Pharmacology 16 Flashcards

Terms Definitions
lopressor
Metoprolol
h
hour
refecoxib
Vioxx
Neo-Synepherine
Vasopressor
Mylanta
Antacid
quetiapine
seroquel
prednisone
steroid
hydromorphone
dilaudid
metopranolol
beta nonselective antagonist
Darvocet
acetaminophen/ apap
Neuro/nephrotoxicity (1)
polymyxins
Retavase
Thrombolytic Agent
oxycodone sr
oxycontin
Lindane
AntiectoparasiteShampoo or lotion ~Absorbed via skin, ↑in fatty tissue, excreted in urine in 5 daysSE: Hematotoxicity (?) NeurotoxicityPediculosis capitis Pediculosis pubis Scabies
Depo-Medrol
Pain and AntiinflammatoryGlucocorticoid - injectable
DEA
Drug Enforcement Administrationresponsible for enforcing the Controlled Substances Act
Opiod analgesics
pg 313
Type of drug?
Morphine
Opioid
Doxycycline
Tetracycline antibiotic

protein synthesis inhibitor (30S), more effective than other tetracyclines against bacillary dysentery. Unlike other tetracyclines, it is eliminated mainly in the feces.

Tox-
see tetracycline
OTC
over the counter
lamivudine=thiocystidine
reverse transcriptase antiretroviral
Anthracyclines
Toxicity
Non-cardiac: Extravasation causes local tissue damage and deep ulceration. Radiation recall may occur in skin, oral mucosa, lung, GI tract, and heart
 
Cardiac: protection with dexrazoxane probably by iron chelation therefore may increase myelosuppression and incidence of 2nd leukemias
antiepileptic drugs:
 
benzodiazepines 
diazepam (Valium)
lorazepam (Ativan)
 
classified as sedative-hypnotic agents
both antiepileptic & anxiolytic properties that reduce seizures & anxiety
produce all levels of CNS depression ranging from mild sedation to coma, depending on the dose ("minor tranquilizers")
used for acute attacks, not maintenance 
Beta BlockersTU
HTNAnginaHFAtrial FibrilationPost MI
drugs for partial seizure
cbzphenytoinvalproatelamotrigineoxcarbazine
-zosin
alpha 1 blocker (terazosin)
which drug --> neurotoxicity/nephrotoxicty
polymyxins
Finasteride
Steroid inhibitor of 5α−reductase

inhibits synthesis of dihydrotestosterone, the active androgen in prostate. Used in BPH
Formula for calculating dosages
DxQ=A-H
Meprobamate
=carbamate, anxiety, muscle rexant
Immunosupressant (3)
Cyclosporine(SANDIMMUNE), Tacrolimus (FK506) and Sirolimus (Rapamycin; RAPAMUNE).All 3 inhibit calcineurin phosphatase, which inhibits T-lymphocyte activation and proliferation. Cyclo and Tacro inhibit IL-2.
Dacarbazine
(non-classic alkylating agent - polyfunctional alkylation)
 
"Dairy Car driven by neurologist Dr. Hodgkin carrying melons and meat"
 
mechanism: methylating DNA and causing direct DNA damage
 
Treatment: malignant melanoma, Hodgkin's, sarcomas, neuroblastoma, brain tumors
Tx of alcoholism
Disulfiram, naltrexone, acamprosate
Parasympathomimetic Drugs (mimics)
Stiumulate PNSMuscarinic agonist
increase platelet aggregation ?
ADP,5TH,TXA2,THROMBINE,ALPHA2 AGONEST
somatodendritic autoreceptors
decrease neuron firing rate
Medications that inhibit the sympathetic nervous system
Sympathilytics
dissociative anesthetic state
eyes open
involuntary movements
vocalization
hallucinations
feel separated from body
toxicity of tacrolimus
nephrotoxic
peripheral neuropath y
HTN
pleural effusion
hyperglycemia
P450 Inducer or Inhibitor:
Barbiturates
P450 Inducer
Zanamivir
oseltamivir
Neuraminidase inhibitors

can be used to reduce severity and duration of influenza symptoms. Prevents penetration of the virion.
Tylenol toxicity leads to
hepatic necroses/toxicity
vidaribine
neucleoside analogue antiviral inhbits viral polymerase
Atropine
Blocks all muscarinic receptor types.(and not nicotinic)
Donepezil
is used to treat Alzheimer’s dementia. It is an Acetylcholine-esterase inhibitor, thus counteracting the effects of cholinergic deficiency in the cortex and basal ganglia.
Phenytoin (Dilantin), Anticonvulsant
Class: AnticonvulsantAction: Prevents and stops seizure activitySide Effects: BLOOD DYSCRASIAS, HEPATOTOXICITY, GINGIVAL HYPERPLASIA, FOLIC ACID DEFICIENCY. ataxia, confusion, slurred speech, agranulocytosis, leukopenia, pancytopenia, thrombocytopenia, toxic hepatitis, hirsutism, Stevens-Johnson syndrome, toxic epidermal necrolysis, Contraindications: sinus bradycardia, SA block, second or third degree AV block, Adams-Strokes syndrome.Nursing considerations: DROWSY, INSOMNIA. Assess prior to start, monitor phenytoin level (therapeutic levels), monitor CBC and calcium levels, check vials, blood pressure, and ECG during IV administration. GIVE WITH MILK, MONITOR DRUG LEVELS.
common tetracyclines
tetracycline (Sumycin) - generic/cheap but short 1/2 life and must be on empty stomach (1-2 hrs after food)
 
doxycycline (Vibramycin)
 
minocycline (Minocin) - better 1/2 life 
most frequently prescribed loop diuretic
Furosemide (Lasix)
how do you treat benzo overdose
flumazenil
Heparin vs CoumarinWhich is more likely to require further Tx after removal of the drug?
Coumarin
(Opiate Agonist - S/E)

Constipation
Suppresses motility/peristalsis. Decreases secretion of fluids into the intestine.
NI: Increase fluids, increase fiber, give colace.
Side effects
The unavoidable, undesired effects frequently seen even in therapeutic doses.
What is the antidote Naloxone/naltrexone used to treat?
opioid toxicity/overdose
side effects of HCTZ
hyperglycemia
hyperlipidemia
hyperuricemia
hypercalcemia
melabolic alkalosis
Mg depletion
Type of drug?
Atracurium
Nondepolarizing Neuromuscular blocking drug
Selective for motor nicotinic receptors
Amiodarone
Group IA and III antiarrhythmic

broad spectrum, blocks sodium, potassium, calcium channels, beta receptors. High efficacy and very long half−life (weeks−months).

