Pharmacology

Using Nursing Process

Pharmakokinetics
ADME

A- Administration
Oral- safest route; generally best on empty stomach;
decrease absorption when exercise
Parental- influence by blood supply; exercise, temperature

D- Distribution
Hepatic First Pass Effect
- pass through liver
- reduce Bioavailability- active form of the drug'
- lipid soluble
Highly Protein Bound
T- Thophaline
D- Digoxin
C- Coumadine
E- Erythromycin

M- Metabolism
Biotransformation

E- Excretions
- Kidney, GI tract, Respiratory
- MEC- Minimum Effective Concentration or Critical
Concentration
- Bolus/Loading Dose: used to reach the critical
concentration time faster
- Therapeutic Index- margin toxic levels and therapeutic
levels

Dosage Interval: 6-12-6-12
Dosage Frequency: 4x

Pharmakodynamics
- Mechanism of action

Drug action
Supplement
- already have but wants to add
Replacement
- lacking, lost > replace
Stimulate Response
- Agonists
- Mimetics
Inhibit Responses
- Antagonist
- -lytic
- block receptors
Irritate
- irritate certain areas for action
Alter Cellular Functions/Activities

Adverse Effect: related to desired
Side Effect: unrelated to the desired effect; wanted or
unwanted

CNS
Stimulant
Depressed

Toxicity
GI> Nausea/Vomiting
CTZ: Chemo Therapeutic Zone
EZ: Emetic Zone

NSAIDS
COX1- protect Gi with mucus
COX2. inflamatory
= after meals

Hepato
- ALT/SGPT
- AST/SGOT
- Jaundice

Nephro
- BUN: influenced by diet
- Crea: more accurate
- Check Urine Output
- Rhabdomyholysis; caused by (-statins)

Bone Marrow
- RBC: oxygen
- WBC: prone infection
- Platelet: prone injury

Dermatologic
Allergy > RASH = discontinue
Photosensitivity




Neurotransmitters
> Acetylcoline
communicate between neves and muscle
> Norepinephrine and Epinephrine
- Catecholamines, released in the nerves of the
sympathetic branch of the ANS
> Dopamine
- High Concentrated in certain areas of the brain, for the
coordination of impulses both motor and intellectual
> GABA
- found in the brain, inhibits nerve activity, prevents over
excitability of the brain
> Serotonin
- found in the limbic system, for arousal and sleep
prevents depression and promotes motivation


Anxiolitics
- prevents feeling of tension or fear
> Sedatives
- calms the patient and makes them unaware of the
environment
- depress the brain; less awareness to envt
- light sleep
> Hypnotics
- can cause sleep
- depress the CNS
> Minor Tranquilizers
- can produce a state of tranquility in an anxious client

Menzodiazepine
- "-zepam", "-zolam"
- Diazepam (Valim)- muscle relaxent, anti tetanus
- Lorazepam (Ativan)
> Adverse Effect
CNS Depressant
- CNS: drowsiness, depression, lethargy
- GI: Dry mouth, constipaiton, NV, increase liver enzymes
- CV: hypo or hypertension, arrythmias
- Gu- hesitant or retention, decrease libido
- Hematologic- blood dyscrasias and anemias
- Local injection sites: phlebitis, thrombosis, irritation
- abrupt cessation can lead to withdrawal symptoms

Barbiturates
- Barbitals
- sedate
- depressant
- antiseizure
- Phenobarbital (luminal)
> Adverse Effect
- CNS depression
- respi: seriou s hypoventilation, depression ,laryngospasm
p hypersensitivity reaction

Nursing Care
- Do not mix with other solution
- Give IV drugs Slowly
- provisions for safety
- Standby life support facilities
- Void before administration
- Taper the dosage gradually
- Monitor CBC, renal and hepatic functions
- Antidote for Benzodiazepine: FLUMAZENIL (ANEXATE)


NARCOTICS
- pain reliever: moderate to severe
- acts specificly the Mu receptors=pain blocking
- other receptors: Kappa, Beta, Sigma receptors
Types
Agonist: stimulate all receptors
Partial Agonist (A): stimulate only the Mu receptors and
blocks others
Antagonists: antidote Lanoxon

