PHARMACOLOGICAL AND PARENTHERAL THERAPIES

I.

Pharmacology Terms and Responsibilities

A. Medication Nomenclature

Example:
chemical name
aminopenicillin

generic name
ampicillin

trade name
(Principen or Omnipen)

1. Chemical name - description of a medication's chemical elements

2. Generic name - simpler version of the chemical name, never
changed and used in medical terminology (always lower case)
3. Trade name - manufacturer's name for medication; is capitalized
and shown in parentheses if it follows generic name (always
capitalized)
1. Pharmacokinetics
1. Absorption
2. Distribution
3. Metabolism
4. Excretion
5. Serum half-life
2. Effects of Medications
1. Therapeutic effect: desired primary effect for which the medication
was given
2. Adverse effect: undesired responses to drug administration
3. Side effect: adverse effect that occurs with usual therapeutic dose
of drug
4. Toxic effect or toxicity: extension of primary action carried to a
extreme
5. Cumulating effect: body holds more of the medication because it
excretes or metabolizes less of it.
6. Hypersensitivity/allergy: anaphylaxis, urticaria, etc.
7. Tolerance: body becomes accustomed to drug so that larger doses
are needed to produce same effects
8. Dependence: medication needed long-term, possibly leading to
abuse
a. Psychic dependence
b. Physical dependence
3. Variables affecting drug action
1. Drug-related
a. Dosage
b. Route
c. Drug-diet interaction

d. Drug-drug interaction
2. Client-Related
a. Age
b. Weight
c. Genetic and ethnic characteristics
4. When a nurse gives medications, the nurse is responsible to:
1. Determine if the medication order is correct
2. Know the usual dosage of the medication, usual route, expected
therapeutic effects and side effects
Get a Clue
Before you give a medication, you should know the "DRES code" for
that medication
Dosage, usual
Route, usual
Effects
Side Effects
and you must check that for this client, you have the FIVE RIGHTS
Right Medication
Right Client
Right Time
Right Dose
Right Route
1. Determine if medication is compatible with others that the client is
taking
2. Exercise independent judgment before give a medication
a. Consider client needs, adverse effects, etc.
b. Use appropriate administration technique
c. Monitor amount of medication in the body (such as its
levels in blood)
I.

Major Routes of administration

A.
B.
C.
D.

Oral (P.O.)
Intramuscular (IM) (illustration )
Subcutaneous (Subq)
Intravenous (IV)
1. Methods of IV Administration
a. IV push
1. Use
a. For quick response
b. Replace IM injects for patient comfort
c. To administer loading doses

b.

c.

d.

e.

f.

2. Nursing interventions
a. First, check that medication, dose and route
are correct
b. Assess patency of IV line
c. Monitor how client reacts to medication
Infusion control devices
1. Use to administer a fluid volume accurately
2. Nursing interventions
a. Know how the device works
b. Double check the flow rate
c. Monitor client closely for complications
such as inflammation, infiltration or
infection at insertion site
d. Explain purpose of infusion device to client
Heparin lock
1. Use - administer periodic IV medication without
continuous IV therapy
2. Nursing interventions
a. Monitor for inflammation, infection or
infiltration at insertion site
b. Follow your facility's policy to maintain
patency
Venous access devices (illustration )
1. Uses
a. Long-term intravenous therapy
b. IV therapy in the home
2. Nursing interventions
a. Monitor for cardiac irregularities, which
may show central catheter placed too deeply
and extending into right atrium
b. Monitor for inflammation, infiltration, and
infection at insertion site
PCA Patient-controlled analgesia (PCA)
1. Purposes
a. Manage pain at a consistent level
b. Client self administers
2. Protocol
a. Prepare infusion and attach to IV
b. Medication is delivered in loading dosage as
ordered
c. Teach client how to use PCA
Intravenous Therapy
1. Use - replace fluid, electrolytes and other nutrients
for clients who cannot eat or drink adequately
2. Types of IV therapy solutions
a. Isotonic

i.

Exert osmotic pressure similar to that

of plasma
ii.
Examples: normal saline 0.9%;
lactated Ringer's solution; 5%
dextrose in water
b. Hypotonic
i.
Exerts less osmotic pressure than
plasma
ii.
Examples: 2.5% dextrose in water;
half strength normal saline 0.45%
c. Hypertonic
i.
Exerts higher osmotic pressure than
plasma (draws water out of the cells)
ii.
Examples: 5% dextrose in normal
saline 0.9%; 5% dextrose in lactated
Ringer's solution
A. Other
1. Sublingual (SL)
2. Intraocular
I.

Classification Of Medications Via Body Systems

A. Managing Cardiac Disease

Mini-overview:
1.
2.
3.
4.
5.
6.
7.
8.

Cardiac Glycosides
Antihypertensives
Thrombolytics
Lipid-Lowering Agents
Antianginals
Hypotension and Shock
Anticoagulants
Antidysrhythmics
1. Cardiac glycosides
a. Action: makes heart beat slower but stronger
1. Improves pumping ability of heart
2. Increases force of heart's contraction
3. Decreases rate of contraction
4. Increases cardiac output
b. Examples
1. Digitoxin (Crystodigin)
2. Digoxin (Lanoxin)
c. Use

1. Congestive heart failure

2. Atrial flutter
3. Atrial fibrillation
d. Contraindications
1. Ventricular tachycardia
2. Ventricular fibrillation
e. Adverse side effects
1. Gastrointestinal effects such as nausea and
vomiting, diarrhea
2. Bradycardia
3. Xanthopsia
4. Muscle weakness
5. Dysrhythmia
f. Nursing interventions
1. Before giving glycoside, check apical pulse and
heart rhythm. Report if < 60 bpm
2. Establish baseline data such as vital signs,
electrolytes, clinical symptoms, creatinine clearance
test
3. Monitor for drug toxicity, whose early symptoms
include
a. In children - cardiac arrhythmias
b. In adults - visual disturbances, nausea and
vomiting, anorexia
4. Monitor drug levels
a. Therapeutic range 0.8 - 2.0 ng/ml
b. Toxic range > 2 ng/ml
c. Diuretics may increase chance of toxicity
5. Monitor intake and output
6. Client teaching
a. Take medication as prescribed
b. Teach client how to take and record pulse
daily
c. Identify and report signs of toxicity
i.
For atrial fibrillation: take pulse and
report if below 60 or above 100 or
changes in rhythm
ii.
Daily weights: report 2 pound
increase
1. Antihypertensives
a. Action: dilates peripheral blood vessels
b. Examples
1. hydralazine HCL (Apresoline)
2. enalapril maleate (Vasotec)
3. reserpine (Serpasil)

4. prazosin HCL (Minipress)

5. methyldopa (Aldomet)
6. clonidine (Catapres)
Get a Clue
Many of the antihypertensives have trade names
that contain
-vas-pres-pasa. Use: hypertension
b. Contraindications
1. Heart block
2. Children
c. Adverse side effects
1. Orthostatic hypotension
2. Dizziness
3. Bradycardia
4. Tachycardia
5. Sexual dysfunction
6. Deterioration in renal function
7. Agranulosis
d. Nursing interventions
1. Monitor vital signs and blood pressure, sitting and
standing
2. Monitor for hearing changes, renal functioning
3. If hypotension, closely monitor client
4. Encourage intake of foods high in vitamin B
5. Teach client
a. Low sodium diet
b. Change positions slowly
c. Take medication as instructed
d. Avoid hazardous activities
e. Protect medication from heat and light
1. Thrombolytics
a. Action: binds with plasminogen to dissolve thrombi (clots)
in coronary arteries within 4 to 6 hours of myocardial
infarction. Activates conversion of plasminogen to plasmin.
Plasmin is able to break down clots (fibrin).
b. Examples
1. streptokinase (Streptase)
2. urokinase (Abbokinase)
c. Uses
1. Myocardial infarction

