Exam 2: NSG 2500: Pharmacology

☆Four major classes of insulin

1. Rapid acting 

   1. **Insulin Lispro

      1. Onset: 15-30 minutes

      2. Peak: 30-90 minutes

      3. Duration: < 5hrs

2. Short acting 

   1. **Regular (ONLY IV insulin)

      1. Onset: 30-60 minutes

      2. Peak: 2-3hrs

3. Intermediate acting

   1. **NPH (Cloudy)

      1. Onset: 1-1.5hrs

      2. Peak: 4-12hrs

      3. Duration- up to 24hrs

4. Long acting 

   1. **Glargine - CAN’T be mixed

      1. Onset: 3-6hrs

      2. Peak: NO PEAK

      3. Duration- 24hrs

   2. Clear (Rapid + Short) before Cloudy (Intermediate)

Sulfonylureas (Lower Glucose)

1. Generic name: **Glyburide

2. What does it do: Stimulate insulin release

3. Why do we give it: Adjunct to diet and exercise, can be used with insulin

4. Side effects: **Hypoglycemia, GI effects, N/V, heartburn

5. Nursing action: Type II diabetes only!!!

Biguanides (Lower Glucose)

1. Generic name: **Metformin

2. What does it do: Decrease glucose in liver to

3. Why do we give it: First-line for Type II

4. Side effects: GI complications ─ usually early on,  Assess for **lactic acidosis (Renal Disorders) 

5. Nursing action: Iodine containing dyes ─ STOP metformin day of exam and 48 hours after

Glucagon Like Polypeptide Receptor Agonists (GLP-1 Agonists) (Lower Glucose)

1. Generic name: **Semaglutide

2. What does it do: Increase insulin, Decrease glucagon, Slow GI emptying

3. Why do we give it: Type 2, weight loss, reduce risk of major CV events in patients with type 2 and CV disease

4. Side effects: Pancreatitis, GI, N/V, decreased appetite, C/D, Thyroid cancer

5. Nursing action: Oral medications = effects may be slowed, not for T1D

Most risk for Hypoglycemic Episodes

• Renal

• Hepatic

• Malnutrition

• Type 1

☆Glucocorticoids

1. Generic name: Prednisone (Intermediate) + Hydrocortisone (Short-acting)

2. ☆What does it do: Anti-inflammatory and immunosuppressive effects → Increase Blood Glucose 

3. Why do we give it: Asthma, Autoimmune diseases (RA, lupus), Allergic reactions, Organ transplant rejection, Adrenal insufficiency

4. ☆Side effects: Cushingoid Effects (Moon face, Buffalo hump, Weight gain), Hyperglycemia, Osteoporosis, infection risk, peptic ulcers, hypertension, K+ loss, Diabetes Mellitus

   1. Adrenal suppression =  causing body’s own production to stop

   2. Contain glucocorticoid and mineralocorticoid activity

Mineralocorticoids

1. Generic name: Fludrocortisone

2. What does it do: ↑ Sodium and Water retention → Decrease potassium excretion, ↑ Blood pressure

3. Why do we give it: Adrenal insufficiency and hypotension

4. Side effects: increased fluid volume, hypokalemia, Metabolic Alkalosis, edema, hypertension

5. Nursing action: Assess weights

☆Thyroid Hormone Replacement (Hypothyroidism)

1. Generic name: Levothyroxine

2. What does it do: Synthetic T4 → converted to T3 → increases metabolic activity

3. Why do we give it: Hypothyroidism, Hashimoto thyroiditis, Myxedema coma, TSH suppression in thyroid cancer

4. ☆Side effects: Tachycardia, Heat intolerance, Weight loss, Anxiety, Insomnia

   1. Overdose → hyperthyroid

   2. Underdose → hypothyroid

5. ☆Take regularly in AM, empty stomach

Antithyroid Drugs (Hyperthyroidism)

1. Generic name: Propylthiouracil (PTU) + Methimazole 

2. What does it do: Block formation of thyroid hormones in thyroid gland

3. Why do we give it: Treat hyperthyroidism

4. Side effects: Agranulocytosis, Fever, Sore throat, Low WBC

5. Nursing action: fever + sore throat = STOP DRUG

Antihypercalcemia Agents

1. Generic name: Alendronate

2. What does it do: Slows bone resorption, lower serum calcium levels, does not prevent bone formation

3. Why do we give it: Paget’s disease; post-menopausal osteoporosis; osteoporosis in males (alendronate)

4. Side effects: Abdominal pain, constipation, diarrhea, nausea, Musculoskeletal pain, Esophageal erosion, increased risk femoral shaft fractures

