Pharmacology

By: Jan Michael Khalid L. Macarambon, RN

Definition of Terms
Pharmacology – is the science of drugs
and their effects on biological systems
Drug – a chemical that can cause a
change in a biological system
Medicine – is a formulation of a drug
(e.g., tablet, capsule, etc.)
Drug Classification
Chemical – according to structure
Pharmacologic – according to
physiologic activities and mechanisms of
action
Therapeutic – according to therapeutic
indications
Drug Names
Chemical name – chemical structure of the compound
Generic name – name selected by the original
manufacturer of the drug based on the chemical structure
that is used worldwide as established through the
committee on International Nonproprietary names of the
WHO; AKA “nonproprietary name.”
Trade/Brand name – proprietary name owned by the
company that manufactures the drug.
Example:
Chemical name – N-Acetyl-para-aminophenol
Generic name – Acetaminophen
Trade/Brand name – Acephen, Tynenol
Drug Sources
Plants(morphine)
Animals (insulin)
Minerals (calcium)

Most modern drugs are synthetic

chemical compounds
Pharmacodynamics
Is the process by which drugs influence
the cell physiology to achieve the desired
result

“WHAT THE DRUG DOES TO THE

BODY”
Pharmacodynamics
Drugs can:
1. Inhibit
2. Activate
3. Replace

They interact with specific sites called

receptors
Receptors – cellular proteins or nucleic acids
that regulate the cellular activities
Pharmacodynamics
Receptors are regulated in two ways:
1. Agonists (activators) – bind to the
receptor and act to produce a
pharmacologic effect
2. Antagonists (blockers) – bind to the
receptor and prevent the cell from
producing an effect
Pharmacokinetics
Is the process by which the body absorbs
the drug into the bloodstream, distributes
it to its site of action, metabolizes it, and
excretes it

