PHARMACOLOGY DRUGS for ATI test

Created by Saross84 

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unfinished.......

Receptors

Norepinephrine-Adrenergic (adrenergic comes from the word adrenalin)
Alpha 1-all sympathetic target organs except the heart-constrict the blood vessels and dilation of pupils
Alpha 2-Presynaptic adrenergic nerve terminal-inhibits the release of norepinephrine
Beta 1-Heart and Kidneys (BETA 1-ONE HEART)-increased heart rate and force of contraction, release of renin
Beta 2-All sympathetic target organs-inhibits smooth muscle (BETA 2-TWO LUNGS)

EXAM 1 DRUGS!!!!

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Beta blockers/olol's

Beta-Adrenergic Blockers
Metoprolol/Lopressor ENDING OLOL
Beta Blockers are use with heart failure, hypertension, angina and with myocardial infarctions.
Action = Blocks Beta-Receptors in the heart causing...
Decreases = HR, force of contraction, Rate of atrioventricular (AV) conduction
SE = Bradycardia, lethargy, GI disturbance, congestive heart failure, decrease BP, depression

The beta blockers stop sympathetic nervous system stimulation of the heart. Does not allow the heart rate and blood pressure to rise with stress thus lowering the oxygen demand of the heart. It is very heart protective!
Will slow the heart rate and lower the blood pressure
Can have beta 2 blockage with larger doses-will constrict the bronchioles-watch for clients with known COPD, Asthma

Nursing Interventions
Check pulse-needs to be 60 or above
Check blood pressure-if hypotensive do not give (Systolic below 100 is a good rule of thumb I go by)
Monitor for sexual dysfunction-impotence for men-a good reason for non-compliance
Drowsiness/Fatigue-operating heavy machinery, driving could put client at risk
Insomnia-
Contraindicated with Heart Blocks, Bradycardia, Worsening Heart Failure
Increases Hypoglycemic effect of Insulin-monitor blood sugars and for hypoglycemia, may need to lower insulin dosage
Beta Blockers have to be weaned slowly to prevent rebound hypertension and tachycardia-if a client wants to stop his beta-blocker they need to contract their physician

CCB,/calcium channel blockers

Nifedipine/Adalat/Procardia/Norvasc-controls blood vessels

Diltiazem/Cardizem
Verapamil/Calan/Isoptin/Verelan-controls heart rate and blood vessels

Angina/Raynaud's/Vasospastic Angina/Atrial Arrhythmia's

Blocks calcium channels in the myocardial and vascular smooth muscles, decreases the contraction of smooth muscle-relaxes the arteries-vasodilation. Blocking of calcium channels in the SA and AV node-Slows conduction through the SA and AV node. Decreases the force of contraction slows heart rate

Grapefruit juice may increase absorption of nifedipine

Side Effects: Relaxes smooth muscle and cardiac muscle-
Headache
Dizziness-Take lying, sitting and standing B/P, educate client to sit and stand slowly
Peripheral edema-assess for edema, monitor for worsening (diuretic)
Flushing
Reflex tachycardia-monitor for elevated heart rate (may need a BB)
Constipation-increase fibers and fluids (if not restricted) stool softener
Fatigue-Due to low heart rate-monitor EKG, pulse rate and rhythm
Weakness-Monitor B/P and Heart Rate
Impotence and sexual dysfunction-Discuss possibility with client-have client to call and not just to stop medications
Hepatotoxicity-ALT, AST, ALK PHOS, Bilirubin
MI-Monitor for chest pain, dyspnea, increases fatigue, weakness
CHF-Monitor for chest pain, dyspnea, edema, increasing weight, decreasing output, increasing HR and B/P
Angioedema-edema in face, throat, trouble swallowing, trouble breathing, thickened tongue
Grapefruit juice may increase absorption of nifedipine

Acute Toxicity
With an overdose or overmedicated
Gastric lavage
Monitor EKG-bradycardia-widening QRS, hypotension
Norepinephrine to treat hypotension and decreased cardiac contractility
Atropine or Isoproterenol-Bradycardia and Cardiac Blocks