5. Nursing action: Upright x 30 min, full glass of water

☆Alpha 1 vs Alpha 2

1. ☆Alpha 1

   1. Vasoconstriction ->  increased BP

   2. Dilates pupil (Wider)

      1. Signs: ↑ Blood pressure, Cold / pale skin (vasoconstriction), Dilated pupils (mydriasis), Urinary retention

1. Alpha 2

   1. Control the release of NE

   2. Decrease in SNS activity -> leads to decrease BP and HR

      1. Signs: ↓ Blood pressure, ↓ heart rate, Sedation / drowsiness

Alpha 1 Adrenergic Agonists (Connect and stimulate)

1. Generic name: Phenylephrine

2. What does it do: Stimulates Alpha 1 receptors (Vasoconstriction, ↑ Peripheral vascular resistance, ↑ Blood pressure)

3. Why do we give it: Hypotension, treat shock, Used in cold and allergy products

4. Side effects: Severe HTN, narrow angle glaucoma, Reflex bradycardia, Dilated pupils (mydriasis), cold, pale skin

☆Alpha 2 Adrenergic Agonists (Connect and stimulate)

1. Generic name: Clonidine

2. What does it do: Alpha 2 receptor stimulation decreases sympathetic outflow from CNS and Inhibits release of norepinephrine

3. Why do we give it: Hypertension 

4. Side effects: Sedation, drowsiness, HA, Hypotension, bradycardia, Rebound Hypertension

Beta 1 vs Beta 2

1. Beta 1

   1. Stimulation increased myocardial activity and HR

   2. Effects Heart

      1. Signs: ↑ Heart rate (tachycardia), ↑ contractility, ↑ cardiac output

1. Beta 2

   1. Stimulation dilate airways (bronchodilation)

   2. Effects Lungs

      1. Signs: Bronchodilation (easier breathing), ↓ airway resistance, Uterine relaxation

☆Beta 2 Adrenergic Agonists (LUNGS) (Connect and stimulate)

1. Generic name: Albuterol (RESCUE inhaler)

2. What does it do: Stimulate sympathetic nervous system → Quickly dilates bronchi and increases rate and depth of respirations (bronchodilation)

3. ☆Why do we give it: Used during asthmatic attacks

4. Side effects: Sympathetic stimulation → Tachycardia, Palpitations, Tremors, Hyperglycemia, Insomnia, Restlessness, Anorexia, HA, Cardiac stimulation

5. Nursing action: Assess lungs sounds pre/post VS pre/post

Alpha and Beta Adrenergic Agonists (Connect and stimulate)

1. Generic name: Dopamine

2. What does it do: Stimulates alpha 1 and beta 1 receptor activity, Stimulates heart and BP, Increases blood flow to kidney

3. Why do we give it: Shock

4. Side effects: Pheochromocytoma, Tachy, arrhythmias or vfib, Hypovolemia

5. Nursing action: Not a treatment for Parkinsons!!

Alpha 1 and Beta 1+2 Adrenergic Agonists (Connect and stimulate)

1. Generic name: *Epinephrine (Emergency situations)

1. What does it do: Increases force of contraction, Increases heart rate, Bronchodilation, Increases blood pressure

2. Why do we give it: Anaphylaxis, Severe asthma attack

3. Side effects: Tachycardia, Hypertension, Arrhythmias, Angina

Alpha 1 Selective Adrenergic Antagonists (Connect and block)

1. Generic name: **Tamsulosin

2. What does it do: Blocks alpha 1 receptors, produces smooth muscle relaxation prostate and bladder improved urine flow

3. Why do we give it: BPH (tamsulosin), some used for HTN

4. Side effects: SNS blockage, orthostatic hypotension, dizziness, Vasodilation, Tachycardia / flushing

5. Nursing action: “First Dose Syncope” 30 - 90 min after dose; start low, wean off, Take at night

Beta 1 Selective Adrenergic Antagonists (Connect and block)

1. Generic name: **Metoprolol 

2. What does it do: Block cardiac beta 1 receptors

3. Why do we give it: Decreases heart rate, contractility, cardiac workload, Post MI, Ophthalmic – reduces IOP (timolol)

4. Side effects: CNS: fatigue, dizziness, bradycardia, hypotension, N/V/D, SOB, edema, wt gain

Direct Acting Cholinergic Agonists (Connect and stimulate)

1. Generic name: **Bethanechol (PNS: Rest & Digest) 

2. What does it do:Increase bladder tone, Increase GI secretions, Increase urinary excretion, Ophthalmic – induce miosis to relieve, IOP

3. Why do we give it: Post-op, urinary retention, Atony of bladder

4. Side effects: Bradycardia, polyuria, Abdominal cramps, Diarrhea

Cholinergic Crisis/Anticholinergics

1. Generic name: **Atropine (DRY EFFECT)

2. What does it do: Occupies ACh receptor sites; Blocks cholinergic activity

3. Why do we give it: (Cholinergic Crisis) Overdose of cholinergic medication, (Anticholinergics) Tx sinus node dysfunction, Treatment of sinus bradycardia, Dry secretions pre-op

