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PHARMACOLOGY a. immediately notify the nursing supervisor, the prescribing physician,

Pharmacology and the
- most simply defined as study of drug. pharmacist.
b. assess the client’s condition and provide any necessary care.
Fundamentals of Pharmacology 9. For postpartum women, advice to take drugs after breastfeeding.
1. Pharmacokinetics Administration of Drugs :
- study of drug’s changes as it enters and passes through the body.
a. absorption Routes and Nursing considerations:
b. distribution 1. Enteral – oral, sublingual, rectal, gastric tubes
c. biotransformation - capsulated pill, sustained release and enteric coated should not be
d. excretion crushed.
2. Parenteral – IV, IM, SQ, ID, IT, IA, epidural.
2. Pharmacodynamics - vastus lateralis (safest site for IM)
- mechanism by which drugs produce changes in body tissue. 3. Topical – skin, inhalants, mucus membrane.
a. desired effect - intended action of drugs
b. adverse effect - harmful unintended reactions Eye medications :
c. side effects – consequence reactions - administer eyedrops first then ointment.
d. toxicity – the degree which something is poisonous - use a separate bottle for each client.
digoxin = 0.5 – 2.0 ng/mL - instruct the client to tilt the head backward, open eyes and look up.
lithium = 0.5 – 1.5 mEq/L - avoid contact of medication bottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
Safety and Efficacy - instruct the client to press the inner canthus for 30-60 seconds.
Nursing Principles : - instruct the client to close the eye gently.
1. Always verify the Five Rights .
a. the right medications Ear drops
b. the right client - in infant and children younger than 3 y.o, pull pinna downward and
c. the right dosage backward.
d. the right form, route and technique - in older children and adult, upward and backward.
e. the right time - direct the solution on the wall of the ear canal, not directly on the ear
2. Chart drug administration only after its been given, never before. drum.
3. Never leave the medication on cart or tray unattended.
4. Chart observed therapeutic and adverse effects accurately and fully. CLASSIFICATIONS OF DRUGS
5. Check history for allergies and potential drug interactions before
administering a DRUGS AFFECTING THE CENTRAL AND AUTONOMIC
newly ordered drug. SYSTEM
6. Inform the prescribing physician of any observed adverse effects; if
cannot be Cholinergic Agents (Parasympathomemitics)
located, inform the nursing supervisor Prototype :
7. Question drug orders that are unclear, that appear to contain errors, or that - synthetic acetylcholine, pilocarpine, carbachol, bethanecol (Urocholine),
have edrophonium (Tensilon), neostigmine (Prostigmine), pyridostigmine
potential to harm. (Mestinon).
8. Take the following actions if an error occurs : Mechanism of action :
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- stimulates cholinergic receptors by mimicking acetylcholine or - epinephrine, norepinephrine, ephedrine, dopamine, dobutamine,
inhibition of phenylephrine,
enzyme cholinesterase. terbutaline, albuterol, isoproterenol.
Indications : Mechanism of actions :
- glaucoma, urine retention, Myasthenia Gravis - stimulate alpha and beta adrenergic receptor directly or trigger the
- antidote to neuromuscular blocking agents : tricyclic antidepressants release of
and atropine catecholamines indirectly causing sympathetic effects.
Adverse effects : Indications :
- blurring of vision, miosis - cardiopulmonary arrest, hypotension
- increase in salivation, intestinal cramps - COPD and asthma, nasal congestions
- bronchoconstriction, wheezing, DOB - allergic reaction, anaphylactic shock
- hypotension and bradycardia Adverse effects :
Nursing considerations : - restlessness, insomnia, tremors, nausea
1. Warn & monitor clients of the side effects. - palpitations, angina, tachycardia, HPN
2. Have atropine available for use as antidote. Nursing considerations :
1. Contraindicated in clients w/ hyperthyroidism,
Cholinergic Blocking Agents (Parasympatholytics, Anticholinergics) pheochromocytoma & cardiovascular disease.
Prototype : 2. Monitor vital signs and advice precautions.
- atropine, scopalamine (Triptone), dicyclomine (Bentyl), 3. Should be taken with food.
propantheline (Pro-Banthine).
Mechanism of actions : ADRENERGIC BLOCKING AGENTS
- block the binding of acetylcholine in the receptors of parasympathetic Prototype :
nerves. a. Alpha blockers
Indications : - phentolamine (Regintine), phenoxybenzamine, prazosin (Minipress),
- use preoperatively to dry up secretions. reserpine (Serpasil), terazosin (Hytrin)
- treat spasticity of GI or urinary tract. - clonidine (Catapress), methyldopa (Aldomet)
- use for treatment of bradycardia, asthma, parkinsonism. b. Beta blockers
- use for antidote in organophosphate poisoning. - atenolol (Tenormin), esmolol (Brevibloc),
Adverse effects : metoprolol (Lopressor), nadolol (Corgard),
- dry mouth , dilatation of pupils, tachycardia propanolol (Inderal), timolol ( Blocadren)
- urinary retention, ileus, heat stroke Mechanism of actions :
Nursing considerations : a. alpha blockers
1. Keep client’s in cool environment. - inhibits action of a-receptors in vascular smooth muscle to cause
2. Watch out for signs of heatstroke and dehydration. vasodilatation.
3. Encourage clients to increase fluid intake and use of sugarless b. beta blockers
gum/candy for dry - compete with epinephrine in b-receptors in heart, pulmonary airways,
mouth. peripheral
4. For GI spasticity, administer 30 minutes before meals and at bed time. circulation and CNS.
Indications :
Adrenergic Agents (Sympathomimetics) - Raynaud’s disease, hypertension, pheochromocytoma.
Prototype : - angina, arrhythmias, mitral valve prolapse, glaucoma
Adverse effects :
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- orthostatic hypotension, bradycardia, CHF

- depression, insomnia and vertigo ANTICONVULSANTS
- bronchospasm and dyspnea, nasal stuffiness, cold extremities Prototype :
Nursing considerations : a. Hydantoins - phenytoin (Dilantin)
1. Administer oral alpha-blockers with milk to minimize GI side effects. b. Barbiturates - phenobarbital ( Luminal)
2. Administer oral beta-blockers before meals and at a.m. if insomnia c. Miscellaneous
occurs. - carbamazepine (Tegretol), diazepam, clorazepate (Tranxene),
3. Check client’s apical pulse rate before drug administration, refer if below valproic acid (Dapakene), ethosuximide (Zarontin).
60 bpm. Mechanism of action :
4. Hypotensive precautions. - treat seizures by depressing abnormal neuronal activity in motor
5. Warn clients not to drive or operate dangerous machinery until he/she cortex.
has Adverse effects :
adjusted to medications. - sedation & drowsiness, gingival hyperplasia
- diplopia, nystagmus, vertigo, dizziness
- thrombocytopenia, aplastic anemia
SKELETAL MUSCLE RELAXANTS AGENTS Nursing considerations :
Prototype : 1. Advise female clients to use contraceptives.
- methacarbamol (Robaxin), baclofen (Lioresal), dantrolene (Dantrium), 2. Inform clients taking phenytoin that harmless urine discoloration is
metaxalone (Skelaxin), orphanedrine (Norgesic), chlorzoxazone common.
Mechanism of actions: 3. Warn clients with diabetes that hydantoins may increase blood sugar
- depress CNS level and that
- inhibit calcium ion release in the muscle valproic acid may produce a false positive result in urine ketone test.
- enhance the inhibitory action of GABA (gamma-amino butyric acid) 4. Teach clients receiving carbamazepine to identify symptoms of bone
Indications : marrow
- for acute musculoskeletal pain depressions.
- for muscle spasticity associated with multiple sclerosis, cerebral palsy, 5. Reassure that barbiturates are not addictive at a low dosage.
CVA, and 6. Avoid taking alcohol with barbiturates.
spinal cord injury. 7. Administer IV phenytoin slowly to avoid cardiotoxicity.
Adverse effects : 8. Avoid mixing other drugs in same syringe with phenytoin.
- hypotonia, ataxia, hypotension, drowsiness
- blurred vision, bradycardia, depression, urine retention