Verapamil (Calan, Covera, Isoptin Verelan)
Class IV antidysrhythmic
Calcium channel blocker
Inhibits the flow of calcium ions both into the myocardia cells and the vascular smooth muscle, slow the conductions velocity and stabilizes dysrhythmias. Lowers the blood pressure, reduces cardiac workload and lowers the blood pressure. Dilates the coronary arteries-anti-anginal
Side Effects: Headache, constipation, hypotension, edema, bradycardia

Pril/ace inhibitors

Enalapril/Vasotec
PRIL-is the ending for ace's
Reduces Angiotensin 2 and aldosterone levels
Prevents Angiotensin 1 from converting to Angiotensin 2 in the lungs-leaves the Angiotensin 1 hanging in the lungs-creates irritation-cough
Vasodilation-mostly arteriole (decreases afterload)
Excretion of sodium and water-retention of K (decreases preload)
Treats hypertension and heart failure
Do not take 2nd and 3rd Trimester of pregnancy

SE = Angioedema-allergic reaction-swelling of tongue, throat-stop taking and notify md
Hyperkalemia-monitor for widening and slowing of pulse/qrs, weakness, fatigue, avoid high K foods, AVOID SALT SUBSTITUTES-usually very high in K, avoid potassium sparing diuretics, sport drinks are high in K also
Orthostatic Hypotension-teach client to sit and stand slowly, enact fall precautions
Neutropenia/Agranulocytosis-monitor CBC-WBC count, reoccurring infections
Renal Insufficiency-Monitor weight, edema, I/O, BUN, Cr, and GFR
Hepatic Insufficiency-Monitor AST, ALT, ALK PHOS, Bilirubin
Cough-Cough lozenges, hard candy, increase fluid intake, sleep with HOB elevated, antihistamines

ACE Inhibitors

Discussed these medications with hypertension

Arb's-Angiotensin receptor blockers, sartan's
No Cough, same effects and side effects as Ace's-just not as potent

Sartan's/angiotension blockers/arb's

...
Arb's-Angiotensin receptor blockers, sartan's
No Cough, same effects and side effects as Ace's-just not as potent

Nitrates

Nitroglycerin/Nitrostat, Nitro-Bid, Nitro-Dur
Nitrates form nitric acid which is a relaxes smooth muscle and dilates venous and arterial blood vessels
Open veins-blood pools in the legs-not as much blood returning to the heart-reduces preload
Open arteries-heart does not have to work as hard to pump blood out of the heart-reduces afterload
Opens the coronary arteries and helps supply blood to the heart tissue

Can be given sublingually, orally, topically, IV, buccal
Can be for acute or long term use
Nitroglycerin dilates any artery and vein-including yours if you touch it while administering it-WEAR GLOVES
Nitroglycerin IV needs a glass bottle and covered from light-some hospitals still use special tubing (nitro is absorbed in the tubing)
Short term-nitrostat-sublingually-1 tablet every 5 minutes x 3 for relief of chest pain-still having chest pain call 911/physician
Long-term nitro-dur will last for up to 14 hours in the body

Side Effects:
Headache-dilates the cerebral arteries-do not give with head trauma or increased intracranial pressure
Hypotension and reflex tachycardia-do not give with hypotension, monitor blood pressure and HR when administering
Hypotension-correct hypervolemia prior to giving nitroglycerin
DO NOT GIVE WITH VIAGRA, LEVITRA, OR CIALIS (nitroglycerin and Viagra increase nitric acid and relaxation of the smooth muscles-can kill a client with hypotension with a combination of these drugs)

Digoxin

Cardiac Glycoside
Digoxin/Digitek, Lanoxin, Lanoxicaps (Dig)
Increases the contractility of the heart muscle - Inotropic effect-
Increases cardiac output
Also Suppresses the SA node and slows conduction through the AV node
Half-life is 3-4 days
Great Drug-real side effects

