This document provides information on several classes of cardiovascular medications, including their mechanisms of action, common uses, potential adverse effects, and nursing considerations. It discusses cardiac glycosides like digoxin, nitrate vasodilators like nitroglycerin, antiarrhythmics, diuretics, and beta-blockers. For each class, it outlines how to monitor the patient and assess for desired or adverse effects of the medication. Key nursing responsibilities are also reviewed, such as assessing vital signs, electrolytes, and teaching patients about safe medication use.
This is a case on Diastolic heart failure with Type 2 Diabetes mellitus. Here we have discussed the pharmaceutical care plan (SOAP) about the treatment and non pharmacological approaches to treat the specified conditions
The presentation covers basics of pharmacotherapy involves in advanced life support scenario including peri-arrest situations which have been updated 2019
The slides describes the medical emergencies which occurs in dentistry and their management in daily practice and awareness about the different medical emergencies in dentistry.
This is a case on Diastolic heart failure with Type 2 Diabetes mellitus. Here we have discussed the pharmaceutical care plan (SOAP) about the treatment and non pharmacological approaches to treat the specified conditions
The presentation covers basics of pharmacotherapy involves in advanced life support scenario including peri-arrest situations which have been updated 2019
The slides describes the medical emergencies which occurs in dentistry and their management in daily practice and awareness about the different medical emergencies in dentistry.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. Cardiac Glycosides
• Example: digoxin (Lanoxin)
• Drug Effects on Cardiac Action
• Positive inotropic: drugs that increase the force of
contraction
• Negative inotropic: drugs that decrease the force of con-
traction
• Positive chronotropic: drugs that increase heart rate
• Negative chronotropic: drugs that decrease heart rate
• Positive dromotropic: drugs that increase the rate of
electrical conduction through the myocardium
• Negative dromotropic: drugs that decrease the rate of
electrical conduction through the myocardium
3. • Mechanisms of Action
• Positive inotropic effect: increases the force of
myocardial contraction
• Negative chronotropic effect: decreases the
heart rate
• Negative dromotropic: decreases the rate of
electrical conduction through the
atrioventricular node
6. • Nursing Process Elements
• Be familiar with client’s baseline VS, electrolyte
levels, and general health
• Assess the following before administering
digoxin:
• —Check serum digoxin, potassium, magnesium,
and calcium levels
• —Take apical pulse for one full minute noting
rate, rhythm, and quality.
• —Assess for toxicity
7. • Withhold digoxin and notify physician if:
• —Pulse rate <60
• —Significant change in pulse rate or rhythm
• —S&S of digoxin toxicity
• —Serum potassium level is less than 4 mEq/l
• —Serum digoxin level > 2 ng/ml (therapeutic range =
• 0.8–2 ng/ml)
• Monitor client’s fluid intake and urinary output
• Monitor client’s weight, signs of edema, lung, and
heart sounds
8. • Assessment Alert
• Take apical pulse for one minute prior to
administering digoxin. Withhold digoxin and
call physician if heart rate is less than 60 bpm.
9. • Nursing Diagnoses
• Cardiac output: decreased
• Tissue perfusion: ineffective
• Knowledge deficit related to medications and
disease
10. • Client teaching for self-care
• Instruct how to count pulse
• Instruct to call physician if pulse < 60 or > 110
• Instruct to call physician if heart rhythm irregular
• Review S&S of toxicity and instruct to report
them to physician
• Weigh each day and report > 2 lb gain per day
• Take digoxin as prescribed at same time each day
12. Mechanisms of Action
• Varies depending on the antiarrhythmic class
used
• Decreases the automaticity of cardiac tissue
• Alters the rate of conduction of electrical
impulses
• Alters the refractory period
15. Monitoring Effects of Antiarrhythmics
• Nursing Process Elements
• Assess heart rate and rhythm and BP prior to
administration and throughout therapy
• Monitor ECG
• Monitor for adverse effects
17. Client teaching for self-care
• Instruct in how to obtain pulse rate, and to
report changes in rate and rhythm to
physician
• Instruct to take doses round the clock and
what to do regarding missed doses and over-
the-counter medications
• Advise regarding importance of follow-up
appointments with health care provider
18. Assessment Alert
• Take BP and heart rate prior to administering
antiarrhythmic medications.
