IMPORTANT MEDICINES

IMPORTANT MEDICINES.

ANTIBIOTICS

1️⃣ Amoxicillin

Class: Penicillin (β-lactam)
Action: Inhibits bacterial cell wall synthesis.
Form: Tablet, capsule, oral suspension, IV
Dose: 250–500 mg every 8 hours (adults)
Route: Oral, IV
Indications: Respiratory infections, otitis media, UTIs, dental infections
Contraindications: Penicillin allergy
Nursing Role:
- Monitor for allergic reactions (rash, anaphylaxis)
- Ensure full course is completed
- Monitor renal function in long-term use

2️⃣ Ceftriaxone

Class: 3rd Generation Cephalosporin
Action: Inhibits bacterial cell wall synthesis
Form: IV, IM injection
Dose: 1–2 g once daily (adults)
Route: IV, IM
Indications: Meningitis, pneumonia, sepsis, gonorrhea
Contraindications: Cephalosporin allergy, neonates with hyperbilirubinemia
Nursing Role:
- Reconstitute correctly before administration
- Monitor liver and renal function
- Assess for diarrhea → risk of C. difficile

3️⃣ Azithromycin

Class: Macrolide
Action: Inhibits protein synthesis by binding 50S ribosomal subunit
Form: Tablet, suspension, IV
Dose: 500 mg on Day 1, then 250 mg once daily × 4 days
Route: Oral, IV
Indications: Respiratory tract infections, skin infections, STDs
Contraindications: Liver disease, QT prolongation
Nursing Role:
- Administer 1 hour before or 2 hours after meals
- Monitor ECG if prolonged use
- Educate on completing therapy

4️⃣ Ciprofloxacin

Class: Fluoroquinolone
Action: Inhibits DNA gyrase, preventing bacterial replication
Form: Tablet, suspension, IV
Dose: 500–750 mg twice daily (oral)
Route: Oral, IV
Indications: UTI, GI infections, respiratory infections
Contraindications: Children, pregnancy, tendon disorders
Nursing Role:
- Encourage hydration
- Avoid giving with dairy/antacids
- Observe for tendon pain → stop if occurs

5️⃣ Doxycycline

Class: Tetracycline
Action: Inhibits bacterial protein synthesis (30S ribosomal subunit)
Form: Capsule, IV
Dose: 100 mg twice daily
Route: Oral, IV
Indications: Acne, malaria prophylaxis, atypical pneumonia
Contraindications: Pregnancy, children <8 years
Nursing Role:
- Avoid sun exposure → causes photosensitivity
- Administer with food (non-dairy)
- Avoid lying down immediately after dose

6️⃣ Metronidazole

Class: Nitroimidazole
Action: Disrupts DNA and inhibits nucleic acid synthesis
Form: Tablet, IV, suppository, topical
Dose: 400–500 mg TID (oral)
Route: Oral, IV, rectal, topical
Indications: Anaerobic infections, trichomoniasis, amoebiasis, C. difficile
Contraindications: Alcohol use, first trimester pregnancy
Nursing Role:
- Avoid alcohol (disulfiram-like reaction)
- Monitor for metallic taste, GI upset
- Educate on dark urine as harmless side effect

7️⃣ Vancomycin

Class: Glycopeptide
Action: Inhibits bacterial cell wall synthesis
Form: IV, oral (for C. difficile only)
Dose: 15–20 mg/kg every 8–12 hrs (IV)
Route: IV, Oral
Indications: MRSA, C. difficile (oral), severe Gram-positive infections
Contraindications: Hypersensitivity
Nursing Role:
- Monitor peak/trough levels
- Infuse slowly → prevent “Red Man Syndrome”
- Assess renal function and ototoxicity

8️⃣ Gentamicin

Class: Aminoglycoside
Action: Inhibits protein synthesis (30S ribosome)
Form: Injection (IV/IM), eye/ear drops
Dose: 3–5 mg/kg/day divided doses
Route: IV, IM, topical
Indications: Severe infections (sepsis, UTI, endocarditis)
Contraindications: Renal impairment, neuromuscular disorders
Nursing Role:
- Monitor peak/trough levels
- Observe for nephro- and ototoxicity
- Ensure adequate hydration

9️⃣ Linezolid

Class: Oxazolidinone
Action: Inhibits protein synthesis (23S of 50S ribosomal RNA)
Form: Tablet, suspension, IV
Dose: 600 mg every 12 hours
Route: Oral, IV
Indications: MRSA, VRE, resistant pneumonia
Contraindications: Concurrent MAOIs, serotonin syndrome risk
Nursing Role:
- Monitor for myelosuppression (CBC)
- Avoid tyramine-rich foods
- Watch for serotonin syndrome if on SSRIs

🔟 Piperacillin + Tazobactam (Zosyn)

Class: Extended-spectrum Penicillin + β-lactamase inhibitor
Action: Inhibits cell wall synthesis and neutralizes β-lactamase enzyme
Form: IV
Dose: 3.375–4.5 g every 6–8 hrs
Route: IV
Indications: Severe hospital-acquired infections, polymicrobial infections
Contraindications: Penicillin allergy
Nursing Role:
- Monitor for allergic reactions
- Check liver/kidney function
- Monitor for diarrhea → C. difficile

1️⃣1️⃣ Meropenem

Class: Carbapenem
Action: Broad-spectrum; inhibits cell wall synthesis by binding to penicillin-binding proteins
Form: IV injection
Dose: 500 mg to 1 g every 8 hours
Route: IV
Indications: Severe intra-abdominal infections, meningitis, sepsis, resistant hospital infections
Contraindications: Hypersensitivity to carbapenems, seizure disorders
Nursing Role:
- Monitor renal function closely
- Watch for seizures, allergic reactions
- Administer IV slowly over 15–30 minutes

1️⃣2️⃣ Trimethoprim + Sulfamethoxazole (Cotrimoxazole)

Class: Sulfonamide + Antifolate
Action: Inhibits folic acid synthesis (essential for bacterial DNA synthesis)
Form: Tablet, suspension, IV
Dose: 160 mg/800 mg BID (standard adult dose)
Route: Oral, IV
Indications: UTIs, Pneumocystis pneumonia (PCP), traveler’s diarrhea, bronchitis
Contraindications: Sulfa allergy, G6PD deficiency, renal/liver failure
Nursing Role:
- Encourage hydration (prevent crystalluria)
- Monitor for rashes (Stevens-Johnson syndrome)
- Watch CBC for blood dyscrasias

1️⃣3️⃣ Levofloxacin

Class: Fluoroquinolone (3rd generation)
Action: Inhibits bacterial DNA gyrase and topoisomerase IV
Form: Tablet, IV
Dose: 500–750 mg once daily
Route: Oral, IV
Indications: UTI, sinusitis, pneumonia, prostatitis
Contraindications: Myasthenia gravis, tendon disorders, children
Nursing Role:
- Avoid with antacids, dairy (reduces absorption)
- Monitor for tendon rupture or QT prolongation
- Ensure renal dose adjustment if needed

1️⃣4️⃣ Clindamycin

Class: Lincosamide
Action: Inhibits protein synthesis by binding to 50S ribosome
Form: Capsule, IV, IM, topical, vaginal
Dose: 150–300 mg every 6–8 hours (oral)
Route: Oral, IV, IM, topical
Indications: Skin infections, dental infections, anaerobic infections
Contraindications: History of colitis, hypersensitivity
Nursing Role:
- Monitor for signs of pseudomembranous colitis (C. difficile)
- Give oral form with a full glass of water to prevent esophageal irritation
- Educate about diarrhea side effects

1️⃣5️⃣ Chloramphenicol

Class: Broad-spectrum antibiotic
Action: Inhibits bacterial protein synthesis at 50S subunit
Form: Capsule, IV, eye/ear drops
Dose: 50–100 mg/kg/day IV divided doses
Route: IV, oral, topical
Indications: Typhoid fever, meningitis, serious infections in children
Contraindications: Blood dyscrasias, liver disease
Nursing Role:
- Monitor CBC weekly (risk of bone marrow suppression)
- Use cautiously in neonates (Gray Baby Syndrome)
- Avoid unnecessary use to prevent toxicity

1️⃣6️⃣ Rifampicin

Class: Rifamycin (Antitubercular)
Action: Inhibits bacterial RNA polymerase
Form: Capsule, IV
Dose: 600 mg daily (adults)
Route: Oral, IV
Indications: Tuberculosis, leprosy, meningococcal prophylaxis
Contraindications: Hepatic impairment, alcohol use, hypersensitivity
Nursing Role:
- Warn patient about red-orange urine, sweat, tears
- Monitor LFTs regularly
- Use alternate contraception (reduces oral contraceptive effectiveness)

1️⃣7️⃣ Isoniazid (INH)

Class: Antitubercular
Action: Inhibits mycolic acid synthesis in TB bacteria
Form: Tablet, syrup, injection
Dose: 5 mg/kg/day (up to 300 mg)
Route: Oral, IM
Indications: TB treatment and prophylaxis
Contraindications: Liver disease, prior INH-induced hepatitis
Nursing Role:
- Monitor LFTs
- Supplement with Vitamin B6 (pyridoxine) to prevent neuropathy
- Check for signs of jaundice

1️⃣8️⃣ Nitrofurantoin

Class: Nitrofuran derivative
Action: Damages bacterial DNA
Form: Tablet, suspension
Dose: 50–100 mg QID for 5–7 days
Route: Oral
Indications: Uncomplicated UTIs
Contraindications: Renal failure, late pregnancy
Nursing Role:
- Give with food or milk to prevent GI upset
- Monitor for pulmonary symptoms (long-term use)
- Educate that urine may turn brown

1️⃣9️⃣ Tigecycline

Class: Glycylcycline (related to tetracyclines)
Action: Inhibits protein synthesis by binding to 30S ribosome
Form: IV only
Dose: Initial 100 mg IV, then 50 mg every 12 hours
Route: IV
Indications: Complicated intra-abdominal and skin infections
Contraindications: Hypersensitivity, pregnancy, children
Nursing Role:
- Monitor for nausea and vomiting
- Ensure correct IV infusion over 30–60 minutes
- Monitor liver function tests

2️⃣0️⃣ Colistin (Polymyxin E)

Class: Polymyxins
Action: Disrupts bacterial cell membrane (Gram-negative)
Form: IV, inhalation
Dose: Depends on renal function and body weight
Route: IV, nebulization
Indications: MDR Gram-negative infections (Pseudomonas, Acinetobacter)
Contraindications: Renal impairment, neuromuscular disease
Nursing Role:
- Monitor kidney function strictly
- Watch for neurotoxicity and respiratory depression
- Use last-resort; educate on resistance risk

🧪 CLASSIFICATION OF ANTIBIOTICS

(🔍 Based on Mechanism of Action & Chemical Structure)

🧱 1. Inhibitors of Cell Wall Synthesis

➡️ Action: Prevent peptidoglycan synthesis, weakening the bacterial cell wall

🔹 Groups & Examples:

Group	Examples	Action
Penicillins	Penicillin G, Amoxicillin, Piperacillin	Inhibit transpeptidase enzyme
Cephalosporins	Ceftriaxone, Cefuroxime, Cefepime	Similar to penicillin; broader spectrum
Carbapenems	Meropenem, Imipenem	Broadest activity; used in resistant infections
Monobactams	Aztreonam	Active against Gram-negative rods
Glycopeptides	Vancomycin, Teicoplanin	Inhibit peptidoglycan synthesis (bind D-Ala-D-Ala)

🔬 2. Inhibitors of Protein Synthesis

➡️ Action: Bind to bacterial ribosomes (30S or 50S)

🔹 Groups & Examples:

Group	Examples	Action
Aminoglycosides	Gentamicin, Amikacin, Tobramycin	Bind 30S; misreading of mRNA
Tetracyclines	Doxycycline, Minocycline	Bind 30S; inhibit tRNA binding
Macrolides	Azithromycin, Erythromycin	Bind 50S; inhibit translocation
Lincosamides	Clindamycin	Bind 50S; inhibit peptide bond formation
Chloramphenicol	Chloramphenicol	Inhibits 50S peptidyl transferase
Oxazolidinones	Linezolid	Bind 50S; inhibit initiation complex
Streptogramins	Quinupristin-dalfopristin	Bind 50S synergistically

🧬 3. Inhibitors of Nucleic Acid Synthesis

➡️ Action: Interfere with bacterial DNA/RNA replication or transcription

🔹 Groups & Examples:

Group	Examples	Action
Fluoroquinolones	Ciprofloxacin, Levofloxacin	Inhibit DNA gyrase and topoisomerase IV
Rifamycins	Rifampicin	Inhibit RNA polymerase
Nitroimidazoles	Metronidazole, Tinidazole	Disrupt DNA helical structure (anaerobic only)

💣 4. Disruptors of Cell Membrane Function

➡️ Action: Increase permeability of bacterial membranes

🔹 Groups & Examples:

Group	Examples	Action
Polymyxins	Colistin (Polymyxin E), Polymyxin B	Bind to phospholipids in cell membrane
Lipopeptides	Daptomycin	Forms pores in Gram-positive bacterial membranes

🧬 5. Antimetabolites (Inhibit Metabolic Pathways)

➡️ Action: Inhibit synthesis of essential bacterial metabolites like folic acid

🔹 Groups & Examples:

Group	Examples	Action
Sulfonamides	Sulfamethoxazole	Inhibit dihydropteroate synthase
Trimethoprim	Trimethoprim	Inhibits dihydrofolate reductase
Combination	Cotrimoxazole (TMP + SMX)	Synergistic block of folate pathway

🌿 6. Miscellaneous Antibiotics

➡️ Antibiotics with unique mechanisms

Example	Action
Fosfomycin	Inhibits MurA enzyme (first step of cell wall synthesis)
Mupirocin	Inhibits isoleucyl-tRNA synthetase
Nitrofurantoin	Damages bacterial DNA in urinary tract
Bedaquiline	Inhibits ATP synthase in TB bacteria

🧠 Summary Chart (For Revision)

Mechanism	Main Classes	Examples
🧱 Cell Wall Synthesis Inhibitors	Penicillins, Cephalosporins, Carbapenems, Vancomycin	Amoxicillin, Ceftriaxone, Meropenem
🔬 Protein Synthesis Inhibitors	Aminoglycosides, Macrolides, Tetracyclines, Linezolid	Gentamicin, Azithromycin, Doxycycline
🧬 Nucleic Acid Synthesis Inhibitors	Fluoroquinolones, Rifamycins, Metronidazole	Levofloxacin, Rifampicin
💣 Cell Membrane Disruptors	Polymyxins, Daptomycin	Colistin, Daptomycin
🌿 Antimetabolites	Sulfonamides, Trimethoprim	Cotrimoxazole
🧪 Miscellaneous	Fosfomycin, Mupirocin, Nitrofurantoin, Bedaquiline	Unique mechanisms

ANTACIDS.

🔹 1. RANITIDINE

🔸 Name:

Generic: Ranitidine
Brand Names: Zantac, Rantac

🔸 Class:

Histamine H2-receptor antagonist (H2 blocker)

🔸 Action:

Blocks H2 receptors in gastric parietal cells, reducing acid secretion and gastric volume.

🔸 Indications:

Peptic ulcer disease
Gastroesophageal reflux disease (GERD)
Zollinger-Ellison syndrome
Dyspepsia
Prophylaxis of stress ulcers in critically ill patients

🔸 Contraindications:

Hypersensitivity to ranitidine
Acute porphyria
Caution in renal impairment

🔸 Specific Side Effects:

Bradycardia (especially with IV use)
Thrombocytopenia
Hepatitis or abnormal liver enzymes
Confusion in elderly
Gynecomastia (rare, long-term use)

🔸 Specific Role & Monitoring:

Monitor renal function and adjust dose in renal impairment.
Monitor for confusion or CNS changes in older adults.
Assess for GI bleeding and evaluate gastric pain relief.
Avoid giving with antacids within 1 hour.

🔹 2. OMEPRAZOLE

🔸 Name:

Generic: Omeprazole
Brand Names: Omez, Prilosec

🔸 Class:

Proton Pump Inhibitor (PPI)

🔸 Action:

Irreversibly inhibits H+/K+ ATPase enzyme (proton pump) in gastric parietal cells, blocking the final step of acid production.

🔸 Indications:

GERD
Duodenal and gastric ulcers
Zollinger-Ellison syndrome
H. pylori eradication (as part of triple therapy)
NSAID-induced ulcers

🔸 Contraindications:

Hypersensitivity to omeprazole or other PPIs
Caution in liver disease and long-term use

🔸 Specific Side Effects:

Vitamin B12 deficiency (long-term use)
Hypomagnesemia
Osteoporosis-related fractures
Rebound acid hypersecretion
C. difficile infection

🔸 Specific Role & Monitoring:

Monitor magnesium, calcium, and vitamin B12 levels with prolonged use.
Educate patient not to crush or chew delayed-release capsules.
Monitor for signs of GI infection, especially diarrhea.

🔹 3. PANTOPRAZOLE

🔸 Name:

Generic: Pantoprazole
Brand Names: Protonix, Pan 40

🔸 Class:

Proton Pump Inhibitor (PPI)

🔸 Action:

Blocks H+/K+ ATPase (proton pump) in the stomach lining, inhibiting acid secretion.

🔸 Indications:

GERD and erosive esophagitis
Zollinger-Ellison syndrome
Maintenance therapy post-ulcer healing
Stress ulcer prophylaxis in ICU

🔸 Contraindications:

Hypersensitivity to pantoprazole or PPI drugs
Caution in hepatic dysfunction, osteoporosis, and hypomagnesemia

🔸 Specific Side Effects:

Headache and dizziness
Flatulence and abdominal pain
Hypomagnesemia, Vitamin B12 deficiency
Risk of bone fractures
C. difficile-associated diarrhea

🔸 Specific Role & Monitoring:

Monitor LFTs in long-term use.
Monitor for low magnesium symptoms (tetany, arrhythmias).
Encourage calcium-rich diet or supplements.
Do not crush or split enteric-coated tablets.

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

🔹 1. IBUPROFEN

🔸 Name:

Generic: Ibuprofen
Brand Names: Brufen, Advil, Motrin

🔸 Class:

Nonselective NSAID (Non-Steroidal Anti-Inflammatory Drug)

🔸 Action:

Inhibits cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes → decreases prostaglandin synthesis → reduces pain, inflammation, and fever.

🔸 Indications:

Mild to moderate pain (headache, dental, musculoskeletal)
Inflammatory conditions like arthritis
Fever
Dysmenorrhea (menstrual pain)

🔸 Contraindications:

Peptic ulcer disease
Severe hepatic or renal impairment
Bleeding disorders
Hypersensitivity to NSAIDs
Use in third trimester of pregnancy

🔸 Specific Side Effects:

Gastric irritation or ulceration
Renal dysfunction
Increased bleeding risk
Tinnitus at high doses
Elevated liver enzymes

🔸 Role of Nurse & Monitoring:

Administer with food or milk to reduce gastric upset.
Monitor for GI bleeding (black stools, vomiting blood).
Assess for signs of renal impairment (↓ urine output, edema).
Monitor LFTs and creatinine with prolonged use.

🔹 2. DICLOFENAC

🔸 Name:

Generic: Diclofenac
Brand Names: Voveran, Voltaren

🔸 Class:

Nonselective NSAID

🔸 Action:

Inhibits COX-1 and COX-2 → reduces prostaglandins → ↓ inflammation, pain, and swelling.

🔸 Indications:

Rheumatoid arthritis, osteoarthritis
Postoperative pain
Ankylosing spondylitis
Soft tissue injuries

🔸 Contraindications:

Asthma exacerbated by NSAIDs
GI bleeding or ulcer history
Severe cardiac, renal, or hepatic impairment
Pregnancy (especially late stage)

🔸 Specific Side Effects:

Hepatotoxicity
Edema, especially in elderly
Elevated blood pressure
GI ulcers or bleeding
Rare skin rashes (Stevens-Johnson syndrome)

🔸 Role of Nurse & Monitoring:

Monitor BP in long-term users.
Watch for signs of liver injury (jaundice, fatigue).
Educate patient to avoid alcohol and smoking.
Check for drug interactions (especially anticoagulants).

🔹 3. NAPROXEN

🔸 Name:

Generic: Naproxen
Brand Names: Naprosyn, Aleve

🔸 Class:

Nonselective NSAID

🔸 Action:

Inhibits both COX-1 and COX-2 → inhibits prostaglandin synthesis → analgesic, antipyretic, anti-inflammatory effects.

🔸 Indications:

Rheumatoid arthritis, osteoarthritis
Gout
Muscle and joint pain
Menstrual cramps

🔸 Contraindications:

Active peptic ulcer or GI bleeding
Severe renal or liver disease
Hypersensitivity to NSAIDs
Concomitant use with anticoagulants

🔸 Specific Side Effects:

Drowsiness or dizziness
GI bleeding or ulcers
Photosensitivity
Renal impairment
Risk of thrombotic events (MI, stroke) with long-term use

🔸 Role of Nurse & Monitoring:

Educate to take with meals.
Monitor for GI distress, renal labs, CBC.
Avoid combining with aspirin or other NSAIDs.
Caution in elderly due to higher GI and cardiac risk.

🔹 4. INDOMETHACIN

🔸 Name:

Generic: Indomethacin
Brand Names: Indocin, Metacin

🔸 Class:

Nonselective NSAID

🔸 Action:

Inhibits COX-1 and COX-2 enzymes → reduces synthesis of prostaglandins → anti-inflammatory, analgesic, and antipyretic effects.

🔸 Indications:

Acute gout
Rheumatoid arthritis
Ankylosing spondylitis
Patent ductus arteriosus (IV form in neonates)

🔸 Contraindications:

History of GI bleeding or ulcer
Severe renal or hepatic impairment
Asthma, nasal polyps, aspirin allergy
Pregnancy (especially 3rd trimester)

🔸 Specific Side Effects:

Severe GI toxicity
CNS effects: dizziness, confusion, headache
Nephrotoxicity
Aplastic anemia (rare)

🔸 Role of Nurse & Monitoring:

Monitor mental status changes, especially in elderly.
Give with meals or milk.
Check CBC, renal function, and BP regularly.
Educate patient to report vision or hearing changes.

🔹 5. NIMESULIDE

🔸 Name:

Generic: Nimesulide
Brand Names: Nimulid, Nise

🔸 Class:

Selective COX-2 inhibitor (with partial COX-1 action)
Use is restricted or banned in some countries due to liver toxicity.

🔸 Action:

Selectively inhibits COX-2 enzyme → reduces prostaglandin synthesis → provides anti-inflammatory and analgesic effects.

🔸 Indications:

Acute pain
Osteoarthritis
Dysmenorrhea
Dental pain

🔸 Contraindications:

Hepatic impairment
Peptic ulcer
Children under 12 years
History of GI bleeding

🔸 Specific Side Effects:

Hepatotoxicity (major concern)
Skin rash
Epigastric pain
Dizziness, edema

🔸 Role of Nurse & Monitoring:

Monitor Liver Function Tests (LFTs) closely.
Limit use to short-term only.
Educate about early signs of liver damage (jaundice, fatigue, nausea).
Not recommended in chronic inflammatory conditions.

🔹 6. ETORICOXIB

🔸 Name:

Generic: Etoricoxib
Brand Names: Etoshine, Nucoxia

🔸 Class:

Selective COX-2 Inhibitor (Coxib group)

🔸 Action:

Inhibits COX-2 enzyme selectively → reduces prostaglandins at the site of inflammation with less effect on the gastric mucosa.

🔸 Indications:

Osteoarthritis
Rheumatoid arthritis
Ankylosing spondylitis
Gouty arthritis
Acute musculoskeletal pain

🔸 Contraindications:

Severe hepatic impairment
Uncontrolled hypertension
Cardiovascular disease or stroke history
Peptic ulcer disease

🔸 Specific Side Effects:

Hypertension
Peripheral edema
Myocardial infarction or stroke risk (high doses/long-term)
Dyspepsia

🔸 Role of Nurse & Monitoring:

Monitor BP regularly during therapy.
Use lowest effective dose for shortest duration.
Monitor for cardiac symptoms like chest pain, shortness of breath.
Avoid in patients with cardiac or vascular risk.

🔹 7. ASPIRIN (Acetylsalicylic Acid)

🔸 Name:

Generic: Aspirin
Brand Names: Disprin, Ecosprin

🔸 Class:

NSAID and Antiplatelet Agent

🔸 Action:

Irreversibly inhibits COX-1 and COX-2, reducing prostaglandins (for pain) and thromboxane A2 (for platelet aggregation).

🔸 Indications:

Mild to moderate pain, fever
Rheumatoid arthritis
Cardiovascular disease (low-dose for MI and stroke prevention)
Post-CABG or stenting

🔸 Contraindications:

Children with viral illness (→ Reye’s syndrome)
Bleeding disorders
Peptic ulcer
Hypersensitivity
Gout (may increase uric acid)

🔸 Specific Side Effects:

GI bleeding, ulcers
Reye’s syndrome in children
Tinnitus
Bronchospasm in asthmatics
Bleeding tendencies

🔸 Role of Nurse & Monitoring:

Monitor for bleeding signs (gums, stool, bruises).
Use enteric-coated tablets to reduce gastric irritation.
Educate patients on avoiding alcohol or anticoagulants.
Monitor platelet counts and renal function.

🔹 8. ACECLOFENAC

🔸 Name:

Generic: Aceclofenac
Brand Names: Zerodol, Hifenac, Acemiz

🔸 Class:

Nonselective NSAID (Phenylacetic acid derivative)

🔸 Action:

Aceclofenac inhibits COX-1 and COX-2 enzymes → decreases the formation of prostaglandins → reduces pain, inflammation, and fever.
It is chemically related to diclofenac but is better tolerated gastrically.

🔸 Indications:

Osteoarthritis
Rheumatoid arthritis
Ankylosing spondylitis
Musculoskeletal pain
Post-traumatic pain and inflammation

🔸 Contraindications:

Known hypersensitivity to Aceclofenac or NSAIDs
Peptic ulcer disease or GI bleeding history
Severe renal or hepatic impairment
Asthma triggered by NSAIDs
Use in pregnancy (especially 3rd trimester) and lactation is not recommended

🔸 Specific Side Effects:

Gastritis, heartburn, dyspepsia
Hepatotoxicity (mild elevations in liver enzymes)
Dizziness, headache, edema
Rash and allergic reactions (rare)
Nephrotoxicity with long-term/high-dose use

🔸 Role of Nurse & Monitoring:

✅ Administration:

Give with meals or milk to reduce GI irritation.
Do not crush sustained-release formulations.

✅ Assessment & Monitoring:

Monitor for signs of gastric bleeding (black stool, vomiting blood).
Monitor liver function tests (LFTs) and renal function (BUN, creatinine) during long-term therapy.
Watch for signs of fluid retention or edema, especially in patients with cardiac history.
Educate patients to avoid alcohol, which increases GI side effects.

✅ Patient Education:

Avoid concurrent use with other NSAIDs or anticoagulants.
Inform patient to report rash, jaundice, or persistent GI discomfort.
Caution in elderly patients due to increased risk of GI or renal adverse effects.

ANTIHYPERTENSIVE DRUGS.

