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