VITAL ESSENTIAL AND NECESSARY

DRUGS (VEN) LISTCLASSIFICATION OF

DRUGSBy Samantha McIntosh

OBJECTIVESO DRUGS USED IN THE DISORDER OF EACH

SYSTEM:O CARDIOVASCULAR SYSTEMO CENTRAL NERVOUS SYSTEMO DERMATOLOGYO EAR, NOSE AND OROPHARYNX (ENT)O ENDOCRIME SYSTEMO GASTROINTESTINAL SYSTEMO RESPIRATORY SYSTEMO MUSCULOSKELETAL SYSTEM AND JOINT

DISEASESO GENITO-URINARY TRACT

O DRUGS USED IN THE TREATMENT OF THE FOLLOWING:O INFECTIONSO MALIGNANT DISEASES AND FOR

IMMUNOSUPPRESSIONO STD’s

o DRUGS USED IN OPTHALMOLOGYo DRUGS USED IN ANNAESTHESIAo VACCINES o ANTIDOTES AND OTHER

SUBSTANCES USED IN POISONING

CARDIVASCULAR SYSTEM

1. Diuretics2. Cardiac glycosides 3. Anti-arrhythmic drugs4. Anti-hypertensive therapy5. Angiotensin converting enzymes (ACE)

inhibitors6. Angiotensin II receptor antagonists7. Anti-anginal8. Sympathomimetics9. Anti-coagulant and anti-platelet 10. Homeostatics11. Lipid lowering12. Fibrinolytic

DIURETICSO Drugs that modify renal function to induce

diuresis. Mainly used in the treatment of heart failure, HTN and oedema.

O Examples: O Furosemide (Lasix) – sulfonamide “Loop”

diuretic and antihypertensive.O hydrochlorothiazide (HTCZ) – thiazide diuretic O Mannitol – osmotic diureticO Indapamide SR – (electrolytic & water

balancing agent; diuretic) thiazide-like diuretic

O Spironolactone – potassium-sparing diuretic O Metolazone, Bendrofluazide.

CARDIAC GLYCOSIDES

O Drugs used to increases contractility of the heart muscles. O Digoxin (Lanoxin)– Inotrope/cardiac glycoside

(Antiarrhythmic effect)O (Check apical pulse for 1 full minute before

administration – if apical pulse is below 60 withhold drug )

Also used in the treatment of Congestive heart failure and Cardiac Arrhythmia.

INOTROPES O Strengthen myocardial contractility.

O Agents that alters the force or energy of muscular contractions.

O Negatively inotropic agents weaken the force of muscular contractions.

O Positively inotropic agents increase the strength of muscular contraction.

ANTI-ARRHYTHMIC DRUGS

O 4 ClassesO Class 1B – Antiarrhythmic

Lignocane (Lidocaine) Class 2 (beta- Adrenergic Blocking Drugs – have a negative inotropic action)Atenolol, Bisoprolol, propranolol.Class 3 - Antiarrhythmic Amiodarone, AdenosineClass 4 (Calcium Channel blockers)Verapamil

Antiarrhythmic drugs are used to treat abnormal heart rhythms resulting from irregular electrical activity of the heart.

CLASS I BO LIDOCAINE – suppresses automaticity in

His-Purkinje system of the heart and elevates electrical stimulation threshold of ventricle during diastole.

O Rapid control of ventricular arrhythmias occurring during acute MI, cardiac surgery and cardiac catheterization and those caused by digitalis intoxication.

CLASS IIBeta- adrenergic blocking antagonist Atenolol, propranolol, Bisoprolol

Antihypertensive & Antianginal effects

Reduces rate and force of cardiac contractions (negative inotropic action): cardiac output is reduced as well as systolic and diastolic blood pressure.

Atenolol decreases peripheral vascular resistance both at rest and with exercise.

ATENOLOLO Measure BP before administration

and monitor throughout.

O Monitor diabetics for loss of glycaemic control. Drug may mask symptoms of hypoglycaemia.

CLASS IIIO Amiodarone hcl – antiarrhythmic O Class III Antiarrhythmic drugs that has

antianginal and antiadrenergic properties. O Acts directly on all cardiac tissues by

prolonging duration of action potential & refractory period.

O Slows conduction time through the AV node & can interrupt the re-entry pathways through the AV node.

Nursing implications for Amiodarone

O Check patient pulse daily once stabilized & report pulse lower then 60 bpm.

O Avoid grapefruit while taking drug.O Avoid exposure to sunlight drug may cause

photsensitivity.

CLASS IVO Calcium Channel Blockers

O Verapamil O Decrease angina attacks by dilating coronary

arteries and inhibiting coronary vasospasms. O Decreasing nodal (SA & AV) conduction,

resulting in an antiarrhythmic effect.O Decrease total peripheral vascular resistance;

& therefore reduce blood pressure

CALCIUM CHANNEL BLOCKERS primarily have 3 effects:

O Acting on vascular smooth muscle they reduce contraction of the arteries and cause an increase in arterial diameter, a phenomenon called vasodilation (CCBs do not work on venous smooth muscle)

O Acting on cardiac muscles (myocardium), they reduce the force of contraction of the heart

O Slowing down the conduction of electrical activity within the heart, they slow down the heart beat.

ANTI-HYPERTENSIVESO Vasodilators -

O reduces Bp by direct effect on smooth muscles of arterial-resistance vessels, resulting in vasodilation.

O Improves cardiac output, renal and cerebral blood flow.O Hydralazine – Nonnitrate vasodilator,

antihypertensive (monitor pt for edema)O sildenafil Citrate – pulmonary antihypertensive

O Centrally Acting Alpha-Agonist - reduces renal vascular resistance; maintain cardiac output, slow heart rate, supports sodium retention.

