PHARMACOLOGY

Pharmacology
- most smpy dened as study of drug.
Fundamentals of Pharmacology
1. Pharmacoknetcs
- study of drugs changes as t enters and passes through the body.
a. absorpton
b. dstrbuton
c. botransformaton
d. excreton
2. Pharmacodynamcs
- mechansm by whch drugs produce changes n body tssue.
a. desred ehect - ntended acton of drugs
b. adverse ehect - harmfu unntended reactons
c. sde ehects - consequence reactons
d. toxcty - the degree whch somethng s posonous
dgoxn = 0.5 - 2.0 ng/mL
thum = 0.5 - 1.5 mEq/L
Safety and Efcacy
urs!ng Pr!nc!"les #
1. Aways verfy the F!$e R!ghts .
a. the rght medcatons
b. the rght cent
c. the rght dosage
d. the rght form, route and technque
e. the rght tme
2. Chart drug admnstraton ony after ts been gven, never before.
3. Never eave the medcaton on cart or tray unattended.
4. Chart observed therapeutc and adverse ehects accuratey and fuy.
5. Check hstory for aerges and potenta drug nteractons before
admnsterng a
newy ordered drug.
6. Inform the prescrbng physcan of any observed adverse ehects; f
cannot be
ocated, nform the nursng supervsor
7. Oueston drug orders that are uncear, that appear to contan errors,
or that have
potenta to harm.
8. Take the foowng actons f an error occurs :
a. mmedatey notfy the nursng supervsor, the prescrbng
physcan, and the
pharmacst.
b. assess the cents condton and provde any necessary care.
9. For postpartum women, advce to take drugs after breastfeedng.
Adm!n!strat!on of %rugs #
Routes and urs!ng cons!derat!ons#
1. Entera - ora, subngua, recta, gastrc tubes
- capsuated p, sustaned reease and enterc coated shoud not be
crushed.
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2. Parentera - IV, IM, SO, ID, IT, IA, epdura.
- vastus ateras (safest ste for IM)
3. Topca - skn, nhaants, mucus membrane.

Eye med!cat!ons #
- admnster eyedrops rst then ontment.
- use a separate botte for each cent.
- nstruct the cent to tt the head backward, open eyes and ook up.
- avod contact of medcaton botte to the eyeba.
- pace prescrbed dose n the ower con|unctva sac.
- nstruct the cent to press the nner canthus for 30-60 seconds.
- nstruct the cent to cose the eye genty.
Ear dro"s
- n nfant and chdren younger than 3 y.o, pu pnna downward and
backward.
- n oder chdren and adut, upward and backward.
- drect the souton on the wa of the ear cana, not drecty on the
ear drum.
CLASS&F&CA'&OS OF %R(GS
%R(GS AFFEC'&G 'HE CE'RAL A% A('OOM&C SYS'EM
Chol!nerg!c Agents (Parasympathomemtcs)
Prototy"e #
- synthetc acetychone, pocarpne, carbacho, bethaneco
(Urochone),
edrophonum (Tenson), neostgmne (Prostgmne),
pyrdostgmne (Mestnon).
Mechan!sm of act!on #
- stmuates chonergc receptors by mmckng acetychone or
nhbton of
enzyme chonesterase.
&nd!cat!ons #
- gaucoma, urne retenton, Myasthena Gravs
- antdote to neuromuscuar bockng agents : trcycc
antdepressants and atropne
Ad$erse e)ects #
- burrng of vson, moss
- ncrease n savaton, ntestna cramps
- bronchoconstrcton, wheezng, DOB
- hypotenson and bradycarda
urs!ng cons!derat!ons #
1. Warn & montor cents of the sde ehects.
2. Have atropne avaabe for use as antdote.
Chol!nerg!c *loc+!ng Agents ,Parasym"atholyt!cs-
Ant!chol!nerg!cs.
Prototy"e #
- atropne, scopaamne (Trptone), dcycomne (Benty),
propanthene (Pro-Banthne).
______________________________________________________________
Mechan!sm of act!ons #
- bock the bndng of acetychone n the receptors of
parasympathetc nerves.
&nd!cat!ons #
- use preoperatvey to dry up secretons.
- treat spastcty of GI or urnary tract.
- use for treatment of bradycarda, asthma, parknsonsm.
- use for antdote n organophosphate posonng.
Ad$erse e)ects #
- dry mouth , dataton of pups, tachycarda
- urnary retenton, eus, heat stroke
urs!ng cons!derat!ons #
1. Keep cents n coo envronment.
2. Watch out for sgns of heatstroke and dehydraton.
3. Encourage cents to ncrease ud ntake and use of sugaress
gum/candy for dry
mouth.
4. For GI spastcty, admnster 30 mnutes before meas and at bed
tme.

