Nursing and pharmacology topics 11-19

TOPIC 11: Quiz #2 and Math Calculations Exam
Preparation for Exam:
The theory quiz will cover content from Class 6-9 Please review Learning Objectives
Please note: Class 9 and Class 10 both are about the Nervous System. Quiz 2 includes the
Learning Objectives for Class 9 ie ANS, meds for Anti-Parkinson, Seizures, Anti-anxiety, Mood,
Psychosis etc
As a partial study guide, you may want to review;
Medication Administration - Principles of med admin, 10 rights, 3 checks, understand all
components of a medication order, types of orders, phone orders, abbreviations, including
dangerous abbreviations, types of meds and routes i.e. suspension, liquid, tablet, capsule,
lozenge, SC, IM, IV, pr, po, inhaler, sl, eye drops, parenteral, enteral, topical, percutaneous.
What do you need to know before administering a medication
Nursing Process and Specific Disorders - assessment, diagnosis, planning, implementation and
evaluation related to medication administration
Meds- bowel meds, classifications, common meds, actions/uses, side effects, nursing
considerations, etc...
Alternative Therapies, use of traditional/indigenous/complementary/alternative meds and the
nurse's role - do the readings - common herbs, vitamins, minerals, etc...
Nervous System - part 1 - adrenergic, cholinergic, Parkinson's, antidepressants, antipsychotics,
seizures, anxiety, mood, sedative-hypnotics.
There are multiple choice questions and matching questions on the theory quiz.
TOPIC 12: Respiratory System and Antimicrobials
Learning Objectives:
Upon completion of the class, the learner will be able to:
· Describe major classes of drugs used to treat diseases/illnesses of the respiratory system and
antimicrobials.
· Describe the main nursing considerations related to these groups of drugs.
· Explain drug interactions, polypharmacy, and food/drug effects to medication used across the
lifespan, particularly the older adult.
· Explain the potential interaction of complementary, Indigenous and herbal preparations with
respiratory and antimicrobial drugs.
· Organize research of drugs used to treat diseases/illnesses of the respiratory system, and
antimicrobial medications, in a way that allows for easy and accurate reference.

· Identify drugs used to treat infectious diseases.
Explain the relationship between antimicrobials and drug resistance.
Preparation:
• Consider your own experience with use of antibiotic/antimicrobial medications
• What kind of infection were you taking the medication for?
• Did you experience any side effects from the medication?
Respiratory System Medications
Med Orders – Critical Thinking
Make sense of this in your head...
MD order reads – “acetaminophen 325-650 mg q4 - 6h PO PRN for pain”
What is the lowest & highest dose you can give in 4 hours?
What is the lowest & highest dose you can give in 6 hours?
Drug Calculations
You may give:
• 325mg q4h - q6h
• 650mg q4h – q6h
• You may also give 325mg q2h if that schedule works better for your client…
Explain why...
Why can’t you give 650mg q2h?
If you’re struggling with this, do the math review covered in class 4. If you are still struggling,
contact the Health Sciences Tutor or your Pharmacology instructor.
Respiratory Drug Classes
• Decongestants (pseudoephedrine)
• Antihistamines (diphenhydramine, ipratropium)
• Expectorants (guaifenesin)
• Antitussives (dextramethorphan)

• Mucolytics (acetylcysteine)
• Bronchodilators (ipratropium, albuterol)
• Corticosteroids (fluticasone, budesonide phosphate)
URT - Terms & some A&P
Autonomic innervation
• Alpha adrenergic receptor stimulation → vasoconstriction
• Cholinergic stimulation → vasodilation
• Rhinitis– inflammation of nasal mucosa → congestion, sneezing, discharge
o Causes – URTI (bacterial/viral), allergy, chronic sinusitis
• Allergic rhinitis – allergen-induced rhinitis
• Sinusitis – inflammation/infection of sinuses
• Histamine– found in most body tissues
o Released in allergic reactions, tissue trauma → inflammatory response
o Actions of histamine – vasodilation (redness, heat), ↑ capillary permeability
(edema, pain)
o Also responsible for dramatic drop in BP in severe allergic reaction
Why does this happen?
Sympathomimetic Decongestants
• Action – alpha adrenergic agonists → vasoconstriction & possible bronchodilation (β 2
receptors)
• Uses – common cold, adjunct to antihistamine in allergic rhinitis
• Precautions - reflex vasodilation with overuse, systemic effects of adrenergic stimulation
- Who is at risk & for what ?
• Meds - pseudoephedrine (Sudafed)
Pseudoephedrine (Sudafed)
• Precautions – diabetes, hyperthyroidism, ischemic heart disease
Why?
• Adverse effects – anxiety, nervousness, palpitations, anorexia
What do the adverse effects remind you of?

• NC - ↑ fluid intake, monitor VS, chest & sputum
What assessments would you make?
• Do not take any herbs containing ephedra or ma huang when taking this medication as
there could be potentially serious interactions. Coleus should also be avoided as it might
increase the effects of the medication.
• Tannin containing herbs such as green and black teas, uva ursi, black walnut, red
raspberry, oak and witch hazel might interfere with the absorption of pseudoephedrine.
• Caffeine can increase the side effects of pseudoephedrine.
Antihistamines
• Action – histamine receptor antagonists in arterioles, capillaries, secretory glands of
mucous membranes
• Uses – allergy, conjunctivitis
• Meds – ipratropium (Atrovent), diphenhydramine hydrochloride (Benadryl), loratadine
(Claritin)
Diphenhydramine (Benadryl)
• Action – as for antihistamines, CNS depressant
• Uses – allergy, anaphylaxis, mild hs sedation, prevention of motion sickness
• Adverse effects – anticholinergic effects (dry mouth, constipation, urinary retention,
tachycardia), confusion, drowsiness
• NC – know why the med is ordered, monitor airway/rashes in allergy, monitor for
excessive CNS depression.
• avoid the use of henbane and other herbs that may cause anticholinergic effects.
LRT - Terms and A&P
• SaO2/oxygen saturation/O2 sat – percentage of oxygen that is bound to hemoglobin
compared to 100% which “could” be bound, measured by an oximeter
• Spirometry – assesses client’s ability to move air in and out of lungs (airway compliance,
thoracic excursion & respiratory muscle strength on inspiration & expiration), measure
by spirometer
Expectorants - guaifenesin

• Action - liquefy mucous by stimulating secretions → better expectoration of ‘tenacious’
secretions when coughing
• Uses – bronchitis, pneumonia, treatment of productive cough – Why?
• Med – guaifenesin (Robitussin)
• Adverse effects – well tolerated
• NC – monitor chest & sputum, ↑ fluids
• avoid foods and herbs that contain caffeine when taking this medication as BP may
increase.
• Licorice, ginseng and ephedra may interact with this medication.
Antitussives
• Action – suppresses cough centre in the brain
• Uses – for dry, hacking, non-productive cough, especially helpful when sleep is disturbed
by cough
Compare the indication for an expectorant versus an antitussive…
• Precaution – CNS depressant
• Meds – codeine, dextromethorphan (Benalyn DM)
Antitussive - dextromethorphan
• Uses – viral URTI, chronic non-productive cough, common ingredient in OTC cough &
cold remedies
• Precautions – safety uncertain in children, CNS depression, do not give to anyone who is
taking or has taken an MAOI within the last 14 days
• Adverse Effects – tolerated well
• NC – monitor chest & for sputum, ↑ fluids
Why? What will you do if you assess a productive cough?
• Do not take with herbs that have a stimulating effect without the advice of a health care
professional.
Mucolytic Agents
• Action – dissolves mucous plugs & ↓ viscosity of pulmonary secretions
• Uses – pre-med for postural drainage & suctioning, acute and chronic pulmonary
disorders (bronchitis, emphysema, pneumonia)

• Meds – acetylcysteine (Mucomyst) – CPS
• Adverse effects – foul odour may cause nausea, bronchospasm
• NC – What will you assess? When?
LRT - Bronchodilators
• Action – relax smooth muscle from trachea to alveolar ducts → bronchodilation → ↓
resistance to air flow
• Uses – bronchodilation in asthma, chronic bronchitis, possibly emphysema
• Meds - (several classes): beta-adrenergic agonists (albuterol - Ventolin,
Salmeterol), anticholinergics (ipratropium bromide), xanthine derivatives (aminophylline)
Albuterol (Ventolin)
• Action – β2 adrenergic agonist in pulmonary smooth muscle → bronchodilation
• Uses – COPD (asthma, chronic bronchitis, emphysema)
• Adverse Effects – restlessness, tremor, chest pain, palpitations
What meds would act as antagonists?
• NC – VS, chest, sputum, teach proper administration (client & family)
• Coleus may increase the bronchodilating effects of albuterol. These two should only be
combined under a doctor's supervision.
Steroid Anti-Inflammatories
• Action – somewhat unknown, antiinflammatory, immune suppression, some
bronchodilation action
• Uses – severe asthma, COPD if unresponsive to other bronchodilators
Why?
• Meds – budesonide (Pulmicort), fluticasone (Flovent), beclomethasone
Fluticasone - Flovent
• Action – locally acting anti-inflammatory & immune suppressant
• Uses – diminish frequency & severity of asthma, to delay need for systemic steroid
control
Why is this advisable?

