DEFINITION OF TERMS Pharmacodynamics – the study the way drugs effect the body. Pharmacokinetics – the study of the way the body deals with drugs and includes absorption, distribution, biotransformation and excretion of the drug. Once the pharmacokinetics of a drug is determined, rational dosage regimen can be instituted. Drug Absorption – refers to what happens to a drug from the time it is introduced to the body until it reaches the circulator fluids and tissues. Drug Distribution – it involves the movement of drugs after absorption or injection into the interstitial or cellular fluids. Onset of Action – the time administered drug produce its effect on system. Biotransformation/Metabolism – the process by which drug s are change into new, less active chemical Excretion – the removal of a drug from the body. The skin, saliva, the lungs, bile and feces are route used to excrete drugs. Critical Concentration – the amount of a drug needed to cause a therapeutic effect. Half-life – the time it takes the amount of drug in the body to decrease to one- half of the peak level it previously achieved. Peak Plasma Level – refer to high plasma concentration of the drug for a maximum therapeutic effect. Therapeutic Blood Level – refer to the drug plasma concentration achieved within the standard margin of safety and effectiveness. PHARMACOKINETICS PROCESSES 1. Absorption – refers to what happens to a drug from the time it is introduced to the body until it reaches the circulating fluid and tissues. Areas of the Body for drug Absorption: a. Gastrointestinal (GI) tract either orally or rectally b. Mucous membrane c. Skin d. Lungs e. Muscle of subcutaneous tissues Process of absorption 1. Passive Diffusion – occurs across a concentration gradient from an area of higher concentration to an area of lower concentration. 2. Active Transport – a process that uses energy to actively remove a molecule across a cell membrane. This process is not important as absorbing drugs, but use in excretion in the kidney 3. Filtration – involves movement through pores in the cell membrane down a concentration gradient or the pull of the plasma protein. This process is use in drug excretion
Transcript
DEFINITION OF TERMS
Pharmacodynamics – the study the way drugs effect the body.Pharmacokinetics – the study of the way the body deals with drugs and includes absorption, distribution, biotransformation and excretion of the drug. Once the pharmacokinetics of a drug is determined, rational dosage regimen can be instituted. Drug Absorption – refers to what happens to a drug from the time it is introduced to the body until it reaches the circulator fluids and tissues. Drug Distribution – it involves the movement of drugs after absorption or injection into the interstitial or cellular fluids.Onset of Action – the time administered drug produce its effect on system.Biotransformation/Metabolism – the process by which drug s are change into new, less active chemicalExcretion – the removal of a drug from the body. The skin, saliva, the lungs, bile and feces are route used to excrete drugs.Critical Concentration – the amount of a drug needed to cause a therapeutic effect.Half-life – the time it takes the amount of drug in the body to decrease to one-half of the peak level it previously achieved.Peak Plasma Level – refer to high plasma concentration of the drug for a maximum therapeutic effect.Therapeutic Blood Level – refer to the drug plasma concentration achieved within the standard margin of safety and effectiveness.
PHARMACOKINETICS PROCESSES
1. Absorption – refers to what happens to a drug from the time it is introduced to the body until it reaches the circulating fluid and tissues.
Areas of the Body for drug Absorption:a. Gastrointestinal (GI) tract either orally or rectallyb. Mucous membranec. Skind. Lungse. Muscle of subcutaneous tissues
Process of absorption
1. Passive Diffusion – occurs across a concentration gradient from an area of higher concentration to an area of lower concentration. 2. Active Transport – a process that uses energy to actively remove a molecule across a cell membrane. This process is not important as absorbing drugs, but use in excretion in the kidney3. Filtration – involves movement through pores in the cell membrane down a concentration gradient or the pull of the plasma protein. This process is use in drug excretion
1. Blood flow – rich blood flow supply enhances absorption, whereas poor circulation hampers absorption2. Pain – slows gastric emptying rate so the drug remain longer in the stomach3. Stress4. Foods5. Exercise – its can decrease blood circulation to the GI tract by causing more blood flow to the muscles6. Nature of the absorbing surface – transport of drug molecule is faster through a single layer of cells (intestinal epithelium) the transverse layers of cells (skin)7. Solubility of the drug- the drug must be in solution
Mucous membranes(Sublingua, buccal)
Perfusion or blood flow to the areaIntegrity of the mucous membranesPresence of food or smokingLength of time drug retained in the area
Topical (skin) Perfusion or blood flow to the areaIntegrity of skin
Inhalation Perfusion or blood flow to the areaIntegrity of lung lining
Ability to administer drug properly
First – pass effect – the breakdown of oral drug in the liver immediately after absorption. Drugs given by other routes often reach reactive tissues before passing throughout the liver for biotransformation
2. Distribution – the portion of the drug that gets through the first-pass effect is delivered to circulation for the transport throughout the body. It involves the movement of drug to the body tissue
Factors that affect Distribution
1. Protein binding – drugs are bound to proteins the blood to be carried in circulation. The drugs must be freed from the protein binding site at the tissue for therapeutic effect2. Barriers to Drug Distribution
Blood – Brain Barrier – is a protective system of cellular activity that keeps many things (Foreign invaders, poisons) away from the CNS Drugs that are highly lipid soluble are more likely to pass the blood-brain barrier cells in CNSTeratogenic – cause defect on fetus may be virusPlacenta Barrier – Many drugs pass through the placenta and the effect the developing fetus. In pregnant women, Drugs should be given only when the benefit clearly outweighs any risk. Many drugs are secreted into the breast milk, thus having the potential to affect the neonate.Note: (Breast milk) The nurse must always check the ability of a drug to pass into breast milk when giving a drug to a nursing mother.
3. Volume distributor – client with edema has enlarged area in which a drug can be distributed and may need an increased dose. Similar dose may be needed for client with dehydration.4. Obesity – body weight plays a role in drug distribution because blood flows through fat slowly, thus increasing time before drug is released.5. Receptor combination – a receptor is an area on a cell where drug attaches and response takes place.
3. Biotransformation (Metabolism)Liver enzyme system – the liver is the most important site of drug metabolism or biotransformation, the process by which drugs are changed into new, less active chemicals. The liver detoxifies many chemicals and uses others to produce needed enzymes and structures.
Factors that affect drug metabolism:1. Age - infant and elderly have reduced ability to metabolize some drugs2. Nutrition – liver enzymes involved in metabolism rely on adequate amounts of amino acids, lipids, vitamins, and carbohydrates3. Insufficient amounts of major body hormones – insulin/adrenal corticosteroids can reduce metabolism of drugs in the liver4. Excretion – is the removal of a drug from the body. The kidney plays the most important role in drug excretion.
Routes use for drug excretion: a. Skinb. Salivac. Lungsd. Bilee. Feces
Factors that affect drug excretion:
1. Renal excretion – carried out by glomerular filtration and tubular secretion, which increases quantity of drug excreted. Other renal processes that result in tubular reabsorption.
-Drug metabolites in urine can be reverted back into the blood stream 2. Drugs can affect elimination of other drugs
Example: Antacid increase elimination of ASA, thus decrease its effect
3. Blood concentration levels – when peak level of blood is reached, excretion becomes greater than absorption and blood levels of drugs begin to drop.4. Half life of a drug - is the time takes for the amount of drug in the body to decrease to one-half of the peak level it previously achieved. It is important in determining the appropriate timing for a drug dose.
Note: The nurse can use her knowledge of drug half life to explain the importance of following a schedule of drug administration in the hospital or at home.
