PHARMACOLOGY

DRUGS AFFECTING THE NERVOUS SYSTEM ANTICONVULSANTS/ANTISEIZURE MEDICATIONS Prototype : a. Hydantoins - phenytoin (Dilantin) b. Barbiturates - phenobarbital ( Luminal) Adver e e!!e"t : - sedation & drowsiness, gingival hyperplasia - diplopia, nystagmus, vertigo, dizziness - thrombo ytopenia, aplasti anemia N#r $%& "o% $der't$o% ! ". #dvise $emale lients to use ontra eptives. %. &n$orm lients ta'ing phenytoin that harmless urine dis oloration is ommon. (. )arn lients with diabetes that hydantoins may in rease blood sugar level. *. +eassure that barbiturates are not addi tive at a low dosage. ,. #void ta'ing al ohol with barbiturates. -. #dminister &. phenytoin slowly to avoid ardioto/i ity. 0. #void mi/ing other drugs in same syringe with phenytoin. ANTIPAR(INSONIAN AGENTS Prototype : a. #nti holinergi agents - trihe/yphenidyl (#rtane), benztropine (1ongentin) b. Dopaminergi agents - Levodopa, arbidopa-levodopa (2inemet), amantidine (2ymmetrel) Adver e e!!e"t o! dop')$%er&$" '&e%t : a. levodopa3nausea, vomiting, anore/ia, orthostati hypotension, dar'- olored urine and sweat b. amantidine 3 an'le edema, onstipation N#r $%& "o% $der't$o% : ". 4ive dopaminergi agents a$ter meals to redu e 4& symptoms. %. +eassure lient that levodopa may ause harmless dar'ening o$ urine and sweat. 3. #void ta'ing .it B- (pyrido/ine) be ause it reverses e$$e ts o$ levodopa. *. 1hange positions slowly to avoid orthostati hypotension. ,. 5levate leg to redu e an'le edema. DRUGS AFFECTING MENTAL FUNCTIONING SEDATIVES* HYPNOTICS* AND AN+IOLYTICS , $%d#"e -eep* ed'te . "'-) "-$e%t Prototype: a. Benzodiazepines (end with 3epam) - diazepam (.alium), lorazepam (#tivan), alprazolam (6ana/), $lurazepam (Dalmane) b. Barbiturates - phenobarbital, Adver e e!!e"t : - hangover-e$$e t, dizziness, 172 depression - respiratory depression, drug-dependen e

N#r $%& "o% $der't$o% : ". )arn lients o$ in8uries and $alls. %. Brie$ period o$ on$usion and e/ itement upon wa'ing up is ommon with benzodiazepines. (. )arn lients not to dis ontinue medi ations abruptly without onsulting a physi ian. *. #void al ohol while ta'ing these drugs. -. +otate and don9t sha'e the ampoules o$ barbiturates. Don9t mi/ with other drugs. 0. )arn $emale lients that diazepam is asso iated with le$t lip. ANTIDEPRESSANTS AND MOOD DISORDER DRUGS Prototype: a. :ri y li antidepressants - amitriptyline (5lavil), imipramine (:o$ranil), desipramine b. ;#<& (monoamine o/idase inhibitors) -phenelzine (7ardil), tranyl ypromine (=ernate) . 2e ond-generation antidepressants - $luo/etine (=roza ) Adver e e!!e"t : - dry mouth, blurred vision, urine retention, onstipation (anti holinergi e$$e ts) - orthostati hypotension, insomnia - hypertensive risis (;#<) N#r $%& "o% $der't$o% : ". 1aution lient to rise slowly to redu e the e$$e ts o$ orthostati hypotension. %. :a'e antidepressant with $ood to enhan e absorption (. 5/plain to lient that $ull response may ta'e several wee's (% wee's) *. #ssess lient $or onstipation resulting $rom tri y li antidepressant use. ,. 1lient ta'ing ;#< inhibitors should avoid tyramine-ri h $oods to avoid hypertensive risis. -aged heese, sour ream, yogurt, beer, wine, ho olate, soy sau e and yeast -. &n$orm physi ian and withhold $luo/etine i$ lient develop rashes. ANTIPSYCHOTIC DRUGS (7eurolepti s) Prototype: a. =henothiazines - hlorpromazine (:horazine), - thioridazine (;ellaril) b. <ther #gents 3 olanzapine (>ypre/a) , haloperidol (Haldol) Me"/'%$ ) o! '"t$o%: - blo ' dopamine re eptors in the limbi system, hypothalamus, and other regions o$ the brain. Adver e e!!e"t : - 5/tra pyramidal syndrome (or 5=2) su h as dystonia, pseudopar'insonism, and an irreversible tardive dys'inesia as mani$ested by! a. lip sma 'ing b. $ine wormli'e tongue movement . involuntary movements o$ arms and leg - 7eurolepti malignant syndrome (7;2) a. $ever, ta hy ardia, ta hypnea, diaphoresis, ardiovas ular ollapse b. mus le rigidity, seizures. - <rthostati hypotension N#r $%& "o% $der't$o% : ". :ea h $amily members the signs o$ 5=2 and 7;2, and report to physi ian immediately %. 7ormalization o$ symptoms may not o ur $or several wee's a$ter beginning o$ therapy (. )at h out $or orthostati hypotension and photosensitivity with phenothiazine. -. Be sure that oral doses are swallowed, and not hoarded.

