Pharmacology
STUDENT ACTIVITY SHEET
BS NURSING / SECOND YEAR
Session 1
LESSON TITLE: INTRODUCTION TO PHARMACOLOGY
Materials:
LEARNING OUTCOMES:
Notebook, pens ,paper and index card
At the end of the lesson, the nursing student can:
1.
2.
3.
4.
References:
Differentiate the three phases of drug action;
Describe the four processes of pharmacokinetics;
Explain the meaning of pharmacodynamics
Define the terms half- life, therapeutic index,
therapeutic drug range, side effects, adverse reaction
and drug toxicity.
Kee, Joyce LeFever, Hayes, Evelyn R. &
McCuistion E. Pharmacoloy A Nursing
Process Approach 6th edition.. Singapore:
Elsevier Saunders Company.
SUBJECT ORIENTATION & GETTING TO KNOW EACH OTHER ACTIVITY (20 minutes)
You will now take note everything about the subject orientation
1.
2.
3.
4.
5.
6.
Calendar of activities
Classroom rules and regulations
Computation of grades
Grading of modules
Election of officers
Requirements – Drug study per period/ term
MAIN LESSON (45 minutes)
THREE PHASES OF DRUG ACTION
1st
Pharmaceutic
Solid form
Liquid form
2nd
Pharmacokinetics
Absorption
Distribution
Metabolism /
Biotransformation
Excretion
3rd
Pharmacodynamics
Drug action : onset, peak &
duration
Receptors
Enzymes
Hormones
I. Pharmaceutic Phase
o Disintegration – is the breakdown of tablet into smaller particles
o Dissolution - dissolving of the smaller particles in the GI fluid before absorption
o 1st phase of drug action
o Rate limiting – time it takes for the drug to disintegrate and dissolve to become available for the body to absorb it.
II. Pharmacokinetic Phase
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Is the process of drug movement to achieve drug action
2nd phase of drug action
What the body does to the drug- refers to the study of how the body processes drugs
It includes the 4 basic components of :
1. Absorption
2. Distribution
3. Metabolism (Biotransformation)
4. Excretion
1. Absorption – the movement of drug particles from the G.I. tract to body fluids by :
a. Passive absorption
b. Active absorption
c. Pinocytosis
a. Passive absorption
o Movement of a drug from the site of administration into the bloodstream.
o Absorption determines how long it takes for a drug to take effect.
o Usually the more rapid the absorption, faster the drug works
o Drugs can be absorbed through plasma primarily by: Diffusion (movement from higher concentration to lower
concentration)
o Does not require energy to move across the membrane.
b. Active absorption
o Requires a carrier such as an enzyme or protein
o Energy is required for active absorption
c. Pinocytosis
o Process by which cells carry drug across their membrane by engulfing the drug paticles
Factors Affecting Absorption
o Surface area
o Contact time with surface
o Circulation
o Solubility (water soluble vs lipid soluble)
o Ionization (weak versus strong acid/base)
o Drug form & drug concentration
o Bioavailability ( after first pass thru liver)
o Route of administration (enteral & parenteral)
o Additives: alter the location of disintegration of drugs as well as increase or decrease the rate of absorption
o Enteric coating allows a drug to dissolve only in an alkaline (pH greater than 7.0) environment such as the
small intestine.
o Sustained release drugs:allow drugs to be released slowly over time, rather than quickly, like conventional
tablets.
o Size of drug particles: smaller the particle, faster the onset.
Drug Absorption varies by form
Liquids, elixirs, syrups
Fastest
Suspension solutions
Powders
Capsules
Tablets
Coated tablets
Enteric-coated tablets
Slowest
2. Distribution: the transport of drugs from the blood to the site of action. A drug must be distributed to its site of action
to have an effect
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Drugs are also distributed to tissues where it has no effect. Competition for drug binding sites affects the amount
of drug available for action in the body.
Volume of Distribution (Vd) - The degree of distribution of a drug into various body compartments and tissue
Factors Affecting Distribution
1. Perfusion Rate
2. Permeability of Membranes
3. Protein binding
4. Tissue Localization
5. Blood Brain Barrier
6. Placenta
3. Metabolism (breakdown of the drug)
o Biotransformation: process by which the body changes the chemical structure of a drug to another form called a
metabolite.
o Metabolite: a more water soluble compound that can be easily excreted. The major organ for this process is the
liver
o First Pass Phenomenon - Drugs are first absorbed through the small intestine then arrive at the liver via the
portal circulation
o There they undergo considerable biotransformation before entering the systemic circulation.
o There will be less active drug available for action in the body cells after this first Pass through the Liver
Variations in Metabolism
o Pharmacogenetics - hereditary influences on drug responses, refers to variations in which individuals
metabolize drugs.
o Circadian Rhythms - the rate of drug absorption, hepatic clearance, half-life and duration of action, have all
been shown to differ depending upon the time of day a drug is administered.
o Effects of Gender and Age
Elimination of the drug from the body is directly influenced by age. Newborns and elderly experience the
effects of drugs for longer and the drug takes a lot longer to be eliminated from the body.
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Newborns : When babies are born to term, their renal function is very quick to establish similar levels to adults within
one week after birth. If the baby is born prematurely it can take 8 weeks or more to reach the level of enzymes
necessary. If drugs are given before the renal function is at this level, the drug elimination from the body takes a lot
longer and so do the effects of the drugs.
Elderly : Renal filtration rate begins to decline at 20 years of age and by 50 years of age it has declined by 50%. This
again will affect the elimination of drugs from the body.
4. Excretion: process where drugs are removed from the body. Kidneys are the major organs of excretion.
o Lungs excrete gaseous drugs.
o Biliary excretion (bile & feces) is important for a few drugs. These drugs may be reabsorbed when passing
through the intestines from the liver ( enterohepatic re-circulation ).
o Intestines, sweat, saliva and breast milk constitute minor routes of drug excretion
o Clearance of drugs - elimination of drugs from circulation by all routes. It affects the time a drug remains in the
body and the dosage required.
Renal Clearance
Hepatic clearance
PLASMA HALF-LIFE
o The elimination half-life of a drug is a pharmacokinetic parameter that is defined as the time it takes for the
concentration of the drug in the plasma or the total amount in the body to be reduced by 50%. In other words,
after one half-life, the concentration of the drug in the body will be half of the starting dose.
o Drugs with short half-lives are quickly eliminated from the body. ( Ex: analgesics : given several X per day )
o Drugs with longer half-lives stay in the body longer
(Ex: Digoxin given once a day )
III.
PHARMACODYNAMIC PHASE
o
What a drug does to the body- refers to the study of the mechanism of drug action on living tissue.
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Drugs may increase, decrease or replace enzymes, hormones or body metabolic functions.
Chemotherapeutic drugs alter an abnormal parasite or growth on the body such as bacteria, viruses or neoplastic
tissue. examples: antibiotics and antineoplastic drugs.
Effects of Drugs
 Therapeutic / Desired effect
a. curative (cures a disease or condition)
b. supportive (supports a body function until other treatments or the body's response can take over
c. substitutive (replaces body fluids or substances)
d. chemotherapeutic (destroys malignant cells)
e. restorative (returns the body to health)
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Adverse drug reaction (ADR) is an unwanted or harmful reaction experienced following the administration of a
drug or combination of drugs under normal conditions of use and is suspected to be related to the drug. An ADR
will usually require the drug to be discontinued or the dose reduced.
Adverse event is harm that occurs while a patient is taking a drug, irrespective of whether the drug is suspected
to be the cause.
Side-effect is any effect caused by a drug other than the intended therapeutic effect, whether beneficial, neutral
or harmful. The term ‘side-effect’ is often used interchangeably with ‘ADR’ although the former usually implies an
effect that is less harmful, predictable and may not even require discontinuation of therapy (e.g. ankle oedema
with vasodilators).
Drug toxicity describes adverse effects of a drug that occur because the dose or plasma concentration has risen
above the therapeutic range, either unintentionally or intentionally (drug overdose).
Drug abuse is the misuse of recreational or therapeutic drugs that may lead to addiction or dependence, serious
physiological injury (such as damage to kidneys, liver, heart), psychological harm (abnormal behavior patterns,
hallucinations, memory loss), or death.
Hypersensitivity / allergy: exaggerated adverse reaction to drug
CHECK FOR UNDERSTANDING (20 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not
allowed. You are given 25 minutes for this activity:
Multiple Choice
1. What is pharmacokinetics?
a. The study of biological and therapeutic effects of drugs
b. The study of absorption, distribution, metabolism and excretion of drugs
c. The study of mechanisms of drug action
d. The study of methods of new drug development
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. The interaction of one drug increased by the presence of a second drug is known as:
a. Potentiation
b. Addictive effects
c. Antagonism
d. Synergism
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________
3. Considering the absorption of medications during administration, which of the following routes would yield the quickest
response?
a. Oral Medications
b. Subcutaneous injections
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c. Intravenous medications
d. Topical medications
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________
4. Which of the following best defines the process of pharmacokinetics?
a. The effect of medication on the body
b. The effect of the body on medication
c. The study of medications
d. The preparation of medications for administration
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________
5. When performing an assessment about medication drug history should include which of the following?
a. Complete vital signs
b. Reason for medication
c. Client’s goal therapy
d. Administration of OTC medications
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________
6. When considering the pharmacotherapeutic effects of drugs administered to clients, the nurse considers which
property of most Importance:
a. Efficacy
b. Potency
c. Interaction with other drugs
d. Toxicity
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________
7. Safety of a drug is determined by the degree between which of the following?
a. Therapeutic and toxic doses
b. Potency and efficacy
c. Subtherapeutic and toxic levels
d. Side and adverse effects
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________
8. The nurse is monitoring the therapeutic drug level for a client on vancomycin (Vancocin) and notes that the level is
within the acceptable range. What does this indicate to the nurse? Select all that apply.
a. The drug should cause no toxicities or adverse effects
b. The drug level is appropriate to exert therapeutic effects
c. The dose will not need to be changed for the duration of treatment
d. the nurse will need to continue monitoring because each client response to a drug is unique
ANSWER: ________
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RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________
9. When a drug is 50% protein bound it means that:
a. 50% of the drug destroys protein
b. A drug not bound to protein is an active drug
c. 50% of the dose is at work
d. Protein must be restricted in the diet
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________
10. When reviewing the patient’s medication regimen, the nurse understands that the interval of drug dosage is related to
what?
a. Half-life
b. Biotransformation
c. Metabolism
d. Therapeutic effect
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________
11. It is important for the nurse to be aware of the four sequential processes of the pharmacokinetic phase. What are
these processes?
a. Distribution, metabolism, excretion, absorption
b. Biotransformation, excretion, absorption, metabolism
c. Absorption, distribution, metabolism, excretion
d. Metabolism, distribution, absorption, excretion
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________
12. The nurse is teaching the client about newly prescribed medication. Which statement made by the client would
indicated the need for further medication education?
a. "the liquid form of the drug will be absorbed faster than the tablets."
b. "If I take more, I'll have a better response"
c. "taking this drug with food will decrease how much gets into my system."
d. "I can consult my health care provider if i experience unexpected adverse effects"
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________
13. The nurse is caring for several clients. Which client will the nurse anticipate is most likely to experience an alteration in
drug metabolism?
a. A 3 day old premature infant
b. A 22 year old pregnant female
c. A 32 year old man with kidney stones
d. A 50 year old executive with hypertension
ANSWER: ________
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RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________
14. A client is being discharged from the hospital with a nebulizer for self-administration of inhalation medication. Which
statement made by the client indicates to the nurse that the client education has been successful?
a. "Inhaled medications should only be taken in the morning."
b. "Doses for inhaled medications are larger than those taken orally"
c. "Medicines taken by inhalation produce a very rapid response."
d. "Inhaled drugs are often rendered inactive by hepatic metabolism reaction”
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________
15. The Nurse is caring for a client with hepatitis and resulting in hepatic impairment. The nurse would expect the duration
of action for most medications to:
a. Decrease
b. Improve
c. Be unaffected
d. Increase
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
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2. ANSWER: ________
RATIO:_______________________________________________________________________________________
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3. ANSWER: ________
RATIO:_______________________________________________________________________________________
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4. ANSWER: ________
RATIO:_______________________________________________________________________________________
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5. ANSWER: ________
RATIO:_______________________________________________________________________________________
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6. ANSWER: ________
RATIO:_______________________________________________________________________________________
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7. ANSWER: ________
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RATIO:_______________________________________________________________________________________
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8. ANSWER: ________
RATIO:_______________________________________________________________________________________
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9. ANSWER: ________
RATIO:_______________________________________________________________________________________
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10. ANSWER: ________
RATIO:___________________________________________________________________________________________
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11. ANSWER: ________
RATIO:___________________________________________________________________________________________
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12. ANSWER: ________
RATIO:___________________________________________________________________________________________
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13. ANSWER: ________
RATIO:___________________________________________________________________________________________
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14. ANSWER: ________
RATIO:___________________________________________________________________________________________
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15. ANSWER: ________
RATIO:___________________________________________________________________________________________
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LESSON WRAP-UP (5 minutes)
You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.
You are done with the session! Let’s track your progress.
Muddiest Point
In today’s session, what was least clear to you?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
For next session, review Principles of Drug Administration, Dosage Calculations
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Pharmacology
STUDENT ACTIVITY SHEET
BS NURSING / SECOND YEAR
Session 2
LESSON TITLE: PRINCIPLES OF DRUG ADMINISTRATION/
DOSAGE CALCULATIONS
Materials:
Book, pen, notebook and index card
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. List safety guidelines for drug administration;
2. Differentiate the routes of administration.; and,
3. Identify nursing interventions related to administration
of medications by various routes.
4. Enumerate three systems of measurement;
5. Convert measurements within the different systems of
measurement;
6. Calculate the correct dose of a drug when given
examples of drug orders and available forms of the
drug ordered; and,
7. Discuss why children require different dosage of drugs
than adult.
References
Hayes, Evelyn R. Pharmacology: A Nursing
Process Approach: 6th Edition. Singapore:
Elsevier Saunders Company.
Karch, Amy M. Focus on Nursing Pharmacology
5th edition. Philedelphia: Lippincott William
and Wilkins
Kozier, Barbara, et.al. Fundamentals of Nursing
Concepts, Process and Practice: 8th Edition.
New Jersey: Pearson Hall.
LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY PRE TEST (15 minutes)
PRE TEST
You may now answer the 20 items pretest. Please follow instructions. Use black ballpen and No erasures. You are given
15 minutes to answer.
I. IDENTIFICATION. Fill each blank with the correct answer. Write your answers on the space provided.
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9. _______________ is the most common form of drug.
10. __________________ are medications and fluids administered directly into the bloodstream and are immediately
available for use by the body.
II.
Convert the given measures to new units. Write your answers on the space provided for each number. No
erasures.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
1 kg
1 tsp
1L
1 kg
1 oz
1g
1 mg
1 tbsp
1 cup
1 pint
12 inches
1 tbsp
1 cc
8 oz
=
=
=
=
=
=
=
=
=
=
=
=
=
=
_____ lb
_____ mL
_____ mL
_____g
_____ mL
_____mg
_____mcg
_____mL
_____fl oz
_____cups
_____foot
_____ tsp
_____ mL
_____mL
1 tsp
= _____gtt
MAIN LESSON (40 minutes)
Principles of Drug Administration
To provide safe drug administration, the nurse should practice the “rights” of drug administration. They are:
1. The right client
2. The right drug
3. The right dose
4. The right time
5. The right route
Experience indicates that five additional rights are essential to professional nursing practice:
1. The right assessment
2. The right documentation
3. The client’s right to education
4. The right evaluation
5. The client’s right to refuse
I. The right client needs to be ensured by checking the wrist band, and by checking a second piece of identification. This
could be a picture on the chart, or a case number that is both on his chart and wristband. This must be done before any
medication is administrated.
II. The right drug means that the client receives the drug that was prescribed by a physician (MD), dentist (DDS), podiatrist
(DPM), or an advanced practice nurse with the license to write prescriptions (APRN).
 The use of computerized systems to record medications has helped to decrease medication errors, because nurses
are not trying to read written forms of the prescriptions. Dr.’s can electronically add a new medication order to a pt.
chart from any location.
 If there is a phone order or verbal order it must be cosigned by the prescribing physician within 24 hours.
 The components of a drug order are as follows:
 Date and time the order is written
 Drug name (generic is preferred)
 Drug dosage
 Route of administration
 Frequency and duration of administration (e.g, x 7 days, x 3 doses)
 Any special instructions for withholding or adjusting dosage based on nursing assessment, drug effectiveness,
or laboratory results
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 Physician or other health care provider’s signature or name if TO or VO
 Signatures of licensed practitioners taking TO or VO.
* If any of these components are missing, the entire order is incomplete and the medication should not be given.
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To avoid error, the nurse must check the bottle against the order for the medication three different times.
1. at the time of contact with bottle or container
2. before pouring the drug, and
3. after pouring the drug.
Drugs given for the first dose, one-time or PRN medication should always be checked against the original order.
Beware of medications that sound alike, and read the labels carefully.
 For example, Percocet contains oxycodone and acetaminophen. Percodan contains oxycodone and aspirin. Percodan
should not be given to someone who has an adverse reaction to aspirin.
Nursing implication includes the following:
1. Check that medication order is complete and legible
2. Know why the client is receiving the medication
3. Check the drug label three times before administration
4. Know the start date that the drug was ordered and the ending date
The following are the four categories of drug orders:
1. Standing orders
2. One-time (single dose)
3. PRN
4. STAT (at once)
III. The right dose is the dose prescribed for a particular client. The nurse is responsible for questioning any dose that looks
too high or too low. Always consult a peer or pharmacist if the dosage appears incorrect. Beware of pediatric doses that are
based on body weight. Weights can change daily so regular assessment of dosages is crucial.
The nursing implications include the following:
a. Calculate the drug dose correctly. For some medications, two nurses are needed to sign off on a new order such a
heparin and insulin.
b. Check the PDR, American hospital formulary, drug package inserts, or other drug references for recommended
range of specific drug doses.
IV. The right time is the time at which the prescribed dose should be administered.
– Nursing implications include the following:
1. Administer drugs at the specified times. Drugs may be given 0.5 hour before or after the time prescribed if the
administration interval is > 2 hours.
2. Administer drugs that are affected by foods, before meals (e.g. tetracycline).
3. Administer drugs that can irritate the stomach (gastric mucosa) with food such as aspirin or potassium.
4. The drug administration schedule can sometimes be flexible in order to accommodate the client’s activities for the day
or preferences.
5. It’s the nurse’s responsibility to be aware of test’s or procedures that are taking place that may affect the medication
administration. (e.g, fasting blood tests, endoscopy)
6. Check the expiration date on medications and return to pharmacy if expired.
7. Antibiotics need to be given evenly over 24 hours as opposed to T.I.D
V. The right route is necessary for adequate or appropriate absorption.
– The following are the nurse’s implications with regard to route:
1. Assess client’s ability to swallow before administering p.o.
2. Do not crush or mix medications into other substances before consultation with the pharmacy. Do not mix meds into
sweetened juices for kids or add to formula for babies. Follow all med administration guidelines for that specific drug.
3. Use aseptic technique when administering drugs. Use sterile technique when administering parenteral meds.
4. Administer drugs to appropriate sites.
5. Stay with client until p.o meds have been swallowed.
6. If it’s necessary to combine a medication with another substance, explain this to the client.
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FORMS AND ROUTES FOR DRUG ADMINISTRATION
Medication safety tips.
1. Avoid distractions.
 The hospital is full of interruptions and distractions. In fact, several studies have concluded that these factors
account to around 45-50% of medication errors.
 Focus. Distractions during medication preparation and administration can cause errors.
 Distractions : From ringing telephones, alarming call bells to short-tempered patients, all of these things can
easily disrupt your focus. Even your co-nurses and patients can take your mind off of what you’re doing.
 Because these factors are hard to eliminate altogether, reaching an agreement with your colleagues can help.
You can ask them to handle patients’ concerns as you focus on preparing and administering the due
medications. Once it’s their turn to administer, offer to attend to your patient’s other needs.
2. Know your Rs.
 The Rights of Drug Administration aren’t that hard to memorize. Putting them into practice, however, can be a
different story particularly if it’s the first time you’re administering a medication.
 The anxiety, fear and tension can easily put you at risk of committing an error. Because of this vulnerability,
certain hospitals implement policies to help new nurses hone their skills without risking the welfare of their
patients.
 Know the 10 rights of drug administration.
3. Always ask and countercheck.
 More often than not, medication errors involve miscommunication and false assumptions.
 If you can’t read your doctor’s handwriting, there’s nothing wrong in verifying it with the doc. Getting shouted by
an annoyed doctor is better than a dead patient.
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“…IT IS STANDARD PRACTICE TO FOR ANOTHER NURSE TO RECOMPUTE AND DOUBLE CHECK IT.”
 In case you are sure or unsure of your calculations, it is standard practice to for another nurse to recompute
and double check it. Any miscalculation can lead to potentially debilitating effects on your patient.
4. Stay updated.
 With a very busy shift, it can be hard to keep up with every update doctors write on your patients’ charts. One
of the best ways you can address this is through a process called Medication Reconciliation. It involves creating
a complete list of medications your patient is receiving and constantly updating the list as transition of care
happens or if there are any changes in his medication chart.
5. Label properly.
 Each hospital has its own policy when it comes to labeling medications. Generally, however, it’s a universal
practice to keep every syringe, vial or container properly labeled to avoid medication error.
 Label your ports and medications. Make it a point to label every syringe or container that has medication in it.
Even bowls, catheters and receptacles have labels on them just to make sure
6. Report.
 In case an error does happen, make it a point to report the incident. Notify all the members of the health team
in charge of the patient’s care as well as the hospital safety committee.
 Depending on your institution’s policy, you may also need to inform the relatives of the patient as to what went
wrong and how was the error managed. A research from the University of Michigan showed that the more the
families are informed about an error, the less likely they are to react legally.
7. Check on antidotes.
 The wrong drug and route can pose fatal risks to your patients. Some incident can even lead to loss of lives,
particularly if not handled correctly.
 This makes preparation and readiness critical. Aside from emergency drugs, have the basic antidotes on stock.
Keeping them within easy reach will enable you to respond quicker to emergent cases.
MEASURING SYSTEMS
1. Metric system
2. Apothecary system
3. Household system
I. Metric System – is a decimal system based on the power of ten. The basic unit of measurement are:
a. Gram for weight
b. Liter for volume
c. Meter for linear measurements or length
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II. Apothecary System
o Solids: grain (gr)
60 gr = 1 dram (dr)
8 dr = 1 ounce (oz)
o Liquids: minim (min)
60 minim = 1 fluidram (f dr)
8 f dr = 1 fluidounce (f oz)
III. Household System
o Solids: pound (lb)
1 lb = 16 ounces (oz)
o Liquids: pint (pt)
2 pt = 1 quart (qt)
4 qt = 1 gallon (gal)
16 oz = 1 pt = 2 cups (c)
32 tablespoons (tbsp) = 1 pt
3 teaspoons (tsp) = 1 tbsp
60 drops (gtt) = 1 tsp
Methods for Calculation / Drug Calculations
Tablet Dosage Calculations
This formula is used to calculate the number of tablets to be administered when given the required dose.
Required Dose
------------------ = Number of tablets to be given
Stock Dose
Units for required dose and stock dose must be the same.
Example 1:
A client is ordered 150mg of aspirin. 300 mg aspirin tablets are available. How many tablets would you give?
150 mg
------------------ = 1/2 tablet
300 mg
Example 2:
How many tablets containing 62.5 mcg will be required to give a dose of 0.125 mg?
STEP 1: CONVERT TO SAME UNITS (Convert 0.125 mg to mcg)
The decimal place is moved 3 places to the right. 0.125 mg = (0.125 * 1000 mcg) = 125 mcg
STEP 2: CALCULATE
125 mcg
------------------ = 2 tablets
62.5 mcg
OR
Convert 62.5 mcg to mg.
The decimal place is moved 3 places to the left; 62.5 mcg = (62.5 * 0.001 mg) = 0.0625 mg
STEP 3: CALCULATE
0.125 mg
------------------ = 2 tablets
0.0625 mg
Fluid Dosage Calculations
This formula is used to calculate the amount of medication in solution for oral, intramuscular, intravenous or subcutaneous
injection to be administered when given a dosage, stock dose and volume:
Required Dose
Stock Volume
---------------------- X ---------------------- = Volume to be given
Stock Dose
1
Units for required dose and stock dose must be the same.
Example1:
A client is ordered 15mg of Stemetil. You have 2ml of solution on hand which contains 25 mg Stemetil. What volume of
solution would you give?
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15 mg
2 ml
30
------------- X --------- = ------ = 1.2 ml
25 mg
1
25
Example 2:
A dose of 75 mg of pethidine has been ordered. It is available in ampules containing 100 mg in 2 ml. How much are you
going to administer ?
75 mg
2 ml
150
------------- X ------ = --------- = 1.5 ml
100 mg
1
100
Intravenous Fluid Computation
Intravenous fluid must be given at a specific rate, neither too fast nor too slow. The specific rate may be measured as
ml/hour, L/hour or drops/min. To control or adjust the flow rate only drops per minute are used. The burette contains a
needle or plastic dropper which gives the number of drops per ml (the drop factor). A number of different drop factors are
available (determined by the length and diameter of the needle).
Common drop factors are:
10 drops/ml (blood set), 15 drops / ml (regular set), 60 drops / ml (microdrop).
To measure the rate we must know:
a. the number of drops
b. time in minutes.
The formula for working out flow rates is:
Example:
1500 ml IV Saline is ordered over 12 hours. Using a drop
factor of 15 drops / ml, how many drops per minute needs to
be delivered?
volume (ml) X drop factor (drops/ml)
---------------------------------------------time (min)
= drops / minute
1500 (ml) X 15 (drops/ml)
---------------------------------------------- = 31 drops / minute
12 x 60 (gives us total minutes)
22,500 ml
720 min
CHECK FOR UNDERSTANDING (30 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not
allowed. You are given 25 minutes for this activity:
Multiple Choice
1. The nursery nurse is putting erythromycin ointment in the newborn’s eyes to prevent infection. She places it in the
following area of the eye:
a. Under the eyelid
b. On the cornea.
c. In the lower conjunctival sac
d. By the optic disc.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. Nursing responsibilities in the assessment phase of the nursing process include which responsibilities? (Select all that
apply.)
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a. Identify side effects of drugs that are nonspecific
b. Check peak and trough levels of drugs
c. Advise client to avoid fatty foods prior to ingesting an enteric coated tablet
d. Evaluate client's reaction to drug
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. The nurse is aware of the many factors related to effective health teaching about the medication. The most essential
component of the teaching plan is to do which?
a. Provide written instructions.
b. Establish a trust relationship.
c. Use colorful charts.
d. Review community resources.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. A medication health teaching plan is tailored to a specific client. Common topics for health teaching include which?
(Select all that apply.)
a. Importance of adherence to the prescribed regimen
b. How to administer medication (s)
c. What side/adverse effects to report to the health care provider
d. Instruction of the client on what foods should be eaten
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. The nurse educator on the unit receives a list of high-alert drugs. Which strategies are recommended to decrease the
risk of errors with these medication? (Select all that apply.)
a. Store medications alphabetically on their usual shelf.
b. Limit access to these drugs.
c. Use special labels.
d. Provide increased information to staff.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. Nurse is preparing to administer a medication to a 13-year-old client. The nurse follows the six rights of medication
administration for a pediatric client. After checking for the right client, the right dose, the right drug, the right time and the
right route, what is the final item the nurse must check for this client?
a. Right age
b. Right Label
c. Right Documentation
d. Right strength
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7.
a.
b.
c.
When performing an assessment about medication, the drug history should include:
Complete vital signs
Client’s goal of therapy
Reason for medication
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d. Administration of OTC medications
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. The volume of SC medication must be no more than:
a. 0.5 mL
b. 1.0 mL
c. 1.5 mL
d. 3.0 mL
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. Which of the following muscles is a possible site for IM injections?
a. Outer aspect of the hip
b. Shoulder
c. Vastus gluteus
d. Vastus lateralis
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10.When deciding on what time of day to give medications, the nurse pays closest attention to the client’s habits
regarding:
a. Eating
b. Sleeping
c. Elimination
d. Activity
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
________________________________________________________________________________________________
11. Doctor’s Order: Tylenol supp 1 g pr q 6 hr prn temp > 101; Available: Tylenol supp 325 mg (scored). How many supp
will you administer?
a. 2 supp
b. 1 supp
c. 3 supp
d. 5 supp
ANSWER: _______
COMPUTATION :
12. Doctor’s Order: Nafcillin 500 mg po pc; Available: Nafcillin 1 gm tab (scored). How many tab will you administer per
day?
a. 2.5 tabs
b. 2 tabs
c. 1.5 tabs
d. 1 tab
ANSWER: _______
COMPUTATION :
13. Doctor’s Order: Synthroid 75 mcg po daily; Available: Synthroid 0.15 mg tab (scored). How many tab will you
administer?
a. 1 tab
b. 0.5 tab
c. 2 tabs
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d. 1.5 tabs
ANSWER: _______
COMPUTATION :
14. Doctor’s Order: Diuril 1.8 mg/kg po tid; Available: Diuril 12.5 mg caps. How many cap will you administer for each
dose to a 31 lb child?
a. 2 caps
b. 2.5 caps
c. 3 caps
d. 1.5 caps
ANSWER: _______
COMPUTATION :
15. Doctor’s Order: Cleocin Oral Susp 600 mg po qid; Directions for mixing: Add 100 mL of water and shake vigorously.
Each 2.5 mL will contain 100 mg of Cleocin. How many tsp of Cleocin will you administer?
a. 3 tsp
b. 5 tsp
c. 3.5 tsp
d. 1 tsp
ANSWER: _______
COMPUTATION :
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
6. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
7. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
8. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
9. ANSWER: ________
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PHINMA Education (Department of Nursing)
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RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
10. ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________________________________________
11. ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________________________________________
12. ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________________________________________
13. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________________
14. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________________
15. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________________
LESSON WRAP-UP (5 minutes)
You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.
You are done with the session! Let’s track your progress.
3-2-1
Three things you learned:
1. _____________________________________________________________
2. _____________________________________________________________
3. _____________________________________________________________
Two things that you’d like to learn more about:
1. _____________________________________________________________
2. _____________________________________________________________
One question you still have:
1. _____________________________________________________________
For the next session review Anti-Infective Agents, Antibiotics
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Pharmacology
STUDENT ACTIVITY SHEET
BS NURSING / SECOND YEAR
Session 3
LESSON TITLE: ANTI-INFECTIVE AGENTS/ ANTIBIOTICS
Materials:
LEARNING OUTCOMES:
Book, Notebook, pens & paper
At the end of the lesson, the nursing student can:
1. Differentiate broad spectrum and narrow spectrum
drugs;
2. Define bacterial resistance to antibiotic; and,
3. Explain ways to minimize bacterial resistance.
4. Explain how an antibiotic is selected for use in a
particular clinical situation;
5. Develop a drug study guide. (therapeutic action,
indication, contraindication, most common adverse
reaction and nursing responsibility) of the different
classes of antibiotics; and,
6. Discuss the use of antibiotics across the lifespan.
References:
Hayes, Evelyn R. Pharmacology: A Nursing
Process Approach: 6 th Edition. Singapore:
Elsevier Saunders Company.
Karch, Amy M. Focus on Nursing Pharmacology
5th edition. Philedelphia: Lippincott William
and Wilkins
LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY (10 minutes)
ANAGRAM
Rearrange the scrambled letters to form a word. Words are related to the lesson.
1. I T N B T I A I O C S
__________________________________
2. E L I N O G Y C O A M S I D S
__________________________________
3. P H N I C O R E A O L P S E
__________________________________
4. F Q U N O L O U I L O R O N E S
__________________________________
5. M I C R B A E O S L
__________________________________
6. C O S A L I N M D E I S
__________________________________
7. M A T C O M A S N B O
__________________________________
8. E N P I L N E C L I S
__________________________________
9. S A M U N I E L D F S O
__________________________________
10. T E N I E L S T C R C A Y
__________________________________
MAIN LESSON (45 minutes)
ANTI-INFECTIVE AGENTS
Development of Anti-infective Therapy
 1920s Paul Ehrlich worked on developing a synthetic chemical effective against infection-causing cells only.
Scientists discovered penicillin in a mold sample
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
1935 The sulfonamides were introduced
Mechanisms of Action
1. Interfere with biosynthesis of the bacterial cell wall
2. Prevent the cells of the invading organism from using substances essential to their growth and development
3. Interfere with steps involved in protein synthesis
4. Interfere with DNA synthesis
5. Alter the permeability of the cell membrane to allow essential cellular components to leak out
Mechanism of Anti-infective Agents
Anti-infective Activity
 Anti-infectives vary in their effectiveness against invading organisms
 Some are selective: they are effective only for a small number of organisms
 Bactericidal: kill the cell
 Bacteriostatic: prevent reproduction of the cell
Narrow Spectrum vs Broad Spectrum
1. Narrow spectrum of activity - Effective against only a few microorganisms with a very specific metabolic pathway or
enzyme
2. Broad spectrum of activity - Useful in treating a wide variety of infections
Human Immune Response
1. Goal of anti-infective therapy is reduction of the population of the invading organism
2. Drugs that eliminate all traces of any invading pathogen might be toxic to the host as well
3. Immune response is a complex process involving chemical mediators, leukocytes, lymphocytes, antibodies, and
locally released enzymes and chemicals
Problems with Treating Infections in Immunosuppressed Patients
 Anti-infective drugs cannot totally eliminate the pathogen without causing severe toxicity in the host
 These patients do not have the immune response in place to deal with even a few invading organisms
Resistance
 Anti-infectives act on a specific enzyme system or biological process; many microorganisms that do not act on a
specific system are not affected by the particular drug
 This is considered natural or intrinsic resistance to that drug
Acquired Resistance
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

