Pharmacology Year 1 Lvl 2 Flashcards
Adrenergic Agents (sympathomimetic)
Meds that mimic NE, cause they mimic axn produced by SNS.
Adrenergic Blocking Agents
inhibit or reduce SNS activity adrenergic activity. (eg. beta blockers “olol”)
Cholinergic Agents (Parasympathomimetics)
Meds that mimic ACH, cause they mimic axns produced by PNS.
Gabapentine
Helps with nerve pain (neuralgia, or shingles)
Anticholinergic drugs
drugs block or inhibit cholinergic axns (block PNS axns)
Classification of sleep pattern disturbances
Transient (lasting a few nights) Short Term (less than three weeks, travel/ anxiety) Chronic (longer than 1 month)
Insomnia (3 types)
Initial: inability to fall asleep
Intermittent: inability to stay asleep
Terminal: early awakening but inability to fall asleep again
Sedatives
Drug that calms and gives feelings of rest and relaxation, not necessarily accompanied by sleep. eg. ativan
Hypnotic
Produces sleep, normal awakening, no hangover effect, no danger of habit formation.
Barbiturates
Axn: Cause CNS depression which is reversible. Sedative and Hypnotic effects. Often used for seizure disorders. eg. phenobarbital
Benzodiazepines
CNS depressant but more site specific, hypnotic and sedative effect. Think “zzz” eg. ativan
Examples of Non Barbiturate, Non Benzodiazepines Sedative/Hypnotic agents
Melatonin, Benadryl, Dimenhydrinate (Gravol), Diphenhydramine (Benadryl)
Parkinson’s Medication Function
Drugs that aim to replace or block destruction of dopamine.
Selegiline & Rasagiline
Causes neuroprotective factors that interfere with the degeneration of dopaminergic neurons
Monoamine Oxidase Inhibitors
Blocks destruction of monoamines serotonin, dopamine, and NE to prolong their effect
Helpful for depression and parkinson’s
Antiparkinsonians
AXN: drug crosses blood brain barrier and metabolizes into dopamine increasing the levels in the brain.
Levadopa and Sinemet (Levadopa & Carbidopa)
Dopamine Agonists (Apomorphine)
AXN: dopamine agonists slow destruction of dopamine and aids in release of of dopamine from its storage site
Do not administer IV
Anticholinergic Agent
Realigns the balance between dopamine and ACH, and decreases ACH in the brain.
Will reduce drooling, and tremors. Slowing PNS so be mindful of side effects could occur, eg. constipation.
Alzheimer’s Agents (Cholinesterase inhibitors)
AXN: Blocks the breakdown of the NT ACH. (Slows progression of ACH destruction. Memory, learning and thinking)
eg. Aricept
Serotonin
NT that helps regulate memory and learning, associated with feelings of happiness, and relaxation.
Melatonin
Is a hormone that is secreted by the pineal gland that helps to regulate sleep schedule and circadian rhythm.
Selective Serotonin Reuptake inhibitor (SSRI)
AXN: decreases the breakdown of serotonin at the synaptic cleft to allow more serotonin available for the neurons.
Serotonin Syndrome
Toxicity of serotonin
S&S: irritability, increased muscle tones, shivering, seizures, myoclonus, tachycardia, reduced consciousness.
Tricyclic Antidepressants
AXN: prolong the axn of NE, dopamine, and serotonin to varying degrees by blocking the reuptake of these NT in the synaptic cleft between neurons. eg . amitriptyline
Miscellaneous Agents - Wellbutrin HCL
Prolongs the axn of NE, dopamine, and serotonin by blocking reuptake (less than tricyclics)
Diuretic
Causes the body to ride itself of excess fluids and sodium through urination
3 types of Diuretics and drugs names
- Loop Diuretic (Furosimide)
- Potassium Sparing Diuretic (Spironolactone)
- Thiazide/ Thiazide - like agents (Hydrochlorothiazide)
Loop Diuretic
Furosemide (Lasix)
Potassium Sparing Diuretic
Spironolactone (Aldactone)
Thiazide/ Thiazide - like agents
Hydrochlorothiazide (Esidrix, Hydrodiuril)
ACE Inhibitors
Expands blood vessels and decreases resistance by lowering levels of angiotensin II. Allows blood to flow more easily and makes the heart’s work easier or more efficient.
