Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
40 Cards in this Set
- Front
- Back
|
Schedule 1
|
highest abuse potential
high physiological and psychological dependence very limited or no clinical use Examples: heroin, LSD, MDMA (ecstasy), GHB, marijuana |
|
|
Schedule 2
|
high abuse potential
high physiological and psychological dependence therapeutic use with prescription Examples: morphine, opium extracts, carfentanil (and most other opioids), cocaine, methamphetamine |
|
|
Schedule 3
|
moderate abuse potential
moderate physiological dependence high psychological dependence therapeutic use with prescription Examples: anabolic steroids, buprenorphine, codeine, marinol (synthetic marijuana), ketamine, |
|
|
Schedule 4
|
lower abuse potential
lower physiological and psychological dependence therapeutic use with prescription Examples: Xanax (alprazolam), diazepam, Brevital (methohexital), Provigil (modafinil), Restoril (temazepam) |
|
|
Schedule 5
|
lowest abuse potential
lowest physiological and psychological dependence therapeutic use without prescription Examples: OTC drugs, cough medicines with codeine |
|
|
Nursing Process (5 steps of nursing)
|
Assessment
Diagnosis Planning care with goals and outcomes Implementation of intervention Evaluating care |
|
|
Nursing Implications and Interventions for Pharmacotherapy
|
Administration
Therapeutic effects Adverse effects Teaching |
|
|
Five Rights of Drug Administration
|
Right client
Right medication Right dose Right route of administration (see chapter 4) Right time of delivery |
|
|
Enteral
|
via the digestive tract
|
|
|
Parenteral
|
not by digestive tract
|
|
|
first-pass metabolism
|
phenomenon of drug metabolism whereby the concentration of a drug is greatly reduced before it reaches the systemic circulation. It is the fraction of lost drug during the process of absorption which is generally related to the liver and gut wall.
To by-pass first-pass metabolism: Sublingual Rectal Parental |
|
|
Therapeutic response
|
= concentration of drug at target tissue
*This is very hard or impossible to measure Therapeutic response = concentration of drug at target tissue *This is very hard or impossible to measure Therapeutic response = plasma concentration of drug |
|
|
Efficacy
|
magnitude of maximal response that can be produce by a drug
aka – maximal efficacy determined by height of dose-response curve |
|
|
Potency
|
refers to amount of drug we need to give to elicit an effect
aka - relative potency determine by position of dose-response curve along x-axis |
|
|
Norepinephrine (NE)
|
Neurotransmitter; Autonomic Nervous System; fight or flight
norepinephrine activates a1, a2, b1 only (Adrenergic receptors) |
|
|
Epinephrine
|
Hormone; (released from adrenal medulla only, not from neurons); Autonomic Nervous System
epinephrine activates all Adrenergic receptors (a1, a2, b1, b2) |
|
|
Acetylcholine
|
Neurotransmitter; Autonomic Nervous System; rest-and-digest
|
|
|
Parasympathetic nervous system (PNS)
|
"rest-and-digest"
Increase gastric secretion (increase digestion) ** Empty bladder ** Empty bowel ** Focus eyes for near vision ** Constrict pupils ** Slows heart rate Contract bronchial smooth muscle |
|
|
Sympathetic nervous system (SNS)
|
1. “fight-or-flight”
2. Regulation of cardiovascular system 3. Regulation of body temperature Increase heart rate and blood pressure Shunting blood flow from skin/vicera to skeletal muscles Dilation of bronchi to improve oxygenation Dilation of pupils (improve visual accuity, more light) Mobilize energy stores – for brain and muscles |
|
|
Nicotinic receptors (nAChR)
|
named for nicotine
lots of subtypes!!! (acetylcholine binds to all subtypes, but selective drugs) at neuromuscular junction (muscle-type) (somatic NS) on ALL postganglionic neurons (neuronal-type) in PNS and SNS (across from preganglionic neurons that release ACh) on adrenal medulla cells **** promotes ganglionic transmission (in postganglionic neuron) release Epi from adrenal medulla contraction of skeletal muscles |
|
|
Muscarinic receptors (mAChR)
|
named for muscarine (found in certain mushrooms)
