AKAL COLLEGE OF NURSING, BADUSAHIB

SUBJECT: MEDICAL SURGICAL NURSING

DRUG BOOK
SUBMITTED TO: - SUBMITTED BY: -

DR. PRIYANKA CHAUDHARY SMRITI

ASSOCIATE PROFESSOR [Link]. NURSING 1ST YEAR

ACN, BADUSAHIB BS23MNS007

SUBMITTED ON: - / /2024

1
 INTRODUCTION

Nurses must possess a wide range of knowledge about the vast number of drugs currently available, including their classification, actions and
indications, routes of administration, appropriate dosages, side effects and adverse reactions, and antidotes (if available). To facilitate
comprehension and retention of this essential information, the drug classification is often aligned for teaching purposes with the procedure,
body system, or disease process in which it is used. In this way, the learner is better able to connect the use of a particular drug with a patient’s
clinical situation. By recognizing the disease process affecting a particular client, the nurse can confirm what drugs should be administered to
that client. The discussion that follows includes relevant information about common drugs although it is not all-inclusive. Drug dosage has
been deliberately omitted and should always be cross-checked against reliable sources.

ANALGESICS AND ANTI-INFLAMMATORY DRUGS

Analgesics are drugs used to provide relief from pain. Included in this category are non- narcotic, nonsteroidal anti-inflammatory drugs
(NSAIDs) and narcotic drugs. Some analgesics also have anti-inflammatory effects. Corticosteroids are drugs used to treat a variety of
conditions by acting to suppress inflammation and the immune system.

2
 1. NON-NARCOTIC ANALGESICS

Category/Drug Actions/Indications Adverse Effects Nursing Considerations

NSAIDs NSAIDs:- block ■ Nausea NSAIDs carry the risk of
cyclooxygenase-2 (COX-2), ■ Vomiting myocardial infarction and
Suffix: -profen (fenoprofen,
an enzyme that causes pain and ■ Diarrhea stroke.
ibuprofen, ketoprofen) Suffix: -
inflammation. ■ Constipation ■ Fenamates (e.g., Ponstel)
fenac (bromfenac, diclofenac,
COX-2 inhibitors selectively ■ Rash are used to treat rheumatoid
nepafenac)
block the COX-2 enzyme and ■ Dizziness arthritis
Examples: Acetic acids: therefore have a lower risk of Ketorolac (Toradol) is the only
indomethacin (Indocin), sulindac causing stomach or intestine NSAID that is available for
(Clinoril); Fenamates (Ponstel); ulcers than other NSAIDs. administration orally,
celecoxib (Celebrex); oxicams These drugs inhibit the production intramuscularly (IM),
(Feldene); Propionic acids: of prostaglandins. intravenously (IV), or topically.
naproxen (Naprosyn); ketorolac Ketorolac tromethamine (Toradol) Ketorolac is contraindicated in
tromethamine (Toradol) is similar to morphine and is used patients with a patent ductus
for short-term management of arteriosus, renal or hepatic
moderately severe acute pain impairment, anemia, myocardial
infarction, or stroke

3
 2. NARCOTICS: -

Category/Drug Actions/Indications Adverse Effects Nursing Considerations

Demerol (meperidine) Acts as an agonist at specific ■ Mood changes (e.g., Give the smallest effective dose
opioid receptors in the central euphoria, dysphoria) for the shortest period of time
nervous system (CNS) to produce ■ Weakness
analgesia, euphoria, and sedation ■ Headache
■ Agitation
■ Tremor and involuntary muscle
movements
Fentanyl Buccal form is used to treat ■ Drowsiness ■ Fentanyl is 100 times stronger
“breakthrough” cancer pain ■ Lightheadedness than morphine
that is not controlled by other ■ Weakness and fatigue
medications; also used as a
pain reliever and anesthetic in
pre-procedures
Morphine Indicated for the relief of ■ Respiratory depression Contraindicated in patients with
pain in patients who require ■ Bradycardia pancreatitis as morphine induces
opioid analgesics for more ■ Seizure (convulsions) “spasm” in the sphincter of Oddi
than a few days; interacts ■ May also cause itching
predominantly with the of the face, mouth, and

4
 opioid mu-receptor; also eyes, which can be
produces respiratory depression treated with
by direct action on the promethazine
brainstem respiratory centers.
Oxycodone (OxyContin) Decreases pain by binding to the ■ Respiratory depression Monitor the patient’s response
opiate receptors in the CNS ■ Flushing closely, especially when giving
■ Physical and psychological sustained- release preparations
dependence

3. CORTICOSTERIODS: -

Category/Drug Actions/Indications Adverse Effects Nursing Considerations

Betamethasone, Steroids have a wide range of ■ Dizziness ■ Administer with meals
prednisone, SoluCortef IV, uses reflecting their anti- ■ Mood swings When discontinuing these drugs,
inflammatory and Hyperglycemia gradually decrease the dosage to
SoluMedrol IV ■

immunosuppressive properties ■ Weight gain prevent adrenal crisis.

(methylprednisolone),
Individual agents may be ■ Electrolyte imbalance
dexamethasone
available in several different ■ Extreme fatigue Unusual
preparations (i.e., oral, IV, bleeding
topical) Betamethasone ■ Black stools
accelerates fetal lung maturity

5
 and reduces intracranial ■ Swelling
hemorrhage in premature ■ Leukocytosis
infants Prednisone suppresses ■ immune suppression
the normal immune response increases the risk of
Dexamethasone is used infections
primarily in the treatment of (especially fungal)
brain edema ■ Prednisone toxicity results in
Cushing’s syndrome
(buffalo hump, moon face, high
glucose levels, and hypertension)

ANESTHETICS AND OTHER DRUGS GIVEN DURING SURGERY

Anesthetics are drugs that cause a reversible loss of sensation. Most anesthetics can cause respiratory depression, hypotension, and arrhythmias.
A less common, but important and potentially fatal adverse reaction is malignant hyperthermia. As the result of an inherited condition,
susceptible individuals develop hyperthermia, rhabdomyolysis, and muscle rigidity following administration of certain anesthetics. Without
prompt treatment with dantrolene, death often occurs.

6
 1. ANESTHETICS

Category/Drug Actions/Indications Adverse Effects Nursing Considerations

Etomidate Short-acting IV anesthetic ■ Injection site pain Unlike many other anesthetics,
used for short-term ■ Eye movements this drug does not cause
procedures or to induce ■ Skeletal movements hypotension
general anesthesia
Ketamine Used to induce and ■ Hallucinations Closely monitor of vital signs
maintain general anesthesia ■ Respiratory depression during administration
in children ■ Cardiovascular side
effects
Pancuronium bromide Competitive acetylcholine ■ Skeletal muscle weakness ■ This drug does not induce
(Pavulon) antagonist used as a muscle ■ Respiratory insufficiency sleep; when administered
relaxant for intubation or for ■ Apnea with other anesthetic drugs,
quick-onset surgery an additive effect occurs
■ Use caution when
administering to
patients with myasthenia
gravis Antidote: The
effects of this drug can
be partially reversed by

7
 administration of an
anticholinesterase drug, such as
neostigmine and pyridostigmine
Propofol Used for sedation and hypnosis ■ Metabolic acidosis ■ Use aseptic technique
■ Hyperlipidemia when administering this
drug
■ Change the IV tubing
used to administer the
drug every 12 hours
Succinylcholine (Anectine) Binds to the nicotinic M ■ Hypotension ■ Because this drug increases
receptors for acetylcholine; ■ Bradycardia intraocular pressure, it
used for relaxing muscles ■ Respiratory paralysis should not be used in
during surgery or when on a ■ Dystonia patients with penetrating eye
ventilator; also used during ■ Akathisia injuries
anesthesia ■ Malignant hyperthermia ■ Other contraindications
for tube insertion ■ Increased intraocular include glaucoma, blood
pressure electrolyte abnormalities,
malignant hyperthermia, or
kidney or liver disease
Thiopental sodium Acts on the gamma ■ Cardiovascular depression Contraindications include liver

(pentothal sodium) aminobutyric acid (GABA) ■ Respiratory depression disease, Addison’s disease,

8
 receptor in the brain and myxedema, and heart disease
spinal cord; a rapid- onset,
short-
acting barbiturate general
anesthetic

2. ANTIMUSCARINIC AGENTS: -

Category/Drug Actions/Indications Adverse Effects Nursing Considerations

Glycopyrrolate [Robinul]) Given preoperatively to reduce ■ Dry mouth (xerostomia) Contraindications include
respiratory and gastric secretions ■ Urinary retention glaucoma, asthma, and prostatic
■ Blurred vision and hypertrophy
photophobia
(due to dilation of pupils
[mydriasis])
■ Increased ocular tension
■ Tachycardia

9
ANTICOAGULANTS
Anticoagulants are drugs that prevent the clotting of blood.

Category/Drug Actions/ Indications Adverse Effects Nursing

Considerations
Aspirin Platelet inhibitor, anti- ■ Gastrointestinal (GI) bleeding ■ Contraindications include
inflammatory, analgesic, antipyretic ■ Heartburn hemophilia and bleeding
■ Nausea ulcers
■ Tinnitus

