Pharmacology Flashcards

Controlled Substances

• DEA Schedules:

  • Know the DEA schedules and common substances associated with each category

  • Controlled Substances Act of 1970:

    • Control over the coding of drugs and the enforcement of these codes given to the FDA and the Drug Enforcement Agency, a part of the U.S. Department of Justice

  • Drug Enforcement Agency (DEA):

    • Schedules of Controlled Substances
      • I: High abuse potential, no accepted medical use (heroin, LSD)
      • II: High abuse potential, severe dependence liability (narcotics, amphetamines, and barbiturates)
      • III: Less abuse potential than schedule II, moderate dependence liability (nonbarbiturate sedatives, nonamphetamine stimulants, limited amounts of certain narcotics)
      • IV: Less abuse potential than schedule III, limited dependence liability (some sedatives antianxiety agents, and nonnarcotic analgesic)
      • V: Limited abuse potential. Primary small amounts of narcotics (codeine) used as antitussives or antidiarrheals. Under federal law, limited quantities of certain schedule V drugs may be purchased without a prescription directly from a pharmacist. Purchaser must be at least 18 y/o and must furnish suitable identification. All such transactions must be recorded by the dispensing pharmacist

Prescription Monitoring

• CURES (Controlled Substance Utilization Review and Evaluation System):
  • A database for Schedule II, Schedule III, Schedule IV, and Schedule V controlled substance prescriptions dispensed in CA serving the public health, regulatory oversight agencies, and law enforcement
• Helpful to providers and patients:
  • It keeps track of prescriptions, when and where they are prescribed for a patient

Pharmacological Principles

• Pharmacokinetics:
  • The way a medication travels through the body; how the body acts on a drug
  • Main topics: absorption, distribution, metabolism, excretion
• Pharmacodynamics:
  • The study of the interactions between the chemical components of living systems and the foreign chemicals, including drugs, that enter living organisms
• Pharmacogenomics:
  • Study of genetically determined variations in response to drugs
• Pharmaceutics:
  • Science of taking a chemical and putting it in a medication form so that it can be used by human beings
• Pharmacotherapeutics:
  • Science of using drugs and what they do to the individual’s body and their DNA

Pharmacokinetics

• Absorption:
  • Degree of stomach acidity
  • Time required for the stomach to empty
  • Whether food is present
  • Amount of contact with villi in the small intestine
  • Flow of blood to villi
• Distribution:
  • Drug’s movement through body fluids
• Metabolism or Biotransformation:
  • Chemical change of drug into a form that can be excreted
• Excretion:
  • Process by which the body removes a drug
• Onset of drug action
• Drug half-life
• Timing of the peak effect
• Duration of drug effects
• Metabolism or biotransformation of the drug
• Site of excretion
• Critical Concentration:
  • The amount of a drug that is needed to cause a therapeutic effect
• Loading Dose:
  • A higher dose than is usually used for treatment, allowing drug to reach critical concentration sooner
• Dynamic Equilibrium:
  • The actual concentration that a drug reaches in the body

Pharmaceutics

• Elixirs (highest absorption)
• Suspensions
• Powders
• Capsules (encapsulated in gel shell)
• Tablets (powder to hard compressed tab)
  • Coated
  • Enteric coated
• Rate of Dissolution:
  • Before drug can be absorbed, it must dissolve
  • Rate of dissolution helps determine absorption
  • Faster dissolution = faster onset

Medication Delivery Routes

• Enteral:
  • Anything oral (through stomach or mucosa)
  • Nursing considerations: watch food intake (milk, orange juice, drug-to-drug interaction)
• Parenteral:
  • IV, IM, SC, ID/injections
  • Nursing considerations: examine for tattoos, moles, broken skin, anything other than intact skin
• Topical:
  • Patches, drops, body surfaces, enemas, inhaler
  • Nursing considerations: clean skin, hair, wet/dry

