Prototype Drugs

Epinephrine (Adrenalin) Class

Non-selective Adrenergic Agonist (Sympathomimetic)

Epinephrine (Adrenalin) Why Prescribed (indications & Use) Hinit:4

1.) Emergency Anaphylaxis & severe allergic reactions

2.) Cardiac Arrest / Asystole / VFib

3.) Severe Asthma & Bronchospasm

4.)Hypotensive Shock

Epinephrine (Adrenalin) - Why it helps (mechanism & action)

Stimulates α 1 , β 1 , and β 2 receptors:

α 1 : Vasoconstriction (elevates BP, reduces mucosal edema)

β 1 : Inotropic/chronotropic (increases HR, contractility, cardiac output)

β 2 : Bronchodilation (relaxes bronchial smooth muscle)

Epinephrine (Adrenalin) - HOW Administered (Route & Technique)

1.) Anaphylaxis: IM into outer thigh (Vastus Lateralis) via EpiPen. Hold for 10 seconds.

2.) Cardiac Arrest: IV/IO push (1 mg q3-5min). •

3.) Inhalation: Nebulized racemic epinephrine for croup.

Epinephrine (Adrenalin) - WHAT to Monitor & Teach (Nursing, BBWs & Safety)

Vital Signs: Monitor continuous ECG, HR, BP closely.

Patient Teaching: Carry EpiPen at all times; inject immediately into outer thigh through clothing if exposed; seek emergency care right after use.

Precautions: Extreme caution in CAD, hyperthyroidism, hypertension.

Epinephrine (Adrenalin)

Tachycardia, dysrhythmias, chest pain, tremors, anxiety, hypertension, hyperglycemia.

Atenolol (Tenormin) - Class

Selective β 1 -Adrenergic Antagonist (Beta-Blocker / Sympatholytic)

Atenolol (Tenormin) - WHY Prescribed (Indications & Use) hinit: 4

1.) Hypertension

2.) Angina Pectoris

3.) Post-Myocardial Infarction (MI) cardioprotection

4.)Cardiac Dysrhythmias

Atenolol (Tenormin) - WHY It Helps (Mechanism & Action)

Selectively blocks β 1 -adrenergic receptors located primarily in cardiac muscle:

Decreases Heart Rate (negative chronotrope)

Decreases Contractility (negative inotrope)

Reduces Myocardial Oxygen Demand

Inhibits Renin release from kidneys

Atenolol (Tenormin) - HOW Administered (Route & Technique)

Oral (PO): Take consistently with or without food.

Check apical pulse & BP immediately before administering.

Atenolol (Tenormin) - WHAT to Monitor & Teach (Nursing, BBWs & Safety)

Nursing Priority: HOLD dose if Apical Pulse < 60 bpm or Systolic BP < 90 mmHg.

BLACK BOX WARNING / Safety: Do NOT stop abruptly! Taper over 1-2 weeks to avoid rebound hypertension, severe angina, or MI.

Diabetic Teaching: Masks hypoglycemia symptoms (tachycardia, tremors); diaphoresis remains key sign.

Atenolol (Tenormin) - Adverse Effects:

Bradycardia, hypotension, fatigue, dizziness, heart failure exacerbation (monitor for crackles, weight gain, peripheral edema).

Which two drugs are Adrenergic Agents (Sympathetic Nervous System)

Epinephrine (Adrenalin) and Atenolol (Tenormin)

Which drug is CHOLINERGIC (Parasympathetic System)?

Bethanechol Chloride (Urecholine)

Bethanechol Chloride (Urecholine) - Class?

Direct-Acting Cholinergic Agonist (Parasympathomimetic)

Bethanechol Chloride (Urecholine) - WHY Prescribed (Indications & Use)

1.) Non-obstructive Urinary Retention (post-operative or postpartum) 2.) Neurogenic bladder atony

Bethanechol Chloride (Urecholine) - WHY It Helps (Mechanism & Action)

1.) Directly stimulates muscarinic acetylcholine receptors:

2.) Contracts the detrusor muscle of the bladder

3.) Relaxes trigone and urinary sphincter (promotes micturition)

4.) Increases GI motility and tone

Bethanechol Chloride (Urecholine) - HOW Administered (Route & Technique)

Oral (PO): Take on an empty stomach (1 hr before or 2 hrs after meals) to reduce nausea/vomiting.