🔹 1. AMLODIPINE

🔸 Name:

Generic: Amlodipine
Brand Names: Amlong, Norvasc

🔸 Class:

Calcium Channel Blocker (Dihydropyridine group)

🔸 Action:

Inhibits calcium influx into vascular smooth muscle cells → vasodilation → ↓ systemic vascular resistance and blood pressure

🔸 Indications:

Hypertension
Angina (chronic stable and vasospastic)
Coronary artery disease

🔸 Contraindications:

Severe hypotension
Cardiogenic shock
Aortic stenosis
Hypersensitivity

🔸 Side Effects:

Peripheral edema
Flushing, dizziness
Gingival hyperplasia
Tachycardia or palpitations

🔸 Nursing Responsibilities & Monitoring:

Monitor BP and HR regularly
Educate patient to change positions slowly (orthostatic hypotension)
Monitor for ankle edema
Encourage dental hygiene

🔹 2. ENALAPRIL

🔸 Name:

Generic: Enalapril
Brand Names: Enam, Vasotec

🔸 Class:

ACE Inhibitor (Angiotensin-Converting Enzyme Inhibitor)

🔸 Action:

Inhibits conversion of angiotensin I to angiotensin II → vasodilation → ↓ aldosterone → ↓ BP and preload/afterload

🔸 Indications:

Hypertension
Congestive heart failure
Post-myocardial infarction
Diabetic nephropathy

🔸 Contraindications:

History of angioedema
Bilateral renal artery stenosis
Pregnancy
Severe hypotension

🔸 Side Effects:

Dry cough (common)
Hyperkalemia
Angioedema (life-threatening)
Hypotension on first dose

🔸 Nursing Responsibilities & Monitoring:

Monitor serum potassium and creatinine
Assess for cough and swelling of face/lips
Avoid salt substitutes (contain potassium)
Monitor BP, especially after first dose

🔹 3. LOSARTAN

🔸 Name:

Generic: Losartan
Brand Names: Losar, Cozaar

🔸 Class:

Angiotensin II Receptor Blocker (ARB)

🔸 Action:

Blocks angiotensin II receptors → vasodilation → ↓ aldosterone → ↓ BP

🔸 Indications:

Hypertension
Diabetic nephropathy
Heart failure
Stroke prevention

🔸 Contraindications:

Pregnancy
Severe hepatic impairment
Hypersensitivity to ARBs

🔸 Side Effects:

Dizziness
Hyperkalemia
Hypotension
Fatigue, back pain

🔸 Nursing Responsibilities & Monitoring:

Monitor BP, serum potassium, and renal function
Educate to avoid potassium supplements
Monitor for signs of hypotension
Safer alternative to ACEIs if patient develops cough

🔹 4. METOPROLOL

🔸 Name:

Generic: Metoprolol
Brand Names: Betaloc, Lopressor

🔸 Class:

Beta-1 selective blocker (Cardioselective Beta Blocker)

🔸 Action:

Blocks beta-1 adrenergic receptors in heart → ↓ heart rate, cardiac output, and BP

🔸 Indications:

Hypertension
Angina
Post-MI
Atrial fibrillation
Heart failure

🔸 Contraindications:

Bradycardia
Heart block (2nd or 3rd degree)
Cardiogenic shock
Asthma (with caution)

🔸 Side Effects:

Bradycardia
Fatigue, dizziness
Cold extremities
Sexual dysfunction

🔸 Nursing Responsibilities & Monitoring:

Monitor HR and BP before each dose
Assess for fatigue and depression
Do not stop abruptly → may cause rebound hypertension or angina
Caution in diabetic patients (masks hypoglycemia symptoms)

🔹 5. HYDROCHLOROTHIAZIDE (HCTZ)

🔸 Name:

Generic: Hydrochlorothiazide
Brand Names: Esidrex, Hydrodiuril

🔸 Class:

Thiazide Diuretic

🔸 Action:

Inhibits sodium and chloride reabsorption in the distal tubule → ↑ excretion → ↓ blood volume → ↓ BP

🔸 Indications:

Hypertension
Mild edema
Heart failure (mild cases)

🔸 Contraindications:

Sulfa allergy
Severe renal impairment
Hypokalemia, hyponatremia
Gout

🔸 Side Effects:

Hypokalemia, hyponatremia
Hyperuricemia (may worsen gout)
Hyperglycemia
Photosensitivity

🔸 Nursing Responsibilities & Monitoring:

Monitor electrolytes, especially potassium and sodium
Encourage potassium-rich diet
Monitor daily weight and BP
Caution in diabetics and gout patients

🔹 6. CLONIDINE

🔸 Name:

Generic: Clonidine
Brand Names: Catapres, Arkamin

🔸 Class:

Central Alpha-2 Adrenergic Agonist

🔸 Action:

Stimulates alpha-2 receptors in the brainstem → inhibits sympathetic outflow → ↓ heart rate and BP

🔸 Indications:

Hypertension (especially resistant cases)
Hypertensive urgency
ADHD
Opioid withdrawal (off-label)

🔸 Contraindications:

Hypersensitivity
Severe bradyarrhythmia
Depression
Recent MI (use cautiously)

🔸 Side Effects:

Sedation, dry mouth, bradycardia
Rebound hypertension on sudden withdrawal
Depression, dizziness

🔸 Nursing Responsibilities & Monitoring:

Monitor BP and HR closely
Educate not to stop abruptly → taper slowly
Monitor mental status and mood
Caution with other CNS depressants

🔹 7. PRAZOSIN

🔸 Name:

Generic: Prazosin
Brand Names: Minipress

🔸 Class:

Alpha-1 Adrenergic Blocker

🔸 Action:

Blocks alpha-1 receptors in blood vessels → vasodilation → ↓ BP

🔸 Indications:

Hypertension
Benign prostatic hyperplasia (BPH)
PTSD-related nightmares (off-label)

🔸 Contraindications:

Hypersensitivity
Hypotension or orthostatic hypotension
Heart failure (caution)

🔸 Side Effects:

First-dose hypotension
Dizziness, syncope
Nasal congestion
Reflex tachycardia

🔸 Nursing Responsibilities & Monitoring:

Administer first dose at bedtime
Monitor BP (especially orthostatic)
Educate to rise slowly from bed
Monitor for urinary symptoms in BPH patients

🔹 8. LABETALOL

🔸 Name:

Generic: Labetalol
Brand Names: Normodyne, Trandate

🔸 Class:

Mixed Alpha-1 and Beta Blocker

🔸 Action:

Blocks alpha-1 → vasodilation
Blocks beta-1 and beta-2 → ↓ HR and CO → powerful BP-lowering effect

🔸 Indications:

Hypertension
Hypertensive emergencies
Pregnancy-induced hypertension (PIH)

🔸 Contraindications:

Asthma or bronchospasm
Severe bradycardia or heart block
Cardiogenic shock
Diabetes (caution)

🔸 Side Effects:

Dizziness, orthostatic hypotension
Fatigue, bradycardia
Bronchospasm
Nausea

🔸 Nursing Responsibilities & Monitoring:

Monitor BP and HR closely
Caution in asthmatic patients
Avoid abrupt withdrawal
Monitor for hypoglycemia symptoms in diabetics

🔹 9. VERAPAMIL

🔸 Name:

Generic: Verapamil
Brand Names: Calan, Isoptin

🔸 Class:

Calcium Channel Blocker (Non-dihydropyridine)

🔸 Action:

Inhibits slow calcium channels in myocardium and vascular smooth muscle → ↓ HR, contractility, and vasodilation

🔸 Indications:

Hypertension
Angina
Supraventricular arrhythmias (SVT, AFib)
Migraine prophylaxis (off-label)

🔸 Contraindications:

Severe bradycardia, heart block, or heart failure
Hypotension
Use with beta-blockers (risk of bradycardia/AV block)

🔸 Side Effects:

Constipation
Bradycardia, hypotension
Edema, flushing
AV block

🔸 Nursing Responsibilities & Monitoring:

Monitor HR and ECG for conduction blocks
Caution in elderly and those on digoxin
Educate about fluid intake for constipation
Monitor BP and symptoms of heart failure

🔹 10. FUROSEMIDE

🔸 Name:

Generic: Furosemide
Brand Names: Lasix

🔸 Class:

Loop Diuretic

🔸 Action:

Inhibits Na⁺-K⁺-2Cl⁻ transporter in thick ascending loop of Henle → strong diuresis → ↓ blood volume and BP

🔸 Indications:

Hypertension (especially with fluid overload)
Pulmonary edema
Congestive heart failure
Hypercalcemia

🔸 Contraindications:

Severe hypokalemia, dehydration
Sulfa allergy
Anuria (no urine output)

🔸 Side Effects:

Hypokalemia, hyponatremia
Ototoxicity (high dose IV)
Dehydration, hypotension
Hyperuricemia (can worsen gout)

🔸 Nursing Responsibilities & Monitoring:

Monitor electrolytes (K⁺, Na⁺, Mg⁺)
Monitor input/output, daily weight, BP
Administer in morning to avoid nocturia
Educate on potassium-rich foods

🔹 11. TELMISARTAN

🔸 Name:

Generic: Telmisartan
Brand Names: Telma, Telsar, Micardis

🔸 Class:

Angiotensin II Receptor Blocker (ARB)

🔸 Mechanism of Action:

Telmisartan selectively blocks angiotensin II receptors (AT₁ subtype) on vascular smooth muscle and adrenal gland.
This leads to:
- Vasodilation → ↓ systemic vascular resistance (SVR)
- ↓ aldosterone secretion → ↓ sodium and water retention
- Overall result: ↓ Blood Pressure

🔸 Indications:

Hypertension (first-line or combination therapy)
Cardiovascular risk reduction in high-risk patients (stroke, MI, etc.)
Diabetic nephropathy
Chronic kidney disease (CKD) with proteinuria

🔸 Contraindications:

Pregnancy (especially 2nd and 3rd trimester)
Bilateral renal artery stenosis
Severe hepatic impairment
Hypersensitivity to telmisartan or any ARB

🔸 Specific Side Effects:

Dizziness, fatigue
Hyperkalemia
Hypotension (especially in volume-depleted patients)
Back pain
Angioedema (rare, less common than ACE inhibitors)
Elevated liver enzymes (rare)

🔸 Nursing Responsibilities & Monitoring:

✅ Pre-administration:

Check baseline BP and serum electrolytes, especially potassium and creatinine

✅ During administration:

Can be given with or without food
Once-daily dosing enhances compliance

✅ Monitoring:

Monitor blood pressure regularly
Monitor serum potassium and renal function periodically (especially in elderly, diabetics, or those on diuretics)
Assess for signs of angioedema (swelling of face, lips, tongue)
Watch for symptoms of hypotension (dizziness, fainting)

✅ Patient Education:

Avoid potassium-rich foods or salt substitutes containing potassium
Report persistent dry cough, although rare with ARBs
Advise contraception in women of childbearing age due to fetal risk

ANTIDIABETIC DRUGS.

🔹 1. METFORMIN

🔸 Name:

Generic: Metformin
Brand Names: Glucophage, Glyciphage, Obimet

🔸 Class:

Biguanide

🔸 Mechanism of Action:

↓ hepatic glucose production (gluconeogenesis)
↑ insulin sensitivity in muscle and fat
↓ intestinal absorption of glucose

🔸 Indications:

Type 2 Diabetes Mellitus (T2DM)
Polycystic Ovary Syndrome (PCOS)
Insulin resistance in obese individuals

🔸 Contraindications:

Renal impairment (eGFR <30 mL/min/1.73 m²)
Liver disease
Alcoholism
Congestive heart failure
History of lactic acidosis

🔸 Side Effects:

GI upset: nausea, diarrhea
Lactic acidosis (rare but serious)
Metallic taste

🔸 Nursing Responsibilities:

Give with food to reduce GI side effects
Monitor renal function (creatinine/eGFR) regularly
Stop before contrast imaging procedures (48 hours before and after)
Educate to avoid alcohol

🔹 2. GLIMEPIRIDE

🔸 Name:

Generic: Glimepiride
Brand Names: Amaryl, Glyree

🔸 Class:

Sulfonylurea

🔸 Mechanism of Action:

Stimulates pancreatic beta cells to increase insulin secretion

🔸 Indications:

Type 2 Diabetes Mellitus

🔸 Contraindications:

Type 1 Diabetes
Diabetic ketoacidosis
Pregnancy & lactation
Severe liver or renal dysfunction

🔸 Side Effects:

Hypoglycemia
Weight gain
Photosensitivity
Skin rashes

🔸 Nursing Responsibilities:

Monitor for signs of hypoglycemia
Educate on balanced meal timing
Avoid alcohol (increases hypoglycemia risk)
Monitor blood glucose regularly

🔹 3. PIOGLITAZONE

🔸 Name:

Generic: Pioglitazone
Brand Names: Actos, Pioz

🔸 Class:

Thiazolidinedione (Glitazone)

🔸 Mechanism of Action:

Increases insulin sensitivity in peripheral tissues
Reduces hepatic glucose production

🔸 Indications:

Type 2 Diabetes Mellitus (as adjunct to diet & exercise)

🔸 Contraindications:

Heart failure (NYHA class III/IV)
Bladder cancer
Liver disease

🔸 Side Effects:

Fluid retention, edema
Weight gain
Increased risk of fractures in women
Hepatotoxicity

🔸 Nursing Responsibilities:

Monitor weight and edema
Monitor liver function tests (LFTs)
Educate on signs of heart failure (SOB, swelling)
Use with caution in postmenopausal women

🔹 4. SITAGLIPTIN

🔸 Name:

Generic: Sitagliptin
Brand Names: Januvia

🔸 Class:

DPP-4 Inhibitor (Dipeptidyl Peptidase-4)

🔸 Mechanism of Action:

Inhibits DPP-4 enzyme → prolongs action of incretin hormones → ↑ insulin secretion & ↓ glucagon → ↓ blood sugar levels

🔸 Indications:

Type 2 Diabetes Mellitus (used alone or with metformin/sulfonylurea)

🔸 Contraindications:

Type 1 Diabetes
Diabetic ketoacidosis (DKA)
Pancreatitis history

🔸 Side Effects:

Nasopharyngitis
Headache
Pancreatitis (rare)
Joint pain

🔸 Nursing Responsibilities:

Monitor blood glucose levels
Watch for signs of pancreatitis (abdominal pain, vomiting)
Report persistent joint pain
No dose adjustment in mild renal impairment; adjust in moderate/severe

🔹 5. INSULIN (Regular)

🔸 Name:

Generic: Insulin (Regular Human Insulin)
Brand Names: Humulin R, Actrapid

🔸 Class:

Short-acting insulin

🔸 Mechanism of Action:

Binds to insulin receptors → facilitates glucose uptake into cells → ↓ blood sugar levels

🔸 Indications:

Type 1 and Type 2 Diabetes Mellitus
Diabetic ketoacidosis (IV)
Perioperative glycemic control

🔸 Contraindications:

Hypoglycemia
Hypokalemia

🔸 Side Effects:

Hypoglycemia
Weight gain
Injection site reactions
Lipodystrophy

🔸 Nursing Responsibilities:

Administer 30 minutes before meals
Monitor blood glucose levels before/after administration
Rotate injection sites
Educate on signs of hypoglycemia and glucose correction

🔹 VOGLIBOSE

🔸 Name:

Generic: Voglibose
Brand Names: Voglib, Volibo, Vocose

🔸 Class:

Alpha-Glucosidase Inhibitor

🔸 Mechanism of Action:

Inhibits the enzyme alpha-glucosidase in the intestinal brush border.
This enzyme is responsible for breaking down complex carbohydrates (starch and disaccharides) into glucose.
Inhibition leads to delayed absorption of glucose → reduced postprandial blood sugar spikes.

🔸 Indications:

Type 2 Diabetes Mellitus, especially:
- In patients with postprandial hyperglycemia
- As add-on therapy with sulfonylureas, metformin, or insulin

🔸 Contraindications:

Inflammatory bowel disease (IBD) (e.g., ulcerative colitis, Crohn’s)
Intestinal obstruction or history of partial obstruction
Severe renal impairment
Hypersensitivity to voglibose or other alpha-glucosidase inhibitors

🔸 Specific Side Effects:

Flatulence, abdominal discomfort
Diarrhea or soft stools
Bloating, especially in high-carb diets
Rare: liver enzyme elevation, skin rash

🔸 Nursing Responsibilities & Monitoring:

✅ Administration Guidelines:

Must be taken immediately before meals (usually 3 times a day)
Educate patient to chew food slowly to reduce gas formation

✅ Monitoring:

Monitor postprandial blood glucose (PPBG) levels regularly
Check LFTs periodically in long-term therapy
Educate patient about diet control, especially limiting simple sugars (sucrose)
Monitor for GI intolerance — may require dose adjustment

✅ Important Nursing Advice:

If patient develops hypoglycemia (especially when on other agents), treat with glucose (dextrose), not sucrose (table sugar), since voglibose delays its absorption.
Explain the importance of low-carb meals to reduce side effects

🩺 INSULIN OVERVIEW

🔹 Mechanism of Action:

Insulin binds to insulin receptors on cells → allows glucose uptake → lowers blood glucose levels. It also promotes glycogen synthesis and fat/protein storage.

🔹 Indications:

Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus (when oral agents are inadequate)
Gestational Diabetes
Diabetic Ketoacidosis (DKA)
Perioperative glucose control

🔹 Contraindications:

Hypoglycemia
Hypokalemia

🔹 Common Side Effects:

Hypoglycemia
Weight gain
Lipodystrophy at injection site
Allergic reactions (rare)

📘 CLASSIFICATION OF INSULIN

🔹 1. Rapid-Acting Insulin

Feature	Description
Onset	10–30 minutes
Peak	30–90 minutes
Duration	3–5 hours
Used for	Mealtime (bolus) insulin

🔸 Examples:

Insulin Lispro (Humalog)
Insulin Aspart (NovoRapid)
Insulin Glulisine (Apidra)

🩺 Nursing Notes:

Inject just before meals
Ensure meal is ready to avoid hypoglycemia

🔹 2. Short-Acting Insulin

Feature	Description
Onset	30–60 minutes
Peak	2–4 hours
Duration	6–8 hours
Used for	Mealtime insulin, IV in emergencies

🔸 Examples:

Regular Insulin (Humulin R, Actrapid)

🩺 Nursing Notes:

Given 30 minutes before meals
IV route preferred in DKA

🔹 3. Intermediate-Acting Insulin

Feature	Description
Onset	1–2 hours
Peak	4–12 hours
Duration	12–18 hours
Used for	Basal control, twice daily

🔸 Examples:

NPH Insulin (Neutral Protamine Hagedorn) – Humulin N, Insulatard

🩺 Nursing Notes:

Can be mixed with short/rapid insulin
Cloudy solution → roll between hands before use

🔹 4. Long-Acting Insulin

Feature	Description
Onset	1–2 hours
Peak	Minimal or no peak
Duration	Up to 24 hours
Used for	Basal control (once-daily dose)

🔸 Examples:

Insulin Glargine (Lantus, Basaglar)
Insulin Detemir (Levemir)
Insulin Degludec (Tresiba – ultra-long acting, 36–42 hours)

🩺 Nursing Notes:

Do not mix with other insulin types
Preferred for night-time or bedtime administration

🔹 5. Premixed Insulin

Feature	Description
Onset	Depends on components
Peak	Dual (due to mix)
Duration	Up to 24 hours
Used for	Convenient for patients needing both basal & bolus coverage

🔸 Examples:

70/30 (70% NPH + 30% Regular) – Humulin 70/30
50/50, 25/75, NovoMix 30 (Aspart + Protaminated Aspart)

🩺 Nursing Notes:

Inject before meals
Roll the pen/vial to mix components

🧾 NURSING RESPONSIBILITIES FOR ALL INSULINS:

✅ Before Administration:

Check blood sugar
Assess dietary intake, meal timing
Use correct insulin syringe or pen

✅ During Administration:

Rotate injection sites to prevent lipodystrophy
Observe for signs of hypoglycemia

✅ After Administration:

Monitor blood glucose response
Educate patient on:
- Symptoms of hypoglycemia (sweating, palpitations, tremors)
- Proper storage (refrigeration, no freezing)
- Handling of insulin pens or vials

🩺 ANTIEMETICS.

Antiemetics are drugs used to prevent or relieve nausea and vomiting caused by various conditions such as gastrointestinal disorders, motion sickness, chemotherapy, and anesthesia.

🔹 1. ONDANSETRON

🔸 Class:

5-HT₃ Receptor Antagonist (Serotonin Antagonist)

🔸 Mechanism of Action:

Blocks serotonin (5-HT₃) receptors in the GI tract and chemoreceptor trigger zone (CTZ) in the brain.

🔸 Indications:

Chemotherapy-induced nausea and vomiting
Postoperative nausea and vomiting
Radiation therapy-induced emesis

🔸 Contraindications:

Hypersensitivity
Congenital long QT syndrome

🔸 Side Effects:

Headache, constipation
QT prolongation (arrhythmia risk)
Dizziness

🔸 Nursing Responsibilities:

Monitor ECG in cardiac patients
Administer before chemotherapy or surgery
Educate about avoiding alcohol or CNS depressants

🔹 2. METOCLOPRAMIDE

🔸 Class:

Dopamine D₂ Receptor Antagonist
Prokinetic agent

🔸 Mechanism of Action:

Blocks dopamine receptors in the CTZ
Enhances gastric emptying by increasing GI motility

🔸 Indications:

Postoperative or drug-induced vomiting
Gastroparesis
Reflux esophagitis
Nausea due to delayed gastric emptying

🔸 Contraindications:

GI obstruction or perforation
Parkinson’s disease
History of seizures

🔸 Side Effects:

Extrapyramidal symptoms (tremors, dystonia)
Sedation, diarrhea
Restlessness

🔸 Nursing Responsibilities:

Monitor for EPS symptoms
Do not give with other dopaminergic drugs (e.g., levodopa)
Assess bowel sounds before giving
Educate to report involuntary muscle movements

🔹 3. DOMPERIDONE

🔸 Class:

Peripheral Dopamine D₂ Antagonist

🔸 Mechanism of Action:

Blocks dopamine receptors in the gut and CTZ, enhancing GI motility

🔸 Indications:

Functional dyspepsia
Nausea/vomiting in gastroparesis
GI motility disorders

🔸 Contraindications:

Prolactin-secreting tumors
QT prolongation
GI bleeding or obstruction

🔸 Side Effects:

Dry mouth
Breast tenderness, galactorrhea
Arrhythmia risk (with high doses)

🔸 Nursing Responsibilities:

Use lowest effective dose
Monitor ECG in long-term use
Avoid combining with QT-prolonging drugs
Monitor for menstrual irregularities

🔹 4. PROMETHAZINE

🔸 Class:

Antihistamine (H₁ Blocker) & Anticholinergic

🔸 Mechanism of Action:

Blocks histamine (H₁) receptors in the vomiting center and vestibular system

🔸 Indications:

Motion sickness
Postoperative nausea
Allergy-related nausea/vomiting
Sedation before/after surgery

🔸 Contraindications:

Children <2 years (risk of respiratory depression)
Glaucoma
Prostatic hypertrophy

🔸 Side Effects:

Drowsiness, dry mouth
Confusion in elderly
Blurred vision, urinary retention

🔸 Nursing Responsibilities:

Educate on sedation risk
Avoid operating heavy machinery
Monitor for anticholinergic effects
Caution in elderly patients

🔹 5. SCOPOLAMINE (HYOSCINE)

🔸 Class:

Anticholinergic

🔸 Mechanism of Action:

Blocks acetylcholine at muscarinic receptors in the vestibular nuclei and CTZ

🔸 Indications:

Motion sickness prevention
Pre-anesthesia medication
Nausea from vestibular causes (e.g., vertigo)

🔸 Contraindications:

Glaucoma
Prostatic hypertrophy
Intestinal or urinary obstruction

🔸 Side Effects:

Dry mouth, drowsiness
Blurred vision
Urinary retention

🔸 Nursing Responsibilities:

Often given as transdermal patch
Instruct on proper patch placement (behind ear)
Educate about dry mouth and vision changes

🧪 ANTIHISTAMINES.

Antihistamines are drugs that block the effects of histamine, a chemical involved in allergic reactions, inflammation, gastric acid secretion, and sleep-wake cycles.

