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PharmacologyPharmacology
Bullet ReviewBullet Review
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Drug classification
Nursing process
applied to
pharmacology
Pharmacokinetics
Pharmacodynamic
s
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Diuretics ComparisonDiuretics ComparisonDiuretic class
Major site of action
Special Sideeffect (s)
1. Carbonicanhydraseinhibitor
Proximal tubule Acidosis
2. Thiazideand thiazidelike
Proximal tubule HyperuricemiaHypokalemia
3. Loop
diuretics
Loop of Henle Hypokalemia
Ototoxicity4. Potassiumsparing
Distal tubule Hyperkalemia
5. Osmoticdiuretic
Glomerulus Hypovolemia &hypotension
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Diuretics ComparisonDiuretics Comparison
Diuretic class Special Uses
1. Carbonicanhydrase
inhibitor
Mountain sickness
Meniere’s disease2. Thiazide andthiazide like
Nephrolithiasis due to calciumstones
Hypocalcemia
3. Loopdiuretics
Hypercalcemia
4. Potassiumsparing
CHF taking digoxin
5. Osmotic Increased ICP
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ThiazidesThiazides
Prototype: HydrochloroPrototype: Hydrochlorothiazidethiazide
1. Bendroflume1. Bendroflumethiazidethiazide 2. Ben2. Benthiazidethiazide 3. Chloro3. Chlorothiazidethiazide (Diuril)(Diuril) 4. Hydroflume4. Hydroflumethiazidethiazide 5. Methylclo5. Methylclothiazidethiazide 6. Trichlorme6. Trichlormethiazidethiazide
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Thiazide-likeThiazide-like
1. Indapamide1. Indapamide
2. Quinethazone2. Quinethazone
3. Metolazone3. Metolazone 4. Chlorthalidone4. Chlorthalidone
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ThiazidesThiazides
PharmacodynamicsPharmacodynamics
These drugs BLOCK the chloride These drugs BLOCK the chloride
pumppump This will keep the Chloride and This will keep the Chloride and
Sodium in the distal tubule to beSodium in the distal tubule to be
excreted into the urineexcreted into the urine
Potassium is alsoPotassium is also
flushed out!!flushed out!!
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ThiazideThiazide
Special Pharmacodynamics: SideSpecial Pharmacodynamics: Side
effectseffects HypokalemiaHypokalemia
DECREASED calcium excretionDECREASED calcium excretion hypercalcemiahypercalcemia
DECREASED uric acid secretionDECREASED uric acid secretion
hyperuricemiahyperuricemia HyperglycemiaHyperglycemia
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Loop DiureticsLoop Diuretics
Prototype: FurosemidePrototype: Furosemide
1. Bumetanide1. Bumetanide 2. Ethacrynic acid2. Ethacrynic acid
3. Torsemide3. Torsemide
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Loop DiureticsLoop Diuretics
PharmacodynamicsPharmacodynamics
High-ceiling diureticsHigh-ceiling diuretics
BLOCK the chloride pump in theBLOCK the chloride pump in theascending loop of Henleascending loop of Henle
SODIUM and CHLORIDE reabsorptionSODIUM and CHLORIDE reabsorption
is preventedis prevented Potassium is also excreted togetherPotassium is also excreted together
with Na and Clwith Na and Cl
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Loop DiureticsLoop Diuretics
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Loop DiureticsLoop Diuretics
Special Pharmacodynamics: side-Special Pharmacodynamics: side-
effectseffects HypokalemiaHypokalemia
Bicarbonate is lost in the urineBicarbonate is lost in the urine
INCREASED calcium excretionINCREASED calcium excretion HypocalcemiaHypocalcemia
Ototoxicity- due to the electrolyteOtotoxicity- due to the electrolyteimbalancesimbalances
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Potassium sparingPotassium sparing
diureticsdiureticsPrototype: SpironolactonePrototype: Spironolactone
1. Amiloride1. Amiloride 2. Triamterene2. Triamterene
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Potassium sparingPotassium sparing
diureticsdiureticsPharmacodynamicsPharmacodynamics
Spironolactone is an ALDOSTERONESpironolactone is an ALDOSTERONE
antagonistantagonist
Triamterene and Amiloride BLOCK Triamterene and Amiloride BLOCK
the potassium secretion in the distalthe potassium secretion in the distal
tubuletubule
Diuretic effect is achieved by theDiuretic effect is achieved by thesodium loss to offset potassiumsodium loss to offset potassium
retentionretention
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Potassium sparingPotassium sparing
diureticsdiuretics
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Potassium sparingPotassium sparing
diureticsdiureticsPharmacokinetics: Side effectsPharmacokinetics: Side effects
HYPERkalemia!HYPERkalemia!
Avoid high potassium foods:Avoid high potassium foods:
BananasBananas PotatoesPotatoes
SpinachSpinach
BroccoliBroccoli
NutsNuts
PrunesPrunes
TomatoesTomatoes
OrangesOranges
PeachesPeaches
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Osmotic DiureticsOsmotic Diuretics
Prototype: MannitolPrototype: Mannitol
1. Glycerin1. Glycerin 2. Isosorbide2. Isosorbide
3. Urea3. Urea
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Osmotic DiureticsOsmotic Diuretics
PharmacodynamicsPharmacodynamics
Mannitol is a sugar not well absorbedMannitol is a sugar not well absorbedin the nephronin the nephron osmotic pull of osmotic pull of
waterwater diuresisdiuresis
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Osmotic DiureticsOsmotic Diuretics
Pharmacokinetics: side effectsPharmacokinetics: side effects Sudden hypovolemiaSudden hypovolemia
Important for the nurse to warm theImportant for the nurse to warm thesolution to allow the crystals tosolution to allow the crystals to
DISSOLVE in the bottle!DISSOLVE in the bottle!
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Carbonic AnhydraseCarbonic Anhydrase
InhibitorsInhibitorsPrototype: AcetazolamidePrototype: Acetazolamide
1. Methazolamide1. Methazolamide
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Carbonic AnhydraseCarbonic Anhydrase
InhibitorsInhibitorsPharmacodynamicsPharmacodynamics
Carbonic Anhydrase forms sodiumCarbonic Anhydrase forms sodiumbicarbonatebicarbonate
BLOCK of the enzyme results toBLOCK of the enzyme results to
slow movement of hydrogen andslow movement of hydrogen and
bicarbonate into the tubulesbicarbonate into the tubules
plus sodium is lost in the urineplus sodium is lost in the urine
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Carbonic AnhydraseCarbonic Anhydrase
InhibitorsInhibitorsPharmacokinetics: side effectsPharmacokinetics: side effects
Metabolic ACIDOSIS happens whenMetabolic ACIDOSIS happens when
bicarbonate is lost bicarbonate is lost
HypokalemiaHypokalemia
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The Nursing Process andThe Nursing Process and
the diureticsthe diuretics
ASSESSMENTASSESSMENT
Assess the REASON why the drug isAssess the REASON why the drug isgiven:given:
______ ______
______ ______
______ ______ ______ ______
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The Nursing Process andThe Nursing Process and
the diureticsthe diuretics
ASSESSMENTASSESSMENT
The nurse must elicit history of The nurse must elicit history of allergy to the drugsallergy to the drugs Allergy to sulfonamides may Allergy to sulfonamides may
contraindicate the use of thiazidescontraindicate the use of thiazides
Assess fluid and electrolyte balanceAssess fluid and electrolyte balance
Assess other conditions like gout,Assess other conditions like gout,
diabetes, pregnancy and lactationdiabetes, pregnancy and lactation
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The Nursing Process andThe Nursing Process and
the diureticsthe diuretics
ASSESSMENTASSESSMENT
Physical assessmentPhysical assessment
Vital signsVital signs
Special electrolyte and laboratorySpecial electrolyte and laboratoryexaminationexamination
Assess symptom of body weaknessAssess symptom of body weaknesswhich may indicate hypokalemiawhich may indicate hypokalemia
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The Nursing Process andThe Nursing Process and
the diureticsthe diuretics
Nursing DiagnosisNursing Diagnosis Fluid volume deficit related to diureticFluid volume deficit related to diuretic
effecteffect
Alteration in urinary patternAlteration in urinary pattern Potential for injury (ototoxocity,Potential for injury (ototoxocity,
hypotension)hypotension)
Knowledge deficitKnowledge deficit
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The Nursing Process andThe Nursing Process and
the diureticsthe diuretics
IMPLEMENTATIONIMPLEMENTATION Administer IV drug slowlyAdminister IV drug slowly Safety precaution forSafety precaution for
dizziness/hypotensiondizziness/hypotension Provide potassium RICH foods forProvide potassium RICH foods for
most diuretics, with the exception of most diuretics, with the exception of
spironolactonespironolactone Provide skin care, oral care andProvide skin care, oral care and
urinary careurinary care
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The Nursing Process andThe Nursing Process and
the diureticsthe diuretics
IMPLEMENTATIONIMPLEMENTATION
Monitor DAILY WEIGHT- to evaluateMonitor DAILY WEIGHT- to evaluatethe effectiveness of the therapythe effectiveness of the therapy
Monitor urine output, cardiac rhythm.Monitor urine output, cardiac rhythm.
Serum electrolytesSerum electrolytes
ADMINISTER in the MORNING!ADMINISTER in the MORNING! Administer with FOOD!Administer with FOOD!
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The Nursing Process andThe Nursing Process and
the diureticsthe diuretics
EVALUATION: for effectiveness of EVALUATION: for effectiveness of
therapytherapy
Weight lossWeight loss
Increased urine outputIncreased urine output
Resolution of edemaResolution of edema
Decreased congestionDecreased congestionNormal BPNormal BP
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The ANXIOLYTICS AND HYPNOTICSThe ANXIOLYTICS AND HYPNOTICS
These drugs are used to change theThese drugs are used to change the
individual’s responses to theindividual’s responses to the
environment.environment.
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The ANXIOLYTICS AND HYPNOTICSThe ANXIOLYTICS AND HYPNOTICS
The medications that can prevent theThe medications that can prevent the
feelings of tension and fear are calledfeelings of tension and fear are called
ANXIOLYTICS. ANXIOLYTICS.
– Anti-anxiety drugs Anti-anxiety drugs
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The ANXIOLYTICS AND HYPNOTICSThe ANXIOLYTICS AND HYPNOTICS
The drugs that can calm individualsThe drugs that can calm individuals
making them unaware of themaking them unaware of the
environment are called SEDATIVES.environment are called SEDATIVES.
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The ANXIOLYTICS AND HYPNOTICSThe ANXIOLYTICS AND HYPNOTICS
The drugs that can induce sleep areThe drugs that can induce sleep are
called HYPNOTICS.called HYPNOTICS.
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The ANXIOLYTICS AND HYPNOTICSThe ANXIOLYTICS AND HYPNOTICS
The drugs in this class are theThe drugs in this class are the
– BENZODIAZEPINESBENZODIAZEPINES
– BARBITURATESBARBITURATES
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Use of The DrugsUse of The Drugs
Clinical indications for the use of theClinical indications for the use of the
anxiolytics, sedatives and hypnoticsanxiolytics, sedatives and hypnotics
1. Prevention of anxiety1. Prevention of anxiety2. Formation of sedative state2. Formation of sedative state
3. Induction of sleep3. Induction of sleep
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The BENZODIAZEPINESThe BENZODIAZEPINES
The benzodiazepines are the most frequentlyThe benzodiazepines are the most frequentlyused anxiolytic drugs.used anxiolytic drugs.
These agents prevent anxiety states withoutThese agents prevent anxiety states withoutcausing much sedation, with less physicalcausing much sedation, with less physicaldependence than other agents.dependence than other agents.
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The BENZODIAZEPINESThe BENZODIAZEPINES
The following are the benzodiazepinesThe following are the benzodiazepines Alprazolam (Xanax) Alprazolam (Xanax)
Chlordiazepoxide (LibriumChlordiazepoxide (Librium))
clonazepamclonazepam
clorazepateclorazepate
Diazepam (Valium)Diazepam (Valium)
estazolamestazolam
flurazepamflurazepam
lorazepamlorazepam
midazolammidazolamoxazepamoxazepam
quazepamquazepam
temazepamtemazepam
triazolamtriazolam
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The BENZODIAZEPINESThe BENZODIAZEPINES
Special usesSpecial uses
Diazepam(Valium)
Status epilepticus
Chlordiazepoxide(Librium)
Alcohol withdrawal
Alprazolam(Xanax) Panic attack
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The BENZODIAZEPINESThe BENZODIAZEPINES
The Mechanism of Action of the BenzodiazepinesThe Mechanism of Action of the Benzodiazepines
These agents act on the Limbic systemThese agents act on the Limbic system
and the RAS (reticular activating system)and the RAS (reticular activating system)to make the GABA ( Gamma-to make the GABA ( Gamma-aminobutyric acid) more effective causingaminobutyric acid) more effective causinginterference with neuron firing.interference with neuron firing.
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The BENZODIAZEPINESThe BENZODIAZEPINES
The Mechanism of Action of the BenzodiazepinesThe Mechanism of Action of the Benzodiazepines
The GABA is an inhibitoryThe GABA is an inhibitory
neurotransmitter.neurotransmitter.This will result to an anxiolyticThis will result to an anxiolyticeffect at lower doses thaneffect at lower doses than
required for sedation/hypnosis.required for sedation/hypnosis.
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The BENZODIAZEPINESThe BENZODIAZEPINES
These agents are indicated for the treatmentThese agents are indicated for the treatmentof of
1.1. anxiety disordersanxiety disorders
2.2.
alcohol withdrawalalcohol withdrawal3.3. hyperexcitability, and agitationhyperexcitability, and agitation
4.4. pre-operative relief of anxiety andpre-operative relief of anxiety andtension and in induction of balancedtension and in induction of balanced
anesthesia.anesthesia.
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The BENZODIAZEPINESThe BENZODIAZEPINES
Pharmacodynamics: The adverse effectsPharmacodynamics: The adverse effects
CNS effects=CNS effects= sedation, drowsiness,sedation, drowsiness,depression, lethargy, blurred visiondepression, lethargy, blurred vision
GIT=GIT= dry mouth, constipationdry mouth, constipation, nausea,, nausea,vomitingvomiting
CVS=CVS= HypotensionHypotension or hypertension,or hypertension,arrhythmias, palpitations, andarrhythmias, palpitations, andrespiratory difficulties.respiratory difficulties.
Hematologic= blood dyscrasias andHematologic= blood dyscrasias andanemiaanemia
GU= urinary retention, hesitancy, loss of GU= urinary retention, hesitancy, loss of libido and sexual functions changes.libido and sexual functions changes.
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The BENZODIAZEPINESThe BENZODIAZEPINES
Nursing Considerations:Nursing Considerations:
Maintain patients on bed for at Maintain patients on bed for at least 3 hours after drug least 3 hours after drug administration.administration.
Instruct to avoid hazardousInstruct to avoid hazardousactivities like driving and machineactivities like driving and machineoperation.operation.
Instruct to avoid consuming Instruct to avoid consuming ALCOHOL while taking the drug ALCOHOL while taking the drug ..
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The BENZODIAZEPINESThe BENZODIAZEPINES
Nursing Considerations:Nursing Considerations:
Provide comfort measures to helpProvide comfort measures to helppatients tolerate drug effects-patients tolerate drug effects- – instruct to urinate before takinginstruct to urinate before taking
drugdrug – give high fiber foodsgive high fiber foods – use side-rails and assistance withuse side-rails and assistance with
ambulation.ambulation.
Have availableHave available FLUMAZENIL as anFLUMAZENIL as anantidote for benzodiazepineantidote for benzodiazepineoverdose.overdose.
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The BARBITURATESThe BARBITURATES
These are also anxiolytics andThese are also anxiolytics andhypnotics with a greater likelihood of hypnotics with a greater likelihood of producing sedation, with increaseproducing sedation, with increase
risk of addiction and dependence.risk of addiction and dependence.
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The BARBITURATESThe BARBITURATES
The following are the barbituratesThe following are the barbiturates
amobarbitalamobarbital
aprobarbitalaprobarbital
butabarbitalbutabarbitalmephobarbitalmephobarbital
pentobarbitalpentobarbital
Phenobarbital Phenobarbital
secobarbitalsecobarbital
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The BARBITURATESThe BARBITURATES
The Mechanism of Action of the BarbituratesThe Mechanism of Action of the Barbiturates
They depress the motor output from theThey depress the motor output from thebrain.brain.
The results of their MOA are sedation,The results of their MOA are sedation,hypnosis and anesthesia, and if extreme,hypnosis and anesthesia, and if extreme,coma.coma.