……Figure above shows the process by which drug is handles by the body
FACTORS INFLUENCING DRUG EFFECTS AND ACTIONS
a. WeightThe recommended dosage of a drug is based on drug evaluation studies and is targeted at a 150-pund person.Heavy individuals require larger doses while lighter individuals require lesser dose of the drug.
b. AgeAge is a factor primarily in children and older adults.Children and older adults have lesser dose compared to an adult.
c. GenderPsychological difference between men and women can influence a drug’s effectMales have more vascular muscle so the effects of the drug will be seen sooner than with femalesFemale have more fat cells than males, so drugs that deposit in fat may be slowly released and cause effects for a prolong period of timeWomen who are given any drug should always be questioned about the possibility of pregnancy
d. Physiological FactorsPhysiological differences such as diurnal rhythm of the nervous and endocrine systemAcid-base balance, hydration and electrolyte balance can affect the way a drug works On the body and the way the body handles a drug. e. Pathological FactorsPathological conditions can change the basic pharmacokinetics of a drug.Presence of pathology (disease) and the severity of symptoms may call for an adjustment of dosage
f. Genetic FactorsGenetic differences can sometimes explain a patient`s varied response to a drug.Some people lack certain enzyme system necessary for metabolizing a drug while others have overactive enzyme systems and break down drugs very quickly.
g. Immunological factorsPeople can develop an allergy to a drug.After exposure to its (drug) proteins, a person can develop antibodies to a drug.Future exposure to that drug may result to a full-blown allergic reaction
h. Psychological FactorsThe patient’s attitude about a drug has been shown to have a real effect on how that drug worksThe nurse‘s positive attitude, combined with additional comfort measure can improve patient‘s response to a medication.
i. Environmental FactorsThe environment can affect the success of drug therapy. Some drugs are helped by a quiet, cool, non-stimulating environmentIf a patient‘s response to a medication is not as expected, the nurse might look for changes in environmental condition.
j. ToleranceSome drugs are tolerated by the body overtimeDrugs that are tolerated no longer cause the same reaction and need to be taken in increasingly larger doses to achieve a therapeutic effect.
k. CumulationWhen a drug is taken is successive doses at intervals that are shorter than recommended, or when the body is not able to eliminate a drug properly, the drug can accumulate in the body, loading to toxic levels and adverse effect
l. Drug – Drug InteractionWhen two or more drugs are taken together there is a possibility that these drugs will interact with each other to cause unanticipated effect in the body.It result in an increase or decrease in the desired therapeutic effect of one or all of the drugs, or an increase in adverse effects.The nurse should first consult a drug guide for a listing of clinically significant drug to drug interaction
m. Drug-Food InteractionsSome food increase acid production speeding the breakdown of the drugs molecule and preventing absorption and distribution of the drugSome food clinically reacts with certain drugs and prevents their absorption into the body.
n. Drug-Laboratory Test InteractionsAdministration of a particular drug may alter test that are done on various chemical levels or reaction as part of a diagnostic studyDrug Laboratory test interaction is a result the drug being give and not necessarily as result of a change in the body‘s response or action
DIFFERENT PHARMACEUTICAL PREPARATIONS
A.1 LIQUIDS (Single phase (Clear)-Aqueous)
Aromatic Water – clear, saturated aqueous solutions of volatile oils or other aromatic substance. Use as a vehicle, flavors or performing agent.Example: Peppermint water – flavored vehicle Rose water – performing agent
Aqueous Acid – the official inorganic acids and organic acids, although of minor significance as therapeutic agents. Has great importance in chemical and pharmaceutical manufacturing.Example: Glacial acetic acid – as causatic agent Hydrochloric acid – as acidifying agent
Solutions (oral) – are liquid preparations that contain one or more soluble chemical substances usually dissolve in water.Example: Oral Rehydration Solutions (Oresol) – as electrolyte replenisher
Juices – is prepared from fresh ripe juice, is aqueous in character and is used in making syrups which are employed as vehicles.Example: Cherry juice – use to prepare cherry syrup Raspberry juice – for raspberry syrup
Syrups – concentrated solutions of sugar as sucrose or other aqueous liquid.Example: Simple syrup – use as flavor (Solution of sucrose in purified water alone)
Honeys – are thick preparations somewhat apllied to the syrups. They are unimportant as a class of preparation today but at one time, before sugar was available, honey was the most common sweetening agent.
Mucilages – are thick, adhesive liquids, produced by dispersing gum in water.Example: Acacia mucilage – use as emulsifying agent for cod liver oil.Jellies – a class of gel in which the structural coherent matrix contains a high proportion of liquid, usually water. They are similar to mucilage but they differ in having a jelly-like consistency.Example: KY Jelly – use as lubricants
Mouthwash – are mostly aqueous in nature, pleasantly flavored solutions often colored and may either be acidic or basic reaction.Example: Listerine, Bactidol – use as antiseptic, deodorant and refreshing effect in the mouth
Gargles – are aqueous solution (frequently containing antiseptic , anti-biotics or anesthetics used for treating the pharynx and nasopharynx by forcing air from the lungs through the gargle which is held in the throat, subsequently the gargle is expectoratedExample: Cepacaine solution – contains a topical anesthetic for the relief of pharyngeal and oral pain.Providone Iodine (Betadine)- 1% gargle – use as oral antiseptic
Douches – is an aqueous solution which is directed against a part or into a cavity of the body, It function as a cleansing or antiseptic agentExample: Vaginal douche – Lactic acid irrigation
Enemas – are rectal injections employed to evacuate the bowel (Evacuation Enema) or influence the general system by absorption or to effect locally the seat of disease (Retention enema) or they may contain radiopaque substances for examination of the lower bowelExample: Sulfasalazine rectal enema – for treatment of ulcerative colitis Barium sulfate enema – use for x-ray visualization of the large intestine
Irrigation solutions – used to wash or bathe surgical incisions, wound or bodily tissues,Example: Sodium chloride irrigation 0.9% - for washing wounds
Eye (Ophthalmic solutions) – are sterile products essentially free from foreign particles, suitably compounded and packaged for insulation into the eyeExample: Tears naturalle II (alcon) – for the relief of dry eyes
Otic (Aural solutions) - are placed in the ear carnal by drops or in small amount for the removal of excessive cerumen (ear wax ) of the treatment of ear infection , inflammation or painExample: Auralgen Otic Solution – for treatment of acute otitis media
Nose (Nasal Solutions) – are usually aqueous solutions designed to be administered to nasal passage in drops or sprays. Example: Nasalcrom Nasal Solution – for seasonal or perennial rhinitis
A.2 LIQUIDS (Single phase – Non – Aqueous)
1. Alcoholic Liquid Preparations Elixir – are clear, pleasantly flavored , sweetened , hydro alcoholic liquids intended for oral useExample: Phenobarbital Elixir – use as sedative and hypnotic
Spirits Essences – alcoholic or hydro alcoholic solution of volatile substances. Use internally for their medicinal value, a few by inhalation and a large number as flavoring agent.Example: Aromatics – Amimonia spirit – use as respiratory stimulant
Dental Liniments – are liquid preparations which are applied to the gums for their local stimulant and anesthetic effect.Example: Delabarre – use during teething period of babies has a soothing effect
2. Glycerin solutions
Glycerins or glycerites – are solutions or mixtures of medical substance in not less than 50% by weight of glycerin (solvent)Example: Extermol {contains 5% carbamide peroxide (urea hydrogen peroxide)} in glycerin- use in dispersing ear wax
3. Ethereal Solutions
Collodions – are liquid preparations containing pyroxylin I a mixture of ethyl ether and ethanol. They are applied to the skin by means of a soft brush or suitable applicator. They are intended for “External Use only” and should be applied to dry tissues,Example: Salicylic Acid Collodion 10% - use as keratotolytic. Agent in treatment of corns or warts
4. Oleaginous Preparations
Liniments – are solution or mixture of various substances in oil, alcoholic solutions of soap or emulsions and may contain anti-microbial preservatives, For “External Use only” IT should not be applied to skin that is bruised or broken.Example: Camphor liniment – use as mild counterirritant for inflamed joints, sprains and rheumatism
Medicated oil – are solutions of medicinal ingredients in bland oil. No longer use.
Toothache Drops (Odontalgicum) – are preparation used for the temporary relief of toothache by application of a small pledget of cotton saturated with the product into the tooth decay cavity.Example: Toothache drops – use as local analgesic
Oleovitamins – are liver oil diluted with edible vegetable oil solution of the indicated vitamins or vitamin concentrate (usually Vitamin A and D) In fish liver oil usually in a form of soft gel capsules
Inhalants/Inhalations – are drugs or solution or suspensions of one or more drugs substances administered by the nasal or oral respiratory route for either a local or systemic effect, this preparation is designed that the drug is carried into the respiratory tree of the patient. Inhalations are administered with the use of nebulizers, metered dose inhalers, and other special inhaler device.Example: Ventolin Inhalation Aaerosol – use as beta-adrenergic agonist
A.3 LIQUIDS [SINGLE phase – Extractives (Obtain from plants)]
Tinctures – are alcoholic or hydro alcoholic solution prepared from vegetable materials or from chemical substances.Example Tincture of Iodine 2% - use a germicide and fungicide strong Iodine 7% use as antiseptic
Fluid extracts – liquid preparation of vegetable drugs, containing alcohol as a solvent or as a preservative, or both. Each ml contains the therapeutic constituents of 1g of the standard drug that it represents. (% concentration – 100%) because of its concentrated nature, fluid extracts are too potent to be taken safety by patient for self – administration it’s no longer used.
