PHARMACOLOGY 4.

INORGANIC COMPOUNDS
- these are salts of various elements which can have
DEFINITION OF TERMS therapeutic effects in the human body and are used to
treat various conditions
PHARMACOLOGY Ex. aluminum (antacid for hyperacidity)
- from Greek φάρμακον, pharmakon, "drug"; and - fluoride (prevention of dental
λογία, -logia, “study” carries and osteoporosis)
- how drugs interact within biological systems to affect
function CLASSIFICATON OF DRUGS
- MORE SPECIFICALLY, it is the study of the 1. PRESCRIPTION DRUGS
interactions that occur between a living • Prescription (order (often in written form) by a qualified
organism and exogenous chemicals that alter health care professional to a pharmacist ℞) is an or other
normal biochemical function. therapist for a treatment to be provided to their patient.

DRUG COMPONENTS
-A substance or mixture of substances used in the • Date & time the drug is written
diagnosis, cure, treatment or prevention of disease. • Drug name
• Drug dosage
PHARMACODYNAMICS • Route of administration
- study of the biochemical and physiological effects of • Frequency & duration of administration
drugs; drug’s mechanism of action • Signature of the physician

PHARMACOKINETICS 2. NON – PRESCRIPTION DRUGS

- study of the absorption, distribution, biotransformation - Also known as over the
(metabolism) and excretion of drugs (ADME) counter drugs
3. INVESTIGATIONAL DRUGS
PHARMACOTHERAPEUTICS - Drugs that are subjected to clinical studies in order to
- study of how drugs may best be used in the treatment evaluate the usefulness of the drug in treating the
of illnesses; which drug would be most or least disease for which it is claimed to be effected.
appropriate to use for a specific disease, what dose 4. ILLICIT DRUGS Or STREET DRUGS
would be required. - distributed illegally; are used for non- medical purposes,
generally to alter mood or feeling
PHARMACOGNOSY e.g. Heroin, Nubain, Cytotec
- study of drugs derived from herbal and other natural
sources DRUG NAMES:

TOXICOLOGY 1. CHEMICAL NAME

- study of poisons and poisonings; deals with the toxic - a systematically derived name which identifies the
effects of substances on the living organism. chemical structure of the drug; shows the exact chemical
constitution of the drug and exact placing of atoms.
SOURCES OF DRUGS Eg. N- Acetyl-para-aminophenol
2. GENERIC NAME/ NONPROPRIETARY NAMES
1. PLANTS - given before drug becomes official; reflects some
Eg. digitalis (purple foxglove), vincristine (periwinkle), important pharmacological or chemical characteristic of
morphine (opium poppy) the drug.
2. ANIMALS/ ANIMAL PRODUCTS Eg. acetaminophen
Eg. insulin – from pigs and cows 3. BRAND (TRADE) NAME
Vaccine- killed attenuated - followed by the symbol ®; indicates the name is
microorganism from horse registered, that its use is restricted to the owner of the
3. SYNTHETIC VERSION drug, who is usually the manufacturer of the product.
- uses genetic engineering to alter bacteria to produce Eg. Tylenol
chemicals that are therapeutic and effective Example:
Chemical name:
4-Thia-1-Azabicyclo [3.2.0] heptane-2-
carboxylic acid, 6 [(aminophenylacetyl) 2. NURSING DIAGNOSIS
amino]-3,3- dimetyl-7-oxo-, [25-[2,  - Made based on the analysis of assessment data
- 5,6(S*)] ]  - May be ACTUAL or POTENTIAL
- KNOWLEDGE DEFICIT about drug action, administration
GENERIC NAME: AMPICILLIN & SE
OFFICIAL NAME:AMPICILLIN, USP - R/T cultural/language barrier or speech articulation
BRAND NAMES: AMCILL, problem.
PRICIPEN, POLYCILLIN - RISK for INJURY R/T forgetfulness.
- INEFFECTIVE THERAEUTIC REGIMEN MANAGEMENT
Chemical Name Generic Name Brand Name - R/T lack of finances
Acetylsalicylic aspirin St. Joseph aspirin
acid 3. PLANNING
N-acetyl-p-amio- acetaminophen Tylenol – is characterized by goal setting or expected outcomes
phenol which represent patient goals and state of desired
Lithium lithium Lithobid patient behaviors of responses that should result from
hydroxide the nursing care.
monohydrate
Idoleacetic acid indomethacin Indocin Included are:
6[(D)-a- ampicilin Omnipen A. identification of the therapeutic intent for every
aminophenyl- medication
acetamido]penici B. side effects to be expected and reported
llanic acid C. identification of the recommended dosage and route
of administration
SOURCES OF DRUG INFORMATION D. scheduling of the administration of medication
E. teaching the patient to keep written records of his
1. Pharmacopoeia responses
2. Formulary F. additional teaching as needed: eg. techniques of
3. Nursing textbook administration, proper storage of medication
4. Package insert
5. Reference books 4. INTERVENTION/ IMPLEMENTATION
1. PDR - NURSING ACTIONS necessary to accomplish GOALS
2. Drug facts & comparisons or expected outcomes.
3. Nursing drug guide/ handbook - DEPENDENT NURSING ACTIONS
6. Journals - INTERDEPENDENT NURSING ACTIONS
1. Medical letter - INDEPENDENT NURSING ACTIONS
2. American journal of nursing
7. Internet CLIENT TEACHING & EDUCATION includes:
 ADMINISTRATION OF DRUG
NURSING PROCESS IN PHARMACOLOGY  ASSESSMENT of DRUG EFFECTIVENESS
1. ASSESSMENT  SELF-ADMINISTRATION
- Forms the basis on which care is planned, implemented  DIET
& evaluated.  SIDE EFFECTS
-Subjective Data  CULTURAL CONSIDERATIONS
-Objective Data 
Check for:
DRUG HISTORY  response to medications; observation for S/S or the
A. to evaluate the patient’s need for medication development of adverse effects; ability to receive pt.
B. to obtain current and past use of medicines (OTC education & self- administer meds; potential for
medicines, prescribed medicines, herbal compliance.
products, illicit drugs)
C. to identify problems related to drug therapy
D. to identify risk factors in drug therapy 5. EVALUATION
- is an ongoing process that assesses response alcohol)
to the following:
DRUG INTERACTIONS
1.) the effectiveness of the medication prescribed Additive Effect Synergistic EffectAntagonistic
2.)observation of signs and symptoms of recurring illness Effect
3.) development of the side/ adverse effects 2 drugs with The combined 1 drug interferes
4.) effectiveness of the health teaching or client similar actions effect of 2 drugs with the action
education are taken for a is > the sum of of another
doubled effect the effect of
each drug given
alone
Ex: Ex: ampicillin + Ex: tetracycline +
propoxyphene + sulbactam = antacid =
aspirin = added prolonged action decrease
anagesic effect of antibiotic absorption of the
tetracycline

