MEdication

1. PHARMACOLOGY
MODULE
By Nursing Education Services
Revised 2023

2. Definition
Medication
A drug or other substance used to treat disease or injury Or It is the act
or process of treating patient with medicine.
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3. Purpose of Medication
• Diagnostic
• Preventive
• Palliative
• Curative
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4. Routes of Medication
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5. Cont..
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6. Routes of Drugs Administration
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7. Drug Classification
Antihypertensive
CNS Drugs
Anticoagulants
Analgesics
Anesthetics
Antimicrobial
Anti-neoplastic
Diabetic Drugs
GI Drugs
Respiratory Drugs

8. 1.Analgesics:
NON- OPIOIDS
• Non-narcotic
• Non-sedating
• Anti Pyretic
• Anti Inflammatory (NSAID only)
• Acts on peripheral nervous system
• For mild to moderate pain
• E.g.. NSAIDS &Acetaminophen
(Tylenol)
Medication used to relieve pain

9. Opioids/ Narcotics
Opioids are used when milder drugs are ineffective.
Examples: Morphine Sulphate, Hydromorphone, Codeine & Fentanyl
Side effects:
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Depressing Effects Stimulating Effects
Perception of pain Stimulate chemoreceptor trigger zone
(CTZ)- causes nausea and vomiting
Respiratory & coughing Stimulates oculomotor nerve: Pupillary
constriction (esp with morphine)
Reduces anxiety Stimulates vagus nerve: bradycardia and
hypotension
Depresses alertness- drowsiness and sleep
Decreases peristalsis-constipation
Spasm of sphincter – urinary retention

10. Nursing Intervention
• Administer the narcotic before pain reaches its peak to maximize the
effectiveness of the drug.
• Monitor V/S (HR, BP, Respiratory rate and effort) at frequent intervals to detect
alterations.
• Monitor urine output.
• Check bowel sounds for decreased peristalsis. Dietary changes may be required.
• Check for Pupillary changes. Pinpoint pupils indicate Morphine overdose.
• Have Naloxone available as an antidote and emergency equipment at bedside
if Opioid overdose occurs.
• Validate child’s and adult’s doses before administration.
• Administer anti-emetic along with opioids, as prescribed
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11. Teaching
• Instruct client to take medicines as prescribed, and not to increase
the dose or its frequency.
• Encourage client not to use alcohol or CNS depressants with narcotic
analgesics.
• Discourage client for driving or operating any machinery while
drowsiness, after taking narcotic analgesics.
• Encourage for high fiber diet such as whole grain cereals, fruits &
vegetables, drink 2-3 quarts of fluid daily.
• Suggest non-pharmacological measures to relieve pain
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12. Non-opioids/Non-narcotics
Non-opiods are less effective than narcotics.
Mechanism of action :
Decreases the level of prostaglandins hence reducing the pain.
• Prototype: Aspirin
Side Effects:
• Gastric irritation
• Anorexia, vomiting, rash
• It increases the risk for bleeding
• Nephrotoxicity
Contraindications
• Peptic ulcer disease
• Impaired renal functions
• Avoid aspirin in children having viral infection to reduce risk for Reye’s Syndrome.
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13. Non-opioids-- Aspirin
• Used as an analgesic, anti-inflammatory, antipyretic or anti-platelet.
• Enteric coated aspirin is slowly absorbed.
• Administer aspirin with meals to reduce gastric irritation.
• Monitor Platelet count (150-450)
• Manifestations of salicylism (Aspirin overdose) includes, Nausea,
vomiting, Fever, Fluid electrolyte imbalance, tinnitus, drowsiness,
confusion and hyperventilation.
• NSAIDs should be taken at least 30 mins to 2 hours after taking
Aspirin
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14. Non-opioids--Acetaminophen
• Acetaminophen is not NSAIDs and is used instead of NSAIDs to
decrease the risk for bleeding.
• It does not have anti-inflammatory property hence only used for pain
& fever.
• Usually used with the patients with hemophilia or peptic ulcers
• Avoid in patients with liver toxicity.
• ALT & AST are tested for acetaminophen overdose.
• Administer NSAID’s with food or full glass of water to reduce GI
irritation.
• E.g. Panadol & Tylenol
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15. 2 Anesthetics
Anesthesia cause loss of sensation with or without loss of
consciousness.
These are primarily used during surgical intervention.
It is divided into two main groups:
• Local
• General
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16. Lidocaine
• Most commonly used.
• Used as infiltration anesthesia in minor and brief surgical
interventions (Angio sheath removal, dental procedures etc.).
• Onset is 1-2 minutes after deposition near the nerve.
• The duration of action is approximately 90 min when used as an
infiltration. It is also used for spinal and epidural anesthesia
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17. Bupivacaine
• Used extensively for local and regional anaesthesia.
• The onset is short, and duration of action is considerably longer than
for lidocaine (up to 8h)
• It is also used for epidural and spinal anesthesia when a long
duration of action is required (longer surgeries
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18. Adverse Effects & Nursing Interventions
• CNS Toxicity: Numbness of tongue, tinnitus, slurred speech
• Cardiovascular Toxicity: Bradycardia, heart block, cardiac arrest,
hypotension
Nursing Interventions:
• Observe for CSF leakage and headache after spinal anesthesia
• and have the physician prescribe analgesics.
• Patient should void within 8 hours. If not, inform immediately
• Observe for allergic reactions
• Observe for systemic toxicity (CNS and Cardiac)
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19. Cont..
• Monitor client’s postoperative state of sensorium. Report if patient
stays non responsive for long.
• Record vital signs for cardiovascular and respiratory functions.
• Assess CNS function (avoid accidental fall, side rails up)
• Post operative pain management after recovery.
• Monitor GI/ GU functions:
• Bowel function
• Assess for nausea and vomiting (prevent aspiration) ---provide anti-
• emetic medications.
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20. ANTINEOPLASTIC
• Cisplatin, cyclophosphamide,
AlkylatingAgents
Antimetabolites
AntineoplasticAntibiotics
Mitotic Inhibitors
Hormones and Hormone
Modulators
Protein Tyrosine Kinase
Inhibitors
Epidermal Growth Factor
Inhibitor
Proteasome Inhibitor
• Bexarotene, hydroxyurea
Other antineoplastics
• Floxuridine, fluorouracil
• Bortezomib
• Bleomycin, mitomycin
• Vincristine, etoposide
• Triptorelin pamoate, flutamide
• Temsirolimus, lapatinib
• Erlotinib

