Drugs

FACTORS AFFECTING DRUG ACTION 1. Absorption • Route of administration • Perfusion status • GI motility

1. Distribution • Plasma protein binding • Lipid solubility Perfusion status • Barriers (BBB, placenta) • Obesity

FACTORS AFFECTING DRUG ACTION 1. • • •

Metabolism Age Drugs Liver disorders

6. • • •

Excretion Drug-drug interaction Blood concentration levels Renal status

NONNARCOTIC ANALGESICS AND ANTIPYRETICS 1. ASA Action • Analgesia • Antipyretic • Anti-inflammatory • Antiplatelet 2. NSAIDs (ibuprofen, naproxen, piroxicam, indomethacin, ketorolac)

Adverse Effects • Salicylism • Drowsiness • Bleeding • Edema • Hypertension • Gastritis • N and V • Hypoglycemia Respiratory alkalosis/metabolic acidosis • Reye’s syndrome

NONNARCOTIC ANALGESICS AND ANTIPYRETICS Nursing Implications • Monitor CBC, PT, kidney and liver function studies • Additive effects if with use with anticoagulants • Drink plenty of fluids • Take with food or fluids. • Never given with children/adolescents with flu • Don’t crush enteric-coated tablets. • Avoid intake of alcohol

NONNARCOTIC ANALGESICS AND ANTIPYRETICS 2. Acetaminophen • Analgesic and antipyretic Adverse effects: • Rash • Thrombocytopeni a • Liver toxicity

Nursing Considerations: • Monitor liver and kidney function and CBC • Antidote: Nacetylcysteine (Mucomyst)

ANTIPSYCHOTIC MEDICATIONS 1. • • • • •

Phenothiazines Thioridazine Haloperidol Thorazine Promethazine Fluphenazine

Action: • Blocks dopamine receptors • Anticholinergic, antihistamine, antiadrenergic effects • Antiemetic

Adverse Effects: • EPS (dystonia, parkinson’s, tardive dyskinesia, akathisia) • Dizziness, sedation • Orthostatic hypotension • Anticholinergic affects • Photosensitivity • Neuroleptic malignant syndrome • Agranulocytosis • Hyperprolactinemia • Hypersensitivity (obst. Jaundice)

ANTIPSYCHOTIC MEDICATIONS Nursing Implications • Wear gloves when handling parenteral or liquid forms. • Give deep IM injection into gluteal muscle and massage well. Store in cool, dark place. • Monitor for EPS. • Take with food or milk. • Take at bedtime. • Advise not to drive or do activities that require attention. • Change position gradually • Report fever and sore throat to physician • Wear protective clothings. • Never abruptly withdraw drug • Avoid smoking

ANTIMANIC MEDICATIONS Lithium

Nursing Implications: Adverse effects: • Monitor serum • Confusion lithium levels • Restlessness monthly • Fatigue • Monitor for lithium • Hand tremors toxicity. • Arrythmias • Hypotension • Teach patient to increase fluid intake. • BOV • Maintain sodium • Weight gain intake of 6-10 g/day. • N and V • hypothyroidism• Take with food.

ANTIDEPRESSANT DRUGS 1. Tricyclic antidepressants • Nortryptyline • amitriptyline • Imipramine Adverse Effects: • Sedation • Confusion • Anticholinergic effects • Orthostatic hypotension • Arrythmias • Blood dyscrasia

Nursing Implications: • Takes 2-4 weeks to take effect. Monitor for suicidal tendencies. • Monitor CBC. • Drug therapy disconitued gradually. • Taken with food • Monitor for toxicities (seizures,coma.arryt

ANTIDEPRESSANT DRUGS 1. MAO Inhibitors • Phenelzine • Tranylcypromine Adverse Effects: • Orthostatic hypotension • Anticholinergic effects • Hypertensive crisis • Leukopenia

Nursing Implications: • Protect patient from injury • Monitor I and O • Inform patient to avoid foods and fluids high in tyramine • Monitor CBC and liver function tests.