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The BARBITURATESThe BARBITURATES
Clinical indications of the BarbituratesClinical indications of the Barbiturates1.1. Relief of anxiety manifestationsRelief of anxiety manifestations
2.2. For sedationFor sedation
3.3. For patients with insomniaFor patients with insomnia4.4. For pre-anesthesiaFor pre-anesthesia
5.5. seizures/epilepsy seizures/epilepsy
6.6. The rapid acting barbiturates are alsoThe rapid acting barbiturates are alsoused for the treatment of acute manicused for the treatment of acute manicreactions and status epilepticusreactions and status epilepticus
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The BARBITURATESThe BARBITURATESPharmacodynamics: The Adverse effectsPharmacodynamics: The Adverse effects
CNS=CNS= CNS depressionCNS depression, somnolence, somnolence,,vertigo, lethargy, ataxia, paradoxicalvertigo, lethargy, ataxia, paradoxicalexcitement, anxiety and hallucinations.excitement, anxiety and hallucinations.
GIT=GIT= nausea, vomiting,nausea, vomiting, constipation/diarrhea and epigastric painconstipation/diarrhea and epigastric pain
CVS= bradycardia, Hypotension andCVS= bradycardia, Hypotension andsyncope.syncope.
Respi= serious hypoventilation, respiratoryRespi= serious hypoventilation, respiratorydepression and laryngospasmsdepression and laryngospasms
Others=Others= hypersensitivity and Stevens-hypersensitivity and Stevens-Johnson syndrome.Johnson syndrome.
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The BARBITURATESThe BARBITURATES
Nursing ConsiderationsNursing ConsiderationsProvide stand-by life support facilitiesProvide stand-by life support facilitiesin cases of severe respiratoryin cases of severe respiratorydepression or hypersensitivitydepression or hypersensitivity
reaction.reaction.Taper the drug gradually after long-Taper the drug gradually after long-term therapy to avoid withdrawalterm therapy to avoid withdrawalsyndrome.syndrome.
Provide comfort measures includingProvide comfort measures includingsmall frequent meals, access tosmall frequent meals, access tobathroom facilities, high-fiber foods,bathroom facilities, high-fiber foods,environmental control, safetyenvironmental control, safety
precaution and skin care.precaution and skin care.
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The CNS stimulantsThe CNS stimulants
These are drugs used to treat certainThese are drugs used to treat certain
disordersdisorders
1.1. exogenous obesityexogenous obesity
2.2. attention-deficit hyperactivityattention-deficit hyperactivity
disorders (ADHD)disorders (ADHD)
3.3. narcolepsynarcolepsy
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The CNS stimulantsThe CNS stimulants
What is unusual is the ability of What is unusual is the ability of
the CNS stimulants to CALM the CNS stimulants to CALM
hyperactive children, whichhyperactive children, whichallows them to focus on oneallows them to focus on one
activity for a longer period.activity for a longer period.
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The CNS stimulantsThe CNS stimulants
The following are the CNS stimulants:The following are the CNS stimulants:
1.1. Methylphenidate (Ritalin)= most Methyl phenidate (Ritalin)= most
commonly used for ADHDcommonly used for ADHD
2. Dextroamphetamine= a CNS stimulant2. Dextroamphetamine= a CNS stimulant
that is used for short tem therapy for that is used for short tem therapy for
obesity.obesity.
3. Modafinil= used for narcolepsy3. Modafinil= used for narcolepsy
4. Pemoline= used for ADHD4. Pemoline= used for ADHD
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The CNS stimulantsThe CNS stimulants
The Mechanism of ActionThe Mechanism of Action
These agents act as to stimulate theThese agents act as to stimulate the
cortical and reticular activating systemcortical and reticular activating system(RAS) of the brain.(RAS) of the brain.
This is by releasing neurotransmittersThis is by releasing neurotransmittersfrom the nerve cells leading tofrom the nerve cells leading to increased increased
stimulation of the post-synaptic stimulation of the post-synaptic neurons.neurons.
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The CNS stimulantsThe CNS stimulants
The paradoxical effect of calming The paradoxical effect of calming
hyperexcitability through CNS hyperexcitability through CNS
stimulation seen in ADHD is believed tostimulation seen in ADHD is believed to
be related to the increased stimulationbe related to the increased stimulationof an IMMATURE Reticular Activating of an IMMATURE Reticular Activating
System leading to the ability to be moreSystem leading to the ability to be more
selective in response to incoming selective in response to incoming stimuli.stimuli.
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The CNS stimulantsThe CNS stimulants
Pharmacodynamics: Adverse effects of the CNSPharmacodynamics: Adverse effects of the CNS
stimulantsstimulants
CNS=CNS= nervousness, insomnianervousness, insomnia, dizziness,, dizziness,
headache, and blurred visionheadache, and blurred visionGIT=GIT= anorexiaanorexia, nausea and weight loss, nausea and weight loss
CVS= hypertension, tachycardia arrhythmias, andCVS= hypertension, tachycardia arrhythmias, and
anginaanginaOthers= rashes, physical/psychologicalOthers= rashes, physical/psychological
dependence.dependence.
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The CNS stimulantsThe CNS stimulantsImplementationImplementation
The nurse must ensure that the drug is only given toThe nurse must ensure that the drug is only given to
the indicated conditionsthe indicated conditions
Administer the drug before 6 pm to reduce the Administer the drug before 6 pm to reduce the
effect of insomniaeffect of insomniaBEST given AFTER meals to prevent the effect BEST g iven AFTER meals to prevent the effect
of anorexiaof anorexia
Consult with school personnel to monitor the patientConsult with school personnel to monitor the patientunder therapyunder therapy
Provide safety measures such as side-rails andProvide safety measures such as side-rails and
assisted ambulationassisted ambulation
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The CNS stimulantsThe CNS stimulants
EvaluationEvaluationEvaluate the effectiveness of the drug:Evaluate the effectiveness of the drug:
1.1. Calming effect in the patient with ADHDCalming effect in the patient with ADHD
2.2. Alertness for patients with narcolepsy Alertness for patients with narcolepsy
The Anti epilepticsThe Anti epileptics
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The Anti-epilepticsThe Anti-epileptics
These agents, also called anticonvulsants,These agents, also called anticonvulsants,
are used to treat epileptic conditions.are used to treat epileptic conditions.
Hydantoins, Barbiturates,Hydantoins, Barbiturates,
benzodiazepines, Succinimides and manybenzodiazepines, Succinimides and many
others are given to a specific type of others are given to a specific type of
seizure.seizure.
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Anti-epileptics Anti-epilepticsAgents for treating TONIC-CLONIC SEIZURESAgents for treating TONIC-CLONIC SEIZURES
1. Hydantoins1. Hydantoins – PhenytoinPhenytoin – EthotoinEthotoin – FosphenytoinFosphenytoin – MephenytoinMephenytoin
2. Benzodiazepines2. Benzodiazepines – DiazepamDiazepam – ClonazepamClonazepam – ClorazepateClorazepate
3. Barbiturates3. Barbiturates – PhenobarbitalPhenobarbital
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Anti-epileptics Anti-epileptics
Agents for treating ABSENCE SEIZURES Agents for treating ABSENCE SEIZURES
1. Succinimides1. Succinimides
a. Ethosuximidea. Ethosuximide
b. Methsuximideb. Methsuximidec. Phensuximidec. Phensuximide
2. Valproic Acid2. Valproic Acid
3. Zosinamide3. Zosinamide
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Anti-epileptics Anti-epileptics
Agents for treating Partial FOCAL SEIZURES Agents for treating Partial FOCAL SEIZURES
1. Carbamazepine1. Carbamazepine
2. Gabapentin2. Gabapentin
3.Lamotrigine3.Lamotrigine4. Tiagabine4. Tiagabine
5. Topiramate5. Topiramate
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The hydantoinsThe hydantoins
These agents are utilized for general seizuresThese agents are utilized for general seizuresbecause they can depress the centralbecause they can depress the central
nervous system.nervous system.
They affect the entire brain and reduce theThey affect the entire brain and reduce thechance of sudden electrical outburst that chance of sudden electrical outburst that
causes seizures.causes seizures.
These agents generally are less sedating thanThese agents generally are less sedating thanother anti-epilepticsother anti-epileptics..
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The hydantoinsThe hydantoins
Mechanism of Action of the HydantoinsMechanism of Action of the Hydantoins
These agents STABILIZE the nerve cell These agents STABILIZE the nerve cell
membrane throughout the brain reducing membrane throughout the brain reducing
and limiting the excitability and and limiting the excitability and
conduction through nerve pathways.conduction through nerve pathways.
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The hydantoinsThe hydantoins
Clinical Indications of the hydantoinsClinical Indications of the hydantoins
1.1. Tonic-clonic seizuresTonic-clonic seizures
2.2. Status epilepticusStatus epilepticus
3.3. For the prevention of seizures inFor the prevention of seizures in
neurosurgeryneurosurgery
4.4. For muscle relaxation.For muscle relaxation.
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The hydantoinsThe hydantoins
Contraindications and PrecautionsContraindications and Precautions
Hydantoins are NOT given to pregnantHydantoins are NOT given to pregnant
patient because it can cause fetalpatient because it can cause fetal
hydantoin syndromehydantoin syndrome..
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The hydantoinsThe hydantoins
Pharmacodynamics: Adverse effects of thePharmacodynamics: Adverse effects of theHydantoinsHydantoins
CNS effects- depression, confusion,CNS effects- depression, confusion,drowsiness, lethargy, fatiguedrowsiness, lethargy, fatigue
GIT- GI upset, constipation, dry mouthGIT- GI upset, constipation, dry mouth,,GINGIVAL HYPERPLASIA , severe liver GINGIVAL HYPERPLASIA , severe liver toxicity which are all related to cellular toxicity which are all related to cellular
toxicity.toxicity.SKIN- hirsutism and coarsening of theSKIN- hirsutism and coarsening of thefacial skinfacial skin
Bone Marrow depressionBone Marrow depression
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The hydantoinsThe hydantoins
ImplementationImplementation Administer the drug with food to Administer the drug with food toalleviate GI irritationalleviate GI irritation
Discontinue the drug at any sign of Discontinue the drug at any sign of hypersensitivity reaction, severe liver hypersensitivity reaction, severe liver dysfunction and severe skin rashes.dysfunction and severe skin rashes.
Provide meticulous mouth oral careProvide meticulous mouth oral care
Rule out pregnancy and advise womenRule out pregnancy and advise womento use contraceptive measures toto use contraceptive measures toprevent pregnancy.prevent pregnancy.
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ff
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Drugs affecting GI secretionsDrugs affecting GI secretions
There are five types of drugs that affecthere are five types of drugs that affectgastric acid secretions and are useful forastric acid secretions and are useful for
the treatment of peptic ulcer.he treatment of peptic u lcer.
1.. Histamine (H2) receptoristamine (H2) receptorantagonist/blockersntagonist/blockers
2.. Antacidsntacids
3.. Proton pump inhibitorsroton pump inhibitors
4.. Mucosal protectantsucosal protectants
5.. Prostaglandin analogsrostaglandin analogs
Drugs affecting secretions:Drugs affecting secretions:
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Drugs affecting secretions:Drugs affecting secretions:
anti ulceranti ulcer Anti-ulcer drugs Prototype
Histamine (H2) receptor antagonist/blockers
Cimetidine
Antacids AlOH and MgOH
Proton pump inhibitors Omeprazole
Mucosal protectants Sucralfate
Prostaglandin analog Misoprostol
General indication of the drugsGeneral indication of the drugs
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General indication of the drugsGeneral indication of the drugs
affecting gastric acid secretionaffecting gastric acid secretion
►Peptic ulcerPeptic ulcer
►GastritisGastritis
►Patient on NPO to prevent stress ulcerPatient on NPO to prevent stress ulcer
General time of administration of theGeneral time of administration of the
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General time of administration of theGeneral time of administration of the
drugs affecting gastric acid secretiondrugs affecting gastric acid secretion
Anti-ulcer drugs Prototype Best time to give
Histamine (H2)receptor antagonist/blockers
Cimetidine With FOOD or ONEhour after ANTACID
Antacids AlOH and MgOH Usually after meals
Proton pumpinhibitors
Omeprazole BEFORE MEALS
Mucosal protectants Sucralfate BEFORE MEALS
Prostaglandin analogMisoprostol WITH MEALS
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Pharmacology of Anti-ulcerharmacology of Anti-ulcer
drugsrugsDrug Mechanism of Action
Antacids- AlOH, MgOH Neutral ize Gastric ACIDITY
H2-Blockers- “t i d i ne ”
Cimetidine, Ranitidine
Block Histamine receptorcausing decreased secretionand acidity
Proton pump inhibitors-“P r a z o l e s ”
Om ep ra z o l e , p an t op r a z o l e
Inhibit Proton Pump in parietalcel l decreasing secretion andacidity
h l f i l dPh l f A ti l d
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Pharmacology of Anti-ulcer drugsPharmacology of Anti-ulcer drugs
Drug Mechanism of Action
Anti-cholinergic- ProphantelineBromide
Blocks VAGUS nerve, decreasessecretion
Sucralfate (Carafate) Coats the mucosal l ining
Misoprostol (Cytotec) Prostaglandin Analogue, causessecretion of MUCUS
Ph d iPh d i
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PharmacodynamicsPharmacodynamics
Histamine (H2) receptor blockersistamine (H2) receptor blockers
►These drugs BLOCK the release ofhese drugs BLOCK the release of
hydrochloric acid in the stomachydrochloric acid in the stomachin response to gastrinn response to gastrin
D ff ti GI tiD ff ti GI ti
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Drugs affecting GI secretionsDrugs affecting GI secretions
Antacidsntacids
►These drugs interact with thehese drugs interact with the
gastric acids at the chemicalastric acids at the chemicallevel to neutralize themevel to neutralize them
D ff ti GI tiD ff ti GI ti
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Drugs affecting GI secretionsDrugs affecting GI secretions
Proton pump inhibitorsroton pump inhibitors
►These drugs suppress thehese drugs suppress the
secretion of hydrochloric acidecretion of hydrochloric acidinto the lumen of the stomachnto the lumen of the stomach
D ff ti GI tiD ff ti GI ti
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Drugs affecting GI secretionsDrugs affecting GI secretions
Mucosal protectantsucosal protectants
►These are agents that coathese are agents that coat
any injured area in theny injured area in thestomach to prevent furthertomach to prevent further
injury from acidnjury from acid
D ff ti GI tiD ff ti GI ti
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Drugs affecting GI secretionsDrugs affecting GI secretions
Prostaglandin analogsrostaglandin analogs
►These are agents thathese are agents that i n h i b i tnh i b i t
the secretion of gastrin andhe secretion of gastrin and►i n c r ea sen c r ea s e the secretion ofthe secretion of
mucus lining of the stomach,ucus lining of the stomach,
providing a buffer.roviding a buffer.
Th H2 Bl k “tidi ”Th H2 Bl k “tidi ”
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The H2 Blockers- “tidines” The H2 Blockers- “tidines”
Prototype: CimetidinePrototype: Cimetidine
►1. Ranitidine1. Ranitidine
►2. Famotidine2. Famotidine
►3. Nizatidine3. Nizatidine
Th H2 Bl k “tidi ”Th H2 Bl k “tidi ”
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The H2 Blockers- “tidines” The H2 Blockers- “tidines”
Pharmacodynamics: Drug Actionharmacodynamics: Drug Action► The H2 blockers are antagonists at thehe H2 blockers are antagonists at the
receptors in the parietal cells of theeceptors in the parietal cells of thestomach.tomach.
► The blockage results to inhibition of thehe blockage results to inhibition of thehormone gastrin.ormone gastrin.
► There will be decreased production ofhere will be decreased production of
gastric acid from the parietal cells.astric acid from the parietal cells.► Also, the chief cells will secrete lesslso, the chief cells will secrete lesspepsinogen.epsinogen.
Th H2 Bl k “tidi ”The H2 Blocke s “tidines”
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The H2 Blockers- “tidines” The H2 Blockers- “tidines”
Therapeutic use of the H2 blockersTherapeutic use of the H2 blockers► Short-term treatment of active duodenal ulcer orShort-term treatment of active duodenal ulcer or
benign gastric ulcerbenign gastric ulcer►
Treatment of hypersecretory conditions like theTreatment of hypersecretory conditions like theZollinger-Ellison syndromeZollinger-Ellison syndrome
► Prevention of stress-induced ulcers and acute GIPrevention of stress-induced ulcers and acute GIbleedingbleeding
► Treatment of erosive GERD (reflux disease)Treatment of erosive GERD (reflux disease)► Relief of Symptoms of heart burn and acidRelief of Symptoms of heart burn and acid
indigestionindigestion
Th H2 Bl k “tidi ”The H2 Blockers “tidines”
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The H2 Blockers- “tidines” The H2 Blockers- “tidines”
Precautions and ContraindicationsPrecautions and Contraindications
► Any known allergy is a clear contraindication Any known allergy is a clear contraindication
to the use of the agents. Conditions such asto the use of the agents. Conditions such as
pregnancy, lactation, renal dysfunction andpregnancy, lactation, renal dysfunction andhepatic dysfunction should warrant cautioushepatic dysfunction should warrant cautious
use.use.
►Nizatidine can be used in hepaticNizatidine can be used in hepaticdysfunction.dysfunction.