21. 3.Anti-Neoplastic Drugs
• Cancer refers to uncontrolled growth of abnormal cells.
• Chemotherapy: Use of drugs to destroy cancer cells. However, these
drugs lacks selective toxicity (they are toxic to normal cells along with
abnormal cells)
• These are used to control and cure purpose both.
• Each dose kills some but not all malignant cells.
• Multiple chemotherapy agents are used to target different cell cycles.
* These drugs should be administered through Central venous access
devices (CVADs) to prevent vesicant drugs to damage small veins
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22. Adverse Reactions
1. Nausea, Vomitting,Anorexia
2. Weight loss
3. Bone marrow suppression
4. Stomatitis (oral inflammation and ulcerations)
5. Alopecia
6. Cardiac arrhythmias, ventricular failure
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23. Classification
1. Alkylating agents
2. Antimetabolites
3. PlantAlkaloids
4. AntitumorAntibiotics
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24. AlkylatingAgent
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Mechanism of action:
• It causes chromosome breakage (both at resting and replicating stages) and prevents the formation
of new DNA.
Examples:
• Chlorambucil, Cyclophosphamide
Adverse effects:
• Toxic metabolites are removed through kidneys and cause Cystitis
Nursing Care:
• Instruct patient to report dysuria and hematuria
• Encourage for increased fluid intake
• Check CBC

25. Antimetabolites
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Mechanism of action:
• These drugs resemble some of the cellular structures; after invading the cells, they inhibit
essential enzymes for DNAand RNAsynthesis
Examples:
• Methotrexate, Fluorouracil
Adverse effects:
• Bone marrow depression (especially with Methotrexate)--- Leucovorin, which saves
• the bone marrow cells from the effect of methotrexate, is administered along with it
• Renal injury (high doses)
Nursing Care:
• Monitor CBC
• Monitor renal function tests (BUN, Creatinine and I/O)

