Pharmacology revision about drugs needed for used to emergency and non emergency situation

1. Pharmacology

2. Cardiac Glycosides
• Example: digoxin (Lanoxin)
• Drug Effects on Cardiac Action
• Positive inotropic: drugs that increase the force of
contraction
• Negative inotropic: drugs that decrease the force of con-
traction
• Positive chronotropic: drugs that increase heart rate
• Negative chronotropic: drugs that decrease heart rate
• Positive dromotropic: drugs that increase the rate of
electrical conduction through the myocardium
• Negative dromotropic: drugs that decrease the rate of
electrical conduction through the myocardium

3. • Mechanisms of Action
• Positive inotropic effect: increases the force of
myocardial contraction
• Negative chronotropic effect: decreases the
heart rate
• Negative dromotropic: decreases the rate of
electrical conduction through the
atrioventricular node

4. • Common Uses
• Congestive heart failure
• Atrial fibrillation
• Atrial flutter
• Paroxysmal atrial tachycardia

5. Toxicity
 Gastrointestinal distress
• —Nausea
• —Vomiting
• —Anorexia
• —Diarrhea
 Neurological effects
• —Restlessness and confusion
• —Headache
• —Weakness
• —Lethargy
• —Blurred vision, double vision, and decreased visual acuity
• —Colored vision and halo visual changes
 Cardiac effects
• Bradycardia (heart rate <60) Atrioventricular block Extrasystole
(extra heart beats)

6. • Nursing Process Elements
• Be familiar with client’s baseline VS, electrolyte
levels, and general health
• Assess the following before administering
digoxin:
• —Check serum digoxin, potassium, magnesium,
and calcium levels
• —Take apical pulse for one full minute noting
rate, rhythm, and quality.
• —Assess for toxicity

7. • Withhold digoxin and notify physician if:
• —Pulse rate <60
• —Significant change in pulse rate or rhythm
• —S&S of digoxin toxicity
• —Serum potassium level is less than 4 mEq/l
• —Serum digoxin level > 2 ng/ml (therapeutic range =
• 0.8–2 ng/ml)
• Monitor client’s fluid intake and urinary output
• Monitor client’s weight, signs of edema, lung, and
heart sounds

8. • Assessment Alert
• Take apical pulse for one minute prior to
administering digoxin. Withhold digoxin and
call physician if heart rate is less than 60 bpm.

9. • Nursing Diagnoses
• Cardiac output: decreased
• Tissue perfusion: ineffective
• Knowledge deficit related to medications and
disease

10. • Client teaching for self-care
• Instruct how to count pulse
• Instruct to call physician if pulse < 60 or > 110
• Instruct to call physician if heart rhythm irregular
• Review S&S of toxicity and instruct to report
them to physician
• Weigh each day and report > 2 lb gain per day
• Take digoxin as prescribed at same time each day

11. ANTIARRHYTHMICS

12. Mechanisms of Action
• Varies depending on the antiarrhythmic class
used
• Decreases the automaticity of cardiac tissue
• Alters the rate of conduction of electrical
impulses
• Alters the refractory period

13. Common Uses
• Suppression of arrhythmias

14. Common Adverse Effects
• Differs among the different drugs

15. Monitoring Effects of Antiarrhythmics
• Nursing Process Elements
• Assess heart rate and rhythm and BP prior to
administration and throughout therapy
• Monitor ECG
• Monitor for adverse effects

16. Nursing Diagnoses
• Cardiac output is decreased
• Knowledge deficit related to medication and
disease

17. Client teaching for self-care
• Instruct in how to obtain pulse rate, and to
report changes in rate and rhythm to
physician
• Instruct to take doses round the clock and
what to do regarding missed doses and over-
the-counter medications
• Advise regarding importance of follow-up
appointments with health care provider

18. Assessment Alert
• Take BP and heart rate prior to administering
antiarrhythmic medications.

19. NITRATE VASODILATORS
• Example: nitroglycerin (Nitrocot)
• Mechanism of Action
• Relaxes smooth muscle
• Dilates venous and arterial blood vessels
• Reduces peripheral resistance
• Decreases venous return to the heart
• Reduces myocardial oxygen consumption
• Decreases BP
• Relieves and prevents angina (chest pain)

