Mater Dei College

College of Nursing
Tubigon, Bohol

Pharmacology (Lab.)
Activity 02

PHARMACODYNAMICS

Name of Student: _John Allan T. Pasana______________________________ Course/Year: BSN-2 Score: _______/ 60 pts.
Instructor: Jennifer J. Valero, MAN-RN Date: September 04, 2021

1. Research and discuss the pharmacodynamics of the following Controlled substances in a tabular form using this format.
Please indicate your source/s.

Drug Name Trade Classification Indication Mechanism of Nursing

Name/s Schedule Action Responsibility

Valium IV Benzodiazepi In general, Diazepam is a Assessment

1. diazepam ne with diazepam is benzodiazepine  History:
anticonvulsa useful in the tranquilliser with Hypersensitivity
nt, anxiolytic, symptomati anticonvulsant, to
sedative, c sedative, muscle benzodiazepine
muscle manageme relaxant and s; psychoses,
relaxant, and nt of mild to amnesic acute narrow-
amnesic moderate properties. angle glaucoma,
properties degrees of Benzodiazepines, shock, coma,
anxiety in such as diazepam, acute alcoholic
conditions bind to receptors in intoxication;
dominated various regions of elderly or
by tension, the brain and debilitated
excitation, spinal cord. This patients;
agitation, binding increases impaired liver or
fear, or the inhibitory renal function;
aggressiven effects of gamma- pregnancy,
ess such as aminobutyric acid lactation
may occur (GABA). GABAs  Physical:
in functions include Weight; skin
psychoneur CNS involvement color, lesions;
osis, in sleep induction. orientation,
anxiety Also involved in the affect, reflexes,
reactions control of hypnosis, sensory nerve
due to memory, anxiety, function,
stress epilepsy and ophthalmologic
conditions, neuronal examination; P,
and anxiety excitability. BP; R,
states with adventitious
somatic sounds; bowel
expression. sounds, normal
Moreover, output, liver
in acute evaluation;
alcoholic normal output;
withdrawal, LFTs, renal
diazepam function tests,
may be CBC
useful in the Intervention:
symptomati  WARNING: Do
c relief of not administer
acute intra-arterially;
agitation, may produce
tremor, and arteriospasm,
impending gangrene.
acute  Change from IV
delirium therapy to oral
tremens. therapy as soon
Furthermor as possible.
e, diazepam  Do not use
is a useful small veins
adjunct for (dorsum of hand
the relief of or wrist) for IV
skeletal injection.
muscle  Reduce dose of
spasm due opioid
to reflex analgesics with
spasm to IV diazepam;
local dose should be
pathologies, reduced by at
such as least one-third
inflammatio or eliminated.
n of the  Carefully
muscle and monitor P, BP,
joints or respiration
secondary during IV
to trauma; administration.
spasticity  WARNING:
caused by Maintain
upper motor patients
neuron receiving
disorders, parenteral
such as benzodiazepine
cerebral s in bed for 3 hr;
palsy and do not permit
paraplegia; ambulatory
athetosis patients to
and the rare operate a
"stiff man vehicle following
syndrome". an injection.
 Monitor EEG in
patients treated
for status
epilepticus;
seizures may
recur after initial
control,
presumably
because of
 short duration of
drug effect.
 Monitor liver
and renal
function, CBC
during long-term
therapy.
 Taper dosage
gradually after
long-term
therapy,
especially in
epileptic
patients.
 Arrange for
epileptic
patients to wear
medical alert ID
indicating that
they are
epileptics taking
this medication.
 Discuss risk of
fetal
abnormalities
with patients
desiring to
become
pregnant.

Teaching Points
 Take this drug
exactly as
prescribed. Do
not stop taking
this drug (long-
 term therapy,
antiepileptic
therapy) without
consulting your
health care
provider.
 Caregiver
should learn to
assess
seizures,
administer rectal
form, and
monitor patient.
 Use of barrier
contraceptives
is advised while
using this drug;
if you become
or wish to
become
pregnant,
consult with
your health care
provider.
 It is advisable to
wear a medical
alert ID
indicating your
diagnosis and
treatment (as
antiepileptic).
 You may
experience
these side
effects:
Drowsiness,
 dizziness (may
lessen; avoid
driving or
engaging in
other dangerous
activities); GI
upset (take drug
with food);
dreams,
difficulty
concentrating,
fatigue,
nervousness,
crying
(reversible).
 Report severe
dizziness,
weakness,
drowsiness that
persists, rash or
skin lesions,
palpitations,
swelling of the
ankles, visual or
hearing
disturbances,
difficulty voiding.

