PHARMACOLOGY II
BY ANGIE LAWSON RN, BSN
SULFONAMIDES
Bacteriostatic - antagonism to PABA, which some bacteria need to multiply
Uses: UTI and 2nd and 3rd degree burns
Adverse Reactions– Agranulocytosis– Thrombocytopenia– Aplastic anemia– Leukopenia
Take with a full glass of water & not with meals
PENICILLINS
Bactericidal or bacteriostatic – prevents bacteria from using a substance necessary for maintaining their cell wall
Uses: UTI’s, septicemia, meningitis, gonorrhea, syphilis, pneumonia and respiratory infections
Adverse reactions (increase risk if allergic to other substances): – Anaphylactic shock - severe hypotension,
respiratory distress– Superinfection – diarrhea
Take with a full glass of water & not with meals
CEPHALOSPORINS
Affect the bacterial cell wall, bactericidal Uses: pharyngitis, tonsillitis, otitis media, lower
resperatory infections, UTI’s septicemia and gonorrhea
Adverse reactions– Nausea, vomiting & diarrhea– Superinfection: sore mouth and throat– urticaria
Take with food or milk
TETRACYCLINE
Bacteriostatic – inhibits bacteria protein synthesis Uses: Rocky mountain spotted fever, intestinal
amebiasis, chlamydia & severe acne
Adverse reactions– Photosensitivity (exaggerated sunburn – avoid
exposure to sunlight or sun lamps
Do not take with milk or milk products
MACROLIDES
Bacteriostatic or bactericidal – binds to the cell membrane and causes changes in protein function
Uses: acne, skin infections & upper respiratory infections
Adverse reactions– Nausea, vomiting, diarrhea– Hypersensitivity reactions (itching, wheezing,
rashes)
Take with full glass of water & avoid alcohol
LINCOSAMIDES
Bactericidal – inhibit protein synthesis Uses: more serious infections
Adverse reactions– Abdominal pain, nausea, vomiting, diarrhea
Take with full glass of water & avoid alcohol
FLUOROQUINOLONES
Bactericidal – interferes with DNA gyrase needed by the bacteria to synthesis DNA
Uses: lower respiratory infections, UTI’s, STD’s & skin infections
Adverse reactions– Ototoxicity, nephrotoxicity, neurotoxicity
Take with full glass of water, drink 6-8 glasses of fluids daily, avoid sunlight, and NO alcohol
AMINOGLYCOSIDES
Bactericidal – blocks a step in protein synthesis preventing multiplication
Uses: preoperatively, hepatic coma Adverse reactions
– Nephrotoxicity, ototoxicity, neurotoxicity– Nausea, vomiting, anorexia, rash, urticaria
Take with full glass of water, drink 6-8 glasses of fluids daily, avoid sunlight, and NO alcohol
OTHER ANTI-INFECTIVES
CHOLORAMPHENICOL LINEZOLID MEROPENEM METRONIDAZOLE PENTAMIDINE ISETHIONATE SPECTINOMYCIN VANCOMYCIN
ANTITUBERCULAR DRUGS
Used to treat NOT cure Bacteriostatic – inhibits bacterial cell wall
synthesis
Giving three drugs for the treatment of TB helps slow the development of bacterial resistance
Must be given for 6-9 months continuously
LEPROSTATIC DRUGS
Bactericidal – exact action unknown Uses: treatment of leprosy Given orally, maybe for years Prior to initializing treatment assess affected
areas on the body.
ANTIVIRAL DRUGS
Inhibit viral DNA or RNA replication Uses: herpes simplex 1 & 2, HIV, chytomegalovirus,
infuenza A, RSV Adverse Reactions
– GI upset Antibiotic can be given at the same time to
prevent or treat secondary bacterial infections, but not to cure a virus.
The drugs will not prevent the spread of the infection to others.
ANTIFUNGAL
Thought to have an effect on the cell membrane
Uses: superficial or deep fungal infections Adverse Reactions
– Local reactions (irritation, burning, redness or stinging)
Be sure to clean area prior to applying topical tx.
