Pharmacology

rnursingnotes rnursingnotes
What is Pharmacology?
Pharmacology is the scientific study of the origin, nature, chemistry,

effects, and uses of drugs. This knowledge is essential to providing

safe and accurate medication administration to your patients

Three basic concepts of pharmacology

- the absorption, distribution, metabolism,
Pharmacokinetics
and excretion of drugs by the body.

- the biochemical and physical effects of

Pharmacodynamics
drugs and the mechanisms of drug

actions

Pharmacotherapeutics - the use of drugs to prevent and treat

diseases
 Pharmacokinetics
Absorption
Medication going from the location of administration to the bloodstream

Oral Subcut & IM IV

Depends on the site
Takes the Quickest
of blood perfusion.
longest absorption
More blood perfusion
to absorb time
= rapid absorption

Distribution
Transportation by bodily fluids of the medication to where it needs to go

Circulation
Influencing factors: Permeability of the cell membrane
Plasma protein binding

Metabolism
How is the medication going to be broken down?
Most common site: LIVER
Age
(Infants & elderly have a limited med-metabolizing

capacity)
Influencing factors:
Medication type
First-pass effect
Liver may inactivate some medication
(may need non enteral route)
Nutritional status

Excretion
How is the medication going to be eliminated from the body?
Most commonly done by KIDNEYS

Kidney dysfunction
Influencing factors: Leads to an increase in the duration and
intensity of a medication response
 10 Rights of Drug

Administration
RIGHT DRUG RIGHT DOCUMENTATION

RIGHT PATIENT RIGHT CLIENT EDUCATION

RIGHT DOSE RIGHT TO REFUSE

RIGHT ROUTE RIGHT TO ASSESSMENT

RIGHT TIME RIGHT TO EVALUATION

Common medication
Types of orders
errors
ROUTINE
Medication error kills,
Given on a regular schedule with
or without a termination date prevention is crucial!

SINGLE "ONE-TIME" Wrong medication

Incorrect dose
Given on a regular schedule with
Wrong...
or without a termination date
➥ Client
STAT ➥ Route
➥ Time
Only for administration once
Administer a medication the

and given immediately

client is allergic to
Incorrect D/C of Medication
PRN
Inaccurate prescribing
"As needed" must have an indication
for use such as pain, nausea & vomiting.
 General principles in drug

administration
Whoever prepares the medication, administers and charts it
Consult a drug reference manual or pharmacist for information on unfamiliar drugs
For elderly clients: use devices like calendars, daily pill dispensers
For pediatric clients, use syringe
Obtain assistance of parents to hold child in position
Assess client’s allergy
Check drug’s expiry date
Read labels three times before administration
Wash hands before and after administration
Do not let the tip of the tube/dropper touch the client
Document administration on medication record and client’s response to medication.

For eye medication:

Position: supine or sitting position with forehead tilted back slightly

Medication is administered into the conjunctival sac
For ointments, apply from inner to outer canthus ending it with a twisting motion
Let the client close his eyes
For liquid medications, press firmly nasolacrimal duct for at least 30 seconds
If medication temporarily affects vision, instruct client not to move until vision is

clearer
Lift side rails and place call light within reach

For ear (otic) instillation:

Wash ear if excess wax in noted

Position: Side-lying, sitting, or semi-Fowler’s position
For adults: pull auricle of ear up and back
For children: down and back (<3 years)
Instruct client to remain in position for 3-5 minutes
 For nasal instillation
Cleanse nares
Position: Sitting with head tilted slightly backwards, or supine with head tilted
back in hyperextended position
Hold dropper ¼ to ½ inch above nares
Instruct client to take one short deep breath after each instillation and to

remain position for 3-5 minutes.

For oral medication:

Do not crush or chew enteric coated tablets.
Many oral medications require administration with milk or food
Schedule first doses of new medications on different hours from other medications

For Pediatric Patients:

If drugs are being mixed with food or liquid, use only small amount
Medicine can also be given through nipples or droppers
Toddlers: allow to choose on method of delivery- spoon, dropper, syringe, and

allow to help
Position: Semi-Fowler’s or sitting
Instruct client to place tablets/ capsules at the back of the throat and to follow

with enough liquid

Administer liquid medications after pills
Remain with the client until all the medications are taken. Check the client’s

mouth
Check client 30-60 minutes later for effects of medication.

For buccal and sublingual medication:

Place under the tongue (sublinggual) and between cheek and gum (buccal)
If client’s mucous membranes are dry, offer a sip of water
 Parental Administration
Absorbed into the system through the digestive tract

Intramuscular
The IM route allows drugs to be injected

directly into various muscle groups at

varying tissue depths.