ANTIPARKINSONIAN AGENTS
Nursing considerations : Prototype :
1. Caution clients that mental alertness may be impaired. a. Anticholinergic agents
2. Monitor neuromuscular status, bowel and bladder functions. - trihexyphenidyl (Artane), benztropine (Congentin)
3. Inform clients that maximum benefit of baclofen is attained for 1-2 b. Dopaminergic agents
months. - Levodopa, carbidopa-levodopa (Sinemet), amantidine (Symmetrel),
4. Reduce baclofen dosage gradually because of associated withdrawal pergolide (Permax), selegiline (Eldepryl), bromocriptine.
symptoms : Mechanism of actions :
Confusion, hallucinations, paranoia & rebound spasticity. a. anticholinergic agents
- inhibit cerebral motor centers.
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b. dopaminergic agents Sedatives, Hypnotics, and Anxiolytics

- increasing dopamine concentrations or Prototype :
enhancing neurotransmitter functioning. a. Benzodiazepines
Adverse effects of dopaminergic agents: - diazepam (Valium), lorazipam (Ativan),
a. levodopa – nausea, vomiting, anorexia, orthostatic hypotension, alprazolam (Xanax), flurazepam (Dalmane)
dark-colored urine and sweat b. Barbiturates
b. amantidine – ankle edema, constipation - amobarbital, phenobarbital, secobarbital
c. bromocriptine – palpitations, tachycardia c. Miscellaneous
Nursing considerations : - chloral hydrate (Noctec), buspirone (Buspar), paraldehyde (Paral)
1. Give dopaminergic agents after meals to reduce GI symptoms. Mechanism of actions :
2. Reassure client that levodopa may cause harmless darkening of urine and a. Benzodiazepines
sweat. - increase the effect of inhibitory neuro transmitter GABA
3. Avoid taking Vit B6 (pyridoxine) with levodopa because it speed up (gamma-amino butyric acid)
metabolism. b. Barbiturates and Miscellaneous agents
4. Educate clients to minimize orthostatic hypotension. - depress CNS
5. Elevate leg to reduce ankle edema. Indications :
- induce sleep, sedate and calm clients

CENTRAL NERVOUS SYSTEM STIMULANTS Adverse effects :

Prototype : - hangover-effect, dizziness, CNS depression
- amphetamines, methylphenidate (Ritalin) - respiratory depression, drug-dependence
Mechanism of actions : Nursing considerations :
- increase excitatory CNS neurotransmitter activity and blocks inhibitory 1. Warn clients of injuries and falls.
impulses. 2. Brief period of confusion and excitement upon waking up is common
Indications : with
- for obesity (amphetamines) benzodiazepines.
- attention deficit hyperactivity disorders 3. Warn clients not to discontinue medications abruptly without consulting
- narcolepsy a physician.
- drug-induced respiratory depressions. 4. Avoid alcohol while taking these drugs.
Adverse effects : 6. Rotate and don’t shake the ampules of barbiturates. Don’t mix with
- nervousness, insomnia, restlessness other drugs.
- hypertension, tachycardia, headache 7. Warn female clients that diazepam is associated with cleft lip.
- anorexia, dry mouth.
Nursing considerations :
1. Should be given at morning. ANTIDEPRESSANTS AND MOOD DISORDER DRUGS
2. Don’t stop amphetamine abruptly to avoid withdrawal symptoms. Prototype :
3. Monitor blood pressure and pulse. a. Tricyclic antidepressants
4. Ice chips or sugarless gum for dry mouth. - amitriptyline (Elavil), protriptyline (Vivactil),
5. Watch out for growth retardation in children taking methylphenidate. - imipramine (Tofranil), desipramine
b. MAO (monoamine oxidase inhibitors )
DRUGS AFFECTING MENTAL FUNCTIONING - isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Pernate)
c. Second-generation antidepressants
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- fluoxetine (Prozac), trazodone (Desyrel) - chlorpromazine (Thorazine),

d. Lithium - trifluoperazine (Stelazine),
Mechanism of actions : - thioridazine (Mellaril)
a. Tricyclic antidepressants b. Other Agents
- increase receptor sensitivity to serotonin and/or norepinephrine. - clozapine (Clozaril), haloperidol (Haldol)
b. MAO inhibitors Mechanism of action :
- inhibit the enzyme MAO that metabolize the neurotransmitters - block dopamine receptor in the limbic system, hypothalamus, and
norepinephrine and other regions of the brain.
serotonin. Adverse effects :
c. Second – generation antidepressants - Extra pyramidal symptoms such as dystonia, pseudoparkinsonism, and
- inhibits the reuptake of serotonin. an irreversible tardive dyskinesia as manifested by :
d. Lithium a. lip smacking
- increase serotonin & norepinephrine uptake b. fine wormlike tongue movement
Adverse effects : c. involuntary movements of arms and leg.
- dry mouth, blurred vision, urine retention, constipation (anticholinergic - Neuroleptic malignant syndrome
effects) a. fever, tachycardia, tachypnea, diaphoresis, cardiovascular collapse
- orthostatic hypotension, insomnia b. muscle rigidity, seizures.
- hypertensive crisis (MAO) - orthostatic hypotension
- dehydration (Lithium).
Nursing considerations : Nursing considerations :
1. Caution client to rise slowly to reduce the effects of orthostatic 1. Teach family members the signs of EPS and NMS, and report to
hypotension. physician
2. Take antidepressant with food to enhance absorption immediately.
3. Explain to client that full response may take several weeks (2 weeks). 2. Normalization of symptoms may not occur for several weeks after
4. Assess client for constipation resulting from tricyclic antidepressant use. beginning of
therapy .
5. Client taking MAO inhibitors should avoid tyramine-rich foods to avoid 3. Avoid administering haloperidol intravenously
hypertensive crisis. 4. Watch out of neutropenia with clozapine.
- aged cheese, sour cream, yogurt, beer, wine, chocolate, soy sauce and 5. Watch out for orthostatic hypotension and photosensitivity with
yeast phenothiazine.
- pentholamine (Regintine) is the drug of choice for hypertensive crisis. 6. Be sure that oral doses are swallowed, and not hoarded.
6. Inform physician and withhold fluoxetine if client develop rashes.
7. Take lithium with food to reduce GI effects
- > 1.5 mEq/L blood level may cause toxicity manifested by: DRUGS USED IN PAIN MANAGEMENT
confusion, lethargy, seizures,hyperreflexia.
- maintain salt and adequate fluid intake General Anesthetics
- tremors may occur but it is temporary Prototype :
- monitor white blood cell count (increase). a. Inhalation anesthetics
- enflurane (Ethrane), halothane
ANTIPSYCHOTIC DRUGS (NEUROLEPTICS) - isoflurane (Forane), nitrous oxide
Prototype : b. Injection anesthetics
a. Phenothiazines - fentanyl (Sublimaze), ketamine (Ketalar),
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thiopental Na (Penthotal), etomidate (Amidate) ibuprofen (Motrin), naproxen, ketoprofen (Orudis),

