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PHARMACOLOGY

A. General Principles
B. Administration of:
1. Oral
2. Parenteral
3. Opthalmic
4. Otic
5. Topical
6. Vaginal
7. Rectal
NERVOUS SYSTEM

CNS PNS

BRAIN SPINAL CORD SOMATIC AUTONOMIC

PARASYMPATHETIC SYMPATHETIC
(cholinergic) ACH (adrenergic) NE
AUTONOMIC

Cholinergic adrenergic
(parasympathomimetic) (sympathomimetic)
Bethanecol, carbachol,
methacoline, *Norepinephrine
*Epinephrine
neostigmine, physostigmine
*Dopamine

Cholinergic blockers Adrenergic blockers


(parasympatholytic) (sympatholytics)

=antimuscarinic drugs * Propranolol


*catecholamines
*belladona alkaloids
(atropine & scopolamine)
1. NARCOTIC AGONISTS

2. NARCOTIC PARTIAL AGONISTS; NARCOTIC


ANTAGONISTS

3. NON-STEROIDAL ANTI-INFLAMMATORY

4. MISCELLANEOUS ANALGESIC AGENTS


Librium – watch for signs of leukopenia,
hypotension

Equanil – metabolizes extensively in the liver &


interferes w/ liver function tests.
- decreases PT if on coumadin

Atarax - does not cause tolerance & can be used


temporarily when other anti-anxiety
agents have been abused

Serax – useful for treating elderly clients. Does not


rely on liver for metabolism
BARBITURATES
*treat grandmal seizures ; tonic-clonic seizure

BENZODIAZEPINES
*diazepam is DOC for Rx of STATUS EPILIPTICUS
*clorazepate is use w/ other antiepileptic agents to
control partial seizures

HYDANTOINS
*Used to depress abnormal neuronal charges &
prevent spread of seizures
*also used to treat dysrhythmias
*A/R: gingival hyperplasia, alopecia, hyperglycemia,
blood dyscracias
*Seizure precaution & dental hygiene
*Give IV with normal saline & never with dextrose
AMPHETAMINES
increase the release of catecholamines (NE from stored sites
in nere terminals)
Block the re-uptake of dopamine & NE following release into
the synapse, & inhibit the action of MAO
Increase stimulating effect on cerebral cortex & RAS

DOXAPRAM (DOPRAM)

METHYLPHEMDATE Hcl (Ritalin)

PEMOLINE (Cylert)

CAFFEIN
DOPAMINERGIC MEDS
amantidine (Symmetrel); bromocriptine (Parlodel); carbidopa-
levodopa (Sinemet) ;trihexyphenidyl (artane)

*Increases the amount of dopamine in the brain

*A/R: involuntary body movements, urinary retention,


constipation, dizziness,

*For levodopa avoid vitamin B6 & eat low-CHON food

*Not to take in ROH & never to discontinue meds abruptly

*Urine & perspiration may be discolored & stain clothing but


this is harmless
*neostigmine bromide (Prostigmin), pyridostigmine bromid
(Mestinon) are used to control myasthenic symptoms
-take meds on time…MG impairs breathing & swallowing
-take a.c. for best absorption
-meds for life & wear Medic-Alert bracelet
*edrophonium chloride (Tensilon) is used to diagnose
myasthenia gravis & differentiate cholinergic crisis (drug
overdose)
-prepare resuscitative equipment & antidote: atropine SO4
-dx as M.G. if client shows marked improvement in muscle
tone within 30-60 seconds after injection lasting 4-5 mins
…positive Tensilon Test
-dx as cholinergic crisis when muscle tone does not improve
upon injection…negative Tensilon Test
-S/Sx: muscle twitching around eyes & face
benztropine mesylate (Cogentin), biperiden HCl (Akineton)
Trihexyphenidyl HCl (Artane), scopolamine, atropine

*Block cholinergic receptors in the CNS, thereby suppressing


acetylcholine activity

*A/R: blurred vision, dry mouth & secretions, urinary retention,


constipation, restlessness & confusion

*Client to have regular eye check up for increase in IOP

*Avoid aspirin, caffeine, smoking & ROH to decrease gastric


acidity
Antianxiety or anxiolytic agents
-zolam -zepam -zepate -zepoxide

Antidepressants
a. selective serotonin reuptake inhibitor
Fluoxetine (proxac), Paroxetine (Paxil),Sertraline hcl (Zoloft)

b. tricyclic
Elavil, Vivactil, Sinequan, Aventyl, Tofranil, Norpramin

c. MAOi
Marplan, Nardil, Parnate
* watch out for strokes!
Neuroleptic (antipsychotic) agents
* blocks dopamine receptors in basal ganglia of brain,
inhibitiing transmission of nerve impulses
a. phenothiazines (zines)
b. butyrophenones (peridol)
c. thioxanthenia (trixene)

antimanic and mood-stabilizing agents (LITHIUM)