20. Common Uses
• Prophylaxis, treatment, and management of
angina pectoris (chest pain)
• Congestive heart failure

21. Common Adverse Effects
• Hypotension
• Headache
• Dizziness
• Syncope

22. Forms of Nitrate Vasodilators
• Sublingual tablet
• —Place tablet under tongue to dissolve within 5
minutes
• Extended-release buccal tablet
• —Place tablet between lip and gum or between cheek
and gum to dissolve over 3–5 hours
• Oral sustained-release tablet or capsule
• Translingual spray
• —Do not shake canister
• —Spray under tongue
• —Do not inhale spray

23. Transdermal ointment:
• —Use dose-determining applicator supplied
with ointment
• —Nurse should wear gloves
Transdermal Unit (patch)
• —Nurse should wear gloves
Parenteral (IV)

24. Monitoring Effects of Nitroglycerin
Nursing Process Elements
• Be familiar with clients baseline VS
• Obtain BP, heart rate prior to administering medication
• Check BP and heart rate after administration
(hypotension may occur)
• Assess chest pain using pain scale, and assess for
associated symptoms: dyspnea, shortness of breath,
jaw, arm, neck pain, nausea, and diaphoresis
• Assess for blurred vision, headache, and dry mouth
• Assess for topical reactions when using the ointment or
transdermal unit

25. Assessment Alert
• Take BP prior to and after administering nitro-
glycerin.

26. Nursing Diagnoses
• Pain: acute
• Tissue perfusion: ineffective
• Knowledge deficit related to medications and
disease

27. Client teaching for self-care
• Instruct that sublingual tablets may be taken
prophylactically 5–10 minutes prior to exercise or other
stimulus known to trigger angina.
• Remind them to keep record of number of angina attacks,
amount of medication taken, and precipitating factors.
• Instruct that contact with water (bathing, swimming) does
not affect transdermal unit.
• Inform that the sublingual form can be taken while trans-
dermal unit or ointment is in place.
• When chest pain occurs, take one nitroglycerine tablet as
prescribed; if chest discomfort is not relieved in 3 minutes,
call 911.

28. • Remind to report blurred vision, dry mouth,
faintness, dizziness, flushing, or increase in
frequency or severity of pain to physician.
• Explain to change positions slowly and avoid
prolonged standing (postural hypotension)
• Inform that SL tablets should be kept in their
original container and tablets need to be
replaced every 6 months to assure potency.

29. • Advise to take medication as directed, avoid
alcohol, and not to take over-the-counter
medications without approval of physician.
• Encourage to keep follow-up appointments
with health care provider.

30. ANTIHYPERTENSIVES

31. Diuretics
• Mechanisms of Action
Thiazide diuretics
• Example: hydrochlorothiazide (HCTZ)
• —Inhibits sodium reabsorption in the distal
tubule, thereby increasing excretion of water
and sodium.
• —Enhances excretion of magnesium, chloride,
and potassium.

32. Loop diuretics
• Example: furosemide (Lasix)
• —Inhibits the reabsorption of sodium and
chloride in the ascending loop of Henle
• —Increases risk of hypokalemia
• —Reduces the ability of the kidneys to
concentrate urine
• —More potent than the thiazides in
promoting sodium and fluid excretion

33. Potassium-sparing diuretics
• Example: spironolactone (Aldactone)
• —Promotes sodium and chloride excretion
without concomitant loss of potassium
• —Inhibits the action of the hormone
aldosterone thereby causing diuresis
• —Lowers BP by unknown mechanism
• —Increases risk of hyperkalemia

34. Common Uses
• Congestive heart failure
• Hypertension
• Renal failure
• Edema

35. Common Adverse Effects
• Hypokalemia (except potassium sparing
diuretics)
• Hyponatremia
• Dehydration
• Postural hypotension
• Hyperglycemia

36. Monitoring Effects of Diuretics
• Nursing Process Elements
• Be familiar with client’s baseline VS
• Obtain BP and heart rate prior to administering
medication
• Check BP and heart rate before and after
administration
• Monitor for signs of hypokalemia
• Fatigue
• Muscle weakness and cramps
• Rapid irregular pulse
• Vomiting

37. • Shortness of breath
• Monitor fluid intake and urinary output
• In hospital, weigh client daily. Monitor for:
• —edema
• —abnormal lung sounds
• —extra heart sounds
• Assess for postural hypotension
• Monitor serum levels
• —Potassium
• —Sodium
• —Chloride
• Blood urea nitrogen (BUN)
• Assess for digoxin toxicity if dehydration or hypokalemia
exists

38. Assessment Alert
• Take BP prior to and after administering
diuretics. Always monitor electrolytes prior to
administering diuretics.

