Page | 1

Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
********* 7
2. Pharmacodynamics
- mechanism by which drugs produce changes in body tissue .
a. desired effect - intended action of drugs
b. adverse effect - harmful unintended reactions
c. side effects – consequence reactions
d. toxicity – the degree which something is poisonous
digoxin = 0.5 – 2.0 ng/mL
lithium = 0.5 – 1.5 mEq/L

Safety and Efficacy

Nursing Principles :
1. Always verify the Five Rights .
a. the right medications
b. the right client
c. the right dosage
d. the right form, route and technique
e. the right time
2. Chart drug administration only after its been given, never before .
3. Never leave the medication on a cart on cart or tray unattended.
4. Chart observed therapeutic and adverse effects accurately and fully.
5. Check history
PHARMACOLOGY for allergies and potential drug interactions before administering a
Pharmacology newly ordered drug.
- most simply defined as study of drug.
6. Inform the prescribing physician of any observed adverse effects; if cannot be
Fundamentals of Pharmacology located, inform the nursing supervisor
1. Pharmacokinetics
7. Question drug orders that are unclear, that appear to contain errors, or that have
- study of a drug's of drug’s
changes as it enters and passes through the body
. potential to harm.
a. absorption 8. Take the following actions if an error occurs :
b. distribution is
a. immediately notify the nursing supervisor, the prescribing physician, and the
c. biotransformation
d. excretion pharmacist.
 Page | 2
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
b. assess the client’s condition and provide any necessary care.
9. For postpartum women, advice to take drugs after breastfeeding.
Administration of Drugs : DRUGS AFFECTING THE CENTRAL AND AUTONOMIC SYSTEM

Routes and Nursing considerations: Cholinergic Agents (Parasympathomemitics)

1. Enteral – oral, sublingual, rectal, gastric tubes Prototype :
- capsulated pill , - synthetic acetylcholine, pilocarpine, c arb
sustained release and enteric coated should not be crushed achol, bethanecol (Urocholine),
.
2. Parenteral – IV, IM, SQ, ID, IT, IA, epidural.
- vastus lateralis (safest site for IM) edrophonium (Tensilon), neostigmine (Prostigmine), pyridostigmine (Mestinon).
3. Topical – skin, inhalants, mucus membrane. Mechanism of action :
●
Eye medic ations : - stimulates cholinergic receptors by mimicking acetylcholine or inhibition of
- administer eye drops eyedrops first then ointment.
enzyme cholinesterase.
- use a separate bottle for each client.
Indications :
- instruct the client to tilt the head backward, open eyes and look up.
- glaucoma, urine retention, Myasthenia Gravis
- avoid contact of medication bottles bottle to the eyeball.
- place prescribed dose in the lower conjunctival sac. - antidote to neuromuscular blocking agents : tricyclic antidepressants and atropine
- instruct the client to press the inner canth us for 30-60 secon ds.
Adverse effects :
- instruct the client to close the eye gently.
- blurring of vision, miosis
- increase in salivation, intestinal cramps
Ear drops - bronchoconstriction, wheezing, DOB
- in infants infant - hypotension and bradycardia
and children younger than 3 y.o, pull pinna downward and backward.
Nursing considerations :
- in older children and adults adult , upward and backward. 1. Warn & monitor clients of the side effects.
- direct the solution on the wall of the ear canal, not directly on the 2. Have atropine available for use as an antidote as antidote .
eardrum ear drum .
Cholinergic Blocking Agents (Parasympatholytics, Anticholinergics)
Prototype :
- atropine, scopalamine (Triptone), dicyclomine (Bentyl),
propantheline (Pro-Banthine).
CLASSIFICATIONS OF DRUGS
Mechanism of actions :
 Page | 3
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
- Nursing considerations :
block the binding of acetylcholine in the receptors of parasympathetic nerves.
1. Contraindicated in clients w/ hyperthyroidism,
Indications : pheochromocytoma & cardiovascular disease.
- use preoperatively to dry up secretions . 2. Monitor vital signs and advice precautions.
- treat spasticity of GI or urinary tract . 3. Should be taken with food.
- use for treatment of bradycardia, asthma, parkinsonism.
- use for antidote in organophosphate poisoning . ADRENERGIC BLOCKING AGENTS
Adverse effects : Prototype :
- dry mouth , dilatation of pupils, tachycardia a. Alpha blockers
- urinary retention, ileus, heat stroke - phentolamine (Regintine), phenoxybenzamine, prazosin (Minipress),
Nursing considerations : reserpine (Serpasil), terazosin (Hytrin)
1. Keep client’s in cool environment. - clonidine (Catapress), methyldopa (Aldomet)
2. Watch out for signs of heatstroke and dehydration. b. Beta blockers
3. Encourage clients to increase fluid intake and use of sugarless gum/candy for dry - atenolol (Tenormin), esmolol (Brevibloc),
metoprolol (Lopressor), nadolol (Corgard),
mouth. propanolol (Inderal), timolol ( Blocadren)
4. For GI spasticity, administer 30 minutes before meals and at bed time . Mechanism of actions :
a. alpha blockers
Adrenergic Agents (Sympathomimetics)
Prototype : - inhibits action of a-receptors in vascular smooth muscle to cause vasodilatation.

- epinephrine, norepinephrine, ephedrine, dopamine, dobutamine, phenylephrine, b. beta blockers

terbutaline, albuterol, isoproterenol. - compete with epinephrine in b-receptors in heart, pulmonary airways, peripheral
Mechanism of actions : circulation and CNS.
- stimulate alpha and beta adrenergic receptor directly or trigger the release of Indications :
- Raynaud’s disease , hypertension hype rtension , pheochromocytoma.
catecholamines indirectly causing sympathetic effects. - angina, arrhythmias, mitral valve prolapse, glaucoma
Indications : Adverse effects :
- cardiopulmonary arrest, hypotension - orthostatic hypotension, bradycardia, CHF
- COPDand asthma, nasal congestions - depression, insomnia and vertigo
- allergic reaction , anaphylactic shock - bronchospasm and dyspnea, nasal stuffiness, cold extremities
Adverse effects : Nursing considerations :
- restlessness, insomnia, tremors, nausea 1. Administer oral alpha-blockers with milk to minimize GI side effects.
- palpitations, angina, tachycardia, HPN
 Page | 4
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
2. Administer oral beta-blockers before meals and at a.m. if insomnia occurs. 3. Inform clients that maximum benefit of baclofen is attained for 1-2 months.

3. Check client’s apical pulse rate before drug administration, refer if below 60 bpm. 4. Reduce baclofen dosage gradually because of associated withdrawal symptoms :
4. Hypotensive precautions. Confusion, hallucinations, paranoia & rebound spasticity.
5. Warn clients not to drive or operate dangerous machinery until he/she has
adjusted to medications. ANTICONVULSANTS
Prototype :
a. Hydantoins - phenytoin (Dilantin)
SKELETAL MUSCLE RELAXANTS AGENTS b. Barb iturates - phenob arb ital ( Luminal)
Prototype : c. Miscellaneous
- methac arb - carb amazepine (Tegretol), diazepam, clorazepate (Tranxene),
amol (Robaxin), baclofen (Lioresal), dantrolene (Dantrium),
valproic acid (Dapakene), ethosuximide (Zarontin).
metaxalone (Skelaxin), orphanedrine (Norgesic), chlorzoxazone Mechanism of action :
Mechanism of actions: -
treat seizures by depressing abnormal neuronal activity in motor cortex.
- depress CNS
- inhibit calcium ion release in the muscle Adverse effects :
- sedation & drowsiness, gingival hyperplasia
- enhance the inhibitory action of GABA (gamma-amino butyric acid)
- diplopia, nystagmus, vertigo, dizziness
Indications : - thrombocytopenia, aplastic anemia
- for acute musculoskeletal pain Nursing considerations :
- for muscle spasticity associated with multiple 1. Advise female clients to use contraceptives.
sclerosis, cerebral palsy, CVA, and
2. Inform clients taking phenytoin that harmless urine discoloration is common.
spinal cord injury.
Adverse effects :
3. Warn clients with diabetes that hydantoins may increase blood sugar level and that
- hypotonia, ataxia, hypotension, drowsiness
- blurred vision, bradycardia, depression, urine retention valproic acid may produce a false positive result in urine ketone test.
4. Teach clients receiving c arb
amazepine to identify symptoms of bone marrow

Nursing considerations : depressions.

