Pharmacology Notes PDF

PHARMA PHARMA Drugs Affecting the Body System: Cardiovascular & Respiratory System Demonstrate proficiency in accurately documenting medication administration, including dosage, route, time, and patient response. Apply standardized documentation pr...

PHARMA PHARMA Drugs Affecting the Body System: Cardiovascular & Respiratory System Demonstrate proficiency in accurately documenting medication administration, including dosage, route, time, and patient response. Apply standardized documentation practices and protocols in medication administration to ensure clarity, accuracy, and completeness of records. Recognize the importance of thorough documentation in promoting patient safety, continuity of care, and interdisciplinary communication. Identify and classify drugs based on their effects on various body systems such as cardiovascular and respiratory systems. Explain the mechanisms of action, therapeutic uses, and potential side effects of drugs affecting different body systems. Demonstrate administration of sublingual and buccal drugs. Apply appropriate techniques in inhalation administration and nebulization CARDIOVASCULAR and RESPIRATORY Drugs Cardiovascular Drugs Anatomy and Physiology: Heart: The heart is a muscular organ divided into four chambers: two atria (upper chambers) and two ventricles (lower chambers). It functions as a pump to circulate blood throughout the body. Blood Vessels: These include arteries, veins, and capillaries. Arteries: Carry oxygen-rich blood away from the heart. Veins: Carry oxygen-poor blood back to the heart. Capillaries: Microscopic vessels where the exchange of gases, nutrients, and waste occurs. Blood: Composed of plasma (liquid part), red blood cells (carry oxygen), white blood cells (fight infection), and platelets (help with clotting). Key Functions: Circulation: The heart and blood vessels work together to deliver oxygen and nutrients to tissues and remove waste products. Regulation: Maintains blood pressure, blood volume, and pH balance. Cardiovascular drugs… Cardiovascular drugs are vital in managing various conditions affecting the cardiovascular system, such as hypertension, heart failure, coronary artery disease, and arrhythmias. Antihypertensives: Mechanism: Lower blood pressure by various means. Types: ACE Inhibitors: Enalapril, Lisinopril Angiotensin II Receptor Blockers (ARBs): Losartan, Valsartan Calcium Channel Blockers: Amlodipine, Diltiazem Beta-Blockers: Metoprolol, Atenolol Diuretics: Hydrochlorothiazide, Furosemide Nursing Management and Considerations Antihypertensives: Monitoring: Blood pressure, kidney function, electrolyte levels. Education: Adherence, potential side effects (e.g., cough with ACE inhibitors), lifestyle modifications. Antiarrhythmics: Mechanism: Regulate heart rhythm. Types: Class I: Sodium channel blockers (e.g., Quinidine, Lidocaine) Class II: Beta-blockers (e.g., Propranolol) Class III: Potassium channel blockers (e.g., Amiodarone) Class IV: Calcium channel blockers (e.g., Verapamil) Nursing Management and Considerations Antiarrhythmics: Monitoring: Heart rhythm, drug levels, and side effects. Education: Importance of regular follow-ups, recognizing signs of arrhythmia Heart Failure Medications: Mechanism: Improve heart function and reduce symptoms. Types: Inotropes: Digoxin Diuretics: Furosemide, Spironolactone Vasodilators: Nitroglycerin, Hydralazine Nursing Management and Considerations Heart Failure Medications: Monitoring: Weight changes, fluid status, heart rate, and rhythm. Education: Adherence to medication, dietary restrictions (e.g., sodium), recognizing symptoms of worsening heart failure. Antianginals: Mechanism: Relieve chest pain by improving blood flow to the heart. Types: Nitrates: Nitroglycerin Beta-Blockers: Metoprolol Calcium Channel Blockers: Amlodipine Nursing Management and Considerations Antianginals: Monitoring: Frequency and severity of angina attacks, response to medication. Education: Proper use of nitroglycerin, avoiding triggers of