Infusions – a dilute solution of the readily soluble constituents of crude drugs. Infusions are unstable and susceptible to attack by bacteria and fungi. It is seldom use now.
Decoction – this once-popular process water-soluble and heat-stable constituent from crude drugs buy boiling in water for 15 minutes cooling straining and passing sufficient cold water through the drug to produce the required volume.
Extracts – concentrated preparations of vegetable or animal drugs obtained by removal of the active constituents of the respective drugs with suitable menstrual, evaporation of all or nearly all of the solvent and adjustment of residual masses or powders to the prescribed standards.
3 Types of ExtractsSemi-liquid extract – use as concentrates in the manufacture of pharmaceuticalsSolid extract – use in ointments and suppositoriesPowdered extract – use in formulation of capsule, tablet or powders
Resins – are natural or induced solid or semi-solid exudations from plants (usually back of tree). It is not commonly use now, but of great importance industrially for waterproofing, soap making and others.
A. 4 LIQUIDS [TWO-phase]
1. Suspensions – Liquid preparations containing suspended insoluble particles is a liquid. Has a “Shake well” label
Mixture – oral liquids containing one or more active ingredients, dissolved, suspended or dispersed in a suitable vehicle. Example: Koalin mixture with pectin – for treatment of diarrhea in children
Lotion – suspensions “for External Use only”: topical application to the skin:Example: Caladryl lotion – use as anti-prutic
Magmas/Milk – are dispersion of insoluble inorganic molecules or suspensions of finely divided materials in small amount of water. They are never refrigerated because they stratify.Example: Milk of magnesia – use as gastric antacid
Gels – semi-solid on standing and liquefies on shaking.Example: Cremalin gel, Aluminum hydroxide gel, Use as antacid
2. Emulsion – a two-phase system in which one liquid is dispersed throughout another liquid in the form of small droplets.Example: Cold liver oil emulsion – use as cathartic
B. SEMI-SOLID
Ointments – semi-solid preparation intended for external application to the skin or mucous membrane.Example: Lidocaine ointment – use as local anesthetic
Creams – Viscous liquid or semi-olid emulsion for external use,Example: Nivea (cleansing cream) – for beautifying purpose
Pastes – are ointment like preparation suited only for external application, they are use to absorb serous secretion making it suited for application on and around moist lesionsExample: Zinc oxide paste – use as mild astringent, protective and antiseptic in the treatment of skin diseases
C. SOLIDS
Powders – mixture of finely divided drug or chemicals in dry powdered state for internal or external use.Example: foot powders – use as antiperspirants
Capsule – are usually made of gelatin which are use to dispense powdered drug. Soft capsules are sealed together
Tablets – preparation of powdered drug which are compressed or molded into small disk. May be covered with a colored coating to make them attractive
Pills – are small, round solid dosage forms containing medicinal agent and are intended for oral administration
Lozenges – are flat, round, or rectangular preparations which are held in mouth until they dissolved,liberating the drug involved.
Suppositories – are solid dosage forms intended for insertion into body orifices where they melt, soften, or dissolved and exert localized or systemic effects
D. Unclassified Pharmaceutical Preparations
Dressing – external applications resembling ointment usually use as a covering or protection.Example: Soltratulle, Sofratulle
Plaster is substances intended for external application of such materials and of such consistency as to adhere to the skin and attach to addressing.Example: Corn plasters, salonpas plaster
Cataplasms/Poultices – it is a soft, moist mass of herbs, seeds etc. usually applied hot in cloth.Example: Kaolin Poultice
Cements – are dental preparation employed primarily as protective coverings for exposed pulpsExample: Zinc-Eugenol cement
Injections/Parenteral – those intended for injection under the through one or more layers or the skin or mucous membrane. Package as either large-volume parenteral (LVP) or small volume parenteral (SVP) multiple dose or single dose.Example: D5LR 1000 ml (LVP)
1. Whole BloodUses:1. Treatment of acute hemorrhage2. Treatment of acute hypovolemic shock3. For exchange transfusion4. Treatment of severe anemia
2. Packed red cellsUse to treat severe anemia
3. Platelet transfusion2 kindsa. PRP-platelet rich plasmab. PC-platelet concentratesUSE: to control or to prevent bleeding in patients with dangerous degree of thrombocypenia
4. Whole plasma
USES1. Treatment of clotting defects2. Treatment of hypovolemia
5. Anti-coagulant – drugs that inhibit clotting of blood; do not dissolve clot that has already formed but it prevents formation of new ones.USES1. Treatmant of pulmonary emboli and coronary occlusion2. Treatment of deep vein thrombosis and thrombophlebitis3. Reduce formation of trombi after MI4. Prevent coagulation of blood of transfusion
2 types1. Direct anticoagulant-act directly in the blood stream; act quickly but don’t last long.
E.g. Heparin-given IV, SC2. Indirect anticoagulant-act to prevent formation of prothromborin by the liver.
E.g. Coumadin, Dicumarol-given orally, Warfarin.
Nursing Considerations:1. Avoid giving Herapin by IM to immunize hematomas2. When giving subcutaneous injection, don’t massage site: also rotate injection site.3. Never give piggy back with other drug like antibiotic because it will in activate the heparin4. Monitor prothomborin time and bleeding time closely-PT, PTT, CT, BT5. Be alert for signs of bleeding- epistaxis, bleeding gums, petechiae, tarry stools6. Use small needle when giving subcutaneus injection, such as G-24, G-25, G-267. Coagulant-drugs used to combat bleeding caused by anticoagulant
E.g. Vit K, Aquamephyton, Hemostan, Protamine SO4
7. Hemostatics - drugs that reduce capillary bleeding or hasten coagulation of blood USES 1. Treat bleeding from dental socket, nasal laryngeal sugery- E.g. tromborin 2. Provide hemostasis during various form of surgery - E.g. gelfoam 3. To correct hypofibrogenemia - E.g. fibrinogen 4. In correction of hemophilia - E.g. anti- hemophilia factors (AHF)
Nursing ConsiderationsMonitor allergic reaction especially with AHFMonitor vital signs-if there is pulse, decrease rate administration
B. DISTURBANCE IN THE OXYGEN CARRYING TRANSPORT
1. Cardiotonics or cardiac stimulant-drugs that act to improve muscular contraction of the heart and slows down heart beat USES1. Treatment of congestive heart failure2. Alleaviate atrial fibrillation and flutter, arterial tachycardia and premature extra systole
Mechanism of actiona. Increase myocardial contractility by direct action on myocardiumb. Increase calcium in myocardial cell to promote muscle protein binding and thus increase cardiac contractionc. Decrease impulse conduction thru AV node to slow down the heart.Examples: Digital, Cedilanid, Lanoxin
>Digitalizing –the process of reaching the desired therapeutic by giving successive doses of cardiotonic drug.Two aspects involed1. Digitalizing or loading dose of the amount needed to obtain a therapeutic effect2. Maintenance dose-the amount needed to maintain the therapeutic effect
Nursing Considerations1. Watch out for rhythm of pulse, vomiting, nausea, anorexia, and headache.2. Observe digitalis precaution-Take apical rate for full minute, if below 60 and above 120, don’t give, but notify doctor3. Obtain baseline data-check cardiac rate and rhythm, BP, electrotes, BUN, creatinine.
