Summery

1. Study Guide
PHARMACOLOGY
Pharmacology- Study of the biological effect of chemicals
Pharmacotherapeitics- Clinical Pharmacology
involving grugs use to treat, prevent, or diagnose a disease
NURSING PROCESS &
MEDICATION ADMINISTRATION
1. Assessment
Allergies
Pattern of health care
Understanding of the disease process
Financial support
2. Physical Assessment
Age & weight
Social support at home
Chromic condition
3. Diagnostic test, Laboratory test
4. Medication History
Prescriptions
OTCS
Herbals
Response to medications
NURSING DIAGNOSIS
Human response to illness Drug therapy
may only be a part of the total picture
Drug therapy is incorporated in the total
picture
PLANNING
1. Identify possible intractions
2. Client and family education
3. Gather equipment, review procedures,
safety measures, timing & frequency
of drugs.
4. Storage of drugs
IMPLEMENTATION
1. Maximizing therapeutic effects
2. Minimizing adverse effects
3. SIX rights of medication administration
Monitor the patient response to drug
therapy expected outcome
Unexpected outcome
EVALUATION
THE 5 RIGHTS
OF MEDICATION
ADMINISTRATION
1. Right drug
2. Right dose
3. Right time
4. Right Route
5. Right patient
SIX ELEMENTS
OF A DRUG ORDER
1. Name of the patient
2. Date order is written
3. Name of medication
4. Dosage which includes
size, frequency &
number of doses
5. Route of delivery
6. Name & signature of
the prescriber

2. DOSAGE CALCULATION
IV Medication Weight Based Calculation
IV Flow Rates: (mL / hr)
IV Flow Rates: (gtts/min)
Order: 1 mg IV
Supplied: 0.4 mg / ml
Order: 2L (over 48 hours)
Order: 2 mcg/kg/min
Weight: 130 lbs
Supplied: 250mg/250ml
Order: 2L (over 48 hours)
Drip Factor: 15 gtts/ml
10 drops/ml approx
7
1 mg
1
1
0.4
2.5 ml
1 ml
0.4 mg
ml/hr
2.5 mL
10
130lbs
1
250 ml
250 mg
1 Kg
2.2lbs
2 L
48 hrs
41.66
2 L
48 hrs
1,000mL
1 L
15gtt
1 mL
30,000
=
2,880
10.41gtts/min
ml
42 ml/hr
1 mg
1,000mcg
2mcg/min
1 Kg
1 hr
60 min
1,000ml
1 L
2,000
48
0.11818ml/min
65,000
550,000
0.11818
1 min
60 min
1 hr
7ml/hr
7.0908
1

3. NURSING DOSAGE CALCULATION
• 1 mg = 1000 mcg
• 1 g = 1000 mg
• 1 Kg = 1000 g
• 1 Kg = 2.2 lbs
• 1 oz = 30 ml
• 1 ml = 1 cc
• 1 L = 1000 ml
• 1 tsp = 5 ml
• 1 tbsp = 15 ml (3 tsp)
• 1 cup = 8 ft oz
• g = gram
• mg = miligram
• mcg = microgram
• kg = kilogram
• lbs = Pound
• oz = Ounce
• mL = mililiter
• tsp = teaspoon
• tbsp = tablespoon
Conversions Comprehensive
Dimensional Analysis
Rounding
• How many mililiter in 9oz?
9oz
1
30 ml
1 oz
• How many micrograms in 30mg?
30 mg
1
1,000mcg
30,000mcg
=
1 mg
• How many kilogram in 170 lbs?
170 lbs
1
1 Kg
= 77.3 Kg
=
2.2lbs
170
2.2
0.5mg
1
1000mcg
5
=
1mg
1 tab
100
500
100
50mg
1
2mL
0.8
=
25mg
1 tab
5mL
100
125
• How many microgram in 0.5 g?
• Determine the unit that you are calculating (Tablets)
• Detemine the quality available (1 Tablet)
• Determine the dose available (300 mg)
• Determine the desired dose (600mg)
Quantity Desired dose
x
x
Available dose
0.5g
1
1,000mg
50,000mcg
=
1 g
1,000mcg
1 mg
• How many miligram in 10 tsp?
10tsp
1
5mL
50 mL
=
1 tsp
Less than 1.0 = Round to nearest
hundredth
Greater than 1.0 = Round to
nearest tenth
5 tab/dose
Solid Dose Medication
Oral Liquid Medication
Order: 0.5 mg daily
Supplied: 100 mcg/dose
0.8 tsp/dose
Order: 50mg 4 hours
Supplied: 25 mg/2 mL
1 Tablet 600 mg
=
x
x
300 mg

