and dopamine in the CNS.
- Decrease signs and symptoms of Parkinson’s disease
- Metabolized in the brain, periphery, and the liver
- Excreted in urine

Drug Examples:
- amantadine (Symmetrel)
- bromocriptine (Parlodel)
- levodopa (Dopar)
- levodopa-carbidopa (Sinemet)
- pergolide (Permax)
- pramipexole (Mirapex)
- ropinirole (Requip)
- selegiline (Eldepryl)

Indications:
- Treat Parkinson’s disease (concurrent use of pergolide, selegiline, or
bromocriptine with levodopa-carbidopa)
- Antiviral to prevent and treat influenza A (amantadine)
- Treat hyperprolactinemia and acromegaly (bromocriptine)
- Treat restless leg syndrome (ropinirole)

Nursing Actions:
- Assess for signs and symptoms of parkinsonism
- Taper medication slowly to prevent serious adverse serious reactions.

b. Anticholinergics (Cholinergic blockers)

- Block acetylcholine receptors in the CNS and ANS, thereby suppressing
acetylcholine activity.

Drug Examples:
- benztropine (Cogentin)
- biperiden (Akineton)
- trihexyphenidyl (Trihexy-2, Trihexy-5)

Indication:
- Treat Parkinson’s disease

Nursing Actions:
- Assess bowel and urinary function for evidence of adverse effects.
- Instruct patient to consult practitioner or pharmacist before taking non-
drug prescription
s
- If GI upset occurs, administer drug with food.
 4. Antimigraine Drugs
- Causes cranial vessel constriction thereby inhibiting and reducing the
inflammatory
process.

Drug Examples:
- almotriptan (Axert)
- eletriptan (Relpax)
- frovatriptan (Frova)
- sumatriptan (Imitrex)

Indications:
- Treat acute moderate to severe migraines with or without aura
- Treat cluster headaches (sumatriptan injection)

Nursing Actions:
- Administer at onset of migraine
- Monitor injection site for redness or irritation

5. Antimyasthenics (Cholinergics)
- Relieve muscle weakness associated with myasthenia gravis by
blocking acetylcholine breakdown at the neuromuscular junction

Drug Examples:
- ambenonium ( Mytelase)
- edrophonium (Tensilon)
- neostigmine (Prostigmin)

Indication:
- Treat myasthenia gravis

Nursing Actions:
- Assess neuromuscular status
- Know that atropine is the antidote for cholinergic overdose

DRUGS AND PAIN

Anatomy and Physiology Highlights

Nociceptors – are where pain begins

- are free nerve endings located primarily in the skin, periosteum, joint
surfaces, and arterial walls

Two types of Nociceptors:

a. Myelinated A-delta fibers – fast-conducting fibers that signal sharp, well-

localized
pain
b. Unmyelinated C fibers - more numerous, smaller, and slower than A-delta
fibers.
- signal dull, poorly localized pain

- Pain acts as protective mechanism indicating an underlying

physiologic or psychological problem.
1. Nonopioid Analgesics
- Act peripherally to prevent prostaglandin formation in inflamed
tissues by two actions:
a. Inhibit stimulation of pain receptors
b. Inhibit prostaglandin synthesis in the CNS and
stimulate peripheral vasodilation to reduce fever
(antipyretic action)

- Metabolized in the liver

- Excreted in urine, breast milk, and feces

Drug Examples:
- choline salicylate (Arthropan)
- diflunisal (Dolobid)
- salsalate (Disalcid)
- acetaminophen (Tempra, Tylenol)
- diclofenac (Cataflam, Voltaren)
- ibuprofen (Advil, Motrin)

Indication
s: - Treat mild to moderate pain (acetaminophen, aspirin, ibuprofen)
- Treat arthritis and osteoarthritis (all drugs except mefenamic acid)
- Reduce fever (acetaminophen, aspirin, ibuprofen)
- Reduce inflammation (aspirin, naproxen, and sulindac)
- Prevent TIA and MI by smoothing platelets (aspirin)
- Treat dysmenorrhea (ibuprofen, celecoxib, mefenamic acid)

Nursing Actions:
- Administer drug before meals for a rapid effect
- Administer drugs after meals for GI irritation reduction

2. Opioid Antagonists
- Completely block the effects of opioid without producing analgesic effects.
- Metabolized in the liver
- Excreted in urine

Drug Examples:
- nalmefene (Revex)
- naloxone (Narcan)
- naltrexone (ReVia, Trexan)

Indication
s: - Reverse CNS and respiratory depression in opioid overdose
- Treat opioid overdose (nalmefene and naloxone)

Nursing Actions:
- Assess respiratory status, BP, pulse, and LOC until the opioid wears off
- Opioid antagonists should be adjusted according to the patient’s pain level

3. GENERAL ANESTHETICS

a. Rapid-acting hypnotics
- Stabilize neuronal membranes to produce progressive, reversible CNS
depression
Drug Examples:
- methohexital, midazolam hydrochloride (Versed)
- propofol (Diprivan)
- thiopental sodium (Pentothal)

Indications:
- Induce and maintain anesthesia for short-term procedures

Nursing Actions:
- Determine if the patient has allergies before the surgery
- Assess cardiovascular, respiratory, and renal status and LOC before
and after Surgery

b. Inhalation Anesthetics
- Depress the CNS to produce loss of consciousness, loss of
responsiveness to sensory stimulation, and muscle relaxation.

Drug Examples:
- desflurane (Suprane)
- enflurane (Ethrane)
- halothane (Fluothane)
- isofluorane (Forane)
- nitrous oxide

Indication
s: - Produce loss of consciousness, loss of responsiveness
to sensory stimulation (including pain), and muscle
relaxation.

Nursing Actions:
- Keep atropine available at all times to reverse possible bradycardia
- Monitor the patient’s temperature frequently. (Hypothermia commonly
occurs with inhalation anesthesia)
- Advise the patient not to eat or drink anything for at least 8 hours
before the surgery to prevent aspiration of the stomach contents
into the lungs during anesthesia.
- Inform the patient that psychomotor functions may be impaired for
24 hours or more after inhalation anesthesia
- If shivering (common during recovery) occurs, keep the patient warm
with extra blankets or heat and administer oxygen as prescribed to
compensate for the increased oxygen demand.

C. Injectable Anlagesic Anesthetics

- Depress the CNS to produce loss of consciousness, loss of
responsiveness to sensory stimulation, and muscle relaxation.

