Pharmacology test 3 Flashcards

Terms Definitions
beta nonselective antagonist
fexofenadine/ pseudoephedrine
Autonomic drugs
Cardiac Glycosides
salmeterol xinaforte
sectral, monitan
MalariaMOA: Synthetic 8-aminiquinolineMET: Absorbed GI Half-life: 3-8 hoursSE: GI, methemoglobinemia Hemolysis in G6PD Cardiac & blood dyscrasias OTH: Only agent active against dormant hypnozoite liver form (P. vivax & P. ovale)TX: Malaria
AntiinfectivesLincosaminesNarrow, gm+, bac.static, toxic in g.pigs, horses,hamsters, rabbits, good w/anaerobic bac.
reduce volume overload
Antipsychotics (neuroleptics)
p. 310
class risperidone
atypical antipsych
Antipsychotic butyrophenone

blocks brain dopamine D2 receptors.

marked EPS dysfunction, hyperprolactinemia; less ANS adverse effects than phenothiazines
Minimum Inhibitory Concentration
H1 selective antagonist
Mechanism: cholinomimetic alkaloid, tertiary amine (well-absorbed, penetrates CNS); excreted by kidney; not an ester so not hydrolyzed by acetylcholinesterase
Treatment: sialogogue (increases salivation), miotic agent; Sjogren's syndrome and after radiation therapy
Side effects: parasympathetic action
common glucocorticosteroid:
fluticasone (Flovent)
ADVAIR DISCUS: (fluticasone + salmeterol)
combined glucocortico. & B agonist
use for long-term control 
non-cardiac symptoms of Digoxin:
St. John's Wart
Mild depression
Reversal agent for precedex
uses of somatostatin
Atypical antipsychotic

low affinity for dopamine D2 receptors, higher for D4 and 5−HT2A receptors; less EPS adverse effects than other antipsychotic drugs.

ANS effects, agranulocytosis (infrequent but significant)

primary drug in combination regimens for tuberculosis; used as sole agent in prophylaxis. Metabolic clearance via N−acetyltransferases (genetic variability).

hepatotoxicity (age−dependent), peripheral neuropathy (reversed by pyridoxine), hemolysis (in G6PD deficiency)
Lidocaine Indications
ventriculare dysrythmias only
nasal flonase, inh flovent
acteylated salicyclic, irreversably inhibits cox-1,2,weak acid, absorbed in upper GI and stomach. Low dose short half life, binds to serum protein, enterohepatic circulation.
Mechanism: choline ester with quaternary ammonium group (poorly absorbed, low penetration of CNS); muscarinic receptor agonist; parasympathetic effects (contraction of ciliary muscle which lowers intraocular pressure)
Treatment: used topically as miotic agent for glaucoma
Side effects:nausea, vomiting, diarrhea, salivation, sweating, cutaneous vasodilation bronchial constriction
Antidote: atropine
What abbreviation stands for Cytochrome P450?
Orthostatic Hypotension, sedation, anticholinergic, seizures, sexual dysfuntion
use in urinary retension
ileus (no cross BBB)
severe, potentially fatal allergic reaction
Chief side effect of antihistaines
skeletal muscle resistant
blocks Ca release from SR
used with pts with spasticity
also treats malignant hyperthemia
no effect on Ach release
skeletal muscle resistant
blocks Ca release from SR
used with pts with spasticity
also treats malignant hyperthemia
no effect on Ach release
unique MOA
toxicityy of selegeliene
enhances l-dopa toxicity
What drug causes:
Acute cholestatic hepatitis
Nonsteroid inhibitor of steroid synthesis

reduces conversion of cholesterol to the hormone precursor, pregnenolone. Used in metastatic breast cancer
what is extra pyramidal symptoms
amphetamine parent, monoamine reuptake inhibitor anti-obesity
Treats pheochromocytoma & Reynaud’s disease; short-term control of hypertension
Irreversible blockade. Alpha 1 and 2 antagonist.
is an antagonist of alpha-1A adrenoceptors in the prostate, leading to relaxation of the smooth muscle. Used to treat benign prostatic hyperplasia.
Bismuth subsalicylate
GI Drug (Mucosal Protectant/Antacid) MOA: React w/proteins in acid medium → protective barrier in ulcer crater SE: Black stools, black tongue Don't use in renal disease May have ABX activity against H. pylori TX: Gastric/duodenal ulcers
Components of the nephron
bowman's capsule
proximal convoluted tubule
loop of henle
distal convoluted tubule
collecting tubule/duct 
Antiadrenergic Drugs:
alpha blockers, and beta blockers
Clinical use?
pain, cough supression (dex), diarrhea (loperamide), acute pulmonary edema, methadone maintenance programs
Which drugs causes cardiotoxicity, alopecia, and myelosuppression?
Doxorubicin (adriamycin)
Generic Name
Identitifies the active ingredient. Derived from the chemical name. Assigned by the drug manu. who first dev. drug.
Diaxepam, lorazepam and phenobarbital are ecamples of __________________ ____ drugs.
Schedule IV
propofol: facts + pros
non-barbiturate sedative-hypnotic agent

used for induction &/or maintenance of anesthesia, to produce prolonged sedation of patients in ICU

pros: rapidly metabolized & redistributed --> very rapid recovery
does NOT accumulate in body w/ chronic dosing
which epileptic drug --> aplastic anemia, liver toxicity, and teratogenesis?
receptor selectivity for epi?
all are equal
Type of drug?
Class III antiarrhythmic
Potassium channel blocker
Toxic herbicide

