Exam 1 Review Flashcards
Exam Prep
The following bullet points describe what?
- Define the patient’s problem
- Specify therapeutic objective
- Collaborate with the patient
- Choose the treatment
- Monitor effectiveness
The Process of Rational Drug Prescribing
What is the “I Can PresCribE A Drug” mnemonic
Indication
Contraindications
Precautions
Cost/Compliance
Efficacy
Adverse effects
Dose/Duration/Direction
Defining the patient’s problem includes:
Assessment
Develop diagnoses
Use diagnostic tests to confirm diagnosis (response to therapy can also help with diagnosis confirmation)
What is included in specifying the therapeutic objective?
What is the goal of treatment?
Cure the disease?
Relieve disease symptoms?
Replace deficiencies?
Long-term prevention?
Choose treatment that is _____________ for each patient.
Individualized
cost effectiveness
Pt preferences
Pt adherence considerations
What should be included in pt education regarding medication prescribing?
How and where drug works
Why pt needs drug
How and when to take
What to do if dose is missed
Food/drug interactions
ADRs to expect vs ADRs to report
Self/provider monitoring
The patient is educated on expected outcome and instructed to contact provider. What type of monitoring is this?
Passive monitoring
What type of monitoring includes follow-up on lab tests and monitoring to measure therapeutic effectiveness?
Active monitoring
What does the FDA regulate? Name 6.
New drug/new indication approval process
Official labeling
Surveillance of ADE
Methods of manufacture and distribution
Medical devices
Advertising of prescription drugs
True or False. The FDA does not regulate individual practitioner prescribing of medication or drugs.
True
What does pharmacodynamics mean?
The action of a drug on the body including receptor interactions, dose response phenomena, and mechanisms of therapeutic/toxic actions.
What is pharmacokinetics?
The action of the body on the drug. Includes the absorption, distribution, metabolism, and excretion of the drug.
Most absorption occurs through what type of diffusion?
Passive
What are the factors that permit passive diffusion?
Lipophilic
Small
Uncharged/Unionized
What properties affect distribution? Name 4.
Solubility (lipophilic)
Molecule size (smaller molecules cross more readily)
Acid vs basic environment (will affect degree of ionization)
Protein binding
What protein in the blood do drugs bind to?
Albumin
What can occur when drugs compete for protein-binding sites?
The drugs that are unsuccessful at binding will remain in greater concentration in the blood
What happens when a pt has hypoalbuminemia?
There is less plasma protein for drugs to bind to increasing the drug concentration in the blood potentially leading to excessive or even toxic levels.
The blood-brain barrier is usually very protective. What kind of drugs are most likely to cross this barrier?
Small/low-molecular-weight
Unionized
Lipid-soluble
True or false. Drugs cross the placental barrier more easily than the BBB?
True
What kind of drugs are the most likely to cross the placental barrier?
Small/low-molecular-weight
Unionized
Lipid-soluble drugs
What is the irreversible biochemical transformation of drug into metabolites to increase excretion from the body via the kidney (fat soluble –> water soluble)?
Metabolism
Where does metabolism mainly occur?
the liver
True or false. During metabolism, the metabolite is usually made more ionized and less lipid-soluble in the process.
True
Metabolism can happen in one of two different phases. Phase I is an oxidation reaction and uses cytochrome P450 enzymes. Phase II is a conjugation reaction. What is the goal of both of these reactions?
Make molecules more water-soluble in preparation for excretion
Kidneys are the primary organ of excretion. What are the other organs of excretion? Name 4.
Lungs
Gi tract
Sweat/saliva
Mammary glands (breast milk)
In order to be excreted by the kidneys, drugs must be:
Available for glomerular filtration (free, unbound from protein, water-soluble)
What are four factors that affect renal excretion?
Kidney function (GFR)
Age
Hydration
Cardiac output
What term describes the time it takes for the plasma concentration of a drug to decrease by half of its initial value?
Half-life
What is a drug’s half-life used to determine?
the frequency of drug dosing
What does “steady state” mean?
