Pharmacology exam 2

isoniazid (INH): mechanism of action

Bactericidal or bacteriostatic, Prevent synthesis of mycotic acid which disrupts the cell wall

isoniazid (INH): adverse effects

Peripheral neuropathy; hepatotoxicity

isoniazid (INH): labs

LFTs, PYRIDOXINE prescribed with INH

Rifampin: mechanism of action

Bactericidal, Blocks DNA/RNA synthesis

Rifampin: adverse effects

Orange discoloration of body fluids; hepatotoxicity

Rifampin: labs

LFTs

Ethambutol: mechanism of action

bacteriostatic, Exact MA unknown, blocks the growth of mycobacteria

Ethambutol: adverse effects

blindness; hepatotoxicity

Ethambutol: labs

LFTs; eye exam

TB drugs: patient education

drug therapy is long term (6-12 months), follow up sputum collection for AFB

antitussives (opiods and non opioids) treat

upper respiratory infection/common cold

Opiods: mechanism of action

works on CNS system to increase cough threshold

Opiods: indications

decrease frequency and intensity of nonproductive cough

Opiods: adverse effects

NS: dizziness, lightheadedness, drowsiness, respiratory, depression, GI: nausea, vomiting, constipation

Opiod: example

Codeine

Non-opioids: mechanism of action

Works on CNS to suppress sough

Non-opioids: indications

Suppresses cough

Non-opioids: adverse effects

dizziness, sedation, nausea

Non-opioids: example

Dextromethorphan

Antihistamines treat

Upper Respiratory Infection; Common Cold

Antihistamines: mechanism of action

Block histamine; compete at sites on cell

Antihistamines: Indications

nasal allergies; rhinitis, allergic reactions, motion sickness, Parkinson’s disease, sleep disorders, common cold

Antihistamines: Adverse effects

drying effect, anticholinergic effect- “reduced urination, reduced lacrimation, reduced saliva, reduced defecation”; DROWSINESS

Antihistamines: example

Sedating:

diphenhydramine (Benadryl)- watch driving, operating

machines, take with sugarless hard candy if dry mouth occurs

promethazine (Phenergan)- anti-nausea effects usually with

surgery/motion sickness

Non-sedating:

loratadine (Claritin), fexofenadine (Allegra); cetirizine (Zyrtec)

Decongestants: mechanism of action

constrict blood vessels that supply secretions; TURN OFF INFLAMMATION

CELLS; shrink engorged membranes- OUCH!

Decongestants: Indications

people with nasal congestion and swelling of nasal passage

Decongestants: Adverse effects

agitation, nervousness, vasoconstriction; insomnia, heart palpitations, tremors; WATCH for rebound congestion if used for more than 5 days; do not use in closed angle glaucoma

Decongestants: Examples

ORAL- pseudoephedrine (Sudafed)

TOPICAL- phenylephrine (Neo-Synephrine):

(used to treat the itching, swelling, and pain of hemorrhoids)

Decongestants: contraindications

patients with hypertensive

Expectorants: mechanism of action

stimulate cough reflex; COUGH OUT SECRETIONS

Expectorants: Indications

productive coughs; removal of mucous

Expectorants: adverse effects

dizziness, GI upset, rash; suggestions- (take with full glass of water); REMEMBER-

good hydration THINS out secretions!!!

Expectorants: example

Guaifenesin

Mucolytics: Mechanism of action

thin secretions

Mucolytics: Indications

those with thick secretions

Mucolytics: adverse effects

aspiration and bronchospasm when administered orally; hepatoxicity, concern for sedation anti-cholinergic effects, GI upset, hallucinations in children, respiratory depression; smells like rotten eggs

Mucolytics: example

Acetylcysteine

Anticholinergics: treat

airflow disorders

Anticholinergics:

block ACH (ACH: acetylcholine- neurotransmitter; causes muscles to contract; activates pain); so it dilates the bronchioles

Anticholinergics: Indications

bronchoconstriction; NOT FOR ACUTE ASTHMA ATTACK (these have slow, prolonged action)