DRUGS USED IN PAIN MANAGEMENT ANALGESICS Prototype: a. 7ar oti analgesi s - odeine, meperidine (Demerol), morphine b. 7on 3 nar oti analgesi s 72#&Ds 3 aspirin (a etylsali yli a id), ibupro$en (;otrin) para etamol and a etaminophen (:ylenol) Me"/'%$ ) o! '"t$o% : a. 7ar oti analgesi s - alter pain per eption by binding to opioid re eptors in 172. b. 7on- nar oti analgesi s - relieve pain and $ever by inhibiting the prostaglandin pathway. N#r $%& "o% $der't$o% : 1. ;onitor respiratory depression & hypotension in lients ta'ing nar oti analgesi s. %. &n8ury and a ident pre autions in lients ta'ing nar oti analgesi . 3. )arn lients about possibility o$ dependen y, and do not dis ontinue nar oti s abruptly in nar oti -dependent lients. 4. 7alo/one is the antidote $or nar oti overdose. 5. #dvi e lients to ta'e 72#&Ds with $ood and monitor $or bleeding ompli ations. -. #spirin is ontraindi ated in lients below "? years old with $lu-li'e symptoms. 0. ;onitor hearing loss in lients ta'ing aspirin. DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM ANTICOAGULANTS Prototype: - Heparin (2@ and &.) )ar$arin (<rally) Me"/'%$ ) o! '"t$o% : a. Heparin - prevents thrombin $rom onverting $ibrinogen to $ibrin. b. )ar$arin - suppress oagulation by a ting as an antagonist o$ vitamin A a$ter *-, days. I%d$"'t$o% : - thrombosis, pulmonary embolism, myo ardial in$ar tion Adver e e!!e"t: - bleeding N#r $%& "o% $der't$o% : ". H5=#+&7 sodium - test ! =:: - antidote ! (protamine sul$ate) %. )#+B#+&7 sodium ( oumadin) - test ! &7+ - redu e inta'e o$ green lea$y vegetables. - antidote ! .itamin A ( #Cuamephyton) ANTIPLATELET MEDICATIONS Prototype: aspirin (#2#), Dipyridamole (=ersantin), 1lopidogrel (=lavi/) Me"/'%$ ) o! '"t$o%: - inhibit the aggregation o$ platelet thereby prolonging bleeding time. I%d$"'t$o% :

used in the prophyla/is o$ long-term ompli ation $ollowing ;.&, oronary revas ularization & thromboti 1.#