Opiate (Narcotic) Agonist
- Codeine: used as an antitusive
- Fentanyl (Durogesic, Sublimaze)
- Hydrocodone (Hycodan)
- Meperidine (Demerol)
- Methadone (Dolophine): used for pt with narcotic
addiction: used to taper
- Morphine SO4
- Oxycodone (Oxycontin)
* PReg. cat. B, do not crush or chew tablets
* HOLD the dose if RR < 12/min
* not allowed to pt with Stones = Cause spasm in the
sphincter

Opiate Partial Agonist
- Nalbuphine (Nabain)
- Buprenorphine
* causes less potential for addiction, tolerance, depression
- have less abuse potentioal
p have abou the same analgesic effect as morphine
Antagonist
- Drugs that bind strongly to opioid receptors
- Nalmefene (Revex)
Naltrexone (ReVia): Oral, alcohol and narcotic dependance
Naloxone (Narcan): antidote


ANESTESIA

FACTORS THAT DETERMINE THE SCHOICE OF
below the nipple line = Local/regional
above the nipple line = General anasthesia
- physical and mental condition of patient
- age and weight of patient
- operation to be performed: duration

Stages of Anesthesia
Stage 1: Induction/Stage of analgesia
- starts from induciton period until pt loses consciousness
- pt may appear drowsy or dizzy
- keep the room quit
- Safety

> Stage 2: Excitement/Delirium
- last from the time the pt loses consciousness until he
loses certain reflexes such as swallowing, gag and eyelid
- May appear excited, may breathe irregularly
- sensitive to external stimuli: hearing is some what
exaggerate
- maintain silence

> Stage 3: Surgical Anesthesia
- from period the pt lost certain reflexes and respiratory
paralysis occurs
- pt with regular respiration, constricted pupils, jaws relax
and auditory sensation is lost
- give muscle relaxant so pt dosnt resist the mechanical
ventilation

> Stage 4: Stage of Danger
- Reached when too much anesthesia is geven
- death may occur, not breating

Types of Anesthesia
> General Anesthesia
- association pathways are broken in the cerebral cortex to
produce more or less lack of sensory and motor
perception
. pain is controlled by general insensibility, the pt is
unconscious, he cannot hear, feel, or move his whole body
- used in operation above the Thoracic level

> Regional Anesthesia
- depresses superficial nerves and interferes with the
conduction of pain impulses from certain area or region
- pain is controlled without loss of consciousness; one
region or an area of the body is anesthetized

General Anesthesia
> inhalation
GETA- General Endotracial Tube Anastasia
GAOT- General Anastasia Oral tube
GANT: Nasal
Laryngeal Mask- "Blind Intubation"
Face mask
Common 'anesthetics
Nitros Oxide
Sevoflurane (Sevorane)
Desflurane (Suprane)
Isoflurane (Forane
Halothane (Fluothane)

> Intravenous
- drug the may produce hyposis, sedation, amnesia and or
analgesia is administrered via IV
COmmon Anesthetics
- Propofol (Diprivan): killed MJ
- Thiopental Na (Pentothal): truth serum
- Ketamine (Ketalar): given for infants
Common Concern:
- PONV- Post Op Nausea and Vomiting
- Malignant Hyperthermia- cells become hyperactive >
rigidity > spasms > harden > increase metabolism >
increase Co2 > increase heat > brown-black blood bc Co2;
antidote: DANTROLENE sodium











Regional Anesthesia
> Epidural Anesthesia
- used for long procedures below the thoracic level
- used for post op management of pain
- uses an epidural Catheter (Perifix)
Common Anesthetic
- Bupivacain (Sensorcaine Isobaric, Marcain)
- Lidocain (for testing)
Complications
- Spinal Head ache- flat on bed;

> Subarachnoid Block
- aka "Spinal Block"
- commonly termed as spinal anesthesia
- For short cases below the thoracic level
- use spinal needle gauge, 22, 25, or 27
Commonly
- Bupivacaine Hyperbaric (Sensorcaine Heavy)
- PDE (Tetracaine (Pontocaine), Dextrose, Ephedrine)
Complications
- Urinary retention: foley catheter

> Field/Nerve Block
- anesthetizing surrounding tissues (ofield)p or group of
nerves (nerves at a given point
Common Anesthetics
- Bupvacain Isobaric (Sensorcaine, Marcaine)
- Lodacaine

> Local Infiltration
- agent is injected into the tissue around incision site
- Lidocaine


