pharm exam #1 prototypes

Trade name of bethanechol

Urecholine

Generic name for Urecholine

bethanechol

Therapeutic class for bethanechol

Treatment of urinary retention

Pharmacological class for bethanechol

Muscarinic cholinergic receptor/direct-acting parasympathomimetic

Actions of bethanechol

Directly stimulated smooth muscle in bladder to contract, gives contraction to initiate peeing

Uses for bethanechol

Post-op urinary retention, neurogenic bladder caused by spinal cord injury to shock

Adverse effects of bethanechol

Don’t give to someone with obstructive GI, active ulcer, or urinary obstruction; caution with COPD

Side effects of bethanechol

Increased salivation, sweating, abdominal cramping and hypotension

Contraindications of bethanechol

Don’t give to patients with asthma, benign prostatic hyperplasia (enlarged prostate), peptic ulcer disease, or bradycardia

What to monitor with administering bethanechol

BP, HR, and RR

Antidote to bethanechol

Atropine

Interactions to look for when using bethanechol

Drug-decrease effects with atropine, epinephrine, and scopolia

Trade name for atropine

Atropen

Generic name for Atropen

atropine

Therapeutic class of atropine

Treatment for bradycardia, antidote for anticholinesterase poisoning

Pharmacological class of atropine

Anticholinergic, muscarinic receptor blocker

Actions of atropine

Inhibits effects of parasympathetic action of ACh, inducing fight or flight response, increase in HR, bronchodilation, decreased GI and respiratory secretions

Uses for atropine

Pre-op to decrease GI and respiratory secretions, anticholinesterase poisoning, treatment of bradycardia, dilate pupils

Adverse effects of atropine

Delirium, coma, tachycardia, palpitations, constipation, and urinary retention in elderly patients,

Side effects of atropine

Dry mouth, constipation, urinary retention, increased HR

Contraindications with atropine

Avoid acute hemorrhage, tachycardia and patients with glaucoma, GI tract disorders, cardiac instability, and BPH (enlarged prostate)

What to monitor with administering atropine?

BP, HR, and RR

Antidote to atropine

Physostigmine

Interactions to look for when using atropine

Drug-increase effect with antihistamines

Trade name(s) for phenylphrine

Neo-synephrine, Sudafed

Generic name for Neo-synephrine/Sudafed

phenylephrine

Therapeutic class for phenylephrine

Nasal decongestant, anti-hypotensive

Pharmacological class for phenylephrine

Adrenergic drug (sympathomimetic)

Actions of phenylephrine

Selective, alpha 1-adrenergic agonist

Intranasal use for phenylephrine

Reduces nasal congestion by constricting c all blood vessels in nasal muscoa

Contraindications for intranasal phenylephrine use

Don’t use for more than 5 days due to rebound congestion

Use for topical phenylephrine

Eye drops to cause pupil dilation

Contraindications to topical phenylephrine use

Don’t use in those with narrow angle glaucoma

Uses for parenteral phenylephrine

Can reverse hypertension due to spinal anesthesia or vascular shock. Lack of beta selectivity meaning it has few cardiac side effects

Contraindications to parenteral phenylephrine use

Use with caution in those with advanced coronary artery disease, hypertension, or hyperthyroidism

Adverse effects of phenylephrine

Burning of mucosa, rebound congestion, narrow-angle glaucoma, reflex bradycardia

Antidote to phenylephrine

Phentolamine (alpha-blocker) - may be needed to treat hypertension

Black box warning on phenylephrine

Severe reactions, including death may occur with IV infusion - even if drug is diluted properly. Use with caution and only when other routes are not feasible

Trade name for prazosin

Minipress

Therapeutic class for prazosin

Antihypertensive

Generic name for Minipress

prazosin

Pharmacological class for prazosin

Adrenergic-blocking drug

Actions and uses for prazosin

Alpha-1 adrenergic antagonist that competes with NE at its receptor on smooth muscles in arterioles and veins; rapid decrease in peripheral resistance that reduces BP; has little effect on cardiac output or HR

Adverse effects of prazosin

Orthostatic hypotension, can cause unconsciousness 30 mins after 1st dose, dizziness, drowsiness, lightheadedness, and reflex tachycardia that could occur due to rapid drop in BP

First dose effect of prazosin

1st dose should be given at bedtime to avoid orthostatic hypotension

Nursing considerations with prazosin

Caution in older patients and use cautiously with other antihypertensives and diuretics

Therapeutic class for morphine

Opioid analgesic

Pharmacological class for morphine

Opioid receptor agonist

Action of morphine

Binds to both mu and kappa receptors to produce profound analgesia

Uses of morphine

Moderate to severe acute or chronic pain not relieved by non-opioid meds, CP connected with MI, relieve shortness of breath in HF and pulmonary edema