19. NITRATE VASODILATORS
• Example: nitroglycerin (Nitrocot)
• Mechanism of Action
• Relaxes smooth muscle
• Dilates venous and arterial blood vessels
• Reduces peripheral resistance
• Decreases venous return to the heart
• Reduces myocardial oxygen consumption
• Decreases BP
• Relieves and prevents angina (chest pain)
20. Common Uses
• Prophylaxis, treatment, and management of
angina pectoris (chest pain)
• Congestive heart failure
22. Forms of Nitrate Vasodilators
• Sublingual tablet
• —Place tablet under tongue to dissolve within 5
minutes
• Extended-release buccal tablet
• —Place tablet between lip and gum or between cheek
and gum to dissolve over 3–5 hours
• Oral sustained-release tablet or capsule
• Translingual spray
• —Do not shake canister
• —Spray under tongue
• —Do not inhale spray
23. Transdermal ointment:
• —Use dose-determining applicator supplied
with ointment
• —Nurse should wear gloves
Transdermal Unit (patch)
• —Nurse should wear gloves
Parenteral (IV)
24. Monitoring Effects of Nitroglycerin
Nursing Process Elements
• Be familiar with clients baseline VS
• Obtain BP, heart rate prior to administering medication
• Check BP and heart rate after administration
(hypotension may occur)
• Assess chest pain using pain scale, and assess for
associated symptoms: dyspnea, shortness of breath,
jaw, arm, neck pain, nausea, and diaphoresis
• Assess for blurred vision, headache, and dry mouth
• Assess for topical reactions when using the ointment or
transdermal unit
26. Nursing Diagnoses
• Pain: acute
• Tissue perfusion: ineffective
• Knowledge deficit related to medications and
disease
27. Client teaching for self-care
• Instruct that sublingual tablets may be taken
prophylactically 5–10 minutes prior to exercise or other
stimulus known to trigger angina.
• Remind them to keep record of number of angina attacks,
amount of medication taken, and precipitating factors.
• Instruct that contact with water (bathing, swimming) does
not affect transdermal unit.
• Inform that the sublingual form can be taken while trans-
dermal unit or ointment is in place.
• When chest pain occurs, take one nitroglycerine tablet as
prescribed; if chest discomfort is not relieved in 3 minutes,
call 911.
28. • Remind to report blurred vision, dry mouth,
faintness, dizziness, flushing, or increase in
frequency or severity of pain to physician.
• Explain to change positions slowly and avoid
prolonged standing (postural hypotension)
• Inform that SL tablets should be kept in their
original container and tablets need to be
replaced every 6 months to assure potency.
29. • Advise to take medication as directed, avoid
alcohol, and not to take over-the-counter
medications without approval of physician.
• Encourage to keep follow-up appointments
with health care provider.
31. Diuretics
• Mechanisms of Action
Thiazide diuretics
• Example: hydrochlorothiazide (HCTZ)
• —Inhibits sodium reabsorption in the distal
tubule, thereby increasing excretion of water
and sodium.
• —Enhances excretion of magnesium, chloride,
and potassium.
32. Loop diuretics
• Example: furosemide (Lasix)
• —Inhibits the reabsorption of sodium and
chloride in the ascending loop of Henle
• —Increases risk of hypokalemia
• —Reduces the ability of the kidneys to
concentrate urine
• —More potent than the thiazides in
promoting sodium and fluid excretion
33. Potassium-sparing diuretics
• Example: spironolactone (Aldactone)
• —Promotes sodium and chloride excretion
without concomitant loss of potassium
• —Inhibits the action of the hormone
aldosterone thereby causing diuresis
• —Lowers BP by unknown mechanism
• —Increases risk of hyperkalemia
36. Monitoring Effects of Diuretics
• Nursing Process Elements
• Be familiar with client’s baseline VS
• Obtain BP and heart rate prior to administering
medication
• Check BP and heart rate before and after
administration
• Monitor for signs of hypokalemia
• Fatigue
• Muscle weakness and cramps
• Rapid irregular pulse
• Vomiting
37. • Shortness of breath
• Monitor fluid intake and urinary output
• In hospital, weigh client daily. Monitor for:
• —edema
• —abnormal lung sounds
• —extra heart sounds
• Assess for postural hypotension
• Monitor serum levels
• —Potassium
• —Sodium
• —Chloride
• Blood urea nitrogen (BUN)
• Assess for digoxin toxicity if dehydration or hypokalemia
exists
38. Assessment Alert
• Take BP prior to and after administering
diuretics. Always monitor electrolytes prior to
administering diuretics.