Topical
- agent applied directly into a mucosa or surface
- Lidocaine spray





Anti Seizure

Hydantoins
- stabilize nerve membranes and limit the spread of
excitability from the
- inhibit the GABA; doest cause too much cns depression
- maintinancy
Common Drugs
- Phenytoin (Dilantan)
Adverse affects
- CNS depression
- Liver toxicity
- GINGIVAL HYPERPLASIA: Frequent oral care, soft bristle
tooth brush, gum massage
- Dermatologic reaction: Hirsutism, Coarsening of facial
skin
- cardiac arrhythmias and BP changes
- Urinary Retention and change sin libido
- Hyperglycemia in long term use
- pinkish to brownish urine

Anti Parkinsonism Agents
- Decrease dopamine > increase dopamine
- Acetly Choline > Anti Colinergic

Anti Cholinergic
- Benztropine (Cogentin)
- Biperiden (Akineton)
- Diphenhydramine (Benadyl)
- Procyclidine (Kemadrin)
- Trihexyphenidyl (Artane)
Caution
- narrow angle glaucoma, GI or GU obstruction
- MG
- Hepatic dysfunciton
- CV disorder- hyphypertension
- Hot environment
> Adverse effect
- CNS: disorientation, confusion, memoryloss, agitaiton,
light headedness, weaknes
- GI: drymount, NV, paralytic ileus
-CV: tachycardia, palitations, hypotension
- GU: urinary retention, hesitancy

Dopamenergics

Levodapo (Dopar, Sinemet)
- Precursor of dopamine crosses the BBB, where it is
converted
- Dopadecarboxylase affect before passing the BBB
- Vit B6 convert levodopa in the periphery: avoid vitamin
B6
- Given with Carbidopa

Other Drugs

Carbidopa
- sacrifice

> Interaction
- MAOI: INCREASE EFFECTS
- Vitamin B6 and Phenytoin: Eggs, chicken, carrots, fish,
liver, kidneys, peas, wheat, germs, walnuts, Multivitamins

Autonomic System

Adrenergic Agonist
- Sympathomimetics
- stimulate the sympathetics nervous system SNS
- Mimic the effects of the SNS neurotransmitters:
Norepinephrine (Ne)
Epinephrine (Epi)

Alpha and Beta Adrenergic Agonists
- Epinephrine
- Norepinephrine (Levophed): Shock
- Dopamin (Intropin)
- Dobutamine (Dobutrex)
- Ephedrine: adrenergic agents for colds
- Mephentermine (Wyamine SO4)

Nursing Consideration
A1
IV: properly placed; ischemia, necrosis
use of infusion pumps
Antidote: Alpha Blocker Phentolamine

A2


Peta Specific Adrenergic Agonists
- used to manage and treat bronchial spasm, asthma,
other obstructive pulmonary condition: (oTerbutaline
- Tocolitic: to stop pre term labor (oRitodrine)
- shock and cardiac arrest (Isoproterenol
Actions
- increase HR. bronchodilaiton, incease blood flow to
skeletal muscles, relaxation fthe uterus
- treatment of shock cardiac arrest and certain
arrhythmias= increases cardiac activity and conduction
- prevents bronchospasm

Adrenergic Blocking Agent
- lytics


Alpha and Bata Andrenergic Blocking Agents
- primarly used to treat cardiac related condition
- contraindicated with asthma, which could be
exacerbated by the loss of bronchodilating effects: shock
or CHF, decrease HR
Amiodarone (Cordarone) Antiarrhythmic;
Bretylium (Bretylate) Antiarrhythmic
Carvidelol (Careg)
Guanadrel (Hylorel)
Guanethidine (oIsmelin)
Labetalol (Normodyne)
- pheochromocytoma and clonidine withdrawal

Alpha1 Selective Adrenergic BLockingAGent
- "-zosin"
- use to treat hypertension and benign prostatic
hyperplasia (BPH)
Doxazosin (ZCardura)
Prazosin
Terazosin
Tamsulosin
Alfuzosin

Beta Adrenergic Blocking Agents
>Types:
B1 selective
B non selective: not alowed for copd, asthma
> common B1 non selective
Propranolol (Inderal)
Penbutolol (Levator)
Pindolol (Vistken)
Sotalol (Betapace)
TImolol (Timoptic); glaucoma
Carteolol (Cartrol)
Nadolol (Corgard)
> COmon B1 selective
MEtroprolol
Esmolol
Betaxolol
Acebutolol
Bisoprostol
Atenolol






