Relias Assessments Assistance Material RN Pharmacology

Insulin

Insulin is a drug that is used to control glucose in patients with diabetes mellitus. It is the only parenteral antidiabetic agent available for exogenous replacement of low levels of insulin. Insulin is the hormone produced by the pancreatic beta cells of the islets of Langerhans. It is released into circulation when the levels of glucose around the cells arise. Insulin circulates through the body and reacts with specific insulin receptor sites to stimulate the transport of glucose into cells to be used for energy (facilitated diffusion). Originally prepared from pork and beef pancreas, virtually all insulin is prepared by recombinant DNA technology now. This is a purer form of insulin and is not associated with sensitivity problems that many patients developed with the animal products.

Muscle Relaxants

Local damage to skeletal muscles can happen due to injuries and accidents. If the damage is severe, normal muscular functioning and central nervous system may be permanently damaged. Spasticity is a condition characterized by sustained contractions of the muscle. It is due to the loss of nerves responsible for the maintenance of balance in corresponding muscle activities. Skeletal muscle relaxants are agents that can treat both temporary and permanent neuronal damage. They do this by interfering with the pain and spasm cycle.

Narcotics, Narcotic Antagonists, and Antimigraine Agents

Narcotics and antimigraine agents provide treatment for acute or chronic severe pain. These agents exert their effect on the brain and spinal cord to alter the way impulses from peripheral nerves are processed. As a result, pain perception and tolerance are altered.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Related Agents

Nonsteroidal anti-inflammatory drugs (NSAIDs) provide strong anti-inflammatory and analgesic effects without the adverse effects associated with corticosteroids. These drugs have associated cardiovascular and gastrointestinal risks when taking them. NSAIDs includes propionic acids, acetic acids, fenamates, oxicam derivatives, and cyclooxygenase-2 (COX-2) inhibitors. They differ in chemical structures but NSAIDs are clinically all-inclusive. Acetaminophen is a related drug which has antipyretic and analgesic properties but does not have the anti-inflammatory effects of the salicylates or the NSAIDs.

What are Proton Pump Inhibitors?

Proton pump inhibitors suppress the secretion of hydrochloric acid into the lumen of the stomach.

Psychotherapeutic Drugs

Psychotherapeutic agents are drugs that are used to treat problems in thought processes of individuals with both perceptual and behavioral disorders. These agents do not provide cure for psychoses but they help both adult and pediatric patients perform activities of daily living and function in a more acceptable manner.

Diuretics

Diuretics are drugs that primarily increase the excretion of sodium. To some extent, they also increase the volume of urine produced by the kidneys. By blocking the absorptive capacity of cells lining the renal tubules for sodium, intravascular volume and the eventual leaking of fluid from capillaries is reduced and prevented. It is used in the management of diseases like glaucoma, hypertension, and edema in heart failure, liver failure, and renal diseases.

Immunosuppressants

Immunosuppressants or immune suppressants are usually used in conjunction with corticosteroids to block inflammatory reaction and decrease initial damage to cells in cases of organ transplantation and autoimmune diseases. Immunosuppressants include immunomodulators, T- and B-cell suppressors, interleukin receptor antagonist, and monoclonal antibodies (antibodies produced by a single clone of B-cells that react with specific antigens).

What are Inhaled Steroids?

Inhaled steroids are used to decrease the inflammatory response in the airway. Inhaling the steroid tends to decrease the numerous systemic effects that are associated with steroid use. It is usually useful to try another preparation if one is not effective within 2 to 3 weeks.

Inhaled Steroids

Inhaled steroids have been found to be a very effective treatment for bronchospasm. The drug of choice depends on the individual patient's response; a patient may have little response to one agent and do very well on another.

General and Local Anesthetics

Anesthetics are drugs used to cause complete or partial loss of sensation. These drugs are subdivided based on site of action and can either be general or local. General anesthetics can cause central nervous system (CNS) depression to produce loss of pain sensation and consciousness. On the other hand, local anesthetics cause the same sensation and feeling in a certain area of the body without producing the systemic effects related to severe CNS depression.

Antihyperlipidemic Drugs

Antihyperlipidemic Drugs lower serum levels of cholesterol and various lipids. They are also called as lipid-lowering agents; these drugs provide effective treatment for hyperlipidemia (increased lipid level in the blood). The incidence of coronary artery disease (CAD), the most common cause of death among adults, is higher in people with hyperlipidemia. High level of lipids and triglyceride is associated with metabolic syndrome consist of insulin resistance, abdominal obesity, hypertension, and proinflammatory and prothrombotic states.