4. PHARMACOLOGIC PRINCIPLES
DRUG
DRUG NAMES
PHARMACOKINETICS PHARMACODYNAMICS
Any chemical that affects the physiologic
mechanism of a living organism
1. Chemical Name
Describe the chemical structure and composition
2. Generic Name
Non propriety name given by USANIC
3. Brand Name
Registered trademark
EXAMPLE
Chemical Name
Propionic acid
Generic Name
Ibuprofen
Brand Name
Motrin
A. Absorption
-movement of drug from the site
of administration
B. Distribution
transport of a drug to the
bloodstraem
C. Metabolism
atleration of a drug in the body
D. Elimination elimination of the drug
or its compound in the body
-Mechanism by which drugs produce
change in body tissue.
1. Desired effect - intended action of
drug
2. Adverse effect - harmful
unintended reactions
3. Side effect - consequence reactions
4. Toxicity - the degree which
something is poisonous
digoxin = 0.5 - 2.0 ng/mL
lithium = 0.5 - 1.5 ,Eq/L
PHARMACOLOGY
The study or science of drugs
Pharmacologic Principles
1. PHARMACEUTICS
2. PHARMACOKINETICS
Study of Drug forms
Deals with the delivery system
The rate at which drug is dissolved and absorbed
a.1. Pharmaceutical pharse
Dose of formulated drug
Administration
Disintegration and dissolution
of the drug in the body
a.2. Pharmacokinetic phase
drug available for absorption
Absorption, distribution, metabolism,
excretion
a.3. Pharmacodynamic Phase
Drug available for action
Drug receptor interaction
Effect
The study of what accually happens to a drug
from the time it enters the body until it has left the body

5. DRUGS AFFECTING THE CENTRAL &
AUTONOMIC SYSTEM
Chalinergic Agent (Parasympathomemitics)
CHOLINERGIC BLOCKING AGENT
(PARASYMPATHOLYTICS,
ANTICHOLINERGICS
CLASSIFICATION OF DRUGS
PROTOTYPE
MECHANISM
OF ACTION
INDICATIONS
ADVERSE
EFFECT
NURSING
CONSIDERA
-TIONS
Synthetic acetylcholine, pilocarpine, carbachol,
bethanecol
(Urocholine), edrophonium (Tensilon), neostigmine
(Prostigmine),
pyridostigmine (Mestinon)
Stimulates cholinergic receptors by mimicking
acetylcholine or inhibition of enzyme
cholinesterase
Glaucoma, urine retention, Myasthenia Gravis -
antidote to neuromuscular blocking agents:
tricyclic antidepressants and atropine
Blurring of vision, miosis - increase in salivation,
intestinal cramps - bronchoconstriction, wheezing,
DOB - hypotension and bradycardia
1. Warn & monitor clients of the side effects.
2. Have atropine available for use as antidote.
Atropine, scopalamine (Triptone), dicyclomine
(Bentyl), propantheline (Pro-Banthine).
Block the binding of acetylcholine in the
receptors of parasympathetics nerves.
e- use preoperatively to dry up secretions -
treat spasticity of GI or urinary tract - use for
treatment of bradycardia, asthma, parkinsonism
use for antidote in organophosphate poisoning.
-dry mouth, dilatation of pupils, tachycardia
-urinary retention, ileus, heat stroke
1. Keep client’s in cool environment.
2. Watch out for signs of heatstroke & dehydration
3. Encourage clients to increase fluid intake & use
of sugarless gum/candy for dry mouth
4. For GI spasticity, administer 30 minutes before
meals and at bed time.
PROTOTYPE
MECHANISM
OF ACTION
INDICATIONS
ADVERSE
EFFECT
NURSING
CONSIDERA
-TIONS

