PHARM EXAM 4 Flashcards
Sympathetic Fight or Flight
(ANTI- SLUDGE)
- Pupils dilate
- Saliva is inhibited
- Heart accelerates/ Blood vessel constrict
- Bronchioles dilate
- Digestion is inhibited
- Liver glycogen breakdown promoted
- Adrenal gland releases epinephrine and norepinephrine
- Sex organs inhibited
Sympathetic Nervous System
- Adrenergic Receptors : Aplha (Blood/Brain/ Postate) / Beta (Heart/ lungs/ kidney)
- Norepinephrine is the neurotransmitter.
- Sympathomimetic
- Parasympathetolytic
- Adrenergic
Sympathomimetics AdrenergicAgonists
Alpha Agonists: treat nasal congestion and hypotension, dilate pupils during eye exams.
Beta Agonists: treat asthma
- Oxymetazoline
- Pseudoephedrine
- Albuterol
- epi-pen
- dopamine
Sympatholytic Anti-adrenergicAntagonistsBlockers
Alpha Blockers: treat hypertension (Doxazosin)
Beta Blockers: treat hypertension and heart failure (metropolol)
Parasympathetic Nervous System
- Muscarinic Receptors: Muscarinic
- Acetocholine is the neurotransmitter
- Parasympathomimetic
- Muscarinic Agonist
- Cholinergic
Parasympathetic Rest and Digest
( SLUDGE)
- Eyes constrict
- Saliva is stimulated
- Heart slows/ Blood vessel dilate
- Bronchioles constrict
- Digestion is stimulated
- Gallbladder is stimulated
- Bladder contracts
- Sex organs are stimulated
Cholinergic (Muscarinic Agonist) (SLUDGE)
Bethanechol
- Oral or SQ
- Used for nonobstructive urinary retention by acting on muscarinic receptors of the GU tract.
- Side effects are cholinergic.
- Avoid in conditions such as asthma or bradycardia
- Reversal of a cholinergic agent is atropine*
- *Avoid PT w/ BPH-asthma-GI obstruction**
Anticholinergics (ANTI- SLUDGE side effects)
or parasympatholytics - similar response
- Atropine
- Atrovent
- Dicyclomine
- Oxybutynin
- Glycopyrrolate
AVOID PT w/ BPH- Tachy- increased BP- CHF- kidney problems
Anticholinergics (Muscarinic Antagonists)
Atropine
- IM or IV
- Atropine –treatment of cholinergic overdose and increases HR.
- Used as an antidote to cholinergic crisis (plant poisons, overtreatment with cholinergic medications)
- Used as part of ACLS protocol for symptomatic bradycardia.- when pt is awake but not able to completely converse & have low BP
-Contraindicated in obstruction of bowel or bladder, BPH, myasthenia gravis
Somatic Nervous System
Controls Voluntary Movement
Skeletal Muscles
Acetocholine is the neurotransmitter
Cholinergic
Myasthenia Gravis
- Autoimmune disease that leads to the breakdown of nicotinic receptors on the muscle.
- The nerve operates normally, there is not enough receptors available leading to a weak/ easily fatigued muscle contraction.
- Symptoms include: when there are less ach receptor = decreased muscle strength/ contraction, easy muscle fatigue. Can also affect other muscles leading to difficulty breathing, difficulty swallowing.
Myasthenia Gravis meds
- Medications block acetocholinesterase so ACH is in the synapse longer and can produce a better, stronger muscle contraction
- Cholinestraise Inhibitor ** increase strength less fatigue
- Fast acting for diagnosis: endonorphium* (TESTER & will make muscle stronger if they have Myasthenia Gravis)
- Long acting for treatment: pyridostigmine*
Pyridostigmine
(SLUDGE)- cholinergics
PO medication
-Used to effect activity at the nicotinic (skeletal muscle) but could effect the muscarinic (smooth muscle) leading to parasympathetic side effects.
-Contraindicated in intestinal and urinary obstruction.
Reversal is atropine. for muscle weakness respiratory paralysis that occurs within 1 hr of admin = serum level too high.
Cenntrally acting muscle relaxers
Cyclobenzoprine
- Suppression of muscle activity in the brain stem, no effect on the actual muscle function. Enhance inhibitory effects of GABA
- Max effect in 1-2 weeks
- Side effects: drowsiness, blurred vision, dry mouth, rash, and tachycardia.
- Use with caution in the elderly.
- Avoid with other sedatives
- Contraindicated in MI
- can not stop right away & start with low dose/ Withdrawal symptoms**
- Anxiety
- Restlessness
- Visual hallucinations
- Seizures
Muscle Spasms & Muscle Spasticity
Muscle Spasms: Involuntary contractions of a muscle, tightened and fixed causing pain and potential impairment of joint function.