39. Nursing Diagnoses
• Fluid volume: excess
• Knowledge deficit related to medications,
disease, and nutrition
40. Client/family teaching
• Instruct regarding weighing at least once per
week
• Remind to have BP monitored weekly
• Advise to follow dietary guidelines, especially
regarding potassium and sodium
• Encourage to change positions slowly to avoid
a decrease in BP (postural hypotension)
41. • Instruct to notify health care provider if
experiencing muscle weakness or cramping,
fatigue, or dizziness
• Advise to take medication as directed and to
not take over- the-counter drugs unless
approved by physician
• Encourage to keep follow-up appointments
with health care provider
43. Think Smart / Test Smart
• The generic names for the beta-blockers end
in “lol,” therefore, you will be able to identify
the beta- blockers from a list of drugs.
44. Mechanisms of Action
• Reduction in heart rate
• Reduces force of cardiac contraction
• Slows electrical conduction
• Reduces myocardial irritability
45. • Management of cardiac arrhythmias
• Hypertension
• Tachyarrhythmias associated with digitalis
toxicity
• Angina Pectoris
46. Common Adverse Effects
• Weakness: fatigue
• Impotence
• Concerns for use: Precautions
• —It may cause bronchoconstriction; therefore, its
use may be contraindicated in clients with chronic
pulmonary diseases
• —It may promote congestive heart failure
therefore use cautiously in clients with risk for
heart failure.
47. Monitoring Effects of Beta-Adrenergic
Blocking Agents
• Nursing Process Elements
• Assess heart rate and rhythm, BP prior to
administration and throughout therapy
• Assess location, intensity, and duration of
anginal pain and associated symptoms
• Monitor ECG
• Monitor for adverse effects
49. Nursing Diagnoses
• Cardiac output, decreased
• Pain: acute
• Tissue perfusion: ineffective
• Knowledge deficit related to medication and
disease
50. Client teaching for self-care
• Instruct in how to obtain pulse rate, and to report
changes in rate and rhythm to physician
• Instruct to take doses round the clock and what
to do regarding missed doses and over-the-
counter medications
• Advise to report chest pain to health care
provider immediately
• Advise regarding importance of follow-up
appointments with health care provider
51. CALCIUM CHANNEL ANTAGONISTS
• Example: nifedipine (Procardia)
Mechanisms of Action
• Relaxation of vascular smooth muscle and lowered BP
• Prevents or reverses spasms of coronary blood vessels
• Dilates coronary arteries and arterioles resulting in an
antianginal effect
• Reduces myocardial oxygen consumption
• Slows electrical impulse conduction (supraventricular
tachycardia)
52. Common Uses
• Prevention and treatment of angina pectoris
• Hypertension
Common Adverse Effects
• Hypotension
• Peripheral edema
• Dizziness
• Headache
53. Monitoring Effects of Calcium
Channel Antagonists Agents
• Nursing Process Elements
• Assess heart rate and rhythm, BP prior to
administration and throughout therapy
• Assess location, intensity, and duration of
anginal pain
• Monitor ECG
• Monitor for adverse effects
54. Assessment Alert
• Always take the client’s BP and heart rate
before and after administering calcium
channel antagonists.
56. Think Smart / Test Smart
• The generic names of the ACE inhibitors end in
“pril,” therefore, you will be able to identify
them from a list.
57. Mechanism of Action
• Dilates peripheral arterioles
• Relaxes vascular smooth muscles
• Reduces peripheral resistance
• Interferes with conversion of angiotensin I to
angiotensin II
• Dilates peripheral vessels thereby reducing BP
59. Common Adverse Effects
• Hypotension
• Postural hypotension
• Dizziness, fainting, and headaches
60. Monitoring Effects of ACE Inhibitors
• Nursing Process Elements
• Be familiar with client’s baseline VS
• Obtain BP and pulse rate prior to administering
medication
• Check BP and pulse rate after administration
• Monitor weight, edema, lung, heart sounds, and
I&O
• Assess for postural hypotension
• Encourage client to rise slowly from lying to
sitting position
61. Assessment Alert
• Always take the client’s BP and heart rate prior
to and after administering ACE inhibitors.
