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NIP2000 Pharmacology & Medicines
Management Workbook

Name : Georgette Gavey
Intake : S16

1

Contents
Page
Introduction…………………………………………………………………3
Section 1
Legal Aspects of Drug Administration………………………………
...
10
Corticosteroids…………………………………………………………
...
18
Diuretics………………………………………………………………
...
25
Diabetes……………………………………………………………………
...
27

2

Anti-emetics…………………………………………………………
...
33
Antimicrobials…………………………………………………
...
37
Section 4
Test your knowledge……………………………………………………
...


Completion of this workbook will help you with preparation for the pharmacology/medicines
management section of the exam and assessment of clinical practice which includes assessment
of the essential skills clusters (ESC) medicines management
...
You will need
to have completed the relevant work on the drug group linked to the topic being addressed each
week for NIP2000 as this should be included as part of the case scenario presentations
...
It is
advisable to read through the resources first before answering the questions
...
All the Journal articles can be accessed
online using Summon or the other online databases available via Learning Resources
...
It is not solely a mechanistic task to be performed in
strict compliance with the written prescription of a medical practitioner (now
independent/supplementary prescriber)
...
”
(NMC 2008, p
...


Resources

Alexis, O
...
(2013) ‘Administration of medicines – the nurse role in ensuring
patient safety’ ​British Journal of Nursing​ 22(1), pp 32-35
Barber, P
...
(2015) ‘​Essentials of Pharmacology for Nurses 3​rd​ ed
...
Chapters 12 &13
Elliott, M
...
and Jordan, S
...

4

NMC (2008) ​‘Standards for medicines management’​ NMC, London
https://www
...
org
...

RCN London, Publication code
001370​https://www
...
org
...
(2015) ‘Medicines management: what nurses need to know’ ​Nursing and Residential
Care​ 17(9), pp 507-511


...
Name
these key pieces of legislation and briefly discuss in your own words your
understanding of the purpose of these pieces of legislation and how it influences
your practice
...

Misuse of drugs act 1971: regulations governing production, supply, possession, etc
...
Methods: ​Must follow correct methods
2
...
Transcribing: ​As a registrant you may transcribe medication from one ‘direction to supply
or administer’ to another form of ‘direction to supply or administer’
4
...

5
...

6
...
g in fridge, locked cupboard
5

7
...
Administration: i​ dentity, allergies, know what the drug does, know the patient's care
plan, check patient’s prescription in eligible and for them, considered dosage, route,
timing, administration, withhold medications depending on the patient's context i
...
Contact doctor if there
are complications from medications such as an allergic reaction
...

9
...
Administration for children and young people: ​must ensure the medicines are being
taken at the correct dose and that the parent/guardian is informed
11
...
T
12
...
Titration: ​If ranges are given on prescription nurses can alter appropriately to suit the
patient's response and needs
14
...
Should be prepared at appropriate time to give to patient
...
Medication through internet: ​mustn't give medicines that are not prescribed to the
patient
...

16
...
Delegation: ​when delegating tasks to others the nurse is accountable for the actions
18
...
Unregistered practitioners: ​are responsible for applying above principles and must
prepare medications, it’s then okay to delegate for them to supervise the medicines are
taken
...
Intravenous medication: ​should be checked by two nurses where possible, not
prepared/done by students
21
...
g sharps box
22
...

23
...

24
...

25
...
You must record this in the patient’s notes, notify the prescriber (if you did not
prescribe the drug) and notify via the Yellow Card Scheme immediately
...
Controlled drugs: ​Registrants should ensure that patients prescribed controlled drugs
are administered these in a timely fashion in line with the standards for administering
6

medication to patients
...


➢ From your reading of the literature and NMC (2008) ‘Standards for medicines
management’, who is accountable for the safe administration of a medicine?
-

The registrant who is giving it or supervising another healthcare trainee
...

The RN is responsible for actions taken including drug errors
Store in appropriate places e
...
Briefly discuss instances when it would be wrong for a
nurse to administer prescribed medicines
...
g haematuria

➢ What factors with rationale does a nurse have to take into consideration when
assessing a patient’s ability to take their medicines safely
-

Can the patient swallow the medicine? What alternative there might be such as using
liquid or thickener if it is dispersible? Painkillers through subcut injections if they are not
digesting them effectively or have IG problems

➢ Discuss with rationale the aspects of drug treatment patients are entitled to know
-

Side effects
What the drug is being used for
How often the drug needs to be administered
Risks of not having the drugs e
...
e subcut, orally, rectally

➢ What is your understanding of a controlled drug and discuss the principles for
administration of a Controlled Drug to a patient in a ward setting
...


