Pharmacology
Pharmacology
5R’s of Medication Error
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-
-
-
Right Patient – ask their name, birthday (two-patient
identifier)
Right Drug – clarify the order with doctor; avoid
abbreviations
o
MSO4 –morphine sulfate
o
MgSO4 – magnesium sulfate
Right Dose
o
Need for conversion when preparing a dose of
medication
Right Route – not everything comes in oral, parenteral.
You can have topical, nasal spray.
o
Insulin – not given oral

There are a lot of drugs inactivated by
gastric juices

Hepatic First Pass – inactivated in liver
Right Time - leeway of 30 minutes; specific time
Ischemia – lack of blood supply – dec. oxygen
Infarction – absence of blood supply – necrosis
The one of produces cholesterol internally is our liver
Cholesterol in our level is produced in liver – 10pm until 2am – statin
Give statin at night – 9pm
Steroids – produced ¾ in morning (4-8am), ¼ in the afternoon (15pm)
No one will drink a medication at 4am
Steroids are gastric irritant
given 8am with breakfast
Assess for allergies
drug of choice for anaphylactic shock is epinephrine =
vasoconstrictor, bronchodilator
DO NOT GIVE
If systolic pressure is below 90mmHg; affect perfusion
If HR is 60bpm; when 60 exactly do not give it.
If RR is less than 12bpm
Go for apical, 2nd na lang yung radial
If pedia, adjust values, do not follow cutoff
Orthostatic Hypotension
Get 3 sets – lying down, sitting, standing (5 mins interval)
A drop of 20-30 mmHg in BP when lying to standing
*Whatever the doctor writes, if you give it, you will be liable
Safety Issues
Adults – computed based on weight and height
Pediatric – adjusted to size but should not reach adult
those since organ immature
Geriatic – degenerate organs; decrease dosage
Nephrotoxic – monitor BUN (10-20) and Crea
o
Streptomycin
Hepatotoxic – ALT, AST
Medication Interaction
can result in toxicity or therapeutic failure
you have take medicines on an empty stomach except if
food is gastric irritant – food delays absorption
Iron
o
“best absorbed” – without food , “how
administered” – w/food
MAOIs – antidepressant
o
Thyramine rich foods – high BP (Hypertensive
Crisis)
University of Santo Tomas – College of Nursing / JSV
Only 2 cheeses w/o thyramine – cottage cheese
and cream cheese
Impact of food on drug action – Vit K, NOT POTASSIUM,
(green leafy vegetables) can reduce effects of
coumadin
Drug to Drug interaction
o
Additive effect – 1+1 =2

Note herbal medications

DOH Herbal Medications

Santalubi

Sambong - diuretic

Akapulko

Niyog-niyogan

Tsaang Gubat

Ampalaya

Lagundi

Ulasimang bato

Bawang

Bayabas

Yerba Buena
o
Antagonistic - counteracting
o
Potentiating – strengthens the other drug

CoAmoxyclav
Creation of unique response
o
Drugs combined in IV solution can form
precipitate (crystallization)
o
Do not give with dextrose solution – Mannitol
and Pheytoin (NSS only)
o
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VITAMINS AND MINERALS
Fat soluble vitamins – needs bile (produced in liver)
o
If problem with liver, problem with ADEK
o
Risk for hypervitaminosis
o
Vit A

integumentary and eye sight

excessive doses can be toxic
especially in pregnancy
(hypervitaminosis)

may have alopecia, yellow sclera
o
Vit D

Calcium absorption
o
Water soluble vitamins – excreted in body – stool and
urine
o
No hypervitaminosis
o
Vit C

Diarrhea and GI upset when excess
o
B Vitamins

Important in synthesis of DNA

Important in blood production – RBC

Formation of nervous system;
regeneration of nerve cells

Not absorbed if you drink alcohol!

Folic acid – green leafy vegetables
(nervous system dev’t – dec. neural
tube defect – spina bifida);
400mcg/day

B12(cyanocobalamin) – meat
products; organ meats;

IM once a month. Once a
week for 1st month, then once
a month for the rest of the life

Needs intrinsic factor
produced in stomach!

Problem with gastrectomy

Deficient in vegetarian –
pernicious anemia
Megaloblastic Anemia
Pharmacology
Mineral
Iron
-
-
Big and immature RBC
Cannot carry oxygen since it’s abnormal
Folic Acid and Vit B12
For hemoglobin regeneration
Teratogenic in megadoses in 1st trimester
Causes GI discomfort
Increased demands in menstruating women, children,
pregnant, alcoholics
Vit C increases absorption
Taken in tablet and liquid (drink with straw since it stains
teeth), IM (Z track method –deep IM to dorso gluteal or
ventro gluteal to prevent staining)
Black stools
-
-
Ca
-
FLUID AND ELECTROLYTES
Water is affected by gender and age
70-80% water – infant
60-70% - water in males; women have water
40-50% - elderly
Very young and very old are most affected by fluid
shifting
-
Fluid Composition
IC - 70%
o
K
EC – 30%
o
IV (Blood) -5%