4. Side effects: (Anticholinergics) Dry mouth, constipation, photophobia (intolerance to light), CNS effects

5. Nursing action: Monitor urinary output 

Anti-seizure medications Implementations

1. Take regularly, same time each day

2. Do not abruptly stop! Taper off

3. Do not crush, chew, open extended-release forms

4. Medic-alert bracelet

5. Risk for injury r/t CNS effects of medication

6. Monitor CBC, LFTs, therapeutic drug levels

7. Driving precautions

8. Shake the bottle well!!

Hydantoins

1. Generic name: Penytoin (Risk for Pregnant women) 

2. What does it do: Stabilize nerve membranes, reduce conduction = reduce movement, (Prevents sodium from moving = action potential is stopped) 

3. Why do we give it: Generalized seizures (Both Hem) 

4. Side effects: Sedatives, Liver toxicity (LFT), Bone marrow suppression (CBC), Skin reactions, Gingival hyperplasia (Enlargement of gums), CNS depression**, hypotension, Ataxia (Spams), LOC

5. Nursing action: Therapeutic range: 10-20mcg/mL (< Seizures or > Toxic), mouth care , Shake the bottle well!!, Less sedating

Barbiturates

1. Generic name: Phenobarbital (Schedule 4) 

2. What does it do: Inhibits impulse conduction in cerebellum, cerebral cortex, lower brainstem, Decreases CNS excitation, motor response

3. Why do we give it: Generalized seizures

4. Side effects: CNS depression, Sedation, hypnosis, anesthesia

5. Nursing action: **Addiction/ withdrawal

Benzos

1. Generic name: Diazepam  (Schedule 4) 

2. What does it do: Increase the effects of GABA -> stabilizing nerve endings -> decreasing nerve excitability

3. Why do we give it: Generalized seizures

4. Side effects: CNS depression, Physical dependence and withdrawal, paradoxical effects (Opposite) 

Other Drugs for seizures

1. Generic name: Valproic acid

2. What does it do: May increase GABA activity, reduces electrical activity

3. Why do we give it: Absence seizures (Generalized), Mania, Migraine prevention

4. Side effects: CNS depression, Liver toxicity, 

5. Nursing action: Follow liver functions (LFTs), esp. first 6 months

Other Drugs for seizures

1. Generic name: Carbamazepine

2. What does it do: Stabilizes nerve endings by altering sodium and calcium channels or Increasing activity of GABA

3. Why do we give it: 

4. Side effects: CNS depression, N/V, anorexia, BBW: serious dermatological reactions (Skin), Depression; Suicidal ideation, Bone Marrow Suppression (CBC)

5. Nursing action: Taper off -> risk for seizures if sudden withdrawal / Take regularly, same time each day

Dopaminergic Agents (Increase effects of dopamine at receptors)

1. Generic name: **Levodopa/Carbidopa (Combined = Reduced signs) 

2. What does it do:

   1. Levodopa: Crosses blood brain barrier, metabolized into dopamine, short duration (**Less levodopa is used, adverse effects reduced**)

   2. Carbidopa: Prevents breakdown of levodopa in GI -> allows more to get to brain

3. Why do we give it: Reduce symptoms/signs of Parkinson 

4. Side effects: GI upset, confusion, anxiety, fatigue, Dyskinesia (involuntary movements), On-Off Syndrome: wears off, ‘freezing’ (levodopa)

5. Nursing Considerations: (Avoid vitamin B-6 -> Increase breakdown of levodopa), BBW: melanoma risk (levodopa), DO NOT take with protein (Slows absorption) 

Dopaminergic Agents

1. Generic name: **Amantadine

2. What does it do: Increase release and inhibits re-uptake of dopamine in the brain -> increasing dopamine levels (Prevents it from returning) 

3. Why do we give it: Initially an antiviral / Parkinson’s (In early onset)

4. Side effects: GI upset, CNS: confusion, anxiety, fatigue, Dyskinesia (involuntary movements), Hypotension, Urinary retention 

5. Nursing Considerations: Do not take with protein (Slows absorption), fall risk

Anticholinergic Therapy

1. Generic name: **Benztropine

2. What does it do: Help to restore chemical balance or Block effects of acetylcholine at receptor sites reducing tremors, rigidity