39. Nursing Diagnoses
• Fluid volume: excess
• Knowledge deficit related to medications,
disease, and nutrition

40. Client/family teaching
• Instruct regarding weighing at least once per
week
• Remind to have BP monitored weekly
• Advise to follow dietary guidelines, especially
regarding potassium and sodium
• Encourage to change positions slowly to avoid
a decrease in BP (postural hypotension)

41. • Instruct to notify health care provider if
experiencing muscle weakness or cramping,
fatigue, or dizziness
• Advise to take medication as directed and to
not take over- the-counter drugs unless
approved by physician
• Encourage to keep follow-up appointments
with health care provider

42. BETA-ADRENERGIC BLOCKING
AGENTS
• Example: propranolol (Inderal)

43. Think Smart / Test Smart
• The generic names for the beta-blockers end
in “lol,” therefore, you will be able to identify
the beta- blockers from a list of drugs.

44. Mechanisms of Action
• Reduction in heart rate
• Reduces force of cardiac contraction
• Slows electrical conduction
• Reduces myocardial irritability

45. • Management of cardiac arrhythmias
• Hypertension
• Tachyarrhythmias associated with digitalis
toxicity
• Angina Pectoris

46. Common Adverse Effects
• Weakness: fatigue
• Impotence
• Concerns for use: Precautions
• —It may cause bronchoconstriction; therefore, its
use may be contraindicated in clients with chronic
pulmonary diseases
• —It may promote congestive heart failure
therefore use cautiously in clients with risk for
heart failure.

47. Monitoring Effects of Beta-Adrenergic
Blocking Agents
• Nursing Process Elements
• Assess heart rate and rhythm, BP prior to
administration and throughout therapy
• Assess location, intensity, and duration of
anginal pain and associated symptoms
• Monitor ECG
• Monitor for adverse effects

48. Assessment Alert
• Always take BP and heart rate prior to
administering beta-blockers.

49. Nursing Diagnoses
• Cardiac output, decreased
• Pain: acute
• Tissue perfusion: ineffective
• Knowledge deficit related to medication and
disease

50. Client teaching for self-care
• Instruct in how to obtain pulse rate, and to report
changes in rate and rhythm to physician
• Instruct to take doses round the clock and what
to do regarding missed doses and over-the-
counter medications
• Advise to report chest pain to health care
provider immediately
• Advise regarding importance of follow-up
appointments with health care provider

51. CALCIUM CHANNEL ANTAGONISTS
• Example: nifedipine (Procardia)
Mechanisms of Action
• Relaxation of vascular smooth muscle and lowered BP
• Prevents or reverses spasms of coronary blood vessels
• Dilates coronary arteries and arterioles resulting in an
antianginal effect
• Reduces myocardial oxygen consumption
• Slows electrical impulse conduction (supraventricular
tachycardia)

52. Common Uses
• Prevention and treatment of angina pectoris
• Hypertension
Common Adverse Effects
• Hypotension
• Peripheral edema
• Dizziness
• Headache

53. Monitoring Effects of Calcium
Channel Antagonists Agents
• Nursing Process Elements
• Assess heart rate and rhythm, BP prior to
administration and throughout therapy
• Assess location, intensity, and duration of
anginal pain
• Monitor ECG
• Monitor for adverse effects

54. Assessment Alert
• Always take the client’s BP and heart rate
before and after administering calcium
channel antagonists.

55. ANGIOTENSIN-CONVERTING ENZYME
(ACE) INHIBITORS
• Example: captopril (Capoten)

56. Think Smart / Test Smart
• The generic names of the ACE inhibitors end in
“pril,” therefore, you will be able to identify
them from a list.

57. Mechanism of Action
• Dilates peripheral arterioles
• Relaxes vascular smooth muscles
• Reduces peripheral resistance
• Interferes with conversion of angiotensin I to
angiotensin II
• Dilates peripheral vessels thereby reducing BP

58. Common Uses
• Hypertension
• Congestive heart failure
• Arrhythmias (irregular heart rhythm)
• Angina Pectoris (chest pain)

59. Common Adverse Effects
• Hypotension
• Postural hypotension
• Dizziness, fainting, and headaches

60. Monitoring Effects of ACE Inhibitors
• Nursing Process Elements
• Be familiar with client’s baseline VS
• Obtain BP and pulse rate prior to administering
medication
• Check BP and pulse rate after administration
• Monitor weight, edema, lung, heart sounds, and
I&O
• Assess for postural hypotension
• Encourage client to rise slowly from lying to
sitting position