Adrenerg!c Agents (Sympathommetcs)
Prototy"e #
- epnephrne, norepnephrne, ephedrne, dopamne, dobutamne,
phenyephrne,
terbutane, abutero, soprotereno.
Mechan!sm of act!ons #
- stmuate apha and beta adrenergc receptor drecty or trgger the
reease of
catechoamnes ndrecty causng sympathetc ehects.
&nd!cat!ons #
- cardopumonary arrest, hypotenson
- COPD and asthma, nasa congestons
- aergc reacton, anaphyactc shock
Ad$erse e)ects #
- restessness, nsomna, tremors, nausea
- paptatons, angna, tachycarda, HPN
urs!ng cons!derat!ons #
1. Contrandcated n cents w/ hyperthyrodsm,
pheochromocytoma & cardovascuar dsease.
2. Montor vta sgns and advce precautons.
3. Shoud be taken wth food.
A%REERG&C *LOC/&G AGE'S
Prototy"e #
a. Apha bockers
- phentoamne (Regntne), phenoxybenzamne, prazosn (Mnpress),
reserpne (Serpas), terazosn (Hytrn)
- condne (Catapress), methydopa (Adomet)
b. Beta bockers
- atenoo (Tenormn), esmoo (Brevboc),
metoproo (Lopressor), nadoo (Corgard),
propanoo (Indera), tmoo ( Bocadren)
Mechan!sm of act!ons #
a. apha bockers
- nhbts acton of a-receptors n vascuar smooth musce to cause
vasodataton.
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b. beta bockers
- compete wth epnephrne n b-receptors n heart, pumonary
arways, perphera
crcuaton and CNS.
&nd!cat!ons #
- Raynauds dsease, hypertenson, pheochromocytoma.
- angna, arrhythmas, mtra vave proapse, gaucoma
Ad$erse e)ects #
- orthostatc hypotenson, bradycarda, CHF
- depresson, nsomna and vertgo
- bronchospasm and dyspnea, nasa stumness, cod extremtes
urs!ng cons!derat!ons #
1. Admnster ora apha-bockers wth mk to mnmze GI sde
ehects.
2. Admnster ora beta-bockers before meas and at a.m. f nsomna
occurs.
3. Check cents apca puse rate before drug admnstraton, refer f
beow 60 bpm.
4. Hypotensve precautons.
5. Warn cents not to drve or operate dangerous machnery unt
he/she has
ad|usted to medcatons.
S+eletal Muscle Rela0ants Agents
Prototy"e #
- methacarbamo (Robaxn), bacofen (Loresa), dantroene
(Dantrum),
metaxaone (Skeaxn), orphanedrne (Norgesc), chorzoxazone
Mechan!sm of act!ons#
- depress CNS
- nhbt cacum on reease n the musce
- enhance the nhbtory acton of GABA (gamma-amno butyrc acd)
&nd!cat!ons #
- for acute muscuoskeeta pan
- for musce spastcty assocated wth mutpe sceross, cerebra
pasy, CVA, and
spna cord n|ury.
Ad$erse e)ects #
- hypotona, ataxa, hypotenson, drowsness
- burred vson, bradycarda, depresson, urne retenton
urs!ng cons!derat!ons #
1. Cauton cents that menta aertness may be mpared.
2. Montor neuromuscuar status, bowe and badder functons.
3. Inform cents that maxmum benet of bacofen s attaned for 1-2
months.
4. Reduce bacofen dosage graduay because of assocated
wthdrawa symptoms :
Confuson, haucnatons, paranoa & rebound spastcty.
A'&CO1(LSA'S
Prototy"e #
a. Hydantons - phenyton (Dantn)
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b. Barbturates - phenobarbta ( Lumna)
c. Msceaneous
- carbamazepne (Tegreto), dazepam, corazepate (Tranxene),
vaproc acd (Dapakene), ethosuxmde (Zarontn).
Mechan!sm of act!on #
- treat sezures by depressng abnorma neurona actvty n motor
cortex.
Ad$erse e)ects #
- sedaton & drowsness, gngva hyperpasa
- dpopa, nystagmus, vertgo, dzzness
- thrombocytopena, apastc anema
urs!ng cons!derat!ons :
1. Advse femae cents to use contraceptves.
2. Inform cents takng phenyton that harmess urne dscooraton s
common.
3. Warn cents wth dabetes that hydantons may ncrease bood
sugar eve and that
vaproc acd may produce a fase postve resut n urne ketone
test.
4. Teach cents recevng carbamazepne to dentfy symptoms of
bone marrow
depressons.
5. Reassure that barbturates are not addctve at a ow dosage.
6. Avod takng acoho wth barbturates.
7. Admnster IV phenyton sowy to avod cardotoxcty.
8. Avod mxng other drugs n same syrnge wth phenyton.
A'&PAR/&SO&A AGE'S
Prototy"e #
a. Antchonergc agents
- trhexyphendy (Artane), benztropne (Congentn)
b. Dopamnergc agents
- Levodopa, carbdopa-evodopa (Snemet), amantdne
(Symmetre),
pergode (Permax), seegne (Edepry), bromocrptne.
Mechan!sm of act!ons #
a. antchonergc agents
- nhbt cerebra motor centers.
b. dopamnergc agents
- ncreasng dopamne concentratons or
enhancng neurotransmtter functonng.
Ad$erse e)ects of do"am!nerg!c agents#
a. evodopa - nausea, vomtng, anorexa, orthostatc hypotenson,
dark-coored urne and sweat
b. amantdne - anke edema, constpaton
c. bromocrptne - paptatons, tachycarda
urs!ng cons!derat!ons #
1. Gve dopamnergc agents after meas to reduce GI symptoms.
2. Reassure cent that evodopa may cause harmess darkenng of
urne and sweat.
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3. Avod takng Vt B6 (pyrdoxne) wth evodopa because t speed up
metabosm.
4. Educate cents to mnmze orthostatc hypotenson.
5. Eevate eg to reduce anke edema.
CE'RAL ER1O(S SYS'EM S'&M(LA'S
Prototy"e #
- amphetamnes, methyphendate (Rtan)
Mechan!sm of act!ons #
- ncrease exctatory CNS neurotransmtter actvty and bocks
nhbtory mpuses.
&nd!cat!ons #
- for obesty (amphetamnes)
- attenton dect hyperactvty dsorders
- narcoepsy
- drug-nduced respratory depressons.
Ad$erse e)ects #
- nervousness, nsomna, restessness
- hypertenson, tachycarda, headache
- anorexa, dry mouth.
urs!ng cons!derat!ons #
1. Shoud be gven at mornng.
2. Dont stop amphetamne abrupty to avod wthdrawa symptoms.
3. Montor bood pressure and puse.
4. Ice chps or sugaress gum for dry mouth.
5. Watch out for growth retardaton n chdren takng
methyphendate.
%R(GS AFFEC'&G ME'AL F(C'&O&G
Sedat!$es- Hy"not!cs- and An0!olyt!cs
Prototy"e #
a. Benzodazepnes
- dazepam (Vaum), orazpam (Atvan),
aprazoam (Xanax), urazepam (Damane)
b. Barbturates
- amobarbta, phenobarbta, secobarbta
c. Msceaneous
- chora hydrate (Noctec), busprone (Buspar), paradehyde
(Para)
Mechan!sm of act!ons #
a. Benzodazepnes
- ncrease the ehect of nhbtory neuro transmtter GABA
(gamma-amno butyrc acd)
b. Barbturates and Msceaneous agents
- depress CNS
&nd!cat!ons #
- nduce seep, sedate and cam cents
Ad$erse e)ects #
- hangover-ehect, dzzness, CNS depresson
- respratory depresson, drug-dependence
urs!ng cons!derat!ons #
1. Warn cents of n|ures and fas.
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2. Bref perod of confuson and exctement upon wakng up s
common wth
benzodazepnes.
3. Warn cents not to dscontnue medcatons abrupty wthout
consutng a physcan.
4. Avod acoho whe takng these drugs.
6. Rotate and dont shake the ampues of barbturates. Dont mx
wth other drugs.
7. Warn femae cents that dazepam s assocated wth ceft p.
A'&%EPRESSA'S A% MOO% %&SOR%ER %R(GS
Prototy"e #
a. Trcycc antdepressants
- amtrptyne (Eav), protrptyne (Vvact),
- mpramne (Tofran), despramne
b. MAO (monoamne oxdase nhbtors )
- socarboxazd (Marpan), phenezne (Nard), tranycypromne
(Pernate)
c. Second-generaton antdepressants
- uoxetne (Prozac), trazodone (Desyre)
d. Lthum
Mechan!sm of act!ons #
a. Trcycc antdepressants
- ncrease receptor senstvty to serotonn and/or norepnephrne.
b. MAO nhbtors
- nhbt the enzyme MAO that metaboze the neurotransmtters
norepnephrne and
serotonn.
c. Second - generaton antdepressants
- nhbts the reuptake of serotonn.
d. Lthum
- ncrease serotonn & norepnephrne uptake
Ad$erse e)ects #
- dry mouth, burred vson, urne retenton, constpaton
(antchonergc ehects)
- orthostatc hypotenson, nsomna
- hypertensve crss (MAO)
- dehydraton (Lthum).
urs!ng cons!derat!ons #
1. Cauton cent to rse sowy to reduce the ehects of orthostatc
hypotenson.
2. Take antdepressant wth food to enhance absorpton
3. Expan to cent that fu response may take severa weeks (2
weeks).
4. Assess cent for constpaton resutng from trcycc antdepressant
use.
5. Cent takng MAO nhbtors shoud avod tyramne-rch foods to
avod
hypertensve crss.
- aged cheese, sour cream, yogurt, beer, wne, chocoate, soy
sauce and yeast
- penthoamne (Regntne) s the drug of choce for hypertensve
crss.
6. Inform physcan and wthhod uoxetne f cent deveop rashes.
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7. Take thum wth food to reduce GI ehects
- > 1.5 mEq/L bood eve may cause toxcty manfested by:
confuson, ethargy, sezures,hyperreexa.
- mantan sat and adequate ud ntake
- tremors may occur but t s temporary
- montor whte bood ce count (ncrease).
A'&PSYCHO'&C %R(GS ,E(ROLEP'&CS.
Prototy"e #
a. Phenothaznes
- chorpromazne (Thorazne),
- truoperazne (Steazne),
- thordazne (Mear)
b. Other Agents
- cozapne (Cozar), haoperdo (Hado)
Mechan!sm of act!on #
- bock dopamne receptor n the mbc system, hypothaamus, and
other regons of the bran.
Ad$erse e)ects #
- Extra pyramda symptoms such as dystona, pseudoparknsonsm,
and
an rreversbe tardve dysknesa as manfested by :
a. p smackng
b. ne wormke tongue movement
c. nvountary movements of arms and eg.
- Neuroeptc magnant syndrome
a. fever, tachycarda, tachypnea, daphoress, cardovascuar
coapse
b. musce rgdty, sezures.
- orthostatc hypotenson
urs!ng cons!derat!ons #
1. Teach famy members the sgns of EPS and NMS, and report to
physcan
mmedatey.
2. Normazaton of symptoms may not occur for severa weeks after
begnnng of
therapy .
3. Avod admnsterng haoperdo ntravenousy
4. Watch out of neutropena wth cozapne.
5. Watch out for orthostatc hypotenson and photosenstvty wth
phenothazne.
6. Be sure that ora doses are swaowed, and not hoarded.
%R(GS (SE% & PA& MAAGEME'
General Anesthet!cs
Prototy"e #
a. Inhaaton anesthetcs
- enurane (Ethrane), haothane
- sourane (Forane), ntrous oxde
b. In|ecton anesthetcs
- fentany (Submaze), ketamne (Ketaar),
thopenta Na (Penthota), etomdate (Amdate)
Mechan!sm of act!ons #
______________________________________________________________
- cause CNS depresson, by producng oss of conscousness,
unresponsveness to pan
stmu, and musce reaxaton.
urs!ng cons!derat!ons #
1. Instruct cent NPO for 8 hours before admnstraton.
2. Montor cardo pumonary depresson and hypotenson.
3. Montor urnary retenton.
4. Montor body temperature
- magnant hyperthermc crss :
dantroene (antdote)
5. Avod acoho or CNS depressants for 24 hours after anesthesa.
6. In patent who receved haothane, montor sgns of hepatc fata
sde ehects :
- rash, fever, nausea, vomtng
- |aundce and atered ver functon.
LOCAL A% 'OP&CAL AES'HE'&C
Prototy"e #
oca : bupvacane, docane, tetracane, procane, mepvacane,
procane
topca : benzocane, butacane, dbucane,gnocane
Mechan!sm of act!on #
- bock transmsson of mpuses across nerve ce membrane.
Ad$erse e)ects #
- cardac dysrhythmas
urs!ng cons!derat!ons #
- gnocane + procane (EMLA cream) shoud be apped topcay 60
mnutes before
procedure.
- admnster cautousy to the areas of arge broken skn.
- observe for feta bradycarda n pregnant cents.
AALGES&CS
Prototy"e #
a. Narcotc anagescs
- codene, meperdne (Demero) morphne, butorphano (Stado)
nabuphne (Nuban)
b. Non - narcotc anagesc
NSAIDs - asprn (amnosacyc acd), mefenamc acd
(Ponstan),
buprofen (Motrn), naproxen, ketoprofen (Oruds),
ketoroac.
paracetamo and acetamnophen (Tyeno)
Mechan!sm of act!ons #
a. Narcotc anagescs
- ater pan percepton by bndng to opod receptors n CNS.
b. Non- narcotc anagesc
- reeves pan and fever by nhbtng the prostagandn pathway.
urs!ng cons!derat!ons #
1. Montor respratory depresson & hypotenson n cents takng
narcotc anagesc.
2. In|ury and accdent precautons n cents takng narcotc anagesc.
3. Warn cents about possbty of dependency,and do not dscontnue
narcotcs
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abrupty n the narcotc-dependent cents.
4. Naoxone s antdote for narcotc overdose.
5. Advce cents to take NSAIDs wth food and montor beedng
compcatons.
6. Asprn s contrandcated n cents beow 18 years od wth u-ke
symptoms.
7. Montor hearng oss n cents takng asprn.
8. Montor ver functon n cents takng acetamnophen.
9. N-acetycystene s antdote for paracetamo overdose.
%R(GS AFFEC'&G 'HE CAR%&O1ASC(LAR SYS'EM
A'&COAG(LA'S
Prototy"e #
- Heparn (SO and IV)
Warfarn (Oray)
Mechan!sm of act!ons #
a. Heparn
- prevents thrombn from convertng brnogen to brn.
b. Warfarn
- suppress coaguaton by actng as an
antagonst of vtamn K after 4-5 days.