Fibrinolytic agents Converts plasminogen to plasmin, ■ Severe internal bleeding NOTE: Before administering

Examples: alteplase, which in turn leaves fibrin, ■ Allergic reaction a fibrinolytic agent, all
thereby causing clot dissolution appropriate blood levels (e.g.,
reteplase, urokinase,
and restoration of blood flow to coagulation levels, fibrinogen,
streptokinase, tissue
ischemic tissues hemoglobin [Hgb]/hematocrit
plasminogen activator (tPA) [HCT] levels) should be obtained
and all appropriate tubes
(e.g., Foley, nasogastric), should be
inserted. Avoid removing any
tube or IV line for 48 hours post-

10
 infusion

Enoxaparin sodium Low-molecular- weight heparin ■ Bleeding ■ Given subcutaneously in the

(Lovenox) lower abdomen

■ Avoid administering within
1 inch of the umbilicus
■ When giving enoxaparin,
there is no need to monitor
coagulation levels

Heparin Inhibits coagulation by forming ■ Heparin induced ■ If HITT occurs, immediately

an antithrombin thrombocytopenia (HITT), stop heparin and administer
that prevents the conversion of characterized by low plate- let argatroban instead
prothrombin to thrombin and by count ■ Has a short half-life (time
preventing liberation of required for the drug to fall to
thromboplastin from platelets half its value as measured at
Used in the treatment of deep the beginning of the time
vein thrombosis (DVT), atrial period)
fibrillation, and disseminated ■ Activated partial
intravascular coagulation thromboplastin time (APTT)
is 1.5–2 times the normal
laboratory value
NOTE: Heparin does not

11
 prevent formed clots.

Warfarin (Coumadin) Inhibits the synthesis of vitamin K ■ Increased risk of serious ■ Prothrombin time [PT] should
clotting factors bleeding be 1.5–2 times the normal
laboratory value
■ Monitor closely when
patients are also taking
drugs that increase the
international normalized
ratio (INR) (e.g., steroids,
metronidazole [Flagyl],
salicylates, quinidine)
NOTE: Teach the patient to
avoid a diet rich in vitamin K
(e.g., green leafy vegetables
such as kale, brussel sprouts,
mustard greens) and liquids
such as green tea, cranberry
juice, and alcohol.

ANTIMICROBIALS:-

Antimicrobials are drugs that destroy or inhibit the growth of micro-organisms. This classification includes antibiotic, antifungal,

12
antiparasitic, and antiviral drugs. There are various methods by which antimicrobials can destroy or inhibit micro-organisms:
• Inhibition of bacterial cell wall synthesis, which weakens the cell wall Agents used: cephalosporins, daptomycin,
penicillins
• Inhibition of protein synthesis, which disrupts protein synthesis of microbes but does not disrupt normal cells
Agents used: aminoglycosides, clindamycin, erythromycin, tetracycline
• Inhibition of metabolic pathways for nucleic acid synthesis, which requires folate Agents used: fluoroquinolones, rifampicin

Category Drug Actions/ Adverse Effects Nursing

Indications Considerations
Aminoglycosides Amikacin Used to treat ■ Kidney damage ■ Closely monitor renal
infections with Hearing loss function and
Suffix: -mycin
■

Acinetobacter and vestibulocochlear nerve

Enterobacter species function
Gentamicin Used to treat gram- ■ Kidney damage ■ Blood level should usually be
negative organisms, 5–10 mcg/
Staphylococcus, mL for peak concentration
Proteus, and and less than 2 mcg/mL
Pseudomonas for trough concentration;
dosage is
also adjusted based
on creatinine level

13
Neomycin Kills bacteria in the ■ Nausea and vomiting ■ Has the highest risk of
intestinal tract, keeps ■ Diarrhea toxicity of all
ammonia levels low, ■ Allergic reaction aminoglycosides
and prevents hepatic
encephalopathy Used
prophylactically,
especially prior to GI
surgery
Streptomycin Used to treat ■ Nausea and vomiting ■ Be alert to symptoms of
infective endocarditis ■ Loss of appetite ototoxicity
and tuberculosis
Tobramycin Used in various ■ Allergic reaction ■ Ineffective orally, so for
severe or life- ■ Changes in hearing systemic use it can only be
threatening gram- ■ Dizziness given IV or IM, or
negative infections administered and inhaled
(e.g., meningitis via nebulizer for
in neonates; Pseudomonas infection
brucellosis)
Erythromycin Used to treat ■ Nephrotoxic and ototoxic ■ Monitor liver function in
(EES, respiratory, skin, and effects, including patients receiving prolonged
E-Mycin) lung conditions impaired balance and therapy

14
 ringing in the ears
■ GI disturbances
■ Arrhythmia with
prolonged QT intervals
(start of Q wave to end of
T wave measurement)

Antiseptics Nitrofurantoin Used to treat urinary ■ Peripheral neuropathy ■ Be alert to signs of urinary
(Mac- rodantin) tract infections ■ Acute and chronic tract superinfections
Interferes with pulmonary reactions ■ Assess for nausea
bacterial
enzyme systems

Beta-lactam Cephalosporins Broad-spectrum ■ Candidiasis, ■ Contraindications include PCN

Prefixes: cef-, antibiotic used to treat pseudomembranous colitis allergies, liver disease, and
antibiotics
ceph- Examples: urinary tract (Clostridium difficile) jaundice
cefaclor (Ceclor), infections (UTIs) ■ Maculopapular rash
cefixime, ■ Nephrotoxicity
cephalexin ■ CNS symptoms
Monobac- tams Inhibits cell wall ■ Rash ■ Patients with kidney and liver
Example: synthesis ■ Diarrhea disease are more likely to
aztreonam Used in the ■ Nausea and vomiting experience side effects
management of

15
 infections caused by
gram-negative aerobic
bacteria such as
Pseudomonas
Carbapenems High resistance to ■ High risk of seizures ■ Ensure close monitoring of
Example: bacterial enzymes patients who are highly
imipenem Used to treat vulnerable to CNS effects
Escherichia coli and
Klebsiella pneumonia
and other infections
not readily treated by
other antibiotics

Broad-spectrum Fluoroqui- nolones Used for com- ■ Peripheral neuropathy ■ Do not administer with

antibacterial Suffix: munity-acquired ■ Prolonged QT interval antacids

-floxacin pneumonia and ■ Hepatotoxicity
agents
Examples: urinary tract ■ CNS effects
levofloxacin infections ■ Clostridium difficile–
(Levaquin), associated diarrhea
azithromycin
(Zithromax),
ciprofloxacin

16
 (Cipro)
Tetracycline Used for up- per and ■ Photosensitivity ■ Advise the patients to avoid
Suffix: lower respiratory tract ■ Tooth discoloration dairy products and antacids
-cycline: infections, skin and ■ Hypoglycemia
Examples: soft tissue infections ■ Increased digoxin levels
demeclocycline,
doxycycline,
minocycline,
tetracycline

Gram-positive Amoxicillin Binds to bacterial ■ Anaphylaxis ■ Contraindications include PCN

antibacterial (Amoxil), cell wall; used to treat ■ Seizures allergies and liver disease
penicillin, gram- Superinfection
penicillin
■

Augmentin, and positive infections ■ Hypersensitivity

antibiotics
ampicillin such as streptococcus,
staphylococcus,
listeria, and
clostridium

Macrolide Erythromycin, Used to treat ■ GI side effects ■ Advise the patient to avoid

antibiotics azithromycin chlamydial infection, ■ Prolonged QT interval grapefruit juice

(Zithromax), and acute bacterial ■ Ototoxicity
clarithromycin exacerbation of ■ Bradycardia

17
 (Biaxin) chronic bronchitis,
cirrhosis, and
kidney problems

Oxazolidinones Linezolid (Zyvox) Used for ■ GI disturbances (most ■ Should not be used by
gram-negative common) patients taking medications that
infections (e.g., inhibit monoamine oxidases
pneumonia, A or B (MAO-A or MAO-B
meningitis) inhibitors)

PCP Pentamidine Antimicrobial used ■ Prolonged QT interval ■ Can cause allergic and toxic
to prevent and treat Nephrotoxicity side effects, especially to
antimicrobial
■

Pneumocystis ■ Stevens– Johnson pancreas

pneumonia (PCP) in syndrome
HIV patients ■ Leukopenia

Quinolone Ciprofloxacin, Inhibits bacteria by ■ Tendon rupture ■ Give 1 hour before or 2 hours

antibiotics levofloxacin, inhibiting DNA ■ Prolonged QT interval after antacids or milk products
moxifloxacin, gyrase. Used to treat a ■ Torsades de pointes
(broad
ofloxacin wide range of
spectrum)
infections.
Suffix: -floxacin
Sulfa antibiotics Sulfamethoxazole– Anti-infective and ■ Slow heart rate, weak ■ Contraindicated in patients
trimethoprim anti- inflammatory pulse with a sulfa allergy