Interfence Incompatibility
1 drug inhibits theShould not be mixed
metabolism / excretion of a together or administered
FACTORS INFLUENCING DRUG ACTION 2nd drug, causing INCREASE at the same time;
1. Age activity of the 2nd drug Signs are haziness, a
- most sensitive to the response of drugs: precipitate, or a change in
A. infants color of solution when
B. very elderly mixed
2. Body weight Ex: probenecid + Ex: ampicillin + gentamicin
- overweight- increase dosage spectinomycin = prolonged = amp. Inactivates
-underweight- decrease in dosage antibacterial activity from gentamicin
-pediatrics- calculated mL of drug/ kgBW spectinomycin due to
3. Metabolic Rate / Genetic Factors blocking renal excretion by
4. Illness probenecid
- pathologic conditions alter rate of absorption,
distribution, metabolism and excretion
- eg. clients: in shock, who are OTHER TERMINOLOGIES
vomiting, with nephrotic syndrome or malnutrition, with
kidney failure Desired action
5. Psychological Aspects - expected response Side effects
- attitudes and expectations Side Effects
- willingness to take medicines as prescribed - effects which result from pharmacological effects of the
6. Dependence drug
- also known as addiction or habituation - actions other than intended therapeutic effects
- Physical dependence- develops withdrawal symptoms resulting from the pharmacological action of a drug
- Psychological dependence- emotionally attached to the Adverse effect
drug - A range of undesirable effects (unintended & occuring
7. Tolerance at normal doses) of drugs that cause mild to severe
- occurs when higher doses are required to produce the reactions
same effect that lower doses once provided Toxicity
- can be caused by psychological dependence - severe adverse effect; quality of being poisonous
8. Cumulative Effect Carcinogenicity
- if the next doses are administered before previously - ability of the drug to induce living cells to mutate and
administered doses have been metabolized or excreted. become cancerous
- may result in drug toxicity
- rate of consumption exceeds rate of metabolism (eg. Teratogenicity
- drug that induces birth defects; causing abnormal dev.
of a fetus in uteros Check why the medication is given & know the
Photosensitivity classification of the drug
- skin reaction d/t exposure to sunlight How will you know if the medication is effective? What
Hypersensitivity / Allergic reaction are your assessment parameters in monitoring the
- hypersensitive response of the client’s immunological effects of the drug?
system in the presence of a drug Exactly what time should the medication be given?
Idiosyncratic Reaction Client teaching tips. What are the therapeutic and side
– may occur when the client is first exposed to the drug; effects of the medication?
result of abnormal reactivity to a drug caused by genetic Keys to giving it safely. You should be able to identify
differences between the client and nonreacting interventions to counteract the adverse effects of the
individuals drug.
Ex. Paralysis due to succinylcholine (enzyme
deficiency)

PRINCIPLES OF DRUG ACTION

DRUGS do not create new cellular functions but rather
alter existing ones
- Ex. antibiotic slows the growth and/or reproduction of
microbial organisms

DRUG ACTION is relative to the physiological

state which existed when the drug was
administered.

DRUGS may interact with the body in

several different ways:
- alter the chemical composition of a body fluid
- accumulate in certain tissues because of their affinity
for a tissue component
- by forming a chemical bond with specific
receptors with in the body

DIFFERENT DRUGS whose molecules

precisely fit into a given receptor elicit a
comparable drug response; those which do
not perfectly fit produce only a weak or no
response at all.
Precise fit  strong effect
Loose fit  weak effect
Ex. Hormones

AGONIST – ANTAGONIST drugs exert some agonist as

well as antagonist action

AGONIST – drugs which interact with a receptor to

produce a response
ANTAGONIST – drugs interact to inhibit or prevent
the action of an agonist
Ex. depression of CNS by narcotic agonists – morphine
reversed by
- NARCOTIC ANTAGONIST – NARCAN (naloxone)
PRINCIPLES APPLIED TO PHARMACOLOGY PHASES OF DRUG THERAPY
 EXCIPIENTS
PHARMACEUTIC - filler or inert substance (additives) used in drug
preparation to allow the drug to take on a particular size
and shape
3 PHASES OF - to enhance the drug’s dissolution
PHARMACOKINETIC
DRUG ACTION - increases absorbability of a drug
EXAMPLE
- K+ = Penicillin Potassium
PHARMACODYNAMICS
- Na+ = Pen G Sodium

PHAMACEUTIC PHASE PHARMACOKINETICS

- is the process of drug movement to achieve drug action
DISINTEGRATION - breakdown of a tablet into smaller
particles
DISSOLUTION -dissolving process of the smaller ABSORPTION
particles in the GIT fluid prior to
absorption DISTRIBUTION
4 PROCESSES
Depends on: METABOLISM
RATE LIMITING and EXCIPIENTS
EXCRETION
ABSORPTION
- The movement of drug particles from the GI tract to
body fluids by passive absorption, active absorption or
pinocytocis
- Lipid soluble and non-ionized are absorbed faster then
water soluble and ionized drugs

RATE LIMITING
- Time it takes for the drug to disintegrate and dissolved
and become available for the body to absorb
PASSIVE ABSORPTION
- drug molecule move from a region of relativity high to
low concentration without requiring energy

ACTIVE ABSORPTION
- process that uses energy to actively move a molecules
across a cell membrane. SQ Perfusion, fat content,
temperature
ORAL Acidity of the stomach,
length of time in the
stomach, blood flow to the
GIT, presence of the
interacting food or drug
MUCOUS MEMBRANE Perfusion, integrity,
presence of food-smoking,
length of time in the area

