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MIDTERMS > PHARMA 2 > Flashcards

PHARMA 2 Flashcards

1
Q

CLASS: Adrenergic antagonist (alpha 1- selective)

MOA: Selectively blocks alpha-1 adrenergic receptors

INDICATION:
● Benign prostatic hyperplasia
● Hypertension

SIDE EFFECT:
First dose orthostatic hypotension
Reflex tachycardia

A

PRAZOSIN

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2
Q

CLASS: Adrenergic antagonist (beta non - selective)

MOA: Blocks β1 and β2 receptors. Blocks sympathetic effects on heart and BP

INDICATION:
● Angina prophylaxis
● Hypertension
● Arrhythmias
● Migraine
● Performance
anxiety
● Hyperthyroidism

SIDE EFFECTS:
● Bronchospasm
● AV block
● Heart failure
● CNS sedation
● Erectile
dysfunction

May mask symptoms of hypoglycemia in diabetic

A

PROPRANOLOL

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3
Q

CLASS: Adrenergic antagonist (beta 1 - selective)

MOA: Selectively blocks β1 receptors. Blocks sympathetic effects on heart and BP

INDICATION:
● Angina
● Hypertension
● Heart failure

SIDE EFFECTS:
● Bronchospasm
(less common)
● AV block
● Heart failure
● CNS sedation,
erectile dysfunction

A

ATENOLOL

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4
Q

NURSING INTERVENTION FOR ADRENOCEPTORS BLOCKERS

A

● Monitor VS (esp BP and HR)
● Report any complaint of stuffy nose
● For clients with DM, have glucagon available and follow adjustment of insulin dose as ordered
● Not to stop abruptly the medication
● Slowly rise from supine or sitting to standing position

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5
Q

● Primary transmitter in all autonomic ganglia and at the synapses between parasympathetic postganglionic
neurons and their effector cells

● Primary transmitter at the somatic (voluntary) skeletal muscle neuromuscular junction

A

ACETYLCHOLINE

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6
Q

● Not very useful for systemic therapy because their effects are not sufficiently selective

○ Parasympathetic and sympathetic ganglia and somatic neuromuscular junctions all may be blocked

● Botulinum toxin is a very large molecule and diffuses very slowly

○ Injection for relatively selective local effects

A

CHOLINERGIC DRUG EFFECTS

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7
Q

M1 -
M2 -
M3 -
Nn -
Nm -

A

LOCATIONS:
M1 - NERVE ENDINGS
M2 - HEART, SOME NERVE ENDINGS
M3 - EFFECTOR CELLS, SMOOTH GLANDS
Nn - ANS GANGLIA
Nm - NEUROMUSCULAR END PLATE

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8
Q

DIRECT ACTING:

MUSCARINIC -
CHOLINE ESTERS -
ALKALOIDS -
NICOTINIC -

A

INDIRECT ACTING:

MUSCARINIC - EDROPHONIUM (SHORT ACTING)
CHOLINE ESTERS - CARBAMATES (INTERMEDIATE TO LONG-ACTING)
ALKALOIDS - ORGANOPHOSPHATES (VERY LONG-ACTING)
NICOTINIC -

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9
Q

DIRECT ACTING CHOLINOMIMETIC:

CLASS: Cholinomimetic (direct - acting, muscarinic)

MOA: Activates M3 receptors in ciliary muscle

INDICATION:
● Glaucoma
● Sjögren syndrome — Xerostomia

SIDE EFFECTS:
● Miosis
● Blurring of vision

A

PILOCARPINE

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9
Q

DIRECT ACTING CHOLINOMIMETIC:

CLASS: Cholinomimetic (direct - acting, muscarinic)

MOA: Activates muscarinic (M1-M3) receptors. Act on M receptors only

INDICATION: Bladder and Bowel atony

SIDE EFFECT:
● Cyclospasm
● Diarrhea
● Urinary urgency
● Vasodilation
● Reflex
tachycardia
● Sweating

