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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
- 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 : 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:
- 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 :
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- 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 :
- atropine, scopalamine (Triptone), dicyclomine (Bentyl), propantheline (Pro-Banthine). Mechanism of actions :
- block the binding of acetylcholine in the receptors of parasympathetic nerves. Indications :
- use preoperatively to dry up secretions.
- treat spasticity of GI or urinary tract.
- use for treatment of bradycardia, asthma, parkinsonism.
- use for antidote in organophosphate poisoning. Adverse effects :
- dry mouth , dilatation of pupils, tachycardia
- urinary retention, ileus, heat stroke Nursing considerations :
- Keep client’s in cool environment.
- Watch out for signs of heatstroke and dehydration.
- Encourage clients to increase fluid intake and use of sugarless gum/candy for dry mouth.
- For GI spasticity, administer 30 minutes before meals and at bed time.
Adrenergic Agents (Sympathomimetics) Prototype : - epinephrine, norepinephrine, ephedrine, dopamine, dobutamine, phenylephrine, terbutaline, albuterol, isoproterenol. Mechanism of actions : - stimulate alpha and beta adrenergic receptor directly or trigger the release of catecholamines indirectly causing sympathetic effects.
Indications : - cardiopulmonary arrest, hypotension - COPD and asthma, nasal congestions - allergic reaction, anaphylactic shock Adverse effects : - restlessness, insomnia, tremors, nausea - palpitations, angina, tachycardia, HPN Nursing considerations :
- Contraindicated in clients w/ hyperthyroidism, pheochromocytoma & cardiovascular disease.
- Monitor vital signs and advice precautions.
- Should be taken with food.
ADRENERGIC BLOCKING AGENTS Prototype : a. Alpha blockers
- phentolamine (Regintine), phenoxybenzamine, prazosin (Minipress), reserpine (Serpasil), terazosin (Hytrin)
- clonidine (Catapress), methyldopa (Aldomet) b. Beta blockers
- atenolol (Tenormin), esmolol (Brevibloc), metoprolol (Lopressor), nadolol (Corgard), propanolol (Inderal), timolol ( Blocadren) Mechanism of actions : a. alpha blockers
- 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.
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- Educate clients to minimize orthostatic hypotension.
- Elevate leg to reduce ankle edema.
CENTRAL NERVOUS SYSTEM STIMULANTS
Prototype : - amphetamines, methylphenidate (Ritalin) Mechanism of actions :
- increase excitatory CNS neurotransmitter activity and blocks inhibitory impulses. Indications :
- for obesity (amphetamines)
- attention deficit hyperactivity disorders
- narcolepsy
- drug-induced respiratory depressions. Adverse effects :
- nervousness, insomnia, restlessness
- hypertension, tachycardia, headache
- anorexia, dry mouth. Nursing considerations :
- Should be given at morning.
- Don’t stop amphetamine abruptly to avoid withdrawal symptoms.
- Monitor blood pressure and pulse.
- Ice chips or sugarless gum for dry mouth.
- Watch out for growth retardation in children taking methylphenidate.
DRUGS AFFECTING MENTAL FUNCTIONING
Sedatives, Hypnotics, and Anxiolytics Prototype : a. Benzodiazepines - diazepam (Valium), lorazipam (Ativan), alprazolam (Xanax), flurazepam (Dalmane) b. Barbiturates - amobarbital, phenobarbital, secobarbital c. Miscellaneous - chloral hydrate (Noctec), buspirone (Buspar), paraldehyde (Paral) Mechanism of actions : a. Benzodiazepines - increase the effect of inhibitory neuro transmitter GABA (gamma-amino butyric acid) b. Barbiturates and Miscellaneous agents
- depress CNS Indications :
- induce sleep, sedate and calm clients
Adverse effects : - hangover-effect, dizziness, CNS depression - respiratory depression, drug-dependence Nursing considerations :
- 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)
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- 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 (2 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 : 1. Teach family members the signs of EPS and NMS, and report to physician immediately. 2. Normalization of symptoms may not occur for several weeks after beginning of therapy. 3. Avoid administering haloperidol intravenously 4. Watch out of neutropenia with clozapine. 5. Watch out for orthostatic hypotension and photosensitivity with phenothiazine. 6. Be sure that oral doses are swallowed, and not hoarded.