“Prils”
Common ones, Benzapril (Lotensin), Ramipril (Altace)
Beta Adrenergic blocking agents
“Beat Blockers” "lol" Decrease HR and cardiac OP, which lowers blood pressure and makes the heart beat more slowly with less force. Atenolol (Tenormin) Metoprolol (Lopressor, Toprol XL) Propranolol (Inderal)
Drug Classes that can be used for Hypertension ABCD?
Diuretics
Beta blockers
ACE inhibitors
Calcium channel blockers
Drugs used for Heart Failure
Vasodilators Inotropic agents Diuretics ACE inhibitors Beta blockers Calcium channel blockers
Most common drug used for HF
Digitalis Glycosides: Digoxin/ Lanoxin
Digitalis Glycosides
Increases the cardiac contractility and slows heart rate.
What must nurses always do before administering Digoxin?
Take apical pulse for one minute and ensure HR is more that 60bpm.
Digitalis Toxicity
Build up of digoxin in body.
S&S
Blurred vision
Anorexia
N&V
Dysrhythmias
a disturbance in the normal conduction of the heart causing abnormal contraction or HR.
Antiarrhythmic Drugs (Common)
Quinidine is the most common class one drug for dysrhythmias
Class 2 beta blockers
Class 4 Calcium Channel Blockers (Diltiazem, Verapamil)
Digitalis Glycoside
Serum Electrolytes
Potassium
Sodium
Chloride
Bicarbonate
Drugs used to treat Angina Pectoris
Nitrates (FOCUS ON THIS PRIMARILY)
Calcium channel blocker
Beta Blocker
Hyperlipidemia
Elevated levels of cholesterol and triglycerides in the blood that can lead to atherosclerosis
Medication Routes
Oral Transdermal Suppository Intramuscular Subcutaneous Buccal Ophthalmic/ intraocular Enteral (GI tract, oral, rectal) Percutaneous (through skin, occular, patch, inhaler, buccal) Parenteral (Bypass GI, IV, IM, Subq, NEEDLES)
10 Rights
Patient Drug/ Med Education Dose Time Document Reason Refusal Evaluation Route
3 important factors when using insulin
Onset
Peak
Duration
4 types of insulin
Rapid acting (meals, hyperglycemia) Short acting (regular same as rapid) Intermediate acting (NPH insulin) Long acting
eg. short/ rapid before breakfast and long acting for the day. ENSURE FOOD IS IN SIGHT FOR RAPID OR SHORT ACTING INSULIN
How should vials of insulin be mixed?
By rolling NOT SHAKING
Metformin
Oral antidiabetic
axn: ^ insulin sensitivity in cells
Insulin must be present for it to work
Used with type 2 diabetes
Glyburide/ Diabeta
Oral anti-diabetic for Type 2
axn: encourage pancreas to ^ insulin production
Antihypoglycemic Agents
Glucagon
Used to treat hypoglycemic reactions, effective 5-20 minutes after injection.
It increases blood sugar
Signs and Symptoms of Hypoglycemia
Shakiness Dizziness Hunger/ slight nausea Irritability Sweating Anxiety Headache Sleepiness that may lead to unconsciousness
Thyroid Hormone Replacement Drugs
Levothyroxine *
Eltroxin
Synthroid*
Nitrates: Nitroglycerin Functions
Coronary Vasodilators ( this increases myocardial oxygen) Decreases venous return and cardiac workload Side effects, headache and hypotension
Red blood clots
Venous thrombus
Mostly erythrocytes and fibrin with very few platelets
Forms in response to venous pooling after immobility, or surgery.
