Pharm Exam #2

Sympathetic vs Parasympathetic responses

Sympathetic (fight/flight)

• Dilate Pupils

• Increase BP (vasoconstriction)

• Increase HR

• Bronchial relaxation

• Constipation

• Urinary retention

• Inhibit salivation

Parasympathetic (rest/digest)

• Contract Pupils

• Decrease BP (vasodilation)

• Decrease HR

• Bronchial contraction

• Stimulate digestion

• Contract bladder

• Stimulate salivation

ANS cholinergic and adrenergic synonyms for types of drugs

Receptor + NT for parasympathetic ns

cholinergic → ACh

Receptors for sympathetic ns

adrenergic → Epi, NE, Dopamine (aka Catacholamines)

What are adrenergic drugs?

drugs that bind to adrenergic receptors in the sympathetic NS to manage cardiac arrest, asthma, and hypotension

List some adrenergic agonists

albuterol, Epi, NE, dopamine

albuterol pharm class

Short acting beta agonist (SABA)

albuterol therapeutic class

albuterol kinetics

• Onset: 5-15 mins

• Duration: 3-6 mins

albuteerol side effects

• bad taste

• BP increases → jitters/anxiety/restless

• variable effect on RR

epinephrine pharm class

nonselective adrenergic agonist (alpha & beta)

epinephrine therapeutic class

---

epinephrine uses

• Anaphylactic shock & allergic reactions

• Acute hypotension

• Nasal decongestion

• Bronchodilation

• Cardiac arrest

• Ocular decongestion

• Topical hemostasis

• Prolong local anesthesia

• Inhibit insulin secretion

• Uterine relaxation

norepinephrine pharm class

direct acting alpha adrenergic agonist

norepinephrine uses

• cardiac arrest

• hypotensive crisis

norepinephrine adverse effects

severe HTN → causes vasoconstriction

What is the antidote to norepinephrine

any alpha blocker → bc it reverses vasoconstriction caused by excssive stimulation of alpha adrenergic receptors

dopamine pharm class

catecholamine, B1 agonist

What type of inotrope does dopamine do?

positive inotrope → this means increased force of contractions of the heart, pumping more blood with fewer pumps of the heart

dopamine uses

• shock

• Heart surgery

• MI

• CHF

• Increased blood to kidney

What are adrenergic antagonists

drugs that inhibit sympathetic system (can be alpha or beta)

List adrenergic antagonists

doxazosin, prazosin, tamsulosin

How can you identify adrenergic antagonists?

-osin

doxazosin, prazosin, tamsulosin uses

• muscle relaxation of prostate bladder

• BPH

doxazosin, prazosin, tamsulosin side effects

• orthostatic hypotension > reflex tachycardia

• this is why we give the 1st dose at bedtime

adrenergic antagonist nursing consideration

give at bedtime!

What do beta blockers do?

decrease HR and BP

How do you identify beta blockers?

-olol

What is positive inotrope?

increased force of heart contractions

What is positive chronotope?

increased HR

What is positive dromotrope?

increased conduction through AV node

What do B1 blockers do?

Heart

• Decrease HR, cardiac output, and blood pressure

• Negative inotrope - less force of heart contractions so the HR lowers

• Prevent MI

What. do B2 blockers do

Lungs

• Constrict bronchi

• Avoid in asthma and COPD patients

List beta blockers

propranolol, metoprolol, atenolol, labetalol, carvedilol

Beta blocker uses

• Angina

• HTN

• MI

• Glaucoma - decreases intraocular pressure

• Prevent migraines

Beta blocker side effects

DO NOT STOP SUDDENLY - can mask hypoglycemia bc it can cause impaired glucose metabolism

• Bradycardia

• CHF

• N/V

• Constipation

• Diarrhea

• Depression

• Masked hypoglycemia (can cause impaired glucose metabolism)

What are CNS drugs?

drugs that work on the CNS

What is psychosis?

a condition caused by increased dopamine that interferes with person’s ability to think clearly and make decisions

What are antipsychotics

meds that treat psychosis

• need to be taken regularly (psychosis cannot be cured)

• DONT stop taking meds if you feel better

Principles of antipsychotics

AWARE

• Adherence

• Weight gain

• Agranulocytosis (2nd gen antipsychotics)

• Risk for sedation

• Elderly patients at risk for death if used in dementia

What are the different types of antipsychotics?