A

BETHANECHOL

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10
Q

DIRECT ACTING CHOLINOMIMETIC:

CLASS: Cholinomimetic (direct - acting, muscarinic)

MOA: Activates nicotinic Ach receptors

INDICATION:
● Smoking cessation

SIDE EFFECTS:
● Generalized ganglionic stimulation

A

NICOTINE

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11
Q

● CNS stimulation
● Eye: Miosis, spasm of accommodation
● Lungs: Bronchoconstriction
● GIT/GUT: Excessive gastrointestinal and
genitourinary smooth muscle activity

A

Muscarinic Toxicity

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12
Q

● Bind to cholinesterase and undergo prompt hydrolysis
○ Alcohol portion released
○ Acidic portion retained and released slowly
- Prevents the binding and hydrolysis of endogenous acetylcholine

A

INDIRECT ACTING CHOLINOMIMETICS

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13
Q

● Ganglionic stimulation
● Blockade of neuromuscular end plate
depolarization

A

Nicotinic Toxicity

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14
Q

INDIRECT ACTING CHOLINOMIMETIC:

CLASS: Cholinomimetic (indirect - acting)

MOA: Inhibits acetylcholinesterase, amplifies endogenously released acetylcholine

INDICATION:
● Myasthenia gravis (diagnosis - Tensilon test)

SIDE EFFECT:
● Miosis
● Salivation
● Nausea
● Vomiting
● Diarrhea
● Bradycardia

A

NEOSTIGMINE

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14
Q

INDIRECT ACTING CHOLINOMIMETIC:

CLASS: Cholinomimetic (indirect - acting, muscarinic)

MOA: Inhibits acetylcholinesterase, amplifies endogenously released acetylcholine

INDICATION:
● Myasthenia gravis (diagnosis - Tensilon test)

SIDE EFFECT:
● Miosis
● Salivation
● Nausea
● Vomiting
● Diarrhea
● Bradycardia

A

EDROPHONIUM

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15
Q

Acute worsening of symptoms due to infection,
stress or under medication

A

Myasthenic Crisis Cholinergic Crisis

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15
Q

INDIRECT ACTING CHOLINOMIMETIC:

CLASS: Prototype nonselective muscarinic blocker

MOA:
Found in Atropa belladonna
Tertiary amine that readily crosses membrane barriers

INDICATION:
● Mydriatic
● Cycloplegic
● Antidote for organophosphate
● Bradycardia
● Hypersalivation

SIDE EFFECTS:
● Tachycardia
● Mydriasis
● Cycloplegia
● Skin flushing
● Delirium
● Hallucinations

A

ATROPINE

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16
Q

● Autoimmune destruction of nicotinic Ach receptors characterized by:
○ Fluctuating muscle weakness
○ Ocular symptoms
○ Bulbar symptoms
○ Proximal muscle weakness

A

Myasthenia Gravis

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17
Q

● Excessive activation of cholinoreceptors (skeletal
muscle weakness and parasympathetic signs) due to
overmedication

A

Myasthenic Crisis Cholinergic Crisis

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18
Q

● Malathion and Parathion: Insecticide
● Sarin, Tabun, Soman: Nerve gasses

● Signs and symptoms: (DUMBBELSS)
○ Diarrhea
○ Urination
○ Miosis
○ Bronchospasm
○ Bradycardia
○ Excitation
○ Lacrimation
○ Sweating
○ Salivation

● Antidote: Pralidoxime (ASAP, Not >36 Hours)
Nursing Consideration/s:

● WOF for bronchospasms, wheezing, bradycardia
● Rise slowly from supine or sitting position to avoid
dizziness or fall
● Monitor VS

A

ORGANOPHOSPHATE POISONING

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18
Q

How does edrophonium differentiate myasthenic crisis from cholinergic crisis?

