FACTORS AFFECTING

DRUG ACTION
1. Absorption 1. Distribution
• Route of • Plasma protein
administration binding
• Perfusion status • Lipid solubility
• GI motility Perfusion status
• Barriers (BBB,
placenta)
• Obesity
FACTORS AFFECTING
DRUG ACTION
1. Metabolism
• Age
• Drugs
• Liver disorders

6. Excretion
• Drug-drug interaction
• Blood concentration levels
• Renal status
 NONNARCOTIC ANALGESICS
AND ANTIPYRETICS

1. ASA Adverse Effects

Action • Salicylism
• Analgesia • Drowsiness
• Antipyretic • Bleeding
• Anti-inflammatory • Edema
• Antiplatelet • Hypertension
• Gastritis
2. NSAIDs • N and V
(ibuprofen, • Hypoglycemia
naproxen, Respiratory
piroxicam, alkalosis/metabolic
indomethacin, acidosis
ketorolac) • Reye’s syndrome
NONNARCOTIC ANALGESICS
AND ANTIPYRETICS
Nursing Implications
• Monitor CBC, PT, kidney and liver
function studies
• Additive effects if with use with
anticoagulants
• Drink plenty of fluids
• Take with food or fluids.
• Never given with
children/adolescents with flu
• Don’t crush enteric-coated
tablets.
• Avoid intake of alcohol
 NONNARCOTIC ANALGESICS
AND ANTIPYRETICS
2. Acetaminophen Nursing
• Analgesic and Considerations:
antipyretic • Monitor liver and
kidney function
and CBC
Adverse effects: • Antidote: N-
• Rash acetylcysteine
• Thrombocytopeni (Mucomyst)
a
• Liver toxicity
 ANTIPSYCHOTIC MEDICATIONS
1. Phenothiazines Adverse Effects:
• Thioridazine • EPS (dystonia,
parkinson’s, tardive
• Haloperidol dyskinesia, akathisia)
• Thorazine • Dizziness, sedation
• Promethazine • Orthostatic
• Fluphenazine hypotension
• Anticholinergic affects
• Photosensitivity
Action:
• Neuroleptic malignant
• Blocks dopamine syndrome
receptors • Agranulocytosis
• Anticholinergic, • Hyperprolactinemia
antihistamine, • Hypersensitivity (obst.
antiadrenergic Jaundice)
effects
• Antiemetic
ANTIPSYCHOTIC MEDICATIONS
Nursing Implications
• Wear gloves when handling parenteral or
liquid forms.
• Give deep IM injection into gluteal muscle
and massage well. Store in cool, dark place.
• Monitor for EPS.
• Take with food or milk.
• Take at bedtime.
• Advise not to drive or do activities that
require attention.
• Change position gradually
• Report fever and sore throat to physician
• Wear protective clothings.
• Never abruptly withdraw drug
• Avoid smoking
ANTIMANIC MEDICATIONS
Lithium Nursing
Implications:
Adverse effects:
• Monitor serum
• Confusion
lithium levels
• Restlessness
monthly
• Fatigue
• Hand tremors • Monitor for lithium
• Arrythmias toxicity.
• Hypotension • Teach patient to
• BOV increase fluid intake.
• Weight gain • Maintain sodium
• N and V intake of 6-10 g/day.
• hypothyroidism• Take with food.
 ANTIDEPRESSANT DRUGS
1. Tricyclic Nursing
antidepressants Implications:
• Nortryptyline
• Takes 2-4 weeks to
• amitriptyline
take effect. Monitor
• Imipramine
for suicidal
tendencies.
Adverse Effects:
• Sedation
• Monitor CBC.
• Confusion • Drug therapy
• Anticholinergic disconitued
effects gradually.
• Orthostatic • Taken with food
hypotension
• Monitor for toxicities
• Arrythmias
(seizures,coma.arryt
• Blood dyscrasia
ANTIDEPRESSANT DRUGS
1. MAO Inhibitors
• Phenelzine
Nursing
• Tranylcypromine Implications:
• Protect patient
Adverse Effects: from injury
• Orthostatic • Monitor I and O
hypotension • Inform patient
• Anticholinergic to avoid foods
effects and fluids high
• Hypertensive in tyramine
crisis • Monitor CBC and
• Leukopenia liver function
tests.
 ANTIDEPRESSANT DRUGS
Adverse Effects:
1. SSRI • CNS stimulation
• Sertraline • Sexual dysfunction
• Fluoxetine • N & V, anorexia
• Weight loss
Uses:
Nursing Implications:
• Major depression • Interacts with warfarin.
• Obsessive- • Cannot be combined
Compulsive D/O with MAOI.
• Taken in the morning
• Report immediately if
with rashes
 ENDOCRINE DRUGS
ANTIDIABETIC • Draw up clear insulin
AGENTS first.
2. Insulin • Rotate injection sites
Adverse Effects: • Monitor blood glucose
• Allergy levels regularly.
• Hypoglycemia • Inform patients
• Lipodystrophy regarding signs of
hypoglycemia and
Nursing Implications: appropriate treatment.
• Do not inject cold • If ill continue taking
insulin. insulin and drink freely
• Discard discolored nancaloric liquids.
solutions or those • Inform regarding
with precipitates. Do avoidance of smoking.
not shake vial.
 Type Appearanc Onse peak Duratio
e t n
Rapid-acting
•Regular •Clear ½-1 2-4 6-8
insulin
•cloudy ½-1 4-6 12-16
•Semilente
insulin
Intermediat
e acting
•NPH •cloudy 1-1 ½ 8-12 18-24

