Pharmacology Bullet Review

Pharmacology Bullet Pharmacology Bullet
Review Review
Drug cIassification
Nursing process
appIied to
pharmacoIogy
Pharmacokinetics
Pharmacodynamic
s
iuretics Comparison iuretics Comparison
iuretic class Major site of action Special Side effect
(s)
J. Carbonic
anhydrase
inhibitor
Proximal tubule Acidosis
2. 1hiazide and
thiazide like
Proximal tubule Hyperuricemia
Hypokalemia
3. Loop diuretics Loop of Henle Hypokalemia
Ototoxicity
4. Potassium
sparing
istal tubule Hyperkalemia
S. Osmotic
diuretic
Glomerulus Hypovolemia &
hypotension
iuretics Comparison iuretics Comparison
iuretic class Special Uses
J. Carbonic
anhydrase inhibitor
Mountain sickness
Meniere's disease
2. 1hiazide and
thiazide like
Nephrolithiasis due to calcium stones
Hypocalcemia
3. Loop diuretics Hypercalcemia
4. Potassium
sparing
CHI taking digoxin
S. Osmotic diuretic
Increased ICP
1|M 1O`C1Y
1hiazides 1hiazides
Prototype: lydrochloro Prototype: lydrochlorotbiaiae tbiaiae
Bendrolume Bendrolumetbiaiae tbiaiae
Ben Bentbiaiae tbiaiae
Chloro Chlorotbiaiae tbiaiae ;Divrit) ;Divrit)
lydrolume lydrolumetbiaiae tbiaiae
Methylclo Methylclotbiaiae tbiaiae
1richlorme 1richlormetbiaiae tbiaiae
1hiazide 1hiazide- -like like
Indapamide Indapamide
Quinethazone Quinethazone
Metolazone Metolazone
Chlorthalidone Chlorthalidone
1hiazides 1hiazides
Pharmacodynamics Pharmacodynamics
1hese drugs BLOCK the chloride pump 1hese drugs BLOCK the chloride pump
1his will keep the Chloride and Sodium in the 1his will keep the Chloride and Sodium in the
distal tubule to be excreted into the urine distal tubule to be excreted into the urine
Potassium is also Potassium is also
lushed out!! lushed out!!
1hiazide 1hiazide
Special Pharmacodynamics: Side eects Special Pharmacodynamics: Side eects
lypokalemia lypokalemia
DLCRLASLD calcium excretion DLCRLASLD calcium excretion b,ercatcevia b,ercatcevia
DLCRLASLD uric acid secretion DLCRLASLD uric acid secretion b,ervricevia b,ervricevia
lyperglycemia lyperglycemia
Loop iuretics Loop iuretics
Prototype: lurosemide Prototype: lurosemide
Bumetanide Bumetanide
Lthacrynic acid Lthacrynic acid
1orsemide 1orsemide
ligh ligh--ceiling diuretics ceiling diuretics
BLOCK the chloride pump in the ascending BLOCK the chloride pump in the ascending
loop o lenle loop o lenle
SODIUM and ClLORIDL reabsorption is SODIUM and ClLORIDL reabsorption is
preented preented
Potassium is also excreted together with Na and Potassium is also excreted together with Na and
Cl Cl
Special Pharmacodynamics: side Special Pharmacodynamics: side--eects eects
Bicarbonate is lost in the urine Bicarbonate is lost in the urine
INCRLASLD calcium excretion INCRLASLD calcium excretion ,ocatcevia ,ocatcevia
Ototoxicity Ototoxicity-- due to the electrolyte imbalances due to the electrolyte imbalances
Potassium sparing diuretics Potassium sparing diuretics
Prototype: Spironolactone Prototype: Spironolactone
Amiloride Amiloride
1riamterene 1riamterene
Spironolactone is an ALDOS1LRONL Spironolactone is an ALDOS1LRONL
antagonist antagonist
1riamterene and Amiloride BLOCK the 1riamterene and Amiloride BLOCK the
potassium secretion in the distal tubule potassium secretion in the distal tubule
Diuretic eect is achieed by the sodium loss to Diuretic eect is achieed by the sodium loss to
oset potassium retention oset potassium retention
Pharmacokinetics: Side effects Pharmacokinetics: Side effects
HYPLRkalemia! HYPLRkalemia!
Avoid high potassium foods: Avoid high potassium foods:
Bananas Bananas
Potatoes Potatoes
Spinach Spinach
Broccoli Broccoli
Nuts Nuts
Prunes Prunes
1omatoes 1omatoes
Oranges Oranges
Peaches Peaches
Osmotic iuretics Osmotic iuretics
Prototype: Mannitol Prototype: Mannitol
Glycerin Glycerin
Isosorbide Isosorbide
Urea Urea
Mannitol is a sugar not well absorbed in the Mannitol is a sugar not well absorbed in the
nephron nephron osmotic pull o water osmotic pull o water diuresis diuresis
Pharmacokinetics: side eects Pharmacokinetics: side eects
Sudden hypoolemia Sudden hypoolemia
Important or the nurse to warm the solution to Important or the nurse to warm the solution to
allow the crystals to DISSOLVL in the bottle! allow the crystals to DISSOLVL in the bottle!
Carbonic Anhydrase Inhibitors Carbonic Anhydrase Inhibitors
Prototype: Acetazolamide Prototype: Acetazolamide
Methazolamide Methazolamide
Carbonic Anhydrase orms sodium bicarbonate Carbonic Anhydrase orms sodium bicarbonate
BLOCK of the enzyme results to slow BLOCK of the enzyme results to slow
movement of hydrogen and bicarbonate into movement of hydrogen and bicarbonate into
the tubules the tubules
plus sodium is lost in the urine plus sodium is lost in the urine
Pharmacokinetics: side eects Pharmacokinetics: side eects
Metabotic .CDO baev. rbev bicarbovate i. to.t Metabotic .CDO baev. rbev bicarbovate i. to.t
1he Nursing Process and the 1he Nursing Process and the
diuretics diuretics
ASSLSSMLN1 ASSLSSMLN1
Assess the RLASON why the drug is gien: Assess the RLASON why the drug is gien:
______ ______
______ ______
______ ______
______ ______
diuretics diuretics
1he nurse must elicit history o allergy to the 1he nurse must elicit history o allergy to the
drugs drugs
.tterg, to .vtfovaviae. va, covtraivaicate tbe v.e of .tterg, to .vtfovaviae. va, covtraivaicate tbe v.e of
tbiaiae. tbiaiae.
Assess luid and electrolyte balance Assess luid and electrolyte balance
Assess other conditions like gout, diabetes, Assess other conditions like gout, diabetes,
pregnancy and lactation pregnancy and lactation
diuretics diuretics
Physical assessment Physical assessment
Vital signs Vital signs
Special electrolyte and laboratory examination Special electrolyte and laboratory examination
Assess symptom o body weakness which may Assess symptom o body weakness which may
indicate hypokalemia indicate hypokalemia
diuretics diuretics
Nursing Diagnosis Nursing Diagnosis
lluid olume deicit related to diuretic eect lluid olume deicit related to diuretic eect
Alteration in urinary pattern Alteration in urinary pattern
Potential or injury ,ototoxocity, hypotension, Potential or injury ,ototoxocity, hypotension,
Knowledge deicit Knowledge deicit
diuretics diuretics
IMPLLMLN1A1ION IMPLLMLN1A1ION
Administer IV drug slowly Administer IV drug slowly
Saety precaution or dizziness,hypotension Saety precaution or dizziness,hypotension
Proide potassium RICl oods or most Proide potassium RICl oods or most
diuretics, with the exception o spironolactone diuretics, with the exception o spironolactone
Proide skin care, oral care and urinary care Proide skin care, oral care and urinary care
diuretics diuretics
IMPLLMLN1A1ION IMPLLMLN1A1ION
Monitor DAIL\ \LIGl1 Monitor DAIL\ \LIGl1-- to ealuate the to ealuate the
eectieness o the therapy eectieness o the therapy
Monitor urine output, cardiac rhythm Serum Monitor urine output, cardiac rhythm Serum
electrolytes electrolytes
ADMINIS1LR in the MORNING! ADMINIS1LR in the MORNING!
Administer with lOOD! Administer with lOOD!
diuretics diuretics
LVALUA1ION: or eectieness o therapy LVALUA1ION: or eectieness o therapy
\eight loss \eight loss
Increased urine output Increased urine output
Resolution o edema Resolution o edema
Decreased congestion Decreased congestion
Normal BP Normal BP
The ANXOLYTCS AND HYPNOTCS The ANXOLYTCS AND HYPNOTCS
These drugs are used to change the These drugs are used to change the
individual's responses to the individual's responses to the
environment. environment.
The medications that can prevent the The medications that can prevent the
feelings of tension and fear are called feelings of tension and fear are called
ANXOLYTCS. ANXOLYTCS.
Anti Anti- -anxiety drugs anxiety drugs
The drugs that can calm individuals The drugs that can calm individuals
making them unaware of the making them unaware of the
environment are called SEDATVES. environment are called SEDATVES.
The drugs that can induce sleep are The drugs that can induce sleep are
called HYPNOTCS. called HYPNOTCS.
The drugs in this class are the The drugs in this class are the
BENZODAZEPNES BENZODAZEPNES
BARBTURATES BARBTURATES
Use of The Drugs Use of The Drugs
Clinical indications for the use of the Clinical indications for the use of the
anxiolytics, sedatives and hypnotics anxiolytics, sedatives and hypnotics
1. Prevention of anxiety 1. Prevention of anxiety
2. Formation of sedative state 2. Formation of sedative state
3. nduction of sleep 3. nduction of sleep
The BENZODAZEPNES The BENZODAZEPNES
The benzodiazepines are the most frequently The benzodiazepines are the most frequently
used anxiolytic drugs. used anxiolytic drugs.
These agents prevent anxiety states without These agents prevent anxiety states without
causing much sedation, with less physical causing much sedation, with less physical
dependence than other agents. dependence than other agents.
%he foIIowing are the benzodiazepines %he foIIowing are the benzodiazepines
Alprazolam (Xanax) Alprazolam (Xanax)
Chlordiazepoxide (Librium Chlordiazepoxide (Librium
cIonazepam cIonazepam
cIorazepate cIorazepate
Diazepam (Valium) Diazepam (Valium)
estazoIam estazoIam
fIurazepam fIurazepam
Iorazepam Iorazepam
midazoIam midazoIam
oxazepam oxazepam
quazepam quazepam
temazepam temazepam
triazoIam triazoIam
Special uses Special uses
Diazepam
(Valium)
Status epilepticus
Chlordiazepoxide
(Librium)
Alcohol
withdrawal
Alprazolam
(Xanax)
Panic attack
The Mechanism of Action of the Benzodiazepines The Mechanism of Action of the Benzodiazepines
These agents act on the Limbic system These agents act on the Limbic system
and the RAS (reticular activating system) and the RAS (reticular activating system)
to make the GABA ( Gamma to make the GABA ( Gamma- -
aminobutyric acid) more effective aminobutyric acid) more effective
causing interference with neuron firing. causing interference with neuron firing.
The Mechanism of Action of the Benzodiazepines The Mechanism of Action of the Benzodiazepines
%he GABA is an inhibitory %he GABA is an inhibitory
neurotransmitter. neurotransmitter.
%his wiII resuIt to an anxioIytic %his wiII resuIt to an anxioIytic
effect at Iower doses than effect at Iower doses than
required for sedation/hypnosis. required for sedation/hypnosis.
%hese agents are indicated for the treatment %hese agents are indicated for the treatment
of of
1. 1. anxiety disorders anxiety disorders
2. 2. aIcohoI withdrawaI aIcohoI withdrawaI
3. 3. hyperexcitabiIity, and agitation hyperexcitabiIity, and agitation
4. 4. pre pre- -operative reIief of anxiety and operative reIief of anxiety and
tension and in induction of baIanced tension and in induction of baIanced
anesthesia. anesthesia.
Pharmacodynamics: %he adverse effects Pharmacodynamics: %he adverse effects
CNS effects= CNS effects= 8edation, drow8ine88, 8edation, drow8ine88,
depre88ion, lethargy, blurred vi8ion depre88ion, lethargy, blurred vi8ion
GI%= GI%= dry mouth, con8tipation dry mouth, con8tipation, nausea, , nausea,
vomiting vomiting
CVS= CVS= Hypoten8ion Hypoten8ion or hypertension, or hypertension,
arrhythmias, paIpitations, and respiratory arrhythmias, paIpitations, and respiratory
difficuIties. difficuIties.
HematoIogic= bIood dyscrasias and HematoIogic= bIood dyscrasias and
anemia anemia
GU= urinary retention, hesitancy, Ioss of GU= urinary retention, hesitancy, Ioss of
Iibido and sexuaI functions changes. Iibido and sexuaI functions changes.
Nursing Considerations: Nursing Considerations:
aintain patient8 on bed for at aintain patient8 on bed for at
lea8t 3 hour8 after drug lea8t 3 hour8 after drug
admini8tration. admini8tration.
In8truct to avoid hazardou8 In8truct to avoid hazardou8
activitie8 like driving and machine activitie8 like driving and machine
operation. operation.
In8truct to avoid con8uming In8truct to avoid con8uming
ALCOHOL while taking the drug ALCOHOL while taking the drug..
Provide comfort measures to heIp Provide comfort measures to heIp
patients toIerate drug effects patients toIerate drug effects- -
instruct to urinate before taking instruct to urinate before taking
drug drug
give high fiber foods give high fiber foods
use side use side- -raiIs and assistance with raiIs and assistance with
ambuIation. ambuIation.
Have avaiIabIe Have avaiIabIe FLUMAZENIL as an FLUMAZENIL as an
antidote for benzodiazepine antidote for benzodiazepine
overdose. overdose.
The BARBTURATES The BARBTURATES
These are also anxiolytics and These are also anxiolytics and
hypnotics with a greater likelihood of hypnotics with a greater likelihood of
producing sedation, with increase producing sedation, with increase
risk of addiction and dependence. risk of addiction and dependence.
The following are the barbiturates The following are the barbiturates
amobarbital amobarbital
aprobarbital aprobarbital
butabarbital butabarbital
mephobarbital mephobarbital
pentobarbital pentobarbital
!henobarbital !henobarbital
secobarbital secobarbital
The Mechanism of Action of the The Mechanism of Action of the
Barbiturates Barbiturates
They depress the motor output from the They depress the motor output from the
brain. brain.
The results of their MOA are sedation, The results of their MOA are sedation,
hypnosis and anesthesia, and if extreme, hypnosis and anesthesia, and if extreme,
coma. coma.