Most common cause of DVT in lower extremities
White Blood Clots
Composed of platelets and fibrin
Forms in areas of high blood flow due to injured vessel walls (no longer smooth due to plaque formation)
Drugs for thromboembolic disorders
Platelet inhibitors (Aspirin, Anacin, Bayer, Plavix) Anticoagulants (Heparin, Coumadin) Fibrinolytic Agents (Thrombolytics)
Platelet Inhibitor Drugs
Aspirin, Anacin, Bayer, Plavix
Anticoagulant Drugs
Heparin, Coumadin
Heparin is usually short term used for surgery via IV, or IM. Coumadin is usually used long term and orally.
Fibrinolytic Agents (Thrombolytics)
just know that they break down clots
What kind of blood test will be done for Coumadin (Warfarin) ?
PT (Prothrombin), PTT(Partial thromboplastin time), and INR
What kind of blood test will be done for Heparin?
aPTT
Lovenox
is a lesser risk low molecular for blood heparin (Dalteparin/ fragmin)
A more gentle version
Nursing Considerations For Anticoagulants
Check lab tests before administering anticoagulants (warfarin) for clotting times (PT, PTT, INR)
Prevent bleeding but report & record
Check urine, stools, and sputum for signs of blood
History of epistaxis
Soft toothbrush
Medical alert bracelet
Drugs used for Psychosis
Antipsychotics
Benzodiazepines for acute episodes
Beta adrenergic agents; antiparkinsonian and anticholinergic agents are sometimes used in treatment for psychoses.
Antipsychotics (First Generation)
AXN: block dopamine in the brain. The atypical APs block serotonin receptors and dopamine receptors.
Used as txt for schizophrenia, mania, psychotic depression and psychotic organic brain syndrome. Often Haldol is used
Extrapyramidal Effect (Side effect from Antipsychotics)
Extrapyramidal Effect
Acute Dystonia (spasmodic movements, prolonged tonic contractions)
Pseudoparkinsonian symptoms (decrease in dopamine causing parkinson’s symptoms)
Akathisia (anxiety and restlessness)
Tardive Dyskinesia (involuntary hyperkinetic abnormal movement, always specific to antipsychotic drugs)
Type 1 Insulins
Humalog (Rapid)
Novorapid (Rapid)
Regular/ Toronto (Short)
NPH (Cloudy Long acting)
Things to remember about insulin
Refrigerated until opened, then room temp for up to 30 days
Vials should be rolled not shaken
Draw up clear first, then cloudy
Shot sites should be rotated
Drugs that treat Upper Respiratory Diseases (common cold, rhinitis, allergic sinusits)
Antihistamines
Nasal Decongestants
Antitussives
Expectorants (mucinex, mucolytics)
H1 Antihistamines Antagonist
Block natural histamine from attaching to the receptor sites. They also have an anticholinergic effect
Helps to prevent adverse consequences of natural histamine stimulation. (Dries nasal secretions, salivary and lacrimal secretions (runny nose, teary and itchy eyes)
Antihistamines
Take before symptoms occur or when they appear. They cannot stop symptoms that are already present
Sedation
Anticholinergic side effects (dry mouth, stuffy nose, blurred vision, constipation, and urinary retention)
Sympathomimetic decongestants
Stimulate alpha adrenergic receptors of the nasal mucosal membranes, which causes vasoconstriction, decreased blood flow to nasal area, promotes sinus drainage.
Indications for use of decongestants
Congestion due to rhinitis
Used antihistamines for allergic rhinitis, (counteracts drowsiness from antihistimines). Routes nasal spray or oral drops.