• Adverse Effects – HA, oropharyngeal fungal infections, dysphonia/hoarseness
What are the nursing implications for this class of inhalers?
• Coleus should be avoided when taking this medication.
Antimicrobial Medications
Antimicrobial Agents
Antimicrobial agents are meds used to treat infections with pathogens, there are three main
types:
1. Antibacterial agents – prevention & treatment of bacterial infections
2. Antifungal agents – treatment of fungal infections
3. Antiviral agents – treatment of viral infections
Antibacterial Subclasses
• Aminoglycosides – gentamicin, tobramycin
• Cephalosporins – cephalexin (Keflex), ceftazidime
• Macrolides – azithromycin (Zithromax), erythromycin
• Penicillins – amoxicillin (Amoxil), ampicillin, penicillin G
• Tetracyclines – tetracycline (Apo-Tetra)
• Quinolones – ciprofloxacin (Cipro), norfloxacin
• Sulphonamides – cotrimoxazole (Septra, Bactrim)
• Antituberculars – rifampin, isoniazid
Antifungal & Antiviral Meds
• Antifungal Agents - clotrimazole, ketoconazole (Nizoral), nystatin
• Antiviral Agents - acyclovir (Avirax), oseltamivir (Tamiflu)
Antibacterial Agents
• Antibacterials or antibiotics are drugs derived from living organisms like penicillin which
is derived from a mould
• Drug choice is made according to the sensitivity of the pathogen to a specific antibiotic –
a culture & sensitivity (C&S) test is usually done in order to select an antibacterial agent that
is sure to kill the specific pathogen

Activity -
Define & describe the C&S procedure to your partner…
Sub-classifications:
Aminoglycosides Class
• Action – inhibit protein synthesis
• Uses – kill pathogens that cause UTIs, meningitis, wound infections, septicemia
• Meds – gentamicin, tobramycin, neomycin, streptomycin
• Ototoxicity!!
Cephalosporin Class
• Action – chemically similar to penicillins, inhibit cell wall synthesis, 3 “generations” of
drugs
• Uses – with caution in clients allergic to penicillins, UTI, RTI, bacteremia, osteomyelitis
• Meds – cephalexin (Keflex), ceftazidime
Macrolide Class
• Uses – RTI, GIT infections, skin and soft tissue infections, useful in client sensitivity to
penicillins, cephalosporins or tetracyclines
• Meds – azithromycin (Zithromax), erythromycin
Penicillin Class
• First antibiotic to be cultured and used
• Bacteria may develop resistance to penicillin, so researchers have developed penicillinase
resistant penicillin drugs
• Action – inhibits cell wall synthesis
• Uses – middle ear infection, meningitis, pneumonia, UTI, syphilis, gonorrhea
• Meds – amoxicillin (Amoxil), ampicillin, penicillin G

Quinolone Class
• Action – interfere with DNA replication
• Uses – broad spectrum antibiotics for UTI, RTI, STDs, important group for nosocomial
and community acquired infections
• generally better tolerated than many others
• Meds – ciprofloxacin (Cipro), levofloxacin, norfloxacin
Sulphonamide Class
• Are synthetic
• Bacterial resistance is a problem so, has led to development of combination of meds
• Action – inhibit folic acid → cell death
• Uses – UTI, middle ear infections
• Caution – penicillin allergy
• Meds – cotrimoxazole (Septra, Septra DS, Bactrim, Bactrim DS)
Tetracycline Class
• Uses – allergy to penicillin, UTIs, some STDs, URTI and LRTI, some skin infections
• Meds – tetracycline (Apo-Tetra, Novo tetra), doxycycline
• products containing milk, iron or magnesium can decrease the absorption and serum
levels of these types of antibiotics.
Antitubercular Agents
• Action – by various mechanisms, often used in combination with other antitubercular
drugs
• Uses – prevention & treatment of tuberculosis
• Adverse effect - discolouration of body fluids to red-orange with rifampin
• Meds – ethambutol, rifampin, isoniazid
There is not a lot of information on possible interactions between antibiotics and herbal
supplements. It is recommended that individuals on antibiotic therapy take probiotics to help

restore and maintain normal intestinal flora. Probiotics can be consumed through foods
containing live bacterial cultures or as a supplement.
Antimicrobials - Common Adverse Effects
• Anaphylaxis – what will you assess? What med is commonly ordered?
• Allergy – what S/S will you see?
• Nausea, vomiting & diarrhea – why? What are the consequences?
• Secondary infection – what are the common ones? Which can be fatal?
NC and Hypersensitivity
• Allergies – known & unknown!
• Reporting - Who needs to know?
• Documentation of known medication allergies & the S/S experienced is critical
• Close monitoring of clients receiving antibiotics is also critical for early detection of
allergic signs/symptoms
• What findings will make you suspect a hypersensitivity reaction?
NC for the ‘big three’
• Take with lots of fluid to ↓ gastritis
• Concurrent use of probiotics to help replace lost flora (lactobacillus acidophilus) – what
would be the benefits of this?
• Monitor, document & report secondary infections – what would you expect?
• Give antiemetics prn
• Monitor electrolytes, emesis & stool, skin
More NC in Antimicrobial Therapy
• Strictly adhere to isolation/infection control policies per facility
• Pt must take all & on time
• Monitor TACT – describe these assessment components
• Monitor for adverse effects – ??

Topical Antifungal Agents
• Actions – unknown, cause leaky cell walls
• Uses – tinea infections, candida infections of skin & mucous membranes
• Adverse Effects – vaginal irritation, hypersensitivity (swelling, redness)
• Meds – clotrimazole, ketoconazole (Nizoral), nystatin
• NC – wash & dry area, wear gloves for application, don’t double dip into container!
Antiviral Agents
• Viruses are not “free-living” organisms as they require a host cell for growth &
multiplication
• Have very sneaky ways of controlling host cells and replicating their own DNA
• Many antivirals have been produced to combat HIV by various mechanisms
• A new HIV drug prevents entry of the HIV organism into the host’s cells
• Actions – many mechanisms (interference with viral enzyme production, protein
synthesis inhibition, block entry into host cells, inhibit cell replication)
• Uses – treatment of viral infections (influenza, herpes, HIV)
• Adverse Effects – nausea, vomiting, diarrhea, rash
• Meds – acyclovir (Avirax), oseltamivir (Tamiflu)
TOPIC 13: Endocrine System
· Describe major classes of drugs used to treat diseases/illnesses of the endocrine system.
endocrine drugs.

· Organize research of drugs used to treat diseases/illnesses of the endocrine system in a way that
allows for easy and accurate reference.
Preparation
· Refer to Reading List for required reading
· Explore the Canadian Diabetes Association website and on-line Health Canada resources
related to diabetes
- Complete the checklist “are you at risk” on the Canadian Diabetes website under
‘Diabetes and you’
· Compare and contrast Type I and Type 2 diabetes
Medications Used To Treat Disorders in the
Endocrine System
Client Teaching in General
For each class that we study in Pharmacology, ask yourself:
• What are the important client teaching topics for this class of medications?
• What resources will you use?
• How will you know your teaching has been successful?
Endocrine System – A & P
• Glands or glandular tissues – pituitary (anterior & posterior), thyroid, parathyroids,
adrenals, pancreas, ovaries, testes…
• Endocrine system together with the nervous system regulates your body's growth and
development, metabolism and maintains internal equilibrium
Hormones – A & P
• Are chemical messengers secreted into the bloodstream & distributed to target cells at
distant sites
• Hormone-binding causes target cells to start or stop doing a “pre-programmed” function
• Insulin & glucagon are examples of chemical messengers
Effects of Aging on the Endocrine System

1. ↓ thyroid function → hypothyroidism
2. ↓ parathyroid secretion → ↓ calcium absorption → osteoporosis
3. ↓ glucose tolerance → Type 2 DM
4. ↓ ovarian function → ↓ estrogen
5. ↓ hormones of adrenal cortex and medulla - decrease in stress response
Thyroid Dysfunction
• TSH is released from anterior pituitary gland → stimulation of thyroid gland to secrete
T3 and T4 (thyroxine)
• Major role in metabolism, temperature regulation, CV function
• Hypothyroidism, hyperthyroidism
• Goal of therapy is to return thyroid function to normal
Thyroid Hormone
Too Much... Too Little...
• Tachycardia, bounding pulse,
arrhythmia, cardiac hypertrophy,
palpitations, diaphoresis
• Tremors
• Wt loss
• ↑ T
• Lethargy, slowed motor responses
• Cold intolerance
• ↓ appetite with wt gain
• ↑ sensitivity to sedatives
• Hypotension, bradycardia
Meds for Hypothyroidism
• Under function of the thyroid → hypothyroidism and is treated with thyroid hormone
replacement
• Thyroid hormone replacement
o levothyroxine (Eltroxin, Synthroid)
o ↑s metabolic rate of tissues – with what effect on VS/QPA?

Nursing Considerations in TH Replacement
• Assessment:
o Baseline weight and vital signs!
o Labs - thyroid levels (initial & ongoing)
o Objective & subjective data – like…
• Evaluation:
o Assess TACT or signs of toxicity (arrhythmia, tachycardia, angina, hypotension,
insomnia
• Lemon balm may interfere with thyroid hormone action.
Levothyroxine
• Action – replacement of T4 hormone
• Uses - hypothyroidism
• Adverse Effects – hyperthyroidism
What S & S will alert you to possible toxicity?
• Nursing Considerations – low dose for elders, give in am, hold if apical HR >100,
monitor wt & VS
Why give in am?
Use of Corticosteroids
• Subclasses organized according to area of use and duration of action
• In smaller doses to replace adrenal insufficiency
• In larger doses – potent antiinflammatory & immunosuppressant action
• Systemic corticosteroids – cortisone, prednisolone, prednisone
• Uses – severe inflammatory conditions (↓pain too), autoimmune disorders, allergic
disorders/diseases, asthma, to suppress immune system in transplant
• Only treats symptoms
• Causes decline in body function over time, therefore only used if other drugs ineffective

Nursing Considerations for Corticosteroids
• Prolonged treatment → adrenal gland suppression, immunosuppression
What are some potential consequences of long term use?
• Baselines needed – VS, electrolyte/glucose levels, weight, LOC
• Assess for hyperglycemia in diabetes!
• Discontinue slowly
• Monitor - for onset of diabetes mellitus, thyroid hormone levels, Cushing’s Syndrome
(“moon” face, elevated blood glucose levels)
• Compare findings with baselines – wt, VS, electrolytes (hypokalemia, altered Na+ &
Cl-), blood glucose
• Signs of infection, delayed/poor wound healing
Why?
• Certain herbs may lead to a potassium deficiency when taken with hydrocortisone over a
prolonged period of time. These include aloe and buckthorn.
• Licorice has been found to reduce the metabolism of prednisone in the body, thereby
possibly increasing the amount of circulating prednisone. It might also prevent the
immunosuppressive actions of cortisone.
• Because corticosteroids are often prescribed for immunosuppression in individuals with
autoimmune disorders or those who have undergone organ transplant, herbs that alter the
immune response should be avoided. Some of these include astragalus, echinacea, goldenseal
and zinc among others.
Prednisone (potent)
• Actions – suppress inflammation, immunosuppression, metabolic effects
• Uses – immune system suppression (autoimmune disorders, transplant), chronic
inflammatory conditions
• Adverse Effects – infection, poor wound healing, immunosuppression, altered body
image, adrenal suppression, very damaging to collagen
Where is collagen in the body?
Hormone Therapy - Estrogen
• Action – maintenance of secondary sex characteristics, ↓ serum cholesterol
• Uses – palliative treatment/slow progression of prostatic & some breast cancers, relief of
menopausal symptoms, contraception, HRT, treatment of menopausal OP, acne in females

