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Pharm Exam Unit 5
Ch. 18-24, 26-28.
Terms in this set (139)
Peripheral Nervous System
Includes the autonomic nervous system and the somatic nervous system.
Autonomic Nervous System
Governs automatic functions of the smooth muscles and glands. Divides into the sympathetic nervous system and the parasympathetic nervous system.
Somatic Nervous System
Controls skeletal muscles.
Sympathetic Nervous System
Controls the fight or flight response and the "cant's" and controlled by the neurotransmitter norepinephrine. Every function is "dry, hot, and revved up."
Parasympathetic Nervous System
Causes salivation, lacrimation/lactation, urination, diarrhea, increased GI peristalsis, and edema/emesis. Controlled by the neurotransmitter acetylcholine.
Vasoconstriction leading to elevated BP, elevated HR, pupil dilation, decreased salivation, decreased urination.
Stops the influx of norepinephrine causing vasodilation, decreased BP and HR, and decreased GI motility. It responds to overstimulation during the fight or flight response so you don't drop dead.
Increases HR and contraction and increases renin secretion so BP goes up.
Works primarily in the lungs, causing bronchodilation, promotes blood flow to skeletal muscles and causes the liver to change stored glucagon to glucose; the net result is that the skeletal muscles will be supplied with O2 and glucose- which they will need in abundance during fight or flight.
Inactivation of Neurotransmitters
By reuptake of the transmitter into the neuron; by enzymatic transformation or degradation; by diffusion away from the transmitter.
Direct Acting Sympathomimetics
Directly stimulate receptor sites. Ex: epinephrine.
Indirect Acting Sympathomimetics
Increase norepinephrine. Ex: amphetamines.
Mixed Acting Sympathomimetics
Directly stimulate the receptor site and increase norepinephrine. Ex: ephedrine.
Acts on more than one receptor (non-selective) and on multiple sites in the body.
Action of Epinephrine
Alpha 1 increases BP, beta 1 increases HR, beta 2 increases bronchodilation.
Pharmacokinetics of Epinephrine
Subq, IV, topically, inhalation, intracardiac, and it can be installed through an intubation tube during codes.
Pharmacodynamics of Epinephrine
Inotropic, vasoconstrictor, and a potent fast acting bronchodilator.
Strengthens myocardial contractions.
Uses of Epinephrine
Anaphylaxis, bronchospasms, cardiogenic shock, and cardiac arrest.
Side Effects of Epinephrine
Tachycardia, elevated BP, cardiac dysrhythmias, pallor, palpitations, syncope/dizziness, decreased renal perfusion and urinary output.
Caution Indications for Epinephrine
HTN, hyperthyroidism, diabetes mellitus, and pregnancy.
Selective to beta 2 adrenergic receptors. Promotes bronchodilation. Treates bronchospasms, asthma, bronchitis, and COPD.
Caution Indications for Albuterol
Severe cardiac disease, HTN, hyperthyroidism, diabetes mellitus (causes hyperglycemia), and pregnancy.
Alpha 1 Blocker
Cause vasodilation, decreased BP. Can decrease BP too much and cause reflex tachycardia as HR tires to compensate for low BP. Used to tx PVD and HTN. Cannot be used to treat both at the same time.
Beta 1 Blocker
Reduce cardiac contractility and decrease pulse causing decreased BP.
Beta 2 Blocker
Cause bronchoconstriction and inhibit glycogenolysis (a person's liver could not correct hypoglycemia by converting glucagon to glucose). This receptor is never deliberately blocked.
Non-selective beta blocker. Used to tx angina, HTN, heart failure, prophylaxis for migraine headaches, and thyroid storms. Contraindication in pt. with COPD and asthma because it causes bronchoconstriction.
Selective beta blockers; selective to beta 1. Used to tx HTN and angina. Have fewer SE than non-selective beta blockers. Watch for bradycardia, hypotension, dizziness/fainting, fatigue, and hypoglycemia. Interacts poorly with NSAIDs, sulfonyureas, and others.
Muscarinic and nicotinic.
Stimulate the smooth muscles and slow heart rate.
Stimulate the striated skeletal muscles maintaining muscle strength and tone.
Pupillary constriction, increased aqueous humor outflow, bronchoconstriction and increased pulmonary secretion, decreased HR, vasodilation causing decreased BP, increased GI peristalsis, bladder contraction, and salivation.
Direct Acting Cholinergic Agonists
Selective to muscarinic receptors in the smooth muscles in heart, GI, GU, and glands. Ex: Reglan
Increases micturition. Used to increase post-op urination, and with pt. who have a neuorgenic bladder due to neurologic disease or injury.