A

● improves muscle strength in myasthenic crisis
● weakens muscle strength in cholinergic crisis

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19
Q

● Side effects:
○ Atropine fever (Hyperthermia)
○ Atropine flush (cutaneous vasodilation)
○ Mydriasis and cycloplegia (paralysis of ciliary
muscles = loss of accommodation)
○ Decreased secretions (saliva, sweat,
bronchiolar)
○ Tachycardia
○ Arrhythmias (Intraventricular conduction blocks)
○ Constipation
○ Blurred vision
○ CNS toxicity

● Antidote: Physostigmine

MNEMONIC FOR ATROPINE TOXICITY:
1. Hot as hare (Increased Temperature)
2. Dry as a bone (Thirsty, decreased secretions)
3. Red as Beet (Flushed Face)
4. Blind as Bat (Blurred Vision)
5. Mad as Hatter (Confusion, delirium)

A

ATROPINE TOXICITY

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20
Q

Contraindication to Muscarinic Blockers:

A

● Cautious use in infants
○ Hyperthermia due to decreased sweating
● Acute angle-closure glaucoma
● Benign Prostatic Hyperplasia

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21
Q

Medicines that stimulate the brain, speeding up both
mental and physical processes.

● They increase energy, improve attention and alertness, and elevate blood pressure, heart rate and respiratory rate.
● They decrease the need for sleep, reduce appetite, improve confidence and concentration, and lessen inhibitions.

A

CNS STIMULANTS

22
Q

MECHANISM:
Stimulates the release of neurotransmitters norepinephrine and dopamine

CLINICAL USE:
● Narcolepsy
● ADHD

SIDE EFFECTS:
● Restlessness
● Insomnia
● Tachycardia
● HPN
● Heart palpitations
● Dry mouth
● Anorexia
● Weight loss
● Diarrhea or
constipation
● Impotence

NOTES:
● CAN DEVELOP
DEPENDENCE
● SHORT-TERM
(12 WEEKS)
● AVOID ABRUPT
WITHDRAWAL

A

AMPHETAMINES

23
Q

AMPHETAMINES NR

A

● RITALIN and Pemoline should be given 30 to 45 minutes before meals (breakfast and lunch)
● Never give within 6 hours before sleep
● Instruct the patient to avoid driving, (because it causes drowsiness)
● Instruct the nursing mother to avoid taking CNS stimulants
● Explain to clients that long-term use may lead to drug abuse.

24
Q

MECHANISM:
Stimulates the release
of neurotransmitters –
norepinephrine and
dopamine

CI:
● APPETITE
SUPPRESSANT

SE:
● Nervousness
● Restlessness
● Irritability
● Insomnia
● Heart palpitations
● HPN

NC:
● Avoid <12 yo.
● Avoid
self-medication
★ Not advisable to
people who are
dieting

A

ANOREXIANTS

25
Q

CI:
● Treat respiratory
depression caused
by drug overdose
● pre-postanesthetic
respiratory depression
● COPD

SE:
● HPN
● Tachycardia
● Trembling
● Convulsions

NC:
★ Route: IV
★ To prevent respi
collapse / depression

A

DOXAPRAM
(DOPRAM

26
Q

A class of drugs that slow down brain activity, which can cause a person to feel calm and relaxed.

Diminish physical and mental response at a lower dosages of certain CNS depressants but does not
affect consciousness

Natural sleep

A

CNS DEPRESSANTS

SEDATION

HYPNOTIC

27
Q

~ Finite episodes of brain dysfunction resulting from
abnormal discharge of cerebral neurons.

● A heterogenous symptom complex – a chronic
disorder characterized by multiple seizures

A

SEIZURE

EPILEPSY

28
Q

~ Seizure is a product of focal lesion/electrical abnormality in some parts of the cerebral cortex

~ Arise from the local part of the brain, manifestation depends on the focus
(e.g. somatosensory – tingling of contralateral face/side of body, visual –
seeing flashes of light, auditory – hearing ringing noise, motor

~ Like simple partial but with impairment of consciousness, awareness and
memory

A

FOCAL SEIZURE

Simple Partial Seizure

Complex Partial Seizure

29
Q

Seizure manifestation indicates bilateral and diffuse cerebral cortical involvement.