*encourage diet containing normal amts of SALT &
FLUID intake of 3L/day

sedative and hypnotic agents


MYDRIATICS & CYCLOPLEGICS

Atropine, Epinephrine, Cyclogyl, & Mydriacyl

*Used to facilitate eye exam & treat uveitis

*A/R: photophobia, impaired distant vision,


increased IOP, blurred vision, reduced
lacrimation
MIOTICS
CARpine, CARbachol, piloCARpine, demeCARium

*Cholinergic drug that causes miosis (contraction) of the


pupil & contraction of the ciliary muscle of the eye

*Decreases IOP in glaucoma & achieves miosis in cataract


surgery

*A/R low toxicity level: transient hypotension & decreased


heart rate, blurred vision & focusing difficulty
*Inhibit response to beta-adrenergic stimulation

*Block release of epi & NE thus decreasing HR & BP

*Used for angina, dysrhythmias, prevention of MI & glaucoma

*A/R: bradycardia, hypotension, weakness & fatigue

*Hold if BP & HR not within parameters prescribed by MD

*Not to D/C meds abruptly…rebound HPN, tachycardia, angina

*Early signs of hypoglycemia such as tachycardia & nervousness can


be masked by these drugs…monitor blood sugar
BETA- BLOCKING AGENTS

BETA1 ADRENERGIC ( CARDIO SELECTIVE)


BLOCKING AGENTS
-acebutolol (Sectral)
-atenolol (Tenormin, Atenol, Premorphine)
-metoprolol (apo-metoprolol, betaloc)

BETA1 & 2 ADRENERGIC (nonselective) BLOCKING


AGENTS
-nadolol (corgard)
-pindolol (visken)
-propranolol( inderal, novopranol)
-timolol (blocadren, betin, temserin)
verapamil (Calan, Isoptin), nifedipine (Procardia)
felodipine (Plendil), diltiazem (Cardizem)

*Decrease cardiac contractility by relaxing smooth muscle


and the workload of the heart…thus decreasing need for O2

*Promote vasodilation of coronary & peripheral vessels

*A/R: bradycardia, hypotension, dizziness & lightheadedness

*Instruct client how to take HR & to inform MD if dizziness


persists
dobutamine (Dobutrex)
*Increases myocardial force & C.O. through beta receptors
stimulation
*Used in clients with CHF
dopamine (Intropin)
*Increases BP & C.O. & increases renal outflow through its
action on alpha & beta receptors
*Treat mild renal failure due to decreased C.O.
epinephrine (adrenalin)
*Cardiac stimulation during cardiac arrest, bronchodilation
asthma & allergy, mydriasis
*Promotes vasoconstriction when combined with local
anesthetics to promote prolonged anesthetic action by
decreased blood flow to area
isoproterenol (Isuprel)
*Stimulates beta receptors & used for cardiac stimulation &
bronchodilation

norepinephrine (Levophed)
*Stimulates heart in cardiac arrest
*Vasoconstricts & increases BP during hypotension & shock

*A/R: tachycardia, angina, restlessness


*If extravasation occurs, infiltrate with normal saline &
phentolamine (Regitine)
GUANETHIDINE, MINOXIDIL, OR
ANGIOTENSIN INHIBITORS

VASODILATOR AGENT

ADRENERGIC BLOCKING AGENT


BETA-BLOCKING AGENT

BETA-BLOCKING AGENT
DIURETIC

Weight reduction, sodium restriction elimination or limited


consumption of alcohol & tobacco, reduction of dietary saturated fats,
regular exercise program, behavior modification to promote relaxation
STEP 2 ADRENERGIC BLOCKING DRUGS

CENTRALLY ACTING SYMPATHOLYTICS


clonidine (Catapres), methyldopa (Aldomet)
*Stimulate alpha receptors in medulla causing
reduction in sympathetic action in heart; decreases rate to
inhibit vasoconstriction & reduce peripheral resistance
*A/R: Na & H2O retention, edema & hypotension
*Instruct client not to D/C meds rapidly because it will
cause rebound HPN
STEP 2 ADRENERGIC BLOCKING DRUGS

PERIPHERALLY-ACTING ALPHA ADRENERGIC


BLOCKERS

prazoline (Minipress), phentolamine (Regitine)

*Decrease sympathetic vasoconstriction by reducing the


effects of NE at the peripheral nerve endings,
resulting to vasodilation & decreased BP
*A/R: orthostatic hypotension, Na & H2O retention, edema
and weight gain
*Client to rise slowly, decrease Na intake & monitor for
fluid retention & edema
STEP 3 VASODILATOR

= exhibit direct action on the smooth muscle walls of


arterioles &/or veins
= stimulation of calcium binding process

1) ARTERIOLAR DILATORS (selective effect on arteries)


-diazoxide, hydralazine, minoxidil

2) ARTERIOLAR & VENOUS DILATORS


-Na nitroprusside.. Acts on arteriolar resistance & venous
capacitance
STEP 4 ACE INHIBITORS

