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Patho-Pharm -- Exam 1 > Week 2 > Flashcards

Week 2 Flashcards

1
Q

drug therapy in pediatrics

A
  • highly sensitive due to immature organs
  • adjust dosage based on WEIGHT or BSA (body surface area)
  • PO route preferred
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2
Q

FDA pregnancy categories - A

A
  • no evidence of risk
  • in controlled human study
  • e.g. thyroid H, folic acid, prenatal vitamins
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3
Q

FDA pregnancy categories - B,C D

A

some risks

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4
Q

FDA pregnancy categories - X

A
  • human teratogen
  • contraindicated
  • e.g. warfarin, live vaccines, accutane
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5
Q

drug therapy during breast feeding

A
  • can be excreted in breast milk
  • little research done
  • take drug w/ shorter half life
  • take after breastfeeding
  • worst case - switch to formula
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6
Q

drug therapy in geriatric patients

A
  • physiologic age more impt than chronological age= individualize therapy (decreased physiologic function –> increased toxicity)
  • likely to have multiple disorders – polypharmacy –> drug interactions/toxicity
  • should include simple dosing regimens
  • frequent plasma drug levels
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7
Q

Acetylcholine

A
  • neurotransmitter of the PNS
  • released by somatic NS & parasympathetic NS
  • released by all preganglionic neurons
  • degraded by acetylcholinesterase (AchE)
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8
Q

Norepinephrine

A
  • released by sympathetic NS

- REuptake into nerve terminals – > stored in vesicles for reuse OR destroyed by MAO (monoamine oxidate)

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9
Q

epinephrine

A
  • release by adrenal medulla

- into blood stream –> hepatic metabolism

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10
Q

receptors of PNS - cholinergic

A
  • nicotinic - skeletal muscles (somatic)

- muscarinic - internal/target organs of parasympathetic NS (rest, relax, eliminate)

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11
Q

receptors of PNS - adrenergic

A

sympathetic NS

  1. alpha 1 - peripheral blood vessels = vasoconstriction/incr BP
  2. alpha 2 - CNS =
  3. beta 1 - heart
  4. beta 2 - lungs, liver, uterus
  5. dopamine
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12
Q

activation of muscarinic cholinergic receptors

A

elicits parasympathetic response in target organ

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13
Q

activation of nicotinic cholinergic receptors

A

causes contraction of skeletal muscle

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14
Q

effects of drugs on steps of synaptic transmission

A
  1. alter synaptic transmission
  2. receptor selectivity - nonselective have more side effects
  3. influence receptor activity on target cells - agonists or antagonists
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15
Q

drugs that affect cholinergic receptors

A
  1. muscarinic agonists (cholinergics)
  2. muscarinic antagonists (anticholinergics)
  3. cholinesterase inhibitors
  4. neuromuscular blockade
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16
Q

muscarinic agonists (cholinergics)

A
  • parasympathomimetic agents = mimic parasympathetic
  • stimulate activity of target cells
  • mimic action of Ach
    Ex. Bethanechol (urecholine)
    1. constrict iris sphincter (mitosis)
    2. ↓ HR
    3. bronchoconstriction; ⇡secretion
    4. ⇡saliva, GI secretion, ⇡ motility, defecation
    5. ⇡ sweating
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17
Q

Bethanechol (urecholine)

- cholinergics

A

MOA - activates muscarinic cholinergic receptors
No effect on nicotinic cholinergic receptors
Indicated for: urinary retention in post-op or part
SEs - ↓ HR, bronchoconstriction, cramping/diahrrea
Contraindicated for asthma pt
NI: ck HR, measure output

18
Q

muscarinic antagonists (anticholinergics)

A
  • parasympatholytic drugs = inhibit parasympathetic system (act like sympathetic)
  • bind to muscarinic cholinergic receptors & inhibit activity of target cells.
  • block the action of Ach at receptors
    Effect:
    eyes: mydriasis (dilate)
    ⇡ HR
    bronchodilation
    ↓ saliva, ↓ motility
    ↓ emptying (promotes urine retention)
    ↓sweating
19
Q

Atropine

anticholinergic

A 
Side effects:
eyes: photophobia, blurred vision, ⇡ IOP
⇡ HR
bronchodilation
dry mouth, constipation
urinary retention
no sweating, so at risk for hyperthermia / hot / red skin
20
Q

