Pharm Exam 1 Meds (ANS Drugs)

Alpha 1 Physiologic Responses

Increases force of heart contraction; vasoconstriction increases blood pressure; mydriasis (dilation of pupils) occurs; secretion in salivary glands decreases; urinary bladder relaxation and urinary sphincter contraction increases

Alpha 2 Physiologic Responses

Inhibits release of norepinephrine; dilates blood vessels; produces hypotension; decreases gastrointestinal motility and tone

Beta 1 Physiologic Responses

Increases heart rate and force of contraction; increases renin secretion, which increases blood pressure

Beta 2 Physiologic Responses

Dilates bronchioles; promotes gastrointestinal and uterine relaxation; promotes increase in blood glucose through glycogenolysis in the liver; increases blood flow in skeletal muscles

Cholinergic Agonist Responses:

stimulate bladder and GI tone, pupillary constriction, increase neuromuscular transmission, decrease heart rate, decrease blood pressure, increase salivary, GI, and bronchial secretions

Cholinergic Antagonist Responses:

decrease GI motility, decrease salivation, pupillary dilation, increased pulse, decrease bladder contraction (urinary retention), decrease rigidity and tremors related to neuromuscular excitement

"SLUDGE" (cholinergic agonist effects)

salivation, lacrimation, urination, defecation, GI cramps, emesis

Cholinergic antagonist effect mnemonic (can't...)

Can't see, can't pee; can't spit, can't ... (defecate)

Acetylcholinesterase inhibitors.....

block acetylcholinesterase to increase the affect of acetylcholine and prevent it from breaking down.

What class is epinephrine?

Nonselective adrenergic agonist

What is the method of action for epinephrine?

It works of alpha receptors 1 + 2, as well as beta receptors 1, 2, and 3

What are the indications for epinephrine?

anaphylaxis, allergic reaction, asthma exacerbation, bronchospasm, angioedema, cardiac arrest, nasal decongestion

What are the main emergency uses for epinephrine?

Anaphylaxis and cardiac arrest

What are the Absolute/Relative Contraindications for epinephrine?

Cardiac dysrhythmias, pregnancy, narrow-angle glaucoma, cardiogenic shock.

If the situation is an emergency, what are the contraindications for epinephrine?

None

What are the side effects of epinephrine?

Nausea, restlessness, tremor, agitation, oliguria, hyperglycemia

What are the adverse effects of epinephrine?

Palpitations, tachycardia, hypertension, myocardial infarction, renal insufficiency

Why might epinephrine cause renal insufficiency?

Vasoconstriction of the blood vessels around the kidneys may cause the loss of perfusion to the kidneys.

Why is hypertension listed as an adverse effect of epinephrine?

The hypertension can go beyond what we would want it to.

What are some things to know or teach your patient about using an EpiPen (epinephrine autoinjector)?

They need to know when to use it and how to use it, and the importance of always having it with you (and a second injector because a second dose may be needed), what the medicine should look like and where the expiration date is, to give it IM through clothing (hold for 10 seconds), to not leave it in temperature extremes (hot car, fridge, etc), and to always call 911 after using it.

What class is albuterol?

Selective beta-adrenergic agonist

What is the method of action for albuterol?

Acts of beta-2 adrenergic receptors causing bronchodilation

What are the indications for albuterol?

Used as a rescue-inhaler for asthma exacerbation and prior to exercise; bronchospasm

What are the Absolute/Relative Contraindications for albuterol?

Cardiac dysrhythmia, heart failure, cardiac disease, hypokalemia, hypocalcemia, MAOI therapy

Why is hypokalemia a contraindication for albuterol?

Albuterol shifts potassium into the cell; sometimes it can be used to treat hyperkalemia.

What are the side effects of albuterol?

Tremor, dizziness, drowsiness, restlessness, agitation, dry mouth, nausea, diarrhea, urinary retention

What are the adverse effects of albuterol?

Tachycardia, hyper/hypotension, hyperglycemia, hypokalemia, chest discomfort, dysrhythmias

Why could albuterol cause tachycardia?

It may also increase beta-1 activity, raising heart rate as an effect

Why could albuterol cause hyperglycemia?

That is an effect of beta-2 receptors.

What is the class for clonidine?

central-acting alpha agonist

What is the method of action for clonidine?

Acts on alpha-2 receptors, decreasing the release of norepinephrine from sympathetic nerves = lowers blood pressure

What are the indications for clonidine?

hypertension and ADHD in children

What are the Absolute/Relative Contraindications for clonidine?

Relative: Concurrent use with CNS depressants and beta-blockers not recommended

Absolute: Hypersensitivity to clonidine

What are the side effects of clonidine?

Dry mouth, nausea, constipation

What are the adverse effects of clonidine?

Hypotension, bradycardia, orthostatic hypotension, sedation, rebound hypertension (discontinue slowly_), CNS depression

What is something the nurse should assess before giving any blood pressure medication?

Blood pressure and heart rate

What is a point of patient education for any patient on a blood pressure medication?

Reposition slowly, sit for a bit before standing completely

What class is tamsulosin?

selective alpha blocker

What is another name you may hear for tamsulosin?

Flomax

What is the method of action for tamsulosin?

aplha-1 blocker; causes relaxation of the muscles in the bladder and prostate gland

What are the indications for tamsulosin?

benign prostate hypertrophy (BPH), kidney stones (off label relaxes ureter)

What are the Absolute/Relative Contraindications for tamsulosin?

