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DEFINITION OF TERMS Pharmacodynamics the study the way drugs effect the body.

. Pharmacokinetics the study of the way the body deals with drugs and includes absorption, distribution, biotransformation and excretion of the drug. Once the pharmacokinetics of a drug is determined, rational dosage regimen can be instituted. Drug Absorption refers to what happens to a drug from the time it is introduced to the body until it reaches the circulator fluids and tissues. Drug Distribution it involves the movement of drugs after absorption or injection into the interstitial or cellular fluids. Onset of Action the time administered drug produce its effect on system. Biotransformation/Metabolism the process by which drug s are change into new, less active chemical Excretion the removal of a drug from the body. The skin, saliva, the lungs, bile and feces are route used to excrete drugs. Critical Concentration the amount of a drug needed to cause a therapeutic effect. Half-life the time it takes the amount of drug in the body to decrease to one-half of the peak level it previously achieved. Peak Plasma Level refer to high plasma concentration of the drug for a maximum therapeutic effect. Therapeutic Blood Level refer to the drug plasma concentration achieved within the standard margin of safety and effectiveness. PHARMACOKINETICS PROCESSES 1. Absorption refers to what happens to a drug from the time it is introduced to the body until it reaches the circulating fluid and tissues. Areas of the Body for drug Absorption: a. Gastrointestinal (GI) tract either orally or rectally b. Mucous membrane c. Skin d. Lungs e. Muscle of subcutaneous tissues Process of absorption 1. Passive Diffusion occurs across a concentration gradient from an area of higher concentration to an area of lower concentration. 2. Active Transport a process that uses energy to actively remove a molecule across a cell membrane. This process is not important as absorbing drugs, but use in excretion in the kidney 3. Filtration involves movement through pores in the cell membrane down a concentration gradient or the pull of the plasma protein. This process is use in drug excretion 1. Blood flow rich blood flow supply enhances absorption, whereas poor circulation hampers absorption 2. Pain slows gastric emptying rate so the drug remain longer in the stomach 3. Stress 4. Foods 5. Exercise its can decrease blood circulation to the GI tract by causing more blood flow to the muscles 6. Nature of the absorbing surface transport of drug molecule is faster through a single layer of cells (intestinal epithelium) the transverse layers of cells (skin) 7. Solubility of the drug- the drug must be in solution Mucous membranes (Sublingua, buccal) Perfusion or blood flow to the area Integrity of the mucous membranes Presence of food or smoking Length of time drug retained in the area Perfusion or blood flow to the area Integrity of skin Perfusion or blood flow to the area Integrity of lung lining

Topical (skin) Inhalation

Ability to administer drug properly First pass effect the breakdown of oral drug in the liver immediately after absorption. Drugs given by other routes often reach reactive tissues before passing throughout the liver for biotransformation 2. Distribution the portion of the drug that gets through the first-pass effect is delivered to circulation for the transport throughout the body. It involves the movement of drug to the body tissue

Factors that affect Distribution 1. Protein binding drugs are bound to proteins the blood to be carried in circulation. The drugs must be freed from the protein binding site at the tissue for therapeutic effect 2. Barriers to Drug Distribution Blood Brain Barrier is a protective system of cellular activity that keeps many things (Foreign invaders, poisons) away from the CNS Drugs that are highly lipid soluble are more likely to pass the blood-brain barrier cells in CNS Teratogenic cause defect on fetus may be virus Placenta Barrier Many drugs pass through the placenta and the effect the developing fetus. In pregnant women, Drugs should be given only when the benefit clearly outweighs any risk. Many drugs are secreted into the breast milk, thus having the potential to affect the neonate. Note: (Breast milk) The nurse must always check the ability of a drug to pass into breast milk when giving a drug to a nursing mother. 3. Volume distributor client with edema has enlarged area in which a drug can be distributed and may need an increased dose. Similar dose may be needed for client with dehydration. 4. Obesity body weight plays a role in drug distribution because blood flows through fat slowly, thus increasing time before drug is released. 5. Receptor combination a receptor is an area on a cell where drug attaches and response takes place. 3. Biotransformation (Metabolism) Liver enzyme system the liver is the most important site of drug metabolism or biotransformation, the process by which drugs are changed into new, less active chemicals. The liver detoxifies many chemicals and uses others to produce needed enzymes and structures. Factors that affect drug metabolism: 1. Age - infant and elderly have reduced ability to metabolize some drugs 2. Nutrition liver enzymes involved in metabolism rely on adequate amounts of amino acids, lipids, vitamins, and carbohydrates 3. Insufficient amounts of major body hormones insulin/adrenal corticosteroids can reduce metabolism of drugs in the liver 4. Excretion is the removal of a drug from the body. The kidney plays the most important role in drug excretion. Routes use for drug excretion: a. Skin b. Saliva c. Lungs d. Bile e. Feces Factors that affect drug excretion: 1. Renal excretion carried out by glomerular filtration and tubular secretion, which increases quantity of drug excreted. Other renal processes that result in tubular reabsorption. -Drug metabolites in urine can be reverted back into the blood stream 2. Drugs can affect elimination of other drugs Example: Antacid increase elimination of ASA, thus decrease its effect

3. Blood concentration levels when peak level of blood is reached, excretion becomes greater than absorption and blood levels of drugs begin to drop. 4. Half life of a drug - is the time takes for the amount of drug in the body to decrease to one-half of the peak level it previously achieved. It is important in determining the appropriate timing for a drug dose. Note: The nurse can use her knowledge of drug half life to explain the importance of following a schedule of drug administration in the hospital or at home. Figure above shows the process by which drug is handles by the body

FACTORS INFLUENCING DRUG EFFECTS AND ACTIONS a. Weight The recommended dosage of a drug is based on drug evaluation studies and is targeted at a 150-pund person. Heavy individuals require larger doses while lighter individuals require lesser dose of the drug. b. Age Age is a factor primarily in children and older adults. Children and older adults have lesser dose compared to an adult. c. Gender Psychological difference between men and women can influence a drugs effect Males have more vascular muscle so the effects of the drug will be seen sooner than with females Female have more fat cells than males, so drugs that deposit in fat may be slowly released and cause effects for a prolong period of time Women who are given any drug should always be questioned about the possibility of pregnancy d. Physiological Factors Physiological differences such as diurnal rhythm of the nervous and endocrine system Acid-base balance, hydration and electrolyte balance can affect the way a drug works On the body and the way the body handles a drug. e. Pathological Factors Pathological conditions can change the basic pharmacokinetics of a drug. Presence of pathology (disease) and the severity of symptoms may call for an adjustment of dosage f. Genetic Factors Genetic differences can sometimes explain a patient`s varied response to a drug. Some people lack certain enzyme system necessary for metabolizing a drug while others have overactive enzyme systems and break down drugs very quickly. g. Immunological factors People can develop an allergy to a drug. After exposure to its (drug) proteins, a person can develop antibodies to a drug. Future exposure to that drug may result to a full-blown allergic reaction h. Psychological Factors The patients attitude about a drug has been shown to have a real effect on how that drug works The nurses positive attitude, combined with additional comfort measure can improve patients response to a medication. i. Environmental Factors The environment can affect the success of drug therapy. Some drugs are helped by a quiet, cool, non-stimulating environment If a patients response to a medication is not as expected, the nurse might look for changes in environmental condition.

j. Tolerance Some drugs are tolerated by the body overtime Drugs that are tolerated no longer cause the same reaction and need to be taken in increasingly larger doses to achieve a therapeutic effect. k. Cumulation When a drug is taken is successive doses at intervals that are shorter than recommended, or when the body is not able to eliminate a drug properly, the drug can accumulate in the body, loading to toxic levels and adverse effect l. Drug Drug Interaction When two or more drugs are taken together there is a possibility that these drugs will interact with each other to cause unanticipated effect in the body. It result in an increase or decrease in the desired therapeutic effect of one or all of the drugs, or an increase in adverse effects. The nurse should first consult a drug guide for a listing of clinically significant drug to drug interaction m. Drug-Food Interactions Some food increase acid production speeding the breakdown of the drugs molecule and preventing absorption and distribution of the drug Some food clinically reacts with certain drugs and prevents their absorption into the body. n. Drug-Laboratory Test Interactions Administration of a particular drug may alter test that are done on various chemical levels or reaction as part of a diagnostic study Drug Laboratory test interaction is a result the drug being give and not necessarily as result of a change in the bodys response or action DIFFERENT PHARMACEUTICAL PREPARATIONS A.1 LIQUIDS (Single phase (Clear)-Aqueous) Aromatic Water clear, saturated aqueous solutions of volatile oils or other aromatic substance. Use as a vehicle, flavors or performing agent. Example: Peppermint water flavored vehicle Rose water performing agent Aqueous Acid the official inorganic acids and organic acids, although of minor significance as therapeutic agents. Has great importance in chemical and pharmaceutical manufacturing. Example: Glacial acetic acid as causatic agent Hydrochloric acid as acidifying agent Solutions (oral) are liquid preparations that contain one or more soluble chemical substances usually dissolve in water. Example: Oral Rehydration Solutions (Oresol) as electrolyte replenisher Juices is prepared from fresh ripe juice, is aqueous in character and is used in making syrups which are employed as vehicles. Example: Cherry juice use to prepare cherry syrup Raspberry juice for raspberry syrup Syrups concentrated solutions of sugar as sucrose or other aqueous liquid. Example: Simple syrup use as flavor (Solution of sucrose in purified water alone) Honeys are thick preparations somewhat apllied to the syrups. They are unimportant as a class of preparation today but at one time, before sugar was available, honey was the most common sweetening agent.