Rhinitis Medicamentosa
Over use and a rebound effect and increase original symptoms
Corticosteroids (Resp)
Respiratory anti inflammatory agents
Used if patients unresponsive to antihistamines and sympathomimetic agents
Nasal spray or topical for allergic rhinitis
Side effects, nasal irritation and adrenal suppression with prolonged use
Factors that cause airway constriction
Hypersecretion of mucous
Mucosal edema
Bronchoconstriction
Treatment of lower respiratory diseases
Expectorants Antitussives Mucolytics Mucolytics Anti inflammatory corticosteroids
Expectorants
Increases serous fluid secretion by respiratory tract. Eg. Guaifenesin/ Robitussin
Antitussive
Cough suppressant (non productive cough) Codeine and dextromethorphan
Codeine
Antitussive, can be addictive and cause respiratory depression, and constipation
Mucolytics
Dissolves chemical bonds within mucus and loosens secretions
Bronchodilators
Beta- adrenergic = stimulates dilation
Anticholinergic = inhibits cholinergic receptors causing bronchoconstriction
Xanthine - Derivative = acts on smooth muscles of bronchial tree, produces bronchodilation
Ventolin
(Salbutamol) KNOW
Short acting: rapid onset, can be used frequently during an acute attack. Generally should not need to be used daily, but it would indicate better treatment is needed
Anti inflammatory agent - Corticosteroid
act on smooth muscle relaxation, enhance beta adrenergic bronchodilators, and inhibit inflammatory response in lungs
Not used for acute relief of bronchospasm
Use bronchodilator first and then corticosteroid (rinse mouth after)
Pulmicort (inhalation) and prednisone (oral) know these two
GERD and ulcer treatment
Antacids: buffers pH of HCL in stomach 1-2 to 3-4
Histamine 2 receptor antagonists: blocks HCL production
Gastrointestinal Prostaglandins: inhibit gastric acid and pepsin secretion
Proton pump inhibitors: Blocks HCL formation
Hyperemesis Gravidarum
During pregnancy, develop starvation, dehydration, and acidosis due to excess vomiting
Psychogenic vomiting
Seeing someone else vomit and it induces vomiting
Drugs used for N&V
Anticholinergic agents: Counterbalance excess amounts of ACH which are thought to cause motion sickness. (dimenhydrinate, dramamine, Gravol*, diphenhydramine, scopolamine)
Kidney Infection
Pyelonephritis
Bladder infection
Cystitis
Prostate infection
Prostatitis
Urethral infection
Urethritis
Medication for disorders of urinary system
Quinolone Antibiotics (Just know norfloxacin, broader spectrum) Urinary anticholinergic (for bladder spasms, oxybutin) Miscellaneous Urinary Agents (Pyridium, analgesic)
Narcotic
Opiates, or controlled substances creating euphoria
Opioid
Synthetic opium
Opiates
Naturally derived
Addiction
Psychological need for the drug
Dependance
Physical need for a drug
equi - analgesia
Very different drugs but have same effect of pain relief
Tylenol vs ibuprofen
Receptors
Receptors
Nerve fibers that transmit messages to the brain
Analgesia
Pain relief
Partial agonist
Milder response drug effect
Antagonist
Oppose or block a response
Agonist
Drug that attaches to a receptor site and causes a response
Pain Threshold
Is the point at which an individual first acknowledges or interprets a sensation being painful
Idiopathic pain
Nonspecific pain of unknown origin, anxiety, depression and stress are often associated with this sort of pain
Neuropathic pain
Is the result of an injury to the PNS or CNS (ie. trigeminal neuralgia)
Nociceptive pain
The result of a stimulus (chemical, mechanical, thermal) to pain receptors
Somatic pain is from the skin, bones, muscle (eg. arthritis) specific, you know where the pain is coming from
Visceral Pain originates from abdominal or thoracic organs
Pain Tolerance
The person’s ability to endure pain
PQRST Method
Provoke (What caused pain)
Quality (What does it feel like)
Radiates (Does the pain go anywhere else)
Severity (1-10) (Do you need meds?)
Time (When did it start, how long does it last)
LOTARP Method
Location (point to pain)
Onset (when did it start)
Type (can you describe it)
Associated Symptoms (other symptoms?)
Aggravating factors (what makes it worse?)
Relieving factors (what makes it better?)
Precipitating events (what where you doing when it started)