&nd!cat!ons #
- thromboss, pumonary embosm, myocarda nfarcton
Ad$erse e)ect #
- beedng
urs!ng cons!derat!ons #
1. HEPARIN sodum
- f gven SO dont asprate or rub the n|ecton ste (above the
scapua - best ste).
- therapeutc eve 1.5-2.5 tmes norma PTT;
norma PTT s 20-35 sec. = 50-85 sec.
- antdote : (protamne sufate)
2. WARFARIN sodum (coumadn)
- warfarn s used for ong-term .
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- onset of acton s 4-5 days.
- therapeutc eve s 1.5-2.5 tmes norma PT;
norma PT = 9.6 -11.8 sec. = 25 - 30 sec.
INR = 2 - 3
- shoud be taken at the same tme of the day to mantan at
therapeutc eve.
- reduce ntake of green eafy vegetabes.
- antdote : Vtamn K ( Aquamephyton)

'HROM*OLY'&CS
Prototy"e #
Streptoknase, Uroknase
Mechan!sm of act!ons #
- actvates pasmnogen to generates pasmn (enzyme that
dssove cots).
&nd!cat!ons #
- use eary n the course of MI (wthn 4-6 hours of the onset)
urs!ng cons!derat!ons #
- montor beedng
- antdote : Amnocarpc acd
Ant!"latelet Med!cat!ons
Prototy"e# asprn, Dpyrdamoe (Persantn)
Copdogre (Pavx), Tcopdne
Mechan!sm of act!on #
- nhbt the aggregaton of pateet thereby proongng beedng
tme.
&nd!cat!ons #
- used n the prophyaxs of ong-term compcaton foowng M.I,
coronary
revascuarzaton, and thrombotc CVA.
urs!ng cons!derat!ons #
______________________________________________________________
HEMOS'AS&S #

Beedng/n|ury
&
Vasoconstrcton Pasmnogen
I I
Pateet aggregaton Pasmn
( temporary pug) I
I I
Cottng factor actvaton -------------- I
I I I
Intrnsc pathway (8,9,10,11,12) Extrnsc pathway (3,7,10) I
(PTT ) (PT) Vt K dep. I
I I I
I Prothrombn actvaton I I
I I
Thrombn I
I I
Fbrnogen ------------Fbrn threads ------------- Fbrn spt products
(coaguaton) ( Removed by ver & speen )
- Montor beedng tme ( NV = 1-9 mns)
- Take the medcaton wth food.
CAR%&AC GLYCOS&%ES
Prototy"e#
- dgoxn (Lanoxn) and dgtoxn (Crystodgn)
Mechan!sm of act!ons #
- ncrease ntraceuar cacum, whch causes the heart musce
bers to contract more
emcenty, producng postve notropc & negatve chronotropc
acton.
&nd!cat!ons #
- use for CHF, atra tachycarda and braton
urs!ng cons!derat!ons #
- Montor for toxcty as evdence by :
nausea, vomtng, anorexa, hao vson, confuson, bradycarda
and heart bocks .
- Do not admnster f puse s ess than 60 bpm.
- Shoud be cauton n patent wth hypothyrodsm and hypokaema.
- Antdote : Dg-bnd
- Phenyton s the drug of choce to manage
dgtas-nduced arrhythma.
!trates
Prototy"e #
- sosorbde dntrate (Isord)
- ntrogycerne (Depont, Ntrostat)
Mechan!sm of act!on #
- produce vasodataton ncudng coronary artery.
&nd!cat!ons #
- angna pectors, MI, perphera artera occusve dsease.
Ad$erse e)ects#
- headache, orthostatc hypotenson .
urs!ng Cons!derat!ons #
1. Transderma patch
- appy the patch to a haress area usng a new patch and dherent
ste each day.
- remove the patch after 12-24 hours, aowng 10-12 hours "patch
free" each day to
prevent toerance.
2. Subngua medcatons :
- note the BP before gvng the medcaton.
- oher sps of water before gvng because dryness may nhbt
absorpton.
- one tabet for pan and repeat every 5 mns. for a tota of three
doses; f not reeved
after 15 mns., seek medca hep.
- stngng or burnng sensaton ndcates that the tabet s fresh.
- nstruct patent not to swaow the p
- sustaned reease medcatons shoud be swaowed and not to be
crush.
- protect the ps from ght.