There are two main types:

H₁ Blockers – used for allergies, motion sickness, insomnia, etc.
H₂ Blockers – used to reduce gastric acid (e.g., ranitidine, famotidine – covered under antacids)

🔷 H₁ ANTIHISTAMINES (Focus of this section)

🔹 1. CHLORPHENIRAMINE MALEATE

🔸 Class:

First-Generation H₁ Receptor Antagonist

🔸 Mechanism of Action:

Blocks histamine H₁ receptors in the CNS and periphery → reduces allergy symptoms

🔸 Indications:

Allergic rhinitis
Common cold
Urticaria
Conjunctivitis

🔸 Contraindications:

Glaucoma
Urinary retention
Prostatic hypertrophy

🔸 Side Effects:

Drowsiness, dry mouth, blurred vision
Constipation
Urinary retention

🔸 Nursing Responsibilities:

Caution with elderly or glaucoma patients
Avoid operating machinery
Ensure adequate hydration and fiber intake

🔹 2. DIPHENHYDRAMINE

🔸 Class:

First-Generation H₁ Antagonist

🔸 Mechanism of Action:

Strongly blocks histamine and muscarinic receptors

🔸 Indications:

Allergic conditions
Motion sickness
Insomnia
Parkinsonism
Cough suppressant

🔸 Contraindications:

Children under 2 years
Narrow-angle glaucoma
Asthma

🔸 Side Effects:

Sedation, dry mouth
Confusion in elderly
Anticholinergic effects (urinary retention, constipation)

🔸 Nursing Responsibilities:

Give at bedtime if sedative effect is intended
Monitor for paradoxical excitement in children
Avoid CNS depressants (e.g., alcohol, opioids)

🔹 3. HYDROXYZINE

🔸 Class:

First-Generation H₁ Antihistamine

🔸 Mechanism of Action:

Antihistaminic and anxiolytic properties via CNS depression

🔸 Indications:

Anxiety
Preoperative sedation
Allergic conditions
Nausea & vomiting

🔸 Contraindications:

Early pregnancy
CNS depression
Glaucoma

🔸 Side Effects:

Sedation, dizziness
Dry mouth
Blurred vision

🔸 Nursing Responsibilities:

Avoid in pregnancy
Educate about sedation
Avoid combining with alcohol or opioids

🔹 4. LORATADINE

🔸 Class:

Second-Generation H₁ Antagonist

🔸 Mechanism of Action:

Selectively blocks peripheral H₁ receptors → non-sedating

🔸 Indications:

Allergic rhinitis
Urticaria
Chronic idiopathic hives

🔸 Contraindications:

Hypersensitivity
Severe liver disease

🔸 Side Effects:

Headache, dry mouth
Rare: palpitations, fatigue

🔸 Nursing Responsibilities:

Preferred in daytime use (non-drowsy)
Monitor for allergy relief
Safe in children and elderly

🔹 5. CETIRIZINE

🔸 Class:

Second-Generation H₁ Antagonist

🔸 Mechanism of Action:

Selectively inhibits peripheral H₁ receptors with minimal CNS penetration

🔸 Indications:

Allergic rhinitis
Urticaria
Atopic dermatitis (adjuvant)

🔸 Contraindications:

Severe renal impairment
Infants <6 months

🔸 Side Effects:

Mild drowsiness, headache
Dry mouth

🔸 Nursing Responsibilities:

Can be used in children >6 months
Monitor renal function in long-term use
Educate patient about dose timing (once daily)

🔹 6. LEVOCETIRIZINE

🔸 Class:

Second-Generation H₁ Receptor Antagonist
Isomer of Cetirizine (more potent and less sedating)

🔸 Mechanism of Action:

Selectively blocks peripheral H₁ receptors, reducing histamine-induced symptoms (runny nose, sneezing, itching, rash)

🔸 Indications:

Allergic rhinitis (seasonal & perennial)
Chronic urticaria
Skin allergies

🔸 Contraindications:

Severe renal impairment
Infants <6 months
Hypersensitivity

🔸 Side Effects:

Headache, dry mouth
Fatigue
Rare: mild sedation

🔸 Nursing Responsibilities:

Preferably given in the evening (once daily)
Monitor renal function in chronic therapy
Well-tolerated in children >6 months

🔹 7. FEXOFENADINE

🔸 Class:

Second-Generation H₁ Antihistamine

🔸 Mechanism of Action:

Selectively blocks peripheral histamine H₁ receptors without significant CNS penetration

🔸 Indications:

Seasonal allergic rhinitis
Chronic idiopathic urticaria

🔸 Contraindications:

Hypersensitivity
Caution in patients with renal impairment

🔸 Side Effects:

Headache, back pain
Dizziness
Rare: menstrual irregularities

🔸 Nursing Responsibilities:

Non-sedating → ideal for daytime use
Avoid fruit juices (may reduce absorption)
Monitor for effectiveness of allergy symptom control

🔹 8. MECLIZINE

🔸 Class:

First-Generation H₁ Antagonist
Also has anticholinergic and anti-vertigo effects

🔸 Mechanism of Action:

Blocks histamine receptors in the vestibular system and vomiting center

🔸 Indications:

Motion sickness
Vertigo (Meniere’s disease)
Nausea/vomiting associated with dizziness

🔸 Contraindications:

Glaucoma
Asthma
Pregnancy (with caution)

🔸 Side Effects:

Drowsiness, dry mouth
Blurred vision, confusion (elderly)

🔸 Nursing Responsibilities:

Educate to take 1 hour before travel for motion sickness
Warn about drowsiness and avoid driving
Use caution in elderly and asthmatics

🔹 9. CYCLOZINE

🔸 Class:

First-Generation Antihistamine with strong anti-nausea effects

🔸 Mechanism of Action:

Acts on vestibular nuclei to block histamine receptors involved in motion-induced nausea

🔸 Indications:

Motion sickness
Morning sickness in pregnancy (with medical supervision)
Postoperative nausea

🔸 Contraindications:

Hypersensitivity
Glaucoma
Severe liver disease

🔸 Side Effects:

Sedation, dry mouth, urinary retention
Rare: tachycardia

🔸 Nursing Responsibilities:

Monitor for drowsiness
Often used in combination with pyridoxine in pregnancy
Encourage hydration

🔹 10. AZELASTINE

🔸 Class:

Second-Generation H₁ Antagonist (Intranasal/ophthalmic)

🔸 Mechanism of Action:

Selectively blocks histamine receptors in the nasal mucosa and conjunctiva

🔸 Indications:

Allergic rhinitis (nasal spray)
Allergic conjunctivitis (eye drops)

🔸 Contraindications:

Hypersensitivity
Not for children under 6 years (intranasal)

🔸 Side Effects:

Bitter taste
Nasal irritation, sneezing
Mild drowsiness

🔸 Nursing Responsibilities:

Instruct on proper spray technique
Avoid sniffing deeply after spraying
Ensure patient doesn’t drive immediately after use if sleepy

🧬 STEROIDS.

Steroids refer to corticosteroids, synthetic forms of natural hormones produced by the adrenal cortex. They are classified into:

Glucocorticoids – affect metabolism, immunity, and inflammation
Mineralocorticoids – regulate sodium and water balance (e.g., aldosterone)

🔹 TYPES & EXAMPLES OF STEROID DRUGS:

Type	Examples
Glucocorticoids	Hydrocortisone, Prednisolone, Dexamethasone, Methylprednisolone, Betamethasone
Mineralocorticoids	Fludrocortisone
Inhaled corticosteroids	Budesonide, Beclomethasone, Fluticasone
Topical steroids	Clobetasol, Hydrocortisone cream

🔬 MECHANISM OF ACTION:

Bind to intracellular steroid receptors
Suppress pro-inflammatory genes (e.g., cytokines, prostaglandins)
Inhibit immune cell migration and reduce inflammation
In mineralocorticoids: act on renal tubules to promote sodium and water retention

🧬 WHAT ARE GLUCOCORTICOIDS?

Glucocorticoids are steroid hormones that regulate metabolism, immune responses, inflammation, and stress adaptation. They are synthesized in the adrenal cortex and used pharmacologically for their anti-inflammatory and immunosuppressive effects.

🔹 1. PREDNISOLONE

Class: Intermediate-acting Glucocorticoid
Action: Suppresses inflammation by inhibiting pro-inflammatory cytokines, reducing immune cell activity, and stabilizing lysosomal membranes

✅ Indications:

Asthma, COPD
Rheumatoid arthritis, lupus
Nephrotic syndrome
Autoimmune hepatitis
Inflammatory bowel disease

⚠️ Contraindications:

Systemic fungal infections
Peptic ulcer disease
Uncontrolled diabetes
Osteoporosis

🚫 Side Effects:

Weight gain, hyperglycemia
Moon face, acne
Osteoporosis
Cushingoid appearance

🩺 Role & Monitoring:

Give with food to avoid gastric irritation
Monitor blood glucose, BP, weight, bone density
Taper slowly after long use to avoid adrenal insufficiency

🔹 2. DEXAMETHASONE

Class: Long-acting Glucocorticoid
Action: Very potent anti-inflammatory effect; crosses blood-brain barrier; suppresses ACTH

✅ Indications:

Cerebral edema
Chemotherapy-induced nausea
COVID-19 with respiratory failure
Severe allergic reactions
Preterm labor (fetal lung maturity)

⚠️ Contraindications:

Infections (TB, fungal)
Glaucoma
GI ulceration
Psychiatric disorders

🚫 Side Effects:

Psychosis, insomnia
Immunosuppression
Hyperglycemia
Muscle wasting

🩺 Role & Monitoring:

Monitor mental status and sleep disturbances
Use cautiously in psychiatric patients
Check CBC, electrolytes, blood sugar regularly

🔹 3. HYDROCORTISONE

Class: Short-acting Glucocorticoid
Action: Mimics endogenous cortisol; both glucocorticoid and mild mineralocorticoid activity

✅ Indications:

Adrenal insufficiency (Addison’s disease)
Septic shock (as adjunct)
Allergic emergencies
Topical/injectable use for eczema or arthritis

⚠️ Contraindications:

Systemic infections
Known hypersensitivity
Recent live vaccines

🚫 Side Effects:

Fluid retention
Increased intracranial pressure (in children)
GI upset
Adrenal suppression

🩺 Role & Monitoring:

Monitor serum cortisol levels in replacement therapy
Educate on stress dosing for patients with adrenal insufficiency
Administer with food

🔹 4. METHYLPREDNISOLONE

Class: Intermediate-acting Glucocorticoid
Action: Suppresses cell-mediated immunity and inflammatory pathways

✅ Indications:

Multiple sclerosis relapse
Organ transplant rejection
Lupus nephritis
Severe asthma attack
Arthritis flares

⚠️ Contraindications:

Peptic ulcer
Diabetes mellitus
Uncontrolled hypertension

🚫 Side Effects:

Delayed wound healing
GI bleeding
Increased intraocular pressure
Insomnia

🩺 Role & Monitoring:

Monitor for GI bleeding, I/O, and infections
Avoid abrupt discontinuation
Educate on infection prevention

🔹 5. BETAMETHASONE

Class: Long-acting Glucocorticoid
Action: Strong anti-inflammatory and fetal lung maturation via surfactant induction

✅ Indications:

Antenatal corticosteroid (for preterm labor)
Severe dermatitis, psoriasis
High-dose for brain tumors or edema
Chronic skin inflammation

⚠️ Contraindications:

Active systemic infection
Osteoporosis
Viral skin lesions

🚫 Side Effects:

Skin thinning (topical)
Immune suppression
Elevated blood sugar
Fetal growth restriction (rare)

🩺 Role & Monitoring:

For pregnancy use: monitor fetal wellbeing, timing of doses
Topical: avoid overuse or occlusion dressings
Watch for skin atrophy and local infection

🧬 WHAT ARE MINERALOCORTICOIDS?

Mineralocorticoids are a subclass of corticosteroids that primarily regulate electrolyte and fluid balance by acting on the distal renal tubules to increase sodium reabsorption and potassium excretion. The main endogenous hormone is aldosterone.

🔹 1. FLUDROCORTISONE

🔸 Class:

Synthetic Mineralocorticoid
Mild glucocorticoid effect also present

🔸 Mechanism of Action:

Acts on mineralocorticoid receptors in the renal distal tubules
Promotes reabsorption of sodium and excretion of potassium and hydrogen ions
Leads to water retention and increased blood pressure

✅ Indications:

Primary adrenal insufficiency (Addison’s disease)
Congenital adrenal hyperplasia (CAH)
Salt-losing syndromes (e.g., adrenogenital syndrome)
Orthostatic hypotension (off-label)

⚠️ Contraindications:

Systemic fungal infections
Heart failure or uncontrolled hypertension
Severe renal impairment
Hypersensitivity to fludrocortisone

🚫 Specific Side Effects:

Hypertension, edema, fluid retention
Hypokalemia (due to potassium loss)
Muscle weakness, headache
Heart failure exacerbation
Weight gain

🩺 NURSING RESPONSIBILITIES & MONITORING:

✅ Pre-administration:

Assess baseline BP, weight, and serum electrolytes (especially Na⁺ and K⁺)
Evaluate for edema or signs of fluid overload

✅ During Therapy:

Daily weight monitoring for fluid retention
Regular BP monitoring (risk of hypertension)
Monitor serum potassium and sodium levels
Educate patient to report:
- Swelling of hands/feet
- Shortness of breath
- Muscle cramps or palpitations (hypokalemia symptoms)

✅ Patient Education:

Take in the morning to mimic natural hormone rhythm
Do not stop abruptly (risk of adrenal crisis)
Low-sodium and potassium-rich diet (e.g., bananas, spinach)
Teach signs of electrolyte imbalance and fluid retention

🔹 OTHER MINERALOCORTICOIDS / ALDOSTERONE AGONISTS

🔸 Aldosterone (natural hormone)

Not used therapeutically due to short half-life

🔸 Desoxycorticosterone (DOCA)

Less commonly used today; previously for adrenal insufficiency

🫁 WHAT ARE INHALED CORTICOSTEROIDS (ICS)?

Inhaled corticosteroids are anti-inflammatory drugs delivered directly into the lungs. They reduce airway inflammation, prevent exacerbations, and improve lung function — especially in asthma and COPD.

🔹 1. BECLOMETHASONE DIPROPIONATE

🔸 Class:

Inhaled Glucocorticoid

🔸 Mechanism of Action:

Suppresses airway inflammation by inhibiting inflammatory cells (eosinophils, mast cells)
Reduces mucosal edema, mucus secretion, and airway hyperresponsiveness

✅ Indications:

Maintenance therapy in asthma
COPD with frequent exacerbations
Allergic rhinitis (as nasal spray form)

⚠️ Contraindications:

Acute bronchospasm (not for emergency use)
Active untreated respiratory infections (e.g., TB)

🚫 Side Effects:

Oral candidiasis (thrush)
Hoarseness (dysphonia)
Sore throat, cough
Rare: adrenal suppression at high doses

🩺 Nursing Role:

Rinse mouth after use to prevent thrush
Use spacer to reduce throat irritation
Monitor respiratory status & symptom control
Educate patient: ICS are preventive, not for quick relief

🔹 2. BUDESONIDE

🔸 Class:

Inhaled corticosteroid (also available as nebulizer and nasal spray)

✅ Indications:

Persistent asthma in children and adults
COPD (with long-acting bronchodilator)
Allergic rhinitis (nasal spray)

⚠️ Contraindications:

Acute asthma attacks
Nasal trauma or surgery (nasal form)

🚫 Side Effects:

Nasal irritation, epistaxis (nasal form)
Cough, fungal infections (oral form)
Systemic effects in high doses: growth suppression (children), adrenal suppression

🩺 Nursing Role:

Educate about consistent daily use
Rinse mouth or gargle after use
Monitor growth in children on long-term therapy

🔹 3. FLUTICASONE PROPIONATE

🔸 Class:

Inhaled corticosteroid

✅ Indications:

Moderate to severe asthma
COPD with eosinophilic component
Allergic rhinitis (Fluticasone nasal spray)

⚠️ Contraindications:

Status asthmaticus
Untreated local infection

🚫 Side Effects:

Dry mouth, throat irritation
Fungal infections, hoarseness
Systemic absorption in high doses: osteoporosis, bruising

🩺 Nursing Role:

Assess respiratory status before and after inhalation
Use spacer device for better drug deposition
Check for oral white patches (thrush)

🔹 4. MOMETASONE FUROATE

🔸 Class:

Inhaled glucocorticoid (also available as nasal spray)

✅ Indications:

Maintenance of asthma
Allergic rhinitis
Nasal polyps

⚠️ Contraindications:

Untreated local fungal infections
Pregnancy (risk-benefit evaluation required)

🚫 Side Effects:

Throat infection, cough, voice changes
Headache, dry nose, nosebleeds (nasal form)

🩺 Nursing Role:

Proper nasal spray technique (head tilted forward)
Warn about possible nasal irritation
Regular follow-up for symptom relief

🔹 5. CICLESONIDE

🔸 Class:

Prodrug inhaled corticosteroid → activated in the lungs

✅ Indications:

Mild to moderate asthma (adults & children >12 years)

⚠️ Contraindications:

Status asthmaticus
Systemic infections

🚫 Side Effects:

Mild hoarseness, throat irritation
Rare: oral thrush, headache

🩺 Nursing Role:

Administer via MDI (metered-dose inhaler)
Monitor response to long-term control
Encourage rinsing mouth post-use

🧴 WHAT ARE TOPICAL STEROIDS?

Topical corticosteroids are anti-inflammatory medications applied to the skin to treat various dermatologic conditions. They are classified by potency, ranging from mild to very potent, depending on the strength and formulation.

🔬 MECHANISM OF ACTION:

Suppress inflammation, itching, and immune responses in the skin
Inhibit the release of inflammatory mediators like prostaglandins and cytokines
Cause vasoconstriction → reduces redness and swelling

🔹 CLASSIFICATION OF TOPICAL STEROIDS BY POTENCY:

Potency	Examples
Low	Hydrocortisone 1%, Desonide
Moderate	Betamethasone valerate 0.05%, Clobetasone
High	Mometasone furoate, Fluocinolone
Very High	Clobetasol propionate 0.05%, Halobetasol

🔹 1. HYDROCORTISONE (1%)

🔸 Class:

Low-potency topical glucocorticoid

✅ Indications:

Eczema, dermatitis
Diaper rash
Insect bites
Mild allergic skin reactions

⚠️ Contraindications:

Fungal, bacterial, or viral infections (untreated)
Acne, rosacea

🚫 Side Effects:

Local irritation
Skin thinning (with prolonged use)
Hypopigmentation

🩺 Nursing Role:

Use thin layer, apply 1–2 times/day
Do not use under occlusive dressings unless prescribed
Educate on short-term use only

🔹 2. CLOBETASOL PROPIONATE (0.05%)

🔸 Class:

Very potent topical corticosteroid

✅ Indications:

Psoriasis
Lichen planus
Severe eczema
Lichen simplex chronicus

⚠️ Contraindications:

Broken or infected skin
Long-term use (risk of systemic absorption)
Use on face, groin, or axilla

🚫 Side Effects:

Skin atrophy
Telangiectasia
Striae (stretch marks)
Systemic effects if absorbed

🩺 Nursing Role:

Limit use to 2 weeks or less
Avoid in sensitive areas (face, genital, axilla)
Monitor for skin changes and signs of overuse

🔹 3. MOMETASONE FUROATE (0.1%)

🔸 Class:

Potent topical corticosteroid

✅ Indications:

Eczema
Contact dermatitis
Psoriasis (limited areas)
Atopic dermatitis

⚠️ Contraindications:

Skin infections
Perioral dermatitis

🚫 Side Effects:

Burning, itching
Rosacea worsening
Folliculitis

🩺 Nursing Role:

Use on intact skin only
Apply once daily
Avoid prolonged use or combining with other strong products

🔹 4. BETAMETHASONE VALERATE (0.05%)

🔸 Class:

Medium-to-high potency corticosteroid

✅ Indications:

Dermatitis
Eczema
Psoriasis (non-facial areas)

⚠️ Contraindications:

Open wounds
Face and flexures (thin skin)

🚫 Side Effects:

Thinning of skin
Delayed wound healing
Rebound dermatitis

🩺 Nursing Role:

Limit application to affected areas only
Monitor improvement vs. damage
Educate on step-down therapy (switching to mild steroid)

🔹 5. DESONIDE (0.05%)

🔸 Class:

Mild topical corticosteroid

✅ Indications:

Atopic dermatitis in children
Facial eczema
Intertrigo
Mild contact dermatitis

⚠️ Contraindications:

Secondary infections
Open wounds

🚫 Side Effects:

Minimal: local irritation or dryness
Rare systemic effects

🩺 Nursing Role:

Safe for longer-term use in sensitive skin
Monitor children for growth and skin integrity

🧬 IMMUNOSUPPRESSIVE DRUGS.

Immunosuppressive drugs are agents that inhibit or reduce the strength of the body’s immune system. They are essential in conditions where the immune system is overactive or needs to be suppressed, such as organ transplantation, autoimmune diseases, or chronic inflammatory conditions.

🔹 1. CYCLOSPORINE

🔸 Class:

Calcineurin Inhibitor

🔸 Mechanism of Action:

Inhibits T-cell activation by blocking the enzyme calcineurin, thus preventing IL-2 transcription, a cytokine essential for T-cell proliferation.

✅ Indications:

Prevention of organ transplant rejection (kidney, liver, heart)
Severe rheumatoid arthritis
Psoriasis
Nephrotic syndrome

⚠️ Contraindications:

Uncontrolled hypertension
Renal impairment
Concurrent use with nephrotoxic drugs

🚫 Specific Side Effects:

Nephrotoxicity
Hypertension
Hirsutism, gingival hyperplasia
Increased risk of infections and malignancies

🩺 Nursing Role & Monitoring:

Monitor renal function (creatinine, BUN) regularly
Check BP frequently
Educate about oral hygiene to prevent gum overgrowth
Instruct patient to avoid grapefruit juice (increases drug levels)

🔹 2. TACROLIMUS

🔸 Class:

Calcineurin Inhibitor

🔸 Mechanism of Action:

Similar to cyclosporine but more potent; binds to FK-binding protein and inhibits calcineurin, reducing T-cell activation.

✅ Indications:

Organ transplantation (especially liver and kidney)
Atopic dermatitis (topical form)

⚠️ Contraindications:

Hypersensitivity
Diabetes mellitus (caution due to risk of hyperglycemia)

🚫 Specific Side Effects:

Nephrotoxicity
Neurotoxicity (tremors, headache)
Hyperglycemia
Increased infection risk

🩺 Nursing Role & Monitoring:

Monitor blood glucose and neuro status
Educate about strict hand hygiene
Monitor tacrolimus blood levels to avoid toxicity
Assess for tremors or confusion

🔹 3. AZATHIOPRINE

🔸 Class:

Antimetabolite (Purine analog)

🔸 Mechanism of Action:

Interferes with DNA synthesis in proliferating immune cells → suppresses B and T lymphocytes

✅ Indications:

Organ transplantation
Autoimmune diseases: Lupus, RA, Inflammatory bowel disease

⚠️ Contraindications:

Pregnancy
Bone marrow suppression
Known hypersensitivity

🚫 Specific Side Effects:

Bone marrow suppression (leukopenia, anemia)
Hepatotoxicity
Increased risk of infections
Pancreatitis

🩺 Nursing Role & Monitoring:

Monitor CBC (WBC, platelets) regularly
Check liver function tests (LFTs)
Avoid in pregnancy and lactation
Educate about infection signs and avoid crowded areas

🔹 4. MYCOPHENOLATE MOFETIL

🔸 Class:

Selective Inhibitor of Inosine Monophosphate Dehydrogenase

🔸 Mechanism of Action:

Inhibits purine synthesis in T and B lymphocytes → blocks cell proliferation

✅ Indications:

Prevention of organ transplant rejection (heart, kidney, liver)
Off-label in autoimmune diseases (SLE, vasculitis)

⚠️ Contraindications:

Pregnancy (teratogenic)
Active infections
Hypersensitivity

🚫 Specific Side Effects:

Diarrhea, nausea
Leukopenia
Risk of congenital malformations
Opportunistic infections

🩺 Nursing Role & Monitoring:

Strict contraception advice for women of childbearing age
Monitor CBC and GI tolerance
Educate about hand hygiene and infection signs

🔹 5. SIROLIMUS (RAPAMYCIN)

🔸 Class:

mTOR (Mammalian Target of Rapamycin) Inhibitor

🔸 Mechanism of Action:

Inhibits T-cell response to IL-2, preventing proliferation

✅ Indications:

Prevention of renal transplant rejection
Stent placement (drug-eluting stents)

⚠️ Contraindications:

Liver disease
Known hypersensitivity
Concurrent use with cyclosporine (↑ toxicity)

🚫 Specific Side Effects:

Hyperlipidemia
Thrombocytopenia
Delayed wound healing
Interstitial lung disease

🩺 Nursing Role & Monitoring:

Monitor lipid profile and platelets
Educate about delayed surgical wound healing
Ensure patient is not on cyclosporine concurrently

🔹 6. CYCLOPHOSPHAMIDE

🔸 Class:

Alkylating Agent (Cytotoxic Immunosuppressant)

🔸 Mechanism of Action:

Cross-links DNA strands, inhibiting DNA replication in rapidly dividing immune cells (T & B lymphocytes)
Causes profound immunosuppression

✅ Indications:

Severe autoimmune diseases (SLE, vasculitis)
Bone marrow transplant conditioning
Some cancers (leukemia, lymphoma)

⚠️ Contraindications:

Active infections
Severe bone marrow suppression
Pregnancy

🚫 Specific Side Effects:

Hemorrhagic cystitis (bladder inflammation)
Myelosuppression (leukopenia, anemia)
Alopecia
Risk of secondary malignancies

🩺 Nursing Role & Monitoring:

Ensure adequate hydration to prevent cystitis
Administer with Mesna (protects bladder)
Monitor CBC, urine output, hematuria
Educate about hair loss and infection precautions

🔹 7. METHOTREXATE

🔸 Class:

Antimetabolite (Folate Antagonist)

🔸 Mechanism of Action:

Inhibits dihydrofolate reductase, leading to inhibition of DNA synthesis
Suppresses T and B cell proliferation

✅ Indications:

Rheumatoid arthritis (RA)
Psoriasis
Lupus, other autoimmune diseases
Some cancers (osteosarcoma, leukemia)

⚠️ Contraindications:

Pregnancy (teratogenic)
Liver disease
Renal impairment

🚫 Specific Side Effects:

Hepatotoxicity
Myelosuppression
Stomatitis, oral ulcers
Pulmonary fibrosis (rare but serious)

🩺 Nursing Role & Monitoring:

Give folic acid supplementation to reduce toxicity
Monitor LFTs, CBC, chest symptoms
Educate about teratogenicity – strict contraception required
Avoid alcohol and NSAIDs

🔹 8. THALIDOMIDE

🔸 Class:

Immunomodulator

🔸 Mechanism of Action:

Inhibits TNF-alpha and modulates immune responses
Also has anti-angiogenic properties

✅ Indications:

Erythema nodosum leprosum
Multiple myeloma (in combination)
Lupus, Behçet’s disease (rare cases)

⚠️ Contraindications:

Pregnancy – severe teratogenicity
Peripheral neuropathy
Hypersensitivity

🚫 Specific Side Effects:

Severe birth defects
Peripheral neuropathy
Sedation
Constipation, DVT

🩺 Nursing Role & Monitoring:

Educate on STRICT contraceptive use (male & female)
Regular neurologic assessment
Monitor for DVT signs
Enroll patient in REMS (Risk Evaluation & Mitigation) programs if applicable

🔹 9. LEFLUNOMIDE

🔸 Class:

Pyrimidine Synthesis Inhibitor (DMARD)

🔸 Mechanism of Action:

Inhibits dihydroorotate dehydrogenase, suppressing T-cell proliferation

✅ Indications:

Rheumatoid arthritis
Psoriatic arthritis

⚠️ Contraindications:

Pregnancy
Hepatic dysfunction
Active infections

🚫 Specific Side Effects:

Hepatotoxicity
Hypertension
Diarrhea
Teratogenic effects

🩺 Nursing Role & Monitoring:

Monitor liver enzymes, BP, CBC
Educate about contraception
Cholestyramine can be used for rapid drug elimination if needed (especially before pregnancy)

🔹 10. RITUXIMAB

🔸 Class:

Monoclonal Antibody – Anti-CD20 (B-cell Depleting Agent)

🔸 Mechanism of Action:

Binds to CD20 antigen on B lymphocytes → causes B-cell destruction

✅ Indications:

Non-Hodgkin’s lymphoma
Chronic lymphocytic leukemia (CLL)
Rheumatoid arthritis (with methotrexate)
ANCA-associated vasculitis

⚠️ Contraindications:

Active severe infections
History of hepatitis B (can reactivate)

🚫 Specific Side Effects:

Infusion reactions (fever, chills, hypotension)
Hepatitis B reactivation
Progressive multifocal leukoencephalopathy (PML)

🩺 Nursing Role & Monitoring:

Screen for hepatitis B before starting
Pre-medicate with antihistamines & acetaminophen
Monitor infusion vitals closely
Educate about delayed infections or neurological changes

🧪 11. Tocilizumab.

Tocilizumab is a monoclonal antibody and immunosuppressive drug that targets the interleukin-6 (IL-6) receptor. It is used in the treatment of various autoimmune and inflammatory conditions.

🧬 Classification

Class: Immunosuppressant / Biological DMARD (Disease-Modifying Anti-Rheumatic Drug)
Type: Humanized monoclonal antibody (IgG1)

⚙️ Mechanism of Action

Tocilizumab binds to both soluble and membrane-bound IL-6 receptors, thereby blocking IL-6–mediated signaling pathways. IL-6 is a key pro-inflammatory cytokine involved in immune responses, inflammation, and autoimmunity. By inhibiting this pathway, it reduces inflammation and tissue damage.

