pharm test ladt

Agonists

Drugs that interact with a receptor to stimulate a response

Antagonist

Drugs that attach to a receptor but do not stimulate a response

Routes of Administration: Enteral

Via the gastrointestinal tract by the oral, rectal, or nasogastric routes

Routes of Administration: Parenteral

Bypass the GI tract by using subcutaneous, intramuscular, or intravenous (through injection)

Routes of Administration: Percutaneous

Absorbed through the skin and mucus membranes ( Inhalation, sublingual, or topical)

LADME: Liberation

Drug released from dosage form and is dissolved in body fluid

LADME: Absorption

Drug transferred from entry site into circulating fluids

LADME: Distribution

Drugs transported throughout the body by body fluids to the sites of action

LADME: Metabolism

Breakdown of drug through liver

LADME: Excretion

Elimination through kidney

Drug Interactions: Onset of Action

When the concentration of a drug at the site of action is enough to start a physiologic response

Drug Interactions: Peak action

Time of which the drug reaches the highest concentration on the target receptor sites

Drug Interactions: Duration of Action

How long the drug has a pharmacologic effect

Drug Reactions: Idiosyncratic Reactions

Occurs when something unusual/abnormal happens

Drug Reactions: Allergic Reactions

Occurs among patients who have previously been exposed to a drug and whose immune system have developed antibodies to the drug

Drug Blood Level

Level of how much the drug is in the blood such as anticonvulsants

How does AGE affect drug therapy for INFANTS?

Infants’ intramuscular absorption is erratic and gastric acidity is reduced

How does AGE affect drug therapy for GERIATRIC PATIENTS?

IM absorption is erratic, reduced salivary flow makes swallowing difficult, and decreased function of organs

How does GENDER affect drug therapy?

Women’s stomach empties solids slower than men, allowing longer contact with absorptive tissue

Cumulative effect

Drug accumulation occurs when the next dose is given before the previous dose given has been metabolized or excreted (may result in toxicity)

Geriatric patients have lower……

Body fat, protein binding, and body water content

Decongestant/Sympathomimetics Prototype

Phenylephrine

Method of action of Phenylephrine

Vasoconstriction of blood vessels which cause nasal turbines to shrink opening nasal passages

What are side effects of Phenylephrine?

CNS related, agitation, anxiety, insomnia, hypertension. heart palpitations, and rebound congestion

What are contraindications of Phenylephrine

Not intended for chronic rhinitis, narrow-angle glaucoma

Phenylephrine indications

Reduce nasal congestion

First gen sedating antihistamine prototype

Diphenhydramine

What is the method of action for Diphenhydramine?

Inhibit release of histamine by blocking H1 receptors

What are side effects of Diphenhydramine?

Sedation, dry mouth, constipation, urinary retention

Indications for Diphenhydramine

Allergies, motion sickness, urticaria

Contraindications for Diphenhydramine

Caution for patients with glaucoma as it raises intraocular pressure

Patient teaching for Diphenhydramine

Do not drive or operate heavy machinery

Prototype for Expectorants

Guaifenesin

Indications for Guaifenesin

Cold or upper respiratory infections that produce mucus

Method of action for Guaifenesin

Reduces surface tension of secretions thinning mucus

Contraindications for Guaifenesin

Known sensitivity

What side effects of Guaifenesin?

Not always causes side effects, patients may experience dizziness, upset GI , headache, nausea, and diarrhea

Patient teaching for Guaifenesin

Instruct patient to drink plenty of water to aid in thinning mucus

Prototype for Mucolytic

Acetylcysteine

Indications for Acetylcysteine

Decrease viscosity of mucus

Robitussin is the brand name for what medication?

Dextromethorphan

Method of action for Acetylcysteine

Breaks up disulfide linkages of proteins in mucus

What are the side effects of Acetylcysteine?

Bronchospasm, nausea, vomiting, rash

Patient teaching for Acetylcysteine

Medication smells like rotten eggs

Prototype(s) for Antitussives

Dextromethorphan and Codeine

Indications for Dextromethorphan/Codeine

Dry, unproductive cough

What is the method of action for Dextromethorphan/Codeine?

Suppresses the cough reflex in the brain

Contraindications for Dextromethorphan/Codeine

Patients taking SSRI medications, patients with reduced respiratory reserve

Side effects for Codeine

Sedation, respiratory depression, hypotension, constipation, and upset GI

Side effects for Dextromethorphan

Dizziness and sedation at high doses

What is the difference between Codeine and Dextromethorphan?