H20 + solutes Electrolytes (Na)
o
IT – 25%
-
Diffusion – movement of solutes - higher to lower
Osmosis – movement of solvent - lesser to grater
Where solutes go, water follows
Increase volume, increase pressure
Na
-
-
Hypernatremia
o
Cell shrinks – dehydrates the cell
o
Fluid shifts from IC to IV
o
Increases IV volume – Inc. BP can cause
aneurysm – maintain BP
o
IV
Hyponatremia
o
Edema – IV to Interstitial/ IC
o
Swelling of cell
o
Sodium tablet
If solution contains more water – Hypotonic
If solution contains more solute – Hypertonic
Equal solute and solvent – Isotonic
Anything more than 0.9 NaCl – is hypertonic
Anything more than D5 (isotonic) – hypertonic
LRS – isotonic
* D5 becomes hypotonic when inside the body since glucose is
metabolized by the body
* All electrolytes are important for nerve impulse transmission –
weakness of muscles
K
-
80 % excreted in kidneys
20 % excreted in GI
Sources: All fresh fruits and vegetables; the drier the fruit,
the higher the content
University of Santo Tomas – College of Nursing / JSV
Hypokalemia
o
Inadequate source, dieresis, diarrhea
o
Oral (gastric irritant - ), IV (vein irritant – do not
give IV push or bolus, give in infusion over 1 hour
– painful and arrhythmia which may lead to
cardiac arrest)
Hyperkalemia
o
Most common in CRF, burns, chemotherapy
(tumor lysis syndrome)
o
Kayexelate (sodium polystyrene) – diarrhea to
excrete potassium if renal cannot excrete.
Monitor bowel movement
o
Diuretics if renal system is working
99% in bones
1% in blood
Blood clotting and muscle contraction
Dairy products
Lactose intolerant – small fish whose bones are intact anchovies
Hypercalcemia
o
High in blood
o
Calcitonin – comes form thyroid gland to bring
back s.calcium in blood

No.1 drug for osteoporosis
o
Prone to fracture
o
Bone cancer – bone breakdown
o
Can lead to kidney stones
o
Diuretics – drink lots of water to flush stones
o
Dialysis
Hypocalcemia
o
High in bones
o
Parathormone – from parathyroid – inc. serum
calcium
o
Thyroidectomy, sometimes parathyroid is
removed – prepare CALCIUM GLUCONATE to
o
Tetany – muscle spasm

Chovstek’s – tap below earlobe

Trosseau’s – BP pressure bring up 20
plus above systolic then monitor for
carpal spasm
Mg
-
Muscle relaxant
Anticonvulsant (tocolytic and ecclampsia in OB)
Sister cation of Potassium; same sources
Infused in an hour: same with K
Hypomagnesemia
o
Neutromuscular irritability – tetany
o
Dysrythmnia
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Hypermagnesemia (Mag toxicity)
o
Muscle relaxation except for heart
o
Loss of DTR
o
Do not give when dec. urine, BP, RR, and loss of
DTR
o
Give calcium gluconate
AUTONOMIC NERVOUS SYSTEM
Sympathetic Nervous System (Adrenergic)
o
Every time stressed, stimulated, excited

Epinephrine (Adrenaline)

Norepinephrine

Dopamine

If it doesn’t attach to a
receptor, it is useless
Amount of blood to go to GI and GU decreases and goes
to more important organs; decreases secretions
Receptors
Pharmacology
o
o
o
o
Alpha1 – vasoconstriction to increase BP
Alpha2 – vasodilation to decrease BP
Beta1 – 1 heart – Inc. heart rate
Beta2 – 2 lungs – bronchodilation (Salbutamolasthma) + relaxation of uterine muscles
(Terbutaline - premature labor)
Alpha and Beta Adrenergic Agonists
o
Epi, Norepi, Dopa
o
stimulates Alpha 1, Beta 1, Beta 2
o
inc. metabolism – energy – inc. blood glucose –
DO NOT REPORT if less than 200, but if higher
report for possible management