Mucilages are thick, adhesive liquids, produced by dispersing gum in water. Example: Acacia mucilage use as emulsifying agent for cod liver oil. Jellies a class of gel in which the structural coherent matrix contains a high proportion of liquid, usually water. They are similar to mucilage but they differ in having a jelly-like consistency. Example: KY Jelly use as lubricants Mouthwash are mostly aqueous in nature, pleasantly flavored solutions often colored and may either be acidic or basic reaction. Example: Listerine, Bactidol use as antiseptic, deodorant and refreshing effect in the mouth Gargles are aqueous solution (frequently containing antiseptic , anti-biotics or anesthetics used for treating the pharynx and nasopharynx by forcing air from the lungs through the gargle which is held in the throat, subsequently the gargle is expectorated Example: Cepacaine solution contains a topical anesthetic for the relief of pharyngeal and oral pain. Providone Iodine (Betadine)- 1% gargle use as oral antiseptic Douches is an aqueous solution which is directed against a part or into a cavity of the body, It function as a cleansing or antiseptic agent Example: Vaginal douche Lactic acid irrigation Enemas are rectal injections employed to evacuate the bowel (Evacuation Enema) or influence the general system by absorption or to effect locally the seat of disease (Retention enema) or they may contain radiopaque substances for examination of the lower bowel Example: Sulfasalazine rectal enema for treatment of ulcerative colitis Barium sulfate enema use for x-ray visualization of the large intestine Irrigation solutions used to wash or bathe surgical incisions, wound or bodily tissues, Example: Sodium chloride irrigation 0.9% - for washing wounds Eye (Ophthalmic solutions) are sterile products essentially free from foreign particles, suitably compounded and packaged for insulation into the eye Example: Tears naturalle II (alcon) for the relief of dry eyes Otic (Aural solutions) - are placed in the ear carnal by drops or in small amount for the removal of excessive cerumen (ear wax ) of the treatment of ear infection , inflammation or pain Example: Auralgen Otic Solution for treatment of acute otitis media Nose (Nasal Solutions) are usually aqueous solutions designed to be administered to nasal passage in drops or sprays. Example: Nasalcrom Nasal Solution for seasonal or perennial rhinitis A.2 LIQUIDS (Single phase Non Aqueous) 1. Alcoholic Liquid Preparations Elixir are clear, pleasantly flavored , sweetened , hydro alcoholic liquids intended for oral use Example: Phenobarbital Elixir use as sedative and hypnotic Spirits Essences alcoholic or hydro alcoholic solution of volatile substances. Use internally for their medicinal value, a few by inhalation and a large number as flavoring agent. Example: Aromatics Amimonia spirit use as respiratory stimulant Dental Liniments are liquid preparations which are applied to the gums for their local stimulant and anesthetic effect. Example: Delabarre use during teething period of babies has a soothing effect

2. Glycerin solutions

Glycerins or glycerites are solutions or mixtures of medical substance in not less than 50% by weight of glycerin (solvent) Example: Extermol {contains 5% carbamide peroxide (urea hydrogen peroxide)} in glycerin- use in dispersing ear wax 3. Ethereal Solutions Collodions are liquid preparations containing pyroxylin I a mixture of ethyl ether and ethanol. They are applied to the skin by means of a soft brush or suitable applicator. They are intended for External Use only and should be applied to dry tissues, Example: Salicylic Acid Collodion 10% - use as keratotolytic. Agent in treatment of corns or warts 4. Oleaginous Preparations Liniments are solution or mixture of various substances in oil, alcoholic solutions of soap or emulsions and may contain anti-microbial preservatives, For External Use only IT should not be applied to skin that is bruised or broken. Example: Camphor liniment use as mild counterirritant for inflamed joints, sprains and rheumatism Medicated oil are solutions of medicinal ingredients in bland oil. No longer use. Toothache Drops (Odontalgicum) are preparation used for the temporary relief of toothache by application of a small pledget of cotton saturated with the product into the tooth decay cavity. Example: Toothache drops use as local analgesic Oleovitamins are liver oil diluted with edible vegetable oil solution of the indicated vitamins or vitamin concentrate (usually Vitamin A and D) In fish liver oil usually in a form of soft gel capsules Inhalants/Inhalations are drugs or solution or suspensions of one or more drugs substances administered by the nasal or oral respiratory route for either a local or systemic effect, this preparation is designed that the drug is carried into the respiratory tree of the patient. Inhalations are administered with the use of nebulizers, metered dose inhalers, and other special inhaler device. Example: Ventolin Inhalation Aaerosol use as beta-adrenergic agonist A.3 LIQUIDS [SINGLE phase Extractives (Obtain from plants)] Tinctures are alcoholic or hydro alcoholic solution prepared from vegetable materials or from chemical substances. Example Tincture of Iodine 2% - use a germicide and fungicide strong Iodine 7% use as antiseptic Fluid extracts liquid preparation of vegetable drugs, containing alcohol as a solvent or as a preservative, or both. Each ml contains the therapeutic constituents of 1g of the standard drug that it represents. (% concentration 100%) because of its concentrated nature, fluid extracts are too potent to be taken safety by patient for self administration its no longer used. Infusions a dilute solution of the readily soluble constituents of crude drugs. Infusions are unstable and susceptible to attack by bacteria and fungi. It is seldom use now. Decoction this once-popular process water-soluble and heat-stable constituent from crude drugs buy boiling in water for 15 minutes cooling straining and passing sufficient cold water through the drug to produce the required volume. Extracts concentrated preparations of vegetable or animal drugs obtained by removal of the active constituents of the respective drugs with suitable menstrual, evaporation of all or nearly all of the solvent and adjustment of residual masses or powders to the prescribed standards. 3 Types of Extracts Semi-liquid extract use as concentrates in the manufacture of pharmaceuticals Solid extract use in ointments and suppositories Powdered extract use in formulation of capsule, tablet or powders

Resins are natural or induced solid or semi-solid exudations from plants (usually back of tree). It is not commonly use now, but of great importance industrially for waterproofing, soap making and others. A. 4 LIQUIDS [TWO-phase] 1. Suspensions Liquid preparations containing suspended insoluble particles is a liquid. Has a Shake well label Mixture oral liquids containing one or more active ingredients, dissolved, suspended or dispersed in a suitable vehicle. Example: Koalin mixture with pectin for treatment of diarrhea in children Lotion suspensions for External Use only: topical application to the skin: Example: Caladryl lotion use as anti-prutic Magmas/Milk are dispersion of insoluble inorganic molecules or suspensions of finely divided materials in small amount of water. They are never refrigerated because they stratify. Example: Milk of magnesia use as gastric antacid Gels semi-solid on standing and liquefies on shaking. Example: Cremalin gel, Aluminum hydroxide gel, Use as antacid 2. Emulsion a two-phase system in which one liquid is dispersed throughout another liquid in the form of small droplets. Example: Cold liver oil emulsion use as cathartic B. SEMI-SOLID Ointments semi-solid preparation intended for external application to the skin or mucous membrane. Example: Lidocaine ointment use as local anesthetic Creams Viscous liquid or semi-olid emulsion for external use, Example: Nivea (cleansing cream) for beautifying purpose Pastes are ointment like preparation suited only for external application, they are use to absorb serous secretion making it suited for application on and around moist lesions Example: Zinc oxide paste use as mild astringent, protective and antiseptic in the treatment of skin diseases C. SOLIDS Powders mixture of finely divided drug or chemicals in dry powdered state for internal or external use. Example: foot powders use as antiperspirants Capsule are usually made of gelatin which are use to dispense powdered drug. Soft capsules are sealed together Tablets preparation of powdered drug which are compressed or molded into small disk. May be covered with a colored coating to make them attractive Pills are small, round solid dosage forms containing medicinal agent and are intended for oral administration Lozenges are flat, round, or rectangular preparations which are held in mouth until they dissolved,liberating the drug involved. Suppositories are solid dosage forms intended for insertion into body orifices where they melt, soften, or dissolved and exert localized or systemic effects D. Unclassified Pharmaceutical Preparations

