Nursing and Pharmacology

A comprehensive
Nursing and pharmacology
review for NR 490
Professor Hughes, MSN, RN

What is pharmacology?
 Pharmacology is –
 the science of drugs including their: origin, composition, pharmacokinetics, pharmacodynamics,
therapeutic use, and toxicology
 Pharmacokinetics is –
 the study of how medications travel through the body and undergo the biochemical processes
that result in absorption, distribution, metabolism, and excretion
 Pharmacodynamics is –
 concerned with the effects of drugs and the mechanism of their action

Nursing’s Role in Pharmacology

 Nurses are responsible to safely and effectively administer medication to their patients
 Knowledge prior to medication administration:
 Medication category/class
 Mechanism of action
 Therapeutic effect
 Side effects
 Adverse effects
 Toxic effects
 Medication interactions
 Precautions/Contraindications
 Preparation, dosage, administration
 Nursing implications
 Ensure and document proper understanding of medications prescribed
 A double check or confirmation system in place
 Note allergies**
 Accurately calculate and administer ordered dose
 Minimize interruptions during medication administration

Safe Medication Administration

 The rights of safe medication administration
 Right patient
 Right medication
 Right dose
 Right time
 Right route
 Right documentation
 Right client education
 Right to refuse
 Right Assessment
 Right evaluation

Nursing Process to Prevent Medication Errors

 Assessment
 Know the medication
 Know the diagnosis
 Question if needed
 Planning
 Identify patient outcomes
 When to give meds
 Implementation
 Know your rights
 Evaluation
 Patient’s response
 Report errors

Complications of IV Therapy
 Infiltration
 Extravasation
 Hematoma
 Catheter embolus
 Phlebitis/thrombophlebitis
 Cellulitis
 Fluid overload

Drug Therapy for Mood & Anxiety Disorders

 Antianxiety agents
 Benzodiazepines
 Alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), chlordiazepoxide
chlordiazepoxide (Librium)
 Antidepressant agents
 Selective serotonin reuptake inhibitors (SSRIs)
 Citalopram hydrobromide (Celexa), escitalopram oxalate (Lexapro), paroxetine
hydrochloride (Paxil), fluoxetine hydrochloride (Prozac),
(Prozac) sertraline hydrochloride (Zoloft)
 Serotonin-norepinephrine reuptake inhibitors (SNRIs)
 Venlafaxine (Effexor), desvenlafaxine (Pristiq), duloxetine (Cymbalta)
 Atypical antidepressants
 Bupropion (Wellbutrin), Mirtazpine (Remeron)
 Tricyclic antidepressants (TCAs)
 Amitriptyline (Elavil),
(Elavil) nortriptyline (Pamelor)
 Monoamine oxidase inhibitors (MAOIs)
 Phenelzine (Nardil), tranylcypromine (Parnate)
● Mood stabilizers
 Antimanic/antidepressant
 Lithobid (Lithium carbonate)
 Mood-stabilizing antiepileptics
 carbamazepine (Tegretol), lamotrigine (Lamictal), valproic acid (Depakote)
● Antipsychotics
 Conventional or first generation antipsychotics
 Chlorpromazine (Thorazine), haloperidol (Haldol), fluphenazine (Prolixin), thiothixene
(Navane)
 Atypical or second and third generation antipsychotics
 olanzapine (Zyprexa), Quetiapine (Seroquel), aripiprazole (Abilify), clozapine
Controlled Substances
 Why are controlled substances prescribed?
 Management of pain
 Management of anxiety or panic disorders
 Anesthesia
 Medical management of artificially ventilated patients
 Management of ADD or ADHD
 Cough suppressants
 Classes of controlled substances
 Narcotics
 Stimulants
 Depressants
 Antianxiety agents
 Cough suppressants
 Antidiarrheal agents

Medications for Pain and Inflammation

 Pain medications
 Opioid agonists
 Fentanyl
Fentanyl, Meperidine (Demerol), Methadone, Codeine, Oxycodone, Hydrocodone,
Hydrocodone
Hydromophone
 Corticosteroids
 Methylprednisolone
 Nonopioid analgesics
 Ketorolac (Toradol),
(Toradol) Ibuprofen, naproxen, indomethacin
 Migraine medications
 Sumatriptan-
Sumatriptan- can cause chest tightness, vertigo, cant take during pregnancy. Has a
tetarogenic effect