Epi – shock, bronchospasm, glaucoma,
cardiac arrest

Norepi- shock and cardiac arrest

Dopamine – drug of choice for shock;
titration

Low dose – vasodilation

High dose – vasoconstriction
Phenylephrine (Neosynephrine/Phenylpropanolamine) –
Alpha 1 agonist; no beta effect
o
If hypertensive, do not drink Neozep since it
causes inc. alpha 1 sti.
Clonidine (Catapres) – stimulates alpha 2 agonist
o
Antihypertensive
Isoproterenol – stimulates beta 1 and 2
o
Do not give if increased HR but causes
bronchodilation
Salbutamol – stimulates only Beta 2
o
Bronchodilation only
Agonist – stimulates
Antagonist/Blockers – stoped
Mydriasis – pupil dilation
-
Block beta – olols
Block alpha – zozin
Increase in heart rate = increased oxygen demand
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-
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Parasympathetic Nervous System (Cholinergic)
o
opposite of SNS
o
Acetylcholine
Cholinergics
Increase acetylcholine (Myesthenia Gravis)
o
Neostigmine (Prostigmine)
o
Edrophonium (Tensilon)
Promote peristalsis
Treat urinary retention
o
Urecholine (Bethanicol) – dieresis, nonobstructive urinary retention
Myesthenia Gravis
Decreased acetylcholine = muscle weakness (ptosis,
DOB, drooling)
Tensilon (Edpronium chiloride) – short acting, works in 5
mins, gone in 20 mins
o
Remove symptoms, (+) tensilon test
o
Diagnostic drug
Neostigmine – long acting cholinergic
Myasthenic Crisis – underdosing
muscle
weakness = same symptoms
Cholinergic Crisis – overdosing
o
Antidote is anticholinergic – atrophine sulfate
Acetylcholine - important for nerve impulse transmission
ANTICHOLINERGIC
Same effect as adrenergic
Atrophine sulfate
o
Dec secretion prior to OA
University of Santo Tomas – College of Nursing / JSV
o
o
Antidote to cholinergic crisis
For symptomatic bradycardia
*Antihistamine have cholinergic properties
Benadryl
Scopolamine – motion sickness
Parkinsons’ Disease
Decrease dopamine, inc. acetylcholine, degenerative,
decreases substantia nigra
NO DIAGNOSTIC TEST, NO CURE
3 cardinal symptoms
o
Tremors at rest
o
Muscle rigidity
o
Bradykinesia
Levadopa – precursor of dopamine; becomes dopamine
o
Converted to dopamine – has receptors in Brain,
heart, GI, GU
Carbidopa – allows more dopamine to go to the brain
Carbidopa-Levodopa (Synemet)
MAO
-
Enzyme that destroys epi,norepi,dopa
Give MAOI (Selegiline, Anti-cholinergics, antihistamine)
Also used for parkinson’s
Pseudoparkinsonism
Given a medication that blocked dopamine
Parkinson itself is degenerative
Glaucoma
Increase IOP
Open angle
o
Overproduction of aqueous humor; obstruction
o
Inc. volume, inc. pressure
o
Pressure on optic nerve
o
Carbonic anhydrase inhibitors (Acetazolamine)
– diuretic, eye drops, press nasolacrimal duct for
2- to prevent systemic absorption
o
Mannitol –eyedrops
o
Ciliary body – aquaeous body -. Posterior
chamber -> anterior chamber trabecular
meshwork in the canal of Schlemm =
trabeculoplasty
Closed/Narrow angle – more dangerous
The more dilated the pupils are, the more obstruction
Pilocarpine – miotic – PNS/ cholinergic to decrease pupils
Eye Medication
OD – right eye
OS – Left eye
OU –both eyes
Pressure on inner canthus
Wait 5 mins per each drug
Drops – lower conjunctival
Ointment – inner to outer
ANTIANEMICS
Normal neutrophil count: neutropenic diet
Erythropoetin (Epogen) – low in CRF; stimulate RBC production
Philgrastim (Nupogen) – stimulates neutrophil production; given
subcutaneous, do not shake and refrigerate; common in
chemotherapy
CARDIAC MEDICATIONS
Ischemia – dec. blood supply
Decrease heart rate in cardiovascular disorders
SFF, no exercises
Pharmacology
Nitrates
Oral, sublingual (fastest at home 3 times, 5 mins. Interval;
after 2 mins before it takes effect), IV (fastest in hospital),
patch (doesn’t matter where you place it; do not touch;
headache – say it is normal but give analgesic)
Vasodilator; increases blood supply
Potency is decreased when exposed to sunlight
Tolerance (Ceiling effect) – inc. dosage
Never give nitrate in patients who had Viagra and other
drugs for ED
Antidone to Viagra is epinephrine
If erection lasts for 4 hours, go to Emergency Room
All drugs in a patch are placed on 12 hours only to prevent
tolerance
Patch are needed in the morning
Calcium channel blockers
dec. heart rate/ check HR
also vasolators/ monitor BP
the more the calcium, the more contraction, the more HR
and oxygen
o
Verapamil
o
Nifedipine
o
Diltiazem
o
–dipine
Beta-blockers
dec. heart rate
olol
ANTIARRYTHMICS
Drugs depend on type of arrhythmia
Rate problem
o
Symptomatic bradycardic – atropine sulfate
o
Tachydardia – beta blocker, calcium channel
blockers
Rhythm problem
o
Atrial - quinidine
o
Ventricular tachycardia – 200-300bpm Lidocaine
P – atrial depolarization (stimulates muscles) – made by SA node –
initial pacemaker
Atrial arrhythmia
SA-AV node – PR interval (0.12-0.20 secs)- to allow filling
Bundle of His
Purkinje Fibers – QRS – Ventricular depolarization (0.04-0.12 secs)
Ventricular arrhythmia
Adenosine – supraventricular tachycardia
Half life is 6 seconds – time it take for half of the drug to
be excreted
Follow with bolus 10-20 cc NSS
Myocardial Infarct
M - Morphine
O - Oxygen
N – Nitroglycerin – patch/IV
A – aspirin (ANTIPLATELET) Ticlobidine – alternative if with
allergy
-
Must have maintenance aspirin or anticoagulant
(Heparin & Warfarin – IV, SQ while the other one is oral)
Enoxaparin (Lovenox) – low molecular weight, less
systemic bleeding, anticoagulant
o
Monitor for bleeding
University of Santo Tomas – College of Nursing / JSV
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-
Warfarin – PT (Control value = 10-15 secs; therapeutic
value = 1.5-2.5xCV) and INR = 2-3; must be checked every
2 weeks for the rest of your life to maintain the level
o
Potent drugs; prone to bleeding
Heparin – aPTT (Control value = 30-45 secs)
Warfarin - If high therapeutic value, give Vit K
Heparin – protamine sulfate
Warfarin takes 2-3 days before it can take effect so Heparin and
Warfarin can both be used
Electric razon, soft bristled toothbrush
Antidote is Vit K
Prone to bleeding, do not do IM, SQ instead!
THROMBOLYTICS
Mas matagal, mas matigas
Mas matigas, mas mahirap tunawin
-
-
Given as soon as possible; 4-6 hours from the onset of
symptoms of MI
Ischemic Stroke – must be given 3-4 hours. NOT
HEMORRHAGIC STROKE
o
CT Scan without contrast
Tissue Plasminogen Activator (Alteplase), Streptokinase,
ER Door-to-Drug – 90 mins but still must conform to the 4-6
hours limit
CARDIAC GLYCOSIDES
Digoxin
increase force of contraction; the more you squeeze the
more ineffective the contraction; dec. heart rate
0.5-2ng/ml
Given to patients with diuretic
Hypokalemia predisposes you to digoxin toxicity
BANDAV – bradycardia, Anorexia, Nausea, Diarrhea,
Abdominal pain, visual illusions , males (gynecomastia)
Antidote: digibind
DIURETICS
Diamox/Mannitol – open angle glaucoma; not given as
antihypertensives
Mannitol – ICP
Furosemide (Lasix)-fast acting drug (oral – 30 mins, venous
– 5 mins) for CHF; not given as antihypertensives since it
will trigger the RAAS system -> rebound hypertension
Thiazides – antihypertensives; gradual diuretics
Spirinolactone – potassium sparing diuretic (Aldactone);
mild
o
Liver cirrhosis
Ascites – high Na, low K – so potassium sparing
Monitor for orthostatic hypertension
ANTIHYPERTENSIVES
Alpha Blockers
Alpha 2 agonists – catapres
Nitroglycerin
Calcium channel blockers
Beta blockers
Vasodilators
-
ACE Inhibitors
o
o
o
Rennin – angiotensin I -> angiotensin II ->
vasoconstrictors
-pril
Side effect: dry cough
Pharmacology
Angiotensin II Receptor Blockers
o
–sartan
o
Most expensive but newest
o
Telmisartan, irbesartan, losartan
o
No dry cough effect
o
Covalsartan – thiazide(diuretic) and sartans
Antilipemics
o
Internal production – statin
o
Cholesterol is made in liver so…
o
Hepatotoxic
Bile Acid Sequestrants
o
Binds with external fats so that it can bind
o
Cholestyramine (Questran)
o
Orlistat (Xenical/Lesofat) – steatorrhea

