PHARMACOLOGY II

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PHARMACOLOGY II

• BY ANGIE LAWSON RN, BSN

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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

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PENICILLINS

• Bactericidal or bacteriostatic prevents
  bacteria from using a substance necessary for
  maintaining their cell wall
• Uses UTIs, 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

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CEPHALOSPORINS

• Affect the bacterial cell wall, bactericidal
• Uses pharyngitis, tonsillitis, otitis media,
  lower resperatory infections, UTIs septicemia
  and gonorrhea
• Adverse reactions
• Nausea, vomiting diarrhea
• Superinfection sore mouth and throat
• urticaria
• Take with food or milk

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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

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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

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LINCOSAMIDES

• Bactericidal inhibit protein synthesis
• Uses more serious infections
• Adverse reactions
• Abdominal pain, nausea, vomiting, diarrhea
• Take with full glass of water avoid alcohol

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FLUOROQUINOLONES

• Bactericidal interferes with DNA gyrase needed
  by the bacteria to synthesis DNA
• Uses lower respiratory infections, UTIs, STDs
  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

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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

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OTHER ANTI-INFECTIVES

• CHOLORAMPHENICOL
• LINEZOLID
• MEROPENEM
• METRONIDAZOLE
• PENTAMIDINE ISETHIONATE
• SPECTINOMYCIN
• VANCOMYCIN

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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

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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.

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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.

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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.

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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

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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.

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SALICYLATES

• All Salicylates are similar in actions, Aspirin
  has a greater anti-inflammatory effect
• Uses pain relief, fever, inflammation, reduce
  the risk of MI and stroke.
• Adverse Reactions
• Gastric upset, heartburn, nausea, vomiting,
  anorexia, GI bleeding.
• Aspirin inhibits the aggregation of platelets.
• SS of mild salicylism dizziness, tinnitus,
  difficulty hearing

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NON SALICYLATES

• Mechanism of action is unknown
• Uses pain relief, fever (doesnt have an
  anti-inflammatory action.)
• Adverse Reactions
• Very few and usually occur with chronic use or
  overdose
• Take with food or full glass of water

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NSAIDS

• Nonsteroidal anti-inflammatory drugs
• 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

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NARCOTIC ANALGESICS

• Agonist Partial Agonist Mixed
  Agonist-Antagonists (see definitions for actions)
• Uses relieve or manage severe acute or chronic
  pain.
• Adverse Reactions
• Light-headedness, dizziness, sedation,
  constipation, anorexia, nausea, vomiting and
  sweating.
• Miosis may occur after giving some narcotic
  analgesics, this puts them at risk for injury

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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

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ADRENERGIC DRUGS

• Mimic the activity of the sympathetic nervous
  system
• Uses hypovolemic shock, episodes of hypotension
  bronchial asthma, superficial asthma, allergic
  reactions
• Adverse Reactions
• Cardiac arrhythmias, headache insomnia,
  nervousness, anorexia
• Relaxes the smooth muscles of the bronchi
• Overuse of nasal decongestants, can cause rebound
  congestions

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ADRENERGIC BLOCKING DRUGS

• Alpha, Beta, Anti- Alpha/Beta Adrenergic Drugs
  (see definitions)
• Alpha adrenergic drugs produce their greatest
  effects on the adrenergic nerves that control the
  vascular system
• Beta adrenergic blocking drugs produce the
  greatest effect on the heart
• Some beta adrenergic blocking drugs can be used
  to treat patients who have glaucoma

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CHOLINERGIC DRUGS

• May act like the neurohormone Ach or inhibit the
  release of the neurohormone AChE
• Uses glaucoma, myasthenia gravis, urinary
  retention
• Adverse Reactions
• Excess salivation, nausea, vomiting, diarrhea
  
• Contraindicated with peptic ulcer disease
• Ongoing treatment should include checking the eye
  and around the eye for redness, inflammation and
  secretions

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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
• Dry mouth, blurred vision, and photophobia
• Contraindicated with glaucoma

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SEDATIVES HYPNOTICS

• Produces CNS depression and mood alteration
• Uses insomnia or as a preoperative regimen
• Adverse Reactions
• Somnolence, agitation, confusion, lethargy,
  respiratory distress, bradycardia, hypotension
• It is only acceptable to give a hypnotic with a
  narcotic analgesic when it is being given
  preoperatively
• When giving to the elderly monitor for marked
  excitement and confusion
• Hold a hypnotic if vital signs vary from the
  patients baseline.