Microorganisms that were once sensitive to the particular drug have begun to develop acquired resistance
This results in serious clinical problems
Ways Resistance Develops
1. Producing an enzyme that deactivates the antimicrobial drug
2. Changing cellular permeability to prevent the drug from entering the cell
3. Altering transport systems to exclude the drug from active transport into the cell
4. Altering binding sites on the membranes or ribosomes, which then no longer accept the drug
5. Producing a chemical that acts as an antagonist to the drug
Preventing Resistance
1. Limit the use of antimicrobial agents to the treatment of specific pathogens sensitive to the drug being used
2. Make sure doses are high enough, and the duration of drug therapy long enough
3. Be cautious about the indiscriminate use of anti-infectives
Identification of the Pathogen
1. Identification of the infecting pathogen is done by culture
2. A culture of a tissue sample from the infected area is done
o A swab of infected tissue is allowed to grow on an agar plate
o Staining techniques and microscopic examination identify the bacterium
3. Stool can be examined for ova and parasites
Sensitivity of Pathogen
1. Shows which drugs are capable of controlling the particular microorganism
2. Important to be done for microorganisms that have known resistant strains
3. Along with a culture, identifies the pathogen and appropriate drug for treatment
Factors Affecting Prescribing Anti-infective Agents
1. Identification of the correct pathogen
2. Selection of the right drug
–One that causes the least complications for that particular patient
–One that is most effective against the pathogen involved
Combination Therapy
1. Use of a smaller dosage of each drug
2. Some drugs are synergistic
3. In infections caused by more than one organism, each pathogen may react to a different anti-infective agent
4. Sometimes, the combined effects of the different drugs delay the emergence of resistant strains
Adverse Reactions to Anti-infective Therapy
1. Kidney damage
2. Gastrointestinal (GI) tract toxicity
3. Neurotoxicity
4. Hypersensitivity reactions
5. Superinfections
Prophylaxis of Anti-infective Agents
 People traveling to areas where malaria is endemic
 Patients who are undergoing gastrointestinal or genitourinary surgery
 Patients with known cardiac valve disease, valve replacements, and other conditions requiring invasive procedures
ANTIBIOTICS