Mechanism of actions : ketorolac.
- cause CNS depression, by producing loss of consciousness, paracetamol and acetaminophen (Tylenol)
unresponsiveness to pain Mechanism of actions :
stimuli, and muscle relaxation. a. Narcotic analgesics
Nursing considerations : - alter pain perception by binding to opiod receptors in CNS.
1. Instruct client NPO for 8 hours before administration. b. Non- narcotic analgesic
2. Monitor cardio pulmonary depression and hypotension. - relieves pain and fever by inhibiting the prostaglandin pathway.
3. Monitor urinary retention. Nursing considerations :
4. Monitor body temperature 1. Monitor respiratory depression & hypotension in clients taking narcotic
- malignant hyperthermic crisis : analgesic.
dantrolene (antidote) 2. Injury and accident precautions in clients taking narcotic analgesic.
5. Avoid alcohol or CNS depressants for 24 hours after anesthesia. 3. Warn clients about possibility of dependency,and do not discontinue
6. In patient who received halothane, monitor signs of hepatic fatal side narcotics
effects : abruptly in the narcotic-dependent clients.
- rash, fever, nausea, vomiting 4. Naloxone is antidote for narcotic overdose.
- jaundice and altered liver function. 5. Advice clients to take NSAIDs with food and monitor bleeding
complications.
6. Aspirin is contraindicated in clients below 18 years old with flu-like
LOCAL AND TOPICAL ANESTHETIC symptoms.
Prototype : 7. Monitor hearing loss in clients taking aspirin.
local : bupivacaine, lidocaine, tetracaine, procaine, mepivacaine, 8. Monitor liver function in clients taking acetaminophen.
prilocaine 9. N-acetylcysteine is antidote for paracetamol overdose.
topical : benzocaine, butacaine, dibucaine,lignocaine
Mechanism of action : DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM
- block transmission of impulses across nerve cell membrane.
Adverse effects : ANTICOAGULANTS
- cardiac dysrhythmias Prototype :
Nursing considerations : - Heparin (SQ and IV)
- lignocaine + prilocaine (EMLA cream) should be applied topically 60 Warfarin (Orally)
minutes before Mechanism of actions :
procedure. a. Heparin
- administer cautiously to the areas of large broken skin. - prevents thrombin from converting fibrinogen to fibrin.
- observe for fetal bradycardia in pregnant clients. b. Warfarin
- suppress coagulation by acting as an
ANALGESICS antagonist of vitamin K after 4-5 days.
Prototype :
a. Narcotic analgesics Indications :
- codeine, meperidine (Demerol) morphine, butorphanol (Stadol) - thrombosis, pulmonary embolism, myocardial infarction
nalbuphine (Nubain) Adverse effect :
b. Non – narcotic analgesic - bleeding
NSAIDs – aspirin (aminosalicylic acid), mefenamic acid (Ponstan), Nursing considerations :
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1. HEPARIN sodium
- if given SQ don’t aspirate or rub the injection site (above the scapula - CARDIAC GLYCOSIDES
best site). Prototype:
- therapeutic level 1.5-2.5 times normal PTT; - digoxin (Lanoxin) and digitoxin (Crystodigin)
normal PTT is 20-35 sec. = 50-85 sec. Mechanism of actions :
- antidote : (protamine sulfate) - increase intracellular calcium, which causes the heart muscle fibers to
contract more
2. WARFARIN sodium (coumadin) efficiently, producing positive inotropic & negative chronotropic action.
- warfarin is used for long-term . Indications :
- onset of action is 4-5 days. - use for CHF, atrial tachycardia and fibrillation
- therapeutic level is 1.5-2.5 times normal PT; Nursing considerations :
normal PT = 9.6 -11.8 sec. = 25 - 30 sec. - Monitor for toxicity as evidence by :
INR = 2 - 3 nausea, vomiting, anorexia, halo vision, confusion, bradycardia and
- should be taken at the same time of the day to maintain at therapeutic heart blocks .
level. - Do not administer if pulse is less than 60 bpm.
- reduce intake of green leafy vegetables. - Should be caution in patient with hypothyroidism and hypokalemia.
- antidote : Vitamin K ( Aquamephyton) - Antidote : Digi-bind
- Phenytoin is the drug of choice to manage
THROMBOLYTICS digitalis-induced arrhythmia.
Prototype : Nitrates
Streptokinase, Urokinase Prototype :
Mechanism of actions : - isosorbide dinitrate (Isordil)
- activates plasminogen to generates plasmin (enzyme that dissolve - nitroglycerine (Deponit, Nitrostat)
clots). Mechanism of action :
Indications : - produce vasodilatation including coronary artery.
- use early in the course of MI (within 4-6 hours of the onset) Indications :
Nursing considerations : - angina pectoris, MI, peripheral arterial occlusive disease.
- monitor bleeding Adverse effects:
- antidote : Aminocarpic acid - headache, orthostatic hypotension .

Antiplatelet Medications Nursing Considerations :

Prototype: aspirin, Dipyridamole (Persantin) 1. Transdermal patch
Clopidoigrel (Plavix), Ticlopidine - apply the patch to a hairless area using a new patch and different site
Mechanism of action : each day.
- inhibit the aggregation of platelet thereby prolonging bleeding time. - remove the patch after 12-24 hours, allowing 10-12 hours “patch free”
Indications : each day to
- used in the prophylaxis of long-term complication following M.I, prevent tolerance.
coronary 2. Sublingual medications :
revascularization, and thrombotic CVA. - note the BP before giving the medication.
Nursing considerations : - offer sips of water before giving because dryness may inhibit absorption.
- Monitor bleeding time ( NV = 1-9 mins) - one tablet for pain and repeat every 5 mins. for a total of three doses; if
- Take the medication with food. not relieved
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after 15 mins., seek medical help. Angiotensin-Converting Enzyme (ACE) Inhibitors