“WHAT THE BODY DOES TO THE

DRUG”
Pharmacokinetics
“ADME”
1. Absorption
2. Distribution
3. Metabolism/biotransformation
4. Excretion
Pharmacokinetics
Factors Affecting Pharmacokinetics
Age
Diseases
Individual Differences
Psychological Factors
Type & Amount of
Drug Prescribed
Social Factors
Routes of Administration
Oral
Pills,
capsules, tablets, liquids
SL, buccal, NG, gastrostomy,
duodenostomy tubes are also included
Assess client’s ability to take oral
medications
Intradermal Injection Sites
Ventralforearm
Upper chest
Shoulder
Subcutaneous Injection Sites
Outer aspects of
the arms & thighs
Hip and lower
abdomen
Above the iliac
crest
Intramuscular
Ventrogluteal
– for 1 year
and above
Preffered site
Intramuscular
Vastus lateralis
– below 1 year
old
Intramuscular
Dorsogluteal –
clients w/ well-
developed gluteal
muscles
Intramuscular
Deltoid
Other Routes
Intravenous
Topical – skin, ophthalmic, otic, nasal,
vaginal, rectal
Respiratory inhalation
Neurologic
1. Cholinergic Agents/Parasymphatomimetics
2. Anticholinergics/Parasymphatolytics
3. Adrenergic Agents/Symphatomimetics
4. Adrenergic Blocking Agents
5. Skeletal Muscle Relaxants
6. Anticonvulsants/Antiepileptics
7. Antiparkinsonian Agents
8. CNS Stimulants
Cholinergic Agents
Mechanism of action – stimulates
cholinergic receptors by mimicking
acetylcholine or inhibition of enzyme
cholinesterase
Indications – glaucoma, urine retention,
Myasthenia Gravis, antidote to
neuromuscular blocking agents : tricyclic
antidepressants and atropine
Cholinergic Agents
Prototype – synthetic acetylcholine,
pilocarpine, carbachol, bethanecol
(Urocholine), edrophonium (Tensilon),
neostigmine (Prostigmine),
pyridostigmine (Mestinon)
Adverse effects – blurring of vision,
miosis, increase in salivation, intestinal
cramps, bronchoconstriction, wheezing,
DOB, hypotension and bradycardia
Cholinergic Agents
Nursing considerations :
1. Warn & monitor clients of the side
effects.
2. Have atropine available for use as
antidote.
Anticholinergic Agents
Mechanism of action – block the binding
of acetylcholine in the receptors of
parasympathetic nerves
Indications – use preoperatively to dry up
secretions; treat spasticity of GI or urinary
tract, use for treatment of bradycardia,
asthma, parkinsonism; use for antidote in
organophosphate poisoning.
Anticholinergic Agents
Prototype – atropine, scopalamine
(Triptone), dicyclomine (Bentyl),
propantheline (Pro-Banthine)
Adverse effects - dry mouth , dilatation of
pupils, tachycardia, urinary retention,
ileus, heat stroke
Anticholinergic Agents
Nursing considerations :
1. Keep client in cool environment.
2. Watch out for signs of heatstroke and
dehydration.
3. Encourage clients to increase fluid
intake and use of sugarless gum/candy
for dry mouth.
4. For GI spasticity, administer 30 minutes
before meals and at bed time.
Adrenergic Agents
Mechanism of action – stimulate alpha
and beta adrenergic receptor directly or
trigger the release of catecholamines
indirectly causing sympathetic effects
Indications – cardiopulmonary arrest,
hypotension, COPD and asthma, nasal
congestions, allergic reaction,
anaphylactic shock
Adrenergic Agents
Prototype - epinephrine, norepinephrine,
ephedrine, dopamine, dobutamine,
phenylephrine, terbutaline, albuterol,
isoproterenol
Adverse Effects – restlessness, insomnia,
tremors, nausea, palpitations, angina,
tachycardia, HPN
Adrenergic Agents
Nursing considerations :
1. Contraindicated in clients w/
hyperthyroidism, pheochromocytoma &
cardiovascular disease.
2. Monitor vital signs and advice
precautions.
3. Should be taken with food.
Adrenergic Blocking Agents
2 Types:
Alpha blockers – phentolamine (Regintine),
phenoxybenzamine, prazosin (Minipress),
reserpine (Serpasil), terazosin (Hytrin),
clonidine (Catapress), methyldopa (Aldomet)
Beta blockers – atenolol (Tenormin),
esmolol (Brevibloc), metoprolol (Lopressor),
nadolol (Corgard), propanolol (Inderal),
timolol ( Blocadren)
Adrenergic Blocking Agents
Mechanism of actions:
Alpha blockers – inhibits action of a-
receptors in vascular smooth muscle to
cause vasodilatation
Beta blockers – compete with epinephrine
in b-receptors in heart, pulmonary
airways, peripheral circulation and CNS
Adrenergic Blocking Agents
Indications - Raynaud’s disease,
hypertension, pheochromocytoma, angina,
arrhythmias, mitral valve prolapse,
glaucoma
Adverse effects - orthostatic hypotension,
bradycardia, CHF, depression, insomnia
and vertigo, bronchospasm and dyspnea,
nasal stuffiness, cold extremities
Adrenergic Blocking Agents
Nursing considerations :
1. Administer oral alpha-blockers with milk to
minimize GI side effects.
2. Administer oral beta-blockers before meals and at
a.m. if insomnia occurs.
3. Check client’s apical pulse rate before drug
administration, refer if below 60 bpm.
4. Hypotensive precautions.
5. Warn clients not to drive or operate dangerous
machinery until he/she has adjusted to medications.
Skeletal Muscle Relaxants
Mechanism of action – depress CNS,
inhibit calcium ion release in the muscle,
enhance the inhibitory action of GABA
(gamma-amino butyric acid)
Indications – for acute musculoskeletal
pain, for muscle spasticity associated with
multiple sclerosis, cerebral palsy, CVA,
and spinal cord injury.
Skeletal Muscle Relaxants
Prototype – methacarbamol (Robaxin),
baclofen (Lioresal), dantrolene
(Dantrium), metaxalone (Skelaxin),
orphanedrine (Norgesic), chlorzoxazone
Adverse effects – hypotonia, ataxia,
hypotension, drowsiness, blurred vision,
bradycardia, depression, urine retention
Skeletal Muscle Relaxants
Nursing considerations :
1. Caution clients that mental alertness may be
impaired.
2. Monitor neuromuscular status, bowel and
bladder functions.
3. Inform clients that maximum benefit of
baclofen is attained for 1-2 months.
4. Reduce baclofen dosage gradually because of
associated withdrawal symptoms : Confusion,
hallucinations, paranoia & rebound spasticity.
Anticonvulsants
3 Types:
Hydantoins – phenytoin (Dilantin)
Barbiturates – phenobarbital (Luminal)
Miscellaneous – carbamazepine
(Tegretol), diazepam, clorazepate
(Tranxene), valproic acid (Dapakene),
ethosuximide (Zarontin)
Anticonvulsants
Mechanism of action – treat seizures by
depressing abnormal neuronal activity in
motor cortex
Adverse effects – sedation & drowsiness,
gingival hyperplasia, diplopia, nystagmus,
vertigo, dizziness, thrombocytopenia,
aplastic anemia
Anticonvulsants
Nursing considerations :
1. Advise female clients to use contraceptives.
2. Inform clients taking phenytoin that harmless urine
discoloration is common.
3. Warn clients with diabetes that hydantoins may increase blood
sugar level and that valproic acid may produce a false positive
result in urine ketone test.
4. Teach clients receiving carbamazepine to identify symptoms of
bone marrow depressions.
5. Reassure that barbiturates are not addictive at a low dosage.
6. Avoid taking alcohol with barbiturates.
7. Administer IV phenytoin slowly to avoid cardiotoxicity.
8. Avoid mixing other drugs in same syringe with phenytoin.
Antiparkinsonian Agents
2 Types:
Anticholinergic agents – trihexyphenidyl
(Artane), benztropine (Congentin)
Dopaminergic agents – Levodopa,
carbidopa-levodopa (Sinemet),
amantidine (Symmetrel), pergolide
(Permax), selegiline (Eldepryl),
bromocriptine
Antiparkinsonian Agents
Mechanism of actions:
Anticholinergic agents – inhibit cerebral
motor centers
Dopaminergic agents – increasing
dopamine concentrations or enhancing
neurotransmitter functioning
Antiparkinsonian Agents
Adverse effects of dopaminergic agents:
levodopa – nausea, vomiting, anorexia,
orthostatic hypotension, dark-colored
urine and sweat
amantidine – ankle edema, constipation
bromocriptine – palpitations, tachycardia
Antiparkinsonian Agents
Nursing considerations :
1. Give dopaminergic agents after meals to
reduce GI symptoms.
2. Reassure client that levodopa may cause
harmless darkening of urine and sweat.
3. Avoid taking Vit B6 (pyridoxine) with
levodopa because it speed up metabolism.
4. Educate clients to minimize orthostatic
hypotension.
5. Elevate leg to reduce ankle edema.
CNS Stimulants
Mechanism of action – increase
excitatory CNS neurotransmitter activity
and blocks inhibitory impulses
Indications – for obesity (amphetamines),
attention deficit hyperactivity disorders,
narcolepsy, drug-induced respiratory
depressions
CNS Stimulants
Prototype – amphetamines,
methylphenidate (Ritalin)
Adverse effects - nervousness, insomnia,
restlessness, hypertension, tachycardia,
headache, anorexia, dry mouth
CNS Stimulants
Nursing considerations :
1. Should be given at morning.
2. Don’t stop amphetamine abruptly to
avoid withdrawal symptoms.
3. Monitor blood pressure and pulse.
4. Ice chips or sugarless gum for dry mouth.
5. Watch out for growth retardation in
children taking methylphenidate.
Psychiatric
Sedatives, hypnotics, &
anxiolytics
Antidepressants & mood
stabilizers
Antipsychotics/neurolepti
cs
Anxiolytics
3 Types:
Benzodiazepines – diazepam (Valium),
lorazipam (Ativan), alprazolam (Xanax),
flurazepam (Dalmane)
Barbiturates – amobarbital, phenobarbital,
secobarbital
Miscellaneous – chloral hydrate (Noctec),
buspirone (Buspar), paraldehyde
Anxiolytics
Mechanism of actions:
Benzodiazepines – increase the effect of
inhibitory neuro transmitter GABA
(gamma-amino butyric acid)
Barbiturates and Miscellaneous agents –
depress CNS
Anxiolytics
Indications - induce sleep, sedate and
calm clients
Adverse effects - hangover-effect,
dizziness, CNS depression, respiratory
depression, drug-dependence
Anxiolytics
Nursing considerations :
1. Warn clients of injuries and falls.
2. Brief period of confusion and excitement upon
waking up is common with benzodiazepines.
3. Warn clients not to discontinue medications
abruptly without consulting a physician.
4. Avoid alcohol while taking these drugs.
5. Rotate and don’t shake the ampules of barbiturates.
Don’t mix with other drugs.
6. Warn female clients that diazepam is associated
with cleft lip.
Antidepressants
4 Types:
Tricyclic antidepressants – amitriptyline
(Elavil), protriptyline (Vivactil), imipramine
(Tofranil), desipramine
MAO (monoamine oxidase inhibitors) –
isocarboxazid (Marplan), phenelzine (Nardil),
tranylcypromine (Parnate)
Second-generation antidepressants – fluoxetine
(Prozac), trazodone (Desyrel)
Lithium
Antidepressants
Mechanisms of actions:
Tricyclic antidepressants – increase receptor
sensitivity to serotonin and/or norepinephrine
MAO inhibitors – inhibit the enzyme MAO that
metabolize the neurotransmitters
norepinephrine and serotonin
Second – generation antidepressants – inhibits
the reuptake of serotonin
Lithium – increase serotonin & norepinephrine
uptake
Antidepressants
Adverse effects - dry mouth, blurred
vision, urine retention, constipation
(anticholinergic effects), orthostatic
hypotension, insomnia, hypertensive crisis
(MAO), dehydration (Lithium)
Antidepressants
Nursing considerations :
1. Caution client to rise slowly to reduce the effects of orthostatic
hypotension.
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.
5. Client taking MAO inhibitors should avoid tyramine-rich foods to avoid
hypertensive crisis such as aged cheese, sour cream, yogurt, beer, wine,
chocolate, soy sauce and yeast. Pentholamine (Regintine) is the drug of
choice for hypertensive crisis.
6. Inform physician and withhold fluoxetine if client develop rashes.
7. Take lithium with food to reduce GI effects – > 1.5 mEq/L blood level
may cause toxicity manifested by: confusion, lethargy, seizures,
hyperreflexia, maintain salt and adequate fluid intake, tremors may
occur but it is temporary, monitor white blood cell count (increase).
Antipsychotics
2 Types:
Phenothiazines – chlorpromazine
(Thorazine), trifluoperazine (Stelazine),
thioridazine (Mellaril)
Other Agents – clozapine (Clozaril),
haloperidol (Haldol)
Antipsychotics
Mechanism of action – block dopamine receptor in the
limbic system, hypothalamus, and other regions of the brain
Adverse effects

