Post on 26-May-2015
Pharmacology FinalBlueprint
Part 1…Includes:Antihistamines, antitussives, asthma meds, decongestants, expectorants,
antihypertensives, antimigraines, antiepileptics, antiparkinsonians,
psychotherapeutics, & sedative hypnotics
Thiazide Diuretics Drug of choice for hypertension b/c:
› Cheap, available, well-tolerated Can cause hypokalemia b/c they induce urinary loss
w/o protecting potassium Used to decrease fluid overload Cause the kidneys to excrete sodium and water into
the urine resulting in less fluid in the blood causing a reduction in blood pressure
Prevent the reabsorption of sodium and chloride through direct action on the end of the ascending loop and beginning of the distal tubule of the Loop of Henle
Promotes the reabsorption of calcium Directly dilates the smooth muscles in the arterioles
DiureticsDrug of choice for hypertension
ACE Inhibitors
Beta Blockers
Beta Blocker Teaching
Statins Taken w/ dinner because the body
naturally produces more cholesterol between midnight and 5 am
May affect liver function & not for use with pregnant women
Drugs used to lower cholesterol act by blocking the substances the body needs to make cholesterol
May also help your body reabsorb cholesterol that has built up in plaques in artery walls preventing further blockage
Zocor Side Effects
Statin medication Gastrointestinal disorders, myalgia,
arthralgia, upper respiratory infections, headache, abdominal pain, constipation, N/V, pruritus, alopecia, pancreatitis, paresthesia, peripheral neuropathy, anemia, depression
Flomax
Tamsulosin Used to treat BPH Alpha-adrenergic blocker; relaxes the
muscles in the prostate and bladder to allow urine to flow easily
What is stepped care?Stepped care is a medication management plan starting with the least invasive drugs and progressing as needed to more invasive drugs.
Vital signs needed with nitro
Blood pressure and pulse before administration
Side effects of nitrates
What are common medications for angina?
What is long-acting nitrate for?
Long acting nitrates and topical, transdermal, transmucosal, and oral sustained-release nitroglycerin products are used:› to prevent or treat anginal attacks WHEN they are
likely to occur Like during exercise
› To reduce the severity and frequency of anginal attacts
› To reduce the work in the heart in cases of MI & chronic heart failure
› For relief of gallbladder GI, urethral, and bronchial smooth muscle pain
How to decrease nitroglycerin?
What is important about the storage of nitroglycerin?
Nitroglycerin instructions…
•Take on an empty stomach, no alcoholic beverages, & minimize foods/drinks w/ caffeine•Pt. can develop a tolerance•In hospital blood pressure should be taken before dosing and between doses•Pt. should keep a record of all anginal attacks•Pt. should use nitro when an attack is expected•Meds are only part of the therapy…weight loss, avoiding triggers, and exercise are important•Keep out of reach of children
Why take andrenergic blockers?
Part of the andrenergic antagonist class that assists in lowering cardiac output and/or peripheral resistance.
Sympathetic nervous system relies on 2 andrenergic neurohormones or neurotransmitters, epinephrine and norepinephrine.
Andrenergic inhibitors (blockers) occupy the adrenergic receptors to prevent stimulation
Lowers blood pressure by stopping epi/norepi which relaxes the walls of the blood vessels and lets the heart pump more slowly and easily
Used in the treatment of HTN
Andrenergic blockers other uses
Can be used to treat benign prostatic hyperplasia
Andrenergic blocker side effects
Narrow Margin for Digoxin
Therapeutic levels are 0.5 to 2 ng/mL (nanograms per milliliter)
Toxic levels 2.5 ng/mL or more “Narrow Margin” refers to the concept
that the Therapeutic and Toxic levels are very close
What are signs of digoxin toxicity?
One of the earliest symptoms is often extreme fatigue!
Atropine counteracts digoxin toxicity!
