PHARMACOLOGY

MODULE
By Nursing Education Services

Revised 2023
Definitions

Medication
A drug or other substance used to treat
disease or injury Or It is the act or process
of treating patient with medicine.
Purpose of Medication
1.Diagnostic
2.Preventive
3.Palliative
4.Curative
Drug Classification
Drugs can be classified on the basis of:
1. Prescribed Vs Over the counter (OTC)
2. Diagnostic drugs
3. Body system (GI, CNS etc.)
4. Therapeutic effects (Anticonvulsant,
antibiotics etc.)
Routes of Drug Administration
Contd…
Routes of Drug Delivery
 Drug Classification CNS Drugs

Analgesics
Antihypertensive

Anticoagulants Antimicrobial

Anesthetics Anti-neoplastic

Diabetic Drugs
GI Drugs

Respiratory Drugs
1. Analgesics: Medication used to relieve pain

NON- OPIOIDS
• Non-narcotic
• Non-sedating
• Anti Pyretic
• Anti Inflammatory (NSAID only)
• Acts on peripheral nervous system
• For mild to moderate pain
• E.g.. NSAIDS & Acetaminophen
(Tylenol)
 Opioids/ Narcotics
• Opioids are used when milder drugs are ineffective.
• Examples: Morphine Sulphate, Hydromorphone, Codeine & Fentanyl

Side effects:
Depressing effects:
• Perception of pain
• Respiratory & coughing depression
• Reduces anxiety
• Depresses alertness- drowsiness and sleep
• Decreases peristalsis-constipation
• Spasm of sphincter – urinary retention

Stimulating effects:
• Stimulate chemoreceptor trigger zone (CTZ)- causes nausea and vomiting
• Stimulates oculomotor nerve: Pupillary constriction (esp with morphine)
• Stimulates vagus nerve: bradycardia and hypotension
Nursing interventions
• Administer the narcotic before pain reaches its peak to maximize the effectiveness
of the drug.
• Monitor V/S (HR, BP, Respiratory rate and effort) at frequent intervals to detect
alterations.
• Monitor urine output.
• Check bowel sounds for decreased peristalsis. Dietary changes may be required.
• Check for Pupillary changes. Pinpoint pupils indicate Morphine overdose.
• Have Naloxone available as an antidote and emergency equipment at bedside if
Opioid overdose occurs.
• Validate child’s and adult’s doses before administration.
• Administer anti-emetic along with opioids, as prescribed
Teaching
• Instruct client to take medicines as prescribed, and not to increase the dose or
its frequency.
• Encourage client not to use alcohol or CNS depressants with narcotic
analgesics.
• Discourage client for driving or operating any machinery while drowsiness,
after taking narcotic analgesics.
• Encourage for high fiber diet such as whole grain cereals, fruits &
vegetables, drink 2-3 quarts of fluid daily.
• Suggest non-pharmacological measures to relieve pain .
Non-opioids/Non-narcotics
Non-opiods are less effective than narcotics.
Mechanism of action : Decreases the level of prostaglandins hence reducing the
pain.
Prototype: Aspirin
Side Effects:
• Gastric irritation
• Anorexia, vomiting, rash
• It increases the risk for bleeding
• Nephrotoxicity
Contraindications
• Peptic ulcer disease
• Impaired renal functions
• Avoid aspirin in children having viral infection to reduce risk for Reye’s
Syndrome.
Non-opioids-- Aspirin
• Used as an analgesic, anti-inflammatory, antipyretic or anti-
platelet.
• Enteric coated aspirin is slowly absorbed.
• Administer aspirin with meals to reduce gastric irritation.
• Monitor Platelet count (150-450)
• Manifestations of salicylism (Aspirin overdose) includes,
Nausea, vomiting, Fever, Fluid electrolyte imbalance, tinnitus,
drowsiness, confusion and hyperventilation.
• NSAIDs should be taken at least 30 mins to 2 hours after
taking Aspirin.
Non-opioids--Acetaminophen
• Acetaminophen is not NSAIDs and is used instead of NSAIDs
to decrease the risk for bleeding.
• It does not have anti-inflammatory property hence only used for
pain & fever.
• Usually used with the patients with hemophilia or peptic ulcers
• Avoid in patients with liver toxicity.
• ALT & AST are tested for acetaminophen overdose.
• Administer NSAID’s with food or full glass of water to reduce
GI irritation.
• E.g. Panadol & Tylenol.
2. Anesthetics
• Anesthesia cause loss of sensation with or without loss of
consciousness.
• These are primarily used during surgical intervention.
• It is divided into two main groups:
1. Local
2. General
Lidocaine
• Most commonly used.
• Used as infiltration anaesthesia in minor and brief
surgical interventions (angiosheath removal, dental
procedures etc.).
• Onset is 1-2 minutes after deposition near the nerve.
• The duration of action is approximately 90 min when
used as an infiltration. It is also used for spinal and
epidural anesthesia
Bupivacaine
• Used extensively for local and regional anaesthesia.
• The onset is short, and duration of action is considerably longer
than for lidocaine (up to 8h)
• It is also used for epidural and spinal anesthesia when a long
duration of action is required (longer surgeries).
Adverse Effects & Nursing Interventions
• CNS Toxicity: Numbness of tongue, tinnitus, slurred speech
• Cardiovascular Toxicity: Bradycardia, heart block, cardiac
arrest, hypotension