Roxicodone II Narcotic Oxycodone The full mechanism Assessment

2. oxycodone Analgesic is indicated of oxycodone is not
for the known. Under  Assess
treatment of conditions of symptoms of
moderate to inflammation or
severe pain. hyperalgesia, respiratory
There is opioid receptors in depression,
also an the heart, lungs,
including
extended liver, decreased
release gastrointestinal
formulation tract, and respiratory rate,
indicated for reproductive confusion,
chronic system are
moderate to upregulated and bluish color of
severe pain transported to the skin and
requiring nerve terminals.
mucous
continuous Oxycodone and its
opioid active metabolites, membranes
analgesics noroxycodone, (cyanosis), and
for an oxymorphone, and
extended noroxymorphone difficult, labored
period. are opioid breathing
agonists. These
compounds (dyspnea).
passively diffuse Monitor pulse
across the blood
oximetry and
brain barrier or
may be actively perform
transported across pulmonary
by an unknown
mechanism. Oxyco function tests to
done and its active quantify
metabolites can
selectively bind to suspected
the mu opioid changes in
receptor, but also
ventilation and
the kappa and
delta opioid respiratory
receptors in the function.
central nervous
system and Excessive
periphery, and respiratory
induce a G protein
coupled receptor depression
signalling requires
pathway. Activation
of mu opioid emergency
receptors inhibits care.
N-type voltage
operated calcium
channels, inhibiting  Be alert for
responses to pain. excessive
sedation or
changes in
mood and
behavior
(euphoria,
dysphoria,
confusion,
hallucinations).
Notify physician
or nurse
immediately if
patient is
unconscious or
extremely
difficult to
arouse.

 Use appropriate
pain scales
(visual analogue
 scales, others)
to document
whether this
drug is
successful in
helping manage
the patient's
pain.

 Assess blood
pressure (BP)
when patient
assumes a
more upright
position (lying to
standing, sitting
to standing,
lying to sitting).
Document
orthostatic
hypotension and
contact
physician when
systolic BP falls
>20 mm Hg, or
diastolic BP falls
 >10 mm Hg.

 Assess
dizziness that
might affect gait,
balance, and
other functional
activities
.Report balance
problems and
functional
limitations to the
physician and
nursing staff,
and caution the
patient and
family/caregiver
s to guard
against falls and
trauma.

Interventions

 Implement
appropriate
manual therapy
 techniques,
physical agents,
and therapeutic
exercises to
reduce pain and
help wean
patient off opioid
analgesics as
soon as
possible.

 Because of the
risk of
respiratory
depression and
orthostatic
hypotension,
use caution
during aerobic
exercise and
other forms of
therapeutic
exercise.
Assess exercise
tolerance
frequently (BP,
 heart rate,
respiratory rate,
fatigue levels),
and terminate
exercise
immediately if
any untoward
responses
occur.

 Help patient
explore other
nonpharmacolo
gic methods to
reduce chronic
pain, such as
relaxation
techniques,
exercise,
counseling, and
so forth.

 Guard against
falls and trauma
(hip fractures,
head injury).
 Implement fall-
prevention
strategies,
especially if
patient exhibits
sedation,
dizziness, or
blurred vision.

 To minimize
orthostatic
hypotension,
patient should
move slowly
when assuming
a more upright
position.

Patient/Client
Instruction

 Advise patient
that opioid
analgesics are
usually more
effective if given
 before pain
becomes
severe;
emphasize that
adequate pain
control.