*Prevent peripheral vasoconstriction by blocking


conversion of angiotensin 1 to angiotensin 2
*Instruct client to take Capoten 20 minutes to 1 hour
a.c.
*Not to D/C meds abruptly because it causes rebound
HPN
*If dizziness persist, report to MD
*Taste for food may be diminished during 1st month of
therapy
NITRATES
nitroglycerin (Nitrostat, Nitrolingual)
nitroglycerin ointment 2% (Nitrol, Transderm-Nitro)
*Produce vasodilation & improved myocardial O2 consumption
*C/I in client with severe hypotension
*A/R: H/A, orthostatic hypotension, dizziness, weakness & faintness

SUBLINGUAL:
*Offer sips of H2O since dryness may inhibit absorption
*Leave under tongue until fully absorbed, not swallowed
*Take 1 tab for pain ff q5 mins for a total of 3 doses. If pain not
relieved in 15 minutes, seek MD help….. may indicate MI
*Stinging/burning feeling means tablet is fresh
TOPICAL
*Remove ointment from previous dose, rotate sites & avoid
touching ointment & hairy areas
*Squeeze ribbon into prescribed length on applicator paper
*Sites: chest, back, abdomen, upper arm & anterior thigh

TRANSDERMAL PATCH
*Apply patch to hairless area, using new patch & different
site every day
*Remove patch after 12-14 hours, allowing 10-12 “patch-
free” hours daily to prevent tolerance
*Stand away from microwave ovens
GROUP 1

generally inhibit the fast sodium channel in cardiac


muscle resulting in an increased refractory period

a. Disopyramide phosphate (NORPACE)


Procainimide hcl (PROCAN)
Quinidine (QUINIDEX)

b. Lidocaine (XYLOCAINE)

b. Flecainide
GROUP 2

BETA BLOCKERS THAT DECREASE STIMULATION OF THE HEART


Beta 1 selective antagonists=cardiogenic blockers;
block Beta1 cardiac receptors
=atelonol (ternonim), acebutolol
sectral, metoprolol (betaloc)

Beta 2 Selective = mucolytics & bronchodilators


Nonseletive Beta Adrenergic = beta1 & beta2 blockers
blocking agents = nadolol (corgard), oxyprenelol
(trasicor), pindolol (visken)
propranolol (inderal) , timolol
GROUP 3
* generally do not affect depolarization but work by
prolonging cardiac repolarization
• Anti adrenergic; positive inotropic action
• Bretylium, amiodarone hcl (cordarone)

GROUP 4

• Calcium antagonist action= depression of heart & smooth


muscle contraction, decreased automaticity, & decreased
conduction velocity
• verapamil
Effects of digitalis
1. Positive inotrope
2. Negative chrono & negative dromo

DIGITALIZATION
*administration of layer dose of digitalis preparation
for an initial 24-48 hours

COMMON S/E
*weakness, fatigue, vomiting, diarrhea, arrhythmia
& PR < 60bts/min
DIGITALIS TOXICITY
* loss of apetite, nausea, extreme fatigue, weakness
of the arms & legs, psychiatric disturbances
(nightmares, agitation, listlessness, or hallucination)
or visual disturbances ( hazy, or blurred vision,
difficulty reading & green color…)

N.I.

1. Take APICAL PULSE 1 full minute


*don’t give for Adult <60/min; child < 90 bts/min
*monitor potassium level specially diuretics
digoxin (Lanoxin)

*Inhibit sodium-potassium pump

*positive inotropic action

*negative chronotropic action

*A/R: anorexia, N/V, visual disturbances

*Monitor serum therapeutic level 0.5-2.0 ng/ml; increased


risk of toxicity in clients with hypokalemia

*Used for CHF, atrial tachycardia, atrial fibrillation & flutter


digoxin (Lanoxin)

*Increase K+ rich food: fresh & dried fruits, fruit juices,


vegetables & potatoes

*Monitor HR & hold if below 60 & above 100 (adults)

*Antidote: digoxin immune FAB (Digibind)

*Life threatening toxicity: ventricular tachycardia, fibrillation,


severe sinus bradycardia

*80% DIGOXIN excreted by kidneys; half life is 36-120H

*90% DIGITOXIN metabolized by liver; half life is 120-210H


*Prevent the extension & formation of clots by inhibiting
factors in the clotting cascade & decreasing blood
coagulability

*Used for thrombosis, pulmonary embolism & MI

*C/I in active bleeding except in disseminated intravascular


coagulation (DIC), bleeding disorders, ulcers

*A/R: hemorrhage, hematuria, epistaxis, ecchymosis,


bleeding gums, thrombocytopenia
heparin Na (Liquaemin Na)