Tox:
deposits in tissues; hypo− or hyperthyroidism; pulmonary fibrosis
Antiemetic
prevents or relieves nausea and vomiting
Aminocaproic acid
less potent haemostatic than Tranexamic acid
G-CSF
expands the population of neutrophil granulocyte precursors, given to prevent or reduce chemotherapy-induced neutropenia.
What drug can cause idiosyncratic blood rx with fatal cases of aplastic anemia and agranulocytosis in elderly for 1st 4 months of treatment?
Carbamazepine
intravenous
Administered through a tube in the vein.
Singulair (Montelukast) Leukotrienes
Class: Antiasthmatic Action: Improves breathingSide Effects: Headache, dizzy, dental pain, infectious gastroenteritis.Contraindications: If acute asthmatic attacks or status asthmaticus. If allergy to drug.Nursing considerations: Monitor for adverse effects.
Beta-Adrenergic Blockers
 
all are competitive antagonists; however they can be subdivided according to 3 major properties: 
selectivity of receptor blockade
possession of intrinsic sympathomimetrics activity (ISA)
capacity to block alpha-adrenergic receptors (alpha 1)
Statin Patient teaching
Take w/food, report muscle pain/weakness, avoid acohol and grapefruit
which B blocker has no hyperlipidemic effeck
acebutolol
pindolol
Name the 1 "all adrenergics" stimulant.
Epinephrine *duh
Define side effect
Unintended response to a drug
Broad spectrum
Good against gram + and -.
These are mediators released from mast cells upon contact with allergens
Leukotrines
Turns down the thalamus and hypothalamus pathways for arousal center
VLPO (GABA)
LPN legal responsibilities for medication admin
can give medications
Cough (1)
ACE inhibitors (losartan --> no cough)
usees for lamotrigine
everything but absence and status
Type of drug?
Nizatidine
Reversible H2 blocker
Decreases acid secretion by stomach parietal cells
Which CYP450 enzyme is involved in metabolism of most drugs?
3A4
Thiazide contraindication
hepatic coma, anuria, sever renal failure
ketoprofen
? used in compounds of topical gels
Prazosin (a-1 inhibitor)
Non-selective for alpha-1 subtypes (also binds alpha-2B). Treats hypertension, Reynaud's, & congestive heart failure. Binds alpha-1-acid glycoprotein (5% of drug is free) – inflammation may alter quantity. Half-life: 2-8 h. Increase dose slowly
Opioids inhibit release of hormone...and stimulate release of 2 hormones.
LH and ADH,Prolactin.
How many enzyme systems does the P450 system have?
12
What type of tolerance is seen in morphine?
pharmacodyanmic
adverse effects of glitazones
well tolerated
 
back pain, diarrhea, fatigue
 
fluid retention - peripheral edema (benign) dose related
 
moderate weight gain 
HYDROLYTIC RXN:Ester hydrolysisadding H20 to ester group
examples- aspirin, esmolol, and procaine
The therapeutic uses of this drug include:Hypertension, Prophylaxis of angina sections, arrthythmias and myocardial infection, prophylaxis of migrane headaches and glaucoma
Propranolol (prototype)
Drug-Food Interactions
interaction with a food that may change drug action
pentazocine (talwin)
-strong kappa agonist and weak my antagonist-analgesia is due to kappa-f=25% so only slightly more potent than codeine po-psychotomimetric effects at large doses due to kappa-talwin Nx (pentazocine and naloxone) is made in response to abuse with solution (talwin and antihistamine triple enamine) to give heroin-like high, with naloxone there is no oral F so IV it blocks talwin
Sympatholytic (ANTIADRENGERIC)
Drug that clocks action of the sympathetic nervous system
Stimulant
A drug that enhances or increases a bodily function.
True or false. ROCM can pass the placental barrier.
True
what is the mechanism of metoprolol
selective beta-adrenergic blocker
A drug infused at a constant rate reaches about 94% of steady state after _______ t 1/2s.
4
What cancer drugs have the SE CNS toxicity?
Nitrosureas
what is the receptor preference for metaproterenol?
beta 2
increased heart rate and myocardial contractility
Beta 2: causes
Affinity
the drugs' ability to bind to the target
Adverse effects of streptomycin
Nephrotoxicity and ototoxicity. Vertigo, hearing loss (may become permanent). Dont use with elderly or patients with impaired renal function.
1 Neoral
1 Microemulsion form of cyclosporine taken orally
 