CIinicaI indications of the Barbiturates CIinicaI indications of the Barbiturates
1. 1. ReIief of anxiety manifestations ReIief of anxiety manifestations
2. 2. For sedation For sedation
3. 3. For patients with insomnia For patients with insomnia
4. 4. For pre For pre- -anesthesia anesthesia
. . 8eizure8epilep8y 8eizure8epilep8y
. . %he rapid acting barbiturates are aIso %he rapid acting barbiturates are aIso
used for the treatment of acute manic used for the treatment of acute manic
reactions and status epiIepticus reactions and status epiIepticus
Pharmacodynamics: %he Adverse effects Pharmacodynamics: %he Adverse effects
CNS= CNS= CNS depre88ion CNS depre88ion, somnoIence , somnoIence, ,
vertigo, Iethargy, ataxia, paradoxicaI vertigo, Iethargy, ataxia, paradoxicaI
excitement, anxiety and haIIucinations. excitement, anxiety and haIIucinations.
GI%= GI%= nau8ea, vomiting, nau8ea, vomiting,
constipation/diarrhea and epigastric pain constipation/diarrhea and epigastric pain
CVS= bradycardia, Hypotension and CVS= bradycardia, Hypotension and
syncope. syncope.
Respi= serious hypoventiIation, respiratory Respi= serious hypoventiIation, respiratory
depression and Iaryngospasms depression and Iaryngospasms
Others= Others= hypersensitivity and Stevens hypersensitivity and Stevens- -
Johnson syndrome. Johnson syndrome.
Nursing Considerations Nursing Considerations
Provide stand Provide stand- -by Iife support faciIities by Iife support faciIities
in cases of severe respiratory in cases of severe respiratory
depression or hypersensitivity reaction. depression or hypersensitivity reaction.
%aper the drug graduaIIy after Iong %aper the drug graduaIIy after Iong- -
term therapy to avoid withdrawaI term therapy to avoid withdrawaI
syndrome. syndrome.
Provide comfort measures incIuding Provide comfort measures incIuding
smaII frequent meaIs, access to smaII frequent meaIs, access to
bathroom faciIities, high bathroom faciIities, high- -fiber foods, fiber foods,
environmentaI controI, safety environmentaI controI, safety
precaution and skin care. precaution and skin care.
The CNS stimulants The CNS stimulants
%hese are drugs used to treat certain %hese are drugs used to treat certain
disorders disorders
1. 1. exogenous obesity exogenous obesity
2. 2. attention attention- -deficit hyperactivity deficit hyperactivity
disorders (ADHD disorders (ADHD
3. 3. narcoIepsy narcoIepsy
%he CNS stimuIants %he CNS stimuIants
hat i8 unu8ual i8 the ability of hat i8 unu8ual i8 the ability of
the CNS 8timulant8 to CAL the CNS 8timulant8 to CAL
hyperactive children, which hyperactive children, which
allow8 them to focu8 on one allow8 them to focu8 on one
activity for a longer period. activity for a longer period.
%he foIIowing are the CNS stimuIants: %he foIIowing are the CNS stimuIants:
1. 1. ethylphenidate (Ritalin)= mo8t ethylphenidate (Ritalin)= mo8t
commonly u8ed for ADHD commonly u8ed for ADHD
2. Dextroamphetamine= a CNS stimuIant 2. Dextroamphetamine= a CNS stimuIant
that is used for short tem therapy for that is used for short tem therapy for
obesity. obesity.
3. ModafiniI= used for narcoIepsy 3. ModafiniI= used for narcoIepsy
4. PemoIine= used for ADHD 4. PemoIine= used for ADHD
%he Mechanism of Action %he Mechanism of Action
%hese agents act as to stimuIate the %hese agents act as to stimuIate the
corticaI and reticuIar activating system corticaI and reticuIar activating system
(RAS of the brain. (RAS of the brain.
%his is by reIeasing neurotransmitters %his is by reIeasing neurotransmitters
from the nerve ceIIs Ieading to from the nerve ceIIs Ieading to increa8ed increa8ed
8timulation of the po8t 8timulation of the po8t- -8ynaptic 8ynaptic
neuron8. neuron8.
%he paradoxical effect of calming %he paradoxical effect of calming
hyperexcitability through CNS hyperexcitability through CNS
8timulation 8een in ADHD i8 believed to 8timulation 8een in ADHD i8 believed to
be related to the increa8ed 8timulation of be related to the increa8ed 8timulation of
an IA%&RE Reticular Activating an IA%&RE Reticular Activating
Sy8tem leading to the ability to be more Sy8tem leading to the ability to be more
8elective in re8pon8e to incoming 8elective in re8pon8e to incoming
8timuli. 8timuli.
Pharmacodynamics: Adverse effects of the CNS Pharmacodynamics: Adverse effects of the CNS
stimulants stimulants
CNS= CNS= nervou8ne88, in8omnia nervou8ne88, in8omnia, dizziness, , dizziness,
headache, and blurred vision headache, and blurred vision
GT= GT= anorexia anorexia, nausea and weight loss , nausea and weight loss
CVS= hypertension, tachycardia arrhythmias, and CVS= hypertension, tachycardia arrhythmias, and
angina angina
Others= rashes, physical/psychological Others= rashes, physical/psychological
dependence. dependence.
mplementation mplementation
The nurse must ensure that the drug is only given to The nurse must ensure that the drug is only given to
the indicated conditions the indicated conditions
Admini8ter the drug before 6 pm to reduce the Admini8ter the drug before 6 pm to reduce the
effect of in8omnia effect of in8omnia
BES% given AF%ER meal8 to prevent the effect BES% given AF%ER meal8 to prevent the effect
of anorexia of anorexia
Consult with school personnel to monitor the patient Consult with school personnel to monitor the patient
under therapy under therapy
Provide safety measures such as side Provide safety measures such as side- -rails and rails and
assisted ambulation assisted ambulation
Evaluation Evaluation
Evaluate the effectiveness of the drug: Evaluate the effectiveness of the drug:
1. 1. Calming effect in the patient with ADHD Calming effect in the patient with ADHD
2. 2. Alertness for patients with narcolepsy Alertness for patients with narcolepsy
The Anti The Anti- -epileptics epileptics
These agents, also called anticonvulsants, These agents, also called anticonvulsants,
are used to treat epileptic conditions. are used to treat epileptic conditions.
Hydantoins, Barbiturates, Hydantoins, Barbiturates,
benzodiazepines, Succinimides and many benzodiazepines, Succinimides and many
others are given to a specific type of others are given to a specific type of
seizure. seizure.
Anti Anti- -epileptics epileptics
Agents for treating %ONIC Agents for treating %ONIC- -CLONIC SEIZURES CLONIC SEIZURES
1. Hydantoins 1. Hydantoins
Phenytoin Phenytoin
Ethotoin Ethotoin
Fosphenytoin Fosphenytoin
Mephenytoin Mephenytoin
2. Benzodiazepines 2. Benzodiazepines
Diazepam Diazepam
CIonazepam CIonazepam
CIorazepate CIorazepate
3. Barbiturates 3. Barbiturates
PhenobarbitaI PhenobarbitaI
Agents for treating ABSENCE SEZURES Agents for treating ABSENCE SEZURES
1. Succinimides 1. Succinimides
a. Ethosuximide a. Ethosuximide
b. Methsuximide b. Methsuximide
c. Phensuximide c. Phensuximide
2. Valproic Acid 2. Valproic Acid
3. Zosinamide 3. Zosinamide
Agents for treating Partial FOCAL SEZURES Agents for treating Partial FOCAL SEZURES
1. Carbamazepine 1. Carbamazepine
2. Gabapentin 2. Gabapentin
3.Lamotrigine 3.Lamotrigine
4. Tiagabine 4. Tiagabine
5. Topiramate 5. Topiramate
The hydantoins The hydantoins
%hese agents are utiIized for generaI seizures %hese agents are utiIized for generaI seizures
because they can depress the centraI because they can depress the centraI
nervous system. nervous system.
%hey affect the entire brain and reduce the %hey affect the entire brain and reduce the
chance of 8udden electrical outbur8t that chance of 8udden electrical outbur8t that
cau8e8 8eizure8. cau8e8 8eizure8.
%hese agents generaIIy are Iess sedating than %hese agents generaIIy are Iess sedating than
other anti other anti- -epiIeptics epiIeptics..
Mechanism of Action of the Hydantoins Mechanism of Action of the Hydantoins
%he8e agent8 S%ABILIZE the nerve cell %he8e agent8 S%ABILIZE the nerve cell
membrane throughout the brain reducing membrane throughout the brain reducing
and limiting the excitability and and limiting the excitability and
conduction through nerve pathway8. conduction through nerve pathway8.
Clinical ndications of the hydantoins Clinical ndications of the hydantoins
1. 1. Tonic Tonic- -clonic seizures clonic seizures
2. 2. Status epilepticus Status epilepticus
3. 3. For the prevention of seizures in For the prevention of seizures in
neurosurgery neurosurgery
4. 4. For muscle relaxation. For muscle relaxation.
Contraindications and Precautions Contraindications and Precautions
Hydantoins are NO% given to pregnant Hydantoins are NO% given to pregnant
patient because it can cause fetaI patient because it can cause fetaI
hydantoin syndrome hydantoin syndrome. .
Pharmacodynamics: Adverse effects of the Pharmacodynamics: Adverse effects of the
Hydantoins Hydantoins
CNS effects CNS effects- - depression, confusion, depression, confusion,
drowsiness, Iethargy, fatigue drowsiness, Iethargy, fatigue
GI% GI%- - GI upset, constipation, dry mouth GI upset, constipation, dry mouth, ,
GINGIVAL HY!ER!LASIA , 8evere liver GINGIVAL HY!ER!LASIA , 8evere liver
toxicity which are all related to cellular toxicity which are all related to cellular
toxicity. toxicity.
SKIN SKIN- - hirsutism and coarsening of the hirsutism and coarsening of the
faciaI skin faciaI skin
Bone Marrow depression Bone Marrow depression
ImpIementation ImpIementation
Admini8ter the drug with food to Admini8ter the drug with food to
alleviate GI irritation alleviate GI irritation
Discontinue the drug at any sign of Discontinue the drug at any sign of
hypersensitivity reaction, severe Iiver hypersensitivity reaction, severe Iiver
dysfunction and severe skin rashes. dysfunction and severe skin rashes.
!rovide meticulou8 mouth oral care !rovide meticulou8 mouth oral care
RuIe out pregnancy and advise RuIe out pregnancy and advise
women to use contraceptive women to use contraceptive
measures to prevent pregnancy. measures to prevent pregnancy.
Drugs affecting C! secretions Drugs affecting C! secretions
There are five types of drugs that affect There are five types of drugs that affect
gastric acid secretions and are useful for the gastric acid secretions and are useful for the
treatment of peptic ulcer. treatment of peptic ulcer.
1. 1. Histamine (H2) receptor Histamine (H2) receptor
antagonist/blockers antagonist/blockers
2. 2. Antacids Antacids
3. 3. Proton pump inhibitors Proton pump inhibitors
4. 4. Nucosal protectants Nucosal protectants
S. S. Prostaglandin analogs Prostaglandin analogs
Drugs affecting secretions: Drugs affecting secretions:
anti ulcer anti ulcer
Anti-ulcer drugs Prototype
Histamine (H2 receptor
antagonist/bIockers
Cimetidine
Antacids
AlOH and gOH
Proton pump inhibitors
Omeprazole
MucosaI protectants
Sucralfate
ProstagIandin anaIog
Misoprostol
Ceneral indication of the drugs Ceneral indication of the drugs
affecting gastric acid secretion affecting gastric acid secretion
Peptic ulcer Peptic ulcer
Castritis Castritis
Patient on NPO to prevent stress ulcer Patient on NPO to prevent stress ulcer
Ceneral time of administration of the Ceneral time of administration of the
drugs affecting gastric acid secretion drugs affecting gastric acid secretion
Anti-uIcer drugs Prototype Best time to give
Histamine (H2
receptor
antagonist/bIockers
Cimetidine With FOOD or ONE
hour after AN%ACID
Antacids AIOH and MgOH UsuaIIy after meaIs
Proton pump
inhibitors
OmeprazoIe BEFORE MEALS
MucosaI
protectants
SucraIfate BEFORE MEALS
ProstagIandin
anaIog
MisoprostoI WI%H MEALS
Pharmacology of Anti Pharmacology of Anti ulcer ulcer
drugs drugs
Drug Drug Nechanism of Action
Antacids Antacids AlOH, NgOH AlOH, NgOH Neutralize Castric AC!D!TY
H2 H2 Blockers Blockers tidine tidine" "
Cimetidine Cimetidine, Ranitidine , Ranitidine
Block Histamine receptor
causing decreased secretion
and acidity
Proton pump inhibitors Proton pump inhibitors
Prazoles" Prazoles"
Omeprazole, pantoprazole Omeprazole, pantoprazole
!nhibit Proton Pump in parietal
cell decreasing secretion and
acidity
Pharmacology of Anti Pharmacology of Antiulcer drugs ulcer drugs
Drug Drug Nechanism of Action
Anti Anti cholinergic cholinergic Prophanteline Prophanteline
Bromide Bromide
Blocks vACUS nerve, decreases
secretion
Sucralfate (Carafate) Sucralfate (Carafate) Coats the mucosal lining
Nisoprostol (Cytotec) Nisoprostol (Cytotec) Prostaglandin Analogue, causes
secretion of NUCUS
Histamine (H2) receptor blockers Histamine (H2) receptor blockers
These drugs BLOCK the release of These drugs BLOCK the release of
hydrochloric acid in the stomach hydrochloric acid in the stomach
in response to gastrin in response to gastrin
Antacids Antacids
These drugs interact with the These drugs interact with the
gastric acids at the chemical gastric acids at the chemical
level to neutralize them level to neutralize them
Proton pump inhibitors Proton pump inhibitors
These drugs suppress the These drugs suppress the
secretion of hydrochloric acid secretion of hydrochloric acid
into the lumen of the stomach into the lumen of the stomach
Nucosal protectants Nucosal protectants
These are agents that coat any These are agents that coat any
injured area in the stomach to injured area in the stomach to
prevent further injury from prevent further injury from
acid acid
Prostaglandin analogs Prostaglandin analogs
These are agents that These are agents that inhibit inhibit the the
secretion of gastrin and secretion of gastrin and
increase increase the secretion of mucus the secretion of mucus
lining of the stomach, providing lining of the stomach, providing
a buffer. a buffer.
'he H2 Blockers 'he H2 Blockers tidines" tidines"
Prototype: Cimetidine Prototype: Cimetidine
1. Ranitidine 1. Ranitidine
2. Famotidine 2. Famotidine
3. Nizatidine 3. Nizatidine
Pharmacodynamics: Drug Action Pharmacodynamics: Drug Action
The H2 blockers are antagonists at the The H2 blockers are antagonists at the
receptors in the parietal cells of the receptors in the parietal cells of the
stomach. stomach.