1. Caution clients that mental alertness may be impaired. 5. Reassure that b arb iturates are not addictive at a low dosage.
2. Monitor neuromuscular status , bowel and bladder functions. 6. Avoid taking alcohol with b arb iturates.
7. Administer IV phenytoin slowly to avoid cardiotoxicity.
 Page | 5
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
8. Avoid mixing other drugs in same syringe with phenytoin. - amphetamines, methylphenidate (Ritalin)
Mechanism of actions :
- increase excitatory CNS neurotransmitter activity and blocks inhibitory impulses.
Indications :
ANTIPARKINSONIAN AGENTS
- for obesity (amphetamines)
Prototype :
- attention deficit hyperactivity disorders
a. Anticholinergic agents
- narcolepsy
- trihexyphenidyl (Artane), benztropine (Congentin)
- drug-induced respiratory depressions.
b. Dopaminergic agents
Adverse effects :
- Levodopa, carb idopa-levodopa (Sinemet), amantidine (Symmetrel),
- nervousness, insomnia, restlessness
pergolide (Permax), selegiline (Eldepryl), bromocriptine.
- hypertension, tachycardia, headache
Mechanism of actions :
- anorexia, dry mouth.
a. anticholinergic agents
Nursing considerations :
- inhibit cerebral motor centers.
1. Should be given at morning.
b. dopaminergic agents
2. Don’t stop amphetamine abruptly to avoid withdrawal symptoms.
- increasing dopamine concentrations or
3. Monitor blood pressure and pulse.
enhancing neurotransmitter functioning.
4. Ice chips or sugarless gum for dry mouth.
Adverse effects of dopaminergic agents:
5. Watch out for growth retardation in children taking methylphenidate.
a. levodopa – nausea, vomiting, anorexia, orthostatic hypotension,
dark-colored urine and sweat
b. amantidine – ankle edema, constipation DRUGS AFFECTING MENTAL FUNCTIONING
w c. bromocriptine – palpitations, tachycardia
Nursing considerations : Sedatives, Hypnotics, and Anxiolytics
1. Give dopaminergic agents after meals to reduce GI symptoms. Prototype :
a. Benzodiazepines
2. Reassure client that levodopa may cause harmless darkening of urine and sweat. - diazepam (Valium), lorazipam (Ativan),
alprazolam (Xanax), flurazepam (Dalmane)
3. Avoid taking Vit B6 (pyridoxine) with levodopa because it speed up metabolism. b. Barb iturates
4. Educate clients to minimize orthostatic hypotension. - amobarb ital, phenob arb ital, secob arb ital
5. Elevate leg to reduce ankle edema. c. Miscellaneous
- chloral hydrate (Noctec), buspirone (Buspar), paraldehyde (Paral)
Mechanism of actions :
a. Benzodiazepines
CENTRAL NERVOUS SYSTEM STIMULANTS
- increase the effect of inhibitory neuro transmitter GABA
Prototype :
 Page | 6
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
(gamma-amino butyric acid) a. Tricyclic antidepressants
b. Barb iturates and Miscellaneous agents - increase receptor sensitivity to serotonin and/or norepinephrine.
- depress CNS b. MAO inhibitors
Indications :
- inhibit the enzyme MAO that metabolize the neurotransmitters norepinephrine and
- induce sleep, sedate and calm clients
serotonin.
Adverse effects : c. Second – generation antidepressants
- hangover-effect, dizziness, CNS depression - inhibits the reuptake of serotonin.
- respiratory depression, drug-dependence d. Lithium
Nursing considerations : - increase serotonin & norepinephrine uptake
1. Warn clients of injuries and falls. Adverse effects :
2. Brief period of confusion and excitement upon waking up is common with - dry mouth, blurred vision, urine retention, constipation (anticholinergic effects)
benzodiazepines. - orthostatic hypotension, insomnia
- hypertensive crisis (MAO)
3. Warn clients not to discontinue medications abruptly without consulting a physician. - dehydration (Lithium).
4. Avoid alcohol while taking these drugs. Nursing considerations :
6. Rotate and don’t shake the ampules of b arb 1. Caution client to rise slowly to reduce the effects of orthostatic hypotension.
iturates. Don’t mix with other drugs.
7. Warn female clients that diazepam is associated with cleft lip. 2. Take antidepressant with food to enhance absorption
3. Explain to client that full response may take several weeks (2 weeks).
4. Assess client for constipation resulting from tricyclic antidepressant use.
ANTIDEPRESSANTS AND MOOD DISORDER DRUGS
Prototype :
a. Tricyclic antidepressants 5. Client taking MAO inhibitors should avoid tyramine-rich foods to avoid
- amitriptyline (Elavil), protriptyline (Vivactil),
- imipramine (Tofranil), desipramine hypertensive crisis.
b. MAO (monoamine oxidase inhibitors ) - aged cheese, sour cream, yogurt, beer, wine, chocolate, soy sauce and yeast
- isocarb
oxazid (Marplan), phenelzine (Nardil), tranylcypromine (Pernate)
- pentholamine (Regintine) is the drug of choice for hypertensive crisis.
c. Second-generation antidepressants
- fluoxetine (Prozac), trazodone (Desyrel) 6. Inform physician and withhold fluoxetine if client develop rashes.
d. Lithium 7. Take lithium with food to reduce GI effects
Mechanism of actions : - > 1.5 mEq/L blood level may cause toxicity manifested by:
 Page | 7
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
confusion, lethargy, seizures,hyperreflexia.
2. Normalization of symptoms may not occur for several weeks after beginning of
- maintain salt and adequate fluid intake
- tremors may occur but it is temporary therapy .
- monitor white blood cell count (increase). 3. Avoid administering haloperidol intravenously
4. Watch out of neutropenia with clozapine.
ANTIPSYCHOTIC DRUGS (NEUROLEPTICS) 5. Watch out for orthostatic hypotension and photosensitivity with phenothiazine.
Prototype :
a. Phenothiazines 6. Be sure that oral doses are swallowed, and not hoarded.
- chlorpromazine (Thorazine),
- trifluoperazine (Stelazine),
- thioridazine (Mellaril) DRUGS USED IN PAIN MANAGEMENT
b. Other Agents
- clozapine (Clozaril), haloperidol (Haldol) General Anesthetics
Mechanism of action : Prototype :
- block dopamine receptor in the limbic system, hypothalamus, and a. Inhalation anesthetics
other regions of the brain. - enflurane (Ethrane), halothane
Adverse effects : - isoflurane (Forane), nitrous oxide
- b. Injection anesthetics
Extra pyramidal symptoms such as dystonia, pseudoparkinsonism, and
- fentanyl (Sublimaze), ketamine (Ketalar),
an irreversible tardive dyskinesia as manifested by : thiopental Na (Penthotal), etomidate (Amidate)
a. lip smacking Mechanism of actions :
b. fine wormlike tongue movement
c. involuntary movements of arms and leg. - cause CNS depression, by producing loss of consciousness, unresponsiveness to pain
- Neuroleptic malignant syndrome stimuli, and muscle relaxation.
a. fever, tachycardia, tachypnea, diaphoresis, cardiovascular collapse Nursing considerations :
1. Instruct client NPO for 8 hours before administration.
b. muscle rigidity, seizures. 2. Monitor cardio pulmonary depression and hypotension.
- orthostatic hypotension 3. Monitor urinary retention.
4. Monitor body temperature
Nursing considerations : - malignant hyperthermic crisis :
dantrolene (antidote)
1. Teach family members the signs of EPS and NMS, and report to physician
5. Avoid alcohol or CNS depressants for 24 hours after anesthesia.
immediately.
6. In patient who received halothane, monitor signs of hepatic fatal side effects :
 Page | 8
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
- rash, fever, nausea, vomiting - relieves pain and fever by inhibiting the prostaglandin pathway.
- jaundice and altered liver function. Nursing considerations :
1. Monitor respiratory
depression & hypotension in clients taking narcotic analgesic.