Dressing external applications resembling ointment usually use as a covering or protection. Example: Soltratulle, Sofratulle Plaster is substances intended for external application of such materials and of such consistency as to adhere to the skin and attach to addressing. Example: Corn plasters, salonpas plaster Cataplasms/Poultices it is a soft, moist mass of herbs, seeds etc. usually applied hot in cloth. Example: Kaolin Poultice Cements are dental preparation employed primarily as protective coverings for exposed pulps Example: Zinc-Eugenol cement Injections/Parenteral those intended for injection under the through one or more layers or the skin or mucous membrane. Package as either large-volume parenteral (LVP) or small volume parenteral (SVP) multiple dose or single dose. Example: D5LR 1000 ml (LVP) ROUTES OF DRUG ADMINISTRATION

TERM Parenteral Intravenous Intraarterial Intraspinal/intrathecal Intraosseous Intraarticular Intrasynovial Intracutaneous/Intradermal Subcutaneous Intramuscular

SITE Other than the gastrointestinal tract (by injection) Vein Artery Spine Bone Joint Joint-fluid area Skin Beneath the skin Muscle

TERM Oral (Per orem) Sublingual Epicutaneous (Topical) Transdermal Intraocular Intranasal Aural Intrarespiratory Rectal Vaginal Urethral

SITE Mouth Under the tongue Skin surface Skin surface Eye Nose Ear Lung Rectum Vagina Urethra

I. DISTURBANCES IN OXYGENATION A. DISTURBANCE IN THE OXYGEN CARRYING METABOLISM 1. Whole Blood Uses: 1. Treatment of acute hemorrhage 2. Treatment of acute hypovolemic shock 3. For exchange transfusion 4. Treatment of severe anemia 2. Packed red cells Use to treat severe anemia 3. Platelet transfusion 2 kinds a. PRP-platelet rich plasma b. PC-platelet concentrates USE: to control or to prevent bleeding in patients with dangerous degree of thrombocypenia 4. Whole plasma

USES 1. Treatment of clotting defects 2. Treatment of hypovolemia 5. Anti-coagulant drugs that inhibit clotting of blood; do not dissolve clot that has already formed but it prevents formation of new ones. USES 1. Treatmant of pulmonary emboli and coronary occlusion 2. Treatment of deep vein thrombosis and thrombophlebitis 3. Reduce formation of trombi after MI 4. Prevent coagulation of blood of transfusion 2 types 1. Direct anticoagulant-act directly in the blood stream; act quickly but dont last long. E.g. Heparin-given IV, SC 2. Indirect anticoagulant-act to prevent formation of prothromborin by the liver. E.g. Coumadin, Dicumarol-given orally, Warfarin. Nursing Considerations: 1. Avoid giving Herapin by IM to immunize hematomas 2. When giving subcutaneous injection, dont massage site: also rotate injection site. 3. Never give piggy back with other drug like antibiotic because it will in activate the heparin 4. Monitor prothomborin time and bleeding time closely-PT, PTT, CT, BT 5. Be alert for signs of bleeding- epistaxis, bleeding gums, petechiae, tarry stools 6. Use small needle when giving subcutaneus injection, such as G-24, G-25, G-26 7. Coagulant-drugs used to combat bleeding caused by anticoagulant E.g. Vit K, Aquamephyton, Hemostan, Protamine SO4 7. Hemostatics - drugs that reduce capillary bleeding or hasten coagulation of blood USES 1. Treat bleeding from dental socket, nasal laryngeal sugery- E.g. tromborin 2. Provide hemostasis during various form of surgery - E.g. gelfoam 3. To correct hypofibrogenemia - E.g. fibrinogen 4. In correction of hemophilia - E.g. anti- hemophilia factors (AHF) Nursing Considerations Monitor allergic reaction especially with AHF Monitor vital signs-if there is pulse, decrease rate administration B. DISTURBANCE IN THE OXYGEN CARRYING TRANSPORT 1. Cardiotonics or cardiac stimulant-drugs that act to improve muscular contraction of the heart and slows down heart beat USES 1. Treatment of congestive heart failure 2. Alleaviate atrial fibrillation and flutter, arterial tachycardia and premature extra systole Mechanism of action a. Increase myocardial contractility by direct action on myocardium b. Increase calcium in myocardial cell to promote muscle protein binding and thus increase cardiac contraction c. Decrease impulse conduction thru AV node to slow down the heart. Examples: Digital, Cedilanid, Lanoxin >Digitalizing the process of reaching the desired therapeutic by giving successive doses of cardiotonic drug. Two aspects involed 1. Digitalizing or loading dose of the amount needed to obtain a therapeutic effect 2. Maintenance dose-the amount needed to maintain the therapeutic effect

Nursing Considerations 1. Watch out for rhythm of pulse, vomiting, nausea, anorexia, and headache. 2. Observe digitalis precaution-Take apical rate for full minute, if below 60 and above 120, dont give, but notify doctor 3. Obtain baseline data-check cardiac rate and rhythm, BP, electrotes, BUN, creatinine. 2. Beta-blockers or cardiac depressant-drugs that block beta-adrenergic reflexes but not alpha receptors USES 1. Use as myocardial depressant in treatment of angina pectoris and subaortic stenosis 2. Treat cardiac arryhythmias Mechanism action It decrease cardiac rate,c ardiac cutput, myocardial contractility and blood pressure Example: Inderal, Quinidine, Lidocaine 3. Vasolidators - drugs that increase blood supply to a part by dilating blood vesseis and relexaton of vascular smooth muscle Two Groups =Group I-drugs used to treat peripheral vascular diseases e.g. Cylclospasmol, Isordil =Group II-treat coronary vascular diseases e.g. Nitrates, Nitrites, Persantin, Peratrate USES 1. Relieve pain of angina pectoris by dilating coronary arteries 2. Treatment of vasospastic and peripheral vascural disease 3. Treat spasm of coronary thromboses e.g. Nitroglycerin Sublingual - Nistrotat, Nitrobid Ointment Nitrol Nursing Consideration 1. Nitroglycerin is not habit forming - may be taken regularly: effect last only for few minutes 2. Oral preparation best taken on an empty stomach 1/2 hour before meals. 3. Sublingual preparation can be repeated Q10 minutes for 3 doses if not relieve of pain call doctor or go to the hospital 4. Antihypertensive - drugs that cause vasodilation and reduction of blood pressure. Uses: Treatment of mild to severe essential hypertension. Mechanism of action a. Relaxes venous and arteriolar smooth muscle b. Causes vasolidation Example:. Minipres, Catapres, Aldomet, Nitpride Nursing Considerations 1. Monitor BP and pulse frequently while taking the drug. 2. Avoid alcohol and stay on diet prescribed by the doctor. 3. Salt and water retention may occur-relieved by diuretic. 4. Reduce dose gradually- if discontinued abruptly can cause excessive hypertension. Nipride (Nitroprusside Soduim)- drug that lower down BP quickly in hypertensive Emergency: it is incorporated to IV fluids. Nursing Consideration a) Due to light sensitivity, keep IV solution and tubing wrapped in foil. b) Monitor VS esp. the BP q 15 minutes c) Best run as piggy back to main IV fluid - no other medication should be added d) Watch for sign of toxicity severe hypertension, acidosis, vomiting, loss of consciousness e) Check IV site always if needle is out the vein it can cause tissue irritation or sloughing off with necrosis 5. Diuretics - drugs that increase urinary excretion of water and sodium