• Adverse effects – MI, thromboembolism
• Meds –estradiol (Estrace, Evra, Estring, Estrogel) conjugated estrogen (Premarin) can be
taken orally, topically, vaginally
• St. John's Wort is thought to make estrogen medications less effective. Herbs that act as
"blood thinners" may interact with estrogens. Other herbs have estrogen like effects and
should only be taken under the advice of a health care professional if the client is also taking
estrogen medications. Some of these herbs include black cohosh, red clover, dong quai, and
soy.
Hormones of the Pancreas
• The pancreas is located posterior to the stomach
• Pancreatic islets or Islets of Langerhans produce and secrete insulin and glucagon
• They are concerned with regulating blood glucose levels
• Their effects are antagonistic to each other
Hormone - Glucagon
• Potent hyperglycemic
• ↑s blood glucose
• Secretion is activated by:
o Hypoglycemia
o Sympathetic NS stimulation
Why is glucagon activated by ↑ in sympathetic activity?
(Why does this make sense?)
Effects of Glucagon in the Body
Glucagon - target site of action is liver
Effect - Raise blood glucose by:
• increase glycogenolysis (makes glucose from glycogen)
• increase gluconeogenesis (formation of new glucose from non-carb sources)
What body states would trigger this?
Hormone - Insulin

• Potent hypoglycemic
• ↓s blood glucose
• Secretion is activated by:
o Hyperglycemia or ↑ blood glucose levels (after a meal)
o ↑ amino acid and fatty acid levels in blood (after a meal)
o ↑ ACh levels from parasympathetic effects
Why does this make sense?
Effects of Insulin in the Body
Insulin - target is body cells
Effect - ↓ blood glucose by:
• ↑ cellular uptake of glucose
• ↑ glycogen formation
• ↓ glycogenolysis and gluconeogenesis
What body states would trigger this?
Diabetes Mellitus
Greek word origins:
• diabetes derives from a word meaning “to pass through” (polyuria)
• mellitus derives from a word meaning “sweet”
What is Diabetes Mellitus?
• DM is a chronic disease of absent or deficient insulin & cell receptor resistance to insulin
• Characterized by disturbance in carbohydrate, protein, and fat metabolism → elevated
levels of glucose in the blood with ‘glucose starvation’ inside cells
What happens to body weight?
Type 1 DM
• 10% of all diabetes – rapid onset
• Autoimmune and/or infectious origin
• Pancreas stops producing insulin

• Tx – require insulin injections & balance between energy intake and energy output
Type 2 DM
• Caused by chronically high blood glucose levels
• 90% of all DM, slow onset (years)
o occurring now in children! – why?
• ↓ insulin secretion & cellular resistance to insulin
• Tx – diet & exercise → oral anti-glycemics → insulin
Goals for Client’s with DM
1. Maintain normal blood glucose levels by balancing diet, medication & activity
2. Early diagnosis and effective lifestyle changes & medical treatment
3. Avoid states of hypo/hyperglycemia
4. Prevent complications of hyperglycemia – most diabetics die from these
Can you think of some?
Antidiabetic Classifications
Oral Agents
• Biguanides
o metformin
• Sulfonylureas
o glipizide
o glyburide
Injectible Agents
• Insulins
o rapid insulin
o regular insulin
o NPH insulin
o NPH/regular insulin mixtures (eg. 30/70)
o lente

o ultralente
• Certain herbs have been found to have hypoglycemic effects. These may be effective for
those individuals with mildly elevated blood glucose levels when used in conjunction with
other lifestyle modifications and under the supervision of a qualified health care professional.
However, they should be used with caution when taking any prescription hypoglycemic
agent. Some of these herbs include fenugreek, cinnamon and momordica charantia.
Antidiabetics – Oral Agents
Use – next treatment for Type 2 diabetes when changing diet isn’t working
Why wouldn’t it work to change diet?
1. Biguanides (metformin)
2. Sulfonylureas (glipizide, glyburide)
Metformin
• Metformin (Glucophage, Novo-metformin)
• Indication/Use – type 2 diabetes
• Action - ↓s hepatic glucose production, ↓s intestinal glucose absorption, ↑s cell’s
sensitivity to insulin
• Adverse reactions – abd bloating, diarrhea, nausea, vomiting
• Nursing Considerations:
o Assess – S/S hyper/hypoglycemia, ketoacidosis; fasting blood glucose (am
glucometer), HbA1c, urine for glucose & ketones, food/snack intake, exercise
o Implementation – DO NOT CRUSH extended release formulas, glucometer per
schedule & prn, have glucogel & carb snack easily available, teaching
o Evaluate – glucometer, S & S, HbA1c
Antidiabetics - Insulins
• Use - treatment of Type 1 & some Type 2 diabetes
• Action- lowers blood glucose by:
o ↑s transport of glucose into cells
o ↑s conversion of glucose to glycogen
o ↓s glycogenolysis & gluconeogenesis in the liver

Insulin - Onset, Peak, Duration
You must know insulin’s onset & peak in order to predict potential hypoglycemia
• ONSET of action – initial effect
• PEAK of action – maximum effect
• DURATION of action – remains active in the body
• Many types of action (rapid…long acting)
Types of Insulins
• Rapid-acting
• Short-acting
• Intermediate-acting
• Long-acting
• Mixed types
Rapid-Acting Insulin
lispro insulin (Humalog)
Use - Types 1 & 2 DM to control hyperglycemia associated with meals
• Onset 10 – 15 min
• Peak 1 – 2 hours
• Duration 3 – 5 hours h
Short-Acting Insulin
regular insulin (Humulin R, Novolin R)
Use – treatment of Types 1 & 2 DM given 30 min ac meals & prn
• Onset 30 - 60 min
• Peak 1 - 4 hrs
• Duration 5 - 10 hrs
Intermediate-Acting Insulin
NPH insulin (Humulin N, Novolin N)

Use – treatment of Types 1 & 2 DM
• Given 30 min ac meals, often mixed with short-acting (regular insulin)
• Onset 1 – 2 hours
• Duration 18 – 24 hours
Long-Acting Insulin
ultralente insulin (Humulin UtraLente, Novolin U)
• Onset 4 – 6 hours
• Duration 36 hours
Mixed Insulins
Regular/NPH (Humulin 50/50, Novolin 70/30)
Use – treatment of Types 1 & 2 diabetes
• Given 30 min ac meals
• Onset 30 min
• Duration 24 hours
Nursing Process - Insulin
Assess:
• Client’s understanding of use, action & it’s effects on blood glucose (related to diet,
exercise, illness)
• Client’s usual diet and usual level of exercise/activity
• Client’s ‘compliance’
• Client & family knowledge of S/S & treatment for hypoglycemia
Assessment & Insulin
Assess for S/S of hypoglycemia

• Possible causes - ↓ food intake, missed hs snack, N & V, illness, too much insulin for
current diet/exercise
Assess for S/S of hyperglycemia
• Possible causes – corticosteroids, ↑food intake, snacking, too little insulin, stresses (that
activate sympathetic activity in body - fever, illness, surgery), failure of oral antidiabetics to
control Type 2 DM
Which is Which & Why?
• Pallor
• Diaphoresis
• Tremors
• Weakness
• Anxiety
• Irritability
• Altered/↓ LOC
• Hypotension
• Tachycardia
• Bradycardia
• Polyuria
• Polydipsia
• Polyphagia
• Glucosuria
• Headache
• N & V
• Abdominal pain
• Dizziness
• Tachycardia
• Tachypnea
• Fruity acetone breath
Assessment & Insulin
• T -
• A -
• C -
• T -
• Glucometer, HbA1c, chemstrip prn
Do you need an MD order to assess BG by glucometer?
Interventions & Insulin
• Obtain BG by glucometer

• MD’s order is checked against the MAR
• Ensure accuracy with sliding scale dose
• Insulin prep is checked by another nurse
• Give insulin 30 min ac meals & prn/order
• Ensure client eats meals & snacks
o Snacks are often forgotten or not eaten
What is the consequence of this?
NI for Hypoglycemia
Assess glucometer, → facility policy
• Administer ½ c sweetened fruit jc (thin or thickened) if able to swallow (glucose gel if
unable to swallow)
• Stay with client - ongoing asmt, support, encouragement
• Re-evaluate glucometer in 15’
• Continue to monitor x 24 hours
Why?
• In some facilities, glucagon may be used for hypoglycemia
• Given SC, IM, IV
• Action - breaks down stored glycogen to glucose therefore increasing blood glucose
levels
Preventing Hypoglycemia
• Client must eat within 30’ of receiving short acting insulin – why?
• Ensure hs snack has been eaten
• Hold insulin if client has not been eating, is vomiting or you assess potential risk for
hypoglycemia
• Report to supervisor or call physician
Evaluation & Insulin
• Apply TACT
• Continue to monitor BG as ordered & prn (are oral agents still enough to maintain normal
blood glucose levels?)