Bethanechol Chloride (Urecholine) - WHAT to Monitor & Teach (Nursing, BBWs & Safety)

Assessment: Monitor I&O;, voiding patterns, BP, and HR.

Contraindications: Mechanical GI or GU obstruction, asthma/COPD, peptic ulcer, severe bradycardia.

ANTIDOTE: Keep Atropine Sulfate readily available for cholinergic crisis

Bethanechol Chloride (Urecholine) - Side Effects

Abdominal cramps, diarrhea, excessive salivation, sweating, flushing, bronchospasm, bradycardia, hypotension.

Atropine (Atropen) - Class

Anticholinergic / Muscarinic Antagonist (Parasympatholytic

Atropine (Atropen) - WHY Prescribed (Indications & Use)

1. ) Symptomatic Bradycardia

2. Pre-operative reduction of secretions

3. Antidote for Cholinergic Toxicity / Organophosphate poisoning

Atropine (Atropen) - WHY It Helps (Mechanism & Action)

1. Competitively blocks acetylcholine at muscarinic receptors:

2. Increases SA node discharge & AV conduction (increases HR)

3. Inhibits salivary, bronchial, and gastric secretions

4. Causes mydriasis (pupil dilation) and cycloplegia

Atropine (Atropen) - HOW Administered (Route & Technique)

IV Push: Rapid IV administration for bradycardia (0.5 - 1 mg q3-5min, max 3 mg).

IM / SubQ / Ophthalmic

Atropine (Atropen) - WHAT to Monitor & Teach (Nursing, BBWs & Safety)

Monitoring: Continuous cardiac monitoring, HR, BP, I&O.;

Contraindications: Narrow-angle glaucoma, severe ulcerative colitis, GI obstruction, obstructive uropathy.

Atropine (Atropen) - Side Effect

Dry mouth, urinary retention, constipation, blurred vision, tachycardia, hyperthermia.

Anticholinergic Mnemonic: 'Dry as a bone, red as a beet, blind as a bat, mad as a hatter, hot as a hare.'

Benztropine (Cogentin) - Class

Centrally-Acting Anticholinergic (Antiparkinson Agent)

Benztropine (Cogentin) - WHY Prescribed (Indications & Use)

1. Parkinson's Disease (tremor/rigidity)

2. Drug-Induced Extrapyramidal Symptoms (EPS) / Acute Dystonia from antipsychotics

Benztropine (Cogentin) - WHY It Helps (Mechanism & Action)

1. Blocks muscarinic receptors in the central nervous system:

2. Restores balance between dopamine and acetylcholine in the basal ganglia

3. Suppresses involuntary tremors and muscle rigidity

Benztropine (Cogentin) - HOW Administered (Route & Technique)

Oral (PO): Administer with meals or at bedtime to reduce GI distress.

IV / IM: For acute dystonic reactions.

Benztropine (Cogentin) - WHAT to Monitor & Teach (Nursing, BBWs & Safety)

Assessment: Assess for resolution of muscle spasms/EPS and Parkinsonian symptoms.

Monitoring: Bowel sounds/constipation (paralytic ileus risk), urinary retention, mental status (confusion/hallucinations in elderly).

Patient Safety: Decreases sweating (anhydrosis) → risk

Tolterodine Tartrate (Detrol / Detrol LA) - Class

Antimuscarinic / Antispasmodic (Urinary Tract Agent)

Tolterodine Tartrate (Detrol / Detrol LA) - WHY Prescribed (Indications & Use)

Overactive Bladder (OAB) with symptoms of urge incontinence, urgency, and frequency

Tolterodine Tartrate (Detrol / Detrol LA) - WHY It Helps (Mechanism & Action)

1. Competitively inhibits muscarinic (M2 , M3 ) receptors in the urinary bladder:

2. Relaxes detrusor smooth muscle

3. Decreases uninhibited bladder contractions • Increases bladder storage capacity

Tolterodine Tartrate (Detrol / Detrol LA) - HOW Administered (Route & Technique)

Oral (PO): Immediate Release (BID) or Extended Release LA (once daily). Swallow LA capsules whole

Tolterodine Tartrate (Detrol / Detrol LA) - WHAT to Monitor & Teach (Nursing, BBWs & Safety)

Monitoring: Urinary frequency, urgency, voiding volumes, and post-void residual urine.

Precautions: Caution in renal/hepatic impairment, narrow-angle glaucoma, controlled severe bladder outlet obstruction.

