1.

Which of the following neurotransmitter is involved

with mood, anxiety, and sleep induction?
A. Acetylcholine
B. Serotonin
C. Dopamine
D. Norepinephrine
Answer B: Serotonin
1. Depression occurs due to the decreasing amount of the
following neurotransmitters, except;
A. Norepinephrine
B. Acetylcholine
C. Serotonin
D. Dopamine
Answer B: Acetylcholine
 REVIEW
OF
PHARMACOLOGY
Part 1
Prepared by: DORITHY B. INOT, RN, MSN, LPT
DEFINITION OF TERMS
▪ PHARMACY- is the art of preparing, compounding, and
dispensing drugs.
DEFINITION OF TERMS

▪ PHARMACIST - a person licensed

to prepare and dispense drugs and
make up prescriptions

▪ CLINICAL PHARMACIST - is a
specialist who often guides the
physician in prescribing drugs.
 DEFINITION OF TERMS

▪ MEDICATION- is a substance
administered for the diagnosis, cure,
treatment, or relief of symptoms or
for prevention of disease.

▪ PRESCRIPTION- written direction for

the preparation and administration
of drugs.
DEFINITION OF TERMS
▪ GENERIC NAME - given before a drug becomes
officially an approved medication; generally used
throughout the drug’s use

▪ CHEMICAL NAME - is the name by which a chemist

knows it; this name describes the constituents of the
drug precisely.

▪ TRADE/BRAND NAME - is the name given by the drug

manufacturer; usually selected to be short and easy to
remember
 EFFECTS OF DRUGS
▪ DRUG TOXICITY- deleterious effect of a
drugs on an organism or tissues: result
from over dosage;
▪ buildup of the drug in the blood because
of impaired metabolism or excretion.

▪ DRUG ALLERGY- an immunologic

reaction to a drug
▪ severe allergic reaction usually occur
immediately after administration of the
drugs is called Anaphylactic Reaction.
 EFFECTS OF DRUGS
▪ DRUG TOLERANCE- exists in a person who has
unusually low physiologic response to a drug and who
requires increases in the dosage to maintain a given
therapeutic effect.
▪ CUMULATIVE EFFECT- is the increasing response
into repeated doses of a drug that occurs when the
rate of administration exceeds
▪ IDIOSYNCRATIC EFFECT- is one that is
unexpected and may be individual to a
client; cause unpredictable and
unexplainable symptoms in a particular
client.
DRUG INTERACTION
▪ DRUG INTERACTION - occurs when the
administration of one drug before, at the same
time as, or after another drug alters the effect of
one or both drugs.
▪ may be beneficial or harmful.
▪ INHIBITING EFFECT – decreasing the effect of
drug
▪ POTENTIATING EFFECT – increasing the effect of drug
▪ ADDITIVE EFFECT - when two of the same types of drug
increase the action of each other
▪ SYNERGISTIC EFFECT - occurs when two different drugs
increase the action of one or another drug.
PHARMACOTHERAPEUTICS
Nurses deal with Pharmacotherapeutics, or Clinical
Pharmacology
▪ the branch of pharmacology that uses drugs to
treat, prevent, and diagnose disease.

▪ Clinical pharmacology addresses

two key concerns:
1. the drug’s effects on the body
2. the body’s response to the drug.
PHARMACODYNAMICS
▪ is the study of the effect of drugs on the body.