Drug Examples:
- alfentanil (Alfenta)
- etomidate, remifentanil (Ultiva)
- sufentanil (Sufenta)

Indications:
- Induce rapid anesthesia (usually for situations requiring anesthesia of short
 duration such as outpatient surgery) or moderate sedation
- Decrease pain

Nursing Actions:
- Continuously assess respiratory status for signs of respiratory depression
- Know that many injectable drugs are incompatible with other drugs or
solutions

d. Neuroleptanesthetics
- Produce dissociation from the environment during induction of anesthesia

Drug Examples:
- droperidol (Inapsine)
- ketamine (Ketalar)

Indications:
- Sedate and induce analgesia before surgery or diagnostic procedures

Nursing Actions:
- Monitor VS and cardiopulmonary status before, during, and after injection
-Minimize environmental stimulation

4. Local Anesthetics
- Provide analgesic relief by blocking the conduction of nerve impulses at
the point of contact.

Drug Examples:
- benzocaine (Dermoplast)
- bupivacaine hydrochloride (Marcaine)
- lidocaine hydrochloride (Xylocaine Hydrochloride)
- tetracaine hydrochloride (Pontocaine)

Indication
s: - Prevent or relieve pain from a medical procedure, disease or injury
- Treat severe pain unrelieved by topical anesthetics or analgesics
- Spinal anesthesia (bupivacaine, procaine, and tetracaine)
- Epidural anesthesia (bupivacaine, lidocaine, and mepivacaine)
- Epidural analgesia and anesthesia (bupivacaine, lidocaine, and tetracaine)

5. Topical Anesthetics
- Block nerve impulse transmission across nerve cell membranes
- Block nerve endings, superficially freeze tissue

Drug Examples:
- benzocaine
- benzyl alcohol
- butacaine
- butamben
- lidocaine
- menthol
- procaine
- tetracaine

Indications:
 - Relieve or prevent pain especially minor pain, itching, and irritation
- Anesthetize site before giving injection
- Numb mucosal surfaces before inserting tube or catheter

Nursing Actions:
- Assess the area where the topical anesthetics is to be applied before,
during , and after drug administration.
- Discontinue drugs if rash develops.

DRUGS AND MOOD ALTERATION

Anatomy and Physiology Review

- Psychopathology is affected by psychosocial and biological factors
- Abnormal neurotransmission can occur among several neurotransmitters
such as acetylcholine, dopamine, gamma-aminobutyric acid
(GABA), serotonin, and norepinephrine.

1. Sedative-Hypnotics and Anxiolytics

a. Barbiturates
- Exact mechanism unknown
- May cause generalized CNS depression

Drug examples:
- Rapid-acting barbiturates: thiopental (Pentothal)
- Short-acting barbiturates: pentobarbital (Nembutal), secobarbital (Seconal
sodium)
- Long-acting barbiturates: phenobarbital (Luminal)

Indications:
- Induce anesthesia: (rapid-acting barbiturates)
- Treat insomnia and as adjuncts to anesthesia (short-acting barbiturates)
- Treat insomnia and seizures (long-acting barbiturates)

Nursing Actions:
- Administer IV doses slowly
- Assess patient’s sleep patterns
- Limit amount of medication available to patient
- Know that long-term use of these drugs may cause physical and
psychological Dependence
- Monitor patient’s respiratory status

b. Benzodiazepines
- May cause generalized CNS depression

Drug Examples:
- alprazolam ( Xanax, Xanax XR)
- chlordiazepoxide ( Librium)
- clonazepam (Klonopin)
- clorazepate (Tranxene)
- Diazepam (Valium)
- estazolam (ProSom)
- flurazepam (Dalmane)
- lorazepam (Ativan)
 - midazolam (Versed)

c. Nonbarbiturates
- Cause generalized CNS depression

Drug Examples:
- buspirone (BuSpar)
- diphenhydramine (Benadryl, Sominex)
- hydroxyzine (Atarax, Vistaril)
- promethazine (Anergan 50, Phenergan)
- propofol (Diprivan)
- zaleplon (Sonata)

Indications:
- Short-term treatment of simple insomnia
- Sedation before surgery and during electroencephalogram studies
- General anesthetic (propofol)

Nursing Actions:
- Use Z-track method of injection to prevent tissue irritation (hydroxyzine I.M.)
- Know that long-term use may cause dependence

2. Antipsychotics

Psychosis: - Any major mental disorder of organic or emotional origin

- Marked by derangement of personality and loss of contact with reality.

a. Phenothiazines
- Block the neurotransmitter dopamine, inhibiting transmission of neural
impulses.
- Metabolized by the liver
- Excreted mostly in the urine

Drug Examples:
- chlorpromazine (Thorazine)
- fluphenazine (Prolixin)
- mesoridazine (Serentil)

Indications:
- Treat psychosis, schizophrenia (fluphenazine, mesoridazine, perphenazine)
Schizophrenia: a mental disorder or group of disorders
characterized by disturbances in the form and content of thought. e.g delusions,
hallucinations
- Treat nausea and vomiting (chlorpromazine, perphenazine)

Nursing Actions:
- Tell patient that phenothiazines may discolour urine to pink or red-brown
- Instruct patient to call practitioner before taking OTC or herbal preparations

b. Butyrophenones
- Block the neurotransmitter dopamine, inhibiting transmission of neural
impulses.
- Metabolized by the liver
- Excreted mostly in the
urine Drug Examples:
 - droperidol (Inapsine)
- haloperidol (Haldol)

Indications:
- Treat nausea and vomiting during surgery and diagnostic procedures
(droperidol)
- Treat psychosis (haloperidol)

Nursing Actions:
- Advise patient to avoid alcohol during therapy

3. Antidepressants

a. Tricyclic, Quadracyclic, Second-Generation, and Miscellaneous Antidepressants

and SSRIs Tricyclic and second-generation antidepressants

- Increase the amount of norepinephrine or serotonin (or both)

Note:
Serotonin: A hormone and neurotransmitter (5-HT or 5-hydroxytriptamine)
- Found in CNS, many tissues, intestinal mucosa
- Inhibition of gastric secretions
- Stimulation of smooth muscles
- Production of vasoconstriction

Selective Serotonin Reuptake Inhibitors (SSRIs)

- Block the reuptake of serotonin into presynaptic cells,
thereby increasing serotonin levels at the synapse.