O Methyldopa

ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS

O ACE inhibitors decreases angiotensin II levels, thus decreasing vasopressor activity and aldosterone secretions.

O Suppress the RAAS systemO Reduce peripheral and arterial resistance.O Lowers Bp.O Improve cardiac output results in increased

exercise tolerance.O Captopril, enalapril

O ACE inhibitors is an enzyme that catalyzes the conversion of angiotensin I to angiotensin II, a vasoconstrictor substance.

ANGIOTENSIN II RECEPTOR ANTAGONISTO Antihypertensive effect due to

vasodilation and inhibition of aldosterone effects on sodium and water retention.O Losarton

ANTI-ANGINALO NitratesO Calcium Channel BlockersO Beta-Adrenergic Blockers

ANTI-ANGINALO NITRATES – Has anti-anginal effects as a result of

vasodilation of the coronary arteries.

O Relaxes vascular smooth muscle with resulting vasodilation.

O Dilation of peripheral blood vessels tends to cause peripheral pooling of blood, decrease venous return to heart, & decrease left ventricular end –diastolic pressure, with consequent reduction in myocardial oxygen consumption.

O Isosorbide Dinitrate – nitrate, vasodilatorO Glyceryl Tinitrate

ANTI-ANGINALO Calcium Channel Blockers – Blocks selectively

blocks calcium influx across cell membranes of cardiac and vascular smooth muscle without changing serum calcium concentrations.

O It reduces coronary vascular resistance and increases coronary blood flow.

O Amlodipine – decrease peripheral vascular resistance, increase oxygen delivery to the myocardial tissues & increase cardiac output.

O Reduce systolic, diastolic & mean arterial blood pressure. It decrease pain due to angina.

O Used in mild to moderate HTN & stable anginaO Nifedipine

ANTI- ANGINALO Beta-Adrenergic Blockers – contributes to BP

reduction. Peripheral vasodilation & therefore, decrease peripheral resistance results from alpha1- blocking activity.

O Carvedilol – an effective antihypertensive agent reducing BP to normotensive range and useful in managing some angina, dysrhythmias, & CHF by decreasing myocardial oxygen demand & lowering cardiac workload.

O Metaprolol

SYMPATHOMIMETICSO Sympathomimetic drugs mimic the effects of

sympathetic activation on the heart and circulation.O Like the sympathetic nerves innervating the heart,

sympathomimetics stimulate the heart through activation.

O Sympathomimetics cause vascular smooth muscle contraction and vasoconstriction through activation.

O INJECTIONSO Adrenaline Chloride (Epinephrine hcl) – reverses

analphylactic reactions & provide temporary from acute asthmatic attach. Restores normal cardiac rhythm.

O Dopamine - O Dobutamine

ANTI-COAGULATED ANTIPLATELET O Heparin – inhibits formation of new clots.

O Has rapid anticoagulant effects.O Does not lyse existing thrombi but may prevent their

extension & propagation.O Warfarin – deters further extension of existing thrombi &

prevents new clots from forming.

O Aspirin (analgesic, antiplatelet, antipyretic)- Inhibits platelet aggregation.O Impair hepatic synthesis of blood coagulation factors VII,

IX & X.

O Inhibits platelet aggregation, reducing ability of blood to clot

HAEMOSTATICSO Agents acting to conserve blood but have differing sites of action in

the complex pathways determining coagulation and fibrinolysis. O Absorbable haemostatics arrest bleeding either by the formation

of an artificial clot or by providing a mechanical matrix that facilitates clotting when applied directly to the bleeding surface.

O These agents function more at the capillary level and are not effective at stemming arterial or venous bleeding under any significant intravascular pressure.

O Inhibit the activation of plasminogen to plasmin, prevent the break-up of fibrin and maintain clot stability.

O Aminocaproic acid (coagulator; systemic haemostatic) – inhibits plasminogen activator substance, and to a lesser degree plasmin (Fribrinolysin) which is concerned with destruction of clots.

O Acts as an inhibitor of fribrinolytic bleeding.

LIPID LOWERING DRUGSO ANION EXCHANGE RESINS – Cholestyramine or

Questran (antilipemic; bile acid sequestrant)O increases faecal loss of bile acids.O Leading to lowered serum total cholesterol by decreasing

(LDL) cholesterol. O Serum triglycerides levels may increase or remain

unchanged.

O STATINS – Simvastatin or Lovastin (antihyperlipemic)O decreases serum triglycerides, decreases LDL, cholesterol

& modests increase in HDL cholesterol.

FIBRINOLYTICO Streptokinase Injection (used intracoronary on

IV)- Streptokinase is used to dissolve blood clots that have formed in the blood vessels.O It is used immediately after symptoms of a heart

attack occur to improve patient survival. O May also be used to treat blood clots in the lungs

(pulmonary embolism) and in the legs (deep venous thrombosis)

O Also used to dissolve blood clots in tubes (catheters) that are inserted in blood vessels.

FRIBRINOLYTICO Tissue Plasminogen Activator -

O Is a protein involved in the breakdown of blood clots. O It is a serine protease found on endothelial cells, the

cells that line the blood vessels.O As an enzyme, it catalyses the conversion

of plasminogen to plasmin. O the major enzyme responsible for clot breakdown. O it works on the clotting system. tPA is used in clinical

medicine to treat embolic or thrombotic stroke.O Use is contraindicated in haemorrhagic stroke and

head trauma.

CENTRAL NERVOUS SYSTEM

O Anticonvulsants O AnxiolyticsO AntidepressantsO AntipsychoticsO SedativesO Drugs used in Vertigo and NauseaO Analgesics, Anti-inflammatory & Anti-

pyretic O Drugs used in Parkinsonism & Related

DisordersO CNS StimulantsO Acetylcholinesterase Inhibitor

ANTICONVULSANTSO Phenytoin – inhibits seizure activity by reducing voltage,

frequency & spread of electrical discharges within the motor cortex.O Not effective for absent seizures.O Effective to prevent or treat seizures occurring during or after

neurosurgery & after head trauma.O Control tonic-clonic seizures. O Used in treatment of trigeminal neuralgia.