ANTIDEPRESSANT DRUGS 1. SSRI • Sertraline • Fluoxetine Uses: • Major depression • ObsessiveCompulsive D/O

Adverse Effects: • CNS stimulation • Sexual dysfunction • N & V, anorexia • Weight loss Nursing Implications: • Interacts with warfarin. • Cannot be combined with MAOI. • Taken in the morning • Report immediately if with rashes

ENDOCRINE DRUGS ANTIDIABETIC AGENTS 2. Insulin Adverse Effects: • Allergy • Hypoglycemia • Lipodystrophy Nursing Implications: • Do not inject cold insulin. • Discard discolored solutions or those with precipitates. Do not shake vial.

• Draw up clear insulin first. • Rotate injection sites • Monitor blood glucose levels regularly. • Inform patients regarding signs of hypoglycemia and appropriate treatment. • If ill continue taking insulin and drink freely nancaloric liquids. • Inform regarding avoidance of smoking.

Type

Appearanc Onse peak Duratio e t n

Rapid-acting •Regular •Clear insulin •Semilente insulin Intermediat e acting •NPH

•cloudy

•cloudy

•Lente Long-acting •ultralente

•Cloudy

½-1

2-4

6-8

½-1

4-6

12-16

1-1 ½ 8-12

18-24

1-1 1/2

8-12

18-24

4-8

1620

30-36

Insulin 1. Drugs that increase effect of insulin • Aspirin • Oral anticoagulants • Beta blockers • TCAs 6. Drugs that decrease insulin effect • Glucocorticoids • Thiazide diuretics • OCP • Thyroid agents

Oral Hypoglycemic agents a. Sulfonylureas – promotes inc. insulin secretion from pancreatic beta cells through direct stimulation (requires at least 30 % normally functioning beta cells) – First-Generation Agents: • Tolbutamide, Acetohexamide, Tolazamide, Chlorpropamide – Second-Generation Agents • Glypizide, Glyburide

Oral Hypoglycemic agents b. Biguanides – reduces hepatic production of glucose by inhibiting glycogenolysis – decrease the intestinal absorption of glucose and improving lipid profile – Agents •Phenformin , Metformin , Buformin

Oral Hypoglycemic agents c. Alpha-glucosidase inhibitors – Inhibits alpha-glucosidase enzymes in the small intestine and alpha amylase in the pancreas – Decrease rate of complex carbohydrate metabolism resulting to a reduced rate postprandially. – Agents • Acarbose (precose), Miglitol (glyset)

Oral Hypoglycemic agents d.

Thiazolidinediones – Enhances insulin action at the cell and post-receptor site and decreasing insulin resistance – Agents • Pioglitazone (Actos), Rosiglitazone (Avandia)

Adverse Effects: • Nausea and vomiting • Hypoglycemia • Hemolytic anemia • Allergy • Photosensitivity Nursing implications: • Tablets should not be crushed • Monitor for signs of hypoglycemia

• Use other forms of contraception aside from OCPs • Alcohol can trigger a hypoglycemic effect. • Cover body is sunshine. Use of sunscreen. • Sulfonylureas are best taken before meals • Monitor for drug to drug interactions.

Oral Hypoglycemic agents Drugs that reduce hypoglycemic effects: • Diuretics • Steroids • OCPs Drugs that potentiates hypoglycemic effects: • Sulfonamides • MAOI • Coumarin • Salicylates • Probenecid • propranolol

CORTICOSTEROIDS • Cortisol, hydrocortisone, prednisone, prednisolone, methylprednisone, triamcinolone, dexamethasone • Mineralocorticoid (fludrocortisone) Uses: • Replacement therapy for adrenocortical insufficiency • Anti-inflammatory agent

Adverse effects: 1. Altered protein metabolism • Muscle wasting • Osteoporosis • Easy bruisability 2. Altered fat metabolism • Moon facies • Buffalo hump • Truncal obesity • hyperlipidemia 3. Altered carbohydrate metabolism • Hyperglycemia