Drug Examples:

Tricyclic and quadracyclic antidepressants:

- amitriptyline (Elavil)
- amoxapine (Asendin)
- clomipramine (Anafranil)
- imipramine (Tofranil

Second-generation and miscellaneous antidepressants:

- bupropion (Wellbutrin)
- fluoxetine (Prozac, Prozac Weekly, Sarafem)

SSRIs:
- citalopram (Celexa)
- fluoxetine (Prozac)
- sertraline (Zoloft)

Indication
s: - Tricyclic antidepressants are the drug of choice for episodes
of major Depression
- Treat enuresis (imipramine)
- Treat anxiety (doxepine)
- Treat obsessive-compulsive disorder (clomipramine; first drug
approved for this use)
- Treat generalized
anxiety disorder,
depression, OC
disorder, and bulimia
 Nervosa

Nursing Actions:
- Know that these drugs should be discontinued gradually
- Know that these drugs may take several weeks to produce desired
effects
- Teach patient to avoid alcohol and non-prescription drugs
- Teach patient to not crush controlled-release tablets, but to
swallow them Whole

b. Monoamine Oxidase (MAO) Inhibitors

- Impair inactivation of norepinephrine, serotonin or both thus
prolonging their presence in CNS synapse

Drug Examples:
- phenelzine (Nardil)
- tranylcypromine (Parnate)

Indication:
- Treatment of panic disorders with agoraphobia, eating disorders, post-
traumatic stress syndrome

Nursing Actions:
- Don’t administer these drugs in the evening
- Assess patient’s mental status for mood changes and suicidal tendencies

4. Antima
nics - Alters sodium transport in nerve and muscle cells
- Antimanic effects may result from increases in norepinephrine reuptake

Drug examples:
- lithium carbonate (Eskalith, Lithobid, Lithonate, Lithotabs)
- lithium citrate (Lithium Citrate Syrup)

Indications:
- Treat mania and bipolar affective disorders (also known as bipolar disorder)

Nursing Actions:
- Know that the therapeutic range for long-term lithium use ranges from 0.6 to 1.2
mEq/L
- Assess for signs and symptoms of lithium toxicity such as vomiting,
diarrhea, slurred speech, decreased coordination, drowsiness, muscle
weakness, and twitching

DRUGS AND THE MUSCULOSKELETAL SYSTEM

a. Antigout drugs

allopurinol (Zyloprim) – Decreases uric acid

production colchicine – Reduces inflammatory

process
 probenecid (Probalan) and sulfinpyrazone – enhance renal excretion of uric acid

Indications:
- colchicine: used IV if rapid response needed during acute attacks
 - Prevent recurrent attacks of gout or gouty arthritis (allopurinol,
probenecid, and sulfinpyrazone)

Nursing Actions:
- Give drugs with food or milk
- Assess joints for pain and immobility
- Teach patient to avoid taking aspirin with antigout drugs.

b. Antiarthritics
- Inhibit prostaglandin synthesis, thereby reducing inflammation

Drug Examples:
- adalimumab (Humira)
- anakinra (Kineret)
- auranofin (Ridaura)
- methotrexate (Rheumatrex)
- leflunomide
(Arava) Indications:
- Treat rheumatoid arthritis

Nursing Actions:
- Know signs and symptoms of toxicity such as pruritus, rash, metallic taste,
stomatitis, and Diarrhea
- Be aware that leflunomide requires loading dose and frequent liver tests
- Know that tuberculin test will likely be ordered before start of infliximab therapy
c. Skeletal Muscle Relaxants
- Interfere with muscle contraction

Drug examples:
- dantrolene (Dantrium)
- baclofen (Lioresal)
- carisoprodol (Soma)
- cyclobenzaprine (Flexeril)
- diazepam (Valium)
- metaxalone (Skelaxin)
- orphenadrine (Norflex)

Indications:
- Treat acute muscle spasms
- Treat spasticity associated with spinal cord injury and stroke (baclofen and
dantrolene)
- Prevent and treat malignant hyperthermia (dantrolene)

Nursing Actions:
- Give these drugs with meals or milk
- Assess involved joints for pain and immobility
- Keep emergency equipment nearby to treat respiratory depression

DRUGS AND THE RESPIRATORY SYSTEM

1. Bronchodilators – Produce

bronchodilation Drug Examples:

Short-acting drugs:
 - albuterol (AccuNeb, Proventil)
- isoproterenol (Isuprel)

Long-acting drugs:
- formoterol (Foradil)
- ipratropium and albuterol (Combivent)

Other examples:
- aminophylline, theophylline (Elixophyllin, Slo-Bid)
- dyphylline (Dilor)

Indications:
- Treat acute bronchospasm (short-acting drugs)
- Prevention and maintenance therapy for bronchospasms in selected patients
with COPD, asthma, and exercise-induced asthma

Nursing Actions:
- Administer drug around the clock as ordered
- Teach patient to avoid respiratory irritants

2. Corticosteroids
- Prevent release of or counteract kinins, serotonin, and histamine. (These are
responsible for edema and airway narrowing)

Drug Examples:
- beclomethasone (Beconase AQ)
- budesonide (Pulmicort)
- cromolyn sodium (Intal Aerosol Spray)
- dexamethasone (Decadron Phosphate Respihaler)
- flunisolide (AeroBid)
- prednisone (Deltasone)
- triamcinolone (Azmacort)

Indications:
- Treat chronic bronchitis (beclomethasone)
- Control bronchial asthma (budesonide, dexamethasone, flunisolide, and
triamcinolone)

Nursing Actions:
- Know that cromolyn is ineffective during acute bronchospasm attacks
- Teach patient to rinse mouth after using inhaled steroids

3. Antitussives
- Suppress the cough reflex by acting on medulla’s cough center

Drug Examples:
- Opioid antitussives:
a. codeine phosphate
b. codeine sulphate (Codeine)
c. hydrocodone (Hycodan)

- Nonopioid antitussives:
a. benzonatate (Tessalon)
b. dextromethorphan (Robitussin DM)
 c. diphenhydramine (Benadryl, Benylin)

Indications:
- Treat non-productive cough and cough that interferes with sleep or daily activities

Nursing Actions:
- Administer codeine cautiously if patient is receiving CNS depression
- Teach patient to maintain fluid of 2 to 3L/day

4. Expectorants
- Decrease the viscosity of tenacious secretions by increasing fluid in the respiratory
tract

Drug Examples:
- guaifenesin (Liquibid, Mucinex, Robitussin, Tussin)

Indications:
- Treat cough associated with common cold and upper respiratory tract infections
including:
a. minor bronchial irritations
b. bronchitis
c. influenza
d. sinusitis
e. emphysema
f.bronchial asthma

- Relieve dry, hacking

cough Nursing Actions:
- Assess breath sounds, cough, and bronchial secretions
- Maintain fluid intake of 2 to 3L/day.

