TABLE OF CONTENTS (Hyperlinked)
2
ANTIBIOTICS
21
ERECTILE DYSFUNCTION DRUGS
5
IMMUNOSUPPRESSANTS
21
HORMONAL CONTRACEPTIVE DRUGS
6
ANTIVIRAL DRUGS
VIRUS
22
ANTI DIEABETIC MEDICATION
7
ANTI- RETROVIRAL DRUGS
RETRO
VIRUS
24
THYROID MEDICATIONS
8
ANTIFUNGAL DRUGS
25
ANXIOLYTICS
9
ANTIALLERGIC MEDICATIONS
26
ANTIDEPRESSANTS
10
ANALGESICS
27
ANTIPSYCHOTICS (NEUROLEPTICS)
11
CARDIOTONIC DRUGS
28
MOOD STABILIZERS
12
ANTIHYPERTENSIVES
29
ADHD MEDICATIONS
14
ANTICOAGULANTS
30
ANS MEDICATIONS
14
ANTIPLATELETS
32
ANTICONVULSANTS
15
THROMBOLYTICs
34
ANTIPARKINSONIAN DRUGS
16
ANTIHYPERLIPIDEMICS
35
ANTI-INFLAMMATORY DRUGS
17
ANTIANGINAL DRUGS
36
BRONCHODILATORS
18
GASTROINTESTINAL MEDICATIONS
37
SECRETION & COUGH MEDICATIONS
20
DIURETICS
38
MEDICATION DOSAGE CALCULATIONS
ANTIBIOTICS
IMMUNE MEDS
Class
PENICILLINS
SUFFIX: - CILLIN
BASIC: GRAM+
BROAD: GRAM +/EXTENDED: GRAM-
CEPHALOSPORINS
PREFIX: Cef- & Ceph1st Gen: GRAM+
2nd Gen: GRAM+, some GRAM3rd Gen: GRAM+, more GRAM4th Gen: + & -, Pseudomonas
5th Gen: + & -, MRSA
GLYCOPEPTIDES
INFIX: -VANSUFFIX: -PLANIN
Effective only against
GRAM+ positive
bacteria.
Types
(Forms)
Effective only against
GRAM+ positive
bacteria.
Indications
Side
Effects
Bactericidal: Cell Wall
PENICILLIN G
Inhibitor
(Benzylpenicillin)
AMOXICILLIN
Attacks
peptidoglycan,
AMPICILLIN
leading
to
cell
wall
PIPERACILLIN
destruction.
FLUCLOXACILLIN
...
Streptococcal infections
Respiratory infections
Meningitis
Otitis media
Endocarditis
Urinary tract infections
Syphilis
Gonorrhea
Anaphylaxis
Gastrointestinal upset
Headaches
Nephrotoxicity
Thrombocytopenia
Stevens-Johnson
syndrome
Bactericidal: Cell Wall
Inhibitor
Urinary tract infections
Skin infections
Osteomyelitis
Otitis media
Respiratory infections
Surgical site infection
prophylaxis
Anaphylaxis
GI upset
Headaches
Nephrotoxicity
Thrombocytopenia
Stevens-Johnson
syndrome
Treatment
of
severe
infections
caused
by
Gram-positive
bacteria,
Attacks
peptidoglycan,
including
methicillinleading
to
cell
wall
resistant
Staphylococcus
destruction.
aureus (MRSA).
Ototoxicity
Nephrotoxicity
Red man syndrome
CEPHALEXIN
CEFTRIAXONE
CEFAZOLIN
CEFEPIME
CEFTAZIDIME
...
VANCOMYCIN
TELAVANCIN
DALBAVANCIN
TEICOPLANIN
DECAPLANIN
...
MACROLIDES
SUFFIX:
-THROMYCIN
Mechanism
of Action
ERYTHROMYCIN
AZITHROMYCIN
CLARITHROMYCIN
TELITHROMYCIN
...
Targets peptidoglycan to
destroy
cell
walls
(structure is very similar to
penicillins).
Bactericidal: Cell Wall
Inhibitor
Bacteriostatic: Protein
Synthesis Inhibitors
Inhibit bacterial protein
synthesis by binding to the
50S ribosomal subunit of
susceptible bacteria
Respiratory
infections
Otitis media
Chlamydia
Pelvic inflammatory
infections
Alternative for those
allergic to penicillin
(caused by rapid infusion)
GI upset
Thrombocytopenia
Dysrhythmias
GI upset
Ototoxicity
Hepatotoxicity
Stevens-Johnson
syndrome
Nursing Considerations
Best taken before meals for optimal absorption
May
reduce
the
effectiveness
of
oral
contraceptives
Check for allergies before administration
May increase bleeding risk when taken with
anticoagulants
Reduces effectiveness of oral contraceptives
Monitor creatinine, BUN, and coagulation levels
Do not use while breastfeeding
Avoid alcohol
Monitor skin for signs of red man syndrome
Close monitoring of trough levels to prevent
toxicity or sub-therapeutic doses (administer
before treatment)
Effective against Gram-positive bacteria only
Best taken before meals for optimal absorption
Monitor liver enzymes
Watch for palpitations or chest pain
ALT: 7-56 u/L
AST: 5-40 u/L
ALP: 40-120 u/L
Bilirubin: 0.1-1.2 mg/dL
GGT: males <50 u/L
females <30 u/L
2
ANTIBIOTICS
Class
TETRACYCLINES
SUFFIX: - CYCLINE
Targets Gram-positive
and Gram-negative
bacteria.
AMINOGLYCOSIDES
Effective only against
Gram- bacteria.
Types
(Forms)
TETRACYCLINE
DOXYCYCLINE
MINOCYCLINE
...
GENTAMICIN
TOBRAMYCIN
AMIKACIN
NEOMYCIN
STREPTOMYCIN
Used as a broad-spectrum
antibiotic for a wide range
of bacterial infections such
Inhibit RNA and protein as:
synthesis,
disrupting
Lyme disease
bacterial
growth
and
Acne
replication.
STDs
Respiratory infections
Urinary tract infections
Bactericidal: Protein
Synthesis Inhibitor
Targets
ribosomes
to
disrupt protein synthesis,
effectively killing bacteria.
Bacteriostatic: Protein
Synthesis Inhibitors
CLINDAMYCIN
LINCOMYCIN
Inhibit RNA and protein
synthesis,
disrupting
bacterial growth and
replication.
Similar structure to
Macrolides
SULFAMIDES
PREFIX: SULFATargets Gram+ and
Gram- Bacteria
@NursingPrints
Indications
Bacteriostatic: Protein
Synthesis Inhibitors
LINCOSAMIDES
Targets Gram+ and
Anaerobic Bacteria
Mechanism
of Action
SULFADIAZINE
SULFASALAZINE
SULFAMETHOXAZOLE
Bacteriostatic: Protein
Synthesis Inhibitors
Inhibit bacterial growth
by disrupting folic acid
synthesis
Severe bacterial infections,
particularly aerobic Gramnegative bacteria.
Severe Urinary tract
infections
Septicemia
Endocarditis
Respiratory infections
Septicemia
Respiratory infections
Necrotizing fasciitis
Gangrene
Dental infections
Intra-abdominal
infections
Skin and soft tissue
infections
Urinary tract infections
Respiratory infections
Otitis media
Meningitis
Toxoplasmosis
Rheumatic fever
Side
Effects
Nursing Considerations
Tooth
discoloration
and delayed bone
growth in children
Hepatotoxicity
Renal toxicity
Allergic reactions
GI upset
Photosensitivity
Contraindicated in children under 8 years old or
pregnant women
Avoid foods high in calcium or iron (decreases
absorption)
Advise patients to avoid direct sunlight and to use
sunscreen due to photosensitivity
Assess liver and kidney function regularly due to
potential hepatotoxicity and renal toxicity
Ototoxicity
Nephrotoxicity
Neurotoxicity
Vertigo
Ataxia
GI upset
Dysrhythmias
Thrombocytopenia
Stevens-Johnson
syndrome
Allergic reactions
Diarrhea
Hepatotoxicity
Nephrotoxicity
Allergic reactions
Photosensitivity
GI upset
Thrombocytopenia
Anemia
Hepatotoxicity
Nephrotoxicity
Highly effective but also highly toxic !
Monitor renal and liver function
Assess hearing for ototoxicity
Watch for nephrotoxicity and neurotoxicity
Extend intervals to minimize toxicity risk
Contraindicated
for
myasthenia
gravis
and
Parkinson's disease because they inhibit acetylcholine
(ACH), which can worsen muscle weakness
Monitor for signs of allergic reactions, including
rash and itching (pruritus).
Assess renal and hepatic function regularly
Monitor bowel movements for diarrhea
Monitor for allergic reactions (rash, itching, hives)
Advise sun protection due to photosensitivity
Encourage adequate fluid intake to prevent kidney
issues
Regularly check renal and liver function
Monitor for GI upset
Check CBC for blood disorders
3
ANTIBIOTICS
Class
FLUOROQUINOLONES
SUFFIX: - FLOXACIN
Targets Gram-positive
and Gram-negative
bacteria.
Types
(Forms)
CIPROFLOXACIN
LEVOFLOXACIN
MOXOIFLOXACIN Targets
ribosomes
to
OFLOXACIN
disrupt protein synthesis,
NORFLOXACIN
effectively killing bacteria.
GEMIFLOXACIN
METRONIDAZOLE
Targets protozoa and
some anaerobic Gramnegative bacteria
Metronidazole is
an antibiotic and
antiprotozoal
medication
Targets Gram+ and
Gram- Bacteria
Indications
Bactericidal: Protein
Synthesis Inhibitor
METRONIDAZOLE
NITROFURANS
Mechanism
of Action
FURAZOLIDONE
Bactericidal: Protein
Synthesis Inhibitor
Inhibits DNA and protein
synthesis, leading to cell
death.
Respiratory infections
Tuberculosis
Urinary tract infections
Bone infections
Skin infections
Intra-abdominal
infections
Prostatitis
Protozoal
infections
(giardiasis, trichomoniasis,
amoebiasis)
Anaerobic
infections
bacterial
H. pylori infection in peptic
ulcer disease
Bactericidal: Protein
Synthesis Inhibitor
NIFURTIMOX
Inhibits bacterial enzymes
for
protein
NITROFURANTOIN essential
synthesis, causing cell
death.
More
specific
to
urinary tract infections.
Gastrointestinal
infections caused by
bacteria and protozoa
reatment of certain
parasitic infections
Side
Effects
GI upset
Dizziness
Headache
Photosensitivity
Allergic reactions
Dysrhythmias
Confusion, agitation,
seizures)
Headache
Metallic taste in the mouth
Nausea, Vomiting
Diarrhea
Dizziness
Dry mouth
Dark urine
Allergic reactions
Seizures (rare)
Dark-colored urine
GI upset
Headaches
Dizziness
Pulmonary toxicity
Allergic reactions
Hepatotoxicity
Peripheral neuropathy
(numbness, tingling)
Nursing Considerations
Monitor for GI upset
Advise on photosensitivity precautions
Report tendon pain or swelling immediately
Monitor for QT prolongation
Watch for peripheral neuropathy symptoms
Check liver function tests regularly
Be alert for CNS effects like confusion or seizures
Take with water and avoid antacids or dairy products
Contraindicated in pregnancy
Avoid alcohol during and for three days after
treatment to prevent severe GI upset
Advise patients to take metronidazole with food to
reduce gastrointestinal discomfort
Explain that metallic taste and dark urine are normal
side effects
Inform patient that discolored urine is a normal
side effect
Assess for GI upset and manage symptoms as
needed
Watch for signs of peripheral neuropathy, such as
numbness or tingling in extremities
Monitor respiratory status for signs of pulmonary
toxicity
MEMORY TRICK TO REMEMBER BACTERICIDAL ANTIBIOTICS
MEMORY TRICK TO REMEMBER BACTERIOSTATIC ANTIBIOTICS
"Great Penicillins Can Fastly Neutralize All Microbes"
"Statics Literally Tie Microbes"
G = Glycopeptides
P = Penicillins
@NursingPrints
C = Cephalosporins
F = Fluoroquinolones
N = Nitroimidazoles
A = Aminoglycosides
M = Metronidazole
S = Sulfonamides
L = Lincosamides
T = Tetracyclines
M = Macrolides
4
IMMUNOSUPPRESSANTS
Medications that suppress the immune system to reduce symptoms in various autoimmune diseases or to prevent rejection
of a transplanted organ
Class
Mechanism
of Action
METHOTREXATE
Methotrexate inhibits folic
acid synthesis, disrupting
DNA synthesis and cell
proliferation, particularly
in rapidly dividing cells
like those in autoimmune
diseases and cancer.
Treatment of rheumatoid arthritis,
psoriasis, and other autoimmune
diseases
Management of certain types of
cancer such as leukemia and
lymphoma
Treatment of ectopic pregnancy
HYDROXYCHLOROQUINE
Suppresses
immune
responses by interfering
with immune cell activation
and reducing inflammatory
cytokine
production,
helping to treat autoimmune
conditions.
Malaria
Lupus
Treatment of autoimmune diseases
such as rheumatoid arthritis and
systemic lupus erythematosus.
Certain viral infections, including
COVID-19
Cyclosporine
is
an
immunosuppressant
that
prevents organ transplant
rejection
and
treats
autoimmune disorders by
inhibiting
calcineurin,
crucial for T-cell activation.
Organ
CYCLOSPORINE
TUMOR NECROSIS
FACTOR (TNF)
INHIBITORS
@NursingPrints
Side
Effects
Indications
transplant
prevention
Rheumatoid arthritis
Psoriasis
Ulcerative colitis
Nephrotic syndrome
Block the activity of tumor
necrosis factor-alpha (TNFα), a key mediator in the
immune
response.
This
Rheumatoid arthritis
reduces inflammation and
autoimmune activity
Ulcerative colitis
Psoriatic arthritis
Ankylosing spondylitis
Crohn's disease
Plaque psoriasis
rejection
Increased susceptibility to
infections
GI upset
Anemia, Thrombocytopenia
Hepatotoxicity
Nephrotoxicity
Allergic reactions
Headaches
Dizziness
Mucositis
GI upset
Skin reactions
Headache
Dizziness
Retinopathy with long-term use
Muscle weakness or pain
Hepatotoxicity
Nephrotoxicity
Nursing Considerations
NEUTROPENIC PRECAUTIONS: safety measures
taken to protect individuals with low neutrophil
counts (neutropenia) from infections.
Regularly monitor liver function tests and renal function
Encourage adequate hydration to minimize the risk of
kidney damage.
Monitor complete blood counts (CBC)
Discuss the importance of contraception during
treatment, as methotrexate can cause birth defects.
NEUTROPENIC PRECAUTIONS
Monitor for adverse effects such as gastrointestinal
discomfort, skin reactions, and visual changes
Schedule regular eye exams to detect any signs of
retinopathy
Treatment with Hydroxychloroquine takes several
months to reach therapeutic levels and show effects
Nephrotoxicity
Hypertension
Increased risk of infections
Gingival hyperplasia
Hyperlipidemia
Tremors
Hirsutism
Hepatotoxicity
NEUTROPENIC PRECAUTIONS
Monitor renal and liver function
Watch for hypertension
High infection risk due to immunosuppression
Advise on oral hygiene: Prevent gingival hyperplasia
Educate on side effects
Ensure therapeutic levels
Increased risk of infections
(tuberculosis, bacterial, viral,
fungal)
Injection site reactions
Headache
Nausea
Rash
NEUTROPENIC PRECAUTIONS
Monitor for signs of infection and perform regular
screening for latent tuberculosis
Monitor for adverse effects such as gastrointestinal
discomfort, skin reactions, and visual changes
Assess for any allergic reactions or hypersensitivity.
5
ANTIVIRAL DRUGS
VIRUS
IMMUN
CELL
Antiviral drugs inhibit viral infections by disrupting viral replication or processes, reducing severity and duration.
They treat influenza, varicella-zoster virus, hepatitis B and C, among others ...
Mechanism
Indications
Nursing Considerations
Side Effects
Class (Mechanism based)
of Action
DNA POLYMERASE
INHIBITORS
PURINE ANALOGUES
ACYCLOVIR, GANCICLOVIR,
FAMCICLOVIR, CIDOFOVIR
PYRIMIDINE ANALOGUES
IDOXURIDINE
,
TRIFLURIDINE, TELBIVUDINE
NON‐NUCLEOSIDES
FOSCARNET
DNA polymerase inhibitors can
be both antivirals and
antiretrovirals
m‐RNA SYNTHESIS
INHIBITORS
RIBAVIRIN ,FOMIVIRSEN
INHIBITORS OF VIRAL
PENETRATION &
UNCOATING
Remdesivir
NEURAMINIDASE
INHIBITORS
Purine analogues Interfere with nucleic acid
synthesis in viruses by being incorporated into
viral DNA or RNA, and disrupting the viral
replication process
Pyrimidine analogues disrupt DNA synthesis by
being incorporated into viral DNA, causing chain
termination or mutations, and inhibiting viral
DNA polymerase, to prevent viral replication.