6. CENTRAL NERVOUS SYSTEM
STIMULANTS
ANTIPARKINSONIAN AGENTS
NURSING
CONSIDERA
-TIONS
ADVERSE
EFFECTS
INDICATIONS
MECHANISM
OF ACTION
PROTOTYPE
a. Anticholinergic agents - trihexyphenidyl
(Artane), benztropine (Congentin)
b. Dopaminergic agents - Levodopa, carbidopa-
levodopa (Sinemet), amantidine (Symmetrel),
pergolide (Permax), selegiline (Eldepryl),
bromocripyine
a. Anticholinergic agents
-inhibit cerebral motor centers.
b. Dopaminergic agents
-increasing dopamine concentration or
enhancing neurotransimitter functioning.
a. levodopa - nausea, vomiting, anorexia, orthos-
tatic hypotension, dark-colored urine and sweat
b. amantidine - ankle edema, constipation
c. bromocriptine - palpitations, tachycardia.
1. Give dopaminergic agents after meals to reduce
GI symptoms.
2. Reassure client that levodopa may cause harm-
less darkening of urine & sweat.
3. Avoid taking Vit B6 (pyridoxine) with levodopa
because it speed up metabolism.
4. Educate clients to minimize orthostatic
hypotension.
5. Elevate leg to reduce ankle edema.
-for acute musculoskeletal pain - for muscle spasticity
associated with multiple sclerosis, cerebral palsy,
CVA, and spinal cord injury.
NURSING
CONSIDERA
-TIONS
ADVERSE
EFFECTS
INDICATIONS
MECHANISM
OF ACTION
PROTOTYPE -amphetamines, methylphenidate (Ritalin)
-increase excitatory CNS neurotransmitter activity
and blocks inhibitory impulses.
1. Should be given at morning
2. Don’t stop amphetamine abruptly to avoid with-
drawal symptoms.
3. Monitor blood pressure and pulse.
4. Ice chips or sugarless gum for dry mouth.
5. Watch out for growth retardation in children
taking methylphenidate.
-for obesity (amphetamines) - attention deficit hyper-
activity disorders - narcolepsy - deug - induced
respiratory depressions.
-nervousness, insomnia, restlessness - hypertention,
tachycardia, headache - anorexia, dry mouth.

7. DRUGS AFFECTING THE
CARDIOVASCULAR SYSTEM
PROTOTYPE
MECHANISM OF ACTION
INDICATIONS
NURSING CONSIDERATION
PROTOTYPE
MECHANISM OF ACTION
INDICATIONS
NURSING CONSIDERATION
Aspirin, Dipyridamole (Persantin) Clopidoigrel
(Plavix), Ticlopidine
-digoxin (Lanoxin) and digitoxin
(Crystodigin)
-increase intracellular calcium which
causes the heart muscle fibers to contract
more efficiently, producing positive
inotropic & negative chronotropic
-use for CHF, atrial tachycardia and
fibrillation
-Monitor for toxicity as evidence by: nausea,
vomiting, anorexia, halo vision, confusion brady-
cardia & heart blocks. -Don’t administer if pulse is
less than 60 bpm. -Should be caution in patient
with hypothyroidism & hypokalemia. -Antidote:
Digi-bind - Phenytoin is the drug of choice to
manage digitalis-induced arrhythmia.
-inhibit the aggregation of platelet thereby
prolonging bleeding time.
-used in the prophylaxis of long-term
complication following M.I, coronary
revascularization, and thrombotic CVA
-Monitor bleeding time (NV=1-9 mins) -
Take the medication with food.
ANTIPLATELET
MEDICATIONS
CARDIAC
GLYCOSIES

