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ATI pharmacology overview

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Pharmacology I (NR-291)

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Pharmacology PathoPharm Pharmacology

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PHARMACOLOGY

Pharmacology

most simply defined as study of drug.

Fundamentals of Pharmacology

Pharmacokinetics

study of drug’s changes as it enters and passes through the body. a. absorption b. distribution c. biotransformation d. excretion

Pharmacodynamics

mechanism by which drugs produce changes in body tissue. a. desired effect - intended action of drugs b. adverse effect - harmful unintended reactions c. side effects – consequence reactions d. toxicity – the degree which something is poisonous digoxin = 0 – 2 ng/mL lithium = 0 – 1 mEq/L

Safety and Efficacy Nursing Principles :

Always verify the Five Rights. a. the right medications b. the right client c. the right dosage d. the right form, route and technique e. the right time
Chart drug administration only after its been given, never before.
Never leave the medication on cart or tray unattended.
Chart observed therapeutic and adverse effects accurately and fully.
Check history for allergies and potential drug interactions before administering a newly ordered drug.
Inform the prescribing physician of any observed adverse effects; if cannot be located, inform the nursing supervisor
Question drug orders that are unclear, that appear to contain errors, or that have potential to harm.
Take the following actions if an error occurs : a. immediately notify the nursing supervisor, the prescribing physician, and the pharmacist. b. assess the client’s condition and provide any necessary care.
For postpartum women, advice to take drugs after breastfeeding. Administration of Drugs :

Routes and Nursing considerations:

Enteral – oral, sublingual, rectal, gastric tubes

capsulated pill, sustained release and enteric coated should not be crushed.

Parenteral – IV, IM, SQ, ID, IT, IA, epidural.

vastus lateralis (safest site for IM)

Topical – skin, inhalants, mucus membrane.

Eye medications :

administer eyedrops first then ointment.
use a separate bottle for each client.
instruct the client to tilt the head backward, open eyes and look up.
avoid contact of medication bottle to the eyeball.
place prescribed dose in the lower conjunctival sac.
instruct the client to press the inner canthus for 30-60 seconds.
instruct the client to close the eye gently.

Ear drops

in infant and children younger than 3 y, pull pinna downward and backward.
in older children and adult, upward and backward.
direct the solution on the wall of the ear canal, not directly on the ear drum.

CLASSIFICATIONS OF DRUGS

DRUGS AFFECTING THE CENTRAL AND AUTONOMIC SYSTEM

Cholinergic Agents (Parasympathomemitics) Prototype :

synthetic acetylcholine, pilocarpine, carbachol, bethanecol (Urocholine), edrophonium (Tensilon), neostigmine (Prostigmine), pyridostigmine (Mestinon). Mechanism of action :
stimulates cholinergic receptors by mimicking acetylcholine or inhibition of enzyme cholinesterase. Indications :
glaucoma, urine retention, Myasthenia Gravis
antidote to neuromuscular blocking agents : tricyclic antidepressants and atropine Adverse effects :
blurring of vision, miosis
increase in salivation, intestinal cramps
bronchoconstriction, wheezing, DOB
hypotension and bradycardia Nursing considerations :

Warn & monitor clients of the side effects.
Have atropine available for use as antidote.

Cholinergic Blocking Agents (Parasympatholytics,

Anticholinergics)

Prototype :

inhibits action of a-receptors in vascular smooth muscle to cause vasodilatation. b. beta blockers
compete with epinephrine in b-receptors in heart, pulmonary airways, peripheral circulation and CNS. Indications :
Raynaud’s disease, hypertension, pheochromocytoma.
angina, arrhythmias, mitral valve prolapse, glaucoma Adverse effects :
orthostatic hypotension, bradycardia, CHF
depression, insomnia and vertigo
bronchospasm and dyspnea, nasal stuffiness, cold extremities Nursing considerations :

Administer oral alpha-blockers with milk to minimize GI side effects.
Administer oral beta-blockers before meals and at a. if insomnia occurs.
Check client’s apical pulse rate before drug administration, refer if below 60 bpm.
Hypotensive precautions.
Warn clients not to drive or operate dangerous machinery until he/she has adjusted to medications.

