UNIT 1 - INTRODUCTION TO PHARMACOLOGY PRESCRIPTION ABBREVIATION

PHARMACOLOGY p.c: after meals

- Branch of medicine concerned with use, a.c: b4 meals
effects & modes of action ad lib.: As much as desired
DRUGS p.o: orally
- A substance used I the diagnosis, PR: per rectum
prevention or treatment of disease PV: per vagina
PHARMACOKINETICS SL: under tongue
- Study of how body interacts with SC: subcutaneous
administered drugs for the entire duration IM: intramuscular
of exposure IV: intravenous
PHARMACODYNAMICS ID: intradermal
- Study of biochemical & physiological effects supp: suppository
of drugs on body & their mechanism susp: suspension
actions syr: syrup
THERAPEUTICS tab: tablet
neb: nebulizer
- Deals with the use of drugs in prevention or
oint: ointment
treatment of disease
soln: solution
TOXICOLOGY
gtt.: drop
- Adverse effects of drugs & also study of
liq: liquid
poisons (detect, prevent, treatment)
fl.: fluid
CHEMOTHERAPY
nocte: night
- Use of chemicals for treatment of QID: 4 times/day
infections & malignancies BD: 2 times/day
SIDE EFFECTS TID: 3 time/day
- Unwanted nontherapeutic effect caused by stat.: now
drug q4h: every 4 hours
ONSET OF DRUG ACTION PRN: when necessary
- Time takes to see the beginning of UNIT 1.1 - INTRODUCTION TO PHARMACOLOGY
therapeutic effect PHARMACOKINETICS: Movement of drugs into,
THE HALF-LIFE OF DRUG within & out of body
- Time takes for the amount of drug in body 4 PHASES
to reduce by half 1. Absorption
PEAK EFFECT - Passage of drug from site of administration
- Max effect of any dose single dose into circulation
administered during multiple-dose regime - Drugs must through various membrane
FIRST PASS METABOLISM depending on route in order to reach the
- Metabolism of drugs during its passage site of action
from site of absorption to systemic - Passive transport
circulation & maybe metabolized in gut b4 - Except IV route, absorption is essential for
reaching systemic circulation all routes
BIOVAILABILITY 2. Distribution
- Fraction of drugs that reach the systemic - In systemic circulation, drugs distributed to
circulation following administration various tissues
EQUIPMENTS - It crosses several barriers b4 reaching site
(i) Syringe of action
(ii) Measuring cup - Distribution involves filtration, diffusion &
(iii) Pull cutter/splitter specialized transport
(iv) Pill counter 3. Metabolism (Biotransformation)
(v) Pill crusher - Process biochemical alteration of drug in
(vi) Mortar & pestle body
(vii) Medicine dropper/pipette - Body tries to inactivate & eliminate drug by
PARTS OF SYRINGE biochemical reactions
- Drug converted to water-soluble so easily
excrete by kidney
- Most important organ for the process is
liver, kidney, gut, lungs, blood & skin
*Catalysed by specific enzyme located in liver
cells/plasma & tissue
4. Excretion
- Drugs excreted after being converted to
water-soluble metabolites while some