DRUG RESPONSE MAY BE:

Primary - always desirable/physiologic effects

Secondary - desirable or undesirable

CLASSIFICATION OF DRUG ACTION

Rapid - few seconds to minutes

- IV, SL, Inhalations

Intermediate - 1 to 2 hours after

administration
- IM, SC

Delayed/Slow - several hours after

administration
- Oral, rectal
DRUG - DRUG INTERACTION

Additive Effect - 2 drugs Synergistic - combined

with similar actions are effect of 2 drugs is
taken for a doubled effect greater than the sum of
▪ 1+1=2 the effect of each drug
▪ Ibuprofen+ given alone; 1+1=3
paracetamol= added ▪ Aspirin = 30%
analgesic effect analgesic effect
▪ Codeine with ▪ codeine – 30%
acetaminophen = better analgesic effect
pain control ▪ combination = 90%
analgesic effect
 DRUG - DRUG INTERACTION
4. Antagonistic - one drug
inhibits the effect of
another drug
PROZAC + ZESTRIL ▪ 1+1=0
▪ Tetracycline + antacid=
3. Potentiation - a drug that decreased absorption of
has no effect enhances the tetracycline
effects of the second drug ▪ Charcoal in alkaloidal
▪ 0+1=2 poisoning
▪ Alcohol enhances the
analgesic activity of aspirin.
▪ Prozac + Zestril TETRACYCLINE +
ANTACID
 PHARMACOKINETICS
Is the process of drug movement to achieve drug actions

1 3

4
Safety and Quality in
PHARMACOTHERAPY
 TYPES OF MEDICATION ORDERS
1. STAT ORDER - indicates that the medication
is to be given immediately and only once

e.g., morphine sulfate 10 milligrams IV stat

2. SINGLE ORDER/ONE-TIME ORDER - is for

medication to be given once at a specified time

e.g., Seconal 100 milligrams at bedtime before

surgery
TYPES OF MEDICATION ORDERS
3. STANDING ODER – may/may not have a termination date.
may be carried out indefinitely (e.g., multiple vitamins daily) until
an order is written to cancel it
▪ may be carried out for a specified number of days (e.g., KCl
twice daily × 2 days)
4. PRN/AS NEEDED ORDER - permits the
nurse to give a medication when, in the
nurse’s judgment, the client requires it
▪ nurse must use good judgment about
when the medication is needed and when
it can be safely administered.
 THE COMPONENTS OF A DRUG
ORDER ARE AS FOLLOWS:
▪ Date and time the order is written
▪ Drug name (generic preferred)
▪ Drug dosage
▪ Route of administration
▪ Frequency and duration of administration
▪ (e.g., × 7 days, × 3 doses)

Furosemide (Lasix) 40 mg, PO, daily

▪ Any special instructions for withholding or adjusting dosage
based on nursing assessment, drug effectiveness, or laboratory
results
 Routes of Drug Administration:
1. Oral Route-
Form: Solid – Tablet, capsule, caplet, lozenge
Liquid- Syrup, drops, elixir, suspension,
emulsion, extract
2. Sublingual- the drug is placed under the tongue
3. Buccal- the drug is placed near the cheek
4. Topical- the medication is applied on the skin or mucus
membrane
1. Forms: Cream, soap, powder, liniment, patch, ointment,
lotion, shampoo, paste, tincture, suppository, pessary, gel,
inhalation
 Routes of Drug Administration:

5. Parenteral
a. Intradermal
b. Subcutaneos
c. Intramuscular
d. Intravenous
Drugs – System and
it’s Disease
Respiratory System
Asthma
- hypersensitivity reaction that can be triggered
by dust, allergens, molds and medications that
can cause bronchoconstriction

Medications:
Acute Attack: Chronic Attack:
1st- Bronchodilator 4th- Mast Cell Stabilizer
2nd- Steroid 5th- Anti-Leukotiene/
Leukotriene Antagonist
3rd- Anti-Cholinergic
Bronchodilator – relaxes smooth muscle
ERENOL
XYLLINE BRONCHODILATOR

Type 1 Type 2 (Xanthines)

1. Beta-agonist- 1st line drugs 1. Theophylline
2. Epinephrine 2. Aminophylline
3. Albuterol
4. Isoprotenerol
5. Metaprotenerol

EFFECT OF BRONCHODILATOR:
Sympathetic Nervous System (SNS) Effect Adverse Effect
1. Increase blood pressure - Hypertension
2. Increase Blood glucose level - Hyperglycemia
3. Increase heart rate - Tachycardia
Bronchodilator – relaxes smooth muscle
XANTHINES- caffeine derivatives