- stinging or burning sensation indicates that the tablet is fresh. Prototype :
- instruct patient not to swallow the pill captopril (Capoten), enalapril (Vasotec), quinapril, lisinopril
- sustained release medications should be swallowed and not to be crush. Mechanism of actions :
- protect the pills from light. - prevent peripheral vasoconstriction by blocking conversion of
angiotensin I to
angiotensin II decreasing peripheral resistance.
ANTI-ARRHYTHMIC DRUGS Adverse effect :
Class I (block Na channels) - it cause hyperkalemia
IA - quinidine, procainamide - induce chronic cough
IB - lidocaine Nursing considerations :
IC - flecainamide - not to discontinue medications because it can cause rebound
Class II (Beta-blockers) hypertension.
propanolol, esmolol - avoid using K+ sparing diuretics.
Class III (block K channels)
amiodarone, bretylium CALCIUM-CHANNEL BLOCKERS
Class IV (block Ca channels) Prototype :
verapramil, diltiazem - Nifedipine (calcibloc, adalat), Amlodipine (norvasc), Felodipine
Nursing considerations : (Plendil)
1. Watch out for signs of CHF. Verapramil (Isoptin)
2. Have client weigh themselves and report Mechanism of action :
weight gain. - decrease cardiac contractility and the workload of the heart, thus
3. Watch out for signs of lidocaine toxicity : decreasing the
- confusion and restlessness need for O2.
- it also promote vasodilatation of the coronary and peripheral vessels.
ANTILIPEMICS Indications :
Prototype : - hypertension, angina, arrhythmia
a. cholesterol-lowering agents Adverse effects :
- cholestyramine, colestipol, lovastatin - bradycardia, hypotension, headache
b. triglyceride-lowering agents - reflex tachycardia, constipation
- gemfibrozil, clofibrate Nursing considerations :
Mechanism of actions : - Administer between meals to enhance absorption.
- interfere with cholesterol synthesis as well as - Take client’s pulse rate before each dose, withhold if pulse is below 60
decreasing lipoprotein & triglyceride synthesis. bpm.
Nursing considerations : - Refer for signs of congestive heart failure.
- monitor liver functions while using statins.
- prevent constipation, flatulence, cholelithiasis DIURETICS
- encourage increase fluid and fiber intake. - usually given at morning
CARBONIC ANHYDRASE INHIBITORS
- Acetazolimide (Diamox)
ANTI – HYPERTENSIVE - increase Na+, K+, & HCO3 secretion, along with it is H2O
- metabolic acidosis
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OSMOTIC DIURETIC
- Mannitol
- Increase osmotic pressure of the glomerular filtrate.
- hypotension
THIAZIDE DIURETICS
- hydrochlorothiazide GLUCOCORTICOIDS (CORTICOSTEROIDS)
- blocks Na and K reabsorption; reabsorb Ca Prototype :
- hypercalcemia - dexamethasone, budesonide, fluticasone, prednisone, beclomethasone.
LOOP DIURETICS Mechanism of actions :
- Furosemide (Lasix) - act as anti-inflammatory agents and reduce edema of the airways, as
- blocks Na, K, and Ca reabsorption well as
- hypocalcemia pulmonary edema.
POTASSIUM SPARING DIURETICS Adverse effects :
- Spironolactone (Aldactone) - Cushing’s syndrome, neutropenia. osteoporosis
- excrete Na and water but it reabsorb K Nursing considerations :
- hyperkalemia - Take drugs at meal time or with food.
- Eat foods high in potassium, low in sodium.
- Instruct client to avoid individuals with RTI.
RESPIRATORY MEDICATIONS - Instruct client not to stop medication abruptly, it should be tapered to
prevent
Bronchodilators adrenal insufficiency
Prototype : - Avoid taking NSAID while taking steroids.
Symphatomimetic Xanthines - Take inhaled bronchodilators first before taking inhaled steroids, and rinse
- albuterol, salbutamol - aminophylline mouth
- isoproterenol, salmeterol - theophylline after using.
- terbutaline

Mechanism of actions: MAST CELL STABILIZERS

- sympathomimetic (b-receptor agonist) bronchodilators, dilate airways. Prototype : cromolyn sodium (Intal)
- xanthine bronchodilators, stimulate CNS for respiration. Mechanism of action :
Indications : - stabilize mast cells that release histamine triggering asthmatic attacks.
- bronchospasm, asthma, bronchitis, COPD. Nursing Consideration:
Adverse effects : - Should be given before asthmatic attacks.
- palpitations and tachycardia - Administer oral capsule at least 30 mins before meals for better
- restlessness, nervousness, tremors absorption.
- anorexia, nausea and vomiting, headache, dizziness. - Drink a few sips of water before & after inhalation to prevent cough &
Nursing considerations : unpleasant taste
- Contraindicated hyperthyroidism, cardiac dysrhythmia, or uncontrolled - Assess for lactose-intolerance.
seizure
disorder. ANTI-HISTAMINES (H-1 BLOCKERS)
- Should be used with caution in patient with HPN and narrow-angle Protoytype :
glaucoma. - Astemizole (Hismanal), Loratidine (Claritin),
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Brompheniramine (Dimetapp), - given on an empty stomach with 8 0z. of water, 1 hour before or 2 hours
Diphenhydramine (Benadryl), after meals
Cetirizine (Iterax), Celestamine (Tavist). and avoid taking antacids with medications.
Mechanism of action : - hepatotoxic thus avoid alcohol.
- decrease nasopharyngeal secretions and decrease nasal itching by - instruct the client that urine, feces, sweat, and tears will be red-orange in
blocking histamine color.
in H1-receptor.
Indications : Pyrazinamide
- common colds, rhinitis, nausea and - given for 2 months.
vomiting, urticaria, allergies and as sleep aid. - increase serum uric acid and cause photosensitivity.
Nursing Considerations :
- Administer with food and drink. Ethambutol
- Given IM via Z-track method or orally. - contraindicated in children under 13 years old.
- Precautions in handling machine and driving while taking these drugs. - obtain a baseline visual acuity because it can cause optic neuritis.
- Ice chips or candy for dry mouth - Instruct the client to notify the physician immediately if any visual
problems occurs.
ANTI-TUBERCULOSIS Streptomycin
Prototype : - aminoglycoside antibiotic given IM.
First line Second line - nephrotoxic and ototoxic.
- Isoniazid (INH) - Cycloserine - obtain baseline audiometric test and repeat every 1-2 months because the
- Rifampicin (Rifadin) - Kanamycin medications impairs the CN VIII.
- Ethambutol - Ethonamide
- Pyrazinamide - Para-aminosalicylic acid
- Streptomycin DRUGS AFFECTING GASTROINTESTINAL SYSTEM

- active tuberculosis are treated with drug combination for 6-9 mos. Antacids
- multidrug-resistant strain (MDR-TB) are medicated for 1 year up to 2 Prototype :
years - aluminum/magnesium compounds (Maalox)
- given before meals - sodium bicarbonate (Alka-Seltzer)
- calcium carbonate (Tums)
Isoniazid - magnesium hydroxide (Milk of Magnesia).
- should be given 1 hr before or 2 hrs after meals because food may delay Mechanism of actions :
absorption. - neutralize the stomach acidity.
- should be given at least 1 hr before antacids. Adverse effects :
- instruct to notify physician for signs of hepatoxicity (jaundice), and - metabolic alkalosis, stone formation
neurotoxicity - electrolyte imbalance
numbness of extremities. - diarrhea (magnesium), constipation (aluminum).
- administer with Vitamin B6 to counteract the neurotoxic side effects. Nursing considerations :
- avoid alcohol. - Give 1 hr after meals.
- Avoid giving medications within 1-2 hrs of antacid administration
Rifampicin (decreases absorption).
- Take fluids to flush after intake of antacid suspensions.
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- Monitor for changes of bowel patterns. - decrease stomach motility and peristalsis.
Nursing considerations :
- Monitor for rebound constipation.
- Be cautious taking if with infectious diarrhea.
HISTAMINE – 2 BLOCKERS - Monitor atropine toxicity with diphenoxylate.
Prototype : - Clay, white or pale stool is common with kaopectate.
- cimetidine (Tagamet), ranitidine (Zantac),
famotidine (Pepcid), nizatidine (Axid). Laxatives
Mechanism of action: a. lactulose (Cephulac), Na biphosphate (Fleet
- blocks H2 receptors in the stomach, reducing enema) & magnesium salt (Milk of Magnesia)
acid secretions. - retain fluid and distend intestine
Nursing considerations : b. ducosate (Dialose)
- Given before or with meals - emulsify fecal fat and water
- Avoid giving other drugs with cimetidine c. bisacodyl (Dulcolax) & senna (X-prep)
- Gynecomastia may developed with chronic use of cimetidine. - irritates intestinal mucosa and
stimulate intestinal smooth muscles
d. bulk-forming laxative (Metamucil)
Proton – Pump Inhibitors (PPI) - increase fecal bulk and water content
Prototype : e. mineral oil
- omeprazole (Losec), Lansoprazole (Lanz), pantoprazole (Pantoloc). - lubricates & prevent colon absorption
Mechanism of action :
- inhibit the proton H+ to combine with Cl- toform hydrochloric acid. EMETICS
Nursing considerations : Prototype : ipecac syrup, apomorphine
- Given before meals preferably at morning. Mechanism of actions :
- induce vomiting through stimulation of vomiting center of medulla.
Indications :
Mucosal Barriers - ingestion of poisonous or toxic substances.
Prototype : Nursing considerations :
- sucralfate (Carafate), misoprostol (Cytotec). - Consult poison control center before induction of vomiting.
Mechanism of action : - Administer ipecac syrup with large amount of fluid.
- coats the mucosa to prevent ulcerations.
Nursing consideration : DRUGS AFFECTING THE ENDOCRINE SYSTEM
- Given before meals.
- Misoprostol is contraindicated for pregnants. THYROID AGENTS
- Sucralfate cause constipation. Prototype :
- Proloid (thryroglobulin )
- Synthroid (levothyroxine)
Anti-diarrheal Agents - Cytomel ( liothyronine).
Prototype : Mechanism of action :
- diphenoxylate (Lomotil), loperamide (Imodium), kaolin/pectin mixture - function as natural or synthetic hormones.
(Kaopectate). Nursing considerations :
Mechanism of actions : - Taken in the morning.
 12

