Albuterol (Proventil, Ventolin)
Class: sympathetic, bronchodilator
MOA: beta-2 AGONIST stimulates adrenergic receptors of SNS causing smooth muscle relaxation of bronchial tree and peripheral vasculature
Indications: bronchospasm w/ reversible obstructive airway disease; prevention of exercise induced asthma
Contraindications: hypersensitivity, tachycardia, dysrhythmias,
Adverse reactions/side effects: JA. fatigue, light-headedness, irritability, restlessness, agreesive behavior, pulmonary edema, hoarsness,nasal congestion, sputum, HTN, tachycardia, dysarrhythmuas, CP, palpitations, n/v, dry mouth, epigastric pain, tremors
Drug interactions: TCA, beta blockers (pulmonary affections_, hypokalemia secondary to diuretics
Route: inhalation (neb or MDI)
Dosage: Adult - 2.5mg. Dilute in 0.5mL 5% solution w/ 2.5mL NL saline in nebulizer over 10 - 15 minutes. MDI 1-2 inhalations and wait 5-10 mins b/n inhalations. Peds - <20 kg. 1.25mg/dose mask over 20 minutes. >20 kg 2.5mg dose via handheld x 20 minutes. Repeat ONCE in 20 minutes.
Duration of action: onset: 5-15 minutes. Peak effect: 30 min - 2 hours. Duration: 3 - 4 hours
Special considerations: Pregnant pt - angina pectoris and dysrhythmia. May need to be coached for proper use.
10 rights of medication administration
Right patient Right medication Right dose Right route Right time Right documentation and reporting Right assessment Right to refuse Right evaluation Right patient education
Definition of chemical name.
Medications precise description of the drug’s chemical composition and molecule structure.
Definition of official name.
Name assigned by USP. Generally followed by USP.
Definition of trade name.
Brand name that a manufacturer gives to a medication. (i.e. Advil, Nitrostat)
Definition of generic name.
Original chemical name, not capitalized, and usually suggested by the first manufacturer and approved by FDA. (i.e. ibuprofen, nitroglycerin)
Pure Food and Drug Act
- First federal legislation in the US aimed at protecting the public from mislabeled, poisonous, or otherwise harmful foods, medications, and alcoholic beverages.
Classification of Controlled Substances
Schedule I - high abuse potential; no medical purpose. (i.e. heroin, THC, LSD)
Schedule II - high abuse potential; legitimate medical purpose. (i.e. Fentanyl, Ritalin, cocaine)
Schedule III - less potential for abuse than II. (i.e. Vicodin, Tylenol #3 w/ codeine, ketamine)
Schedule IV - less potential for abuse than III. (i.e. diazepam, lorazepam)
Schedule V - less potential for abuse than IV. (i.e. narcotic cough meds)
Regulations of US falls under the jurisdiction by what agencies?
FDA
DEA
Public Health Service
Federal Trade Commission (FTC)
Role of FDA
Determines the safety and efficacy of drugs before they are allowed to enter the market.
Role of DEA
Division of Justice Department responsible for executing Controlled Substance Act including registration of physician who are permitted to dispense controlled substances.
Role of Public Health Service
Regulates biological products - medications with living organisms such as vaccines and antitoxins
Role of FTC
Monitors drug advertising and ensure it is not misleading or inappropriate. Involved in direct-to-consume advertisements.
Alpha-1 receptor
Peripheral vasoconstriction
Alpha-2 receptor
Peripheral vasodilation
Little or no bronchodilation
Beta-1 receptor
Increased HR
Increased automaticity
Increased contractility
Increased conductivity
Guidelines for providing drug therapy.
Understand pharmacology
Use correct precautions and technique
Observe and document the effects of medication
Obtain pt drug hx and drug reactions
Perform evaluation to identify drug indications and contraindications
Establish and maintain professional relationship
Keep your knowledge base current for charges and trends in pharmacology
Seek drug reference literature
Consult with medical direction
Sympathomimetic medications.
Mimic effects of SNS hormones epinephrine and norepinephrine.
Sympatholytic medications
Block the actions of SNS
Antagonist medications
Counteracts the action of something else, has an affinity for cell receptor, and can prevent the cell from responding when it binds to a receptor.