63. Client teaching for self-care
• Instruct on monitoring BP weekly
• Remind to change positions slowly to prevent
rapid decrease in BP
• Encourage to follow dietary restrictions: low
sodium
• Instruct regarding reporting weight changes,
edema, and dizziness to physician
• Emphasize importance of follow-up
appointments with health care provider
64. ANTIMICROBIAL AGENTS
• Classification of Antimicrobial Agents
• Bactericidal and bacteriostatic
• —Bactericidal agents have a killing action on
the bacteria
• —Bacteriostatic agents inhibit the growth of
bacteria permitting the host’s immunological
defenses to destroy the organism
65. Site of Action
• Agents that inhibit cell wall synthesis
• Agents that inhibit protein synthesis
• Agents that interfere with the permeability of
the bacterial cell membrane
• Agents with antimetabolite action block or
alter steps essential for the normal growth of
the bacteria
66. Narrow or Broad Spectrum of Action
• Narrow spectrum
• —Effective against a limited number of
organisms
• —Use when identity of organism and
susceptibility of the antibiotic is known
• —Usually do not disrupt normal bacterial flora
67. • Broad spectrum
• —Act on a wide variety of organisms
• —Useful in treating infections when the
identity and susceptibility to antimicrobial
treatment of the infecting organism is
unknown
• —However, they destroy the body’s normal
microbes and may permit superinfection and
diarrhea
69. • Organ toxicity
• —High doses and/or over long periods of time
• —Can involve liver, kidneys, central nervous
system, etc
• Ototoxicity (detrimental effect on eighth nerve or
organs of hearing)
• Hematological disorders
• —Anemia
• —Increased bleeding time
70. Major Classes
• Penicillins (beta-lactams) Example: ampicillin
(Polycillin)
• —Bactericidal agents
• —Inhibit the synthesis of the bacterial cell
wall
• —Narrow and broad-spectrum agents
71. Cephalosporins
• —Chemically and pharmacologically related to
the penicillins
• —Bactericidal or bacteriostatic effect
• —Interferes with bacterial cell wall syntheses
• —Four “generations” of cephalosporins
• —Use caution when client has allergy to
penicillins
72. Tetracyclines:
• Example: tetracycline (Tetracyn)
• —Bacteriostatic
• —Broad-spectrum agents
• —Inhibits protein synthesis in the bacterial cell
• —May interfere with normal calcification of
temporary and permanent teeth and discolor
developing teeth
• —May interfere with bone growth
• —Clients more susceptible to sunburn
73. Macrolides:
• Example: erythromycin (Ery-Tab)
• —Bacteriostatic
• —May be bactericidal in high concentrations
• —Inhibits protein synthesis in the bacterial
cell
74. Aminoglycosides:
• Example: gentamicin (Garamycin)
• —Bactericidal or bacteriostatic
• —Inhibits protein synthesis in the bacterial
cell
• —May produce nephrotoxicity and ototoxicity
75. Monitoring Effects of Antibiotics
• Take a careful medication history before
administering antibiotics
• Know exactly why your client is receiving
antibiotics
• If ordered, obtain specimen for culture and
susceptibility before administering the antibiotic
• Know what a therapeutic response to antibiotic
treatment would include for each specific client
situation
• Administer oral doses of antibiotics on empty
stomach or with food as specified
76. • Be aware of food–drug and drug–drug
interactions, for example, penicillin can
interfere with effectiveness of oral
contraceptives.
• Monitor VS and S&S of infection
• Monitor WBC count, BUN, creatinine, and
other laboratory values
• Observe for adverse effects
• Observe for S&S of superinfections
77. Nursing Intervention Alert
• If cultures are ordered by the physician,
always obtain the specimen prior to
administering the first dose of antibiotic.