-Extra pyramidal symptoms such as dystonia,

pseudoparkinsonism, and an irreversible tardive dyskinesia
as manifested by : lip smacking, fine wormlike tongue
movement, involuntary movements of arms and leg.
-Neuroleptic malignant syndrome – fever, tachycardia,
tachypnea, diaphoresis, cardiovascular collapse, muscle
rigidity, seizures.
-Orthostatic hypotension
Antipsychotics
Nursing considerations :
1. Teach family members the signs of EPS and NMS,
and report to physician immediately.
2. Normalization of symptoms may not occur for
several weeks after beginning of therapy.
3. Avoid administering haloperidol intravenously.
4. Watch out of neutropenia with clozapine.
5. Watch out for orthostatic hypotension and
photosensitivity with phenothiazine.
6. Be sure that oral doses are swallowed, and not
hoarded.
Musculoskeletal
General Anesthetics
Local & Topical
Anesthetics
Analgesics
General Anesthetics
2 Types:
Inhalation anesthetics – enflurane
(Ethrane), halothane, isoflurane (Forane),
nitrous oxide
Injection anesthetics – fentanyl
(Sublimaze), ketamine (Ketalar),
thiopental Na (Penthotal), etomidate
(Amidate)
General Anesthetics
Mechanism of action – cause CNS
depression, by producing loss of
consciousness, unresponsiveness to pain
stimuli, and muscle relaxation
General Anesthetics
Nursing considerations :
1. Instruct client NPO for 8 hours before administration.
2. Monitor cardio pulmonary depression and hypotension.
3. Monitor urinary retention.
4. Monitor body temperature – malignant hyperthermic
crisis : dantrolene (antidote)
5. Avoid alcohol or CNS depressants for 24 hours after
anesthesia.
6. In patient who received halothane, monitor signs of
hepatic fatal side effects : - rash, fever, nausea,
vomiting, jaundice and altered liver function.
Local & Topical Anesthetics
2 Types:
Local : bupivacaine, lidocaine, tetracaine,
procaine, mepivacaine, prilocaine
Topical : benzocaine, butacaine,
dibucaine,lignocaine