DRUGS USED IN PAIN MANAGEMENT
General Anesthetics Prototype : 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 :
- cause CNS depression, by producing loss of consciousness, unresponsiveness to pain stimuli, and muscle relaxation. Nursing considerations :
- Instruct client NPO for 8 hours before administration.
- Monitor cardio pulmonary depression and hypotension.
- Monitor urinary retention.
- Monitor body temperature
- malignant hyperthermic crisis : dantrolene (antidote)
- Avoid alcohol or CNS depressants for 24 hours after anesthesia.
- In patient who received halothane, monitor signs of hepatic fatal side effects :
- rash, fever, nausea, vomiting
- jaundice and altered liver function.
LOCAL AND TOPICAL ANESTHETIC
Prototype :
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- 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 : - Monitor bleeding time ( NV = 1-9 mins) - Take the medication with food.
CARDIAC GLYCOSIDES Prototype:
- digoxin (Lanoxin) and digitoxin (Crystodigin) 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 evidence by : 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 : Digi-bind
- Phenytoin is the drug of choice to manage digitalis-induced arrhythmia. 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 after 12-24 hours, 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 15 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 to be crush. - protect the pills from light.
ANTI-ARRHYTHMIC DRUGS
Class I (block Na channels) 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
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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. Indications :
- bronchospasm, asthma, bronchitis, COPD. Adverse effects :
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- 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. Nursing considerations : - Given before meals preferably at morning.
Mucosal Barriers Prototype : - sucralfate (Carafate), misoprostol (Cytotec). Mechanism of action : - coats the mucosa to prevent ulcerations. Nursing consideration : - Given before meals. - Misoprostol is contraindicated for pregnants. - Sucralfate cause constipation.
Anti-diarrheal Agents Prototype :
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- 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. lactulose (Cephulac), Na biphosphate (Fleet enema) & magnesium salt (Milk of Magnesia) - retain fluid and distend intestine b. ducosate (Dialose) - emulsify fecal fat and water c. bisacodyl (Dulcolax) & senna (X-prep) - irritates intestinal mucosa and stimulate intestinal smooth muscles d. bulk-forming laxative (Metamucil) - increase fecal bulk and water content e. mineral oil - lubricates & prevent colon absorption
EMETICS Prototype : ipecac syrup, apomorphine Mechanism of actions :
- induce vomiting through stimulation of vomiting center of medulla. Indications :
- ingestion of poisonous or toxic substances. Nursing considerations :
- Consult poison control center before induction of vomiting.
- Administer ipecac syrup with large amount of fluid.
DRUGS AFFECTING THE ENDOCRINE SYSTEM
THYROID AGENTS 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)
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Prototype : - bromocriptine (Parlodel) Mechanism of action : - decrease serum prolactin levels Adverse effects :
- drowsiness, headache, nausea, palpitations
DRUGS FOR TREATING INFECTION
Antibacterial Agents
- Cell wall inhibitors a. penicillins - pen G, amoxicillin, cloxacillin b. cephalosphorins - cephalexin, cefaclor c. glycopeptide - vancomycin
- Protein synthesis inhibitors a. aminoglycosides - amikacin, gentamycin b. macrolide - erythromycins, roxithromycin c. lincosamides - clindamycins d. chloramphenicol, tetracyclines
- Antimetabolites - blocks folic acid synthesis a. Sulfonamides - cotrimoxazole
- DNA synthesis inhibitors
a. quinolones - ciprofloxacin, ofloxacin
b. metronidazole
Adverse effects :
- Aminoglycoside - nephrotoxicity & ototoxicity
- Sulfonamides - Steven-Johnson’s syndrome, photosynsetivity
- Quinolones - insomnia
- Tetracyclines - bone problems
- Chloramphenicol - Gray syndrome, bone marrow depression
- Erythromycin - hepatitis
Nursing considerations : 1. Collect appropriate specimen for C & S before starting antibiotics. 2. Check client’s history of allergies. 3. Avoid administering erythromycin and quinolones with food. 4. Pregnant precautions. 5. Report for diarrhea - pseudomembranous colitis (clindamycin) 6. Monitor adverse effects.
