Pharmacology NCM 106 PDF

PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 CLINICAL PHARMACOLOGY PHARMACOLOGY...

PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 CLINICAL PHARMACOLOGY PHARMACOLOGY ○ The study of drugs in humans ○ The study of drugs in patients as The study of biological effects of chemicals. well as in healthy volunteers In clinical practice, health care providers focus on how chemicals act on living THERAPEUTICS organisms ○ Also known as Derived from the greek word “pharmakon” pharmacotherapeutics which means remedy ○ Use of drugs to diagnose, prevent, or treat disease or to prevent WHAT ARE DRUGS? pregnancy ○ The medical use of drugs Chemicals that are introduced into the body to cause change PROPERTIES OF AN IDEAL DRUG Either good or bad EFFECTIVENESS PHARMACOTHERAPEUTICS/CLINICAL PHARMACOLOGY ○ an effective drug is one that elicits the responses for which it is given A branch of pharmacology that uses drugs ○ effectiveness is the most important to treat, prevent, and diagnose disease property that a drug can have FOUR BASIC TERMS SAFETY DRUGS ○ a safe drug is defined as one that ○ A drug is defined as any chemical cannot produce harmful effects even that can affect living processes if administered in very high doses and for a very long time PHARMACOLOGY ○ The study of drugs and their interactions with living systems SELECTIVITY ○ Encompasses the study of the physical and chemical properties of ○ a selective drug is defined as one drugs as well as their biochemical that elicits only the response for and physiologic effects which it is given ○ Includes knowledge on the history, sources, and uses of drugs as well as drug absorption, distribution, metabolism, and excretion. BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 ADDITIONAL PROPERTIES OF AN IDEAL PROPERTIES OF AN IDEAL DRUG DRUG - Reversible Action ADMINISTRATION - it is important that drug effects are reversible; we want drug actions to - Dosage size and the route and timing of subside within an appropriate time administration are important determinants of drug responses - Predictability - Poor px compliance and medication errors - the certainty just how a given px by hospital staff can result in major should respond discrepancies - Ease of Administration ○ Oral Route - Should be simple to administer; is the most frequently used the route should be convenient, drug administration route in and the number of doses per day clinical practice should be low non invasive less expensive - Freedom from Drug Interaction safest way to deliver drugs - when the px is taking 2 or more drugs, those drugs can ○ Intravenous Route interactions may augment or IV drugs reach their full reduce drug responses strength at the time of administration - Low Cost - an ideal drug should be easy to ○ Intramuscular Route afford Absorbed directly into the capillaries in the muscle and - Chemical Stability sent into circulation - some drugs lose effectiveness during storage (e.g. temperature, or being photosensitive) - others may be stable on the shelf, can rapidly lose effectiveness when put into solution - because of chemical instability, stocks of certain drugs must be periodically discarded BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 PHARMACODYNAMICS PHARMACOKINETICS - The science dealing with interactions - Involves the study of absorption, between the chemical components of living distribution, metabolism systems and the foreign chemicals (biotransformation), and excretion of drugs Drug Actions - In clinical practice, pharmacokinetic ○ Drugs work in one of four ways: considerations include the onset of drug To replace or act as action, drug half-life, timing of the peak substitutes for missing effects,duration of drug effects, metabolism chemicals (e.g. lacking or biotransformation of the drug, and the insulin in diabetes type 1) site of excretion To increase or stimulate - Biotransformation of drug happens in the certain cellular activities liver to depress or slow cellular - Excretion happens in the kidney; through activities (e.g. urination, saliva, sweat, and feces anti-hypertensives) To interfere with the Critical Concentration functioning of foreign cells, ○ the amount of drug that is needed to such as invading cause a therapeutic effect microorganisms or ○ desired dose neoplasms (chemotherapeutics drugs) Loading Dose ○ some drugs that take a prolonged Receptor Sites period to reach a critical ○ drugs act at specific areas on cell concentration; if their effects are membranes called Receptor Site needed quickly, a loading dose is recommended Drug-Enzyme Interactions ○ used to trigger the body for it to work ○ drugs can also cause their effects by with the medicine interfering with the enzyme systems ○ E.g. that act as a catalyst for various Digoxin (Lanoxin), a drug chemical reactions used to increase the strength ○ some act with enzymes some act of heart concentrations with protein Xanthine bronchodilators used to treat asthma attack Selective Toxicity are often started with a ○ the ability of a drug to attack only loading dose to reach the those systems found in foreign cells critical concentration ○ affects an enzyme unique to ○ The critical concentration then is bacteria, causing bacterial cell death maintained by using the without disrupting normal human cell recommended dosing schedule functioning BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 Dynamic Equilibrium ○ Active Transport ○ The actual concentration that a drug a process that uses energy reaches in the body results from a to actively move a molecule dynamic equilibrium involving across a cell membrane several factors: Absorption from the site of ○ Filtration entry commonly used in drug Distribution to the active site excretion Biotransformation involves movement through (metabolism) in the liver pores in the cell membrane. Excretion from the body either down a concentration gradient or as a result of the Absorption pull of plasma proteins ○ refers to what happens to a drug from the time it is introduced to the First-Pass Effect body until it reaches