Unit 1 (communication, safety, sensory)

PHARMACOKINETICS: what the body does to drug

• absorption: location of admission → bloodstream; factors include rate, amount, and route

• distribution: transportation of drug to site of action

• metabolism: changes drug into less/in-active form via enzymes

• excretion: elimination of drug from body

therapeutic index (TI) if high = wide safety margin, if low = narrow safety margin

PHARMACODYNAMICS: what drug does to body

• agonist: drug binds to/mimics receptor activity

• antagonist: drug blocks receptor activity

• partial agonist: drug works as agonist & antagonist

MED ADMINISTRATION & PT EDUCATION

• enteral (oral)

• parenteral (topical, injection, inhaled, suppository, etc.)

OTC DRUGS

must be/have:

1. indication for use: benefits > risks for dosages

2. good safety profile: low abuse potential, high TI, limited drug interactions

3. practical: easy to use/monitor

SUPPLEMENTS

VITMAINS/MINERALS

water soluble vitamins:

• B1 (thiamine):

  • beriberi or Wernicke Korsakoff syndrome (deficiency)

• B2 (riboflavin):

  • red tongue, cracked lips/corner of mouth (deficiency)

• B3 (niacin):

  • pellagra (deficiency)

• B6 (pyroxidine): involved in metabolism, amino acid absorption, and neurotransmitter synthesis

  • deficiency: abnormal CNS function

• B12 (cyanocobalamin): involved in DNA synthesis & cell division; needs intrinsic factor to be absorbed through oral administration

  • pernicious anemia (deficiency)

• C (ascorbic acid): active in oxidation-reduction rxns, used in metabolic activities, enhances iron absorption

  • scurvy (deficiency)

fat soluble vitamins:

• A: essential for vision, skin, and immune system

  • sources: animal liver, fruits/vegetables (esp. carotenes)

  • xerophthalmia, keratinization (deficiency)

• D: essential for bones & teeth

  • sources: fortified foods (milk, cereal, OJ), fatty fish/fish liver oils, mushrooms

• E: antioxidant properties

  • sources: nuts, seeds, vegetable oils

• K: essential for blood clotting

  • sources: leafy green vegetables

  • black tarry stools (deficiency)

  • anemia, jaundice (toxicity)

minerals:

• calcium: high concentration in bones & teeth; sufficient vit D required for absorption: essential for nervous, muscular & skeletal systems

  • hypocalcemia (deficiency)

    • rickets (children)

    • osteomalacia, osteoporosis (adults)

  • hypercalcemia (toxicity): N/V/D

  • chelation- calcium salts binding with tetracyclines to → insoluble complex (ex: digoxin)

• magnesium: essential for metabolism, nerve physiology, & muscle contraction; used for (pre)/eclampsia

  • hypomagnesia (deficiency)

  • hypermagnesia (toxicity): tendon reflex loss, CNS depression, heart block, resp distress, hypothermia, difficult BMs

• phosphorus: “building block”

• zinc: essential in metabolic reactions of proteins & carbohydrates, normal tissue growth & repair

• folic acid: used in pregnancy to prevent CNS issues in fetus

  • women of childbearing years should be taking 400 mcg/day

• iron

• potassium: never push K bolus do not use with K+ sparing diuretics or ACE inhibitors, or pts with chronic kidney disease

  • hypokalemia (deficiency): <3.5

  • hyperkalemia (toxicity): >5

OPTHALMIC DRUGS

mydriatics dilate the pupil

• sympathomimetics

miotics constrict the pupil

• cholinergic drugs

cycloplegics paralyze the ciliary body + mydriatic properties

OTIC DRUGS

• antifungals

• antibiotics

• earwax emulsifiers

• acetic acid

• hydrocortisone

Unit 2 (mobility, nutrition, gas exchange)

PARKINSONS DRUGS

• MAOIs: inhibit dopamine breakdown

  • selegiline

  • rasagiline

• dopamine modulators:

  • amantadine

• COMT inhibitors: prolong levodopa effects

  • entacapone

• NDDRAs: directly stimulate dopamine receptors

  • bromocriptine

• dopamine replacement drugs:

  • levodopa

• anticholinergic drugs: block effects of Ach

  • benztropine

ALZEHEIMERS DRUGS

• rivastigmine: inhibits AchE, treats mild-moderate AD

CNS DEPRESSANTS & MUSCLE RELAXANTS

• dantrolene

• baclofen

• kava HERB

• valerian HERB

ANTIDIARRHEALS

• adsorbents: coat GI tract & bind to the “toxin”