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 directly w/o metabolism - Many drugs compete for the same binding site
- Major organ for excretion is kidney, TISSUE BINDING
intestine, biliary system & lungs - Some drugs bound to certain tissue due to special
- Unabsorbed portion of orally administered affinity
drugs are eliminated thru feces - Tissue binding delays excretion & prolongs duration
- Liver transfers unionized molecules into action
bile for specific transport - Serves as a reservoir to drugs
- Some drugs get absorbed in lower gut & BLOOD-BRAIN BARRIER (BBB)
carried back to liver thru enterohepatic - Brain capillaries & glial cells form BBB
circulation (prolong duration of dug action) - Lipid soluble, unionized frugs can cross BBB
- Lungs main route of excretion for gases & PLACENTA BARRIER
volatile liquids - Lipid soluble, unionized drugs readily cross placenta
- Small amounts drugs are eliminated thru - Drugs taken by mom can cause unwanted effects in
sweat & saliva fetus
FACTORS INFLUENCING ABSORPTION OF DRUGS PHARMACODYNAMIC: Study of action & mechanism
1. Disintegration & dissolution time of action of drugs on the body
 Oral drugs should break & dissolve in order *Drugs produce effects by interacting with the
to be absorb physiology systems of body
 Liquids absorb faster ACTIONS OF DRUGS
 S/C & I/M injections have to dissolve in 1. Stimulation
tissue fluids - > activity of specialized cells (adrenaline
2. Pharmaceutical preparation stimulates heart)
 Drugs formulated to produce required 2. Depression
absorption - < activity of specialized cells (barbiturate
3. Particle size depress CNS)
 Smaller size better absorbed 3. Irritation
 Drug has to act on the gut & its absorption - Occurs on all types of tissues & result in
is not required, then size should be big inflammation, corrosion & necrosis of cells
4. Lipid solubility 4. Replacement
 Lipid soluble drugs absorbed better & faster - Drugs used for replacement when there’s
by phospholipids of cell membrane deficiency of natural substances like
5. pH & Ionization hormone/nutrients
 Ionized drugs poorly absorbed as compared 5. Anti-infective or Cytotoxin action
to unionized drugs - Drugs act by specifically destroying
6. Area & vascularity of the absorbing surface infective organisms cytotoxin effect on
 The larger & more vascular the surface cancer cells
area, better the absorption 6. Modification of the immune system
7. GIT motility - Vaccines act by improving immunity while
 If gastric emptying fast, drug will be immune-suppressants act by depressing
absorbed faster in intestine immunity
8. Presence of food SITE & MECHANSIISM OF DRUGS ACTION
 Foods delay stomach emptying & dilute 1. Locally
drug & delay absorption - Acts on site application (skin, eyes, GIT
9. Metabolism mucosa, nasal mucous membrane,
 Some drugs maybe degraded in gut like respiratory mucosa)
insulin - Preparations such as cream, drops, inhaler,
10. Health status enema
 Disease of gut like malabsorption will < 2. Systematically
absorption - Maybe absorb into blood & act
FACTORS INFLUENCING DISTRIBUTION systematically
1. Lipid solubility - Produce effects by binding to specific target
2. Ionization proteins (receptors, enzymes, ion channel
3. Blood flow & act on cell membrane)
4. Plasma protein binding FUNDAMENTAL MECHANISM OF DRUGS ACTION
5. Cellular proteins 1. Through receptors
PLASMA PROTEIN BIDNING - Receptor is a site on cell which drug binds
- Acid drugs bind to albumin & basic drugs bind to to bring out a change
alpha acid glycoprotein - It’s protein present in cytoplasm or on
- Free/unbound fraction drug is only form available nucleus
for action, metabolism & excretion but protein bound - It has to identify compound, once they
form serves as reservoir bind, it will cause a response
- Protein binding prolongs duration of action of drugs - Drug binds to receptor & produce response

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 called “agonist” 3. Minerals
- Drugs bind to receptor & prevents action of - Iron, Mg sulphates, Al hydroxide
agonist on receptor called “antagonist” 4. Microorganism
2. Through enzymes & pumps - Antibacterial agents obtained from bacteria
- Acts by inhibition of enzymes by altering & fungi such as penicillin
enzyme reaction or inhibit membrane 5. Human
pumps - Immunoglobulin from blood & chorionic
3. Through ion channel gonadotrophins from urine of pregnant
- Interfere with movement ions across mom
specific channels SYNTHETICS
4. By physical action 1. Cell cultures
- Act due to its physical properties (activated - Urokinase from human kidney cells
charcoal for absorption) 2. Recombination DNA technology
5. By chemical interaction - Human insulin (some from cow)
- Acts by its chemical reactions (antacid to 3. Hybridoma technique
neutralized gastric acid) - Monoclonal antibodies
6. By altering metabolic process DRUG INFORMATION SOURCES
- Alter metabolic pathway in microbes 1. Official compendia
resulting in destruction of microbes - Pharmacopeia
FACTORS INFLUENCING ACTION OF DRUGS - Drug formulary
1. Body weight 2. No-official compendia
- recommended dose is calculated to - Textbooks
medium build person, obese & - Journals
underweight & has to calculate individually - Periodicals
2. Age 3. Medline
- Pharmacokinetics of drugs change with age  E-source
resulting in altered response in extremes of LIQUID CATEGORY
age 1. Solutions: Prepared by diluting liquid
3. Gender concentrated/powder
- Hormonal effects & smaller body size 2. Tintures: Extracted using alcohol
influence drugs response in woman 3. Suspension: Liquid drug with solid drug particles
4. Diet 4. Spirits: Alcohol
- Food interferes the absorption of drugs 5. Emulsions: Oily substance mixed
5. Route of administration 6. Elixirs: Mixture of alcohol & water
- Occasionally route of administration 7. Syrups: Sweetened solutions
influence response PARTS OF DRUG LABEL
6. Genetics factors 1. Trade name (brand name)
- Difference response to drugs due to genetic 2. Generic name (official name of drug)
mediated 3. Dosage strength (amount/weight)
7. Dose 4. Form (indicate how drug’s supplied)
- Dose >, response > till “maximum” is 5. Route (indicate how drug to be administered)
reached 6. Direction (instruction to follow)
8. Disease UNIT 2.1 - DOSAGE CALCULATION
- Presence of certain disease can influence Dose required X Stock volume
drug response Dose in stock
9. Repeated doses : Volume to be given
- Result in toxicity & tolerance
DRUG CALCULATION
(accumulation)
1. Tab calculation
10. Psychological factor
2. Syrup calculation
- Doctor-patient & nursing care may
3. Parental calculation
influence the response
4. IV flow rate calculation
11. Presence of other drugs
5. Inotrops calculation
- Concurrent use of 2 or > drugs may
UNIT 2.2 - PRINCIPLE OF DRUG ADMINISTRATION
influence response of each other
7 RIGHTS OF DRUG ADMINISTRATION
UNIT 2 - PHARMACEUTICAL PREPARATIONS
1. Right patient
Sources of drugs:
2. Right drug
(i) Natural sources
3. Right dose
(ii) Synthetics
4. Right time
NATURAL SOURCES
5. Right route
1. Plants
6. Right documentation
- Atropine, morphine, quinine, digoxin
7. Right to refuse by client
2. Animals
KOZIER 10 PRINCIPLES OF DRUG ADMINISTRATION
- Insulin, heparin

