Adelphi University NUR 300 Pharmacology Drug Classification Worksheet

Drug Classifications HYPOTHALAMIC AND PITUITARY DRUGS HYPOTHALAMIC HORMONES ANTERIOR PITUITARY Corticotropin, Cosyntropin, Somatrem, Somatropin, Goserelin, Histrelin, HCG, Choriogonandotropin Leuprolide, Nafarelin, alpha, Follitropin alfa, Octreotide, Triptorelin Follitropin beta, Menotropins, Pegvisomant, A synthetic analogue of Thyrotropin alfa, LHRH. Urofollitropin Initially causes a transient Binds to growth hormone increase in testerone; (GH) receptor sites on cell however, with continuous surfaces, blocking the effects administration, testerone of endogenous growth levels are decreased. hormone Reduces gonadotropins, Bound to polyethylene testosterone, and estradiol. glycol (PEG) to reduce clearance and increase duration of action. Rapidly and almost completely absorbed following SQ injection. More slowly absorbed following IM administration of depot form. Side Effects: headache, anxiety, depression, dizziness, fatigue, insomnia, weakness.dyspnea, chest pain, MI CEREBROVASCULAR ACCIDENT 57% absorbed following SQ injection. Metabolism unknown. Side Effects: hypertension, peripheral edema. LFTs. back pain. growth hormone deficiency, glucose tolerance. lipohypertrophy. POSTERIOR PITUITARY

Examples & Action:

Desmopressin, Vasopressin, Oxytocin An analogue of naturally occurring vasopressin (antidiuretic hormone). Primary action is enhanced reabsorption of water in the kidneys

Metabolism, absorption, & side effects:

5% absorbed following oral administration; some 1020% absorbed from nasal mucosa. Metabolism unknown Side Effects: SEIZURES, drowsiness, headache, listlessness.nasal congestion, rhinitis. dyspnea. hypertension, hypotension, tachycardia (large IV doses only). mild abdominal cramps, nausea.

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Adelphi University NUR 300 Pharmacology Drug Classification Worksheet

Nursing Implications Monitor patients with vertebral metastases for increased back pain and decreased sensory/motor function Monitor intake and output ratios and assess for bladder distention in patients with urinary tract obstruction during initiation of therapy Assess patient for signs and symptoms of endometriosis before and periodically during
therapy.

Assess patient for signs and symptoms of acromegaly. Monitor patient for signs and symptoms or hepatitis or other liver injury Monitor serum IGF-1 levels 4 6 wk after therapy is initiated. Monitor serum glucose carefully in patients with insulin-dependent diabetes Measure liver tests (serum ALT, AST, total bilirubin and alkaline at baseline.

Monitor frequency of enuresis throughout therapy Monitor urine and plasma osmolality and urine volume frequently. Weigh patient daily and assess for edema Monitor plasma factor VIII coagulant, factor VIII antigen, and ristocetin cofactor.

Drug Classifications GLUCOCORTICOIDS Examples & Action: Beclamethasone, Bethametasone, Budesonide, Cortisone, Dexamethasone, Flunisolide, Fluticasone, Hydrocortisone, Methylprednisolone, MOmetasone, Prednisolone, Prednisone In pharmacologic doses, suppresses inflammation and the normal immune response. Has numerous intense metabolic effects (see Adverse Reactions and Side Effects) MINERALOCORTICOIDS HYPOTHYROIDISM Levothyroxine Replacement of or supplementation to endogenous thyroid hormones. Principal effect is increasing metabolic rate of body tissues Promote gluconeogenesis Increase utilization and mobilization of lycogen stores Stimulate protein synthesis Promote cell growth and differentiation Aid in the development of the brain and CNS

Fludrocortisone Causes sodium reabsorption, hydrogen and potassium excretion, and water retention by its effects on the distal renal tubule

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Adelphi University NUR 300 Pharmacology Drug Classification Worksheet

Metabolism, absorption, & side effects: Well absorbed after oral administration. Sodium phosphate salt is rapidly absorbed after IM administration. Metabolized mostly by the liver Side Effects: depression, euphoria, headache, intracranial pressure (children only), personality changes, psychoses, restlessness. cataracts, intraocular pressure Assess patient for signs of adrenal insufficiency. Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care professional if these occur. Well absorbed following oral administration Mostly metabolized by the liver Side Effects: dizziness, headache. CHF, arrhythmias, edema, hypertension. anorexia, nausea. adrenal suppression, weight gain. hypokalemia, hypokalemic alkalosis. Monitor blood pressure periodically during therapy. Monitor for fluid retention Monitor patients with Addison's disease closely and stop treatment if a significant increase in weight or blood pressure, edema, or cardiac enlargement occurs. Monitor serum electrolytes closely. Levothyroxine is variably (40 80%) absorbed from the GI tract Metabolized by the liver and other tissues to active T3. Thyroid hormone undergoes enterohepatic recirculation and is excreted in the feces via the bile. Side effects: headache, insomnia, irritability.angina pectoris, arrhythmias, tachycardia.abdominal cramps, diarrhea, vomiting.sweating. Assess apical pulse and blood pressure prior to and periodically during therapy. Assess for tachyarrhythmias and chest pain.Monitor height, weight, and psychomotor development. Monitor thyroid function studies prior to and during therapy.Monitor blood and urine glucose in diabetic patients.