Mechanism of action – block transmission

of impulses across nerve cell membrane
Local & Topical Anesthetics
Adverse effects – cardiac dysrhythmias
Nursing considerations :

1. Lignocaine + prilocaine (EMLA cream)

should be applied topically 60 minutes
before procedure.
2. Administer cautiously to the areas of
large broken skin.
3. Observe for fetal bradycardia in
pregnant clients.
Analgesics
2 Types:
Narcotic analgesics – codeine, meperidine
(Demerol) morphine, butorphanol
(Stadol), nalbuphine (Nubain)
Non – narcotic analgesic – NSAIDs –
aspirin (aminosalicylic acid), mefenamic
acid (Ponstan), ibuprofen (Motrin),
naproxen, ketoprofen (Orudis), ketorolac
paracetamol and acetaminophen (Tylenol)
Analgesics
Mechanisms of action:
Narcotic analgesics – alter pain
perception by binding to opiod receptors
in CNS.
Non-narcotic analgesic – relieves pain
and fever by inhibiting the prostaglandin
pathway.
Analgesics
Nursing considerations :
1. Monitor respiratory depression & hypotension in clients taking
narcotic analgesic.
2. Injury and accident precautions in clients taking narcotic analgesic.
3. Warn clients about possibility of dependency,and do not discontinue
narcotics abruptly in the narcotic-dependent clients.
4. Naloxone is antidote for narcotic overdose.
5. Advice clients to take NSAIDs with food and monitor bleeding
complications.
6. Aspirin is contraindicated in clients below 18 years old with flu-like
symptoms.
7. Monitor hearing loss in clients taking aspirin.
8. Monitor liver function in clients taking acetaminophen.
9. N-acetylcysteine is antidote for paracetamol overdose.
Infectious
Antibacterials
Antivirals
Antifungals
Antiparasitics
Antihelminthics
Antibacterials
4 Major Types:
1. Cell Wall Inhibitors
a. Penicillins – pen G, amoxicillin
b. Cephalosporins – cephalexin, cefuroxime
c. Glycopeptides – vancomycin
2. Protein Synthesis Inhibitors
a. Aminoglycosides – gentamycin, amikacin
b. Macrolides – erythromycin
c. Lincosamides – clindamycin
d. Chloramphenicols, tetracyclines
3. Antimetabolites
a. Sulfonamides – cotrimoxazole
4. DNA Synthesis Inhibitors
a. Quinolones – ciprofloxacin
b. Metronidazole
Antibacterials
Adverse effects :
1. Aminoglycoside - nephrotoxicity & ototoxicity
2. Sulfonamides - Steven-Johnson’s syndrome,
photosynsetivity
3. Quinolones – insomnia
4. Tetracyclines - bone problems
5. Chloramphenicol - Gray syndrome, bone
marrow depression
6. Erythromycin - hepatitis
Antibacterials
Nursing considerations :
1. Collect appropriate specimen for C & S before
starting antibiotics.
2. Check client’s history of allergies.
3. Avoid administering erythromycin and
quinolones with food.
4. Pregnant precautions.
5. Report for diarrhea - pseudomembranous
colitis (clindamycin)
6. Monitor adverse effects.
Antivirals
Mechanism of action - inhibits virus
specific enzymes involve in DNA
synthesis. They only control the growth of
virus but it does not cure
Prototype - acyclovir (Zovirax),
ganciclovir (Cytovene), vidarabine (Vira-
A), amantidine (Symmetrel), ribavirin
(Virazole), zidovidine (Retrovir)
Antivirals
Adverse Effects - granulocytopenia,
thrombocytopenia, nausea, nervousness, headache,
nephrotoxicity
Nursing consideration :
1. Pregnant and breastfeeding precautions.
2. Administer IV antivirals to avoid crystallization in
renal tubules.
3. Give ribavirin only with aerosol generator.
4. Monitor CBC and creatinine level.
5. Refer for signs of bleeding.
6. Take amantidine after meals.
Antifungals
Mechanism of action - inhibit the
synthesis of fungal sterol
Prototype - amphotericin B
(Fungisone), nystatin, fluconazole
(Diflucan), ketoconazole (Nizoral)
Adverse effects - nephrotoxicity
and neurotoxicity, bone marrow
depression, chills, fever, joint
pains, abdominal pain and
headache
Antifungals
Nursing considerations :
1. Dilute amphotericin B with sterile water
solution not with electrolyte solution.
2. Tell clients that fever, chills, GI upset, joint and
muscle pain will subside as amphotericin B
continues.
3. With oral candidiasis, let nystatin tablet dissolve
in mouth rather than swallowing it.
4. Refrain ketoconazole with antacids.
5. Report for signs of bleeding, infection & fatigue
Antiparasitics
2 Types:
Antimalarial – chlroquine, mefloquine,
primaquine, quinine, pyrimethamine
 Antiamebiasis – metronidazole (Flagyl),
iodoquinol, furozolidone (Furoxone)
Antiparasitics
Mechanisms of action:
Antimalarial – alters protozoal DNA,
depleting folates, & reducing nucleic acid
production
Antiamoeba – block protein synthesis
Antiparasitics
Nursing considerations :
1. Administer anti-malarial drugs with food.
2. Take seizure precautions while
administering antimalarial drugs.
3. Refer cinchonism during quinine
treatment: - tinnitus, headache, vertigo,
fever, and visual changes.
4. Inform clients that iodoquinol falsify
thyroid function test for up to 6 months.
Antihelminthics
Prototype – mebendazole (Vermox),
thiabendazole, niclosamide (Niclocide),
piperazine (Antepar), praziquantel
(Biltricide)
Mechanism of action – paralyze larva and
adult helmints by acting on parasite
microtubules
Antihelminthics
Adverse effects - GI upset, urinary odor
(thiabendazole), headache, dizziness, fatigue
Nursing considerations :
1. Treat all the family members for nematodes
infection to prevent recurrence.
2. Praziquantel must swallowed rapidly because
of its bitter taste to avoid gagging.
3. Other antihelmintics should be chewed.
Oncologic
Alkylating Agents
Antitumor Antibiotic Agents
Antimetabolites
Mitotic
Inhibitors
Hormonal Medications
Alkylating Agents
inhibits cell production by causing cross
linking of DNA
Busulfan – hyperuricemia
Chlorambucil – gonadal suppression
Cisplatin – ototoxicity and nephrotoxicity
Cyclophosphamide – hemorrhagic cystitis.
Antitumor Antibiotic Agents
interferein DNA and RNA synthesis
Plicamycin – affects bleeding time
Doxurubicin – cardiotoxicity
Bleomycin – pulmonary toxicity
Antimetabolites
replace normal proteins required for DNA
synthesis by inhibiting the S phase
Cytarabine – hepatotoxicity
5-flourouracil – phototoxicity reaction and
cerebellar dysfunctions
6-marcaptopurine – hyperuricemia
Methotrexate – photosensitivity, given with
leucoverin to lessen its toxicity
Mitotic Inhibitors
prevent mitosis acting on the M phase
causing cell death
Vincristine sulfate – neurotoxicity,
numbness
Hormonal Medications
block the normal hormones in hormone
sensitive tumors
Tamoxifen citrate – visual problems, elevate
cholesterol & triglycerides level
Diethylstilbestrol – impotence and
gynecomastia in men
Side Effects
stomatitis  - notify physician if WBC is <2000/mm3
 - bland diet, avoid strong mouthwash  - monitor for signs of infection
 - soft tooth brush, ice chips  - reverse isolation
diarrhea, nausea and vomiting  - low bacteria diet
 - anti-emetic, replace fluids and anemia
electrolytes  - iron, B-12, folic acid rich food
 - alopecia  - provide rest periods
 - reassure that it is temporary bleeding
 - encourage o wear wigs, hats and head  - avoid NSAIDs
scarf
 - minimize invasive procedures
skin pigmentation
 - use soft toothbrush and electric razor
 - inform that it is only temporary
menstrual changes
tumor lysis syndrome
 - reassure that menstruation will resume
 - hyperuricemia & hyperkalemia
 - force fluids