the circulating ○ happens when the drug is taken per fluids and tissues orem Drugs can be absorbed from many different ○ a large percentage of the oral dose areas in the body; is destroyed at this point and never Through the GI tract (orally or reaches the tissues rectally administered) Through mucous membranes Blood Brain Barrier Through the skin ○ A protective system of cellular Through the lungs activity that keeps substances away Through muscles or subcutaneous from the CNS tissues ○ drugs that are not lipid soluble are not able to pass the BBB (Blood Drugs can be absorbed into cells through Brain Barrier) various processes; Placenta and Breast Milk ○ Passive Diffusion ○ the nurse must always check the major process through which ability of a drug to pass into the drugs are absorbed into the breast milk when giving a drug to a body breast-feeding mother occurs across a concentration gradient; when Biotransformation there is a greater ○ enzymes in the liver concentration of drug on one ○ lining of the GI tract side of a cell membrane move to an area of lower concentration BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 Excretion Duration ○ the removal of a drug from the body. ○ refers to the length of time the ○ skin, saliva, lungs, bile, and feces medication produces its desired are some of the routes to excrete therapeutic effect. drugs ○ For example, the duration of oral ○ Kidneys - play the most important acetaminophen is four to six hours, role in drug excretion; drugs that at which time the client will likely have been made water soluble in the require an additional does for pain liver are often readily excreted from the kidney by the glomerular function Side Effects ○ undesirable effect of the drug Half-Life ○ expected ○ the time it takes for the amount of drug in the body to decrease to 4 Major Pharmacokinetic Processes: one-half of the peak level it Drug Absorption previously achieved. ○ when it enters your body ○ E.G. If a px takes 20mg of a drug Drug Distribution with a half life of 2 hours, the 10mg ○ going to the systems of the drug will remain 2 hours after Drug Metabolism administration. 2 hours later, 5mg ○ happens in the liver and lining of the will be left, in 2 more hours, only GI tract 2.5mg will remain. Drug Excretion ○ happens in the kidney Mechanism of Action ○ term used to describe how a drug or ADVERSE EFFECTS other substance produces an effect in the body - Unexpected unlike side effects Onset of medication - Undesired effects that may be ○ refers to when the medication first unpleasant or dangerous. They can begins to take effect occur for many reasons including; - The drug may have other Peak effects on the body besides ○ refers to the maximum concentration the therapeutic effect of medication in the body and the - The px is sensitive to the client shows evidence of greatest drug being given therapeutic effects - The drug's action on the body causes other responses that are undesirable - The px is taking too much or too little of the drug leading to adverse effects BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 ○ Primary Actions NURSING PHARMACOLOGY The desired therapeutic effect NURSING RESPONSIBILITIES ○ Secondary Actions Primary effect + beneficial or 1. Administering Drugs harmful effect 2. Assessing drug effects 3. Intervening to make the drug regimen more ○ Hypersensitivity tolerable Some pxs have an unusually 4. Providing px teaching about drugs and the strong reaction to a drug drug regimen 5. Monitoring the overall px care plan to ○ Drug Allergy prevent medication errors The body’s immune system reacts to a specific drug SOURCES AND EVALUATION OF DRUGS Types of Drug Allergies 1. Anaphylactic Reaction Sources of Drugs 2. Cytotoxic Reaction - Chemicals that might prove useful as drugs 3. Serum Sickness Reaction can come from many natural sources, such 4. Delayed Reaction as plants, animals, or inorganic compounds, or they may be developed synthetically ADVERSE EFFECTS SOURCES OF DRUGS ❖ Dermatologic Reactions Rash Hives PLANTS Stomatitis plants and plant parts have been used as ❖ Superinfections medicines The normal flora that protects the e.g. body from invasion of bacteria, ○ digitalis products used to treat viruses, fungi, and etc is destroyed cardiac disorders (Antibiotics) ○ opiates used for sedation drugs may also be processed using a ❖ Toxicity synthetic version of the active chemical Liver Injury found in a plant Renal Injury e.g. Poisoning ○ Marijuana leaf; a synthetic version allows for an accepted form to ❖ Blood Dyscrasia achieve the desired therapeutic Bone marrow suppression caused effect in cancer patients by drug effects BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 ANIMAL PRODUCTS DRUG EVALUATION Used to replace human chemicals that are PRECLINICAL TRIALS not produced because of disease or genetic problems e.g. Chemicals may have therapeutic value and ○ insulin as tx for diabetes (from are tested on animals pancreas of cows and pigs) 2 purposes GENETIC ENGINEERING — the process of ○ To determine whether they have the altering the DNA to produce a substance presumed effects in living tissue ○ To evaluate any adverse effects At the end of clinical trials, chemicals are INORGANIC COMPOUND discarded for the following reasons: ○ The chemical lacks therapeutic salts of various elements can have activity when used with living therapeutic effects in the hun body animals e.g. ○ The chemical is too toxic to living ○ Aluminum animals to be worth the risk of decrease gastric acidity developing into drugs ○ Fluoride ○ The chemical is highly teratogenic prevention of dental cavities ○ The safety margins are so small that prevention of osteoporosis the chemical would not be useful in ○ Iron the clinical setting tx of iron deficiency anemia ○ Gold PHASE 1 STUDIES Tx of rheumatoid arthritis Use healthy human volunteers to test the SYNTHETIC SOURCES drugs Trials are performed by specially trained scientists use genetic engineering to alter clinical investigators bacteria to produce chemicals that are Reasons chemicals are dropped from the therapeutic