PHARMACOLOGY -study of drugs and its interaction to the body.

DRUG -any substance used to diagnose, cure, or prevent a condition or disease.

DRUG NAME:
1. Chemical Name refers to the chemical structure of the drug.
2. Generic Name common or official name not restricted by trademark;usually written in small caps.
3. Band Name TRADEMARK; name given by the manufacturer

PHARMACOKINETICS is the process of drug movement to achieve drug action.

1.ABSORPTION - process from the time of administration until it enters the bloodstream.
2.DISTRIBUTION - is the transportation of a drug to body fluids and tissues
PLASMA-PROTEIN BINDING
a. Medications attach to plasma proteins (albumin: anticonvulsants or globulin:lidocaine)
b. Protein-bound drugs inactive bcoz it is not available to receptors
c. Free or Active drugs can cause a pharmacologic response by binding to cell receptors
d. Clients with reduced plasma proteins (kidney/liver d/s malnutrition) could receive a
heightened drug effect and eventually drug toxicity.
BARRIERS - prevent some medications from entering certain body organs.
a. Blood-brain barrier - to pass this barrier, drug must be lipid soluble and loosely attached
to plasma protein.
b. Placental barrier many substances ( nicotine, alcohol) can cross

3.METABOLISM (biotransformation) - irreversible transformation of drugs

- major organ responsible: LIVER

a. First-pass effect the process wherein drugs pass through the liver first before entering
the systemic circulation and some portion of the drug is inactivated.
b. Bioavailability percentage of the administered drug dose that reaches the systemic
circulation.
c. Infants and elderly have reduced ability to metabolize some drugs.

4.EXCRETION - process by which drugs are eliminated from the body

- major organ responsible: KIDNEYS
- other organs: intestines, lungs, and mammary, sweat, and salivary glands
a. Half-life (t1/2) the time it takes for one half of the drug to be eliminated.

!!!Note: Most accurate test to determine Renal function: Creatinine Clearance (CLCR) (N: 85-135ml/min)

DRUG INTERACTION
1. Synergistic Effect/Potentiation two drugs with different mechanism of action produce greater effect
2. Antagonistic Effect effects of two drugs cancel each other
Antidotes:
-- basis for specific antidotes
1. acetaminophen
2. benzodiazepine
DRUG ORDER
3. digoxin
o Types of Medication Orders
a. Stat Order given at once or immediately 4. heparin
b. Standing Order ongoing order or may be given 5. warfarin
for a specific number of doses or days. 6. iron
c. PRN Order given as needed 7. magnesium sulfate
d. Verbal Order telephone order and must be 8. mestinon
signed by the doctor w/in 24 Hours. 9. neostigmine
If possible a medicine intern should take 10.narcotics
the telephone order.
e. Single Order given once and usually at a specific time

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 10 RIGHTS
b. RIGHT CLIENT
a. The nurse must verify the clients identity.
b. Check the identification bracelet.
c. Have the client state his name. (dont call out his name)
d. Check the bed tag. (least reliable)

c. RIGHT DRUG
a. The client must receive the prescribed drug.
b. Check the drug label three times.
b.1. At the time of contact with the drug container
b.2. Before preparing the drug
b.3. After preparing the drug

d. RIGHT DOSE
a. Refers to the dose prescribed to a client.
b. Calculate the drug dose correctly.
c. When in doubt, it should be checked by another nurse.
d. Check the drug handbook for recommended range of specific drug doses.
e. Dosage Calculations:
e.1. D V
H
Drop Factor:
e.2. Flow Rate
Macrodrip:
gtts/min = Amount of fluid x Drop Factor(gtts/ml)
a. Abbott 15
H x mins/H (60)
b. Cutter 20
ml/H = Amount of Solution c. Travenol 10
# of Hours Microdrip:
ml/min = Milliliters per Hour a. Minidrip sets 60
60 mins

No. of H = Amount of Solution

ml/H
Common Conversion
60 drops = 1 tsp
e.3. Freids Rule 1 tbsp = 15 ml
Age in Months x Adult Dose 3 tsps = 1 tbsp
150 1 gr = 60 mg
e.4. Clarks Rule 8 oz = 1 glass
Weight in Pounds x Adult Dose 15 gr = 1 gram
150 1000 mcg = 1 mg
e.5. Youngs Rule 15 gtts = 1 ml
Age in Years
Age in years + 12

e. RIGHT TIME
f. RIGHT ROUTE
a. Oral liquid, elixir, suspension, pill, tablet, capsule
b. Sublingual under tongue for venous absorption; high rate of absorption
c. Buccal between gum and cheek
d. Via feeding tube - NGT
e. Topical applied to the skin
f. Inhalation aerosol sprays
g. Instillation EEN
h. Suppository rectal or vaginal
i. 4 Parenteral Routes: IV, IM, SC, ID
j. Stay with the client until oral drugs have been swallowed.

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 g. RIGHT ASSESSMENT
a. Requires that the appropriate data be collected before drug administration.
Ex. Assess Apical heart rate before giving digitalis.
Asses blood sugar before giving insulin. Assess ability of the elderly to coordinate eye
medication instillation at home.
h. RIGHT DOCUMENTATION
i. RIGHT TO EDUCATION based on informed consent
j. RIGHT EVALUATION
k. RIGHT TO REFUSE

General Drug Administration Guidelines:

Practice asepsis.
Nurses who administer medications are responsible for their own actions. Do not administer medication
prepared by another nurse.
Check medication order with physicians order, Kardex, medicine sheet, medicine card.
Use only medications that are in clearly labeled containers.
Return liquid that are cloudy or have changed in color to the pharmacy.
Before administering a medication identify the client correctly.
Do not leave the medication.
If the pt vomits after taking the oral medication, report this to the nurse in charge and/ or physician.
When a medication error is made, report it immediately to the nurse in charge and /or physician.

ROUTES OF ADMINISTRATION Solid: tab, cap, pill, powder

a. Enteral Route Liquid:
ORAL MEDICATIONS -Syrup: sugar-based
- Position: -Susp: water-based; shake well b4 use
Adult: Sit the client upright -Emulsion: oil-based
Infant: 45 degrees angle -Elixir: alcohol-based; wait 3o mins b4
1. TABLETS AND CAPSULES
giving water
- Ensure the patients ability to swallow.
- Place medication well back on the tongue.
- Give pt liquid to swallow the medication (60-100ml except cough syrups).
- Remain with the pt while the medication is taken and until its gone.
- Do not crush enteric-coated tablets or sustained-release tablets.
- Scored tablets can be broken *Crushing enteric-coated tabs: irritate gastric
2. LIQUIDS mucosa.
- Shake liquid medication. *Crushing sustained-release tabs: release all of
- Pour away from bottle label. the medications at once decreasing its duration.
- Read the liquid amount at the lower meniscus at eye level.
- Administer the drug immediately. (prevent contamination)
- Iron or HCl: have the client use straw to prevent staining the teeth.
3. SUBLINGUAL AND BUCCAL
*SUBLINGUAL under the tongue for venous absorption (high rate of absorption)
*BUCCAL between gum and cheek
Nursing Alert!!!!
- Instruct the pt NOT to swallow the medication.
- Do not give fluids 30 minutes following administration.
4. NASOGASTRIC TUBE
- Indication: inability to swallow
- Position: Semi-Fowlers to High Fowlers position or on the Right side if comatose
- Measurement: NEX
- Liquid form of the drug should be used.
- If tablet: Crush medications and dissolve in 5-10 ml of water
- Check location of the NGT before administering the medication.