angina, adherence to therapy. Anticoagulants and Antiplatelets: Mechanism: Prevent blood clot formation. Types: Anticoagulants: Warfarin, Heparin, Direct Oral Anticoagulants (DOACs) like Apixaban Antiplatelets: Aspirin, Clopidogrel Nursing Management and Considerations Anticoagulants and Antiplatelets: Monitoring: Coagulation levels (e.g., INR for warfarin), signs of bleeding. Education: Avoiding activities that increase bleeding risk, dietary considerations, adherence to regimen. Lipid-Lowering Agents: Mechanism: Reduce cholesterol levels. Types: Statins: Atorvastatin, Simvastatin Fibrates: Fenofibrate Niacin: Niacin Nursing Management and Considerations Lipid-Lowering Agents: Monitoring: Lipid levels, liver function tests, and muscle symptoms. Education: Adherence to medication, lifestyle changes, recognizing side effects. Respiratory Drugs Respiratory drugs are used to manage and treat conditions affecting the respiratory system, such as asthma, chronic obstructive pulmonary disease (COPD), and allergic rhinitis. These drugs can be categorized into several classes, each with specific mechanisms of action, indications, and nursing considerations. Anatomy and Physiology of the Respiratory System Structure and Function: Upper Respiratory Tract: Includes the nose, nasal cavity, pharynx, and larynx. It warms, humidifies, and filters the air. Lower Respiratory Tract: Comprises the trachea, bronchi, bronchioles, and alveoli. It conducts air to the lungs where gas exchange occurs. Mechanisms of Breathing: Ventilation: Movement of air in and out of the lungs. Diffusion: Exchange of oxygen and carbon dioxide between alveoli and blood. Perfusion: Circulation of blood through the pulmonary capillaries. Regulation: Neural Control: Respiratory centers in the medulla and pons. Chemical Control: Chemoreceptors respond to changes in CO2, O2, and pH levels. Bronchodilators Mechanism: Relax bronchial smooth muscle to widen airways. Monitoring: Assess lung function, heart rate, and for signs of tremors or tachycardia. Education: Proper inhaler use, adherence to regimen, and potential side effects. Bronchodilators: common types Beta-2 Agonists: Albuterol (short-acting), Salmeterol (long-acting) Ipratropium (short-acting), Tiotropium (long-acting) Mucolytics and Expectorants: Mechanism: Thin and loosen mucus. Monitoring: Effectiveness in clearing mucus and any respiratory distress. Education: Encourage fluid intake and proper administration techniques. Antihistamines: Mechanism: Block histamine receptors to reduce allergy symptoms. Monitoring: Sedation (first-generation) and effectiveness in symptom control. Education: Caution with activities requiring alertness and selecting appropriate generation based on needs. Decongestants: Mechanism: Constrict blood vessels in the nasal passages. Monitoring: Blood pressure (oral decongestants) and rebound congestion (topical decongestants). Education: Limit use of nasal sprays to avoid rebound congestion (Rhinitis medicamentosa ) and use cautiously with comorbid conditions. Antitussives: Mechanism: Suppress the cough reflex. Monitoring: Cough type and frequency, and potential for dependence (codeine). Education: Proper use, adherence, and reporting side effects. Common GI Disorders Requiring Pharmacological Intervention Vomiting (antiemetic) Diarrhea (antidiarheal) Constipation  GI Tract Ulcerations Gastroesophageal Reflux Disease (GERD) Drugs for Vomiting (Antiemetics) 1. Serotonin Receptor Antagonists Common Drugs: Ondansetron (Zofran), Granisetron (Kytril), Palonosetron (Aloxi) Mechanism of Action: Blocks serotonin (5-HT3) receptors in the CNS and GI tract to prevent the vomiting reflex. Side Effects (S.E.): Headache, constipation, dizziness, fatigue. Adverse Effects (A.E.): QT prolongation (risk of arrhythmias). Nursing Considerations: Monitor ECG: Especially in patients with cardiac risk factors. Patient Education: Increase hydration, high fiber diet. Timing: Administer 30 minutes prior to chemotherapy or surgery. 