Alexis Daniel David Midterms (Reviewer)

BSN IV-A Doc Neil Espiritu

MEDICATION ORDER
• Full name of client
• Generic or brand name of drug
• Dose, route, frequency
THIS REVIEWER INCLUDES: • Date, time, and signature of provider
• 10 Rights of medication administration *The nurse should know why the medication is ordered, as
• Mechanism of action of the following drugs: well as the drug’s classification, safe dose, action, how to
o Diuretics administer, and its side effects
o CNS
o GIT 3. Nurses are legally required to document medications that are
o Selected Endocrine administered to clients. When should the nurse document?
o Common side effects “After administration of medication”
o Nursing Process involved per medication 4. If a nurse experiences a problem reading a physician’s
medication order, the most appropriate action will be to:
“Call the physician to verify order”
DEFINITION OF TERMS
• Pharmacology- The study of how drugs work; The science
which concerns the effect of the drugs on the body and the DIURETICS
effect of the body on drugs which includes absorption,
metabolism, distribution, and excretion
• PharmacoKinetics- The study of what the body does to the
drug; ADME
o Absorption
o Distribution
o Metabolism
o Excretion
• PharmacoDynamics- The study of what the drug does to
the body, its mechanism of action in living tissues

10 RIGHTS OF MEDICATION ADMINISTRATION

• Right Patient
• Right Medication
• Right Dosage
• Right Route
• Right Time
• Right Documentation
• Right Client Education
• Right to Refuse
• Right Assessment
• Right Evaluation

1. The day shift charge nurse is making rounds. A patient tells

the nurse that the night shift nurse never gave him his
medication, which was due at 11 PM. What should the nurse
do FIRST to determine whether the medication was given?
-Check the medication sheet. 1. CARBONIC ANHYDRASE INHIBITOR
2. The patient’s Medication Sheet lists two antiepileptic • Mechanism of Action
medications that are due at 9 AM, but the patient is on NPO
for a barium study. The nurse’s coworker suggests giving the
drug via IV since the patient is NPO. What should the nurse
do? “Call the physician to clarify instructions”

LEGAL RESPONSIBILITIES
• Safe and accurate administration
• Sufficient knowledge to recognize and question erroneous
orders
• Monitor client’s response to a medication
• Follow safe practices (10 Rights)

o Carbonic Anhydrase forms Sodium Bicarbonate

(Na+HCO3)
o Block the enzyme that results to slow movement
of H and HCO3 into the tubules, thereby
promoting excretion of Na HCO3 through urine
• Prototype: Acetazolamide
o Methazolamide
• Major site of action
o Proximal Tubule
• Side Effect
o Metabolic Acidosis
o Hypokalemia
• Special use
o Mountain sickness

Page | 1
Alexis Daniel David Midterms (Reviewer)
BSN IV-A Doc Neil Espiritu
o Hypokalemia
2. THIAZIDE AND THIAZIDE-LIKE DIURETIC o Hypocalcemia (increased divalent loss of calcium)
• Mechanism of Action o Ototoxicity- Due to the electrolyte imbalances in
the endolymph
o Bicarbonate is lost in the urine
• Special use
o Hypercalcemia

4. POTASSIUM SPARING
• Mechanism of Action
o Spironolactone: Aldosterone ANTAGONIST
(causing NO sodium and water retention, and NO
potassium excretion)
o Triamterene and Amiloride: Blocks the potassium
excretion in the distal tubule
o Diuretic effect is achieved by the sodium loss to
offset potassium retention
• Prototype: Spironolactone
o Amiloride
o Triamterene
• Major Site of action
o Blocks the Na/Chloride transporter in Distal o Cortical Collecting Duct
Convoluted Tubule (DCT), making it stay in the • Side effect
DCT for excretion through urine, however o Hyperkalemia
Potassium is also excreted o AVOID! Foods rich in potassium:
• Prototype: Hydrochlorthiazide ▪ Bananas
o Bendroflumethiazide ▪ Potatoes
o Benthiazide ▪ Spinach
o Chlorothiazide (Duril) ▪ Broccoli
o Hydroflumethiazide ▪ Nuts
o Methylclothiazide ▪ Prunes
o Trichlormethiazide ▪ Tomatoes
• Thiazide-Like ▪ Oranges
o Indapamide ▪ Peaches
o Quinethazone • Special uses
o Metolazone o Hyperaldosteronism
o Chlorthalidone o CHF taking Digoxin