The blockage results to inhibition of the The blockage results to inhibition of the
hormone gastrin. hormone gastrin.
There will be decreased production of There will be decreased production of
gastric acid from the parietal cells. gastric acid from the parietal cells.
Also, the chief cells will secrete less Also, the chief cells will secrete less
pepsinogen. pepsinogen.
'herapeutic use of the H2 blockers 'herapeutic use of the H2 blockers
Short Shortterm treatment of active duodenal ulcer or term treatment of active duodenal ulcer or
benign gastric ulcer benign gastric ulcer
'reatment of hypersecretory conditions like the 'reatment of hypersecretory conditions like the
Zollinger ZollingerEllison syndrome Ellison syndrome
Prevention of stress Prevention of stressinduced ulcers and acute C! induced ulcers and acute C!
bleeding bleeding
'reatment of erosive CERD (reflux disease) 'reatment of erosive CERD (reflux disease)
Relief of Symptoms of heart burn and acid Relief of Symptoms of heart burn and acid
indigestion indigestion
Precautions and Contraindications Precautions and Contraindications
Any known allergy is a clear contraindication Any known allergy is a clear contraindication
to the use of the agents. Conditions such as to the use of the agents. Conditions such as
pregnancy, lactation, renal dysfunction and pregnancy, lactation, renal dysfunction and
hepatic dysfunction should warrant cautious hepatic dysfunction should warrant cautious
use. use.
Nizatidine can be used in hepatic Nizatidine can be used in hepatic
dysfunction. dysfunction.
Pharmocodynamics Pharmocodynamics Side effects and adverse effects Side effects and adverse effects
C!' diarrhea or constipation C!' diarrhea or constipation
CNS Dizziness, headache, drowsiness, confusion CNS Dizziness, headache, drowsiness, confusion
and hallucinations and hallucinations
Cardio arrhythmias, Cardio arrhythmias, HYPOTENS!ON HYPOTENS!ON (related to (related to
H2 receptor blockage in the heart) H2 receptor blockage in the heart)
Cimetidine Cimetidine TRENORS, TRENORS, Cynecomastia and Cynecomastia and
impotence in males impotence in males
Drug Drug drug !nteractions drug !nteractions
Cimetidine, Famotidine, Ranitidine Cimetidine, Famotidine, Ranitidine
are metabolized in the liver are metabolized in the liver they can they can
cause slowing of excretion of other cause slowing of excretion of other
drugs leading to their increased drugs leading to their increased
concentration. concentration.
Drug Drug drug !nteractions drug !nteractions
These drugs can interact with These drugs can interact with
C!NET!D!NE anticoagulants, C!NET!D!NE anticoagulants,
phenytoin, alcohol, antidepressants. phenytoin, alcohol, antidepressants.
Nursing considerations: Nursing considerations:
Administer the drug Administer the drug !'H !'H meals meals at at
BED'!NE BED'!NE to ensure therapeutic level to ensure therapeutic level
One hour after Antacids One hour after Antacids
Stress the importance of the Stress the importance of the
continued use for the length of time continued use for the length of time
prescribed prescribed
Nonitor the cardiovascular status Nonitor the cardiovascular status
especially if the drugs are given !v especially if the drugs are given !v
Warn patient of the potential Warn patient of the potential
problems of increased drug problems of increased drug
concentration if the H2 blockers are concentration if the H2 blockers are
used with other drugs or OTC drugs. used with other drugs or OTC drugs.
Advise consultation first! Advise consultation first!
Provide comfort measures like Provide comfort measures like
analgesics for headache, assistance analgesics for headache, assistance
with ambulation and safety measures with ambulation and safety measures
Warn the patients taking cimetidine Warn the patients taking cimetidine
that drowsiness may pose a hazard if that drowsiness may pose a hazard if
driving or operating delicate machines. driving or operating delicate machines.
Provide health teaching as to the dose, Provide health teaching as to the dose,
frequency, comfort measures to initiate frequency, comfort measures to initiate
when side when sideeffects are intolerable effects are intolerable
Evaluate the effectiveness: Evaluate the effectiveness:
Relief of symptoms of ulcer, heart burn and Relief of symptoms of ulcer, heart burn and
CERD CERD
'he Antacids 'he Antacids
'hese are drugs or inorganic chemicals that 'hese are drugs or inorganic chemicals that
have been used for years to neutralize acid in have been used for years to neutralize acid in
the stomach. 'he following are the common the stomach. 'he following are the common
antacids that can be bought O'C: antacids that can be bought O'C:
Aluminum salts (hydroxide) Aluminum salts (hydroxide)
Calcium salts (carbonate) Calcium salts (carbonate)
Nagnesium Nagnesium salts (milk of magnesia) salts (milk of magnesia)
Sodium bicarbonate Sodium bicarbonate
Nagaldrate (aluminum and magnesium Nagaldrate (aluminum and magnesium
combination) combination)
Pharmacodynamics: drug action Pharmacodynamics: drug action
'hese agents act to neutralize the acidic pH 'hese agents act to neutralize the acidic pH
in the stomach. in the stomach.
'hey do not affect the rate of gastric acid 'hey do not affect the rate of gastric acid
secretion. secretion.
'he administration of antacid may cause an 'he administration of antacid may cause an
acid rebound. acid rebound.
Neutralizing the stomach content to an Neutralizing the stomach content to an
alkaline level stimulates gastrin production alkaline level stimulates gastrin production
to cause an increase in acid production and to cause an increase in acid production and
return the stomach to its normal acidic return the stomach to its normal acidic
state. state.
'herapeutic !ndications 'herapeutic !ndications
Symptomatic relief of upset stomach Symptomatic relief of upset stomach
associated with hyperacidity associated with hyperacidity
Hyperacidic conditions like peptic ulcer, Hyperacidic conditions like peptic ulcer,
gastritis, esophagitis and hiatal hernia gastritis, esophagitis and hiatal hernia
Special use of ANPHOCEL (aluminum Special use of ANPHOCEL (aluminum
hydroxide): to B!ND phosphate hydroxide): to B!ND phosphate
Precautions of Antacid Use Precautions of Antacid Use
Known allergy is a clear contraindication. Known allergy is a clear contraindication.
Caution should be instituted if used in Caution should be instituted if used in
electrolyte imbalances, C! obstruction and electrolyte imbalances, C! obstruction and
renal dysfunction. renal dysfunction.
Sodium bicarbonate is rarely used because Sodium bicarbonate is rarely used because
of potential systemic absorption of potential systemic absorption
Pharmacokinetics Pharmacokinetics
'hese agents are taken orally and act 'hese agents are taken orally and act
locally in the stomach locally in the stomach
Pharmacodynamics: Effects of drugs Pharmacodynamics: Effects of drugs
1. 1. C!' rebound acidity, alkalosis may occur. C!' rebound acidity, alkalosis may occur.
Calcium salts may lead to Calcium salts may lead to hypercalcemia hypercalcemia
Nagnesium salts can cause D!ARRHEA Nagnesium salts can cause D!ARRHEA
Aluminum salts may cause Aluminum salts may cause
CONST!PAT!ON and CONST!PAT!ON and
hypophosphatemia by binding with hypophosphatemia by binding with
phosphates in the C!T. phosphates in the C!T.
2. 2. Fluid retention Fluid retention due to the high sodium due to the high sodium
content of the antacids. content of the antacids.
Administer the antacids apart from any Administer the antacids apart from any
other medications by other medications by ONE hour before ONE hour before
or or TWO hours after TWO hours after to ensure adequate to ensure adequate
absorption of the other medications absorption of the other medications
'ell the patient to 'ell the patient to CHEW CHEW the tablet the tablet
thoroughly before swallowing. Follow it thoroughly before swallowing. Follow it
with one glass of water with one glass of water
Regularly monitor for manifestations of Regularly monitor for manifestations of
acid acidbase imbalances as well as electrolyte base imbalances as well as electrolyte
imbalances imbalances
Provide comfort measures to alleviate Provide comfort measures to alleviate
constipation associated with aluminum and constipation associated with aluminum and
diarrhea associated with magnesium salts. diarrhea associated with magnesium salts.
Nonitor for the side Nonitor for the side effects, effectiveness of effects, effectiveness of
the comfort measures, patient's response to the comfort measures, patient's response to
the medication and the effectiveness of the the medication and the effectiveness of the
health teachings health teachings
Evaluate for effectiveness: Evaluate for effectiveness:
Decreased symptoms of ulcer and Decreased symptoms of ulcer and
pyrosis pyrosis
Decreased Phosphate level (amphogel) Decreased Phosphate level (amphogel)
'he PP! 'he PP!
'hese are the newer agents for ulcer 'hese are the newer agents for ulcer
treatment treatment
'he prazoles" 'he prazoles"
Prototype: Ome Prototype: Omeprazole prazole
aniso anisoprazole prazole
Esome Esomeprazole prazole
Panto Pantoprazole prazole
'he PP! 'he PP!
'hey act at specific secretory surface 'hey act at specific secretory surface
receptors to prevent the final step of acid receptors to prevent the final step of acid
production and thus decrease the level of production and thus decrease the level of
acid in the stomach. acid in the stomach.
'he pump" in the parietal cell is the 'he pump" in the parietal cell is the H H K K
A'Pase enzyme system on the secretory A'Pase enzyme system on the secretory
surface of the gastric parietal cells surface of the gastric parietal cells
'he PP! 'he PP!
Clinical use of the PP!s Clinical use of the PP!s
Short Shortterm treatment of active duodenal term treatment of active duodenal
ulcers, CERD, erosive esophagitis and ulcers, CERD, erosive esophagitis and
benign gastric ulcer. benign gastric ulcer.
ong ongterm term maintenance therapy for maintenance therapy for
healing of erosive disorders. healing of erosive disorders.
'he PP! 'he PP!
Clinical use of the PP!s. Clinical use of the PP!s.
Precautions with the use of the PP!s Precautions with the use of the PP!s
Known allergy is a clear contraindication. Known allergy is a clear contraindication.
Caution if patient is pregnant Caution if patient is pregnant
'he PP! 'he PP!
Pharmacodynamics: Adverse effects Pharmacodynamics: Adverse effects
CNS CNS dizziness dizziness, , headache, asthenia (loss of headache, asthenia (loss of
strength), strength), vertigo vertigo, , insomnia, apathy insomnia, apathy
C!T C!T diarrhea, abdominal pain, nausea, diarrhea, abdominal pain, nausea,
vomiting, dry mouth vomiting, dry mouth and tongue atrophy and tongue atrophy
Respi Respi cough, stuffy nose, hoarseness and cough, stuffy nose, hoarseness and
epistaxis. epistaxis.
'he PP! 'he PP!
Administer the drug Administer the drug BEFORE BEFORE meals. Ensure meals. Ensure
that patient does not open, chew or crush that patient does not open, chew or crush
the drug. the drug.
Provide safety measures if CNS dysfunction Provide safety measures if CNS dysfunction
happens. happens.
Arrange for a medical follow Arrange for a medical followup if symptoms up if symptoms
are NO' resolved after 4 are NO' resolved after 48 weeks of 8 weeks of
therapy. therapy.
'he PP! 'he PP!
Provide health teaching as to drug name, Provide health teaching as to drug name,
dosages and frequency, safety measures to dosages and frequency, safety measures to
handle common problems. handle common problems.
Nonitor patient response to the drug, the Nonitor patient response to the drug, the
effectiveness of the teaching plan and the effectiveness of the teaching plan and the
measures to employ measures to employ
'he PP! 'he PP!
Evaluate for effectiveness of the drug Evaluate for effectiveness of the drug
Healing of peptic ulcer Healing of peptic ulcer
Decreased symptoms of ulcer Decreased symptoms of ulcer
'he Nucosal Protectant 'he Nucosal Protectant
Sucralfate Sucralfate
'his is given to protect the eroded ulcer 'his is given to protect the eroded ulcer
sites in the C!' from further damage by sites in the C!' from further damage by
acid and digestive enzymes acid and digestive enzymes
Pharmacodynamics: Action of drug Pharmacodynamics: Action of drug
!t forms an !t forms an ulcer ulceradherent complex adherent complex at at
duodenal ulcer sites, protecting the sites duodenal ulcer sites, protecting the sites
against acid, pepsin and bile. against acid, pepsin and bile.
'his action prevents further breakdown of 'his action prevents further breakdown of
proteins in the area and promotes healing. proteins in the area and promotes healing.
Clinical use of sucralfate Clinical use of sucralfate
Short and long term management of Short and long term management of
duodenal ulcer. duodenal ulcer.
NSA!Ds induced gastritis NSA!Ds induced gastritis
Prevention of stress ulcer Prevention of stress ulcer
'reatment of oral and esophageal ulcers 'reatment of oral and esophageal ulcers
due to radiation, chemotherapy or due to radiation, chemotherapy or
sclerotherapy. sclerotherapy.
Precautions on the use of Sucralfate Precautions on the use of Sucralfate
'his agent should NO' be given to any 'his agent should NO' be given to any
person with known allergy to the drug, person with known allergy to the drug,
and to those patients with renal and to those patients with renal
failure/dialysis because of build failure/dialysis because of buildup of up of
aluminum may occur if used with aluminum may occur if used with
aluminum containing products. aluminum containing products.
Pharmacodynamics: Side Pharmacodynamics: Sideeffects S adverse effects S adverse
reactions reactions
Primarily C!T= CONST!PAT!ON, Primarily C!T= CONST!PAT!ON,
occasionally diarrhea, nausea, occasionally diarrhea, nausea,
indigestion, gastric discomfort, and dry indigestion, gastric discomfort, and dry
mouth may also occur mouth may also occur
CNS dizziness, drowsiness, vertigo CNS dizziness, drowsiness, vertigo
Others rash and back pain Others rash and back pain
Drug Drugdrug interactions drug interactions
!f used with aluminum salts= high risk !f used with aluminum salts= high risk
of accumulation of aluminum and of accumulation of aluminum and
toxicity toxicity. .