multiple subtypes (acetylcholine binds to all subtypes, but selective drugs) on organs innervated by postganglionic parasympathetic nerves (cardiac muscle, smooth muscle, some glands) * on sweat glands innervated by postganglionic sympathetic nerves **** causes: *increased glandular secretions (pulmonary, gastric, intestinal, sweat) *contraction of smooth muscle (bronchi, bladder, GI tract) slows heart (decreases HR, decreases force of contraction) *contract sphincter of iris (miosis = decrease pupil diameter) contract ciliary muscles of eye (to focus lens for near vision) **on blood vessels, not innervated, don’t know how or why they are here, BUT cause vasodilation! |
|
|
Alpha1 (alpha1 = a1)
|
Iris – pupil dilation
Blood vessels (veins, arterioles) – vasoconstriction Male sex organs – ejaculation Smooth muscle of bladder neck and prostatic capsule - contraction |
|
|
Alpha2 (alpha2 = a2)
|
On nerve terminals – not clinically relevant in periphery
* relaxes blood vessels |
|
|
Beta1 (beta1 = b1)
|
Heart – increase HR, force of contraction, AV conduction
Kidney – renin release→angiotensin release - vasoconstriction |
|
|
Beta2 (beta2 = b2)
|
Lungs – bronchial dilation
Arterioles – vasodilation Liver, skeletal muscle - glycogen → glucose Uterus – relaxation of smooth muscle |
|
|
bethanechol (Urecholine)
|
Muscarinic agonists (parasympathomimetics)
Pharmacological effects: smooth muscle contraction (bladder, GI tract, bronchi) exocrine gland secretions (sweat, salivation, bronchi, gastric) eye – miosis, contract ciliary muscle (near) heart – bradycardia (slow heart rate) vascular smooth muscle – dilation - hypotension Main sites of action: urinary tract and GI tract, contraction Therapeutic use: urinary retention (constrict bladder, relax sphincter) - following surgery under general anesthesia - to treat nonobstructive urinary retention (postpartum) Administration: p.o., s.c. Adverse effects: bradycardia, excessive salivation, abdominal cramps, diarrhea, fainting (syncope), hypotension Contraindicated in patients with: gastric ulcers, intestinal obstruction, bladder weakness, asthma, epilespy, Parkinson’s diease |
|
|
atropine
|
2. Muscarinic antagonists (anticholinergics, cholinergic blockers)
Pharmacological effects: smooth muscle relaxation (bladder, GI tract, bronchi) ↓ exocrine gland secretions (sweat, salivation, bronchi, gastric) eye – mydriasis, relax ciliary muscle (far) heart – tachycardia (increase heart rate) vascular smooth muscle – no effect (only in presence of bethanechol) Main sites of action: all muscarinic receptors Therapeutic use: reverse bradycardia from anesthetics, for opthalamic procedures, ↓ gastric acid secretions, muscarinic poisoning Administration: p.o., s.c. Adverse effects:dry mouth, constipation, urinary retention, tachycardia, CNS excitement, delirium – agitation, convulsions Contraindicated in patients with: glaucoma, obstructive GI, bladder obstruction, myasthenia gravis, hemorrhage atropine decreases effects of levodopa (PD) tricyclic antidepressant antihistamines quinidine procainamide To reverse poisoning – increase acetylcholine (cholinestera |
|
|
Tubocurare (curare)
|
Neuromuscular blocking agents (muscle-type, nicotinic antagonist)
arrow poison causing muscle paralysis death from paralyzing respiratory muscles - can use to relax muscles for surgery (VERY UNLIKELY) |
|
|
Succinylcholine
|
Neuromuscular blocking agents (muscle-type, nicotinic antagonist)
-in clinical use -blocks muscle-type nicotinic receptors -ultra-short acting -charged molecule, stays in periphery used for muscle relaxation during endotracheal intubation, and electroconvulsive therapy (ECT) and endoscopy. |
|
|
neostigmine (Prostigmin)
|
Cholinesterase inhibitor (anticholinesterase agent)
Mechanism of action: prevent breakdown in ACh at therapeutic doses – mimics muscarinic agonists and activate nAChR (nicotinic) at NMJ (neuromuscular junction) Pharmacological effects: smooth muscle contraction (bladder, GI tract, bronchi) exocrine gland secretions (sweat, salivation, bronchi, gastric) eye – miosis, contract ciliary muscle (near) heart – bradycardia (slow heart rate) vascular smooth muscle – dilation – hypotension *NMJ – increase muscle contraction Main sites of action: cholinesterase enzyme Therapeutic use: myasthenia gravis Administration: s.c., IM, IV Adverse effects:hypotension, bradycardia, excessive salivation, abdominal cramps, diarrhea, fainting (syncope) |