Nursing implications & pt ed: anticholinergics

A
  • drink water
  • sunglasses
  • intake of fiber (for constipation)
  • show how to check pulse (for tachycardia)
21
Q

cholinesterase inhibitors

A
  • degrade cholinesterase, so more ACh is allowed
    1. reversible
    2 irreversible
22
Q

myasthenia gravis

A

autoimmune disease that destroys ACh receptors
- s/sx muscle weakness & fatigue; eyelid droops; diplopia;

myasthenia crisis: sudden exacerbation of s/sx = respiratory weakness, needs ventilator

diagnose w/ anti cholinesterase test - short term, quick acting - if symptoms subside = make diagnosis = therapy is Neostigmine

23
Q

reversible cholinesterase inhibitors

A

MOA - prevent degradation of ACh by AChE
⇡ ACh transmission at all cholinergic receptors

SE: cholinergic OD (crisis) - excessive stem of all cholinergic receptors
- ↓ HR
- muscle weakness – respiratory failure
Ex. Neostigmine
Antidote: ATROPINE, intubation & mechanical ventilation

24
Q

irreversible cholinesterase inhibitors

A
  • long duration & toxic effects
  • puts pt into cholinergic crisis (excessive muscle & CNS stimulation)
  • caused by insecticides, nerve gas, chemical weapons
  • antidote: ATROPINE
25
Q

neuromuscular blockade

A

“nicotinic cholinergic blockage” - block nicotinic cholinergic receptors @ NMJ
- prevent ACh from activating receptors on skeletal muscles –> muscle weakness (flaccidity/paralysis

Indications: used in ICU & surgery, intubation
- no effect on pain or consciousness (!); must be used with anesthetic & analgesic

26
Q

botulinum toxin (botox)

A

neurotoxin - blocks release of ACh & block neurotransmission at NMJ
Indications:
cosmetic; severe underarm sweating, migraine HA, overactive bladder, limb spasticity (parkinson’s)
SE: HA, loss of facial expression, flu-like symptoms
Contraindications: preg, breast-feeding

27
Q

Adrenergic receptors

A

sympathomimetics - mimics actions of sympathetic NS

Main effects are on: heart, lungs, blood vessels

28
Q

where are: Alpha-1

A

eyes, blood vessels

29
Q

where are: Alpha-2

A

CNS

30
Q

where are: Beta-1

A

heart

31
Q

where are: Beta-2

A

lungs

32
Q

Cathecholamines

A

adrenergic agonist

  • IV only
  • brief duration of action
  • used for cardiac stimulants
  • don’t cross BBB
33
Q

Epinephrin (Adrenalin)

A

drug of choice in cardiac arrest, anaphylactic shock
- ⇡blood flow to vital organs - heart, lung, brain
- ↓ blood flow to periphery - skin, kidney
Route: injection (EpiPen), inhalation
IV, topical w/lidocaine

34
Q

adrenergic antagonists

A

blockers / sympatholytics
Actions: ↓HR, vasodilation, ↓ BP, ⇡bronchconstriction
mitosis

35
Q

Drugs for glaucoma

A

caused by ⇡IOP; can be open angle (90%) or closed angle (10%).
SE - blurred vision, systemic absorption = bradycardia, bronchospasm
Rx:
1. PARASYMPATHOMIMETICS (Piolcarpine.Humorosol) or 2. PROSTAGLANDIN ANALOGS (Latanoprost or Travoprost)
3. BETA BLOCKERS (-olol)
4. CARBONIC ANHYDRASE INHIBITORS (Acetazolamide (Diamox) PO or Trusopt (eye drops))

DO NOT GIVE ATROPINE

36
Q

parasympathomimetics - to treat glaucoma

A

pupil constriction - ⇡ outflow of aqueous humor
Ex: Pilocarpine; Humorosol
SE: ↓ night vision

37
Q

open angle glaucoma

A

progressive loss of peripheral visual field (tunnel vision)
90% of cases
Rx: eye drops, systemic drugs (Timolol)
Goal: reduce IOP in anterior chamber (promote drainage)
Contraindicated: asthma pt, CAD (coronary artery disease)

38
Q

closed angle glaucoma

A
  • less common, but is an emergency when occurs (acute onset)
  • w/o treatment – blindness w/in 1-2 days
  • very painful
39
Q

factors affecting hemodynamics (BP)

A
  1. Heart
  2. Blood volume
  3. Arterioles
40
Q

RAAS

A

Renin Angiotensin Aldosterone System

Patho-Pharm -- Exam 1 (3 decks)

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