26. Plant Alkaloids
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Mechanism of action:
• Block mitosis by binding to the spindle fibres
Examples:
• Etoposide, Vinblastine, Vincristine
Adverse effects:
• Peripheral neuropathy and seizures, depression, muscle weakness, constipation, severe allergic
reactions (bronchospasm and skin rash as these are driven from plants)
Nursing Care:
• Monitor bowel function
• Frequent neuro checks
• Assess for mood status and depression
• Assess for, and teach signs of seizures

27. Anti-Tumor Antibiotics
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Mechanism of action:
• Inhibits DNAreplication
Examples:
• Doxorubicin, Daunorubicin
Adverse effects:
• Cardiac toxicity (most common)
• Bone marrow suppression
Nursing care:
• Monitor for dyspnea, crackles (due to decreased ejection fraction)
• Have complete cardiac examination done along with ECG and ECHO
• Check CBC
• Monitor IV site very carefully esp. with Doxorubicin, as it is a severe vesicant

28. Antidiabetic Drugs
Types of anti-diabetic agent
Insulin
RapidActing
ShortActing
Intermediate Acting
LongActing
Combinations
Oral Anti Diabetic
Sulphonylureas
Biguanides
(Glucophage)
Miglitinides
Alpha-glucosidase
Inhibitors
Thiazolidinediones
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29. Oral anti diabetic Drugs
Oral antidiabetic drugs are used to treat type 2 diabetes, which is
characterized by insulin resistance and high blood sugar levels.
Oral diabetes medications work in different ways to lower blood sugar,
including helping pancreas produce more insulin.
Beyond medication, exercise is a key part of naturally reducing insulin
resistance
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30. Cont..
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Side Effects:
• Common adverse effects include hypoglycemia, lactic acidosis, GI upset, nausea,
anorexia, diarrhea, heartburn, and allergic skin reaction.
• Pioglitazone is strongly linked with an increased risk of bladder cancer if it is used
for over 1 year.
• Rosiglitazone is linked with increased risk of cardiovascular problems.
Contraindication and Caution:
• Allergy to sulfonylureas and other anti-diabetic agents. Avoid
hypersensitivity reactions
• Type 1 diabetes. These patients do not have functioning beta cells and would
have no benefit from the drug.
• Pregnancy and lactation. Potential adverse effect on the fetus or neonate.

31. Insulin
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Classification Onset
of
Action
Duratio
n of
Action
Route Examples Considerations
RapidActing 5-15
min
3-5 hours SC Humalog (Lispro) Produces rapid
hypoglycemia. Must not
be given more than 5 min
before meal.
ShortActing 30 min-
1 Hr
5-8 hours SC/IV Humulin-R Can be given 30 min
before meal.
Intermediate
Acting
1-3 Hrs 12-16
hours
SC Humulin N It prolongs the action of
insulin hence given
regardless of the meal
time.
LongActing 4-8 Hrs Upto 24
hours
SC Glargine (Lantus) Usually given once daily
so it maintains blood
sugar levels for entire day.

32. Combination Insulin
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• These are mixed commercially.
• The onset of action is usually between 30-60 min and duration of action is 10-16
hours.
• Examples:
1. Humulin 70/30 (70% Humulin N & 30% Humulin R)
2. Humulin 50/50 (50% Humulin N & 50% Humulin R)

33. Side Effect of Insulin
• Hypoglycemia (Confusion,Agitation, Tremors, Headache,
weakness, lethargy, Fatigue)
• Redness, irritation or swelling at insulin injection site.
• Lipodystrophy: Degenerative changes in adipose tissue of the insulin
injection site
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34. Nursing Considerations for patientreceiving
Insulins
• Assess the patient’s blood sugar level before administering insulin
• Insulin injection sites should be rotated in order to prevent
lipodystrophy.
• Teach the patient to keep a candy with them to deal with subsequent
hypoglycemia.
• When mixing 2 insulin, regular insulin should be drawn first.
• If I/V insulin is given, watch for signs of hypokalemia.
• Smoking decreases insulin absorption, avoid that.
• Discard the vial if you notice any clumpy precipitate inside the insulin vial.
• *Glucagon is used for the treatment of severe hypoglycemia.
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35. Antihypertensive & Anti-Arrhythmic
1. Angiotensin converting enzyme inhibitors (ACEI)
2. Angiotensin II Receptor Blockers
3. Beta Blockers
4. Calcium channel blockers
5. Direct vasodilators
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36. Angiotensin converting enzyme inhibitors
(ACEI)
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Block the enzyme that converts angiotensin I to angiotensin II
(Angiotensin II is a potent vasoconstrictor + stimulatesAldosterone
production)
ACEIs act as antihypertensives by vasodilation and by decreasing
aldosterone production (decreased retention and more excretion of
sodium and water)
• Example: Captopril , Zestril
• Side Effects: Persistent dry cough or orthostatic
hypotension Can cause hyperkalemia