Non-nucleoside DNA polymerase inhibitors bind
directly to the viral DNA polymerase, altering its
function to prevent viral DNA synthesis
messenger RNA (mRNA) synthesis inhibitors
work by work by blocking the translation of
mRNA into
replication
proteins
essential
for
viral
They interfere with the processes that viruses
use to fuse with host cell membranes or to
uncoat and release their genetic material into
the host cell's cytoplasm
Neuraminidase
inhibitors
block
the
neuraminidase enzyme, preventing the
release and spread of new viral particles
DNA polymerase inhibitors
are generally indicated for
infections caused by:
Herpes simplex virus (HSV)
Varicella-zoster virus (VZV)
Cytomegalovirus (CMV)
Herpes genitalis
Shingles (Herpes zoster)
Herpes labialis
Hepatitis B virus (HBV)
IMMUNOMODULATORS
Interferons, Palivizumab ,
Imiquimod
@NursingPrints
production of antiviral proteins like
interferons, to improve the body's ability to
target and eliminate viruses
Educate patients about common side effects and posology
Regularly monitor the patient's vital signs, including renal
and hepatic function tests, blood counts (CBC), and
electrolyte levels
Monitor for signs of bone marrow suppression, such as
anemia and thrombocytopenia
Monitor for signs of lactic acidosis, such as weakness,
fatigue, or abdominal pain
Encourage adequate hydration to prevent crystalluria and
support kidney function
Black Box !
Respiratory syncytial virus
(RSV) infections
hepatitis C virus (HCV)
infections
Cytomegalovirus (CMV)
Fatigue
Nausea
Headache
Insomnia
Anemia (reduced red blood cell
count)
Influenza virus infections
Respiratory syncytial virus
Herpes simplex infections
Hepatitis C infections
Corona virus infections
Ebola virus disease
Sweating
Nausea
Anemia, Thrombocytopenia
Hypokalemia
Hypotension
Hepatotoxicity
Injection site reactions
Regularly monitor the patient's vital signs, including renal
and hepatic function tests, blood counts (CBC), and
electrolyte levels
Ensure adequate hydration and antiemetics if needed
Rotate injection sites
Nausea
Vomiting
Diarrhea
Headache
Dizziness
Allergic reaction
Administer within 48 hours of symptom onset for maximum
effectiveness
Monitor for signs of allergic reaction or unusual side effects
Educate patients about GI upset (take medication with food)
Ensure patients complete the full course of treatment even if
symptoms improve
Influenza A
Influenza B
Oseltamivir, Zanamivir,
Peramivir
They can stimulate immune cells, increase the
Nausea, Vomiting, Diarrhea
Fatigue
Headache
Myelosuppression (bone marrow)
Anemia
Thrombocytopenia
Liver toxicity
Nephrotoxicity
Crystalluria (formation of crystals
in urine)
Lactic acidosis
Pancreatitis
Chronic
viral
infections
(Hepatitis B and C, HIV/AIDS...)
Nausea, Vomiting, Diarrhea
Certain cancers (Melanoma...)
Depression,
Immunodeficiency disorders
Use before or during pregnancy by either sex may lead
to birth defects in the baby ( Teratogenic )
Educate patients about common side effects and posology
Regularly monitor the patient's vital signs, including renal
and hepatic function tests, blood counts (CBC)
Monitor Vital Signs and Laboratory Tests (CBC, ALT, AST
BUN, Creatinine)
Hepatotoxicity
Anxiety,
mood
Inform patients about potential side effects
changes, Insomnia
Monitor gastrointestinal symptoms
Anemia, Thrombocytopenia
Rotate injection sites
6
ANTI- RETROVIRAL DRUGS
RETRO
VIRUS
IMMUN
CELL
ANTI- RETROVIRAL DRUGS: Medications specifically used to treat retroviruses, such as HIV.
They work by inhibiting different stages of the retroviral lifecycle, helping to manage and suppress the viral load
Class(Action)
PROTEASE INHIBITORS
Ritonavir, Lopinavir,
Darunavir, Atazanavir
Mechanism
of Action
Indications
Protease inhibitors block the
protease enzyme, essential for
viral replication, to prevent
viral maturation and reduce
HIV/AIDS
Hepatitis C
viral load
FUSION INHIBITORS
Enfuvirtide
Fusion inhibitors prevent the
fusion of the viral envelope
with the host cell membrane,
blocking the virus's entry into
the host cell and its ability to
infect new cells and spread.
Treatment of HIV infection
in combination with other
antiretroviral medications
Block the CCR5 receptor on
CCR5 INHIBITORS
Maraviroc
the surface of immune cells (Tcells), preventing HIV from
entering and infecting these
Treatment of HIV infection,
typically in combination with
other antiretroviral agents
cells, reducing viral replication
Integrase inhibitors block the
INTEGRASE INHIBITORS
Raltegravir, Dolutegravir,
Elvitegravir ...
integrase enzyme, preventing
HIV from inserting its viral DNA
into the host cell's DNA, to stop
viral replication and spread.
NRTIs block reverse transcriptase,
essential
for
retrovirus
replication, by mimicking natural
nucleosides in viral DNA. They
Nucleoside Reverse
integrate into viral DNA through
Transcriptase Inhibitors (NRTIs)
reverse transcriptase, halting
Zidovudine, Stavudine,
viral replication
REVERSE
TRANSCRIPTASE
INHIBITORS
Lamivudine, Zalcitabine ...
NNRTIs
Non‐nucleoside Reverse
transcriptase inhibitors (NNRTIs) transcriptase,
Nevirapine, Delavirdine,
Etravirine ...
inhibit
reverse
a crucial enzyme
for HIV replication. This prevents
the enzyme from converting viral
Treatment of HIV infection
in combination with other
antiretroviral medications
Treatment of HIV infection
in combination with other
Side Effects
Nursing Considerations
Nausea, Vomiting, Diarrhea
Fatigue
Lipodystrophy
Hyperglycemia
Elevated liver enzymes
Increased cholesterol and triglyceride levels
Monitor liver function tests regularly
Educate patients about potential side effects
Advise patients to avoid high-fat meals as they can affect
medication absorption
Watch for signs of lipodystrophy and manage symptoms
accordingly
Injection site reactions
Increased risk of bacterial pneumonia
Fatigue
Nausea
Allergic reaction
Insomnia
Rotate injection sites to minimize reactions
Monitor for signs of infection, particularly respiratory infections
Educate patients on proper injection techniques
Assess for signs of allergic reactions
Encourage adherence to therapy for effectiveness
Cough
Fever
Increased risk of respiratory tract infections
Allergic reaction
Dizziness
Abdominal pain
Hepatotoxicity
Regularly check liver function tests
Assess for any history of heart conditions before starting therapy
Educate patients to report symptoms like cough, fever, or rash
Watch for signs of upper respiratory tract infections and other
infections
Encourage adherence to therapy for effectiveness
Headache, Dizziness
Nausea, Diarrhea
Fatigue, Insomnia
Allergic reaction (Rash)
Hepatotoxicity
Weight gain
Discuss potential side effects and their management strategies
Monitor liver function tests regularly
Monitor for signs and symptoms of allergic reactions, including
rash, swelling, or difficulty breathing
Manage common side effects such as headache, nausea, and
diarrhea
Lactic acidosis
Lipodystrophy
Educate patients on the potential side effects
Anemia, neutropenia, thrombocytopenia
Monitor for signs of adverse effects such as rash, liver enzyme
antiretroviral medications,
Nausea, vomiting, diarrhea
elevations, CBC, renal function, and neurological symptoms
to suppress HIV replication,
Hepatotoxicity
reduce viral load, maintain
Consider fall risk assessments, especially in patients experiencing
Insomnia, dizziness, headache
immune function, and
delay disease progression
neurological side effects like dizziness
Skin reactions, including Stevens-Johnson
syndrome
Osteopenia (long-term complication)
RNA into DNA and blocking viral
replication
@NursingPrints
7
ANTIFUNGAL DRUGS (ANTIMYCOTICS)
Bacteria are prokaryotic, have unique structural and metabolic targets different from the human host. In contrast,
fungi are eukaryotic, making most antifungal agents toxic to the host as well
Mechanism
Side Effects
Indications
Nursing Considerations
Class
of Action
AZOLES
SUFFIX: - AZOLE
Ketoconazole, Miconazole,
Clotrimazole, Itraconazole,
Fluconazole, Voriconazole,
Posaconazole ...
POLYENES
Amphotericin B
Nystatin
Natamycin(Pimaricin)
Azoles inhibit the enzyme lanosterol 14alpha-demethylase, blocking ergosterol
synthesis
essential
for
fungal
cell
membranes. They effectively treat fungal
infections with minimal impact on human
cells, which do not contain ergosterol
Polyenes target the fungal cell membrane
by binding to ergosterol, creating pores
that increase membrane permeability,
causing leakage of essential intracellular
contents and resulting in fungal cell death
Candidiasis
Ringworm
Aspergillosis
Cryptococcal Meningitis
Histoplasmosis
Tinea Versicolor
Coccidioidomycosis
Blastomycosis
Nausea, Vomiting, Diarrhea
Hepatotoxicity
Alopecia( Hair loss ) Fluconazole
Hypertension
Hypokalemia
Itraconazole
Edema
Nephrotoxicity
Voriconazole
Photosensitivity
Educate on the potential side effects
Regularly check liver function tests (ALT, AST, bilirubin)
Amphotericin B: Broad spectrum
Nausea, Vomiting, Diarrhea
Nephrotoxicity
Hypokalemia, Hypomagnesemia
Hepatotoxicity
Anemia, Thrombocytopenia
Hypotension, Arrhythmias
Local Irritation
Eye irritation
Hypersensitivity reactions
Long-term use may lead to cumulative toxic effects,
especially with prolonged therapy or high doses
Aspergillosis
Cryptococcosis
Histoplasmosis
Candidiasis
Mucorales
Dimorphic (endemic) fungi
Nystatin
Non-invasive candidiasis
Not used intravenously due to toxicity
Natamycin(Pimaricin)
ECHINOCANDINS
SUFFIX: - FUNGIN
Caspofungin, Micafungin
Anidulafungin
ALLYLAMINE,
THIOCARBAMATES AND
MORPHOLINES
Fenpropimorph, Amorolfine,
Terbinafine, Tolnaftate
PYRIMIDINE ANALOGS
Flucytosine
@NursingPrints
Allylamines and thiocarbamates inhibit the
ERG1 gene, which is essential for ergosterol
biosynthesis in fungi. Morpholines target the
ERG24 and ERG2 genes. These actions
disrupt fungal cell membrane integrity,
leading to fungal cell death
Flucytosine disrupts fungal RNA and DNA
synthesis
by
inhibiting
thymidylate
synthetase and interfering with nucleic acid
metabolism. This leads to impaired fungal
protein synthesis and cell function, ultimately
causing cell death
Echinocandins are often used as first-line
agents for treating candidemia and
invasive candidiasis
Invasive Aspergillosis
Minimal activity against Mucorales and
Dimorphic fungi
Prophylactic use in high-risk patients
Review all medications the patient is taking to identify
potential drug interactions
Check for dermatologic reactions
Regularly assess CBC, BUN, creatinine, and electrolytes
Ensure adequate hydration to minimize nephrotoxicity
Administer slowly over 2-6 hours
Monitor vital signs closely during infusion
Watch for local irritation and hypersensitivity reactions
Instruct patients on the correct application technique
(oral, topical, eye drop or vaginal)
Fungal eye infections (fungal blepharitis,
conjunctivitis, keratitis)
Echinocandins
inhibit
β-(1,3)-D-glucan
synthesis, crucial for fungal cell wall
integrity. This disruption leads to osmotic
instability, causing fungal cell lysis and
death. They are generally non-toxic to
mammalian cells.
Educate patient to report symptoms of liver dysfunction
(jaundice, dark urine ...)
Fever
Headache
Nausea, Diarrhea
Hypokalemia
Severe side effects and drug
interactions
are
relatively
uncommon;
however,
a
major
disadvantage is its high cost
ALLYLAMINE, THIOCARBAMATES, AND
MORPHOLINES are primarily used to
treat dermatophyte fungal infections
Fungal nail infections (Onychomycosis)
Gastrointestinal upset
Headache
Dysgeusia (changes in taste sensation)
Allergic reactions
Cryptococcal Meningitis
Infections caused by Candida species
Chromoblastomycosis and Chromomycosis
Cancer Treatment
Viral Infections
Gastrointestinal upset
Allergic reactions
Hepatotoxicity
Myelosuppression (bone marrow)
Nephrotoxicity
Hepatotoxicity
Monitor vital signs and renal function regularly
Educate
on
completing
treatment
and
reporting
symptoms
Monitor fluid and electrolyte balance
Assess for signs of infection or infusion-related reactions
Educate patients on proper application techniques for
topical medications
Educate patients about common side effects such as
gastrointestinal upset and skin irritation
Monitor for signs of allergic reactions
Flucytosine can cause significant toxicity, especially with
prolonged use or at higher doses
Monitoring of liver function tests, kidney function tests,
and complete blood counts
8
ANTIALLERGIC MEDICATIONS
Antiallergic medications are drugs used to prevent or relieve allergic reactions by inhibiting the body's response
to allergens
Class
Mechanism
of Action
ANTIHISTAMINES
Medications that counteract the
effects of histamine, a chemical
involved in allergic reactions.
(H1 ANTAGONISTS)
Diphenhydramine,
Chlorpheniramine,
Loratadine, Cetirizine,
Fexofenadine
GLUCOCORTICOIDS
Prednisone,
Hydrocortisone,
Dexamethasone,
Methylprednisolone
They Block H1 receptors,
reducing
the
effects
of
Cromolyn sodium
Nedocromil
Anticholinergic
symptoms
Blurred vision
Constipation
Urinary retention
which indicate that the
patient is experiencing
significant drying
effects
LEUKOTRIENE
RECEPTOR
ANTAGONISTS
Montelukast, Zafirlukast
@NursingPrints
Educate patients about potential drowsiness
Encourage hydration to reduce dry mouth
Use with caution in elderly patients due to increased
risk of sedation and falls
Can't spit
Can't poop
Encourage patients to avoid known allergens
Weight gain
Asthma and chronic obstructive
pulmonary disease (COPD)
Hyperglycemia
Osteoporosis
Assess for signs of infection due to immunosuppression
Autoimmune
diseases
rheumatoid arthritis)
Hypertension
Increased risk of infection
Educate patients on the importance of not stopping the
medication abruptly to prevent adrenal insufficiency
Muscle weakness
Provide calcium and vitamin D supplements as needed
Irritability, Mood swings
Cushing syndrome (moon
Advise patients to take oral corticosteroids with food to
reduce gastrointestinal discomfort
face, buffalo hump ...)
Watch for signs of Cushing's syndrome with long-term use.
Allergic rhinitis
Allergic Conjunctivitis
Asthma
Nasal irritation
Cough
Unpleasant taste (inhaled forms)
Encourage patients to avoid known allergens
Educate patients on the importance of regular use to
prevent symptoms
Educate patients on the correct use of nasal sprays, eye
drops, or inhalers to ensure optimal delivery of the
medication
Inform patients that these medications may take several
days to weeks to achieve their full effect
Asthma
Allergic Rhinitis
Headache
Gastrointestinal Disturbances
Neuropsychiatric
symptoms
(Agitation, Anxiety, Depression ...)
Inform patients that these medications are not for the relief
of acute asthma attacks!
(lupus,
or not well-tolerated
Leukotriene receptor antagonists
are medications used primarily to
manage and prevent symptoms of
asthma and allergic rhinitis by
blocking leukotriene receptors in
the respiratory tract to reduce
inflammation, bronchoconstriction,
mucus production
Encourage patients to avoid known allergens
Allergic reactions
Crohn's disease, ulcerative colitis
Prevent the release of histamine
and
other
inflammatory
mediators from mast cells,
usually
used
when
antihistamines are not working
Dry mouth
Can't pee
Can't see
Dermatological conditions (eczema,
psoriasis)
MAST CELL
STABILIZERS
Nursing Considerations
Sedation, Dizziness
Allergic rhinitis
Urticaria (hives)
Allergic conjunctivitis
Anaphylaxis (as adjunct therapy)
histamine on smooth muscles
and capillaries, which alleviates
allergic symptoms
Reduce
inflammation
by
inhibiting
multiple
inflammatory cytokines, which
helps reduce nasal congestion,
sneezing, and runny nose
Side
Effects
Indications
Monitor blood glucose levels, especially in diabetic patients
Instruct patients to take the medication regularly, even
when asymptomatic, for effective management of asthma or
allergic rhinitis
Regularly assess lung function and respiratory status to
evaluate the effectiveness of therapy
9
ANALGESICS
Class
Mechanism
of Action
Nonsteroidal AntiInflammatory
Drugs (NSAIDs)
NSAIDs inhibit cyclooxygenase
(COX enzymes), which are
involved in the synthesis of
prostaglandins.
