Pharmacological Profiles Flashcards
(162 cards)
1
Q
Drug agents in the sedatives and hypnotic class
A
barbiturates, benzodiazepine, and melatonin agonist.
2
Q
action of barbiturates
A
barbiturates depress the sensory cortex, decrease motor activity, alter cerebellar function and produce drowsiness, sedation, and hypnosis.
In high doses, exhibit anticonvulsive activity. barbiturates produce dose dependent respiratory depression.
3
Q
use for barbiturates
A
sedation
seizures
4
Q
are barbiturates indicated for use with insomnia?
A
no, risk of dependence with long term use.
5
Q
adverse effects of barbiturates
A
a) dependence
b) CNS: somnolence
c) Respiratory: Hypoventilation
d) GI: Nausea
e) bradycardia
f) other: agitation, confusion, nightmares, vomiting, diarrhea, and hypotension.
6
Q
contraindications/warning/caution with barbiturates
A
hypersensitivity to phenobarbital. hepatic impairment. dyspnea. porphyria. use with patients with a hx of sedative/hypnotic addiction, nephritic patient
7
Q
antianxiety drugs
A
benzodeiazepines
non benzodiazepines
8
Q
benzodiazepines action
A
generalized CNS depression. produce tolerance with long term use and have potential for dependence. No analgesic properties.
Bind to receptors in the GABA complex, enhances binding.
9
Q
which anti anxiety meds are better for short term use
A
benzodiazepines
10
Q
which anti anxiety meds are more useful for long term use
A
Tricyclics, SSRI, SNRI’s.
11
Q
adverse effects of long term use of benzodiazepines
A
withdrawal after as little as 4-6 weeks of therapy. never discontinue abruptly.
12
Q
withdrawal symptoms of long term benzo use
A
fatigue, metallic taste, HA, numbness in extremities, sweating, and dry mouth.
13
Q
contraindication of benzodiazepines
A
comatose patients, those with CNS depression, avoid during pregnancy or lactation, should not be used with uncontrolled severe pain
caution with impaired liver or kidney function
not do be combined with alcohol, tricyclic antidepressants, or antipsychotics.
14
Q
benzodiazepines are which pregnancy class?
A
D
15
Q
Benzos have which drug ending?
A
-ZEPAM or -ZOLAM
16
Q
non benzodiazepines are which pregnancy class
A
B
17
Q
Classes of Antidepressants
A
MAOI’s
SSRI
SNRIs
TCAs
18
Q
Action of TCA’s
A
inhibits reuptake of norepinephrine and serotonin (SSRI,SNRI combo)
19
Q
Action of MAOIs
A
inhibits the activity of monamine oxidase
20
Q
Use of antidepressants
A
depressive symptoms, anxiety (class dependent), obsessive compulsion disorder, smoking cessation (bupriopion-wellburtin)
21
Q
adverse effects of TCA
A
dry mouth, blurred vision, postural hypotension, urinary retention, constipation, and orthostatic hypotension
22
Q
adverse effects of MAOI
A
food interactions (cheese and wine) med interactions, vertigo, nausea, constipation, dry mouth, headache, and over activity.
23
Q
adverse effects of SSRI
A
nausea, vomiting (transient), sexual dysfunction, insomnia, and weight gain.
24
Q
contraindications/warning/caution of TCAs
A
hypersensitivity, coadministration within 14 days of MAOIs, recovery phase following MI
25
Contraindication/Warning/Caution: MAOI
Current use of SSRI/SNRI/DNRI/Meperidine (can cause Serotonin
Syndrome), diet high in red wine or smoked meats/cheeses,CVA disease,
hypertension, CHF, and elderly. MANY MEDICATION INTERACTIONS
26
Contraindication/Warning/Caution: SSRI
Fluoxetine is less effective in patients who smoke
27
Action: of Antipsychotic
Block dopamine receptors in the brain; also alter dopamine release and turnover.
Peripheral effects include anticholinergic properties and alpha-adrenergic
blockade.
28
adverse effects of antipsychotic:
Anticholinergic:.
(b) Extrapyramidal:
(c) Tardive dyskinesia: I
(d) Neuroleptic malignant syndrome: Mainly seen in Haloperidol (Haldol),
hyperthermia, rare but may progress rapidly over 24-72 hours. Immediately stop
medication, requires intensive symptomatic treatment.