37. Angiotensin II Receptor Blockers
• ARBs are a class of antihypertensive medications that block the action
of angiotensin II by binding to its receptors.
• Angiotensin II is a hormone that causes blood vessels to constrict,
resulting in an increase in blood pressure.
• ARBs prevent angiotensin II from binding to its receptors, causing
blood vessels to relax and widen, reducing blood pressure.
Examples of ARBs include
losartan, valsartan, irbesartan, candesartan, Olmesartan, and
telmisartan
Side effects
• dizziness, headache, and hypotension.
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38. Beta Blockers
• Beta blockers are a class of medications that block the action of the hormone
adrenaline on the beta receptors in the heart and other parts of the body. This
results in decreased heart rate, decreased blood pressure, and decreased
myocardial contractility.
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Selective
•Decrease heart rate and blood pressure by
blocking the beta 1 receptors on heart and
blood vessels
Side Effects: Bradycardia, Hypotension,
Impotence or erectile dysfunction
Example Tenormin (atenolol) Concor
(Bisoprolol
Non Selective
These drugs block Beta 1and Beta 2
receptors--- Most profound side effect is
bronchospasm, because of which these are
avoided in patients with reactive airway
diseases like asthma.
Example Inderal (propanolol) Corgard
(nadolol)

39. Calcium Channel Blocking Agents
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Block calcium channels in blood vessels and heart, dilate peripheral arteries and
decrease peripheral vascular resistance by relaxing vascular smooth muscle.
Examples:
 Norvasc (amlodipine)
 Cardizem (diltiazem)
Side Effects:
• Orthostatic hypotension, Peripheral edema, Bradycardia or heart block with Non-
Dihydropyridines

40. Vasodilators
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Relax smooth muscle in blood vessels resulting in dilation and decreased peripheral vascular
resistance, resulting in decreased blood pressure
Reduce afterload so helpful in heart failure.
Examples:
• Apresoline (hydralazine)—IV, IM or PO (IV forms are given for hypertensive emergencies)
• Nitroglycerine– SublingualAngised, PO Isosorbide mononitrate,
•Nitroglycerine (GTN), GTN patches. Nitroglycerine is an anti anginal as well; it works by
vasodilating and thus increasing blood flow to the myocardium.
Side Effects: Throbbing headache, orthostatic hypotension.
Special Consideration
• These drugs should not be abruptly stopped, but these should be tapered gradually. Otherwise,
patient may develop rebound hypertension.
• Protect drug from sunlight to maintain drug potency.

41. Nursing Consideration
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1.Monitor blood pressure regularly to ensure it is within the therapeutic range.
2.Assess the patient's heart rate, rhythm, and blood pressure before administering medication.
3.Monitor for adverse effects, such as dizziness, lightheadedness, headache, nausea, and fatigue.
4.Instruct the patient to report any symptoms or changes in blood pressure.
5.Monitor for signs and symptoms of hypotension, such as weakness, fainting, and confusion.
6.Educate the patient about the importance of medication adherence, including the need to take medications at the
same time each day.
7.Counsel the patient on lifestyle modifications, such as a low-salt diet, regular exercise, and smoking cessation.
8.Monitor for drug interactions, especially with other antihypertensive medications, diuretics, or NSAIDs.
9.Monitor for electrolyte imbalances, especially with diuretics, and adjust medication dosages accordingly.
10.Educate the patient about potential adverse effects and the need to report any new or worsening symptoms to
their healthcare provider.

