PHARMACOLOGY (metabolism), and excretion of

Introduction to Pharmacology drugs.

Ms. Awayan ●​ Pharmacokinetics - study of what
the body does to the drug. The study
Why Study Pharmacology? of the absorption, distribution,
●​ Medical Errors biotransformation (metabolism), and
●​ Medication error > adverse events excretion of drugs.
●​ Outside documentation and ●​ Pharmacodynamics - the study of
communication, medication-related what the drug does to the body;
task involves drug-receptor relationships.
●​ Medication administration is the last
task involved in pharmacotherapy Contraindications
-​ List of conditions for which the drug
Note: should not be given.
Adverse Effects = Unexpected
Effects/Reactions Side Effects and Adverse Reactions
-​ a list of possible unpleasant or
Medication Errors Originate and are dangerous effects, other than the
Intercepted: desired effects.
●​ Prescribing
●​ Transcribing Note:
●​ Dispensing -​ Level 1 Penicillin is not beneficial for
●​ Administration pregnant women.

Pharmacology (pharmacon = drug; logos Interactions

= science) -​ A list of other drugs for food that
-​ Study of how chemical substances may alter the effects of the drug and
interact with living systems. usually should be given during the
Drug same course of therapy.
-​ Chemicals that affect the physiologic
processes of a living organism can
broadly be defined.

3 Basic Areas of Pharmacology:

●​ Pharmaceutics
-​ the body of how various dosage
forms influence how the drug
affects the body.
-​ “Kung unsa nga porma sa medicine,
whether tablet or syrup, etc. makapa
influence unsa ang pag apekto sa
lawas.”
-​ The study of the absorption,
distribution, biotransformation
 Pharmacognosy
Pharmacotherapeutic -​ Study of drugs derived from herbal
-​ Uses drugs to treat, prevent, and and natural resources.
diagnose. Toxicology
Ex. Vasopressors, Volume expands, and -​ Study of poisons and poisoning
Intensive chemotherapy -​ Can result from a variety of causes,
ranging from drug overdose, to
Types of Volume Expanders: ingestion to household cleaning
●​ Crystalloids (PLNSS, D5LR,) are agents to snakebite.
“water-soluble to the body.” -​ The science of the adverse effects of
●​ Colloids (mixed substance) chemicals on living organisms

Pharmacotherapeutic Types:
●​ Acute
●​ Maintenance
●​ Supplemental
●​ Palliative
●​ Supportive
●​ Prophylactic