• Typical antipsychotics (1st gen)

  • Low potency

  • High potency

  • Watch for EPS and NMS

• Atypical antipsychotics (2nd gen)

  • Drugs of choice

  • No EPS! but……

  • watch for

    • agranulocytisis w CBC count tho

    • weight gain from metabolic syndrome

    • Can alter glucose metabolism → and lead to type 2 diabetes

antipsychotic adverse effects (general)

• Dizziness/Drowsiness/Sedation

• Orthostatic hypotension

• Sexual dysfunction lol

• Seizures

• Anticholinergic effects

• BLACK BOX = do not give to patient with dementia

  • Extrapyramidal symptoms

  • Neuroleptic malignant syndrome

• Agranulocytosis & weight gain (2nd gen)

What do Extrapyramidal symptoms (EPS) look like?

Pseudo parkinsonism, acute dystonia, akathisia, tardive dyskinesia

What does Neuromalignant syndrome (NMS) look like?

Fever, confusion, unstable BP, sweating, dyspnea, muscle rigidity, incontinence (*can be fatal)

List Typical antipsychotics (1st gen)

• low potency: phenothiazine

• high potency: haloperidol

List Atypical antipsychotics (2nd gen)

• olanzapine (watch wt gain)

What is depression?

depressive symptoms for more than 2 wks

What are antidepressants?

drugs to tx depression, anxiety disorders, and neuropathic/chronic pain

antidepressant contraindications

• schizophrenic/bipolar (can make them manic)

• hepatic disease

What are the different antidepressant classes?

• MAOIs (a and b)

• TCA

• SSRI

• SNRI

Principles of antidepressants

SAFET

• Suicide risk increased in 18-24 y.o

• Alcohol doesn’t mix with it!

• Food interactions with MAOIs

• Excessive energy can lead to mania

• TAPER THIS SHIT

What are MAOIs?

• drugs that inhibit the enzyme that breaks down something

• interacts with tyramine (lots of food/drug interactions)

• can cause hypertensive crisis

List MAOIs

• phenelzine (different from phenothiazine!!!)

phenelzine

• also selegiline at higher doses to treat parkinsons

• watch for hypertensive crisis

• again, remember to avoid tyramine containing foods!

selegiline Transdermal Patch

• used for major depression

• contraindications: for known drug allergy

• avoid direct heat or sunlight exposure (we don’t want to fasten absorption of drug)

MAOI side effects

• anticholinergic effects ("can't see, can't pee, can't spit, can't poop". Key effects include dry mouth, constipation, urinary retention, blurred vision, dizziness, and cognitive impairment)

• increased risk of hypoglycemia

What are TCAs?

• drugs that inhibit the reuptake of NE adn serotonin

• Take at bedtime to reduce daytime sedation!

• Well absorbed bc of hepatic 1st pass

• Takes 2-6 wks to feel therapeutic effects

• MONITOR ECG

List TCAs

nortriptyline

TCA side effects

• anticholinergic effects

• take at bedtime to reduce daytime sedation

• MONITOR ECG bc it can cause cardiac arrythmias (and orthostatic hypotension)

What are SSRIs?

• DRUG OF CHOICE (good safety profile) for tx depression

  • doesnt cause anticholinergic effects, ortho hypotension, dcardiac arrythmias, and sedation unlike TCAs

• Can take 5 wks to take effect

• BLACK BOX for 18-26 (risk of suicide

• RISK FOR SEROTONIN SYNDROME - can also trigger mania, tis why antidepressants are contraindicated in pt w shizo/bpd

What does serotonin syndrome look like?

excess serotonin → fever, sweats, HTN, muscle spasms, restless/confusion, BP INSTABILITY, hyperthermia, seizure, coma

vitals that make you go what the fuck

What meds put pts at risk for serotonin syndrome?

ones increasing serotonin legvelslevels

• SSRIs

• selegiline

• tramadol

• carbamazepine

• triptans

• antipsychotics

• dextromothorphan

What is lithium?