Antibiotics are defined as: Chemicals that inhibit specific bacteria
Types of Antibiotics
1. Bacteriostatic - Substances that prevent the growth of bacteria
2. Bactericidal - Substances that kill bacteria directly
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Signs of Infection
1. Fever
2. Lethargy
3. Slow-wave sleep induction
4. Classic signs of inflammation (redness, swelling, heat, and pain)
Goal of Antibiotic Therapy
Decrease the population of the invading bacteria to a point where the human immune system can effectively deal with the
invaders
Selecting Treatment
• Identification of the causative organism
• Based on the culture report, an antibiotic is chosen that is known to be effective at treating the invading organism
Bacteria Classification
1. Gram-positive - The cell wall retains a stain or resists decolorization with alcohol
2. Gram-negative - The cell wall loses a stain or is decolorized by alcohol
3. Aerobic - Depend on oxygen for survival
4. Anaerobic - Do not use oxygen
I.
•
–
–
–
–
–
–
Aminoglycosides - A group of powerful antibiotics used to treat serious infections caused by gram-negative aerobic
bacilli
Common medications:
Amikacin (Amikin)
Gentamicin (Garamycin)
Kanamycin (Kantrex)
Neomycin (Mycifradin)
Streptomycin
Tobramycin (Nebcin, Tobrex)
•
•
•
•
–
–
–
–
•
•
•
Bactericidal
Indications: treatment of serious infections caused by susceptible bacteria
Action: inhibit protein synthesis in susceptible strains of gram-negative bacteria causing cell death
Pharmacokinetics
Poorly absorbed from the GI tract but rapidly absorbed after IM injection, reaching peak levels within 1 hour
Widely distributed throughout the body, crossing the placenta and entering breast milk
Excreted unchanged in the urine and have an average half-life of 2 to 3 hours
Depend on the kidney for excretion and are toxic to the kidney
Contraindications: Known allergies, renal or hepatic disease, and hearing loss
Adverse effects: Ototoxicity and nephrotoxicity are the most significant
Drug-to-drug interactions: Diuretics and neuromuscular blockers
II.
•
•
•
•
–
–
•
•
•
Cephalosporins
Similar to penicillin in structure and activity
Action - Interfere with the cell-wall–building ability of bacteria when they divide
Indication - Treatment of infection caused by susceptible bacteria
Pharmacokinetics
Well absorbed from the GI tract
Metabolized in the liver, excreted in the urine
Contraindications: Allergies to cephalosporins or penicillin
Adverse effect: GI tract
Drug-to-drug interactions: Aminoglycosides, oral anticoagulants, and ETOH
III.
Fluoroquinolones
• Relatively new class of antibiotics with a broad spectrum of activity
• Indications: treat infections caused by susceptible strains of gram-negative bacteria, including urinary tract, respiratory
tract, and skin infections
• Actions: interferes with DNA replication in susceptible gram-negative bacteria, preventing cell reproduction
• Pharmacokinetics
– Absorbed in the GI tract
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–
–
•
•
•
Metabolized in the liver
Excreted in the urine and feces
Contraindications: Known allergy, pregnancy, and lactation
Adverse effects: Headache, dizziness, and GI upset
Drug-to-drug interactions: Antacids, quinidine, and theophylline
IV.
Macrolides
• Antibiotics that interfere with protein synthesis in susceptible bacteria
• Indications: treatment of respiratory, dermatologic, urinary tract, and GI infections caused by susceptible strains of
bacteria
• Actions: bind to cell membranes causing a change in protein function and cell death; can be bacteriostatic or
bactericidal
• Pharmacokinetics
– Absorbed from the GI tract
– Metabolized in the liver, excreted in the bile to feces
• Contraindications: Allergy and hepatic dysfunction
• Adverse effects: GI symptoms
• Drug-to-drug interactions: Digoxin, oral anticoagulants, theophylline, and corticosteroids
V.
•
•
•
•
–
•
•
Lincosamides
Similar to macrolides but more toxic
Action: Similar to macrolides
Indications: Severe infections
Pharmacokinetics: Well absorbed from the GI tract or IM
Metabolized in the liver and excreted in the urine and feces
Contraindications: Hepatic or renal impairment
Adverse effects: GI reactions
VI.
Monobactams
• Unique structure with little cross-resistance
• Action: Disrupts bacteria cell wall synthesis, which promotes the leakage of cellular content and cell death
• Indications: Treatment of infections caused by susceptible bacteria; UTI, skin, intra-abdominal, and gynecologic
infections
• Pharmacokinetics: Well absorbed from the IM injection; Excreted unchanged in the urine
•
Contraindications: Allergy
• Adverse effects: GI and hepatic enzyme elevation
VII. Penicillins
• First antibiotics introduced for clinical use
• Action: Inhibit synthesis of the cell wall in susceptible bacteria, causing cell death
• Indications: Treatment of infections caused by streptococcal, pneumococcal, staphylococcal, and other susceptible
bacteria
• Pharmacokinetics: Well absorbed from the GI tract; Excreted unchanged in the urine
• Contraindications: Allergy; Caution in patients with renal disease
• Adverse effects: GI effects
• Drug-to-drug interactions: Tetracyclines and aminoglycosides
VIII.
•
•
•
•
•
•
•
IX.
•
•
Sulfonamides
Drugs that inhibit folic acid synthesis
Action: Interfere with the cell-wall–building ability of dividing bacteria
Indications: Treatment of infections caused by gram-negative and gram positive-bacteria
Pharmacokinetics: Well absorbed from the GI tract; Metabolized in the liver and excreted in the urine
Contraindications: Allergy and pregnancy
Adverse effects: GI symptoms and renal effects related to the filtration of the drug
Drug-to-drug interactions: Cross sensitivity with thiazide diuretics; Sulfonylureas
Tetracyclines
Developed as semisynthetic antibiotics based on the structure of a common soil mold
Action: Inhibit protein synthesis in susceptible bacteria, preventing cell replication
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• Indications: Treatment of various infections caused by susceptible strains of bacteria and acne, and when penicillin is
contraindicated for eradication of susceptible organisms
• Pharmacokinetics: Adequately absorbed from the GI tract; Concentrated in the liver and excreted unchanged in the
urine
• Contraindications: Allergy, pregnancy, and lactation
• Adverse effects: GI, skeletal: damage to bones and teeth
• Drug-to-drug interactions: Penicillin G, oral contraceptive therapy, methoxyflurane, and digoxin
X.
•
•
•
•
•
•

Antimycobacterials
Contain pathogens causing tuberculosis and leprosy
Action: Act on the DNA of the bacteria, leading to lack of growth and eventual bacterial death
Indication: Treatment of acid-fast bacteria
Pharmacokinetics: Well absorbed from the GI tract; Metabolized in the liver and excreted in the urine
Contraindications: Allergy and renal or hepatic failure
Adverse effects: CNS effects and GI irritation
• Drug-to-drug interactions: Rifampin and INH can cause liver toxicity
CHECK FOR UNDERSTANDING (30 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not
allowed. You are given 25 minutes for this activity:
Multiple Choice
1. The nurse is administering an anti-infective that is considered to be a bacteriocidal. Before beginning therapy, the
nurse should assess the client for:
a. Any neurologic abnormalities.
b. Cardiac history.
c. Hypersensitivity.
d. Respiratory conditions.
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
2. The client asks the nurse why the physician didn't prescribe the same antibiotic that he always takes for an infection.
The best response by the nurse would be:
a. "It doesn't matter which antibiotic is taken."
b. "Try this medicine, and if you're not better in 10 days, return to the office."
c. "You don't want to take the same antibiotic all the time."
d. "Bacteria can become resistant to some antibiotics.
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
3. A nurse is preparing to administer a broad-spectrum antibiotic medication to a client. An important nursing intervention
prior to administration regarding anti-infectives is:
a. Obtaining the culture report before starting any medication.
b. Performing a culture within 24 hours after starting the medication.
c. Performing the culture for evidence before administering the first dose of the anti-infective.
d. Administering medicine, and omitting performing cultures.
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
4. A client has been on an antibiotic for two weeks for treatment of an ulcer caused by Helicobacter pylori. The client asks
the nurse why a superinfection is caused by this medication. The nurse responds:
a. "This is a secondary infection due to "Candida."
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b. "The infection has developed immunity to the current drug."
c. "The infection has become severe."
d. "The infection has a restricted group of microorganisms."
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
5. A client has been discharged with a prescription for penicillin. Discharge instructions includes which of the following?
a. Penicillin can be taken while breastfeeding.
b. The entire prescription must be finished.
c. All penicillin can be taken without regards to eating.
d. Some possible side effects include abdominal pain and diarrhea
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
6. An antimicrobial medication that has selective toxicity has which characteristic?
a. Ability to transfer DNA coding
b. Ability to suppress bacterial resistance
c. Ability to avoid injuring host cells
d. Ability to act against a specific microbe
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what?
a. Resistant infection
b. Superinfection
c. Nosocomial infection
d. Allergic reaction
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. A client has been prescribed tetracycline. When providing information regarding this drug, the nurse would be correct in
stating that tetracycline:
a. Is classified as a narrow-spectrum antibiotic.
b. Is used to treat a wide variety of disease processes.
c. Has been identified to be safe during pregnancy.
d. Is contraindicated in children under 8 years of age.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. Important information to include in the client's education regarding taking aminoglycosides is that:
a. The drug can cause discoloration of teeth.
b. Fluid intake should be decreased to prevent retention.
c. This drug primarily is given orally, because it is absorbed in the GI tract.
d. A serious side effect is hearing loss.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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10. A client has been prescribed ciprofloxacin (Cipro). Important information that the nurse must know includes:
a. This medicine must be taken on an empty stomach to increase absorption.
b. This medicine is classified as an aminoglycoside and is given for systemic bacterial infections.
c. This medicine should be given with an antacid to increase the absorption and effectiveness of the medicine.
d. This medicine should not be given with the ordered multivitamin.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
11. A nursing intervention for administering sulfamethoxazole-trimethoprim (Bactrim) to a client is to:
a. Have the client drink a full glass of water with the medicine.
b. Have the client drink a glass of milk.
c. Have the client take the medicine with solid foods.
d. Have the client take the medicine on an empty stomach.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
12. This antibiotic can have an adverse effect of dizziness, vertigo, and loss of hearing.
a. Chloramphenicol
b. Aminoglycoside
c. Vancomycin
d. Fluoroquinolones
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
13. A 60 year old male patient on fourth day of his antibiotic therapy complains of dizziness and nausea. Which is the
most appropriate nursing action?
a. Institute safety precaution and raise side rails.
b. Collaborate with the doctor about antibiotic therapy’s dosage and duration.
c. Provide comfort measures.
d. Instruct client to inform you if symptoms get worse.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
14. A middle-aged woman came to the ER and complains of ringing in the ears, paresthesias of the extremities, and
erythema of the back. She also noticed that she had decreased urine output. What history of drug intake should the nurse
ask?
a. Oral contraceptive pills (OCPs)
b. Antifungals
c. Vancomycin
d. Trimethoprim-sulfamethoxazole
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
15. The physician orders penicillin for a patient with streptococcal pharyngitis. The nurse administers the drug as ordered,
and the patient has an allergic reaction. The nurse checks the medication order sheet and finds that the patient is allergic
to penicillin. Legal responsibility for the error is:
a. Only the nurse’s—she should have checked the allergies before administering the medication.
b. Only the physician’s—she gave the order, the nurse is obligated to follow it.
c. Only the pharmacist’s—he should alert the floor to possible allergic reactions.
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d. The pharmacist, physician, and nurse are all liable for the mistake
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
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3. ANSWER: ________
RATIO:_______________________________________________________________________________________
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4. ANSWER: ________
RATIO:_______________________________________________________________________________________
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5. ANSWER: ________
RATIO:_______________________________________________________________________________________
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6. ANSWER: ________
RATIO:_______________________________________________________________________________________
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RATIO:_______________________________________________________________________________________
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8. ANSWER: ________
RATIO:_______________________________________________________________________________________
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9. ANSWER: ________
RATIO:_______________________________________________________________________________________
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10. ANSWER: ________
RATIO:___________________________________________________________________________________________
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11. ANSWER: ________
RATIO:___________________________________________________________________________________________
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12. ANSWER: ________
RATIO:___________________________________________________________________________________________
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13. ANSWER: ________
RATIO:___________________________________________________________________________________________
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14. ANSWER: ________
RATIO:___________________________________________________________________________________________
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15. ANSWER: ________
RATIO:___________________________________________________________________________________________
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LESSON WRAP-UP (5 minutes)
You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.
You are done with the session! Let’s track your progress.
TWO ROSES AND A THORN
Each student must note two topics or concepts he or she enjoyed learning about, and another they didn’t like or still have
questions about.
For the next session, review Antifungal & Antiprotozoal Drugs
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Pharmacology
STUDENT ACTIVITY SHEET
BS NURSING / SECOND YEAR
Session 4
LESSON TITLE: ANTIFUNGAL & ANTIPROTOZOAL
DRUGS
Materials:
LEARNING OUTCOMES:
Notebook, Pharmacology book, drug handbook,
pens & paper
At the end of the lesson, the nursing student can:
References:
Kee, Joyce LeFever, Hayes, Evelyn R. &
McCuistion E. Pharmacoloy A Nursing
Process Approach 6th edition.. Singapore:
Elsevier Saunders Company.
1. List common fungal infection and protozoal infections
including cause and clinical presentation;
2. Describe the five groups of antifungal drugs;
3. Compare and contrast antimalarials with other drugs
used to treat protozoal infection; and,
4. Formulate a drug study guide for antifungal and
antiprotozoal agents.
LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY (5 minutes)
FOCUSED LISTING
List the key ideas or concepts from assigned work.
___________________________________________
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MAIN LESSON (50 minutes)
ANTIFUNGAL
What Is a Fungus?
 Composed of a rigid cell wall made up of chitin and various polysaccharides, and a cell membrane containing
ergosterol
 Protective layers of the fungal cell make the organism resistant to antibiotics
Patients Susceptible to Fungal Infections
 Patients with AIDS and AIDS-related complex (ARC)
 Patients taking immunosuppressant drugs
 Patients who have undergone transplantation surgery or cancer treatment
 Members of growing elderly population no longer protected from environmental fungi
Culture
 Culture is needed prior to prescribing antifungal agents
 Patients on antifungal agents are immuno-compromised at onset
Antifungals (Antimycotic drugs) are used to treat mycosis, or infections caused by fungi. Fungi are different from bacteria
in the sense that their cell walls are made up of chitin and various polysaccharides rendering these organisms resistant
to antibiotics.
Common fungal infections
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1. Athlete’s foot (tinea pedis) is a fungal infection that affects the skin on your feet, often between your toes. Typical
symptoms of athlete’s foot include: itching, or a burning, stinging sensation between your toes or on the soles of
your feet; skin that appears red, scaly, dry, or flaky; cracked or blistered skin
2. Jock itch (tinea cruris) is a fungal skin infection that happens in the area of your groin and thighs. It’s most common
in men and adolescent boys.
 The main symptom is an itchy red rash that typically starts in the groin area or around the upper inner thighs.
The rash may get worse after exercise or other physical activity and can spread to the buttocks and abdomen.
 The affected skin may also appear scaly, flaky, or cracked. The outer border of the rash can be slightly raised
and darker.
3. Ringworm of the scalp (tinea capitis) This fungal infection affects the skin of the scalp and the associated hair shafts.
It’s most common in young children and needs to be treated with prescription oral medication as well as antifungal
shampoo. The symptoms can include:
 localized bald patches that may appear scaly or red
 associated scaling and itching
 associated tenderness or pain in the patches
4. Tinea versicolor sometimes called pityriasis versicolor, is a fungal/yeast skin infection that causes small oval
discolored patches to develop on the skin. It’s caused by an overgrowth of a specific type of fungus
called Malassezia, which is naturally present on the skin of about 90 percent of adults.
 These discolored skin patches most often occur on the back, chest, and upper arms. They may
look lighter or darker than the rest of your skin, and can be red, pink, tan, or brown. These patches can be itchy,
flaky, or scaly.
 Tinea versicolor is more likely during the summer or in areas with a warm, wet climate. The condition can
sometimes return following treatment.
5. Cutaneous candidiasis is a skin infection that’s caused by Candida fungi. This type of fungi is naturally present on
and inside our bodies. When it overgrows, an infection can happen.
 Candida skin infections occur in areas that are warm, moist, and poorly ventilated. Some examples of typical
areas that can be affected include under the breasts and in the folds of the buttocks, such as in diaper rash.
 The symptoms of a Candida infection of the skin can include: a red rash, itching, small red pustules
6. Onychomycosis (tinea unguium) is a fungal infection of your nails. It can affect the fingernails or the toenails,
although infections of the toenails are more common.
 You may have onychomycosis if you have nails that are: discolored, typically yellow, brown, or white, brittle or
break easily & thickened
Antifungals can be systemic and/or topical.
 Systemic antifungals are used to treat systemic mycoses and can be toxic to the host and not to be used
indiscriminately. It is important to get a culture of the fungus causing the infection to ensure that the right drug
is being used so that the patient is not put at additional risk from the toxic adverse effects associated with these
drugs.
 Topical antifungals are used to treat a variety of mycoses of skin and mucous membranes. Some systemic
antifungals have topical forms.
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Claasification of Antifungal Drugs and its Mechanism of Action
1. Polyenes: Act by binding to ergo sterol in the fungal cell membrane. This binding results in depolarization of the
membrane. This binding results in depolarization of the membrane and formation of pores that increase permeability
to proteins and monovalent and divalent cations, eventually leading to cell death.
2. Echinocandins: noncompetitively inhibit beta-1,3-D-glucan synthase enzyme complex in susceptible fungi to disturb
fungal cell glucan synthesis. Beta-glucan destruction prevents resistance against osmotic forces, which leads to cell
lysis. They have fungistatic activity against Aspergillus species
3. Antimetabolites: Inhibits fungal protein synthesis by replacing uracil with 5 fluro uracil in fungal RNA, also inhibit
thymidilate synthetase via 5-flourodeoxy-uridine monophosphate and thus interferes with fungal DNA synthesis.
4. Allylamines: Inhibits ergo sterol synthesis by inhibiting the enzyme squaline epoxidase.
5. Azoles: Inhibition of cytochrome P450 14a-demethylase. This enzyme is in the sterol biosynthesis pathway that leads
from lanosterol to ergo sterol.
ANTIFUNGAL AGENTS
Amphotericin B Indications
 Aspergillosis
 Leishmaniasis
 Cryptococcosis
 Blastomycosis
 Moniliasis
 Coccidioidomycosis
 Histoplasmosis
 Mucormycosis
 Candida infections (topically)
Amphotericin B
 Indications: progressive, potentially fatal fungal infections
 Pharmacokinetics: IV form, excreted in the urine
 Contraindication: kidney disease
 Adverse reaction: kidney failure
Systemic Antifungal Agents
 Caspofungin (Cancidas) (IV) : Approved for the treatment of invasive aspergillosis in patients who are refractory to
other treatments
 Flucytosine (Ancobon) (oral) :Less toxic drug used for the treatment of systemic infections caused by Candida or
Cryptococcus
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
o
Nystatin (Mycostatin, Nilstat) (oral): Used for the treatment of intestinal candidiasis; also available in a number of
topical preparations
Voriconazole & Terbinafine
 Voriconazole (Vfend) : Available in oral and IV forms. Treats invasive aspergillosis and serious infections caused
by Scedosporium apiospermum and Fusarium species
 Terbinafine (Lamisil) : Blocks the formation of ergosterol, Inhibits a CYP2D6 enzyme system. Oral drug for the
treatment of onychomycosis of the toenail or fingernail
Azoles
Newer class of drugs used to treat systemic fungal infections. Less toxic than amphotericin B, Less effective than
amphotericin B
Ketoconazole (Nizoral)
 Used orally to treat many of the same mycoses as amphotericin B
 Works by blocking the activity of a steroid in the fungal wall
 Has side effect of blocking the activity of human steroids, including testosterone and cortisol
 Pharmacokinetics: absorbed from the GI tract, metabolized in the liver, excreted in the feces
 Contraindications: not drug of choice for patients with endocrine or fertility problems
 Adverse reaction: hepatic toxicity
 Drug-to-drug interactions: many
Fluconazole (Diflucan)
 Not associated with the endocrine problems seen with ketoconazole
 Used to treat candidiasis, cryptococcal meningitis, and other systemic fungal infections
 Prophylactic agent for reducing the incidence of candidiasis in bone marrow transplant recipients
 Pharmacokinetics: available in oral and IV preparations, excreted unchanged in the urine
 Contraindications: renal dysfunction
 Adverse reactions:
 Drug-to-drug interactions: inhibits CYP450 and may be associated with drug-to-drug interactions
Itraconazole (Sporanox)