infection
Cardiovascular
Anticoagulants
Thrombolytics
Hemostatic Agents
Antiplatelets
Cardiac Glycosides
Nitrates
Anti-arrhythmics
Antilipemics
ACE Inhibitors
Calcium-Channel Blockers
Diuretics
Vasodilating Agents
Anticoagulants
2 Types:
1. Heparin – SQ & IV
2. Warfarin – Oral
Mechanism of actions :
Heparin – prevents thrombin from
converting fibrinogen to fibrin.
Warfarin – suppress coagulation by acting
as an antagonist of vitamin K after 4-5
days
Anticoagulants
Indications– thrombosis, pulmonary
embolism, myocardial infarction
Adverse effect – bleeding
Nursing Considerations
1. HEPARIN sodium
if given SQ don’t aspirate or rub the
injection site (above the scapula - best
site).
therapeutic level 1.5-2.5 times normal
PTT;
normal PTT is 20-35 sec. = 50-85 sec.
antidote : (protamine sulfate)
Nursing Considerations
2. WARFARIN sodium (coumadin)
warfarin is used for long-term.
onset of action is 4-5 days.
therapeutic level is 1.5-2.5 times normal PT;
normal PT = 9.6 -11.8 sec. = 25 - 30 sec.
should be taken at the same time of the day
to maintain at therapeutic level.
reduce intake of green leafy vegetables.
antidote : Vitamin K ( Aquamephyton)
Thrombolytics
Mechanism of action – activates
plasminogen to generates plasmin
(enzyme that dissolve clots)
Indication - use early in the course of MI
(within 4-6 hours of the onset)
Prototype – Streptokinase, Urokinase
Nursing considerations - monitor
bleeding, antidote : Aminocaproic acid
Hemostatic Agents
Mechanism of action – terminates/stops
bleeding
Indications – treatment of bleeding as a
side effect for anticoagulant/thrombolytic
therapy
Prototype – Aminocaproic acid (Amicar),
Tranexamic acid (Hemostan), Protamine
sulfate, Vitamin K (aquaMEPHYTON,
Konakion)
Antiplatelets
Mechanism of action – inhibit the
aggregation of platelet thereby prolonging
bleeding time
Indication - used in the prophylaxis of
long-term complication following M.I,
coronary revascularization, and
thrombotic CVA
Antiplatelets
Prototypes - aspirin, Dipyridamole
(Persantin), Clopidoigrel (Plavix),
Ticlopidine
Nursing Considerations - Monitor
bleeding time ( NV = 1-9 mins), take the
medication with food
Cardiac Glycosides
increase intracellular calcium, which
causes the heart muscle fibers to contract
more efficiently, producing positive
inotropic & negative chronotropic action
Indications – use for CHF, atrial
tachycardia and fibrillation
Cardiac Glycosides
Prototype – digoxin (Lanoxin) and digitoxin (Crystodigin)
Nursing considerations :
1. Monitor for toxicity as evidence by : nausea, vomiting,
anorexia, halo vision, confusion, bradycardia and heart
blocks.
2. Do not administer if pulse is less than 60 bpm.
3. Should be caution in patient with hypothyroidism and
hypokalemia.
4. Antidote : Digi-bind
5. Phenytoin is the drug of choice to manage digitalis-
induced arrhythmia
Nitrates
Mechanism of action – produce
vasodilatation including coronary artery
Indication – angina pectoris, MI,
peripheral arterial occlusive disease
Prototype – isosorbide dinitrate (Isordil),
nitroglycerine (Deponit, Nitrostat)
Adverse effects – headache orthostatic
hypotension
Nitrates
Nursing Considerations :
1. Transdermal patch
- apply the patch to a hairless area using a new patch and different site each
day.
- remove the patch after 12-24 hours, allowing 10-12 hours “patch free”
each day to prevent tolerance.
2. Sublingual medications
- note the BP before giving the medication.
- offer sips of water before giving because dryness may inhibit absorption.
- one tablet for pain and repeat every 5 mins. for a total of three doses; if not
relieved after 15 mins., seek medical help.
- stinging or burning sensation indicates that the tablet is fresh.
- instruct patient not to swallow the pill
- sustained release medications should be swallowed and not to be crush.
- protect the pills from light.
Anti-arrhythmics
Class I (block Na channels)
IA - quinidine, procainamide
IB - lidocaine
IC - flecainamide
Class II (Beta-blockers)