Skeletal Muscle Relaxants Agents

Prototype : - methacarbamol (Robaxin), baclofen (Lioresal), dantrolene (Dantrium), metaxalone (Skelaxin), orphanedrine (Norgesic), chlorzoxazone Mechanism of actions:

depress CNS
inhibit calcium ion release in the muscle
enhance the inhibitory action of GABA (gamma-amino butyric acid) Indications :
for acute musculoskeletal pain
for muscle spasticity associated with multiple sclerosis, cerebral palsy, CVA, and spinal cord injury. Adverse effects :
hypotonia, ataxia, hypotension, drowsiness
blurred vision, bradycardia, depression, urine retention Nursing considerations :

Caution clients that mental alertness may be impaired.
Monitor neuromuscular status, bowel and bladder functions.
Inform clients that maximum benefit of baclofen is attained for 1- months.
Reduce baclofen dosage gradually because of associated withdrawal symptoms : Confusion, hallucinations, paranoia & rebound spasticity.

ANTICONVULSANTS

Prototype : a. Hydantoins - phenytoin (Dilantin) b. Barbiturates - phenobarbital ( Luminal) c. Miscellaneous

carbamazepine (Tegretol), diazepam, clorazepate (Tranxene), valproic acid (Dapakene), ethosuximide (Zarontin). Mechanism of action :
treat seizures by depressing abnormal neuronal activity in motor cortex.

Adverse effects :

sedation & drowsiness, gingival hyperplasia
diplopia, nystagmus, vertigo, dizziness
thrombocytopenia, aplastic anemia Nursing considerations :

Advise female clients to use contraceptives.
Inform clients taking phenytoin that harmless urine discoloration is common.
Warn clients with diabetes that hydantoins may increase blood sugar level and that valproic acid may produce a false positive result in urine ketone test.
Teach clients receiving carbamazepine to identify symptoms of bone marrow depressions.
Reassure that barbiturates are not addictive at a low dosage.
Avoid taking alcohol with barbiturates.
Administer IV phenytoin slowly to avoid cardiotoxicity.
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), pergolide (Permax), selegiline (Eldepryl), bromocriptine. Mechanism of actions : a. anticholinergic agents
inhibit cerebral motor centers. b. dopaminergic agents
increasing dopamine concentrations or enhancing neurotransmitter functioning. Adverse effects of dopaminergic agents: a. levodopa – nausea, vomiting, anorexia, orthostatic hypotension, dark-colored urine and sweat b. amantidine – ankle edema, constipation c. bromocriptine – palpitations, tachycardia Nursing considerations :

Give dopaminergic agents after meals to reduce GI symptoms.
Warn clients of injuries and falls.
Brief period of confusion and excitement upon waking up is common with benzodiazepines.
Warn clients not to discontinue medications abruptly without consulting a physician.
Avoid alcohol while taking these drugs.
Rotate and don’t shake the ampules of barbiturates. Don’t mix with other drugs.
Warn female clients that diazepam is associated with cleft lip.

ANTIDEPRESSANTS AND MOOD DISORDER DRUGS

Prototype : a. Tricyclic antidepressants

amitriptyline (Elavil), protriptyline (Vivactil),
imipramine (Tofranil), desipramine b. MAO (monoamine oxidase inhibitors )
isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Pernate) c. Second-generation antidepressants
fluoxetine (Prozac), trazodone (Desyrel) d. Lithium Mechanism of actions : a. Tricyclic antidepressants
increase receptor sensitivity to serotonin and/or norepinephrine. b. MAO inhibitors
inhibit the enzyme MAO that metabolize the neurotransmitters norepinephrine and serotonin. c. Second – generation antidepressants
inhibits the reuptake of serotonin. d. Lithium
increase serotonin & norepinephrine uptake Adverse effects :
dry mouth, blurred vision, urine retention, constipation (anticholinergic effects)
orthostatic hypotension, insomnia
hypertensive crisis (MAO)
dehydration (Lithium). Nursing considerations :

Caution client to rise slowly to reduce the effects of orthostatic hypotension.
Take antidepressant with food to enhance absorption
Explain to client that full response may take several weeks ( weeks).
Assess client for constipation resulting from tricyclic antidepressant use.
Client taking MAO inhibitors should avoid tyramine-rich foods to avoid hypertensive crisis.

aged cheese, sour cream, yogurt, beer, wine, chocolate, soy sauce and yeast
pentholamine (Regintine) is the drug of choice for hypertensive crisis.

Inform physician and withhold fluoxetine if client develop rashes.
Take lithium with food to reduce GI effects

> 1 mEq/L blood level may cause toxicity manifested by: confusion, lethargy, seizures,hyperreflexia.
maintain salt and adequate fluid intake
tremors may occur but it is temporary
monitor white blood cell count (increase).