The amount of the drug being absorbed equals the amount of drug being excreted
What is a loading dose and why would it be used?
The loading dose is an initial higher dose of a drug that may be given at the beginning of a course of treatment used to rapidly achieve a steady state.
What is the definition of an ADR?
any undesirable or unintended effect occurring after administration of a medical product
Drug-receptor binding is largely __________, but some are ____________.
reversible; irreversible
Drug-receptor binding is selective or nonselective?
Selective
Drug-receptor binding is graded. What does this mean?
The more receptors that are filled, the greater the pharmacological response will be.
Drugs that bind to receptors may be agonists, partial agonists, or antagonists. What is an agonist? What is a partial agonist?
What is an antagonist?
Agonist- binds to the receptor and causes an action
Partial agonist- binds to the receptor and causes an action
Antagonist- binds to the receptor and blocks an action
What term describes the ability of the drug to bind to the receptor; attraction?
Affinity
What term describes the ability of a drug to produce a pharmacological response after attaching to the receptor; effect?
Efficacy or Intrinsic Activity
What term describes the amount of a drug (usually in milligrams or units) that it takes to achieve efficacy; strength?
Potency
The route of administration affects what three aspects of drug action?
onset, peak, and duration
What is the first pass metabolism by the liver?
Oral/enteral drugs must first pass through the liver and be metabolized before entering systemic circulation for distribution.
What are the nine factors that influence metabolism?
Age
Genetically determined differences
Pregnancy
Liver disease
Time of day
Environment
Diet
Alcohol
Drug interactions
In which metabolism phase is a drug made more water-soluble through oxidation, hydrolysis, or reduction? This phase uses the CYP 450 system, a non-synthetic reaction, to break drugs into smaller components.
Phase I
In which metabolism phase is a drug molecule united with a water-soluble substance to make it more water/soluble? This phase uses synthetic reactions where two or more simple elements/compounds combine to form a more complex product.
Phase II
Most drugs are metabolized in the liver using which metabolism phase?
Phase I
Phase I of metabolism uses hepatic isoenzymes. What are the most common (5)?
1A2, 2C9, 2C19, 2D6, 3A4 (3A3/4)
What is a prodrug?
A drug that is administered in an inactive (or significantly less active) form. It becomes active through metabolism.
A type I hypersensitivity response results from a reaction mediated by ___ antibodies on ____ cells after exposure to an antigen. Anaphylaxis can result, so it can be fatal if not treated immediately. What are the three main symptoms?
IgE; mast
Urticaria, wheezing, rhinitis
A type II hypersensitivity response occurs when a drug binds to ____ (____) and is recognized by an antibody, usually ___. Complement and cytotoxic T cells are activated. Can cause hemolytic anemia, thrombocytopenia, drug-induced lupus (these can improve with removal of drug). This hypersensitivity is ____.
cells; RBCs; IgG; rare
Type III hypersensitivity occurs when antibodies ___ and ___ are formed against _______ antigens. The antigen-antibody complexes are deposited in _______ such as ______ and _____. Causes a serum sickness response (systemic response), arthralgias, fever, swollen lymph glands, and splenomegaly. Has nonpharmacologic causes including rheumatoid arthritis, systemic lupus erythematosus and other __________ diseases.
IgG; IgM; soluble; tissues; joints; lungs; autoimmune
Type IV hypersensitivity response is ____-_______ and is a _______-type hypersensitivity. Cytotoxic T cells are activated. Well known type IV responses are allergies to poison ivy and latex. Causes _______ __________. Repeated exposure to drugs can trigger a “________ _____” 24-48 hours after drug contact.
cell-mediated; delayed; contact dermatitis; cytokine storm
Which hypersensitivity is IgE-mediated, occurs within one hour, and can cause anaphylaxis?
Type I
Which hypersensitivity is IgG or IgM and cytotoxic, occurs in hours to days, and has hemolytic anemia as an example?
Type II
Which hypersensitivity is immune complex mediated, occurs in 1-3 weeks and has serum sickness as an example?