5. Mucolyt
ics - Decrease mucus viscosity by breaking or altering the chemical bonds of
glycoprotein complexes in mucus

Drug Examples:
- acetylcysteine (Mucomyst)
- dornase alfa (Pulmozyme)

Indications:
- Treat abnormal, viscid or thick, and hard mucus
- Antidote for acetaminophen overdose

Nursing Actions:
- Assess breath sounds, cough, and bronchial secretions
- Maintain fluid intake of 2 to 3L/day.

6. Decongestants
- Causes vasoconstriction and nasal decongestion

Drug Examples:
- ephedrine (Pretz-D)
- fluticasone (Flonase)
- phenylephrine (Afrin Children’s)
 Indications:
- Temporary relief of nasal congestion due to common cold
- Promote nasal or sinus drainage

Nursing Actions:
- Monitor pulse rate, BP, and ECG.
- Notify practitioner if insomnia occurs.

DRUGS AND THE CARDIOVASCULAR SYSTEM

1. Inotropic Drugs

a. Cardiac Glycosides
- Inhibit the sodium-potassium activation of adenosine triphosphate, which
regulates the amount of sodium and potassium inside the cell

- Positive inotropic action: Promote movement of calcium from extracellular to

intracellular cytoplasms and strengthens myocardial contractility

- Negative chronotropic action: Act on the central nervous system slowing the
contractility through the SA and AV nodes.

Drug Examples:
- digoxin (Digitek, Lanoxicaps,
Lanoxin) Indications:
- Treat heart failure
- Control ventricular rate in atrial fibrillation, atrial flutter, and paroxysmal atrial
tachycardia

Nursing Actions:
- Before administering digoxin, assess patient’s apical pulse, serum drug,
electrolyte levels, and renal function
- Withhold drug and notify practitioner if pulse rate is below 60 beats/minute
- Know that digoxin immune Fab is and antidote for toxicity
- Know that reduced dosage is needed in patients with renal impairment

2. Antiarrhythmics
- Slows conduction in the AV nodes

Drug Examples:
- adenosine (Adenocard)
- atropine sulphate

Indications:
- Treat symptomatic sinus bradycardia (atropine)

Nursing Actions:
- Monitor heart rate, respiratory rate, BP, and ECG
- Give these drugs around the clock as prescribed
- Administer adenosine by rapid IV bolus

3. Antihypertensives
a. Beta-Adrenergic Blockers
- Decrease cardiac output
- Compete with epinephrine for beta-adrenergic receptor sites

Drug examples:
- acebutolol (Sectral)
- atenolol (Tenormin)
- metoprolol (Lopressor, Toprol)
- propranolol (Inderal)

Indications:
- Treat mild hypertension

Nursing Actions:
- Don’t discontinue drug abruptly
- Give propranolol with food

b. Angiotensin-Converting Enzyme (ACE) Inhibitors

- Block the conversion of angiotensin I to angiotensin II, preventing
peripheral vasoconstriction.

Drug examples:
- benazepril (Lotensin)
- captopril (Capoten)
- enalapril (Vasotec)
- lisinopril (Prinivil, Zestril)

Indications:
- Treat mild hypertension
- Treat heart failure after MI
- Reduce the risk of MI, stroke

Nursing Actions:
- Administer captopril on empty stomach
- Monitor patient taking captopril for proteinuria every 2 to 4 weeks for first three
months

c. Calcium Channel Blockers

- Dilate vessels, preventing calcium from entering the cells

Drug examples:
- amlodipine (Norvasc)
- diltiazem (Cardizem)
- felodipine (Plendil)
- nifedipine (Procardia)
- verapamil (Calan)

d. Diuretics
- Inhibit sodium and chloride reabsorption, thereby increasing urine output and
decreasing edema, circulating blood volume, and cardiac output

Drug examples:
- chlorothiazide (Diuril)
- chlorthalidone (Hygroton)
 - furosemide (Lasix)

Indications:
- Treat mild hypertension

Nursing Actions:
- Instruct patient not to take double dose after missing a dose
- Warn patient not to stop drug abruptly
- Teach patient to monitor BP weekly, watch for weight gain, and peripheral edema

4. Antianginals

Angina – Paroxysmal pain in the chest, often radiating to the arms particularly the left
- Usually due to the interference with the supply of oxygen to the heart
muscle.

Prinzmetal’s angina – angina at rest.

a. Nitrates
- Produce vasodilation, reduce myocardial oxygen consumption

Drug examples:
- isosorbide dinitrate (Isordil)
- isosorbide mononitrate (Imdur)
- nitroglycerin (Nitro-Bid, Nitrodisc, Nitro-Dur, Nitrolingual, Nitrostat, TransdermNitro,
Tridil)

Indications:
- Treatment and prophylactic management of acute angina
- Treat surgical hypertension (IV nitroglycerin)

Nursing Actions:
- Teach patient to repeat dose if no relief occurs in 5 minutes
- Teach patient to seek emergency medical help if no relief occurs after taking 3
tablets in 15 minutes
- Inform patient that headache is common adverse effect of nitrates and
typically subsides with continued therapy

b. Calcium Channel blockers

- Prevent passage of calcium ions across the myocardial cell membrane and
vascular smooth muscle thereby dilating coronary arteries.

Drug examples:
- amlodipine (Norvasc)
- diltiazem (Cardizem)
- felodipine (Plendil)
- nifedipine (Procardia)
- verapamil (Calan)

Indication:
- Long-term prevention of angina

Nursing Actions:
- If patient’s systolic pressure is less than 90 mmHg or heart rate is less
than 60 beats/minute, withhold dose and notify practitioner
 - Monitor patient for signs and symptoms of heart failure

c. Beta-Adrenergic Blockers
- Reduce myocardial oxygen demands by slowing the heart rate and decreasing
the force of myocardial contractions

Drug examples:
- acebutolol (Sectral)
- atenolol (Tenormin)
- metoprolol (Lopressor, Toprol)
- propranolol (Inderal)

Nursing Actions:
- Assess location, duration, and intensity of angina pain
- Teach patient to change position slowly
- Assess VS and ECG

DRUGS AND THE URINARY SYSTEM

1. Thiazide and Thiazide-like Diuretics

- Increase water excretion by either increasing the GFR or decreasing or
inhibiting sodium reabsorption from the tubules

Note: Glomerular Filtration Rate (GFR) - The amount of blood filtered by the
glomeruli in a
given time.
- The normal GFR is about 125 ml/min.
Drug examples:
- chlorothiazide (Diuril)
- chlorthalidone (Hygroton)
- hydrochlorothiazide (Oretic)

Indications:
- Treat hypertension, edema, and heart failure
- Prevent recurrence of renal calculi