Vit ADEK Deficiency since it cannot be
absorbed
-
-
-
RESPIRATORY DRUGS
Injury -> broken skin -> inflammatory response ->mast cells
(chemical mediators – histamine, kinins, leukotrienes) ->
blood -> cell effect
o
Histamine – vasodilator, inc. capillary
permeability -> edema
Oral Decongestants
Nasal Congestion (vasodilation) - Adrenergics –
vasoconstriction
Anti-inflammatory
No rebound congestion (oral)
Ex. phenylpropanolamine (Neozep), phenyleprine
(Neosynephrine)
Topical Decongestants
Topical – adrenergic and steroids –the more you use it
rebound congestion (rhinitis medicamentosa)
Decongestants are stimulants. May cause hypertension,
palpitation, and CNS stimulation
Cough
-
-
Dry cough
o
Antitussive (cough suppressant) – opiods

Opioids – CNS Depressants

Drowsy; do not do activities
requiring mental alertness

Can suppress respiration

Robitussin with codeine

Reduced peristalsis

Prescription
o
Robitussin with dextrometorphan – no sleep
Productive cough
o
Expectorants – plain Robitussin

Reduce the viscosity of secretions

Disintegrate and thin secretions

Thinner mucus that is easier to remove

Acetylcysteine (Fluimucil, Mucomyst) –
antidote to Tylenol
(Paracetamol)overdose,
Carbocysteine
o
Mucolytics
Any drug that affects CNS may be potentially addictive
COPD
-
Chronic bronchitis – treat the cause
University of Santo Tomas – College of Nursing / JSV
o
Anti-inflammatory
Emphysema
o
Alveoli filled with air – bullae – may lead to
spontaneous pneumothorax - bullectormy
Asthma
o
Triggered by environment and other allergens
o
Hypersensitivity reaction
o
Edema of bronchioles
o
Leukotrienes- bronchoconstriction, tighten up
muscles
o
Oxygen does not really help
o
Salbutamol – beta 2 only; bronchodilators
o
Xanthenes – aminophylline and theophylline (1020mcg/ml)