Type III
Which hypersensitivity is T-cell mediated, occurs in days to weeks, and has rash as an example?
Type IV
Types of ADR’s. Fill in the Blanks.
Type A: _______________ reactions (85-90% of ADRs)
____ _: Idiosyncratic reactions
____ _: Chronic medication use
Type D: _______ reactions
Type E: Drug-____ interactions
Type F: treatment _________
Pharmacological (dose-dependent, predictable)
Type B (not dose-dependent, not predictable)
Type C
Delayed
drug
failures
Rapid reactions
First-dose reactions
Early reactions
Intermediate reactions
Late reactions
Delayed reactions
These are all examples of what type of ADRs?
Time-related
Risk factors for ADRs include (8)
Genetic factors
Age (extremely young/old)
Body mass (adult dosing based on average wt 150 lbs)
Gender (different fat distribution, pregnancy changes)
Environment (physical environment: low O2 and temp)
Time of administration (timing with food, biorhythms)
Pathological state (renal/hepatic dysfunction)
Psychological factors (cultural/faith-based attitudes)
How is absorption different in pediatric patients?
Gastric pH higher (less acidic); by 3 years, acid per kg of body weight is similar to adults)
How is metabolism different in pediatric patients?
Liver is immature and does not produce enough microsomal enzymes. Older children may have increased metabolism requiring higher dosing.
How is distribution different in pediatric patients?
Total body water is different. Infants have more water and less fat. TBW becomes similar to adult levels between 1 and 12 years. Children have decreased protein binding and an immature blood-brain barrier.
How is excretion different in pediatric populations?
Kidney immaturity affects glomerular filtration rate and tubular secretion. Decreased perfusion rate of the kidneys. Renal clearance reaches adult values after 2 years.
What are six methods for improving medication adherence in pediatric patients?
Increase med concentration (less to swallow)
Written/oral instructions
Calendars (sticker charts)
Telephone reminders
Administering meds at school
Contracts
How is absorption (bioavailability) affected in geriatric patients?
Amount absorbed is not changed; however, peak serum concentration may be lower and delayed.
EXCEPTION: drugs with extensive first-pass effect (bioavailability may increase because less drug is extracted by the liver, which is smaller with reduced blood flow)
How is distribution affected in geriatric patients?
Decreased body water (lower volume for hydrophilic drugs)
Decreased lean body mass (lower volume for drugs that bind to muscle)
Increased fat stores (higher volume for lipophilic drugs)
Decreased plasma protein (higher percentage of drug that is unbound/active)
How is metabolism affected in the geriatric population?
Aging decreases liver blood flow and liver mass = decrease in rate at which drugs are broken down
How is elimination affected in the geriatric population?
Decreased kidney size
Decreased kidney blood flow
Decreased number of functioning nephrons
Decreased renal tubular secretion
**this means elimination is decreased
What are risk factors for ADRs in older adults?
Nonadherence (intentional and unintentional)
Unsafe practices
Polypharmacy (high prevalence of OTCs and herbals)
How can the risk of polypharmacy be mitigated in geriatric patients?
Reconcile meds with all care transitions/hospitalizations (are there any duplications?)
Ensure pt symptom is not part of normal aging or an ADR from another drug
Collect a complete drug history before prescribing and at least every 6 months
Avoid med if benefit is only marginal
Start low and go slow
Prescribe nonpharmacological treatments when possible
What is the purpose of the Beers criteria?
Help identify potentially inappropriate meds for elders. These meds cause issues in ALL patients, so the alerts are not geriatric-specific.
What are the five Beers criteria?
- Meds that are potentially inappropriate in older adults
- Meds that should be avoided in older adults with certain conditions as they may exacerbate the condition
- Meds to use with caution in older adults
- Potentially clinically important drug-drug interactions that should be avoided in older adults
- Meds that should be avoided or have the drug dose reduced based on kidney function.
What are the neurotransmitters that work on adrenergic receptors? (Think sympathetic nervous system.)