This form of administration provides rapid

systemic action and allows for absorption

of relatively large doses (up to 3 mL).

Aqueous suspensions and solutions in oil as

well as drugs that aren’t available in oral

forms are given IM.

Needle size: 18-27 gauge
Uses Z-track method

Subcutaneous

small amounts of a drug are injected

beneath the dermis and into the

subcutaneous tissue, usually in the patient’s

upper arm, thigh, or abdomen.

This allows the drug to move into the

bloodstream more rapidly than if given by

mouth.
Drugs given by the subcutaneous route

include nonirritating aqueous solutions and

suspensions contained in up to 1 mL of fluid,

such as heparin and insulin.

Needle size: 25-18 gauge
Note: Do not inject more than 15mL of

solution
 Intravenous
The IV route allows injection of drugs and other

substances directly into the bloodstream through a

vein.
Appropriate substances to administer IV include

drugs, fluids, blood or blood products, and

diagnostic contrast agents.

Administration can range from a single dose to an

ongoing infusion that’s delivered with great

precision.
Needle size:
- 16 gauge- patients who have trauma
- 18 gauge- surgery and blood administration
- 22 to 24 gauge- children. older adults and clients

who have medical issues or are stable post-op

Intradermal
Drugs are injected into the skin.
A needle is inserted at a 10- to 15-

degree angle so that it punctures

only the skin’s surface.

Used mainly for diagnostic purposes,

such as testing for allergies or

tuberculosis.
Should form a "BLEB"
Needle size: 26-27 gauge

Intramuscular Subcutaneous Intravenous Intradermal

 Nonparental Administration
Absorbed into the system through the digestive tract

Oral or Enteral Suppositories

Rectal:
Contradictions:
Lateral or sims' position
Use lubrication
vomiting, aspiration Insert beyond the internal

precautions/absence of a gag reflex, sphincter

decreased LOC, difficulty swallowing Leave it in for 5 minutes
Vaginal:
→ Have client sit at 90 angle to help with
Supine with knees bent & feet

swallowing flat on the bed, close to hips

→ NEVER crush enteric-coated or time-
Insert the suppository along the

release medications posterior wall of the vagina (3 -

→ Break or cut scored tablets only! 4 inches deep)

Stay supine for at least 5

minutes
Transdermal
Inhalation

Place the patch on a dry and clean

Rinse mouth after the use of

area of skin (free of hair)

steroids
Rotate the sites of the patch to

20 - 30 seconds between puffs

prevent skin irritation
2 - 5 minutes between different

Always take off the old patch

medications
before placing a new one on
Use a spacer if possible to prevent

thrush
 Sublingual and buccal Inhalation

Sublingual: Under the tongue Rinse mouth after the use of steroids
Buccal: Between the cheek & the gum
20 - 30 seconds between puffs
Keep the tablet in place until it has
2 - 5 minutes between different

completely absorbed
medications
DO NOT eat or drink until the tablet

has completely dissolved Use a spacer if possible to prevent thrush

Intravenous Therapy
TYPES OF SOLUTIONS

Hypertonic Solution
Hypotonic Solution
A solution that contains more dissolved

A solution that has lower osmotic

particles (such as salt and other

pressure than another solution to

electrolytes) than is found in normal

which it is compared
cells and blood

D5N5 0.45% NS

Low levels of sodium or

Helps kidneys excrete excess fluids
chloride; metabolic alkalosis

2.5% Dextrose
5% Dextrose in 0.45% Saline

Maintenance Fluid Treats intracellulardehydration

(DKA)
5% Dextrose in LR
2.5% Dextrose
replaces fluids
Used for burns, bleeding,
Never give to patients with

dehydration burns or liver

 Isotonic Solution

5% Dextrose in Water
0.9% saline (NS)
Replaces deficits of total body

Sodium or chloride replacement

water
Used with blood products
Not used alone: dilution of

electrolytes can occur

Ringer's Solution
Replaces fluids
Used for burns, bleeding, dehydration

Intravenous Therapy
COMPLICATIONS

Symptoms Treatment
Air embolism Tachycardia Clamp the tubing
Chest pain Turn the patient on their

air enters the vein through

left side & place in

Hypotension
the IV tubing Trendelenburg position
Decreased LOC Notify the HCP
Cyanosis

Infiltration
Pain Remove the IV
Swelling Elevate the extremity
Coolness Apply warm or cool

IV fluid leaks into the surrounding

Numbness in the site compress
tissues No blood return Do not rub the area

Tachycardia

Infection
Redness Remove the IV
Swelling Obtain cultures
Chills & fever Possible antibiotics
entry of microorganism into the body
Malaise administration
via IV Nausea & Vomiting
Circulatory
Symptoms Treatment

