Pharmacology Exam I

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Prazosin (Minipress) does what to BP

Lowers

Prazosin is what kind of drug?

Alpha Adrenergic Antagonist

Prazosin does what to cardiac output?

(-) chronotropic, (-) inotropic

Prazosin does what to peripheral perfusion?

Increases peripheral vasodilation

Prazosin does what to UA flow

Improves flow by inhibiting muscle contraction

Prazosin does what to the lungs

Bronchoconstriction

What drug would help with Reynaud's or frostbite?

Prazosin

What drug would help to prevent local necrosis at an IV infiltration site by increasing peripheral vasodilation?

Prazosin

What drug would assist with the impaired urine flow caused by benign prostatic hypertrophy?

Prazosin

List 3 contraindications to Prazosin

1. Hypotension
2. MI (lowers cardiac output and O2 delivered to heart muscle, no good)
3. Angina (lowers cardiac output and O2 delivered to heart muscle, no good)

Considering that Prazosin is used to lower BP, what is a serious adverse drug effect of this med?

First-dose syncope due to hypotension

What are some common adverse effects of Prazosin, and other BP lowering meds?

Light-headedness, dizziness, drowsiness, weakness, tachycardia due to decreased BP, palpitations

List the prototype Adrenergic agonist

Epinephrine

Does GI function slow or increase on epinephrine?

Slow

Epinephrine: bronchodilate or bronchoconstrict?

Bronchodilate

Epinephrine's effects on blood sugar and fatty acid content in blood?

Both are increased (think fight or flight)

Epinephrine affects cardiac output how?

(+) chronotropic, (+) inotropic

You're really sweaty and you just took an andrenergic agonist. What did you take?

Epinephrine

Epinephrine stimulates the CNS resulting in what sort of symptoms?

Tension, anxiety, restlessness, insomnia?

Epinephrine stimulates what division of the ANS?

SNS

Epinephrine will cause peripheral....

Vasoconstriction

List a few reasons you might use epi on a patient?

Cardiac arrest, shock, hypotension, obstructive pulmonary disease, bronchial asthma

If your patient has severe hypertension and tachycardia, what adrenergic agonist will you NOT give to them?

Epinephrine

What does epinephrine do to blood sugars?

Increases them

Propanolol has what trade name?

Inderal

What sort of drug is Inderal?

Beta-1 Adrenergic Antagonist

Where are Beta 1 receptors located?

Heart

What does Inderal do to cardiac output?

Lowers it in all ways; (-) chronotropic, (-) inotropic, (-) dromotropic

What does Inderal do to glucose metabolism? (Think: is is an ADRENERGIC antagonist)

Makes it less effective

What does Inderal do to the lungs?

Bronchoconstriction

What does Inderal do to BP?

Lowers

Your pt. has angina due to not being able to supply his heart with enough O2 for its needs. What type of drug might you use to lower his cardiac output so that the pain will subside?

Beta 1 blocker like Inderal

Would Inderal be appropriate for asthma?

No, because it causes bronchoconstriction

Would Inderal be a good choice for a patient with palpitations?

Yes, because it slows down heart conduction

With Inderal being a beta 1 blocker, what are some common adverse effects you might expect?

Hypotension, bradycardia

Phenobarbital is the prototype for what class of drug?

Barbiturates

Due to its tolerance-inducing qualities, Phenobarbital is no longer widely used for sedative effects. However, it is still used for which of its properties?

Anti-convulsant

Diazepam, or Valium, is the prototype for what class of drugs?

Benzodiazepines

Benzodiazepines increase the inhibitory effects of what neurotransmitter?

GABA

Flumazenil (Romazicon) will work if given in time for what kind of OD?

Benzodiazepines

Diazepam (Valium) depresses the CNS. What therapeutically, in terms of anxiety, does this achieve?

Sedation

As a result of its CNS depressant qualities, Diazepam (Valium), may decrease what vital function?

Respiratory rate

Your pt. is acting out in a severe psychosis. Is diaepam (Valium) the right drug for him?

No, it is contraindicated with psychoses!

Because of these common adverse effects of diazepam (Valium), pts. should use caution when driving.

Drowsiness, confusion, ataxia.

What is one major lifestyle question you must ask when prescribing benzodiazepines?

What is your alcohol intake? Alcohol and benzos cannot be combined!

Your pt. presents to ED with acute ETOH withdrawal. What is the right class of drug for him, sedation wise?

Benzodiazepines - diazepam, Valium

Name the four therapeutic properties of ASA

1. Analgesic
2. Anti-pyretic
3. Anti-inflammatory
4. Anti-thrombotic

How long does it take for ASA to separate from the platelets?

It doesn't. Once it binds, it's with the platelet for the rest of its lifespan (approx. 8 days.)

Reye's syndrome is a risk for children under 16 with viral illness, related to administration of which drug?

ASA

Which COX does ASA inhibit?

COX 1 & COX 2

Is ASA good for gout pain?

No! It inhibits uric acid excretion by the kidneys.

What is a bothersome but reversible ear effect of ASA?

Tinnitus

What is the antidote for ASA overdose?

There is none. Gastric lavage and support are all there is.

What is a major risk accompanying long-term ASA treatment?

Bleeding

Your pt. with back pain and a history of GI ulcerations is asking what sort of OTC to take. Is ASA appropriate?

No! ASA increases bleeding risk.

In contrast to the long-term anti-thrombotic qualities of ASA, how long do the anti-thrombotic qualities of Ibuprofen last?

As long as the drug is in the system, which is about 4 hours.

What are two common GI adverse effects related to Ibuprofen?

Nausea & vomiting

By blocking the "good" Cox 1 which suppresses gastric acid production and secretes mucus to protect the stomach lining, what does Ibuprofen increase the risk of?

GI bleeding, ulceration

Acetaminophen has 2 major therapeutic uses, unlike its friends ASA and Ibuprofen. What are they?

Analgesic and antipyretic.

Your pt. complains of a swollen and red knee after running. Which is better, Ibuprofen or Acetaminophen?

Ibuprofen, bc acetaminophen has no anti-inflammatory properties.

Celebrex is a selective Cox inhibitor. Which COX does it inhibit?

2

Ah, Morphine. Which part of the nervous system does it act on?

Central nervous system

What is a common adverse effect related to GI with Morphine use?

Constipation

What is the mechanism by which Morphine produces constipation?

Reduces GI tract motility

By depressing the CNS, especially in the area of the brainstem, what is the risk of Morphine?

Depressed respiratory function.

Naloxone (Narcan) is the antidote to OD of what opiate agonist?

Morphine

By activating the emetic centers in the brain, Morphine produces what common adverse effect?

Nausea & vomiting

What are some bedside measures you could implement to improve respiratory outcomes for your pt. on Morphine?

Incentive spirometry and coughing and deep breathing

Pentazocine (Talwin) is the prototype for what class of drug?

Opiate agonist/antagonist

Why is pentazocine (Talwin) not a good choice for an opiate addict?

Because the antagonistic qualities of the drug could produce withdrawal symptoms.

By increasing systemic vascular resistance and pulmonary artery pressure, what severe adverse drug effects can pentazocine (Talwin) create?

Circulatory and respiratory depression

Pentazocine (Talwin) produces similar common adverse drug effects to the other narcotics; list 3 of them.

1. Nausea/vomiting
2. Dizziness
3. Light-headedness

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