1 It has the same MOA as cyclosporine but is made into smaller vesicles so that there is more surface area and better absorption 
What receptors does chlorpromazine interact with?
D2 R antagonist (defining property)alpha 1 antagonist (hypotension & sexual dysfxn)M antagonist (autonomic side fx)H1 antagonist (sedation)non-competitive channel blocker (calcium, sodium, cardiac side fx)
pharmacodynamics of thioamides
block iodine's ability to combine w/ tyrosine, thereby preventing thyroid hormone synthesis (formation of T3 & T4)
PTU also inhibits the conversion of T4 to T3
have no effect on the thyroglobulin already stored in the gland; therefore observation of any clinical effects of these drugs may be delayed until thyroglobulin stores are depleted
effects are slow in onset; these drugs are not effective in thyroid storm
PTU lowers serum T3 faster than methimazole, more frequently used when more rapid improvement is needed
Example of Diagnostic use
-Radiopaque dyes used during x-ray procedures-Drugs given to stimulate cardiac excerise in patients who cannot undergo regular excercise stress testing
Pancuronium: Class of drug, length of duration, and use.
Non-depolarizing/Competitive skeletal muscle relaxant - lasts for 60 minutes - used to relax muscles for surgery, electroshock, tetanus treatment
Define oxyidation
The loss of hydrogen atoms or the acceptance of an oxygen atom. This increases + charge (or lessens the - charge) on the molecule.
Additive Effect
2 like drugs are combined and the result is the sum of the drugs effects. 1 + 1 = 2.
Stimulation of the PNS results in:
-Pupillary constriction
-Secretion of digestive glands
-Increase smooth muscle activity in the digestive tract
-Bronchoconstriction
-Reduction in heart rate and cardiac contractility
Drug
metabolized by CYP2D6 and CYP3A4
long lasting
Donepezil
Drug
metabolized by CYP2D6 and CYP3A4
long lasting
limited effect with Alzeimer's cognition
fewer liver side effects
What are common toxicities?
renal damage, aplastic anemia, GI distress, ulcers
clinical use of trimethoprim
used in combo with sulfamethoxaole
treats recurrent uti's, shigella, salmonella, PCP
What do recombination repair systems do?
Ss breaks, ds breaks
- Lungs contain many of these
Cholinergic Receptors
Pirinzepine
Binds M1 receptors more than M2 or M3, but selectivity diminishes at higher doses. (Good for minimizing gastric acid secretions (ulcers))
Acetazolamide is contraindicated in...
Cirrhosis because it becomes more difficult to excrete NH4+ (NH3 + H+) that will contribute to hepatic encephalopathy.
1 lb= ____oz (dry weight)
1 lb.= 16 oz (dry weight)
drug interactions with amphotericin B
vancomycin & other mephrotoxic drugs: increased chance of renal impairment
 
steroids: exacerbation of hypokalemia & increased risk of superinfection
 
digoxin: increased risk for toxicity due to hypokalemia
 
electrolyte solutions: inactivate amphotericin B when diluted in the same solution
What are class III drugs used to treat?
- Ventricular tachycardia
Thiothixene: Class of drug, use
D2 blockers - block dopamine receptors, diminishing psychosis, calming, can be used as antihistamines or thermostat *The D2 class is super calm from the Haloperidol, reading magaZINES, watching Priscilla THIO do TRIX, and eating LOX at PINE Springs Ranch
Define bioavailability
Amount of a drug that is still active after it reaches its target tissue.
Three nonopioid medications that have analgesic properties
Salicylates (ASA), NSAIDS (Motrin), Para-aminophenol (Tylenol)
what is myasthenic weakness
weakness experienced by MG during the course of anticholinesterase therapy. This weakness may be related to an exacerbation of
the disease, or inadequate blood levels of the anticholinesterase agent.
What type of antiarrhythmic is mexiletine?
Class 1B (includes Lidocaine, mexiletine, tocainide)
What would happen to the curve with noncompetitive antagonism?
shifts right
decrease Emax
Flu vaccine
created new each year; two type A and 1 type B strains; based on what is most likely to circulate in US; preservative is egg; made up of grown viruses that are inactive; helps with herd immunity
Tetracyclines are not given with...
Beta-lactams because the two are antagonistic.
Sotalol and ibutilide, dofetilide, bretylium, and amiodarone
Class 3
Prolongs the APD (inc QT interval). Blocks the rapid component of the delayed rectifier potassium current (amiodarone is a Na channel blocker) thus prolonging refractory period. 
Treatment: Ventricular arrythmias and maintaining sinus rhythm in patients with a-fib. Supraventricular and ventricular arrythmias in children
 
Side-effects: Bradycardia, Asthma, Torsades-de-Pointes
Enzyme CAH is found primarily in _______.
 