USES: 1. Treatment of edema in cardiac patient with aim of reducing fluid accumulation and relieve the ailing heart 2. Treatment of hypertension 3. Reduce intracranial and intraocular pressure Mechanism of action 1. Loop diuretic inhibit reabsorption of Na and CI in the ascending loop of henle 2. Mercurial diuretic inhibit renal tubular absorption of Na, CI and water in the cortical diluting segment Side effects: Hypokalemia, dehydration, electrolyte depletion Examples: 1. Furosemide Lasix 2. Spironolactone aldactone 3. Frusema, diamox 4. Mannitol 250 cc Nursing Consideration: 1. Monitor electrolytes BUN, CO2, Na, K 2. Watch for sign of hypokalemia like muscle weakness and cramps patients needs supplement 3. Monitor intake output 4. Monitor daily weight 6. Oxygen indicated in all types of coronary infarction especially with cyanosis =In coronary infarction and cyanosis this is occlusion impaired cardiac function edema result in poor absorption of 02 increase anoxia. =O2 will relieve dyspnea, lessen pain, slow down heart rate =80 100% should be used via nasal catheter. c. DISTURBANCES IN OXYGEN EXCHANGE 1. Bronchodilator or anti-asthmatic drugs drugs that cause bronchodilation thereby making breathing easier for the patient USES: In management of bronchial asthma, wheezing membrane, reduce secretion of mucus Mechanism of Action: Relieve boncho spasm, shrink swollen mucous membrane, reduce secretion of mucus Examples: a. Theophylline aminophylline, bricanyl, quibron, ventolin, brondil b. Isoprotrenol isuprel for inhalation 2. Cough and cold remedies a. Expectorant/mucolytic drug that loosen secretions, reduce thick or tenacious respiratory secretions and promote an facilitate expulsion of mucus from the respiratory passages. USES: 1. Facilitate expectorant in pneumonia, bronchitis, emphysema, bronchial asthma 2. Treatment of chronic respiratory disorder Mechanism of Action: Increase respiratory tract fluid to help liquefy and reduce viscosity of thick tenacious secretions E.g. Resyl, Robitussin, Benadryl, Mucomyst, Mucosolvan, Loviscol Nursing Consideration: 1. Patient should not smoke 2. Avoid driving 3. Do deep breathing exercises 4. Encourage fluid intake to help liquefy secretions



b. Anti-tussive or cough suppressant drug that suppress cough reflex but are used usually when cough is non-purulent; best given in liquid USES: Suppress non-productive cough Mechanism of Action: Has direct effect on cough center in brain to suppress cough reflex Examples: 1. Dextromethorphan hydrobromide: Rondec DM, Trind DM, Robitussin DM 2. Codeine Phosphate c. Decongestant drug used to shrink engorged mucous membrane of the nose USES: for nasal congestion Mechanism of Action: Shrink engorged mucous membrane by vasoconstriction Two kinds: a. Topical nasal drops b. Systemic PO Exmples: Trind DM, Ornade Spansule, Sinutab, Drexin

II. FLUIDS AND ELECTROLYTE IMBALANCE A. Calories nutritional substances which furnish calories to be utilized as energy sources in metabolism USES: 1. Supplies calories in patient who cannot maintain adequate oral calorie intake 2. Partial fluid replacement Examples: With electrolyte added 1. Dextrose 5% in water 2. Isolyte M 3. Ionosol MB 4. Normosol R 5. Lactated Ringers Solution LRS 6. 0.3 % NaCl B. Electrolyte Replacement solutions used to replace the lost anions or cations or prevent their depletion. Replacement of specific anion and cation Examples: -Calcium a. Calcium Sandoz effervescent (PO) b. Calcium gluconate (incorporated to IV) c. Calcium chloride -Sodium a. 3% NaCl IV solution b. 0.9% NaCl IV solution -Potassium Chloride a. Kcl (incorporated to IV) b. Food high in K (banana, oranges) -Magnessium a. Magnessium sulfate (given deep IM) C. Oral Rehydration solutions taken orally to replace lost electrolytes Examples: Pedialyte, Oresol, Gatorade (commercial) D. Peritoneal dialysis a minor operation done to remove toxic substance from the body as in case of renal failure; acts by principle of osmosis and diffusion

Dialyzing fluid the solution used that resembles electrolyte composition of blood plasma Example: Inpersol Nursing Considerations 1. 1-2 L of solution is allowed to run rapidly (10-20 mins) 2. Solution remain in peritoneal cavity for 15-30 mins 3. Solution is allowed to flow out 4. Outflow should approximate inflow 5. Repeated for 12-36 hours 6. 30-50 liters is usually exchanged 7. Monitor VS closely 8. Abdominal pain may indicate or build up fluid due to incomplete outflow 9. Accurate recording is necessary

III. DISTURBANCES IN METABOLISM A. Nutrition 1. Vitamins substances present in minute amount found in natural food. They are not synthesized by the human body. USES: 1. Promote normal growth and development and nutrition 2. Maintain and restore health 3. Overcome specific deficiencies Two main categories 1. Fat soluble vitamins Vitamin A, D, E, K require bile, fat, pancreatic secretion for absorption 2. Water soluble vitamins Vitamin B complex, Vitamin C Fat Soluble Vitamins 1. Vitamin A fat soluble vitamin which is unstable and readily destroyed by oxidation Uses: 1. Proper maintenance of epithelial 2. Proper visual functioning Vitamin A deficiency would result in: a. Keratosis dryness and roughness of skin b. Xerophthalmia eye disease in which eyeball dries and atrophies (leads to blindness) c. Night blindness nyctalopia Sources: a. Liver, yellow vegetables, milk, egg, butter b. Alaxin 2. Vitamin D Sunshine vitamin Uses: Regulates the metabolism of calcium and phosphorus in the body Vitamin D deficiency would result to: a. Rickets disease manifested by improper tooth and bone development b. Osteomalacia softening of bone, becomes flexible and twisted deformity Sources: a. Milk and milk products b. Sunshine c. Calciferol

3. Vitamin E fertility Uses: a. For fertility b. For virility Sources: a. Wheat germ, vegetable oil b. Synthetic Vitamin E 4. Vitamin K Antihemorrhagic vitamin Uses: a. Treat or prevent bleeding tendencies b. As coagulant Vitamin K deficiency would result to: a. Prolonged clotting time of blood b. Hemorrhagic tendencies Sources: a. Tomotoes, milk, egg b. Aquamephyton, Vitamin K, Synkavit Water Soluble Vitamins 1. Vitamins B divided and subdivided into several types a) Thiamine Vit B1 Anti beri beri vitamin Uses = treat beri beri = treat pellagra B1 deficiency would lead to = tendency to edema = neuritis, neuralgia = muscular weakness Sources: = beef, liver, legumes = Thiamine HCL PO or IM b) Riboflavin Vit B2 Use: Play a role in carbohydrates (protein metabolism) B2 definciency would result to = vascularization of cornea = glossitis tongue is painful = lip lesion Sources: = egg, yeast, milk = Riboflavin c) Pyridoxine Vit B6 Uses: = as co enzymes in metabolism of amino acids = utilization of essential fatty acid B6 deficiency = dermatitis = skin oral lesion d) Cobalamine B12 very impotant anti anemic vitamin

Use: treat pernicious enemia B12 definciency =pernicious enemia Sources: = milk, fish, lean, meat = Rubramin e) Nicotiric Acid or Niacin Uses: = as a vasodilator in peripheral vascular disease = treatment of pellagra Deficiency = pellagra Sources = liver ,yeast ,eggs, cereals = Niacin,Nicotinic Acid f) Folic Acid Uses: = essential in blood = treat marcocytis anemia Deficiency: = glossitis, anemia g) Panthothenic acid, Cholin, Biotin essential for proper metabolic process of the body 2. Vitamin C Ascorbic acid Uses: = essential for growth = needed for formation of teeth and body = maintain intercellular cement substance = promote and repair of damage tissue and healing wounds and destroyed by heat Deficiency = capillary fragility = scurvy = bleeding gums Sources: = citrus fruits, tomotoes, guavas = ce-vi-sol, ascorbic acid 2. Minerals a. Calcium Phosphorus Uses: 1. Needed in proper development and maintenance for bone and teeth 2. Maintenance of general body cell activity Deficiency 1. Rickets and osteomalacia 2. Osteoporosis calcium and phosphorus are absorbed but fail be deposited in the bones 3. Renal osteopathy acidosis causes excessive calcium and phosphorus absorption from the bones and last in the urine. 4. Tetany low calcium level would result in increased excitability or peripheral nerve that would result in muscle cramp leading to tonic muscle contraction. Sources: 1. Milk and milk products