An oral agent used for the treatment of assorted systemic mycoses
Associated with hepatic failure
Slowly absorbed from the GI tract, it is metabolized in the liver by the CYP450 system
Excreted in the urine and feces
There is an increased incidence of fungal infections in immunocompromised patients (e.g., patients with AIDS, those
taking immunosuppressants like organ transplant recipients, etc.).
Overall Contraindications to Systemic Antifungal Agents
 Anyone with a known allergy
 Pregnant or lactating women (with the exception of terbinafine for life-threatening infections)
 Patients with renal or liver disease : Drug metabolism or excretion may be altered, or condition may worsen as a
result of the actions of the drug
Overall Adverse Reactions to Systemic Antifungal Agents
 CNS effects : Headache, dizziness, fever, shaking, and chills
 GI effects:Nausea, vomiting, dyspepsia, and anorexia
 Hepatic dysfunction
 Dermatologic effects :Rash and pruritus associated with local irritation
 Renal dysfunction
ANTIPROTOZOAL AGENTS
Antiprotozoals are agents used to treat protozoan infections. Protozoan infections are common in tropical
areas. Protozoans are single-celled organisms that pass through several stages in their life cycles, including at least one
phase as a human parasite. While protozoans thrive in tropical climate, they may also survive and reproduce in any area
where people live in very crowded and unsanitary conditions.
Causes of Protozoal Infections
1. Insect bites : Malaria, Trypanosomiasis, Leishmaniasis
2. Ingestion or contact with the causal organism : Amebiasis, Giardiasis, Trichomoniasis
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Protozoal Parasites Identified as Causes of Malaria
1. Plasmodium falciparum : Considered the most dangerous type of protozoan
Plasmodium vivax : Milder form of the disease; seldom results in death
2. Plasmodium malariae : Endemic in tropical countries; mild symptoms
3. Plasmodium ovale : Rarely seen; in the process of being eradicated
Life cycle of a Plasmodium
Protozoal Diseases
Malaria
 It is a disease characterized by a cycle of fever and chills transmitted through a bite of a female Anopheles mosquito.
Identified causes include Plasmodium falciparum, vivax, malariae, and ovale. Malaria is endemic in many parts of the
world.
 Sporozoites travel through bloodstream and become lodged in the liver and other tissues.
Amebiasis
 It is an intestinal infection caused by Entamoeba histolytica. It is often known as amoebic dysentery. The disease is
transmitted through fecal-oral route.
 Amebiasis is characterized by mild to fulminant diarrhea. In worst cases, it is able to invade extraintestinal tissue.
Leishmaniasis
 Is a disease caused by a protozoan that is passed from sand flies to humans. It is characterized by serious lesions in
the skin, viscera, and mucous membranes of host.
Trypanosomiasis
 Is caused by Trypanosoma leading to African sleeping sickness and Chagas’ disease.
 African sleeping sickness is caused by T.brucei gambiense and is transmitted by tsetse fly. It is characterized by
lethargy, prolonged sleep, and even death.
 Chagas’ disease is caused by T.cruzi and is passed to humans by common housefly. It is characterized by severe
cardiomyopathy.
Trichomoniasis
 Is caused by T.vaginalis, a common cause of vaginitis (reddened, inflamed vaginal mucosa, itching, burning, and
yellowish-green discharge).
 It is usually transmitted through sexual intercourse.
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 Asymptomatic in men
Giardiasis
 Is caused by G.lamblia, the most commonly diagnosed intestinal parasite in the United States.
 Transmission is through contaminated water or food, and trophozoites.
 Characterized by diarrhea, rotten egg-smelling stool, and pale and mucus-filled stool. Some patients experience
epigastric pain, weight loss, and malnutrition.
Commonly used oral antiprotozoal drugs can be generally classified into two main groups: antimalarial drugs and
miscellaneous antiprotozoals. In addition to their use as antiprotozoals, some of them such as metronidazole and
doxycycline are also used for treating bacterial infections
Antimalarials: Antimalarials are agents used to attack Plasmodium at various stages of its life cycle. Through this, it
becomes possible to prevent acute malarial reaction in individuals who have been infected by the parasite.
 These agents can be:
o schizonticidal (acting against the red-blood-cell phase of the life cycle),
o gametocytocidal (acting against the gametocytes),
o sporontocidal (acting against the parasites that are developing in the mosquito), or
o schizonts as prophylactic or antirelapse agent work against tissue t.
 Quinine (Qualaquine) was the first drug found to be effective in the treatment of malaria. Treatment of chloroquineresistant plasmodial infections
 Chloroquine (Aralen): Prevention and treatment of plasmodial malaria; treatment of extraintestinal amebiasis
 Halofantrine (Halfan): Treatment of plasmodial malaria in combination with other drugs
 Hydroxychloroquine (Plaquenil): Treatment of plasmodial malaria in combination with other drugs (particularly
primaquine)
 Mefloquine (Lariam): Prevention and treatment of plasmodial malaria in combination with other drugs
 Primaquine (generic): Prevention of relapses of Plasmodium vivax and Plasmodium malariae infections; Radical cure of
P. vivax malaria
 Pyrimethamine (Daraprim) : Prevention of plasmodial malaria in combination with other agents to suppress
Therapeutic Action of antimalarials is:
 Entering human red blood cells and changing the metabolic pathways necessary for the reproduction. Chloroquine, the
mainstay of treatment, in addition to this main mechanism, is directly toxic to parasites and decreases the ability of the
parasite to synthesize DNA.
 Interrupt plasmodial reproduction of protein synthesis
 Agents that do not appear to affect the sporozoites are used for prophylaxi
Contraindications: Known allergy, Liver disease, Alcoholism, Lactation
 Cautions: Retinal disease or damage, Psoriasis
Adverse Effects: Headache, Dizziness, Fever, Chills, Malaise, Nausea, Vomiting, Hepatic dysfunction
Drug-to-Drug Interactions
 Quinine derivatives and quinine create risk for cardiac toxicity
 Antifolate drugs with pyrimethamine can increase risk of bone marrow suppression
Other Antiprotozoal Drugs
 Actions: Inhibiting DNA synthesis in susceptible protozoa, interfering with cell’s ability to reproduce, subsequently
leading to cell death
 Contraindications: Known allergy, pregnancy, CNS disease, and hepatic disease
 Adverse reactions: Headache, dizziness, ataxia, nausea, vomiting, and diarrhea
CHECK FOR UNDERSTANDING (30 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not
allowed. You are given 25 minutes for this activity:
Multiple Choice
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1. A patient receiving topical antifungal complains of blisters in her perineum. Which is/are a possible explanation(s) for
this?
a. Fungal infection is not healing.
b. Patient is allergic to the drug.
c. Both A and B
d. None of the above
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. Which of the following will alert the nurse for possible adverse effect in patients receiving long-term itraconazole
therapy?
a. Central obesity
b. Cataract
c. Thickening of the skin
d. Pathologic U wave
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. An eight (8) month old infant is receiving antifungals. Which should be included in the nurse’s health teaching to the
mother?
a. Cover the area of lesions with diaper to prevent additional infection.
b. Make sure area is free from occlusive dressings.
c. Apply more topical cream on draining areas because it is where fungi are most
d. Advise that redness and rashes are negligible side effects of antifungal therapy and should not be a cause of worry.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. Which of these antifungals can be used in pregnant women?
a. Fluconazole
b. Nystatin
c. Ketoconazole
d. Amphotericin B
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. Arvic, a 16-year-old student, has acquired systemic fungal infection, he should be treated with:
a. Amphotericin B
b. Miconazole (Monistat IV)
c. Ketoconazole
d. Griseofulvin (Fulvicin)
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. Which of the following must always be present before beginning antifungal therapy?
a. Coagulation profile
b. Confirmed diagnosis
c. Biopsy of infected site
d. Urinalysis
ANSWER: ________
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RATIO:___________________________________________________________________________________________
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7. A 32-year-old woman presents to her gynecologist with a 4 days history of perineal pruritus and a non-malodorous,
thick, cheesy vaginal discharge. The only medication the woman is taking is an oral contraceptive. A wet preparation of
vaginal secretion shows budding yeast cells and pseudohyphae. Which of the following drugs, given locally, would be
appropriate for this patient?
a. Mebendazole
b. Metronidazole
c. Miconazole
d. Saquinavir
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. The nurse sees a patient in the clinic who has been taking chloroquine for the treatment of malaria. While the nurse
measures vital signs, the patient repeatedly rubs her eyes. When the nurse questions why, the patient says, "I guess it's
time for a trip to the eye doctor. My glasses don't seem to work very well and I'm having trouble with my vision." What
does the nurse suspect is happening with this patient?
a. Adverse effect of medication
b. Muscles controlling the eye are impacted by malaria
c. Chemical actions of the medication are reducing aqueous humor
d. Malaria infection is damaging optic tissue
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. The nurse is caring for a patient taking antimalarials for prophylaxis while serving in the Peace Corps in Africa. The
patient has taken the medication for 2 months and is continuing to lose significant weight due to the GI effects of the drug.
What recommendations can the nurse make to reduce GI adverse effects and promote healthy nutrition for this patient?
(Select all that apply.)
a. Avoid alcohol.
b. Add extra fat to diet for calories.
c. Take the drug immediately after meals.
d. Eat 5 to 6 small meals a day.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. An instructor is describing the action of primaquine. What would the instructor include?
a. The drug blocks the use of folic acid.
b. It changes the metabolic pathways for reproduction.
c. The drug increases the acidity of plasmodial food vacuoles.
d. It disrupts the mitochondria, killing the gametocytes.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
________________________________________________________________________________________________
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
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RATIO:_______________________________________________________________________________________
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2. ANSWER: ________
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3. ANSWER: ________
RATIO:_______________________________________________________________________________________
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5. ANSWER: ________
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6. ANSWER: ________
RATIO:_______________________________________________________________________________________
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7. ANSWER: ________
RATIO:_______________________________________________________________________________________
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8. ANSWER: ________
RATIO:_______________________________________________________________________________________
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9. ANSWER: ________
RATIO:_______________________________________________________________________________________
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10. ANSWER: ________
RATIO:___________________________________________________________________________________________
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LESSON WRAP-UP (5 minutes)
You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.
You are done with the session! Let’s track your progress.
MINUTE PAPER
Compose two to three sentences to explain what she/he has leaned using the key ideas listed in lesson review.
For next session review antiviral and anthelmintic.
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Pharmacology
STUDENT ACTIVITY SHEET
BS NURSING / SECOND YEAR
Session 5
LESSON TITLE: ANTIVIRAL & ANTHELMENTIC DRUGS
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. Name several antiviral drugs and their uses;
2. Identify the various helminthes and the human body
sites used for their infestation;
3. Describe action of anthelmintic;
4. Identify several nursing interventions for antiviral and
anthelmintic drug therapy; and,
5. Develop a drug study guide (therapeutic action,
indication, contraindication, most common adverse
reaction And nursing responsibility ) of antiprotozoal
ad anthelmintic.
Materials:
Notebook, Pharmacology book, drug handbook,
pens & paper
References:
Kee, Joyce LeFever, Hayes, Evelyn R. &
McCuistion E. Pharmacoloy A Nursing
Process Approach 6th edition.. Singapore:
Elsevier Saunders Company.
LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY (5 minutes)
EVERYBODY WRITES
How did the Pandemic (COVID 19) of 2020 affected you and your family?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
MAIN LESSON (50 minutes)
ANTIVIRAL
Antivirals are agents used to treat the diseases caused by viruses such as warts and common colds.
 Viruses are composed of a single DNA or RNA inside a protein coat. Viruses must enter a cell in order for them to carry
on with their metabolic processes.
 Upon successful entry, viruses inject their DNA or RNA to the cell and the cell is altered in such a manner that it is now
“programmed” to control the metabolic processes that the virus needs to survive.
 Because viruses are contained in the cells, researchers find it difficult to develop vaccines. However, viruses respond
to some antiviral therapy including influenza A viruses, herpes viruses, CMV, HIV, hepatitis B and C viruses, and some
viruses that cause warts and eye infections.
Viruses That Respond to Antiviral Therapy
 Influenza A and some respiratory viruses
 Herpes viruses
 Cytomegalovirus (CMV)
 Human immunodeficiency virus (HIV) that causes acquired immune deficiency syndrome (AIDS)
 Some viruses that cause warts and certain eye infections
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Characteristics of Common Viruses
 Viral replication: A virus cannot replicate on its own
o It must attach to and enter a host cell
o It then uses the host cell’s energy to synthesize protein, DNA, and RNA
 Viruses are difficult to kill because they live inside our cells
o Any drug that kills a virus may also kill our cells
Stage of Virus replication
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Characteristics of Antiviral Drugs
 Able to enter the cells infected with virus
 Interfere with viral nucleic acid synthesis and/or regulation
 Some agents interfere with the ability of the virus to bind to cells
 Some agents stimulate the body’s immune system
Common Respiratory Viruses
 Influenza A
 Influenza B
 Respiratory syncytial virus
Signs & Symptoms of Respiratory Viruses
 Cough, Fever, Inflammation of the nasal mucosa, Inflammation of the mucosa of the respiratory tract
Signs and Symptoms of Herpes Virus
 Painful vesicles that often occur in clusters on skin, cornea, or mucous membranes
 Usual course of primary disease is 2 weeks
 Duration of recurrences varies
Signs and Symptoms of CMV
 May be asymptomatic, Fatigue, Nausea, Jaundice
 If contracted during pregnancy, can result in stillbirth, brain damage, or birth defects
Signs and Symptoms of HIV/AIDS
 Attach helper T cells
 Acute infection: fever, rash, and myalgia
 Asymptomatic infection: follows acute infection; duration varies
 Persistent generalized lymphadenopathy: adenopathy persists more than 3 months
 Constitutional symptoms: fever lasting more than a month, involuntary weight loss, chronic fatigue
 Neurologic disease: dementia
 Secondary infections: pneumocystis carinii and disseminated herpes simplex
Drugs for Influenza A & Respiratory Viruses
 Action: prevent shedding of the viral protein coat
 Pharmacokinetics: administered orally and excreted unchanged in the urine
 Contraindications: allergy, pregnancy, and lactation
 Adverse reactions: dizziness, insomnia, nausea, orthostatic hypotension
 Drug-to-drug interactions: anticholinergic agents
Drugs for Herpes & Cytomegalovirus
 Action: inhibit viral DNA replication by competing with viral substrates to form shorter, noneffective DNA chains
 Pharmacokinetics: administered orally, IV, or topically; excreted unchanged in the urine
 Contraindications: pregnancy and lactation
 Adverse reactions: nausea, vomiting, headache, rash, and hair loss
 Drug-to drug-interactions: nephrotoxic drugs and zidovudine
Drugs Used to Treat HIV/AIDS
1. Reverse transcriptase inhibitors
2. Protease inhibitors
3. Nucleosides
4. Fusion inhibitors
Reverse Transcriptase Inhibitors
 Action: bind directly to HIV reverse transcriptase, blocking both RNA- and DNA-dependent DNA polymerase
activities
 Pharmacokinetics: given orally, metabolized in the liver, and excreted in the urine
 Contraindications: pregnancy and lactation
 Adverse reactions: headache, nausea, vomiting, rash, chills, fever, and diarrhea
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Protease Inhibitors
 Action: block protease activity within the HIV virus
 Pharmacokinetics: agents are teratogenic except for saquinavir
 Contraindications: pregnancy and lactation
Nucleosides
 Action: interfere with HIV replication by inhibiting cell protein synthesis
 Pharmacokinetics: given orally or IV, metabolized in the liver, and excreted in the urine
 Adverse reactions: HA, insomnia, dizziness, nausea, diarrhea, fever, and rash
Fusion Inhibitors
 Action: prevent the fusion of the virus with the human cellular membrane
 Pharmacokinetics: given sub-q, metabolized in the liver, recycled in the tissues, and not excreted
 Contraindication: no true contraindication
 Adverse reactions: HA, dizziness, myalgia, nausea, vomiting, and diarrhea
 Drug-to-drug interactions: pimozide, rifampin, triazolam, midazolam, and oral contraceptives
Locally Active Antiviral Agents
 Action: act on viruses by interfering with normal viral replication and metabolic processes
 Pharmacokinetics: not absorbed systemically
 Contraindication: allergy to the drug
 Adverse reactions: local burning, stinging, and discomfort
Antivirals Across Lifespan
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ANTHELMINTIC AGENTS
Two Types of Helminths Commonly Infecting Humans
1. Nematodes or roundworms: Pinworms, whipworms, threadworms, Ascaris, and hookworms
2. Platyhelminthes or flatworms : Cestodes (tapeworms) and flukes (schistosomes)
Measures to Control Infection
 Keep nails short
 Keep hands clean
 Frequent handwashing
 Shower in the morning
 Change and launder undergarments, bed linens, and pajamas daily
 Disinfect toilet seat daily
 Handwashing after using the bathroom
Tissue-Invading Worms
 Trichinosis : Caused by ingestion of the encysted larvae of the roundworm, Trichinella spiralis, in undercooked pork
 Filariasis: Infection of the blood and tissues of healthy individuals by worm embryos, injected by insects
 Schistosomiasis : Infection by a fluke that is carried by a snail
Life Cycle of Schistosoma
Mebendazole (Vermox)
 Most commonly used of all of the anthelmintics
 Effective against pinworms, roundworms, whipworms, and hookworms
 Available in the form of a chewable tablet
 Few adverse effects
 Not metabolized in the body; most is excreted unchanged in the feces
 Should not be used during pregnancy
Pyrantel (Antiminth, Pin-Rid, Pin-X, Reese’s Pinworm)
 Oral drug effective against pinworms and roundworms
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