Belong to same family as caffeine
o
Generally, all bronchodilators will increase HR
Techniques in Administration (Inhaler)
Inhaler must be 1-2 inches away because if directly done
corticosteroid can kill normal flora which may predispose
to oral thrush (candidiasis), rinse mouth with water after
Hold your breath for 5- 10 seconds
Use spacer to prevent staying
If disk type (powder), it must be in contact with mouth
-
Long Term Steroids
Inhaled long-acting beta-2 agonists
o
Salmetrol (Severent diskus)
Leukotriene antagonist
o
Montelukast (singulair) – avoid bronchospasm
Mast cells stabilizer
o
Cromolyn Na – maintenance
o
AE: bronchospasm
ANTITUBERCULOSIS
Airborne/ droplet
6-9 months treatment
Rifampicin
reddish orange secretion; hepatotoxic
INH
LFT, pyridoxine (b6), to prevent peripheral neuritis
No.1 drug for TB
PZA
Raises uric acid, monitor LFT
Ethambutol
Optic neuritis
Streptomycin
Ototoxic, nephrotoxic
Multi-drug therapy – combination to decrease tolerance
Family member – INH/ 1-3 months
Multi-drug Resistant
Quinolones – -floxacin
GASTRIC MEDICATIONS
Ulcers- may perforate the organ and cause peritonitis
1. Increased amount of acid
2. Decreased amount of mucus
-
-
Food acts as a buffer that protects GI lining
Stress can increase chances of ulcer
Gastric ischemia – dec. blood supply
Bacterial infection – Helicobacter pylori – no. 1 cause
since it stimulates parietal cells which stimulate gastric
acid production
o
Antibiotic is best medication
o
Proton pump inhibitors
Burns – curling’s ulcer
Pharmacology
-
Neurological – cushing’s ulcer
Location:
Gastric
o
o
o
-
Normal to hypo secretion of mucus
May have abortifacient effect
Cytotec(Misoprostol)

Increase production

causes uterine contractions
o
Do no give proton pump or H2 blockers
Duodenal
o
Hyperacidity - hypersecretion
o
more common
o
Decrease acid production

Proton pump inhibitors - prazole

H2 blockers – rantidine
Antacids – for neutralization (magnesium, aluminum, calcium)
Magnesium SE: Diarrhea
Aluminum, Calcium SE; Constipation
Maalox – Magnesium-Aluminum – SE depends on patient
Provide protective coating over ulcerated site
o
Sucralfate – coats the ulcer
EMETICS AND ANTI-EMETICS
Vomiting – causes
o
Obstruction
o
Trigger of vomiting center (medulla oblongata)
o
Chemical imbalance

acetylcholine increase

Inc Epi, NE, Dopa (mostly manipulated)
– Dopamine antagonist

Block dopa – EPS
o
Akthesia
o
Acute dystonia
o
Pseudoparkinsonism
o
Tardive dyskinesia

Block serotonin – no EPS
o
Atyptical
antipsychotics
Endogenous Depression – depression due to chemical imbalance
Many SNS - Psychotic
Decreased PNS - Depressed
All anticholinergic are antihistamines
All antipsychotics are antiemetics
-
Serotonin antagonists (Atypical Antipsychotics) – block
serotonin receptors
Increase Dopamine
TCA
MAOI – breaks down dopamine
Increase Serotonin
SSRI
EMETICS
Syrup of ipecac
o
For overdose and poisoning
o
Do not induce vomiting if corrosive substance
(petroleum) or unconscious (aspiration)
o
Activated Charcoal/Gastric lavage – if corrosive
o
But if with antidote, give it!
Ipecac syrup – more concentrated
University of Santo Tomas – College of Nursing / JSV
*Increase fiber plus water in constipation!
LAXATIVES
For constipation
1.
Bulk forming agents– increase water
2. Gastric Stimulant
a. Stimulate peristaltic activity
b. Cramps
3. Stool softeners – not with MI, inc ICP
4. Lubricants – Lactulose – to decrease ammonia in Liver
CIrrosis
CHO -> Glucose -> ATP
Fats -> fatty acids
CHON -> ammonia -> urea -> kidneys
Hepatic encephalopathy – cannot convert urea; ammonia build
up which is toxic to brain
ANTIDIARRHEA
If cause of diarrhea is bacteria/toxin/poison, do not drink
these medicines since it will counteract with
compensatory mechanisms
If other reason, drink medicines
1. Opiods
a. Decrease intestinal motility and peristalsis
b. Can cause drowsiness
c. Depress breathing
ENDOCRINE MEDICATIONS
Pituitary Gland – master gland, common site of tumors
If you have pituitary gland, you can have brain tumor –
Inc. ICP
Last option = remove pituitary gland (hypophysis) –
hypophysectomy
Tumor = excessive disorder
Anterior Pituitary
o
FSH
o
LH
o
Growth Hormone

Growth of long bones – epiphyseal
plate closes at 18 for women, 21-24 for
males

Growth of cells and tissues

Decreased GH – Dwarfism

Somatropin – do not inject if
epiphysis is closed

SQ injection; anabolic – builds
up

SE: fluid retention and
myalgia

Anabolic substance
nandroxone and
oxandrolone – stimulates
protein synthesis, inc.
cartilage, and bone growth

May have cardiac arrest

Increased GH if open epiphysis –
Gigantism

Somatostatin analogs

Sandostatin (Octreotide
Acetate)
o
Anti GH
o
SQ 3x/week IM 2-4
weeks

Dopamine agonists
o
Bromocriptine
(Parlodel)
Pharmacology
GH receptor antagonists
o
Pegvisomant
(Somavert)
Increased GH if closed epiphysis –
Acromegaly

Prognatism – enlarged jaw


o
o
TSH -. Thyroid glant to produce T3 and T4

Needs iodine to produce

T3 – Triiodoformin (?)