42. Anti-Arrhythmic
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Used for the treatment and prevention of cardiac rhythm disorders that
result from abnormality in electrical cardiac conduction system.
Examples:
• Quinidine, Lidociane, Procainamide.
• Amiodarone (Both atrial and ventricular dysrhythmias).
Nursing consideration:
• Instruct the patient to restrict coffee, cola or tea when receiving antiarrhythmic
drugs.

43. Adenosine
• Adenosine is a medication used primarily
for the treatment of supraventricular
tachycardia (SVT), which is a rapid
heartbeat originating from the upper
chambers of the heart.
• Side Effects
Flushing, Shortness of breath ,Chest
discomfort or pressure, Headache ,Dizziness
or lightheadedness
Nausea, Metallic taste in the mouth,
Sweating
Fatigue or weakness, Low blood pressure
• Amiodarone is used to treat life-
threatening heart rhythm problems called
ventricular arrhythmias.it is commonly use
in Arterial fibrillation.
• Side Effects
Tremor, SOB, sleep disturbance, peripheral
neuropathy, skin discoloration,
hyperthyroidism, bradycardia, hepatic
dysfunction.
Amiodarone

44. Adenosine
• Nursing Consideration
1. Adenosine should be administered rapidly over 1-2
seconds followed by as a bolus injection into a large
vein, preferably in the antecubital fossa or a central
venous line.
2. During administration, the patient should be closely
monitored for adverse effects such as flushing, chest
discomfort, shortness of breath, or palpitations.
3. Adenosine can cause transient heart block or
asystole, so it should only be administered in a
setting where cardiac resuscitation equipment and
personnel are available.
• Nursing Consideration
1. Monitor vital signs, especially
blood pressure and heart rate,
before and during administration.
2. Administer amiodarone according
to the prescribed dose and
schedule.
3. Monitor for adverse effects, such
as hypotension, bradycardia, and
pulmonary toxicity.
Amiodarone

45. Adenosine
• Nursing Consideration
4. It is important to inform the patient about the
temporary effects of Adenosine, such as a brief
period of asystole, and to reassure them that
normal heart rhythm will resume shortly.
5. Adenosine is rapidly metabolized in the body, so it
has a short half-life. The nurse should be prepared
to administer a second dose if necessary
• initial dose for adults is 6 mg, a second dose of 12 mg
can be given two minutes after the first dose. In some
cases, a third dose of 12 mg can be given two
minutes after the second dose.
• Nursing Consideration
4. Monitor electrolyte levels,
especially potassium and
magnesium, as amiodarone can
affect these levels.
5. Monitor liver function tests
regularly, as amiodarone can
cause liver toxicity.
Amiodarone

46. Definitions
Chronotropic: affecting heartrate
Positive Chronotropic increases heart rate Negative chronotropic decreases heart rate.
Inotropic: affecting contractility,
Positive Inotropic increases contractility Negative Inotropic decreases contractility.
Alpha-adrenergic stimulator-drugs that stimulate the alpha division of sympathetic nervous
system (causing vasoconstriction).
Alpha-adrenergic blocker: drugs that block the effects of alpha system (causing vasodilation).
Beta-adrenergic stimulator: drugs- that stimulate beta sympathetic system (causing increase
in heart rate, contractility, conduction through the AV node and bronchodilation).
 Beta-adrenergic blocker- drugs that effects the beta system (causing decreased heart)

47. Cardiotonic Drugs:
• Cardiotonic drugs are used to treat heart failure and arrhythmias.They increase the
strength and efficiency of heart contractions.
Examples Digitoxin digoxin milrinone
• They work by increasing the amount of calcium in heart muscle cells, which leads to
stronger contractions.
Side effects
Nausea, vomiting, diarrhea, headache, and dizziness.
Adverse Effects
CNS: headache, weakness, drowsiness, vision changes (most commonly reported is seeing
yellow halo around objects)
CV: arrhythmias
GI: GI upset, anorexia
NURSING ALERT! Signs and symptoms of digitalis toxicity: anorexia,
• nausea, vomiting, malaise, depression, hypokalemia, bradycardia, irregular heart
rhythms (e.g. heart block, heart arrhythmias, and ventricular tachycardia)
.

48. Inotropic Drugs
Inotropes are medications that increase the strength and force of heart contractions, and they
are commonly used in the treatment of heart failure and low blood pressure. The most
commonly used inotropes include dopamine, dobutamine, epinephrine, and norepinephrine.