18
 (Bactrim), sulfadia- drugs used to treat ■ Severe tingling, ■ Advise the patient to avoid
zine, PCP numbness, and muscle foods and fluids that are
sulfamethoxazole pneumonia and other weakness acidic, avoid alcohol, drink

infections ■ Steven– Johnson and 1.5 L of water per day

syndrome ■ Patients must have a urine pH
■ Blood dyscrasias less than 5.5
(anemia)
■ Crystalluria
(crystallization in renal
tubules) and severe renal
damage

Vancomycin Tricyclic glyco- Used to treat serious ■ Ototoxicity and ■ Can cause histamine release,
peptide antibiotic infections caused by nephrotoxicity resulting in an anaphylactic
that is the only gram-positive bacteria response known as “red man
drug in its class known or suspected syndrome”
to be resistant to other
antibiotics

ANTIFUNGAL Clotrimazole Stops the growth of ■ Nausea ■ Monitor for an allergic

Azoles (Mycelex), the yeast (Candida) ■ Stomach pain response: patients allergic to
fluconazole that causes thrush ■ Itchy skin other azole antifungals may be
Suffix: -nazole
(Diflucan), keto- ■ Possible allergic allergic to fluconazole

19
 conazole (Nizoral) reaction

Mycostatin Used to treat fungal ■ Redness, itching, or ■ Generally well- tolerated

(Nystatin) skin infections hypersensitivity even with prolonged therapy

ANTIPARASITI Mebendazole Used to treatment ■ Diarrhea ■ Warn patients that the drug

C Antihelmintics pinworm, whipworm, may turn stools red or cause

roundworm, and urine to have an asparagus-
Suffix: -dazole
hookworm like smell

ANTIVIRAL Cidofovir, Anticytomegalovirus ■ Kidney damage ■ Monitor patient for

Suffixes: -tadine, ganciclovir (anti- CMV) hypersensitivity reactions,

■ white blood cell count
-vir
(neutropenia),
■ stomatitis,
■ blood pressure,
■ Monitor HIV RNA assay,
CD4 counts, liver function,
kidney function, CBC,
■ blood glucose, and serum
amylase and triglyceride
levels (these will
■ determine the effectiveness
and toxicity of the drug)

20
Amanta- dine, Antiflu ■ Agitation
rimantadine, ■ Headache
zanamivir ■ Nausea
Adefovir, Anti-hepatitis ■ Weakness
entecavir, ribavirin ■ Headache
■ Abdominal pain
Acyclovir; Anti-herpes ■ Nausea and vomiting
famciclovir (for ■ Abdominal pain
herpes zoster,
genital herpes, and
chickenpox
[varicella])
Abacavir, ritonavir, Anti-HIV ■ Nausea
tenofovir ■ Headache
■ Fatigue
■ Vomiting
Nucleoside analogs Used to treat ■ Stomach upset
— lamivudine, hepatitis B and C, ■ Possible peripheral
stavudine, telbivu- herpes simplex, and neuropathy
dine, zidovudine HIV infections

21
ANTIPYRETICS
Antipyretics are fever-reducing drugs.

Drug Actions Indications Adverse Effects Nursing

Considerations
Aspirin Inhibits prostaglandin Used as an analgesic, ■ GI ulcers, stomach Antidote: Salicylate
(necessary for normal antipyretic, anti- bleeding, and tinnitus poisoning can be rapidly
(acetylsalicylic acid
cell function) inflammatory, and an fatal; administer charcoal
[ASA])
antiplatelet, and enhances to reduce absorption of the
anticoagulants drug Young children with
fever or flu-like symptoms
should not be given aspirin
because of
the risk of developing Reye’s
syndrome (characterized
■ by rash and detrimental
effects to many
organs, especially
the brain
(encephalitis) and liv

22
 er)

Drug Para- Produces analgesia by Has antipyretic and Can cause liver Phenylketonuria patients
elevation of the pain analgesic effects insufficiency and blood should avoid Tylenol with
aminophenol
threshold dyscrasias aspartame (NutraSweet)
derivatives:
and children’s Tylenol)
acetaminophen Antidote:
(Tylenol, other N-acetylcysteine
trade names) (Mucomyst) or charcoal
NOTE: Do not take more
than 1 g
(1000 mg) of Tylenol per
dose or 4 g (4000 mg) per

CARDIAC DRUGS: -
Category Drug Actions/ Adverse Effects Nursing
Indications Considerations
Alpha- Relaxes smooth Benign prostatic ■ Syncope ■ Can negatively affect
muscle hypertrophy (BPH), Significant cataract surgery
adrenergic ■

surrounding gestational hypertension hypotension

inhibitors
blood vessels ■ Bradycardia
Example:
■ Paresthesia

23
doxazosin ■ Thrombocy topenia
Decreased or absent
mesylate ■

reflexes
(Cardura)
Alpha agonists Stimulates alpha- Hypertension, ■ May cause renal ■ Must obtain baseline CBC
receptors in the gestational hypertension failure before initiating medication
Examples:
brain, enhancing ■ Hemolytic anemia
clonidine
blood flow in ■ Black tongue
(Catapres),
peripheral ■ Aggravation of
methyldopa arteries, angina pectoris
(Aldomet, decreasing ■ Congestive heart
Aldoril) resistance, and failure (CHF)
decreasing blood ■ Bone marrow
pressure suppression
■ Toxic epidermal
necrolysis

Alpha Blocks Hypertension, heart ■ Renal problems ■ Be sure that patient is not

blockers, anti- conversion of failure, diabetic ■ Hypotension pregnant before beginning

angiotensin I to neuropathy Angioedema of treatment
adrenergic
■

angiotensin extremities, face, lips,

Suffix: -pril
mucous membranes,
Examples:

24
captopril and

(Capoten), tongue

enalapril
(Vasotec)
Angiotensin II Blocks the action Used in diabetic ■ Hypotension ■ Caution is indicated when

receptor of angiotensin, patients with kidney ■ Arrhythmias these drugs are used in
resulting problems to treat Conduction disorder combination
antagonists
■

in dilation of hypertension and heart with potassium- sparing

Suffix: -sartan
blood vessels and failure diuretics or NSAIDs
Examples:
decrease in blood
irbesartan pressure
(Avapro),
losartan,
valsartan
Beta-1– Reduces the force Used to treat ■ Side effects are NOTE: If beta- blocker eye

selective of contraction of hypertension, angina generally mild and drops such as timolol are
heart muscle and pectoris, and migraines transient used, pressure must be
(cardioselective
lowers blood applied to the lacrimal duct
) adrenoceptor
pressure for 5 seconds to minimize
blocking agents the occurrence

25
Suffix: -olol of systemic bradycardia or

Examples: hypotension. Patients with

bronchospastic disease
atenolol
should not receive beta
(Tenormin),
blockers. Beta blockers can
metoprolol, also
nadolol mask the symptoms of
(Corgard), hypoglycemia
pindolol,
propranolol,
timolol
Calcium Negative Used to treat ■ Heart block ■ Advise the patient to avoid

channel inotropic agents migraines, hyper- ■ Liver insufficiency grapefruit juice

that inhibit tension, Angioedema
blockers
■

calcium transport supraventricular ■ Stevens–Johnson

Suffix: -dipine into myocardial tachyarrhythmias (e.g., syndrome
Examples: and smooth atrial fibrillation, atrial ■ Constipation
benzothiazides muscle cells, flutter, and paroxysmal ■ Headache
— diltiazem inhibit supraventricular ■ Nausea
atrioventricular tachycardia), and Rash
hydrochloride ■

conduction, and exertional angina

26
 (Cardizem); decrease pectoris ■ Edema
sinoatrial (SA) Sexual dysfunction
dihydropyridin ■

node automaticity
es— nifedipine,
nicardipine,
felodipine,
amlodipine;
verapamil
Hydralazine Vasodilator Used to treat hyper- ■ Shortness of breath, ■ Use with caution in patients

(Apresoline) tension skin rash, edema with suspected coronary

artery disease

Nipride Vasodilator Administered to reduce ■ Anemia ■ Drug is sensitive to light

afterload, and as an ■ Bradycardia ■ Byproduct is cyanide;
antidote for ergot ■ Hypotension monitor thiocyanate serum
alkaloid poisoning ■ Encephalopathy, or toxicity
other conditions in
which intracranial
pressure is increased,
causes confusion,
tremors, and
arrhythmias

27
Antiarrhythmic drugs

Adenosine Slows conduction Used for paroxysmal ■ Breathing problems ■ Contraindicated in patients
time through the A- supraventricular ■ Chest pain with second- or
V node tachycardia (PSVT) third-degree A-V block,
sick
sinus syndrome, or
symptomatic bradycardia

Atropine Blunts the increased May be used in the ■ Dry mouth ■ Contraindicated in patients
vagal tones and operating room to ■ Blurred vision with glaucoma, pyloric
increases heart rate reduces secretions Also ■ photophobia stenosis, or BPH
used as an antidote for ■ Tachycardia
inadvertent overdose of
cholinergic drugs

Calcium channel
blockers (see
above, under
Antihypertensives
)