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 X-RAY ASPIRATION OF GASTRIC INTRODUCTION OF AIR
CONTENTS
-normal gastric color: grassy green,
-Confirms proper yellow to brown, clear -auscultation of gurgling sounds
placement -litmus paper color:RED
-pH:1-5; respi and intestinal: >7

Procedure:
1. Clamp the tubing and attach bulb syringe.
2. Unclamp the tubing and allow the medication to run.
3. Flush tubing with 50 ml of water or prescribed amount.
4. Clamp the tubing at the end of the medication administration.
5. Maintain pt in semi-fowlers for at least 30 minutes after administration.
6. Provide oral care if necessary.

b. PARENTERAL ROUTE
1. INTRADERMAL ROUTE
a. Action:
-Local Effect
-Used for observation on an inflammatory (allergic) reaction to foreign proteins.
b. Sites: lightly pigmented, hairless, thinly keratinized
-ventral forearm
-scapular area
-upper chest (clavicular area)
c. Equipment:
-Needle: 26-27g; 1 inch in length (max vol: 0.1 ml)
-Syringe: 1 ml or tuberculin syringe
d. Angle:
-10-15 degrees, bevel up
e. Technique:
-Put on gloves.
-Cleanse the area.
-Stretch the skin taut.
-Inject the medication slowly to form a wheal.
-Dont massage.
-Mark with a pen, and ask the client not to wash it off.
-Assessed after 48-72 hours.

2. SUBCUTANEOUS ROUTE
a. Action:
-Systemic and Sustained Effect
-Used for small doses of non-irritating, water-soluble drugs.
b. Sites: adequate fat pads
-Lateral aspect of the upper arm
-Upper back, scapular area e. Technique:
-Anterior thigh -Put on gloves.
-Abdomen (1 in away from umbilicus) -Cleanse the area.
-Upper Hips -Pinch the skin to form SC fold.
c. Equipment: -Aspirate, except for insulin or
5
-Needle: 25-27g; - /8 inches in length, 1 inch heparin.
-Syringe: 1 to 3 ml -Gently massage the area unless
-Maximum volume of 1.5 ml CI.
d. Angle -45 degrees (90 degrees in abdomen)

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 3. INTRAMUSCULAR ROUTE
a. Action:
-Systemic Effect
-Used for irritating drugs, aqueous suspensions, and oil-based drugs.
b. Sites: adequate muscle size, minimal nerves and blood vessels
-Ventrogluteal
-Vastus lateralis
-Dorsogluteal
-Deltoid
c. Equipment:
-Needle: 18-23g; 1-3 inches in length
-Syringe: 1 to 3 ml
-Maximum volume of 5 ml
d. Angle:
-90 degrees
e. Technique:
-Put on gloves.
-Cleanse the area.
-Flatten the injection site.
-Aspirate.
-Massage the area.

VASTUS LATERALIS (anterior thigh) DELTOID

-Recommended site for infants and children (bcoz -NOT safe (small muscle and close to the radial nerve
its well developed in both adults and children) and artery)
-No major blood vessels nor nerves
-Site: middle third of the anterior lateral aspect of -most convenient (readily accessible for children over
the thigh 18 mos and adults)
-Position: supine or sitting -site: 2-3 fingerbreadths below the acromnion
-Volume: Pediatrics <0.5 to 1 ml process
Adults 1 to 2 ml -Volume: <2ml
(gluteus minimus)
DORSOGLUTEAL (gluteus medius) VENTROGLUTEAL (von Hochsteters site)

-Not used for children under age 3 years unless the

child has been walking for at least 1 year (this muscle -Safest (No major nerves or blood vessels)
is developed by walking, so if the child havent been -Site:
walking, this muscle aint developed yet) 1. Place the heel of hand on greater trochanter
2. Point index finger towards the anterior iliac
-Site:
spine
1. Draw an imaginary line from greater
3. Abduct middle finger forming V
trochanter to Posterior Iliac Spine
2. Injection site: ABOVE THE IMAGINARY -Position: PRONE or LATERAL
LINE -Volume: 1-3 ml
-Position: PRONE or LATERAL
-Volume: 1-3 ml
-Nursing alert!!!: Avoid HITTING THE SCIATIC
NERVE

Z-TRACK METHOD
Purpose: To seal the drug deep into the muscle, prevent drug leakage into the SC tissue, and prevent
permanent staining of the skin.
Best Site: Ventrogluteal muscle and Dorsogluteal muscle

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 Procedure:

1. Change the needles after withdrawing the drug from the vial.
2. The skin is stretched or pulled into one side.
3. Inject the needle into the muscle.
4. Aspirate to check for blood.
5. Wait for 10 seconds after injecting the medication before withdrawing the needle.
6. Release the displaced skin.
7. Do not massage or rub the site.

4. INTRAVENOUS ROUTE
a. Action: -Systemic Effect: -Most rapid route
b. Sites: -Cephalic vein, Median Cubital vein, Dorsal and metacarpal veins, Radial vein, Basilic vein
c. Equipment:
-Needle:
*Adults: 20-21g; 1-1.5 inches
*Children: 22g; 1 inch
*Infants: 24g; 1 inch
*Blood Transfusion: Adults: 18-19g; Children: 23g

d. Angle: -25 degrees

e. Technique:
-Apply a tourniquet.
-Cleanse the area using aseptic technique.
-Insert needle until blood returns. Remove the tourniquet.
-Stabilize the needle and dress site.
-Monitor the flow rate, distal pulses, skin color, temperature, and insertion site.
f. General Considerations:
1. Prime tubing.
2. Avoid use of the veins of the lower extremities.
3. Avoid use of vessels over a bony prominence.
4. Initiate the IV in the nondominant hand.
5. Select site from distal to proximal.
6. Do not use an extremity with an impaired blood flow.
7. Commonly used veins: dorsal vein network, cephalic, basilic.

HYPERTONIC ISOTONIC (N:275-295 HYPOTONIC

-higher concentration of mOsm/kg) -lower concentration of solutes
solutes than the cells -same solute concentration as than the body fluids
-Cells SHRINK cells and blood -Cells SWELL
-Use: Clients with Edema -Cells maintain normal shape and Use: DHN, Hemorrhage
sixe
-Use: Burn clients
1. 3% NSS 1. 0.9% Saline 1. 0.45% Saline
2. 5 % NSS 2. D5W 2. 0.225% Saline
3. D10W 3. D5 in 0.25% NSS 3. 0.33 % Saline
4. D5 in 0.9 %NSS 4. LR
5. D5 in 0.45% NSS 5. NSS
6.D5LR

Nursing Interventions: a. Avoid D5W if client is at risk a. CI for clients with IICP.
a. Monitor for circulatory for IICP bcos it moves from the b. Monitor client carefully (LOC:
overload. intravascular to the cos fluid shifts into brain cells)
b. CI for clients with Renal & intracellular compartment.
cardiac d/o. b. D5W, when infused
c. CI for clients with DHN. continuously or rapidly, becomes
a hypotonic solution.

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 Complications
THROMBOPHLEBITIS inflammation of the vein + clot INFILTRATION - dislodgement of the IV catheter +
formation accumulation of fluids in the SC tissues

S/S Nursing Mgt: S/S Nursing Mgt:

a. Pain along the vein. a. Change IV site q72H. a. Pain a. Change the insertion
b. Hard & cord-like vein. b. Use large veins for b. Edema site.
c. Edema & redness @ irritating fluids. c. Cold skin @ needle site. b. Apply warm compress to
insertion site. c. Stabilize venipuncture d. Pallor of the site. reabsorb fluids.
d. Warmth on the site. e. Flow of IV decreases or
insertion site. d. Apply cold compress to stops.
relieve pain & inflammation. f. Absence of backflow of
e. Apply warm compress to blood.
stimulate circulation and
absorption.

