The Orphan Drug Act of 1983: designed D.

Evidence of human risk to the fetus

to promote the development and exists; however, benefits may outweigh
manufacture of drugs used in the risks in certain situations
treatment of rare diseases. The acts
three primary incentives are: X. Controlled studies in both animals
1. Federal funding of grants and and humans demonstrate fetal
contracts to perform clinical trials of abnormalities; the risk in pregnant
orphan products women outweighs any
2.50% tax credit for costs of clinical
testing FIVE-PLUS-FIVE RIGHTS OF
3. Exclusive rights to market the drug MEDICATION ADMINISTRATION
for 7 years from the marketing approval
date. 1. Right Patient- ask the patient of
his/her full name and birth date,
The Generic Name: official non- compare with the patient's ID band and
proprietary name for the drug; this the medication administration record.
name is not owned by any drug Distinguish between two patients with
company and is universally accepted. the same first and last name. Place
"name-alert sticker"
The Brand Name: the proprietary
name; chosen by the drug company and 2. Right Drug: nurse must accurately
is usually a registered trademark. determine the right drug.
When the doctor orders medications by
Over the Counter Drugs: safe and directly speaking the nurse via
appropriate for use without the direct telephone (T/O) or verbal order (V/O),
supervision of a health care provider. the doctor must sign the order within
24hours. If the order is a controlled
Counterfeit Drugs: look like the desired medication, most facilities require 2
drug but may have no active ingredient, nurses to listen to sign it. NURSING
the wrong active ingredient, or the STUDENTS ARE NOT ALLOWED TO TAKE
wrong amount of the active ingredient. OR ACCEPT THE DOCTOR'S ORDERS,
but are allowed to administer after it
Pregnancy Category: has been verified by the nurse.

Category Description 3. Right Dose: The right dose refers to

the verification by the nurse that the
A. Controlled studies in humans show dose administered is the amount
no risk to the fetus ordered and that it is safe for the
patient for whom it is prescribed. Some
B. No controlled studies have been drugs can be crushed, and some should
conducted in humans; animal studies not be crushed. Do not crush EC and
show no risk to the fetus extended or sustained release drugs
because this will change the
C. No controlled studies have been pharmacokinetic phase of the drug.
conducted in animals or humans
4. Right Time: the time the prescribed
dose is ordered to be administered. THE FORMS AND ROUTES OF DRUG
ADMINISTRATION:
I. Administer drugs that are affected by
food, hour before of 2 hours after A. Tablets and Capsules
• most common drug forms, convenient
II. Give food with drugs that can irritate and less expensive.
the stomach • Not given to patients who are
vomiting and comatose
III. Check whether the patient is • Do not mix drugs with infant formula
scheduled for any diagnostic • Do not mix drugs with large amounts
procedures that contraindicate the of foods or beverages
administration or medications • Administer irritating drugs with food
to decrease GI discomfort
IV. Check the expiration date
B. Liquids
5. Right Route: necessary for • Elixirs- sweetened, hydroalcoholic
appropriate absorption. STAY WITH THE liquids used in the preparation of oral
PATIENT UNTIL ORAL DRUGS HAVE liquid medications
BEEN SWALLOWED. • Emulsions- mixture of 2 liquids that
are not mutually soluble
6. Right Assessment: collection of the • Suspensions- liquids in which particles
appropriate baseline data before the are mixed but not dissolved
administration of the drug. Example:
vital signs, lab works. C. Transdermals
• Stored in a patch placed on the skin
7. Right Documentation: requires the and is absorbed through the skin to
nurse to record immediately the produce a systemic effect. A patch may
appropriate information about the drug be left in place for as little as 12 hours
administered. or as long as 7 days depending on the
drug.
8. Right to Education requires the
patient to receive accurate and D. Topicals
thorough information about the drugs • Most frequently applied to the skin by
they are taking and how each drug painting or spreading the medication
relates to their particular condition, over an area and applying a moist
including the side effects, indications, dressing or leaving the area exposed to
contraindications the air.
• Medication can be applied to skin in
9. Right Evaluation: determines the several ways such as with a glove,
effectiveness of the drug based on the tongue blade, cotton-tipped applicator.
patient's response to the drug • Nurses should never apply a topical
medication without first protecting their
10. Right to Refuse: The patient has the own skin with gloves
right to refuse and it is the nurse's
responsibility to determine the reason E. Instillations: liquid medications
for the refusal usually administered as drops,
ointments or sprays e.g. eyedrops, eye Pregnancy category: X; PB: UK; t ½ 14-
ointments, ear drops, nose drops and 25h
sprays
2. Anticholinergics: motion sickness,
F. Inhalations: Metered-dose inhalers nausea and vomiting and IBS. Same side
(MDIs) are handheld devices used to effects as antihistamines.
deliver a number of commonly Scopolamine: Pregnancy category: C,
prescribed asthma and bronchitis drugs PB:UK; t ½ 8h
to the lower respiratory tract
3. Dopamine Antagonists: These agents
G. Nasogastric and Gastrostomy Tubes suppress the emesis by blocking
dopamine receptors in the CTZ.
H. Suppositories- solid medical Dopamine is a neurotransmitter in your
preparation that is cone or spindle brain that contributes to feelings of
shaped for insertion into the rectum, alertness, focus and motivation and
globular or egg shaped for use into the happiness. A flood of dopamine can
vagina or pencil shaped for insertion make you feel euphoric. The most
into the urethra. common side effects of dopamine
agonists include: headache, nausea,
GASTRO-INTESTINAL DRUGS vomiting.