DISTRIUTION
PINOCYTOSIS - is the process b which the drug become available to
- process by which cells carry drug across the membrance body fluid and body tissues
engulfing the drug particle - Factors influencing drug distribution:
A. Blood flow
B. Affinity to the body tissues
C. Protein-binding effect

HOW DRUS ARE DISTRIBUTED

PROTEIN BINDING
- Drugs that bind with specific protein component such as
albumin and globulin.
Example: anticonbulsants - albumin
Antidysrhythmics - globulin
FACTORS AFFECTING ABSORPTION
- The portion of the drug that is bound to protein is
1. Blood flow
inactive (do not cause pharmacologic response)
2. Pain
- The portion of the drug that is unbound is called FREE
3. Stress and food
DRUG which is an active drug (causes pharmacologic
4. Exercise
response)
5. Nature of absorbing surface-transport of drug
molecules is faster through a single layer of cells
(intestinal epithelium) than the transverse layers of cells
(skin)
6. Drug solubility
7. pH - When 2 highly protein-bound drugs are given
8. Drug concentration concurrently DRUG TOXICITY may result
9. Dosage form
10. Hepatic first-pass effect - inactivation of drug DRUG TOXICITY - too much of free drug release in the
enzymes in the liver before the drug reaches the systemic circulation (eg. Two higly CHON-bound drugs and low
circulation for distribution albumin)
- Bioavalability - the percentage of the administered
drug dose that reaches the systemic circulation BLOOD-BRAIN BARRIER
11. Enterohepatic recycling - absorption of drug the bile - is a protective system of cellular activity that keeps
into the small bowel and then into circulating system foreign invaders/poisons away from the CNS.
12. Route of administration - linked to blood supply - High lipid soluble drugs are more likely to pass the
blood brain barrier
Route of administration Factor affecting the - Antibiotics can not pass the BBB
absorption - CNS effect by medications are result of indirect drug
IV Blood volume effects and not the actual reaction of the drug to the CNS
IM Perfusion, fat content,
temperature PLACENTA AND BREASTMILK
- Drugs readily pass through the placenta and affect the 1 3 hour 325 mg 50%
developing fetus 2 6 hour 162 mg 25%
- Drugs are secreted into breast milk and therefore have 3 9 hour 81 mg 12.5%
the potential to affect the neonate 4 12 hour 40 mg 6.25%
5 15 hour 20 mg 3.1%
PREGNANCY CATEGORIES 6 18 hour 10 mg 1.55%

EXCRETION

- Process of eliminating substances by body organs or

tissues as part of a natural metabolic activity
- KIDNEYS - MAIN ROUTE of elimination (free, water
soluble unbound drugs)
- Others: Bile, Feces, Lungs, Saliva, Sweat and Breastmilk
- Urine pH - influences excretion
- Acid Urine - elimination of weak base drugs
METABOLISM/ BIOTRANSFORMATION - Alkaline urine - elimination of weak acid drugs
- Chemical changes a substance undergoes in the body
such as by the action of enzymes SUMMARY OF PHARMACOKINETICS
- Drugs are metabolized in both the GI tract and liver
(primary site of metabolism)
- Most drugs are inactivated by liver enzymes and are
converted to water soluble substances (inactive
metabolites) for renal excretion
- Liver disease such as cirrhosis and hepatitis affect drug
metabolism

HALD LIFE ( t 1/2)

- time it takes for 1/2 of the drug concentration to be
eliminated
Hours - 2 hours Dosage 20mg %
2 hours 10 mg 50%
4 hours 5 mg 25%
6 hours 2.5 mg 12.5%
8 hours 1.25 mg 6.25%

EXAMPLE:
HALF - LIFE OF 60mg of Aspirin
PHARMACODYNAMIC PHASE
# t 1/2 Time of Dosage % Left
- is the study of drug concentration and its effects on the
elimination remaining
body
- drugs response can cause a primary and secondary
physiologic effect
- The primary effect is desirable an the secondary effect
may be desirable or undesirable
EXAMPLE: diphenhydramine (Benadryl)
- 1 effect = treat allergy
- 2 effect = central nervous system depression
(drowsiness)

RECEPTOR THEORY
- drugs act through receptors by binding to the receptor
to produce (initiate) a response or to block (prevent) a
response
- the better the drug fits at the receptor site, the more
biologically active the drugs is.

DRUG ACTIONS:
- replace or act as substitutes for missing chemicals
- Increase or stimulate certain cellular activities
- depress or slow cellular activities
- interfere with the functioning of foreign cells such as
invading organism

ONSET OF ACTION - time it takes to reach the minimum

effective concentration (MEC) after a drug is
administered
PEAK of ACTION - condition that occurs when the drug
reaches its highest blood or plasma concentration
DURATION of ACTION - length of time the drug has a
pharmacological effects

AGONIST - drugs that produce a response

ANTAGONIST - drugs that block a response

THERAPEUTIC INDEX - measured the margin of safety of

a drug
- Low TI: narrow margin of safety
- High TI: wide margin of safety
- The closer the ratio is to 1 the greater the danger of
toxicity

THERAPEUTIC RANGE (Therapeutic window) - between

the minimum effective concentration in the plasma and
the minimum toxic concentration
EXAMPLE: Digoxin (0.5 to 2ng/ml)
PEAK DRUG LEVEL - is the highest plasma concentration APPLYING NURSING PROCESS TO DRUG THERAPY
of drug at a specific time
- Indicate the rate of absorption of the drug ASSESSMENT OF CLIENT
- Collect subjective and objective data; client, drug and
TROUGH LEVEL - is the lowest plasma concentration of a environment
drug and measures the rate at which the drug is - Use current drug handbook/text reference/ licensed
eliminated pahrmacist
- Indicate the rate of elimination of the drug - Complete a drug history
- Perform a nursing physical assessment
- Create a medication profile