A'&2ARRHY'HM&C %R(GS
Class & (bock Na channes)
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&A 2 qundne, procanamde
&* 2 docane
&C 2 ecanamde
Class && (Beta-bockers)
propanoo, esmoo
Class &&& (bock K channes)
amodarone, bretyum
Class &1 (bock Ca channes)
verapram, dtazem
urs!ng cons!derat!ons #
1. Watch out for sgns of CHF.
2. Have cent wegh themseves and report
weght gan.
3. Watch out for sgns of docane toxcty :
- confuson and restessness
A'&L&PEM&CS
Prototy"e #
a. choestero-owerng agents
- choestyramne, coestpo, ovastatn
b. trgycerde-owerng agents
- gembroz, cobrate
Mechan!sm of act!ons #
- nterfere wth choestero synthess as we as
decreasng poproten & trgycerde synthess.
urs!ng cons!derat!ons #
- montor ver functons whe usng statns.
- prevent constpaton, atuence, choethass
- encourage ncrease ud and ber ntake.
A'& 3 HYPER'ES&1E
Ang!otens!n2Con$ert!ng En4yme ,ACE. &nh!5!tors
Prototy"e #
captopr (Capoten), enaapr (Vasotec), qunapr, snopr
Mechan!sm of act!ons #
- prevent perphera vasoconstrcton by bockng converson of
angotensn I to
angotensn II decreasng perphera resstance.
Ad$erse e)ect #
- t cause hyperkaema
- nduce chronc cough
urs!ng cons!derat!ons #
- not to dscontnue medcatons because t can cause rebound
hypertenson.
- avod usng K+ sparng duretcs.
CALC&(M2CHAEL *LOC/ERS
Prototy"e #
- Nfedpne (cacboc, adaat), Amodpne (norvasc), Feodpne
(Pend)
Verapram (Isoptn)
Mechan!sm of act!on #
- decrease cardac contractty and the workoad of the heart, thus
decreasng the
______________________________________________________________
need for O2.
- t aso promote vasodataton of the coronary and perphera
vesses.
&nd!cat!ons #
- hypertenson, angna, arrhythma
Ad$erse e)ects #
- bradycarda, hypotenson, headache
- reex tachycarda, constpaton
urs!ng cons!derat!ons #
- Admnster between meas to enhance absorpton.
- Take cents puse rate before each dose, wthhod f puse s beow
60 bpm.
- Refer for sgns of congestve heart faure.

%&(RE'&CS
- usuay gven at mornng
CAR*O&C AHY%RASE &H&*&'ORS
- Acetazomde (Damox)
- ncrease Na+, K+, & HCO3 secreton, aong wth t s H2O
- metaboc acdoss
OSMO'&C %&(RE'&C
- Mannto
- Increase osmotc pressure of the gomeruar trate.
- hypotenson
'H&A6&%E %&(RE'&CS
- hydrochorothazde
- bocks Na and K reabsorpton; reabsorb Ca
- hypercacema
LOOP %&(RE'&CS
- Furosemde (Lasx)
- bocks Na, K, and Ca reabsorpton
- hypocacema
PO'ASS&(M SPAR&G %&(RE'&CS
- Spronoactone (Adactone)
- excrete Na and water but t reabsorb K
- hyperkaema
RESP&RA'ORY ME%&CA'&OS
*ronchod!lators
Prototy"e #
Symphatommetc Xanthnes
- abutero, sabutamo - amnophyne
- soprotereno, sametero - theophyne
- terbutane
Mechan!sm of act!ons#
- sympathommetc (b-receptor agonist) bronchodators, date
arways.
- xanthne bronchodators, stmuate CNS for respraton.
______________________________________________________________
&nd!cat!ons #
- bronchospasm, asthma, bronchts, COPD.
Ad$erse e)ects #
- paptatons and tachycarda
- restessness, nervousness, tremors
- anorexa, nausea and vomtng, headache, dzzness.
urs!ng cons!derat!ons #
- Contrandcated hyperthyrodsm, cardac dysrhythma, or
uncontroed sezure
dsorder.
- Shoud be used wth cauton n patent wth HPN and narrow-ange
gaucoma.


GL(COCOR'&CO&%S (CORTICOSTEROIDS)
Prototy"e #
- dexamethasone, budesonde, utcasone, prednsone,
becomethasone.
Mechan!sm of act!ons #
- act as ant-nammatory agents and reduce edema of the
arways, as we as
pumonary edema.
Ad$erse e)ects #
- Cushngs syndrome, neutropena. osteopoross
urs!ng cons!derat!ons #
- Take drugs at mea tme or wth food.
- Eat foods hgh n potassum, ow n sodum.
- Instruct cent to avod ndvduas wth RTI.
- Instruct cent not to stop medcaton abrupty, t shoud be tapered
to prevent
adrena nsumcency
- Avod takng NSAID whe takng sterods.
- Take nhaed bronchodators rst before takng nhaed sterods, and
rnse mouth
after usng.
MAS' CELL S'A*&L&6ERS
Prototy"e # cromoyn sodum (Inta)
Mechan!sm of act!on #
- stabze mast ces that reease hstamne trggerng asthmatc
attacks.
urs!ng Cons!derat!on#
- Shoud be gven before asthmatc attacks.
- Admnster ora capsue at east 30 mns before meas for better
absorpton.
- Drnk a few sps of water before & after nhaaton to prevent cough
& unpeasant taste
- Assess for actose-ntoerance.
A'&2H&S'AM&ES (H-1 BLOCKERS)
Protoyty"e #
- Astemzoe (Hsmana), Loratdne (Cartn),
______________________________________________________________
Bromphenramne (Dmetapp),
Dphenhydramne (Benadry),
Cetrzne (Iterax), Ceestamne (Tavst).
Mechan!sm of act!on #
- decrease nasopharyngea secretons and decrease nasa tchng by
bockng hstamne
n H1-receptor.
&nd!cat!ons #
- common cods, rhnts, nausea and
vomtng, urtcara, aerges and as seep ad.
urs!ng Cons!derat!ons #
- Admnster wth food and drnk.
- Gven IM va Z-track method or oray.
- Precautons n handng machne and drvng whe takng these
drugs.
- Ice chps or candy for dry mouth
A'&2'(*ERC(LOS&S
Prototy"e #
F!rst l!ne Second l!ne
- Isonazd (INH) - Cycoserne
- Rfampcn (Rfadn) - Kanamycn
- Ethambuto - Ethonamde
- Pyraznamde - Para-amnosacyc acd
- Streptomycn
- actve tubercuoss are treated wth drug combnaton for 6-9 mos.
- mutdrug-resstant stran (MDR-TB) are medcated for 1 year up to 2
years
- gven before meas
&son!a4!d
- shoud be gven 1 hr before or 2 hrs after meas because food may
deay absorpton.
- shoud be gven at east 1 hr before antacds.
- nstruct to notfy physcan for sgns of hepatoxcty (|aundce), and
neurotoxcty
numbness of extremtes.
- admnster wth Vtamn B6 to counteract the neurotoxc sde
ehects.
- avod acoho.
R!fam"!c!n
- gven on an empty stomach wth 8 0z. of water, 1 hour before or 2
hours after meas
and avod takng antacds wth medcatons.
- hepatotoxc thus avod acoho.
- nstruct the cent that urne, feces, sweat, and tears w be red-
orange n coor.
Pyra4!nam!de
- gven for 2 months.
- ncrease serum urc acd and cause photosenstvty.
______________________________________________________________
Etham5utol
- contrandcated n chdren under 13 years od.
- obtan a basene vsua acuty because t can cause optc neurts.
- Instruct the cent to notfy the physcan mmedatey f any vsua
probems occurs.
Stre"tomyc!n
- amnogycosde antbotc gven IM.
- nephrotoxc and ototoxc.
- obtan basene audometrc test and repeat every 1-2 months
because the
medcatons mpars the CN VIII.

%R(GS AFFEC'&G GAS'RO&'ES'&AL SYS'EM
Antac!ds
Prototy"e #
- aumnum/magnesum compounds (Maaox)
- sodum bcarbonate (Aka-Setzer)
- cacum carbonate (Tums)
- magnesum hydroxde (Mk of Magnesa).
Mechan!sm of act!ons #
- neutraze the stomach acdty.
Ad$erse e)ects #
- metaboc akaoss, stone formaton
- eectroyte mbaance
- darrhea (magnesum), constpaton (aumnum).
urs!ng cons!derat!ons #
- Gve 1 hr after meas.
- Avod gvng medcatons wthn 1-2 hrs of antacd admnstraton
(decreases absorpton).
- Take uds to ush after ntake of antacd suspensons.
- Montor for changes of bowe patterns.

H&S'AM&E 3 7 *LOC/ERS
Prototy"e #
- cmetdne (Tagamet), rantdne (Zantac),
famotdne (Pepcd), nzatdne (Axd).
Mechan!sm of act!on#
- bocks H2 receptors n the stomach, reducng
acd secretons.
urs!ng cons!derat!ons #
- Gven before or wth meas
- Avod gvng other drugs wth cmetdne
- Gynecomasta may deveoped wth chronc use of cmetdne.
Proton 3 Pum" &nh!5!tors ,PP&.
Prototy"e #
- omeprazoe (Losec), Lansoprazoe (Lanz), pantoprazoe (Pantooc).
Mechan!sm of act!on #
- nhbt the proton H+ to combne wth C- toform hydrochorc acd.
______________________________________________________________
urs!ng cons!derat!ons #
- Gven before meas preferaby at mornng.
Mucosal *arr!ers
Prototy"e #
- sucrafate (Carafate), msoprosto (Cytotec).
Mechan!sm of act!on #
- coats the mucosa to prevent uceratons.
urs!ng cons!derat!on #
- Gven before meas.
- Msoprosto s contrandcated for pregnants.
- Sucrafate cause constpaton.

