pharmacology exam 2

diphenhydramine

diphenhydramine

therapeutic class: drug to treat allergies

actions and uses: minor symptoms of allergy and common cold such as sneezing, runny nose, and tearing of eyes; Parkinson’s disease; motion sickness; insomnia

administration: PO/IV/IM/topical; take at night; avoid alcohol; sugarless candies; increase fluids

adverse effects: drowsiness, paradoxical CNS stimulation, dry mouth, tachycardia, mild hypotension, photosensitivity

contraindications: BPH, narrow-angle glaucoma, GI obstruction

interactions: alcohol/opioids (CNS depressant), other OTC cold drugs may increase anticholinergic affects, MAOIs may cause hypertensive crisis

fluticasone

actions and uses: allergic rhinitis, asthma, skin inflammation, nasal stuffiness

administration: Intranasal - two sprays in each nostril twice daily, then decreases to once daily

pharmacokinetics: onset is 12 hours to one day, and duration is several days

adverse effects: nasal irritation, epistaxis

contraindications: hypersensitivity

phenylephrine

constricts small blood vessels, shrinking inflamed tissue, allowing the nasal secretions to drain more freely. more systemic effect and less effective at relieving severe congestion

often combined with antihistamine preparations

antitussives (codeine and hydrocodone)

forcibly removes excess secretions and foreign material that inhibits

opioids: suppress cough reflex by direct action on the cough center in the medulla, drying out the mucosa of the respiratory tract and reduces runny nose and post nasal drip

dextromethorphan

therapeutic class: cough suppressant

pharmacological class: antitussive

actions and uses: non-opioid drug in many OTC severe cold and flu drugs for nonproductive coughs

administration: PO

adverse effects: drowsiness, headache, GI upset

contraindications: chronic cough, no children under 6 years of age

interactions: driving

albuterol

therapeutic class: bronchodilator

actions and uses: SABA, acute bronchospasm

administration: not for long term use, rinse mouth after taking

adverse effects: tachycardia, palpitations, restlessness, tremors

contraindications: cardiac patients

interactions: avoid caffeine, beta-blockers inhibit action, MAOIs

ipratropium

therapeutic class: bronchodilator

pharmacological class: anticholinergic

actions and uses: severe asthma exacerbations

administration: inhaled and intranasal; wait 2-3 minutes between doses

adverse effects: cough, dry nasal mucosa, hoarseness, bitter taste

methylxanthines

bronchodilators

chronic asthma pharmacotherapy

adverse effects: N/V, CNS stimulation

IV/PO

long-term prophylaxis of asthma that is unresponsive to beta agonists or corticosteroids

corticosteroids

inhaled, drug of choice for asthma

must be taken daily, side effects rarely observed

oral, limit to 10 days

leukotriene modifers

mediators of immune response, used for asthma prophylaxis, reduce inflammatory component

adverse effects: headache, cough, nasal congestion, GI upset

mast cell stabilizers

inhibit mast cells from releasing histamine and other mediators

montelukast

therapeutic class: anti-inflammatory for asthma prophylaxis

actions and uses: prophylaxis of persistent and chronic asthma, exercise-induced bronchospasm, and allergic rhinitis

administration: PO, only one approved for pediatrics; take drug 2 hours before activity

adverse effects: headache, suicidal ideation, hallucinations, aggressiveness, depressio

heparin

therapeutic class: anticoagulant

pharmacological class: thrombin inhibitor

actions and uses: prolong coagulation time to prevent excessive clotting; higher doses treat DVT and pulmonary embolism

administration: parenteral; patient weight + PTT + clinical indication

adverse effects: bleeding (monitor aPTT), heparin induced thrombocytopenia (5-10 days after)

contraindications: active internal bleeding, bleeding disorders, severe HTN, recent trauma, intracranial hemorrhage

interactions: other anticoagulants increase risk of bleeding; aspirin/indomethacin/ibuprofen may induce bleeding; nicotine, digoxin, tetracycline, or antihistamines may inhibit anticoagulation

herbal: ginger, garlic, green tea, ginkgo, feverfew

reversal: protamine sulfate

warfarin

therapeutic class: anticoagulant

pharmacological class: vitamin K antagonist

actions and uses: prevention of stroke, DVT, MI, pulmonary embolism; hip/knee surgery; long term central lines/ports or prosthetic heart valves

administration: several days to reach max effect, INR 2-3

adverse effects: bleeding

black-box: major or fatal bleeding, monitor INR regularly

contraindications: recent trauma, active internal bleeding, bleeding disorders, intracranial hemorrhage

interactions: NSAIDs, SSRI, steroids, vitamin K

clopidogrel

therapeutic class: antiplatelet

actions and uses: reduce the rate of MI or stroke with ST-elevation, angina, non-ST-elecation, PCI, or CABG; thrombi formation

administration: with aspirin, discontinue drug at least 5 days before surgery

adverse effects: flulike symptoms, headache, dizziness, bruising, rash, puritis

contraindications: active bleeding

interactions: other anticoagulants, other anti platelets, thrombolytics, NSAIDs; g foods

