Nursing Pharmacology Module

Prepared by: Vincent Dave L. Farhat MD, EdD

Introduction:
The nurse is in the frontline of treatment of human diseases. Although the medical doctor
decides what drugs are to be used on patients, it is actually the nurse who administers these drugs
directly to the patient. She spent more time and effort than the doctor in the actual management of
patients in the hospital. Nursed should have a basic knowledge on pharmacology to make her a more
efficient and effective ally in the war on human diseases.

Methodology:
This module only gives the student a broad and concise knowledge of pharmacology. In the
absence of the usual face to face classroom interaction of teachers and students where question and
answers are asked, the stdents are asked not only to ask question through cellphone texting and calls but
also to read a more comprehensive pharmacology textbook to aid them in the acquiring knowledge and
skills. Whenever feasible, the topics could also be delivered through a lecture using the Google
Classroom platform in the Internet.

General Objectives:
At the end of the course, the students are able to:
1. Acquire basic knowledge on the forms route, action, indication, side-effects and
contraindication of drugs.
2. Develop skills in the safe administration of these drugs
3. Appreciate the importance of drugs in the management of human diseases.

Time Frame: 48 hours

Module 1: Basic Pharmacology

Introduction:
The first part of the course is a broad but concise introduction on the nature of the drugs, its use
and effect on the human body. This knowledge is an important prerequisite in the safe, efficient and
effective use of these drugs in the treatment of the different human diseases.

Specific Objectives:
At he end of the module, the students are able to:
1. Appreciate the nature and importance of drugs in the management of human
diseases.
2. Develop basic skills in the safe administration of these drugs.
3. Understand the general effects of these drugs in the human body.
4. Identify the different drug forms and be able to know how to administer them to
patients.

Time Frame: 6 hours

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Topic 1A: Introduction

A. Pharmacology – study of drugs and their origin, nature, properties and effects on living
organism. We need to know why drugs are given, how they work and what effects to expect.
B. Pharmacological Classification
C. General Information in a drug
1. Therapeutic Use
2. Most common side-effect
3. Precaution
4. Contraindication
5. Interaction
D. Identifying Name
1. Generic name
2. Brand name
E. Type of drug based on accessibility
1. Over the counter (OTC) drug
2. Prescription drug
3. Controlled drug
F. Drug Action
1. Indication – a list of medical conditions or diseases for which the drug is meant to be
used.
2. Action - a description of the cellular change that occur as a result of the drug.
3. Contraindication – a list of conditions for which the drug should not be given
4. Caution – a list of conditions or type of patients that warrant closer observation for
specific side-effects when given the drug
5. Interaction – a list of other drugs or foods that may alter the effect of the drug and
usually should not be given during the same course of therapy.

Topic 1B: Sources and Bodily Effects of Drugs

A. Source of drugs
1. Plants
2. Minerals
3. Animals
4. Synthetic
B. Effects of drugs
1. Systemic effect
2. Local effect
C. Pharmacokinetics
1. Absorption – getting into the bloodstream – could be affected by
a. pH – acidic drugs are easily absorbed in the stomach while alkaline drugs are
better absorbed in the small intestine.
b. Lipid solubility – drugs with high lipid solubility are easily absorbed
c. Presence of food in the stomach
2. Distribution
a. moving from the bloodstream into the tissues and fluids of the body
b. blood-brain barrier and placental barrier

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 c. selective distribution – affinity or attraction of a drug to a specific organ – Ex.
HCG to ovary, methamphetamines to CNS and Iodine to the thyroid gland
3. Metabolism – physical and chemical alteration that a substance undergoes in the body –
biotransformation in the liver to make it more water soluble to be excreted into the
urine
4. Excretion – eliminating waste products of a drug metabolized from the body – kidney,
skin, lungs feces and breast milk
Toxicity – condition that result from exposure either to poison or a dangerous
amount of a drug that is normally safe when given in a smaller amount. In
drug therapy, the goal is to give just enough of the drug to cause the desired
(therapeutic) effect while keeping the amount below the level at which toxic
effects are observed.
5. Drug Accumulation
6. Drug Half Life
D. Other variables affecting drug action
1. Age
2. Weight
3. Sex
4. Psychological state – placebo effect
E. Drug interaction
1. Synergism – the action of two drugs working together in which one helps the other
simultaneously for an effect that neither could produce alone
2. Potentiation – the action of two drugs on which one prolongs or multiplies the effect of
the other
3. Antagonism – the opposing action of two drugs in which one decreases or cancels out
the effect of the other
4. Examples:
a. Desirable synergism – Prometazine + Demerol
b. Undesirable synergism – Sedative + Barbiturates
c. Desirable potentiation – Penicillin + Probenecid
d. Undesirable potentiation – Tagamet increase the blood level of Tofranil
e. Desirable antagonism – Narcotic antagonist (Naloxone) for narcotic overdose
f. Undesirable antagonism – Antacids change the pH of stomach preventing the
absorption of Tetracyclines
F. Dosage
1. Minimum dose – smallest amount of a drug that will produce a therapeutic effect
2. Maximum dose – largest amount of a drug that will produce the desired effect without
producing symptoms of toxicity
3. Loading dose – initial high dose (often maximum dose) used to quickly elevate the level
of the drug in the blood (often followed by a series of lower maintenance doses)
4. Maintenance dose – dose required to keep the drug blood level at a steady state in order
to maintain a desired effect
5. Toxic dose – amount of a drug that will produce harmful side-effects
6. Lethal dose – dose that can cause death
7. Therapeutic dose – dose that is customarily given (average adult dose based on body
weight of 150 lbs) adjusted according to variation from the norm
G. Route
1. Gastrointestinal route

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 a. Oral
b. Nasogastric Tube
c. Rectal
2. Parenteral route
a. Sublingual or buccal
b. Inhalation
c. Topical
d. Injection
1. Intravenous
2. Intramuscular
3. Subcutaneous
4. Intradermal
5. Intracardiac
6. Intraspinal
7. Intracapsular

The doctor’s choice of a particular route of administration may depend on desired

effect (e.g. fast or slow, local or systemic) absorption qualities of the drug and how the drug
is supplied. The oral route is the easiest and cheapest but the effects are slower because of
the time required for the disintegration of the drug in the gastrointestinal tract before
absorption. The IV route is the fastest: drugs enter the bloodstream immediately. Doses to
be given IV are small amounts; effects are immediate and can be quite dangerous if given in
amounts recommended for other routes. IV drugs can be administered IV push or bolus (a
concentrated drug solution) or they can be diluted and solutions are then infused more
slowly by IV drip. IV is the best route of treatment for emergencies because of the speed of
action. Parenteral routes are the choice when the patient can take nothing by mouth (NPO)
or the drug is not suitable for GI absorption. If it is desirable to retard the speed of
absorption, a drug to be given IM may be added to an oily base.