Medications to Support Withdrawal

 Withdrawal from alcohol
 Benzodiazepines
 Lorazepam (Ativan), chlordiazepoxide (Librium), diazepam (Valium)
 Withdrawal from opioids
 Medications to support withdrawal/abstinence of opioids
 Methadone (Dolophine), Clonidine (Catapres), Buprenorphine (Suboxone)
 Withdrawal from nicotine
 Nicotine replacement therapy
 Nicotine lozenge, gum, patch, nasal spray, and inhaler
 Antidepressants
 Bupropion
Bupropion (Wellbutrin)

Drug Therapy for Chronic Neurologic Disorders

 Chronic neurologic disorders
 Cholinesterase inhibitors
 Neostigmine,
Neostigmine physotigmine, donepezil
 Anti-Parkinson’s medications
 Combination medications
 Levodopa/carbidopa (Sinemet)- can cause malignant melanoma
  Dopamine agonists
 Pramipexole (Mirapex), ropinirole (requip)
 Antiepileptics
 Traditional antiepileptics
 Phenobarbitol, phenytoin (Dilantin),
(Dilantin) carbamazepine (Tegretol), valporic acid (Depakote)
 Newer antiepileptics
 Lamotrigine (Lamictal), levetiracetam (Keppra), topiramate (Topamax), gabapentin
(Neurontin), pregabalin (Lyrica)

Drug Therapy for the Nervous System

 Miscellaneous CNS system medications
 Neuromuscular blocking agents
 Succinylcholine (Anectine), cisatracurium (Nimbex),
vecuronium (Norcuron), pancuronium (Pavulon)
 Muscle relaxants and antispasmodics
 Baclofen (Lioresal), cyclobenzaprine (Amrix), tizanidine (zanaflex), dantrolene
 Muscarinic antagonists
 oxybutynin
 Sedative-hypnotics
 Nonbenzodiazepines
 Zolpidem (Ambien), temazepam (Restoril)
Eye and Ear Disorders
 Anti-glaucoma
 Beta-adrenergic blockers
 Timolol, carteolol, metipranolol, levobunolol
 Otitis media
 Antimicrobials
 Amoxicllin, Amoxicillin/clavulanate (Augmentin)
 (the following are used for mild PCN allergy or PCN resistant otitis media) Ceftriaxone,
cefdinir, cefuroxime, cefpodoxime
 (the following are used for severe PCN allergy) ceftriaxone, azithromycin, clindamycin
Drug Therapy for the Respiratory System
 Airflow disorders
 Beta₂-adrenergic agonists
 Albuterol, levalbuterol (Xopenex), salmeterol (Serevent), Inhaled anticholinergics
 Ipratropium (Atrovent)
SE: Tachycardia, palpitations, tremors
 Glucocorticoids
 Inhaled – Beclomethasone (Qvar), budesonide (Symbicort), and combinations…
 Oral - Prednisone
 IV – hydrocortisone (Solucortef), methylprednisolone (Solumedrol)
 Leukotriene modifiers
 Montelukast (Singulair), Zileuton (Zyflo), Zafirlukast (Accolate)
Drug Therapy for the Respiratory System
 Upper Respiratory disorders
 Antitussives – opioids
 codeine
  Antitussives – nonopioids
 Dextromethorphan (Robitussin, Delsym, Zicam), diphenhydraine (Benedryl)
 Expectorants
 Guaifenesin (Mucinex, Robitusin)
 Mucolytics
 Acetylcysteine (Acetadote)
 Decongestants
 Phenylephrine (NeoSynephrine), pseudoephedrine(Sudafed)
 Antihistamines
 First generation – Diphenhydramine (Benedryl), promethazine (Phenergan)
 Second generation – loratadine (Claritin), cetirlzine (Zyrtec)
 Intranasal/intraocular antihistamines – olopatadine (Patanol)
 Nasal glucocorticoids
 Fluticasone (Flonase), triamcinolone (Aristocort)