treatment of overdose: platelet infusions

fibrinolytics

-tPa, alteplase

-promote process of fibrinolysis; converts plasminogen to plasmin

-give within 4 hours of clot formation

-treat MI, DVT, CVA, PE, clear IVs

-monitor for bleeding

furosemide

therapeutic class: drug for heart failure and HTN

actions and uses: heart failure; prevent reabsorption of sodium and chloride in the loop of henle

administration: PO/IV (IV within 5 min); monitor potassium

adverse effects: hypokalemia, dehydration, hypotension, syncope, ototoxicity

interactions: digoxin - hypokalemia; aminoglycosides - nephrotoxicity and ototoxicity; lithium - lithium toxicity

hydrochlorothiazide

therapeutic class: thiazide

actions and uses: HTN, ascites, edema, heart failure, decrease reabsorption of sodium

adverse effects: hyponatremia and hypokalemia

interactions: NSAIDs - nephrotoxicity; digoxin; carbamazepine

spironolactone

therapeutic class: antihypertensive

actions and uses: mild HTN, reduce edema, slowing heart failure

administration: give food to increase absorption, NO POTASSIUM

adverse effects: hyperkalemia, gynecomastia

contraindications:

interactions: aspirin increases K levels; decreases effects of digoxin; potassium supplements; ACE inhibitors increase K

mannitol

-reduce intracranial pressure due to cerebral edema

-maintain urine flow in prolonged surgery, AKI, or severe renal hypoperfusion

losartan

therapeutic class: HTN, angiotensin II receptor blocker

actions and uses: HTN

administration: can be combined with hydrochlorothiazide

adverse effects: hypoglycemia, dizziness, angioedema, AKI

black-box: fetal injury and death may occur when ARBs are taken during pregnancy

contraindications:

interactions: NSAIDs, potassium supplements, potassium-sparing diuretics, other antihypertensives

beta-andrenergic blockers

uses: decrease HR and contractility; reduce COP and lower systemic BP

alpha 1 adrenergic antagonists

uses: HTN and BPH

alpha 2 adrenergic agonists: clonidine

uses: decrease outflow of CNS to heart and arterioles

adverse effects: hemolytic anemia, leukopenia, thrombocytopenia, lupus

alpha 1 blockers

doxazosin, prazosin, terazosin, tamsulosin

uses: dilate arteries and veins

carvedilol

uses: HTN; mild to moderate HR in conjunction with digoxin, diuretics, and ACE inhibitors

contraindications: known allergy, cardiogenic shock, severe bradycardia or HF, bronchospastic conditions such as asthma and COPD, various conduction cardiac problems

ACE inhibitors

uses: HTN, HF, slow progression of left ventricular hypertrophy after MI, renal protective

adverse: persistent dry cough, angioedema, postural hypotension, kyperkalemia

hydralazine

therapeutic class: direct acting vasodilator

actions and uses: HTN and heart failure

administration: abrupt withdrawal may cause rebound HTN and anxiety; low doses to gradually increase

adverse effects: headache, reflex tachycardia, flushing

contraindications: angina or rheumatic mitral valve heart disease, lupus

interactions: other antihypertensives, NSAIDs, hawthorn

procainamide

therapeutic class: sodium channel blocker

actions and uses: slows conduction; atrial and ventricular dysrhythmias

administration: IV/IM; supine position

adverse effects: hypotension, headache, CNS effects

black-box: increased titer of antinuclear antibodies; lupus like symptoms; agranulocytosis, bone marrow depression, neutropenia, hypo plastic anemia, and thrombocytopenia

contraindications: complete AV block, severe HF

propanolol

therapeutic class: beta-adrenergic antagonist

actions and uses: slows HR and reduces BP, HTN, angina, prevents HF, migraine, decrease portal HTN and esophageal varices, tachycardia

administration: do not discontinue abruptly, monitor pulse before tacking

adverse effects: hypotension, bradycardia, diminished libido, hypoglycemia

contraindications: cariogenic shock, bradycardia, heart block, COPD, asthma

interactions: CCB cause brady and hypotension, phenothiazines cause hypotension, MAIO cause hypotension

amiodarone

therapeutic class: potassium channel blockers

actions and uses: ventricular tachycardia, atrial dysrhythmias,

administration: PO/IV

adverse effects: pulmonary toxicity, elevated LFTs, thyroid dysfunction

contraindications: bradycardia, cariogenic shock, AV block

interactions: warfarin, beta blockers, CCB, st. johns wort, grapefruit juice

verampamil

therapeutic class: calcium channel blocker

actions and uses: stabilizes dysrhythmias

administration: PO/IV

adverse effects: headache, flushed skin, constipation, hypotension, bradycardia

contraindications: heart blocks, sick sinus syndrome, hypotension

interactions: digoxin, antihypertensives, statins,

adenosine

uses: supraventricular tachycardia

adverse: new or worse dysrhythmias, facial flushing, dyspnea

digoxin

uses: certain types of atrial dysrhythmias

adverse: nausea, vomiting, headache, visual disturbances

lisinopril

therapeutic class: ACE inhibitor

actions and uses: HF, HTN

administration: assess BP, monitor renal function

adverse effects: dry cough, angio edema, headache, dizziness, orthostatic hypotension, hyperkalemia