Contraindicated to a STIMULANT LIKE:

- Coffee
-Tea
- Cola
- Chocolates
Steroids- reduces inflammation

SONE STEROID

1. Triamcinolone
2. Methyl prednisone
3. Prednisone

1. EFFECT:
5S’s
Salt Hypernatremia
Sick Sickly
Sugar Hyperglycemia
Sad
Depression
Sex
Secondary Sexual Characteristics (prolonged used)

Taken via MDI (Meter Dose Inhaler/Multi-Dose Inhaler)

 Steroids- reduces inflammation
2. It can cause ORAL FUNGAL INFECTION OR ORAL THRUSH
Teaching: Rinse the mouth after use of MDI

3. Excrete CALCIUM (Prone to have OSTEOPOROSIS and

FRACTURE

4. Delayed WOUND HEALING (because of the effect of

STEROID -reduces inflammation)

5. Immunocompromised

6. May retain FATS (buffalo hump, truncal obesity)

ANTICHOLINERGIC- reduces mucus secretion

ATROVENT
IPATROPIUM

EFFECT: Peristalsis
Urine Output
Pupil
Constriction
 ANTICHOLINERGIC- reduces mucus secretion
Remember: Nursing Implementation

▪ Administer oral drug with food or milk to relieve GI irritation if GI upset is a

problem.
▪ Teach the patients - to use it 30 to 60 minutes before exercising to ensure
peak therapeutic effects when they are needed.
▪ Alert the patient that long-acting adrenergic blockers are not for use during
acute attacks
▪ Increase oral fluid intake. Ensure adequate hydration sugarless lozenges
to relieve dry mouth and GI upset.
▪ Caution the patient not to exceed 12 inhalations in 24 hours to prevent
serious adverse effects.
Mast Cell Stabilizer-use as management for long
term asthma

Chromolyn Has unpleasant taste

Nedocromyl

1. Give SIPS of water after taking mast cell stabilizer

2. Given 30 minutes before exposure

 Anti-Leukotiene/Leukotriene Antagonist - drugs
block many of the signs and symptoms of asthma

Zafirleukast

Monteleukast Given an hour

before meal

HEPATOTOXIC!!!

They do not have immediate effects on the airways and are not
indicated for treating acute asthma attacks.
Meter Dose Inhaler- steroid administered; deliver
medication to the lower respiratory tract
Used:
“R” – Remove the cover and shake
“E” – extend the neck and exhale (to remove the CO2)
“O” – one to two inches away if with no spacer
“P” – press during inhalation, continue 3-5 seconds
“E” – exale after for 10 seconds
“N” – next dose –same medications- 1 minute apart
- different methods – 5 minutes apart

SPACER- ENHANCES THE DELIVERY OF DRUGS

Lung Surfactant
-reduce the surface tension within the alveoli, allowing expansion of
the alveoli for gas exchange.

- Used to replace the surfactant that is missing in the lungs of

neonates with RDS.
Indications of Lung surfactants
▪ Rescue treatment of infants who have RDS.
▪ Prophylactic treatment of infants at high risk for
development of RDS (birth weight of <1, 350g, birth weight
>1, 350g who have evidence of respiratory immaturity).
▪ tried in the treatment of adult RDS and with adults
after near drowning.
Urinary System
 KIDNEY

Glomerulus Tubules

FILTER
EXCRETION REABSORPTION

Glomerular Filtration Rate- 125 ml/min

Plasma volume (70-kg young adult man) = about 3L, the kidneys filter the
plasma some 60 times in a day.
 MEDICATIONS

NOTE:

K-Wasting Only used for tubules

Used for ascending

Loop Diuretics-
loop of Henle

Our overall health is strongly dependent on proper functioning of the

kidney.
 Potassium Wasting
1. Osmotic Diuretics- excrete Na, K, H2O
Medications for proximal tubules
Example: Mannitol, Isosorbide
NOTE: All Diuretics excrete Na, H2O, K
COMPLICATION: Hyperglycemia
MOST COMMON COMPLICATION:
2. Loop Diuretics- excrete Na, H2O, K, Mg and Ca Hypokalemia and Hypotension
Medications for Ascending Loop of Henle
Example: Furosemide, Bumetanide, Torsemide

COMPLICATION: Rare (Ototoxic, Photosensitive)

3. Thiazide Diuretics- excrete Na, H2O, K and Hydrogen Complication: Metabolic Alkalosis
- retain Calcium Complication: Hypercalcemia

Medications for Distal Convoluted Tubules

Example: Diuril, Metalozone
Renin Angiotensin Aldosterone Activating System
is a vital system of human body, as it maintains plasma sodium concentration, arterial blood
pressure and extracellular volume.

Functions:
Na K

BP

Medications Provide Kidney Protections:

1. Angiotensin Receptor Blockers (ARBs)- SARTAN (Ex. Losartan, Valsartan)
ACTIONS:

BP
Na K X Cough
 HYPOKALEMIA- decreases impulse

- skeletal muscle weakness and muscle cramps

Decrease in blood pressure trigger Renin Angiotensin

Aldosterone Activating System (RAAS) which functions is
to:

1. Increase sodium
2. Increase BP
3. Decrease potassium

Medications: Angiotensin Receptor Blockers (ARBs) –

“SARTAN” Ex. Losartan, Telmisartan, Valsartan
Actions: 1. Decrease blood pressure
2. Increase potassium
3. Decrease Sodium
4. Has lower incidence of cough
 HYPOKALEMIA- decreases impulse

2. ACE Inhibitor (end in PRIL)

ACTIONS: Vasodilation
Increase Potassium
Decrease Sodium

- should be taken an hour before meal

- it might develop cough
-increase potassium level

3. Potassium Sparing Diuretics (Spirinolactone,

Amiloride and Triamterene)- are medicines that
increase diuresis (urination) without the loss of
potassium.
 HYPERKALEMIA
Cause :
1. Medications like ACE Inhibitor, ARBS, and K-Sparing Diuretics
2. Acidosis

Medications:
1. Sodium bicarbonate- use to reverse acidosis
2. Insulin + Dextrose
3. Diuretics (Potassium Wasting Diuretics)
4. Calcium Gluconate (cardiac stimulant)
Kidney Disease:
1. Nephrotic Syndrome
Drug of Choice: Immunosuppressant ( Steroid and Cyclosporine)- use to lower their bodies'
immune response.
2. Benign Prostatic Hypertrophy
Treatment Medicine:
a. (Ex. Saw Palmetto and Finasteride)
b. Alpha 1 Blocker- “ZOSIN” –it reHormonal Replacement Therapy lax the
bladder neck that facilitate to increase urine output.

NO TO: ANTICHOLINERGIC- because it induces urinary

retention.
ANTIHISTAMINE- make it harder to urinate
and may trigger complete urinary retention.
Kidney Disease:
3. Urinary Tract Infection
Medications:
a. Phenazopyridine- act as urinary analgesia
s/e: red orange urine
b. Nitrofurantoin- decrease bacteria in urine
s/e: brown urine
c. Methenamine –decrease bacteria
- should eat an acid ash diet

4. Urinary Calculi
Medication: IV Narcotics Analgesic (Ex. Demerol (Meperidine)
 Kidney Disease:
5. . End Stage of Renal Disease
Drug of Choice: Epoietin Alpha (used to treat severe anemia on
patient with or without anemia
- to be given subcutaneously
- takes 2 to 6 weeks before your RBC count
increases
- it causes RBC productions which is indications of
its effectiveness: will improve hematocrit level
- KEEP IT IN REFRIGERATOR!!
6. Renal Osteodystrophy
Medications: Activated Vitamin D
Phosphate binder - used to decrease the absorption
of phosphate from food in the digestive tract
–should be given with food
Ex. Calcium carbonate
NO TO Magnesium – it can cause Magnesium toxicity
Neurologic System
Myasthenia Gravis- muscle weakness which causes
the death of the patient