Colenergic Agents

> Drug Effects: SLUDGE
Salivation
Lacrimation
Urinary Incontinence
Diarrhea
Gastrointestinal Cramps
Emesis

> Types
Direct acting Cholinergic
- stimulate Cholinergic receptors
Indirect acting
- acts on the Acetylcholinesterase
- "Acetylcholinesterase Inhibitors"

Direct Acting Cholinergic Agonist
- used to increase bladder tone and urinary excretions and
as ophthalmic agents
- used for : miosis, motility, gu
- Bethanecho (Urecholine)
- Carbachol (Miostat)
- Pilocarpine (Pilocar): opthalmic solution


Myasthenia Gravis
- Autoimmune disorder
- lack of acetylcholine reaching the cholinergic receptor
- antibodies attach ach recepters
- Decending paralysis
- Problem related to thymic hyperlasia

> Diagnosis: Edrophonium (Tensilon) Test acts on the
acetylcoholinesterase
1 Myasthenia crisis
- paralyis is resolved in 20 min
- related to inadequate dosing
2. Cholinergic Crisis
- no effect
- excess of acetylcholine
- antidote: atropine SO4

Acetylcholinesterase Inhibitor
- inhibit action of the enzyme
- Does not cross the BBB
NAPE
Neostigmine (Prostigmine)
Pyridostigmine (Mestinon); longer acting drug; 6 hours
Ambenonium (Mytelase
Edrophonium (Tensilon)


Althzimers
- Can cross the BBB
TRiDoG
Tacrine
Rivartigmine
Donepezil
Galamtamine













Anticholinergic Agents

Mydriasis
Cycloplegia- inability of the lens to accomidate



Anticholinergic AGents
dx procedures
- Mydriasis
- cycloplegia

Atropine: blocks PNS effects and variethy of situation
DIcyclomine (Antispas): relax GI for IBS
Propantheline (Probanthine) adjunct for treatment of
ulcers
Scopalomine Motion sickness, ulcers, urinary problems
and pupil dilation
















Anti Hypertensive

Diuretics
> Thiazide and THiazide Like: loop convoluted tubule: K
wasting
- Hydrochlorothiazide
- Chlorothiazide
> Loop DiureticsL loop of henle; K wasting
Bumetanide
Furosemide
> Carbonic Anhydrase inhibitors: NaHCO3 formation
Acetazolamide
Methazolamide
> K- Sparing Diuretic: aldosterone antagonist
Amiloride
Spironalactone
> Osmotic Diuretic
Mannitol

ACE
- for hyprtension
- tx of CHF and LVD
- normal for initial hypotensive affect
Action
- decrease peripheral vascular resisrtancw ithout:
increased cardiac output, rate, contractility

Angiotensin II Receptor BLockers ARB
- -sartains
Telmisartan
Irbesartan
Losartan
Eprosartan
- Eprosartan
- Candesartan
- Valsartan
- decrase HPN, patassium

CC Blocker
- inhibit movement of Ca ions across the membrane of
myocardial and arterial muscle
- Ca=force of contraction
- depressing myocardial contractile
VND- Very Nice Drugs
Verapanil
Nifedipine and other -pine
Diltiazen
Comon drugs
felodipine
Nicardipine
Nifedipine
Amlodipine
Diltiazem
Verapamil


Vasodilators
- Hydralazine (apresoline) - maintains or increases renal
blood flow
- Nitroprusside (Nitropress) cyanide toxicity
- Diazoxide (Hyperstat) also blocks insulin release
- Minoxidil (Loniten) associated with reflex tachycardia and
increased renin release



Congestive Heart Failure

LSHF RSHF

Cardiac Glycosides
DIgoxin (lanoxin, Lanoxicaps)p
0.5-2 nano grams
. Adverse afefects
CNS: Yellow halow areound objects, head ach, weakness
Nsg Care
- Monitor Apical Pulse of r 1 full minute
HOLD if less than 60 BPM for adult and 90 BPM infant
- administer IV doses very slowly for a period of 6 minutes
- Avoid IM injections
- Arrange for taking the client weight everyday
Emergency equimpent
- K salts, lidocaine, phenytoin, atropine So4
Antidote: Digoxin Immun Fab (DIgibind, Digifab)
Health Techings
- food rich in K but low in Na
- overdose
- Hypo Kalemia, Hypo Magnesemia, Hyper Calium =
Toxicity
- doont sus wiht highlyprotein bound drugs






