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PHARMACOLOGY NURSING
Organs Sensitive to Blood Supply : ● Brain ● Myocardium ● Kidneys ○ Priority organs in exercise, hunger, and stress. ❖ IV - fast route. ❖ SQ - slow or maintained. ❖ Protein Binding Capacity - decrease protein in the body. There is an increased risk in drug toxicity. ➢ If 50% of protein is bound, only 50% will work. Factors in Absorption and Distribution : ❖ Acidic Drug - acidic environment. ❖ Fat Soluble > H 2 O Soluble in Absorption ➢ GI Lining - made up of lipid (carrier - protein). ❖ Non-Ionized Drugs > Ionized Drugs in Absorption ➢ Increased Fat in Diet = decreased aborption/distribution. ➢ Exercise, Hunger, and Stress = decreased absorption and distribution. Pharmacokinetics - movement of drug into the body. ● Absorption - movement of drug from small intestine to the blood stream. ● Distribution - from the blood stream to targen organ/cell. ● Metabolism - biotransformation at the liver; first pass phenomena → PO drugs undergo metabolism. ● Excretion - main organ is kidney; acidic drugs are excreted in an alkaline environment. Pharmacodynamics - effect of the drug in the body. ● Therapeutic Effect - desired effect. ● Adverse Effect - other effects. ● Interactions: ○ Additive (Summation) - combine two drugs/substances with the same effect. ○ Syngergism - combine two drugs/substance with different action or effects; potentiation. ○ Antagonism - blocks the action of a drug. ● Side Effects - minor or common effects of a drug; expected effects and are manageable. ● Hypersensitivity Reaction - immune response of the body. ● Allergic Reaction - worse effect of hypersensitivity reaction; anaphylactic shock; DOC: epinephrine. Food-Drug/Drug-Drug Interactions DRUG FOODS TO AVOID DRUG INTERACTIONS Antacids
Antibiotics Tetracycline Anticoagulants MAO Inhibitors Diuretics Digoxin Ten Rights
- Right Patient - ask name, bracelet, chart.
- Right Drug - read or check it three times.
- Right Dosage
- Right Time and Frequency
- Right Route
- Right Assessment
- Right Education
- Right to Refuse
- Right Evaluation
- Right Documentation a. Refusal of Medication - patient signs the doctor’s order. General Rule in Drug Administration (COMPLIANCE) ● C hildren ● O bserve Adverse Effect ● M edications - no OTC medications. ● P regnant Mothers ● L actating/Liver Function (ALT) ● I nteractions ● A llergy (antibiotics) - skin testing. ● N o Crushing of Enteric Coated Drugs ● C ompliance - avoid drug ressistance. ● E lderly Half-Life - time it takes for the ½ concentration of the drug is elminated. ❖ Example: ➢ Amoxicillin 500 mg half-life is 1 hour. ■ 1st half-life - 250 mg ■ 2nd half-life - 125 mg ■ 3rd half-life - 62.5 mg Pediatric Calculations ❖ Nomogram Method - BSA (m^2 ) ➢ Formula: BSA/1.73 x Adult Dose ➢ Use chart ➢ With formula