and effective process: alter chemicals with proven therapeutic ○ They lack therapeutic effect in effectiveness to make it better human ○ They cause unacceptable adverse effects ○ They are highly teratogenic ○ They are too toxic BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 PHASE 2 STUDIES Allow clinical investigators to try the drug in pxs who have the disease that the drug is meant to treat Reasons chemicals are dropped from the process: ○ It is less effective than anticipated ○ Too toxic when used with patients ○ Produces unacceptable adverse effects ○ Has a low benefit-to-risk ratio PHASE 3 STUDIES Prescribers observe px very closely for any adverse effects Prescribers ask pxs to keep journals and record any symptoms they experience Prescribers then evaluate then reported effects to determine whether they are cause by the disease or by the drug Information are collected and shared with the FDA BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 NURSING PROCESS IN PHARMACOLOGY QSEN (QUALITY SAFE EDUCATION FOR NURSES) 2 functions of nurse: To promote nurses working at top of license Independent for high quality care and best outcomes ○ d na need doctor ○ mga assessment, positioning Fostering patient family engagement in drug Dependent regimen ○ need doctor ○ giving medications GOAL: Safe, timely, delivery of drug administration Nurses’ Time Allocation on Communication: Hands-on tasks, and locations 1. ASSESSMENT On average, in a 4-hour observation, nurses spent: Illness and drug regimen - medication, health problems, lifestyle: Communication: ○ Current history ○ with patients (29.99 mins) ○ other nurses (26.68 mins) ○ Swallowing problems ○ S/S Hands-on tasks: ○ Concerns: side effects, OTC ○ charting in HER -electronic health remedies, contraceptives, attitudes record (31.63 mins) & beliefs ○ reviewing information in EHR (21.51 ○ Allergies mins) ○ Financial barriers ○ medication administration (15.70 mins) ○ Dietary barriers ○ getting medications (8.15 mins) ○ Caregiver needs and support (order, ○ spending on delegable tasks (13.52 prepare, organize) mins) Locations: 2. NURSING DIAGNOSIS ○ nurses at patients' room (60.17 (Drug Therapy) mins) ○ nursing station (53.55 mins) Examples: Pain (acute or chronic) related to surgery Confusion, acute, related to adverse reaction to medication Knowledge, deficient related to effects to anticoagulants Noncompliance, related to forgetfulness BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 3. PLANNING 5. EVALUATION Patient-centered (collaboration of patient Determining if goals are met and family Ongoing assessment SMART Revision of objectives, plans, interventions It met, document successful attainment of Examples: Nursing plan of care The patient will independently administer the prescribed dose of 4 units of regular insulin by the end of the 3rd session of instructions The patient will prepare 3-day medication recording sheet that correctly reflects the prescribed medication schedule at the end of second session of instruction 4. IMPLEMENTATION OF NURSING INTERVENTIONS Education, drug administration and patient care 1. Assessment of drug effectiveness 2. Education/Teaching a. Timing… What is the best time to learn b. Barriers to learn c. Educational Level i. consistency to adherence ii. dose is adjusted iii. pregnancy iv. added supplements/OTC meds v. side effects vi. self-administration (eye/nose/oral buccal/ suppository, SQ, inhaler (return demo) 3. Patient Care a. Drug box b. Recording sheet/Alarm reminder device BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 MEDICATION ADMINISTRATION TYPES OF DOCTOR’S ORDER BRAND NAME VS GENERIC DRUGS Standing Order: Pre written order for a medication to be administered under specific conditions. Remains in effect until Brand Name Generic Drugs canceled or modified. (e.g. every 6 hours) Active no difference no difference Ingredient PRN Order (Pro Re Nata): An order of medication as much as needed and you use Price higher in cost lower in cost your judgment in administering medication. Ihatag lng kung may gna batyag ang Insurance Covered if no Normally Coverage Generic Form always covered pasyente nga sakit pero always follow sa Exists standing order if may ara (e.g. 6 hours ang standing order, so patapuson gid ang 6 Inactive Tested and May Differ - But hours bsan masakit na before mag hatag) Ingredient approved by proven to be the FDA acceptable by the FDA Single (One-Time) Order: Once, at a specific time and circumstance. (E.g Strength/ No difference No Difference surgical patients, antibiotics once before the Dosage procedure, to prevent infection Prior 1 hour Appearance/ Drugs are Packaging and before operation. Single dose before Look standard un the drug itself surgery. size, color, may look packaging different Stat Order: Urgent order that indicates that a medication should be administered Brand name if may “®” sa punta immediately. Used for emergency situations where 1 prompt administration is critical (e.g STAT order for epinephrine during anaphylactic shock) Routine Order: Regular or scheduled interval. A routine order in healthcare refers to instructions from a doctor for treatments or medications that are to be administered on a regular, scheduled basis as part of a patient's standard care regimen. These orders are not emergency or one-time instructions but are intended to be carried out consistently over a specified period. BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 Titration Order: Where dosage is adjusted ABBREVIATIONS: based on the patient’s response and TIMING specific parameters. Such as bp and blood glucose. (e.g. For Blood sugar, give insulin QD: Every day 5 units subcutaneous, for other, instead of QW: Every week 5) QH: Every hour OD: Once a day Taper Order: Order of gradually decreasing BID: Twice a day the dose over a set period of time (e.g. TID: Thrice a day steroids: should not be discontinued QID: Four times a day abruptly, dapat amat2 lang). QHS: Every night at bedtime Q2H: Every 2 hours ABBREVIATIONS: Q4H: Every 4 hours ROUTES OF ADMINISTRATION Q6H: Every 6 hours Q8H: Every 8 hours Q12: Every 12 hours PO (Per Orem): By mouth (oral) PRN: As needed IV: Intravenous STAT: Immediately IM: Intramuscular AC: Before meals SC or SQ: subcutaneous PC: After meals SL: Sublingual (under the tongue PR: Per rectum (rectal) TOP: Topical (applied to the skin) ABBREVIATIONS: INH: Inhalation DOSAGE FORMS ID: Intradermal NG: Nasogastric (via a tube through the TAB: Tablet nose into the stomach) CAP: Capsule GTT: Drops (e.g., eye or ear drops) SUSP: Suspension NST: Negative Skin Test ELIX: Elixir ANST: After Negative Skin Test SYR: Syrup UNG: Ointment SOL: Solution IU: International Units mEq: Milliequivalents BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 TYPES OF DOCTOR’S ORDER: BASE ON TIMING Standing Orders PRN Orders Single Orders Stat Orders Routine Orders Example of a Complete Doctor’s Order: Order: “Administer ceftriaxone 1g IV Q12H for 7 days for suspected bacterial infection” Medication/Drug Name: Ceftriaxone Dose: 1 gram Route: Intravenous IV Frequency: Every 12 hours (Q12H) Duration: 7 days (complete so bacteria won't be resistant) Indication: Suspected bacterial infection Example of a Written Drug Order: Patient: Ben Jackson MRN 0651325 9/9/2023 0730 - Amoxil 500 mg po qid pc and hs J. Physician, M.D. Interpretation: ○ Give Amoxil 500 milligrams by mouth four times a day after meals and at bedtime BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 Never crush eccentric-coated or sustained PRINCIPLES IN ADMINISTERING MEDICATION release tablets ○ Mucositis or gastric irritation ○ Higher than expected initial level of Observe the “10 rights” of drug meds administration ○ Shorter than expected duration of action e.g if your patient vomits as administering ○ assess the medication and the vomitus if ang color is same with the drug, if the tablet is the same tablet refer immediately to the doctor ○ you should record it and include note “patient vomited pinkish or yellowish in color” Pre-op meds: on call for surgery - d.o. give medication prior to OR, after OR na Before administering, identify the client discontinue na dapat correctly. Write time, reason for holding the Observe Asepsis medication encircle it dayon - when Knowledgeable (Never give unfamiliar med, medication is omitted not clearly labeled containers) E.g. instead of giving 3 tablets bid, you Responsible for own your actions gave 3 tablets od, patient is underdosed If unsure, do not give/administer. refer immediately underdosage is less threatening than Do not leave medication at bedside overdose If the client vomits after taking the med, study about the drug for the patient gd report. mag duty!! When the meds is omitted for any reason, record the fact together with the reason When the meds error is made, report ROUTES immediately to the nurse in-charge/physician Oral The nurse who prepares the drug, Sublingual administers it Buccal If the client vomits after taking meds, report Topical Pre-op meds are usually discontinued Rectal during the post-op period. Parenteral Narcotics kept are locked Intraosseous When the meds is omitted for any reason, Intrathecal record the fact together with the reason Endotracheal When the meds error is made, report immediately to the nurse in-charge / physician BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 WHICH DRUG ADMINISTRATION ROUTE IS patches FASTEST Ocular Solutions, Varies by (Conjunctival) suspensions, dosage forms ointments, ROUTE TIME gels, inserts Intravenous 30-60 seconds Ocular Solutions, Within 10 (Intravitreal) suspensions, minutes Intraosseous 30-60 seconds implants Endotracheal 2-3 minutes Sublingual Tablets, troches or Inhalation 2-3 minutes lozenges Sublingual 3-5 minutes Intranasal Solutions, Rapid aerosol Intramuscular 10-20 minutes sprays, inhalants, Subcutaneous 15-30 minutes ointments Rectal 5-30 minutes Lung Aerosol and dry-powder Ingestion 30-90 minutes inhalers Transdermal (Topical) variable (minutes to Rectal Solutions, Rapid hours) suspensions, formlocal ointments, effects creams, LOCAL ROUTES OF ADMINISTRATION AND suppositones, foams DOSAGE FORM Vaginal Solutions, Rapid for local crams, gels, effects ROUTE DOSAGE ONSET tablets, FORMS sponges, suppositories, Oral Tablets, Varies by rings suspensions, dosage forms magmas, gels Urethral Solutions, Rapid for local suppositories effects Buccal Tablets, Rapid for local lozenges, effects solutions, Never Crush Enteric-Coated or Sustained suspensions Release Tablets Skin (Topical) Ointments, Rapid for local creams, effects May Cause: pastes, gels, Mucositis or gastric irritation lotions, Higher than expected initial level of poweders, meds and a shorter than expected aerosol sprays, duration of action BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 Instruct the client to close the eyes gently for 1 - 2 minutes TOPICAL ROUTE OF DRUG ADMINISTRATION Position client and explain to help not to blink squeeze strip of ointment (abut ¼) Dermatologic onto conjunctival sac Ophthalmic Close eyes 2-3 minutes Otic Instruct for blurred vision for a short time Nasal Inhalation Suppositories/Vaginal IRRIGATION ○ Napuling ka tas gin wash mo sha sang tubig DERMATOLOGIC INSTILLATION ○ ga drop ka medication sa eyes Includes lotions, liniments, and ointments Wash and pat dry area well before OTIC application to facilitate absorption Use surgical asepsis when open wounds is Includes instillations & irrigations present Remove previous application before the INSTILLATION next application To soften earwax Apply only thin layer of meds to prevent To reduce inflammation & treat systemic absorption infection Use gloves when applying the meds over a To relieve pain longer large surface IRRIGATION OPHTHALMIC To remove cerumen or pus To apply heat Includes instillation and irrigation To remove foreign body INSTILLATION Warm solution at room/ body temperature To provide an eye medication that Side Lying position with the ear being the client requires treated uppermost Clean the pinna and meatus of the ear IRRIGATION canal with cotton-tipped applicator To clear the eye of noxious or other Straighten the ear canal foreign materials ○ 0-3 years old: pull pinna downward and backward Position client either sitting or lying ○ Older than 3 years old: pull pinna Instill eye drops into lower conjunctival sac upwards and backward Instill a max of 2 drops at a time Instill ear drops on the side of the auditory Wait for 5 minutes if additional drops are canal needed Press gently but firmly a few times in the Avoid dropping a solution onto the cornea tragus directly, it causes discomfort Ask the client to remain in side lying position for about 5 minutes BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 Insert a small piece of cotton fluff loosely at VAGINAL the meatus of the auditory canal for 15-20 minutes Drug Forms: ○ Tablet Note the proper procedure for assessing ○ Liquid the ears (child - down back , adult - up ○ Cream back) kung duwa ka ears infected, treat one at a ○ Jelly time ○ Foam ○ Suppository NASAL Use applicator or sterile gloves for vaginal administration of medication INSTILLATION usually are instilled for their: Advantage Astringent effect ( to shrink ○ Provides local therapeutic effect swollen mucous membrane) To loosen secretions Disadvantages To facilitate drainage ○ Has limited use To treat infections of the nasal cavity/sinuses VAGINAL IRRIGATION Have the client blow their nose prior to nasal instillation The washing of the vagina by a liquid at low Assume back lying position or sit up & lean pressure head back Also called douche Empty the bladder before the procedure INHALATION Position & drape the client Use of nebulizers, metered-dose ○ Instillation: back-lying position with inhalers (MDI) knees flexed & hips rotated laterally Shake the canister several times ○ Irrigation: back-lying position with Instruct the client to hold breath for the hips higher than the shoulders 10 seconds (use bedpan) Administer bronchodilator before Irrigating container should be 30 cm (12 other inhalation meds inches) above Instruct client to rinse mouth, if Ask the client to remain in bed for 5-10 steroid had been administered to minutes following administration of vaginal prevent oral fungal infection suppository, cream, foam, jelly or irrigation BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 RECTAL INTRADERMAL (ID) Insert the suppository, pointed end first, The administration of a drug into the dermal about ½ to 1 inch in infants and 1 inch in layer of the skin beneath the epidermis adults The sites are the inner lower arm, upper Refrigerate your suppository chest & back, & beneath scapulae Breath through the mouth Indicated for allergy & tuberculin testing & Remain in lateral position 20 mins after for vaccinations administration Use left arm for tuberculin tests & right for all other tests Use the needle gauge 25, 26, 27 suppositories should always be refrigerated, and should always be Needle length 3/8", 5/8" or ½" labeled, if wla ref sa community, huluman Needle at 10-15 degree angle, bevel up sa tubig nga cold, butang sa cooler, sa Inject a small amount of drug slowly over tuslukan sang banana stalk 3-5 sec to form a wheal or bleb do not massage the site of injection PARENTERAL the higher the number of the gauge, the smaller the size of the needle, sizes is Types of Injection Routes limited to gauge 27 Intradermal Subcutaneous Intramuscular SUBCUTANEOUS ○ involves tetanus, vaccines; seldom done in the hospital 45 degree angle; drugs administered Intravenous subcutaneously are as follows: Intraarterial ○ vaccines intraosseous ○ pre op meds ○ narcotics Intramuscular involves tetanus, vaccines; seldom ○ insulin done in hospitals ○ heparin For thin patients: 45 degree angle GENERAL PRINCIPLES IN PARENTERAL For obese patients: 90 degree angle MEDICATION ADMINISTRATION For heparin injection, don’t aspirate & massage Drug order For insulin injection, don’t massage & inject Respect to 90 degree angle Asepsis Materials Adjust the length of the needle depending Techniques on the size of the client for insulin Documentation administration For other meds, aspirate before injection of meds to check if blood vessel had been hit BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 The sites are the outer aspects of the upper Identify areas for injection: deltoid and arms, interior aspect of the thighs, buttocks use upper outer quadrant (don't abdomen, scapular areas of the upper back inject sa tunga kay maigo ang sciatic and ventrogluteal and dorsogluteal areas nerve causing paralysis to the patient) Only small doses of meds should be injected via SC route (0.5 to 1mL) Rotate sites of injection to minimize tissue SITES damage Needle length and gauge are the same as for ID injections VENTROGLUTEAL use 5” or 8” needle for adults when injection is administered at 45 degree angle, 1” or 2” von Hochstetter’s site is used to a 90 degree angle Use gluteal medius which lies over the 45 degree angle (sq) gluteus minimus muscle Search for vaccines about SQ Area contains no large nerves or BV and Insulin syringe has a orange hub; used to less fat give Insulin; needle is shorter - IM and SQ Farther from rectal area, less contaminated can be used; pwde perpendicular Ang Position client in prone/side lying - relaxes pag tusok sng needle the gluteus muscles SQ has lesser number of blood vessels therefore there is not much blood mag ○ Prone - curl the toes inward inject ○ Side lying - flex the knee and hip To locate the site, place the heel of the hand over the greater trochanter INTRAMUSCULAR Point the index finger towards anterior superior iliac spine Introduction of needle into the muscle Abduct the middle (3rd finger) Needle is 1”. 