CAH catalyzes the formation of: 
the proximal convoluted tubular epithelium
 
 
CO2 and H20 from H2CO3; absence of CAH leads to H & HCO3; the result is increased  urinary excretion of HCO3 & Na, leading to diuresis 
What 2 abmormal impulse conductions lead to arrhythmias?
1) Unidirectional block -> retrograde conduction
2) Reentry of ventricular tissue
Cocaine: Class of drug, use, two side effects.
Cortical stimulant (NON methylxanthine or amphetamine) - local anesthetic - Causes convulsions and perforation of the nasal septum *I’m on crack! I’m on crack! I’m convulsing and my septum is cracked! I’m on crack!
What parameters are needed for drugs to interact with receptors in the body?
*Must have appropriate SIZE, ELECTRICAL CHARGE, SHAPE, AND COMPOSITION.
Explain what anesthetic results look like.
remove sensation of pain (ex. benzocaine)
what is the clinical application of lithium
mood stabilizer for bipolar disorder
In decreasing effect, which CCBs have most effect on vascular smooth muscle?
nifedipine > diltiazem > verapemil
What is the dose for flagyl?
250-500 mg
4 times per day
5-10 days
3. Relate the interaction of core drug knowledge to core patient variables for drugs that effect lipid levels.  
Determine health history of diseases and serum cholesterol and lipid levels before therapy. Obtain blood work periodically that monitors complete lipid profile. Therapy is effective when the total cholesterol is below 200mg/dl, LDL is lower than 100mg/dl, and HDL is above 40mg/dl.
What happens in Phase I of Biotransformation?
Makes drugs more water soluable, Hydrolysis, oxygenation, reduction.
What is the major plasma protein used for binding drugs? What plasma protein do basic drugs readily bind to (from book)?
Albumin. Alpha1 Acid Glycoprotein, AKA Orosomucoid
Function of Calcium channel blockers
Affect the heart, decrease SA and AV node automaticity, mainly decreases conductivity
Warfarin is monitored by _________ while Heparin is monitored by ___________.
Warfrin is monitored by PT (extrinsic pathway) (WEPT) and heparin is monitored by PTT (intrinsic pathway)
What does wildtype p53 do?
arrests cells with damaged DNA in G1 or G2 to allow DNA repair mechanism to take place
4 effects of sedative hypnotics on sleep
The effects of most sedative-hypnotics on sleep patterns is to decrease latency, increase stage 2 of non-REM sleep (non-REM sleep constitutes 70-75% of sleep, and stage 2 non-REM 50%), decrease REM sleep, and decrease slow wave sleep (stages 3 and 4 of no
decreasing dose & maintaining dosage interval
What type of dosage adjustment for a patient with renal impairment is preferred when a relatively constant plasma concentration of the drug is desired?
Why is methyldopa an oddball Alpha-2 Adrenergic Stimulant?
Adrenergic receptors see it as NE, but they DON'T activate
what are the components of a microtubule
polymerized dimers of alpha and beta tubulin (+2 GTPs per dimer)
2 things CL (clearance) does not depend on (3 things)
Vd (volume of distribution), t1/2, or F.
if pts on MAO inhibitor what things should avoid and why?
red wine ,cheese , sausage ,avocado ,dried fish(tyramine containing)
amphetamine
cold medication like...................................ephedrine
which drugs --> nephrotoxicity AND ototoxicity
"if you call, i won't be able to hear you in the bathroom"

Cisplatin
aminoglycoside
loop diuretics
Who should not get the flu shot?
- the flu vaccine is grown in eggs. People with a severe egg allergy should not get it.
- Those with GBS should ask their dr.
- People who are moderately or severely ill.
- Those with latex allergy
Ibuprofen NSAID-non steroidal antiflammatory drug
Dosage:200 - 400 mg PO 4 to 6 hrs up to 1200 mgDef:Protype nsaid w significant analgesic and antipyretic prperties it also inhibits platelt affefation and incrase bleeding time antipyretic propertiesInd:Reduce fever and relieve minor to moderate painContr:sensitivty asprin or nsaids active peptic ulcer bledding abnormalitesPre: HTN,GI Ulceration,hepatic renal impairment,cardiac decompensation
SUBCUTANEOUS
PARENTERAL
gtt
drop
gtt
1 mL=15 (16)minims=15 (16)drops(gtts)
mg
milligram
Drug sources
plant 
animal
mineral
synthetic
Topical agents
Opthalmic
Nasopharyngeal
Buccal
Vaginal
Bladder
*Usually for local effects
* Newer topical agents for systemic effects
- Synthetic ADH (Desmopression) OR H1N1 Flu mist vaccine
betamethasone(Diprolene)
Topical corticosteroid
a.c.
before meals
a.c.
"antes comer"
noc, noct
at night
noc, noct
noct=nocturnal
Torsemide
-Demadex
-loop diuretic
Glucose Elevating Agents
glucagon
"pril" drugs
ACE Inhibitors
(Exalgo)
Hydromorphone sustained release
dicloxacillin (Dynapen
Penicillinase-Resistant Penicillins
Adverse effects Cephalosporins
AllergyBleedingThrombophlebitis
Idiosyncratic Reactions
Drug Allergy
Clopidogrel
-Plavix
-antiplatelet med
-prophylaxis following MI, stroke
CNS STIMULANTS
 
CENTRALLY ACTING STIMULANTS
DEXTROAMPHETAMINE
DRUGS AFFECTING CHOLINERGIC FUNCTION
 
AGONISTS
 
DIRECT-ACTING NICOTINIC
NICOTINE

metoprolol (Lopressor)
alpha1, beta1 or beta2, drug effect, uses
 
beta1-blocker
 
reduces cardiac stimulation
 
HTN, early and late MI
major antitussives
* dextromethorphan
* diphenhydramine
* codeine - opioid
 
antitussives do not suppress the productive cough of chronic lung disease (emphysema, asthma, bronchitis) - don't use them!
pregnancy category for cyclosporine
C
Intermediate-Acting Insulin
Cloudy
Potamine- prolongs action
Zinc- slows onset of action and prolongs action
Onset: 1-2 hours
Peak: 6-12 hours
Duration: 18-24 hours
Given in am

NPH (protamine)
Lente (Zinc)
Humulin N (protamine)
Humulin L (Zinc)
Opioid Classifications
Opioid agonistOpioid agonist/antagonistOpioid antagonist
Downregulation is equal to
Tolerance
p.m., PM
evening, before midnight
Doxazosin
-Cardura
-peripherally acting alpha adrenergic blocker
DRUGS FOR HYPERTENSION
 
CENTRALLY ACTING ALPHA-2 AGONISTS
CLONIDINE (CATAPRES)
DRUGS AFFECTING BLOOD GLUCOSE
 
ORAL HYPOGLYCEMICS
 
BIGUANIDES
METFORMIN (GLUCOPHAGE)
Adverse effects of alpha-adrenergic agents


CP, Vasoconstriction, Hypertension, Tachycardia, Palpitations or dysrhythmias



Effects on other body systems:
Anorexia or loss of appetite, Dry mouth, Nausea, Vomiting, Taste changes


Antihypertensives: Vasodilators
 
AEs

 


 dizziness, HA, anxiety, tachycardia, edema, nasal congestion, dyspnea, etc.

