pharmacology test 3

names of the adrenergic receptor organ cells:

alpha 1, alpha 2, beta 1, and beta 2

where are the alpha receptors located?

in the blood vessels, eyes, bladder, and the prostate

what does alpha 1 do?

increases force of heart contraction; results in vasoconstriction of blood vessels (increased BP), mydriasis, decreases secretion of salivary glands, bladder relaxation and prostate contraction increase

what is mydriasis?

dilation of pupils

what is miosis?

constriction of pupils

what does alpha 2 do?

inhibits release of norepinephrine; this dilates the blood vessels (decreased BP), decreases GI motility and tone

where are the beta 1 receptors located?

located primarily in the heart but are also found in the kidneys

what does beta 1 do?

increases heart rate and force of contraction; increases renin secretion and angiotensin (increases BP)

where are the beta 2 receptors located?

smooth muscles of the lung and GI tract, the liver, and the uterine muscle

what does beta 2 do?

bronchodilation; promotes GI and uterine relaxation; increases blood glucose (glycogenolysis in liver), increases blood flow in skeletal muscles

what drug can activate the four receptors?

dopamine

what drug is responsible for the inactivation of neurotransmitters?

norepinephrine

what are the 2 enzymes that inactivate norepinephrine?

monoamine oxidase (inside neuron) and catechol-o-methyltransferase (outside neuron)

what is epinephrine used for? how does it work?

epinephrine is used for anaphylactic shock; it increases blood pressure, heart rate, and airflow through the lungs

it is given intramuscularly, subcutaneously, intravenously (not given IV for anaphylactic shock; give for cardiac arrest), or endotracheally

what is albuterol?

it is a beta 2-adrenergic agonist (noncatecholamines) that is given typically when the patient is unable to breathe. It relaxes the bronchial smooth muscles and promotes bronchodilation to prevent bronchospasm; given for asthma or COPD

what are some of the main side effects of albuterol?

tremors, tachycardia, dizziness, nausea, and urinary retention

what does a cholinergic agonist do?

it stimulates the parasympathetic nervous system by mimicking the neurotransmitter, acetylcholine

types of cholinergic agonists:

direct-acting and indirect acting

what do direct-acting agonists do?

they act on receptors to activate a tissue response

what is bethanechol chloride?

it is a direct-acting cholinergic agonist that acts on the muscarinic receptor; used to increase urination

what do indirect-acting agonists do?

they inhibit the action of the enzyme cholinesterase (AKA, acetylcholinesterase); drugs that inhibit this enzyme are called "cholinesterase inhibitors"

actions of direct-acting (cholinergic agonists) cholinergics:

decrease BP
decrease pulse rate
constrict bronchioles
miosis & increased accommodation
increase salivation, perspiration, and tears
increase urinary contraction
increase peristalsis & tone/motility
relaxes sphincter muscles
increase neuromuscular transmission and maintenance of strength/tone

actions of indirect-acting cholinesterase (anticholinesterase) inhibitors:

increases muscle tone

types of cholinergic receptors:

muscarinic and nicotinic

what do the cholinergic muscarinic receptors act on?

it affects the smooth muscles and slows the heart rate

what do the cholinergic nicotinic receptors act on?

affects skeletal muscles

anticholinergic (cholinergic antagonists) mechanism of action:

inhibits actions of acetylcholine by occupying the acetylcholine receptors (also called cholinergic antagonists)

actions of anticholinergics:

increase pulse rate; large doses increase, small doses decrease
decrease mucous secretions
decrease GI motility & relaxed tone/motility
increase urinary retention (constriction of sphincter)
mydriasis & decreased accommodation
decreased salivation, perspiration, and bronchial secretions
bronchodilation
decreased tremors & rigidity of muscles

drowsiness, disorientation, and hallucinations can result from large doses

what is atropine?

it is an anticholinergic (muscarinic antagonist) used to decrease salivary secretions and increase the heart rate when bradycardia is present

what is used for an antidote for a cholinergic overdose?

atropine sulfate

what is the antidote for atropine?

physostigmine; it reverses the anticholinergic toxicity

what is benztropine?

it is an anticholinergic used to treat Parkinson's disease or drug-induced parkinsonism (helpful in decreasing tremors)

side effects: constipation, blurred vision, ocular hypertension, xerostomia, nausea, anhidrosis, and urinary retention

contraindications: dementia, tachycardia, cardiac disease, etc.

what is ibuprofen (motrin/advil)?

