COLLEGE OF NURSING AND PHARMACY

C-NCM 106 – PHARMACOLOGY

First Semester | AY 2020-2021
Salonga, Hale Khim B.

Activities for Self-Directed Learning

Prepare the following as part of the home activity to enhance learning for the topics in this module. The output for this home
activity will be part of the portfolio that is to be submitted as the end of the semester.

1. Drug Study
A. Learning Outcomes
 Apply appropriate nursing concepts and actions holistically and comprehensively
 Implement safe and quality interventions with the client to address the health needs.
B. Description of the Activity
 Read information about the following drugs:
a. Ivermectin
b. Remdesivir
c. Linhua Qingwen
 Accomplish the Table below for each of the drug identified.

Drug Name Classification Mechanism of Action Therapeutics Effects Nursing Considerations

Generic Name: Anthelmintics / Ivermectin binds selectively and Indications: Side effects: These are the important
(Ivermectin) Antiparasitic with high affinity to glutamate- STROMECTOL (ivermectin) The common side effects of things the nurse should
drugs gated chloride ion channels in is indicated for the Stromectol (Ivermectin) to include in conducting
Brand Name: invertebrate muscle and nerve cells treatment of the following treat Strongyloidiasis of the assessment, history taking,
Stromectol of the microfilaria. This binding infections: intestinal tract or infections and examination:
causes an increase in the  Strongyloidiasis are:  Assess for the
Appearance: permeability of the cell membrane of the intestinal tract.  Asthenia/fatigue mentioned cautions
 Oral Tablet: to chloride ions and results in  Onchocerciasis  Abdominal pain and
3mg hyperpolarization of the cell, due to the nematode  Anorexia contraindications
Stromectol leading to paralysis and death of the parasite Onchocerca  Constipation (e.g. known
(Ivermectin parasite. Ivermectin also is believed volvulus.  Diarrhea allergies,
) to act as an agonist of the  Nausea hepatorenal
 Ivermectin neurotransmitter gamma-  Vomiting dysfunction,
Cream aminobutyric acid (GABA),  Dizziness  pregnancy and
 (Soolantra): thereby disrupting GABA-mediated Contraindications:  Somnolence lactation, etc.) to
1% central nervous system (CNS)  Contraindicated  Vertigo prevent any
 Rosiver neurosynaptic transmission. in patients who are  Tremor untoward
Topical Ivermectin may also impair normal hypersensitive to any  Pruritus complications.
Cream: 1% intrauterine development of O. component of this  Rash  Perform a thorough
 Sklice volvulus microfilariae and may product.  Urticaria physical
(Ivermectin inhibit their release from the uteri assessment (other
) Lotion: of gravid female worms. The common side effects of medications taken,
0.5% Stromectol (Ivermectin) to reflexes and muscle
treat Onchocerciasis are: strength, skin color,
 Arthralgia/synovitis temperature,
 Axillary, Cervical. texture, etc.) to
Inguinal, and other establish baseline
lymph node data before drug
Enlargement and therapy begins, to
Tenderness determine
 Pruritus effectiveness of
 Edema therapy, and to
 Papular evaluate for
 Pustular or frank occurrence of any
Urticarial rash adverse effects
 Fever associated with
drug therapy.
Adverse effects:  Assess the patient’s
Ivermectin have been reported liver function,
most frequently: including liver
 Pain in your neck and function tests to
back determine
 Serious eye problems. appropriateness of
Symptoms can therapy and to
include: monitor for toxicity.
Redness, bleeding,  Obtain a culture of
swelling, pain, and stool for ova and
loss of vision parasites to
 Shortness of breath determine the
 Inability to control infecting worm and
urination establish
 Inability to control appropriate
bowel movements treatment.
 Trouble standing or  Assess the abdomen
walking to evaluate for any
 Confusion changes from
 Extreme tiredness baseline related to
 Extreme drowsiness the infection,
 Seizures identify possible
 Coma adverse effects, and
 Low blood pressure, monitor for
especially when you improvement.
get up after sitting or
lying down. Symptoms
can include:
Lightheadedness,
dizziness, fainting
 Severe skin reactions.
Symptoms can
include:
severe rash, redness,
blistering skin, peeling
skin
 Liver damage.
Symptoms can include
tiredness,
nausea, vomiting, loss
of appetite, pain on
the right side of
stomach, dark urine
yellowing of your skin
or the whites of eyes.
 Drug Name Classification Mechanism of Action Therapeutics Effects Nursing Considerations
Generic Name: Antiviral drug VEKLURY® (remdesivir) acts to Indications: Side Effects: The recommendations for
Remdesivir inhibit the SARS-CoV-2 RNA-  VEKLURY is The common side effects of using Remdesivir for COVID-
dependent RNA polymerase indicated for the Veklury (Remdesivir) after the 19 are based on currently
Brand Name: (RdRp), which is essential for viral treatment of adults injection include: available medical evidence,
Veklury replication—and thus creation of and pediatric  Hypotension clinician input, and expert
virions that circulate in the body. patients ≥12 years  Hypertension opinion.
Appearance: 1. VEKLURY is a prodrug that old and weighing  Tachycardia  Cerner has a
This product is distributes into cells where ≥40 kg requiring  Bradycardia Power Plan with
available in the it is metabolized into the hospitalization for  Hypoxia guidance for the