8. DRUG AFFECTING MENTAL FUNCTIONING
PROTOTYPE
SEDATIVES, HYPNOTICS & ANXIOLYTICS ANTIDEPRESSANTS & MOOD DISORDER
MECHANISM OF ACTION
INDICATIONS
NURSING CONSIDERATION
a.Benzodiazepines - diazepam (Valium),lorazipam
(Ativan), alprazolam (Xanax), flurazepam (Dalmane)
b.Barbiturates - amobarbital, phenobarbital, seco-
barbital c. Miscellaneous - chloral hydrate (Noctec),
buspirone (Buspar), paraldehyde (Paral)
a.Benzodiazepines - increase the effect of
inhibitory neuro transmitter GABA (gammaamino
butyric acid) b. Barbiturates and Miscellaneous
agents - depress CNS
-induce sleep, sedate and calm clients
ADVERSE EFFECTS
-hangover-effect, dizziness, CNS depression
respiratory depression, drug-dependence
1. Warn clients of injuries and falls
2. Brief period of confusion & excitement upon
waking up is comon with benzodiazepines.
3. Warn clients not to discontinue medications
abruptly without consulting a physician
4. Avoid alchohol while taking these drugs.
5. Rotate & don’t shake the ampules of
barbiturates. Don’t mix with other drugs.
6. Warn female clients that diazepam is
associated with cleft liip
PROTOTYPE
MECHANISM OF ACTION
ADVERSE EFFECTS
NURSING CONSIDERATION
a.Tricyclic antidepressants - amitriptyline (Elavil),
protriptyline (Vivactil), imipramine (tofranil),
desipramine b. MAO (monoamine oxidase
inhibitors) - isocarboxazid (Marplan), phenelzine
(Nardil), tranylcypromine (Pernate) c. Second-
generation antidepressants - fluoxetine (Prozac)
trazodone (Desyrel d. Lithium
a.Tricyclic antidepressants - increase receptor
sensitivity to serotonin &/no norepinephrine.
b.MAO inhibitors - inhibit the enzyme MAO that
metabolize the neurotransmitters norepinephrine
& serotonin. c. Second - generation antidepressants
inhibits the reuptake of serotonin. d. Lithium
increase serotonin & norepinephrine uptake
-dry mouth, blurred vision, urine retention,
constipation (anticholinergic effects) -
orthostatic hypotension, insomnia - hypertensive
crisis (MAO) - dehydration (Lithium).
1.Caution client to rise slowly to reduce the effect of orthostatic
2.Take antidepressant with food to enhance absorption
3.Explain to client that full response may take several weeks
4.Assess client for constipation resulting from tricyclic anti-
depressant use
5.Client taking MAO inhibitors should avoid tyramine-rich food
to avoid hypertensive crisis aged cheese, sour cream yogurt,
beer, wine chocolate, soy sause & yeast - pentholamine
(Regintine) is the drug of choice for hypertensive crisis.

9. DRUGS USED IN PAIN
MANAGEMENT
PROTOTYPE
MECHANISM OF ACTION
ADVERSE EFFECTS
NURSING CONSIDERATION
PROTOTYPE
MECHANISM OF ACTION
NURSING CONSIDERATION
a.Phenothiazines - chlorpromazine (Thorazine),
trifluoperazine (Stelazine),thioridazine (Mellaril),
b. Other Agents - clozapine (Clozaril), haloperidol
(Haldol)
a.Inhalation anesthetics - enflurance (Ethrane), halo-
thane - isoflurance (Forane), nitrous oxide b. Injection
anesthetics - fentanyl (Sublimaze), ketamine (Ketalar),
thiopental Na (Penthotal), etomidate (Amidate)
-cause CNS depression, by producing loss of
consciousness, unresponsiveness to pain stimuli, &
muscle relaxation.
1. Instruct client NPO for 8 hours before administra-
tion,
2. Monitor cardio pulmonary depression & hypoten-
sion.
3. Monitor urinary retention.
4. Monitor body temperature - malignant hyperther-
mic crisis: danttrolene (antidote).
5. Avoid alchohol or CNS depressants for 24 hours
after anesthesia.
6. In patient who received halothane, monitor signs
of hepatics fatal side effect: -rash, fever, nausea,
vomiting - jaundice & altered liver function.
-block dopamine receptor in the limbic system, hypo-
thalamus, and other regions of the brain.
-Extra phyramidal symptoms such as dystonia,
pseudoparkinsonism, & an irreversible tardive dyskinesia
as manifested byL a. lip smacking b. fine wormlike tongue
movement c. involuntary movements of arms and legs.
Neuroleptic malignant syndrome a. fever, tachycardia,
tachypnea, diaphoresis, cardiovascular collapse b. muscle
rigidity, seizures,- orthostatic hypotension
1. Teach family members the signs of EPS & NMS, & report
to physician immediately
2. Normalization of symtoms may not occur for several
weeks after beginning of therapy.
3. Avoid administering haloperidol intravenously.
4. Watch out of neutropenia with clozapine.
5. Watch out of orthostatic hypotension & photosensitivity
with phenothiazine.
6. Be sure that oral doses are swallowed, & not hoarded.
ANTIPSYCHOTIC DRUG (NEUROLEPTICS)