Digoxin SE =
Dysrhythmias
Toxicity 0.5-1.8 normal level
Signs of toxicity-halos around objects, Nausea/Vomiting/Anorexia, blurred vision, fatigue
Bradycardia-must take an apical pulse for one full minute, must be 60 or above to give digoxin
Give with caution with pediatric and geriatric patients due to inadequate renal or hepatic metabolic enzymes
Hyperkalemia can reduce effects of digoxin
Digoxin and Beta Blockers can really lower the pulse
Give with caution with renal failure-digoxin excreted via the kidneys
DIGIBIND IS THE ANTIDOTE FOR DIGOXIN TOXICITY

Digoxin
Decreases automaticity of the SA nose and slows conduction through the AV node
Atrial dysrhythmias
All the side effects and warnings are still important

Heparin

Naturally found in the liver and lining of blood vessels
Prolong coagulation time
IV immediate onset, Sub Q 1 hour
Destroyed by gastric enzymes
Weight based
aPTT (PTT also, but in the hospital we use the aPTT)
Sub Q
Thrombocytopenia occurs in 30% of client
Protamine Sulfate is the antidote, 1 mg for every100 units of heparin, works for Lovenox also

Coumadin

Warfarin/Coumadin
Warfarin inhibits the action of Vitamin K, and without adequate Vitamin K the synthesis of clotting factors 2, 7, 9, and 10 is diminished
INR/PT
Warfarin takes 2-3 days to achieve therapeutic effect-99% of warfarin is bound to plasma proteins and unavailable to produce effects
Vitamin K is the antidote-green leafy veggies Aquamephyton-works within 6 hours
Normal INR therapeutic range is 2-3
Normal INR for everyone who is not taking an anticoagulant is around 1
Category X for pregnancy
Avoid alcohol, diuretics, SSRI's, Antidepressants, Steroids, Antibiotics, Vaccines, Some Vitamins, Amiodarone-all can potentiate warfarin
Bleeding-

Amiodarone

Amiodarone (Cordarone/Pacerone)
Class III antidysrhythmic
Potassium channel blocker
Ventricular and Atrial Arrhythmias-especially with heart failure
IV onset or PO onset looks to be 2-3 days to 1-3 weeks
Half life can be greater than 100 days
Check K and MG levels prior to starting therapy
Side Effects: Fibrosis of lungs, destruction of thyroid, Photosensitivity-Smurfs, Liver destruction, N/V, Hypotension, Blindness, very hard on the stomach-GI Distress
Can increase serum digoxin levels by 70%, Increase warfarin levels, Increase phenytoion (Dilantin), Stop BB and CCB?

Statins (Lipitor)

HMG-CoA reductace inhibitor-(liver is where the cholesterol is made, it is where the HMG-CoA work)

LDL/Cholesterol is reduced
Give with food to reduce GI symptoms
Lipitor can be taken at anytime, most of the class of this medication needs to be taken at bedtime-cholesterol is made by the liver at night
Up to 30 days to achieve full affect

Side Effects:
GI-constipation, bloating, gas, nausea
Liver-monitor enzymes-alt, ast, alk phas, bilirubin, jaundice, enlarged liver-ascites
Rhabdomyolysis-muscle destruction-CK elevation-muscle pain-MD has to be notified.
Renal failure is very common with Rhabdomyolysis-need to make sure urine output is 30 ml or greater an hour
No grapefruit juice
The statins are hard on the liver-you need to make sure other drugs the client is on is not hard on the liver-Amiodarone and Nizoral are two drugs that come immediately to my mind

furosemide/lasix

...Loop Diuretics-prevents Na/Cl reabsorption, thus Na leaves the body, water follows Na and K follows the water
Furosemide/Lasix, Bumex/Bumetanide, Torsemide/Demadex
Work on the entire Loop of Henle-large volumes of water, Na, and K are removed
Works in renal failure
Hypovolemic and hypokalemia very common