Absorption

• What happens to a drug from the time it is introduced to the body until it reaches the circulating fluids and tissues
• Route and Administration:
  • Influence drug absorption
  • Oral route most frequently used, but affected by a number of barriers aimed at destroying ingested foreign chemicals
• Absorption processes:
  • Passive diffusion
  • Active transport
  • Filtration
• Factors affecting absorption

Distribution

• Factors affecting distribution:
  • Affected by lipid solubility, ionization, perfusion of reactive tissue
• Protein Binding:
  • The more bound to protein, the more difficult it can be for the medication to be released and to cross membranes to get to the tissue cells
• Role of Albumin
• Lipid Soluble vs. Water Soluble:
  • Drugs that are highly lipid soluble are more likely to pass through the blood-brain barrier (BBB) and reach the CNS
  • Drugs that are not lipid soluble are not able to pass through the BBB
    • Effective antibiotic treatment can occur only when the infection is severe enough to alter the blood-brain barrier and allow antibiotics to cross

Metabolism/Biotransformation

• Factors affecting metabolism:
  • Age
    • Infants have immature livers; medications always given mg/kg
    • Elderly have degeneration of liver and drugs can accumulate; smaller doses are acceptable
  • Genetics
  • Disease
  • Concurrent use of other drugs
• Biotransformation (and role of the liver):
  • Process by which drugs are changed into new chemicals
    • Liver as a sewer treatment plant
    • Everything that is absorbed from the GI tract first enters the liver to be “treated”
    • Liver detoxifies many chemicals and uses others to produce needed enzymes and structures (first-pass effect)
  • Most medications are changed to be less active and more easily excreted
  • Some medications are captivated by biotransformation and some medications have active metabolites, even after biotransformation
• End-Stage Liver Disease (ESLD):
  • ESLD affects biotransformation because the liver is unable to metabolize the medication, which can lead to toxicity
• Bioavailability:
  • Portion of drugs that reaches circulation
    • The way that the medication is given determines whether the drug is more or less bioavailable
    • Most drugs given orally has less than 100% bioavailability
    • Drugs administered by the IV route have 100% bioavailability
• Inducer vs. Inhibitor:
  • Inducers increase rate of drug metabolism but decrease bioavailability
  • Inhibitors decrease rate of drug metabolism and increase bioavailability

Excretion

• Half-Life:
  • The time it takes for the amount of drug in the body to decrease to one-half of its peak level
  • Important in determining appropriate dose scheduling or the duration of a drug’s effect on the body
  • Shorter half-life: the medication leaves the body more quickly and will need more frequent dosing to maintain a therapeutic level
  • Longer half-life: the medication stays in the body longer, requiring less frequent dosing, and has a greater risk of medication accumulation causing toxicity
• Liver or Kidney Disease:
  • Absorption rate, distribution to tissues, the speed of biotransformation, and how fast the drug is excreted are all taken into consideration when determining the half-life of a drug
  • Half-life that is indicated in any drug monograph is the mean half-life for a healthy person
  • One can estimate the half-life of a drug for a patient with kidney or liver dysfunction (which could prolong biotransformation and the time required for excretion of a drug), allowing the prescriber to make changes in the dosage schedule

Therapeutic Index

• Subtherapeutic/Supratherapeutic and Therapeutic Index (TI):
  • Therapeutic index: ratio of the blood concentration at which a drug becomes toxic to the concentration at which the drug is effective
  • Subtherapeutic: changes that can be made to increase effectiveness include increasing the frequency or dosage of medications
  • Supratherapeutic: changes that can be made to decrease effectiveness include decreasing the frequency or dosage of medications

Agonist and Antagonist

• Agonist: supplements function
• Antagonist: blocks function

Pharmacological Factors Affecting the Elderly

• Lifespan considerations due to the degeneration of organs

10 Rights of Medication Safety

• Right:
  • Medication
  • Client/Patient
  • Dose
  • Route
  • Time
  • Assessment
  • Documentation
  • Evaluation
  • Education
  • To Refuse