2. Deep venous thrombosis

3. Pulmonary emboli
d. Contraindications
1. Active bleeding
2. Cerebral embolism/thrombosis/hemorrhage
3. Recent intraarterial diagnostic procedure or surgery
4. Recent major surgery
5. Neoplasms of the CNS
6. Severe hypertension
e. Adverse side effects
1. Bleeding
2. Allergic reactions:urticaria, itching, flushing,
headache (illustration )
3. Elevation of temperature
f. Nursing interventions
1. Monitor for bleeding
2. Monitor coagulation studies
3. Monitor for allergic reactions
4. Keep available: aminocaproic acid (fibrinolysis
inhibitor)
2. Lipid-Lowering Agents (antilipidemic)
a. Action and use: lower LDL levels by reducing the synthesis
of cholesterol and/or triglycerides. Use: primary
hypercholesterolimia
b. Examples
1. cholestyramine (Questran)
2. atorvastatin (Lipitor)
3. colestipol (Colestid)
4. nicotinic acid (Niacin)
c. Contraindications:
1. Hypersensitivity
2. Pregnancy/lactation
3. Active liver disease
d. Adverse side effects
1. Skin flushing
2. Gastric upset
3. Niacin: temporary, intense flushing of face, neck
and ears
4. Reduced absorption of fat-soluble vitamins
5. Disruption of liver function
e. Nursing interventions
1. Monitor cholesterol levels
2. Monitor liver function tests
3. Teach client
a. Blood work and eye exams will be
necessary during treatment

b. To report blurred vision, severe GI

symptoms, or headache
c. About low-cholesterol high-fiber diet
4. With cholestyramine, colestipol: Give other
medications (e.g., such as thiazide diuretics,
digoxin, warfarin, and certain antibiotics)1 hour
before or 4 hours administration of cholestryramine
and colestipol, so that they will not react with bileacid-binding resins
1. Antianginals
a. Nitrates
1. Examples: Nitroglycerin, isosorbide dinitrate (Isordil)
2. Action: dilate arterioles which lowers peripheral vascular
resistance (afterload)
3. Uses: treatment and prevention of acute chest pain caused by
myocardial ischemia
4. Adverse effects: postural hypotension, headache, flushing,
dizziness
5. Contraindications
a. Hypersensitivity
b. Severe anemia
c. Hypotension
d. Hypovolemia
6. Nursing Interventions
a. Monitor for orthostatic hypotension
b. Monitor for tolerance with long term use
c. Administer every five minutes but not more than 3 tablets
in 15 minutes
d. If pain not relieved after 15 minutes and 3 tablets, notify
physician immediately
e. Instruct client
1. Take pulse before taking medication
2. Take oral preparations without food
3. When to seek medical attention
4. Not to chew or swallow sublingual tabs
5. Make position changes slowly
6. Carry drug so that it is always within reach but
avoid exposure to body heat and light
7. Replace drug approximately every 6 months
8. No alcohol
a. Beta-Adrenergic Blocking Agents
1. Examples: propranolol (Inderal)

2. Action: Inhibit sympathetic stimulation of beta receptors in the heart

decreases heart rate and force of myocardial contraction thus decreasing
myocardial oxygen consumption
3. Uses: reduces frequency and severity of acute anginal attacks,
dysrhythmias
4. Adverse effects: blood dyscrasias, hypotension, GI disturbances
5. Contraindications:
a. Hypersensitivity
b. Cardiogenic shock
c. Cardiac failure
6. Nursing interventions
a. Weigh daily. Report weight gain of 5 lbs.
b. Monitor ECG if using for dysrhythmia
c. Administer on an empty stomach
d. Protect injectable solution from light
e. Instruct client
1. Take pulse before taking drug
2. Not to discontinue medication abruptly
3. Avoid hazardous activities if drowsiness occurs
4. Make position changes slowly
5. Take drug at same time each day
b. Calcium Channel Blockers
7. Examples: verapamil (Isoptin), nifedipine (Adalat), diltiazem (Cardizem)
8. Action: Prevent the movement of extracellular calcium into the cell
resulting in coronary and peripheral artery dilation
9. Uses: stable angina, dysrhythmias, hypertension
10. Adverse effects: headache, drowsiness, dizziness, GI disturbances
11. Contraindications: hypersensitivity
12. Nursing interventions
a. Monitor chest pain
b. Monitor ECG if used for dysrhythmia
c. Administer with food
d. Instruct client
1. Increase fluids to counteract constipation
2. Take pulse before taking drug
3. Avoid hazardous activities until stabilized on drug
4. Limit caffeine consumption
5. No alcohol
6. Change position slowly
1. Hypotension and Shock
a. Natural and synthetic catecholamines
b. Examples: epinephrine, dopamine (Intropin), dobutamine (Dobutrex)

c. Actions: increase cardiac output

d. Uses: dopamine and dobutamine: hypovolemic and cardiogenic shock,
epinephrine: anaphylactic shock
e. Adverse effects: dysrhythmias, hypotension, tissue necrosis if
extravasation occurs. Tremors, anxiety, dizziness with epinephrine
f. Contraindications
1. Hypersensitivity
2. Ventricular fibrillation
3. Tachydysrhythmias
g. Nursing interventions
1. Correct hypokalemia before administering
2. Monitor vital signs frequently
3. Monitor ECG continuously during administration
4. Administer with infusion pump
5. Start drug slowly and increase according to MD orders
6. Monitor injection site for extravasation
7. Protect solution from light
8. Do not use discolored solution
9. Stop the drug gradually
1. Anticoagulants
a. Action: disrupt the blood coagulation process, thereby
suppressing the production of fibrin
b. Examples
1. heparin: parenteral administration
2. coumadin (Warfarin): oral administration
c. Use
1. Pulmonary embolism
2. Deep vein thrombosis
3. Myocardial infarction
4. Atrial fibrillation
5. Adverse side effects
6. Allergic responses such as chills, fever and urticaria
7. Use cautiously if client tends to bleed (hemophilia,
peptic ulcer)
d. Contraindications
1. Hemophilia
2. Leukemia
3. Peptic ulcer
4. Blood dyscrasias
e. Nursing interventions
1. heparin: monitor APTT (activated partial
thromboplastin time)
a. Normal 40 seconds.
b. At therapeutic levels, APTT increases by a
factor of 1.5 to 2

2. coumadin - monitor PT (prothrombin time)

a. Normal 12 seconds
b. INR (International normalized ratio) 2 to 3
3. Do baseline blood studies before therapy
4. Have antidote ready:
a. Antidote to heparin: protamine sulfate
b. Antidote to coumadin: vitamin K
5. Monitor client for symptoms of hemorrhage such as
increased pulse, decreased BP
6. Avoid salicylates (such as aspirin)
7. Avoid IM injections
8. Teach client
a. Take medication at same time every day
b. Wear medical alert jewelry: wearer takes
anticoagulants (illustration )
c. Use a soft toothbrush
d. Do not use a straight razor; use an electric
razor
e. Avoid alcohol and smoking
f. Report any signs of bleeding, red or black
bowel movements, headaches, rashes, red or
pink-tinged urine, sputum
g. Avoid trauma
h. Blood levels of the anticoagulant may be
monitored
i. Do not take over-the-counter (OTC)
medications without physician's approval
a. Action
1. Prevent abnormal heart rhythms
2. Action depends on type of antidysrhythmics drug
(see below)
b. Examples
1. Class I: Sodium channel blockers - quinidine
(Quinidex), lidocaine; increase duration of action
potential and effective refractory period
2. Class II: Beta blockers -propranolol (Inderal);
reduce calcium entry and depress phase-4
depolarization thereby reducing automaticity in SA
node, slow conduction in A-V node and reduce
contractility in atria and ventricles
3. Class III: Delayers of repolarization - bretylium
(Bretylol); block potassium channels and thereby
delay repolarization of fast potentials
4. Class IV: Calcium channel blockers - verapamil
(Isoptin); inhibit calcium ion influx across cell

membrane during cardiac depolarization, reduce

automaticity in SA node, decrease conduction
through AV node, and reduce myocardial
contractility
5. Others - digoxin (Lanoxin), adenosine (Adenocard);
decrease conduction through AV node and reduce
automaticity in SA node
c. Use: to treat abnormalities in cardiac rate and rhythm
Be Prepared
Try to pace yourself when answering the
questions. Take the time you need to answer each
question but try not to spend too much time on any
one question.
a. Adverse effects
1. Hypotension
2. Nausea and vomiting
3. Blood dyscrasias
4. Toxicity such as CNS disturbances due to
neurotoxicity, and diarrhea due to GI irritation
b. Nursing interventions
1. Monitor cardiac rhythm
2. Monitor blood levels
3. Monitor for blood dyscrasias
4. Administer oral preparations with meals
5. Monitor EKGs
6. Use infusion-control devices for IV administration
7. Teach client
a. Report changes in heart rate and/or rhythm
b. Report any side effects
1. Managing Respiratory Disease
Mini Overview:
1.
2.
3.
4.
5.
6.