very small oral (but not inhaled) doses cause lethal pulmonary fibrosis
Mechanism: Increase the frequency of Cl channel opening. No GABA mimetic activity. BZ1 mediates sedation, hypnotic while BZ2 mediates antianxiety, impairment of cognitive functions, muscle relaxant, etc.
Uses: anxiety, panic, phobias
Most widely used BZ
L-type Ca channel blocker vascular selective
Reduces bronchospasms by blocking M3 receptors. (causes brochodilation and reduces bronchial secretions)
...induce synthesis of renal prostaglandins and improve renal blood flow
Loop diuretics
is used in the treatment of Alzheimer’s disease. It is an NDMA receptor antagonist, which may help prevent excitotoxicity and neuronal cell death.
RA (COX1 & COX2 Irreversible inh) Duration: Low = 15 min High = 4 h ↑ High = 13 h OTH: 1) binds serum proteins (depends on dose) 2) irreversibly acetylates COX-1&2, 3) irreversibly inhibits platelet aggregation SE: 1) salicylism, respirary alkalosis, met. acid 2) NSAID-asthma 3) Reyes syndome TX: Rheumatoid Arthritis, Inflammation
lowest serum level, taken 30 mins before next dose - used to determine drug accumulation & toxicity

GER: passage of gastric contents into the esophagus

regurgitation: passage of gastric contents into the oropharynx

emesis: expulsion of gastric contents from the mouth
S/E hydrlazine
SLE like syndrome
no cause CNS depreesion
or postural Hypotesion
reflex tachycardia
What type of drug administration is usually used for CSF?
inhibit NT release
-inhibit uptake of precursor-inhibit synthesis-inhibit uptake/storage in vesicle-inhibit release into cleft-increase destruction
What drug is made of Valproic acid?
Cholinergics anatagonists that block the effects of ACh almost exclusivley at muscarinic receptors
Muscarinic Cholinergic Antagonist
pH of all narcotics and local anesthetics
strategies to study pharmacology
concentrate on therapeutic classifications
keep a reference handy
use own words in notes/cards
understand how drug works in body - applies to rest of class
Clinical uses of Ivermectin.
Onchocerciasis "rIVER blindness treated with IVERmectin".
MOA nitroprusside
vasodilation of arteries and veins
contact with RBC --> decomposition of drug and release of NO
NO, via activation of guanylate cyclase --> vasodilation
Type of drug?
Class Ib antiarrhythmic
Na channel blocker
What is another name for vitamin B12?
Aminophyllin OD S/S
first signs: insomina, tachycardia, arrhythmias, seizures; then anorexia, N, V, stomach cramps, restlessness, confusion, headache, flushing, increased urination,
what types of drugs affect the parasympathetic nervous system?
used for local anasthesia, has epi mixed with it for slower removal coz of its vasoconstrictive effect, dental work.
IV or bolus anesthetic, rapid onset, 10 min. anesthesia, slowly metab. by liver but out of brain quickly, get hangover, decreases cerebral blood flow so good for head injuries and grain tumors, reduces hepatic blood flow and GFR, NOT AN ANALGESIC.
"I am going to eat ALL ASParagus"
Mechanism: enzyme that depletes asparagine (many tumors cannot synthesize their own)
Treatment: ALL
Side-effects: Allergic reactions, decreased protein synthesis (hypoinsulinemia/hyperglycemia, reduced clotting factors/inhibitors), ASP (allergies, spare GI and bone marrow, and protein deficiency), cerebral dysfunction, pancreatitis
All sedative/hypnotics except for ______ are general CNS _________ capable of producing _________ that can progress to _________
1. Benzodiazepines2. depressants3. dose-dependant CNS depression4. medulla oblongata depression, coma, death
antifungal agents:
terbinafine (Lamisil) 
similar spectrum as Griseofulvin
PO & topical administration
drug of choice for fingernal (8 wks PO) & toenail (12 wks PO) fungi - "onycomycosis" 

for persons allergic or NOT responding to TCAs

those w/low psychomotor actvity

those w/strong anxiety

ATYPICAL depression:

labile moods, rejection sensitivity,eating disorders
As the dosage administered to a single subject or isolated tissure is increased, the pharmacologic effect will also increase until at certain dose, the effect reaches a maximum. What is this called?
Graded responses
This drug used to treat testicular cancer and lymphomas may cayse pulmonary fibrosis, skin chnages, and myelosuppression
Bleomycin, Dactinomycin
propagation of a seizure
-recruitment of normal neurons-local or distant-gradual or instantaneous
Tricycli Antideressants (TCA)
Antidepressants act by blocking the reuptake of norepi and seretonin, extending the duration of their actions
Beta 2 receptors
-Cause broncho and vasodilation when stimulated.
-Can inhibit uterine contractions when stimulated.
-Side effects of muscle tremors possible with over stimulation.
What does the abbreviation stand for: VO
verbal order
Most common resistance mechanism for Chlorampenicol.
Modification via acetylation.
Type of drug?
Blocks M1 receptors on ECL cells(↓Histamine) & M3 receptors on parietal cells (↓acid)
what is the duration of ipratropium bromide?
4-6 hour
signs of drug diversion
arriving early/staying late; comming in on off days; signing out large quanity; volunteering to give meds to other nurses patients; frequent bathroom breaks, discrepencies in documentation, meds being signed out for patients who are not at the unit
MAOB i, reduces DA metabolism in CNS, parkinsons
Two prototypical TCA drugs
Imipramine and amitriptyline. (both are tertiary compounds and both inhibit NE and 5-HT uptake ) They are metabolized to secondary compounds that are also antidepressants (desipramine and nortriptyline). Tertiary have more prominent side effects.
Drugs for the treatment of TB?
isoniazid, rifampin, pyrazinamide, ethambutal. American Thoracic Society recommends 3 drug regimen of isoniazid, rifampin, and pyrazinamide
There are 3 types of interindividual genetic variations that influence pharmacotherapy, which are?
Pharmacokinetic variation, pharmacodynamic variation & genetic asso. w/ idiosyncratic drug effect
3rd generation quinolones/2nd generation fluoroquinolones
broad spectrum (not good for atypicals)
gram-neg coverage as above
greater gram-pos coverage 
Therapeutic uses of Mannitol [Osmitrol]
Prophylaxis of renal failure
Reduction of intracranial pressure
Reduction of intraocular pressure
What biological item may be used as a model for drug-receptor interactions?
how to modify synaptic function
-inhibit NT release-facilitate NT release-decrease NT in cleft-increase Nt in cleft-mimic action of NT on post-block access of NT to receptor on post-decrease action of NT-increase action of NT
Extended Spectrum
Gram + and -. Also good against pseudomones and proteins (everything).
What are two big respiratory depressants?
Opium and barbiturate groups
antidote for anticholinesterates & organophosphates (too much ACh) =
atropine & pralidoxime (which regenerates cholinesterASE)
Fluoxetine, sertraline, paroxetine, citalopram are what class of drugs?
pg 311 SSRI's for endogenous depression
what 2 cholesterol drugs, if taken concurrently, will cause rhabdomyolysis
statins and fibrates
What is the problem with Ephedra?
-relative of amphetamine
-myocardial infarct
ETOH abuse - frequent complications
cirrhosis of the liver, cardiomyopathy, vitamin B deficiency (wernicke's encephalopathy, korsakoff's psychosis, polyneuritis, nicotinic acid deficiency, encephalopathy
Max response that can be achieved by a drug.
Maternal intake of...may cause neurobehavioral deficits.
Enter your back text here.
Loading dose
What type of dosage would be used if it is clinically important to acheive therapeutic concentrations immediately?
other agents affecting the cell wall:
vancomycin (Vancocin) 
effective against all gram-pos organisms
presently reserved for tx of  severe infections caused by MRSA or serious gram-pos infection in PCN-allergic pts (b/c not safe)
also used to treat C.diff-induced pseudomembranous colitis & for prophylaxis in pts w/ prostatic valves who are undergoing oral surgery
adminstered IV, except when treating pseudomembranous colitis, then POadmin IV over 90+ min to avoid Red Man's Syndrome (regardless of dose)
What do class I drugs target?
What states do they work on?
What phase in the action potential does it affect?
Sodium channel blockers
Open & inactive state
Phase 0
Because that is when sodium channels are open to enter the cell
Scopalamine: Class of drug, use.
Muscarinic Blocker - to prevent motion sickness and insomnia *puts you to sleep so you don’t puke on the Scope boat
Site of action
location within the body where a drug exerts its therapeutic effect, often a type of receptor
Once dug has FDA official name it is listed where and will have what next to name of drug
Pharmocpeia, USP
Disulfiram-like reaction can be due to which drugs?
- metronidazole
- cephalosporins w/methylthiotetrazole group
- procarbazine (Hodgekin's)
- sulfonylureas (insulin release for type 1 diabetes)
which beta blockers are used to treat glaucoma
timolol, betxolol, carteolol
What is the triple therapy for H. pylori ulcers?
Bismuth or sucralfate
Amoxicillin(or tetracycline)
Tyroid replacement therapy action
is to achieve normal thyroid levels (euythroid)
Levofloxacin, moxifloxacin, and gemifloxacin have good antibiotic effects on... And their adverse side effects.
Gram-neg. and gram pos (strep., staph, and respiratory pathogens). Prolong QT interval and should not be given to patients being receiving class I or III antirrhythmics.
What is presumptive antibiotic therapy?
Given when there is a strong possibility of an established infection. (acute cholecystitis or pancreatitis of less that 24 hour duration)
Pharmacodynamics of Fibric Acid Derivatives:
mech. of action is not well understood
believed that fibric acid derivatives increase the activity of lipoprotein lipase, a plasma enzyme that degrades chylomicrons & VLDL
How do you properly measure BP?
Arm should be at level of heart
What is the normal function of Beta-2 receptors?
Relax bronchial smooth muscles
specific mechanisms of AED: enhance GABA inhibition
-Gaba facilitation (drug binds and helps gaba bind)-increase gaba synthesis/release (increase GAD-glu acid decarboxylase, decrease Gaba-T- gaba tranaminase, SSA- succininc semi-aldehyde)-decrease gaba metabolism-decrease gaba reuptake
What does the abbreviation stand for: SOS
si opus sit, if necessary
what are the side effects of antipsychotics
extrapyramidal side effects (EPS), sedation, endocrine, muscarinic blockade, alpha blockade, histamine blockade
which drugs cause SLE like syndrome
"it's not HIPP to have lupus"

