Exam 1 Prototype drugs

Epinephrine

• Sympathomimetic, adrenergic agonist: this means that it stimulates adrenergic receptors (Alpha1, Alpha2, Beta1, Beta2) in order to produce sympathetic system responses

• It is nonselective in regards to receptors (binds to both alpha and beta)

• Action

  • increases vasoconstriction, BP, HR, and cardiac output

  • promotes bronchodilation

• Uses

  • anaphylaxis & anaphylactic shock

  • bronchospasm, status asthmaticus

  • cariogenic shock & cardiac arrest

• Onset and Peak

  • rapid

• Side effects/adverse reactions

  • cardiac dysrhythmias, palpitations

  • tachycardia, hypertension

  • dizziness, headache, paresthesias (numbness/tingling)

  • agitation, restlessness, tremors

  • hyperglycemia, oliguria

• Drug interaction

  • beta blockers decrease epinephrine action (block the site on beta receptors where epinephrine is supposed to bind to)

  • digoxin causes cardiac dysrhythmias

  • TCAs and MAOIs intensify and prolong effects

Atenolol

• Beta 1 blocker and an adrenergic antagonist (it produces the opposite effects of the sympathetic system)

• Nonselective in regards to receptors

• Action

  • decreases HR and BP

  • hypertension when interacting with other drugs or use is suddenly stopped

• Uses

  • angina (chest pain)

  • acute myocardial infarction (heart attack)

• Onset and Peak

  • onset is 1 hour

  • peak is 2-4 hours

• Side/Adverse effects

  • depression

  • dizziness, drowsiness

  • erectile dysfunction

• Drug interaction

  • increased absorption with anticholinergics

  • decreased effect with NSAIDs

  • increased risk of hypoglycemia when on insulin or other oral meds (sulfonylureas) [contraindications]

Bethanechol chloride

• Parasympathomimetic (imitates actions of the parasympathetic system)

• direct acting at cholinergic receptors (cholinergic agonist)

• promotes contraction of the bladder

• Use

  • treats non-obstructive urinary retention, neurogenic bladder

• Side/adverse reactions

  • hypotension, diaphoresis, miosis

  • increased salivation and gastric acid

  • nausea, vomitiing, diarrhea, abdominal cramps

  • LIFE THREATENING: causes bronchospasm and wheezing

• Contraindications

  • bradycardia, hypotension, peptic ulcer

  • parkinsonism, hyperthyroidism

  • urinary tract obstruction

Atropine

• anticholinergic, parasympatholytic, muscarinic antagonist (works against the parasympathetic response)

• blocks acetylcholine by occupying the muscarinic receptor

• Action

  • increases HR, promotes pupil dilation, decreases GI motility, spasms, peristalsis, salivary and gastric secretions

• Uses

  • reduce salivation

  • increase HR during bradycardia

• Side effects

  • dry mouth, dehydration, headache

  • blurred vision, photophobia

  • urinary retention, constipation

• Adverse reactions

  • tachycardia, paradoxical bradycardia, angina, ileum, seizures

  • LIFE THREATENING: dysrhythmias, laryngospasms, coma

Benzotropine

• Anti-Parkinson— Anticholinergic Drugs

• Blocks acetylcholine receptors & blocks dopamine reuptake, decreasing ACh to reduce excess cholinergic activity

• Action

  • decreases involuntary movement, tremors, and muscle rigidity

• Use

  • Parkinsonism

• Side/adverse effects

  • dry mouth/skin, headache

  • blurred vision, photophobia

  • tachycardia, ocular hypertension

  • urinary retention, constipation

Tolterodine tartrate

• antimuscarinic agent, anticholinergic

• action

  • increases HR, promotes pupil dilation, decreases GI motility, spasms, peristalsis, salivary & gastric secretions

• uses

  • decrease urinary frequency, urgency, and nocturne not related to a UTI (overactive bladder syndrome)

• side effects

  • drowsiness

  • dizziness

  • dry mouth and eyes

  • headache

  • blurred vision

  • confusion

  • diarrhea

  • abdominal pain

  • constipation

  • dyspepsia

  • dysuria

  • fatigue

  • weight gain

  • arthralgia

  • hallucinations

  • urinary retention

• adverse reactions

  • angioedema, chest pain, tachycardia, peripheral edema

  • LIFE THREATENING: stevens-johnsons syndrome

Trimethoprim & Trimethoprim-sulfamethoxazole

• urinary antiseptics/antiinfectives & antibiotics

• bactericidal

• use

  • treat bacterial and urinary infections

• side effects/adverse reactions

  • nausea, vomiting, diarrhea

  • anorexia, abdominal pain

  • renal failure, hyperkalemia, hyponatremia, hypoglycemia

• contraindications

  • hypersensitivity (especially to sulfonamides)