Nursing Interventions:
• Observe for CSF leakage and headache after spinal anesthesia
and have the physician prescribe analgesics.
• Patient should void within 8 hours. If not, inform immediately
• Observe for allergic reactions
• Observe for systemic toxicity (CNS and Cardiac)
 cont..
• Monitor client’s postoperative state of sensorium.
Report if patient stays non responsive for long.
• Record vital signs for cardiovascular and respiratory
functions.
• Assess CNS function (avoid accidental fall, side rails
up)
• Post operative pain management after recovery.
• Monitor GI/ GU functions:
1. Bowel function
2. Assess for nausea and vomiting (prevent aspiration) ---provide anti-
emetic medications.
3. Urinary output (some anaesthetics cause renal toxicity)
ANTINEOPLASTIC
Alkylating Agents • Cisplatin, cyclophosphamide,

Antimetabolites • Floxuridine, fluorouracil

Antineoplastic Antibiotics • Bleomycin, mitomycin

Mitotic Inhibitors • Vincristine, etoposide

Hormones and Hormone • Triptorelin pamoate, flutamide
Modulators
Protein Tyrosine Kinase
Inhibitors • Temsirolimus, lapatinib
Epidermal Growth Factor • Erlotinib
Inhibitor
Proteasome Inhibitor • Bortezomib

Other antineoplastics • Bexarotene, hydroxyurea

3. Anti-Neoplastic Drugs
• Cancer refers to uncontrolled growth of abnormal cells.
• Chemotherapy: Use of drugs to destroy cancer cells. However,
these drugs lacks selective toxicity (they are toxic to normal
cells along with abnormal cells)
• These are used to control and cure purpose both.
• Each dose kills some but not all malignant cells.
• Multiple chemotherapy agents are used to target different cell
cycles.
* These drugs should be administered through Central venous
access devices (CVADs) to prevent vesicant drugs to damage
small veins.
Adverse Reactions
1. Nausea, Vomiting, Anorexia
2. Weight loss
3. Bone marrow suppression
4. Stomatitis (oral inflammation and ulcerations)
5. Alopecia
6. Cardiac arrhythmias, ventricular failure
Classification
1. Alkylating agents
2. Antimetabolites
3. Plant Alkaloids
4. Antitumor Antibiotics
 I. Alkylating Agent
Mechanism of action:
It causes chromosome breakage (both at resting and replicating stages) and prevents the
formation of new DNA.