2. Dopamine Antagonists Common Drugs: Metoclopramide (Reglan), Prochlorperazine (Compazine), Promethazine (Phenergan) Mechanism of Action: Blocks dopamine receptors in the brain's chemoreceptor trigger zone (CTZ). S.E.: Sedation, dry mouth, constipation, hypotension. A.E.: Severe extrapyramidal symptoms (EPS), tardive dyskinesia, neuroleptic malignant syndrome (NMS). Nursing Considerations: Monitor for EPS and NMS: Regular assessments and emergency response if suspected. Fall Risk: Implement fall precautions due to sedation. Monitor CNS Depression: Coordinate with healthcare providers if combined with other CNS depressants. 3. Antihistamines Common Drugs: Diphenhydramine (Benadryl), Meclizine (Antivert), Dimenhydrinate (Dramamine) Mechanism of Action: Blocks histamine (H1) receptors, effective for motion sickness and vertigo- related nausea.  S.E.: Drowsiness, dry mouth, blurred vision, urinary retention. A.E.: Severe sedation, especially in elderly, increased risk of falls. Nursing Considerations : Assess for Sedation: Educate patients on avoiding activities requiring full alertness. Monitor for Anticholinergic Effects: Provide interventions for dry mouth and constipation. 4. Anticholinergics Common Drugs: Scopolamine (Transderm Scop) Mechanism of Action: Blocks acetylcholine receptors to reduce vomiting center activity. S.E.: Drowsiness, dry mouth, blurred vision, confusion. A.E.: Severe confusion, exacerbation of glaucoma, urinary retention. Nursing Considerations: Monitor for Anticholinergic Toxicity: Especially in patients with pre-existing conditions. Monitor Ocular Pressure: Educate patients with glaucoma to report vision changes. Drugs for Diarrhea (Antidiarrheals) 1. Anti-Motility Agents Common Drugs: Loperamide (Imodium), Diphenoxylate with Atropine (Lomotil) Mechanism of Action: Slows intestinal movement, allowing more water absorption, making stools firmer. S.E.: Drowsiness, dizziness, dry mouth, constipation. A.E.: Risk of toxic megacolon, CNS depression, potential for abuse. Nursing Considerations: Monitor for Toxic Megacolon: Educate patients on proper usage and signs of severe abdominal pain. Monitor CFACS: Consistency, Frequency, Amount, and Color of Stool. WOF: Signs of dehydration. 2. Adsorbents Common Drugs: Activated Charcoal, Kaolin-pectin, Bismuth Subsalicylate, Attapulgite  Mechanism of Action: Binds to toxins and other harmful substances in the intestine, preventing irritation. S.E.: Constipation, bloating, gas, black stools (with Bismuth Subsalicylate). A.E.: Bismuth Toxicity, Salicylate Toxicity, Electrolyte Imbalance. Nursing Considerations: Activated Charcoal: Administer promptly after toxin ingestion; avoid concurrent administration with other medications. Kaolin-pectin/Attapulgite: Ensure adequate hydration; monitor for drug interactions. Monitor for Adverse Effects: Watch for signs of neurotoxicity and salicylate toxicity 3. Antisecretory Agents Common Drugs: Octreotide, proton pump inhibitor (PPIs), H2 Receptor Antagonists, Bismuth Subsalicylate Mechanism of Action: Reduces fluid secretion in the GI tract, helpful in managing diarrhea from hypersecretory conditions. Nursing Considerations: Monitor Fluid Secretion: Assess for effectiveness in reducing diarrhea volume and frequency. Educate Patients: On the importance of adhering to prescribed treatments and reporting unusual symptoms. COMMON DISORDER FOR ENDOCINE SYSTEM mellitus (type 1 and 2) hypothyroidism (low thyroid hormone) cushing syndrome (prolonged exposure to high leve of cortisol (glucosteroid) addison disease (do not poduce high level of cortisol and aldosterone) DM1 (autoimmune) -insulin therapy -rapid acting insulin -regular acting insulin (short acting insulin) -intermediate acting insulin -long acting insulin DM1 INSULiN DRUG rapid acting insulin -lispro, aspart, glulisine onset 15 mins peak 1-2 hours duration 3-4 hours -commonly used before meal to control postprandial blood glucose spike monitor -hypoglyclemia -ensure patient has eaten before administration to prevent hypoglycemia short-acting insulin (Regular