Th H2 Bl k “ idi ”Th H2 Bl k “tidi ”
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The H2 Blockers- “tidines” The H2 Blockers- “tidines”
Pharmocodynamics- Side effects and adverse effectsPharmocodynamics- Side effects and adverse effects► GIT= diarrhea or constipationGIT= diarrhea or constipation
► CNS= Dizziness, headache, drowsiness, confusionCNS= Dizziness, headache, drowsiness, confusion
and hallucinationsand hallucinations► Cardio= arrhythmias,Cardio= arrhythmias, H Y P O T E N S I O NY P O T E N S I O N (related to(related to
H2 receptor blockage in the heart)H2 receptor blockage in the heart)
►
Cimetidine=Cimetidine= T R E M O R S ,R E M O R S ,
Gyne com as t ia a ndyne com as t ia a nd
imp o t en ce i n ma l e sm p o t en ce in m a le s
The H2 Blocke s “tidines”The H2 Blockers “tidines”
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The H2 Blockers- “tidines” The H2 Blockers- “tidines”
Drug-drug Interactionsrug-drug Interactions
►Cimetidine, Famotidine, Rani tidineimetidine, Famotidine, Ranitidine
are metabolized in the l iver- theyre metabolized in the l iver- they
can cause slowing of excretion ofan cause slowing of excretion ofother drugs leading to theirther drugs leading to their
increased concentration.ncreased concentration.
The H2 Blockers “tidines”The H2 Blockers “tidines”
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The H2 Blockers- “tidines” The H2 Blockers- “tidines”
Drug-drug Interactionsrug-drug Interactions
►These drugs can interact withhese drugs can interact with
CIMETIDINE anticoagulants,IMETIDINE anticoagulants,
phenytoin, alcohol, antidepressants.henytoin, alcohol, antidepressants.
The H2 Blockers “tidines”The H2 Blockers “tidines”
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The H2 Blockers- “tidines” The H2 Blockers- tidines
Nursing considerations:ursing considerations:►Administer the drugdminister the drug WITH WITH mealseals atat
BEDTIME BEDTIME to ensure therapeutico ensure therapeutic
levelevel►One hour after Antacidsne hour after Antacids
►Stress the importance of thetress the importance of the
continued use for the length ofontinued use for the length oftime prescribedime prescribed
The H2 Blockers “tidines”The H2 Blockers “tidines”
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The H2 Blockers- “tidines” The H2 Blockers- tidines
Nursing considerations:ursing considerations:►Monitor the cardiovascular statusonitor the cardiovascular statusespecial ly if the drugs are given IVspecial ly if the drugs are given IV
►
Warn patient of the potentialarn patient of the potentialproblems of increased drugroblems of increased drugconcentration if the H2 blockersoncentration if the H2 blockersare used with other drugs or OTCre used with other drugs or OTC
drugs. Advise consultation first!rugs. Advise consultation first!
The H2 Blockers “tidines”The H2 Blockers “tidines”
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The H2 Blockers- “tidines” The H2 Blockers- tidines
Nursing considerations:Nursing considerations:
►Provide comfort measures l ikerovide comfort measures l ike
analgesics for headache, assistancenalgesics for headache, assistance
with ambulation and safety measuresith ambulation and safety measures►Warn the patients taking cimetidinearn the patients taking cimetidine
that drowsiness may pose a hazard i fhat drowsiness may pose a hazard if
driving or operating delicateriving or operating delicatemachines.achines.
The H2 Blockers “tidines”The H2 Blockers “tidines”
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The H2 Blockers- tidines The H2 Blockers- tidines
Nursing considerations:Nursing considerations:►Provide health teaching as to the dose,Provide health teaching as to the dose,
frequency, comfort measures to initiatefrequency, comfort measures to initiate
when side-effects are intolerablewhen side-effects are intolerable
Evaluate the effectiveness:Evaluate the effectiveness:
►Relief of symptoms of ulcer, heart burn andRelief of symptoms of ulcer, heart burn and
GERDGERD
The AntacidsThe Antacids
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The AntacidsThe Antacids
► These are drugs or inorganic chemicals thatThese are drugs or inorganic chemicals thathave been used for years to neutralize acid inhave been used for years to neutralize acid inthe stomach. The following are the commonthe stomach. The following are the commonantacids that can be bought OTC:antacids that can be bought OTC:
► Aluminum salts (hydroxide) Aluminum salts (hydroxide)► Calcium salts (carbonate)Calcium salts (carbonate)► MagnesiumMagnesium salts (milk of magnesia)salts (milk of magnesia)►
Sodium bicarbonateSodium bicarbonate► Magaldrate (aluminum and magnesiumMagaldrate (aluminum and magnesiumcombination)combination)
The AntacidsThe Antacids
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The AntacidsThe Antacids
Pharmacodynamics: drug actionPharmacodynamics: drug action►These agents act to neutralize the acidic pHThese agents act to neutralize the acidic pH
in the stomach.in the stomach.
►They do not affect the rate of gastric acidThey do not affect the rate of gastric acid
secretion.secretion.
The AntacidsThe Antacids
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The AntacidsThe Antacids
Pharmacodynamics: drug actionPharmacodynamics: drug action►The administration of antacid may cause anThe administration of antacid may cause an
acid rebound.acid rebound.
►Neutralizing the stomach content to anNeutralizing the stomach content to an
alkaline level stimulates gastrin productionalkaline level stimulates gastrin production
to cause an increase in acid production andto cause an increase in acid production and
return the stomach to its normal acidicreturn the stomach to its normal acidicstate.state.
The AntacidsThe Antacids
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The AntacidsThe Antacids
Therapeutic IndicationsTherapeutic Indications►Symptomatic relief of upset stomachSymptomatic relief of upset stomach
associated with hyperacidityassociated with hyperacidity
►Hyperacidic conditions like peptic ulcer,Hyperacidic conditions like peptic ulcer,
gastritis, esophagitis and hiatal herniagastritis, esophagitis and hiatal hernia
►S pe c i a l u s e o f AM P H O G EL ( a lu m in u mpe c i a l u s e o f AM P H O G EL ( a lu m in u m
hyd ro x id e ) : t o B IND pho sp ha t eyd r o x id e ) : t o B IND pho sp ha t e
The AntacidsThe Antacids
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The AntacidsThe Antacids
Precautions of Antacid UsePrecautions of Antacid Use►Known allergy is a clear contraindication.Known allergy is a clear contraindication.
Caution should be instituted if used inCaution should be instituted if used in
electrolyte imbalances, GI obstruction andelectrolyte imbalances, GI obstruction andrenal dysfunction.renal dysfunction.
►Sodium bicarbonate is rarely used becauseSodium bicarbonate is rarely used because
of potential systemic absorptionof potential systemic absorption
The AntacidsThe Antacids
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The AntacidsThe Antacids
PharmacokineticsPharmacokinetics► These agents are taken orally and actThese agents are taken orally and act
locally in the stomachlocally in the stomach
The AntacidsThe Antacids
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The AntacidsThe Antacids
Pharmacodynamics: Effects of drugsPharmacodynamics: Effects of drugs1.1. GIT= rebound acidity; alkalosis may occur.GIT= rebound acidity; alkalosis may occur.► Calcium salts may lead toCalcium salts may lead to hype r ca l c em iaype r ca l c em ia ►
Magnes i um sa l t s c an cause D IARRH EAagnes i um sa l ts c an cause D IARRH EA► A lum inum sa l ts may causel um inum sa l t s may cause
CON STIPAT ION andON STIPAT ION and
hypophospha t em ia by b i nd ing w i thypophospha t em ia by b i nd ing w i th
pho sph a tes i n the G IT.hos pha tes i n the G IT.2.2. F lu i d r e t en t i onlu i d r e t en t i on due to the high sodiumdue to the high sodium
content of the antacids.content of the antacids.
The AntacidsThe Antacids
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The AntacidsThe AntacidsNursing Considerations:Nursing Considerations:
► Administer the antacids apart from any Administer the antacids apart from anyother medications byother medications by O N E h ou r b e f o reNE h ou r b e f o re oror T W O h ou r s a f t e r-W O h ou r s a f t e r- to ensureto ensure
adequate absorption of the otheradequate absorption of the othermedicationsmedications
►Tell the patient toTell the patient to C H E WH E W the tabletthe tabletthoroughly before swallowing. Follow itthoroughly before swallowing. Follow it
with one glass of waterwith one glass of water►Regularly monitor for manifestations of Regularly monitor for manifestations of
acid-base imbalances as well as electrolyteacid-base imbalances as well as electrolyte
imbalancesimbalances
The AntacidsThe Antacids
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The AntacidsThe Antacids
Nursing Considerations:ursing Considerations:► Provide comfort measures to alleviaterovide comfort measures to alleviate
constipation associated with aluminum andonstipation associated with aluminum and
diarrhea associated with magnesium salts.iarrhea associated with magnesium salts.
► Monitor for the side-effects, effectivenessonitor for the side-effects, effectiveness
of the comfort measures, patient’sf the comfort measures, patient’s
response to the medication and theesponse to the medication and theeffectiveness of the health teachingsffectiveness of the health teachings
The AntacidsThe Antacids
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The AntacidsThe Antacids
Nursing Considerations:ursing Considerations:►Evaluate for effectiveness:valuate for effectiveness:
Decreased symptoms of ulcer andecreased symptoms of ulcer and
pyrosisyrosis
Decreased Phosphate level (amphogel)ecreased Phosphate level (amphogel)
The PPIThe PPI
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The PPIThe PPI
These are the newer agents for ulcerThese are the newer agents for ulcertreatmenttreatment
►The “prazoles” The “prazoles”
Prototype: OmePrototype: Omep ra zo l era zo l e
►LanisoLanisop razo l era zo l e
►EsomeEsomep ra zo l era zo l e
►PantoPantop razo l era zo l e
The PPIThe PPI
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The PPIThe PPIPharmacodynamics: drug actionPharmacodynamics: drug action
►They act at specific secretory surfaceThey act at specific secretory surface
receptors to prevent the final step of acidreceptors to prevent the final step of acid
production and thus decrease the level of production and thus decrease the level of
acid in the stomach.acid in the stomach.
►The “pump” in the parietal cell is theThe “pump” in the parietal cell is the H -K-K
ATPase enzyme system on the secretory ATPase enzyme system on the secretory
surface of the gastric parietal cellssurface of the gastric parietal cells
The PPIThe PPI
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The PPIThe PPI
Clinical use of the PPIsClinical use of the PPIs►Short-term treatment of active duodenalShort-term treatment of active duodenal
ulcers, GERD, erosive esophagitis andulcers, GERD, erosive esophagitis and
benign gastric ulcer.benign gastric ulcer.► Long-term- maintenance therapy forLong-term- maintenance therapy for
healing of erosive disorders.healing of erosive disorders.
The PPIThe PPI
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The PPIThe PPI
Clinical use of the PPIs.Clinical use of the PPIs.Precautions with the use of the PPIsPrecautions with the use of the PPIs
►Known allergy is a clear contraindication.Known allergy is a clear contraindication.
Caution if patient is pregnantCaution if patient is pregnant
The PPIThe PPI
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The PPIThe PPI
Pharmacodynamics: Adverse effectsPharmacodynamics: Adverse effects►CNS-CNS- d i z z i n e s si z z i n e s s ,, headache, asthenia (lossheadache, asthenia (loss
of strength),of strength), ve r t i goe r t i g o ,, insomnia, apathyinsomnia, apathy
►GIT- d i a r r h ea , a bdo m ina l p a in ,I T- d i a r r h ea , a b dom ina l p a i n ,
n au sea , vom i t i n g , d r y m ou t hau sea , v om i t i n g , d r y m ou t h andand
tongue atrophytongue atrophy
►Respi- cough, stuffy nose, hoarseness andRespi- cough, stuffy nose, hoarseness andepistaxis.epistaxis.
The PPIThe PPI
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The PPIThe PPI
Nursing considerations:Nursing considerations:► Administer the drug Administer the drug B E F O R EE F O R E meals.meals.
Ensure that patient does not open, chew orEnsure that patient does not open, chew or
crush the drug.crush the drug.►Provide safety measures if CNS dysfunctionProvide safety measures if CNS dysfunction
happens.happens.►
Arrange for a medical follow-up if symptoms Arrange for a medical follow-up if symptomsare NOT resolved after 4-8 weeks of are NOT resolved after 4-8 weeks of therapy.therapy.
The PPIThe PPI
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The PPIThe PPI
Nursing considerations:Nursing considerations:►Provide health teaching as to drug name,Provide health teaching as to drug name,
dosages and frequency, safety measures todosages and frequency, safety measures to
handle common problems.handle common problems.►Monitor patient response to the drug, theMonitor patient response to the drug, the
effectiveness of the teaching plan and theeffectiveness of the teaching plan and the
measures to employmeasures to employ
The PPIThe PPI
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The PPIThe PPI
Nursing considerations:Nursing considerations:
Evaluate for effectiveness of the drugEvaluate for effectiveness of the drug
►Healing of peptic ulcerHealing of peptic ulcer
►Decreased symptoms of ulcerDecreased symptoms of ulcer
The Mucosal ProtectantThe Mucosal Protectant
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The Mucosal ProtectantThe Mucosal Protectant
SucralfateSucralfate►This is given to protect the eroded ulcerThis is given to protect the eroded ulcer
sites in the GIT from further damage bysites in the GIT from further damage by
acid and digestive enzymesacid and digestive enzymes
SucralfateSucralfate
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SucralfateSucralfate
Pharmacodynamics: Action of drugPharmacodynamics: Action of drug►It forms anIt forms an ulcer-adherent complex ulcer-adherent complex atat
duodenal ulcer sites, protecting the sitesduodenal ulcer sites, protecting the sites
against acid, pepsin and bile.against acid, pepsin and bile.►This action prevents further breakdown of This action prevents further breakdown of
proteins in the area and promotes healing.proteins in the area and promotes healing.
SucralfateSucralfate
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SucralfateSucralfate
Clinical use of sucralfateClinical use of sucralfate►Short and long term management of Short and long term management of
duodenal ulcer.duodenal ulcer.
►NSAIDs induced gastritisNSAIDs induced gastritis
►Prevention of stress ulcerPrevention of stress ulcer
►Treatment of oral and esophageal ulcersTreatment of oral and esophageal ulcers
due to radiation, chemotherapy ordue to radiation, chemotherapy or
sclerotherapy.sclerotherapy.
SucralfateSucralfate
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SucralfateSucralfate
Precautions on the use of SucralfatePrecautions on the use of Sucralfate►This agent should NOT be given to anyThis agent should NOT be given to any
person with known allergy to the drug,person with known allergy to the drug,
and to those patients with renaland to those patients with renalfailure/dialysis because of build-up of failure/dialysis because of build-up of
aluminum may occur if used withaluminum may occur if used with
aluminum containing products.aluminum containing products.
The Mucosal ProtectantThe Mucosal Protectant
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The Mucosal ProtectantThe Mucosal Protectant
Pharmacodynamics: Side-effects & adversePharmacodynamics: Side-effects & adversereactionsreactions
►P r im a r i l y G I T = CO NS T I P AT I O N ,r im a r i l y G I T = CO NS T I P AT I O N ,
o c c a s i ona l ly d i a r rh ea , n au sea ,c c a s iona l ly d i a r rh ea , n au sea ,i nd i ge s t i on , ga s t r i c d i s c om fo r t , andnd i ge s t i on , ga s t r i c d is c om fo r t , and
d r y m ou t h m a y a ls o o c cu rr y m ou t h m a y a ls o o c cu r
►CNS= dizziness, drowsiness, vertigoCNS= dizziness, drowsiness, vertigo►Others= rash and back painOthers= rash and back pain
The Mucosal ProtectantThe Mucosal Protectant
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The Mucosal ProtectantThe Mucosal Protectant
Drug-drug interactionsDrug-drug interactions► I f u s ed w i th a l um i num s a l ts= h i ghf u s ed w i th a l u m i n u m s a l t s= h i g h
r is k o f a c c u m u la t io n o f a l u m i n u m a n dis k o f a c c u m u la t io n o f a l u m in u m a n d
tox i c i t yox i c i t y ..►If used with phenytoin, fluoroquinolonesIf used with phenytoin, fluoroquinolones
and penicillamines- decreased levels of and penicillamines- decreased levels of
these drugs when taken with sucralfatethese drugs when taken with sucralfate
The Mucosal ProtectantThe Mucosal Protectant
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The Mucosal ProtectantThe Mucosal Protectant
Nursing ConsiderationsNursing Considerations► Administer drug Administer drug O N A N E M P T Y st om a c hN A N E M P T Y s to m a c h , 11
hou r b e f o r e me a l s , o r 2 hou r a f t e r m ea l sou r b e f o r e me a l s , o r 2 hou r a f te r m ea l s
and a t BE DT IMEnd a t BE DT IME
► Monitor for side-effects like constipation and GIMonitor for side-effects like constipation and GIupsetupset
► Encourage intake of high-fiber foods andEncourage intake of high-fiber foods andincreased fluid intakeincreased fluid intake
► Administer antacids Administer antacids B E T W E E NE T W E E N doses of doses of sucralfate,sucralfate, N O T W I T H I N 3 0O T W I T H I N 3 0 minutes of minutes of sucralfate dosesucralfate dose
The Mucosal ProtectantThe Mucosal Protectant
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The Mucosal ProtectantThe Mucosal Protectant
Nursing ConsiderationsNursing Considerations►Provide comfort measures if CNS effectsProvide comfort measures if CNS effects
occuroccur
►Provide health teaching as to drug name,Provide health teaching as to drug name,dosages and frequency, safety measures todosages and frequency, safety measures tohandle common problems.handle common problems.