Anti Anginal Agents
Coronary Artery Disease
Atheromas- fatty tumors in the intima of th evessels
Atherosclerosis- narrowing of the arteries caused by build
up of atheromas, swelling and acculation of platelets;
leads to a loss of elasticity and responsiveness to stimuli


Nitrates
- cause
decreases venour return
decrease arterial pressue
reduce cardiac workload
decrease myocardial oxygen consumption
- has no effect on atherosclerotic vessels
Nitroglycerine (Nitro Bid)
Isosorbide Dinitrate (Isordil)
Isosorbide mononitrate
Amyl nitrate
> Intraction
Heparin: decrease therapeutic effect of NTG
- Sildenafil= enhance hypotensive effect
- Antigcholinergic= decrease absorbtion


Anti Infective Agents
- selectively on foreign organism
- selective toxicity
- agent found on mold

Mechanism of Action
- interfere with bacterial wall synthesis
- penicillins, cephalosporins, carbapenems, vancomycin
Prevention of utilizing substances essential for growth and
development
- interfere with protein synthesis: macrolides,
chloramphenicol, tetracyclies, aminoglycosides
Interfrew ith DNA Synthesis: fluoroquinolones,
antimycobacterium
- Alter cell membrane Permeability: antifungal and
antiprotozoal


Penicillins
- Bactericidal:
- aka Betalactams
- Effective against Gram Positive Bacteria
- inhibits cell wall synthesis
Common Drugs
Penicillins
Pen G
Pen V
> Extended spectrum Penicillin
Amoxicillin
> Penicillinase Resistant Antibiotics
bacteria develop Beta Lactamase
Dicloxacillin
Oxacillin

Penicillinase or Beta lactamase inhibitors
Clavulanic Acid
Tazobactam
Sulbactam

> Adverse Reaction
- Assess alergies for Penicillin
- Gi upset: glossitis, stomatitis, sore moutn NV, Diarrhea
- anaphylaxis
- Thrombocytopenia and Leukopenia

Drug Interactions
- increase Probenecid plasma concentration
- decrease secretion of Methotrexate
- Tetracycline and Chloramphenicol: decreases penicillin
action
- Decreaed effectiveness of hormonal contraceptives
- aminoglycosides
- don't give oral meds with fruit juices; reduction in drug
absorbtion
- Synergistic effect: Penicillin and Gentamycin: cause
incompatability > will distroy eachother; give 2 hours apart

Amminoglycosides
- Bacteridalp- ihibits proteins
- Gram negative infections
- Ear, opthalmic infections
Nosocomial infections, UTI, CNS and Eye infection
- often used in combinaiton with other antibiotics for
synargistic effect
- absorbed poorly in the GI tract
Commonon Drugs "-mycin
GANTSK
Gentamycin (Servigenta, Garamycin)
Amikacin (Amikin)
Neomycin
Tobramycin
Streptomycin
Kanamycin
> Drug Interaction
- anesthetics, muscle relaxants
- diuretics
- other antibiotics

>Adverse Effect
- cause Ototoxicity and Nephrotoxicity
- neurotoxicity
- cariac effects
- bone marrow depression
- GI irritation



Cephalosporins "Cef-"
- Broad spectrum
- structurally and pharmacologically related to penicillins
- semisynthetic derivatives from a fungus
> Adverse Reaction
Pseudomembranous Colitis: Bloody diarrhea
- CNS- Headach, dizziness
- Hypoprothrombinemia
- phlebitis
> Drug Interactions
Aminoglycosides
Alcohol: Disulfiram like reactions: Antabus: adverse
reaction

1st Generation
Cephalexin Gram +
cefazolin
2nd Generation
Cefaclor Gram +, slight -
3rd Generation
Defatoxim Gram -
4th Generation
cefepime Gram +&- , broad spectrum



FLuoroquinolones "Floxacin
- Bactericidal and Bacteriostatic
- Effective agains Gram - bacteria
- uti, respi, derma, eye, ear, bone and joint infeciton, after
anthrax, typhoid
> Adverse Effects
Photosensitivity: highlight
headache, dizzines
Gi upsi
> Common Drugs
CLONG
Ciprofloxacin
Levofloxacin
ofloxacin
norfloxin

