NCM 106 (PHARMA) - FINALS

GASTROINTESTINAL DRUGS  Gynecomastia may developed with

chronic use of cimetidine.
Antacids

Prototype : Proton – Pump Inhibitors (PPI)

● aluminum/magnesium OH (Maalox)
● sodium bicarbonate (Alka-Seltzer), Prototype :
calcium carbonate (Tums)  omeprazole (Losec)
● magnesium hydroxide (Milk of  Lansoprazole (Lanz),
Magnesia).  pantoprazole (Pantoloc)

Mechanism of actions Mechanism of action :

● neutralize the stomach acidity.  inhibit the proton H+ to combine
with Cl to form hydrochloric acid
Adverse effects :
● metabolic alkalosis, stone formation Nursing considerations :
● electrolyte imbalance, diarrhea  Given before meals
(magnesium)
● constipation (aluminum). Mucosal Barriers

Nursing considerations : Prototype :

● Give 1 hr after meals.  sucralfate (Carafate)
● Avoid giving medications within 1-2
 misoprostol (Cytotec)
hrs of antacid administration

(decreases absorption).
Mechanism of action :
● Monitor for changes of bowel
 coats the mucosa to prevent
patterns.
ulcerations

Histamine – 2 blockers
Nursing consideration :
Prototype :  Given before meals
 cimetidine (Tagamet)  Misoprostol is contraindicated for
pregnant
● ranitidine (Zantac),
● famotidine (Pepcid),  Sucralfate cause constipation.
● nizatidine (Axid).
Anti-diarrheal Agents
Mechanism of action:
 blocks H2 receptors in the stomach, Prototype :
reducing acid secretions.  diphenoxylate (Lomotil),
 loperamide (Imodium)
Nursing considerations :  kaolin/pectin mixture (Kaopectate)
 Given before or with meals.
 Avoid giving other drugs with Mechanism of actions :
cimetidine.  decrease GI motility and peristalsis
NCM 106 (PHARMA) - FINALS

Nursing considerations : Emetics

 monitor for rebound constipation.
 be cautious taking if with infectious Prototype : ipecac syrup, apomorphine
diarrhea.
Mechanism of actions :
Laxatives  stimulates the vomiting center in
medulla
Hyperosmolar laxatives
- lactulose (Cephulac), Na biphosphate Indications :
(Fleet enema)  ingestion of poisonous or toxic
- magnesium salt (Milk of Magnesia) substances

Emollient laxatives (stool softeners) Nursing considerations :

- ducosate (Dialose)  Consult poison control center
before induction of vomiting (not
Stimulant laxatives use for corrosive poisoning)
- bisacodyl (Dulcolax), senna (X-prep),
castor oil Antiemetic
Prototype :
Bulk-forming laxatives  antihistamine - diphenhydramine,
- psyllium (Metamucil), methyllcelulose meclizine, trimethobenzamide
 phenothiazine - chlorpromazine,
Lubricant laxatives - mineral oil promethazine
 serotonin receptor antagonist –
Nursing considerations : ondansteron
 Laxatives should not be used for  miscellaneous – metoclopramide
long term therapy.
 Maintain stools to 2-3 times per/day Mechanism of action :
 Maintain fluid intake while on  they block the dopamine and
laxatives serotonin receptor in the
 Abdominal discomfort is expected chemoreceptor trigger zone
particularly in stimulant laxative.
Indications :
The nurse tells a patient that the group of  Meniere’s disease and motion
laxatives that is considered the safest and sickness (antihistamine)
most natural is the ?...  Post-operative and post-
chemotherapy induced nausea and
a. Stimulant laxative group vomiting (phenothiazine and
b. Lubricant laxative group serotonin antagonist)
c. Stool softener group
d. Bulk-forming laxative group
NCM 106 (PHARMA) - FINALS