VOMITING 4. Phenothiazines
Vomiting- expulsion of the gastric Prochlorperazine maleate- for nausea
contents and vomiting, may cause drowsiness,
Nausea- quesy sensation that may or dizziness, insomnia. Not approved for
may not precede the expulsion. patients with dementia. Pregnancy
category C, PB: 91-99%; t /2 6-10h
TWO MAJOR CEREBRAL CENTERS: Chlorpromazine and prochlorpromazine
1. Chemoreceptor trigger zone (CTZ)- edislate- used for both psychosis and
lies near the medulla vomiting.
2. Vomiting Center- in the medulla,
when stimulated causes vomiting 5. Benzodiazepines- indirectly control
nausea and vomiting that may occur
Non-pharmacologic measures: with cancer chemotherapy. Lorazepam
1. Weak tea is the drug of choice
2. Flat soda
3. Gelatin 6. Cannabinoids-the active ingredients
4. Gatorade in Cannabis, to alleviate nausea and
5. Pedialyte vomiting

PRESCRIPTION ANTIEMETICS 7. Metochlopramide-suppresses the

emesis by blocking the dopamine
1. Antihistamines: receptors in the CTZ. For the treatment
Hydroxyzine- For post op nausea and of post operative emesis, cancer,
vomiting. Give IM deep in large muscle. chemotherapy and radiation therapy
Watch for side effects like drowsiness,
fatigue, blurred vision.
DIARRHEA causing drug dependence than other
Diarrhea, frequent liquid stool, is a opiates such as codeine.
symptom of an intestinal disorder. Difenoxin is an active metabolite of
The cause of diarrhea should be diphenoxylate, but it is more potent
identified. than diphenoxylate.
• Nonpharmacologic treatment for Both drugs are combined with atropine
diarrhea is recommended until the to decrease abdominal cramping,
underlying cause can be determined. intestinal motility, and hypersecretion.
• Clear liquids and oral solutions such as
Gatorade (for adults) and Pedialyte or Diphenoxylate with atropine is well
Rehydralyte (for children) and IV absorbed from the GI tract. The
electrolyte solutions. diphenoxylate is metabolized by the
• Antidiarrheal drugs are frequently liver;
used in combination with • There are two half-lives: 3 hours for
nonpharmacologic treatment. diphenoxylate and 3 to 14 hours for
the diphenoxylate metabolites.
Travelers' Diarrhea • The drug is excreted in the feces and
Travelers' diarrhea, also called acute urine
diarrhea, is usually caused by E coli. • If this drug is taken with alcohol,
• lasts less than 2 days; narcotics, or sedative-hypnotics,
• however. if it becomes severe, CNS depression can occur.
fluoroquinolone antibiotics are usually
prescribed. Adsorbents
• Loperamide may be used to slow Adsorbents act by coating the wall of
peristals and decrease the frequency of the GI tract and adsorbing bacteria or
defecation. toxins that cause diarrhea.
• Travelers' diarrhea can be reduced by • These agents are combined as a mild
drinking bottled water, washing fruit, or moderate antidiarrheal that can be
and eating cooked vegetables. Meats purchased without a prescription and
should be cooked until well done. used in combination with other
antidiarrheals.
Antidiarrheals • Bismuth subsalicylate is considered an
Opiates and Opiate-Related Agents adsorbent because it adsorbs bacterial
Opiates decrease intestinal motility toxins.