2. Calcium lactate PO 3. Calcium gluconate IM b. Iron Uses: Treatment of iron deficiency anemia (hypochromic type) - *Tarry stool is expected Sources: 1. Meat, eggs, legumes 2. Ferrous sulfate (FeSO4) PO; Jectofer, Imperon 3. Organ meat c. Iodine used in proper functioning of thyroid Sources: a. Seafoods b. Lugols solutions 3. Total Parenteral Nutrition (TPN) method of providing complete nutrition by IV route. As much 7, 000 calories/day is given. Use: Given to patient who is unable to maintain nutrition adequate for metabolic need as in chronic diarrheal state or inflammatory bowel/disease. Component 1) Nitrogen 2) Glucose

3) Electrolyte 4) Vitamins

5) Minerals 6) Amino Acid

B. Gastro Intestinal Tract Disturbances 1. Antacid drugs used in the treatment of hyperacidity and peptic ulcer Uses: controls peptic ulcer or hyperacidity by neutralizing the gastic acidity in the stomach Examples: MOM , Riopan , Cremalin , Galusil , Maalox 2. Antiflatulent drugs used to prevent or relieve flatulence Use: Relieve symptoms of acute gas in the stomach Mechanism of action: Acts in the stomach and intestine to form a film that causes air bubbles to collapes Examples: Festal, Digestalin 3. Absorbent drugs that inhibit gastro intestinal absorption of wide variety of drugs, chemical and toxin Use: As antidote in certain acute oral poisoning mechanism of action adhere to wide variety of drug thereby inhibiting absorption of this agent from GI tract. Not absorbed but excreted unchanged in faces black stool Example: Charcocaps, Charcotabs 4. Anti Cholinergic drugs drugs that inhibit gastro intestinal absorption of wide variety of drug thereby inhibiting absorption of these agent from GI tract Uses: a. Treatment of peptic ulcer b. Pre operative medication c. Mydriatics d. Artispasmodic Mechanism of action: a. Decrease of motility of GI tract b. Delay emptying time of the stomach c. Decrease gastric secretion Examples: Atrropine S04, Librax, Behytl , Donnatal Side effect: dryness of mouth

5. Antipasmodic drugs that relieve spasm of smooth muscle Uses : a. Gastro intestinal colic b. Neurogenic bladder Example: Spasmocibalgin 6. Anti-diarrheal - drugs used to control diarrhea Uses : a. Inhibit peristaltic activity b. Absorption of toxic substances c. Suppression of enterophatic organism Example : lomotil , Immodium, Lormide, Kaopectate, Humagel 7. Emetics drug that will induce vomiting Use: Ingestion of poisonous substances Example: Ipecac Syrup 8. Anti emetic drugs used in the relief and treatment of nausea, vomiting vertigo Use: Treatment and prevention of nausea, vomiting and motion sickness Mechanism of action: Inhibit vestibular function and or suppression of the vomiting center Side Effects: drowsiness, blurring of vision Examples: Bonamine, Dramamine, Compazine 9. Cathartic or Laxative drug that promotes defecation or relieves constipation Uses: a. Relief of constipation b. Bowel evacuation before diagnostic x-ray c. Softening of stool to prevent straining during defecation Mechanism of action: a. Hydrate stool thereby increasing its bulk and water content b. Promote peristalsis which aids in the passage of the stool 10. Anti amoebic drugs used in the treatment of amoebiasis Use: Treats patient with intestinal and extra intestinal amoebic infestation Example: Flagyl, Furamide 11. Anti helmentics drugs used to treat infestation of various worms Use : Eradication of virous species of worm Example: Combatrin C. Hormonal Disturbances Hormones are substance secreted into the bloodstream by the ductless gland for regulation of body process. Uses of Hormones: 1. Replacement of therapy when gland do not secrete the needed hormone 2. In cases of stress when the bodys normal supply is insufficient 3. Used in retarding growth of certain types of cancer 4. Used as oral contraceptive 5. Anabolic drugs group of synthetic hormone used to promote tissue healing after long illness 1. Insulin hormone secreted by the islet of langerhans in the pancreas responsible for converting glycogen Use: In treatment of diabetes mellitus Mechanism of action: 1. Increase glucose transport across muscle and fat cell from the bloodstream thereby reducing blood sugar 2. Promotes conversion of glucose to its storage from Glycogen

Types of Insulin: Divided according to onset and duration Peak of Action 3 to 4 hours 12 to 24 hours 8 hours 8 hours 8 hours Duration of Action 6 to 8 hours 24 to 32 hours 24 hours 24 hours 24 to 32 hours

Quick acting regular Long lasting a) Protamine Zinc b) Eslobin Zinc c) NPH (Neutral Protamine Hagedorn) d) Lente or Semilente

Nursing Consideration a) Test urine before meals + -No insulin ++ - 5 units of regular insulin +++ - 10 units of regular insulin ++++ - 15 units of regular insulin b) Insulin usually given by subcutaneous route 90 degress because is destroyed by GI tract c) Rotate site of injection prevent atrophy of subcutaneous tissue d) Measure in unit match the unit being used with the insulin syringes e) Insulin should be kept cool refrigerated not frozen dont shake but warm by rolling hand f) Patients who are diabetic should always carry sugar with them. In the hospital provide sugar or any juice ready to bedside g) Strict aseptic technique is essential h) Watch out for sign of insulin toxicity or insulin shock of hypoglycemic shock, such a Nervousness - Drowsiness Weakness - Mental confusion Cold clammy skin - Stuper Blurred vision - Convulsion When these symptoms occurs with the diabetic patient give sugar or fruit juices or 50% dextrose 2. Oral hypoglycemic agent or anti- diabetic drugs Use mechanism of action same as insulin Example: Orinase , Diabianese , Dymelor , Tolinase 3. Thyroid hormone hormone secreted by thyroid gland whose active principles is thyroxine which contains iodine that is essential for the proper functioning of the general body metabolism Uses : a. Replacement therapy in treatment of myxedema cretirism or simple goiter b. Treatment of confirmed hypothyroidism Mechanism of action a. Thyroid hormone affects the rate metabolism, growth and development via calorigenic and protein anabolic effect. It increase rate of oxidation in the cell, thereby increasing rate expenditure and heat production. Example: Proloid , Thyroxine 4. Anti-thyroid drugs drugs that suppress or inhibit the production of thyroid hormone .they do not Counteract the effect of the circulating thyroid hormone Uses: a. Treat hyperthyroidism, thyroiditis b. Treat thyrotoxicsis c. Prepare patient for surgery Mechanism of action a. They block the organic biding of iodine in into thyroglobulin to form thyroid hormones b. Iodine block the release of thyroid hormone Example: Tapazole , Lugols solution

5. Pituitary hormone secretion of the anterior and posterior of the pituitary gland (hypophysis) it is composed of the anterior lobe Hyperpitutarism: would result in gigantism or acromegaly Hypopituitarism: would result in dwarfism >Five know hormones secreted by anterior pituitary a) Growth hormone somototropin (GH) controls general body growth and bone growth. b) Thyroid stimulating hormone (TSH) increased the activity of thyroid gland and causes it to release thyroid hormone. c) Adrenocorticotropic hormone (ACTH) stimulate adrenal cortex to release corticosteroids (used in treatment of gout, rheumatic lupus erythematosus) d) Follicle stimulating hormone (FSH) = Female responsible for development of graffian follicle in ovaries = Male increase size of seminiferous tubules e) Luteinizing Hormone (LH) or interstitial cell stimulating hormone (ICSH) = Female controls for development of corpus luteum after follicle has ruptured = Male stimulates interstitial cell of testes to produce male sex hormones testosterones Two hormones secreted by posterior pituitary 1. Oxytocin direct stimulating action on uterine muscles causing uterus to contract Uses: a) To induce labor b) Contracts uterus and reduce hemorrhage after delivery Examples : Methergin , Syntocinon, Ergotrate 2. Vasopressin or ADH Pressor effect cause peripheral vascular constriction Antidiuretic effect increase renal water absorption Use: Treatment of symptoms of diabetes insipidus Adrenal Gland located above kidney >Adrenal Medulla secretes a hormone called epinephrine Action of epinephrine a) Increase heart rate b) Increase blood pressure c) Cause dilation of pupils > Adrenal Cortex secret hormone called corticosteroids Two Categories of corticosteroids a) Glucocorticoid stimulates conversion of protein to carbohydrates: stop inflammation b) Mineralcorticoids cause kidney to retain Na and excrete K Uses: a. Treatment of adrenal insufficiency b. Suppression of inflammation in rheumatic fever, collagen and nephrotic syndrome c. Suppression of inflammatory reaction in food and drug allergies d. Relief of cerebral edema after surgery e. Emergency treatment of shock and anaphylaxis f. Anti inflammation effect in organ and tissue transplant preventing rejection g. Adjunctive therapy in some form of cancer Mechanism of action a. Stabilizes the cell membrane, inhibit release of proteolythc ehzymes thereby preventing normal inflammatory response b. Interfere with the immune and allergic response by decreasing number of lymphocytes, eosinophils in the blood c. Mineral corticoid act on distal tubule of kidney to promote reabsorption of Na ions and increase urinary excretion of K. Example : Prednisone, Celstone, Hydrocortesine, Decadrone Side effects in prolong use of steroids