What to monitor with morphine

Respiratory depression, sedation, urinary retention, nausea/vomiting, constipation, asses BP, HR, and RR prior to and during admin, may cause orthostatic hypotension

Adverse effects of morphine

Hallucinations, severe respiratory depression, or cardiac arrest

Side effects of morphine

Nausea, constipation, dizziness, itching, restlessness, anxiety

Contraindications with morphine

Don’t consume while taking, patients with severe asthma, liver, or kidney impairment

Antidote for morphine

Naloxone

Interactions with morphine to look out for

Other CNS depressants, antidepressants, St John Wort

Nursing considerations with morphine

Asses BP, pulse, and RR prior to and during admin; admin stool softener to avoid constipation, request one if not ordered; may cause orthostatic hypotension; discontinue use once pain is managed with non-opioid meds; requires 2 RN sign off of meds to waste

Therapeutic class of naloxone

Drug for acute opioid overdose or misuse

Pharmacological class of naloxone

Opioid receptor antagonist

Action of naloxone

Competes with opioids at the receptor site, blocking both mu and kappa receptors

Uses for naloxone

Reversal of opioid intoxication or overdose

What to monitor when using naloxone

Immediate opioid withdrawal symptoms in dependent patients (nausea, vomiting, diarrhea, fever, sweating, body aches, crying, and irritability)

Adverse effects to naloxone

Rapid reversal of opioid = pain, increased BP, hyperventilation; administer for RR less than 10 breaths/min; have drug available of administering opioids (esp a PCA or continuous IV admin)

Side effects of naloxone

Minimal toxicity

Contraindications for naloxone

Hypersensitivity to naloxone

Interactions to look out for when using naloxone

None

Therapeutic class for aspirin

Non-opioid analgesic, nonsteroidal anti-inflammatory, anti-pyretic

Pharmacological class of aspirin

Salicylate, non-selective COX inhibitor

Actions of aspirin

Inhibits the synthesis of prostaglandins involved in pain and inflammation, anticoagulation activity may prevent stroke and MI

Max dose of apirin

4g/24h

What to monitor with aspirin

Hepatic and renal function, GI irritation, signs of bleeding

Adverse effects of aspirin

GI discomfort, stomach pain, and bleeding

Nursing considerations with aspirin

Take with food or enteric coated, use in caution with bleeding disorders esp patients with chronic alc use, and with other drugs that increase risk of bleeding (warfarin, heparin, and clopidogrel)

Contraindications with aspirin

Patient with anticoagulation therapy

Interactions to look out for when using aspirin

Many drug interactions, check with PCP, Reyes syndrome in kids

Antidote to aspirin

Activate charcoal, gastric lavage

Trade name for acetaminophen

Tylenol

Generic name for Tylenol

acetaminophen

Therapeutic class for acetaminophen

Analgesic, anti-pyretic

Pharmacological class for acetaminophen

Para-aminophenol derivative (chem structure)

Action of acetaminophen

Inhibits the synthesis of prostaglandins in the brain, dilating peripheral blood vessels, enabling sweating and dissipation of heat

Uses of acetaminophen

Fever, mild to moderate pain (often in combo with opioid)

Adverse effects of acetaminophen

Skin reactions or blisters indicate Stevens Johnson syndrome, severe liver injury, anaphylaxis

Side effects of acetaminophen

Minimal if at therapeutic doses

What to monitor when using acetaminophen/nursing considerations

Ensure correct dose admin as recommended. Don’t use with patients with hepatic insufficiency or those who drink 3+ alc drinks/day

Max dose of acetaminophen

3,000mg/day for adults or dependent on ped patient’s weight

Contraindications with acetaminophen

Chronic alc consumption

Interactions to look out for with acetaminophen

Can cause toxic levels of warfarin, risk for bleeding

Antidote for acetaminophen

IV N-acetylcysteine (Acetadote)

Trade name for sumatriptan

Imitrex

Generic name for Imitrex

sumatriptan

Therapeutic class for sumatriptan

Antimigraine drug

Pharmacological class for sumatriptan

Triptan, serotonin (5-T) receptor drug, vasoconstrictor of intracranial arteries

Action of sumatriptan

Causes vasoconstriction of cranial arteries

Uses for sumatriptan

Migraine headache treatment

Side effects of sumatriptan

“Triptan rush” - a sense of tingling, soreness, tightness, or pressure in chest/throat/jaw, heaviness, and warm flushing sensation; transient, injection site reactions; can be confused with angina/cardiac pain

Nursing considerations for sumatriptan

Not preventative, can only work once headache has started; may cause mild sedative effects; not pregnancy safe

Contraindications for sumatriptan

Don’t use in patients with angina or history of MIs, acute kidney injury, or hepatic impairment

Interactions to look out for when using sumatriptan

With other triptans or ergot alkaloids, ginkgo, St. Johns Wort

Trade name for ibuprofen

Advil, Motrin