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1. Right client DISADVANTAGE OF ENTERAL ROUTE
 Med given to intended client 1. Onset of action is slower
 Ask client name 2. Irritant & unpalatable drugs can’t be given
 Check wrist band 3. Some maybe destroyed by stomach acid/enzyme
2. Right drug 4. Irritation leads to vomit
 Med given was right 5. Irregularities in absorption
 Check with doc’s prescription 6. Can’t be given to unconscious & uncooperative pt
 Check 3 time (b4, during, after) 7. Pt forget to take med
3. Right time 8. Some maybe undergo extensive 1st pass
 Given in right frequency metabolism in liver
 Med given within 30 mins b4/after ADVANTAGES OF PARENTAL ROUTE
schedule time is acceptable 1. Action more rapid & predictable
4. Right route 2. Can be given to unconscious & uncooperative pt
 Give med by the ordered route 3. Gastric irritants can be given
 Check doc’s prescription 4. Can be given to pt with vomiting & unable to
5. Right dose swallow
 Appropriate dose ordered 5. Digestion by digestive juices & 1st pass metabolism
 Double check calculation can be avoided
6. Right client education DISADVANTAGES OF PARENTAL ROUTE
 Explain about the med to client (name, 1. Asepsis must maintain
function, side effects) 2. Injection maybe painful
7. Right documentation 3. More expensive, less safe & inconvenient
 Document med administration after giving 4. Injury to nerve & other tissue may occur
med NOT B4 (date, time, sign) TYPES OF PARENTAL ROUTE
8. Right client to refuse 1. Injection
 Nurses have to ensure that client is fully  ID (10-15’)
informed of potential consequences of - into layer of skin by raising bleb
refusal to health care provider - ex: BCG vaccine
9. Right assessment  SC (45’)
 Some med required specific assessment - deposit in s/c tissue
prior to administration (vital sign) - < vascular, absorption < & uniform &
10. Right evaluation make drugs long acting
 Monitor pt’s response to med - ex: insulin
 Desired effect achieved or not?  IM (90’)
 Did pt experienced any side effects? - absorption into plasma by simple
UNIT 2.3 - ROUTES OF DRUGS ADMINISTRATION diffusion & larger molecules thru lymphatic
Type of routes: vessels
(i) Enteral - absorption rapid & quite uniform bcs
 Common, oldest, safest route muscle is vascular
 Surface, difference pH helps effective - need to draw plunger to make sure
absorption needle is not in blood vessel
 Acid & enzyme secreted & biochemical - shouldn’t > 10ml, deltoid only 1-2ml
activity of bacteria flora can destroy drugs  IV (25’)
(ii) Parental - use when immediate response is needed
 Drugs directly delivered to into tissue 2. Inhalation
fluids/blood  Metered dose inhaler
ADVANTAGES OF ENTERAL ROUTE - inhale into lungs in aerosol form to act
1. Safest locally within respiratory system
2. Most convenient  Nebulizer
3. Most economical - convert liquid med to mist to inhale it
4. Can be self-administered easily & inhale to lungs to act locally
5. Non-invasive route 3. Transdermal route
TYPES OF ENTERAL DRUGS  Adhesive patch
1. Oral (PO) - waterproof adhesive patch applied on
site to release med over a long period
 Given by mouth & usually swallowed but
some have to chew or suck  Creams/ointment
2. Sublingual (SL) - direct apply on skin & will be absorbed
 Drug placed under tongue & left to absorb  Eye drop
- instilled into pt’s lower eyelid
 Frequent used will affect on heart
4. Transmucosal route
3. Per rectum (PR)
- Intranasal, buccal, rectal & sublingual
 Administered into rectum as
enema/suppository DISADVANTAGES OF SC INJECTION