a) Cushingoid syndrome type of obesity in which fat is distributed to shoulder causing buffalo hump, in face moonfaced and around waist b) Hirsutism, acne c) Growth suppression in children d) Headache, vertigo e) Slow wound healing f) Depression Hypofunction of adrenal cortex cause condition known as Adddisons disease Hypersecretion of adrenal cortex cause condition known as Cushing syndrome 3) Adrenal Steroid drug that resembles in action and chemical properties the secretion of adrenal cortex. Examples: Dexametahasone decadron; Hydrocortesone solu-cortef IV. DISTURBANCE IN SEXUALITY AND REPRODUCTION 1) Sex hormones A) Female Hormone a) Estrogen - natural hormones secreted by the ovaries essential for secondary sex characteristics of female and for maintaining normal menstrual cycle Uses : 1) Correction of hormonal imbalance 2) Replacement therapy in menopause and after complete hysterectomy 3) Relieve pain form post partum breast engorgement 4) Inhibit lactation by inhibiting lactogenic hormone 5) Treatment of sexual infantilism Example: Depo-estradoil, Premarin, Trace, Stlbestrol b) Progesterone ovarian hormone secreted by corpus luteum during last half of menstrual cycle. It causes swelling and development of endometrium to prepare uterus for implantation of endometrium to prepare uterus for implantation of fertilized ovum Progesterone meaning for gestation is also secreted by placenta during pregnancy that help Decrease uterine contraction which prevent spontaneous abortion Prepare breast for lactation Cause cell to develop in endometrium which nourishes young embryo Uses: 1) Treatment of dysfunctional uterine bleeding amenorrhea 2) Treatment of endometriosis Nursing Consideration: Both are contraindicated for patient with history of cancer of breast or reproductive organ. B) Male Hormone a) Androgen natural or synthetic male hormone (Testosterone) responsible for the development of secondary male sex characteristics as facial and body hair, deep voice muscle development Uses : 1) Treatment of sexual infantilism 2) As anabolic agent to promote muscular growth and weight gain 3) Use in female to treat menstrual disorder as menorrhagia, premenstrual tension 4) To suppress lactation treat breast engorgement 2) Oxytoxics drugs from plants or synthetic that are used for their effect on smooth muscle of the uterus and constriction of peripheral blood vessel Uses: a) To induce labor b) Prevention and treatment of post-partum hemorrhage

c) Relieve migraine and other vascular headache Mechanism of action: Hasten uterine contraction thereby lessening bleeding Fertility drugs drugs used to enhance fertility and increase chance of pregnancy in anovulatory woman Mechanism of action: It appears to increase the output of pituitary gonadotropin which in turn stimulates the maturation and endocrine activity of the ovarian follicle and subsequent development and function of corpus luteum Example : Clomid, Pergonal Nursing Consideration: a) Contraindicated in presence of ovarian cyst since further enlargement of ovary may occur b) Incidence of multiple pregnancy has increased 4) Anti-fertility drugs or oral contraceptive drugs that prevent ovulation Mechanism of action a) Inhibit secretion of pituitary gonadtropin by maintaining high blood level of estrogen and progesterone there is inhibition of FSH, ovarian follicle cannot mature, ovulation cant take place. b) Cause thickening of cervical mucus which inhibit sperm movement Uses: 1. Prevent conception 2. Treat menstrual disorder as dysmenorrhea, menorrhagia Example: Estrogen and progesterone combination - Ovulen, Ovral INFLAMMATORY AND IMMUNOLOGIC DISTURBANCES 1) Anti-inflammatory drugs drugs that are uses in the treatment of inflammation and in condition characterized by inflammatory process. It also relieves itching and constricts blood vessel. They encompass wide pharmacologic spectrum salicylates corticosteroid anti inflammatory enzymes Uses : a) Reduction of inflammation in chronic or recurrent inflammatory condition b) Treatment of cronic inflammatory dermatoses. Such eczema, psoriasis,contact dermatitis Example: Prednisone, Papase, Diprosene cream, Betnovate 2) Enzymes complex proteins that hastens or induce chemical without being changed themselves Uses: a) To reduce swelling in trauma b) To liquefy pus c) To promote drainage d) To soften mucus e) To clean wound of dread tissue f) To dissolve fibrin and clots g) To improve some inflammatory condition f) To reduce inflammation and edema after surgery Example : Papase , Varidose Anti inflammatory enzymes that are helpful in reduction in inflammation and edema Example: Chemolose, Papase 3) Anti histamines or anti - allergies drugs that will block or counteract the effect of histamines. > Histamines - natural constituent of many tissues both plants and animals, released by stimulation of either physical or chemical nature causing symptoms of allergic response as watery eyes, sneezing, coryza, rashes, bronchiolar constriction Uses: a. Symptomatic relief of allergic rhinitis b. Treatment of mild urticaria or pruritus c. Treatment of minor allergic reaction d. Sedation e. Prevention of motion sickness

Example: Tacaryl, Benadryl, Phenegran, Chlortrimeton Anti histamine decongestant combination Example: Actifed , Drixine, rondec C, Dimetapp, Tuss Ornade 4) Immunization - artificial introduction of antigen into the body, it is done in the following ways: a. Introduction of living virulent organism b. Introduction of attenuated organism those are alive but no longer capable of producing the disease c. The use of dead organism d. Secretion such as exotoxins > Immunity - is said to exist when the level circulating anti bodies against specific information is high enough so that the individual is not susceptible to that infection Drugs - used to promote immunity 1) Active immunity a) Vaccine - killed attenuated microganisms that are not strong enough to cause the disease but which will trigger the immune procces, antigen-antibody formation b) Toxoid substances containing exotoxins that has been treated which chemical or heat so that they are no longer poisonous but which is still able to induce formation of antibodies Uses: 1) Prevention of certain infectious disease and childhood disease such as mumps, measles, pertussis, poliomyelitis 2) Prevention of disease transmitted through injury or animal bite such as tetanus or rabies 2) Passive immunity a) Antitoxin and antivenoms substances obtained from blood or person or animal who have had the disease Uses: a) Prevention and treatment of bacterial toxin infection b) Treatment of symtoms caused by insects,spider and snake bites b) Immune Serum Globulin (Gamma Globulin) preparation made from plasma or serum of hyper immunized donors that contains these antibodies.They are normally present in adult human blood Use - prevention of various infectious disease Active immunizations 1. Diptheria Toxoid sterile solution of formaldehyde treated toxin product from corynabacteium Diphtheria given 3 doses at 1cc IM qt 4 6 weeks interval. 2. Tetanous toxoid sterile solution of treated toxins products from clostridium tetany doses -0.5cc IM at 3-4 weeks interval 3. Polio Vaccine a. Salk vaccine 1cc. IM 4 -6 weeks interval x 3doses b. Sabine vaccine given orally 4. Typhoid vaccines suspension of killed typhoid bacilli - 3 doses of 0.5cc subcutaneously at 7-28 days interval 5. Measles vaccines (Lirugen) suspension of live attenuated rubeola virus one simple dose of 0.5cc subcutaneous 6. MMR vaccine measles, mumps, rubella vaccine one simple dose vial given subcutaneous 7. Cholera suspension of killed vibrio organism 0.5cc IM followed in 7-10 days by 1cc IM 8. Rabies vaccine preparation of killed fixed virus which has been grown in duck embryo tissues 1cc subcutaneous daily for 14 days - Given before rabies virus attack nervous system - Observe dog if there are signs of rabies-gives vaccine right away - If symptoms have occur, vaccine is useless 9. BCG Bacilles, Calmette, Guerin vaccine against PTB 0.05 cc intradermally