1 ½ “, 2” The triangle formed by the index finger, the ○ to reach the muscle layer 3rd finger and the crest of the ilium is the Use needle gauge 20, 21, 22, and 23 site ○ depending on the viscosity of meds Clean the injection site w/ alcoholized cotton Vastus Lateralis: Middle Third means balls dividing your thigh into 3 Inject, aspirate (to check for blood) and inject the meds slowly to allow the tissues to accommodate the volume Injected perpendicularly (90 degree angle) Sites: ventrogluteal site, dorsogluteal site, vastus lateralis site, rectus femoris, and deltoid site BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 DORSOGLUTEAL DELTOID SITE Use the gluteus medius muscle Not used often for IM injection due to Position of the client is similar to relatively small muscle and close to radial Ventrogluteal site nerve and artery Site should not be used for infants and To locate the site, palpate the lower edge of under 3 the acromion process and the midpoint on Locating the site is to divide the buttocks the lateral aspect of the arm that is in line w/ into 4 quadrants the axilla The upper outer quadrant is the injection Approx. 5cm (2 inches) or 2-3 site fingerbreadths below the acromion process Palpate the crest of the ilium to ensure that the site is high Z - TRACK TECHNIQUE Usually sa buli nagamit Used for parenteral iron preparation Upper outer area (quadrant 1-6) Retract the skin laterally, inject the Basi maigo ang sciatic nerve medication slowly Hold the attraction of skin until the needle is VASTUS LATERALIS withdrawn Do not massage the site injection Recommended site for injection for infants Located at the middle third of the anterior INTRAVENOUS (IV) lateral aspect of the thigh Assume back lying or sitting position They direct IV, IV push, and IV Infusion RECTUS FEMORIS Most rapid route of absorption of medication Predictable, therapeutic blood levels of medicines can be obtained Located at the middle third, anterior aspect The route can be used for clients with of the thigh compromised G.I. function or peripheral circulation Larger doses of medication can be administered BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 DRUG CALCULATIONS CONVERSIONS: METRIC MEASUREMENTS CONVERSIONS UNITS OF WEIGHT: Liter (L) 1 milliliter = 0.001 l or 1/1,000 Apothecary - drums, minims, pint ○ most oftenly used in the hospital Household measurements - tsp 1 centiliter = 0.01 l or 1/100 1 deciliter = 0.1 L or 1/10 Metric System - fluid or solid 1 decaliter = 10 L ○ not often used so it is converted CONVERSIONS: HOUSEHOLD MEASUREMENTS UNITS OF WEIGHT: gram (G or gm) 1 microgram (mcg) = 0.000001 G or 1/1,000,000 1 quart = 4 cups 1 milligram (mg) = 0.001 G or 1/1,000 1 pint = 2 cups 1 centigram (cg) = 0.01 G or 1/100 1 cup = 8 ounces, 240 cc or 180 cc 1 decigram (dg) = 0.1 G or 1/10 ○ A calibrated cup has a specification 1 kilogram (kg) = 1000 G (ex. 240 cc) 1 ounce = 30 ml UNIT OF LENGTH: Meter (m) 1 teacup = 6 ounces 1 millimeter (mm) = 0.001 or 1/1, 100 1 tablespoon (tbsp.) = 3 tsp or 15-16 ml 1 centimeter (cm) = 0.01 or 1/100 1 Teaspoon (tsp) = 60 gtts (drops) or 4-5 ml 1 decimeter (dm) = 0.1 or 1/10 1 hectometer (hm) = 100 meters CONVERSIONS: APOTHECARY MEASUREMENTS CONVERSIONS: OTHER EQUIVALENTS 60 minims = 1 fluidram 8 fluid drams or 480 minims = 1 fluidounce 1 gram (G) = 15 grains (gr) 16 fluidounces = 1 pint (pt) 1 grain (gr) = 60 mg 2 pints = 1 quart (qt) 1 milligram (mg) = 1,000 mcg 4 quarts = 1 gallon (C) 1 milliliter (ml) = 1cc or 15 gtts r 60 mcgtts 1 Liter (L) = 1 quart, 1000 ml 1 gallon (gal) = 4 liters, 4 quarts, 4000 ml 1 ounce (oz) = 30 grams, 30 ml r 30 cc ○ used for neonates 1 kilogram (kg) = 2.2 pounds (lbs) 1 pound (lb) = 16 ounces (oz) BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 APPROXIMATE EQUIVALENT ORAL/PARENTERAL DOSAGES 1 G = gr vx Calculating dosages according to Kg of BW 1 gr = 60 mg and determine if dose is safe 1 dram = 1 tsp = 4-5ml = 4-5cc Other measurements: unit or mEq 1 ounce = 30 mL 1 qt = 1000 ml FORMULA: 1 ml = 15-16 minims = 15-16 gtts ORAL MEDS (SOLID) 1 G = 1 ml Desired Dose (D) - ang gna order sang doctor nga SAMPLE CONVERSION QUIZ dosage or the dose that is to be received by the patient 1 mg = ___ mcg Stock Dose (S) - Also called have dose. It is what 1.25 g = ___ mg is available 520 cc = ___ L 3 g = ___ mg Quantity of the drug (Q) = amount to be given to 2 gtts = ___ minims the patient ½ cup = ___ cc 1 dram = ___ tsp Formula: D/S = Q 4 oz = ___ glass 1 pint = ___ L FORMULA: 2 T = ___ drams ORAL/ PARENTERAL MEDS (LIQUID) 112 kg = ___ grams 2 grains = ___ mg Formula: D/S X Dilution = Q IMPORTANT: Regardless of the source of an error, if you administer the wrong dosage you are LEGALLY responsible. Never assume what an order states! … clarify an order when in doubt BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 CALCULATIONS OF ORAL MEDICATIONS INSULIN SOLIDS AND LIQUIDS Fast - Acting: regular, semilente, humalog Desired/Have x Quantity = Amount to give Intermediate - Acting: Lente, NPH Long - Acting : ultra lente, Lantus Convert to same weight of measurement Estimate Dose Appearance: Clear - regular, humalog, Lantus SAMPLE PROBLEMS Cloudy 1. Order: cloxacillin sodium 0.25 g Do not shake insulin syringe Stock: 125 mg per 5 ml Administer it in an insulin syringe Regular insulin is always drawn up in the 2. Order: Furosemide 24 mg po qd insulin syringe FIRST! Stock: 10mg/ml 3. Order: Digoxin 0.5 mg IM qd Stock: vial labeled 0.25 mg/ml IV FLOW RATES 4. Order: Cleocin 0.3 gm IM q6h Calculating fluid volume received/hr when Stock: liquid in a vial labeled 300 mg/ 2 ml fluid volume/min is known Calculating the amount if medication a person is receiving when FR id known SAFE DOSE RANGES Calculate low safe dose CALCULATING FLOW RATE Calculate high safe dose Evaluate the order in relation to the SDR 3 step method: and frequency of schedule 1. cc/hr = Total Fluid / # of hours 1. Drug x 10 mg tid 2. cc/min = cc/hr divided by 60 min/hr SDR; 10 - 30 mg/day 3. FR (gtt/min) = cc/min x drop factor 2. Drug x10 mg tid SDR: 30 mg/day in 2-3 divided doses BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 PEDIATRIC DOSAGES Clark’s Rule: Formula: Weight in pounds/150 x Usual Adult dose = Safe Child’s Dose Freid’s Rule: Formula: Age in Months/150 x Usual Adult Dose = Safe Child’s Dose Young’s Rule: Formula:( Age in Years/ Age in Years + 12) x Usual Adult Dose = Safe Child’s Dose PREPARING SOLUTIONS BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 Having too much or too little aldosterone in CARDIOVASCULAR SYSTEM DRUGS your body can cause health issues. Aldosterone can be found