2. Beta-blockers or cardiac depressant-drugs that block beta-adrenergic reflexes but not alpha receptorsUSES 1. Use as myocardial depressant in treatment of angina pectoris and subaortic stenosis 2. Treat cardiac arryhythmias Mechanism actionIt decrease cardiac rate,c ardiac cutput, myocardial contractility and blood pressureExample: Inderal, Quinidine, Lidocaine
3. Vasolidators - drugs that increase blood supply to a part by dilating blood vesseis and relexaton of vascular smooth muscle Two Groups =Group I-drugs used to treat peripheral vascular diseases – e.g. Cylclospasmol, Isordil =Group II-treat coronary vascular diseases – e.g. Nitrates, Nitrites, Persantin, PeratrateUSES1. Relieve pain of angina pectoris by dilating coronary arteries2. Treatment of vasospastic and peripheral vascural disease3. Treat spasm of coronary thromboses – e.g. ‘’Nitroglycerin’’ Sublingual - Nistrotat, Nitrobid Ointment – Nitrol
Nursing Consideration1. Nitroglycerin is not habit forming - may be taken regularly: effect last only for few minutes2. Oral preparation best taken on an empty stomach 1/2 –hour before meals.3. Sublingual preparation can be repeated Q10 minutes for 3 doses – if not relieve of pain call doctor or go to the hospital
4. Antihypertensive - drugs that cause vasodilation and reduction of blood pressure. Uses: Treatment of mild to severe essential hypertension. Mechanism of actiona. Relaxes venous and arteriolar smooth muscleb. Causes vasolidation Example:. Minipres, Catapres, Aldomet, Nitpride
Nursing Considerations1. Monitor BP and pulse frequently while taking the drug.2. Avoid alcohol and stay on diet prescribed by the doctor.3. Salt and water retention may occur-relieved by diuretic.4. Reduce dose gradually- if discontinued abruptly can cause excessive hypertension.
Nipride (Nitroprusside Soduim)- drug that lower down BP quickly in hypertensiveEmergency: it is incorporated to IV fluids.
Nursing Considerationa) Due to light sensitivity, keep IV solution and tubing wrapped in foil.b) Monitor VS esp. the BP q 15 minutesc) Best run as piggy back to main IV fluid - no other medication should be addedd) Watch for sign of toxicity – severe hypertension, acidosis, vomiting, loss of consciousnesse) Check IV site always – if needle is out the vein it can cause tissue irritation or sloughing off with necrosis
5. Diuretics - drugs that increase urinary excretion of water and sodium
USES:1. Treatment of edema in cardiac patient with aim of reducing fluid accumulation and relieve the ailing heart2. Treatment of hypertension3. Reduce intracranial and intraocular pressure
Mechanism of action1. Loop diuretic inhibit reabsorption of Na and CI in the ascending loop of henle 2. Mercurial diuretic inhibit renal tubular absorption of Na, CI and water in the cortical diluting segmentSide effects: Hypokalemia, dehydration, electrolyte depletion
Nursing Consideration:1. Monitor electrolytes BUN, CO2, Na, K2. Watch for sign of hypokalemia like muscle weakness and cramps – patients needs supplement3. Monitor intake – output4. Monitor daily weight
6. Oxygen – indicated in all types of coronary infarction especially with cyanosis=In coronary infarction and cyanosis this is occlusion impaired cardiac function congestion pulmonary edema result in poor absorption of 02 increase anoxia.=O2 will relieve dyspnea, lessen pain, slow down heart rate=80 – 100% should be used via nasal catheter.
c. DISTURBANCES IN OXYGEN EXCHANGE
1. Bronchodilator or anti-asthmatic drugs – drugs that cause bronchodilation thereby making breathing easier for the patientUSES: In management of bronchial asthma, wheezing membrane, reduce secretion of mucusMechanism of Action: Relieve boncho spasm, shrink swollen mucous membrane, reduce secretion of mucusExamples:
a. Theophylline – aminophylline, bricanyl, quibron, ventolin, brondilb. Isoprotrenol – isuprel for inhalation
2. Cough and cold remedies
a. Expectorant/mucolytic – drug that loosen secretions, reduce thick or tenacious respiratory secretions and promote an facilitate expulsion of mucus from the respiratory passages.USES:
1. Facilitate expectorant in pneumonia, bronchitis, emphysema, bronchial asthma2. Treatment of chronic respiratory disorder
Mechanism of Action:Increase respiratory tract fluid to help liquefy and reduce viscosity of thick tenacious secretionsE.g. Resyl, Robitussin, Benadryl, Mucomyst, Mucosolvan, Loviscol
Nursing Consideration:1. Patient should not smoke2. Avoid driving3. Do deep breathing exercises4. Encourage fluid intake to help liquefy secretions
b. Anti-tussive or cough suppressant – drug that suppress cough reflex but are used usually when cough is non-purulent; best given in liquidUSES: Suppress non-productive coughMechanism of Action:
Has direct effect on cough center in brain to suppress cough reflexExamples:
c. Decongestant – drug used to shrink engorged mucous membrane of the noseUSES: for nasal congestionMechanism of Action: Shrink engorged mucous membrane by vasoconstrictionTwo kinds:
B. Electrolyte Replacement – solutions used to replace the lost anions or cations or prevent their depletion.
Replacement of specific anion and cation Examples: -Calcium
a. Calcium Sandoz effervescent (PO)b. Calcium gluconate (incorporated to IV)c. Calcium chloride
-Sodiuma. 3% NaCl IV solutionb. 0.9% NaCl IV solution
-Potassium Chloridea. Kcl (incorporated to IV)b. Food high in K (banana, oranges)
-Magnessiuma. Magnessium sulfate (given deep IM)
C. Oral Rehydration – solutions taken orally to replace lost electrolytesExamples: Pedialyte, Oresol, Gatorade (commercial)
D. Peritoneal dialysis – a minor operation done to remove toxic substance from the body as in case of renal failure; acts by principle of osmosis and diffusion
Dialyzing fluid – the solution used that resembles electrolyte composition of blood plasmaExample: “Inpersol”
Nursing Considerations1. 1-2 L of solution is allowed to run rapidly (10-20 mins)2. Solution remain in peritoneal cavity for 15-30 mins3. Solution is allowed to flow out4. Outflow should approximate inflow5. Repeated for 12-36 hours6. 30-50 liters is usually exchanged7. Monitor VS closely8. Abdominal pain may indicate or build up fluid due to incomplete outflow9. Accurate recording is necessary
III. DISTURBANCES IN METABOLISM
A. Nutrition
1. Vitamins – substances present in minute amount found in natural food. They are not synthesized by the human body.
USES: 1. Promote normal growth and development and nutrition2. Maintain and restore health3. Overcome specific deficiencies
Two main categories1. Fat soluble vitamins – Vitamin A, D, E, K – require bile, fat, pancreatic secretion for absorption2. Water soluble vitamins – Vitamin B complex, Vitamin C
Fat Soluble Vitamins1. Vitamin A – fat soluble vitamin which is unstable and readily destroyed by oxidation Uses:
1. Proper maintenance of epithelial2. Proper visual functioning
Vitamin A deficiency would result in:a. Keratosis – dryness and roughness of skinb. Xerophthalmia – eye disease in which eyeball dries and atrophies (leads to blindness)c. Night blindness – nyctalopia
2. Vitamin D – “Sunshine vitamin”Uses: Regulates the metabolism of calcium and phosphorus in the body
Vitamin D deficiency would result to:a. Rickets – disease manifested by improper tooth and bone developmentb. Osteomalacia – softening of bone, becomes flexible and twisted deformity
Sources:a. Milk and milk productsb. Sunshinec. Calciferol
3. Vitamin E – fertilityUses:
a. For fertilityb. For virility
Sources:a. Wheat germ, vegetable oilb. Synthetic Vitamin E
4. Vitamin K – “Antihemorrhagic vitamin”Uses:
a. Treat or prevent bleeding tendenciesb. As coagulant
Vitamin K deficiency would result to:a. Prolonged clotting time of bloodb. Hemorrhagic tendencies
1. Vitamins B – divided and subdivided into several types
a) Thiamine –Vit B1 – Anti beri – beri vitamin” Uses = treat beri – beri = treat pellagra
B1 deficiency –would lead to = tendency to edema
= neuritis, neuralgia = muscular weakness
Sources: = beef, liver, legumes = Thiamine HCL – PO or IM
b) Riboflavin – Vit B2
Use: Play a role in carbohydrates (protein metabolism) B2 definciency would result to = vascularization of cornea = glossitis – tongue is painful = lip lesion Sources: = egg, yeast, milk = Riboflavin c) Pyridoxine – Vit B6
Uses: = as co enzymes in metabolism of amino acids = utilization of essential fatty acid B6 deficiency = dermatitis = skin oral lesion d) Cobalamine – B12 very impotant anti – anemic vitamin
g) Panthothenic acid, Cholin, Biotin – essential for proper metabolic process of the body
2. Vitamin C – Ascorbic acidUses:
= essential for growth= needed for formation of teeth and body= maintain intercellular cement substance= promote and repair of damage tissue and healing wounds and destroyed by heat
1. Needed in proper development and maintenance for bone and teeth2. Maintenance of general body cell activity
Deficiency1. Rickets and osteomalacia2. Osteoporosis – calcium and phosphorus are absorbed but fail be deposited in the bones3. Renal osteopathy – acidosis causes excessive calcium and phosphorus absorption from the bones and last in the
urine.4. Tetany – low calcium level would result in increased excitability or peripheral nerve that would result in muscle
cramp leading to tonic muscle contraction.Sources:
1. Milk and milk products
2. Calcium lactate – PO3. Calcium gluconate – IM
b. IronUses: Treatment of iron deficiency anemia (hypochromic type) - *Tarry stool is expectedSources:
c. Iodine –used in proper functioning of thyroidSources:
a. Seafoodsb. Lugol’s solutions
3. Total Parenteral Nutrition (TPN) – method of providing complete nutrition by IV route. As much 7, 000 calories/day is given.Use: Given to patient who is unable to maintain nutrition adequate for metabolic need as in chronic diarrheal state or inflammatory bowel/disease.