28
Example: digoxin Increases the strength Used to treat mild to ■ Heart block ■ Check apical pulse; if less

(Lanoxin) and vigor moderate heart failure and ■ Nausea and than 60 bpm, hold
of heart contractions atrial fibrillation vomiting medication.
■ Visual disturbances ■ Check digoxin and
(blurred or yellow potassium levels prior to
vision) administration; digoxin
■ Digitalis increases blood levels should be 0.8–
ventricular irritability 2.0 mg/mL
and could convert a ■ Potassium- depleting
rhythm to ventricular diuretics are the major
fibrillation following contributing
cardioversion factor to digitalis toxicity
■ Antidote: digoxin immune
Fab (Digibind)
Drugs Used to Treat Congestive Heart Failure (CHF)

Nesiritide Human B-type Improves breathing in ■ Headache ■ Do not ad- minister for

(Natrecor) natriuretic peptide that patients with CHF ■ Dizziness more than 48 hours in
relaxes and dilates failure ■ Nausea and patients with
blood vessels vomiting acutely decompensated CHF
■ Back pain ■ Monitor blood pressure

29
Phosphodiesterase Vasodilation; Used to treat acute ■ Hypotension ■ Mothers who are breast

(PDE) 3 inhibitors increases contractility decompensated heart ■ Arrhythmias feeding should be instructed to
and heart rate failure, and reduce ■ Cutaneous flushing discontinue this practice for
preload and afterload the duration of drug treatment

Drugs Used to Treat High Serum Cholesterol Levels

Atorvastatin Lipid- lowering Used to manage ■ Muscle pain ■ Evaluate fat consumption

(Lipitor) HMG-CoA hypercholesterolemia, ■ Fever ■ Monitor liver function tests

reductase inhibitor prevent stroke, and ■ Dark-colored urine ■ Advise the patient to avoid
lower total low-density ■ Fatigue grapefruit
lipoprotein (LDL) juice and follow dietary
cholesterol and restrictions
triglyceride
levels

Drug Used to Treat Pulmonary Hypertension

Vasodilation; these Used to treat ■ Headache NOTE: Patients cannot take
Phosphodiesterase agents relax muscles pulmonary hypertension, ■ Tremors nitrates with (PDE) 5 inhibitors
(PDE) 5 inhibitors around blood vessels, anti- inflammatory agent ■ Easy bruising
Suffix: -afil (e.g., promoting dilation for COPD, asthma, and
impotence.
vardenafil,
tadalafil)
30
Examples:
milrinone
Drugs Used to Treat Ventricular Arrhythmias
Amiodarone Multiple and Can be used for atrial ■ Pulmonary toxicity ■ Concurrent administration

(Cordarone) complex effects on and ventricular (most serious reaction) with numerous drugs (e.g.,
the electrical activity arrhythmias antibiotics, other cardiac drugs)
of the heart, can increase toxicity
normalizing heart ■ Advise the patient to avoid
rhythm grapefruit juice and St. John’s
Wort

Bretylium Adrenergic neuron Used to treat life- ■ Dizziness, lightheaded- ■ This drug has been
blocking threatening ventricular ness, faintness discontinued; however,
arrhythmias when other generic formulations may be
drugs are ineffective available

Disopyramide Prolongs Used to treat abnormal ■ Dizziness ■ Advise the patient to avoid

(Norpace), repolarization heart rhythms taking with alcohol

procainamide
(Pronestyl), and
quinidine

31
Lidocaine HCI Accelerates Used to prevent and ■ CNS symptoms ■ May cause cardiac toxicity,
repolarization treat ventricular (lidocaine toxicity) hypotension, and bradycardia
(Xylocaine)
tachycardia include slurred speech,
tonic– colonic seizures

Vasoconstrictors

Dopamine Positive inotrope that Used to treat low blood ■ Ectopic heart- beats ■ Contraindicated in patients
increases peripheral pressure due to shock ■ Tachycardia with pheochromocytoma,
vascular resistance and other serious ■ Angina uncorrected tachyarrhythmias,
and arterial blood medical conditions ■ Palpitations or ventricular fibrillation
pressure ■ Vasoconstriction
■ Hypotension
■ Dyspnea
■ Nausea and
vomiting
■ Headache

Epinephrine Positive inotrope that Relieves respiratory ■ Anxiety ■ Contraindicated in patients

(Adrenalin) increases peripheral distress due to ■ Headache with narrow-angle glaucoma

vascular resistance bronchospasm, allergic ■ Fear ■ Use caution with elderly
and arterial blood reactions, cardiac arrest ■ Palpitations patients who have
pressure cardiovascular disease,

32
 hypertension, diabetes
mellitus, or hyperthyroidism

Norepinephrine Positive inotrope that Used to treat life- ■ Headache ■ Contraindicated in patients
increases peripheral threatening hypotension ■ Severe hypertension with mesenteric or peripheral
vascular resistance that occurs ■ Reflex bradycardia vascular thrombosis because it
and arterial blood with some medical may increase ischemia
pressure conditions

Phenylephrine Positive inotrope that Used to treat nasal or ■ Restlessness ■ Contains sulfites that may

(Neo- increases peripheral sinus congestion or ■ Anxiety cause allergic reactions in

vascular resistance congestion of the Nervousness certain individuals (e.g.,
Synephrine)
■

and arterial blood eustachian tubes ■ Dizziness asthma patients)

pressure

Vasopressin Increases urine Used in prevention and ■ Local gangrene ■ Antidote: phentolamine

antidiuretic osmolality and treatment of diabetes ■ Coronary thrombosis (Regitine) for

decreases water insipidus, (chest pain) extravasation
hormone (ADH)
excretion to control bleeding, and ■ Mesenteric infarction ■ Carefully monitor ST
(Pitressin)
for management in ■ Venous thrombosis segment for ischemia
septic shock patients not ■ Infarction and necrosis
responding to high of the small bowel
doses of inotropes ■ Peripheral emboli

33
Vasodilators

Nitrates Decreases preload Used to treat heart ■ Flushing ■ Systolic blood pressure should

Examples: and afterload conditions such as ■ Syncope be maintained at greater than

angina, coronary heart Hypotension or equal to 100
nitroglycerin,
■

disease, and chronic ■ Headache ■ If pain persists, the patient’s

isosorbide
heart failure Dilates condition is considered
mononitrate healthy vessels, reduces unstable
(Imdur); cardiac oxygen demand, and further diagnostic tests are

34
 available in and causes increased required

sublingual flow through collateral

coronary vessels
(Nitrospan oral),
transdermal, IV,
or spray
formulations
Beta-adrenergic Acts on the beta- Used to treat ■ Hypertension ■ Contraindicated in patients

agonists receptors to increase cardiogenic shock and ■ Angina with a history of heart valve
myocardial acute heart failure Arrhythmia problems, adrenal gland tumor,
Examples:
■

contractility and ■ Tachycardia in- creased irregular heartbeat,

dobutamine,
stroke volume and or
isoproterenol, open calcium an enlarged left ventricle
and epinephrine channels caused by narrowing of the
Dobutamine aortic blood vessel
stimulates beta
receptors

CHEMOTHERAPEUTIC DRUGS
Chemotherapeutic (antineoplastic) drugs are used for palliative or curative effects in the treatment of patients with cancer. These agents inhibit
different phases of the cell cycle, inhibiting DNA replication, cell division, or growth.

35
Alkylating Agents
Nitrogen Prevents mitosis, thus Used to treat certain ■ Missed menstrual ■ Administer only

mustard interfering with cell types of brain tumors and periods under the supervision of a
replication multiple myeloma ■ Painful rash physician experienced in
(Mustine, other
■ Dizziness anticancer medications
trade names)
■ Joint pain
Suffix:
-mustine
Anthracycline Antibiotics
Suffix: -bicin Targets DNA Used to treat leukemias ■ Labeled as a vesicant ■ Must be administered by a

Examples: (doxorubicin, (a carefully trained nurse under the

idarubicin), lymphomas chemical that causes supervision of a physician
doxorubicin
(doxorubicin, extensive tissue damage experienced in anticancer
(Adriamycin, other
epirubicin), breast, and blistering if it escapes medications
trade names), uterine, and ovarian from the veins)
epirubicin, cancers (epirubicin), ■ Bone marrow depression,
idarubicin, bladder cancer leukopenia, and

valrubicin (valrubicin), and lung thrombocytopenia

cancer (epirubicin) ■ Major side effect is heart
failure

36
 Daunomycin Attacks cancer cells Treats cancer of the ■ Anemia ■ Patients with CHF who are
during cell division bladder, breast, head, ■ Leucopenia immuno- suppressed cannot
neck, liver, and lung; ■ Stomatitis take this drug
leukemia; lymphoma;
mesothelioma; and
multiple myeloma

Mitomycin Potent DNA cross- Used to treat cancer ■ Severe anemia ■ Do not administer to patients

(Mutamycin) linker of the stomach and ■ Thrombocytopenia, and with shingles or chickenpox
pancreas ■ Irreversible renal failure
(hemolytic uremic
syndrome)