Bronchodilators
Mucolytics
Antitussives
Anti-TB
Antihistamines
NSAIDs
1. Bronchodilators
a. Action:
1. Dilate air passages in the lungs, specific action
dependent on type of drug.

b.

c.
d.

e.

f.

2. Increase heart rate

3. Act on the autonomic nervous system
Examples
1. Adrenergics: ephedrine sulfate (Neorespin),
isoproterenol HCL (Isuprel) act on beta-adrenergic
receptors of sympathetic nervous system
2. Xanthines: aminophylline, theophylline (Theo-Dur)
acts on bronchial smooth muscle
3. epinephrine HCL (Adrenalin) - increases the rate
and strength of cardiac contraction through the
sympathetic nervous system
4. isoproterenol HCL (Isuprel) - increases the heart
rate by stimulating the beta-adrenergic blocking
agent of the sympathetic nervous system
5. atropine sulfate: increases the heart rate by
suppressing the parasympathetic nervous system at
the SA (sinoatrial) and AV (atrioventricular) nodes
Use
1. Bronchospasms
2. Asthma
Adverse effects
1. Dizziness
2. Tremors
3. Anxiety
4. Palpitations
5. Gastric disturbances
6. Atropine anticholinergic effects: dry mouth, blurred
vision, urinary retention
7. Headache
8. Tachycardia
9. Dysrhythmias
Contraindications
1. Hypersensitivity
2. Narrow angle glaucoma
3. Tachydysrhythmias
4. Severe cardiac disease
Nursing interventions
1. Monitor theophylline levels (normal 10-20 mcg/dl)
2. Monitor intake and output, and vital signs
3. Monitor EKG, vital signs during therapy
4. Teach clients:
a. Take medication as prescribed only
b. Report adverse effects
c. Stop smoking during therapy
d. Take with meals
e. Avoid OTC drugs

2. Mucolytics/Expectorants
a. Action
1. Mucolytics: disrupt molecular bonds and thins
mucus
2. Expectorants: stimulate a gastric mucosal reflex to
increase production of lung mucous
b. Examples
1. Mucolytic: acetylcysteine (Mucomyst)
2. Expectorant: guaifenesin (Robitussin)
c. Uses
1. Asthma
2. Acute or chronic bronchopulmonary disease
3. Cystic fibrosis
4. Mucomyst: acetaminophen toxicity
d. Adverse side effects
1. Oropharyngeal irritation
2. Bronchospasm
3. Gastric effects
e. Contraindications
1. Increased intracranial pressure
2. Status asthmaticus
f. Nursing interventions
1. Monitor respiratory status
2. Teach client
a. Take no fluids directly after oral
administration
b. Do take plenty of fluids
c. Encourage coughing and deep breathing,
especially before treatment
3. Antitussives
a. Action: to supress coughs through medullary cough center
or indirect action on sensory nerves
b. Examples
1. Narcotic: codeine, hydrocodone bitartrate (Hycoda)
2. Nonnarcotic - diphenhydramine HCL (Benadryl)
c. Use: colds, respiratory congestion, pneumonia, bronchitis,
TB, cystic fibrosis, emphysema
d. Adverse effects
1. Drowsiness
2. Nausea
3. Dry mouth
4. Dizziness
e. Contraindications:
1. Hypothyroidism
2. Iodine sensitivity
f. Nursing interventions

1.
2.
3.
4.

Monitor blood counts with long term therapy

Increase fluid intake
Humidify client's room
Teach client
a. Increase fluid intake if not contraindicated
b. Do not to take fluids immediately after
medication
c. Avoid driving and other hazardous activity
especially if taking narcotic type
d. Antitussives add to the effects of alcohol
4. Antituberculosis agents
a. Action: appears to inhibit RNA synthesis, so stops tubercle
bacilli from multiplying (first line) or functioning (second
line)
b. Examples
1. First line:
a. ethambutol (Myambutol) decreases
mycobacterial RNA synthesis
b. isoniazid (INH) - suppresses mycobacterial
cell-wall synthesis
2. Second line: inhibits mycobacterial cell metabolism
a. capreomycin (Capastat)
b. pyrazinamide (PZA)
c. Adverse effects
1. Gastric irritation
2. CNS disturbances
3. Liver disturbances
4. Blood dyscrasias
5. Streptomycin - ototoxicity
6. ethambutol - visual disturbances
7. Isoniazid - suppressed absorption of fat and vitamin
B complex
d. Contraindications:
1. Severe renal disease
2. Hypersensitivity
e. Nursing interventions
1. Monitor client response to therapy
2. Monitor blood work during therapy
3. If CNS disturbances are evident, take safety
precautions
4. Teach client
a. To take medication as ordered
b. To eat foods rich in B-complex vitamins
c. Avoid use of alcohol
d. Report if become pregnant

e. Ethambutol: report eye problems, have

regular eye exams
5. Antihistamines
a. Action: blocks histamine at receptor sites
b. Examples
1. promethazine HCL (Phenergan)
2. chlorpheniramine maleate (Chlor-Trimeton)
c. Uses
1. Relieves symptoms of allergies, colds, pruritus
2. Prevents problems in blood transfusion and drug
reactions
d. Adverse effects
1. Drowsiness
2. Gastric effects
3. Dry mouth
4. Headache
5. Thickening of bronchial secretions
e. Contraindications
1. Acute asthma
2. Lower respiratory heart disease
3. Narrow angle glaucoma
f. Nursing interventions
1. Discontinue 4 days before skin testing for allergies
2. Avoid interaction with CNS depressants
3. Teach client
a. Avoid driving and hazardous activities
b. Take antihistamines with food
c. Additive effect with alcohol, other CNS
depressants
d. Wear medic alert jewelry
6. Antiasthmatics
a. Action: stabilizes mast cells so chemical mediators are not
released as easily; decreases bronchial hyperreactivity
b. Example: cromolyn sodium (Disodium)
c. Use: to prevent asthma attacks, exercise-induced
bronchospasms
d. Adverse effects
1. Cough
2. CNS disturbances
3. Burning, stinging eyes
4. Throat irritation
5. Headache
e. Contraindications
1. Status asthmaticus
2. Hypersensitivity
f. Nursing interventions

1. Monitor eosinophil count

2. Monitor respiratory status
3. Store in tightly closed light-resistant container; keep
cool
4. Teach client
a. How to use the inhaler
b. Cough and breathe deeply before taking the
NSAID
c. What to do for acute asthma attack, if
cromolyn is not effective
d. That therapeutic effect may take up to 4
weeks
1. Neurological (including anesthetics)
Mini Overview:
1. Anticonvulsants
2. Antiparkinson Agents
3. Cholinesterase inhibitors
4. Antidepressants
5. Antimanic Agents
6. Antipsychotic
7. Hypnotics
8. Antianxiety (Anxiolytic)
9. General Anesthetics
10. Local Anesthetics
1. Anticonvulsants
a. Action - modifies bioelectric activity at subcortical and
cortical areas
b. Examples
1. diazepam (Valium)
2. magnesium sulfate
3. phenytoin (Dilantin)
4. phenobarbital (Luminal)
c. Use: prevents seizures
d. Adverse effects
1. Blood dyscrasias
2. Gastric effects - nausea, vomiting
3. CNS depression - dizziness, drowsiness
4. Phenytoin: ataxia, hirsutism, hypotension
e. Contraindications
1. Hypersensitivity
f. Nursing interventions
1. Give medication with food

2. With phenytoin: monitor condition of oral mucosa,

don't mix with other IV therapy, monitor blood lab
results, monitor urine
3. Renal, liver, and blood studies
4. Teach clients:
a. Avoid alcohol
b. Notify physician of unusual symptoms
c. Carry medical alert information
d. Take medication on schedule; do not
discontinue
e. Avoid driving and other potentially
hazardous activities
f. Phenytoin: good oral hygiene
1. Antiparkinson Agents
a. Action
1. Anticholinergics: block or compete at central acetylcholine
receptors
2. Dopamine agonists: activation of dopamine receptors

Antiparkinson Agent

Brand
Name

Adverse Effects

Nursing Interventions

benztropine mesylate

Cogentin

Dry mouth, drowsy,

dizzy, blurred vision,
urine retention, weak
muscles

Monitor I/O and muscle

strength. If weak muscles,
decrease dosage.

trihexyphenidyl Hcl

Artane

CNS disturbances, dry

mouth

Monitor I&O; Monitor for

behavior changes; Monitor for
tolerance over long-term
therapy

levodopa

Dopar

Orthostatic hypotension, Monitor for behavior changes;

ataxia, CNS
early signs of over dose are
disturbances, leukopenia muscle spasms and spasmodic
winking

amantadine Hcl

Symmetrel Orthostatic hypotension, Monitor I&O; administer at

ataxia, CNS
least 4 hours before HS
disturbances,
leukopenia, CHF
3. Teach client
a. Do not stop taking antiparkinsonian meds suddenly: may
precipitate parkinsonian crisis

b.
c.
d.
e.
f.