►Monitor patient response to the drug, theMonitor patient response to the drug, theeffectiveness of the teaching plan and theeffectiveness of the teaching plan and themeasures employedmeasures employed
The Mucosal ProtectantThe Mucosal Protectant
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The Mucosal ProtectantThe Mucosal Protectant
Nursing ConsiderationsNursing Considerations►Evaluate effectiveness of therapyEvaluate effectiveness of therapy
Healing of ulcerHealing of ulcer
No formation of ulcerNo formation of ulcer
Prostaglandin analogueProstaglandin analogue
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Prostaglandin analogueostag a d a a ogue
MisoprostolMisoprostol►This agent is a synthetic prostaglandin E1This agent is a synthetic prostaglandin E1
analog that is employed to protect the lininganalog that is employed to protect the lining
of the mucosa of the stomachof the mucosa of the stomach
Prostaglandin analogueProstaglandin analogue
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Prostaglandin analogueg g
Misoprostol: PharmacodynamicsMisoprostol: Pharmacodynamics►Being a prostaglandin analog, itBeing a prostaglandin analog, it i n h i b i t snh i b i t s
gastric acid secretion to some degreegastric acid secretion to some degree
►ItIt I N C R E A S E S m u c u sN C R E A S E S m u c u s production in theproduction in thestomach lining.stomach lining.
Prostaglandin analogueProstaglandin analogue
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Prostaglandin analogueg g
Misoprostol: Clinical useMisoprostol: Clinical use►NSAIDs-induced gastric ulcersNSAIDs-induced gastric ulcers
►Duodenal ulcers unresponsive to H2Duodenal ulcers unresponsive to H2
antagonists.antagonists.
Prostaglandin analogueProstaglandin analogue
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ostag a d a a ogueg g
Precautions of Misoprostol UsePrecautions of Misoprostol Use► This drug is CONTRAINDICATED during pregnancyThis drug is CONTRAINDICATED during pregnancy
because it is anbecause it is an abo r t i f a c i en t .bo r t i f a c i en t .
► Women should be advised to have aWomen should be advised to have a nega t i v eega t i v e
p r egnan cy t e s t w i t h in 2 w eek s o fr egnan cy t e s t w i t h in 2 w eek s o fb eg i nn i ng t he r apy and shou l d b eg i n theeg i nn i ng t he rapy an d shou l d b eg i n t he
d rug on t he s e con d o r t h i r d day o f t herug on t he s e cond o r t h ir d day o f t he
nex t m ens t r ua l c y c le .e x t m ens t r ua l c y c le .
► They should be instructed in the use of They should be instructed in the use of contraceptives during therapy.contraceptives during therapy.
Prostaglandin analogueProstaglandin analogue
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g gg g
Pharmacodynamic effects: drug reactionsPharmacodynamic effects: drug reactions►GIT= Nausea, diarrhea, abdominal pain,GIT= Nausea, diarrhea, abdominal pain,
flatulence, vomiting, dyspepsiaflatulence, vomiting, dyspepsia
►GU effects= miscarriages,GU effects= miscarriages, ex ce s s i v ex ce s s i v e
u t e r i n e CR AM P I NG a n d b l e e d in gt e r i n e CR AM P I NG a n d b l e e d in g ,,
spotting, hypermenorrhea and menstrualspotting, hypermenorrhea and menstrual
disorders.disorders.
Prostaglandin analogueProstaglandin analogue
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g gg g
Nursing ConsiderationsNursing Considerations► Administer to patients at risk for NSAIDs-induced Administer to patients at risk for NSAIDs-induced
ulcers during the full course of NSAIDs therapyulcers during the full course of NSAIDs therapy
► Administer four times daily with meals and at Administer four times daily with meals and atbedtimebedtime
► Obtain pregnancy test within 2 weeks of beginningObtain pregnancy test within 2 weeks of beginning
therapy. Begin the therapy on second or third daytherapy. Begin the therapy on second or third day
of menstrual periodof menstrual period to ensure that the woman is to ensure that the woman is not pregnant not pregnant
Prostaglandin analogueProstaglandin analogue
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g gg g
Nursing ConsiderationsNursing Considerations► Provide patient with both written and oralProvide patient with both written and oral
information regarding the associated risks of information regarding the associated risks of
pregnancypregnancy
► Provide health teaching as to drug name,Provide health teaching as to drug name,
dosages and frequency, safety measures todosages and frequency, safety measures to
handle common problems.handle common problems.
► Monitor patient response to the drug, theMonitor patient response to the drug, theeffectiveness of the teaching plan and theeffectiveness of the teaching plan and the
measures to employmeasures to employ
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LaxativesLaxatives
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Type Prototype Action
Chemicalstimulants
Bisacodyl (Dulcolax) Direct stimulation of theGIT nervesIrritant laxatives
Mechanical (bulk)stimulants
Lactulose Increased fluid content of the fecal material causingstimulation of the localreflex
Lubricants Docusate Lubricating the intestinalmaterial to promotepassage through the GIT
LaxativesLaxatives
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►Generally used to INCREASE the passage of Generally used to INCREASE the passage of the colonic contentsthe colonic contents
►The general classifications is as follows:The general classifications is as follows:
1. Chemical stimulants1. Chemical stimulants
2. Mechanical stimulants2. Mechanical stimulants
3. Lubricants3. Lubricants
Therapeutic Indications of theTherapeutic Indications of the
LaxativesLaxatives
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LaxativesLaxatives
►SHORT term relief of SHORT term relief of Cons t i p a t i onons t i p a t i on
►P reve n t i on o f s t ra i n i ngreven t ion o f s t ra i n i ng in conditions likein conditions like
CHF, post-MI, post partum, post-opCHF, post-MI, post partum, post-op
►Preparation forPreparation for d i agno s t i c e x am i na t io ni a gno s t ic e x a m i na t io n
►Removal of poison or toxinsRemoval of poison or toxins
► Adjunct in anti-helminthic therapy Adjunct in anti-helminthic therapy
Contraindications in Laxative useContraindications in Laxative use
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► ACUTE abdominal disorders ACUTE abdominal disorders Append i c i t i sppend i c i t i s
Dive r t i cu l i t i si ve r t i cu l i t i s
U l ce ra t i ve co l i t isl ce ra t i ve c o l i t is
Chemical Stimulant CatharticsChemical Stimulant Cathartics
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Prototype: BisacodylPrototype: BisacodylIrritant laxatives:Irritant laxatives:
►1. Castor oil1. Castor oil
►2. Senna2. Senna
►3. Cascara3. Cascara
►
4. Phenolphthalein4. Phenolphthalein
Chemical Stimulant CatharticsChemical Stimulant Cathartics
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PharmacodynamicsPharmacodynamics►These agents DIRECTLY stimulate the nerveThese agents DIRECTLY stimulate the nerve
plexus in the intestinal wallplexus in the intestinal wall
►The result is INCREASED movement orThe result is INCREASED movement ormotility of the colonmotility of the colon
Mechanical Stimulant CatharticsMechanical Stimulant Cathartics
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►Prototype: LACTULOSE (Cephulac)Prototype: LACTULOSE (Cephulac)Bulk-forming laxativesBulk-forming laxatives
►1. Magnesium (citrate, hydroxide, sulfate)1. Magnesium (citrate, hydroxide, sulfate)
►2. Psyllium2. Psyllium
►3. Polycarbophil3. Polycarbophil
Mechanical Stimulant CatharticsMechanical Stimulant Cathartics
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PharmacodynamicsPharmacodynamics►These agents are rapid-acting laxatives thatThese agents are rapid-acting laxatives that
INCREASE the GI motility byINCREASE the GI motility by
Increasing the fluids in the colonic materialIncreasing the fluids in the colonic material Stimulating the local stretch receptorsStimulating the local stretch receptors
Activating Activating local defection reflexlocal defection reflex
LubricantsLubricants
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►Prototype: DocusatePrototype: Docusate
►1. Glycerin1. Glycerin
►2. Mineral oil2. Mineral oil
LubricantsLubricants
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PharmacodynamicsPharmacodynamics►Docusate increases the admixture of fat andDocusate increases the admixture of fat and
water producing a softer stoolwater producing a softer stool
►GlycerinGlycerin►Mineral oil forms a slippery coat on theMineral oil forms a slippery coat on the
colonic contentscolonic contents
Pharmacokinetics:harmacokinetics:
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Common Side-effects of the Laxativesommon Side-effects of the Laxatives
►DiarrheaDiarrhea► Abdominal cramping Abdominal cramping
►NauseaNausea
►Fluid and electrolyte imbalanceFluid and electrolyte imbalance
►Sympathetic reactions- sweating,Sympathetic reactions- sweating,
palpitations, flushing and faintingpalpitations, flushing and fainting
►CATHARTIC dependenceCATHARTIC dependence
The Nursing Process and LaxativeThe Nursing Process and Laxative
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ASSESSMENT ASSESSMENT►Nursing History- elicit allergy to anyNursing History- elicit allergy to any
laxatives, elicit history of conditions likelaxatives, elicit history of conditions like
diverticulitis and ulcerative colitisdiverticulitis and ulcerative colitis►Physical Examination- abdominalPhysical Examination- abdominal
assessmentassessment
►Laboratory Test: fecalysis, electrolyte levelsLaboratory Test: fecalysis, electrolyte levels
The Nursing Process and LaxativeThe Nursing Process and Laxative
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NURSING DIAGNOSISNURSING DIAGNOSIS► Alteration in bowel pattern Alteration in bowel pattern
► Alteration in comfort: pain Alteration in comfort: pain
►Knowledge deficitKnowledge deficit
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The Nursing Process and LaxativeThe Nursing Process and Laxative
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IMPLEMENTATIONIMPLEMENTATION4.4. Encourage fluid intake, high fiber diet andEncourage fluid intake, high fiber diet and
daily exercisedaily exercise
5 . DO N OT adm i n is t e r i f a c u t e. DO N OT adm i n is t e r i f a c u t e
abd om ina l c ond i t i o n l ik ebdom ina l c ond i t i o n l ik e
app end i c i t i s i s p r e s en tpp end i c i t i s is p r e sen t
6. Advise to change position slowly an avoid6. Advise to change position slowly an avoidhazardous activities because of potentialhazardous activities because of potential
dizzinessdizziness
The Nursing Process and LaxativeThe Nursing Process and Laxative
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EVALUATION of drug effectivenessEVALUATION of drug effectiveness1.1. Evaluate relief of GI symptoms, absence of Evaluate relief of GI symptoms, absence of
staining and increased evacuation of GIstaining and increased evacuation of GI
tracttract2.2. For Lactulose: decreased ammoniaFor Lactulose: decreased ammonia
The Anti-diarrhealsThe Anti-diarrheals
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►These are agents used to calm the irritationThese are agents used to calm the irritationof the GIT for the symptomatic relief of of the GIT for the symptomatic relief of
diarrheadiarrhea
►General ClassificationsGeneral Classifications1. Local anti-motility1. Local anti-motility
2. Local reflex inhibition2. Local reflex inhibition
3. Central action on the CNS3. Central action on the CNS
The Anti-diarrhealsThe Anti-diarrheals
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Type Prototype Action
Local reflex inhibitor Bismuth subsalicylate Locally coats thelining of the GIT tosoothe irritation that
may stimulate thereflex
Local anti-motility Loperamide Directly inhibits theintestinal muscleactivity to SLOW
peristalsisCentral acting agent Opium derivatives
(paregoric)Stops GIT spasm by CNS action
Clinical Indications of drug useClinical Indications of drug use
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►Relief of symptoms of acute and chronicRelief of symptoms of acute and chronicdiarrheadiarrhea
►Reduction of fecal volume discharges fromReduction of fecal volume discharges from
ileostomiesileostomies►Prevention and treatment of traveler'sPrevention and treatment of traveler's
diarrheadiarrhea
Contraindications of anti-diarrhealContraindications of anti-diarrheal
UseUse
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UseUse
►Po i s on i ngo i s on i ng►Drug a l le r g yrug a l l e r g y
►G I ob s t r u c t ionI ob s t r u c t i on
►Acu t e abdo m ina l c ond i t io n scu t e abdom ina l c ond i t io n s
Pharmacokinetics: Side effectsPharmacokinetics: Side effects
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►Cons t i p a t i onons t i p a t i on►Na usea , vom i t i n gau sea , vom i t i n g
►Abd om ina l d i s ten t i o n and d i s c om fo rtbdom i na l d i s ten t i o n and d i s c om fo rt
►T O X IC M E G A C O L O NO X IC M E G A C O L O N
Nursing process and anti-diarrhealsNursing process and anti-diarrheals
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ASSESSMENT ASSESSMENT►Nursing History – Elicit history of drugNursing History – Elicit history of drug
allergy, conditions like poisoning, GIallergy, conditions like poisoning, GI
obstruction and acute abdominal conditionsobstruction and acute abdominal conditions►Physical Examination- AbdominalPhysical Examination- Abdominal
examinationexamination
►Laboratory test- electrolyte levelsLaboratory test- electrolyte levels
Nursing process and anti-diarrhealsNursing process and anti-diarrheals
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NURSING DIAGNOSISNURSING DIAGNOSIS► Alteration in bowel pattern Alteration in bowel pattern
► Alteration in comfort: pain Alteration in comfort: pain
Nursing process and anti-diarrhealsNursing process and anti-diarrheals
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IMPLEMENTATIONIMPLEMENTATION1.1. Monitor patient response within 48 hours.Monitor patient response within 48 hours.