Side Effects of Urecholine
"HyperSLUDGE." Bradycardia, hypotension, sweating, increased salivation, N/V, diarrhea, abdominal cramps, bronchoconstriction, hypersecretion of gastric acid.
Antidote to Cholinergics
Indirect Acting Cholinergic Agonists
Aka cholinterase inhibitors. Break down the enzyme cholinterase, allowing ACH to activate the muscarinic and nicotinic receptors. Used to tx myasthenia gravis to increase muscle tone.
Inhibit the action of ACH by occupying ACH receptors.
Side Effects of Anticholinergics
CANT's, increased HR, decreased respiration, decreased muscle rigidity and tremors, decreased bronchial secretions, and bronchodilation.
Uses of Anticholinergics
Asthma/COPD, parkinson's disease, pseudoparkinson's (seen with antipsychotic meds), and motion sickness.
Increases pulse, decreases GI motility and peristalsis, and decreases salivary secretions.
Uses of Atropine
Part of balanced anesthesia, as end of life care, and as the antidote to cholinergics.
Side Effects of Atropine
CANT's, abdominal distention, and tachycardia/palpitations. Contraindicated in glaucoma pt.
CNS Stimulant Uses
ADHD, narcolepsy, obesity (under strict physician supervision), stimulation of respiration and reversal of respiratory distress.
Caused by a disregulation of the transmitters serotonin, dopamine, and norepinephrine. Usually dx prior to age 7, predominantly in boys. May see abnormal EEG's.
Occurs when a pt. cannot control their sleep during daytime hours. They can even fall asleep while talking, driving, eating, etc.
Stimulate release of norepinephrine and dopamine. Used to tx ADHD and narcolepsy.
Side Effects of Amphetamines
Tachycardia, palpitations, HTN, weight loss, restlessness, and irritability.
Ex: Ritalin and Provigil. Has the same therapeutic effects as amphetamines.
NI for Amphetamines
Give on empty stomach before breakfast and lunch. Avoid caffeine and chocolate. Watch weight carefully. Stop immediately if ADHD child loses 10% of baseline weight or stops gaining weight with growth.
Helps pt. eat less. Should only be used under strict HCP supervision. Not sold OTC in the US but can be bought online from other countries.
Include caffeine and theophylline. Stimulate respiration in newborns.
Side Effects of Analeptics
Restlessness, insomnia, palpitations.
Respiratory CNS Stimulants
Ex: Dopram in adults. Used for respiratory depression resulting from OD or post-op. Very rapid onset: 20-40 seconds. Peaks in 2 minutes. SE are HTN and tachycardia.
Cause varying degrees of reduction in the functional activity of the CNS. The degree of depression and LOC is dependent on both the drug and the dosage taken.
The 4 stages of sleep bring the person into successfully deeper sleep. All 4 stages must occur with uninterrupted REM to achieve healthful sleep.
Sleep Deprivation Affects on Health
Impaired judgement, mood, emotions, and can produce hallucinations.
More common in females. Increases with age for both males and females.
Therapeutic class for temporary tx of insomnia. Sedatives produce the mildest form of CNS depression; reduce physical and mental responses, but do not affect consciousness. When this dose is increased, you produce a form of "natural sleep."
Pharmacologic Classes of Sedative Hypnotics
Barbituates, benzodiazepines, and nonbenzodiazepines.
Not commonly used as sleep aids due to high risk of physical/psychological dependence. Used for 2 weeks or less with interrupted therapy (not every night).
Short Acting Barbituates
Used in general anesthesia.
Long Acting Barbituates
Used to control seizures.
First developed as anxiety meds and are used as sleep aids now for 3-4 weeks only. If used longer, it needs to be with interrupted therapy. Ex: Restoril.
Antidote for Benzo OD
Used short term (fewer than 10 days) for insomnia. Ex: Ambien and Lunesta. Decrease the dose with the elderly.
Reduce sensation (which leads to analgesia because without sensation there is no pain).
Reduces sensation in the CNS leading to LOC, amnesia, muscle relaxation, and analgesia. Person becomes ventilator dependent. Given inhalation and IV.
Numbs or reduces sensation in a limited area in which no pain would be felt. Ex: Novacaine. Given topical, transdermal, SC, and intraspinal.
A local anesthetic is injected in the subarachnoid at the third or fourth lumbar space creating anesthesia distal from that point. This is the epidural seen in labor/delivery.