Ultram IV Narcotic Tramadol is Tramadol is a Assessment & Drug

3. tramadol Analgesic approved centrally acting μ- Effects
for the opioid receptor  Assess for
manageme agonist and SNRI level of
nt of (serotonin/norepine pain relief
moderate to phrine reuptake- and
severe pain inhibitor) that is administer
in adults. structurally related prn dose as
Tramadol is to codeine and mor needed but
also used phine. Tramadol not to
off-label in binds weakly to κ- exceed the
the and δ-opioid recommend
treatment of receptors and to ed total
premature the μ-opioid daily dose.
ejaculation receptor with 6000-  Monitor
fold less affinity vital signs
than morphine. and assess
Tramadol exists as for
a racemic mixture orthostatic
consisting of two hypotensio
pharmacologically n or signs
active enantiomers of CNS
that both contribute depression.
to its analgesic  Discontinue
property through drug and
different notify
mechanisms: (+)- physician if
tramadol and its S&S of
primary metabolite hypersensit
(+)-O-desmethyl- ivity occur.
tramadol (M1) are  Assess
agonists of the μ bowel and
opioid receptor bladder
while (+)-tramadol function;
inhibits serotonin report
reuptake and (-)- urinary
tramadol inhibits frequency
norepinephrine or
reuptake. These retention.
pathways are  Use seizure
complementary precautions
and synergistic, for patients
improving who have a
tramadol's ability to history of
modulate the seizures or
perception of and who are
response to pain. concurrentl
y using
drugs that
lower the
seizure
threshold.
 Monitor
ambulation
and take
appropriate
safety
precautions
.
Interventions
 Implement
appropriate
 manual therapy
techniques,
physical agents,
and therapeutic
exercises to
reduce pain and
help wean
patient off
centrally acting
analgesics as
soon as
possible.

 Help patient
explore other
nonpharmacolo
gic methods to
reduce chronic
pain, such as
relaxation
techniques,
exercise,
counseling, and
so forth.

 Guard against
 falls and trauma
(hip fractures,
head injury).
Implement fall-
prevention
strategies,
especially if
patient exhibits
sedation,
dizziness, or
blurred vision.

Patient & Family

Education
 Exercise
caution with
potentially
hazardous
activities
until
response to
drug is
known.
 Understand
potential
adverse
effects and
report
problems
with bowel
and bladder
 function,
CNS
impairment,
and any
other
bothersome
adverse
effects to
physician.
 Do not
breast feed
while taking
this drug.

Abstral II Narcotic Fentanyl Fentanyl binds to Assessment

4. fentanyl Analgesic intravenous opioid receptors,  Repeated
or especially the mu intraoperative
intramuscul opioid receptor, doses can
ar injections which are coupled cause
are to G- respiratory
indicated for proteins. Activation depression to
short term of opioid receptors persist into the
analgesia causes GTP to be postoperative
during exchanged for period.
induction, GDP on the G-  Fentanyl
maintenanc proteins which in interferes with
e, and turn down respiratory
recovery regulates function and
from adenylate cyclase, pupil reaction,
general or reducing both of which
regional concentrations of are essential
anesthesia.  cAMP. Reduced parts of
These cAMP decreases neurological
injections cAMP dependant assessment.
are also influx of calcium  Assess the
used with a ions into the
neuroleptic cell. The exchange therapeutic
for of GTP for GDP response and in
premedicati results in breakthrough
on, hyperpolarization cancer pain
induction, of the cell and consider
and as an inhibition of nerve adjustment of
adjunct to activity. background
maintenanc analgesia where
e of this is
anesthesia.  appropriate.
Finally,  Excessive heat
fentanyl may increase
intravenous absorption from
or patches so local
intramuscul heat should not
ar injections be applied and
are used patients with
with oxygen fever should be
for carefully
anesthesia monitored.
in high risk
patients.
Fentanyl Patient Teaching
sublingual
tablets,
transmucos  Medication
al lozenges, should be kept
buccal out of reach of
tablets, children and in
sublingual its original
sprays, packaging.
transdermal  Avoid activities
systems, that require
and nasal alertness if
sprays are patient is
indicated for affected by
 the drowsiness.
manageme  Lozenges
nt of should be
breakthroug removed from
h pain in foil just before
opioid administration
tolerant and sucked over
cancer a 15-minute
patients period, not
who require chewed.
around the  Patches should
clock pain be applied to
manageme dry, intact skin,
nt. non-irradiated
non-hairy skin
on the torso or
upper arm.
Replacement
patches should
be sited on a
different area.