H. Unexpected Responses to Drugs

1. Teratogenic effect – cause the development physical defects in a fetus
2. Idiosyncrasy – unique unusual response to a drug
3. Paradoxical – opposite effect from that expected
4. Tolerance – decrease response to a drug that develops after repeated doses are given. To
achieve the desired effect, the drug dosage may be increased or the drug be replaced
5. Dependence – a psychological dependence involves only psychological craving. A
physical dependence develops when there are symptoms of withdrawal (nausea, tremor,
pain, sweating).
6. Hypersensitivity – allergy – mild allergy involves rashes, hives, or severe possible fatal
allergy (itching, hives, hyperemia (reddened warm skin), hypotension, shock, cyanosis,
laryngeal edema, and dyspnea. Management includes CPR, epinephrine to increase BP,
corticosteroids to reduce inflammation and antihistamines to reduce itchiness, redness
and edema.

Topic 1C: Information Bases to Administering Drugs

A. Generic and Brand Names

B. Classification – see MIMS

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C. Pregnancy Category
1. A – No risk to the fetus in any trimester
2. B – No adverse effect demonstrated in animals, No human studied available
3. C – Animal studies shown adverse reaction. No human studies available. Given only after
the risk of the fetus have been considered
4. D – definite fetal abnormality, may be given in spite of risk to the fetus if needed for a
life-threatening condition
5. X – Absolute fetal abnormality; not to be used anytime during pregnancy
D. Dosage - different doses for children, adults and the aged
E. Route
F. Action – how a drug produce its effect
G. Indication – use, disease it aims to cure
H. Side-effect and adverse effect
1. Side-effect – non-therapeutic effect that are transient and does not require any nursing
intervention. Ex. drowsiness
2. Adverse effect – non-therapeutic effect that may be harmful to the patient and may
require lowering the dose or discontinuation of the drug – ex. Agranulocytosis
I. Contraindication and Precaution – condition in which a drug should be given with caution or not
given at all
J. Interaction and incompatibilities – good or undesired effect when a drug is given together with
another drug or with a specific food
K. Nursing Implication – information that a nurse needs in order to administer the drug safely
L. Sign of effectiveness
M. Patient Teaching – tell the patient the name of the drug, why is it given and the expected results
N. Pharmacokinetics
O. Five Rights before administering medications
1. right medications
2. right patient
3. right dosage
4. right route
5. right time
P. Requirements for medication orders
1. Patient’s name and room number
2. Date
3. Name of the drug
4. Route of administration
5. Time of administration of the drug
6. Physician’s signature
Q. Type of Medication Order
1. Standing order with termination – once a day for 5 days
2. Standing order without termination – once a day
3. prn (as necessary) orders – I tablet 3x a day prn for fever
4. Single dose order – I tablet at 6:00 P.M.
5. Stat order – I tablet now
R. Drug Labels
1. Brand and Generic Names
2. Dosage strength
3. Form

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 4. Supply dosage
5. Total Volume
6. administration route
7. Direction for mixing or reconstituting
8. Label alerts
9. Expiration Date
10. Lot or Control Number
11. National Drug Code
12. Bar Code Symbol

Topic 1D: Common Abbreviation for Medication Orders

Time of Administration of Drugs

Abbreviation Latin Terms English Meaning
ac ante cebum Before meals
pc post cebum After meals
qd quaque die Everyday, daily
od Once a die
bid bis in die Twice a day
tid ter in die Three times a day
qid quarter en die Four times a day
qh quaque hora Every hour
hs hora somni At bedtime, at hours of sleep
qn quaque nocte Every night
stat statem immediately
prn pro re nata As necessary
qod Quaque otra die Every other day
tiv Ter in vices Three times a week
biv Bis in vices Two times a week

Route of Administration
Abbreviation Latin Terms English Meaning
AD Aures dextra Right ear
AS Aures sinister Left ear
AU Aures utrae Each ear
IM Intramuscularly
IV Intravenously
IVP Intravenous push
IVTT intravenous through tube
IVPB Intravenous peggy back
NGT Nasogastric tube
MDI Metered –dose inhaler
OD Oculus dexter In the right eye
OS Oculus sinister In the left eye
OU Oculus utrae In both eyes
po Per orem Oral or by mouth
pr Per rectum In the rectum
SC subcutaneously
SL Sub lingue sublingual

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 Sig. Signatura Instruction
Take this

Common Abbreviations for Medication Orders

Abbreviation Meaning Abbreviation Meaning
ad As desired NS or N/S Normal Saline or 0.9%
Sodium Chloride
amp ampoule OTC Over the counter drug
cap capsule oz ounce
D/c discontinue pt patient
DW Distilled water Q2h Every two hours
D5W Dextrose 5% in R rectal
water
ER Extended release or RL Ringer’s lactate
Emergency Room
Fe Iron sol solution
Gm or g Gram SR Sustained release
gtt drop supp suppository
h or hr hour tab tablet
KCl Potassium chloride Tbsp or tbs or T tablespoon
Kg or kilo Kilogram Tsp or t teaspoon
KVO Keep the vein open vag vaginal
L Liter Vit Vitamin
lb pound VO Verbal order
mEq milliequivalent @ at
mcg microgram NEB nebulizer
mg milligram NG nasogastric
ml or mL milliliter NPO or npo Nothing by mouth
mm millimeter

Topic 1E: Drug Preparations

A. Oral route
1. tablet – disk of compressed drug in a variety of shapes, may be coated for easy
swallowing or scored (evenly divided
2. enteric coated tablet – not to be chewed or crushed – will not dissolve in the
stomach but only in the small intestine
3. Capsule – with gelatin type container
4. Spansule or time-released or sustained release capsule – do not chew or crush
5. lozenges (troche) – tablet containing palatable flavoring for a local soothing
effect in the throat or mouth – do not swallow but allow to dissolve slowly in
the mouth – do not drink liquids 15 minutes after administration to prevent
washing off the lozenges contents.
6. Syrups – sweetened, flavored liquid drug form
7. Elixirs – liquid drug form with alcohol base – hydroalcoholic liquids
8. Fluid extracts or Tinctures – very concentrated

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 9. Solutions – liquid drug form in which the drug is totally and evenly (clear)
dissolved in water
10. Suspensions – liquid medication that must be shaken well before administration
because solid drug particles settle at the bottom
11. Magmas – contains large bulky particles – ex. Milk of Magnesia
12. gels
13. Emulsions – creamy fat suspension or liquid drug preparation that contains oil
and fat in water
14. Powders
B. Rectal Drug Form
1. Suppository – drug suspended in a substance that melts at body temperature
2. Enema solution
C. Parenteral route – IM, IV, SC, IVPB, IVTT
1. Solution – aqueous or oily
2. Powder – mixed with diluting solution – they are stable longer in powder form
than in solution form
D. Topical route
1. Ointment – for dry lesions – semisolid properties in a petroleum or lanolin base
2. Cream – for wet lesions
3. Lotion – liquid preparation applied externally to the skin
4. Dermal patch – Skin patch containing drug molecules that is absorbed in the
skin
5. Eye, ear and Nose drops
6. Eye ointment
7. Vaginal cream
8. Vaginal suppositories
9. Buccal tablet
10. Douche solution
11. Aerosol powders and liquids
12. Powders
13. Pastes – thick ointment used to protect the skin
E. Inhalable drug form
1. 1. Spray or mist – spray bottle, nebulizers, metered dose inhaler
2. Gas – anesthetic such nitrous oxide and oxygen

Evaluation:
The evaluation consists of written objective tests in the form of multiple choice questions, true
or false questions, matching and enumeration. This could be given in a normal face to face interaction or
it can be given through the use of Google Classroom platform in the Internet.