Increase blood pressure Decrease flow rate (keep

Overload Distended neck veins

Dyspnea
vein-open rate)
Elevate head of the bed
Keep the patient warm
Wet cough and
administration of fluids too
Notify the physician
crackles
rapidly (FLUID VOLUME OVERLOAD)

Phlebitis Heat
Redness
Remove the IV
Notify the physician
Restart the IV on the

inflammation of the veins that can

Tenderness at the site
opposite side
lead to thrombophlebitis Decrease flow of IV

Hematoma Ecchymosis
Blood Elevate the extremity
Apply pressure and ice
Hard painful lump at the

collection of blood in the tissues site

Intravenous Therapy
Equipment

Equipment Purpose Considerations

Tubing Passageway for IV solution Ensure there are no bubbles

Drip chamber allow gas to rise out from a fluid

fill 1/3 - 1/2
so that it is not passed downstream
IV bag Check for particulates +

Hold IV solution discoloration

Clamp Stop flow of IV solution Always clamp before dc

Y-site allows for multiple bags to infuse Insert y-site when priming

into one IV site tubing

 D R U G S
ANTIBIOTICS/ANTIBACTERIALS
Broad spectrum antibiotics -oxacin
Tetracyclines -cycline
Sulfonamides sulf-
Cephalosporins -cef ceph-
Penicillins -cillin
Aminoglycosides & macrolides -mycin
Fluoroquinolones -floxacin

ANTIVIRALS

Antiviral (disrupts viral maturation) -virimat

Antiviral (undefined group) vir- -vir- -vir
Antiviral (neuraminidase inhibitors) -amivir
Antiviral (acyclovir) -cyclovir
HIV protease inhibitors -navir
HIV / AIDS -vudine

ANTIFUNGAL

Antifungal -azole
 ANTIHYPERTENSIVES

ACE inhibitors -pril

Beta-blockers -olol
Angiotensin II receptor antagonists -sartan
Calcium channel blockers -pine -amil
Vasopressin receptor antagonists -vaptan
Alpha-1 blockers -osin
Loop diuretics -ide -semide
Thiazide diuretics -thiazide
Potassium sparing diuretics -actone

ANTIHYPERLIPIDEMICS

HMG-CoA reductase inhibitors –statin

OTHERS

Anticoagulants (Factor Xa inhibitors) -xaban

Anticoagulants (Dicumarol type) -arol
Anticoagulants (Hirudin type) -irudin
Low-molecular-weight heparin (LMWH) -parin
Thrombolytics (clot-buster) -teplase -ase
Antiarrhythmics -arone
 RESPIRATORY
UPPER RESPIRATORY

Second-gen antihistamines (H1 antagonist) -adine

Second-gen antihistamines (H1 antagonist) -tirizine
Second-gen antihistamines (H1 antagonist) -ticine
Nasal decongestants -ephrine -zoline

LOWER RESPIRATORY
Beta2-agonists (Bronchodilator) -terol
Xanthine derivatives -phylline
Cholinergic blockers -tropium
Cholinergic blockers -clindidiun
Immunomodulators & -zumab -lukast
leukotriene modifiers

ANESTHETICS / ANTIANXIETY

Local anesthetics -caine

Barbiturates (CNS depressant) -barbital
Benzodiazepines (for anxiety/sedation) -zolam
Benzodiazepines (for anxiety/sedation) -zepam
 ANTIDEPRESSANTS

Selective serotonin -oxetine -talopram -zodone

reuptake inhibitors (SSRIs)

Serotonin-norepinephrine -faxine -zodone -nacipram

reuptake inhibitors
(SNRI/DNRI)

Tricyclic antidepressants (TCAs) -triptyline -pramine

ANALGESICS / OPIOIDS

Opioids -done
Opioids -one
NSAID’s (anti-inflammatory) -olac -profen
Salicylates Asprin (ASA)
Nonsalicylates Acetaminophen