Nursing interventions
Know your potassium level prior to administration
Assess Lung Sounds, Weight, I/O, Edema, SaO2, RR, Blood Pressure, K Level prior to administration, assess all of these post administration, especially K Level and Lung Sounds, Sao2, I/O. If you urine bag is not twice as full 30 minutes post IV Lasix administration, check your IV site. If your client without a Foley has not called to urinate within an hour of giving po Lasix, check your client
Warn your client to get up slowly after taking Lasix, watch for orthostatic hypotension
Lasix does have sulfa as a base component
May not be used with anuria, hepatic coma
Use with extreme caution with electrolyte depletion
Low K with Digoxin can equal lethal Dysrhythmias, know your potassium level-has a digoxin level been ran

plavix

Anti-platelet drugs
ASA
Persantine
ADP Receptor Blockers (Plavix, Ticlid, Effient)
Glycoprotein 2b./3a receptor antagonist (Repro, Integrillin, Aggrastat

ADP receptor blockers

Irreversibly alter the plasma membrane of platelets, alters the ability of platelets to aggregate
Ticlid and Plavix are given orally
Ticlid can cause Agranulocytosis-only used when someone is allergic to Plavix
Glycoprotein is an enzyme necessary for platelet aggregation, IV only, Very expensive used with MI's Strokes, and PTCA's

Clopidogrel (Plavix) Antiplatelet drug
ADP receptor blocker
Inhibits ADP binding to its receptor's-irreversible and will be with the platelet for their lifespan (5-7 days)
Used for MI's, CVA's, PAD/PVD, Unstable Angina, PTCA's-first 6 months post ptca's
Bleeding is a problem

EXAM 2 DRUGS!!!!!!!!!!!!

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Vasopressin (pitressin)

The antidiuretic action of vasopressin is ascribed to increasing reabsorption of water by the renal tubules
40u IV
Adverse = cardiac ischemia/angina

DDAVP (desmopressin)

Prevents or controls thirst and frequent urination caused by diabetes insipidus and certain brain injuries.
Works on posterior pituitary....Treatment for: diabetes insipidus, bedwetting(nocturia), brain injuries, hemophilia A w/ some factor VIII production
nasally, IV, oral/subling tab
up to 20 hours

Synthroid

Treats hypothyroidism. Also treats an enlarged thyroid gland (goiter) and thyroid cancer.

Cortef

Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt-retaining properties, are used as replacement therapy in adrenocortical deficiency states. Their synthetic analogs are primarily used for their potent anti-inflammatory effects in disorders of many organ systems. Glucocorticoids cause profound and varied metabolic effects. In addition, they modify the body's immune responses to diverse stimuli.

Hydrocortisone

Hydrocortisone belongs to the family of medications known as corticosteroids. It is used to treat many different conditions. It works by reducing swelling, inflammation, and irritation or as a replacement when the body does not make enough cortisol. Hydrocortisone is more commonly used to treat allergic reactions, some skin conditions, severe asthma, lupus, and arthritis.
It can also be used to treat steroid deficiency in the body, certain blood disorders, certain types of cancer, multiple sclerosis, and ulcerative colitis.

Cortisol

When people are under stress, levels of cortisol hormone rise. Chronic stress can result in chronically high levels of cortisol, which can lead to symptoms like weight gain, memory problems, high blood pressure, and other health problems. The stress release of cortisol is designed to enable the flight or fight response with a quick burst of energy, but when people are in a state of constant high stress, levels of the hormone never have a chance to fall back down to normal levels. This is one reason why treatments for chronic stress include exercises and activities that are designed to reduce stress levels, allowing production of this hormone to slow down.

Tapazole

Treats hyperthyroidism (too much thyroid hormone produced by the thyroid gland).

PTU

Treats Graves' disease and hyperthyroidism (too much thyroid hormone from the thyroid gland) in patients who have already been treated with other medicines (such as methimazole) that did not work well.

H2 Blockers (-tidine)

Ranitidine

PPI's (-prazole)

Omeprazole

Antacids

...

Maalox

30mL QID

Mylanta

This medication is used to treat the symptoms of too much stomach acid such as stomach upset, heartburn, and acid indigestion. Aluminum and magnesium antacids work quickly to lower the acid in the stomach. Liquid antacids usually work faster/better than tablets or capsules.