Epinephrine
Norepinephrine
What is the neurotransmitter associated with the parasympathetic nervous system?
Acetylcholine
What are the two types of receptors associated with the parasympathetic nervous system?
Muscarinic
Nicotinic
What kind of drugs act on receptors stimulated by epinephrine and norephinephrine?
Adrenergic
What type of drugs act on receptors activated by acetylcholine?
Cholinergic
Alpha-1 receptors are found in what three locations? (More than three in the body, so think three categories)
Smooth muscle (stimulates contraction)
Liver (stimulates glycogenolysis)
Salivary glands (stimulates secretion)
In GI smooth muscle, alpha 1 receptors produce relaxation or constriction?
relaxation
Alpha 2 receptors are found where in the body? (4)
Presynaptic neurons (decrease NE and Ach release)
Pancreas (decrease insulin release)
Platelets (decrease platelet aggregation)
CNS (decrease sympathetic discharge)
Beta 1 receptors are found where?
Kidneys (renin release)
Heart (rate, force, automaticity, and cardiac output)
Adipose tissue (lipolysis)
Where are beta 2 receptors found? (5)
Smooth muscle (relaxation)
Blood vessels (vasodilation)
Liver (glycogenolysis)
Mast cells (decrease histamine release)
Adrenergic neurons (increase NE release)
What type of drugs are parasympathomimetic?
Cholinergic drugs
What type of drugs are parasympatholytic, anticholinergic, or antimuscarinic?
Cholinergic antagonist drugs
What type of drugs are sympathomimetic?
Adrenergic drugs
What type of drugs are sympatholytic or antiadrenergic?
Adrenergic antagonist drugs
What are the indications for Alpha 1 receptor agonists? (3)
Nasal congestion
Hypotension
Dilation of pupils for eye exam
What are the indications for Alpha 2 receptor agonists?
Hypertension
ADHD
ODD
What are the indications for Beta 1 receptor agonists?
Cardiac arrest
Heart failure
Shock
What are the indications for beta 2 receptor agonists?
Asthma
Premature labor contractions
What are the main uses of cholinergic drugs?
Decrease intraocular pressure in glaucoma
Treat atony of GI tract and urinary bladder
Diagnose and treat myasthenia gravis
What drug is used to treat anticholinergic toxicity?
Physostigmine
Where are muscarinic receptors located?
Eyes
Heart
Vessels
Lungs
GI
GU
Bladder
Sweat glands
What type of drugs work by encouraging Ach release from the PNS resulting in muscarinic receptor stimulation which increases detrusor muscle tone, causing bladder contractions/emptying? Also, increases gastric tone and salivation.
Direct cholinergic Agonists/Muscarinic agonists
Bethanechol (Urecholine) and Pilocarpine are both examples of what type of drug?
Direct Cholinergic (Muscarinic) Agonist
What medication is used to treat neurogenic bladder atony and other causes of urinary retention?
Bethanechol (Urecholine)
Which med is used to treat Glaucoma?
Ophthalmic pilocarpine
Which med is used to treat xerostomia?
Oral pilocarpine
Direct cholinergic (muscarinic) agonists, like Bethanechol and Pilocarpine, are contraindicated in patients with what five conditions?
Peptic ulcer disease
Intestinal obstruction
Urinary tract obstruction or weakened bladder wall
Latent or active bronchospastic disease
Hyperthyroidism
Cholinergic toxicity can occur from certain mushrooms or too much cholinergic medication. What are the five symptoms of cholinergic toxicity and what is the antidote?
Abdominal cramps
Salivation
Flushing
Nausea
Vomiting
Atropine
What are the CNS, Cardiac/Resp, GI, and other ADRs associated with Cholinergic agonists?
Lightheadedness
Postural hypotension
Abdominal cramps
N/V/D
Flushing of the face
Constriction of pupils (miosis)
How are Cholinergic agonists monitored?
BP and pulse
I/O
Abdominal assessment
What education should you give a patient that you are prescribing a Cholinergic Agonist?