Given as a single dose
Poorly absorbed; excreted unchanged in the feces
Not recommended for use during pregnancy and lactation
Safety not established for children age <2 years
Adverse effects may include GI side effects and diarrhea
Thiabendazole (Mintezol)
 Treats roundworm, hookworm, and whipworm infections
 Not the anthelmintic drug of choice (not as effective, more adverse effects)
 Best drug for treatment of threadworm infections
 Readily absorbed from the GI tract; reaches peak levels in 1 to 2 hours
 Metabolized in the liver and excreted in the urine
Albendazole (Albenza)
 Treats active lesions caused by pork tapeworm and cystic disease of the liver, lungs, and peritoneum caused by
dog tapeworm
 Serious adverse effects
 Should be used only after causative worm is identified
 Poorly absorbed from the GI tract; reaches peak levels in about 5 hours
 Metabolized in the liver and primarily excreted in the urine
 Should not be used during pregnancy and lactation
Ivermectin (Stromectol)
 Effective against the nematode that causes onchocerciasis, or river blindness
 Used to treat threadworm disease or strongyloidiasis
 Readily absorbed from the GI tract; reaches peak plasma levels in 4 hours
 Completely metabolized in the liver with a half-life of 16 hours; excreted through the feces
 Should never be taken during pregnancy; used with caution during lactation
Praziquantel (Biltricide)
 Very effective in the treatment of a wide number of schistosomes, or flukes
 Taken in a series of three doses at 4- to 6-hour intervals
 Has relatively few adverse effects
 Rapidly absorbed from the GI tract; reaches peak plasma levels within 1 to 3 hours
 Metabolized in the liver with a half-life of 0.8 to 1.5 hours
 Excreted primarily through the urine
Anthelmintic Actions/Indications
 Affects metabolic processes that are different in worms than in human hosts or are not found in humans
 Causes death of the worm by interfering with normal functioning
Anthelmintic Contraindications
 Presence of known allergy to any of these drugs
 Lactation
 Pregnancy (in most cases)
 Caution should be used in the presence of renal or hepatic disease or severe diarrhea and malnourishment
Anthelmintic Adverse Effects
 Abdominal discomfort
 Diarrhea
 Pain
 Headache
 Dizziness
 Fever
 Chills
Anthelmintic Drug-to-Drug Interactions
 Theophylline = increased levels of theophylline
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
Albendazole with dexamethasone increases the overall effect of the drug
Use of Anthelmintic Agents Across the Lifespan
CHECK FOR UNDERSTANDING (30 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not
allowed. You are given 25 minutes for this activity:
Multiple Choice
1. Patient X has genital herpes and is using antiviral creams for her condition. Which of the following is a potential side effect of
the medication?
a. Vulvitis
b. Headache
c. Dizziness
d. Staining of the skin
ANSWER: ________
RATIO:________________________________________________________________________________________________
______________________________________________________________________________________________________
__________________________________________________________________________________________
2. A 15 y/o patient came in for a severe case of respiratory flu and would need drug therapy. Which of the following drugs should
the nurse anticipate to be prescribed?
a. Acyclovir (Zovirax)
b. Amantadine (Symmetrel)
c. Abacavir (Ziagen)
d. Ganciclovir (Cytovene)
ANSWER: ________
RATIO:________________________________________________________________________________________________
______________________________________________________________________________________________________
__________________________________________________________________________________________
3. Which of the following antiviral agents is effective as treatment for H1N1?
a. Zidovudine
b. Acyclovir
c. Oseltamivir
d. Selzentry
ANSWER: ________
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RATIO:________________________________________________________________________________________________
______________________________________________________________________________________________________
__________________________________________________________________________________________
4. A student nurse administering acyclovir was asked by the clinical instructor on how the drug works. The student nurse would
be correct by stating that this drug works in which way?
a. Unknown; but it is believed to be shedding the protein coat of the virus.
b. It competes with viral receptors found in the host cells
c. It takes away the necessary substances needed by viruses to form DNA chains
d. Trapping the viruses and disintegrating them directly
ANSWER: ________
RATIO:________________________________________________________________________________________________
______________________________________________________________________________________________________
__________________________________________________________________________________________
5. Which of the following prescribed antiviral should the nurse question for a patient with severe hypokalemia?
a. Foscarnet
b. Cidofovir
c. Valganciclovir
d. Nevirapine
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. Which enzyme is essential for the maturation of infectious viruses?
a. Reverse transcriptase
b. Protease
c. Nucleosidase
d. CCR5-ase
ANSWER: ________
RATIO:________________________________________________________________________________________________
______________________________________________________________________________________________________
__________________________________________________________________________________________
7. A senior nurse would be correct to advise her colleague to monitor which parameter in patients receiving cyclosporine and
zidovudine at the same time?
a. Skin lesion, temperature, and color
b. Flu-like symptoms
c. Level of consciousness
d. CBC with differential count
ANSWER: ________
RATIO:________________________________________________________________________________________________
______________________________________________________________________________________________________
__________________________________________________________________________________________
8. The only protease inhibitor that is not teratogenic.
a. Darunavir
b. Indinavir
c. Fosamprenavir
d. Saquinavir
ANSWER: ________
RATIO:________________________________________________________________________________________________
______________________________________________________________________________________________________
__________________________________________________________________________________________
9. Which of the following physical assessment findings will alert the nurse for anthelmintic drug toxicity in elderly patients?
a. Muscle strength +2
b. Blunt liver edge upon palpation
c. 10 bowel sounds in one minute on right lower quadrant (RLQ) upon auscultation
d. Non-palpable spleen
ANSWER: ________
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RATIO:________________________________________________________________________________________________
______________________________________________________________________________________________________
__________________________________________________________________________________________
10. Which drug is indicated for threadworm infections?
a. albendazole
b. ivermectin
c. pyrantel
d. mebendazole
ANSWER: ________
RATIO:________________________________________________________________________________________________
______________________________________________________________________________________________________
__________________________________________________________________________________________
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
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2. ANSWER: ________
RATIO:_______________________________________________________________________________________
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3. ANSWER: ________
RATIO:_______________________________________________________________________________________
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4. ANSWER: ________
RATIO:_______________________________________________________________________________________
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5. ANSWER: ________
RATIO:_______________________________________________________________________________________
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6. ANSWER: ________
RATIO:_______________________________________________________________________________________
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7. ANSWER: ________
RATIO:_______________________________________________________________________________________
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8. ANSWER: ________
RATIO:_______________________________________________________________________________________
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9. ANSWER: ________
RATIO:_______________________________________________________________________________________
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10. ANSWER: ________
RATIO:___________________________________________________________________________________________
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LESSON WRAP-UP (5 minutes)
You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.
You are done with the session! Let’s track your progress.
THREE W’s
Students discuss or write:
• What did you learn today?
• So What? (relevancy, importance, usefulness)
• Now What? (how does this fit into what you are learning, does it affect your thinking)
For the next lesson review antineoplastic.
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Pharmacology
STUDENT ACTIVITY SHEET
BS NURSING / SECOND YEAR
Session 6
LESSON TITLE: ANTINEOPLASTIC/ ANTI-CANCER DRUGS
Materials:
LEARNING OUTCOMES:
Notebook, Pharmacology book, Drug handbook
pens & paper
At the end of the lesson, the nursing student can:
1. Describe the nature of cancer and changes the body
undergoes when cancer occurs;
2. Differentiate cell- cycle specific and cell-cycle nonspecific drugs;
3. Identify nursing interventions and client education
guidelines for administering chemotherapy;
4. Enumerate ways the nurse can avoid absorption of
chemotherapeutic agents; and,
5. Develop a drug study guide . (therapeutic action,
indication, contraindication, most common adverse
reaction And nursing responsibility ) of antineoplastic
drugs.
References:
Kee, Joyce LeFever, Hayes, Evelyn R. &
McCuistion E. Pharmacoloy A Nursing
Process Approach 6th edition.. Singapore:
Elsevier Saunders Company.
LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY (5 minutes)
EVERYBODY WRITES .
What are changes the body undergoes when cancer occurs?
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
MAIN LESSON (50 minutes)
CANCER
Cancer: is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the
body.
Types of Cancer
 Carcinoma is a cancer that starts in the skin or the tissues that line other organs. These are most commonly
diagnosed cancers
 Sarcoma is a cancer of connective tissues such as bones, muscles, cartilage, and blood vessels.
 Leukemia is a cancer of bone marrow, which creates blood cells.
 Lymphoma and myeloma are cancers of the immune system.
 Melanoma are cancers that arise in the cells that make the pigment in the skin
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ANTINEOPLASTIC AGENTS
 comprise one aspect of chemotherapy. These drugs act on and kill altered human cells. While their action is
intended to target abnormal cells, normal cells are also affected. These drugs can work by affecting cell survival or
by boosting the immune system in its efforts to combat the abnormal cells.
Neoplasm Cancer—Mechanisms of Growth
a. Anaplasia : Cancerous cells lose cellular differentiation and organization and are unable to function normally
b. Autonomy : Cancerous cells grow without the usual homeostatic restrictions that regulate cell growth and control. This
allows the cells to form a tumor
c. Metastasis: Cancer cells travel from the place of origin to develop new tumors in other areas of the body
d. Angiogenesis : Abnormal cells release enzymes to generate blood vessels and supply oxygen and nutrients to the
cells, generating growth. Cancerous cells rob the host cells of energy and nutrients and block normal lymph
The Body’s Immune System Response to Cancerous Cells
 Can damage or destroy some neoplastic cells
 T cells recognize the abnormal cells and destroy them
 Antibodies form in response to parts of the abnormal cell protein
 Interferons and tissue necrosis factor (TNF) play a role in the body’s attempt to eliminate the abnormal cells
Possible Causes of Cancer
 Genetic predisposition
 Viral infection
 Constant irritation and cell turnover
 Stress
 Lifestyle factors
 Environmental factors
Classifications of Tumors
 Solid tumors
 May originate in any body organ
 Carcinomas (originate in epithelial cells)
 Sarcomas (originate in the mesenchyma)
 Hematologic malignancies
 Leukemias and lymphomas that occur in the blood-forming organs
Medical management of cancer includes the use of chemotherapy. First used in the early 1950s, there are now more than
80 effective drugs available.
Chemotherapy is method of choice when there is suspected or confirmed spread of malignant cells.
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Goal of Cancer Treatment
 To destroy cancer cells using the following methods:
o Surgical removal
o Stimulation of the immune system to destroy them
o Radiation therapy to destroy them
o Drug therapy to kill them during various phases of the cell cycle
Mechanism of Action
 Functions at cellular level by interrupting cell life—modifies or interferes with DNA synthesis.
 Chemotherapeutic agents eradicate cells, both normal and malignant, that are in the process of cell
reproduction.
Drug Classification
Drugs classified by group into those that act on a certain phase of cell reproduction (cell cycle specific) or those that do
not reproduce (cell cycle nonspecific).
A. Cell cycle–specific agents: antimetabolites and mitotic inhibitors.
 Act on the cell during a particular phase of reproduction.
 Most effective in tumors where a large number of cells are dividing.
 Divided doses produce greater cytotoxic effects (not all cells will be in the same phase at the same time).
 Antimetabolites.
a. Specific for the S phase—replaces building blocks of DNA so cell can’t divide.
b. Examples of antimetabolites: Trexall (methotrexate), Purinethol (6-mercaptopurine), Adrucil (5-fluorouracil),
Vidaza (azacitidine), Cytosar-U (cytarabine), Hydrea (hydroxyurea).
 Plant alkaloids.
a. Specific for the M phase—prevent cell division by destroying the mitotic spindle.
b. Examples of mitotic inhibitors: plant alkaloids—Oncovin (vincristine), Eldisine (vindesine), Velban (vinblastine),
Vumon (teniposide).
B. Cell cycle–nonspecific drugs: alkylating agents, antitumor antibiotics, and nitrosoureas.
 Act on cells during any phase of reproduction— some drugs will attack cells in the resting phase (not actively
dividing).
 Agents are dose dependent—the more drug given, the more cells destroyed.
 These drugs are more toxic to normal tissue because they are less selective.
 Alkylating agents
a. These drugs prevent cell division by damaging the DNA “ladder” structure and are effective in all phases of the
cell cycle.
b. Included in almost all chemotherapy regimens.
c. Examples of alkylating agents: Cytoxan (cyclophosphamide), Myleran (busulfan), Alkeran (melphalan [L-PAM]),
Thioplex (thiotepa), Platinol (cisplatin).
 Antitumor antibiotics.
a. These drugs attack DNA (they act like alkylating drugs) by slipping between the DNA strands and preventing
replication.
b. Examples of antitumor antibiotics: Adriamycin (doxorubicin), Cosmegen (dactinomycin).
 Nitrosoureas.
a. Alkylating agents that are stronger and have a greater ability to attack cells in the resting phase of cell growth.
b. These drugs can cross the blood–brain barrier.
c. Examples of nitrosoureas: Zanosar (streptozocin), semustine (methyl-CCNU), Gliadel (carmustine or BCNU),
azacitidine (chlorozotocin or DCNU).
C. Other miscellaneous agents (such as Matulane [procarbazine]) are used in the chemotherapy group, but their exact
mechanism of action is unknown.
D. Hormonal agents (estrogens, androgen, progestins) work in all cycles and are used in therapy to affect the hormonal
environment (Decadron [dexamethasone], DES, Halotestin [fluoxymesterone], Nolvadex [tamoxifen], Deltasone
[prednisone]).
 Affect the growth of hormone-dependent tumors.
 Steroids interfere with the synthesis of protein and alter cell metabolism (lymphomas and leukemias).
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 Antihormones (Nolvadex and Evista [Raloxifene]) block tumor growth by depriving the tumor of the necessary
hormones.
E. Combination chemotherapy.
 Most often administered in combination, which enhances the response rate: for example, Adriamycin,
Blenoxane (bleomycin), Velban, and dacarbazine (ABVD) used for Hodgkin’s lymphoma.
 Studies at Stanford University now suggest ABVD and a fifth or sixth chemotherapy drug be combined with
Deltasone (for its antiinflammatory effect) for 3 months for Hodgkin’s disease.
 Cancer cells divide erratically on different schedules; thus drugs that are effective alone and have different
mechanisms of action can combine to destroy even more cells.
 Drugs used in combination for synergistic activity.
 Guidelines for drug administration are carefully planned and referred to as protocols or regimens.
a. Package inserts are based on single-agent therapy, so it is important to adhere to the ordered protocol.
b. Dosages of drugs are based on height and weight calculated as body surface area.
F. Other chemotherapeutic agents that do not fall into specific categories.
 Elspar (asparaginase)—an enzyme used to treat lymphocytic leukemia; Eulexin (flutamide)—antiandrogen used
to treat prostate cancer; and Taxol (paclitaxel)—used to treat ovarian, breast, and cell lung cancers.
 Chemotherapeutic drugs cause myelosuppression; nursing interventions include blood counts and instituting
precautions if blood count falls below normal, and assess for infection.
Goals of Treatment
A. The major goal is to cure the malignancy.
 Chemotherapy, as primary mode of treatment, may include curing certain malignancies such as acute
lymphocytic leukemia, Hodgkin’s disease, lymphosarcomas, Wilms’ tumor.
 Cure may also occur in combination with other modes of treatment, radiation, or surgery.
B. Control may be the goal when cure is not realistic; the aim is to extend survival and improve the quality of life.
C. Palliation may be the goal when neither cure nor control may be achieved; this goal is directed toward client
comfort.
Chemotherapeutic Administration
A. Chemotherapeutic agents are administered through a variety of routes.
 Oral route—used frequently. Safety precautions must be observed.
 Intramuscular and subcutaneous used infrequently, as drugs are not vesicants.
 Intravenous is the most common route—provides for better absorption.
a. Potential complications: infection, phlebitis.
b. Prevention of complications: Use smallest gauge needle possible; maintain aseptic technique; monitor
intravenous (IV) site frequently; change IV fluid every 4 hours.
 Central venous catheter infusion—used for continuous or intermittent infusions.
a. Potential complications: infection, catheter clotting, sepsis, malposition of needle.
b. Prevention of complications: Maintain aseptic technique and monitor site daily; flush catheter daily and
between each use with heparin solution; assess client for signs of sepsis.
 Venous access devices (VADs)—used for prolonged infusions.
a. Potential complications: infection and infiltration from malposition.
b. Assess site frequently and assess for systemic infection.
 Intra-arterial route—delivers agents directly to tumor in high concentrations while decreasing drug’s systemic
toxic effect.
a. Potential complications: infection or bleeding at catheter site, catheter clotting,or pump malfunction.
b. Change dressing site daily and assess for signs of infection; irrigate catheter with heparin solution and avoid
kinks in tubing.
 Intraperitoneal—used for ovarian and colon cancer. High concentration of agents delivered to peritoneal cavity
via catheter, then drained.
 Other less frequently used routes are intrapleural, intrathecal, and ventricular reservoir.
B. Factors for deciding dosage and timing of drugs.
 Dosage calculated on body surface area and kilograms of body weight.
 Time lapse between doses to allow recovery of normal cells.
 Side effects of each drug and when they are
likely to occur.
 Liver and kidney function, as most antineoplastics are metabolized in one of these organs.
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Chemotherapy Safety Guidelines
A. Antineoplastic drugs are potentially hazardous to personnel and may have teratogenic and/or carcinogenic effects.
B. Safety guidelines have been issued by the Occupational Safety and Health Administration (OSHA).
 Obtain special training for drug administration.
 Use two pairs of powder-free, dispensable chemotherapy gloves, and a disposable, closed, long-sleeved gown
with outer pair of gloves covering gown cuff whenever there is risk of exposure to hazardous drugs.
 Provide syringes and IV sets with Luer lock fittings for preparing and administering hazardous drugs. Also
provide containers for their disposal.
 Use a closed-system drug-transfer device and needleless system to protect nursing personnel during drug
administration.
 Label all prepared drugs appropriately.
 Double-bag chemotherapy drugs once prepared, before transport.
 Have equipment ready to clean up any accidental spill (spill kit).
 Dispose of all materials in marked containers labeled hazardous waste.
 Dispose of all needles and syringes intact.
 Follow facility’s policies and procedures when preparing to administer chemotherapy.
 Double-check chemotherapy orders with another oncology nurse.
 Read material safety data sheets (MSDS) prior to administration.
 Use personal protective equipment (PPE).
 Wash your hands both before you put on and after you take off gloves.
 After infusion is complete, promptly dispose of any equipment that contained the drug in a puncture-proof
container that is clearly marked.
 Chemotherapy agents may be excreted in body fluids; these may be contaminated for 48 hours after the last
drug dose. Wear PPE when handling such excreta, and wash your hands after removing gloves.
 Check facility’s policies about handling linen that’s been contaminated with chemotherapy.
 If a chemotherapy drug comes into contact with your skin or a client’s skin, thoroughly wash the affected area
with soap and water, but don’t abrade the skin with a scrub brush.
 If the drug gets in your eyes, flush with copious amounts of water for at least 15 minutes while holding back
your eyelids. Then get evaluated by employee health or the emergency department (ED).
C. When infusing vesicant drugs, monitor IV carefully—at first sign of extravasation, remove IV and implement Rx
protocol.
Side Effects and Nursing Management
A. Side effects occur primarily due to the mechanism of action of potent drugs on normal cells.
 Normal cells most affected are bone marrow cells, epithelial cells of the gastrointestinal (GI) tract and hair
follicles, and cells of the gonads.
 Since other normal cells are not actively reproducing (except with tissue injury and repair), they are not
severely affected.
 Time of most severe depression of cells (termed nadir) is different for each type of cell.
B. Skin and mucosa, protective linings of the body, are damaged.
 Mucositis (cells of the mucosa are affected)—may extend from oral cavity and stomach through GI tract.
a. Symptoms may be nausea, vomiting, anorexia, fluid and electrolyte imbalance, dietary insufficiency, and
stomatitis.
b. Assess for erythema, tenderness, and ulceration.
 Clients at high risk are those with dental caries, those with gum disease, smokers, and those who drink
alcohol.
 Nursing interventions include good oral hygiene with soft toothbrush, mouthwashes (viscous Xylocaine
[lidocaine]), avoiding foods that are hot, sharp, spicy, or acidic—diet should be soft, bland, tepid.
C. Alopecia, or hair loss, caused by damage to rapidly dividing cells of the hair follicles.
 Hair loss begins 2–3 weeks after chemotherapy and continues through the cycles of chemotherapy; regrowth
occurs following the course of therapy.
 Nursing interventions include scalp hypothermia (ice cap) and scalp tourniquet; both reduce the amount of
drug reaching the hair follicle and may prevent hair loss.
D. Nausea, vomiting, and anorexia are common in clients receiving chemotherapy.
 Antiemetic regimens (Reglan [metoclopramide], Zofran [ondansetron]) may counteract these symptoms.
 Nursing interventions include supporting changes in food preferences, additional or less seasoning, small and
more frequent high-calorie, high-protein meals.
 Offer high-calorie and protein supplements.
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E. Elimination disturbance occurs when the client does not eat well, is not exercising, or has mucositis.
 Diarrhea is related to toxicity of the drugs on the mucosal lining and can quickly cause fluid volume deficit; diet
bland and low residue.
 Constipation may be related to the drugs (especially Velban and Oncovin) that affect nerve endings in the GI
tract.
a. Add more fiber and liquid to diet (3000 mL/day).
b. Avoid milk and dairy products.
c. Include low-residue foods and foods high in potassium.
d. Stool softeners are ordered to minimize constipation; may add vegetable laxative.
F. Elevated uric acid and crystal urate stone formation may occur.
G. Hematological disruptions: Damage to normal cells in the bone marrow can be life-threatening and is, therefore, the
most dangerous side effect.
 White blood cells (WBCs) and platelets have a shorter life span than red blood cells so they are more
susceptible to damage.
 White blood cell suppression—leukopenia (less than 5000/mm3 when normal white blood cell count is 5000–
10,000/mm3).
a. Granulocytes are the most suppressed, which places client at risk for bacterial infection.
b. Common sites of infection are the lung, urinary tract, skin, and blood.
c. Implementation includes meticulous aseptic technique for IV therapy as well as hand hygiene; avoid
exposure to infected persons.
d. Assess for fever, chills, and sore throat.
e. Teach signs and symptoms of infection to the cancer client with instructions to report symptoms to the
doctor or nurse.
f. Medications may be given to stimulate the production of WBCs, e.g., Neupogen (filgrastim).
 Platelet suppression to below normal (less than 150,000 mm3) is called thrombocytopenia.
a. A number less than 50,000/mm3 makes the client susceptible to bleeding gums and/or nose, easy bruising,
heavier menstrual flow, etc.
b. Teach client precautions: soft toothbrush, avoidance of douches and enemas, care with trimming nails,
avoiding venipunctures when possible, and avoidance of any activity that might increase intracranial pressure
(ICP).
 Red blood cell suppression—anemia is not usually a severe toxicity.
H. All hormonal agents cause fluid retention: Monitor weight gain, intake and output (I&O), edema, and administer
diuretics as ordered.
Nursing Considerations
Nursing Assessment
These are the important things the nurse should include in conducting assessment, history taking, and examination:
 Assess for the mentioned cautions and contraindications (e.g. drug allergies, hepatorenal impairment, bone
marrow suppression, pregnancy and lactation, etc.) to prevent any untoward complications.
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