Muscle Spasticity: Muscle groups in a continuous state of contraction due to neuromuscular disorder (like spinal injury)
Peripherally acting muscle relaxers
Dantrolene
- Direct acting
- Blocks release of calcium in the muscle cells blocking contraction
- IV (irritating to tissue) or oral suspension
- Side effects: weakness, drowsiness, dizziness, nausea, diarrhea, photosensitivity, urinary retention.
- Avoid in patients with impaired cardiac or lung function
- Avoid in patients with liver disease 35 yrs and older, can cause hepatotoxicity
- IV emergency med that is used to reverse malignant hyperthermia**
Anticholinergics (Muscarinic Antagonists)
Atrovent
Parasympatholytic/ Medications that block ACH on cholinergic receptors. This action has a similar effect as sympathomimetics.
-Atrovent- relaxation of bronchioles (asthma)- COPD
Anticholinergics (Muscarinic Antagonists)
Oxybutynin
Parasympatholytic/ Medications that block ACH on cholinergic receptors. This action has a similar effect as sympathomimetics.
-Oxybutynin- treatment of incontinence (over active bladder)
Anticholinergics (Muscarinic Antagonists)
Glycopyrrolate
Parasympatholytic/ Medications that block ACH on cholinergic receptors. This action has a similar effect as sympathomimetics.
-Glycopyrrolate (Robinul)-dry up secretions for surgery* IV- so there is no aspiration during SX
Anticholinergics (Muscarinic Antagonists)
Dicyclomine
Parasympatholytic/ Medications that block ACH on cholinergic receptors. This action has a similar effect as sympathomimetics.
-Dicyclomine (Bentyl)-IBS, decrease crampy pain*
Adrenergic agonists: afrin (Oxymetazoline) and albuterol
afrin (Oxymetazoline)- vaso constriction
lbuterol- bronco dilate
Anti-Adrenergic: doxazocin and metoprolol
- Drugs that manipulate the sympathetic nervous system*
- Blocks Beta/ alpha
Admin Eye drops
-take out contacts
-Lie supine or tilt head back
-With non-dominant hand pull down lower lid.
Look up
-Hold ¼ above conjunctival sac, instill required drops. Do not touch dropper to eye.
If ointment, thin line from inner to outer canthus.
-Close eye, apply gentle pressure to nasolacrimal duct. (decreased systemic absorption)
Gently blot eye
Replace dropper, do not rinse.
Glaucoma
Pressure has increased.
- To decrease the pressure inside the eye then decrease the amount of aqueous humor or increase the outflow of aqueous humor.
- Dilated pupil, means a smaller thinner iris and decreased aqueous outflow increasing pressure.
GOAL= stop dilation & decrease fluid productions
Prostaglandin Analogs: Latanoprost (Xalatan)
-Decreases IOP by increase in outflow of aqueous humor metabolized in the cornea
Instill eye drop, wait 5 minutes before instilling another drop in same eye.
-Cannot wear contacts for 15 minutes.
-Increased length of lashes, darkening of iris, sensation of FB in eye, ocular symptoms (edema, itching, dryness)
Systemic Absorption: respiratory infection, angina, muscle/joint pain)
- hold inner corner of eye to avoid systematic effect
Beta Adrenergic Blockers: Timolol (Betimol)
Decreased formation of aqueous humor & decrease pressure & blood vessel constrict
Given 1-2x per day.
Takes 2-4 weeks to work.
Can be combined with other medication
Diagnostic Exams
Mydriatic drugs dilate pupil for better assessment
Cycloplegic drugs paralyze the ciliary muscle and prevent the lens from moving during assessment.
Common Ear complaints
Cerumen Impaction: Carbamide peroxide (Debrox)
4 gtts, 3-4x per day
Otitis Externa: Ciprofloxacin/ Hydrocortisone
Otitis Media: oral antibiotics
Mastoiditis: IV/ oral ABX gentamicin, ticarcillin (14 days)
Instillation of ear drops
Side lying, head tilted
Clean if necessary
Hold dropper ¼ inch above ear canal, instill drops into side of canal
Apply pressure to the tragus 3-4 times
Stay in position for 10 minutes
If cotton ball ordered soak in medication and insert into outer most ear canal.
Wipe ear with tissue.
Adults: UPWARD and backward
Children under Age 3: DOWNWARD and backward
Risk of Peptic Ulcers
Family history Blood group O Smoking tobacco Caffeine NSAIDS and platelet inhibitors Stress H. Pylori Infection: Bacteria that breaks up mucus that protects the stomach and lets acid destroy the stomach
Proton Pump Inhibitors
Omeprazole (Prilosec)*
FOR GERD/PUD
Omeprazole (Prilosec)*
Irreversibly binding to proton pumps
Give before breakfast on an empty stomach. Do not open capsules, no chewing or crushing
irreversible for 7 days
Proton Pump Inhibitors
Omeprazole (Prilosec)* SIDE EFFECTS
FOR GERD/PUD
HA, diarrhea, nausea, rash, dizziness
Increased risk of osteoporosis, hypomagnesium, C.diff
Rare blood disorders with fatigue and weakness
H2 Receptor Antagonist
Ranitidine (Zantac)*
FOR GERD/PUD
Administer nightly, PO
IV for acute stress induced bleeding ulcer
Monitor liver and kidney function
H2 Receptor Antagonist
Ranitidine (Zantac)* SIDE EFFECTS
FOR GERD/PUD
Diarrhea, constipation, HA, fatigue, nausea, gynecomastia.