10. RESPIRATORY MEDICATIONS
PROTOTYPE
MECHANISM OF ACTION
INDICATIONS
NURSING CONSIDERATION
-Symphatomimetic Xanthines
-Albuterol, salbutamol
-Aminophylline
-Isoproterenol, salmeterol
-Theophylline
-Terbutaline
-Sympathomimetic (b-receptor agonist)
bronchodilators, dilate airways, - xanthine
bronschodilators, stimulate CNS for respiration.
- bronchospasm, asthma, bronchitis, COPD
ADVERSE EFFECTS
- palpitations and tachycardia
- restlessness, nervousness, tremors
- anorexia, nausea and vomiting, headache,
dizziness
- Contraindicated hyperthyroidism, cardiac
dysrhythmia, or uncontrolled seizure disorder.
- Should be used with caution in patient with
HPN and narrow-angle glaucoma.
BRONCHODILATORS
GLUCOCORTICOIDS
(CORTICOSTEROIDS)
PROTOTYPE
MECHANISM OF ACTION
ADVERSE EFFECTS
NURSING CONSIDERATION
- dexamethasone, budesonide, fluticasone,
prednisone, beclomethasone.
- act as anti-inflammatory agents and reduce
edema of the airways, as well as pulmonary
edema.
- act as anti-inflammatory agents and reduce
edema of the airways, as well as pulmonary
edema.
- Take drugs at meal time or with food. - Eat
foods high in potassium, low in sodium. - Instruct
client to avoid individuals with RTI. - Instruct
client not to stop medication abruptly, it should
be tapered to prevent adrenal insufficiency -
Avoid taking NSAID while taking steroids. - Take
inhaled bronchodilators first before taking
inhaled steroids, and rinse mouth after using.

11. ADVERSE EFFECT
1. Aminoglycoside - nephrotoxicity &
ototoxicity
2. Sulfonamides - Steven-Johnson’s
syndrome, photosynsetivity
3. Quinolones - insomnia
4. Tetracyclines - bone problems
5. Chloramphenicol - Gray syndrome,
bone marrow depression
6. Erythromycin - hepatitis
NURSING CONSIDERATION
1. Collect appropriate specimen for C & S
before starting antibiotics.
2. Check client’s history of allergies.
3. Avoid administering erythromycin and
quinolones with food.
4. Pregnant precautions.
5. Report for diarrhea - pseudomembranous
colitis (clindamycin)
6. Monitor adverse effects.
DRUGS FOR TREATING
INFECTION
ANTIBACTERIALAGENTS
1. Cell wall inhibitors
a. penicillins - pen G, amoxicillin, cloxacillin
b. cephalosphorins
- cephalexin, cefaclor
c. glycopeptide - vancomycin
3. Antimetabolites
- blocks folic acid synthesis a. Sulfonamides -
cotrimoxazole
4. DNAsynthesisinhibitors
a. quinolones - ciprofloxacin, ofloxacin
b. metronidazole
2. Protein synthesisinhibitors
a. aminoglycosides - amikacin, gentamycin
b. macrolide - erythromycins, roxithromycin
c. lincosamides - clindamycins
d. chloramphenicol, tetracyclines