ASSESSING DRUG HISTORY OF CLIENT

- OTC meds (Example: aspirin, vitamins, dietary
supplements, NSAIDS, laxatives, dietary supplements,
antacids, mineral, elements)
- Prescription Medications (Example: birth control pills,
hormone replacements, drugs for sexual dysfunction)
- Street drugs (Example: marijuana, cocaine, PCP, LSD,
illegal narcotics ie oxycontin)
- Herbals and homeopathic substances
- Problems with drug therapy in the past (e.h. allergies,
adverse effects, disease or injuries, organ pathology)
- Growth and development issues as related to the
client’s age and specific expectations (Examples:
Erickson’s stages of development) and task for each
major group)

THE INTERVIEW PROCESS/ MED EVAL

- Establish a therapeutic relationship with client
- Use open ended questions (avoid “yes” or “no”
answers)

Questions/content of questions should include:

- Oral intake of client: how does client tolerate fluids
- swallow problems
- Laboratory/diagnostic test value e.g. renal liver panels,
hgb/hct., protein albumin levels
- Consider client’s experience with meds/health care
system, previous hospital
- Check vital signs (establich baseline)
- Lisr meds client is taking/ how taken/when
- List new meds ordered
- Use holistic framework - identify emotional, physical,
cognitive, cultural and socioeconomic factors impacting
drug therapy and nursing process
- Check drugs adverse effects and contraindications,
routes of administration, toxicity, therapeutic levels
- Drug action
- Are there any “age specific” developmental concerns
- How does the cultural origin and racial/ethnic group of
client influence the drug therapy
MEDICATION ORDERS - Right to proper storage/ documentation
- Right to accurate calculations and preparations
ORDERS MUST CONTAIN 6 ELEMENTS - Right to careful checking of transcription or orders
- Client’s name - Client safety - use of correct administration procedures
- Date and time order was written - Right to accurate routes of administration
- Name of medication (includes size, frequency and - Right to close consideration of special situations
number of doses) (Example: difficulty with swallowing, client with NG tube
- Route delivery or who is unconscious)
- Signature or prescriber - Right to having all measures taken to prevent and
report med errors if they occur
SEARCHING THE MEDICATION ORDERED - Right to individualized/ complete client teaching
- Use current text/handbook - Right to accurate documentation
REVIEW:
- Classification, mechanism of action
- Doses, routes, side effects, contraindications, drug
incompatibilities
- Interactions, precautions and nursing implications

ANALYSIS OF DATE: DEVELOPING A NURSING

DIAGNOSIS
- Base diagnosis on conclusion about risk factors, actual
client needs or problems based on knowledge base
EXAMPLE: nursing diagnosis include:
- Deficient knowledge; risk for injury; incompliance
- Diagnosis based on s/e or risk factors e.g: fatigue,
constipation, impaired tissue perfusion, sexual
dysfunction, sleep disturbance, urinary retention

PLANNING CARE: IDENTIFYING GOALS AND OUTCOME

CRITERIA

- Prioritize the nursing diagnosis

- Specify, measurable, realistic goals
- Establish a time period for achievement of outcomes
- If order is in question - do not give- call physician for
clarification/further instructions
- Document all information obtained.

IMPLEMENTATION
- Requires constant communication and collaboration
with client and health care team
- Follow the “six right”
- Right drugs
- Right dose
- Right Time
- Right route
- Right client
- Right documentation

CLIENT/PATIENT’S RIGHT WITH REGARDS TO

MEDICATION

- Right to a “double check”

 ANTI-BACTERIALS E. Adverse effects 
F. Continuous infusion regimen VS. intermittent
ANTIMICROBIALS /ANTIBACTERIAL– inhibit the growth of dosing 
or kill bacteria/ microorganisms  ANTIBIOTICS – G. Once daily dosing = less severe adverse
chemicals that are produced by 1 kind of microorganism reactions ; increase adherence
that inhibits the growth of or kills another
RESISTANCE TO ANTIBACTERIALS
- INHERENT or NATURAL – occurs without previous
exposure to the antibacterial drug  - (gram (-)
pseudomonas aeruginosa resistant to Pen G 
- ACQUIRED - caused by PRIOR exposure to antibacterial
- Responsible for causing Penicillin resistance =
PENICILLINASE 
- enzyme that metabolizes PenG = drug is ineffective
- CAUSES : 
-mutant bacteria- grown a thicker cell - wall 
transfer of genetic instruction to another bacterial
species

To beat the problem: 