DRUG OF CHOICE: 1. Neostigmine Anticholinesterase

2. Stigmine -decrease choline
3. Pyridostigmine -increase acetylcholine

EFFECT: OVERDOSE: Cholinergic

Crisis
Dx Test: Tensilon Test
Overdose: worsen Antidote:
Underdose: improve 1. Anticholinergic Ex.
EDROPHONIUM INJECTION
Atrophine SO4
2. Anticholinesterase
UNDERDOSE: Myasthenia
Crisis
Myasthenia Gravis- muscle weakness which causes
the death of the patient
Medication should be given on time

STIGMINE –given before breakfast

Causes: GI Irritation
Give light snack (crackers)

Nursing Responsibilities:
Monitor for any aspiration and breathing proble
Do not give muscle relaxant
Medication should be given on time
Amyotrophic Lateral Sclerosis- person is having
muscle paralysis

-also called as Lou Gehrigs’ Disease

Theory: Too much glutamate (neurotransmitter)

destroys the motor neuron.

Drug of Choice: Glutamate antagonists: Rilutek and

Riluzole

Riluzole - extends survival and/or time to

tracheostomy.
Parkinsons Disease- with destructions of dopamine
producing cells
Dopamine- found at substantia nigra located at basal ganglia
What happened? There is decrease dopamine level and increase
acetylcholine

Dopamine: inhibitory in nature (adrenergic)

Acetylcholine- excitatory (cholinergic)

Drug of Choice: Dopaminergic- to increase dopamine

Anticholinergic- to decrease acetylcholine

DOPAMINERGIC DRUGS: Amantidine- teratogenic both animals and human

Ropinerole
Bromocriptine
Selegiline
Parkinsons Disease- with destructions of dopamine
producing cells
ANTICHOLINERGIC
Ex: Benztropine
Biperidine
Procyclidine
Tolcapine
Entacopone

OTHER DRUGS: Levodopa

Carbidopa

SINEMET with combination of Levodopa and Carbidopa

Carboxylaze enzyme convert levodopa to Dopamine

Carbidopa- combined with levodopa to inactivate Decarboxylase found outside the brain.
Parkinsons Disease- with destructions of dopamine
producing cells
Side Effect: Levodopa
1. Dark urine (expected)
2. Orthostatic Hypotension
3. Peristalsis
4. Urine output increase

Adverse Effect: Dyskinesia

Psychosis
For patient who is taking LEVODOPA
-NO to MAO inhibitor 14 days before taking Levodopa because it can cause HPN Crisis.
-NO to Tyramine rich food like red wine, aged cheese and fermented soy sauce.
-LOW Protein Diet because it blocks CHON in the brain
-Avoid Excessive amount of Vitamin B6.

NOTE: ANTI-PARKINSONS drug are Teratogenic.

 MIGRAINE
Abortive Therapy (more
effective if given early in the
course of headache)
Preventive Therapy Can be taken
Vasoconstrictor 3x within 24
Calcium Channel Blocker - it is to be taken if there is hour period
Ex. Nifedipine headache already
Amlodipine Ex: Ergotamine Must be limited
Filidopine TRIPTANs to 2-3 days a
1. Sumatriptan week
2. Almotriptan
3. Flavotriptan
 Seizures- due to increase CNS impulse
DRUG OF CHOICE: Anticonvulsant- facilitate decrease in CNS impulse.
S/E or Cause: Drowsiness and slurred speech

Ex. Diazepam Phenobarbital (Barbiturates)

Lorazepam (Benzodiazepene) Phenytoin
Valproic acid Tegetrol (Carbamazepene)
Depakene (Valproate) GABA Pentine