ANTIPSYCHOTIC DRUGS (NEUROLEPTICS)

Prototype : a. Phenothiazines

chlorpromazine (Thorazine),
trifluoperazine (Stelazine),
thioridazine (Mellaril) b. Other Agents
clozapine (Clozaril), haloperidol (Haldol) Mechanism of action :
block dopamine receptor in the limbic system, hypothalamus, and other regions of the brain. Adverse effects :
Extra pyramidal symptoms such as dystonia, pseudoparkinsonism, and an irreversible tardive dyskinesia as manifested by : a. lip smacking b. fine wormlike tongue movement c. involuntary movements of arms and leg.
Neuroleptic malignant syndrome a. fever, tachycardia, tachypnea, diaphoresis, cardiovascular collapse b. muscle rigidity, seizures.
orthostatic hypotension Nursing considerations :

Teach family members the signs of EPS and NMS, and report to physician immediately.
Normalization of symptoms may not occur for several weeks after beginning of therapy.
Avoid administering haloperidol intravenously
Watch out of neutropenia with clozapine.
Watch out for orthostatic hypotension and photosensitivity with phenothiazine.
Be sure that oral doses are swallowed, and not hoarded.

DRUGS USED IN PAIN MANAGEMENT

General Anesthetics Prototype : a. Inhalation anesthetics

enflurane (Ethrane), halothane
isoflurane (Forane), nitrous oxide b. Injection anesthetics
fentanyl (Sublimaze), ketamine (Ketalar), thiopental Na (Penthotal), etomidate (Amidate) Mechanism of actions :

abruptly in the narcotic-dependent clients. 4. Naloxone is antidote for narcotic overdose. 5. Advice clients to take NSAIDs with food and monitor bleeding complications. 6. Aspirin is contraindicated in clients below 18 years old with flu-like symptoms. 7. Monitor hearing loss in clients taking aspirin. 8. Monitor liver function in clients taking acetaminophen. 9. N-acetylcysteine is antidote for paracetamol overdose.

DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM

ANTICOAGULANTS

Prototype :

Heparin (SQ and IV) Warfarin (Orally) Mechanism of actions : a. Heparin
prevents thrombin from converting fibrinogen to fibrin. b. Warfarin
suppress coagulation by acting as an antagonist of vitamin K after 4-5 days.

Indications :

thrombosis, pulmonary embolism, myocardial infarction Adverse effect :
bleeding Nursing considerations :

HEPARIN sodium

if given SQ don’t aspirate or rub the injection site (above the scapula - best site).
therapeutic level 1.5-2 times normal PTT; normal PTT is 20-35 sec. = 50-85 sec.
antidote : (protamine sulfate)

WARFARIN sodium (coumadin)

warfarin is used for long-term.
onset of action is 4-5 days.
therapeutic level is 1.5-2 times normal PT; normal PT = 9 -11 sec. = 25 - 30 sec. INR = 2 - 3
should be taken at the same time of the day to maintain at therapeutic level.
reduce intake of green leafy vegetables.
antidote : Vitamin K ( Aquamephyton)

THROMBOLYTICS

Prototype : Streptokinase, Urokinase Mechanism of actions :

activates plasminogen to generates plasmin (enzyme that dissolve clots). Indications :
use early in the course of MI (within 4-6 hours of the onset) Nursing considerations :
monitor bleeding
antidote : Aminocarpic acid

Antiplatelet Medications Prototype: aspirin, Dipyridamole (Persantin) Clopidoigrel (Plavix), Ticlopidine Mechanism of action :

inhibit the aggregation of platelet thereby prolonging bleeding time. Indications :
used in the prophylaxis of long-term complication following M, coronary revascularization, and thrombotic CVA. Nursing considerations :

HEMOSTASIS :

Bleeding/injury I Vasoconstriction Plasminogen I I Platelet aggregation Plasmin ( temporary plug) I I I Clotting factor activation -------------- I I I I Intrinsic pathway (8,9,10,11,12) Extrinsic pathway (3,7,10) I (PTT ) (PT) Vit K dep. I I I I I Prothrombin activation I I I I Thrombin I I I Fibrinogen ------------Fibrin threads ------------- Fibrin split products (coagulation) ( Removed by liver & spleen )

IA - quinidine, procainamide IB - lidocaine IC - flecainamide Class II (Beta-blockers) propanolol, esmolol Class III (block K channels) amiodarone, bretylium Class IV (block Ca channels) verapramil, diltiazem Nursing considerations :