> Side effects in almost all vaccines and toxoids: a) low mild fever, malaise, pain, edema, redness at injection site. Passive Immunization 1. Diphtheria antitoxin sterile concentrated isotonic solution of antitoxinbearing globulins from plasma of horses immunized with diphtheria toxoid and toxin Prophylactic dose 10.000 u IM Therapeutic dose 10.000 u 200.000 u IM or IV 2. Tetanus antitoxin obtained from human of horse serum Prophylactic dose 5,000 10,000 u IM Therapeutic dose 40, 00 60,00 u IM 3. Gas gangrene antitoxin Prophylactic dose 5,000 - 10,000 u IM Therapeutic dose 20,00 60,00 u IM VI. DISTURBANCES IN PERCEPTION AND CORDINATION A. Neurologic 1) CNS stimulant drugs that increase or enhance the cognitive function in the central nervous system; such as: a) Stimulant exerting effect on cerebal cortex useful for increasing alertness, wakefulness and mental activity Example - Caffeine, Amphetamine b) Stimulant that effect medullary centers used to stimulate vomiting and respiratory center Examples Nikethamide (Coramine), Apomorphine Uses: a) Treatment of mental depression, exhaustion b) Treatment of narcolepcy and catalepcy c) Appetite suppression and weight reduction by stimulation of pre-frontal lobe which affect satiety center of hypothalamus 2) CNS depressant drugs that cause depression of central nervous system. Action would depend on what area of the brain is involved a) Analgesic b) Sedative c) Anticonvulsant d) Anesthetics 3) Parasympatomimetics or Cholinergics drug that stimulate the parasympathetics system. Uses: a) Diagnosed and treat myasthenia gravis b) Prevent post operative abdominal distention c) Treat post operative atony of the bladder and urinary retention d) Constricts pupils of the eyes to produce miosis Mechanism of action: It stimulates or increases the effect of acetylcholine Example: Prostigmine, Neostigmine,Pilocarpine 4) Sympathomimetics or Adrenergic drugs that stimulate the sympathetic system Uses: a) Treatment of circulatory emergencies like cardiogenic shock cardiac output is increased, force and rate of cardiac beat is increased, blood pressure in increased b) Treatment of bronchial asthma c) Control local hemorrhage

d) Treatment of rhinitis e) Treatment of allergic response Mechanical of action: Stimulate or increase the effect of epinephrine Example: Intropin, Ephedrine, Adreline, Aramine 5) Sympatholytics or Adrenergic BLOCKERS drugs that inhibit or decrease the effect of epinephrine Uses: a) Treatment of peripheral vascular disease b) Treatment of vascular headache Mechanism of action: Block of epinephrine Examples: Ergotamine (Cafergot) 6) Neuromuscular blocking agents drugs used for the relief of muscle spasm give parenteral Uses : a) Symptomatic control of muscle spasm in convulsive state of tetanus or epilepsy b) Facilities intubation c) Potentiation of surgical anesthesia Mechanism of action: Blocks transmission of nerve impulse at skeletal neuromuscular junction B. Eyes 1) Miotic - drugs that cause papillary constriction (miosis) Uses: a) Treatment of glaucoma b) Treatment after ocular surgery Mechanism of action: Cholinergics cause contraction of sphincter/ ciliary muscle of iris resulting in pupillary constriction Examples: Pilocarpine, Carbacil, Alphagam 2) Mydriatic - drug that cause papillary dilation and cycloplegia Uses: a) Diagnostic procedure requiring nydriasis or cycloplegia b) Use in acute iris inflammation Mechanism of action: Adrenergic dilates pupil by contraction of dilator muscle of iris Examples: Atropine Sulfate, Epinephrine HCL 3) Ophthalmic anti-infective drugs used the treatment of eye infection or inflammation. Uses: a) Treatment of surface bacterial infection b) Treatment of keratoconjunctivitis c) Prevention of gonorrheal opthalmia neonatorum d) Bacteriostatic irrigating solution Mechanism of action: a) It hihibits bacterial protein synthesis b) It interferes with viral DNA synthesis Examples: Chloromycetin Ophthalmia ointment, Silver Nitrate, Boric Acid, Maxitrol 4) Ophthalmic Anti-inflammatory agents drugs used to treat inflammatory ophthalmic disorder of the eyelid, conjunctiva and cornea Examples: Decadron Phosphate Ophthalmic Ointment 5) Carbonic Anhydrase inhibitors drugs that will cause depression of the rate of secretion of aqueous humor. It is used as supplement to miotic medication Uses: Treatment in glaucoma by reducing intra-ocular pressure Example: Diamox C. Nose

1) Nasal decongestant D. Ear 1) Otics - drugs used to treat infection, inflammation and pain of ear disorder Mechanism of action: a) Anti-infectives inhibit or destroy bacteria present in the ear b) Corticosteroid control inflammation, edema and pruritus Examples: Auralgan otic solution, Chloromycetin otic drops E. Musculo-Skeletal 1) Muscle relaxant drugs used for the relief of muscle spasm-giving oral Use: Relief of acute muscle spasm associated with trauma and inflammation Mechanism of action: a) Depress transmission of nerve impulses from spinal cord to skeletal muscle b) Directly inhibit muscle activation Examples: Robaxisal, Robaxin, Skelan, Anectine 2) Anti convulsant drugs used to treat, prevent, or reduce frequency or severity of seizures caused by epilepsy, eclampsia, meningitis and head trauma Uses: a) Treatment, prevention, reduction of severity of epileptic or non epileptic seizures b) Treatment of status epilepticus Mechanism of action: a) Depression of nerve tissue b) Inhibit carbonic abnormal neuronal discharge c) They reduce monosynaptic or polysyonatic impulse transmission thus decreasing excitability in the entire nerve cell Examples : Valium, Magnesium Sulfate, Phenobarbital ( Sodium Luminal), Dilantin 3) Anti-Parkinsonians drugs used to treat Parkinsons disease Example: Levodopa VI. ANTIBIOTICS substances produce by living cells that are detrimental to life of other organisms Classification according to activity against microorganism a) gram positive b) gram negative c) viral d) fungal e) broad spectrum antibiotic effective against 1 2 classes Classification according to susceptibility of invading organism a) Bacteriostatic - inhibitory action b) Bacterical lethal effect A) Penicillin broad spectrum or narrow spectrum anti- biotic which are primarily bacteridical in active concentration they are soluble. Nontoxic and readily absorbed Uses: Highly effective against gram positive and gram negative cocci Mechanism of action: Act as inhibiting bacterial well synthesis during stage of actual multiplication Examples : a) Ampicillin Penbritin, Pensyn, Flexil b)Pen-G-Sodium c) Compocillin d) Prostaphillin

B. Cephalosporin semi-synthetic anti-biotic, active against most gram positive organism. It acts both as bacterial and bacteriostatic agens Uses: a) Treat infection of respiratory tract ,genetic-urinary tract ,septicemia b) Treat gram positive cocci Mechanism of action: Inhibit cell wall synthesis Examples: Ceporex, Keflex, Keflin C .Tetracycline broad spectrum antibiotic that is primarily bacteriostatic Uses: a) Treat gram positive organism that are resistant of penicillin b) Effective in some anaerobic infection c) Alternative treatment of both gonorrhea and synthesis Mechanism of action: Inhibit protein synthesis Examples: Terramycin, Vibramycin, Ledermycin,Tetrex D. Sulfonamides effective against gram positive and gram negative bacteria including E.coli Use: a) Treat urinary tract infection b) Provide pre-operative and post-operative suppression of bowel flora c) Treatment of ulcerative colitis Mechanism of action interfere with bacterial synthesis of folic-acid thereby inhibiting growth and multiplication of bacterial Examples: Azo-gantrisin,sulfazalazine E. Chloramphenicols effective against Salmonella typhi infection Side effect - blood dyscarias (IV and orally) Example Chloromycetin Succinate F. Erythromycin agents used to treat acute pelvic inflammatory disease Example - Erythrocin, Iloson, Rulid G. Aminoglycoside broad spectrum bacterial antibiotic used for serious life threatening infection Examples: Amikacin, Kantrex, Gentamicin Nursing consideration in all antibiotic 1) For parenteral administration skin testing is necessary 2) Punctual administration to maintain blood level of the medicine 3) Usually given 10- 14 days H. Other Chemotherapeutics 1) Anti TB drug drugs effective on the growing tubercle bacilli Use treat and prevent all forms of tuberculosis Mechanism of action inhibit DNA and protein synthesis in susceptible organism Examples: INH (isoniazid), PAS (para-aminosalicylic acid), Rifampin, Streptomycin Sulfate, Pyrazinamide 2) Anti leprotics agents that has a bacteriostatic effect on mycobacterium leprae. Use to treat all forms of leprosy Example: Dapsone 3) Anti-malarial drugs used for both prophylaxis and treatment of malaria Use provide treatment of acute attacks of malaria Examples: Aralen, Camoquin