Dilantin (Hydrantin)- most popular D-ental Care

I- nfection (WBC)
Management: Prevent “gingival hyperplasia” L-ess Sedating
A-bnormal Estrogen metabolism
Always visit the dentist, brush teeth carefully. N-ormal for them to have brown
urine
T-en to 20 mcg/dl therapeutic level
I-ncrease blood sugar level
N-SS only
 Bell’s Palsy-(CN7) unilateral inflammation
- a neurological disorder that causes paralysis or weakness on one side of the face

DRUG OF CHOICE: Steroids (for Cranial 7 nerve pain)

Trigeminal Neuralgia (TIC DOLOREAUX)- an

excruciating facial pain that involves the CN5 where
even winds can cause pain
DRUG OF CHOICE: Anticonvulsant
Ex. Tegetrol (Carbamazepene)
Dilantin
Diazepam
 Increase ICP
Head injury:
DRUG OF CHOICE: Mannitol (Osmotic Diuresis)
Dexamethasone- anti- inflammatory
Stool softener – to avoid Valsalva
maneuver

Nitroglycerine (vasodilator)- effect: increase

NO ICP level
Morphine- it can cause respiratory acidosis
Cardiovascular
System
A VASODILATOR
Angiotensin Converting Enzymes (ACE) INHIBITOR- indicated for
the treatment of hypertension, alone or in combination with other drugs

s/sx: muscle
weakness &
diarrhea

Should be taken an hour BEFORE MEAL

DO NOT GIVE FOOD RICH IN POTASSIUM!!!
CONTRAINDICATED: Asthma, Orange juice and Sodium substitute
A
ARBS (Angiotensin 2 Receptor Blockers)
BLOCK the blood pressure raising effects of the renin – angiotensin system
(RAAS) and lower blood pressure.

SARTAN DRUG: Losartan

Irbesartan

Effects: Decrease blood pressure

increase potassium
no dry cough observed
no angioedema
A
SYMPATHETIC NERVOUS SYSTEM BLOCKERS
1. Alpha 1 Blockers- Ex. Dexazosin
- action: decrease blood pressure Terazosin
Prazocin
Tamsulosin
Taken by patient with BPH to increase urine output

2. Alpha-adrenergic blockers Ex. Dibenzyline- slow acting

Phentolamine- fast acting (used in emergency)
Reserpine- side effect: depression
suicide

3. Alpha 2 Agonist (negative chronotropic) Ex. Catapres

- decrease heart rate Aldomet/Methyldopa
Guanabenz

(-) chronotropic- decrease heart rate

(+) chronotropic- increase heart rate
Chronotropic drugs
❑ may change the heart rate and rhythm by affecting the electrical conduction system of the
heart and the nerves that influence it, such as by changing the rhythm produced
by the sinoatrial node.

Positive chronotropes increase heart rate

Negative chronotropes decrease heart rate.

B Beta Blockers- negative Chronotropic and Inotropic
Effect
-decrease heart rate- in taking this type of medication TAKE THE APICAL PULSE before administration

EFFECT: Autonomic Nervous System (ANS)

Affect: SNS PNS

▪ BP
▪ HR
▪ Cardiac
▪ BP Contraction Negative inotropic
▪ HR ▪ Glucose
▪ Cardac ▪ Constriction
Contraction of Bronchus
▪ Glucose
▪ Dilation of
bronchus
What are Inotropic drugs?
Inotropes are drugs that tell your heart muscles to beat or contract with more power or less
power, depending on whether it’s a positive or negative inotrope.

Positive inotropes can help when your heart can’t get enough blood to your body because it
is too weak to pump the amount of blood your body needs.
Actions:
❑ make your heart muscle contractions stronger
❑ raising your cardiac output to a normal level
❑ increasing the amount of blood your heart can pump out.
❑ helps your organs get the blood and oxygen they need to keep working.