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CNS STIMULANTS

• Analeptics, Amphetamines Anorexiants (see
  definitions)
• Uses limited in medicine, analeptics temp. tx
  of respiratory depression amphetamines temp.
  tx of exogenous obesity, narcolepsy ADHD
  anorexiants tx of exogenous obesity
• Adverse reactions
• Dizziness, headache, apprehension,
  disorientation, insomnia
• Anorexiants and amphetamines are highly addictive
  and have a abuse potential

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ANTICONVULSANTS

• Reduce the excitability of the neurons in the
  brain
• Uses the more common types of seizures
• Adverse Reactions
• Sedation, nausea, vomiting, constipation,
  nystagmus
• Take with food to decrease nausea
• Do not abruptly discontinue taking med because it
  can cause seizures

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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

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PSYCHOTHERAPEUTIC DRUGS

• ANTIANXIETY DRUGS
• ANTIDEPRESSANT DRUGS
• ANTIPSYCHOTIC DRUGS

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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

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ANTIDEPRESSANTS

• Exact mechanism of action is unknown, thought to
  slow the adaptive changes in noreepinephrine and
  serotonin receptor systems.
• Uses depression, major and minor
• Adverse Reactions
• Sedation, dry mouth, dry eyes, urinary retention,
  nausea
• A serious adverse reaction of a MAOI is
  hypertensive crisis
• The nurse must check for cheeking

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ANTIPHSYCHOTIC DRUGS

• Thought to inhibit or block the release of the
  neurohormone dopamine in the brain
• Uses manage acute and chronic psychoses
• Adverse Reactions
• Dry mouth, sedation, hypotension, nasal
  congestion, headache
• Do not take OTC drugs Take exactly as directed
  Do not drink alcohol

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CHOLINESTERASE INHIBITORS

• Increase the level of actylcholine in the CNS by
  inhibiting its breakdown and slowing neuronal
  destruction
• Uses dementia associated with Alzheimers
  disease
• Adverse Reactions
• Limited anorexia, nausea, vomiting, weight loss
• It is not a cure, but just a delay in progression

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ANTIEMETIC DRUGS

• Inhibits the CTZ or depresses the sensitivity of
  the vestibular apparatus of the inner ear
• Uses prophylactic or tx of nausea and vomiting
• Adverse Reactions
• Varying degrees of drowsiness
• Avoid driving, take as directed, avoid alcohol
  and other sedatives

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ANTIVERTIGO DRUGS

• Inhibits the CTZ or depresses the sensitivity of
  the vestibular apparatus of the inner ear
• Uses vertigo (see definitions)
• Adverse reactions
• Varying degrees of drowsiness
• Avoid driving, take as directed, avoid alcohol
  and other sedatives

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ANESTHETIC DRUGS

• LOCAL ANESTHESIA topical, local infiltration,
  regional (spinal conduction blocks)
• PREANESTHETIC to prepare for anesthesia, the
  antianxiety drug will aid in reducing the dose of
  the anesthetic induction agent needed.
• GENERAL ANETHESIA several drugs used
• POST ANESTHESIA - check airway, respiratory
  status and give O2 as needed, position to prevent
  aspiration, and monitor VS q 5-10mins

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ANTIHISTAMINES

• Prevent histamine from entering the histamine
  receptor site
• Uses relief of SS of allergies, motion
  sickness, nausea vomiting sedation
• Adverse Reactions
• Drowsiness, sedation, dry mucus membranes
• Most are given with food to prevent gastric upset.

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DECONGESTANTS

• Produce localized vasoconstriction of the small
  blood vessels of the nasal membranes
• Uses congestion assoc. with colds, allergies and
  middle ear infections
• Adverse Reactions
• Nasal burning, stinging dryness
• Contraindicated with hypertension
• Overuse can make symptoms worse

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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)

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ANTIASTHMA DRUGS

• CORTICOSTEROIDS
• LEUKOTRIENES
• MAST CELL STABILIZERS

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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

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MUCOLYTICS EXPECTORANTS

• Increases mucus production by decreasing the
  viscosity of the mucus
• Uses emphysema, bronchitis, asthma, TB
• Adverse Reactions
• Sedation, nausea, drowsiness
• If equipment is being utilized teach patient how
  to use it properly

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CARDIOTONICS

• Increases cardiac output through positive
  inotropic activity
• Uses heart failure, atrial fibrillation
• Adverse reactions
• Headache, weakness, drowsiness
• If taking Digoxin and c/o nausea and blurred
  vision (call dr. STAT)

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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 IO
• Check B/P, apical radial pulse and respirations
  q 1-4 hours

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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.