➢ Lipidemia ➢ Bronchospasm/Constriction ➢ CHF ➢ Vasoconstriction ➢ Exhaustion ➢ Recognition to Hyperglycemia is Decreased ○ Cardio-Selective - Beta 1 Blocker ■ Metoprolol (Neobloc) ■ Acebutolol (Sectral) ■ Esmolol (Brevibloc) ■ Atenelol (Tenormin) ■ Betaxolol (Kerlone) ● Non-Selective - Beta 1 + Beta 2 Blockers ○ Propanolol (Inderal) ○ Carvedilol (Coreg) ○ Nadolol (Corgard) ○ Labetalol (Normodyme) ○ Timolol (Blocadren) ❖ SNS - fight or flight. ❖ B1 - increases heart rate. ➢ Muscle Tissue → Lypolysis → Increased Glucose ❖ B ➢ Lungs → Bronchodilation → Increased Respiratory Rate ➢ Liver → Glycogenolysis and Gluconeogenesis ➢ Uterus → Relaxation ❖ Alpha 1 ➢ Blood Vessel → Vasoconstriction ➢ Pupils → Mydriasis → Pupillary Dilatation ➢ Urinary Bladder → Sphincter Contraction → Decreased Urine Output ❖ Alpha 2 - regulates release of norepinephrine. Parasympathetic Drugs ❖ Rest or digest. ❖ Increased GI and GU. ❖ Main Neurotransmitter - acetylcholine (Ach). ❖ Glaucoma ➢ Open - increased aqueous humor → increased IOP. ➢ Closed - obstruction in the trabecular mesh → decreased drainage. ■ Management: trabeculoplasty ➢ Complication - retinal detachment → increased IOP. ■ Curtain Vision ■ Scleral Buckling ➢ Diuretic: ■ Acetazolamide (Diamox) - decreases aqueous humor. ➢ After Eye Surgery - wear goggles to decrease IOP. ● Direct-Acting Cholingergics - increases acetylcholine → increased PNS. ○ Pilocarpine - glaucoma: increased IOP → increased aqueous humor → tunnel vision → loss of peripheral vision.
○ Betanechol - paralytic ileus, and urinary retention. ● Indirect-Acting Cholinergics - increased acetlycholine by decreasing acetylcholinesterase. ○ Neostigmine - given. ❖ Myasthenia Gravis ➢ Destruction of the neuromuscular junction. ➢ Increased acetylcholinesterase → breaks acetylcholine. ● Anti-Cholinergics ○ Atropine Sulfate - sinous bradycardia; used as a pre-op drug. ○ Propantheline Bromide and Scopolamine - are used for motion sickness; side effect is nausea and vomiting. ○ Meclizine (Antivert) - an antivertigo, and antihistamine. Anti-Hypertensive Drugs - pressure. ● Angiotensin I Converting Enzyme (ACE) Inhibitors ○ Side Effects: ■ Cough ■ Hyperkalemia ■ First Dose → Orthostatic Hypotension ■ In Heart Failure → Decreased Venous Return ○ Management: low potassium diet. ○ Captopril (Capoten) ○ Lisinopril (Prinivil) ○ Enalapril (Vasotec) ○ Benzapril (Lotension) ● Angiotension II Receptor Blockers ○ Irbesartan (Avapro) ○ Losartan (Cozaar) ○ Telmisartan (Micardis) ○ Valsartan (Diovan) ● Alpha Adrenergic Blockers ○ Doxazosin (Cardura) ○ Prazosin (Minioress) ○ Terazosin (Hytrin) ● Beta Blockers - ends with “-lol” ❖ Vasodilators: ➢ Central-Acting ■ Clonidine → Decreased NE Release → Vasodilation ➢ Direct-Acting/Peripheral - direct to blood vessels → vasodilation. ■ Hydralazine ■ Minoxidil ➢ Do not stop medication adminstration abruptly - to prevent rebound hypertension (in doctor’s order: for titration). ❖ AHA Line of Treating Hypotension: ➢ Diuretics - thiazide. ➢ ACE Inhibitors/ARBs ➢ Ca Channel Blocker
○ INR - 2 to 3 seconds. ● Thrombolytics - dissolves clots. Only effective within 6 hours after the onset of the attack e.g. transient ischemic attack/mild stroke (TID). ○ Streptokinase (Streptase) ○ Urokinase (Abbokinase) ○ Alteplase (TPA) ● Antiplatelet - decreases platelet aggravation. Only effective 6 hours after the onset of the attack. ○ Aspirin (ASA) ○ Ticlopidine (Ticlid) ○ Clopidogrel (Plavix) ● Anti-Anemia ○ Ferrous Sulfate (Iron) - given together with vitamin C for increased absorption of iron. ○ Epogen - synthetic erythropoietin; given