4) Anti-fungal drugs with fungistatic and fungicidal properties Uses: a) Treat severe fungal infection caused by candida b) Treat monilial infection of oral cavities (thrush) c) Treat monilial infection of vaginal and intestinal tract Examples: Mycostatin oral suspension, Mycostatin vaginal suppository 5) Urinary tract germicides are anti-bacterial drugs concentrated in renal tubules and other areas of kidney and bladder Uses bacteriuria, cystitis, pyelonephritis Examples: Azo-gantrizin, Mandelamine, Macrodantin VII. DRUGS USED FOR RELIEF OF PAIN A) Analgesic drug that relieve pain, without producing loss of consciousness, do not cause tolerance or addiction Example: Aspirin, Ponstan Mechanism of action depression of peripheral chemoreceptors to block pain impulse B) Antipyretics drugs that relieve or reduce fever mechanism of hypothalamus to reduce the fever Example: Tempra, Biogesic, Tylenol, Medicol C) Salicylates group of analgesic derived from salicylate acid frequently used in the treatment of arthritis and rheumatic fever, it also relieves symptoms of inflammation, pain, fever Examples: Ascriptin, Aspirin, Doloxene Nursing Considerations 1) Salicylates are irritating to the gastric mucosa and cause gastric irritation 2) Watch out for salicylates toxity, such as- nausea, tinnitus (ringing of ears), vomiting, headache D) Narcotic Analgesics drugs - that will relieved pain without producing loss of consciousness but may cause physical and psychologic dependence. They are controlled substances Uses: a) Relief of moderate to severe pain b) Pre-operative sedation alone or in combination with tranquilizer Mechanism of action: Acts on the sensory cortex of the brain to produce analgesia Example: Codeine Sulfate, Morphine S04, Demerol E) Narcotic Antagonist drugs used to reverse or antagonize action caused by narcotics Uses as antidote for narcotic overdose reverse the respiratory depression Mechanism of action: It competes with narcotic for the receptor site Examples: Narcan, Nalline HCI VIII. MAL-ADAPTIVE BEHAVIOR PATTERN, A. Tranquilizer drugs that relive emotional tension usually without impairing mental ability Uses: 1) Treat symptoms associated with neuropsychiatric condition as manic depression 2) Control of anxiety associated with other condition such as peptic ulcer, asthma, menopausal anxiety 3) Treat nausea and vomiting Two groups Major tranquallizer more potent and action more effective in treatment of major Psychiatric disorder and more likely to cause serious side effects Examples: Thorazine, Sparine, Compazine Minor tranquilizer Examples: Librium, Miltown, Valium, Equanil

B. Anti-depressant or Psych energizer drug whose main action is relieve symptoms of depression making patient more energetic and communicative Uses: 1) Treat symptoms associated with psychiatric disorder 2) Control appetite in treatment of obesity Examples: Benzedrine, Doxedrine, Tofranil C. Hypnotic Sedative Sedative drugs use to calm or dispel anxiety or hyperactivity by mild depression of higher brain center Hypnotic drug used to induce sleep Examples: Palmate, Nembutal Sedative becomes a hypnotic when given in a larger dose Example: Choral Hydrate Types of sedative hypnotic 1) Barbiturates drugs that depress CNS, it is used as sedative in small doses and hypnotic in larger doses Examples: Amytal, Seconal, Pentothal, Nembutal 2) Chloral hydrate relieve withdrawal symptoms in alcohol and narcotic addiction Uses of Sedative Hypnotic a) Treatment of insomnia before an operative or diagnostic procedure b) Sedation and relief of anxiety c) Alleviate alcohol withdrawal syndrome d) Prevent nausea and vomiting Mechanism of action: Depression of CNS D. Anesthesia 1) Local anesthesia drug that cause temporary loss of feeling and motor activity without loss of consciousness Uses: a) Infiltration anesthesia in dental and minor surgical procedure b) Used in regional spinal and caudal anesthesia Mechanism of action: Prevention of nerve impulse generation and conduction Examples: Pontoccaine, Xyloccaine, Novocaine 2) General Anesthesia agents that produce unconsciousness: given rectally, IV or by inhalation Mechanism of action: Depression of CNS Examples: Ketalar, Sodium , Pentothal IX. CELLULAR ABERRATIONS A. Antineoplastic Drugs drugs used to destroy cancer cells in the body or inhibit cell division or Inhibit cell division Classification 1) Alkylating Drugs - drugs used in the treatment of sarcomas, lymphomas, leukemias Mechanism of action: a) Interfere with cell function as synthesis and respiration b) Attack nucleoproteins that are essential for all cell division thereby inhibit replication Examples: Nitrogen mustard, Cytoxan, mylaran 2) Antimetabolites drugs used in the treatment of choriocarcinoma, leukemia, osteogenic cancer Mechanism of action a) Interfere with the normal metabolism of cell b) Interfere with pattern synthesis, they prevent cells from reproducing and surviving

Three groups of metabolites a) Folic Acid antagonist inhibit enzyzmes that prevent reduction of folic acid to tethahydrolic acid Inhibit Example Methotrexate b) Purine Antagonist interferes with the synthesis of purine necessary for formation of nucleic acid c) Pyramidine Antagonist inhibit pyramidine necessary for growth development of abnormal cell 3) Hormones drugs that are used for palliative effect in breast and endomentrial cancer Mechanism of action a) Inhibit neoplastic cell growth in reproductive organ by creating unfavorable environment b) Inhibit changes in hormonal balance of the body Examples: Mehace, Teslac 4) Radioactive Isoptopes Mechanism of action: Destroy or inhibit cell by radioactive particle emission when beta or gamma particles hit the tissue, it will cause ionization of tissue fluid and gaseous molecules will lead to chaotic interaction eventually death of tissue. Millie Currie (MC) - unit of measurement of radioactive isotopes Example: Radioactive lodine 1 131 a) Used for thyroid disease b) Palliative treatment in thyroid cancer c) Diagnosis of thyroid function Nursing Consideration a) Knowledge of half life so you will know when to discontinue precaution b) Knowledge of biological activity and behavior or substance c) Time spent with the patient should be minimal d) Distance should be considered talk to the patient in the doorway e) WEAR PROTECTIVE SHIELD 5) Alkaloids drugs derived from periwinkle plants Mechanism of action a) High concentration of vinca alkaloids will alter nuclei acid and protein synthesis b) Asparaginase breakdown amino acid resulting in tumor cell Example: Vincristin Oncovin 6) Antineoplastic Antibiotic drugs used to treat lymphomas, Sacromas, leukemias Mechanism of action: inhibit DNA and RNA synthesis thereby inhibiting proper cell division Example: Pactinomtcin, Mithracin X. DIAGNOSTIC AGENTS Classification: 1) X-ray Opaque Drugs drugs used to aid physician in demonstration of abnormal condition Uses: Demonstrate gastrointestinal disorder as gastric duodenal ulcer, cancer, adhesions and diverticuli Examples: Barium, Bismuth 2) Drugs used to stimulate the secretions of various glandular substances Examples: Bromsulphalein to test the function of the liver 3) Radioactive Subtances - used to locate disease area because of their affinity for specific body tissues References: 1) Essential Drugs List by the Department of health 2) Karch, Amy M. focus on Nursing Pharmacology, 2 Ed. Lippincott Williams and Wilkins A Wolters Kluwer Company: Philadelphia,2004 3) Nurses Drug Handbook

4) PIMS MIMS 5) Other Pharmacology of Nursing Textbooks ELVIE A. IMASON, MAN, MN, RN Clinical Coordinator