29
contraindications for antipsychotics:
(a) Not recommended for use in severely depressed patient.
| (b) Hypotension
30
examples of antipsychotic medications
(a) Haloperidol: Haldol (1st Generation)
(b) Prochlorperazine: Compazine (1st Generation)
(c) Quetiapine: Seroquel (2nd Generation)
(d) Olanzapine: Zyprexa (2nd Generation)
31
action of CNS stimulants
Produce CNS stimulation by increasing levels of neurotransmitters in the CNS.
Produce CNS and respiratory stimulation, dilated pupils, increased motor
activity and mental alertness, and a diminished sense of fatigue. In children with
ADHD these agents decrease restlessness and increase attention span.
32
What is the use of CNS stimulants?
The treatment of narcolepsy and as adjunctive treatment in the management of attention deficit hyperactivity disorder (ADHD).
33
adverse effects of CNS stimulants
(a) Headache, dizziness, and apprehension
(b) Over stimulation of the CNS
(c) Insomnia, tachycardia, and blurred vision
34
Contraindication/Warning/Caution: CNS stimulants
(a) Moderate to severe, Hypertension, and stroke
(b) Glaucoma
(c) Hypersensitivity to Amphetamines:
1) Risk of physical dependence
35
Examples of CNS stimulants
(a) Amphetamines
1) Methylphenidate HCL: Concerta
2) Dextroamphetamine: Adderall
(b) Anorexiants
1) Phentermine: Ionamin
36
Action of anti convulsant
Reduction of excitability of the neurons of the brain.
37
use of anti convulsant
Decrease the incidence and severity of seizures of various etiologies. Several anticonvulsants also are used to treat neuropathic pain & headache syndromes.
38
adverse effects of anti convulsant
(a) Nausea, vomiting, constipation, bradycardia, hypoventilations, agitation, bleeding, fever, and sore throat.
(b) Steven-Johnson (considered a medical emergency): Skin rash, pruritic, exfoliative, and bullous.
39
contraindications of anti convulsant
(a) In patients with CNS depression (drowsiness & lethargy).
(b) Not recommended for use in pregnancy (Pregnancy (D)).
(c) Psychoses, acute narrow-angle glaucoma
40
patient management of anti convulsive
a) Do not miss a dose
(b) Regular serum plasma levels of the anticonvulsant.
(c) Avoid alcohol consumption.
(d) For an acute seizure you will use a benzodiazepine treat all patients with
generalized convulsive status epilepticus (GCSE). GCSE is operationally
defined as ≥ 5 minutes of continuous seizure activity, or more than one seizure
without recovery in between.
41
action of anti emetics
Phenothiazines act on the chemoreceptor trigger zone to inhibit nausea and
vomiting. Dimenhydrinate, Scopolamine, and Meclizine act as antiemetic
mainly by diminishing motion sickness. Metoclopramide decreases nausea and
vomiting by its effects on gastric emptying. Ondansetron block the effects of
serotonin at 5-HT3 receptor sites.
(b) Primarily by inhibiting the chemoreceptor trigger zone or by depressing the
sensitivity of the vestibular apparatus of the inner ear.
42
Use of antiemetics
(a) Antiemetic: Prophylaxis or treatment of nausea or vomiting.
(b) Antivertigo: Treatment of vertigo
43
adverse effects of Antiemetics/Antinauseants.
(a) Drowsiness
44
Contraindication/Warning/Caution: anti emetics
(a) Not recommended for use in patients who are in severe CNS depression.
(b) Not recommended for pregnant patients (Pregnancy (X)).
(c) Do not use with alcohol.
(d) Will make sedation worse.
45
patient management of anti emetics
(a) Consider fluid replacement if repeated vomiting.
(b) Use Phenothiazines cautiously in children who may have viral illnesses. Choose agents carefully in pregnant patients (no agents are approved for safe use).
46
What is local anesthesia
Produce a local anesthesia by inhibiting transport of ions
| across neuronal membranes, thereby preventing initiation and conduction of normal nerve impulses.
47
What is a drug we use for general anesthesia
ketamine
48
How does ketamine work?
A non-competitive antagonist of glutamate at the N-methyl-Daspartate (NMDA) receptor-cation channel complex, causing neuro-inhibition and anesthesia, where the patient is dissociated from the surrounding.