AIR EMBOLISM presence of air in tubing that CIRCULATORY OVERLOAD caused by RAPID rate
managed to get into the circulatory system (>5 ml) of infusion

S/S Nursing Mgt: S/S Nursing Mgt:

a. Chest, Shoulder, Back a. Do not allow IV bottle to a. H/A a. Slow the infusion to KVO
pain run dry. b. Flushed skin (5-10 gtts/min)
b. Hypotension b. Prime tubing before c. Tachycardia b. Place the pt in high
c. Dyspnea starting infusion. d. HTN fowlers position to ease
d. Cyanosis c. Turn the pt to his left e. Weight gain breathing.
e. Tachycardia side in the Trendelenburg f. Syncope or faintness c. Administer diuretics or a
f. Increased venous position. To allow air to rise g. Pulmonary edema bronchodilator as ordered.
pressure in the right side of the h. Crackles
g. Loss of consciousness heart and would prevent air i. SOB
embolism. j. Tachypnea
k. Coughing

C. PERCUTANEOUS ADMINISTRATION
1. EYE DROPS AND OINTMENT
-Purpose:
a. Instill required eye medication.
b. Irrigate foreign bodies from the eye.
-Position: supine or sit with head turned to affected side to aid in gravitational flow
Procedure: EYEDROPS Procedure: EYE OINTMENT
1. Squeeze strip of ointment (1/4 in) onto
1. Wash Hands. conjunctival sac.
2. Check the medication. 2. Apply meds from inner to outer canthus.
3. Have the pt look upward. 3. Have the pt blink 2-3 times.
4. Apply gentle traction to the lower eyelid to expose 4. Close the eye gently for 2-3 mins.
the lower conjunctiva. 5. Instruct the pt to expect blurred vision for a
5. Administer medication to the lower conjunctiva short time.
not on the cornea.
6. Close the eye gently. NURSING ALERT!!!!
7. Press lacrimal duct for 1-2 mins. Avoid touching the tip of the medication to the
8. Wait 3-5 mins before instilling another drop. eye!!!!

2. EAR DROPS
-Purpose:
a. Soften & Remove cerumen
b. Treat inflammation and infection
c. Relieve pain
d. Remove a foreign body.
-Position: Side-lying with the ear being treated uppermost

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 Procedure:
-Children under 3yrs old: Pull the PINNA down and back
-children over 3 yrs old & adults: Pull the pinna UP and back
-Warm eardrops at room or body temperature.
-DO NOT insert dropper into the ear canal.
-Administer medication on the lateral walls of the auditory canal.
-Maintain position for 5-10 mins.
3. NOSE DROPS
-Purpose:
a. Shrink swollen mucous membrane
b. Loosen secretions & Facilitate drainage
c. Treat infections
-Position: Supine or Sitting and lean head backwards
-Procedure:
-Gently blow the nose.
-Instill medication.
-Have the pt remain in the position for 5 mins.
-Inform client the drops may produce an unpleasant taste.
4. RECTAL SUPPOSITORIES
-Absorption: Local or Systemic
-Position: Left Sims Lateral
-Procedure:
-Provide privacy.
-Use a glove for insertion.
-Ask pt to take a deep breath & exhale thru mouth. (relaxes anal sphincter)
-Gently insert the suppositories at approximately 2 inches. (use KY jelly)
-Ensure that the suppository is in contact with the rectal wall. (Accurate absorpt!)
-Remain lying on the side for 10-20 mins. (if enema: 20-30 mins)

5. VAGINAL MEDICATIONS
-Position: Dorsal Recumbent or Lithotomy
-Procedure:
-Have the client void.
-Cleanse the perineum.
-Lubricate the applicator tip.
-spread the labia to expose the vagina
-gently insert the applicator or suppository (2 inches)
-remain in supine position with the hips elevated for 15-20 mins.

D. INHALATION ROUTE
-Use of a Nebulizer or Metered-Dose Inhalers (MDI)
-Position: Semi to High Fowlers, Standing
Procedure:
-Insert the medication firmly into the inhaler.
-Remove the cap from the mouthpiece.
-Shake the inhaler. (To mix the medication & ensure uniform dosage delivery)
-Hold mouthpiece 1-2 inches from the mouth.
-Have the pt inhale fully while pressing on the inhaler.
-Remove inhaler and hold breath for 10 s.
-Exhale slowly thru the pursed lips
-Wait 2 minutes between puffs.
-Give bronchodilator inhalant before a glucocorticoid for an interval of 5 mins.
-Instruct client to rinse mouth after steroid inahalation. (prevent oral fungal infxn)
NOTE: To better facilitate delivery of inhalant medications, use a SPACER.

8
 DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM:
SYMPATHETIC NERVOUS SYSTEM PARASYMPATHETIC NERVOUS SYSTEM
- Flight or Fight response - Rest and Digest

- Major Neurotransmitter: EPINEPHRINE - Major Neurottransmitter: ACETYLCHOLINE

- Stimulates ALL body systems EXCEPT GIT/GUT - Inhibits ALL body systems EXCEPT GIT/GUT

- All vasoconstricts EXCEPT PUPILS, BRONCHUS, - All vasodilates EXCEPT PUPILS, BRONCHUS,

UTERUS UTERUS

-DRUG Classifications: -DRUG Classifications:

1. Adrenergic 1. Adrenergic Blocking Agents

2. Sympathomimetics 2. Parasympathomimetics

3. Cholinesterase 3. Anticholinesterase

4. Anticholinergic 4. Cholinergic

Action: STIMULATES Action: BLOCKS

Alpha1 vasoconstriction BP vasodilation BP

Beta1 HR CO BP HR CO BP
Beta2 relax smooth muscles (bronchodilation, contraction of smooth muscles
uterine relaxation) (bronchoconstriction, uterine contraction)

SIDE EFFECTS: SNS SIDE EFFECTS: PNS

1. Tachycardia 1. Bradycardia
2. HTN 2. Hypotension
3. Dry mouth 3. Increased salivation
4. Constipation 4. Diarrhea
5. Urinary retention 5. Increased urination
6. Pupil and bronchodilation 6. Pupil and bronchoconstriction
7. Uterine relaxation 7. Stimulates uterine contraction
8. Vasoconstriction except in smooth muscles 8. Vasodilation except in smooth muscles

SNS DRUGS
Adrenergic Drugs: Indications Nursing Management:
1. epinephrine (Adrenaline Chloride)
2. norepinephrine (Levophed, 1. Best taken: EARLY MORNING
a. SHOCK: Cardiac stimulant
Levarterenol)
3. dopamine (Intropin)
b. CARDIAC FAILURE
2. Assess HR & BP
4. dobutamine (Dobutrex) (tachycardia/dysrhythmias)

5. Bronchodilators: 3. Monitor I/O (Urgency/urinary

a. albuterol (Ventolin, Proventil) incontinence)
b. salmeterol (Serevent) 4. Monitor lung sounds. (Epi = pulmo
a. ASTHMA
c. terbutaline sulfate (Brethine, edema, bronchodilator = absence of
b. BRONCHOSPASM wheezing)
Bricanyl)
d. isoproterenol (Isuprel) c. CAL 5. Administer through a large vein (E/NE).
e. ipratropium bromide (Atrovent) 6. If extravasation occurs, infiltrate the
f. ipratropium + albuterol site with normal saline and phentolamine
(Combivent) (regitine)..

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 Anticholinergic: Indications Nursing Management:
1. atropine sulfate (Isopto) a. Preanesthetic med 1. Avoid driving (blurred vision)
2. scopolamine (Hydrolomide) (secretions & bradycardia) 2. Encourage use of sunglasses
3. glycopyrrolate (Robinul) (photophobia)
b. Mydriatics
3. Relieve dry mouth (hard candy, ice
chips, sugarless gum)
4. benztropine (Cogentin) a. Anti-EPS 4. CI in glaucoma. (eye exams)
5. trihexiphenidyl (Artane) b. Anti-Parkinsonian 5. fluids & high fiber intake
6. biperiden (Akineton) (Constipation).
7. procyclidine (Kemadrin) 6. Monitor for heatstroke.