N#r $%& "o% $der't$o% : - ;onitor bleeding time ( 7. D "-E mins) - :a'e the medi ation with $ood. CARDIAC GLYCOSIDES Prototype: digo/in (Lano/in) Me"/'%$ ) o! '"t$o% : in rease intra ellular al ium, whi h auses the heart mus le $ibers to ontra t more e$$i iently, produ ing positive inotropi & negative hronotropi a tion. I%d$"'t$o% : use $or 1HB, atrial ta hy ardia and $ibrillation N#r $%& "o% $der't$o% : - ;onitor $or to/i ity as eviden ed by! o nausea, vomiting, anore/ia, halo vision, on$usion, brady ardia and heart blo 's - Do not administer i$ pulse is less than -F bpm. - 2hould be aution in patient with hypothyroidism and hypo'alemia. - #ntidote ! Digo/in &mmune B#B NITRATES Prototype: - isosorbide dinitrate (&sordil) - nitrogly erine (Deponit, 7itrostat) Me"/'%$ ) o! '"t$o%: - produ e vasodilatation in luding oronary artery. I%d$"'t$o% : - angina pe toris, ;&, peripheral arterial o lusive disease. Adver e e!!e"t : - heada he, orthostati hypotension . N#r $%& Co% $der't$o% : ". :ransdermal pat h - apply the pat h to a hairless area using a new pat h and di$$erent site ea h day - remove the pat h, allowing "F-"% hours Gpat h $reeH ea h day to prevent toleran e %. 2ublingual medi ations ! - note the B= be$ore giving the medi ation. - o$$er sips o$ water be$ore giving be ause dryness may inhibit absorption. - one tablet $or pain and repeat every , mins.$or a total o$ three dosesI i$ not relieved a$ter "F mins., see' medi al help. - stinging or burning sensation indi ates that the tablet is $resh - instru t patient not to swallow the pill - sustained release medi ations should be swallowed and not rushed - prote t the pills $rom light ANTI , HYPERTENSIVES ANGIOTENSIN0CONVERTING ENZYME 1ACE2 INHI3ITORS 1DRUG NAMES END IN 4ITH 50PRIL62 Prototype : aptopril (1apoten), enalapril (.asote ), Cuinapril, lisinopril Me"/'%$ ) o! '"t$o% :

prevent peripheral vaso onstri tion by blo 'ing onversion o$ angiotensin & to angiotensin && de reasing peripheral resistan e. Adver e e!!e"t : - hyper'alemia - $ndu e hroni dry ough N#r $%& "o% $der't$o% : - not to dis ontinue medi ations be ause it an ause rebound hypertension. - avoid using AJ sparing diureti s. ADRENERGIC 3LOC(ING AGENTS Prototype: Beta blo 'ers (drug names end with G-ololH) - atenolol (:enormin), metoprolol (Lopressor), propanolol (&nderal), timolol ( Blo adren) Me"/'%$ ) o! '"t$o% : ompete with epinephrine in b-re eptors in heart, pulmonary airways, peripheral ir ulation and 172. I%d$"'t$o% : - +aynaud9s disease, hypertension, pheo hromo ytoma. - angina, arrhythmias, mitral valve prolapse, glau oma Adver e e!!e"t : - orthostati hypotension, brady ardia, 1HB - depression, insomnia and vertigo - bron hospasm and dyspnea, nasal stu$$iness, old e/tremities N#r $%& "o% $der't$o% : ". #dminister oral beta-blo 'ers be$ore meals and at a.m. i$ insomnia o urs. 2. 1he ' lient9s api al pulse rate be$ore drug administration, re$er i$ below -F bpm. (. 1hange positions slowly to avoid orthostati hypotension. 4. )arn lients not to drive or operate dangerous ma hinery until heKshe has ad8usted to medi ations. CALCIUM0CHANNEL 3LOC(ERS Prototype : - 7i$edipine ( al iblo , adalat), #mlodipine (norvas ), .erapramil (&soptin) Me"/'%$ ) o! '"t$o%: - de rease ardia ontra tility and the wor'load o$ the heart, thus de reasing the need $or <% - it also promotes vasodilatation o$ the oronary and peripheral vessels. I%d$"'t$o% : - hypertension, angina, arrhythmia Adver e e!!e"t : - brady ardia, hypotension, heada he - re$le/ ta hy ardia, onstipation N#r $%& "o% $der't$o% : - #dminister between meals to enhan e absorption. - :a'e lient9s pulse rate be$ore ea h dose. )ithhold i$ pulse is below -F bpm. - +e$er $or signs o$ ongestive heart $ailure. DIURETICS - usually given at morning T/$'7$de - hydro hlorothiazide - blo 's 7a and A reabsorptionI reabsorb 1a - hyper al emia