Ibuprofen, Naproxen,
Diclofenac, Sulindac,
Ketorolac, Meloxicam
Indomethacin
Prostaglandins play a key role
in inflammation, pain, and
fever
ACETAMINOPHEN
(PARACETAMOL)
Ibuprofen, Naproxen,
Diclofenac, Sulindac,
Ketorolac, Meloxicam
Indomethacin
Acetaminophen inhibits the
synthesis of prostaglandins in
the central nervous system and
works peripherally to block
pain impulse generation. It also
has antipyretic properties
Indications
Mild to moderate pain (headaches,
muscle aches, dental pain)
Inflammatory diseases
arthritis)
Fever reduction
(Rheumatoid
Dysmenorrhea (menstrual pain)
Relieves mild to moderate pain and
fever, including headaches and
musculoskeletal pain
Side
Effects
GI upset/ulcers/bleeding
Hypersensitivity
reactions
(anaphylaxis...)
Increased risk of cardiovascular
problems (long term use)
Edema
Hepatotoxicity
Nephrotoxicity
Kidney injury
GI upset
Hepatotoxicity (at high doses
or with chronic use)
Antidote: N- ACETYLCYSTEINE
Salicylates, such as aspirin, are
SALICYLATES
a type of NSAID that inhibit
cyclooxygenase enzymes. In
addition
to
reducing
ASPIRIN
inflammation, pain, and fever,
they
also
have
antiaggregation properties
LOCAL
ANESTHESICS
Local anesthetics block sodium
channels
in
nerve
cell
membranes, preventing nerve
Lidocaine, Bupivacaine,
impulse transmission.
Pain relief (mild to moderate pain)
Fever reduction
Anti-inflammatory purposes
Prevention of thromboembolic events
Local or regional anesthesia for surgical,
dental, or diagnostic procedures
Pain management
GI upset/ulcers/bleeding
Hypersensitivity
reactions
(anaphylaxis, Rash...)
Tinnitus (ringing in the ears)
Hepatotoxicity
Nephrotoxicity
Nursing Considerations
Avoid taking on an empty stomach
Increased risk of bleeding with anticoagulants
Reduce effectiveness of antihypertensive drugs
Contraindicated in patients with asthma, GI bleed, kidney
disease, congestive heart failure (CHF), and peptic ulcer
disease
Maximum daily dose for adults typically should not
exceed 4 grams to prevent liver damage
Monitor liver enzymes
ALT: 7-56 u/L
Watch for signs of liver damage,
such as jaundice and dark urine
Avoid use in patients with known
hypersensitivity to acetaminophen
AST: 5-40 u/L
ALP: 40-120 u/L
Bilirubin: 0.1-1.2 mg/dL
GGT: males <50 u/L
females <30 u/L
Avoid taking on an empty stomach
Increased risk of bleeding when used with anticoagulants
Contraindicated in patients with GI bleed, kidney disease,
peptic ulcer disease, children with viral infections, and
bleeding or coagulation disorders
Localized pain or swelling at
the injection site
Assess the patient for any history of allergies to local
anesthetics
Allergic reactions (rare)
Ensure proper techniques for administering
anesthetics to prevent systemic toxicity
local
Mepivacaine, Prilocaine
OPIOID
ANALGESICS
Morphine, Codeine,
Oxycodone, Fentanyl
Methadone, Tramadol,
Hydrocodone
@NursingPrints
Opioid analgesics bind to
opioid receptors in the central
nervous system and peripheral
tissues,
inhibiting
the
transmission of pain signals
and altering the perception of
pain to provide analgesia
Moderate to severe pain relief
Acute pain (Surgery, Trauma, Burns,
Dental pain...)
Chronic pain (Neuropathy, Cancer, Low
back pain...)
Palliative care
Black Box !
Respiratory depression
potential for addiction
Constipation
Nausea, Vomiting
Urinary retention
Pruritus
Sedation
Dizziness and confusion
Assess pain level, type, and location using appropriate
pain scales
valuate the patient's history for any contraindications or
risk factors for opioid use
Monitor vital signs, particularly respiratory rate
Use the lowest effective dose for the shortest duration
necessary
Inform patients about the risk of tolerance, dependence,
and addiction
10
CARDIOTONIC DRUGS
CARDIOVASCULAR MEDs
Cardiotonic drugs, also known as inotropic agents, increase cardiac contractility,
enhancing the heart's pumping strength and improving cardiac output.
Class
Mechanism
of Action
DIGOXIN
Digoxin increases the force of myocardial
contraction by increasing intracellular calcium
levels, and causes the heart to beat stronger and
slower by slowing AV node conduction. It does
not affect blood pressure
PHOSPHODIESTE
RASE INHIBITORS
Inhibit phosphodiesterase enzyme, leading to
enhanced myocardial contractility (positive
inotropic effect) and vasodilation
CARDIAC
GLYCOSIDES
Indications
Heart failure
Atrial fibrillation
Cardiogenic shock
Cardiogenic shock
Heart failure that is not
responsive
to
other
medications
MILRINONE
CATECHOLAMINES
ADRENALINE
NORADRENALINE
DOPAMINE
DOBUTAMINE
ISOPROTERENOL
Catecholamines stimulate
adrenergic receptors (alpha
and/or beta):
Alpha-1 receptors:
vasoconstriction,
increasing blood pressure
ADRENALINE (Epinephrine)
Stimulates both alpha and beta adrenergic receptors,
leading to increased heart rate, myocardial
contractility, bronchodilation, vasoconstriction, and
elevated blood pressure. Low doses can cause
vasodilation !
NORADRENALINE (Norepinephrine)
Primarily stimulates alpha-adrenergic receptors,
resulting in vasoconstriction and increased blood
pressure. It also has a mild effect on beta-1
DOPAMINE
Low doses: Stimulates dopaminergic receptors, causing
renal and mesenteric vasodilation
Moderate doses: Stimulates beta-1 adrenergic
receptors, increasing heart rate and myocardial
contractility
High doses: Stimulates alpha-1 adrenergic receptors,
causing vasoconstriction and increased blood pressure.
blood vessels
@NursingPrints
ISOPROTERENOL
Stimulates both beta-1 and beta-2 receptors. This
leads to increased heart rate, myocardial contractility,
bronchodilation
Digoxin
toxicity
signs
Check apical pulse before administration (hold if pulse is below
60 bpm)
Monitor serum digoxin levels regularly
Assess renal function (impaired renal function can increase the
risk of toxicity)
Assess potassium levels and advise a potassium-rich diet
Arrhythmias
Hypotension
Headache
Nausea, vomiting
Thrombocytopenia (low platelet count)
Monitor blood pressure and heart rate closely
Assess for signs of arrhythmias
Monitor platelet counts to detect thrombocytopenia
Use with caution in patients with electrolyte imbalances,
especially hypokalemia and hypomagnesemia
Nausea, vomiting, diarrhea
Visual disturbances
Anorexia
Arrhythmias
ADRENALINE
ADRENALINE
Monitor vital signs, especially heart rate and blood pressure
Observe for signs of arrhythmias and ischemia
Ensure proper dosage and administration route (IV, IM, SC)
Tachyarrhythmias
Palpitations, Hypertension
Headache
Anxiety
NORADRENALINE
NORADRENALINE
NORADRENALINE
Severe hypotension
Septic shock
adrenergic receptors, which can increase heart rate
and myocardial contractility
DOBUTAMINE
Beta-1 receptors: increased
Primarily stimulates beta-1 adrenergic receptors,
heart rate (chronotropy)
increasing myocardial contractility and stroke volume
and myocardial
with minimal effects on heart rate and peripheral
contractility (inotropy)
Beta-2 receptors:
bronchodilation
ADRENALINE
Anaphylactic shock
cardiogenic shock
cardiac arrest (1st line
treatment)
severe asthma attacks
Nursing Considerations
Side Effects
Hypertension
Bradycardia, Arrhythmias, Anxiety
Headache,
DOPAMINE
DOPAMINE
cardiogenic shock
Heart failure
Hypotension
DOBUTAMINE
Acute heart failure
Cardiogenic shock
Low cardiac output states
Tachyarrhythmias
Hypertension
Extravasation can cause
necrosis
Nausea and vomiting
Monitor blood pressure continuously during administration
Assess for signs of excessive vasoconstriction and ischemia
Use caution to avoid extravasation, as it can cause tissue
necrosis
Be prepared to manage potential arrhythmias and other
cardiovascular effects
DOPAMINE
tissue
DOBUTAMINE
Tachyarrhythmias
Hypertension
Nausea
Headache, Chest pain
ISOPROTERENOL
ISOPROTERENOL
Bradycardia
Heart block
Adams-Stokes syndrome
Bronchospasm
during
anesthesia
Tachycardia, Arrhythmias, Palpitations
Hypotension
Tremors
Nervousness
Headache
Monitor blood pressure continuously during administration
Assess heart rate and rhythm for potential arrhythmias
Use caution to avoid extravasation, as it can cause tissue necrosis
Monitor urine output to assess renal perfusion
DOBUTAMINE
Monitor blood pressure and heart rate during administration
Assess for signs of arrhythmias and monitor ECG
Monitor cardiac output and hemodynamic parameters
Watch for signs of myocardial ischemia, such as chest pain
Ensure proper intravenous access to avoid extravasation.
ISOPROTERENOL
Monitor blood pressure, heart rate, and ECG during administration
Assess respiratory status
Monitor for signs of excessive beta-adrenergic stimulation, such as
palpitations and tremors
Ensure proper intravenous access to avoid extravasation
11
ANTIHYPERTENSIVES
CARDIOVASCULAR MEDs
Class
Adrenergic Blockers
ALPHA-1
BLOCKERS
SUFFIX: -ZOSIN
Enalapril, Lisinopril,
Ramipril
Mechanism
of Action
Side
Effects
Indications
Block alpha-1 adrenergic receptors on
blood vessels, leading to vasodilation,
smooth
muscle
relaxation,
and
decreased blood pressure
Alpha 1 & Alpha 2 have opposing
actions on arteries
Orthostatic hypotension (Sudden hypotension
when moving from lying or sitting to standing)
Hypertension
Benign prostatic
hyperplasia (BPH)
SUFFIX: -OLOL
Metoprolol, Atenolol,
Propranolol, Bisoprolol
Selective BB act only on
Beta 1 receptors
Non Selective BB, affect
Beta 1 and Beta 2
Block beta-adrenergic receptors in the
heart and blood vessels, reducing heart
rate, cardiac output, and blood pressure
Beta-1 receptors increase heart
contractility and rate, and act on
juxtaglomerular cells in the kidneys
Educate patients about dizziness
hypotension; advise them to rise slowly
Not commonly used
Clonidine, Methyldopa
and
orthostatic
Advise taking the medication at bedtime to minimize
dizziness and orthostatic hypotension
Monitor urinary symptom relief in patients with BPH
Hypertension
Bradycardia
Angina
Hypotension
Heart failure
Fatigue
Myocardial infarction
Dizziness
Arrhythmias
Bronchospasm
Glaucoma
beta blockers)
Monitor heart rate and blood pressure regularly
Caution in patients with asthma taking non-selective beta
blockers
(in
non-selective
Do not abruptly stop taking the medication to avoid rebound
hypertension and tachycardia
Hypoglycemia
Monitor blood glucose levels in diabetic patients (beta
blockers can mask hypoglycemia symptoms)
Drowsiness
Monitor blood pressure and heart rate regularly
Hypertension
Dry mouth
(norepinephrine and epinephrine)
ADHD
Constipation
Educate patients on the potential for drowsiness and advise
caution when performing activities requiring alertness
They stimulate alpha-2 receptors,
Withdrawal symptoms
Bradycardia
reducing sympathetic outflow and
from opioids and
Rebound hypertension if abruptly
decreasing
alcohol
Beta-2 receptors dilate bronchioles
in the lungs
Central
ALPHA-2 AGONISTS
(STIMULATORS)
Monitor blood pressure regularly
Inform patients about the significant drop in blood pressure
with the first dose (first-dose effect)
Dizziness
Syncope
Fatigue
Headache
Nasal congestion
Alpha 1 action: Vasoconstriction
Alpha 2 action: Vasodilatation
BETA
BLOCKERS
Nursing Considerations
Alpha-2
Agonists
adrenergic
neurons
in
preventing
catecholamines
peripheral
target
the
CNS,
release
vascular
discontinued
Instruct patients to avoid abruptly discontinuing
medication to prevent rebound hypertension
the
Encourage adequate fluid intake and dietary fiber to
manage constipation
resistance and blood pressure
CALCIUM CHANNEL
BLOCKERS (CCBS)
SUFFIX: - DIPINE &
-ZEM & -MIL
Nicardipine, Amlodipine,
Cardizem, Verapamil
@NursingPrints
Monitor blood pressure and heart rate regularly
Hypertension crisis
Orthostatic hypotension
Assess for signs of peripheral edema
cardiac and smooth muscle cells,
Heart failure
Constipation
reducing heart contractility, dilating
Angina
Headache
Educate patients on the possibility of dizziness and to change
positions slowly
blood vessels and lowering blood
Myocardial infarction
Flushing
pressure
Diabetic nephropathy
Edema
Inhibit the entry of calcium ions into
Encourage a diet high in fiber and fluids to prevent
constipation, particularly with verapamil
Monitor for signs of heart failure, especially in patients with
pre-existing conditions
12
CARDIOVASCULAR MEDs
Class
DIURETICS
THIAZIDE DIURETICS
SUFFIX : - THIAZIDE :
Hydrochlorothiazide,
Chlorothiazide
LOOP DIURETICS SUFFIX : - IDE
Furosemide, Bumetanide,
Torsemide
POTASSIUM SPARING DIURETICS
Spironolactone, Eplerenone,
Amiloride, Triamterene
OSMOTIC DIURETICS
Mannitol
Renin-Angiotensin-Aldosterone System
(RAAS) inhibitors
Diuretics promote urination to
remove excess fluid and reduce
hypertension.
ANGIOTENSIN
COVERTING
ENZYME (ACE)
INHIBITORS
SUFFIX: - PRIL
Enalapril, Lisinopril,
Ramipril
ANGIOTENSIN
RECEPTOR
BLOCKER
(ARBs)
SUFFIX: - SARTAN
Losartan, Valsartan,
Candesartan
@NursingPrints
ANTIHYPERTENSIVES
Mechanism
of Action
THIAZIDE DIURETICS
Block sodium and chloride
reabsorption, increasing the
excretion of Na, Cl, and H2O
LOOP DIURETICS:
block the absorption of sodium,
chloride, and water, increasing
the excretion of potassium,
magnesium, and calcium in urine
POTASSIUM SPARING DIURETICS
Block sodium reabsorption in the
distal tubule and collecting duct
while conserving potassium. They
block aldosterone, leading to the
excretion of sodium and water
OSMOTIC DIURETICS
Osmotic diuretics increase serum
osmolality, drawing fluid from
intracellular spaces into the
interstitial space and bloodstream
Inhibit the enzyme that converts
angiotensin I to angiotensin II,
preventing vasoconstriction and
water/sodium retention,
leading to decreased blood
pressure and reduced workload
on the heart
Side
Effects
Indications
THIAZIDE DIURETICS
Hypertension
Edema associated with heart
failure, liver cirrhosis, and renal
disorders
LOOP DIURETICS
Hypertension
Acute pulmonary edema
Edema associated with heart failure,
liver cirrhosis, and renal disease
POTASSIUM SPARING DIURETICS
Hypertension
Heart failure (spironolactone)
Edema associated with cirrhosis
Hyperaldosteronism
Nephrotic syndrome
OSMOTIC DIURETICS
Cerebral edema
Glaucoma (Increased intraocular
pressure)
Acute renal failure (maintain urine
output)
THIAZIDE DIURETICS
Hypokalemia
Hyponatremia
Hyperglycemia
Hyperuricemia
Dehydration
LOOP DIURETICS
Hypokalemia
Hyponatremia
Hypocalcemia
Ototoxicity (hearing loss)
Dehydration
POTASSIUM SPARING DIURETICS
Hyperkalemia
Hyponatremia
Gynecomastia
Amenorrhea
Erectile dysfunction
GI upset
OSMOTIC DIURETICS
Electrolyte imbalances
Fluid volume overload
Pulmonary edema
Headache
THIAZIDE DIURETICS
Monitor electrolyte levels, especially potassium and sodium
Assess for signs of dehydration and hypotension
Educate patients about the importance of dietary potassium
intake and Encourage K+ rich foods
LOOP DIURETICS
Monitor electrolyte levels and renal function
Assess for signs of dehydration and hypotension
slow IV administration (20mg/min) to avoid ototoxicity
Educate patients about the importance of dietary potassium
intake and Encourage K+ rich foods
POTASSIUM SPARING DIURETICS
Monitor potassium levels and signs of hyperkalemia (muscle
cramps, dysrythmias, peaked T waves)
EKG:
Monitor electrolytes
Educate patients to avoid potassium-rich foods and supplements
Be cautious with patients taking ACE inhibitors or ARBs due to the
increased risk of hyperkalemia.
OSMOTIC DIURETICS
Monitor fluid and electrolyte balance.
Monitor neurological status.
Use with caution in patients with heart failure or renal
impairment.