What is sick sinus syndrome?
SA node is damaged, fibrotic or infected causing a lack of firing
Histamine neurons found where in the brain?
Tuberomammillary nucleus in the hypothalamus (neuroendocrine control, thermoreg., and arousal.)
examples of combinations of PCNs + B-lactamase inhibitors
amoxicillin + clavulanic acid = augmentin
piperacillin + tazobactam = zosyn 
What equation is used to calculate half-life? What equation is used to estimate amount of a drug in the body at some point after it is given?
Half life = kt=0.693. Concentration at time t = Amount of drug at time zero/2^number of half lives that have gone by since time zero
Thiazide Diuretics - MOA, Uses, and S/E
Most widely used; the first choice.
MOA: Blocks reabsorption of Na and Cl in the distal convoluted tubule. (won't reabsorb water, blood volume decreases)
Uses: Hypertension and edema
S/E: Lyte/H2O imbalance, increases uric acid (which causes gout), hypokalemia, increased blood sugar, (hyperglycemia inhibits release of insulin).
Also, mediators elicit a ________ response is which leads to bronchial __________ and is treated with __________.
mediators elicit a late response and this leads to bronchial hyperactivity. This is best treated with steroids.
what is the process of absorption done by most drugs?
Passive Diffusion

(there is also active trans and carrier mediated)
Bethanechol (and other main drug in this group and group function)
Ach/choline ester mimetic (M-3 agonist (cevimeline also one)) for stomach and bladder-detrusor muscle, relaxes trigone, and external sphincter) Carbachol (broader effects).
What are special considerations (5) in patients that you should consider in drug metabolism?
- Age- Induction of drug metabolizing enzymes- First pass effect- Nutrition- Drug competition
Name the four places that Nicotinic receptors are found.
1 Autonomic ganglia 2 Adrenal medulla 3 CNS 4 Skeletal muscle
T or F: penicillin is effective against gram pos and gram neg rods
False: penicillin is used to treat common streptococci (but not staph), meningococci, gram pos bacilli and spirochetes (i.e. syphilis, treponema). Not used to treat gram neg rods.
What is the formula for augmentin?
250 or 500 mg amoxicillin + 125 clavulonic acid
What does angiotensis II do to SM cells?
Causes them to contract & proliferate -> ↑ strength of vascular wall (↑ tone) -> ↓ compliance (not able to relax as easy)
Which of these is not a mechanism of penicillin action: (1) binds penicillin-binding protein, (2) blocks peptidoglycan synthesis, (3) blocks transpeptidase catalyzed cross-linking of cell wall and (4) activates autolytic enzymes
Penicillin does not block peptioglycan synthesis, bacitracin, vancomycin and cycloserine do that
What lab work would be ordered for a patient to evaluate lipid levels?
A total cholesterol level, an LDL level, and HDL level.
What do the following drugs inhibit: 1. MAO inhibitors, 2. Desipramine/maprotilline, 3. Mirtazapine and 4. Fluoxetine/trazodone?
1. MAO 2. NE reuptake 3. Alpha 2-R 4. 5HT reuptake
a small glass vial containing solutions for hypodermic injection

1milliliter (ml)
tobramycin (Nebcin)*
Fever reducer
sol, soln
-ACE inhibitor
Potential drug interactions
slower or faster absorption
slower or faster metabolism
slower or faster excretion
Nursing Process
1.  Assess
Ends in "ase"
metipranolol (Optipranolol)
Beta-Adrenergic Blockers
drugs kill bacteria
hydrogen peroxidemineral oilCerumenexDebrox
Rifampin uses
M. tuberculosis
gt, GT
gastrostomy tube
gt, GT
gt is not the same as gtt!
-peripherally acting alpha adrenergic blocker
drugTherapeutic uses: depression, bipolar disorder, neuropathy painadverse effects: ortostatic hypotension, anticholinergic effects (cant see, pee spit, poop)sedation, cardiac toxicity.Drug interactions: CNS depressants*huge issues with overdose/toxicity, these drugs can be tough to reverse!
1 gallon (gal)
4 quarts

Antihypertensives: Vasodilators


Severe HTN

Parenteral form is generally reserved for treatment of severe or malignant HTN
prototype for sulfonamides
sulfamethoxazole-trimethoprim (bactrim)
levothyroxine (Synthroid)
Classification: Thyroid hormone
Action: increases metabolic rate, controls protein synthesis, increases cardiac output, body temp, renal blood flow, O2 consumption, blood volume, growth, and development at cellular level.
SE: anxiety, insomnia, tremors, thyroid storm, tachycardia, palpitations, angina, dysrhythmias, cardiac arrest.
Contraindicated: adrenal insufficiency, recent MI, throtoxicosis, hypersensitivity to beef.
Considerations: take in am at same time daily on empty stomach; report excitability, irritability, anxiety -- OD; avoid foods high in iodine - iodized salt, soybeans, tofu, turnips, high-iodine seafood.
Rheumatoid arthritis meds
NSAIDsCorticosteroidsdexamethasone (Decadron)prednisone (Sterapred)triamcinolone (Kenalog)Disease modifying antirheumatic drugs (DMARDs)
Diflucan (Flucanazole)
Class: Anti-fungals
Side effects:
nausea, headache, abdominal pain, diarrhea, pain distortion
Nursing care:
used to treat candidiasis
reduces metabolism of tolbutamide, glyburide, glypizide so blood glucose should be monitored closely- hyperglycemia
t.i.d., tid
three times a day
t.i.d., tid
tres in dia
-peripherally acting alpha adrenergic blocker
Calcium supplements are contraindicated in pts who have
bone tumors
1 quart (qt)
1 liter (L)
amiodarone (Cordarone)
Type, Mechanism of Action, Uses
Type: antidysrhythmic
Mechanism of Action: Class III - principal effect on myocardial tissue is to increase action potential duration
Uses: Treatment of V-tach, V-fib, V flutter and A fib
Treats only ventricular dysrhythmias
*Proarhythmic properties
Vancomycin- RN responsibilities
Infection-focused physical examinationMonitor blood pressure and heart rate during IV administration; take at least 60 minutesMonitor for red man syndromeMonitor urinalysis and renal and hepatic functions; do hematologic studiesMonitor blood levels in certain patientsAssess baseline and periodic hearingMonitor fluid balance; report changes in intake and output ratio and patternNote oliguria or cloudy or pink urine