Ant!2d!arrheal Agents
Prototy"e :
- dphenoxyate (Lomot), operamde (Imodum), kaon/pectn mxture
(Kaopectate).
Mechan!sm of act!ons #
- decrease stomach motty and perstass.
urs!ng cons!derat!ons #
- Montor for rebound constpaton.
- Be cautous takng f wth nfectous darrhea.
- Montor atropne toxcty wth dphenoxyate.
- Cay, whte or pae stoo s common wth kaopectate.
La0at!$es
a. actuose (Cephuac), Na bphosphate (Feet
enema) & magnesum sat (Mk of Magnesa)
- retain fuid and distend intestine
b. ducosate (Daose)
- emulsify fecal fat and water
c. bsacody (Ducoax) & senna (X-prep)
- irritates intestinal mucosa and
stimulate intestinal smooth muscles
d. buk-formng axatve (Metamuc)
- increase fecal bulk and water content
e. mnera o
- lubricates & prevent colon absorption
EME'&CS
Prototy"e : pecac syrup, apomorphne
Mechan!sm of act!ons #
- nduce vomtng through stmuaton of vomtng center of
medua.
&nd!cat!ons #
- ngeston of posonous or toxc substances.
urs!ng cons!derat!ons #
- Consut poson contro center before nducton of vomtng.
- Admnster pecac syrup wth arge amount of ud.
%R(GS AFFEC'&G 'HE E%OCR&E SYS'EM
'HYRO&% AGE'S
______________________________________________________________
Prototy"e #
- Prood (thryrogobun )
- Synthrod (evothyroxne)
- Cytome ( othyronne).
Mechan!sm of act!on #
- functon as natura or synthetc hormones.
urs!ng cons!derat!ons #
- Taken n the mornng.
- Cauton wth coronary artery dsease.
- Montor for sgns of hyperthyrodsm and refer for decreasng the
dose.
PARA'HYRO&% AGE'S
Prototy"e #
a. cactonn (Cacmar), etdronate (Ddrone),
b. cactro (Rocatro), cacfedo (Cacedro)
Mechan!sm of act!on #
a. reduce bone resorpton
b. promotes cacum absorpton
urs!ng cons!derat!ons #
- Montor sgns of cacum mbaance
- Report for bone pans.
- Reman sttng uprght after takng etdronate.
Oral Hy"oglycem!c Agents ,OHA.
1. Sulfonylureas
- stmuate nsun secretons and ncrease tssue senstvty to
nsun.
Frst Generaton :
Chorpropamde (Dabenese)
- dsuram precautons
Tobutamde (Ornase)
- congenta defect
Second Generaton :
Gypzde, Gymeprde
2. *!guan!des
- factates nsun acton on the perphera receptor ste.
Metformn and Gucophage (Gucovance)
- sde ehect s actc acdoss
3. Al"ha2glucos!dase !nh!5!tors
______________________________________________________________
- deay carbohydrate absorpton n the ntestna system.
Acarbose (Precose) - sde ehect s darrhea
4. 'h!a4ol!n!d!ne
- ncrease tssue senstvty of nsun.
Rosgtazone (Avanda)
5. Megl!t!n!des
- stmuate nsun reease n pancreatc B-ces.
Repagnde (Prandn)
urs!ng cons!derat!ons #
- Ehectve ony for type II DM.
- Contrandcated to pregnant & breastfeedng.
- Gven before meas.
- Montor for sgns of hypogycema.
&nsul!n
Insun Onset Peak Duraton
Immedate-actng 0.15h 0.5-1h 5 h
(spro)
Short-actng 0.5-1 h 2-4 h 5-7h
(reguar, semente)
Intermedate-actng 1-3 h 6-12 h 18-24 h
(NPH, ente)
Long-actng 4-6h 10-30 h 24-36 h
(utraente)
Mxed 0.5 h 4-8 h 25 h
(reguar 30%, NPH 70%)
urs!ng cons!derat!ons #
- Usuay gven before meas.
- Ro the botte n pam of hands, dont shake.
- In|ect amount of ar that s equa to each dose
nto the botte - short actng ast (cear).
- Asprate short actng rst, then ong or ntermedate (coudy).
- Acoho s recommended for ceansng botte but not wth skn.
- Pnch skn, avod I.M, dont asprate.
- Rotate the n|ecton ste an nch a part.
- Preed syrnges are stored vertcay, neede-up.
- May ncrease dose durng nesses.
- Used bottes stored n room temperature, unused botte stored n
refrgerator.
- Montor for acute hypogycema :
a. 3-4 commercay prepared gucose tabet
b. 4-6 ounce of frut |uce or reguar soda
c. 2-3 teaspoon or honey
d. Gucagon 1 gm SO or IM
e. D50-50 IV.
ES'ROGES A% PROGES'&S
Prototy"e #
______________________________________________________________
- con|ugated estrogen (Premarn), estrone (Bestrone), estrado
(Estrace),
dethystbestro (DES).
&nd!cat!ons #
- prostate cancer, contraceptons
- estrogen repacement
Ad$erse e)ects #
estrogen - endometra CA, gabadder dsease, HPN, mgrane,
breast tenderness
progesterone - atered menstrua ow, rsk of thrombo embosm
urs!ng cons!derat!ons #
1. Mx estrogen or progestns pror to IM admnstraton by rong vas
between pams.
2. Montor bood pressure
3. Teach patent how to perform BSE.
4. Reguar foow-up examnaton s requred to detect assocated rsk
of acqurng CA

%R(GS AFFEC'&G LA*OR and LAC'A'&O

(ter!ne St!mulat!ng Agents
Protoyt"e #
a. Oxytocn (Ptocn), ergonovne (Ergotrate), methyergonovne
(methergne)
b. carbopost (Prostn), dnoprostone (Prostn E2)
Mechan!sm of act!ons #
a. stmuates uterne smooth musces
b. rpenng of cervx
Ad$erse react!ons #
- feta bradycarda (oxytocn),
- hypertenson (ergonovne), paptatons
- aergc reactons (Prostagandns)
(ter!ne &nh!5!t!ng Agents (Tocoytc)
Prototy"e #
- rtodrne (Yutopar), terbutane (Brethne)
Mechan!sm of act!ons #
- reaxes the uterus by stmuatng the B2- adrenergc receptors
Ad$erse e)ects #
- tremors, nausea, vomtng and tachycarda
______________________________________________________________
Lactat!on Su""ressants
Prototy"e #
- bromocrptne (Parode)
Mechan!sm of act!on #
- decrease serum proactn eves
Ad$erse e)ects #
- drowsness, headache, nausea, paptatons

%R(GS FOR 'REA'&G &FEC'&O
Ant!5acter!al Agents
1. Cell 8all !nh!5!tors
a. pencns - pen G, amoxcn, coxacn
b. cephaosphorns - cephaexn, cefacor
c. gycopeptde - vancomycn
2. Prote!n synthes!s !nh!5!tors
a. amnogycosdes - amkacn, gentamycn
b. macrode - erythromycns, roxthromycn
c. ncosamdes - cndamycns
d. choramphenco, tetracycnes
3. Ant!meta5ol!tes - bocks foc acd synthess
a. Sufonamdes - cotrmoxazoe
4. %A synthes!s !nh!5!tors
a. qunoones - cprooxacn, ooxacn
b. metrondazoe
Ad$erse e)ects #
1. Amnogycosde - nephrotoxcty & ototoxcty
2. Sufonamdes - Steven-|ohnsons syndrome, photosynsetvty
3. Ounoones - nsomna
4. Tetracycnes - bone probems
5. Choramphenco - Gray syndrome, bone marrow depresson
6. Erythromycn - hepatts
urs!ng cons!derat!ons #
1. Coect approprate specmen for C & S before startng antbotcs.
2. Check cents hstory of aerges.
3. Avod admnsterng erythromycn and qunoones wth food.
4. Pregnant precautons.
5. Report for darrhea - pseudomembranous cots (cndamycn)
6. Montor adverse ehects.