A combination of drugs that are frequently used in general anesthesia. May include the following: a hypnotic given the night before; premedication with an opioid analgesic or benzo plus an anticholinergic given about 1 hour before surgery to decrease secretions; a short acting barbituate; an inhaled gas (often a combo of nitrous oxide and oxygen); a muscle relaxant given as needed.
Benefits of Balanced Anesthesisa
Minimizes cardiovascular problems, decreases the amount of general anesthetic needed, reduces possible postanesthesia N/V, minimizes the disturbance of organ function, and decreases pain. Because the pt. does not receive large doses of general anesthetics, fewer adverse reactions occur. Recovery is enhanced by allowing quicker mobility.
A seizure disorder.
Results from abnormal electric discharge from the cerebral neurons (sometimes called "storms in the brain") and is characterized by a loss or disturbance of consciousness and convulsions.
First anticonvulsant drug and still commonly used today. Has a narrow TI: 10-20 mcg/ml. Random serum plasma levels are drawn. Causes gingivitis and overgrowth of gums. Contraindicated in pregnancy.
Overgrowth of gums.
Side Effects of Anticonvulsants
Dizziness, slurred speech, decreased coordination, depression, and thrombocytopenia.
Chronic progressive neurologic condition affecting the EPS tract of the brain which controls posture, balance, and locomotion. Onset is slow and begins unilaterally. Causes too little dopamine and too much ACH. Characterized by tremors, rigidity, and bradykinesia.
Nonpharmacologic Measures for Parkinson's
Exercise to improve mobility and flexibility. Nutritional support for constipation and weight loss. Support groups for both the pt. and the caregivers/family members.
Supply levodopa to the CNS where its converted to dopamine. Most effective drug for the S/Sx of Parkinson's.
Side Effects of Dopaminergics
Orthostatic hypotension, urinary retention, dry mouth, nausea. Sometimes palpitations and dysrhythmias. Sometimes psychosis and depression.
Twitches of the head and shoulders.
Stimulate dopamine receptors. An antiviral for influenza A. Can be taken alone or with other Parkinson's medication.
Progressive, incurable, degenerative dementia affecting memory, cognition, and personality. Usually dx 45-65. It is a leading cause of death in the U.S. Characterized by the formation of neuritic plaques outside the neurons and in the cerebral cortex, neuronal neurofibrillary tangles and insufficient ACH.
Allow more ACH in neuron receptors. Ex: aricept, exelon, namenda. Increase cognitive function back to baseline for a time and used with mild-moderate Alzheimer's. Helps normalized life, ability to perform ADL's, ability to maintain social relationships and hopefully to live at home longer.
Side Effects of Acetylcholinterase Inhibitors
GI distress, constipation, hepatoxicity, blurred vision, BP changes.
A progressive, incurable autoimmune disease. A lack of ACH reaching the cholinergic receptors cause a decrease in nerve impulses and muscle response. Characterized by muscle weakness and fatigue, respiratory muscle paralysis, ptosis, and difficulty chewing and swallowing.
Inhibit the enzyme that degrades ACH. Overdosing and underdosing cause ultra SLUDGE SE. Atropine is also the antidote for an OD of this drug.
An incurable progressive autoimmune disorder with a slow onset. Pt immune system attacks and destroys the myelin sheath of the nerve fibers in the brain and spinal cord causing lesions or plaques. Characterized by remissions and exacerbations, muscle weakness and spasticity in the extremities, and diplopia.
Side Effects of MS Drugs
Pose increased risk for infections since they all suppress the pt. immune system and inflammatory response.
Skeletal Muscle Relaxants
Relieve muscular spasms; pain associated with traumatic injuries and from chronic neuromuscular disorders.
Centrally Acting Muscle Relaxants
Suppress muscular hyperactivity and relax muscles in spasm. SE include drowsiness, dizziness, GI distress, and hypotension.
Occurs suddenly and response to tx; can result from trauma, tissue injury, inflammation, or surgery.
Pain persists for greater than 6 months and is difficult to treat or control.
Pain from pressure on nerves and organs, blockage to blood supply, or metastasis to bone.
Pain of skeletal muscles, ligaments, and joints.
Pain from surface areas such as skin and mucous membranes.
Pain from vascular or perivascular tissues contributing to headaches or migraines.
Pain from smooth muscle and organs.
Used for mild to moderate acute and chronic pain; block the peripheral formation of pain sensation by blocking COX 2 or prostaglandins.
Protects the stomach lining and controls platelets.
Creates pain and inflammation.
For moderate to severe pain; can be used for acute or chronic pain. An agonist that works in the CNS and stimulate pleasure centers thus blocking pain sensations from reaching the CNS.