O Gabapentin – used in conjunct with other anticonvulsants.O Effective in controlling painful neuropathies.

O Carbamazepine – inhibit sustained repetitive impulses.O Reduces post-tetanic synaptic transmission in the spinal

cord.O Limits the spread of seizure activity.O Provides relief in trigeminal neuralgia by reducing synaptic

transmission within trigeminal nucleus.

ANXIOLYTICSO Alprazolam or Xanax (sedative –hypnotic,

benzodiazepine) – a CNS depressant that appears to act at the limbic, thalamic & hypothalamic levels of the CNS.O Alcohol withdrawal.

O Diazepam or Valium- sketal muscle relaxation properties.

O Larazepam

ANTIDEPRESSANTSO Amitriptyline HCL – interference with the reuptake

of serotonin & norepinephrine from the synaptic gap. Restores the levels of these neurotransmitters .

O Also used as a prophylaxis for cluster migraine &chronic tension headaches .

O Fluoxetine HCL or Prazac – selective serotonin reuptake inhibitor.

O Inhibition of CNS neuronal uptake of serotonin, a neural transmitter.

SEDATIVESO Sedatives work by slowing down brain activity resulting in

drowsiness or relaxation. O Sedatives are central nervous system (CNS) depressants, a

category of drugs that slow normal brain function. O There are various kinds of CNS depressants, most of which act on

the brain by affecting the neurotransmitter gamma-aminobutyric acid (GABA)

O Sedatives are central nervous system (CNS) depressants, a category of drugs that slow normal brain function.

O There are various kinds of CNS depressants, most of which act on the brain by affecting the neurotransmitter gamma-aminobutyric acid (GABA)

O Phenobarbital – interference with impulse transmission of cerebral cortex by inhibition of reticular activating system. O Limiting spread of seizure activity results by increasing the threshold for motor cortex

stimulation.O Effective as a sedative, hypnotic and an anticonvulsant with no analgesic effect.

O Drugs used in diabetesO Thyroid and Anti-thyroid drugsO CorticosteroidsO HormonesO Contraceptives

DRUGS USED IN DIABETESO InsulinO Biguanides / MetforminO SulphonylureasO Meglitinides / Prandial glucose regulator /

GlinidesO Alpha-glucosidase inhibitorsO Thiazolidinedione / GlitazonesO DPP-4 inhibitors / GliptinsO Incretin mimetics / GLP-1 analoguesO Amylin analogues

INSULINSO Insulin is a hormone which helps to regulate

blood sugar.O Insulin is prescribed for people with type 1

diabetes and for people with type 2 diabetes who have not responded so well on oral medication (tablets).

O There are 4 types of insulin, based on how soon the insulin starts working (onset), when it works the hardest (peak time) and how long it lasts in your body (duration).

O However, each person responds to insulin in his or her own way.

TYPES OF INSULINO Rapid-acting insulin (Lispro) – Onset 15 minutes after

injection. O It peaks 30 to 90 minutes later and may last as long as 5 hours.

O Short-acting (regular) - Onset 30 minutes after injection.O It peaks 2 to 4 hours later and stays in the blood for about 4 to 8

hours. O Intermediate acting (NPH and lente) - Onset 2 to 6 hours

after injection. O They peak 4 to 14 hours later and stay in the blood for about 14

to 20 hours. O Long acting (ultralente) - Onset 6 to 14 hours to start

working. O It has no peak or a very small peak 10 to 16 hours after injection. O It stays in the blood between 20 and 24 hours.

O http://www.diabetes.co.uk/about-insulin.html

STORAGE & SAFETY OF INSULINO Using cold insulin can make your shot more painful.O You can warm an insulin bottle by gently rolling it

between your hands before you fill your syringe.O Store extra bottles in the refrigerator until ready to use.O Never store insulin at very cold or very hot

temperatures as extreme temperatures destroy insulin.O Do not put insulin in the freezer or in direct sunlight.O Insulin may lose some potency if the bottle has been

opened for more than 30 days.O Look at the bottle closely to make sure the insulin looks

'normal'. For example, if you use regular insulin, it should be perfectly clear - no floating pieces or colour.

O Do not use insulin past the expiration date.O http://www.diabetes.co.uk/about-insulin.html

BIGUANIDESO Biguanides prevent the liver from producing glucose and

helps to improve the body’s sensitivity towards insulin.

O Metformin is commonly used as a first line treatment for type 2 diabetes and may occasionally be prescribed, in combination with insulin, for people with type 1 diabetes.

O Metformin - only available diabetes medication in the biguanides class of drugs.

O Metformin is sold both under brand names, and also as a generic drug. Common brand names include: Glucophage, Riomet,,Fortamet, Glumetza, Obimet, Dianben, Diabex, Diaformin.

SULPHONYLUREA O Sulphonylureas are the class of antidiabetic

drug for type 2 diabetes that tends to include those drugs which end in ‘ide’.

O Glibenclamide –also known as Glyburide (Daonil), Glipizide (Glucotrol), Gliquidone (Glurenorm), Glyclopyramide (Deamelin-S), Glimepiride (Amaryl), Gliclazide (Diamicron)

O Sulphonylureas work by increasing the amount of insulin the pancreas produces and increasing the working effectiveness of insulin.

O The mode of action of sulphonylureas means that hypoglycemia and weight gain can be relatively common side effects.

MEGLITINIDESO Prandial glucose regulator / Glinides.O The glinides are a class of drug which have a

similar response as sulphonylureas but act for a shorter time. Meglitinides are prescribed to be taken by people with type 2 diabetes within half an hour before eating. As the drugs act for a shorter period than sulphonylureas, the side effects of hypoglycemia and weight gain have a smaller likelihood.