• Monitor chart for HbA1c values
• Client teaching
Sliding Scale Insulin
• See most recent sliding scale MD order
• Dose of regular insulin is determined by glucometer value assessed immediately prior to
insulin administration
• Is often checked by 2 nurses (per facility policy)
• Is often given with NPH insulin in same syringe
Sample MD order:
Regular insulin by sliding scale ac meals & hs:
Glucometer:
• 0 – 9.9 give Ø u
• 10.0 – 14.9 give 6 u
• 15.0 – 19.9 give 8 u
• 20.0 – 24.9 give 10 u
Sliding Scale Insulin Scenarios
Your diabetic client is also taking PO prednisone to ↓ symptoms of myasthenia gravis.
Based on the previous MD order, how much regular insulin will you give?
• At 0730, your client’s glucometer reading is 8.4 mmol/L
• At 1130, the reading is 17.0 mmol/L
TPS - Sliding Scale Insulin
You come on shift the following morning at 0700. In report, you are told that this client was
vomiting in the night. As per the MD order, his insulin is due at 0730. When you go to him to do
his QPA, you see his hs snack at the bedside. You assess hypoglycemia and confirm this with a
glucometer value is 2.1 mmol/L…
1. List all possible QPA data for this client
2. List other assessment findings for this client

3. List your nursing interventions in the order that you will perform them
Nursing Practice Tip: When you are in clinical or have started working, keep an index card in
your pocket with the signs and symptoms of hypo and hyperglycemia; the onset, peak and
duration of action of each type of insulin; and, the names (or initials) of the clients on your unit
who are diabetic. That way if you come upon a diabetic client in distress you will have a better
idea of how to respond in a timely fashion.
TOPIC 14: Cardiovascular System
· Describe major classes of drugs used to treat diseases/illnesses of the cardiovascular system.
cardiovascular drugs.
· Organize research of drugs used to treat diseases/illnesses of the cardiovascular system in a way
that allows for easy and accurate reference.
Preparation:
Refer to reading list for required reading
Drugs Used to Treat
CARDIOVASCULAR DISORDERS
Classes in this Group
• Dyslipidemics/Lipid Lowering Agents (statins)
• Antihypertensives (ACE inhibitors, angiotensin II blockers, beta adrenergic blockers,
Ca+ channel blockers, diuretics)
• Antianginals (nitrates, beta blockers)
• Antiarrythmics (digitalis glycosides)
• Platelet Inhibitors (aspirin)

• Anticoagulants warfarin (Coumadin), heparins (dalteparin - Fragmin, enoxaparin -
Lovenox)
• Thrombolytic / Fibrinolytic Agents – dissolve existing clots (streptokinase)
1. Dyslipidemia Drugs aka Lipid Lowering Agents / Statins
o Hyperlipidemia – ↑ serum cholesterol & triglycerides (genetic & lifestyle factors)
o → atherosclerosis, arteriosclerosis → hypertension → CAD, angina, MI, CHF,
PVD
o Antilipemics (statins) used when diet, exercise & weight reductions fail – why ?
o Goal is to ↓ LDL-C to < 100 mg/dL
o In case you were wondering, the US, and other parts of the world, measure
cholesterol in milligrams of cholesterol per decilitre of blood. In this system of
measurement, < 200 is considered acceptable. In Canada, and most of Europe,
cholesterol is measured in millimoles of cholesterol per litre of blood. In this system of
measurement, < 5.2 is considered acceptable.
Statins
 Uses – reduce cholesterol thereby ↓ing risk for CAD, atherosclerosis,
hypertension…
 Action - inhibits enzyme responsible for cholesterol production in liver
(↓cholesterol production → removal of LDL from blood), also ↓s inflammation,
platelet aggregation, thrombin formation, plasma viscosity!
 Drugs – atorvastatin (Lipitor), simvastatin (Zocor)
Simvastatin (Zocor)
o Uses - hypercholesterolemia
o Action – see above
o Adverse Reactions – rhabdomyolysis (disintegration of striated muscle with
myoglobin in urine), abdominal cramps, constipation, diarrhea, flatus
o NC – obtain baseline for somatic pain & abd symptoms, monitor for development
of myalgia, monitor diet & exercise, monitor cholesterol & triglycerides, monitor LFTs
• Grapefruit juice is know to inhibit the metabolism of statins. This means that the drug is
not being broken down in the body and therefore, the client may end up with a toxic level of
the statin.

2. Antihypertensives
• Drugs are indicated when either SBP ≥ 140 mmHg or DBP is ≥ 90 mmHg on two or
more separate occasions
• Goal (in conjunction with lifestyle changes) is maintenance of a BP < 140/90 mmHg
thereby ↓ing risk of angina, MI, CHF, CVA, renal failure, retinopathy…
• Goal for clients with diabetes <130/80 mmHg
[IMAGE: Layers_of_Artery.jpg]
Antihypertensive Classes
A is for Angiotensin Converting Enzyme Inhibitors (ACE inhibitors)
• Uses – alone or with other agents for hypertension, mgmt of CHF
• Action - inhibits angiotensin II production (inhibits aldosterone secretion from kidneys
→ systemic vasodilation, blocks conversion of angiotensin 1 to angiotensin 2) – with what
effect?
• Drugs – Ramipril (Altace), captopril, trandolapril
• Ramipril:
o Uses – alone or with other agents for hypertension, prevention of MI, CVA in
those with high risk (ramipril only) – recall the risk factors!
o Adverse Effects – renal impairment in elders, agranulocytosis, neutropenia,
cough, hypotension
o NC – monitor VS, monitor CBC, differential & electrolytes, KFTs, monitor for
OH
A is for Angiotensin II Receptor Blockers (ARBs)
• Uses – hypertension & secondary HF, hypertension in clients with Type 2 DM
(prevention or delay of nephropathy)
• Action – blocks receptors for angiotensin II
• Adverse effects – less hyperkalemia than ACE inhibitors, hypotension
• NC – monitor for S/S of CHF, orthostatic hypotension
• Drugs – losartan (Cozaar), valsartan (Diovan)
B is for Beta Adrenergic Blockers
• Uses – hypertension, angina, tachyarrhythmia, migraine HA, MI prevention, stable CHF

• Actions - inhibits cardiac response to SNS stimulation → ↓CO, ↓HR, ↓BP, inhibits renin
secretion by kidneys
• Drugs – metoprolol, timolol, atenolol, propanolol
• Metoprolol (Lopresor, Betaloc):
o Uses - hypertension, angina
o Action – selectively blocks myocardial β1 receptors – with what effects?
o Adverse Effects - weakness, CHF, OH, bradycardia, pulmonary edema,
impotence
o NC – monitor VS, chest/PVD baseline & ongoing, ensure safety, monitor for
additive effects with similarly acting drugs
C is for Calcium Channel Blockers
• Uses – hypertension, prevention of angina & antiarrhythmic
• Actions - inhibits Ca+ ion movement across smooth & cardiac muscle cell membrane →
↓HR, ↓ in vascular smooth muscle tone (promotes systemic vasodilation) & ↓ in
dysrrhythmias, ↑ excretion of Na+ by kidneys → ??
• Drugs – diltiazem (Cardizem), nifedipine, amlodipine
• Diltiazem (Cardizem):
o Uses – hypertension, angina pectoris & vasospastic angina, tachyarrhythmias,
atrial fibrillation
o Adverse Effects – peripheral edema, arrhythmias, CHF
o NC – monitor VS, monitor for CHF (list ALL of these asmts), ensure safety
• When used with melatonin, there may be an increase in BP and HR
• Use caution with any herbal supplements that might affect blood clotting.
D is for Diuretics
• Most commonly prescribed subclass of antihypertensives
• Three types:
o Thiazide Diuretics – commonly used (hydrochlorothiazide)
o Loop Diuretics – furosemide (Lasix)
o K+ sparing Diuretic (spironolactone)
o Furosemide (Lasix):

 Uses – all stages of hypertension, edema associated with CHF
 Action – promotes blood volume depletion through diuresis, Na+
excretion, peripheral vasodilation
 Adverse Effects – hypokalemia, hyperkalemia (with supplements),
dehydration, OH
Peak is 1-2 hr, what is the significance?
 NC – ensure safe access to BR, monitor VS, monitor serum K+
• Use of calcium supplements while on hydrochlorothiazide may lead to hypercalcemia.
Care should also be taken when taking herbs such as ginko in combination with this drug as
it may actually cause an increase in BP.
• There are possible interactions between ginseng and loop diuretics.
TPS – Nursing Considerations for Antihypertensive Medications
Activity -
• List rationale for each assessment
• Document potential “positive” asmt findings
• Monitor VS, O2 sat
• Orthostatic BP, safety
• CHF prn Weight, skin turgor, edema, breath sounds, peripheral circulation
• Bronchospasm
• Labs – CBC, electrolytes (especially K+)
• Hawthorn has BP lowering properties. Taking hawthorne with an antihypertensive could
lead to hypotension.
3. Antiarrhythmics
• Impulse begins in SA node → atria → AV node → ventricles
• Ventricular contraction is from the apex toward the base
• New arrhythmias should be assessed with ECG (electrocardiogram) & documented
• Many classes - beta adrenergic blockers (propanolol, metoprolol), Ca+ channel blockers
(diltiazem), Na+ channel blockers (lidocaine), digitalis glycoside class (digoxin – Lanoxin)
•

o
Uses – tachyarrhythmia, atrial fibrillation, CHF
o Action – prolongs refractory period at AV node (↓s conduction velocity → ↓ HR),
↑s force of contraction - both of these actions improve chamber filling and result in ↑ CO
o Adverse Effects – toxicity, bradycardia, arrhythmia, N&V, weakness
o NC – monitor BP & apical, hold & notify MD for bradycardia (HR < 60 or per
policy) or arrhythmia (assess serum K+), monitor safety especially to ambulate,
digitalization may or may not be ordered (check & monitor levels), monitor for
sign/symptoms of toxicity (if suspected, hold & report to MD), monitor chest and
extremities for edema - how could this occur?
• Digoxin Toxicity!
o The half-life of digoxin is 36 – 48 hours!
o Based on your knowledge, who is most at risk for developing toxicity?
o What other concurrent pathology increases the risk of toxicity?
o What lab values will you assess & report prn?
o Sign & Symptoms – abdominal pain, anorexia, mild nausea, altered HR or
rhythm, confusion, altered behaviour – are these signs/symptoms unusual in the
elder? What is the significance of this ? (check serum K+)
o Antidote may be ordered for digoxin toxicity, inactivates digoxin by binding &
excreting via kidneys – digoxin immune Fab (Digibind, DigiFab)
• There could be a possible interaction between hawthorn and digoxin. Use with caution.
• Ginseng may increase risk of digoxin toxicity. Ephedra and ma huang may cause
dysrhythmias in clients taking digoxin. It is not advisable for a client on digoxin to take any
herbal remedies without first discussing it with their physician.
• Amiodorone, used to treat ventricular tachycardia interacts with a number of drugs and
herbs, including echinacea, aloe and grapefruit juice.
4. Antianginals - Nitrates
• Goal - to ↓ O2 demand of myocardium, eliminate symptom of angina, prevent MI
• Activities that precipitate angina – exercise, cold exposure, caffeine, smoking, big meals,
emotional stress
• Co-morbidity risk factors – dyslipidemia, diabetes, hypertension
• Adjunctive therapies – platelet aggregation inhibitors, statins – does this make sense?