49. Dopamine
• Dopamine is an endogenous catecholamine that acts as a neurotransmitter and hormone.
It is primarily used as an inotropic and vasopressor medication to treat low blood
pressure..
Mechanism of Action: Dopamine acts as an inotrope to increase cardiac output and
improve blood pressure by stimulating beta-1 adrenergic receptors in the heart. It also
dilates blood vessels to improve blood flow to vital organs.
Dosage and Administration:
•The initial dose of dopamine is usually 2-5 mcg/kg/min and can be increased gradually
up to 20-50 mcg/kg/min based on patient response.
Adverse Effects:
Tachycardia, Hypertension ,Dysrhythmias ,Nausea and vomiting , Headache ,Extravasation
may cause tissue damage

50. Cont.….
Nursing Considerations:
• Monitor vital signs frequently, including blood pressure, heart rate, and urine
output.
• Assess the patient for signs of extravasation, and if it occurs, discontinue the
infusion immediately and apply warm compresses to the affected area.
• Monitor for adverse effects, including dysrhythmias and hypertension.
• Dopamine should be used with caution in patients with a history of arrhythmias or
hypertension.
• Dopamine should not be mixed with other medications or solutions

51. Dobutamine
• Dobutamine is a synthetic catecholamine that stimulates beta-1 adrenergic receptors in
the heart, resulting in increased contractility and heart rate.
• It is used primarily in the management of heart failure and cardiogenic shock.
Side Effects:
Dobutamine can cause arrhythmias, so it should be used with caution in patients with pre-
existing arrhythmias or those at risk for arrhythmias..
Common side effects of dobutamine include headache, nausea, and palpitations.
Nursing Consideration
The medication should be discontinued immediately if the patient experiences chest pain,
shortness of breath, or other signs of a cardiac event.
Check the patient's fluid balance and urine output regularly, as dobutamine can increase
urinary output.

52. Epinephrine and Norepinephrine
Epinephrine Norepinephrine
Effects Acts on both alpha and beta adrenergic receptors Acts mainly on alpha adrenergic receptors
Mechanism of
Action"
Causes vasoconstriction and increases cardiac
output, blood pressure, and heart rate
Causes vasoconstriction and increases blood
pressure
Indication Used for anaphylaxis, cardiac arrest, and severe
asthma
Used for hypotension and septic shock
Side effects Side effects include anxiety, tremors, palpitations,
and hypertension
Side effects include headache, palpitations,
and hypertension
Nursing
considerations
Nursing considerations include monitoring vital
signs, administering through IV or IM route, and
being prepared to treat potential adverse
reactions
Nursing considerations include monitoring
vital signs, administering through IV route,
and being prepared to treat potential adverse
reactions.

53. DrugsAffecting Coagulation
• These groups of drugs affect clot formation and resolution by hindering different steps in
clotting formation which include;
Anti-Platelet Drug
•Platelets are released in the
presence of vascular injury.
They are attracted to injured
vessel walls and stick to them
forming a platelet plug. Drugs
in this category inhibit
platelets from gathering
together and sticking (platelet
aggregation) so preventing clot
from forming. Example: Aspirin
and Clopidogrel
Anti-Coagulant Drug
•Prevent the
formation of a clot
(thrombus) or
prevent the extension
of an existing clot
Example: heparin,
enoxaparin and
warfarin
Thrombolytic Agents
•These are only drugs
that can DISSOLVE A
CLOT. They are used
in cardiac and
neurological acute
events. Example:
Alteplase and
Streptokinase

54. Anti-Coagulants
Anticoagulants, commonly known as blood thinners, are chemical substances that prevent
or reduce coagulation of blood, prolonging the clotting time.
It is also given to CBR patients or Post-operatively to prevent Deep Vein Thrombosis (DVT).
Example:
• Heparin Warfarin
Side Effects
blood or coughing up blood. Heavy periods in women.
Hematuria Bleeding gums
Severe bruising Prolonged nosebleeds
Vomiting

55. Nursing Care of Anticogulaents
• Watch for the signs of bleeding.
• Check APTT level before starting heparin therapy.
• Do not use if sensitive to heparin, with bleeding disorders, severe thrombocytopenia, and
uncontrolled active bleeding.
• Educate patient on ways to promote safety like using electric razor, soft-bristled
toothbrush, and cautious movement because any injury at this point can precipitate
bleeding.
• Use cautiously in pregnant and postpartum patients and women older than age 60.
• Instruct patient to avoid green leafy vegetables, milk, tomatoes, banana and fish when on
warfarin therapy.
• Regular testing of the PT and INR is essential for all people taking warfarin.
• Antidote:
• Heparin: Protamine Sulphate. Warfarin:
• Vitamin K.