49
When may ketamine be used for anesthesia?
Ketamine may be selected to induce anesthesia in hypotensive patients or those likely to develop hypotension during induction due to hypovolemia, hemorrhage, sepsis, or severe cardiovascular compromise. Ketamine typically increases blood pressure (BP), heart rate (HR), and cardiac output (CO) by increasing sympathetic tone.
50
How long for ketamine effect taken IM?
IM: Anesthetic effect: 3 to 4 minutes
51
what are some adverse effects of ketamine?
(a) Ketamine: In patient with ischemic heart disease, sympathomimetic effects that increase HR and BP may be detrimental due to imbalance between myocardial
oxygen supply and demand.
(b) Prolonged emergence from anesthesia (12%; includes confusion, delirium, dreamlike state, excitement, hallucinations, irrational behavior, vivid imagery).
52
Contraindication/Warning/Caution: ketamine or local anesthesia
(a) Hypersensitivity to ketamine or any component of the formulation.
(b) Ketamine: Conditions in which increase in blood pressure would be hazardous.
(c) When used for procedural sedation and analgesia: Known or suspected schizophrenia (even if currently stable or controlled with medications).
53
the use of ketamine increases the risk of what?
laryngospasm
54
patient management of anesthesia
(a) Advise patient on risk and benefits
(b) Assess allergies
(c) Advise of pain from injection
(d) Ketamine: Heart rate, blood pressure, respiratory rate, transcutaneous O² saturation, emergence reactions; cardiac function should be continuously monitored in patients with increased blood pressure or cardiac decompensation.
55
ketamine dosing
Ketamine given at doses of 10-20 mg IV are used for analgesia, where a dose of 1- 2 mg/kg IV is given for induction of anesthesia and will need to manage airway at that point. The IM induction of anesthesia dose is 4 to 6 mg/kg.
(f) If giving Ketamine IM for pain control, then give 20-40 mg IM.
56
examples of analgesic classes
(a) Salicylate
(b) Non-salicylate
(c) Nonsteroidal Anti-inflammatory Drugs (NSAIDS)
(d) Urinary Analgesics
57
action of salicylates
Inhibition of prostaglandins, dilates peripheral blood vessels (cools body), prolong bleeding by inhibiting aggregation of platelets
58
what do we use salicylates for
(a) Relief of mild to moderate pain
(b) Reduction of body temperature
(c) Inflammatory conditions
(d) Decrease risk of myocardial infarction
(e) Prevention and treatment of blood clots.
59
adverse effects of salicylates
(a) Gastric upset, heartburn, nausea, vomiting, anorexia, and gastrointestinal bleeding.
(b) May cause Reye Syndrome in children with chickenpox or influenza.
60
Contraindication/Warning/Caution:
| salicylates
(a) Not recommended for use during pregnancy (Pregnancy (Cat D)).
(b) Not recommended for use in patients with bleeding disorders
61
action of non salicylate
Analgesic and antipyretic
62
use of non salicylate
(a) Relieve mild to moderate pain
(b) Reduce body temperature (antipyretic)
(c) Arthritis
63
adverse affects of non salicylate
(a) Urticaria
(b) Hemolytic anemia
(c) Hepatotoxicity
(d) Hypersensitivity to acetaminophen or any component of the formulation.
(e) Severe hepatic impairment or severe active liver disease.
(f) OTC labeling: When used for self-medication, do not use with other drug products containing acetaminophen or if allergic.
64
Contraindication/Warning/Caution: Non-salicylate
Hepatotoxicity: Acetaminophen is associated with acute liver failure, at time resulting in liver transplant and death. Hepatotoxicity is usually associated with excessive acetaminophen intake and often involves more than one product that
contains acetaminophen. Do not exceeds the maximum recommended daily dose
(>4g daily in adults). In addition, chronic daily may also result in liver damage
in some patients
65
patient management of non salicylate
(a) Tylenol may be administered orally without regard to food; may administer with food to decrease possible GI upset.
(b) Mostly safe in pregnancy. (Pregnancy (CAT: B))
(c) Assess for alcohol use before prescribing Tylenol.
66
action of NSAIDs
Inhibit the action of the enzyme cyclooxygenase (COX-1 & COX-2
(Nonselective) or Cox 2 -Selective) which is responsible for prostaglandin synthesis.