1. Altered immune response 2. Sodium and water retention 3. Hypertension 7. Hypokalemia, metabolic alkalosis 8. Emotional instability 9. Excessive androgen activity 10. Gastric irritation

Nursing Implications: • Review patient’s medical history prior to giving the drug • Administer in light-resistant containers • Observe for mental changes. • Monitor for BP, weight, I and O, glucose, electrolytes. • Take with food or milk. • Take drug before 9 AM. • Never abruptly stop taking the drug • Teach patient ways to prevent infection. • Restrict sodium, alcohol and caffeine intake. • Increase intake of foods high in potassium. • Rinse mouth after using inhaled steroids • Teach patient to avoid strenous activities

ANTITHYROID DRUGS • Propylthiouracil (PTU) and methimazole • During pregnancy PTU, is the preferred therapy • A few of the infants born to mothers receiving antithyroid medication will be hypothyroid. • Mechanism of action – Blocks thyroid hormone synthesis

Propylthiouracil (PTU) and methimazole Adverse effects: • Skin rash • Urticaria • Agranulocytosis • Hepatitis • Myalgia • Headache • Hypoprothrombinemia • hypothyroidism

PTU/Methimazole

Nursing considerations • Give the drug with meals to reduce GI effects • Watch for signs of hypothyroidism • WOF: Agranulocytosis • Instruct patient to report for skin eruptions • The drug should be stopped if severe rash develops or cervical lymph nodes become enlarged • Advise patient to avoid foods high in iodine or potassium • Warn the patient against the use of the over-the-counter medication • Store the drug in a light-resistant container • Monitor for weight and PR regularly.

SSKI/Lugol’s solution Potassium or sodium iodide (potassium iodide SSKI), strong iodine solution (Lugol’s solution) • Treatment for thyrotoxic crisis • Mechanism of action: – Inhibits the release and synthesis of thyroid hormones – Decreases the vascularity of the thyroid gland – Decreases thyroidal uptake of radioactive iodine following radiation emergencies or administration of radioactive isotopes of iodine

SSKI/Lugol’s solution Adverse Effects: • Unpleasant tase • Hypersalivation • Acne • Rashes • angioedema • Burning sensation

SSKI/Lugol’s solution Potassium or sodium iodide, (potassium iodide solution, SSKI), strong iodine solution (Lugol’s solution) • Dilute oral doses in water or fruit juice and give with meals. • Warn the patient that sudden withdrawal may precipitate thyrotoxicosis • Store in a air-tight and light-resistant container. • Give iodides through a straw to avoid tooth discoloration • Force fluids to prevent fluid volume deficit

Radioactive iodine (sodium iodide or 131I ) • Food may delay absorption. The patient should fast overnight before administration • After dose for hyperthyroidism, the patient’s urine and saliva are slightly radioactive for 24 hours; vomitus is highly radioactive for 6 to 8 hours. • Institute full radiation precautions during this time • Instruct the patient to use appropriate disposal methods when coughing and expectorating.

Radioactive iodine (sodium iodide or 131I ) – The patient should drink as much fluid as possible for 48 hours after drug administration to facilitate excretion. – Limit contact with the patient to 30 minutes per shift per person the 1st day; may increase time to 1 hour on 2nd day and longer on 3rd day.

THYROID HORMONES • Levothyroxine • Liothyronine • Thyroglobulin (Proloid) Adverse Effects: • Signs of hyperthyroidism

THYROID HORMONES Nursing Implications: • Different brands of levothyroxine may not be bioequivalent. • Warn the patient (especially the elderly) to tell the doctor if with signs of hyperthyroidism • Instruct the patient to take thyroid hormones at the same time each day to maintain constant hormone levels. • Medications taken in the morning. • Monitor apical pulse and blood pressure. If pulse is >100 bpm, withhold the drug. • Store in air-tight and light-resistant containers. • Monitor prothrombin time; a patient taking these hormones usually requires less