Minoxidil: 
T-wave changes on ECG
Cardiac tamponade
Breast tenderness or gynecomastia (men grow breasts)

Nipride:
Potential for cerebral steal and/or coronary steal - can causes profound hypotension
Cyanide toxicity – metabolized down to cyanide
hypertension stage 1
140-159 or 90-99
Rhogam Pregnancy Category
Pregnancy Category C
 
celecoxib (Celebrex) 
Classification: NSAIDs, antirheumatic; COX-2 inhibitor
Action: inhibits prostaglandin synthesis by selectively inhibiting COX-2 - enzyme needed for biosynthesis.
SE: fatigue, anxiety, depression, nervousness, paresthesia, stroke, MI, tachycardia, CHF, GI bleeding/ulceration, nephrotoxicity, blood dyscrasias, platelet aggregation, serious/fatal stevens-johnson syndrome, toxic epidermal necrolysis.
Contraindicated in pregnancy (D). Notify prescriber of GI sxs - black tarry stools, cramping, rash, edema of extremities, weight gain; of chest pain, skin eruptions - d/c immediately. Do not exceed recommended dose.
corticotropin (Acthar)
 
ACTH drug
adrenocorticol disorder, anti-inflammatory agent, acute MS

is used to diagnose adrenal gland disorders, to treat adrenal gland insufficiency, and as an anit-inflammatory drug in the treatment of allergic response.
DOSE: 10-25 units in 500 ml D5W every 8 hours (dx testing)
80-120 units/day SQ/IM for 2-3 weeks (Acute MS)
SE: n/v, mood swings, increased appetite, water/sodium retention, hypokalemia, hypocalcemia
Adverse: osteoporosis, muscle atrophy, decreased wound healing, cataracts, glaucoma, edema, pancreatitis, ulcer.
Drug-Drug: ulcrs with aspirin, decreases effects of insulin/antidiabetics
CAUTION: phychiatric disorders, hepatic disease, PUD (peptic ulcer disease), MG,CHF, fungal infection, increase glucose (hyperglycemia)
pentazocine (Talwin)
Opioid Agonist Antagonist Analgesics
Vancomycin (Lyphocin)* adrs
OtotoxicityThrombophlebitis(rare clots and inflamation) Allergy
Diphenhydramine (Benadryl
Administration: oral, IM, IVInteractionsIncrease CNS depression with alcohol and other CNS depressantsAvoid use of MAOIsSide effectsDrowsiness, dry mouth, dizziness, blurred vision, wheezing, photosensitivity, urinary retention, constipation, GI distress, blood dyscrasias
parenteral
drug administration occurring outside the alimentary tract; injected into the body through some route other than the alimentary canal (e.g., intramuscularly)
Factors affecting drug response
Age
diet
dx
other meds
gender infection
OI/CV/Renal/Hepatic Function
Oxybutynin(Ditropan)
another anti-cholinergic drug that is used for overactive bladder.
DRUGS FOR UPPER RESPIRATORY SYSTEM
 
EXPECTORANT
GUAIFENESIN (ROBITUSSIN)
Indications for anticholinergics


Parkinson's disease: decrease muscle rigidity and diminish tremors
Bradycardia: low-doses: effect cardiac center at medulla = slow HR; high-doses: effect SA and AV nodes = accelerate HR d/t unopposed sympathetic activity
Pulmonary dysfunction (bronchospasm): decreased secretions of nose, mouth, pharynx and bronchi; relaxation of smooth muscles in the bronchi and bronchioles  = decreased airway resistance and bronchodilation
Given to asthmatics or pts with COPD
Irritable bowel syndrome: decreased secretions, relaxation of smooth muscle, and decreased GI motility and peristalsis
Crohn’s and ulcerative colitis
Reflex neurogenic bladder and incontinence: relax detrusor muscles of the bladder and increase constriction of the internal sphincter
Bladder overactivity
Beta-blockers: Indications


Treatment of typical exertional angina (caused by exercise), MI, HTN, cardiac dysrhythmias and essential tremor
Slow contractility, HR and conduction.

atenolol (Tenormin)
 
Agent, Class, Mechanism of Action

 
Agent: Antianginal Agent
 
Class: Beta1-blocker
 
Mechanism of Action: Block the beta receptors of the heart to slow the HR (slows firing of SA node, slow conduction to AV node and reduce myocardial contractility)
leukotriene modifiers
* PO
* suppresses leukotrienes  (↓infammation, bronchoconstriction, airway edema, mucous secretion, recruitment of eosinophils and other inflammatory mediators to the area)
* ADR's: liver injury (zileuton, zafirlukast), Chrug-Strauss syndrome when glucocorticoid is withdrawan (zafilukast, monelukast)
     - Chrug-Strauss: wt. loss, flu-like sx, pulmonary vascularitis
* zileuton (Zyflo), zafirlukast (Accolate), montelukast (Singulair)
clinical indications for urecholine
non-obstructive urinary retention
Absorption Routes
Oral, sublingual, rectal, vaginal, skin, parenteral (IV,IM,SC), intrathecal
Lubricants
alleviate dryness, during surgery, CNS disorders with excessive blinking
 
liquid and ointments
Colonizaton
small pocket of infection. Treat locally not systemically
Antiviral-herpes simplex for the skin
acyclovir (Zovirax
contraindications of Cycloplegic Mydriatics
narrow angle glaucoma
Fluticasone (Flonase), triamcinolone (Nasacort)
ActionAntiinflammatory Decreases allergy symptoms (sneezing, congestion, runny nose)Use Treat allergic rhinitis (short-term use)May be used alone or in combination with H1 antihistaminesDexamethasone should not be used longer than 30 days to avoid systemic effects
supportive
supports body function until other treatments or the body's response can take over
p(with a line above the letter)
after
p(with a line above the letter)
post
cholinergics/ muscarinic
mimic the actions of the parasympathetic nervous system. will either do the same thing as the pns or encourage these actions. A blank promtes the action of the neurotransmitter acetylcholine.
DRUGS AFFECTING MUSCLE SPASM AND SPASTICITY
 
SPASMOLYTICS
 
CENTRALLY ACTING
 
BACLOFEN (LIORESAL)


What's the difference between direct-acting cholinergic drugs and indirect-acting cholinergic drugs?
Direct-acting cholinergics: cholinergic drugs that bind directly to cholinergic receptors to activate them.
 
