Pharma

cholinergics

a class of medications that enhance the activity of the neurotransmitter acetylcholine in the body. They can stimulate the cholinergic receptors and mimic the effects of acetylcholine.

are used in the treatment of various conditions, including Alzheimer's disease, glaucoma, and urinary retention. Examples of cholinergic drugs include donepezil, rivastigmine, and bethanechol.

pilocarpine

close angled glaucoma

Bethanecol (Urecholine)

Non-obstructive urine retention, neurogenic bladder, spinal cord injury, abdominal distention and ileus → to activate peristaltic activity

Endrophium (Tensilon)

short acting acetylcholine for 5-20 minutes, for diagnostic test for myasthenia gravis and not for maintenance

Neostigmine (Prostigmin), Pyridostigmin (Metinon)

longer acting acetylcholine for myasthenia gravis

anticholinergics

parasympatholytics, cholinergic blockers; not the same drugs as adrenergics but has same effects

atropine, benztropine, cogentin,dyclomine(Bentyl), glycopyrrolate (Robinul), mecitzine (antivert), pro-banthine, scopolamine, trihexyphenidyl, diphenhydramine (benadryl)

atropine

symptomatic bradycardia

to decrease saliva and bronchial secretions preoperatively - to prevent aspiration

produce mydriasis

antidote for cholinergic crisis

benztropine, trihexyphenidyl (artane)

for parkinsonism to decrease acetylcholine

scopolamine, bonamine, benadryl

to decrease motion sickness

adrenergics

sympathomimetics, mimics SNS (Alpha 1, Beta 1, Beta 2)

also known as adrenergic agonists, are a class of drugs that stimulate the adrenergic receptors in the sympathetic nervous system. They mimic the effects of the neurotransmitter norepinephrine, leading to increased heart rate, blood pressure, and bronchodilation.

are commonly used in the treatment of conditions such as asthma, hypotension, and shock. Examples of adrenergic drugs include epinephrine, norepinephrine, and albuterol. neozep

alpha 1 effect

vasoconstriction → increases BP, HR

alpha 2 effect

vasodilation → compensation/ regulates para di sumobra → clonidine, a anti hypertensive drug

beta 1 effect

increases heart rate

beta 2 effect

bronchodilation, uterine relaxation

alpha specific adrenergic agonists

no beta effects, such as phenylephrine

not for asthma

beta specific adrenergic agonist

such as salbutamol

do not give if HR is >120

adrenergic blockers

a class of drugs that inhibit the actions of the sympathetic nervous system. They block the binding of adrenaline and noradrenaline to adrenergic receptors, thereby reducing the effects of these neurotransmitters.

are used to treat various conditions such as hypertension, angina, and certain cardiac arrhythmias. They can also be used to manage symptoms of conditions like benign prostatic hyperplasia and migraines. Examples of adrenergic blockers include beta blockers and alpha blockers.

opioid analgesics

a class of medications used to relieve pain. They work by binding to opioid receptors in the brain, spinal cord, and other parts of the body, reducing the perception of pain.

Common examples include morphine, codeine, oxycodone, and fentanyl. These medications can be highly effective for managing severe pain, but they also carry the risk of dependence, addiction, and other side effects.

opioid antagonists

are medications that block the effects of opioids in the body. They bind to opioid receptors without activating them, preventing opioids from binding and producing their analgesic or euphoric effects.

Some commonly used include naloxone(narcan), naltrexone, and nalorphine. These medications are often used to reverse the effects of opioid overdose or to treat opioid addiction.

non-opioid analgesics and antipyretics

Both are commonly used to manage pain and fever in various conditions.

paracetamol, acetaminophen (tylenol), acetylsalicylic acid (aspirin) 300-355 mg, phenazopyrindine (pyridum) for UTI pain

baby aspirin (aspilet)

80-81 mg, chewable, for prophylactic treatment

antidote for tylenol

acetylceisteine (mucolytics)

non steroidal anti inflammatory drugs

a class of medications commonly used to reduce pain, inflammation, and fever. They work by inhibiting the production of certain chemicals in the body that cause inflammation.

Some examples include ibuprofen, naproxen, and aspirin. These medications are widely available over-the-counter and can also be prescribed by a healthcare professional for more severe conditions.

CNS stimulants

substances that increase activity in the central nervous system. They can enhance alertness, attention, and energy levels.

Examples include medications like amphetamines (e.g., Adderall) and methylphenidate (e.g., Ritalin) commonly used to treat attention deficit hyperactivity disorder (ADHD).