thereby decreasing peristalsis. • Bismuth subsalicylate is an OTC drug
Constipation is a common side effect. commonly used to treat travelers'
• Codeine is an example. diarrhea, and it can also be used as an
• Opium can cause CNS depression antacid for gastric discomfort.
when taken with alcohol, and
tranquilizers. Nursing interventions
• The duration of action of opiates is • Record vital signs.
approximately 2 hours. • Report tachycardia or systolic blood
pressure decreases of 10 to 15 mm Hg.
Antidiarrheals Monitor respirations.
Diphenoxylate with atropine is an • Monitor frequency of bowel
opiate that has less potential for movements and bowel sounds. Notify a
health care provider if intestinal ANTIBIOTICS
hypoativity occurs when taking a drug DEVELOPMENT OF ANTI-INFECTIVE
• Check for signs and symptoms of THERAPY
dehydration resulting from persistent
diarrhea. 1920S PAUL EHRLICH worked on
Fluid replacement may be necessary. developing a synthetic chemical
With prolonged diarrhea, check serum effective against infection-causing cells
electrolytes. only. ü Scientist discovered penicillin in
• Administer antidiarrheals cautiously a mold sample (mouldy petri dish in
to pregnant patients and those with 1928) ü Alexander Fleming, a physician-
glaucoma, liver disorders, or ulcerative scientist who was recognized for
colitis. discovering penicillin upon examining
• Recognize that a drug may need to be some colonies of staphylococcus
withheld if diarrhea continues for more aureus. He noted that a mold called
than 48 hours or acute abdominal pain Penicillum Notatum contaminated
develops. contaminated his petri-dish.
ü 1935 sulfonamides were introduced.
Patient Teaching
• Instruct patients not to take sedatives, NARROW SPECTRUM VS BROAD
tranquilizers, or other narcotics with SPECTRUM:
antidiarrheal drugs. CNS depression • Narrow Spectrum of activity-
may occur. effective against only a few
• Tell patients to avoid OTC microorganisms with a very specific
preparations; they may contain alcohol metabolic pathway or enzyme (eg
and can promote liver damage, and Penicillin, Gentamycin, Erythromycin)
concurrent use wah loratadine and for staphylococci, clostridia,
loperamide may lead to significant streptococci
• Recommended daily maximum dose • Broad Spectrum off Activity- useful in
and the need not to exceed it; treating a wide variety of infections
• Signs and symptoms of adverse
effects, including measures to minimize PREVENTING RESISTANCE:
or prevent them; safety measures, such • Limit the use of antimicrobial agents
as avoiding driving and obtaining to the treatment of specific pathogens
assistance with ambulation as needed sensitive to the drug being used.
to reduce the risk of injury due to • Make sure doses are high enough, and
weakness or dizziness; duration of drug therapy is long enough
• Danger signs and symptoms that need • Be cautious about the indiscriminate
to be reported immediately; the use of anti-infective
importance of notifying the health care
provider if diarrhea is not controlled ADVERSE REACTIONS TO ANTI-
within 48 hours; and the need for INFECTIVE THERAPY
follow-up to enhance patient • Kidney Damage
knowledge about drug therapy and to • Gastrointestinal (GI) tract toxicity