Antihypertensive Drugs

Antihypertensive drugs affect different areas of blood pressure control so in most cases, these agents are combined for synergistic effect. Ninety percent of cases of hypertension have no known cause. Therefore, the main action of antihypertensive agents is to alter the body's regulating mechanisms (e.g. baroreceptors, renin-angiotensin-aldosterone system, etc.) responsible for maintaining normal blood pressure.

Antiviral Drugs

Antivirals are agents used to treat the diseases caused by viruses such as warts and common colds.

Anxiolytic and Hypnotic Drugs

Anxiolytic-hypnotics agents are used to alter an individual's responses to environmental stimuli. These agents are referred to as anxiolytics (prevent feelings of tension or fear), sedatives (help patient feel calm and unaware of their environment), and hypnotics (help patients sleep).

Inhaled Steroids Nursing Assessments

Assess for possible contraindications and cautions: acute asthmatic attacks and allergy to the drugs, which are contraindications; and systemic infections, pregnancy, or lactation, which require cautious use. Perform a physical examination to establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy. Assess temperature to monitor for possible infections. Monitor blood pressure, pulse, and auscultation to evaluate cardiovascular response. Assess respirations and adventitious sounds to monitor drug effectiveness. Examine the nares to evaluate for any lesions that might lead to systemic absorption of the drug.

PPI Nursing Assessment

Assess for possible contraindications and cautions: history of allergy to a proton pump inhibitor to reduce the risk of hypersensitivity reaction and current status of pregnancy or lactation because of the potential for adverse effects on the fetus or nursing baby. Perform a physical examination to establish baseline data before beginning therapy to determine the effectiveness of the therapy and to evaluate for the occurrence of any adverse effects associated with drug therapy. Inspect the skin for lesions, rash, pruritus, and dryness to identify possible adverse effects. Assess neurological status, including level of orientation, affect and reflexes to evaluate for CNS effects of the drug. Inspect and palpate the abdomen to determine potential underlying medical conditions; assess for changes in bowel elimination and GI upset to identify possible adverse effects. Assess respiratory status, including respiratory rate and rhythm; note evidence of cough, hoarseness, and epistaxis, to monitor for potential adverse effects of the drugs.

Bronchodilators and Antiasthmatics Nursing Assessments

Assess for possible contraindications or cautions: any known allergies to prevent hypersensitivity reactions; cigarette use which affects the metabolism of the drug; peptic ulcer, gastritis, renal or hepatic dysfunction, and coronary disease, all of which could be exacerbated and require cautious use; and pregnancy and lactation, which are contraindications because of the potential for adverse effects on the fetus or nursing baby. Perform a physical examination to establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy. Perform a skin examination, including color and the presence of lesions, to provide a baseline as a reference for drug effectiveness. Monitor blood pressure, pulse, cardiac auscultation, peripheral perfusion, and baseline electrocardiogram to provide a baseline for effects on the cardiovascular system. Assess bowel sounds and do a liver evaluation and monitor liver and renal function tests to provide a baseline for renal and hepatic function tests. Evaluate serum theophylline levels to provide a baseline reference and identify conditions that may require caution in the use of xanthines. Evaluate urinary output and prostate palpation as appropriate to monitor anticholinergic effects. Evaluate orientation, affect, and reflexes to evaluate CNS effects.

Sulfonylureas

Sulfonylureas are another group of agent used to control blood glucose level. These drugs are only effective in patients who have functioning beta cells. They are not effective for all diabetics and may lose their effectiveness over time with others. Sulfonylureas are further classified as first-generation or second-generation sulfonylureas. Use of first-generation sulfonylureas is declining as more effective drugs have become available. Also, they are now thought to possibly cause an increase in cardiovascular death. Use of second-generation sulfonylureas have several advantages over first-generation, including: safer for patients with renal dysfunction as they are excreted in urine and bile, absence of interaction to many protein-bound drugs, and longer duration of action. All of sulfonylureas can cause hypoglycemia.

Adrenergic Agonists (Sympathomimetics)

The autonomic nervous system (ANS) works to keep the body's homeostasis against internal and external changes in the environment which alter the body's internal functions (e.g., blood pressure regulation, urinary excretion, water balance, and digestive functions). Adrenergic agonists are autonomic nervous system drugs that stimulate the adrenergic receptors of the sympathetic nervous system (SNS), either directly (by reacting with receptor sites) or indirectly (by increasing norepinephrine levels). An adrenergic agonist is also called a sympathomimetic because it stimulates the effects of SNS. Adrenergic agonists are further classified into three: alpha- and beta-adrenergic agonists, alpha-specific adrenergic agonists, and beta-specific adrenergic agonists.

