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Pharmacology Review For Nurses
Pharmacology Review For Nurses
ANTICONVULSANTS/ANTISEIZURE MEDICATIONS
Prototype :
a. Hydantoins - phenytoin (Dilantin)
b. Barbiturates - phenobarbital ( Luminal)
Adverse effects :
- sedation & drowsiness, gingival hyperplasia
- diplopia, nystagmus, vertigo, dizziness
- thrombocytopenia, aplastic anemia
Nursing considerations :
1. Advise female clients to use contraceptives.
2. Inform clients taking phenytoin that harmless urine discoloration is common.
3. Warn clients with diabetes that hydantoins may increase blood sugar level.
4. Reassure that barbiturates are not addictive at a low dosage.
5. Avoid taking alcohol with barbiturates.
6. Administer IV phenytoin slowly to avoid cardiotoxicity.
7. Avoid mixing other drugs in same syringe with phenytoin.
ANTIPARKINSONIAN AGENTS
Prototype :
a. Anticholinergic agents - trihexyphenidyl (Artane), benztropine (Congentin)
b. Dopaminergic agents - Levodopa, carbidopa-levodopa (Sinemet), amantidine (Symmetrel)
Adverse effects of dopaminergic agents:
a. levodopa–nausea, vomiting, anorexia, orthostatic hypotension, dark-colored
urine and sweat
b. amantidine – ankle edema, constipation
Nursing considerations:
1. Give dopaminergic agents after meals to reduce GI symptoms.
2. Reassure client that levodopa may cause harmless darkening of urine and sweat.
3. Avoid taking Vit B6 (pyridoxine) because it reverses effects of levodopa.
4. Change positions slowly to avoid orthostatic hypotension.
5. Elevate leg to reduce ankle edema.
Nursing considerations:
1. Caution client to rise slowly to reduce the effects of orthostatic hypotension.
2. Take antidepressant with food to enhance absorption
3. Explain to client that full response may take several weeks (2 weeks)
4. Assess client for constipation resulting from tricyclic antidepressant use.
5. Client taking MAO inhibitors should avoid tyramine-rich foods to avoid hypertensive crisis.
-aged cheese, sour cream, yogurt, beer, wine, chocolate, soy sauce and yeast
6. Inform physician and withhold fluoxetine if client develop rashes.
Nursing considerations:
1. Monitor respiratory depression & hypotension in clients taking narcotic analgesics.
2. Injury and accident precautions in clients taking narcotic analgesic.
3. Warn clients about possibility of dependency, and do not discontinue narcotics abruptly in
narcotic-dependent clients.
4. Naloxone is the antidote for narcotic overdose.
5. Advice clients to take NSAIDs with food and monitor for bleeding complications.
6. Aspirin is contraindicated in clients below 18 years old with flu-like symptoms.
7. Monitor hearing loss in clients taking aspirin.
ANTIPLATELET MEDICATIONS
Prototype: aspirin (ASA), Dipyridamole (Persantin), Clopidogrel (Plavix)
Mechanism of action:
- inhibit the aggregation of platelet thereby prolonging bleeding time.
Indications:
- used in the prophylaxis of long-term complication following M.I, coronary revascularization &
thrombotic CVA
Nursing considerations:
- Monitor bleeding time ( NV = 1-9 mins)
- Take the medication with food.
CARDIAC GLYCOSIDES
Prototype: digoxin (Lanoxin)
Mechanism of actions:
increase intracellular calcium, which causes the heart muscle fibers to contract more
efficiently, producing positive inotropic & negative chronotropic action.
Indications:
use for CHF, atrial tachycardia and fibrillation
Nursing considerations:
- Monitor for toxicity as evidenced by:
o nausea, vomiting, anorexia, halo vision, confusion, bradycardia and heart blocks
- Do not administer if pulse is less than 60 bpm.
- Should be caution in patient with hypothyroidism and hypokalemia.
- Antidote : Digoxin Immune FAB
NITRATES
Prototype:
- isosorbide dinitrate (Isordil)
- nitroglycerine (Deponit, Nitrostat)
Mechanism of action:
- produce vasodilatation including coronary artery.
Indications:
- angina pectoris, MI, peripheral arterial occlusive disease.
Adverse effects:
- headache, orthostatic hypotension .
Nursing Considerations:
1. Transdermal patch
- apply the patch to a hairless area using a new patch and different site each day
- remove the patch, allowing 10-12 hours “patch free” each day to prevent tolerance
2. Sublingual medications :
- note the BP before giving the medication.