3. Why do we give it: Useful as adjunctive therapy, Useful when levodopa no longer effective

4. Side effects: r/t block PSNS, hypotension, dry mouth, decrease sweating -> heat stroke, Urinary retention

Antitussives

1. Generic name: Dextromethorphan

2. What does it do: Suppress cough reflex by direct action on medullary cough center of the brain

3. Why do we give it: Cough suppressant

4. Side effects: Increase viscosity of secretions, CNS depression

5. Nursing action: Cough needed to ensure airway

Topical Nasal Decongestants

1. Generic name: Phenylphrine (Alpha 1 -> Constriction) 

2. What does it do: Vasoconstriction -> decrease edema/inflammation nasal membranes

3. Why do we give it: Nasal congestion

4. Side effects: Localized stinging and burning, Rebound congestion, no systemic effects 

5. Nursing action: Nasal lesions -> Systemic effects 

Oral Decongestants

1. Generic name: *Pseudoephedrine (Alpha 1 -> Constriction) 

2. What does it do: Shrink nasal mucous membrane  -> promoting drainage of sinuses/improving airflow

3. Why do we give it: Nasal congestion, (Ear infections) Pain associated with otitis media

4. Side effects: Rebound congestion, Systemic effects r/t stimulating sympathetic nervous system (palpations, insomnia,)

5. Nursing action: Caution with OTC cold and flu medications

Nasal Steroid Decongestants

1. Generic name: Fluticasone

2. What does it do: Anti-inflammatory effect

3. Why do we give it: Allergic rhinitis

4. Side effects: Local burning, dryness of mucosa, Irritation, Generally no systemic effects, candida albicans

5. Nursing action: Not immediate onset -> takes time (weeks) to see full effect, Mouth care (candida albicans)

Antihistamines

1. Generic name: Diphenhydramine

2. What does it do: Directly compete with histamine for specific receptor sites

3. Why do we give it: Nasal allergies, rhinitis (hay fever), Allergic reactions, Motion sickness, Parkinson’s disease, Sleep disorders

4. Side effects: Drowsiness, sedation, Anti-cholinergic effects (DRYING), GI: nausea, arrhythmias, urinary retention

5. Nursing action: Long QT syndrome -> Cardiac disorders

Expectorants

1. Generic name: Guaifenesin

2. What does it do: Increase productive cough, decrease viscosity, reduces adhesiveness

3. Why do we give it: Remove secretions, induce cough 

4. Side effects: GI: N/V, anorexia

5. Nursing action: Assess persistent coughs for underlying disease

Mucolytics

1. Generic name: Acetylcysteine

2. What does it do: Increase or liquefy respiratory secretions in high risk respiratory patients

3. Why do we give it: Thin secretions 

4. Side effects: GI upset, Stomatitis

5. Nursing action: Administration: nebulization (Separate nebulizer), mouth care

Xanthine

1. Generic name: Theophylline

2. What does it do: Direct effect on smooth muscles of bronchi causing dilation and decreasing swelling -> relaxation 

3. Why do we give it: Asthma; Bronchospasms

4. Side effects: GI upset/ nausea, Irritability/ restlessness, Tachycardia

5. Nursing action: Therapeutic levels: 10-20 mcg/mL (Nicotine causes an increase in metabolism -> Need a higher dose)

Proper administration of inhaler

1. Shake canister

2. Exhale and bring to mouth

3. Compress inhaler WHILE inhaling (over 3-5 secs)

4. Hold for slow 10 secs

5. Exhale through mouth

   1. Use 30 to 60 minutes prior to exercise

Anticholinergics

1. Generic name: Ipratropium

2. What does it do: BLOCKS action of acetylcholine (ACh) -> bronchoconstriction is prevented, airways dilate

3. Why do we give it: Prevention (NOT rescue!!), Useful for patients unable to tolerate beta-agonists (but not as effective)

4. Side effects: Anticholinergic effects  dizziness, headache, fatigue, dry mouth, palpitations, urinary retention

5. Nursing action: Allergy to soy products or peanuts

Inhaled Steroids

1. Generic name: Budesonide

2. What does it do: Reduces inflammation, Increases beta-agonist activity  muscle relaxation

3. Why do we give it: Treatment of bronchospastic disorders, Used early in disease process with bronchodilator, In acute episodes corticosteroid is given IV 

4. Side effects: Limited due to inhalation, Dry mouth, sore throat, hoarseness, Oral fungal infections (**oral care!!)

5. Nursing action: ***Bronchodilate first…. then steroid

Leukotriene Receptor Antagonists

1. Generic name: Montelukast

2. What does it do: Prevent leukotrienes from attaching to receptors on cells in the lungs and in circulation, Decreases vascular permeability, Decreases mucus production, Inflammation in the lungs is blocked, and asthma symptoms are relieved

3. Why do we give it: Prophylaxis and chronic treatment of asthma in adults and children (NOT meant for management of acute asthmatic attacks), allergic rhinitis

4. Side effects: HA, N/V/D, Elevated LFTs, Generalized myalgia, Long term effects not fully studied

5. Nursing action: fetal toxicity in animal studies (***Bronchodilate first…. then steroid)