(a) Anti-inflammatory
(b) Analgesic
(c) Antipyretic
67
use of NSAIDs
(a) Arthritis
(b) Mild to moderate pain relief.
(c) Dysmenorrhea (painful menstruation)
(d) Fever reduction
68
adverse effects of NSAIDs
(a) Gastrointestinal: Nausea, and vomiting
(b) FDA warning: Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase your risk of heart attack or stroke.
(c) Celecoxib: Dyspepsia, and renal function
1) (Relative reduction in GI toxicity compared with nonselective NSAIDs)
(d) Ibuprofen: Due to effects on platelets and their role in clotting. Increased risk with higher dose. FDA Warning: https://www.fda.gov/ForConsumers/Cons
69
Contraindication/Warning/Caution: NSAIDs
(a) Celecoxib (COX-2 Selective) --> allergy to sulfonamides (celecoxib is a sulfa drug)
(b) Ibuprofen (Non-Selective) --> peptic ulcer, GI bleed, and hypertension
(c) ALL NSAIDs have risk of causing increased risk of bleeding
70
patient management of NSAIDs
(a) Stop if prolonged bleeding or dark stools.
(b) Long term use may lead to GI bleed. COX-2 Selective NSAIDS are preferred for long term use to reduce the risk of GI bleed.
(c) Take with food or milk
71
action of Urinary Anesthetic/Analgesic
Pyridium is a topical bladder and urethral anesthetic and analgesic through an unknown mechanism.
72
use of Urinary Anesthetic/Analgesic
Is a bladder analgesic used to treat pain associated with a urinary tract infection.
73
adverse effects of Urinary Anesthetic/Analgesic
(a) Pyridium is known to turn the patient's urine a reddish-orange color that can stain undergarments. Warn patients about these two changes.
(b) Headaches, dizziness
(c) Stomach cramps
74
contraindications and warnings of Urinary Anesthetic/Analgesic
(a) Allergy to Pyridium or renal insufficiency.
| (b) Patient Management: Pregnancy B
75
action of Narcotic Analgesics
Opioids bind to opiate receptors in the CNS, where they act as agonists of endogenously occurring opioid peptides (endorphins). The result is alteration to the perception of and response to pain.
76
use of narcotic analgesics
Narcotic analgesics-short term management of moderate to severe pain.
77
adverse effects of narcotic analgesics
(a) Respiratory Depression
(b) Light-headedness
(c) Constipation
(d) Nausea/vomiting
78
Contraindication/Warning/Caution: narcotic analgesics
(a) Head injury or increased ICP
(b) Hypoxia
(c) Hepatic impairment
(d) Hypersensitive to opioids or naloxone
79
patient management of narcotic analgesics
(a) Identify the level of pain
(b) Determine the effectiveness of the narcotic after administration.
(c) Advise of risk of constipation
(d) Advise of respiratory risk
(e) Avoid concomitant use of narcotics and benzodiazepines (antianxiety
medication) or other CNS depressants when possible.
1) Avoid concomitant use of narcotics and some antianxiety Herbal Remedies:
Passion Flower, Kava & St. John's Wort.
80
action of narcotic antagonist
An opioid antagonist is a receptor antagonist that acts on opioid receptors. Naloxone is a commonly used opioid antagonist drug which is competitive antagonists that bind to the opioid receptors with higher affinity than agonists but do not activate the receptors. This effectively blocks the receptor, preventing the body from responding to opiates and endorphins.
81
use for narcotic antagonist
Overdose of a Narcotic
82
Adverse Effect of narcotic antagonist
Acute opioid withdrawal: Administration of naloxone causes the release of catecholamines which may precipitate acute withdrawal or unmask pain in those
who regularly take opioids. Symptoms of acute withdrawal in opioid-dependent patients may include pain, tachycardia, hypertension, fever, sweating, abdominal cramps, diarrhea, nausea, vomiting, agitation, and irritability
83
Contraindications/Warning/Caution: narcotic antagonist
Hypersensitivity to naloxone or any component of the formulation. Use with caution in patients with CAD, pregnant women, and opioid dependent patients.
84
patient management of narcotic antagonist
(a) Vital Signs
(b) Monitor for respiratory depression
(c) Dependency side effect risk
85
what is a histamine
Histamine: Is a chemical created in the body. Highest amount found in basophils (WBC) and mast cells. Produce vasodilation of arterioles and increased permeability of capillaries and venule, which allows fluid to escape into the surrounding tissue resulting in localized swelling.
