Pharmacology Test 1

Carbamazepine

Therapeutic Use: Partial seizures, tonic clonic seizures, BPD, neuropathic pain

Mechanism of action: Inhibits the influx of sodium through sodium channels decreasing the discharge of neurons around the areas of increased activity

Side Effects: Visual disturbances, decrease blood production, skin rash, photosensitivity

Other: Pregnancy Risk

Second and Third Gen ASMs (oxcarbazepine)

Therapeutic Use: Seizures, migraine, neuropathic pain

Mechanism of action: Binds to sodium channels and inhibits the release of glutamate

Side Effects: Dizziness drowsiness, change in vision, headache, leukopenia, decreased bone mineral density

Other: Monitor sodium and WBC

Short Acting Barbiturates (methohexital sodium)

Therapeutic Use: Brief rapid induction of anesthesia

Mechanism of action: CNS depression and enhance the inhibitory effects of GABA

Side Effects: Suicide, abuse, tachycardia, hypotension, respiratory depression

Other: Precautions with hepatic or renal disease

Opioids (fentanyl)

Therapeutic Use: General anesthesia, muscle relaxant

Mechanism of action: Analgesic and sedative effects

Side Effects: Sedation, nausea, respiratory depression

Other: Interacts with MAOIs

Methyphenidate

Therapeutic Use: ADHD, narcolepsy

Mechanism of action: Increases the release of norepinephrine and dopamine

Side Effects: Insomnia, anorexia, weight loss, hypertension, tachycardia, heart palpitations

Other: Avoid caffeine

Non-amphetamines (Modafinil)

Therapeutic Use: Narcolepsy, obstructive sleep apnea

Mechanism of action: Unknown but block reuptake of norepinephrine

Side Effects: Nausea, diarrhea, headache, tachycardia, hypertension

Other: Decreases effectiveness of oral contraceptives

Direct acting dopamine receptor agonist (pramipexole)

Therapeutic Use: Relieves manifestations of Parkinson’s and restless leg syndrome

Mechanism of action: Bind to dopamine receptors and cause a response similar to body dopamine

Side Effects: Nausea, drowsiness, muscle weakness, orthostatic hypotension

Other: Give before bedtime

Monoamine oxidase type B inhibitors (selegilne)

Therapeutic Use: Parkinson’s and major depression

Mechanism of action: Inhibit the action of the enzyme monoamine oxidase B to stop it from inactivating neurotransmitters

Side Effects: Insomnia, hypertension, irritation of oral mucous

Other: precautions with peptic ulcer disease

NMDA receptor antagonist (memantine)

Therapeutic Use: Alzheimer’s disease

Mechanism of action: Decreases influx of calcium into neurons in the brain

Side Effects: Dizziness, headache, increased confusion

Other: renal failure is a contraindication

Serotonin Norepinephrine reuptake inhibitors (venlafaxine)

Therapeutic Use: Depression, social and generalized anxiety

Mechanism of action: Block the neuronal reuptake without having a major impact on other receptors or neurotransmitters and increase serotonin and norepinephrine

Side Effects: Nausea, vomiting, headache, hypertension, insomnia

Other: Suicidal ideation

Atypical antidepressants (bupropion)

Therapeutic Use: Depression, SAD, smoking cessation

Mechanism of action: Inhibit dopamine uptake

Side Effects: Nausea, weight loss, seizures, insomnia, psychosis, tremor

Other: Suicidal ideation

Atypical antipsychotics (Risperidone)

Therapeutic Use: Manifestations of schizophrenia, BPD

Mechanism of action: Blocks receptors for dopamine and serotonin

Side Effects: Drowsiness, insomnia, dizziness, weight gain

Other: Photosensitive

Beta Adrenergic blockers (betaxolol)

Therapeutic Use: Chronic open angle glaucoma and acute closed agnel glaucoma

Mechanism of action: decrease production of aqueous humor and pressure

Side Effects: Stinging, burning, eye discomfort, bradycardia, hypotension

Other: Heart problems is contraindicated

Cholinergic agonists

Therapeutic Use: Lower IOP glaucoma

Mechanism of action: Contract ciliary muscle attached to lens and enhances drainage of aqueous humor

Side Effects: Headache, retinal detachment, bradycardia, decreased visual acuity

Other: Avoid driving at night

Cholinesterase inhibitors (echothiophate)

Therapeutic Use: lower IOP glaucoma

Mechanism of action: decreases breakdown of acetylcholine

Side Effects: decreased visual acuity, cataracts

Other: Contraindicated for retinal detachment

Biologic DMARDs (etanercept)

Therapeutic Use:

Mechanism of action: inactivates of tumor necrosis factor resulting in reduced inflammation and immunosuppression

Side Effects: Dizziness, abdominal pain, heart failure, increased susceptibility to infections

Other: Report signs of infection

Targeted Synthetic DMARDs (tofacitinib)

Therapeutic Use:

Mechanism of action: Disturpt the signaling pathways part of the inflammatory and immune responses

Side Effects: neutropenia, elevated liver enzymes, creatinine, lipids, GI perforation

Other: Contraindicated for anemia and infection

Bisphosphonates (alendronate)

Therapeutic Use: Postmenopausal, age related, and glucocorticoid related osteoporosis

Mechanism of action: Decrease bone resorption by inhibiting activity of osteoclasts

Side Effects: esophagitis, GI disturbances, muscle and joint pain, eye pain

Other: give 30 min before breakfast

Monoclonal Antibody Against RANKL (denosumab)

Therapeutic Use: Treats osteoporosis for postmenopausal, age related

Mechanism of action: binds to receptor activator of RANKL to decreases ability of osteocytes to produce osteoclasts

Side Effects: Hypocalcemia, jaw pain, loose teeth, atypical fractures, musculoskeletal pain, hypertension, headaches, diarrhea

Other: Contraindicated for infections

Anabolic Agents (terparatide)

Therapeutic Use: Osteoporosis

Mechanism of action: regulates calcium homeostasis and pathways that cause an increase number of osteoblasts

Side Effects: hypertension, orthostatic hypotension, leg cramps, angina, hypercalcemia

Other: Do not use if pregnant

Calcitonin (calcitonin salmon)

Therapeutic Use: Postmenopausal osteoporosis, hypercalcemia

Mechanism of action: inhibits the action of osteoclasts and increase excretion of calcium

Side Effects: nasal dryness, hypocalcemia, nausea, polyuria

Other: Need to do allergy test before

Calcium Supplements (calcium citrate)

Therapeutic Use: Hypocalcemia and at risk for osteoporosis

Mechanism of action: Given to provide non dietary source of calcium

Side Effects: Hypercalcemia, nausea, constipation, kidney stones

Other: Do not give if low phosphate levels or dysrhythmias

Methylxanthines (theophylline)

Therapeutic Use: long term management of chronic asthma

Mechanism of action: Relaxing smooth muscles of bronchi by blocking phosphodiesterase

Side Effects: nausea, vomiting, diarrhea, seizures, dysrhythmias, restlessness

Other: Do not use tobacco or caffeine

Mast Cell Stabilizers (cromolyn)

Therapeutic Use: long term treatment of allergy asthma, allergic rhinitis, seasonal allergies

Mechanism of action: suppress inflammation

Side Effects: allergic reactions

Other: Administer epinephrine and anti-hisamines to reverse anaphylaxis

Leukotriene Modifiers (montelukast)

Therapeutic Use: Adjunctive therapy in asthma, allergic rhinitis, exercise induced bronchospasms

Mechanism of action: Suppress effect of leukotrienes that mediate immune response

Side Effects: Liver damage with other meds, suicidal ideations

Other: Contraindicated for acute asthma exacerbations

Second Gen Nonsedating Antihistamines (cetirizine)

Therapeutic Use: Management of allergic rhinitis and chronic idiopathic urticaria (hives)

Mechanism of action: Antagonize histamine effects at H1 receptors without binding or inactivating histamine

Side Effects: Drowsiness, fatigue, dry mouth, nose, throat

Other: Do not take with opioids or alcohol

Sympathomimetics (phenylephrine)

Therapeutic Use: Allergic rhinitis, sinusitis, common cold

Mechanism of action: mimics the actions of sympathetic nervous system by activating the alpha 1 adrenergic receptors in the nose causing vasoconstriction

Side Effects: CNS stimulation, hypertension, tachycardia, bradycardia

Other: Only use 3 to 5 days to avoid rebound congestion

Antitussives (codeine and dextromethorphan)

Therapeutic Use:

Mechanism of action: Suppress cough reflex in brain

Side Effects: CNS depression, constipation, lightheadedness, nausea

Other: Encourage fluids and fiber, avoid St john’s wort

Expectorants (guaifenesin)

Therapeutic Use: Coughs related to viral upper respiratory tract infections

Mechanism of action: reduction of surface tension of secretions

Side Effects: Nausea, diarrhea, dizziness, drowsiness, headache

Other: Use only when needed

Mucolytics (Acetylcysteine)

Therapeutic Use: Decrease viscosity of mucous, reverse acetaminophen overdose

Mechanism of action: Breaking proteins in mucus

Side Effects: Bronchospasm, GI distress

Other: Rotten egg smell

Alpha/Beta Blockers (carvedilol)

Therapeutic Use: treat hypertension, angina, MI, dysrhythmias, heart falure

Mechanism of action: Blocks both alpha and beta receptors causing dilation of arterioles and excretion of water and sodium

Side Effects: Heart failure, bradycardia

Other: Check pulse daily

Thiazide Diuretics (hydrochlorothiazide)

Therapeutic Use: heart failure, cirrhosis, hypertension

Mechanism of action: Blocks reabsorption of sodium and chloride which carries water with it when excreted