Lanoxin/Digoxin Oral
Used to treat heart failure and abnormal heart rhythms (arrhythmias)/atrial afibrillation
Furosemide
Loop diuretic Used to treat high blood pressure & the
fluid retention caused by heart and liver disease
Lasik
Lopressor
Peripheral vasodilator Metoprolol Used alone or in combination with
other medications to treat high blood pressure, prevent angina, and to improve survival after a heart attack
Verapamil
Calcium Channel blocker Used to treat high blood pressure and
control angina Relaxes the blood vessels so that the heart
doesn’t have to work as hard They selectively limit the passage of
extracellular calcium ions through specific ion channels of the cell membrane in cardiac, vascular, and smooth muscle cells which causes a lowered peripheral vascular resistance & a fall in systolic and diastolic bp
Pyridium
Restoril Benzodiazepine Sedative-hypnotic
indicated for the short term treatment (7-10 days) of insomnia
Induces sleep in 20-40 minutes Generally in 30 mg doses for adults; in
elderly or debilitated patients 15 mg doses
SE = drowsiness, headache, fatigue, nervousness, lethargy, hangover, N/V/D, anorexia, ataxia, tremor, dyspnea, palpitations, amnesia, & hallucinations
Lithium & BW
Primary drug used to treat patients in a manic state
Therapeutic levels are close to toxic levels, so serum lithium level must be monitored on a regular basis.
Blood should be drawn 12 hours after the dose of lithium is given.
Monitoring should be carried out every few days during the initial therapy and at least every 2 months thereafter
Therapeutic level is 1 to 1.5 mEq/L
What is the special teaching about Dilantin?What is the initial dose?
Patients taking hydantoins (like Dilantin) should see a dentist every 6 months & maintain good oral hygiene brushing teeth and gums twice a day with a soft toothbrushing and rinsing well
Initial dose: Children 5 mg/kg/day PO in 2 or 3 equally
divided doses initially Adults 100 mg PO 3 times daily initially
What is Elavil/Welbutrin used for?
Elavil› Amitriptyline/elavil is a tricyclic
antidepressant used to treat the symptoms of endogenous depression
Welbutrin› Buproprion/welbutrin is an antidepressant
that worked in the brain to treat major depression, seasonal affective disorder, and for smoking cessation
MAO inhibitor teachings…
MAO inhibitors
Block the inactivation of the biogenic amines resulting in an increased concentration of dopamine, epinephrine, norepinephrine, and serotonin at neuronal synapses
Used to relieve the symptoms of severe reactive or endogenous depression that have NOT responded to tricyclic antidepressant therapy, electro-convulsive therapy, or other modes of psychotherapy
Ritalin
CNS stimulant intended to treat ADD, ADHD, & narcolepsy
Paxil
SSRI indicated for the treatment of major depression, panic disorder, OCD, generalized anxiety disorder, social anxiety disorder, PTSD
NOT to be used concurrently with MAO inhibitors
Aricept
Reversible acetyl cholinesterase inhibitor
Indicated for the treatment of dementia of the Alzheimer’s type
Should be taken in the evening w/ or w/o food
Antiparkinson Meds
Goal of Parkinson Treatment There is no known cure for Parkinson’s Treatment goals are designed to relieve
symptoms and maintain movement and activity of the patient
Symptoms are controlled by changing the neurotransmitters produced in the brain
Two main actions: Block uptake of acetylcholine at postsynaptic
muscarinic cholinergic receptor sites Elevate the functional levels of dopamine in
motor regulatory centers
Antimigraine Teachings
Imitrex Serotonin (5-HT) Receptor Agonist Indicated for use as an antimigraine in
adults that have migraines with no aura
Serious cardiac & hypertensive crises have occurred with the use of imitrex
Not for use with MAOIs Not for use in patients with history of
ischemic or cerebrovascular syndromes
Valium Diazepam Indicated for the treatment or management of:
› Anxiety› Alcohol withdrawal tremors› Relief of skeletal muscle spasm› Spasticity from cerebral palsy or paraplegia› Athetosis› Epilepsy› Tetanus
Can be habit forming Diazepines accumulate in the adipose tissue, which
substantially increases their half-life, making them dangerous, particularly for elderly patients
Abrupt termination of these agents may cause delayed withdrawal up to a week later
Expectorant Teachings – agents that decrease the thickness of respiratory secretions