Tolterodine Tartrate (Detrol / Detrol LA) -

Dry mouth (xerostomia), constipation, dry eyes, blurred vision, dizziness, somnolence.

Solifenacin Succinate (Vesicare) - Class

Selective Urinary Antimuscarinic / Bladder Antispasmodic

Solifenacin Succinate (Vesicare) - WHY Prescribed (Indications & Use)

Overactive Bladder (OAB) with urge urinary incontinence, urgency, and urinary frequency

Solifenacin Succinate (Vesicare) - WHY It Helps (Mechanism & Action)

1. Selective antagonist at M3 muscarinic receptors in bladder detrusor muscle:

2. Exerts direct antispasmodic action on bladder smooth muscle

3. Reduces detrusor muscle hypertonicity and muscle spasms

Solifenacin Succinate (Vesicare) - HOW Administered (Route & Technique)

Oral (PO): Administer once daily with liquids; swallow whole with or without food.

Solifenacin Succinate (Vesicare) - WHAT to Monitor & Teach (Nursing, BBWs & Safety)

Assessment: Track daily voiding episodes, urge incontinence events.

Safety Warnings: Can prolong QT interval; risk of angioedema.

Patient Teaching: Report inability to void, severe abdominal pain/constipation, or blurred vision immediately

Solifenacin Succinate (Vesicare) - Adverse Effects

Severe dry mouth, constipation, urinary retention, dry eyes.

Potassium Chloride (KCl) - Class

Essential Electrolyte / Intracellular Cation Replacement

Potassium Chloride (KCl) - WHY Prescribed (Indications & Use)

Treatment & Prevention of Hypokalemia (< 3.5 mEq/L)

Potassium depletion from diuretic therapy, GI losses, or ketoacidosis

Potassium Chloride (KCl) - WHY It Helps (Mechanism & Action)

1.) Primary intracellular cation (ICF):

2.) Essential for conducting nerve impulses

3.) Maintains cardiac, skeletal, and smooth muscle contraction

4.) Regulates acid-base balance and cell membrane excitability

Potassium Chloride (KCl) - HOW Administered (Route & Technique)

Oral (PO): Take with food and a full glass of water to prevent GI erosion.

IV Infusion: MUST use IV infusion pump. Dilute thoroughly.

CRITICAL SAFETY: NEVER IV PUSH, SubQ, or IM! (Fatal cardiac arrest).

Max rate: 10 mEq/hr (med-surg); 20 mEq/hr (ICU with cardiac monitor).

Potassium Chloride (KCl) - WHAT to Monitor & Teach (Nursing, BBWs & Safety)

Renal Rule: Check renal function & urine output (≥ 30 mL/hr) — 'No pee, no K!'

ECG Monitoring: Hyperkalemia = Peaked T waves, wide QRS; Hypokalemia = Flattened T waves, U waves.

IV Site: Monitor peripheral line for phlebitis, burning, and tissue extravasation.

Potassium Chloride (KCl) - Range

3.5 - 5.0 mEq/L

Calcium (Gluconate / Chloride) - Class

Essential Mineral / Cation Replacement

Calcium (Gluconate / Chloride) - WHY Prescribed (Indications & Use)

1.) Hypocalcemia (< 8.6 mg/dL)

2.) Hyperkalemia / Hypermagnesemia cardiac toxicity (cardioprotection)

3.) Tetany, severe hypocalcemic seizures

Calcium (Gluconate / Chloride) - WHY It Helps (Mechanism & Action)

Essential extracellular cation:

1. Regulates nerve transmission, cardiac & muscle contraction

2. Required for blood coagulation cascade

3. Calcium Chloride has 3x more elemental calcium than Calcium Gluconate

Calcium (Gluconate / Chloride) - HOW Administered (Route & Technique)

Oral (PO): Give 1-2 hrs after meals with Vitamin D.

IV Slow Infusion: Administer slowly (max 0.5-2 mL/min). Calcium Chloride requires central line preferred (vesicant).

Calcium (Gluconate / Chloride) -

Assessment: Trousseau's Sign (carpopedal spasm) & Chvostek's Sign (facial twitching) indicate hypocalcemia/tetany.

Monitoring: ECG for bradycardia, cardiac arrest, QT shortening during IV administration.

Digoxin Caution: IV calcium increases risk of fatal digoxin toxicity

Calcium (Gluconate / Chloride) - Range

8.6 - 10.2 mg/dL.