Raloxifene (Evista) 


Classification: hormone modifier, selective estrogen receptor modulator (SERM)
Action: reduces resorption of bone and decreases bone turnover; mediated through estrogen receptor binding.
SE: CVA, nausea, hot flashes, leg cramps, pulmonary embolism.
Contraindicated in pregnancy (X) & women c active hx of DVT
Considerations: B/P, weight gain, BDT baseline & during treatment. D/C drug 72hrs to prolonged immobilization.

Meperidine (Demerol) produces what metabolite?

ARDS And Asthma
Symptoms of ARDS:
decreased breath sounds
Symptoms of Asthma:
Wheezing on expiration
Non productive cough
Examples of Endogenous Ligands:
Neurotransmitters bind to ________________.
Neurotransmitter receptors
acute allergic response to an antigen that results in severe hypotension and may lead to life-threatening shock if untreated
hypotension & may be life-threatening
Pharmacological Class groups drugs by
shared characteristics
Receptors that bind to acetylcholine are called?
Nursing Process
1. Primary medical problem
2. Secondary medical problems
3.Social, psychological, educational,environmental, safety,nutritional problems
cardiac glycosides help patients manage
systolic HF
Beta-adrenergic agonists stimulate
Beta-1 receptors: cardiac stimulation
Beta-2 receptors: bronchodilation
cromolyn sodium (Intal)
* anti-allergic, anti-inflammatory properties.  mast cell stabilizer, not a bronchodilator!  stabilizes mast cell membrane, decreasing the release of histamine & other mediators
     - inhibits eosinophils, macrophages and other inflammatory cells
* do not use to abort an acute attack
* safest antiasthmatic med!* especially effective for seasonal allergy attacks; e.g. 15min before mowing the lawn!* ADR's: cough, bronchospasm (low incidence)
* works in 15min; 1-2 weeks to get maximum benefits!
* allergic rhinnitis: Nasalcrom (intranasally)
What types of injections should patients avoid for 3 months after completeing therapy with aldesleukin (Proleukin)?
nursing responsibilities 
-weigh daily
-monitor BP and ortho hypo
-monitor elecrolytes (Na+, K+, Ca+)
-Hypo K+ <3.5: muscle weakness, abdominal distention, leg cramps, dysrythmias
-Hyper K+ >5.5: nausea, diarrhea, abdominal cramps, bradycardia, ecg change,  oliguria
-Hypo Na+: LOC, headache, irritability,neurochanges, seizures, hallucinations
-take in AM
Verruca Vulgaris (Warts)
cautery / laser
note: wart can also be removed by surgical excision
Beta-Adrenergic Blockers
Decrease production of aqueous humor
Clindamycin (Cleocin) Can induce antibiotic-associated
pseudomembranous colitis
Rubs & Liniments
temporary relief muscular aches
Montelukast (Singulair)Zafirlukast (Accolate)
ActionsSelective and competitive receptor antagonist of cysteinyl leukotriene receptor. Leukotrienes are part of the inflammatory pathway that causes bronchoconstriction.reduce inflammatory process and decrease bronchoconstrictionUsesprophylactic and maintenance for chronic asthma NOT acute asthma attacks. Used in combination with other drugs to treat asthmaNot bronchodilators; given orally. Should not be used to treat acute episodes of asthma.The cysteinyl leukotriene receptor is the one that leukotriene D4 and E4 stimulates to trigger asthma symptoms.
Another great comparison of Somatic Nervous System and Autonomic Nervous System
s(with a line above the letter)
beta-adrenergic blockers
inhibit beta adrenergic stimulation decreasing CO
-block the release of catecholamines, epinephrine, and norepinephrine decreasing HR and BP-used for angina, dysrhythmias, HTN, migranes, MI prevention, glaucoma
The drug of choice for stopping ongoing migraine attacks; also used for cluster headaches

With administration of epinephrine and similar drugs (used for cardiac, bronchial, antiallergic, ophthalmic and vasopressor effects), assessment should focus on:

Vital signs
Breath sounds
Arteriole blood gas levels (ABGs)
ECG findings
Antidysrhythmics: 3 key drugs
lidocaine (Xylocaine)

amiodarone (Cordarone)

adenosine (Adenocard)
Allergy or hypersensitivity to PCN, what is given?
Erythromycin (macrolide)
* ↓ (renal) BP - kidneys secrete renin
* converts angiotensinogen to angiotensin I
* angiotensin I is converted to angiotensin II via ACE (angiotensin converting enzyme) from the lungs
* angiotensin II → strong vasoconstrictor!  Stimulates the release of aldosterone (saves Na+ and water (and secretes K+) which in the end ↑ blood volume, which ↑BP!
what is the onset of pyridium
30 min
APAP poisoning s/s
anorexia, nausea, vomiting, dizziness, lethargy, diaphoresis, chills, epigastric or abd pain, diarrhea
Protein Binding
Binding of drugs to Plasma Proteins:
- Albumin- major carrier for acidic drugs
- Alpha-1 acid glycoprotein- major carrier for basic drugs (alkaline drugs)
- Sex hormone binding globulin
- Thyroxin binding globulin
Storage of Insulin
unopened vial is refrigerated
opened vials 4 weeks at room temp., 12 weeks refrigerator
less irritating to tissues injected at room temp.
do not place in heat / direct sunlight
prefilled syringes in refrigerator and used in 1-2 weeks (at home)
prednisone (Deltasone, Orasone)
glucocorticoid (adrenal cortex)
decreases inflammatory occurrence; as an immunosuppressant; to treat dermatologic disorders
mode: suppression of inflammation and adrenal function
Dose: 5-60 mg/day; may taper dose to avoid severe adrenal insufficiency
SE: N/D, increased appetitie, headache, weight gain, depression, mood changes, euphoria, hyperglycemia, abnormal fat deposits
Adverse: HTN, tachycardia, osteoporosis, muscle wasting, IOP, thin skin with purpurs, growth retardation, GI hemorrhage, thrombophlebitis.
Alpha-Glucosidase Inhibitors
acarbose (Precose): inhibits enzyme in the small intestine responsible for the release of glucose from complex carbs in the diet; cannot absorb carbs and are passed through to large intestine; not significantly absorbe, no systemic effects; used in conjuction with diet; does not cause hypoglycemia; may combine with sulfonylurea
Dose: 25 mg with meals

miglitol(Glyset): is absorbed from GI tract ; does not cause hypoglycemia unless taken with insulin or sulfonylurea
Dose: 25-100 mg with meals
Somogyi Syndrome
hypoglycemia at 2-4 am
reduce bedtime insulin
Equianalgesic Opioid Doses codiene
O:180-200 mg parentral:130 mg
Tetracyclines used to treat
Rickettsiae, Mycoplasma, ChlamydiaN. meningitidis, N. gonorrhoeae, Lyme disease, anthrax (doxycycline), helicobacter pylorii, acne
theophylline (Theo-Dur)
LOW THERAPEUTIC INDEX: must monitor serum levelsAction: relaxes smooth muscle of bronchi, bronchiolesUse: maintenance therapy for chronic stable asthmaTheophyllineTherapeutic range: 10-20 mcg/ml (toxicity greater than 20) MUST KNOW THIS VALUE!!!!
An undesirable or dangerous effect of a drug brought about by high drug levels
What is the medication route of administration that involves a needle?
Inamrinone lactate
-used for short-term management of congestive heart failure in those who have not responded adequately to cardiac glycosides, diuretics, ad vasodilators
Name of Drug: Hydrochlorothiazide(HCTZ) Trade Name: Aquazide H, HydroDIURIL, Microzide, Apo-Hydro, othersClassification: thiazide diuretic, antihypertensive
Actions/Uses: diuretic, reduces the kidneys’ ability to absorb sodium, which in turn reduces the ability to reabsorb water, causing increased urinary output. The decreased levels of fluid in the blood help the heart pump more efficiently and decrease cardiac output. Used to treat a variety of conditions including: hypertension, congestive heart failure, symptomatic edema, the prevention of kidney stones and multiple other disorders. This drug has also been found helpful in treating diabetes insipidus(excessive urine production), although this mechanism is unknown.
Adverse effects of beta-adrengergic agents

Adversely effect CNS, causing:
Mild tremor

Cardiovascular effects:
Increased HR (positive chronotrophy)
Palpitations (dysrhythmias)
Fluctuations in BP

Other significant effects:
Muscle cramps
Implementing Teaching Plan
Role of pt stress and anxiety
Planning and timing of sessions
Learning capacity
Variety of teaching methods

Verbal education
group settings

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AEs of cardiac glycosides

Very narrow therapeutic window: normal level is 0.8-2 ng/ml

Bradycardia, A/N/V, colored vision, halo vision are classic!

CV - Any type of dysrhythmia, including bradycardia or tachycardia
CNS - HA, fatigue, malaise, confusion, convulsions

Eye - Colored vision (i.e., green, yellow or purple), halo vision or flickering lights