79. Client teaching for self-care
• Advise to call health care provider if symptoms do
not improve
• Remind to take all doses of the medication even if
their symptoms are no longer present, and to
follow instructions regarding taking medication
with or without food
• Instruct to inform health care provider if
diarrhea, vomiting occur, black, hairy growth
develops on tongue, and vaginal irritation occurs
• Advise to keep all follow-up appointments with
health care provider
80. ANTICOAGULANTS
• Mechanism of Action
• Parenteral anticoagulants
• Example: heparin; enoxaparin (Lovenox)
• Exerts direct effect on blood coagulation
(clotting) by blocking the conversion of
prothrombin to thrombin and fibrinogen to
fibrin.
• Inhibits formation of new clots
81. Oral anticoagulant
• Example: warfarin sodium (Coumadin)
• Indirectly interferes with blood clotting by
depressing hepatic synthesis of vitamin K.
• Deters further extension of existing thrombi
and prevents new clots from forming.
• Has no effect on platelets.
• Unlike heparin, action is cumulative and more
prolonged.
82. Common Uses
• Heparin and Lovenox
• —Prophylaxis and treatment of venous
thrombosis and pulmonary embolism (blood
clot to leg or lung)
• —Prevent thromboembolic complications
arising from cardiac surgery and vascular
surgery
• —During acute stages of myocardial infarction
(heart attack)
83. • Coumadin
• Prophylaxis and treatment of deep venous
thrombosis and pulmonary embolism (blood clot
in leg or lung)
• Treatment of atrial fibrillation.
• An adjunct in treatment of coronary occlusion,
cerebral transient ischemic attacks
• Prophylactic treatment for clients with prosthetic
cardiac valves
84. Common Adverse Effects
• Bleeding
• Hematuria
• Tarry stools
• Excessive vaginal bleeding
• Abdominal, flank, or joint pain
• Headaches
• Changes in neurological status, restlessness
• Hematoma or bruising
• Vomiting blood
• Bleeding from the nose or gums
• Weak, rapid pulse rate
• Hypotension
85. Monitoring Effects of Heparin
• Nursing Process Elements
• Before administration check coagulation tests, hemoglobin,
hematocrit, and platelet counts.
• In general, the goal is to keep the partial thromboplastin
time (PTT) at 1.5–2.5 times its normal value of 35–45
seconds.
• Safely administer heparin via ordered route, i.e.,
subcutaneous injection, continuous intravenous infusion, or
intermittent intravenous infusion.
• No intramuscular injections
• Observe for S&S of bleeding
• Use soft toothbrush and electric razor
87. Monitoring Effects of Coumadin
• Before administration check coagulation tests, hemoglobin,
hematocrit, and platelet counts
• In general, the goal is to maintain a prothrombin time (PT)
of 1.5–2 times the control or reference value and maintain
the international normalized ratio (INR) at a value of 2–3.
The PT control value is generally 11–15 seconds
• The daily oral dose is based on the PT and INR results until
maintenance dosage is established
• Observe for S&S of bleeding
• No intramuscular injections
• No aspirin containing products
• Use soft toothbrush and electric razor
92. • Mechanisms of Action
• Sulfonylureas
• Example: glyburide: (DiaBeta )
• Directly stimulates functioning pancreatic beta
cells to secrete insulin
• Increases sensitivity of peripheral insulin
receptors resulting in increased insulin binding
93. • Biguanide
• Example: metformin (Glucophage)
• Increases glucose transport across cell
membrane, with enhanced glucose utilization
in skeletal muscles
• Increases the binding of insulin to its receptor
and potentiating insulin action
94. • Meglitinides
• Example: repaglinide (Prandin)
• Stimulates release of insulin from the
pancreatic islets
102. Monitoring Effects of Hypoglycemic
Agents
• Nursing Process Elements
• Monitor for S&S of hypoglycemia
• —Fatigue, restlessness
• —Cool, moist skin
• —Weakness and dizziness
• —Headache
• —Confusion, slurred speech
• Monitor for S&S of hyperglycemia
• —Flushed, dry skin
• —Increased urine output
• —Increased thirst
• —Increased appetite
• —Drowsiness
• Monitor blood glucose results as ordered
103. Assessment Alert
• Assess the lower extremities and feet of
clients with diabetes. Provide foot care and
assure that client has shoes to wear while in
the hospital.
109. Monitoring Effects of Bronchodilators
• Be familiar with client’s baseline VS
• Monitor client’s lung sounds, respiratory effort, and
oxygen saturation percentages via pulse oximetry
• Monitor for cyanosis of lips, ear lobes, mucous mem-
branes, and nailbeds
• Monitor theophylline plasma levels, if ordered.