Indirect-acting cholinergic agonists: cholinergic drugs that work indirectly by making more ACh available at the receptor site.
Adrenergic Agents: AEs

Pts experience sedation and drowsiness -  sympathetic outflow from CNS is reduced which reduces BP
(body is less stimulated, systems are slowed)
 
Orthostatic hypotension - a sudden drop in BP during changes in position.

 
spironolactone (Aldactone)
 
Type, Mechanism of Action and Uses
Type: Diuretic Agent
 
Mechanism of Action: Binds to aldosterone receptors (blocks aldosterone) >>> blocks resorption of Na+ and water, spare potassium
 
Uses: hyperaldosteronism, HTN, reverse K+ loss caused by K+ wasting (loop, thiazide) diuretics

 
epinephrine
* drug of choice for anaphylactic shock
* nasal decongestant d/t α1 stimulation
* all adrenergic receptors (minus DA...only DA can stimulate DA!)
* MAOi's and TCA's prolong and intensify effects!
* ADR's: HTN crisis (d/t excessive α1 stimulation), dysrhythmias (β1), angina, extravasation (IV), hyperglycemia (β2 = glycogenolysis!)
omalizumab (Xolair)
* MOA: antagonism of IgE → decreases release of inflammatory mediators
* after d/c it takes 1 year for IgE to return to pre-treatment levels
* 2nd line for allergy-related asthma > age 12 and ONLY when preferred options have failed
* SQ
therapeutic class of cefazolin (Ancef, Kefzol)
antibacterial (cephalosporins)
Peak (Time vs. effect)
Maximal effect is acheived
calcitriol (Rocaltrol)
to treat hypoparathyroidism and manage hypocalcemia in chronic renal failure.

*promotes calcium absorption for GI tract, increasing serum calcium level.
*monitor calcium levels weekly
DOSE: 0.25 mcg/d, has long onset, peak and duration
SE: anorexia, N/V/D, cramps, headache, lethargy, dizzinness, photophobia
Adverse: hypercalciuria, hyperphosphatemia, hematuria
Caution: malabsorption, CVD, renal calculi, elevated vitamin D
Drug-Drug: increase cardiac dysrhythmia with digoxin, verapamil
Drug-lab: increase serum calcium with thiazide diuretics.
Physical dependence
a pharmacologic property causing the occurrence of withdrawal symptoms with abrupt discontinuation or administration of an antagonist.
bupivicaine (Marcaine, Sensorcaine)
Local Anesthetics, epidural and local
 
 
 
Proparacaine Hydrochloride (Proparacaine)
 
 
 
Eye anesthetic. Avoid from rubbing or touching because it may cause corneal damage.
Adrenergic Receptor Subtypes
 
Where are Beta-1 Receptors? What response do they produce?
 Beta-1 Receptors
Heart, SA Node: Increase heart rate
Heart, AV Node: Increases speed of conduction
Heart, Ventricular Muscle: Increased Contractibility
Kidney: Release of Renin (causes arterial constriction)
drug
a chemical compound taken for disease prevention, diagnosis, cure, or relief or to affect the structure or function of the body.
enteral route
drugs given orally, and those administered through nasogastric or gastrostomy tubes
enteral route
passes through the GI system
Seizure Type: Status Epilepticus
Manifestation: Seizures persisting for 30 min or longer
DRUGS FOR TREATING THE UPPER GI TRACT
 
H2 RECEPTOR ANTAGONISTS
RANITIDINE (ZANTAC)

What is neostigmine (Prostigmin)?
 
Anticholinesterase agent - increases ACh
 
(therefore, a cholinergic agent)
Primary effect of cardiac glycosides
 
inhibits sodium-potassium ATPase pump which increases cellular sodium and calcium concentrations - overall effect is enhanced myocardial contraction
Antidysrhythmic: lidocaine (Xylocaine)

Classification and Uses

Class Ib - block sodium channel, delay repolarization, éAPD

Used to treat PVCs (with more than 6 at a time) and V-tach
 
Lidocaine (Xylocaine) treats only _ventricular_ dysrhythmias.
therapeutic effects of β-blockade
* ↓HR, force of contraction & velocity of conduction
* ↓ renin release
* AP, HTN, dysrhythmias, MI, HF (carvedilol, bisoprolol, metoprolol), migraine, hyperthyroidism, stage fright, glaucoma (↓ production of aqueous humor), pheochromocytoma 
Key points for Urised
formsformaldehyde (keeps the urine acidic); used to treat gram (-) and (+) organisms
Which drug law separated drugs into legend and nonlegend
Durham-Humphrey Amendments
Your patient's blood pressure drops sudden 2-12 hours after treatment with aldesleukin (Proleukin). What adverse effect is he experiencing?
Capillary leak syndrome
clinical indications for acyclovir
herpes (prophylaxis and treatment); cytomegally virus; epstein-Barr virus
Renal excretion
Changes in renal function impact drug elimination
- Neonates
- Adults (decreases by about 1% a year as the person ages)
- Only unbound drugs are eliminated through renal excretion
- Urine pH effects excretion
Drug-induced Dermatitis
An adverse reaction to drug therapy may result in skin lesions that vary from a rash, urticaria, papules, and vesicles to life-threatening skin eruptions such as erthema multiforme (red blinsters over a large portion of the body), stevens-johnson sydrome (large blisters in the oral cavity and anogenital mucose, pharynx, eyes, and viscera, and toxic epidermal necrolysis (widespread detachment of the epidermis from underlying skin layers.)
Growth Hormone Excess
 
 
Anterior lobe of Pituitary
GH hypersecretion 2nd to pituitary tumor
 
* radiation to destroy tumor or bromocriptine (Parlodel) to inhibt release of GH.
 