1. Antacid –drugs used in the treatment of hyperacidity and peptic ulcer Uses: controls peptic ulcer or hyperacidity by neutralizing the gastic acidity in the stomach Examples: MOM , Riopan , Cremalin , Galusil , Maalox
2. Antiflatulent – drugs used to prevent or relieve flatulence Use: Relieve symptoms of acute gas in the stomach Mechanism of action: Acts in the stomach and intestine to form a film that causes air bubbles to collapes Examples: Festal, Digestalin
3. Absorbent – drugs that inhibit gastro intestinal absorption of wide variety of drugs, chemical and toxinUse: As antidote in certain acute oral poisoning mechanism of action adhere to wide variety of drug thereby inhibiting absorption of this agent from GI tract.Not absorbed but excreted unchanged in faces black stoolExample: Charcocaps, Charcotabs
4. Anti – Cholinergic drugs – drugs that inhibit gastro intestinal absorption of wide variety of drug thereby inhibiting absorption of these agent from GI tractUses:
a. Treatment of peptic ulcerb. Pre operative medicationc. Mydriaticsd. Artispasmodic
Mechanism of action:a. Decrease of motility of GI tract
b. Delay emptying time of the stomachc. Decrease gastric secretion
5. Antipasmodic – drugs that relieve spasm of smooth muscle Uses :
a. Gastro intestinal colicb. Neurogenic bladder
Example: Spasmocibalgin
6. Anti-diarrheal - drugs used to control diarrhea Uses :
a. Inhibit peristaltic activityb. Absorption of toxic substancesc. Suppression of enterophatic organism
Example : lomotil , Immodium, Lormide, Kaopectate, Humagel
7. Emetics – drug that will induce vomitingUse: Ingestion of poisonous substancesExample: Ipecac Syrup
8. Anti – emetic – drugs used in the relief and treatment of nausea, vomiting vertigoUse: Treatment and prevention of nausea, vomiting and motion sicknessMechanism of action: Inhibit vestibular function and or suppression of the vomiting centerSide Effects: drowsiness, blurring of visionExamples: Bonamine, Dramamine, Compazine
9. Cathartic or Laxative – drug that promotes defecation or relieves constipationUses:
a. Relief of constipation b. Bowel evacuation before diagnostic x-ray
c. Softening of stool to prevent straining during defecation Mechanism of action:
a. Hydrate stool thereby increasing its bulk and water contentb. Promote peristalsis which aids in the passage of the stool
10. Anti – amoebic – drugs used in the treatment of amoebiasis Use: Treats patient with intestinal and extra intestinal amoebic infestation Example: Flagyl, Furamide
11. Anti – helmentics – drugs used to treat infestation of various worms Use : Eradication of virous species of wormExample: Combatrin
C. Hormonal DisturbancesHormones – are substance secreted into the bloodstream by the ductless gland for regulation of body process.Uses of Hormones:
1. Replacement of therapy when gland do not secrete the needed hormone2. In cases of stress when the body’s normal supply is insufficient3. Used in retarding growth of certain types of cancer4. Used as oral contraceptive5. Anabolic drugs – group of synthetic hormone used to promote tissue healing after long illness
1. Insulin – hormone secreted by the islet of langerhans in the pancreas responsible for converting glycogenUse: In treatment of diabetes mellitus
Mechanism of action:1. Increase glucose transport across muscle and fat cell from the bloodstream thereby reducing blood sugar2. Promotes conversion of glucose to its storage from Glycogen
Types of Insulin: Divided according to onset and duration
Peak of Action Duration of ActionQuick acting regular 3 to 4 hours 6 to 8 hours Long lasting a) Protamine Zinc 12 to 24 hours 24 to 32 hoursb) Eslobin Zinc 8 hours 24 hoursc) NPH (Neutral Protamine Hagedorn) 8 hours 24 hoursd) Lente or Semilente 8 hours 24 to 32 hours Nursing Considerationa) Test urine before meals+ -No insulin++ - 5 units of regular insulin+++ - 10 units of regular insulin ++++ - 15 units of regular insulin
b) Insulin usually given by subcutaneous route – 90 degress because is destroyed by GI tractc) Rotate site of injection – prevent atrophy of subcutaneous tissued) Measure in unit – match the unit being used with the insulin syringese) Insulin should be kept cool – refrigerated not frozen don’t shake but warm by rolling handf) Patients who are diabetic should always carry sugar with them. In the hospital provide sugar or any juice ready to bedside g) Strict aseptic technique is essential h) Watch out for sign of insulin toxicity or insulin shock of hypoglycemic shock, such a
Nervousness - Drowsiness Weakness - Mental confusionCold clammy skin - Stuper Blurred vision - ConvulsionWhen these symptoms occurs with the diabetic patient – give sugar or fruit juices or 50% dextrose
2. Oral hypoglycemic agent or anti- diabetic drugs Use mechanism of action – same as insulinExample: Orinase , Diabianese , Dymelor , Tolinase
3. Thyroid hormone – hormone secreted by thyroid gland whose active principles is thyroxine which contains iodine that is essential for the proper functioning of the general body metabolismUses :
a. Replacement therapy in treatment of myxedema cretirism or simple goiterb. Treatment of confirmed hypothyroidism
Mechanism of actiona. Thyroid hormone affects the rate metabolism, growth and development via calorigenic and protein anabolic effect. It increase rate of oxidation in the cell, thereby increasing rate expenditure and heat production.Example: Proloid , Thyroxine
4. Anti-thyroid drugs – drugs that suppress or inhibit the production of thyroid hormone .they do notCounteract the effect of the circulating thyroid hormoneUses:
a. Treat hyperthyroidism, thyroiditisb. Treat thyrotoxicsisc. Prepare patient for surgery
Mechanism of actiona. They block the organic biding of iodine in into thyroglobulin to form thyroid hormones b. Iodine block the release of thyroid hormoneExample: Tapazole , Lugol’s solution
5. Pituitary hormone – secretion of the anterior and posterior of the pituitary gland (hypophysis) it is composed of the anterior lobe Hyperpitutarism: would result in gigantism or acromegalyHypopituitarism: would result in dwarfism
>Five know hormones secreted by anterior pituitarya) Growth hormone – somototropin (GH) controls general body growth and bone growth.b) Thyroid stimulating hormone (TSH) –increased the activity of thyroid gland and causes it to release thyroid hormone.c) Adrenocorticotropic hormone (ACTH) – stimulate adrenal cortex to release corticosteroids (used in treatment of gout, rheumatic lupus erythematosus)d) Follicle stimulating hormone (FSH)
= Female – responsible for development of graffian follicle in ovaries= Male – increase size of seminiferous tubules
e) Luteinizing Hormone (LH) or interstitial cell stimulating hormone (ICSH)= Female – controls for development of corpus luteum after follicle has ruptured= Male – stimulates interstitial cell of testes to produce male sex hormones testosterones
Two hormones secreted by posterior pituitary
1. Oxytocin – direct stimulating action on uterine muscles causing uterus to contract Uses: a) To induce labor b) Contracts uterus and reduce hemorrhage after deliveryExamples : Methergin , Syntocinon, Ergotrate
2. Vasopressin or ADH Pressor effect – cause peripheral vascular constriction Antidiuretic effect – increase renal water absorptionUse: Treatment of symptoms of diabetes insipidus
Adrenal Gland – located above kidney>Adrenal Medulla – secretes a hormone called epinephrine Action of epinephrine a) Increase heart rate b) Increase blood pressure c) Cause dilation of pupils
> Adrenal Cortex – secret hormone called corticosteroids Two Categories of corticosteroids a) Glucocorticoid – stimulates conversion of protein to carbohydrates: stop inflammation b) Mineralcorticoids – cause kidney to retain Na and excrete KUses:
a. Treatment of adrenal insufficiencyb. Suppression of inflammation in rheumatic fever, collagen and nephrotic syndromec. Suppression of inflammatory reaction in food and drug allergies
d. Relief of cerebral edema after surgery e. Emergency treatment of shock and anaphylaxis
f. Anti – inflammation effect in organ and tissue transplant preventing rejectiong. Adjunctive therapy in some form of cancer