LOCAL AND TOPICAL ANESTHETIC 2. Injury and accident precautions in clients taking narcotic analgesic.
Prototype : 3. Warn clients about possibility of dependency,and do not discontinue narcotics
local : bupivacaine, lidocaine, tetracaine, procaine, mepivacaine, prilocaine abruptly in the narcotic-dependent clients.
topical : benzocaine, butacaine, dibucaine,lignocaine 4. Naloxone is antidote for narcotic overdose.
Mechanism of action : 5. Advice clients to take NSAIDs with food and monitor bleeding complications.
- block transmission of impulses across nerve cell membrane.
Adverse effects : 6. Aspirin is contraindicated in clients below 18 years old with flu-like symptoms.
- cardiac dysrhythmias
Nursing considerations : 7. Monitor hearing loss in clients taking aspirin.
8. Monitor liver function in clients taking acetaminophen.
- lignocaine + prilocaine (EMLA cream) should be applied topically 60 minutes before 9. N-acetylcysteine is antidote for paracetamol overdose.
procedure.
- administer cautiously to the areas of large broken skin. DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM
- observe for fetal bradycardia in pregnant clients.
ANTICOAGULANTS
ANALGESICS Prototype :
Prototype : - Heparin (SQ and IV)
a. Narcotic analgesics Warfarin (Orally)
- codeine, meperidine (Demerol) morphine, butorphanol (Stadol) Mechanism of actions :
nalbuphine (Nubai n) a. Heparin
b. Non – narcotic analgesic - prevents thrombin from converting fibrinogen to fibrin.
NSAIDs – aspirin (aminosalicylic acid), mefenamic acid (Ponstan), b. Warfarin
- suppress coagulation by acting as an
ibuprofen (Motrin), naproxen, ketoprofen (Orudis), ketorolac. antagonist of vitamin K after 4-5 days.
paracetamol and acetaminophen (Tylenol)
Mechanism of actions : Indications :
a. Narcotic analgesics - thrombosis, pulmonary embolism, myocardial infarction
- alter pain perception by binding to opiod receptors in CNS. Adverse effect :
b. Non- narcotic analgesic - bleeding
 Page | 9
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
Nursing considerations : Mechanism of action :
1. HEPARIN sodium - inhibit the aggregation of platelet thereby prolonging bleeding time.
Indications :
- if given SQ don’t aspirate or rub the injection site (above the scapula - best site).
- used in the prophylaxis of long-term complication following M.I, coronary
- therapeutic level 1.5-2.5 times normal PTT;
normal PTT is 20-35 sec. = 50-85 sec. revascularization, and thrombotic CVA.
- antidote : (protamine sulfate) Nursing considerations :
- Monitor bleeding time ( NV = 1-9 mins)
2. WARFARIN sodium (coumadin) - Take the medication with food.
- warfarin is used for long-term .
- onset of action is 4-5 days. CARDIAC GLYCOSIDES
- therapeutic level is 1.5-2.5 times normal PT; Prototype:
normal PT = 9.6 -11.8 sec. = 25 - 30 sec. - digoxin (Lanoxin) and digitoxin (Crystodigin)
INR = 2 - 3 Mechanism of actions :
- should be taken at the same time of the day to maintain at therapeutic level. - increase intracellular calcium, which causes the heart muscle fibers to contract more
- reduce intake of green leafy vegetables.
efficiently, producing positive inotropic & negative chronotropic action.
- antidote : Vitamin K ( Aquamephyton)
Indications :
THROMBOLYTICS - use for CHF, atrial tachycardia and fibrillation
Prototype : Nursing considerations :
Streptokinase, Urokinase - Monitor for toxicity as evidence by :
Mechanism of actions : nausea, vomiting, anorexia, halo vision, confusion, bradycardia and heart blocks .
- activates plasminogen to generates plasmin (enzyme that dissolve clots). - Do not administer if pulse is less than 60 bpm.
Indications : - Should be caution in patient with hypothyroidism and hypokalemia.
- use early in the course of MI (within 4-6 hours of the onset) - Antidote : Digi-bind
Nursing considerations : - Phenytoin is the drug of choice to manage
- monitor bleeding digitalis-induced arrhythmia.
- antidote : Aminocarpic acid Nitrates
Prototype :
Antiplatelet Medications - isosorbide dinitrate (Isordil)
Prototype: aspirin, Dipyridamole (Persantin) - nitroglycerine (Deponit, Nitrostat)
Clopidoigrel (Plavix), Ticlopidine Mechanism of action :
 Page | 10
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
- produce vasodilatation including coronary artery. Class III (block K channels)
Indications : amiodarone, bretylium
- angina pectoris, MI, peripheral arterial occlusive disease. Class IV (block Ca channels)
Adverse effects: verapramil, diltiazem
- headache, orthostatic hypotension . Nursing considerations :
1. Watch out for signs of CHF.
Nursing Considerations : 2. Have client weigh themselves and report
1. Transdermal patch weight gain.
3. Watch out for signs of lidocaine toxicity :
- apply the patch to a hairless area using a new patch and different site each day. - confusion and restlessness
- remove the patch after 12-24 hours, allowing 10-12 hours “patch free” each day to
ANTILIPEMICS
prevent tolerance. Prototype :
2. Sublingual medications : a. cholesterol-lowering agents
- note the BP before giving the medication. - cholestyramine, colestipol, lovastatin
b. triglyceride-lowering agents
- offer sips of water before giving because dryness may inhibit absorption.
- gemfibrozil, clofibrate
Mechanism of actions :
- one tablet for pain and repeat every 5 mins. for a total of three doses; if not relieved
- interfere with cholesterol synthesis as well as
after 15 mins., seek medical help. decreasing lipoprotein & triglyceride synthesis.
- stinging or burning sensation indicates that the tablet is fresh. Nursing considerations :
- instruct patient not to swallow the pill - monitor liver functions while using statins.
- prevent constipation, flatulence, cholelithiasis
- sustained release medications should be swallowed and not to be crush.
- encourage increase fluid and fiber intake.
- protect the pills from light.