classification: NSAID

action: Inhibits COX-1, COX-2 by blocking arachidonate; analgesic, anti-inflammatory, antipyretic

contraindications: Avoid pregnancy 3rd trimester, NSAIDs, salicylates, asthma, severe renal/hepatic disease

purpose: Used to decrease pain, inflammation, and fever

what is celebrex (celecoxib)?

classification: NSAIDs, COX-2 inhibitor

therapeutic Effects: analgesic, anti- inflammatory, & anti- pyretic

adverse reactions & side effects: GI BLEEDING, dermal rash, GI effects

nursing implications & teaching: assess pain, ROM and swelling. do not give if allergic to sulfonamides, aspirin or NSAIDs. watch for tarry stools.

what is lasix (furosemide)?

classification: loop diuretic

therapeutic effects: diuresis; lowering of blood pressure

adverse reactions & side effects: dehydration, hypochloremia, hypokalemia, hypomagnesaemia, hyponatremia, hypovolemia, metabolic alkalosis

nursing implications & teaching: monitor for thirst, dry mouth, lethargy, weakness, hypotension, oliguria and notify physician. monitor K+, Ca++, Mg. can increase BUN, glucose and creatinine, TAKE WITH FOOD

what is phenergan (promethazine)?

classification: antiemetic; antihistamine (H1); sedative/ hypnotic; phenothiazine

therapeutic effects: decrease symptoms of excess histamine, sedation, decrease N/V

adverse reactions & side effects: neuroleptic malignant syndrome, confusion, disorientation, sedation, dizziness

nursing implications & teaching: monitor for extrapyramidal side effects; educate on techniques to help dry mouth; oral care, photosensitivity; orthostatic hypotension risk; avoid ETOH & other CNS depressants; monitor sedation. a known vesicant!

what is morphine?

it is an opioid analgesic (potent) used to treat severe pain (7/10-10/10 pain)

side effects: respiratory depression, orthostatic hypotension, miosis, urinary retention, constipation, and cough suppression

what is the antidote for morphine?

naloxone

what are beta blockers?

used as antihypertensive medications or in combination with a diuretic; reduce cardiac output by diminishing the SNS response

with continued use, beta blockers lower BP and reduce heart rate, contractility, and renin levels

native americans have a reduced or lower response to beta blockers; african americans do not respond well

medications typically end in -lol; acebutolol, atenolol, betaxolol, bisoprolol, and metoprolol

what is a schedule I drug?

substances that have the highest potential for abuse; have no currently accepted medical use; heroin, LSD, marijuana

what is a schedule II drug?

substances that have a high potential for abuse and have a currently accepted medical use (morphine, oxycodone, adderall)

what is a schedule III drug?

substances that have less potential for abuse; abuse may lead to moderate or low physical dependence or high physiological dependence (ketamine, testosterone, tylenol with codeine)

what is a schedule IV drug?

substances that have a low potential for abuse relative to substance in C-III (xanax, ativan, valium)

what is a schedule V drug?

substances that have the lowest potential for abuse; consist primarily of preparations containing limited quantities of certain narcotics (phenergan with codeine, bromfed)

what is aspirin?

aspirin is from a family of salicylates derived from salicylic acid; oldest anti inflammatory agent

it is an anti inflammatory, antiplatelet, and antipyretic

what is the toxic serum level of aspirin?

greater than 300 mcg/ml

salicylates:

interactions: increased bleeding with anti-coagulants and other NSAIDS; risk for hypoglycemia with oral antidiabetics; increased gastric ulcer risk with glucocorticoids; decreased effects of ACE inhibitors, loop diuretics, probenecid

lab interactions: increases prothrombin, bleeding time, INR, and uric acid; decreases cholesterol, T3 and T4 levels, and potassium

foods that contain salicylates: prunes, raisins, licorice, and some spices (curry and paprika)

different types of headaches:

migraine, cluster, and tension

what is a migraine?

a headache characterized by a unilateral throbbing head pain accompanied by nausea, vomiting, and photophobia

preventative treatment includes: beta blockers (propranolol and atenolol), anticonvulsants (valproic acid and gabapentin), and TCAs (amitriptyline and imipramine)

treatment of an attack depends on the intensity of pain; analgesics, opioid analgesics, ergot alkaloids, and selective serotonin receptor agonists

what is a cluster headache?

a headache characterized by a severe, unilateral, nonthrobbing pain usually located around the eye; men are usually affected more

what is a tension headache?