➢ From your reading you should have established that education and information
about drug therapies is a key part of your role in patient care
...
g BD
Compliance: how much the patient follows the advice of the medical professional
Concordance: the patient and practitioner need to come to an agreement
Managing drug therapy: utilise communication between the patient and friends and family,
modify or negotiate drug regimes, emphasise the self-management on taking the drugs
for the disease, use technologies and devices (phones can prompt/remind to take
medicines), developing better communication skills
...
Knowledge and understanding of the
legal aspects of medicines administration is important to your everyday practice
...


Take time out now for section two

Section Two
Pharmacology

Throughout the Adult Field Programme you will be involved in the safe administration of drugs
via different routes to patients in different clinical settings, and should have knowledge of
different groupings of common drugs
...

Students worry a lot about how they can learn everything about drugs
...
This section of the workbook is to help you review your knowledge and
understanding of the common drug groupings used in acute/critical care settings as well as in
the community
...
You will need to access
the resources in the module as well as the references to reading below

Reading resources
Anwar, A
...
and Robertson, D
...
’​ Open
University Press
...
(2010) ‘Medicine management: pharmacokinetic update for community nurses’
British Journal of Community Nursing​ 15(9) pp 436-444
Reddy, B
...
, Devit, R and Wong, M
...
and Young, S
...


➢ Why is knowledge and understanding of the two concepts ​‘pharmacokinetics’
and ​‘pharmacodynamics’​ relevant for nursing practice?
-

Knowledge of how the drugs move in the body through different administrations vs
...
What do the letters in the mnemonic stand for? Explain each
process and the factors that may affect each process
...
Orally, rectally (suppository), transdermal,
inhalation, subcutaneous, intramuscular, sublingual/buccal, intravenous, nasal, ocular,
intraosseous, transvaginally (pessary), intra arterial (dye, picc-lines), intracardiac (needle
into the heart)
...
g some
have longer half-lives
...
g insulin must be injected otherwise the stomach absorbs it
...
g pessary soothes the area
rapidly
...
g swallowing impaired
...
From the small intestine the drug is chemically
altered in a process called first pass metabolism
...
Mainly occurs in the liver, but can also be carried
out in other organs - gut wall, lungs, kidney and in the plasma
...
Drugs and metabolites are filtered out from
plasma through the capillaries within the glomeruli of the kidneys
...

-

-

-

Drug: ​a medicine or other substance which has a physiological effect when ingested or
otherwise introduced into the body
Receptor: a molecule in a cell membrane that responds to a specific neurotransmitter,
hormone, antigen or other substance
...

Activation: Drugs that bind to the receptor activate them - see below:
Agonist: ​Positive effect on the receptor (i
...
Drug + Receptor =
D-Receptor complex making a therapeutic response
...
g morphine binds to receptors in
CNS which inhibits/reduces pain, salbutamol binds to B2 receptor in bronchi and
produces dilation of airways, diazepam binds to GABA receptors in the brain and reduces
anxiety
Antagonist: ​Blocking effect, stops the drug/neurotransmitter from binding to it (it’s already
there)
...
g Naloxone and atropine (reverses morphine but has a smaller half life than
morphine)
➢ Once a drug enters the circulation its concentration will start to fall rapidly
...
Why do you think it is important for nurses to know about drug
half-life?

-

Required to prevent nurses from over or under dosing, the BFN helps to guide on
management, maximum doses, timing, drug interactions, etc
...
Sometimes the result of first pass metabolism means that
only a proportion of the drug reaches the circulation
...
This first pass through the liver thus greatly
reduces the bioavailability of the drug
...
Make a table of the different routes that drugs
12

can be administered by explaining the site and how the drug is given as well as
the advantages and disadvantages of the route
...
Therefore pharmacokinetics should be considered
using other methods of administration such as IV or subcutaneous so that more of the
drug is absorbed therefore having a better half-life
...