O Examples of prandial glucose regulators are (brand names in brackets):O Repaglinide (Prandin)O Nateglinide (Starlix)

ALPHA GLOCSIDASE INHIBITORS

O Alpha-glucosidase inhibitors,

O such as Acarbose (marketed as Precose or Glucobay) or Miglitol (branded as Glyset) are drugs for type 2 diabetes.

O These drugs slow down the digestion of carbohydrates in the small intestine and therefore can help to reduce after meal blood sugar levels.

THIAZOLIDINEDIONE/ GLITAZONES

O Medication use in treatment of type 2 diabetes which help to improve insulin sensitivity and have been found to help decrease triglyceride levels.

O Decrease hepatic glucose output & increase insulin-dependent muscle glucose uptake in skeletal muscles & adipose tissue.

O Enhance insulin sensitivity of cells without stimulating pancreatic insulin secretion.

O In September 2010, the most popularly prescribed drug in this class rosiglitazone (Avandia) was banned for use by the European medicines Agency over heart attack concerns. http://www.diabetes.co.uk/Diabetes-drugs.html

O Pioglitazone (Actos) has also made the news in connection with instances of bladder cancer, however, the danger has not been deemed sufficient to need to ban the drug in the UK. http://www.diabetes.co.uk/Diabetes-drugs.html

DDP-4 INHIBITORS/GLIPTINS

O Class of drug which help to stimulate the production of insulin and reduce the production of glucagon, particularly during digestion.

O DPP-4 inhibitors are usually prescribed for people with type 2 diabetes who have not responded well to drugs such as metformin and sulphonylureas.

O This drug class includes following medications (trade names in brackets):

O Sitagliptin (Januvia)O Vildagliptin (Galvus)O Saxagliptin (Onglyza)O Linagliptin (Tradjenta) –approved for use in the USA

http://www.diabetes.co.uk/Diabetes-drugs.html

INCRETIN MIMETICS/GLP-1ANALOGUES

O These are injectable treatment for type 2 diabetes.O Incretin mimetics mimics the effect of a group of

hormones called incretins which increase the production of insulin and decrease the release of glucagon in a relatively similar way DPP-4 inhibitors.

O GLP-1 analogues have been found to be particularly effective in helping to improve blood glucose levels and helping with weight loss.

O The following GLP-1 analogues are prescribed in the UK:O Exenatide (Byetta) – improves glycemic control by

reducing fasting & post-prandial glucose concentrations in type 2 diabetes.

O Liraglutide (Victoza)

AMYLIN ANALOGUESO Amylin is a hormone produced by the pancreas and

released at the same time as insulin, but in much smaller quantities (about 1% compared with insulin).

O Amylin helps to suppress glucagon release and therefore reduce post meal blood glucose levels.

O Pramlintide acetate (marketed as Symlin) is an injectable drug for the treatment of both type 1 and type 2 diabetes.

O The use of amylin with insulin can carry an increased chance of hypoglycemia.

THYROID & ANTI-THYROIDO Thyroid hormone replacement (Levothyroxine

sodium T4) – replaces decreased or absent thyroid hormone.

O Restoring metabolic rate of a hypothyroid Individual.O Increase diuresis, loss of weight & puffiness.O Increase a sense of well-being & activity tolerance plus

rise of T3 & T4.O Anti-thyroid hormone (Propylthiouracil (PTU)) –

Interferes with the use of iodine & blocks synthesis of Thyroxine (T4), & Triiodothyroxine (T3)

CORTICOSTEROIDS/ STEROIDSCorticosteroids are man-made drugs that closely

resemble cortisol, a hormone that your adrenal glands produce naturally.

Steroids work by decreasing inflammation and reducing the activity of the immune system. (Inhibits Phagocytosis)

O Steroids reduce the production of inflammatory chemicals in order to minimize tissue damage.

O Dexamethasone (Adrenal corticoid & Gucocorticoid)– has both anti-inflammatory & immunosuppression properties.

O Methyl prednisolone -

HORMONESO Hormones are chemical messengers or

substances generated in one organ & carried by the blood to another, in which it excites activity. (Bailliere’s)

O Estradiol Valerate or acetate - O Oxytocin – initiate an improve uterine

contraction at term.

CONTRACEPTIVESO Hormonal contraceptives work by inhibiting

ovulation and fertilization.O Changes in the cervical mucus that inhibit sperm

penetration. O Depo-provera – slows release of luteinizing

hormone (LH) preventing follicular maturation & ovulation.

O Levonorgestrel Implant (Norplant)O Low Dose Perle TabletsO Lofeminal TabletsO Levonorgestrel Tablets 750 mcg

GASTROINTESTINAL

O Antacids O Antispasmodics & other drugs

altering gut motility O Drugs used to treat diarrhoeaO Ulcer healing drugsO Laxatives/Bowel cleansing solutions

ANTACIDSO Antacids perform a neutralization reaction, (buffer

gastric acid), raising the pH to reduce acidity in the stomach.O When gastric hydrochloric acid reaches the nerves in the

gastrointestinal mucosa, they signal pain to the central nervous system. This happens when these nerves are exposed, as in peptic ulcers. The gastric acid may also reach ulcers in the esophagus or the duodenum.

O Antacids also alter the profile of prostaglandins produced by gastroduodenal mucosa and this may promote mucosal healing and be related to its therapeutic effect.

O Alka- Selter, Maalox, Milk of magnesia, Tums, Pepto-bismol, Andrews.