• Nitrate type – Nitroglycerine:
o Uses – drug of choice for angina
o Actions
1. Peripheral vasodilation → ↓ preload in the heart → ↓ myocardial stretch
(Starling’s law) → ↓ oxygen demand of myocardium while ↑ing CO
2. Coronary artery vasodilation prevents ischemia by ↑ing perfusion &
delivery of O2
o Available in SL with half-life 1-4 min (treatment) & prophylactic SR transdermal
forms
o Adverse Effects – hypotension, dizziness, tachycardia, intense HA, tolerance
o NC - prevent tolerance (remove transdermal patch at hs or observe nitrate-free
periods per order), monitor BP, HR, pqrst, administer SL per protocol
What is the protocol?
5. Drugs for Thromboembolic Disorders
• These disorders are a major cause of morbidity & mortality – what can they cause?
• Thrombus - formation of a clot
• Embolus – thrombus ‘embolizes’ and circulates until it gets stuck → ischemia and
infarction with CVA, PE, MI depending on site
• Risk factors – immobility with venous stasis, dehydration, surgery/trauma, heart failure,
hypertension (atherosclerosis, arteriosclerosis), chronic inflammatory
diseases/disorders/stress
• Associated diagnostic tests – PT, INR, platelets, doppler US, angiogram
Thromboembolic Meds
Three classes:
1. Platelet Inhibitors – Aspirin, Clopidogrel (Plavix)
o Aspirin
 Action – inhibits platelet aggregation, prolongs bleeding time (DOES
NOT dissolve clots)
 Uses – unstable angina, ↓s risk of TIA, CVA, MI
 Adverse Effects – GI bleeding & irritation, dyspepsia, nausea

 NC – may mask fever, monitor VS, & hematocrit, assess emesis & stool
for blood, give with food
o Heparin
 Uses – prevent & treat DVT, PE, acute embolisms, prevention (prosthetic
heart valves, pre/post op, immobility)
 Action - interferes with clotting cascade, prevents soluble fibrin clots from
becoming insoluble, does not dissolve existing insoluble clots
 Adverse Effects – hemorrhagic stroke, anemia, thrombocytopenia,
bleeding, ecchymosis
 NC – NOTE onset is rapid, give SC in abdomen & monitor site, assess
labs (hgb, hematocrit, platelets, OB prn), continually assess for S/S of:
 bleeding - ? hemorrhage - ?
 What’s the difference?
o Warfarin:
 Action – potent, interferes with clotting cascade (inhibits vitamin K
synthesis)
 Uses – prevention of venous thrombosis, embolism from atrial fibrillation
or heart valve replacement, PE, post MI
 NC – the same as for heparin (assess for S/S of bleeding), monitor INR
 Describe potential QPA data if client is bleeding or hemorrhaging
• A number of herbal supplements may interfere with clotting (causing increased or
decreased clotting) or may increase the risk of bleeding. Make sure you do research so that
you may provide your clients with the appropriate education. Some of these herbs include,
but are not limited to, arnica, feverfew, chamomile, clove, ginko, garlic and ginger.
Related Lab Values
Prothrombin Time (PT)
• Time in seconds that it takes blood to clot
• ‘normal’ ~ 10 – 14
• Anticoagulating range is 50% higher ~ 18 (if ‘normal’ is 12)
• Therapeutic Range – enough anticoagulant to maintain the anticoagulating range without
bleeding

• International Normalizing Ratio (INR) – standardized calculation value for PT needed
because labs were using different reagents resulting in different reference values
• Therapeutic Range – 2.0 – 3.0 Assessed frequently during initiation of warfarin therapy
& when dose is changed – why?
6. Anticoagulants - NC
• Assess all skin/mucous membranes for ecchymosis & bleeding
• Assess for blood in emesis, stool, urine, sputum, nasal secretions
• Monitor VS
• Monitor INR & evaluate target range per MD’s order – call MD prn with result
o Usual anticoagulating range 2.0 - 4.5
• Monitor other labs – hematocrit, CBC
Activity - Abbreviations
1. How many doses in 24 hours if a drug is ordered: q8h, TID, OD, BID, q12h, q4h, ac
meals, hs, QID, q6h, pc meals ?
2. How many doses in a month if doses are ordered q weekly, q monthly ?
3. How many times is a STAT drug given ?
TOPIC 15: Quiz#3
TOPIC 16: Gastrointestinal System
· Describe major classes of drugs used to treat diseases/illnesses of the gastrointestinal system.
gastrointestinal drugs.
· Organize research of drugs used to treat diseases/illnesses of the gastrointestinal system in a
way that allows for easy and accurate reference.

Gastrointestinal System Drugs
Review Medication Calculations
1. Ordered - Nitroglycerin 0.3 mg, SL, Q5min prn for chest pain x 3 doses maximum. On
hand - Nitroglycerin 0.15 mg SL tablets.
How many tablets will you give per dose?
2. Ordered - Potassium Chloride 30mEq po BID. On hand - Potassium Chloride oral
solution 80 mEq/5ml.
How many mL will you administer per dose?
Gastrointestinal System Classes & Subclasses
1. Antacids (aluminum hydroxide)
2. Histamine (H2) Receptor Antagonists (ranitidine)
3. GI Prostaglandins (misoprostol)
4. Proton Pump Inhibitors (omeprazole)
5. Antiemetics - dopamine antagonist (metoclopramide), anticholinergic (dimenhydrinate
and/or diphenhydramine)
6. Anticholinergics - dimenhydrinate
7. Laxatives – stimulant (bisacodyl), saline (magnesium hydroxide), lubricant (mineral oil),
stool softeners (docusate sodium), bulk-forming (psyllium)
8. Antidiarrheals – locally acting (bismuth subsalicylate), systemically acting (loperamide)
Meds for GERD & PUD
• Gastro-Esophageal Reflux Disease (GERD) – reflux of gastric acid into esophagus with
inflammation, corrosion & scarring of esophageal wall
• Peptic Ulcer Disease (PUD) – ulceration in wall of stomach or duodenum
• Drug classes used to treat the above are antacids, prostaglandins, H2 receptor antagonists,
proton pump inhibitors
Antacids
• Action – buffers gastric acid from pH 1 - 2 to pH 3 – 4 → ↓ damage to tissues
• Uses – symptomatic relief by reducing gastric acidity for treatment of GERD, PUD,
gastritis, hiatus hernia

• Adverse Effects – constipation (aluminum & calcium based), diarrhea (magnesium
based)
• NC - give 1 hr ac or 2 hr pc other meds (↓ absorption of digoxin & antibiotics, ↑
absorption of levodopa), overuse & self-medicating can mask underlying disease
What accounts for an antacid’s ability to interfere in absorption of other meds?
• Meds:
o aluminum hydroxide (Amphojel, Maalox, Mylanta)
o magnesium hydroxide/oxide (Milk of Magnesia)
o calcium carbonate (Tums)
• Antacids may interfere with the actions of many herbal preparations in the same way that
they interfere with the absorption of other medications.
Histamine (H2) Receptor Antagonists
• Action – ↓s hydrochloric acid secretion
• Uses – GERD, PUD, stress-induced ulcers
• Adverse Effects – diarrhea, constipation
• NC – usual bowel pattern, maintain hydration, underlying infection/disease should be
ruled out (eg. H. Pylori infection)
• Meds – ranitidine (Zantac)
Why is cimetidine no longer a drug of choice in GERD & PUD?
• Nicotiana species herbs (tobacco) affect the acid blocking effects of ranitidine.
GI Prostaglandins
• Action – inhibits gastric acid & pepsin secretion
• Uses – prevention & treatment of gastric ulcers caused by NSAIDs and salicylates
• Adverse Effects – constipation, diarrhea
• NC – assess for adverse effects & intervene prn – With what NI?
• Med – misoprostol (Cytotec) Clients with what conditions might also be taking these?
• There are a number of herbs that influence prostaglandins. There is little information
regarding their interaction with GI prostaglandins, however, it is always better to consult a
health care professional when taking both herbs and western medications. Some of the herbs
or supplements that affect prostaglandins are curcumin, mangosteen, and pomegranate juice.

Proton Pump Inhibitors
• Action – inhibit gastric acid secretion
• Uses – treatment of severe GERD, esophagitis, PUD, hypersecretory disorders, with
antibiotics in tx of H. Pylori infection
What can this cause?
• Adverse Effects – diarrhea, rash
• Meds – omeprazole (Losec), rabeprazole (Aciphex)
• One study showed that taking St. John's wort greatly decreased blood levels of
omeprazole by accelerating the metabolism of the omeprazole. This could affect the action of
the omeprazole.
NI – Drugs for GERD & PUD
• Assess for C/O esophageal or epigastric pain, reflux, blood in emesis, stool if indicated, ?
tested for HP?
• Assess reason & pattern of use of OTC antacids
• Teach about adverse effects & appropriate NIs (diarrhea, constipation)
• Teach about taking antacids ac or pc other meds
Antiemetics
• Vomiting - a reflex originating in the medulla (stimulated by cholinergic & dopaminergic
fibres)
• We do have some cortical control
• N&V common in antineoplastic therapy (chemo and/or radiation), post op, pregnancy,
motion sickness, intoxication
• Possible consequences - dehydration, malnutrition, electrolyte imbalance, aspiration, GI
bleeding/trauma, aspiration
• Ginger is know to have antiemetic properties and has been found helpful in nausea and
vomiting due to motion sickness, pregnancy and post-operative procedures.
Dopamine Antagonist Antiemetics
• Action – block dopamine receptors along vomit centre pathways (but also at other CNS
sites)
• Uses – antineoplastic therapy, post-op

• Adverse Effects – extrapyramidal effects in larger doses (dystonia, parkinsonism, tardive
dyskinesia)
Make sense of this adverse effect...
• Meds – metoclopramide (Maxeran), prochlorperazine (Stemetil)
• These medication have a number of very serious side effects. They interact with a
number of drugs, therefore, it stands to reason that they may also interact with certain herbal
supplements. If you have a patient on a dopamine antagonist, educate them regarding the
importance of discussing their use of ALL medications and herbal supplements with their
physician.
Anticholinergic Antiemetics
• Action – reduces Ach on vomit centre pathways & those associated with vestibular
apparatus
• Uses- pregnancy and (What else? _______________________ )
• Adverse Effects – variable effectiveness, sedation is common, anticholinergic effects
(constipation, urinary retention, dry mouth)
• Meds – scopolamine, diphenhydramine (Benadryl), dimenhydrinate (Gravol)
• Herbs such as henbane which have anticholinergic side effects should not be taken with
anticholinergic antiemetics as the anticholinergic side effects may be increased.
• Some of these medications cause drowsiness so herbs that also cause drowsiness should
be avoided.
NC - Antiemetics
• Assess – underlying cause (chemo/radiation therapy, illness, medication side effect),
emesis (amount, presence of blood, mucous, colour, consistency), pattern of nausea,
food/fluid preferences, meds that may be responsible, VS & weight baselines, oral asmt,
abdominal asmt, hydration status, labs (electrolytes, albumin, pH, hgb, hct)…
• NC – give prior to expected onset of symptoms to ↑ therapeutic effect, frequent oral asmt
& oral care, smaller meals of well tolerated foods/fluids, pre-med for known meds that cause
N&V, prevent aspiration, suction equipment available, consult dietician prn, try supported
side lying position or ¾ prone, quiet room with low light, restful music per client’s
preference
Constipation & Laxatives
• Constipation – infrequent, incomplete or painful BMs due to ↓GI motility