Negative inotropes keep your heart muscles from working too hard by beating with less
force.
Indications:
❑ high blood pressure
❑ chest pain
❑ an abnormal heart rhythm
❑ a disease like hypertrophic cardiomyopathy.
B
Beta Blockers- negative Chronotrophic and
Inotrophic Effect
- block vasoconstriction, decrease heart rate, decrease cardiac muscle contraction, and tend to
increase blood flow to the kidneys, leading to a decrease in the release of renin.

Complication
Monitor for: Ex. ATENOLOL (Tenormin)
1. Hypotension - can cause male impotence
2. Bradycardia Psychosis
Night mare
3. Heart failure- edema, crackles or rales sound in the lungs
4. Hypoglycemia

Contraindicated:
1. Heart block
2. Asthma
 Beta – Adrenergic Blockers
drugs which block or lyse the effects of sympathetic
stimulation; also called as sympatholytics.
Therapeutic action
▪ reduce the oxygen demand of the heart by:
▪ decreased blood pressure, contractility and heart rate by
BLOCKING THE BETA-RECEPTORS in the heart and
juxtaglomerular apparatus of the kidneys.
▪ USED WITH NITRATES to reduced adverse effects and increased
exercise tolerance.
▪ Not indicated for variant angina - can cause vasospasm.
 Beta – Adrenergic Blockers
Indications
▪ Nadolol is used for management of chronic angina. It is the drug of choice in angina patients
with hypertension.
▪ Propranolol is the prototype drug of this class. It is used for treatment of angina and syncope.
▪ Nebivolol, the newest adrenergic blocking agent does not produce the same adverse effects seen in
propranolol.
 Calcium Channel Blockers
C
- as antihypertensive agents DECREASE blood pressure, cardiac workload, and myocardial
consumption of oxygen.
▪ drugs which block heart contraction by inhibiting movement of calcium ions, thereby altering
arterial and cardiac muscle action potentials.
▪ They basically produce vasodilation and relief of spasm.
▪ Relieves vasospasm in variant angina, thereby increasing blood flow to the heart.

Ex. Nifedipine Verapamil

Amlodipine Diltiazem
Micardipine
HR
Action: (-) Chronotropic BP
(-) Inotropic Contraction
Vasodilator

Contraindicated: GRAPE FRUIT JUICE!!! –decrease metabolism

- can cause toxicity that leads into death
 Calcium Channel Blockers
▪ drugs which block heart contraction by inhibiting movement of calcium ions, thereby
altering arterial and cardiac muscle action potentials.
▪ They basically produce vasodilation and relief of spasm.
▪ Relieves vasospasm in variant angina, thereby increasing blood flow to the heart.

▪ include amlodipine (Norvasc), diltiazem (Cardizem),nicardipine (Cardene), nifedipine (Adalat),

and verapamil (Isoptin).
 PIPERAZINE ACETAMIDE AGENT
▪ very effective in treating angina and has the added benefits of decreasing blood glucose levels when
used in diabetic patients

▪ it does not decrease heart rate or blood pressure, but it does decrease myocardial workload, bringing
the supply and demand for oxygen back into balance.

▪ RANOLAZINE is approved as a first-line treatment for angina or for use in combination with nitrates,
beta-blockers, or amlodipine.
D
Direct Acting Vasodilator
Ex. Nitroprusside- lowering of blood pressure immediately in adults and children with high
blood pressure.

REMEMBER: X sunlight exposure

administer thru IV
brown color- good or potent
red or blue color- DISCARD!!!

Hydralazine (Apresoline) – absence of pressure

- direct acting vasodilator

Diaxozide- is used to treat low blood sugar (hypoglycemia) caused by hyperinsulinism

D
Direct Acting Vasodilator
DIURETICS

K-Sparing Diuretics
HYPERKALEMIA-
Ex. Spironolactone eliminate Na and
Amiloride retained K IT SHOULD NOT BE GIVEN IN COMBINATION WITH
VASODILATOR!!!

