Exam 3- Pharmacology

What is the Autonomic Nervous System?

System that controls involuntary body functions

What are some of the functions that the ANS has?

heart rate, pupils, blood pressure, GI motility,

What are the subdivisions of the ANS?

Sympathetic Nervous system, and the parasympathetic nervous system

What does the SNS deal with?

“fight or flight” Increased HR, BP, dilated pupils, urine retention, bronchodilation, DECREASED GI motility.

What are the neurotransmitters involved in the SNS?

norepinephrine, epineprine

Is the SNS the dry or wet system?

Dry

What does the PNS system deal with?

“rest and digest” Deals with decreased HR, BP, INCREASED GI motility, secretions, urination, **bronchoconstriction

What is the neurotransmitter that is associated with the PNS?

Acetylcholine

Is the PNS system the dry or wet system?

Wet

Cholinergic drugs are also known as what?

parasympathetic agonists

What is the MOA for Cholinergic drugs?

Stimulates the PNS or BLOCKS acetylcholinesterase, to prevent the breakdown of Acetylcholine (blocking the enzyme causes there to be increased ACh available)

What are the effects of Cholinergic drugs on the body?

miosis, decreased HR/BP, bladder contraction (go to the bathroom quicker), increased GI motility, and bronchoconstriction

When dealing with cholinergic drugs with respiratory patients what may be needed?

Alternative med, due to bronchoconstriction

What are examples of Cholinergic drugs?

bethanechol, pilocarpine ,donepezil

What are side effects of cholinergic drugs?

SLUDGE- salivation, lacrimation, urination, defecation, GI, emesis

What is a cholinergic crisis?

when there is too much ACh, it causes excessive stimulation of cholinergic receptors

What are the symptoms and signs of cholinergic crisis?

severe sludge, bradycardia, bronchoconstriction

what is the antidote for cholinergic drugs?

ATROPINE, excites the body, and increases the HR

The brain likes what, that can be used to slow the progression of alzheimers?

ACh

Anti-cholinergic drugs are also known as what?

Parasympathetic antagonists (but they don’t necessarily turn on the SNS)

What is the main method of anti-cholinergic drugs?

Dry up and speed up

What is the MOA for anti-cholinergic drugs

Block acetylcholine receptors in the nervous system, reducing the action of the parasympathetic nervous system.

What are the effects of anti-cholinergic drugs on the body?

Mydriasis (pupil dilation), Increased HR, decreased GI, decreased secretions, urinary retention (think BPH in elderly), dry mouth/eyes

What are examples of Anti-cholinergic drugs?

atropine, scopolamine, oxybutynin, ipratropium

What are the s/s of anti-cholinergic toxicity?

hot, dry, and confused

What is the antidote for anticholinergic drugs?

Physostigmine

What are nursing considerations related to anti-cholinergic drugs?

DO NOT use in patients with glaucoma (increases intraocular pressure), caution in elderly, overheating (decreased sweating), constipation

What are adrenergic drugs also known as?

Sympathetic agonists

What is the MOA for adrenergic drugs?

mimics epinephrine, and norepinephrine,

What are examples of adrenergic drugs?

epinephrine, norepinephrine, phenylephrine, dopamine, albuterol

What are the effects of adrenergic drugs?>

increase HR/BP, pupil CONSTRICTION, increase ease of breathing

What are the side effects related to adrenergic drugs?

HTN, anxiety, tremors, tachycardia

what are nursing considerations with adrenergic drugs?

no caffeine, caution in cardiac patients, watch HR, BP, RR, and in elderly

what do you do if a adrenergic drug extravasates in a IV?

Stop the IV line and give PHENTOLAMINE or the tissue will necrose

What are anti-adrenergic drugs also known as?

sympathetic antagonists (mimics PNS)

What is the main thing that anti-adrenergic drugs do?

calms everything down

What is the MOA of anti-adrenergic drugs?

block SNS receptors to inhibit adrenergic effects and reduce sympathetic responses.

What are the 2 types of anti-adrenergic drugs?

Alpha and beta blockers

What do anti-adrenergic beta blockers do?

decreases HR/BP

What do anti-adrenergic alpha blockers do?

decreases BP, vasodilation, decreases urinary retention, which can also be good for BPH patients

What are examples of anti-adrenergic drugs?

Metoprolol (beta) , propranolol (beta) tamsulosin (alpha)

When should tamsulosin be taken?

At night, (think BPH) given at night to help reduce urinary symptoms and improve sleep.

What are nursing considerations for anti-adrenergic drugs?

Assess HR/BP before giving, don’t give to BP <100 or HR < 60,

What do you need to watch for when blocking beta receptors which normally relax bronchial smooth muscle?

bronchospams

What do beta blockers typically mask s/s of?

Hypoglycemia ( increased HR, and sweating)

Where are alpha-1 receptors located

in the vessels

What do alpha 1 receptors do in the body

vasoconstriction

where are alpha 2 receptors located

CNS

What does alpha-2 receptors do to the body

decrease blood pressure

where are beta-1 blockers located?

in the heart

What do beta-1 receptors do in the body?

decrease HR, and decrease contractility

Where are beta-2 receptors located in the body

in the lungs

What do beta-2 receptors do in the body

deal with bronchodilation

What is the mechanism of action for Antacids?

Neutralize existing stomach acid by raising gastric pH ( makes it more basic)

Do antacids stop acid production?

