PHARMACOLOGY

A. General Principles
B. Administration of:
1. Oral
2. Parenteral
3. Opthalmic
4. Otic
5. Topical
6. Vaginal
7. Rectal
 NERVOUS SYSTEM

CNS PN
S

BRAIN SPINAL SOMATIC AUTONOMI

CORD C

PARASYMPATHETI SYMPATHETIC
C (cholinergic) (adrenergic) NE
ACH
 AUTONOMIC

Cholinergic adrenergic
(parasympathomimetic) (sympathomimeti
Bethanecol, carbachol, c)
methacoline, *Norepinephrine
*Epinephrine
neostigmine,
*Dopamine
physostigmine
Cholinergic blockers Adrenergic
(parasympatholytic) blockers
(sympatholytics)
=antimuscarinic drugs * Propranolol
*catecholamines
*belladona alkaloids
(atropine &
scopolamine)
1. NARCOTIC AGONISTS

2. NARCOTIC PARTIAL AGONISTS; NARCOTIC

ANTAGONISTS

3. NON-STEROIDAL ANTI-INFLAMMATORY

4. MISCELLANEOUS ANALGESIC AGENTS

Librium – watch for signs of leukopenia,
hypotension

Equanil – metabolizes extensively in the liver

&
interferes w/ liver function tests.
- decreases PT if on coumadin

Atarax - does not cause tolerance & can be

used
temporarily when other anti-anxiety
agents have been abused

Serax – useful for treating elderly clients.

BARBITURATES
*treat grandmal seizures ; tonic-clonic seizure

BENZODIAZEPINES
*diazepam is DOC for Rx of STATUS
EPILIPTICUS
*clorazepate is use w/ other antiepileptic
agents to control partial seizures

HYDANTOINS
*Used to depress abnormal neuronal charges
& prevent spread of seizures
*also used to treat dysrhythmias
*A/R: gingival hyperplasia, alopecia,
hyperglycemia, blood dyscracias
*Seizure precaution & dental hygiene
*Give IV with normal saline & never with
dextrose
AMPHETAMINES
increase the release of catecholamines (NE from stored
sites in nere terminals)
Block the re-uptake of dopamine & NE following
release into the synapse, & inhibit the action of MAO
Increase stimulating effect on cerebral cortex & RAS

DOXAPRAM (DOPRAM)

METHYLPHEMDATE Hcl (Ritalin)

PEMOLINE (Cylert)

CAFFEIN
DOPAMINERGIC MEDS
amantidine (Symmetrel); bromocriptine (Parlodel);
carbidopa-levodopa (Sinemet) ;trihexyphenidyl (artane)

*Increases the amount of dopamine in the brain

*A/R: involuntary body movements, urinary retention,

constipation, dizziness,

*For levodopa avoid vitamin B6 & eat low-CHON food

*Not to take in ROH & never to discontinue meds

abruptly

*Urine & perspiration may be discolored & stain clothing

but
this is harmless
*neostigmine bromide (Prostigmin), pyridostigmine
bromid (Mestinon) are used to control myasthenic
symptoms
-take meds on time…MG impairs breathing &
swallowing
-take a.c. for best absorption
-meds for life & wear Medic-Alert bracelet
*edrophonium chloride (Tensilon) is used to diagnose
myasthenia gravis & differentiate cholinergic crisis
(drug overdose)
-prepare resuscitative equipment & antidote: atropine
SO4
-dx as M.G. if client shows marked improvement in
muscle tone within 30-60 seconds after injection
lasting 4-5 mins
…positive Tensilon Test
-dx as cholinergic crisis when muscle tone does not
improve upon injection…negative Tensilon Test
benztropine mesylate (Cogentin), biperiden HCl
(Akineton) Trihexyphenidyl HCl (Artane), scopolamine,
atropine

*Block cholinergic receptors in the CNS, thereby

suppressing
acetylcholine activity

*A/R: blurred vision, dry mouth & secretions, urinary

retention,
constipation, restlessness & confusion

*Client to have regular eye check up for increase in IOP

*Avoid aspirin, caffeine, smoking & ROH to decrease

gastric
acidity
Antianxiety or anxiolytic agents
-zolam -zepam -zepate -zepoxide

Antidepressants
a. selective serotonin reuptake inhibitor
Fluoxetine (proxac), Paroxetine (Paxil),Sertraline hcl
(Zoloft)

b. tricyclic
Elavil, Vivactil, Sinequan, Aventyl, Tofranil,
Norpramin

c. MAOi
Marplan, Nardil, Parnate
* watch out for strokes!
Neuroleptic (antipsychotic) agents
* blocks dopamine receptors in basal ganglia of brain,
inhibitiing transmission of nerve impulses
a. phenothiazines (zines)
b. butyrophenones (peridol)
c. thioxanthenia (trixene)

antimanic and mood-stabilizing agents (LITHIUM)