• Major site of action 5. OSMOTIC DIURETIC

o Distal Convoluted Tubule • Mechanism of Action
• Side Effect
o Hypokalemia- due to potassium wasting capacity
o Hyper-GLUC:
o Glycemia
o Lipidemia
o Urecemia- decreased uric acid secretion
o Calcemia- decreased calcium excretion
• Special uses
o Nephrolithiasis due to calcium stones

3. LOOP DIURETICS
• Mechanism of Action

o Mannitol is a sugar not well absorbed in the

nephron~ osmotic pull of water = DIURESIS
• Prototype: Mannitol
o Glycerin
o Isosorbide
o Urea
• Major site of action
o Glomerulus
• Side effects
o Hypovolemia (Sudden)
o Hypotension
o High-ceiling diuretics • Special use
o Blocks the Sodium/Potassium/2Chloride pump o Management for Increased ICP
(Na/K/2Cl pump is a protein that aids in the • SPECIAL CONSIDERATIONS:
transport of Na/K/2Cl into cells) in the thick o Warm the solution to allow the crystals to dissolve
ascending loop of Henle, preventing reabsorption in the bottle
thereby promoting Na, K, 2Cl excretion through
urine. Assessment and Implementation for Diuretics:
o Divalent loss of Calcium (Ca) o Assess for history of allergy to drugs specifically
• Prototype: Furosemide Sulfonamides when giving Thiazides
o Ethacrynic Acid o Assess F&E balance
o Torsemide o Assess other conditions like gout, diabetes,
• Major site of action pregnancy and lactation
o Loop of Henle o Assess vital signs and symptoms of body
• Side effects weakness that may indicate hypokalemia

Page | 2
Alexis Daniel David Midterms (Reviewer)
BSN IV-A Doc Neil Espiritu
o Administer IV drug SLOWLY, and administer in o Maintain patient on bed for at least 3 hours after
the MORNING! (To prevent nocturia) administration
o Safety precaution for dizziness/hypotension o AVOID! Hazardous activities like driving, and
o Provide potassium rich foods *(See potassium machine operation
sparing diuretic part for list of K rich foods)* for o Provide comforting measures too help patients
most diuretics, EXCEPT for Spironolactone tolerate drug effects
(Spironolactone is a potassium-sparing diuretic, it ▪ Instruct to urinate before taking drug
reabsorbs potassium, increasing risk for ▪ Give high fiber foods
HYPERKALEMIA) ▪ Use side rails and assistance with
o Provide skin care, oral care, and urinary care ambulation
• Implementation o Have available FLUMAZENIL as an
o Monitor daily weight ANTIDOTE for benzodiazepine overdose.
o Monitor Urine Output (to assess effectiveness), o AVOID!
cardiac rhythm, serum electrolytes ▪ Alcohol- causes synergistic effect with
o Administer in the MORNING benzos as they also act as CNS
• Nursing Diagnosis depressants
o Deficient Fluid Volume RT diuretic effect BARBITURATES
o Alteration in urinary pattern -These are also anxiolytics and hypnotics with a greater likelihood of
o Potential for Injury (ototoxicity, hypotension) producing sedation, with increased risk for addiction and dependence
o Knowledge Deficit • Drugs in this class are the ff:
• EVALUATION: for effectiveness of therapy o Phenobarbital
o Increased urine output o Pentobarbital
o Resolution of edema o Amobarbital
o Decreased Congestion o Aprobarbital
o Normal BP (For correction of High BP due to o Butobarbital
Hypervolemia) o Mephobarbital
o Secobarbital
CNS DRUGS • Mechanism of Action
DEFINITION OF TERMS o Depress the motor output from the brain
• Anxiolytics and Hypnotics o Results in sedation, hypnosis, and anesthesia, and
o Used to change the individual’s responses to the in extreme doses, COMA
environment • Indications
• ANXIOLYTICS o Relief of anxiety manifestations
o Prevents feeling of tension and fear (anxiety) w o Sedation
• SEDATIVES o Insomnia
o Calms individuals, making them unaware of the o Pre-anesthesia
environment o Seizures/epilepsy
• HYPNOTICS o FOR RAPID ACTING: Treatment of acute
o Drugs that can induce sleep. manic reactions and status epilepticus
o Involves more pronounced CNS depression than • Adverse effects
sedation o CNS: Depression, somnolence, vertigo, lethargy,
ataxia, paradoxical excitement, anxiety, and
ANXIOLYTICS and HYPNOTICS hallucinations
• Drugs include: o GIT: N/V, constipation/diarrhea, epigastric pain
o Benzodiazepines- Frequently used anxiolytic o CVS: Bradycardia, hypotension and syncope
drug; prevents anxiety states without causing o Respiratory: Serious hypoventilation, respiratory
much sedation, with less physical dependence than depression, laryngospasms
other agents. o Others: Hypersensitivity, and Stevens-Johnson
o Barbiturates Syndrome
• Nursing Considerations/Responsibilities
BENZODIAZEPINES o Provide stand-by life support facilities in cases of
DIAZEPAM Status Epilepticus severe respiratory depression or hypersensitivity
(Valium) reaction
o Taper the drug gradually after long-term therapy
CHLORDIAZEPOXIDE Alcohol withdrawal to avoid withdrawal syndrome
(Librium) o Provide comfort measures including access to
ALPRAZOLAM Panic Attacks bathroom facilities, give high fiber foods,
(Xanax) environmental control, safety precaution
• Mechanism of Action CNS STIMULANTS
o These agents act on the Limbic System and RAS
Methylphenidate Most commonly used for
(Reticular Activating System) to make the GABA
(Ritalin) Attention Deficit Hyperactivity
(Gamma-Aminobutyric Acid more effective,
Disorder (ADHD)
causing interference with neuron firing
o GABA is an inhibitory neurotransmitter Dextroamphetamine CNS stimulant used for short-
o Results to an anxiolytic effect at lower doses than term therapy for exogenous
required for sedation/hypnosis obesity
• Indications Modafinil Used for Narcolepsy (A
o Anxiety disorder disorder of excessive
o Alcohol withdrawal sleepiness)
o Hyperexcitability and agitation Pemoline Used for ADHD
o Pre-operative relief of anxiety and tension and in • Mechanism of Action
induction of balanced anesthesia o Stimulates the cortical and reticular activating
• Adverse effects system (RAS) of the brain by releasing
o CNS: Sedation, drowsiness, depression, lethargy, neurotransmitters from the nerve cells leading to
blurred vision increased stimulation of the post-synaptic
o GIT: Dry mouth, constipation, N/V neurons.
o CVS: Hypotension or hypertension, arrhythmias, o It calms hyperactive children which allows them
palpitations, and respiratory difficulties to focus on one activity for a longer period
o Hematologic: Blood dyscrasias and anemia • Indications
o GU: Urinary retention, hesitancy, loss of libido o Treatment for ADHD
and sexual function changes o Treatment for Narcolepsy
• Nursing Considerations/Responsibilities o Short-term therapy for exogenous obesity