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Module 2: Applied Pharmacology (Part 1)

Introduction:
This module is a broad but concise discussion on the different drugs used against different
human diseases. The drugs are divided into different classes based on the different systems of the
human body to which these drugs are used. In each drug class, specific drugs are given as examples with
their corresponding indication, side-effects, interaction with other drugs, contraindications and drug
information that should be conveyed by the nurse to their patients. The drugs included are those used
for diseases of the nervous system, respiratory system, gastrointestinal system cardiovascular system and
urinary system.

Specific Objectives:
At the end of the module, the students are able to acquire basic understanding in the use of
drugs in the treatment of diseases of the nervous system ,respiratory system, gastrointestinal system,
cardiovascular system and urinary system.

Time Frame: 14 hours

Module 2A: Central Nervous System Drugs

A. Paracetamol – use for mild to moderate pain and fever

B. Salicylates and other NSAIDs
1. Ex. – Aspirin, Diclofenac, mefenamic Acid
2. Use – analgesic, anti-inflammatory
3. Side-effect –
a. prolong bleeding time and bruising
b. gastritis
c. hepatic and renal dysfunction
d. allergy
4. Contraindication
a. Peptic ulcer
b. Allergy to aspirin
c. Vitamin K deficiency
5. Caution – anemia, hepatic and renal disease, pre/postoperatively
6. Interaction
a. Alcohol and corticosteroids may increase the potential
for ulceration and bleeding
b. Increase of insulin, oral antidiabetic drugs and
anticoagulants

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 c. Decrease effect of ACE Inhibitors, Beta-blockers and
diuretics
d. Antacids may decrease the effect of NSAIDs
7. Patient Education – take it during meals
C. Tricyclic Antidepressants
1. Ex. Trimipramine, Clomipramine
2. Use - depression
3. SE – dryness of the throat, drowsiness, blurred vision, constipation, urinary
retention and postural hypotension
4. CI - glaucoma
D. SSRIs
1. Ex. – Flouxetine, Sertraline
2. Use - depression
3. SE – sexual dysfunction, insomnia, drowsiness, headache, nervousness
4. Caution – suicide prone, may precipitate manic attacks in bipolar disorder
E. Lithium
1. Use – Bipolar Disorder
2. SE – cardiac arrhythmias, Hypotension, tremors, thirst and polyurea, seizure,
coma
3. Caution – thyroid disease, cardiovascular and kidney disorders
F. Anticonvulsants
1. Ex. – Carbamazepine, Diphenylhydantoin, Valproic Acid,
Clonazepam
2. Use – Epilepsy, bipolar disorder
3. SE – sedation, Stevens-Johnson Syndrome, leukopenia
4. CI – hematological diseases
5. PE – caution in driving or operating machineries, do not discontinue
abruptly
G. Anxiolytics and Hypnotics
1. Ex. – Diazepam, Zolpidem, Alprazolam, Midazolam
2. Use – Anxiety disorders, muscle relaxant, posttraumatic stress
disorder, panic disorders, phobia, akathesia, psychotic agitation
3. SE – drowsiness, ataxia
4. Caution – depressed vital signs, operating machinery, driving,
paradoxical reactions in the elderly
H. Antipsychotics
1. Chlorpromazine, Haloperidol, Fluphenazine decanoate,
Respiridone, Amilsupride, Quetiapine, olanzapine
2. Use – Schizophrenia, Mania, Psychotic depression, Tourette’s
disease, Sydenham’s chorea, delirium
3. SE – extra-pyramidal side-effects (dystonia, akinesia, bradykenesia,
tremors, dyskinesia, hypersalivation), anticholinergic side-effects,
sedation, weight gain, tardive dyskinesia,
4. CI – coma, cerebrovascular disease
5. Caution – benign prostatic hypertrophy, older patients
6. Interaction – potentiated by CNS Drugs, antagonize anticonvulsants
7. PE – avoid smoking and alcohol and caffeine containing beverages,
instruct the patient what meds to take to counteract side-effect

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 I. Antiparkinsonian Drugs
1. Ex. – Biperiden, levodopa
2. Use – Extrapyramidal side-effect, Parkinson’s disease
3. SE – anticholinergic side-effects, psychosis
4. Caution – glaucoma, benign prostatic hypertrophy

Module 2B: Autonomic Nervous System drugs

A. Introduction
1. Sympathetic Nervous System Functions – epinephrine release
a. Bronchodilation
b. Inc heart rate
c. Medriasis
d. Increase cardiac output leads to increase BP
e. Increase blood flow to brain, lungs, heart and muscles
f. Decrease gastric motility
g. Decrease urine
h. Decrease blood to the skin
i. hyperglycemia
2. Parasympathetic Nervous System Functions
a. Bronchoconstriction
b. Decrease heart rate
c. Meiosis
d. Decrease blood flow to the brain, heart, muscles and lungs
e. Decrease cardiac output leads to decrease BP
f. Increase gastric motility
g. Increase blood to skin
h. Increase urine
i. hypoglycemia
B. Adrenergics or Sympatomimetic – mimic the effect of epinephrine
1. Ex. – epinephrine, ephedrine, dopamine, isoproterenol, norepinephrine
2. Use – shock, constrict capillaries in nosebleed and nasal congestion, dilate
bronchioles in asthma, anaphylaxis, dilate pupils in ophthalmic procedures
3. SE – palpitation, nervousness, hypertension, peripheral vasoconstriction that
can cause tissue necrosis, hyperglycemia
4. Caution – Coronary insufficiency, hypertension, glaucoma, hyperthyroidism

C. Beta Adrenergic Blockers or Beta Blockers

1. Ex.- Propanolol, metoprolol
2. Use – Hypertension, cardiac arrhythmia, angina pectoris, migraine headache
3. SE – hypotension, impotence, bradycardia, fatigue, lethargy, hypoglycemia
4. Caution – Congestive heart failure, heart block, hypotension, asthma, diabetes
5. PE – slowly rise to avoid postural hypotension, avoid alcohol, antihistamines,
muscle relaxants, tranquilizers and sedatives because they potentiate CNS
depression and sedation
D. Cholinergics or Parasympatomimetics drugs
1. Ex. – Pilocarpine, neostigmine, betanechol

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 2. Action – increase peristalsis, increase contraction of the urinary bladder,
increase secretions (sweat, saliva, gastric juices), lower intraocular pressure,
constrict pupil, slows the heart, increase muscle strength
3. Use –
a.Non-obstructive urinary retention – betanechol
b.Abdominal distention – neostigmine
c.Myasthenia gravis – neostigmine
d.Open- angle glaucoma - Pilocarpine
4. SE – diarrhea, bradycardia, hypotension, sweating, excessive salivation,
lacrimation, flushing, bronchospasm, respiratory depression
5. Caution – Bronchial asthma, congestive heart failure