• Prolonged constipation → drier stool
• Causes – low fibre and/or fluid, immobility or sedentary lifestyle, smooth muscle
weakness (from failure to go, excessive laxative use), tumours, drug effects – Which classes
particularly?
• Frequently → hemorrhoids & blood loss
• Treatment - start with non-drug interventions to the clients abilities (fibre, hydration,
exercise, teach stress management techniques)
• Contraindications – unexplained abdominal pain, N & V, fever, prolonged use
What is the risk associated with prolonged use?
• Nursing Asmts – usual pattern, size, consistency, colour, time of day, behaviour (does the
client respond immediately to the urge to have a BM), exercise/dietary fibre/fluid intake,
history of surgery, current medications, baseline wt/VS, abdominal asmt, labs as ordered,
current/past use of laxatives
• What is the consequence of long term use?
• A number of herbs have laxative effects. These should be avoided when taking other
laxative drugs as severe diarrhea could result and, if diarrhea continues over a prolonged
period of time, electrolyte imbalance could occur. Some herbs with laxative properties
include cascara sagrada, aloe, senna, rhubarb and others.
NC - Laxatives
• ABDOMINAL ASMT – Why?
• Assess and treat underlying cause if possible
• Promote physical activity within client’s limits
• Consult with client & dietician for added fibre and fluids of choice
• Assess for/teach prevention of dependency
• Assess for adverse effects – abdominal discomfort
• Teach not to strain! – What is this called and what happens to HR?
Stimulant Laxatives
• Action - stimulates smooth muscle to promote peristalsis
o PO act in 6 – 10 hours
o PR act in 60 – 90 minutes

• Adverse Effects – cramping, continuous use can cause loss of muscle tone → dependency
• Meds - bisacodyl (Dulcolax) – do not give with milk or antiulcer/antacids, sennosides
(Colace) → dissolution of enteric coating
Saline Laxatives
• Action - hypertonic fluid attracts water → distends bowel → promotes peristalsis
o PO acts in 1 – 3 hours
o continuous use can cause electrolyte imbalance & loss of muscle tone →
dependency
• Meds - magnesium citrate (Citromag), magnesium hydroxide (Milk of Magnesia)
• Adverse Effects – diarrhea, dependency, cramping
Stool Softening Laxatives
• Action – soften stool by drawing water into bowel, PO takes up to 72 hours to act
• Uses – post MI to prevent straining, drug of choice for active geriatric & pregnant client
with constipation
• Med – docusate sodium (Colace)
Bulk Forming Laxatives
• Action – promotes bulk (combines with water & intestinal contents), promotes peristalsis
• Uses – drug of choice for immobile client requiring ongoing laxative use, irritable bowel
syndrome, control of some forms of diarrhea
• Med – psyllium (Metamucil)
• Adverse Effects – bowel obstruction
How can this occur? Be prevented?
Antidiarrheals
Diarrhea - frequent or watery stools, may be acute/chronic, mild/severe
• IS A SYMPTOM, not a disease, may be a sign of colorectal ca
• Causes – intestinal infection (food poisoning or clostridium difficile), fatty foods,
excessive laxative use, medication adverse effect, emotional stress, irritable bowel syndrome,
hyperthyroidism

NC - Diarrhea
• Nursing asmts are the same as for constipation
• Specimen for C&S may be ordered
• Skin/mucous membrane asmt
• Frequent peri-care & application of barrier cream
• Comfort measure & privacy (call bell and/or bedpan, TP and hand wipes within reach)
• Assess for dehydration, orthostatic BP, wt loss, bloodwork
What specifically?
• Tannin containing herbs such as green and black teas, black walnut, uva ursi, red
raspberry, oak and witch hazel may decrease the activity or absorption of antidiarrheals such
as Lomotil.
• Herbs with a laxative effect may decrease the action of antidiarrheal medications.
Locally-acting Antidiarrheals
• Action – absorb excess water, irritants or bacteria → production of a soft stool
• Uses – diarrhea of sudden onset lasting 2-3 days with dehydration and electrolyte losses,
IBS, post GI surgery
• Meds - bismuth subsalicylate (Pepto-Bismol, Kaopectate), psyllium (Metamucil)
Systemic Antidiarrheals
• Uses – adjunct for acute diarrhea, ileostomy, irritable bowel disease (IBD)
o Do not use in GIT infection - Why?
• Adverse Effects – abdominal distension, constipation, worsening of diarrhea
• Med – loperamide (Imodium)
• Action – decrease autonomic stimulation of peristalsis → ↓ GIT motility → slows transit
time → ↑ time for intestinal water absorption → production of formed stool
What class of meds could cause this effect (mimic this mechanism of action)?
( Hint - see "Anticholinergic Antiemetics")
TOPIC 17: Genitourinary and Musculoskeletal System

· Describe major classes of drugs used to treat diseases/illnesses of the genitourinary and
musculoskeletal system.
· Define the major classes of drugs used totreat diseaseillness in the reproductive system.
genitourinary and musculoskeletal drugs.
· Organize research of drugs used to treat diseases/illnesses of the genitourinary and
musculoskeletal system in a way that allows for easy and accurate reference.
Genitourinary and Musculoskeletal Systems
Calculation Practice
1. A physician orders erythromycin 1G daily in 2 equally divided doses. On hand you have
250 mg capsules.
How many capsules will you give per dose?
2. Acetaminophen elixir is stocked as 160 mg/5 mL. The physician has ordered 15 mL to be
given q4-6h prn for pain.
How many mg will you be administering?
How many mL in 0.5 oz?
Genitourinary System Drugs
• UTI is the second most common infection (treated with antibiotics)
• UTI includes infection in the kidneys, bladder, prostate & urethra
• Urinary retention can → UTI (Why?) & is treated with cholinergic agonists – Why?
• Women at 10 x risk than men – Why?
• 80% of UTIs caused by Escherichia Coli – How does this occur?
• Estrogens and progestins as oral contraceptives - most common use of hormone therapy
is to prevent pregnancy.
• Hormone replacement therapy used to treat symptoms of menopause and to prevent
conditions caused by estrogen loss. HRT refers to replacement of both estrogen and

progesterone whereas estrogen replacement therapy (ERT) refers solely to estrogen
replacement.
• Oxytocics - uterine stimulants used to stimulate contractions.
• Tocolytics - uterine relaxants used to inhibit contractions in preterm labour.
• Male hypogonadism - insufficient testosterone production - numerous causes -What are
the causes of hypogonadism?
• Erectile dysfunction -What are the possible causes of erectile dysfunction?
• Benign prostatic hyperplasia (BPH) - most men will experience at least some
enlargement of their prostate as they age.
• Renal failure -What is it? What is the primary treatment goal?
• Diuretic therapy -What is the purpose of diuretic therapy?
UTI Treatment - norfloxacin
• Action – inhibits DNA synthesis, broad spectrum (What does this mean?)
• Uses – treatment of UTI, RTI, GU infection, bone & joint infections
• Adverse Effects – colitis, diarrhea, abdominal pain, N/V/D – Why these effects?
• NC – assess urine (how?), evaluate S/S of UTI, teach importance of finishing Rx as
ordered, ↑ fluid intake 2L/day to ↑ urine output
Why?
Anticholinergics - oxybutynin
• Use – overactive bladder syndrome (frequency, urgency, urinary incontinence)
• Action – blocks Ach receptors in smooth muscle of bladder – Does this make sense to
you?
• Adverse effects – Based on your knowledge of this general class (anticholinergics):
What would these be? What bladder condition would CI this med?
• NC – monitor & document urine & voiding pattern, monitor VS & compare with
baselines
Cholinergic - bethanechol
• Action – increases Ach action in GU & GI system smooth muscle
• Uses – treatment of non-obstructive urinary retention

• Adverse Effects – skin flushing, HA, nausea, diaphoresis, abd. cramps, diarrhea,
involuntary voiding or bowel evacuation
• NC – assess urine & voiding pattern
Contraceptives - estrogens and progestins
• Action - prevent fertilization by inhibiting ovulation and changing the cervical mucus and
the lining of the uterus to make implantation of an embryo less likely.
• Uses - to prevent pregnancy
• Adverse effects -What are the adverse effects of oral contraceptives?
• NC -Based on what you know about the adverse effects of oral contraceptives, what are
the NC?
Hormone Replacement Therapy
• Uses - to treat symptoms of menopause, prevent long-term consequences of estrogen loss,
and in some cases, to treat prostate and breast cancer.
• Adverse effects - there are a number of adverse effects related to hormone replacement
therapy and estrogen replacement therapy.According to your pharm text or drug guide, what
are these adverse effects? What are the drug interactions that you must monitor for when a pt
is on HRT or ERT?
• NC -Based on your knowledge of the adverse effects, what are the most important
nursing considerations when caring for a patient on HRT or ERT?
• Avoid herbs that are purported to have an effect on hormones while undergoing hormone
replacement therapy. Some of these include black cohosh, wild yam, chaste berry, damiana,
licorice, evening primrose.
Drugs Used in the Management of Labor/Preterm Labor
Oxytocics
• Action - stimulate uterine contractions.
• Uses - induce labor.
• Adverse effects - fetal complications may include dysrhythmias or intracranial
hemorrhage. Complications in the mother may include uterine rupture, seizures or coma.
Oxytocics interact with several drugs including vasoconstrictors which may lead to
hypertension.
• NC - monitor fetal heart rate, maternal vital signs, frequency, duration and intensity of
contractions, monitor fluid balance, monitor for post-partum hemorrhage.
Tocolytics - Terbutaline (beta -2-adrenergic agonist)
• Action - inhibit uterine contractions.