GASTROINTESTINAL

Histamine H2 antagonists (H2-blockers) -tidine -dine

Proton pump inhibitors (PPIs) -prazole
Laxatives -lax
 ANTIDIABETIC

Oral hypoglycemic –ide –tide –linide

Inhibitor of the DPP-4 enzyme –gliptin
Thiazolidinedione –glitazone

OTHERS

Corticosteroids -asone -olone -inide

Triptans (anti-migraine) -triptan

Ergotamines (anti-migraine) -ergot-

Antiseptics -chloro

Antituberculars (TB) rifa-

Bisphosphonates -dronate

Neuromuscular blockers -nuim

Retinoids (anti-acne) tretin-

Phosphodiesterase 5 inhibitors -afil

Carbonic anhydrase inhibitors -lamide

Progestin (female hormone) -trel

Atypical antipsychotics -ridone

 Common Meds & their

drug classification
ANTIBIOTICS ANTIFUNGAL AGENTS ANTIHELMINTIC
Penicillin Fluconazole Albendazole
Ampicillin Ketoconazole Ivermectin
Oxacillin Itraconazole Mebendazole
Cefuroxime Sodium Amphotericin-B Praziquantel
Cefotaxime Sodium Flucytosine Pyrantel
Co-amoxiclav Cystatin
Piperacillin + Tazobactam Griseofulvin
Ciprofloxacin
Clindamycin
Erythromycin

ANTIVIRAL DRUGS ANTIPROTOZOAL AGENTS ANTINEOPLASTIC

Acyclovir Metronidazole Cisplatin
Zidovudine Pentamidine Cyclophosphamide
Oseltamivir Tinidazole Carboplatin
Nitazoxanide Dacarbazine
Ribavirin Atovaquone Chlorambuc
Ganciclovir
Indinavir
Amantadine
Zanamivir
Trifluridine
Penciclovir
 ANTIDOTES
Opiods/narcotics Naloxone (Narcan)
Warfarin Vitamin K
Heparin Protamine sulfate
Digoxin Digibind
Anticholinergics Physostigmine
Benzodiazepines Flumazenil (Romazicon)
Cholinergic crisis Atropine (Atropen)
Acetaminophen (Tylenol) Acetylcysteine
Magnesium sulfate Calcium gluconate
Iron Deferoxamine
Lead Chelation agents; Dimercaprol

Alcohol withdrawal &disodiumchlordiazepoxide

Beta blockers Glucagon
Calcium channel blockers Glucagon, insulin, calcium
Aspirin Sodium bicarbonate
Insulin Glucose
Pyridoxine Deferoxamine
Tricyclic antidepressants Sodium bicarbonate
Cyanide Hydroxocobalamin
 Emergency drugs
Lidocaine
- Used for Ventricular arrhythmias, topical/local anesthetic
Epinephrine

- Used for Bronchodilation; anaphylaxis; hypersensitivity

reaction; Acute asthma attack; Chronic simple glaucoma
Atropine Sulfate

- Used to decrease respiratory secretions; treats sinus

bradycardia; reverse effects of anticholinesterase medication

Narcan
- Used for Opioid-induced toxicity; opioid-induced respiratory

depression; used in neonates to counteract or treat effects from

narcotics given to mother during labor

Non-Opiate Analgesics
Tylenol
(acetaminophen)
also an antipyretic
should not exceed 4g within 24

hours
no anti-inflammatory properties or
Monitor liver function, assess

GI irritation for jaundice and increase LFT

Educate the patient to avoid

Hepatotoxicity alcohol while taking

Nausea/vomiting and acetaminophen

gastric irritation
 Aspirin
(Acetylsalicylic acid)

antipyretic, anti-inflammatory, anti-platelet

Side effects
GI irritation is expected
NOTE: if GI bleeding develops, report

immediately
Decreased platelets count and has

higher risk of bleeding

Nursing considerations
Watch for signs of salicylism (aspirin overdose) which includes:

Tinnitus Confusion
Impaired hearing and vision Nausea and
Fever vomiting
Dizziness Sweating

NSAIDs

COX-1 inhibitors ibuprofen

COX-2 inhibitors vioxx
Educate patient to report for
celebrex
any rashes, itching and vision
changes as this could be
NSAIDs should be avoided in those

Stevens-Johnsons Syndrome.
patients with IBS or ulcer disease

because of possible GI bleeding

Take note that NSAIDs can also
impair kidney function.
Dizziness, drowsiness and possible risk

of stroke is associated with the use

of NSAIDs
 Opiate Analgesics
Morphine Oxycodone (Oxycontin)
Fentanyl (Duragesic) Hydromorphone (Dilaudid)
Methadone (Dolophine) Ultram (Tramadol)
Codeine Sulfate Meperidine (Demerol)

Use for relieving pain w/o producing

Opiates act on opioid receptor by

loss of consciousness or reflex

altering perception of, and

activity. reducing severe pain.

nursing considerations
Frequently assess pain level and document its effectiveness.
Take VS before administering the medication. Hold if RR drops to below 12 breaths

per min.
Administer IV opioids SLOWLY.
Educate patient on long-term use of high
dosage of opioids to wean off slowly.

Side effects

Respiratory Constipation
Depression

Ensure that patient is well-hydrated.