61. Assessment Alert
• Always take the client’s BP and heart rate prior
to and after administering ACE inhibitors.

62. Nursing Diagnoses
• Tissue perfusion: ineffective
• Knowledge deficit related to medications and
disease

63. Client teaching for self-care
• Instruct on monitoring BP weekly
• Remind to change positions slowly to prevent
rapid decrease in BP
• Encourage to follow dietary restrictions: low
sodium
• Instruct regarding reporting weight changes,
edema, and dizziness to physician
• Emphasize importance of follow-up
appointments with health care provider

64. ANTIMICROBIAL AGENTS
• Classification of Antimicrobial Agents
• Bactericidal and bacteriostatic
• —Bactericidal agents have a killing action on
the bacteria
• —Bacteriostatic agents inhibit the growth of
bacteria permitting the host’s immunological
defenses to destroy the organism

65. Site of Action
• Agents that inhibit cell wall synthesis
• Agents that inhibit protein synthesis
• Agents that interfere with the permeability of
the bacterial cell membrane
• Agents with antimetabolite action block or
alter steps essential for the normal growth of
the bacteria

66. Narrow or Broad Spectrum of Action
• Narrow spectrum
• —Effective against a limited number of
organisms
• —Use when identity of organism and
susceptibility of the antibiotic is known
• —Usually do not disrupt normal bacterial flora

67. • Broad spectrum
• —Act on a wide variety of organisms
• —Useful in treating infections when the
identity and susceptibility to antimicrobial
treatment of the infecting organism is
unknown
• —However, they destroy the body’s normal
microbes and may permit superinfection and
diarrhea

68. Adverse Effects
• Hypersensitivity reactions
• —Rash
• —Urticaria
• —Fever
• —Bronchospasm
• —Anaphylactic shock

69. • Organ toxicity
• —High doses and/or over long periods of time
• —Can involve liver, kidneys, central nervous
system, etc
• Ototoxicity (detrimental effect on eighth nerve or
organs of hearing)
• Hematological disorders
• —Anemia
• —Increased bleeding time

70. Major Classes
• Penicillins (beta-lactams) Example: ampicillin
(Polycillin)
• —Bactericidal agents
• —Inhibit the synthesis of the bacterial cell
wall
• —Narrow and broad-spectrum agents

71. Cephalosporins
• —Chemically and pharmacologically related to
the penicillins
• —Bactericidal or bacteriostatic effect
• —Interferes with bacterial cell wall syntheses
• —Four “generations” of cephalosporins
• —Use caution when client has allergy to
penicillins

72. Tetracyclines:
• Example: tetracycline (Tetracyn)
• —Bacteriostatic
• —Broad-spectrum agents
• —Inhibits protein synthesis in the bacterial cell
• —May interfere with normal calcification of
temporary and permanent teeth and discolor
developing teeth
• —May interfere with bone growth
• —Clients more susceptible to sunburn

73. Macrolides:
• Example: erythromycin (Ery-Tab)
• —Bacteriostatic
• —May be bactericidal in high concentrations
• —Inhibits protein synthesis in the bacterial
cell

74. Aminoglycosides:
• Example: gentamicin (Garamycin)
• —Bactericidal or bacteriostatic
• —Inhibits protein synthesis in the bacterial
cell
• —May produce nephrotoxicity and ototoxicity

75. Monitoring Effects of Antibiotics
• Take a careful medication history before
administering antibiotics
• Know exactly why your client is receiving
antibiotics
• If ordered, obtain specimen for culture and
susceptibility before administering the antibiotic
• Know what a therapeutic response to antibiotic
treatment would include for each specific client
situation
• Administer oral doses of antibiotics on empty
stomach or with food as specified

76. • Be aware of food–drug and drug–drug
interactions, for example, penicillin can
interfere with effectiveness of oral
contraceptives.
• Monitor VS and S&S of infection
• Monitor WBC count, BUN, creatinine, and
other laboratory values
• Observe for adverse effects
• Observe for S&S of superinfections

77. Nursing Intervention Alert
• If cultures are ordered by the physician,
always obtain the specimen prior to
administering the first dose of antibiotic.