56. Diuretics
A diuretic is any substance that promotes diuresis, the increased production of urine.
Types:
•Loop Diuretics – Furosemide (Lasix)
•Thiazides (Hydrochlorothiazide)
•Potassium-Sparing Diuretics (Spironolactone)
•Osmotic Diuretics (Mannitol)
Side effects:
• Hearing loss. • Muscle cramps
• Dehydration. • Dizziness.
• Hypokalemia • Joint disorders (gout).
• Headaches.

57. Nursing Care Diuretics
• Nursing Care:
• Monitor weight daily.
• Strict intake and output charting.
• Check serum electrolyte levels.
• Follow blood urea nitrogen and creatinine levels regularly.
• Perform ECG monitoring as hypokalemia can cause intermittent PVC and U waves.
• Teach the patient that the medication must be continued so the fluid problem is
controlled.
• Reinforce dietary instructions for a client receiving Spironolactone to avoid taking
• this medication with high potassium fruits such as apricots, papaya, banana etc.

58. Female ReproductiveSystemDrugs
OXYTOCICS:
• These are uterine stimulants used in course of pregnancy, delivery and immediately
postpartum period.
Example
Dinoprostone, (PGE2)
Methergin, Synocinon pitocin (Oxytocin).
Adverse Effects:
General : Nausea, Vomiting (especially with PGE2), Headache, Weakness
Specific: : Pitocin causes Fetal Brady or tachycardia
Methergine causes Uterine rupture, transient chest pain, palpitations.
Oxytocin causes cardiac arrhythmias, hypertension, fetal bradycardia, N/V,
uterine rupture, pelvic hematoma, uternine hypertonicity

59. Nursing Care
• Monitor uterine contractions.
• Monitor B/P, maternal & fetal H/R. Discontinue drug if BP rises dramatically.
• Monitor vaginal bleeding.
• Dinoprostone and Synto should NOT be given in patient with history of previous
cesarean section.
• I/V Methergin is not routinely recommended, however, in case of life threatening
conditions it should be administered slowly over 1 hour with careful monitoring of
blood pressure. Moreover it is contraindication in 1st and 2nd stage of labor.
• Dinoprostone and Synto are indicated for induction of labor.

60. GI Drugs

61. Antiemetics---MechanismofAction
The vomiting center in the brainstem is triggered by various
stimuli, including chemical, mechanical, and emotional factors.
These stimuli activate receptors in the GI tract, vestibular system,
and chemoreceptor trigger zone.
Once the vomiting center is activated, it sends signals to various
organs and systems involved in the vomiting reflex. These
include the diaphragm, abdominal muscles, salivary glands, and
upper GI tract.
The coordinated contraction of the abdominal muscles and
diaphragm results in increased intra-abdominal pressure and
the forced expulsion of stomach contents. This is achieved by
the reverse peristaltic movement of the intestines.

62. Nursing Consideration with Anti Emetics
• Give anti emetics pre meals and maintain I/V hydration to prevent excessive fluid loss.
• Advise patient and family to use non pharmacological measures such as to begin with
sips of liquids, crackers, dry toast and small, non greasy meals; provide oral hygiene;
and remove noxious stimuli from environment. Take history and check hepatic
function and renal status, which may be the cause of vomiting.
• Monitor V/S, I/O and assess skin turgor.
• Some of the antiemetic drugs may cause drowsiness. So, instruct patient to call for
assistance when ambulating.
• Avoid activities that require alertness e.g. driving etc. after antiemetic administration.
• Watch for extrapyramidal symptoms when administering
metoclopramide.