Adverse effects : a. Iodine - potassium iodide, Lugol’s

 depression solution
 Endolymphatic hydrops
 Vertigo side effects : vomiting, abdominal pain
 Tinnitus
 Hearing loss 3. Destroying thyroid tissue
a. Radioactive Iodine (131i)
 advise to flush toilet 3 times after
using
HORMONAL DRUGS AND DRUGS FOR  major complication is
LABOR AND LACTATION hypothyroidism
 not used for pregnant women
Endocrine System - Releases hormones
Levothyroxine is ordered to the client with
hypothyroidism. Before giving this drug, the
Thyroid Agents nurse should not only verify the doctor
orders but also:
Prototype : A. Take the weight of the client
● Proloid (thyroglobulin ) B. Take the BP and PR of the patient
● Synthroid (levothyroxine) - DOC C. Advise the client to stay in bed
● Cytomel ( liothyronine) D. Take the body temperature and RR

Mechanism of action : Which of the following nursing statements

 function as natural or synthetic regarding thyroid extracts (Levothyroxine)
hormones. require a further education ?
a. “Increase in weight gain and fatigue
Nursing considerations : may suggest that patient is under dose of
● Taken in the morning. this drug.”
● Caution with coronary artery b. “Palpitation and tachycardia are the
disease. side effects of this drug.”
● Monitor for signs of overmedication c. “The effect of this drug will be noticed
and under medications. after 1-2 weeks of continuous medication.”
d. “This drug should be taken at
Antithyroid Drugs bedtime.”

1. Inhibit hormone synthesis and action: Drugs used for Parathormone disorders
a. Thiomides - propylthiouracil (PTU)
methimazole (Tapazole) Prototype :
a. calcitonin (Calcimar)
side effects : leukopenia, bleeding etidronate (Didronel)
- for hyperparathyroidism - reduce
2. Inhibit release of thyroid hormone and bone resorption
reduce the vascularity of the thyroid gland. b. calcitrol (Rocaltrol), calcifediol
(Calcedrol)

DM 1 - JUVENILE ONSET
destruction of beta cells
 1st sign of hypoglycemia - RESTLESSNESS
Last sign - SEIZURES/COMA
NCM 106 (PHARMA) - FINALS
normal level of sugar - 60-200 (random)
60-120 (fasting)
- for hypoparathyroidism - promotes  Given before meals.
calcium absorption  Monitor for signs of hypoglycemia.

Nursing considerations : The nurse explains to the client that OHA

 Monitor for signs of calcium (Tolbutamide) is believed to lower the blood
imbalances. glucose level by which of the following
 Take calcitrol with vitamin D. actions?
 Take etidronate in an empty a. Potentiating the action of glucagon.
stomach and remain sitting upright. b. Lowering the renal threshold of
glucose.
Oral Hypoglycemic Agents (OHA) c. Stimulating insulin release from the
functioning beta cells in the pancreas.
1. Sulfonylureas d. Combining with glucose to render its
- stimulate insulin secretions and inert effect.
increase tissue sensitivity to insulin.
 Chlorpropamide (Diabenese) The nurse should monitor for which
 Tolbutamide (Orinase) potential serious side effect of the drug
 Glypizide OHA?
 Glymepiride a. Lactic acidosis
b. Explosive diarrhea
2. Biguanides c. Hypoglycemia
- facilitates insulin action on the d. Ketoacidosis
peripheral receptor site.
 Metformin and Glucophage A client with D.M. is taught to take NPH
insulin at 8:00 AM each day. At which time
3. Alpha-glucosidase inhibitors would the client be at greatest risk for
- delay carbohydrate absorption in the hypoglycemia..?
intestinal system. -sugar eliminate
 Acarbose (Precose) causing diarrhea a. About 11 AM, shortly before lunch
- pampaniwang b. About 2 PM, shortly after lunch
4. Thiazolinidine c. About 5 PM, shortly before dinner
- increase tissue sensitivity of insulin. d. About 11 PM, shortly before bed time
 Rosiglitazone (Avandia)

Nursing considerations :
5. Meglitinides
- stimulate insulin release in pancreatic B-  Usually given before meals.
cells.  Roll the bottle in palm of hands,
 Repaglinide (Prandin) don’t shake.
 Cleanse the bottle with alcohol
Nursing considerations :  Aspirate short acting first (clear),
 Effective only for type II DM. then long or intermediate (cloudy).
 Contraindicated to pregnant &  Pinch skin, avoid I.M, don’t aspirate.
breastfeeding.  Rotate the injection site an inch a
part.
NCM 106 (PHARMA) - FINALS