for chronic renal failure Respiratory Drugs ❖ Asthma - is a hyperallergenic response → release of chemical mediators (histamine, bradykinin, prostaglandin, leukotriene) → signs and symptoms of inflammation. ➢ 3 Pathologic Phases: ■ Hypersecretion of Mucus - due to histamine. ■ Airway Edema ■ Bronchospasm ● Anti-Histamine - if there is sneezing. ○ Dyphenhydramine (Benadryl) ○ Loratidine (Claritin) ○ Hydroxyzine (Atarax, Visatril) ○ Meclizine (Antivert) ○ Promethazine (Phenegran) ○ Cetirizine (Cetzy) ○ Celestamine (Caladryl) ● Decongestants ○ Neozep ● Mucolytics - loosens/dissolves mucus secretions. ○ Acetylcysteine (Mucomyst) ○ Carbocysteine (Soulmux) ● Expectorants - patient needs to increase OFI. ○ Guiafenessin (Robitussin) ● Xanthine Derivatives ○ Aminophylline (Theophylline) ● Antitussive - cough suppressants; is given for irritating and non-productive cough. ○ Codeine ○ Dextromethorphan Bromide ● Mast Cell Stabilizers ○ Cromolyn Sodium (Intal) - given as a preventive drug (prophylaxis), not effective against acute attack. ● Leukotriene Receptor Antagonist - blocks the receptor site of leukotriene → no inflammation.
○ Montelukast (Singulair) ○ Zafirlukast (Accolate) ● Corticosteroids - delivered via meter dose inhaler. Instruct patient to inhale 2 to 3 puffs then hold it for 10 seconds then do oral care for 1 to 2 minutes interval. Best time to take corticosteroids is early in the morning. Do not stop it abruptly. ❖ Adrenal Sufficiency - patient may die from dehydration or shock due to aldosterone not released. ❖ Types of Hypersensitivity: ➢ Immediate IgE ➢ Cytotoxic/Cytolytic - hemolysis e.g. blood transfusion reaction, rhogam to prevent erythroblastosis fetalis. ➢ Antigen and Antibody Complex - GABHS infection (tonsilitis, otitis media, URTI) → inflammation. ➢ Delayed Graft VS Host Disease - “organ rejection”. ■ Administer immunosuppressants: methotrexate, cyclophosphamide (Cytoxan), azathioprine (Imuran). We can administer corticosteroids but we are after for the side effect → bone marrow depression. ○ Methylprednisolone ○ Beclomethasone (Beclovent) ○ Prednisone ○ Triancinolone (Azmacort) ○ Flunisolide (AreoBid) Anti-Ulcer Drugs ● Antacids - only anti-ulcer drug given after meals to neutralize gastric acid. Cannot be combined with other drugs. ○ Aluminum Hydroxide (Amphogel) - S/E → constipation. ○ Magnesium Hydroxide (MOM) - S/E → diarrhea. ○ Calcium Carbonate (Tums) - instruct patient to increase OFI to prevent renal stones. ○ Maalox - combined Amphogel and MOM because it has lesser side effects. ● H2 Blockers - given before meals; decreases gastric acid production. ○ Ranitidine (Zantac) ○ Cimetidine (Tagamet) ○ Famotidine (Pepcid) ○ Nizatidine (Axid) ● Proton Pump Inhibitor - given before meals; decreases gastric acid production. ○ Omeprazole (Protonix) ○ Pantoprazole (Prilosec) ○ Lansoprazole (Prevacid) ○ Esomeprazole (Nexium) - most effective PPI but expensive. ■ Protonics - can be used for a maximum of 16 weeks, purpose is to heal the ulcer. ● Cytoprotective Drug - given before meals; will create a barrier to protect the GI mucosa from gastric acid. ○ Sucralfate (Carafate) ○ Misoprostol (Cytotec) - not advisable since there is an abortive effect.