86
actions of antihistamine
(a) H¹ - antihistamines work by binding to histamine H¹ receptors in mast cells, smooth muscle, and endothelium in the body as well as in the in the brain in order to prevent the release of histamine. They suppress the histamine-induced wheal response (swelling) and flare response (vasodilation).
(b) 1st generation antihistamines have increase side effects such as drowsiness since they cross the blood brain barrier. 2nd Generation antihistamines has fewer CNS side effects.
87
uses for antihistamines, H1
(a) H¹- antihistamines are used to treat allergic reactions (e.g., itching, runny nose, and sneezing). In addition, they may be used to treat insomnia, motion sickness, or vertigo caused by problems with the inner ear (Dimenhydrinate and Meclizine), urticaria, and as adjunctive therapy in anaphylactic reactions and angioedema. Topical and ophthalmic antihistamines may minimize systemic
side effects,
88
use for antihistamines, H2
(b) H² - antihistamines bind to histamine H² receptors in the upper gastrointestinal tract, primarily in the stomach. Antihistamines that target the histamine H² - receptor are used to treat gastric acid conditions (e.g., peptic ulcers and acid reflux). May also help with the relief of Parkinson-like reactions (Diphenhydramine)
89
adverse reactions of antihistamines
(a) Anticholinergic effects: Drying effect may increase thickening of bronchial secretions, dizziness, fatigue, hypotension, and headache.
(b) 1st generation antihistamines have increase side effects such as drowsiness since they cross the blood brain barrier. 2nd Generation antihistamines has fewer CNS side effects.
90
Contraindication/Warning/Caution: antihistamines
(a) Some antihistamine are classified as pregnancy CAT D and C, may result in jaundice, hyperreflexia extrapyramidal symptoms in infants whose mothers received antihistamines (particularly promethazine).
(b) Patients taking 1st generation antihistamines should be counseled to not operate weapons, heavy machinery or motor vehicles while taking these medications.
91
patient management with antihistamines
(a) Give medication with food due to GI upset.
(b) Risk of injury due to drowsiness.
(c) Do not use with alcohol.
(d) The patient may have photosensitivity.
92
examples of 1st generation antihistamines
1) Diphenhydramine: Benadryl, Diphenhydramine may be used for the
treatment of allergic conditions in pregnant women when a first-generation
antihistamine is indicated (Pregnancy Cat: B).
2) Hydroxyzine: Atarax
3) Promethazine: Phenergan
93
2nd Generation Antihistamines
1) Cetirizine HCL: Zyrtec
2) Fexofenadine: Allegra
3) Loratadine: Claritin
94
what do decongestants do?
Reduce swelling of nasal passages
| Enhance drainage of sinuses
95
what is the action of decongestants?
) The vast majority of decongestants act by enhancing norepinephrine
(noradrenaline) and epinephrine (adrenaline) or adrenergic activity by stimulating the alpha-adrenergic receptors. This induces vasoconstriction of the blood vessels in the nose, throat, and paranasal sinuses, which results in reduced inflammation (swelling) and mucus formation in these areas.
96
difference between pseudoephedrine and Oxymetazoline
Decongestant nasal sprays and eye drops often contain
Oxymetazoline and are used for topical decongestion. Pseudoephedrine acts indirectly on the adrenergic receptor system, whereas phenylephrine and Oxymetazoline are direct agonists.
97
use for decongestants
Common cold, hay fever or upper respiratory allergies, sinus congestion, and pressure.
98
adverse effects of decongestants
Sleeplessness, anxiety, dizziness, excitability, and nervousness. Topical nasal or ophthalmic decongestants quickly develop tachyphylaxis thus long-term use is not recommended, since these agents lose effectiveness after a few days.
99
Contraindication/Warning/Caution: decongestants
(a) Use with caution in hypertension, DMII, and increased intraocular pressure.
(b) May worsen prostatic hyperplasia/urinary obstruction.
(c) Elderly may be more sensitive
(d) Pregnancy CAT C. Not recommended for use in pregnancy.
(e) Overuse of topical can cause rebound nasal congestion.
(f) Typically paired with an antihistamine.