*Prevents thrombin from converting fibrinogen to fibrin

*Prevents thromboembolism

*Therapeutic dose does not dissolve clots, but prevents


new thrombus formation

*Blood levels: normal APTT is 20-36 seconds;


maintain APTT is 1.5-2.5 times normal;
APTT therapy should be measured q 4-6H
during initial therapy & then daily
heparin Na

*Monitor clotting time; normal is 8-15 minutes; maintain


clotting time 15-20 minutes

*Observe for signs of bleeding

*Inject SQ into the abdomen with 25-28g at 90 degrees


angle; don’t aspirate or rub injection site

*Antidote is protamine SO4


warfarin Na (Coumadin)

*Decreases prothrombin activity & prevents the use of


vitamin K by the liver

*Used for long-term anticoagulation

*Prolongs clotting time & monitor PT (prothrombin time)

*Used mainly to prevent thromboembolitic conditions such


as thrombophlebitis, pulmonary embolism, embolism
caused by heart valve damage, atrial fibrillation & MI

*Given 2-3 months after an MI to prevent DVT


warfarin Na (Coumadin)

*Average PT is 9.6 to 11.8 seconds & normal INR is 1.3-2.0


Goal is to raise the INR to 2 to 3

*Observe for signs of bleeding

*Antidote: Vitamin K (AquaMEPHYTON)


THROMBOLYTIC MEDS

*Activates plasminogen which generates plasmin

*Used 4-6 hrs after MI to restore blood flow, limit


myocardial damage, preserve left ventricular function

*C/I: active bleeding, history of thoracic, pelvic or


abdominal surgery within the last 10 days

*A/R: bleeding & allergy

*Check APTT, PT, fibrinogen, platelet count


THROMBOLYTIC MEDS

*Monitor for bleeding, hypotension & tachycardia

*Avoid injections; apply pressure to puncture site for


20-30 minutes

*Handle clients minimally & let clients use electric


razors & brush teeth gently

*Antidote: aminocaproic acid (Amicar)


•FACTOR VIII
-replace the missing factor

*ANTIINHIBITOR COAGULANT COMPLEX


-made from pooled human plasma
-help correct clotting time in factor VIII

•FACTOR IX COMPLEX
-contains factor II, VII, IX & X
(vit K coagulant factor)
-hemophilia
SYSTEMIC HEMOSTATICS
aminocaproic acid (AMIKAR, EPSIKARON)
- competetive antagonist of plasminogen
- C/I in intravascular active clotting

TOPICAL HEMOSTATICS
- absorbable gelatin sponge (Gelfoam)
- absorbable gelatin film (Gelfilm)
- absorbable gelatin powder
- oxidized cellulose
*Reduce serum level of cholesterol, triglycerides &
low- density lipoprotein when diet alone is not
enough

*Elevated levels of these will place client at high


risk for CAD

*Restrict fats, cholesterol, carbohydrates & ROH


BILE ACID SEQUESTRANTS
cholestyramine (Questran)
*Mix powder thoroughly with juice & H2O
*A/R: constipation & PUD

HMGCoA REDUCTASE INHIBITORS


atorvastatin (Lipitor)
simvastatin (Zocor)
*Check serum liver enzymes & eye exam annually for cataract
OTHERS
clofibrate (Lopid)
*Don’t take with anticoagulants
EXPECTORANT
-liquify mucus by stimulating secretion of natural lubricant
*Ammonium chloride * KISS
*Gaifenesin (robitussin) * saline soltions

ANTITUSSIVE

-cough suppresant
* Codeine * dyphenhydramine * benzonatate

MUCOLYTIC

Decrease thickness of pulmonary secretions by acting directly


on mucus plugs
* Acetylcysteine (mucomyst)
* Used for allergic rhinitis, acute bronchospasm, acute
& chronic asthma, bronchitis, COPD, emphysema

•Caution with clients with glaucoma & HPN

* A/R: palpitations, tachycardia, nervousness,


tremors, restlessness & HA
•Give RTC to maintain therapeutic blood level

* Avoid caffeine products


SYMPATHOMIMETICS

albuterol (Ventolin)
*Dilate the airways of the respiratory tree making air
exchange and respiration easier for client; relaxes bronchial
smooth muscle

XANTHINE DERIVATIVES

aminophylline (Truphylline)
Theophylline

*Stimulate the CNS & respirations, dilate coronary &


pulmonary vessels, cause diuresis & relax smooth muscle

*Serum theophylline level is 10-20 ug/ml

*IV preparation of these drugs must be given slowly & with


infusion pumps
astemizole (Hismanal), diphenylhydramine (Benadryl)
loratadine (Claritin)