Take 1 hour before or 2 hours after a meal
ADRs
What to report to provider
Why are Indirect Cholinergic Agonists considered “indirect?”
They inhibit cholinesterase, so they “indirectly” increase the affect of Ach.
Which type of drug works by inhibiting the breakdown of Ach by the Ach-ase enzyme allowing more Ach to remain in the cleft and meet with receptors?
Indirect Cholinergic Agonists: Cholinesterase Inhibitors
How do cholinesterase inhibitors help patients with Myasthenia Gravis?
They improve neuron signaling to the muscles
How do cholinesterase inhibitors help patients with Alzheimer’s disease?
They improve brain function by allowing more connection of Ach with receptors.
What are three drug examples of Cholinesterase inhibitors?
Neostigmine bromide (Prostigmin)
Pyridostigmine (Mestinon)
Donepezil (Aricept) for Alzheimer’s Disease
Cholinesterase inhibitors are contraindicated in what conditions?
GI or GU obstruction
If prescribing a cholinesterase inhibitor in pregnancy, the benefits should outweigh what risks?
Risk of uterine irritability and preterm labor and fetal effects
True or false. Cholinesterase inhibitors should not be used in lactating women.
True
Cholinesterase inhibitors can cause hepatotoxicity, so what can be done in clients with reduced hepatic or renal function?
Dose adjustments
Use caution when prescribing cholinesterase inhibitors to people with what diagnoses?
Bronchospastic disease
PUD
Cardiac diseases that worsen with decreased pulse and BP
Hyperthyroidism
What are CNS ADRs related to cholinesterase inhibitors?
Seizures
Muscle weakness
Vertigo
Fasciculations
Cramps
Emotional lability
What are cardiac/resp ADRs from cholinesterase inhibitors?
hypotension
bradycardia
What are GI ADRs from cholinesterase inhibitors?
NVD
Increased acid production
Excessive salivation
Cramping
Hepatotoxicity
What needs to be monitored when prescribing a cholinesterase inhibitor?
Baseline and periodic renal and hepatic function tests
For Donepazil, monitor CBC and CMP.
What education should be provided to pts being prescribed cholinesterase inhibitors?
MOA
Take at the same time daily (esp “stigmine” drugs for MG)
take with food or milk to reduce GI effects
ADRs
when to notify provider
Cholinergic antagonists work against the PNS. What are other terms for these drugs?
Cholinergic blockers
Muscarinic antagonists
Anticholinergics
What are seven examples of cholinergic antagonists?
Atropine- suppress/decrease respiratory secretion production pre-OR. At high doses, blocks vagal stimulation to heart. Used ophthal to relax sphincter muscle of iris causing mydriasis (pupil dilation)
Belladonna tincture- asthma, common cold, hemorrhoids, Parkinson disease, many others
Oxybutynin Cl (Ditropan)- decrease bladder spasms
Scopolamine (Hyoscine)- motion sickness
Trihexyphenidyl (Artane) and Benztropine (Cogentin)- improve muscle control and reduce tremors/rigidity of parkinsonism. Can treat extrapyramidal effects of certain psychotropic meds.
Ipratropium bromide- bronchodilator
What kind of drug has this MOA: blocks most muscarinic receptors producing a myriad of responses; reduced respiratory secretions and bronchodilation (relaxes bronchial smooth muscle), increased heart rate, generally no vessel effects except some dilation of coronary arteries.
Cholinergic antagonists
What are CNS ADRs of anticholinergics?
confusion
mild excitation (not with scopolamine–CNS depression)
What are cardiac/resp ADRs of cholinergic antagonists?
tachycardia
bronchodilation
decreased resp secretions
What are GI/GU ADRs of cholinergic antagonists?
decreased GI motility (ileus-severe)
constipation
xerostomia
dysphagia
aspiration risk
decreased salivation
urinary hesitancy
urinary retention
What are misc ADRs of anticholinergics?
Increased intraocular pressure
Blurred vision
Photophobia
Anhidrosis (no sweat)
When are anticholinergics contraindicated?