Loop d$#ret$" - $urosemide (Lasi/) - blo 's 7a, A, and 1a reabsorption - hypo al emia Pot' $#) p'r$%& d$#ret$" - 2pironola tone (#lda tone) - e/ rete 7a and water but it reabsorbs A - hyper'alemia RESPIRATORY MEDICATIONS 3RONCHODILATORS Prototype : 2ymphatomimeti 6anthines - albuterol, salbutamol - aminophylline - isoproterenol, salmeterol - theophylline - terbutaline Me"/'%$ ) o! '"t$o% : - sympathomimeti ( -receptor agonist) bron hodilators, dilate airways. - /anthine bron hodilators, stimulate 172 $or respiration. I%d$"'t$o% : - bron hospasm, asthma, bron hitis, 1<=D. Adver e e!!e"t : - palpitations and ta hy ardia - restlessness, nervousness, tremors - anore/ia, nausea and vomiting, heada he, dizziness. N#r $%& "o% $der't$o% : - 1ontraindi ated in hyperthyroidism, ardia dysrhythmia, or un ontrolled seizure disorder. - 2hould be used with aution in patients with H=7 and narrow-angle glau oma. GLUCOCORTICOIDS (1orti osteroids) Prototype: - prednisone Me"/'%$ ) o! '"t$o% : - a t as anti-in$lammatory agents and redu e edema o$ the airways, as well as pulmonary edema. Adver e e!!e"t :1ushing9s syndrome, neutropenia. osteoporosis N#r $%& "o% $der't$o% : - :a'e drugs with $ood. - 5at $oods high in potassium, low in sodium. - &nstru t lient to avoid individuals with +:&. - &nstru t lient not to stop medi ation abruptly it should be tapered to prevent adrenal insu$$i ien y - #void ta'ing 72#&Ds while ta'ing steroids. - :a'e inhaled bron hodilators $irst be$ore ta'ing inhaled steroids, and rinse mouth a$ter using. ANTI0HISTAMINES (H-" blo 'ers) Prototype: - Loratidine (1laritin) - Brompheniramine (Dimetapp) - Diphenhydramine (Benadryl) Me"/'%$ ) o! '"t$o% :

de rease nasopharyngeal se retions and de rease nasal it hing by blo 'ing histamine in H"-re eptor. I%d$"'t$o% : - ommon olds, rhinitis, nausea and vomiting, urti aria, allergies and as sleep aid. N#r $%& Co% $der't$o% : - #dminister with $ood and drin'. - =re autions in handling ma hinery and driving while ta'ing these drugs. - & e hips or andy $or dry mouth DECONGESTANTS - pseudoephedrine (2uda$ed) 3 adrenergi (sympathomimeti ) agent - 1aution ! do not use with lients with H=7 DRUGS AFFECTING GASTROINTESTINAL SYSTEM ANTI0ULCER DRUGS ANTACIDS Prototype : - aluminumKmagnesium ompounds (;aalo/) - sodium bi arbonate (#l'a-2eltzer) - al ium arbonate (:ums) - magnesium hydro/ide (;il' o$ ;agnesia). Me"/'%$ ) o! '"t$o% : - neutralize the stoma h a idity. Adver e e!!e"t : - metaboli al'alosis, stone $ormation - ele trolyte imbalan e - diarrhea (magnesium), onstipation (aluminum). N#r $%& "o% $der't$o% : - 4ive " hr a$ter meals. - #void giving medi ations within "-% hrs o$ anta id administration (de reases absorption). - :a'e $luids to $lush a$ter inta'e o$ anta id suspensions. - ;onitor $or hanges o$ bowel patterns. HISTAMINE08 3LOC(ERS 1END 4ITH ,IDINE2 Prototype: - imetidine (:agamet), ranitidine (>anta ), $amotidine (=ep id), nizatidine (#/id). Me"/'%$ ) o! '"t$o%: - blo 's H% re eptors in the stoma h, redu ing a id se retions. N#r $%& "o% $der't$o% : - 4iven be$ore or with meals - #void giving other drugs with imetidine - 4yne omastia may develop with hroni use o$ imetidine. PROTON , PUMP INHI3ITORS 1PPI2 1END 4ITH ,AZOLE2 =rototype : - omeprazole (Lose ), Lansoprazole (Lanz), pantoprazole (=antolo ). Me"/'%$ ) o! '"t$o% : - inhibit the proton HJ to ombine with 1l- to$orm hydro hlori a id. N#r $%& "o% $der't$o% :