➢ The other group of patients that you may have contact with as an Adult nurse
will be pregnant women and breastfeeding mothers
...
Taking medicines while breastfeeding exposes the baby to
drugs that it will struggle to metabolise
...
The baby may get sick due to taking the drugs or hurt the baby’s growth
...
g
babies can be born with a nicotine addiction or in some cases may die
...
As stated previously, memorising lists of drugs is
difficult, but it is easy to remember something when it is associated to a patient you have
cared for or a condition
...
For this level of study and
also as you work towards NMC registration, it is a requirement as part of the understanding of
the nursing management of certain conditions that you are aware of the drug therapies

Respiratory drugs: Bronchodilators

Resources
Barber, P
...
(2012) ‘​Essentials of
Pharmacology for Nurses 3​rd​ ed
...
Chapter 8 pg 116-121
Jordan, S
...
(2001) ‘Bronchodilators;
implications for nursing practice
...

Kaufman, G
...
​Nurse Prescribing ​11(13) 122-129
14

Bronchodilators are used for the immediate reversal of airway narrowing caused by asthma and
chronic obstructive pulmonary disease (COPD)
...

➢ Give an example of a bronchodilator drug from each group
...
They are primarily used to treat asthma and other
pulmonary disorders, such as COPD
...

Tablet/Capsule

-

Anticholinergics (biperiden): An anticholinergic agent is a substance that blocks the
neurotransmitter acetylcholine in the central and the peripheral nervous system
...

➢ State the different routes bronchodilators can be given
-

Inhalation
Orally (tablet/liquid)
Injection (subcutaneous)
Intravenous

Bronchodilator therapy can produce a multitude of side effects, which influence many
physiological systems
...

➢ In what ways can bronchodilator therapy adversely affect the cardiovascular
system?
-

Stimulates the heart rate, sometimes causing tachycardia
Causes cardiac arrhythmia
➢ In what ways can bronchodilator therapy adversely affect the central nervous
system?

15

The autonomic nervous system consists of the sympathetic and parasympathetic nervous
systems
...
The
parasympathetic nervous system provides a counterbalance by maintaining the equilibrium to
ensure the body is not in a permanent state of readiness for ‘flight, fright or fight’
...


Corticosteroids
Resources
Barber, P
...
(2012)
‘​Essentials of Pharmacology for Nurses 3​rd​ ed
...
Chapter 6 pp 102-113
Jordan, S
...
’
Nursing Standard​, 18(27), 2 page insert
...
There are two
categories of corticosteroid drugs ​mineralocorticoids​ and ​glucocorticoids ​(well known for
immunosuppressive and anti-inflammatory effect)​
...

1
...
Also used to treat
psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, bursitis, acute gouty
arthritis and epicondylitis
...
Can be used in the
treatment of leukemias, lymphomas, thrombocytopenia purpura and autoimmune
hemolytic anemia
...

2
...
Such as ​allergic disorders, skin conditions, ulcerative colitis, arthritis,
16

lupus, psoriasis, breathing disorders, inflammatory eye conditions, blood cell
disorders, leukemia, or endocrine disorders
...

➢ Give an example of a corticosteroid given via the different routes in the pictures
and the possible reasons for its usage
...
Injection is used usually as the drug can’t be taken
orally or when a fast response to the drug is needed
...
​Inhaler ​to treat asthma,

There are many side effects and possible drug interactions of corticosteroid therapies
➢ What are the special precautions/contraindications that you need to be aware of
when administering glucocorticosteroids to your patient?
-

Side effects: Increase in blood sugar level (be aware if the patient is diabetic), increase in
cholesterol (history of myocardial infarctions), increased risk of stomach ulcers and
gastritis (any existing bleeding/relevant GI conditions)

➢ What advice would you need to give a patient who is on long term steroids?
-

-

Be aware of the side effects if taking the medicine long term such as:
- Decreased fertility/damage, liver diseases, changes in character “roid
rage”, paranoia, mood swings, depression
Regular monitoring of:
- Blood pressure
- Blood sugar
- Up-to-date vaccinations
- Blood tests

Cardiac Drugs

Resources
Barber, P
...
(2012)
‘​Essentials of Pharmacology for Nurses 3​rd​ ed
...
Chapter 10, pg
...
(2006) ‘The use of digoxin in the treatment of
17

Arrhythmias and heart failure’ ​British Journal of Cardiac
Nursing​ 1(9) pp442-447
Gallimore, D
...
(2004) ‘Prescription drugs and effects: ACE inhibitors:
cardiovascular disease
...

O’Donovan, K
...
Statins and their role in the prevention of cardiovascular
disease’ ​Nurse Prescribing​ 10(12) pp1-11
Patel, B
...
(2008) ‘ACE inhibitors: use, actions and prescribing rationale’
...