Rare(Adverse effect) : blood dyscrasia (Bone marrow supression), blurred vision, tachycardia.
Antacids: Aluminum hydroxide
FOR GERD/PUD
Aluminum hydroxide (minimal absorption, aluminum reduces constipation) Calcium carbonate (more systemic absorption) *coat the stomach to protect the stomach *
Antacids: Aluminum hydroxide
SIDE EFFECTS
FOR GERD/PUD
SE: constipation, nausea, stomach cramps,
Adverse: fecal impaction, electrolyte imbalance
Constipation
Freq + consistency
- is it different? Does it feel bad
Bulk Forming-psyllium
For Constipation
Bulk Forming-psyllium abdominal fullness, cramping, fainting, esophageal/GI obstruction if taken with insufficient fluid. (need full 8oz of water or will lose benefit of med)
Saline/Osmotic-lactulose
For Constipation
Saline/Osmotic-lactulose, polyethylene glycol diarrhea, abd cramping trying to pull water into stool
Stimulant- bisacodyl
For Constipation
Stimulant- bisacodyl, castor oil abd cramping, nausea, fainting, diarrhea *contraction to bowl *
Stool softener- Colace
For Constipation
Stool softener –Colace-increases water and fat in stool
Melt onto stool gel like to make it easier
Herbal agent- Senna
For Constipation
Herbal agent- Senna-irritates bowels
Diarrhea : Having multiple watery stool
Opioids: (causes slowing of bowl) diphenoxylate with atropine (Lomotil)- addictive potential, drowsy, dizzy, lightheaded, nausea
Anticholinergic effects: constipation, CNS and respiratory depression, toxic megacolon
Miscellaneous:
Bismuth salts-(has ASA)
Lactobacillus-probiotics
Octreotide-severe secretory diarrhea
C.Diff Associated Diarrhea
Treatment with vancomycin
Fecal Microbiota Transplant (FMT)
Enema, colonoscopy, or NG
Anti-Emetics- prevent vomiting / Nausea
Antihistimines (scopolamine)
Phenothiazine (prochlorperazine, metoclopramide)
SSRI ondansetron (Zofran)
before SX/ after chemo/ traveling
Anti-Emetics
Prochlorperazine- Compizine
- Is part of the phenothiazine antipsychotic family
- Blocks dopamine
- Dose related anticholinergic side effects
- Increased risk for death in patient’s with dementia
PancreatitisPancrelipase
- Enzymes stay in pancreas instead of GI tract (lipase, protease, amylase)
- Can give pancreatic enzymes (1-2 hours prior to meals)
- Releases in small intestine
- Side effects are minimal as not systemically absorbed
- Nausea, vomiting, diarrhea*
Malnutrition
Elderly HIV/AIDS Alcoholism Burns Cancer IBD Eating Disorders Neurologic Disease Surgery Trauma
Enteral Nutrition
- Polymeric-the GI tract works. Protein, carbs, lipids. Can be used in blenderized diet and replacement supplements.
- Elemental-malabsorption, decreased fat, individual amino acids.
- Semi-elemental-direct to intestines, larger protein molecules
- Modular-disease specific
TPN- IV Nutrient
- only central line - infection if given peripherally*
- At risk for hyperglycemia- so √ BS*
Severe malnourishment
Inability to absorb through the GI tract
Hypertonic: amino acid, lipids, emulsions, carbohydrates, electrolytes, vitamins, and minerals-insulin
Reservoir for infection, central line
Monitor for hyperglycemia, fluid status, renal status
Obesity
Qualify for medical therapy with a BMI > 30
BMI >27, with HTN, HLD, DM
Lipase inhibitors
Orlistat
Lipase inhibitor TID, during or just prior to a meal. Works only when the meal has fat content GI side effects, oily stools, frequent urgency, flatus with discharge Can decrease absorption of medications
Neurotransmitter
Acetylcholine = cholinergic
receptors
Epinephrine = adrenergic receptors
Norepinephrine = adrenergic
receptors
Sympathetic avoid Pt with:
Avoid pt with:
- Glc
- Heart problems
- increased BP
- CHF
- kidney problems
Avoid meds:
- Beta blockers (Doxasin/ metropolol)
- CA
Parasympathetic avoid Pt with:
Avoid pt with:
- asthma
- GI obstruction
- BPH
Avoid meds:
anti-cholinergics ex: Ipratropin(broncho dilator) atropine/ Dicyclomine/ Gyclopyrrolate/ Oxybutin/ Atrovent