Nursing Implications

Drug Classifications HYPERTHYROIDISM ORAL CALCIUM PROD. VIT. D PREPARATIONS

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Adelphi University NUR 300 Pharmacology Drug Classification Worksheet

Examples & Action: Propylthiouracil, Methimazole, Strong Iodine solution Lugols solution, saturated solution of potassium iodide, sodium iodide, Propanolol Blocks stimulation of beta1(myocardial) and beta2 (pulmonary, vascular, and uterine)-adrenergic receptor sites Metabolism, absorption, & side effects: Well absorbed but undergoes extensive first-pass hepatic metabolism. Almost completely metabolized by the liver. Side Effects: fatigue, weakness, anxiety, dizziness, drowsiness, insomnia, memory loss, mental depression, mental status changes, nervousness, nightmares. bronchospasm, wheezing. ARRHYTHMIAS, BRADYCARDIA, CHF, PULMONARY EDEMA Calcium Acetate, Calcium carbonate, calcium citrate, calcium gluconate, calcium chloride Essential for nervous, muscular, and skeletal systems Maintain cell membrane and capillary permeability Act as an activator in the transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscle

Calcitrol, cholecalciferol, ergocalciferol, paricalcitrol Calcitriol is the active form of vitamin D Promotes the absorption of calcium and decreases parathyroid hormone concentrations

Absorption from the GI tract requires vitamin D Excreted mostly in the feces; 20% eliminated by the kidneys Side Effects: headche, tingling. arrhythmias, bradycardia. constipation, nausea, vomiting. calculi, hypercalciuria.

IV administration results in complete bioavailability; well absorbed following oral administration Undergoes enterohepatic recycling and is excreted mostly in bile. Side Effects: albuminuria, azotemia, decreased libido, nocturia, polyuria. pruritus.hypercalcemia.pain at injection site

Facquet_Fall 2010

Adelphi University NUR 300 Pharmacology Drug Classification Worksheet

Nursing Implications Monitor BP and pulse. Patients receiving propranolol IV must have continuous ECG monitoring and may have pulmonary capillary wedge pressure (PCWP) or central venous pressure (CVP) monitoring during and for several hours after administratiom Observe patient closely for symptoms of hypocalcemia Monitor patient on digitalis glycosides for signs of toxicity. Monitor serum calcium or ionized calcium, chloride, sodium, potassium, magnesium, albumin concentrations before and periodically during therapy for treatment of hypocalcemia Assess for symptoms of vitamin deficiency prior to and periodically during therapy Assess patient for bone pain and weakness prior to and during therapy Observe patient carefully for evidence of hypocalcemia Monior height and weight daily

Drug Classifications SELECTIVE ESTROGEN REC. Examples & Action: PARATHYROID HORMONE Teriparatide, phosphate salt, prednisone or hydrocortisone, 0.9% Sodium Chloride injection Regulates calcium and phosphate metabolism in bone and kidney by binding to specific cell receptors; stimulates osteoblastic activity Increases serum calcium and decreases serum phosphorus BIPHOSPHONATES

Raloxifene, Calcitoninsalmon Binds to estrogen receptors, producing estrogen-like effects on bone, resulting in reduced resorption of bone and decreased bone turnover

Alendronate, Ibandronate, Pamidronate, Risedronate, Zoledronate Inhibits resorption of bone by inhibiting osteoclast activity

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Adelphi University NUR 300 Pharmacology Drug Classification Worksheet

Metabolism, absorption, & side effects: Although well absorbed (>60%), after oral administration, extensive first-pass metabolism results in 2% bioavailability Extensively metabolized by the liver; undergoes enterohepatic cycling; excreted primarily in feces Side Effects: STROKE, deep vein thrombosis, pulmonary embolism, retinal vein thrombosis.leg cramps. hot flashes. Assess patient for bone mineral density with x-ray, serum, and urine bone turnover markers Poorly absorbed (0.60.8%) after oral administration. Side Effects: headache. blurred vision, conjunctivitis, eye pain/inflammation. atrial fibrillation. abdominal distention, abdominal pain, acid regurgitation, constipation, diarrhea, dyspepsia, dysphagia, esophageal cancer, esophageal ulcer, flatulence, gastritis, nausea, taste perversion, vomiting. Assess patients for low bone mass before and periodically during therapy Assess for symptoms of Paget's disease (bone pain, headache, decreased visual and auditory acuity, increased skull size)

Extensively absorbed after subcut administration Metabolized by the liver Side effects: orthostatic hypotension. muscle spasms

Nursing Implications Assess patient for bone mineral density before and periodically during therapy. Monitor labs.

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