12. DRUGSAFFECTING
GASTROINTESTINAL SYSTEM
ANTACIDS
PROTON – PUMP INHIBITORS (PPI)
HISTAMINE
2 BLOCKERS
PROTOTYPE
MECHANISM OF ACTION
ADVERSE EFFECT
NURSING CONSIDERATION
- aluminum/magnesium compounds (Maalox) - sodium
bicarbonate (Alka-Seltzer) - calcium carbonate (Tums)
- magnesium hydroxide (Milk of Magnesia).
- neutralize the stomach acidity.
- metabolic alkalosis, stone formation - electrolyte
imbalance - diarrhea (magnesium), constipation
(aluminum).
PROTOTYPE
MECHANISM OF ACTION
- cimetidine (Tagamet), ranitidine (Zantac),
famotidine (Pepcid), nizatidine (Axid).
NURSING CONSIDERATION
- blocks H2 receptors in the stomach,
reducing acid secretions.
- Given before or with meals
- Avoid giving other drugs with cimetidine -
Gynecomastia may developed with chronic use of
cimetidine.
PROTOTYPE
MECHANISM OF ACTION
: ipecac syrup, apomorphine
NURSING CONSIDERATION
- induce vomiting through stimulation of
vomiting center of medulla.
- Consult poison control center before induction
of vomiting. - Administer ipecac syrup with large
amount of fluid.
INDICATIONS
- ingestion of poisonous or toxic substances
- Give 1 hr after meals.
- Avoid giving medications within 1-2 hrs of
antacid administration (decreases absorption).
- Take fluids to flush after intake of antacid suspensions.
- Monitor for changes of bowel patterns.

13. DRUGSAFFECTINGTHE
ENDOCRINE SYSTEM
THYROIDAGENTS
PROTOTYPE
MECHANISM OF ACTION
NURSING CONSIDERATION
-- Proloid (thryroglobulin ) - Synthroid
(levothyroxine) - Cytomel ( liothyronine)
- function as natural or synthetic hormones.
- Taken in the morning. - Caution with coronary
artery disease. - Monitor for signs of
hyperthyroidism and refer for decreasing the
dose.
PROTON – PUMP
INHIBITORS (PPI)
PROTOTYPE
MECHANISM OF ACTION
NURSING CONSIDERATION
a. calcitonin (Calcimar), etidronate
(Didronel), b. calcitrol (Rocaltrol), calcifediol
(Calcedrol)
a. reduce bone resorption b. promotes
calcium absorption
- Monitor signs of calcium imbalance - Report for
bone pains. - Remain sitting upright after taking
etidronate.
PARATHYROIDAGENTS

14. DRUGSAFFECTINGTHE
ENDOCRINE SYSTEM
THYROIDAGENTS
1. Sulfonylureas
2. Biguanides
3.Alpha-glucosidase inhibitors
- stimulate insulin secretions and increase
tissue sensitivity to insulin. First Generation :
Chlorpropamide (Diabenese) - disulfiram
precautions Tolbutamide (Orinase) -
congenital defect Second Generation :
Glypizide, Glymepiride
- facilitates insulin action on the peripheral
receptor site. Metformin and Glucophage
(Glucovance) - side effect is lactic acidosis
Nursing considerations
- Effective only for type II DM. - Contraindicated
to pregnant & breastfeeding. - Given before
meals. - Monitor for signs of hypoglycemia.
- delay carbohydrate absorption in the
intestinal system. Acarbose (Precose) – side
effect is diarrhea
4. Thiazolinidine
- increase tissue sensitivity of insulin.
Rosiglitazone (Avandia)
5. Meglitinides
- stimulate insulin release in pancreatic
B-cells. Repaglinide (Prandin)
PROTON – PUMP INHIBITORS (PPI)

15. DRUGS FOR TREATING
INFECTION
ANTIVIRALAGENTS ANTIFUNGALAGENTS
PROTOTYPE
MECHANISM OF ACTION
ADVERSE EFFECT
NURSING CONSIDERATION
PROTOTYPE
MECHANISM OF ACTION
ADVERSE EFFECT
NURSING CONSIDERATION
- acyclovir (Zovirax), ganciclovir (Cytovene),
vidarabine (Vira-A), amantidine (Symmetrel),
ribavirin (Virazole), zidovidine (Retrovir).
- amphotericin B (Fungisone), nystatin,
fluconazole (Diflucan), ketoconazole
(Nizoral).
- inhibit the synthesis of fungal sterol.
- nephrotoxicity and neurotoxicity - bone
marrow depression - chills, fever, joint pains,
abdominal pain and headache.
- Dilute amphotericin B with sterile water
solution not with electrolyte solution.
- Tell clients that fever, chills, GI upset, joint and
muscle pain will subside as amphotericin B
continues.
- With oral candidiasis, let nystatin tablet dissolve
in mouth rather than swallowing it.
- Refrain ketoconazole with antacids.
- Report for signs of bleeding, infection & fatigue.
- inhibits virus specific enzymes involve in
DNA synthesis. They only control the growth
of virus but it does not cure.
- granulocytopenia, thrombocytopenia,
nausea, nervousness, headache,
nephrotoxicity.
- Pregnant and breastfeeding precautions.
- Administer IV antivirals to avoid crystallization
in renal tubules.
- Give ribavirin only with aerosol generator.
- Monitor CBC and creatinine level.
- Refer for signs of bleeding.
- Take amantidine after meal