Mechanism of action a. Stabilizes the cell membrane, inhibit release of proteolythc ehzymes thereby preventing normal inflammatory responseb. Interfere with the immune and allergic response by decreasing number of lymphocytes, eosinophils in the bloodc. Mineral corticoid act on distal tubule of kidney to promote reabsorption of Na ions and increase urinary excretion of K.Example : Prednisone, Celstone, Hydrocortesine, Decadrone
Side effects in prolong use of steroids
a) Cushingoid syndrome – type of obesity in which fat is distributed to shoulder causing ‘’buffalo hump,’ ’in face – moonfaced and around waistb) Hirsutism, acnec) Growth suppression in childrend) Headache, vertigoe) Slow wound healingf) DepressionHypofunction of adrenal cortex – cause condition known as “ Adddisons disease”Hypersecretion of adrenal cortex – cause condition known as Cushing syndrome
3) Adrenal Steroid – drug that resembles in action and chemical properties the secretion of adrenal cortex.Examples: Dexametahasone – decadron; Hydrocortesone – solu-cortef
IV. DISTURBANCE IN SEXUALITY AND REPRODUCTION
1) Sex hormones A) Female Hormone
a) Estrogen - natural hormones secreted by the ovaries essential for secondary sex characteristics of female and for maintaining normal menstrual cycle
Uses : 1) Correction of hormonal imbalance 2) Replacement therapy in menopause and after complete hysterectomy 3) Relieve pain form post – partum breast engorgement 4) Inhibit lactation by inhibiting lactogenic hormone 5) Treatment of sexual infantilism Example: Depo-estradoil, Premarin, Trace, Stlbestrol
b) Progesterone – ovarian hormone secreted by corpus luteum during last half of menstrual cycle. It causes swelling and development of endometrium to prepare uterus for implantation of endometrium to prepare uterus for implantation of fertilized ovum
Progesterone – meaning for “ gestation” is also secreted by placenta during pregnancy that helpDecrease uterine contraction which prevent spontaneous abortionPrepare breast for lactationCause cell to develop in endometrium which nourishes young embryoUses: 1) Treatment of dysfunctional uterine bleeding – amenorrhea 2) Treatment of endometriosis
Nursing Consideration:Both are contraindicated for patient with history of cancer of breast or reproductive organ.
B) Male Hormonea) Androgen – natural or synthetic male hormone (Testosterone) responsible for the development of secondary male sex characteristics as facial and body hair, deep voice muscle development
Uses : 1) Treatment of sexual infantilism 2) As anabolic agent to promote muscular growth and weight gain 3) Use in female to treat menstrual disorder as menorrhagia, premenstrual tension 4) To suppress lactation – treat breast engorgement
2) Oxytoxics – drugs from plants or synthetic that are used for their effect on smooth muscle of the uterus and constriction of peripheral blood vesselUses:
a) To induce laborb) Prevention and treatment of post-partum hemorrhage
c) Relieve migraine and other vascular headacheMechanism of action: Hasten uterine contraction thereby lessening bleeding
Fertility drugs – drugs used to enhance fertility and increase chance of pregnancy in anovulatory womanMechanism of action: It appears to increase the output of pituitary gonadotropin which in turn stimulates the maturation and endocrine activity of the ovarian follicle and subsequent development and function of corpus luteumExample : Clomid, Pergonal
Nursing Consideration:a) Contraindicated in presence of ovarian cyst since further enlargement of ovary may occurb) Incidence of multiple pregnancy has increased
4) Anti-fertility drugs or oral contraceptive – drugs that prevent ovulationMechanism of action
a) Inhibit secretion of pituitary gonadtropin by maintaining high blood level of estrogen and progesterone – there is inhibition of FSH, ovarian follicle cannot mature, ovulation can’t take place.b) Cause thickening of cervical mucus which inhibit sperm movement
Uses:1. Prevent conception 2. Treat menstrual disorder as dysmenorrhea, menorrhagia
Example: Estrogen and progesterone combination - Ovulen, Ovral
INFLAMMATORY AND IMMUNOLOGIC DISTURBANCES
1) Anti-inflammatory drugs – drugs that are uses in the treatment of inflammation and in condition characterized by inflammatory process. It also relieves itching and constricts blood vessel. They encompass wide pharmacologic spectrum – salicylates corticosteroid anti inflammatory enzymesUses :
a) Reduction of inflammation in chronic or recurrent inflammatory conditionb) Treatment of cronic inflammatory dermatoses. Such eczema, psoriasis,contact dermatitis
2) Enzymes – complex proteins that hastens or induce chemical without being changed themselvesUses:
a) To reduce swelling in traumab) To liquefy pusc) To promote drainaged) To soften mucuse) To clean wound of dread tissuef) To dissolve fibrin and clotsg) To improve some inflammatory condition f) To reduce inflammation and edema after surgery
Example : Papase , Varidose
Anti inflammatory enzymes that are helpful in reduction in inflammation and edema Example: Chemolose, Papase
3) Anti – histamines or anti - allergies – drugs that will block or counteract the effect of histamines. > Histamines - natural constituent of many tissues both plants and animals, released by stimulation of either physical or chemical nature causing symptoms of allergic response as watery eyes, sneezing, coryza, rashes, bronchiolar constrictionUses:
a. Symptomatic relief of allergic rhinitis b. Treatment of mild urticaria or pruritus
c. Treatment of minor allergic reactiond. Sedation
4) Immunization - artificial introduction of antigen into the body, it is done in the following ways:a. Introduction of living virulent organismb. Introduction of attenuated organism those are alive but no longer capable of producing the diseasec. The use of dead organism
d. Secretion such as exotoxins> Immunity - is said to exist when the level circulating anti – bodies against specific information is high enough so that the individual is not susceptible to that infection
Drugs - used to promote immunity
1) Active immunity
a) Vaccine - killed attenuated microganisms that are not strong enough to cause the disease but which will trigger the immune procces, antigen-antibody formation
b) Toxoid – substances containing exotoxins that has been treated which chemical or heat so that they are no longer poisonous but which is still able to induce formation of antibodies Uses:
1) Prevention of certain infectious disease and childhood disease such as mumps, measles, pertussis, poliomyelitis
2) Prevention of disease transmitted through injury or animal bite such as tetanus or rabies
2) Passive immunity
a) Antitoxin and antivenoms – substances obtained from blood or person or animal who have had the diseaseUses:
a) Prevention and treatment of bacterial toxin infectionb) Treatment of symtoms caused by insects,spider and snake bites
b) Immune Serum Globulin – (Gamma Globulin) preparation made from plasma or serum of hyper immunized donors that contains these antibodies.They are normally present in adult human blood Use - prevention of various infectious disease
Active immunizations1. Diptheria Toxoid – sterile solution of formaldehyde treated toxin product from corynabacteium Diphtheria given 3 doses at 1cc IM qt 4 – 6 weeks interval.2. Tetanous toxoid – sterile solution of treated toxins products from clostridium tetany doses -0.5cc IM at 3-4 weeks interval3. Polio Vaccine a. Salk vaccine – 1cc. IM – 4 -6 weeks interval x 3doses b. Sabine vaccine – given orally4. Typhoid vaccines – suspension of killed typhoid bacilli - 3 doses of 0.5cc subcutaneously at 7-28 days interval5. Measles vaccines (Lirugen) – suspension of live attenuated rubeola virus – one simple dose of 0.5cc subcutaneous 6. MMR vaccine – measles, mumps, rubella vaccine – one simple dose vial given subcutaneous7. Cholera – suspension of killed vibrio organism 0.5cc IM followed in 7-10 days by 1cc IM8. Rabies vaccine – preparation of killed fixed virus which has been grown in duck embryo tissues 1cc subcutaneous daily for 14 days - Given before rabies virus attack nervous system - Observe dog – if there are signs of rabies-gives vaccine right away - If symptoms have occur, vaccine is useless9. BCG – Bacilles, Calmette, Guerin – vaccine against PTB – 0.05 cc intradermally
> Side effects in almost all vaccines and toxoids: a) low mild fever, malaise, pain, edema, redness at injection site.