Page | 3
Alexis Daniel David Midterms (Reviewer)
BSN IV-A Doc Neil Espiritu
• Adverse effects • Adverse Effects
o CNS: Nervousness, insomnia, dizziness, o CNS: Depression, confusion, drowsiness,
headache, and blurred vision lethargy, fatigue
o GIT: Anorexia, nausea and weight loss o GIT: GI upset, constipation, dry mouth, Gingival
o CVS: Hypertension, tachycardia, arrhythmias, and Hyperplasia, severe liver toxicity RT cellular
angina toxicity
o Others: Rashes, physical/psychological o Skin: Hirsutism and coarsening of the facial skin
dependence o Bone Marrow depression
• Nursing Considerations/Responsibilities • Nursing Considerations/Responsibilities
o Ensure that the drug is only given to the indicated o Administer drug with food to alleviate GI irritation
conditions o Discontinue the drug at any sign of
o Administer the drug before 6 pm to prevent hypersensitivity reaction, severe liver dysfunction,
insomnia and severe skin rashes
o Best given after meals to prevent anorexia o Provide meticulous oral care
o Consult with school personnel to monitor the o Rule out pregnancy and advise women to use
patient under therapy contraceptive measures to prevent pregnancy
o Provide safety measures such as side-rails and while on therapy
assisted ambulation
• Evaluation GIT DRUGS
o Evaluate calming effect in patients with ADHD
o Alertness for patients with Narcolepsy Anti-ulcer Drug Prototype When to give
Histamine-2 Cimetidine WITH meals HS, or
ANTI-EPILEPTICS Receptor Blockers (Tagamet) 1 hour after antacid
• These agents are also called Anticonvulsants; used to treat Antacids AlOH and MgOH 1-2 hours AFTER
epileptic conditions meals
• Drugs include: Proton pump Omeprazole BEFORE meals or
o For TONIC-CLONIC SEIZURES Inhibitors (PPI) (Prilosec) HS
▪ Hydantoins Mucosal Sucralfate BEFORE meals
• Phenytoin Protectants (Carafate) (best taken on
• Ethotoin empty stomach)
• Fosphenytoin Prostaglandin E1 Misoprostol WITH meals
• Mephenytoin Analogues (Cytotec)
▪ Barbiturates
• Phenobarbital 1. HISTAMINE-2 RECEPTOR BLOCKERS
▪ Benzodiazepines • Mechanism of Action
• Diazepam o Blocks the release of Hydrochloric Acid (HCl) in
• Clonazepam the stomach in response to Gastrin
• Clorazepate o H2 Blockers are antagonists at the receptors in the
o For ABSENCE SEIZURE acid-producing parietal cells of the stomach,
▪ Succinimides which results to inhibition of the hormone Gastrin
• Ethosuximide and less response to Histamine
• Methsuximide • Prototype: Cimetidine
• Phensuximide o Ranitidine
▪ Valproic Acid o Famotidine
▪ Zosinamide o Nizatidine
o For Partial FOCAL SEIZURES • Indications
▪ Carbamazepine o Short-term treatment of active duodenal ulcer or
▪ Gabapentin benign gastric ulcer
▪ Lamotrigine o Treatment of hypersecretory conditions like
▪ Tiagabine Zollinger-Ellison Syndrome
▪ Topiramate o Prevention of stress-induced ulcers and acute GI
HYDANTOINS bleeding
• Mechanism of Action o Treatment of erosive Gastroesophageal Reflux
o Stabilizes the nerve cell membrane throughout the Disease (GERD)
brain, reducing and limiting the excitability and o Relief of symptoms of heart burn and acid
conduction through nerve pathways. indigestion
o Depress the CNS, affects the entire brain and • Contraindications
reduce chance of sudden electrical outburst that o Any known allergy is a clear contraindication to
causes seizures the use of the agents. Conditions such as
o Less sedating than other anti-epileptics pregnancy, lactation, renal dysfunction and
• Indications hepatic dysfunction should warrant cautious use
o Tonic-Clonic seizures o Nizatidine CAN BE USED in hepatic dysfunction
o Status Epilepticus • Adverse effects:
o Prevention of seizures in Neurosurgery o GIT: Diarrhea or constipation
o Muscle relaxation o CNS: Dizziness, headache, drowsiness, confusion
• Contraindications and hallucinations
o DON’T GIVE! To Pregnant women o CIMETIDINE: (Crosses BBB) Tremors,
▪ Causes Fetal Hydantoin Syndrome gynecomastia, impotence in males
• Drug-drug Interactions
o Cimetidine, Famotidine, and Ranitidine are
metabolized in the liver which can cause slowing
of excretion of other drugs leading to toxicity
o Cimetidine: Interacts with anticoagulants,
phenytoin, alcohol, antidepressants
• Nursing Considerations/Responsibilities
o Administer with meals at bedtime to ensure
therapeutic level; or
o One hour after antacid
o Emphasize importance of the continued use for the
length of time prescribed
o Monitor cardiovascular status especially if the
drugs are given IV