*encourage diet containing normal amts of SALT &
FLUID intake of 3L/day

sedative and hypnotic agents

 MYDRIATICS &
CYCLOPLEGICS

Atropine, Epinephrine, Cyclogyl, &

Mydriacyl

*Used to facilitate eye exam & treat

uveitis

*A/R: photophobia, impaired distant

vision, increased IOP, blurred vision,
reduced lacrimation
 MIOTICS
CARpine, CARbachol, piloCARpine, demeCARium

*Cholinergic drug that causes miosis (contraction) of the

pupil & contraction of the ciliary muscle of the eye

*Decreases IOP in glaucoma & achieves miosis in cataract

surgery

*A/R low toxicity level: transient hypotension & decreased

heart rate, blurred vision & focusing difficulty

*Inhibit response to beta-adrenergic stimulation

*Block release of epi & NE thus decreasing HR & BP

*Used for angina, dysrhythmias, prevention of MI &

glaucoma

*A/R: bradycardia, hypotension, weakness & fatigue

*Hold if BP & HR not within parameters prescribed by MD

*Not to D/C meds abruptly…rebound HPN, tachycardia,

angina

*Early signs of hypoglycemia such as tachycardia &

nervousness can be masked by these drugs…monitor blood
sugar
 BETA- BLOCKING AGENTS

BETA1 ADRENERGIC ( CARDIO SELECTIVE)

BLOCKING AGENTS
-acebutolol (Sectral)
-atenolol (Tenormin, Atenol,
Premorphine)
-metoprolol (apo-metoprolol, betaloc)

BETA1 & 2 ADRENERGIC (nonselective)

BLOCKING AGENTS
-nadolol (corgard)
-pindolol (visken)
-propranolol( inderal, novopranol)
-timolol (blocadren, betin, temserin)
verapamil (Calan, Isoptin), nifedipine (Procardia)
felodipine (Plendil), diltiazem (Cardizem)

*Decrease cardiac contractility by relaxing smooth

muscle
and the workload of the heart…thus decreasing need for
O2

*Promote vasodilation of coronary & peripheral vessels

*A/R: bradycardia, hypotension, dizziness &

lightheadedness

*Instruct client how to take HR & to inform MD if

dizziness
persists
dobutamine (Dobutrex)
*Increases myocardial force & C.O. through beta
receptors
stimulation
*Used in clients with CHF
dopamine (Intropin)
*Increases BP & C.O. & increases renal outflow through
its
action on alpha & beta receptors
*Treat mild renal failure due to decreased C.O.
epinephrine (adrenalin)
*Cardiac stimulation during cardiac arrest,
bronchodilation
asthma & allergy, mydriasis
*Promotes vasoconstriction when combined with local
anesthetics to promote prolonged anesthetic action by
isoproterenol (Isuprel)
*Stimulates beta receptors & used for cardiac
stimulation &
bronchodilation

norepinephrine (Levophed)
*Stimulates heart in cardiac arrest
*Vasoconstricts & increases BP during hypotension &
shock

*A/R: tachycardia, angina, restlessness

*If extravasation occurs, infiltrate with normal saline &
 GUANETHIDINE, MINOXIDIL, OR
ANGIOTENSIN INHIBITORS

VASODILATOR AGENT

ADRENERGIC BLOCKING AGENT

BETA-BLOCKING AGENT

BETA-BLOCKING AGENT
DIURETIC

Weight reduction, sodium restriction elimination or limited

consumption of alcohol & tobacco, reduction of dietary saturated fats,
regular exercise program, behavior modification to promote relaxation
STEP 2 ADRENERGIC BLOCKING DRUGS

CENTRALLY ACTING SYMPATHOLYTICS

clonidine (Catapres), methyldopa (Aldomet)
*Stimulate alpha receptors in medulla causing
reduction in sympathetic action in heart; decreases rate to
inhibit vasoconstriction & reduce peripheral resistance
*A/R: Na & H2O retention, edema & hypotension
*Instruct client not to D/C meds rapidly because it will
cause rebound HPN
STEP 2 ADRENERGIC BLOCKING DRUGS

PERIPHERALLY-ACTING ALPHA ADRENERGIC

BLOCKERS

prazoline (Minipress), phentolamine

(Regitine)

*Decrease sympathetic vasoconstriction by reducing

the
effects of NE at the peripheral nerve endings,
resulting to vasodilation & decreased BP
*A/R: orthostatic hypotension, Na & H2O retention,
edema
and weight gain
 STEP 3 VASODILATOR

= exhibit direct action on the smooth muscle walls of

arterioles &/or veins
= stimulation of calcium binding process

1) ARTERIOLAR DILATORS (selective effect on arteries)

