Pharmacology Test 3

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miosis:

  • constricted pupils

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mydriasis:

  • dilated pupils

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four main receptors:

alpha1, alpha2, beta1, beta2

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alpha 1:

  • Increase force of heart contraction

  • vasoconstriction increases blood pressure

  • mydriasis (dilation of pupils) occurs

  • decreases secretion in salivary glands

  • increases urinary bladder relaxation and urinary sphincter contraction

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alpha 2:

  • Inhibits release of norepinephrine

  • dilates blood vessels

  • produces hypotension

  • decreases gastrointestinal motility and tone

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beta 1:

  • increases HR + force of contraction

  • increase renin secretion which increases BP

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beta 2:

  • dialates bronchioles

  • promotes uterine relaxation

  • promotes increase in blood glucose through glycoglnolysis in the liver

  • increased blood flow in skeletal mucles

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What drug can activate the four receptors?

  • dopamine

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START OF STUDY GUIDE

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Adrenergic Function:

  • stimulate sympathetic nervous system

  • mimic neurotransmitters norepinephrine and epinephrine

  • act on adrenergic receptor sites: heart, bronchi, GI tract, Urinary bladder, ciliary eye muscle

  • pupils constrict, heart rate increases, lungs dilate, blood vessels constrict, GU relaxes, bladder relaxes, uterus relaxes

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alpha 1:

  • increase cardiac contractility

  • vasoconstriction

  • use for heart attacks

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alpha 2:

  • promotes vasodilation and decreases BP, GI motility, and tone

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beta 1:

  • increase cardiac contractility, BP, and HR

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beta 2:

  • bronchodilation

  • decreases GI tone and mobility

  • increased blood flow in skeletal muscles

  • relaxes smooth muscles of uterus

  • activates liver glycogenolysis and increase blood glucose

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Location of dopaminergic adrenergic receptors:

  • renal

  • mesenteric

  • coronary

  • cerebral

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dopaminergic receptor:

  • stimulation effects vasodilation and increases blood flow

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sulfa drugs:

  • drugs that are used to fight certain bacterial infections

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anti-histamines:

  • Allegra (fexofenadine)

  • Flonase (fluticasone)

  • Benadryl (diphenehydramine)

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anti-anxiety:

  • Xanax (alprazolam)

  • Klonopin (clonazepam)

  • Valium (diazepam)

  • Ativan (lorazepam)

  • Restoril (temezepam)

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antibiotics:

  • Augmentin (amoxicillin/clavulanate)

  • Zithromax (azithromycin)

  • Omnicef (cefdinir)

  • Keflex (cephalexin)

  • Cipro (ciprofloxacin)

  • Vibramycin (doxycycline hyclate)

  • Diflucan (fluconazole)

  • Levaquin (levofloxacin)

  • Bactrim (sulfamethoxazole/trimethoprim)

  • Flagyl (metronidazole)

  • Zosyn (piperacillin/tazobactam)

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COX:

  • cyclooxygenase enzyme

  • converts arachidonic acid into prostaglandins

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COX-1:

  • protects stomach lining and regulates blood platelets

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COX-2:

  • triggers inflammation and pain

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Opioids are used for:

  • moderate to severe pain

  • antitussive and antidiarrheal effects

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Opioids act on:

  • the CNS

  • suppressed pain impulses

  • suppresses respiration and coughing

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Opioid side effects:

  • nausea

  • vomiting

  • constipation

  • urinary retention

  • orthostatic hypotension

  • respiratory depression

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Beta Blockers:

  • olol

  • aka: anti-hypertensive drugs

  • decrease heart rate and dilate arteries by blocking beta receptors

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fight or flight response

  • sympathetic nervous system (adrenergic)

  • pupils dilation

  • increase heart rate

  • relax bladder

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rest and digest response

  • parasympathetic nervous system (cholinergic)

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Diuretics:

  • Lasix

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Cholinergic function

  • mimic parasympathetic neurotransmitter acetylcholine

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Cholinergic: Muscarinic receptors:

  • affect smooth muscles and slows heart rate

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Cholinergic: Nicotinic receptors:

  • affect skeletal muscles

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Cholinergic: Direct acting

  • acts on receptors to activate tissue response

  • muscarinic receptors located in smooth muscles (heart, GI, GU, glands)

