Pharmacology Midterm reviewer Flashcards
Drugs affecting the
ANS
CNS
Respiratory
Cardiovascular
ANS Agents
Autonomic nervous system
stimulate sympathetic response
Agonist
block sympathetic response
Antagonist
-heart rate, bp = increased, GI decreased, mydriaisis (dilation
of the pupils)
SYMPATHETIC NERVOUS SYSTEM
epinephrine, adrenaline
Neurotransmitters
alpha and beta receptors
Receptors
vasoconstriction - increase heart rate, contraction, mydriasis,
increases blood pressure
Example: phenylephrine, epinephrine
Alpha 1 receptor agonist
vasodilation – decrease in bp
ex: Clonidine
Alpha 2 receptor agonist
increased heart contractility and heart rate
(presence of dysrhythmia – hold the ordered dose and inform the
doctor) - Increased myocardial contractility
Beta 1 receptor agonist
bronchodilation
Beta 2 receptor agonist
the nurse should monitor the patient for palpitations
Albuterol
blocks both A1 and A2
ex: Phentolamine
Non-Selective Alpha Antagonist
blocks only Alpha 1 causing vasodilation,
decrease heart rate, contractility and bp.
ex: Prazosin
Alpha 1 Selective Antagonist
Beta Blockers
Non Selective
Selective B1 antagonist/blocker
blocks both B1 and B2 causing vasodilation
decreasing bp but bronchoconstriction – don’t give to patient with
asthma or respiratory problems.
Eg : Propranolol
Non Selective
blocks only B1 causing
vasodilation causing a decrease in BP but no bronchoconstriction.
Eg: Metoprolol – less likely to precipitate bronchoconstriction
Selective B1 antagonist/blocker
PARASYMPATHETIC NERVOUS SYSTEM
Parasympathomimetics
Neurotransmitters
cholinergic agonists
Receptors
Muscarinic agonist
heart rate, bp = decreased, GI
increased, miosis
PARASYMPATHETIC NERVOUS SYSTEM
Cholinesterase inhibitors
Parasympathomimetics
Acetylcholine
Neurotransmitters
mimic Acetylcholine
cholinergic agonists
Nicotinic and Muscarinic
Receptors
increase salivation, sweating, urination, gastric acid
Pilocarpine
Muscarinic agonist
skeletal muscle contraction
Nicotinic receptor agonist
will cause miosis, diarrhea and bradycardia
Bethanechol
Perform
urinary assessment
clinical manifestation of extreme
muscarinic stimulation
Excessive perspiration
as a neuromuscular relaxant
Succinylcholine
cholinesterase inhibitor
Physostigmine
bradycardia, hypotension, bronchospasm
Side effects
antimuscarinic agents causing bladder relaxation
preventing urinary incontinence.
Vasico selective
treatment for bladder incontinence – will
cause decrease unrination
Oxybutynin
muscarinic antagonists – decrease saliva, mucus
secretions, prevent vomiting
Atropine
for excessive dosing of bethanechol
Antidote
increase temp, confusion, flushed face,
dryness of mouth, very thirsty
Atropine overdose
muscle relaxation
Neuromuscular blocking drugs
Parasympatholitics
Spasmolytics
Mydriatics
Antiparkinsonian
Scopolamine
nicotinic receptor antagonist
Spasmolytics
Dantrolene
Spasmolytics
skeletal muscle relaxation
Dantrolene
dilation of pupils
Mydriatics
increase dopamine
Antiparkinsonian
Levodopa
muscarinic receptor antagonist – given to patient with
motion sickness
Scopolamine
increase the release of and block the reuptake of
excitatory neurotransmitters
CNS Stimulants
CNS Stimulants Indications
- Narcolepsy- excessive daytime sleepiness
- attention deficit disorder in children
- endogenous obesity
- reversal of respiratory distress
CNS
Central nervous system
CNS
Common Drugs:
Amphetamines
Methylphenidate (Ritalin)
Analeptics
Anorexiants
for ADHD to increase a child’s attention span,
decrease a child’s hyperactivity and decrease impulsiveness
- Given in the morning on an empty stomach.