Discontinue drug use if no effectDiscontinue drug use if no effect
2.2. Provide comfort measures for painProvide comfort measures for pain
3.3. Provide teachingProvide teaching
Nursing process and anti-diarrhealsNursing process and anti-diarrheals
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EVALUATIONEVALUATION1.1. Monitor effectiveness of drug-Monitor effectiveness of drug- R EL I E F o fE L I E F o f
d i a r r h eai a r r h ea
2.2. Monitor adverse effects, effectiveness of Monitor adverse effects, effectiveness of pain measures and effectiveness of pain measures and effectiveness of
teaching planteaching plan
Emetics and Anti-emeticsEmetics and Anti-emetics
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E m e t ic A gen tm e t ic A gen t► Sy rup o f I p e ca cy rup o f I p e ca c
Anti-emetics Anti-emetics► 1. Phenothiazines1. Phenothiazines► 2. Non-phenothiazines2. Non-phenothiazines► 3. Anticholinergics/Antihistamines3. Anticholinergics/Antihistamines
► 4. Serotonin receptor Blockers4. Serotonin receptor Blockers► 5. Miscellaneous5. Miscellaneous
EMETICEMETIC
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►Prototype: Ipecac SyrupPrototype: Ipecac Syrup
EMETICEMETIC
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PharmacodynamicsPharmacodynamics►Ipecac syrup irritates the GI mucosa locally,Ipecac syrup irritates the GI mucosa locally,
resulting to stimulation of the vomitingresulting to stimulation of the vomiting
centercenter►It acts within 20 minutesIt acts within 20 minutes
EMETICEMETIC
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Clinical Use of ipecacClinical Use of ipecac►To induce vomiting as a treatment for drugTo induce vomiting as a treatment for drug
overdose and certain poisoningsoverdose and certain poisonings
EMETICEMETIC
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Contraindications of Ipecac useContraindications of Ipecac use►Ingestion of CORROSIVE chemicalsIngestion of CORROSIVE chemicals
►Ingestion of petroleum productsIngestion of petroleum products
►Unconscious and convulsing patientUnconscious and convulsing patient
EMETICEMETIC
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Pharmacokinetics: side effects of IpecacPharmacokinetics: side effects of Ipecac►NauseaNausea
►DiarrheaDiarrhea
►GI upsetGI upset
►Mild CNS depressionMild CNS depression
►CARDIOTOXICITY if large amountsARDIOTOXICITY if large amounts
are absorbed in the bodyre absorbed in the body
Nursing process and the EMETICNursing process and the EMETIC
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ASSESSMENT ASSESSMENT►Nursing History- elicit the exact nature of Nursing History- elicit the exact nature of
poisoningpoisoning
►Physical Examination- CNS status andPhysical Examination- CNS status andabdominal examabdominal exam
Nursing process and the EMETICNursing process and the EMETIC
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IMPLEMENTATIONIMPLEMENTATION1.1. Administer to Administer to conscious patient onlyconscious patient only
2.2. Administer ipecac Administer ipecac as soon as possibleas soon as possible
3.3. Administer with a large amount of water Administer with a large amount of water
4.4. Vomiting should occur within 20 minutes Vomiting should occur within 20 minutes
of the first dose.of the first dose. Repeat the dose andRepeat the dose and
expect vomiting to occur with 20 minutesexpect vomiting to occur with 20 minutes
Nursing process and the EMETICNursing process and the EMETIC
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IMPLEMENTATIONIMPLEMENTATION5. Provide comfort measures like ready access5. Provide comfort measures like ready access
to bathroom, assistance with ambulationto bathroom, assistance with ambulation
6. Offer support6. Offer support
Nursing process and the EMETICNursing process and the EMETIC
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EVALUATIONEVALUATION1.1. Evaluate patient response within 20Evaluate patient response within 20
minutes of drug ingestionminutes of drug ingestion
2.2. Monitor for adverse effectsMonitor for adverse effects3.3. Evaluate effectiveness of comfortEvaluate effectiveness of comfort
measures and teaching planmeasures and teaching plan
ANTI-EMETICS ANTI-EMETICS
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►These are agents used to manage nauseaThese are agents used to manage nauseaand vomitingand vomiting
►They act either locally or centrallyThey act either locally or centrally
ANTIEMETICS ANTIEMETICS
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Anti-emetic types Common examples
Phenothiazines Prochlorperazine, promethazine
Non-phenothiazines Metoclopramide
Anticholinergics and Antihistaminics Meclizine, buclizine
Serotonin Receptor blockers “setron”- dolasetron
Miscellaneous Dronabinol, hydroxyzine
ANTIEMETICS ANTIEMETICSTypes Pharmacodynamics
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Types Pharmacodynamics
Phenothiazines Centrally block the vomitingcenter in the medulla
Non-phenothiazine Reduces the responsiveness
of the nerve cell in the medulla
Anticholinergics Block the transmission of theimpulses to the medulla
Serotonin receptor blockers
Centrally and locally inhibitsthe serotonin receptors
Miscellaneous Act in the CNS , either in themedulla or in the cortex
ANTIEMETICS ANTIEMETICSTypes Clinical Use
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Types Clinical Use
Phenothiazines N/V associated withanesthesia, intractable hiccups
Non-phenothiazine N/V associated with chemicalstimulation
Anticholinergics N/V associated with motionsickness
Serotonin-receptor Blockers N/V associated with chemotherapy
Miscellaneous N/V associated with chemotherapy
ANTIEMETICS ANTIEMETICS
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ContraindicationsContraindications►1. Severe CNS depression1. Severe CNS depression
►2. Severe liver dysfunction2. Severe liver dysfunction
ANTIEMETICS ANTIEMETICS
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Pharmacokinetics: Side-effectsPharmacokinetics: Side-effects1.1. P H O T H O S ENS I T I V I T YH O T H O S ENS I T I V I T Y
2.2. Drow s in e s s , d i z z i n e s s , weakn e s sr ows i n e s s , d i zz in e s s , w eakn e s s
a n d t rem o r s a n d DE H YD R AT O Nn d t rem o r s a n d DE H YD R AT O N
3. Phenothiazines= autonomic3. Phenothiazines= autonomic anti-anti-
cholinergic effectscholinergic effects like dry mouth, nasallike dry mouth, nasal
congestion and urinary retentioncongestion and urinary retention
Nursing Process and theNursing Process and the ANTIEMETICS ANTIEMETICS
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ASSESSMENT ASSESSMENT► Nursing History- elicit allergy, impairedNursing History- elicit allergy, impaired
hepatic function and CNS depressionhepatic function and CNS depression
► Physical Examination- CNS status andPhysical Examination- CNS status andabdominal examinationabdominal examination
► Laboratory test- Liver function studiesLaboratory test- Liver function studies
Nursing Process and theNursing Process and the ANTIEMETICS ANTIEMETICS
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NURSING DIAGNOSISNURSING DIAGNOSIS1.1. Alteration in comfort: pain Alteration in comfort: pain
2.2. High risk for injuryHigh risk for injury
3.3. Knowledge deficitKnowledge deficit
Nursing Process and theNursing Process and the ANTIEMETICS ANTIEMETICS
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IMPLEMENTATIONIMPLEMENTATION1.1. Assess patient’s intake of other drugs that Assess patient’s intake of other drugs that
may cause dangerous drug interactionmay cause dangerous drug interaction
2.2. Emphasize that this is given on a shortEmphasize that this is given on a shortterm basisterm basis
Nursing Process and theNursing Process and the ANTIEMETICS ANTIEMETICS
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IMPLEMENTATIONIMPLEMENTATION3.3. Provide comfort and safety measuresrovide comfort and safety measures Advise to change position slowlydvise to change position slowly
Avoid hazardous activitiesvoid hazardous activities Provide mouth care and ice chipsrovide mouth care and ice chips
Monitor for dehydration and offer fluidsonitor for dehydration and offer fluids
if it occursf it occurs
Nursing Process and theNursing Process and the ANTIEMETICS ANTIEMETICS
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IMPLEMENTATIONIMPLEMENTATION4. Protect from sun exposure4. Protect from sun exposure SunscreensSunscreens
Protective coveringProtective covering
5. Provide health teaching5. Provide health teaching
Nursing Process and theNursing Process and the ANTIEMETICS ANTIEMETICS
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EVALUATIONEVALUATION1.1. Monitor for the drug effectivenessonitor for the drug effectiveness
• Relief of nausea and vomitingelief of nausea and vomiting
2. Monitor for adverse effects2. Monitor for adverse effects3. Evaluate effectiveness of comfort measures3. Evaluate effectiveness of comfort measures
and teaching planand teaching plan
Pharmacology of thePharmacology of the
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Pharmacology of thePharmacology of the
Selected EndocrineSelected Endocrine
DrugsDrugs
Nursing ReviewNursing Review
Endocrine MedicationsEndocrine Medications
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Anti-diuretic hormonesAnti-diuretic hormonesEnhance re-absorption of water in theEnhance re-absorption of water in the
kidneyskidneys
Used in DIUsed in DI
1. Desmopressin and Lypressin1. Desmopressin and Lypressin
intranasallyintranasally
2. Pitressin IM2. Pitressin IM
Endocrine MedicationsEndocrine Medications
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Anti-diuretic hormonesAnti-diuretic hormonesSIDE-effectsSIDE-effects
Flushing and headacheFlushing and headacheWater intoxicationWater intoxication
Thyroid MedicationsThyroid Medications
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Thyroid hormonesThyroid hormones
These products are used to treatThese products are used to treat
the manifestations of the manifestations of hypothyroidismhypothyroidism
Replace hormonal deficit in theReplace hormonal deficit in thetreatment of HYPOTHYROIDSMtreatment of HYPOTHYROIDSM
Thyroid MedicationsThyroid Medications
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Thyroid hormonesThyroid hormones
Levothyroxine (Synthroid)Levothyroxine (Synthroid)
Liothyroxine (Cytomel)Liothyroxine (Cytomel)
Thyroid dessicatedThyroid dessicated
Liotrix (Thyrolar)Liotrix (Thyrolar)
Thyroid MedicationsThyroid Medications
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Thyroid hormones: ActionsThyroid hormones: Actions
Increase the metabolic rateIncrease the metabolic rate
Increase O2 consumptionIncrease O2 consumption
Increase HR, RR, BPIncrease HR, RR, BP
Thyroid MedicationsThyroid Medications
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Thyroid hormonesThyroid hormonesSide-effectsSide-effects
1.1. Nausea and VomitingNausea and Vomiting
2.2. Signs of increased metabolism=Signs of increased metabolism=
tachycardia, hypertension, cardiactachycardia, hypertension, cardiac
arrhythmias, anxiety, headachearrhythmias, anxiety, headache
Thyroid MedicationsThyroid Medications
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Thyroid hormones : Nursing responsibilityThyroid hormones : Nursing responsibility
1. Monitor weight, VS1. Monitor weight, VS
2. Instruct client to take daily2. Instruct client to take daily
medication the same timemedication the same time eacheach
morning WITHOUT FOODmorning WITHOUT FOOD
Monitor blood tests to check theMonitor blood tests to check theactivity of thyroidactivity of thyroid
Thyroid MedicationsThyroid Medications
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Thyroid hormones: Nursing responsibilityThyroid hormones: Nursing responsibility
3. Advise to report palpitation,3. Advise to report palpitation,
tachycardia, and chest paintachycardia, and chest pain4. Instruct to avoid foods that4. Instruct to avoid foods that
inhibit thyroid secretions likeinhibit thyroid secretions like
cabbage, spinach and radishescabbage, spinach and radishes
ANTI-Thyroid Medications ANTI-Thyroid Medications
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ANTI-THYROID medicationsANTI-THYROID medications
The thyroid becomesThe thyroid becomes
oversaturated with iodine andoversaturated with iodine andstop producing thyroidstop producing thyroid
hormonehormone
ANTI-Thyroid Medications ANTI-Thyroid Medications
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ANTI-THYROID medicationsANTI-THYROID medications
Drugs used to BLOCK theDrugs used to BLOCK the
thyroid hormones and treatthyroid hormones and treathyperthyroidismhyperthyroidism
Inhibit the synthesis of thyroidInhibit the synthesis of thyroidhormoneshormones
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ANTI-Thyroid Medications ANTI-Thyroid Medications
ANTI THYROID medicationsANTI THYROID medications
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ANTI-THYROID medicationsANTI-THYROID medications
Side-effects of thionamidesSide-effects of thionamides N/V, drowsiness, lethargy,N/V, drowsiness, lethargy,
bradycardia, skin rashbradycardia, skin rash GI complaintsGI complaints AGRANULOCYTOSIS AGRANULOCYTOSIS
Most important to monitor Most important to monitor
ANTI-Thyroid Medications ANTI-Thyroid Medications
ANTI THYROID medicationsANTI-THYROID medications
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ANTI-THYROID medicationsANTI-THYROID medications
Side-effects of Iodine solutionsSide-effects of Iodine solutions Most common adverse effects isMost common adverse effects is
HYPOTHYROIDISMHYPOTHYROIDISM Iodism= metallic taste, burning inIodism= metallic taste, burning in
the mouth, sore teeth and gums,the mouth, sore teeth and gums,diarrhea, stomach upsetdiarrhea, stomach upset
ANTI-Thyroid Medications ANTI-Thyroid Medications
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ANTI-THYROID medicationsANTI-THYROID medicationsNursing responsibilitiesNursing responsibilities
1. Monitor VS, T3 and T4,1. Monitor VS, T3 and T4,weightweight
2. The medications2. The medications WITH WITH
MEALS MEALS to avoid gastric upsetto avoid gastric upset
ANTI-Thyroid Medications ANTI-Thyroid Medications
ANTI-THYROID medications NursingANTI-THYROID medications Nursing
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ANTI THYROID medications Nursingg
responsibilitiesresponsibilities3. Instruct to report SORE3. Instruct to report SORETHROAT or unexplained FEVERTHROAT or unexplained FEVER
4. Monitor for signs of 4. Monitor for signs of hypothyroidism.hypothyroidism.
Instruct not to stop abruptInstruct not to stop abruptmedicationmedication
ANTI-Thyroid Medications ANTI-Thyroid MedicationsANTI-THYROID medicationsANTI-THYROID medications
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Lugol’s SolutionLugol’s SolutionUsed to decrease the vascularity of theUsed to decrease the vascularity of thethyroid (in preparation for thyroid surgery)thyroid (in preparation for thyroid surgery)
T3 and T4 production diminishesT3 and T4 production diminishesGiven per orem, can be diluted with juiceGiven per orem, can be diluted with juice
Use straw to decrease stainingUse straw to decrease staining
Monitor iodism (metallic taste, burning inMonitor iodism (metallic taste, burning inmouth)mouth)
STEROIDSSTEROIDS
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Replaces the steroids inReplaces the steroids inthe bodythe body
Interfere with the releaseInterfere with the releaseof inflammatory factorsof inflammatory factors
and immune responsesand immune responses
STEROIDSSTEROIDS
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Cortisol, cortisone,Cortisol, cortisone,betamethasone, andbetamethasone, and
hydrocortisonehydrocortisone
Dexamethasone= longDexamethasone= long
actingacting
STEROIDSSTEROIDS
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These drugs enter theThese drugs enter thecells and bind tocells and bind to
receptorsreceptors
They inhibit the enzymeThey inhibit the enzyme
phospholipasephospholipase
STEROIDSSTEROIDS
C ti t id d t i ll
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Corticosteroids are used topicallyCorticosteroids are used topically
and locally to achieve the desiredand locally to achieve the desired
anti-inflammatory effects at aanti-inflammatory effects at a
particular siteparticular site
STEROIDSSTEROIDS
St id Cli i l
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Steroid Clinical use
Dexamethasone Use to induce theformation of lungsurfactant
Other steroids Use for the treatment of immune-related diseases,control of asthma and
allergic symptoms
STEROIDSSTEROIDS
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Side-effectsSide-effects HYPERglycemiaHYPERglycemia Increased susceptibility toIncreased susceptibility to
infectioninfection(immunosuppression)(immunosuppression)
HypokalemiaHypokalemia Edema and HypertensionEdema and Hypertension Peptic ulcerationPepti c ulceration
STEROIDSSTEROIDS
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Side-effectsSide-effects If high doses- osteoporosis,If high doses- osteoporosis,
growth retardation, pepticgrowth retardation, peptic
ulcer, hypertension,ulcer, hypertension,
cataractcataract, mood changes,, mood changes,
hirsutism, and fragile skinhirsutism, and fragile skin
STEROIDSSTEROIDS
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Nursing responsibilitiesNursing responsibilities1. Monitor VS, electrolytes,1. Monitor VS, electrolytes,
glucoseglucose2. Monitor weight edema2. Monitor weight edema
and I/O. Encourageand I/O. EncouragePotassium supplementsPotassium supplements
STEROIDSSTEROIDS
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Nursing responsibilitiesNursing responsibilities3. Protect patient from infection3. Protect patient from infection
4. Handle patient gently4. Handle patient gently
5. Instruct to take meds5. Instruct to take meds WITH WITH
MEALS MEALS to prevent gastric ulcer to prevent gastric ulcer
formationformation
STEROIDSSTEROIDS
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Nursing responsibilitiesNursing responsibilities6. Caution the patient NOT to6. Caution the patient NOT to
abruptly stop the drugabruptly stop the drug
7.7. Drug is tapered to allow theDrug is tapered to allow the
adrenal gland to secreteadrenal g land to secrete
endogenous hormonesendog enous hormones
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The cardiac glycosidesThe cardiac glycosides These are agents extracted from theThese are agents extracted from the
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These are agents extracted from theThese are agents extracted from the
foxglove plant. They are available infoxglove plant. They are available inoral and parenteral preparations. Theoral and parenteral preparations. The
following are the cardiac glycosides:following are the cardiac glycosides:
Digoxin (Lanoxin) Digoxin (Lanoxin)
Digitoxin (Crystodigin) Digitoxin (Crystodigin)
Ouabain Ouabain
The cardiac glycosidesThe cardiac glycosides
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Pharmacodynamics: the Mechanism of Pharmacodynamics: the Mechanism of actionaction
TheyThey i n c rease the l eve l o fnc r ease the l e ve l o f
CALC IUMALC IUM inside the cell by inhibitinginside the cell by inhibitingthe Sodium-Potassium pump.the Sodium-Potassium pump.
More calcium will accumulate inside theMore calcium will accumulate inside the
cell during cellular depolarization.cell during cellular depolarization.
The cardiac glycosidesThe cardiac glycosides Pos i t i v e i no t rop i co s i t iv e i n o t r op i c Effect-Effect- thethe
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myocardium will contract forcefullymyocardium will contract forcefully – Increased cardiac outputIncreased cardiac output
– Increased blood flow to the body organs likeIncreased blood flow to the body organs likethe kidney and liverthe kidney and liver
Ne ga t i ve c h r ono t r op icega t i v e c h r ono t r op ic effect- the hearteffect- the heartrate is slowed due to decreased rate of rate is slowed due to decreased rate of cellular repolarizationcellular repolarization
– BradycardiaBradycardia De c r ea s ed c on du c t i o n v e l o c i tye c r e a s ed c ondu c t io n v e l o c i ty
through the AV nodethrough the AV node
The cardiac glycosidesThe cardiac glycosides
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Clinical Use of the cardiac glycosidesClinical Use of the cardiac glycosides Treatment of Treatment of congestive heart failurecongestive heart failure
Treatment of Treatment of dysrhythmiasdysrhythmias like atriallike atrial
flutter, atrial fibrillation andflutter, atrial fibrillation and
paroxysmal atrial tachycardiaparoxysmal atrial tachycardia
The cardiac glycosidesThe cardiac glycosidesContraindications and PrecautionsContraindications and Precautions
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Contraindicated in the presence of allergyContraindicated in the presence of allergyto any cardiac glycoside.to any cardiac glycoside.