Monitor VS and have naloxone available. Encourage mobility
Avoid administering w/other CNS
Administer stool softeners or stimulant

depressants. laxatives to avoid constipation

 Basic Dosage Calculation
D
=
desired dose

H
amount on hand /
available dosage
x V Volume dose

of the medication

IV FLOW RATES

=
ml of solution
ml/hr
total no. of hours

ml of solution

total no. of minutes

x drop factor = gtt/min

Sample:
1. Administer digoxin 0.5 mg IV
3. A patient is receiving 250 mL
2. Nurse A will infuse 1 1/2 L of

daily. The drug concentration

normal saline IV over 4 hours,

NS in over 7 hours; drop factor

available from the pharmacy is

using tubing with a drip factor

is 15 gtt/mL. What flow rate

digoxin 0.25 mg/mL. How many

of 10 drops/mL. How many

(mL/hr) will the nurse set on

ML will you need to administer a

drops per minute should be

the IV infusion pump?

0.5 mg dose? delivered?

D / H x V = Dose mL of solution / total minutes x

mL of solution / total hours = mL/hr
drop factor = gtt/min
0.5 / 0.25 x 1 = 2mL 1,500mL / 7hrs = 214.3 mL/hr
250 mL x 10gtts per mL / 240 mins

= 10.42 gtts/min
 Conversion
BASED ON VOLUME
1 dram = 5 mL
1 mg = 1,000 mcg
1 tbsp = 15 mL
1 g = 1,000 mg
1 tbsp = 3 tsp
1 oz = 30 mL
1 L = 1,000 mL
8 oz = 1 cup
1 mL = 15 gtts (drops)
1 tsp = 5 mL

THE METRIC SYSTEM TIP!

Moving to a larger unit? Move the decimal

place to the Left

Large unit to small unit (Ex: mcg → mg) (Larger unit think Left)
move decimal to the right
EXAMPLE!
1500 mcg = mg
Small unit to large unit A “mg” is larger (Larger unit think Left)

move decimal to the left than a “mcg” Therefore you move decimal 3

places to the Left 1500. mcg = 1.500 mg (1.5

mg)

BASED ON WEIGHT

lb kg DIVIDE by 2.2 kg lb MULTIPLY by 2.2

1 kg = 2.2 lbs
Example: Example:
1 lb = 16 oz
120 lbs = kg 45.6 kg = lb
120 lbs / 2.2 = 54.545 kg 45.6 kg x 2.2 = 100.32 lb
 Classification of drugs
Drugs affecting the central and autonomic system

Cholinergic Agents (Parasympathomemitics)

Prototype Mechanism of action Adverse effects

synthetic acetylcholine,
stimulates cholinergic
- blurring of vision,

miosis
pilocarpine, carbachol,
receptors by mimicking

- increase in salivation,

bethanecol (Urocholine), acetylcholine or inhibition

intestinal cramps
edrophonium (Tensilon),
of enzyme cholinesterase. - bronchoconstriction,

wheezing, DOB
neostigmine (Prostigmine),

- hypotension and

pyridostigmine (Mestinon). bradycardia

Nursing considerations

1. Warn & monitor clients of the side effects.

2. Have atropine available for use as antidote.

Cholinergic Blocking Agents (Parasympatholytics, Anticholinergics)

Prototype Mechanism of action Adverse effects

- dry mouth , dilatation

atropine, scopalamine
block the binding of

of pupils, tachycardia
(Triptone), dicyclomine
acetylcholine in the

- urinary retention, ileus,

(Bentyl), propantheline
receptors of

heat stroke
(Pro-Banthine) parasympathetic nerves
Indications Nursing considerations

- use preoperatively to dry up secretions. 1. Keep client’s in cool environment.

- treat spasticity of GI or urinary
2. Watch out for signs of heatstroke and

tract. dehydration.
- use for treatment of bradycardia,
3. Encourage clients to increase fluid intake and

use of sugarless gum/candy for dry

asthma, parkinsonism.
mouth.
- use for antidote in organophosphate

4. For GI spasticity, administer 30 minutes before

poisoning. meals and at bed time

 Adrenergic Agents (Sympathomimetics)

Prototype Mechanism of actions Adverse effects

- epinephrine,
- stimulate alpha and beta
- restlessness, insomnia,

norepinephrine, ephedrine,
adrenergic receptor
tremors, nausea
dopamine, dobutamine,
directly or trigger the
- palpitations, angina,

phenylephrine, release of catecholamines

tachycardia, HPN
terbutaline, albuterol,
indirectly causing

isoproterenol. sympathetic effects.