E. Anticholinergics or Parasympatolytics
1. Ex. – Atropine, propentheline, probanthine
2. Action – decrease secretions preoperatively, decrease G.I. motility, dilate pupils
3. Use –
a. antispasmodics
b. antisecretory for G.I. and G.U.
c. hypermotility
d. preoperative drugs
e. neuromuscular blockage and spastic disorders
f. antidote for insecticide poisoning and mushroom poisoning
g. dilation of the pupils
h. bronchodilation
4. SE –
a. blurred vision
b. dry mouth
c. constipation
d. urinary retention
e. tachycardia
5. Caution – angle-closure glaucoma, hypertension and cardiac arrhythmia

Module 2C: Respiratory System Drugs

A. Oxygen
1. Use – Hypoxia, heart and lung diseases. Carbon monoxide poisoning
2. Side effect – too high concentration or too prolong administration may cause
hypoventilation in Chronic Obstructive Pulmonary Disease and blindness in
premature infants
3. caution in COPD (hypoventilation), inflammable – avoid smoking, match and
electrical equipments that may spark are not allowed in rooms where oxygen is
in use

B. Sympatomimetics
1. Ex. – epinephrine, terbutaline, albuterol
2. Use – Brochodilator for bronchial asthma – use metered dose inhaler instead of
oral route to avoid systemic effect
3. S.E. – Nervousness, tachycardia, hypertension, hyperglycemia

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 4. Interaction – beta blockers decrease the effectiveness of sympatomimetics

C. Xanthenes
1. Ex. – Theophyline, Aminophyline
2. Use - Bronchodilator
3. SE – epigastric pain, nervousness, insomnia, tachycardia, mild diuresis,
hyperglycemia
4. Caution – Diabetes mellitus, peptic ulcer, glaucoma,
5. Interaction –
a. Cimetidine, allupurinol, erythromycin, oral contraceptives, calcium
channel blockers and beta blockers increase theophyline blood levels
b. Smoking, phenytoin and rifampicin decrease theophyline
effectiveness
D. Corticosteroids
1. Ex. – Budesonide, Triamcinolone
2. Use – relieve inflammation, reduce swelling in asthma and COPD – metered
dose inhales has less systemic side-effect
3. SE – throat irritation and dry mouth, hoarseness – oral fungal infection
4. Extreme caution – Infection (decrease inflammatory response), hypertension,
diabetes mellitus
E. Mucolytics and Expectorants
1. Ex. – Guaifensin, Carbocisteine
2. Use – for cough in URTI, pneumonia, bronchitis, measles
3. SE – drowsiness, dizziness
4. Caution – persistent or chronic cough
F. Antitussives
1. Ex. – Codeine, Hydrocodone, dextromethorphan
2. Use – prevent cough in non-productive cough that can cause insomnia, fatigue
and even pain (fractured ribs, pleural effusion)
3. SE – respiratory depression, constipation, urinary retention, sedation, dizziness
4. Caution – person driving and operating machineries
5. Contraindication –
a. Narcotics are contraindicated for addiction-prone patients, asthma
and COPD
b. Dextrometorphan may suppress cough and may prevent the mucus
to be expelled – do not use in asthma and COPD
G. Antihistamines
1. Ex. – Chlorpheneramine, Diphenhydramine, loratidine and fexofenadine (2nd
generation antihistaminic)
2. Action – counteract the increased capillary permeability and edema,
inflammation and itch caused by histamine release
3. Use -
a. anti-allergic – for rhinitis, allergic conjunctivitis, skin allergy
b. Vertigo, motion sickness (Dimenhydrinate)
4. SE –
a. dryness of secretions in eyes, ears, nose and throat
b. sedation, urinary retention and constipation
5. Caution – asthma and COPD, operating machineries, BPH, infants

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 6. Interaction –
a. potentiation of CNS depression with tranquilizers, analgesics,
hypnotics, alcohol and muscle relaxants
b. potentiation of anticholinergic side-effects with anticholinergic drugs
and MAO inhibitors
7. Patient’s Education –
a. Avoid prolong use
b. May increase nasal and bronchial obstruction and to sticky mucus
c. Avoid alcohol
H. Decongestants
1. Ex. – Phenylpheneprine, Pseudoephedrine, Phenylpropolamine
2. Action – constrict blood vessel in the respiratory tract – shrinkage of swollen
mucus membrane and help to open nasal airway passage
3. Use – Colds and cough
4. Caution – Hyperthyroidism, diabetes mellitus, glaucoma, BPH,

Module 2D: Gastrointestinal System Drugs

A. Antacids
1. Ex. – magnesium hydroxide, aluminum hydroxide, sodium bicarbonate and
calcium carbonate
2. Use – Peptic ulcer
3. SE –
a. Constipation (aluminum and calcium)
b. Diarrhea (magnesium)
c. Osteoporosis (aluminum)
d. Electrolyte imbalance
e. Urinary calculi (calcium)
f. Belching and flatulence (sodium bicarbonate and calcium carbonate
4. Contraindication – Congestive Heart Failure, renal calculi, cirrhosis of the liver,
edema, dehydration
5. Interaction –
a. should not be taken within two hours of another drug
b. decrease the effect of antibiotics, digoxin, iron, salicylates and thyroid
hormone
c. increase the effect of diazepam (sedation)
d. enteric coated drugs may be release prematurely in the stomach
6. Patient’s education –
a. avoid taking with other drugs
b. avoid taking it if patient has edema, renal, cardiac and liver disease

B. Proton Pump Inhibitors

1. Ex. – Omeprazole, esomeprazole, pantoprazole, rabeprazole, lansoprazole
2. Use – Gastric anti-secretory, symptomatic relief of peptic ulcer
3. SE –constipation, nausea and vomiting, headache, dizziness, Vit B12 defeciency
4. Interaction –
a. H2 blockers decrease the pump inhibition effect
b. increase the serum level of diazepam by decreasing its metabolism

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 c. should be taken in an empty stomach

C. H2 Blockers
1. Ex. – Cimetidine, Ranitidine, famotidine
2. Use – Peptic Ulcer
3. SE – diarrhea, dizziness, rash, headache
4. Contraindication – impaired renal and liver function, children
5. Interaction –
a. Increase blood concentration of diazepam, propanolol, theophyline
and tricyclic antidepressants
b. Antacids may interfere with the absorption of H2 blockers

D. Diphenoxylate with atropine and Loperamide - Antispasmodic

1. Use – diarrhea
2. SE – anticholinergic side-effect of atropine and abdominal distention, nausea
and vomiting
3. Contraindications –
a. diarrhea due to infection and poisoning
b. young children and pregnancy
c. Liver cirrhosis
4. Patient’s education – adequate fluids and electrolytes, short term use only

E. Stimulant laxatives
1. Ex. – Bisacodyl
2. Use – cathartic – increase peristaltic activity for constipation and for enema as
preparation for Upper GI Series
3. SE –
a. Abdominal cramps, nausea, diarrhea
b. Loss of normal bowel function in prolong use (addiction)
c. Electrolyte imbalance
4. Contraindication –
a. Acute abdominal pain – danger of ruptured appendicitis
b. Children, pregnancy, lactation
c. Long term use

F. Meclizine - Anticholinergic
1. Use – nausea, vomiting, motion sickness, Meniere’s disease
2. SE – sedation, dry mouth, blurred vision
3. Contraindication – pregnancy and lactation, angle-closure glaucoma, BPH,
cardiac arrhythmia, COPD, asthma seizure, hypertension
4. Interaction – increase the sedative effect of CNS depressants, alcohol and
muscle relaxants