💉 Indications / Therapeutic Uses

Tocilizumab is used in:

Rheumatoid arthritis (moderate to severe)
Juvenile idiopathic arthritis
Giant cell arteritis
Cytokine release syndrome (CRS), especially in CAR-T cell therapy
Systemic lupus erythematosus (off-label)
Severe COVID-19 pneumonia (under emergency use/approved in some protocols)

💊 Dosage and Route

IV infusion or subcutaneous injection
Dose depends on the condition, patient weight, and formulation:
- IV: 4–8 mg/kg every 4 weeks
- SC: e.g., 162 mg weekly or every other week

⚠️ Contraindications

Active infections (e.g., TB, sepsis)
Hypersensitivity to Tocilizumab or any of its components
Caution in liver dysfunction, low neutrophil or platelet count

⚠️ Adverse Effects / Side Effects

🟡 Common:

Upper respiratory tract infections
Headache
Hypertension
Injection site reactions

🔴 Serious:

Serious infections (TB, fungal, bacterial)
Hepatotoxicity (↑ liver enzymes)
Gastrointestinal perforation
Neutropenia, thrombocytopenia
Anaphylaxis or hypersensitivity

👩‍⚕️ Nursing Responsibilities

Monitor for signs of infection (fever, cough, sore throat).
Check liver function tests, WBC, and platelet counts regularly.
Educate patient to avoid contact with infected persons.
Do not administer live vaccines during treatment.
Assess for hypersensitivity reactions during infusion.
Monitor blood pressure and signs of GI symptoms.

🧠 Key Points

Tocilizumab is not a first-line drug; used when patients fail standard DMARDs.
IL-6 blockade may reduce immune response to infections and vaccines.
May be considered in COVID-19 with elevated IL-6 levels and severe inflammation.

🧫 ANTIFUNGAL DRUGS.

Antifungal drugs are used to treat fungal infections (mycoses) caused by yeasts, molds, and dermatophytes. They may be topical, oral, or intravenous, depending on the severity and site of infection.

🔹 1. AMPHOTERICIN B

🔸 Class:

Polyene Antifungal

🔸 Mechanism of Action:

Binds to ergosterol in fungal cell membranes, creating pores → cell contents leak out → cell death

✅ Indications:

Severe systemic fungal infections (e.g., cryptococcal meningitis, histoplasmosis, mucormycosis)
Neutropenic fever with suspected fungal infection

⚠️ Contraindications:

Hypersensitivity
Pre-existing renal disease (relative)

🚫 Specific Side Effects:

Nephrotoxicity
Infusion reactions (fever, chills, hypotension)
Hypokalemia, anemia

🩺 Nursing Role & Monitoring:

Pre-medicate with antipyretics/antihistamines
Monitor renal function, electrolytes (K⁺, Mg²⁺)
Use liposomal form to reduce toxicity
Administer via IV infusion slowly over hours

🔹 2. FLUCONAZOLE

🔸 Class:

Azole Antifungal (Triazole)

🔸 Mechanism of Action:

Inhibits ergosterol synthesis (via inhibition of fungal cytochrome P450 enzyme)

✅ Indications:

Candidiasis (oral, vaginal, systemic)
Cryptococcal meningitis
Prophylaxis in immunocompromised patients

⚠️ Contraindications:

Liver disease
Concomitant drugs causing QT prolongation
Pregnancy (high doses)

🚫 Specific Side Effects:

Hepatotoxicity
Nausea, headache
QT interval prolongation

🩺 Nursing Role & Monitoring:

Monitor LFTs in long-term use
Educate about drug interactions
Avoid alcohol and monitor for liver symptoms

🔹 3. KETOCONAZOLE

🔸 Class:

Imidazole Antifungal

🔸 Mechanism of Action:

Inhibits fungal cytochrome P450, preventing ergosterol synthesis

✅ Indications:

Seborrheic dermatitis (topical form)
Tinea infections
Refractory systemic fungal infections (oral form – rarely used now)

⚠️ Contraindications:

Hepatic dysfunction
Pregnancy
Co-administration with drugs metabolized by CYP3A4

🚫 Specific Side Effects:

Severe hepatotoxicity (boxed warning)
Gynecomastia, decreased libido (hormonal effects)
GI upset

🩺 Nursing Role & Monitoring:

Prefer topical use to minimize systemic side effects
If oral, monitor LFTs, hormonal changes
Educate about signs of liver damage

🔹 4. ITRACONAZOLE

🔸 Class:

Triazole Antifungal

🔸 Mechanism of Action:

Inhibits fungal ergosterol synthesis

✅ Indications:

Histoplasmosis, blastomycosis, onychomycosis
Oral and esophageal candidiasis

⚠️ Contraindications:

Heart failure (negative inotropic effect)
Liver impairment
Pregnancy

🚫 Specific Side Effects:

CHF exacerbation
Hepatotoxicity
GI disturbances
Drug interactions (CYP3A4)

🩺 Nursing Role & Monitoring:

Administer capsules with food, solution on empty stomach
Monitor LFTs, heart failure symptoms
Educate about drug–drug interactions

🔹 5. TERBINAFINE

🔸 Class:

Allylamine Antifungal

🔸 Mechanism of Action:

Inhibits squalene epoxidase, blocking ergosterol synthesis in fungal cell membranes

✅ Indications:

Tinea infections (e.g., athlete’s foot, jock itch)
Onychomycosis (nail fungus) – oral use
Ringworm, scalp infections

⚠️ Contraindications:

Liver disease
Severe renal impairment

🚫 Specific Side Effects:

Hepatotoxicity
Taste disturbances
Rash, GI upset

🩺 Nursing Role & Monitoring:

Monitor LFTs before and during oral treatment
Advise patient to report loss of taste, fatigue, jaundice
Educate on proper hygiene for fungal infections

🔹 6. VORICONAZOLE

🔸 Class:

Triazole Antifungal (Second Generation)

🔸 Mechanism of Action:

Inhibits fungal cytochrome P450 enzymes, blocking ergosterol synthesis

✅ Indications:

Invasive aspergillosis
Candidemia
Fungal infections resistant to amphotericin B or fluconazole

⚠️ Contraindications:

Concurrent use with drugs affecting CYP3A4
Liver disease
Pregnancy

🚫 Specific Side Effects:

Visual disturbances (blurred vision, color change)
Hepatotoxicity
Photosensitivity
Hallucinations (rare)

🩺 Nursing Role & Monitoring:

Administer on empty stomach
Monitor LFTs, visual changes
Educate patient to avoid sunlight and report hallucinations

🔹 7. POSACONAZOLE

🔸 Class:

Extended-spectrum Triazole

🔸 Mechanism of Action:

Blocks lanosterol demethylase, inhibiting ergosterol synthesis

✅ Indications:

Prophylaxis of invasive fungal infections in immunocompromised patients
Oral/esophageal candidiasis
Mucormycosis (alternative to amphotericin B)

⚠️ Contraindications:

Liver dysfunction
Concomitant CYP3A4 substrates (e.g., statins)

🚫 Specific Side Effects:

GI upset, headache
QT prolongation
Liver enzyme elevations

🩺 Nursing Role & Monitoring:

Give with high-fat meals for better absorption
Monitor LFTs and ECG (QT interval)
Educate about drug interactions and compliance

🔹 8. NATAMYCIN

🔸 Class:

Polyene Antifungal (Topical/Ophthalmic)

🔸 Mechanism of Action:

Binds to ergosterol in fungal membranes → leakage of intracellular contents

✅ Indications:

Fungal keratitis (eye infection)
Blepharitis, conjunctivitis (fungal origin)

⚠️ Contraindications:

Viral eye infections
Hypersensitivity to natamycin

🚫 Specific Side Effects:

Eye irritation, blurred vision
Redness, photophobia

🩺 Nursing Role & Monitoring:

Teach proper eye drop technique
Do not use contact lenses during treatment
Monitor for eye irritation or allergic response

🔹 9. NYSTATIN

🔸 Class:

Polyene Antifungal (Topical and Oral)

🔸 Mechanism of Action:

Binds ergosterol → disrupts fungal membrane integrity → cell death

✅ Indications:

Oral thrush (candidiasis)
Skin and vaginal candidiasis

⚠️ Contraindications:

Hypersensitivity
Not absorbed systemically → safe in most cases

🚫 Specific Side Effects:

Nausea, vomiting (oral)
Local irritation (topical)

🩺 Nursing Role & Monitoring:

For oral suspension: instruct to swish and swallow
Ensure full course to prevent recurrence
Monitor for relapse or secondary infections

🔹 10. ECONAZOLE / CLOTRIMAZOLE / MICONAZOLE

🔸 Class:

Imidazole Antifungals (Topical)

🔸 Mechanism of Action:

Inhibits ergosterol biosynthesis, impairing fungal cell membranes

✅ Indications:

Dermatophytosis (tinea infections)
Cutaneous and vaginal candidiasis
Ringworm, athlete’s foot, jock itch

⚠️ Contraindications:

Hypersensitivity
Avoid internal use (unless indicated)

🚫 Specific Side Effects:

Burning, itching, skin irritation
Rare allergic reactions

🩺 Nursing Role & Monitoring:

Apply to clean, dry skin
Educate about daily hygiene, regular use
Avoid covering with tight bandages

🧠 ANTICONVULSIVE DRUGS.

Anticonvulsants (antiepileptics) are medications used to prevent or control seizures. They work by modulating neuronal excitability, enhancing GABA activity (inhibitory), or blocking excitatory neurotransmitters (e.g., glutamate).

🔹 1. PHENYTOIN

🔸 Class:

Hydantoin derivative

🔸 Mechanism of Action:

Blocks voltage-gated sodium channels, stabilizing neuronal membranes and reducing repetitive firing

✅ Indications:

Generalized tonic-clonic seizures
Focal seizures
Status epilepticus (after benzodiazepines)

⚠️ Contraindications:

Sinus bradycardia, AV block
Hypersensitivity
Liver failure

🚫 Specific Side Effects:

Gingival hyperplasia, hirsutism
Nystagmus, ataxia, slurred speech
Skin rash, Stevens-Johnson syndrome
Megaloblastic anemia

🩺 Nursing Responsibilities:

Monitor serum drug levels (10–20 mcg/mL)
Educate about good oral hygiene
Avoid abrupt withdrawal
Monitor CBC, liver function, skin for rash

🔹 2. CARBAMAZEPINE

🔸 Class:

Iminostilbene

🔸 Mechanism of Action:

Blocks sodium channels, decreasing synaptic transmission

✅ Indications:

Focal and generalized tonic-clonic seizures
Trigeminal neuralgia
Bipolar disorder

⚠️ Contraindications:

Bone marrow suppression
History of hepatic porphyria
Use with MAO inhibitors

🚫 Specific Side Effects:

Aplastic anemia, agranulocytosis
Dizziness, drowsiness, blurred vision
Hyponatremia (SIADH)
Skin rashes, especially in Asians with HLA-B*1502

🩺 Nursing Responsibilities:

Monitor CBC, electrolytes (Na⁺), LFTs
Genetic testing for HLA-B*1502 in Asian patients
Educate patient about signs of infection or bleeding

🔹 3. VALPROIC ACID / DIVALPROEX SODIUM

🔸 Class:

Fatty acid derivative

🔸 Mechanism of Action:

Increases GABA levels
Blocks Na⁺ channels and T-type Ca²⁺ channels

✅ Indications:

Generalized seizures (absence, myoclonic)
Bipolar disorder
Migraine prophylaxis

⚠️ Contraindications:

Pregnancy (teratogenic)
Liver disease
Pancreatitis

🚫 Specific Side Effects:

Hepatotoxicity, pancreatitis
Thrombocytopenia, weight gain, tremor
Neural tube defects (in pregnancy)

🩺 Nursing Responsibilities:

Monitor LFTs, amylase/lipase, and platelet counts
Avoid use in pregnant women
Educate on signs of liver and pancreatic damage

🔹 4. LAMOTRIGINE

🔸 Class:

Phenyltriazine

🔸 Mechanism of Action:

Blocks voltage-sensitive sodium channels
Inhibits glutamate release

✅ Indications:

Generalized and focal seizures
Lennox-Gastaut syndrome
Bipolar disorder

⚠️ Contraindications:

Hypersensitivity
Caution in hepatic or renal impairment

🚫 Specific Side Effects:

Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN)
Diplopia, dizziness, headache
Insomnia

🩺 Nursing Responsibilities:

Titrate dose slowly to prevent skin reactions
Educate about rash reporting
Monitor for mood changes and suicidal ideation

🔹 5. LEVETIRACETAM

🔸 Class:

Pyrrolidine derivative

🔸 Mechanism of Action:

Binds to synaptic vesicle protein SV2A → modulates neurotransmitter release

✅ Indications:

Adjunctive therapy for focal and generalized seizures
Myoclonic seizures

⚠️ Contraindications:

Hypersensitivity
Severe renal impairment

🚫 Specific Side Effects:

Behavioral changes (aggression, irritability)
Sedation, fatigue
Infection risk

🩺 Nursing Responsibilities:

Monitor for mood or personality changes
Adjust dose in renal impairment
Educate caregivers about irritability or aggression

🔹 6. GABAPENTIN

🔸 Class:

GABA Analog (not GABA agonist)

🔸 Mechanism of Action:

Binds to voltage-gated calcium channels in CNS → reduces excitatory neurotransmitter release

✅ Indications:

Focal seizures (adjunct therapy)
Postherpetic neuralgia
Neuropathic pain
Off-label: fibromyalgia, anxiety

⚠️ Contraindications:

Severe renal impairment
Hypersensitivity

🚫 Side Effects:

Sedation, dizziness
Weight gain
Peripheral edema

🩺 Nursing Role:

Monitor renal function (adjust dose if impaired)
Watch for sedation or suicidal thoughts
Educate patient to avoid alcohol and driving initially

🔹 7. PREGABALIN

🔸 Class:

GABA Analog (similar to Gabapentin)

🔸 Mechanism of Action:

Binds alpha-2-delta subunit of calcium channels → reduces excitatory neurotransmitter release

✅ Indications:

Focal seizures (adjunct)
Diabetic neuropathy
Postherpetic neuralgia
Fibromyalgia
Generalized anxiety disorder

⚠️ Contraindications:

Hypersensitivity
Alcohol use (increases sedation)

🚫 Side Effects:

Drowsiness, dizziness
Weight gain, edema
Euphoria (risk of abuse)

🩺 Nursing Role:

Assess for abuse potential
Monitor weight and swelling
Advise about fall risk in elderly

🔹 8. TOPIRAMATE

🔸 Class:

Sulfamate-substituted monosaccharide

🔸 Mechanism of Action:

Blocks Na⁺ channels, enhances GABA activity, and antagonizes AMPA/kainate glutamate receptors

✅ Indications:

Focal and generalized seizures
Migraine prophylaxis
Off-label: bipolar disorder, binge eating

⚠️ Contraindications:

Metabolic acidosis
Glaucoma

🚫 Side Effects:

Cognitive dysfunction (“Dopamax”)
Weight loss, kidney stones
Paresthesia, metabolic acidosis

🩺 Nursing Role:

Encourage hydration to prevent kidney stones
Monitor bicarbonate levels
Educate about word-finding difficulty, slow titration

🔹 9. ETHOSUXIMIDE

🔸 Class:

Succinimide derivative

🔸 Mechanism of Action:

Inhibits T-type calcium channels in thalamic neurons

✅ Indications:

Absence seizures (drug of choice) in children
Not used in tonic-clonic seizures

⚠️ Contraindications:

History of porphyria
Liver/kidney impairment

🚫 Side Effects:

GI upset, fatigue, headache
Behavioral changes
Rare: Stevens-Johnson Syndrome, blood dyscrasias

🩺 Nursing Role:

Monitor CBC, LFTs, seizure frequency
Teach about nausea control (give with food)
Report any rashes or mood swings

🔹 10. CLONAZEPAM

🔸 Class:

Benzodiazepine (long-acting)

🔸 Mechanism of Action:

Potentiates GABAergic activity → inhibitory effect on neurons

✅ Indications:

Myoclonic and absence seizures
Lennox-Gastaut syndrome
Anxiety disorders

⚠️ Contraindications:

Liver disease
Respiratory insufficiency
History of substance abuse

🚫 Side Effects:

Sedation, drowsiness
Tolerance, dependence
Ataxia, slurred speech

🩺 Nursing Role:

Monitor for respiratory depression
Educate on risk of dependence
Avoid abrupt discontinuation (withdrawal seizures)

✅ ADDITIONAL DRUGS IN CLINICAL USE

Drug Name	Key Use	Notable Points
Brivaracetam	Adjunct in focal seizures	Similar to levetiracetam but better tolerated
Perampanel	Focal & generalized seizures	Blocks AMPA receptors; can cause aggression
Tiagabine	Adjunct for partial seizures	Inhibits GABA reuptake; risk of status epilepticus
Zonisamide	Broad-spectrum antiepileptic	Sulfa drug – avoid in allergy; watch for stones
Lacosamide	Focal seizures	Enhances slow inactivation of sodium channels

EMERGENCY DRUGS.

🚨 1. ADRENALINE (EPINEPHRINE)

🔸 Class:

Sympathomimetic (Adrenergic Agonist)

🔸 Action:

Stimulates alpha and beta receptors → ↑ HR, ↑ BP, bronchodilation, vasoconstriction

✅ Indications:

Anaphylaxis
Cardiac arrest (asystole, VF, pulseless VT)
Severe asthma attack
Septic shock

⚠️ Contraindications:

None in life-threatening situations
Caution in hypertension, hyperthyroidism

🚫 Side Effects:

Tachycardia, palpitations, arrhythmia
Hypertension, anxiety, tremors

🩺 Nursing Role:

Monitor vital signs, ECG, perfusion
Use IM in anaphylaxis, IV in arrest (1:10,000)
Educate on EpiPen use in allergic patients

🚨 2. ATROPINE

🔸 Class:

Anticholinergic (Muscarinic antagonist)

🔸 Action:

Blocks parasympathetic activity → ↑ HR, ↓ secretions

✅ Indications:

Bradycardia
Organophosphorus poisoning
Pre-anesthesia (to reduce secretions)

⚠️ Contraindications:

Glaucoma
Urinary retention
Myasthenia gravis

🚫 Side Effects:

Dry mouth, blurred vision, tachycardia
Urinary retention, confusion (elderly)

🩺 Nursing Role:

Monitor HR, pupils, urinary output
Ensure airway patency in OP poisoning
Educate about dryness & visual changes

🚨 3. ADENOSINE

🔸 Class:

Antiarrhythmic

🔸 Action:

Slows AV node conduction, interrupts re-entrant pathways

✅ Indications:

Paroxysmal Supraventricular Tachycardia (PSVT)
Diagnostic aid for wide-complex tachycardia

⚠️ Contraindications:

Asthma, 2nd/3rd-degree AV block, sick sinus syndrome

🚫 Side Effects:

Transient asystole, flushing, dyspnea, chest discomfort

🩺 Nursing Role:

Administer rapid IV push with flush
Continuous ECG monitoring
Warn patient of brief chest discomfort

🚨 4. AMIODARONE

🔸 Class:

Class III Antiarrhythmic

🔸 Action:

Prolongs cardiac repolarization and refractory period

✅ Indications:

Ventricular fibrillation, VT, AF, SVT (refractory)

⚠️ Contraindications:

Severe sinus bradycardia, heart block, thyroid disease

🚫 Side Effects:

Hypo/hyperthyroidism
Pulmonary fibrosis, photosensitivity, blue-gray skin
Liver dysfunction

🩺 Nursing Role:

Monitor ECG, thyroid, liver, lung function
Use central line for IV (caustic)
Educate on long half-life (up to 60 days)

🚨 5. LIDOCAINE (IV)

🔸 Class:

Class Ib Antiarrhythmic / Local anesthetic

🔸 Action:

Blocks Na⁺ channels, shortens action potential

✅ Indications:

Ventricular arrhythmias (especially post-MI)
VF/VT (alternative to amiodarone)

⚠️ Contraindications:

Severe heart block, bradycardia

🚫 Side Effects:

CNS toxicity: confusion, tremors, seizures
Hypotension, bradycardia

🩺 Nursing Role:

Monitor CNS signs, cardiac rhythm
Titrate dose carefully
Have resuscitation equipment ready

🚨 6. NALOXONE

🔸 Class:

Opioid antagonist

🔸 Action:

Blocks opioid receptors (mu, kappa) → reverses effects of opioids, especially respiratory depression

✅ Indications:

Opioid overdose
Reversal of respiratory depression from narcotics
Postoperative opioid reversal

⚠️ Contraindications:

None in emergencies
Caution in opioid-dependent individuals (can trigger withdrawal)

🚫 Side Effects:

Acute withdrawal symptoms (nausea, agitation, pain)
Tachycardia, hypertension
Pulmonary edema (rare)

🩺 Nursing Role:

Administer IM/IV/SC or intranasal
Monitor respiratory rate, LOC, BP
Be prepared for repeat dosing (shorter half-life than many opioids)

🚨 7. MAGNESIUM SULFATE

🔸 Class:

Electrolyte / CNS depressant

🔸 Action:

Stabilizes cardiac membranes, acts as a calcium antagonist, and suppresses seizures

✅ Indications:

Eclampsia / pre-eclampsia seizures
Torsades de pointes (arrhythmia)
Severe hypomagnesemia
Asthma (adjunct)

⚠️ Contraindications:

Heart block
Myasthenia gravis
Renal failure

🚫 Side Effects:

Respiratory depression
Loss of deep tendon reflexes (DTRs)
Hypotension, flushing

🩺 Nursing Role:

Monitor DTRs, respiratory rate, BP
Have calcium gluconate as antidote
Monitor serum magnesium (therapeutic: 4–7 mg/dL in eclampsia)

🚨 8. SODIUM BICARBONATE

🔸 Class:

Alkalinizing agent

🔸 Action:

Neutralizes hydrogen ions, raises blood pH, corrects metabolic acidosis

✅ Indications:

Cardiac arrest with acidosis
Hyperkalemia
TCA (tricyclic antidepressant) overdose
Severe metabolic acidosis

⚠️ Contraindications:

Alkalosis, hypocalcemia, CHF

🚫 Side Effects:

Metabolic alkalosis, hypokalemia
Tetany, sodium overload
Seizures (rare)

🩺 Nursing Role:

Administer slow IV push
Monitor ABG, electrolytes (K⁺, Ca²⁺)
Avoid mixing with calcium or catecholamines

🚨 9. DOPAMINE

🔸 Class:

Sympathomimetic (Inotrope/Vasopressor)

🔸 Action:

Dose-dependent receptor stimulation:
🔹 Low dose → renal perfusion (dopaminergic)
🔹 Medium dose → ↑ HR and contractility (β1)
🔹 High dose → vasoconstriction (α1)

✅ Indications:

Shock, hypotension
Bradycardia (2nd-line)
Heart failure (low-output state)

⚠️ Contraindications:

Pheochromocytoma
Uncorrected tachyarrhythmias

🚫 Side Effects:

Arrhythmias, tachycardia
Hypertension, gangrene (if extravasated)

🩺 Nursing Role:

Give via central line
Titrate based on MAP/urine output
Monitor for IV site necrosis, use phentolamine if extravasation occurs

🚨 10. NITROGLYCERIN

🔸 Class:

Nitrate / Vasodilator

🔸 Action:

Relaxes vascular smooth muscle → vasodilation, ↓ preload & myocardial oxygen demand

✅ Indications:

Acute coronary syndrome (angina, MI)
Pulmonary edema
Hypertensive crisis

⚠️ Contraindications:

SBP <90 mmHg, right-sided MI
Use of PDE-5 inhibitors (e.g., sildenafil)

🚫 Side Effects:

Hypotension, headache
Reflex tachycardia, dizziness

🩺 Nursing Role:

Monitor BP every 5–15 min
Titrate IV dose to symptoms/BP
Educate about headache, light sensitivity (store in dark)

🚨 11. FUROSEMIDE

🔸 Class:

Loop Diuretic

🔸 Action:

Inhibits Na⁺-K⁺-2Cl⁻ symporter in loop of Henle → promotes diuresis → reduces preload, pulmonary congestion

✅ Indications:

Acute pulmonary edema
Congestive heart failure
Hypertensive crisis with fluid overload
Hyperkalemia

⚠️ Contraindications:

Anuria, severe electrolyte depletion, sulfa allergy

🚫 Side Effects:

Hypokalemia, hyponatremia
Hypotension, ototoxicity
Dehydration, metabolic alkalosis

🩺 Nursing Role:

Monitor I/O, daily weight, electrolytes, BP
Administer slow IV to prevent ototoxicity
Replace potassium if needed

🚨 12. GLUCOSE (50% DEXTROSE / D50W)

🔸 Class:

Hypertonic solution / Caloric agent

🔸 Action:

Provides immediate glucose for cellular energy
Rapidly reverses hypoglycemia

✅ Indications:

Hypoglycemia (unconscious or NPO)
Insulin overdose
Hyperkalemia (as part of insulin + glucose therapy)

⚠️ Contraindications:

Intracranial hemorrhage (caution)
Hyperglycemia

🚫 Side Effects:

Hyperglycemia, local phlebitis, tissue necrosis if extravasated

🩺 Nursing Role:

Administer via large vein or central line
Monitor blood glucose before/after
Check for IV patency

🚨 13. INSULIN (REGULAR)

🔸 Class:

Short-acting insulin

🔸 Action:

Promotes glucose uptake by cells
Drives potassium into cells (used in hyperkalemia)

✅ Indications:

Diabetic ketoacidosis (DKA)
Hyperkalemia (with glucose)
Hyperglycemic crisis

⚠️ Contraindications:

Hypoglycemia, sensitivity to insulin

🚫 Side Effects:

Hypoglycemia, hypokalemia, sweating, shakiness

🩺 Nursing Role:

Monitor blood glucose and potassium
Always use with glucose in hyperkalemia
Prepare IV insulin drip carefully with accurate infusion pump

🚨 14. CALCIUM GLUCONATE

🔸 Class:

Electrolyte replacement

🔸 Action:

Stabilizes cardiac membranes in hyperkalemia, hypocalcemia, magnesium toxicity

✅ Indications:

Hyperkalemia with ECG changes
Calcium channel blocker overdose
Magnesium sulfate toxicity

⚠️ Contraindications:

Ventricular fibrillation, hypercalcemia, digitalis toxicity

🚫 Side Effects:

Bradycardia, vasodilation, hypotension
Extravasation necrosis (if given peripherally)

🩺 Nursing Role:

Give slow IV via central line
Monitor ECG, serum calcium, BP
Be prepared with resuscitation support

🚨 15. MIDAZOLAM

🔸 Class:

Short-acting benzodiazepine

🔸 Action:

Enhances GABA activity in the brain → sedation, anticonvulsant, anxiolytic

✅ Indications:

Status epilepticus
Preoperative sedation
Conscious sedation for procedures

⚠️ Contraindications:

Severe respiratory depression, glaucoma, hypotension

🚫 Side Effects:

Respiratory depression, amnesia, hypotension
Paradoxical reactions (agitation, hallucination in elderly)

🩺 Nursing Role:

Ensure resuscitation equipment and oxygen ready
Monitor RR, O₂ sat, BP, level of sedation
Be prepared with Flumazenil (antidote)

😴 SEDATIVE DRUGS.

Sedative drugs are central nervous system (CNS) depressants used to induce calmness, reduce anxiety, promote sleep, or assist in procedural sedation. They include benzodiazepines, barbiturates, antihistamines, and newer hypnotics.