Examples:
Chlorambucil, Cyclophosphamide

Adverse effects:
Toxic metabolites are removed through kidneys and cause Cystitis

Nursing Care:
• Instruct patient to report dysuria and hematuria
• Encourage for increased fluid intake
• Check CBC
II. Antimetabolites
Mechanism of action:
These drugs resemble some of the cellular structures; after invading the cells, they
inhibit essential enzymes for DNA and RNA synthesis

Examples:
Methotrexate, Fluorouracil

Adverse effects:
• Bone marrow depression (especially with Methotrexate)--- Leucovorin, which saves
the bone marrow cells from the effect of methotrexate, is administered along with it
• Renal injury (high doses)

Nursing Care:
• Monitor CBC
• Monitor renal function tests (BUN, Creatinine and I/O)
III. Plant Alkaloids
Mechanism of action:
Block mitosis by binding to the spindle fibres

Examples:
Etoposide, Vinblastine, Vincristine

Adverse effects:
• Peripheral neuropathy and seizures, depression, muscle weakness, constipation,
severe allergic reactions (bronchospasm and skin rash as these are driven from plants)

Nursing Care:
• Monitor bowel function
• Frequent neuro checks
• Assess for mood status and depression
• Assess for, and teach signs of seizures
IV. Anti-Tumor Antibiotics
Mechanism of action:
Inhibits DNA replication

Examples:
Doxorubicin, Daunorubicin

Adverse effects:
• Cardiac toxicity (most common)
• Bone marrow suppression

Nursing care:
• Monitor for dyspnea, crackles (due to decreased ejection fraction)
• Have complete cardiac examination done along with ECG and ECHO
• Check CBC
• Monitor IV site very carefully esp. with Doxorubicin, as it is a severe vesicant
 4. Antidiabetic Drugs
Types of anti-diabetic agent

Insulin Oral anti-diabetic

Rapid Acting Sulphonylureas

Short Acting Biguanides

(Glucophage)
Intermediate Alpha-glucosidase
Acting Inhibitors

Long Acting Thiazolidinediones

Combinations Miglitinides
Oral anti diabetic Drugs
Side Effects:
• Common adverse effects include hypoglycemia, lactic acidosis, GI upset,
nausea, anorexia, diarrhea, heartburn, and allergic skin reaction.
• Pioglitazone is strongly linked with an increased risk of bladder cancer if it is
used for over 1 year.
• Rosiglitazone is linked with increased risk of cardiovascular problems.

Contraindication and Caution:

• Allergy to sulfonylureas and other anti-diabetic agents. Avoid
hypersensitivity reactions
• Type 1 diabetes. These patients do not have functioning beta cells and
would have no benefit from the drug.
• Pregnancy and lactation. Potential adverse effect on the fetus or neonate.
Insulins
Classification Onset Duratio Route Examples Considerations
of n of
Action Action
Rapid Acting 5-15 3-5 hours SC Humalog (Lispro) Produces rapid
min hypoglycemia. Must not
be given more than 5
min before meal.

Short Acting 30 min- 5-8 hours SC/IV Humulin-R Can be given 30 min
1 Hr before meal.
Intermediate 1-3 Hrs 12-16 SC Humulin N It prolongs the action of
Acting hours insulin hence given
regardless of the meal
time.
Long Acting 4-8 Hrs Upto 24 SC Glargine (Lantus) Usually given once daily
hours so it maintains blood
sugar levels for entire
day.
Combination Insulin
• These are mixed commercially.
• The onset of action is usually between 30-60 min and duration
of action is 10-16 hours.
• Examples:
1. Humulin 70/30 (70% Humulin N & 30% Humulin R)
2. Humulin 50/50 (50% Humulin N & 50% Humulin R)
Side effects of Insulin
• Hypoglycemia (Confusion, Agitation, Tremors, Headache,
weakness, lethargy, Fatigue)

• Redness, irritation or swelling at insulin injection site.