- Caution with coronary artery disease. - Given before meals.

- Monitor for signs of hyperthyroidism and refer for decreasing the dose. - Monitor for signs of hypoglycemia.

PARATHYROID AGENTS
Prototype :
a. calcitonin (Calcimar), etidronate (Didronel),
b. calcitrol (Rocaltrol), calcifediol (Calcedrol) Insulin
Mechanism of action : Insulin Onset Peak Duration
a. reduce bone resorption
b. promotes calcium absorption Immediate-acting 0.15h 0.5–1h 5h
Nursing considerations : (lispro)
- Monitor signs of calcium imbalance Short-acting 0.5-1 h 2-4 h 5-7h
- Report for bone pains. (regular, semilente)
- Remain sitting upright after taking etidronate. Intermediate-acting 1-3 h 6-12 h 18-24 h
(NPH, lente)
Oral Hypoglycemic Agents (OHA) Long-acting 4-6h 10-30 h 24-36 h
1. Sulfonylureas (ultralente)
- stimulate insulin secretions and increase tissue sensitivity to insulin. Mixed 0.5 h 4-8 h 25 h
First Generation : (regular 30%, NPH 70%)
Chlorpropamide (Diabenese)
- disulfiram precautions Nursing considerations :
Tolbutamide (Orinase) - Usually given before meals.
- congenital defect - Roll the bottle in palm of hands, don’t shake.
Second Generation : - Inject amount of air that is equal to each dose
Glypizide, Glymepiride into the bottle – short acting last (clear).
2. Biguanides - Aspirate short acting first, then long or intermediate (cloudy).
- facilitates insulin action on the peripheral receptor site. - Alcohol is recommended for cleansing bottle but not with skin.
Metformin and Glucophage (Glucovance) - Pinch skin, avoid I.M, don’t aspirate.
- side effect is lactic acidosis - Rotate the injection site an inch a part.
3. Alpha-glucosidase inhibitors - Prefilled syringes are stored vertically, needle-up.
- delay carbohydrate absorption in the intestinal system. - May increase dose during illnesses.
Acarbose (Precose) – side effect is diarrhea - Used bottles stored in room temperature, unused bottle stored in
4. Thiazolinidine refrigerator.
- increase tissue sensitivity of insulin. - Monitor for acute hypoglycemia :
Rosiglitazone (Avandia) a. 3-4 commercially prepared glucose tablet
5. Meglitinides b. 4-6 ounce of fruit juice or regular soda
- stimulate insulin release in pancreatic B-cells. c. 2-3 teaspoon or honey
Repaglinide (Prandin) d. Glucagon 1 gm SQ or IM
e. D50-50 IV.
Nursing considerations :
- Effective only for type II DM.
- Contraindicated to pregnant & breastfeeding. ESTROGENS AND PROGESTINS
 13

Prototype : Prototype :
- conjugated estrogen (Premarin), estrone (Bestrone), estradiol (Estrace), - bromocriptine (Parlodel)
diethylstilbestrol (DES). Mechanism of action :
Indications : - decrease serum prolactin levels
- prostate cancer, contraceptions Adverse effects :
- estrogen replacement - drowsiness, headache, nausea, palpitations
Adverse effects :
estrogen - endometrial CA, gallbladder disease, HPN, migraine, breast DRUGS FOR TREATING INFECTION
tenderness
progesterone - altered menstrual flow, risk of thrombo embolism Antibacterial Agents
Nursing considerations : 1. Cell wall inhibitors
1. Mix estrogen or progestins prior to IM administration by rolling vials a. penicillins - pen G, amoxicillin, cloxacillin
between palms. b. cephalosphorins - cephalexin, cefaclor
2. Monitor blood pressure c. glycopeptide - vancomycin
3. Teach patient how to perform BSE. 2. Protein synthesis inhibitors
4. Regular follow-up examination is required to detect associated risk of a. aminoglycosides - amikacin, gentamycin
acquiring CA b. macrolide - erythromycins, roxithromycin
c. lincosamides - clindamycins
d. chloramphenicol, tetracyclines
DRUGS AFFECTING LABOR and LACTATION 3. Antimetabolites - blocks folic acid synthesis
a. Sulfonamides - cotrimoxazole
Uterine Stimulating Agents 4. DNA synthesis inhibitors
Protoytpe : a. quinolones - ciprofloxacin, ofloxacin
a. Oxytocin (Pitocin), ergonovine (Ergotrate), methylergonovine b. metronidazole
(methergine) Adverse effects :
b. carbopost (Prostin), dinoprostone (Prostin E2) 1. Aminoglycoside - nephrotoxicity & ototoxicity
Mechanism of actions : 2. Sulfonamides - Steven-Johnson’s syndrome, photosynsetivity
a. stimulates uterine smooth muscles 3. Quinolones - insomnia
b. ripening of cervix 4. Tetracyclines - bone problems
Adverse reactions : 5. Chloramphenicol - Gray syndrome, bone marrow depression
- fetal bradycardia (oxytocin), 6. Erythromycin - hepatitis
- hypertension (ergonovine), palpitations
- allergic reactions (Prostaglandins) Nursing considerations :
Uterine Inhibiting Agents (Tocolytic) 1. Collect appropriate specimen for C & S before starting antibiotics.
Prototype : 2. Check client’s history of allergies.
- ritodrine (Yutopar), terbutaline (Brethine) 3. Avoid administering erythromycin and quinolones with food.
Mechanism of actions : 4. Pregnant precautions.
- relaxes the uterus by stimulating the B2- adrenergic receptors 5. Report for diarrhea - pseudomembranous colitis (clindamycin)
Adverse effects : 6. Monitor adverse effects.
- tremors, nausea, vomiting and tachycardia