Fluid Distribution in the Body

• Intracellular, extracellular, and spaces between
  • Intracellular and extracellular fluids make up 50%-60% of body weight
    • Intracellular fluid makes up ⅔, fluid inside the cell
    • Extracellular makes up ⅓ and has 2 components: interstitial fluid and intravascular; fluid outside the cell
      • Interstitial fluid is between blood vessels and cells, ¾ of ECF
      • Intravascular is the whole blood volume (plasma), ¼ of ECF; inside blood vessels
• Fluid is shifted or moved between spaces via diffusion, a passive process of fluid moving in or out of cells

Crystalloids and Fluid Flow

• Hypertonic solution: high solute/low solvent
  • Flows out of cell, cell shrinks
  • 3%-7.5% NaCl
• Isotonic solution: equal solute/solvent
  • No flow outside or inside of cell, cell stays the same
  • 0.9% NS or LR
• Hypotonic solution: low solute/high solvent
  • Flow into cell, cell swells
  • 0.45% or 0.33% NaCl

Common Indications for Isotonic Fluids:

• NaCl 0.9%:
  • Primary fluid of choice for dehydration and resuscitative efforts
  • The only fluid used when administering blood products
  • Typically used on those who are:
    • Fluid challenge
    • DKA
    • Hypercalcemia
    • Hyponatremia
    • Metabolic alkalosis
    • Shock
    • Vomiting/diarrhea
• Lactated Ringers (LR):
  • Good choice of fluid replacement for burn and surgical patients
  • Typically used on those who have:
    • Acute blood loss
    • Dehydration (not always primary choice)
    • Hypovolemia caused by 3rd spacing
    • Lower GI tract fluid loss
    • Acidosis
• D5W:
  • Sugar water
  • Isotonic THEN becomes hypotonic
    • Isotonic because the ratio of dextrose in the solution makes its solute concentration (tonicity) similar to intravascular fluid
    • Hypotonic because once the dextrose is metabolized it provides 100% “free water” (which will push water into the cell)
  • Typically used on those who are:
    • NPO and surgical patients
    • Patients with low blood sugar
      CANNOT bolus D5W

Lactated Ringers (LR) and Acidosis

• LR helps prevent the development of lactic acid that contributes to acidosis
• LR is problematic for nursing due to incompatibilities with many other solutions; ensure pharmacy checks prior to mixing
  • NOT compatible with blood; use alone

Fluid Flow: Edematous vs. Dehydrated

• Dehydrated patients:
  • D5W (because of glucose)
  • LR (because of electrolytes)
  • NS 0.9% - primary fluid of choice for dehydration and resuscitative efforts
• Edematous patients:
  • Give hypertonic solutions because we want the water to leave the cell
  • Ex.) D10W, D5NS, etc.

3% Hypertonic NaCl

• Benefits:
  • Decreases cellular edema - particularly in the brain
  • Immediate response
• Indications & uses:
  • Stroke or trauma causing cerebral edema
  • Severe hyponatremia

Hypertonic Fluid Concerns

• High potential for intravascular fluid volume overload
• Pulmonary edema
• Hypernatremia
• Frequent neuro-monitoring because it can cause brain cells to shrink

Major Transfusion Reactions with Blood Products

• Allergic:
  • Mild
  • Facial flushing
  • Hives/rash
  • Increased anxiety
  • Wheezing
  • Decreased BP
• Febrile:
  • Headache
  • Tachycardia
  • Tachypnea
  • Fever/chills
  • Anxiety
• Hemolytic:
  • Decreased BP
  • Increased RR
  • Hemoglobinuria
  • Chest pain
  • Apprehension
  • Lower back pain
  • Fever
  • Tachycardia
  • Chills