Nursing Actions:
- Monitor digoxin levels in patients taking digoxin concurrently with these drugs.
- Give diuretic in morning or early afternoon

2. Loop Diuretics
- Inhibit sodium and chloride reabsorption from the loop of Henle and distal tubule
- Increase sodium and water excretion by inhibiting sodium and chloride
reabsorption in the proximal tubule
 Drug examples:
- bumetanide (Bumex)
- ethacrynic acid (Edecrin)
- furosemide
- torsemide (Demadex)

Indications:
- Treat edema associated with heart failure
- Treat hypertension
- Adjunct to mannitol to treat cerebral edema
(furosemide) Nursing Actions:
- Administer IV doses slowly over 1 to 2 minutes
- Know that bumetanide is 40 times more potent than furosemide
- Be especially alert for sodium and potassium level
- Give diuretic with food or milk if GI upset occurs

3. Potassium-sparing diuretics
- Conserve potassium excretion

Drug examples:
- amiloride (Midamor)
- spironolactone
- triamterene (Dyrenium)

Indications:
- Conserve potassium or enhance effects of loop or thiazide diuretics
- Treat hypokalemia

Nursing Actions:
- Monitor patient for signs of hyperkalemia
- Instruct patient to avoid potassium-rich foods except with practitioner
approval

4. Osmotic Diuretics
- Increase osmotic pressure of glomerular filtrate, inhibiting reabsorption of
water and electrolytes.

Note: Osmosis is the process of water movement through a semipermeable

membrane from
 an area of low solute concentration to an area of high solute
concentration.

Osmotic pressure is the amount of pressure

required to stop the osmotic flow of
water.

Drug examples:
- glycerin (Osmoglyn)
- isosorbide (Ismotic)
- mannitol (Osmitrol)
- urea (Ureaphil)

Indications:
- Treat cerebral edema
- Reduce ICP and IOP
- Promote diuresis in acute renal failure (mannitol)
- Interrupt acute attacks of glaucoma (glycerin and isosorbide)

Nursing Actions:
- Monitor VS, urine output
- Assess neurologic status

DRUGS AND THE HEMATOLOGIC SYSTEM

1. Anticoagulants
- Prevent extension and formation of clots

Drug examples:
- IV forms:
- heparin
- bivalirudin (Angiomax)
- lepirudin (Refludan)

- SubQ forms:
- dalteparin (Fragmin)
- enoxaparin (Lovenox)

- Oral forms:
- warfarin (Coumadin, Jantoven)

Indications:
- Treat or prevent thromboembolic disorders such as DVT, pulmonary embolus,
and atrial fibrillation with embolization
 Nursing Actions:
- Don’t give heparin by IM route
- Minimize venipunctures and injections; apply pressure to all puncture sites
- Inject subQ heparin and enoxaparin into abdomen

2. Thrombolytics
- Activate plasminogen, leading to its conversion to plasmin (clot-degrading
substance)

Drug examples:
- alteplase (Activase)
- reteplase (Retavase)
- streptokinase (Streptase)
- urokinase (Abbokinase)

Indications:
- Lysis of thrombi
- Treatment of massive pulmonary emboli, acute ischemic stroke, and acute MI

DRUGS AND THE ENDOCRINE SYSTEM

1. Antidiuretic Hormones
- Enhance reabsorption of water in kidneys
- Promote vasoconstriction and decreases hepatic blood flow (vasopressin)

Drug examples:
- desmopressin (Stimate)
- vasopressin (Pitressin)

Indications:
- Treat diabetes insipidus
- Treat nocturnal enuresis (nighttime bedwetting) (desmopressin)

Nursing Actions:
- Monitor fluid I and O
- Warn patients to ingest only enough fluid to satisfy thirst (prevents water
intoxication)

2. Antidiabetics

a. Insulin
- Reduces serum glucose level by increasing glucose transport into cells

Drug Examples:
- Rapid-acting insulins:
- insulin aspart (Novolog)
- insulin lispro (Humalog)
- regular insulin (Humulin R, Novolin R, Regular Iletin II)

- Intermediate-acting insulins:
- isophane insulin suspension (NPH [Humulin N, Novolin N)

- Long-acting insulins:
- extended insulin zinc suspension (Ultralente)
- insulin glargine (Lantus)
 Note:
Duration of Insulin:
- Insulin injection (regular): 8 to 12 hours
- Lispro insulin solution: 6 to 8 hours
- Insulin aspart solution: 3 to 5 hours
- Isophane insulin suspension: 24 hours
- Insulin zinc suspension: 24 hours
- Insulin glargine solution: 24 hours
- Extended insulin zinc suspension: 36 hours

b. Oral Hypoglycemics
- Stimulate the pancreas to produce more insulin, ultimately decreasing the
serum glucose Level

Drug examples:
- metformin (Glucophage)
- glimepiride (Amaryl)
- glipizide (Glucotrol)

Indications:
- Treat type 2 diabetes mellitus unresponsive to dietary measures and exercise

Nursing Actions:
- Assess patients for hypoglycaemia and hyperglycemia
DRUGS AND THE IMMUNE SYSTEM

1.Antihistamines
- Block histamine’s effects on body in hypersensitivity or allergic reaction

Drug examples:
- cetirizine (Zyrtec)
- diphenhydramine (Benadryl)
- fexofenadine (Allegra)
- loratadine (Claritin)
- promethazine (Phenergan)

Indications:
- Symptomatic relief of symptoms of seasonal allergic rhinitis in adults and children
- Treatment of chronic, idiopathic urticaria

Urticaria: skin rash: a skin rash, usually occurring as an allergic reaction, that is
marked by itching and small pale or red swellings, and often lasts for
a few days

Nursing Actions:
- Observe for hypersensitivity reactions
- Administer with food or milk
- Withhold before allergy skin test

2. Immunosuppressants
- Alters anti-body formation
- Inhibit activation of lymphocytes
Drug examples:
- antilymphocyte globulin
- azathioprine (Imuran)

Indications:
- Prevent organ transplant rejection

Nursing Actions:
- Maintain isolation precautions as indicated
- Instruct patient to report unusual bleeding and signs of infection

3. Antibacterial drugs

a. Penicillins
- Bactericidal: inhibit synthesis of bacterial cell wall and cause rapid cell lysis

Drug examples:
- amoxicillin (Amoxil)
- amoxicillin/clavolanate (Augmentin)
- ampicillin (Principen)
- ampicillin and sulbactam (Unasyn)