Macrolides
- bactericidal or bacteriostatic
- effective agains many sensitive organisms and intestinal
amoebiasis
- usually enteric coated
- given if allergic to Penicillin
> common Drugs DACE
Dirithromycin (Dynabac)
Azithromycin (Zithromax)
Clarithromycin (Klaricid)
Erythromycin (Ilosone, Erythrocin, Erycin)
> adverse Effect
GI upset

> interact
- Theophylline
digoxin
Coumadin


Lincosamides
- inhibits bacterial Protein Synthesis
- Similar to Macrolides in therms of Coverage
- Associated with severe toxicity
Drugs:
Clindamycin (Dalacin C)
Lincomycin (Lincocin)
- careful monitoring of gi activity
STOP once bloody diarrhea occurs



Vancomycin
- used to treat methicillin resistant S. Aureus MRSA
- with increase incidence of vancomycin resistant therefor
should bde sued only when C&uS confirms need for it
- Giving slowly: serious dilatory effect> Red Man/Red Neck
Syndrome
> adverse reaciton
- Renal Failure ototoxicity and super infections
- RED Man Syndrome: sudden and severe hypotension,
fever, chills, paresthesia and erythema of the neck and
back


Chloramphenicol
- Prevents bacterial cell wall division
- common treatment for Typhoid Fever
> Adverse affects
- Gray Syndrome: abdominal distention, cyanosis,
vasomotor collapse, irregular respiration, and even death
. Bone Marrow Depression: Aplastic anemia

Sulfonamides
- Bacteriostatic
- Effective agains Gram negative and gram positive
bacgteria and many resistant strains
Can Cause Crystal urie: incoruage fluid intake
> Common Drugs
p- Cotrimoxazole
Sulfadiazine
> interactions
- Sulfonylureas: used for DM, can cause hypglycemia
- Cyclosporine


Tetracycline
- Natural and Semi synthetic
- obtain for cultures of streptomyces
- Bacgteriostatic
- wide range
- Acne Treatment
- Given on empty somach
- Absor-iton affected by food, calcium and iron> COmmon
Drugs DOM=T
Doxycyline
Oxytetracycline
Minocycline
Tetracyclin
> caution use on
- pregnant women
- children under 8 years
- can cause perminent tooth stain enamel hyperplasia

Isoniazid Itis Vitamin B5
Ethambutol Eyes
Streptomycin Nephrotoxicity



















































Anti Neoplastic Agents and Biologic Response Modulators

Neoplasm Characteristics
Anaplasia: loss of organizations and structure
Autonomy: loss of normal controls and reactions that
inhibit growth and spreading
Metastasis: ability to enter the circulatory or lymphatic
system and travel to other areas
Angiogenesis: abnormal cell release enymes that generate
blood vessels


2 General Types of Anti Cancer Drugs
Cell Cycle Non Specific
- more effective for slow growing
Cell Cycle Specific


Alkylating Agents
- Nitrogen Mustards
- make convalant bonds > DNA replicaiton is inhibit
- avoid direct contact can cause severe skin, eye and
respiratory reaction
Cyclophsphamide
CHlorambucil
Ifosfamide
Mechlorathamine
> Comon Side EFFEct
FABV
Fertility Issues
Alopecia
Bone Marrow Suppresion
Vomit, Nausea
> Cytoprotectiv Agents
amifostine- for cisplatin
Masna- ifosfamide, cyclophosphamide prevent
hemorrhage cytitis
- Give Antiemetics


Antibetabolite
Folic Acid Analogues
- Methotrexate (Folex, Rheumatrix)
- Hepatotoxic, renal failure, GI Toxicity
- Leucoverin (Folinic Acid) Used to minimize adverse
reactions

Myrimidine Analoges
- sensitive to light; can cause toxicity
- colon cancer
Cytarabine (Ara C)p meningeal and myelocytic leukemia
Floxuridine
Fluorouracil (Adrucil) Gi cancers; phototoxicity

Purine Analogues
- Mercaptopurine (oPurinethol): Leukemias
choriocarcinomas: hyperuricemia, jaundice
Thioguanine: GI Toxicity, miscarriage