Continue medical supervision

Avoid alcohol while on therapy
Take with meals
Caution with hazardous activities
To change position slowly to prevent orthostatic
hypotension
g. Levodopa
1. Eliminate Vitamin B6 from diet
2. Do not take OTC medications without physician's
approval
3. Sweat and urine may be dark colored
4. Levodopa toxicity: mental personality changes,
increased twitching, grimacing, tongue protrusion
3. Cholinesterase inhibitors
a. Action
1. Prevents breakdown of acetylcholine at nerve
endings
2. Facilitates transmission of impulses across
myoneural junction
3. Strengthens muscle contractions including
respiratory muscles
b. Examples
1. edrophonium chloride (Tensilon) for diagnostic
purposes
2. neostigmine bromide (Prostigmin)
3. ambenonium chloride (Mytelase)
c. Use: treat myasthenia gravis
d. Adverse effects
1. Gastric irritation: nausea, vomiting, diarrhea
2. Hypersalivation
3. CNS disturbances
4. Orthostatic hypotension
5. Toxicity: pulmonary edema, respiratory failure,
bronchospasm
e. Contraindications:
1. Intestinal obstruction
2. Renal obstruction
3. Peritonitis
f. Nursing interventions
1. Monitor client response to medication; may need to
adjust dosage
2. Monitor vital signs during period of dosage
adjustment
3. Keep atropine sulfate available for overdosage
4. Administer medication with food

5. Administer medication as per schedule

6. Teach client:
a. Wear medic alert jewelry and ID
b. Change position cautiously; sit at first
feeling of faintness.
5. Antimanic agents
a. Action: reduces adrenergic neurotransmitter levels in
cerebral tissue
b. Examples
1. Antimanic agents: lithium carbonate (Lithane)
2. Alternative antimanic agents: carbamazepine
(Tegretol), clonazepam (Klonopin)
c. Use: control of manic phase of mood disorders; bipolar
disorder
d. Adverse effects
1. Metallic taste
2. Hand tremors
3. Excess voiding and extreme thirst
4. Slurred speech
5. Disorientation
6. Cogwheel rigidity
7. Renal failure
8. Respiratory depression
e. Nursing interventions
1. Monitor blood levels
2. Avoid concurrent administration of adrenergic drugs
3. Evaluate client's response to medication
4. Teach client
a. Effect of medication may take several weeks
b. High intake of fluids and normal sodium
c. Toxicity signs: diarrhea, vomiting, weak
muscles, confusion etc.
d. Take medication with meals
6. Antipsychotics
a. Action blocks dopamine hydrochloride receptors in the
CNS and sympathetic nervous system
b. Examples
1. Phenothiazines: chlorpromazine (Thorazine),
thioridazine (Mellaril)
2. Benzisoxazole: risperidone (Risperdal)
3. Thioxanthenes: chlorprothixene (Taractan)
4. Butyrophenones: haloperidol (Haldol)
c. Use: treatment of psychotic symptoms in schizophrenia,
psychosis, Tourette's syndrome, bipolar disorder
d. Adverse effects

1.
2.
3.
4.
5.
6.
7.

Excessive sedation
Jaundice
Orthostatic hypotension
Urinary retention
Anorexia
Dry mouth
Hypersensitivity reactions (such as photoallergic
reaction, impotence, cardiac toxicity)
8. Extrapyramidal side effects: dystonia,
pseudoparkinsonism, akathisia, akinesia, tardive
dyskinesia
9. Neuroleptic malignant syndrome: fever, muscle
rigidity, agitation, confusion, deliruim, respiratory
failure
e. Nursing interventions
1. Assess client's response to therapy
2. Monitor for signs of infection, liver toxicity,
extrapyramidal symptoms
3. Monitor blood work if long-term therapy
4. Monitor vital signs
5. Give medication at bedtime
6. Teach client
a. Avoid alcohol use
b. Avoid driving or other hazardous activities
c. Avoid exposure to direct sunlight
d. Good oral hygiene
e. Report extrapyramidal symptoms or signs of
infection to physician
f. Drink plenty of water
Study Smart
While studying, review content by formulating
questions about the content.

7. Hypnotics
a. Action: depress CNS
b. Examples
1. Barbiturates: pentobarbital (Nembutal), secobarbital
(Seconal): physical dependency may result with
long term use
2. Acetylinic alcohol: ethchlorvynol (Placidyl)
3. Chloral derivatives: chloral hydrate (Noctec)
c. Uses: insomnia, sedation
d. Adverse reactions
1. Respiratory depression

2. Hypotension
3. Barbiturate toxicity: hypotension; pulmonary
constriction; cold, clammy skin; cyanosis of lips;
insomnia; hallucinations; delirum
e. Contraindications
1. Hypersensitivity
2. Pregnancy
f. Nursing interventions
1. Monitor client response to medication
2. Teach client
a. Take medication exactly as prescribed
b. Avoid alcohol and other depressant use
c. Avoid driving and other hazardous activities
while under the influence
8. Antianxiety (Anxiolytic)
a. Action: depress CNS
b. Examples
1. Benzodiazepines: alprazolam (Xanax),
chlordiazepoxide (Librium): physical dependency
and withdrawal symptoms after long term use
2. Propanediols: meprobamate (Equanil)
3. Quinazolines: methaqualone (Quaalude)
c. Uses: anxiety, sleep disorders, alcohol withdrawal
d. Adverse reactions
1. CNS disturbances: dizziness, drowsiness, lethargy,
orthostatic hypotension
2. Skin rash
3. Blood dyscrasias
e. Contraindications
1. Hypersensitivity
2. Acute narrow angle glaucoma
3. Liver disease
f. Nursing interventions
1. Notify physician if systolic BP drops 20 mm Hg
2. Administer with food or milk
3. Teach client
a. Take medication as prescribed
b. Do not take OTC medication without
physician's approval
c. Use caution when driving or hazardous
activities
d. Action potentiated with alcohol or sedatives
e. Never abruptly stop taking benzodiazepine
f. With chlordiazepoxide - avoid excessive
sunlight
9. General Anesthetics

a. Action: depresses the CNS through a progressive sequence

b. Examples
1. Inhalation anesthetics: cyclopropane, enflurane
(Ethrane), ether, nitrous oxide
2. IV barbiturates: thiopental sodium (Pentothal),
methohexital sodium (Brevital)
3. IV and IM nonbarbiturates: midazolam HCL
(Versed), ketamine HCL (Ketaject)
c. Use: used in combination for surgical anesthesia
d. Adverse effects
1. Inhalation anesthetics: excitement and restlessness,
nausea and vomiting, respiratory distress
2. IV barbiturates: respiratory depression,
hypotension, tachycardia, laryngospasm
3. IV and IM nonbarbiturates: respiratory failure,
hyper/hypotension, rigidity, psychiatric disturbances
e. Contraindications
1. CVA
2. Increased intracranial pressure
3. Severe hypertension
4. Cardiac decompensation
f. Nursing interventions
1. Have oxygen and emergency treatment available
2. Monitor vital signs
3. Use precautions if agent flammable
4. Use safety precautions when client induced
10. Local Anesthetics
a. Action: decreases nerve membrane permeability to sodium
ion influx
b. Examples
1. Topical: benzocaine, cocaine, lidocaine HCL
(Xylocaine)
2. Spinal: dibucaine (Nupercaine), procaine HCL
(Novocaine)
3. Nerve block: bupivacaine HCL (Marcaine),
mepivacaine HCL (Carbocaine)
c. Use: pain control while client is conscious
d. Adverse effects
1. Allergic reactions
2. Respiratory arrest
3. Arrhythmias, cardiac arrest
4. Convulsions
5. Hypotension
e. Nursing interventions
1. Have oxygen and emergency equipment available