Xanax IV Benzodiazepi Alprazolam Alprazolam (Xanax Assessment and

5. alprazolam ne is indicated XR, Niravam), is an Examination
for the anti-anxiety
acute medication in the  Monitor daytime
treatment of benzodiazepine drowsiness and
generalized drug family, the
anxiety same family that “hangover”
disorder in includes diazepam symptoms
adults. Alpr (Valium),
(headache,
azolam is clonazepam nausea,
also (Klonopin),
indicated, lorazepam (Ativan), irritability,
either as a flurazepam lethargy,
standard or (Dalmane), and
extended- others. Alprazolam dysphoria).
release and other Repeated or
formulation, benzodiazepines
excessive
for the act by enhancing
treatment of the effects of symptoms may
panic gamma- require change
disorder aminobutyric acid
with or (GABA) in the in dose or
without brain. GABA is a medication.
agoraphobi neurotransmitter (a
a in adults. chemical that nerve  Assess
Alprazolam cells use to dizziness that
may also be communicate with
might affect gait,
prescribed each other) that
off-label for inhibits activity in balance, and
insomnia, the brain. It is other functional
premenstru believed that
al excessive activity activities.
syndrome, in the brain may Report balance
and cause anxiety or
depression. other psychiatric problems and
disorders. functional
limitations to the
physician, and
caution the
patient and
family/caregiver
s to guard
 against falls and
trauma.
 Report any
behavioral or
personality
changes such
as confusion,
decreased
mental acuity, or
excessive
excitation.

Interventions

 Guard against
falls and trauma
(hip fractures,
head injury, and
so forth).
Implement fall-
prevention
strategies,
especially in
older adults or if
drowsiness and
dizziness carry
over into the
 daytime.
 Help patient
explore
nonpharmacolo
gic methods to
reduce anxiety
and depression,
such as
relaxation
techniques,
exercise,
counseling,
support groups,
and so forth.

Patient/Client-Related
Instruction

 Instruct patients
on prolonged
treatment to not
discontinue
medication
without
consulting their
physician.
Abrupt
 withdrawal can
cause insomnia,
unusual
irritability or
nervousness,
and seizures.
 Advise patient
or
family/caregiver
s about the
potential risk of
tolerance and
physical/psychol
ogic
dependence.
Emphasize that
addiction is
more likely
during
prolonged,
excessive, or
inappropriate
use of this drug.
 Advise patient
to avoid alcohol
 and other CNS
depressants
because of the
increased risk of
sedation and
adverse effects.
 Instruct patient
to report other
bothersome
side effects
such as severe
or prolonged
headache,
blurred vision,
rash, weight
gain, or GI
problems
(nausea,
vomiting,
diarrhea,
constipation).

Ativan IV Benzodiazepi Lorazepam Lorazepam Assessment

ne, is FDA- allosterically
6. lorazepam Anticonvulsa  History: Hy
approved binds on the persensitivit
nts, for the benzodiazepine
Antianxiety y to
short-term receptors in the benzodiaze
 Agent, relief of post-synaptic pines,
Anxiolytic anxiety GABA-A ligand- propylene
symptoms gated chloride glycol,
related to channel in polyethylen
e glycol or
anxiety different sites of
benzyl
disorders the central alcohol;
and nervous system psychoses;
anxiety (CNS). This acute
associated binding will result narrow-
with in an increase on angle
depressive the GABA glaucoma;
symptoms inhibitory effects shock;
such as which is coma;
anxiety- translated as an acute
associated increase in the alcoholic
intoxication
insomnia. flow of chloride
with
It is as well ions into the cell depression
used as an causing of vital
anesthesia hyperpolarization signs;
premedicat and stabilization pregnancy;
ion in of the cellular lactation;
adults to plasma impaired
relieve membrane. liver or
anxiety or According to the renal
to produce binding site of function,
sedation/a lorazepam, we debilitation
 Physical: S
mnesia can observe
kin color,
and for the different activities lesions; T;
treatment as the binding in orientation,
of status the amygdala is reflexes,
epilepticus. known to help affect,
Some off- mainly in anxiety ophthalmol
label disorders while ogic
indications the binding in the examinatio
of cerebral cortex n; P, BP; R,
lorazepam helps in seizure adventitiou
include disorders. s sounds;
liver
rapid
evaluation,
tranquilizat abdominal
ion of an examinatio
agitated n, bowel
patient, sounds,
alcohol normal
withdrawal output;
delirium, CBC, LFTs,
alcohol renal
withdrawal function
syndrome, tests