78. Nursing Diagnoses
• Infection:
• risk for Knowledge deficit related to
medication or disease

79. Client teaching for self-care
• Advise to call health care provider if symptoms do
not improve
• Remind to take all doses of the medication even if
their symptoms are no longer present, and to
follow instructions regarding taking medication
with or without food
• Instruct to inform health care provider if
diarrhea, vomiting occur, black, hairy growth
develops on tongue, and vaginal irritation occurs
• Advise to keep all follow-up appointments with
health care provider

80. ANTICOAGULANTS
• Mechanism of Action
• Parenteral anticoagulants
• Example: heparin; enoxaparin (Lovenox)
• Exerts direct effect on blood coagulation
(clotting) by blocking the conversion of
prothrombin to thrombin and fibrinogen to
fibrin.
• Inhibits formation of new clots

81. Oral anticoagulant
• Example: warfarin sodium (Coumadin)
• Indirectly interferes with blood clotting by
depressing hepatic synthesis of vitamin K.
• Deters further extension of existing thrombi
and prevents new clots from forming.
• Has no effect on platelets.
• Unlike heparin, action is cumulative and more
prolonged.

82. Common Uses
• Heparin and Lovenox
• —Prophylaxis and treatment of venous
thrombosis and pulmonary embolism (blood
clot to leg or lung)
• —Prevent thromboembolic complications
arising from cardiac surgery and vascular
surgery
• —During acute stages of myocardial infarction
(heart attack)

83. • Coumadin
• Prophylaxis and treatment of deep venous
thrombosis and pulmonary embolism (blood clot
in leg or lung)
• Treatment of atrial fibrillation.
• An adjunct in treatment of coronary occlusion,
cerebral transient ischemic attacks
• Prophylactic treatment for clients with prosthetic
cardiac valves

84. Common Adverse Effects
• Bleeding
• Hematuria
• Tarry stools
• Excessive vaginal bleeding
• Abdominal, flank, or joint pain
• Headaches
• Changes in neurological status, restlessness
• Hematoma or bruising
• Vomiting blood
• Bleeding from the nose or gums
• Weak, rapid pulse rate
• Hypotension

85. Monitoring Effects of Heparin
• Nursing Process Elements
• Before administration check coagulation tests, hemoglobin,
hematocrit, and platelet counts.
• In general, the goal is to keep the partial thromboplastin
time (PTT) at 1.5–2.5 times its normal value of 35–45
seconds.
• Safely administer heparin via ordered route, i.e.,
subcutaneous injection, continuous intravenous infusion, or
intermittent intravenous infusion.
• No intramuscular injections
• Observe for S&S of bleeding
• Use soft toothbrush and electric razor

86. Nursing Intervention Alert
• Always check the PTT prior to administering
heparin.

87. Monitoring Effects of Coumadin
• Before administration check coagulation tests, hemoglobin,
hematocrit, and platelet counts
• In general, the goal is to maintain a prothrombin time (PT)
of 1.5–2 times the control or reference value and maintain
the international normalized ratio (INR) at a value of 2–3.
The PT control value is generally 11–15 seconds
• The daily oral dose is based on the PT and INR results until
maintenance dosage is established
• Observe for S&S of bleeding
• No intramuscular injections
• No aspirin containing products
• Use soft toothbrush and electric razor

88. Nursing Intervention Alert
• Always check the PT and INR prior to
administering Coumadin.

89. Antidotes
• Heparin: Protamine sulfate
• Coumadin: Vitamin K

90. Nursing Diagnoses
• Injury: risk for ineffective tissue perfusion
• Knowledge deficit related to medications,
disease

91. ANTIDIABETIC AGENTS

92. • Mechanisms of Action
• Sulfonylureas
• Example: glyburide: (DiaBeta )
• Directly stimulates functioning pancreatic beta
cells to secrete insulin
• Increases sensitivity of peripheral insulin
receptors resulting in increased insulin binding

93. • Biguanide
• Example: metformin (Glucophage)
• Increases glucose transport across cell
membrane, with enhanced glucose utilization
in skeletal muscles
• Increases the binding of insulin to its receptor
and potentiating insulin action

94. • Meglitinides
• Example: repaglinide (Prandin)
• Stimulates release of insulin from the
pancreatic islets

95. • Thiazolidinediones
• Example: rosiglitazone (Avandia)
• Improves target cell response to insulin
• Decreases hepatic glucose output

96. • Alpha-Glucosidase Inhibitors
• Example: acarbose (Precose)
• Inhibits or delays the absorption of sugars
from the intestinal tract