○ Gentamycin (Garamycin) - used for children with infections in combination with other antibiotics. ○ Amikacin (Amikin) - used for children with infections in combination with other antibiotics. ○ Neomycin (Neobiotic) - via enema; for hepatic encephalopathy → decreases the bacteria in the intestine → taken together with lactulose. ○ Streptomycin ○ Kanamycin (Kantrex) - used for children with infections in combination with other antibiotics. ❖ Side Effects: ➢ Ototoxic ➢ Nephrotoxic - check creatinine. ➢ Neurotoxic ● Cephalosporins - safe with pregnant mothers. ○ First Generation: Cefazolin (Ancef), Cephalexin (Keflex), Cpehradine (Velosef) - effective against gram positive bacteria e.g. E-coli infection. ○ Second Generation: Cefaclor (Ceclor), Cefuroxime (Ceftin) , Cefoxitin (Mefoxin) - effective against gram positive and negative bacterias. Given as a pre-op drug together with metronidazole. ○ Third Generation: Cefixime (Suprax), Cefotoxime (Cefizox), Ceftriaxone (Rocephin) , Ceftazidime (Fortaz) - effective against gram negative bacteria. Ceftriaxone for sepsis and gonorrhea. ○ Fourth Generation: Cefepime (Maxipime) ● Fluoroquinolones - effective against GI and GU infections. ○ Ciprofloxacin (Cipro) ○ Ofloxacin (Floxin) ○ Levofloxacin (Levaquin) ● Macrolide - effective against H. pylori, streptococcal infections. Avoid fruit juice (decreases absorption). ○ Erythromycinn (E-Mycin) ○ Azithromycin (Zithromax) ○ Clarithromycin (Biaxin) ● Sulfonamides ○ Sulfasalazine - used for inflammatory bowel disorders. ○ Sulfadiazine ○ Sulfisoxazole (Gantrisin) ○ Trimethoprim-Sulfamethoxazole (Bactrim, Septra) ○ Mafenide Acetate - used for patients with burns. ○ Silver Nitrate - used for patients with burns. ● Tetracycline - use straw. ○ Tetracycline (Anchromycin) ○ Doxycycline (Vibramycin) - for leptospirosis ○ Minocycline (Minocin) ● Vancomycin Hydrocholoride (Vancocin) - most effective antibiotic. ○ Side Effect - red neck syndrome. ○ Monitor - creatinine. ○ Can be mixed with NSS (no other IV fluids) ● Anti-TB Drugs
○ Rifampicin ○ Isoniazid ○ Pyrazinamide ○ Ethambutol ○ Streptomycin ● Anti-Fungal ○ Amphoterecin B - for systemic fungal infection e.g. cryptococcal neoformans → meningitis ■ Before Administering (TERRIBLE): ● T ylenol - to decrease the side effect. ○ Check temperature during the administration of amphterecin. ● A( E )dd Hydrocortisone to Infusion - for 4 hours. ● R eview Kidney Function - creatinine. ● R elaxing Environment - small frequent feeding. ● I nput and Output Monitor, and IV Site Check - phlebitis. ● B enadryl ● Toxic to L iver ● E valuate Temperature and Serum Potassium - hyperkalemia. ■ DOC for meningitis. ○ Fluconazole (Diflucan), Nystatin (Nilstat), Miconazole (Monistat), Ketoconazole (Nizoral), Clotrimazole (Lotrimin), Gentian Violet, Tolfanate - for local fungal infection. ■ Things to Know (ZOLE): ● Ends with - z ole ● O bserve Hygiene - may cause superinfections. ● Check L iver ● E ducate with Food - best absorbed in an acidic environment. ● Anti-Protozoal ○ Metronidazole (Flagyl) - for protozoal infection e.g. amoebiasis, trichomoniasis (STD) character sign is greenish vaginal discharge. ■ When Taking Metrodinazole (FAINT): ● F lushing ● A norexia ● I ncreased Vomiting - avoid alcohol. ● N ausea ● Metallic T aste ● Anti-Viral ○ Acyclovir (Zovirax) ○ Retrovir (Zidovudine) ○ Oseltamivir (Tamiflu) Endocrine Drugs ● Anti-DM ○ Oral Hypoglycemic Agents - DM II ■ Sulfonylureas - site of action is pancreas to release insulin (glipizide (Glucotrol)).