!f used with phenytoin, fluoroquinolones !f used with phenytoin, fluoroquinolones
and penicillamines and penicillamines decreased levels of decreased levels of
these drugs when taken with sucralfate these drugs when taken with sucralfate
Administer drug Administer drug ON AN ENPTY stomach ON AN ENPTY stomach, 1 , 1
hour before meals , or 2 hour after meals hour before meals , or 2 hour after meals
and at BEDT!NE and at BEDT!NE
Nonitor for side Nonitor for sideeffects like constipation and C! effects like constipation and C!
upset upset
Encourage intake of high Encourage intake of highfiber foods and fiber foods and
increased fluid intake increased fluid intake
Administer antacids Administer antacids BETWEEN BETWEEN doses of doses of
sucralfate, sucralfate, NOT W!TH!N 30 NOT W!TH!N 30 minutes of minutes of
sucralfate dose sucralfate dose
Provide comfort measures if CNS effects Provide comfort measures if CNS effects
occur occur
measures employed measures employed
Evaluate effectiveness of therapy Evaluate effectiveness of therapy
Healing of ulcer Healing of ulcer
No formation of ulcer No formation of ulcer
Prostaglandin analogue Prostaglandin analogue
Nisoprostol Nisoprostol
'his agent is a synthetic prostaglandin E1 'his agent is a synthetic prostaglandin E1
analog that is employed to protect the lining analog that is employed to protect the lining
of the mucosa of the stomach of the mucosa of the stomach
Nisoprostol: Pharmacodynamics Nisoprostol: Pharmacodynamics
Being a prostaglandin analog, it Being a prostaglandin analog, it inhibits inhibits
gastric acid secretion to some degree gastric acid secretion to some degree
!t !t !NCREASES mucus !NCREASES mucus production in the production in the
stomach lining. stomach lining.
Nisoprostol: Clinical use Nisoprostol: Clinical use
NSA!Ds NSA!Dsinduced gastric ulcers induced gastric ulcers
Duodenal ulcers unresponsive to H2 Duodenal ulcers unresponsive to H2
antagonists. antagonists.
Precautions of Nisoprostol Use Precautions of Nisoprostol Use
'his drug is CON'RA!ND!CA'ED during pregnancy 'his drug is CON'RA!ND!CA'ED during pregnancy
because it is an because it is an abortifacient. abortifacient.
omen should be advised to have a omen should be advised to have a negative negative
pregnancy test within 2 weeks of beginning pregnancy test within 2 weeks of beginning
therapy and should begin the drug on the therapy and should begin the drug on the
second or third day of the next menstrual second or third day of the next menstrual
cycle. cycle.
'hey should be instructed in the use of 'hey should be instructed in the use of
contraceptives during therapy. contraceptives during therapy.
Pharmacodynamic effects: drug reactions Pharmacodynamic effects: drug reactions
C!' Nausea, diarrhea, abdominal pain, C!' Nausea, diarrhea, abdominal pain,
flatulence, vomiting, dyspepsia flatulence, vomiting, dyspepsia
CU effects miscarriages, CU effects miscarriages, excessive excessive
uterine CRANP!NC and bleeding uterine CRANP!NC and bleeding, ,
spotting, hypermenorrhea and menstrual spotting, hypermenorrhea and menstrual
disorders. disorders.
Administer to patients at risk for NSA!Ds Administer to patients at risk for NSA!Dsinduced induced
ulcers during the full course of NSA!Ds therapy ulcers during the full course of NSA!Ds therapy
Administer four times daily with meals and at Administer four times daily with meals and at
bedtime bedtime
Obtain pregnancy test within 2 weeks of beginning Obtain pregnancy test within 2 weeks of beginning
therapy. Begin the therapy on second or third day therapy. Begin the therapy on second or third day
of menstrual period of menstrual period to ensure that the woman is to ensure that the woman is
not pregnant not pregnant
Provide patient with both written and oral Provide patient with both written and oral
information regarding the associated risks of information regarding the associated risks of
pregnancy pregnancy
measures to employ measures to employ
axatives axatives
%ype Prototype Action
ChemicaI
stimuIants
BisacodyI (DuIcoIax
Direct stimuIation of the
GI% nerves
Irritant Iaxatives
MechanicaI (buIk
stimuIants
LactuIose
Increased fIuid content
of the fecaI materiaI
causing stimuIation of
the IocaI refIex
Lubricants Docusate
Lubricating the intestinaI
materiaI to promote
passage through the GI%
axatives axatives
Cenerally used to !NCREASE the passage of Cenerally used to !NCREASE the passage of
the colonic contents the colonic contents
'he general classifications is as follows: 'he general classifications is as follows:
1. Chemical stimulants 1. Chemical stimulants
2. Nechanical stimulants 2. Nechanical stimulants
3. ubricants 3. ubricants
'herapeutic !ndications of the 'herapeutic !ndications of the
axatives axatives
SHOR' term relief of SHOR' term relief of Constipation Constipation
Prevention of straining Prevention of straining in conditions like in conditions like
CHF, post CHF, postN!, post partum, post N!, post partum, postop op
Preparation for Preparation for diagnostic examination diagnostic examination
Removal of poison or toxins Removal of poison or toxins
Adjunct in anti Adjunct in antihelminthic therapy helminthic therapy
Contraindications in axative use Contraindications in axative use
ACU'E abdominal disorders ACU'E abdominal disorders
Appendicitis Appendicitis
Diverticulitis Diverticulitis
Ulcerative colitis Ulcerative colitis
Chemical Stimulant Cathartics Chemical Stimulant Cathartics
Prototype: Bisacodyl Prototype: Bisacodyl
!rritant laxatives: !rritant laxatives:
1. Castor oil 1. Castor oil
2. Senna 2. Senna
3. Cascara 3. Cascara
4. Phenolphthalein 4. Phenolphthalein
Chemical Stimulant Cathartics Chemical Stimulant Cathartics
'hese agents D!REC' stimulate the nerve 'hese agents D!REC' stimulate the nerve
plexus in the intestinal wall plexus in the intestinal wall
'he result is !NCREASED movement or 'he result is !NCREASED movement or
motility of the colon motility of the colon
Nechanical Stimulant Cathartics Nechanical Stimulant Cathartics
Prototype: AC'UOSE (Cephulac) Prototype: AC'UOSE (Cephulac)
Bulk Bulkforming laxatives forming laxatives
1. Nagnesium (citrate, hydroxide, sulfate) 1. Nagnesium (citrate, hydroxide, sulfate)
2. Psyllium 2. Psyllium
3. Polycarbophil 3. Polycarbophil
Nechanical Stimulant Cathartics Nechanical Stimulant Cathartics
'hese agents are rapid 'hese agents are rapidacting laxatives that acting laxatives that
!NCREASE the C! motility by !NCREASE the C! motility by
!ncreasing the fluids in the colonic material !ncreasing the fluids in the colonic material
Stimulating the local stretch receptors Stimulating the local stretch receptors
Activating Activating local defection reflex local defection reflex
ubricants ubricants
Prototype: Docusate Prototype: Docusate
1. Clycerin 1. Clycerin
2. Nineral oil 2. Nineral oil
ubricants ubricants
Docusate increases the admixture of fat and Docusate increases the admixture of fat and
water producing a softer stool water producing a softer stool
Clycerin Clycerin
Nineral oil forms a slippery coat on the Nineral oil forms a slippery coat on the
colonic contents colonic contents
Pharmacokinetics: Pharmacokinetics:
Common Side Common Side effects of the Laxatives effects of the Laxatives
Diarrhea Diarrhea
Abdominal cramping Abdominal cramping
Nausea Nausea
Fluid and electrolyte imbalance Fluid and electrolyte imbalance
Sympathetic reactions Sympathetic reactions sweating, sweating,
palpitations, flushing and fainting palpitations, flushing and fainting
CA'HAR'!C dependence CA'HAR'!C dependence
'he Nursing Process and axative 'he Nursing Process and axative
ASSESSNEN' ASSESSNEN'
Nursing History Nursing History elicit allergy to any elicit allergy to any
laxatives, elicit history of conditions like laxatives, elicit history of conditions like
diverticulitis and ulcerative colitis diverticulitis and ulcerative colitis
Physical Examination Physical Examination abdominal abdominal
assessment assessment
aboratory 'est: fecalysis, electrolyte levels aboratory 'est: fecalysis, electrolyte levels
NURS!NC D!ACNOS!S NURS!NC D!ACNOS!S
Alteration in bowel pattern Alteration in bowel pattern
Alteration in comfort: pain Alteration in comfort: pain
Knowledge deficit Knowledge deficit
!NPENEN'A'!ON !NPENEN'A'!ON
1. 1. Emphasize that it is use on a Emphasize that it is use on a SHOR' term SHOR' term
basis basis
2. 2. Provide comfort and safety measures like Provide comfort and safety measures like
ready access to the bathroom, side ready access to the bathroom, siderails rails
3. 3. Administer with a Administer with a full glass of water full glass of water
4. 4. Encourage fluid intake, high fiber diet and Encourage fluid intake, high fiber diet and
daily exercise daily exercise
S. DO NOT administer if acute abdominal S. DO NOT administer if acute abdominal
condition like appendicitis is present condition like appendicitis is present
6. Advise to change position slowly an avoid 6. Advise to change position slowly an avoid
hazardous activities because of potential hazardous activities because of potential
dizziness dizziness
EvAUA'!ON of drug effectiveness EvAUA'!ON of drug effectiveness
1. 1. Evaluate relief of C! symptoms, absence of Evaluate relief of C! symptoms, absence of
staining and increased evacuation of C! staining and increased evacuation of C!
tract tract
2. 2. For actulose: decreased ammonia For actulose: decreased ammonia
'he Anti 'he Antidiarrheals diarrheals
'hese are agents used to calm the irritation 'hese are agents used to calm the irritation
of the C!' for the symptomatic relief of of the C!' for the symptomatic relief of
diarrhea diarrhea
Ceneral Classifications Ceneral Classifications
1. ocal anti 1. ocal antimotility motility
2. ocal reflex inhibition 2. ocal reflex inhibition
3. Central action on the CNS 3. Central action on the CNS
'he Anti 'he Antidiarrheals diarrheals
Type Prototype Action
Local reflex inhibitor Bismuth subsalicylate
LocaIIy coats the
Iining of the GI% to
8oothe irritation that
may stimuIate the
refIex
Local anti-motility Loperamide
DirectIy inhibits the
intestinaI muscIe
activity to SLO
peri8tal8i8
Central acting agent Opium derivatives
(paregoric)
Stop8 GI% 8pa8m by
CNS action
Clinical !ndications of drug use Clinical !ndications of drug use
Relief of symptoms of acute and chronic Relief of symptoms of acute and chronic
diarrhea diarrhea
Reduction of fecal volume discharges from Reduction of fecal volume discharges from
ileostomies ileostomies
Prevention and treatment of traveler's Prevention and treatment of traveler's
diarrhea diarrhea
Contraindications of anti Contraindications of antidiarrheal diarrheal
Use Use
Poisoning Poisoning
Drug allergy Drug allergy
C! obstruction C! obstruction
Acute abdominal conditions Acute abdominal conditions
Pharmacokinetics: Side effects Pharmacokinetics: Side effects
Constipation Constipation
Nausea, vomiting Nausea, vomiting
Abdominal distention and discomfort Abdominal distention and discomfort
TOX!C NECACOLON TOX!C NECACOLON
Nursing process and anti Nursing process and antidiarrheals diarrheals
Nursing History Nursing History -- Elicit history of drug Elicit history of drug
allergy, conditions like poisoning, C! allergy, conditions like poisoning, C!
obstruction and acute abdominal conditions obstruction and acute abdominal conditions
Physical Examination Physical Examination Abdominal Abdominal
examination examination
aboratory test aboratory test electrolyte levels electrolyte levels
Alteration in bowel pattern Alteration in bowel pattern
Alteration in comfort: pain Alteration in comfort: pain
1. 1. Nonitor patient response within 48 hours. Nonitor patient response within 48 hours.