Mylanta

This medication works only on existing acid in the stomach. It does not prevent acid production. It may be used alone or with other medications that lower acid production (e.g., H2 blockers such as cimetidine/ranitidine and proton pump inhibitors such as omeprazole).
This medication can cause nausea, constipation, diarrhea, or headache
by mouth, usually after meals and at bedtimehis product may react with other medications (e.g., digoxin, iron, tetracycline antibiotics, quinolone antibiotics such as ciprofloxacin), preventing them from being fully absorbed by your body.

Bulk-Producing Laxative

Metamucil
decrease the absorption and effects of Warfarin, Digoxin and Aspirin. Do not give to patients with: GI obstructions, fecal impaction or abdominal pain and N/V
Monitor elevated serum glucose

Lomotil

Antidiarrheal, Anticholinergic

Insulins

(dec blood sugar)

Insulin

Is a polypeptide hormone that controls the storage and metabolism of carbohydrates, proteins, and fats. This activity occurs primarily in the liver, in muscle, ind in adipose tissues after binding of the insulin molecules to receptor sites on cellular plasma membranes

Logs -->fast acting

is a man-made insulin used to control high blood sugar in adults/children with DM.

Reg -->short acting

Humulin® R U-100 is a polypeptide hormone structurally identical to human insulin synthesized through rDNA technology in a special non-disease-producing laboratory strain of Escherichia coli bacteria

NPH -->intermediate-acting

Often used in combination with a shorter-acting insulin. NPH insulin is a man-made insulin product is the same as human insulin. It replaces the insulin that your body would normally make. It is an insulin (isophane). It starts to work more slowly but lasts longer than regular insulin. Helps blood sugar (glucose) get into cells so your body can use it for energy.

Lantas -->long-acting insulin

Treats diabetes mellitus. Insulin is a hormone that helps get sugar from the blood to the muscles, where it is used for energy. This type of insulin usually works longer than regular insulin.

Glucophage (metformin)

Used with diet and exercise to control blood sugar in patients with type 2 diabetes. May be used alone or with other medicines.
starting dose of GLUCOPHAGE (metformin hydrochloride) Tablets is 500 mg twice a day or 850 mg once a day, given with meals. Dosage increases should be made in increments of 500 mg weekly or 850 mg every 2 weeks, up to a total of 2000 mg per day.
The purpose of both insulin and metformin is to lower blood glucose levels. Insulin injections replace the insulin your body can no longer make when the cells in the pancreas cease to function. Metformin is an oral hypoglycemic, which lowers blood glucose levels by decreasing the liver's output of glucose. Metformin also increases insulin sensitivity, and improves not only blood glucose levels but also lipid levels and often results in weight loss.

Diabetics:

14% take insulin only
57% take oral medications only
14% take a combo of both.

Insulin VS Metformin Treatments? Mechanisms

Oral hypoglycemics are used only in Type 2 diabetes, because Type 1 diabetics make little or no insulin, so reducing the glucose levels produced by the liver won't reduce blood glucose levels. Without insulin, glucose can't enter cells and remains in the bloodstream. While all Type 1 diabetics take insulin, some Type 2 diabetics also need insulin in addition or instead of oral hypoglycemics such as metformin. Insulin, which must be injected, comes in several forms and doses, and can have rapid or slow onset.

Insulin VS Metformin Treatments?....Considerations

For Type 1 diabetics, insulin is the only medication choice. For Type 2 diabetics, medical practitioners generally start with an oral hypoglycemic such as metformin and add insulin only when oral hypoglycemics can't stabilize blood glucose levels.

Insulin VS Metformin Treatments?....Benefits

Both metformin and insulin help to normalize blood glucose levels. Keeping blood glucose levels as close to normal levels as possible limits the damage high blood glucose imposes on every blood vessel and organ of the body. High blood glucose levels lead to poor circulation, heart problems, vision problems, nerve damage, susceptibility to infection and kidney damage. While damage occurs earlier in Type 1 diabetics, Type 2 diabetics can also experience complications.

Insulin VS Metformin Treatments?....Side Effects

Diarrhea, the most common side effect of metformin, improves if metformin is taken with food. Liver failure and increased acidity, acidosis, occur rarely, The Merck Manuals Online Medical Library states. Insulin must be carefully calibrated or blood glucose levels may drop too low, a condition called hypoglycemia. Taking insulin without eating or taking too much insulin for the amount of food eaten can cause hypoglycemia. Symptoms of hypoglycemia include weakness, shakiness, sweating, lightheadedness and confusion; coma and death can result in severe cases.