A

GENERALIZED SEIZURE

30
Q

1.)
● Phenobarbital
● Mephobarbital

2.)
● Amobarbital (Amytal)
● Aprobarbital (Alurate)
● Butabarbital (Butisol)
- sleep sustainers for maintaining long period of sleep

3.)
● Secobarbital (Seconal)
● Pentobarbital (Nembutal)
- induce sleep for those difficulty falling asleep

4.)
● Thiopental Na (Pentothal)
- general anesthetics

A

1.)LONG ACTING
2.)INTERMEDIATE- ACTING
3.) SHORT-ACTING
4.)ULTRASHORT- ACTING

31
Q

ACTION:
● Increase the action of
inhibitory neurotransmitter
GABA > neuron excitability is
reduced!

● FLURAZEPAM (DALMANE) –
first — used to treat
insomnia

SE:
● Triazolam
(Halcion) – A/R:
loss of memory

NR:
● Avoid alcohol,
antidepressants,
antipsychotics
● Asking the patient to
urinate before taking the
drug

A

BENZODIAZEPINES:
● Temazepam
(Restoril)
● Estazolam
(ProSom)
● Quazepam
(Doral)
● Diazepam
(Valium)
● Lorazepam
(Ativan)

32
Q

NONBENZODIAZEPINES:

1.)
● Short term treatment of Insomnia (<10 days)
● Duration of Action: 6-8 hours
● Metabolized in the liver
● Excreted in the urine

2.)
● Induces sleep and decrease nocturnal awakenings

A

1.) ZOLPIDEM (AMBIEN)
2.) CHLORAL HYDRATE

33
Q

1.)
● A state of unconsciousness, amnesia, immobilization,
reflex inhibition, and skeletal muscle relaxation (partial
or complete)
● Usual methods: Inhalational, Intravenous, or
Combined (MOST COMMON)

2.)
● A state of where there is loss of sensation and blockade
of major nerves

3.)
● Loss of sensation induced in a part of the body by
infiltration or topical application of local anesthetics
near the nerve

A

1.) GENERAL ANESTHESIA
2.) REGIONAL ANESTHESIA
3.) LOCAL ANESTHESIA

33
Q

1.)
● Decreased pain awareness
● Sometimes with amnesia
● Impaired consciousness but not lost

2.)
● Excitation
● Amnesia
● Enhance reflexes
● Uncontrolled movement
● Irregular respiration
● Urinary incontinence

3.)
● Unconscious
● No pain reflex
● Regular respiration
● Maintained BP
○ Plane

A

1.) 1ST – ANALGESIA / INDUCTION
2.) 2ND – EXCITEMENT OR DELIRIUM
3.) 3RD – SURGICAL STAGE

34
Q

INHALATION ANESTHETICS

A

● HALOTHANE, ENFLURANE, ISOFLURANE, SEVOFLURANE, METHOXYFLURANE, NITROUS OXIDE

35
Q

● Mucous membrane; broken or unbroken skin surface, burns
● Solution, liquid spray, ointment, cream, and gel

LOCAL ANESTHETICS – LIDOCAINE! – DENTAL PROCEDURES, SUTURES, DIAGNOSTICS – LUMBAR
PUNCTURE, THORACENTESIS

A

TOPICAL ANESTHETICS

35
Q

● Local anesthesia injected into subarachnoid space 3rd to 4th lumbar space – children! 1st LS (adult)

● S/E and A/R: respiratory distress

A

SPINAL ANESTHESIA

36
Q

● Also called “ANTIEPILEPTICS”
● ACTION: to suppress the abnormal electrical impulses from the seizure focus to other cortical areas, preventing
seizures

A

ANTICONVULSANTS

37
Q

1.) Short lapses of consciousness that causes a blank stare

2.) Stiffening of muscles

3.) Brief sudden jerks like a startle reaction

4.) Sudden tonic adduction of limbs with head flexion

5.) Grand mal seizure, easily recognized TONIC = STIFF / CLONIC = JERKING

A

1.) Absence (Petit Mal)
2.) Tonic
3.) Myoclonic
4.) Infantile/Epileptic Spasms
5.) Generalized tonic-clonic