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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

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PERIPHERAL VASODILATING DRUGS

• Acts on the smooth muscle layers of peripheral
  blood vessels
• Uses peripheral vascular disease
• Adverse Reactions
• Hypotension, headache, dizziness, palpitations
• Avoid driving and sudden changes in position
• Stop smoking

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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

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ANTIHYPERLIPIDEMICS

• Bile acid sequestrants
• HMG-CoA Reductase Inhibitors
• Fibric Acid Derivatives
• Uses lower serum lipid levels
• Adverse Reactions
• Nausea, vomiting, headache, abdominal pain
• A paradoxical elevation of the lipid levels may
  occur
• Usually drugs will be discontinued if no
  improvement in 3 months.

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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

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THROMBOLYTIC DRUGS

• Break down fibrin clots by converting plasminogen
  to plasmin
• Uses treat acute MI, PE, DVT
• Adverse Reactions
• external or internal bleeding
• Need continuous monitoring, bed rest during
  therapy

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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

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ANEMIA DRUGS (CONT.)

• Anemia assoc. with chronic renal failure
• Epoetin Alfa hypertension, headache tachycardia
• Folic acid deficiency anemia
• Leucovorin few adverse reactions,
• Pernicious anemia
• Vitamin B12 mild diarrhea and itching

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DIURETICS

• Carbonic Anhydrase Inhibiotors
• Loop Diuretics
• Osmotic Diuretics
• Potassium Sparing Diuretics
• Thiazides
• If take drug once daily, take in the early
  morning
• ALERT- poor skin turgor dry mucous membranes
  are signs of excess diuresis

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URINARY ANTIINFECTIVES

• Uses UTIs
• Adverse Reactions
• Nausea, vomiting, anorexia, abdominal pain
• Stress the importance of completing a full course
  of therapy
• Avoid the use of nonprescription drugs

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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

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GI SYSTEM DRUGS (cont.)

• GI stimulants
• Mode of action unclear
• Uses GERD, gastric stasis
• Adverse reactions mild, drowsiness or dizziness
• Histamine H2 antagonists
• Inhibit the action of histamine at the receptor
  cells of the stomach
• Uses gastric or duodenal ulcers
• Adverse reactions -

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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

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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

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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

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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

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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

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PITUITARY ADRENOCORTICAL HORMONES

• Hormone supplement or replacement
• Measure IO 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

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THYROID ANTITHYROID DRUGS

• Uses hyper or hypothyroidism
• Adverse reactions
• Signs of hyper or hypothyroidism
• Administer med early in the morning preferably
  before breakfast

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MALE FEMALE HORMONES

• Male hormones
• Androgens, anabolic steroids, androgen hormone
  inhibitors
• Female hormones
• Estrogens, progestins, contraceptive hormones
• Taking anabolic steroids can cause severe mental
  and personality changes
• Oral contraceptives are best taken with evening
  meal or at bedtime

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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

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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

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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

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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

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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

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OTIC OPTIC DRUGS

• Otic
• Uses to relieve pain, treat infection and
  inflammation, aid in the removal of ear wax
• Adverse reactions prolonged use
  (superinfection)
• Ophthalmic
• Uses glaucoma, infections, inflammation and
  allergies
• Adverse Reactions varies depending on type
• Warm otic solutions prior to instillation to
  prevent dizziness

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FLUIDS ELECTROLYTES

• Uses to correct nutritional of fluid deficiencies
  or treat certain diseases and conditions
• Fluids
• Blood plasma, plasma proteins fractions, protein
  substrates, energy substrates, plasma expanders,
  intravenous replacement solutions
• Electroytes
• Bicarbonate, calcium, magnesium, potassium,
  sodium,
• Adverse reactions
• Hypokalemia

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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

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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

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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

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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