100
actions of beta 2 agonists
Release stimulants and reuptake inhibitors that increase the levels of endogenous catecholamine’s. Beta² receptors are in bronchial smooth muscle and when stimulated cause relaxation (dilation) of bronchioles.
101
use of beta 2 agonists
Release stimulants and reuptake inhibitors that increase the levels of endogenous catecholamine’s. Beta² receptors are in bronchial smooth muscle and when stimulated cause relaxation (dilation) of bronchioles.
102
adverse effects of beta 2 agonists
(a) Excessive use may result in paradoxical bronchospasm when used by inhalation.
(b) Nausea, vomiting, and restlessness.
(c) Tachycardia, increase respirations.
(d) Nervousness, headache, palpitations, and hyperglycemia.
103
Contraindication/Caution/Warnings: beta 2 agonist
(a) Cardiac arrhythmias, narrow angle glaucoma.
(b) If used while taking a Beta blocker it may inhibit the effects of the beta² agonist.
(c) Use albuterol (beta² agonist) with caution in patients with diabetes mellitus: May increase serum blood glucose.
104
patient management of beta 2 agonist
(a) Ensure proper education is provided to the patient regarding use of inhalers
(b) Provide a spacer and face mask to ensure optimal dosing with each administration.
105
action of Muscarinic Antagonists
Antagonizes acetylcholine receptors, producing bronchodilation.
106
use of Muscarinic Antagonists
Symptomatic relief or prevention of bronchial asthma and the management of chronic obstructive pulmonary disease (COPD).
107
Adverse Effects of anticholinergics:
(a) Drowsiness or sedation /Flushed face (Red as beet).
(b) Blurred vision/mydriasis (Blind as Bat).
(c) Urinary retention (Stuffed as a pipe).
(d) Confusion or delirium (Mad as a hatter).
(e) Hallucinations (Mad as a hatter)
(f) Increased heart rate/Increased body temperature (Hot as a hare)
(g) Dry mouth ( Dry as Bone)
108
Contraindication/Warnings/Caution: muscarinic antagonist
(a) Peptic ulcer, seizure, arrhythmias, and hyperthyroid.
(b) Caution with >60 years old
(c) Pregnancy Category C. Use in pregnancy only if potential benefit outweighs the risk.
109
what is a leukotriene action
Broncho constrictive substance released by the body during
| inflammation. Antagonist results in bronchodilation.
110
what is mast cell stabilizer action
Inhibit the release of substances that cause bronchoconstriction and inflammation from the mast cells in the respiratory tract.
111
use of Leukotriene Antagonist and Mast Cell Stabilizers
(a) Treatment of Asthma
| (b) Treatment of COPD
112
adverse effects of Leukotriene Antagonist and Mast Cell Stabilizers
Headache, dizziness, unpleasant taste, and fatigue
113
Contraindication/Warning/Caution: Leukotriene Antagonist and Mast Cell Stabilizers
(a) Acute Asthma/bronchospasm: Not FDA approved for use in the reversal of bronchospasm in acute asthma attacks including status asthmaticus.
(b) Aspirin-sensitive asthmatics: Montelukast (Singular will not interrupt bronchoconstrictor response to aspirin or other NSAIDs. Patients with unknown aspirin sensitivity should avoid these agents.
114
action of Inhaled Corticosteroids
(a) Produce profound and varied metabolic effects, in addition to modifying the
normal immune response and suppressing inflammation.
(b) Decrease inflammatory process in the airway through inhibiting multiple
different inflammatory cytokines
115
use of Inhaled Corticosteroids
(a) Larger doses are usually used for their anti-inflammatory, immunosuppressive,
or antineoplastic activity.
(b) Inhalant corticosteroids are used in the chronic management of reversible airway
disease (asthma); intranasal and ophthalmic corticosteroids are used in the
management of chronic allergic and inflammatory conditions.
116
adverse effects of Inhaled Corticosteroids
(a) Throat irritation; cough
(b) Candida albicans (yeast infection) - to avoid this tell the patient to rinse their mouth out with water after using an inhaler.
117
Contraindication/Warning/Caution: of inhaled corticosteroids
(a) Acute bronchospasm, status asthmaticus
| (b) Caution with compromised immune system
118
action of antitussives:
(a) Central acting: Depresses cough center.
| (b) Peripheral acting: Anesthetize stretch receptors.