Therapeutic range is 10–20 µg/ml.
• Observe client for adverse effects
• Ensure that client uses metered dose inhaler correctly
110. • Nursing Diagnoses
• Ineffective Breathing pattern:
• Ineffective Airway clearance:
• Knowledge deficit related to medications and
disease
112. Mechanisms of Action
• Laxatives
• Stimulant laxative:
• Example: bisacodyl (Dulcolax)
• Increases motility of gastrointestinal tract by chemical
irritation of the intestinal mucosa
• Increases the secretion of water into large and small intes-
tines
• Saline laxatives:
• Example: magnesium hydroxide (milk of magnesia)
• Draws water through the intestinal wall by osmotic action
increasing the fluidity of the stool and stimulates greater
intestinal motility
113. • Bulk-forming laxatives:
• Example: psyllium hydrophilic (Metamucil)
• Absorbs fluid and the compound swells in the intestine,
stimulating peristaltic action.
• Lubricant laxatives:
• Example: mineral oil
• Act as lubricant to facilitate passage of fecal mass
through the intestines
• Stool softeners:
• Example: docusate sodium (Colace)
• Permits water and fat to penetrate and soften stool
114. • Common Uses for Laxatives
• Prevent or treat constipation
• Prepare clients for a lower gastrointestinal X-ray
series or surgery
• Reduce the strain of defecation in clients with
cardiovascular disease or in postoperative clients
• Diagnose and treat parasitic infestations of the
gastrointestinal tract
• Help remove unabsorbed poisons from the
gastrointestinal tract
115. Histamine receptor antagonists
• Example: famotidine (Pepcid)
• Inhibits the action of histamine at the
histamine-sensitive H2 receptor site of the
parietal cells in the stomach
• Results in reduction in acid secretion
116. • Proton pump inhibitors
• Example: lansoprazole (Prevacid)
• Suppresses gastric acid secretion by inhibiting
the gastric acid pump in the parietal cells of
the stomach
117. • Common Uses for Histamine Receptor
Antagonists and Proton Pump Inhibitors
• Treatment of duodenal ulcer
• Treatment of gastric ulcer
• Gastroesophageal reflux disease
• Gastritis
• Erosive esophagitis
118. • Adverse Effects of Histamine Receptor
Antagonists and Proton Pump Inhibitors
• Diarrhea
• Headache
120. ANALGESIC, ANTIPYRETIC, AND ANTI-
INFLAMMATORY AGENTS
• Mechanisms of Action
• Opioid analgesics
• Example: morphine (Roxanol)
• Opioid and opioid-like agents bind onto opioid
receptors found in the central nervous system
and act to inhibit the transmission of pain
impulses and alter pain perception
• Suppresses medullary cough centers
• Suppresses the motility of the gastrointestinal
tract
121. Assessment Alert
• Always assess client’s respiratory rate prior to
and after administering morphine. Many
institutional policies state that the nurse
should not administer morphine to a client
with a respiratory rate of less than 10 breaths
per minute.