Side Effects: electrolyte imbalance, hyperglycemia, gouty arthritis

Other: Lithium toxicity may occur

Potassium Sparing Diuretics (spironolactone)

Therapeutic Use: hypertension, heart failure, cirrhosis, hypokalemia

Mechanism of action: Blocks action of aldosterone and increases excretion of sodium but not potassium

Side Effects: Hyperkalemia, mensural irregularities

Other: Pregnancy risk

Cardiac Glycosides (digoxin)

Therapeutic Use: Heart failure, A-fib, Atrial flutter, paroxysmal atrial tachycardia

Mechanism of action: Inhibits sodium potassium ATPase causing calcium to collect within the cells of the heart increasing cardiac contractility

Side Effects: Cardiac dysrhythmias, GI manifestations, CNS manifestations

Other: Take apical pulse before administering

Sympathomimetics (dobutamine)

Therapeutic Use: short term increase cardiac output in heart failure

Mechanism of action: Increases cardiac contractility increases cardiac output

Side Effects: Tachycardia, dysrhythmias, angina

Other: IV infusion only

Phosphodiesterase Inhibitors (milrinone)

Therapeutic Use: short term for low cardiac output in heart failure

Mechanism of action: Increases contractility

Side Effects: hypokalemia, hypotension, angina

Other: IV infusion only

Angiotensin Receptor/Neprilysin Inhibitor (sacubitril/valsartan)

Therapeutic Use: heart failure, hypertension

Mechanism of action: Increases blood pressure and afterload heart pumps faster

Side Effects: hyperkalemia, renal failure, hypotension, cough, dizziness

Other: Monitor BP, potassium, urine output, renal function

Sodium Glucose Cotransporter 2 inhibitors (empagliflozin)

Therapeutic Use: type 2 diabetes, heart failure, cardiovascular disease

Mechanism of action: Inhibit transporter in kidney increases excretion of glucose

Side Effects: hypoglycemia, dehydration, hypotension, fracture, kidney injury

Other: Monitor for UTI

Hyperpolarization Activated Cyclic Nucleotide Gated Blocker (Ivabradine)

Therapeutic Use: heart failure

Mechanism of action: Blocks hyperpolarization of HCN slows heart rate and allow heart ventricles to fill more effectively

Side Effects: Bradycardia, hypotension, hypertension, A-tib, visual impairment

Other: Avoid grapefruit

Adrenergic Agonist (epinephrine)

Therapeutic Use: cardiac dysfunction, anaphylaxis

Mechanism of action: Vasoconstriction by stimulating receptors of vascular smooth muscles

Side Effects: angina, MI, hypertensive crisis, tissue necrosis, tachycardia, seizures, edema

Other: Monitor cardiac rhythm

Antidiuretic Hormone (vasopressin)

Therapeutic Use: heart failure, shock

Mechanism of action: Decreases urine volume and causes vascular smooth muscle constriction

Side Effects: hypertension, MI, angina, water intoxication, seizures, GI manifestations

Other: Close monitoring

Class IC Sodium Channel Blockers (flecainide)

Therapeutic Use: Supraventricular and v tach dysrthythmias

Mechanism of action: Decrease in sodium slows impulse conduction and decrease automaticity

Side Effects: Dizziness, dyspnea, visual disturbances, heart failure worsening

Other: Monitor ECG

Class III Potassium Channel Blockers (amiodarone)

Therapeutic Use: V tach or fib

Mechanism of action: Blocks potassium channels and decreases automaticity slowing conduction

Side Effects: Gi manifestations, pulmonary toxicity, dizziness, fatigue, ataxia, bradycardia, hypotension, blue gray discoloration of skin

Other: Take baseline chest xray before starting

Class IV Calcium Channel Blockers (verapamil)

Therapeutic Use: convert supraventricular tachycardia to a sinus rhythm, slow a-fib and flutter

Mechanism of action: Slow automaticity of SA node

Side Effects: hypotension, bradycardia, heart failure, lightheadedness

Other: Monitor cardiac rhythm and keep supine following dose

Magnesium Sulfate Atropine (Magnesium Sulfate)

Therapeutic Use: anticonvulsant and antiarrhythmic

Mechanism of action: Regulate electrical activity of heart muscle cells and balance membrane potential

Side Effects: hypotension, cardiac arrest, CNS depression, hypocalcemia, hypermagnesemia

Other: Monitor magnesium levels every 6 to 8 hours

Atropine

Therapeutic Use: Treats bradycardia, dry up respiratory tract secretions

Mechanism of action: Inhibits cholinergic receptors

Side Effects: tachycardia, hypotension, a-fib, dry mouth, blurred vision, hallucinations

Other: Do not give clients this is they had a heart transplant

Oseltamivir Action (antiviral)

Treat and prevents flu

palivizumab and ribarivin

Binds with the A antigenic site of RSV fusion protein blocking the virus