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1. Rich supply of nerves, irritant drugs can’t be 3. Keep & Store of Dangerous & Psychotropic Drug
injected  Keep drugs in DDA cupboard with double
2. In shock, absorption not dependable due to lock at all time
vasoconstriction  Keep DDA par level at all times (Periodic
3. Repeated injections site can cause lipoatrophy Automatic Replacement – indicate min.
(loss fat locally) amount of stock to avoid shortage &
FACTORS INFLUENCE ACTION OF DRUGS overstocking & ensure a consistent supply
1. Age level while reducing waste)
 Infants - immature enzymatic drug  Keep empty ampoules for exchange
inactivation  Broke/missing ampoules to be reported
 Children - hyper-reactive to certain drugs immediately to pharmacist & sister
 Older adults - have impaired liver & kidney 4. Recording of controlled drugs
function & likely suffer from toxic reaction  Immediately document drugs used
2. Body weight  Document particulars
 Concentration of drug will depend on dose - pt name
per kg of body - RN num.
3. Route of administration (> : faster) - date & time
 IV > liq > powder > cap > tab > coated tab - drug used
4. Psychological taste - dosage given
 Anxious pt requires > dose of general - stock balance
anesthesia - name & initial of SN
5. Disease taste - name of consultant who ordered drug
 Drug metabolism is depressed in liver - 2 SN to counter check drugs
failure  Document drugs & dosage in pt’s med chart
 Drug excretion is < in damaged kidney & time
UNIT 3 - DANGEROUS DRUG ACT (DDA)  For outpatient: report in pt’s case note
List of drugs under control of DDA act 1952: 5. Replenishment of controlled drugs indenting
1. Analgesics (Narcotic)  Indent drug in DDA indent book (write
 Morphine Sulphate (10mg/ml) balance & amount required to indent)
 Morphine HCL (10mg/5ml solution)  Send items to pharmacy when indenting:
 Pethidine HCL (50mg/ml) - DDA indent book
- DDA record book
- Empty ampoules of injections
2. Analgesics medium
 Follow indent schedule as given by
 Dehydrocodeine Tartrate (30mg/tab) (DF
pharmacist
118)
6. Collecting drugs
 Nalbuphine HCL (10mg/ml injection)
 Only SRN to collect drugs
(Nubain)
 Check following when collecting drugs:
- amount supplied tally with requisition
3. Tranquillisers/Hypnotics/Sedatives note
 Midazolam (7.5mg/tab) (Dormicum) - total drug supplied
 Midazolam (5mg/ml injection) (Dormicum)  Sign at columns to indicate receipt:
 Diazepam (5mg/tab) (Valium) - DDA indent book
 Diazepam (10mg/2ml injection) (Valium) - DDA record book
 Syrup Chloral Hydrate (200mg/ml) 7. Missing of drugs
 Report immediately if inaccurate count
4. Anticonvulsants  Remain on duty & search for missing
 Phenobarbitone (30mg/tab) (Luminal) narcotics
 Phenobarbitone Sodium (200mg/ml  Fill up incident report & sign with witness
injection) (Gardenal) (special precautions used to help control
NURSING RESPONSIBILITIES IN HANDLING DDA drug abuse)
1. Checking of controlled drugs  Breakage of drug ampoule must be
 Check DDA every shift for balance of drugs documented in DDA book:
as documented in DDA record book (date, - date
time, pt name, RN num.) - reason of waste
 Check expiry date (send to pharmacy if 3 - amount waste
months b4 due date) - sign of SN
2. Passing over controlled drugs - sign of witness SN
 Pass over from shift to shift regarding drugs UNIT 4.1 - ANALGESICS
used & balance DEFINITION – Medications that relieve different type
 Check & receive balance & document in of pain, includes inflammatory
DDA record book CLASSIFICATION OF ANALGESIC