Anti-hypertensives
The main agents include:
o
o
o

Beta-adrenoreceptor antagonists (Beta blockers),
Calcium antagonists
Angio-converting enzyme (ACE) inhibitors
...
When you take beta blockers, your heart beats more slowly
and with less force, thereby reducing blood pressure
...

Calcium channel blockers prevent calcium from entering cells of the heart and blood
vessel walls, resulting in lower blood pressure
...

Side Effects:
●
●
●
●
●
●
●
●

Headache
Palpitations
Dizziness
Rash
Drowsiness
Flushing
Nausea
Swelling in the feet and lower legs
● Constipation

➢ Explain how ACE inhibitors control blood pressure and list the major side
effects
ACE inhibitors lower your blood pressure by reducing angiotensin II in your body
...
It also lowers the amount of water your body retains, which lowers your
blood pressure
...

Dizziness
...

● Loss of taste

Statins
Statins are widely used to prevent and reduce coronary events
...

Besides lowering low-density lipoprotein (LDL)-cholesterol, statins have pleiotropic
effects such as improved endothelial function, reduced inflammation, and reduced
thrombus formation
➢ What factors need to be considered prior to the usage of statin therapies?
The following issues need to be considered when prescribing a statin:

19

-

Identifying patients in whom additional advice should be sought prior to initiation
Contraindications and cautions
Drug interactions
Baseline and follow up monitoring

➢ Give 3 examples of statin therapies
...
Digoxin is the most commonly used cardiac glycoside that you will see prescribed in
clinical practice
➢ Explain how digoxin works and the different routes that the drug can be given and
rationale for chosen route
...

- Becoming overheated or dehydrated during exercise, in hot weather, or by not drinking
enough fluids can cause an overdose
...

➢ What specific observations would you need to carry out on a patient who is
prescribed digoxin and why?
-

Frequent blood tests required, kidney function screening, heart rate, blood pressure, ECG
(if concerns) to ensure that the drug is working at a safe level

Nitrates
20

Nitrates are used for the treatment of angina, either as a prophylactic or for symptomatic relief
...
(Blood flow to heart muscle is restricted because the heart
(coronary) arteries are narrowed
...
This causes them to widen (dilate)
...

This type of nitrate has a short half life in order to solve pain that has suddenly been
brought on, patches of other drugs can be used for longer pain that have a better
half-life
...

fast, slow, pounding, or uneven heart rate;
blurred vision or dry mouth;
nausea, vomiting, sweating, pale skin, feeling like you might pass out; or
...


➢ What specific advice would you give to a patient about how and when to use
their prescribed nitrate in the event of an angina episode?
-

When symptoms occur they should take their prescribed as needed dose as soon as
they begin to feel the effects
...


Diuretics

21

Resources
Jordan, S
...
’
Nursing Standard​, 18(37),2 page insert
...
(2014) ‘Diuretics: how they work, cautions
and contraindications’
...
They are commonly used in
the treatment of hypertension, heart failure and fluid retention
...

➢ Briefly explain how each category of these diuretic drugs work and which part
of the nephron they influence
...

-

-

-

22

Thiazide:
- Is a type of molecule, inhibits reabsorption of sodium and chloride ions
from the distal convoluted tubules in the kidneys by blocking the
thiazide-sensitive Na+-Cl- (sodium & chloride) symporter
- They are active in tubular fluid
- Inhibits/decreases secretion of calcium but promotes secretion of
magnesium
- Increases urea in proximal tubule therefore increases plasma uric acid
Loop:
- Works at the Loop of Henle (works in the thick ascending loop)
- Prevents chloride from being reabsorbed and also calcium and magnesium
ions long-term)
- Therefore decreases BP
- Increases urine flow
Potassium Sparing Diuretics:
- Used in conjunction with other diuretics
- Inhibits sodium reabsorption
- Works in collecting ducts

➢ Why are potassium supplements often prescribed for those patients taking
thiazide and loop diuretics?
- Water tends to follow sodium so when sodium is absorbed so is water
which increases BP
- Most diuretics will prevent potassium from being absorbed into the plasma
which could lead to a insufficiency of that mineral

➢ What are the major side effects of diuretic therapy?
Common Side Effects:
- Too little or too much potassium in the blood
- Headaches
- Dizziness
- Thirst
- Muscle cramps
- Gout
Serious Side Effects:
- Kidney Failure
- Allergic Reaction
- Irregular cardiac rhythm
➢ What specific monitoring is required if you have a patient diagnosed with heart
failure being treated with a loop diuretic on an acute ward and why may it be
prescribed?
-

Can help relieve fluid buildup such as swelling in the legs and ankles
Heart monitoring, ECG, pulse bpm, pulse oximeter
...