• Uses - prevent preterm labor.
• Adverse effects - tachycardia in mother and fetus.Based on your knowledge of adrenergic
agonists, what other adverse effects might you see?
• NC - monitor heart rate in mother and fetus.
• Used at the same time as caffeine containing products such as colas, teas, coffee, guarana,
yerba mate will increase the stimulant effect of these products.
Treatment for Male Hypogonadism - testosterone or other androgens
• Use - to restore normal gonadal development and secondary male sex characteristics.
• Adverse effects - water retention, edema, potential for liver damage, acne, skin irritation.
Testosterone, when taken by women for other disorders, may cause virilization.What is
virilization?
• NC - provide education to client, monitor client's condition, monitor liver enzymes,
physical assessment for signs of increased or decreased sex hormone production.What might
you expect to see?
Treatment for Erectile dysfunction - sildenafil (Viagra)
• Use - treatment of erectile dysfunction
• Action - acts by relaxing smooth muscle in the corpus cavernosum, allowing increased
blood flow into the penis, resulting in a firmer and longer-lasting erection.
• Adverse effects - hypotension occurs in men also taking nitrates for angina. Other side
effects are HA, dizziness, flushing, rash, nasal congestion, GI upset, UTI and chest pain.
There have also been reports of erections lasting longer than 6 hrs which could lead to
permanent damage to the penile tissues.
• NC - educate client re: not taking sildenafil and nitrates for angina at the same time; do
not take with high fat meals as absorption will be decreased; avoid grapefruit juice when
taking sildenafil.
• Viagra should not be taken with any herbs that claim to enhance sexual performance.
Benign Prostatic Hyperplasia (BPH)
• Treatment - alpha-adrenergic blockers (doxazosin, prazosin, tamsulosin, terazosin) and 5-
alpha reductase inhibitors (finasteride)
• Use - to relieve symptoms of BPH - do not cure the disease. May take 6-12 months of
treatment before relief of symptoms is noted.
• Action - alpha-adrenergic blockers act by relaxing smooth muscle in the prostate gland,
bladder neck, and urethra, easing the urinary obstruction.
• Adverse effects - HA, fatigue and dizziness, reflex tachycardia, hypotension, depression

• NC - assess for changes in urinary elimination (what might you see?), assess vital signs
(why?), monitor emotional status.
• Studies have shown that saw palmetto is as effective as finasteride in treating mild to
moderate BPH and has less undesirable side effects. Do not take finasteride and saw
palmetto at the same time.
Renal Failure
• Treatment - focuses on the cause of the renal failure - what are some of the causes of
acute and chronic renal failure?Diuretics are usually prescribed for renal failure. Loop
diuretics, thiazide diuretics, potassium-sparing diuretics, miscellaneous diuretics.
• Use - to increase urine output.
• Action - act by blocking sodium reabsoroption in the nephron and sending more sodium
to the urine. Chloride follows the sodium. Water molecules also tend to move with the
sodium which blocks the reabsorption of the sodium, increasing urine volume.
• Adverse effects - dehydration, electrolyte imbalance, hypotension, dizziness, fainting.
Ototoxicity may rarely occur with loop diuretics. Thiazide diuretics may cause
hyperglycemia in diabetic patients.
• NC - with loop and thiazide diuretics potassium loss may lead to hypokalemia resulting
in dysrhythmias. Potassium loss is of particular concern to clients also taking digoxin -
digitalis induced heart disturbances could result when taken in combination with certain
diuretics. Monitor for signs of dehydration, electrolyte imbalances, hypotension, weight loss
or gain, monitor intake and output.
• Avoid herbs that may increase potassium loss such as licorice, aloe, buckthorn. Also
avoid herbs with a diuretic effect such as dandelion, uva ursi, juniper, buchu, cleavers, and
horsetail. Avoid herbs that may affect blood pressure - ginko, licorice.
Musculoskeletal System
Muscle Relaxants – 4 types
• Centrally-acting muscle relaxants – what does this mean?
• Direct-acting muscle relaxants
• Blocking Agents
• Miscellaneous group
What NC will you implement for this general group of medications?

Muscle Relaxants - central
• Use - for acute muscle spasm, not for upper motor neuron lesion (UMNL) spasticity
• Action - CNS depression
• Adverse effects – sedation & other CNS depression S/S – Like…?
• NC – monitor pain, muscle strength/ROM, for CNS depression, DB&C prn – What will
you assess for?
• Med – methocarbamol (Robaxin), benzodiazepines, cyclobenzaprine, others.
Muscle Relaxants - direct (dantrolene, Botox)
• Use – for spasticity & hyperreflexia associated with UMNL disorders such as CP, MS,
SCI
• Action – interferes with Ca+ release in skeletal muscle cells
• Adverse effects – weakness, drowsiness, dizziness
• NC – ensure safety, assess muscle strength/ROM/pain, onset is 1 week
Muscle Relaxants - Blockers
• Use – for general anesthesia, ET tube insertion, ECT, given by anesthetist
• Action - blocks transmission of motor impulses at neuromuscular junction
• Adverse effects - ↓ cough reflex, dysphagia, salivation
• NC - What NC make sense for these?
Misc. Muscle Relaxants - baclofen
• Action – CNS depression through ↓ reflex activity at spinal cord level
• Uses – treatment of spasticity from MS, SCI
• Adverse Effects – drowsiness, HA, nausea, fatigue
• NC – DC slowly, caution if spasticity is providing balance/stability, monitor pain and
self-care abilities, RR
• Herbs that may have muscle relaxing properties include cayenne, wild yam, saw
palmetto, rosemary, goldenrod, chamomile and celery seed.

Treatment of Hypocalcemia
• Treatment - with dietary modification or supplementation with calcium and vitamin D.
• NC - assess for hypo and hypercalcemia - What would you expect to see in both of
these? Monitor serum calcium levels, obtain thorough health history, provide client
education.What will you educate the client regarding? When are calcium supplements
contraindicated?
Treatment of Osteomalacia (Rickets)
• Treatment - calcium and vitamin D supplements
• Adverse effects - because vitamin D is a fat-soluble vitamin it could lead to toxicity if
accumulation occurs.What are the S&S of vitamin D toxicity?
• NC -what assessments and client education are needed?
Bone Resorption Inhibitors
• Generally the biphosphonate group
• Uses - treatment of osteoporosis & hypercalcemia (alendronate, etidronate, ibandronate)
• calcitonin-salmon can also be used to ↓ pain in clients with cancer that has metastasized
to the bones
Bone Resorption Inhibitors - alendronate
• Action – inhibits osteoclast activity
• Uses – treatment & prevention of OP in men, postmenopausal women and those on
corticosteroids (≥ 7.0 mg/day)
Think about why these clients are at risk...
• Adverse Effects – well tolerated
• NC – MUST be taken at least 30’ before food/drink/vitamins/minerals/other meds
o Give with 8oz water, must sit/stand for 30’ post dose
• Adjunctive therapy in OP - wt bearing exercise, Ca+, Mg and vitamin D
Arthritis (osteoarthritis, rheumatoid arthritis and gout)
• mainly treated with analgesics and anti-inflammatory medications. Other drugs are
specific to each type of arthritis.
• osteo - NSAIDS, cox-2 inhibitors (celecoxib), sodium hyaluronate
• rheumatoid - glucocorticoids, hydroxychloroquine, sulfasalazine, methotrexate

• gout - indomethacin, cox-2 inhibitors, colchicine, allopurinol
• Adverse effects - specific to individual drug classes
• NC - pain assessment, monitor for side effects of medications, use of non-
pharmacological therapies for arthritis pain management -what are some non-
pharmacological therapies?
• Chondroitin and glucosamine are two supplements used to treat osteoarthritis. Many
other herbs are suggested for the treatment of arthritis including horsetail, yarrow, celery,
gotu kola and many others.
TOPIC 18: Miscellaneous Drug Classifications and Review
· Define the major classes of drugs used to treat diseaseillness in the reproductive system
· Identify miscellaneous classifications of drugs and their respective actions and uses: anti
neoplastic agents and medications for eye/ear disorders
· Organize research of drugs used to treat diseasesillnesses covered in this topic in a way that
allows for easy and accurate reference.
· Identify the main nursing considerations related to these groups of drugs.
Miscellaneous Drug Classifications
Miscellaneous Systems & Meds
1. Antineoplastics – alkylating agents, antimetabolites, hormones
2. Meds for eye disorders – timolol
3. Meds for inflammation, fever, allergies
4. Anaphylaxis & medication administration (epinephrine)
5. Meds for skin disorders
Antineoplastics
• Goal of chemotherapy is to administer a “dose large enough to be…cytotoxic to cancer
cells, but small enough to be tolerable for normal cells” (Clayton & Stock, 2007, p. 716)
• Action - interferes with cell’s metabolism at various points in the cell’s life cycle
• Chemotherapy is most toxic to rapidly dividing cells (ca cells & some normal cells)

• Cytotoxic Meds – alkylating agents (busulfan, cisplatin), antimetabolites (methotrexate),
natural products (etoposide, vincristine), antibiotics (daunorubicin), hormones (flutamide),
other agents (interferon a)
• Agents are often used together in a “protocol” to provide best specific cytotoxic effect
• Uses – ca treatment, to control the disease or for palliation to control symptoms
• Adverse Effects – nausea, vomiting, diarrhea, bone marrow suppression - with what
potential effects?
What systems have rapidly dividing cells so will also be adversely affected?
NC for Antineoplastics
Understand the treatment goals What are the possible options?
• Monitor - VS, labs – which labs values?
• Monitor for S/S of infection due to ___________________
• Monitor for anemia due to ____________________________________
• Monitor for bleeding due to _________________________________
• Manage pain and N&V effectively (give analgesics & antiemetics prophylactically as
ordered) – how ill you assess effectiveness?
• some herbs and supplements can be helpful managing side effects during cancer
treatment but others may interfere with treatment. Some of those that may interfere are
curcumin and quercetin which are strong anti-cancer flavonoids but they may disrupt the
anti-tumor activity of cyclophosphamide.
Drugs for Eye Disorders - NC
• Most meds given topically
• Ointments may block action of other meds
• Lacrimal canal must be blocked for 3 - 5 minutes to prevent drainage of medication and
subsequent systemic absorption
Why does it matter?
• More than 1 gtt per eye is not advised (separate by 5 minutes prn)
• May cause temporary visual disturbance
β adrenergic blocker – timolol
• Action – ↓s production of aqueous humour → ↓ IOP