38
Q

CI:
● First anticonvulsant;
1938
● Focal seizure, Status
epilepticus (1st line
prophylaxis)

SE:
● Gingival
Hyperplasia
● Pseudolymphoma
● Hirsutism

A

HYDANTOINS – PHENYTOIN

38
Q

CI:
Treatment for: Partial,
Grand Mal and Status
Epilepticus.
● Status Epilepticus -
Life Threatening
seizures that last for
more than 5 minutes

SE:
Teratogenic

A

BARBITURATES
(PHENOBARBITAL)

39
Q

CI:
● Used for ABSENCE OR
PETIT-MAL SEIZURES
● Brief seizures that
last for less than 20
seconds
● Common in children
and indicated by a
BLANK STARE

A

SUCCINIMIDES

40
Q

● Used to treat
PETIT-MAL SEIZURE

A

OXAZOLIDINONES/ OXAZOLIDINEDIONE

41
Q

CI:
● Grand mal and
partial seizures
● Bipolar disease
● Trigeminal
Neuralgia
● Alcohol withdrawal

A

IMINOSTILBENES
(CARBAMAZEPINE)

42
Q

CI:
● Petit-mal
● Grand mal
● Mixed types of
seizures

SE:
HEPATOTOXIC

A

VALPROATE
(VALPROIC ACID)

43
Q

● Does not cross blood
brain barrier (BBB)
● Converted into
dopamine
● Most effective in
diminishing symptoms
of parkinson’s disease

A

LEVODOPA

44
Q

● Alternative drug
combined with
levodopa

A

CARBIDOPA

45
Q

1.)
Antiviral that acts
on the dopamine
receptors

SE:
● ORTHOSTATIC
HYPOTENSION
● Confusion
● Urinary retention

2.)
Acts directly on
CNS, CVS, and GIT

SE:
● ORTHOSTATIC
HYPOTENSION
● Chest pain

A

AMANTADINE HCL

BROMOCRIPTINE

46
Q

1.)
DRUGS FOR SKELETAL MUSCLE SPASTICITY

2.)
DRUGS FOR MUSCLE SPASMS

A

1.)
● Baclofen (Lioresal)
● Dantrolen (Dantrium)
● Diazepam (Valium)

2.)
● Carisoprodol (Soma)
● Methocarbamol (Robaxin)
● Orphenadrine Citrate (Norflex)

47
Q

Blocks Dopamine
A.k.a Major Tranquilizers

SE:
● Blurred Vision
● Dry Mouth
● Photosensitivity
● Orthostatic Hypertensio

A

ANTIPSYCHOTICS

48
Q

A.K.A. Minor Tranquilizers; Anti Anxiety
Decreases Reticular Activating System
Stimulates action of Gamma-Aminobutyric Acid

SE:
● Dizziness
● Drowsiness
● Dry mouth
● Sedation

A

ANXIOLYTICS

49
Q

1.) Prolongs NOREPINEPHRINE’S Action
2.)Prevents destruction of NOREPINEPHRINE

A

TRICYCLICS (TCA)
IMIPRAMINE (TOFRANIL) - 1ST ANTIDEPRESSANT

2.) MAO INHIBITORS

50
Q

treatment for BIPOLAR DISORDER

A

LITHIUM CARBONATE AND CARBAMAZEPINE

51
Q

● Three modes of transmission of HIV infection

A
  1. Injection of infected blood
  2. Sexual contact
  3. Maternal-fetal transmission
52
Q

○ Reduce the detectable viral load of HIV RNA as
low as possible
○ Maintain this level of suppression for as long
as possible

A

ANTIRETROVIRAL THERAPY

53
Q

○ Decreasing Virus Level to an undetectable
levels
○ Preserving and increasing the number of CD4+
T cells

A

Highly active antiretroviral therapy (HAART)

MIDTERMS (7 decks)

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