insulin) -humulin R, novolin R, onset 30 mins peak 2-4 hours duration 5-8 hours used 30 mins before meal and can be use to a insulin drip to prevent hypoglycemia INTERMEDIATE-ACTING INSULIN NPH insulin -HUMULIN N, NOVOLIN N onset 1-2 hours peak 4-12 hours duration 12-18 hours used combination with rapid or short -acting insulin - BID morning and evening, -monitor night time glycemia LONG ACTING INSULIN GLARGINE (lantus) and DETEMIR (levemir) these insulin have slow onset and povide a steady level of insulin up to 24 hour making them suitable for basal insulin coverage DM2 -oral hypoglycemic agent -injectable non-insulin agent -insulin therapy in type 2 DM low acting provide steady insulin throughout a day OD adiministration MONITORING CBG (capillary blood glucose) -sign of hypoglycemia -keep fasting acting carbohydrate (hard candy, soda) -look for hypoglycemia (deadly) S&S hypoglycemia (shakiness, sweating, confusion, dizziness and palpitation) what to do when this present HATAG OG SUGAR OR TAMIS KAY UBOS ANG SUGAR eg. coke, candy (fast acting carbs ) insulin therapy consideration rotate the injection site to prevent LIPODYSTROPHY and ensure consistent insulin absorption insulin storage unopen vial or pen at refrigerator and open at room temperature monitor for diabetic ketoacidosis (DKA and common in type 1) sign of DKA fruity smelling breath, rapid breath, nausea long term complication (brain.eye,kidney.heart) neuropathy,retinopathy,nephropathy and cardiovascular disease DM2 DRUG common oral hypoglycemic agent METFORMIN - decrease hepatic glucose production (GLUCOGENESIS) - should be taken with food reduce risk of gi absent - should be temporarily discontinue before contrast imaging procedure involving the iodine iodinated contrast to reduce risk of lactic acidosis -monitor renal function (excreted through renal) - look for lactic acidosis (rare) metformin -GI distress (should be taken with food) -lactic acidosis especially with renal impairement GLIPIZIDE (sulfonylurase) stimulate beta cell of pancrease to release more insulin -dosage depend patient blood glucose -taken 30 mins before meal to ensure peak drug level coincide with meal induce blood glucose elevation -dosage adjustment for elderly or renal or hepatic imparement to reduce risk of hypoglycemia -monitor sign of hypoglycemia especially elderly patient -avoid skipping meal and alcohol COMMON NON INSULIN INJECTABLE (EXETINAMIDE,LIRAGLUTIDE) EXETINATIDE- mimic action if glucagon like peptide-1 (GLP1) and incretin hormone that is normally released by gut in respone to food intake -GI side affect -thyroid c cell tumor -weight loss -glucagon like peptide 1 and incretin HYPOTHYROIDISM AND HYPERTHYROIDISM thyroid hormones T3 -TRIIODOTHYRONINE T4 -THYROXINE CALCITONIN hypothyroidism (cold intolerance) weight gain decrease sweating constipation hyperthyroidism (heat intolerance) weight loss increase sweating diarrhea DRUG MANAGEMENT for hypothyroidism (oral) levothyroxine (SYNTHROID,LEVOXYL) -synthetic T4 hormone liothyronine (CYTOMEL) -synthetic T3 hormone DESICCATED THYROID (ARMOUR THYROID) -thyroid gland that has been dried and powdered for medical use. (T3 & T4) -baboy gikan (porcine gland) HYPERTHOIDISM (hyperactive dako leog, mata) Propylthiouracil (PTU) -inhibit enzyme thyroid peroxidase which role is sythesis of thyroid, -it stop production of this enzyme -strong -*drug of choice * methimazole (tapazole) -inhibit thyroid peroxidase preventing systhesis of thyroid -it does not inhibit peripheral conversion of T4 to T3 -generally prefered over PTU by the patient -longer duration of action and fewer side effect CUSHING SYNDROME -too much of the hormone cortisol (glucocorticoid) -taking medication glucocorticoid meds (caused) symptoms of cushing syndrome -fatty hump between shulder (buffalo hump) -rounded face -purple strecth marks S&S -hypertension -bone loss -type 2 diabetes -low sexdrive -low fertility -erictile dysfunction -moody DRUGS for cushing syndrome inhibit steroid production (steroidogenesis) ketozonazole -inhibit enzyme invloved in the synthesis of cortisol in adrenal gland monitor - liver (hepatotoxic) cortisol level side effect -GI discomfort -head ache -liver disfunction (jaundice and white poop) MYTYRAPONE -inhibit 11 beta hydroxylase enzyme that block final step in cortical synthesis. monitor (6s) -cortisol level -increase blood pressure (common side effect) -electrolyte imbalances -nausea -hirsutism (balhibohon sa bae murag laki kung naay pcos) -adrenal insuffiency (especially when suddenly stop medication) so need to taper to avoid adrenal insuffiency ACTH SECRETION (adrenocorticotropic hormone) anterior which signal adrenal to produce -injectable (subcutaneous) 4 PASIREOTIDE (somatostatin analog) -inhibit adrenocorticotropic hormone from pituitary gland (pituitary adrenomas) MONITOR -blood glucose (hyperglycemia) makapataas -nausea & dizziness (common side effect) CABERGULINE (dopamine agonist) inhibit ACTH sercretion from anterior pituitary adrenomas -taken with food to avoid GI upset MONITOR -cadiac valvulopathy (inflamed heart valve) -head ache and dizziness -prolactin level (could lower especially pregnant) GLUCOCORTICOID RECEPTOR ANTAGONIST block cortisol in the receptor (glucocorticoid receptor) MIFEPRISTONE OD oral -take medication with food for better absorption MONITOR -HYPOKELEMIA (POTASSIUM) -HYPERTENSION ADDISON DISEASE (adrenal insuffiency) -low level of aldosterone and cortisol s&s -extreme fatigue -areas of darken skin (dili hyperpigmentation) -low blood pressure (fainting) -low blood sugar (deadly) -irritability (depressive) -hair loss -low sex drive addisonian crisis (SEVERE)- acute status of severe cortisol and aldosterone deficiency DRUGS FOR ADDISON DISEASE (GLUCOCORTICOID REPLACEMENT) hyrocortisone (synthetic form if cortisol) -taken upon waking and with food monitor under and over replacement (sobra inom) prednisone-converted to prednisolone in the liver monitor blood glucose level hypoglycemia lead to (addisonian crisis) -hyperglycemia dexamethasone (potent synthetic gucocorticoid) -affecting gene transcription -strong drug MINERALOCORTICOID REPLACEMENT (primarily aldoterone) -maintain sodium and potassium balance fludrocortisone(flurinef) -mimic affect of aldosterone -orally, OD, taken in the morning since frequent urination Drugs affecting renal Diuretic thiazide diuretic loop diuretic potassium sparring osmotic diuretic Diuretics are medications that help the body remove excess salt and water through urine, commonly used to treat conditions like hypertension, heart failure, and edema. They work by acting on different parts of the kidneys. Here's a breakdown of the types you mentioned: 1. Thiazide Diuretics: (sodium)  Mechanism of action: They act on the distal convoluted tubule in the kidney to inhibit sodium reabsorption, leading to water loss. Common drugs: Hydrochlorothiazide, Chlorthalidone, Indapamide. Uses: Primarily for managing high blood pressure, and sometimes for heart failure and edema. Side effects: Can cause hypokalemia (low potassium), hypercalcemia (high calcium), and hyperglycemia. 2. Loop Diuretics:(sodium,potasium,chloride) Mechanism of action: They inhibit sodium, potassium, and chloride reabsorption in the ascending loop of Henle, causing significant fluid loss. Common drugs: Furosemide, Bumetanide, Torsemide. Uses: Used in acute situations like pulmonary edema, chronic heart failure, and kidney diseases. Side effects: Can cause electrolyte imbalances, particularly hypokalemia, dehydration, and ototoxicity (hearing problems at high doses). 3. Potassium-Sparing Diuretics:(block sodium without potasium loss) Mechanism of action: These work in the distal nephron to block sodium reabsorption without causing potassium loss. Common drugs: Spironolactone, Eplerenone, Amiloride, Triamterene. Uses: Often combined with other diuretics to prevent potassium loss. Spironolactone is also used in conditions like heart failure, hyperaldosteronism, and acne. Side effects: Can lead to hyperkalemia (high potassium), especially when used with other medications that retain potassium. 