- NEW ANTIBIOTICS ARE DEVELOPED. == linezolid (Zyvox)
- Methicillin-resistant staphylococcus - VRE-
vancomycin-resistant enterococci & penicillin-resistant
streptococci 
- Quiniupristin/dalfopristin (Synercid) against VRE
and treatment of bacteremia, S. aureus & strepotoccus
pyrogenes  - DEVELOPMENT OFANTIBIOTIC RESISTANT
DISABLERS  -disable antibiotic-resistant mechanism in
the bacteria 
- BACTERIAL VACCINE – against pneumococcus -
PNEUMONIA & MENINGITIS 
PHARMACOKINETICS - PREVENT ANTIBIOTIC ABUSE 
- Must only penetrate the bacterial cell wall in sufficient - COMPLIANCE and MULTI ANTIBIOTIC THERAPY
concentration; must have affinity to the binding sites . 
- TIME drug remains at the binding site = INCREASE ANTIBIOTIC COMBINATIONS:
EFFECT;  - ADDITIVE EFFECT – equal to the SUM of the effects
- Controlled by DISTRIBUTION, HALFLIFE & ELIMINATION of 2 antibiotics 
 - POTENTIATIVE EFFECT – one antibiotic potentiates
- Most are not highly CHON bound = longer HALF-LIFE the effect of the 2nd antibiotic  - ANTAGONISTIC –
greater concentration at binding sites; mostly eliminated combination of a drug that is BACTERICIDAL PENICILLIN +
from the body through URINE after the 7th half-life drug that is BACTERIOSTATIC, TETRACYCLINE = desired
effect may be reduced 
PHARMACODYNAMICS
- DRUG CONCENTRATION & AFFINITY is needed to SPECTRUM  NARROW SPECTRUM
achieve MEC necessary to halt growth of microorganism. - against one type of organism Penicillin &
- CONSTANT increase drug concentration above MEC Erythromycin FOR GRAM (+) BACTERIA 
=BACTERICIDAL EFFECT  - BROAD SPECTRUM - against both gram (+) & gram
- FREQUENCY, DOSE & DURATION of drug administration (-) Tetracyline & Cephalosporins
depends on: 
A. Severity of infection 
B. Site of infection 
C. Type of pathogen  GENERAL ADVERSE REACTIONS
D. Immunocompetence of the host  1. HYPERSENSITIVITY – rash, pruritus & hives ; severe
anaphylactic shock RESISTANT 
TX: antihistamine, epinephrine, bronchodilators - Examples:  a
2. SUPERINFECTION – secondary infection due to - mpicillin (Ampicin) amoxicillin (Amoxin) (most
disturbed normal flora; occur with use of broad spectrum prescribed for adults & children)  - bacampicillin
antibiotics (Penglobe) 
3. ORGAN TOXICITY – damage to organs that are involved - amoxicillin-clauvanate (Amoxyclav, Augmentin) 
in drugs metabolism & excretion (liver & kidneys)
aminoglycosides = OTOTOXIC & NEPHROTOXIC PENICILLINASE-RESISTANT PENICILLIN /
Antistaphylococcal penicillin 
CATEGORIES OF ANTIBACTERIALS  - Used to treat penicillinase-producing S. aureus
Penicillins  gram (+); not effective against gram (-) organisms 
Cephalosporins  - Examples: [Oral] cloxacillin (Prostaphlin-A),
Tetracyclines  dicloxacillin (Dynapen)  - [Parenteral] methicillin
Aminoglycosides  (Staphcillin), nafcillin (Vigopen) 
Macrolides and Lincosamides  - Less effective than Pen G against gram (+)
Vancomycin  organism
Chloramphenicols 
Fluoroquinolones  EXTENDED SPECTRUM PENICILLIN / Antipseudomonal
Sulfonamides  penicillin 
Peptides - Effective against Pesudomonas aeroginosa [gram
(-)] 
PENICILLIN - Not penicliinase-resistant; effective against gram
- Natural antibacterial agent from MOLD GENUS called (–) organism- == Proteus, Klebsiella pneumoniae,
PENICILLIUM NOTATUM ( 1928, Alexander Fleming)  Enterobacter 
- Moldy bread used on wounds to treat infection (3500 - Less toxic than aminoglycosides 
yrs. Ago)  Referred to as Beta-Lactam – inactivated by - Examples:  Piperacillin, ticarcillin disodium 
Penicillinase 
- Both Bactericidal ( kills bacterial) and Bacteriostatic BETA-LACTAMASE INHIBITORS 
(inhibits growth of bacteria) - Penicillinase sensitive penicillin + Beta-Lactamase
- Interferes with the bacterial cell wall synthesis by inhibitors 
inhibiting bacterial enzyme ; do not disrupt existing - Examples:  [O] amoxicillin (BSP) + clavulanic acid
bacterial cell wall, but only newly forming and actively ==Augmentin, Amoxyclav 
growing cell wall  - [P] ampicillin (BSP) + sulbactam == Unasyn 
- PENICILLIN G – primarily bactericidal; DOC for - [P} piperacillin (ESP) + tazobactam == Tazocin
treating many infections caused by penicillin-sensitive
organisms PHARMACODYNAMICS
> first penicillin administered ORALLY and by - MODE of ACTION : 
Injection (ORAL –only 1/3 of the dose is absorbed; IM/IV - BACTERICIDAL – interfere with the ability of
—more effective in achieving a therapeutic serum per susceptible bacteria to build their cell walls – weaken the
level  walls == SWELL then BURST from osmotic pressure 
- PROCAINE PENICILLIN G (Wycillin)- extends the - ONSET : 0.5 HR 
drug’s action; has milky color; less painful during injection - PEAK : 1-2 HR 
 - DURATION : 6-8 HR
- AQUEOUS PEN G – short duration of action; IM - [A] rapidly in the GIT---- peak level in 1 hr; sensitive to
route is very painful (IM or IV)  gastric acid levels in the stomach 
- PENICILLIN V – preferred for ORAL adminstered.- - taken on empty stomach == ensure adequate
2/3 absorbed in GIT, but is less POTENT; effective against absorption 
mild-mod Infection, including ANTHRAX. - [ + 1 glass of water, 1 hr ac or 2-3 hrs pc]
- [E] unchanged in the URINE; enter in breastmilk – can
BROAD SPECTRUM PENICILLINS / AMINOPENICILLIN  - cause DIARRHEA & ADVERSE Reactionbaby
Used to treat both gram (+) and gram (-) bacteria (E. Coli,
H. Influenzae, Shigella dysenteriae, Proteus mirabilis,
Salmonella) - Costlier than penicillin; not PENICILLINASE
CONTRAINDICATIONS: 
Allergies to penicillins, cephalosporins, other
allergens 
CAUTION : 
- With RENAL disease (lower doses necessary b’coz
excretion is reduced)  - Pregnant & lactating women –
diarrhea & superinfections in infant

ADVERSE EFFECTS: 
- MAJOR = involve in GIT = N,V,D {mgt: SFF}  -
glossitis, stomatitis, soremouth, furry tongue[mgt: ice
chips, sugarless candy} rt loss of bacteria from normal
flora = superinfection (may lead to yeast infections)  -
HYPERSENSITIVITY RXN = rash, fever, wheezing
(anaphylactic shock and death) 
- PAIN & INFLAMMATION at injection site /Phlebitis
{mgt: administer slowly, remove IV line, warm compress,
gentle massage}

DRUG-LAB-FOOD INTERACTIONS: 
- DRUG : Increase effect with ASPIRIN, PROBENECID;
Decrease effect with Tetracyclines, erythromycin –
antagonistic {should be avoided or increase dosage of
Penicillin, but increase AE}; if taken with contraceptive
pills – OCP less effective  - LAB : elevate AST, ALT 
- FOOD : decreased effect with acidic or juice