ANTI – HYPERTENSIVE
ANTI-ARRHYTHMIC DRUGS
Class I (block Na channels) Angiotensin-Converting Enzyme (ACE) Inhibitors
IA - quinidine, procainamide Prototype :
IB - lidocaine captopril (Capoten), enalapril (Vasotec), quinapril, lisinopril
IC -flecainamide Mechanism of actions :
Class II (Beta-blockers)
propanolol, esmolol - prevent peripheral vasoconstriction by blocking conversion of angiotensin I to
 Page | 11
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
angiotensin II decreasing peripheral resistance. - increase Na+, K+, & HCO3 secretion, along with it is H2O
Adverse effect : - metabolic acidosis
- it cause hyperkalemia OSMOTIC DIURETIC
- induce chronic cough - Mannitol
Nursing considerations : - Increase osmotic pressure of the glomerular filtrate.
- hypotension
- not to discontinue medications because it can cause rebound hypertension.
THIAZIDE DIURETICS
- avoid using K+ sparing diuretics. - hydrochlorothiazide
- blocks Na and K reabsorption; reabsorb Ca
CALCIUM-CHANNEL BLOCKERS - hypercalcemia
Prototype : LOOP DIURETICS
- Furosemide (Lasix)
- Nifedipine (calcibloc, adalat), Amlodipine (norvasc), Felodipine (Plendil) - blocks Na, K, and Ca reabsorption
Verapramil (Isoptin) - hypocalcemia
Mechanism of action : POTASSIUM SPARING DIURETICS
- Spironolactone (Aldactone)
- decrease cardiac contractility and the workload of the heart, thus decreasing the - excrete Na and water but it reabsorb K
need for O2. - hyperkalemia
- it also promote vasodilatation of the coronary and peripheral vessels.
Indications :
- hypertension, angina, arrhythmia RESPIRATORY MEDICATIONS
Adverse effects :
- bradycardia, hypotension, headache Bronchodilators
- reflex tachycardia, constipation Prototype :
Nursing considerations : Symphatomimetic Xanthines
- Administer between meals to enhance absorption. - albuterol, salbutamol - aminophylline
- Take client’s pulse rate before each dose, withhold if pulse is below 60 bpm. - isoproterenol, salmeterol - theophylline
- terbutaline
- Refer for signs of congestive heart failure.
Mechanism of actions:
DIURETICS
- sympathomimetic ( b-receptor agonist
- usually given at morning ) bronchodilators, dilate airways.
CARBONIC ANHYDRASE INHIBITORS
- xanthine bronchodilators, stimulate CNS for respiration.
- Acetazolimide (Diamox)
Indications :
 Page | 12
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
- bronchospasm, asthma, bronchitis, COPD.
- Take inhaled bronchodilators first before taking inhaled steroids, and rinse mouth
Adverse effects :
- palpitations and tachycardia after using.
- restlessness, nervousness, tremors
- anorexia, nausea and vomiting, headache, dizziness.
Nursing considerations : MAST CELL STABILIZERS
- Contraindicated hyperthyroidism, cardiac dysrhythmia, or uncontrolled seizure Prototype : cromolyn sodium (Intal)
Mechanism of action :
disorder. - stabilize mast cells that release histamine triggering asthmatic attacks.
- Should be used with caution in patient with HPN and narrow-angle glaucoma. Nursing Consideration:
- Should be given before asthmatic attacks.
-
Administer oral capsule at least 30 mins before meals for better absorption.

- Drink a few sips of water before & after inhalation to prevent cough & unpleasant tast
- Assess for lactose-intolerance.
GLUCOCORTICOIDS
(CORTICOSTEROIDS)
Prototype : ANTI-HISTAMINES (H-1 BLOCKERS)
Protoytype :
- dexamethasone, budesonide, fluticasone, prednisone, beclomethasone. - Astemizole (Hismanal), Loratidine (Claritin),
Mechanism of actions : Brompheniramine (Dimetapp),
- Diphenhydramine (Benadryl),
act as anti-inflammatory agents and reduce edema of the airways, as well as Cetirizine (Iterax), Celestamine (Tavist).
pulmonary edema. Mechanism of action :
Adverse effects : - decrease nasopharyngeal secretions and decrease nasal itching by blocking histamine
- Cushing’s syndrome, neutropenia. osteoporosis
Nursing considerations : in H1-receptor.
- Take drugs at meal time or with food. Indications :
- Eat foods high in potassium, low in sodium. - common colds, rhinitis, nausea and
- Instruct client to avoid individuals with RTI. vomiting, urticaria, allergies and as sleep aid.
Nursing Considerations :
- Instruct client not to stop medication abruptly, it should be tapered to prevent - Administer with food and drink.
adrenal insufficiency - Given IM via Z-track method or orally.
- Avoid taking NSAID while taking steroids. - Precautions in handling machine and driving while taking these drugs.
 Page | 13
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
- Ice chips or candy for dry mouth
Pyrazinamide
ANTI-TUBERCULOSIS - given for 2 months.
Prototype : - increase serum uric acid and cause photosensitivity.
First line Second line
- Isoniazid (INH) - Cycloserine Ethambutol
- Rifampicin (Rifadin) - Kanamycin - contraindicated in children under 13 years old.
- Ethambutol - Ethonamide - obtain a baseline visual acuity because it can cause optic neuritis.
- Pyrazinamide - Para-aminosalicylic acid
- Streptomycin - Instruct the client to notify the physician immediately if any visual problems occurs.
Streptomycin
- active tuberculosis are treated with drug combination for 6-9 mos. - aminoglycoside antibiotic given IM.
- nephrotoxic and ototoxic.
- multidrug-resistant strain (MDR-TB) are medicated for 1 year up to 2 years
- obtain baseline audiometric test and repeat every 1-2 months because the
- given before meals medications impairs the CN VIII.

Isoniazid
DRUGS AFFECTING GASTROINTESTINAL SYSTEM
- should be given 1 hr before or 2 hrs after meals because food may delay absorption.
- should be given at least 1 hr before antacids. Antacids
Prototype :
- instruct to notify physician for signs of hepatoxicity (jaundice), and neurotoxicity
- aluminum/magnesium compounds (Maalox)
numbness of extremities. - sodium bic arb onate (Alka-Seltzer)
- administer with Vitamin B6 to counteract the neurotoxic side effects. - calcium c arb onate (Tums)
- avoid alcohol. - magnesium hydroxide (Milk of Magnesia).
Mechanism of actions :
Rifampicin - neutralize the stomach acidity.
Adverse effects :
- given on an empty stomach with 8 0z. of water, 1 hour before or 2 hours after meals - metabolic alkalosis, stone formation
and avoid taking antacids with medications. - electrolyte imbalance
- hepatotoxic thus avoid alcohol. - diarrhea (magnesium), constipation (aluminum).
Nursing considerations :
- instruct the client that urine, feces, sweat, and tears will be red-orange in color. - Give 1 hr after meals.
 Page | 14
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
- Avoid giving medications within 1-2 hrs of antacid administration - coats the mucosa to prevent ulcerations.
(decreases absorption). Nursing consideration :
- Take fluids to flush after intake of antacid suspensions. - Given before meals.
- Monitor for changes of bowel patterns. - Misoprostol is contraindicated for pregnants.
- Sucralfate cause constipation.