Administer the drug only IV and monitor the administration site
Monitor blood pressure regularly
Dry Cough
Hypertension
Hyperkalemia
Heart failure
Hypotension
Post-myocardial infarction
Angioedema
Diabetic nephropathy
Dizziness
Fatigue
Block
the
angiotensin
II
receptors on blood vessels and
adrenal glands.
Prevent vasoconstriction and
reduce aldosterone secretion,
leading to decreased blood
pressure and reduced workload
on the heart
Nursing Considerations
Hypertension
Heart failure
Diabetic nephropathy
Chronic kidney disease
Post-myocardial infarction
Dizziness
Assess renal function and electrolyte levels ( hyperkalemia )
Advise patients to avoid potassium supplements
potassium-sparing diuretics to prevent hyperkalemia
or
Contraindicated in pregnancy; it can be teratogenic, causing
birth defects in the fetus
Advise patients not to stop taking ARBs abruptly, as
cessation can cause rebound hypertension
Monitor blood pressure regularly
Hyperkalemia
Assess renal function and electrolyte levels ( hyperkalemia )
Hypotension
Advise patients to avoid potassium supplements
potassium-sparing diuretics to prevent hyperkalemia
Renal impairment
Fatigue
Angioedema (rare)
or
Contraindicated in pregnancy; it can be teratogenic, causing
birth defects in the fetus
Advise patients not to stop taking ARBs abruptly, as
cessation can cause rebound hypertension
13
ANTICOAGULANTS
CARDIOVASCULAR MEDs
Class
Mechanism
of Action
Heparins
SUFFIX: - PARIN
Unfractionated heparin
(UFH)
Low molecular weight
heparins (Dalteparin,
Enoxaparin)
Vitamin K
Antagonists
(VKAs)
Warfarin (Coumadin)
Direct Oral
Anticoagulants
(DOACs)
SUFFIX: - BAN & -TRAN
Enhance
antithrombin
Side
Effects
Indications
III
activity, inhibiting thrombin and
factor Xa to inhibit formation of
fibrin clots
Inhibit vitamin K epoxide
reductase,
reducing
the
production of vitamin Kdependent clotting factors (II,
VII, IX, and X) and inhibiting
prothrombin formation
Inhibit specific clotting factors in
the coagulation cascade, such
as Factor Xa or thrombin,
depending on the type of DOAC
Treatment
of
acute
venous
thromboembolism
Deep vein thrombosis (DVT)
pulmonary embolism (PE)
Prevention of clotting in acute
coronary syndromes
Prevention
of
clotting
in
extracorporeal circulation during
procedures like hemodialysis or
cardiopulmonary bypass
ASPIRIN
ADP Receptor
Inhibitors (P2Y12
Inhibitors)
Clopidogrel, Prasugrel,
Ticagrelor
Heparin-induced thrombocytopenia
(HIT) : ( decrease in platelet count
due to formation of antibodies
against heparin )
Prevention and treatment
thromboembolic disorders
of
Bruising
Hematuria
Epistaxis
Atrial fibrillation
GI bleeding
Prevention and treatment
thromboembolic disorders
of
Bleeding
Bruising
Hematuria
Stroke prevention
fibrillation
in
atrial
Epistaxis
GI upset
Anemia
CARDIOVASCULAR MEDs
Cyclooxygenase
(COX) Inhibitors
Osteoporosis (Prolonged use)
Bleeding
Apixaban, Rivaroxaban,
Dabigatran, Edoxaban
Class
Bleeding (Epistaxis, Hematuria ...)
Mechanism
of Action
Inhibit
the
enzyme
cyclooxygenase,
reducing
thromboxane A2 synthesis,
which is necessary for platelet
aggregation
Block the P2Y12 component of
ADP receptors on the platelet
surface, preventing activation of
the GPIIb/IIIa receptor complex,
reducing platelet aggregation
Nursing Considerations
Monitor activated partial thromboplastin time (aPTT) for UFH
to ensure therapeutic levels
Monitor platelet counts regularly
Educate patients on signs of bleeding and importance of
reporting any unusual bleeding promptly
Antidote
Reversed by Protamine Sulfate in case of bleeding
Monitor INR levels regularly
Contraindicated in pregnancy (teratogenic)
Educate patients to avoid foods high in vitamin K
Antidote
Vitamin K & Fresh Frozen Plasma (FFP) for reversing
anticoagulation effects in case of excessive bleeding
No routine blood monitoring required, unlike VKAs
No need to limit Vitamin K intake
Use caution in patients with renal impairment
Antidote
IDARUCIZUMAB for dabigatran, ANDEXANET alfa
for Factor Xa inhibitors
ANTIPLATELETS
Indications
Prevention
of
myocardial
infarction stroke.
Acute coronary syndrome (ACS).
Peripheral arterial disease
Prevention
of
myocardial
infarction stroke
Peripheral arterial disease
Secondary prevention for ischemic
stroke
Side Effects
GI upset/ulcers/bleeding
Hypersensitivity
Tinnitus (ringing in the ears)
Hepatotoxicity
Nephrotoxicity
Bleeding (including gastrointestinal
and intracranial hemorrhage)
Bruising
Thrombocytopenia
Dyspnea
Gastrointestinal upset
Nursing Considerations
Avoid taking on an empty stomach
Contraindicated in patients with GI bleed, kidney disease,
peptic ulcer disease, children with viral infections, and
bleeding or coagulation disorders
Monitor platelet counts and renal function periodically
Monitor for signs of bleeding and respiratory status
Periodically assess platelet counts for thrombocytopenia
Advise patients to avoid NSAIDs and other bleeding risk
medications
14
CARDIOVASCULAR MEDs
THROMBOLYTICs
Also known as fibrinolytics, are medications used to dissolve blood clots that have acutely formed in the blood vessels. They are
primarily used in emergency situations such as myocardial infarction (heart attack), ischemic stroke, and pulmonary embolism
Class
Mechanism of Action
Indications
Side Effects
Nursing Considerations
Acute myocardial infarction (AMI)
Bleeding (intracranial,
Acute ischemic stroke
gastrointestinal, etc.)
Thrombolytics are most effective when administered within
6 hours of symptom onset
Pulmonary embolism (PE)
Allergic reactions (rare)
All thrombolytic drugs work by converting
FIBRIN-SPECIFIC
AGENTS
(RECOMBINANT tPAS)
ALTEPLASE (tPA)
plasminogen to plasmin, which breaks
down fibrin clots
ALTEPLASE (tPA)
A recombinant form of human tPA that
selectively binds to fibrin in the thrombus,
converting entrapped plasminogen to
plasmin
RETEPLASE (rPA)
RETEPLASE (rPA)
a
second
generation
recombinant
plasminogen activator that works more
TENECTEPLASE (TNK-tPA) rapidly with lower bleeding tendency than
the first generation agent alteplase with a
These agents primarily require longer half-life, allowing for bolus
administration
the presence of fibrin to
effectively convert plasminogen
to plasmin
NON-FIBRINSPECIFIC AGENTS
STREPTOKINASE
UROKINASE
These agents do not require the
presence of fibrin for the
conversion of plasminogen to
plasmin.
@NursingPrints
Central venous catheter occlusion
Hypotension
Acute
Reperfusion arrhythmias
peripheral
arterial
occlusion
Occlusion of indwelling catheters
Intracardiac thrombus formation
Monitor for signs of bleeding, especially intracranial
hemorrhage
Regularly check for signs of gastrointestinal bleeding
Avoid intramuscular injections to minimize the risk of
bleeding
Assess neurological status frequently in stroke patients
Monitor vital signs and cardiac rhythm
Absolute Contraindications
Recent intracranial hemorrhage (ICH)
TENECTEPLASE (TNK-tPA)
Tenecteplase is a modified form of tPA that
binds to fibrin in a clot and converts
plasminogen to plasmin, leading to fibrin
degradation. It is as efficient as alteplase
while exerting a lower risk of non-cerebral
bleeding.
Structural cerebral vascular lesion
STREPTOKINASE
Streptokinase is a widely used fibrinolytic
agent due to its low cost and good safety
profile. Although it has lower efficacy than
alteplase, it poses a lower risk of intracranial
hemorrhage. As a bacterial protein, it forms
a complex with plasminogen to convert it to
plasmin, but it is less fibrin-specific than tPA
and can induce a systemic lytic state
Significant head injury or facial trauma within the last three
months
UROKINASE
Urokinase, produced by renal parenchyma
and purified from human urine, directly
converts plasminogen to plasmin, leading to
fibrin clot breakdown
Intracranial neoplasm
Ischemic stroke within the last three months
Suspected aortic dissection
Active bleeding or bleeding diathesis
Recent intracranial or spinal surgery
Thrombolytics: Used in emergencies to dissolve blood clots
Relative Contraindications
that have acutely formed in blood vessels
Anticoagulants: Used to prevent the formation of clots or to
inhibit the growth of existing clots by interfering with factors
in the clotting cascade
Severe hypertension (systolic blood pressure >180 mmHg
or diastolic blood pressure >110 mmHg)
Dementia
Internal bleeding within the past 2 to 4 weeks
Antiplatelets: Prevent platelets from clumping together and
Pregnancy
forming clots, commonly used to prevent arterial clots that
Active peptic ulcer
can lead to heart attacks or strokes
15
CARDIOVASCULAR MEDs
ANTIHYPERLIPIDEMICS
Hyperlipidemia refers to elevated levels of lipids (fats) in the blood, which includes cholesterol
and triglycerides
HDL helps remove cholesterol from the bloodstream by transporting it from the arteries
and tissues to the liver excreted
LDL transports cholesterol from the liver to the arteries and tissues, where it can
accumulate and form plaques
Class
STATINS (HMG-CoA
Reductase Inhibitors)
Mechanism
of Action
Inhibit HMG-CoA reductase, an
Atorvastatin, Simvastatin,
Rosuvastatin, Pravastatin,
Lovastatin, Fluvastatin,
enzyme involved in the synthesis
of cholesterol in the liver, leading
to
decreased
cholesterol
production
and
increased
clearance
of
low-density
lipoprotein (LDL) cholesterol
BILE ACID
SEQUESTRANTS
Bind bile acids in the intestine,
preventing
their
reabsorption,
which prompts the liver to use
Cholestyramine,
Colestipol, Colesevelam
cholesterol to produce more bile
acids, thereby lowering blood
cholesterol levels
FIBRIC ACID
DERIVATIVES
(FIBRATES)
Activate peroxisome proliferatoractivated receptors (PPARs), leading
to
increased
lipolysis
and
INFIX: -FIB-
elimination
of
triglyceride-rich
particles from plasma
SUFFIX: - STATIN
Side
Effects
Indications
Niacin, also known as vitamin B3,
works by inhibiting lipolysis in
adipose tissue, reducing hepatic
VLDL (very low-density lipoprotein)
Immediate-release niacin
synthesis, and increasing HDL
Extended-release niacin
Sustained-release niacin (high-density lipoprotein) levels
@NursingPrints
Cholesterol: < 200 mg/dL
Triglycerides: < 150 mg/dL
LDL (low-density lipids): < 100 mg/dL
HDL (high-density lipids): > 60 mg/dL
Nursing Considerations
GI upset
Muscle pain (myalgia)
Liver enzyme abnormalities
Hyperglycemia (risk of diabetes)
Obtain baseline liver function tests and lipid profile
Monitor liver function tests periodically
Inform patients to report unexplained muscle pain,
tenderness, or weakness immediately
Contraindicated in:
- Active liver disease
- Pregnancy and breastfeeding (statins are teratogenic)
- Known hypersensitivity to the drug
Constipation
Gastrointestinal discomfort
Vitamin deficiencies
Cholesterol Gallstones
Advise patients to take other medications at least 1 hour
before or 4-6 hours after bile acid sequestrants to avoid
drug interactions.
Encourage a high-fiber diet to prevent constipation
Monitor for signs of gallstones
Severe hypertriglyceridemia, mixed
dyslipidemia
Gastrointestinal disturbances
Gallstones
Myopathy
Hepatotoxicity
Monitor liver function and lipid levels periodically
Administer 30 minutes before breakfast and dinner
Be aware that it increases the effects of warfarin
Inform patients about the potential for muscle pain and to
report any unusual symptoms
Monitor for signs of gallstones
Hyperlipidemia, particularly when
there is a need to increase HDL
levels
Hypertriglyceridemia
Used in combination with other
lipid-lowering
agents
for
comprehensive lipid control
Flushing and itching of the skin
Gastrointestinal discomfort (nausea,
vomiting, diarrhea)
Hepatotoxicity
Hyperglycemia
Hyperuricemia
Myopathy
Advise patients to take niacin with food to reduce
gastrointestinal discomfort
Hypercholesterolemia
Primary prevention in patients with
high risk of cardiovascular events
(diabetes, high LDL levels ...)
Prevention of atherosclerosis by
reducing plaque formation in blood
vessels
Post-myocardial infarction
Hyperlipidemia (especially
statins are not tolerated)
when
Gemfibrozil, Fenofibrate,
Ciprofibrate, Bezafibrate
Niacin
(Nicotinic Acid)
Lipid Panel
Monitor liver function tests (LFTs), fasting blood glucose,
and uric acid levels periodically
Contraindicated in active peptic ulcer disease
16
CARDIOVASCULAR MEDs
ANTIANGINAL DRUGS
Antianginal drugs are medications used to manage and relieve the symptoms of angina pectoris,
which is chest pain caused by reduced blood flow to the heart
VS
ANGINA
Definition: Angina is chest pain or discomfort that occurs when the heart muscle doesn't get
enough oxygen-rich blood. It can be stable (predictable and triggered by exertion) or unstable
(unpredictable and can occur at rest)
Symptoms: Chest pain or discomfort, often described as pressure, squeezing, or fullness. Pain
may radiate to the shoulders, arms, neck, jaw, or back. Typically relieved by rest or nitroglycerin
Troponin Levels: Generally normal, but may be slightly elevated in unstable angina
Management: Includes lifestyle changes, medications like nitrates, beta-blockers, calcium channel
blockers, and antiplatelet agents
Class
NITRATES
SUFFIX: - STATIN
Atorvastatin, Simvastatin,
Rosuvastatin, Pravastatin,
Lovastatin, Fluvastatin,
CALCIUM CHANNEL
BLOCKERS
SUFFIX: - PINE &
-.ZEM & -MIL
Nicardipine, Amlodipine,
Cardizem, Verapamil
BETA
BLOCKERS
SUFFIX: -OLOL
Metoprolol, Atenolol,
Propranolol, Bisoprolol
@NursingPrints
Mechanism
of Action
Nitrates are vasodilators that
relieve angina by reducing the
heart's workload and increasing
Definition: Myocardial infarction occurs when blood flow to a part of the heart is blocked for a
prolonged period, leading to damage or death of heart muscle tissue
Symptoms: Similar to angina but more severe and prolonged. Includes chest pain or discomfort,
shortness of breath, sweating, nausea, light-headedness, and pain radiating to other areas
Troponin Levels: Significantly elevated, indicating heart muscle damage
Management: Emergency treatment includes oxygen, nitroglycerin, aspirin, anticoagulants,
thrombolytics, and procedures like angioplasty or surgery
Side
Effects
Indications
Angina pectoris
Hypertensive crisis
blood flow to the heart muscle.
They release nitric oxide, which
causes relaxation of vascular
smooth muscle (vasodilation)
Calcium channel blockers help
prevent
angina
by
dilating
coronary arteries and reducing the
MYOCARDIAL INFARCTION (Heart Attack)
Headache
Dizziness
Hypotension
Flushing
Nursing Considerations
Monitor blood pressure regularly
Educate patients to sit or lie down when taking the
medication to prevent dizziness
Avoid abrupt discontinuation to prevent angina rebound
Assess for tolerance with long-term use
Monitor blood pressure and heart rate regularly
Hypertension crisis
Orthostatic hypotension
Heart failure
Constipation
heart's workload. They inhibit
calcium ions' entry into cardiac
and smooth muscle cells, reducing
heart contractility and dilating
blood vessels
Angina
Headache
Myocardial infarction
Flushing
Diabetic nephropathy
Edema
Block beta-adrenergic receptors in
the heart and blood vessels,
leading to vasodilation and a
decrease in heart rate and
myocardial
oxygen
demand,
thereby reducing angina symptoms
Chronic angina prevention.
Bradycardia
Post-myocardial infarction
Fatigue
Hypertension
Dizziness
Heart failure
Depression
Arrhythmias
Hypotension
Glaucoma
Hypoglycemia
Assess for signs of peripheral edema
Educate patients on the possibility of dizziness and to
change positions slowly
Encourage a diet high in fiber and fluids to prevent
constipation, particularly with verapamil
Monitor for signs of heart failure, especially in patients with
pre-existing conditions
Monitor heart rate and blood pressure
Educate patients about signs of bradycardia
Avoid abrupt withdrawal to prevent rebound angina
Monitor blood glucose levels in diabetic patients (beta
blockers can mask hypoglycemia symptoms)
17
GASTROINTESTINAL MEDICATIONS
Class
Mechanism
of Action
Indications
Immediately neutralizes stomach
acid by increasing the pH of
ANTACIDS
gastric
contents.