Perform a thorough physical assessment (other medications taken, orientation and reflexes, vital signs, bowel
sounds, etc.) to establish baseline data before drug therapy begins, to determine effectiveness of therapy, and
to evaluate for occurrence of any adverse effects associated with drug therapy.
Monitor result of laboratory tests such as CBC with differential to identify possible bone marrow suppression
and toxic drug effects and establish appropriate dosing for the drug; and liver and renal function tests to
determine need for possible dose adjustment and identify toxic drug effects.
Nursing Diagnoses
Here are some of the nursing diagnoses that can be formulated in the use of these drugs for therapy:
 Acute pain related to GI, CNS, and skin effects of the drug
 Disturbed body image related to alopecia, skin effects, and impaired fertility
 Anxiety related to diagnosis
 Risk for infection related to bone marrow suppression
Implementation
These are vital nursing interventions done in patients who are taking alkylating agents:
 Arrange for blood tests before, periodically during, and for at least 3 weeks after therapy to monitor bone
marrow function to aid in determining the need for a change in dose or discontinuation of the drug.
 Administer medication according to scheduled protocol and in combination with other drugs as indicated to
improve effectiveness.
 Ensure that patient is well hydrated to decrease risk of renal toxicity.
 Protect the patient from infection; limit invasive procedures when bone marrow suppression limits the patient’s
immune/inflammatory responses.
 Provide small, frequent meals, frequent mouth care, and dietary consultation as appropriate to maintain
nutrition when GI effects are severe.
 Arrange for proper head covering at extremes of temperature if alopecia occurs; a wig, scarf, or hat is
important for maintaining body temperature.
 Plan for rest periods because fatigue and weakness are common effects of the drug.
Evaluation
Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:
 Monitor patient response to therapy (alleviation of cancer being treated, palliation of signs and symptoms of
cancer).
 Monitor for adverse effects (bone marrow suppression, GI toxicity, neurotoxicity, and alopecia, renal or hepatic
dysfunction).
 Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse
effects to watch for.
 Monitor patient compliance to drug therapy.
CHECK FOR UNDERSTANDING (30 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not
allowed. You are given 25 minutes for this activity:
Multiple Choice
1. Chemotherapy dosing is usually based on the total body surface. What should the nurse do before administering
chemotherapy?
a. Get the body mass index (BMI).
b. Ask the client about intake and output.
c. Weigh and measure the height of the patient on the day of administration.
d. Ask the client for the height and weight.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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2. The nurse is caring for of a client who is receiving a chemotherapy. Which of the following would be expected as a result
of the massive cell destruction that occurred from the chemotherapy?
a. Leukopenia.
b. Anemia.
c. Thrombocytopenia.
d. Hyperuricemia.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. Mitomycin (Mutamycin) is prescribed to a client with colorectal cancer. All of which are the routes of administration,
except?
a. Oral
b. Intravenous
c. Intravesical
d. Intraarterial
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. The client with a testicular cancer is being treated with Etoposide (Etopophos). Which of the following side effect is
specifically associated with this medication?
a. Chest pain
b. Edema
c. Alopecia
d. Orthostatic hypotension
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. The clinic nurse provides instructions to a client receiving an antineoplastic medication. When implementing the plan,
the nurse tells the client to?
a. To drink beverages containing alcohol in moderate amount during the evening.
b. To avoid hot foods and high fiber rich foods.
c. To take acetylsalicylic acid as needed for headache.
d. To consult with health care providers before receiving immunization.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. The nurse is providing teachings to a client receiving cyclophosphamide (Cytoxan). The nurse tells the client to which
of the following?
a. Eat foods rich in potassium.
b. Increase fluid intake to 2-3 liters per day.
c. Take the medication with food.
d. Eat foods rich in purine.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. The nurse is monitoring a patient receiving an Iv infusion of an antineoplastic medication. During the infusion, the patient
complains of pain and redness at the insertion site. The nurse should take which actions? Select all that apply.
a. Reinsert the IV at a distal part of the same vein.
b. Increase the flow rate of the medication.
c. Notify the physician.
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d. Apply a heat or ice compress to the site.
e. Administer an antidote as prescribed.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. The nurse is caring for a client receiving chemotherapy when an anaphylactic reaction occurs from the medication. The
nurse should take which actions? Select all that apply.
a. Stop the medication.
b. Remove the IV line.
c. Administer Oxygen.
d. Administer epinephrine.
e. Positioned the client in a reverse Trendelenburg position.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. The nurse is caring for a client who is receiving Fluorouracil (Adrucil). Which of the following symptoms would
necessitate the nurse to immediate discontinuation of the medication?
a. Palmar-plantar erythrodysesthesia.
b. Ataxia.
c. Constipation.
d. Insomnia.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. Nausea and vomiting are frequent adverse effects associated with antineoplastic therapy. What should the nurse advise
clients experiencing these unpleasant adverse effects?
a. Increase intake of dry or high-fiber foods, and foods that have a rough texture.
b. Consider relaxation techniques because these symptoms should improve over time.
c. Use antacids to relieve the irritation to the stomach, which should stop the nausea.
d. Try to maintain hydration and nutrition, which are very important during treatment.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
GUIDED / RATIONALIZATION ACTIVITY (15 minutes)
Your instructor will now rationalize the answers to you and to your classmates. Pay attention. You can now ask questions
and debate among yourselves for (ten) 10 minutes. Write the correct answer and correct/additional ratio in the space
provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
6. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
7. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
8. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
9. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
10. ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________________________________________
LESSON WRAP-UP (5 minutes)
You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.
You are done with the session! Let’s track your progress.
I CARE WHY? (5 minutes)
In three sentences explain relevancy of the concept to your life or how you might use it. State ways on how to prevent
cancer.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
For next session, review Anti- Inflammatory Drugs, Vaccines & Sera
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Pharmacology
STUDENT ACTIVITY SHEET
BS NURSING / SECOND YEAR
Session 7
LESSON TITLE: ANTI- INFLAMMATORY DRUGS/
VACCINES & SERA
Materials:
LEARNING OUTCOMES:
Student: Notebook, Pharmacology book, drug
handbook, pens & paper
At the end of the lesson, the nursing student can:
Teacher: Projector and SAS
1. Identify the five cardinal signs of inflammation;
2. Describe the action action of non-steroidal antiinflammatory drug (NSAID’s);
3. Explain the use of disease modifying antirheumatic
drugs (DMARD’s); and,
4. Develop a drug study guide (therapeutic action,
indication, contraindication, most common adverse
reaction and nursing responsibility) of antineoplastic
drugs.
5. Differentiate active from passive immunity;
6. Identify infectious diseases for which vaccines are
currently available;
7. Outline the currently recommended childhood
immunization schedule; and,
8. Distinguish nursing interventions, including client
teaching-related to the administration of vaccines.
References:
Hayes, Evelyn R. Pharmacology: A Nursing
Process Approach: 6 th Edition. Singapore:
Elsevier Saunders Company.
Karch, Amy M. Focus on Nursing Pharmacology
5th edition. Philedelphia: Lippincott William
and Wilkins
LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY (10 minutes)
WORD SEARCH
Stimulate your brain and answer this fun and easy word search. Find the words listed at the right side of the puzzle and
encircle the. The first five students who would finish will have a reward.
This document and the information thereon is the property of
PHINMA Education (Department of Nursing)
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Salicylates
Parachlorobenzoic
Propionic
Phenylacetic
Fenamates
Oxicams
Antihistamines
Corticosteroids
Aspirin
Tylenol
Acetaminophen
Rubor
Calor
Tumor
Dolor
MAIN LESSON (45 minutes)
Inflammation (from Latin: 2unction2ion) is part of the complex biological response of body tissues to harmful stimuli, such
as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molecular
mediators.
Inflammation is characterized by five cardinal signs:
1. rubor (redness),
2. calor (increased heat),
3. tumor (swelling),
4. dolor (pain), and.
5. funtio laesa (loss of function).
ANTI-INFLAMMATORY AGENTS
Inflammatory Response
 Protects the body from injury and pathogens
 Uses chemical mediators to produce the reaction that helps destroy pathogens and promote healing
Anti-inflammatory Agents