HISTAMINE – 2 BLOCKERS Anti-diarrheal Agents

Prototype : Prototype :
- cimetidine (Tagamet), ranitidine (Zantac), - diphenoxylate (Lomotil), loperamide (Imodium), kaolin/pectin mixture (Kaopectate).
famotidine (Pepcid), nizatidine (Axid).
Mechanism of action: Mechanism of actions :
- blocks H2 receptors in the stomach, reducing - decrease stomach motility and peristalsis.
acid secretions. Nursing considerations :
Nursing considerations : - Monitor for rebound constipation.
- Given before or with meals - Be cautious taking if with infectious diarrhea.
- Avoid giving other drugs with cimetidine - Monitor atropine toxicity with diphenoxylate.
- Gynecomastia may developed with chronic use of cimetidine. - Clay, white or pale stool is common with kaopectate.

Laxatives
Proton – Pump Inhibitors (PPI) a. lactulose (Cephulac), Na biphosphate (Fleet
Prototype : enema) & magnesium salt (Milk of Magnesia)
- omeprazole (Losec), Lansoprazole (Lanz), pantoprazole (Pantoloc). -retain fluid and distend intestine
Mechanism of action : b. ducosate (Dialose)
- inhibit the proton H+ to combine with Cl- toform hydrochloric acid. -emulsify fecal fat and water
Nursing considerations : c. bisacodyl (Dulcolax) & senna (X-prep)
- Given before meals preferably at morning. -irritates intestinal mucosa and
stimulate intestinal smooth muscles
d. bulk-forming laxative (Metamucil)
-increase fecal bulk and water content
Mucosal Barriers e. mineral oil
Prototype : -lubricates & prevent colon absorption
- sucralfate (Carafate), misoprostol (Cytotec).
Mechanism of action :
EMETICS
 Page | 15
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
Prototype : ipecac syrup, apomorphine - Remain sitting upright after taking etidronate.
Mechanism of actions :
- induce vomiting through stimulation of vomiting center of medulla. Oral Hypoglycemic Agents (OHA)
Indications : 1. Sulfonylureas
- ingestion of poisonous or toxic substances. - stimulate insulin secretions and increase tissue sensitivity to insulin.
Nursing considerations : First Generation :
- Consult poison control center before induction of vomiting. Chlorpropamide (Diabenese)
- Administer ipecac syrup with large amount of fluid. - disulfiram precautions
Tolbutamide (Orinase)
DRUGS AFFECTING THE ENDOCRINE SYSTEM - congenital defect
Second Generation :
THYROID AGENTS Glypizide, Glymepiride
Prototype : 2. Biguanides
- Proloid (thryroglobulin ) - facilitates insulin action on the peripheral receptor site.
- Synthroid (levothyroxine) Metformin and Glucophage (Glucovance)
- Cytomel ( liothyronine). - side effect is lactic acidosis
Mechanism of action : 3. Alpha-glucosidase inhibitors
- function as natural or synthetic hormones. - delay carb ohydrate absorption in the intestinal system.
Nursing considerations : Acarb ose (Precose) – side effect is diarrhea
- Taken in the morning. 4. Thiazolinidine
- Caution with coronary artery disease. - increase tissue sensitivity of insulin.
Rosiglitazone (Avandia)
- Monitor for signs of hyperthyroidism and refer for decreasing the dose. 5. Meglitinides
- stimulate insulin release in pancreatic B-cells.
PARATHYROID AGENTS Repaglinide (Prandin)
Prototype :
a. calcitonin (Calcimar), etidronate (Didronel), Nursing considerations :
b. calcitrol (Rocaltrol), calcifediol (Calcedrol) - Effective only for type II DM.
Mechanism of action : - Contraindicated to pregnant & breastfeeding.
a. reduce bone resorption - Given before meals.
b. promotes calcium absorption - Monitor for signs of hypoglycemia.
Nursing considerations :
- Monitor signs of calcium imbalance
- Report for bone pains.
 Page | 16
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth

Insulin
InsulinOnset Peak Duration ESTROGENS AND PROGESTINS
Prototype :
Immediate-acting 0.15h 0.5–1h 5h
- conjugated estrogen (Premarin), estrone (Bestrone), estradiol (Estrace),
Short-acting 0.5-1 h 2-4 h 5-7h diethylstilbestrol (DES).
(regular, semilente) Indications :
Intermediate-acting 1-3 h 6-12 h 18-24 h - prostate cancer, contraceptions
- estrogen replacement
Long-acting 4-6h 10-30 h 24-36 h Adverse effects :
estrogen - endometrial CA, gallbladder disease, HPN, migraine, breast tenderness
Mixed 0.5 h4-8 h 25 h
(regular 30%, NPH 70%) progesterone - altered menstrual flow, risk of thrombo embolism
Nursing considerations :
Nursing considerations : 1. Mix estrogen or progestins prior to IM administration by rolling vials between palms.
- Usually given before meals.
- Roll the bottle in palm of hands, don’t shake. 2. Monitor blood pressure
- Inject amount of air that is equal to each dose 3. Teach patient how to perform BSE.
into the bottle – short acting last (clear). 4. Regular follow-up examination is required to detect associated risk of acquiring CA
- Aspirate short acting first, then long or intermediate (cloudy).
- Alcohol is recommended for cleansing bottle but not with skin.
- Pinch skin, avoid I.M, don’t aspirate.
- Rotate the injection site an inch a part. DRUGS AFFECTING LABOR and LACTATION
- Prefilled syringes are stored vertically, needle-up.
- May increase dose during illnesses. Uterine Stimulating Agents
Protoytpe :
- Used bottles stored in room temperature, unused bottle stored in refrigerator.
a. Oxytocin (Pitocin), ergonovine (Ergotrate), methylergonovine (methergine)
- Monitor for acute hypoglycemia :
a. 3-4 commercially prepared glucose tablet b. carb opost (Prostin), dinoprostone (Prostin E2)
b. 4-6 ounce of fruit juice or regular soda Mechanism of actions :
c. 2-3 teaspoon or honey a. stimulates uterine smooth muscles
d. Glucagon 1 gm SQ or IM b. ripening of cervix
e. D50-50 IV. Adverse reactions :
 Page | 17
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
- fetal bradycardia (oxytocin), a. quinolones - ciprofloxacin, ofloxacin
- hypertension (ergonovine), palpitations b. metronidazole
- allergic reactions (Prostaglandins) Adverse effects :
Uterine Inhibiting Agents (Tocolytic) 1. Aminoglycoside - nephrotoxicity & ototoxicity
Prototype : 2. Sulfonamides - Steven-Johnson’s syndrome, photosynsetivity
- ritodrine (Yutopar), terbutaline (Brethine) 3. Quinolones - insomnia
Mechanism of actions : 4. Tetracyclines - bone problems
- relaxes the uterus by stimulating the B2- adrenergic receptors 5. Chloramphenicol - Gray syndrome, bone marrow depression
Adverse effects : 6. Erythromycin - hepatitis
- tremors, nausea, vomiting and tachycardia
Nursing considerations :
Lactation Suppressants 1. Collect appropriate specimen for C & S before starting antibiotics.
Prototype : 2. Check client’s history of allergies.
- bromocriptine (Parlodel) 3. Avoid administering erythromycin and quinolones with food.
Mechanism of action : 4. Pregnant precautions.
- decrease serum prolactin levels h 5. Report for diarrhea - pseudomembranous colitis (clindamycin)
Adverse effects : 6. Monitor adverse effects.
- drowsiness, headache, nausea, palpitations

