Rinehart and Associates

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Rinehart and Associates

• Pharmacology Made Easy

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Florence Nightingale, Nursing has been limited
to little more than the administration of
medicines and the application of poultices.

• Times Have Changed

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The administration of drugs is an integral part
of the nurses role.
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The study of pharmacology includes 3 areas

• Pharmacokinetics-the study of how drugs are
  absorbed, distributed, metabolized, and excreted
• Pharmacodynamics-the study of how the drug is
  used by the body
• Pharmacotherapeutics-the study of how the client
  responds to the drug

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Lets look at abbreviations

• DurDuration
• SRSustained Release
• CRContinuous Release
• SASustained Action
• ContinContinuous
• LALong Acting
• Bidtwice per day
• TidThree times per day

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The clients mother contacts the clinic regarding
medication administration stating, my daughter
cant swallow this capsule, it is too
large.Investigation reveals that the medication
is a capsule marked S-R. The nurse should
instruct the mother to

• A. open the capsule and mix the medication in
  ice cream.
• B. crush the medication and administer with
  eight ounces of liquid.
• C. call the pharmacist and request an alternate
  preparation of the medication.
• D. stop the medication and inform the the
  physician at the follow-up visit.

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The nurse is expected to use the five rights
when administering medications to the client.

• right client
• right route
• right drug
• right amount
• right time

All medication errors that are made are related
to omission of one or more of these.
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The nurse is responsible for teaching the client
and / or the family.
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The nurse is responsible for supervising others
in the administration of medications.
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The nurse collaborates with the health care team
to formulate a plan of care that includes
pharmacologic agents.
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The Federal Food and Drug Administration is
responsible for insuring the purity and efficacy
of pharmacologic agents.
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Whats in a name?

• chemical name-
• -1-(2S)-3-mercapto-2-methylproplonyl-L-prol
  ineMW217.29
• generic name-
• -captopril
• trade name-
• -Capoten
• official name
• -captopril

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Many drugs have more than one trade name.

• Its much safer to learn the generic name since
  trade names may differ.

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Building a Professional Knowledge Base

• Nurses are expected to utilize their knowledge
  of pharmacology to
• recognize common uses and side effects of the
  clients medication
• challenge medication errors
• meet the clients learning needs.

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What medications will the new nurse be giving?

• The medications the nurse is expected to
  administer depends on
• Area of practice
• Assigned clients

RN
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Most new graduates work within the hospital
setting with medical/surgical clients.
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Remembering the Drugs by Classifications

• First look at the generic name.
• Then look at the trade name.

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Lets look at some examples

• Drugs that affect the cardiovascular system.

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Examples of Commonly Administered Cardiovascular
Medications

• ACE Inhibitors
• Antiarrythmics
• Anticholinergics
• Anticoagulants
• Calcium Channel Blockers

• Inotropic Agents (Digitalis)
• Beta Blockers
• Antilipidemics
• Thrombolytic Agents

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Remembering side effects and nursing implications
of similar drugs is made easier by looking for
commonalities within the generic name.
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Examples of Heart Medications (Antihypertensives)
angiotensin converting agents

• benazepril (Lotensin)
• captopril (Capoten)
• enalapril (Vasotec)
• fosinopril (Monopril)
• moexipril (Univas)
• quinapril (Acupril)
• ramipril (Altace)

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Action/Use For Antihypertensives

• ACE inhibitors act by blocking the sympathetic
  vasomotor centers response. This action
  reduces sympathetic nervous system response
  thereby lowering the blood pressure, pulse rate,
  and cardiac output.