Block or alter the chemical reactions associated with the inflammatory response

Anti-inflammatory agents have additional properties such as relief of pain (analgesics), reduction of elevated body
temperature (antipyetic), and inhibition of platelet aggregation (anticoagulant).

Aspirin is the oldest anti-inflammatory drug
Types of Anti-inflammatory Agents

Corticosteroids: used systemically to block the inflammatory and immune systems

Antihistamines: block the release of histamine in the initiation of the inflammatory response
NSAIDs (Nonsteroidal Anti-inflammatory drug)
 Provide strong anti-inflammatory and analgesic effects
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
Sold over the counter, which may lead to abuse
Seven Types of NSAIDs
1. Salicylates: Aspirin (ASA- acetylsalicylic acid)
2. Parachlorobenzoic acid or derivatives or indoles: Indomethacin, Sulindac, Tolmetin
3. Propionic acids: Fenoprofen, Ibuprofen,
4. Phenylacetic acids : Diclofenac, Etodolac, Keterolac, Diclofenac (Voltaren)
5. Fenamates: Mefenamic acid, Meclofen-amate sodium monohydrate
6. Oxicams: Piroxicam
7. Cyclooxygenase-2 inhibitors : Celecoxib
NSAIDs Indications
 Relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis
 Relief of mild to moderate pain
 Treatment of primary dysmenorrhea
 Fever reduction
Side Effects
 Gastric irritation
Contraindications to NSAIDs
 Presence of allergy to any NSAID or salicylate
 Cardiovascular dysfunction or hypertension
 Peptic ulcer or known GI bleeding
 Pregnancy and lactation
 Caution with renal or hepatic dysfunction
Nursing Interventions
 Observe for bleeding
 Report if client has GI discomfort
 Monitor vital signs and check for peripheral edema especially in the morning
Salicylates
 Can block the inflammatory response
 Have antipyretic (fever-blocking) properties
 Have analgesic (pain-blocking) properties
Common Salicylates
 Aspirin (Bayer,etc.): treats inflammatory conditions
 Balsalazide (Colazal): new drug that treats ulcerative colitis
 Choline magnesium trisalicylate (Trilisate): treats mild pain and fevers as well as arthritis
 Choline salicylate (Arthropan): treats mild pain and fevers as well as arthritis
 Mesalamine (Pentasa, etc.): treats inflammation of the large intestine
 Olsalazine (Dipentum): converted to mesalamine in the colon; has the same direct anti-inflammatory effects
 Salsalate (Argesic, etc.): treats pain, fever, and inflammation
 Sodium thiosalicylate (Rexolate): treats episodes of acute gout and muscular pain as well as rheumatic fever
Salicylates
 Action/indication: Inhibit synthesis of prostaglandin; used to treat mild to moderate pain and fever
 Pharmacokinetics: Absorbed from the stomach, peak in 5 to 30 min., metabolized in the liver, and excreted in the
urine
 Contraindications: Known allergy, bleeding abnormalities, and impaired renal function
 Drug-to-drug interactions : Interact with other drugs by interfering with absorption
 Adverse Effects
o GI irritation : Nausea, dyspepsia, and heartburn
o Clotting system : Blood loss and bleeding abnormalities
o Eighth cranial nerve stimulation
o Salicylism : Ringing in the ears, Acidosis, Nausea, vomiting, and diarrhea & Mental confusion and lassitude
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Other Anti-inflammatory Agents
 Acetaminophen (Tylenol)
 Gold compounds
 Antiarthritic drugs
Acetaminophen
 Action/indications
o Acts directly on the thermoregulatory cells of the hypothalamus
o Mechanism of action related to analgesic effects is not certain
o Used to treat pain and fever
1. Treatment of pain and fever associated with a variety of conditions, including influenza
2. Prophylaxis of children receiving diphtheria–pertussis–tetanus (DPT) immunizations
3. Relief of musculoskeletal pain associated with arthritis
 Pharmacokinetics
o Absorbed from the GI tract
o Peaks in ½ to 2 hours
o Metabolized in the liver
o Excreted in the urine
o T½ is about 2 hours

Contraindications : Known allergy; Use with caution in pregnancy and lactation

Adverse reactions : Headache, hemolytic anemia, renal dysfunction, skin rash, fever, and hepatotoxicity

Drug-to-drug interactions : Oral anticoagulants increase bleeding
Gold Compounds (DMARD-Disease Modifying Antirheumatic Drugs
 Action : Absorbed by macrophages, which results in inhibition of phagocytosis
 Indication : Tissue destruction is decreased
 Pharmacokinetics : Absorption varies based on the site of administration; Widely distributed throughout the body
 Contraindications : Known allergy; Diabetes, CHF, and renal or hepatic impairment
 Adverse reactions : Stomatitis, glossitis, gingivitis, bone marrow depression, and dermatitis
 Drug-to-drug interactions : Penicillamine, antimalarials, cytotoxic drugs, and immunosuppressive agents
VACCINES AND SERA
Biologicals—Actions
 Stimulate the production of antibodies
 Provide preformed antibodies to facilitate an immune reaction
 React specifically with the toxins produced by an invading pathogen
Types of Immunity
1. Active immunity : The body recognizes a foreign protein and begins producing antibodies to react with it
2. Passive immunity : Occurs when preformed antibodies are injected into the system and react with a specific antigen
Immunization
 Definition
o The process of artificially stimulating active immunity
o Exposes the body to weakened or less toxic proteins associated with specific disease-causing organisms
 Goal
o To cause an immune response without having the patient suffer the full course of a disease
Childhood Vaccinations
 Diphtheria, pertussis, and tetanus
 Haemophilus B
 Hepatitis B and hepatitis A
 Chickenpox
 Polio
 Measles, mumps, and rubella
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VACCINES
Indications
 Stimulate active immunity in people who are at risk
 The vaccine needed depends on the exposure the person will have to pathogens
 Vaccines are thought to provide lifelong immunity
Contraindications
 In the presence of immune deficiency
 During pregnancy
 Known allergies to any of the components of the vaccine
 Patients who receive immune globulin or who have received blood or blood products within the last 3 months
 Caution with history of febrile convulsions or cerebral injury, conditions in which high fever would be dangerous,
and during acute infection
Adverse Effects
 Fever
 Rash
 Malaise
 Chills
 Fretfulness
 Drowsiness
 Anorexia
 Vomiting
 Irritability
 Pain, redness, and swelling at the injection site
Site of Action of Vaccines, Immune Sera, and Antitoxins