G. Metoclopramide
1. Use –
a. Antiemetic
b. Accelerate gastric emptying and peristalsis in gastric stasis
2. SE – depression, restlessness, drowsiness, fatigue, extrapyramidal side-effect

15
 3. Interaction – may potentiate the effect of CNS depressants, alcohol and muscle
relaxants

Module 2E: Cardiovascular System Drugs

A. Digoxin
1. Action – increase the force of myocardial contraction
2. Use – Congestive heart failure
3. SE – abdominal cramps, diarrhea, bradycardia, cardiac arrhythmia
4. Caution – Hypothyroidism, Myocardial infarction, cardiac arrhythmia,
pregnancy and lactation
5. Interaction –
a. antacids, neomycin, rifamficin, reduce digoxin absorption
b. diuretics, calcium, verapamil, corticosteroids increase the risk for
arrhythmia
c. Phenobarbital, ephedrine and phenytoin reduce digoxin blood levels
6. Patient’s education
a. do not discontinue abruptly
b. Check Blood pressure and heart rate regularly
B. Beta Blockers
1. Ex. – Propanolol, Metoprolol
2. Use – cardiac arrhythmia, tachycardia, toxic goiter, akathesia, hypertension
3. SE – Hypotension, bradycardia, heart block, cardiac arrest, bronchospasm,
hypoglycemia
4. Caution – Diabetes mellitus, Asthma, bradycardia, heart block, Congestive heart
failure, COPD
5. Interaction –
a. antagonize by epinephrine, anticholinergics, tricyclic antidepressants
b. diuretics, antihypertensives, phenothiazines and sedatives potentiate
its hypotensive effect
C. Calcium Channel Blockers
1. Ex. – Verapamil, Nifedipine, Diltiazem
2. Action – antiarrhthmic, coronary vasodilator
3. Use – Cardiac arrhythmia, Myocardial infarction, hypertension
4. SE – hypotension, headache, bradycardia with heart block, edema, constipation
5. Caution – Heart block, CHF, pregnancy, lactation, Children
6. Interaction –
a. antagonize salicylates, phenytoin, rifampicin, lithium
b. Diuretics, ACE inhibitors and beta blockers potentiate its hypotensive
effect
7. Patient’ education –
a. do not discontinue medication even if the patient feels well
b. If medication is forgotten, do not double the next dose

D. Angiotensin-Converting Enzyme (ACE) Inhibitors

1. Ex. – Catoprel
2. Use – hypertension, slow the progression of renal failure
3. SE – severe hypotension, hyperkalemia, loss of taste perception

16
 4. Caution – heart failure, pregnancy, lactation
5. Interaction –
a. diuretics and vasodilators potentiated hypotension
b. potassium sparing diuretics and potassium supplements increase the
risk of hyperkalemia
c. NSAIDs and salicylates antagonize the effect of ACE inhibitors so may
increase the deterioration of kidney function
d. Antacids decrease absorption of ACE inhibitors

E. Methyldopa
1. Action – centrally acting vasodilator
2. Use – Hypertension
3. SE – Hypotension< drowsiness, sexual dysfunction
4. Caution – Liver disorders
5. Interaction – with levodopa may lead to psychosis
F. Hydralazine – Peripheral vasodilator
1. Action – peripheral vasodilator, Inc heart rate and cardiac output
2. Use – Hypertension, preeclampsia and eclampsia
3. SE – Tachycardia, headache, orthostatic hypotension, edema, weight gain
4. Contraindication – Systemic lupus erythrematosus, Coronary artery disease,
Rheumatic heart disease
G. Clonidine
1. Action – centrally acting vasodilator
2. Use – Hypertension, nicotine and opiate withdrawal, glaucoma, Tourette’s
syndrome, severe pain in cancer patients

H. Prazocin
1. Action – Centrally acting vasodilator
2. Use - Hypertension
3. Patient’s education
a. A. Low salt diet
b. May impair driving
c. Do not bite extended release meds – quick release – sudden
hypotension – loss of consciousness due to shock

I. Coronary Vasodilators
1. 1. Ex. – Nitrates – Nitroglycerin and Isosorbide – given as sublingual, sustained release
tablet, transdermal and IV infusion
2. Use – Angina pectoris and myocardial infarction
3. SE – Headache, postural hypotension, transient flushing
4. Caution – glaucoma, increased intracranial pressure, hypotension,
administration of Seldanefil (Viagra) may cause sudden severe hypotension
5. Patient’s education
a. A. take it while sitting down, may feel dizzy
b. Rise slowly from a reclining position
c. Avoid taking Viagra while taking nitrates
d. Slow-release forms may act too slowly to help once an attack starts
e. Sublingual tablets should not be chewed nor swallowed

17
 f. Repeating sublingual tablets in 5-10 minutes for a maximum of 3
tablets. If no relief of chest pain within 15-30 minutes, call a physician
or report to the emergency room
g. Avoid physical and emotional stress

J. Vasoconstrictors
1. Ex. – Norepenephrine
2. Use – Shock
3. SE – palpitations, necrosis in injection site, hypertension
K. Aspirin
1. Action – prevent thrombose formation by inhibiting platelet aggregation
2. Use – Analgesics, Cerebrovascular thrombosis and embolism, prosthetic heart valve
3. SE – cerebrovascular hemorrhage, gastric irritation (reduced if film coated
tablet, enteric coated tablet and buffered aspirin preparation)
4. Contraindication – bleeding disorders, Peptic ulcer, gastritis, Dengue
hemorrhagic fever

Module 2F: Urinary System Drugs

A. Thiazides
1. Ex. – Hydrochlorthiazides
2. Use – Edema, hypertension, prophylaxis for kidney disorders
3. SE –
a. Hypokalemia may lead to cardiac arrhythmia
b. Muscle weakness, spasm, anorexia, vomiting, diarrhea
c. Postural hypotension, vertigo, headache, fatigue, lethargy
d. Hyperglycemia and increased in uric acid
5. Contraindication
a. Diabetes mellitus
b. Gout
c. Allergy for sulfonamides
d. Severe renal disease
e. Impaired renal function
6. Patient’s education
a. Eat potassium-rich foods
b. Take in with food to avoid gastric irritation
c. Take it in the morning to avoid disturbance of sleep
d. Rising slowly from reclining position to avoid postural hypotension
7. Interaction –
a. Corticosteroids increase the potassium loss
b. Potentiate hypotensive drugs
c. Reduce the renal clearance of lithium which may lead to lithium
toxicity
L. Loop Diuretics
1. Ex. – Furosemide

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 2. Use – Edema, Congestive heart failure, pulmonary edema, ascites, hypertension
3. SE – Dehydration, hypokalemia, hypotension
4. Contraindication – liver cirrhosis, renal failure, dehydration, digitalized patient,
diabetes mellitus, gout, pregnancy and lactation
5. Interaction –
a. same with thiazides
b. aminoglycosides increase the chance of deafness
c. Indomethacin and anticonvulsants decrease its diuretic effect