Indications Nursing considerations

- cardiopulmonary arrest, hypotension 1. Contraindicated in clients w/

- COPD and asthma, nasal congestions hyperthyroidism,

- allergic reaction, anaphylactic shock pheochromocytoma &

cardiovascular disease.
2. Monitor vital signs and advice

precautions.
3. Should be taken with food.

Andrenergic blocking agents

Prototype Mechanism of actions Adverse effects

a. Alpha blockers a. alpha blockers - orthostatic

- phentolamine (Regintine),
- inhibits action of
hypotension,

phenoxybenzamine, prazosin
a-receptors in vascular
bradycardia, CHF
(Minipress), reserpine (Serpasil),
smooth muscle to cause
- depression,

terazosin(Hytrin) vasodilatation insomnia and vertigo

- clonidine (Catapress),
- bronchospasm and

methyldopa (Aldomet) b. beta blockers dyspnea, nasal

- compete with
stuffiness, cold

b. Beta blockers epinephrine in b-

extremities
- atenolol (Tenormin), esmolol
receptors in heart,

(Brevibloc), metoprolol
pulmonary airways,

(Lopressor), nadolol (Corgard),

peripheral circulation

propanolol (Inderal), timolol

and CNS.
(Blocadren)
 Indications Nursing considerations

- Raynaud’s disease, hypertension,

1. Administer oral alpha-blockers with milk

pheochromocytoma. to minimize GI side effects.

- angina, arrhythmias, mitral
2. Administer oral beta-blockers before

valve prolapse, glaucoma meals and at a.m. if insomnia occurs.

3. Check client’s apical pulse rate before

drug administration, refer if below 60 bpm.

4. Hypotensive precautions.
5. Warn clients not to drive or operate

dangerous machinery until he/she has

adjusted to medications.

Skeletal Muscle Relaxants Agents

Prototype Mechanism of actions Adverse effects

- methacarbamol (Robaxin),
- depress CNS
- hypotonia, ataxia,

baclofen (Lioresal),
- inhibit calcium ion

hypotension, drowsiness
dantrolene (Dantrium), release in the muscle
- blurred vision,

metaxalone (Skelaxin),
- enhance the inhibitory

bradycardia, depression,

orphanedrine (Norgesic),
action of GABA (gamma-

urine retention
chlorzoxazone amino butyric acid)

Indications Nursing considerations

- for acute musculoskeletal pain 1. Caution clients that mental alertness

- for muscle spasticity associated

may be impaired.
with multiple sclerosis, cerebral
2. Monitor neuromuscular status, bowel

palsy, CVA, and spinal cord injury. and bladder functions.

3. Inform clients that maximum benefit

of baclofen is attained for 1-2 months.

4. Reduce baclofen dosage gradually

because of associated withdrawal

symptoms :
Confusion, hallucinations, paranoia &

rebound spasticity.
 Anticonvulsants

Prototype Mechanism of actions Adverse effects

a. Hydantoins - phenytoin
- treat seizures by depressing
- sedation &drowsiness,

(Dilantin) abnormal neuronal activity in

gingival hyperplasia
b. Barbiturates -
motor cortex. - diplopia, nystagmus,

phenobarbital (Luminal) vertigo, dizziness

c. Miscellaneous - thrombocytopenia,

- carbamazepine
aplastic anemia
(Tegretol), diazepam,

clorazepate (Tranxene),
valproic acid (Dapakene),

ethosuximide (Zarontin)

Nursing considerations

1. Advise female clients to use contraceptives.

2. Inform clients taking phenytoin that harmless urine discoloration is common.
3. Warn clients with diabetes that hydantoins may increase blood sugar level and

that valproic acid may produce a false positive result in urine ketone test.
4. Teach clients receiving carbamazepine to identify symptoms of bone marrow
depressions.
5. Reassure that barbiturates are not addictive at a low dosage.
6. Avoid taking alcohol with barbiturates.
7. Administer IV phenytoin slowly to avoid cardiotoxicity.
8. Avoid mixing other drugs in same syringe with phenytoin

Antiparkinsonian Agents

Prototype Mechanism of actions Adverse effects

a. Anticholinergic agents a. levodopa – nausea,

- trihexyphenidyl (Artane),
a. anticholinergic agents
vomiting, anorexia,

benztropine (Congentin) - inhibit cerebral motor

orthostatic hypotension,

centers
dark-colored urine and

b. Dopaminergic agents sweat

- Levodopa, carbidopa-levodopa
b. dopaminergic agents
b. amantidine – ankle

(Sinemet), amantidine
- increasing dopamine

edema, constipation
(Symmetrel), pergolide
concentrations or enhancing

c. bromocriptine –

(Permax), selegiline (Eldepryl),

neurotransmitter
palpitations, tachycardia
bromocriptine. functioning
 Nursing considerations
1. Give dopaminergic agents after meals to reduce GI symptoms.
2. Reassure client that levodopa may cause harmless darkening of urine and sweat.
3. Avoid taking Vit B6 (pyridoxine) with levodopa because it speed up metabolism.
4. Educate clients to minimize orthostatic hypotension.
5. Elevate leg to reduce ankle edema.