in adrenal glands WHAT IS RAAS (on top of kidney) Renin Angiotensin Aldosterone System An important hormone that helps regulate your blood pressure by increasing it. It's a part of a complex system of hormones, enzymes and proteins called the renin-angiotensin-aldosterone system. It regulates your blood pressure by increasing sodium (Na) reabsorption, water reabsorption (retention) and vascular tone (the degree to which your blood vessels constrict, or narrow). The RAAS consists of three major substances, including: RENIN An enzyme that helps control your blood pressure and maintain healthy levels of sodium and potassium in your body. Made by prorenin (juxtaglomerular cells) in your kidneys, renin is released into your bloodstream when your blood pressure RAAS: Renin Angiotensin Aldosterone drops too low System ○ regulates blood pressure ○ consists of 3 major substances ANGIOTENSIN II Ejection Fraction - ○ If you have a heart problem, per An important hormone that helps regulate ejection of blood you only get 10 your blood pressure by increasing it. It's a liters(?) of blood part of a complex system of hormones, enzymes and proteins called the Renin is an enzyme renin-angiotensin-aldosterone system. Angiotensin is a hormone ALDOSTERONE Hormone that helps regulate your blood pressure by managing the levels of sodium (Na) and potassium (K) in your blood and impacting blood volume. BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 High Coronary disease risk: STEPPED-CARE APPROACH TO TREATMENT OF CHRONIC HYPERTENSION 1. Diuretic 2. Beta-blocker 3. ACE inhibitor Step 1: 4. Calcium Channel Blocker Non pharmacologic approaches ○ Proper diet and exercise Diabetes: ○ Lifestyle modification 1. Diuretic 2. Beta-blocker Step 2: 3. ACE inhibitor Drug 1: diuretic or beta blocker or Calcium 4. ARB channels blocker or ACE inhibitor 5. Calcium channel blocker Step 3: Chronic Kidney Disease Increase dose of drug 1 or add drug from 1. ACE inhibitor other class or substitute drug from other 2. ARB class Recurrent Stroke Prevention: Step 4: 1. Diuretic Add drug 3 from a different class or 2. ACE inhibitor substitute from other class Step 5: TYPES OF CARDIOVASCULAR DRUGS Further evaluate or add 3rd and 4th drug ANTICOAGULANTS DRUG CLASS RECOMMENDATIONS FOR ANTIPLATELETS agents COMPELLING INDICATIONS BASED ON ACE Inhibitors VARIOUS CLINICAL TRIALS Angiotensin II receptor blockers Angiotensin receptor-neprilysin inhibitors Heart Failure; Beta Blockers 1. Diuretic Calcium Channel Blockers 2. Beta-blocker Digitalis 3. ACE inhibitor Nitrates Vasodilators 4. ARB 5. Aldosterone antagonist ANTIHYPERTENSIVE DRUGS Postmyocardial infarction: Alpha-2 Agonists (Centrally acting) 1. Beta-blocker ACE Inhibitors 2. ACE inhibitor Angiotensin 2 receptor blockers 3. Aldosterone antagonist Calcium Channel Blockers Direct Acting Arteriolar Vasodilators Direct Renin Inhibitors Selective Aldosterone Receptor Blocker BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 NURSING CONSIDERATIONS ALPHA-2 AGONISTS (CENTRALLY ACTING) 1. Clonidine (Catapres) should be discontinued gradually over the course of MECHANISM OF ACTION 2-4 days 2. Take BP before administrations Act within the CNS to decrease sympathetic ○ Check first bp before you give outflow resulting in decreased stimulation of the adrenergic receptors (both alpha and beta receptors) of the heart and peripheral They work centrally (central nervous vascular system system) Acts on brain to tell heart receptors to Always know the difference between side decrease BP effects and adverse effects Before giving anything to lower bp, check DRUGS bp anay olweys Arrhythmias Clonidine (Catapres) ○ Irregular heart rate (below 60 bpm ○ Take sublingually (under the tounge) or above 100 bpm Guanfacine HCL (Tenex) Clonidine (Catapres) - nahatag lang kun Methyldopa (Aldomet) taas bp Nursing Action if taas BP: SIDE EFFECTS ○ Pahigdaon ang client Drowsiness ○ Important to acknowledge since it can lead to a client getting into accidents if not advised to sleep for a while before letting them go Dry Mouth Dizziness Bradycardia ADVERSE EFFECTS Peripheral Edema ○ Swelling of extremities Rebound Hypertension ○ Temporary/sudden increase of blood pressure ○ Occurs when you abruptly stop taking your hypertensive drugs Dysrhythmias ○ Irregular heartbeat (Lub Dub irregularities) Tremors BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 test of the patient’s potassium to know if it is above normal or not ACE INHIBITORS (-pril) (Angiotensin-Converting-Enzyme Inhibitor) Chest pain Angina ○ medical term for chest pain MECHANISM OF ACTION CHF (Congestive Heart Failure) Arrhythmias Block the conversion of Angiotensin 1 to GI irritation and ulceration Angiotensin 2 in the lungs Constipation DRUGS NURSING CONSIDERATIONS 1. Benazepril (Lotensin) Captopril 2. Captopril (Capoten) ○ take on an empty stomach (1 or 2h 3. Enalapril (Vasotec) ac: before meals) 4. Fosinopril (Monopril) Advise patient to notify the provider if 5. Lisinopril (Prinicil, Zestril) cough, rash, dysgeusia (lack of taste), 6. Moexpril (Uivasc) and/or signs of infections occur 7. Perindopril (Aceon) Monitor the px’s WBC count every 2 weeks 8. Quinapril (Accupril) for 3 months, periodically 9. Ramipril (Altac) ○ High WBC indicates infection 10. Trandolapril (Mavik) Inform pxs to notify the provider at the first sign of infection (fever, sore throat) because SIDE EFFECTS medication should be discontinued Antagonistic effects when given with 1. Cough NSAIDs ○ conversion of angiotensin 1 to ○ avoid when taking ACE inhibitors angiotensin 2 happens in the lungs If given with K (potassium) supplement, may therefore causing coughs cause hyperkalemia 2. N/V/D 3. Headache 4. Dizziness Not all medications with “pril” are ACE 5. Fatigue inhibitors 6. Insomnia Capoten is the most common ace 7. Hyperkalemia inhibitors used in the philippines ○ Increased potassium in the body 3.5 - 5.5 normal range of potassium Water follows sodium ADVERSE EFFECTS If sodium is high, potassium is low Synergistic Effect - mas ganami effect ni FIRST DOSE = hypotension and ACE inhibitor hyperkalemia