Transcript Document 7224909

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