-diazoxide, hydralazine, minoxidil

2) ARTERIOLAR & VENOUS DILATORS

-Na nitroprusside.. Acts on arteriolar resistance &
venous capacitance
 STEP 4 ACE INHIBITORS

*Prevent peripheral vasoconstriction by blocking

conversion of angiotensin 1 to angiotensin 2
*Instruct client to take Capoten 20 minutes to 1
hour a.c.
*Not to D/C meds abruptly because it causes
rebound HPN
*If dizziness persist, report to MD
*Taste for food may be diminished during 1st
month of therapy
NITRATES
nitroglycerin (Nitrostat, Nitrolingual)
nitroglycerin ointment 2% (Nitrol, Transderm-Nitro)
*Produce vasodilation & improved myocardial O2
consumption
*C/I in client with severe hypotension
*A/R: H/A, orthostatic hypotension, dizziness, weakness &
faintness

SUBLINGUAL:
*Offer sips of H2O since dryness may inhibit absorption
*Leave under tongue until fully absorbed, not swallowed
*Take 1 tab for pain ff q5 mins for a total of 3 doses. If pain
not relieved in 15 minutes, seek MD help….. may indicate MI
*Stinging/burning feeling means tablet is fresh
TOPICAL
*Remove ointment from previous dose, rotate sites &
avoid
touching ointment & hairy areas
*Squeeze ribbon into prescribed length on applicator
paper
*Sites: chest, back, abdomen, upper arm & anterior
thigh

TRANSDERMAL PATCH
*Apply patch to hairless area, using new patch &
different
site every day
*Remove patch after 12-14 hours, allowing 10-12 “patch-
free” hours daily to prevent tolerance
*Stand away from microwave ovens
 GROUP 1

generally inhibit the fast sodium channel in

cardiac muscle resulting in an increased
refractory period

a. Disopyramide phosphate (NORPACE)

Procainimide hcl (PROCAN)
Quinidine (QUINIDEX)

b. Lidocaine (XYLOCAINE)

b. Flecainide
 GROUP 2

BETA BLOCKERS THAT DECREASE STIMULATION OF THE

HEART
Beta 1 selective antagonists=cardiogenic blockers;
block Beta1 cardiac
receptors
=atelonol (ternonim),
acebutolol sectral,
metoprolol (betaloc)

Beta 2 Selective = mucolytics & bronchodilators

Nonseletive Beta Adrenergic = beta1 & beta2 blockers
blocking agents = nadolol (corgard),
 GROUP 3
* generally do not affect depolarization but work by
prolonging cardiac repolarization
• Anti adrenergic; positive inotropic action
• Bretylium, amiodarone hcl (cordarone)

GROUP 4

• Calcium antagonist action= depression of heart &

smooth muscle contraction, decreased automaticity, &
decreased conduction velocity
• verapamil
Effects of digitalis
1. Positive inotrope
2. Negative chrono & negative dromo

DIGITALIZATION
*administration of layer dose of digitalis
preparation for an initial 24-48 hours

COMMON S/E
*weakness, fatigue, vomiting, diarrhea,
arrhythmia & PR < 60bts/min
DIGITALIS TOXICITY
* loss of apetite, nausea, extreme fatigue,
weakness of the arms & legs, psychiatric
disturbances (nightmares, agitation,
listlessness, or hallucination) or visual
disturbances ( hazy, or blurred vision, difficulty
reading & green color…)

N.I.

1. Take APICAL PULSE 1 full minute

*don’t give for Adult <60/min; child < 90
bts/min
*monitor potassium level specially diuretics
digoxin (Lanoxin)

*Inhibit sodium-potassium pump

*positive inotropic action

*negative chronotropic action

*A/R: anorexia, N/V, visual disturbances

*Monitor serum therapeutic level 0.5-2.0 ng/ml;

increased
risk of toxicity in clients with hypokalemia

*Used for CHF, atrial tachycardia, atrial fibrillation &

flutter
digoxin (Lanoxin)

*Increase K+ rich food: fresh & dried fruits, fruit juices,

vegetables & potatoes

*Monitor HR & hold if below 60 & above 100 (adults)

*Antidote: digoxin immune FAB (Digibind)

*Life threatening toxicity: ventricular tachycardia,

fibrillation, severe sinus bradycardia

*80% DIGOXIN excreted by kidneys; half life is 36-120H

*90% DIGITOXIN metabolized by liver; half life is 120-

210H
*Prevent the extension & formation of clots by
inhibiting
factors in the clotting cascade & decreasing blood
coagulability

*Used for thrombosis, pulmonary embolism & MI

*C/I in active bleeding except in disseminated

intravascular
coagulation (DIC), bleeding disorders, ulcers

*A/R: hemorrhage, hematuria, epistaxis, ecchymosis,

bleeding gums, thrombocytopenia
heparin Na (Liquaemin Na)