Glaucoma
Use anticholinergics cautiously in patients with what disease(s)?
Hypertension
Cardiac disease
Anticholinergics are used when benefits outweigh risks in what groups?
Pregnancy
Lactation
Pediatrics
What is monitored when anticholinergics are prescribed?
ADRs
What education should be provided to pts prescribed anticholinergics?
MOA
administration instructions (Benztropine is given with food; Scopolamine place 4 hrs before needed)
What are Alpha-1 receptors top-five reactions?
Vasoconstriction
Increased peripheral resistance
Increased blood pressure
Mydriasis (pupil dilation)
Increased closure of bladder sphincters
Alpha-1 receptors are more responsive to norepinephrine or epinephrine?
Norepinephrine
What are the top-three actions of Alpha-2 receptors?
Inhibit norepinephrine release
Inhibit Ach release
Inhibit insulin release
Alpha-2 receptors are more responsive to epi or norepi?
Epinephrine
What are the top four actions of Beta-1 receptors?
Increased heart rate
Increased lipolysis
Increased myocardial contractility
Increased renin
Beta-1 receptors respond more to epi or norepi?
Responds to both equally!
What are the top six actions of beta-2 receptors?
Vasodilation
Decreased peripheral resistance
Bronchodilation
Increased glycogenolysis (muscle, liver)
Increased glucagon release
Relaxes Uterine smooth muscle
Beta-2 receptors respond more to epi or norepi?
E»NE
Adrenergic receptors include what three types of receptors?
Alpha- A1, A2
Beta- B1 to B3
Dopamine- D1-D5
Cholinergic receptors include what two subtypes?
Muscarinic- M1-M5
Nicotinic
What type of drug has this MOA? Slow heart rate and cause vasodilation by working centrally in the CNS to reduce sympathetic outflow.
Alpha2 agonists
**Remember: these are not sympathomimetic
What is an example of an Alpha-2 agonist?
Clonidine
Indications for alpha-2 agonists:
Elevated BP and HR
Withdrawal symptoms
Alpha-2 agonists are the preferred medications for what three specific diagnoses?
HTN in pregnancy
ADHD
ODD
What are ADRs of Alpha-2 agonists? **Think decreased SNS effect)
CNS: Drowsiness, insomnia, nightmares
Cardiac: hypotension, bradycardia, chest pain/angina
Anticholinergic effects: can’t see, pee, spit, sh-poop
GI: Vomiting, anorexia, abd pain, altered taste
Endocrine: gynecomastia
What should be monitored when an Alpha-2 agonist is prescribed?
BP
Apical pulse
Liver and renal functions
What education should be provided to a pt being prescribed an Alpha-2 agonist?
MOA
take at same time daily
do not stop suddenly
BP monitoring & logs
OTC meds/herbals–CAUTION
If using patch: proper application and site changes
Which drug has the following MOA: Stimulates Beta-2 receptors in the lungs causing bronchodilation; can also be used in preterm labor to cause smooth muscle relaxation of the uterus
Beta-2 agonists
What are two examples of Beta-2 agonists?
Albuterol: bronchodilation
Ritodrine: uterine smooth muscle relaxation
What are ADRs associated with Beta-2 agonists?
CNS: tremor, other signs of stimulation
Cardiac: tachycardia, palpitations, chest pain, dysrhythmias
Other: may potentiate decrease in serum K+ and affect glucose levels
What are three clinical uses of beta-2 agonists?
Asthma or COPD (inhaled)
preterm labor (systemic)
Beta-2 agonists should be used cautiously in patients with a history of what?
Angina
Are beta-2 agonists used in pediatric and pregnant populations?
yes
What monitoring should occur with beta-2 agonists?
Pulmonary function testing
K+ or glucose in pts with type 1 or 2 diabetes
What education should be given to a pt taking a beta-2 agonist?
MOA
Use as directed
Instructions for use of inhaler, spacing device, nebulizer
ADRs
when to call/see provider
What are indications for alpha-1 receptor antagonists?