Pharmacogenomics
-​ study of the influence of genetic
factors on drug response, including
the nature of genetic aberrations that
result in the absence,
overabundance, or insufficiency of
drug-metabolizing enzymes.
Sources of Drugs and Drug Information:
Pharmacoeconomics ●​ Physician's Desk Reference (PDR)
-​ Study of economic factors impacting ●​ Package Inserts
the cost of drug therapy. ●​ Nursing Drug Guides, Nursing
-​ Examine the treatment outcome. Journals
Economic ●​ Internet Websites
> Cost benefit
> Cost effectiveness Drug Classifications
> Cost minimization -​ Are classified according to their
> Cost utility effects on body systems, and their
therapeutic uses.
Humanistic Based on:
> Quality of life ●​ Chemical Nature
> Patient preferences ●​ Source
> Patient satisfaction ●​ Target Organ
●​ Mode of Action
 ●​ Therapeutic Use B.​ Schedules of Controlled Substances
●​ Physiological System Schedule I — drugs with a high abuse risk.
These drugs have NO safe, accepted medical
Physical Effects use in the United States. Some examples are
Prescription Drugs heroin, marijuana, LSD, PCP, and crack
-​ Those that have on their labels the cocaine.​
prescription legend. Schedule II — drugs with a high abuse risk,
-​ May be prescribed by legally but also have safe and accepted medical uses
authorized health practitioners as in the United States. These drugs can cause
severe psychological or physical dependence.
part of their specific practice.
Schedule II drugs include certain narcotics,
stimulants, and depressant drugs. Some
examples are morphine, cocaine, oxycodone
Prescriptions:
(OxyContin®), , methylphenidate (Ritalin®),
-​ Legal order— and dextroamphetamine (Dexedrine®).​
●​ Doctor Information Schedule III, IV, or V — drugs with an abuse
●​ Patient Information risk less than Schedule II. These drugs also
●​ Drug Information have safe and accepted medical uses in the
United States. Schedule III, IV, or V drugs
Prescription and Non Prescription Drugs include those containing smaller amounts of
Non Prescription Drugs certain narcotic and non-narcotic drugs,
-​ Drugs that may be legally acquired anti-anxiety drugs, tranquilizers, sedatives,
by the client without the prescription stimulants, and non-narcotic analgesics.
order. Some examples are acetaminophen with
-​ Also known as over the counter codeine (Tylenol® No.3), paregoric, diazepam
drugs (OTC) (Valium®), alprazolam (Xanax®) and
pentazocine (Talwin®).
Investigational Drugs
-​ A new drug which a manufacturer Controlled Drug Regulations
wishes to market. ●​ 2 Licensed Personnel, count every
-​ Must fulfill the requirements of the shift
FDA ●​ Witness to all discards
●​ Record on Control Substance Sheet
Orphan Drug of all administrations and wastes
-​ Drugs that have been discovered but
are not financially viable and 10 R’s of Drug Administration
therefore have not been “adopted” ●​ Right Drug
by any drug company. ●​ Right Patient
●​ Right Dose
Illicit Drugs ●​ Right Route
-​ “Street” drugs are those which are ●​ Right Time
used and/or distributed illegally. ●​ Right to Refuse
●​ Right Knowledge and Understanding
Legal Regulation of Drugs ●​ Right Questions or Challenges
A.​ FDA Pregnancy Categories ●​ Right Response or Outcomes
 ●​ Right Advice ●​ phase III study: use of a proposed
drug on a wide scale in the clinical
setting with patients who have the
disease the drug is thought to treat
14 Rights of Administration of Drug ●​ phase IV study: continuous
evaluation of a drug after it has been
released for marketing
●​ preclinical trials: initial trial of a
chemical thought to have therapeutic
potential; uses laboratory animals,
not human subjects
●​ teratogenic: having adverse effects
on the fetus

Stages of Clinical Trials

Drug Name Analysis:

Generic Name/Official Name: e.g
amoxicillin
-​ Name of the drug as it appears in
the official reference.
-​ The original designation that a drug
is given when the drug company that
developed it applies for the approval
Philippine National Drug Formulary process
-​ Make quality essential—
Brand Name/Trade Name - name given to
a drug by the pharmaceutical company that
developed it.
Testing and Clinical Trials
-​ Begins with animal studies to Chemical Name
determine potential uses and effects. -​ Name that reflects the chemical
structure of a drug
Phases of Clinical Trials
●​ phase I study: a pilot study of a Drug Routes of Administration:
potential drug using a small number ●​ Sublingual
of selected, usually healthy human ●​ Oral
volunteers ●​ Buccal
●​ phase II study: a clinical study of a
proposed drug by selected Enteral Administration
physicians using actual patients who ●​ Lavage = out
have the disorder the drug is ●​ Gavage = in
designed to treat; patients must
provide informed consent
 ●​

Parenteral Administration Assessment

Types of Injections: Past history
-​ Chronic conditions
-​ Drug use
-​ Allergies
-​ Level of Education
-​ Level of Understanding of Disease
and Therapy
-​ Social Support
-​ Financial Supports
-​ Pattern of Healthcare
Topical Administration of Drugs
●​ — Physical Examination
-​ Weight
Types of Drug Preparation -​ Age
●​ Aerosol Spray -​ Physical parameters related to the
●​ Aqueous Suspension disease state or known drug effects.
●​ Aqueous Solution
●​ Capsule Nursing Diagnosis
●​ Cream ●​ Patient has knowledge deficit related
●​ Extract to drug therapy and reasons for use;
●​ Elixir need for follow up test and office
●​ Gel or Jelly visits
●​ Liminents ●​ Patient is at risk for injury related to
●​ Lotion adverse effects of medications
●​ Lozenge ●​ Patient is at risk for falls related to
●​ Ointment various anticipated or unanticipated
●​ Paste side effects of medications
●​ Pill ●​ Diarrhea (or constipation) related to
●​ Powder side effects of medications.
●​ Suppository ●​ Ineffective health maintenance
●​ Syrup related to inability to make
●​ Tablet appropriate judgements or to lack of
●​ Tincture resources.