○ Phenytoin (Dilantin) - via IV, flush the NSS → phenytoin → flush NSS. ■ Side Effect - gingival hyperplasia; use soft bristled toothbrush. ○ Barbiturates ■ Phenobarbital ● Side Effect - CNS depression ○ Valproic Acid - for manic patients; check ALT. ○ Carbamazepine - for manic patients, trigeminal neuralgia. ○ Suximines - ends with -mine. ● Anti-Manic Drugs - there’s an -ith within the name. ○ Lithium - to stabilize the mood for manic patients. ■ N: 0.5 to 1.5 mg/L, ■ >2 mg/L → tremors/toxicity ● Antidote - mannitol/hemodialysis ■ Diet - normal sodium ■ Increased OFI ● Anti-Depressant Drugs - needs 2 to 4 weeks to take effect; to increase serotonin → improves sleep. ○ Watch out for suicide in the 3rd week (has energy but still has thoughts about suicide). ○ TCA - second choice; problem is dry mouth, constipation. ○ SSRI - first choice; lesser side effects. ○ MAOI - third choice; avoid tyramine-rich foods; hypertensive give phentolamine (potent vasodilator). ○ ECT - last resort. ■ Before ECT: ● ATSU 4 ● Succinylcholine ● Volts - 70 to 110 volts ● .1 to 1 second ● 2 to 3 times a week ● Total of 6 to 12 sessions ● Anti-Psychotic Drugs - for decreased dopamine; S/E → Pseudoparkinsonism/EPS. ○ Akineton, Artone ○ Benadryl ○ Cogentin ○ Typical ■ Haldol ■ Chlordiazepoxide ○ Atypical - agrunolocytosis; ends with -done or -pine. Rheumatoid Arthritis ● Causes: ○ Autoimmune Disorder - risk factor is frequent viral infection. ○ Antigen Antibody Complex ○ Idiopathic ● Affectation: ○ Carpals (fingers) ● Pain:
○ Increased Cold Weather → Increases Pain ○ Increased Activity (swimming) → Decreases Pain ● Management: ○ NSAIDS ■ Severe Pain (7 to 10) - narcotic analgesics e.g. morphine and demerol (chronic pancreatitis and cholecystitis). ■ Moderate Pain (4 to 6) - opioid analgesics “-codone” or tramadol. ■ Mild Pain (1 to 3) - acetaminophen, biogesic. But if the pain is related to muscular pain → NSAIDS (given with food since it’s a GI irritant). ○ Corticosteroids ○ Immunosuppressants ○ DMARDS (Disease Modifying Antirheumatic Drugs) - gold therapy e.g. auranofin, solganal, chloroquine. ● Sjogren’s Syndrome - everything is dry (eyes, vagina, etc.). ● Felty’s Syndrome: ○ Signs and Symptoms: ■ Splenomegaly ■ Anemia ■ Neutropenia ■ Thrombocytopenia ■ Arthritis Osteoarthritis ● Cause: ○ Degenerative Disease (Aging) “Wear and Tear” ● Risk Factor: ○ Obesity ● Affectation: ○ Weight-Bearing Joints - hips, spine, and pelvis. ● Pain: ○ Increased Activity → Increases Pain Gouty Arthritis ● Cause: ○ Metastasis of Increased Uric Acid Synthesis → Big Toe ● Pain: ○ Tophi Formation ● Medications: ○ Allopurinol (Zinopril) - decreases uric acid production/synthesis. Also used in chemotherapy drugs (since S/E is hyperuricemia). ○ Probenecid (Probalan) - increases uric acid excretion. ○ Colchicine - for acute attack of pain. ● Management: ○ Increase OFI ○ Avoid Uric-Rich Foods Regional Enteritis (Crohn's Disase) ● Affects: small intestine (segmental) ● Cause: autoimmune