This
provides
immediate treatment but is not
suitable for long-term use, as the
Aluminum hydroxide
Magnesium hydroxide
Calcium carbonate
Immediate relief of heartburn
Acid indigestion
Upset stomach
GERD (Gastroesophageal Reflux
Disease)
Peptic Ulcer Disease (PUD)
body will produce acid again. It is
a symptomatic treatment
Side
Effects
Nursing Considerations
Avoid mix with other meds (can affect absorption)
Take 1 hour before or after other meds
Monitor for signs of electrolyte imbalance, especially in
patients with renal impairment
Aluminum Hydroxide
Constipation, hypophosphatemia
Magnesium Hydroxide
Diarrhea, hypermagnesemia
Calcium Carbonate
Constipation, hypercalcemia,
stones
Aluminum Hydroxide
Use with caution in patients with renal impairment
kidney
Calcium Carbonate
Monitor for hypercalcemia in long-term use
Sodium Bicarbonate
Alkalosis, hypernatremia
Sodium bicarbonate
Magnesium Hydroxide
Avoid in patients with renal failure
Sodium Bicarbonate
Not recommended for long-term use
H2 RECEPTOR
ANTAGONISTS
Block histamine H2 receptors on
SUFFIX: - TIDINE
reducing acid secretion
parietal
cells
in
the
stomach,
Gastroesophageal reflux disease
(GERD)
peptic ulcer disease (PUD)
Zollinger-Ellison syndrome
Cimetidine, Famotidine,
Nizatidine
Headache
Dizziness
Constipation
Diarrhea
Decreased libido
Gynecomastia
Vitamin
B12
prolonged use
deficiency
with
Monitor for relief of symptoms such as heartburn and
indigestion
Educate patients to take the medication as prescribed,
usually before meals or at bedtime.
Advise patients to avoid smoking, as it can decrease the
effectiveness of H2 receptor antagonists
Inform patients to avoid alcohol and NSAIDs, which can
exacerbate stomach issues
Monitor for signs of vitamin B12 deficiency, especially with
long-term use
N S AIDs
PROTON PUMP
INHIBITORS (PPIS)
SUFFIX: - PRAZOLE
Omeprazole, Esomeprazole,
Lansoprazole,
Pantoprazole, Rabeprazole,
Dexlansoprazole
PPIs work by inhibiting the H+/K+
ATPase enzyme system (proton
pump) on the gastric parietal cells,
which reduces the production of
gastric acid
Gastroesophageal reflux disease
(GERD)
Peptic ulcer disease
Zollinger-Ellison syndrome
Erosive esophagitis
Prevention of stress ulcers
H. pylori infection (in combination
with antibiotics)
Headache
Nausea
Diarrhea or constipation
Osteoporosis-related fractures with
long-term use
Monitor Liver Function and Electrolytes
Vitamin
B12
prolonged use
Be alert for signs of hypomagnesemia, such as muscle
cramps or seizures, and symptoms of gastrointestinal
infections
deficiency
with
Hypomagnesemia
Reduced acid can lead to bacterial
overgrowth and increase risk of
infection (Clostridium infection)
@NursingPrints
Inform patients to take PPIs before meals, typically 30-60
minutes before breakfast, to enhance efficacy
Encourage a diet low in acidic and spicy foods to help
manage symptoms
Explain the potential risks of long-term use, including
vitamin B12 deficiency, bone fractures, and increased
susceptibility to infections
18
GASTROINTESTINAL MEDICATIONS
Class
ANTIEMETICS
SEROTONIN RECEPTOR
ANTAGONISTS
DOPAMINE ANTAGONISTS
ANTIHISTAMINES (H1
Mechanism
of Action
Side
Effects
Indications
SEROTONIN RECEPTOR ANTAGONISTS
SEROTONIN RECEPTOR ANTAGONISTS
Block serotonin receptors in the
central
nervous
system
and
gastrointestinal tract
Postoperative nausea and vomiting,
Radiation
/
chemotherapy-induced
nausea and vomiting
DOPAMINE ANTAGONISTS
DOPAMINE ANTAGONISTS
Block dopamine receptors in the
brain's chemoreceptor trigger zone
ANTIHISTAMINES (H1 ANTAGONISTS)
Severe
nausea
and
gastroparesis, and GERD
vomiting,
ANTIHISTAMINES (H1 ANTAGONISTS)
ANTAGONISTS) ...
Motion sickness, vertigo, nausea due to
Block histamine H1 receptors in the
inner ear disorders and some allergic
brain and vestibular system
symptoms
ANTIDIARRHEALS
Coats the lining of the gastrointestinal
tract and binds to bacteria or toxins
causing diarrhea
ADSORBENTS
Adsorbents
Antimotility Agents
(Opioids)
Antisecretory Agents
Probiotics
ANTIMOTILITY AGENTS
Slow down bowel motility, allowing
more time for water and electrolytes
to be absorbed from the fecal matter
ANTISECRETORY AGENTS
Reduces gastrointestinal
and motility
secretion
PROBIOTICS
Live microorganisms, also known as
"friendly bacteria," similar to those
naturally found in the human gut.
They help restore the natural balance
of gut flora and inhibit the growth of
pathogenic bacteria
ADSORBENTS
Mild to moderate diarrhea
ANTISPASMODICS
Antispasmodics (Alverine,
Mebeverine)
ionic channels involved in muscle
contraction (Antispasmodics)
Indirect Action: Blocking the action
of neurotransmitters (acetylcholine)
Anticholinergics
(Dicyclomine, Hyoscyamine) that stimulate muscle contractions,
and reducing involuntary muscle
SEROTONIN RECEPTOR ANTAGONISTS
Headache, constipation, dizziness,
QT prolongation
Assess the patient's response to the antiemetic medication,
noting any continued or resolved symptoms of nausea and
vomiting
DOPAMINE ANTAGONISTS
Be aware of and manage potential side effects specific to
the class of antiemetic being administered
Drowsiness, extrapyramidal
(EPS), tardive dyskinesia
symptoms
ANTIHISTAMINES (H1 ANTAGONISTS)
Drowsiness, dry mouth, blurred vision,
urinary retention
Bowel
Consider non-pharmacological interventions in conjunction
with medication, such as dietary adjustments, hydration,
and relaxation techniques
Evaluate Underlying Causes: Always assess and address
potential underlying causes of nausea and vomiting
ADSORBENTS
ADSORBENTS
Constipation, black stools, darkened
tongue (with bismuth subsalicylate)
Monitor for signs of constipation, educate patients about
harmless discoloration of stools and tongue with bismuth
subsalicylate
ANTIMOTILITY AGENTS
Acute
diarrhea,
Irritable
Syndrome with diarrhea (IBS-D)
ANTIMOTILITY AGENTS
ANTIMOTILITY AGENTS
Drowsiness, dizziness, dry mouth,
constipation, potential for abuse (with
diphenoxylate)
Monitor for signs of constipation and CNS depression, use
cautiously in patients with a history of substance abuse
ANTISECRETORY AGENTS
ANTISECRETORY AGENTS
Nausea, bloating, injection site pain,
gallstones
Monitor for gallstones and other gastrointestinal side effects,
rotate injection sites to reduce pain
ANTISECRETORY AGENTS
Severe diarrhea associated with certain
conditions like carcinoid tumors
PROBIOTICS
Antibiotic-associated diarrhea, infectious
diarrhea, IBS
Direct Action: Relaxing the smooth
muscles by interfering with the
Nursing Considerations
PROBIOTICS
PROBIOTICS
Gas,
bloating,
infections
immunocompromised individuals
in
ANTISPASMODICS
Irritable bowel syndrome (IBS)
spastic
colon,
and
other
gastrointestinal conditions involving
muscle spasms
Generally well-tolerated, but may
include dizziness, headache, and nausea
ANTICHOLINERGICS
Dry mouth, blurred vision, constipation,
urinary
retention,
dizziness,
and
tachycardia
Monitor for improvement in symptoms, educate patients on the
benefits of maintaining gut health through diet and probiotics
Evaluate the cause and severity of gastrointestinal spasms
before administering antispasmodics
Assess for contraindications, such as glaucoma, urinary
retention, and myasthenia gravis for anticholinergics
Regularly monitor for relief of spasms and pain, as well as
for any adverse effects
Avoid use in patients with known hypersensitivity to the
medications
spasms (Anticholinergics)
@NursingPrints
19
DIURETICS
Genito-urinary drugs
Diuretics are medications that increase urination to eliminate excess fluids and electrolytes.
They are used to treat hypertension, heart failure, and edema by reducing fluid buildup and lowering blood pressure
Mechanism
of Action
Class
THIAZIDE
DIURETICS
Block
sodium
reabsorption,
SUFFIX : - THIAZIDE
and
chloride
increasing
the
excretion of Na, Cl, and H2O
Hydrochlorothiazide,
Chlorothiazide
LOOP
DIURETICS
block
SUFFIX : - IDE
increasing the excretion of
Furosemide, Bumetanide,
Torsemide
potassium, magnesium, and
POTASSIUM SPARING
DIURETICS
Spironolactone,
Eplerenone, Amiloride,
Triamterene
the
absorption
Side Effects
Indications
of
sodium, chloride, and water,
calcium in urine
Hypertension
Hypokalemia
Monitor electrolyte levels, especially potassium
Edema associated with heart
Hyponatremia
and sodium
failure, liver cirrhosis, and
Hyperglycemia
Assess for signs of dehydration and hypotension
renal disorders
Hyperuricemia
Educate patients about the importance of dietary
Dehydration
potassium intake and Encourage K+ rich foods
Hypertension
Hypokalemia
Monitor electrolyte levels and renal function
Acute pulmonary edema
Hyponatremia
Assess for signs of dehydration and hypotension
Edema associated with heart
Hypocalcemia
slow IV administration (20mg/min) to avoid
failure, liver cirrhosis, and
Ototoxicity (hearing loss)
ototoxicity
renal disease
Dehydration
Educate patients about the importance of dietary
potassium intake and Encourage K+ rich foods
Block sodium reabsorption in
Hypertension
Hyperkalemia
the distal tubule and collecting
Heart failure (spironolactone)
Hyponatremia
duct
Edema
Gynecomastia
while
conserving
associated
with
cirrhosis
Amenorrhea
aldosterone, leading to the
Hyperaldosteronism
Erectile dysfunction
excretion of sodium and water
Nephrotic syndrome
GI upset
Osmotic
diuretics
increase
Cerebral edema
serum
osmolality,
drawing
Glaucoma
potassium.
Nursing Considerations
They
block
Monitor potassium levels and signs of
hyperkalemia (muscle cramps, dysrythmias,
peaked T waves)
EKG:
Monitor electrolytes
Educate patients to avoid potassium-rich foods and
supplements
Be cautious with patients taking ACE inhibitors or
ARBs due to the increased risk of hyperkalemia.
Monitor fluid and electrolyte balance.
OSMOTIC
DIURETICS
Mannitol
@NursingPrints
(Increased
Electrolyte imbalances
Monitor neurological status.
Fluid volume overload
Use with caution in patients with heart failure or
fluid from intracellular spaces
intraocular pressure)
Pulmonary edema
renal impairment.
into the interstitial space and
Acute renal failure (maintain
Headache
Administer the drug only IV and monitor the
bloodstream
urine output)
administration site
20
Erectile Dysfunction Drugs
Genito-urinary drugs
While ED can be due to physical factors such as cardiovascular disease, diabetes, or hormonal imbalances, it is frequently caused
by psychological factors like stress, anxiety, or depression. Treating the underlying cause, whether physical or psychological, is
crucial for effective management of ED !
Class
Phosphodiesterase
Type 5 Inhibitors
(PDE5 Inhibitors)
Mechanism
of Action
Indications
type 5 (PDE5) receptors, causing an
increase in nitric oxide levels. This
the
enzyme
cyclic
SUFFIX : - THIAZIDE
guanosine monophosphate (cGMP),
Sildenafil, Tadalafil,
Vardenafil
leading to relaxation of smooth
Nursing Considerations
Assess cardiovascular status, especially in patients with a
Selectively inhibit phosphodiesterase
activates
Side Effects
Erectile dysfunction (ED)
Headache
Pulmonary arterial hypertension
Flushing
(for Sildenafil and Tadalafil)
Dyspepsia (indigestion)
Blurred vision
Nasal congestion
Priapism (prolonged erection)
muscle and increased blood flow to
history of heart disease. PDE5 inhibitors can cause vasodilation
and hypotension
Contraindicated in patients using nitrates or nitric oxide donors
due to the risk of severe hypotension
It should be taken 30 minutes to 4 hours before sexual activity,
depending on the specific drug
Caution patients about potential interactions with other
the corpus cavernosum, resulting in
medications, such as alpha-blockers and antihypertensives,
an erection
which can lead to additive blood pressure-lowering effects
Genito-urinary drugs
Class
Combined Oral
Contraceptives
(COCs)
Hormonal Contraceptive Drugs
Mechanism of Action
Indications
Side Effects
Inhibit
FSH
Contraception
Nausea
Contraindicated in breast feeding < 6 months
LH
Regulation of menstrual
Weight gain
Screen for contraindications, such as smoking and a history
cycles
Mood changes
of thromboembolic disorders
Treatment of acne
Hypertension
Advise taking a missed pill as soon as possible and
Endometriosis
Risk of blood clots
continuing the rest as usual
Adenomyosis
Risk of ischemic stroke
ovulation
by
(Follicle-Stimulating
suppressing
Hormone)
and
(Luteinizing Hormone)
Alter uterine lining to prevent implantation
Thicken cervical mucus to block sperm
Progestin-Only
Contraceptives
(POPs)
Inhibit ovulation
Contraception, especially
Irregular bleeding
Thicken cervical mucus
in breastfeeding women
weight gain
Thin the uterine lining
or those who cannot take
headache
estrogen
mood changes
Nursing Considerations
If a day is missed, do not take two pills the next day
Ensure the patient understands the importance of taking the
pill at the same time every day
Educate patients on correct use and possible side effects
Advise using backup contraception (condoms) if a pill is
missed by more than 3 hours
POPs are less effective when taken with certain antiepileptic
drugs (carbamazepine, barbiturates...) and rifampicin
@NursingPrints
21
ANTI DIEABETIC MEDICATION
Endocrine Meds
Type 1 Diabetes
VS
Type 1 Diabetes Mellitus (Insulin-dependent diabetes) is caused by
genetic / immunological factors, resulting in inadequate insulin
production. Patients require daily insulin injections. It is usually
diagnosed in childhood or adolescence. Symptoms include
hyperglycemia, polydipsia, polyphagia, and polyuria
Types
Class
INSULIN
RAPID ACTING
(Lispro, Aspart, Glulisine)
SHORT ACTING
(Regular)
Side Effects
Nursing Considerations
Long-acting insulin should never be mixed with other
insulins in the same syringe
Hyperosmolar hyperglycemic
state
Hypoglycemia (highest risk
with rapid-acting insulins)
Weight gain
Lipodystrophy at injection sites
Allergic reactions (rare)
Hypokalemia
Edema (rare)
Hyperglycemia
Hypoglycemia
Educate patients on proper injection techniques and rotation
of injection sites to prevent lipodystrophy
Cold and clammy skin
Irritability
Diaphoresis (Excessive sweating)
Shakiness or tremors
Rapid or irregular heartbeat
Advise patients to carry a source of fast-acting glucose
(glucose tablets) to treat hypoglycemia
Type 1 Diabetes
ONSET: < 15 Minutes
PEAK: 30 - 90 Minutes
DURATION: 03 - 06 Hours
Adjunct treatement for type 2
diabetes
Diabetes ketoacodosis (DKA)
SHORT ACTING
ONSET: < 30 - 60 Minutes
PEAK: 02 - 04 Hours
DURATION: 06 - 10 Hours
INTERMEDIATE ACTING
ONSET: 01 - 02 Hours
INTERMEDIATE ACTING PEAK: 04 - 12 Hours
(NPH)
Polyphagia
Polyuria
Polydipsia
Fruity breath
DURATION: 10 - 18 Hours
Headache
LONG ACTING
(Glargine, Detemir)
Type 2 Diabetes Mellitus (Non-insulin-dependent diabetes) is a
metabolic disorder where the body becomes resistant to insulin or
the pancreas fails to produce enough insulin. It is often associated
with obesity and sedentary lifestyle. It is typically diagnosed in
middle age (around 45 years old)
Indications
RAPID ACTING
LONG ACTING
Nausea and vomiting
ONSET: 01 - 02 Hours
PEAK: None
DURATION: > 24 Hours
Type 2 Diabetes
Dry mouth
Hunger
Fatigue or weakness
Dizziness, Headache
Blurred vision
Regular insulin can be mixed with NPH insulin
When mixing regular insulin with NPH, always draw up
regular insulin into the syringe first
Monitor blood glucose levels before and after insulin
administration to assess efficacy and prevent hypoglycemia
Educate patients on maintaining a healthy diet and exercise
regimen
Teach patients the signs and symptoms of hypoglycemia
and hyperglycemia
ORAL ANTIDIABETIC DRUGS
Mechanism of Action:
BIGUANIDES
Metformin
Reduces
hepatic
glucose
production,
increases
insulin
sensitivity,
and
enhances
peripheral glucose uptake and
utilization
@NursingPrints
Gastrointestinal disturbances
(nausea, diarrhea...)