Example of— Planning

●​ Nurses will prioritize identified
needs, keeping patient comfort and
safety as top priorities.
Information that should not be delegated ●​ List the steps for correctly drawing
●​ Assessment up his or her insulin dosage.
●​ Documentation
 ●​ Demonstrate the correct technique Drugs and Solutions
for self administration of a Ms. Awayan
medication patch Measuring Systems
●​ Verbalize the most common side ●​ Metric System
effects of medication -​ The most widely used systems of
●​ Report pain relief of at least 3 on measure
scale of 10 within 30mins -​ Based on the decimal system, all
units are determined as a multiple of
Implementation 10.
●​ Proper drug administration -​ Uses the gram as the basic unit of
(Consider the Rights) solid measure and the liter as the
-​ Drug basic unit for liquid measure.
-​ Storage
-​ Route ●​ Apothercarie’s System
-​ Dose -​ Very old system of measurement
-​ Preparation that was specifically developed for
-​ Timing use by apothecaries or pharmacists.
-​ Recording -​ Uses the minim as the basic unit of
●​ Comfort measures liquid measure and grain as the
-​ Placebo effect basic unit of solid measure.
-​ Managing adverse effects -​ Much harder to use and rarely seen
-​ Lifestyle adjustment in most clinical settings
●​ Patient/Family Education
●​ Household System
Compliance—- -​ Measuring system that is found in
recipe books. Uses the teaspoon as
Evaluation the basic unit of fluid measure and
●​ The patient is continually evaluated the pound as the basic unit of solid
for therapeutic response, the measure.
occurrence of adverse drug effects,
and the occurrence of drug to drug,
drug to food, drug to alternative LENGTH
therapy, or drug to laboratory test 1 km = 1k meters
interactions. 1 m = 100 cm
1m = 1k mm
Monitoring 1 cm = 10 mm
●​ Adverse Effects
●​ Therapeutic Index MASS
●​ Drug Concentration 1kg = 1k grams
●​ Patient’s Condition 1 gram = 100 centigram
●​ Tolerance and Dependence 1 gram = 1k milligrams
●​ Interactions 1 mg = 1k milliliters
●​ Adverse Drug Events
VOLUME Faster Absorption
1kiloliter = 1k liters ●​ Parenterally
1 liter = 100 centiliters ●​ Inhaled
1 liter = 1k milliliters ●​ Directly into the Brain
1ml = 1k mg
Absorption: Solubility
Dosage Calculations Systems of ●​ Water-soluble
Measurements ●​ Lipid-soluble (fat)
SAFETY MEASURES:
●​ Three checks (Upon, During, and Dissociation constant or pKa - to measure
After) and 10 “Rights” the strength of an acid.
●​ Maintaining Safe Environment
●​ Caring for Controlled Substances This affects a drug’s solubility, permeability,
Safely binding, and other characteristics.
●​ Identifying the Patient

Drug Calculations Bioavailability

Terms: -​ Fraction of drug administered
●​ Route reaching the systemic circulation.
●​ Medication -​ Dosage of drugs with a high hepatic
●​ Dose extraction.
●​ Vehicle
Effect of Organs on Drug Metabolism (First
Pediatric Considerations Pass Effect)
●​ Age
●​ Weight Factors that affect Bioavailability:
●​ Body Surface Area ●​ Psychological Properties
-​ State of drugs
-​ Particles Size
Characteristics of pediatric patients that -​ pKa value and state of ionization
have a significant effect on dosage include -​ Route of administration
the following: -​ Plasma Protein binding
●​ Skin is thinner and more permeable. ●​ Biological Properties
●​ The stomach lacks acid to kill ●​ Dosage Form
bacteria.
●​ Lungs have weaker mucous barriers Pharmacokinetics
●​ Body temperature is less well Distribution
regulated— -​ The drug is distributed throughout
the body after it has been absorbed
into the bloodstream.
—---- -​ Distribution depends on the rate of
perfusion and capillary permeability
to the drug.
 -​ Drug distribution to the CNS is Renal Elimination of Drug
limited because the blood-brain 1.​ Glomerular Filtration
barrier, which is composed of ●​ Drugs enter the kidney through renal
capillaries with tight walls, limits the arteries, which divide to form a
movement of drug molecules into glomerular capillary plexus.
brain tissue.
Glomerular filtration rate (GFR)
Pharmacokinetics -​ Normal: 125ml/min
-​ The fluid that filters through the
Metabolism/Biotransformation glomerulus into a bowman's capsule
-​ It involves the biochemical alteration is called “glomerular filtration”.
of the drug into an inactive
metabolite, a more soluble
compound, a more— Stages of Chronic Kidney Disease
Stage 1-5
Phases of Metabolism
Drug Metabolism
Phase 1: Functionalization
●​ Hydrolytic Reaction
●​ Oxidation
●​ Reduction
Phase 2: Conjugation