• Uses – tx of open-angle glaucoma
• Adverse Effects – bradycardia, hypotension, arrhythmia, bronchospasm – how could
these occur?
• NC – block systemic absorption by teaching client how to compress lacrimal duct x 5
minutes, monitor VS & compare with baselines – why?do not give with cardiovascular
stimulants
• do not give with epinephrine
Treatment of Inflammation
NSAIDS - ASA, celecoxib, diclofenac, ibuprofen,naproxen
• Action - have analgesic, antipyretic, and anti-inflammatory effects. Used for mild to
moderate inflammation. Act by inhibiting prostaglandin synthesis. Block inflammation by
inhibiting COX-1 and COX-2 preventing them from forming inflammatory
prostaglandins.What are the undesirable side effects of blocking COX-1?
• Adverse effects - salicylism with high doses of ASA - what does this refer to? Adverse
effects of ibuprofen-like NSAIDS include nausea and vomiting.
• NC - assess for sensitivity to NSAIDs, presence of bleeding disorders, peptic ulcer
disease, anticoagulant drugs or herbs, CHF, fluid retention, heart disease -why? Why should
these drugs not be administered to someone with liver dysfunction? What client teaching
should you provide?
• do not give any herbs that affect blood coagulation with NSAIDs because of their "blood
thinning" properties ginko, ginseng,
SYSTEMIC GLUCOCORTICOIDS - prednisone, betamethasone, cortisone
• Action - suppress histamine release and inhibit the synthesis of prostaglandins by COX-2.
Can inhibit the immune system by suppressing certain functions of phagocytes and
lymphocytes.
• Use - suppresses severe inflammation
• Adverse effects - suppress normal function of adrenal glands - why is this an issue? can
also cause hyperglycemia, mood changes, cataracts, peptic ulcers, electrolyte imbalances and
osteoporosis; may mask other infections -What may result from masking infection and
suppressing the immune system? What might occur in long-term treatment with
glucocorticoids?
• NC - screen for existing infection, obtain baseline data - what would this be? monitor
diabetic clients closely as well as clients with heart failure, hypertension, or renal disease
-why?

• avoid ginseng when taking prednisone as it may create an additive effect. Also avoid teas
meant to stimulate the immune system as the purpose of prednisone is to suppress the
immune system. Some of these include astragalus, cat's claw, licorice and echinacea.
Treatment of Fever - antipyretics
NSAIDs and acetaminophen
• Use - to decrease fever
• Acetaminophen is the antipyretic of choice.Why?
• NC - assess temp before and after administration of antipyretic. Assess developmental
status and baseline lab data -why?
Treatment of Allergy
• all allergies are caused by exposure to an antigen which is anything recognized as foreign
by the body.
Antihistamines - diphenhydramine
• Action - block the actions of histamine at the H1-receptor.
• Use - prevent allergy symptoms from occurring.
• Adverse effects - first generation antihistamines caused CNS depression and significant
drowsiness; newer ones generally don't cause drowsiness. Contraindicated in clients with
dysrhythmias and heart failure. Also contraindicated in clients with narrow-angle glaucoma
because of anticholinergic effects.
• NC - monitor for profound sedation and altered consciousness especially in older clients
who are at risk of falling and other injuries.
• Herbs that may interfere with antihistamines include St. John's wort; caution should be
taken with any herbs that may cause drowsiness or CNS depression.
Intranasal Glucocorticoids - fluticasone
• Action - act locally to treat inflammation.
• Adverse effects - when applied to broken mucous membranes, systemic effects may
occur. May mask signs of infection in the mouth and throat
• NC - assess mucous membranes of the nose, assess for signs of infection, provide
education -what will you educate the client about?
Adrenergics - pseudoephedrine
• Action - stimulate the sympathetic branch of the autonomic nervous system.
• Use - relieve nasal congestion when given by oral or intranasal route.

• Adverse effects - rebound congestion
• NC - because of rebound congestion intranasal adrenergics should not be used for longer
than 3-5 days. Possibility of systemic side effects is greater with oral adrenergics.
Hypertension and CNS stimulation leading to anxiety and insomnia are potential side effects.
Treatment of Anaphylaxis
• Occurs in 6% – 10% of clients
• Allergic response ranges from delayed hypersensitivity with urticaria → anaphylaxis
upon re-exposure
• Any allergic S/S must be documented and that drug identified as an allergen for that
client
Why?
• Client must be instructed to tell all MDs, nurses, pharmacists, dentists…
Anaphylaxis - epinephrine
• Use – anaphylaxis, cardiac arrest, asthma
What class of med is this?
• Action - binds rapidly to α (vasoconstriction), β1 (cardiac) & β2 (pulmonary) receptors,
blocks histamine release
With what effects?
• Onset of action is route dependent (IV, IM, SC), SC EpiPen onset is 5’-10’
• Adverse effects – palpitations, nervousness, tachycardia, flushing, tremors, angina,
arrhythmia, hypertension
Do these make sense?
What other medications have similar adverse effects?
NC for Epinephrine
• Monitor for hypersensitivity – what would you expect?
• Continuous VS
• Monitor for adverse effects (arrhythmia, angina, HR >110, hypertension)
• In DM – monitor glucometer for hyperglycemia
• In asthma - ↑ HOB, monitor chest/respirations/sputum, monitor for paradoxical
bronchospasm

CAUTION!
Fatalities have occurred because nurses chose:
• Wrong concentration!
• Wrong pre-filled syringe!
• How could this happen?
• How can you ensure you never do this?
• Use tuberculin syringe for SC – Why?
Trade names – EpiPen, Adrenalin, Asthma-Haler Mist
Treatment of Skin Disorders
Skin Infections - bacterial, fungal, viral
• topical antibiotics - bacitracin, chloramphenicol, gentamicin, neomycin
• topical antifungals- fluconazole, nystatin, ketoconazole, miconazole
Treatment with scabicides and pediculicides
• Use - to kill mites and lice
• Action - lindane is absorbed into lice, mites and their eggs producing seizures and death
• Adverse effects - risk of CNS toxicity. If over-applied or accidentally ingested, ct may
experience HA, N&V, irritation of nose, ears or throat, dizziness, tremors, restlessness or
convulsions.
• NC - wear gloves when applying lindane, provide client education re: possible side
effects. Educate client and/or family re: non-chemical approaches to treating head lice such
as physically removing all lice and eggs.
Treatment of Acne
• many OTC formulations available - benzoyl peroxide, salicylic acid
• Action - keratolytic effect - helps to dry out and shed outer layer of skin.
• prescription acne treatments include retinoids, antibiotics, ethinyl estradiol
• retinoids have an irritant action that decreases comedone formation and increases
extrusion of comedones from the skin, others reduce the size of sebaceous glands - tretinoin,
isotretinoin.
• antibiotics decrease the redness and inflammation associated with acne - doxycycline,
tetracycline.
• ethinyl estradiol is an estrogen hormone that is sometimes used to treat acne.

• Adverse effects -based on what you know about these drugs, what are the adverse effects
you should be aware of?Isotretinoin has been linked to an increase in depression and suicidal
ideation
• NC - many prescription treatments for acne should not be used during pregnancy
TOPIC 19: Final Comprehensive Exam
Prep for Final
• Comprehensive Final Pharm Exam December 9/2013 @ 09:00
• 35% of final grade
(If you feel that you are not doing well in pharmacology, please make an appointment to see the
health sciences tutor asap.)
This following is a summary prepared by Nicole from the last Pharm course!
"This list may not be completely inclusive. Basically, you are responsible for all the course
content. I have not listed every classification and every med on this list, but you are responsible
for ALL pharmacology content covered during this course."
- Pharmacology/pharmacokinetics/pharmacodynamics
Pharmacokinetics – what the body does to the drug: absorption,distribution, metabolism,
excretion
Pharmacodynamics – what the drug does to the body.
Differences between -generic, brand and trade name
OTC/controlled substances/prescription drugs/drug schedules
Food and drug act/ drug legislation
half-life
abbreviations
agonist/antagonist/partial agonist
drug actions and reactions
-Medication administration - types of med admin, routes of med admin, associated terms, 10
rights, 3 checks, MAR, preventing med errors, what to do in case of an error
-Nursing process – how do the components fit in with medication administration?

- Be clear what controlled substances are and understand the differences between controlled
substances and prescriptions.
Know the drug schedules ie what is a schedule 1 drug? others?
- Make sure you know abbreviations ie. bid, tid, qid, prn, stat, qd, MAR, NPO, IM, PO, IV, SC,
SL, others?
-Know the function of the MAR and prn record – when are they completed?
-Classifications- actions, uses, side effects, nursing implications, assessments, etc… of all the
meds covered in pharm. (make a big chart or drug cards to keep these all straight).
bowel meds, eye and ear meds as noted in course material - know actions, uses, nursing
considerations
herbal supplements and vitamins - know the common ones listed in the unit - St. John's wort,
ginko, black cohosh, feverfew
Understand the nurse's responsibility when the client is taking herbal supplements.
Info specific to older adults and med. Admin.
Effects of aging on absorption, distribution, metabolism, excretion of drugs
Cholinergics, anticholinergics, adrenergics, etc… which one mimics the parasympathetic
nervous system, etc…
Polypharmacy in the older adult
Nursing implications, health teaching, safe med admin for the older adult
Pain control principles, opioids, methadone, NSAIDS
What assessments need to be done before and/or after administering certain medications?
Why?
Symptoms of toxicity of certain meds
Are there certain meds you can/can’t give together? Why or why not?
Lab tests to monitor blood levels of certain meds
Reasons for using chemo and side effects, etc… of chemotherapy i.e. chemotherapy is used
for aggressive cancer treatment and also palliative cancer treatment.
Side effects of chemo
S&S of hypo and hyperglycemia
Onset of different types of insulin, use of sliding scale
Oral hypoglycemics

Antitussives, antihistamines, mucolytics, expectorants
ALL MEDS COVERED IN EVERY UNIT!!!!!!
Good luck

Nursing and pharmacology topics 11-19

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Nursing and pharmacology topics 11-19

Similar to Nursing and pharmacology topics 11-19 (20)

More from Jack Frost

More from Jack Frost (20)

Recently uploaded

Recently uploaded (20)

Nursing and pharmacology topics 11-19