EXAM 3 DRUGS

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NSAIDS---->Ibuprofen (advil/motrin)

Antipyretic
Analgesis
Work on Cox 1/Cox 2
Take with FOOD
Stop production of prostaglandins
Can cause --> kidney toxicity
NSAIDS = N/V, gi bleed, platelet aggregation, kidney toxicity possible)

NSAIDS (Ibuprofen)

Analgesic, anti-inflammatory, antipyretic, antiprostaglandin
Sodium based = may increase BP/heart failure, causes Ulcers
SE = N/V, GI bleeding, heartburn, epigastric pain, GI ulcer, renal impairment, bruising, blood in urine
Caution = with MI's and bypass patient's.
No more than 3,200 Mg/day (it can kill the kidneys/especially w/long term use)

Nursing interventions = check GFR, platelets, bleeding times, liver enzymes.

Aspirin (ASA)

Non-opioid
non-steroidal
anti-inflammatory
antipyretic
Blood thinner
Aspirin = binds to Cox 1/Cox 2 (stops platelet aggregation, gi upset, tinnitus, HA, sweating)

Aspirin (ASA)

Increased risk for GI bleeding (coffee ground emesis, black tarry stool)
Increase Prothrombin time (PT/INR) ...stop a week before surgery due to platelet life of 7 days
Enteric coated = prevent GI bleed/upset
Toxicity = tinnitus, humming, dizzy, bad balance, nausea
Caution = with heparin, lovenox, coumadin, Nsaids

Tylenol (acetaminophen)

Acetaminophen (Tylenol/APAP)
Antipyretic/analgesic-Centrally acting Cox Inhibitor
Acts on hypothalamus--->dilates peripheral blood vessels
No Anti-inflammatory Property/Enhances opioids for pain relief
Hepatotoxic ....NO MORE THAN 4 GRAMS/DAILY
Side Effects:
Renal/Hepatic failure, N/V, Chills, abd. discomfort, Inhibits warfarin metabolism (can cause it to accumulate)
Acetylcystiene/Mucomyst---antidote for Tylenol OD
Baby Drops(babies)
Liquids (children)

Tylenol

Anti-pyretic--Analgesis---Centrally acting Cox Inhibitor
Acts on Hypothalamus --> dilates peripheral blood vessels
No inflammatory property

PCA pumps

4 hour dose limit
Set machine for how many mg/hour.
Encourage = use before activities
Assess client = LOC, RR, BP, HR
Educate = it's very hard to OD on pumps
Nursing Intervention = check IV line patency, ask to change PCA to oral med if they're feeling better
Nursing Prejudices = assess their pain, respirations must be 12+
Pain 1-4 = PO meds
Pain 5-10 = IV meds

Narcan (naloxone)

Opioid antagonist
Treats Overdose = competes w/opioid receptors
Don't give with pregnancy
(Rebound resp depression, abstinence syndrome, titrate dosage, rapid infusion)
IV, IM, SQ, NOT ORALLY
1/2 LIFE = 60-90 MINUTES
1/2 LIFE = 3-4 hours
Can lead to rebound respiratory depression
Respirations = Monitor for 4 hours after giving it

Narcan

SE = tachycardia, tachypnea, ventricula arrhythmia, pulmonary edema
Abstinence syndrome = cramping, HTN, vomiting (by stopping morphine effect, we can induce withdrawal quickly)
Caution = history of heart failure/pulm edema (the HTN/teachycardia can induce heart failure by increasing workload of the heart)
Contraindicated = with opioid dependency (immediate withdrawal)
Titrate dosage = relieve pain, reverse respiratory depression (if you don't titrate it can cause sudden onset of pain/withdrawal)
Rapid Infusion = HTN, tachycardia, N/V

Morphine (opioid)