Type 2 Diabetes Mellitus
Lactic acidosis
Vitamin B12 deficiency with
long-term use
Monitor renal function regularly
Take with meals to reduce gastrointestinal side
effects
Biguanides can cause lactic acidosis
22
ANTI DIEABETIC MEDICATION
Endocrine Meds
ORAL ANTIDIABETIC DRUGS
Class
SULFONYLUREAS
SUFFIX : - IDE
Mechanism of Action
Stimulate
insulin
release
from
pancreatic beta cells
Indications
Type 2 Diabetes Mellitus
Glimipride, Glipzide,
Glyburide
Thiazolidinediones
(TZDs)
Increase
SUFFIX : - GLITAZONE
hepatic glucose production.
insulin
sensitivity
in
peripheral tissues and decrease
Type 2 Diabetes Mellitus
Pioglitazone, Rosiglitazone
Dipeptidyl Peptidase-4
(DPP-4) Inhibitors
SUFFIX : - GLIPTIN
Sitagliptin, Saxagliptin,
Linagliptin
DPP-4 inhibitors increase incretin
hormones,
this
enhances
release,
helping
regulate
Type 2 Diabetes Mellitus
SUFFIX : - GLIFLOZIN
excretion in urine
kidneys,
increasing
glucose
Delay carbohydrate absorption in
Acarbose, Miglitol
postprandial blood glucose levels
Meglitinides
Stimulate rapid and short-duration
SUFFIX : - GLINIDE
Repaglinide, Nateglinide
@NursingPrints
the
intestines,
reducing
insulin release from pancreatic beta
cells
Administer 30 minutes before meals
Photosensitivity (rare)
Contraindicated in diabetes ketoacodosis (DKA)
Weight gain
Monitor liver function tests periodically
Edema
Assess for signs of heart failure ( Edema, shortness of
Increased risk of heart failure
breath)
Bone fractures
Educate patients on maintaining bone health
Upper
Genital
Type 2 Diabetes Mellitus
Canagliflozin, Dapagliflozin,
Empagliflozin
Alpha-Glucosidase
Inhibitors
hypoglycemia
Gastrointestinal disturbances
respiratory
blood
glucose
levels
to
prevent
Monitor for signs of pancreatitis
tract
Educate patients on maintaining good respiratory
hygiene
Pancreatitis (rare)
sugar in Type 2 Diabetes Mellitus.
Block reabsorption of glucose in the
Monitor
Weight gain
infections
blood
Sodium-Glucose CoTransporter 2 (SGLT2)
Inhibitors
Hypoglycemia
Nasopharyngitis
insulin
secretion and decreases glucagon
Nursing Considerations
Side Effects
/
tract
Monitor renal function and hydration status
infections
Educate patients on recognizing signs of infections
Dehydration
and maintaining good personal hygiene
Hypotension
Advise patients to stay well-hydrated
Gastrointestinal
Type 2 Diabetes Mellitus
Urinary
disturbances
(bloating, gas, diarrhea)
Administer with the first bite of each main meal
Educate patients on managing gastrointestinal side
effects
Hypoglycemia
Type 2 Diabetes Mellitus
Weight gain
Administer before meals
Monitor
blood
glucose
levels
to
prevent
hypoglycemia
Educate patients on recognizing and managing
symptoms of hypoglycemia
23
THYROID MEDICATIONS
Endocrine Meds
Thyroid hormones
T3 (Triiodothyronine): 100 - 200 ng/dL - produced by the thyroid gland
T4 (Thyroxine): 5.0 - 12.0 ug/dL - produced by the thyroid gland
TSH (Thyroid-stimulating hormone): 0.4-4.0 mIU/L - Secreted by the anterior pituitary gland to stimulate the thyroid gland
Hyperthyroidism
Increased T3 and/or T4
Nervousness, irritability
Tachycardia
Exophtalmos
weight loss
Tremors, sweating
Enlarged thyroid (goiter)
Class
THYROID
HORMONES
Levothyroxine,
Liothyronine
SUFFIX : -THYRONINE
-THYROXINE
VS
Hypothyroidism
Increased TSH
Decreased T3 and or T4
Fatigue
Bradycardia
Cold intolerance
Constipation
Weight gain
Amenorrhea
Too much ENERGY!
Hyperthyroidism can be caused by Graves'
disease (also known as Basedow's disease, an
autoimmune
condition),
toxic
adenoma,
multinodular goiter, thyroiditis, excessive iodine
intake, or tumors
Mechanism of Action
Indications
Side Effects
LEVOTHYROXINE
LEVOTHYROXINE
LEVOTHYROXINE
Levothyroxine is a synthetic form of
thyroxine (T4), It increases metabolic rate,
affecting protein synthesis and increasing
the body's sensitivity to catecholamines
LIOTHYRONINE
Liothyronine is a synthetic form of
triiodothyronine (T3), It is more potent
than T4 and has a faster onset of action.
Hypothyroidism
Hyperthyroidism symptoms
Myxedema coma
Osteoporosis with long-term use
TSH
suppression
in
Allergic reactions (rare)
LIOTHYRONINE
(when
response
needed)
Methimazole,
Propylthiouracil
@NursingPrints
Hyperthyroidism
Administer on an empty stomach, usually in the
morning, to enhance absorption
is
LIOTHYRONINE
Monitor TFTs closely
higher risk of cardiovascular side
Use cautiously in patients with cardiovascular disease
effects due to its potency
Educate patients on the importance of adhering to the
prescribed dosing schedule
Agranulocytosis
Inhibits the synthesis of thyroid hormones
by blocking the oxidation of iodine in the
thyroid gland
LEVOTHYROXINE
Monitor thyroid function tests (TFTs) regularly
Similar to levothyroxine, with a
Myxedema coma
THYROID
ANTAGONISTS
Nursing Considerations
each day
LIOTHYRONINE
rapid
Hypothyroidism can be caused by Hashimoto's
thyroiditis (an autoimmune condition), radiation
therapy, thyroidectomy, certain drugs (like
lithium), iodine deficiency, or conditions
affecting the pituitary or hypothalamic glands ...
Educate patients to take the medication at the same time
thyroid cancer
Hypothyroidism
Not enough ENERGY!
(severe
Monitor thyroid function tests (TFTs) and complete blood
reduction in white blood cells)
count (CBC) regularly
Hepatotoxicity
Monitor liver function tests
Rash
Methimazole can cause congenital abnormalities, so
Gastrointestinal upset
Propylthiouracil is recommended for pregnant patients
24
ANXIOLYTICS
Mental Health Drugs
Class
Mechanism
of Action
BENZODIAZEPINES
Benzodiazepines enhance the
effect of the neurotransmitter
gamma-aminobutyric
acid
Diazepam, Lorazepam,
Alprazolam,
Clonazepam
SUFFIX : -ZEPAM
-ZOLAM
(GABA) at the GABA-A receptor,
leading to sedative, hypnotic,
anxiolytic, anticonvulsant, and
Indications
Generalized Anxiety Disorder (GAD)
Panic Disorder
Side Effects
Respiratory depression (especially
at high doses or when combined
with other CNS depressants)
Insomnia (short-term use)
Dependence and tolerance
Muscle spasms
Drowsiness
Alcohol withdrawal
Monitor for signs of sedation, respiratory depression,
and dependency
Advise against alcohol and other CNS depressants
while taking benzodiazepines
Educate about the potential for dependence and not
abruptly stopping the medication
Dizziness
muscle relaxant properties
Nursing Considerations
Use the lowest effective dose for the shortest duration
Confusion
possible
Monitor the patient's anxiety level and response to the
NONBENZODIAZEPINES
Buspirone
Buspirone acts as a partial
agonist at serotonin (5-HT1A)
receptors, providing anxiolytic
effects
without
significant
sedation or dependency risk
Generalized Anxiety Disorder (GAD)
Dizziness
medication
Headache
Educate about the importance of taking the medication
Nausea
consistently, as it may take several weeks to see full
Nervousness
effects
Lightheadedness
Advise patients that buspirone does not cause sedation
or dependency, unlike benzodiazepines
Monitor for sedation and other anticholinergic side
Drowsiness
ANTIHISTAMINES
Antihistamines block histamine
receptors, leading to a sedative
effect that can reduce anxiety
Dry mouth
Anxiety
effects
Blurred vision
Insomnia
Anticholinergic
symptoms
Constipation
Urinary retention
Can't pee
Can't see
Paroxetine,
Escitalopram,
Fluoxetine
SUFFIX : -OXETINE
-PRAM
@NursingPrints
caution when operating heavy machinery or driving
Inform about the importance of staying hydrated
Hydroxyzine
Selective Serotonin
Reuptake Inhibitors
(SSRIs)
Educate about the potential for drowsiness and advise
SSRIs block the reabsorption
(reuptake) of serotonin into
neurons, increasing its levels in
the brain and improving mood
and anxiety symptoms
Can't spit
Can't poop
Advise patients to report any severe or persistent side
effects to their healthcare provider
Generalized Anxiety Disorder (GAD)
Nausea
Panic Disorder
Insomnia or drowsiness
Social Anxiety Disorder
Sexual
dysfunction
(decreased
Major Depressive Disorder (MDD)
libido,
delayed
ejaculation,
Post-Traumatic Stress Disorder (PTSD)
anorgasmia)
Premenstrual
Dry mouth
Encourage taking the medication at the same time daily
(PMDD)
Dizziness, Headache
Avoid use with MAOIs due to serotonin syndrome risk
Obsessive-Compulsive Disorder (OCD)
Increased sweating
Dysphoric
Disorder
Explain the importance of taking the medication as
prescribed, even if symptoms improve
Advise patients not to abruptly stop the medication
without consulting their healthcare provider
25
Mental Health Drugs
Class
Mechanism
of Action
Selective Serotonin
Reuptake Inhibitors
(SSRIs)
SSRIs block the reabsorption
(reuptake) of serotonin into
neurons, making more serotonin
available in the brain. This helps
improve mood and reduce
symptoms of depression and
anxiety
Fluoxetine, Paroxetine,
Citalopram
SUFFIX : -OXETINE
-PRAM
SerotoninNorepinephrine
Reuptake Inhibitors
(SNRIs):
Venlafaxine, Duloxetine,
Desvenlafaxine
SNRIs are antidepressants that
treat depression and mood
disorders by blocking the
reabsorption of serotonin and
norepinephrine, increasing their
levels in the brain
ANTIDEPRESSANTS
Indications
Major Depressive Disorder (MDD)
Generalized Anxiety Disorder (GAD)
Panic Disorder
Obsessive-Compulsive Disorder (OCD)
Post-Traumatic Stress Disorder (PTSD)
Social Anxiety Disorder
Premenstrual Dysphoric Disorder (PMDD)
Amitriptyline,
Nortriptyline
prescribed, even if symptoms improve
libido,
delayed
ejaculation,
anorgasmia)
consulting their healthcare provider
Dry mouth
Encourage taking the medication at the same time daily
Dizziness, Headache
Nausea, Constipation
Same as above
Generalized Anxiety Disorder (GAD)
Dizziness
Social Anxiety Disorder
Dry mouth
Panic Disorder
Insomnia
Chronic pain conditions (fibromyalgia,
Increased sweating
neuropathic pain)
Sexual dysfunction
Serotonin syndrome
Serotonin syndrome is a potentially life-threatening
condition caused by excessive serotonin activity in the
central nervous system, often due to the overdose or
interaction of medications that increase serotonin levels,
such as SSRIs, SNRIs, and MAOIs
Orthostatic hypotension
Major Depressive Disorder (MDD)
dopamine. TCAs also block
acetylcholine
and
histamine
Insomnia
Chronic pain conditions
Obsessive-Compulsive Disorder (OCD)
receptors, which can contribute
to their side effects
levels
of
serotonin,
norepinephrine, and dopamine
in the brain. This helps improve
mood and alleviate symptoms of
depression
Advise patients not to abruptly stop the medication without
Major Depressive Disorder (MDD)
Anxiety disorders
Monoamine Oxidase
Inhibitors (MAOIs) the
@NursingPrints
Explain the importance of taking the medication as
Sexual dysfunction (decreased
Avoid use with MAOIs due to serotonin syndrome risk
reabsorption of serotonin and
norepinephrine,
but
not
MAOIs inhibit the monoamine
oxidase enzyme, which increases
Phenelzine,
Tranylcypromine,
Isocarboxazid,
Selegiline (transdermal
patch)
Monitor mood, behavior, and signs of suicidal ideation
Insomnia or drowsiness
Monitor mood, behavior, and signs of suicidal ideation
Tachycardia
Dry mouth
Blurred vision
Constipation
Urinary retention
Anticholinergic
symptoms
SUFFIX : -TYLINE
-PRAMINE
Nausea
Hypertension
TCAs are a second choice after
SSRIs.
They
block
the
Nursing Considerations
Increased sweating
SUFFIX : -INE
Tricyclic
Antidepressants
(TCAs)
Side Effects
Drowsiness
Advise against abruptly stopping the medication without
consulting a healthcare provider
Assess for side effects, particularly cardiovascular effects
and anticholinergic symptoms.
Orthostatic hypotension
Used when patient does not respond to
Weight gain, Edema
Avoid foods high in tyramine (e.g., red wine, beer,
SSRI or TCA
Insomnia
avocado, chocolate, aged cheese)
Atypical depression
Sexual dysfunction
Parkinson's disease
Hypertensive
crisis
MAOIs taken with amphetamines or sympathomimetics
(when
may
increase
catecholamine
release
and
cause
a
taken with certain foods or
hypertensive crisis
medications)
Stop MAOIs 2 weeks before starting another antidepressant
Dizziness, Headache
26
Mental Health Drugs
ANTIPSYCHOTICS (NEUROLEPTICS)
Antipsychotics, also known as neuroleptics, are medications used to manage psychosis, including delusions,
hallucinations, and disorganized thinking. While they are effective in controlling symptoms, they are not curative and
are commonly used in conditions such as schizophrenia and mania
Class
Mechanism of Action
Indications
Typical (FirstGeneration)
Antipsychotics
Typical antipsychotics primarily
block dopamine receptors in the
brain,
reducing
psychotic
symptoms but potentially causing
motor side effects (Extrapyramidal
Symptoms
(EPS),
Neuroleptic
Malignant Syndrome (NMS))
Treatment of positive symptoms of
Extrapyramidal
symptoms
schizophrenia (think "Haloperidol"
(EPS):
akathisia,
for
parkinsonism
PHENOTHIAZINES
Trifluoperazine,
Perphenazine,
Acetophenazine ....
BUTYROPHENONES
Side Effects
"Hallucinations"—both
start
with "Hal")
Acute psychosis
Acute mania
Haloperidol
Certain
Thiothixene,
Chlorprothixene
personality
disorders
(borderline personality disorder)
DIBENZOXAZEPINES
Short-term management of severe
Loxapine
agitation
DIHYDROINDOLES
dystonia,
depression and alcohol withdrawal syndrome
Should not be used in dementia-related psychosis
Monitor ECG due to the risk of QT prolongation
malignant
Monitor for EPS and tardive dyskinesia
syndrome (NMS)
Do not administer haloperidol via IV
Sedation
Monitor for signs of Neuroleptic Malignant Syndrome
Orthostatic hypotension
(NMS), a rare but life-threatening condition
Weight gain
Delusional disorder
THIOXANTHENES
Contraindicated in Parkinson’s disease, bone marrow
Neuroleptic
Schizoaffective disorders
Nursing Considerations
Hyperprolactinemia
Anticholinergic effects
Higher risk of
neurological side effects
Key Signs of (Neuroleptic Malignant Syndrome (NMS)
Hight Fever and Diaphoresis
Muscle rigidity
Change in mental status
Tremors
“Dantrolene” is used as an antidote for
Neuroleptic Malignant Syndrome (NMS)
Molindone
Weight gain
Atypical (SecondGeneration)
Antipsychotics
Risperidone,
Olanzapine, Quetiapine,
Aripiprazole, Clozapine
Atypical
antipsychotics
block
dopamine, serotonin, Ach, and
alpha-adrenergic
receptors,
reducing psychotic symptoms with
a lower risk of EPS compared to
typical antipsychotics
Treatment
of
both
positive
symptoms and negative symptoms
of schizophrenia
Diabetes
Dyslipidemia
Lower risk of neurological side effects like EPS and
NMS, but higher risk of metabolic side effects
Hyperprolactinemia
Regularly monitor weight, blood glucose levels, and
Extrapyramidal symptoms (EPS)
lipid profile due to the risk of metabolic syndrome
Treatment-resistant schizophrenia
Tardive dyskinesia
(weight gain, diabetes, dyslipidemia)
Schizoaffective disorders
Sedation
Acute psychosis
Anticholinergic effects
Delusional disorder
Orthostatic hypotension
Perform regular blood tests to monitor white blood cell
Decreased libido
count, especially if the patient is on clozapine
Increased risk of infection with
Continue to monitor for EPS and NMS, even though the
Manic episodes
clozapine
Monitor blood pressure regularly
risk is lower than with first-generation antipsychotics.