*Prevents thrombin from converting fibrinogen to

fibrin

*Prevents thromboembolism

*Therapeutic dose does not dissolve clots, but

prevents
new thrombus formation

*Blood levels: normal APTT is 20-36 seconds;

maintain APTT is 1.5-2.5 times normal;
APTT therapy should be measured q 4-
6H during initial therapy & then daily
heparin Na

*Monitor clotting time; normal is 8-15 minutes;

maintain
clotting time 15-20 minutes

*Observe for signs of bleeding

*Inject SQ into the abdomen with 25-28g at 90

degrees
angle; don’t aspirate or rub injection site

*Antidote is protamine SO4

warfarin Na (Coumadin)

*Decreases prothrombin activity & prevents the use of

vitamin K by the liver

*Used for long-term anticoagulation

*Prolongs clotting time & monitor PT (prothrombin

time)

*Used mainly to prevent thromboembolitic conditions

such
as thrombophlebitis, pulmonary embolism, embolism
caused by heart valve damage, atrial fibrillation & MI

*Given 2-3 months after an MI to prevent DVT

warfarin Na (Coumadin)

*Average PT is 9.6 to 11.8 seconds & normal INR is 1.3-2.0

Goal is to raise the INR to 2 to 3

*Observe for signs of bleeding

*Antidote: Vitamin K (AquaMEPHYTON)

THROMBOLYTIC MEDS

*Activates plasminogen which generates

plasmin

*Used 4-6 hrs after MI to restore blood flow,

limit myocardial damage, preserve left
ventricular function

*C/I: active bleeding, history of thoracic, pelvic

or abdominal surgery within the last 10 days

*A/R: bleeding & allergy

*Check APTT, PT, fibrinogen, platelet count

THROMBOLYTIC MEDS

*Monitor for bleeding, hypotension &

tachycardia

*Avoid injections; apply pressure to puncture

site for 20-30 minutes

*Handle clients minimally & let clients use

electric razors & brush teeth gently

*Antidote: aminocaproic acid (Amicar)

•FACTOR VIII
-replace the missing factor

*ANTIINHIBITOR COAGULANT COMPLEX

-made from pooled human plasma
-help correct clotting time in factor VIII

•FACTOR IX COMPLEX
-contains factor II, VII, IX & X
(vit K coagulant factor)
-hemophilia
SYSTEMIC HEMOSTATICS
aminocaproic acid (AMIKAR, EPSIKARON)
- competetive antagonist of plasminogen
- C/I in intravascular active clotting

TOPICAL HEMOSTATICS
- absorbable gelatin sponge (Gelfoam)
- absorbable gelatin film (Gelfilm)
- absorbable gelatin powder
- oxidized cellulose
*Reduce serum level of cholesterol,
triglycerides & low- density lipoprotein when
diet alone is not enough

*Elevated levels of these will place client at

high risk for CAD

*Restrict fats, cholesterol, carbohydrates &

ROH
BILE ACID SEQUESTRANTS
cholestyramine (Questran)
*Mix powder thoroughly with juice & H2O
*A/R: constipation & PUD

HMGCoA REDUCTASE INHIBITORS

atorvastatin (Lipitor)
simvastatin (Zocor)
*Check serum liver enzymes & eye exam annually for
cataract
OTHERS
clofibrate (Lopid)
*Don’t take with anticoagulants
 EXPECTORANT
-liquify mucus by stimulating secretion of natural
lubricant
*Ammonium chloride * KISS
*Gaifenesin (robitussin) * saline soltions
ANTITUSSIVE

-cough suppresant
* Codeine * dyphenhydramine * benzonatate

MUCOLYTIC

Decrease thickness of pulmonary secretions by acting

directly on mucus plugs
* Acetylcysteine (mucomyst)
* Used for allergic rhinitis, acute bronchospasm,
acute & chronic asthma, bronchitis, COPD,
emphysema

•Caution with clients with glaucoma & HPN

* A/R: palpitations, tachycardia, nervousness,

tremors, restlessness & HA
•Give RTC to maintain therapeutic blood level

* Avoid caffeine products

 SYMPATHOMIMETICS

albuterol (Ventolin)
*Dilate the airways of the respiratory tree making air
exchange and respiration easier for client; relaxes
bronchial smooth muscle

XANTHINE DERIVATIVES

aminophylline (Truphylline)
Theophylline

*Stimulate the CNS & respirations, dilate coronary &

pulmonary vessels, cause diuresis & relax smooth
muscle

*Serum theophylline level is 10-20 ug/ml

*IV preparation of these drugs must be given slowly &

astemizole (Hismanal), diphenylhydramine (Benadryl)
loratadine (Claritin)