Opioid agonist
TX of moderate/severe pain
Induces pleasure
Activates Mu receptors (analgesia, sedation, resp. depression, euphoria)
Activates Kappa Receptors (analgesia, sedation, decreased GI motility)
Attaches to receptors in CNS & alters perception & response to pain.
Complications = respiratory depression, constipation, orthostatic hypotenstion, urinary retention, cough supression (cough hourly), sedation, biliary colic (spasm of sphincter of Oddi--use meperidine), emesis
Overdose? Coma, respiratory depression, pinpoint pupils
Monitor -->Breath sounds, vitals, Narcan, mechanical ventilation

Morphine

PO, SQ, IM, Rectal, IV epi, Intrathecal

Must have RR of 12 or higher!!!!
Don't use = premature infants, demerol w/renal failure, with head injuries (LOC is too hard to access)
Precautions = asthma, emphasema, older, babies, respiratory depression, pregnancy, labor, obesity, IBD, enlarged prostate, liver/renal disease--prolonged accumulation of drug)
Anticholinergic agent--Benadryl, will increase effects of constipation/urinary retention
MAOI = high fever/coma
Anti-hypertensive meds = hypotensive effect
Nursing administration = assess pain, docoument, 1-10 scale
Oral = 45 - hr later
IV = 30 mintes later
Cancer? give fixed schedule, around the clock, PRN
Addicted? Taper off over 3 days!!!

Atrovent (ipratropium) ----> MDInhaler

Bronchodilator anti-cholinergic
Blocks parasympathetic NS
TX ---> COPD/ASTHMA
Onset = 5-15 minutes (2-3 minutes between squirts)
**little absorbed, peanut allergy, nasty taste

Atrovent

Inhaled anticholinergic work well on COPD/brochospasm allergen induced/exercise induced asthma
Very little absorbed from lungs, few systemic effects, dry nasal mucosa, dry mouth, hoarseness
Rinse mouth (for nasty taste), peanut allergy (don't use)
Anticholinergic = dry mouth, urine retention (suck on candies/sip liquids)
Usually 2 puffs/dose

Don't use with ....GLAUCOMA OR ENLARGED PROSTATE

Afrin (oxymetazoline)

Nasal decongestant/sympathomimetic

Short-term = 3-5 days
Stimulates the Alpha adrenergic receptors
Arterioles constrict - dries mucous membranes

Afrin

SE = use for 3-5 days only or could have Rebound congestion (worse than before), insomnia
Contraindicated = Heart disease, diabetes, HTN
Nursing Implications = Rebound congestion, taper use one nare @ a time.
CNS stimulation (nervous, uneasy, aggitated)
Vasoconstriction (avoid with CAD/HTN)
Administer = lay on side, lateral, head low on side
Effective? Breathe, sleep, no agitation, no HTN, no chest pain, no nasal congestion



**Oral decongestants = work body wide, no rebound congestion, slower (SE = insomnia, anxiety)

Histamines

Increase capillary permeability
Increase Blood
Increase runny nose
Brocho-constriction (try to keep out the allergens/dust)

Benadryl (diphenhydramine)

H1 receptor antagonist (1st Generation)
antihistamine/makes you sleepy
Treats: N/V, allergic reactions
Effects #1 = dry mouth
IM --> Z track, deep injection
Antihistamines = prevent release of histamine by blocking H1 receptor sites on the mast cells in nasal cavity.

Benadryl

SE = drowsy(excitation in kids)
anticholinergic(dry mouth, urinary retention, gi upset)
ACUTE toxicity (flushed face, fever, tachy, dry mouth, dilated pupils, mild hypotension)
Contraindicated--> BPH, glaucoma, 3rd trimester, breastfeeding, newborn, bowel obstruction, CNS depressants/alcohol INC effects
Toxicity = induce vomiting, remove anti-histamine, activated charcoal, tylenol for fever, ice packs, send them to ER
MAOI's = hypertensive crisis

Effectiveness? No Rhinitus (runny, itchy nose), no Uticaria (no itching, no allergic reactions)

Beclomethasone (Beconase) --> intranasal

Intranasal corticosteroid
Decrease inflammation of nasal passage
Few systemic effects unless swallowed in large amounts

Beconase (nasal)

SE = Nasal irritation, nosebleed, it masks signs of infections
Licorice = potentiate effects
Assess = signs of oral fungal infection, alternate nares, hoarseness, changes in voice
Interventions = blow nose before meds!!