16. INTRODUCTION TO THE
KIDNEY AND THE URINARY TRACT
Renal system:
• Urinary tract
• Ureters
• Urinary bladder
• Urethra
4 major functions of the renal system:
• Maintain the value and
composition of the body fluids
w/in normal range
• Regulating vitamin D activation
• Regulating blood pressure
• Regulating red blood cell
production •
>the kidneys are two small organs that
receive about 25% of the cardiac output
Nephron
•the functional unit ofthe kidneys
•is composed ofthe Bowman’s
capsule, proximal convoluted
tubule, loop of Henle, distal
convoluted tubule, and collecting
duct
Renal Processes
a.) Filtration - straining fluid into the nephron
>approximately 125 mL of fluid is filtered
each minute, or 180L/day >99% of the
filtered fluid is returned to the bloodstream
>approx. 1% of the filtrate, less than
2 L of fluid is excreted each day in the
form of urine
b.) Secretion – actively removing compo-
nents from the capillary system &
depositing them into the tubule
c.) Absorption – removing from the
tubule to return them to the capillary
system and circulation >about 99% of
the water filtered at the glomerulus
is reabsorbed >the filtrate components
include the vitamins, glucose, electrolytes,
sodium bicarbonate, and sodium chloride
>precision of the reabsorption process
allows the body to maintain the correct
extracellular fluid volume and composition
Maintenance of Volume and composition
of Body Fluid

17. DRUGS USED TO TREAT ANEMIAS
PROTOTYPE
MECHANISM OF ACTION
INDICATIONS
NURSING CONSIDERATION
epoetin alfa Epogen, Procrit
- acts like the natural glycoprotein erythropoietin to stimulate
the production of RBCs in the bone marrow
- treatment of anemia with renal failure
- to the need for blood transfusion in patients undergoing
surgery
- treatment of anemias related to treatment for AIDS
- treatment of anemia associated with cancer
chemotherapy (Procrit only)
ADVERSE EFFECTS
- presence of uncontrolled hypertension - allergy - lactation
Adverse Effects - result of cellular response to
glycoprotein: CNS effects
- nausea, vomiting, diarrhea - related to in RBC numbers:
CV symptoms
- confirm chronic, renal failure before drug administration
- give epoetin alfa 3 times a week, IV or SQ
- do not mix with any other drug solution
- monitor access lines for clotting
- arrange for hematocrit reading before drug administration
- evaluate iron stores before and during therapy
- maintain seizure precautions on standy
PROTOTYPE
MECHANISM OF ACTION
ADVERSE EFFECTS
NURSING CONSIDERATION
ferrous sulfate (Feosol)
- elevate the serum iron concentration
- direct GI irritation
- with increasing serum levels, iron can be
CNS toxic, causing coma and death
- parenteral iron: severe anaphylactic
reactions, local irritation, staining of the
tissues, phlebitis
- confirm chronic, renal failure before drug
administration
- give epoetin alfa 3 times a week, IV or SQ
- do not mix with any other drug solution
- monitor access lines for clotting
- arrange for hematocrit reading before drug
administration
- evaluate iron stores before and during therapy
- maintain seizure precautions on standy
INDICATIONS
- treatment of iron deficiency anemias -
adjunctive therapy in patients receiving
epoetin alfa