- Advise patient to report signs of palpitations
- Advise patients to avoid alcohol consumption
- Advise the patients to avoid driving and using hazardous equipment while on
this drug
Avoid giving beverages containing caffeine – will cause cardiac dysrhythmias
Methylphenidate (Ritalin)
Avoid giving beverages containing caffeine
will cause cardiac dysrhythmias
to stimulate respiration – Methylxanthine – caffeine,
aminophylline, theophylline
Analeptics
suppress appetite, given to control weight
imbalanced nutrition, less than body requirements – common nursing
diagnosis
Anorexiants
common nursing
diagnosis
imbalanced nutrition, less than body requirements
CNS Depressants
Common Drugs:
Sedative-hypnotics
Anesthetics
Analgesics
Anticonvulsants
Anxiolytics
Antidepressants
Sedative-hypnotics
Common Drugs:
Benzodiazepine
– action – amplify the effects of GABA– calming
effect
Benzodiazepine
notify the doctor
immediately if the RR is below 10
Anticonvulsants- Phenobarbital
Increase in 3Ds - drowsiness, dizziness, and decrease
in BP
Anxiolytics
TCA, MAOI, SSRI
Antidepressants
CNS Depressant drugs
Barbiturates
Benzodiazepine
sedative-hypnotic - cause chloride ions to flow into the cell
and hyperpolarize
○ have a higher risk of toxicity than Benzodiazepines.
○ have a narrow therapeutic index.
○ increase the effects of GABA.
○ a central nervous system depressant.”
Barbiturates
sedative – hypnotic
Example: Alprazolam, Lorazepam, Clorazepate
■ Should not be given together with antihistamine
Alprazolam ( Benzodiazepine overdose) - give flumazenil
Benzodiazepine
give flumazenil
Alprazolam (Benzodiazepine overdose)
drugs that relieve the sensation of pain
Analgesic
Analgesic
Non-narcotic analgesics
Narcotic analgesics
Non-narcotic analgesics
Salicylates
NSAID
Para aminophenols
Narcotic analgesics
Naloxone
Narcotic analgesics
Nursing implications
● assess respiratory status – Naloxone (Narcan) for opiod toxicity
● assess for hypotension
● monitor bowel elimination
● evaluate pain response to medication
Vasodilators
decrease bp, dilates vessels, decrease vascular resistance
Should never be given together with viagra because it could lead to widening
of the blood vessels, dropping the blood pressure so low, arrhythmia and heart
attack.
Nitroglycerin
Unrelieved pain in cardiac disease after morphine
administration
Myocardial Infarction
Nursing Considerations
Do not leave the patients bedside when you are giving a
newly prescribed
antihypertensive especially beta blockers.
Nursing Considerations
bp, breathing and blood sugar
bp, breathing and blood sugar
nausea and
vomiting and dizziness – the nurse should advise the patient to rise to a
sitting or standing position slowly.
Angiotensin-converting enzyme inhibitors - Side effect
are given to patients with low heart rate
Pril and sartan
are given as anti-clumping and anti- clogging effect for better
blood circulation
Aspirin
ACEI
Angiotensin antagonist
or
Angiotensin converting enzyme inhibitor
(Angiotensin converting enzyme inhibitor or
ACEI)
● PRILS
● enalapril
● lisinopril
● captopril
The “sartans”
Angiotensin II receptor blockers
Losartan
Angiotensin II receptor blockers
Valsartan
Angiotensin II receptor blockers
newest group, may only be indicated
when ACEI are intolerable, mostly
free of side effects but very costly
Angiotensin II receptor blockers
Will decrease blood pressure to
hypertensive patient
Angiotensin II receptor blockers
Angiotensin II receptor blockers
● The “sartans”
● Losartan
● Valsartan
● newest group, may only be indicated when ACEI are intolerable, mostly free of side effects but very costly.