contraindications: hyperkalemia, previous angio edema

interactions: NSAIDs, potassium-sparing diuretic, other antihypertensives, potassium

metoprolol

therapeutic class: beta blockers

actions and uses: decrease heart load, decrease HR, slows HF, angina, HTN

administration: monitor ECG, BP, and pulse before administering

adverse effects: bradycardia, hypotension

contraindications: cardiogenic shock, heart block, hypotension, COPD, asthma

interactions: other antihypertensives

digoxin

therapeutic class: cardiac glycoside

actions and uses: increase contractibility or strength of contraction

administration: assess apical pulse (>60)

adverse effects: dysrhythmias, hypokalemia, N/V, yellow halos

contraindications:

interactions: potassium sparing diuretics, hypokalemia, ACE inhibitors, potassium supplements, beta-blockers, CCB

milrinone

therapeutic class: phosphodiesterase inhibitor

actions and uses: heart failure, increases force of contraction

administration: IV only, monitor HR and BP

adverse effects: cardiac dysrhythmias, hypotension

contraindications:

interactions:

nitroglycerin

therapeutic class: abtianginal, vasodilator, organic nitrate

actions and uses: sublingual/PO/IV/transdermal/topical/XL

adverse effects: hypotension, headache, reflex tachycardia

contraindications: hypotension, increased ICP or head trauma

interactions: phosphodiesterase-5 inhibitors cause hypotension/CV collapse;

diltiazem

therapeutic class: CCB

actions and uses: HTN, angina, dysrhythmias

administration: PO/IV

adverse effects: headache, dizziness

contraindications: AV heart block, sick sinus syndrome

alteplase

therapeutic class: fibrinolytic

actions and uses: dissolve blood clots

administration: IV within 20 minutes,

adverse effects: bleeding

contraindications: history of stroke, head injury, active internal bleeding, recent trauma/surgery

interactions: aspirin, anticoagulants, platelet inhibitors; g foods

atorvastatin

therapeutic class: antihyperlipidemic

actions and uses: hyperlipidemia, reduce risk of MI or stoke

administration: give with food to decrease GI discomfort, better to take at night, can take 2 weeks to see effects

adverse effects: GI upset, hepatotoxicity, rhabdomyolysis

contraindications: severe liver disease, hypersensitivty

interactions: HIV protease inhibitors increase rhabdomyolysis, macrolide antibiotics increase risk of rhabdomyolysis; grapefruit

cholestyramine

therapeutic class: antihyperlipidemic

actions and uses: high cholesterol

administration: powder mixed with fluid once or BID, may take 30 days for max effect, mix with non-carbonated beverages, give other meds 2 hours before or 4 hours after

adverse effects: constipation, bloating, gas, and nausea

contraindications: total biliary obstruction

interactions: many!

ezetimibe

uses: inhibits absorption of cholesterol in small intestine; lowering LDL levels

adverse effects: nasopharyngitis, myalgia, URI, arthralgia, diarrhea

niacin

uses: b-complex vitamin to decrease VLDL

adverse effects: flushing, hot flashes, nausea, excess gas, diarrhea, hepatotoxicity, gout

administration: take with full glass of water

omega-3 fatty acids

foods: tuna, salmon, halibut, flaxseeds, soybeans, walnuts

supplements: fish oil, cod liver oil, algal oil

drugs: lovaza, vascepa

adverse effects: eructation, fishy taste, diarrhea

decongestants

MOA: causes reduction in inflammation of nasal membranes

examples: pseudoephedrine, phenylpropanolamine, chlorphenramine

uses: nonallergic rhinitis, nasal congestion, sinusitis, common cold and flu

effects: hypertension, tachycardia, heart palpitations, insomnia, anxiety, nasal and oral dryness, headache, nausea

antihistamines

MOA: h1 receptor antagonist

examples: 1st gen/sedating/short-acting - diphenhydramine, promethazine. 2nd get/non-sedating/long-acting - citirazine, loratadine

uses: allergic reactions, common cold, itchy eyes, hives

effects: drowsiness, paradoxical CNS stimulation (kids), dry mouth, tachycardia, mild hypotension, photosensitivity

nursing: take at night, increase fluid intake, suck on sugarless candies, avoid alcohol, take prior to allergy season

expectorants

MOA: reduce thickness of bronchial secretions and increase mucus flow that is more easily removed by coughing

examples: gauifenesin (mucinex), acetylcysteine (mucomyst)

uses: cystic fibrosis, pneumonia, bronchitis, COPD, chest congestion, rhinitis, colds/cough

effects: drowsiness, dizziness, GI upset, dyspnea, fatigue, allergic reaction, increased congestion

nursing: increase fluids, take with water, report cough lasting longer than a week