- offer sips of water before giving because dryness may inhibit absorption.
- one tablet for pain and repeat every 5 mins.for a total of three doses; if not relieved after 10
mins., seek medical help.
- stinging or burning sensation indicates that the tablet is fresh
- instruct patient not to swallow the pill
- sustained release medications should be swallowed and not crushed
- protect the pills from light
ANTI – HYPERTENSIVES
ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS (DRUG NAMES END IN WITH “-PRIL”)
Prototype :
captopril (Capoten), enalapril (Vasotec), quinapril, lisinopril
Mechanism of actions:
- prevent peripheral vasoconstriction by blocking conversion of angiotensin I to angiotensin II
decreasing peripheral resistance.
Adverse effect :
- hyperkalemia
- induce chronic dry cough
Nursing considerations :
- not to discontinue medications because it can cause rebound hypertension.
- avoid using K+ sparing diuretics.
CALCIUM-CHANNEL BLOCKERS
Prototype :
- Nifedipine (calcibloc, adalat), Amlodipine (norvasc), Verapramil (Isoptin)
Mechanism of action:
- decrease cardiac contractility and the workload of the heart, thus decreasing the need for O2
- it also promotes vasodilatation of the coronary and peripheral vessels.
Indications:
- hypertension, angina, arrhythmia
Adverse effects:
- bradycardia, hypotension, headache
- reflex tachycardia, constipation
Nursing considerations:
- Administer between meals to enhance absorption.
- Take client’s pulse rate before each dose. Withhold if pulse is below 60 bpm.
- Refer for signs of congestive heart failure.
DIURETICS
- usually given at morning
Thiazides - hydrochlorothiazide
- blocks Na and K reabsorption; reabsorb Ca
- hypercalcemia
Loop diuretics - furosemide (Lasix)
- blocks Na, K, and Ca reabsorption
- hypocalcemia
RESPIRATORY MEDICATIONS
BRONCHODILATORS
Prototype :
Symphatomimetic Xanthines
- albuterol, salbutamol - aminophylline
- isoproterenol, salmeterol - theophylline
- terbutaline
Mechanism of actions:
- sympathomimetic (-receptor agonist) bronchodilators, dilate airways.
- xanthine bronchodilators, stimulate CNS for respiration.
Indications :
- bronchospasm, asthma, bronchitis, COPD.
Adverse effects :
- palpitations and tachycardia
- restlessness, nervousness, tremors
- anorexia, nausea and vomiting, headache, dizziness.
Nursing considerations:
- Contraindicated in hyperthyroidism, cardiac dysrhythmia, or uncontrolled seizure disorder.
- Should be used with caution in patients with HPN and narrow-angle glaucoma.
GLUCOCORTICOIDS (Corticosteroids)
Prototype:
- prednisone
Mechanism of actions :
- act as anti-inflammatory agents and reduce edema of the airways, as well as
pulmonary edema.
Adverse effects :Cushing’s syndrome, neutropenia. osteoporosis
Nursing considerations :
- Take drugs with food.
- Eat foods high in potassium, low in sodium.
- Instruct client to avoid individuals with RTI.
- Instruct client not to stop medication abruptly it should be tapered to prevent adrenal
insufficiency
- Avoid taking NSAIDs while taking steroids.
- Take inhaled bronchodilators first before taking inhaled steroids, and rinse mouth after using.
DECONGESTANTS
- pseudoephedrine (Sudafed) – adrenergic (sympathomimetic) agent
- Caution : do not use with clients with HPN
ANTI-ULCER DRUGS
ANTACIDS
Prototype :
- aluminum/magnesium compounds (Maalox)
- sodium bicarbonate (Alka-Seltzer)
- calcium carbonate (Tums)
- magnesium hydroxide (Milk of Magnesia).
Mechanism of actions :
- neutralize the stomach acidity.
Adverse effects:
- metabolic alkalosis, stone formation
- electrolyte imbalance
- diarrhea (magnesium), constipation (aluminum).
Nursing considerations:
- Give 1 hr after meals.
- Avoid giving medications within 1-2 hrs of antacid administration (decreases absorption).
- Take fluids to flush after intake of antacid suspensions.
- Monitor for changes of bowel patterns.