Ant!$!ral Agents
Prototy"e #
- acycovr (Zovrax), ganccovr (Cytovene),
vdarabne (Vra-A), amantdne (Symmetre),
rbavrn (Vrazoe), zdovdne (Retrovr).
Mechan!sm of act!ons #
- nhbts vrus specc enzymes nvove n DNA
synthess. They ony contro the growth of
vrus but t does not cure.
Ad$erse e)ects #
- granuocytopena, thrombocytopena, nausea,
nervousness, headache, nephrotoxcty.
______________________________________________________________
urs!ng cons!derat!on #
- Pregnant and breastfeedng precautons.
- Admnster IV antvras to avod crystazaton n rena tubues.
- Gve rbavrn ony wth aeroso generator.
- Montor CBC and creatnne eve.
- Refer for sgns of beedng.
- Take amantdne after meas.

Ant!fungal Agents
Prototy"e #
- amphotercn B (Fungsone), nystatn,
uconazoe (Ducan), ketoconazoe (Nzora).
Mechan!sm of act!ons #
- nhbt the synthess of funga stero.
Ad$erse e)ects #
- nephrotoxcty and neurotoxcty
- bone marrow depresson
- chs, fever, |ont pans, abdomna pan and headache.
urs!ng cons!derat!ons #
- Dute amphotercn B wth stere water souton not wth eectroyte
souton.
- Te cents that fever, chs, GI upset, |ont and musce pan w
subsde as
amphotercn B contnues.
- Wth ora canddass, et nystatn tabet dssove n mouth rather
than swaowng t.
- Refran ketoconazoe wth antacds.
- Report for sgns of beedng, nfecton & fatgue.

A'&PARAS&'&C AGE'S
Prototy"e #
a. Antmaara
- chroqune, meoqune, prmaqune,
qunne, pyrmethamne
b. Antamebass
- metrondazoe (Fagy), odoquno,
furozodone (Furoxone).
Mechan!sm of act!ons #
a. antmaara - aters protozoa DNA, depetng foates, & reducng
nucec acd
producton
b. antamoeba - bock proten synthess.
urs!ng cons!derat!ons #
1. Admnster ant-maara drugs wth food.
2. Take sezure precautons whe admnsterng
antmaara drugs.
3. Refer cnchonsm durng qunne treatment:
- tnntus, headache, vertgo, fever, and vsua changes.
4. Inform cents that odoquno fasfy thyrod functon test for up to 6
months.
______________________________________________________________
A'&HELM&'&C
Prototy"e #
- mebendazoe (Vermox), thabendazoe,
ncosamde (Ncocde), pperazne (Antepar),
prazquante (Btrcde).
Mechan!sm of act!ons #
- parayze arva and adut hemnts by actng on paraste
mcrotubues.
Ad$erse e)ects #
- GI upset, urnary odor (thabendazoe)
- headache, dzzness, fatgue
urs!ng cons!derat!ons #
1. Treat a the famy members for nematodes nfecton to prevent
recurrence.
2. Prazquante must swaowed rapdy because of ts btter taste to
avod gaggng.
3. Other anthemntcs shoud be chewed.