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1. Opioid 4. Take drug with food to prevent GIT bleeding
2. Non-opioid NON-OPIOID ACETAMINOPHEN
(i) Salicylates - Example
(ii) Acetaminophen  Paracetamol
(iii) NSAIDs - Indications
OPIOID  Mild-moderate pain as analgesia
- Derivatives from opium plant/synthetic drug that  Fever as antipyretic
imitates natural narcotics - Function
- Example:  < fever by effect on hypothalamus leading
 Codeine to sweating & vasodilation
 Morphine  Inhibit effect of pyrogens on heat-
 Pethidine regulating centre on hypothalamus
 Fentanyl  Inhibit CNS prostaglandin synthesis as an
- Indication: analgesia
 Moderate-severe pain - Side effects
- Side effects:  Skin rash
 CNS (analgesia, euphoria, drowsiness,  Hepatotoxicity
mood change, mental clouding, deep sleep) NURSING RESPONSIBILITY ON SERVING
 Respiratory system (depress respiration, ACETAMINOPHEN
depress cough reflex) 1. Aware the max dose is 1g 6 hourly
 GIT (nausea, vomit, < peristaltic motility) 2. Administer b4 fever & pain
 Others (vasodilation hypotension, pupil 3. Monitor signs of allergic reaction (hives, skin rash,
constriction) swelling face)
NURSING RESPONSIBILITY ON SERVING OPIOID 4. Give N- acetyleystine for toxicity to prevent
1. Remind pt to be careful when getting out of bed & hepatic damage by inactivating acetaminophen
walking metabolites which cause liver effect
2. Monitor pt RR (RR < 12, withhold med) NON-OPIOID NSAIDs
3. Administer med b4 pain arise - Example
4. Administer antiemetics b4 nausea & vomit  Diclofenac Sodium (Voltaren)
5. Give Naloxone (Narcan) for toxicity - used to  Indomethacin (Indocid)
reverse respiratory depression due to overdose  Ibuprofen (Brufen)
NON-OPIOID SALICYLATES - Indications
- Example  RA
 Aspirin  Osteoarthritis
- Indication  Gout
 Control pain  Musculoskeletal disease
 Reduce fever & inflammation  Severe toothache
- Function - Function
 Relief pain by inhibit synthesis of  < prostaglandin synthesis
prostaglandin - Side effects
 Reduce fever by stimulate hypothalamus &  Peptic & duodenal ulcer
produce peripheral blood vessel dilation &  GI bleeding
> sweating  Nausea & vomit
 Inhibit platelets aggregation (clumping of  Tinnitus
platelets to form clot)  Loss of hearing
- Side effects NURSING RESPONSIBILITY ON SERVING NSAIDs
 Hearing loss 1. Take with milk/meal/antacids to < GIT bleeding
 Bleeding tendencies 2. Report sign of GI bleeding
 GIT upset 3. Instruct pt to report sign of bleeding, blurring
- Contraindications vision, tinnitus, rashes
 Hypersensitivity to salicylates UNIT 4.2 – ORAL HYPOGLYCEMIA AGENTS
 Asthma DEFINITION – Any of various agents that < level of
 Pre/post-surgery glucose in blood & used un treatment for DM
 Bleeding disorder (hemophilia) *Type 2 diabetes (disorder involving < insulin
 GIT bleeding production or insulin resistance to secrete insulin)
 Peptic ulcer
NURSING RESPONSIBILITY ON SERVING SALICYLATES CLASSIFICATIONS
1. Avoid use to children may trigger Reye’s Syndrome 1. Sulfonylureas
(swelling in liver & brain) 2. Biguanides
2. Avoid use for surgery pt, discontinue 1 week b4 3. Alpha-glucosidase inhibitors
surgery due to risk of post-op bleeding 4. Thiazolidinediones
3. Watch signs of bleeding (gum bleeding) 5. Dipeptidyl peptidase-4 enzyme inhibitors

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SULFONYLUREAS 1. Take with meals
2. Monitor side effects of stomach bloating
GENERIC NAME TRADE NAME 3. Monitor liver function (carb. metabolism)
Glimepiride Amaryl 4mg THIAZOLIDINEDIONES
Glibenclamide Daonil 5mg
Gliclazide Diamicron MR 30mg GENERIC NAME TRADE NAME
Diamicron 80mg Rosiglitazone Avandia 4mg
Glyade 80mg Pioglitazone Actos
Glipizide Minidiab 5mg
- Function
- Function  > sensitivity of tissue to insulin action
 Stimulate insulin secretion from pancreatic - Side effects
B-cells  > adiposity (weight gain)
- Side effects  Peripheral edema (hands/legs)
 Hypoglycemia  > risk of fracture
 Stomach upset NURSING RESPONSIBILITY
 Weight gain (insulin > appetite) 1. Monitor blood glucose
NURSING RESPONSIBILITY 2. Monitor liver function
1. Monitor pt signs of hypoglycemia 3. Don’t serve to heart failure pt
2. Monitor blood glucose & urine ketone to assess DIPEPTIDYL PEPTIDASE-4 ENZYME INHIBITORS
effectiveness
3. Taking beta-adrenergic blocking agent may mask GENERIC NAME TRADE NAME
warning signs of hypoglycemia Linagliptin Tradjenta
4. Avoid alcohol Saxagliptin Onglyza
BIGUANIDES Sitagliptin Januvia

GENERIC NAME TRADE NAME - Function

Metformin Glucophage 500mg  > level of incretins hormone released from
Glucophage Retard 850mg intestine, which turn > beta-cell insulin
Glucophage XR 500mg secretion in pancrease, < postprandial
Glibeclamide & Glocovance (can’t eat after food) & fasting
Metformin 1.25/250/2.5/500/5/500mg