*Histamine antagonists or H1 blockers; compete with

histamine
for receptor sites preventing histamine response thus
constricting smooth muscles
*Decrease nasopharyngeal secretions & decreases itching
which
causes sneezing
*Used for common colds, rhinitis, urticaria, nausea &
vomiting,
motion sickness & sleep aid
*CNS depressant with ROH, narcotics, barbiturates &
sedatives
*Caution with COPD clients & Benadryl C/I in clients with
glaucoma
*react with gastric acid to produce neutral salts or salts
of low
acidity
*inactivate pepsin and enhance mucosal protection but
do not coal ulcer to protect from acid & pepsin
*used for patients with PUD & GRF (gastroesophageal
reflex disease)
*antacid tablets should be chewed and followed with
glass of H2O or milk
*administer 1 hour apart from other meds to minimize
the chance of drug interactions
sucralfate (Carafate)
*creates a protective barrier against acid & pepsin
*given po & on an empty stomach
*A/R: constipation, impede absorption of warfarin Na,
phenytoin, theophylline, digoxin & some antibiotics…
administer 2 hours apart from these meds

magnesium hydroxide (Milk of Magnesia)

*rapid acting & A/R is diarrhea
*usually combined with aluminum hydroxide to counter
diarrhea
(MAALOX)

aluminum hydroxide (Amphojel, Alu-cap)

*slow acting & A/R: constipation
*with significant Na content…caution in clients with HPN
&
heart failure; reduce effect of tetracyclines, warfarin Na
&
calcium carbonate (Tums)

*rapid acting & A/R: constipation

sodium bicarbonate

*rapid onset
*A/R: liberates CO2 & increases intra-abdominal
pressure
causing flatulence, caution in clients with HPN &
heart
failure, systemic alkalosis in clients with renal
failure
*suppress secretion of gastric acid
*indicated for PUD & heart burn & for GRF disease
cimetidine (Tagamet)
*taken on an empty stomach
*administered 1 hour apart from antacids
*crosses the blood-brain barrier & may cause mental
confusion, agitation, anxiety & disorientation
*dosages of these meds are reduced when taken
together:
warfarin Na, phenytoin, theophyllin & lidocaine
ranitidine (Zantac)

*not affected by food

*S/E are uncommon & does not cross blood-
brain barrier
pancreatin (Creon),
pancrelipase (Cotazym, Viokase & Pancrease)

*used to supplement pancreatic enzymes

*taken with meals or snacks

*interacts with calcium carbonate &

magnesium hydroxide
lactulose (Cephulac)
*reduces the ammonia level
*given p.o. in the form of a syrup
*improves CHON tolerance in clients with advanced liver
cirrhosis
*lowers colonic pH from 7 to 5; acidification pulls
ammonia into
the bowel to be excreted in the feces thus decreasing
the
ammonia level

Neomycin (Mycifradin)
*reduces the number of colonic bacteria that normally
convert
urea & amino acids into ammonia
*given p.o. or via NGT
*used with caution in clients with kidney impairment
BULK FORMING LAXATIVES
psyllium hydrophillic mucilloid (Metamucil)
*absorbs water into the feces & increase bulk to form
large and
soft stools
*C/I bowel obstruction
*A/R: dehydration, electrolyte imbalance & dependency

STOOL SOFTENERS
docusate calcium (Surfak), docusate sodium (Colace)
*inhibit the absorption of H2O so fecal mass remains
large &
soft
*used to avoid straining
LUBRICANTS
mineral oil
*soften stools, ease strain of passing stools; lessen the
irritation of hemorrhoids
*interferes with absorption of fat-soluble vitamins A, D,
E, K

SALINE CATHARTICS
glycerin suppositories (Senokot); Mg hydroxide
*Attract H2O to large intestine to produce bulk,
stimulate
peristalsis & effect begins in 2-6 hours

STIMULANT CATHARTICS
biscodyl (Dulcolax): give 1 hour before/after antacids &
milk cascara (Castor Oil): effect 2-6 hours; give with
juice
 PROXIMAL TUBULE DIURETICS

CARBONIC ANHYDRASE INHIBITORS

acetazolamide (Diamox)

*Inhibits the enzyme carbonic anhydrase causing

increased
Na, K & bicarbonate excretion

*Used to produce diuresis & decrease IOP

*A/R: hypokalemia, hyperglycemia & orthostatic

hypotension
 DILUTING SEGMENT DIURETICS
THIAZIDE DIURETICS
Chlorothiazide (Diuril)

*Increase Na & H2O excretion by inhibiting Na

reabsorption
in the distal tubule of the kidney

*Used for clients with HPN & peripheral edema

*A/R: hypokalemia, hyponatremia, hypovolemia,

hypotension

*Monitor U/O, take meds in the morning, eat foods high in

potassium, change position slowly & use sunscreen

*Clients with diabetes must monitor bld glucose level

 LOOP DIRETICS
furosemide (Lasix)