No, the only buffer what is there and provide temporary relief from heartburn and indigestion.

What are examples of antacids?

Calcium Carbonate (tums),

Mg hydroxide (milk of magnesia,

Aluminum hydroxide (amphojel)

Sodium Bicarbonate (alka-seltzer)

What are side effects of certain types of antacids?

Calcium carbonate- constipation, gas, rebound hyperacidity

Magnesium Hydroxide- diarrhea (think magnesium and what it does)

Aluminum hydroxide- constipation

Sodium Bicarbonate- metabolic alkalosis

What are the indications for antacids?

GERD, PUD, gastritis, heartburn

What are the contraindications for antacids?

Renal Disease- avoid Mg and Ca products (mg and ca is harder for kidneys to excrete when there is renal impairment, leading to accumulation which is toxic)

CHF/HTN- avoid sodium-based antacids- they can cause fluid retention leading to excess fluid/edema and raise BP

GI Bleeding- antacids can mask symptoms

What are adverse effects for antacids?

Constipation, diarrhea, gas/bloating, metabolic alkalosis (Na bicarb)

What are the interactions with antacids?

Absorption changes,

Chelation (the process where a molecule binds tightly to a metal ion and forms a stable complex that the body can then excrete.),

increase in stomach pH which alters absorption

increase in urinary pH- alters excretion

What are nursing considerations for antacids?

Give 1-2 hours apart from other meds

Safe in pregnancy (Al-based preferred)

Assess renal function

Avoid chronic overuse

What causes toxicity with antacids?

Renal failure+ Mg/Ca antacids

When the kidneys can excrete Mg/Ca what happens?

Bradycardia, hypotension, arrhythmias

What is an adverse effect of calcium carbonate?

Rebound acid

What does the stomach do when it senses MORE alkalinity?

it produces more acid

Dark stools from Bismuth subsalicylate (Pepto) or iron can hide what?

Melena (blood in the stool)

What is the suffix for H2 receptor blockers?

-tidine

What is the mechanism of action of h2 receptor blockers?

blocks h2 receptors in the stomach, which decreases gastric acid secretion.

What are examples of h2 receptor blockers?

Famotidine (pepcid), cimetidiine, nizatidine

What are H2 receptor blockers?

antacids

What are the indications for H2 receptor blockers?

GERD, PUD, erosive esophagitis, stress ulcer prophylaxis

What are the adverse effects of H2 receptor blockers?

Confusion (elderly), thrombocytopenia (famotidine), gynecomastia, impotence (cimetidine)

What are the main nursing considerations for H2 receptor blockers

Give 1 hours apart from antacids, monitor mental status in older adults, assess for GI bleeding

Cimetidine can cause confusion, primarily in the eldery because why?

Cimetidine can cross the blood brain barrier

Cimetidine can cause gynecomastia and impotence in males why?

blocks androgen receptors

What should you monitor if H2 receptor blockers can cause thrombocytopenia?

platelets (especially if patient bruises easily)

What is another type of antacid?

Proton pump inhibitors (PPI)

What do proton pump inhibitors end with?

-prazole

What is the mechanism of action of proton pump inhibitors

Binds irreversibly to the H/K ATPase pump, which blocks the final step of acid production

What are examples of proton pump inhibitors?

Common examples include omeprazole, lansoprazole, pantoprazole

What are indications of Proton-pump inhibitors

GERD, erosive esophagitis, active ulcers, NSAID-induced ulcers, stress ulcer prophylaxis

What are the adverse effects of protein pump inhibitors

C.diff infection, osteoporosis(fractures), pneumonia, possible dementia link

What are certain interactions with Proton Pump Inhibitors

increases levels of warfarin, phenytoin, diazepam,

decreases effectiveness of clopidogrel

sucralfate delays absorption

What are nursing considerations for PPIs?

give 30-60 minutes before meals,

assess swallowing ability

monitor bone density in long term abuse (ca absorption)

When you block acid with PPIs?

the bacteria survive and there is increase C. diff risk

what is needed for calcium absorption?

acid, if there is no acid there is a decreased amount of Calcium which can lead to osteoporosis

When PPIs inhibit CYP enzymes what happens?

increase warfarin/phenytoin, which can lead to a bleeding/seizure risk

What can lead to a clot risk in cardiac patients?

Omeprazole blocks clopidrogel (anticoag med) activation

What is used for GI Bleeds because it stabalizes the clot?

pantoprazole IV drip- PPIs stabilize clots in GI bleeding by raising gastric pH, which protects the clot from being dissolved by acid and pepsin.

Mucosal protectants are what type of med?

antacids

Sucralfate (carafate) is a type of what?

mucosal protectant, (antacid)

What is the moa for sucralfate?

Formas a protective barrier over ulcers

What are nursing considerations for sucralfate?

give 1 hour before meals, and interferes with absorption of many drugs

Sucralfate works only in what environment

ACIDIC, which is why the timing is critical

since sucralfate creates a physical barrier what happens to other meds?

it delays the absorption of other meds

Does sucralfate neutrralize acid

No it does not, it protects the tissue

What type of med is Misoprostol (cytotec)

mucosal protectant,

what is the moa of misoprostol

they mimic prostaglandins, which help to protect the stomach lining

should you give misoprostol to pregnant women?

NO, Category X