  • hepatic or renal impairment

  • clients with lupus

Solifenacin succinate

• urinary antimuscarinic, anticholinergic, bladder antispasmodic

• direct action on the smooth muscles of the urinary tract

• can relieve spasms from urinary infection or injury and block parasympathetic nerve impulses to decrease urinary frequency and urgency

• use

  • treat overactive bladder and urinary incontinence

• side effects

  • blurred vision, dizziness, fatigue, cough, pharyngitis, dry mouth

  • nausea, vomiting, abdominal pain, constipation, dyspepsia

  • cystitis, urinary retention, peripheral edema

• adverse reactions

  • tachycardia, hypertension, angioedema, GI obstruction

  • LIFE THREATENING: dysrhythmias and hyperkalemia

• contraindications

  • glaucoma, gastroparesis, GI obstruction, or urinary rentention

Potassium chloride

• use

  • electrolyte replacement

  • must be diluted if given by IV

  • painful so infuse slowly

  • monitor ECG

  • given via pump & monitor

  • note K+ levels

• side effects

  • N/V

  • diarrhea

• adverse reactions

  • hyperkalemia

  • cardiac dysrhythmias

Calcium

• use

  • electrolyte replacement

• caution

  • IV infiltration (tissue necrosis)

  • can enhance digoxin effects

  • note different preparations (calcium gluconate & calcium chloride)

• side effects

  • N/V

  • constipation

  • pain

• adverse reactions

  • ECG changes

  • renal failure

  • cardiac arrest

Crystalliod solutions

• short term maintenance therapy

• treats dehydration & electrolyte imbalance

• lowers risk for allergic reaction

• Hypotonic

  • lower osmolarity than the blood

  • causes water to move from the extracellular space into the intracellular space

  • risk of cell swelling and rupture

• isotonic

  • equal osmolarity as the blood

  • water equally transfers in and out of the cell

  • helps expand intravascular space

  • risk of fluid overload, increase in D5W

  • contraindications: not for patients with liver disease

• hypertonic

  • higher osmolarity than the blood

  • causes water to move from the intracellular space to the extracellular space

  • risk of cell dehydration and shrinkage

Colloid solutions

• contains protein & large molecules

• increases osmolarity

• higher risk for allergic reaction

• includes albumin and blood products

• large molecules that don’t cross the capillary wall but stay within the intravascular space

• pulls water through oncotic pressure from interstitial space to intravascular space

• includes albumin, dextran, hydroxyethyl starches, and blood products

• risks of allergic reactions, fluid volume overload, and bleeding problems

Doxycycline (tetracycline)

• action

  • inhibit protein synthesis

  • bacteriostatic

  • bactericidal

• use

  • acne

  • skin infections

  • respiratory infections

  • urinary infections

• side effects

  • discoloration of permanent teeth, tongue, nails

  • photosensitivity

  • headaches

  • glossitis

  • GI distress

• adverse reactions

  • anaphylaxis

  • superinfection

  • hepatotoxicity (blood toxicity)

  • nephrotoxicity

  • angioedema

  • stevens-johnsons syndrome

• contraindications

  • pregnant patients during trimester 1

  • last trimester of pregnancy and children younger than 8

Gentamicin sulfate (aminoglycoside)

• action

  • inhibit bacterial protein synthesis, bactericidal

• use

  • can be given IM or IV

  • effective against gram negative E.coli, Proteus, Pseudomonas species

  • treats serious respiratory, skin, urinary, bone/joint, intraabdominal infections, plague, bacteremia, sepsis, endocarditis, meningitis

• side effects/adverse reactions

  • anaphylaxis, ototoxicity, nephrotoxicity, neurotoxicity

• drug interactions

  • penicillins decrease amino glycoside effectiveness

  • increased action of oral anticoagulants

• caution

  • renal disease

  • neuromuscular disorders

  • electrolyte imbalance

  • dehydration

  • hearing impairment

  • tinnitus

  • pregnancy

Ciprofloxacin (fluoroquinolone)

• action

  • interfere with enzyme DNA gyrase needed to synthesize

  • bactericidal

  • effective against gram + and gram - bacteria S. pneumonia, S. aureus, H. influenza, P. aeruginosa, salmonella, and shigella species

• use

  • anthrax, sinusitis, prostatitis, typhoid fever, STIs, skin, bone/joint, intaabdominal, urinary, and respiratory, otitis media

• side effects

  • headaches

  • dizziness

  • insomnia

  • hearing loss

  • photosensitivity

  • eye damage

  • visual disturbances

  • GI- N/V/D

• adverse reactions

  • anaphylaxis, superinfection, angioedema, hypertriglyceridemia, tendon rupture