● Will decrease blood pressure to hypertensive patient
BETA BLOCKERS
- Propanolol– Inderal
- Labetalil
- atenolol
- bisoprolol
block the effects
of the epinephrine/adrenaline.
Beta blockers
Reduces the sympathetic
stimulation in cardiac muscle.
Beta blockers
Causing the heart to beat more
slowly and with less force, which
lowers blood pressure.
Beta blockers
also help open up
veins and arteries to improve blood
flow.
Beta blockers
Increase blood flow to the kidney.
Beta blockers
monitor for wheezing
Propanolol– Inderal
CARDIAC GLYCOSIDES
digoxin
(Lanoxin)
CARDIAC GLYCOSIDES
digitoxin
(Crystodigin)
CARDIAC GLYCOSIDES
increase force of contraction
positive inotropic effect
CARDIAC GLYCOSIDES
decrease heart rate
Negative chronotropic effect
CARDIAC GLYCOSIDES
Adverse reactions:decrease pulse rate . Monitor
apical pulse
digitalis toxicity
CARDIAC GLYCOSIDES
0.5 to 2.0 nanograms/mL)
Therapeutic level
CARDIAC GLYCOSIDES
Antidote:
digoxin immune fab (Digibind)
● digoxin (Lanoxin)
● digitoxin (Crystodigin)
Effects:
● positive inotropic effect – increase force of contraction
● Negative chronotropic effect - decrease heart rate
● Adverse reactions: digitalis toxicity – decrease pulse rate . Monitor apical pulse
● Therapeutic level is 0.5 to 2.0 nanograms/mL)
● Antidote: digoxin immune fab (Digibind)
CARDIAC GLYCOSIDES
digoxin (Lanoxin)
CARDIAC GLYCOSIDES
digitoxin (Crystodigin)
CARDIAC GLYCOSIDES
Effects:
● positive inotropic effect – increase force of contraction
● Negative chronotropic effect - decrease heart rate
● Adverse reactions: digitalis toxicity – decrease pulse rate . Monitor
apical pulse
● Therapeutic level is 0.5 to 2.0 nanograms/mL)
● Antidote: digoxin immune fab (Digibind)
CARDIAC GLYCOSIDES
DRUGS USED FOR ARRHYTHMIA
- Class 1 Antiarrhythmic Drugs/
SODIUM CHANNEL BLOCKERS - CLASS II ANTIARRHYTHMIC DRUGS/
BETA BLOCKERS - CLASS III ANTIARRHYTHMIC DRUGS/
Potassium channel blockers - CLASS IV ANTIARRHYTHMIC DRUGS/ CALCIUM CHANNEL
BLOCKERS
Mechanism of Action:
Decrease sodium influx to cardiac cells, decreasing
automaticity of the ventricular cells
- quinidine and procainamide
Class 1 Antiarrhythmic Drugs/
SODIUM CHANNEL BLOCKERS
EXAMPLE:
* Acebutolol
* Esmolol
* Propranolol
* Nadolol
CLASS II ANTIARRHYTHMIC DRUGS/
BETA BLOCKERS
acts directly on the muscle cells prolonging
the repolarization and the refractory period, increasing the threshold for
ventricular fibrillation.
EXAMPLE
Amiodarone Dofetilide
CLASS III ANTIARRHYTHMIC DRUGS/
Potassium channel blockers
ANTIANGINAL DRUGS
- Nitroglycerin
- Beta-blockers
- Calcium-channel blockers
Diltiazem
CLASS IV ANTIARRHYTHMIC DRUGS/ CALCIUM CHANNEL
BLOCKERS
Mechanism of Action:
act directly on heart muscle cells to prolong repolarization and the refractory period, increasing the threshold for ventricular
fibrillation; also act on peripheral smooth muscle to decrease peripheral resistance
CLASS III ANTIARRHYTHMIC DRUGS/
Potassium channel blockers
for patient with chest pain
ANTIANGINAL DRUGS
Relaxes vascular smooth muscle with
resultant decrease in venous return and arterial bp
Nitroglycerin
ANTIANGINAL DRUGS
Rapidly acting agents
● E.g. nitroglycerine (Nitrostat, Transderm Nitro)
● Usually given sublingually
● Used to terminate acute attack of angina
● Take 1 tablet, then an additional tablet every
5 minutes, for a total of 3 tablets. Calls the
physician if pain persist after 3 tablets.