They areThey are N OTOT given to patients withgiven to patients with
ventricular dysrhythmias, heart block orventricular dysrhythmias, heart block orsick sinus syndrome, aortic stenosis, acutesick sinus syndrome, aortic stenosis, acuteMI, electrolyte imbalancesMI, electrolyte imbalances((H Y P O K A L E M I A , H Y P O M A G N E S E M I AY P O K A L E M IA , H Y P O M A G N E S E M I A
a n d H Y P E R C A L C E M I An d H Y P E R C A L C E M I A ) and) and renal failurerenal failure (may cause accumulation of drug)(may cause accumulation of drug)
The cardiac glycosidesThe cardiac glycosides
Pharmacodynamics: the Adverse Effects of thePharmacodynamics: the Adverse Effects of the
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yy
Cardiac glycosidesCardiac glycosides CNS- Headache, weakness , seizures andCNS- Headache, weakness , seizures and
drowsinessdrowsiness
CVS- arrhythmiasCVS- arrhythmias If digitalis toxicity is developing- the nurse mustIf digitalis toxicity is developing- the nurse must
assess the following adverse effects:assess the following adverse effects: Ano rex i a ,no r ex i a ,
nau sea and vom it ing , v is ua l c hange s -au sea a nd vom i t ing , v i sua l c hange s -
YE L LOW ha l o a round an ob j e c t, a ndE L LOW ha l o a round an ob j e c t, a nd
pa l p i t a t ions o r ve r y s l ow hea r t ra t ea l p i t a t ions o r ve r y s l ow h ea r t ra t e
The cardiac glycosidesThe cardiac glycosides
Remember= NAVDA and hypokalemiaRemember= NAVDA and hypokalemia
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Remember NAVDA and hypokalemiaRemember NAVDA and hypokalemia
The cardiac glycosidesThe cardiac glycosides
Drug-Drug InteractionsDrug-Drug Interactions
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Drug Drug InteractionsDrug Drug Interactions
I f ta k en w i th po t a s s ium - lo s i n gf t a k en w i th p o t a s s ium - lo s i n g
d i u r e t i c s l i k e fu r o se m ide - c ani u r e t ic s l i k e fu r o se m ide - c an
INCR EAS E t h e r i s k o f t o x ic i ty a n dNC RE ASE t h e r i s k o f t o x ic i ty a n d
a r r h y t hm i a s . P o t a s s i um r ep l a c em en tr r h y t hm i a s . P o t a s s i um r ep l a c em en t
m u s t b e g iv e n .u s t b e g i v en .
The cardiac glycosidesThe cardiac glycosidesImplementationImplementation
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Administer the initial rapid digitalization Administer the initial rapid digitalizationand loading dose as ordered intravenouslyand loading dose as ordered intravenously
Monitor theMonitor the AP I CALP I CAL pulse rate for ONEpulse rate for ONE
full minute before administering the drug.full minute before administering the drug.Withhold the drug if Withhold the drug if – Less than 60 in adultsLess than 60 in adults
– Less than 90 in infantsLess than 90 in infants
– More than 110 in adultsMore than 110 in adults
Retake pulse in one hour, if pulses remainRetake pulse in one hour, if pulses remainabnormal, refer!abnormal, refer!
The cardiac glycosidesThe cardiac glycosidesImplementationImplementation
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Check the spelling of the drug- DIGOXINCheck the spelling of the drug- DIGOXINis different from DIGITOXIN!is different from DIGITOXIN!
Check the dosage preparation and theCheck the dosage preparation and the
level of digitalis in the blood. (level of digitalis in the blood. (Therapeutic Therapeutic level is 0.5 to 2.0 nanograms/mL level is 0.5 to 2.0 nanograms/mL ))
Administer intravenous drug VERY slow IV Administer intravenous drug VERY slow IV
over 5 minutes to avoid arrhythmias. Doover 5 minutes to avoid arrhythmias. DoNOT administer intramuscularly because itNOT administer intramuscularly because it
can cause severe paincan cause severe pain
The cardiac glycosidesThe cardiac glycosidesImplementationImplementation
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Administer the drug Administer the drug w i thou t food i f po s s i b lei thou t f ood i f po s s i b let o a vo i d de l a yed ab so rp t iono a vo i d de l a yed ab so rp t ion . Weight patient. Weight patient
daily to determine fluid retentiondaily to determine fluid retention
Maintain emergency equipment and drugs=Maintain emergency equipment and drugs=
Potassium salts, Lidocaine for arrhythmias,Potassium salts, Lidocaine for arrhythmias,
phenytoin for seizures, atropine for bradycardia.phenytoin for seizures, atropine for bradycardia.
Provide comfort measures- small, frequentProvide comfort measures- small, frequent
meals, adequate lighting, comfortable position,meals, adequate lighting, comfortable position,rest periods and safety precautionsrest periods and safety precautions
The cardiac glycosidesThe cardiac glycosides
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ImplementationImplementation Provide health teaching- drug name, action,Provide health teaching- drug name, action,
dosage and side effects. Advise the patient todosage and side effects. Advise the patient to
report any of the following:report any of the following: V i sua l changes ,i s ua l changes ,rap id w e igh t ga in , unu sua l l y low h ea r tap i d we i gh t ga i n , unusua l ly l ow hea r t
r a t e , pe r s i s t en t nausea , vom i t i ng anda te , pe r s i s ten t nausea , vom i t i ng and
ano rex i ano rex i a
Mon i to r s e rum p o t a s s ium l e ve lon i t o r s e rum po t a s s ium l e vel
The cardiac glycosidesThe cardiac glycosides
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Eva lua t i onva lua t i onEva lua te e f f ec t ivene ss o f theva lua te e f fec t i veness o f the
d rug :r ug :
Inc reased u r ine ou tpu tnc reased u r i ne ou tpu t
No rma l hea r t ra t e i n a r r hy thm iao rm a l hea r t r a te i n a r r hy thm ia
The Antianginal drugshe Antianginal drugs
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In the treatment of angina, three agentsIn the treatment of angina, three agentsare commonly employed-are commonly employed-
– O rgan i c n i t ra t e srgan i c n i tr a t e s
– Be t a - b l o c ke r s ande t a - b lo c ke r s an d
– Ca l c ium - channe l b lo c ke r s .a l c ium - channe l b l o c ke r s .
The benefits of the drugs lie in theirThe benefits of the drugs lie in their
different mode of action.different mode of action.
The Antianginal drugshe Antianginal drugs
The nitrates can cause vasodilatationThe nitrates can cause vasodilatation
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of the veins and to some extent,of the veins and to some extent,coronary arterycoronary artery
The Antianginal drugshe Antianginal drugs
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Beta-blockers will decrease the heartBeta-blockers will decrease the heart
raterate
The Antianginal drugshe Antianginal drugs
Calcium-channel blockers will decreaseCalcium-channel blockers will decrease
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force of contraction leading to aforce of contraction leading to adecreased myocardial workload anddecreased myocardial workload and
demand.demand.
They can also produce vasodilationThey can also produce vasodilation
The Organic nitratesThe Organic nitrates
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These agents are simple nitric and nitrousThese agents are simple nitric and nitrousacid esters of alcohols. Being alcohol, theyacid esters of alcohols. Being alcohol, they
differ in their volatility. The following arediffer in their volatility. The following are
the nitrates commonly used:the nitrates commonly used:
N i t r og l y c e r i n -i t r og l y c e r i n - A moderately volatile A moderately volatile
nitratenitrate
Isosorbide Dinitrate (Isordil) orIsosorbide Dinitrate (Isordil) ormononitratemononitrate
Amyl nitrate- an extremely volatile nitrate Amyl nitrate- an extremely volatile nitrate
The Organic nitratesThe Organic nitrates
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Nitroglycerinitroglycerin This agent is supplied in oral, spray,This agent is supplied in oral, spray,
transdermal and ointment preparations.transdermal and ointment preparations.
The Organic nitratesThe Organic nitrates
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Pharmacodynamics: the mechanism of Pharmacodynamics: the mechanism of actionaction
Ni t rog l yce r i n re l axes the sm oothi t rog l yce r in r e l axes the sm ooth
m usc l e s i n t he vascu l a r s y s t emusc l e s i n the vascu l a r sys temby i t s conve r s i on to n i t r i c ox ide ,y i t s conve r s i on to n i t r i c ox ide ,
a chem i ca l m ed i a to r in t he bod ychem i ca l med i a to r in t he bod y
tha t re l a xes sm oo th m usc l e s .ha t r e la xes smo o th m usc l e s .
The Organic nitratesThe Organic nitrates Administered nitrates Administered nitrates
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Increased nitrates in the bloodIncreased nitrates in the blood
increased formation of nitric oxideincreased formation of nitric oxide
increased cGMP formationincreased cGMP formation
increased dephosphorylation of myosinincreased dephosphorylation of myosin
Vascular smooth muscle relaxation Vascular smooth muscle relaxation
vasod i l a t a t i onasod i l a t a t i on
The Organic nitratesThe Organic nitrates
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Pharmacokinetics- absorption to excretionPharmacokinetics- absorption to excretion It can be given orally, parenterally andIt can be given orally, parenterally and
topically.topically.
The onset of action of nitroglycerin isThe onset of action of nitroglycerin ismore than 1 hour.more than 1 hour.
Because significant first-pass hepaticBecause significant first-pass hepatic
effect,effect, Nitroglycerin is givenNitroglycerin is givenSUBLINGUALY.SUBLINGUALY.
The Organic nitratesThe Organic nitratesPharmacodynamics: Side effects andPharmacodynamics: Side effects and
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adverse effectsadverse effects H E A D A C H E i s t h e m o s t c o m m o nE A D A C H E i s th e m o s t c o m m o n
e f fe c t o f n i t rog l y c e r i nf f e c t o f n i t r og l y ce r i n .
CVS- postural Hypotension, facial flushing,CVS- postural Hypotension, facial flushing,tachycardiatachycardia
TOLERANCETOLERANCE- the tolerance to the actions- the tolerance to the actions
of nitrates develop rapidly. This can beof nitrates develop rapidly. This can bemanaged by providing a day of managed by providing a day of
abstinence.abstinence.
The NitratesThe NitratesImplementationImplementation
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Monitor vital signs, especially watchful forMonitor vital signs, especially watchful forhypotensive episodeshypotensive episodes
Advise patient to remain supine or sit on a Advise patient to remain supine or sit on a
chair when taking the nitroglycerin for thechair when taking the nitroglycerin for thefirst time. Emphasize that he shouldfirst time. Emphasize that he shouldchange his position slowly or rise from bedchange his position slowly or rise from bedslowly to avoid orthostatic Hypotensionslowly to avoid orthostatic Hypotension
Offer sips of water before givingOffer sips of water before givingsublingual nitroglycerin because drynesssublingual nitroglycerin because drynessmay inhibit drug absorptionmay inhibit drug absorption
The NitratesThe NitratesImplementationImplementation
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Apply nitroglycerin ointment to the Apply nitroglycerin ointment to thedesignated mark on paper.designated mark on paper.
The nurse should remove any excessThe nurse should remove any excess
ointment on the skin from the previousointment on the skin from the previousdose.dose.
She shouldShe should N E V E R U S EE V E R U S E her bare fingersher bare fingers
because the drug can be absorbed, utilizebecause the drug can be absorbed, utilizegloves or tongue blades instead.gloves or tongue blades instead.
The NitratesThe Nitrates
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ImplementationImplementation Apply nitroglycerin patch to an area with Apply nitroglycerin patch to an area with
few hairs. Never touch the medicationfew hairs. Never touch the medication
portion.portion. The patch and the ointment should NOTThe patch and the ointment should NOT
be applied near the area for defibrillationbe applied near the area for defibrillation
because explosion and skin burns maybecause explosion and skin burns may
resultresult
The NitratesThe Nitrates
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IMPLEMENTATIONIMPLEMENTATION Emphasize that tolerance to theEmphasize that tolerance to the
nitroglycerin can occur.nitroglycerin can occur.
If the medication cannot relieve the pain,If the medication cannot relieve the pain,report to the hospital immediately.report to the hospital immediately.
The NitratesThe Nitrates
IMPLEMENTATIONIMPLEMENTATION
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Provide client health teaching- the sublingualProvide client health teaching- the sublingualnitroglycerin tablet is USED if chest pain occursnitroglycerin tablet is USED if chest pain occurs
The dose may be repeated if pain ishe dose may be repeated if pain is
unrelieved within 5 minutes.nrelieved within 5 minutes. Repeat the medication administration ifepeat the medication administration if
the pain has not yet subsidedhe pain has not yet subsided .
DO NOT g iv e m o r e t h an 3 t a b le t s !O NOT g iv e m o r e t h an 3 t a b le t s ! !! If! If
chest pain persists for more than 15hest pain persists for more than 15minutes, hospital consult should be doneinutes, hospital consult should be doneimmediately.mmediately.
The NitratesThe Nitrates
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IMPLEMENTATIONIMPLEMENTATION Instruct the client to avoid alcohol whileInstruct the client to avoid alcohol while
taking nitroglycerin to avoid potentiatingtaking nitroglycerin to avoid potentiating
the hypotensive effect of the medicationthe hypotensive effect of the medication If beta blockers and calcium-channelIf beta blockers and calcium-channel
blockers are given, instruct the patients toblockers are given, instruct the patients to
consult the physician before discontinuingconsult the physician before discontinuing
the medicationthe medication
The NitratesThe Nitrates
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IMPLEMENTATIONIMPLEMENTATION Other components of health teaching forOther components of health teaching for
home self-administration:home self-administration: – If taking Sublingual Nitroglycerin, the patientIf taking Sublingual Nitroglycerin, the patient
should be instructed toshould be instructed to p lace the t ab l e tl a ce the t ab l e t
unde r t h e t onguende r t h e t ongue for quick absorption.for quick absorption.
– A burning sensation/biting/stinging sensation A burning sensation/biting/stinging sensation
may indicate that the tablet ismay indicate that the tablet is FRESH !RESH !
– Store the tablet in aStore the tablet in a da rk con ta i ne ra r k con ta i ne r , keep it, keep it
away from heat and direct sunlight to avoidaway from heat and direct sunlight to avoid
lessening the potencylessening the potency
The NitratesThe NitratesIMPLEMENTATIONIMPLEMENTATION
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Other components of health teaching for homeOther components of health teaching for homeself-administration:self-administration:
– HEADACHESHEADACHES are common in the initial period of are common in the initial period of
nitroglycerin therapy. Advise patient to takenitroglycerin therapy. Advise patient to take
PARACETAMOL for relief PARACETAMOL for relief – The nitroglycerin patch is applied once a day,The nitroglycerin patch is applied once a day,
usually in the morning. The sites should beusually in the morning. The sites should be
rotated, in the chest, arms and thighs avoidingrotated, in the chest, arms and thighs avoiding
hairy areas.hairy areas.
The NitratesThe Nitrates
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IMPLEMENTATIONIMPLEMENTATION Other components of health teaching forOther components of health teaching for
home self-administration:home self-administration: – Position supine with elevated legs to managePosition supine with elevated legs to manage
Hypotension.Hypotension.
– N i t rog l yce r i n t ab l e t can be takeni t rog l yce r i n t ab l e t can be take n
p rophy l ac t i ca l l y in s i t ua t i ons wh ererophy l ac t i ca l l y in s i t ua t i ons wh ere
ches t pa in is an t i c i pa ted- Sex , exe rc i se ,hes t pa in i s an t i c i pa ted- Sex , exe rc i se ,
e t c . .t c . .
– If patient is taking beta blockers, instruct how toIf patient is taking beta blockers, instruct how to
obtain heart rate in a minuteobtain heart rate in a minute
Drugs for Shock Drugs for Shock
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DopamineDopamine This is a sympathomimetic drug oftenThis is a sympathomimetic drug often
used to treat Hypotension in shock statesused to treat Hypotension in shock states
that are not caused by Hypovolemia.that are not caused by Hypovolemia. This drug is an immediate precursor of This drug is an immediate precursor of
nor-epinephrine, occurs naturally in thenor-epinephrine, occurs naturally in the
CNS basal ganglia where it functions as aCNS basal ganglia where it functions as a
neurotransmitter.neurotransmitter.
Drugs for Shock Drugs for Shock
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DopamineDopamine Pharmacodynamics: It can activate thePharmacodynamics: It can activate the
alpha and beta adrenergic receptoralpha and beta adrenergic receptor
depending upon the concentration. Itdepending upon the concentration. Itstimulates receptors to causestimulates receptors to cause c a r d i a ca rd i a c
s t im u l a t i on and r en a l v a sod i la t i ont im u l a t i on and r en a l v a sod i la t i on ..
The dose range is 1-20 micrograms/kg/minThe dose range is 1-20 micrograms/kg/min
Drugs for Shock Drugs for Shock
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DopamineDopamine Pharmacokinetics: Dopamine isPharmacokinetics: Dopamine is
administered IV, excreted in the urine.administered IV, excreted in the urine.