Central Nervous System Stimulants

Prototype Mechanism of actions Adverse effects

- amphetamines,
- increase excitatory CNS
- nervousness, insomnia,

methylphenidate
neurotransmitter activity and
restlessness
(Ritalin) blocks inhibitory - hypertension,

tachycardia, headache
- anorexia, dry mouth.

Indications Nursing considerations

- for obesity (amphetamines) 1. Should be given at morning.

- attention deficit hyperactivity
2. Don’t stop amphetamine abruptly to avoid

disorders withdrawal symptoms.

- narcolepsy 3. Monitor blood pressure and pulse.
- drug-induced respiratory
4. Ice chips or sugarless gum for dry mouth.
depressions. 5. Watch out for growth retardation in

children taking methylphenidate.

DRUGS AFFECTING MENTAL FUNCTIONING

Sedatives, Hypnotics, and Anxiolytics

Prototype

a. Benzodiazepines - diazepam (Valium), lorazipam (Ativan), alprazolam (Xanax),

flurazepam (Dalmane)
b. Barbiturates - amobarbital, phenobarbital, secobarbital
c. Miscellaneous - chloral hydrate (Noctec), buspirone (Buspar), paraldehyde (Paral)
 Mechanism of actions
a. Benzodiazepines - increase the effect of inhibitory neuro transmitter GABA

(gamma-amino butyric acid)

b. Barbiturates and Miscellaneous agents - depress CNS

Adverse effects
- hangover-effect, dizziness, CNS depression
- respiratory depression, drug-dependence

Indications

- induce sleep, sedate and calm clients

Nursing considerations
1. Warn clients of injuries and falls.
2. Brief period of confusion and excitement upon waking up is common with
benzodiazepines.
3. Warn clients not to discontinue medications abruptly without consulting a

physician.
4. Avoid alcohol while taking these drugs.
6. Rotate and don’t shake the ampules of barbiturates. Don’t mix with other drugs.
7. Warn female clients that diazepam is associated with cleft lip.

ANTIDEPRESSANTS AND MOOD DISORDER DRUGS

Prototype
a. Tricyclic antidepressants
- amitriptyline (Elavil), protriptyline (Vivactil),
- imipramine (Tofranil), desipramine
b. MAO (monoamine oxidase inhibitors )
- isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Pernate)
c. Second-generation antidepressants
- fluoxetine (Prozac), trazodone (Desyrel)
d. Lithium
 Mechanism of actions
a. Tricyclic antidepressants
- increase receptor sensitivity to serotonin and/or norepinephrine.
b. MAO inhibitors
- inhibit the enzyme MAO that metabolize the neurotransmitters norepinephrine and
serotonin.
c. Second – generation antidepressants
- inhibits the reuptake of serotonin.
d. Lithium
- increase serotonin & norepinephrine uptake

Adverse effects
- dry mouth, blurred vision, urine retention, constipation (anticholinergic effects)
- orthostatic hypotension, insomnia
- hypertensive crisis (MAO)
- dehydration (Lithium)

Nursing considerations
1. Caution client to rise slowly to reduce the effects of orthostatic hypotension.
2. Take antidepressant with food to enhance absorption
3. Explain to client that full response may take several weeks (2 weeks).
4. Assess client for constipation resulting from tricyclic antidepressant use.
5. Client taking MAO inhibitors should avoid tyramine-rich foods to avoid
hypertensive crisis.
- aged cheese, sour cream, yogurt, beer, wine, chocolate, soy sauce and yeast
- pentholamine (Regintine) is the drug of choice for hypertensive crisis.
6. Inform physician and withhold fluoxetine if client develop rashes.
7. Take lithium with food to reduce GI effects
- > 1.5 mEq/L blood level may cause toxicity manifested by:
confusion, lethargy, seizures,hyperreflexia.
- maintain salt and adequate fluid intake
- tremors may occur but it is temporary
- monitor white blood cell count (increase).
 ANTIPSYCHOTIC DRUGS (NEUROLEPTICS)
Prototype
a. Phenothiazines
- chlorpromazine (Thorazine),
- trifluoperazine (Stelazine),
- thioridazine (Mellaril)
b. Other Agents
- clozapine (Clozaril), haloperidol (Haldol)

Mechanism of actions
- block dopamine receptor in the limbic system, hypothalamus, and other regions of

the brain.