•Lente 1-1 8-12 18-24

Long-acting 1/2
•ultralente •Cloudy 4-8 16- 30-36
20
 Insulin
1. Drugs that increase effect of
insulin
• Aspirin
• Oral anticoagulants
• Beta blockers
• TCAs
6. Drugs that decrease insulin effect
• Glucocorticoids
• Thiazide diuretics
• OCP
• Thyroid agents
 Oral Hypoglycemic
agents
a. Sulfonylureas
– promotes inc. insulin secretion from
pancreatic beta cells through direct
stimulation (requires at least 30 %
normally functioning beta cells)
– First-Generation Agents:
• Tolbutamide, Acetohexamide,
Tolazamide, Chlorpropamide
– Second-Generation Agents
• Glypizide, Glyburide
 Oral Hypoglycemic
agents
b. Biguanides
– reduces hepatic production of
glucose by inhibiting
glycogenolysis
– decrease the intestinal
absorption of glucose and
improving lipid profile
– Agents
•Phenformin , Metformin ,
Buformin
 Oral Hypoglycemic
agents
c. Alpha-glucosidase inhibitors
– Inhibits alpha-glucosidase enzymes
in the small intestine and alpha
amylase in the pancreas
– Decrease rate of complex
carbohydrate metabolism resulting
to a reduced rate postprandially.
– Agents
• Acarbose (precose), Miglitol (glyset)
 Oral Hypoglycemic
agents
d. Thiazolidinediones
– Enhances insulin action at the
cell and post-receptor site and
decreasing insulin resistance
– Agents
• Pioglitazone (Actos),
Rosiglitazone (Avandia)
Adverse Effects: • Use other forms of
• Nausea and contraception
vomiting aside from OCPs
• Hypoglycemia • Alcohol can trigger
a hypoglycemic
• Hemolytic anemia effect.
• Allergy • Cover body is
• Photosensitivity sunshine. Use of
sunscreen.
Nursing implications: • Sulfonylureas are
• Tablets should not best taken before
be crushed meals
• Monitor for signs of • Monitor for drug to
hypoglycemia drug interactions.
Oral Hypoglycemic
agents
Drugs that reduce hypoglycemic
effects:
• Diuretics
• Steroids
• OCPs
Drugs that potentiates
hypoglycemic effects:
• Sulfonamides
• MAOI
• Coumarin
• Salicylates
• Probenecid
• propranolol
 CORTICOSTEROIDS
• Cortisol, hydrocortisone,
prednisone, prednisolone,
methylprednisone, triamcinolone,
dexamethasone
• Mineralocorticoid (fludrocortisone)
Uses:
• Replacement therapy for
adrenocortical insufficiency
• Anti-inflammatory agent
Adverse effects: 1. Altered immune
1. Altered protein response
metabolism
2. Sodium and water
• Muscle wasting retention
• Osteoporosis
3. Hypertension
• Easy bruisability
7. Hypokalemia,
2. Altered fat metabolic alkalosis
metabolism
• Moon facies
8. Emotional
instability
• Buffalo hump
9. Excessive
• Truncal obesity
androgen activity
• hyperlipidemia
10. Gastric irritation
3. Altered carbohydrate
metabolism
• Hyperglycemia
Nursing Implications:
• Review patient’s medical history prior to
giving the drug
• Administer in light-resistant containers
• Observe for mental changes.
• Monitor for BP, weight, I and O, glucose,
electrolytes.
• Take with food or milk.
• Take drug before 9 AM.
• Never abruptly stop taking the drug