🔹 1. MIDAZOLAM

🔸 Class:

Short-acting Benzodiazepine

🔸 Mechanism of Action:

Enhances GABA-A receptor activity → CNS depression → sedation, anxiolysis, muscle relaxation

✅ Indications:

Preoperative sedation
Status epilepticus
Conscious sedation for procedures
ICU ventilator sedation

⚠️ Contraindications:

Severe respiratory depression
Myasthenia gravis
Glaucoma

🚫 Side Effects:

Respiratory depression, amnesia, hypotension
Paradoxical agitation (especially in elderly)

🩺 Nursing Role:

Monitor RR, O₂ saturation, BP, sedation level
Ensure resuscitation equipment is ready
Antidote: Flumazenil

🔹 2. DIAZEPAM

🔸 Class:

Long-acting Benzodiazepine

🔸 Mechanism of Action:

Increases GABAergic activity, suppresses neuron excitability

✅ Indications:

Anxiety, alcohol withdrawal, muscle spasms
Seizures, sedation before procedures

⚠️ Contraindications:

Sleep apnea, severe hepatic impairment
Narrow-angle glaucoma

🚫 Side Effects:

Sedation, confusion, dizziness
Hypotension, dependence, withdrawal

🩺 Nursing Role:

Monitor vital signs, especially RR and BP
Educate about risk of dependence
Use cautiously in elderly

🔹 3. LORAZEPAM

🔸 Class:

Intermediate-acting Benzodiazepine

🔸 Mechanism of Action:

Binds to GABA-A receptors, enhancing inhibitory neurotransmission

✅ Indications:

Severe anxiety, status epilepticus, ICU sedation
Insomnia (short-term)

⚠️ Contraindications:

Respiratory insufficiency, hypersensitivity to benzos
Severe hepatic impairment

🚫 Side Effects:

CNS depression, ataxia, confusion
Hypotension, paradoxical reactions

🩺 Nursing Role:

Titrate dose carefully, monitor sedation and respiratory rate
Reassess need regularly to prevent dependence

🔹 4. PROPOFOL

🔸 Class:

General Anesthetic (sedative-hypnotic)

🔸 Mechanism of Action:

Potentiates GABA-A receptors → rapid sedation and hypnosis

✅ Indications:

Induction and maintenance of anesthesia
ICU sedation, procedural sedation

⚠️ Contraindications:

Egg or soy allergy
Hypotension, unstable cardiac status

🚫 Side Effects:

Hypotension, bradycardia, apnea
Propofol infusion syndrome (long-term)

🩺 Nursing Role:

Administer via infusion pump
Continuous ECG, BP, and oxygen monitoring
Check for metabolic acidosis or rhabdomyolysis in long-term use

🔹 5. DEXMEDETOMIDINE

🔸 Class:

Selective alpha-2 adrenergic agonist

🔸 Mechanism of Action:

Decreases sympathetic tone → sedation without significant respiratory depression

✅ Indications:

ICU sedation
Procedural sedation
Postoperative anxiety control

⚠️ Contraindications:

Bradycardia, advanced heart block
Severe hypotension

🚫 Side Effects:

Bradycardia, hypotension, dry mouth
Less risk of respiratory depression

🩺 Nursing Role:

Monitor HR and BP closely
Titrate slowly, do not give rapid IV bolus
Useful in ventilated patients

🔹 6. PHENOBARBITAL

🔸 Class:

Barbiturate (long-acting)

🔸 Mechanism of Action:

Enhances GABA activity → CNS depression

✅ Indications:

Seizures, status epilepticus, preoperative sedation

⚠️ Contraindications:

Porphyria, respiratory disease, liver dysfunction

🚫 Side Effects:

Sedation, ataxia, dependence, respiratory depression

🩺 Nursing Role:

Monitor RR, CNS status
Use cautiously in elderly and hepatic impairment
Ensure resuscitative equipment available

🔹 7. ZOLPIDEM

🔸 Class:

Non-benzodiazepine hypnotic (Z-drug)

🔸 Mechanism of Action:

Binds to GABA-A receptors (BZ1 subtype) → induces sleep with minimal muscle relaxant or anticonvulsant effects

✅ Indications:

Short-term treatment of insomnia

⚠️ Contraindications:

Severe hepatic impairment
Sleep apnea, myasthenia gravis

🚫 Side Effects:

Daytime drowsiness, dizziness, sleepwalking
Memory loss, abnormal dreams

🩺 Nursing Role:

Administer just before bedtime
Caution patients against driving or operating machinery next morning
Monitor for unusual behaviors during sleep

🔹 8. CHLORAL HYDRATE

🔸 Class:

Sedative-hypnotic

🔸 Mechanism of Action:

CNS depressant via GABA-A receptor activation

✅ Indications:

Pediatric sedation
Short procedures or sleep induction

⚠️ Contraindications:

Severe hepatic or renal impairment, gastritis, depression

🚫 Side Effects:

GI irritation, arrhythmia, sedation, respiratory depression

🩺 Nursing Role:

Monitor RR and cardiac rhythm
Watch for nausea and vomiting
Administer with food or milk to minimize GI upset

🔹 9. HYDROXYZINE

🔸 Class:

Antihistamine (H1 blocker) with sedative effect

🔸 Mechanism of Action:

Blocks histamine H1 receptors, has anxiolytic and sedative properties

✅ Indications:

Anxiety, preoperative sedation, allergic reactions with anxiety

⚠️ Contraindications:

QT prolongation, early pregnancy, glaucoma

🚫 Side Effects:

Drowsiness, dry mouth, urinary retention, confusion

🩺 Nursing Role:

Avoid use with CNS depressants
Monitor for QT prolongation in ECG if on multiple medications
Caution in elderly due to anticholinergic effects

🔹 10. DIPHENHYDRAMINE

🔸 Class:

First-generation antihistamine

🔸 Mechanism of Action:

Crosses BBB → blocks histamine receptors → causes CNS sedation

✅ Indications:

Sleep aid, motion sickness, allergic reactions, anxiety (off-label)

⚠️ Contraindications:

Glaucoma, BPH, urinary retention

🚫 Side Effects:

Drowsiness, dizziness, dry mouth, confusion

🩺 Nursing Role:

Monitor CNS effects, especially in elderly
Educate on no driving after use
Check hydration and urinary retention

🔹 11. RAMELTEON

🔸 Class:

Melatonin receptor agonist

🔸 Mechanism of Action:

Selectively binds MT1 and MT2 melatonin receptors in the hypothalamus → regulates circadian rhythm and sleep onset

✅ Indications:

Chronic insomnia (difficulty falling asleep)

⚠️ Contraindications:

Severe hepatic impairment, concurrent fluvoxamine use

🚫 Side Effects:

Dizziness, fatigue, hormonal changes (↓ testosterone, ↑ prolactin)

🩺 Nursing Role:

Monitor sleep quality and hormone side effects
Educate on regular bedtime for effectiveness
Safer alternative for elderly or substance use disorder

🔹 12. MELATONIN (Herbal supplement)

🔸 Class:

Endogenous hormone / Supplement

🔸 Mechanism of Action:

Regulates sleep-wake cycles by acting on melatonin receptors in the brain

✅ Indications:

Jet lag, shift work sleep disorder, insomnia

⚠️ Contraindications:

Autoimmune disorders, pregnancy, lactation (use caution)

🚫 Side Effects:

Morning drowsiness, vivid dreams, headache

🩺 Nursing Role:

Encourage use under medical supervision
Educate on circadian hygiene (dark environment)
Avoid with CNS depressants or sedatives

ANESTHETIC DRUGS.

💉 TYPES OF ANESTHETIC DRUGS

Anesthetic agents are broadly categorized as:

General anesthetics (IV and inhalational)
Local anesthetics
Adjunctive agents (e.g., neuromuscular blockers, sedatives)

🔹 1. PROPOFOL

🔸 Class:

IV General Anesthetic / Sedative-Hypnotic

🔸 Action:

Enhances GABA-A receptor activity → rapid CNS depression, loss of consciousness

✅ Indications:

Induction and maintenance of general anesthesia
Sedation in ICU, procedural sedation

⚠️ Contraindications:

Egg or soy allergy
Hypotension, cardiac instability

🚫 Side Effects:

Bradycardia, hypotension, apnea
Pain on injection, propofol infusion syndrome

🩺 Nursing Role:

Administer via infusion pump only
Monitor BP, ECG, RR, O₂ saturation continuously
Be ready for intubation/resuscitation

🔹 2. KETAMINE

🔸 Class:

Dissociative Anesthetic / NMDA antagonist

🔸 Action:

Blocks NMDA receptors, causes dissociative anesthesia, analgesia, and amnesia while maintaining respiratory drive

✅ Indications:

Procedural sedation
Induction in trauma or asthma patients
Pediatric anesthesia

⚠️ Contraindications:

Hypertension, raised ICP, psychosis history

🚫 Side Effects:

Hallucinations, hypertension, tachycardia
Salivation, emergence delirium

🩺 Nursing Role:

Pre-medicate with benzodiazepines to reduce hallucinations
Suction available for secretions
Provide a calm environment during recovery

🔹 3. THIOPENTAL SODIUM

🔸 Class:

Ultra-short acting Barbiturate

🔸 Action:

Enhances GABA activity → CNS depression, hypnosis

✅ Indications:

Rapid induction of anesthesia
Status epilepticus (refractory)

⚠️ Contraindications:

Porphyria, asthma, respiratory disease

🚫 Side Effects:

Laryngospasm, hypotension, respiratory depression
Prolonged sedation

🩺 Nursing Role:

Ensure airway management ready
IV bolus only in monitored setting
Avoid in patients with airway sensitivity

🔹 4. ISOFLURANE

🔸 Class:

Volatile Inhalational Anesthetic

🔸 Action:

Causes dose-dependent CNS depression and smooth muscle relaxation

✅ Indications:

Maintenance of general anesthesia (after IV induction)

⚠️ Contraindications:

Malignant hyperthermia, hepatic dysfunction, increased ICP

🚫 Side Effects:

Hypotension, arrhythmias, respiratory depression
Shivering, post-op nausea

🩺 Nursing Role:

Monitor temperature (risk of MH)
Ensure proper scavenging system to avoid staff exposure
Assess airway patency and oxygenation

🔹 5. LIDOCAINE

🔸 Class:

Amide-type Local Anesthetic

🔸 Action:

Blocks sodium channels → prevents nerve impulse transmission → local loss of sensation

✅ Indications:

Local/regional anesthesia
IV use for ventricular arrhythmias

⚠️ Contraindications:

Hypersensitivity, heart block (IV use)
Severe hepatic dysfunction

🚫 Side Effects:

CNS toxicity: tinnitus, seizures
Cardiac depression, allergic reactions

🩺 Nursing Role:

Monitor for signs of systemic toxicity (LAST)
Calculate safe dose (< 4.5 mg/kg without epinephrine)
For IV use: monitor ECG continuously

🔹 6. BUPIVACAINE

🔸 Class:

Long-acting Amide Local Anesthetic

🔸 Action:

Blocks Na⁺ channels, leading to prolonged regional anesthesia

✅ Indications:

Epidural and spinal anesthesia, nerve blocks

⚠️ Contraindications:

Sepsis at injection site, coagulopathy

🚫 Side Effects:

Cardiotoxicity (most dangerous)
Bradycardia, seizures, hypotension

🩺 Nursing Role:

Test dose to rule out intravascular injection
Monitor cardiac rhythm, BP, CNS symptoms
Lipid emulsion therapy available for toxicity

🔹 7. ETOMIDATE

🔸 Class:

Non-barbiturate IV General Anesthetic

🔸 Action:

Enhances GABA activity → rapid induction of anesthesia with minimal cardiovascular depression

✅ Indications:

Rapid Sequence Intubation (RSI)
Induction of anesthesia in hemodynamically unstable patients

⚠️ Contraindications:

Known hypersensitivity, adrenal insufficiency

🚫 Side Effects:

Myoclonus, nausea/vomiting
Adrenal suppression, injection site pain

🩺 Nursing Role:

Useful in trauma and critically ill
Monitor for adrenal suppression (electrolytes, BP)
Co-administer fentanyl or midazolam to prevent myoclonus

🔹 8. SEVOFLURANE

🔸 Class:

Volatile inhalational anesthetic

🔸 Action:

Induces anesthesia via dose-dependent CNS depression

✅ Indications:

Induction and maintenance of general anesthesia (especially in pediatrics)

⚠️ Contraindications:

Malignant hyperthermia, liver disease, renal impairment

🚫 Side Effects:

Hypotension, delirium in children, nephrotoxicity (rare)
Nausea, shivering

🩺 Nursing Role:

Monitor oxygenation and airway, especially in pediatrics
Use in well-ventilated, scavenged systems
Observe for emergence agitation

🔹 9. DESFLURANE

🔸 Class:

Volatile inhalational anesthetic

🔸 Action:

Produces fast onset and offset of anesthesia (low blood/gas partition coefficient)

✅ Indications:

Maintenance of general anesthesia, especially in outpatient surgeries

⚠️ Contraindications:

Airway disease (asthma) due to pungency
Malignant hyperthermia

🚫 Side Effects:

Airway irritation, laryngospasm
Tachycardia, hypertension

🩺 Nursing Role:

Not suitable for induction (can irritate airway)
Monitor for airway reactions and hemodynamic changes
Ensure proper ventilation/exhaled gas monitoring

🔹 10. TETRACAINE

🔸 Class:

Ester-type local anesthetic

🔸 Action:

Blocks sodium channels in nerves → prevents impulse transmission

✅ Indications:

Spinal anesthesia, ophthalmic procedures, topical anesthesia

⚠️ Contraindications:

Sepsis at injection site, hypersensitivity, heart block

🚫 Side Effects:

Hypotension, bradycardia, CNS toxicity
Allergic reactions (more common in ester types)

🩺 Nursing Role:

Use in monitored settings only
Observe for allergic reactions and hypotension
Support cardiac monitoring and oxygenation

🔹 11. PRILOCAINE

🔸 Class:

Amide-type local anesthetic

🔸 Action:

Blocks nerve sodium channels, inhibits depolarization

✅ Indications:

Local and regional anesthesia, dental anesthesia
Component of EMLA cream (eutectic mix for topical)

⚠️ Contraindications:

Methemoglobinemia, anemia, G6PD deficiency

🚫 Side Effects:

Methemoglobinemia, tingling, numbness

🩺 Nursing Role:

Limit total dose to prevent methemoglobinemia
Administer methylene blue as antidote if needed
Educate on numbness duration post-dental procedure

🔹 12. SUCCINYLCHOLINE

🔸 Class:

Depolarizing neuromuscular blocker

🔸 Action:

Binds to nicotinic receptors at NM junction, causes initial contraction, then flaccid paralysis

✅ Indications:

Rapid sequence intubation (RSI)
Short-term paralysis during surgery

⚠️ Contraindications:

Hyperkalemia, burns >48 hours, neuromuscular disorders, malignant hyperthermia

🚫 Side Effects:

Bradycardia, hyperkalemia, fasciculations
Malignant hyperthermia, apnea

🩺 Nursing Role:

Monitor K⁺ levels, have dantrolene ready
Administer with sedation, never alone
Be prepared for mechanical ventilation

🔹 13. NEOSTIGMINE

🔸 Class:

Acetylcholinesterase inhibitor

🔸 Action:

Inhibits breakdown of acetylcholine → reverses neuromuscular blockade

✅ Indications:

Reversal of non-depolarizing muscle relaxants (e.g., rocuronium, vecuronium)

⚠️ Contraindications:

GI obstruction, urinary obstruction, peritonitis

🚫 Side Effects:

Bradycardia, nausea, bronchospasm, salivation

🩺 Nursing Role:

Administer with atropine or glycopyrrolate to prevent bradycardia
Monitor respiratory function and muscle strength
Watch for cholinergic crisis

💓 ANTIARRHYTHMIC DRUGS

Antiarrhythmic drugs are classified using the Vaughan-Williams Classification, divided into 5 classes:

Class I – Sodium channel blockers
Class II – Beta-blockers
Class III – Potassium channel blockers
Class IV – Calcium channel blockers
Class V – Miscellaneous (Adenosine, Digoxin, Magnesium)

🔹 1. LIDOCAINE

🔸 Class:

Class Ib Antiarrhythmic / Local anesthetic

🔸 Mechanism of Action:

Blocks sodium channels in ventricular cells → shortens action potential duration

✅ Indications:

Ventricular tachycardia (VT)
Ventricular fibrillation (VF) (alternative to amiodarone)

⚠️ Contraindications:

Severe heart block, bradycardia, hypersensitivity

🚫 Side Effects:

CNS toxicity: confusion, tremors, seizures
Hypotension, bradycardia

🩺 Nursing Role:

Administer via IV under cardiac monitoring
Watch for neuro signs and ECG changes
Dose adjustment in hepatic impairment

🔹 2. AMIODARONE

🔸 Class:

Class III Antiarrhythmic

🔸 Mechanism of Action:

Blocks K⁺ channels, prolongs repolarization and refractory period

✅ Indications:

Atrial fibrillation, VT, VF
SVT resistant to other therapies

⚠️ Contraindications:

Thyroid dysfunction, severe bradycardia, pregnancy

🚫 Side Effects:

Pulmonary fibrosis, thyroid dysfunction, corneal deposits
Photosensitivity, blue-gray skin discoloration

🩺 Nursing Role:

Baseline and regular ECG, LFT, PFT, TFT
Use central line for IV amiodarone
Educate on photosensitivity precautions

🔹 3. ADENOSINE

🔸 Class:

Class V Antiarrhythmic (Miscellaneous)

🔸 Mechanism of Action:

Slows AV node conduction, interrupts re-entry circuits

✅ Indications:

Paroxysmal supraventricular tachycardia (PSVT)

⚠️ Contraindications:

Asthma, 2nd/3rd-degree AV block, sick sinus syndrome

🚫 Side Effects:

Flushing, dyspnea, transient asystole, chest discomfort

🩺 Nursing Role:

Administer rapid IV push followed by saline flush
Continuous ECG monitoring
Warn patient about brief chest symptoms

🔹 4. PROPRANOLOL

🔸 Class:

Class II (Beta-blocker)

🔸 Mechanism of Action:

Blocks beta-adrenergic receptors → ↓ sympathetic stimulation of the heart → slows HR and conduction

✅ Indications:

Atrial arrhythmias, SVT, rate control in AF
Also used in hypertension, anxiety, thyrotoxicosis

⚠️ Contraindications:

Asthma, heart block, severe bradycardia

🚫 Side Effects:

Bradycardia, hypotension, bronchospasm, fatigue

🩺 Nursing Role:

Monitor HR, BP, signs of bronchospasm
Hold if HR < 50 bpm or SBP < 90 mmHg
Educate about do not stop suddenly

🔹 5. VERAPAMIL

🔸 Class:

Class IV Antiarrhythmic (Calcium channel blocker)

🔸 Mechanism of Action:

Blocks L-type calcium channels → slows AV conduction → reduces HR

✅ Indications:

SVT, atrial fibrillation/flutter (rate control)
Also used in angina, hypertension

⚠️ Contraindications:

Severe hypotension, 2nd/3rd-degree AV block, HF

🚫 Side Effects:

Constipation, hypotension, bradycardia, edema

🩺 Nursing Role:

Monitor BP, HR, ECG
Avoid in sick sinus syndrome or CHF
Educate about orthostatic hypotension

🔹 6. DIGOXIN

🔸 Class:

Cardiac glycoside (Class V)

🔸 Mechanism of Action:

Inhibits Na⁺/K⁺-ATPase → ↑ intracellular Ca²⁺ → improved contractility + vagal stimulation ↓ HR

✅ Indications:

Atrial fibrillation/flutter (rate control)
Heart failure

⚠️ Contraindications:

Ventricular arrhythmias, AV block, hypokalemia

🚫 Side Effects:

Bradycardia, nausea, blurred vision (yellow halos)
Digoxin toxicity

🩺 Nursing Role:

Monitor digoxin level (0.5–2.0 ng/mL)
Watch for toxicity signs, K⁺ level
Antidote: Digoxin immune Fab (Digibind)

🔹 7. QUINIDINE

🔸 Class:

Class Ia Antiarrhythmic

🔸 Mechanism of Action:

Blocks sodium and potassium channels → slows conduction and prolongs action potential duration

✅ Indications:

Atrial fibrillation, atrial flutter
Ventricular tachycardia

⚠️ Contraindications:

AV block, myasthenia gravis, QT prolongation, digitalis toxicity

🚫 Side Effects:

Cinchonism (tinnitus, headache, blurred vision)
Hypotension, QT prolongation → Torsades de Pointes

🩺 Nursing Role:

Monitor ECG for QT interval
Watch for signs of cinchonism or arrhythmia worsening
Check for drug interactions (especially digoxin)

🔹 8. PROCAINAMIDE

🔸 Class:

Class Ia Antiarrhythmic

🔸 Mechanism of Action:

Blocks Na⁺ channels → slows conduction, prolongs refractory period

✅ Indications:

Supraventricular and ventricular arrhythmias
Stable VT with pulse

⚠️ Contraindications:

Systemic lupus erythematosus (SLE)
Torsades risk, heart block

🚫 Side Effects:

Lupus-like syndrome, QT prolongation, bone marrow suppression

🩺 Nursing Role:

Monitor for ANA, CBC, renal function
Observe QT interval on ECG
Monitor for joint pain, rash, fever

🔹 9. FLECAINIDE

🔸 Class:

Class Ic Antiarrhythmic

🔸 Mechanism of Action:

Potent Na⁺ channel blocker → slows conduction velocity

✅ Indications:

Supraventricular arrhythmias (AF, atrial flutter)
Ventricular arrhythmias in structurally normal hearts

⚠️ Contraindications:

Structural heart disease, recent MI, heart failure

🚫 Side Effects:

Proarrhythmia, dizziness, visual disturbances
Worsening HF

🩺 Nursing Role:

Baseline and regular ECG (PR, QRS widening)
Caution in elderly and those with LV dysfunction
Educate to report chest pain or palpitations

🔹 10. SOTALOL

🔸 Class:

Class III Antiarrhythmic + Non-selective beta-blocker

🔸 Mechanism of Action:

Blocks K⁺ channels and beta receptors → prolongs action potential and controls rate

✅ Indications:

Atrial fibrillation, ventricular tachyarrhythmias

⚠️ Contraindications:

Asthma, heart block, QT prolongation

🚫 Side Effects:

Torsades de Pointes, bradycardia, bronchospasm

🩺 Nursing Role:

Monitor QT interval, HR, BP
Hold drug if QTc > 500 ms
Avoid in respiratory patients (e.g., asthma)

🔹 11. IBUTILIDE

🔸 Class:

Class III Antiarrhythmic

🔸 Mechanism of Action:

Promotes influx of Na⁺ and slows K⁺ efflux → prolongs action potential

✅ Indications:

Acute conversion of atrial fibrillation/flutter to sinus rhythm

⚠️ Contraindications:

QT prolongation, ventricular arrhythmias

🚫 Side Effects:

Torsades de Pointes, bradycardia, hypotension

🩺 Nursing Role:

Continuous ECG monitoring during and 4 hours after infusion
Monitor Mg²⁺ and K⁺ levels
Have defibrillator ready due to torsades risk

🔹 12. MAGNESIUM SULFATE

🔸 Class:

Electrolyte supplement (Class V-like antiarrhythmic)

🔸 Mechanism of Action:

Stabilizes myocardial membranes, suppresses early afterdepolarizations (especially in torsades)

✅ Indications:

Torsades de Pointes, digoxin-induced arrhythmias, hypomagnesemia

⚠️ Contraindications:

Renal failure, heart block, hypotension

🚫 Side Effects:

Flushing, hypotension, respiratory depression

🩺 Nursing Role:

Monitor serum Mg²⁺, RR, BP, and reflexes
Be prepared with calcium gluconate (antidote)

🩸 ANTICOAGULANT DRUGS.

Anticoagulants are medications that prevent blood clot formation by interfering with the coagulation cascade. They are used to treat or prevent thromboembolic disorders.

They are classified into:

Parenteral anticoagulants (e.g., heparins)
Oral anticoagulants (e.g., warfarin, DOACs)

🔹 1. HEPARIN (Unfractionated Heparin – UFH)

🔸 Class:

Indirect thrombin inhibitor (parenteral anticoagulant)

🔸 Mechanism of Action:

Activates antithrombin III → inhibits factor Xa and thrombin (IIa)

✅ Indications:

DVT, PE, MI, unstable angina, during dialysis
Prevention of clotting in central lines

⚠️ Contraindications:

Active bleeding, hemophilia, severe thrombocytopenia, recent surgery (CNS/eye)

🚫 Side Effects:

Bleeding, heparin-induced thrombocytopenia (HIT)
Osteoporosis (long-term)

🩺 Nursing Role:

Monitor aPTT (therapeutic: 1.5–2.5 times normal)
Monitor for signs of bleeding (gums, stool, urine)
Antidote: Protamine sulfate

🔹 2. LOW MOLECULAR WEIGHT HEPARIN (LMWH – e.g., Enoxaparin)

🔸 Class:

Parenteral anticoagulant

🔸 Mechanism of Action:

Inhibits factor Xa > IIa (thrombin) via antithrombin III

✅ Indications:

DVT/PE prophylaxis and treatment, post-surgical VTE prevention
Unstable angina, NSTEMI

⚠️ Contraindications:

Bleeding disorders, renal failure, HIT history

🚫 Side Effects:

Bleeding, bruising, HIT (less than UFH)

🩺 Nursing Role:

Administer subcutaneously in abdomen, do not massage
Monitor platelet count, renal function
No need for routine aPTT monitoring

🔹 3. WARFARIN (Coumadin)

🔸 Class:

Vitamin K antagonist (oral anticoagulant)

🔸 Mechanism of Action:

Inhibits vitamin K-dependent clotting factors (II, VII, IX, X)

✅ Indications:

Atrial fibrillation, DVT, PE, mechanical heart valves

⚠️ Contraindications:

Pregnancy, bleeding, liver failure, uncontrolled hypertension

🚫 Side Effects:

Bleeding, skin necrosis, teratogenicity
Purple toe syndrome

🩺 Nursing Role:

Monitor INR (target: 2.0–3.0 or 2.5–3.5 for valve)
Educate on diet (vitamin K) and drug interactions
Antidote: Vitamin K (phytonadione)

🔹 4. DABIGATRAN (Pradaxa)

🔸 Class:

Direct thrombin inhibitor (oral anticoagulant)

🔸 Mechanism of Action:

Inhibits free and clot-bound thrombin (factor IIa)

✅ Indications:

Non-valvular AF, DVT/PE treatment and prevention

⚠️ Contraindications:

Mechanical heart valves, renal failure, bleeding disorders

🚫 Side Effects:

GI upset, bleeding, dyspepsia

🩺 Nursing Role:

Do not crush or open capsules
Monitor renal function (CrCl)
Antidote: Idarucizumab (Praxbind)

🔹 5. RIVAROXABAN (Xarelto)

🔸 Class:

Direct Factor Xa Inhibitor (oral anticoagulant)

🔸 Mechanism of Action:

Selectively inhibits Factor Xa → prevents thrombin formation

✅ Indications:

AF (non-valvular), DVT/PE, orthopedic surgery prophylaxis

⚠️ Contraindications:

Active bleeding, hepatic/renal impairment

🚫 Side Effects:

Bleeding, elevated liver enzymes

🩺 Nursing Role:

Monitor renal and liver function
Take with food (for doses ≥15 mg)
Antidote: Andexanet alfa (if available)

🔹 6. APIXABAN (Eliquis)

🔸 Class:

Direct Factor Xa Inhibitor

🔸 Mechanism of Action:

Selectively inhibits Factor Xa, reducing thrombin generation

✅ Indications:

Stroke prevention in AF, DVT/PE, surgical prophylaxis

⚠️ Contraindications:

Active bleeding, liver disease, renal dysfunction

🚫 Side Effects:

Bleeding, anemia, nausea

🩺 Nursing Role:

No routine monitoring required
Watch for signs of bleeding, CBC, renal profile
Reversal: Andexanet alfa

🔹 7. FONDAPARINUX (Arixtra)

🔸 Class:

Synthetic Factor Xa inhibitor (Parenteral anticoagulant)

🔸 Mechanism of Action:

Selectively inhibits activated Factor Xa via antithrombin, without affecting thrombin

✅ Indications:

DVT and PE prevention after orthopedic/abdominal surgery
Treatment of acute DVT and PE

⚠️ Contraindications:

Severe renal impairment (CrCl < 30 mL/min)
Active bleeding, bacterial endocarditis

🚫 Side Effects:

Bleeding, anemia, injection site reactions

🩺 Nursing Role:

Administer subcutaneously (once daily)
Monitor renal function, CBC
No routine coagulation tests needed
No specific antidote available

🔹 8. ARGATROBAN

🔸 Class:

Direct thrombin inhibitor (parenteral)

🔸 Mechanism of Action:

Directly inhibits thrombin (IIa) → inhibits fibrin formation, platelet aggregation

✅ Indications:

Heparin-induced thrombocytopenia (HIT)
Percutaneous coronary intervention (PCI) in HIT patients

⚠️ Contraindications:

Active major bleeding, severe liver impairment

🚫 Side Effects:

Bleeding, hypotension, elevated liver enzymes

🩺 Nursing Role:

Administer IV infusion, monitor aPTT
Adjust dose in hepatic dysfunction
No specific antidote – discontinue if bleeding occurs

🔹 9. BIVALIRUDIN

🔸 Class:

Direct thrombin inhibitor (parenteral)

🔸 Mechanism of Action:

Binds directly to both circulating and clot-bound thrombin

✅ Indications:

PCI with or without HIT
Unstable angina undergoing angioplasty

⚠️ Contraindications:

Active bleeding, severe uncontrolled hypertension

🚫 Side Effects:

Bleeding, back pain, nausea

🩺 Nursing Role:

Administer IV during PCI, adjust based on ACT (Activated Clotting Time)
Monitor for bleeding, renal function

🔹 10. EDOXABAN (Savaysa)

🔸 Class:

Direct Factor Xa Inhibitor (oral)

🔸 Mechanism of Action:

Inhibits Factor Xa, preventing thrombin formation and clot development

✅ Indications:

Stroke prevention in AF, DVT/PE treatment

⚠️ Contraindications:

CrCl > 95 mL/min or < 15 mL/min, active bleeding, pregnancy

🚫 Side Effects:

Bleeding, liver enzyme elevation, anemia

🩺 Nursing Role:

Monitor renal/liver function before and during use
Educate on adherence and bleeding risks
Andexanet alfa may be used off-label for reversal

🔹 11. DESIRUDIN

🔸 Class:

Parenteral direct thrombin inhibitor

🔸 Mechanism of Action:

Directly binds thrombin, inhibiting its action in clotting

✅ Indications:

DVT prophylaxis after hip replacement

⚠️ Contraindications:

Bleeding disorders, renal failure, active bleeding

🚫 Side Effects:

Bleeding, injection site hematoma

🩺 Nursing Role:

Administer SC, not IM
Monitor serum creatinine, aPTT if needed

🩺 GENERAL NURSING RESPONSIBILITIES (Continued)

✅ Always evaluate bleeding risk vs. thrombotic risk
✅ Check CBC, PT/INR, aPTT, LFTs, renal profile regularly
✅ Assess injection sites for hematomas or local bleeding
✅ Educate patients:

Avoid NSAIDs, alcohol, herbs (like ginkgo, garlic)
Use soft toothbrush, electric razor, no contact sports

🧬 COAGULANT DRUGS.