Nursing Considerations and Procedures for Blood Administration

• Considerations:
  • Verify patient identity with 2 identifiers
  • Perform 2 RN check and document including VS w/ temperature
    • Patient name, MRN, patient blood type
    • Blood bank ID number, blood type, expiration date, volume
  • Administer blood per institutional reaction
  • Assess VS 15 mins post initiation of transfusion then 30 min x 2 then Q1 hour during the remainder of transfusion
  • Transfuse blood in 4 hours or less from receipt
  • Y-connector tubing can be used twice unless administration of blood exceeds 4 hours, then use once
  • DO NOT administer other medications with blood except 0.9% NS
• Procedures:
  • Blood:
    • Collect blood for type and cross to determine patient’s blood type and Rh type
  • Verify:
    • Verify doctor’s order
    • Verify signed consent unless emergency
    • Verify patient’s religious/cultural beliefs regarding limitations on receiving blood and/or blood products
  • Question:
    • Question patient on history of blood transfusion
    • Has patient ever had a transfusion reaction

Blood Type Compatibility

• The Rh system:
  • Based on presence/absence of major D antigen on the RBC surface
    • Presence of D antigen = Rh+
    • Absence of D antigen = Rh-
  • Most important when a mother becomes pregnant
  • Rh+ moms will need this
• The ABO system:
  • Type A blood has A antigen
  • Type B blood has B antigen
  • Type AB blood has both A and B antigen
  • Type O blood has no antigens
• Compatibility depends on presence or absence of A and/or B antigens and antibodies
• Type O- is the universal donor
  • Reserved for females at childbearing age
  • DO NOT give O+ because it can change the antigen
• AB+ is the universal recipient of blood

Albumin and Dialysis

• Albumin increases fluid volume using oncotic pressure (volume expander without using volume)
• Uses:
  • Hemolytic disease
  • Hypovolemia
  • Burns
  • Dialysis
  • Hypoalbuminemia
• Drawbacks: fluid overload
• Albumin is useful for patients on dialysis because it lessens the episodes of hypotension and improves fluid removal

IV Complications

• Infiltration:
  • Vein will burst, or nurse may blow the vein by puncturing it; sometimes fluid will back up and go out of vein = infiltration
  • S/S: swelling
• Extravasation:
  • An infiltration that is extreme, rupture of vein; outside of tissue, caused by damaging medication
  • S/S: open wound, dead skin
• Phlebitis:
  • Usually caused by antibiotics, could be too small of vein as well; swelling of vessels
  • S/S: red veins, irritated veins down the arm, inflamed and irritated veins, infected veins

Fluid Overload

• Cause: fluid in lungs leads to pulmonary edema, lack of oxygen, which causes tachycardia to try and compensate for a lack of oxygen
• S/S:
  • Weight gain
  • Normothermic
  • Bounding pulses
  • Moist lung sounds
  • HTN
  • Pale, cool, clammy skin
  • Peripheral edema
  • Distended neck veins
  • Low Hgb/Hct
  • Restless

Intrinsic and Extrinsic Pathways

• The intrinsic pathway converts prothrombin to thrombin to seal system
• The extrinsic pathway clots the blood that has leaked out of vascular system

Drugs Affecting Clot Formation/Resolution

• Anticoagulants:

  • Interfere with clotting cascade and thrombin formation
    • Heparin
    • Warfarin

• Antiplatelets:

  • Alter formation of platelet plug
    • Inhibit platelet adhesion and aggregation by blocking receptor sites on the platelet membrane
      • Anagrelide: blocks production of platelets in bone marrow
    • Aspirin

• Thrombolytic drugs:

  • Break down the thrombus that has formed by stimulating the plasmin system
    • Activate plasminogen to plasmin, which in turn breaks down fibrin threads in a clot to dissolve a formed clot
      • Alteplase (Activase) (TPA)
      • Tenecteplase (TNKase)

Overdose Treatments and Lab Values

• Heparin overdose:
  • Reversal: Protamine Sulfate
  • Lab value indicating supratherapeutic dosing: aPTT (prothrombin time)
    • Normal: 21-35 seconds
    • Goal for a patient on IV heparin: 1.5x-2.5x normal rate
• Warfarin hemorrhage/uncontrolled bleeding:
  • Treatment: K-Centra or prothrombin complex
• Warfarin overdose:
  • Treatment: Vitamin K (no bleeding, only if lab values are high)
  • Lab values indicating supratherapeutic dosing:
    • PT lab value
      • Normal: 21-35 seconds
      • Goal for patient: 1.5x-2.5x normal rate
    • INR (internationalized normal ratio) lab value
      • Normal: 1
      • Goal for patient: 2-3
    • Higher PT and INR = greater risk for abnormal bleed