122. Salicylates
• Example: aspirin (Ecotrin)
• Anti-inflammatory action: Inhibits prostaglandin
synthesis
• Analgesic action: Acts peripherally to interfere with
action of prostaglandins
• Antipyretic action: In addition to inhibiting
prostaglandin synthesis, it lowers body temperature in
fever by causing centrally mediated peripheral
vasodilation and sweating
• Antiplatelet action: Aspirin inhibits platelet
aggregation, therefore, aspirin helps prevent strokes
and myocardial infarction (heart attack)
123. Nonnarcotic analgesic and antipyretic
• Example: acetaminophen (Tylenol)
• Produces analgesia by unknown mechanism,
perhaps by action on peripheral nervous
system
• Reduces fever by direct action on
hypothalamus, peripheral vasodilation, and
sweating
124. Nonsalicylates
• Example: celecoxib (Celebrex)
• Newer NSAIDs inhibit prostaglandin synthesis
by inhibiting COX-2
• Provides analgesic and anti-inflammatory
effects
• Less adverse effects on the gastrointestinal
system and less antiplatelet activity
125. Corticosteroids
• Example: prednisone (Pred-Pak)
• Synthetic steroid used primarily for its
glucocorticoid effects—anti-inflammatory
agent
• Reduces the severity of inflammatory
symptoms
126. Opioid analgesics
• Moderate to severe pain
• Cough suppressant
• Suppressing the motility of the
gastrointestinal tract (diarrhea)
131. • Cholinesterase Inhibitors
• Example: donepezil (Aricept)
• Mechanism of Action
• Enhances cholinergic function by increasing levels
of acetylcholine
• Common Uses
• Mild to moderate dementia associated with
Alzheimer’s disease
143. ANTIDEPRESSANTS
• There are two major classes: tricyclic
antidepressants and selective serotonin
reuptake inhibitors (SSRIs)
• Examples: nortriptyline (Aventyl), paroxetine
(Paxil)
144. • Mechanisms of Action
• Tricyclic antidepressants
• Potentiates the effect of norepinephrine and
serotonin
• Possesses anticholinergic action
145. • Selective serotonin reuptake inhibitors
• Inhibits uptake of serotonin in the CNS
• Common Uses
• Treatment of depression
146. • Common Adverse Effects
• Fatigue
• Drowsiness
• Blurred vision and dry eyes
• Dry mouth and constipation
• Hypotension
148. • Example: promethazine (Phenergan)
• Mechanisms of Action
• Inhibits the chemoreceptor trigger zone in the
medulla
• Common Uses
• Treatment and prevention of N&V
• Allergic conditions
• Motion sickness
• Sedation
149. • Common Adverse Effects
• Sedation
• Disorientation
• Monitoring Effects of Antiemetic Agents
• Nursing Process Elements
• Assess for N&V, and abdominal pain
• Assess for fluid volume deficit (dry mucous
membranes, poor skin turgor, decreased urine output,
and thirst)
• Monitor I&O
• Implement safety precautions to prevent falls
150. ANTIFUNGUAL AGENTS
• Example: fluconazole (Diflucan)
• Mechanisms of Action
• Inhibits synthesis of fungal sterols
• Affects the permeability of the fungal cell
membrane or protein synthesis within the cell
• Common Uses
• Treatment of fungal infections
• Prevention of fungal infections
• Common Adverse Effects
• abdominal discomfort
151. ANTIHISTAMINE AGENTS
• Example: fexofenadine (Allegra)
• Mechanisms of Action
• Blocks the effects of histamine at peripheral
histamine-1 receptors
• Common Uses
• Relief of allergic rhinitis
• Urticaria
• Common Adverse Effects
• No common adverse effects
152. Nursing Intervention Alert
• Apple, orange, and grapefruit juice will
decrease the absorption of fexofenadine
(Allegra).
153. ANTIPLATELET AGENTS
• Mechanisms of Action
• Glycoprotein IIb/IIIa inhibitors: eptifibatide (Integrilin)
• Platelet Aggregation Inhibitors: dipyridamole (Persantine)
• Platelet Adhesion Inhibitors: clopidogrel (Plavix)
• Common Uses
• Prevention of myocardial infarction or stroke
• Treatment of acute coronary syndromes
• Common Adverse Effects
• Dizziness
• Headache
• Bruising
154. • Client teaching for self-care
• Instruct to take medication as prescribed and to avoid
using over-the-counter medication containing aspirin
or NSAIDs without prior approval from physician
• Advise to avoid using alcohol and tobacco products due
to the vasoconstriction action
• Instruct to notify physician if signs of bleeding
(bruising, headache, blood in urine, dark stools,
headache, weakness)
• Encourage to keep appointments with health care
providers
155. ANTIVIRAL AGENTS
• Example: acyclovir (Zovirax)
• Mechanisms of Action
• Inhibits viral DNA replication
• Common Uses
• Treatment of herpes zoster (shingles)
• Treatment of herpes simplex virus types 1 and 2
• Treatment of genital herpes infections
• Common Adverse Effects
• Headache and dizziness
• Nausea, vomiting, and diarrhea
157. • Mechanisms of Action
• Reduces total cholesterol, LDL, and triglycerides
and increases HDL
• Common Uses
• Reduce lipids/cholesterol in order to decrease
risk for myocardial infarction and stroke
• Common Adverse Effects
• Indigestion, diarrhea, and constipation
• Rash