Crystalloid Solutions (0.9% NS, LR, D5W) - Class

Intravenous Fluid Replacement (Small Molecule)

0.9% NS (Isotonic) - WHY Prescribed (Indications & Use)

Shock, fluid resuscitation, blood transfusion.

Lactated Ringer's (LR, Isotonic) - WHY Prescribed (Indications & Use)

Burns, trauma, surgery.

D5W (Hypotonic in body) - WHY Prescribed (Indications & Use)

Hypernatremia, dehydration

Crystalloid Solutions (0.9% NS, LR, D5W) - WHY It Helps (Mechanism & Action)

1. Supplies water, dextrose, and electrolytes to restore volume:

Crystalloid Solutions (0.9% NS, LR, D5W) - HOW Administered (Route & Technique)

IV Infusion: Infuse via IV line using proper gravity or pump rate based on fluid balance requirements.

Crystalloid Solutions (0.9% NS, LR, D5W) - WHAT to Monitor & Teach (Nursing, BBWs & Safety)

Assessment: Monitor lung sounds (crackles), BP, HR, daily weights, I&O;, serum electrolytes & osmolality.

Contraindications: D5W contraindicated in infant/head injury (increased ICP/cerebral edema). LR contraindicated in severe liver disease (lactate) & renal failure (potassium).

Crystalloid Solutions (0.9% NS, LR, D5W) - Fluid Overload Signs:

Dyspnea, bounding pulse, peripheral edema, JVD.

Isotonic (275-295 mOsm/kg):

Expands ECF/intravascular space.

Hypotonic (< 275 mOsm/kg)

Shifts fluid into cells (swelling).

Hypertonic (> 295 mOsm/kg)

Draws fluid out of cells (shrinkage).

What are the two Colloid Solutions?

Albumin 5% and 25%, Dextran

What are the three Crystalloid Solutions?

0.9% NS, LR, and D5W

Colloid Solutions (Albumin 5%/25%, Dextran) - Class

Plasma Volume Expanders (Large Molecule)

Colloid Solutions (Albumin 5%/25%, Dextran) - WHY Prescribed (Indications & Use)

Hypovolemic Shock, severe hemorrhage, major burns, severe hypoalbuminemia, ascites in liver failure

Colloid Solutions (Albumin 5%/25%, Dextran) - WHY It Helps (Mechanism & Action)

High molecular weight protein/starch particles remain in vascular bed:

1. Raises plasma oncotic pressure ('vacuum cleaner')

2. Pulls fluid from interstitial spaces into blood vessels

3. Rapidly expands intravascular blood volume

Colloid Solutions (Albumin 5%/25%, Dextran) - HOW Administered (Route & Technique)

IV Infusion: Administer via IV infusion. Albumin 25% infuses slowly (1-2 mL/min).

Colloid Solutions (Albumin 5%/25%, Dextran) - WHAT to Monitor & Teach (Nursing, BBWs & Safety)

Monitoring: Monitor BP, HR, CVP, intake & output, and lung sounds.

Safety Warning: High risk of Fluid Volume Excess / Pulmonary Edema (dyspnea, crackles, elevated BP).

Monitor for allergic reactions (fever, chills, urticaria, hypotension).

TMP-SMX (Trimethoprim-Sulfamethox azole / Bactrim) - Class

Sulfonamide Antiinfective

TMP-SMX (Trimethoprim-Sulfamethox azole / Bactrim) - WHY Prescribed (Indications & Use)

1. Urinary Tract Infections (UTIs, Acute Cystitis)

2. Otitis Media

3. Pneumocystis jirovecii pneumonia (PCP)

TMP-SMX (Trimethoprim-Sulfamethox azole / Bactrim) - WHY It Helps (Mechanism & Action)

Inhibits sequential steps in bacterial folic acid synthesis:

1. Sulfamethoxazole inhibits dihydropteroate synthase

2. Trimethoprim inhibits dihydrofolate reductase •

3. Synergy produces bactericidal action

TMP-SMX (Trimethoprim-Sulfamethox azole / Bactrim) - HOW Administered (Route & Technique)

Oral (PO) / IV Infusion.

Administer with a full glass of water.

TMP-SMX (Trimethoprim-Sulfamethox azole / Bactrim) - WHAT to Monitor & Teach (Nursing, BBWs & Safety)

Fluid Teaching: Force fluids (≥ 2-3 L/day) to prevent crystalluria and renal calculi.