propanolol, esmolol
Class III (block K channels)

amiodarone, bretylium
Class IV (block Ca channels)

verapramil, diltiazem
Anti-arrhythmics
Nursing considerations :
1. Watch out for signs of CHF.
2. Have client weigh themselves and report
weight gain.
3. Watch out for signs of lidocaine
toxicity : - confusion and restlessness
Antilipemics
Mechanism of action – interfere with
cholesterol synthesis as well as decreasing
lipoprotein & triglyceride synthesis
Prototype :
cholesterol-lowering agents –
cholestyramine, colestipol, lovastatin,
atorvastatin (Lipitor)
triglyceride-lowering agents –
gemfibrozil, clofibrate
Antilipemics
Nursing considerations :
- monitor liver functions while using
statins.
- prevent constipation, flatulence,
cholelithiasis
- encourage increase fluid and fiber
intake.
ACE Inhibitors
Mechanism of action – prevent peripheral
vasoconstriction by blocking conversion
of angiotensin I to angiotensin II
decreasing peripheral resistance
Prototype – captopril (Capoten), enalapril
(Vasotec), quinapril, lisinopril
Adverse effects – it cause hyperkalemia,
induce chronic cough
ACE Inhibitors
Nursing considerations :
- not to discontinue medications because
it can cause rebound hypertension.
- avoid using K+ sparing diuretics.
Calcium-Channel Blockers
Mechanism of action – decrease cardiac
contractility and the workload of the
heart, thus decreasing the need for O2, it
also promotes vasodilatation of the
coronary and peripheral vessels
Indications – hypertension, angina,
arrhythmia
Calcium-Channel Blockers
Prototype – Nifedipine (calcibloc, adalat),
Amlodipine (norvasc), Felodipine
(Plendil), Verapramil (Isoptin)
Adverse Effects – bradycardia,
hypotension, headache, reflex
tachycardia, constipation
Calcium-Channel Blockers
Nursing considerations :
- Administer between meals to enhance
absorption.
- Take client’s pulse rate before each
dose, withhold if pulse is below 60 bpm.
- Refer for signs of congestive heart
failure.
Diuretics
CARBONIC ANHYDRASE - blocks Na and K
INHIBITORS reabsorption; reabsorb Ca
 - Acetazolimide (Diamox)  - hypercalcemia
 - increase Na+, K+, & LOOP DIURETICS
HCO3 secretion, along  - Furosemide (Lasix)
with it is H2O  - blocks Na, K, and Ca
 - metabolic acidosis
reabsorption
OSMOTIC DIURETIC  - hypocalcemia
 - Mannitol
POTASSIUM SPARING
 - Increase osmotic pressure DIURETICS
of the glomerular filtrate.  - Spironolactone
 - hypotension (Aldactone)
THIAZIDE DIURETICS  - excrete Na and water but
 - hydrochlorothiazide it reabsorb K
 - hyperkalemia
Respiratory
Bronchodilators
Glucocorticoids
Mast Cell Stabilizers
Antihistamines (H1)
Anti-TB
Decongestants, Antitussives,
& Expectorants
Bronchodilators
2 Types:
1. Symphatomimetic – albuterol,
salbutamol, isoproterenol, salmeterol,
terbutaline
2. Xanthines – aminophylline, theophylline
Bronchodilators
Mechanism of actions:
- sympathomimetic (b-receptor agonist)
bronchodilators – dilate airways
- xanthine bronchodilators – stimulate
CNS for respiration
Indications – bronchospasm, asthma,
bronchitis, COPD
Bronchodilators
Adverse effects – palpitations and
tachycardia, restlessness, nervousness,
tremors, anorexia, nausea and vomiting,
headache, dizziness
Nursing considerations :
- Contraindicated hyperthyroidism, cardiac
dysrhythmia, or uncontrolled seizure disorder
- Should be used with caution in patient with
HPN and narrow-angle glaucoma
Glucocorticoids
Mechanism of action – act as anti-
inflammatory agents and reduce edema of
the airways, as well as pulmonary edema
Prototype – dexamethasone, budesonide,
fluticasone, prednisone, beclomethasone
Adverse effects – Cushing’s syndrome,
neutropenia, osteoporosis
Glucocorticoids
Nursing considerations :
- Take drugs at meal time or with food.
- Eat foods high in potassium, low in sodium.
- Instruct client to avoid individuals with RTI.
- Instruct client not to stop medication abruptly, it
should be tapered to prevent adrenal insufficiency
- Avoid taking NSAID while taking steroids.
- Take inhaled bronchodilators first before taking
inhaled steroids, and rinse mouth after using.
Mast Cell Stabilizers
Mechanism of action – stabilize mast cells that
release histamine triggering asthmatic attacks
Prototype – cromolyn sodium (Intal)