Discontinue drug use if no effect Discontinue drug use if no effect
2. 2. Provide comfort measures for pain Provide comfort measures for pain
3. 3. Provide teaching Provide teaching
EvAUA'!ON EvAUA'!ON
1. 1. Nonitor effectiveness of drug Nonitor effectiveness of drug REL!EF of REL!EF of
diarrhea diarrhea
2. 2. Nonitor adverse effects, effectiveness of Nonitor adverse effects, effectiveness of
pain measures and effectiveness of pain measures and effectiveness of
teaching plan teaching plan
Emetics and Anti Emetics and Antiemetics emetics
Emetic Agent Emetic Agent
Syrup of !pecac Syrup of !pecac
Anti Antiemetics emetics
1. Phenothiazines 1. Phenothiazines
2. Non 2. Nonphenothiazines phenothiazines
3. Anticholinergics/Antihistamines 3. Anticholinergics/Antihistamines
4. Serotonin receptor Blockers 4. Serotonin receptor Blockers
S. Niscellaneous S. Niscellaneous
ENE'!C ENE'!C
Prototype: !pecac Syrup Prototype: !pecac Syrup
ENE'!C ENE'!C
!pecac syrup irritates the C! mucosa locally, !pecac syrup irritates the C! mucosa locally,
resulting to stimulation of the vomiting resulting to stimulation of the vomiting
center center
!t acts within 20 minutes !t acts within 20 minutes
ENE'!C ENE'!C
Clinical Use of ipecac Clinical Use of ipecac
'o induce vomiting as a treatment for drug 'o induce vomiting as a treatment for drug
overdose and certain poisonings overdose and certain poisonings
ENE'!C ENE'!C
Contraindications of !pecac use Contraindications of !pecac use
!ngestion of CORROS!vE chemicals !ngestion of CORROS!vE chemicals
!ngestion of petroleum products !ngestion of petroleum products
Unconscious and convulsing patient Unconscious and convulsing patient
ENE'!C ENE'!C
Pharmacokinetics: side effects of !pecac Pharmacokinetics: side effects of !pecac
Nausea Nausea
Diarrhea Diarrhea
C! upset C! upset
Nild CNS depression Nild CNS depression
CARD!OTOX!C!TY if large amounts are CARD!OTOX!C!TY if large amounts are
absorbed in the body absorbed in the body
Nursing process and the ENE'!C Nursing process and the ENE'!C
Nursing History Nursing History elicit the exact nature of elicit the exact nature of
poisoning poisoning
Physical Examination Physical Examination CNS status and CNS status and
abdominal exam abdominal exam
1. 1. Administer to Administer to conscious patient only conscious patient only
2. 2. Administer ipecac Administer ipecac as soon as possible as soon as possible
3. 3. Administer with a large amount of water Administer with a large amount of water
4. 4. vomiting should occur within 20 minutes vomiting should occur within 20 minutes
of the first dose. of the first dose. Repeat the dose and Repeat the dose and
expect vomiting to occur with 20 minutes expect vomiting to occur with 20 minutes
S. Provide comfort measures like ready access S. Provide comfort measures like ready access
to bathroom, assistance with ambulation to bathroom, assistance with ambulation
6. Offer support 6. Offer support
EvAUA'!ON EvAUA'!ON
1. 1. Evaluate patient response within 20 Evaluate patient response within 20
minutes of drug ingestion minutes of drug ingestion
2. 2. Nonitor for adverse effects Nonitor for adverse effects
3. 3. Evaluate effectiveness of comfort Evaluate effectiveness of comfort
measures and teaching plan measures and teaching plan
AN'! AN'!ENE'!CS ENE'!CS
'hese are agents used to manage nausea 'hese are agents used to manage nausea
and vomiting and vomiting
'hey act either locally or centrally 'hey act either locally or centrally
AN'!ENE'!CS AN'!ENE'!CS
Anti-emetic types Common examples
Phenothiazines Prochlorperazine, promethazine
Non-phenothiazines Metoclopramide
Anticholinergics and Antihistaminics Meclizine, buclizine
Serotonin Receptor blockers "setron- dolasetron
Miscellaneous Dronabinol, hydroxyzine
Types Pharmacodynamics
Phenothiazines
Centrally block the vomiting
center in the medulla
Non-phenothiazine
Reduces the responsiveness
of the nerve cell in the
medulla
Anticholinergics
Block the transmission of the
impulses to the medulla
Serotonin receptor blockers
Centrally and locally inhibits
the serotonin receptors
Miscellaneous
Act in the CNS , either in the
medulla or in the cortex
Types Clinical Use
Phenothiazines
N/V associated with
anesthesia, intractable
hiccups
Non-phenothiazine
N/V associated with
chemical stimulation
Anticholinergics
N/V associated with motion
sickness
Serotonin-receptor Blockers N/V associated with chemotherapy
Miscellaneous N/V associated with chemotherapy
Contraindications Contraindications
1. Severe CNS depression 1. Severe CNS depression
2. Severe liver dysfunction 2. Severe liver dysfunction
Pharmacokinetics: Side Pharmacokinetics: Sideeffects effects
1. 1. PHOTHOSENS!T!v!TY PHOTHOSENS!T!v!TY
2. 2. Drowsiness, dizziness, weakness and Drowsiness, dizziness, weakness and
tremors and DEHYDRATON tremors and DEHYDRATON
3. Phenothiazines autonomic 3. Phenothiazines autonomic anti anti
cholinergic effects cholinergic effects like dry mouth, nasal like dry mouth, nasal
congestion and urinary retention congestion and urinary retention
Nursing Process and the Nursing Process and the
Nursing History Nursing History elicit allergy, impaired elicit allergy, impaired
hepatic function and CNS depression hepatic function and CNS depression
Physical Examination Physical Examination CNS status and CNS status and
abdominal examination abdominal examination
aboratory test aboratory test iver function studies iver function studies
1. 1. Alteration in comfort: pain Alteration in comfort: pain
2. 2. High risk for injury High risk for injury
3. 3. Knowledge deficit Knowledge deficit
1. 1. Assess patient's intake of other drugs that Assess patient's intake of other drugs that
may cause dangerous drug interaction may cause dangerous drug interaction
2. 2. Emphasize that this is given on a short Emphasize that this is given on a short
term basis term basis
3. 3. Provide comfort and safety measures Provide comfort and safety measures
Advise to change position slowly Advise to change position slowly
Avoid hazardous activities Avoid hazardous activities
Provide mouth care and ice chips Provide mouth care and ice chips
Nonitor for dehydration and offer fluids Nonitor for dehydration and offer fluids
if it occurs if it occurs
4. Protect from sun exposure 4. Protect from sun exposure
Sunscreens Sunscreens
Protective covering Protective covering
S. Provide health teaching S. Provide health teaching
EvAUA'!ON EvAUA'!ON
1. 1. Nonitor for the drug effectiveness Nonitor for the drug effectiveness
- - Relief of nausea and vomiting Relief of nausea and vomiting
2. Nonitor for adverse effects 2. Nonitor for adverse effects
3. Evaluate effectiveness of comfort measures 3. Evaluate effectiveness of comfort measures
and teaching plan and teaching plan
Pharmacology of the Pharmacology of the
Selected Endocrine Selected Endocrine
Drugs Drugs
Nursing Review Nursing Review
Endocrine Medications Endocrine Medications
Anti Anti- -diuretic hormones diuretic hormones
Enhance re Enhance re- -absorption of water in the absorption of water in the
kidneys kidneys
Used in DI Used in DI
1. Desmopressin and Lypressin 1. Desmopressin and Lypressin
intranasaIIy intranasaIIy
2. Pitressin IM 2. Pitressin IM
Endocrine Medications Endocrine Medications
Anti Anti- -diuretic hormones diuretic hormones
SIDE SIDE- -effects effects
FIushing and headache FIushing and headache
Water intoxication Water intoxication
Thyroid Medications Thyroid Medications
%hyroid hormones %hyroid hormones
%hese products are used to treat %hese products are used to treat
the manifestations of the manifestations of
hypothyroidism hypothyroidism
RepIace hormonaI deficit in the RepIace hormonaI deficit in the
treatment of HYPO%HYROIDSM treatment of HYPO%HYROIDSM
Levothyroxine (Synthroid Levothyroxine (Synthroid
Liothyroxine (CytomeI Liothyroxine (CytomeI
%hyroid dessicated %hyroid dessicated
Liotrix (%hyroIar Liotrix (%hyroIar
%hyroid hormones: Actions %hyroid hormones: Actions
Increase the metaboIic rate Increase the metaboIic rate
Increase O2 consumption Increase O2 consumption
Increase HR, RR, BP Increase HR, RR, BP
Side Side- -effects effects
1. 1. Nausea and Vomiting Nausea and Vomiting
2. 2. Signs of increased metaboIism= Signs of increased metaboIism=
tachycardia, hypertension, tachycardia, hypertension,
cardiac arrhythmias, anxiety, cardiac arrhythmias, anxiety,
headache headache
%hyroid hormones : Nursing responsibiIity %hyroid hormones : Nursing responsibiIity
1. Monitor weight, VS 1. Monitor weight, VS
2. Instruct cIient to take daiIy 2. Instruct cIient to take daiIy
medication the same time medication the same time each each
morning I%HO&% FOOD morning I%HO&% FOOD
Monitor bIood tests to check the Monitor bIood tests to check the
activity of thyroid activity of thyroid
%hyroid hormones: Nursing responsibiIity %hyroid hormones: Nursing responsibiIity
3. Advise to report paIpitation, 3. Advise to report paIpitation,
tachycardia, and chest pain tachycardia, and chest pain
4. Instruct to avoid foods that 4. Instruct to avoid foods that
inhibit thyroid secretions Iike inhibit thyroid secretions Iike
cabbage, spinach and radishes cabbage, spinach and radishes
ANT ANT- -Thyroid Medications Thyroid Medications
AN%I AN%I- -%HYROID medications %HYROID medications
%he thyroid becomes %he thyroid becomes
oversaturated with iodine and oversaturated with iodine and
stop producing thyroid stop producing thyroid
hormone hormone
Drugs used to BLOCK the Drugs used to BLOCK the
thyroid hormones and treat thyroid hormones and treat
hyperthyroidism hyperthyroidism
Inhibit the synthesis of thyroid Inhibit the synthesis of thyroid
hormones hormones
1. MethimazoIe (%apazoIe 1. MethimazoIe (%apazoIe
2. P%U (prophyIthiouraciI 2. P%U (prophyIthiouraciI
3. Iodine soIution 3. Iodine soIution- - SSKI and SSKI and
LugoI's soIution LugoI's soIution
Side Side- -effects of thionamides effects of thionamides
N/V, drowsiness, Iethargy, N/V, drowsiness, Iethargy,
bradycardia, skin rash bradycardia, skin rash
GI compIaints GI compIaints
AGRAN&LOCY%OSIS AGRAN&LOCY%OSIS
o8t important to monitor o8t important to monitor
Side Side- -effects of Iodine soIutions effects of Iodine soIutions
Most common adverse effects is Most common adverse effects is
HYPO%HYROIDISM HYPO%HYROIDISM
Iodism= metaIIic taste, burning in Iodism= metaIIic taste, burning in
the mouth, sore teeth and gums, the mouth, sore teeth and gums,
diarrhea, stomach upset diarrhea, stomach upset
Nursing responsibiIities Nursing responsibiIities
1. Monitor VS, %3 and %4, 1. Monitor VS, %3 and %4,
weight weight
2. %he medications 2. %he medications I%H I%H
EALS EALS to avoid gastric upset to avoid gastric upset
AN%I AN%I- -%HYROID medications Nursing %HYROID medications Nursing
responsibiIities responsibiIities
3. Instruct to report SORE 3. Instruct to report SORE
%HROA% or unexpIained %HROA% or unexpIained
FEVER FEVER
4. Monitor for signs of 4. Monitor for signs of
hypothyroidism. hypothyroidism.
Instruct not to stop abrupt Instruct not to stop abrupt
medication medication
LugoI's SoIution LugoI's SoIution
Used to decrease the vascuIarity of the Used to decrease the vascuIarity of the
thyroid (in preparation for thyroid surgery thyroid (in preparation for thyroid surgery
%3 and %4 production diminishes %3 and %4 production diminishes
Given per orem, can be diIuted with juice Given per orem, can be diIuted with juice
Use straw to decrease staining Use straw to decrease staining
Monitor iodism (metaIIic taste, burning in Monitor iodism (metaIIic taste, burning in
mouth mouth
STERODS STERODS
RepIaces the steroids in RepIaces the steroids in
the body the body
Interfere with the reIease Interfere with the reIease
of infIammatory factors of infIammatory factors
and immune responses and immune responses
STERODS STERODS
CortisoI, cortisone, CortisoI, cortisone,
betamethasone, and betamethasone, and
hydrocortisone hydrocortisone
Dexamethasone= Iong Dexamethasone= Iong
acting acting
STERODS STERODS
%hese drugs enter the %hese drugs enter the
ceIIs and bind to ceIIs and bind to
receptors receptors
%hey inhibit the enzyme %hey inhibit the enzyme
phosphoIipase phosphoIipase
STERODS STERODS
Corticosteroids are used topicaIIy Corticosteroids are used topicaIIy
and IocaIIy to achieve the desired and IocaIIy to achieve the desired
anti anti- -infIammatory effects at a infIammatory effects at a
particuIar site particuIar site
STERODS STERODS
Steroid Steroid Clinical use Clinical use
Dexamethasone Dexamethasone Use to induce the Use to induce the
formation of lung formation of lung
surfactant surfactant
Other steroids Other steroids Use for the treatment of Use for the treatment of
immune immune- -related related
diseases, control of diseases, control of
asthma and allergic asthma and allergic
symptoms symptoms
STERODS STERODS
HYPERgIycemia HYPERgIycemia
Increased susceptibiIity to Increased susceptibiIity to
infection infection
(immunosuppression (immunosuppression
HypokaIemia HypokaIemia
Edema and Hypertension Edema and Hypertension
!eptic ulceration !eptic ulceration
STERODS STERODS
If high doses If high doses- - osteoporosis, osteoporosis,
growth retardation, peptic growth retardation, peptic
uIcer, hypertension, uIcer, hypertension,
cataract cataract, mood changes, , mood changes,
hirsutism, and fragiIe skin hirsutism, and fragiIe skin
STERODS STERODS
1. Monitor VS, eIectroIytes, 1. Monitor VS, eIectroIytes,
gIucose gIucose
2. Monitor weight edema 2. Monitor weight edema
and I/O. Encourage and I/O. Encourage
Potassium suppIements Potassium suppIements
STERODS STERODS
3. Protect patient from infection 3. Protect patient from infection
4. HandIe patient gentIy 4. HandIe patient gentIy
5. Instruct to take meds 5. Instruct to take meds I%H I%H
EALS EALS to prevent gastric uIcer to prevent gastric uIcer
formation formation
STERODS STERODS
. Caution the patient NO% to . Caution the patient NO% to
abruptIy stop the drug abruptIy stop the drug
7. 7. Drug i8 tapered to allow the Drug i8 tapered to allow the
adrenal gland to 8ecrete adrenal gland to 8ecrete
endogenou8 hormone8 endogenou8 hormone8
STERODS STERODS
EvaIuation: EvaIuation:
%he drugs are effective if there %he drugs are effective if there
is: is:
1. 1. ReIief of signs and symptoms ReIief of signs and symptoms
of infIammation of infIammation
2. 2. Return of adrenaI function to Return of adrenaI function to
normaI normaI
'he cardiac glycosides 'he cardiac glycosides
'hese are agents extracted from the 'hese are agents extracted from the
foxglove plant. 'hey are available in foxglove plant. 'hey are available in
oral and parenteral preparations. 'he oral and parenteral preparations. 'he
following are the cardiac glycosides: following are the cardiac glycosides:
Digoxin (anoxin) Digoxin (anoxin)
Digitoxin (Crystodigin) Digitoxin (Crystodigin)
Ouabain Ouabain
Pharmacodynamics: the Nechanism of Pharmacodynamics: the Nechanism of
action action
'hey 'hey increase the level of increase the level of
CALC!UN CALC!UN inside the cell by inhibiting inside the cell by inhibiting
the Sodium the SodiumPotassium pump. Potassium pump.
Nore calcium will accumulate inside Nore calcium will accumulate inside
the cell during cellular depolarization. the cell during cellular depolarization.
Positive inotropic Positive inotropic Effect Effect the the
myocardium will contract forcefully myocardium will contract forcefully
-- !ncreased cardiac output !ncreased cardiac output
-- !ncreased blood flow to the body organs like !ncreased blood flow to the body organs like
the kidney and liver the kidney and liver
Negative chronotropic Negative chronotropic effect effect the heart the heart
rate is slowed due to decreased rate of rate is slowed due to decreased rate of
cellular repolarization cellular repolarization
-- Bradycardia Bradycardia
Decreased conduction velocity Decreased conduction velocity
through the Av node through the Av node
Clinical Use of the cardiac glycosides Clinical Use of the cardiac glycosides
'reatment of 'reatment of congestive heart failure congestive heart failure
'reatment of 'reatment of dysrhythmias dysrhythmias like atrial like atrial
flutter, atrial fibrillation and flutter, atrial fibrillation and
paroxysmal atrial tachycardia paroxysmal atrial tachycardia
Contraindications and Precautions Contraindications and Precautions
Contraindicated in the presence of allergy Contraindicated in the presence of allergy
to any cardiac glycoside. to any cardiac glycoside.