Page | 4
Alexis Daniel David Midterms (Reviewer)
BSN IV-A Doc Neil Espiritu
o Warn patient of the potential problems of o Pantoprazole
increased drug concentration if the H2 blockers • Indications:
are used with other drugs or OTC drugs. Advise o Short-term treatment of active duodenal ulcers,
consultation first! PUD, GERD, erosive esophagitis, and benign
o Provide health teaching as to the dose, frequency, gastric ulcer
comfort measures to initiate when side-effects are o Long-term maintenance therapy for healing of
intolerable erosive disorders
• Evaluation • Contraindications:
o Evaluate for relief of symptoms of ulcer, heart o Known allergies
burn, and GERD • Precautions:
o Pregnant Women
2. ANTACIDS • Adverse effects:
• Mechanism of Action: o CNS: Dizziness, headache, asthenia (loss of
o Acts to neutralize the acidic pH in the stomach strength), vertigo, insomnia, apathy
o Does not affect the rate of gastric acid secretion o GIT: Diarrhea, abdominal pain, nausea, vomiting,
o May cause an Acid Rebound dry mouth, and tongue atrophy
o Neutralizing the stomach content to an alkaline o PULMO: Cough, stuffy nose, hoarseness of voice,
level stimulates gastrin production to cause an epistaxis.
increase in acid production and return the stomach • Nursing Considerations/Responsibilities:
to its acidic state o Administer BEFORE MEALS. Ensure that
• Generic Names: patient does not open, chew, or crush the pill.
o Aluminum Hydroxide (Al OH)/Aluminum salts o Provide safety measures if CNS dysfunction
▪ Amphogel occurs
o Calcium Carbonate (CaCO3)/Calcium salts o Arrange for a follow-up if symptoms are NOT
o Magnesium Salts (Milk of Magnesia) resolved after 4-8 weeks of therapy.
o Sodium Bicarbonate (NaHCO3) o Provide health teaching as to drug name, dosage,
o Magaldrate (Al OH+Mg OH) and frequency, and safety measures
• Indications: o Monitor patient’s response to the drug, the
o Symptomatic relief of stomach upset associated effectiveness of the teaching plan and the
with hyperacidity measures to employ
o Hyper acidic conditions like Peptic Ulcer Disease • Evaluation:
(PUD), gastritis, esophagitis, and hiatal hernia. o Effectiveness on healing of peptic ulcer and
o Special use: AMPHOGEL- to bind phosphate decreased symptoms of ulcer
• Contraindications:
o Known allergy is a clear contraindication. Caution 4. MUCOSAL PROTECTANTS
should be instituted if used in electrolyte • Mechanism of Action:
imbalances, GI obstruction, and renal dysfunction o Forms an ulcer-adherent complex at duodenal
o Sodium bicarbonate is rarely used because of ulcer sites, protecting the sites against acid,
potential systemic absorption (May cause pepsin, and bile.
metabolic alkalosis) o This action prevents further breakdown of proteins
• Adverse effects: in the area and promotes healing
o GIT: rebound acidity; alkalosis may occur • Prototype:
o Calcium salts may lead to Hypercalcemia o Sucralfate (Carafate)
o Magnesium salts can cause diarrhea • Indications:
o Aluminum salts may cause constipation and o Short-term and long-term management of
hypophosphatemia by binding phosphates in the Duodenal Ulcers.
GIT o NSAID-induced gastritis
o Fluid retention due to the high sodium content of o Prevention of stress ulcer
the antacids o Treatment of oral and esophageal ulcers due to
• Nursing Considerations/Responsibilities: radiation, chemotherapy, or sclerotherapy
o Administer the antacids apart from any other • Contraindications:
medications by ONE HOUR BEFORE or TWO o Known allergies
HOURS AFTER to ensure adequate absorption o Renal failure and patients undergoing Dialysis
of other medications (build-up of aluminum may occur if used with
o Tell the patient to CHEW the tablet thoroughly aluminum-containing products)
before swallowing. Follow it with one glass of • Adverse effects:
water o GIT: Constipation, nausea, indigestion, gastric
o Regularly monitor for manifestations of acid-base discomfort, and dry mouth may also occur
imbalances as well as electrolyte imbalances o CNS: Dizziness, drowsiness, vertigo
o Provide comfort measures to alleviate o Others: Rash and back pain
constipation associated with Aluminum salts • Drug-drug interactions:
and diarrhea associated with Magnesium salts. o Aluminum salts- High risk of accumulation of
o Monitor for the side-effects, effectiveness of the aluminum and toxicity
comfort measures, patient’s response to o Phenytoin, fluoroquinolones, penicillamines-
medication and the effectiveness of health Decreased levels of these drugs when taken with
teachings sucralfate
• Evaluation: • Nursing Considerations/Responsibilities:
o Evaluate for effectiveness such as decreased o Administer drug on an EMPTY STOMACH, 1
symptoms of ulcer and pyrosis, and decreased HOUR BEFORE MEALS, or 2 HOURS AFTER
phosphate level MEALS and at BEDTIME.
o Monitor GI side effects
3. PROTON PUMP INHIBITORS o Encourage intake of high-fiber foods and
• Mechanism of Action increased fluid intake
o Acts on specific secretory surface receptors o Administer antacids between doses of Sucralfate,
(H+/K+ ATPase enzyme system, or commonly NOT WITHIN 30 MINUTES of Sucralfate dose.
known as Gastric Proton Pump) of the gastric o Provide comfort measures if CNS effects occur
parietal cells to block the final step of acid o Provide health teaching as to drug name, dosage
production, thus decreasing the level of HCl in the and frequency, and safety measures
stomach o Monitor patient response to the drug, the
• Prototype: Omeprazole effectiveness of the teaching plan, and the
o Lansoprazole measures employed
o Esomeprazole • Evaluation:

Page | 5
Alexis Daniel David Midterms (Reviewer)
BSN IV-A Doc Neil Espiritu
o Effectiveness of therapy on ulcers, no formation of 3. LUBRICANTS
ulcers. • Mechanism of Action:
5. PROSTAGLANDIN E1 ANALOGUE o Docusate: Increases the admixture of fat and
• Mechanism of Action: water, producing a softer stool
o Inhibits gastric secretion to some degree while o Glycerin and Mineral Oil forms a slippery coat
increasing mucus production in the stomach lining on the colonic contents
• Prototype: • Prototype: Docusate
o Misoprostol (Cytotec) o Glycerin
• Indications: o Mineral Oil
o NSAID-induced gastric ulcer • General Side Effects of Laxatives:
o Duodenal ulcers unresponsive to H2 Blockers o Diarrhea
• Contraindications: o Abdominal cramping
o PREGNANT WOMEN o Nausea
▪ Cytotec is an ABORTIFICIENT. It o F&E Imbalance
causes uterine contraction leading to o Sympathetic Reactions- Sweating, palpitations,
miscarriage flushing and fainting
▪ Women should be negative on o CATHARTIC DEPENDENCE
pregnancy test within 2 weeks of • Assessment:
beginning of therapy and should begin o Nursing History- Elicit allergy to any laxative, as
the drug on the 2nd or 3rd day of the next well as history of conditions like diverticulitis
menstrual cycle. and ulcerative colitis
▪ Should be instructed in the use of o Abdominal Physical Exam
contraceptives during therapy o Laboratory Test: Fecalysis, electrolyte levels
• Adverse effects: • Nursing Diagnosis:
o GIT: Nausea, diarrhea, abdominal pain, flatulence, o Alteration in bowel pattern
vomiting, dyspepsia o Acute pain
o GU: Miscarriages, excessive uterine cramping and o Knowledge deficit
bleeding, spotting, hypermenorrhea and menstrual • Implementation:
disorders o Emphasize that it is used on a SHORT-TERM
• Nursing Considerations/Responsibilities: BASIS
o Administer to patients at risk for NSAID-induced o Provide comfort and safety measures; ready
Ulcers during the full course of NSAID therapy access to bathroom
o Administer four times daily WITH MEALS and o Administer oral form with a full glass of water
at BEDTIME o Encourage fluid intake, high-fiber diet, and daily
o Obtain pregnancy test within 2 weeks of beginning exercise
of therapy. Begin the therapy on the 2nd or 3rd day o DO NOT ADMINISTER in patients with
of menstrual period to ensure that the woman is ACUTE ABDOMINAL CONDITIONS
not pregnant o Advise to change position slowly; and
o Provide patient with both written and oral o AVOID! Hazardous activities because of
information regarding the associated risks of potential dizziness
pregnancy • Evaluation:
o Provide health teachings as to drug name, dosage o Evaluate relief of GI symptoms, absence of
and frequency, and safety measures. straining and increased evacuation of GI tract
o Monitor patient’s response to the drug, the contents
effectiveness of the teaching plan, and the o For LACTULOSE: Decreased ammonia
measures to employ.