2. Monitor vital signs during local anesthesia

3. If spinal anesthesia, keep client flat for 6-12 hours
to prevent headaches
4. Managing Musculoskeletal Conditions
Mini Overview:
1. Skeletal Muscle Relaxants
2. NSAIDs
3. Antigout Agents
1. Skeletal muscle relaxants
a. Use: relax muscles, treat spasm disorders
Central

Peripheral

Use:

Relief of muscle spasm and Facilitation of

pain
endotracheal intubation,
orthopedic manipulation

Action:

Depress CNS, leading to

relaxation of voluntary
muscles

Block nerve impulses at

the myoneural junction

Examples:

cyclobenzapine (Flexeril),
diazepam(Valium),
orphenadrine(Norflex)

gallemine
triethiodide(Flaxedil ),
succinylcholine chloride
(Anectine)

Adverse
Effects:

Tachycardia, dizziness,
drowsiness, dry mouth,
edema of tongue, CNS
disturbances

Hypotension, respiratory
depression, arrhythmias

Nursing
Monitor client for safety
Interventions: precautions; teach client to
avoid alcohol and hazardous
activities; administer with
meals; fluids for dry mouth;
do not discontinue meds
abruptly

Have resuscitation
equipment available;
monitor vital signs, client
condition, and response to
medication; Withhold
medication and call
physician if client shows
signs of hypersensitivity
1. Nonsteroidal Antinflammatory Drugs (NSAIDS)
a. Action: interferes with prostaglandin synthesis
b. Examples: ibuprofen (Motrin), indomethacin (Indocin)
c. Use: rheumatoid arthritis, osteoarthritis, dysmenorrhea
d. Adverse effects
1. Gastric disturbances

2. Skin rash
3. Blood dyscrasias/bleeding
4. CNS disturbances
5. Nephrotoxicity
e. Contraindications
1. Hypersensitivity
2. Asthma
3. Renal Disease
4. Liver disease
f. Nursing interventions
1. Administer 1 hour before or 2 hours after meals
2. Monitor blood work, vital signs
3. Monitor response to medication
2. Antigout agents
a. Action: Increases excretion of uric acid and decreases uric
acid formation
b. Examples
1. allopurinol (Zyloprim)
2. colchicine (Novocolchine)
3. probenecid (Benemid)
c. Use: prevent gout attacks
d. Adverse effects
1. Gastric effects: nausea and vomiting, indigestion
2. Blood dyscrasias
3. Liver damage
4. Skin rash
5. GI disturbances
e. Contraindications: hypersensitivity
f. Nursing interventions
1. Increase fluid intake to prevent renal calculi
2. Monitor fluid intake and output
3. Administer with meals
4. Monitor blood work, including serum uric levels,
and electrolyte levels
5. Instruct client
a. Lose weight if needed
b. Avoid high purine foods (organ meats,
sardines, shellfish, etc.)
c. Avoid fermented beverages such as beer, ale,
wine
1. Managing Integumentary Conditions
Mini-Overview:
1. Scabicides/Pediculicides

2. Anti-pruritics
3. Anti-infectives
4. Anti-inflammatory Steroids
1. Scabicides/Pediculicides (illustration 1 illustration 2 )
a. Action: targets the parasite's nerve-cell membrane
b. Examples
1. permethrin (Nix) (Elimite)
2. lindane (Kwell)
c. Use: treat parasitic arthropods: itch mites (scabies)
and lice
d. Adverse reaction: skin irritation
e. Contraindications: hypersensitivity
f. Nursing interventions
1. Use precautions to prevent spread of
parasites (for example, use gown and gloves,
keep infected linen separate, etc.)
2. Keep medication away from eyes and
mucous membranes
3. Monitor for skin irritation
4. Determine source of contamination
5. Evaluate effectiveness of treatment
1. Antipruritics
a. Action: inhibits conduction of nerve impulses to
sensory endings
b. Examples 1. benzocaine (Solarcaine)
2. lidocaine HCL (Xylocaine)
c. Use: temporary relief of skin problems such as
minor burns, insect bites, sunburn
d. Adverse reactions - skin irritation
e. Nursing interventions
1. Monitor effect of treatment
2. Avoid contact with eyes
1. Anti-infectives
a. Action: interfere with essential metabolic actions of
microbial cells
b. Examples
1. silver sulfadiazine (Silvadene)
2. silver nitrate 0.1%-0.5% solution
b. Uses
1. Ophthalmic solutions: treat ophthalmic infections;

2. Bladder and urethra irrigations

c. Adverse effects
1. silver sulfadiazine: skin irritation
2. silver nitrate
a. Electrolyte imbalance
b. Brownish black discoloration produced on
contact
b. Nursing interventions
1. Monitor client's condition during treatment
2. For eyes, use only silver nitrate in ophthalmic
solution
3. Handle silver nitrate with care: solutions stain skin
and clothing
4. silver sulfadiazine: use aseptic technique when
applying
2. Anti-inflammatory (Steroids, glucocorticoids)
a. Action: stabilize leukocyte lysomal membranes, inhibit
phagocytosis and release of allergic substances
b. Examples
1. Hydrocortisone sodium succinate (Solu-Cortef)
2. Hydrocortisone sodium phosphate (Hydrocortone)
c. Use: to suppress inflammatory or immune responses
d. Adverse reactions
1. Sodium and fluid retention
2. Nausea, acne, impaired wound healing
3. Anaphylactic reaction
4. Masking of infection
5. Behavior changes
e. Contraindications:
1. Hypersensitivity
2. Systemic fungal infections
f. Nursing interventions
1. Establish baseline of vital signs, I/O ratio, weight
2. Monitor blood pressure during stabilization period
3. Assess client's response to treatment
4. Teach client
a. Take oral steroid with food
b. Take anti-inflammatories on schedule and
don't stop abruptly
c. Expect a slight weight gain
d. Avoid alcohol and caffeine
e. Don't use OTC medications unless approved
by physician
f. Report slow healing, vague feeling of being
sick, or relapse

g. Use medic alert jewelry or ID

6. Managing Gastrointestinal Conditions
Mini-Overview:
1.
2.
3.
4.

Antacids
Laxatives
Antidiarrheals
Pancreatic Enzymes
1. Antacids
a. Action
1. Neutralizes gastric acid
2. Coats stomach lining
b. Examples
1. aluminum hydroxide gel (Amphojel)
2. aluminum and magnesium hydroxides (Maalox)
3. magaldrate (Riopan)
c. Use: peptic ulcers, reflux esophagitis, hiatal hernia
d. Adverse reactions
1. Aluminum compounds - constipation, intestinal
obstruction
2. Magnesium compounds - diarrhea
3. Reduced absorption of calcium and iron
e. Nursing interventions
1. Shake oral suspension well
2. Monitor client's response to treatment
3. Administer with 8 oz glass of water
4. Instruct client
a. Avoid overuse of antacids
b. Dietary restrictions for ulcers
c. Need for diet high in calcium and iron
d. For clients on low sodium diets: antacids
contain sodium
e. May color stools whitish
2. Laxatives
a. Action: moves stool; mechanism dependent on type of
laxative
b. Examples
1. Lubricants moisten stool; mineral oil
2. Stool softeners allow water to penetrate stool;
dioctyl sodium sulfosuccinate (Colace)
3. Bulk forming: increase bulk in intestine; psyllium
hydrophilic mucilloid (Metamucil)
4. Colon irritant stimulates peristalsis; bisacodyl
(Dulcolax)

c.
d.

e.

f.