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 taste
- Assess for lactose-intolerance
H1 Blockers
Mechanism of action – decrease
nasopharyngeal secretions and decrease
nasal itching by blocking histamine in
H1-receptor
Indications – common colds, rhinitis,
nausea and vomiting, urticaria, allergies
and as sleep aid
H1 Blockers
Prototype - Astemizole (Hismanal), Loratidine
(Claritin), Brompheniramine (Dimetapp),
Diphenhydramine (Benadryl), Cetirizine
(Iterax), Celestamine (Tavist)
Nursing Considerations :
- Administer with food and drink.
- Given IM via Z-track method or orally.
- Precautions in handling machine and driving
while taking these drugs.
- Ice chips or candy for dry mouth
Anti-TB
FirstLine:
Rifampicin Second Line:
Isoniazid Cycloserine
Pyrazinamide Kanamycin
Ethambutol Ethonamide
Streptomycin Para-
aminosalicylic
Acid
Anti-TB
- active tuberculosis are treated with drug
combination for 6-9 mos.
- multidrug-resistant strain (MDR-TB) are
medicated for 1 year up to 2 years
- given before meals
Rifampicin
- given on an empty stomach with 8 0z. of
water, 1 hour before or 2 hours after meals
and avoid taking antacids with
medications.
- hepatotoxic thus avoid alcohol.
- instruct the client that urine, feces,
sweat, and tears will be redorange in
color.
Isoniazid
- 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.
- instruct to notify physician for signs of
hepatoxicity (jaundice), and neurotoxicity,
numbness of extremities.
- administer with Vitamin B6 to counteract
the neurotoxic side effects.
- avoid alcohol.
Pyrazinamide
- given for 2 months.
- increase serum uric acid and cause
photosensitivity.
Ethambutol
- contraindicated in children under 13
years old.
- obtain a baseline visual acuity because it
can cause optic neuritis.
- Instruct the client to notify the physician
immediately if any visual problems
occurs.
Streptomycin
- aminoglycoside antibiotic given IM.
- nephrotoxic and ototoxic.
- obtain baseline audiometric test and
repeat every 1-2 months because the
medications impairs the CN VIII.
Cough & Cold Remedies
3 Types:
1. Decongestants
2. Antitussives
3. Expectorants
Decongestants
Mechanism of action – acts through
sympathomimetic action, usually by
constricting arterioles & reducing blood
flow to the area
Prototype – phenylephrine
Antitussives
Mechanism of action – suppresses the
cough center in the medulla
Prototype – dextromethorpan
Expectorant
Mechanism of action – facilitate the
secretion of fluid in the respiratory tract,
thus liquefying secretions and allowing
for easier expectoration during a cough
Prototype – guaifenesin (Robitussin)
Gastrointestinal
Antacids
H2 Blockers
Proton-Pump Inhibitors
Mucosal Barriers
Anti-diarrheals
Laxatives
Emetics
Antiemetics
Antacids
Mechanism of action – neutralize the
stomach acidity
Prototype – aluminum/magnesium
compounds (Maalox), sodium bicarbonate
(Alka-Seltzer), calcium carbonate (Tums),
magnesium hydroxide (Milk of Magnesia)
Antacids
Adverse effects - metabolic alkalosis,
stone formation, electrolyte imbalance,
diarrhea (magnesium), constipation
(aluminum)
Antacids
Nursing considerations :
- Give 1 hr after meals.
- Avoid giving medications within 1-2 hrs
of antacid administration (decreases
absorption).
- Take fluids to flush after intake of
antacid suspensions.
- Monitor for changes of bowel patterns.
H2 Blockers
Mechanism of action - blocks H2
receptors in the stomach, reducing acid
secretions
Prototype – cimetidine (Tagamet),
ranitidine (Zantac), famotidine (Pepcid),
nizatidine (Axid)
H2 Blockers
Nursing considerations :
- Given before or with meals
- Avoid giving other drugs with
cimetidine
- Gynecomastia may developed with
chronic use of cimetidine
Proton-Pump Inhibitors
Mechanism of action – inhibit the proton
H+ to combine with Cl- to form
hydrochloric acid
Prototype – omeprazole (Losec),
Lansoprazole (Lanz), pantoprazole
(Pantoloc)
Nursing considerations :
- Given before meals preferably at
morning.
Mucosal Barriers
Mechanism of action - coats the mucosa to
prevent ulcerations
Prototype - sucralfate (Carafate),
misoprostol (Cytotec)
Nursing consideration :
- Given before meals.
- Misoprostol is contraindicated for
pregnants.
- Sucralfate cause constipation.
Anti-diarrheals
Mechanism of action – decreases stomach
motility and peristalsis
Prototype – diphenoxylate (Lomotil),
loperamide (Imodium), kaolin/pectin
mixture (Kaopectate)
Anti-diarrheals
Nursing considerations :
- Monitor for rebound constipation.
- Be cautious taking if with infectious
diarrhea.
- Monitor atropine toxicity with
diphenoxylate.
- Clay, white or pale stool is common
with kaopectate.
Laxatives
a. lactulose (Cephulac), Na biphosphate (Fleet
enema) & magnesium salt (Milk of Magnesia)
 - retain fluid and distend intestine
b. ducosate (Dialose)
 - emulsify fecal fat and water
c. bisacodyl (Dulcolax) & senna (X-prep)
 - irritates intestinal mucosa and stimulate intestinal smooth
muscles
d. bulk-forming laxative (Metamucil)
 - increase fecal bulk and water content
e. mineral oil
 - lubricates & prevent colon absorption
Emetics
Mechanism of action – induce vomiting
through stimulation of vomiting center of
medulla
Indications – ingestion of poisonous or
toxic substances
Prototype - ipecac syrup, apomorphine
Emetics
Nursing considerations :
- Consult poison control center before
induction of vomiting.
- Administer ipecac syrup with large
amount of fluid.
Antiemetics
Mechanism of action – inhibit the
vomiting reflex
Prototype – metoclopramide (Plasil)
Endocrine
Thyroid Agents
Parathyroid Agents
Oral Hypoglycemic
Agents
Insulin
Estrogen/Progesterone
Thyroid Agents
Mechanism of action – function as natural
or synthetic hormones
Prototype – Proloid (thryroglobulin ),
Synthroid (levothyroxine), Cytomel
( liothyronine)
Thyroid Agents
Nursing considerations :
- Taken in the morning.
- Caution with coronary artery disease.
- Monitor for signs of hyperthyroidism
and refer for decreasing the dose.
Parathyroid Agents
Mechanism of action – reduce bone
resorption, promotes calcium absorption
Prototype – calcitonin (Calcimar), etidronate
(Didronel), calcitrol (Rocaltrol), calcifediol
(Calcedrol)
Nursing considerations :
- Monitor signs of calcium imbalance
- Report for bone pains.
- Remain sitting upright after taking etidronate
Oral Hypoglycemics
Sulfonylureas
Biguanides
Alpha-glucosidase Inhibitors
Thiazolinidine
Meglitinidines
Sulfonylureas
- stimulate insulin secretions and increase
tissue sensitivity to insulin.
First Generation :
Chlorpropamide (Diabenese) – disulfiram
precautions
Tolbutamide (Orinase) – congenital defect
Second Generation :
Glypizide, Glymepiride
Biguanides
- facilitates insulin action on the
peripheral receptor site.
Metformin and Glucophage (Glucovance) –
side effect is lactic acidosis
Alpha-glucosidase Inhibitors
- delay carbohydrate absorption in the
intestinal system.
Acarbose (Precose) – side effect is diarrhea
Thiazolinidine
- increase tissue sensitivity of insulin.
Rosiglitazone (Avandia)
Meglitinidines
- stimulate insulin release in pancreatic B-
cells.
Repaglinide (Prandin)
Insulin
Insulin Onset Peak Duration
Immediate-acting ¼-½ ½-1 3
(lispro)
Short-acting ½-1 2–4 6–8
(regular,
semilente)
Intermediate- 1–2 6 – 12 18 – 24
acting (NPH,
Lente)
Long-acting 2–4 10 – 30 24 – 36
(ultralente)
Mixed (reg. 30%, ½ 4–8 25
NPH 70%)
Insulin
Nursing considerations :
- Usually given before meals.
- Roll the bottle in palm of hands, don’t shake.
- Inject amount of air that is equal to each dose into the bottle – short acting last (clear).
- 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.
- Prefilled syringes are stored vertically, needle-up.
- May increase dose during illnesses.
- Used bottles stored in room temperature, unused bottle stored in refrigerator.
- Monitor for acute hypoglycemia :