• Lipodystrophy: Degenerative changes in adipose tissue of the

insulin injection site.
Nursing Considerations for Insulins
• Assess the patient’s blood sugar level before administering insulin
• Insulin injection sites should be rotated in order to prevent
lipodystrophy.
• Teach the patient to keep a candy with them to deal with subsequent
hypoglycemia.
• When mixing 2 insulin, regular insulin should be drawn first.
• If I/V insulin is given, watch for signs of hypokalemia.
• Smoking decreases insulin absorption, avoid that.
• Discard the vial if you notice any clumpy precipitate inside the
insulin vial.

*Glucagon is used for the treatment of severe hypoglycemia.

5. Antihypertensive & Anti-Arrhythmic

Antihypertensive Classes
1. Angiotensin converting enzyme inhibitors (ACEI)
2. Angiotensin II Receptor Blockers
3. Beta Blockers
4. Calcium channel blockers
5. Direct vasodilators
ACEI
Block the enzyme that converts angiotensin I to angiotensin II (Angiotensin II
is a potent vasoconstrictor + stimulates Aldosterone production)
• ACEIs act as antihypertensives by vasodilation and by decreasing
aldosterone production (decreased retention and more excretion of sodium
and water)

Example: Captopril , Zestril

Side Effects: Persistent dry cough or orthostatic hypotension

Can cause hyperkalemia
Beta Blockers
Non Selective
Selective

• Decrease heart rate and These drugs block Beta 1and Beta 2
blood pressure by blocking receptors--- Most profound side effect
the beta 1 receptors on heart is bronchospasm, because of which
and blood vessels these are avoided in patients with
• Side Effects: Bradycardia, reactive airway diseases like asthma.
Hypotension, Impotence or
erectile dysfunction

➢ Inderal (propanolol)
➢ Tenormin (atenolol)
➢ Corgard (nadolol)
➢ Concor (Bisoprolol
Calcium Channel Blocking Agents
Block calcium channels in blood vessels and heart, dilate
peripheral arteries and decrease peripheral vascular resistance by
relaxing vascular smooth muscle.

Examples:
➢ Norvasc (amlodipine)
➢ Cardizem (diltiazem)

Side Effects:
Orthostatic hypotension, Peripheral edema, Bradycardia or heart
block with Non-Dihydropyridines
Vasodilators
➢ Relax smooth muscle in blood vessels resulting in dilation and decreased peripheral
vascular resistance, resulting in decreased blood pressure
➢ Reduce afterload so helpful in heart failure.
➢ Examples: (IV forms are given for hypertensive emergencies)
➢ Apresoline (hydralazine)—IV, IM or PO
➢ Nitroglycerine– Sublingual Angised, PO Isosorbide mononitrate,
Nitroglycerine (GTN), GTN patches. Nitroglycerine is an anti anginal as well; it works
by vasodilating and thus increasing blood flow to the myocardium.

Side Effects: Throbbing headache, orthostatic hypotension.

Nursing Consideration:
➢ Protect drug from sunlight to maintain drug potency.
➢ These drugs should not be abruptly stopped, but these should be tapered gradually.
Otherwise, patient may develop rebound hypertension.
➢ Instruct patient to get up slowly from bed or after sitting for a long time.
Anti-Arrhythmic
Used for the treatment and prevention of cardiac rhythm
disorders that result from abnormality in electrical cardiac
conduction system.

Examples:
Quinidine, Lidociane, Procainamide.
Amiodarone (Both atrial and ventricular dysrhythmias).

Nursing consideration:
• Instruct the patient to restrict coffee, cola or tea when receiving
antiarrhythmic drugs.
Cardiotonic and Inotropic Drugs
It increases the force of cardiac contraction.