These stimulants work by increasing the levels of certain neurotransmitters in the brain, such as dopamine and norepinephrine.

methamphetamie

shabu, ice, bato, siopao

ceiling effect

you can tolerate the usual dose given so some people increases the dose to maintain the effect which then becomes dependent on it

anticonvulsants

a class of medications used to prevent or control seizures. They work by stabilizing the electrical activity in the brain, reducing the likelihood of seizures.

Some commonly prescribed include phenytoin, carbamazepine, valproic acid, and lamotrigine. These medications are primarily used to treat epilepsy but may also be prescribed for other conditions such as bipolar disorder or neuropathic pain.

10-20 mcg/mL

phenytoin (dilatin) normal serum levels; keep it that way to prevent seizures

cerebral hypoxia

can lead to this if seizure is >1 min

antiparkinsonians

for parkinson’s disease to increase levels of dopamine as well as in drug induced extramyramidal symptoms that includes pseudo parkinsonism

commonly given are amantadine (symmetrel), parlodel, carbidopa-levodaopa(sinemet), levedopa, pergolide, selegiline (carbex, epedryl)

sedatives, hypnotics and anxiolytics

for anxiety - hydroxyzine

for insomnia - diphenhydramine, barbiturates, chloral hydrate

for sedation - promethazine, barbiturates, chloral hydrate

antidepressants

for clinical depression

examples are SSRI’s, TCA’a and MAUIs

selective serotonin-reuptake inhibitors

first line antidepressants, taken during morning because it can cause insomnia and nervousness

increases serotonin which is from endorphins which we can get from chocolates and bananas

examples are fluoxetine(prozec), paroxetine (paxil)

can take 2-4 weeks to take effect

Trycyclics (TCA’s)

increases dopamine; amitriplyne, imipramine (tofranil), notriptyline

sedating so give at night, can cause orthostatic hypotension, palpitations

MAOIs (Monoamine oxidase inhibitors)

increases dopamine; parnate, marplan, nardil

alternative and last option as antidepressant

can lead to hypertensive crisis; avoid high in tyramine foods (cured, smoked, fermented, processed foods)

antianginals

for chest pain caused by ischemia of the coronary arteries; decreases the heart’s workload and reduce the need for oxygen

common drugs are beta blockers (reduces hr → reduce O2 demand), CCB (amlodipine, diltiazem, nifedipine, verapamil), nitrates: ISMN (oral/tablet), nitroglycerine(ointment/patch → use during morning because more effort is needed

avoid using at night to prevent drug tolerance

anti arrhythmias

for cardiac arrhythmias, specifically afib, premature ventircular contractions, vtach, vfib and supreventricular tachycardia

promotes normal sinus rhythm and regular ventricular response

ventricular - quinidine gluconate

other common drugs: lidocaine, phenytoin, procainamide, beta blockers, amiodarone, CCB

antihypertensives

to decrease BP/hypertension

ACE inhibitors (-pril), Beta Blockers (-olol), CCB (Verapamil, nifedipine, Diltiazem), ARBS (-sartan)

ace inhibitors side effects

dry cough and nephrotoxic

cardiac arrest

give epinephrine

antilipemics

reduces serum lipid levels when dietary measures haven’t been successful

primary prevention of cardiac events (pravanstatin, simvastatin)

common drugs include atorvastatin, questran, lovastyati, niacin, simvastatin

do not give if has fat soluble vit deficiency, severe constipation, gi disorder and impaired liver function history

do not drink alcohol

atorvastatin (lipitor)

inhibits cholesterol production

digoxin(lanoxin)

cardiac glycoside; for heart failure and atrial tachyarrhythmias to control ventricular rate

SE: N/V, bradycardia, hypotension, weakness and fatigue, visual impairmennt, abdominal pain

monitor apical pulse before adm and check for signs and symptoms of toxic reaction (SE)

diuretics

for heart failure, edema and hypertesion; cerebral edema (mannitol); open angle glaucoma (acetazolamide/diamox, mannitol)

examples includes carbonic anhydrase inhibitors (diamox), loop diuretics (furosemide/lasix), osmotic diuretics (mannitol, urea), K-sparing diuretics (spironolactone), thiazide diuretics (chiorothiazide/diuril, indapamide)

administer diuretics at times that doesn’t disturb sleep

Most potent diuretics

Acetozolamide > osmotic diuretics (mannitol) > loop diuretics (lasix, fast, can stimulate RAAS so not anti htn) > thiazides (best for hypertension but not in diabetic → hyperglycemia) > spinorolactone (K-sparing)

anticoagulants

treat and prevent clotting disorders such as dvt, phlebitis, pulmonary embolus, peripheral vascular disease and disorders arising from prolonged bed rest

common drugs are dalteparin (fragmin), enoxaparin (levonox), heparin, warfarin (coumadin)