PNS DRUGS
Adrenergic Blocking Agents: Indications Nursing Management:
1. prazosin (Minipress) a. HTN 1. Assess BP
2. phentolamine (Regitine) (Antidote for:)
3. terazosin (Hytrin) 2. Do not discontinue abruptly (reflex
4. reserpine (Serpasil, Serpalan) tachycardia)
5. nitroprusside (Nipride)
6. hydralazine (Apresoline) 3. Priority : SAFETY (Light-headed,
7. atenolol (Tenormin) dizzy, orthostatic hypotension)
8. propranolol (Inderal)
9. metoprolol (Lopressor) 4. Decrease salt intake (can cause
10. nadolol (Corgard) edema/h2o retention)
5. Inform regarding sexual
difficulties (vasoconstriction of
smooth muscles)
NOTE: Reserpine can cause depression,
GI irritation, impotence, increase risk for
breast CA.

Cholinergic: Indications Nursing Management:

- aka anticholinesterase 1. Prepare antidote:
1. acetylcholine chloride (Miochol) a. Miosis -atropine sulfate
2. neostigmine (Prostigmin) b. Myasthenia Gravis -pralidoxime chloride (PAL)
3. pyridostigmine (Mestinon, 2. Effectiveness:
Regonol) -improved muscle strength
c. Urinary retention
4. edrophonium chloride (Tensilon)
5. bethanecol (Urecholine) 3. Monitor for cholinergic crisis
(used to tx post op urine retention) 4. Take with drug or food (<GI irr)

Common Board Exam Questions:

Drug for the diagnosis of Myasthenia Gravis: edrophonium chloride (Tensilon)
Drug for the prevention of Pre Term Labor: terbutaline sulfate (Brethine, Bricanyl)
Contraindicated for Glaucoma: Anticholinergics
Common emergency drug for allergic reaction and bronchospasm: Epinephrine (Adrenaline)
Drug of choice for hypertensive Crisis: phentolamine mesylate (Regitine); nitroprusside (Nipride)
Drug for Urinary Retention: bethanecol (Urecholine)
Drug for BPH: terazosin (Hytrin) (relaxes bladder sphincter) (DOC: finasteride [Proscar]=androgen inhibitor)

10
 PSYCHOTROPIC AGENTS

ANTIANXIETY / ANXIOLYTICS
Referred to as: a. Antianxiety b. Minor Tranquilizers c. Downers
1. Benzodiazepine -am, -pam Side Effects: c. Interventions:
Diazepam (Valium) 1. CNS depression S/E 1. Rinse mouth with water often and eat
Alprazolam (Xanax) -dizziness, confusion, sugarless gum.
Oxazepam (Serax) disorientation, ataxia, fatigue
Lorazepam (Ativan) 2. Assist in ambulation.
Clonazepam (Klonopin) 2. Anticholinergic S/E
Chlorazepate -everything is dry; dry eyes, dry 3. Caution against driving.
(Tranxene) mouth, constipation, urinary
Chlordiazepoxide retention 4. Not used with daily minor stresses.
(Librium)
Estazolam (ProSom) 3. Orthostatic/Postural 5. Caution in patients with glaucoma.
Midazolam (Versed) hypotension
2. Nonbenzodiazepine 6. No alcohol and CNS depressants.
Meprobamate (Equanil,
Miltown) 7. Therapeutic benefit is achieved in 2
Buspirone (BuSpar) weeks.
Hydroxyzine (Vistaril,
8. Cautious IV use as drug can
Atarax)
precipitate.
3. Sedative Hypnotic
Benzodiazepines 9. Smoking decreases drug effect.
Flurazepam (Dalmane) 10. Avoid abrupt discontinuation.
Triazolam (Halcion) 11. Antidote for OD:
Temazepam (Restoril) flumazenil (Romazicon)
DOC for alcohol withdrawal: Chlordiazepoxide (Librium) DOC for Status Epilepticus: Diazepam (Valium)
Anxiolytic considered as: DOC as pre-op medication: Lorazepam (Ativan)
DOC for elderly: Oxazepam (Serax); Lorazepam (Ativan)

ANTIPSYCHOTICS:
Referred to as:
a. Neuroleptics b. Major Tranquilizers
Phenothiazines: Side Effects: Nursing Management:
1. Chlorpromazine (Thorazine) 1. CNS Depressant Effects:
2. Trifluoperazine (Stelazine) -dizziness, confusion, For CNS Depression:
3. Fluphenazine (Prolixin) disorientation, ataxia, fatigue 1. Safety precautions
4. Perphenazine (Trilafon) 2. Avoid activities that requires
5. Triflupromazine (Vesprin) Alertness (DRIVING)
6. Thioridazine (Mellaril)
7. Molindone (Moban) For Anticholinergic Effects:
2. Anticholinergic Effects:
1. Relieve dry mouth.
-everything is dry; dry eyes,
Nonphenothiazines: 2. CI in Pxs with galucoma
dry mouth, constipation,
Butyrophenones urinary retention
1. Haloperidol (Haldol) For orthostatic hypotension:
2. Droperidol (Inapsine) 1. Monitor BP
3. Orthostatic Hypotension
Thioxanthenes 2. Gradual change of position
4. Prolactin levels
1. Chlorprothixene (Taractan) 3. Assist in ambulation
5. PHOTOSENSITIVITY
2.Thiothixene (Navane) 6. Diminished libido, Erectile
Atypical and orgasmic dysfunction FOR PHOTOSENSITIVITY:
1. Clozapine (Clozaril) 7. Weight gain 1. Apply sunblock. (SPF:15-30)
2. Risperidone (Risperdal) 8. Pruritis 2. Protective clothing.
3. Olanzapine (Zyprexa) 9. Neuroleptic Malignant
4. Quetiapine (Seroquel) Syndrome (NMS)
5. Ziprasidone (Geodon)
New Generation
1. Aripiprazole (Abilify)

11
 Extra Pyramidal Symptoms (EPS)
Dystonia Pseudoparkinsonism Akathisia Tardive Dyskinesia
REVERSIBLE REVERSIBLE REVERSIBLE IRREVERSIBLE
Risk: 1-5 days Risk: 1-4 weeks Risk: 1-6 weeks Risk: Long term use
Frightening spasms of Akinesia Uncontrolled motor Involuntary:
major muscle groups Rigidity restlessness and the tongue movement
Torticollis Bilateral fine hand inability to sit still sucking
Opisthotonus tremors, pill-rolling Pacing lip smacking
Oculogyric crisis Mask-like face, Foot tapping chewing
drooling grimacing
Shuffling, festinating blinking
gait licking

Anti EPS drugs: (Anticholinergic drugs)

Benztropine COGENTIN A Artane; Akineton
B Benadryl
Biperidin AKINETON
C Cogentin
Diphenhydramine BENADRYL D diazepam
Trihexyphenidyl ARTANE S Symmetrel (Dopa agonist)
Procyclidine KEMADRINE
Amantadine SYMMETREL
Diazepam (Valium)
When is the best time to refill Clozapine? Q7d (meds are usually dispensed good for 7 days only)
Typical Antipsychotics relieve what Sx? Positive
Aypical Antipsychotics relieve what Sx? Both Positive and Negative Sx
Most potent TYPICAL Antipsychotic: Haloperidol (Haldol)
Major reason why Atypical Antipsychotics are preferred: Lesser EPS
Lag period: 3-6 weeks
DOC for Dystonia: Diphenhydramine (Benadryl)
Beta-blocker used for Drug-induced Akathisia: Propranolol (Inderal)

ANTIDEPRESSANTS
Referred to as:
a. Mood elevator
b. Psychic energizer

1. TCAs Side Effects: Nursing Management:

MOA: Blocks the reuptake of NE -in general
and 5-HT Interventions:
1. Initiate safety precautions.
Imipramine (Tofranil) Photosensitivity 2. Administer with meals.
Amitriptyline (Elavil) Cardiovascular disturbances: 3. Monitor the suicidal client
Trimipramine (Surmontil) arrhythmias especially during improved mood.
Clomipramine (Anafranil) Tachycardia 4. Instruct the client to change
Maprotiline (Ludiomil) Orthostatic hypotension positions slowly.
Protriptyline (Vivactil) Weight gain 5. Instruct the client to avoid
Nortriptyline (Pamelor) Decreased libido, Ejaculatory driving and other activities
Doxepin (Sinequan) disturbances requiring alertness.
Desipramine (Norpramine)
Amoxapine (Asendin)