O Aluminium Hydroxide 250 mg/O Magnesium Hydroxide 500mg/5ml Susp.O Bismuth Subsalicylate Suspension

ANTISPASMODICS & OTHER DRUGS ALTERING GUT MOTILITY

O Drugs that suppresses muscle spasms.O Antispasmodics is used for smooth muscle contraction,

especially in tubular organs of the gastrointestinal tract. O The effect is to prevent spasms of the stomach, intestine or

urinary bladder. O Dicyclomine and Hyoscyamine are antispasmodic due to their anticholinergic action.

Both of these drugs are specific to the smooth musclesand have general side effects and can worsen gastroesophageal reflux disease

O Buscopan (hhyoscine) is known as an anticholinergic medicine.O It relieves the pain of stomach and bowel cramps by helping

your digestive system to relax.O Hyoscine is used to relieve smooth muscle spasms (cramps) in

the stomach and intestines and in the bladder and urethra.O Metoclopramide Hydrochloride – (antiemetic, Gi – stimulant)

ANTI-DIARRHEAL O Oral rehydration salts -

O Will be explained later.

ANTI-ULCERSO Antiulcer drugs are a class of drugs, exclusive

of the antibacterial agents, used to treat ulcers in the stomach and the upper part of the small intestine.

O Omeprazole or prilosec – proton pump inhibitor; anti-secretory. (suppress gastric acid secretion).

O Ranitidine Hydrochloride or Zantac – H2receptor antagonist or H2 blocker; anti-secretory. (blocks daytime & night time gastric secretion stimulated by histamine & reduces gastric acid release in response to food, caffeine.

O Prescription forms:O Tagamet (cimetidine)O Pepcid (famotidine)

H2 BLOCKERS PROTON PUMP

INHIBITORSO Suppress gastric

secretionsO block one of the

first stimuli for acid production

O blocking the histamine receptors in acid producing cells in the stomach

O begin working within an hour

O usually only work up to 12 hours.

O Suppress gastric secretions

O block the final step in the pathway of acid secretion in the stomach

O shut down the proton pumps in the stomach

O have a delayed onset of action

O work for a longer period of time; most up to 24 hours and the effects may last up to three days.

O Recurrent gastric and duodenal ulcers are caused by Helicobacter pylori infections, and are treated with combination treatments that incorporate antibiotic therapy with gastric acid suppression.

O The primary class of drugs used for gastric acid suppression are the proton pump inhibitors, omeprazole, lansoprazole, pantoprazole and rabeprazole.

O The H-2 receptor blocking agents, cimetidine, famotidine, nizatidine, and ranitidine have been used for this purpose, but are now more widely used for maintenance therapy after treatment with the proton pump inhibitors.

LAXATIVES & BOWEL CLEANSERS

Laxatives (purgatives, aperients) are foods, or drugs taken to loosen the stool, most often taken to treat constipation. Laxatives work to increase the movement of faeces along the colon.Laxatives may be oral and/or in suppository form.O Bisacodyl Tablets or Suppositories – induces peristaltic

contractions by direct stimulation of sensory nerve endings in the colonic wall.

O Glycerine Suppositories (paediatric & adult) – hyperosmotic laxative – relieves constipation by absorption of water & stimulation of peristalsis.

O Fleet Enema O Mineral oil

MUSCULOSKELETAL & JOINTS

O Non-steroidal Anti-inflammatory (Nsaids) Drugs

O CorticosteroidsO ImmunosuppressantO AntibioticsO Neuromuscular drugs

NSAIDSO These are a class of drugs that provide analgesic and

antipyretic (fever-reducing) effects, and, in higher doses, anti-inflammatory effects.

O The term nonsteroidal distinguishes these drugs from steroids, which, among a broad range of other effects, have a similar eicosanoid-depressing, anti-inflammatory action.

O The most prominent members of this group of drugs are:O Aspirin (anti-platelet, salicylate, antipyretic & nonnarcotic

analgesic)- inhibits prostaglandin synthesis thus reducing inflammation (also in or near the hypothalamus thus reducing temperature).

O Direct effects on the CNS causing pain relief.

O ibuprofen, and naproxen

CAUTION!!!!O Aspirin has been linked with Reye's syndrome, so use

caution when giving aspirin to children or teenagers.

O Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin.

O Reye's (Ryes) syndrome is a rare but serious condition that causes swelling in the liver and brain.

O Reye's syndrome most often affects children and teenagers recovering from a viral infection and who may also have a metabolic disorder.

O Signs and symptoms such as confusion, seizures and loss of consciousness require emergency treatment.

O Early diagnosis and treatment of Reye's syndrome may improve prognosis.

O mayoclinic.com

IMMUNOSUPPRESSANTS Immunosuppressive drugs or immunosuppressive

agents are drugs that inhibit or prevent activity of the immune system.

They are used in immunosuppressive therapy to: Prevent the rejection of transplanted organs and tissues

(e.g., bone marrow, heart, kidney, liver) Treat autoimmune diseases or diseases that are most

likely of autoimmune origin (e.g., rheumatoid arthritis, multiple sclerosis, myasthenia gravis, systemic lupus erythematosus, sarcoidosis, focal segmental glomerulosclerosis, Crohn's disease, Behcet's Disease, pemphigus, and ulcerative colitis).

Treat some other non-autoimmune inflammatory diseases (e.g., long term allergic asthma control).

O IMMUNOSUPPRESSANT CAN BE CLASSIFIED INTO 5 GROUPS:

O GlucocorticoidsO Immunosuppressive mechanismO Antiinflammatory effects

O CytostaticsO Alkylating agentsO Antimetabolites

O AntibodiesO Polyclonal antibodiesO Monoclonal antibodies

O Drugs acting on immunophilinsO CiclosporinO TacrolimusO Sirolimus

O Other drugsO InterferonsO OpioidsO TNF binding proteinsO MycophenolateO Small biological agents

O Immunosuppressive drugs can be classified into five groups:O Glucocorticoids - glucocorticoids are used to suppress various

allergic, inflammatory, and autoimmune disorders.O They are also administered as posttransplantory immunosuppressants

to prevent the acute transplant rejection and graft-versus-host disease.O Do not prevent an infection and also inhibit later reparative processes.