Aspirin (ASA) and Children w/ Fever

• Contraindicated due to risk of Reye’s Syndrome

Hyperacute Ischemic Stroke Treatment

• Thrombolytics:
  • Alteplase (TPA) and Tenecteplase (TNKase)
    • Activates plasminogen to plasmin, which in turn breaks down fibrin threads in a clot to dissolve a formed clot
  • Contraindications:
    • Allergy
    • Any condition that would be worsened by dissolution of clots
  • Key Nursing Considerations:
    • History of physical exam and known allergy
    • Recent surgery, active internal bleeding, CVA within last 2 months, aneurysm, obstetrical delivery, organ biopsy, recent serious GI bleeding, rupture of a non compressible blood vessel, recent major trauma
    • Known blood-clotting defects, cerebrovascular disease, uncontrolled HTN, liver disease
    • Baseline status to include, VS, skin, orientation, appropriate lab values and ECG
  • Hemorrhagic Stroke:
    • Thrombolytics are not appropriate due to the risk of increased bleeding

Receptor Site Stimulation

• Alpha:
  • Generally excitatory effects (vasoconstriction)
  • Exceptions are receptors in the intestine and the pupils which are inhibitory
• Beta:
  • Inhibitory effects (smooth muscle relaxation)
  • Exception: receptors in the heart which are excitatory
    • B1: primarily in heart muscle
      • Causes positive chronotropic, dromotropic, inotropic effects
        • Chronotropic: affects HR
          • Positive: adrenaline
          • Negative: digoxin
        • Dromotropic: affects conduction velocity through the conducting tissues of the heart
          • Positive: phenytoin
          • Negative: verapamil
        • Inotropic: affects the force of cardiac contraction
          • Positive: dopamine, adrenaline
          • Negative: labetalol and propranolol
    • B2: smooth muscle of airways, blood vessels
      • Causes vasodilation, bronchodilation

Alpha 1 Receptors

• Location: Sympathetic NS (mainly in smooth muscles of blood vessels and muscle tissues of heart)
  • Body’s response when A1 is activated:
    • Eyes: dilate
    • Mouth: mucosal edema and salivation
    • Vessels: vasoconstriction
    • Liver: glycogenolysis and glycogen to glucose
    • Kidneys: urine retention, release of renin, increase BP
    • Bladder: urinary sphincter contracts
    • Sex organs: prostate constricts
    • Smooth muscle: constricts
  • Body’s response when A1 is activated by an adrenergic antagonist:
    • Vessels: vasodilate
    • Kidneys: decrease BP
• Adrenergic Agonists (sympathomimetics):
  • Epinephrine
  • Norepinephrine
  • Dopamine
  • Phenylephrine (neosynephrine): used in nasal congestion and hypotension
  • Midodrine- severe orthostatic hypotension
    • SE: may cause severe rebound supine hypertension
• Adrenergic Antagonists (sympatholytic):
  • Prazosin/Minipress: most effective on BP, but can affect prostate as well
  • Tamulosin/Flomax: most effective on prostate, but can affect BP as well

Alpha 2 Receptors

• Location: Sympathetic NS (mainly works in CNS)
  • Body’s response when A2 is activated:
    • Predominant brainstem effects
    • GI coupled receptor
    • Vascular: decrease PVR, BP
    • CNS: increase effects of sedation and overall tone
    • Blood: increases platelet aggregation
  • Body’s response when A2 is activated by an adrenergic antagonist:
    • No meds used in humans in this section
• Adrenergic Agonists:
  • Clonidine
    • Uses: HTN, not endogenous so it is long acting, can be given PO and it does cross into CNS. Useful in ADHD pts unless they have low BP. Very useful in pt who are undergoing ETOH or narcotic withdrawal
• Adrenergic Antagonists:
  • Not used in human clinical settings
  • Used in vet settings and there are a few drug companies that are working on but nothing right now