119
use of antitussives
(a) Relieve a non-productive cough
| (b) Sometimes with a productive cough
120
adverse effects of antitussives
(a) Codeine = respiratory depression, euphoria, and sedation
121
Contraindication/Warnings/Caution: of antitussives
(a) Premature infants
(b) Caution with persistent or chronic cough - Sought for an underlying cause.
(c) Caution when using codeine in Respiratory disorders.
122
patient management of antitussives
Advise patient if worsening symptoms to return to clinic; fever, nausea, and vomiting
123
action of Mucolytic and Expectorants
(a) Mucolytic: Loosens and mobilize thick mucus from respiratory system.
(b) Expectorant: Loosen and mobilize thick mucus from respiratory system.
124
use of Mucolytic and Expectorants
(a) Mucolytic: Bronchopulmonary diseases
| (b) Expectorant: Common cold
125
adverse effects of mucolytics and expectorants
Nausea, vomiting and drowsiness
126
Contraindication/Warning/Caution:Mucolytic and Expectorants
Caution if persistent cough
127
Patient Management: Mucolytic and Expectorants
(a) Lung sounds, sputum consistency.
| (b) Assess for changes in patient symptoms.
128
what is a cardiac arrhythmia
Abnormal electric current in the heart.
129
actions of Antiarrhythmic.
(a) Blockade of Na or K channels
(b) Raise the potential threshold
(c) Block beta receptor stimuli
(d) Block calcium channels
130
action of class 1 antiarrhythmic
Class 1: Depresses myocardial excitability to electrical stimuli thus
decreasing the pulse rate. Lidocaine (Xylocaine), raises the threshold in the ventricular myocardium. Some arrhythmias have too much stimuli and lidocaine will depress the threshold of the muscle.
131
action of class 2 antiarrhythmic
Class 2: Beta blockers block stimulation of the beta receptors of the heart.
Adrenergic neurohormones stimulate the beta receptors and increase the
heart rate.
132
action of class 3 antiarrhythmic
Class 3: Amiodarone blocks potassium channels in the heart. This is used for
ventricular dysrhythmias and atrial fibrillation.
133
actions of class 4 antiarrhythmic
Class 4: Verapamil blocks calcium channels which are critical in the
production of muscle contraction and electrical conduction.
134
use of antiarrhythmics
Treat cardiac arrhythmias such as:
1) Premature ventricular contractions
2) Tachycardia
3) Premature atrial contractions
4) Ventricular dysrhythmias
5) Atrial fibrillation and Atrial flutter
135
adverse effects of antiarrhythmics
(a) Light-headedness
(b) Weakness
(c) Hypotension
(d) Bradycardia
136
what is angina
Decrease in oxygen supply to the heart muscle resulting in chest pain or pressure.
137
action of nitrates
Direct relaxing effect on smooth muscle of blood vessels (both arterials and veins).
138
use of nitrates
Treatment of angina pectoris.
139
adverse effects of nitrates
(a) Headache, hypotension
| (b) Dizziness, vertigo and weakness but disappears with continued use.
140
Contraindication/Warning/Caution: nitrates
Postural hypotension, closed-angle glaucoma, and right sided heart failure.
141
patient management of nitrates
(a) Always take a blood pressure before and after giving medication. If BP is <100 systolic do not give NTG.
(b) If there is no improvement in 5-15 minutes call 911.
(c) Do not use with any phosphodiesterase inhibitors such as Viagra, Cialis, Levitra, or herbal supplements such as Yohimbine (used for erectile dysfunction).
142
guidelines for hypertension
(a) Normal blood pressure – Systolic <120mm Hg and diastolic <80 mmHg.
(b) Elevated blood pressure – Systolic 120 – 129 mg Hg and diastolic, 80mm Hg.
(c) Stage 1 - Systolic 130-139 mm Hg or diastolic 80 to 89 mm Hg.
(d) Stage 2 – Systolic at least 140 mm Hg or diastolic at least 90 mm Hg.
(e) If there is disparity in category between the systolic and diastolic pressures, the higher value determines the stage.
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first step of treating hypertension
Salt restriction Weight reduction Exercise Stress reduction Sleep.
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step 2 of treating hypertension
Step 2: Use of Thiazide Diuretic, ACE-I, ARB, or CCB (use one).
1) Diuretic are used to control 80% of patients.
