NR-291 Pharmacology I Study Guide – Exam 2

1 NR-291 Pharmacology I Study Guide – Exam 2 Effects of the Peripheral Vascular System • Cholinergic – Parasympathetic Nervous System (feed and breed; rest and digest) oCholinergic effects (SLUD) ▪ Salivation, Lacrimation, Urination, Defecation oAnticholinergic effects (Mad as a Hatter) ▪ Hyperthermia, blindness, confused, dry mouth, urinary retention, shaking, grabbing invisible objects, tachycardia, absent bowel sounds, flushed skin, mydriasis • Adrenergic – Sympathetic Nervous System (fight or flight) oAlpha effects ▪ Vasoconstriction (treat hypotension), CNS stimulation, relaxation of GI smooth muscles (decreased motility), constriction of bladder sphincter, contraction of pupillary muscles of the eye (dilated pupils), contraction of uterus, male ejaculation oBeta 1 and Beta2 effects ▪ 1 – increased force of contraction (positive inotropic effect). Increased HR (positive chronotropic effect), increased conduction through AV node (positive dromotropic effect) ▪ 2 – bronchodilation (relaxation of the bronchi), glycogenolysis in the liver, increased renin secretion in the kidneys, relaxation of GI smooth muscles (decreased motility), uterine relaxation, inhibits histamine release from mast cells, increases intraocular pressure oDopaminergic effects ▪ Vasodilation (resulting in increased blood flow) to: renal (diuresis), mesenteric, coronary (increase CO and contractility without increasing HR), cerebral Chapter 36: Antihistamines, Decongestants, Antitussives, and Expectorants • Know and apply pharmacology treatment for the common cold oCombination use of: antihistamines, nasal decongestants, antitussives, expectorants oTreatment is symptomatic only, not curative oTreatment is empiric therapy • Antihistamines (-dine) (-iramine) (-tadine) oKnow and apply common uses of H 1 versus H2 blockers or antagonists ▪ H1 – relief of allergy symptoms, treat non-allergy conditions (insomnia, motion sickness, Parkinson-like reactions due to anticholinergic effects) ▪ H2 – reduce gastric acid , gastric and duodenal ulcer, GERD, acid indigestion, heartburn oNice to know: ▪ Adv Eff – dry mouth, difficulty urinating, constipation, mild drowsiness to deep sleep, changes in vision o Good to know: ▪ Due to Adv Eff, use with caution in pts with – HTN, angina, MI, Asthma or COPD, hyperthyroidism, peptic ulcer disease (antihistamines stimulate gastric acid secretion), BPH or urinary retention bound 2 ▪ Antihistamines appear on Beers List (geriatric clients at risk for orthostatic hypotension) o Got to know: ▪ Pt education: report excessive sedation, confusion or hypo/hypertension, avoid driving or operating heavy machinery, advise againse consuming alcohol or other CNS depressant ▪ Contraindicated in glaucoma (angle-closure) – due to anticholinergic properties ▪ Diphenhydramine has multiple uses and is often combined with many other OTC meds oDiphendydramine oCimetidine • Decongestants oVasoconstrict blood vessels of the nose, throat and paranasal sinus, decreases inflammation and mucous formation o Good to know: ▪ Oral (adrenergics) – prolonged decongestant effects but delayed onset, less potent than topical, no rebound congestion ▪ Pt education – avoid caffeine, report a fever, cough, or other symptoms lasting longer than a week o Got to know: ▪ Topical or nasal adrenergics – prompt onset, rapid absorption, rapid decline in therapeutic activity, potent, sustained use over several days causes re congestion making the condition worse (cause overuse and dependency) ▪ Avoid or consult with prescriber – HTN, palpitations, BPH oOral – pseudooephedrine oIntranasal – phenylephrine, fluticasone, ipratropium • Antitussives – only for nonproductive coughs oOpioid – codeine ▪ Suppress the cough reflex by direct action on the cough center in the medulla oNonopioids – benzonatate, dextromethorphan ▪ Suppress the cough reflex by numbing the stretch receptors in the respiratory tract and preventing the cough reflex from being stimulated o Good to know: ▪ Report any of the following symptoms to the caregiver: cough that lasts more than a week (possible CHF), a persistent headache, fever, rash o Got to know: ▪ Antitussive drugs are for nonproductive coughs only! • Expectorants oIrritates GI tract which causes a loosening and thinning of respiratory tract