Side Effects of Opioids
Respiratory depression, sedation, hypotension, urinary retention, confusion, N/V, itching, and constipation.
Contraindications for Opioids
Head injuries, intracranial pressure, respiratory disorders, and shock or hypotension.
Combine an opioid with its antiodte. It binds with opiate receptors and increases the pain threshold.
Used to reverse narcotics. Almost instantly reverses respiratory depression, oversedation, and hypotension. Has a very short half life so more than one dose usually has to be given.
Methadone Tx Programs
Cannot get high from it. Used to decrease the negative SE of withdrawl from opioid addiction.
Cause severe unilateral throbbing pain, N/V, sensitivity to light and sound. Can last for hours or days; more common in women than men.
Cause severe unilateral nonthrobbing pain, centered around an eye. The attacks cluster, increasing in frequency and duration over a period of weeks. More common in men than women.
A behavioral disorder in which the pt. loses the ability to relate to others and recognize reality. Can be seen with schizophrenia, advanced dementia, bipolar disorder, and can also be an ADR of drugs. Caused by too much dopamine in the brain.
A chronic psychotic disorder usually dx in adolescence or early adulthood.
Positive Sx of Schizophrenia
An exaggeration or increase in behavior; agitation, delusions, paranoia, auditory and visual hallucinations, incoherent speech, difficulty in processing information and coming to conclusions.
Negative Sx of Schizophrenia
Decrease of loss of function, poor self care, poverty of speech, social withdrawl, and catatonia in the most severe form.
Atypical Antipsychotic Meds
Treat both positive and negative sx of Schizophrenia.
Typical Antipsychotic Meds
Treat only positive sx of Schizophrenia.
Side Effects of Typical Antipsychotic Meds
Varying degrees of orthostatic hypotension, sedation, and EPS. At low doses they have an antiemetic effect. The higher doses are used to tx psychosis.
Parkinsonism, acute dystonia,akathisia, and tardive dyskinesia.
Muscle spasms of face, tongue, neck and back, laryngeal spasms, facial grimacing, and involuntary upward eye movements.
Constant pacing and motion at rest.
Protrusion and rolling of the tongue, chewing action, and smacking lips.
Neuroleptic Malignant Syndrome
Rare and potentially fatal. Muscle rigidity leads to rhabdomylosis, which causes acute renal failure, sudden high fever with seizures, BP fluctuations, tachycardia, and dysrhythmias.
Classified as primary (no underlying cause) and secondary (r/t a medication ADR), or underlying physical or psychiatric condition.
Only tx with medication if the underlying condition is untreatable, severe, and cause disability. Ex: COPD= these pt. are often on b.i.d. Xanax because the constant O2 deficiency cause anxiety.
Work in the CNS to produce a rapid calming effect by inhibiting neurtransmitter GABA. Used for short term measure. Have a high risk of tolerance/dependence.
Withdrawal Symptoms of Anxiolytics
Tremor, agitation, nervousness, anorexia, muscle cramps, and sweating. Cold turkey sx include paranoia, panic, HTN, and status epilepticus (deadly).
Most common psychiatric disorder; a mood disorder. Characterized by depressed mood, despair, insomnia (or only wanting to sleep), loss of interest in normal activities, fatigue, decreased ability to think, and can lead to suicidal thoughts/attempts and death.
Sudden onset after a specific event such as the loss of a spouse.
Gradual onset and progresses to deep depression.
Primary Major Depression
This kind just happens.
Secondary Major Depression
R/t serious health problems with a poor prognosis such as cancer, AIDS, or a progressive neuro disorder.
Mood swings between manic (euphoric) and depressive (dysphoria).
Block uptake of norepinephrine and serotonin in the CNS. That means they are kept active at the neuronal terminals, which "chills you out." Have lots of SE.
Selective Serotonin Reuptake Inhibitors
Block uptake of serotonin. Takes 2-4 weeks to become therapeutic. Has fewer SE than TCA's and most decrease as the drug become therapeutic.
Monoamine Oxidase Inhibitors
Inactivate norepinephrine, dopamine, epinephrine, and serotonin. SE: anticholinergic effects, orthostatic hypotension, agitation, restlessness, and insomnia. AVOID TYRAMINE!
Blocks ion transport (Na+) in muscle and nerve cells leading to increased cell receptor sensitivity to serotonin. Tx manin episodes in bipolar pt. Narrow TI; toxic >2 mEq/L. Highly teratogenic.
Side Effects of Lithium
Hyponatremia, orthostatic hypotension, edema in the hands/ankles (avoid NSAIDs), pronounced weight gain, increased urination (avoid diuretics), and nephrotoxicity.
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