Pharm Review Notes

Adrenergic Receptors

  • A2, A1, B1, B2 are primary sites.
  • Clonidine: Stimulates A2 receptors centrally in the brain but blocks norepinephrine release from the adrenal glands.
  • B1: One heart.
  • B2: Two lungs.
  • Rest: Vasoconstriction/vasodilation, urethral constriction/dilation, peripheral circulation.

Arrhythmias and Heterogeneity

  • Fibrillation: Chaotic "quivering" of the heart.
  • Heterogeneity: Damaged heart cells cause rogue electrical patterns, influencing other cells and leading to fibrillation.

Exam 2 Review

  • 58 questions, 1.5 minutes per question.

Alpha One Blockers

  • Drugs: OSIN meds.
  • Treat BPH by dilating the urethra.
  • Treat Hypertension by blocking A1 receptors to promote vasodilation.
  • Side effects: Monitor blood pressure due to systemic vasodilation.

TURP

  • Transurethral Resection of the Prostate.
  • Continuous bladder irrigation (CBI) is required.
  • With CBI, monitor drainage for clots and pressure to prevent explosion of the irrigant bag. Nurses are responsible for cleaning up spills.

Rifampin and Warfarin Interaction

  • Rifampin reduces the effectiveness of Warfarin increasing the risk of blood clots.
  • Conversely, certain drugs like oral contraceptives can decrease the effectiveness of warfarin.
  • Consequences of decreased warfarin effectiveness: Blood clots, PE, stroke, death.

Bicalutamide (Casodex)

  • Anti-androgen used to treat testosterone-dependent prostate cancer.
  • Mechanism: Inhibits androgen uptake or binding, starving the cancer of testosterone.
  • Prostate cancer has an affinity to bone and lymph.

Oral Contraceptives

  • Can be rendered ineffective by rifampin (antitubercular) and certain antibiotics (penicillins, cephalosporins).
  • Always ask female patients if they could be pregnant before prescribing medications that may interfere with oral contraceptives.

Diphenhydramine (Benadryl)

  • Antihistamine (H1 blocker).
  • Side effects: Drowsiness.
  • Uses: Allergic reactions, sleep aid.
  • Can cause cardiac dysrhythmias.
  • Alternatives: Methylprednisolone (IV corticosteroid) for severe allergic reactions.

Lupron (Leuprolide) for BPH

  • Shrinks the prostate by blocking androgens.
  • Inhibits the secretion of pituitary gonadotropin, leading to hypogonadism.
  • Side effects: Smaller gonads, female characteristics.

Bisphosphonates (Alendronate)

  • Treat osteoporosis.
  • Mechanism: Prevents osteoclastic action (bone breakdown).
  • Requires concurrent vitamin D and calcium supplementation.
  • Weight-bearing exercise is important.
  • Administration: Patient must sit upright for 30 minutes with at least 8 ounces of water to prevent esophageal necrosis.

Bronchodilators

  • Three Major Categories:
    • Adrenergics (e.g. Albuterol)
    • Xanthine Derivatives (e.g. Theophylline, Aminophylline) - old school
    • Anticholinergics (e.g. Ipratropium) - sympathetic

Anticholinergics

  • Sympathetic effects.
  • COPD patients often exhibit tachycardia and shakiness.
  • Side effects: Dry mouth, bitter taste, throat and nasal irritation.

Furosemide (Lasix)

  • Diuretic.
  • Side effects: Orthostatic hypotension.
  • Management: Dangle patient's legs before ambulation, monitor blood pressure.
  • Mechanism: Vasodilation or fluid loss.

Pulmonary Embolism (PE)

  • Symptoms: Sudden onset shortness of breath, pain, desaturation.
  • Risk factor: Oral contraceptive use.
  • Diagnosis: Stat X-ray to rule out pneumonia, VQ scan.

Androgenic Steroids

  • Clinical Use: Build tissue, especially muscle, in bed-bound patients.
  • Also known as Anabolic steroids.
  • Dark Side/Downsides:
    • Exogenous administration leads to decreased endogenous production.
    • Hypogonadism. Sterility.
    • Misuse by bodybuilders, leading to liver cancer/failure, CV disease, psychological and physical dependence, "roid rage".
  • Clinical Use: Weight gain after major surgery, trauma, and chronic diseases.