  • bismuth subsalicylate

• anticholinergics: slow peristalsis + drying effect

  • belladonna alkaloid compounds

• opiates

• probiotics: restore “good” flora, suppress “bad” bacteria

LAXATIVES

• bulk-forming

  • methylcellulose

• emollient

  • docusate salts

• hyperosmotic

  • lactulose

• saline

  • magnesium salts

• stimulant

  • bisacodyl

  • senna

ANTIEMETICS

• anticholinergics

  • scopolamine

• antihistamines

  • meclizine

• antidopaminergics

  • prochlorperazine

  • promethazine

• neurokinin receptor antagonists

  • aprepitant

• prokinetic drugs

  • metoclopramide

• serotonin blockers

  • ondansetron

• tetrahydrocannabinoids

  • dronabinol

• ginger HERB

ANTIHISTAMINES

• loratadine

• diphenhydramine

DECONGESTANTS beware of rebound congestion

adrenergics:

• ephedrine

• oxymetazoline

anticholinergics:

• ipratropium

corticosteroids:

• fluticasone

• flunisolide

• triamcinolone

ANTITUSSIVES only for NONproductive cough

opioids:

• codeine

• hydrocodone

nonopioids:

• benzonatate

• dextromethorphan

EXPECTORANTS

• guaifenesin

RESPIRATORY DRUGS

bronchodilators give before corticosteroids

• beta-adrenergic agonists

• anticholinergics: airway relaxation/dilation -tropium

• xanthine derivatives: decrease cAMT levels

nonbronchodilators

• LTRAs: prevent bronchoconstriction -lukast/leuton

• corticosteroids: rinse mouth to prevent thrush

• phosphodiesterase inhibitors: prevent cough/mucus from worsening

• monoclonal antibody antiasthmatics: decrease immune response -lizumab

Unit 3 (perfusion, pain)

antilipemic drugs

• HMG-CoA reductase inhibitors -statins

• niacin

• bile acid sequestrants

• fibrates

• flax HERB

• garlic HERB

• omega 3 fatty acids HERB

COAGULATION MODIFIERS

anticoagulants

• heparins -parin monitor aPTT & INR give protamine sulfate to reverse effects

• coumarins monitor PT & INR give vitamin K to reverse effects

• thrombin inhibitors -tran/ban

• selective factor Xa inhibitors

antiplatelet drugs

• aspirin Reye syndrome!

• clopidogrel

thrombolytic drugs -ase

• alteplase

antifibrinolytic drugs: promote coagulation

• desmopressin

• tranexamic acid

• aminocaproic acid

ANTIHYPERTENSIVE DRUGS

• alpha 2 receptor agonists

  • clonidine

  • methyldopa

• alpha 1 receptor blockers -azosin

  • doxazosin

• beta blockers -olol

• alpha 1 + beta receptor blockers

  • carvedilol

  • labetalol

• ACE inhibitors - pril monitor potassium levels

• ARBs -sartan

• CCBs

• diuretics

• vasodilators: mostly used in emergency situation

ANALGESICS

opioids: target mu, kappa, and delta receptors black box warnings

• agonists: ex) codeine, morphine, oxycodone

• agonist-antagonists: ex) buprenorphine

• antagonists: ex) naloxone, naltrexone

MIGRAINE DRUGS

• serotonin receptor agonists: abort migraine attack -triptan

• ergot alkaloids: abort migraine attack

Unit 4 (infection, inflammation, and tissue integrity)

ANTIINFLAMMATORY DRUGS

ANTI-GOUT DRUGS

ANTIBIOTICS

ANTIVIRALS

ANTIFUNGALS

DERMATOLOGIC DRUGS

Unit 5 (nutrition, elimination, reproduction)

ACID-CONTROLLING DRUGS

• antacids: neutralize stomach acid, contain Ca, Mg, Al, or Na

• H2 receptor antagonists -tidine

• PPIs -prazole take on an empty stomach

• misc drugs

  • sucralfate: used for ulcer tx take 1 hour before meals & at bedtime

  • misoprostol: Preg X take with meals

  • simethicone: used to decrease gas

REPPRODUCTIVE DRUGS

OSTEOPOROSIS DRUGS

• bisphosphonates: inhibit bone resorption take with 8 oz of water & sit upright for 30 minutes

  • alendronate

• selective estrogen receptor modulators (SERMs): stimulate estrogen receptors → increased bone density

  • raloxifene may also improve cholesterol

• calcitonin: inhibit osteoclastic bone resorption

• teriparatide: stimulate bone formation do not take for more than 24 months

• denosumab: block osteoclast activation take with daily Ca & Vitamin D supplement