Antiviral Agents
Prototype : - acyclovir (Zovirax), ganciclovir (Cytovene), vidarabine (Vira-A), amantidine (Symmetrel), ribavirin (Virazole), zidovidine (Retrovir). Mechanism of actions :
- inhibits virus specific enzymes involve in DNA synthesis. They only control the growth of virus but it does not cure. Adverse effects :
- granulocytopenia, thrombocytopenia, nausea, nervousness, headache, nephrotoxicity.
Nursing consideration : - Pregnant and breastfeeding precautions. - Administer IV antivirals to avoid crystallization in renal tubules. - Give ribavirin only with aerosol generator. - Monitor CBC and creatinine level. - Refer for signs of bleeding. - Take amantidine after meals.
Antifungal Agents Prototype : - amphotericin B (Fungisone), nystatin, fluconazole (Diflucan), ketoconazole (Nizoral). Mechanism of actions : - inhibit the synthesis of fungal sterol. Adverse effects : - nephrotoxicity and neurotoxicity - bone marrow depression - chills, fever, joint pains, abdominal pain and headache.
Nursing considerations : - Dilute amphotericin B with sterile water solution not with electrolyte solution. - Tell clients that fever, chills, GI upset, joint and muscle pain will subside as amphotericin B continues. - With oral candidiasis, let nystatin tablet dissolve in mouth rather than swallowing it.
- Refrain ketoconazole with antacids.
- Report for signs of bleeding, infection & fatigue.
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ANTIPARASITIC AGENTS
Prototype : a. Antimalarial - chlroquine, mefloquine, primaquine, quinine, pyrimethamine b. Antiamebiasis - metronidazole (Flagyl), iodoquinol, furozolidone (Furoxone). Mechanism of actions : a. antimalarial – alters protozoal DNA, depleting folates, & reducing nucleic acid production b. antiamoeba – block protein synthesis. Nursing considerations :
- Administer anti-malarial drugs with food.
- Take seizure precautions while administering antimalarial drugs.
- Refer cinchonism during quinine treatment:
- tinnitus, headache, vertigo, fever, and visual changes.
- Inform clients that iodoquinol falsify thyroid function test for up to 6 months.
ANTIHELMINTIC
Prototype : - mebendazole (Vermox), thiabendazole, niclosamide (Niclocide), piperazine (Antepar), praziquantel (Biltricide). Mechanism of actions : - paralyze larva and adult helmints by acting on parasite microtubules. Adverse effects : - GI upset, urinary odor (thiabendazole) - headache, dizziness, fatigue Nursing considerations :
- Treat all the family members for nematodes infection to prevent recurrence.
- Praziquantel must swallowed rapidly because of its bitter taste to avoid gagging.
- Other antihelmintics should be chewed.
ANTI-NEOPLASTIC DRUGS
General considerations : - kills or inhibit the reproduction of neoplasmic cells but as well as normal cells.
- it could be cell cycle phase specific or cell cycle non-specific.
- preferably given through IV route.
Prototype : 1. Alkylating Agents - inhibits cell production by causing cross linking of DNA a. Busulfan – hyperuricemia b. Chlorambucil – gonadal suppression c. Cisplatin – ototoxicity and nephrotoxicity d. Cyclophosphamide – hemorrhagic cystitis. 2. Antitumor Antibiotic Agents - interfere in DNA and RNA synthesis a. Plicamycin – affects bleeding time b. Doxurubicin – cardiotoxicity c. Bleomycin – pulmonary toxicity.