Anticholinergics: Adverse effects

drying, constipation, urinary retention, heart palpitations, H/A, cough, anxiety; wait 5 min between different inhaled meds

Anticholinergics: example (pium)

Ipratropium, Tiotropium

Beta2 adrenergic agonists: treats

acute asthma attacks

Beta2 adrenergic agonists: mechanism of action

dilation of airways; relax smooth muscle in bronchi/bronchioles

Beta2 adrenergic agonists: indications

relief of bronchospasm r/t ASTHMA, BRONCHITIS, PULMONARY DISEASES

Beta2 adrenergic agonists: adverse effects

tremors, angina, H/A, changes in BP, palpitations)

Beta2 adrenergic agonists: examples

• Albuterol- inhaled SABA (short acting beta agonist); OR oral LABA

(longer acting beta agonist)

• Salmeterol- oral LABA

• Terbutaline- oral LABA

Epinephrine: adverse effects

insomnia, restlessness, anorexia, H/A from vasodilation, increased B.S, tremor, heart palpitation

Short acting bronchodilators rules

• 15 to 30 minutes to start working

• last 4 to 6 hours

• used when symptoms are once in a while

Long acting bronchodilators rules

• 12 to 24 hours to relieve symptoms

• used when symptoms are frequent

Long acting bronchodilators: examples

• Formoterol (foradil, perforomist),

• Salmeterol (servent)

• Tiotropium (spirvia)

Glucocorticosteriods: Mechanism of action

Anti-inflammatory; decrease bronchoconstriction; CAN BE WEEKS BEFORE FULL EFFECTS

Glucocorticosteriods: Indications

chronic asthma, not acute attacks

Glucocorticosteriods: Adverse effects

pharyngeal irritation; cough, dry mouth, oral fungal infections no spacers; WATCH blood sugars (can raise blood sugar)

Glucocorticosteriods: Examples

• Beclomethasone- RINSE (risk of thrush)

• Prednisone- (watch for myopathy; PUD-peptic ulcer disease; infection;

wt gain; adrenal insufficiency; bone density decrease; increased blood

sugar)

Should you abruptly stop this dose?

NO because it can risk getting adrenocortical insufficiency

Leukotriene Modifiers (Leukotriene receptor antagonists): mechanism of action

prevention of leukotriene attachment to cells--- this then decreases inflammation, decreases bronchoconstriction, and decreases coughing, wheezing, SOB So leukotrienes are released when there is a trigger; these drugs stop

their attachments to cells

Leukotriene Modifiers (Leukotriene receptor antagonists): indications

prophylaxis/treatment of asthma- not acute asthma attack; allergic rhinitis

Leukotriene Modifiers (Leukotriene receptor antagonists): adverse effects

H/A, nausea, dizziness, WATCH LIVER (hepatic impairment)

Leukotriene Modifiers (Leukotriene receptor antagonists): examples

• Montelukast (Singulair); (watch liver, watch 4 depression) It is used in children as young as 12 months of age

• Zafirlukast

Xanthine Derivatives:

smooth muscle relaxation; bronchodilating; increases airflow

Xanthine Derivatives: indications

asthma, bronchitis, emphysema, COPD

Xanthine Derivatives: adverse effects

n/v, increase blood sugar, reflux, dysrhythmias,

Xanthine Derivatives: examples

• Theophylline

• Theobromine- long term therapy

(ATI 5-15 level in blood; 10-20- text); WATCH CAFFEINE WITH USAGE

(increased CNS stimulation with combo); be cautious with peptic ulcer

disease/GI/cardiac

RAAS

• renin released from kidney

• liver releases angiotensin 1

• angiotensin 1 becomes angiotensin converting enzyme in the lungs

• that converts angiotensin 1 to angiotensin 2

• then causes vasoconstriction and releases aldosterone from the adrenal glands

• releases aldosterone holds on water and salt and releases potassium increasing BP

Furosemide/ Bumetanide/ torsemide: class

loop diuretic (-mide)