-

Diuretics decrease the amount of H2O absorbed into the blood plasma by blocking
the symporters which therefore decreases blood pressure and alleviates
hypertension

Anticoagulants

Resources

23

Barber, P
...
(2015) ‘​Essentials
of Pharmacology for Nurses 3​rd​ ed
...
Chapter 7
Casey, G
...
​Nursing Standard​,
18(7), 45-51, 53,55
...
They can be given orally or via a parenteral route
...
Briefly
discuss how it works on the body, the major side effects, any special
precautions/contraindications, the antidote for your chosen drug and the nursing
responsibilities when administering your chosen drug
...

- Side Effects: bleeding, headaches, weakness, bruising, coffee ground vomit,
swelling, pain, nosebleeds, gum bleeding, hematurea
- Precautions: Only to be taken if it is taken on time each day, every day
...

- Nursing Responsibilities: When was the patient's last coagulation profile test? Ask
if there has been any bruising or swelling recently, how alert is the patient
...
Briefly discuss how your chosen
drug works on the body, the major side effects, any special
precautions/contraindications and your responsibilities as a nurse when
administering chosen drug
...

- Precautions: Drug chart, allergies, drug interactions, R’s before administration
- Responsibility: Is the drug in date? Intact/untouched? Given in correlation with
doctors recommendations? Is the site different to the last site of injection?

➢ If a patient has intentionally or accidentally overdosed on their anticoagulant drugs
what action would need to be taken and what drug can be given to counteract the
effect?
-

For people who need rapid reversal of warfarin such as due to serious bleeding
or need emergency surgery, the effects of warfarin can be reversed with ​vitamin
K​,​prothrombin complex concentrate​ (PCC), or fresh frozen plasma (FFP) in
addition to intravenous ​vitamin K​
...
and Robertson, D
...
’​ Open University
Press
...
diabetes
...
uk/diabetes-medication/
http://www
...
co
...
html

These drugs are used in the management of patients with diabetes mellitus
...

-

25

Sulphonylureas:
- work by increasing the amount of insulin the pancreas produces and
increasing the working effectiveness of insulin
...

- E
...
Metformin is commonly used as a first line
treatment for type 2 diabetes and may occasionally be prescribed, in
combination with insulin, for people with type 1 diabetes
...


-

Meglitinides:
- The glinides are a class of drug which have a similar response as
sulphonylureas but act for a shorter time
...
As the
drugs act for a shorter period than sulphonylureas, the side effects of
hypoglycemia and weight gain have a smaller likelihood
...


-

Gliptins:
- DPP-4 inhibitors, also known as gliptins, are a class of drug which help to
stimulate the production of insulin and reduce the production of glucagon,
particularly during digestion

➢ What are the special precautions/contraindications that you need to be aware of
when administering drugs from these categories?
-

Be aware of the patient's Blood Glucose levels and ketones
Never omit a patient's insulin
Other medications that the patient is taking
Food/meal chart
What type of diabetes they have

➢ Explain how insulin works and discuss the different types of insulin therapies
-

26

Insulin mimics human insulin which is usually made in the pancreas, insulin
absorbs glucose and converts it to glycogen in the liver
Therapies:
- Intensive Insulin Therapy:
- Frequent testing and monitoring of blood sugar
- Includes regular shots of insulin or a pump
- The goal is to have stable blood sugar levels as often as possible

Insulin Type & Name

Onset

Peak

How long it lasts

5 - 15 minutes

45 - 75 minutes

3 - 4 hours

30 - 45 minutes

2 - 4 hours

6 - 8 hours

2 hours

4 - 12 hours

16 - 24 hours

2 hours

No clear peak

14 - 24 hours

(Rapid Acting:)
Insulin aspart
Insulin glulisine
Insulin lispro
(Short Acting:)
Insulin regular (Humulin
R)
(Intermediate Acting:)
Insulin NPH (Humulin N)
(Long Acting:)
Insulin glargine
Insulin detemir

➢ What relevant health education you would need to give to a patient who is on
insulin therapy?
-