*Inhibit Na & Cl reabsorption from the loop of Henle &

the
distal tubule

*Little effect on blood glucose level but causes marked

depletion of water & electrolytes

*More potent than the thiazides causing rapid diuresis,

decreasing vascular volume, cardiac output & BP

*Caution with clients on digoxin & lithium

 LOOP DIRETICS

furosemide (Lasix)

*A/R: hypo- kalemia, natremia, calcemia &

magnesemia,
orthostatic hypotension, ototoxicity & deafness
esp. with rapid IV administration, dehydration

*Monitor urine output & electrolytes, signs &

symptoms
of digitalis & lithium toxicity

*Take in the morning & eat K+ rich food

 DISTAL TUBULE DIURETIC/ K+ SPARING
AMILORIDE (MIDAMOR)
SPIRONOLACTONE (ALDACTONE)
TRIEAMTRENE

*Used for edema, hypertension, increase U/O to Rx fluid

overload with CHF, nephrotic syndrome, hepatic cirrhosis,
diuretic-induced hypokalemia
*Monitor for hyperkalemia…K+ level higher than 5.3 MEQ/L,
S/Sx are nausea, diarrhea, abdominal cramps, oliguria,
narrow & peaked T wave on ECG
 OSMOTIC DIURETICS

Mannitol (osmitrol)
Isosorbide
Urea (ureaphil)
URINARY TRACT ANTISEPTICS
nitrofurantoin (Furadantin, Furalan, Macrobid)
*Inhibits the growth of bacteria in the urine
*Indicated for UTIs & do not achieve antibacterial
effects in
the blood or tissues
*Given with milk or meals to prevent GI distress
*A/R: pulmonary reactions like dspnea, chest pain,
chills,
fever, cough & will resolve 2-4 days after treatment
*Imparts a harmless brown color to urine

URINARY ANALGESICS
phenazopyridine HCl (Pyridium)
*Used to treat pain from UTI or irritation
*usually given together with antibiotics
*A/R: nausea, headache, vertigo, urine will turn red or
orange
CHOLINERGIC
bethanechol chloride (Duvoid, Urecholine)
*Used to treat nonobstructive urinary retention
*Used to increase bladder tone & function
*A/R: hypotension, diarrhea, urinary urgency & broncho-

constriction
*antidote: atropine SO4

ANTISPASMODICS
oxybutynin chloride (Ditropan) relaxes smooth muscles
of urinary tract
*A/R: leukopenia, bradycardia, anxiety
propantheline bromide (Pro-banthine) decreases
bladder muscle spasms
*A/R: palpitations, blurred vision, urinary hesitancy &
urgency,
dry mouth & constipation
HEMATOPOIETIC GROWTH FACTOR

epoetin alfa (Epogen, Procrit)

*Used to stimulate RBC

*Reverses anemia in chronic renal failure
*Initial effects seen in 1-2 weeks and hematocrit level
reaches
normal (30-33%) in 2-3 months
*Monitor CBC & BP for hypertensive S/E
*Caution in clients with uncontrolled
HPN,hypersensitivity to
human albumin
PREVENTING ORGAN REJECTION
Immunosuppressants
cyclosporine (Sandimmune)

*Used to prevent kidney transplant rejection by acting to

suppress
the action of T-lympocytes
*Administered together with prednisone
*A/R: nephrotoxicity, hirsutism (reversible) & infection
*Take with milk or orange juice, grapefruit juice increases
drug
level

Cytotoxic Meds
azathioprine (Imuran)

*suppresses immune response by inhibiting B & T

lymphocytes
 ACYCLOVIR (ZOVIRAX)

*Inhibits viral DNA replication. Does not cure

nor
prevent transmission of herpes infections but
decreases the severity & duration of the
infection

*Indicated for herpes simplex 1 & 2, varicella

and
herpes zooster infection
 ZIDOVUDINE (AZT, RETROVIR)

*Developed to control AIDS or ARC (AIDS- Related

Complex)

*A/R: Leukocytopenia & Anemia, hepatotoxic &

nephrotoxic,
dizziness..crosses blood & brain barrier

*Safe for pregnant women

Related Drugs: didanosine (Videx), Lamivudine (Epivir) &

Zalcitabine (ddC)

***Nucleoside reverse transcriptase inhibitors indicated

 PROTEASE INHIBITORS
saquinavir (Invirase)
*A/R: photosensitivity

ritonavir (Norvir)
*A/R: increase triglyceride levels

stavudine (d4T, Zerit)

*for those who do not respond to conventional
therapy
*A/R: peripheral neuropathy, unsteady gait
 SULFONAMIDES- SULFISOXAZOLE (GANTRISIN)