T4 Thyroxine

Mental and growth capacity

Who do not have sources of iodine

Mountain – Highlanders

Goitrogenic – interfere with
iodine synthesis
o
Cabbage, broccoli,
cauliflower,
chopsuey!
o
Metabolism = SNS

Severe Hypothyroidsm (Myedema)

Children without Thyroid gland
(cretinism)

Mentally retarded

Thyroid hormones

Levothyroxine (Synthroid) – T4

Liothyronine (Cytomel) – T3

Liotrix (Euthyroid) –
combination

Thyroidectomy – no frequent
swallowing is at the neck; bleeding at
neck

Shrink and reduce vascularity
of the thyroid gland before
throidectomy with
SSKI/Lugol’s solution
ACTH – targets adrenal glands: cortex and
medulla

Cortex

Glucocorticoids
(Cortisol/Steroids)
o
Catabolic –
breakdown CHON,
CHO, Fats -> high
glucose -> CHON
breakdown (fluid
shifting) -> edema,
muscle wasting,
osteoporosis, stretch
marks,
immunosuppressant
(antibodies are
made of proteins) ->
fat breakdown ->
central (truncal)
obesity
o
Buffalo hump
o
Anabolic steroids –
pure androgen;
used by athletes

Mineralocorticoids
(Aldosterone)
o
Retains Na and
water

Androgens (secondary male
characteristics)
o
Hirsutism
University of Santo Tomas – College of Nursing / JSV
Stimulation of
sebaceous glands

High GMA – Cushing’s
Disease
o
High water and
sodium; low
potassium
o
SIADH – no high
sodium
o
If secondary to
medicine –
Cushing’s Syndrome

Low GMA – Addison’s
o
Steroids
o
Addisonian(Adrenal)
Crisis – do not stop
abruptly

Taken with
meals
Medulla: E, NE

Pheochromocytoma – more
E,NE due to tumor
o
Antihypertensive
o
Remove adrenal
gland
(adrenelectomy)
o

ANTI THYROID MEDICATIONS
PTU(Propythiouracil)
o
Prevent the formation of thyroid hormone
o
Not for pregnant women – cretinism
o
SE: Aggranulocytosis – monitor for signs of
infection
o
Tapazole (Methimazole)
Tonsillectomy – frequent swallowing
Hyper = increase
Hypo = decrease
-
Posterior Pituitary
o
Oxytocin
o
ADH (vasopressin) – water
retention/reabsorption

Inc. ADH – SIADH

High BP, edema

Fluid restriction

Diuretics

Dilutional hyponatremia
o
3% NaCl

Dec. ADH – Diabetes Insipidus

Polyuria

Dehydration -> polydipsia

Fluid Deprivation Test
o
Even if deprived for
10 hours, urinate
o
1kilo – 1 L

Give vasopressin (Pitressin,
Lypressin; nasal,
Desmopressin: oral IV, nasal
spray)
INSULIN
Type 1 – No Insulin
Type 2 – With less functional insulin
1.
2.
Rapid Acting: Lispor (Humalog)
a. 10-15 mins, 1 hour peak, duration 3 hours
Short acting: Regular
a. O 30 mins-1hr P 2-4 hrs, D 6-8 hrs
Pharmacology
3.
4.
5.
Intermediate acting: NPH and Lente
a. O 2-4 hrs P 8-12 D 12-16 hrs
Long acting insulin
Glargine (Lantus) – no peak; no hypoglycemia; 24 hour
insulin
o
o
o
o
*Peak action is the time when you experience hypoglycemia –
Regular and NPH
Monitor for elevate K and for tumor lysis
syndrome
Affects the normal and abnormal cells
Serotonin antagonist – zetron, no dopamine
antagonist
Chemo = massive cell destruction

Hyperuricemia and hyperkelmia

Allopurino – preventive

Increase hydration
Regular insulin is SQ and IV
Regular first. Clear then cloudy. Rotate sites (1 in apart) to prevent
lipodystrophy
DO NOT MIX LANTUS
Oral Antidiabetic – must have functioning beta cells (Type
2)
Administer all insulin SQ, only regular for IV
DKA – Type 1; HHNKS – Type 2
Abdomen fastest route, then arms
Do not inject cold insulin (lipodystrophy)
Store in room temp (1 month), refrigerator (3 months)
INSULIN PUMP
Pump that secretes insulin continuously
Mimics pancreatic functioning
Needle is changed only 3 days; embedded; not
changing everyday
Hyperglycemic Agents
Choose liquid first since it’s fast absorbed!
Unconscious
o
Dextrose 50% IV (unconscious IV access)
o
Very concentrated
o
If without IV access, glucagon SQ/IM
Neutropenic Precautions
NO
o
Fresh flowers, fruits, or vegetables
o
Visitors with infection
o
Rectal temps, suppositories, enema
o
Catheters
YES
o
Handwashing
o
Mask and gloves
o
Watch for signs of infection
Bleeding Precautions
Soft bristled toothbrush
Electric toothbrush
Drugs:
-
-
-
CANCER
Cell Cycle
G0 – cell is resting; no replication; even if you give chemo,
no effect
G1 – preparatory phase; needs protein based
o
By product of protein is uric acid
S – DNA synthesis
G2 – RNA and other enzymes needed
M – division; mitosis
Antineoplastic Agents
Cell division gone wild!
Acts on cell cycle
Chemotherapy – interferes with cell division
Cannot be done consecutively
CCS (Cell Cycle Specific), CCNS (Cell Cycle Non Specific)
Mitotic Inhibitors (vin-) and Antimetabolites (S) –
methotrexate
Chemotherapy in cycle – kills cells; done repeatedly to
avoid G0 phase
1cycle =5 sessions
SE:
o
Bone marrow depression (40-70% neutrophil)