  • Metoclopramide, Bethanechol Chloride, Pilocarpine

  • increase gastric emptying, treats gastroparesis, nausea, GERD, used to increase urination, used to constrict pupils and treat glaucoma

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Cholinergic: Indirect acting

  • inhibits action of enzyme cholinesterase

  • allow ACh to accumulate at receptor sites

  • skeletal muscle contraction, increased muscle tone, bronchial constriction, bradychardia, miosis, increased GI motility, promote urination

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Cholinergic effects on the cardiovascular system:

  • decrease HR and BP

  • vasodilation

  • slow conduction of AV node

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Cholinergic effects on the GI system:

  • Increase tone, motility, peristalsis

  • relaxes sphincter muscles

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Cholinergic effects on the GU system:

  • increase ureter tone

  • contracts bladder

  • relaxes sphincter muscles

  • stimulates urination

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Cholinergic effects on the eye:

  • constricts pupils

  • increases accommodation

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Cholinergic effects on the lungs:

  • bronchial constriction

  • increases secretions

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Cholinergic effects on the glands:

  • increase salivation, perspiration and tears

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Cholinergic effects on the striated muscle:

  • increase neuromuscular transmission

  • maintain muscle strength and tone

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Action of Anti-Cholinergics:

  • inhibit acetylcholine action by occupying acetylcholine receptors

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Example of an anti-cholinergic drug:

  • Atropen (Atropine)

  • cant see, spit, or sh*t

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Anti-Cholinergic drug effects on the heart:

  • large doses increase HR

  • small doses decrease HR

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Anti-Cholinergic drug effects on the lungs:

  • bronchodilation

  • decreases secretion

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Anti-Cholinergic drug effects on the GI system:

  • relax smooth muscle tone

  • decreases motility and peristalsis

  • decreases secretions

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Anti-Cholinergic drug effects on the GU system:

  • relax detrusor muscle

  • increase sphincter constriction

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Anti-Cholinergic drug effects on the eyes:

  • dilates pupils

  • decreases accommodation

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Anti-Cholinergic drug effects on the exocrine glands:

  • decreases salivation and perspiration

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Anti-Cholinergic drug effects on the CNS:

  • decreases tremors and rigidity of muscles

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ProAir HFA (Albuterol):

  • bronchodilator

  • nonacatecholamines

  • used for asthma

  • side effects include tremors and increased HR

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Anti-Parkinson-Anticholinergic Drugs:

  • Cogentin (benxotropine)

  • Artane (trihexyphenidyl HCl)

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Benxotropine and Trihexyphenidyl HCl:

  • these decrease involuntary movement, tremors, and muscle rigidity

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Side effects of Benzotropine and Trihexyphenidyl HCl:

  • dry mouth/skin

  • headache

  • blurred vision

  • photophobia

  • tachycardia

  • ocular hypertension

  • urinary retention

  • constipation

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NSAIDS first generation:

  • salicylates

  • perchlorobenzoic acid derivatives

  • propionic acid derivatives

  • fenamates

  • oxicams

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NSAIDS second generation:

  • Celecoxib Inhibits COX-2

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Salicylate examples:

  • aspirin

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Toxic serum level of Aspirin:

  • greater than 300mcg/mL

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Drug interactions with Salicylates:

  • Increased bleeding with Anti-Coags and other NSAIDS

  • Risk for hypoglycemia with oral antidiabetics

  • Increased gastric ulcer risk with glucocorticoids

  • Decreased effects of ACE inhibitors, loop diuretics, probenecid

  • toxic is over 100

  • normal 15-30mg

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Lab interactions with Salicylates:

  • increases PT, bleeding time, INR, uric acid

  • decreased cholesterol, T3 and T4 levels, K

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Foods containing salicylates:

  • prunes, raisins, licorice

  • some spices like curry and paprika

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Perchlorobenzoic acid derivatives:

  • decreases prostaglandin synthesis by INHIBITING cox-1 and cox-2

  • used for rheumatoid arthritis, osteoarthritis, gouty arthritis

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Propionic Acid Derivatives:

  • ibuprofen, naproxen

  • inhibits cox-1 and cox-2 by blocking arachidonate binding

  • used for pain, osteoarthritis, rheumatoid arthritis

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Fenamates:

  • decreases prostaglandin synthesis by BLOCKING cox-1 and cox-2

  • used for osteoarthritis, rheumatoid arthritis, pain, dysmenorrhea

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Oxicams:

  • decreases prostaglandin synthesis by INHIBITING cox-1 and cox-2

  • used for osteoarthritis and rheumatoid arthritis

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Gout:

  • due to too much uric acid

  • type of arthritis

  • most common in the big toe

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Demerol (meperidine):

  • Narcotic Analgesic

  • common for pregnant women

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Morphine:

  • narcotic drug derived from opium, used to treat severe pain

  • can cause respiratory depression

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Fentanyl:

  • patient controlled analgesia

  • more potent than morphine

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Scheduled drugs:

  • classified according to their potential for abuse

  • Schedule 1 is the most addictive/dangerous

  • Schedule 5 is least addictive/dangerous

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Epinephrine:

  • given for anaphylaxis

  • IM in the quad

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Cogentin (Benztropine):

  • Antiparkinson Agent

  • Anticholinergic

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Urecholine (Benthanechol):

  • cholinergic

  • increase peristalsis of bladder

  • used for bladder retention

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Motrin, Advil (Ibuprofen):

  • inhibits COX-1 and COX-2 by blocking arachidonate

  • analgesic, anti-inflammatory, antipyretic

  • avoid in 3rd trimester; severe renal/hepatic disease;

  • fenamate (potent NSAIDS used for acute and chronic arthritis)

  • avoid using if history of peptic ulcers

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Celebrex (celecoxib):

  • Classification: NSAIDs, COX-2 inhibitor

  • Therapeutic Effects: Analgesic, anti- inflammatory, & anti- pyretic

  • Adverse Reactions & side effects: GI BLEEDING, dermal rash, GI effects

  • Nursing Implications & teaching: Assess pain, ROM and swelling. Do not give if allergic to sulfonamides, aspirin or NSAIDs. Watch for tarry stools.

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Lasix (furosemide):

  • Classification: Loop Diuretic

  • Therapeutic Effects: Diuresis. Lowering of blood pressure

  • Adverse Reactions & side effects: Dehydration, hypochloremia, hypokalemia, hypomagnesaemia, hyponatremia, hypovolemia, metabolic alkalosis

  • Nursing Implications & teaching: Monitor for thirst, dry mouth, lethargy, weakness, hypotension, oliguria and notify physician. Monitor K+, Ca++, Mg. Can increase BUN, glucose and creatinine, TAKE WITH FOOD

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Aspirin (ASA):

  • Non-opioid, anti-inflammatory, anti-pyretic, anti-platelet

  • Blood thinner

  • binds to Cox 1/Cox 2 (stops platelet aggregation, gi upset, tinnitus, HA, sweating)

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Opioids:

  • synthetic opiates that are prescribed for pain relief that produce morphine-like-effects

  • Naloxone, Oxycodone, Hydrocodone, Morphine, Methadone

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Phenergan (promethazine):

  • Classification: Antiemetic. Antihistamine (H1). Sedative / hypnotic. Phenothiazine

  • Therapeutic Effects: Decrease symptoms of excess histamine, sedation, decrease N/V

  • Adverse Reactions & side effects: neuroleptic malignant syndrome, confusion, disorientation, sedation, dizziness

  • Nursing Implications & teaching: Monitor for extrapyramidal side effects; educate on techniques to help dry mouth; oral care, photosensitivity; orthostatic hypotension risk; avoid ETOH & other CNS depressants; monitor sedation. A known Vesicant!

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Migraine:

  • unilateral throbbing pain

  • nausea, vomiting, photophobia

  • triggers are cheese, chocolate, red wine, fatigue, stress, odors, light, hormonal changes, drugs, weather

  • due to neurovascular events in cerebral cortex

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Cluster Headache:

  • severe unilateral nonthrobbing pain

  • usually located around eye

  • occur in a series of cluster attacks

  • not associated with an aura

  • does not cause nausea or vomiting

  • more common in males

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Tension Headache:

  • pain like a band squeezing the head

  • occurs from long, endured contraction of the skeletal muscles around the face, scalp, upper back, and neck

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Anti-spasmodic drugs:

  • Atropine (atropine sulfate)

  • Cogentin (benzotropine)

  • Artane (trinexypenenidyl HCl)

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