'hey are 'hey are NOT NOT given to patients with given to patients with
ventricular dysrhythmias, heart block or ventricular dysrhythmias, heart block or
sick sinus syndrome, aortic stenosis, acute sick sinus syndrome, aortic stenosis, acute
N!, electrolyte imbalances N!, electrolyte imbalances
((HYPOKALEN!A, HYPONACNESEN!A HYPOKALEN!A, HYPONACNESEN!A
and HYPERCALCEN!A and HYPERCALCEN!A) and ) and renal failure renal failure
(may cause accumulation of drug) (may cause accumulation of drug)
Pharmacodynamics: the Adverse Effects of the Pharmacodynamics: the Adverse Effects of the
Cardiac glycosides Cardiac glycosides
CNS CNS Headache, weakness , seizures and Headache, weakness , seizures and
drowsiness drowsiness
CvS CvS arrhythmias arrhythmias
!f digitalis toxicity is developing !f digitalis toxicity is developing the nurse must the nurse must
assess the following adverse effects: assess the following adverse effects: Anorexia, Anorexia,
nausea and vomiting, visual changes nausea and vomiting, visual changes
YELLOW halo around an object, and YELLOW halo around an object, and
palpitations or very slow heart rate palpitations or very slow heart rate
Remember NAvDA and hypokalemia Remember NAvDA and hypokalemia
Drug DrugDrug !nteractions Drug !nteractions
!f taken with potassium !f taken with potassium losing losing
diuretics like furosemide diuretics like furosemide can can
!NCREASE the risk of toxicity and !NCREASE the risk of toxicity and
arrhythmias. Potassium replacement arrhythmias. Potassium replacement
must be given. must be given.
!mplementation !mplementation
Administer the initial rapid digitalization Administer the initial rapid digitalization
and loading dose as ordered intravenously and loading dose as ordered intravenously
Nonitor the Nonitor the AP!CAL AP!CAL pulse rate for ONE pulse rate for ONE
full minute before administering the drug. full minute before administering the drug.
ithhold the drug if ithhold the drug if
-- ess than 60 in adults ess than 60 in adults
-- ess than 30 in infants ess than 30 in infants
-- Nore than 110 in adults Nore than 110 in adults
Retake pulse in one hour, if pulses remain Retake pulse in one hour, if pulses remain
abnormal, refer! abnormal, refer!
Check the spelling of the drug Check the spelling of the drug D!COX!N D!COX!N
is different from D!C!'OX!N! is different from D!C!'OX!N!
Check the dosage preparation and the Check the dosage preparation and the
level of digitalis in the blood. ( level of digitalis in the blood. ('herapeutic 'herapeutic
level is 0.S to 2.0 nanograms/m level is 0.S to 2.0 nanograms/m))
Administer intravenous drug vER slow !v Administer intravenous drug vER slow !v
over S minutes to avoid arrhythmias. Do over S minutes to avoid arrhythmias. Do
NO' administer intramuscularly because it NO' administer intramuscularly because it
can cause severe pain can cause severe pain
Administer the drug Administer the drug without food if possible without food if possible
to avoid delayed absorption to avoid delayed absorption. eight patient . eight patient
daily to determine fluid retention daily to determine fluid retention
Naintain emergency equipment and drugs Naintain emergency equipment and drugs
Potassium salts, idocaine for arrhythmias, Potassium salts, idocaine for arrhythmias,
phenytoin for seizures, atropine for bradycardia. phenytoin for seizures, atropine for bradycardia.
Provide comfort measures Provide comfort measures small, frequent small, frequent
meals, adequate lighting, comfortable position, meals, adequate lighting, comfortable position,
rest periods and safety precautions rest periods and safety precautions
Provide health teaching Provide health teaching drug name, action, drug name, action,
dosage and side effects. Advise the patient to dosage and side effects. Advise the patient to
report any of the following: report any of the following: visual changes, visual changes,
rapid weight gain, unusually low heart rapid weight gain, unusually low heart
rate, persistent nausea, vomiting and rate, persistent nausea, vomiting and
anorexia anorexia
Nonitor serum potassium level Nonitor serum potassium level
Evaluate effectiveness of the drug: Evaluate effectiveness of the drug:
!ncreased urine output !ncreased urine output
Normal heart rate in arrhythmia Normal heart rate in arrhythmia
The Antianginal drugs The Antianginal drugs
!n the treatment of angina, three agents !n the treatment of angina, three agents
are commonly employed are commonly employed
-- Organic nitrates Organic nitrates
-- Beta Beta blockers and blockers and
-- Calcium Calcium channel blockers. channel blockers.
'he benefits of the drugs lie in their 'he benefits of the drugs lie in their
different mode of action. different mode of action.
'he nitrates can cause vasodilatation 'he nitrates can cause vasodilatation
of the veins and to some extent, of the veins and to some extent,
coronary artery coronary artery
Beta Betablockers will decrease the heart blockers will decrease the heart
rate rate
Calcium Calciumchannel blockers will channel blockers will
decrease force of contraction leading decrease force of contraction leading
to a decreased myocardial workload to a decreased myocardial workload
and demand. and demand.
'hey can also produce vasodilation 'hey can also produce vasodilation
'he Organic nitrates 'he Organic nitrates
'hese agents are simple nitric and nitrous 'hese agents are simple nitric and nitrous
acid esters of alcohols. Being alcohol, they acid esters of alcohols. Being alcohol, they
differ in their volatility. 'he following are differ in their volatility. 'he following are
the nitrates commonly used: the nitrates commonly used:
Nitroglycerin Nitroglycerin A moderately volatile A moderately volatile
nitrate nitrate
!sosorbide Dinitrate (!sordil) or !sosorbide Dinitrate (!sordil) or
mononitrate mononitrate
Amyl nitrate Amyl nitrate an extremely volatile nitrate an extremely volatile nitrate
Nitroglycerin Nitroglycerin
'his agent is supplied in oral, spray, 'his agent is supplied in oral, spray,
transdermal and ointment preparations. transdermal and ointment preparations.
Pharmacodynamics: the mechanism of Pharmacodynamics: the mechanism of
action action
Nitroglycerin relaxes the smooth Nitroglycerin relaxes the smooth
muscles in the vascular system muscles in the vascular system
by its conversion to nitric oxide, by its conversion to nitric oxide,
a chemical mediator in the body a chemical mediator in the body
that relaxes smooth muscles. that relaxes smooth muscles.
Administered nitrates Administered nitrates
!ncreased nitrates in the blood !ncreased nitrates in the blood
increased formation of nitric oxide increased formation of nitric oxide
increased cCNP formation increased cCNP formation
increased dephosphorylation of myosin increased dephosphorylation of myosin
vascular smooth muscle relaxation vascular smooth muscle relaxation
vasodilatation vasodilatation
Pharmacokinetics Pharmacokinetics absorption to excretion absorption to excretion
!t can be given orally, parenterally and !t can be given orally, parenterally and
topically. topically.
'he onset of action of nitroglycerin is 'he onset of action of nitroglycerin is
more than 1 hour. more than 1 hour.
Because significant first Because significant firstpass hepatic pass hepatic
effect, effect, Nitroglycerin is given Nitroglycerin is given
SUB!NCUA. SUB!NCUA.
Pharmacodynamics: Side effects and Pharmacodynamics: Side effects and
adverse effects adverse effects
HEADACHE is the most common HEADACHE is the most common
effect of nitroglycerin effect of nitroglycerin..
CvS CvS postural Hypotension, facial flushing, postural Hypotension, facial flushing,
tachycardia tachycardia
'OERANCE 'OERANCE the tolerance to the actions the tolerance to the actions
of nitrates develop rapidly. 'his can be of nitrates develop rapidly. 'his can be
managed by providing a day of managed by providing a day of
abstinence. abstinence.
'he Nitrates 'he Nitrates
Nonitor vital signs, especially watchful for Nonitor vital signs, especially watchful for
hypotensive episodes hypotensive episodes
Advise patient to remain supine or sit on a Advise patient to remain supine or sit on a
chair when taking the nitroglycerin for the chair when taking the nitroglycerin for the
first time. Emphasize that he should first time. Emphasize that he should
change his position slowly or rise from bed change his position slowly or rise from bed
slowly to avoid orthostatic Hypotension slowly to avoid orthostatic Hypotension
Offer sips of water before giving Offer sips of water before giving
sublingual nitroglycerin because dryness sublingual nitroglycerin because dryness
may inhibit drug absorption may inhibit drug absorption
Apply nitroglycerin ointment to the Apply nitroglycerin ointment to the
designated mark on paper. designated mark on paper.
'he nurse should remove any excess 'he nurse should remove any excess
ointment on the skin from the previous ointment on the skin from the previous
dose. dose.
She should She should NEvER USE NEvER USE her bare fingers her bare fingers
because the drug can be absorbed, utilize because the drug can be absorbed, utilize
gloves or tongue blades instead. gloves or tongue blades instead.
Apply nitroglycerin patch to an area with Apply nitroglycerin patch to an area with
few hairs. Never touch the medication few hairs. Never touch the medication
portion. portion.
'he patch and the ointment should NO' 'he patch and the ointment should NO'
be applied near the area for defibrillation be applied near the area for defibrillation
because explosion and skin burns may because explosion and skin burns may
result result
Emphasize that tolerance to the Emphasize that tolerance to the
nitroglycerin can occur. nitroglycerin can occur.
!f the medication cannot relieve the pain, !f the medication cannot relieve the pain,
report to the hospital immediately. report to the hospital immediately.
Provide client health teaching Provide client health teaching the sublingual the sublingual
nitroglycerin tablet is USED if chest pain occurs nitroglycerin tablet is USED if chest pain occurs
The dose may be repeated if pain is The dose may be repeated if pain is
unrelieved within S minutes. unrelieved within S minutes.
Repeat the medication administration if Repeat the medication administration if
the pain has not yet subsided the pain has not yet subsided. .
DO NOT give more than 3 tablets! DO NOT give more than 3 tablets!!! !f !! !f
chest pain persists for more than 1S chest pain persists for more than 1S
minutes, hospital consult should be done minutes, hospital consult should be done
immediately. immediately.
!nstruct the client to avoid alcohol while !nstruct the client to avoid alcohol while
taking nitroglycerin to avoid potentiating taking nitroglycerin to avoid potentiating
the hypotensive effect of the medication the hypotensive effect of the medication
!f beta blockers and calcium !f beta blockers and calciumchannel channel
blockers are given, instruct the patients to blockers are given, instruct the patients to
consult the physician before discontinuing consult the physician before discontinuing
the medication the medication
Other components of health teaching for Other components of health teaching for
home self home selfadministration: administration:
-- !f taking Sublingual Nitroglycerin, the patient !f taking Sublingual Nitroglycerin, the patient
should be instructed to should be instructed to place the tablet place the tablet
under the tongue under the tongue for quick absorption. for quick absorption.
-- A burning sensation/biting/stinging sensation A burning sensation/biting/stinging sensation
may indicate that the tablet is may indicate that the tablet is FRESH! FRESH!
-- Store the tablet in a Store the tablet in a dark container dark container, keep it , keep it
away from heat and direct sunlight to avoid away from heat and direct sunlight to avoid
lessening the potency lessening the potency
Other components of health teaching for home Other components of health teaching for home
self selfadministration: administration:
-- HEADACHES HEADACHES are common in the initial period of are common in the initial period of
nitroglycerin therapy. Advise patient to take nitroglycerin therapy. Advise patient to take
PARACE'ANO for relief PARACE'ANO for relief
-- 'he nitroglycerin patch is applied once a day, 'he nitroglycerin patch is applied once a day,
usually in the morning. 'he sites should be usually in the morning. 'he sites should be
rotated, in the chest, arms and thighs avoiding rotated, in the chest, arms and thighs avoiding
hairy areas. hairy areas.
Other components of health teaching for Other components of health teaching for
home self home selfadministration: administration:
-- Position supine with elevated legs to manage Position supine with elevated legs to manage
Hypotension. Hypotension.
-- Nitroglycerin tablet can be taken Nitroglycerin tablet can be taken
prophylactically in situations where chest prophylactically in situations where chest
pain is anticipated pain is anticipated Sex, exercise, etc.. Sex, exercise, etc..
-- !f patient is taking beta blockers, instruct how !f patient is taking beta blockers, instruct how
to obtain heart rate in a minute to obtain heart rate in a minute
Drugs for Shock Drugs for Shock
Dopamine Dopamine
'his is a sympathomimetic drug often 'his is a sympathomimetic drug often
used to treat Hypotension in shock states used to treat Hypotension in shock states
that are not caused by Hypovolemia. that are not caused by Hypovolemia.
'his drug is an immediate precursor of 'his drug is an immediate precursor of
nor norepinephrine, occurs naturally in the epinephrine, occurs naturally in the
CNS basal ganglia where it functions as a CNS basal ganglia where it functions as a
neurotransmitter. neurotransmitter.
Dopamine Dopamine
Pharmacodynamics: !t can activate the Pharmacodynamics: !t can activate the
alpha and beta adrenergic receptor alpha and beta adrenergic receptor
depending upon the concentration. !t depending upon the concentration. !t
stimulates receptors to cause stimulates receptors to cause cardiac cardiac
stimulation and renal vasodilation stimulation and renal vasodilation. .
'he dose range is 1 'he dose range is 120 micrograms/kg/min 20 micrograms/kg/min
Dopamine Dopamine
Pharmacokinetics: Dopamine is Pharmacokinetics: Dopamine is
administered !v, excreted in the urine. administered !v, excreted in the urine.
At At low dose low dose ((112 micrograms 2 micrograms), ),
dopamine D!A'ES the renal and dopamine D!A'ES the renal and
mesenteric blood vessels producing an mesenteric blood vessels producing an
increase output (dopaminergic effect) increase output (dopaminergic effect)
Dopamine Dopamine
At At moderate dose moderate dose of of 2210 micrograms, 10 micrograms,
dopamine enhance cardiac output by dopamine enhance cardiac output by
increasing heart rate ( increasing heart rate (beta 1 beta 1adrenergic adrenergic
effect) effect) and elevates blood pressure and elevates blood pressure
through peripheral vasoconstriction through peripheral vasoconstriction (alpha (alpha
adrenergic effect) adrenergic effect)
Dopamine Dopamine
At higher doses of At higher doses of more than 10 more than 10
micrograms micrograms vasoconstriction of all vasoconstriction of all
vessels vessels will predominate that can lead to will predominate that can lead to
diminished tissue perfusion diminished tissue perfusion
Dopamine Dopamine
Dopamine is indicated to treat Hypotension, to Dopamine is indicated to treat Hypotension, to
increase heart rate and to increase urine output increase heart rate and to increase urine output
(given less than S mg/kg/min) (given less than S mg/kg/min)
'he nurse typically prepares the dopamine drip 'he nurse typically prepares the dopamine drip
dopamine (at a concentration of 400 dopamine (at a concentration of 400800 mg) is 800 mg) is
mixed in 2S0 m DS and administered as drip mixed in 2S0 m DS and administered as drip
via an infusion pump for precise dosage via an infusion pump for precise dosage
administration. administration.