Vaginal Suppositories should be given, high in the vagina and at bedtime.
ANTIHELMINTIC
Kills the parasite Uses: roundworms, pinworms, whipworms,
hookworms, and tapeworms
Adverse Reactions– Mild if they even occur
Educate patients to wash hands thoroughly after urinating or defecating
ANTIMALARIAL
Interfere with the life cycle of the plasmodium Uses: prevention and management of malaria
Adverse Reactions– Hypotension, visual disturbances, headache,
nausea– Photosensitivity, anorexia, nausea– Tinnitus, dizziness, headache, GI disturbances
When used for prevention take once weekly, on the same day each week.
SALICYLATES
All Salicylates are similar in actions, Aspirin has a greater anti-inflammatory effect
Uses: pain relief, fever, inflammation, reduce the risk of MI and stroke.
Adverse Reactions– Gastric upset, heartburn, nausea, vomiting, anorexia,
GI bleeding. Aspirin inhibits the aggregation of platelets. S&S of mild salicylism – dizziness, tinnitus,
difficulty hearing
NON SALICYLATES
Mechanism of action is unknown Uses: pain relief, fever (doesn’t have an anti-
inflammatory action.)
Adverse Reactions– Very few and usually occur with chronic use or
overdose
Take with food or full glass of water
NSAIDS
Nonsteroidal anti-inflammatory drug’s Thought to act by inhibiting prostaglandin
synthesis Uses: pain relief, primary dysmenorrhea, fever
reduction
Adverse Reactions– GI reactions, can be severe or even fatal– Age increases the risk of adverse reactions
Take with food or a full glass of water
NARCOTIC ANALGESICS
Agonist – Partial Agonist – Mixed Agonist-Antagonists (see definitions for actions)
Uses: relieve or manage severe acute or chronic pain.
Adverse Reactions– Light-headedness, dizziness, sedation, constipation,
anorexia, nausea, vomiting and sweating.
Miosis may occur after giving some narcotic analgesics, this puts them at risk for injury
NARCOTIC ANTAGONISTS
Counteracts the actions of something else. Uses: complete or partial reversal of narcotic
depression Adverse Reactions
– Nausea, vomiting, sweating tachycardia & anxiety
Monitor V/S every 5 minutes initially after giving an narcotic antagonist
ADRENERGIC DRUGS
Mimic the activity of the sympathetic nervous system
Uses: hypovolemic shock, episodes of hypotension bronchial asthma, superficial asthma, allergic reactions
Adverse Reactions– Cardiac arrhythmias, headache insomnia,
nervousness, anorexia
Relaxes the smooth muscles of the bronchi Overuse of nasal decongestants, can cause
rebound congestions
ADRENERGIC BLOCKING DRUGS
Alpha, Beta, Anti- & Alpha/Beta Adrenergic Drugs (see definitions)
Alpha adrenergic drugs produce their greatest effects on the adrenergic nerves that control the vascular system
Beta adrenergic blocking drugs produce the greatest effect on the heart
Some beta adrenergic blocking drugs can be used to treat patients who have glaucoma
CHOLINERGIC DRUGS
May act like the neurohormone Ach or inhibit the release of the neurohormone AChE
Uses: glaucoma, myasthenia gravis, urinary retention
Adverse Reactions:– Excess salivation, nausea, vomiting, & diarrhea
Contraindicated with peptic ulcer disease Ongoing treatment should include checking the
eye and around the eye for redness, inflammation and secretions
Inhibits the activity of acetylocholine in parasympathetic nerve fibers
Uses: pylorospasm, peptic ulcer, ureteral colic, reduce secretions of upper respiratory tract (preoperatively)
Adverse Reactions– Dry mouth, blurred vision, and photophobia
Contraindicated with glaucoma
ANTI-CHOLINERGIC DRUGS
SEDATIVES & HYPNOTICS
Produces CNS depression and mood alteration Uses: insomnia or as a preoperative regimen Adverse Reactions
– Somnolence, agitation, confusion, lethargy, respiratory distress, bradycardia, hypotension
It is only acceptable to give a hypnotic with a narcotic analgesic when it is being given preoperatively
When giving to the elderly monitor for marked excitement and confusion
Hold a hypnotic if vital signs vary from the patients baseline.