NURSING CONSIDERATIONS
Monitor for superinfections
Evaluate renal [BUN & creatinine] & liver [AST,ALT]
functions
Diarrhea r/t superinfections {mgt: take yogurt, more
fluids}
Inform physician before taking other meds Cultures- prior
to 1st dose
Alcohol is OUT!/ ask about allergies
Take full course of meds CEPHALOSPORINS
Evaluate cultures, WBC, C&S
- Group of antibiotics chemically and pharmacologically
related to the penicillin.
- First introduced in 1960s; FUNGUS (cephalosporium
acremonium) discovered in seawater (1948) 
- Effective against gram + and gram – bacteria - Resistant
to beta-lactamase 
- 1960 – cephalosporins used with clinical effectiveness 
- BACTERICIDAL OR BACTERIOSTATIC depending upon: 
- Susceptibility of the organism being treated 
- Dose used 
- Tissue concentration of the drug 
- Rate at which bacteria are multiplying

PHARMACOKINETICS PHARMACODYNAMICS:

[A]:PO well absorbed

[D] :PB 75-85%
[M]:SHL – t ½ = 1.5 -2.5 hr
[E]:unchanged in urine 60%-80%

{IM} {PO} {
ONSET : rapid rapid immediate SIDE EFFECTS:
PEAK : 0.5-2 hrs 0.5-1 hr 5-15’ - ORAL - GI: Flatulence, NAVDA (bloody stool- {stop} /
DURATION: ----UNKNOWN --- {best administered with food or milk – increase
absorption} 
- BEST to be taken on an empty stomach 
- IF with gastric irritation – take with food 
- Fever, rash, pruritus, headaches, vertigo (CNS
symptoms) =HYPERSENSITIVITY RXN {STOP}
- IV/ IM - prolonged /high doses = PHLEBITIS or
THROMBOPHLEBITIS {mgt: use small gauge needle, large
veins, alternate infusion sites}

ADVERSE REACTIONS: 
NEPHROTOXICITY- RENAL FAILURE  SUPERINFECTIONS 
ANAPHYLAXIS

With aminoglycosides/vancomycin === INCREASED

NEPHROTOXICITY 
With anticoagulant or thrombolytics/NSAIDS – increased
RISK of bleeding {monitor blood loss}

EDUCATION: 
- Administer on an empty stomach 
- Refrigerate ORAL suspension 
- False urine test for GLUCOSE with use of clinitest tab or
Benedict’s solution, therefore use blood to check for
glucose level.

TETRACYCLINES
 - TERATOGENIC EFFECT –not taken 1st trimester – PC : D
- Isolated from STREPTOMYCES AUREOFACIENS in 1948. 
- 1 st broad spectrum antibiotics effective against gram - Discolors teeth (irreversible) == not taken last trimester
(+) bacteria & many organisms [mycobacterium, & children < 8yrs 
rickettsiae, spirochetes, chlamydiae]  - Balance difficulty – damage to vestibular part of the
- Not effective against S. aureus, Pseudomonas or inner ear (minocycline) {safety}
Proteus  - NEPHROTOXICITY – if given in high doses 
- Can be used against Mycoplasma pneumoniae. - SUPERINFECTION –disrupt microbial flora {oral hygiene}
- + Metronidazole and bismuth subsalicylate == useful in
treating Helicobacter pylori (peptic Ulcer)  EDUCATION
- ORAL and TOPICAL tetracycline – used to treat severe S unlight sensitivity [decomposes in light/heat = TOXIC-
acne vulgaris store out of light & extreme heat]
T ake full glass of H20 
MOA  O antacid, IRON & MILK
INHIBIT BACTERIAL P[ROTEIN SYNTHESIS {Bacteriostatic} P ut drug into empty stomach
continuous use of tetra – resulted in bacterial resistance;
increased resistance in the treatment of pneumococci & DRUG INTERACTIONS
gonococci infections - ANTACIDS, IRON containing drugs, MILK – prevent
absorption of Tetra {take 2 hrs apart}
CLASSIFICATIONS - ORAL CONTRACEPTIVES – lessened effect of OCP 
SHORT ACTING  - PENICILLIN – decreased activity of Penicillin 
- tetracycline {Tetracyn, Panmycin} >gram (+), gram - AMINOGLYCOSIDES – increased risk Nephrotoxicity
(-), RT, skin disorders, chlamydial, gonnorhea, syphilis,
ricketssial [t ½ = 6-12 hrs]  AMINOGLYCOSIDES
- oxytetracycline Hcl {terramycin} > UTI - ACT by inhibiting bacterial protein synthesis
INTERMEDIATE  (Bactericidal) 
- demeclocycline HCl (Declomycin) > broad spectrum - Used against serious infections caused by gram (-)
[t ½ = 10-17 hrs] bacteria [E. coli, Proteus, Pseudomonas & Serratia] 
LONG-ACTING (to be taken with food)  doxycycline - Cannot be absorbed in the GIT, cannot cross CSF (in
hyclate (Vibramycin) > bacterial infection & acne  adults only) 
minocycline HCl (Minocin) [t ½ = 11-20 hrs] - Primarily administered IV 
- DOC : Tularemia & Bubonic Plague 
1 st aminoglycosides === STREPTOMYCIN SULFATE –
- frequently prescribed for ORAL use, available also for IM used in treatment f TB; derived from bacterium
[cause pain on injection & tissue irritation]; IV route – Streptomyces griseus in 1944, administered IV
treat severe infections 
- newer ORAL : DOXYCYCLINE, MINOCYCLINE, ORAL PREPARATIONS:
METHACYCLINE : rapidly & complete absorbed  - not to given to decrease bacteria in the bowel
be taken with MAGNESIUM and ALUMINUM preparation 1)paromomycin -useful in treating intestinal
(antacids), MILKPRODUCTS containing calcium or Iron- amebiasis & tapeworm
containing drugs == prevent absorption of the drug  2)neomycin - used as preoperative bowel
- TAKEN on EMPTY STOMACH – 1 hr ac or 2 hrs pc (except antiseptic
doxycycline & minocycline) Others: (treat pseudomonas) 
- Gentamycin (1963)[IM/IV]> against gram (-) esp.
pseudomonas 
- Kanamycin [PO/IM/IV] > for hepatic coma 
- Tobramycin (1970) [IM/IV] > kill Pseudomonas 
- Amikacin (1970) [IM/IV] > effective against Pseudo
SIDE EFFECTS and ADVERSE REACTIONS esp. if resistant to gentamicin & tobramycin 
- Netilmicin (1980) [IM/IV] > less toxic compared to
- GI- NVD {mgt: SFF, ice chips, replace fluids} - other aminoglycosides
PHOTOSENSITIVITY – sunburn reaction {sunblock,
clothing}  PHARMACOKINETICS
 - Recommend using sunblock & protective clothing when
Gentamycin Netilmicin(latest) exposed to the sun.
PC : C (can’t rule out) PC :D (+ risk)
“THE AMINO MICE” ( toxic mice!!!!! )
[A} : IM,IV “ONE CAN’T HEAR” – OTOTOXICITY
[M] : T ½ short (SHL)-3-4X a day, PB – low “ONE CAN’T PEE..” – NEPHROTOXICITY
[E] : unchanged in URINE “ONE CAN’T FEEL” - NEUROTOXICITY
Gentamycin Netilmicin
(latest) DRUG COMPUTATION
ONSET IM/IV: RAPID IM: RAPID - Captopril 100 mg daily is prescribed. Captopril 25 mg
IV: IMMEDIATE tablets are on hand.How many tablets will you give? 
PEAK 1-2hrs 0.5-1.5hrs
- The doctor ordered paracetamol 250mg. If the label on
DURATION 6-8hr unknown the multidose vial of paracetamol reads 50mg/cc, how
much paracetamol in cc will you give? 