Lactation Suppressants Antiviral Agents

 14

Prototype :
- acyclovir (Zovirax), ganciclovir (Cytovene),
vidarabine (Vira-A), amantidine (Symmetrel), ANTIPARASITIC AGENTS
ribavirin (Virazole), zidovidine (Retrovir). Prototype :
Mechanism of actions : a. Antimalarial
- inhibits virus specific enzymes involve in DNA - chlroquine, mefloquine, primaquine,
synthesis. They only control the growth of quinine, pyrimethamine
virus but it does not cure. b. Antiamebiasis
Adverse effects : - metronidazole (Flagyl), iodoquinol,
- granulocytopenia, thrombocytopenia, nausea, furozolidone (Furoxone).
nervousness, headache, nephrotoxicity. Mechanism of actions :
a. antimalarial – alters protozoal DNA, depleting folates, & reducing
Nursing consideration : nucleic acid
- Pregnant and breastfeeding precautions. production
- Administer IV antivirals to avoid crystallization in renal tubules. b. antiamoeba – block protein synthesis.
- Give ribavirin only with aerosol generator. Nursing considerations :
- Monitor CBC and creatinine level. 1. Administer anti-malarial drugs with food.
- Refer for signs of bleeding. 2. Take seizure precautions while administering
- Take amantidine after meals. antimalarial drugs.
3. Refer cinchonism during quinine treatment:
Antifungal Agents - tinnitus, headache, vertigo, fever, and visual changes.
Prototype : 4. Inform clients that iodoquinol falsify thyroid function test for up to 6
- amphotericin B (Fungisone), nystatin, months.
fluconazole (Diflucan), ketoconazole (Nizoral).
Mechanism of actions :
- inhibit the synthesis of fungal sterol. ANTIHELMINTIC
Adverse effects : Prototype :
- nephrotoxicity and neurotoxicity - mebendazole (Vermox), thiabendazole,
- bone marrow depression niclosamide (Niclocide), piperazine (Antepar),
- chills, fever, joint pains, abdominal pain and headache. praziquantel (Biltricide).
Mechanism of actions :
- paralyze larva and adult helmints by acting on parasite microtubules.
Nursing considerations : Adverse effects :
- Dilute amphotericin B with sterile water solution not with electrolyte - GI upset, urinary odor (thiabendazole)
solution. - headache, dizziness, fatigue
- Tell clients that fever, chills, GI upset, joint and muscle pain will subside Nursing considerations :
as 1. Treat all the family members for nematodes infection to prevent
amphotericin B continues. recurrence.
- With oral candidiasis, let nystatin tablet dissolve in mouth rather than 2. Praziquantel must swallowed rapidly because of its bitter taste to avoid
swallowing it. gagging.
- Refrain ketoconazole with antacids. 3. Other antihelmintics should be chewed.
- Report for signs of bleeding, infection & fatigue.
 15

stomatitis
ANTI-NEOPLASTIC DRUGS - bland diet, avoid strong mouthwash
- soft tooth brush, ice chips
General considerations : diarrhea, nausea and vomiting
- kills or inhibit the reproduction of neoplasmic cells but as well as normal - anti-emetic, replace fluids and electrolytes
cells. alopecia
- it could be cell cycle phase specific or cell cycle non-specific. - reassure that it is temporary
- preferably given through IV route. - encourage o wear wigs, hats and head scarf
skin pigmentation
- inform that it is only temporary
Prototype : tumor lysis syndrome
1. Alkylating Agents - hyperuricemia & hyperkalemia
- inhibits cell production by causing cross linking of DNA - force fluids
a. Busulfan – hyperuricemia infection
b. Chlorambucil – gonadal suppression - notify physician if WBC is <2000/mm3
c. Cisplatin – ototoxicity and nephrotoxicity - monitor for signs of infection
d. Cyclophosphamide – hemorrhagic cystitis. - reverse isolation
2. Antitumor Antibiotic Agents - low bacteria diet
- interfere in DNA and RNA synthesis anemia
a. Plicamycin – affects bleeding time - iron, B-12, folic acid rich food
b. Doxurubicin – cardiotoxicity - provide rest periods
c. Bleomycin – pulmonary toxicity. bleeding
- avoid NSAIDs
- minimize invasive procedures
3. Antimetabolites - use soft toothbrush and electric razor
- replace normal proteins required for DNA synthesis by inhibiting the S menstrual changes
phase - reassure that menstruation will resume.
a. Cytarabine – hepatotoxicity
b. 5-flourouracil – phototoxicity reaction and cerebellar dysfunctions THE END
c. 6-marcaptopurine – hyperuricemia REVIEW QUESTIONS
d. Methotrexate – photosensitivity
- given with leucoverin to lessen its toxicity. SITUATION: Mr. Hero Fernando, a 60 year-old bank manager
4. Mitotic Inhibitors (Vinca Alkaloids) had experienced a sensation of chest tightness, chest pain,
- prevent mitosis acting on the M phase causing cell death sweating and a feeling of apprehension. A diagnosis of CAD with
a. Vincristine sulfate – neurotoxicity, numbness angina pectoris was established
5. Hormonal Medications and Enzymes 1. The physician orders for nitroglycerin tablet. The nurse knows that
- block the normal hormones in hormone sensitive tumors the pharmacological action of the drug is:
a. Tamoxifen citrate – visual problems a. To dissolve the atheromatous plaque in the coronary artery
– elevate cholesterol & triglycerides level b. Constrict the venous vessels and capillaries
b. Diethylstilbestrol – impotence and gynecomastia in men. c. Dilate the coronary arteries
d. Decrease the myocardial consumption of oxygen
Side Effects:
 16

2. The nurse gave instructions to the patient on nitroglycerin intake. He

remarked, “I think I will try not to take too many of these pills.” At 7. Hero asked the nurse what he could do about his concern about sex
this instance, the nurse’s BEST reply would be: activity. The nurse best suggests:
a. “I agree, nitroglycerin can cause drug addiction, that is why a. Tell him to avoid sex for several months while his heart is on
you must not take too many of the pills” therapy
b. “I must inform you that nitroglycerin is non-habituating and b. Suggests that his wife assume the top position
you should take the pills many times to relieve the pain” c. Tell him to avoid sex on days when he is anxious
c. “You will be needing only three tablets to ease the pain and d. Advise that he should have sex only once a month
if unrelieved, you must seek medical attention”
d. “ There is no problem with continuous daily intake because 8. The nurse understands that her discharge teaching is effective
nitroglycerin does not cause a tolerance effect” regarding life style modification when the patient says:
a. “I know that I will need to eat less, so I will eat once a day
3. The nurse must emphasize to the patient which ONE of the only”
following side-effects of nitroglycerin: b. “I will stay on bed most of the time so I wont experience
a. Headache c. Nausea and vomiting chest pain”
b. Hypertension d. Visual changes c. “I will stop what I’m doing whenever I have pain and take
the pill”
4. What other information must the nurse provide to the patient taking d. “I need to enroll in a gym class to have a vigorous exercise
the nitroglycerin? to condition my heart”
a. Keep the tablet in a clear container
b. Take the tablet with meals SITUATION: Manny is admitted to the medical ward with the
c. Continue to take as many tablets of nitroglycerin until chest diagnosis of essential hypertension. He had hypertensive emergency
pain subsides 2 hours ago and was hospitalized for further observation.
d. A burning sensation under the tongue is expected 9. The nurse administers prescribed anti-hypertensive meds. If it can be
any of the following, she will check the pulse prior to giving:
a. Nifedipine
b. Metoprolol
5. The nurse applies the ordered nitroglycerin ointment on the patient’s c. Clonidine
chest wall. Which nursing action is considered inappropriate? d. Captopril
a. The nurse chooses a hairless area
b. She spreads the ointment with her fingers 10. After administering a blood-pressure lowing agent, the nurse must
c. She removes the ointment on the skin from the previous dose caution the patient:
d. She rotates the sites of ointment application a. To avoid straining during defecation
b. To avoid low-sodium and potassium diet
6. The nurse gives which of the following discharge instructions to this c. To avoid abrupt change of positions
patient with angina regarding nitroglycerin therapy? d. To take warm shower immediately after taking the drug
a. Only take the nitroglycerin as desired
b. The drug should be taken before engaging in exertional 11. The nurse prepares to give a diet appropriate for a hypertensive
activities patient. Which food should the nurse include in the menu?
c. The tablet should be taken only in the morning a. Canned meat loaf
d. If the drug does not relieve the pain, increase the frequency b. Scallops and shrimps
of the dose c. Fresh citrus juice and cake
 17