If lower, neutropenia
o
Alopecia – will grow back again
o
Muscous membranes affected (stomatitis) – do
not use anything that is alcohol based
o
Nausea/Vomiting –
o
Antiemetics given 30 to 1 hour before and after
surgery
o
Vomiting center is medulla
o
Elevates uric acid
University of Santo Tomas – College of Nursing / JSV
-
-
-
Hormonal
o
For hormone dependent hormones
o
Signs and symptoms for
o
Estrogen, tamoxifen (antiestrogen
Corticosteroids/Predisone
o
Don’t withraw abruptly
o
predisone
Antibiotics
o
Doxorubicin – cardiotoxic
o
Bleamomycin – pulmonary toxi
Antimetabolite
o
S phase
o
If given much, give
o
Leucovorin (folicinic acid)- antidote
o
5FU, cytosine, methotrexate
Alkyating Agent
o
Cyclophosphamide (Cytoxan)
o
Hemorrhagic cystitis
Vinca Alkaloids
o
Stops mitosis
o
Vincristine, Vinblastine
Major component of a cell is folic acid
Do not use small veins since chemotherapy are vesicants
Infliltration - NR
Extrasavation - strong concentrated chemical
o
Chemical

Wash and run in water 15-30 mins.
o
Can have either warm or cold compress
depending on drug
ANTIBIOTICS
Reasons for Resistance
Takes it for long time
Take antibiotic but does not complete it
o
Some antibiotics are just bacteriostatic not
bacteriocidal
Large doses of antibiotic
If admitted with fracture, give broad spectrum
Superinfection – infection due to decrease in normal flora
Pharmacology
Opportunistic infection
The more broader the antibiotic, the more prone to superinfection
Diarrhea due to bacteria – pseudomembranous colitis
Narrow spectrum – either gram negative, gram positive
Medications
-
-
-
-
Penicillin
o
GI symtoms; hypersensitivity reaction
o
“miracle drug”
o
No. 2 drug for syphilis
o
Not effective for gonorrhea
Cephalosporins
o
Same chemical structure as PCN (beta-lactom) ;
more prone to infection (broad specturm)
o
Chemically related – cross resistance and cross
allergy with penicillin
o
More broad spectrum; more prone to
superinfection
Tetracycline
o
yellow discoloration of teeth photo sensitivity (do
not use for last half of pregnancy until 8 years o
age)
o
Yellow teeth, yellow sun
o
Not allowed to children
Aminoglycosides
o
Nephrotoxic, ototoxic (VIII) – vertigo and tinnitus
o
-mycin
o
Neomycin is a prophylactic antibiotic, given for
liver cirrhosis – bacteria increases ammonia
conversion
-
Quinolones
o
Drug of choice in MDR TB, UTI, RTI
o
Crytalluria; photosensitivity
o
–floxacin
-
Macrolides
o
Good for RTI
o
Extremely GI irritant; take with food
o
Erythromycin, azithromycin (only drug for 3 days
for CAP), once a day
o
MRSA - Vancomycin (antibiotic of choice)
o
RED – Red Man’s Syndrome – causes redness
from neck to below due to fast administration –
vasodilation, dec. BP, not an allergic response –
infused in 1-2 hours
-
Sulfonamides
o
First antibiotic; for UTI, skin infections, burns
o
Crystalluria, photosensitivity, Steven Johnson
syndrome – derma condition which looks like a
second degree burn, blisters
o
Sulfa-, cotrimoxazole
o
Yeilds sulfuric acid which can cause metabolic
acidosis
Local
Oral Candidiasis
Nystatin (Mycostatin)
Oral suspension: swish and spit (mouth)/ swish and
swallow (lower GI)
Yeast infection (Vaginal candidiasis)
Cheesy drainage, foul smelling
Nystatin – tablet/ suppository
Candidiasis can occur in moist areas in body
Nystatin power/ointment
Ringworm (Tinea)
Capitis
Corporis
An an, buni, had had
-azole
ANTIHELMINTHICS
Lindane – for pediculosis
Head – Quel – neurotoxic so wash away
Corporis – leave Quel to 12 to 24 hours
Mebendzaole - deworming
Quinine – antimalarial; may be used for prophylaxis 2 weeks before
and 2 weeks after, same time for one week
ANTIVIRAL
ALL ARE NEPHROTOXIC, drink lots of water
ANTIGOUT
Hyperuricemia
o
eating high foods in purine which yield uric acid
o
shellfish, legumes in general, nuts and oats
o
Kidneys excrete uric acid; kidney dysfunction
impairs excretion which may cause uric acid
stone or may deposit in the big toes (tophi)
o