- Function
 < glucose production by liver
 > insulin sensitivity at tissue
 > glucose transport into cells
- Side effects
 Nausea
 Anorexia
 Diarrhea
NURSING RESPONSIBILITY
1. Monitor renal function bcs it can cause lactic
acidosis hyperglycemia
2. > risk of acute renal failure with use of iodinated
contrast for diagnostics studies NURSING RESPONSIBILITY
ALPHA-GLUCOSIDASE INHIBITORS 1. Monitor blood glucose level
2. Watch signs of side effects
GENERIC NAME TRADE NAME UNIT 4.3 - INSULIN THERAPY
Acarbose Glucobay 50mg Essential for Type I DM
Glucobay 100mg Required for Type II DM
- When meal planning & OHA (orally
administered anti-hyperglycemia agent)
- Function
ineffective
 Slow digestion pf CO2 & delay glucose
- During illness, infection, pregnancy, surgery
absorption
- Side effects
 Flatulence (passing gas from digestive
system out back passage) TYPES OF INSULIN
 Stomach bleeding
NURSING RESPONSIBILITY

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 (vi) Anti-platelets
CLASSIFICATION EXAMPLE (vii) Anti-lipemics (< lipids)
1. Rapid acting Novorapid INOTROPES
(eat 5-15mins after
injection) +VE INOTROPIC -VE INOTROPIC
2. Short acting Actrapid Epinephrine Flecainide
(administer 20-10mins Norepinephrine Verapamil
b4 meals) Dopamine Cibenzoline
3. Intermediate acting Monotard, Humalin L, Dobutamine Clonidine
(eat within 15mins Humalin N, Insulatard Levosimendan Atenolol
after injection) Milrinone Disopyramide
4. Long acting Levemir, Lantus Amrinon Sunitinib
(absorb slowly in 24h) Enoximone Itraconazole

HOW TO GIVE SC WITH ASPIRATION

1. Use alcohol swab on the injection site
2. Gently pinch skin & insert needle into skin at 45’ +VE INOTROPES
3. After insert, release grasp on skin - Function
4. Gently pull back plunger to check for blood (if  Act on cardiomyocytes to contract with >/<
presence, withdraw needle & syringe & gently press power, depends on =ve/-ve inotrope
alcohol swab on skin. Start over with new needle)  +ve inotrope makes heart contraction
5. If blood is absence, inject all solution by gently & stronger, > cardiac output & ensure organs
steadily pushing down the plunger get blood & O2
6. Withdraw needle & syringe & press an alcohol  -ve inotrope keeps heart muscles from
swab gently on spot. working too hard by beating with < force,
FACTORS AFFECT INSULIN ABSORPTION helpful to high BP, chest pain, abnormal
1. Diet heart rhythm/hypertrophic
2. Exercise cardiomyopathy
3. Site of injection (most constant from abdomen) - Indications
COMPLICATION OF INSULIN  Septic shock
1. Hypoglycemia  Cardiogenic shock
2. Local allergic reactions (redness, swelling,  Heart failure
tenderness)  Pulmonary hypertension
3. Systemic allergy (urticaria, generalize edema)  Postoperatively after open-heart surgery
4. Lipoatrophy (loss of fat at the site of injection)  Bradycardia
5. Lipohypertrophy (enlargement sc fat depots)  Major surgery
STORAGE OF INSULIN  Major trauma
1. Unopened insulin store in refrigerator (2-8’C)  Allergic reactions
2. Insulin in use (room tempt) - Side effects
3. Avoid freezing, heat, direct sunlight  Arrhythmias (no rhythms)
HEALTH TEACHING  Tachycardia
1. For people whose pancreas doesn’t produce any  Hypotension
more insulin (Type 1) or insufficient amount of insulin  Hypertension
(Type 2)  Anxiety
2. All Type 1 have to take daily  Fever
3. Follow insulin plan (instructed by doc/nurse)  High BP
4. Timing injection & meals is important (don’t eat  Headache
soon/delay meals)  Myocardial ischemia
5. Don’t keep insulin in freezer compartment  Pulmonary edema
6. Don’t inject cold insulin  Intracranial bleeding (blood vessel rupture)
7. Don’t shake insulin (just roll)
8. If miss injection, don’t double next dose -VE INOTROPES
9. Don’t change insulin type w/o consulting
- Indications
doc/nurse
 High BP
10. Recognize signs/symptoms of hypoglycemia
 Angina
UNIT 4.4 – Cardiovascular Pharmacology
 Arrhythmia
Classifications of CVS drugs:
 Hypertrophic obstructive cardiomyopathy
(i) Inotropes
- Side effects
(ii) Cardiac glycosides (for heart failure/irregular HR)
 Dizziness
(iii) Cardiac vasodilators
 Weakness
(iv) Anti-hypertension
 Headache
(v) Anti-coagulant (> bleeding)