muscle
Interventions
spasms,
insomnia,  Sublingual
panic administrati
disorder, on has
delirium, more rapid
chemother absorption
apy- than PO,
and
associated
bioavailabili
anticipator ty
y nausea compares
and to IM use.
vomiting,  Do not
and administer
psychogen intra-
ic arterially;
catatonia. arteriospas
m or
gangrene
 may result.
 Give IM
injections of
undiluted
drug deep
into muscle
mass,
monitor
injection
sites.
 Do not use
solutions
that are
discolored
or contain a
precipitate.
Protect
drug from
light, and
refrigerate
oral
solution.
 Intensol is
a
concentrate
d solution;
it is
recommend
ed it be
mixed with
water,
juice, soda,
applesauce
, or
pudding.
 WARNING:
 Keep
equipment
to maintain
a patent
airway
readily
available
when drug
is given IV.
 Refrigerate
injection
and oral
solution
(36° to 46°
F).
 Reduce
dose of
opioid
analgesics
by at least
half in
patients
who have
received
parenteral
lorazepam.
 Keep
patients
who have
received
parenteral
doses
under close
observation
, preferably
in bed, up
 to 3 hr. Do
not permit
ambulatory
patients to
drive
following an
injection.
 WARNING:
Taper
dosage
gradually
after long-
term
therapy,
especially
in patients
with
epilepsy.

Teaching points
 Take drug
exactly as
prescribed;
do not stop
taking drug
(in long-
term
therapy)
without
consulting
health care
provider.
 You may
experience
these side
effects:
 Drowsiness
, dizziness
(may be
transient;
avoid
driving or
engaging in
dangerous
activities);
GI upset
(take drug
with food);
nocturnal
sleep
disturbance
s for
several
nights after
discontinuin
g the drug if
used as a
sedative
and
hypnotic;
depression,
dreams,
emotional
upset,
crying.
 Report
severe
dizziness,
weakness,
drowsiness
that
persists,
 rash or skin
lesions,
palpitations
, edema of
the
extremities;
visual
changes;
difficulty
voiding.

Ritalin II Stimulant Methylpheni Methylphenidate Assessment

7.methylpheni Drug (CNS date HCl non- ·        History: Hyper
date HCl Stimulant) hydrochlorid competitively sensitivity to
e is blocks the reuptake methylphenidate
indicated for of dopamine and ; marked
the noradrenaline into anxiety, tension,
treatment of the terminal by and agitation;
Attention blocking dopamine glaucoma;
Deficit transporter (DAT) motor
Hyperactivit and noradrenaline tics, Tourette sy
y Disorder transporter (NAT), ndrome; severe
(ADHD) in increasing levels of depression;
patients 6 dopamine and normal fatigue
years of noradrenaline in state; seizure
age and the synaptic cleft. disorders;
older and hypertension;
for the drug
treatment of dependence,
narcolepsy. alcoholism,
emotional
instability;
pregnancy,
lactation
·        Physical: Wei
 ght; T; skin
color, lesions;
orientation,
affect,
ophthalmologic
examination
(tonometry); P,
BP,
auscultation; R,
adventitious
sounds; bowel
sounds, normal
output; CBC
with differential,
platelet count,
baseline ECG
 
Interventions
·        Ensure proper
diagnosis before
administering to
children for
behavioral
syndromes;
drug should not
be used until
other causes or
concomitants of
abnormal
behavior
(learning
disability, EEG
abnormalities, n
eurologic deficit
s) are ruled out.
·        Interrupt drug
 dosage
periodically in
children to
determine if
symptoms
warrant
continued drug
therapy.
·        Monitor
growth of
children on
long-term
methylphenidate
therapy.
·        Ensure that all
timed-release
tablets and
capsules are
swallowed
whole, not
chewed or
crushed.
·        Dispense the
least feasible
dose to
minimize risk of
overdose.
·        Give before
6 PM to prevent
insomnia.
·        Monitor CBC
and platelet
counts
periodically in
patients on
long-term
 therapy.
·        Monitor BP
frequently early
in treatment.
 