a. 3-4 commercially prepared glucose tablet

b. 4-6 ounce of fruit juice or regular soda
c. 2-3 teaspoon or honey
d. Glucagon 1 gm SQ or IM
e. D50-50 IV.
Estrogens & Progesterones
Prototype – conjugated estrogen (Premarin),
estrone (Bestrone), estradiol (Estrace),
diethylstilbestrol (DES)
Indications – prostate cancer, contraceptions,
estrogen replacement
Adverse effects :
estrogen - endometrial CA, gallbladder disease,
HPN, migraine, breast tenderness
progesterone - altered menstrual flow, risk of
thrombo embolism
Estrogens & Progesterones
Nursing considerations :
1. Mix estrogen or progestins prior to IM
administration by rolling vials between
palms.
2. Monitor blood pressure.
3. Teach patient how to perform BSE.
4. Regular follow-up examination is
required to detect associated risk of
acquiring CA.
Gynecologic
Uterine Stimulating Agents
Uterine Inhibiting Agents
Lactation Suppressants
Uterine Stimulating Agents
Mechanism of action – stimulates uterine
smooth muscles, ripening of cervix
Prototype – Oxytocin (Pitocin), ergonovine
(Ergotrate), methylergonovine (methergine),
carbopost (Prostin), dinoprostone (Prostin E2)
Adverse reactions :
- fetal bradycardia (oxytocin),
- hypertension (ergonovine), palpitations
- allergic reactions (Prostaglandins)
Uterine Inhibiting Agents (Tocolytics)
Mechanism of action – relaxes the uterus
by stimulating the B2- adrenergic
receptors
Prototype – ritodrine (Yutopar),
terbutaline (Brethine)
Adverse effects – tremors, nausea,
vomiting and tachycardia
Lactation Suppressants
Mechanism of action – decrease serum
prolactin levels
Prototype – bromocriptine (Parlodel)
Adverse effects – drowsiness, headache,
nausea, palpitations