- Antimetabolites
- replace normal proteins required for DNA synthesis by inhibiting the S phase a. Cytarabine – hepatotoxicity b. 5-flourouracil – phototoxicity reaction and cerebellar dysfunctions c. 6-marcaptopurine – hyperuricemia d. Methotrexate – photosensitivity
- given with leucoverin to lessen its toxicity.
- Mitotic Inhibitors (Vinca Alkaloids)
- prevent mitosis acting on the M phase causing cell death a. Vincristine sulfate – neurotoxicity, numbness
- Hormonal Medications and Enzymes
- block the normal hormones in hormone sensitive tumors a. Tamoxifen citrate – visual problems
- elevate cholesterol & triglycerides level b. Diethylstilbestrol – impotence and gynecomastia in men.
Side Effects: stomatitis - bland diet, avoid strong mouthwash - soft tooth brush, ice chips diarrhea, nausea and vomiting - anti-emetic, replace fluids and electrolytes alopecia - reassure that it is temporary
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- The nurse understands that her discharge teaching is effective regarding life style modification when the patient says: a. “I know that I will need to eat less, so I will eat once a day only” b. “I will stay on bed most of the time so I wont experience chest pain” c. “I will stop what I’m doing whenever I have pain and take the pill” d. “I need to enroll in a gym class to have a vigorous exercise to condition my heart”
SITUATION: Manny is admitted to the medical ward with the diagnosis of essential hypertension. He had hypertensive emergency 2 hours ago and was hospitalized for further observation. 9. The nurse administers prescribed anti-hypertensive meds. If it can be any of the following, she will check the pulse prior to giving: a. Nifedipine b. Metoprolol c. Clonidine d. Captopril
After administering a blood-pressure lowing agent, the nurse must caution the patient: a. To avoid straining during defecation b. To avoid low-sodium and potassium diet c. To avoid abrupt change of positions d. To take warm shower immediately after taking the drug
The nurse prepares to give a diet appropriate for a hypertensive patient. Which food should the nurse include in the menu? a. Canned meat loaf b. Scallops and shrimps c. Fresh citrus juice and cake d. Butter and pork steaks
If the physician orders Captopril as the home medication for the high BP, the nurse must caution that the side-effect of this drug that is disturbing is: a. Rashes b. Cough c. Pruritus d. Ringing of the ears
If the client is discharged with home medication of Propranolol hydrochloride, the nurse must include in her medication-teaching plan which one? a. Take the medication on an empty stomach b. Obtain blood pressure readings regularly c. Perform active exercises to prevent Hypotension d. Caution to avoid hazardous activities after taking the drug
The nurse determines that the following drugs are calcium channel blockers that can be prescribed by the physician to the patient. One is not included: a. Nifedipine b. Verapamil c. Telmisartan d. Diltiazem
SITUATION: Joseph,, 50 y. Businessman awakens in the middle of the night with dyspnea, bilateral basilar rales and frothy sputum. He is brought to the Mulawin hospital. His diagnosis is congestive heart failure. 15. The physician gives the patient furosemide and digoxin. The nurse’s main concern is to: a. Take the central venous pressure reading b. Observe for decrease edema c. Observe for signs and symptoms of hypokalemia d. Force fluids
The mechanism of action of dioxin that makes it useful in patients with CHF is that it: a. Produces a negative inotropic effect b. Increases cardiac conduction c. Enhances cardiac contractility d. Increases the heart rate
The nurse is very vigilant about digoxin overdose. Which one statement below by the patient may alert the nurse of a possible development of toxicity? a. “Nurse, I don’t feel like eating for the past few days” b. “I am having constipation lately” c. “I am developing a nagging cough and night terrors” d. “I am experiencing dryness of the eyes and sandy sensation”
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The nurse evaluates that the drug digoxin is effective when the patient manifests: a. Decreased bowel sounds b. Increased urine output c. Increased drowsiness d. Decreased sympathetic response of the body