CNS STIMULANTS
Analeptics, Amphetamines & Anorexiants (see definitions)
Uses: limited in medicine, analeptics – temp. tx of respiratory depression; amphetamines – temp. tx of exogenous obesity, narcolepsy; ADHD; anorexiants – tx of exogenous obesity
Adverse reactions– Dizziness, headache, apprehension, disorientation,
insomnia Anorexiants and amphetamines are highly
addictive and have a abuse potential
ANTICONVULSANTS
Reduce the excitability of the neurons in the brain
Uses: the more common types of seizures
Adverse Reactions– Sedation, nausea, vomiting, constipation, nystagmus
Take with food to decrease nausea Do not abruptly discontinue taking med because
it can cause seizures
ANTIPARKINSONISM DRUGS
Mechanism of action is not completely understood
Uses: Parkinson's disease Adverse Reactions
– Dystonic movements (facial grimacing, protruding tongue, jerking of extremities), dry mouth, blurred vision & dizziness
Avoid alcohol, do not increase, decrease or omit dose without consulting physician
PSYCHOTHERAPEUTIC DRUGS
ANTIANXIETY DRUGS ANTIDEPRESSANT DRUGS ANTIPSYCHOTIC DRUGS
ANTIANXIETY DRUGS
Exact mechanism of action unknown. Acts on the limbic system and reticular formation in the brain
Uses: anxiety disorders, long and short term
Adverse Reactions– mild drowsiness(1st few days), lethargy, fatigue,
sedation
Do not discontinue abruptly
ANTIDEPRESSANTS
Exact mechanism of action is unknown, thought to slow the adaptive changes in noreepinephrine and serotonin receptor systems.
Uses: depression, major and minor Adverse Reactions
– Sedation, dry mouth, dry eyes, urinary retention, nausea
A serious adverse reaction of a MAOI is hypertensive crisis
The nurse must check for cheeking
ANTIPHSYCHOTIC DRUGS
Thought to inhibit or block the release of the neurohormone dopamine in the brain
Uses: manage acute and chronic psychoses
Adverse Reactions– Dry mouth, sedation, hypotension, nasal
congestion, headache
Do not take OTC drugs; Take exactly as directed; Do not drink alcohol
CHOLINESTERASE INHIBITORS
Increase the level of actylcholine in the CNS by inhibiting its breakdown and slowing neuronal destruction
Uses: dementia associated with Alzheimer’s disease
Adverse Reactions– Limited – anorexia, nausea, vomiting, weight loss
It is not a cure, but just a delay in progression
ANTIEMETIC DRUGS
Inhibits the CTZ or depresses the sensitivity of the vestibular apparatus of the inner ear
Uses: prophylactic or tx of nausea and vomiting
Adverse Reactions– Varying degrees of drowsiness
Avoid driving, take as directed, avoid alcohol and other sedatives
ANTIVERTIGO DRUGS
Inhibits the CTZ or depresses the sensitivity of the vestibular apparatus of the inner ear
Uses: vertigo (see definitions)
Adverse reactions– Varying degrees of drowsiness
Avoid driving, take as directed, avoid alcohol and other sedatives
ANESTHETIC DRUGS
LOCAL ANESTHESIA – topical, local infiltration, regional (spinal & conduction blocks)
PREANESTHETIC – to prepare for anesthesia, the antianxiety drug will aid in reducing the dose of the anesthetic induction agent needed.
GENERAL ANETHESIA – several drugs used POST ANESTHESIA - check airway, respiratory
status and give O2 as needed, position to prevent aspiration, and monitor VS q 5-10mins
ANTIHISTAMINES
Prevent histamine from entering the histamine receptor site
Uses: relief of S&S of allergies, motion sickness, nausea & vomiting & sedation
Adverse Reactions– Drowsiness, sedation, dry mucus membranes
Most are given with food to prevent gastric upset.