Antagonistic Effect - naga lessen effect ○ For hypotension: protect your patient sang ACE inhibitor since they may fall (e.g. assist patient, raise side rails) ○ For hyperkalemia: eat potassium in moderation, get baseline laboratory BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 ANGIOTENSIN 2 RECEPTOR BLOCKERS Also called the ARBs (-sartan) These are the “sartan” drugs Most common ang lozartan (Cozaar) Also called the ARBs If mag dry ang mouth ○ paimnon tubig (sips of water only if MECHANISM OF ACTION may heart problem) ○ pagamiton lipbalm Selectively bind the angiotensin 2 receptors in blood vessels to prevent vasoconstriction and prevent the release of aldosterone DRUGS 1. Candesartan (Atacand) 2. Eprosartan (Tevetan) 3. Irbesartan (Avapro) 4. Losartan (Cozaar) 5. Olmesartan (Benicar) 6. Telmisartan (Micardis) 7. Valsartan (Diovan) SIDE EFFECTS 1. Hypotension (Headache, dizziness, dry, mouth, hyperkalemia) ADVERSE EFFECTS Diarrhea Abdl (abdominal) pain Nausea Dry mouth Tooth Pain URTI ○ Upper Respiratory Tract Infection Nose, Throat, Pharynx, Larynx Rash Dry Skin Alopecia ○ Hair loss BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 ADVERSE EFFECTS CALCIUM CHANNEL BLOCKER (-dipine) Hepatic injury MECHANISM OF ACTION Dysrhythmias Rash Interferes with the muscle cell’s ability to Peripheral Edema contract leading to a loss of smooth muscle Dermatitis Inflammation of the skin tone, causing vasodilation and a decrease ○ inflammation of the skin in peripheral resistance Reflex Tachycardia ○ HR is 5.5 mmol/L = hyperkalemia active site of the renin enzyme Direct renin inhibitors block renin, stopping NURSING CONSIDERATIONS the formation of angiotensin I and II, leading to vasodilation and lower blood pressure. 1. Initial lab test (Serum k) 2. Obtain Hx of bowel elimination patterns DRUGS 1. Aliskiren (tekturna) Dyspepsia ○ The only FA approved direct renin ○ Medical term for indigestion inhibitor Angioedema ○ Swelling beneath the skin SIDE EFFECTS ○ Usually happen around eyes and lips Orthostatic Hypotension Eyes - periorbital edema ○ Dizziness, syncope (fainting) ○ kun naga higda ka kag gulpi kalang nagbangon ○ Nursing Intervention: Instruct client to rise gradually Headache Dyspepsia Cramps Diarrhea Stuffy nose ADVERSE EFFECTS Angioedema ○ swelling in the lips and skin ○ Angioedema is an area of swelling of the lower layer of skin and tissue just under the skin or mucus membranes. The swelling may occur in the face tongue, layering, abdomen, or arms and legs. ○ Face swells ○ Periorbital edema = swelling of the eyes BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 Px should not take any OTC drugs without first checking with the attending. SELECTIVE ALDOSTERONE RECEPTOR BLOCKER PO meds should be taken with meals Educate px on concurrent lifestyle (SARBS) modifications: Diet, exercise, stress reduction. MECHANISM OF ACTION Instruct px that these drugs should not be stopped abruptly as this may cause a Selective blockage of aldosterone receptor rebound hypertensive crisis and perhaps causing retention of K and increase lead to CVA (Cerebrovascular accident). excretion of Na and h2O ○ CVA is aka stroke Inversely proportional Take BP before administering drugs. ○ Sodium in, potassium out! Oral forms should be given with meals so ○ Sodium out, potassium in! that absorption is more gradual and aka Mineralocorticoid Receptor effective. Antagonists Administer IV forms with extreme caution and use an IV infusion pump. DRUGS Instruct px to change positions slowly. Hot showers, tubs,weather,exercise, 1. Eplerenone (Inspra) alcohol, prolonged sitting/standing may cause hypotension, dizziness, fainting. SIDE EFFECTS Px should report: SOB, Dyspnea, Peripheral and/or angioedema, excessive weight gain, Orthostatic Hypotension chest pain, palpitations, ○ Dizziness, faintness Men may experience impotence as ○ gulpi2 ka nag tindog kundi tumba ka expected SE gaga ○ Impotence Nausea and Diarrhea Erectile dysfunction Fatigue Headache PREVENTING ORTHOSTATIC HYPOTENSION ADVERSE EFFECTS Change position slowly. Sit at the edge of the bed or chair for a few Hyperkalemia minutes before standing up. Hypertriglyceridemia Stand up for a few minutes before starting Hyperuricemia to walk. Nephrotoxicity Ask for assistance when necessary. Hepatotoxicity If you feel dizzy or light headed, sit or lie down immediately. NURSING CONSIDERATIONS Make sure to drink adequate amounts of fluid throughout the day. Educate px about the importance of not missing a dose, taking the medications exactly as prescribed, never doubling up doses, and not stopping abruptly. BUENAVISTA, TABUADA, YAP RNs 2027  PHARMACOLOGY FIRST SEMESTER - PRELIMS NCM 106 BETA - BLOCKERS Bradycardia - below 60 (-OLOL) Tachycardia - above 100 MECHANISM OF ACTION 90/60 - 120/80 - Normal BP - Anything below is hypo Decreased renin and reduced cardiac - Anything above is hyper output Nauseous patients DRUGS - Pakanon candies - Suck on ice chips Metoprolol (Lopressor) Carvedilol (Carvidol Dry eyes patients Atenolol (Tenolol) - give eye-drops as prescribed Propranolol (Inderal) Dry mouth SIDE EFFECTS - Chapstick - Increase oral fluid intake Bradycardia Hypotension Bronchospasms Arrhythmias - hard to breath Fatigue - commonly seen to patients with asthma Nausea Insomnia Syncope Dry mouth or eyes - Lipong Low libido (women) Sexual or Erectile dysfunction (rare) Beta-blockers are contraindicated to patients with asthma because it causes bronchospasms ADVERSE EFFECTS Bronchospasms (pxs with Asthma) Raynaud’s Phenomenon Low blood pressure (hypotension) ○ May be aggravated by taking Less than 90/60 mm Hg metoprolol Normal Blood Pressure: Hypoglycemia 90/60 mm Hg to 120/80 mm Hg ○ Syncope, seizures, sweating Elevated Blood Pressure: 120/80 mm Hg to 129/80 mm Hg NURSING CONSIDERATIONS High Blood Pressure (Hypertension Stage 1): 130/80 mm Hg to 139/89 mm Hg Monitor VS (especially BP and RR) High Blood Pressure (Hypertension Stage 2): Let nauseous patients eat candy 140/90 mm Hg or higher Give eye drops for patients with dry eyes Hypertensive Crisis: Higher than 180/120 mm Hg (Seek