Decongestants & Hypertension When the drugs are absorbed from the
GI tract, systemic effects such as nervousness, nausea, dizziness, tachycardia, dysrhythmia & a transient INCREASE in blood pressure may occur
Should be used with caution in stable hypertensive patients on guanethidine, bethanidine, or debrisoquine sulfate
Antitussives & Addiction Antitussives are used to relieve
overactive or nonproductive coughs Narcotic antitussives may cause drug
dependence Some narcotic antitussives are
Schedule II controlled substances
Antihistamine Dosing Over dosage is potentially fatal, especially in
children Infants/young children often have anticholinergic
side effects Pediatric patients w/ spastic paralysis or brain
damage often need lower dosing In hot weather children have an increased risk of
developing rapid body temp increase Dosage adjustments are needed for infants, Down
Syndrome, & blonds Elderly patients need lower doses because they
are susceptible to developing extrapyramidal reactions and paradoxical reactions
“Go Slow and Stay Low” is important
How antihistamines affect vitals As adverse reactions…antihistamines can
actually cause both hypertension and hypotension
They block the action of histamine by competing with it for the H1 receptor sites on the “effector structures” which limits the vasodilation and increases capillary permeability and reduces the edema caused by histamine
Nurses should monitor pulse and blood pressure before and during therapy
Nurse should assess lung sounds and character of bronchial secretions
Extrapyramidal Effects
A group of adverse reactions occurring on the extrapyramidal portion of the nervous system
Parkinson like symptoms› Akathisia› Dystonia
Tardive Dyskinesia (TD)› Syndrome of potentially irreversible involuntary rhythmic
movements of the tongue, face, mouth, jaw, or extremities.
› May occur in patients who are on antipsychotic drugs or after discontinuing such drugs
› There is NO known treatment› When it occurs the drug must be discontinued
Treatment for Asthma
How are antibiotics chosen? Each infection in a patient must be carefully
evaluated to identify the specific organism causing the infection and the drug that will be most effective against it
Whenever possible cultures should be drawn before starting antibiotic therapy…you may need to culture sputum, urine, blood, wound, or nonhealing sites on the skin
The type of infection will dictate the antibiotic used and whether treatment guidelines apply
Diagnosis of previous food/drug allergies, dementia, and dehydration may all influence the drug ordered, the dosage, & the rate of administration
Broad Spectrum Antibiotics
Antibiotics effective against a wide variety of organisms
Act in different ways to affect pathogenic bacteria…may attack a bacterium’s internal cell processes or they may destroy the external cell wall
Many cross the placental barrier and are secreted in breast milk
Penicillin Interferes with creation of mucopeptide cell wall Main antibiotics for many years Allergy to penicillin has increased over the years
as has the development of penicillin resistant diseases…these are the result of overuse of penicillin to treat infections for which they were not effective
Broad spectrum drug of choice for susceptible gram-positive and gram-negative organisms
Also used for prophylactic treatment against bacterial endocarditis in patients with rheumatic or congenital heart disease before surgery/dental
Some penicillins may be useful against organisms used by terrorists as bioweapons
Adverse reactions to penicillin
Antibiotics & Birth Control Pills
Some antibiotics and oral contraceptives together have produced menstrual irregularities and unplanned pregnancies
How do you know if aminoglycosides are working?
They have a narrow therapeutic range…closely monitor blood levels to avoid toxicity
Dosage is calculated by weight and increased to achieve blood level
This is all I could find…ask Cheryl Ball :lol:
Antibiotic Teaching Patient should:
› Take medication as prescribed and not stop because symptoms stop. Every dose should be taken
› Use care when bathing/brushing teeth to watch for signs of itching, irritation, & infection
› Notify HCP if rash, hives, decreased urination, diarrheas or other symptoms develop
› If treatment is for an STD, then sexual activity should cease until treatment is over and all partners should be tested/treated
› Drink water› Avoid excessive sunlight exposure