Classification Generic Name

digitoxin
Cardiac glycosides
digoxin
Phosphodiesterase inhibitors milrinone

Adverse Effects
• CNS: headache, weakness, drowsiness, vision changes (most commonly
reported is seeing yellow halo around objects)
• CV: arrhythmias
• GI: GI upset, anorexia
• NURSING ALERT! Signs and symptoms of digitalis toxicity: anorexia,
nausea, vomiting, malaise, depression, hypokalemia, bradycardia,
irregular heart rhythms (e.g. heart block, heart arrhythmias, and ventricular
tachycardia)
 Adrenergic Agonist
Classification Generic Name
dobutamine
dopamine
Alpha- and Beta- Adrenergic
Drugs epinephrine
norepinephrine
Alpha-Specific
phenylephrine
Adrenergic Agonists
albuterol
Beta-Specific Adrenergic Agonists
terbutaline
Adverse Reactions:
• Related to sympathetic stimulation: headache, sweating, feelings of tension
or anxiety, tremors.
• CV: arrhythmias, hypertension, palpitations, angina, dyspnea
• GI: nausea, vomiting, constipation, oral thrush.
• WARNING Because of vasoconstrictive effects, care must be taken to avoid
extravasation of any infused drugs. The vasoconstriction in the area of
extravasation can lead to necrosis and cell death in that area.
 Drugs Affecting Coagulation
These groups of drugs affect clot formation and resolution by hindering different
steps in clotting formation which include;
Anti-Platelet Drug Anti-Coagulant Drug Thrombolytic Agents

• Platelets are released in • Prevent the formation • These are only drugs
the presence of of a clot (thrombus) or that can DISSOLVE A
vascular injury. They prevent the extension CLOT. They are used
are attracted to injured of an existing clot in cardiac and
vessel walls and stick • Example: heparin, neurological acute
to them forming a enoxaparin and events.
platelet plug. Drugs in warfarin • Example: Alteplase
this category inhibit and Streptokinase
platelets from
gathering together and
sticking (platelet
aggregation) so
preventing clot from
forming.
• Example: Aspirin and
Clopidogrel
Anti-Coagulants
Anticoagulants, commonly known as blood thinners, are chemical substances
that prevent or reduce coagulation of blood, prolonging the clotting time.
It is also given to CBR patients or Post-operatively to prevent Deep Vein
Thrombosis (DVT).

Example:
Heparin
Warfarin

Side effects:
•hematuria.
•severe bruising.
•prolonged nosebleeds.
•bleeding gums.
•vomiting blood or coughing up blood.
•heavy periods in women.
Nursing Care:
• Watch for the signs of bleeding.
• Check APTT level before starting heparin therapy.
• Do not use if sensitive to heparin, with bleeding disorders, severe thrombocytopenia,
and uncontrolled active bleeding.
• Educate patient on ways to promote safety like using electric razor, soft-bristled
toothbrush, and cautious movement because any injury at this point can precipitate
bleeding.
• Use cautiously in pregnant and postpartum patients and women older than age 60.
• Instruct patient to avoid green leafy vegetables, milk, tomatoes, banana and fish when
on warfarin therapy.
• Regular testing of the PT and INR is essential for all people taking warfarin.

Antidote:
Heparin: Protamine Sulphate.
Warfarin: Vitamin K.
 Diuretics
A diuretic is any substance that promotes diuresis, the increased production of
urine.

Types:
•Loop Diuretics – Furosemide (Lasix)
•Thiazides (Hydrochlorothiazide)
•Potassium-Sparing Diuretics (Spironolactone)
•Osmotic Diuretics (Mannitol)

Side effects:
•Hearing loss.
•Hypokalemia.
•Dizziness.
•Headaches.
•Dehydration.
•Muscle cramps.
•Joint disorders (gout).
Nursing Care:
• Monitor weight daily.
• Strict intake and output charting.
• Check serum electrolyte levels.
• Follow blood urea nitrogen and creatinine levels regularly.
• Perform ECG monitoring as hypokalemia can cause intermittent PVC and U waves.
• Teach the patient that the medication must be continued so the fluid problem is
controlled.
• Reinforce dietary instructions for a client receiving Spironolactone to avoid taking
this medication with high potassium fruits such as apricots, papaya, banana etc.
6. Female Reproductive System Drugs
OXYTOCICS:
• These are uterine stimulants used in course of pregnancy, delivery and immediately
postpartum period.