|
|
phenylephrine
|
Adrenergic agonists (sympathomimetics)
Mechanism of action: alpha1 agonist Pharmacological effects: vasoconstriction of veins, arterioles pupil dilation Main sites of action: blood vessels Therapeutic use: nasal- ↓ congestion by constricting blood vessels in nasal mucosa; constricts blood vessels to reduce hypotension; dilate pupil during examination Administration: intranasal, opthalmic, IM, s.c., IV Adverse effects: burning of nasal mucosa, reflex bradycardia anxiety, restlessness, tremor Contraindicated in patients with: glaucoma, heart disease Drug-drug interactions: MAO inhibitors (hypertensive crisis), tricyclic antidepressants, alpha-blockers, beta-blockers, oxytocin, digoxin (cause arrhythmia) |
|
|
clonidine
|
Mechanism of action: alpha2 agonist
Pharmacological effects: no significant peripheral effects in CNS ↓ sympathetic flow to heart and blood vessels treat hypertension Pharmacological effects: contraction of heart Main sites of action: heart Therapeutic use: heart failure (improve cardiac performance), shock (condition causes hypotension – increase HR and contract force to increase blood supply) Administration: intracardiac, IV Adverse effects: tachycardia, arrhythmia |
|
|
albuterol (Proventil, Ventolin)
|
Adrenergic agonists (sympathomimetics)
Pharmacological effects: bronchodilation relaxes uterine smooth muscle Main sites of action: lungs, uterus Therapeutic use: asthma, premature labor (ritodrine, Yutopar) Administration: inhalation Main sites of action: lungs, uterus Therapeutic use: asthma, premature labor (ritodrine, Yutopar) Administration: inhalation Adverse effects: if using non-selective beta2 agonist (epinephrine), then be aware of beta1 actions on heart (contraindicated in heart conditions) – use selective beta2, inhalation |
|
|
prazosin
|
Adrenergic antagonists
Pharmacological effects: vasodilation (arterioles and veins) decrease peripheral resistance decrease blood pressure Main sites of action: blood vessels Therapeutic use: hypertension Administration: p.o. Adverse effects: orthostatic hypotension (start with low doses, give at bedtime) dizziness, drowsiness reflex tachycardia nasal congestion inhibition of ejaculation Drug-drug interactions: alcohol, antihypertensives, diuretics |
|
|
atenolol (Tenormin)
|
Adrenergic antagonists
Mechanism of action: beta1 antagonist Pharmacological effects: reduce heart rate reduce force of contraction reduce velocity of conduction through AV node Main sites of action: heart Therapeutic use: hypertension, angina, “stage fright” Administration: p.o. Adverse effects and contraindications: bradycardia insufficient tissue perfusion conduction in heart (AV block) if withdrawn abruptly, rebound cardiac excitation (arrhythmia, angina) |
|
|
propranolol (Inderal)
|
Adrenergic antagonists;
Mechanism of action: beta1 and beta2 antagonist (b-blocker)**** Pharmacological effects: reduce heart rate (beta1) reduce force of contraction (beta1) reduce velocity of conduction through AV node (beta1) broncoconstriction (beta2) Main sites of action: heart Therapeutic use: hypertension, angina, cardiac dysrhythmias, “stage fright” Administration: p.o. Adverse effects: bradycardia bronchoconstriction CNS effects (depression, insomnia, nightmares, hallucinations) Contraindicated for: heart failure, patients with pre-existing AV block * don’t abruptly stop taking – rebound tachycardia |
|
|
Epinephrine
|
non-selective drugs
binds to and activates all adrenergic receptors. Although mainly used for its ability to activate b1 receptors and get the heart pumping, what else will it do? b1 agonist activity – ↑ HR, ↑ force of contraction, ↑ AV conduction b2 agonist activity – dilate bronchi a1 agonist activity - vasoconstriction adverse effects: too much stimulation of heart (tachycardia, arrhythmias, angina) - can give some atenolol/propranolol to slow heart severe hypertension - can give a1 blocker/antagonist to decrease BP |
|
|
Isoproterenol (Isuprel)
|
b1 and b2 agonist
|
|
|
Human chorionic gonadotropin (hCG)
|
similar effect to LH increases testosterone and sperm production
|
|
|
Menotropin (Pergonal)
|
mixture of follicle stimulating hormone (FSH) and luteinizing hormone (LH)
|