 Advice patient to sought consultation Estrogen and Progestin

during illnesses to increase dose.
 Prefilled syringes are stored Prototype :
vertically, needle-up.  estrogen (Premarin)
 Used bottles stored for 2 months in  estrone (Bestrone)
room temperature; unused bottle  estradiol (Estrace)
stored in refrigerator. Frozen are  diethylstilbestrol (DES)
discarded.
 Monitor for acute hypoglycemia : Indications :
a. 3-4 commercially prepared glucose  prostate cancer, prevent
tablet 75-100 g osteoporosis,
b. 4-6 ounce of fruit juice or regular  control symptoms of menopause,
soda and contraception
c. 2-3 teaspoon of honey 
d. Glucagon 1 gm SQ or IM Adverse effects :
e. D50-50 IV.  estrogen – endometrial and breast
CA, gallbladder disease, HPN,
migraine
Morning hyperglycemia  progesterone - altered menstrual
a. Dawn phenomenon flow, risk of embolism
- result from decrease in tissue
sensitivity to insulin Nursing considerations :

b. Insulin waning 1. Monitor blood pressure

- a declining effect of insulin 2. Teach patient how to perform BSE.
3. Regular follow-up examination is
d. Somogyi phenomenon required to detect associated risk of
- rebound hyperglycemia after acquiring CA.
hypoglycemia as effect of other counter- 4. Educate patient taking OCP’s that they
regulatory hormones. may have delay in ovulation for 6
months after withdrawal of drugs.
In a diabetic client suffering from pain, what
medication the nurse should question that Growth Hormone
may aggravate the hyperglycemia of the
client? Prototype : Somatropin ( Humatrope)
A. Steroids
B. NSAID’s Indication : Dwarfism secondary to growth
C. Muscle relaxant hormone failure
D. Narcotics
Nursing consideration :
 Not given to patient more than 20 to
25 years old.
 given at bedtime
NCM 106 (PHARMA) - FINALS

The nurse reviews the assessment data in Mechanism of actions :

the client’s health record, knowing that a. stimulates uterine muscles
growth hormone is contraindicated in which (cervical dilatation)
of the following conditions? b. ripening of cervix
A. A child with growth hormone deficiency (cervical effacement)
B. A 25-year-old with growth failure c. prevent postpartum bleeding
C. A child with pituitary dwarfism
D. A child with stunted growth Adverse reactions:
 fetal bradycardia (oxytocin)
Anti-diuretic hormones  maternal tachycardia
 hypertension palpitations
Prototype : Vasopressin, Desmopressin (ergonovine)
Lypressin (Diaped)  allergic reactions (prostaglandins)

Indications : Uterine Inhibiting Agents (Tocolytic)

 diabetes insipidus
 bleeding Prototype :
  ritodrine (Yutopar),
Nursing considerations :  terbutaline (Brethine)
 Given through IM or intranasal route  magnesium sulfate
 Precautions for patient with cardiac 
ischemia Mechanism of actions :
 relaxes the uterus by stimulating the
The nurse administers the prescribed B2-adrenergic receptors
vasopressin to a patient with Diabetes 
Insipidus through IM route in the evening . Nursing considerations:
This drug is given to the client because it  tremors, nausea, vomiting and
acts to : tachycardia
A. Decrease tubular reabsorption of water  in giving magnesium sulfate monitor
B. Decrease tubular reabsorption of salt :hypotension, hyporeflexia,
and water bradypnea and oliguria
C. Increase tubular reabsorption of water
D. Increase tubular reabsorption of salt Which statements concerning
and water methylergonovine (Methergine ) is correct?
It is given:..
Uterine Stimulating Agents (Uterotonics) a. to manage premature labor
b. in the first stage of labor
Prototype :
c. after placental delivery
a. Oxytocin (Pitocin) d. to increase BP
ergonovine (Ergotrate)
methylergonovine (methergine)
b. carbopost (Prostin)
dinoprostone (Prostin E2)