DECONGESTANTS
Produce localized vasoconstriction of the small blood vessels of the nasal membranes
Uses: congestion assoc. with colds, allergies and middle ear infections
Adverse Reactions: – Nasal burning, stinging & dryness
Contraindicated with hypertension Overuse can make symptoms worse
BRONCHODILATORS
Opens the bronchi and allow more air to enter the lungs
Uses: reversible airway obstruction, (asthma, bronchitis, emphysema)
Adverse Reactions– Elevated B/P, anxiety, cardiac arrythmias
Avoid smoking (makes it hard to adjust dose)
ANTIASTHMA DRUGS
CORTICOSTEROIDS LEUKOTRIENES MAST CELL STABILIZERS
ANTITUSSIVES
Depresses the cough center located in the medulla, centrally acting drugs
Uses: to relieve non productive coughs
Adverse Reactions– Respiratory depression, euphoria, light-headedness,
sedation, nausea, vomiting
Do not exceed recommended dose Push fluids If cough is productive call Dr STAT
MUCOLYTICS & EXPECTORANTS
Increases mucus production by decreasing the viscosity of the mucus
Uses: emphysema, bronchitis, asthma, TB Adverse Reactions
– Sedation, nausea, drowsiness
If equipment is being utilized teach patient how to use it properly
CARDIOTONICS
Increases cardiac output through positive inotropic activity
Uses: heart failure, atrial fibrillation
Adverse reactions– Headache, weakness, drowsiness
If taking Digoxin and c/o nausea and blurred vision (call dr. STAT)
ANTIARRHYTHMIC DRUGS
The drug works differently depending on what class it falls in
Uses: prevent and treat cardiac arrhythmias
Adverse Reactions– Light-headedness, weakness, hypotension,
bradycardia & drowsiness
If taking parenterally, measure and record I&O Check B/P, apical & radial pulse and respirations
q 1-4 hours
ANTIANGINALS (Nitrates)
Relaxes the smooth muscles of the blood vessels
Uses: angina pectoris
Adverse Reactions– Headache, hypotension, dizziness, vertigo,
weakness, flushing
Do not use alcohol, Keep an adequate supply of meds on hand, Do not change name brands.
ANTIANGINALS (Calcium channel blockers)
Dilate coronary arteries and arterioles, Dilate peripheral arteries and reduces the workload of the heart
Uses: vasospastic angina and chronic stable angina Adverse Reactions
– Dizziness, light-headedness, nausea, diarrhea, flushing
Make position changes slowly, Do not use alcohol, Keep an adequate supply of meds on hand
PERIPHERAL VASODILATING DRUGS
Acts on the smooth muscle layers of peripheral blood vessels
Uses: peripheral vascular disease
Adverse Reactions– Hypotension, headache, dizziness, palpitations
Avoid driving and sudden changes in position Stop smoking
ANTIHYPERTENSIVES
Dilate or increase the size of the arterial blood vessels
Uses: high blood pressure
Adverse Reactions– Postural hypotension, dizziness, light-headedness,
orthostatic hypotension
Must assess B/P immediately prior to giving med Prior to giving the a B/P med for the initial time
take B/P in both arms
ANTIHYPERLIPIDEMICS
Bile acid sequestrants HMG-CoA Reductase Inhibitors Fibric Acid Derivatives Uses: lower serum lipid levels Adverse Reactions
– Nausea, vomiting, headache, abdominal pain A paradoxical elevation of the lipid levels may
occur Usually drugs will be discontinued if no
improvement in 3 months.