Hormones
Tamoxifen, Interferes with steroid Used to treat female ■ Edema ■ Advise the patient

flutamide hormones that bind and male breast ■ Hypertension of the importance of having
to steroid receptors cancer, endometrial ■ Diabetes mellitus estrogen receptors tested
cancer, and prostate ■ Cushing’s
cancer syndrome

Kinase Inhibitors
Suffix: -nib Interferes with repair of Used to treat various ■ QT prolongation ■ May decrease fertility in men

Examples: DNA cancers and polycystic and women

37
 dasatinib, kidney disease

erlotinib,
imatinib,
sorafenib
Miscellaneous

383.8 pt Blocks amino acids Used to treat chronic ■ Hepatotoxicity ■ Be alert for signs of serious
myelogenous leukemia, infection or bleeding
ovarian cancer, and
melanoma

Plant Alkaloids

Vincristine Disrupts mitosis Leukemias, ■ Extravasation ■ Advise the patient

(Oncovin) lymphomas, and ■ Neurotoxicity to avoid grapefruit or grapefruit

childhood cancers ■ Hair loss juice, which can change the
■ Bone marrow blood level of the drug
suppression

DIABETIC MEDICATIONS
All patients who take diabetic medications are at risk for hypoglycemia. Control of blood glucose requires a thorough knowledge of the onset,
peak, and duration of action of each drug being taken by the patient. In addition, there are numerous drugs that may cause either hypoglycemia

38
(e.g., beta blockers) or hyperglycemia (e.g., steroids).

Category Drug Actions/Indica- Adverse Effects Nursing

tions Considerations
Oral Alpha- Prevents ■ Flatulence ■ Initiate therapy

antidiabetic drugs glucosidase digestion of ■ Diarrhea with a low dose and increase
inhibitors carbohydrates to desired amount
Metformin Increases the sensitivity ■ Abdominal discomfort ■ Can cause lactic acidosis
(Glucophage) of the liver, muscle, fat, ■ Cough or hoarseness ■ The drug must be stopped 2
and other tissues to the ■ Decreased appetite days before an IV contrast test
uptake and effects of and should not be restarted
insulin until
2 days after the test
Sulfonylureas: Reduces blood ■ Nausea ■ Because many drugs can
glipizide, glyburide, glucose by stimulating ■ Diarrhea interact with sulfonylureas, it is
glibenclamide, the pancreas to ■ Constipation important that patients report all
glimepiride produce more insulin ■ Dizziness drugs that they are taking

Thiazolidin- ediones: Attaches to insulin Upper respiratory tract Concurrent use of rifampin may
rosiglitazone receptors; makes cells infection, headache, back decrease effectiveness
(Avandia), more sensitive to pain
pioglitazone (Actos) insulin and facilitates

39
 removing glucose
from blood
Insulin Allows body to NOTE: When mixing a long-
process glucose and acting insulin and a short-acting
avoid complications insulin, care must
from hyperglycemia be taken to avoid contaminating
the bottle containing the long-
acting insulin. Patients taking
steroid medications (e.g.,
prednisone) may require extra
insulin
Short-acting analogs: Onset: within 30 ■ Hypoglycemia Because of its rapid onset, a short-
Humulin Regular, minutes (headache, hunger, acting insulin analog should not
Novolin Peak: within 2 hours weakness, sweating) be administered to the patient

Duration: 6 hours until a meal is provided NOTE:

Regular insulin is the only
insulin that can be given by the
IV route
Rapid-acting analogs: Onset: within minutes ■ Site reactions (pain, ■ Administered by subcutaneous
Insulin NovaLog Peak: within 2 hours redness, irritation) injection in the abdominal wall,
aspart, insulin lispro Duration: 4 hours thigh, or upper arm

40
 (Humalog),
insulin glulisine
(Aprida) ■ Hypoglycemia
Immediate- acting: Onset: within 2 hours ■ Hyperglycemia ■ Administered by
Lente, NPH Peak: within 4 hours subcutaneous injection

Duration: 16 hours
Onset: within 1 hour ■ Hypoglycemia

Long-acting: Duration:
■ Do not mix or dilute Lantus
Ultralente, Lantus, 24 hours with any other solution or
Levemir
insulin
Long-acting analogs: Onset: within 2 hours ■ Hypoglycemia ■ Administered by
insulin glargine, Duration: subcutaneous injection
insulin 24 hours

DIURETICS
Diuretics are used to treat fluid overload

41
 Drug Actions Indications Adverse Effects Nursing
Considerations
Bumetanide Works on the Used to treat edema ■ Dizziness ■ Administer before furosemide

(Bumex) ascending limb of the associated with CHF, ■ Dehydration (Lasix) when the patient is
loop of Henle hepatic disease, and taking both diuretics
renal disease, including
nephrotic syndrome

Carbonic Suppresses carbonic Used to treat ■ Numbness and tingling ■ Contraindicated in patients

anhydrase anhydrase, which glaucoma, acute in fingers and toes with sickle cell anemia, allergy
converts carbon mountain sickness, ■ Increased risk of to sulfa medications,
inhibitors
dioxide and water to CHF, and seizure developing calcium liver or kidney disease, adrenal
Example:
carbonic acid disorders oxalate and calcium gland failure (Addison’s
acetazolamide phosphate kidney stones disease), or women who are
(Diamox) pregnant

Chlorothiazide Helps kidneys remove Used to treat CHF, ■ Nausea and vomit ing ■ Contraindications: sulfa allergy

sodium (Diuril) excess fluid from the hypertension, or renal ■ Excessive urine
body insufficiency production
■ Dehydration
■ Hypokalemia

42
 ■ Hypomagnesia

Furosemide Hinders the absorption Used to treat edema ■ Can damage the ■ Contraindicated in patients

(Lasix) of sodium and chloride associated with CHF structures of the inner with allergies to sulfa drugs
in the proximal and ear, causing tinnitus, ■ Teach the patient to avoid
distal tubules and in dizziness, and corticosteroids,
the loop of Henle disequilibrium adrenocorticotropic hormone
(ACTH), licorice in large
amounts (will deplete
potassium), and prolonged use
of laxatives
■ Digitalis therapy may
exaggerate the metabolic
effects of hypokalemia,
especially myocardial effects
■ Ototoxicity is associated with
rapid injection, dehydration,
and electrolyte depletion

Osmotic diuretics Induces osmotic stress Used to prevent and ■ Chest discomfort ■ Contraindicated in patients with

Example: treat acute renal failure, ■ Cough a history of heart failure

reduce intracranial Difficulty breathing
mannitol
■

pressure

43
 in cerebral edema,
reduce intraocular
pressure, and promote
excretion of toxic
substances in urine

Potassium- Blocks sodium and Used in the ■ Abdominal pain ■ Do not promote the excretion

sparing diuretics water reabsorption in management of ■ Nausea and of potassium in patients taking
the kidneys hypertension, CHF, vomiting these drugs
Examples:
cirrhosis of the liver, ■ Rash ■ Monitor for hyperkalemia
triamterene,
nephrotic syndrome, and ■ Advise the patient to avoid the use
Dyazide, spironol-
edema of salt substitutes (which contain
actone (Aldactone) potassium); instead, patients
should follow a low- sodium diet

Thiazide diu- Acts in the distal Used in the man- ■ Weakness ■ May worsen kidney dysfunction

retics Example: tubule and diluting agement of hyper- ■ Low blood pressure
segment of Henle tension, to treat edema, Light sensitivity
hydrochlo-
■

and as an
rothiazide
antidiuretic in patients
(Hydrodiuril)
with diabetes insipidus

Thiazide-like Causes the kidneys to Used to treat edema ■ Hyponatremia or ■ Administer

diuretic: eliminate certain resulting from CHF and hypokalemia 30 minutes before furosemide

44
 metolazone chemicals that allow nephrotic ■ Sensitivity reactions (Lasix) when the patient is
large amounts of water syndrome (angioedema, taking both diuretics
(Zaroxolyn)
to be eliminated bronchospasms)
■ Hyperglycemia
■ Increase in serum uric
acid
■ Orthostatic
hypotension
■ Hyperparathyroidism
■ Systemic lupus
erythematosus

GASTROINTESTINAL MEDICATIONS
Drugs used to treat gastrointestinal conditions.

Drug Actions/ Indications Adverse Effects Nursing Considerations

Aluminum Used for relief of GI ■ Aluminum- containing ■ Products such as Ascriptin

hydroxide discomfort or to reduce antacids can cause contain significant amounts of

phosphate levels in patients Osteoporosis and should be aluminum hydroxide combined
(Amphojel),
with kidney conditions avoided by women after with buffered aspirin
magnesium
menopause and by patients with ■ Antacids containing aluminum,
hydroxide (Milk calcium, or magnesium may bind
renal disease
of Magnesia;
45
 MOM). phosphate in the gut, leading to
hypophosphatemia (low
phosphate levels) when used
chronically.