Nasal congestion
Hypotension
Dilation of pupils for eye exam
What are indications for nonselective Beta 1&2 receptor antagonists?
Angina
Tachyarrhythmias
Migraine prophylaxis
Anxiety
What are indications for selective beta-1 receptor antagonists?
HTN
Angina
Post myocardial infarction (MI)
dysrhythmias
Alpha-1 receptor antagonists, nonselective beta 1&2 antagonists, and selective beta-1 receptor antagonists are all an example of what type of drug?
Adrenergic antagonist/Sympatholytic medications
What is the MOA of alpha-1 antagonists?
target receptors leading to vasodilation
What are indications for alpha-1 antagonists?
HTN
Benign prostatic hyperplasia (BPH)
Raynaud’s disease
Migraine headaches
What are examples of Alpha-1 antagonists?
Prazosin (Minipress)- HTN or BPH (sometimes for ureteral stones or PTSD)
Tamsulosin (Flomax)- BPH
What are ADRs associated with alpha-1 antagonists?
CNS: lightheadedness, asthenia, fatigue
Cardiac: hypotension (first dose effect), fluid retention/edema, postural hypotension
Resp: rhinitis, nasal congestion
Other: sexual dysfunction/impotence, blurred vision, constipation, nausea
With alpha-1 antagonists, titrate to reduce first dose ___________. These drugs may also cause ______ tachycardia (except Prazosin).
hypotension; reflex
What should be monitored in pts prescribed alpha-1 antagonists?
BP
Edema
Weight gain
Baseline CBC and LFTs
Prostate specific antigen test in pts taking it for BPH
What education should be provided to pts taking alpha-1 antagonists?
MOA
First dose at bedtime
Take as directed
Take with or after a meal
Limit NSAIDs
Discuss OTC meds with provider or pharmacist
ADRs
Change positions slowly
Symptoms to report (BPH: worsening urinary stream issues, inability to empty bladder, frequency urination, fever, HTN–BP monitoring and log reporting, severe reductions/elevations see provider>
What type of drug has this MOA: block the effects of catecholamines on adrenergic receptors. Can be “selective” to beta-1 receptors or “nonselective” to beta 1&2 receptors
Beta antagonists
What are indications for beta antagonists?
**HTN
Angina
Post myocardial infarction as antidysrhythmic
Propranolol- anxiety and migraine prophylaxis (nonselective)
Glaucoma when taken ophthally
What are two examples of beta antagonists/blocker?
Propranolol (nonselective)
Atenolol (selective)
What are ADRs related to beta blockers?
CNS: fatigue, depression
Cardiac: hypotension, bradycardia, severe rebound tachycardia, HTN, and dysrhythmias if stopped suddenly (upregulation of B1 receptors with chronic use)
Other: impotence/sexual side effects, bronchoconstriction
When are beta blockers contraindicated?
AV block
When should beta blockers be used cautiously?
People with asthma, diabetes
Lactation only if benefit outweighs barriers
True or false. Beta blockers are sometimes used in hyperthyroidism for symptom management.
True
What should be monitored in pts taking beta blockers?
BP
Apical pulse
Baseline and periodic LFTs and renal functions (make dose adjustments as needed)
What education should be provided to patients taking beta blockers?
MOA
Administration (consistently either with or without food)
BP and pulse checks and logs (call if outside parameters)
No abrupt withdrawal
Caution with OTC/herbals
Change positions slowly
These meds do not treat acute angina–call 911
ADRs
Beta blockers and alpha-beta blockers end in what?
“-lol”
Central alpha-2 agonists are what two drugs:
Clonidine
Methyldopa
Alpha-1 antagonists end in
“-sin”M
Muscarinic agonists contain what in their name?
“-chol”
Exception: pilocarpine
Cholinesterase inhibitors end in what?
“-mine” Neostigmine and Pyridostigmine
Exception: donepezil
Memantine is discussed under cholinesterase inhibitors, but it has a different MOA and is used to treat AD
Most cholinergic blockers end in what?
“-ine” Atropine, Scopolamine