Contraindications: Sulfa allergy, severe renal/hepatic impairment, late pregnancy

TMP-SMX (Trimethoprim-Sulfamethox azole / Bactrim) - Severe Adverse Effect:

Monitor for Stevens-Johnson Syndrome (SJS) (widespread skin rash, blistering, peeling) — discontinue at first sign of rash. •

TMP-SMX (Trimethoprim-Sulfamethox azole / Bactrim) - Side Effects

Photosensitivity, hyperkalemia, blood dyscrasias (leukopenia, thrombocytopenia).

Doxycycline (Vibramycin) - Class

Tetracycline Antibiotic

Doxycycline (Vibramycin) - WHY Prescribed (Indications & Use)

UTIs, Rickettsial infections (Lyme disease, RMSF), Chlamydia, Acne, Atypical Pneumonia

Doxycycline (Vibramycin) - WHY It Helps (Mechanism & Action)

Binds to the 30S ribosomal subunit of susceptible bacteria:

1. Inhibits bacterial protein synthesis

2. Bacteriostatic spectrum

Doxycycline (Vibramycin) - HOW Administered (Route & Technique)

Oral (PO) / IV. • Take with full glass of water. Remain upright for 30 mins after dose.

Doxycycline (Vibramycin) - WHAT to Monitor & Teach (Nursing, BBWs & Safety)

Chelation Warning: Do NOT take with dairy products, antacids, iron, or calcium (chelates and blocks absorption).

Pediatric/Pregnancy Warning: Contraindicated in children < 8 years and pregnancy (causes permanent tooth discoloration & bone growth suppression).

Teaching: Strict sun protection (severe photosensitivity).

Gentamicin Sulfate - Class

Aminoglycoside Antibiotic

Gentamicin Sulfate - WHY Prescribed (Indications & Use)

Severe, life-threatening Gram-Negative infections (Septicemia, complicated UTIs, endocarditis)

Gentamicin Sulfate - WHY It Helps (Mechanism & Action)

Binds irreversibly to the 30S ribosomal subunit:

1. Inhibits protein synthesis and causes misreading of genetic code

2. Bactericidal action

Gentamicin Sulfate - HOW Administered (Route & Technique)

IV Infusion / IM. • Infuse over 30-60 minutes.

Gentamicin Sulfate - WHAT to Monitor & Teach (Nursing, BBWs & Safety

BLACK BOX WARNINGS:

1. Ototoxicity: Irreversible vestibular & auditory damage (tinnitus, hearing loss, vertigo).

2. Nephrotoxicity: Acute tubular necrosis (elevated BUN/Cr, oliguria).

Therapeutic Drug Monitoring: Mandatory Peak & Trough levels.

Trough: Drawn immediately (30 mins) before next dose.

Peak: Drawn 30 mins after IV infusion completion

Ciprofloxacin (Cipro) - Class

Fluoroquinolone Antibiotic

Ciprofloxacin (Cipro) - WHY Prescribed (Indications & Use)

Complicated UTIs, Pyelonephritis, Respiratory, Bone/Joint infections, Anthrax exposure

Ciprofloxacin (Cipro) - WHY It Helps (Mechanism & Action)

Inhibits bacterial DNA Gyrase (Topoisomerase II) & Topoisomerase IV:

1. Prevents bacterial DNA replication, transcription, and repair

2. Bactericidal action

Ciprofloxacin (Cipro) - HOW Administered (Route & Technique)

Oral (PO) / IV Infusion. • Stagger PO dose: Give 2 hrs before or 6 hrs after antacids, iron, calcium, sucralfate

Ciprofloxacin (Cipro) - WHAT to Monitor & Teach (Nursing, BBWs & Safety)

BLACK BOX WARNINGS:

1. Tendonitis & Achilles Tendon Rupture (discontinue if tendon pain/swelling occurs).

2. Peripheral Neuropathy & CNS toxicity.

3. Exacerbation of Myasthenia Gravis.

Cardiac Monitoring: Risk of QT Prolongation and fatal dysrhythmias.

Teaching: Avoid sunlight (photosensitivity); increase fluids

Chloride - Range

96-106

Chloride - Function

Major Contributor of acid-base balance

Hypochloremia - Cues

Tremors and Twitching

Hyperchloremia - Cues

Weakness and Lethargy

Calcium - Function

1. Bone and teeth formation

2. Transmission of nerve impulses

3. muscle contraction