Sodium bicarbonate will inactivate the dopamine Sodium bicarbonate will inactivate the dopamine
Dopamine Dopamine
Pharmacodynamics: side effects Pharmacodynamics: side effects
'achycardia 'achycardia
hypertension hypertension
ectopic beats, angina, dysrhythmias, ectopic beats, angina, dysrhythmias,
myocardial ischemia, nausea and myocardial ischemia, nausea and
vomiting. vomiting.
Dopamine: Nursing consideration Dopamine: Nursing consideration
-- Check the !v site hourly for signs of drug Check the !v site hourly for signs of drug
infiltration of dopamine, which can cause infiltration of dopamine, which can cause
tissue necrosis. tissue necrosis.
-- Phentolamine Phentolamine should be infiltrated in should be infiltrated in
multiple areas to reduce tissue damage. multiple areas to reduce tissue damage.
-- Drug is effective if Urine output is increased Drug is effective if Urine output is increased
and BP is increased and BP is increased
Antihypertensive drugs Antihypertensive drugs
The Drugs employed to control hypertension The Drugs employed to control hypertension
can be classified as: can be classified as:
Diuretics Diuretics
Beta Beta blockers blockers
Alpha adrenergic blockers Alpha adrenergic blockers
Calcium channel blockers Calcium channel blockers
Angiotensin Angiotensin converting enzyme inhibitors converting enzyme inhibitors
Angiotensin !! receptor blockers Angiotensin !! receptor blockers
Peripheral vasodilators Peripheral vasodilators
Common Drugs in HPN Common Drugs in HPN
!N Evaluating the effectiveness of these !N Evaluating the effectiveness of these
drugs is simply to monitor the BP if it drugs is simply to monitor the BP if it
becomes NORNA becomes NORNA
Anti Antihypertensive drugs hypertensive drugs
Class Class Prototype Prototype NOA NOA Side effects Side effects
Diuretics Diuretics Furosemide Furosemide Decreases blood Decreases blood
volume volume
Hypokalemia Hypokalemia
Beta Beta blocker blocker Propranolol Propranolol Blocks B1 receptor Blocks B1 receptor
in the heart in the heart
Bradycardia, Bradycardia,
hypoglycemia hypoglycemia
ACE ACE
!nhibitors !nhibitors
Captopril Captopril Prevents A1 to A!! Prevents A1 to A!!
conversion conversion
Headache, Cough, Headache, Cough,
flushing flushing
Ca channel Ca channel
blockers blockers
Nifedipine Nifedipine Blocks Ca entry Blocks Ca entry
into cell into cell
Headache, flushing, Headache, flushing,
reflex tachycardia reflex tachycardia
vasodilator vasodilator Nitroglycerin Nitroglycerin Dilates veins and Dilates veins and
arteries arteries
HEADACHE HEADACHE
Alpha Alpha
blockers blockers
Prazozin Prazozin Blocks alpha Blocks alpha
receptor in Bv receptor in Bv
causing causing
vasodilatation vasodilatation
Urination Urination
Central alpha Central alpha
agonist agonist
Clonidine Clonidine Stimulates CNS Stimulates CNS
alpha 2 receptor alpha 2 receptor
Depression Depression
Anticoagulants Anticoagulants
HEPAR!N HEPAR!N WARFAR!N WARFAR!N
Parenteral (SQ and !v) Parenteral (SQ and !v) Oral Oral
Action is to enhance natural Action is to enhance natural
anti anti thrombin !!! in the blood thrombin !!! in the blood
Action is to !NH!B!T vitamin Action is to !NH!B!T vitamin K K
dependent clotting factors dependent clotting factors
(10,3,7,2) (10,3,7,2)
Acts within minutes Acts within minutes Acts within days Acts within days
Nonitor for aPTT Nonitor for aPTT Nonitor for PT and !NR Nonitor for PT and !NR
Large molecule, can be given to Large molecule, can be given to
pregnant pregnant
Small molecule CANNOT be Small molecule CANNOT be
given to pregnant given to pregnant
Antidote: Protamine Antidote: Protamine
sulfate sulfate
Antidote: vit. K Antidote: vit. K
SE: bleeding, decreased SE: bleeding, decreased
platelets platelets
SE: Bleeding SE: Bleeding
The antianemics: !ron The antianemics: !ron
preparations and Epoetin preparations and Epoetin
!ron preparations !ron preparations
!ron is important for hemoglobin formation. !ron is important for hemoglobin formation.
'he iron preparations are: 'he iron preparations are:
Ferrous sulfate Ferrous sulfate
Ferrous fumarate Ferrous fumarate
Ferrous gluconate Ferrous gluconate
Side Side effects: effects:
C!T C!T constipation (usually), diarrhea, constipation (usually), diarrhea,
vomiting, vomiting, epigastric pain, gastric epigastric pain, gastric
ulceration and ulceration and darkening of stools. darkening of stools.
Liquid preparation can stain the Liquid preparation can stain the
teeth, and injectable iron can cause teeth, and injectable iron can cause
tissue discoloration tissue discoloration
Other Other dizziness dizziness
Drug Drug Drug interaction Drug interaction
'etracyclines combine with iron 'etracyclines combine with iron
preparations and render the iron preparations and render the iron
unabsorbable. unabsorbable.
Antacids and cimetidine Antacids and cimetidine decrease iron decrease iron
absorption and effects absorption and effects
Foods can impair iron absorption but they Foods can impair iron absorption but they
should be taken with iron to reduce C! should be taken with iron to reduce C!
discomfort. discomfort.
Nilk containing foods, coffee, tea and eggs Nilk containing foods, coffee, tea and eggs
are NO' given with iron because they delay are NO' given with iron because they delay
iron absorption. iron absorption.
Encourage the patient to eat iron Encourage the patient to eat ironrich foods like liver, lean rich foods like liver, lean
meat, egg yolk, dried beans, green leafy vegetables. meat, egg yolk, dried beans, green leafy vegetables.
Administer iron preparations orally with foods to decrease C! Administer iron preparations orally with foods to decrease C!
discomfort. discomfort.
!f increased absorption is necessary, administer !N BE'EEN !f increased absorption is necessary, administer !N BE'EEN
meals with full glass of water or juice. meals with full glass of water or juice.
!t is best to offer citrus juices because the vitamin C !t is best to offer citrus juices because the vitamin C
content can increase iron absorption. content can increase iron absorption.
!nstruct the patient to swallow the whole tablet and remain !nstruct the patient to swallow the whole tablet and remain
upright for 30 minutes to prevent esophageal corrosion from upright for 30 minutes to prevent esophageal corrosion from
reflux. reflux.
DO NO' administer iron together with or within 1 hour of DO NO' administer iron together with or within 1 hour of
ingesting tetracyclines, antacids, milk and milk ingesting tetracyclines, antacids, milk and milkcontaining containing
products. products.
Advise clients to increase fluid intake and consume fiber rich Advise clients to increase fluid intake and consume fiber rich
foods if constipation becomes a problem. foods if constipation becomes a problem.
Emphasize that the therapeutic effect of iron Emphasize that the therapeutic effect of iron
therapy may not be apparent until several therapy may not be apparent until several
weeks. weeks.
!f injecting a parenteral iron preparation, inject !f injecting a parenteral iron preparation, inject
DEEP !N utilizing DEEP !N utilizing the Z the Z track method to avoid track method to avoid
leakage into the subcutaneous tissues and skin leakage into the subcutaneous tissues and skin. .
Offer straw if giving liquid iron preparation to Offer straw if giving liquid iron preparation to
avoid staining the teeth. avoid staining the teeth.
To prevent undue alarm, instruct the patient To prevent undue alarm, instruct the patient
that the stools may turn black or dark green. that the stools may turn black or dark green.
This is a harmless occurrence. This is a harmless occurrence.
'he nurse evaluates the effectiveness of the 'he nurse evaluates the effectiveness of the
drug therapy by determining that the drug therapy by determining that the client is client is
not fatigued, with absence of pallor, and with not fatigued, with absence of pallor, and with
hemoglobin results within desired range hemoglobin results within desired range. .
Erythropoietin Erythropoietin
The mechanism of action of epoetin The mechanism of action of epoetin
alfa alfa
(Epogen) (Epogen)
'his drug acts like the natural glycoprotein 'his drug acts like the natural glycoprotein
erythropoietin to stimulate the production erythropoietin to stimulate the production
of RBC in the bone marrow. of RBC in the bone marrow.
Clinical indications Clinical indications
!t is given SUBCU'ANEOUS or !t is given SUBCU'ANEOUS or
!N'RAvENOUS !N'RAvENOUS for the treatment of for the treatment of
anemia associated with renal failure or for anemia associated with renal failure or for
patients on dialysis patients on dialysis. .
!t is also used in patients for blood !t is also used in patients for blood
transfusion to decrease the need for blood transfusion to decrease the need for blood
in surgical patients. in surgical patients.
Pharmacodynamics: the adverse Pharmacodynamics: the adverse
effects of epoetin alfa effects of epoetin alfa
CNS CNS headache, fatigue, asthenia, headache, fatigue, asthenia,
dizziness and seizures dizziness and seizures these are due to these are due to
the cellular response to the glycoprotein. the cellular response to the glycoprotein.
C!' C!' nausea, vomiting and diarrhea nausea, vomiting and diarrhea
CvS CvS hypertension, edema and hypertension, edema and chest pain chest pain
due to increase RBC number due to increase RBC number
Administer the drug SC or !v usually 3 times per week. Administer the drug SC or !v usually 3 times per week.
Nonitor the !v access line if given !v. Do not mix with Nonitor the !v access line if given !v. Do not mix with
other solutions other solutions
Determine periodically the level of hematocrit and iron Determine periodically the level of hematocrit and iron
stores during therapy. !f patient does not respond to the stores during therapy. !f patient does not respond to the
drug, reevaluate the cause of anemia. drug, reevaluate the cause of anemia.
Naintain seizure precaution on stand by as seizure can Naintain seizure precaution on stand by as seizure can
occur. occur.
Provide comfort measures like small frequent feedings Provide comfort measures like small frequent feedings
and pain medications for headache. and pain medications for headache.
Provide thorough health teaching: need for lifetime Provide thorough health teaching: need for lifetime
injection injection
Nonitor patient response to the drug Nonitor patient response to the drug
increased hemoglobin increased hemoglobin
Psychotrophic drugs Psychotrophic drugs
W W Drugs that can: Drugs that can:
Stimulate the release o neurotransmitters Stimulate the release o neurotransmitters
Block the receptor,actiity o the Block the receptor,actiity o the
neurotransmitter~ like dopamine neurotransmitter~ like dopamine
Stimulate the receptors in the CNS Stimulate the receptors in the CNS
Preents the breakdown o the Preents the breakdown o the
neurotransmitters or the re neurotransmitters or the re--uptake mechanism uptake mechanism
Anti Anti- -Psychotics/Neuroleptics Psychotics/Neuroleptics
W W Drugs used to treat PS\ClOSLS Drugs used to treat PS\ClOSLS
W W MAIN AC1ION: Blockage o the DOPAMINL MAIN AC1ION: Blockage o the DOPAMINL
receptor in the CNS receptor in the CNS
Class Class Prototype Prototype Others Others
Phenothiazines Phenothiazines Chlorpromazine Chlorpromazine 1hioridazine, 1hioridazine,
Iluphenazine, Iluphenazine,
Perphenazine Perphenazine
Butyrophenones Butyrophenones Haloperidol Haloperidol droperidol droperidol
1hioxanthines 1hioxanthines Chlorprothixene Chlorprothixene thirothixene thirothixene
ibenzoxapine ibenzoxapine Molindone Molindone
iphenylbutlypiperidine iphenylbutlypiperidine Pimozide Pimozide
Atypical drugs Atypical drugs Clozapine Clozapine Olanzapine Olanzapine
Risperidone Risperidone quetiapine quetiapine
esired Lffects esired Lffects
Reduced hallucination and illusions Reduced hallucination and illusions
CNS sedation and emotional slowing CNS sedation and emotional slowing
ecreased ambivalence, reduced delusion ecreased ambivalence, reduced delusion
Reduced agitation resulting to calmness Reduced agitation resulting to calmness
Relief of emotional turmoil Relief of emotional turmoil
Reduced flattening of affect Reduced flattening of affect
Common SL Common SL
Nursing Interventions Nursing Interventions
Anticholinergic effects Anticholinergic effects
Sugarless gum, bed rest Sugarless gum, bed rest
Photosensitivity Photosensitivity
Sunglasses, sunscreen, avoid Sunglasses, sunscreen, avoid
sun sun
Postural hypotension Postural hypotension
Change position slowly, lie Change position slowly, lie
prone for J hour after drug prone for J hour after drug
intake, monitor BP intake, monitor BP
Agranulocytosis Agranulocytosis
Instruct to report sore throat Instruct to report sore throat
and fever, monitor WBC and fever, monitor WBC
Seizure Seizure
Monitor LLG Monitor LLG
Sedation Sedation
Safety, no machine operation Safety, no machine operation
Lxtra Lxtra- -Pyramidal Syndrome Pyramidal Syndrome Nursing Intervention Nursing Intervention
Parkinsonism Parkinsonism- -1remor, rigidity, 1remor, rigidity,
bradikinesia bradikinesia
Avoid abrupt withdrawal, give anti Avoid abrupt withdrawal, give anti- -
LPS drugs like Cogentin LPS drugs like Cogentin
ystonia ystonia- - torticollis, contraction torticollis, contraction
of face and tongue of face and tongue
Remain with client, administer anti Remain with client, administer anti- -
LPS LPS
Akathisia= motor restlessness Akathisia= motor restlessness Verbalize understanding of the Verbalize understanding of the
condition, administer anti condition, administer anti- -LPS LPS
1ardive yskinesia= irreversible 1ardive yskinesia= irreversible
drooling, tongue movement and drooling, tongue movement and
shuffling gait shuffling gait
No treatment except discontinue No treatment except discontinue
drug drug
Neuroleptic Malignant Neuroleptic Malignant