d. Butter and pork steaks

17. The nurse is very vigilant about digoxin overdose. Which one
12. If the physician orders Captopril as the home medication for the high statement below by the patient may alert the nurse of a possible
BP, the nurse must caution that the side-effect of this drug that is development of toxicity?
disturbing is: a. “Nurse, I don’t feel like eating for the past few days”
a. Rashes b. “I am having constipation lately”
b. Cough c. “I am developing a nagging cough and night terrors”
c. Pruritus d. “I am experiencing dryness of the eyes and sandy sensation”
d. Ringing of the ears
18. The nurse evaluates that the drug digoxin is effective when the
13. If the client is discharged with home medication of Propranolol patient manifests:
hydrochloride, the nurse must include in her medication-teaching a. Decreased bowel sounds
plan which one? b. Increased urine output
a. Take the medication on an empty stomach c. Increased drowsiness
b. Obtain blood pressure readings regularly d. Decreased sympathetic response of the body
c. Perform active exercises to prevent Hypotension
d. Caution to avoid hazardous activities after taking the drug 19. The following manifestations must be assessed by the nurse to detect
14. The nurse determines that the following drugs are calcium channel beginning digitalis toxicity, with the exception of:
blockers that can be prescribed by the physician to the patient. One is a. Nausea and vomiting
not included: b. Palpitations
a. Nifedipine c. Diplopia and visual yellow-green halos
b. Verapamil d. Hypertension
c. Telmisartan
d. Diltiazem 20. The nurse instructs the patient on diet modification during digitalis
therapy. She is certain that her teaching is effective when the patient
SITUATION: Joseph,, 50 y.o. Businessman awakens in the middle will choose all the foods items below, except:
of the night with dyspnea, bilateral basilar rales and frothy sputum. a. Fresh orange juice and potato fries
He is brought to the Mulawin hospital. His diagnosis is congestive b. Dried mangoes and tomato juice
heart failure. c. Broccoli salad with bean sprouts
15. The physician gives the patient furosemide and digoxin. The nurse’s d. Flavored gelatin and iced tea
main concern is to:
a. Take the central venous pressure reading 21. The nurse obtains an apical pulse of 78 beats/min. She is bringing
b. Observe for decrease edema the next dose of digoxin and then proceeds to do which one action
c. Observe for signs and symptoms of hypokalemia below?
d. Force fluids a. Withhold the drug and notify the physician
b. Start IV infusion of Digibind (digoxin antibody)
16. The mechanism of action of dioxin that makes it useful in patients c. Instruct patient to consume more meat and nuts
with CHF is that it: d. Administer the drug
a. Produces a negative inotropic effect
b. Increases cardiac conduction SITUATION: Armida, an 18-year-old adolescent is seen in the
c. Enhances cardiac contractility health center because of easy fatigability and frequent dizziness
d. Increases the heart rate
 18

22. The health center physician determines that she has iron-deficiency 28. The patient remained pale and weak, upon further examination, it
anemia. The nurse will anticipate the doctor to order for: was determined that she has pernicious anemia. The pathophysiology
a. Bone marrow aspiration of this hematological disorder is:
b. Hemoglobin level determination a. Absence of Vitamin E in the diet
c. Platelet count b. Presence of excessive iron in the liver
d. BUN and Creatinine c. Absence of intrinsic factor in the stomach
23. A drug is administered to correct anemia, such as an iron. This drug d. Temporary bone marrow depression.
is classified as:
a. Antihelminthic DRUGS THAT AFFECT THE HEMATOLOGICAL SYSTEM
b. Anticoagulant SITUATION: Mrs. Rosalinda Amor, 23 year-old actress is admitted
c. Hematinic because of a diagnosis of deep vein thrombosis.
d. Antihistaminic 29. The nurse employs which of the following non-pharmacological
measures in caring for Mrs. Amor?
24. The nurse administers the oral iron tablet. She will give the a. Ice compress over the involved leg TID
medication: b. Elevate the legs with a pillow
a. With milk and dairy products c. Maintain on strict bed rest with minimal bathroom privileges
b. With antacids to minimize gastric upset d. Massage the involved area
c. With fruit juices like calamansi and orange
d. With a full glass of coffee or tea 30. The physician orders Heparin sodium for Mrs. Amor. The nurse
understands the reason for this therapy is that:
25. The nurse instructs the patient to eat iron-rich foods. She determines a. Heparin will dissolve the clots in the inflamed veins to
that her teaching is effective when the client will choose: prevent emobolization
a. Pomelo juice and hamburger b. There is a need to prevent further clot formation in the
b. Gelatin and marshmallows involved vessels
c. Lean meat and buttered corn c. Heparin will anticoauglate the blood by inhibiting vitamin K
d. Liver and eggyolk metabolism
d. The clot formed in the vein must be lysed by activating
26. The doctor decides to order Iron dextran one ampoule. The nurse plasmin, the action of heparin
prepares to administer the drug:
a. Intravenously. Slow IV push 31. If the doctor orders for heparin therapy monitoring, the nurse must
b. Intamuscular, Z-track method obtain which laboratory tests from the lab unit?
c. Subcutaneous a. Prothrombin time
d. Intrathecal b. Clotting time
c. Partial thromboplastin time
27. The nurse must warn the patient taking oral iron preparations that it d. Prothrombin consumption test
can cause which side effect/s?
a. Yellowish discoloration of the skin and mucus membrane 32. The above laboratory value must is considered therapeutic if the
b. Darkening of stool color result is about:
c. Anorexia and loss of hair a. 3 times the normal
d. Ulceration of the skin and cough b. 2 times the normal
c. Equals the normal
d. Less than the normal
 19