OXYTOCIN Uses: • Promotion of uterine contractions • Control of bleeding • Release of milk from breast Oxtocin-related drugs: • Methergine • ergonovine

Adverse Effects: • Hypotension • Tachycardia • Water intoxication • Uterine rupture • Nausea and vomiting • Cardiovascular collapse • Anaphylaxis • Hypertension (oxytocin-related

OXYTOCIN

Nursing Implications: • Use infusion pump for administration. Never give IM • Monitor BP, heart rate and I and O. • Regularly monitor for uterine contractions and FHR. • Discontinue if:  With note of tetanic uterine contractions.  Signs of fetal distress  Urinary flow is less than 30 ml/hour  Signs of abruptio placenta and uterine rupture • For ergonovine/methergine- C/I for patients with vascular, renal and

ANTIASTHMA DRUGS • Beta adrenergic agonists • Anticholinergic drugs • Methylxanthines • Mast Cell stabilizers • Leukotriene inhibitors • Cortocosteroids

Methylxanthines • • •

Theophylline Aminophylline Theo-dur

Action: • Bronchodilator • CNS stimulant • Increased renal blood flow

Adverse Effects: • CNS stimulation • Tachycardia, hypotension, palpitations • Nausea and vomiting • Rectal irritation with suppository

Methylxanthines Nursing Implications: • Monitor theophylline levels. • Monitor VS, I and O and symptoms of toxicity • Avoid smoking and use of marijuana. • Administer with milk if with GI distress, otherwise take before meals with water. • Avoid excessive caffeine use • Do not crush or chew time-release or enteric coated tablets

Mast Cell Stabilizer • Cromolyn sodium • Nedocromil Actions: • Prophylaxis against asthma attacks • Allergic rhinitis

Adverse Effects: • Bronchoconstriction • Cough • Nasal congestion • rash

Mast Cell Stabilizer Nursing Implications: • Teach patient to use before exercising. • Teach about proper use of inhaler     

With spinhaler place capsule in container and exhale fully. Place mouthpiece between lips. Tilt head back and inhale fully. Remove inhaler, Hold breath Exhale slowly

• Rinse to reduce irritation in the mouth. • Discontinue use if an allergic reaction occurs.

ANTINEOPLASTIC AGENTS • • • • • • •

A. General Adverse Effects GI symptoms alopecia BM depression hepatotoxicity ↑ uric acid fatigue

• B. Prototype – Cyclophosphamide(Cytoxan) 1. Action. Produces cytoxic effects by damaging DNA • and interfering with cell replication. 2. Adverse Effects. Hemorrhagic and nonhemorrhagic • cystitis • ANTIMETABOLITES • Prototype – Methotrexate with leucovorin rescue – 5-Fluorouracil (5-FU) – Mercaptopurine (Purinethol) – Cytarabine (Cytosar-U)

• Action. Leucovorin calcium is a folic acid analog that interferes with mitotic process by blocking folinic acid.

•

ANTIBIOTIC ANTINEOPLASTIC AGENTS

• •

Action. Attaches to DNA and prevents DNA synthesis in vulnerable cells. Adverse Effects.

• •

VINCA ALKALOIDS Prototype – Vincristine (Oncovin) and Vinblastine

• •

MISCELLANEOUS ANTINEOPLASTIC AGENTS L-Asparaginase (Elspar)

•

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Prototype – Dactinomycin and Doxorubicin HCl (Adriamycin)

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hyperuricemia cardiotoxic BM depression

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Action. Acts on cells undergoing mitosis, thus stopping cell division. Adverse Effects. Neuropathy and neurotoxic

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Action. Enzyme that destroys asparagines, an amino acid necessary for protein synthesis of leukemia cells. Adverse Effects. Azotemia, hemorrhagic pancreatitis, hyperglycemia, hepatotoxicity

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Action. Urea derivative that kills granulocytes

Hydroxyurea (Hydrea)