Codeine is a opioid medication and dextromethorphan is a nonopioid medication

Prototype for Methylxanthines

Theophylline

Indications for Theophylline

Long-term management of chronic asthma

Method of action of Theophylline

Relaxes smooth muscle of bronchi by blocking phosphodiesterase

Contraindications of Theophylline

Caution with smokers and patients with coronary heart disease

Side effects of Theophylline therapeutic blood level

Restlessness, Big 3’ , palpitations and muscle twitching

Side effects of Theophylline at toxic blood level

Life threatening seizures and dysrhythmias

Prototype for Mast Cell Stabilizers

Cromolyn

Indications for Cromyln

Long term allergy related asthma and prevention of exercise induced bronchospasm

Method of action of Cromolyn

Prevent the release of leukotrienes and histamine, prevent WBC inflammatory response minimizing inflammation in the air ways

Side effects of Cromolyn

Minimal to none, may cause cough or bronchospasm

Contraindication for Cromolyn

Allergy

Prototype for Leukotriene Receptor Antagonists

Montelukast

Indications for Montelukast

Adjunctive therapy treatment of allergic rhinitis, asthma, and exercise induced bronchospasm

What is the method of action for Montelukast

Suppress the effect of leukotrienes and decrease inflammation by preventing activation of leukotrienes

Contraindication for Montelukast

Not intended for acute attacks

Side effects of Montelukast

Potential to cause suicidal thoughts or behaviors

What difference does Montelukast have compared to other Leukotriene Receptor Antagonists

Montelukast does not cause liver damage as a side effect, unlike zafirlukast

Prototype for Beta₂ Adrenergic Agonists

Albuterol

Indications for Albuterol

Asthma and COPD, typically acute attacks

Method of action for Albuterol

Stimulate beta₂ - adrenergic receptors of the sympathetic nervous system, resulting in bronchodilation

Side effects of Albuterol

Tachycardia, palpitations, angina occurs especially with patients that have compromised blood vessels

Contraindications for Albuterol

Allergy, exercise with caution, and people with compromised blood vessels or other cardiac problems

Prototype for Glucocorticoids

Budesonide

Indications for Budesonide

Asthma

Method of action for Budesonide

Prevents release of leukotrienes, prostaglandins, and histamine while preventing the actions of WBC minimizing inflammation

Nursing care for Budesonide

If prescribed with a bronchodilator it must be administered prior to the glucocorticoids

Side effects of Budesonide

Oral candidiasis, hoarseness, difficulty speaking, adrenal insuffiency, bone demineralization, hyperglycemia, and peptic ulcer disease

Patient teaching for Budesonide

Rinse mouth with water, medication can not be stopped abruptly must be tapered down

What is Loperamide used for

Antidiarrheal

What is Diphenoxylate-Atropine used for

Antidiarrheals

Classification of Loperamide, Diphenoxylate, atropine

Opioid

Method of action for Loperamide

Inhibits peristalsis and prolongs transit time

Adverse effects of opioid antidiarrheals

Can cause cardiac arrest and arrythmias

Side effects of Opioid antidiarrheals

dry mouth, constipation, urinary retention, and drowsiness

Classification of sulfasalazine

GI anti-inflammatory agent

Indications of Sulfasalazine

IBS, Chron’s disease, and ulcerative colitis

Method of action for Sulfasalazine

Inhibits prostaglandin synthesis which reduses inflammation in the colon

Contraindications for Sulfasalazine

Allergy

Side effects of Sulfasalazine

Fever, rash, nausea, headaches, agranulocytosis and red blood cell disorders

Classification of Azathioprine

Immunosuppressant

Indications of Azathioprine

inflammatory bowel disease

Method of action for Azathioprine

Inhibit the production of B and T lymphocytes which decrease immune response in the body

Side effects of Azathioprine

Nausea, vomiting, anorexia, hepatoxicity, fever, and bone marrow suppression

Contraindications for Azathioprine

Low WBC and active infection

Classification of Metoclopramide

Prokinetic Agents

Indications for Metoclopramide

Nausea and gastroparesis

How does Metoclopramide treat gastroparesis

Increases peristalsis in the stomach and intestines