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Side Effects/Adverse Reactions

• hypotension
• bradycardia
• tachycardia
• headache
• nausea/vomiting
• respiratory symptoms

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Nursing Considerations

• Lab monitor platelet and neutrophil counts
• Lab monitor creatinine levels
• Physical Changes respiratory, circulation

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Teach the client to

• Rise slowly (postural hypotension)
• Report a rash, fever, urticaria
• Monitor urinary output
• Report swelling in feet or hands

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Beta Adrenergic Blockers

• Selective beta-1 receptor blockers
• acebutolol (Monitan,Rhotral,Sectral)
• atenolol (Tenormin, Apo-Atenol, Nova-Atenol)
• esmolol (Brevibloc)
• metaprolol (Alupent)
• propanolol (Inderal)

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Beta-Adrenergic Blockers

• Act by blocking sympathetic vasomotor response
• Lower blood pressure
• Lower pulse rate
• Lower cardiac output

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Side Effects/Adverse Reactions

• orthostatic hypotension
• bradycardia
• nausea/vomiting
• diarrhea
• congestive heart failure
• blood dyscrasias

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Nursing Considerations

• Monitor the client for changes in lab values
  (protein, BUN, creatinine) that indicate
  nephrotic syndrome.
• Monitor clients blood pressure, heart rate and
  rhythm.
• Monitor client for signs of edema.

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Teach the client to

• rise slowly
• report bradycardia, dizziness, confusion,
  depression, fever
• taper off the medication

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Antiinfectives ( Aminoglycosides)

• gentamicin- Garamycin,Alcomicin,Genoptic
• kanamycin- Kantrex
• neomycin -Mycifradin
• streptomycin- Streptomycin
• tobramycin - Tobrex,Nebcin
• amikacin-Amikin

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Antiinfectives

• Interfere with protein synthesis of the cell
  causing the bacteria to die.

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Side Effects/Adverse Reactions

• Ototoxicity
• Nephrotoxicity
• Seizures
• Blood dyscrasias
• Hypotension
• Rash

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Nursing Considerations

• Monitor intake and output.
• Monitor vital signs during infusion.
• Maintain patency of IV site.
• Monitor for therapeutic levels . Peak level drawn
  at 30-60 minutes after the third or fourth IV
  dose or 60 minutes after third or fourth IM dose.
  Trough level drawn 30 minutes before next dose.
• Monitor for signs of nephrotoxicity.
• Monitor for signs of ototoxicity.

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Teach the client to

• report signs of allergic reaction.
• report changes in renal function.
• report changes in hearing.
• report sign of superinfection, ie, fever,malaise,
  redness pain, swelling, perineal itching,
  diarrhea, stomatitis, change in cough, sputum.

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Lets look at some other drug names. What can
you tell from the name?
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Benzodiazepines (Anticonvulsants/Sedative/Antianxi
ety)

• Clonazepam-Klonopin
• Diazepam-Valium
• Chlordiazepoxide-Librium
• Lorazepam-Ativan

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Phenothiazines (Antipsychotic/Antiemetic)

• Chlopromazine-Thorazine
• Prochlorperazine-Compazine
• Trifluoperazine-Stelazine
• Promethazine-Phenergan
• Hydroxyzine-Vistaril

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Glucocorticoids
Taper off these medications to prevent CHF and
Addisonian Crises. May cause fluid retention,
weight gain, insomnia, nervousness
and depression.

• prednisolone
• prednisone
• betamethasone
• dexamethasone
• cortisone
• hydrocortisone
• methylprednisolone
• triamcinolone

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Protease inhibitors

• acyclovir
• ritonavir
• saquinovir
• indinavir

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Diabetic Medications
Well have fun a learn a lot!

• Metformin-(Glucophage)
• (biguanide)-increases insulin sensitivity
• acarbose (Precose)-inhibits the enzyme
  alphaglucosidase in theGI tract
• (If the client has a hypoglycemic reaction
  give glucose source (glucotrol) not orange juice.)

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Cholesterol Lowering Agents

• atorvastatin (Lipitor)
• cerivastatin (Baycol)
• fluvastatin (Lescol)
• Lovastatin (Mevacor)
• pravastatin (Pravachol)
• simvastatin (Zocar)

Register by calling 662-728-4622 visit our web
site at www.nclexreview.net
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Searching the Web

• www.micromedex.com
• Nurses on the web ring
• Virtual Nurse
• www.medscape

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Join Us MS, La, TN, Al, Ky, Fl, Ga To register
call Rinehart and Associates 662-728-4622 or
e-mail us at wrinehar_at_tsixroads.com. Visit our
web site at www.nclexreview.net

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You can pass the NCLEX-RN. We can help.