4. Osmotic Diuretics: (inhibit water reabsorption) Mechanism of action: They increase osmolarity in the nephron tubules, preventing water reabsorption. This increases urine output without significant electrolyte loss. Common drugs: Mannitol. Uses: Often used in emergencies, such as reducing intracranial pressure or treating acute kidney failure. Side effects: Can cause dehydration, electrolyte imbalance, and sometimes pulmonary edema due to fluid shifts. RAAS inhibitor ACE inhibitor ARBs ALDOTERONE antagonist DIRECT Renin inhibitor The Renin-Angiotensin-Aldosterone System (RAAS) plays a crucial role in regulating blood pressure, fluid, and electrolyte balance. Various classes of medications target this system to treat conditions like hypertension, heart failure, and kidney disease. Here's a breakdown: 1. RAAS Inhibitors: Mechanism of action: RAAS inhibitors target different points in the RAAS pathway to lower blood pressure and reduce the workload on the heart. These include ACE inhibitors, ARBs, aldosterone antagonists, and direct renin inhibitors. Effect: By inhibiting different parts of this system, these drugs reduce vasoconstriction (narrowing of blood vessels), decrease sodium and water retention, and lower blood pressure. 2. ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors): Mechanism of action: These drugs inhibit the enzyme ACE, which is responsible for converting angiotensin I to angiotensin II, a potent vasoconstrictor. Common drugs: Lisinopril, Enalapril, Ramipril, Captopril. Uses: Primarily for hypertension, heart failure, and to protect kidney function in diabetes. Side effects: Common side effects include cough (due to bradykinin buildup), hyperkalemia (high potassium), and rarely angioedema (swelling). Contraindications: Not recommended during pregnancy or in people with a history of angioedema. 3. ARBs (Angiotensin II Receptor Blockers): Mechanism of action: ARBs block the action of angiotensin II by binding to its receptor, preventing vasoconstriction and aldosterone secretion. Common drugs: Losartan, Valsartan, Telmisartan, Irbesartan.  Uses: Similar to ACE inhibitors, used in hypertension, heart failure, and kidney protection in diabetic patients. Often prescribed when ACE inhibitors cause a cough. Side effects: Hyperkalemia, hypotension, and very rarely angioedema (though less common than with ACE inhibitors). Contraindications: Like ACE inhibitors, ARBs are contraindicated during pregnancy. 4. Aldosterone Antagonists (Mineralocorticoid Receptor Antagonists): Mechanism of action: These drugs block the effects of aldosterone, a hormone that promotes sodium and water retention, leading to lower blood pressure and reduced fluid overload. Common drugs: Spironolactone, Eplerenone. Uses: Used in heart failure, hypertension, and conditions with excess aldosterone (e.g., primary hyperaldosteronism). Side effects: Hyperkalemia is a major concern. Spironolactone can also cause gynecomastia (breast enlargement in men) and menstrual irregularities due to its hormonal effects. Contraindications: Should be used with caution in patients with high potassium or kidney issues. 5. Direct Renin Inhibitors: Mechanism of action: These drugs block the enzyme renin, which is responsible for initiating the RAAS cascade by converting angiotensinogen to angiotensin I. Common drug: Aliskiren. Uses: Primarily for treating hypertension. It is a newer class of drug. Side effects: Diarrhea, hyperkalemia, and potential risk of angioedema. Contraindications: Should not be used in pregnancy or in combination with ACE inhibitors or ARBs, especially in patients with diabetes, due to an increased risk of adverse effects. IV computation. Macro 20 (drops) Micro 60 (drops) Dosage devide time times drop devide pila ka minutes example 1 hour = 60 Weight computation of drugs Dosage devided by weight example 50 mg child weight 20kg, drop every 6 hours 50x20 = 1000 Every 6 hour, so 24 hours devide 6 = 4 So 1000 devided by 4 = 250