O Cytostatics - Cytostatics inhibit cell division. In immunotherapy, they are used in smaller doses than in the treatment of malignant diseases. O They affect the proliferation of both T cells and B cells. Due to

their highest effectiveness, purine analogs are most frequently administered.

O Dactinomycin is the most important. It is used in kidney transplantations. Other cytotoxic antibiotics are anthracyclines, mitomycin C, bleomycin, mithramycin.

O Antibodies :O Antibodies are sometimes used as a quick and potent

immunosuppressive therapy to prevent the acute rejection reactions as well as a targeted treatment of lymphoproliferative or autoimmune disorders .

O Drugs acting on immunophilins :O Ciclosporin - Ciclosporin is thought to bind to the cytosolic protein

cyclophilin (an immunophilin) of immunocompetent lymphocytes, especially T-lymphocytes.

O This complex of ciclosporin and cyclophilin inhibits the phosphatase calcineurin, which under normal circumstances induces the transcription of interleukin-2.

O The drug also inhibits lymphokine production and interleukin release, leading to a reduced function of effector T-cells.

O Other drugs:O Interferons - IFN-β suppresses the production of Th1 cytokines and

the activation of monocytes. It is used to slow down the progression of multiple sclerosis. IFN-γ is able to trigger lymphocytic apoptosis.

O Opiods - Prolonged use of opioids may cause immunosuppression of both innate and adaptive immunity.

O Decrease in proliferation as well as immune function has been observed in macrophages, as well as lymphocytes.

NEUROMUSCULARO Drugs acting on immunophilins- Like tacrolimus,

ciclosporin (Novartis' Sandimmune) is a calcineurin inhibitor (CNI). It has been in use since 1983 and is one of the most widely used immunosuppressive drugs. It is a cyclic fungal peptide, composed of 11 amino acids.O Ciclosporin is thought to bind to the cytosolic protein

O Other drugs - Prolonged use of opioids may cause immunosuppression of both innate and adaptive immunity.O Decrease in proliferation as well as immune function has

been observed in macrophages, as well as lymphocytes. O It is thought that these effects are mediated by opioid

receptors expressed on the surface of these immune cells

DRUGS AFFECTING NUTRITION & BLOOD

O Drugs affecting:O Nutrition O Fluid and Electrolytes

O Intravenous infusionsO BloodO Other (water irrigation)

DRUGS AFFECTING NUTRITIONO Vitamins

O Any group of substance that are required, in very small amount, for healthy growth and development. They are also required for nucleoprotein synthesis and maintenance of normal erythropoiesis.

O Examples are:O Ascorbic acid (vitamin C) needed for healing wounds, and for

repairing and maintaining bones and teeth. O Vitamin B complex

O Cyanocobalamin (B12) essential to cell growth and reproduction, nucleoprotein and myelin synthesis, and has been associated with fat and carbohydrate metabolism and protein synthesis.

O Folic acid (B9) Used to treat megaloblastic anemias due to sprue, nutritional deficiency, infancy and childhood. It is also essential in pregnancy to help prevent congenital birth defects.

O Multivitamin Syrup O Pyridoxine InjectionO Thiamine HydrochlorideO Hydroxocobalamin

FLUID & ELECTROLYTESO Fluids

are liquids originating from inside the bodies of living people. The main purposes are regulate body temperature, blood circulation, remove toxins, keep the skin moist and help the digestive process.

O Electrolytes electrolytes are substances that become ions in solution and

acquire the capacity to conduct electricity. Electrolytes are present in the human body, and the balance of the electrolytes inside the body is essential for normal function of cells and organs.

Examples of electrolytes are: Sodium: Regulates fluid balance Potassium: Regulates metabolism Magnesium: Regulates the levels of other electrolytes Calcium: Regulates muscle contraction and heart rhythm

FLUID & ELECTROLYTES CONTINUED

O Fluid and electrolytes O To control fluid passage across cell

membranes, cells regulate the movement of electrolytes into and out of them, which causes water to follow the charged particles around wherever they go. Some examples include:O Calcium ChlorideO Calcitriol Injection O Potassium Chloride tablet or injection O Oral rehydration salt

INTRAVENOUS INFUSIONS

O Intravenous infusions The slow injection of substances into a vein. A

common method for replacing fluid and electrolytes and continuous administration of drug.

Solutions used for IV infusion can be: O Isotonic- a solution having the same osmotic

pressure as blood.O Hypotonic- a solution that pushes fluid into a

cells.O Hypertonic-a solution that pulls fluid from

cells.

SOLUTIONS

INTRAVENOUS INFUSIONS CONTINUED

Examples of intravenous infusions are:O Normal Saline (Sodium Chloride) is a sterile,

nonpyrogenic solution for fluid and electrolyte replenishment for intravenous administration. It contains no antimicrobial agents. The nominal pH is 5.5 (4.5 to 7.0).O 0.45% Sodium Chloride Injection, contains 4.5 g/L Sodium

Chloride (sodium chloride injection) , It contains 77 mEq/L sodium and 77 mEq/L chloride

O 0.9% Sodium Chloride Injection, USP contains 9 g/L Sodium Chloride (sodium chloride injection). It contains 154 mEq/L sodium and 154 mEq/L chloride.

INTRAVENOUS INFUSIONS CONT’D

O Dextrose is another name for glucose, a type of sugar; dextrose IVs are sometimes referred to as “sugar water. As with every other form of sugar, prolonged or incorrect use of dextrose can cause hyperglycemia.