ANTI DARRHEALS
LAXATIVES TYPE PROTOTYPE MECH. OF
ACTION
GENERAL CONTRAINDICATIONS FOR LAXATIVE USE Local reflex Bismuth Locally coats the
• ACUTE Abdominal Disorders inhibitor Subsalicylate lining of the GIT to
o Appendicitis soothe irritation that
o Diverticulitis may stimulate the
o Ulcerative Colitis reflex
Local anti-motility Loperamide Directly inhibits the
1. CHEMICAL STIMULANT CATHARTICS intestinal muscle
*Irritant Laxatives activity to slow
• Mechanism of Action: peristalsis
o Directly stimulate the nerve plexus in the Central acting Opium derivatives Stops GIT spasm by
intestinal wall which results in increased agent (Paregoric) CNS action
movement or motility of the colon • Indications:
• Prototype: Bisacodyl (Dulcolax) o Relief of symptoms of acute and chronic diarrhea
o Castor Oil o Reduction of fecal volume discharges from
o Senna ileostomies
o Cascara o Prevention and treatment of traveler’s diarrhea
o Phenolphthalein • Contraindications:
o Poisoning
2. MECHANICAL STIMULANT CATHARTICS o Drug allergy
*Bulk-forming Laxatives o GI obstruction
• Mechanism of Action: o Acute abdominal conditions
o Rapid-acting laxatives that increase the GI ▪ Appendicitis
motility by increasing the fluids in the colonic ▪ Diverticulitis
material, stimulating the local stretch receptors ▪ Ulcerative Colitis
and activating local defecation reflex o Constipation
• Prototype: Lactulose (Cephulac) o Nausea/vomiting
o Magnesium citrate/hydroxide/sulfate o Abdominal distention and discomfort
o Psyllium o TOXIC MEGACOLON
o Polycarbophil • Assessment:
o Nursing History- Elicit allergy to any laxative, as
well as history of conditions like diverticulitis
and ulcerative colitis