ANTII-EMETICS (ANTI-VOMITING)
- Dimenhydrinate (Gravol) – an anticholinergic; used also for motion sickness
- Diphenhydramine (Benadryl) – an antihistamie
- Metoclopramide (Reglan) – dopamine antagonist
o Not available in Canada; EPS side effects
ANTI-DIARRHEAL AGENTS
Prototype :
- diphenoxylate (Lomotil), loperamide (Imodium), kaolin/pectin mixture (Kaopectate).
Mechanism of actions :
- decrease stomach motility and peristalsis.
Nursing considerations :
- Monitor for rebound constipation.
- Be cautious taking if with infectious diarrhea.
- Monitor atropine toxicity with diphenoxylate.
- Clay, white or pale stool is common with kaopectate.
LAXATIVES
a. Osmotic : lactulose (Duphalac), Na biphosphate (Fleet enema) & magnesium salt (Milk of
Magnesia)
- retain fluid and distend intestine
b. Fecal softeners : ducosate (Dialose)
- emulsify fecal fat and water
c. Stimulant : bisacodyl (Dulcolax) & senna (X-prep)
- irritates intestinal mucosa and stimulates intestinal smooth muscles
d. bulk-forming laxative (Metamucil)
- increase fecal bulk and water content
e. Emollient/Lubricant : mineral oil
- lubricates & prevent colon absorption
ANTIDIABETICS
ORAL HYPOGLYCEMIC AGENTS (OHA)
1. Sulfonylureas
stimulate insulin secretions and increase tissue sensitivity to insulin.
First Generation: Chlorpropamide (Diabenase) - disulfiram precautions
Second Generation: Glypizide, Glymepiride
2. Biguanides
facilitates insulin action on the peripheral receptor site
Metformin and Glucophage (Glucovance) - side effect is lactic acidosis
3. Alpha-glucosidase inhibitors
delay carbohydrate absorption in the intestinal system
Acarbose (Precose) – side effect is diarrhea
4. Thiazolinidine
increase tissue sensitivity of insulin; e.g Rosiglitazone (Avandia) – already discontinued
Nursing considerations:
- Effective only for type II DM
- Contraindicated to pregnant & breastfeeding.
- Given before meals
- Monitor for signs of hypoglycemia.
Insulin
Type of Insulin Onset Peak Duration
Immediate 15 min 0.5 – 1h 5h
Short-acting (regular) 30 min-1h 2-4 h 5-7 h
Intermediate (NPH) 1-3 h 6-12 h 18-24 h
Long-acting 4-6 h 10-30 h 24-36 h
Mixed (regular 30%, NPH 70%) 0.5 h 4-8 h 25 h
Nursing considerations:
- Usually given before meals.
- Roll the bottle in palm of hands, don’t shake.
- Inject amount of air that is equal to each dose into the bottle- short acting last (clear).
- Aspirate short acting first, then long or intermediate (cloudy).
- Alcohol is recommended for cleansing bottle but not with skin.
- Pinch skin, avoid I.M, don’t aspirate.
- Rotate the injection site an inch a part.
- Prefilled syringes are stored vertically, needle-up.
- May increase dose during illnesses.
- Used bottles stored in room temperature, unused bottle stored in refrigerator.
- Monitor for acute hypoglycemia; treat with:
a. 3-4 commercially prepared glucose tablet
b. 4-6 ounce of fruit juice or regular soda
c. 2-3 teaspoons of honey
d. Glucagon 1 gm SQ or IM
e. D50-50 IV.
Adverse effects :
1. Aminoglycoside - nephrotoxicity & ototoxicity
2. Sulfonamides - Steven-Johnson’s syndrome, photosensitivity (remember the client vacationing
in Mexico????)
3. Quinolones - insomnia
4. Tetracyclines - bone problems
5. Erythromycin - hepatitis
Nursing considerations:
1. Collect appropriate specimen for C & S before starting antibiotics.
2. Check client’s history of allergies.
3. Monitor adverse effects: ALL antibiotics can cause nausea, vomiting & diarrhea
Nursing considerations:
1. Keep clients in cool environment.
2. Watch out for signs of heatstroke and dehydration.
3. Encourage clients to increase fluid intake and use of sugarless gum/candy for dry mouth.
4. For GI spasticity, administer 30 minutes before meals and at bedtime.
MISCELLANEOUS DRUGS
ANTI-GOUT
- Acute attacks : phenylbutazone (an NSAID), colchicine
- Maintenance : allopurinol