5. Saline cathartics increase osmotic pressure thereby

absorbing fluid from bowel wall; milk of magnesia
Use: to treat constipation
Adverse reactions
1. Gastric effects: nausea, cramping, diarrhea
2. Dependence with long-term use
3. Intestinal lubricants inhibit absorption of fat-soluble
vitamins
4. Saline cathartics: dehydration, hypernatremia
Contraindications:
1. GI obstruction
2. Suspected appendicitis
3. Megacolon
4. Abdominal pain
5. Nausea
Nursing interventions
1. Monitor effects of medication
2. Teach client
a. dietary considerations (increased fiber and
fluid intake)
b. maintain/increase activity level
c. caution regarding overuse of laxatives
d. mix bulk-forming laxatives with a glass of
water and follow with another glass of water

Plan to finish studying for NCLEX at least several days prior

to your scheduled time to test. Last minute cramming will
increase your anxiety.
1. Anti-diarrheal
a. Action: forms the stool; mechanism depends on type of
medication
b. Examples
1. Fluid absorbents - decrease fluid content; kaolin and
pectin (Kaopectate)
2. Motility suppressants - decrease motility of GI tract;
diphenoxylate HCL (Lomotil), loperamide HCL
(Imodium)
3. Enteric bacterium - replacements help intestine turn
carbohydrates into lactic acid; lactobacillus
acidophilus (Bacid)
c. Use: treat diarrhea
d. Adverse reactions
1. Fluid absorbents: gastric disturbances, CNS toxicity
2. Enteric bacterium replacements: excessive
flatulence, abdominal cramps

3. Motility suppressants: urinary retention,

tachycardia, sedation, paralytic ileus, respiratory
depression
e. Contraindications:
1. Ulcerative colitis
f. Nursing interventions
1. Monitor effect of medication
2. Assess for fluid and electrolyte imbalance
3. Assess for cause of diarrhea
4. Motility suppressants may cause physical
dependence, may impair ability to perform
hazardous activities
2. Pancreatic Enzymes
a. Action: replacement for natural pancreatic enzymes
b. Examples
1. pancreatin (Dizymes)
2. pancrelipase (Cotazym)
c. Use: aid in digestion; cystic fibrosis
d. Adverse reactions, with large doses
1. Diarrhea
2. Nausea
3. Hypersensitivity reaction: sneezing, skin rashes
e. Contraindications:
1. Hypersensitivity to pork
2. Chronic pancreatic disease
f. Nursing interventions
1. Monitor for symptoms of diabetes mellitus (such as
polyuria, thirst, hunger)
2. Monitor weight, intake and output
3. Administer with meals
4. Do not crush enteric coated medications
5. Determine client's response to therapy
1. Managing Endocrine Conditions
Mini-Overview:
1.
2.
3.
4.
5.

Antidiabetic Agents
Hypothyroid Agents
Hyperthyroid Agents
Anterior Pituitary Growth Hormone
Antidiuretic Hormone
1. Antidiabetic agents
a. Action: provides insulin to promote transport of glucose;
exact mechanism dependent on type of antidiabetic agent
b. Examples

1. Oral hypoglycemics stimulate pancreatic beta cells

to produce insulin tolazamide (Tolinase),
tolbutamide (Orinase)
2. Parenteral agents provide exogenous insulin
c. Use: treat diabetes mellitus
d. Adverse effects
1. Hypoglycemia, irritability, confusion
2. Convulsions, tachycardia, tremor
3. Moist skin, headache, hunger
e. Contraindications:
1. Hypersensitivity
f. Nursing interventions
1. Assess client for effect of medication
2. Monitor blood/urine glucose levels
3. Guidelines for administration of insulin
a. Rotate sites
b. Administered subcutaneously
c. Only regular insulin is administered IV
d. When mixing insulin, regular insulin is
withdrawn into the syringe first
4. Instruct client
a. How to administer the medication
b. Compliance with dietary restrictions
c. Urine and blood testing
d. Wear medic alert jewelry
e. How to cope with hypoglycemic reactions
f. Signs of ketoacidosis
2. Hypothyroid agents
a. Action: help regulate the metabolic rate of cells
b. Examples
1. levothyroxine sodium (Synthroid)
2. thyroglobulin (Proloid)
3. thyroid (Thyrar)
c. Use: replace thyroid hormones
d. Adverse reactions
1. Hyperactivity
2. Cardiac stimulation
3. Thyroid storm
e. Contraindications
1. Adrenal insufficiency
2. Myocardial infarction
3. Thyrotoxicosis
4. Hypersensitivity to beef
f. Nursing interventions
1. Monitor client's response to medication
2. Teach client

a. Usually lifelong therapy

b. Take medication same time each day
c. Monitor pulse rate; report pulse rate over
100
d. Report signs of toxicity (such as chest pain,
palpitations, nervousness)
e. Wear medic alert jewelry / ID
f. Avoid OTC medications unless approved by
physician
g. Continue medical supervision
3. Hyperthyroid agents
a. Action: blocks synthesis of thyroid hormone
b. Examples
1. iodine (Lugol's solution)
2. methimazole (Tapazole)
3. propylthiouracil (PTL)
c. Use: treat hyperthyroidism
d. Adverse effects
1. Agranulocytosis
2. Skin disturbances
3. Decreased metabolism
4. Gastric disturbances
5. Iodine: stains teeth, bitter taste
e. Contraindications:
1. Hypersensitivity
f. Nursing interventions
1. Administer iodine preparations through a straw
2. Monitor effects of medication
3. Instruct client
a. Report side effects
b. Avoid OTC drugs containing iodine
c. Do not discontinue medication abruptly
d. Carry medic alert jewerly
4. Anterior pituitary: growth hormone
a. Action: stimulates the growth of practically all organs and
tissues
b. Examples
1. somatrem (Protropin)
2. somatropin (Humatrope)
c. Use: treat dwarfism
d. Adverse effects
1. Hyperglycemia
2. Hypothyroidism
3. Antibodies to growth hormone
4. Interaction with glucocorticoids
e. Contraindications:

1. Hypersensitivity to benzyl alcohol

2. Closed epiphyses
3. Intracranial lesions
f. Nursing interventions
1. Monitor diabetic client closely
2. Instruct client
a. Record height measurements at regular
intervals
b. Report to physician if growth is less than
expected
5. Antidiuretic Hormone
a. Action: Helps distal renal tubules reabsorb water
b. Examples
1. lypressin (Diapid)
2. vasopressin (Pitressin)
c. Use: treatment of diabetes insipidus
d. Adverse effects
1. Gastric disturbances
2. Hyponatremia
3. Water intoxication
4. Cardiac disturbances
e. Nursing interventions
1. Monitor response to therapy: intake and output,
blood pressure
2. Assess for dehydration
1. Managing Genitourinary Diseases
Mini-overview:
1.
2.
3.
4.

Diuretics
Sulfonamides
Immunosuppressants
Anti-infectives
1. Diuretics
a. Action: interferes with sodium reabsorption
b. Examples
1. Loop diuretics interrupt the transport of sodium ions
in Loop of Henle
a. ethacrynic acid (Edecrin)
b. furosemide(Lasix)
2. Potassium sparers act on distal nephron sites to
decrease sodium reabsorption
a. spironalactone (Aldactone)
b. trimterine (Dyrenium)

3. Thiazides: inhibit reabsorption of Na+ and CL- in

early distal tubule
a. chlorothiazide (Diuril)
b. hydrochlorothiazide (Hydrodiuril)
4. Osmotic: increase osmotic pressure of glomerular
filtrate
a. Mannitol
b. Urea
c. Use: Treat hypertension, edema
d. Adverse side effects
1. Gastrointestinal irritation
2. Electrolyte imbalance: hyponatremia, hypokalemia
3. Orthostatic hypotension
4. Dehydration
e. Contraindications
1. Electrolyte imbalances
2. Dehydration
3. Anuria
f. Nursing interventions
1. Monitor weight, intake and output, vital signs
2. Give medication in morning
3. Monitor client for fluid & electrolyte imbalance
4. Teach client
a. Change positions slowly
b. Report changes in hearing
c. Diabetic clients: closely monitor glucose
levels
2. Sulfonamides
a. Action: substitutes a false metabolite for p-aminobenzoic
acid, which is essential for the bacterial synthesis of folic
acid
b. Example
1. succinylsulfathiazole (Sulfasuxidine)
2. sulfisoxazole (Gantrisin)
3. sulfamethoxazole and trimethoprim (Bactrim,
Septra)
c. Use: urinary tract infections
d. Adverse effects
1. Gastric irritation: nausea and vomiting, stomatitis
2. Rash
3. Malaise
4. Blood dyscrasias
5. Crystalluria
6. Photosensitivity
7. Allergic response
e. Contraindications:

1. Hypersensitivity
2. Infants < 2 mo
3. Pregnancy at term
f. Nursing interventions
1. Check if client has a history of allergies
2. Monitor client response to treatment
3. Monitor vital signs and blood work
4. Teach client
a. Drink plenty of fluids
b. Take medication as prescribed
c. Avoid OTC medications unless approved by
physician
d. Avoid direct sunlight
3. Immunosuppressants
a. Action: inhibit immune responses
b. Example: cyclosporine (Sandimmune)
c. Use
1. Prevent organ rejection in transplant patient
2. Treat autoimmune disorders (such as rheumatoid
arthritis, systemic lupus erythematosus)
d. Adverse effects
1. Nephrotoxicity (poisons kidneys)
2. Infection
3. Hypertension
4. Tremor
5. Hirsutism
e. Contraindications:
1. Hypersensitivity
2. Nursing interventions
3. Monitor BUN and creatinine; liver function tests
4. Teach client
a. Report early signs of infection (such as
fever, sore throat)
b. Medication may be taken with meals
c. Take medication same time each day
d. Hirsutism is reversible when treatment stops
4. Antinfective
a. Action: interferes with several bacterial enzyme systems
b. Example
1. nitrofurantoin (Furadantin)
2. nalidixic acid (NegGram)
c. Use: treat pyelonephritis, pyelitis, cystitis
d. Adverse effects
1. Anorexia
2. Nausea and vomiting
3. Nalidixic acid: visual disturbances

4. Nitrofurantoin: exfoliative dermatitis, interstitial

nephritis, necrosis
e. Contraindications
1. Hypersensitivity
2. Anuria
3. Severe renal disease
4. Infants < 1 mo
f. Nursing interventions
1. Monitor intake and output
2. Teach client
a. Take medication as prescribed
b. Drink plenty of fluids
c. Take medication with food or milk
d. With nitrofurantoin:
i.
Do not crush pill because it stains
teeth; dilute oral suspensions and
rinse mouth after taking
ii.
Report changes in urinary pattern
iii.
Report muscle weakness, tingling or
numbness
iv. Urine may look brown or rust yellow
v. Avoid alcohol
e. With nalidixic acid:
i.
Avoid direct exposure to sunlight
while on therapy
ii.
Report visual disturbances
iii.
Avoid driving or other hazardous
activities
1. Managing Hematological Conditions
1. Hematopoietic growth agent
a. Action: stimulates production of red blood cells
b. Example
1. filgrastim (Neupogen)
2. epoetin alfa (Epogen)
c. Use: chronic renal failure, HIV-infected clients,
nonmyeloid malignancies
d. Adverse effects
1. filgrastim: bone pain, thrombocytopenia
2. epoetin alfa: hypertension
e. Contraindications:
1. Hypersensitivity to proteins of E. Coli
f. Nursing interventions
1. Take baseline CBC and diff (complete blood count
and differential count) prior to treatment
2. Monitor blood signs until target reached

2. Iron supplements
a. Action: iron transported as transferrin to bone marrow and
incorporated into hemoglobin
b. Examples
1. ferrous sulfate (Feosol)
2. ferrous fumarte (Feco-T)
3. ferrous gluconate (Fergon)
c. Use: correct simple iron deficiency anemia
d. Adverse effects
1. Gastric disturbances
2. With massive overdose - lethargy, drowsiness,
leading to metabolic acidosis, shock and
cardiovascular collapse
e. Contraindications:
1. Hypersensitivity
2. Ulcerative colitis
3. Peptic ulcer disease
4. Hemolytic anemia
5. Cirrhosis
f. Nursing interventions
1. Monitor hemoglobin level
2. Teach client
a. Take on empty stomach
b. Liquid preparation - take with a straw
c. Protect from moisture and heat
d. May cause dark or greenish stools
I.

Antibiotics, Antivirals, Antifungals, Antiparasitics

A. Antibiotics
1. Action: destroys or inhibits bacteria
2. Examples
a. Penicillins, broad spectrum
1. ampicillin (Omnipen)
2. penicillin V (V-cillin)
b. Cephalosporins, broad spectrum
1. cefazolin sodium (Ancef)
2. cephalothin sodium (Keflin)
c. Erythromycins
1. erythromycin (E-mycin)
2. lincomycin HCL (Lincocin)
d. Tetracyclines, broad spectrum
1. doxycycline (Vibramycin)
2. oxytetracycline (Terramycin)
e. Aminoglycosides, broad spectrum
1. gentamicin sulfate (Cidomycin)

2. streptomycin sulfate (Strycin)

f. Polymyxin: polymyxin B sulfate (Aerosporin)
g. chloramphenicol (Chloromycetin)
3. Use: treat bacterial infection
4. Adverse effects
a. Gastric disturbances: nausea / vomiting, poor appetite,
diarrhea
b. Allergic reactions
c. Superinfection
d. Loss of water-soluble vitamins and minerals
e. Tetracyclines: hepatotoxicity, phototoxicity, hyperuricemia,
tooth enamel hypoplasia, and bone defects in children
under 8 years of age
f. Aminoglycosides: ototoxicity, leukopenia,
thrombocytopenia, headache, confusion, peripheral
neuropathy, optic neuritis
g. chloramphenicol: blood dyscrasias, fever, rash, jaundice
5. Contraindications:
1. hypersensitivity
2. Nursing interventions
a.

Monitor client for allergies

b. Monitor client's response to treatment
c. Teach client
1. Take all of prescribed medication
2. Symptoms of allergic response
3. If taking a liquid (suspension), shake it first
4. Take medication before meals
d.
Tetracyclines
1. Not for young children or in last half of pregnancy
2. Possible oral anticoagulant effect
e.
Aminoglycosides and polymyxins: May potentiate neuromuscular blocking
agents, general anesthesia or magnesium effects; monitor for all three potentiation effects
f. chloramphenicol
1. Assess blood work during therapy
2. Assess for potentiation of phenytoin, oral
antidiabetic agents or coumadin anticoagulant
effects
B. Antivirals
1. Action: interfere with DNA synthesis needed for viral replication
2. Examples
a.
acyclovir sodium (Zovirax)
b. amantadine HCL (Symmetrel)
c. methisazone (Maroran)
3. Use: viral infections such as herpes, viral encephalitis

a.

a.
a.

a.

a.

a.
a.

c.

a.

4. Adverse effects
Orthostatic hypotension
b. Dizziness
c. GI disturbances
d. Nephrotoxicity
e. Blood dyscrasias
5. Contraindications:
Hypersensitivity
b. Immunosuppression
6. Nursing interventions
Monitor vital signs during antiviral therapy
b. Monitor effect of therapy
c. Increased fluid intake
d. Monitor for signs of superinfection: sore throat, fever,
fatigue
C. Antifungals (systemic)
1. Action: destroys fungal cells or inhibits their reproduction
2. Examples
amphotericin B (Fungizone)
b. griseofulvin (Grisactin)
c. nystatin (Mycostatin)
3. Use - treat local and systematic fungal infections such as
histoplasmosis, candidiasis
4. Adverse effects
Gastric irritability: nausea, vomiting
b. Headache
c. Fever, chills
d. Paresthesia
e. Renal impairment
5. Contraindications:
Severe bone marrow depression
b. Hypersensitivity
6. Nursing interventions
Monitor vital signs and I and O during therapy
b. With amphotericin B:
1. protect IV solution from light
2. monitor blood work
3. use infusion device for IV administration
With griseofulvin: instruct client to avoid sunlight
D. Antiparasitics
1. Action: interferes with parasite metabolism and reproduction
2. Examples
Anthelmintics : mebendazole (Vermox), piperazine (Vermizine) (illustration )
b. Amebicides: chloroquine HCL (Aralen), metronidazole
(Flagyl)

c. Antimalarials: chloroquine HCL (Aralen), quinine sulfate

(Quinamm)
3. Use: kills parasites, helminths (pinworm and tapeworm), protozoa
(amebiasis and malaria)
4. Adverse effects
Anthelmintics: GI upset, CNS disturbances, skin rash, headache
b. Amebicides: GI upset, blood dyscrasias, skin rash, CNS
disturbances
c. Antimalarials: GI upset, blood dyscrasia, visual
disturbances
5. Nursing interventions
Administer medication with food
b. Monitor vital signs, blood work during therapy
c. Use safety precautions if CNS disturbances manifested
d. Teach client to prevent further infection
e. With antimalarials: frequent visual examinations, urine may
turn rust colored

a.

a.