-

Type 1 Diabetes: Explain to them about their condition and the management of the
insulin therapy that they are taking including side effects, the onset, peak and how
long it lasts
...
(2008) ‘Proton pump inhibitors: use, action and prescribing
rationale’ ​Nurse Prescribing​ 6(1), pp 26-30
Chowdhury, S
...
(2007) ‘Laxatives: choice, mode of action and
prescribing issues’ ​Nurse Prescribing​ 5(10) pp 456 -461

The main drug groups that will be addressed in this section are ​laxatives​ and p
​ roton pump
inhibitors​ ​(PPI)​ as they are common drugs that you will see been prescribed in practice for a
wide range of reasons
Laxatives
➢ What are the four main groups of laxatives and briefly discuss how each group
works giving an example of a drug for each group and the information you would
need to give to the patient about the drug
...
Fiber products / bulk-forming agents:
- These laxatives make stool larger (helps intestines contract and
provokes a bowel movement)
- Slow acting working from 12 hours to 3 days
- Users need to drink a lot of fluids such as water and juice
- Side effects: bloating, abdominal pain, gas, blockage, skin rash
- E
...
Osmotic Agents and Saline Laxatives:
- Laxatives which pull water into the large intestine creating bulk and
pressure to stimulate contractions
...
g lactulose, enema
3
...
g docusate calcium/sodium
4
...

- Tablets take 6-8 hours whereas suppositories start within 15-60
minutes
...

- Use for no longer than 3 days
- Side effects can be muscle cramps, discoloured urine/stools, fatigue,
electrolyte imbalance
28

-

E
...
g codeine)
IBS
Eating disorders
Not enough water/fiber in diet
Issues with nerves/muscles
Underactive thyroid

YES (2-3 days)
YES (3 days)
NO (body needs to preserve minerals)
YES (2-3 days)
YES (but only for occasional use)
YES (softeners, 2+ days)

➢ What are the complications associated with long term use of laxatives?
-

Complications:
- Stimulant laxatives: can develop a laxative dependence, muscles will stop to work
unless a laxative has been administered
- Osmotic agents: not too severe but can cause dehydration if fluid intake isn’t
sufficient to be using both
- Fibre/products: need a good fluid intake to prevent dehydration
- Being dehydrated can cause weakness, fainting, kidney damage

Proton pump inhibitors (PPI)
This group of drugs is used primarily to reduce hydrochloric acid secretion in the stomach
...
These patient will experience a reflux of acid in the
oesophogus which is quite uncomfortable
...
Taking a PPI for this will help as it will allow the
ulcer to heal
...

-

29

Proton pump inhibitors (PPIs) block the gastric H,K-ATPase, inhibiting gastric acid
secretion
...


➢ What are the main adverse effects of PPIs?
-

Adverse effects: Headaches, diarrhea, constipation, abdominal pain, flatulence, fever,
vomiting, nausea, rash
...
(2009) ‘Antiemetics: uses, mode of action and
prescribing rationale’
...

-

-

Cyclizine:
- Injection / tablets / IV
- Acts on receptors
- Nursing responsibility: make the patient aware of any side effects and how the
drug works and how it will be administered
...


Analgesics
Resources
Barber, P
...
(2015) ‘​Essentials of
Pharmacology for Nurses 3​rd​ ed
...
Chapter 4
Chowdhury, S
...
(2004) ‘Prescription drugs and effects:
Non-steroidal anti-inflammatory drugs
...


31

These are drugs used for pain relief and there are a wide variety of drugs in this category
...

-

NSAID: Naproxen/ibuprofen, muscle/inflammatory pains, relieves fever
Strong Opioids: Diamorphine patches/syringe driver, tramadol used often
in palliative care
Weak Opioids: Codeine Phosphate, paracetamol used for most types of
chronic/regular pain

➢ Choose 1 drug example from each of the groups and briefly discuss how they
act on the body, the major side effects of your chosen drug, any special
precautions/contraindications and the nursing responsibilities/care when
administering your chosen drugs
...

Best used when combined with paracetamol
Ensure no other drugs will interact or contain the same types of medication, refer to BNF
Naproxen:

-

Reduces the hormones in the body that cause inflammation and pain
Can increase risk of heart attack and stroke as it can cause hypertension
Can cause stomach or other GI bleeding which could be fatal as it can cause stomach irritation, the
best way to avoid this is to take the medicine before/after a meal
Ensure no other NSAID’s are being taken unless advised by the pt’s doctor
...
g for fever rather than pain

Antimicrobials
Resources

Barber, P
...
(2015) ‘​Essentials of
Pharmacology for Nurses 3rd ed
...
Chapter 5
Knight, J
...
(2004) ‘Antibacterial drugs’
Nursing Standard​,18(19), 2 page insert
...
For the purpose of year 2 the focus will be on antibiotics, for which
there are a number of antibiotics available for use
...