18. DRUGS AFFECTING THE URINARY
TRACT AND THE BLADDER
DRUGS:
2 types: antibiotics & anti infectives works
to acidify the urine
Antibiotics
• Cinoxacin(Cinobac)- interferes with the DNA
replication in gram negative bacteria
• Norfloxacin (Noroxin)- a newer & more broad
spectrum drug, is effective against even more
gram negative strains than cinoxacin
• Fosfomycin (Monurol)- has the convenience
of only one dose. It is not recommended for
patients younger than 18 years of age
• Nalidixic (NegGram)- is an older drug that is
not effective against as many strains of
gram-negative bacteria as the other antibiotics
used for UTIs
• Nitrofurantion (Furadantin)- is another older
drug with a very short half-life (20-60 minutes)
Anti-infective works to acidify urine
• Methenamine (Hiprex)- undergoes metabolism
in the liver and is excreted in the urine
• Methylene blue (Urolene Blue)- is widely
distributed, metabolized in the tissues, and
excreted in urine, bile, and feces
MECHANISM OF ACTION
ADVERSE EFFFECT
These drugs are contraindicated in the
presence of any of these drugs. They should
be used with caution in the presence of renal
dysfunction, which could interfere with the
excretion and action of these drugs, and with
pregnancy and lactation because of the
potential for adverse effects on the fetus or
neonate.
• nausea, vomiting, diarrhea, anorexia, bladder
irritation, and dysuria
• infrequent symptoms include pruritus,
urticaria, headache, dizziness, nervousness,
and confusion
• GI irritation caused by the agent, which is
alleviated if drug is taken with food

19. ANTICOAGULANTS THROMBOLYTICS
DRUGS AFFECTING THE
CARDIOVASCULAR SYSTEM
PROTOTYPE
MECHANISM OF ACTION
INDICATIONS
NURSING CONSIDERATION
- Heparin (SQ and IV) Warfarin (Orally)
a. Heparin - prevents thrombin from
converting fibrinogen to fibrin. b. Warfarin -
suppress coagulation by acting as an
antagonist of vitamin K after 4-5 days.
- thrombosis, pulmonary embolism,
myocardial infarction
ADVERSE EFFECTS
- bleeding
1. HEPARIN sodium - if given SQ don’t aspirate
or rub the injection site (above the scapula -
best site). - therapeutic level 1.5-2.5 times
normal PTT; normal PTT is 20-35 sec. = 50-85
sec. - antidote : (protamine sulfate) 2.
WARFARIN sodium (coumadin) - warfarin is
used for long-term .
PROTOTYPE
MECHANISM OF ACTION
INDICATIONS
NURSING CONSIDERATION
Streptokinase, Urokinase
- use early in the course of MI (within 4-6
hours of the onset)
- activates plasminogen to generates plasmin
(enzyme that dissolve clots).
- monitor bleeding - antidote : Aminocarpic
acid

20. DRUGS AFFECTING
GASTROINTESTINAL SYSTEM
PROTOTYPE
MECHANISM OF ACTION
NURSING CONSIDERATION
- omeprazole (Losec), Lansoprazole (Lanz),
pantoprazole (Pantoloc).
- inhibit the proton H+ to combine with Cl -
to form hydrochloric acid
- Given before meals preferably at morning.
PROTOTYPE
MECHANISM OF ACTION
NURSING CONSIDERATION
- omeprazole (Losec), Lansoprazole (Lanz),
pantoprazole (Pantoloc).
- inhibit the proton H+ to combine with Cl -
to form hydrochloric acid
- Given before meals preferably at morning.
PROTON – PUMP
INHIBITORS (PPI)
PROTOTYPE
MECHANISM OF ACTION
NURSING CONSIDERATION
- diphenoxylate (Lomotil), loperamide
(Imodium), kaolin/pectin mixture (Kaopectate).
- decrease stomach motility and peristalsis.
- Monitor for rebound constipation.
- Be cautious taking if with infectious diarrhea.
- Monitor atropine toxicity with diphenoxylate.
- Clay, white or pale stool is common with
kaopectate.
a. lactulose (Cephulac), Na biphosphate
(Fleet enema) & magnesium salt (Milk of Magnesia)
- retain fluid and distend intestine
b. ducosate (Dialose) - emulsify fecal fat and water
c. bisacodyl (Dulcolax) & senna (X - prep) - irritates
intestinal mucosa and stimulate intestinal
smooth muscles
d. bulk-forming laxative (Metamucil)
- increase fecal bulk and water content
e. mineral oil
- lubricates & prevent colon absorption
ANTI-DIARRHEALA-
GENTS
Mucosal Barriers
Laxatives