Most drugs are lipid-soluble, a characteristic

that aids their movement across cell
membranes.

The kidneys, which are primary excretory Serum Drug Levels

organs, can excrete only water-soluble -​ Laboratory measurement of the
substances. amount of a drug in the blood at a
particular time.
First Pass Effect —- -​ It reflects dosage, absorption,
bioavailability, half-life, and the rates
of metabolism and excretion.
Pharmacokinetics
Excretion The drug level continues to climb as more of
-​ Refers to the elimination of a drug the drug is absorbed until it reaches its
from the body. highest concentration and peak drug action
-​ Effective excretion requires occurs.
adequate functioning of the
circulatory system and of the organs Serum half-life or elimination half-life
of excretion (kidneys, bowel, lungs, -​ The time required for the serum
and skin). concentration of a drug to decrease
by 50%.
 effect without producing symptoms
Onset, Peak, and Duration— of toxicity.
●​ Loading Dose - initial high dose
Pharmacodynamics used to quickly elevate the level of
-​ Involves drug actions on target cells the drug in the blood (often followed
and the resulting alterations in by a series of lower doses).
cellular biochemical reactions and ●​ Maintenance Dose - dose required
functions (what the drug does to to keep the drug blood level at a
the body). steady state in order to maintain the
-​ Study of biochemical and desired effect.
physiological effects of drugs. ●​ Toxic Dose - amount of drug that
Mechanisms of Action: will produce harmful effects or
●​ Receptor Interactions symptoms of toxicity.
●​ Enzyme Interactions ●​ Lethal Dose - dose that can cause
death.
Note: ●​ Therapeutic Dose - dose that is
Necrotic - affected with, characterized by, or customarily given; adjusted
producing death of a usually localized area according to variations from the
of living tissue norm.

An agonist is a medication that mimics the Route of Administration:

action of the signal ligand by binding to and 2 Major Routes:
activating a receptor. On the other hand, an ●​ Enteral
antagonist is a medication that typically ●​ Parenteral
binds to a receptor without activating them,
but instead, decreases the receptor's ability Parenteral nutrition means feeding
to be activated by another agonist. intravenously (through a vein). "Parenteral"
means "outside of the digestive tract."
Agonist = Enhance the Action Whereas enteral nutrition is delivered
Antagonist = Inhibit the Action (Stop the through a tube to your stomach or the small
action of the immune system to stop the intestine, parenteral nutrition bypasses your
inflammation) entire digestive system, from mouth to anus.

Antibiotics are administered because they

are prophylactic. Drug Interaction:
Potentiating Effect = enhance
Terms: ●​ Additive - two drugs with similar
●​ Minimum Dose - administered to pharmacological actions are taken.
patients dependent on the drug; the Ex. Ethanol + sedative drug =
smallest amount of a drug that will increased sedation.
produce a therapeutic effect.
●​ Maximum Dose - a large amount of ●​ Synergistic or potentiation - two
a drug that will produce a desired drugs with different sites or
mechanisms of action produce
 greater effects when taken together
than either does when taken alone. Adverse Effects of Drugs:
Ex. Acetaminophen (non-opioid ●​ CNS effects may result from CNS
analgesic) + codeine (opioid stimulation.
analgesic) = increased analgesia ●​ Gastrointestinal Effects are among
the most common adverse reactions
to drugs. Diarrhea occurs with drugs
Interference - by one drug with the that cause local irritation or increase
metabolism or elimination of a second drug peristalsis.
may result in intensified effects of the ●​ Hematologic Effects are relatively
second drug. common and potentially life
Ex. Cimetidine Inhibits CYP 1A, 2C, and 3A threatening. Excessive bleeding is
drug-metabolizing enzymes in the liver and most often associated with
therefore interferes with the metabolism of anticoagulants and thrombolytics.
many drugs. ●​ Hepatotoxicity - is potentially life
When these drugs are given concurrently threatening.
with cimetidine, they are likely to cause ●​ Nephrotoxicity
adverse and toxic effects. ●​ Hypersensitivity or Allergy
●​ Drug Fever
Displacement - one drug from plasma ●​ Drug Dependence
protein binding sites by a second drug ●​ Carcinogenicity
increases the effects of the displaced drug. ●​ Teratogenicity