*Histamine antagonists or H1 blockers; compete with histamine


for receptor sites preventing histamine response thus
constricting smooth muscles
*Decrease nasopharyngeal secretions & decreases itching which
causes sneezing
*Used for common colds, rhinitis, urticaria, nausea & vomiting,
motion sickness & sleep aid
*CNS depressant with ROH, narcotics, barbiturates & sedatives
*Caution with COPD clients & Benadryl C/I in clients with
glaucoma
*A/R: dizziness, dry mouth, blurred vision
*react with gastric acid to produce neutral salts or salts of low
acidity
*inactivate pepsin and enhance mucosal protection but do not
coal ulcer to protect from acid & pepsin
*used for patients with PUD & GRF (gastroesophageal reflex
disease)
*antacid tablets should be chewed and followed with glass of
H2O or milk
*administer 1 hour apart from other meds to minimize the
chance of drug interactions
sucralfate (Carafate)
*creates a protective barrier against acid & pepsin
*given po & on an empty stomach
*A/R: constipation, impede absorption of warfarin Na,
phenytoin, theophylline, digoxin & some antibiotics…
administer 2 hours apart from these meds

magnesium hydroxide (Milk of Magnesia)


*rapid acting & A/R is diarrhea
*usually combined with aluminum hydroxide to counter diarrhea
(MAALOX)

aluminum hydroxide (Amphojel, Alu-cap)


*slow acting & A/R: constipation
*with significant Na content…caution in clients with HPN &
heart failure; reduce effect of tetracyclines, warfarin Na &
digoxin
*reduce phosphate absorption
calcium carbonate (Tums)

*rapid acting & A/R: constipation

sodium bicarbonate

*rapid onset
*A/R: liberates CO2 & increases intra-abdominal pressure
causing flatulence, caution in clients with HPN & heart
failure, systemic alkalosis in clients with renal failure
*suppress secretion of gastric acid
*indicated for PUD & heart burn & for GRF disease
cimetidine (Tagamet)
*taken on an empty stomach
*administered 1 hour apart from antacids
*crosses the blood-brain barrier & may cause mental
confusion, agitation, anxiety & disorientation
*dosages of these meds are reduced when taken together:
warfarin Na, phenytoin, theophyllin & lidocaine
ranitidine (Zantac)

*not affected by food


*S/E are uncommon & does not cross blood-brain
barrier
pancreatin (Creon),
pancrelipase (Cotazym, Viokase & Pancrease)

*used to supplement pancreatic enzymes

*taken with meals or snacks

*interacts with calcium carbonate & magnesium


hydroxide
lactulose (Cephulac)
*reduces the ammonia level
*given p.o. in the form of a syrup
*improves CHON tolerance in clients with advanced liver
cirrhosis
*lowers colonic pH from 7 to 5; acidification pulls ammonia into
the bowel to be excreted in the feces thus decreasing the
ammonia level

Neomycin (Mycifradin)
*reduces the number of colonic bacteria that normally convert
urea & amino acids into ammonia
*given p.o. or via NGT
*used with caution in clients with kidney impairment
BULK FORMING LAXATIVES
psyllium hydrophillic mucilloid (Metamucil)
*absorbs water into the feces & increase bulk to form large and
soft stools
*C/I bowel obstruction
*A/R: dehydration, electrolyte imbalance & dependency

STOOL SOFTENERS
docusate calcium (Surfak), docusate sodium (Colace)
*inhibit the absorption of H2O so fecal mass remains large &
soft
*used to avoid straining
LUBRICANTS
mineral oil
*soften stools, ease strain of passing stools; lessen the
irritation of hemorrhoids
*interferes with absorption of fat-soluble vitamins A, D, E, K

SALINE CATHARTICS
glycerin suppositories (Senokot); Mg hydroxide
*Attract H2O to large intestine to produce bulk, stimulate
peristalsis & effect begins in 2-6 hours

STIMULANT CATHARTICS
biscodyl (Dulcolax): give 1 hour before/after antacids & milk
cascara (Castor Oil): effect 2-6 hours; give with juice
*stimulate motility of large intestine
PROXIMAL TUBULE DIURETICS

CARBONIC ANHYDRASE INHIBITORS


acetazolamide (Diamox)

*Inhibits the enzyme carbonic anhydrase causing increased


Na, K & bicarbonate excretion

*Used to produce diuresis & decrease IOP

*A/R: hypokalemia, hyperglycemia & orthostatic hypotension


DILUTING SEGMENT DIURETICS
THIAZIDE DIURETICS
Chlorothiazide (Diuril)

*Increase Na & H2O excretion by inhibiting Na reabsorption


in the distal tubule of the kidney

*Used for clients with HPN & peripheral edema

*A/R: hypokalemia, hyponatremia, hypovolemia, hypotension

*Monitor U/O, take meds in the morning, eat foods high in


potassium, change position slowly & use sunscreen

*Clients with diabetes must monitor bld glucose level periodically


LOOP DIRETICS
furosemide (Lasix)

*Inhibit Na & Cl reabsorption from the loop of Henle & the


distal tubule

*Little effect on blood glucose level but causes marked


depletion of water & electrolytes

*More potent than the thiazides causing rapid diuresis,


decreasing vascular volume, cardiac output & BP

*Caution with clients on digoxin & lithium


LOOP DIRETICS

furosemide (Lasix)