97. • Rapid Acting Insulin
• Example: insulin lispro (Humalog)
• Onset of action: within 15 minutes
• Peak action: 30–90 minutes
• Duration: 3–4 hours

98. • Short-Acting Insulins
• Example: Regular insulin (Humulin R)
• Onset of action: 30–60 minutes
• Peak action: 2–3 hours
• Duration: 3–6 hours

99. • Intermediate-Acting Insulins
• Example: NPH (Humulin N)
• Onset of action: 2–4 hours
• Peak Action: 6–10 hours
• Duration: 10–16 hours

100. • Long-Acting Insulins
• Example: Insulin glargine (Lantus)
• Onset of action: 2 hours
• Peakless
• Duration: 24 hours

101. • Inhalation Agents
• Insulin human inhalation powder

102. Monitoring Effects of Hypoglycemic
Agents
• Nursing Process Elements
• Monitor for S&S of hypoglycemia
• —Fatigue, restlessness
• —Cool, moist skin
• —Weakness and dizziness
• —Headache
• —Confusion, slurred speech
• Monitor for S&S of hyperglycemia
• —Flushed, dry skin
• —Increased urine output
• —Increased thirst
• —Increased appetite
• —Drowsiness
• Monitor blood glucose results as ordered

103. Assessment Alert
• Assess the lower extremities and feet of
clients with diabetes. Provide foot care and
assure that client has shoes to wear while in
the hospital.

104. Nursing Diagnoses
• Noncompliance
• Knowledge deficit related to medication, diet,
and disease
• Nutrition: imbalanced

105. BRONCHODILATORS
• Mechanisms of Action
• Sympathomimetic agents
• Example: albuterol (Proventil) and xanthine
derivatives (theophylline [Uniphyl])
• Relax smooth muscle of bronchi and
pulmonary vessels producing bronchodilation
• Increase vital capacity

106. • Leukotriene receptor antagonists
• Example: montelukast (Singulair)
• Decreases bronchial edema and inflammation
• Causes bronchodilation

107. • Common Uses
• Prophylaxis and symptomatic relief of
bronchial asthma
• Relieve bronchospasm associated with
bronchitis and emphysema

108. • Common Adverse Effects
• Tremor
• Tachycardia
• Nausea

109. Monitoring Effects of Bronchodilators
• Be familiar with client’s baseline VS
• Monitor client’s lung sounds, respiratory effort, and
oxygen saturation percentages via pulse oximetry
• Monitor for cyanosis of lips, ear lobes, mucous mem-
branes, and nailbeds
• Monitor theophylline plasma levels, if ordered.
Therapeutic range is 10–20 µg/ml.
• Observe client for adverse effects
• Ensure that client uses metered dose inhaler correctly

110. • Nursing Diagnoses
• Ineffective Breathing pattern:
• Ineffective Airway clearance:
• Knowledge deficit related to medications and
disease

111. AGENTS AFFECTING
GASTROINTESTINAL FUNCTION

112. Mechanisms of Action
• Laxatives
• Stimulant laxative:
• Example: bisacodyl (Dulcolax)
• Increases motility of gastrointestinal tract by chemical
irritation of the intestinal mucosa
• Increases the secretion of water into large and small intes-
tines
• Saline laxatives:
• Example: magnesium hydroxide (milk of magnesia)
• Draws water through the intestinal wall by osmotic action
increasing the fluidity of the stool and stimulates greater
intestinal motility

113. • Bulk-forming laxatives:
• Example: psyllium hydrophilic (Metamucil)
• Absorbs fluid and the compound swells in the intestine,
stimulating peristaltic action.
• Lubricant laxatives:
• Example: mineral oil
• Act as lubricant to facilitate passage of fecal mass
through the intestines
• Stool softeners:
• Example: docusate sodium (Colace)
• Permits water and fat to penetrate and soften stool

114. • Common Uses for Laxatives
• Prevent or treat constipation
• Prepare clients for a lower gastrointestinal X-ray
series or surgery
• Reduce the strain of defecation in clients with
cardiovascular disease or in postoperative clients
• Diagnose and treat parasitic infestations of the
gastrointestinal tract
• Help remove unabsorbed poisons from the
gastrointestinal tract

115. Histamine receptor antagonists
• Example: famotidine (Pepcid)
• Inhibits the action of histamine at the
histamine-sensitive H2 receptor site of the
parietal cells in the stomach
• Results in reduction in acid secretion