DRUGS FOR TREATING INFECTION Antiviral Agents

Prototype :
Antibacterial Agents - acyclovir (Zovirax), ganciclovir (Cytovene),
1. Cell wall inhibitors vidarabine (Vira-A), amantidine (Symmetrel),
a. penicillins - pen G, amoxicillin, cloxacillin ribavirin (Virazole), zidovidine (Retrovir).
b. cephalosphorins - cephalexin, cefaclor Mechanism of actions :
c. glycopeptide - vancomycin - inhibits virus specific enzymes involve in DNA
2. Protein synthesis inhibitors synthesis. They only control the growth of
a. aminoglycosides - amikacin, gentamycin virus but it does not cure.
b. macrolide - erythromycins, roxithromycin Adverse effects :
c. lincosamides - clindamycins - granulocytopenia, thrombocytopenia, nausea,
d. chloramphenicol, tetracyclines nervousness, headache, nephrotoxicity.
3. Antimetabolites - blocks folic acid synthesis
a. Sulfonamides - cotrimoxazole Nursing consideration :
4. DNA synthesis inhibitors - Pregnant and breastfeeding precautions.
 Page | 18
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
- Administer IV antivirals to avoid crystallization in renal tubules. quinine, pyrimethamine
- Give ribavirin only with aerosol generator. b. Antiamebiasis
- Monitor CBC and creatinine level. - metronidazole (Flagyl), iodoquinol,
- Refer for signs of bleeding. furozolidone (Furoxone).
- Take amantidine after meals. Mechanism of actions :
a. antimalarial – alters protozoal DNA, depleting folates, & reducing nucleic acid
Antifungal Agents
Prototype : production
- amphotericin B (Fungisone), nystatin, b. antiamoeba – block protein synthesis.
fluconazole (Diflucan), ketoconazole (Nizoral). Nursing considerations :
Mechanism of actions : 1. Administer anti-malarial drugs with food.
- inhibit the synthesis of fungal sterol. 2. Take seizure precautions while administering
Adverse effects : antimalarial drugs.
- nephrotoxicity and neurotoxicity 3. Refer cinchonism during quinine treatment:
- bone marrow depression - tinnitus, headache, vertigo, fever, and visual changes.
- chills, fever, joint pains, abdominal pain and headache.
4. Inform clients that iodoquinol falsify thyroid function test for up to 6 months.

Nursing considerations :
ANTIHELMINTIC
- Dilute amphotericin B with sterile water solution not with electrolyte solution.
Prototype :
- mebendazole (Vermox), thiabendazole,
- Tell clients that fever, chills, GI upset, joint and muscle pain will subside as
niclosamide (Niclocide), piperazine (Antepar),
amphotericin B continues. praziquantel (Biltricide).
Mechanism of actions :
- With oral candidiasis, let nystatin tablet dissolve in mouth rather than swallowing it.
- paralyze larva and adult helmints by acting on parasite microtubules.
- Refrain ketoconazole with antacids. Adverse effects :
- Report for signs of bleeding, infection & fatigue. - GI upset, urinary odor (thiabendazole)
- headache, dizziness, fatigue
Nursing considerations :
ANTIPARASITIC AGENTS 1. Treat all the family members for nematodes infection to prevent recurrence.
Prototype :
a. Antimalarial 2. Praziquantel must swallowed rapidly because of its bitter taste to avoid gagging.
- chlroquine, mefloquine, primaquine,
 Page | 19
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
3. Other antihelmintics should be chewed. b. 5-flourouracil – phototoxicity reaction and cerebellar dysfunctions
c. 6-marcaptopurine – hyperuricemia
d. Methotrexate – photosensitivity
- given with leucoverin to lessen its toxicity.
4. Mitotic Inhibitors (Vinca Alkaloids)
- prevent mitosis acting on the M phase causing cell death
a. Vincristine sulfate – neurotoxicity, numbness
ANTI-NEOPLASTIC DRUGS 5. Hormonal Medications and Enzymes
- block the normal hormones in hormone sensitive tumors
General considerations : a. Tamoxifen citrate – visual problems
- kills or inhibit the reproduction of neoplasmic cells but as well as normal cells. – elevate cholesterol & triglycerides level
b. Diethylstilbestrol – impotence and gynecomastia in men.
- it could be cell cycle phase specific or cell cycle non-specific.
- preferably given through IV route. Side Effects:
stomatitis
- bland diet, avoid strong mouthwash
Prototype : - soft tooth brush, ice chips
1. Alkylating Agents diarrhea, nausea and vomiting
- inhibits cell production by causing cross linking of DNA - anti-emetic, replace fluids and electrolytes
a. Busulfan – hyperuricemia alopecia
b. Chlorambucil – gonadal suppression - reassure that it is temporary
c. Cisplatin – ototoxicity and nephrotoxicity - encourage o wear wigs, hats and head scarf
d. Cyclophosphamide – hemorrhagic cystitis. skin pigmentation
2. Antitumor Antibiotic Agents - inform that it is only temporary
- interfere in DNA and RNA synthesis tumor lysis syndrome
a. Plicamycin – affects bleeding time - hyperuricemia & hyperkalemia
b. Doxurubicin – cardiotoxicity - force fluids
c. Bleomycin – pulmonary toxicity. infection
- notify physician if WBC is <2000/mm3
- monitor for signs of infection
3. Antimetabolites - reverse isolation
- low bacteria diet
- replace normal proteins required for DNA synthesis by inhibiting the S phase anemia
a. Cytarabine – hepatotoxicity - iron, B-12, folic acid rich food
 Page | 20
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
- provide rest periods c.
“You will be needing only three tablets to ease the pain and if unrelieved
bleeding
- avoid NSAIDs d.
“ There is no problem with continuous daily intake because nitroglyceri
- minimize invasive procedures
- use soft toothbrush and electric razor
menstrual changes 3.
- reassure that menstruation will resume. The nurse must emphasize to the patient which ONE of the following side-effects
a. Headachec. Nausea and vomiting
b. Hypertensiond. Visual changes