ANTICOAGULANTS
Interfere with the clotting mechanism of the blood Uses: DVT, MI, embolizms
Adverse Reactions– Mild to severe bleeding, nausea, vomiting, alopecia
INR must be reported if the level is above 2 Give Vit K to reverse the action of an oral
anticoagulant
THROMBOLYTIC DRUGS
Break down fibrin clots by converting plasminogen to plasmin
Uses: treat acute MI, PE, DVT Adverse Reactions external or internal bleeding Need continuous monitoring, bed rest during
therapy
ANEMIA DRUGS (Iron)
Elevate the serum iron concentration Uses: iron deficiency anemia
Adverse Reactions– GI irritation, nausea, black stools, constipation
If giving iron IM, give in the buttock using the Z-track method
If giving oral, do not give with tetracylines
ANEMIA DRUGS (CONT.)
Anemia assoc. with chronic renal failure– Epoetin Alfa – hypertension, headache
tachycardia
Folic acid deficiency anemia– Leucovorin – few adverse reactions,
Pernicious anemia– Vitamin B12 – mild diarrhea and itching
DIURETICS
Carbonic Anhydrase Inhibiotors Loop Diuretics Osmotic Diuretics Potassium Sparing Diuretics Thiazides If take drug once daily, take in the early morning ALERT- poor skin turgor & dry mucous
membranes are signs of excess diuresis
URINARY ANTIINFECTIVES
Uses: UTI’s Adverse Reactions
– Nausea, vomiting, anorexia, abdominal pain
Stress the importance of completing a full course of therapy
Avoid the use of nonprescription drugs
GI SYSTEM DRUGS
Antacids – Reduce the acidity of stomach and duodenal contents – Uses – heartburn, GERD, sour stomach– Adverse reactions – constipation
Anticholinergics– Reduces gastric motility– Uses – peptic ulcers– Adverse reactions – dry mouth, blurred vision, urinary
retention
GI SYSTEM DRUGS (cont.)
GI stimulants– Mode of action unclear– Uses – GERD, gastric stasis– Adverse reactions – mild, drowsiness or dizziness
Histamine H2 antagonists– Inhibit the action of histamine at the receptor cells of
the stomach– Uses – gastric or duodenal ulcers– Adverse reactions -
GI SYSTEM DRUGS (cont.)
Antidiarrheals– Decreases intestinal peristalsis– Uses – diarrhea– Adverse reactions –anorexia, nausea, constipation,
vomiting Antiflatulents
– Has a defoaming action the disperses and prevents the formation of mucus-surrounded gas pockets in the intestines
– Uses – painful symptoms of excess gas– Adverse reactions – none
GI SYSTEM DRUGS (cont.)
Digestive enzymes– Breakdown and digest fats– Uses – pancreatic enzyme insufficiency– Adverse reactions – none reported
Emetics– Causes local irritation of the stomach and induces
vomiting– Uses – ingested poison or drug overdose– Adverse reactions – none reported
GI SYSTEM DRUGS (cont.)
Gallstone – Solubilizing drugs– Suppress the manufacture of cholesterol Uses –
nonsurgical tx of radiolucent gallstones– Adverse reactions – diarrhea, cramps, nausea,
vomiting, (prolonged use – toxic to the liver) Laxatives
– Each works differently but they produce a relief in constipation
– Uses: constipation– Adverse reactions – diarrhea, abdominal pain,
flatulence
GI SYSTEM DRUGS (cont.)