Beta 1 Receptors

• Location: Sympathetic NS (mainly works in the heart)
  • Body’s response when B1 is activated:
    • Increase HR, increase contractility = CO, increased AV conduction
    • Kidneys: increased renin release resulting in increased BP due to urinary retention
  • Body’s response when B1 is activated by an adrenergic antagonist:
    • Decrease HR
    • Kidneys: decrease renin resulting in decreased BP due to urinary excretion
    • Decreases oxygen demand to the heart
• Adrenergic Agonists:
  • Epinephrine
  • Norepinephrine
  • Dopamine
  • Dobutamine: useful in ESRD pts
• Adrenergic Antagonists (Beta Blockers):
  • Propranolol (Inderal): not selective affects both B1 and B2
  • Metoprolol (Lopressor): selective to cardiac tissue only; only B1 (better choice for those who have pre-existing lung or kidney issues)

Beta 2 Receptors

• Location: Sympathetic NS (mainly works in the lungs)

  • Body’s response when B2 is activated:
    • Lungs: Bronchodilator
    • Vessels: vasodilate; small doses of Epi will cause vasodilation
    • Pancreas: increase insulin production
    • GI: motility decreased
    • Uterus: relaxes uterus, stops labor
  • Body’s response when B2 is activated by an adrenergic antagonist:
    • Lungs: bronchoconstrict
    • Vessels: vasoconstrict
    • Decreased insulin production
    • Increased GI motility
    • Contractions of the uterus

• Adrenergic Agonists:

  • Epinephrine: drug has highest affinity to B2 receptors until they are full
  • Albuterol: asthma
  • Terbutaline: asthma and preterm labor
  • Magnesium: asthma and preterm labor

• Adrenergic Antagonists:

  • Propranolol: can induce labor, use with caution in diabetics (decreases insulin), not helpful in pts with asthma, COPD, emphysema (bronchoconstriction)
    • Effective for HTN