GI - Anorexia, nausea, vomiting, diarrhea
variant angina-prinzmetal's/vasospastic
* coronary vasospasm
* you can wake up in the middle of the night with this one!
* treatment is symptomatic only: nitrates and CCBs
seasonal rhinnitis, cont.
* Nasalcrom - intranasal cromolyn sodium.  
     - works in 1-2 weeks.
* sympathomimetrics (PO and intranasal decongestants used adjunctively)
     - relieves stuffiness, not sneezing, runny nose or itching
     - limit use to 3-5 days or else will REBOUND (all symptoms will reappear!)
          - phenylephrine (Neo-synephrine), Sudafed PE, Afrin
     - potential for abuse (like amphetamines) - pseudoephedrine, ephedrine
     - ADR's: CNS excitation (irritability anxiety, insomnia)
clinical indications bactrim
infections caused by h.influenza and streptococcus pneumonia; pneumocystis carnii (associated with HIV/AIDS); urinary tractinfections; GI infections (caused by shigella and salmonella); otitis media; STDs; burn wound infections (ex. silvadene used topically)
Teach Family- Hep B
Return for all follow-up dosesImmediately report a fever of 39.4°C (103°F) or higher, difficulty breathing, confusion, swelling of eyes or face, irritability, or confusionNotify if known or suspected pregnancy prior to vaccinePrior to vaccination, report use of all vaccines, immunosuppressant drugs, or those to treat or prevent organ transplant rejection or cancerMaintain a current and accurate record of all vaccinationsH
Contraindications for Intron A:
hypersinsitivity to IFN's, autoimmune hepatitis, hepatic decompensation, neonates and infants,
drug interactions of diflucan
oral contraceptives ( decreases effectiveness)
Transdermal absorption
Only fat soluble drugs are appropriate for trandermal application
Bypasses the 1st pass effect, abosorbed immediately into the vascular system.
fludrocortisones (Florinef)
is an oral mineralocorticoid that can be given with a glucocorticoid. It can cause a negative nitrogen balance; therefore a high-protein diet is usually indicated
potassium excretion occurs with use of mineralocorticoids and glucocorticoids, the serum K+ level should be monitored due to hypokalemia
0.1-0.2 mg/day
infliximab (Remicade)
Tumor Necrosis Factor Blockers used in treatment for RA
use of chemicals to fight things in your body
Side effects of Beta-2 Antagonist include bronchoconstriction. What does this mean for patients with asthma taking a beta-2 antognists?
Could worsen asthma
process by which a drug changes the body
c(with a line above the letter)
c(with a line above the letter)
&quot;con&quot; in Spanish=&quot;with&quot; in English
Verapamil and flunarizine
are the only two calcium channel blockers that appear useful in relieving migraines
Adrenergic Storm Definition

Sudden and dramatic increase in the serum levels of catecholamines epinephrine (increases HR and SV) and norepinephrine (increases HR and BP) with a less significant increase in dopamine (a monoamine and precursor to epinephrine and norepinephrine).
ACE Inhibitors (the "prils"): Renin-Angiotensin-Aldosterone System (RAAS)

These drugs block the angiotensin-converting enzyme (ACE) - ultimately prevents vasoconstriction and aldosterone secretion.

(Aldosterone - responsible for reabsorption of salt and water and excretion of potassium in the kidneys)

What is antibiotic trough?
indicates how much has been metabolized by the body system, obtained 30 mins before administration
antibiotics mechanisms of action
(there are 4)
1. inhibits cell wall synthesis
2. inhibits protein synthesis
3. disruption of membrane permeability
4. inhibit synthesis of essential metabolites
Nursing responsibilities for patients receiving penicillin G
infection-focused exam (VS, WBC); accurate hx; obtain blood, urine, sputum, wound cultures for C&S; evaluate renal, hepatic, and hematologic fxn; monitor for hypersensitivity
long-term High-doses of aspirin may cause....
tinnitus and hearing loss
- Fetal pH of 7.0 somewhat more acidic than maternal pH of 7.4, and this can cause trapping of basic drugs
- Drugs that cross placental barrier and which administered to mother immediately before birth may therefore have adverse effect on fetus
- Drugs which are administered during pregnancy and which cross the placental barrier may cause anomolies. These are called teratogenic agents
* take meds with meals
*do not stop abruptly; thyroid crisis
S/S hypothyroid
1-3 weeks for improvement
monitor pulse for increase or decrease
SE: rash, hives, alopecia, loss of hair pigment, bruising, weakness
* report fever or sore throat (agranulocytosis); monitor CBC
Fluoroquinolones Interactions
antacids, iron or zinc should not be taken within 2 hr, bind makes the antacids ineffective.
Which of the following terms is defined as "the ability of a drug to activate a receptor upon binding"?
A. Affinity
B. Intrinsic Activity
C. Efficacy
D. Potency
B. Intrinsic Activity
medication interactions
occurs when the admin. of one drug before, at the same time as, or after another drug alters the effect of one or both drugs (may be beneficial or harmful)
Schedule V Drugs
have the lowest potential for abuse; the only category in which some drugs may be dispensed w/o a prescription because the quantities of the controlled drug are so low that the possibility of causing dependence is extremely low.
Stimulation of what receptor causes decreased GI motility?
Beta2 - decreased GI motility

Diuretic Agents: Osmotic Diuretics
Mechanism of Action


Produces osmotic pressure in the GF >>> pulls fluid into tubules >>> diuresis
Disease-modifying anti-rheumatic drugs (DMARDs)
* reduce joint destruction and retards disease progression in RA
* efficacy in 3wks-6mos depending on the drug
* concurrent use with NSAIDs while waiting for effects
* multiple DMARDs with persistent joint injury progression 
Which drug law required a drug to be both safe and effective, set guidelines for clinical trials, and established the Drug Efficacy Study Implementation (DESI)?
Kefauver-Harris Amendments
what is the "three-bag method"?
Treatment of APAP overdose; acetadote loading dose: dilute 150mg/kg in 200ml of d5w and administer over 50 minutes second dose: dilute 50mg/kg in 500ml of d5w and administer over 4 hours third dose: dilute 100mg/kg in 1000ml of 5% dextrose and administer over 16 hours
clinical indications of rifampin
treatment of TB; treatment of other mycobacterial infections
Organs of excretion
- Kidney is the most important organ in excretion
- GI tract eliminates unabsorped drugs or metabolites excreted in bile
- Breast milk excretion is important because of potential passage of drugs to the infant
- Lungs excrete gases, ketones, etc.
Acyclovir routes
Topical - apply q3hr x 7 daysAlso may be given PO and IV (renal alert
What is an autonomic ganglion?
- Clusters of neuronal cell bodies and dendrites
- Part of the Postganglionic Neuron
- A junction between autonomic nerves originating from the CNS and autonomic nerves innervating their target organs in the periphery.
The Nursing Process in Pharmacology:
* Maximize therapeutic effects and minimize adverse effects
* Include the patient & family in the planning
What is the use of drugs that are used to prevent, dx, and cure disease processes or to relieve s/s?
Drug therapy
Diuretic Agents: Loop Diuretics
Edema with HF and hepatic or renal disease