Proton pump inhibitors– Suppress gastric acid secretions by blocking the
production of gastric acid– Uses – ulcers, GERD, – Adverse reactions – headache, diarrhea, abdominal
pain
Take stool softeners and laxatives with a full glass of water
Do Not give ipecac syrup if the patient has ingested gasoline
ANTIDIABETIC DRUGS (Insulin)
Insulin helps glucose enter the cells of striated muscle and adipose tissue
Uses: diabetes mellitus type 1 & 2
Adverse Reactions– Hypoglycemia, hyperglycemia
Rotate injections sites, follow the prescribed diet, wear an medical ID bracelet
PITUITARY & ADRENOCORTICAL HORMONES
Hormone supplement or replacement Measure I&O daily Avoid alcohol Wear a medical alert tag Drink one or two glasses of water prior to taking
med Long-term glucocorticoid therapy adverse
reactions are decreased resistance to infection
THYROID & ANTITHYROID DRUGS
Uses: hyper or hypothyroidism Adverse reactions
– Signs of hyper or hypothyroidism
Administer med early in the morning preferably before breakfast
MALE & FEMALE HORMONES
Male hormones– Androgens, anabolic steroids, androgen hormone
inhibitors
Female hormones– Estrogens, progestins, contraceptive hormones
Taking anabolic steroids can cause severe mental and personality changes
Oral contraceptives are best taken with evening meal or at bedtime
DRUGS ACTING ON THE UTERUS
Oxytocic drugs – used before birth to induce contractions (stimulates the uterus)
Uterine relaxants – decrease uterine activity and prolongs pregnancy
Keep the patient under constant observation if receiving IV oxytocin
IMMUNOLOGIC AGENTS
Vaccines & toxoids – stimulate the immune response within the body to specific antigens or toxins.
Immune Globulins and Antivenins – contain ready made antibodies & are given for passive immunity against disease
Fatalities and serious viral infections have been associated with the administration of vaccines
ANTINEOPLASTIC DRUGS
Generally affect cells that rapidly proliferate Uses: they interfere in some way with cell
division Adverse Reactions
– Bone marrow suppression, nausea, vomiting, stomatitis diarrhea and hair loss
Take drug on an empty stomach, keep all appointments, Do not take OTC meds, Avoid Alcohol
TOPICAL DRUGS FOR THE SKIN
Anti-infectives – direct local affect on bacteria, fungi and viruses
Antiseptics & Germicides – reduce the number of bacteria on the skin surface
Corticosteroids – localized anti-inflammatory activity Antipsoriatics – tx of psoriasis
TOPICAL DRUGS FOR THE SKIN (cont)
Enzymes – removal of dead soft tissues Keratolytics – removes excess growth of the epidermis Local anesthetics – temp. inhibit the conduction of
impulses from sensory nerve fibers
Remove a drug with soap and warm water prior to apply more
OTIC & OPTIC DRUGS
Otic – Uses: to relieve pain, treat infection and inflammation,
aid in the removal of ear wax– Adverse reactions – prolonged use (superinfection)
Ophthalmic – – Uses: glaucoma, infections, inflammation and allergies– Adverse Reactions – varies depending on type
Warm otic solutions prior to instillation to prevent dizziness
FLUIDS & ELECTROLYTES
Uses to correct nutritional of fluid deficiencies or treat certain diseases and conditions
Fluids– Blood plasma, plasma proteins fractions, protein
substrates, energy substrates, plasma expanders, & intravenous replacement solutions
Electroytes – Bicarbonate, calcium, magnesium, potassium, sodium,
Adverse reactions– Hypokalemia
DEFINITIONS:
BACTERICIDAL – destruction of bacteria by an antibiotic
BACTERIOSTATIC- slows the multiplication of bacteria
ANAEROBIC- able to live without oxygen AGONIST – binds to a receptor and causes a response PARTIAL AGONIST – binds to a receptor, but the
response is limited MIXED AGONISTS – ANTAGONISTS – properties
of both the agonist and antagonist
DEFINITIONS cont:
Alpha adrenergic blocking drugs – block alpha adrenergic receptors
Beta adrenergic blocking drugs – block beta adrenergic receptors
Anti-adrenergic drugs- block adrenergic nerve fibers
Alpha/beta adrenergic blocking drugs – block both alpha and beta adrenergic receptors
DEFINITIONS cont:
ANALEPTICS – drugs that stimulate the respiratory center
AMPHETAMINES – produce euphoria and wakefulness
ANOREXIANTS - suppress the appetite TARDIVE DYSKINESIA – rhythmic voluntary
movements of the tongue or face
DEFINITIONS cont:
ACETYLCHOLINE – chemical in the brain required for memory and thinking
VERTIGO – a feeling of spinning or a rotation-type motion
LOADING DOSE – series of doses of the drug until it starts to exert full therapeutic effect
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