Note: Toxic Effects of Drugs

Naloxone - antidote for morphine ●​ Drug Toxicity

Other Factors influencing the drug

response: Drug Therapy During Pregnancy:
●​ Age ●​ The first trimester of pregnancy is
●​ Weight generally the period of greatest
●​ Gender danger and drug induced
●​ Physiological developmental defects.
●​ Pathological ●​ Breast milk is not the primary route
●​ Physiological for maternal drug excretion.
●​ Immunological
●​ Psychological Considerations for Elderly Patients:
●​ Environmental ●​ Result in adverse effects and toxicity
●​ Tolerance ●​ Complementary and alternative
medications.
●​ Polypharmacy - simultaneous use
Drug Tolerance - occurs when the body of multiple medications.
becomes accustomed to a particular drug
over time so that larger doses must be
given to produce the same effects.
 Note:
●​ Plasma is a clotting factor
Anti-inflammatory, Analgesics, and ●​ Arachidonic Acid (this is where
Anesthetics corticosteroids work) produces
Ms. Awayan cyclooxygenase to stimulate
inflammatory response.
Drug Classifications: ●​ Neutrophils are WBC
The anti-inflammatory, analgesic, and ●​ Phagocytosis eats and dissolves
antipyretic effects of the NSAIDs are largely foreign pyrogens.
related to inhibition of prostaglandin
synthesis.

Anti-inflammatory - agents that are used

to reduce inflammation

Autoimmune disease means that the

Autoimmune system is attacking its own
body.

Analgesics are pain relievers.

What happens during the inflammatory
process?
If there is a release of PROSTAGLANDIN,
PAIN is present.

INHIBIT = stop, resist, prevent.

Patients taking corticosteroids tend to be

big or have complications nga naay
nidako sa lawas.

Disease-modifying antirheumatic agents

(DMARDs) - agents that alter disease
processes rather than manifestations. DOLOR = pain
TUMOR = swelling
Protective Mechanisms: RUBOR = redness
●​ Physical barrier (skin) CALOR = heat
●​ Inflammatory Response
●​ Immune Response Salicylates
-​ Are popular anti-inflammatory
Responsible for inflammatory response: agents not only because of their
●​ Leukotrienes ability to block the inflammatory
●​ Lymphocytes response.
●​ T-Cells
 -​ Oldest and first antiinflammation Salicylate Poisoning
drug discovered. ●​ Tinnitus (Ringing in ears)
-​ Antipyretic (fever-blocking) ●​ Nausea
-​ Analgesic (pain blocking) ●​ Vomit
●​ Increase Temperature
// BAWAL SA BATA AND PATIENT WITH ●​ Hyperventilation
ULCER \\ ●​ Lethargic
-​ Kay grabe ang effect sa liver ●​ Severe toxicity
which can cause Reye’s
syndrome (children) Toxic level for a 30lb.
Child = 12 Adult aspirin or 48 baby aspirin
RISK FOR BLEEDING
Indication: mild to moderate pain Ischemic Attack = stroke (blood clot sa
brain)
MORPHINE = for patients at end stage Hemorrhagic Attack = nibuto ang vessel
and ni spread na
●​ NSAIDS
●​ Corticosteroids - used to Management:
suppress the immune system and 1.​ Administer with food if GI upset is
inflammatory process severe.
●​ Androgens 2.​ Ensure that the patient is well
●​ Glucocorticoids hydrated.
●​ Mineralocorticosteroids. 3.​ Monitor for severe reactions
●​ Gold Compounds - used for
conditions unresponsive to usual Nonsteroidal Anti-Inflammatory (NSAID)
anti-inflammatory treatment. and Related Agents
●​ DMARDS ●​ Corticosteroids

Therapeutic Effects: Acetaminophen (Tylenol)