H2 antagonists Reduces the amount of ■ Can deplete calcium, folic ■ Most common side effect is

Examples: stomach acid secreted by acid, iron, vitamin B12, headache but famotidine
glands in the lining of the vitamin D, and zinc (Pepcid) can affect the platelet
ranitidine
stomach count
(Zantac, Tritec),
famotidine
(Pepcid),
nizatidine
(Axid),
cimetidine
(Tagamet)
Imodium Used to control acute diarrhoea ■ Dizziness ■ Chronic diarrhoea usually
■ Drowsiness responds within 10 days
and chronic diarrhoea associated
■ Constipation ■ If improvement does not occur
with inflammatory bowel disease
Skin rash within this time, it is unlikely that
Contains a narcotic-like drug that
■

symptoms will be controlled by

further admin- istration

46
 slows the action of the intestines

and the passage of stool

Paregoric (anhydrous Used to treat diarrhoea ■ Lightheaded- ness ■ Can produce drug

morphine) ■ Dizziness dependence

■ Sedation
■ Nausea and vomiting

Subsalicylate (Kaopectate), Slows expulsion of fluids into the ■ Dark tongue ■ Contraindicated in clients who

bismuth subsalicylate digestive system by irritated ■ Dark stools are allergic to aspirin
tissues by “coating” them. Anxiety ■ Patients with glaucoma, prostate
(Pepto-Bismol)
■

■ Loss of hearing symptoms, or liver or kidney

disease should not use antidiarrheal
preparations
■ Do not administer to children who
may have the flu or chickenpox as
salicylates increase the risk of
Reye’s syndrome

Sucralfate Coats the stomach and treats ulcers ■ Constipation ■ Be aware of drug interactions;
of the upper gastrointestinal tract schedule other medications
accordingly

Antiemetic

47
Benzamides Example: Used to treat nausea or ■ Most serious complication is NOTE: Teach the patient to

metoclopramide vomiting due to diabetic irreversible tardive dyskinesis report tremors or other
gastroparesis involuntary movements
(Reglan)
Chlorpromazine Used to treat certain mental ■ Coma ■ Establish baseline blood

(Thorazine) and behavioral disorders ■ CNS or bone marrow pressure (in standing and
Controls nausea and depression recumbent positions), and pulse,
vomiting, nervousness ■ Reye’s syndrome before initiating treatment
before surgery, and hiccups

Haloperidol (Haldol) Has antiemetic and ■ Cardiovascular symptoms ■ Monitor patient’s mental status
neuroleptic actions (hypotension, arrhythmias, and QT daily
Used to treat schizophrenia prolongation)
Relieves pain, nausea, and ■ Dystonia
vomiting ■ Tardive dyskinesia

Ondansetron (Zofran) Treats nausea resulting from ■ Temporary vision loss ■ Adjust dosage in patients with
chemotherapy and surgery ■ Bradycardia impaired renal function
■ Anxiety ■ Contraindicated in with liver
■ Agitation disease, CHF, and electrolyte
imbalance

48
 Phenothiazine, Antihistamine; causes ■ Dizziness ■ May suppress cough reflex and

promethazine sedation (sleep) to assist in ■ Drowsiness cause thickening of bronchial

controlling postoperative Blurred vision secretions
(Phenergan)
■

pain, nausea, vomiting, ■ Tinnitus

and motion sickness

Prochlorperazine Antiemetic, antipsychotic, ■ Extrapyramidal effects such ■ Position nauseated patients who

(Compazine) tranquilizer as involuntary muscle movements, have received this drug carefully to
hypotension, fatigue, anxiety, and prevent aspiration of vomitus
agitation

Pancreatic Enzyme Supplements

Pancrelipase (Creon, Used as replacement ■ Stomach ache ■ Administer prior to food

Ultrase), Pancrease therapy in pancreatic ■ Bowel obstruction or bloating ingestion

insufficiency and cystic
fibrosis

Laxatives
Docusate (Colace, Peri- Stool softener and laxative ■ Mild diarrhea or nausea ■ Assess bowel movements,

Colace) diarrhea

49
 Lactulose Osmotic laxative; binds with ■ Diarrhea NOTE: If the patient is confused
urea to remove ammonia ■ Nausea because of alcohol abuse, obtain an
Used to treat chronic con- ■ Bloating ammonia level
stipation, and to prevent or ■ Stomach pain
treat hepatic encephalopa-
thy

Magnesium citrate Used to empty bowels prior ■ Mild abdominal discomfort or ■ Overuse may cause persistent
to surgery or colonoscopy nausea diarrhea, dehydration, and mineral
imbalances (e.g.,
hypomagnesemia)
NOTE: do not use in patients with
kidney disease

Senokot Stimulant laxative ■ Stomach cramps ■ May alter the color or urine and
■ Bloating feces
■ Mild diarrhea

IMMUNOSUPPRESSANTS
Immunosuppressant drugs suppress or reduce the strength of the body’s immune system

Drug Actions/ Adverse Effects Nursing Considerations

Indications

50
 Mycophenol Prevents kidney rejection ■ Electrolyte imbalance ■ Teach patients to avoid taking

ate mofetil by suppressing T- and ■ Leucopenia simultaneously with antacids

B-lymphocyte formation Assess for signs for organ
(CellCept) ■

rejection
■ Monitor hepatic function

Tacrolimus Prevents kidney rejection ■ Ascites NOTE: Advise the patient to

(Prograf) by inactivating T ■ Hyperglycemia avoid grapefruit and shellfish

lymphocytes ■ Electrolyte imbalance
■ Thrombocytopenia
■ Hypertension
Drugs Used to Treat HIV

Fusion inhibitors (T-20) Helps prevent HIV from ■ Kidney problems ■ Give at ordered times around the
entering and infecting ■ Hypotension clock
human cells ■ Paralysis ■ Assess for bone marrow
■ Severe rash suppression, anemia, leukopenia,
■ Difficulty breathing and granulocytopenia

Non-nucleoside reverse Blocks viral replication of ■ Resistance to single- medicine

transcriptase inhibitors HIV by binding to the NNRTI treatment develops

enzyme reverse transcriptase quickly; for this reason, these
(NNRTIs)
drugs should be used only in

51
 combination with other
antiretroviral agents to treat
HIV infection or to prevent or
delay the development of
resistance

Protease inhibitors Used to treat or prevent ■ Assess for stomach upset,

infection nausea, and diarrhea
by viruses, including HIV
and Hepatitis C.

IV FLUIDS
IV fluids are used to maintain water balance or as replacement or restorative therapy

IV Fluid Actions Indications Nursing Considerations

0.45% sodium chloride Hypotonic: Causes a Used for dehydration, gastric fluid ■ Do not give hypotonic solutions to

solution sudden fluid shift out of loss, and cellular dehydration from patients at risk for third space fluid
the blood vessels and into excessive diuresis. shifts, especially with cerebral
cells that can cause edema; these fluids make the
cardiovascular collapse patient retain more water and salt,
Expands the intracellular increase tendency for edema, and
the patient may become

52
 compartment hypokalemic.

0.9% sodium chloride Isotonic: Correlates with Used to treat diabetic ketoacidosis, ■ Lactated Ringer’s solution

solution and lactated the osmolality of plasma, in the early treatment of burns, and contains potassium, sodium,
temporarily expands the in adrenal insufficiency Ringer’s chloride, and calcium
Ringer’s solution
extracellular lactate is frequently used during ■ Ringer’s lactate is
compartment during surgical procedures contraindicated in patients with
times of circulatory liver disease because they cannot
insufficiency Replenishes metabolize it
sodium and chloride ■ Also classified as crystalloids are
losses so that fluid stays normal saline and lactated Ringer’s
in the intravascular space solution

5% dextrose in Hypertonic: Pulls water Used to treat severe ■ Will cause fluid overload in
from the intracellular hyponatremia and to provide patients with a history of heart
0.9% sodium chloride
space into the calories for energy failure or hypertension
solution, 3% normal
extracellular space, ■ Can cause hyperglycemia,
saline solution, and causing leading to osmotic diuresis and
dextrose 10% in water the cells to shrink and hyperosmolar coma
allowing fluid volume
and intracranial pressure
(ICP) to increase

Colloids

53
 Albumin, hetastarch Stays in the circulation, Increases plasma volume during ■ Administration of 250 mL of

(Hespan) enabling much smaller shock caused by burns, bleeding, albumin is equal to 4 L of normal
amounts to be used for surgery, or other forms of trauma saline
the same volume ■ Can cause edema and can also
expansion trigger anaphylaxis

NEUROLOGICAL AND PSYCHOACTIVE DRUGS

These drugs are used to treat various neurological, cognitive, and psychological disorders

Drug Actions/ Adverse Effects Nursing Considerations

Indications
Barbiturates Sedative, hypnotic, ■ Lethargy ■ Therapeutic blood level of

Suffix: -bital anticonvulsant, and CNS ■ Respiratory depression phenobarbital is 10–25

depressant effects mcg/mL
Examples:
secobarbital,
phenobarbital,
allobarbital
Carbamazepine Used for bipolar disorder ■ Dizziness ■ Does not cause significant side
and seizure disorder if the

54
 (Tegretol) patient cannot take ■ Nausea effects
valproate (Depakote) ■ Headache