DECREASE HEART RATE
Beta-blockers
DECREASE FORCE OF
CONTRACTION
Calcium-channel blockers
● E.g. nitroglycerine (Nitrostat, Transderm Nitro)
● Usually given sublingually
● Used to terminate acute attack of angina
● Take 1 tablet, then an additional tablet every
5 minutes, for a total of 3 tablets. Calls the
physician if pain persist after 3 tablets.
ANTIANGINAL DRUGS
Rapidly acting agents
ANTIANGINAL DRUGS: Rapidly acting agents
E.g. nitroglycerine
(Nitrostat, Transderm Nitro)
Rapidly acting agents
Usually given sublingually
ANTIANGINAL DRUGS
Rapidly acting agents
Used to terminate acute attack of angina
ANTIANGINAL DRUGS
Rapidly acting agents
Take 1 tablet, then an additional tablet every
5 minutes, for a total of 3 tablets. Calls the
physician if pain persist after 3 tablets.
ANTIANGINAL DRUGS
Rapidly acting agents
antilipidemic agents – given to
patient with hypercholesterolemia ( increased cholesterol in the blood)
○ Atorvastatin
HMG CoA reductase inhibitors (statins)
monitor for signs of bleeding
For patient receiving tissue plasminogen activator like alteplase
○ Decrease bp
○ Dilate blood vessels
○ Decrease heart rate
○ Decrease vascular resistance
Vasodilators
Vasodilators
○ Decrease bp
○ Dilate blood vessels
○ Decrease heart rate
○ Decrease vascular resistanc
blocks H1 receptors thereby decreasing allergic
response.
○ Allergic responses like itchy, watery eyes, rhinitis.
○ Benadryl AH, Dimetapp
○ Can be taken 45 minutes before exposure to an allergen
○ First generation anti histamine has higher incidence of drowsiness
Antihistamine
Allergic responses like itchy, watery eyes, rhinitis.
Antihistamine
Benadryl AH, Dimetapp
Antihistamine
Can be taken 45 minutes before exposure to an allergen
Antihistamine
First generation anti histamine has higher incidence of
drowsiness
Antihistamine
eliminate or reduce congestion or swelling.
● Common drugs –pseudoephedrine, phenylephrine
● limit 5-7 days to prevent rebound nasal congestion.
● Side effects - hypertension
Decongestants
Decongestants
Common drugs
pseudoephedrine, phenylephrine
limit 5-7 days to prevent rebound nasal congestion.
Decongestants
Decongestants
Side effects
hypertension
promotes expectoration by reducing the viscosity of pulmonary secretion or by decreasing the tenacity with which
exudates adhere to the lower respiratory tract
Expectorant
common expectorant in over-the-counter medications
○ loosen bronchial secretions for effective coughing.
○ Benadryl, Robitussin
○ Increase water intake.
Guafenesin
supress the cough reflex. Non-productive cough.
● dextromethorphan (Robitussin DM)
○ reduce the frequency of cough.
○ Waits 15 to 20 minutes after taking the syrup before drinking any
liquid
○ Narcotic cough syrup – synergistic effect with alcohol
Antitussives
dextromethorphan (Robitussin DM)
Antitussives
Lower Respiratory Tract disorder
Common disorder:
Bronchial asthma
Reversible airway obstruction that is
characterized by hyperirritability and inflammation of the
airways.
Bronchial asthma
Bronchial asthma
Main problems
bronchoconstriction and inflammation
Bronchial asthma
Medications
Bronchodilators
Bronchial asthma
Side effects:
tachyarrhythmias,
tachycardia