V.

Total Parenteral Nutrition (TPN)

A. A form of specialized nutritional support in which nutrients are provided
by the intravenous route
B. Purpose: to sustain clients nutritionally. Solutions consist of water, amino
acids, glucose, minerals, vitamins and lipid emulsions, and trace elements
which are calculated for each client individually.
C. Used for clients who are unable to digest or absorb enteral nutrition
D. Complications
1. Hypoglycemia
2. Hyperglycemia
3. Fluid overload
4. Catheter - related sepsis
5. Air embolism
6. Central venous thrombosis
7. Catheter acclusion
E. Administration
1. Via peripheral administration - up to 10% glucose solutions
2. Via central administration - up to 35% glucose solutions
F. Nursing Interventions
1. Before administration of TPN
a. Check label of solution with medical order
b. Check rate of infusion with medical order
c. Inspect TPN bottle for precipitates or turbidity
d. Administer via an infusion pump
2. During administration
a. Monitor vital signs every four hours

b. Observe for signs of air embolism, pneumothorax, or

allergic responses (such as chills, increased temperature,
urticaria etc.)
c. Monitor client's weight daily
d. Monitor laboratory values; if blood glucose levels rise, may
need to use sliding-scale insulin therapy
e. Monitor client for fluid overload
f. Monitor respiratory rate: tachypnea may indicate excess
carbohydrates are increasing carbon dioxide production
g. Monitor insertion site for infection
h. Monitor infusion rate
1. If rate too high, hyperosmolar diuresis and
dehydration
2. If too slow, little benefit
3. Do not overcorrect flow rate if too slow or fast
4. Accurately record intake and output
5. Change insertion site dressing as per facility's
policy
6. Encourage exercise as tolerated to promote the
development of muscle instead of fat
7. While changing tube, instruct client to use Valsalva
maneuver and clamp tube to prevent an air
embolism
I.

Antineoplastics (cytotoxic, antiproliferative agents)

A. Action
1. Highly toxic agents that attack all rapidly dividing cells, both
normal and malignant
2. Represents a systemic approach that bases its action on disruption
of the cell life cycle
3. Most agents modify or interfere with DNA synthesis
B. Examples
1. Alkalyting agents: mechlorethamine HCl (Nitrogen Mustard),
cyclophosphamide (Cytoxan): produce breaks in DNA molecule
and cross-linking of strands thus interfering with DNA replication;
most effective in hematologic malignancies
2. Antitumor antibiotics: Biomycin; bind directly with DNA changing
its configuration and inhibiting replication
3. Antimetabolites: methotrexate, 5-fluorouracil, floxuridine, cytosine
arabinoside, 6-mercaptopurine, 6-thioguanine: inhibit DNA
synthesis; most effective against rapidly growing tumors enzymes
necessary for cell function and replication
4. Plant alkaloids: Vinblastine, Vincristine, Etoposide: Bind to
substances needed to form mitotic spindle, thus preventing cell
division

C.

D.
E.

F.

5. Hormones and hormone inhibitors: Tamoxifen alters the endocrine

environment to make it less conducive to cell growth; used in
cancers of the breast, prostate, and other reproductive organs
Routes of administration
1. Intravenous (peripheral or central venous access)
2. Oral
3. Intraarterial
4. Intraperitoneal
5. Intrapleural
6. Intrathecal
7. Via ventricular reservoir
Use
1. To cure, control or palliate results of neoplasm
2. May be used as an adjunct to surgery and radiation
Adverse effects: result from the damage to normal cells
1. Nausea/ vomiting, Stomatitis, Alterations in taste, Anorexia
2. Diarrhea, Constipation
3. Alopecia, Dermatitis, Pruritus, Paresthesia, Rash, Bruising
4. Hemorrhagic cystitis
5. Cardiomyopathy
6. Fatigue, Dyspnea, Fever, Chills
7. Sterility, Amenorrhea
8. Depression, Anxiety
9. Myelosuppression
Nursing interventions
1. Monitor lab studies as ordered
2. Monitor IV administration site for extravasation
3. Maintain strict asepsis
4. Administer antiemetic agents as ordered and prophylactically
before chemotherapy.
5. Give antihistamines as ordered
6. Withhold food and fluids for 4-6 hours before treatment
7. Between treatments, give small, frequent, bland meals
8. Give antidiarrheals as ordered
9. Monitor for signs of dehydration and encourage fluids as tolerated
10. Provide frequent oral hygiene, lubricate lips as indicated
11. For stomatitis, use topical anesthetics before eating and as
indicated
12. Apply lotion to skin as indicated; avoid harsh, drying soaps
13. Provide a restful environment, emotional support and anxiolytics
as ordered
14. Teach client
a. Medications and side effects
b. That alopecia is temporary
c. To avoid bruising, aspirin products, and persons with
infections

d. To conserve energy
e. To recognize signs of bleeding; anemia, infection
f. To use a soft-bristle toothbrush
g. Avoid use of razors
G. Special nursing considerations
1. Exposure to chemotherapeutic agents can lead to adverse reactions
a. Contact dermatitis
b. Nausea and vomiting
c. Diarrhea
2. Exposure during pregnancy can lead to
a. Increased risk of fetal abnormalities
b. Ectopic pregnancies
c. Spontaneous abortions
3. Guidlines for reducing risks when handling cytotoxic
antineoplastic drugs
a. Wear a mask to avoid inhaling powder when handling a
powder form of a drug.
b. Do not prepare drugs in eating places Wear gloves, eye
protectors and protective clothing when in contact with
injectable solutions.
c. Dispose of contaminated materials in puncture-proof
containers labeled as hazardous material.
d. Wear gloves when handling linens contaminated with drugs
for at least 48 hours after contamination.
e. Wash hands thoroughly before and after exposure to drugs.
f. Follow organizational procedure to clean-up after chemical
spill
I.

Blood Transfusion
A. Use: restore blood volume or blood components
B. Nursing responsibilities and interventions
1. Verify that blood had been typed and cross matched
2. Verify five factors:
a. client number
b. blood type
c. Rh factor
d. blood number
e. expiration date
3. Pretransfusion assessment includes baseline vital signs
4. Verify informed consent
5. Start infusion with blood administration set, filter, and normal
saline IV
6. Watch for signs of hemolytic reaction; usually occurs within the
first 15 minutes (shivering, headache, lower back pain, oliguria,
hypotension)

7. Watch for signs of febrile reaction; usually occurs within first 30

minutes (hematemesis, confusion, back pain, elevated temperature,
headache, shaking)
8. Watch for allergic reaction (hives, wheezing, pruritus, joint pain)
9. Monitor vital signs
10. If reaction occurs:
a. Stop blood immediately
b. Maintain IV with saline
c. Notify physician
d. Send blood and urine specimen to lab
e. Monitor client during transfusion
f. Monitor lab results - hemoglobin and hematocrit

The dosage of medication needed for a therapeutic effect can vary with age,
weight, gender, health status and environmental factors.

Most drugs produce a mixture of therapeutic and adverse effects.

Medications require a written order from a physician or a nurse practitioner
legally permitted to prescribe them.
Because most drugs are metabolized in the liver, it is especially susceptible to
drug induced injury.
The nurse is responsible to judge independently before giving a prescribed
medication.
The route of administration will be chosen to achieve a certain therapeutic action,
at a certain speed.
Medications interact with foods, and that interaction can block or slow therapeutic
action
People metabolize medications differently, depending on age, gender, body size,
health status, drug tolerance, cumulative effect of medication, and genetics.
Inhalers are most effective when their users know the right technique. Teach the
technique and then test how well the client uses it.
Medications are especially likely to cause hypotension in elderly people.
There are two types of drug dependence: psychic and physical. Psychic
dependence implies a craving to use the drug periodically. Physical dependence
implies physical symptoms when the drug is withheld.

Hypersusceptibility
Idiosyncrasy
Pharmacodynamics
Potentiation
Tachyphylaxis
Toxicology