Pharmacology Test 3

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