Passive Immunization
1. Diphtheria antitoxin – sterile concentrated isotonic solution of antitoxinbearing globulins from plasma of horses immunized with diphtheria toxoid and toxinProphylactic dose – 10.000 “ u” IM Therapeutic dose 10.000 “ u “ – 200.000 “ u “ IM or IV
2. Tetanus antitoxin – obtained from human of horse serumProphylactic dose – 5,000 – 10,000 “ u “ IMTherapeutic dose – 40, 00 – 60,00 “ u “ IM
3. Gas – gangrene antitoxinProphylactic dose – 5,000 - 10,000 “ u “ IMTherapeutic dose – 20,00 – 60,00 “ u “ IM
VI. DISTURBANCES IN PERCEPTION AND CORDINATION
A. Neurologic
1) CNS stimulant – drugs that increase or enhance the cognitive function in the central nervous system; such as:a) Stimulant exerting effect on cerebal cortex – useful for increasing alertness, wakefulness and mental activity Example - Caffeine, Amphetamineb) Stimulant that effect medullary centers – used to stimulate vomiting and respiratory center Examples – Nikethamide (Coramine), Apomorphine Uses: a) Treatment of mental depression, exhaustion b) Treatment of narcolepcy and catalepcy
c) Appetite suppression and weight reduction by stimulation of pre-frontal lobe which affect satiety center of hypothalamus
2) CNS depressant – drugs that cause depression of central nervous system. Action would depend on what area of the brain is involved
a) Analgesicb) Sedative
c) Anticonvulsant d) Anesthetics
3) Parasympatomimetics or Cholinergics – drug that stimulate the parasympathetics system. Uses: a) Diagnosed and treat myasthenia gravis
b) Prevent post – operative abdominal distentionc) Treat post – operative atony of the bladder and urinary retentiond) Constricts pupils of the eyes to produce miosis
Mechanism of action: It stimulates or increases the effect of acetylcholine Example: Prostigmine, Neostigmine,Pilocarpine
4) Sympathomimetics or Adrenergic drugs that stimulate the sympathetic systemUses:
a) Treatment of circulatory emergencies like cardiogenic shock – cardiac output is increased, force and rate of cardiac beat is increased, blood pressure in increased
b) Treatment of bronchial asthmac) Control local hemorrhage
d) Treatment of rhinitise) Treatment of allergic response
Mechanical of action: Stimulate or increase the effect of epinephrine Example: Intropin, Ephedrine, Adreline, Aramine
5) Sympatholytics or Adrenergic BLOCKERS – drugs that inhibit or decrease the effect of epinephrine Uses: a) Treatment of peripheral vascular disease b) Treatment of vascular headache Mechanism of action: Block of epinephrine Examples: Ergotamine (Cafergot)
6) Neuromuscular blocking agents –drugs used for the relief of muscle spasm – give parenteralUses :
a) Symptomatic control of muscle spasm in convulsive state of tetanus or epilepsyb) Facilities intubationc) Potentiation of surgical anesthesia
Mechanism of action: Blocks transmission of nerve impulse at skeletal neuromuscular junction
B. Eyes1) Miotic - drugs that cause papillary constriction (miosis)Uses:
a) Treatment of glaucomab) Treatment after ocular surgery
Mechanism of action: Cholinergics cause contraction of sphincter/ ciliary muscle of iris resulting in pupillary constrictionExamples: Pilocarpine, Carbacil, Alphagam
2) Mydriatic - drug that cause papillary dilation and cycloplegiaUses:
a) Diagnostic procedure requiring nydriasis or cycloplegiab) Use in acute iris inflammation
Mechanism of action: Adrenergic dilates pupil by contraction of dilator muscle of irisExamples: Atropine Sulfate, Epinephrine HCL
3) Ophthalmic anti-infective – drugs used the treatment of eye infection or inflammation.Uses:
a) Treatment of surface bacterial infectionb) Treatment of keratoconjunctivitisc) Prevention of gonorrheal opthalmia neonatorumd) Bacteriostatic irrigating solution
Mechanism of action:a) It hihibits bacterial protein synthesisb) It interferes with viral DNA synthesis
4) Ophthalmic Anti-inflammatory agents – drugs used to treat inflammatory ophthalmic disorder of the eyelid, conjunctiva and corneaExamples: Decadron Phosphate Ophthalmic Ointment
5) Carbonic Anhydrase inhibitors – drugs that will cause depression of the rate of secretion of aqueous humor. It is used as supplement to miotic medicationUses: Treatment in glaucoma – by reducing intra-ocular pressureExample: Diamox
C. Nose
1) Nasal decongestant
D. Ear
1) Otics - drugs used to treat infection, inflammation and pain of ear disorderMechanism of action:
a) Anti-infectives inhibit or destroy bacteria present in the earb) Corticosteroid – control inflammation, edema and pruritus
1) Muscle relaxant – drugs used for the relief of muscle spasm-giving oralUse: Relief of acute muscle spasm associated with trauma and inflammationMechanism of action:a) Depress transmission of nerve impulses from spinal cord to skeletal muscleb) Directly inhibit muscle activationExamples: Robaxisal, Robaxin, Skelan, Anectine
2) Anti – convulsant – drugs used to treat, prevent, or reduce frequency or severity of seizures caused by epilepsy, eclampsia, meningitis and head traumaUses: a) Treatment, prevention, reduction of severity of epileptic or non epileptic seizures b) Treatment of status epilepticus Mechanism of action: a) Depression of nerve tissue b) Inhibit carbonic abnormal neuronal discharge c) They reduce monosynaptic or polysyonatic impulse transmission thus decreasing excitability in the entire nerve cell Examples : Valium, Magnesium Sulfate, Phenobarbital ( Sodium Luminal), Dilantin
3) Anti-Parkinsonians – drugs used to treat Parkinsons diseaseExample: Levodopa
VI. ANTIBIOTICS – substances produce by living cells that are detrimental to life of other organisms
Classification according to activity against microorganisma) gram positiveb) gram negativec) virald) fungale) broad spectrum antibiotic – effective against 1 – 2 classes
Classification according to susceptibility of invading organism a) Bacteriostatic - inhibitory action b) Bacterical – lethal effect
A) Penicillin – broad spectrum or narrow spectrum anti- biotic which are primarily bacteridical in active concentration they are soluble. Nontoxic and readily absorbedUses: Highly effective against gram positive and gram negative cocciMechanism of action: Act as inhibiting bacterial well synthesis during stage of actual multiplicationExamples :
a) Ampicillin – Penbritin, Pensyn, Flexilb)Pen-G-Sodium
c) Compocillin d) Prostaphillin
B. Cephalosporin – semi-synthetic anti-biotic, active against most gram positive organism. It acts both as bacterial and bacteriostatic agensUses:a) Treat infection of respiratory tract ,genetic-urinary tract ,septicemiab) Treat gram positive cocciMechanism of action: Inhibit cell wall synthesisExamples: Ceporex, Keflex, Keflin
C .Tetracycline – broad spectrum antibiotic that is primarily bacteriostaticUses: a) Treat gram positive organism that are resistant of penicillin b) Effective in some anaerobic infection c) Alternative treatment of both gonorrhea and synthesisMechanism of action: Inhibit protein synthesisExamples: Terramycin, Vibramycin, Ledermycin,Tetrex
D. Sulfonamides –effective against gram positive and gram negative bacteria including E.coliUse:a) Treat urinary tract infectionb) Provide pre-operative and post-operative suppression of bowel florac) Treatment of ulcerative colitisMechanism of action – interfere with bacterial synthesis of folic-acid thereby inhibiting growth and multiplication of bacterialExamples: Azo-gantrisin,sulfazalazine
E. Chloramphenicols – effective against Salmonella typhi infectionSide effect - blood dyscarias (IV and orally)Example – Chloromycetin Succinate F. Erythromycin – agents used to treat acute pelvic inflammatory diseaseExample - Erythrocin, Iloson, Rulid G. Aminoglycoside – broad spectrum bacterial antibiotic used for serious life threatening infectionExamples: Amikacin, Kantrex, Gentamicin
Nursing consideration in all antibiotic1) For parenteral administration – skin testing is necessary2) Punctual administration to maintain blood level of the medicine3) Usually given 10- 14 days
H. Other Chemotherapeutics