Divalproex Blocks sodium or ■ Nausea and vomiting ■ Therapeutic blood level of

sodium calcium channels; for ■ Gastrointestinal distress valproate is 50–100 mcg/mL

treatment of epilepsy or ■ May cause fatal hepatitis and ■ Rapid onset of action
(Depakote)
bipolar mania pancreatitis

Fosphenytoin Treats certain types of ■ Dizziness ■ Discontinue infusion and notify

seizures (e.g., status ■ Drowsiness physician if rash appears
epilepticus) ■ Headache ■ Be prepared to substitute an
■ Dry mouth alternative therapy rapidly to
prevent withdrawal-precipitated
seizures; substitute when unable to
use phenytoin (Dilantin)

Levetiracetam Inhibits spread of seizure ■ Suicidal ideation ■ Drug levels may be obtained to

(Keppra) activity in the brain ■ Hypertension monitor compliance

Alternative to valproate ■ Drowsiness

(Depakote) for patients ■ Low long-term risk

with milder symptoms ■ Acute infection of nose, throat,
Oxcarbazepine Anticonvulsant; inhibits and sinuses
(Trileptal) seizure activity ■ Vertigo
■ Double vision

55
 ■ Mild skin rash
■ Dizziness ■ Must be given slowly

■ Sleep problems ■ Therapeutic drug level of

■ Headache phenytoin is 10–20 mcg/mL

Phenytoin ■ Joint pain ■ Toxicity symptoms include poor
(Dilantin) gait and coordination, slurred
speech, nausea, lethargy, and
diplopia
Contraindicated in pregnancy as it
may cause fetal Dilantin
syndrome (craniofacial anomalies,
mental retardation),
drug-induced lupus, life-threatening
skin
reactions (Stevens–Johnson
syndrome), toxic epidermal
necrolysis, life- threatening liver
failure, and pancreatitis NOTE:
This drug is only compatible in
normal saline. An increased risk
of adverse cardiovascular

56
 reactions
is associated with rapid
administration

Verapamil Used for drug-resistant ■ Constipation ■ Possible alternative antiseizure

(Calan) epilepsy ■ Headache medication for pregnant women

■ Low incidence of side effects

Drugs Used to Treat Other Neurological Diseases and Psychological Disorders

Attention Deficit Disorder

Dextroampheta- mines: Used for attention deficit ■ Severe nervousness NOTE: Supervise drug withdrawal

methylpheni- date (Ritalin) disorder ■ Chest pain carefully following prolonged use.
■ SVTs Abrupt withdrawal may result in
■ Hypertension severe depression and psychotic
■ Uncontrollable head, mouth, neck, behavior
arm, or leg movements

Myasthenia Gravis

Acetylcholinesterase Inhibits the cholinesterase ■ Muscle twitching NOTE: Neostigmine and

inhibitors enzyme from breaking ■ Blurred vision pyridostigmine are the antidote to
down acetylcholine Used anticholinergic poisoning
Examples: neostigmine,
to treat myasthenia
pyridostigmine

57
 gravis, glaucoma, and
Alzheimer’s disease

Parkinson’s Disease

Benztropine mesylate Antidyskinetic; used as an ■ Abdominal cramps ■ Can produce anhidrosis (absence

(Cogentin) adjunct in the treatment of ■ Bloating of sweating), resulting in heat

all forms of parkinsonism ■ Dizziness stroke
and in control of ■ Dry mouth ■ Contraindicated in patients
extrapyramidal disorders with angle- closure glaucoma

Levodopa Metabolized to dopamine in ■ Uncontrolled movements of body ■ May cause a drug- induced
the body parts extrapyramidal disorder
Used to treat symptoms ■ Irregular heartbeat ■ Contraindicated in patients
of stiffness, tremors, spasms, taking
and poor monoamine oxidase inhibitors
muscle control in (MAOIs) and in those with narrow-
Parkinson’s disease angle glaucoma or malignant
melanoma

58
 Sinemet Used to treat Parkinson’s ■ Mild nausea ■ May turn sweat, saliva, and urine
disease ■ Dry mouth reddish brown
■ Loss of appetite
■ Headache
■ May cause drowsiness

Trihexyphenidyl (Artane) Antidyskinetic; used to ■ Dry mouth ■ Adverse effects are usually dose
treat the symptoms of ■ Blurred vision related and may be minimized
Parkinson’s disease and ■ Drowsiness or dizziness by dosage reduction
tremors caused by other ■ Older adults appear to be more
medical problems or drugs sensitive to the drug effects and
adjustment
of standard adult dosages may be
needed

Anxiety

Azapirones Example: Used as anxiolytics, for ■ Dizziness ■ Monitor for therapeutic

buspirone (BuSpar) generalized anxiety disorder; ■ Nausea effectiveness

added to antidepressants ■ Headaches ■ The desired response may begin
such as selective serotonin ■ Nervousness within 7–10 days; however,
reuptake inhibitors (SSRIs) optimal results generally take 3–4
weeks

59
 ■ Reinforce with the patient the
importance of continuing
treatment while drug response is
being evaluated

Benzodiazepines Used for anxiety disorders; ■ CNS effects and respiratory ■ Side effects are dose dependent

Suffixes: -zolam, has sedative, hypnotic, depression ■ Antidote for benzodiazepine

anticonvulsant, muscle ■ Ataxia overdosage: flumazenil
-zepam Examples:
relaxant, and amnesic effects ■ Renal and hepatic failure
lorazepam (Ativan),
alprazolam, midazolam,
diazepam
Diphenhydramine Used as an anxiolytic and ■ Motor impairment (ataxia) ■ Monitor patients for drowsiness,

(Benadryl) antihistamine; has potent ■ Flushed skin dizziness, and fatigue

anticholinergic effects ■ Photophobia

Antipsychotics

Lithium Used to treat bipolar ■ Hypothyroidism ■ Caution the patient to avoid

disorder and syndrome of ■ Decreased renal function NSAIDs, thiazide diuretics, and
inappropriate antidiuretic ■ Hyperparathyroidism muscle relaxants
hormone (SIADH) ■ Decreased sodium levels ■ Monitor for signs and symptoms
secretion of lithium toxicity (persistent

60
 nausea, vomiting, diarrhea, ataxia,
blurred vision, and ringing in the
ears)
■ Lithium levels should be obtained
12 hours after the last dose

Quetiapine (Seroquel) Atypical (second- ■ Drowsiness ■ Monitor the patient for weight
generation) antipsychotic; ■ Dry mouth gain
used for sleep problems and ■ Constipation
agitation, and in the ■ Weight gain
treatment of bipolar disorder

Risperidone Atypical (second- ■ Drowsiness ■ Reassess the patient periodically

generation) antipsychotic; ■ Dizziness and maintain on the lowest
used in elderly patients at ■ Dry mouth effective drug dose
low dosage ■ Weight gain
Ziprasidone Atypical (second- ■ Skin rash ■ Causes less weight gain than

(Geodon) generation) antipsychotic; ■ Anxiety olanzapine (Zyprexa)

used to treat schizophrenia ■ Depressed mood
■ Headache
Other antipsychotic Used to treat ■ Dry mouth ■ May take up to 4 weeks to achieve

drugs schizophrenia ■ Blurred vision a therapeutic effect

■ Hypotension NOTE: The combination of the
Examples:
61
chlorpromazine ■ Irreversible degenerative following symptoms is

(Thorazine), pigmentary retinopathy considered a crisis:

■ Photosensitivity hyperthermia, dyspnea,
thioridazine
■ Blue-gray discoloration seizures, and unstable blood
(Mellaril-S),
■ Orthostatic hypotension pressure
loxapine (Loxitane), ■ Lowered seizure threshold
molindone (Moban), ■ Ventricular arrhythmias
perphenazine ■ Acute dystonia (spasms of tongue,

(Trilafon), neck, and back— mimics seizures),

may occur 1–5 days after initial
thiothixene
treatment; manage with
(Navane),
antiparkinson drugs
trifluoperazine ■ Parkinsonism (rigidity, tremors,
(Stelazine), masked expression, shuffling gait)
haloperidol may occur 5–30 days after

(Haldol, Serenace), initial treatment

Akathisia (motor restlessness— not
fluphenazine
■

anxiety) may occur within 5–60

(Prolixin),
days; reduction in dosage is
droperidol, required or benzodiazepine must be
prochlorperazine administered

62
 ■ Akinesia (fatigue related)
■ Tardive dyskinesia (continuous
movement of the mouth, jaw,
hands, or legs) may occur after
months to years of treatment
■ Rabbit syndrome (periorbital
tremor) may occur after months to
years of treatment; manage with
antiparkinson drugs
5-HT2 antagonists Used to treat ■ Induces weight gain ■ Patients should not use alcohol

Examples: schizophrenia and bipolar ■ High frequency of extrapyramidal and other CNS depressants
disorder, acute psychotic motor side effects (dystonias, because of the possible additive
fluphenazine
states, and delirium akathisia, pseudoparkinsonism) CNS depressant effects with
(Prolixin),
■ Agranulocytosis concurrent use
haloperidol ■ QT prolongation ■ Patients may develop
(Haldol) , olanzapine hyperglycemia and diabetes
(Zyprexa),
risperidone
(Risperdal)