The following manifestations must be assessed by the nurse to detect beginning digitalis toxicity, with the exception of: a. Nausea and vomiting b. Palpitations c. Diplopia and visual yellow-green halos d. Hypertension
The nurse instructs the patient on diet modification during digitalis therapy. She is certain that her teaching is effective when the patient will choose all the foods items below, except: a. Fresh orange juice and potato fries b. Dried mangoes and tomato juice c. Broccoli salad with bean sprouts d. Flavored gelatin and iced tea
The nurse obtains an apical pulse of 78 beats/min. She is bringing the next dose of digoxin and then proceeds to do which one action below? a. Withhold the drug and notify the physician b. Start IV infusion of Digibind (digoxin antibody) c. Instruct patient to consume more meat and nuts d. Administer the drug
SITUATION: Armida, an 18-year-old adolescent is seen in the health center because of easy fatigability and frequent dizziness 22. The health center physician determines that she has iron-deficiency anemia. The nurse will anticipate the doctor to order for: a. Bone marrow aspiration b. Hemoglobin level determination c. Platelet count d. BUN and Creatinine 23. A drug is administered to correct anemia, such as an iron. This drug is classified as: a. Antihelminthic b. Anticoagulant c. Hematinic
d. Antihistaminic
The nurse administers the oral iron tablet. She will give the medication: a. With milk and dairy products b. With antacids to minimize gastric upset c. With fruit juices like calamansi and orange d. With a full glass of coffee or tea
The nurse instructs the patient to eat iron-rich foods. She determines that her teaching is effective when the client will choose: a. Pomelo juice and hamburger b. Gelatin and marshmallows c. Lean meat and buttered corn d. Liver and eggyolk
The doctor decides to order Iron dextran one ampoule. The nurse prepares to administer the drug: a. Intravenously. Slow IV push b. Intamuscular, Z-track method c. Subcutaneous d. Intrathecal
The nurse must warn the patient taking oral iron preparations that it can cause which side effect/s? a. Yellowish discoloration of the skin and mucus membrane b. Darkening of stool color c. Anorexia and loss of hair d. Ulceration of the skin and cough
The patient remained pale and weak, upon further examination, it was determined that she has pernicious anemia. The pathophysiology of this hematological disorder is: a. Absence of Vitamin E in the diet b. Presence of excessive iron in the liver c. Absence of intrinsic factor in the stomach d. Temporary bone marrow depression.
DRUGS THAT AFFECT THE HEMATOLOGICAL SYSTEM SITUATION: Mrs. Rosalinda Amor, 23 year-old actress is admitted because of a diagnosis of deep vein thrombosis. 29. The nurse employs which of the following non-pharmacological measures in caring for Mrs. Amor?
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a. PT and PTT b. PT and INR c. Clotting time and bleeding time d. Platelet count and PT
SITUATION: Mrs. Avery had a previous attack of mild stroke and coronary artery disease. She is taking Aspirin. 41. The reason aspirin is utilized as an anti-platelet medication is because: a. Aspirin can prolong the bleeding time b. Aspirin affects the thromboxane production of the platelet c. Aspirin interferes with the receptor binding of the platelets d. Aspirin blocks the degranulation process inhibiting release of histamine
The nurse administers aspirin: a. On an empty stomach to increase absorption b. With meals c. In Between meals d. Intramuscularly
Mrs. Avery had a sudden severe and prolonged chest pain. Acute MI is suspected. The nurse anticipates the doctor to order a fibrinolytic, and this may be: a. Tranexamic Acid b. Dipyridamole c. Steptokinase d. Coumadin
If the above drug is ordered to be given IV drip, the nurse must be aware of which potential effect? a. Hypersensitivity reaction b. Congestive heart failure c. Further damage to the myocardium d. Excessive clot formation
If the patient is receiving tissue-plasminogen activator, the nurse must make which one priority intervention? a. Have heparin sodium available b. Monitor closely the renal status c. Observe for psychotic symptoms d. Obtain a stand by Aminocaproic acid