Drug Therapy for the Cardiovascular System

 Medications affecting urinary output
 Loop diuretics
 furosemide (Lasix)
 Thiazide diuretics
 Hydrochlorothiazide (Microzide)
 Potassium-sparing diuretics
 spironolactone (Aldactone)
 Osmotic diuretics
 Mannitol
Drug Therapy for the Cardiovascular System
 Heart failure medications
 Cardiac glycosides
 Digoxin (Lanoxin)
SE: Digoxin toxicity, GI effects (anorexia, NV, Abdominal pain) CNS effects (fatigue,
weakness, diplopia, blurred vision, yellow-green or white halos around objects)
 Adrenergic agonists
 Epinephrine, Dopamine,
Dopamine Dobutamine (Dobutrex), Norepinephrine (Levophed)
 Antihypertensive agents (HF, HTN, MI, Diabetic Neuropathy)
 Angiotensin-Converting Enzyme (ACE) Inhibitors
 Enalapril (Vasotec),
(Vasotec) lisinopril (Zestril), captopril (Capoten)
SE: Persistent nonproductive cough with Ace inhibitors, Angioedema, Hypotension
 Angiotensin II Receptor Blockers (ARBs)
 Losartan (Cozaar), valsartan (Diovan), olmesartan (Benicar)
 Calcium Channel Blockers
 Nifedipine (Procardia), diltiazem (Cardizem),
(Cardizem) amlodipine (Norvasc)
SE: Constipation, reflex tachycardia, peripheral edema, toxicity
 Beta Blockers
 Atenolol (Tenormin), metoprolol (Lopressor or Toprol), propranolol (Inderal)
SE: Bradycardia, nasal stuffiness, AV block, Bronchospasm, rebound myocardium
excitation if stopped abruptly
 Antianginal agents
 Nitrates
 Isosorbide dinitrate (Isordil), isosorbide mononirate (Imdur), nitroglycerin (Nitrostat),
(Nitrostat)
 ranolazine (Ranexa)
 Antiarrhythmic agents
 Indicated tachycardia, atrial fibrillation, atrial tachycardia, or premature ventricular
contractions (PVCs)
 Amiodarone (Cordarone), dronedarone(Multaq), procainamide (Procan), adenosine
(Adenocard)
 Lipid lowering agents
 HMG CoA reductase inhibitors (statins)
 Atorvastatin (Lipitor),
(Lipitor) lovastatin (Mevacor), simvastatin (Zocor)
SE: Prolonged bleeding in clients taking warfarin, do not administer with
graprefruit juice, multiple drug interactions
 Fibric Acid
 Fenofibrate (TriCor), gemfibrozil (Lopid)
 Miscellaneous antilipidemic
 Niacin (Niaspan)
 Oral anticoagulant agents
 Indicated for A-fib, CVA, mechanical valve replacement, pulmonary embolism, DVT, STEMI
 Warfarin (Coumadin)
 Dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis)
 Heparin,
Heparin enoxaparin
 Antiplatelets
 Indicated for acute coronary syndrome, thrombotic CV events, post stent placement
 Clopidogrel (Plavix), prasugrel (Effient), tricagrelor (Brillinta)
 The wonder drug
 Analgesic, anti-inflammatory, antipyretic, and
platelet aggregation inhibitor
 Aspirin (Aspirin)
Drug Therapy for the Hematologic System
 Growth factors
 Erythropoietic growth factors
 Epoetin alfa (Epogen)
 Leukopoietic growth factors
 Filgrastim ((Neupogen), pegfilgrastim (Neulasta)
 Thrombopoietic growth factors
 Oprelvekin (Neumega)
Drug Therapy for the Gastrointestinal System
 Medications to manage GERD (gastroesophageal reflux disease)
 Proton pump inhibitors (PPIs)
 Omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole
(Aciphex), esomeprazole (Nexium)
 H₂ Blockers
 Famotidine (Pepcid), cimetidine (Tagamet), ranitidine (Zantac)
 Antacids
 Aluminum hydroxide/magnesium hydroxide/simethicone (Mylanta or Maalox), magnesium
hydroxide (MOM), calcium carbonate (Tums)
 Cytoprotectants
 Sucralfate (Carafate)
 Medications for Peptic Ulcer Disease (PUD)
 Proton pump inhibitors
 Omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole
(Aciphex), esomeprazole (Nexium)
 Medications to manage H. pylori
 Proton pump inhibitor (PPI) AND
 Omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole
(Aciphex), esomeprazole (Nexium)
 Antibiotics
 Clarithromycin (Biaxin) AND amoxicillin (Amoxil) OR metronidazole (Flagyl) *if allergic to
PCN*
 Gastrointestinal Disorders
 Prokinetic agents
 Metoclopramide (Reglan)
 Surfactant laxatives
 Docusate sodium
 Antidiarrheal
 Atropine/diphenoxylate (Lomotil)
Drug Therapy for the Endocrine System
 Types of insulin
 rapid-acting
 Insulin lispro (Humalog or Novolog)
 Short-acting
 Insulin regular (Humulin ® or Novolin ®)
 Intermediate-acting
 Insulin NPH (Humulin N or Novolin N)
 Long-acting
 Insulin glargine (Lantus)
 Intermediate and short-acting mixtures
 Premixed NPH (70%) and regular insulin (30%) (Humulin 70/30 or Novolin 70/30)
 Intermediate and rapid-acting mixtures
 Premixed lispro protamine suspension and lispro (Humalog Mix)
 Intermediate and rapid-acting mixtures
 Premixed aspart protamine suspension and aspart (NovoLog Mix)
 Oral diabetic agents
 Biguanides
 Metformin (Glucophage)
 Sulfonylureas (SU)
 Glipizide (Glucotrol), glyburide (Diabeta),
(Diabeta) glimepride (Amaryl)
 Thiazolidinediones (TZD)
 Rosiglitazone (Avandia), pioglitazone (Actos)
 Meglitinides
 Repaglinide (Prandin), nateglinide (Starlix)
 Alpha-glucosidase inhibitors
 Acarbose (Precose), miglitol (Glyset)
 Dipeptidyl peptidase-4 (DPP-4) inhibitors
 Sitagliptin (Januvia), saxagliptin (Onglyza)
 Hypothyroid medications
  Hypothyroidism is caused by an inadequate production of thyroid hormone
 Levothyroxine (Synthroid), liothyronine (Cytomel)
 Hyperthyroid medications
 Hyperthyroidism is an excess production of thyroid hormone
 Methimazole (Tapazole), propylthiouracil (PTU)
Bacteria and Therapy
 Bacterial infections are:
 gram + (bacteria retain dye microscope slide),
 gram – (bacteria do not retain dye), OR
 mycobacteria (tough cell walls that do not stain)
 Bacterial infections are:
 Aerobic (requiring oxygen) OR
 Anaerobic (not requiring oxygen)
 Types of therapy are:
 Empiric therapy (following guidelines based on s/s)
 Definitive therapy (confirmed culture and sensitivity)
 Prophylactic therapy (pre-treatment)
 Spectrum of activity:
 Narrow spectrum (antibiotic affects limited number of microorganisms)
 Broad spectrum (antibiotic affects broad number of microorganisms)