●​ Salicylates inhibit the synthesis of -​ antipyretic and analgesic effects
prostaglandin, an important mediator -​ Mild to moderate pain
of the inflammatory reaction. -​ SEVERE LIVER TOXICITY
●​ Blocking of a prostaglandin mediator
of pyrogens at the thermoregulatory Reye Syndrome
center of the hypothalamus. Aspirin > Encephalopathy / Liver Damage
●​ Affects platelet aggregation by
inhibiting the synthesis of Encephalopathy
thromboxane A2. ●​ Lethargy
●​ Mild to moderate pain, fever and ●​ Confusion
numerous inflammatory conditions, ●​ Seizures
including rheumatoid arthritis and ●​ Coma
osteoarthritis.
Liver Damage
●​ Tiredness
 ●​ Nausea ●​ For treatment of primary
●​ Elevated AST dysmenorrhea
●​ Elevated ALT ●​ And for fever reduction

Aspartate aminotransferase (AST) Adverse Effects:

●​ It affects GI integrity—
Note:
Typically the range for normal AST is ANALGESICS
reported between 10 to 40 units per liter NSAIDS:
and ALT between 7 to 56 units per liter. C - Celebrex
Mild elevations are generally considered to N - Naproxen
be 2-3 times higher than the normal range. S - Salicylate (aspirin)
A - Advil (ibuprofen)
Acetaminophen I - Indomethacin
-​ Used for patients with PUD and D - toraDol (ketorolac)
hemophilia
-​ A - absence of bleeding NSAIDS: Precautions
-​ A - Alcohol History N- Not always good
-​ A - Acetylcysteine = Antidote S- Sticky blood clots
A - Asthma caution
Nonsteroidal Anti-Inflammatory Drugs I- Increased bleeding
●​ NSAIDs block the two enzymes, D- Dysfunction (Kidneys)
known as cyclooxygenase-1
(COX-1) and COX-2 Aspirin-Induced Asthma (AIA) Symptoms
●​ COX1 is present in all tissues and
seems to be involved in many Contraindication: NSAID
functions, including blood clotting, ●​ A - aspirin
protecting the stomach lining, and ●​ A - Avoid kids
maintaining sodium and water ●​ T- Toxicity
balance in the kidney. ●​ T - tinnitus > REPORT TO HCP
●​ COX2 is active at sites of trauma or
injury when more prostaglandins are Precautions:
needed but does not seem to be Not good for the entire body
involved in the other tissue ●​ GI bleeding - bad for ulcers
functions. ●​ Lungs - bad for asthma
●​ Heart - HTN & Heart Failure
Note: ●​ Kidney clogging - increased
NSAIDS - given for mild to moderate pain. Creatinine & BUN
●​ Blood Clots
NSAIDs are indicated for relief of the
signs and symptoms of: Note:
●​ Rheumatoid arthritis Normal Ranges:
●​ Osteoarthritis BUN: 10-20 mg/dL
●​ For relief of mild to moderate pain Creatinine: 0.5 - 1.3mg/dL
 immune system to treat various
Corticosteroids (Steroids) health problems.
-​ RISK FOR INFECTION AND FLUID
RETENTION SUGAR DADDY SYNDROME:
●​ Used to relieve pain in inflamed -​ Risk for adrenal gland suppression
parts of the body. with corticosteroid therapy (dapat e
●​ Reduce inflammation, redness, taper kada adjustment)
itching, and allergic response
●​ Corticosteroids can be systemic or Side Effects:
localized. Localized steroids target a Beclomethasone:
specific part of the body. ●​ Buffalo hump
●​ The adrenal gland releases ●​ Easy bruising
corticosteroids ●​ Cataracts
●​ Decreases immune system activity ●​ Larger appetite
●​ Good for autoimmune diseases ●​ Obesity
Ex. ●​ Moonface
●​ Hydrocortisone ●​ Euphoria
●​ Prednisolone ●​ Thin arms & legs
●​ Dexamethasone ●​ Hypertension/Hyperglycemia
●​ Beclomethasone ●​ Avascular Necrosis of Femoral Head
●​ Budesonide ●​ Skin thinning
●​ Fluticasone ●​ Osteoporosis
●​ Negative nitrogen balance
Therapeutic Effects: ●​ Emotional lability
●​ Steroids work by lowering
inflammation and decreasing Anti Allergy
immune activity. ●​ When histamine, a substance
produced by the immune system
Corticosteroids are involved in: overreacts to an allergen such as
●​ Stress response pollen or pet hair, it can cause
●​ Immune Response symptoms such as coughing,
●​ Regulation of inflammation sneezing, and watery eyes.
●​ Carb metabolism (increased blood
sugar) Allergies
●​ Protein Catabolism ●​ Histamine causes blood vessels to
●​ Blood electrolyte levels expand and widen–.
●​ Behavior
Signs and Symptoms
2 Types of Corticosteroids: ●​ Too much histamine caused by the
●​ MineraloCorticoids - regulate salt body being oversensitive and
and water balances overreacting to an allergen, causes
●​ GlucoCorticoids - fight a variety of symptoms.
inflammation and work with your
Antihistamine PRECAUTIONS:
-​ Used to treat allergy symptoms. ●​ DONT DRIVE
-​ Should be given 30 mins before ●​ DO NOT TAKE MORE THAN
blood transfusion. PRESCRIBED
Signs and symptoms:
●​ Cough
●​ Skin rash Note:
●​ Eye redness First Gen = drowsiness effect
●​ Headache Second Gen = less drowsiness effect
●​ Sneezing Third Gen = less drowsiness effect
●​ Itchy skin
●​ Runny nose
●​ Lacrimation of eyes Side Effects of Antihistamine Drugs:
–
First Generation: OTC
(These are given before blood Precautions:
transfusion) 1.​ Don't drive or do anything else that
●​ Benadryl requires attentiveness.
●​ ChlorTrimetron 2.​ Do not take more medication than is
prescribed.
BENADRYL OVERDOSE
●​ Excessive sleepiness ANTIARTHRITIS
●​ Confusion -​ Potentially debilitating inflammatory
●​ Hallucinations process in the joints that cause pain
●​ Fast heartbeat and bone deformities.
●​ Seizures -​ Gold compounds are used to
●​ Coma prevent and suppress arthritis.
-​ Used to block the inflammation and
Second and third-generation tissue damage of rheumatoid
antihistamines: arthritis.
This helps to reduce negative effects like
drowsiness. Common RA Treatments:
●​ NSAIDs
2nd generation Antihistamines: ●​ Biologics
●​ Acrivastine ●​ DMARDS (Disease-modifying
●​ Cetirizine anti-rheumatic drugs)
●​ Cortatadine ●​ Steroids