- 4iven be$ore meals pre$erably at morning. MUCOSAL 3ARRIERS Prototype : - su ral$ate (1ara$ate), misoprostol (1ytote ). Me"/'%$ ) o! '"t$o%: - oats the mu osa to prevent ul erations. N#r $%& "o% $der't$o%: - 4iven be$ore meals. - ;isoprostol is ontraindi ated $or pregnants. - 2u ral$ate ause onstipation. ANTII0EMETICS 1ANTI0VOMITING2 - Dimenhydrinate (4ravol) 3 an anti holinergi I used also $or motion si 'ness - Diphenhydramine (Benadryl) 3 an antihistamie - ;eto lopramide (+eglan) 3 dopamine antagonist o 7ot available in 1anadaI 5=2 side e$$e ts ANTI0DIARRHEAL AGENTS Prototype ! - dipheno/ylate (Lomotil), loperamide (&modium), 'aolinKpe tin mi/ture (Aaope tate). Me"/'%$ ) o! '"t$o% : - de rease stoma h motility and peristalsis. N#r $%& "o% $der't$o% : - ;onitor $or rebound onstipation. - Be autious ta'ing i$ with in$e tious diarrhea. - ;onitor atropine to/i ity with dipheno/ylate. - 1lay, white or pale stool is ommon with 'aope tate. LA+ATIVES a. <smoti ! la tulose (Duphala ), 7a biphosphate (Bleet enema) & magnesium salt (;il' o$ ;agnesia) - retain $luid and distend intestine b. Be al so$teners ! du osate (Dialose) - emulsi$y $e al $at and water . 2timulant ! bisa odyl (Dul ola/) & senna (6-prep) - irritates intestinal mu osa and stimulates intestinal smooth mus les d. bul'-$orming la/ative (;etamu il) - in rease $e al bul' and water ontent e. 5mollientKLubri ant ! mineral oil - lubri ates & prevent olon absorption DRUGS AFFECTING THE ENDOCRINE SYSTEM THYROID AGENTS Prototype: 2ynthroid (levothyro/ine) Me"/'%$ ) o! '"t$o%: - $un tion as natural or syntheti hormones. N#r $%& "o% $der't$o% : - :a'en in the morning. - 1aution with oronary artery disease. - ;onitor $or signs o$ hyperthyroidism and re$er $or de reasing the dose.

ANTIDIA3ETICS ORAL HYPOGLYCEMIC AGENTS 1OHA2 ". S#-!o%y-#re' stimulate insulin se retions and in rease tissue sensitivity to insulin. Birst 4eneration! 1hlorpropamide (Diabenase) - disul$iram pre autions 2e ond 4eneration! 4lypizide, 4lymepiride %. 3$&#'%$de $a ilitates insulin a tion on the peripheral re eptor site ;et$ormin and 4lu ophage (4lu ovan e) - side e$$e t is la ti a idosis (. A-p/'0&-#"o $d' e $%/$9$tor delay arbohydrate absorption in the intestinal system # arbose (=re ose) 3 side e$$e t is diarrhea *. T/$'7o-$%$d$%e in rease tissue sensitivity o$ insulinI e.g +osiglitazone (#vandia) 3 already dis ontinued N#r $%& "o% $der't$o% : - 5$$e tive only $or type && D; - 1ontraindi ated to pregnant & breast$eeding. - 4iven be$ore meals - ;onitor $or signs o$ hypogly emia. I% #-$% Type o! I% #-$% &mmediate 2hort-a ting (regular) &ntermediate (7=H) Long-a ting ;i/ed (regular (FL, 7=H 0FL) O% et ", min (F min-"h "-( h *-- h F., h Pe': F., 3 "h %-* h --"% h "F-(F h *-? h D#r't$o% ,h ,-0 h "?-%* h %*-(- h %, h

N#r $%& "o% $der't$o% : - Msually given be$ore meals. - +oll the bottle in palm o$ hands, don9t sha'e. - &n8e t amount o$ air that is eCual to ea h dose into the bottle- short a ting last ( lear). - #spirate short a ting $irst, then long or intermediate ( loudy). - #l ohol is re ommended $or leansing bottle but not with s'in. - =in h s'in, avoid &.;, don9t aspirate. - +otate the in8e tion site an in h a part. - =re$illed syringes are stored verti ally, needle-up. - ;ay in rease dose during illnesses. - Msed bottles stored in room temperature, unused bottle stored in re$rigerator. - ;onitor $or a ute hypogly emiaI treat with! a. (-* ommer ially prepared glu ose tablet b. *-- oun e o$ $ruit 8ui e or regular soda . %-( teaspoons o$ honey d. 4lu agon " gm 2@ or &; e. D,F-,F &..