Sympathomimetics vs Sympatholytic

• Medications act or block specific receptors to produce a specific effect, or no effect at all
• An MAOI (monoamine oxidase INHIBITOR) will BLOCK the breakdown of neurotransmitters in the pre-synapse PROMOTING CONTINUED action of the neurotransmitter. This allows the neurotransmitter to CONTINUE promoting its effect on and on and on (i.e. for epinephrine on alpha 1 it will keep on vasoconstricting). If a patient takes an MAOI, and then is given an alpha-adrenergic agonist, what would be the effect? Would it be contraindicated?
  • Yes, because it causes increased risk of HTN, stroke, or death
• If stimulating a beta 1 receptor what is the biggest concern? (remember this has to do with cardiac arrhythmias….so the nurse would need to assess WHAT as a priority assessment)
  • Biggest concern is arrhythmias as they can occur in pt already has high BP because when site is stimulated, it increases CO, contractility, and BP due to release of renin from kidneys
• Understand the concept of nonselective vs selective
  • Nonselective: works on all receptors
  • Selective: works on specific receptor
• Why could alpha stimulation without beta stimulation be dangerous for pts with existing cardiac impairment (think increased demand –vasoconstriction - without increased supply – increased contractility & bronchodilation)
  • Alpha stimulation without beta stimulation could be dangerous for pts with existing cardiac impairment because it can lead to vasoconstriction and overworking/failure of the heart because it can’t compensate for high blood pressure
• Why is beta 2 blocking dangerous for patients with respiratory impairment
  • Beta 2 blocking is dangerous for pts with respiratory impairment because it causes their lungs to bronchoconstrict
• What are key nursing considerations for all the medications on your medication cards
• Patient education when patients take adrenergic antagonists (sympatholytics) that affect blood pressure and cardiac output.
  • Take medication as prescribed, do not stop abruptly because of rebound HTN or chest pain (ischemia)
  • Change pt position slowly
  • Avoid activities that precipitate hypotension and elderly should avoid extreme heat
• The terminology- adrenergic, antagonists, agonists, sympatholytic, sympathomimetics
  • Adrenergic: works on epinephrine and norepinephrine receptors
    • Nerve cells use tyrosine found in our diets to produce L-Dopa. L-Dopa is converted to dopamine, and adrenergic cells convert dopamine to norepinephrine and store it until needed. When stimulated, it is released
  • Agonists: allows
  • Antagonists: blocks
  • Sympatholytic: drug that lyses, or blocks effects of SNS
  • Sympathomimetic: drugs that mimics SNS with S/S seen when SNS is stimulated
    • Used to assist the endogenous catecholamines of the SNS for therapeutic benefit
• Know how the dosage of dopamine is affected: what does a high dosage of dopamine affect, what does a med dosage and a low dosage effect?
  • Dopamine receptor site:
    • Many in CNS, specifically in hippocampal area
    • Low levels of dopamine: dopamine receptors
    • Mid levels of dopamine: B1
    • High levels of dopamine: A1
• Unused Norepi (Reuptake)
  • Monoamine Oxidase (MAO)
    • Norepinephrine that is unused is recycled and undergoes metabolism with an enzyme MAO
  • COMT
    • A Catechol-O-Transferase another enzyme that actually eats or destroys the unused norepinephrine
• Catecholamines
  • Epinephrine
  • Norepinephrine
  • Dopamine
  • Only given parenteral, NOT oral
  • Do not pass the blood-brain barrier
  • Very short half-life
  • If endogenous (produced naturally), they are fully utilized (MAO/COMT); shorter acting
    • Synthetic lasts longer because there is no MAO or COMT
    • Well absorbed, typically rapid onset through various routes
      • Clonidine is not well absorbed transdermal
  • Metabolized in the liver
  • Excreted in the urine
  • Phenylephrine (Alpha 1)
    • Uses
      • Oral: URI and allergy
      • Intranasal: allergic rhinitis
      • Optic: pupil dilation and glaucoma
      • Parenterally: shock, sepsis, and cardiac arrest
    • Actions
      • Vasoconstriction
  • Midodrine (Alpha 1)
    • Uses:
      • Oral: orthostatic hypotension
      • Parenterally: cardiogenic shock, heart failure, and hypotension
    • Actions:
      • Alpha 1 specific
      • Peripheral vasoconstriction, increases vascular tone, increases BP
      • May cause profound supine HTN

Respiratory System

• Conducting Airway:
  • Nose
  • Pharynx
  • Larynx
  • Trachea
• Gas Exchange Airway:
  • Bronchi
  • Bronchioles
  • Alveoli: if not enough lubricant, they can collapse (stick to each other)

Drugs for Upper Respiratory Tract:

• Antitussives: Block the cough reflex
  • Opioid:
    • Codeine
    • Hydrocodone
  • Nonopioid:
    • Dextromethorphan
    • Benzonatate (Local)
• Decongestants: Decrease blood flow to Upper RT = decrease secretions
  • Topical Nasal (-zoline)
    • Common Cold, Sinusitis, Allergic Rhinitis
      • Naphazoline
      • Oxymetazoline
      • Phenylephrine
      • Tetrahydrozoline
      • Xylometazoline
  • PO
    • Common Cold, Sinusitis, Allergic Rhinitis
      • Pseudoephedrine
      • Phenylephrine
  • Steroid Nasal
    • Allergic Rhinitis
    • First line meds for nasal congestion, need to taper
      • Beclomethasone
      • Budesonide
      • Flunisolide
      • Fluticasone
      • Triamcinolone
• Antihistamines: Block histamine (increases secretions & narrows airways)
  • Allergic Rhinitis
    • 1st Gen.
      • Diphenhydramine (Benadryl)
    • 2nd Gen.
      • Fexofenadine (Allegra)
      • Loratadine (Claritin)
      • Cetirizine (Zyrtec)
• Expectorants: Increase productive cough to clear airway
  • Guaifenesin