EXAMPLES:
➢ Dinoprostone, (PGE2)
➢ Methergin, Synocinon pitocin (Oxytocin).

ADVERSE EFFECTS:
• General: nausea, vomiting (especially with PGE2), headache, weakness
• Specific: Pitocin causes Fetal Brady or tachycardia
Methergine causes Uterine rupture, transient chest pain, palpitations.

Oxytocin causes cardiac arrhythmias, hypertension, fetal bradycardia, N/V, uterine

rupture, pelvic hematoma, uternine hypertonicity.
Nursing care:
• Monitor uterine contractions.
• Monitor B/P, maternal & fetal H/R. Discontine drug if BP rises dramatically.
• Monitor vaginal bleeding.
• Dinoprostone and synto should not be given in patient with history of
previous cesarean section.
• I/V Methergin is not routinely recommended, however, in case of life
threatening conditions it should be administered slowly over 1 hour with
careful monitoring of blood pressure. Moreover it is contraindication in 1st
and 2nd stage of labor.
• Dinoprostone and synto are indicated for induction of labor.
GI Drugs
7. Antiemetics ---Mechanism of Action
In medulla, when CTZ and Vomiting Centre are triggered by chemoreceptors, episodes
of vomiting occur.

Neurotransmitter dopamine and serotonin are vomiting stimulants and they trigger
CTZ.

Increased ICP or increased amount of toxins in blood releases Serotonin and

Dopamine, hence CTZ and Vomit Center are triggered.
Nursing Considerations:
• Give anti emetics pre meals and maintain I/V hydration to prevent excessive
fluid loss.
• Advise patient and family to use non pharmacological measures such as to
begin with sips of liquids, crackers, dry toast and small, non greasy meals;
provide oral hygiene; and remove noxious stimuli from environment. Take
history and check hepatic function and renal status, which may be the cause
of vomiting.
• Monitor V/S, I/O and assess skin turgor.
• Some of the antiemetic drugs may cause drowsiness. So, instruct patient to
call for assistance when ambulating.
• Avoid activities that require alertness e.g. driving etc. after antiemetic
administration.
• Watch for extrapyramidal symptoms when administering
metoclopramide.
8. Antidiarrheal drugs
• Treat diarrhea by decreasing hyper motility .
• Anti diarrheal should not be used for more than 2 days and should not be used if the
client has fever along with diarrhea (infective diarrhea).

Example: Loperamide (Imodium)

Nursing Care:
• Take history and determine the underlying cause of diarrhea.
• Monitor & Maintain fluid and electrolyte balance.
• Monitor V/S, I/O and bowel sounds.
• Encourage oral liquid intake, boiled water and washing fruits and vegetables well
before eating.
• Cook vegetables and meat well.
• Clients with diarrhea should avoid milk (causes indigestion and bloating due to lack
of lactase) & food rich in fat (stimulates peristalsis).
9. Anti-Ulcer Drugs
Gastric mucosal barrier is thick, viscous mucosal layer which provides
barrier between the mucosal lining and the gastric secretions against
corrosive material. Anti ulcer drugs prevent and treat ulcer disease by
decreasing cell destructive effects or increasing cell protective effects.

These are:

➢ Drugs that reduce acid secretion

➢ Drugs that increase mucous secretion
➢ Drugs that neutralize HCL
➢ Drugs that remove H. Pylori
Histamine (H2) receptorAntagonists:
Histamine (H2)-antagonist directly inhibits histamine action on H2-receptors in parietal
cells. Thus, decreasing acid production and it’s concentration.

Example:
➢ Ranitidine (Zantac)

Proton Pump Inhibitors:

Suppresses gastric secretion by inhibiting the hydrogen/ potassium ATPase pump,
which acts as a proton pump. Its inhibition reduces HCl production.

