Bluprint drugs exam 3

Pseudoephedrine

Classification: alpha agonist

Indications: upper airway infections

MOA: shrinks nasal mucous membranes and reduces nasal congestion

Considerations:

• limited use due to illicit drug manufacturing

• don’t use with glaucoma, HTN, or enlarged prostate

• don’t administer within 2 hr of bed time

Tamsulosin (Flomax)

Classification: alpha 1 antagonists

Indications: treats BPH

MOA: selectively blocks alpha receptors in the prostate and urethra

Adverse effects: orthostatic hypotension

dobutamine

Classification: beta 1 agonist

Indications: cardiogenic shock or sever heart failure

MOA: stimulates beta 1 receptors —> increase HR and force of contraction and conductivity velocity

Considerations: notify provider immediately for chest pain, SOB, numbness/tingling in extremities

Adverse effects:

• HTN

• SOB

• palpitations

• tachycardia

metoprolol

Classification: beta 1 antagonists (selective beta blocker)

Indications: HTN, angina, arrhythmias

MOA: blocks beta 1 receptors in the heart —> lowers HR and BP

Considerations:

• take apical pulse

• limit caffeine

• don’t stop abruptly

Adverse effects:

• hypotension

• nightmares/insomnia

• masks s/s of hypoglycemia

• erectile dysfunction

albuterol

Classification: beta 2 agonists (selective)

Indications: asthma and COPD

MOA: stimulates beta 2 receptors in lungs

Adverse effects: paradoxical bronchospasm

epinephrine/norepinephrine

Classification: alpha/beta agonists (catecholamine)

Indications: bronchospasm and cardiac resuscitation

MOA:

• decreases vasodilation (alpha)

• increase vascular permeability (alpha)

• bronchial smooth muscle relaxation (beta)

Considerations:

• contraindicated for narrow angle glaucoma

• caution with elderly with CV

dopamine

Classification: alpha/beta agonists (catecholamine)

Indications: perfuse organs and improve cardiac output

MOA: dose based

• low dose = stimulates dopamine receptors and dilates renal vasculature (perfusing)

• moderate dose = stimulates beta receptors and has positive inotropic effect (conduction)

• high dose = stimulates alpha receptors constricting blood vessels and increase BP

Notify provider if:

• sweating

• dizziness

• palpitations

• decrease blood flow to extremities

nicotine patch

Classification: nicotine receptor agonists

Indications: aid in nicotine cessation

MOA: bind activates nicotinic acetylcholine receptors

Adverse effects: nicotine OD

pilocarpine

Classification: muscarinic receptor agonists

Indications: treat glaucoma

MOA: acts on muscarinic receptors in iris to increase outflow of aqueous humor

• constricts pupil

• stimulate goblet cells —> tearing

asprin

Indications: mild pain, fever, inflammation, and decrease aggregation

MOA: inhibits COX, pain/fever, and platelet aggregation

Considerations:

• > 12 y/o —> Reye’s Syndrome

• avoid alcohol

• stop 7 days before surgery

ibuprofen

Indications: mild pain, fever, inflammation

MOA: inhibits COX, pain/fever, and platelet aggregation

Considerations:

• enteric precautions

• stop 7 days before surgery

• don’t take more that 10 days

• don’t exceed 3500 mg/day

• contraindicated with post op pain with CABG

Adverse effects:

• steven johnson syndrome

• renal failure

Ketorolac (toradol)

Indications: acute pain/breakthrough pain

MOA: inhibition of prostaglandin synthesis

Considerations:

• adults only

• reduce dosing for >65 y/o

• don’t use more than 5 day s

• don’t use aspirin

Adverse effects:

• steven johnson syndrome

• renal failure = volume depletion

• bleeding

• hypersensitivity

celecoxib (celebrex)

Indications: pain from arthritis

MOA: inhibition of prostaglandin synthesis COX 2

Considerations:

• take lowest effective does for shortest period of time

• avoid alcohol and aspirin

Adverse effects:

• heart failure w/ edema

• hyperkalemia

• renal failure

• stevens johnson syndrome

morphine

Indications: moderate to severe pain

MOA: mimics opioid peptide primarily at mu receptors

Adverse effects:

• respiratory depression

• hypotension

• sedation

naloxone (narcan)

Indications: reduces CNS suppression caused by opioid agonists

MOA: compete with opioid receptors in the brain and displaces and prevent opioid occupying receptors

Adverse effects:

• decreased respirations

• HTN

• agitation

allopurinol (zyloprim)

Indications: prevention/treatment of gouty arthritis and nephropathy

MOA: block production of uric acid

Adverse effects:

• orthostatic hypotension

• sedating effects

• hepatotoxicity

gabapentin

Classification: anticonvulsant

Indications: seizures, partial seizures, neuropathic pain

MOA: unknown

Considerations:

• don’t stop abruptly

• don’t take with antacids

Adverse effects:

• behavioral abnormalities

• coordination difficulties

phenytoin (dilantin)

Classification: anticonvulsant

Indications: seizures and tonic clonic

MOA: interfere with sodium channels in brain

Considerations:

• don’t stop abruptly

• avoid other CNS depressants

Adverse effects:

• gingival hyperplasia

• nystagmus

• ataxia

methylphenidate (ritalin/concerta)

Classification: CNS stimulants

Indications: ADHD

MOA: stimulates brain; blocks reuptake of norepinephrine and dopamine into presynaptic neuron

Adverse effects:

• lethargy

• peripheral vasculopathy (Raynaud’s)

• gynecomastia

carbidopa/levodopa (sinemet)

Classification: anti-parkinson

Indications: parkinson and restless leg syndrome

MOA: carbidopa prevents levodopa from being broken down before crossing the BBB and then it can convert to dopamine in the brain

Considerations:

• contraindicated with MAOI

• high protein diet decrease absorption

• don’t stop abruptly

• don’t take with antacids

Adverse effects:

• sedation

• suicidality

• intense gambling addiction and sexual urges

• risk of melanoma

donepezil (aricept)

Classification: cholinesterase inhibitors

Indications: mild to moderate/severe dementia

MOA: prevents breakdown of ACH and increases availability of ACH at cholinergic synapses

Considerations: 1/12 patients benefit

Adverse effects:

• bronchoconstriction

• bradycardia

echinacea

Indications: used to prevent/ treat colds, fly, promotes wound healing and UTI

Considerations:

• immune suppression

• decrease effectiveness of immunosuppressants

• contraindicated w/ autoimmune disease

garlic

Indications: antimicrobial, antilipidemic, antithrombotic, antitumor, and antiinflammatory

Considerations:

• potentiates anticoagulants, antiplatelets, antihypertensives, antihyperlipidemic, and diabetic meds

• decrease effectiveness of hormonal contraceptives

• contraindicated with PUD/GERD

ginger

Indications: antiemetic, anti inflammatory, and digestive aid

Considerations:

• potentiates antiplatelet, anticoagulants, antidiabetic meds, and herbs that increase bleeding

• contraindicated w/ gallstones

saw palmetto

Indications: mild diuretic and urinary antiseptic

• BPH

• increase sexual vigor

• cystitis

Considerations:

• interact with hormonal meds

• cause false negative on PSA

Adverse effects:

• constipation

• back pain

• decrease libido

St. John’s Wort

Indications: mild to moderate depression, sleep disorders, skin, and wound healing

Usually decrease effectiveness of:

• digoxin

• antiviral meds

• aids meds

• theophylline

• warfarin

• hormonal contraceptives

Contraindicated for:

• major depression

• transplant recipients

• SSRI/MAOI

Adverse effects:

• photosensitivity

• dry mouth

• dizziness

Hawthorn

Indications: mild to moderate heart failure, HTN, and cholesterol reduction

Considerations: potentiate/interfere with wide range of CV meds for heart failure, angina, arrhythmias, HTN, and vasodilation

short acting insulin (regular)

MOA: stimulates peripheral glucose uptake by skeletal muscle and fat and inhibits hepatic glucose production

• give with meals

intermediate acting insulin (NPH)

MOA: mimics basal insulin levels

• roll to mix

long acting insulin (lantus)

MOA: stimulates peripheral glucose uptake by skeletal muscle and fat and inhibits hepatic glucose production

• no peak

glipizide

Classification: sulfonylurea

Indications: type 2 hyperglycemia

MOA: stimulates insulin secretion from beta islet cells in pancreas

• contraindicated for diabetic ketoacidosis

• potentiated by nonsteroidal anti-inflammatory drugs

Adverse effects:

• arrhythmias

• hypoglycemia

• anemia

• erythema malformation

levothyroxine (synthroid)

Classification: thyroid replacement

Indications: T4 deficiency

Considerations:

• lifelong med

• take with water on empty stomach 30-60 min before breakfast

• way worse glycemic control

• increase response to oral anticoagulants

• affects several meds

propylthiouracil (PTU)

Indications: hyperthyroidism

MOA: inhibit synthesis of thyroid hormones

Considerations: monitor patients weight

Adverse effects:

• agranulocytosis

• vasculitis

• jaundice

• bleeding/bruising