Higher risk of metabolic
side effects
@NursingPrints
27
MOOD STABILIZERS
Mental Health Drugs
Mood stabilizers are a class of medications used primarily to treat mood disorders, particularly bipolar disorder, where
they help to stabilize mood swings between mania and depression
Class
LITHIUM
Mechanism of Action
Indications
Side Effects
Nursing Considerations
Contraindicated in pregnancy (teratogenic).
Not fully understood, but it
Bipolar disorder (particularly for
Lethargy
affects sodium transport in
nerve and muscle cells and may
stabilize neurotransmitter levels
controlling mania and preventing
Tremor
Ensure adequate fluid intake to prevent dehydration.
mood swings)
Weight gain
Monitor blood lithium levels every 2 months.
Monitor kidney and thyroid function regularly.
Hypothyroidism
Signs of lithium toxicity
Polyuria
Potential lithium toxicity
nausea
vomiting
diarrhea
ataxia
Therapeutic level: 0.6 - 1.2 meq/L
ANTICONVULSANTS
CARBAMAZEPINE
CARBAMAZEPINE
Stabilizes nerve activity by
blocking
sodium
channels,
reducing seizures and mood
swings
VALPROIC ACID
LAMOTRIGINE
Also known as antiepileptic
drugs,
anticonvulsants
were initially developed to
treat epilepsy and seizures.
CARBAMAZEPINE
CARBAMAZEPINE
Bipolar disorder
Epilepsy
(for
partial
and
Agranulocytosis (infection risk)
Dizziness, Drowsiness, Nausea
Monitor electrolyte levels, especially sodium, to
generalized seizures)
Hyponatremia
Trigeminal neuralgia
Skin
reactions
detect and manage hyponatremia
(including
Stevens-Johnson Syndrome)
VALPROIC ACID
Increases levels of gammaaminobutyric acid (GABA), an
inhibitory neurotransmitter, which
helps to stabilize mood and
prevent seizures
VALPROIC ACID
Bipolar disorder (manic episodes)
Epilepsy (for treating various
types of seizures)
Migraine prevention
VALPROIC ACID
@NursingPrints
LAMOTRIGINE
Stabilizes mood and prevents
seizures by inhibiting sodium
channels, which reduces the
release
of
excitatory
neurotransmitters like glutamate
types of seizures)
Monitor for signs of infection
VALPROIC ACID
Weight gain
signs of pancreatitis
Tremor
Check blood levels of valproic acid to ensure they
Hair loss
LAMOTRIGINE
Epilepsy (for treating various
contraceptives (advise using alternative methods)
Regularly monitor liver function tests and watch for
Liver toxicity, Pancreatitis
Bipolar disorder (manic episodes)
Carbamazepine can decrease the efficacy of oral
Nausea
Teratogenic effects
They were later found to
be effective as mood
stabilizers in managing
bipolar disorder symptoms
CARBAMAZEPINE
Regularly check complete blood counts (CBC)
LAMOTRIGINE
remain within the therapeutic range
Avoid use during pregnancy due to teratogenic effects
Therapeutic level: 50 - 100 mcg / ml
LAMOTRIGINE
Aseptic meningitis
Educate patients to report any rash immediately, as
Rash
Lamotrigine can cause serious skin reactions, including
Dizziness, Headache, Nausea
Stevens-Johnson Syndrome
Blurred vision
Avoid abrupt discontinuation of the medication to
Insomnia
prevent withdrawal seizures or mood destabilization
28
ADHD MEDICATIONS
Mental Health Drugs
ADHD (Attention Deficit Hyperactivity Disorder) is a neurodevelopmental disorder characterized by persistent
patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development.
Treatment for ADHD includes education, support, behavioral therapy (such as coping mechanisms), stimulant
medications, and non-stimulant medications.
Class
STIMULANTS
AMPHETAMINE /
DEXTROAMPHETAMINE
Mechanism of Action
Indications
increases the release of dopamine
and norepinephrine in the brain
and blocks their reuptake,
leading to improved attention,
focus, and control over impulsive
behaviors
Primarily used to treat ADHD
Insomnia
Also prescribed for narcolepsy
Decreased appetite, weight loss
Side Effects
Nursing Considerations
Regularly check height and weight to ensure normal
Hypertension, Tachycardia
development in children
Monitor blood pressure and heart rate consistently.
Watch for signs of misuse or dependence
Anxiety and nervousness
Contraindicated
Risk of dependence
patients taking certain medications
in
glaucoma,
hypertension,
and
Methylphenidate is primarily used in children and is
less effective in adults
METHYLPHENIDATE
SNRIs
Increase norepinephrine levels in
the brain by inhibiting its
reuptake, improving attention
and impulse control
ALPHA-2 ADRENERGIC
AGONISTS
to
Nausea
Regularly monitor mood and behavior
for
Fatigue
Explain the importance of taking the medication as
patients who cannot tolerate
Decreased appetite
prescribed, even if symptoms improve
stimulants
Sleep disturbances
Used
as
stimulants,
an
alternative
particularly
or
have
Increased blood pressure and
heart rate
ALPHA-2 ADRENERGIC
AGONISTS
Stimulate alpha-2 adrenergic
receptors in the brain, helping to
reduce hyperactivity and improve
focus
SNRIs
SNRIs
contraindications to their use
NON-STIMULANTS
Selective Norepinephrine
Reuptake Inhibitors
(SNRIs)
SNRIs
ALPHA-2 ADRENERGIC
AGONISTS
ALPHA-2 ADRENERGIC
AGONISTS
Same as above
Drowsiness
Advise patients not to abruptly stop the medication
Encourage taking the medication at the same time
daily
Avoid use with MAOIs due to serotonin syndrome risk
ALPHA-2 ADRENERGIC AGONISTS
Monitor blood pressure and heart rate regularly
Educate patients on the potential for drowsiness and
Fatigue
advise caution when performing activities requiring
Low blood pressure
alertness
Dry mouth
Advise patients not to abruptly stop the medication
Constipation
@NursingPrints
29
NEURO MEDS
AUTONOMIC NERVOUS SYSTEM MEDICATIONS
Autonomic Nervous System (ANS) drugs affect involuntary functions controlled by the ANS, such as heart rate, digestion,
respiratory rate, and blood pressure. These drugs are categorized based on their effects on the SYMPATHETIC and
PARASYMPATHETIC nervous systems, either by inhibiting or enhancing the action of ACETYLCHOLINE."
Sympathetic Nervous Systems (SNS)
VS
FIGHT OR FLIGHT
Prepares the body for "fight or
flight" responses during stressful
situations (Survival Mode).
Promotes "rest and digest" activities,
conserving energy and maintaining daily bodily
functions
Heart: Increases heart rate and contraction force
Neurotransmitter
Lungs: Dilates bronchioles for more airflow
Eyes: Dilates pupils for better vision
NOREPINEPHRINE
Digestive Tract: Slows digestion, reduces saliva
and
Blood Vessels: Constricts to raise blood pressure
EPINEPHRINE
Bladder: Relaxes, reducing urination urge
Adrenal Glands: Releases adrenaline and noradrenaline
Class
Mechanism of Action
CHOLINERGICS
Mimic the action of acetylcholine
by stimulating muscarinic and
nicotinic receptors, enhancing
parasympathetic nervous system
activity
(Parasympathomimetics)
Acetylcholine, Carbachol,
Bethanechol, Pilocarpine
PNS :
Parasympathetic Nervous Systems (PNS)
Indications
Memory Enhancement
Heart: Decreases heart rate
Lungs: Constricts bronchioles, reducing airflow at rest Neurotransmitter
Eyes: Constricts pupils (miosis) for better near vision
Digestive Tract: Stimulates digestion, increases
ACETYLCHOLINE
peristalsis, and saliva production
Bladder: Contracts bladder, promoting urination
Muscle Tone: Improves muscle tone
Glaucoma
Bradycardia
Urinary retention
Hypotension
Myasthenia gravis
Diarrhea
Alzheimer's disease management
Abdominal cramps
REST and DIGEST
Monitor heart rate and blood pressure for signs of
bradycardia and hypotension.
Use with caution in patients with asthma or chronic
obstructive pulmonary disease (COPD) due to risk of
excessive salivation and bronchoconstriction
Bronchoconstriction
Be
Increased salivation and sweating
medications that affect the cholinergic system (Beta-
SNS :
ANTICHOLINERGICS
(Parasympatholytics)
Atropine, Scopolamine,
Ipratropium, Oxybutynin
SNS :
Bradycardia
Motion sickness and vertigo
COPD
Parkinson's disease
FIGHT
FLIGHT
OR
Overactive bladder
Reduction of saliva and mucus
production during surgery
@NursingPrints
aware
of
potential
interactions
with
other
blockers, Antihistamines, TCAs ...)
Inhibit
the
parasympathetic
nervous system by blocking
acetylcholine receptors
PNS :
Nursing Considerations
Side Effects
Monitor for signs of anticholinergic toxicity, especially
Dry mouth
Blurred vision
Constipation
in elderly patients
Anticholinergic
symptoms
Encourage patients to stay hydrated and consume
high-fiber foods to manage side effects
Urinary retention
Use with caution in patients with glaucoma, urinary
Tachycardia
retention, or prostate enlargement
Contraindicated in hemorrage and myasthenia gravis
30
NEURO MEDS
AUTONOMIC NERVOUS SYSTEM MEDICATIONS
Class
Mechanism of Action
ADRENERGICS
Mimic
the
effects
of
the
sympathetic nervous system by
stimulating adrenergic receptors
(alpha and beta receptors)
Catecholamines
(Sympathomimetics)
Catecholamines
Epinephrine,
Norepinephrine,
Dopamine
Non-Catecholamines
Phenylephrine, Clonidine,
Albuterol, Terbutaline ...
Indications
Side Effects
Nursing Considerations
Cardiac arrest
Hypertension
Regularly check blood pressure, heart rate, and
Acute asthma attack
Tachycardia
respiratory status
Anaphylaxis
Tremors
Be alert for signs of excessive adrenergic effects, such
Severe hypotension
Anxiety
as palpitations or severe hypertension
Use with Caution in patients with cardiovascular
Non-Catecholamines
diseases, as these drugs can exacerbate conditions
Non-catecholamine
adrenergics
can either directly stimulate
adrenergic receptors (alpha or
beta) or increase the release of
endogenous catecholamines
like arrhythmias and angina
FIGHT
PNS :
FLIGHT
OR
SNS :
Alpha-blockers
ANTIADRENERGICS
Inhibit alpha-adrenergic receptors,
leading to vasodilation and
reduced
blood
pressure
by
relaxing the blood vessels
(Sympatholytics)
Alpha-blockers
Prazosin, Terazosin ...
Beta-blockers
Propranolol, Atenolol ...
Alpha-2 agonists
Clonidine, Methyldopa ...
Beta-blockers
Block beta-adrenergic receptors,
reducing heart rate, myocardial
contractility, and blood pressure,
while also decreasing oxygen
demand
Alpha-2 agonists
Hypertension
Bradycardia
Regularly monitor blood pressure and heart rate
Anxiety disorders
Hypotension
Assess for signs of depression or mood changes, as
Glaucoma
Dizziness
these drugs can exacerbate depressive symptoms
Migraine prophylaxis
Fatigue
Benign prostatic hyperplasia
Depression
Certain arrhythmias
Sexual dysfunction
Heart failure (in certain cases)
Cold extremities
Bronchoconstriction (especially in
Monitor respiratory status in patients with asthma or
COPD
Do not abruptly stop the medication, as this can lead
to rebound hypertension
asthma or COPD patients)
Nasal congestion
Stimulate
alpha-2
adrenergic
receptors in the brain, decreasing
the release of norepinephrine,
which reduces sympathetic activity
PNS :
REST and DIGEST
SNS :
@NursingPrints
31
NEURO MEDS
ANTICONVULSANTS (ANTIEPILEPTICS)
Anticonvulsants are medications used to prevent and control seizures by stabilizing abnormal electrical activity in the
brain. They are also effective in managing certain psychiatric conditions, such as bipolar disorder
Class
BARBITURATES
SUFFIX : -BARBITAL
Pentobarbital, Secobarbital,
Phenobarbital ...
BENZODIAZEPINES
SUFFIX : -ZEPAM
-ZOLAM
Mechanism of Action
Indications
Stimulates
the
gammaaminobutyric
acid
(GABA)
neurotransmitter,
leading
to
increased chloride influx and
hyperpolarization of neurons,
which
reduces
neuronal
excitability and prevents seizures
Generalized tonic-clonic and
Drowsiness
Monitor Respiratory Status due to the risk of
partial seizures
Respiratory depression (can be fatal)
respiratory depression
Status epilepticus
Dependence and tolerance
Be aware of the potential for addiction and
Sedative for surgery
Hypotension
withdrawal symptoms
Enhance GABA activity, leading to
increased chloride ion influx and
hyperpolarization of neurons,
which
reduces
neuronal
excitability
Anxiety disorders
Avoid abrupt discontinuation of the medication
Insomnia
Contraindicated in liver or kidney disease
Seizure disorders
Insomnia
Muscle spasms
Alcohol withdrawal syndrome
Sedation
Diazepam, Clonazepam,
Lorazepam ...
Nursing Considerations
Side Effects
for
medical
procedures
Drowsiness and sedation
Use with opioids can be fatal, causing profound
Respiratory depression
sedation, respiratory depression, and death
Dependence
Monitor for dependence and withdrawal
Impaired coordination and cognitive
Use caution in patients with substance abuse history
function
Avoid abrupt discontinuation of the medication
Hypotension (in high doses or when
Monitor
combined
especially with high doses or other CNS depressants
with
other
CNS
respiratory
and
cardiovascular
status,
Educate patients on drowsiness and advise against
depressants)
operating heavy machinery or driving
SUCCINIMIDES
SUFFIX : -SUXIMIDE
Ethosuximide
Methsuximide
HYDANTOINS
(PHENYTOIN)
SUFFIX : -TOIN
Phenytoin, Ethotoin,
Fosphenytoin ...
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Primarily used to treat absence
seizures, a type of seizure
characterized by brief, sudden
lapses in attention. They work by
reducing calcium influx in neurons,
which
decreases
abnormal
electrical activity in the brain
Stabilizes neuronal membranes by
reducing sodium influx, blocking
voltage-gated sodium channels to
decrease excitability and prevent
seizure activity
Succinimides
are
especially
Gastrointestinal Upset
Regularly monitor liver and kidney function tests
effective
in
treating
absence
Drowsiness
Periodically check blood levels to ensure they are
seizures
(petit
seizures),
Dizziness
within the therapeutic range (40 - 100 mcg/mL)
which are more common in
Rash (rare)
Monitor for signs of rash, fever, or other symptoms
children
Can cause sedation or fatigue
indicating an allergic reaction
mal
Avoid abrupt discontinuation of the medication
Generalized tonic-clonic (grand
Gingival hyperplasia
Regularly monitor serum phenytoin levels to maintain a
mal) seizures
Nystagmus
therapeutic range of 10-20 mcg/mL
complex partial seizures
Ataxia
Prevention of seizures following
Confusion
neurosurgery
Hypotension
Monitor liver function tests and complete blood counts
SIGNS OF
TOXICITY
periodically
Avoid
abrupt
discontinuation
to
prevent
rebound
seizures
Rash (Stevens-Johnson syndrome)
Educate patients to take phenytoin at the same time each
Hepatotoxicity
day, preferably with food
32
NEURO MEDS
ANTICONVULSANTS (ANTIEPILEPTICS)
Class
Mechanism of Action
VALPROATES
Valproates are anticonvulsants
used for seizure disorders,
bipolar disorder, and migraine
prevention.
(VALPROIC ACID)
SUFFIX : -VALPROATE
-VALPROIC
Valproic acid
Divalproex sodium
Valproate sodium ...
CARBAMAZEPINE
They
increase
gammaaminobutyric acid (GABA) levels
in the brain to stabilize neuronal
activity and prevent seizures
Indications
Epilepsy
seizure
Nausea and vomiting
Oxcarbazepine
stabilizes
neuronal membranes by blocking
voltage-gated sodium channels. It
is similar to carbamazepine but
generally has fewer side effects
and drug interactions
Regularly monitor liver function tests and watch for
Tremor
signs of pancreatitis
Bipolar disorder (mania)
Weight gain
Check blood levels of valproic acid to ensure they
Migraine prevention
Hair loss
remain within the therapeutic range
Liver toxicity
Avoid use during pregnancy due to teratogenic
Pancreatitis
effects
Teratogenic effects (risk of birth
defects)
Carbamazepine
stabilizes
neuronal membranes by reducing
sodium influx through voltagegated channels, which decreases
neuronal excitability.