Page | 6
Alexis Daniel David Midterms (Reviewer)
BSN IV-A Doc Neil Espiritu
o Abdominal Physical Exam • Contraindications:
o Laboratory Test: Electrolyte levels o Severe CNS depression
• Nursing Diagnosis: o Severe liver dysfunction
o Alteration in bowel pattern • Side effects:
o Alteration in comfort: pain o Photosensitivity
• Nursing Considerations/Responsibilities: o Drowsiness, dizziness, weakness and tremors and
o Monitor patient response within 48 hours, dehydration
discontinue use if there is no effect o Phenothiazines- autonomic anticholinergic
o Provide comfort measures for pain effects like dry mouth, nasal congestion, and
o Provide teaching urinary retention
• Evaluation: • Assessment
o Monitor for effectiveness- Relief of diarrhea o Elicit the exact nature of poisoning
o Monitor adverse effect, effectiveness of pain o Physical Exam: CNS Status and Abdominal Exam
measures, and effectiveness of teaching plan o Laboratory test: Liver function tests
• Nursing Diagnosis:
EMETICS AND ANTI-EMETICS o Alteration in comfort: Pain
EMETICS o High risk for injury
• Mechanism of Action o Knowledge deficit
o Irritates the GI mucosa locally, resulting to • Nursing Considerations/Responsibilities:
stimulation of the vomiting center, acts within 20 o Assess patient’s intake of other drugs that may
minutes cause dangerous interaction
• Prototype: Syrup of Ipecac o Emphasize that this is given on a short-term basis
• Indications: o Provide comfort and safety measures
o Induction of vomiting as a treatment for drug ▪ Advise to change position slowly
overdose and certain poisonings ▪ Provide mouth care and ice chips
• Contraindications: ▪ Monitor for dehydration and offer fluids
o Ingestion of corrosive chemicals o AVOID! Hazardous activities
o Ingestion of petroleum products o Protect from sun exposure
o Unconscious and convulsing patient ▪ Sun screen
• Side effects: ▪ Protective covering
o Nausea o Provide health teaching
o Diarrhea • Evaluation
o GI Upset o Monitor for drug effectiveness
o Mild CNS depression ▪ Relief of nausea and vomiting
o CARDIOTOXICITY if large amounts are o Monitor for adverse effect
absorbed in the body o Evaluate effectiveness of comfort measures and
• Assessment teaching plan
o Elicit the exact nature of poisoning
o Physical Exam: CNS Status and Abdominal Exam
• Nursing Considerations/Responsibilities SELECTED ENDOCRINE DRUGS
o Administer to conscious patient only
o Administer Ipecac as soon as possible ANTI-DIURETIC HORMONES
o Administer with a large amount of water • Enhance reabsorption of water in the kidneys
o Vomiting should occur within 20 minutes of the • Used in DI
first dose. Repeat the dose and expect vomiting to o Desmopressin and Lypressin intranasally
occur within 20 minutes o Pitressin intramuscularly
o Provide comfort measures; ready access to • Side effects
bathroom, assistance with ambulation o Flushing and headache
o Offer support o Water intoxication
o Monitor for adverse effects THYROID HORMONES
• Evaluation • Used to treat the manifestations of hypothyroidism
o Evaluate patient response within 20 minutes of • Replace hormonal deficit in the treatment of hypothyroidism
drug intake • Thyroid Hormones:
o Evaluate effectiveness of comfort measures and o Levothyroxine (Synthroid)
teaching plan o Liothyronine (Cytomel)
ANTI-EMETICS o Thyroid Desiccated
TYPES (Prototypes) MECH OF ACTION INDICATION o Liotrix (Thyrolar)
Phenothiazines Centrally block the N/V associated with • Mechanism of actions
(Prochlorperazine, vomiting center in the anesthesia, intractable o Increase metabolic rate
Promethazine) medulla hiccups o Increase O2 consumption
o Increase HR, RR, BP
Non-phenothiazine Reduces the N/V associated with
(Metoclopramide responsiveness of the chemical stimulation • Side effects:
[Reglan]) nerve cell in the o Nausea and vomiting
medulla o Signs of increased metabolism
▪ Tachycardia
Anticholinergic and Block the transmission N/V associated with ▪ Hypertension
Antihistaminic of the impulses to the motion sickness ▪ Cardiac arrhythmias
(Meclizine, Buclizine) medulla ▪ Anxiety
▪ Headache
Serotonin-receptor Centrally and locally N/V associated with • Nursing Considerations/Responsibilities
Blockers inhibit the serotonin chemotherapy o Monitor weight and vital signs
(Ondansetron, receptors o Instruct to take daily medication the same time
Dolasetron) each morning WIHOUT FOOD to ensure
maximal absorption
Miscellaneous Acts in the CNS, either o Monitor serum thyroid hormones to check activity
(Dronabinol, in the medulla or in the of thyroid
Hydroxyzine) cortex o Advise to report palpitation, tachycardia, and
chest pain
o AVOID! Foods that inhibit thyroid secretions
▪ Cabbage
▪ Spinach
▪ Radish