IMMUNE SERA
Definition : Sera that contain antibodies to specific bacteria or viruses
Types : Antitoxin and antivenom
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o
Immune sera have antibodies to specific toxins that might be released by invading pathogens, or to venom
from spider or snake bites
Immune Sera and Antitoxins
Indications
 Provide passive immunity to a specific antigen or disease
 Used as prophylaxis against specific disease after exposure
 May lessen the severity of a disease
Contraindications
 History of severe reaction to any immune sera
 Use with caution:
o Pregnancy
o Coagulation defects
o Previous exposure to the immune sera
o Rash
o Nausea
o Vomiting
o Chills
o Fever
 Allergic reaction
o Chest tightness, decreased blood pressure, and difficulty breathing
 Local reaction
 Swelling, tenderness, pain, and muscle stiffness at the injection site
CHECK FOR UNDERSTANDING (30 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not
allowed. You are given 25 minutes for this activity:
Multiple Choice
1. As a well-rounded health care provider, you know that corticosteroid therapy is indicated in all of the following conditions
except:
a. Osteoarthritis
b. Rrheumatoid arthritis
c. Systemic lupus erythematosus
d. Acute spinal cord injury
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. An appropriate nursing diagnosis for clients who are taking NSAIDs and anticoagulants would be which of the following?
a. Risk for injury related to prolonged bleeding time, inhibition of platelet aggregation, and increased risk of GI bleeding.
b. Potential for injury related to GI toxicity and decrease in bleeding time.
c. Altered protection related to GI bleeding and increasing platelet aggregation.
d. Risk for injury related to thrombocytosis prolonged prothrombin time.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3.
a.
b.
c.
d.
Teaching has been adequate when a client being treated with acetylsalicylic acid states:
“I can crush the pills before i swallow them.”
“I should take the pills with antacids.”
“Taking the pills on an empty stomach will help absorption.”
“If the pills smell like vinegar, I should throw them out.”
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ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. Which of the following groups of clients are most at risk for GI bleeding from the use of NSAIDs?
a. Clients with dysmenorrhea
b. Clients with headaches
c. Clients with arthritis
d. Clients with renal failure
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. Which of the following NSAIDs is used to prevent thrombosis?
a. Motrin
b. Toradol
c. Aspirin
d. Naproxen
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. To minimize the risk of dyspnea and GI bleeding, OTC ibuprofen is given:
a. IV
b. With orange juice
c. On an empty stomach
d. With meals
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. Nurse Kate is taking care of patients taking ibuprofen. Which of the following should be included in her assessment and
monitoring?
a. Blood pressure and bowel sounds
b. Weight and appetite
c. Muscle strength and range of motion
d. Respiratory rate, depth, and rhythm
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. The nurse is discussing vaccines with the mother of a 4-year-old child who attends a day care center that requires
the DTaP vaccine. The mother, who is pregnant, tells the nurse that she does not want her child to receive the
pertussis vaccine because she has heard that the disease is "not that serious" in older children. What information
will the nurse include when discussing this with the mother?
a. If she gets the vaccine, both she and her 4 year-old child will be protected.
b. If the 4-year-old child contracts pertussis, it can be passed on to her newborn.
c. The vaccine will not be given to her child while she is pregnant.
d. Vaccinating the 4-year-old will provide passive immunity for her unborn child.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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9. A woman who is pregnant tells the nurse she has not had any vaccines but wants to begin so she can protect her unborn
child. Which vaccine(s) may be administered to this patient?
a. Gardasil vaccine
b. Trivalent influenza vaccine
c. MMR vaccine
d. Varivax vaccine
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. A 4-year-old child is receiving amoxicillin (Amoxil) to treat otitis media and is in the clinic for a well-child checkup on the
last day of antibiotic therapy. The provider orders varicella (Varivax); mumps, measles, and rubella (MMR); inactivated polio
(IPV); and diphtheria, tetanus, and acellular pertussis (DTaP) vaccines to be given. Which action by the nurse is correct?
a. Administer the vaccines as ordered.
b. Discuss giving the MMR vaccine in 4 weeks.
c. Hold all vaccines until 2 weeks after antibiotic therapy.
d. Recommend aspirin for fever and discomfort.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
11. A 48-month-old child is scheduled to receive the following vaccines: MMR, Varivax, IPV, and DTaP. The child's parents
want the child to receive two vaccines today and the other two in 1 week. To accommodate the parents' wishes, the nurse
will administer
a. DTaP and Varivax today and the MMR and IPV in 1 week.
b. IPV and MMR today and the Varivax and DTaP in 1 week.
c. MMR and DTaP today and the Varivax and IPV in 1 week.
d. MMR and Varivax today and the DTaP and IPV in 1 week.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
12. The nurse is preparing to administer rotavirus vaccine to a 4-month-old infant. The nurse notes that the infant received
Rotarix vaccine at 2 months of age. The nurse will plan to administer
a. Rotarix today.
b. Rotarix today and again at age 6 months.
c. Rota Teq today.
d. Rota Teq today and again at age 6 months.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
13. Which is an example of acquired passive immunity?
a. Administration of IgG to an unimmunized person exposed to a disease
b. Administration of an antigen via an immunization
c. Inherent resistance to a disease antigen
d. Immune response to an attenuated virus
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
14. The parent of a 12-month-old child who has received the MMR, Varivax, and hepatitis A vaccines calls the clinic to report
redness and swelling at the vaccine injection sites and a temperature of 100.3° F. The nurse will perform which action?
a. Recommend aspirin or an NSAID for pain and fever.
b. Recommend acetaminophen and cold compresses.
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c. Report these adverse effects to the Vaccine Adverse Event Reporting System (VAERS).
d. Schedule an appointment in clinic so the provider can evaluate the child.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
15. A mother calls the pediatric clinic to ask when her daughter will receive the Varicella vaccine. Your answer to her question
is:
a. at 2, 4, and 6 months
b. at 12 months and 4-6 years
c. at 6 and 12 months
d. at 4 months and 4-6 years
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
6. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
7. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
8. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
9. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. ANSWER: ________
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RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________________________________________
11. ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________________________________________
12. ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________________________________________
13. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________________
14. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________________
15. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________________
LESSON WRAP-UP (5 minutes)
You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.
You are done with the session! Let’s track your progress.
S-T-O-P Summary
Summarize the lesson by completing the following sentences: We Started the lesson…., the Topic was……, Our
Opportunities for practice were…., the Purpose of the lesson
For the next session, review Antipsychotic & Anxiolytic Drugs
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Pharmacology
STUDENT ACTIVITY SHEET
BS NURSING / SECOND YEAR
Session 8
LESSON TITLE: ANTIPSYCHOTIC & ANXIOLYTIC DRUGS
Materials:
LEARNING OUTCOMES:
Student: Notebook, Pharmacology book, Drug
handbook, pens & paper
At the end of the lesson, the nursing student can:
1. Differentiate two major categories of antipsychotic
agents;
2. Identify the general side effects associated with
antipsychotics and anxiolytics; and,
3. Develop a drug study guide . (therapeutic action,
indication, contraindication, most common adverse
reaction And nursing responsibility ) of antipsychotic
and anxiolytic agents.
Teacher: Projector and SAS
References:
Kee, Joyce LeFever, Hayes, Evelyn R. &
McCuistion E. Pharmacoloy A Nursing
Process Approach 6th edition.. Singapore:
Elsevier Saunders Company.
LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY (15 minutes)
PRE TEST
I.
True or False. Write T if the statement is TRUE and F if FALSE. Write our answers on the space provided before each
number.
___1. All typical antipsychotics block dopamine D2 receptors in the limbic system of the brain.
___2. Tardive dyskinesia: stereotype oral-facial movements due to long-term antipsychotic use.
___3. Haloperidol is a High potency-typical antipsychotic drug
___4. Atypical antipsychotics have more extrapyramidal effects than typical antipsychotics.
___5. The major group of anxiolytics are benzodiazepine.
___6. Anxiolytics are also known as antianxiety drugs.
___7. Protrusion and rolling of tongue is a sign of acute dystonia.
___8. Benzodiazepines are considered more effective than barbiturates because they enhance action of GABA.
___9. Shuffling gate is one of the signs of pseudoparkinsonism.
___10. Antipsychotic are also known as sedative hypnotics.
II. Enumeration
1. What are the two major categories of antipsychotic drug?
2. Give at least three extrapyramidal (neurologic) side effects of antipsychotic drugs.
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MAIN LESSON (40 minutes)
ANTIPSYCHOTIC
 Antipsychotic medications, sometimes referred to as neuroleptics or major tranquilizers, are prescribed to treat
schizophrenia and to reduce the symptoms associated with psychotic conditions such as bipolar, psychotic
depression, senile psychoses, various organic psychoses, and drug-induced psychoses.
 People experiencing psychosis are sometimes, but not always, a danger to themselves and others.
 Antipsychotic medications have both a short-term sedative effect and the long-term effect of reducing the chances
of psychotic episodes.
CLASSIFICATION OF ANTIPSYCHOTICS
1. Typical Antipsychotics, or First Generation Antipsychotic Drugs : were first developed in the 1950s.
 Are divided into two Phenothiazines and non-phenothiazines.
 Haldol (haloperidol) and Thorazine (chlorpromazine) are the best known typical antipsychotics.
 useful in the treatment of severe psychosis and behavioral problems when newer medications are
ineffective
 medications do have a high risk of side effects, some of which are quite severe
 INDICATION for schizophrenia and manifestations of other psychotic disorders including hyperactivity,
combative behavior, and severe behavioral problems. Some antipsychotics are approved for treatment
of bipolar disorder.
 THERAPEUTIC ACTION: Block dopamine receptors, preventing dopamine from stimulating the
postsynaptic neurons.
o They also have anticholinergic, antihistaminic, and alpha-adrenergic blocking effects, all of
which are related to its dopamine-receptor blocking action.
o Other than that, they depress the RAS to limit the stimulation entering the brain.
o Cause several adverse effects including hypotension, anticholinergic effects, and extrapyramidal side
effects (EPS)
2. Atypical Antipsychotics, or Second Generation Antipsychotic Drugs.
 new medications were approved for use in the 1990s. Clozapine (Clozaril), RIsperidone (Risperdal),
Olanzapine (Zyperea) and Quetiapine (Seroquel)
 Clozapine was categorized as the first atypical antipsychotic drug. This category of drugs has also been
of great value in studying the pathophysiology of schizophrenia and other psychoses.
 INDICATION: are used for treatment of severely ill patients with schizophrenia but are unresponsive to
standard drugs. It also reduces the risk of recurrent suicidal behaviors in patients with schizophrenia and
schizoaffective disorders.
 Risperidone is commonly used for treatment of irritability and aggression in children and adolescents
with autism
 THERAPEUTIC ACTION: Block both dopamine and serotonin receptors.
o This dual blocking action help relieve neurological adverse effects associated to typical
antipsychotics( may alleviate son of the unpleasant neurologic effects)
SIDE EFFECTS AND ADVERSE DRUG REACTIONS
People who take antipsychotic medications may experience negative side effects, such as:
 Extrapyramidal Effects: Dystonias, akathisia, tardive dyskinesia, Parkinson’s-like symptoms, unwanted
movements, ataxia, muscle breakdown, rigidity, tremors, and seizures are some major effects of this category
of drugs. Neuroleptic malignant syndrome may occur as well.
 Effects on the Central Nervous System: Drowsiness, sedation, and hypnosis occur. Confusion, vertigo,
syncope, disturbed sleep, nightmares, and agitation are also reported by various studies. Dementia, amnesia,
and loss of memory are some adverse effects. Suicidal ideation in old and young with
increased mania, anxiety, agitation, violent behavior, and depression can also be seen in people taking these
drugs.
 Effects on the Cardiovascular System: Cardiomyopathy is noted in nine out of every 100,000 people using
clozapine. Alteration in electrocardiogram (ECG) readings, chest pain, an gina, myocarditis, palpitation,
tachycardia, edema, phlebitis, and arrhythmias are serious adverse effects. Myocardial infarction (heart
attack) occurs in only 1% of people using this category of drug. Orthostatic hypotension —the medical name
for the fuzzy feeling you get when standing up to quickly—is very common.
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Hepatic (Liver) Effects: These agents increase the serum concentration of alkaline aminotransferase.
Reversible liver cell hyperplasia, increase in bilirubin, jaundice, drug induced hepatitis, and necrosis have
been recorded in studies.
Gastrointestinal Effects: Constipation, dry mouth, anorexia, weight gain, increases in pancreatic enzymes,
epigastric distress, abdominal cramps, dyspepsia, heartburn, and nausea ar e some common adverse effects.
Genitourinary (Urinary and Reproductive) Effects: Impotence, delayed and premature ejaculation, testicular
swelling, priapism, increased or decreased libido, virginal itching, enuresis, polyuria, breast engorgement,
galactorrhea, and anorgasmia have been reported.
Other Effects: Cases of blurred vision, hot flashes, dry throat, nasal congestion, severe hyperglycemia,
numbness, chills, glaucoma, leukopenia, neutropenia, hyperlipidemia, agranulocytosis, and respiratory
depression have been reported.
Pregnancy and Lactation: Antipsychotic drugs can be used in pregnant females since they have shown no
teratogenic (development of the fetus or embryo) effects in animal studies. Drugs like clozapine and
olanzapine have shown no harm to the fetus. However, during lactation, the metabolites may be disturbed in
the milk and could harm the newborn.
CONTRAINDICATION
 Presence of diseases that can be exacerbated by dopamine-blocking effects.
 CNS depression, circulatory collapse, Parkinsons’ disease, coronary disease, severe hypotension, bone
marrow suppression, blood dyscrasias. Exacerbated by drug effects.
 QTc interval prolongation. Contraindicated to mesoridazine, thioridazine, and ziprasidone; can lead to serious
cardiac arrhythmias.
 Dementia. Use is associated with increased risk of CV events and death.
 Glaucoma, peptic ulcer, urinary or intestinal obstruction. Exacerbated by anticholinergic effects of
antipsychotics.
 Seizure disorders. Possible severe neurosensitivity can lower seizure threshold in patients with thyrotoxicosis.
 Active alcoholism. Antipsychotics can potentiate CNS depression.
 Immunosuppression, cancer. Caution is applied because antipsychotics can result to bone marrow suppression
and blood dyscrasias.
 Pregnancy, lactation. Potential adverse effects on the fetus or neonate.
 Caution is used in children younger than 12 years of age who have chicken pox or a CNS infection because
children are more likely to develop dystonia and this could cause confusion in the diagnosis of Reye’s syndrome.
DRUG INTERACTIONS
Antipsychotics cannot be used with the following substances:
 Anti-anxiety drugs and other central nervous system depressants
 Antidepressants
 Hypotensive agents
 Anticholinergic agents
 Anticoagulants
 Levodopa
 Carbidopa
 Alcohol
 Valproic acid
 Lithium
 Drugs affecting seizure threshold
 Smoking
NURSING RESPONSIBILITIES
 Do not allow patient to crush or chew sustained-release capsules as this will speed up absorption and may
cause toxicity.
 Keep patient in recumbent position for 30 minutes if administering parenteral forms to reduce risk of orthostatic
hypotension.
 Monitor CBC results to arrange to discontinue the drug at signs of bone marrow suppression.
 Monitor blood glucose levels with long-term use to detect development of glucose intolerance.
 Provide comfort measures (e.g. positioning of legs and arms for dyskinesia, sugarless candy and ice chips for
dry mouth, voiding before taking drugs for urinary hesitancy or retention, etc.) to help patient tolerate drug
effects.
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Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent injuries.
Educate client on drug therapy to promote understanding and compliance.
WITHDRAWAL SYMPTOMS
Withdrawal from antipsychotics should be slow and gradual. A period of at least 15–30 days should be considered
for this purpose. Nausea, vomiting, psychotic symptoms, hypertension, and sleep disturbances might come back if
sudden discontinuation of therapy occurs.
ANXIOLYTICS
Therapeutic Actions
o Act in the limbic system and the RAS
o Make GABA more effective
o Cause interference with neurons firing
o Lower doses cause anxiolytic effects
o Higher doses cause sedation and hypnosis
Indications
o Anxiety disorders
o Alcohol withdrawal
o Hyperexcitability and agitation
o Preoperative relief of anxiety and tension
Pharmacokinetics
o Well absorbed from the GI tract
o Peak levels achieved in 30 minutes to 2 hours
o Lipid soluble and well distributed throughout the body
o Cross placenta
o Enter breast milk
o Metabolized in the liver
o Excretion is primarily in the urine
Contraindications & Cautions
o Allergy to benzodiazepines
o Psychosis
o Acute narrow angle glaucoma
o Shock
o Coma
o Acute alcohol intoxication
o Pregnancy
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Adverse Effects
o Sedation
o Drowsiness
o Depression
o Lethargy
o Blurred vision
o Confusion
o Dry mouth
o Constipation
o Nausea
o Vomiting
o Hypotension
o Urinary retention
Drug-to-Drug Interactions
o Increase CNS depression when taken with alcohol
o Increase in effect when taken with cimetidine, oral contraceptives, or disulfiram
o Decrease in effect if given with theophylline or ranitidine
CHECK FOR UNDERSTANDING (30 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not
allowed. You are given 25 minutes for this activity:
Multiple Choice
1. A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication
should a nurse expect a physician to order to address this type of symptom?
A. Haloperidol (Haldol) to address the negative symptom
B. Clonazepam (Klonopin) to address the positive symptom
C. Risperidone (Risperdal) to address the positive symptom
D. Clozapine (Clozaril) to address the negative symptom
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1
mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine?
A. Tactile hallucinations
B. Tardive dyskinesia
C. Restlessness and muscle rigidity
D. Reports of hearing disturbing voices
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. A client diagnosed with chronic schizophrenia presents in an emergency department (ED) with uncontrollable tongue
movements, stiff neck, and difficulty swallowing. The nurse would expect the physician to recognize which condition and
implement which treatment?
A. Neuroleptic malignant syndrome and treat by discontinuing antipsychotic medications
B. Agranulocytosis and treat by administration of clozapine (Clozaril)
C. Extrapyramidal symptoms and treat by administration of benztropine (Cogentin)
D. Tardive dyskinesia and treat by discontinuing antipsychotic medications
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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4. After taking chlorpromazine (Thorazine) for 1 month, a client presents to an emergency department (ED) with severe
muscle rigidity, tachycardia, and a temperature of 105oF (40.5C). The nurse expects the physician to recognize which
condition and implement which treatment?
A. Neuroleptic malignant syndrome and treat by discontinuing Thorazine and administering dantrolene (Dantrium)
B. Neuroleptic malignant syndrome and treat by increasing Thorazine dosage and administering an antianxiety medication
C. Dystonia and treat by administering trihexyphenidyl (Artane)
D. Dystonia and treat by administering bromocriptine (Parlodel)
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse
immediately report to the client's attending psychiatrist?
A. Respirations of 22 beats/minute
B. Weight gain of 8 pounds in 2 months
C. Temperature of 104F (40C)
D. Excessive salivation
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. An aging client diagnosed with chronic schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent
(propranolol) for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is
most appropriate?
A. "Make sure you concentrate on taking slow, deep, cleansing breaths."
B. "Watch your diet and try to engage in some regular physical activity."
C. "Rise slowly when you change position from lying to sitting or sitting to standing."
D. "Wear sunscreen and try to avoid midday sun exposure."
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side
effects of this medication should prompt a nurse to intervene immediately?
A. Sore throat, fever, and malaise
B. Akathisia and hypersalivation
C. Akinesia and insomnia
D. Dry mouth and urinary retention
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. If clozapine (Clozaril) therapy is being considered, the nurse should evaluate which laboratory test to establish a
baseline for comparison in order to recognize a potentially life-threatening side effect?
A. White blood cell count
B. Liver function studies
C. Creatinine clearance
D. Blood urea nitrogen
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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9. During an admission assessment, a nurse notes that a client diagnosed with schizophrenia has allergies to penicillin,
prochlorperazine (Compazine), and bee stings. Based on this assessment data, which antipsychotic medication would be
contraindicated?
A. Haloperidol (Haldol), because it is used only in elderly patients
B. Clozapine (Clozaril), because of a cross-sensitivity to penicillin
C. Risperidone (Risperdal), because it exacerbates symptoms of depression
D. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. A newly admitted client has taken thioridazine (Mellaril) for 2 years with good symptom control. Symptoms exhibited on
admission included paranoid delusions and hallucinations. The nurse should recognize which potential cause for the return
of these symptoms?
A. The client has developed tolerance to the antipsychotic medication.
B. The client has not taken the medication with food.
C. The client has not taken the medication as prescribed.
D. The client has combined alcohol with the medication.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
11. A client rates anxiety at 8 out of 10 on a scale of 1 to 10, is restless, and has narrowed perceptions. Which of the
following medications would appropriately be prescribed to address these symptoms? Select all that apply.
A. Chlordiazepoxide (Librium).
B. Clonazepam (Klonopin).
C. Lithium carbonate (lithium).
D. Clozapine (Clozaril).
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
.
12. A client diagnosed with generalized anxiety disorder is placed on clonazepam (Klonopin) and buspirone (BuSpar).
Which client statement indicates teaching has been effective?
A. The client verbalizes that the clonazepam (Klonopin) is to be used for long-term therapy in conjunction with buspirone
(BuSpar).
B. The client verbalizes that buspirone (BuSpar) can cause sedation and should be taken at night.
C. The client verbalizes that clonazepam (Klonopin) is to be used short-term until the buspirone (BuSpar) takes full effect.
D. The client verbalizes that tolerance can result with long-term use of buspirone (BuSpar).
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
13. In which situation would benzodiazepines be prescribed appropriately?
A. Long-term treatment of posttraumatic stress disorder, convulsive disorder, and alcohol withdrawal.
B. Short-term treatment of generalized anxiety disorder, alcohol withdrawal, and preoperative sedation.
C. Short-term treatment of obsessive-compulsive disorder, skeletal muscle spasms, and essential hypertension.
D. Long-term treatment of panic disorder, alcohol dependence, and bipolar affective disorder: manic episode.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
14. A client recently diagnosed with generalized anxiety disorder is prescribed clonazepam (Klonopin), buspirone (BuSpar),
and citalopram (Celexa). Which assessment related to the concurrent use of these medications is most important?
A. Monitor for signs and symptoms of worsening depression and suicidal ideation.
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B. Monitor for changes in mental status, diaphoresis, tachycardia, and tremor.
C. Monitor for hyperpyresis, dystonia, and muscle rigidity.
D. Monitor for spasms of face, legs, and neck and for bizarre facial movements.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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15. Which of the following symptoms are seen when a client abruptly stops taking diazepam (Valium)? Select all that apply.
A. Insomnia.
B. Tremor
C. Delirium
D. Dry mouth
E. Lethargy.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
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2. ANSWER: ________
RATIO:_______________________________________________________________________________________
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3. ANSWER: ________
RATIO:_______________________________________________________________________________________
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4. ANSWER: ________
RATIO:_______________________________________________________________________________________
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5. ANSWER: ________
RATIO:_______________________________________________________________________________________
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6. ANSWER: ________
RATIO:_______________________________________________________________________________________
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7. ANSWER: ________
RATIO:_______________________________________________________________________________________
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This document and the information thereon is the property of
PHINMA Education (Department of Nursing)
8 of 9
8. ANSWER: ________
RATIO:_______________________________________________________________________________________
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9. ANSWER: ________
RATIO:_______________________________________________________________________________________
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10. ANSWER: ________
RATIO:___________________________________________________________________________________________
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11. ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
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12. ANSWER: ________
RATIO:___________________________________________________________________________________________
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13. ANSWER: ________
RATIO:___________________________________________________________________________________________
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14. ANSWER: ________
RATIO:___________________________________________________________________________________________
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15. ANSWER: ________
RATIO:___________________________________________________________________________________________
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LESSON WRAP-UP (5 minutes)
You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.
You are done with the session! Let’s track your progress.
MUDDIEST POINT
In today’s session, what was least clear to you?
__________________________________________________________________________________
__________________________________________________________________________________
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For the next lesson, review Antidepressant & Mood Stabilizer
This document and the information thereon is the property of
PHINMA Education (Department of Nursing)
9 of 9