Indications:
- Treat infections

Nursing Actions:
- Obtain an allergy history
- If there’s allergic reaction, discontinue the drug and notify the practitioner
- Instruct patient to avoid taking oral penicillins with acidic juices or carbonated
beverages (may reduce drug absorption)

b. Cephalosporins
- Chemically and pharmacologically similar to penicillins

Drug examples:
- First-generation:
- cefadroxil (Duricef)
- cefazolin (Ancef)
- cephalexin (Keflex)

- Second-generation:
- cefaclor (Ceclor)
- cefoxitin (Mefoxin)
- cefuroxime (Ceftin)

- Third-generation:
- cefdinir (Omnicef)
- cefotaxime (Claforan)
- ceftazidime (Tazicef)
- ceftriaxone (Rocephin)

- Fourth-generation:
- cefepime (Maxipime)
Indications:
- Treat infections

Nursing Actions:
- Obtain an allergy history
- If there’s allergic reaction, discontinue the drug and notify the practitioner

c. Aminoglycosides
- Bactericidal: exact mechanism unclear
- Thought to bind to ribosomal subunits, inhibiting bacterial protein synthesis

Drug examples:
- amikacin (Amikin)
- gentamicin (Garamycin)
- kanamycin (Kantrex)
- streptomycin

Indications:
- Treat septicaemia

Nursing actions:
- Assess for vertigo and hearing loss before and during treatment
- Monitor renal function for evidence of nephrotoxicity
- Promote fluid intake of 1500 to 2000 ml/day to maintain adequate renal function
d. Tetracyclines
- Bacteriostatic: inhibition of bacterial growth and multiplication by a chemical agent

Drug examples:
- demeclocycline (Declomycin)
- doxycycline (Vibramycin)
- oxytetracycline (Terramycin)

Indications:
- Treat Lyme disease (an infectious bacterial disease transmitted by ticks, in
which skin rash, fever, and headache precede arthritis and nervous
disorder)

- Treat gonorrhoea (a sexually transmitted bacterial disease that causes

inflammation of the genital mucous membrane, burning pain when
urinating, and a discharge.
It is caused by a gonococcus bacterium.)

- Treat syphilis (a serious sexually transmitted disease caused by the spirally

twisted bacterium Treponema pallidum that affects many body organs
and parts, including the genitals, brain, skin, and nervous tissue)

Nursing Actions:
- If giving drug IV, monitor IV sites for phlebitis

e. Fluroquinolones
- Broad-spectrum: describes antibiotics or other chemicals that destroy a wide
range of organisms such as bacteria or agricultural pests
Drug examples:
 - ciprofloxacin (Cipro)
- levofloxacin (levaquin)

Indications:
- Treat bone and joint infections, intra-abdominal infections, UTIs

Nursing Actions:
- Administer with 8 ounces of water at least 2 hours before or after patient
takes antacid, calcium, and iron

f.Miscellaneous anti-infectives
- May be bactericidal or bacteriostatic

Drug examples:
- azithromycin (Zithromax)
- chloramphenicol (Chloromycetin)
- clindamycin (Cleocin)
- erythromycin (Erythrocin)
- metronidazole (Flagyl)

Indications:
- Treat severe infections and ampicillin-resistant Haemophilus influenza
infections (chloramphenicol)

Nursing actions:
- Monitor the patient’s renal status
- Maintain adequate hydration to minimize the risk of nephrotoxicity

g. Urinary Tract Antiseptics

- Bacteriostatic: inhibit growth of bacteria in the urine

Drug examples:
- co-trimoxazole (Bactrim)
- sulfadiazine
- sulfisoxazole

Indications:
- Treat infections caused by susceptible organisms in urinary tract

Nursing Actions:
- Assess for signs and symptoms of UTI (urinary frequency and urgency,
burning on urination, and flank pain)

- Make sure patients maintain a fluid intake of 2 to 3L/day to prevent crystalluria

- Instruct woman taking hormonal contraceptives to use an alternative
contraceptive method (barrier method) during the entire course of
therapy)

4. Antifungals
- Kill or inhibit fungal growth
- Inhibiting protein synthesis within fungal cells

Drug examples:
- amphotericin B (Amphocin, Amphotec)
 - ketoconazole (Nizoral)
- nystatin (Mycostatin)

Indications:
- Treat serious systemic fungal infections (amphotericin B)
- Treat oral and vaginal candida infections (clotrimazole, nystatin,

fluconazole) Candida: fungus that can cause yeast infection, especially in

the mouth and vagina.

- Treat ringworm, athlete’s foot (econazole)

Nursing Actions:
- Know that amphotericin B is administered only to hospitalized patient or
those under closed medical supervision
- Administer amphotericin B by infusion pump as ordered

5. Antihelmintics
- Paralyze parasitic worm (helminth)

Drug examples:
- albendazole (Albenza)
- ivermectin (Stromectol)
- mebendazole (Vermox)
- praziquantel (Biltricide)
- thiabendazole
(Mintezol) Indications:
- Treat parasitic worm infections

Nursing Actions:
- Explain that all family members should be evaluated
- Advise the patient to complete the full course of therapy even if symptoms subside.

6. Antivirals
- Inhibit viral replication or prevent viral penetration into host cell
- Most antivirals inhibit transcriptase (enzyme essential for retroviral DNA
synthesis) thereby inhibiting viral replication

Drug examples:
- abacavir sulfate (Ziagen)
- acyclovir (Zovirax)
- amantadine (Symmetrel)

Indications:
- Treat genital herpes simplex (viral skin disease marked by clusters of small
watery blisters, one affecting the area of the mouth and lips and the
other the genitals)

- Treat chickenpox (varicella) (acyclovir and valacyclovir)

- Prevent influenza A viral infection (amantadine and rimantadine)

Nursing Actions:
- Administer IV infusions by infusion pump as prescribed
- Promote abstinence or condom use while lesions are present (genital herpes)
DRUGS AND CANCER

- Cancer drugs or antineoplastics, destroy cancer cells and normal tissues

especially rapidly dividing cells.

- Proliferation: a process of cell renewal and replacement

- In cancer, the proliferation process becomes unbalanced because normal control
mechanisms can’t halt the process.

- Differentiation: a process by which cells diversify, acquire specific structural and

functional characteristics, and mature
- In cancer, cells are poorly differentiated

1. Alkylating drugs
- Affect the synthesis of DNA to inhibit cell production

Drug examples:
- chlorambucil (Leukeran)
- cyclophosphamide (Cytoxan)
- busulfan (Busulfex)
- cisplatin (Platinol-AQ)

Indications:
- Treat cancers including leukemia, brain tumors.