*Prevents conversion of (PABA) to folic acid which is

needed for bacterial growth; bacteriostatic &
bactericidal
*Used for UTIs, eye infections, otitis media, vaginitis
*A/R: Steven-Johnson syndrome (acute onset of fever,
bullae on
skin & ulcers on mucus membranes of lips, eyes, mouth,
nasal
passages & genitalia. Pneumonia & joint pains may
occur; fever
after 7-10 days after onset of therapy indicates
hypersensitivity
or hemolytic anemia
*Caution diabetics that drug may cause hypoglycemia;
 PENICILLINS
PENICILLIN G POTASSIUM
(PENTIDS)
*Inhibits cell wall synthesis of
microorganisms;
bactericidal

*Systemic infections of gram-positive cocci;

syphilis, prophylaxis for rheumatic fever &
bacterial endocarditis

*A/R: hypersensitivity; GI upset, nephritis,

anemia, leukopenia & thrombocytopenia
PENICILLIN G POTASSIUM (PENTIDS)
Probenecid (Benemid) may be given to increase blood
levels of penicillins

RELATED DRUGS:
A. PENICILLINASE-RESISTANT PENICILLINS
METHICIN Na (STAPHCILLIN) & NAFCILLIN Na (NAFCIN,
UNIPEN)
*Used to treat penicillinase-producing organisms

B. AMINOPENICILLINS
AMPICILLIN(AMCILL, POLYCILLIN) & AMOXICILLIN
TRIHYDRATE (AMOXIL)
*Increased effectiveness against gram-negative
organisms
 FIRST-GENERATION – CEFAZOLIN Na (ANCEF)

*Inhibits bacterial cell wall synthesis;

bactericidal
(same action for all generations)
*Against gram-positive cocci
*A/R: hypersensitivity; nephrotoxicity &
hepato-
toxicity; bone marrow depression
*Cross-allergy with penicillin
*Probenecid therapy
SECOND GENERATION – CEFOXITIN Na
(MEFOXIN)

*Used against gram-negative & gram-positive bacteria

*A/R is the same for all generations
*Lidocaine used as diluent for IM injection to reduce the
pain

THIRD GENERATION – CEFOTAXIME (CLAFORAN)

*Used in serious gram-negative & gram-positive

infections
such as neonatal meningitis & gonorrhea
*A/R is the same for all generations
*Protect IV solutions from light & do not mix with amino-
 CHLORAMPENICOL (CHLOROMYCETIN)
*Inhibits CHON synthesis; bacteriostatic &
bactericidal

*Used against Haemophilus influenzae meningitis,

salmonella typhi- used only in severe infections
where other antibiotics can’t be used because
A/R are aplastic anemia & gray baby syndrome
(seen in premature infant & children below 2
years…experiences vomiting, abdominal
distention, irregular respirations & circulatory
collapse)
*referred to as 4 quinolone or fluroqinolone

CIPROFLOXACIN (CIPROBAY)

S/E =N/V, diarrhea, discomfort, dizziness,

lightheadedness
S/E TO REPORT
= rash
= neurologic effects: H/A, mental
depression
DRUG INTERACTION
= antacids
= probenecid
 TETRACYCLINE HCl (ACHROMYCIN V)
*Inhibits bacterial cell wall synthesis;
bacteriostatic &
bactericidal; reduces fatty acids from
triglycerides

*Used for acne vulgaris, gonorrhea & spirochetes

*A/R: photosensitivity, hepatotoxicity; chelating to

teeth and new bones..avoid giving to pregnant &
nursing women, children under 8 as drug binds
to Ca in teeth & new bones causing permanently
 General Information on all agents

GENTAMICIN (GARAMYCIN)
“Mycins”
*Suppresses protein synthesis in bacterial
cell;
bactericidal
*Against gram-negative bacterial infections;
eye infections

*A/R: ototoxicity; nephrotoxicity &

neuromuscular
 VANCOMYCIN HCl (VANCOCIN)

*Interferes with cell membrane activities;

bacteriostatic & bactericidal

*Effective against gram(+) cocci like

staphylococcus

*A/R: ototoxicity, nephrotoxicity,

thrombophlebitis, Red-neck syndrome
(flushing & hypotension from rapid IV infusion)
*Clindamycin hcl capsules (cleocin, dalacin C)

*lincomycin hcl (lincocin)

- semisynthetic derivative of lincomycin, is
more effective & causes fewer untoward
effects
ERYTHROMYCINS – ERYTHROMYCIN BASE (E-MYCIN)

*Inhibits protein synthesis in bacterial cell;

bacteriostatic

*Used in persons with allergy to penicillins; indicated for

acne, streptococcal & staphylococcal infections

*A/R: GI irritation, allergic reactions, hepatitis,

reversible
hearing loss

*Do not give with acids e.g. orange juice

Amphoterizin B (fun gizone)
* shld be mixed only w/ water & slowly infuse
* BUN, liver enzymes, u/a shld be checked
Butoconazole nitrate (femstat)

Ketonazole (nizoral)

Miconazole (monistat)