Teaching points
·        Take this drug
exactly as
prescribed.
Timed-release
tablets and
capsules must
be swallowed
whole, not
chewed or
crushed. Metad
ate CD capsule
s may be
opened and
entire contents
sprinkled on soft
food—do not
chew or crush
granules.
·        Take drug
before 6 PM to
avoid nighttime
sleep
disturbance.
·        Avoid alcohol
and OTC drugs,
including nose
drops, cold
remedies; some
OTC drugs
could cause
 dangerous
effects.
·        You may
experience
these side
effects:
Nervousness,
restlessness,
dizziness,
insomnia,
impaired
thinking (may
lessen; avoid
driving or
engaging in
activities that
require
alertness);
headache, loss
of appetite, dry
mouth.
·        Report
nervousness,
insomnia,
palpitations,
vomiting, rash,
fever.
Ketalar III Anesthetic Ketamine is Ketamine interacts Assessment and
8. ketamine indicated as with N-methyl-D- Examination
an aspartate (NMDA)
anesthetic receptors, opioid  Assess
agent for receptors, respiration and
recommend monoaminergic
ed receptors, notify physician
diagnostic muscarinic immediately if
and surgical receptors and
patient exhibits
procedures. voltage sensitive any interruption
If skeletal Ca ion channels.
muscle Unlike other in respiratory
relaxation is general anesthetic rate (apnea) or
needed, it agents, ketamine
should be does not interact signs of
combined with GABA respiratory
with a receptors.
depression,
muscle
relaxant. If including
the surgical decreased
procedure
involves respiratory rate,
visceral confusion,
pain, it
should be bluish color of
supplement the skin and
ed with an
mucous
agent that
obtunds membranes
visceral (cyanosis), and
pain.
Ketamine difficult, labored
can be used breathing
for induction
of (dyspnea).
anesthesia Monitor pulse
prior other
oximetry and
general
anesthetic perform
agents and pulmonary
as a
supplement function tests to
of low quantify
potency
agents. suspected
 changes in
ventilation and
respiratory
function. Apnea
or excessive
respiratory
depression
requires
emergency
care.

 Monitor signs of
laryngeal
spasm,
including
tightness in the
throat and
chest,
wheezing,
cough, and
severe
shortness of
breath. Notify
physician or
nursing staff
immediately if
 these reactions
occur.

 Assess signs of
increased
intracranial
pressure,
including
decreased
consciousness,
headache,
lethargy,
seizures, and
vomiting. Notify
physician or
nursing staff
immediately of
these signs.

 Be alert for
signs of
emergence
reactions,
including
nightmares,
hallucinations,
 and other
changes in
mood and
behavior.
Report these
signs to the
physician or
nursing staff.

 Assess blood
pressure (BP)
and compare to
normal values.
Report changes
in BP, either a
problematic
decrease in BP
(hypotension) or
a sustained
increase in BP
(hypertension).

 Assess heart
rate, ECG, and
heart sounds,
especially
 during exercise.
Report
abnormal heart
rhythms or
symptoms of
arrhythmias,
including
palpitations,
chest
discomfort,
shortness of
breath, fainting,
and
fatigue/weaknes
s.

 Be alert for
residual muscle
rigidity and
increased
skeletal muscle
tone. Report a
sustained
increase in
muscle tone.
  Monitor injection
site for pain,
swelling, and
irritation. Report
prolonged or
excessive
injection site
reactions to the
physician.

Interventions

 Implement
breathing
activities and
other
therapeutic
exercises to
encourage
ventilation and
help overcome
any residual
effects of the
anesthetic.

 Because of the
risk of
 respiratory
depression,
arrhythmias,
and abnormal
BP responses,
use caution
during aerobic
exercise and
other forms of
therapeutic
exercise.
Assess exercise
tolerance
frequently .

Robitussin V Expectorant Temporarily Guaifenesin with c Assessment and

9. codeine- Ac and Narcotic controls odeine is an oral, Examination
guaifenesin Analgesic cough due liquid cough
to minor medicine.  Assess the
throat and Guaifenesin is an quantity and
bronchial expectorant, which
irritation as works by thinning consistency of
may occur and increasing the sputum to help
with the volume
common of mucus. Codeine  document
cold or is a narcotic cough whether this
inhaled suppressant that drug is
irritants. works by
Helps suppressing successful in
loosen the cough reflex in
phlegm the brain, reducing the
(mucus) eventually reducing viscosity of
and thin the frequency
bronchial of cough. respiratory
secretions secretions.
to make
coughs
more  Assess
productive. dizziness that
might affect gait,
balance, and
other functional
activities.
Report balance
problems and
functional
limitations to the
physician, and
caution the
patient and
family/caregiver
s to guard
against falls and
trauma.