*A/R: hypo- kalemia, natremia, calcemia & magnesemia,


orthostatic hypotension, ototoxicity & deafness esp.
with rapid IV administration, dehydration

*Monitor urine output & electrolytes, signs & symptoms


of digitalis & lithium toxicity

*Take in the morning & eat K+ rich food


DISTAL TUBULE DIURETIC/ K+ SPARING
AMILORIDE (MIDAMOR)
SPIRONOLACTONE (ALDACTONE)
TRIEAMTRENE

*Used for edema, hypertension, increase U/O to Rx fluid overload


with CHF, nephrotic syndrome, hepatic cirrhosis, diuretic-induced
hypokalemia
*Monitor for hyperkalemia…K+ level higher than 5.3 MEQ/L,
S/Sx are nausea, diarrhea, abdominal cramps, oliguria,
narrow & peaked T wave on ECG
OSMOTIC DIURETICS

Mannitol (osmitrol)
Isosorbide
Urea (ureaphil)
URINARY TRACT ANTISEPTICS
nitrofurantoin (Furadantin, Furalan, Macrobid)
*Inhibits the growth of bacteria in the urine
*Indicated for UTIs & do not achieve antibacterial effects in
the blood or tissues
*Given with milk or meals to prevent GI distress
*A/R: pulmonary reactions like dspnea, chest pain, chills,
fever, cough & will resolve 2-4 days after treatment
*Imparts a harmless brown color to urine

URINARY ANALGESICS
phenazopyridine HCl (Pyridium)
*Used to treat pain from UTI or irritation
*usually given together with antibiotics
*A/R: nausea, headache, vertigo, urine will turn red or orange
CHOLINERGIC
bethanechol chloride (Duvoid, Urecholine)
*Used to treat nonobstructive urinary retention
*Used to increase bladder tone & function
*A/R: hypotension, diarrhea, urinary urgency & broncho-
constriction
*antidote: atropine SO4
ANTISPASMODICS
oxybutynin chloride (Ditropan) relaxes smooth muscles of
urinary tract
*A/R: leukopenia, bradycardia, anxiety
propantheline bromide (Pro-banthine) decreases bladder
muscle spasms
*A/R: palpitations, blurred vision, urinary hesitancy & urgency,
dry mouth & constipation
*Never given in clients with glaucoma, obstructive uropathy &
colitis
HEMATOPOIETIC GROWTH FACTOR

epoetin alfa (Epogen, Procrit)

*Used to stimulate RBC


*Reverses anemia in chronic renal failure
*Initial effects seen in 1-2 weeks and hematocrit level reaches
normal (30-33%) in 2-3 months
*Monitor CBC & BP for hypertensive S/E
*Caution in clients with uncontrolled HPN,hypersensitivity to
human albumin
PREVENTING ORGAN REJECTION
Immunosuppressants
cyclosporine (Sandimmune)

*Used to prevent kidney transplant rejection by acting to suppress


the action of T-lympocytes
*Administered together with prednisone
*A/R: nephrotoxicity, hirsutism (reversible) & infection
*Take with milk or orange juice, grapefruit juice increases drug
level

Cytotoxic Meds
azathioprine (Imuran)

*suppresses immune response by inhibiting B & T lymphocytes


*adjunct to cyclosporine
*A/R: neutropenia & thrombocytopenia
ACYCLOVIR (ZOVIRAX)

*Inhibits viral DNA replication. Does not cure nor


prevent transmission of herpes infections but
decreases the severity & duration of the infection

*Indicated for herpes simplex 1 & 2, varicella and


herpes zooster infection

*A/R crystalluria & phlebitis at injection site


ZIDOVUDINE (AZT, RETROVIR)

*Developed to control AIDS or ARC (AIDS- Related Complex)

*A/R: Leukocytopenia & Anemia, hepatotoxic & nephrotoxic,


dizziness..crosses blood & brain barrier

*Safe for pregnant women

Related Drugs: didanosine (Videx), Lamivudine (Epivir) &


Zalcitabine (ddC)

***Nucleoside reverse transcriptase inhibitors indicated for


CD4 of 500 & less
PROTEASE INHIBITORS
saquinavir (Invirase)
*A/R: photosensitivity

ritonavir (Norvir)
*A/R: increase triglyceride levels

stavudine (d4T, Zerit)


*for those who do not respond to conventional therapy
*A/R: peripheral neuropathy, unsteady gait
SULFONAMIDES- SULFISOXAZOLE (GANTRISIN)