12
 2.SSRIs Side Effects: Principles of MAOI &
MOA: Blocks serotonin reuptake N/V TCA Administration
Diarrhea 1. TCAs given first
Fluoxetine (Prozac) Photosensitivity 2. Dont use together with alcohol
Sertraline (Zoloft) Insomnia 3. Expect a lag
Paroxetine (Paxil) Nervousness TCA: 2-4 weeks
Fluvoxamine (Luvox) H/A, dizziness SSRI: 1-3 weeks
Citalopram (Celexa) Male sexual dysfunction (ED) MAOI: 2-6 weeks
Escitalopram (Lexapro) 4. Gap between meds: 14 days
5. Surgery: 10 days
3. MAOIs Side Effects:
MOA: Inhibits Monoamine Oxidase Orthostatic hypotension for MAOIs:
Insomnia 1. Assess for hypertensive crisis
Tranylcypromine (Parnate) Weakness 2. Avoid tyramine-containing
Phenelzine (Nardil) GI upset foods: Wine (except vodka),
Isocarboxacid (Marplan) Weight gain cheese (except cottage and
Rasagiline (Azilect) Peripheral edema cream), yogurt, vinegar
Selegiline (Eldepryl, Emsam) Delay in ejaculation
HYPERTENSIVE CRISIS
Therapeutic effect of antidepressant: lifting of depression
Foods to avoid when taking MAOI: Tyramine-rich foods
Most recommended antidepressant: SSRIs 9safe and fewer cardiovascular SEs)
DOC for OCD: Fluvoxamine (Luvox), Clomipramine (Anafranil)

ANTIMANIC
Action: the release of norepinephrine

Availabilty: Side Effects: Nursing Management:

-Tablet -Capsule -Syrup a. Polyuria, Polydipsia, Dry 1. Administer the medication on time
Trade Name: mouth and with food.
Eskalith, Lithotabs, Lithobids, b. Anorexia, Nausea 2. Do not skimp on dietary Na intake.
Cibalith, Lithonate c. Weight gain 3. Drink 10-13 glasses of water per
Lag period: 10-21 days d. Abdominal bloating day.
Points to ponder regarding LiCO3: e. Soft stools or diarrhea 4. Avoid excessive use of beverages
1. LiCO3 is maintained with 300mg f. Fine hand tremors containing caffeine and alcohol.
T.I.D. g. Inability to concentrate 5. Notify physician if fever,
2. Blood level is checked 8-12 hours h. Muscle weakness, PERSISTENT vomiting or diarrhea
after last dose. Then: fatigue, occurs.
a. every week for the 1st month i. H/A, drowsiness, 6. Carry alert card always.
b. every 2-3 months dizziness 7. Lithium should be tapered off and
3. Therapeutic level j. Hair loss not discontinued abruptly.
* 0.5 1.5 mEq/L adults
* ).6 1.8 mEq/L children

1. Lithium Toxicity Prodrome 2. Lithium Intoxication

V (> 2.5 mEq/L)
A Nystagmus Impaired consciousness
N Oliguria or Anuria Seizure
D Coma Deatth
A
L
T

13
 ANTICONVULSANTS
Action: Prevents dissemination of electrical discharges in motor cortex area of the brain by enhancing GABA.

Hydantoins: -toin Side Effects: Nursing Management:

1. phenytoin (Dilantin) 1. Gingival hyperplasia
Therapeutic level: 10-20 mcg/ml a. Oral Care 1. Monitor serum level.
Toxic Level: >30 mcg/ml b. Use soft-bristled toothbrush 2. Monitor signs of toxicity.
2. ethotoin (Peganone) c. Brush 2-3 times a day 3. IV phenytoin should be diluted in NSS
3. mephenytoin (Mesantoin) d. Massage gums (dextrose -> precipitate).
4. fosphenytoin (Cerebyx) 2. Slurred speech 4. Good oral hygiene.
3. confusion 5. Increase folic acid. (interferes with
4. Depression folic acid absorption)
5. N/V 6. Do not stop drug abruptly (gradual as
6. Constipation it can lead to status epilepticus)
7. H/A 7. Can turn urine pink, red, or red-brown.
8. Hyperglycemia 8. Tablet can be crushed. (mix with food)
9. Blood dyscracias 9. Suspension must be shaken well. (make
(leukopenia/thrombocytopenia) sure accurate dosage is given)
10. Alopecia 10. Lag period: 7-10 days
11. Hirsutism
Barbiturates -bital Side Effects: Nursing Management:
1.phenobarbital ( Luminal) 1. CNS depression 1. Taken with food. (reduce gastric
2. amobarbital (Amytal) a. dizziness, drowsiness distress)
3. pentobarbital (Nembutal) b. ataxia 2. Do not discontinue abruptly.
4. secobarbital (Seconal) c. hand tremors 3. Avoid alcohol.
5. mephobarbital (Mebaral) 2. Hypotension 4. Avoid activities that requires
6. thiopental Na (Pentothal Na) 3. Respiratory depression alertness.
7. butabarbital (Butisol) 5. Drowsiness in first few weeks & will
8. primidone (Mysoline) decrease.
Lag time: 3-4 weeks 6. report symptoms of blood dyscrasias
Other Anticonvulsants: MOA: hinders movement of
7. Give reconstituted solutions within 30
minutes of mixing.
1. carbamazepine (Tegretol) impulses from the thalamus to the
8. Teratogenic
2. valproic acid (Depakene) brain cortex.
3. divalproex Na (Depakote)
4. lamotrigine (Lamictal)
5. gabapentin (Neurontin)
6. falbamate (Felbatol)
7. topiramate ( Topamax)
Most common side effect of phenytoin (Dilantin): Gingival Hyperplasia

ANTIPARKINSONS DRUGS

Anticholinergics: Side Effects: Nursing Management:

MOA: Reduce tremors and rigidity by 1. CNS Depression 1. Avoid foods high in Vitamin B6
inhibiting Ach. a. Dyskinesia (impaired (increases levodopa metabolism to
1. benztropine mesylate (Cogentin) voluntary movement) dopamine in the PNS) and high
2. trihexiphenidyl ( Artane) b. Dizziness protein foods.
3. biperidine HCl (Akineton) c. Ataxia 2. Dont abruptly stop the drug.
4. procyclydine HCl ( Kemadrin) d. Confusion 3. Change position slowly.
2. Anticholinergic Effects
Dopaminergics: a. Urinary retention 4. Avoid alcohol
b. Constipation
1. amantadine (Symmetrel) c. Dry mouth 5. Discoloration of sweat and urine is
2. bromocriptine (Parlodel) d. blurred vision harmless.
3. carbidopa-levodopa (Sinemet) 3. Orthostatic hypotension
4. levodopa (Larodopa, Dopar) 4. Nausea and vomiting

What vitamin should be avoided when taking levodopa? Pyridoxine

14
 DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM

ANTIHYPERTENSIVES ABCD

ACE Inhibitors:-pril Side Effects: Nursing Management:

Action: Prevents vasoconstriction by 1. N/V, diarrhea 1. Monitor V/S: especially the BP.
inhibiting conversion of Angiotensin I 2. Persistent cough
3. Hypotension 2. Do not discontinue abruptly.
to Angiotensin II.
4. Tachycardia
5. Ageusia (1st month only) 3. Avoid alcohol.
1. benazepril ( Lotensin)
2. captopril ( Capoten) 6. Dizziness
7. H/A 4. For orthostatic hypotension
3. enalapril ( Vasotec)
8. Hypoglycemia - avoid hot baths
4. fosinopril ( Monopril)
- gradual change of position
5. lisinopril ( Prinivil, Zestril)
6. ramipril (Altace)
7. losarten (Cozaar) ACE INHIBITORS
Beta Blockers: -olol -Expect dry cough
Side Effects:
Action:Blocks beta receptors. 1. Bradycardia
2. Bronchospasm BETA BLOCKERS
1. acebutolol ( Sectral) 3. Hypotension -C/I: ASTHMA & COPD
2. atenolol (Tenormin) 4. N/V
3. betaxolol (Betoptic) 5. Intensified
4. esmolol (Brivibloc) hypoglycemia
5. metoprolol (Lopressor)
6. nadolol (Corgard)
7. propranolol (Inderal)
8. pindolol (Visken)
Calcium Channel Blockers -dipine Side Effects:
Action:Inhibits movement of Ca across the cell 1. Bradycardia
membrane into cardiac and smooth muscles 2. Hypotension
3. Headache
1. verapamil ( Calan, Isoptin) 4. Dizziness
2. nifedipine (Procardia) 5. Constipation
3. diltiazem (Cardizem)
4. amlodipine (Norvasc)
5. felodipine ( Plendil)
6. nicardipine (Cardene)
7. nimodipine (Nimotop)
Diuretics Side Effects: Nursing Considerations:
1. LOOP DIURETICS 1. Give early in the morning. (prevent
Action: inhibit NA & Cl reabsorption at the 1. Orthostatic Hypotension nocturia)
loop of Henle 2. Hyperuricemia
1. furosemide (Lasix) 3. Drowsiness 2. Monitor I/O and weight.
2. ethacrynic acid (Edecrin) 4. H/A
3. bumetamide (Bumex) 5. Anorexia 3. Make positional changes slowly.
4. torsemide (Demadex) 6. Hypokalemia except K- 4. Administer with food.
sparing 5. Monitor for fluid and electrolyte
2. THIAZIDE DIURETICS 7. Rash Imbalance.
Action: blocks Na reabsorption in the DCT 8. Hyponatremia HYPOKALEMIA
1. chlorothizide (Diuril) 9. Dehydration
2. hydrochlorothiazide ( HydroDIURIL, HYPERKALEMIA
Esidrex) For Thiazide:
3. benzthiazide (Exna) 1. Hypercalcemia HYPERCALCEMIA
6. Assess BP before administration.
3. OSMOTIC DIURETIC For K-sparing: 7. Consume foods rich in K.
Action: inhibit reabsorption of F/E 1. Hyperkalemia
1. mannitol (Osmitrol)
2. urea (Ureaphil)

15
 NOTE: OSMOTIC 8. For potassium sparing:
4. POTASSIUM SPARING DIURETIC DIURETICS DECREASE Monitor for kidney function.
Action: blocks aldosterone, inhibits ICP; DEC. IOP IN Avoid K-rich foods.
reabsorption of water & Na NARROW-ANGLE
1. spironolactone (Aldactone) GLAUCOMA
2. amiloride ( Midamor)
9. Antidote for Hyperkalemia:
3. triamterene ( Dyrenium) NOTE: CAI DECREASE *Na polystyrene sulfate (Kayexalate)
IOP IN OPEN-ANGLE -exchanges Na for K in the colon;
5. CARBONIC ANHYDRASE GLAUCOMA; USED TO rectal or oral
INHIBITORS
TREAT METABOLIC *IV NaHCO3 = promotes intracellular
Action: Promotes excretion of Na, K, HCO3,
ALKALOSIS shift of K
and water.
1. acetazolamide (Diamox) *Insulin and glucose = promotes
2. dichlorphenamide (Daranide) intracellular shift of K
3. Methazolamide (Neptazane)

Side Effects: Nursing Considerations:

DIRECT ACTING VASODILATORS 1. Monitor V/S.
Action: Promotes direct relaxation of a. Hypotension 2. Na Nitroprusside
arteriolar smooth muscle causing vasoldilation.
b. Palpitations a. Monitor cyanide and
1. hydralazine (Apresoline) c. H/A thiocyanate levels.
2. nitroprusside ( Nipride, Nitropress) d. Confusion and dizziness b. Protect from light. (cos drug
3. diazoxide ( Hyperstat) decomposes) IV tubing and
4. nitroglycerine (Nitrobid) container must be covered in
5. minoxidil (Loniten) aluminum foil.
c. Discard if medication is
red/blue.
DOC for Angina Pectoris: NTG
Diuretic drug for cerebral edema: Mannitol (Osmitrol)
Calcium Sparing Diuretic: Thiazide
Diuretic for Metabolic Alkalosis: CAI
Drug used for Hypertensive Crisis: Nitroprusside (Nipride)
Beta blocker used to tx akathisia: Propranolol (Inderal)

NITRATES
Action: Decrease preload and afterload thus reduce myocardial oxygen consumption.
Nursing Management:
1. nitroglycerine (Nitrostat, Side Effects: 1. Rise slowly.
Nitrobid) Headache 2. Best taken when seated
2. isosorbide dinitrate (Isordil) Orthostatic Hypotension 3. Expect for headache
3. isosorbide mononitrate (Imdur) Dizziness SL:
Onset:
Faintness 1. One tablet every 5 minutes (for a
SL: 1-3 mins
Flushing or pallor total of 3 doses).
SR Cap: 20-45 mins
Ung: 20-60 mins 2. Store drug in a dark container
Patch: 30-60 mins 3. Shell life: 3 - 6 months
Patch/Ung Sites:
IV: 1-3 mins 4. Expect for SUBLINGUAL
Chest, back, abdomen, upper TINGLING (potent)
arm, anterior thigh Patch:
1. Apply on hairless area
2. Remove patch after 12-14H (remain
patch free for 10-12H to avoid
tolerance)
Ung:
1. Remove previous Ung from skin
2. Spread over a 6x6 inch area & cover
w/ a plastic wrap

16
 CARDIAC GLYCOSIDES/DIGITALIS
ACTION: positive inotropy (thus increasing cardiac output; used for CHF); negative chronotropy

Nursing Management:
1. digoxin ( Lanoxin) Monitor for toxicity: 1. Assess APICAL PULSE (withhold if
2. digitoxin ( Crystodigin) Bradycardia <60bpm & notify Ap)
2. Monitor serum potassiumand Encourage
Anorexia
SE: foods high in K. (N: 3.5-5; hypoK inc
-dizziness, drowsiness N/V digoxin toxicity)
-fatigue
-insomnia
Diarrhea 3. Monitor therapeutic level. (0.5-2ng/ml;
-H/A Abdominal cramps 10-35ng/mldigitoxin)
Visual disturbances 4. Antidote: Digoxin immune Fab
(Digibind)
blurred vision, green or
yellow halos
5. Monitor for sign of effectiveness:

When is the best time to refill nitroglycerin? Q6mos

An indication of nitroglycerin effectivess: Relief from chest pain
An Indication of SL NTG potency: Tingling or burning sensation under the tongue
Most common side effect of nitroglycerine: H/A
Important assessment before giving digoxin: Apical pulse >60 bpm
Electrolyte to monitor when taking digoxin: Potassium
Earliest Sx of Digoxin toxicity: Bradycardia
Antidote for Digoxin: Digoxin Immune Fab (Digibind)
Effect of Hypokalemia in clients taking Digoxin: Increased risk for toxicity

ANTICOAGULANTS
Action: Inhibits clot formation.
Subcutaneous: Side effects: Nursing Management:
a. Hemorrhage 1. Do not aspirate (to prevent
1. heparin (Liquaemin) b. Hematuria hematoma)
2. enoxaparin (Lovenox) c. Epistaxis 2. Antidote at bedside:
3. ardeparin (Normiflo) d. Ecchymosis Heparin: Protamine sulfate
4. danaparoid (Orgaran) e. Bleeding gums Warfarin: Vitamin K
(therapy: 7-14days) f. Thrombocytopenia 3. Monitor Coagulation tests:
ORAL: (blocks prothrombin g. Hypotension Heparin: aPTT
synthesis) (N:20-36s x INR: 1.5-2/ maintain at
60-80s) or 30-45 x INR in other
1. warfarin (Coumadin) (usu given for 2-3 sources
mos after MI) Warfarin: PT
2. bihydrooxycoumarin (Dicumarol) (N:9.6-11.8s x 2-3 =19 -36)
3. anisindione (Miradon) (Ordered 4. For warfarin:
seldomly) a. desired effect: 2-3 days
b. avoid green leafy vegetables
Nursing Management: very important
1. Assess for bleeding 2. Bleeding Precautions: 3. Avoid taking with ASPIRIN