3rd generation antihistamines: Gold Compounds

●​ Desloratadine -​ Only if another anti-inflammatory
●​ Fexofenadine drug is not responding to the
●​ Levocetirizine therapies.
 -​ Some of these patients respond to Leflunomide - relieving s/s of inflammation
treatment with gold salts, also known and blocking the structural damage this
as chrysotherapy. inflammation can cause, slowing disease
-​ Chrysotherapy is reserved for use progression.
in patients who are unresponsive to
conventional therapy and can be Penicillamine - lowers igM rheumatoid
very toxic. factor levels; relieves s/s of inflammation.
Side Effects: Bone Suppression, Renal
Toxicity Common Side Effects:
●​ Loss of appetite
Therapeutic Actions and Indications ●​ Nausea
-​ Chrysotherapy results in the ●​ Diarrhea
inhibition of phagocytosis. ●​ Abdominal pain
-​ Phagocytosis is blocked, release of ●​ Rash, allergic reaction
lysosomal enzymes is inhibited, and ●​ Liver problems
tissue destruction is decreased. ●​ Increased risk of infections
-​ This action allows gold salts to ●​ Low WBC count (leukopenia),
suppress and prevent some arthritis RBC count (anemia), and platelet
and synovitis. count (thrombocytopenia).
-​ These drugs do not repair damage;
they prevent further damage; are 15min
most effective if used early in the Naloxone = Antidote; non-opioid drug,
disease. can be given to a patient with overdose of
morphine.
DMARDs
-​ Adverse effects associated with
these drugs can be severe to life
threatening because they alter the
ability of the body to initiate or carry
on an inflammatory reaction.

Anakinra - responsible for the degradation

of cartilage in rheumatoid arthritis.