Interventions

 When
 implementing
airway
clearance
techniques or
other pulmonary
interventions,
attempt to
intervene when
the drug has
produced
expectorant
effects. Effects
typically begin
30 min after oral
administration.

 Design and
implement
breathing
exercises to
maximize
ventilation and
help prevent
infections
caused by
pulmonary
 congestion.

Patient/Client-Related
Instruction

 Instruct patient
and
family/caregiver
s to report other
troublesome
side effects
such as severe
or prolonged
headache, skin
reactions (rash,
welts), or GI
problems
(diarrhea,
nausea,
vomiting,
stomach pain).

Lomotil V Antidiarrheal This By acting on the Assessment and

10.diphenoxyl s, Antimotility medication presynaptic opioid Evaluation
ate/atropine Agents, is used to receptors, it blocks
Narcotic treat the release of  Monitor
Analgesics, diarrhea. It acetylcholine in the improvements in
Anticholinergi helps to synaptic cleft and
cs decrease hence inhibits the GI symptoms
the number motility and
and secretory action of (decreased
frequency the enteric nervous diarrhea) to help
of bowel system. This action
movements. leads to a document
It works by decrease in whether drug
slowing the segmental
therapy is
movement contractions and
of the prolongation of successful.
intestines. gastrointestinal
transit time.
 Assess
dizziness that
might affect gait,
balance, and
other functional
activities.
Report balance
problems and
functional
limitations to the
physician, and
caution the
patient and
family/caregiver
s to guard
against falls and
trauma.
 Monitor other
CNS side
effects such as
confusion,
drowsiness,
blurred vision,
headache,
nervousness, or
insomnia.
Report severe
or prolonged
CNS symptoms
to the physician.

 Assess heart
rate, ECG, and
heart sounds,
especially
during exercise.
Report
increased heart
rate
(tachycardia) or
symptoms of
other
arrhythmias
 such as
palpitations,
chest
discomfort,
shortness of
breath, fainting,
and
fatigue/weaknes
s.

Interventions

 Because of the
tachycardia, use
caution during
aerobic exercise
and other forms
of therapeutic
exercise.
Assess exercise
tolerance
frequently
(blood pressure,
heart rate,
fatigue levels),
and terminate
exercise
 immediately if
any untoward
responses
occur.

Patient/Client-Related
Instruction

 Advise patient
to avoid alcohol
and foods that
may increase GI
irritation and
diarrhea.

 Instruct patient
to report other
bothersome
side effects
such as severe
or prolonged
urinary
retention, skin
redness/warmth
, or GI problems
(constipation,
nausea,
 vomiting,
heartburn, dry
mouth).

2. While each of these terms is similar, nurses and other health care providers should be aware of the differences. Explain
briefly their differences.

a. Addiction

Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to
control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but
repeated drug use can lead to brain changes that challenge an addicted person’s self-control and interfere with
their ability to resist intense urges to take drugs. These brain changes can be persistent, which is why drug
addiction is considered a "relapsing" disease—people in recovery from drug use disorders are at increased risk
for returning to drug use even after years of not taking the drug. (NIDA, 2018)

b. Pseudo-addiction
Pseudo-addiction imitates the behavior of an addicted person. A person with unrelieved pain, i.e., one who is
undertreated, might present physical signs and symptoms which may seem like drug-seeking behavior or physical
withdrawal. They may try to increase their dose illegally by getting the drugs without approval or turn to street drugs. They
also might complain, act aggressively and even lie to get another prescription. The fact is pseudo-addiction looks a lot like
addiction – but it is not. When pain is properly controlled and effectively treated, these drug-seeking behaviors stop, hence
confirming pseudo-addiction rather than true addiction.
c. Dependence

