Pharmacology Test 3

miosis:

miosis:

• constricted pupils

mydriasis:

• dilated pupils

four main receptors:

alpha1, alpha2, beta1, beta2

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

alpha 2:

• Inhibits release of norepinephrine

• dilates blood vessels

• produces hypotension

• decreases gastrointestinal motility and tone

beta 1:

• increases HR + force of contraction

• increase renin secretion which increases BP

beta 2:

• dialates bronchioles

• promotes uterine relaxation

• promotes increase in blood glucose through glycoglnolysis in the liver

• increased blood flow in skeletal mucles

What drug can activate the four receptors?

• dopamine

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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

alpha 1:

• increase cardiac contractility

• vasoconstriction

• use for heart attacks

alpha 2:

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

beta 1:

• increase cardiac contractility, BP, and HR

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

Location of dopaminergic adrenergic receptors:

• renal

• mesenteric

• coronary

• cerebral

dopaminergic receptor:

• stimulation effects vasodilation and increases blood flow

sulfa drugs:

• drugs that are used to fight certain bacterial infections

anti-histamines:

• Allegra (fexofenadine)

• Flonase (fluticasone)

• Benadryl (diphenehydramine)

anti-anxiety:

• Xanax (alprazolam)

• Klonopin (clonazepam)

• Valium (diazepam)

• Ativan (lorazepam)

• Restoril (temezepam)

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)

COX:

• cyclooxygenase enzyme

• converts arachidonic acid into prostaglandins

COX-1:

• protects stomach lining and regulates blood platelets

COX-2:

• triggers inflammation and pain

Opioids are used for:

• moderate to severe pain

• antitussive and antidiarrheal effects

Opioids act on:

• the CNS

• suppressed pain impulses

• suppresses respiration and coughing

Opioid side effects:

• nausea

• vomiting

• constipation

• urinary retention

• orthostatic hypotension

• respiratory depression

Beta Blockers:

• olol

• aka: anti-hypertensive drugs

• decrease heart rate and dilate arteries by blocking beta receptors

fight or flight response

• sympathetic nervous system (adrenergic)

• pupils dilation

• increase heart rate

• relax bladder

rest and digest response

• parasympathetic nervous system (cholinergic)

Diuretics:

• Lasix

Cholinergic function

• mimic parasympathetic neurotransmitter acetylcholine

Cholinergic: Muscarinic receptors:

• affect smooth muscles and slows heart rate

Cholinergic: Nicotinic receptors:

• affect skeletal muscles

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

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

Cholinergic effects on the cardiovascular system:

• decrease HR and BP

• vasodilation

• slow conduction of AV node

Cholinergic effects on the GI system:

• Increase tone, motility, peristalsis

• relaxes sphincter muscles

Cholinergic effects on the GU system:

• increase ureter tone

• contracts bladder

• relaxes sphincter muscles

• stimulates urination

Cholinergic effects on the eye:

• constricts pupils

• increases accommodation

Cholinergic effects on the lungs:

• bronchial constriction

• increases secretions

Cholinergic effects on the glands:

• increase salivation, perspiration and tears

Cholinergic effects on the striated muscle:

• increase neuromuscular transmission

• maintain muscle strength and tone

Action of Anti-Cholinergics:

• inhibit acetylcholine action by occupying acetylcholine receptors

Example of an anti-cholinergic drug:

• Atropen (Atropine)

• cant see, spit, or sh*t

Anti-Cholinergic drug effects on the heart:

• large doses increase HR

• small doses decrease HR

Anti-Cholinergic drug effects on the lungs:

• bronchodilation

• decreases secretion

Anti-Cholinergic drug effects on the GI system:

• relax smooth muscle tone

• decreases motility and peristalsis

• decreases secretions

Anti-Cholinergic drug effects on the GU system:

• relax detrusor muscle

• increase sphincter constriction

Anti-Cholinergic drug effects on the eyes:

• dilates pupils

• decreases accommodation

Anti-Cholinergic drug effects on the exocrine glands:

• decreases salivation and perspiration

Anti-Cholinergic drug effects on the CNS:

• decreases tremors and rigidity of muscles

ProAir HFA (Albuterol):

• bronchodilator

• nonacatecholamines

• used for asthma

• side effects include tremors and increased HR

Anti-Parkinson-Anticholinergic Drugs:

• Cogentin (benxotropine)

• Artane (trihexyphenidyl HCl)

Benxotropine and Trihexyphenidyl HCl:

• these decrease involuntary movement, tremors, and muscle rigidity

Side effects of Benzotropine and Trihexyphenidyl HCl:

• dry mouth/skin

• headache

• blurred vision

• photophobia

• tachycardia

• ocular hypertension

• urinary retention

• constipation

NSAIDS first generation:

• salicylates

• perchlorobenzoic acid derivatives

• propionic acid derivatives

• fenamates

• oxicams

NSAIDS second generation:

• Celecoxib Inhibits COX-2

Salicylate examples:

• aspirin

Toxic serum level of Aspirin:

• greater than 300mcg/mL

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

Lab interactions with Salicylates:

• increases PT, bleeding time, INR, uric acid

• decreased cholesterol, T3 and T4 levels, K

Foods containing salicylates:

• prunes, raisins, licorice

• some spices like curry and paprika

Perchlorobenzoic acid derivatives:

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

• used for rheumatoid arthritis, osteoarthritis, gouty arthritis

Propionic Acid Derivatives:

• ibuprofen, naproxen

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

• used for pain, osteoarthritis, rheumatoid arthritis

Fenamates:

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

• used for osteoarthritis, rheumatoid arthritis, pain, dysmenorrhea

Oxicams:

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

• used for osteoarthritis and rheumatoid arthritis

Gout:

• due to too much uric acid

• type of arthritis

• most common in the big toe

Demerol (meperidine):

• Narcotic Analgesic

• common for pregnant women

Morphine:

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

• can cause respiratory depression

Fentanyl:

• patient controlled analgesia

• more potent than morphine

Scheduled drugs:

• classified according to their potential for abuse

• Schedule 1 is the most addictive/dangerous

• Schedule 5 is least addictive/dangerous

Epinephrine:

• given for anaphylaxis

• IM in the quad

Cogentin (Benztropine):

• Antiparkinson Agent

• Anticholinergic

Urecholine (Benthanechol):

• cholinergic

• increase peristalsis of bladder

• used for bladder retention

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

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.

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

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)

Opioids:

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

• Naloxone, Oxycodone, Hydrocodone, Morphine, Methadone

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!

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

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

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

Anti-spasmodic drugs:

• Atropine (atropine sulfate)

• Cogentin (benzotropine)

• Artane (trinexypenenidyl HCl)

Anti-lipemic drugs:

• Lipitor (atorvastatin)

• Zetia (ezetimibe)

• Tricor (fenofibrate)

• Mevacor (lovastatin)

• Pravachol (pravastatin)

• Crestor (rosuvastatin)

• Zocor (simvastatin)

Anti-Coagulant Drugs (Platelet inhibitors) :

• Plavix (clopidogrel)

• Heparin (heparin)

• Lovenox (enoxaparin)

• Coumadin (warfarin)

Sulfonamide drugs:

• Bactrim (sulfamethoxazole/trimethoprim)

• used for UTI

Anti-Gout Drugs:

• Zyloprim (allopurinol)

• Colcrys (colchicine)

Anti-hypertensive drugs:

• Tenormin (atenolol)

• Coreg (carvedilol)

• Catapres (clonidine)

• Vasotec (enalapril)

• Microzide (hydrochlorothiazide)

• Prinivil, Zestril (lisinopril)

• Prinizide (lisinopril/hydrochlorothiazide)

• Cozaar (losartan)

• Toprol (metoprolol)

• Aldactone (spironolactone)

• Diovan (valsartan)

Hypnotic Drugs:

• Ambien (zolpidem)

Anti-emetic Drugs:

• Phenergan (promethazine)

• Zofran (ondansetron)

Anti-pyretic drugs: (Analgesic)

• Tylenol with codeine (acetaminophen/codiene)

• Celebrex (celecoxib)

• Voltaren (diclofenac)

• Cymbalta (duloxetine)

• Neurontin (gabapentin)

• Lortab, Norco, Vicodin (hydrocodone/acetaminophen)

• Motrin, Advil (ibuprofen)

• Mobic (meloxicam)

• Naprosyn (naproxen)

• Percocet (oxycodone/acetaminophen)

• Lyrica (pregabalin)

• Ultram (tramadol)

• Aspirin (acetylsalicylic acid)

• Medrol DosePak (methylpresnisolone)

• Dilaudid (hydromorphone)

OD:

• right eye

OS:

• left eye

AD:

• right ear

AS:

• left ear

EBL:

• estimated blood loss

PCA pumps:

• patient controlled analgesia

• no one is allowed to touch it besides the patient

Where are nociceptors found?

• everywhere

1 tsp = ___ mL

5 mL