AMINOGLYCOSIDES - Clindamycin 1g is prescribed. Clindamycin liquid is

SIDE EFFECTS :  labeled 200mg per 5 mL. How much in mL will you give?
GI- NAV; rash, numbness, tremors, visual
disturbances, tinnitus, muscle cramps or weakness, MACROLIDE
photosensitivity 
- Macrolides, Vancomycin, Lincosamides, Ketolides }
ADVERSE REACTIONS:  similar spectrum although differ in structure 
URTICARIA,PALPITATIONS  - Mild to moderate infections of the RT(sinuses, GIT, skin,
Thrombocytopenia  soft tissues; diphtheriae, impetigo, STD
Superinfections- agranulocytosis 
Liver damage ERYTHROMYCIN (1950s) (Erythrocin, Erymax) 
- derived from Streptomyces erytheus 
Most serious:  - most commonly prescribed if with allergy to PCN 
OTOXICITY – 8 th cranial nerve damage {safety}  - effective against gram (+) and some gram (-) except S.
NEPHROTOXICITY – oliguria {slowly administered} aureus
NEUROTOXICITY- neuromuscular blockade, - DRUG OF CHOICE: Mycoplasma P., Leggionaire’s disease
numbness  
- Prevention of Rheumatic Fever 
INTERACTIONS :  - PC: B (no risk evident) 
Penicillin – less effective aminoglycoside  - MOA: inhibits CHON synthesis, BACTERIOSTATIC (low
Anticoagulant (Warfarin)– increased its activity dose)/BACTERICIDAL (high dose) 
- CI: Hepatic disease, Lactation