Nursing Actions:
- Ensure safe preparation and handling of antineoplastic drugs.
- Reduce pain with administration by altering the infusion rate
- When administering cisplatin, frequently assess for dizziness, tinnitus,
hearing loss, numbness or tingling of extremities.
- Monitor for phlebitis with IV administration

2. Antitumor Antibiotics
- Interfere with DNA synthesis

Drug examples:
- bleomycin (Blenoxane)
- dactinomycin (Cosmegen)
- epirubicin (Ellence)

Indications:
- Treat carcinoma of the head and neck, lymphomas
- Treat malignant pleural effusions
- Prevent recurrent pleural effusions (bleomycin)

Nursing Actions:
- When administering daunorubicin or idarubicin, assess for signs and
symptoms of heart failure.

3. Antimetabolites
- Replace normal proteins required for DNA synthesis, thereby interfering with
DNA and RNA synthesis.
Drug examples:
- capecitabine (Xeloda)
- methotrexate (Rheumatrex)
- pentostatin (Nipent)

Indications:
- Treat GI carcinomas, breast and cervical carcinomas

Nursing Actions:
- Monitor the patient for bone marrow suppression

DRUGS AND THE GASTROINTESTINAL SYSTEM

1.Antiulceratives

a. Antacids
- Neutralize gastric acid, thereby increasing pH in the GI tract.

Drug examples:
- aluminum hydroxide (Amphojel)
- calcium carbonate (Tums)
- aluminum hydroxide and magnesium hydroxide (Maalox)
- magnesium hydroxide (Milk of magnesia)

Indications:
- Treat indigestion, reflux esophagitis, and peptic ulcers

Nursing Actions:
- Instruct the patient to shake the suspension well
- Instruct the patient to chew chewable tablets thoroughly and then drink half
a glass of water to promote passage to the stomach.
- Assess the patient for epigastric or abdominal pain, frank bleeding, and occult
bleeding.

b. Histamine-2 Receptor Antagonists

- Inhibit gastric acid secretion by inhibiting the action of histamine at
histamine-2 (H2) receptors in gastric parietal cells.

Drug examples:
- cimetidine (Tagamet)
- famotidine (Pepcid)
- nizatidine (Axid)
- ranitidine (Zantac)

Indications:
- Promote healing of duodenal and gastric ulcers
- Decrease gastric acid production and prevent stress ulcers
- Treat heartburn, acid indigestion

Nursing actions:
- Don’t give an antacid within one hour of administering H 2-receptor
antagonists, may decrease absorption of drug.
- Assess the patient for epigastric or abdominal pain, frank bleeding, and occult
bleeding.
 c. Proton Pump Inhibitors
- Block gastric acid secretions by inhibiting acid pump in gastric parietal cells

Drug examples:
- esomeprazole (Nexium)
- iansoprazole (Prevacid)
- omeprazole (Prilosec)
- pantoprazole (Protonix)

Indications:
- Treat erosive esophagitis and GERD
- Treat duodenal ulcer
- Short-term treatment of active gastric ulcer

Duodenal ulcer Gastric ulcer

Age = 30-60 Age = 50 and over

Male:Female = 2-3:1 Male: female= 1:1
80%of peptic ulcers are duodenal 15% of peptic ulcers are gastric

Signs and Symptoms: Signs and Symptoms:

- Hypersecretion of HCL - Hyposecretion of HCL

- May have weight gain - Weight loss may occur
- Pain occurs 2-3h after a meal - Pain occurs ½ to Ih after a meal
- often awakened 1-2 AM - rarely occurs at night
- ingestion of food relieves pain - may be relieved by vomiting
- Vomiting uncommon - ingestion of food does not help, sometimes increase
- Hemorrhage less likely than with pain
gastric ulcer, but if present, - Vomiting common
melena more common than - Hemorrhage more likely to occur. Hematemesis
hematemesis common than melena.

Nursing Actions:
- Administer 1 hour before meals
- Teach patient to swallow capsules whole

2. Antiemetics
- Increases the rate of gastric emptying and enhances gastroesophageal sphincter
tone

Drug examples:
- metoclopramide (Reglan)
 - aprepitant (Emend)
- dimenhydrinate (Dramamine)
- droperidol (Inapsine)

Indications:
- Manage nausea and vomiting associated with chemotherapy (aprepitant)
- Promote gastric emptying in patients receiving tube feedings (metoclopramide)
- Prevent vomiting during surgery (droperidol)

Nursing Actions:
- Assess patient for nausea and vomiting
- Instruct patient not to consume alcohol when taking an antiemetic to prevent
additive CNS depression.

3. Antidiarrheals
- Slow intestinal motility
- Reduce fluid content of stools

Drug examples:
- bismuth (Pepto-Bismul)
- loperamide (Imodium)
- polycarbophil (FiberCon)

Indications:
- Control and relieve symptoms of acute or chronic nonspecific diarrhea

Nursing Actions:
- Assess patient’s skin turgor and monitor fluid and electrolyte balance for
evidence of dehydration
- Assess for abdominal pain and distention

4. Laxatives

Bulk-forming laxatives – Increase water content of stools, forming a viscous solution

that
promotes peristalsis

Lubricant laxatives – Increase water retention in stools

- Lubricate and soften intestinal contents

Hyperosmotic laxatives – Increase water content of stools and

soften stools.

Saline cathartic laxatives – Draw water into bowel, increasing the bulk of intestinal
contents
and stimulating peristalsis

Stimulant laxatives – Stimulate peristalsis

Stool softener – Allow more fluid and fat to penetrate feces, producing a softer fecal
mass

Drug examples:
Bulk-forming laxatives: - methylcellulose (Citrucel)
- polycarbophil (Fiber-Con)
 Lubricant laxatives – mineral oil (Fleet Mineral Oil

Enema) Hyperosmotic laxatives – lactulose

(Cephulac)

Saline cathartic laxatives – magnesium hydroxide (Milk of Magnesia)

Stimulant laxatives – bisacodyl (Dulcolax)

- castor oil
- senna (Senokot)

Stool softener – docusate calcium (Surfak)

- docusate sodium (Colace)

Indications:
- Treat or prevent constipation
- Prepare bowel for radiologic or endoscopic procedures

Nursing Actions:
- Assess for abdominal pain and distention
- Evaluate stools for frequency and consistency
- Monitor patient for fluid and electrolyte imbalances

DRUGS AND THE REPRODUCTIVE SYSTEM

1. Androgens
- Replace deficient hormones or treat hormone-sensitive disorders
- Stimulate production of RBC

Drug examples:
- danazol (Danocrine)
- testolactone (Teslac)
- testosterone (Androderm)

Indications:
- Treat hypogonadism (gonad: an organ that produces reproductive cells gametes,
e.g. a
testis or an ovary)
- Treat delayed puberty
- Treat endometriosis (endometriosis: a medical condition in which the mucous
membrane
endometrium that normally lines only the womb is present
and functioning in the ovaries or elsewhere in the body)

Nursing Actions:
- Testosterone must be administered IM only
- Warn women that androgen therapy may cause hoarseness, deeper voice,
facial hair, acne, and menstrual irregularities
- Instruct the female patient to use a nonhormonal contraceptive (barrier
method) during therapy)
2. Hormonal Contraceptives
 - Suppress production and release of gonadotropin, thereby inhibiting ovulation.