promote compliance. • Neurotoxicity
• Hypersensitive reactions
• Superinfections
TYPES OF ANTIBIOTICS
• Bacteriostatic- substances that Gentamycin (Garamycin, Streptomycin,
prevent the growth of bacteria Amikacin (Amikin), Kanamycin
• Bactericidal- substances that kill the (Kantrex),
bacteria directly Neomycin(Mycifrandin), Tobramycin
(Nebcin, Tobrex)
SIGNS OF INFECTION Indications: Treatment of serious
• Fever infections caused by susceptible
• Lethargy bacteria
• Slow wave sleep inductions Action: Inhibit protein synthesis in
• Classic sign of inflammation: susceptible strains of of gram-negative
-Redness-rubor bacteria causing cell death.
-Swelling- tumor
-Heat- calor
- Pain- dolor Pharmacokinetics:
-Loss -of- function- functio laesa Poorly absorbed from the GI tract but
rapidly absorbed after IM injection,
CLASSIFICATION/CLASSES: reaching peak levels within 1 hour.
• Aminoglycosides Widely distributed throughout the
• Cephalosporins body, crossing the placenta and
• Fluoroquinolones/Quinolones entering breastmilk Excreted
• Macrolides unchanged in the urine and half an
• Lincosamides average half-life of 2-3 hours.
• Monobactams Depend on the kidney for excretion and
• Penicillins are toxic to kidney.
• Sulfonamides Contraindications: known allergies,
• Tetracyclines renal or hepatic disease and hearing
• Antimycobacterials loss
Adverse effects: ototoxicity and
GOAL OF ANTIBIOTIC THERAPY: nephrotoxicity are the most significant
Decrease the population of the invading Drug to drug interactions: diuretics and
bacteria to a point where the human neuromuscular blockers.
immune system can effectively deal
with the invaders. Cephalosporins: Similar to Penicillin in
structure and activity.
BACTERIAL CLASSIFICATION: Bacteria: 3rd generation (P. Aeruginosa)
Action: Interfere with cell-wall-binding
• GRAM POSITIVE: cell wall retains a ability to bacteria when they divide.
stain or resists decolorization with Indication: Treatment of infection
alcohol caused by susceptible bacteria
• GRAM NEGATIVE: cell wall loses a Pharmacokinetics:
stain or is decolorized by alcohol. Well absorbed from GI tract
• AEROBIC: depend on oxygen survival Metabolized in the liver, excreted in the
• ANAEROBIC: do not use oxygen. urine
Contraindications: allergies to
Aminoglycosides: A group of antibiotics cephalosporins or penicillin
used to treat serious infections caused Adverse effect: GI tract
by gram-negative aerobic bacilli.
Drug to drug interactions:
Aminoglycosides, oral anticoagulants
and EtOH

Fluoroquinolones: New class of

antibiotics with broad spectrum off
activity.
Indications: Treatment of infections
caused by susceptible strains of gram-
negative bacteria, including urinary
tract, respiratory tract, and skin
infections.
Action: interfere with DNA replication
in susceptible gram-negative bacteria,
preventing cell production.
Pharmacokinetics:
Absorbed in the GI tract
Metabolized in the liver
Excreted in the urine and feces
Contraindication: known allergy,
pregnancy, and lactation Adverse
effects: headache, dizziness and the GI
tract
Drug-to-drug interaction: Antacids,
Quinidine and Theophylline
Bacteria: S. Pneumoniae, H. Influenzae,
P. Aeruginosa, Salmonella and Shigella