Example:
➢ Omeprazole (prilosec)
➢ Esomeprazole (Nexium)
Mucosal Protective drugs
Binds with proteins at the ulcer site to form a viscous substance that covers and sticks
to the ulcer site and helps protect the ulcer from gasric acid and pepsin (acts locally).

Example:
Sucralfate

Nursing care:
• Administer sucralfate on empty stomach.
• Administer other oral medications 2 hours before giving sucralfate to prevent drug
interaction, because sucralfate provides protective barrier to the GI mucosa.
Antacids
Promote ulcer healing by neutralizing acid in the stomach, by raising the
stomach PH (to alkaline).

Example:
➢ Calcium Carbonate
➢ Sodium bicarbonate
Nursing Considerations
• Educate the patient to report hematemesis, or malena.
• Avoid alcohol, smoking, caffeine, spicy food.
• Eat 5- 6 small meals instead of 3 large meals.
• PPIs should be taken 30 minutes prior to food
ingestion, usually before breakfast.
• Avoid antacids with drugs such as tetracycline,
digoxin, iron, H2 receptor antagonists b/c antacids
inactivate these drugs.
10. Neuromuscular Junction Blocking
Agent
Blocks nerve stimulation on muscle cells and cause paralysis of the muscles directly
without total CNS depression.

Examples:
Succinylcholine
Atracurium

Adverse Effects:
• Profound and prolonged muscle paralysis
• Respiratory paralysis characterized by depressed respiration, bronchospasm, and
apnea.
• Prolonged drug use may cause GI paralysis, constipation, vomiting,
regurgitation, aspiration
• Pressure ulcers may develop because patient loses reflex muscle movement that
protects the body.
 Anti Convulsant
Classifications Generic Name
Hydratoins Phenytoin,
Barbiturates and barbiturate-like drugs Phenobarbital
Clonazepam
Benzodiazepines
Diazepam

Adverse Reactions:
Depression, confusion, drowsiness, lethargy, fatigue, arrhythmias, changes
in blood pressure, constipation, dry mouth, anorexia, urinary retention, loss of libido &
Cellular toxicity which is characterized by severe liver toxicity, bone marrow suppression,
gingival hyperplasia, and serious dermatological reaction (e.g. hirsutism, Steven-Johnson
syndrome).

Antidote:
Antidote for toxic Benzodiazepine is Flumazenil.
Nursing Care:
• Teach the patient to brush and floss carefully after each meal.
• Tell the patient to avoid taking anti-convulsant with milk, calcium, antacid and milk of
magnesia.
• Teach the patient that these drugs possess the risk for birth defects, therefore,
consult with the doctor to evaluate her for specific risks and possible pregnancy.
• Instruct the patient to check liver function and hematology levels every 3-6 months.
11. Anticholinergics
Anticholinergics are drugs that oppose the effects of acetylcholine. In essence, they
also lyse and block the effects of parasympathetic nervous system (PNS) so they are
also called as parasympatholytics.

Atropine is currently the only widely used anticholinergic drug. It is the drug of
choice to treat symptomatic bradycardia in adults. Also, it is used as an antidote for
cholinergic overdose.

Other common examples include ipratropium.

Adverse effects:
Blurred vision, pupil dilation, photophobia, increased intraocular pressure, dizziness,
tachycardia, palpitation, dry mouth, Urinary hesitancy and retention.
12. Antiviral

Influenza A and
Respiratory Viruses • Ribavirin
Drugs

• Acyclovir
Herpes Drugs • Valacyclovir
Adverse Effects
Headache, depression, neuropathy, seizures, especially in patients with
electrolyte imbalance,nausea, vomiting, serious pancreatitis, hepatomegaly
renal dysfunction and failure

• IV and topical site: rash, inflammation, burning sensation, bone marrow

suppression

• Others: serious-to-fatal hypersensitivity reactions (fever, chills, rash, fatigue,