A'&2EOPLAS'&C %R(GS
General cons!derat!ons #
- ks or nhbt the reproducton of neopasmc ces but as we as
norma ces.
- t coud be ce cyce phase specc or ce cyce non-specc.
- preferaby gven through IV route.
Prototy"e #
1. Al+ylat!ng Agents
- nhbts ce producton by causng cross nkng of DNA
a. Busufan - hyperurcema
b. Chorambuc - gonada suppresson
c. Cspatn - ototoxcty and nephrotoxcty
d. Cycophosphamde - hemorrhagc cystts.
2. Ant!tumor Ant!5!ot!c Agents
- nterfere n DNA and RNA synthess
a. Pcamycn - ahects beedng tme
b. Doxurubcn - cardotoxcty
c. Beomycn - pumonary toxcty.
3. Ant!meta5ol!tes
- repace norma protens requred for DNA synthess by nhbtng
the S phase
a. Cytarabne - hepatotoxcty
b. 5-ourourac - phototoxcty reacton and cerebear
dysfunctons
c. 6-marcaptopurne - hyperurcema
d. Methotrexate - photosenstvty
- gven wth eucovern to essen ts toxcty.
4. M!tot!c &nh!5!tors ,1!nca Al+alo!ds.
- prevent mtoss actng on the M phase causng ce death
a. Vncrstne sufate - neurotoxcty, numbness
5. Hormonal Med!cat!ons and En4ymes
______________________________________________________________
- bock the norma hormones n hormone senstve tumors
a. Tamoxfen ctrate - vsua probems
- eevate choestero & trgycerdes eve
b. Dethystbestro - mpotence and gynecomasta n men.
S!de E)ects#
stomatts
- band det, avod strong mouthwash
- soft tooth brush, ce chps
darrhea, nausea and vomtng
- ant-emetc, repace uds and eectroytes
aopeca
- reassure that t s temporary
- encourage o wear wgs, hats and head scarf
skn pgmentaton
- nform that t s ony temporary
tumor yss syndrome
- hyperurcema & hyperkaema
- force uds
nfecton
- notfy physcan f WBC s <2000/mm3
- montor for sgns of nfecton
- reverse soaton
- ow bactera det
anema
- ron, B-12, foc acd rch food
- provde rest perods
beedng
- avod NSAIDs
- mnmze nvasve procedures
- use soft toothbrush and eectrc razor
menstrua changes
- reassure that menstruaton w resume.
'HE E%
RE1&E9 :(ES'&OS
S&'(A'&O# Mr; Hero Fernando- a <= year2old 5an+ manager had
e0"er!enced a sensat!on of chest t!ghtness- chest "a!n- s8eat!ng and
a feel!ng of a""rehens!on; A d!agnos!s of CA% 8!th ang!na "ector!s
8as esta5l!shed
1. The physcan orders for ntrogycern tabet. The nurse knows that the
pharmacoogca acton of the drug s:
a. To dssove the atheromatous paque n the coronary artery
b. Constrct the venous vesses and capares
c. Date the coronary arteres
d. Decrease the myocarda consumpton of oxygen
2. The nurse gave nstructons to the patent on ntrogycern ntake. He
remarked, "I thnk I w try not to take too many of these ps." At ths
nstance, the nurses BEST repy woud be:
a. "I agree, ntrogycern can cause drug addcton, that s why you must
not take too many of the ps"
b. "I must nform you that ntrogycern s non-habtuatng and you shoud
take the ps many tmes to reeve the pan"
c. "You w be needng ony three tabets to ease the pan and f
unreeved, you must seek medca attenton"
______________________________________________________________
d. " There s no probem wth contnuous day ntake because
ntrogycern does not cause a toerance ehect"
3. The nurse must emphasze to the patent whch ONE of the foowng sde-
ehects of ntrogycern:
a. Headache c. Nausea and vomtng
b. Hypertenson d. Vsua changes
4. What other nformaton must the nurse provde to the patent takng the
ntrogycern?
a. Keep the tabet n a cear contaner
b. Take the tabet wth meas
c. Contnue to take as many tabets of ntrogycern unt chest pan
subsdes
d. A burnng sensaton under the tongue s expected
5. The nurse appes the ordered ntrogycern ontment on the patents chest
wa. Whch nursng acton s consdered napproprate?
a. The nurse chooses a haress area
b. She spreads the ontment wth her ngers
c. She removes the ontment on the skn from the prevous dose
d. She rotates the stes of ontment appcaton
6. The nurse gves whch of the foowng dscharge nstructons to ths patent
wth angna regardng ntrogycern therapy?
a. Ony take the ntrogycern as desred
b. The drug shoud be taken before engagng n exertona actvtes
c. The tabet shoud be taken ony n the mornng
d. If the drug does not reeve the pan, ncrease the frequency of the
dose
7. Hero asked the nurse what he coud do about hs concern about sex actvty.
The nurse best suggests:
a. Te hm to avod sex for severa months whe hs heart s on therapy
b. Suggests that hs wfe assume the top poston
c. Te hm to avod sex on days when he s anxous
d. Advse that he shoud have sex ony once a month
8. The nurse understands that her dscharge teachng s ehectve regardng fe
stye modcaton when the patent says:
a. "I know that I w need to eat ess, so I w eat once a day ony"
b. "I w stay on bed most of the tme so I wont experence chest pan"
c. "I w stop what Im dong whenever I have pan and take the p"
d. "I need to enro n a gym cass to have a vgorous exercse to condton
my heart"
S&'(A'&O: Manny s admtted to the medca ward wth the dagnoss of
essenta hypertenson. He had hypertensve emergency 2 hours ago and was
hosptazed for further observaton.
9. The nurse admnsters prescrbed ant-hypertensve meds. If t can be any of
the foowng, she w check the puse pror to gvng:
a. Nfedpne
b. Metoproo
c. Condne
d. Captopr
10. After admnsterng a bood-pressure owng agent, the nurse must cauton the
patent:
a. To avod stranng durng defecaton
b. To avod ow-sodum and potassum det
c. To avod abrupt change of postons
d. To take warm shower mmedatey after takng the drug
11. The nurse prepares to gve a det approprate for a hypertensve patent.
Whch food shoud the nurse ncude n the menu?
______________________________________________________________
a. Canned meat oaf
b. Scaops and shrmps
c. Fresh ctrus |uce and cake
d. Butter and pork steaks
12. If the physcan orders Captopr as the home medcaton for the hgh BP, the
nurse must cauton that the sde-ehect of ths drug that s dsturbng s:
a. Rashes
b. Cough
c. Prurtus
d. Rngng of the ears
13. If the cent s dscharged wth home medcaton of Propranoo hydrochorde,
the nurse must ncude n her medcaton-teachng pan whch one?
a. Take the medcaton on an empty stomach
b. Obtan bood pressure readngs reguary
c. Perform actve exercses to prevent Hypotenson
d. Cauton to avod hazardous actvtes after takng the drug
14. The nurse determnes that the foowng drugs are cacum channe bockers
that can be prescrbed by the physcan to the patent. One s not ncuded:
a. Nfedpne
b. Verapam
c. Temsartan
d. Dtazem
S&'(A'&O: |oseph,, 50 y.o. Busnessman awakens n the mdde of the nght
wth dyspnea, batera basar raes and frothy sputum. He s brought to the
Muawn hospta. Hs dagnoss s congestve heart faure.
15. The physcan gves the patent furosemde and dgoxn. The nurses man
concern s to:
a. Take the centra venous pressure readng
b. Observe for decrease edema
c. Observe for sgns and symptoms of hypokaema
d. Force uds
16. The mechansm of acton of doxn that makes t usefu n patents wth CHF s
that t:
a. Produces a negatve notropc ehect
b. Increases cardac conducton
c. Enhances cardac contractty
d. Increases the heart rate
17. The nurse s very vgant about dgoxn overdose. Whch one statement beow
by the patent may aert the nurse of a possbe deveopment of toxcty?
a. "Nurse, I dont fee ke eatng for the past few days"
b. "I am havng constpaton atey"
c. "I am deveopng a naggng cough and nght terrors"
d. "I am experencng dryness of the eyes and sandy sensaton"
18. The nurse evauates that the drug dgoxn s ehectve when the patent
manfests:
a. Decreased bowe sounds
b. Increased urne output
c. Increased drowsness
d. Decreased sympathetc response of the body
19. The foowng manfestatons must be assessed by the nurse to detect
begnnng dgtas toxcty, wth the excepton of:
a. Nausea and vomtng
b. Paptatons
c. Dpopa and vsua yeow-green haos
d. Hypertenson
20. The nurse nstructs the patent on det modcaton durng dgtas therapy.
She s certan that her teachng s ehectve when the patent w choose a
the foods tems beow, except:
a. Fresh orange |uce and potato fres
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b. Dred mangoes and tomato |uce
c. Brocco saad wth bean sprouts
d. Favored geatn and ced tea
21. The nurse obtans an apca puse of 78 beats/mn. She s brngng the next
dose of dgoxn and then proceeds to do whch one acton beow?
a. Wthhod the drug and notfy the physcan
b. Start IV nfuson of Dgbnd (dgoxn antbody)
c. Instruct patent to consume more meat and nuts
d. Admnster the drug
S&'(A'&O: Armda, an 18-year-od adoescent s seen n the heath center
because of easy fatgabty and frequent dzzness
22. The heath center physcan determnes that she has ron-decency anema.
The nurse w antcpate the doctor to order for:
a. Bone marrow aspraton
b. Hemogobn eve determnaton
c. Pateet count
d. BUN and Creatnne
23. A drug s admnstered to correct anema, such as an ron. Ths drug s
cassed as:
a. Anthemnthc
b. Antcoaguant
c. Hematnc
d. Anthstamnc
24. The nurse admnsters the ora ron tabet. She w gve the medcaton:
a. Wth mk and dary products
b. Wth antacds to mnmze gastrc upset
c. Wth frut |uces ke caamans and orange
d. Wth a fu gass of cohee or tea
25. The nurse nstructs the patent to eat ron-rch foods. She determnes that her
teachng s ehectve when the cent w choose:
a. Pomeo |uce and hamburger
b. Geatn and marshmaows
c. Lean meat and buttered corn
d. Lver and eggyok
26. The doctor decdes to order Iron dextran one ampoue. The nurse prepares to
admnster the drug:
a. Intravenousy. Sow IV push
b. Intamuscuar, Z-track method
c. Subcutaneous
d. Intratheca
27. The nurse must warn the patent takng ora ron preparatons that t can
cause whch sde ehect/s?
a. Yeowsh dscooraton of the skn and mucus membrane
b. Darkenng of stoo coor
c. Anorexa and oss of har
d. Uceraton of the skn and cough
28. The patent remaned pae and weak, upon further examnaton, t was
determned that she has perncous anema. The pathophysoogy of ths
hematoogca dsorder s:
a. Absence of Vtamn E n the det
b. Presence of excessve ron n the ver
c. Absence of ntrnsc factor n the stomach
d. Temporary bone marrow depresson.