Nystatin (mycostatin)
General Considerations

ISONIAZID (INH)

*Initial TTT against PTB; prophylaxis for high-risk groups

*A/R: peripheral neuritis)…give vitamin B6 (pyridoxine);
hepatitis…check liver enzymes frequently;
hyperexcitability
*Taken on empty stomach, avoid alcohol & interferes with

Phenytoin (Dilantin) requiring lowering of INH dose

ETHAMBUTOL (MYAMBUTOL)
 RIFAMPICIN

*A/R: hepatitis, flu-like syndrome, may turn body fluids

(urine,
tears, saliva etc. ) orange
*Interacts with anticoagulants, oral contraceptives, oral
hypoglycemics, methadone & corticosteroids

STREPTOMYCIN

*A/R: cranial nerve 8 damage (roaring, ringing & feeling

of
fullness in the ear); vestibular damage (dizziness &
vertigo)

PYRAZINAMIDE
ACNE PRODUCTS

Isotretinoin (Accutane)

*metabolite of vitamin A
*treatment for severe cystic acne
*C/I: sun exposure, ROH & pregnancy

BURNS PRODUCT

Mafenide (Sulfamylon)
*bacteriostatic against gram-negative & gram-positive org.
*apply 1/6 inch film directly to burn
*A/R diffuses via devascularized areas; may precipitate
metabolic
acidosis manifested by hyperventilation; bone marrow
depression
Burns Products
nitrofurazone (Furacin)

*bactericidal
*apply 1/16 inch film directly to burn
*A/R: contact dermatitis & rash

silver sulfadiazine (Silvadene, Flint SSD)

*bactericidal against gm-positive, gm-negative org. &

yeast
*apply 1/16 inch film to burn
*A/R: leukopenia

silver nitrate
*antiseptic against gm-negative org.
*apply to dressing & not to wound or broken skin
*A/R: stains anything it comes into contact with but
 ALKYLATING MEDICATIONS

*Affects by crosslinking DNA to inhibit cell production

Eg: chlorambucil (Leukeran), mechlorethamine HCl
(Mustargen)
*A/R gonadal suppression & hyperuricemia
cisplatin (Platinol)
*A/R: ototoxicity, tinnitus, hypokalemia, hypocalcemia,
hypomagnesemia & nephrotoxicity
*assess for dizziness, tinnitus, hearing loss,
incoordination,
numbness & tingling extremities

cyclophosphamide (Cytoxan)
*A/R: gonadal suppression, hemorrhagic
cystitis..hematuria &
dysuria…encourage 2-3 liters of fluids/day unless C/I
*Encourage diet low in purine to alkalinize urine & lower
blood
uric acid level purine food: organ meats
ANTITUMOR ANTIBIOTIC MEDS

*Interfere with DNA & ribonucleic acid synthesis

plicamycin (Mithracin)
*A/R: prolongs bleeding time…avoid aspirin,
anticoagulants &
antithrombolytics
daunorubicin (Cerubidine)
*A/R: CHF & dysrhythmias

bleomycin SO4 (Blenoxane)

*A/R: pulmonary toxicity
doxorubicin (Adriamycin) & idarubicin (Idamycin)
*A/R: cardiotoxicity, dyspnea, hypotension, ECG
changes &
weight gain
* Hydration to prevent hyperuricemia
ANTIMETABOLITE MEDS

*Halt the synthesis of cell CHON; replaces CHON needed

for DNA synthesis
Cytarabine HCl (ara-C, Cytosar-U)
*A/R: hepatotoxicity
5-Fluorouracil (5-FU; Adrucil)
*A/R: phototoxicity & cerebellar dysfunction (dizziness/
weakness)
6-mercatopurine (Purinethol)
*A/R: hepatotoxicity

Methotrexate (Folex)…given with leukovorin (folinic

acid)
*A/R: photosensitivity, hepatotoxicity, hematologic, GI &
skin toxicity
VINCA (PLANT) ALKALOIDS
*Prevents mitosis causing cell death
vincristine SO4 (Oncovin)
*A/R: neurotoxic…tingling & numbness of extremities

HORMONAL MEDS & ENZYMES

*suppress the immune system & block normal

hormones in
hormone-sensitive tumors; change hormonal
balance &
slows growth of certain tumors

aspariginase (Elspar)
*A/R: impaired pancreatic function
HORMONAL MEDS & ENZYMES

mitotane (Lysodren)
*A/R: hemorrhagic cystitis & hypercholesterolemia

tamoxifen citrate (Nolvadex)

*A/R: edema. Hypercalcemia, elevated cholesterol &
triglyceride levels; decreases estrogen effect

Diethylstilbestrol (DES, Stilphostrol)

*A/R: impotence & gynecomastia in men; alter effects
of
anti-coagulants, oral hypoglycemic agents & insulin