63
Depression
Bupropion (Wellbutrin Atypical antidepressant; ■ Extrapyramidal symptoms ■ Patients should not take this

XL, Zyban) assists in smoking cessation ■ Grand mal seizures medication with other medications
■ Cardiac disease that contain bupropion such as
■ Suicide risk MAOIs

Monoamine oxidase Acts by inhibiting the ■ Metallic, bitter taste ■ Considered the last-line treatment

inhibitors (MAOIs) activity of monoamine ■ Akathisia (“inner” restlessness that because of numerous lethal
oxidase Used to treat manifests with an inability to sit still dietary and drug interactions
Examples: isocarboxazid
panic disorders, social or remain motionless) ■ Should not be administered in
(Marplan), phenelzine
phobia, atypical depression, patients who take other
(Nardil), tranylcypromine bulimia, post- traumatic psychoactive substances; common
(Parnate) stress disorder, and examples include SSRIs, tricyclic
borderline personality antidepressants, and meperidine
disorder

Selective serotonin Used to treat depression ■ Persistent pulmonary hypertension NOTE: Treatment for approximately

reuptake inhibitors and anxiety disorders by ■ Orthostatic hypotension 3 weeks is required to evaluate
increasing ■ Akathisia desired response
(SSRIs)
serotonin levels ■ Suicidal ideation
Examples: citalopram
■ Syndrome of inappropriate
(Celexa), escitalopram antidiuretic hormone hypersecretion
(Lexapro) , fluoxetine (SIADH)

64
(Prozac), paroxetine
(Paxil), sertraline
(Zoloft)
Serotonin modulators Used to treat major ■ Increased risk of suicide ■ Monitor pulse rate and regularity

Example: trazodone depressive episodes; ■ Priapism (sustained and painful before administration if the
inhibits reuptake of erection) patient has preexisting cardiac
hydrochloride (Desyrel)
serotonin disease

and directly increases the

action of serotonin
Blocks the absorption of
serotonin and
norepinephrine in the Nausea
Serotonin– ■

brain Dry mouth NOTE: SNRIs can cause

norepinephrine
■

■ Sleepiness dangerously high levels of

reuptake inhibitors
■ Fatigue serotonin. This is known as
(SNRIs)
serotonin syndrome (confusion,
Examples: duloxetine rapid or irregular heart rate,
(Cymbalta), venlafaxine Used for depression or dilated pupils, fever, and

(Effexor, Effexor XR) schizophrenia unconsciousness)

65
 Thioxanthene NOTE: These drugs may cause

derivatives Examples: ■ Motor impairment (ataxia) neuroleptic malignant syndrome

■ Flushed skin (hyperpyrexia, muscle rigidity,
clomipramine
■ Photophobia altered mental status, and
(Anafranil), thiothixene
evidence of autonomic instability)
(Navane)
Tricyclic Used primarily for ■ Hypotension ■ Monitor for signs and symptoms

antidepressants (TCAs) depression ■ Weight gain of drowsiness and dizziness (initial

■ Urinary retention stages of therapy), and institute
Suffix: -tyline
■ Photosensitivity measures to prevent falling
Examples: Monitor for overdose or suicidal
■ May cause blurred vision, change ■

amitriptyline, in urination, and drowsiness ideation in patients who abuse

nortriptyline, alcohol

protriptyline

REPRODUCTIVE DRUGS: HORMONES

Reproductive drugs act upon the reproductive system and are important for the regula tion of ovulation and menstruation.

Drug Actions/ Adverse Effects Nursing Considerations

Indications

66
 Estrogen (Premarin) A mixture of conjugated ■ Increased risk of myocardial ■ Arrange for pretreatment and

Suffix: -trel Examples: estrogens derived from infarction, cerebrovascular periodic (at least annual) history
natural sources used to treat accident and physical exam, which should
female hormones
postmenopausal symptoms (CVA), invasive breast cancer, include assessment of blood
(progestin)— desogestrel,
endometrial cancer pulmonary pressure, breasts, abdomen, pelvic
etonogestrel, norgestrel emboli (PE), and DVT organs, and a Pap smear

Progesterone (Provera) Used to induce bleeding in ■ Increased risk of blood clots, ■ Monitor for signs and
women who have amenorrhea stroke, heart attack, and breast symptoms of
cancer thrombophlebitis

RESPIRATORY DRUGS
Respiratory drugs are used to treat diseases of the pulmonary system (respiratory tract and lungs), including inflammatory and obstructive
diseases, such as reactive airway and chronic obstructive pulmonary diseases

Drug Actions/ Indications Adverse Effects Nursing

67
 Considerations
Anticholin Used for chronic obstructive ■ Headache ■ Contraindicated in patients

ergic drugs pulmonary disease ■ Dizziness with renal and hepatic

Dry mouth insufficiency
Examples:
■

■ Cough
ipratropiu
m bromide
(Atrovent)
Beta-2 Short acting; used for reversible ■ Arrhythmias ■ Monitor respiratory and cardiac

adrenergic obstructive airway disease ■ Seizure disorder status

Hyperthyroidism
agonists
■

■ Nervousness
Examples:
■ Tremors
albuterol
(Ventolin),
Beta- Relaxes airway smooth muscle ■ Tremors ■ Can be used for acute and

adrenergic with subsequent bronchodilation ■ Tachycardia chronic conditions

Hypokalemia ■ Administer with caution to
bronchodilato
■

patients being treated

rs Suffix: -
with MAOIs and TCAs, or
terol patients with ischemic heart

68
 Examples: disease, hypertension, or

arformoteol, cardiac arrhythmias

formoterol,
levalbuterol,
salmeterol
Leukotriene Used for asthma and to reduce ■ Hepatic and renal ■ Monitor effectiveness carefully

receptor bronchospasm insufficiency when used in combination

■ Montelukast (Singulair) with phenobarbital or other
antagonists
can cause severe behavior potent cytochrome P450
Examples:
and mood-related changes enzyme inducers
zafirlukast
(Accolate),
montelukast
(Singulair)
Steroid Opens airways in the lungs to ■ Nausea ■ Instruct patient to rinse and

inhalers make breathing easier ■ Diarrhea gargle after each use of a

Upset stomach steroid inhaler to prevent
Examples:
■

■ Dry mouth or throat thrush (candidiasis)

fluticasone
Allergy and Asthma

69
Acetylcysteine Used for dissolving mucus, to treat ■ Unusual or unpleasant smell ■ Concurrent use with a beta

(Mucomyst) Tylenol overdoses, and as a nephron- while using the medication blocker can
protective agent when IV contrast ■ White patches or sores cause dangerous reductions in
agents must be administered inside the mouth or lips heart rate

Dornase alfa Used for cystic fibrosis treatment and ■ Sore/dry throat or hoarseness ■ Monitor for changes in blood

(Pulmozyme) allergic reactions. ■ Eye irritation and redness glucose levels or unusual
bleeding

Fexofenadine Histamine H1-receptor antagonist ■ Headache ■ Do not administer with

hydrochloride (Allegra) Used to treat seasonal allergic rhinitis ■ Diarrhea aluminum- and magnesium-
and chronic idiopathic urticaria in ■ Nausea and vomiting containing antacids
adults and children 2 years of age and ■ Weakness
older

Methylxanthine drugs Used in the treatment of chronic ■ Headache ■ Normal blood level less
obstructive pulmonary Irritability than 20 mg/L
Example: theophylline ■

disease (COPD) and asthma Positive ■ Sleeplessness ■ Caution the patient to avoid
inotropic that relaxes smooth muscles consuming large amounts of
and increases heart muscle caffeine-containing beverages or
contractility and efficiency supplements

70
 ■ Monitor for signs and
symptoms of toxicity (nausea,
diarrhea, increased heart rate,
arrhythmias, and CNS
excitation)
Beta-adrenergic agonist used for ■ Cardiac arrhythmia ■ Assess baseline pulse and
asthma Tocolytic; can be used for ■ Poorly controlled thyroid blood pressure before each
preterm labor disease dose
■ Diabetes mellitus
■ Migraines
■ Cardiopulmonary
arrhythmias or ischemia
■ Hypotension
■ Tachycardia
■ Hypokalemia

BIBLIOGRAPHY

BOOK REFERENCES: -
1. Horne R, Weinman J, Barber N, Elliott R, Morgan M. Concordance, adherence and compliance in medicine-taking, Report for the
National Co-ordinating Centre for NHS Service Delivery and Organisation R & D. 2005.
2. Department of Health. Pharmacy in England, building on strengths - delivering the future. 2008. pp. 1–141.

71
3. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst
Rev. 2008;(2):CD000011.
4. Horne R. Compliance, adherence, and concordance: implications for asthma treatment. Chest. 2006;130(1 Suppl):65S–72S. [PubMed]
5. Horne R. Compliance, adherence and concordance. In: Taylor KHG, editor. Pharmacy Practice. Taylor and Francis; 2001. pp. 165–184.

INTERNET REFERNCES: -
1. A. Talwar. Drug Book ;2019; Available from:

[Link]

2. [Link]

3. [Link]

72