Furosemide/ Bumetanide/ torsemide: mechanism of action

Works in the kidney on the loop of henle blocks reabsorption of sodium, calcium, and water causing diuresis

Furosemide/ Bumetanide/ torsemide: indications

• fluid overload

• edema

• HF

• pulmonary edema

• hypercalcemia

Furosemide/ Bumetanide/ torsemide: adverse effects

• dehydration

• Hypokelmia

• Ototoxicity

• Hypotension

• hyponatremia

• hypotension

Furosemide/ Bumetanide/ torsemide: labs

BP, cardiac status, UIO, daily weights, electrolytes(dehydration), hearing loss/tinnitus/dizzy (ototoxicity)

Furosemide/ Bumetanide/ torsemide: nursing considerations

Take medication in morning and change positions slowly

Hydrochlorthiazide/ chlorothiazide: class

Thiazide (-thiazide)

Hydrochlorthiazide/ chlorothiazide: mechanism of action

Works in the kidney in the distal convoluted tubule, blocks reabsorption of sodium, and calcium and water

Hydrochlorthiazide/ chlorothiazide: indications

first line choice for HTN, edema, mild to mod HF, liver disease, kidney disease

Hydrochlorthiazide/ chlorothiazide: adverse effects

• dehydration

• hypokelmia

• hyperuricemia

• hyperglycemia

• hyponatremia

• hypomagneismia

Hydrochlorthiazide/ chlorothiazide: labs

BP, cardiac status, I/O, daily weights, electrolytes (for dehydration), glucose (hyperglycemia)

Hydrochlorthiazide/ chlorothiazide: nursing considerations

take medication in morning and change positions slowly

Spironolcatone: class

Potassium sparing

Spironolcatone: mechanism of action

blocks action of aldosterone resulting in sodium excretion, water excretion, potassium retention

Spironolcatone: indications

• HTN

• edema

• HF

• liver failure

Spironolcatone: adverse effects

• hyperkalemia

• endocrine effects: gynecomastia, hirsutism

• deppened voice

• menstrual irregularities

• impotence

• drowsniess

• metabolic acidosis

Spironolcatone: labs

Spironolcatone: nursing considerations

Take meidication in morning and change positions slowly, LIMIT FOOD HIGH IN POTASSIUM AND AVOID SALT SUBSTITUTES

Mannitol: class

Osmotic

Mannitol: mechanism of action

increase serum osmolarity, increase osmotic pressure in the kidneys , blocks reabsorption of water and electrolytes

Mannitol: indications

• increase ICP (increased intracranial pressure)

• increase IOP (increase intaocular pressure_

• prevents AKI (acute kidney injury) in trauma and shock patients

Mannitol: adverse effects

• dehydration

• hyponatrenia

• HF and pulmonary edem

• HA

Mannitol: labs

• Cardio and neurological status

• VS

• I/O

• daily weights

• Renal function

• electrolytes

• IOP

Mannitol: nursing considerations

IV administration only using a filter needle

Captopril/ Lisinopril (PRIL): class

Angiotensin converting enzyme inhibitors (ACEI) - PRIL

Captopril/ Lisinopril (PRIL): mechanism of action

Blocks conversion of angiotensin I to angiotensin II, causing vasodilation

Captopril/ Lisinopril (PRIL) : indications

• HTN

• heart failure

• MI

• diabetic

• nephropathy

Captopril/ Lisinopril (PRIL) : labs

BP, change positions slowly

Captopril/ Lisinopril (PRIL) : side effects

• Angioedema

• cough

• hyperkalemia

Losartan (SARTAN): class

Angiotensin II receptor blockers (ARBS) - SARTAN

Losartan (SARTAN): mechanism of action

Blocks action of angiotensin II

Losartan (SARTAN): Indications

• HTN

• heartfailure

• MI

• diabetic

• nephropathy

Losartan (SARTAN): labs

monitor BP

Losartan (SARTAN): side effects

• angioedema

• GI upset

• hyperkalemia

• insomnia

• URI

• H/A

Metoprolol/ Labetalol/ Propanolol: class

Beta-blockers

- LOL