SITUATION: A patient is determined to have hypercholesterolemia and is admitted in the hospital for treatment of her condition. The doctor ordered Lovastatin OD. 46. The nurse determines that the BEST time to give the drug is: a. In the morning before breakfast to promote absorption b. In the afternoon to promote sleep because it is sedating c. At bedtime d. In between meals
The nurse is knowledgeable about the mode of action of lovastatin that it: a. It Inhibits the formation of chylomicrons in the intestinal cells b. It prevents the enzyme that synthesizes cholesterol c. It binds with bile acids and cholesterol promoting excretion d. It promotes cholesterol metabolism in the adipose tissue to lower the plasma cholestero
The nurse is prepared to provide comfort measure to the common side effects of the drug. She monitors the patient for: a. Abdominal fullness, flatulence and diarrhea b. Confusion and psychoses c. Palpitations and arrhythmias d. Hypertension and rashes
The nurse must monitor for these serious adverse effects of lovastatin. Which one is not included? a. Glaucoma b. Cataract c. Myositis d. Hepatic failure
The nurse reads the drug order sheet and is most concern to consult the physician if he orders: e. Paracetamol f. Gemfibrozil g. Vitamin supplements h. Omeprazole
- The nurse is giving Guaifenesin to a patient. She includes in her teaching which of the following interventions? a. Warn the patient that extreme drowsiness may occur b. Offer a full glass of water c. Nausea and vomiting are potential problems alleviated by small frequent meals
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d. Suggest to buy a nebulizer machine to be used at home e. Vitamin ADEK supplements because of impaired absorption
To be able to detect the effectiveness of Salbutamol, the nurse should check for: a. Blood pressure and CVP readings b. Urinary output per hour c. Breath sounds d. Level of consciousness e. Pupillary reflexes
The patient is receiving theophylline capsule OD. The nurse cautions the patient to avoid foods with components similar to theophyline and they can be: a. Sugar and cream b. Coffee and chocolate c. Spinach and broccoli d. Beans and aged cheese e. Canned goods and wine
The patient is receiving theophylline capsule OD. The nurse cautions the patient to avoid foods with components similar to theophyline and they can be: a. Sugar and cream b. Coffee and chocolate c. Spinach and broccoli d. Beans and aged cheese e. Canned goods and wine
The nurse is administering acetylcysteine nebulization to a patient. It is very much important to keep which item below at bedside? a. Scissors b. Ambu bag c. Suction machine d. Tracheostmy set e. NG tube
After giving diphenhydramine to the patient, the nurse must ensure that the patient understands the teachings below, EXCEPT: a. Refrain from manipulating delicate machines b. Take sugarless candy in the mouth to relieve dryness c. Avoid taking the drug with alcohol
d. Check pulse rate before taking the drug e. Manage gastric upset by taking it with food
The nurse watches out for a side-effect associated with intake of codeine sulfate and provides appropriate intervention, this can be: a. Constipation- provide liberal fluids b. Excitement- provide less stimulation c. Tachycardia- administer lidocaine d. Polyuria- give the drug in the morning e. Tachypnea- position on semi-fowler’s
Terbutaline sulfate is administered to a patient with asthma. If the patient has another disease, the nurse is most vigilant and cautious if this condition exists: a. Hypothyroidism b. Rheumatoid arthritis c. Diabetes mellitus d. Polycystic ovarian disease e. Emphysema
The nurse is administering oxymetazoline nasal decongestant. She includes in her care plan all of the following interventions, EXCEPT? a. Instruct the patient to clear the nasal passage of mucus before instilling b. Remind patient to keep the head tilted for a few seconds after administration c. Advise increased fluid intake d. Encourage the use for one week for better effect e. Caution that tachycardia and urinary retention may occur with systemic absorption
The physician asks the nurse for an anticholinergic drug to be used for the asthmatic patient. The nurse obtains from the pharmacy which drug? a. Albuterol b. Terbutaline c. Metaproterenol d. Ipratropium bromide e. Salbutamol
Pharmacology Reviewer
Course: bs nursing
University: Southwestern University PHINMA
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