Tiamterene

K- Wasting
Loop Diuretics- Furosemide
- Bumetanide
- Torsemide
Osmotic- Mannitol, Isosorbide
Thiazide- Diuril, Hydrochlorodiuril, Metolazone
-both Na and K will be wasting
 ANTILIPID/ANTILIPIDEMIA- give in patient with
hypercholesterol
1. Hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors, also known as "statins
Ex. Simvastatin Action: Increase HDL
Atorvastatin Decrease LDL & Triglyceride
Lovastatin

Remember: Take it in the EVENING

NO GRAPEFRUIT JUICE!!!
Observe: Liver- hepatotoxic (check the liver enzyme)
Eye- cataract formation (do annual eye exam)
Report: Pregnancy- Teratogenic
Muscle weakness/Tendernes – RHABDOMYOLISIS
Myolisis- muscle destroy
Rhabdo- lead to kidney failure
 ANTILIPID/ANTILIPIDEMIA- give in patient with
hypercholesterol
2. Nicotinic Acid- Increase HDL
Decrease LDL and Triglyceride
Problem: Hepatotoxic
Increase uric acid
Increase blood glucose level

3. Folic Acid Sequestrants- Increase HDL

Decrease LDL
no effect on TRIGLYCERIDE

Colestipol
Colestyramine S/E: Constipation

It can be mixed with juices (no contraindication with FRUIT JUICES)

 ANTI-ANGINA
1. Nitrates- antianginal agents that provide fast action .The main effect is drop in systemic
blood pressure
Ex. Nitroglycerine- nitrate of choice for treatment of acute angina attack
Isosorbide dinitrate
Administration: Sublingual
Avoid: Anticholinergic medication because it decrease secretion
Do not swallow the saliva, wait until the medicines dissolved
Given: 1 tablet for chest pain or before chest pain developed. Carry at all times.

Still with chest pain (interval

1st dose---5mins----2nd dose------5mins------3rd dose

Storage: Dry, tight, dark container 6 months expiration

Not store in refrigerator do not take 4th dose

If patient still in chest pain after 3 doses , patient is already having an MI

 Myocardial Infarction
Morphine
Strong: Narcotic
Analgesic
CNS Effect

RR Respiratory acidosis ANTIDOTE:

BP NALOXONE (Narcan)
HR For respiratory depression
GIT Can also an antidote of Fentanyl
GUT Pinpoint (reaction to
Pupil size Morphine Toxicity
 Antiplatelet
Abciximab Clopidogrel
Tirofiban (Ticlid) Acetyl salycilic acid
Dypiridamole (Flavix)

AFFECT: Lifespan of Platelet

Normal lifespan: 7 to 10 days
WARNING: Do not take for 7 to 10 days prior to tooth extraction

ACETYLSALYCILIC ACID
Mild Toxic

Salicylism- can develop tinnitus, fever and increase Respiratory Akalosis

DYPIRIDAMOLE- also used in stress test

Ex. Dypiridamole
Thallium Scan
 Anticoagulant
1. Heparin- Parenteral Monitor: Activated Charcoal
NO IM!!! Thromboplastin time

Ex. Enoxaparin- Subcutaneous only!!

Antagonize: Thrombin--- prevent clot

Antidote: Protamine sulfate

2. Coumadin/Warfarin Monitor: Prothrombine time: 9-12 sec max: 30 sec

Oral drugs
Take 2-3 days

Anticoagulant antagonize Vitamin K (ANTIDOTE!!!)

No dark green leafy vegetable
Present of clot
 Common Drugs
and their Antidote
 ANTIDOTE
❑ are medications admini
stered to counter the
effects of poisons
and drugs, and also to
treat certain diseases
Common drugs and their Antidote
Common drugs and their Antidote
Common drugs and their Antidote
Common drugs and their Antidote
Common drugs and their Antidote
Common drugs and their Antidote
Common drugs and their Antidote
-Thank you-