Gonadotropin: a hormone secreted by the pituitary gland and in some mammals

by the placenta during pregnancy, that influences gonadal activity.

Drug examples:
- ethinyl estradiol and desogestrel (Apri)
- ethinyl estradiol and drospirenone (Yasmin)

Indications:
- Prevent pregnancy in females
- Treat moderate acne in females older than age 15 (Ortho Tri-Cyclen)

Nursing Actions:
- Instruct the patient to take drug at the same time everyday.

3. Estrogens and Progestins

- Restore hormonal balance and treat hormone-sensitive tumors

Drug examples:
- conjugated estrogenic substances (Premarin)
- medroxy-progesterone (Provera)

Indications:
- Provide contraception
- Treat hormonal deficiencies
- Regulate or restore the menstrual cycle

Nursing Actions:
- Explain the importance of complying with therapy
- Warn the patient not to smoke while taking these drugs; smoking increases
the risk of thromboembolism

4. Fertility Drugs (Ovulation Stimulants)

- Stimulate ovarian function by increasing levels of pituitary gonadotropins

Drug examples:
- choriogonadotropin alfa (Ovidrel)
- follitropin alfa (Gonal-f)
- urofollitropin (Bravelle)

Indications:
- Treat infertility secondary to anovulation
- Treat infertility in females with polycystic ovary syndrome (urofollitropin)

Nursing Actions:
- Instruct the importance of complying with therapy.
- Warn of the risk of ovarian hyperstimulation syndrome and multiple births

5. Abortifacients
- Compete with progesterone resulting in inactivity of progesterone and
termination of pregnancy.
Drug examples:
- mifepristone (Mifeprex)
- misoprostol (Cytotec)
- dinoprostone (Prostin E2)

Indications:
- Termination of pregnancy
- Uterine content evacuation
- Management of benign hydatidiform mole (dinoprostone)

Nursing Actions:
- Warn the patient that surgical intervention may be needed in cases of
incomplete abortion or severe bleeding
- Explain to the patient that she may experience bleeding or spotting for 9 to 16
days or up to 30 days after treatment.

6. Oxytocic Drugs
- Enhance uterine motility by directly stimulating uterine and smooth muscle
contraction

Drug examples:
- ergonovine maleate (Ergotrate Maleate)
- oxytocin (Pitocin, Syntocinon)

Indications:
- Manage postpartum haemorrhage
- Promote labor, induce therapeutic abortion

Nursing Actions:
- Oxytocin is given by IV infusion only when inducing labor
- Monitor the fetal heart rate

7. Labor Suppressants (Uterine Relaxants)

- Relax uterine muscles and decrease uterine contractions

Drug example:
- terbutaline (Brethine)

Indication:
- Prevent premature labor from 29 to 36 weeks of gestation

Nursing Actions:
- Place the patient in a left lateral recumbent position to promote venous return to
heart and decrease hypotension
- Monitor patient and fetus closely

8. Erectile Dysfunction Drugs

- Promote blood flow into the corpus cavernosum

corpus cavernosum : columns of erectile tissue at either side of the penis that produce
an erection when filled with blood

Drug examples:
 - alprostadil (Caverject)
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra)

Indication:
- Treat erectile dysfunction

Nursing Actions:
- Instruct the patient to take the drug 30 minutes to 4 hours before anticipated
sexual activity
- Inform the patient to tell all his health care providers he’s taking an erectile
dysfunction drug.

DRUGS AND THE INTEGUMENTARY SYSTEM

1. Topical drugs

Emollients: Allow skin to retain water

Debriding and wound-healing agents: Digest necrotic collagenous tissue, thereby

removing substances necessary for bacterial growth

Antipruritics: Relieve itching of skin and mucous membranes

Acne products: Clean and dry skin, reduce bacteria that cause
infection Drug examples:
Emollients:
- Lanolin
- Mineral oil

Debriding and wound-healing drugs:

- becaplermin (Regranex)
- trypsin (Granulex)

Antipruritics:
- Calamine lotion
- oatmeal (Aveeno)

Acne products:
- clindamycin (Cleocin T)
- erythromycin (Eryderm)
- benzoyl peroxide
- isotretinoin (Accutane)

Indications:
- Lubricate and moisturize skin to treat dryness and itching
- Fight bacterial skin infections
- Treat pruritus and acne vulgaris

Nursing Actions:
- Before applying a topical drug, assess skin and remove remains or
previously applied Medication
- Use sterile technique when applying medications to open lesions
DRUGS AND THE SENSORY SYSTEM

1. Ophthalmic drugs

Lubricants: Replace tears or add moisture to the eye

Miotics: Reduce IOP

Mydriatics and cyclopegics: Dilate and paralyze pupil (mydriatics: for eye

surgery) Drug Examples:

Lubricants: hydroxypropyl methylcellulose (Lacrisert)

Miotics: carbachol (Carboptic)

Mydriatics and cyclopegics: atropine (Isopto Atropine)

Nursing actions:
- Assess for eye disorders
- Wait at least 5 minutes before instilling a second medication
- Keep all medications sterile
- Inform patient receiving mydriatic or cyclopegic that dark glasses may be
needed after eye Examination to prevent photophobia
- Minimize systemic absorption by applying pressure to lacrimal sac on inner
canthus for 3 to 5 minutes

2. Otic drugs

Ceruminolytics: Emulsify and loosen cerumen (earwax)

deposits. Anti-infectives: Kill bacteria

Anti-inflammatories: Reduce redness and

itching Drug examples:

Anti-infectives and anti-inflammatories: Boric

acid Ceruminolytics: carbamide peroxide

(Debrox)

Nursing actions:
- Assess for hearing loos, drainage, and pain
- Use the correct method to instill ear drops
- Instruct patient to keep head tilted for 10 minutes to allow drug to be absorbed
- Instruct patient how to administer a ceruminolytic:
*Moisten a cotton ball with medication before insertion.
*Don’t use a swab because it may cause trauma
*Flush ear gently with warm water using a soft rubber bulb ear syringe
within 30 minutes to remove cerumen