monitor PTT (heparin) and PT(coumadin)

thrombolytics

used un emergent situations, such as dissolving clots in coronary arteries, pulmonary arteries and deep veins and preventing the extension of MI

common drugs are alteplase (activase), anistreplase (eminase), streptokinase

administer only if closely monitored

warfarin (coumadin)

oral and for maintentance anticoagulant

antidote is Vit K

heparin

SC/IV, immediate anticoagulant

antidote is protamine sulfate

enoxaparin

a low molecular heparin to decrease bleeding

anti anemics

for iron deficiency anemia, pernicious anemia, vit b12 deficiency, folic acid deficiency

don’t administer until anemia has been diagnosed

best absorbed on empty stomach

iron products

ferrous gluconate - stool is green

ferrous sulfate - stool is black

iron dextran

there might be staining at injection site if IM preparation

epoetin alfa (epogen, procrit)

given to anemics that has bone marrow suppression

folic acid deficiency

can lead to neural tube defects or spina bifida to fetus if with this

bronchodilators

for bronchospasm associated with asthma, bronchitis and other obstructive pulmonary diseases and acute bronchospasm

common drugs includes albuterol, aminophylline, epinephrine, isoetharine, isopreterenol, salmaterol, terbutaline, theophylline (monitor serum levels, 10-20mg/dl)

salbutamol does not cause tachycardia

antitussives, expectorants and mucolytics

for unproductive or excessive coughs; and to promote rest; encourage to increase fluid intake to reduce mucous viscosity

commo drugs are

• codeine, dextromethorpan (pertussin), diphenhydramine (benadryl)

• guaifenesin (robitussin)

• acetylcysteine (mucomyst), potassium iodide saturated solution

antacids

for hyperacidity, gastroesophageal reflux, peptic ulcer disease

common drugs includes alumunim hydroxide (amphogel), and magnesium hydroxide and simethicone; calcium carbonate

opioid expectorant

suppresses cough reflex

robitussin w/ codeine (Robitussin AC)

non opioid expectorant

dextremethorphan

robitussin DM

vicks formula 44

sedative

antidiarrheals

for acute diarrhea, chronic diarrhea

common drugs includes attapulgite(Kaopectate), Bismuth subsalicylate (Pepto Bismol), diphenoxylate with atropine (limotil), loperamide (imodium)

contraindicated if with undiagnosed abdominal pain and infectious diarrhea

antiemetics

depresses the vomiting center in the medulla by acting on the chemoreceptor trigger zone - metoclopramide, prochiorperazine, promethazine → these 3 could cause extrapyramidal reactions

decreases the effects of motion on the vomiting center - dimenhydrinate, meclizine, scopolamine

dimenhydrinate (dramamine) is bonamine

promethazine (phenergen)

belongs to the family of thorazin

an antiemetic, antihistamine and antipsychotic

antiulcerative

H2 antagonists: treat and prevent gastric and duodenal ulcers, treat hypersecretion - common drugs are cimetidine(tagamet), famotidine, nizatidine (axid), ranitidine (zantac). don’t administer with antacids

prostaglandin-like: inhibit gastric acid secretion in patients taking high doses of NSAIDs by synthetically mimicking prostaglandin - common is misoproslol (cytotec). do not take if pregnant. take w/ meals and at bedtime

proton pump inhibitors

for peptic ulcer disease and gastroesophageal reflux disease.

do not use if lactating

treatment is for 8 weeks

common drugs are omeprazole (prilosec) and lanzoprazole(prevacid)

pepsin inhibitor

for peptic ulcer disease and forms a protective coating over the ulcer. constipation is the most common adverse effect

common drug is sucralfate (carafate)

give on empty stomach about 1 hr before meals and at bedtime

laxatives

for constipation associated with many conditions and medications; for straining during defacation (stool softeners)

common drugs includes

• bulk forming agents - methylcellulose (citrucel), psyllium (metamucil)

• lubricants - hyperosmolar agents, lactulose (cephulac), magnesium citrate, magnesium hydroxide, magnesium sulfate (epsom salts). mineral oil

• stimulants - dulcolax, castor oil, senokot

• stool softeners - docusate calcium (surfak), docusate sodium (colace, dialose)