O Dextrose IVs contain combinations of dextrose and water, in differing concentrationsO Dextrose 2.5%: Dextrose 2.5%, or D2.5W, is a dextrose IV that contains 2.5

grams of dextrose per 100 ml of water. D2.5W is used to dilute other IV solutions or to supply the patient with water and calories.

O Dextrose 5% (D5W): used to hydrate patients or to dilute other IVs and medications. D5W keeps the body from using up protein and muscle mass by giving it carbohydrates and can decrease sodium and potassium levels. D5W quickly becomes hypotonic, having a lower salt concentration than the blood or other cells in the body, and hence is not used for resuscitation like some other solutions with similar chemical makeup, such as normal saline. It is used as source of free water and to prevent cell dehydration

INTRAVENOUS INFUSIONS CONT’D

O Dextrose 10 % and 20% (D10W and D20W): Dextrose 10% is a more concentrated form of dextrose IV fluid. It’s usually used to counterattack hypoglycemia. D20W can also provide more nutrition to the patient in the long term.

O Dextrose 50% (D50W): Along with dextrose 20%, it is used for more long-term IVs since it can provide more nutrition to the body. But dextrose IVs used for too long can result in a number of negative side effects. Any dextrose IV therapy can cause hypokalemia (a drop in potassium levels) and hyponatremia, a condition in which there is not enough sodium in the body outside of the cells. This is a very serious condition that can lead to brain damage and death.

INTRAVENOUS INFUSIONS CONT’D

O Gelofusine is a volume expander that is used as a blood plasma replacement if a significant amount of blood is lost due to extreme hemorrhaging, trauma or dehydration. It behaves similar to blood filled with albumins thus resulting in an increase blood volume, blood flow, cardiac output, and oxygen transportation.O Fractionated Ovolecithin O Fractionated Soya OilO Glycerol O Hemodialysis Solution O Mannitol O Peritoneal Dialysis SolutionO Sodium Bicarbonate 8.4

DRUGS AFFECTIONG BLOODO Iron Preparations

The therapeutic action of iron preparation is to elevate the serum iron concentration, and is then converted to Hgb or trapped in the reticuloendothelial cells for storage and eventually converted to usable form of iron.

Some examples are:O Ferric Ammonium Citrate CompoundO Ferrous Fumarate Tablets O Ferrous Sulphate O Iron - Dextran Complex O Iron and Multivitamin O Iron Sucrose Injection

DRUGS AFFECTIONG BLOOD CONT’D

O Haemostatics O The therapeutic action of systemic drug is to

inhibit fibrinolysis by inhibiting plasminogen activator substances and by plasmin activity; this action prevents the breakdown of clots, the following are examples:

O Aminocaproic Acid InjectionO Aminocaproic Acid Syrup O Phytomenadione InjectionO Phytomenadione TabletsO Tranexamic Acid Tablet O Tranexamic Acid Injection

WATER IRRIGATIONO Sterile Water for Irrigation is a sterile, hypotonic,

nonpyrogenic irrigating fluid or pharmaceutic aid

(solvent) entirely composed of Sterile Water for

Injection USP. It is prepared by distillation and

contains no antimicrobial or bacteriostatic agents or

added buffers. The pH is 5.7 (5.0–7.0).

DRUGS USED IN TREATMENT OF RESPIRATORY SYSTEM

O BronchodilatorsO Corticosteroids O AntihistaminesO Anti-infectives (Antibiotics)O Expectorants and Cough

SuppressantsO Respiratory Stimulants

Pulmonary surfectant Oxygen Aromatic Inhalations Nasal decongestants (ENT)

BRONCHODILATORSO Bronchodilators relaxes bronchial smooth muscle, causing

bronchodilation and increasing vital capacity, which has been impaired by bronchospasm and air trapping; in higher concentration, it also inhibits the release of slow-reacting substances of anaphylaxis and histamine and suppresses the response of airways to stimuli.

O Examples of bronchodilators are:O Ipratropium Bromide Inhaler (Atrovent)

Atrovent causes dilates the bronchial airway and inhibits secretion from serous and seromucous gland lining the nasal mucosa; it also has anticholinergic effects. Used in maintenance treatment foe COPD, chronic bronchitis and emphysema. Relieves symptoms of rhinorrhea, common cold and rhinitis.

BRONCHODILATORS CONT’DO Albuterol (Ventolin)

in low does it acts relatively selective at beta2-adrenergic receptors to cause dilation of bronchial airway and vasodilation; it higher doses beta2 selectivity is lost, and the drug acts beta2 receptors to cause typical sympathomimetic cardiac effects

O Other examples of bronchodilators continued:O Aminophylline Injection O Formoterol 160mcg/Budesonide O Metered Dose Inhaler (MDI)O Ipratropium Bromide Nebuliser Solution O Salbutamol Inhaler, nebuliser, syrup, tablet and expectorant

ANTIHISTAMINESO Antihistamines completely blocks the effects

of histamine at peripheral H1 receptor sites, and also has anticholinergic and antipruritic effects.

O Types of antihistamines are:O Diphenhydramine Hydrochloride elixir or capsules

(DPH)DPH is an antihistamine drug with several other effects, these include: antipruritic sedative, cough suppressant, and anti-motion-sickness effects. This drug is commonly used in mental health facilities to counteract the side effects of parkinsonism.

ANTIHISTAMINES CONTINUED O Loratidine Tablets or syrup(Claritin)

Non sedative type of histamine; used to treat the symptoms of seasonal allergies, such as sneezing, watery eyes, and runny nose and itching of the nose and throat. Claritin is also used

O Some other example of antihistamine continued:O Chlorpheniramine Syrup O Clemastine Fumarate TabletsO Diphenhydramine Hydrochloride InjectionO Ketotifen ElixirO Promethazine Hydrochloride Tablets

EXPECTORANTS & COUGH SUPPRESSANTS

O Expectorants Drugs that increase the bronchial secretion and enhance the expulsion of mucus by air passages of the lungs. This makes it is easier to cough up the phlegm or sputum. Expectorants are used in cough mixtures for chesty coughs. Some examples are:O Bromhexine Hydrochloride Elixir (Bisolvant)

Bisolvin Elixir is for conditions where breathing is difficult due to a lot of secretions (mucus) in the air passages. Such conditions include bronchitis and emphysema.