*octreotide (Sandostatin)- supress GH release
-giantism (during childhood)
-acromegaly (in adulthood): physical changes of overgrowth (hands, hump on forehead)
Fentanyl buccal (Fentora)
Indicated for breakthrough pain Buccal tablets each deliver 100-800 mcg fentanyl
Prostaglandin analogs what does it do
↑ outflow fluid
Uses for nsaids
rheumatoid arthritis, OA, pain, fever, bursitis, tendonitis
Sympathetic Nervous System Receptors
 
CNS > Preganglionic Neuron >
___(receptor?)__ > Postganglionic Neuron > ___(receptor?)__ > Sweat Glands
CNS > Preganglionic Neuron >
Acetylcholine > Postganglionic Neuron > Acetylcholine > Sweat Glands
controlled substances
aspect of nursing practice governed by law; kept in a locked drawer, cupboard, medication cart, or computer-controlled dispensing system.
therapeutic classification
clearly states what a particular drug does clinically and is based on the drug's usefulness in treating a particular disease. Example: antihypertensive, antihistamine, etc
Adrenergic antagonistsAlpha blockers, and Beta Blockers
cause direct blockade of adrenergic receptors. there are two major groups..what are they?
A client's pupils are dilated.  What receptors have been stimulated?
Alpha1 - mydriasis
Calcium Channel Blockers (CCBs): AEs


Peripheral edema, bradycardia, and HF are common.
(Related to the over-expression of the therapeutic effects of CCBs)
furosemide (Lasix) 
 
Mechanism of Action and Uses
AKA - Loop diuretic
 
Mechanism of Action: block chloride absorption, blocks sodium - water follows sodium and excreted
(unfortunately, K+ is also excreted)
 
Uses: rapid diuresis
afterload
* tension produced by a chamber of the heart in order to contract ("load" the heart must eject blood against!)
* ↑ afterload = ↓ SV
* ↓ afterload = ↑ SV
Which drug law required proof of safety and efficacy of medical devices and established standards for existing devices?
Medical Devices Act
MOA of azathioprine
inhibits DNA synthesis leading to DNA damage and chromosome breakdown
actions of tamiflu
decreases the release of virus from infected cells; decreases spread of infection; decreases severity and duration of symptoms
Nitro-Bid (Ointment) - measured on supplied papers.
 
Nitrostat (SL)
 
Nitro-Dur (Transdermal) - apply a new patch daily, remove after 12-14hrs. to prevent tolerance
Classification: coronary vasodilator, antianginal
Action: Decreases preload, afterload; decreases left ventricular end-diastolic pressure, systemic vascular resistance; dilates coronary arteries, improves blood flow through coronary vasculature, dilates arterial & venous beds systemically.
SE: headache, flushing, dizziness, postural hypotension, collapse.
Considerations: Never use erectile dysfunction products [ sildenafil, tadalafil, vardenafil] may cause severe hypotension, death.
Aminoglycosides action and spectrum
Disrupt protein synthesis and cause rapid bacterial death.Narrow spectrum
Use for Fluorescein (AK-Fluor)*
Visualizes foreign bodies and corneal abrasions
What are baroreceptors?
Sensors located in the blood vessels of the body.
 
They detect blood flow and communicate with the CNS to increase or decrease cardiac output
Controlled Substances:
Drug Schedules
 
Explain the differences between schedule 1-5 controlled substances
Schedule 1: High Abuse, No acceptable use, research only (ex: Heroin, LSD)
Schedule II: High Abuse, triplicate prescriptions, no refills (ex: Amphetamines, Opiods)
Schedule III: Moderate Abuse, Written or telephone prescription every 6 months refills allowed (Stimulants, Anabolic steroids)
Schedule IV: Low Abuse, Written or telephone presciription every 6 months refills allowed (Tranquilizers, weak opoids)
Schedule V: Limited Abuse, Many OTC, (Ex: Antidiarheals)
single order
medication that is to be given only once, and at a specific time, such as a preoperative order
Name of Drug: Terbutaline Trade Name: BrethineClassification: Beta 2 agonist, noncatecholamine
Action/Uses: Can reduce airway resistance in asthma by causing beta 2-mediated bronchodilation. Also used to delay preterm labor by relaxing uterine smooth muscle.
Beta-adrenergic agonists: overall effects and AE
Effect: Stimulates both β1 and β2 receptors which will lead to cardiac stimulation and bronchodilation.
 

AE: β1 action can result in too much stimulation with severe tachycardia and possibly chest pain if CAD is present.

 
How do direct-acting cholinergics work?
Drugs that bind directly to cholinergic receptors to activate them
 
Topical use only - increase GI motility and bladder relaxation
properties of cephazolin
similar in structure to pcn; also has beta-lactam structure
contraindications to hep b vaccine
Hypersensitivity to yeast or any component of the vaccine
characteristics of antiretroviral agents
used in the treatment of HIV; preventions and treatment of opportunistic infections secondary to AIDS
Individualize Drug dosages
- Avoid the one size fits all approach
- Why? Because too much variability can occur in important variables.
- When the Therapeutic index is low, monitor the drug, but avoid drug monitoring pitfalls...
-When to draw specimen when intermittent dosing is used? Especially important when the lethal dose and therapeutic dose are close or the Therapeutic Index is narrow.
- One rule does not apply to all. Concentrations of digoxin exceed toxic range if drawn from 2 hours postadministration, but this peak effect does not cause toxicity. So,,, When is the maintenance dose of digoxin monitored? Before the next planned dose.
Triple Antibiotic (neomycin / polymixin B / Bacitracin)
 
antiinfective
effective against gram - bacteria (combination dosage form effective against many gram- organisms)
 
ointment - 1 cm applied in conjunctival sac q 3-4h
Fentanyl buccal soluble film (Onsolis)
Indicated for severe breakthrough pain in opioid tolerant patients with cancer painOnset 15-30 minutes
Acetylcholine is the neurotransmitter for Postganglionic neurons for the Parasympathetic Division.
 