%R(GS 'HA' AFFEC' 'HE HEMA'OLOG&CAL SYS'EM
S&'(A'&O: Mrs. Rosanda Amor, 23 year-od actress s admtted because of
a dagnoss of deep ven thromboss.
29. The nurse empoys whch of the foowng non-pharmacoogca measures n
carng for Mrs. Amor?
a. Ice compress over the nvoved eg TID
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b. Eevate the egs wth a pow
c. Mantan on strct bed rest wth mnma bathroom prveges
d. Massage the nvoved area
30. The physcan orders Heparn sodum for Mrs. Amor. The nurse understands
the reason for ths therapy s that:
a. Heparn w dssove the cots n the named vens to prevent
emobozaton
b. There s a need to prevent further cot formaton n the nvoved
vesses
c. Heparn w antcoaugate the bood by nhbtng vtamn K metabosm
d. The cot formed n the ven must be ysed by actvatng pasmn, the
acton of heparn
31. If the doctor orders for heparn therapy montorng, the nurse must obtan
whch aboratory tests from the ab unt?
a. Prothrombn tme
b. Cottng tme
c. Parta thrombopastn tme
d. Prothrombn consumpton test
32. The above aboratory vaue must s consdered therapeutc f the resut s
about:
a. 3 tmes the norma
b. 2 tmes the norma
c. Equas the norma
d. Less than the norma
33. The nurse must admnster heparn to Mrs. Amor. She determnes that the
most common routes of admnstraton are:
a. IV and IM
b. SC and IV
c. ID and IM
d. IV and ntratheca
34. When the nurse s montorng the patent for heparn overdose, she s
observng for the foowng sgns/symptoms, except?
a. Ecchymoses
b. Postve Homans sgn
c. Dark, coa-coored urne
d. Epstaxs
35. Whch one ehect of heparn therapy w cause nursng concern?
a. Thrombocytopena
b. Constpaton
c. Bone marrow depresson
d. Dzzness
36. In the event of an overdose of heparn n|ecton, the nurse prepares whch one
antdote for toxcty?
a. Phytomenadone
b. Atropne Sufate
c. Protamne sufate
d. Deferoxamne cheators
37. The doctor swtched from standard heparn to ow moecuar weght heparn
n|ecton. The advantage of LMWH over the standard heparn s:
a. The LMWH can be admnstered IM
b. The LMWH does not need frequent aboratory montorng
c. The LMWH has a better potency
d. The LMWH does not cause beedng probems
38. The nurse reads the chart and notes for an order of ora Warfarn sodum,
whe the patent s on heparn therapy. The nurse w:
a. Oueston the order because of potenta excessve beedng f gven
smutaneousy
b. Admnster the drug as ordered
______________________________________________________________
c. Wthhod the heparn and admnster the Warfarn oray
d. Report the error to the nurse supervsor as the patent may be at rsk
for toxcty
39. IF Mrs. Amor s dscharge wth warfarn sodum, the nurse must ncude n her
dscharge teachng whch one?
a. Keep Vtamn A ampue avaabe for n|ecton c/o the heath center n
case of emergency
b. Report any brght red bood n the stoo or urne
c. Take asprn to manage the headache sde-ehect of the drug
d. Utze rm toothbrush when brushng to prevent bud up of paques
and gngva hyperpasa
40. The nurse must remnd the patent that warfarn therapy s montored wth the
use of whch aboratory examnatons?
a. PT and PTT
b. PT and INR
c. Cottng tme and beedng tme
d. Pateet count and PT
S&'(A'&O: Mrs. Avery had a prevous attack of md stroke and coronary
artery dsease. She s takng Asprn.
41. The reason asprn s utzed as an ant-pateet medcaton s because:
a. Asprn can proong the beedng tme
b. Asprn ahects the thromboxane producton of the pateet
c. Asprn nterferes wth the receptor bndng of the pateets
d. Asprn bocks the degranuaton process nhbtng reease of hstamne
42. The nurse admnsters asprn:
a. On an empty stomach to ncrease absorpton
b. Wth meas
c. In Between meas
d. Intramuscuary
43. Mrs. Avery had a sudden severe and proonged chest pan. Acute MI s
suspected. The nurse antcpates the doctor to order a brnoytc, and ths
may be:
a. Tranexamc Acd
b. Dpyrdamoe
c. Steptoknase
d. Coumadn
44. If the above drug s ordered to be gven IV drp, the nurse must be aware of
whch potenta ehect?
a. Hypersenstvty reacton
b. Congestve heart faure
c. Further damage to the myocardum
d. Excessve cot formaton
45. If the patent s recevng tssue-pasmnogen actvator, the nurse must make
whch one prorty nterventon?
a. Have heparn sodum avaabe
b. Montor cosey the rena status
c. Observe for psychotc symptoms
d. Obtan a stand by Amnocaproc acd
S&'(A'&O: A patent s determned to have hyperchoesteroema and s
admtted n the hospta for treatment of her condton. The doctor ordered
Lovastatn OD.
46. The nurse determnes that the BEST tme to gve the drug s:
a. In the mornng before breakfast to promote absorpton
b. In the afternoon to promote seep because t s sedatng
c. At bedtme
d. In between meas
47. The nurse s knowedgeabe about the mode of acton of ovastatn that t:
a. It Inhbts the formaton of chyomcrons n the ntestna ces
______________________________________________________________
b. It prevents the enzyme that syntheszes choestero
c. It bnds wth be acds and choestero promotng excreton
d. It promotes choestero metabosm n the adpose tssue to ower the
pasma choestero
48. The nurse s prepared to provde comfort measure to the common sde ehects
of the drug. She montors the patent for:
a. Abdomna funess, atuence and darrhea
b. Confuson and psychoses
c. Paptatons and arrhythmas
d. Hypertenson and rashes
49. The nurse must montor for these serous adverse ehects of ovastatn. Whch
one s not ncuded?
a. Gaucoma
b. Cataract
c. Myosts
d. Hepatc faure
50. The nurse reads the drug order sheet and s most concern to consut the
physcan f he orders:
a. Paracetamo
b. Gembroz
c. Vtamn suppements
d. Omeprazoe
51. The nurse s gvng Guafenesn to a patent. She ncudes n her teachng
whch of the foowng nterventons?
a. Warn the patent that extreme drowsness may occur
b. Oher a fu gass of water
c. Nausea and vomtng are potenta probems aevated by sma
frequent meas
d. Suggest to buy a nebuzer machne to be used at home
e. Vtamn ADEK suppements because of mpared absorpton
52. To be abe to detect the ehectveness of Sabutamo, the nurse shoud check
for:
a. Bood pressure and CVP readngs
b. Urnary output per hour
c. Breath sounds
d. Leve of conscousness
e. Pupary reexes
53. The patent s recevng theophyne capsue OD. The nurse cautons the
patent to avod foods wth components smar to theophyne and they can
be:
a. Sugar and cream
b. Cohee and chocoate
c. Spnach and brocco
d. Beans and aged cheese
e. Canned goods and wne
54. The patent s recevng theophyne capsue OD. The nurse cautons the
patent to avod foods wth components smar to theophyne and they can
be:
a. Sugar and cream
b. Cohee and chocoate
c. Spnach and brocco
d. Beans and aged cheese
e. Canned goods and wne
55. The nurse s admnsterng acetycystene nebuzaton to a patent. It s very
much mportant to keep whch tem beow at bedsde?
a. Scssors
b. Ambu bag
c. Sucton machne
______________________________________________________________
d. Tracheostmy set
e. NG tube
56. After gvng dphenhydramne to the patent, the nurse must ensure that the
patent understands the teachngs beow, EXCEPT:
a. Refran from manpuatng decate machnes
b. Take sugaress candy n the mouth to reeve dryness
c. Avod takng the drug wth acoho
d. Check puse rate before takng the drug
e. Manage gastrc upset by takng t wth food
57. The nurse watches out for a sde-ehect assocated wth ntake of codene
sufate and provdes approprate nterventon, ths can be:
a. Constpaton- provde bera uds
b. Exctement- provde ess stmuaton
c. Tachycarda- admnster docane
d. Poyura- gve the drug n the mornng
e. Tachypnea- poston on sem-fowers
58. Terbutane sufate s admnstered to a patent wth asthma. If the patent has
another dsease, the nurse s most vgant and cautous f ths condton
exsts:
a. Hypothyrodsm
b. Rheumatod arthrts
c. Dabetes metus
d. Poycystc ovaran dsease
e. Emphysema
59. The nurse s admnsterng oxymetazone nasa decongestant. She ncudes n
her care pan a of the foowng nterventons, EXCEPT?
a. Instruct the patent to cear the nasa passage of mucus before
nstng
b. Remnd patent to keep the head tted for a few seconds after
admnstraton
c. Advse ncreased ud ntake
d. Encourage the use for one week for better ehect
e. Cauton that tachycarda and urnary retenton may occur wth
systemc absorpton
60. The physcan asks the nurse for an antchonergc drug to be used for the
asthmatc patent. The nurse obtans from the pharmacy whch drug?
a. Abutero
b. Terbutane
c. Metaprotereno
d. Ipratropum bromde
e. Sabutamo
61. The physcan orders dextromethorphan for a patent who s companng of
very uncomfortabe coughng. The nurse understands that ths drug acts to
suppress cough by:
a. Increasng the secretons of the broncha gands
b. Removng the rrtaton from the respratory tract
c. Inhbtng the medua obongata cough center
d. Inhbtng the stretch receptors n the ungs
e. Trggerng the vaga responses
62. Inhaed cortcosterod ke becomethasone s admnstered to the patent wth
asthma. It s mportant for the nurse to stress that ths drug:
a. Acts rapdy to decrease nammaton
b. Promotes the secreton of mucus
c. May depress the mmune functon
d. Hghy ehectve n termnatng acute asthma attack
e. Is habtuatng and addctng
______________________________________________________________
63. The second generaton ant-hstamnes ke cetrzne have the advantage over
the rst generaton anthstamnes ke dphenhydramne because second
generaton anthstamnes:
a. Have shorter duraton of acton that can be reversed rapdy
b. Have ess sedaton and antchonergc propertes
c. Posses ess drug senstvty reactons
d. Have a greater safety proe
e. Have ess abuse potenta
64. The nurse cautons the patent takng dphenhydramne (Benadry) to expect
a of the foowng sde ehects, except?
a. Dry mouth
b. Burred vson
c. Urnary frequency
d. Drowsness
e. Dzzness
65. The nurse must remember to admnster theophyne sowy or wth an
nfuson pump because ths drug, f gven rapdy can cause:
a. Increased aertness
b. Severe hypotenson
c. Tachycarda
d. Paor
e. Headache
______________________________________________________________