116. • Proton pump inhibitors
• Example: lansoprazole (Prevacid)
• Suppresses gastric acid secretion by inhibiting
the gastric acid pump in the parietal cells of
the stomach

117. • Common Uses for Histamine Receptor
Antagonists and Proton Pump Inhibitors
• Treatment of duodenal ulcer
• Treatment of gastric ulcer
• Gastroesophageal reflux disease
• Gastritis
• Erosive esophagitis

118. • Adverse Effects of Histamine Receptor
Antagonists and Proton Pump Inhibitors
• Diarrhea
• Headache

119. PAIN MANAGEMENT

120. ANALGESIC, ANTIPYRETIC, AND ANTI-
INFLAMMATORY AGENTS
• Mechanisms of Action
• Opioid analgesics
• Example: morphine (Roxanol)
• Opioid and opioid-like agents bind onto opioid
receptors found in the central nervous system
and act to inhibit the transmission of pain
impulses and alter pain perception
• Suppresses medullary cough centers
• Suppresses the motility of the gastrointestinal
tract

121. Assessment Alert
• Always assess client’s respiratory rate prior to
and after administering morphine. Many
institutional policies state that the nurse
should not administer morphine to a client
with a respiratory rate of less than 10 breaths
per minute.

122. Salicylates
• Example: aspirin (Ecotrin)
• Anti-inflammatory action: Inhibits prostaglandin
synthesis
• Analgesic action: Acts peripherally to interfere with
action of prostaglandins
• Antipyretic action: In addition to inhibiting
prostaglandin synthesis, it lowers body temperature in
fever by causing centrally mediated peripheral
vasodilation and sweating
• Antiplatelet action: Aspirin inhibits platelet
aggregation, therefore, aspirin helps prevent strokes
and myocardial infarction (heart attack)

123. Nonnarcotic analgesic and antipyretic
• Example: acetaminophen (Tylenol)
• Produces analgesia by unknown mechanism,
perhaps by action on peripheral nervous
system
• Reduces fever by direct action on
hypothalamus, peripheral vasodilation, and
sweating

124. Nonsalicylates
• Example: celecoxib (Celebrex)
• Newer NSAIDs inhibit prostaglandin synthesis
by inhibiting COX-2
• Provides analgesic and anti-inflammatory
effects
• Less adverse effects on the gastrointestinal
system and less antiplatelet activity

125. Corticosteroids
• Example: prednisone (Pred-Pak)
• Synthetic steroid used primarily for its
glucocorticoid effects—anti-inflammatory
agent
• Reduces the severity of inflammatory
symptoms

126. Opioid analgesics
• Moderate to severe pain
• Cough suppressant
• Suppressing the motility of the
gastrointestinal tract (diarrhea)

127. Nonsalicylates (NSAIDs)
• Osteoarthritis
• Mild to moderate pain
• Primary dysmenorrhea
• Reduction of fever

128. Opioid analgesics
Side effects:
• N&V
• Constipation
• Pruritus (itching)
• Decrease in respiratory rate (Naloxone
[Narcan] is opioid antagonist and reverses
respiratory depression)

129. • Corticosteroids
• Insomnia
• Fluid retention
• Hyperglycemia
• Altered fat deposition causing “moon face”
• Weight gain
• Hypertension

130. ANTI-ALZHEIMER’S AGENTS

131. • Cholinesterase Inhibitors
• Example: donepezil (Aricept)
• Mechanism of Action
• Enhances cholinergic function by increasing levels
of acetylcholine
• Common Uses
• Mild to moderate dementia associated with
Alzheimer’s disease

132. • Common Adverse Effects
• Headache
• Diarrhea
• Nausea

133. • Monitoring Effects of Therapy
• Assess memory, attention, language, and
ability to follow directions or perform simple
tasks.

134. Assessment Alert
• A home safety survey may need to be con-
ducted in order to provide a safe, therapeutic
environment.