Antineplastic Antibiotics
- cell cycle specific drugsnon specific
Bleumycin: Pulmonary Function Test PFT
Dexrazoxane (Zinacard)
- Highlight: Give in a new vein every


Mitotic Inhibitors
- Venblastine: effective an M phaase; lymphomas, and
sarcomas



























Drugs acting on the Endocrine System
- deals with hormones

Adreoncorticotropic Hormones
Glucocorticoids
- SSS
Sugar; important to intake sugar; hyperglycemia
Salt: sodium will attract water: increas circulating blood
volume > BP > CHF > hyper Na > Hypo K, Edema
Sex:

Inflammation > COX1(gi protection) > irritaliton

decrease Immune response> auto immune disease

COmmon Drugs
Dexamethasone: CNS infection
Betamethasone: lung maturity for preterm
Hydrocortisone: anti inflammatory effect
Methylprednisolone
Prednisone

Nsg Consideration
after meals > cause gi irritaiton
Na levels monitored bc hyper Na: limit na in diet
- do not discontinue drug abruptly






Thyroid and Parathyroid Agents

Thyroid Drugs
- Replacement Therapy
> Common Drugs
Levothyroxine (Synthroid)p T4
Liothyronine (Cytomel) T3
Liotrix
Thyroid Desiccated
Thyroglobulin

Antithyroid
Thioamides
- blocks iodines ability to combine with thyrosine
Propylthiouracil PTU :does not cross placenta
- gi irritation is common
Methimazole (Tapazole)- corsses placenta
- bone marrow suppression

Iodine Solutions
- stable or high doses of iodine inhibits hormone synthesis
in which excess iodine decreases the formation and
release of thyroid hormone
- Potassium Iodide (Thyro Block)
- Solium Iodide
> caution
allergy, pulmonary edema or PTB
> Adverse Effects
- hypothyroidism which can lead to development of goiters
Iodism: metallic taste and burning in the mouth, sore teeth
and gums
Diarrhea, cold symptoms and stomach upset
- staining to the teeth, skin rash


Antihypercalcemia Agents
BIsphosphates
- slow the normal and abnormal bone resorption but do
not inhibit normal bone formation and mineralization
- Indication: Paget's disease and Post menopausal
osteoporosis
Common Drugs
Alendronate (Fosamax): can cause esophageal errosion,
osteoporosis in men




















Antidiabetic Agents

Replacement Insulin
DM 1; not enought produce
DM 2: insulin resistant
Types Rapid acting


Inusin

Rapid
Lispro (oHumalog)
Short
Regular (Humulin R, Novolin R
Semilente
Insulin aspartin
Intermediate
NPH (H N, Nn
Lente (H L, NL
Long
PZI
Ultralente

Milienda TIme
Only IV: Humulin R
D50W plus insulin


Lipodystrophy
- tissue atrophy which may interfere with insulin
absorption
- Cold insulin, didnt rotate site
- lead to unknown absorption of insulin


Oral Anti Diabetic Agents
Sulfonylureas
- bind to potassium channels on pancreatic beta cells to
increase insulin secretion
- may improve insulin binding to insulin receptors and
increase the number of insulin receptors
- increase the effect of ADH on renal Cels
- Effective only in Patients who have Functioning Beta Cells
- SImples: increase insulin production
First Generation: more complications; nephrotoxic
Acetohexamide
Cholrpropamide
Tolazamide
TOlbutamide
2nd Generation
- safer to use in cclients with renal disorders
- do not interact with highly CHON bound drugs
- Long During of Action
- Glimepiride (Amaryl)
Glipizide (Glucotrol)
GLyburide (Micronase)

NonSulfonylureas
Alpha Glucosidase Inhibitor
- inhibits the enzyme that breaks down glucose for
absorption
- delay absorption of glucose
- with mefals
Acarbose OPrecose)
Miglitol (oGLyset

Biguanide
- decrease the producion and increase uptake of glucose
- after meals
- effective in lowering blood glucose levels and does not
cause hypoglycemia
Metformin(Glucophage)

Meglitinides
- increase insulin release
- taken just before meals
Repaglinide
Nateglinide

Thiazolidinediones
- Decreases insulin resistance
- use in combination with sulfonylureas or metformin
Pioglitazone (Actos)
Rosiglitazone (oAvandia)