M. Potassium Sparing Diuretics

1. Ex. – Spironolactone
2. Use – edema, ascites, hypertension
3. SE
a. Hyperkalemia may lead to cardiac arrhythmia
b. Nausea, vomiting, diarrhea, dehydration, weight loss, hypotension,
gynecomastia
4. Caution – Renal failure, liver cirrhosis, pregnancy and lactation
5. Interaction
a. Potassium supplements, ACE inhibitors, salicylates, NSAID may cause
hyperkalemia
b. Reduced lithium clearance in the kidneys may lead to lithium toxicity
6. Patient’ education
a. Avoid potassium rich food
b. Rise slowly from reclining position
c. Report excessive dehydration and sudden weight loss and
hypotension
d. Take medication after meals

N. Osmotic Agents
1. Ex. – Mannitol and Urea
2. Use – decrease intraocular and intracranial pressure, excretion of toxin
3. SE – dehydration, hypotension, electrolyte imbalance
4. caution – renal and heart failure, pregnancy and lactation
5. Interaction – decrease the blood level of lithium and salicylates
6. Patient’s education – same with spirinolactone

O. Allopurinol
1. Use – prevent hyperurecemia and uric acid stone formation
2. SE – rash, fever, chills, nausea, vomiting, diarrhea, drowsiness, vertigo, allergy
3. Contraindication – Impaired renal and liver function, pregnancy and lactation
4. Interaction – alcohol and diuretics increase the serum level of urates
5. Patient’s education
a. Drink large quantities of water
b. Take medications after meals
c. Avoid alcohol and uric acid rich food

Evaluation:

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 The evaluation consists of written objective tests in the form of multiple choice questions, true
or false questions, matching and enumeration. This could be given in a normal face to face interaction or
it can be given through the use of Google Classroom platform in the Internet.

Module 3: Applied Pharmacology (Part 2)

Introduction:
This module is a continuation of Module 2. This module includes drugs used as antibiotics as well
as drugs used for diseases of the endocrine system and topical drugs.

Specific Objectives:
At the end of the module, the students are able to acquire basic understanding in the use of
antibiotics as well as drugs in the treatment of diseases of the endocrine system and topical drugs.

Time Frame: 14 hours

Module 3A: Antibiotics

A. Introduction
1. Treatment selection could be based on
a. Mode of action – bacteriostatic vs. Bactericidal
b. Causative agent
c. Resistance – due to frequent use, underdosage and short duration of
treatment
d. Age of the Patient
e. Hepatic and Renal Status
f. Pregnancy and Lactation
g. Allergy

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 2. Adverse Effect - Allergic Reaction – mild rash, hives, anaphylaxis

B. Penicillins - Bactericidal
1. Ex.
a. Penicillin G
b. Ampicillin and Amoxycillin (Extended spectrum)
c. Cloxacillin, dicloxacillin and oxacillin (penicillinase-resistant)
2. Use – Gram positive bacterial infection
3. SE – Allergy, super infection, diarrhea
4. Contraindication – allergy, impaired renal function
5. Interaction
a. Increased effect if used with probenecid and salicylates
b. Delayed absorption if with food and antacids
c. May inhibit the effect of estrogen pills
6. Patient’s education – take it with an empty stomach one hour before or two
hours after meals, avoid antacids

C. Cephalosporins - Bactericidal
1. Ex.
a. 1st generation cephalosporin – cephalexin, cephradine
b. 2nd generation cephalosporin – cefaclor, cefuroxime
c. 3rd generation cephalosporin – cefixime, cefotaxime
d. 4th generation cephalosporin - cefepime
2. Use –
a. 1st generation cephalosporin are for gram positive bacterial infection
b. 2nd, 3rd, and 4th generation cephalosporin are for both gram positive
and gram negative bacterial infection
3. SE – allergy, renal toxicity, nausea, vomiting, diarrhea, phlebitis at IV
administration site, pain at IM site and blood dyscrasias
4. Contraindication
a. Renal impairment
b. Prolong use may lead to superinfection
c. Pregnant nursing women and children
d. Allergy to penicillin
5. Interaction
a. Increased effectiveness with probenicid
b. Disulfiram-like reactions
c. Increased nephrotoxicity if used with macrolides or loop diuretics
6. Patient’s education – avoidance of alcohol, report for any sign of allergy and
abnormal bleeding

D. Macrolides - Bactericidal
1. Ex. – Erythromycin, Azithromycin, Clarithomycin
2. Use – if allergic to penicillin, diphtheria, syphilis, mycoplasma and chlamydial
infections, gram positive bacterial infections
3. SE – Superinfection, anorexia, nausea, vomiting, diarrhea, stimulate gastric
emptying
4. Contraindication – Liver dysfunction, alcoholism

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 5. Interaction
a. Increase the sedative effect of benzodiazepines
b. Can cause fatal cardiac arrhythmia if used with verapamil and diltiazim
(calcium channel blockers)
6. Patient’s education – take it 1 hour before or 2 hours after meals

E. Aminoglycosides - Bacteriostatic
1. Ex. – Gentamycin, Amikacin, Tobramycin
2. Use – Gram negative bacterial infection
3. Side effect – nephrotoxicity and ototoxicity (hearing loss and vertigo)
4. Contraindication
a. Tinnitus, vertigo, high frequency hearing loss
b. Dehydration and impaired renal function
c. Pregnant and nursing women
d. Infants and older adults
5. Patient’s education – report any hearing loss

F. Tetracyclines - Bacteriostatic
1. Ex. – Oxyterracycline, Minocycline, Tetracycline, Doxycycline
2. Use – Gram negative bacterial infection esp. Cholera el tor and Amebiasis
3. Side effect
a. Superinfection
b. Photosensitivity (exaggerated sunburn)
c. Discolored teeth in fetus and young children
d. Retarded bone growth in fetus and young children
4. Contraindication – pregnancy, lactation, children below 8 years old, direct
sunlight
5. Interaction
a. Decrease absorption with the use of antacids, calcium, iron and zinc
supplements, magnesium laxative
b. Pregnancy and breakthrough bleeding may occur with the use of oral
contraceptives
6. Patient’s education
a. Avoid exposure to sunlight
b. Avoid in pregnant and nursing mothers and children below 8 years
old
G. Nystatin
1. Use – antifungal
2. Caution – pregnant and nursing mothers
3. Patient’s education – take it for prolong period of time even if symptoms
subside

H. INH and Rifamficin – (Anti-TB drugs) - Bactericidal

1. Use – Tuberculosis, leprosy
2. Side effect – Peripheral neuropathy, hepatic toxicity, red-orange excretions
3. Contraindication - liver cirrhosis, alcoholism, impaired renal function
4. Interaction

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 a. May reduce blood levels of oral hypoglycemics, corticosteroids,
digitalis, anticoagulants, and estrogen
b. Increase the effect of Dilantin (diphenylhydantoin
c. Alcohol may increase the possibility of liver toxicity)
5. Patient’s education
a. Take the medication for several months even if asymptomatic
b. Birth control pills may be ineffective
c. Red-orange urine, sweat, saliva, tears and stool
d. Avoid alcohol

I. Metronidazole and Nitronidazole - Bacteriostatic

1. Use – amebiasis, Trichomonas vaginitis, gram negative bacterial infection
2. Side effect – metallic taste, dark urine, disulfiram-like reaction
3. Contraindication – alcohol, history of blood dyscrasias, pregnancy and lactation