Coagulant drugs are used to stop or prevent excessive bleeding by promoting clot formation. They are mainly classified into:

Vitamin K and its analogs
Fibrinogen/Clotting factor replacements
Systemic or local hemostatics
Antifibrinolytics

🔹 1. VITAMIN K (PHYTONADIONE)

🔸 Class:

Fat-soluble vitamin / Coagulant

🔸 Mechanism of Action:

Promotes synthesis of clotting factors II, VII, IX, and X in the liver (Vitamin K–dependent)

✅ Indications:

Warfarin overdose, Vitamin K deficiency, neonatal hemorrhagic disease

⚠️ Contraindications:

Hypersensitivity, DIC (Disseminated Intravascular Coagulation) unless vitamin K deficiency is confirmed

🚫 Side Effects:

Flushing, sweating, anaphylactoid reactions (IV route)

🩺 Nursing Role:

Give oral or IM for routine cases; IV in emergencies (slowly)
Monitor PT/INR values
Educate patient to avoid sudden dietary changes in vitamin K-rich foods

🔹 2. FACTOR VIII (Anti-Hemophilic Factor A)

🔸 Class:

Plasma-derived/recombinant clotting factor

🔸 Mechanism of Action:

Replaces deficient factor VIII needed for intrinsic pathway of coagulation

✅ Indications:

Hemophilia A, trauma-related bleeding in deficient patients

⚠️ Contraindications:

Known allergy, history of inhibitor antibodies

🚫 Side Effects:

Allergic reactions, fever, inhibitor development, thrombosis

🩺 Nursing Role:

Monitor aPTT, factor levels, signs of inhibitor formation
Educate on self-administration (IV infusion) at home
Emergency kit should include antihistamines or epinephrine

🔹 3. FACTOR IX (Anti-Hemophilic Factor B)

🔸 Class:

Coagulation factor replacement

🔸 Mechanism of Action:

Replaces factor IX, part of intrinsic pathway

✅ Indications:

Hemophilia B (Christmas disease)

⚠️ Contraindications:

Hypersensitivity, DIC, inhibitor development

🚫 Side Effects:

Infusion reactions, clot formation (rare)

🩺 Nursing Role:

Administer IV, check baseline and post-infusion levels
Educate about bleeding precautions, home infusion if needed

🔹 4. TRANEXAMIC ACID (TXA)

🔸 Class:

Antifibrinolytic agent

🔸 Mechanism of Action:

Inhibits plasminogen activation → prevents fibrin breakdown

✅ Indications:

Heavy menstrual bleeding, surgical bleeding, trauma, tooth extraction in hemophiliacs

⚠️ Contraindications:

Active thromboembolism, subarachnoid hemorrhage

🚫 Side Effects:

Nausea, thrombosis, seizures (high doses)

🩺 Nursing Role:

Administer oral or IV slowly
Monitor for clot signs (e.g., leg pain, swelling)
Ensure hydration to avoid renal risk

🔹 5. ETHAMSYLATE

🔸 Class:

Synthetic hemostatic agent

🔸 Mechanism of Action:

Improves platelet adhesiveness and capillary resistance, reducing bleeding time

✅ Indications:

Menorrhagia, post-surgical bleeding, capillary fragility

⚠️ Contraindications:

Porphyria, active thromboembolism

🚫 Side Effects:

Headache, hypotension, rash

🩺 Nursing Role:

Administer IV or oral, not for major bleeding
Monitor platelet count and BP
Educate patient on short-term use only

🔹 6. FACTOR VIIa (Recombinant Activated Factor VII – rFVIIa)

🔸 Class:

Recombinant coagulation factor

🔸 Mechanism of Action:

Activates extrinsic pathway, promotes thrombin burst and clot formation

✅ Indications:

Hemophilia with inhibitors, life-threatening bleeding, surgical bleeding

⚠️ Contraindications:

Thromboembolic disease, DIC

🚫 Side Effects:

Thrombosis, fever, allergic reaction

🩺 Nursing Role:

Administer IV bolus, monitor for DVT/PE signs
Requires hospital monitoring for bleeding control

🩺 GENERAL NURSING RESPONSIBILITIES FOR COAGULANTS

✅ Monitor bleeding control vs. thrombosis risk
✅ Use aseptic technique during IV administration
✅ Perform coagulation studies (PT, aPTT, INR, Factor assays) as ordered
✅ Educate patients on:

Recognizing clot symptoms (e.g., chest pain, leg swelling)
Avoiding NSAIDs and smoking
Reporting headache or vision changes (risk of stroke/clot)

🧬 ANTIPLATELET DRUGS

Antiplatelets inhibit platelet aggregation, preventing clot formation in arteries. They are primarily used for arterial thromboembolic conditions like MI, stroke, and peripheral artery disease.

🔸 Classes include:

COX-1 inhibitors (e.g., Aspirin)
ADP receptor blockers (e.g., Clopidogrel, Ticagrelor)
GP IIb/IIIa inhibitors (e.g., Abciximab)
PDE inhibitors (e.g., Dipyridamole, Cilostazol)

🔹 1. ASPIRIN (Acetylsalicylic Acid)

🔸 Class:

COX-1 inhibitor / NSAID / Antiplatelet

🔸 Mechanism:

Irreversibly inhibits cyclooxygenase (COX-1) → blocks thromboxane A₂ synthesis → inhibits platelet aggregation

✅ Indications:

MI, stroke, TIA prevention
Post-angioplasty or stenting
Acute coronary syndrome (ACS)

⚠️ Contraindications:

Active bleeding, peptic ulcer, asthma, hypersensitivity

🚫 Side Effects:

Gastric ulcers, bleeding, tinnitus, bronchospasm

🩺 Nursing Role:

Administer with food or enteric-coated tablets
Monitor for GI bleeding, bruising, tarry stools
Avoid combining with NSAIDs or alcohol

🔹 2. CLOPIDOGREL (Plavix)

🔸 Class:

ADP receptor inhibitor / Thienopyridine

🔸 Mechanism:

Blocks P2Y12 ADP receptors on platelets → inhibits platelet activation and aggregation

✅ Indications:

MI, stroke, PAD prevention
Post-coronary stent placement
Dual therapy with aspirin in ACS

⚠️ Contraindications:

Active bleeding, severe liver disease, hypersensitivity

🚫 Side Effects:

Bleeding, diarrhea, rash, TTP (rare)

🩺 Nursing Role:

Monitor CBC and platelet count
Educate patients to report unusual bruising or petechiae
Avoid PPIs (omeprazole) which reduce efficacy

🔹 3. TICAGRELOR (Brilinta)

🔸 Class:

Reversible P2Y12 receptor inhibitor

🔸 Mechanism:

Reversibly inhibits ADP-induced platelet aggregation

✅ Indications:

Acute coronary syndrome (ACS)
Prevention of recurrent MI

⚠️ Contraindications:

Intracranial hemorrhage, active bleeding, severe hepatic impairment

🚫 Side Effects:

Bleeding, dyspnea, bradycardia, increased uric acid

🩺 Nursing Role:

Administer twice daily, educate on strict adherence
Monitor dyspnea, bleeding, and ECG for bradycardia
Avoid strong CYP3A4 inhibitors/inducers

🔹 4. PRASUGREL

🔸 Class:

Thienopyridine (ADP receptor blocker)

🔸 Mechanism:

Irreversibly blocks P2Y12 receptors, reducing platelet aggregation

✅ Indications:

ACS undergoing PCI, especially stent placement

⚠️ Contraindications:

History of stroke/TIA, age >75, active bleeding

🚫 Side Effects:

Major bleeding, hypertension, anemia

🩺 Nursing Role:

Use cautiously in elderly, monitor Hb, BP
Educate on bleeding risk signs
Avoid in history of CVA or TIA

🔹 5. ABCIXIMAB (ReoPro)

🔸 Class:

Glycoprotein IIb/IIIa inhibitor (IV only)

🔸 Mechanism:

Blocks GPIIb/IIIa receptors → prevents fibrinogen binding and final step of platelet aggregation

✅ Indications:

PCI, unstable angina, MI

⚠️ Contraindications:

Thrombocytopenia, active bleeding, recent stroke or surgery

🚫 Side Effects:

Severe bleeding, thrombocytopenia, hypotension

🩺 Nursing Role:

Monitor platelet count, aPTT, bleeding at puncture sites
Maintain IV site care, avoid IM injections or invasive procedures

🔹 6. CILOSTAZOL

🔸 Class:

PDE III inhibitor / Antiplatelet + Vasodilator

🔸 Mechanism:

Inhibits platelet aggregation and causes vasodilation by increasing cAMP

✅ Indications:

Intermittent claudication, peripheral arterial disease (PAD)

⚠️ Contraindications:

Heart failure, active bleeding

🚫 Side Effects:

Headache, palpitations, GI upset

🩺 Nursing Role:

Give 30 min before or 2 hours after meals
Monitor for cardiac symptoms, GI tolerance
Educate on lifestyle modification in PAD

🩺 GENERAL NURSING RESPONSIBILITIES

✅ Educate on bleeding risk and avoidance of trauma
✅ Avoid NSAIDs, warfarin, or IM injections during therapy
✅ Monitor CBC, platelets, stool/urine for blood
✅ Watch for signs of GI bleeding, bruising, petechiae
✅ Ensure medication compliance, especially post-stenting

🧬 tPA DRUGS (Thrombolytics)

Tissue Plasminogen Activators (tPAs) are fibrinolytic agents that help dissolve clots by activating plasminogen to plasmin, which breaks down fibrin. These are used in life-threatening thromboembolic events like stroke, myocardial infarction (MI), and pulmonary embolism (PE).

🔹 1. ALTEPLASE (rtPA)

🔸 Class:

Recombinant Tissue Plasminogen Activator (rtPA)
Thrombolytic / Fibrinolytic agent

🔸 Mechanism of Action:

Converts plasminogen to plasmin, which dissolves fibrin clots

✅ Indications:

Acute ischemic stroke (within 4.5 hours)
ST-Elevation Myocardial Infarction (STEMI)
Massive Pulmonary Embolism (PE)
Central venous catheter clearance (low dose)

⚠️ Contraindications:

Active internal bleeding, recent stroke or head trauma (past 3 months)
Intracranial tumor or hemorrhage, uncontrolled hypertension (>185/110 mmHg)
Major surgery or trauma within past 14 days

🚫 Side Effects:

Intracranial hemorrhage, GI bleeding, hypotension, allergic reactions

🩺 Nursing Role:

Administer IV within defined therapeutic window
Monitor neuro status, bleeding signs, vitals continuously
Avoid IM injections or invasive procedures for 24 hours
Monitor PT, aPTT, INR, fibrinogen, CBC
Keep antidote (aminocaproic acid or cryoprecipitate) ready

🔹 2. TENECTEPLASE (TNK-tPA)

🔸 Class:

Genetically modified tPA (longer half-life)
Fibrinolytic agent

🔸 Mechanism of Action:

Binds fibrin and converts plasminogen to plasmin to dissolve clots

✅ Indications:

Acute STEMI (used as a single bolus IV injection)

⚠️ Contraindications:

Same as alteplase: bleeding, recent surgery, stroke, severe HTN

🚫 Side Effects:

Bleeding, anemia, arrhythmias (reperfusion-related)

🩺 Nursing Role:

Administer as a single IV bolus (weight-based dosing)
Monitor for bleeding, ECG changes, hypotension
Avoid heparin and antiplatelets for first few hours post-dose unless ordered

🔹 3. RETEPLASE (rPA)

🔸 Class:

Recombinant plasminogen activator

🔸 Mechanism of Action:

Converts plasminogen to plasmin → breaks down fibrin clots

✅ Indications:

Acute MI

⚠️ Contraindications:

Similar to other thrombolytics – active bleeding, recent stroke/trauma, HTN, aortic dissection

🚫 Side Effects:

Bleeding, hypotension, allergic reactions

🩺 Nursing Role:

Administer as double IV bolus (2 doses 30 minutes apart)
Monitor BP, heart rhythm, neurologic status
Do not give concurrently with heparin in same IV line

🩺 GENERAL NURSING RESPONSIBILITIES FOR tPA ADMINISTRATION

✅ Perform baseline CT brain (for stroke) to rule out hemorrhage
✅ Start 2 large-bore IV lines (one for drug, one for fluids)
✅ Monitor:

Vital signs every 15 mins during infusion, then hourly
Neuro status for stroke signs
Bleeding (gums, stool, urine, puncture sites)
ECG for arrhythmias (MI/PE cases)
✅ Avoid:
Invasive lines, catheters, NG tubes, and arterial punctures

🫁 BRONCHODILATORS

Bronchodilators are medications that relax the smooth muscles of the airways, dilating the bronchi and bronchioles, improving airflow. They are vital in treating asthma, COPD, and bronchospasm.

🔸 Main Classes:

Beta-2 Adrenergic Agonists (short & long-acting)
Anticholinergics / Muscarinic Antagonists
Methylxanthines
Combination Inhalers

🔹 1. SALBUTAMOL (Albuterol)

🔸 Class:

Short-Acting Beta-2 Adrenergic Agonist (SABA)

🔸 Mechanism of Action:

Stimulates β2-receptors in bronchial smooth muscle → bronchodilation

✅ Indications:

Acute asthma attack, exercise-induced bronchospasm, COPD

⚠️ Contraindications:

Hypersensitivity, tachyarrhythmias, severe cardiac disease

🚫 Side Effects:

Tremors, palpitations, nervousness, hypokalemia

🩺 Nursing Role:

Instruct on correct inhaler/nebulizer use
Monitor HR, respiratory status, serum K⁺
Warn about overuse or tachycardia

🔹 2. SALMETEROL

🔸 Class:

Long-Acting Beta-2 Adrenergic Agonist (LABA)

🔸 Mechanism:

Long-term β2 stimulation → sustained bronchodilation for ~12 hours

✅ Indications:

Maintenance therapy in asthma and COPD

⚠️ Contraindications:

Monotherapy in acute asthma, QT prolongation, hypersensitivity

🚫 Side Effects:

Tachycardia, headache, muscle cramps, paradoxical bronchospasm

🩺 Nursing Role:

Not for acute relief; always combine with ICS in asthma
Monitor lung function (PEFR), adherence
Educate about black box warning (asthma-related death with LABA monotherapy)

🔹 3. IPRATROPIUM BROMIDE

🔸 Class:

Short-Acting Anticholinergic (SAMA)

🔸 Mechanism:

Blocks muscarinic (M3) receptors → prevents acetylcholine-induced bronchoconstriction

✅ Indications:

COPD, acute asthma (with SABA)

⚠️ Contraindications:

Glaucoma, prostatic hypertrophy, urinary retention

🚫 Side Effects:

Dry mouth, blurred vision, cough, urinary retention

🩺 Nursing Role:

Teach use of metered dose inhaler (MDI)
Advise to rinse mouth to reduce dry mouth
Monitor respiratory rate and breath sounds

🔹 4. TIOTROPIUM

🔸 Class:

Long-Acting Muscarinic Antagonist (LAMA)

🔸 Mechanism:

Long-acting inhibition of M3 receptors → prolonged bronchodilation

✅ Indications:

Maintenance therapy in COPD and severe asthma

⚠️ Contraindications:

Hypersensitivity to atropine, glaucoma, urinary retention

🚫 Side Effects:

Dry mouth, constipation, blurred vision, angioedema (rare)

🩺 Nursing Role:

Administer via dry powder inhaler (DPI)
Do not use for acute attacks
Monitor for anticholinergic side effects

🔹 5. THEOPHYLLINE

🔸 Class:

Methylxanthine

🔸 Mechanism:

Inhibits phosphodiesterase → increases cAMP → bronchodilation; mild anti-inflammatory

✅ Indications:

Chronic asthma, COPD (2nd-line)

⚠️ Contraindications:

Seizure disorders, peptic ulcer, cardiac arrhythmias

🚫 Side Effects:

Tachycardia, seizures, nausea, arrhythmias, toxicity

🩺 Nursing Role:

Monitor serum theophylline level (10–20 µg/mL)
Avoid caffeine (potentiates side effects)
Observe for toxicity signs: nausea, confusion, palpitations

🔹 6. LEVALBUTEROL

🔸 Class:

Selective SABA (R-isomer of albuterol)

🔸 Mechanism:

Stimulates β2 receptors → rapid bronchodilation with fewer side effects

✅ Indications:

Acute asthma, COPD exacerbation, especially in cardiac-sensitive patients

⚠️ Contraindications:

Same as salbutamol, but fewer effects

🚫 Side Effects:

Tremors, tachycardia (less than albuterol)

🩺 Nursing Role:

Preferred in patients with heart disease
Educate on inhalation technique, proper dose spacing

🩺 GENERAL NURSING RESPONSIBILITIES

✅ Assess respiratory rate, breath sounds, oxygen saturation before/after administration
✅ Educate on:

Correct inhaler technique (MDI, DPI, nebulizer)
Spacer use if needed
✅ Instruct to rinse mouth after inhaled anticholinergics
✅ Monitor for overuse, especially with SABAs (risk of rebound bronchospasm)
✅ Check for drug interactions (e.g., theophylline + macrolides)

🔹 7. FORMOTEROL

🔸 Class:

Long-Acting Beta-2 Adrenergic Agonist (LABA)

🔸 Mechanism of Action:

Stimulates β2-receptors in airway smooth muscle → prolonged bronchodilation (up to 12 hours)
Onset is faster than salmeterol

✅ Indications:

Asthma maintenance (with ICS)
COPD long-term management

⚠️ Contraindications:

Monotherapy in asthma, cardiac arrhythmias, hypersensitivity

🚫 Side Effects:

Tachycardia, tremor, headache, QT prolongation

🩺 Nursing Role:

Used in combination with inhaled corticosteroids
Not a rescue inhaler
Educate patient on adherence and timing (morning/evening)

🔹 8. INDACATEROL

🔸 Class:

Ultra-Long Acting Beta-2 Agonist (uLABA)

🔸 Mechanism of Action:

Provides 24-hour bronchodilation by activating β2 receptors

✅ Indications:

Maintenance therapy in COPD only
Not approved for asthma

⚠️ Contraindications:

Asthma, severe arrhythmias, hypersensitivity

🚫 Side Effects:

Cough, headache, dizziness, paradoxical bronchospasm

🩺 Nursing Role:

Administer once daily
Monitor respiratory rate, wheezing, and adverse symptoms
Do not use for acute relief

🔹 9. AMINOPHYLLINE

🔸 Class:

Methylxanthine / Bronchodilator

🔸 Mechanism of Action:

Relaxes bronchial smooth muscle, increases cAMP
Has mild anti-inflammatory effects
Used IV in emergency bronchospasm

✅ Indications:

Status asthmaticus, severe COPD exacerbation

⚠️ Contraindications:

Seizure disorder, peptic ulcers, tachyarrhythmias

🚫 Side Effects:

Nausea, vomiting, arrhythmia, seizures

🩺 Nursing Role:

Requires plasma level monitoring (therapeutic: 10–20 mcg/mL)
Watch for toxicity symptoms: restlessness, palpitations, confusion
Administer slow IV infusion only

🔹 10. VILANTEROL (in combination)

🔸 Class:

Ultra-Long Acting Beta-2 Agonist (uLABA)

🔸 Mechanism of Action:

24-hour bronchodilation, only available in combination products

✅ Indications:

Maintenance treatment of COPD and asthma (with ICS or LAMA)

⚠️ Contraindications:

Asthma monotherapy, severe cardiac disorders

🚫 Side Effects:

Tachycardia, tremors, nasopharyngitis

🩺 Nursing Role:

Instruct on once-daily use
Monitor respiratory status, ECG if cardiac symptoms
Ensure adherence, especially in elderly COPD patients

🔹 11. COMBINATION BRONCHODILATORS

A. Ipratropium + Salbutamol (Duolin / Combivent)

Class: SAMA + SABA
Indication: Acute COPD exacerbations, asthma unresponsive to SABA alone
Side Effects: Dry mouth, tachycardia, cough
Nurse’s Role: Nebulize as ordered, observe for synergistic effects, monitor O₂ saturation

B. Formoterol + Budesonide

Class: LABA + Inhaled Corticosteroid (ICS)
Indication: Moderate to severe asthma, COPD maintenance
Side Effects: Thrush, tremors, hoarseness
Nurse’s Role: Rinse mouth post-use, assess adherence, avoid abrupt withdrawal

C. Tiotropium + Olodaterol

Class: LAMA + LABA
Indication: Maintenance therapy in COPD
Side Effects: Dry mouth, hypertension, dizziness
Nurse’s Role: Teach use of respimat device, monitor BP and breathing patterns

🩺 GENERAL NURSING CONSIDERATIONS (EXTENDED)

✅ Before giving:

Assess baseline respiratory rate, breath sounds, peak flow
Confirm no contraindications (e.g., glaucoma for anticholinergics)

✅ After administration:

Reassess breathing effort, O₂ sat, side effects

✅ Educate patient:

Spacer device use, inhalation technique
Adherence to long-acting agents; not to substitute for rescue meds

✅ Labs (for theophylline/aminophylline):

Theophylline level, serum K⁺, cardiac rhythm

🧠 CHOLINERGIC DRUGS

Cholinergic drugs (also known as parasympathomimetics) mimic acetylcholine (ACh) and stimulate muscarinic and/or nicotinic receptors. These drugs either directly activate receptors or indirectly increase ACh levels by inhibiting acetylcholinesterase.

🔸 Classification:

Direct-acting cholinergic agonists (e.g., Bethanechol, Pilocarpine)
Indirect-acting cholinergic drugs (Anticholinesterases) (e.g., Neostigmine, Donepezil)

🔹 1. BETHANECHOL

🔸 Class:

Direct-acting muscarinic agonist

🔸 Mechanism of Action:

Stimulates muscarinic receptors → increases bladder and GI smooth muscle contraction

✅ Indications:

Urinary retention (non-obstructive), postoperative ileus

⚠️ Contraindications:

Asthma, peptic ulcer, obstruction (GI or urinary), hypotension

🚫 Side Effects:

Bradycardia, diarrhea, abdominal cramps, sweating, bronchospasm

🩺 Nursing Role:

Monitor for urination post-dose
Assess BP, HR, breath sounds
Administer on empty stomach

🔹 2. PILOCARPINE

🔸 Class:

Direct-acting muscarinic agonist

🔸 Mechanism of Action:

Stimulates muscarinic receptors in eye → miosis, increased aqueous humor outflow

✅ Indications:

Glaucoma, xerostomia (dry mouth in Sjogren’s)

⚠️ Contraindications:

Acute iritis, uveitis, asthma (systemic use)

🚫 Side Effects:

Blurred vision, brow pain, sweating, salivation

🩺 Nursing Role:

Instruct proper eye drop technique
Monitor intraocular pressure
Educate about temporary visual disturbance

🔹 3. NEOSTIGMINE

🔸 Class:

Reversible anticholinesterase / Indirect cholinergic agonist

🔸 Mechanism of Action:

Inhibits acetylcholinesterase, increasing ACh at NMJ and muscarinic receptors

✅ Indications:

Myasthenia gravis, post-op urinary retention, antidote for non-depolarizing muscle relaxants

⚠️ Contraindications:

Mechanical GI/GU obstruction, asthma, bradycardia

🚫 Side Effects:

Excessive salivation, abdominal cramps, bradycardia, muscle twitching

🩺 Nursing Role:

Monitor muscle strength, breathing, pulse
Have atropine ready (antidote) for cholinergic crisis
Administer on time to avoid myasthenic crisis

🔹 4. PYRIDOSTIGMINE

🔸 Class:

Reversible cholinesterase inhibitor

🔸 Mechanism:

Inhibits AChE, prolonging action of ACh at neuromuscular junction

✅ Indications:

Myasthenia gravis (maintenance)
Nerve gas prophylaxis

⚠️ Contraindications:

Same as neostigmine

🚫 Side Effects:

Sweating, GI upset, muscle cramps, cholinergic crisis (OD)

🩺 Nursing Role:

Teach life-long compliance in myasthenia gravis
Educate on timing with meals (usually before meals)
Differentiate myasthenic vs. cholinergic crisis

🔹 5. DONEPEZIL

🔸 Class:

Central acetylcholinesterase inhibitor

🔸 Mechanism of Action:

Inhibits CNS acetylcholinesterase, enhancing ACh in the brain

✅ Indications:

Mild to moderate Alzheimer’s disease

⚠️ Contraindications:

Bradycardia, active GI bleeding, asthma

🚫 Side Effects:

Nausea, insomnia, dizziness, bradycardia, syncope

🩺 Nursing Role:

Monitor cognitive status, HR, sleep pattern
Give at bedtime to reduce nausea
Educate family on long-term benefit expectation

🔹 6. EDROPHONIUM (Tensilon)

🔸 Class:

Short-acting cholinesterase inhibitor

🔸 Mechanism:

Temporarily increases ACh levels at neuromuscular junction

✅ Indications:

Diagnosis of myasthenia gravis, differentiate from cholinergic crisis

⚠️ Contraindications:

Bradycardia, asthma, cardiac arrhythmias

🚫 Side Effects:

Fasciculations, increased secretions, hypotension

🩺 Nursing Role:

Monitor for rapid improvement in muscle strength
Emergency resuscitation equipment should be ready
Antidote: Atropine

🩺 GENERAL NURSING CONSIDERATIONS

✅ Baseline and ongoing vital signs, HR, BP, RR
✅ Monitor for signs of cholinergic toxicity (SLUDGE: salivation, lacrimation, urination, diarrhea, GI upset, emesis)
✅ Keep antidote (Atropine) accessible
✅ Differentiate between myasthenic crisis vs. cholinergic crisis
✅ Educate patients on adherence and timing of doses

🧠 ANTICHOLINERGIC DRUGS

Anticholinergic drugs (also known as parasympatholytics) block the action of acetylcholine at muscarinic receptors, inhibiting parasympathetic nervous system responses. This leads to effects like drying secretions, bronchodilation, increased heart rate, and reduced GI motility.