clinical indications of cephazolin
UTI caused by e. coli; surgical wounds (prophylaxis against infection); endocarditis, abdominal and pelvic infections; skin, joint, billiary, genital infections; septicemia
ASA is contraindicated in this age group:
• Contraindicated in children and teens (Reyes Syndrome)
Elimination of Half-Life
A measure of the rate of removal of the drug from the body
Penicillins are combined with what to extend the spectrum
a beta-lactamase inhibitors, the antimicrobial spectrum is extended
What are Non-Specific Beta Blockers?
Block both Beta 1 (heart receptors) and Beta 2 (Lung) receptors
However, they are more likely to cause bronchospasms than cardiovascular beta-1 specific antagonists
Nonspecific Beta Blocker Drugs:
Sources of drug information
1. Pharmacology book (Not a good way for updates; website stays current)
2. Physicians Desk Reference (PDR) for prescription and OTC drugs - comes with the drugs to protect the drug companies
3. Formularies
4. Drug compendiums - useful for dosage, not mechanism of action or class
5. Reputable websites (Mayoclinic, associations (heart, diabetic), advocacy websites

Where are the major sites of action for anticholinergic agents? 

Muscarinic receptors of the PSNS 
What are the symptoms of pyelonephritis?
Symptoms of an upper UTI, would include chills, high fever, flank pain, pain during urination, urinary frequency and urgency, and pyuria.
if your pt is taking celebrex with diuretics or ACE inhibitors, what may happen?
antihypertensitive action of diuretics or ACE inhibitors may be reduced
Opioid Agonist Antagonist Analgesics general adrs
Have a greater risk of dysphoric side effects (spinning, not good)
Orthostatic Hypotension is an adverse effect of an Alpha-1 Blockade (Antagonist) drug. Explain why.
When a person stands up, their sympathetic nervous system is activated and their alpha-1 receptors are stimulated with norepinephrine.
Norephinephrine (an alpha-1 receptor) constrict arteries and veins to increase venous return to the heart and arterial blood pressure and to allow them to maintain full blood flow to the brain
When Alpha-1 Receptors are blocked, this activity does not occur and the person may feel dizzy or faint when standing up
Phase III:
The large clinical trial of hundreds of subjects who have the condition must demonstrate _________ & ____________ of the drug in treating that __________.
The large clinical trial of hundreds of subjects who have the condition must demonstrate safety & efficacy of the drug in treating that indication.
What is PIH? What does it do and what is it treated with?
Pregnancy induced hypertension, gestational hypertension: elevated blood pressure without proteinuria after 20 gestational weeks in clients normotensive prior to pregnancy; nonpharmacologic treatments include activity reduction, lying on the left side, increased dietary protein (supplemental 90 g/day), psychosocial therapy and biofeedback; methyldopa (aldomet), hydralazine (apresoline), and Labetalol (trandate) are considered first line therapy for preeclampsia, additional alternatives include beta blockers, prazosin, nifedipine and clonidine; magnesium sulfate and hydralazine are the two most common
Why should infants and neonates not recieve Intron A?
it contains benzyl alcohol, which is associated with an increased incidence of neurologic and other serious complications in this age group
Topical / Systemic preps for Psoriasis
Keratolytics (salicylic acid / sulfer)
* psoratic scales may be loosened with keratolytics (salicylic acid/ sulfer)
Topical glucocoritcoids are sometimes used for mild psoriasis.
other topical preps for psoriasis include anthralin (Anthra-Derm, Lasan) and coal tar (Estar, PsoriGel)
What is the function of the Autonomic Nervous System (ANS)?
Regulate, Adjust and Coordinate vital viseral (organ) functions:
* Blood Pressure & Blood Flow
* Body Temperature
* Respiration
* Digestion
* Metabolism
* Elimination
Patient Specific Factors that may produce what results when taking the drug? (2)
1. Alter the drugs ability to produce its therapeutic effects or increase its side effects
2. Might cause an idiosyncratic reaction, like a drug allergy, or other effects particular to the patient
is urised used in the treatment of UTI
No; itis used to prevent reccurence for a pt who has chronic UTIs
What type of system is the Autonomic Nervous System (ANS)?
The ANS is a motor system
It innervates (sends nerve signals to) smooth and cardiac muscles and glands.
Your pt has overdosed on IBU, what s/s are you looking for and what is the treatment for IBU overdose?
• overdose may lead to acute renal failure, apnea, cyanosis, drowsiness, GI bleeding, N/V, sweating. Treatment = charcoal
What is more important, a more potent drug or a drug that has more efficacy?
Efficacy - we want the drug to work.
Some drugs will never create a desired response like others - Example: Morphine for pain will create a needed result for someone going through surgery, where tylenol would not even compare. In this situation, tylenol would have less efficacy and morphine would have more
How do we overcome the effects of a competitive antagonist?
Give an agonist in higher doses to increase the chance that a vacant receptor will be occupied by the agonist instead of the antagonist.
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