• Teach patient ways to prevent infection.
• Restrict sodium, alcohol and caffeine
intake.
• Increase intake of foods high in potassium.
• Rinse mouth after using inhaled steroids
• Teach patient to avoid strenous activities
ANTITHYROID DRUGS
• Propylthiouracil (PTU) and
methimazole
• During pregnancy PTU, is the
preferred therapy
• A few of the infants born to
mothers receiving antithyroid
medication will be hypothyroid.
• Mechanism of action
– Blocks thyroid hormone
synthesis
Propylthiouracil
(PTU) and
methimazole
Adverse effects:
• Skin rash
• Urticaria
• Agranulocytosis
• Hepatitis
• Myalgia
• Headache
• Hypoprothrombinemia
• hypothyroidism
 PTU/Methimazole
Nursing considerations
• Give the drug with meals to reduce GI
effects
• Watch for signs of hypothyroidism
• WOF: Agranulocytosis
• Instruct patient to report for skin eruptions
• The drug should be stopped if severe rash
develops or cervical lymph nodes become
enlarged
• Advise patient to avoid foods high in iodine
or potassium
• Warn the patient against the use of the
over-the-counter medication
• Store the drug in a light-resistant container
• Monitor for weight and PR regularly.
 SSKI/Lugol’s solution
Potassium or sodium iodide
(potassium iodide SSKI), strong
iodine solution (Lugol’s solution)
• Treatment for thyrotoxic crisis
• Mechanism of action:
– Inhibits the release and synthesis of
thyroid hormones
– Decreases the vascularity of the thyroid
gland
– Decreases thyroidal uptake of
radioactive iodine following radiation
emergencies or administration of
radioactive isotopes of iodine
SSKI/Lugol’s solution
Adverse Effects:
• Unpleasant tase
• Hypersalivation
• Acne
• Rashes
• angioedema
• Burning sensation
SSKI/Lugol’s solution
Potassium or sodium iodide,
(potassium iodide solution,
SSKI), strong iodine solution
(Lugol’s solution)
• Dilute oral doses in water or fruit
juice and give with meals.
• Warn the patient that sudden
withdrawal may precipitate
thyrotoxicosis
• Store in a air-tight and light-resistant
container.
• Give iodides through a straw to avoid
tooth discoloration
• Force fluids to prevent fluid volume
deficit
Radioactive iodine (sodium
iodide or 131I )
• Food may delay absorption. The patient
should fast overnight before
administration
• After dose for hyperthyroidism, the
patient’s urine and saliva are slightly
radioactive for 24 hours; vomitus is
highly radioactive for 6 to 8 hours.
• Institute full radiation precautions
during this time
• Instruct the patient to use appropriate
disposal methods when coughing and
expectorating.
 Radioactive iodine
(sodium iodide or 131I )
– The patient should drink as
much fluid as possible for 48
hours after drug administration
to facilitate excretion.
– Limit contact with the patient to
30 minutes per shift per person
the 1st day; may increase time
to 1 hour on 2nd day and longer
on 3rd day.
THYROID HORMONES

• Levothyroxine
• Liothyronine
• Thyroglobulin (Proloid)