*Prevents conversion of (PABA) to folic acid which is needed for


bacterial growth; bacteriostatic & bactericidal
*Used for UTIs, eye infections, otitis media, vaginitis
*A/R: Steven-Johnson syndrome (acute onset of fever, bullae on
skin & ulcers on mucus membranes of lips, eyes, mouth, nasal
passages & genitalia. Pneumonia & joint pains may occur; fever
after 7-10 days after onset of therapy indicates hypersensitivity
or hemolytic anemia
*Caution diabetics that drug may cause hypoglycemia; women
on oral contraceptives need an alternative method of
contraception
PENICILLINS
PENICILLIN G POTASSIUM (PENTIDS)
*Inhibits cell wall synthesis of microorganisms;
bactericidal

*Systemic infections of gram-positive cocci;


syphilis, prophylaxis for rheumatic fever &
bacterial endocarditis

*A/R: hypersensitivity; GI upset, nephritis,


anemia, leukopenia & thrombocytopenia
PENICILLIN G POTASSIUM (PENTIDS)
Probenecid (Benemid) may be given to increase blood levels of
penicillins

RELATED DRUGS:
A. PENICILLINASE-RESISTANT PENICILLINS
METHICIN Na (STAPHCILLIN) & NAFCILLIN Na (NAFCIN,
UNIPEN)
*Used to treat penicillinase-producing organisms

B. AMINOPENICILLINS
AMPICILLIN(AMCILL, POLYCILLIN) & AMOXICILLIN
TRIHYDRATE (AMOXIL)
*Increased effectiveness against gram-negative organisms
FIRST-GENERATION – CEFAZOLIN Na (ANCEF)

*Inhibits bacterial cell wall synthesis; bactericidal


(same action for all generations)
*Against gram-positive cocci
*A/R: hypersensitivity; nephrotoxicity & hepato-
toxicity; bone marrow depression
*Cross-allergy with penicillin
*Probenecid therapy
SECOND GENERATION – CEFOXITIN Na (MEFOXIN)

*Used against gram-negative & gram-positive bacteria


*A/R is the same for all generations
*Lidocaine used as diluent for IM injection to reduce the pain

THIRD GENERATION – CEFOTAXIME (CLAFORAN)

*Used in serious gram-negative & gram-positive infections


such as neonatal meningitis & gonorrhea
*A/R is the same for all generations
*Protect IV solutions from light & do not mix with amino-
glycosies---nephrotoxic
CHLORAMPENICOL (CHLOROMYCETIN)
*Inhibits CHON synthesis; bacteriostatic & bactericidal

*Used against Haemophilus influenzae meningitis,


salmonella typhi- used only in severe infections where
other antibiotics can’t be used because A/R are aplastic
anemia & gray baby syndrome
(seen in premature infant & children below 2
years…experiences vomiting, abdominal distention,
irregular respirations & circulatory collapse)
*referred to as 4 quinolone or fluroqinolone

CIPROFLOXACIN (CIPROBAY)

S/E =N/V, diarrhea, discomfort, dizziness,


lightheadedness
S/E TO REPORT
= rash
= neurologic effects: H/A, mental depression
DRUG INTERACTION
= antacids
= probenecid
= theophylline
TETRACYCLINE HCl (ACHROMYCIN V)
*Inhibits bacterial cell wall synthesis; bacteriostatic &
bactericidal; reduces fatty acids from triglycerides

*Used for acne vulgaris, gonorrhea & spirochetes

*A/R: photosensitivity, hepatotoxicity; chelating to teeth


and new bones..avoid giving to pregnant & nursing
women, children under 8 as drug binds to Ca in teeth &
new bones causing permanently discolored teeth &
retarded bone growth
General Information on all agents

GENTAMICIN (GARAMYCIN) “Mycins”


*Suppresses protein synthesis in bacterial cell;
bactericidal
*Against gram-negative bacterial infections;
eye infections

*A/R: ototoxicity; nephrotoxicity & neuromuscular


blockage
VANCOMYCIN HCl (VANCOCIN)

*Interferes with cell membrane activities;


bacteriostatic & bactericidal

*Effective against gram(+) cocci like staphylococcus

*A/R: ototoxicity, nephrotoxicity, thrombophlebitis,


Red-neck syndrome (flushing & hypotension from
rapid IV infusion)
*Clindamycin hcl capsules (cleocin, dalacin C)

*lincomycin hcl (lincocin)


- semisynthetic derivative of lincomycin, is more
effective & causes fewer untoward effects
ERYTHROMYCINS – ERYTHROMYCIN BASE (E-MYCIN)

*Inhibits protein synthesis in bacterial cell; bacteriostatic

*Used in persons with allergy to penicillins; indicated for


acne, streptococcal & staphylococcal infections

*A/R: GI irritation, allergic reactions, hepatitis, reversible


hearing loss

*Do not give with acids e.g. orange juice


Amphoterizin B (fun gizone)
* shld be mixed only w/ water & slowly infuse
* BUN, liver enzymes, u/a shld be checked
Butoconazole nitrate (femstat)

Ketonazole (nizoral)

Miconazole (monistat)

Nystatin (mycostatin)
General Considerations

ISONIAZID (INH)