Metformin

biguanide- used to decrease hepatic production of glucose in T2DM

contraindicated in renal impairment, hepatic dysdunction, alcohol abuse, and if taking cimetidine

can cause adverese effects like GI symptoms, vit b12 malabsorption, risk of lactic acidosis with kidney disease

antithyroids

for hyperthyroidism or grave’s disease(autoimmune so given steroids)

common drugs includes methimazole (tapazole), potassium iodide, propylthiouracil (PTU), sodium iodide

do not use if pregnant or lactatig → cretinism to baby

take drugs in the morning, same time everyday

thyroid hormones

for supplemental or replace natural thyroid hormone; hypothyroidism, myxedema, goiter, post-thyroidectomy

common drugs are levothyroxine (synthroid), thyroid (thyrar)

administer drug in the morning to prevent insomnia

adrenocorticosteroids

replacement therapy in patients with adrenal insufficiency; given in shock to increase cardiac output and blood pressure

given in inflammatory disorders scuh as joint disorders, GI disorders and skin allergies; also in cerebral edema

drugs than ends with -one

administer oral doses with milk or food to decrease risk of GI distress

addisonian crisis

if patient did not taper the use of steroids

antihistamines

for allergic symptoms from common allergies and severe allergic reactions; for nausea and vomiting, motion sickness (phenergen, bonamine)

it also increases effect of analgesics and promote sedation

common drugs that ends with -ine

take drug with foods to prevent GI distress, maintain adequate fluid intake, avoid alcohol

immunosuppressants

prevent rejection of organ transplants and severe rheumatoid arthritis

common drugs are azathioprine (Imuran), cyclosporine (Neoral, Randimmune)

assess and prevent infection

aminoglycosides

drugs that ends with -mycin

cephalosphorins

drugs that starts with cef-

sulfonamides

drugs that ends with -xazole

penicillin

drugs that ends with -cillin

tetracyclins

drugs that ends with - cycline

antifungals

for systemic and local fungal infections, candida infections, ringworm infections

common drugs includes Amphotericin, clotrimazole, fluconazole, miconazole, nystatin

antihelmintics

for malaria, roundworm, pinworm, whipworm, hookworm, tapeworm, lice and other parasitic infections

common drugs are iodoquinol, lindane (kwell), mebendazole, metronidazole, quinine (with food)

do not give if pregnant and lactating and below 1 yr old. do not also give to myasthenia gravis patient if it is quinine

rifampin side effect

red orange urine

isoniazid (INH) side effect

peripheral neuritis

Pyrazinamide side effect

gout, gi symptoms

ethambutol side effect

in the eyes - optic neuritis

antituberculosis

for tuberculosis prevention in those who are exposed to it; In active TB

RIPES

antacid can delay absorption

antiviral

for genital, encephalic and opthalmic herpes simplex; for influenza A and B virus prevention; Human immunodeficiency virus

drugs that ends with -clovir

other common drugs, symmetrel, zidovudine (retrovir)

colchicine

an antihyperurecemic drug that decreases acute joint inflammation from increased uric acid

allopurinol and probenecid

antihyperurecemic drugs that prevents uric acid to build up

antihyperurecemic drugs

colchicine, allopurinol, prebenecid

encourage to drink at least 2L of fluid per day; administer after meals to decrease GI distress

call if rash developd

Thirty minutes before each meal

Apolinario has MG, and had difficulty chewing. When will the patient with myasthenia gravis take the prescribed pyrostigmine bromide (Mestinon)?

To accumulate water in the stool and increase peristalsis

Luna has constipation. She was prescribed with Senna (Senokot), in which she asked what this medicine is for?

bleeding in gums, ecchymoses on skin, pink-tinged urine, tarry stools, occult blood

Pnoy is receiving heparin sodium by continous intravenous infusion. What are the adverse effects on this therapy?

motor incoordination, ataxia

Diazepam (Valium), a benzodiazepine, was prescribed to Sara who has anxiety. What side effects could happen to Sara?

Nateglinide (Starlix)

an example of an antidiabetic medication for T2DM whose disease cannot be controlled by only with diet and exercise. It results to calcium influx which induces insulin secretion

nephrotoxicity, ototoxicity, red-neck syndrome

What are the possible side effects of Vancomycin Hydrochloride (Vancocin) antibiotic

Toiterodine tartrate

an antispasmodic med used to treat overactive bladder and symptoms of urinary frequency, urgency or urge incontinence. Contraindicated in urinary retention and uncontrolled narrow-angle glaucoma.

eight ounces of liquid

what should be taken with psyllium (Metamucil), a bulk-forming laxative, to help prevent impaction in the stomach or small intestine

Cyclosporine (Sandimmune)

an immunosuppressant medication used to prevent transplant rejection. SO be alert for signs and symptoms of infection and refer if meron. other SE includes hypertension, increased facial hair, tremors, gingival hyperplasia and GI complaints

0.5-2.0 ng/ml

therapeutic blood level of digoxin

10-20 mcg/ml

therapeutic range for serum phenytoin level in clients with normal serum albumin levels and renal function. if below, at risk for seizure activity. if above, toxic range