THE END 4.
What other information must the nurse provide to the patient taking the nitrogly
REVIEW QUESTIONS
a. Keep the tablet in a clear container
b. Take the tablet with meals
c.
Continue
SITUATION: Mr. Hero Fernando, a 60 year-old bank manager had experienced a sensation of chest to take
tightness, as pain,
chest manysweating
tablets ofand
nitroglycerin
a feeling ofuntil chest pain A
apprehension. subsid
diag
d. A burning sensation under the tongue is expected
1.
The physician orders for nitroglycerin tablet. The nurse knows that the pharmacological action of the drug is:
a.
To dissolve the atheromatous plaque in the coronary artery
5.
b. Constrict the venous vessels and capillaries
The nurse applies the ordered nitroglycerin ointment on the patient’s chest wall.
c. Dilate the coronary arteries
d. Decrease the myocardial consumption of oxygen a. The nurse chooses a hairless area
b. She spreads the ointment with her fingers
2. c.
The nurse gave instructions to the patient on nitroglycerin intake. He remarked, “I think I will tryShe
notremoves the many
to take too ointment on the
of these skin At
pills.” from
thisthe previous
instance, thedose
nurse’s BEST
d. She rotates the sites of ointment application
a.
“I agree, nitroglycerin can cause drug addiction, that is why you must not take too many of the pills”
6.
b. The nurse gives which of the following discharge instructions to this patient with
“I must inform you that nitroglycerin is non-habituating and you should take the pills many times to relieve the pain”
a. Only take the nitroglycerin as desired
 Page | 21
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
b. b. Metoprolol
The drug should be taken before engaging in exertional activities
c. Clonidine
c. The tablet should be taken only in the morning d. Captopril
d.
If the drug does not relieve the pain, increase the frequency of the dose
10.
After administering a blood-pressure lowing agent, the nurse must caution the p
7. a. To avoid straining during defecation
Hero asked the nurse what he could do about his concern about sex activity. The nurse best suggests:
b. To avoid low-sodium and potassium diet
a.
Tell him to avoid sex for several months while his heart is on therapy
c. To avoid abrupt change of positions
d. To take warm shower immediately after taking the drug
b. Suggests that his wife assume the top position
c. Tell him to avoid sex on days when he is anxious 11.
d. Advise that he should have sex only once a month The nurse prepares to give a diet appropriate for a hypertensive patient. Which
a. Canned meat loaf
8. b. Scallops and shrimps
The nurse understands that her discharge teaching is effective regarding life style modification when the patient says:
c. Fresh citrus juice and cake
a. d. Butter and pork steaks
“I know that I will need to eat less, so I will eat once a day only”
b. 12.
“I will stay on bed most of the time so I wont experience chest pain”
If the physician orders Captopril as the home medication for the high BP, the nu
c.
“I will stop what I’m doing whenever I have pain and take the pill”
a. Rashes
d. b. Cough
“I need to enroll in a gym class to have a vigorous exercise to condition my heart”
c. Pruritus
d. Ringing of the ears
SITUATION
13.
: Manny is admitted to the medical ward with the diagnosis of essential hypertension. He had hypertensive emergency 2 hours ago and was hospitalized for fu
If the client is discharged with home medication of Propranolol hydrochloride, t
9. a. Take the medication on an empty stomach
The nurse administers prescribed anti-hypertensive meds. If it can be any of the following, she
b. will checkblood
Obtain the pulse priorreadings
pressure to giving:regularly
c. Perform active exercises to prevent Hypotension
a. Nifedipine d. Caution to avoid hazardous activities after taking the drug
 Page | 22
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
14. d.
“I am experiencing dryness of the eyes and sandy sensation”
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 18.
b. Verapamil The nurse evaluates that the drug digoxin is effective when the patient manifests
c. Telmisartan a. Decreased bowel sounds
d. Diltiazem b. Increased urine output
c. Increased drowsiness
SITUATION d. Decreased sympathetic response of the body
: Joseph,, 50 y.o. Businessman awakens in the middle of the night with dyspnea, bilateral basilar rales and frothy sputum. He is brought to the Mulawin hosp
19.
The following manifestations must be assessed by the nurse to detect beginning d
15. a. Nausea and vomiting
The physician gives the patient furosemide and digoxin. The nurse’s main concern is to:
b. Palpitations
a. Take the central venous pressure reading c. Diplopia and visual yellow-green halos
b. Observe for decrease edema d. Hypertension
c. Observe for signs and symptoms of hypokalemia
d. Force fluids 20.
The nurse instructs the patient on diet modification during digitalis therapy. She
16.
The mechanism of action of dioxin that makes it useful in patients with CHF is that it:
a. Fresh orange juice and potato fries
a. Produces a negative inotropic effect b. Dried mangoes and tomato juice
b. Increases cardiac conduction c. Broccoli salad with bean sprouts
c. Enhances cardiac contractility d. Flavored gelatin and iced tea
d. Increases the heart rate
21.
17. The nurse obtains an apical pulse of 78 beats/min. She is bringing the next dose o
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. Withhold the drug and notify the physician
a. “Nurse, I don’t feel like eating for the past few days” b. Start IV infusion of Digibind (digoxin antibody)
b. “I am having constipation lately” c. Instruct patient to consume more meat and nuts
c. “I am developing a nagging cough and night terrors” d. Administer the drug
 Page | 23
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
SITUATION a. Intravenously. Slow IV push
: Armida, an 18-year-old adolescent is seen in the health center because of easy fatigability and frequent dizziness
b. Intamuscular, Z-track method
22. c. Subcutaneous
d. Intrathecal
The health center physician determines that she has iron-deficiency anemia. The nurse will anticipate the doctor to order for:

a. Bone marrow aspiration 27.

b. Hemoglobin level determination The nurse must warn the patient taking oral iron preparations that it can cause
c. Platelet count a. Yellowish discoloration of the skin and mucus membrane
d. BUN and Creatinine b. Darkening of stool color
23. c. Anorexia and loss of hair
A drug is administered to correct anemia, such as an iron. This drug is classified as:
d. Ulceration of the skin and cough
a. Antihelminthic
b. Anticoagulant 28.
c. Hematinic The patient remained pale and weak, upon further examination, it was determin
d. Antihistaminic
a. Absence of Vitamin E in the diet
24. b. Presence of excessive iron in the liver
The nurse administers the oral iron tablet. She will give the medication:
c. Absence of intrinsic factor in the stomach
a. With milk and dairy products d. Temporary bone marrow depression.
b. With antacids to minimize gastric upset
c. With fruit juices like calamansi and orange DRUGS THAT AFFECT THE HEMATOLOGICAL SYSTEM
d. With a full glass of coffee or tea SITUATION
: Mrs. Rosalinda Amor, 23 year-old actress is admitted because of a
25. 29.
The nurse instructs the patient to eat iron-rich foods. She determines that her teaching isThe nursewhen
effective employs whichwill
the client of the following non-pharmacological measures in cari
choose:
a. Ice compress over the involved leg TID
a. Pomelo juice and hamburger b. Elevate the legs with a pillow
b. Gelatin and marshmallows c.
c. Lean meat and buttered corn Maintain on strict bed rest with minimal bathroom privileges
d. Liver and eggyolk d. Massage the involved area

26. 30. the drug:

The doctor decides to order Iron dextran one ampoule. The nurse prepares to administerThe physician orders Heparin sodium for Mrs. Amor. The nurse understands th
 Page | 24
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
a.
Heparin will dissolve the clots in the inflamed veins to prevent emobolization
b. Positive Homan’s sign
c. Dark, cola-colored urine
b. d. Epistaxis
There is a need to prevent further clot formation in the involved vessels
c. 35. Which one effect of heparin therapy will cause nursing concern?
Heparin will anticoauglate the blood by inhibiting vitamin K metabolism
a. Thrombocytopenia
d. b. Constipation
The clot formed in the vein must be lysed by activating plasmin, the action of heparin
c. Bone marrow depression
d. Dizziness
31.
If the doctor orders for heparin therapy monitoring, the nurse must obtain which laboratory tests from the lab unit?
36.
a. Prothrombin time In the event of an overdose of heparin injection, the nurse prepares which one an
b. Clotting time a. Phytomenadione
c. Partial thromboplastin time b. Atropine Sulfate
d. Prothrombin consumption test c. Protamine sulfate
d. Deferoxamine chelators
32.
The above laboratory value must is considered therapeutic if the result is about:
37.
a. 3 times the normal The doctor switched from standard heparin to low molecular weight heparin inj
b. 2 times the normal
c. Equals the normal a.
The LMWH can be administered IM
d. Less than the normal b. The LMWH does not need frequent laboratory monitoring
c. The LMWH has a better potency
33. d. ofThe LMWH does are:
not cause bleeding problems
The nurse must administer heparin to Mrs. Amor. She determines that the most common routes administration
a. IV and IM 38.
b. SC and IV The nurse reads the chart and notes for an order of oral Warfarin sodium, while
c. ID and IM a.
d. IV and intrathecal Question the order because of potential excessive bleeding if given simul
b. Administer the drug as ordered
34. c.
When the nurse is monitoring the patient for heparin overdose, she is observing for the following Withhold the heparin
signs/symptoms, and administer the Warfarin orally
except?
d.
a. Ecchymoses Report the error to the nurse supervisor as the patient may be at risk fo
 Page | 25
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
c. In Between meals
39. d. Intramuscularly
IF Mrs. Amor is discharge with warfarin sodium, the nurse must include in her discharge teaching which one?
a. 43.
Keep Vitamin A ampule available for injection c/o the health center in case of emergency
Mrs. Avery had a sudden severe and prolonged chest pain. Acute MI is suspected
b. Report any bright red blood in the stool or urine
c. a. Tranexamic Acid
Take aspirin to manage the headache side-effect of the drug b. Dipyridamole
d. c. Steptokinase
Utilize firm toothbrush when brushing to prevent build up of plaques and gingival hyperplasia
d. Coumadin