J. Sulfonamides - Bacteriostatic
1. Ex. – Cotrimoxazole (Trimetoprim + Sulfamethoxazole)
2. Use – gram negative bacterial infection esp. UTI
3. Side effect – Blood dyscrasias, hepatic and renal toxicity, crystaluria
4. Contraindication – pregnancy and lactation, impaired hepatic and renal
function,
5. Interaction
a. Potentiation of anticoagulants and hypoglycemics
b. Antagonism with digitalis and dilantin
c. Procaine may inhibit the antibacterial activity of sulfonamides
6. Patient’s education – drink large amounts of water to avoid crystaluria

K. Quinolones - Bactericidal
1. Ex. – Ciprofloxacin, Norfloxacin, Ofloxacin
2. Use – gram negative bacterial infections
3. Side effect – headache, dizziness, insomnia, nausea, vomiting, diarrhea, dry
mouth, photosensitivity, bone marrow depression
4. Contraindication
a. caution in the presence of seizure and impaired renal function
b. allergy, pregnant and lactating women,
5. patient’s education – avoid exposure to sunlight

Module 3B: Endocrine System Drugs

A. Adrenal Corticosteroids
1. Ex. – Dexamethasone, Prednisolone, Prednisone
2. Action – anti-inflammatory drug
3. Use – allergy, autoimmune diseases, rheumatoid arthritis, bronchial asthma,
cancer, organ transplant, Addison’s disease
4. Side effect –
a. Delayed wound healing
b. Increased susceptibility to infection
c. Edema, hypertension, congestive heart failure

23
 d. Osteoporosis
e. Increased intraocular pressure and cataract
f. Stunted growth
g. Hyperglycemia
h. Amenorrhea
i. Cushing’s Syndrome
j. Gastric and esophageal ulceration and hemorrhage
k. Psychosis
l. Skin thinning
m. petechiae
5. Contraindication –
a. Infections
b. Liver cirrhosis (exaggerated response to corticosteroids)
c. Hypertension and congestive heart failure
d. Glaucoma
e. Psychosis
f. Diabetes mellitus
g. Peptic Ulcer
h. Thromboembolic disorders
i. Children, pregnant and lactating women
6. Interaction
a. Estrogen potentiate corticosteroids
b. NSAIDs may increase the chance of GI ulceration
c. Corticosteroids inhibits the antibody response to vaccines and toxoids
7. Patient’s education
a. Follow exact dosage
b. Do not use for prolong period of time
c. Do not discontinue abruptly
d. Take it after meals

B. Thyroid Agents
1. Ex. – levothyroxine
2. Action – increase metabolic rate
3. Use – hypothyroidism (cretinism and myxedema)
4. Side effect – Hyperthyroidism
5. caution – Diabetes mellitus, euthyroid persons
6. Interaction
a. Increase the dosage of insulins and hypoglycemics
b. Estrogen, oral contraceptives and soy products decrease thyroid
response
7. Patient’s education
a. Should be taken everyday for life
b. Laboratory examination for monitoring
c. Instruct the patient on the symptoms of hyperthyroidism

C. Antithyroid Agents
1. Ex. –Tapazole and Prophylthiouracil
2. Indication - Hyperthyroidism

24
 3. Side effect – Hypothyroidism
4. Caution – prolong therapy, pregnancy and lactation
5. Patient’s education – instruct the patient about symptoms of hypothyroidism

D. Insulin
1. Use – Diabetes mellitus type 1 and type 2 (if diet and oral hypoglycemics fail or
when on surgery, severe infection, pregnancy, diabetic ketoacidosis and coma
2. Types of Insulin
a. Rapid acting – very short duration – Lispro and Aspart – 15 min. onset
– 3 hr. duration
b. Regular – rapid acting, short duration – 30 min. onset and 8 hrs.
duration
c. Isophene (NPH) and lente – Intermediate acting – 1 r. onset and 24
hrs. duration
d. 70/30 combination – onset 30 min and 24 hrs. duration
e. Glargine and Ultralente – long acting – 4-6 hrs. onset and 28 hrs.
duration
3. Side effect –
a. Hypoglycemia – due to overdose of insulin, delayed or insufficient
food intake, excessive exercise may produce the following symptoms:
i. Increased perspiration
ii. Irritability and confusion
iii. Tremor, weakness and headache
iv. Blurred vision, convulsion, loss of consciousness
b. Hyperglycemia – due to insufficient insulin dose, infection, surgery
and other trauma, emotional stress and pregnancy which may
produce the following symptoms:
i. Dehydration, polyurea and excessive thirst
ii. anorexia and unexplained weight loss
iii. lethargy, weakness and fruity breath
4. Interaction – insulin is antagonized by corticosteroids, epinephrine,
contraceptive pills and estrogen
5. Patient’s education
a. In type 1 diabetes, insulin is given regularly, everyday and
continuously
b. Explain the signs and symptoms of hyperglycemia and hypoglycemia
c. Frequent small meals
d. Kept ready something sweet in case of hypoglycemia

E. Sulfonylureas
1. Ex. – Glibenclamide, Glipizide, Glimeride
2. Action – stimulate the pancreas to produce and release insulin
3. Use – Type 2 Diabetes Mellitus
4. Side effect – Hypoglycemia, increased risk for myocardial infarction,
disulfiram-like reaction
5. Caution – unstable diabetes mellitus, major surgery, severe infection, severe
trauma

25
 6. Interaction
a. Potentiated by beta blockers
b. Antagonized by NSAIDs, thyroid hormone, diuretics, corticosteroids,
phenothiazines, estrogen, contraceptives, calcium channel blockers,
INH and rifampicin

F. Alpha-Glucosidase Inhibitors
1. Ex. – Acarbose, Voglibose
2. Action – delay the digestion of complex carbohydrates and delay its absorption
3. Use – Type 2 diabetes mellitus
4. Side effect –flatulence, abdominal pain, abdominal distention, diarrhea
5. Caution – inflammatory bowel disease, intestinal obstruction, pregnancy,
lactation and use in children
6. Patient’s education – take it at the start of a meal
G. Biguanides
1. Ex. – Metformin
2. Action – decrease hepatic glycogenolysis and enhance insulin sensitivity in
muscles
3. Use – Diabetes mellitus
4. Side effect – anorexia, hypoglycemia
5. Contraindication
a. Pregnancy, lactation, children and the elderly
b. Withhold metformin 48 hrs. before administration of radiocontrast
dye (may cause renal failure)
6. Interaction – increase metformin effect with alcohol, calcium channel blockers,
cimetidine, furosemide, digoxin, ranitidine and trimetoprim
H. Miglitinides
1. Ex. – Netiglinide and repaglinide
2. Action – stimulate the pancreas to produce insulin
3. Use – Type 2 Diabetes mellitus
4. Side effect – hypoglycemia
5. Caution – pregnancy, lactation and children
6. Patient’s education – take it before meals to maximize absorption
I. Thiazolidinediones
1. Ex. –Pioglitazone and Rosiglitazone
2. Action – decrease insulin resistance in muscle and adipose tissues
3. Use – Type 2 Diabetes mellitus
4. Side effect – edema, hypoglycemia
5. Caution
a. May cause resumption of ovulation in premenopausal women so
increase the risk for pregnancy
b. Pregnancy, lactation and children
6. Interaction – Pioglitazone reduce the effectiveness of contraceptives
J. Patient’s education for Type 1 Diabetics
1. rotate site of insulin injection
2. do not shake vial, rotate gently
3. store unopened insulin at 2-8 degrees centigrade (not freezing)
4. opened insulin may be stored at room temperature at less than one month