Drugs Affecting Coagulation (Anticoagulants, Antiplatelets, Thrombolytics)

These groups of drugs affect clot formation and resolution by hindering different steps in clotting formation which include altering the formation of platelet plug (antiplatelet drugs), interfering the clotting cascade and thrombin formation (anticoagulant drugs), and stimulating the plasmin system to break down the formed clot (thrombolytic agents).

Bronchodilators and Antiasthmatics

Bronchodilators or antiasthmatics are medications used to facilitate respiration by dilating the airways. They are helpful in symptomatic relief or prevention of bronchial asthma and for bronchospasm associated with COPD.

What are antacids?

Antacids are a group of inorganic chemicals that neutralize stomach acid. Antacids are available OTC, and many patients use them to self-treat a variety of GI symptoms. The choice of an antacid depends on adverse effects and absorption factors.

Antacids

Antacids are used to chemically react with and neutralize the acid in the stomach. They can provide rapid relief from increased acid levels. They are known to cause GI alterations such as diarrhea or constipation and can alter the absorption of many drugs.

Salicylates

Anti-inflammatory agents are drugs that block the effects of the inflammatory response. A popular and one of the oldest groups of anti-inflammatory agents is the salicylates. Salicylates are salicylic acid compounds with anti-inflammatory, antipyretic (fever-blocking), and analgesic (pain-blocking) properties. These drugs are widely available as nonprescription drugs and are relatively nontoxic when used as directed. However, an individual's response to different salicylates may vary. Since salicylates are widely available over the counter (OTC), there is potential for abuse and overdosing. These drugs may also block the signs and symptoms of a present illness, contributing to the possibility of misdiagnosis.

Antianginal Drugs

Antianginal drugs are used primarily to restore the balance between the oxygen supply and demand of the heart. These drugs dilate the coronary vessels to increase the flow of oxygen to the ischemic regions. Other than that, they also decrease the workload of the heart so the organ would have less demand for oxygen. Learn about antianginal drugs, nitrates, beta-blockers, and calcium channel blockers in this simplified guide for nursing pharmacology.

Antiarrhythmic Drugs

Antiarrhythmics address arrhythmia by altering cells' automaticity and conductivity. All cells in the heart are capable of undergoing spontaneous contractions (automaticity). Therefore, these cells are capable of generating excitatory impulses. Disruptions in the conduction of these impulses affect contractility of the heart as well as the volume of blood pumped by the heart each minute (cardiac output). Arrhythmia is the term applied for disruptions that interfere with generation of impulses and conduction of these impulses to the myocardium.

Antiarthritic Drugs

Antiarthritic drugs include gold compounds that prevent and suppress arthritis in selected patients with rheumatoid arthritis and other anti-arthritis drugs that help block the inflammation and tissue damage of rheumatoid arthritis.

Antibiotics

Antibiotics are agents made from living microorganisms, synthetic manufacturing, and genetic engineering that are used to inhibit specific bacteria. They can be bacteriostatic, bactericidal, or both. The major classes of antibiotics include: aminoglycosides, penicillins and penicillinase-resistant drugs, sulfonamides, tetracyclines, and antimycobacterials (e.g. antitubercular and leprostatic) Others include ketolides, lincosamides, lipoglycopeptides, macrolides, and monobactams.

Anticholinergics (Parasympatholytics)

Anticholinergics are drugs that oppose the effects of acetylcholine. In essence, they also lyse and block the effects of parasympathetic nervous system (PNS) so they are also called as parasympatholytics. Atropine is currently the only widely used anticholinergic drug. Other common examples include meclizine, scopolamine and ipratropium.

Antidepressants

Antidepressants are used to alter the concentration of neurotransmitters in the brain that is responsible for the depressed affect (feelings in response to the environment, whether positive and pleasant or negative and unpleasant). These drugs counteract the effects of neurotransmitter deficiencies in three ways: Inhibit the effects of monoamine oxidase (MAO) resulting to increased norepinephrine and serotonin or 5-hydroxytryptamine (5-HT) in the synaptic cleft; Block the reuptake function of the synaptic cleft resulting to increased neurotransmitter levels in the synaptic cleft; and Regulate receptor sites and breakdown of neurotransmitters resulting in accumulation of neurotransmitter in the synaptic cleft. Antidepressants are classified into three groups: tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs).