40. 44.
The nurse must remind the patient that warfarin therapy is monitored with the use of which
If the
laboratory
above drug
examinations?
is ordered to be given IV drip, the nurse must be aware of whi
a. PT and PTT a. Hypersensitivity reaction
b. PT and INR b. Congestive heart failure
c. Clotting time and bleeding time c. Further damage to the myocardium
d. Platelet count and PT d. Excessive clot formation

SITUATION 45.
: Mrs. Avery had a previous attack of mild stroke and coronary artery disease. Shepatient
If the is taking Aspirin. tissue-plasminogen activator, the nurse must make whi
is receiving
41. a. Have heparin sodium available
The reason aspirin is utilized as an anti-platelet medication is because:
b. Monitor closely the renal status
a. Aspirin can prolong the bleeding time c. Observe for psychotic symptoms
b. Aspirin affects the thromboxane production of the platelet d. Obtain a stand by Aminocaproic acid

c. SITUATION
Aspirin interferes with the receptor binding of the platelets
: A patient is determined to have hypercholesterolemia and is admit
d.
Aspirin blocks the degranulation process inhibiting release of histamine
46. The nurse determines that the BEST time to give the drug is:
a. In the morning before breakfast to promote absorption
42. The nurse administers aspirin: b. In the afternoon to promote sleep because it is sedating
a. On an empty stomach to increase absorption c. At bedtime
b. With meals d. In between meals
 Page | 26
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
a. Warn the patient that extreme drowsiness may occur
47. b. Offer a full glass of water
The nurse is knowledgeable about the mode of action of lovastatin that it: c.
Nausea and vomiting are potential problems alleviated by small frequen
a.
It Inhibits the formation of chylomicrons in the intestinal cells d. Suggest to buy a nebulizer machine to be used at home
b. It prevents the enzyme that synthesizes cholesterol e.
Vitamin ADEK supplements because of impaired absorption
c.
It binds with bile acids and cholesterol promoting excretion
d. 51.
To be able to detect the effectiveness of Salbutamol, the nurse should check for:
It promotes cholesterol metabolism in the adipose tissue to lower the plasma cholestero
48. a. Blood pressure and CVP readings
The nurse is prepared to provide comfort measure to the common side effects of the drug. She
b. monitors
Urinarythe patient
output perfor:
hour
a. Abdominal fullness, flatulence and diarrhea c. Breath sounds
b. Confusion and psychoses d. Level of consciousness
c. Palpitations and arrhythmias e. Pupillary reflexes
d. Hypertension and rashes
52.
49. The patient is receiving theophylline capsule OD. The nurse cautions the patient
The nurse must monitor for these serious adverse effects of lovastatin. Which one is not included?
a. Glaucoma a. Sugar and cream
b. Cataract b. Coffee and chocolate
c. Myositis c. Spinach and broccoli
d. Hepatic failure d. Beans and aged cheese
e. Canned goods and wine

53.
The nurse reads the drug order sheet and is most concern to consult the physician if he orders:
e. Paracetamol The patient is receiving theophylline capsule OD. The nurse cautions the patient
f. Gemfibrozil
g. Vitamin supplements a. Sugar and cream
h. Omeprazole b. Coffee and chocolate
c. Spinach and broccoli
d. Beans and aged cheese
50. e. interventions?
The nurse is giving Guaifenesin to a patient. She includes in her teaching which of the following Canned goods and wine
 Page | 27
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
54. c. Diabetes mellitus
The nurse is administering acetylcysteine nebulization to a patient. It is very much importantd.to keep
Polycystic
which ovarian disease
item below at bedside?
e. Emphysema
a. Scissors
b. Ambu bag 58.
c. Suction machine includes
The nurseinisher care plan all
administering of the following
oxymetazoline nasalinterventions,
decongestant. She includes in he
d. Tracheostmy set EXCEPT?
e. NG tube a.
Instruct the patient to clear the nasal passage of mucus before instilling
55. b.
After giving diphenhydramine to the patient, the nurse must ensure that the patient understandsRemind
the teachings
patientbelow,
to keep the head tilted for a few seconds after administr
EXCEPT:
a. Refrain from manipulating delicate machines c. Advise increased fluid intake
b. Take sugarless candy in the mouth to relieve dryness d. Encourage the use for one week for better effect
c. Avoid taking the drug with alcohol e.
Caution that tachycardia and urinary retention may occur with systemi
d. Check pulse rate before taking the drug
e. Manage gastric upset by taking it with food
59.
56. The physician asks the nurse for an anticholinergic drug to be used for the asthm
The nurse watches out for a side-effect associated with intake of codeine sulfate and provides appropriate intervention, this can be:
a. Albuterol
a. Constipation- provide liberal fluids b. Terbutaline
b. Excitement- provide less stimulation c. Metaproterenol
c. Tachycardia- administer lidocaine d. Ipratropium bromide
d. Polyuria- give the drug in the morning e. Salbutamol
e. Tachypnea- position on semi-fowler’s
60.
The physician orders dextromethorphan for a patient who is complaining of very

57. a. Increasing the secretions of the bronchial glands

b. the
Terbutaline sulfate is administered to a patient with asthma. If the patient has another disease, Removing the irritation
nurse is most fromcautious
vigilant and the respiratory tract exists:
if this condition
c. Inhibiting the medulla oblongata cough center
a. Hypothyroidism d. Inhibiting the stretch receptors in the lungs
b. Rheumatoid arthritis e. Triggering the vagal responses
 Page | 28
Twitter: @nursehooman
Facebook: facebook.com/nurse.hooman

Eye medications :
- administer eye dropseyedrops 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 bottlesbottle to the eyeball.
- place prescribed dose in the lower conjunctival sac.
- instruct the client to press the inner canth
61. e. Headache
Inhaled corticosteroid like beclomethasone is administered to the patient with asthma. It is important for the nurse to stress that this drug:

a. Acts rapidly to decrease inflammation

b. Promotes the secretion of mucus
c. May depress the immune function
d. Highly effective in terminating acute asthma attack
e. Is habituating and addicting

62.
The second generation anti-histamines like cetirizine have the advantage over the first generation antihistamines like diphenhydramine because second generation antihi

a.
Have shorter duration of action that can be reversed rapidly
b. Have less sedation and anticholinergic properties
c. Posses less drug sensitivity reactions
d. Have a greater safety profile
e. Have less abuse potential

63.
The nurse cautions the patient taking diphenhydramine (Benadryl) to expect all of the following side effects,
except ?
a. Dry mouth
b. Blurred vision
c. Urinary frequency
d. Drowsiness
e. Dizziness

64.
The nurse must remember to administer theophylline slowly or with an infusion pump because this drug, if given rapidly can cause:

a. Increased alertness
b. Severe hypotension
c. Tachycardia
d. Pallor