DRUGS FOR TREATING INFECTION ANTI3ACTERIAL AGENTS ;< Ce-- ='-- $%/$9$tor a. peni illins - pen 4, amo/i illin, lo/a illin b. ephalosphorins - ephale/in, e$a lor c. gly opeptide 3 van omy in 8< Prote$% y%t/e $ $%/$9$tor a. aminogly osides - ami'a in, gentamy in b. ma rolide 3 erythromy in . tetra y line9s 3. A%t$)et'9o-$te - blo 's $oli a id synthesis a. 2ul$onamides 3 otrimo/azole >< DNA y%t/e $ $%/$9$tor a. Cuinolones - ipro$lo/a in, nor$lo/a in b. metronidazole (Blagyl) Adver e e!!e"t : ". #minogly oside - nephroto/i ity & ototo/i ity 2. 2ul$onamides - 2teven-Nohnson9s syndrome, photosensitivity (remember the va ationing in ;e/i oOOOO) (. @uinolones - insomnia *. :etra y lines - bone problems ,. 5rythromy in - hepatitis N#r $%& "o% $der't$o% : ". 1olle t appropriate spe imen $or 1 & 2 be$ore starting antibioti s. %. 1he ' lient9s history o$ allergies. 3. ;onitor adverse e$$e ts! #LL antibioti s an ause nausea, vomiting & diarrhea D+M42 with ;ML:&=L5 M252 CHOLINERGIC 3LOC(ING AGENTS (=arasympatholyti s, #nti holinergi s) Prototype: atropine Me"/'%$ ) o! '"t$o% : - blo ' the binding o$ a etyl holine in the re eptors o$ parasympatheti nerves. I%d$"'t$o% : - use preoperatively to dry up se retions. - treat spasti ity o$ 4& or urinary tra t. - use $or treatment o$ brady ardia, asthma, par'insonism. - use $or antidote in organophosphate poisoning (inse ti ide) Adver e e!!e"t : - dry mouth , dilatation o$ pupils, ta hy ardia - urinary retention, ileus, heat stro'e N#r $%& "o% $der't$o% : ". Aeep lients in ool environment. %. )at h out $or signs o$ heatstro'e and dehydration. (. 5n ourage lients to in rease $luid inta'e and use o$ sugarless gumK andy $or dry mouth. *. Bor 4& spasti ity, administer (F minutes be$ore meals and at bedtime. ADRENERGIC AGENTS (2ympathomimeti s) Prototype:

lient

- epinephrine, phenylephrine, terbutaline, albuterol, isoproterenol. Me"/'%$ ) o! '"t$o% : - stimulate alpha and beta adrenergi re eptor dire tly or trigger the release o$ ate holamines indire tly ausing sympatheti e$$e ts. I%d$"'t$o% : - ardiopulmonary arrest, hypotension - 1<=D and asthma, nasal ongestions - allergi rea tion, anaphyla ti sho ' Adver e e!!e"t : - restlessness, insomnia, tremors, nausea - palpitations, angina, ta hy ardia, H=7 N#r $%& "o% $der't$o% : ". 1ontraindi ated in lients wK hyperthyroidism, pheo hromo ytoma & ardiovas ular disease. %. ;onitor vital signs and advi e pre autions MISCELLANEOUS DRUGS ANTI0GOUT - # ute atta 's ! phenylbutazone (an 72#&D), ol hi ine - ;aintenan e ! allopurinol

Drugs and their Antidotes 1. Digitalis 3 Digo/in &mmune B#B

%. Heparin - =rotamine 2ul$ate (. ;orphine sul$ate - 7alo/one Hydro hloride 4. )ar$arin- .itamin A