Dependence means that when a person stops using a drug, their body goes through “withdrawal”: a group of
physical and mental symptoms that can range from mild (if the drug is caffeine) to life-threatening (such
as alcohol or opioids, including heroin and prescription pain relievers). Many people who take a prescription
medicine every day over a long period of time can become dependent; when they go off the drug, they need to
 do it gradually, to avoid withdrawal discomfort. But people who are dependent on a drug or medicine aren’t
necessarily addicted. (NIDA, 2017)

d. Tolerance

Tolerance happens when a person no longer responds to a drug in the way they did at first. So it takes a
higher dose of the drug to achieve the same effect as when the person first used it. This is why people with
substance use disorders use more and more of a drug to get the “high” they seek. (NIDA, 2017)
With tolerance, certain cell receptors in the body that activate when the drug is present stop responding like
they once did. Opposingly, there is also a tendency that your body might clear the medication faster, too.
(Ghoshal, 2019)
 REFERENCES

Ciccone, C. (2013). Davis’s Drug Guide for Rehabilitation Professionals. Retrieved from

https://fadavispt.mhmedical.com/content.aspx?bookid=1873&sectionid=139020947

Drug Bank. (2021). Diazepam. Retrieved from https://go.drugbank.com/drugs/DB00829

Drug Bank. (2021). Fentanyl. Retrieved from https://go.drugbank.com/drugs/DB00813

Drug Bank. (2021). Ketamine. Retrieved from https://go.drugbank.com/drugs/DB01221

Drug Bank. (2021). Lorazepam. Retrieved from https://go.drugbank.com/drugs/DB00186

Drug Bank. (2021). Methylphenidate. Retrieved from https://go.drugbank.com/drugs/DB00422

Drug Bank. (2021). Oxycodone. Retrieved from https://go.drugbank.com/drugs/DB00497

Drug Bank. (2021). Tramadol. Retrieved from https://go.drugbank.com/drugs/DB00193

Ghoshal, M. (2019). Understanding Drug Tolerance. Retrieved from https://www.healthline.com/health/drug-tolerance

Jain, M., & Wylie, W. (2021). Diphenoxylate and Atropine. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK559300/

National Institute on Drug Abuse. (2017). Tolerance, Dependence, Addiction: What’s the Difference? Retrieved from

https://archives.drugabuse.gov/blog/post/tolerance-dependence-addiction-whats-difference
National Institute on Drug Abuse. (2018). Understanding Drug Use and Addiction Drug Facts. Retrieved from

https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction

Nursing Considerations for methylphenidate hydrochloride. Retrieved from

https://download.lww.com/downloads/thePoint/9780781760331_Videbeck/Drug_Monograph/mg/methylphenidate.htm

Nursing Crib. (2007). Tramadol Hydrochloride. Retrieved from https://nursingcrib.com/drug-guides/tramadol-hydrochloride/

Nursing Times. (2004). Fentanyl. Retrieved from https://www.nursingtimes.net/clinical-archive/medicine-management/fentanyl-20-11-

2004/

Ogbru, O. (2019). alprazolam (Xanax). Retrieved from

https://www.medicinenet.com/alprazolam/article.htm#what_are_the_uses_for_xanax

Ogbru, O. (n.d.). guaifenesin and codeine (Cheratussin, Iophen). Retrieved from

https://www.medicinenet.com/guaifenesin_with_codeine-

oral/article.htm#what_is_guaifenesin_with_codeine_and_how_does_it_work_mechanism_of_action

Pain Management & Spine Care. (n.d.). What’s the difference between addiction and pseudo-addiction? Retrieved from

https://brooksvillepainmanagement.com/whats-the-difference-between-addiction-and-pseudo-addiction/
PsychSceneHub. (n.d.). Methylphenidate – Mechanism of Action, Side Effects and Dosing. Retrieved from

https://psychscenehub.com/psychpedia/methylphenidate-mechanism-of-action-side-effects-and-dosing/

RNpedia. (n.d.). diazepam Nursing Considerations & Management. Retrieved from https://www.rnpedia.com/nursing-

notes/pharmacology-drug-study-notes/diazepam/

RNpedia. (n.d.). lorazepam Nursing Considerations & Management. Retrieved from https://www.rnpedia.com/nursing-

notes/pharmacology-drug-study-notes/lorazepam/

RxList. (2004). ROBITUSSIN AC. Retrieved from https://www.rxlist.com/robitussin-ac-drug.htm#description

WebMD. (n.d.). Diphenoxylate-Atropine. Retrieved from https://www.webmd.com/drugs/2/drug-2326/diphenoxylate-atropine-

oral/details