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  Constipation  Keep tab in dark glass bottle
 Dry mouth  Instruct pt if chest pain, put tab under
 Nervousness tongue. If not relieve in 5min, take 2nd tab.
 Nausea If not relieve after 5min, take 3rd tab & rush
 Blurry vision to hosp
 Diarrhea 2. Transdermal Nitroglycerin
 Sweating  Apply when wake up in morning & remove
CARDIA GLYCOSIDASE b4 bedtime
- Functions  Avoid hairy skin
 > output force of heart  Don’t stand near microwave oven
 < its rate of contractions by inhibit cellular 3. Assess baseline BP prior to administration of
sodium-potassium ATPase pump nitrates (SBP<90Hg, withhold drug)
- Example 4. IV nitrates should never stop suddenly. Sudden
 Digoxin (Cardoxin & Lanoxin) withdrawal can aggravate angina
 Digitalis (Digitoxin) ANTI-HYPERTENSIVE
- Indication - Med that brings BP down in various ways
 Heart failure
 Atrial fibrillation (AF) GROUPS OF DRUGS DRUGS
- Contraindication Diuretics Thiazides:
 Hypertropic obstructive cardiomyopathy - Hydrochlorothiazide,
 Heart blocks - Chlorthalidone
 Bradycardia High loop diuretics:
- Side effects of Digoxin toxicity -Furosemide
 Bradycardia Torsemide K+ Sparing:
 Nausea & vomit - Amiloride
 Headache ACE inhibitors Captopril, Enalapril,
 Blurred vision Ramipril, Lisinopril
MANAGEMENT OF DIGOXIN TOXICITY Angiotensin I (AT1 Losartan, Telmisartan,
1. Withhold dose receptor blockers) Valsartan
2. Monitor vital sign (Angiotensin II
3. Administer anti-emetics for nausea & vomit receptor antagonists)
4. Check serum Digoxin & potassium level a adrenergic blocker Terazosin, Prazosin,
NURSING RESPONSIBILITY Phentolamine,
1. Assess HR by counting apical pulse b4 Phenoxybenzamine
administration B adrenergic blocker Atenolol, Propanolol,
2. Assess ECG, if heart block, withhold drug & inform Metoprolol
doc a+B adrenergic Labetalol, Carvedilol
3. Review serum potassium level, if <, withhold drug blocker
& inform doc Calcium channel Verapamil, Nifedipine,
4. Observe signs & symptoms of digoxin toxicity blocker Amlodipine, Diltiazem,
CARDIAC VASODILATOR - NITRATES Felodipine
- Function Central Clonidine, Methyldopa
 Vasodilation of arteries that used to trat Sympatholytics
angina pains Vasodilators Arteriolar=Minoxidil,
- Example Diazoxide, Hydralazine
 Sublingual Glyceryl Trinitrate (GTN) Arteriolar+Venus=Sodium
 Isordil Nitroprusside
 Isosorbide Dinitrate Direct renin inhibitors Aliskiren
 Transdermal nitroglycerin (Nitrodisc)
- Indication
 Angina pectoris DIURETICS
 Unstable angina
- Function
 Myocardial angina
 Get rid of Na & H2O, < amount of fluid in
 Hypersensitive crisis blood vessels & < BP
- Side effects
 Treat hypertension
 Hypotension
 Fluid volume excess & edema (congested
 Tachycardia heart failure, cirrhosis of liver or renal
 Headache dysfunction)
 Facial flushing - Side effects
NURSING RESPONSIBILITY  Hypotension
1. Sublingual GTN  Dry mouth