GI upset, flu-like symptoms) can occur and drug must be discontinued
immediately.
 13. Antifungals
• Systemic Antifungals
• Fluconazole
• Amphotericin B

• Topical Antifungals
• Nystatin
Adverse Effects
• liver toxicity, hepatic and renal failure, nausea, vomiting,
potentially severe diarrhea, anorexia, weight loss, urinary
frequency, burning, Severe effects on a fetus or a nursing
babies, bone marrow depression, rash, pain at injection site with
phlebitis
Adverse Effects
• CNS: headache, dizziness, ataxia, loss of coordination, peripheral neuropathy
• Immunological: fever, shaking, chills, malaise
• GI: nausea, vomiting, dyspepsia, anorexia, hepatic dysfunction, unpleasant
taste, cramps
• Dermatological: rash, pruritus, loss of hair associated with changes in protein
synthesis
• Eyes: visual changes, possible blindness
• Ears: ototoxicity related to nerve damage
• Cinchonism (nausea, vomiting, tinnitus, and vertigo) may occur with high
levels of quinine
• Super infections
14. Anti Bacterial Agents
The major classes of antibiotics include: aminoglycosides, penicillins and
penicillinase-resistant drugs, sulfonamides, tetracyclines, and
antimycobacterials (e.g. antitubercular and leprostatic)

• Beta-Lactam Antibiotics (Penicillin/Cephalosporin/Carbapenems)

• Macrolides-Example: Clarithromycin
• Lincosamides-Example: Clindamycin
• Tetracycline-Example: Doxycycline
• Aminoglycosides-Example: Amikacin
• Fluroquinolones-Example: Levofloxacin, Ciprolfloxacin
• Glycopeptide group-Vancomycin
Side Effects:
• Ototoxicity, irreversible deafness, vestibular tingling, weakness, nausea,
vomiting, diarrhea, weight loss, stomatitis, hepatotoxicity, Hypersensitivity reactions
• Renal: renal failure, Nephrotoxicity in patients who have predisposing renal
insufficiency
• Superinfections

Antimycobacterials adverse effects:

Neuritis, dizziness, headache, malaise, drowsiness, and hallucinations, nausea,
vomiting, anorexia, stomach upset, abdominal pain, bone marrow
suppression.

*Pyridoxine (Vitamin B6) is given to prevent Isonizade induced neuritis.

• Rifampincan cause discoloraion of body fluids from urine to sweat and tears. They
may stain orange-tinged and may permanently stain contact lenses.
Nursing consideration:
• Teach the patient to complete the course of antibiotic even if the symptoms
stop sooner.
• Check culture and sensitivity reports to ensure that this is the drug of choice
for this patient.
• Should be administered slowly over 60 mins.
• Stop the medication if flushing of skin develops within 10 mins of
administration.
• Monitor hepatic and renal function and perform ophthalmological
examination before and periodically during treatment to ensure early
detection and prompt intervention with cessation of drug if signs of failure
or deteriorating vision occur.
• Provide safety measures to protect the patient if CNS effects (e.g. confusion,
disorientation, numbness) occur.
• Provide the following patient teaching: safety precautions (e.g. changing
positions, avoiding hazardous tasks, etc.), drinking lots of fluids and to
maintain nutrition even though nausea and vomiting may occur, report
difficulty breathing, severe headache, fever, diarrhea, and signs of infection.
References
• http://medical-dictionary.thefreedictionary.com/
• Drug Distribution System policy PHA-SLD-PP-O04
• Patient Own Medications policy PHA-SLD-PP-O2O
• Food-Drug interaction policy PHA-SLD-PP-O4O
• https://nurseslabs.com/category/nursing-notes/nursing-pharmacology/
• https://tech.snmjournals.org/content/46/2/81
• https://www.msdmanuals.com/home/drugs/administration-and-kinetics-of-
drugs/drug-administration