🔸 Classes:

CNS anticholinergics (e.g., Benztropine, Trihexyphenidyl)
Respiratory anticholinergics (e.g., Ipratropium, Tiotropium)
GI/Bladder anticholinergics (e.g., Oxybutynin, Dicyclomine)
Cardiac use (e.g., Atropine)

🔹 1. ATROPINE

🔸 Class:

Antimuscarinic / Anticholinergic (tertiary amine)

🔸 Mechanism of Action:

Blocks muscarinic receptors in heart, glands, GI, eye → increases HR, dries secretions, dilates pupils

✅ Indications:

Bradycardia, preanesthesia (dry secretions), organophosphate poisoning, eye exam (mydriasis)

⚠️ Contraindications:

Glaucoma, urinary retention, intestinal obstruction, tachyarrhythmias

🚫 Side Effects:

Dry mouth, blurred vision, tachycardia, urinary retention, confusion (in elderly)

🩺 Nursing Role:

Monitor HR, ECG, watch for anticholinergic toxicity
Educate patients about dryness, light sensitivity, voiding schedule

🔹 2. IPRATROPIUM BROMIDE

🔸 Class:

Short-Acting Muscarinic Antagonist (SAMA)

🔸 Mechanism:

Blocks muscarinic M3 receptors in the airways → bronchodilation

✅ Indications:

COPD, acute asthma adjunct

⚠️ Contraindications:

Allergy to atropine, glaucoma, urinary retention

🚫 Side Effects:

Dry mouth, cough, nausea, blurred vision

🩺 Nursing Role:

Teach inhaler technique
Advise rinsing mouth after inhalation
Monitor for relief of dyspnea, and side effects

🔹 3. TIOTROPIUM

🔸 Class:

Long-Acting Muscarinic Antagonist (LAMA)

🔸 Mechanism:

M3 receptor blocker → sustained bronchodilation

✅ Indications:

Maintenance therapy in COPD and severe asthma

⚠️ Contraindications:

Glaucoma, urinary retention, prostatic hyperplasia

🚫 Side Effects:

Constipation, dry mouth, urinary issues

🩺 Nursing Role:

Instruct on dry powder inhaler (DPI) use
Assess for anticholinergic side effects, improvement in breathing

🔹 4. OXYBUTYNIN

🔸 Class:

Urinary antispasmodic / Anticholinergic

🔸 Mechanism:

Blocks muscarinic receptors in the bladder → reduces bladder spasms and urgency

✅ Indications:

Overactive bladder, urge incontinence, neurogenic bladder

⚠️ Contraindications:

Urinary retention, narrow-angle glaucoma, GI obstruction

🚫 Side Effects:

Dry mouth, constipation, dizziness, blurred vision, heat intolerance

🩺 Nursing Role:

Encourage fluid intake
Monitor bladder function, bowel movement
Educate to avoid overheating and report blurred vision

🔹 5. DICYCLOMINE

🔸 Class:

Antispasmodic / Anticholinergic

🔸 Mechanism:

Inhibits acetylcholine at smooth muscles in GI tract → reduces intestinal motility and spasms

✅ Indications:

Irritable bowel syndrome (IBS), intestinal cramping

⚠️ Contraindications:

GI obstruction, myasthenia gravis, glaucoma

🚫 Side Effects:

Dry mouth, nausea, confusion, palpitations

🩺 Nursing Role:

Give 30 minutes before meals
Monitor for reduced abdominal pain, dryness, and mental status changes

🔹 6. BENZTROPINE

🔸 Class:

Anticholinergic (centrally acting)

🔸 Mechanism:

Blocks muscarinic receptors in the CNS → balances dopamine and acetylcholine

✅ Indications:

Parkinson’s disease, extrapyramidal side effects (EPS) from antipsychotics

⚠️ Contraindications:

Glaucoma, urinary retention, GI obstruction

🚫 Side Effects:

Sedation, confusion, dry mouth, blurred vision, tachycardia

🩺 Nursing Role:

Monitor mental status, motor function, hydration
Caution in elderly (delirium risk)

🩺 GENERAL NURSING RESPONSIBILITIES

✅ Assess:

Baseline vitals, HR, urinary and GI function
CNS changes in elderly

✅ Educate:

Encourage hydration, high-fiber diet
Avoid driving if drowsy or blurred vision
Avoid overheating, especially with oxybutynin

✅ Report:

Urinary retention, hallucinations, severe constipation, or confusion

💧 INTRAVENOUS (IV) FLUIDS / SOLUTIONS

🎯 Used for fluid replacement, electrolyte balance, and volume resuscitation

💧 1. Normal Saline (0.9% NaCl)

Class: Isotonic crystalloid
Action: Expands intravascular volume without altering intracellular volume
Indications:
- Hypovolemia
- Shock
- Hyponatremia
- Blood transfusion compatibility
Contraindications:
- Heart failure
- Fluid overload states
- Severe hypertension
Side Effects:
- Fluid overload
- Hypernatremia
- Metabolic acidosis (prolonged use)
Nursing Role & Monitoring:
✅ Monitor for signs of fluid overload (edema, crackles, hypertension)
✅ Monitor electrolytes, especially sodium and chloride
✅ Assess lung sounds and urine output regularly

💧 2. Ringer’s Lactate (Lactated Ringer’s – RL)

Class: Isotonic crystalloid
Action: Replaces electrolytes (Na⁺, K⁺, Ca²⁺, Cl⁻) and lactate, which acts as a buffer
Indications:
- Burns
- Dehydration
- Surgical or trauma fluid loss
- Acute blood loss
Contraindications:
- Liver disease (impaired lactate metabolism)
- Hyperkalemia
- Severe metabolic alkalosis
Side Effects:
- Hyperkalemia
- Alkalosis
- Fluid overload
Nursing Role & Monitoring:
✅ Monitor electrolytes (esp. potassium)
✅ Avoid in renal failure or hyperkalemia
✅ Monitor for signs of volume overload

💧 3. 5% Dextrose in Water (D5W)

Class: Hypotonic solution (after metabolism)
Action: Provides free water and glucose for energy; dilutes extracellular fluid
Indications:
- Dehydration
- Hypernatremia
- Prevent ketosis in NPO patients
Contraindications:
- Increased intracranial pressure (ICP)
- Diabetics (risk of hyperglycemia)
- Hypovolemic shock
Side Effects:
- Hyperglycemia
- Hyponatremia (dilutional)
- Cellular edema
Nursing Role & Monitoring:
✅ Monitor blood glucose levels
✅ Watch for neurological symptoms (ICP risk)
✅ Avoid rapid infusion in infants and elderly

💧 4. 0.45% Sodium Chloride (Half Normal Saline)

Class: Hypotonic crystalloid
Action: Provides free water, some Na⁺ and Cl⁻ → hydrates cells
Indications:
- Cellular dehydration (e.g., DKA)
- Hypernatremia
Contraindications:
- Burns
- Liver disease
- Cerebral edema or head injury
Side Effects:
- Hypotension
- Cellular edema
- Electrolyte imbalance
Nursing Role & Monitoring:
✅ Administer slowly to prevent cellular swelling
✅ Monitor neurological status and sodium levels
✅ Avoid in trauma or increased ICP

💧 5. Dextrose 5% in 0.9% NS (D5NS)

Class: Hypertonic crystalloid
Action: Provides volume expansion + glucose for energy
Indications:
- Temporary treatment of shock
- Hyponatremia with caloric support
Contraindications:
- Cardiac/renal failure
- Hypernatremia
Side Effects:
- Hyperglycemia
- Fluid overload
- Cellular dehydration
Nursing Role & Monitoring:
✅ Monitor blood glucose and serum sodium
✅ Assess for fluid overload (edema, lung sounds)
✅ Use cautiously in patients with diabetes

💧 6. Dextrose 10% in Water (D10W)

Class: Hypertonic glucose solution
Action: Supplies high-calorie fluid, small fluid replacement
Indications:
- Hypoglycemia
- Nutritional support when TPN is delayed
Contraindications:
- Hyperglycemia
- Diabetic ketoacidosis
Side Effects:
- Phlebitis (if given peripherally)
- Electrolyte imbalance
- Hyperglycemia
Nursing Role & Monitoring:
✅ Preferably give through central line
✅ Monitor blood glucose and electrolytes
✅ Ensure proper rate using infusion pump

💧 7. 3% Sodium Chloride (Hypertonic Saline)

Class: Hypertonic saline solution
Action: Pulls water from cells into vascular space → reduces cerebral edema
Indications:
- Severe hyponatremia
- Increased intracranial pressure (ICP)
Contraindications:
- Hypernatremia
- CHF, renal failure
Side Effects:
- Fluid overload
- Central pontine myelinolysis (if corrected rapidly)
- Vein irritation
Nursing Role & Monitoring:
✅ Administer via central line only
✅ Strict monitoring of serum sodium
✅ Infuse very slowly with ICU-level observation

💧 8. Albumin (5% or 25%)

Class: Colloid (plasma volume expander)
Action: Increases oncotic pressure, draws fluid into intravascular space
Indications:
- Hypoalbuminemia
- Shock, burns, nephrotic syndrome
- Paracentesis in cirrhosis
Contraindications:
- Severe anemia
- Heart failure
- Allergy to albumin
Side Effects:
- Hypersensitivity reactions
- Fluid overload
- Febrile response
Nursing Role & Monitoring:
✅ Use a dedicated line, infuse at prescribed rate
✅ Monitor vital signs, urine output, signs of overload
✅ Check for fever, rash, hypotension

🌬️ DRUGS FOR RESPIRATORY DISORDERS

💊 1. Salbutamol (Albuterol)

Class: Short-acting Beta-2 Adrenergic Agonist (SABA)
Action: Relaxes bronchial smooth muscle → bronchodilation
Indications: Acute asthma, bronchospasm, COPD
Contraindications: Hypersensitivity, severe cardiac disorders
Side Effects: Tremors, palpitations, tachycardia, hypokalemia
Nursing Role & Monitoring:
- Assess respiratory rate, rhythm, lung sounds before and after use
- Monitor for chest pain, arrhythmias
- Teach correct inhaler use and importance of spacing between puffs

💊 2. Ipratropium Bromide

Class: Anticholinergic (Short-acting Muscarinic Antagonist – SAMA)
Action: Blocks acetylcholine at muscarinic receptors → bronchodilation
Indications: COPD, bronchial asthma adjunct
Contraindications: Hypersensitivity to atropine, glaucoma, BPH
Side Effects: Dry mouth, blurred vision, urinary retention
Nursing Role & Monitoring:
- Instruct on mouth rinsing to prevent dry mouth
- Monitor urinary output and vision changes
- Educate patient not to swallow capsules (in inhaler form)

💊 3. Theophylline

Class: Methylxanthine bronchodilator
Action: Inhibits phosphodiesterase → increased cAMP → bronchodilation
Indications: Chronic asthma, COPD (when unresponsive to inhalers)
Contraindications: Peptic ulcer, seizure disorder, cardiac arrhythmia
Side Effects: GI upset, insomnia, seizures, tachycardia
Nursing Role & Monitoring:
- Monitor therapeutic levels (10–20 mcg/mL) – narrow therapeutic index
- Avoid caffeine (additive effect)
- Observe for toxicity signs: nausea, vomiting, arrhythmias

💊 4. Montelukast

Class: Leukotriene Receptor Antagonist (LTRA)
Action: Blocks leukotriene-mediated inflammation and bronchoconstriction
Indications: Asthma prophylaxis, allergic rhinitis
Contraindications: Acute asthma attack, severe liver disease
Side Effects: Headache, abdominal pain, neuropsychiatric symptoms (e.g., mood changes)
Nursing Role & Monitoring:
- Administer in evening for better asthma control
- Educate patient it is preventive, not for acute relief
- Monitor for behavior/mood changes in children

💊 5. Budesonide (Inhaled Corticosteroid)

Class: Corticosteroid (Inhaled)
Action: Reduces airway inflammation and hyperresponsiveness
Indications: Maintenance treatment of asthma and COPD
Contraindications: Acute asthma, untreated infections
Side Effects: Oral thrush, hoarseness, adrenal suppression (long-term use)
Nursing Role & Monitoring:
- Instruct to rinse mouth after use to prevent fungal infection
- Monitor growth in children on long-term therapy
- Educate about adherence and slow onset of action

💊 6. Prednisolone (Oral Corticosteroid)

Class: Systemic Corticosteroid
Action: Suppresses inflammation and immune response
Indications: Severe asthma, acute exacerbations of COPD
Contraindications: Systemic fungal infections, peptic ulcers
Side Effects: Hyperglycemia, mood changes, osteoporosis, infections
Nursing Role & Monitoring:
- Monitor blood glucose, blood pressure, signs of infection
- Taper dose gradually to prevent adrenal crisis
- Provide calcium/vitamin D if long-term use

💊 7. Omalizumab

Class: Monoclonal antibody (Anti-IgE)
Action: Binds IgE → reduces allergic inflammation
Indications: Severe persistent allergic asthma
Contraindications: Hypersensitivity, parasitic infections
Side Effects: Injection site reactions, anaphylaxis
Nursing Role & Monitoring:
- Administer subcutaneously in healthcare setting
- Observe for 2 hours after injection (risk of anaphylaxis)
- Educate patient on recognizing allergic reaction signs

💊 8. Acetylcysteine

Class: Mucolytic
Action: Breaks disulfide bonds in mucus → reduces viscosity
Indications: Thick respiratory secretions, COPD, cystic fibrosis
Contraindications: Asthma (risk of bronchospasm), active GI bleeding
Side Effects: Bronchospasm, nausea, unpleasant odor
Nursing Role & Monitoring:
- Administer via nebulization in well-ventilated area
- Monitor for bronchospasm; have bronchodilator ready
- Warn about sulfur smell – not a sign of spoilage

💊 9. Guaifenesin

Class: Expectorant
Action: Increases respiratory tract fluid → eases mucus expulsion
Indications: Productive cough in bronchitis, respiratory infections
Contraindications: Persistent cough from smoking, asthma, or emphysema
Side Effects: Drowsiness, GI upset
Nursing Role & Monitoring:
- Encourage increased fluid intake to assist mucolytic effect
- Monitor for cough duration >1 week – may indicate other illness
- Educate patient not to use in dry, unproductive coughs

💊 10. Tiotropium

Class: Long-acting Muscarinic Antagonist (LAMA)
Action: Blocks M3 receptors → prolonged bronchodilation
Indications: Maintenance therapy of COPD and severe asthma
Contraindications: Hypersensitivity to atropine, narrow-angle glaucoma, urinary retention
Side Effects: Dry mouth, constipation, urinary retention
Nursing Role & Monitoring:
- Administer using HandiHaler or Respimat as prescribed
- Teach patient not to swallow the capsule
- Monitor for signs of glaucoma or urinary difficulty

💊 11. Formoterol

Class: Long-acting Beta-2 Agonist (LABA)
Action: Stimulates β2 receptors → sustained bronchodilation
Indications: Maintenance of asthma and COPD (always with ICS)
Contraindications: Monotherapy in asthma, cardiac arrhythmia
Side Effects: Tremors, palpitations, muscle cramps
Nursing Role & Monitoring:
- Ensure used with inhaled corticosteroid
- Monitor heart rate, respiratory rate
- Instruct on proper use and not for acute attacks

💊 12. Fluticasone + Salmeterol

Class: Combination (Inhaled corticosteroid + LABA)
Action: Anti-inflammatory + long-acting bronchodilation
Indications: Moderate to severe asthma, COPD maintenance
Contraindications: Acute asthma, severe milk protein allergy
Side Effects: Oral thrush, cough, palpitations
Nursing Role & Monitoring:
- Rinse mouth after inhalation
- Monitor peak flow and symptom control
- Check for effectiveness and side effects regularly

💊 13. Hydrocortisone (IV/IM)

Class: Systemic corticosteroid
Action: Suppresses inflammation, allergic responses
Indications: Status asthmaticus, severe allergy, ARDS
Contraindications: Untreated infection, systemic fungal disease
Side Effects: Hyperglycemia, edema, mood changes
Nursing Role & Monitoring:
- Monitor vital signs, blood glucose
- Assess for signs of infection or GI bleeding
- Use in emergency with caution

💊 14. Roflumilast

Class: PDE-4 Inhibitor (Anti-inflammatory)
Action: Reduces lung inflammation by inhibiting phosphodiesterase-4
Indications: Severe COPD with chronic bronchitis
Contraindications: Liver impairment, depression with suicidal tendency
Side Effects: Weight loss, diarrhea, insomnia, depression
Nursing Role & Monitoring:
- Monitor mood changes and weight
- Educate about non-bronchodilator nature
- Assess liver function periodically

💊 15. Phenylephrine

Class: Alpha-1 adrenergic agonist (Decongestant)
Action: Vasoconstriction → nasal mucosal shrinkage
Indications: Nasal congestion, sinusitis
Contraindications: Hypertension, closed-angle glaucoma
Side Effects: Rebound congestion (if overused), headache, insomnia
Nursing Role & Monitoring:
- Limit use to <5 days to avoid rebound
- Monitor BP and signs of nasal irritation
- Educate on correct nasal spray technique

💊 16. Dextromethorphan

Class: Antitussive
Action: Suppresses medullary cough center (non-opioid)
Indications: Dry, non-productive cough
Contraindications: Asthma, MAOI therapy, productive cough
Side Effects: Drowsiness, dizziness, nausea
Nursing Role & Monitoring:
- Instruct to avoid use in productive cough
- Monitor for drowsiness
- Caution against overdose in children

💊 17. Codeine (low dose)

Class: Opioid Antitussive
Action: Depresses cough reflex via CNS action
Indications: Severe, non-productive cough
Contraindications: Respiratory depression, children <12 years, head injury
Side Effects: Sedation, constipation, dependency risk
Nursing Role & Monitoring:
- Monitor respiratory status and level of consciousness
- Assess for signs of misuse or dependence
- Administer at bedtime to avoid daytime sedation

💊 18. Bromhexine

Class: Mucolytic agent
Action: Breaks down mucus structure, facilitates expectoration
Indications: Productive cough, bronchitis, COPD
Contraindications: Gastric ulcers, asthma (risk of spasm)
Side Effects: Gastric irritation, nausea
Nursing Role & Monitoring:
- Encourage fluid intake
- Monitor for GI upset
- Use with caution in ulcer patients

💊 19. Epinephrine (Adrenaline)

Class: Non-selective adrenergic agonist
Action: Stimulates alpha and beta receptors → bronchodilation + vasoconstriction
Indications: Anaphylaxis, severe acute asthma, bronchospasm
Contraindications: Hypertension, arrhythmias, hyperthyroidism
Side Effects: Palpitations, hypertension, anxiety
Nursing Role & Monitoring:
- Monitor cardiac function and BP closely
- Give IM for anaphylaxis; ensure proper technique
- Have emergency resuscitation ready

🧠 DRUGS USED IN NERVOUS SYSTEM DISORDERS

🎯 Targeting the Brain, Spinal Cord, and Nerves

💊 1. Phenytoin

Class: Antiepileptic (Hydantoin group)
Action: Stabilizes neuronal membranes by blocking voltage-gated sodium channels, reducing repetitive firing of action potentials.
Indications: Tonic-clonic seizures, status epilepticus (IV form), seizure prophylaxis post-neurosurgery.
Contraindications: Hypersensitivity, heart block, sinus bradycardia, porphyria.
Specific Side Effects:
- Gum hypertrophy (gingival hyperplasia)
- Hirsutism
- Ataxia, nystagmus
- Folic acid deficiency
- Stevens-Johnson Syndrome (rare but serious)
Nursing Role & Monitoring:
✅ Monitor serum drug levels (therapeutic range: 10–20 mcg/mL)
✅ Assess oral hygiene and encourage dental care
✅ Observe for signs of toxicity (slurred speech, tremor, confusion)
✅ Never mix IV phenytoin with dextrose (precipitates)

💊 2. Levodopa + Carbidopa (Sinemet)

Class: Dopaminergic agent (Antiparkinsonian)
Action: Levodopa converts to dopamine in CNS; Carbidopa prevents peripheral breakdown of levodopa.
Indications: Parkinson’s disease
Contraindications: Narrow-angle glaucoma, malignant melanoma, history of psychosis
Specific Side Effects:
- Dyskinesias (involuntary movements)
- Orthostatic hypotension
- Hallucinations, vivid dreams
- “Wearing off” and “on-off” phenomena
Nursing Role & Monitoring:
✅ Administer before meals for better absorption
✅ Avoid high-protein diet (interferes with absorption)
✅ Monitor for motor fluctuations and adjust dosing
✅ Educate on slow movement to prevent falls

💊 3. Diazepam

Class: Benzodiazepine (Anxiolytic, anticonvulsant)
Action: Enhances GABA activity → CNS depression (sedative, anxiolytic, muscle relaxant effects)
Indications: Acute seizures, anxiety, status epilepticus, muscle spasms
Contraindications: Severe respiratory insufficiency, hepatic impairment, sleep apnea
Specific Side Effects:
- Drowsiness, sedation
- Respiratory depression (especially IV form)
- Dependence, tolerance with long-term use
Nursing Role & Monitoring:
✅ Monitor respiratory rate, especially after IV use
✅ Use short-term only; educate patient on addiction risk
✅ Monitor liver function in chronic use
✅ Keep emergency resuscitation nearby if IV use

💊 4. Haloperidol

Class: Typical antipsychotic (Butyrophenone)
Action: Blocks dopamine D2 receptors in brain → reduces psychotic symptoms
Indications: Schizophrenia, acute psychosis, agitation, delirium
Contraindications: Parkinson’s disease, CNS depression, cardiac arrhythmias
Specific Side Effects:
- Extrapyramidal symptoms (dystonia, akathisia, tardive dyskinesia)
- Neuroleptic Malignant Syndrome (NMS – emergency!)
- QT prolongation
Nursing Role & Monitoring:
✅ Monitor for abnormal movements (AIMS scale)
✅ Educate family to watch for fever, muscle rigidity (NMS)
✅ Perform baseline ECG for QT interval
✅ Do not stop suddenly – risk of rebound psychosis

💊 5. Valproic Acid (Sodium Valproate)

Class: Broad-spectrum antiepileptic
Action: Increases GABA levels, blocks sodium and calcium channels → stabilizes neuronal firing
Indications: Generalized seizures, bipolar disorder, migraine prophylaxis
Contraindications: Liver disease, urea cycle disorder, pregnancy (teratogenic)
Specific Side Effects:
- Hepatotoxicity
- Pancreatitis
- Weight gain, hair loss
- Tremor
Nursing Role & Monitoring:
✅ Monitor LFTs regularly (ALT, AST)
✅ Educate women about pregnancy risks (Category D)
✅ Check serum levels (50–100 mcg/mL)
✅ Watch for abdominal pain and jaundice signs

💊 6. Amitriptyline

Class: Tricyclic Antidepressant (TCA)
Action: Inhibits reuptake of norepinephrine and serotonin
Indications: Depression, neuropathic pain, migraine prophylaxis
Contraindications: Recent MI, glaucoma, urinary retention
Specific Side Effects:
- Dry mouth, constipation (anticholinergic effects)
- Drowsiness, weight gain
- Cardiac arrhythmias (overdose risk)
Nursing Role & Monitoring:
✅ Start with low dose, especially in elderly
✅ Monitor ECG and BP
✅ Educate about suicide risk in early therapy
✅ Avoid abrupt withdrawal

💊 7. Donepezil

Class: Acetylcholinesterase inhibitor
Action: Inhibits breakdown of acetylcholine → enhances cognition
Indications: Alzheimer’s disease (mild to moderate)
Contraindications: GI bleeding, cardiac conduction disorders
Specific Side Effects:
- Nausea, vomiting
- Bradycardia, syncope
- Insomnia, muscle cramps
Nursing Role & Monitoring:
✅ Give at bedtime to reduce GI upset
✅ Monitor heart rate and cognitive status
✅ Educate caregivers about realistic expectations – not a cure
✅ Watch for weight loss in elderly

💊 8. Carbamazepine

Class: Anticonvulsant
Action: Inhibits sodium channel firing in neurons → reduces seizures
Indications: Epilepsy, trigeminal neuralgia, bipolar disorder
Contraindications: Bone marrow suppression, MAOI use, liver dysfunction
Specific Side Effects:
- Aplastic anemia, agranulocytosis
- Dizziness, ataxia
- Stevens-Johnson syndrome (especially in Asian populations with HLA-B*1502 gene)
Nursing Role & Monitoring:
✅ Perform CBC regularly
✅ Screen Asian patients for HLA-B*1502 before starting
✅ Monitor for skin rash, sore throat, fever
✅ Educate to report vision changes and tremors

💊 9. Gabapentin

Class: Anticonvulsant / Neuropathic pain agent
Action: Modulates calcium channels → reduces excitatory neurotransmitter release
Indications: Partial seizures, neuropathic pain, post-herpetic neuralgia
Contraindications: Hypersensitivity, severe renal impairment
Specific Side Effects:
- Sedation, dizziness
- Ataxia, fatigue
- Weight gain, peripheral edema
Nursing Role & Monitoring:
✅ Monitor renal function (adjust dose)
✅ Educate about drowsiness – avoid driving initially
✅ Gradually titrate dose to minimize side effects
✅ Monitor for misuse (some abuse potential)