1) Anti – TB drug – drugs effective on the growing tubercle bacilli Use – treat and prevent all forms of tuberculosis Mechanism of action – inhibit DNA and protein synthesis in susceptible organism Examples: INH – (isoniazid), PAS – (para-aminosalicylic acid), Rifampin, Streptomycin Sulfate, Pyrazinamide
2) Anti leprotics – agents that has a bacteriostatic effect on mycobacterium leprae. Use – to treat all forms of leprosy Example: Dapsone 3) Anti-malarial – drugs used for both prophylaxis and treatment of malariaUse – provide treatment of acute attacks of malariaExamples: Aralen, Camoquin
4) Anti-fungal – drugs with fungistatic and fungicidal propertiesUses:a) Treat severe fungal infection caused by candidab) Treat monilial infection of oral cavities (thrush)c) Treat monilial infection of vaginal and intestinal tractExamples: Mycostatin oral suspension, Mycostatin vaginal suppository
5) Urinary tract germicides – are anti-bacterial drugs concentrated in renal tubules and other areas of kidney and bladderUses – bacteriuria, cystitis, pyelonephritisExamples: Azo-gantrizin, Mandelamine, Macrodantin
VII. DRUGS USED FOR RELIEF OF PAIN A) Analgesic – drug that relieve pain, without producing loss of consciousness, do not cause tolerance or addiction Example: Aspirin, PonstanMechanism of action – depression of peripheral chemoreceptors to block pain impulse
B) Antipyretics – drugs that relieve or reduce fever mechanism of hypothalamus to reduce the feverExample: Tempra, Biogesic, Tylenol, Medicol
C) Salicylates – group of analgesic derived from salicylate acid frequently used in the treatment of arthritis and rheumatic fever, it also relieves symptoms of inflammation, pain, feverExamples: Ascriptin, Aspirin, Doloxene
Nursing Considerations1) Salicylates – are irritating to the gastric mucosa and cause gastric irritation2) Watch out for salicylates toxity, such as- nausea, tinnitus (ringing of ears), vomiting, headache
D) Narcotic Analgesics drugs - that will relieved pain without producing loss of consciousness but may cause physical and psychologic dependence. They are controlled substancesUses:a) Relief of moderate to severe painb) Pre-operative sedation alone or in combination with tranquilizerMechanism of action: Acts on the sensory cortex of the brain to produce analgesiaExample: Codeine Sulfate, Morphine S04, Demerol
E) Narcotic Antagonist – drugs used to reverse or antagonize action caused by narcoticsUses as antidote for narcotic overdose – reverse the respiratory depressionMechanism of action: It competes with narcotic for the receptor siteExamples: Narcan, Nalline HCI
VIII. MAL-ADAPTIVE BEHAVIOR PATTERN, A. Tranquilizer – drugs that relive emotional tension usually without impairing mental abilityUses:1) Treat symptoms associated with neuropsychiatric condition as manic depression2) Control of anxiety associated with other condition such as peptic ulcer, asthma, menopausal anxiety3) Treat nausea and vomiting
Two groupsMajor tranquallizer – more potent and action more effective in treatment of majorPsychiatric disorder and more likely to cause serious side effectsExamples: Thorazine, Sparine, Compazine
Minor tranquilizerExamples: Librium, Miltown, Valium, Equanil
B. Anti-depressant or Psych energizer – drug whose main action is relieve symptoms of depression making patient more energetic and communicativeUses:1) Treat symptoms associated with psychiatric disorder2) Control appetite in treatment of obesityExamples: Benzedrine, Doxedrine, Tofranil
C. Hypnotic – SedativeSedative – drugs use to calm or dispel anxiety or hyperactivity by mild depression of higher brain centerHypnotic – drug used to induce sleepExamples: Palmate, Nembutal
Sedative becomes a hypnotic when given in a larger doseExample: Choral Hydrate
Types of sedative – hypnotic
1) Barbiturates – drugs that depress CNS, it is used as sedative in small doses and hypnotic in larger dosesExamples: Amytal, Seconal, Pentothal, Nembutal
2) Chloral hydrate – relieve withdrawal symptoms in alcohol and narcotic addictionUses of Sedative Hypnotica) Treatment of insomnia before an operative or diagnostic procedureb) Sedation and relief of anxietyc) Alleviate alcohol withdrawal syndromed) Prevent nausea and vomitingMechanism of action: Depression of CNS
D. Anesthesia
1) Local anesthesia – drug that cause temporary loss of feeling and motor activity without loss of consciousness Uses: a) Infiltration anesthesia in dental and minor surgical procedureb) Used in regional spinal and caudal anesthesiaMechanism of action: Prevention of nerve impulse generation and conductionExamples: Pontoccaine, Xyloccaine, Novocaine
2) General Anesthesia – agents that produce unconsciousness: given rectally, IV or by inhalationMechanism of action: Depression of CNSExamples: Ketalar, Sodium , Pentothal
IX. CELLULAR ABERRATIONS
A. Antineoplastic Drugs – drugs used to destroy cancer cells in the body or inhibit cell division or Inhibit cell divisionClassification1) Alkylating Drugs - drugs used in the treatment of sarcomas, lymphomas, leukemiasMechanism of action:a) Interfere with cell function as synthesis and respirationb) Attack nucleoproteins that are essential for all cell division thereby inhibit replicationExamples: Nitrogen mustard, Cytoxan, mylaran
2) Antimetabolites – drugs used in the treatment of choriocarcinoma, leukemia, osteogenic cancerMechanism of actiona) Interfere with the normal metabolism of cellb) Interfere with pattern synthesis, they prevent cells from reproducing and surviving
Three groups of metabolitesa) Folic Acid antagonist – inhibit enzyzmes that prevent reduction of folic acid to tethahydrolic acid – Inhibit Example – Methotrexateb) Purine Antagonist – interferes with the synthesis of purine necessary for formation of nucleic acidc) Pyramidine Antagonist – inhibit pyramidine necessary for growth development of abnormal cell
3) Hormones – drugs that are used for palliative effect in breast and endomentrial cancerMechanism of actiona) Inhibit neoplastic cell growth in reproductive organ by creating unfavorable environmentb) Inhibit changes in hormonal balance of the bodyExamples: Mehace, Teslac
4) Radioactive IsoptopesMechanism of action: Destroy or inhibit cell by radioactive particle emission – when beta or gamma particles hit the tissue, it will cause ionization of tissue fluid and gaseous molecules – will lead to chaotic interaction – eventually death of tissue.Millie Currie (MC) - unit of measurement of radioactive isotopesExample: Radioactive lodine – 1 131
a) Used for thyroid diseaseb) Palliative treatment in thyroid cancerc) Diagnosis of thyroid function
Nursing Considerationa) Knowledge of half life – so you will know when to discontinue precautionb) Knowledge of biological activity and behavior or substancec) Time spent with the patient should be minimald) Distance should be considered – talk to the patient in the doorwaye) WEAR PROTECTIVE SHIELD
5) Alkaloids – drugs derived from periwinkle plantsMechanism of actiona) High concentration of vinca alkaloids will alter nuclei acid and protein synthesisb) Asparaginase breakdown amino acid resulting in tumor cellExample: Vincristin – Oncovin
6) Antineoplastic Antibiotic – drugs used to treat lymphomas, Sacromas, leukemiasMechanism of action: inhibit DNA and RNA synthesis thereby inhibiting proper cell divisionExample: Pactinomtcin, Mithracin
X. DIAGNOSTIC AGENTS
Classification: 1) X-ray Opaque Drugs – drugs used to aid physician in demonstration of abnormal conditionUses: Demonstrate gastrointestinal disorder as gastric duodenal ulcer, cancer, adhesions and diverticuliExamples: Barium, Bismuth
2) Drugs used to stimulate the secretions of various glandular substancesExamples: Bromsulphalein – to test the function of the liver
3) Radioactive Subtances - used to locate disease area because of their affinity for specific body tissues
References:1) Essential Drugs List by the Department of health2) Karch, Amy M. focus on Nursing Pharmacology, 2 Ed. Lippincott Williams and Wilkins A Wolters Kluwer Company: Philadelphia,20043) Nurses Drug Handbook
4) PIMS MIMS5) Other Pharmacology of Nursing Textbooks ELVIE A. IMASON, MAN, MN, RN Clinical Coordinator