Agonist medications
Mimics the action of a specific neurotransmitter or hormone by binding to the specific receptor of the naturally occurring substance.
Beta blocker medications
Common class of cardiac drugs that blocks beta effects, causing a decrease in the workload of the heart by reducing the speed contraction and reducing BP.
Parasympathomimetic medications
Produce the same effects as PNS. AKA cholinergic.
Parasympatholytics medications
Blocks the actions of the PNS. AKA anticholinergics.
Cholinergic medications
Stimulate cholinergic receptors.
Anticholinergic medications
Acts to prevent activation of cholinergic receptors by binding.
Opiod antagonist medications
Reverse the effect of opioid drugs by binding to the opioid receptor in an antagonist manner. Opioid molecules cannot get to the receptor and cannot initiate its action. Most common Narcan.
Opioid antagonist medications
Reverse the effect of opioid drugs by binding to the opioid receptor in an antagonist manner. Opioid molecules cannot get to the receptor and cannot initiate its action. Most common Narcan.
Opioid agonist-antagonists medications
Agonistic and antagonistic properties. Can decrease pain but does not diminish the function of respiratory system or result in addiction.
Chronotropic effects
Affects heart rate
Inotropic effects
Affects force on contraction
Dromotropic effects
When a drug alters the velocity of the electrical conduction in the heart.
Sodium channel blockers
Slows conductions through heart (negative dromotropic effect)
Potassium channel blockers
Increases the heart’s contractility (positive inotrophy) and works against reentry of blocked impulses.
Calcium channel blockers
Decreasing the force of contraction and automaticity. May also decrease conduction velocity. (negative dromotropic effects)
Antiotensin-converting enzyme (ACE) inhibitors
Suppressed the conversion of angiotensin I to angiotensin II, thereby decreasing BP.
Role of angiotensin II
Potent vasoconstrictor. Promotes smooth muscle contraction in the arterioles and raised BP by increasing peripheral resistance.
Rate of absorption per medication route
SL - rapid PR - rapid IN - rapid Inhalation - rapid IV - intermediate IO - intermediate IM - moderate Oral - slow SQ - slow Transcutaneous - slow
What is therapeutic index?
Ratio of a drug’s lethal dose to its effective dose. Indication of margin of safety.
What is therapeutic threshold?
Minimum effective concentration
Iatrogenic response
Adverse condition inadvertently induced by tx given.
Cumulative effect
Increased effect when a medication is given in several successive dose which may result in therapeutic or nontherapeutic effects.
Idiosyncratic reaction
Individual reaction to drug
Drug antagonism
One medication can block the body’s response to another medication when multiple medications are taken.
Synergism
Action of two drugs in which the total effects are grater than the sum of the independent effects of the drugs.
Summation effect
Additive effect. If medication with same or similar side effects are taken can increase the body’s response.
Potentiation
One drug may enhance the effect of another. (i.e. Tylenol and ETOH)
Aspirin
Class : platelet inhibitor, anti-inflammatory
MOA : preventions formation of thromboxane A2; antipyretic and analgesic
Indications : new onset ACS sxs
Contraindications : hypersensitivity, active ulcer disease or asthma
Adverse reactions/side effects : bronchospasm, anaphylaxis, wheezing prolonged bleeding, GI bleeding, epigastric distress, n/v, heartburn, Reye syndrome
Drug interactions: Caution w/ allergy to NSAIDs
Route : chewable, oral
Dosage : adult - 160 to 325 mg PO. Chew.
DOA : Onset 5-30 minutes. Peak 1-3 hours. Duration 3-6 hours
General : Pregnancy safety category D. Weigh risks vs. benefits.
Dextrose
Class : carb, antihypoglycemic, hypertonic solution
MOA : rapidly increased serum glucose levels. Short term osmotic diuresis
Indications : Hypoglycemia, AMS, coma, seizure of unknown origin, status epilepticus
Contraindications : intracranial hemorrhage w/ nl glucose level
Adverse reaction/side effects : extravasation leads to tissue necrosis. Cerebral hemorrhage, cerebral ischemia, pulmonary edema; warmth, pain, burning from IV, hyperglycemia
Drug interactions : sodium bicarbonate, warfarin
Route : IV, IO
Dosage : Adult - D50 25 g slow IV push.