following dosage pharmacologically active COVID-19.  Fever
prescriber for
forms: remdesivir triphosphate  VEKLURY should  Dyspnea
 Solution (RDV-TP). only be  Wheezing Remdesivir
 Powder for 2. RDV-TP acts as an analog of administered in a  Angioedema ordering.
Solution ATP and competes with it hospital or  Rash  Ensure that Patient
for incorporation into healthcare setting  Nausea receives “Fact
nascent viral RNA. capable of  Diaphoresis Sheet for Patients
3. The incorporation of RDV- providing acute  Shivering and
TP into nascent viral RNA care comparable to
results in delayed chain inpatient hospital Adverse Effects:
Parent/Caregivers
termination (position i+3) care.  eGFR (estimated Emergency Use
which disrupts the  For information glomerular filtration Authorization
replication of SARS-CoV-2 about emergency rate) decreased in (EUA) of
viral RNA. use to treat 18% Remdesivir for
4. Another mechanism exists suspected or  CrCl* (calculated by Coronavirus
that provides a second laboratory- Cockcroft-Gault) Disease 2019
opportunity for RDV-TP to confirmed COVID- decreased in 10-18%
inhibit viral replication. 19 in hospitalized  Creatinine increased
(COVID-19)” and is
The inhibition of viral RNA pediatric patients in 5-15% documented in
synthesis can occur after weighing 3.5 kg to  Hemoglobin their Medical
RDV-TP is incorporated less than 40 kg or decreased in 6-15% Record (Found on
into the template viral RNA hospitalized  Glucose increased in InTouch >
as a result of read-through pediatric patients 11-12% COVID/PUI Patient
by the viral polymerase less than 12 years  Lymphocytes Resources).
that may occur at higher of age weighing at decreased in 11%
 Check the rights of
nucleotide concentrations. least 3.5 kg  Prothrombin time
medication
5. When remdesivir increased in 9%
administration
nucleotide is present in the Contraindications:  ALT increased in 3-8%
(Right Patient, Right
viral RNA template, the It is contraindicated in  AST increased in 6-7% Drug, Right Dose,
efficiency with which it patients with a history of  Nausea Right Route, Right
incorporates the clinically significant  Bilirubin increased in Time, Right
complementary natural hypersensitivity reactions 2% Documentation).
nucleotide is compromised, to VEKLURY or any of its  Hypersensitivity  Check if patient has
thereby inhibiting viral components, including reactions history of allergy /
RNA synthesis. infusion-related and  Seizure hypersensitivity to
anaphylactic reactions.  Rash Remdesivir or its
components:
 Inactive ingredient:
sulfobutylether-β-
cyclodextrin
sodium salt
(SBECD).
 Check labs
(Baseline renal and
hepatic function
should be obtained
for ordering
Remdesivir)
 Drug Name Classification Mechanism of Action Therapeutics Effects Nursing Consideration
Generic Name: Antiviral, In vivo, Lianhua Qingwen Capsule Indications: Side Effects/Adverse Effects:  To begin the
Lianhua Qingwen Antibacterial, can effectively inhibit the  Lianhua Qingwen  Nausea therapy, assess for
and Anti- infiltration of macrophages, further have been officially  Vomiting any underlying
Brand Name: inflammatory reduce the edema of lung tissue, approved to treat  Abdominal Pain disease and medical
N/a drug. reduce the temperature fluctuation COVIC-19 patients,  Diarrhea history, including
caused by ALI, and alleviate the which may be due  Rashes medications
Appearance: lung pathological injury of ALI. to its antiviral, lung  Itching (previous and
 Capsule/ protection, and  Dry mouth present), and
Granule  By using network regulation of  Dizziness allergies.
pharmacology and inflammation  Assess the vital
molecule docking analyses, response as well as signs and
identified formononetin, immune regulation nutritional status.
stigmasterol, 3-methoxy- actions.  Assess for
glycerol, anhydroicaritin,  The efficacy of the contraindications
beta-sitosterol, crude- drug form and conditions of
glycerin, glycyrrhizin B, (capsules/granules the patients that
and other key compounds ) may indicate
from Jinhua Qinggan in the treatment of cautious use, and
Granules as having a COVID-19 has been potential drug
certain degree of affinity evaluated through interactions.
with the SARS-CoV-2 3CL Several  Encourage the
hydrolase and ACE2— experiments. clients to consult
which might regulate  Lianhua Qingwen first their assigned
downstream TNF, IL17, could enhance the physicians before
PI3K/Akt, and HIF-1 disappearance rate taking other
signaling pathways and and shorten the medications.
other signaling pathways duration of the  Explain the
and regulate their activity main clinical importance of good
on targets such as PTGS2, symptoms of hygiene and well
HSP90AB1, HSP90AA1, COVID-19 (fever, groomed.
PTGS1, NCOA2, AKTI, and fatigue, cough) and  Notify the clients
RELA—for the prevention computerized about the
of COVID-19-related lung tomography symptoms of the
injury. imaging showed antiviral drug to
that the human body.
the mechanism of action of Jinhua inflammation in the
Qinggan Granules in the treatment lung was alleviated
of COVID-19 involved multiple the clinical cure
targets and multiple pathways rate was increased,
related to antiviral activity, immune and the progression
regulation, inflammation inhibition, to severe cases was
and apoptosis regulation. decreased by 50%,
compared to the
control group,
showing a good
tendency but
without statistical
significance.