135. ANTIANXIETY AGENTS

136. • Example: alprazolam (Xanax)
• Mechanisms of Action
• Benzodiazepine group
• Slows nerve impulses by enhancing the activity of
GABA
•
• Common Uses
• Anxiety
• Panic attacks

137. • Common Adverse Effects
• Dizziness
• Fatigue
• Drowsiness

138. Nursing Intervention Alert
• Always place call bell within client’s reach, and
keep bed in lowest position.

139. ANTICONVULSANTS

140. • Example: phenytoin (Dilantin)
• Mechanisms of Action
• Alters ion transport thereby limiting seizure
propagation
• Improves AV conduction thus reducing
incidents of arrhythmias

141. • Common Uses
• Treatment and prevention of tonic-clonic
seizures and complex partial seizures
• Treatment and prevention of arrhythmias

142. Common Adverse Effects
• Hypotension
• Nausea
• Rashes
• Diplopia
• Gingival hyperplasia
• Ataxia

143. ANTIDEPRESSANTS
• There are two major classes: tricyclic
antidepressants and selective serotonin
reuptake inhibitors (SSRIs)
• Examples: nortriptyline (Aventyl), paroxetine
(Paxil)

144. • Mechanisms of Action
• Tricyclic antidepressants
• Potentiates the effect of norepinephrine and
serotonin
• Possesses anticholinergic action

145. • Selective serotonin reuptake inhibitors
• Inhibits uptake of serotonin in the CNS
• Common Uses
• Treatment of depression

146. • Common Adverse Effects
• Fatigue
• Drowsiness
• Blurred vision and dry eyes
• Dry mouth and constipation
• Hypotension

147. ANTIEMETIC AGENTS

148. • Example: promethazine (Phenergan)
• Mechanisms of Action
• Inhibits the chemoreceptor trigger zone in the
medulla
• Common Uses
• Treatment and prevention of N&V
• Allergic conditions
• Motion sickness
• Sedation

149. • Common Adverse Effects
• Sedation
• Disorientation
• Monitoring Effects of Antiemetic Agents
• Nursing Process Elements
• Assess for N&V, and abdominal pain
• Assess for fluid volume deficit (dry mucous
membranes, poor skin turgor, decreased urine output,
and thirst)
• Monitor I&O
• Implement safety precautions to prevent falls

150. ANTIFUNGUAL AGENTS
• Example: fluconazole (Diflucan)
• Mechanisms of Action
• Inhibits synthesis of fungal sterols
• Affects the permeability of the fungal cell
membrane or protein synthesis within the cell
• Common Uses
• Treatment of fungal infections
• Prevention of fungal infections
• Common Adverse Effects
• abdominal discomfort

151. ANTIHISTAMINE AGENTS
• Example: fexofenadine (Allegra)
• Mechanisms of Action
• Blocks the effects of histamine at peripheral
histamine-1 receptors
• Common Uses
• Relief of allergic rhinitis
• Urticaria
• Common Adverse Effects
• No common adverse effects

152. Nursing Intervention Alert
• Apple, orange, and grapefruit juice will
decrease the absorption of fexofenadine
(Allegra).

153. ANTIPLATELET AGENTS
• Mechanisms of Action
• Glycoprotein IIb/IIIa inhibitors: eptifibatide (Integrilin)
• Platelet Aggregation Inhibitors: dipyridamole (Persantine)
• Platelet Adhesion Inhibitors: clopidogrel (Plavix)
• Common Uses
• Prevention of myocardial infarction or stroke
• Treatment of acute coronary syndromes
• Common Adverse Effects
• Dizziness
• Headache
• Bruising

154. • Client teaching for self-care
• Instruct to take medication as prescribed and to avoid
using over-the-counter medication containing aspirin
or NSAIDs without prior approval from physician
• Advise to avoid using alcohol and tobacco products due
to the vasoconstriction action
• Instruct to notify physician if signs of bleeding
(bruising, headache, blood in urine, dark stools,
headache, weakness)
• Encourage to keep appointments with health care
providers

155. ANTIVIRAL AGENTS
• Example: acyclovir (Zovirax)
• Mechanisms of Action
• Inhibits viral DNA replication
• Common Uses
• Treatment of herpes zoster (shingles)
• Treatment of herpes simplex virus types 1 and 2
• Treatment of genital herpes infections
• Common Adverse Effects
• Headache and dizziness
• Nausea, vomiting, and diarrhea

156. Lipid Lowering Agents
• Example: HMG-CoA Reductase Inhibitors:
rosuvastin (Crestor)

157. • Mechanisms of Action
• Reduces total cholesterol, LDL, and triglycerides
and increases HDL
• Common Uses
• Reduce lipids/cholesterol in order to decrease
risk for myocardial infarction and stroke
• Common Adverse Effects
• Indigestion, diarrhea, and constipation
• Rash