26
 5. Never omit insulin
K. Patient’s education for Type 2 Diabetics
1. Proper diet therapy. Never skip meals
2. carry ready source of carbohydrates in case of hypoglycemia
3. Proper balanced diet – limit calories, avoid simple sugars, reduce fat, increase fiber
4. regular exercise – proper body weight
5. carry ID
6. take meds approximately same time each day
7. check FBS regularly

L. Phosphodiesterase Inhibitors
1. Ex. – Seldenafil, Vardenafil, Tadalafil
2. Action – peripheral vasodilators
3. Use – Impotence
4. Side effect –
a. syncope, tachycardia, hypotension and 2% have angina pectoris
b. nasal congestion, flushing, headache
5. Contraindication - Concurrent use of nitrates and macrolides potentiate its
hypotensive effect
6. Patient’s education - If erection present more than 4 hours, consult physician
M. Contraceptive Pills (combined estrogen and progesterone)
1. Action
a. Suppress the release of FSH and LH thus prevent ovulation
b. Make cervical mucus thick to prevent sperm penetration
c. Make the endometrium thin thus not conducive for implantation
2. Use
a. Prevention of pregnancy
b. Endometriosis
c. Painful heavy periods
d. Irregular menstrual cycle
e. Acne
f. progesterone decrease the incidence of ovarian cyst, ovarian and
endometrial cancer, benign breast tumor, ectopic pregnancy and
pelvic inflammatory disease
3. Side effect –
a. fluid retention and weight gain
b. Bleeding between periods and scanty menstrual flow
c. Mood changes and changes in libido
4. Caution
a. More than 35 years old, currently smoking 15 or more cigarettes per
day
b. Migraine headache at the start of taking pills
c. Hypertension
d. Diabetes mellitus
e. Undiagnosed vaginal bleeding
f. Lactation
5. Contraindication – Estrogen is contraindicated in:

27
 a. Thrombophlebitis, Thromboembolic disorders, Cerebrovascular
disease
6. Patient’s education
a. Use backup contraceptive in the first month on oral contraceptives
and first 2 weeks of Depo-Provera
b. Take the pills at the same time of the day
c. If missed one pill, double it the next day but use backup methods
until the next period begins. If 2 or more pills are missed, stop the
pills wait for the next period and start another pack of pills
d. Stops using the pills if you suspect pregnancy
e. Stop smoking
f. Report to the health care providers if these symptoms appear
i. Chest pain
ii. Severe headache
iii. dizziness and weakness
iv. numbness and severe leg pain
N. Oxytocin
1. Ex. Syntocinon
2. Action – cause contraction of uterine muscles in labor
3. Use – Induction of labor
4. Side effect - tetanic contraction of uterine muscles may lead to:
a. Uterine rupture
b. Cervical laceration
c. Abruptio placenta
d. Fetal trauma
e. Fetal asphyxia
5. Contraindication
a. Cephalopelvic disproportion
b. Transverse lie
c. Breech presentation
d. Cervical and uterine scarring from previous surgery
e. Fetal distress
f. Placenta previa
g. Cord coil and cord prolapse
h. Multiparity

O. Methylergometrine
1. Use – Methergin
2. Use – Postpartum and post-abortion hemorrhage
3. Side effect – abdominal pain
4. Contraindication –
a. may lead to retained placenta if given at the 3rd stage of labor
b. Placenta previa

Module 3C: Topical Drugs

A. Antipruritics
1. Ex.
a. Local anesthetic – benzocaine

28
 b. Drying agents – calamine
c. Anti-inflammatory – corticosteroids
d. Antihistaminics - diphenhydramine
2. Action – relieve itching
3. Use – dermatitis, allergic reaction, hives, insect bites
4. Side effect – allergy
5. Contraindication – in open wounds, corticosteroids slows healing
6. Patient’s education
a. Short term use
b. Avoid contact with eyes or mucus membrane

B. Topical Corticosteroids
1. Ex. Dexamethasone, prednisone
2. Use – skin allergy, psoriasis
3. Side effect – epidermal thinning, skin tear, slow healing, increased risk for
infection
4. Contraindication – skin infections, open wounds immunosuppressed, cancer
chemotherapy
C. Keratolytics
1. Ex. – salicylic acid, sulfur, coal tar, podophyllin
2. Use – dandruff, psoriasis, wart, corns, calluses, seborrheic dermatitis
3. Side effect – skin irritation
4. Patient’s education
a. Avoid contact with eyes and mucus membranes
b. Avoid contact with normal surrounding tissues
D. Scabicides or Pediculocides
1. Ex. – Permethrin (Kwell), Benzyl benzoate
2. Use – Scabies, pediculuosis pubis, corporis and capitis
3. Contraindication – acutely inflamed, raw and weeping surface
4. Patient’s education
a. Follow instruction in the administration of Lindane
b. Treat close contact
c. Wash and dry in sunlight the beddings and clothing

E. Antifungals
1. Ex. – Nystatin, Clotrimazole, Ketoconazole, tolnaftate
2. Use –
a. Ointment or cream for fungal infection of the skin
b. lozenges for oral thrush
3. Side effect – allergy
4. Contraindication – vaginal preparations are contraindicated in pregnancy
5. Patient’s education
a. Expose to air
b. With genital fungus, avoid tight undergarments
c. Athlete’s foot – use open sandals
d. For oral suspensions and lozenges – apply after meals after thorough
rinsing of the mouth – no food or liquid for at least one hour after
treatment

29
 F. Local Antiseptics
1. Ex. – Chlorhexidine, Providone-iodine
2. Use – inhibit bacterial growth (bacteriostatic), may kill bacteria (bactericidal)
3. Side effect – skin irritation
G. Burn Medication
1. Ex. – silver sulfadiazine, mafenide, nitrofurazone
2. Use – prevent infections on burns
3. Side effect – pain, itching, burning sensation
4. caution – allergy to sulfonamides

Evaluation:
The evaluation consists of written objective tests in the form of multiple choice questions, true
or false questions, matching and enumeration. This could be given in a normal face to face interaction or
it can be given through the use of Google Classroom platform in the Internet.

Reference

Adams, M. P. et al. (2018) Pharmacology for Nurses: Pathophysiological Approach. 2nd Canadian ed.
Ontario: Pearson.

DePiro, J. et al. (2020) Pharmacotheraphy. New York: McGraw-Hill.

Hassens, C. & Wojcek, B. (2019) Dosage calculations for Nursing Students New York: McGraw-Hill
.
McFadden, R. (2019) Introducing Pharmacology for Nursing and Healthcare 3rd ed. New York: Rutledge.

Sharma, S. & Valpadean, T. (2019) Illustrated Review in Pharmacology New York: Wolters Kluwer.

30
 Modules in
Nursing
Pharmacology
Prepared by:

Vincent Dave L. Farhat M.D., Ed.D.

31