*Initial TTT against PTB; prophylaxis for high-risk groups


*A/R: peripheral neuritis)…give vitamin B6 (pyridoxine);
hepatitis…check liver enzymes frequently; hyperexcitability
*Taken on empty stomach, avoid alcohol & interferes with
Phenytoin (Dilantin) requiring lowering of INH dose

ETHAMBUTOL (MYAMBUTOL)

*A/R: optic neuritis & loss of red-green color discrimination but


it’s reversible
RIFAMPICIN

*A/R: hepatitis, flu-like syndrome, may turn body fluids (urine,


tears, saliva etc. ) orange
*Interacts with anticoagulants, oral contraceptives, oral
hypoglycemics, methadone & corticosteroids

STREPTOMYCIN

*A/R: cranial nerve 8 damage (roaring, ringing & feeling of


fullness in the ear); vestibular damage (dizziness & vertigo)

PYRAZINAMIDE

*A/R: increased uric acid causing gout or hepatitis


ACNE PRODUCTS

Isotretinoin (Accutane)

*metabolite of vitamin A
*treatment for severe cystic acne
*C/I: sun exposure, ROH & pregnancy

BURNS PRODUCT

Mafenide (Sulfamylon)
*bacteriostatic against gram-negative & gram-positive org.
*apply 1/6 inch film directly to burn
*A/R diffuses via devascularized areas; may precipitate metabolic
acidosis manifested by hyperventilation; bone marrow depression
& hemolytic anemia
Burns Products
nitrofurazone (Furacin)

*bactericidal
*apply 1/16 inch film directly to burn
*A/R: contact dermatitis & rash

silver sulfadiazine (Silvadene, Flint SSD)

*bactericidal against gm-positive, gm-negative org. & yeast


*apply 1/16 inch film to burn
*A/R: leukopenia

silver nitrate
*antiseptic against gm-negative org.
*apply to dressing & not to wound or broken skin
*A/R: stains anything it comes into contact with but
discoloration is not permanent
ALKYLATING MEDICATIONS

*Affects by crosslinking DNA to inhibit cell production


Eg: chlorambucil (Leukeran), mechlorethamine HCl (Mustargen)
*A/R gonadal suppression & hyperuricemia

cisplatin (Platinol)
*A/R: ototoxicity, tinnitus, hypokalemia, hypocalcemia,
hypomagnesemia & nephrotoxicity
*assess for dizziness, tinnitus, hearing loss, incoordination,
numbness & tingling extremities

cyclophosphamide (Cytoxan)
*A/R: gonadal suppression, hemorrhagic cystitis..hematuria &
dysuria…encourage 2-3 liters of fluids/day unless C/I
*Encourage diet low in purine to alkalinize urine & lower blood
uric acid level purine food: organ meats
ANTITUMOR ANTIBIOTIC MEDS

*Interfere with DNA & ribonucleic acid synthesis


plicamycin (Mithracin)
*A/R: prolongs bleeding time…avoid aspirin, anticoagulants &
antithrombolytics
daunorubicin (Cerubidine)
*A/R: CHF & dysrhythmias

bleomycin SO4 (Blenoxane)


*A/R: pulmonary toxicity
doxorubicin (Adriamycin) & idarubicin (Idamycin)
*A/R: cardiotoxicity, dyspnea, hypotension, ECG changes &
weight gain
* Hydration to prevent hyperuricemia
ANTIMETABOLITE MEDS

*Halt the synthesis of cell CHON; replaces CHON needed for


DNA synthesis
Cytarabine HCl (ara-C, Cytosar-U)
*A/R: hepatotoxicity
5-Fluorouracil (5-FU; Adrucil)
*A/R: phototoxicity & cerebellar dysfunction (dizziness/
weakness)
6-mercatopurine (Purinethol)
*A/R: hepatotoxicity

Methotrexate (Folex)…given with leukovorin (folinic acid)


*A/R: photosensitivity, hepatotoxicity, hematologic, GI &
skin toxicity
VINCA (PLANT) ALKALOIDS
*Prevents mitosis causing cell death
vincristine SO4 (Oncovin)
*A/R: neurotoxic…tingling & numbness of extremities

HORMONAL MEDS & ENZYMES

*suppress the immune system & block normal hormones in


hormone-sensitive tumors; change hormonal balance &
slows growth of certain tumors

aspariginase (Elspar)
*A/R: impaired pancreatic function
HORMONAL MEDS & ENZYMES

mitotane (Lysodren)
*A/R: hemorrhagic cystitis & hypercholesterolemia

tamoxifen citrate (Nolvadex)


*A/R: edema. Hypercalcemia, elevated cholesterol &
triglyceride levels; decreases estrogen effect

Diethylstilbestrol (DES, Stilphostrol)


*A/R: impotence & gynecomastia in men; alter effects of
anti-coagulants, oral hypoglycemic agents & insulin