NURS 271 Exam 1 Patho Meds

Bronchodilator albuterol proventil

Opens airway

Indications: respiratory acidosis

Mucolytic Acetylcysteine Mucomyst

Thins secretions

Indications: respiratory acidosis

Benzodiazepine

Sedative

Indications: Panic induced Respiratory Alkalosis and Seizures

Aldactone (spironolactone)

K sparing diuretic

Indications: Hypokalemia, metabolic alkalosis

Tolvaptan/Samsca

vasopressin ADH antagonist, enhances water excretion while still retaining Na

Indications: Hyponatremia

Colloids

Fluid resus for interstitial edema

Bacitracin

Topical antibiotic

for minor burns less than 25% of TBSA (total body surface area)

Silver sulfadiazine (Silvadene)

Topical antibiotic

2nd or 3rd degree burns greater than 25% of TBSA- Bactericidal

Silver nitrate

Topical antibiotic

for >25% TBSA, fungal infections, used for patients with sulfa allergies- Small doses bacteriostatic, high doses are bactericidal

Mafenide acetate (Sulfamylon)

Topical antibiotic

mainly for electrical injury and wounds resistant to other agents- Bacteriostatic

Lispro & Aspart

Rapid

15 mins

60-90 mins

3-4 hours

Regular

Short

30-1 hour

2-3 hours

3-6 hours

NPH

Intermediate

2-4 hours

4-10 hours

10-16 hours

Glargine (Lantus)

Long acting

1-2 hours

No peak

24 hours

Sulfonylurea agents

Chlorpropamide (Diabinese)

Stimulates remaining beta cell functions by increasing # of receptor sites on the pancreas for insulin

Stimulates release of insulin over a period of several hours

Patients need to have some beta cell function

Meglitinide analogues

Repaglinide (Pradin)

Very similar to above Diabenese but by triggering insulin secretion from the pancreas in a Burst of time

Better for meals

Biguanides

Metformin (Glucophage)

Decreases glucose production by the liver & improves insulin receptor sensitivity

Reduces insulin resistance

Common drug

Alpha-glucosidase inhibitors

Acarbose (Precose)

Slow the digestion of carbohydrates and delay glucose absorption - results in a smaller and slower rise of blood glucose following meals throughout the day

Delays rather than prevents

MUST Be taken with the first bite of food to be effective

Thiazolidinediones TZDs

Rosiglitazone (Avandia)

Improve insulin sensitivity and reduce liver glucose production

Reduce blood lipid levels

NOT RECOMMENDED for patients with heart failure- TZDs exacerbate Heart Failure!

Slow onset of action- requires weeks to months to receive the maximum effect

Often combined

Carbamazepine (Tegretol)

Interferes with Sodium Ion movement by keeping gates closed and decreasing neuron firing

Ataxia→ loss of ability to coordinate muscle movement

Nystagmus→ rapid involuntary movement of the eyeballs

Indication: Partial simple, partial complex, and tonic-clonic seizures

$400/month

Phenytoin (Dilantin)

Interferes with Sodium Ion movement by keeping gates closed and decreasing neuron firing

Ataxia and Nystagmus ^

Gingival hyperplasia→ overgrowth of gum tissue

Partial simple, partial complex, and tonic-clonic seizures

$25/month

Oldest non sedating drug used for seizures

Valproic acid (Depakene)

Similar to ^ blocks influx of Na channels and suppresses Ca movement through through type T channelsIncreases GABA production and decreases neuronal activity (GABA= inhibitory NT)

ADE:

Hepatotoxicity

Teratogenic→ congenital malformations concerning neural tube defects during 1st trimester

Spina Bifida

Anencephalie- cerebral hemisphere is absent, lifespan of hours or days

INDICATIONS

Partial simple, partial complex, tonic-clonic, absence, myoclonic seizures

Treats All!!!

$400/month

For ADEs, liver labs will be needed

Ethosuximide (Zarontin)

Suppresses the neurons in the thalamus which is between the brain, midbrain, and brain stem

Decreases the firing of neurons and stabilizes nerve activity→ suppress seizure activity

INDICATION

Absence seizures

Drug of choice for absence seizures

Levodopa (L-Dopa)

the gold standard for PD treatment

Process/ Pharmacokinetics

Enters the brain by active transport system that carries it across the blood brain barrier

Enzyme Decarboxylase converts Levodopa to dopamine

Problem! Conversion takes place in the stomach, intestines, and liver→ in the periphery! SO less is available to cross the blood brain barrier

Improvement in 2-3 weeks

Pharmacokinetics of L-dopa

PO and undergoes rapid absorption from the small intestine

Metabolized in the periphery by decarboxylase enzyme

LESS than 1 % reaches the brain

Excreted by kidneys

Problems with Levodopa/L-Dopa!

6 months to reach a therapeutic level - half a year is a long time to wait

ADE→ Dyskinesia (head bopping, tics, grimacing), N/V, cardiac dysrhythmias

Carbidopa (Lodosyn)

Carbidopa (Lodosyn) + L dopa = Sinemet

Prevents breakdown of levodopa in the intestines and peripheral tissues

Does not prevent conversion of L dopa to dopamine by decarboxylase within the brian because C dopa can not cross blood brain barrier

Can cause a Levodopa Induced Psychosis (Antipsychotic → Clozapine)

Which ADE are you willing to live with?

Amantadine (Symmetrel)

Releases dopamine- conservers

Amantadine (Symmetrel) → releases dopamine, promotes the release from the remaining dopamine neurons and blocks the uptake of dopamine

Was initially an antiviral drug

Benztropine (Cogentin)

Trihexyphenidyl (Artane)

Increase dopamine (Anticholinergics)- blockers

Benztropine (Cogentin) → both block acetylcholine receptors

Trihexyphenidyl (Artane) ^

Bromocriptine (Parlodel)

Pramipexole (Mirapex)

Dopamine agonists- trickers

Bromocriptine (Parlodel) → both stimulate parts of the brain triggered by dopamine- tricks the body

Pramipexole (Mirapex) → ^ and mimics dopamine