O Guaifenesin (Ributussin)Sypmtomatic relieve of respiratory conditions characterised by dry, non-productive cough and when there is mucus in the respiratory tract

EXPECTORANTS & COUGH SUPPRESSANTS

OCough suppressants Cough suppressants, also known as antitussives, are a class of cough medication that are intended to suppress (stop) a cough. They Control cough spasm by depressing the cough center in the medulla.O Dextromethorphan

Controls non-productive coughs but will not treat a cough that is caused by smoking, asthma, or emphysema.

RESPIRATORY STIMULANTSO Ammonia Spirit (aromatic ammonia spirit)

O Respiratory stimulant used as a smelling salts to treat or prevent fainting.

O For preventing or treating fainting:O For inhalation dosage form (inhalants):

O Adults and teenagers—The inhalant should be held away from the face and crushed between the fingers. The inhalant should then be held about four inches away from the nostrils, and the vapor slowly inhaled until the patient awakens or no longer feels faint.

O Children—Use and dose must be determined by your doctor.

O For inhalation dosage form (solution):O Adults and teenagers—After the top is taken off the container, the vapor may

be slowly inhaled until the patient awakens or no longer feels faint.O Children—Use and dose must be determined by your doctor.

PULMONARY SUFECTANTSO Pulmonary surfactant is a surface-active lipoprotein

complex (phospholipoprotein) formed by type II alveolar cells. It reduces the surface tension of the alveolar air-liquid interface, thereby providing mechanical stability and preventing alveolar atelectasisO Beractant Suspension (Survanta)

a sterile, non-pyrogenic pulmonary surfactant intended for intratracheal use only. It is a natural bovine compound containing lipids and apoproteins that reduce surface tension and allow expansion of the alveoli; replaces the surfactant missing in neonates siffering from respiratory distress syndrome(RDS).

OXYGENO Oxygen therapy : a treatment that provides extra oxygen, a gas that the

body needs to work well. Normally, the lungs absorb oxygen from the air. However, some diseases and conditions can prevent the consumption of enough oxygen.

O Oxygen flows through a tube and is delivered to the lungs in one of the following ways:O Through a nasal cannula, which consists of two small plastic tubes, or prongs,

that are placed in both nostrils.O Through a face mask, which fits over your nose and mouth.O Through a tracheostomy tube (small tube inserted into your windpipe through

the front of your neck). A needle or small incision can be used to place the tube. Oxygen delivered this way is called transtracheal oxygen therapy.

AROMATIC INHALATIONSO Menthol Crystals are clear, colorless, crystals that are

obtained from steam distilled peppermint oil. They are formed when peppermint oil is distilled by steam. They can be used to alleviate a variety of aches, pains and other ailments.

O Menthol crystals provide relief for symptoms of congestion, upper respiratory problems, sore throat and coughs. Most lozenges, cough drops, and respiratory balms will list menthol as the chief ingredient. For congested, after inhaling the scent of menthol crystals, the menthol vapors attacking and breaking up lung congestion, giving a cooling and soothing sensation can be very relieving.

AROMATIC INHALATIONS CONTINUED

O Tincture Benzoin Compound O Plain Tincture of Benzoin can be inhaled in steam as

a treatment for various conditions including

bronchitis and colds

VACCINES

VACCINESO A preparation of a weakened or killed

pathogen, such as a bacterium or virus, or of a portion of the pathogen's structure that upon administration stimulates antibody production or cellular immunity against the pathogen but is incapable of causing severe infection.

VACCINES CONTINUED

O Common vaccines used are:O BCG protects against tuberculosisO DPT protects against diphtheria,

pertussis and tetanus

O MMR protects against measles mumps and rubella

O OP/IPV protects against (oral/injectable polio) poliomyelitis

VACCINES CONTINUED

O Hep B protects against hepatitis B

O HIB protects against Haemophilus

influenzae

ANTIDOTES & SUBSTANCES USED IN POISONING

O Specific O Non-specific

SPECIFICO Acetylcysteine Injection 200 mg/mlO Desferrioxamine Injection 500 mgO Dimercaprol Injection 50 mg/mlO Flumazenil Injection 0.1 mg/mlO Glucagon Injection 1 mg/mlO Naloxone HCl Injection 400 mcg/mlO Pralidoxime Mesylate Injection 200 mg/mlO Protamine Sulphate Injection 50 mg/mlO Sodium Calcium Edetate Injection 200mg/ml

NON-SPECIFICO Activated Charcoal PowderO Adrenaline Injection 0.1%O Atropine Sulphate Injection 1 mgO Calcium Gluconate Injection 100 mg/mlO Diazepam Injection 5 mg/mlO Fuller's Earth (Bentonite)O Ipecacuanha Syrup 14 mg/10ml

SOME COMMON DRUGS

O Morphin , pethidine – Naloxone or Narcan

O Heparin – protamine sulfate O Warfarin – Vitamin KO Digoxin – DigibindO Paracetamol - acetylcysteine

REFERENCESO Diabetes drugs classification retrieved September 14,

2013 from www.diabetes.co.uk O Porth, C. Essential of Pathophysiology. 3rd edition.

Lippincott Williams & Wilkins 2001 Market Street, PA 19103 USA.

O Wilson, B. Pearson Nurses Drug Guide. 2013. Pearson Education, Inc. Upper Saddle River, NJ 07458.

O Weller,. B. Bailliere’s Nurses Dictionary . 3rd edition. RCN Publishing Company.