secretions oGuaifensin o Good to know: ▪ Report a fever, cough, or other symptoms lasting longer than a week o Got to know: ▪ Pt education – encourage more fluids, if permitted, to help loosen and liquefy secretions Chapter 37: Respiratory Drugs 3 • Know Evidence-Based Practice Guideline from GINA (stepwise plan) • Know classifications and actions of respiratory drugs (Bronchodilators, etc...) oBronchodilators – relax smooth muscles that line airway oBeta-agonists – increase mucociliary clearance oAnticholinergics – prevent bronchospasm oCorticosteroids – block inflammation that narrows airway • Relievers oShort-acting beta 2-agonist (SABA) ▪ albuterol, epinephrine oShort-acting anticholinergics ▪ ipratropium bromide, oxitropium bromide • Controllers oInhaled corticosteroids (ICS) ▪ beclomethasone, budesonide, fluticasone: 1, 2, 3, 5, 11, 12 oICS / Long-acting beta2-agonist (LABA) ▪ Advair – fluticasone / salmeterol: 1, 2 ▪ Symbicort – budesonide / formoterol: 1, 2 • Leukotriene receptor antagonists (LTRAs) omontelukast, zileuton oCounteract substances that cause air passages to constrict and secrete mucus • Xanthine derivatives otheophylline, aminophylline oinhibit action of mast cells • Anti-IgE oomalizumab: 1, 2 • Long-acting anticholinergics otiotropium: 1, 2 • Know and apply asthma action plan, definition of control, questions asked, peak meter flow • Good to know: o Pt education ▪ Use inhaled bronchodilator (albuterol) first to open up airways, then use inhaled corticosteroid to better penetrate the lungs • Hold breathe for 10 seconds, then slowly exhales, if a second puff of the same medication is ordered wait 1-2 mins, wait 5 mins before another inhalant ▪ Inhaled medications • Prime (shake) the unit before using, discard the canister after 200 sprays, rinse their mouth with water and spit after each inhalation dose, and once a week clean the mouthpiece in warm, soapy water • Use a spacer if difficulty coordinating breathing with inhaler activation ▪ Corticosteroids • Inhaled forms reduce systemic effects and are the most consistently effective long-term control medication sat all steps in both children and adult asthma • Got to know: o Pt education 4 ▪ Epinephrine (EpiPen) inject directly through clothing, into outer thigh and hold in place for 10 seconds to deliver all of the drug ▪ Albuterol, if used too frequently, loses its beta2-specific actions at larger doses • As a result, beta 1 receptors are stimulated, causing nausea, increased anxiety, tremors, vascular headache, palpitations, angina, and increased HR ▪ If you need quick-relief medicine more than 4 times in 1 day to stop asthma attacks, you need help from a doctor today! o Theophylline therapeutic level (10-20 mcg/mL) ▪ Draw peak levels 15-20 mins after IV loading dose ▪ Benzodiazepine (diazepam) to treat seizures ▪ Multiple drug and food interactions (cigarette smoking enhances xanthine metabolism) ▪ Contraindications: history of PUD or GI disorders (stimulates gastric acid secretion) ▪ Cautious use: cardiac disease (sinus tach, extrasystoles, palpitations, ventricular dysrhythmias • Nicotine o Good to know: ▪ Cravings can continue for several weeks even after physical dependence stops o Got to know: ▪ Nicotine abuse – patients cannot smoke while wearing nicotine patch Chapter 41: Antitubercular Drugs • Common infection sites ▪ Lung (primary), brain, bone, liver, kidney • TB-Related Injections oPPD: 1, 12 oBCG: 1, 2, 3, 12 • Know and apply concepts of bactericidal and bacteriostatic therapy • Know and apply concepts of culture and sensitivity of TB sputum cultures • Know patient and family education regarding spread of infection • Know and apply concept of MDR-TB • Know first-line drug therapy (RIPE) for TB, including length of treatment orifampin: bactericidal oisoniazid (INH): bacteriostatic opyrazinamide (PZA): 1, 5, 12 oethambutol: 1, 5, 12 ostreptomycin: 1, 5, 12 o Good to know: ▪ Rifampin • Can cause reddish-orange discoloration of urine, sweat, tears, feces, urine, and skin • Should not wear soft contact lenses while taking drug (turn orange) • Another form of birth control will be needed ▪ Oral preparations may be given with meals to reduce GI upset, even though recommendations are to take them 1 hr before or 2 hrs after meals ▪ Monitor for therapeutic effects (start within 2 weeks)