63. Antidiarrheal drugs
• Treat diarrhea by decreasing hyper motility .
• Anti diarrheal should not be used for more than 2 days and should not be used if the client has fever
along with diarrhea (infective diarrhea).
Example: Loperamide (Imodium)
Nursing Care:
• Take history and determine the underlying cause of diarrhea.
• Monitor & Maintain fluid and electrolyte balance.
• Monitor V/S, I/O and bowel sounds.
• Encourage oral liquid intake, boiled water and washing fruits and vegetables well before eating.
• Cook vegetables and meat well.
• Clients with diarrhea should avoid milk (causes indigestion and bloating due to lack of lactase) & food
rich in fat (stimulates peristalsis).

64. Anti-Ulcer Drugs
• Gastric mucosal barrier is thick, viscous mucosal layer which provides barrier
between the mucosal lining and the gastric secretions against corrosive material.
Anti ulcer drugs prevent and treat ulcer disease by decreasing cell destructive
effects or increasing cell protective effects.
• These are:
Drugs that reduce acid secretion
Drugs that increase mucous secretion
Drugs that neutralize HCL
Drugs that remove H. Pylori

65. Cont.
Histamine (H2) receptorAntagonists:
• Histamine (H2)-antagonist directly inhibits histamine action on H2-receptors in parietal
cells. Thus, decreasing acid production and it’s concentration.
Example Ranitidine (Zantac)
Proton Pump Inhibitors:
• Suppresses gastric secretion by inhibiting the hydrogen/ potassiumATPase pump, which
acts as a proton pump. Its inhibition reduces HCl production.
Example:
Omeprazole (prilosec)
Esomeprazole (Nexium)

66. Mucosal Protective drugs
Bind with proteins at the ulcer site to form a viscous substance that covers and sticks to the
ulcer site and helps protect the ulcer from gastric acid and pepsin (acts locally).
Example: Sucralfate
Nursing care:
• Administer sucralfate on empty stomach.
• Administer other oral medications 2 hours before giving sucralfate to prevent drug
interaction, because sucralfate provides protective barrier to the GI mucosa.
Antacids
Promote ulcer healing by neutralizing acid in the stomach, by raising the stomach PH (to
alkaline)
Example: . Calcium Carbonate . Sodium bicarbonate
.

67. Nursing Consideration
• Educate the patient to report hematemesis, or malena.
• Avoid alcohol, smoking, caffeine, spicy food.
• Eat 5- 6 small meals instead of 3 large meals.
• PPIs should be taken 30 minutes prior to food ingestion, usually
before breakfast.
• Avoid antacids with drugs such as tetracycline, digoxin, iron, H2 receptor
antagonists b/c antacids inactivate these drugs.

68. NeuromuscularJunction Blocking Agent
Blocks nerve stimulation on muscle cells and cause paralysis of the muscles directly without total CNS
depression.
Examples:
• Succinylcholine
• Atracurium
Adverse Effects:
• Profound and prolonged muscle paralysis
• Respiratory paralysis characterized by depressed respiration, bronchospasm, and apnea.
• Prolonged drug use may cause GI paralysis, constipation, vomiting, regurgitation, aspiration
• Pressure ulcers may develop because patient loses reflex muscle movement that protects the
body.

69. Anti Convulsant
Adverse Reactions:
Depression, confusion, drowsiness, lethargy, fatigue, arrhythmias, changes
in blood pressure, constipation, dry mouth, anorexia, urinary retention, loss of
libido & Cellular toxicity which is characterized by severe liver toxicity, bone
marrow suppression, gingival hyperplasia, and serious dermatological reaction
(e.g. hirsutism, Steven-Johnson syndrome).
Antidote:
Antidote for toxic Benzodiazepine is Flumazeni

70. Anticholinergics
Anticholinergics are drugs that oppose the effects of acetylcholine. In essence, they also
lyse and block the effects of parasympathetic nervous system (PNS) so they are also called
as para-sympatholytics.
Atropine is currently the only widely used anticholinergic drug. It is the drug of choice to
treat symptomatic bradycardia in adults. Also, it is used as an antidote for cholinergic
overdose.
Other common examples include ipratropium.
Adverse effects:
Blurred vision, pupil dilation, photophobia, increased intraocular pressure, dizziness,
tachycardia, palpitation, dry mouth, Urinary hesitancy and retention.

71. Antiviral