Absolute: cataract surgery (iris prolapse); do not give with other alpha1 blockers (doxazosin); pregnancy

Relative: Concurrent use with CYP3A4 inhibitors (e.g. grapefruit juice, ketoconazole)

What are the side effects of tamsulosin?

Nasal congestion, miosis

What are the adverse effects of tamsulosin?

Orthostatic hypotension, sexual dysfunction

What is a point of pre-operative nursing that needs to be addressed with a patient on tamsulosin?

They need to discontinue it if they are about to have cataract surgery.

What class is atenolol?

Selective beta-blocker

What is the method of action for atenolol?

Selectively blocks beta-1 sites, suppressing the RAAS system and lowers blood pressure.

What are the indications for atenolol?

Hypertension, angina, prophylaxis and treatment of acute myocardial infarction

What are the Absolute/Relative Contraindications for atenolol?

Absolute: bradycardia, heart block greater than 1st degree, cardiogenic shock, uncompensated heart failure

Relative: renal dysfunction, diabetes mellitus, bronchospasms, myasthenia gravis, pregnancy, lactation

What are the side effects of atenolol?

Drowsiness, dizziness, headache, depression, fatigue, nausea, erectile dysfunction

What are the adverse effects of atenolol?

Bradycardia, tachycardia, hypotension, chest pain, heart failure, dyspnea, orthostatic hypotension, bronchospasm, dysrhythmia,

What can abrupt cessation of atenolol cause?

dysrhythmias and myocardial infarction

What class is bethanechol chloride?

Cholinergic agonist

What is the method of action for bethanechol chloride?

Stimulates the muscarinic receptors (stimulate smooth muscle and slows heart rate) - promotes contraction of the detrusor urine muscle, increases GI secretions and peristalsis, pupillary constriction, bronchoconstriction, blood vessel dilation

What are the indications for bethanechol chloride?

Urinary retention and neurogenic bladder

What are the Absolute/Relative Contraindications for bethanechol chloride?

Absolute: intestinal or urinary obstruction, bradycardia, hypotension, asthma

Relative: COPD, older adults

What are the side effects of bethanechol chloride?

Nausea and vomiting, diarrhea, abdominal cramps, hypersalivation, diaphoresis, urinary urgency, dizziness

What are the adverse effects of bethanechol chloride?

Tachycardia, hypotension, bronchospasm, wheezing, seizures

What should you give if there is an overdose of bethanechol?

Use an anticholinergic as a reversal, like atropine.

Why is asthma a contraindication with the use of bethanechol?

Bethanecol causes bronchoconstriction.

How can we remember bethanechol?

"Beth can't pee!"

What class is pyridostigmine?

acetylcholinesterase inhibitor

What is the method of action for pyridostigmine?

Prevents the destruction of ACh by AChE allowing more ACh to bind with receptors promoting neuromuscular impulses across myoneural junctions (↑muscle use) - cholinergic agonist

What are the indications for pyridostigmine?

Myasthenia gravis attack of the cholinergic receptors

What are the Absolute/Relative Contraindications for pyridostigmine?

Absolute: GI and GU obstructions

Relative: COPD, older adults

What are the side effects of pyridostigmine?

Abdominal pain, confusion, depression, diarrhea, incontinence, seizures

What are the adverse effects of pyridostigmine?

bradycardia, cardiac dysrhythmias

What class is atropine?

cholinergic antagonist

What is the method of action for atropine?

Inhibits ACh by occupying the receptors; increases heart rate by blocking vagus stimulation; promotes pupil dilation by blocking iris sphincter muscle

What are the indications for atropine?

Preoperative medication to reduce salivation, increases heart rate in bradycardia, reversal for cholinergic agonists overdose, dilate pupils for eye exams

What are the Absolute/Relative Contraindications for atropine?

Relative: Renal, hepatic, or respiratory impairment, cardiovascular disease, myocardial ischemia, tachycardia, GI obstruction, glaucoma, hypertension

What are the side effects of atropine?

Blurred vision and photophobia (mydriasis), urinary retention, dry mouth, constipation

What are the adverse effects of atropine?

tachycardia, palpitations, paradoxical bradycardia, hypertension, angina, ileus, dysrhythmias, laryngospasm, increased anticholinergic effects with antihistamines

What is atropine the first-line drug for?

Symptomatic sinus bradycardia

What class is benztropine?

Anticholinergic; anti-Parkinson's drug

What is the method of action for benztropine?

Anticholinergics affect the CNS by suppressing tremors and muscular rigidity; restores acetylcholine and dopamine balance by reducing the amount of acetylcholine

What are the indications for benztropine?

Parkinson's Disease- Dopamine and acetylcholine imbalance - too much acetylcholine not enough dopamine; drug-induced extrapyramidal symptoms

What are the Absolute/Relative Contraindications for benztropine?

Absolute: Narrow angle glaucoma, obstructive GI disorders, paralytic ileus, ulcerative colitis, tachycardia, BPH, myasthenia gravis, myocardial ischemia

What are the side effects of benztropine?

Dizziness, blurred vision, urinary retention, dry mouth, constipation, nausea, anhidrosis,

What are the adverse effects of benztropine?

Tachycardia, hypotension, paralytic ileus

Why is glaucoma a contraindication for benztropine?

Benztropine causes pupillary dilation and a buildup of fluid due to a reduced outflow tract in the eye.

Why is a paralytic ileaus a contraindication for benztropine?

Benztropine can cause constipation.