At At l ow d o s eow d o s e ((1-2 micrograms1-2 micrograms),),dopamine DILATES the renal anddopamine DILATES the renal and
mesenteric blood vessels producing anmesenteric blood vessels producing an
increase output (dopaminergic effect)increase output (dopaminergic effect)
Drugs for Shock Drugs for Shock
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DopamineDopamine At At m od e r a te d o s eode r a t e do s e of of 2-10 micrograms,2-10 micrograms,
dopamine enhance cardiac output bydopamine enhance cardiac output by
increasing heart rate (increasing heart rate (beta 1-adrenergicbeta 1-adrenergiceffect)effect) and elevates blood pressureand elevates blood pressure
through peripheral vasoconstrictionthrough peripheral vasoconstriction (alpha(alpha
adrenergic effect)adrenergic effect)
Drugs for Shock Drugs for Shock
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DopamineDopamine At higher doses of At higher doses of more than 10more than 10
micrograms-micrograms- va socon s t r ic t i on o f a l la s o co ns t r i c t ion o f a l l
v e s se l se s se l s
will predominate that can lead towill predominate that can lead todiminished tissue perfusiondiminished tissue perfusion
Drugs for Shock Drugs for Shock
Dopamine
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Dopamine Dopamine is indicated to treat Hypotension, toDopamine is indicated to treat Hypotension, to
increase heart rate and to increase urine outputincrease heart rate and to increase urine output
(given less than 5 mg/kg/min)(given less than 5 mg/kg/min)
The nurse typically prepares the dopamine drip-The nurse typically prepares the dopamine drip-dopamine (at a concentration of 400-800 mg) isdopamine (at a concentration of 400-800 mg) is
mixed in 250 mL D5W and administered as dripmixed in 250 mL D5W and administered as drip
via an infusion pump for precise dosagevia an infusion pump for precise dosage
administration.administration.
Sodium bicarbonate will inactivate the dopamineSodium bicarbonate will inactivate the dopamine
Drugs for Shock Drugs for Shock
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DopamineDopamine Pharmacodynamics: side effects-Pharmacodynamics: side effects-
TachycardiaTachycardia
hypertensionhypertensionectopic beats, angina, dysrhythmias,ectopic beats, angina, dysrhythmias,
myocardial ischemia, nausea andmyocardial ischemia, nausea and
vomiting.vomiting.
Drugs for Shock Drugs for Shock
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Dopamine: Nursing considerationDopamine: Nursing consideration – Check the IV site hourly for signs of drugCheck the IV site hourly for signs of drug
infiltration of dopamine, which can causeinfiltration of dopamine, which can cause
tissue necrosis.tissue necrosis.
– Phen to l am i nehen to l am i ne should be infiltrated inshould be infiltrated inmultiple areas to reduce tissue damage.multiple areas to reduce tissue damage.
– Drug is effective if Urine output is increasedDrug is effective if Urine output is increased
and BP is increasedand BP is increased
Antihypertensive drugs Antihypertensive drugs
The D rug s em p lo y ed t o c on t ro lh e D r ug s em p lo y ed t o c on t ro l
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hype r t en s i on c an be c l a s s i f i e d a s :ype r t en s i on c an be c la s s i f i e d a s :
D iu re t i c si u re t i c s
Be t a - b l o c ke r se t a -b l o cke r s
A l pha a d r ene rg i c b l o c ke r sl pha ad r ene rg i c b l o c ke r s Ca l c i um cha nne l b lo c ke r sa l c ium chan ne l b l o c ke r s
Ang i o ten s i n - conve r t i ng e n zym e inh i b i t o r sng i o t en s in - conve r t ing en zym e inh i b i to r s
Ang i o ten s i n I I r e cep t o r b l o c ke rsng i o t en s in I I r e cep t o r b l o c ke rs
Pe r i phe ra l v a sod i la t o r se r i phe ra l v a sod i la t o r s
Common Drugs in HPNCommon Drugs in HPN
l i h ff i f hl i h ff i f h
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IN Evaluating the effectiveness of theseIN Evaluating the effectiveness of thesedrugs is simply to monitor the BP if itdrugs is simply to monitor the BP if it
becomes NORMALbecomes NORMAL
Anti-hypertensive drugs Anti-hypertensive drugsClass Prototype MOA Side effects
Diuretics Furosemide Decreases blood Hypokalemia
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volume
Beta-blocker Propranolol Blocks B1 receptorin the heart
Bradycardia,hypoglycemia
ACE Inhibitors Captopril Prevents A1 to AIIconversion
Headache, Cough,flushing
Ca channelblockers
Nifedipine Blocks Ca entry intocell
Headache, flushing,reflex tachycardia
Vasodilator Nitroglycerin Dilates veins andarteries
HEADACHE
Alpha blockers Prazozin Blocks alpha
receptor in BVcausingvasodilatation
Urination
Central alphaagonist
Clonidine Stimulates CNSalpha 2 receptor
Depression
Anticoagulants AnticoagulantsHEPARIN WARFARIN
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Parenteral (SQ and IV) OralAction is to enhance natural
anti-thrombin III in the blood
Action is to INHIBIT Vitamin-Kdependent clott ing factors(10,9,7,2)
Acts within minutes Acts within daysMonitor for aPTT Monitor for PT and INR
Large molecule, can be given topregnant
Small molecule CANNOT begiven to pregnant
Antidote: Protaminesulfate
Antidote: Vit. K
SE: bleeding, decreasedplatelets
SE: Bleeding
The antianemics: Ironhe antianemics: Ironpreparations and Epoetinreparations and Epoetin
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Iron preparationsron preparations Iron is important for hemoglobin formation.Iron is important for hemoglobin formation.
The iron preparations are:The iron preparations are: Ferrous sulfateFerrous sulfate Ferrous fumarateFerrous fumarate Ferrous gluconateFerrous gluconate
The antianemics: Ironhe antianemics: Ironpreparations and Epoetinreparations and Epoetin
Side-effects:ide-effects:
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GIT- constipation (usually), diarrhea,IT- constipation (usually), diarrhea,vomiting,omiting, ep i ga s t r i c pa i n , ga s t r icp i ga s t r i c pa i n , g a s t r i cu l c e r a t ion an dl c e r a t ion a nd da r k en ing o f s t o o ls .a r ke n i ng o f s t oo ls .
Liquid preparation can stain theiquid preparation can stain theteeth, and injectable iron can causeeeth, and injectable iron can causetissue discolorationissue discoloration
Other- dizzinessther- dizziness
The antianemics: Ironhe antianemics: Ironpreparations and Epoetinreparations and Epoetin
Drug-Drug interactionrug-Drug interactionT li bi i h i
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Tetracyclines combine with ironTetracyclines combine with ironpreparations and render the ironpreparations and render the ironunabsorbable.unabsorbable.
Antacids and cimetidine- decrease iron Antacids and cimetidine- decrease ironabsorption and effectsabsorption and effects Foods can impair iron absorption but theyFoods can impair iron absorption but they
should be taken with iron to reduce GIshould be taken with iron to reduce GI
discomfort.discomfort. Milk containing foods, coffee, tea and eggsMilk containing foods, coffee, tea and eggs
are NOT given with iron because they delayare NOT given with iron because they delayiron absorption.iron absorption.
The antianemics: Ironhe antianemics: Ironpreparations and Epoetinreparations and Epoetin
ImplementationImplementation
E th ti t t t i i h f d lik li lE th ti t t t i i h f d lik li l
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Encourage the patient to eat iron-rich foods like liver, leanEncourage the patient to eat iron-rich foods like liver, leanmeat, egg yolk, dried beans, green leafy vegetables.meat, egg yolk, dried beans, green leafy vegetables. Administer iron preparations orally with foods to decrease GI Administer iron preparations orally with foods to decrease GI
discomfort.discomfort. If increased absorption is necessary, administer IN BETWEENIf increased absorption is necessary, administer IN BETWEEN
meals with full glass of water or juice.meals with full glass of water or juice. I t i s bes t t o o f f e r c it ru s j u i ce s becau se the v i t am in Ct i s bes t t o o f f e r c it ru s j u i ce s becau se the v i t am in C
con t en t c an i n c r ea se i r on abso rp t i on .on t en t c an i n c r ea se ir on abso rp t i on . Instruct the patient to swallow the whole tablet and remainInstruct the patient to swallow the whole tablet and remain
upright for 30 minutes to prevent esophageal corrosion fromupright for 30 minutes to prevent esophageal corrosion fromreflux.reflux.
DO NOT administer iron together with or within 1 hour of DO NOT administer iron together with or within 1 hour of ingesting tetracyclines, antacids, milk and milk-containingingesting tetracyclines, antacids, milk and milk-containingproducts.products.
Advise clients to increase fluid intake and consume fiber rich Advise clients to increase fluid intake and consume fiber richfoods if constipation becomes a problem.foods if constipation becomes a problem.
The antianemics: Ironhe antianemics: Ironpreparations and Epoetinreparations and Epoetin
Implementationmplementation
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Emphasize that the therapeutic effect of ironmphasize that the therapeutic effect of irontherapy may not be apparent until severalherapy may not be apparent until severalweeks.eeks.
If injecting a parenteral iron preparation,f injecting a parenteral iron preparation,
inject DEEP IM util izingnject DEEP IM util izing t h e Z - t ra c k m e thod t ohe Z - t ra c k m e thod t oa vo i d le a kage i n t o th e s ub cu t aneou s t i s s u e svo i d le a kage i n t o th e s ub cu t aneou s t i s s u e s
and s k i nnd s k i n . Offer straw if giving liquid iron preparation toffer straw if giving liquid iron preparation to
avoid staining the teeth.void staining the teeth. To p r e ven t und ue a l a rm , i n s t r u c t t h e pa t i e n to p r e ven t und ue a l a rm , in s t r u c t th e pa t i e n t
t h a t t h e s t o o l s may t u r n b l a c k o r d a r k g r e en .h a t t h e s t o o l s may t u r n b l a c k o r d a r k g r e en .
Th i s is a h a rm l e s s o c cu r ren c e .h i s is a h a rm l e s s o c cu r r en c e .
The antianemics: Ironhe antianemics: Ironpreparations and Epoetinreparations and Epoetin
EvaluationEvaluation Th l t th ff ti f thTh l t th ff ti f th
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The nurse evaluates the effectiveness of theThe nurse evaluates the effectiveness of thedrug therapy by determining that thedrug therapy by determining that the client isclient isnot fatigued, with absence of pallor, and withnot fatigued, with absence of pallor, and withhemoglobin results within desired rangehemoglobin results within desired range..
ErythropoietinErythropoietin
The mechanism of action of epoetinhe mechanism of action of epoetin
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alfalfa(Epogen)(Epogen)
This drug acts like the natural glycoproteinThis drug acts like the natural glycoprotein
erythropoietin to stimulate the productionerythropoietin to stimulate the productionof RBC in the bone marrow.of RBC in the bone marrow.
ErythropoietinErythropoietin
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Clinical indicationslinical indications It is given SUBCUTANEOUSLY orIt is given SUBCUTANEOUSLY or
INTRAVENOUSLY INTRAVENOUSLY for the treatment of for the treatment of
anemia associated with renal failure or foranemia associated with renal failure or for
patients on dialysispatients on dialysis..
It is also used in patients for bloodIt is also used in patients for blood
transfusion to decrease the need for bloodtransfusion to decrease the need for blood
in surgical patients.in surgical patients.
ErythropoietinErythropoietin
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Pharmacodynamics: the adverseharmacodynamics: the adverseeffects of epoetin alfaffects of epoetin alfa
CNS- headache, fatigue, asthenia,CNS- headache, fatigue, asthenia,
dizziness and seizures- these are due todizziness and seizures- these are due to
the cellular response to the glycoprotein.the cellular response to the glycoprotein.
GIT- nausea, vomiting and diarrheaGIT- nausea, vomiting and diarrhea
CVS- hypertension, edema andCVS- hypertension, edema and chest painchest paindue to increase RBC numberdue to increase RBC number
ErythropoietinErythropoietinImplementationImplementation
Administer the drug SC or IV usually 3 times per weekAdminister the drug SC or IV usually 3 times per week
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Administer the drug SC or IV usually 3 times per week. Administer the drug SC or IV usually 3 times per week. Monitor the IV access line if given IV. Do not mix withMonitor the IV access line if given IV. Do not mix with
other solutionsother solutions Determine periodically the level of hematocrit and ironDetermine periodically the level of hematocrit and iron
stores during therapy. If patient does not respond to thestores during therapy. If patient does not respond to the
drug, reevaluate the cause of anemia.drug, reevaluate the cause of anemia. Maintain seizure precaution on stand by as seizure canMaintain seizure precaution on stand by as seizure can
occur.occur. Provide comfort measures like small frequent feedingsProvide comfort measures like small frequent feedings
and pain medications for headache.and pain medications for headache. Provide thorough health teaching: need for lifetimeProvide thorough health teaching: need for lifetime
injectioninjection
ErythropoietinErythropoietin
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EvaluationEvaluation
Monitor patient response to the drug=Monitor patient response to the drug=
increased hemoglobinincreased hemoglobin
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Psychotrophic drugsPsychotrophic drugs
•Drugs that can:Drugs that can:
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Drugs that can:Drugs that can:1.1. Stimulate the release of Stimulate the release of
neurotransmittersneurotransmitters
2.2. Block the receptor/activity of theBlock the receptor/activity of theneurotransmitter= like dopamineneurotransmitter= like dopamine
3.3. Stimulate the receptors in the CNSStimulate the receptors in the CNS
4.4. Prevents the breakdown of thePrevents the breakdown of theneurotransmitters or the re-uptakeneurotransmitters or the re-uptake
mechanismmechanism
Anti-Anti-Psychotics/NeurolepticsPsychotics/Neuroleptics
•Drugs used to treat PSYCHOSESDrugs used to treat PSYCHOSES
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Drugs used to treat PSYCHOSESDrugs used to treat PSYCHOSES
• MAIN ACTION: Blockage of theMAIN ACTION: Blockage of the
DOPAMINE receptor in the CNSDOPAMINE receptor in the CNS
Anti-Anti-Psychotics/NeurolepticsPsychotics/Neuroleptics
Class Prototype Others
Phenothiazines Chlorpromazine Thioridazine
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Phenothiazines Chlorpromazine Thioridazine,Fluphenazine,Perphenazine
Butyrophenones Haloperidol droperidol
Thioxanthines Chlorprothixene thirothixene
Dibenzoxapine Molindone
Diphenylbutlypiperi
dine
Pimozide
Atypical drugs Clozapine Olanzapine
Risperidone quetiapine
Anti-Anti-Psychotics/NeurolepticsPsychotics/NeurolepticsDesired Effects
1 Reduced hallucination and illusions
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1 Reduced hallucination and illusions
2 CNS sedation and emotional slowing
3 Decreased ambivalence, reduced
delusion4 Reduced agitation resulting to
calmness
5 Relief of emotional turmoil6 Reduced flattening of affect
Anti-Anti-Psychotics/NeurolepticsPsychotics/Neuroleptics
Common SE Nursing Interventions
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Common SE Nursing InterventionsAnticholinergiceffects
Sugarless gum, bed rest
Photosensitivity Sunglasses, sunscreen,
avoid sun
Posturalhypotension
Change position slowly,lie prone for 1 hour afterdrug intake, monitor BP
Agranulocytosis Instruct to report sorethroat and fever, monitorWBC
Anti-Anti-Psychotics/NeurolepticsPsychotics/Neuroleptics
Extra-Pyramidal
Syndrome
Nursing Intervention
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Syndrome
Parkinsonism-Tremor,rigidity, bradikinesia
Avoid abrupt withdrawal,give anti-EPS drugs likeCogentin
Dystonia- torticollis,contraction of face andtongue
Remain with client,administer anti-EPS
Akathisia= motorrestlessness
Verbalize understanding of the condition, administeranti-EPS
Tardive Dyskinesia=irreversible drooling,tongue movement and
No treatment exceptdiscontinue drug
Review Outline
Adrenergic Agonists
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Adrenergic Antagonists
Cholinergic Agonists
Cholinergic Antagonists
Comparison of the Sympathetic and
Parasympathetic Nervous systemCharacteristics Sympathetic Parasympathetic
CNS origin Thoraco-lumbar spinal Cranio-Sacral spinal
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CNS origin Thoraco lumbar spinalcord
Cranio Sacral spinalcord
Pre-ganglionic neuron Short axon Long axon
Pre-ganglionic NTA Acetylcholine Acetylcholine
Ganglia location Next to spinal cord Near target organ
Post-ganglionic neuron Long axon Short axon
Post-ganglionic NTA Epi and NE Acetylcholine
Enzyme for NTA MAO, COMT Acetylcholine-ESTERASE
General response Fight or flight Rest and Digest
The autonomic drugs
Pharmacologic use depends on their
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Pharmacologic use depends on theirEFFECTS on the body
They can STIMULATE= agonists OR mimetics
They can DECREASE THE RESPONSE=
antagonists OR blockers
The autonomic drugs
They can STIMULATE= agonists OR
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They can STIMULATE= agonists OR mimetics
DIRECT STIMULATION by binding with
receptors
INDIRECT STIMULATION by blocking
the enzymes that degrade theneurotransmitters or increasing the release
of neurotransmitters
The autonomic drugs
They can DECREASE THE RESPONSE=
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They can DECREASE THE RESPONSE=antagonists OR blockers
DIRECT blockage by removing theneurotransmitter or competing with the
neurotransmitter
Binding with the receptor and NORESPONSE will happen
The autonomic drugsThey can be
NON SELECTIVE h th ti l t
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NON-SELECTIVE when they stimulate orblock many receptors
SELECTIVE when they stimulate or block specific receptors
