Pharmacology of Autonomic Drugs, Vaccines, and Chemotherapy Agents

Albuterol

adrenergic agonist

Metoprolol

adrenergic antagonist

Bethanechol

cholinergic agonist 'DUMBBELLS'

Atropine

cholinergic antagonist 'DRY, TIRED, TACHY'

Live-Attenuated Vaccines

use weakened pathogens to mimic natural infections → strong, long-lasting immune response, generally avoided for immunocompromised

Inactivated Vaccines

use killed pathogens to safely trigger response, need multiple doses to maintain immunity (6 types)

Whole-cell inactivated

use the entire killed bacteria

Subunit conjugates

use necessary parts of pathogen with stronger antigen

Toxoids

use inactivated toxins produced by bacteria

Recombinant Vaccines

protein-based, no virus

Viral vector vaccines

use modified, safe-proteins, contains genetic instructions

mRNA Vaccines

use same genetic code to produce viral proteins, no virus

Contraindications for Vaccines

Immunocompromised, Severe allergic reactions, History of Guillain-Barre syndrome, Pregnancy

Vaccine Side Effects

PO- nausea, vomiting, diarrhea; Intranasally- runny nose; IM/SQ- localized soreness, swelling, inflammation around injection site

Vaccine Adverse Effects

Local- redness, swelling, pain/itching at site; Systemic- fever, muscle aches, headache, fatigue; Anaphylaxis

Antineoplastics

CHEMO

Alkylating Agents

NONSELECTIVE (3) disrupt DNA in rapidly dividing cells → tumor reduction

Nitrogen mustards

interferes with DNA replication and RNA transcription

Nitrosoureas

readily crosses BBB to treat brain cancers

Platinum compounds

kills cancer cells by creating cross-links between 2 DNA strands

Client Teaching for Chemotherapy

Risk of extravasation, Wear gloves when handling oral chemotherapy, Adequate hydration to flush out toxins and prevent complications

Antineoplastic Antibiotics

Include anthracyclines and non-anthracyclines that are NONSELECTIVE.

Binding with DNA

Distorts the expected structure and causes breaks within DNA strands.

Binding with topoisomerase II

Inhibits DNA repair and causes eventual cell death.

Adverse effects of Antineoplastic Antibiotics

GI distress, myelosuppression, cardiotoxicity.

Doxorubicin Hydrochloride

Also known as Adriamycin.

Mitotic Inhibitors

Include vinca alkaloids and taxanes that disrupt cell division.

Adverse effects of Mitotic Inhibitors

Alopecia, GI distress, myelosuppression, neurotoxicity, peripheral neuropathy.

Vinca alkaloids

Bind to microtubules of mitotic spindle, stopping assembly and causing cellular arrest in metaphase.

Vincristine

Also known as Oncovin; can cause birth defects.

Taxanes

Bind to microtubules of mitotic spindle, stopping disassembly.

Paclitaxel

Also known as Taxol.

Client teaching for Mitotic Inhibitors

Possibility of localized reactions at administration site, GI distress, paralytic ileus formation.

Antimetabolites

Include folic acid analogs, pyrimidine analogs, purine analogs that interfere with expected metabolism of cells.

Adverse effects of Antimetabolites

Alopecia, GI distress, myelosuppression, hepatotoxicity.

Folic acid analogs

Imitate folic acid required for DNA synthesis and cell division.

Methotrexate

Also known as Trexall; classified as HIGH ALERT.

Pyrimidine analogs

Imitate pyrimidine bases, essential components of DNA and RNA.

Cytarabine

Also known as Cytosar-U; classified as HIGH ALERT.

Purine analogs

Imitate purines, chemical building blocks of DNA and RNA.

Mercaptopurine

Also known as Purinethol.

Client teaching for Antimetabolites

Increased risk for infections, avoid alcohol, need for ongoing monitoring of cell counts throughout treatment, pregnancy prevention.

Topoisomerase Inhibitors

Play an important role in maintenance of DNA structures and functions.

Adverse effects of Topoisomerase Inhibitors

Myelosuppression, GI distress, interstitial lung disease.

Topotecan

Used for metastatic ovarian cancer, small cell lung cancer, cervical cancer.

Irinotecan

Used for metastatic colorectal cancer.

Belotecan

Used for lung and ovarian cancer.

Client teaching for Topoisomerase Inhibitors

Instruct the client to notify their provider of new manifestations, pregnancy prevention.

Analgesics

Include opioids, dual-mechanism agents, NSAIDs, nonopioid analgesics, COX-2 inhibitors, anesthetics, adjuvant analgesics.

Opioid agonists

Used for severe pain, sedation, anxiety reduction.

Morphine

Also known as Duramorph.

Opioid agonists-antagonists

Used for moderate-severe pain and act adjunct to anesthesia.

Butorphanol Tartrate

Also known as Stadol.

Dual-Mechanism Agents

Treat moderate to severe pain, serotonin and NE reuptake inhibitor (SNRI).

Tramadol

A mu-opioid agonist that blocks pain signals and enhances pain relief.

Opioid Antagonists

Used to reverse effects of opioids.

Naloxone

Also known as Narcan; can cross BBB.

Naltrexone

Helps prevent alcohol and opioid dependence; can cross BBB.

Methylnaltrexone

Treats opioid-induced constipation; CANNOT cross BBB.

Nonopioid Analgesics

Used for mild-moderate pain and antipyretic; can be used with opioids.

Acetaminophen

Also known as Tylenol; blocks production of prostaglandins in CNS.

NSAIDs

Better than Tylenol for inflammation; inhibit COX-1 and COX-2.

Ketorolac

Also known as Toradol; blocks COX enzymes and inhibits prostaglandins.

COX-2 inhibitor

Blocks COX-2 to prevent synthesis of prostaglandins.

Celecoxib

A COX-2 inhibitor with adverse effects including sensitivity to other NSAIDs.

Local anesthetics

Block pain signals in specific areas during procedures.

Lidocaine

Inhibits initiation and conduction of nerve impulses, creating a numbing effect.

General anesthesia

Induces unconsciousness via mask or IV.

Propofol

Rapid onset, short duration; decreases brain O2 consumption.

Etomidate

Helps maintain BP; rapid onset and short duration.

Ketamine

Provides pain relief and has dissociative properties.

Synthetic opioids

Mu agonists that help with pain mediation.

Fentanyl

A synthetic opioid that can cross BBB.

Benzodiazepines

Preferred for seizures; enhance GABA effects.

Midazolam

Benzodiazepine with a reversal agent of Flumazenil.

Barbiturates

Mainly used for seizures and reducing brain pressure.

Methohexital sodium

A barbiturate with rapid onset and short-acting properties.

Neuromuscular Blocking Agents

Used to achieve muscle relaxation for easier intubation.

Succinylcholine

A depolarizing muscle relaxant that mimics Ach.

Rocuronium

A nondepolarizing muscle relaxant.

Inhalation Anesthetics

Delivered in vaporized/gas form to induce general anesthesia.

Isoflurane

A volatile anesthetic that inhibits NT in CNS.

Nitrous Oxide

Also known as 'laughing gas'; used in dental procedures.

Ester and Amides

Types of local anesthetics; esters are broken down by plasma cholinesterase, amides by hepatic enzymes.