Watch out for signs of CHF.
Have client weigh themselves and report weight gain.
Watch out for signs of lidocaine toxicity :

confusion and restlessness

ANTILIPEMICS

Prototype : a. cholesterol-lowering agents

cholestyramine, colestipol, lovastatin b. triglyceride-lowering agents
gemfibrozil, clofibrate Mechanism of actions :
interfere with cholesterol synthesis as well as decreasing lipoprotein & triglyceride synthesis. Nursing considerations :
monitor liver functions while using statins.
prevent constipation, flatulence, cholelithiasis
encourage increase fluid and fiber intake.

ANTI – HYPERTENSIVE

Angiotensin-Converting Enzyme (ACE) Inhibitors 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 :
it cause hyperkalemia
induce chronic 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), Felodipine (Plendil) Verapramil (Isoptin) Mechanism of action :
decrease cardiac contractility and the workload of the heart, thus decreasing the

need for O2.

it also promote 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 CARBONIC ANHYDRASE INHIBITORS
Acetazolimide (Diamox)
increase Na+, K+, & HCO3 secretion, along with it is H2O
metabolic acidosis OSMOTIC DIURETIC
Mannitol
Increase osmotic pressure of the glomerular filtrate.
hypotension THIAZIDE DIURETICS
hydrochlorothiazide
blocks Na and K reabsorption; reabsorb Ca
hypercalcemia LOOP DIURETICS
Furosemide (Lasix)
blocks Na, K, and Ca reabsorption
hypocalcemia POTASSIUM SPARING DIURETICS
Spironolactone (Aldactone)
excrete Na and water but it reabsorb K
hyperkalemia

RESPIRATORY MEDICATIONS

Bronchodilators Prototype : Symphatomimetic Xanthines

albuterol, salbutamol - aminophylline
isoproterenol, salmeterol - theophylline
terbutaline

Mechanism of actions:

sympathomimetic ( b-receptor agonist ) bronchodilators, dilate airways.
xanthine bronchodilators, stimulate CNS for respiration.

Brompheniramine (Dimetapp), Diphenhydramine (Benadryl), Cetirizine (Iterax), Celestamine (Tavist). Mechanism of action :

decrease nasopharyngeal secretions and decrease nasal itching by blocking histamine in H1-receptor. Indications :
common colds, rhinitis, nausea and vomiting, urticaria, allergies and as sleep aid. Nursing Considerations :
- Administer with food and drink.
Given IM via Z-track method or orally.
Precautions in handling machine and driving while taking these drugs.
Ice chips or candy for dry mouth

ANTI-TUBERCULOSIS

Prototype : First line Second line

Isoniazid (INH) - Cycloserine
Rifampicin (Rifadin) - Kanamycin
Ethambutol - Ethonamide
Pyrazinamide - Para-aminosalicylic acid
Streptomycin
active tuberculosis are treated with drug combination for 6-9 mos.
multidrug-resistant strain (MDR-TB) are medicated for 1 year up to 2 years
given before meals

Isoniazid - should be given 1 hr before or 2 hrs after meals because food may delay absorption.

should be given at least 1 hr before antacids.
instruct to notify physician for signs of hepatoxicity (jaundice), and neurotoxicity numbness of extremities.
administer with Vitamin B6 to counteract the neurotoxic side effects.
avoid alcohol.

Rifampicin - given on an empty stomach with 8 0z. of water, 1 hour before or 2 hours after meals and avoid taking antacids with medications.

hepatotoxic thus avoid alcohol.
instruct the client that urine, feces, sweat, and tears will be red- orange in color.

Pyrazinamide - given for 2 months.

increase serum uric acid and cause photosensitivity.

Ethambutol

contraindicated in children under 13 years old.
obtain a baseline visual acuity because it can cause optic neuritis.
Instruct the client to notify the physician immediately if any visual problems occurs. Streptomycin
- aminoglycoside antibiotic given IM.
nephrotoxic and ototoxic.
obtain baseline audiometric test and repeat every 1-2 months because the medications impairs the CN VIII.

DRUGS AFFECTING GASTROINTESTINAL SYSTEM

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.

HISTAMINE – 2 BLOCKERS

Prototype :

cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid). Mechanism of action:
blocks H2 receptors in the stomach, reducing acid secretions. Nursing considerations :
Given before or with meals
Avoid giving other drugs with cimetidine
Gynecomastia may developed with chronic use of cimetidine.