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  Thirst effectiveness or potency
- Adverse reactions of diuretics ANGIOTENSIN (AT1 RECEPTOR BLOCKER)
 Hypokalemia - Produce arteriolar & venous dilation & block
- weakness aldosterone secretion, thus < BP & < salt & H2O
- muscle cramps/pain retention
- muscular fatigue - Similar pharmacological effects to ACE inhibitor
- dysrhythmia a ADRENERGIC BLOCKERS
 Hyponatremia - < BP by keeping hormone norepinephrine from
- lethargy (lack energy) tightening muscles in walls of smaller arteries & veins
- drowsiness - Alpha-blocker mainly used in combination with
- restlessness other hypertensive in order to trat high BP
 Confusion B ADRENERGIC BLOCKERS
 Seizures - < BP by blocking effects of hormone epinephrine
NURSING RESPONSIBILITY - Function
1. Administer with milk/foods  < HR
2. Administer IV diuretics slowly (fast infusion cause  < heart contractility
sudden & severe changes in electrolyte balance) - Indication
3. Educate pt about function & side effects adverse  Hypertension
reactions in order to empower safe self-administer of  Angina pectoris (low blood supply to heart)
med  Myocardial infarction
4. Encourage proper hydration but remind pt to  Heart failure
follow the prescribed oral fluid restriction (excessive - Side effects
fluids intake will nullify the diuretics goal to eliminate  Hypotension
excessive fluid in body)  Bradycardia
5. If pt has dry mouth, encourage to rinse mouth with  Heart blocks
cold H2O & spit it out  Diarrhea
6. Administer oral diuretics early morning & avoid  Nausea & vomit
giving in evening to < tendency to urinate during NURSING RESPONSIBILITY
sleeping hour
1. Assess vital sign b4 & after (if SBP<90mmHg &
7. Check blood glucose routinely especially diabetic
HR<45, withhold drugs)
(Thiazide diuretics may change serum glucose level)
2. Observe side effects
ACE INHIBITOR 3. Sudden withdrawal of drug can aggravate angina
- Blocking conversion of Angiotensin I to Angiotensin a+B ADRENERGIC BLOCKERS
II
- Used to treat high BP
- Indication
- Side effects
 Hypertension
 Fatigue & dizziness
 Heart failure
 Poor circulation
 Myocardial infarction
 GIT symptoms
- Side effects
 Sexual dysfunction
 Dry cough
 Weight gain
 Hyperkalemia
CALCIUM CHANNEL BLCOKER
 Fatigue
- < BP by preventing Ca2+ from entering cells of
 Dizziness due to low BP
arteries & heart that causes to contract strongly
 Headache
- Indication
 Loss of taste
 Hypertension
NURSING RESPINSIBILITY
 Angina
1. Administer on empty stomach, 1-2h prior to main  Myocardial infarction
meals (ensure optimal absorption & therapeutical - Side effects
action)
 Hypotension
2. Med review to ensure pt doesn’t take with NSAIDs
 Heart failure
(may lower effectiveness of ACE inhibitor)
 Bradycardia
3. Educate pt about function, indication, side effects
NURSING RESPONSIBILITY
& adverse reactions & how to self-administer (to
1. Assess vital sign b4 & after (if SBP<90, withhold
empower safely self-administer of med)
drug)
4. Monitor pt input & output & stool chart (cause
2. Observe sign & symptoms of side effects
diarrhea)
5. Discourage intake of fish oil, banana, orange & CENTRAL SYMPATHOLYTICS
other potassium-rich foods (cause hyperkalemia) - < BP by < sympathetic nerve activity & neuronal
6. Encourage reduction of alcohol (cause release norepinephrine to heart & peripheral
hypotension)7. Encourage pt to change position circulation
slowly (prevent orthostatic hypotension)
7. ACE inhibitor usually be crushed w/o affecting

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VASODILATORS - Function
- < BP by producing vascular smooth muscle  < hyperlipidemia that lead to additional
relaxation, primarily in arteries & arterioles result in < health prob (stroke, myocardial infarction,
in peripheral resistance angina & heart failure)
DIRECT RENIN INHIBITORS - Example
- Directly inhibits renin  Statins
- Act in RAAS, then ACE inhibitors & angiotensin - < LDL-C
blocker - Lovastatin, Pravastatin, Simvastatin,
ANTI-COAGULANT Atorvastatin
- Function  Fibrates
 > time take to clot - < triglycerides & > HDL-C
 Prevent clot formation - Gemfibrozil
- Example - Indication
 Heparin  For hyperlipidemia & prevention of
 Warfarin cardiovascular disease
 Clexane & Fraxiparine (Low molecular
weight heparin)
- Indication
 Heparin
- Myocardial infarction
- Unstable angina
- Pulmonary embolism (obstruction of
artery due to blood clot/air bubble)
 Warfarin
- Atrial fibrillation
- Post heart valve surgery
- Side effect
 Bruising
 Hemorrhage
NURSING RESPONSIBILITY
1. Monitor coagulation profile, INR, aPPT, PT
2. Observe for active bleeding (gum, hematuria,
melanic stool)
3. Inform pt to report to doc if any bleeding occurred
4. Antidote:
 Heparin: Protamine Sulphate/ Transfusion
of Fresh Frozen Plasma (FFP)
 Warfarin: Vitamin K/ Transfusion of Fresh
Frozen Plasma (FFP)
ANTI-PLATELETS
- Function
 Inhibits platelets aggregation/sticking
together
- Example
 Aspirin
 Clopidogrel (Plavix)
 Ticlopidine (Ticlid)
- Indication
 Angina pectoris
 Myocardial infarction
- Side effects
 Heart burn
 GIT bleeding
 Thrombocytopenia (lack of thrombocytes)
NURSING RESPONSIBILITY
1. Serve with meals to avoid GIT irritation
2. Observe pt for unusual bruising & bleeding

ANTI-LIPEMICS

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