Drug Therapy for Bacterial Infections

 Penicillin
 Amoxicillin (Amoxil), ampicillin (Ampicillin),
 β-lactamase inhibitors
 Amoxicillin & Clavulanate (Augmentin), ampicillin & sulbactam (Unasyn), piperacillin &
tazobactam (Zosyn)
 Cephlalosporins
 Cefazolin (Ancef), Cefaclor (Cefaclor), cefdinir (Omnicef), cefepime (Maxipime), ceftriaxone
(Rocephin), cefuroxime (Ceftin), cephalexin ( Keflex)
 Macrolides
 Azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (E.E.S.)
 Quinolones and Fluroquinolones
 ciprofloxacin (Cipro),
(Cipro) levofloxacin (Levaquin), moxifloxacin (Avelox)
 Aminoglycosides
 Gentamycin (Gentamycin)
 Nitroimidazoles
 Metronidazole (Flagyl)
 Tetracyclines
 Doxycycline (Doryx),
(Doryx), minocycline (Minocin), tetracycline (Tetracycline)
 Sulfonamides combination agent
 Sulfamethoxazole & trimethopim (Bactrim or Septra)
 Other classes of antibiotics that are commonly used
 Clindamycin (Cleocin), linezolid (Zyvox), meropenem (Merrem), rifampin (Rifadin),
tigecycline (Tygacil), vancomycin (Vancocin)
 Antimycobacterial (antituberculosis)
 Isoniazid, pyrazinamide, ethambutol, rifapentine
 Rifampin
 Antifungals
 Amphotericin B-
B- used to do bladder irrigations years ago, antifungal, category D for
pregnancy