The Receptor for the Postganglionic neurons of the Parasympathetic Division is ________________.
The Receptor for the Postganglionic neurons of the Parasympathetic Division is Muscarinic Receptor.
Frequency Distribution Curve Explanation
1. Response is strictly defined. (Ex: 10% reduction in BP)
 
2. If a low dose is given, a few people will exhibit a response. These people are removed from the mix.
 
3. As the dose increases, more and more people will achieve a response
 
4. At some dose, ll of the subjects will achive a response.
 
5. When the curve is plotted, there will be some dose at which 50% of the population tested will have an achieved response. This dose is called the effective dose 50% or ED50
Name of Drug: Xanax Classification: Alprazolam, Benzodiazephines
Action: Potentiates the effects of GABA, depresses the CNS, and suppresses the spread of seizure activity. Uses: anxiety


A client is prescribed a beta-blocker for HTN.  Is it a problem if he has heart failure too?


Any preexisting condition (such as HF) that might be exacerbated by the use of these drugs may be a contraindication or caution.
Sulfonamides can cause crystalluria, what patient teaching needs to be done?
Drink lots of water, increasing fluid intake dilutes the drug helping to prevent crystalluria
What phrase must all legend drugs contain on their label?
"Caution: Federal law prohibits dispensing without a prescription."
anti tuberculosis drug therapy key points
consist of several drugs administered concurrently; duration of therapy is 6-9 months
Transdermal Fentanyl onset, plateau, half life
Onset of action: gradual increases in serum levelsSteady state achieved at 12 to 24 hoursDuration of action: up to 72 hoursElimination half-life: approximately 17 hours
What are structural differences betwen the Preganglionic Neuron and the Postganglionic Neuron?
Preganglionic Neuron:
- Cell body is in the Spinal Cord or Brain (CNS)
- Axons are myelinated
 
Postganglionic
- Cell body is ouside of the CNS
- Axons are unmyelinated
Modified Occupancy Theory
A drug that produces no effect at the recetpor will produce an effect in the body by .......
Preventing the binding of the endogenous ligand.
Name of Drug: Bethanecol Trade: UrecholineClassification: cholinergic
Action/Uses: Prinicipal indication is urinary retention
Fight or flight response effects
Think: brain is getting the body ready for action
Adrenaline released for fight/flight
Increased BP
Glycogenolysis (liver)
Slowed or ceased digestion
Sphincters close, then relax
Cortisol is released (responsible for helping the body deal with stress - depresses the immune system)
Pupils dilate
Mucous membrane dry out
Muscles tense for action
Increased HR (chest pains, palpitations)
Sweating
Resp: fast and shallow (hyperventilation - increased oxygen need for muscle action)
What drug laws promoted drug studies in children and set the stage for for pediatric drug trials?
The Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act
Gole related to dosing: maintenance, loading, individualizing
Goal- maintain steady state or target concentration, rate of drug administration is adjusted so that rate of input equals rate of loss
KNOW therapeutic range, Digoxin 0.8 - 2.0 ng/ml
Intermittent dosing: peaks and troughs
Intermittent dosing: Amoxicillin has half-life of 2 hours, but usual dosing is every 8 hours.
 
 
 
 
Steps to Self breast exam
Stand infront of mirror with hands at sides
 
While standing press hands firmly into hip and bow slightly
 
While standing raise one arm and palpate breast firmly. Repeat on other hand.
 
Lay down, raise one hand and palpate breast firmly. Repeat on other hand.
What is a drug?
A drug is any chemical that can affect a living process.
trailing zero, lack of leading zero
DO NOT USE-decimal point is missed. Never write a zero by itself after a decimal point(X mg), and always use a zero before a decimal point (0.X mg).
What is thrush and the proper course of action?
Candidiasis of the oral cavity, characterized by small whitish eruptions on the mouth, throat and tongue; call the doctor
Your pt is taking ASA with a beta blocker(s), what do you expect to happen?
Antihypertensive effects of beta blockers may decrease if administered concurrently with ASA
Causes of pain could be due to ...
(3 Pain Etiologies)
1. Disease Related
2. Trauma Related
3. Treatment Related
What is Phase II of the drug approval process?
Participants: Patients with the condition or disease are treated
 
Dosages: Are adjusted based on response
 
Blood and urine are taken to determine drug distribution and elimination
 
Purpose: Learn about drug distribution and elimination and an effective dosage range to treat the condition
 
*Less then 50 people
For a client with myasthenia gravis, give physostigmine 30 min before meals.  Why? 


Allows time for onset of action and therapeutic effects (e.g., decreased dysphagia)
Your pt drinks 3 alcoholic drinks daily, and also takes ASA, what do you expect to happen?
• If pt consumes 3 or more alcoholic drinks per day, it may lead to increased GI ulceration
Safety Studies in Animals:Before being able to test a new drug on humans, the drug company will run clinical trials on ______________ with the understanding that it is meant for evenutal use in _________.
Before being able to test a new drug on humans, the drug company will run clinical trials on animals with the understanding that it is meant for evenutal use in humans.
 
CYP 1A1 &2, CYP 2A6, CYP2B1, CYP 2E1
Do not catalyze drugs to a great extent but DO catalyzed procarcinogenic chemicals to carcinogenic forms (Tar involved in tobacco smoking to carcinogenic agents e.i. lung cancer)
Do you treat pts who are just at risk for HF but have no heart disease or symptoms?
You can treat them with lifestyle changes and possibly ACEI
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Term:
Definition:
Definition:

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