Contraindications:
 Contraindicated for
patients with
hemorrhage,
pregnant women,
women during
periods, and stroke
patients from yin
deficiency and fire
hyperactivity.
References:
https://www.rxlist.com/stromectol-drug.htm
https://www.rxlist.com/soolantra-drug.htm
https://www.rxlist.com/sklice-drug.htm
https://go.drugbank.com/drugs/DB00602
https://www.medicalnewstoday.com/articles/ivermectin-oral-tablet#side-effects
https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/050742s017,s018lbl.pdf
https://nurseslabs.com/anthelmintics/#nursing_considerations
https://www.mayoclinic.org/drugs-supplements/remdesivir-intravenous-route/description/drg-20503608
https://www.vekluryhcp.com/about/about-moa.php
https://reference.medscape.com/drug/veklury-remdesivir-4000090#0
https://www.samc.com/assets/documents/covid19/nursing/remdesivir-nursing-info-samc.pdf
https://www.sciencedirect.com/science/article/pii/S2095754821000260
https://www.frontiersin.org/articles/10.3389/fphar.2021.668407/full
https://www.istclinic.com/7lparp4/lianhua-qingwen-contraindication
https://newsinfo.inquirer.net/1329036/lianhua-qingwen-not-to-be-taken-without-doctors-ok