Prednisone (ORAL glucocorticoid)

Anti-inflammatory corticosteroid
Glucocorticoids = inhibits making of prostaglandins, suppress histamine, stops some functions of phagocytes/lympocytes
Short-term use only/taper them off
auto-immune disease = long-term use

Fever = signs of inflammation/natural defense to neutralize foreign organisms
Prolonged fever in children = febrile seizures
Prolonged fever in adults = breakdown body tissue, delirium/coma
Obscure causes of fever --> SSRI (serotonin syndrome), Thorazie, Anesthetics (malignant hyperthermia), immunodilators, cytotoxic drugs, chemotherapy, neutropenic agents

Beclomethasone (Beconase) ---> inhaled

Inhaled glucocorticoid/Dilates Bronchi
Anti-flammatory for Asthma/COPD
Allergic Rhinitus
Onset = 1-4weeks......1/2 life = 15 hours

Beconase (inhaled)

Supress inflammation, decrease mucous, promote Beta 2 response (dilation of the bronchi)
Anti-inflammatory for Asthma, COPD, allergic rhinitis, inhaled corticosteroid
SE = hoarse, dry mouth, changes in taste
MUST rinse mouth after/spit the water out --> Can cause Oral Candidiasis
Oral Candidiasis = fungal yeaste, look for white spots in the mouth.

Corticoidsteroids -- glucocorticoids

Anti-inflammatory drugs
Must taper them off
Inhibits --> Making of prostaglandins, suppress histamines, stops some functions of phagocytes/lympocytes (so, when infection happens they're aren't enough WBC to fight off infection)
SE = suppress adrenal glands --> Addison's crisis...hyperglycemia, mood changes, cataracts, PUD, electrolyte inbalance, osteoporosis, mask infections.
Long-term = Cushing's syndrome

Glucocorticoids = inhaled, oral, IV
End in -one
We give all 3 types for Asthma/COPD

Sickest = IV, then PO, then inhaled glucocorticoid

ORAL, IV systemic glucocorticoids

Suppresses the adrenal glands
Must taper them off the dose or.....
Can send them into Addison's Crisis
Addison's = Low BP, no energy, bone loss, increase blood sugar, muscle weakness, PUD (huge issue), take with food/no NSAIDS, sore throat.
Sodium Retention = hypokalemia (weak muscle/cramps)
Give Ca with Vitamin D
WATCH for edema, weight gain, HTN
Inflammation = Defense brought on by injury, toxic chemicals, heat, microorganisms, cell death, allergen response.
Sighs = swell, pain, warmth, redness
Acute = 1-2 weeks
Chronic = Lupus, RA

Who responds to inflammation?
Mast cells, Bradykins, leukotrines, histamines, prostaglandins.

Bronchodilators

Beta 2 adrenergic agonists (Beta 2 - 2 lungs)
Activates SNS (relaxes smooth muscle/dilates bronchi)
**Relief of bronchospasm, histamine release stopped, increase ciliary motility.

Proventil

Beta 2 adrenergic agonist
Brochodilator
Quick-acting rescue inhaler (5 minutes)
Use before exercise to prevent Bronchoconstriction
Use beta 2 agonist inhaler before glucocorticoid

Proventil

SE = HA, irritate throat, tremor, nervousness, tachycardia
Caution = HTN, cardiac, heart failure, seizures
Patients = keep log of attacks/frequency/what triggers them
Lungs = lotsa blood supply/large surface area, making them a quick onset (we don't give PO)
Use = asthma control, prevent exercise induced asthma
Effective? Clear breath sounds--NO wheezing/rhonchi, respiratory rate @ baseline, SaO2 @ baseline 90%

Note = Long-acting are combined w/corticosteroids. Get bronchi open and the corticosteroid can get in there easier when it's dilated!

Mucomyst

Antidote for tylenol
Effectiveness?? Liver enzymes are normal/no enlargement)

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