💊 10. Lamotrigine

Class: Broad-spectrum antiepileptic
Action: Inhibits sodium channels, stabilizes neuronal membranes
Indications: Epilepsy (partial, generalized), bipolar disorder
Contraindications: Hypersensitivity
Specific Side Effects:
- Skin rashes (can progress to Stevens-Johnson Syndrome)
- Headache, dizziness
- Double vision
Nursing Role & Monitoring:
✅ Start low, go slow – to prevent rash
✅ Educate patient to report rash immediately
✅ Monitor mood in bipolar patients
✅ Avoid abrupt withdrawal

💊 11. Rivastigmine

Class: Acetylcholinesterase inhibitor
Action: Increases acetylcholine → improves cognition in dementia
Indications: Alzheimer’s disease, Parkinson’s dementia
Contraindications: Bradycardia, asthma, GI ulcer
Specific Side Effects:
- Nausea, vomiting
- Weight loss, dizziness
- Bradycardia
Nursing Role & Monitoring:
✅ Monitor weight and food intake
✅ Administer with meals to reduce GI symptoms
✅ Observe for syncope or slow pulse
✅ Apply patch to clean, dry, non-hairy skin (if transdermal)

💊 12. Lithium Carbonate

Class: Mood stabilizer
Action: Alters sodium transport and affects neurotransmitter metabolism
Indications: Bipolar disorder (especially manic episodes)
Contraindications: Renal disease, dehydration, pregnancy (Category D)
Specific Side Effects:
- Tremor, hypothyroidism
- Polyuria, polydipsia (nephrogenic diabetes insipidus)
- Toxicity: Nausea, confusion, ataxia, seizures
Nursing Role & Monitoring:
✅ Narrow therapeutic index (0.6–1.2 mEq/L) → monitor levels
✅ Maintain adequate hydration & sodium intake
✅ Monitor renal and thyroid function
✅ Avoid NSAIDs & diuretics (increase toxicity)

💊 13. Risperidone

Class: Atypical antipsychotic
Action: Blocks serotonin (5-HT2) and dopamine (D2) receptors
Indications: Schizophrenia, bipolar disorder, autism-related irritability
Contraindications: Dementia-related psychosis, CNS depression
Specific Side Effects:
- Weight gain, hyperglycemia
- Increased prolactin → gynecomastia, amenorrhea
- Extrapyramidal symptoms at high doses
Nursing Role & Monitoring:
✅ Monitor weight, blood glucose, and lipid profile
✅ Educate on hormonal changes
✅ Assess for EPS (tremors, rigidity)
✅ Avoid alcohol and sedatives

💊 14. Zolpidem

Class: Sedative-hypnotic (non-benzodiazepine)
Action: Enhances GABA at benzodiazepine receptor sites → promotes sleep
Indications: Short-term insomnia treatment
Contraindications: Severe hepatic impairment, respiratory depression, history of complex sleep behaviors
Specific Side Effects:
- Drowsiness, dizziness
- Sleepwalking, abnormal sleep behaviors
- Memory issues, confusion
Nursing Role & Monitoring:
✅ Administer just before bedtime on empty stomach
✅ Educate not to engage in activities after taking (risk of amnesia)
✅ Monitor for abnormal behaviors (e.g., eating, walking during sleep)
✅ Avoid alcohol and other CNS depressants

💊 15. Clonazepam

Class: Benzodiazepine (long-acting)
Action: Enhances GABA → anxiolytic, sedative, anticonvulsant
Indications: Panic disorder, epilepsy (absence seizures), restless leg syndrome
Contraindications: Liver disease, glaucoma, sleep apnea
Specific Side Effects:
- Drowsiness, fatigue
- Tolerance, dependence
- Respiratory depression (in overdose)
Nursing Role & Monitoring:
✅ Taper slowly to prevent withdrawal seizures
✅ Educate about habit-forming nature
✅ Monitor respiratory rate and mental alertness
✅ Avoid combining with alcohol or opioids

💊 16. Methylphenidate (Ritalin)

Class: CNS stimulant
Action: Inhibits reuptake of dopamine and norepinephrine → increased attention
Indications: ADHD, narcolepsy
Contraindications: Cardiac arrhythmias, glaucoma, anxiety, Tourette’s syndrome
Specific Side Effects:
- Insomnia, anorexia
- Tachycardia, increased BP
- Growth suppression in children
Nursing Role & Monitoring:
✅ Monitor height and weight in pediatric use
✅ Administer early in the day to avoid insomnia
✅ Assess heart rate and BP regularly
✅ Store securely due to abuse potential

💊 DRUGS FOR CARDIOVASCULAR DISORDERS

🎯 Treating Hypertension, Angina, Arrhythmias, Heart Failure, and More

💓 1. Amlodipine

Class: Calcium Channel Blocker (Dihydropyridine)
Action: Inhibits calcium influx into vascular smooth muscle → vasodilation → ↓BP
Indications: Hypertension, chronic stable angina
Contraindications: Severe aortic stenosis, hypotension
Side Effects:
- Peripheral edema
- Flushing, dizziness
- Reflex tachycardia
Nurse’s Role & Monitoring:
✅ Monitor BP and HR before and after administration
✅ Educate patient to avoid grapefruit juice
✅ Warn about postural hypotension – rise slowly

💓 2. Atenolol

Class: Beta-1 Selective Blocker
Action: Blocks β1 receptors in heart → ↓HR, ↓contractility, ↓BP
Indications: Hypertension, angina, post-MI, arrhythmias
Contraindications: Bradycardia, asthma, heart block
Side Effects:
- Bradycardia
- Fatigue, cold extremities
- Masked hypoglycemia
Nurse’s Role & Monitoring:
✅ Check apical pulse – withhold if <60 bpm
✅ Monitor blood glucose in diabetics
✅ Taper off slowly to prevent rebound tachycardia

💓 3. Enalapril

Class: ACE Inhibitor
Action: Inhibits angiotensin-converting enzyme → ↓Angiotensin II → vasodilation, ↓aldosterone
Indications: Hypertension, heart failure, post-MI nephropathy
Contraindications: Pregnancy, renal artery stenosis, history of angioedema
Side Effects:
- Dry cough
- Hyperkalemia
- Angioedema (life-threatening)
Nurse’s Role & Monitoring:
✅ Monitor renal function and potassium
✅ Educate to report facial swelling or difficulty breathing
✅ Switch to ARB (e.g., Losartan) if cough intolerable

💓 4. Furosemide

Class: Loop Diuretic
Action: Inhibits Na⁺/K⁺/Cl⁻ reabsorption in the loop of Henle → diuresis
Indications: Edema in CHF, pulmonary edema, hypertension
Contraindications: Anuria, electrolyte depletion
Side Effects:
- Hypokalemia, dehydration
- Ototoxicity (high doses)
- Hypotension
Nurse’s Role & Monitoring:
✅ Monitor BP, I/O, weight, electrolytes
✅ Encourage potassium-rich foods
✅ Administer early in day to avoid nocturia

💓 5. Nitroglycerin

Class: Nitrate (Vasodilator)
Action: Releases nitric oxide → relaxes smooth muscle → dilates veins & arteries → ↓preload & afterload
Indications: Angina, MI, heart failure (acute)
Contraindications: Hypotension, sildenafil use (within 24 hrs)
Side Effects:
- Headache
- Hypotension, flushing
- Reflex tachycardia
Nurse’s Role & Monitoring:
✅ Monitor BP closely
✅ Educate on sitting/lying down during angina dose
✅ Store tablets in dark, airtight container
✅ Check for nitrate tolerance with patch-free interval

💓 6. Digoxin

Class: Cardiac Glycoside
Action: Inhibits Na⁺/K⁺-ATPase → ↑intracellular calcium → ↑contractility; ↓AV node conduction
Indications: Heart failure, atrial fibrillation
Contraindications: Heart block, hypokalemia, renal failure
Side Effects:
- Nausea, visual disturbances (“yellow vision”)
- Bradycardia, arrhythmias
- Toxicity (especially with low K⁺)
Nurse’s Role & Monitoring:
✅ Monitor serum digoxin level (0.8–2 ng/mL)
✅ Check apical pulse for 1 full minute before administration
✅ Monitor K⁺ and renal function
✅ Teach signs of toxicity: nausea, confusion, visual halos

💓 7. Atorvastatin

Class: HMG-CoA Reductase Inhibitor (Statin)
Action: Inhibits cholesterol synthesis in liver → ↓LDL, ↑HDL
Indications: Hyperlipidemia, CAD prevention
Contraindications: Liver disease, pregnancy
Side Effects:
- Myopathy, muscle pain
- Elevated liver enzymes
- Rhabdomyolysis (rare but serious)
Nurse’s Role & Monitoring:
✅ Monitor liver function (ALT, AST)
✅ Report unexplained muscle pain or weakness
✅ Give in the evening (cholesterol synthesis peak)
✅ Avoid grapefruit juice

💓 8. Clopidogrel

Class: Antiplatelet (ADP receptor inhibitor)
Action: Inhibits platelet aggregation by blocking P2Y12 receptor
Indications: MI, stroke, peripheral arterial disease, post-stent
Contraindications: Active bleeding, peptic ulcer, liver disease
Side Effects:
- Bleeding (GI, bruising)
- Thrombocytopenia
- Rash, diarrhea
Nurse’s Role & Monitoring:
✅ Monitor CBC, bleeding signs
✅ Educate to report black stools or unusual bleeding
✅ Avoid NSAIDs concurrently unless prescribed
✅ Ensure adherence post-PCI to prevent clotting

💓 9. Heparin (Unfractionated)

Class: Anticoagulant
Action: Enhances antithrombin III → inactivates thrombin & Factor Xa
Indications: DVT, PE, ACS, during dialysis
Contraindications: Active bleeding, thrombocytopenia
Side Effects:
- Bleeding
- Heparin-Induced Thrombocytopenia (HIT)
- Osteoporosis (long-term use)
Nurse’s Role & Monitoring:
✅ Monitor aPTT (target: 1.5–2.5x normal)
✅ Watch for HIT – monitor platelets
✅ Antidote: Protamine sulfate
✅ Avoid IM injections to reduce hematoma risk

💓 10. Amiodarone

Class: Class III Antiarrhythmic
Action: Prolongs action potential duration → stabilizes cardiac rhythm
Indications: Atrial fibrillation, ventricular arrhythmias
Contraindications: Severe sinus node dysfunction, iodine allergy
Side Effects:
- Pulmonary fibrosis
- Thyroid dysfunction (hypo or hyper)
- Corneal deposits, skin discoloration
Nurse’s Role & Monitoring:
✅ Monitor ECG, thyroid, liver, and lung function
✅ Chest X-ray before and during therapy
✅ Educate about photosensitivity (blue-gray skin)
✅ Report cough or breathlessness promptly

💓 11. Losartan

Class: Angiotensin II Receptor Blocker (ARB)
Action: Blocks angiotensin II receptors → vasodilation & ↓aldosterone → ↓BP
Indications: Hypertension, diabetic nephropathy, heart failure (alternative to ACEI)
Contraindications: Pregnancy, bilateral renal artery stenosis
Side Effects:
- Hyperkalemia
- Hypotension
- Less cough than ACEIs
Nursing Role & Monitoring:
✅ Monitor BP, renal function, serum potassium
✅ Educate to avoid potassium-rich foods or supplements
✅ Used when ACEI causes intolerable cough

💓 12. Spironolactone

Class: Potassium-sparing diuretic / Aldosterone antagonist
Action: Inhibits aldosterone → Na⁺ excretion & K⁺ retention
Indications: Heart failure, hypertension, primary hyperaldosteronism, edema in liver disease
Contraindications: Hyperkalemia, anuria, Addison’s disease
Side Effects:
- Hyperkalemia
- Gynecomastia in males
- Menstrual irregularities
Nursing Role & Monitoring:
✅ Monitor K⁺ and renal function
✅ Avoid potassium supplements and salt substitutes
✅ Observe for muscle weakness or ECG changes (signs of hyperkalemia)

💓 13. Hydrochlorothiazide (HCTZ)

Class: Thiazide Diuretic
Action: Inhibits sodium reabsorption in distal tubule → mild diuresis, ↓BP
Indications: Hypertension, mild heart failure, edema
Contraindications: Sulfa allergy, anuria
Side Effects:
- Hypokalemia
- Hyperglycemia
- Hyperuricemia (may trigger gout)
Nursing Role & Monitoring:
✅ Monitor electrolytes (esp. K⁺), glucose, uric acid
✅ Encourage potassium-rich foods
✅ Check weight and BP regularly

💓 14. Diltiazem

Class: Calcium Channel Blocker (Non-dihydropyridine)
Action: Slows AV node conduction, reduces HR and contractility
Indications: Hypertension, atrial fibrillation, angina
Contraindications: Heart block, severe heart failure, bradycardia
Side Effects:
- Bradycardia
- Constipation
- Hypotension
Nursing Role & Monitoring:
✅ Monitor ECG, HR, BP
✅ Assess for signs of heart failure
✅ Caution in elderly for bradycardia

💓 15. Warfarin

Class: Oral Anticoagulant (Vitamin K antagonist)
Action: Inhibits vitamin K-dependent clotting factors (II, VII, IX, X)
Indications: Atrial fibrillation, prosthetic heart valves, DVT/PE prophylaxis
Contraindications: Pregnancy, active bleeding, recent surgery
Side Effects:
- Bleeding
- Skin necrosis (rare)
- Teratogenic effects
Nursing Role & Monitoring:
✅ Monitor INR (target: 2–3)
✅ Teach consistent dietary vitamin K (avoid excess leafy greens)
✅ Use soft toothbrush, report signs of bleeding
✅ Antidote: Vitamin K

💓 16. Dopamine (IV infusion)

Class: Sympathomimetic / Vasopressor
Action: Dose-dependent → ↑HR, ↑contractility, ↑renal perfusion
Indications: Cardiogenic shock, heart failure with hypotension
Contraindications: Pheochromocytoma, tachyarrhythmias
Side Effects:
- Tachycardia, arrhythmias
- Limb ischemia (high doses)
- Extravasation injury
Nursing Role & Monitoring:
✅ Administer via central line if possible
✅ Monitor HR, BP, urine output, infusion site
✅ Antidote for extravasation: Phentolamine

💓 17. Dobutamine (IV infusion)

Class: Beta-1 adrenergic agonist
Action: Increases myocardial contractility → improves cardiac output
Indications: Acute decompensated heart failure, cardiogenic shock
Contraindications: Hypovolemia, atrial fibrillation with RVR
Side Effects:
- Tachycardia, palpitations
- Arrhythmias
- Angina
Nursing Role & Monitoring:
✅ Monitor cardiac output, BP, ECG continuously
✅ Titrate dose based on response
✅ Ensure adequate volume status before starting

💓 18. Alteplase (tPA)

Class: Thrombolytic (Tissue Plasminogen Activator)
Action: Converts plasminogen to plasmin → dissolves fibrin clot
Indications: Acute MI, ischemic stroke (within 3–4.5 hrs), PE
Contraindications: Recent surgery, active bleeding, history of hemorrhagic stroke
Side Effects:
- Major bleeding (GI, cerebral)
- Hypotension
- Allergic reactions
Nursing Role & Monitoring:
✅ Monitor for signs of bleeding (neuro checks!)
✅ Strict IV/IM avoidance post-administration
✅ Obtain consent, labs, and CT brain before stroke use
✅ Antidote: Aminocaproic acid

💓 19. Ivabradine

Class: SA node modulator
Action: Inhibits funny current (If) in the sinoatrial node → ↓HR
Indications: Chronic stable angina, heart failure with high resting HR
Contraindications: Bradycardia, acute decompensated HF, hypotension
Side Effects:
- Bradycardia
- Visual disturbances (phosphenes)
- Atrial fibrillation
Nursing Role & Monitoring:
✅ Monitor HR regularly
✅ Educate about temporary vision changes
✅ Do not use in acute worsening of HF

💓 20. Sacubitril/Valsartan (Entresto)

Class: ARNI (Angiotensin Receptor Neprilysin Inhibitor)
Action: Enhances natriuretic peptides + blocks angiotensin II
Indications: Heart failure with reduced ejection fraction (HFrEF)
Contraindications: ACEI use within 36 hours, pregnancy
Side Effects:
- Hypotension
- Hyperkalemia
- Angioedema
Nursing Role & Monitoring:
✅ Monitor BP, potassium, and renal function
✅ Educate to stop ACEI 36 hours before starting
✅ Warn about rare but serious angioedema

👁️ DRUGS FOR EYE DISORDERS

🎯 Commonly used in Glaucoma, Infections, Inflammation, and Diagnostic Procedures

👁️ 1. Timolol

Class: Non-selective Beta Blocker (Ophthalmic)
Action: Decreases aqueous humor production → reduces intraocular pressure (IOP)
Indications: Open-angle glaucoma, ocular hypertension
Contraindications: Asthma, COPD, sinus bradycardia, heart block
Specific Side Effects:
- Burning or stinging in eyes
- Bradycardia, hypotension (systemic absorption)
- Bronchospasm
Nursing Role & Monitoring:
✅ Monitor pulse and BP (even with topical use)
✅ Apply nasolacrimal pressure for 1 minute to prevent systemic absorption
✅ Instruct patient not to rub eyes after administration

👁️ 2. Latanoprost

Class: Prostaglandin Analog
Action: Increases outflow of aqueous humor via uveoscleral pathway
Indications: Primary open-angle glaucoma, ocular hypertension
Contraindications: Hypersensitivity, intraocular inflammation
Specific Side Effects:
- Iris pigmentation (permanent darkening)
- Eyelash growth (hypertrichosis)
- Conjunctival hyperemia
Nursing Role & Monitoring:
✅ Administer once at night for best effect
✅ Inform patient about possible iris color change
✅ Monitor for redness, visual changes

👁️ 3. Pilocarpine

Class: Cholinergic (Miotic Agent)
Action: Stimulates muscarinic receptors → pupil constriction (miosis), increases aqueous humor drainage
Indications: Open-angle and angle-closure glaucoma, preoperative miosis
Contraindications: Retinal detachment, acute iritis
Specific Side Effects:
- Blurred vision, brow ache
- Poor night vision
- Headache
Nursing Role & Monitoring:
✅ Educate patient about temporary blurred vision
✅ Avoid hazardous activities (e.g., driving at night)
✅ Administer in lower conjunctival sac

👁️ 4. Brimonidine

Class: Alpha-2 Adrenergic Agonist
Action: Reduces aqueous humor production and increases uveoscleral outflow
Indications: Open-angle glaucoma, ocular hypertension
Contraindications: Infants <2 years, MAOI therapy
Specific Side Effects:
- Eye dryness, foreign body sensation
- Drowsiness, fatigue (systemic)
- Dry mouth
Nursing Role & Monitoring:
✅ Apply pressure on nasolacrimal duct to reduce systemic effects
✅ Monitor for allergic conjunctivitis
✅ Inform patient not to wear contact lenses immediately after use

👁️ 5. Acetazolamide

Class: Carbonic Anhydrase Inhibitor (Systemic)
Action: Inhibits carbonic anhydrase → reduces aqueous humor production
Indications: Acute angle-closure glaucoma, altitude sickness, edema
Contraindications: Sulfa allergy, severe renal/hepatic disease
Specific Side Effects:
- Paresthesia, GI upset
- Electrolyte imbalance (hypokalemia, hyponatremia)
- Kidney stones
Nursing Role & Monitoring:
✅ Monitor electrolytes, renal function
✅ Encourage fluid intake to prevent kidney stones
✅ Observe for signs of metabolic acidosis

👁️ 6. Tropicamide

Class: Mydriatic (Anticholinergic)
Action: Blocks muscarinic receptors → pupil dilation (mydriasis)
Indications: Fundus examination, uveitis, cycloplegic refraction
Contraindications: Narrow-angle glaucoma
Specific Side Effects:
- Photophobia
- Blurred vision
- Increased IOP (in predisposed patients)
Nursing Role & Monitoring:
✅ Advise patient to wear sunglasses after use
✅ Monitor for signs of angle-closure glaucoma
✅ Use lowest effective dose in elderly

👁️ 7. Prednisolone Acetate (Ophthalmic)

Class: Corticosteroid (Topical)
Action: Reduces inflammation by suppressing leukocyte infiltration and cytokine production
Indications: Ocular inflammation, uveitis, postoperative inflammation
Contraindications: Viral eye infections (e.g., herpes simplex keratitis), untreated bacterial infections
Specific Side Effects:
- Cataract formation (prolonged use)
- Increased IOP
- Secondary infection
Nursing Role & Monitoring:
✅ Do not use for more than prescribed period
✅ Monitor IOP in long-term use
✅ Educate patient to report vision changes or eye pain

👁️ 8. Moxifloxacin (Eye drops)

Class: Fluoroquinolone Antibiotic (Ophthalmic)
Action: Inhibits bacterial DNA gyrase → bactericidal
Indications: Bacterial conjunctivitis, corneal ulcers
Contraindications: Allergy to quinolones
Specific Side Effects:
- Eye irritation or burning
- Bitter taste
- Superinfection with prolonged use
Nursing Role & Monitoring:
✅ Ensure proper hand hygiene before and after instillation
✅ Advise full course even if symptoms improve early
✅ Avoid contamination of dropper tip

👁️ 9. Artificial Tears (e.g., Carboxymethylcellulose)

Class: Lubricating ophthalmic agent
Action: Moistens the ocular surface and relieves dryness
Indications: Dry eye syndrome, keratoconjunctivitis sicca
Contraindications: Hypersensitivity to ingredients
Specific Side Effects:
- Temporary blurred vision
- Eye irritation (rare)
Nursing Role & Monitoring:
✅ Store at room temperature; discard if cloudy or discolored
✅ Teach patient to avoid touching tip to eye surface
✅ Use preservative-free formulations in chronic dry eye

🚰 DRUGS FOR KIDNEY (RENAL) DISORDERS

🎯 Focused on managing electrolyte balance, renal function, anemia, BP, and complications of renal failure

💊 1. Furosemide

Class: Loop Diuretic
Action: Inhibits Na⁺-K⁺-2Cl⁻ reabsorption in loop of Henle → strong diuresis
Indications: Acute kidney injury (AKI), edema in CKD, fluid overload
Contraindications: Anuria, electrolyte depletion
Specific Side Effects:
- Hypokalemia, dehydration
- Ototoxicity (with high IV doses)
- Hypotension
Nursing Role & Monitoring:
✅ Monitor BP, electrolytes (especially K⁺, Na⁺), and daily weight
✅ Encourage potassium-rich diet unless contraindicated
✅ Administer early in the day to avoid nocturia

💊 2. Erythropoietin (Epoetin alfa)

Class: Hematopoietic growth factor
Action: Stimulates red blood cell production in bone marrow
Indications: Anemia in chronic kidney disease (CKD), dialysis patients
Contraindications: Uncontrolled hypertension, hypersensitivity
Specific Side Effects:
- Hypertension
- Headache, arthralgia
- Thromboembolic events
Nursing Role & Monitoring:
✅ Monitor hemoglobin (target: ~10–11 g/dL)
✅ Check BP regularly
✅ Administer subcutaneously or IV as prescribed
✅ Ensure adequate iron stores for optimal response

💊 3. Calcium Acetate

Class: Phosphate binder
Action: Binds dietary phosphate in the GI tract → reduces serum phosphate
Indications: Hyperphosphatemia in CKD
Contraindications: Hypercalcemia
Specific Side Effects:
- Constipation
- Hypercalcemia
- Nausea
Nursing Role & Monitoring:
✅ Administer with meals to maximize phosphate binding
✅ Monitor serum calcium and phosphate
✅ Educate to avoid calcium supplements without consulting provider

💊 4. Sodium Bicarbonate

Class: Alkalinizing agent
Action: Buffers excess hydrogen ions → corrects metabolic acidosis
Indications: Metabolic acidosis in CKD
Contraindications: Alkalosis, hypocalcemia, heart failure
Specific Side Effects:
- Hypernatremia
- Hypokalemia
- Fluid retention
Nursing Role & Monitoring:
✅ Monitor ABG, serum electrolytes, and fluid balance
✅ Educate to avoid overuse without monitoring
✅ Use caution in hypertensive or cardiac patients

💊 5. Sevelamer

Class: Non-calcium phosphate binder
Action: Binds phosphate in the GI tract without affecting calcium
Indications: Hyperphosphatemia in dialysis patients
Contraindications: Bowel obstruction
Specific Side Effects:
- Nausea, constipation
- Abdominal pain
- Reduced absorption of fat-soluble vitamins
Nursing Role & Monitoring:
✅ Administer with meals
✅ Monitor phosphate levels
✅ Educate about adequate hydration and regular bowel habits

💊 6. Cinacalcet

Class: Calcimimetic
Action: Increases sensitivity of parathyroid gland to calcium → ↓PTH secretion
Indications: Secondary hyperparathyroidism in CKD
Contraindications: Hypocalcemia
Specific Side Effects:
- Hypocalcemia
- Nausea, vomiting
- Seizures (rare)
Nursing Role & Monitoring:
✅ Monitor serum calcium, phosphate, PTH levels
✅ Educate to report signs of low calcium (tingling, cramps)
✅ Take with food to reduce GI upset

💊 7. Labetalol

Class: Alpha and beta blocker
Action: Lowers BP by blocking both α and β-adrenergic receptors
Indications: Hypertension in renal disease, hypertensive emergencies
Contraindications: Asthma, bradycardia, heart block
Specific Side Effects:
- Hypotension
- Bradycardia
- Dizziness, fatigue
Nursing Role & Monitoring:
✅ Monitor BP and HR closely
✅ Administer IV in hypertensive crisis; monitor ECG
✅ Educate about avoiding abrupt discontinuation

💊 8. Iron Sucrose (IV)

Class: Parenteral iron supplement
Action: Replenishes iron stores for erythropoiesis
Indications: Iron-deficiency anemia in CKD patients on EPO therapy
Contraindications: Iron overload, allergy to iron
Specific Side Effects:
- Metallic taste
- Hypotension during infusion
- Injection site reactions
Nursing Role & Monitoring:
✅ Administer via slow IV infusion
✅ Monitor hemoglobin, ferritin, and transferrin saturation
✅ Watch for allergic reactions or hypotension

💊 9. Mannitol

Class: Osmotic diuretic
Action: Increases osmolarity in renal tubules → promotes diuresis
Indications: Prevention of acute renal failure, cerebral edema, intraocular pressure
Contraindications: Anuria, severe dehydration, pulmonary edema
Specific Side Effects:
- Fluid and electrolyte imbalance
- Pulmonary edema
- Headache
Nursing Role & Monitoring:
✅ Monitor urine output, electrolytes, and renal function
✅ Use a filter needle (crystallization risk)
✅ Observe for signs of fluid overload

💊 10. Allopurinol

Class: Xanthine oxidase inhibitor
Action: Reduces uric acid production
Indications: Hyperuricemia in CKD, gout, uric acid nephropathy
Contraindications: Hypersensitivity, active liver disease
Specific Side Effects:
- Rash (can be severe: Stevens-Johnson Syndrome)
- GI upset
- Hepatotoxicity
Nursing Role & Monitoring:
✅ Monitor renal and liver function tests
✅ Encourage hydration to prevent uric acid stones
✅ Educate patient to report rash immediately

Published May 3, 2025By mynursingapp

Categorized as FREE MATERILES, Uncategorised