THROMBOLYTICS -ase
Action: Dissolve clots.
Side Effects: Nursing Management:
Indicated: Pulmonary emboli, DVT, MI (w/in 4- a. Bleeding 1. Bleeding precautions.
6H of the onset of the infarct to restore blood b. Dysrhythmias 2. Asses pulses. (tachycardia)
flow) 3. Pressure over puncture site for
c. Fever
20-30 mins.
1. streptokinase (Streptase)
d. Allergic Reactions
4. Use electric razor for shaving
2. urokinase (Abbokinase) and soft toothbrush.
3. alteplase (Tissue Plasminogen Activator [t- 5. Antidote: Aminocaproic acid
PA])

17
 (Amicar)

Rapid acting anticoagulant: Heparin (Liquaemin) Used to monitor effectiveness of warfarin: PT

Foods to avoid if on Dicumarol: Vit K rich foods Antidote for Heparin: Protamine sulfate
Antidote for Thrombolytics: Aminocaproic acid (Amicar) Antidote for Warfarin: Vit. K

DRUGS AFFECTING THE DIGESTIVE SYSTEM

ANTI-ULCERS
ANTACIDS:
Action: Neutralize gastric acids (by inactivating pepsin)
ALUMINUM-BASED: MAGNESIUM-BASED: CALCIUM-BASED: Al-Mg COMBINATION
1. aluminum hydroxide 1.magnesium hydroxide 1.calcium carbonate 1. Mg-Al hydroxide
(Amphojel) (Milk of Magnesia) (Tums, Dicarbosil) ( Maalox, Mylanta)
2. aluminum carbonate 2. Mg-Al trisilicate
(Basaljel) Side Effect: (Gaviscon)
-Constipation, belching, 3. magaldrate (Riopan)
Side Effect: Side Effect: flatulence, HyperCa,
-Constipation -Diarrhea H/A
Nursing Management: Antacids
1. Taken 1-2 hours after meal.
for aluminum based: for calcium based: for magnesium based:
2. Never give along with other drugs. -Hypophosphatemia -dont take w/ Vit D -CI for RF
(1H gap)

H2 BLOCKERS -tidine TPAZ Side Effects: Nursing Management:

Action: Supress secretion of gastric acid. a. Confusion 1. Taken with meals.
1. cimetidine (Tagamet) b. Dizziness, drowsiness 2. Never give along with antacids.
2. famotidine (Pepcid) c. H/A (decrease absorption)
3. nizatidine (Axid) 3. Stop smoking. (dec effect)
d. Depression
4. ranitidine ( Zantac) 4. Caution with CNS S/Es.

PROTON PUMP INHIBITORS: -prazole Side Effects: Nursing Management

Action: Supress secretion of gastric acid a. Diarrhea 1. Taken before meal
up to 90% greater than H2 blockers. b. Abdominal pain 2. Monitor lab tests
1. esomeprazole (Nexium) c. Nausea - liver function test
2. lansoprazole ( Prevacid) d. H/A - renal function test
3. omeprazole ( Prilosec)
4. pantoprazole (Protonix)
5. rabeprazole (Aciphex)
MUCOSAL PROTECTIVE DRUGS Side Effects: Nursing Management:
ACTION: Covers and protect the For Sucralfate: 1. Taken before meals and HS.
ulcer from acid and pepsin. a. Sleepiness 2. Increase fluids, dietary bulk, , and
b. Constipation exercise.
1. sucralfate (Carafate) c. Dry mouth 3. Separate administration from other
2. misoprostol (Cytotec) d. back pain drugs. (by 2H;dec absorption of
warfarin, phenytoin, theophylline,
For Misoprostol: digoxin, tetracycline)
a. Diarrhea 4.Avoid gastric irritants. (caffeine,
b. Abdominal pain alcohol, spices)
c. Flatulence For Misoprostol:
1. Taken with meals.
2. CI in pregnant women.
DOC for GERD: Proton Pump Inhibitors especially esomeprazole (Nexium)
Common side effect of Magnesium-based:

18
Common side effect of Aluminum-based:
Antacid of choice for hyperphosphatemia:
H2 blocker that has CNS side effects: Cimetidine (Tagamet)
An abortive drug: Misoprostol (Cytotec)

PAIN MEDICATIONS:
NON-NARCOTICS: Side Effects: Nursing Management:
1.acetylsalicylic acid (Aspirin [Ecotrin, a. GI Bleeding (melena, 1. Take with food, antacid, or milk.
Bayer, Aspilet] [buffered: Alka- hematochezia) 2. Avoid giving to children with Viral
Seltzer, Bufferin]) b. Epistaxis Infection. (may cause Reyes Syn)
4 As c. Bruising 3. Never give along with anticoagulants.
Antipyretic d. Diarrhea (potentiates anticoag)
Analgesic 4. Report signs of bleeding.
Anti-inflammatory Aspirin/ Salicylate 5. Assess for hearing problems.
Antiplatelet Toxicity: 6. Avoid use in pregnant women.
a. Tinnitus (earliest) 7. Should not be taken with NSAIDs.
b. Confusion (dec effect of nsaids)
c. Dizziness 8. D/C 3-7 days before surgery.
d. Metabolic acidosis
e. Respi alkalosis
Side Effects: Nursing Management:
2. acetaminophen ( Tylenol) a. Anorexia 1. Assess history of liver dysfunction.
b. N/V 2. Monitor hepatic damage. (N/V,
-Antipyretic c. Hypoglycemia diarrhea, abdominal pain)
-Analgesic adverse effect: 3. Monitor liver enzyme tests.
HEPATOXICITY 4. Antidote: Acetylcysteine (Mucomyst)
NSAIDS: Side effects: Nursing Management:
Action:Inhibit synthesis of Prostaglandin a. Gastric irritation 1. Take with food.
(prostaglandin inhibitors) b. Dizziness
Indications: Pain, Arthritis c. Tinnitus 2. Do not take with Aspirin.
1. diclofenac Na (Voltaren) d. Hypotension
2. ibuprofen (Motrin, Advil) e. Na and H2O retention 3. Monitor liver enzymes.
3. naproxen (Flanax, Naprosyn,
Anaprox)
4. ketorolac (Toradol) (1st injectable
NSAID [IM])
5. piroxicam (Feldene)
6. indomethacin (Indocin)
7. mefenamic acid (Ponstan)
8. sulindac (Clinoril)
9. diflunisal (Dolobid)

19
 NARCOTICS/OPIATES Side Effects: Nursing Management:
Action: Blocks pain receptors. (induces a. Dizziness 1. Assess RR/VS. (w/hold:RR=12cpm)
sedation, analgesia, euphoria) b. Decrease RR 2. Antidote at bedside
Indications: Moderate to severe pain c. Hypotension *Narcan = IM, IV, SC: qive q2-3
1. morphine (Morphine SO4) d. Constipation mins
2. codeine (Codeine SO4)
3. meperidine HCl (Demerol) *Oxycodone + Aspirin: *Revia = PO once per day given
4. oxycodone (Oxycontin) Percodan after Narcan
5. propoxyhene (Darvon) *Oxycodone + * 3. Avoid alcohol. (CNS depression)
6. methadone (Dolophine) Acetaminophen: 4. Safety precautions. (CNS depression)
7. hydromorphone (Dilaudid) Percocet -side rails, night light, supervised
ambulation
8. fentanyl (Duragesic)
9. pentazocine (Talwin) *Darvon contains aspirin
10. nalbuphine (Nubain) *Darvon-N:
11. Butorphanol (Stadol) acetaminophen
Narcotic of choice for pancreatitis (pain): Meperidine HCl (Demerol)
NSAID used for the closure of Patent Ductus Arteriosus: Indomethacin (Indocin)
Drug of choice for opioid withdrawal: Methadone (Dolophine) (replacement med for opiate dependence/withdrawal)