Adverse effects
- Extra pyramidal symptoms such as dystonia, pseudoparkinsonism, and an

irreversible tardive dyskinesia as manifested by :

a. lip smacking
b. fine wormlike tongue movement
c. involuntary movements of arms and leg.
- Neuroleptic malignant syndrome
a. fever, tachycardia, tachypnea, diaphoresis, cardiovascular collapse
b. muscle rigidity, seizures.
- orthostatic hypotension

Nursing considerations
1. Teach family members the signs of EPS and NMS, and report to physician
immediately.
2. Normalization of symptoms may not occur for several weeks after beginning of
therapy .
3. Avoid administering haloperidol intravenously
4. Watch out of neutropenia with clozapine.
5. Watch out for orthostatic hypotension and photosensitivity with phenothiazine.
6. Be sure that oral doses are swallowed, and not hoarded.
 Drugs used in pain management
General Anesthetics
Prototype Mechanism of actions

a. Inhalation anesthetics - cause CNS depression, by producing

- enflurane (Ethrane), halothane loss of consciousness, unresponsiveness

to pain stimuli, and muscle relaxation.

- isoflurane (Forane), nitrous oxide
b. Injection anesthetics
- fentanyl (Sublimaze), ketamine

(Ketalar), thiopental Na (Penthotal),

etomidate (Amidate)

Nursing considerations
1. Instruct client NPO for 8 hours before administration.
2. Monitor cardio pulmonary depression and hypotension.
3. Monitor urinary retention.
4. Monitor body temperature
- malignant hyperthermic crisis :
dantrolene (antidote)
5. Avoid alcohol or CNS depressants for 24 hours after anesthesia.
6. In patient who received halothane, monitor signs of hepatic fatal side effects :
- rash, fever, nausea, vomiting
- jaundice and altered liver function.

Local and Topical Anesthetics

Prototype Mechanism of actions

local: bupivacaine, lidocaine,

- block transmission of impulses

tetracaine, procaine, mepivacaine,

across nerve cell membrane.
prilocaine
topical : benzocaine, butacaine,

dibucaine,lignocaine
 Adverse effects Nursing considerations

- cardiac dysrhythmias - lignocaine + prilocaine (EMLA cream)

should be applied topically 60 minutes

before procedure.
- administer cautiously to the areas of

large broken skin.

- observe for fetal bradycardia in

pregnant clients.

Analgesics
Prototype Mechanism of actions

a. Narcotic analgesics - codeine,

a. Narcotic analgesics
meperidine (Demerol) morphine, - alter pain perception by binding

butorphanol (Stadol) nalbuphine (Nubain) to opiod receptors in CNS.

b. Non – narcotic analgesic b. Non- narcotic analgesic

NSAIDs – aspirin (aminosalicylic acid),
- relieves pain and fever by

mefenamic acid (Ponstan), ibuprofen

inhibiting the prostaglandin pathway.
(Motrin), naproxen, ketoprofen (Orudis),

ketorolac, paracetamol and acetaminophen

(Tylenol)

Nursing considerations

1. Monitor respiratory depression & hypotension in clients taking narcotic analgesic.

2. Injury and accident precautions in clients taking narcotic analgesic.
3. Warn clients about possibility of dependency,and do not discontinue narcotics
abruptly in the narcotic-dependent clients.
4. Naloxone is antidote for narcotic overdose.
5. Advice clients to take NSAIDs with food and monitor bleeding complications.
6. Aspirin is contraindicated in clients below 18 years old with flu-like symptoms.
7. Monitor hearing loss in clients taking aspirin.
8. Monitor liver function in clients taking acetaminophen.
9. N-acetylcysteine is antidote for paracetamol overdose.
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References:
Chelsea (2020). Complete Nursing School Bundle. CeceStudyGuides.
Koharchik, L.S. & Hardy, E.C. (2013). As easy 1,2,3! Dosage calculations. Nursing

Made Incredibly
Easy!, 11(1), 25-29. https://www.doi.org/10/.1097/01.NME.0000424170.34092.7a
Tuttle, K. (2020). The Complete Nursing School Bundle. NurseInTheMaking LLC.
Vera, M. (2019). Pharmacology Nursing Mnemonics & Tips. Nurses Labs.

Retrieved from
https://nurseslabs.com/pharmacology-nursing-mnemonics-tips/
Wilson, K.M. (2013). The nurse's quick guide to I.V. drug calculations. Nursing

Made Incredibly
Easy! 11(2), 1-2. https://www.doi.org/10.1097/01.NME.0000426306.10980.65