NURSING INTERVENTIONS
PHARMACOKINETICS
- Monitor periodical audiograms, BUN/creatinine & - PO form is well-absorbed in the duodenum; ACID
vestibule function studies over 10 days therapy  resistant salts (ETHYLSUCCINATE STEARATE, ESTOLATE)
- Adjust renal insufficiency  are added to decrease dissolution, increase absorption in
- Monitor VS, peak and serum levels  the intestines; FOOD does not hamper absorption of
- For IV admin., dilute and administer slowly to prevent ACID resistant macrolides. 
toxicity  - NO IM, IV –give slowly to prevent PHLEBITIS
- Monitor I & O, hydrate well before and during therapy - PB : 65% 
(flush in between)  - t ½ : PO (1-2 hr), IV (35 hr) 
- If anorexia or nausea occurs, SFF meals  - Establish plan - Excreted : through the BILE, FECES & small amount
for safely if vestibular nerve effects occur.  through the urine.
- Administer other antibiotics 1 hour before/after amino
 PHARMACODYNAMICS
PO  - A : PO x 5 days 
Onset : 1 hr  - D : t ½ : 20-50 hrs 
Peak : 4 hrs  - M: PB = uk 
Duration : 6 hrs - E : bile, feces 
- Side Effects: NAVDA is common, TAKE with FOOD,
SIDE EFFECTS : NAVDA, PRURITUS, RASH, TINNITUS or within 1 hr of eating
ADVERSE EFFECTS : Superinfections, Urticaria, Hearing
loss,  NURSING CARE
- Hepatotoxicity [“yellow sclera”],  - Do not refrigerate suspension form of Klarithromycin 
- anaphylaxis - Monitor liver enymes – signs & symptoms of
hepatotoxicity 
DRUG INTERACTIONS: - Administer IV slowly 
- Acetaminophen, Phenothiazine, Sulfonamide ----- ↑ - Give IM into deep muscle  Avoid fruit juices 
HEPATOTOXICITY (reversible)  - Manage NAVDA 
- ↑ Effect of DIGOXIN, CARBAMAZEPINE, THEOPHYLLINE, - Check for superinfections. Give YOGURT/BUTTERMILK
CYCLOSPORINE, WARFARIN, TRIAZOLAM  - Check drug interactions. 
- ↓Effect of PCN, CLINDAMYCIN  - Evaluate effectiveness: WBC level , temperature,
- ↓ absorption if taken with ANTACIDS  cultures
- Erythromycin + Verapami, Diltiazem, Clarithromycin,
Fluconazole = elevate Erythro concentration = cardiac THE MACROLIDE GIRL
death G- GI disturbances ( undesirable effects)
I- IV site ( check irritation)
EXTENDED MACROLIDE GROUP R- reduces activity of med if given with acids (fruit juices)
1. azithromycin (ZITHROMAX)  or food
- Indications: mild-moderate streptomycin infection, L- liver function test
RTI, gonorrhea, chancroid {STD}, H. influenzae, Strep. , S.
aureus  LINCOSAMIDES
- PC :C (can’t be ruled out)  Similar to macrolides but more toxic
- A : PO – once a day x 5 days – incompletely Change CHON function & prevent cell division or cause
absorbed in the GIT  cell death (both)
- D : t ½ : 40-50 hrs; only 37% reaches in the systemic
circulation  1. CLINDAMYCIN [Cleocin] 
- E : bile, feces & urine (less)  - widely prescribed against most gram (+) organism;
- Side Effects:  NAVDA is uncommon, give AC./ 1 hr absorbed better, more effective, fewer toxic 
ac or 2 hr pc + 1 glass of water not FRUIT JUICE  - for severe infections caused by same strains of
- IV PREP – must be diluted in NSS or D5W – to bacteria that are susceptible to macrolides 
prevent phlebitis [A] rapidly absorbed from GIT or from IM injections
[D] t ½ = 2-3 hrs – PB: 94%; crosses the placenta &
2. Clarithromycin (KLARICID)  enters breastmilk 
- Indications: RTI, gram (-) & (+), tissue infections, H. PC : B; only if benefit clearly outweighs risk 
pylori  [M] liver – caution – HEPATIC & RENAL impairment 
- PC : C  [E] urine & feces 
- A: PO  SIDE EFFECTS = GI reaction- pseudomembranous
- D: t ½ : 3-6 hrs ==== 2 x a day  colitis; GI irritation
- M : PB = 65-75% 
- E: bile  2. LINCOMYCIN (Lincocin) 
- Side Effects: NAVDA is common, TAKE with -to treat severe infections when penicillin cannot be
MILK/MEAL given 
[A] rapidly absorb in GIT or from IM injections 
3. dirithromycin (DYNABAC)  [D] t ½ = 5 hrs 
- Indications: CHRONIC BRONCHITIS, URTI, CAP, Skin [M] liver – caution – hepatic & renal impairment
Infections, H. pylori, Legionnaire’s disease, Chlamydia  [E] urine & feces  TOXIC EFFECTS : GI reaction, Pain,
- PC : C  Skin infection, BM depression
NSG CARE: SAME WITH MACROLIDES –  - Check baseline hearing. Refer to EENT. Report ringing in
CAREFUL MONITORING  ears or hearing loss, fever and sorethroat. 
GI activity & fluid balance  - Monitor blood pressure during administration 
STOP if with bloody diarrhea - Monitor renal function tests- Creatinine, BUN and urine
output ;and Liver enzymes 
- Yogurt for superinfection. 
VANCOMYCIN HCl (Vancocin) - Check for pregnancy & lactation
- ALMOST abandoned = nephrotoxicity & ototoxicity
(damage auditory or vestibular [CN 8])  Rudolf the Red – Neck reindeer
- glycopeptide bactericidal antibiotic (1950s); against Rudolf the red – neck reindeer
staphylococcal infxns  Had an adverse side effect
- used against drug-resistant S. aureus and in cardiac From the Drug Vancomycin
surgical prophylaxis with PEN allergies; potentially life- Must keep all labs in check
threatening infections not responding to other less toxic Caution with renal failure,
antibiotics. Hearing Loss and allergies,
Take a temp and blood cultures,
MODE OF ACTION: BACTERICIDAL  ‘Specially a CBC!!!
- inhibits bacterial cell wall synthesis
FLUOROQUINOLONES
Pharmacokinetics: - MODE OF ACTION: interfere with the enzyme DNA
- ORAL – not absorbed systemically, excreted in the gyrase (needed to synthesize bacterial DNA) = Broad
feces spectrum bactericidal
- IV – for sever infections due to MRSA, septicemia,
bone, skin and lower respiratory tract infections that are I. NALIDIXIC ACID (Negram) / CINOXACIN (Cinobac) 
resistant to other antibiotics - Prescribed primarily for UTI by gram (-) E.coli, LRTI,
- excreted in the urine skin, soft tissue, bone & joint infxns
PB: 30% Half-life : 6 hours II. CIPROFLOXACIN (Cipro) / NORFLOXACIN (Noroxin) 
- Broad spectrum including P. aeruginosa
DRUG INTERACTIONS: III. LEVOFLAXACIN (Levaquin)/SPARFLOXACIN (Zagam)/
- Drug-drug  TROVAFLOXACIN (Trovan) = new 
- = if with amphotericin B, polymycin, furosemide, - Treat respiratory problems CAP, chronic bronchitis,
cisplatin - ↑ NEPHROTOXICITY  acute sinusitis, UTI & skin infections. 
- = if with methotrexate - ↑ methotrexate toxicity - Absorbed from GIT, low PB, moderately short half-
life, 75% excreted in the urine
SIDE EFFECTS AND ADVERSE REACTIONS IV. GATIFLOXACIN (Tequin)/ MOXIFLOXACIN (Avelox) =
- chills, dizziness, fever, rashes, nausea, vomiting, 1999
thrombophlebitis @ injection site - OD dosing more active than Levofloxacin against
S. pneumoniae
DOSE RELATED TOXICITY: 
- tinnitus, high tone deafness, hearing loss &
nephrotoxicity. RAPID IV INFUSION:  SIDE EFFECTS
- “RED-NECK or RED MAN SYNDROME” resulting in - photosensitivity - use sunglasses, sunblock, protective
Histamine release & chills, fever, tachycardia,  clothing 
- profound fall in BP, pruritus or red nose/ neck/ - Dizziness, N/V, diarrhea, flatulence, abdominal cramps,
arms/ back. tinnutis, rash

NURSING MANAGEMENT
NURSING CARE Assess RENAL function : I/O, BUN, Creatinine 
- Refrigerate IV solution after reconstruction, use within Drug & diet history : 
96 hrs.  - Avoid caffeine 
- Flush IV line in between antibacterials. Evaluate IV site - Antacids & Iron prep = decreases absorption of
for phlebitis, avoid extravasation.  Fluoroquinolones 
- Ensure safety  - Monitor serum theophylline & blood glucose levels-
with Theo, caffeine, Oral hypoglycemics = INCREASE their
effects 
- With NSAIDS = CNS reactions = seizure  =
- Administer 2 hrs ac or after antacids 
- With IRON preparation = give with full glass of water 
- IV – infuse over 30 mins, dilute with approximate
amount 
- Check S/S of SUPERINFECTIONS (stomatitis, furry
black tongue, genital discharge, itching) 
- Check symptoms of CNS stimulation = nervousness,
insomnia, anxiety & tachycardia >>> avoid hazardous
machinery