Antifungal Drugs

Antifungals are used to treat mycosis, or infections caused by fungi. Fungi are different from bacteria in the sense that their cell walls are made up of chitin and various polysaccharides rendering these organisms resistant to antibiotics. There is an increased incidence of fungal infections in immunocompromised patients (e.g., patients with AIDS, those taking immunosuppressants like organ transplant recipients, etc.). Antifungals can be systemic and/or topical. Systemic antifungals are used to treat systemic mycoses and can be toxic to the host and not to be used indiscriminately. It is important to get a culture of the fungus causing the infection to ensure that the right drug is being used so that the patient is not put at additional risk from the toxic adverse effects associated with these drugs. Topical antifungals are used to treat a variety of mycoses of skin and mucous membranes. Some systemic antifungals have topical forms.

Inhaled Steroids: Generic and Brand Names

Here is a list of some of the most commonly encountered inhaled steroids. ClassificationGeneric nameBrand nameInhaled steroidsbeclomethasoneBecloventbudesonidePulmicortciclesonideAlvescofluticasoneFloventtriamcinoloneAzmacort

Antacids: Generic and Brand Names

Here is a list of the most commonly encountered antacids and their brand names. ClassificationGeneric nameBrand nameAntacidsaluminum saltsAlternaGELcalcium saltsOystercal, TumsmagaldrateLosopan, Riopanmagnesium saltsMilk of Magnesia, otherssodium bicarbonateBell-ans

Proton Pump Inhibitors: Generic and Brand Names

Here is a table of the most commonly encountered proton pump inhibitor: ClassificationGeneric nameBrand nameProton pump inhibitorsdexlansoprazoleKapidexesomeprazoleNexiumlansoprazolePrevacidomeprazolePrilosecpantoprazoleProtonixrabeprazoleAciphex

Histamine-2 Antagonist: Generic and Brand Names

Here is a table of the most commonly used H2 antagonists. ClassificationGeneric nameBrand nameHistamine-2 antagonistscimetidineTagametranitidineZantacfamotidinePepcidnizatidineAxid

Histamine-2 (H2) receptor antagonists

Histamine-2 (H2) receptor antagonists block the release of acid in response to gastrin or parasympathetic release.

H2 blockers Therapeutic actions

The desired actions of H2 antagonists include the following: Selectively block H2 receptors located on the parietal cells. Prevents the release of gastrin, a hormone that causes local release of histamine (due to stimulation of histamine receptors), ultimately blocking the production of hydrochloric acid. Decreases pepsin production by the chief cells.

Antacids Therapeutic actions

The desired actions of antacids include the following: Neutralize stomach acid by direct chemical reaction. Symptomatic relief of an upset stomach associated with hyperacidity, as well as the hyperacidity associated with peptic ulcer, gastritis, peptic esophagitis, gastric hyperacidity, and hiatal hernia.

Antacids Contraindications and Cautions

The following are contraindications and cautions when using antacids: Allergy. The antacids are contraindicated in the presence of any known allergy to antacid products or any component of the drug to prevent hypersensitivity reactions. Co-morbidities. Caution should be used in the following instances: any condition that can be exacerbated by electrolyte or acid-based imbalance to prevent exacerbations and serious adverse effects; any electrolyte imbalance , which could be exacerbated by the electrolyte-changing effects of these drugs; GI obstruction which could cause systemic absorption of the drugs and increase adverse effects; renal dysfunction, which could lead to electrolyte disturbance if any absorbed antacid is neutralized properly. Pregnancy and lactation. Antacids are contraindicated for pregnant and lactating women because of the potential for adverse effects on the fetus or neonate.

Proton Pump Inhibitors

The gastric acid pump or proton pump inhibitors suppress gastric acid secretion by specifically inhibiting the hydrogen-potassium adenosine triphosphate enzyme system on the secretory surface of the gastric parietal cells.

Thyroid Agents

Thyroid gland is located in the middle of the neck and surrounds the trachea like a shield. It produces two hormones: thyroid hormone and calcitonin. The thyroid gland uses iodine to produce thyroid hormones that regulate body metabolism. Thyroid agents either replace or remove hormones to prevent deficiency and excess. Thyroid agents include thyroid hormones (T3, T4, TSH)and antithyroid drugs (further classified as thioamides and iodine solution).