ENDOCRINE DRUGS
INSULIN -action: Facilitates transport of glucose across the cell.
SHORT-ACTING INTERMEDIATE LONG-ACTING

Insulin Type Regular NPH (Isophane) Ultralente

-Regular Iletin - NPH Iletin - Humulin U
-Humulin R -Humulin N
-Novolin R - Actrapid N
-Semilente - Lente

Onset 30 mins 1H 24H 6 12 H

Peak 2 4H 6 -12 H 18 24 H

Duration 6 12H 18 24 H 36 72 H

Nursing Management:
1. Rotate injection sites. (lipodystrophy: lipohypetrophy=devt of fibrous fatty masses caused by repeated
use of an injection site; abdomen, arms [posterior], thigh [anterior], hips)
2. Do not massage. (increase absorption rates thus hypoglycemia)
3. When mixing 2 insulins : *Inject air: N R *Withdrawing of insulin: R- N
4. Stable at room temperature, if prefilled or mixed keep refrigerated (not frozen).
5. Dont inject cold insulin. (lipodystrophy: lipoatrophy loss of SC fat and appears as slight dimpling)
6. Gently roll insulin bottle before use. Dont shake. (to ensure insulin is mixed well; bubbles will cause
inaccurate dosage)
7. Monitor blood glucose level.
Intervention for Hypoglycemia:
8. Avoid smoking. (dec insulin absorption)
if conscious: give fast acting simple CHO
9. Assess for hypoglycemia
if unconscious:
T -tired
hospital: 25 50 ml of D50W
I -irritability
home: Glucagon (SC/ IM, 2nd dose at 10
R -restless
mins if client remains unconscious))
E excessive hunger
D -diaphoresis

ORAL HYPOGLYCEMIC AGENTS Action: Stimulates beta cells of the pancreas

- Sulfonylureas: to produce more insulin.
chlorpropamide (Diabinese)

20
 tolazamide (Tolinase) - second generation sulfonylureas:
tolbutamide (Orinase) glimiperide (Amaryl)
glipizide (Glucotrol)
glyburide (Diabeta)

-Non-Sulfonylureas:
Action: hepatic glucose production
metformin (Glucophage) acarbose (Precose) miglitol (Glyset) rosiglitazone (Avandia)

NURSING ALERT!!!
* Assess allergy to sulfur!!! [For sulfonylureas]
* Take with meals.
* Avoid alcohol. [trigger hypoglycemic rxn]
*Inform the client that insulin is needed during stress, infection, or surgery.

Only IV type Insulin: Regular insulin

Site with even and rapid insulin absorption: Abdomen
Distance between insulin site injections: 1 inches (2.54 cm)
Most common premixed insulin: NPH Regular

ANTIINFECTIVE MEDICATIONS

1. ANTIBIOTICS
Aminoglycosides: -micin or -mycin Fluoroquinolones: -floxacin
Indications: gram negative infections broad spectrum
-Escherichia Coli Indications: wide range of gram + and gram
-Klebsiella -UTI -bronchitis
-Enterobacter -STDs -bone and joint infection

1. gentamicin sulfate (Garamycin) 1. ciprofloxacin (Cipro)

2. neomycin sulfate (Mycifradin) 2. levofloxacin (Levaquin)
3. kanamycin sulfate (Kantrex) 3. norfloxacin (Noroxin)
4. streptomycin sulfate (Streptomycin) 4. ofloxacin (Floxin)

Cephalosporins ceph/-cef
First Generation Second Generation Third Generation
1. cefadroxil (Duricef) 1. cefaclor (Ceclor) 1. cefdinir (Omnicef)
2. cefazolin (Ancef, Kefzol) 2. cefmetazole (Zefazone) 2. cefixime (Suprax)
3. cephalexin (Keflex) 3. cefonicid (Monocid) 3. cefoperazone (Cefobid)
4. cephapirin (Cefadyl) 4. cefotetan (Cefotan) 4. cefotaxime (Claforan)
5. cefoxitin (Mefoxin) 5. ceftazidime (Fortaz)
6. cefpodoxime (Vantin) 6. ceftibuten (Cedax)
7. cefprozil (Cefzil) 7. ceftizoxime (Cefizox)
8. cefuroxime (Zinacef) 8. ceftriaxone (Rocephin)

Macrolides: -mycin Pennicillins: -cillin

1. erythromycin (Erythrocin) 1. amoxicillin (Amoxil)

2. azithromycin (Zithromax) 2. ampicillin (Omnipen)
3. clarithromycin (Biaxin) 3. cloxacillin (Apo-Cloxi)
4. methicillin (Staphcilin)
5. penicillin G (Pentids)
6. penicillin V (V-Cillin)
7. amoxicillin cluvanate (Augmentin)

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 Sulfonamides: -sulf Tetracyclines: -cycline

1. sulfixazole (Gantrisin) 1. tetracycline (Achromycin)

2. sulfamethoxazole-trimthoprim(Bactrim) 2. doxycycline (Vibramycin)
3. sulfasalazine (Azuldifine) 3. democlocycline (Declomycin)
4. minocycline (Minocin)

Nursing Management:
1. Obtain culture 4. Monitor I&O and renal function
2. Monitor for allergic reaction 5. Adequate hydration
3. Taken best on empty stomach 6. Monitor hearing and balance

2. ANTIVIRALS Adverse Effects: Nursing Management:

1. acyclovir (Zovirax) -Bone Marrow Suppression 1. Monitor CBC
2. cidofovir (Vistide) -Nephrotoxicity 2. Increase Vitamins ACE
3. indinavir (Crixivan0 3. Increase Fiber
4. ritonavir (Norvir) Side Effects:
5. ganciclovir (Cytovene) 1. headache
Antiretrovirals: 2. nausea and vomiting
6. zidovudine (AZT,Retrovir)
7. lamivudine (Epivir)
8. stavudine (Zerit)
9. nevirapine (Viramune)
3. ANTIFUNGALS Indications: Nursing Management:
1. candidiasis 1. Monitor BUN, Creatinine,
1. amphotecerin B(Fungizone) 2. histoplasmosis 2. Take with food
2. ketoconazole (Nizoral) 3. ringworm infections of 3. Take full course of meds
3. miconazole (Monistat) the skin 4. Hygeine measures
4. nystatin (Mycostatin) 5. Infusion pump
5. clotrimoxazole (Mycelex)
6. fluconazole (Dilfulcan)
4. ANTIPROTOZOAL Indications: Nursing Management:
1. Trichomoniasis 1. best taken with food
1. metronidazole (Flagyl) 2. Amoebiasis
2. eflornithine (Ornidyl) 3. Giardiasis 2. avoid alcohol
3. hydroxychloroquine (Plaquenil) 4. PCP
4. pentamidine (Pentam 300) 5. Malaria 3. Monitor S/Es:

4. Reminder: this drug is teratogenic

Remember:
1. Metronidazole (Flagyl) should not be taken with alcohol because it can cause disulfiram-like reactions
(Antabuse-like reactions).
2. Remember the brand names and the different preparations of Lithium carbonate.
3. Diazepam (Valium) is commonly asked in the exam.
4. Propofol (Diprivan) is a sedative given to clients in mechanical ventilation and to those undergoing surgical
procedures. It is milk-like or cream-like in color. This is given intravenously. It was rumored that M.J. died
from propofol overdose.
5. R.A. 9165 Comprehensive Dangerous Drugs Act of 2002
6. R.A. 9502 Cheaper Medicines Act of 2008
7. R.A. 6675 Generics Act

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