➢ What is the difference between these two classes of antibiotics?
-

Broad Spectrum:
- Acts against a wide range of disease-causing bacteria
- Acts against both Gram-positive and Gram-negative bacteria
- Usually prescribed prior to pathology testing if there is uncomfort or there is a
serious risk to the patient, for example the meningitis patient that could die within
hours if antibiotics are not initiated
...
Using these antibiotics may also
give rise to drug resistance
...

- Less ability to cause superinfection
- Less resistance of the bacteria as it will only deal with that specific bacteria

Below is a list of the family groups of antibiotics, as it is best to understand the groupings of
antibiotics
...

➢ 4-QUINOLONES:
o
o
o
o
o

Broad-Spectrum antibiotics that share a bicyclic structure
E
...

Should only be used for infections that cannot be treated with a safer antibiotic
...
g Paromomycin, Garamycin
Should be taken with food, stored away from moisture and heat
Can cause diarrhea, little/no urination, stomach cramping

➢ ANTI-TUBERCULOUS DRUGS
o
o
o
o
o
o
o

Used to treat tuberculosis
Narrow spectrum drug
Infection that primarily affects the lungs
Involves giving 2-4 drugs simultaneously which all work differently in order to target the
organism in different ways and prevents drug resistant strains of mycobacterium from
evolving
...
nice
...
uk/treatment-summary/tuberculosis
...
g aminosalicylates, diarylquinolines, streptomyces derivatives
Side effects: tiredness, fever, joint pain, skin rash, weaknesses, severe abdominal pain,
headache, backache, yellow eyes or skin, pain while urinating

➢ CEPHALOSPORINS
o
o
o
o
o
o
o

Broad-spectrum antibiotics, can be used for pneumonia, meningitis, septicaemia, UTI infections
Bactericidal (kill bacteria) working in similar ways to penicillins
Bind to and block the activity of enzymes responsible for making peptidoglycan
Side effects: hypersensitivity, many people have allergic reactions to the drug
First generation: ceflaxein, cefradine, etc
Second generation: cephalosporin, cefaclor
Generations 1-5

➢ MACROLIDES
o
o
o
o

Broad-spectrum antibiotics
Inhibits protein synthesis bacteria by reversibly binding to the P site of the 50S unit of the
ribosome
...
g Erythrocin, biaxin
Side effects: nausea, vomiting, diarrhea, tinnitus, inflammation and congestion of liver bile
ducts, allergic reaction

➢ PENICILLINS
o
o
o

o

Narrow-spectrum antibiotics
E
...

It interferes with the synthesis of peptidoglycan
...
Finally, we learned that
penicillin is a narrow-spectrum antibiotic and is more effective against Gram-positive
bacteria
...
The most sensitive biochemical reaction that is inhibited is the synthesis of proteins
[21]
...

Active against gram positive and gram negative bacteria
Side effects: cramps or burning of the stomach, diarrhea, sore mouth or tongue, dizziness

Before prescribing antibiotics the known or likely causative organism of the infection should be
considered as well as the patient
...
e it exposes the foreign infection to a lethal amount of antibodies within the plasma/blood
tissue for the duration of the treatment
...
Discuss the reason for this
...
Trough concentrations
above​ the therapeutic range may increase the risk of nephrotoxicity
...

Gentamicin stops the growth of bacteria and/or kills them

➢ What effect can certain antibiotics have if a patient is on an oral contraceptive pill
and what information would you have to give to such a patient?
-

If the antibiotics or the illness they are treating cause diarrhoea or vomiting, absorption of
the contraceptive pill may be affected
...
, McKenzie, J
...
and Hind, C
...
4​th​ ed​’
...


Richards, A
...


Useful Websites
www
...
org
...
doh
...
uk
www
...
org
...
medicines
...
uk
www
...
net
www
...
org
...
The second section is a scenario based short answer quiz
...
Which of the following drugs would be most beneficial for immediate relief of an
acute angina attack?
A
...

C
...


Verapamil
Propanalol
Glycerine Trinitrite
Isosorbide mononitrite

2
...
One
B
...
Three
37

D
...
Which of the following is the normal therapeutic range for oral Digoxin in an adult?
Note to self: Digoxin has a small therapeutic index so needs to be regularly monitored
A
...