• a mood stabilizer that treats bipolar disorder

• therapeutic effects related to Na levels

  • low sodium levels = at risk of lithium toxicity

  • high sodium levels = non-therapeutic effects

• has a target serum level of 0.6 - 1.2 mEq/L

  • Excreted by kidneys - still at risk for renal toxicity at normal levels so check kidney labs

What are signs of lithium toxicity?

• target serum levels above 2.5 mEq/L

• nystagmus + tremors/twitching

• Decreased BP

• confusion/impaired consciousness

• Convulsions

• coma

What can treat lithium toxicity?

a hemodialysis on the pt!

lithium adverse effects

• nausea

• metallic taste

• hand tremors

• polyuria

• polydipsia

• diarrhea

• muscle weakness/fatigue

• edema/wt gain

What are antiepileptic drugs (AEDs)/anticonvulsants, antiseizure?

drugs that treat seizures (they are CNS depressant in nature)

• Risk for pregantn women

• IV/rectal is used to stop active seizures

• TAPERRR

• STOP if someone shows sign of alelrgy/rash

• BLACK BOX for suicidality

• Benzos intensify the effects of gabba

List some AEDs

• phenytoin

• dilantin

• carbamazepine

• benzodiazepines

  • diazepam/lorazepam

• pregabalin

• valproic acid (a fuckass AED, worst one)

• levitiracetam

• topiramate

• gabapentin

phenytoin pharm class

AED

phenytoin kinetics

• NARROW therapeutic index = 10-20

  • can get phenytoin toxicity: nystagmus, ataxia, arrythmia

• IV - mix w only saline and give over 50 mins as it can drop BP and cause arrythmia if not done so (phenytoin toxicity

phenytoin adverse effects

• liver toxicity

• GINGIVAL HYPERTROPHY

• rash

• decreased BP

dilantin pharm class

AED

dilantin adverse effects

STEVEN JOHNSON SYNDROME (SJS)

What does Steven Johnson syndrome (SJS) look like?

fever, cough, mucosal surface eruption, bullous, crusting

dilantin drug interactions

• doxazosin

• sulfa

• oral contraceptives

• benzos

• ethanol

• ibuprofen

• acetaminophen

carbamazepine pharm class

AED

carbamazepine uses

• seizure disorders

• BPD

• facial pain associated with trigeminal neuralgia (intense facial pain on one side)

carbamazepine monitoring

RBC, CBC, and platelet abnormalities

benzos diazepam/lorazepam for seizures

• can treat life threatening seizures of status epilepticus

• short duration of action

pregabalin pharm class

AED

pregabalin uses

partial seizures + neuropathic pain

pregabalin side effects

• sedation, weight gain, edema, depression

• MUST TAPER

valproic acid pharm class

a fuckass AED drug)

valproic acid uses

seizures, bpd, migraines

valproic acid adverse effects

hepatotoxicity and pancreatitis

levetiracetam pharm class

AED

levetiracetam side effects

minimal side effects and drug interactions

topiramate pharm class

AED

topiramate uses

seizures, migrains, and alcohol dependence

topiramate side effects

• kidney stones, weight loss, CNS depression

• MUST TAPER UP AND DOWN

• push fluids!

gabapentin pharm class

AED

gabapentin uses

seizures, neuropathic pain, bpd

gabapentin side effects

renal dosing

• dizziness/drowsiness/fatigue

• Loss of muscle coordination

• gingivitis

• pruritis

• MUST TAPER

What drugs treat Parkinson’s?

dopaminergic drugs

What do dopaminergic drugs do?

they restore dopamine function + block teh effect of ACh

List dopaminergic drugs

• ropinirole

• bromocriptine

• entacapone

• selegiline

• levodopa/carbidopa

ropinirole pharm class

dopamine receptor agonist

ropinirole side effects

• similar side effects to anti-PD drugs

• can cause narcolepsy, addictive behavior possible

• avoid w alcohol

• contraindicated in pregnancy

bromocriptine pharm class

dopamine receptor agonist

entacapone pharm class

COMT inhibitor - extends action of dopamine