Etanercept - these receptors react with

free-floating TNF released by active
leukocytes in autoimmune inflammatory
disease to prevent the damage caused by
TNF (Tumor Necrosis Factor)

Hyaluronidase - Cushion and lubricate the

joint and relieve the pain associated with
degenerative arthritis.
NURSING CARE MANAGEMENT
21min

RESPIRATORY DRUGS
Non productive Cough: Dry cough: Upper
Respi Tract Infect; Virus; provide antitussive
drugs.

Productive cough: Lower Respi Tract Infect;

Mucus; Bacterial Invasion

—-40min kulang
 ​
50min

Antihistamine - to prevent inflammatory

process
Glucocorticoids - suppress process

Decongestants - mimic
—1:10hr
—missed between 18 min
Preventing Asthma Attacks 37min
—-45min missed
—missed 57min
 Teratogenic effect

RIPES:
Hemoptysis = blood in sputum
Drugs Affecting the Neurologic System:
Peripheral Nervous System
Miss Awayan

Parasympathetic:
●​ Muscarinic
●​ Nicotinic

Sympathetic:
●​ Alpha Receptors (A1, A2)
●​ Beta Receptors (B1, B2)

Alpha 1 = Vasoconstriction Neurotransmitter Receptor

Beta 2 = Vasodilation -​ Structure on a cell’s surface that
binds to a specific neurotransmitter.
Sympathetic = Adrenergic System
(norepinephrine, epinephrine, dopamine) How to study PNS drugs
Parasympathetic = Cholinergic System Receptors involved + agonist or antagonist
(Acetylcholine) = expected response of the drug
Note:
Adverse Effects happen when a patient is
overdosed.

Acetylcholine = excitatory neurotransmitter

Norepinephrine

Dopamine

Endorphins

Serotonin Myasthenia Gravis

-​ Chronic muscular disease caused by
a defect in neuromuscular
transmission.
-​ Thought to be an autoimmune
disease in which patients make
antibodies to their ACh receptors.
-​ These antibodies cause gradual
destruction of the ACh receptors,
resulting in fever or fever receptor
sites available for stimulation.

Early Symptoms:
●​ Droopy Eyelids = ptosis
●​ Blurry or double vision = diplopia

Alzheimer's disease
- most common type of dementia
- memory loss and possibly leading to carry
on a conversation and around to the
environment
- control thought, memory and language

Risk factors::
●​ increased age (over 55 yrs of age)
●​ hypertension
●​ increased cholesterol levels
●​ Coronary artery disease
 ●​ Diabetes Dalfampridine (ampyra)
●​ genetics Potassium Channel Blocker
●​ Smoking and alcohol use -​ Increases conduction of action
potentials in unmyelinated axons.

Side effects
Down Syndrome ●​ Insomnia
symptoms: ●​ Dizziness
●​ memory problems ●​ Headache
●​ trouble with decision making ●​ Asthenia (Loss of Strength, Energy)
●​ forgetfulness ●​ Back Pain
●​ difficulty
Adverse Effects:
●​ UTI occurs in 12% of pts.
Alila medical media multiple sclerosis ●​ Nausea
animation
Nursing Management:
MULTIPLE SCLEROSIS ●​ Creatinine Clearance, BUN, CBC,
-​ Autoimmune condition serum chemistries should be
-​ Attacks the layer that surrounds and obtained prior to treatment.
protects the nerves called myelin
sheath
Fingolimod (Gilenya)
Risk factors: Immunomodulator
●​ age (20-40yrs old) -​ Reduce frequency of clinical
●​ sex (women have more chance) exacerbations
●​ family (genetic susceptibility)
●​ smoking Side effects
●​ stress, fatigue ●​ Headache
●​ physical injury ●​ Diarrhea
●​ Back pain
Signs: ●​ Cough
●​ Cognitive dysfunction
●​ Vision problems Adverse Effects
●​ Balance issues
●​ Chronic fatigue
●​ Depression Nursing Management:
●​ Monitor for bradycardia for 6 hrs.

Glatiramer (Copaxone)
Immunosuppressive

Side Effects
Pain
Erythema
Inflammation
Pruritus at injection site
Asthenia

Adverse Effects

Nursing Management

Interferon beta-1A (Avonex)

BIologic response modifier
slows MS, slows progression of disability

Nursing Management
Obtain Hgb, CBC platelet count

Interferon beta-1b (Betaseron)

Biologic Response modifier