Adverse Effects:
• Signs of hyperthyroidism
 THYROID HORMONES
Nursing Implications:
• Different brands of levothyroxine may not be
bioequivalent.
• Warn the patient (especially the elderly) to
tell the doctor if with signs of hyperthyroidism
• Instruct the patient to take thyroid hormones
at the same time each day to maintain
constant hormone levels.
• Medications taken in the morning.
• Monitor apical pulse and blood pressure. If
pulse is >100 bpm, withhold the drug.
• Store in air-tight and light-resistant
containers.
• Monitor prothrombin time; a patient taking
these hormones usually requires less
 OXYTOCIN
Uses: Adverse Effects:
• Promotion of uterine • Hypotension
contractions • Tachycardia
• Control of bleeding • Water intoxication
• Release of milk from • Uterine rupture
breast
• Nausea and
Oxtocin-related
vomiting
drugs:
• Cardiovascular
• Methergine
collapse
• ergonovine
• Anaphylaxis
• Hypertension
(oxytocin-related
 OXYTOCIN
Nursing Implications:
• Use infusion pump for administration.
Never give IM
• Monitor BP, heart rate and I and O.
• Regularly monitor for uterine
contractions and FHR.
• Discontinue if:
 With note of tetanic uterine
contractions.
 Signs of fetal distress
 Urinary flow is less than 30 ml/hour
 Signs of abruptio placenta and uterine
rupture
• For ergonovine/methergine- C/I for
patients with vascular, renal and
ANTIASTHMA DRUGS
• Beta adrenergic agonists
• Anticholinergic drugs
• Methylxanthines
• Mast Cell stabilizers
• Leukotriene inhibitors
• Cortocosteroids
 Methylxanthines
• Theophylline Adverse Effects:
• Aminophylline • CNS stimulation
• Theo-dur • Tachycardia,
hypotension,
palpitations
Action:
• Nausea and vomiting
• Bronchodilator
• Rectal irritation
• CNS stimulant with suppository
• Increased renal
blood flow
 Methylxanthines
Nursing Implications:
• Monitor theophylline levels.
• Monitor VS, I and O and symptoms of
toxicity
• Avoid smoking and use of marijuana.
• Administer with milk if with GI distress,
otherwise take before meals with water.
• Avoid excessive caffeine use
• Do not crush or chew time-release or
enteric coated tablets
 Mast Cell Stabilizer
• Cromolyn sodium Adverse Effects:
• Nedocromil • Bronchoconstriction
• Cough
Actions: • Nasal congestion
• Prophylaxis against • rash
asthma attacks
• Allergic rhinitis
 Mast Cell Stabilizer
Nursing Implications:
• Teach patient to use before exercising.
• Teach about proper use of inhaler
 With spinhaler place capsule in container and exhale fully.
 Place mouthpiece between lips.
 Tilt head back and inhale fully.
 Remove inhaler, Hold breath
 Exhale slowly
• Rinse to reduce irritation in the mouth.
• Discontinue use if an allergic reaction
occurs.
 ANTINEOPLASTIC AGENTS
• A. General Adverse Effects
• GI symptoms
• alopecia
• BM depression
• hepatotoxicity
• ↑ uric acid
• fatigue
• B. Prototype – Cyclophosphamide(Cytoxan)
• 1. Action. Produces cytoxic effects by damaging DNA
and interfering with cell replication.
• 2. Adverse Effects. Hemorrhagic and nonhemorrhagic
cystitis
• ANTIMETABOLITES
• Prototype – Methotrexate with leucovorin rescue
– 5-Fluorouracil (5-FU)
– Mercaptopurine (Purinethol)
– Cytarabine (Cytosar-U)
• Action. Leucovorin calcium is a folic acid analog that
interferes with mitotic process by blocking folinic acid.
• ANTIBIOTIC ANTINEOPLASTIC AGENTS
– Prototype – Dactinomycin and Doxorubicin HCl (Adriamycin)
• Action. Attaches to DNA and prevents DNA synthesis in vulnerable cells.
• Adverse Effects.
– hyperuricemia
– cardiotoxic
– BM depression
• VINCA ALKALOIDS
• Prototype – Vincristine (Oncovin) and Vinblastine
– Action. Acts on cells undergoing mitosis, thus stopping cell division.
– Adverse Effects. Neuropathy and neurotoxic
• MISCELLANEOUS ANTINEOPLASTIC AGENTS
• L-Asparaginase (Elspar)
– Action. Enzyme that destroys asparagines, an amino acid necessary for protein synthesis of
leukemia cells.
– Adverse Effects. Azotemia, hemorrhagic pancreatitis, hyperglycemia, hepatotoxicity
• Hydroxyurea (Hydrea)
– Action. Urea derivative that kills granulocytes