Nursing Considerations
disorders
Epilepsy:
For
partial
and
generalized seizures
Bipolar Disorder: For mood
stabilization
Trigeminal
OXCARBAZEPINE
and
Side Effects
Drowsiness
Regularly check complete blood counts (CBC)
Dizziness
Monitor electrolyte levels, especially sodium, to
Nausea
detect and manage hyponatremia
Rash
Hyponatremia
Neuralgia:
For
Therapeutic level: 50 - 100 mcg / ml
Liver enzyme abnormalities
Carbamazepine can decrease the efficacy of oral
contraceptives (advise using alternative methods)
Monitor for signs of infection
nerve pain
Agranulocytosis (infection risk)
Partial seizures
Drowsiness
Monitor serum sodium levels for hyponatremia
Generalized seizures
Dizziness
Watch for skin reactions
Headache
Regular liver function tests are less critical compared
Nausea
Rash
Therapeutic range: 4 - 12 mcg / mL
to carbamazepine
Therapeutic range: 12 - 30 mcg / mL
Hyponatremia
LAMOTRIGINE
Stabilizes mood and prevents
seizures by inhibiting sodium
channels, which reduces the
release
of
excitatory
neurotransmitters like glutamate
Bipolar
disorder
(manic
episodes)
Epilepsy (for treating various
types of seizures)
Aseptic meningitis
Monitor for signs of rash, especially during the first
Rash (can progress to Stevens-
few weeks of treatment
Johnson Syndrome)
Avoid abrupt discontinuation to prevent rebound
Dizziness, Headache, Nausea
seizures or mood instability
Blurred vision
Insomnia
Educate patients about the importance of gradual
dose escalation to minimize the risk of severe skin
reactions
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33
NEURO MEDS
ANTIPARKINSONIAN DRUGS
Antiparkinsonian drugs are medications used to manage symptoms of Parkinson's disease, a neurodegenerative
disorder characterized by tremors, rigidity, bradykinesia, and change in posture. In Parkinson's disease, the
neurotransmitter imbalance is characterized by too little Dopamine
and too much Acetylcholine
Antiparkinsonian drugs aim to relieve symptoms and restore mobility by either inhibiting acetylcholine or
enhancing dopamine
Class
(Parasympatholytics)
Benztropine,
Trihexyphenidyl
Indications
Anticholinergics
inhibit
the
effects of acetylcholine in the
central nervous system to
control tremors in Parkinson's
disease but have minimal
effects on bradykinesia, rigidity,
and balance abnormalities
Tremor-dominant Parkinson's
disease
Blurred vision
Bradycardia
Motion sickness and vertigo
Constipation
Urinary retention
COPD
Overactive bladder
mucus
Monitor for signs of anticholinergic toxicity,
Dry mouth
Reduction
of
saliva
production
and
during
especially in elderly patients
Encourage patients to stay hydrated and consume
high-fiber foods to manage side effects
Use with caution in patients with glaucoma,
Tachycardia
urinary retention, or prostate enlargement
Confusion
Contraindicated in hemorrage and myasthenia
Memory
loss,
concentrating,
surgery
Nursing Considerations
Side Effects
Anticholinergic
symptoms
ANTICHOLINERGICS
Mechanism of Action
and
difficulty
particularly
gravis
in
older adults
DOPAMINERGICs
Levodopa
Dopamine Agonists
COMT Inhibitors
MAO-B Inhibitors
Dopaminergics are a class of
medications used to treat
Parkinson's
disease
by
increasing dopamine levels or
mimicking dopamine effects in
the brain
Parkinson's Excessive dopamine = uncontrolled
movements
disease to manage motor
Monitor for dyskinesia and adjust dosage as
symptoms
Dyskinesia (involuntary movements)
Avoid use in patients taking MAO inhibitors,
Muscle twitching
SSRIs, or TCAs
Insomnia
Monitor
mood changing
tendencies
Orthostatic hypotension
Contraindicated in patients with cardiac, kidney,
Treatment
for
needed
for
mood
changes
and
suicidal
or liver disease
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34
RESPIRATORY MEDS
ANTI-INFLAMMATORY DRUGS
Respiratory anti-inflammatory drugs reduce airway inflammation, which helps decrease narrowing, mucus production,
and hyper-responsiveness. They are used to manage conditions such as asthma, COPD, and allergic reactions
Class
CORTICOSTEROIDS
SUFFIX : -SONE &
-SONIDE & -OLONE
Beclomethasone,
Budesonide, Fluticasone,
Prednisolone,
Methylprednisolone
LEUKOTRIENE
MODIFIERS
SUFFIX : -LUKAST
Montelukast,
Zafirlukast
MAST CELL
STABILIZERS
Cromolyn sodium,
Nedocromil sodium
Mechanism of Action
Corticosteroids
are
antiinflammatory medications used
to reduce inflammation in the
airways, decreasing swelling
and mucus production, thereby
improving breathing
Leukotriene Modifiers work by
either blocking the leukotriene
receptors or inhibiting the
enzyme
responsible
for
leukotriene
production.
This
action helps reduce inflammation,
bronchoconstriction,
mucus
production, and airway edema
Stabilize mast cells, preventing
them from releasing histamine
and
other
mediators
that
contribute to inflammation and
bronchoconstriction
Indications
Long-term
management
Side Effects
of
Asthma and COPD
Allergic
reactions
and
inflammatory conditions
Hoarseness of voice
Instruct patients to rinse mouth after inhalation to
Osteoporosis
prevent oral thrush
Hyperglycemia
Monitor blood glucose, especially in diabetics
Weight gain
Increased risk of infections
Asthma
Allergic rhinitis
Nursing Considerations
Encourage calcium and vitamin D intake to prevent
osteoporosis
Watch for signs of infection and advise against
Oral candidiasis (thrush) when
abrupt discontinuation
inhaled
Watch for signs of Cushing's syndrome with long-
Allergic reactions
term use
Headache
Regularly perform liver function tests, especially in
Nausea
patients with pre-existing liver conditions
Abdominal pain
Assess for neuropsychiatric symptoms
Liver enzyme elevation (rare)
Leukotriene Modifiers are not for acute asthma
Neuropsychiatric effects (such
attacks but are intended for long-term management
as mood changes, agitation, or
Contraindicated in patients with active infections
sleep disturbances)
Long-term
management
of
asthma
Throat irritation
Prevention of exercise-induced
bronchospasm
Allergic
Cough
rhinitis
Unpleasant taste in the mouth
Mast Cell Stabilizers are for long-term control, not
immediate relief
Ensure proper inhaler or nebulizer use
Monitor for signs of hypersensitivity or worsening
asthma symptoms
and
Advise regular use, even when symptom-free
conjunctivitis
@NursingPrints
35
RESPIRATORY MEDS
BRONCHODILATORS
Bronchodilators are medications that relax and widen the airways (bronchi) in the lungs, making it easier to breathe.
They are commonly used to treat respiratory conditions like Asthma and COPD.
By reducing bronchospasm, these drugs help alleviate symptoms such as wheezing, shortness of breath, and chest tightness.
Class
BETA-2
ADRENERGIC
AGONISTS
SUFFIX : - TEROL
Albuterol, Salmeterol,
Formoterol
Indications
Mechanism of Action
Stimulates beta-2 adrenergic
receptors in the lungs, leading to
relaxation of bronchial smooth
muscle and bronchodilation
MEMORY TRICK
Side Effects
Nursing Considerations
Asthma
Tremors
Monitor Respiratory Status ()
COPD
Tachycardia
Monitor heart rate and blood pressure
Bronchospasm
Palpitations
Educate patients on proper inhaler technique
Caution in patients with cardiovascular disease
Nervousness
We have one heart and two lungs:
Beta-1 affects the heart (1 heart)
Beta-2 affects the lungs (2 lungs)
Dry mouth
Asthma
Educate patients on the correct use of inhalers
Blurred vision
Monitor for signs of anticholinergic side effects
COPD
Constipation
Use with caution in patients with glaucoma, urinary
Bronchospasm
Urinary retention
retention, or prostate enlargement
Tachycardia, Palpitations
Contraindicated in hemorrage and myasthenia gravis
SUFFIX : - TROPIUM
Tremors
Monitor for signs of anticholinergic toxicity, especially
Ipratropium, Tiotropium
Confusion
in elderly patients
ANTICHOLINERGICs
(Muscarinic
Antagonists)
METHYLXANTHINES
SUFFIX : - PHYLLINE
Theophylline,
Aminophylline
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Block the action of acetylcholine
on muscarinic receptors in the
airways,
leading
to
bronchodilation
Relax bronchial smooth muscle
and reduce airway reactivity,
likely through inhibition of
phosphodiesterase, leading to
increased cyclic AMP
COPD
Nausea
Asthma (less commonly used
Vomiting
due
Nervousness
to
side
effects
and
Monitor serum drug levels (narrow therapeutic
index)
SIGNS OF TOXICITY
Educate patients about avoiding caffeine
narrow therapeutic range)
Arrhythmias
Monitor for signs of toxicity
Bronchospasm
Seizures
Therapeutic range 10 to 20 mcg/mL
Insomnia
36
RESPIRATORY MEDS
SECRETION & COUGH MEDICATIONS
Expectorants: Loosen and clear mucus from the airways
Mucolytics: Break down and thin mucus to make it easier to expel
Decongestants: Reduce nasal congestion by constricting blood vessels in the nasal passages
Antitussives: Suppress the cough reflex
Class
EXPECTORANTS
Guaifenesin
MUCOLYTICS
N-acetylcysteine (NAC)
Indications
Mechanism of Action
Nursing Considerations
Side Effects
Expectorants are medications
that help clear mucus from the
airways by stimulating mucus
production, which thins and
loosens mucus, making it easier
to expel
Chronic bronchitis
Mucolytics break down and thin
mucus in the airways, making it
easier to clear by reducing
mucus
viscosity
through
breaking disulfide bonds in
mucus proteins
Chronic bronchitis
Nausea
Monitor for allergic reactions such as rash or
Cystic fibrosis
Vomiting
swelling
COPD
Diarrhea
Ensure adequate hydration to aid mucus clearance
Other respiratory conditions
Rash
Use with caution in asthma or bronchospasm
with thick, tenacious mucus
Irritation of the airways
COPD
Encourage adequate fluid intake to enhance
Gastrointestinalup set
medication effectiveness
Drowsiness
Flu with productive cough
Other respiratory conditions
Promote coughing and deep breathing exercises
Rash
Observe for signs of allergic reactions, such as rash
Headache
or swelling
with excessive mucus
Hypertension
DECONGESTANTS
Pseudoephedrine,
Phenylephrine
Oxymetazoline,
Xylometazoline
Medications that relieve nasal
congestion by reducing swelling
and inflammation in the nasal
passages
Avoid prolonged use of topical decongestants to
Nasal congestion due to colds
Insomnia
Allergic rhinitis
Nervousness
Sinusitis
Dizziness
prevent rebound congestion
Monitor blood pressure and heart rate with
systemic decongestants
Dry mouth
Rebound
congestion
with
prolonged use (Topical)
Opioid Antitussives
ANTITUSSIVES
Opioid Antitussives
codeine, hydrocodone ...
Non-Opioid Antitussives
Dextromethorphan
@NursingPrints
Act on the central nervous system
to suppress the cough reflex
Non-Opioid Antitussives
Act on the cough center in the
medulla to suppress coughing
without the sedation or addiction
risks of opioids
Opioid Antitussives
Persistent,
non-productive
Drowsiness
coughs
Constipation
Cough associated with colds and
Nausea
flu
Respiratory depression
Non-Opioid Antitussives
Cough due to irritation of the
Drowsiness
throat
Dizziness
Advise patients to stay hydrated to help alleviate
dryness
Monitor for signs of dependency and abuse (Opioid)
Watch for drowsiness and advise patients against
operating heavy machinery if affected
Avoid combining with other central nervous system
Educate patients on proper dosing and potential side
effects
Gastrointestinal disturbances
37
TERMINOLOGY AND ABBREVIATIONS
DOSAGE CALCs
TERMS & TERMINOLOGY
abbreviations
PO
Routes
Times
by mouth
Ac
before meals
IM
intramuscular
Pc
after meals
IV
Intravenous
Daily
every day
IO
Intraosseous
Bid
IVP
Intravenous Push
Tid
twice a day
three times a day
IN
Intranasal
Qid
IP
Intraperitoneal
four times a day
Gh
every hour
SC/SubQ Subcutaneous
Ad Lib
as desired
SL
Sublingual
Stat
immediately
NG
nasogastric
Hs
at bedtime
GT
gastrostomy tube
Prn
as needed
Drug Preparation
Tab
tablet
Cap
capsule
Elix
elixir
Sup
suppository
Susp
suspension
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Household / Apothecary
Gtt
drop
Tsp
teaspoon
Tbsp
Tablespoon
Pt
pint
Gal
gallon
Dr
dram
Oz
ounce
Dose :
amount of drug per unit
time given to the patient
expressed as mg/min, g/hr
,Unit/min ...
Concentration :
amount of the drug in a
given
volume
usually
expressed as mg/ml, g/l ...
Drop Factor :
is the number of drops per
unit volume Expressed as
drops/mL ( gtts/mL ).
Milliequivalent (mEq) :
The number of grams of a
medication contained in 1
milligram of a solution
Conversion Factor :
a multiplier used to convert
between different units of
measurement.
Flow Rate :
is the volume per unit time
usually expressed as ml/hr,
ml/min or ml/sec.
Drip Rate :
is the number of drops per
unit time usually expressed
as drops/min.
Titration :
adjustment
of
the
IV
medication dosage within
prescribed
parameters
to
achieve a desired effects.
BANNED
ABBREVIATIONS
μ
T.I.W
U
write microgram(mcg) instead
write 3 times weekly instead
write unit instead
IU
write International unit instead
QD
write daily instead
D/C
write discharge or discontinue
38
DOSAGE CALCs
Conversion
Factors
8 oz = 1 cup
1 mL = 15 gtts
1 cc = 1 mL
1 oz = 30 mL = 2 tbsp
1 tbsp = 15 mL
1 tbsp = 3 tsp
1 tsp = 5 mL
1 dram = 5 mL
1 gallon = 4 quart
1 kg = 2.2 lb
1 lb = 16 oz
1 inch = 2.54 cm
12 inches = 1 foot
1 pint = 2 cups
2 pints = 1qt
60 mg = 1 Grain (gr)
@NursingPrints
CONVERSIONS
systems of measurement
There are three different types of measurements you will encounter when dealing with
medications: Household, Apothecary and Metric.
Type
Solids
Liquids
Metric
Grams (g)
Meters (m)
Liters (L)
Apothecary
Grains (gr)
Drams (dr)
Minum (m)
Fluid Dram (dr)
Household
Teaspoons (tsp)
Tablespoons (Tbsp)
Pounds (lb)
Drop (gtt)
Ounce (oz)
Cup (c)
Pint (pt)
Quart (qt)
CONVERSIONS (Between Metric Units)
Mass:
mcg → mg → g → kg ( ÷ by 1000 )
mcg ← mg ← g ← kg ( x by 1000 )
lb → kg ( ÷ by 2.2 )
lb ← kg ( x by 2.2 )
Volume:
mcL → mL → L → kL ( ÷ by 1000 )
mcL ← mL ← L ← kL ( x by 1000 )
Time:
min → hr ( ÷ by 60 )
min ← hr ( x by 60 )
39
METHODS FOR DRUG DOSAGE CALCULATIONS
DOSAGE CALCs
Various methods are used for solving medication calculation, the most common methods are : Desired Over Have or Formula
Method, Ratio and Proportion Method, Dosage by Weight Method
Dosage By Weight
Formula Method
DESIRED (D)
HAVE (H)
Symbol
This type of dosage calculation is commonly encountered in pediatric drug
administration.
x QUANTITY (Q) = Y (amount to administer)
Meaning
D
Dosage
dose
H
Dose on hand or dose, on the
label of bottle, vial, ampule.
250 milligrams
100 mg
Q
The unit of measure for the specific
dosage strength or supply on hand
(the form in which the drug comes)
per tablet
per capsule
in 2 mL ....
Y
ordered
or
Example
desired
Give 1.2 milliliters
The doctor orders 90 milligrams
To determine the appropriate dosage, body weight-based calculations
involve two main steps :
Step 1: Using the formula below, calculate the total required
dosage based on given the body weight.
Weight (kg) x Dosage Ordered (per kg) = Y (Required Dosage)
6 mg / 30 mL
D
Step 2: Apply the ( H x Q ) formula to calculate the actual
amount of medication to be administered.
The dosage you are trying to calculate
Ratio and Proportion Method
IV Flow Rate in gtts/min
Considered as the oldest method used in drug calculations.
Volume (mL)
Time (min)
The known
quantities
are on the
left side
©
HAVE (H)
QUANTITY (Q)
=
DESIRED (D)
Y
The desired dose
and the unknown
amount to
administer are on
the right side.
D = Desired dose or dose ordered by the primary care provider.
H = dose on hand or dose on the label of bottle, vial, ampule.
Q = the form in which the drug comes (i.e., tablet or liquid).
Y = amount to administer
@NursingPrints
x Drop Factor (gtts/mL) = Y (Flow Rate in gtts/min)
Note: Since a fraction of a drop is not possible to give to a patient, it is usual to
round the answers to the nearest whole number.
IV Flow Rate in mL/h
Volume (mL)
Time (h)
=
Y (Flow Rate in mL/h)
Note: If the question is asking for flow rate and you're given units of mL, you need to
write the answers in mL/h
40