Proton – Pump Inhibitors (PPI) Prototype :

omeprazole (Losec), Lansoprazole (Lanz), pantoprazole (Pantoloc). Mechanism of action :
inhibit the proton H+ to combine with Cl- toform hydrochloric acid.

Prototype :

Proloid (thryroglobulin )
Synthroid (levothyroxine)
Cytomel ( liothyronine). Mechanism of action :
function as natural or synthetic hormones. Nursing considerations :
Taken in the morning.
Caution with coronary artery disease.
Monitor for signs of hyperthyroidism and refer for decreasing the dose.

PARATHYROID AGENTS

Prototype : a. calcitonin (Calcimar), etidronate (Didronel), b. calcitrol (Rocaltrol), calcifediol (Calcedrol) Mechanism of action : a. reduce bone resorption b. promotes calcium absorption Nursing considerations :

Monitor signs of calcium imbalance
Report for bone pains.
Remain sitting upright after taking etidronate.

Oral Hypoglycemic Agents (OHA)

Sulfonylureas

stimulate insulin secretions and increase tissue sensitivity to insulin. First Generation : Chlorpropamide (Diabenese)
disulfiram precautions Tolbutamide (Orinase)
congenital defect Second Generation : Glypizide, Glymepiride

Biguanides
- facilitates insulin action on the peripheral receptor site. Metformin and Glucophage (Glucovance)

side effect is lactic acidosis

Alpha-glucosidase inhibitors

delay carbohydrate absorption in the intestinal system. Acarbose (Precose) – side effect is diarrhea

Thiazolinidine

increase tissue sensitivity of insulin. Rosiglitazone (Avandia)

Meglitinides
- stimulate insulin release in pancreatic B-cells. Repaglinide (Prandin)

Nursing considerations :

Effective only for type II DM.
Contraindicated to pregnant & breastfeeding.
Given before meals.
Monitor for signs of hypoglycemia.

Insulin Insulin Onset Peak Duration

Immediate-acting 0 0–1h 5 h (lispro) Short-acting 0-1 h 2-4 h 5-7h (regular, semilente) Intermediate-acting 1-3 h 6-12 h 18-24 h (NPH, lente) Long-acting 4-6h 10-30 h 24-36 h (ultralente) Mixed 0 h 4-8 h 25 h (regular 30%, NPH 70%) 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, 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 : a. 3-4 commercially prepared glucose tablet b. 4-6 ounce of fruit juice or regular soda c. 2-3 teaspoon or honey d. Glucagon 1 gm SQ or IM e. D50-50 IV.

ESTROGENS AND PROGESTINS

Prototype :

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ATI pharmacology overview

Course: Pharmacology I (NR-291)

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Students shared 597 documents in this course

University: Chamberlain University

Multiple Choice

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PHARMACOLOGY

Pharmacology

- most simply defined as study of drug.

Fundamentals of Pharmacology

1. Pharmacokinetics

- study of drug’s changes as it enters and passes through the body.

a. absorption

b. distribution

c. biotransformation

d. excretion

2. Pharmacodynamics

- mechanism by which drugs produce changes in body tissue.

a. desired effect - intended action of drugs

b. adverse effect - harmful unintended reactions

c. side effects – consequence reactions

d. toxicity – the degree which something is poisonous

digoxin = 0.5 – 2.0 ng/mL

lithium = 0.5 – 1.5 mEq/L

Safety and Efficacy

Nursing Principles :

1. Always verify the Five Rights .

a. the right medications

b. the right client

c. the right dosage

d. the right form, route and technique

e. the right time

2. Chart drug administration only after its been given, never before.

3. Never leave the medication on cart or tray unattended.

4. Chart observed therapeutic and adverse effects accurately and

fully.

5. Check history for allergies and potential drug interactions before

administering a

newly ordered drug.

6. Inform the prescribing physician of any observed adverse effects; if

cannot be

located, inform the nursing supervisor

7. Question drug orders that are unclear, that appear to contain

errors, or that have

potential to harm.

8. Take the following actions if an error occurs :

a. immediately notify the nursing supervisor, the prescribing

physician, and the

pharmacist.

b. assess the client’s condition and provide any necessary care.

9. For postpartum women, advice to take drugs after breastfeeding.

Administration of Drugs :

Routes and Nursing considerations:

1. Enteral – oral, sublingual, rectal, gastric tubes

______________________________________________________________