2) Consider using ARB instead of an ACE-I in African American patients due to the increased risk of angioedema
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step 3 of treating hypertension
Step 3: Increase dose of drugs or combine two drugs.
| 1) Example: Thiazide Diuretic with an ACE-I.
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what is step 4 of treating hypertension
Step 4: Combine 2-3 of Step 3.
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classes of antihypertension medications
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(a) ACE inhibitors, Angiotensin II antagonists (called ARB - Angiotensin II
receptor blockers).
(b) Diuretics
(c) Calcium channel blockers
(d) Beta blocker
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action of ACE inhibitors, ARBS
(a) Lower blood pressure by dilating or increasing the size of the arterial blood vessels.
(b) Angiotensin-converting Enzyme (ACE): Converts angiotensin I to angiotensin II.
(c) Angiotensin II is a vasoconstrictor. It also stimulates the secretion of the hormone aldosterone by the adrenal cortex (on the kidney. Aldosterone promotes retention of sodium which results in increased intravascular volume and thus and increased in blood pressure. ACE-I (ACE-Inhibitor) interrupts the process by inhibiting the conversation of angiotensin I to angiotensin II.
(d) Have 1st line indication in the treatment of hypertension in patients with Diabetes mellitus.
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use of ACE inhibitors and ARBS
Treatment of Hypertension and diabetic nephropathy (diabetic kidney disease).
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adverse effects of ARBS and ACE inhibitors
(a) Postural or orthostatic hypotension.
(b) ACE-I: Angioedema (especially in African American patients), and hyperkalemia
(c) Further Adverse Effects discussed later in the course with specific medication.
(d) A dry, hacking cough has been described in 5 to 20 percent of patients treated with an ACE inhibitor.
(e) Dry cough usually begins within one to two weeks of instituting therapy, but it can be delayed up to six months.
(f) Cough is much less common with ARBs.
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Contraindication/Warning/Caution: ARBS. ACE inhibitors
(a) Caution with renal or hepatic disease.
| (b) Electrolyte imbalance
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patient management of ARBS and ACE inhibitors
(a) Obtain BP
(b) Ensure same arm, same position.
(c) Take 60-90 minutes separate from other medication.
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action of calcium channel blockers
These agents act by causing peripheral vasodilation (it inhibits calcium from getting into the muscle cells to cause contraction)
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use of CCB
Treating HTN, atrial cardiac arrhythmias. There are two categories of CCB:
1) Dihydropyridines: These are potent vasodilators that have little or no negative effect upon cardiac contractility or conduction. These are primarily used for treatment of HTN.
2) Non-dihydropyridines: These are less potent vasodilators but have a greater depressive effect on cardiac conduction and contractility. These are used for treatment of chronic stable angina, cardiac arrhythmias, and for proteinuria
reduction.
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adverse effects of CCB
(a) Dihydropyridines: HA, lightheadedness, flushing, and peripheral edema in up to 20% of patients.
(b) Non-dihydropyridines: Constipation (in up to 25% of patients), bradycardia, heart failure, heart block.
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Contraindication/Warning/Caution: CCBs
(a) Dihydropyridines: Allergy to CCB, hepatic impairment, severe CAD, and severe Aortic stenosis.
(b) Non-dihydropyridines: Sick sinus syndrome, second or third-degree heart block, Acute myocardial infarction, and CHF.
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Patient management of CCBs
CCB are much more effective in the older and in black patients with HTN.
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action of beta blockers
Beta blockers compete with adrenergic (sympathetic) neurotransmitters (epinephrine and norepinephrine) for adrenergic receptor sites.
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use of beta blockers
Management of hypertension, angina pectoris, tachyarrhythmia, hypertrophic subaortic stenosis, migraine headache (prophylaxis), MI (prevention), glaucoma (ophthalmic use), congestive heart failure (CHF) (Carvedilol and sustained release Metoprolol only) and hyperthyroidism (management of symptoms only)
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adverse effects of beta blockers
(a) Orthostatic hypotension
(b) Bradycardia
(c) Bronchospasm
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Contraindication/Warning/Caution: beta blockers
(a) Sinus bradycardia
(b) Heart Block
(c) Hypotension
(d) Bronchial asthma ( Non-Selective Beta blocker (for example : Propranolol)
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patient management of beta blockers
(a) Do not stop abruptly
| (b) Consider use for difficulty speaking in-front of groups