Page | 7
Alexis Daniel David Midterms (Reviewer)
BSN IV-A Doc Neil Espiritu
ANTI-THYROID • Evaluation
• Drugs used to block the thyroid hormones and treat o Relief of signs and symptoms of inflammation
hyperthyroidism o Return of adrenal function to normal
• Inhibit synthesis of thyroid hormones
• Anti-thyroid medications:
o Methimazole (Tapazole)
o Propylthiouracil
o Saturated Solution of Potassium Iodide (SSKI) or
Lugol’s Solution:
▪ Used to decrease vascularity of the
thyroid (in preparation for thyroid
surgery)
▪ T3 and T4 production diminishes
▪ Given PO, can be diluted with juice
▪ Use straw to decrease staining
▪ Monitor iodism (metallic taste, burning
sensation in mouth)
• Side effects: Thionamides
o N/V, drowsiness, lethargy, bradycardia, skin rash
o GI complaints
o Agranulocytosis- Most important to monitor
• Side effects: Iodine solutions
o Hypothyroidism
o Iodism: Metallic taste, burning in the mouth, sore
teeth and gums, diarrhea, stomach upset
• Nursing Considerations/Responsibilities
o Monitor VS and weight
o Monitor serum T3 and T4
o Take the medication WITH MEALS to avoid
gastric upset
o Instruct to report sore throat or unexplained fever
o Monitor for signs of hyperthyroidism
▪ Instruct not to abruptly stop medication

STEROIDS
STEROID INDICATION
Dexamethasone Used to induce the formation of
lung surfactant
Other steroids Used for the treatment of
immune-related diseases,
control of asthma and allergic
symptoms

• Replaces steroids in the body

• Mechanism of Action
o Interfere with the release of inflammatory factors
and immune responses
o Enters cells and binds to receptors and inhibits the
enzyme phospholipase
• Steroids:
o Cortisol
o Cortisone
o Betamethasone
o Hydrocortisone
o Dexamethasone- LONG ACTING
• Indications
o Corticosteroids are used topically and locally to
achieve the desired anti-inflammatory effects at a
particular site
• Side effects:
o Hyperglycemia
o Increased susceptibility to infection (Due to their
immunosuppressive effect)
o Hypokalemia
o Edema and Hypertension
o Peptic Ulceration
o High doses: OSTEOPOROSIS, growth
retardation, peptic ulcer, hypertension, cataract,
mood changes, hirsutism, and fragile skin
• Nursing Considerations/Responsibilities
o Monitor VS, electrolytes, glucose
o Monitor weight, edema, I&O
o Encourage intake of potassium-rich foods and
supplements
o Implement infection control measures
o Handle patient gently
o Instruct to take meds WITH MEALS to prevent
gastric ulcer formation
o Inform patient NOT to ABRUPTLY STOP the
drug
o Taper to allow the adrenal gland to secrete
endogenous hormones

Page | 8