a headache that is typically caused by stress; feels like a "tight band around the head"

what are some examples of medications used to treat anxiety?

benzodiazepines are antianxiety medications that act by binding to a GABA receptor site, making the postsynaptic receptor more sensitive to GABA and its neurotransmission; this decreases signs and symptoms of anxiety

xanax (alprazolam)
klonopin (clonazepam)
valium (diazepam)
ativan (lorazepam)
restoril (temazepam)

end in -am

antispasmodics:

synthetic anticholinergic drugs are also used antispasmodics to treat peptic ulcers and intestinal spasticity; used to treat abdominal pain, including spasms and cramps

what are some examples of antilipidemic medications?

medications used to lower lipid levels (cholesterol medications)

lipitor (atorvastatin)
zetia (ezetimibe)
tricor (fenofibrate)
mevacor (lovastatin)
pravachol (pravastatin)
crestor (rosuvastatin)
zocor (simvastatin)

typically end in -statin

what classification of medication is clopidogrel (plavix)?

platelet inhibitor

what are sulfonamides?

first group of drugs used against bacteria

bactrim (trimethoprim/sulfamethoxazole); used for UTIs

what is gout?

an inflammatory condition that attacks joints, tendons, and other tissues; due to too much uric acid (type of arthritis)

what are antigout medications?

zyloprim (allopurinol)
colcrys (colchine)

what are antihypertensives?

medications used to treat hypertension; lowers blood pressure (preventative for MI, stroke, renal failure, and death)

tenormin (atenolol)
coreg (carvedilol)
catapres (clonidine)
vasotec (enalapril)
microzide (hydrochlorothiazide)
prinivil (lisinopril)
prinizide (lisinopril and HCTZ)
cozaar (losartan)
toprol (metoprolol)
aldactone (spironolactone)
diovan (valsartan)

beta blockers: end in -lol
ACE inhibitors: end in -pril
ARBs (angiotensin II receptor blockers): end in -sartan

what are hypnotics?

typically ordered for treatment of sleep disorders (sedatives)

ambien (zolpidem); schedule IV drug

what are antiemetics?

antiemetics are used to control vomiting

phenergan (promethazine)
zofran (ondansetron)
reglan (metoclopramide) - typically used for nausea that accompanies radiation or chemotherapy

what is metoclopramide HCL?

it is a direct-acting cholinergic agonist that is usually prescribed to treat gastroparesis, nausea (from chemo/radiation), and GERD

what are anticoagulants?

anticoagulants are used to inhibit clot formation; thin the blood

used to prevent DVT

heparin
lovenox (enoxaparin)
coumadin (warfarin)

what does EBL stand for?

estimated blood loss

what are antipyretics used for?

antipyretics are used to reduce elevated body temperature

tylenol (acetaminophen)

what are PCA pumps?

PCA = patient controlled analgesia; it is an alternative route for opioid administration for self-administered pain relief as needed

only the PATIENT can control the pump; the nurse may not touch it

what is COX 1?

COX-1 protects the stomach lining, regulates blood platelets, and promotes blood clotting

what is COX 2?

COX-2 triggers inflammation and pain at the injured site

what are the first generation NSAIDs?

salicylates
salicylate derivatives
para-chlorobenzoic acid
propionic acid
fenamates
oxicams

aspirin
indomethacin
ibuprofen
naproxen
meloxicam
nabumetone

what are the 2nd generation NSAIDs?

celebrex (celecoxib)

newer NSAIDs, called COX-2 inhibitors, block only COX-2 and not COX-1

what is demerol (meperidine)?

a narcotic analgesic commonly used in pregnant women; preferred over morphine because it does not diminish uterine contractions and causes less neonatal respiratory depression

where are nociceptors found?

everywhere

what is the fight or flight response? what is it controlled by?

it is a physiological reaction that occurs in response to an emotional situation; typically triggered by feelings of stress, fear, anxiety, aggression, and anger; controlled by the sympathetic nervous system

what is the rest and digest response? what is it controlled by?

it is a physiological reaction that relaxes your body after an emotional situation (due to stress or fear); controlled by the parasympathetic nervous system

what are antihistamines?

medications often used to relieve symptoms of allergies; also used to prevent motion sickness and as short-term treatment for insomnia

reduce or block histamines to stop or reduce allergy symptoms

allegra (fexofenadine)
flonase (fluticasone)
benadryl (diphenhydramine)
claritin (loratadine)
zyrtec (cetirizine)