Colchicine – for pain and inflammation
o
Allopurinol – preventive and maintenance,
reduces production
o
Probenecid - Uricosuric – secretes uric acid
ANALGESICS
Opiod
Suppresses respiration and cough (Antitussive)
Constipation
Morphine – one of the best drugs for MI
ASA, NSAID, Paracetamol – stops the inflammatory process; blocks
prostaglandins
-
Pyridium – urinary analgesic for dysuria; not an antibiotic, causes
redish-orange urine; give with other antibiotics
ANTIFUNGALS
Systemic – Ampothericin B (Fungizone)
Shake and Bake syndrome
Seizure and pyrexia - antipyretics
University of Santo Tomas – College of Nursing / JSV
-
ASA – most effects; analgesic, antipyretic,
antiinflammatory, antiplatelet
o
Can cause bleeding
o
Ototoxic (tinnitus)
o
Reye’s Syndrome – not given to children
younger than 15. NOT GIVEN IF only manifesting
viral symptoms, causes liver damage
NSAID - analgesic, antipyretic, anti-inflammatory
o
Gastric irritants
o
COX 2 – not so much gastric irritants
Pharmacology
Ibuprofen, advil, ponstan, mefenamic acid,
ketorolac
Paracetamol (Tylenol) - analgesic, antipyretic
o
Neoaspilet (Neokiddielets)
o
Hepatotoxic
o
MAXIMUM DOSE: 4g/day
o
Antidote: Acetylcysteine (Fluimucil/Mucomyst)
-
CNS STIMULANTS
Amphetamine – aceepted; methampethamine – not accepted
Pupils is the test for addiction – dilated in addicts
Caffeine – addictive substances
-
o
-
*For narcolepsy, ADHD (more focused/paradoxical effect)
-
Usually mixed with dietary pills to increase metabolism;
only good for 6 weeks
May cause cardiac arrest
CNS DEPRESSANTS, SEDATIVE, ANXIOLYTICS
Barbiturates – barbi
All CNS depressants are used for anesthesia; may cause respiratory
depression
ANTICONVULSANTS
Anticonvulsants are CNS depressants
Phenobarbital – long acting barbiturate (anticonvulsant)
Tonic clonic
partial
Bendzodiazepin – Valium (IV)
status epilepticus – continuous seizure activity
cerebral hypoxia – damage
Antidote: Flumazenil
Hydantoin
Phenytoin (Dilantin)
Gingival hyperplasia – increase number of cells, can be
lessened by massaging the gums, soft bristled toothbrush
Monitor serum level NV; 10-20mcg/ml
Can cause redish brown urine (NORMAL)
ANTIDEPRESSANTS
* Effects can be seen after 2-4 weeks
TCA (Amitriptyline-Elavil)
o
Sedating, orthostatic hypotension, palpitations
o
Give in evening
o
Palpitation – Cardiac Arrest
MAOI
o
Last option to be given
o
Hypertensive crisis
o
Avoid tyramine rich foods
o
MAO – destroys E,NE,D
o
MAOI – increases E, NE,D
o
PArnate,MArplan,NArdil
SSRI (Fluxetine-Prozac)
o
First drug
o
Give in morning since may cause insomnia,
anxiety
ANTIPSYCHOTICS
Block dopamine receptors in brain
EPS results
Acute dystonia – oculogyric crisis – occurs early in the
treatment acute muscle spasms, opisthotonus (back
muscle), torticollis (neck)
Akathisia – develops in 1st 2 months – uncontrolled need
to move-foot tapping and pacing
University of Santo Tomas – College of Nursing / JSV
-
Pseudoparkinsonism – tremors, rigidity and bradykinesia
Tardive dyskinesia
o
Needs to be stopped when this happens
o
In many patients, it is irreversible
o
Bizarre face and tongue movements
STOP THE MEDICINE IF IT OCCURS
Tx: Antichoinergic drugs
Benzotropine (Cogentin), trihexyphenidyl (Artane),
Diphenhydramine (Benadryl)
Neuroleptic Malignant Syndrome- NOT AN EPS
o
High temp and seizures
Typical Antipsychotic - Block dopamine (+ symptoms)
Haldol, thorazine
May cause EPS
Atypical Antipsychotic - Block serotonin (- symptoms)
Few or no EPS
Clozapine (Clozaril), risperidone (Risperidal), olanzapine
(Zyprexa)
Blood dyscrasias - agranulocytosis (Clozapine)
Lithium
Controlling the manic phase
Calming effect without impairing intellectual activity
Controls flight of ideas an hyperactivity
TE: 0.6-1.2mEq/L
1.5-2mEq/L – TOXIC
Monitor for every month or two
Serum Na levels needs to be monitored – lithium tends to
deplete Na – adequate sodium intake, increase fluid
intake
Review mild, moderate, severe
No 1 cause of death - dehydration