d. Report the error to the nurse supervisor as the patient may be

33. The nurse must administer heparin to Mrs. Amor. She determines at risk for toxicity
that the most common routes of administration are:
a. IV and IM 39. IF Mrs. Amor is discharge with warfarin sodium, the nurse must
b. SC and IV include in her discharge teaching which one?
c. ID and IM a. Keep Vitamin A ampule available for injection c/o the health
d. IV and intrathecal center in case of emergency
b. Report any bright red blood in the stool or urine
34. When the nurse is monitoring the patient for heparin overdose, she is c. Take aspirin to manage the headache side-effect of the drug
observing for the following signs/symptoms, except? d. Utilize firm toothbrush when brushing to prevent build up of
a. Ecchymoses plaques and gingival hyperplasia
b. Positive Homan’s sign
c. Dark, cola-colored urine 40. The nurse must remind the patient that warfarin therapy is monitored
d. Epistaxis with the use of which laboratory examinations?
a. PT and PTT
35. Which one effect of heparin therapy will cause nursing concern? b. PT and INR
a. Thrombocytopenia c. Clotting time and bleeding time
b. Constipation d. Platelet count and PT
c. Bone marrow depression
d. Dizziness SITUATION: Mrs. Avery had a previous attack of mild stroke and
coronary artery disease. She is taking Aspirin.
36. In the event of an overdose of heparin injection, the nurse prepares 41. The reason aspirin is utilized as an anti-platelet medication is
which one antidote for toxicity? because:
a. Phytomenadione a. Aspirin can prolong the bleeding time
b. Atropine Sulfate b. Aspirin affects the thromboxane production of the platelet
c. Protamine sulfate c. Aspirin interferes with the receptor binding of the platelets
d. Deferoxamine chelators d. Aspirin blocks the degranulation process inhibiting release
of histamine
37. The doctor switched from standard heparin to low molecular weight
heparin injection. The advantage of LMWH over the standard 42. The nurse administers aspirin:
heparin is: a. On an empty stomach to increase absorption
a. The LMWH can be administered IM b. With meals
b. The LMWH does not need frequent laboratory monitoring c. In Between meals
c. The LMWH has a better potency d. Intramuscularly
d. The LMWH does not cause bleeding problems
43. Mrs. Avery had a sudden severe and prolonged chest pain. Acute MI
38. The nurse reads the chart and notes for an order of oral Warfarin is suspected. The nurse anticipates the doctor to order a fibrinolytic,
sodium, while the patient is on heparin therapy. The nurse will: and this may be:
a. Question the order because of potential excessive bleeding if a. Tranexamic Acid
given simultaneously b. Dipyridamole
b. Administer the drug as ordered c. Steptokinase
c. Withhold the heparin and administer the Warfarin orally d. Coumadin
 20

b. Cataract
44. If the above drug is ordered to be given IV drip, the nurse must be c. Myositis
aware of which potential effect? d. Hepatic failure
a. Hypersensitivity reaction
b. Congestive heart failure The nurse reads the drug order sheet and is most concern to
c. Further damage to the myocardium consult the physician if he orders:
d. Excessive clot formation e. Paracetamol
f. Gemfibrozil
45. If the patient is receiving tissue-plasminogen activator, the nurse g. Vitamin supplements
must make which one priority intervention? h. Omeprazole
a. Have heparin sodium available
b. Monitor closely the renal status 50. The nurse is giving Guaifenesin to a patient. She includes in her
c. Observe for psychotic symptoms teaching which of the following interventions?
d. Obtain a stand by Aminocaproic acid a. Warn the patient that extreme drowsiness may occur
b. Offer a full glass of water
SITUATION: A patient is determined to have hypercholesterolemia c. Nausea and vomiting are potential problems alleviated by
and is admitted in the hospital for treatment of her condition. The small frequent meals
doctor ordered Lovastatin OD. d. Suggest to buy a nebulizer machine to be used at home
46. The nurse determines that the BEST time to give the drug is: e. Vitamin ADEK supplements because of impaired absorption
a. In the morning before breakfast to promote absorption
b. In the afternoon to promote sleep because it is sedating 51. To be able to detect the effectiveness of Salbutamol, the nurse should
c. At bedtime check for:
d. In between meals a. Blood pressure and CVP readings
b. Urinary output per hour
47. The nurse is knowledgeable about the mode of action of lovastatin c. Breath sounds
that it: d. Level of consciousness
a. It Inhibits the formation of chylomicrons in the intestinal e. Pupillary reflexes
cells
b. It prevents the enzyme that synthesizes cholesterol 52. The patient is receiving theophylline capsule OD. The nurse cautions
c. It binds with bile acids and cholesterol promoting excretion the patient to avoid foods with components similar to theophyline
d. It promotes cholesterol metabolism in the adipose tissue to and they can be:
lower the plasma cholestero a. Sugar and cream
48. The nurse is prepared to provide comfort measure to the common b. Coffee and chocolate
side effects of the drug. She monitors the patient for: c. Spinach and broccoli
a. Abdominal fullness, flatulence and diarrhea d. Beans and aged cheese
b. Confusion and psychoses e. Canned goods and wine
c. Palpitations and arrhythmias
d. Hypertension and rashes 53. The patient is receiving theophylline capsule OD. The nurse cautions
the patient to avoid foods with components similar to theophyline
49. The nurse must monitor for these serious adverse effects of and they can be:
lovastatin. Which one is not included? a. Sugar and cream
a. Glaucoma b. Coffee and chocolate
 21

c. Spinach and broccoli a. Instruct the patient to clear the nasal passage of mucus
d. Beans and aged cheese before instilling
e. Canned goods and wine b. Remind patient to keep the head tilted for a few seconds
after administration
54. The nurse is administering acetylcysteine nebulization to a patient. It c. Advise increased fluid intake
is very much important to keep which item below at bedside? d. Encourage the use for one week for better effect
a. Scissors e. Caution that tachycardia and urinary retention may occur
b. Ambu bag with systemic absorption
c. Suction machine
d. Tracheostmy set 59. The physician asks the nurse for an anticholinergic drug to be used
e. NG tube for the asthmatic patient. The nurse obtains from the pharmacy
which drug?
55. After giving diphenhydramine to the patient, the nurse must ensure a. Albuterol
that the patient understands the teachings below, EXCEPT: b. Terbutaline
a. Refrain from manipulating delicate machines c. Metaproterenol
b. Take sugarless candy in the mouth to relieve dryness d. Ipratropium bromide
c. Avoid taking the drug with alcohol e. Salbutamol
d. Check pulse rate before taking the drug
e. Manage gastric upset by taking it with food 60. The physician orders dextromethorphan for a patient who is
complaining of very uncomfortable coughing. The nurse understands
56. The nurse watches out for a side-effect associated with intake of that this drug acts to suppress cough by:
codeine sulfate and provides appropriate intervention, this can be: a. Increasing the secretions of the bronchial glands
a. Constipation- provide liberal fluids b. Removing the irritation from the respiratory tract
b. Excitement- provide less stimulation c. Inhibiting the medulla oblongata cough center
c. Tachycardia- administer lidocaine d. Inhibiting the stretch receptors in the lungs
d. Polyuria- give the drug in the morning e. Triggering the vagal responses
e. Tachypnea- position on semi-fowler’s
61. Inhaled corticosteroid like beclomethasone is administered to the
patient with asthma. It is important for the nurse to stress that this
drug:
57. Terbutaline sulfate is administered to a patient with asthma. If the a. Acts rapidly to decrease inflammation
patient has another disease, the nurse is most vigilant and cautious if b. Promotes the secretion of mucus
this condition exists: c. May depress the immune function
a. Hypothyroidism d. Highly effective in terminating acute asthma attack
b. Rheumatoid arthritis e. Is habituating and addicting
c. Diabetes mellitus
d. Polycystic ovarian disease 62. The second generation anti-histamines like cetirizine have the
e. Emphysema advantage over the first generation antihistamines like
diphenhydramine because second generation antihistamines:
58. The nurse is administering oxymetazoline nasal decongestant. She a. Have shorter duration of action that can be reversed rapidly
includes in her care plan all of the following interventions, b. Have less sedation and anticholinergic properties
EXCEPT? c. Posses less drug sensitivity reactions
 22

d. Have a greater safety profile

e. Have less abuse potential

63. The nurse cautions the patient taking diphenhydramine (Benadryl) to

expect all of the following side effects, except?
a. Dry mouth
b. Blurred vision
c. Urinary frequency
d. Drowsiness
e. Dizziness

64. The nurse must remember to administer theophylline slowly or with

an infusion pump because this drug, if given rapidly can cause:
a. Increased alertness
b. Severe hypotension
c. Tachycardia
d. Pallor
e. Headache