C
...


62
...

A
...

C
...


When does the onset of fast acting insulin occur?
Less than 15 minutes
30-60 minutes
1-2 hours
4-8 hours

Note to self: onset occurring in 5–15 minutes, a peak in 45– 90 minutes, and an overall duration of
about 3–4 hours
...
Bactericidal means that the antibacterial drug:
A
...

C
...


A narrow spectrum of action against bacteria
A wide spectrum action against bacteria
Inhibits the formation and growth of new bacteria
Inhibits enzymes that are necessary for bacterial cell wall maintenance and life thus
killing the bacteria

6
...
Has a narrow spectrum action against bacteria
B
...
Has a wide spectrum action against bacteria
D
...
Which adverse effect of opiates is the most serious?
A
...

C
...


Dilated pupils
Seizures
Constipation
Respiratory depression

8
...
Adrenal insufficiency
B
...
Sudden death
38

D
...
If someone has accidentally overdosed on morphine, which drug, would you give
as an antidote?
A
...

C
...


Diamorphine
Naloxone
Metoclopromide
Adrenaline

10
...

B
...

D
...
Which of the following is an adverse effect of furosemide?
A
...

C
...


Black stools
Increased seizure activity
Hyperkalaemia
Lens opacity

12
...

B
...

D
...
Which of the following represents the action of an NSAID?
A
...

C
...


Reduces serum urate levels
Inhibits formation of prostaglandins
Inhibits destructive lyosomal enzyme activity in joints
Induces euphoria

14
...
Lisinopril
B
...
Verapamil
39

D
...
Which of the following ​is not​ an action of inhaled corticosteroids?
A
...

C
...


Inhibit the inflammatory response in the airways
Decrease oedema of the airway mucosa
Increases hyper responsiveness of the airways to increase mucous production
Increases the number and sensitivity of bronchial β2- receptors

16
...
Decreases elevated blood glucose levels
B
...
Increases the formation of glucose in the liver
D
...
Which of the following is​ not​ an antibiotic drug group?
A
...

C
...


Cephalosporin
Sulphonamide
Sulphonylurea
Aminoglycoside

18
...

B
...

D
...
Which of the following vitamins is essential for the synthesis of blood coagulation
factors in the liver?
A
...

C
...


Vitamin B
Vitamin C
Vitamin D
Vitamin K

20
...
Acts primarily in the ascending loop of henle as well as the proximal and distal tubules
B
...
Increases potassium levels
D
...

Scenario based short answer questions
Scenario one

Ahmed, a 54-year-old male of Asian origin with a history of high cholesterol
...
The paramedics had given him GTN and aspirin en route to hospital but
he was still experiencing pain on arrival
...
He was diagnosed as having unstable angina and was
transferred to the CCU for monitoring
...
What type of drug is GTN and how does it work?
Nitroglycerin, also known as ​glyceryl trinitrate​ (GTN), is a medication used for heart failure, high
blood pressure, and to treat and prevent chest pain from not enough blood flow to the heart
(angina)
2
...
To what group of drugs does diamorphine belong?
-

Diamorphine is an opioid painkiller used for strong pain
...
What are two side effects of diamorphine?
-

Drowsiness
Mental clouding

5
...
Why was he given cyclizine and what is it?
- Cyclizine is an antiemetic used to reduce feelings of nausea which is a common side
effect of using opioids
...
She also has a productive cough
...
What group of drugs does salbutamol belong to?
- Respiratory medications (bronchodilators)
2
...
When
salbutamol stimulates these receptors it causes the muscles in the airways to relax
...

3
...
Why was it given in this scenario?
- Prednisone and other steroids (inhaled, oral, or by injection) help calm airway
inflammation in asthma
5
...
What do the abbreviations od and tds mean
- O
...
D
...
He has
been taking Ibuprofen regularly for pain relief
...
He is commenced on omeprazole, however shortly afterwards Paul vomits s further
700mls of blood and becomes drowsy
...
What type of drug is Ibuprofen?
-

Ibuprofen is an anti-inflammatory drug

2
...
Name one common side effect
-

Stomach pain

4
...
Briefly​ ​ explain what is happening to Paul
-

Paul may be vomiting blood because his stomach wall may have become damaged and
ulcerated from taking ibuprofen which irritates the stomach wall a lot therefore causing
bleeding
...


6

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