SPECIFIC when only ONE type of receptor isstimulated or blocked
The autonomic drugs: Pharmacologic use
depends on their EFFECTS on the body
Effect on the body Therapeutic use
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Effect on the body Therapeutic use
Increases BP Used for SHOCK where
there is LOW BP
Decreases BP and heart rate Used for HYPERTENSION
and Tachycardia
The Adrenergic AGONISTS
Also called SYMPATHOMIMETIC agents
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Also called SYMPATHOMIMETIC agents
These drugs MIMIC the effects of the
sympathetic nervous system
The Adrenergic AGONISTS
They usually stimulate DIRECTLY the
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They usually stimulate DIRECTLY thereceptors of the adrenergic system
The Adrenergic AGONISTS
Alpha and Beta agonists (non-selective)
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Alpha and Beta agonists (non selective) Prototype: Epinephrine
Alpha Agonists (Selective) Prototype: Phenylephrine
Beta Agonists (Selective) Prototype: Isoproterenol
The Adrenergic AGONISTS
Alpha and Beta agonists (non-selective)
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Alpha and Beta agonists (non selective)Pharmacodynamics:
These agents stimulate ALL types of
adrenergic receptors in the body by directinteraction or by releasing
neurotransmitters from the nerve cells
The Adrenergic AGONISTS
Alpha and Beta agonists
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Alpha and Beta agonists Prototype: Epinephrine
1. Ephedrine
2. Epinephrine
3. Metaraminol
4. Norepinephrine
5. Dobutamine (sometimes a B1 specific)
6. Dopamine
The Adrenergic AGONISTS
Alpha and Beta agonists: Clinical Use
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Alpha and Beta agonists: Clinical Use 1. Dopamine- used in shock
2. Epinephrine- drug of choice of
anaphylaxis, Status asthmaticus 3. Norepinephrine- used in shock
4. Dobutamine- used in CHF
5. Ephedrine- used in shock, asthma and
rhinitis
The Adrenergic AGONISTS Alpha and Beta agonists: Desirable effects
I d di l t tilit
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Increased myocardial contractility
Bronchial DILATATION
Vasoconstriction
Increased blood pressure
Decreased intraocular pressure
Pupillary dilatation
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The Adrenergic AGONISTS Alpha and Beta agonists: Adverse effects
Sympathetic stimulation effects
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Sympathetic stimulation effects
CVS- hypertension, tachycardia, palpitations
Respi- tachypneaGI- nausea, vomiting
Others- sweating, headache, piloerection
The Adrenergic AGONISTS
Alpha and Beta agonists: Nursing
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Alpha and Beta agonists: Nursingconsiderations
1. Monitor patient response to the drug
2. Emphasize to avoid the use with MAOIsand TCA
3. Maintain phentolamine (alpha blocker) to
manage extravasation of IV drug4. Usually given IV
The Adrenergic AGONISTS
Alpha and Beta agonists: Nursing
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Alpha and Beta agonists: Nursingconsiderations
Determine effectiveness of the drug:
Increased BP in shock
Relief of anaphylaxis and asthma attack
Relief of nasal congestion
The Adrenergic AGONISTS
Alpha Agonists (selective)
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Alpha Agonists (selective)
Prototype: phenylephrine
clonidine (alpha-2 specific)
The Adrenergic AGONISTS
Alpha Agonists Pharmacodynamics:
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p go s s cody cs:
These agents bind primarily to the alpha
receptors in the body
Clonidine
Stimulating the ALPHA-2 receptor causes
decreased sympathetic outflow from theCNS/ decreased release of NE
The Adrenergic AGONISTS
Alpha Agonists: Clinical use
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p g
1. Phenylephrine- vasoconstricting drug,
used topically to decrease the symptoms of rhinitis
2. Clonidine- for hypertension
The Adrenergic AGONISTS
Alpha Agonists: Contraindication
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p g1. Allergy to drug
2. Caution in the following conditions:
• Hyperthyroidism-aggravation of symptoms
• Diabetes- increased glucose levels
• Tachyarrhythmias- possible additive effect
The Adrenergic AGONISTS
Alpha Agonists: Adverse effects
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p gCNS- anxiety, depression, fatigue
CVS- palpitations
GI- nausea, vomiting and anorexia
GU- oliguria, dysuria
The Adrenergic AGONISTS
Alpha Agonists: Nursing considerations
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p g g1. DO NOT discontinue drug abruptly to
prevent rebound effect
2. Maintain phentolamine if giving IV drug
3. Provide comfort measures- rest, quiet
environment, analgesics
The Adrenergic AGONISTS
Alpha Agonists: Nursing considerations
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p g gEvaluate effectiveness:
Decreased BP
Decreased Nasal congestion
The Adrenergic AGONISTS
Beta Agonists (Selective): ANTI-ASTHMADRUGS
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g ( )DRUGS
Prototype: isoproterenol (B1 and B2)
salbutamol (Ventolin)= B2 specific
1. Ritodrine (B2 specific)
2. “terol”- albuterol, salmeterol, bitolterol
3. Terbutaline (B2)
The Adrenergic AGONISTS
Beta Agonists Pharmacodynamics
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g y
These agents bind to the BETA receptors
causing the sympathetic manifestationsand effects
The Adrenergic AGONISTS
Beta Agonists Clinical use
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g1. Asthma- due to the bronchodilation!
2. Preterm labor- ritodrine is given to relax
the uterine muscles
3. Shock= To increase BP
The Adrenergic AGONISTS
Beta Agonists Adverse effects
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gCNS- restlessness, headache, anxiety , tremors
CVS- tachycardia, angina, palpitations
GI- nausea, vomiting and anorexia
Others- pupilary dilation, rash, sweating,
pulmonary edema
The Adrenergic AGONISTS
Beta Agonists Nursing considerationsM it VS h i i th d
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g g1. Monitor VS when giving the drug
2. Remind mothers to lie on the left side
during ritodrine administration3. Maintain a beta blocker on stand by
4. Provide comfort- quiet environment, rest,analgesics.
5. Prevent over-hydration to avoidpulmonary edema
The Adrenergic AGONISTS
Beta Agonists Nursing considerations
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g g These are given usually inhalational for
asthma attack
Instruct on how to use inhalers andnebulizers
Evaluate effectiveness:
Normal RR
Clear breath sounds
The Adrenergic ANTAGONISTS
These are called adrenergic blockers
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g
They can be Alpha Blockers (selective)
Beta Blockers (selective)
Both Alpha & Beta Blockers
(non-selective)
The Adrenergic ANTAGONISTS
The alpha blockers (selective)
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Prototype: Phentolamine
Phenoxybenzamine
“zosin”- prazosin, doxazosin,
terazosin- these are
alpha 1blockers
The Adrenergic ANTAGONISTS
The alpha blockers: Pharmacodynamics
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These agents have affinity for the ALPHA
receptors
Blocking the alpha receptors will cause:
Vasodilation
Sphincter relaxation in the bladder
The Adrenergic ANTAGONISTS
The alpha blockers: Clinical use
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1. Phenoxybenzamine- used in
pheochromocytoma
2. Phentolamine- also used inpheochomocytoma
3. “zosin” drugs- are used to decrease blood
pressure and to relax the urinarysphincter in BPH!
The Adrenergic ANTAGONISTS
The alpha blockers: Contraindications
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1. Myocardial infarction
2. Allergy
The Adrenergic ANTAGONISTS
The alpha blockers: Adverse EffectsCVS h i fl h di
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CVS- hypotension, reflex tachycardia,
flushing
CNS- dizziness, weakness, fatigue, drowsinessOthers- nasal congestion, reddened eyes,
priapism
The Adrenergic ANTAGONISTS
The alpha blockers: nursing consideration1 Monitor heart rate and BP
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1. Monitor heart rate and BP
2. Caution to change position slowly
3. Advise to avoid hazardous activities4. Provide supportive measures like quiet
environment, rest and analgesics
5. Monitor response to the drug-improvement of blood pressure readingsand urination
The Adrenergic ANTAGONISTS
The Beta blockersTh t d t t t
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These are agents used to treat
cardiovascular problems- Hypertension,
CHF, angina Blocking beta receptor will cause
decreased heart rate
decreased BP
The Adrenergic ANTAGONISTS
The Beta blocker or The “olol”sThey can be beta 1 blockers beta 2
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They can be beta 1 blockers, beta 2blockers or Both
Prototype of non-selective: propranOLOL(beta 1 and 2)
carteOLOL
nadOLOL
penbutOLOL
sotaLOL
The Adrenergic ANTAGONISTS
The Beta blocker or The “olol”sTh b b t 1 bl k b t 2
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They can be beta 1 blockers, beta 2
blockers or Both
Prototype of B1 selective: atenOLOLacebutOLOL
betaxOLOL
esmOLOL
metoprOLOL
The Adrenergic ANTAGONISTS
The Beta blockers: pharmacodynamicsTh t bl k th b t t f
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These agents block the beta receptors of
the sympathetic system. The selective B1
antagonists block the B1 receptors,especially in the heart and the kidney
The Adrenergic ANTAGONISTS
The Beta blockers: Clinical useH t i
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1. Hypertension
2. Angina and MI
3. Cardiac arrhythmias
4. Migraine headache
5. HYPERTHYROIDISM
The Adrenergic ANTAGONISTSThe Beta blockers: Clinical use
H t i t d BP
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Hypertension to decrease BP
Angina and MI to decrease cardiac workload
Cardiac tachyarrhythmias to terminate arrhythmias
Migraine headache to cause vasoconstriction in thecranial vessels
HYPERTHYROIDISMto decrease the tachycardia
The Adrenergic ANTAGONISTS
The Beta blockers: contraindicationsAll
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1. Allergy
2. Heart blocks
3. Bradycardia
4. COPD
5. Precaution in DM
The Adrenergic ANTAGONISTS
The Beta blockers: Adverse effectsCVS b d di h potension h t bl k
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CVS- bradycardia, hypotension, heart block
CNS- fatigue, dizziness, depression
Respi- bronchospasm, pulmonary edema
GI- nausea, vomiting, diarrhea, hypoglycemia
GU- decreased libido, impotence, dysuria
The Adrenergic ANTAGONISTS
The Beta blockers: nursing considerations1 Emphasize NOT to stop abruptly the drug
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1. Emphasize NOT to stop abruptly the drug
intake
2. Give with FOODS to improve absorption3. Provide comfort measures
Adequate rest periods
Avoidance of hazardous activities Change position slowly
The Adrenergic ANTAGONISTS
The Beta blockers: nursing considerationsEvaluate effectiveness:
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Evaluate effectiveness:
Decreased BP in hypertension
Decreased HR in hyperthyroidism
Decreased PAIN angina
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The Cholinergic Agonists
These are also calledparasympathomimetic agents
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parasympathomimetic agents
Their action mimics the parasympatheticnervous system
The Cholinergic Agonists
These agents INCREASE the activity of acetylcholine in the acetylcholine receptors
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acetylcholine in the acetylcholine receptors
DIRECTLY by occupying the receptor
INDIRECTLY by blocking the enzyme thatdegrades the acetylcholine, preventing it
from breakdown - the enzyme:
acetylcholin ESTERASE
The Cholinergic Agonists Direct acting cholinergic agonists
Prototype: BetaneCHOL
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CarbaCHOL
Pilocarpine Indirect acting cholinergics
Prototype: Pyridostigmine
NeostigmineEndrophonium (Tensilon)
The Cholinergic Agonists Direct acting cholinergic agonists
Pharmacodynamics
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They are similar to acetylcholine and
directly act on the acetylcholine
receptors
The Cholinergic Agonists Direct acting cholinergic agonists
Parasympathetic stimulation will cause:
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DUMBELS
urinationmiosis (pupil constriction)
The Cholinergic Agonists Direct acting cholinergic agonists: Clinical use
1. Post operative and post partum urinary
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retention and to treat neurogenic bladder
2. Relief of increased intraocular pressure of
glaucoma by inducing miosis
The Cholinergic Agonists Direct acting cholinergic agonists: Clinical use
1. The drugs INCREASE the bladder tone,
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RELAX the GI and urinary sphincters
2. The topical agent (pilocarpine) topically
causes pupilary constriction to reduce IOP
The Cholinergic Agonists Direct acting cholinergic agonists:
Contraindications
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1. Bradycardia
2. Hypotension
3. Asthma
The Cholinergic Agonists Direct acting cholinergic agonists: Adverse
effects (DUMBELS)
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CVS- bradycardia, heart block, hypotension
GIT- nausea, vomiting, diarrhea, increased
salivation, lacrimation
GUT- sense of urgency, sphincter relaxation
Others- increased sweating, headache, miosis
The Cholinergic Agonists Direct acting cholinergic agonists: nursing
considerations
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1. Assure proper administration of
ophthalmic preparations
2. Administer on EMPTY stomach
3. Provide safety precautions- because of
poor visual acuity
4. Promote cool environment, maintain
access to the bathroom (urination)
The Cholinergic Agonists: evaluateeffectiveness
Drug effectiveness
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Pilocarpine Decreased IOP in glaucoma
Betanechol/Carbachol Urination/ relief of bladder
distention
The Cholinergic Agonists Indirect acting cholinergic agonists
Pharmacodynamics
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These agents DO NOT react directly with
the receptors but REACT chemically with
the enzyme= acetylcholinesterase
The Cholinergic Agonists Indirect acting cholinergic agonists
Pharmacodynamics
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The acetylcholine breakdown is prevented
so that the effect of acetylcholine is
prolonged!= increased muscle contraction
They are used IN myasthenia gravis
The Cholinergic Agonists Indirect acting cholinergic agonists
Clinical use
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1. Myasthenia gravis
Physostigmine, pyridostigmine, Neostigmine,
and endrophonium
2. Alzheimer's disease
Tacrine and Donepezil
The Cholinergic Agonists Indirect acting cholinergic agonists
Adverse effects
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GI- nausea, vomiting, cramps, diarrhea,
increased salivation, involuntary defection
CVS- bradycardia, heart block, hypotension
GU- urinary urgency
Others- blurred vision, miosis, headache,dizziness
The Cholinergic Agonists Indirect acting cholinergic agonists
Nursing considerations
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1. Administer IV drug slowly
2. Administer with foods BUT better BEFORE meals
3. Maintain atropine sulfate as antidote
4. Discontinue the drug if excessivesalivation, diarrhea, vomiting become
problematic
The Cholinergic Agonists Indirect acting cholinergic agonists
Nursing considerations
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Evaluate effectiveness
Decreased muscle weaknessDecreased dysphagia, ptosis
Increased muscular activity
The ANTI-cholinergics
These are drugs that BLOCK the effect of acetylcholine
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They are also called parasympatholytic
agents In effect, the sympathetic system becomes
unopposed!!!
The ANTI-cholinergics
Anticholinergics:Prototype: Atropine
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o o ype t opi e
dicyclomine
glycopyrrolate
propantheline
scopolamine
The ANTI-cholinergics
Anticholinergics: pharmacodynamicsThese agents work by BLOCKING or
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g y
COMPETING with acetylcholine for the
acetylcholine receptors
BEST taken BEFORE MEALS
Atropine
Depresses salivation Decreases bronchial secretions
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Mydriasis
Cyclopedia Inhibits vagal response in the heart
Reverses cholinergic toxicity
Atropineeffects Clinical use
Depresses salivation Used as pre-op med
Decreases bronchialsecretions
Used as pre-op med
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Mydriasis Used in cataract surgery
Cyclopledia Used in cataract surgeryInhibits vagal response inthe heart
Used in BRADYCARDIAand heart block
Constipation Used in partly to control diarrhea (in
Lomotil)
Reverses cholinergictoxicity
Used in Cholinergic andOrganophosphate poisoning
Scopolamine
Decreases nausea and vomiting associatedwith motion sickness
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Anticholinergic
Contraindications of anticholinergic
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1. Known allergy
2. Glaucoma
3. Bladder obstruction (like PBH)
Anticholinergic
Adverse effects: anticholinergic effectsCNS- blurred vision, pupil DILATION,
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, p p ,
photophobia, cycloplegia and increased
Intraocular pressureGI- dry mouth, constipation, bloatedness
CVS- tachycardia, palpitations
GU- urinary retentionOthers- decreased sweating, flushing
Anticholinergic
Nursing considerations1. Provide comfort measures
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Frequent mouth care
Provide increased fluids Protect eyes form lights
Advise to avoid hazardous activities
Provide high-fiber diet and laxative Avoid extremes of temperature
Instruct to void before administering the drug
Anticholinergic
Nursing considerations2. Monitor for toxicity:
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y
3. Ensure adequate hydration to prevent