syndrome= elevated temp, syndrome= elevated temp,
treme muscle rigidity treme muscle rigidity
Notify physician, prepare to Notify physician, prepare to
administer dantrolene administer dantrolene
Review Outline
Adrenergic Agonists
Adrenergic Antagonists
Cholinergic Agonists
Cholinergic Antagonists
Comparison oI the Sympathetic and
Parasympathetic Nervous system
Characteristics Sympathetic Parasympathetic
CNS origin Thoraco-lumbar spinal
cord
Cranio-Sacral spinal
cord
Pre-ganglionic neuron Short axon Long axon
Pre-ganglionic NTA Acetylcholine Acetylcholine
Ganglia location Next to spinal cord Near target organ
Post-ganglionic
neuron
Long axon Short axon
Post-ganglionic NTA Epi and NE Acetylcholine
Enzyme Ior NTA MAO, COMT Acetylcholine-
ESTERASE
General response Fight or Ilight Rest and Digest
The autonomic drugs
Pharmacologic use depends on their
EFFECTS on the body
They can STIMULATE agonists OR
mimetics
They can DECREASE THE RESPONSE
antagonists OR blockers
The autonomic drugs
They can STIMULATE agonists OR
mimetics
DIRECT STIMULATION by binding with
receptors
INDIRECT STIMULATION by blocking
the enzymes that degrade the
neurotransmitters or increasing the release
of neurotransmitters
The autonomic drugs
They can DECREASE THE RESPONSE
antagonists OR blockers
DIRECT blockage by removing the
neurotransmitter or competing with the
neurotransmitter
Binding with the receptor and NO
RESPONSE will happen
The autonomic drugs
They can be
NON-SELECTIVE when they stimulate or
block many receptors
SELECTIVE when they stimulate or block
specific receptors
SPECIFIC when only ONE type of receptor is
stimulated or blocked
The autonomic drugs: Pharmacologic use
depends on their EFFECTS on the body
EIIect on the body Therapeutic use
Increases BP Used Ior SHOCK where
there is LOW BP
Decreases BP and heart
rate
Used Ior
HYPERTENSION and
Tachycardia
The Adrenergic AGONISTS
Also called SYMPATHOMIMETIC agents
These drugs MIMIC the effects of the
sympathetic nervous system
They usually stimulate DIRECTLY the
receptors of the adrenergic system
Alpha and Beta agonists (non-selective)
Prototype: Epinephrine
Alpha Agonists (Selective)
Prototype: Phenylephrine
Beta Agonists (Selective)
Prototype: Isoproterenol
Alpha and Beta agonists (non-selective)
Pharmacodynamics:
These agents stimulate types of
adrenergic receptors in the body by direct
interaction or by releasing
neurotransmitters from the nerve cells
Alpha and Beta agonists
Prototype: Epinephrine
1. Ephedrine
2. Epinephrine
3. Metaraminol
4. Norepinephrine
5. Dobutamine (sometimes a B1 specific)
6. Dopamine
Alpha and Beta agonists: Clinical Use
1. Dopamine- used in shock
2. Epinephrine- drug of choice of
anaphylaxis, Status asthmaticus
3. Norepinephrine- used in shock
4. Dobutamine- used in CHF
5. Ephedrine- used in shock, asthma and
rhinitis
Alpha and Beta agonists: Desirable effects
Increased myocardial contractility
Bronchial %%
Vasoconstriction
Increased blood pressure
Decreased intraocular pressure
!:5illary dilatation
Alpha and Beta agonists:
Contraindications
Pheochromocytoma
Tachyarrhythmias
With halogenated anesthesia- increased
sensitivity to adrenergic drugs
Alpha and Beta agonists: Adverse effects
$ym5athetic stim:lation effects
CVS- hypertension, tachycardia, palpitations
Respi- tachypnea
GI- nausea, vomiting
Others- sweating, headache, piloerection
Alpha and Beta agonists: Nursing
considerations
1. Monitor patient response to the drug
2. Emphasize to avoid the :se with Ms
and %
3. Maintain phentolamine (alpha blocker) to
manage extravasation of IV drug
4. Usually given IV
Alpha and Beta agonists: Nursing
considerations
Determine effectiveness of the drug:
ncreased B! in shock
Relief of ana5hylaxis and asthma attack
Relief of nasal congestion
Alpha Agonists (selective)
Prototype: phenylephrine
clonidine (alpha-2 specific)
Alpha Agonists Pharmacodynamics:
These agents bind primarily to the alpha
receptors in the body
lonidine
Stimulating the ALPHA-2 receptor causes
decreased sympathetic outflow from the
CNS/ decreased release of NE
Alpha Agonists: Clinical use
1. Phenylephrine- vasoconstricting drug,
used topically to decrease the symptoms of
rhinitis
2. Clonidine- for hypertension
Alpha Agonists: Contraindication
1. Allergy to drug
2. Caution in the following conditions:
Hyperthyroidism-aggravation of symptoms
Diabetes- increased glucose levels
Tachyarrhythmias- possible additive effect
Alpha Agonists: Adverse effects
CNS- anxiety, de5ression, fatigue
CVS- palpitations
GI- nausea, vomiting and anorexia
GU- oliguria, dysuria
Alpha Agonists: Nursing considerations
1. DO NOT discontinue drug abruptly to
prevent rebound effect
2. Maintain phentolamine if giving IV drug
3. Provide comfort measures- rest, quiet
environment, analgesics
Alpha Agonists: Nursing considerations
Evaluate effectiveness:
Decreased BP
Decreased Nasal congestion
Beta Agonists (Selective): ANTI-ASTHMA
DRUGS
Prototype: isoproterenol (B1 and B2)
salbutamol (Ventolin) B2 specific
1. Ritodrine (B2 specific)
2. ~terol- albuterol, salmeterol, bitolterol
3. Terbutaline (B2)
Beta Agonists Pharmacodynamics
These agents bind to the BETA receptors
causing the sympathetic manifestations
and effects
Beta Agonists Clinical use
1. Asthma- due to the -ronchodilation!
2. Preterm labor- ritodrine is given to relax
the uterine muscles
3. Shock To increase BP
Beta Agonists Adverse effects
CNS- restlessness, headache, anxiety , tremors
CVS- tachycardia, angina, palpitations
GI- nausea, vomiting and anorexia
Others- pupilary dilation, rash, sweating,
5:lmonary edema
Beta Agonists Nursing considerations
1. Monitor VS when giving the drug
2. Remind mothers to lie on the left side
during ritodrine administration
3. Maintain a beta blocker on stand by
4. Provide comfort- quiet environment, rest,
analgesics.
5. Prevent over-hydration to avoid
pulmonary edema
Beta Agonists Nursing considerations
These are given usually inhalational for
asthma attack
Instruct on how to use inhalers and
nebulizers
ormal RR
lear -reath so:nds
The Adrenergic ANTAGONISTS
These are called adrenergic blockers
They can be Alpha Blockers (selective)
Beta Blockers (selective)
Both Alpha & Beta Blockers
(non-selective)
The alpha blockers (selective)
Prototype: Phentolamine
Phenoxybenzamine
osin"- 5raosin, doxaosin,
teraosin- these are
al5ha 1
-lockers
The alpha blockers: Pharmacodynamics
These agents have affinity for the ALPHA
receptors
Blocking the alpha receptors will cause:
'asodilation
$5hincter relaxation in the -ladder
The alpha blockers: Clinical use
1. Phenoxybenzamine- used in
pheochromocytoma
2. Phentolamine- also used in
pheochomocytoma
3. ~zosin drugs- are used to decrease blood
pressure and to relax the urinary
sphincter in BPH!
The alpha blockers: Contraindications
1. Myocardial infarction
2. Allergy
The alpha blockers: Adverse Effects
CVS- hypotension, reflex tachycardia,
flushing
CNS- dizziness, weakness, fatigue, drowsiness
Others- nasal congestion, reddened eyes,
priapism
The alpha blockers: nursing consideration
1. Monitor heart rate and BP
2. Caution to change position slowly
3. Advise to avoid hazardous activities
4. Provide supportive measures like quiet
environment, rest and analgesics
5. Monitor response to the drug-
improvement of blood pressure readings
and urination
The Beta blockers
These are agents used to treat
cardiovascular problems- Hypertension,
CHF, angina
Blocking beta receptor will cause
decreased heart rate
decreased BP
The Beta blocker or The olol"s
They can be beta 1 blockers, beta 2
blockers or Both
Prototype of non-selective: propranOLOL
(beta 1 and 2)
carteOLOL
nadOLOL
penbutOLOL
sotaLOL
The Beta blocker or The olol"s
They can be beta 1 blockers, beta 2
blockers or Both
Prototype of B1 selective: atenOLOL
acebutOLOL
betaxOLOL
esmOLOL
metoprOLOL
The Beta blockers: pharmacodynamics
These agents block the beta receptors of
the sympathetic system. %he selective B1
antagonists -lock the B1 rece5tors,
es5ecially in the heart and the kidney
The Beta blockers: Clinical use
1. Hypertension
2. Angina and MI
3. Cardiac arrhythmias
4. Migraine headache
5. HYPERTHYROIDISM
The Beta blockers: Clinical use
Hypertension
to decrease BP
Angina and MI
to decrease cardiac workload
Cardiac tachyarrhythmias to terminate arrhythmias
Migraine headache
to cause vasoconstriction in
the cranial vessels
HYPERTHYROIDISM
to decrease the tachycardia
The Beta blockers: contraindications
1. Allergy
2. Heart blocks
3. Bradycardia
4. COPD
5. Precaution in DM
The Beta blockers: Adverse effects
CVS- -radycardia, hypotension, heart -lock
CNS- fatigue, dizziness, depression
Respi- -ronchos5asm, pulmonary edema
GI- nausea, vomiting, diarrhea, hy5oglycemia
GU- decreased libido, impotence, dysuria
The Beta blockers: nursing considerations
1. Emphasize NOT to stop abruptly the drug
intake
2. Give with FOODS to improve absorption
3. Provide comfort measures
Adequate rest periods
Avoidance of hazardous activities
Change position slowly
The Beta blockers: nursing considerations
Decreased BP in hypertension
Decreased HR in hyperthyroidism
Decreased PAIN angina
The Cholinergic Agonists
These are also called
parasympathomimetic agents
Their action mimics the parasympathetic
nervous system
These agents INCREASE the activity of
acetylcholine in the acetylcholine receptors
DIRECTLY by occupying the receptor
INDIRECTLY by blocking the enzyme that
degrades the acetylcholine, preventing it
from breakdown - the enzyme:
acetylcholin$%R$
irect acting cholinergic agonists
!rototy5e: BetaneCHOL
CarbaCHOL
!ilocar5ine
ndirect acting cholinergics
!rototy5e: Pyridostigmine
Neostigmine
ndro5honi:m (%ensilon)
Pharmacodynamics
%hey are similar to acetylcholine and
directly act on the acetylcholine
receptors
Parasympathetic stimulation will cause:
DUMBELS
:rination
miosis (5:5il constriction)
irect acting cholinergic agonists: linical :se
1. Post operative and post partum urinary
retention and to treat neurogenic bladder
2. Relief of increased intraocular pressure of
glaucoma by inducing miosis
irect acting cholinergic agonists: linical :se
1. %he dr:gs R$ the -ladder tone,
R the C and :rinary s5hincters
2. %he to5ical agent (5ilocar5ine) to5ically
ca:ses 5:5ilary constriction to red:ce !
irect acting cholinergic agonists:
ontraindications
1. Bradycardia
2. Hypotension
3. Asthma
irect acting cholinergic agonists: dverse
effects (&MB$)
CVS- bradycardia, heart block, hypotension
GIT- nausea, vomiting, diarrhea, increased
salivation, lacrimation
GUT- sense of urgency, sphincter relaxation
Others- increased sweating, headache, miosis
irect acting cholinergic agonists: n:rsing
considerations
1. Assure proper administration of
ophthalmic preparations
2. Administer on EMPTY stomach
3. Provide safety precautions- because of
5oor vis:al ac:ity
4. Promote cool environment, maintain
access to the bathroom (urination)
The Cholinergic Agonists: evaluate
effectiveness
Drug eIIectiveness
Pilocarpine Decreased IOP in
glaucoma
Betanechol/Carbachol Urination/ relieI oI bladder
distention
ndirect acting cholinergic agonists
!harmacodynamics
These agents DO NOT react directly with
the receptors but REACT chemically with
the enzyme acetylcholinesterase
!harmacodynamics
The acetylcholine breakdown is prevented
so that the effect of acetylcholine is
prolonged! increased m:scle contraction
They are used IN myasthenia gravis
Clinical use
1. Myasthenia gravis
Physostigmine, 5yridostigmine, Neostigmine,
and endro5honi:m
2. lheimer's disease
Tacrine and Donepezil
dverse effects
GI- na:sea, vomiting, cram5s, diarrhea,
increased salivation, involuntary defection
CVS- -radycardia, heart block, hypotension
GU- urinary urgency
Others- -l:rred vision, miosis, headache,
dizziness
:rsing considerations
1. Administer IV drug slowly
2. Administer with foods BUT -etter
BR meals
3. Maintain atro5ine s:lfate as antidote
4. Discontinue the drug if excessive
salivation, diarrhea, vomiting become
problematic
val:ate effectiveness
Decreased muscle weakness
Decreased dysphagia, ptosis
Increased muscular activity
The ANTI-cholinergics
These are drugs that BLOCK the effect of
acetylcholine
They are also called parasympatholytic
agents
In effect, the sympathetic system becomes
unopposed!!!
Anticholinergics:
Prototype: tro5ine
dicyclomine
glycopyrrolate
propantheline
sco5olamine
Anticholinergics: pharmacodynamics
These agents work by BLOCKING or
COMPETING with acetylcholine for the
acetylcholine receptors
BEST taken BEFORE MEALS
Atropine
Depresses salivation
Decreases bronchial secretions
Mydriasis
Cyclopedia
Inhibits vagal response in the heart
Reverses cholinergic toxicity
Atropine
eIIects Clinical use
Depresses salivation Used as pre-op med
Decreases bronchial
secretions
Used as pre-op med
Mydriasis Used in cataract surgery
Cyclopledia Used in cataract surgery
Inhibits vagal response in
the heart
Used in BRADYCARDIA
and heart block
Constipation
Used in partly to control diarrhea
(in Lomotil)
Reverses cholinergic
toxicity
Used in Cholinergic and
Organophosphate poisoning
Scopolamine
Decreases nausea and vomiting associated
with motion sickness
Anticholinergic
Contraindications of anticholinergic
1. Known allergy
2. Cla:coma
3. Bladder obstruction (like PBH)
Anticholinergic
Adverse eIIects: anticholinergic eIIects
CNS- -l:rred vision, 5:5il %,
5hoto5ho-ia, cyclo5legia and increased
ntraoc:lar 5ress:re
GI- dry mo:th, constipation, bloatedness
CVS- tachycardia, palpitations
GU- :rinary retention
Others- decreased sweating, fl:shing
Anticholinergic
1. Provide comfort measures
Frequent mouth care
Provide increased fluids
Protect eyes form lights
Advise to avoid hazardous activities
Provide high-fiber diet and laxative
Avoid extremes of temperature
Instruct to void before administering the drug
Anticholinergic
2. Monitor for toxicity:
3. Ensure adequate hydration to prevent
hyperpyrexia
Evaluate effectiveness of drug:
Increased HR in heart block
Decreased secretions in pre-op patients
Relief of motion sickness (scopolamine)

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