Pharm Test 1, Note Set 3

Front 1

Neuropharmacology

Back 1

Majority of drugs exert their effects by altering neuroreceptors (except hormones or anti-infectives)

Front 2

T/F: A drug's ability to directly/indirectly influence receptor activity on target cells is independent of the impact of a drug on a neuronally regulated process

Back 2

F: It is dependent

Front 3

Sympathetic nervous system functions

Back 3

Regulates CV system, body temp, "fight-or-flight"

Front 4

Acetylcholine (Ach)

Back 4

Preganglionic, sympathetic

Front 5

Norepinephrine (Epinephrine-Adrenalin)

Back 5

Postganglionic, sympathetic
Released in quanta from presynaptic vesicles

Front 6

Adrenergic

Back 6

Similar effects to epinephrine

Front 7

Sympathomimetic

Back 7

Acts like sympathetic

Front 8

Catecholamines

Back 8

Hormones produced by adrenal glands

Front 9

COMT (Catechol-O-methyl transferase)

Back 9

Catalyzes catecholamines

Front 10

MAO (monamine oxidase)

Back 10

Inactivate catecholamines

Front 11

Fight or flight rxn is triggered by:

Back 11

Epinephrine

Front 12

Flight or flight causes:

Back 12

Dilation of vessels in heart, lungs, muscles; bronchodilation; glycogenolysis
Uterine relaxation; mydriasis (pupil dilation)
Constrict vessels to skin, viscera, MM
Increased heart rate, force of contraction

Front 13

Direct acting adrenergic agonists

Back 13

Actually stimulates receptor

Front 14

Indirect acting adrenergic agonists

Back 14

Stimulates release, or blocks reuptake or metabolism of NT = increase concentration of NT at synapse

Front 15

Mixed-acting acting adrenergic agonists

Back 15

Both direct/indirect

Front 16

Tachyphylaxis acting adrenergic agonists

Back 16

Reduced response on repeated dosing
NT released in quanta w/ each dose, more released - can deplete supply = less NT available w/ each dose
Drugs: phenylephrine, oxymetazoline

Front 17

Chrontropic

Back 17

Affects heart rate

Front 18

+ chrontropic

Back 18

Increased heart rate

Front 19

- chrontropic

Back 19

Decreased heart rate

Front 20

Inotropic

Back 20

Affects force of contraction of heart

Front 21

+ inotropic

Back 21

Increase force of contraction

Front 22

- inotropic

Back 22

Decrease force of contraction

Front 23

Epinephrine

Back 23

Non-specific adrenergic agonist
Affects all adrenergice receptors

Front 24

Epinephrine therapeutic effects:

Back 24

Vasoconstriction = increased BP
+ chronotropic = increased HR
Bronchodilation
+ inotropic

Front 25

Epinephrine uses:

Back 25

Cardiac arrest
Shock
Asthma
Anaphylactic shock

Front 26

Epinephrine routes:

Back 26

IV, ET, SQ, IM, inhaled, SQ infiltration

Front 27

T/F: it is very important to know the IV epi concentration

Back 27

T: 1 mL of 1:1,000 = 10 mL of 1:10,000

Front 28

Epinephrine adverse effects:

Back 28

Hypertension
Tachycardia, dysrhythmias
Angina
Necrosis if extravasates (leaks out of IV)
Hyperglycemia
CNS stimulation

Front 29

Epinephrine interactions

Back 29

MAO inhibitor = hypertension
General anesthetics = increased dysrhythmias
Adrenergic blockers (alpha/beta) = reduced effects
Non-selective beta blockers - alpha effects dominate = severe HTN

Front 30

Epinephrine nursing implications:

Back 30

Monitor BP, pulse, cardiac rhythm, lung sounds
IV infusion
Watch IV site, if pt cold/pale DC IV
Watch site of local anesthetic for blanching
Inform client they may feel nervous/shaky

Front 31

Norepinpehrine (Levophed)

Back 31

Potent alpha agonist, little Beta 2 activity, some Beta-1
Used IV ONLY for shock via pump
Very potent vasoconstrictor
Same effects as epi

Front 32

Ephedrine

Back 32

Indirect acting and mixed acting adrenergic agonist
Used IV to increase BP
PO as decongestant

Front 33

Phenylephrine

Back 33

Indirect acting and mixed acting adrenergic agonist
IV to increase BP
Nasal spray for decongestant
Opthalmic for mydriasis

Front 34

Pseudoephedrine

Back 34

Indirect acting and mixed acting adrenergic agonist
PO as decongestant

Front 35

Oxymetazoline

Back 35

Indirect acting and mixed acting adrenergic agonist
Nasal spray as decongestant

Front 36

Adverse effects of indirect acting and mixed acting adrenergic agonist

Back 36

CNS stimulation (restlessness)
HTN, tachycardia
Tachyphylaxis w/ multiple dosing

Front 37

Nursing implications for indirect acting and mixed acting adrenergic agonist

Back 37

Monitor BP for hypotension
Teach: avoid use in HTN, cardiac disease, prolonged use
Herbal products that contain ephedra (Ma Huang, Ephedra)

Front 38

Major effect of alpha adrenergic antagonists (AAA) (blockers):

Back 38

Vasodilation

Front 39

Major use of AAA:

Back 39

HTN

Front 40

Adverse effects of AAA:

Back 40

Orthostatic hypotension
Reflex tachycardia
Nasal congestion
Inhibit ejaculation

Front 41

Phentolamine (Regitine)

Back 41

Non-selective alpha blocker
Few uses d/t nonselective blockade and severe hypotension

Front 42

Alpha-1 blocker effects:

Back 42

Relax smooth muscle; vascular and at bladder neck, prostate capsule
None on cholesterol, CO, HR
Reduces afterload
Increased plasma volume = edema
1st dose effect = severe postural hypotension

Front 43

Alpha-1 blocker uses:

Back 43

HTN
Reduce urinary retention in prostatic hypertrophy

Front 44

Alpha-1 blocker nursing implications:

Back 44

Teach how to take
Teach re postural hypotension, start at lower doses at night
Teach to rise slowly
Monitor BP, edema

Front 45

Prazosin (Minipress)

Back 45

HTN
Terazosin/Doxazosin = used for HTN an BPH
Tamsulosin (Flomax)/Alfulzosin (Uroxatral) = more selective for bladder neck, urethra, less effect on BP, more for BPH

Front 46

Beta-1 stimulation

Back 46

Beta adrenergic agonist
+ chronotropic
+ inotropic
Increase A-V conduction
Renin released from kidney

Front 47

Desired effects of beta-1:

Back 47

Increased heart rate in cardiac arrest
Increased force of contraction = heart failure, treat shock
Increased A-V conduction = heart block

Front 48

Undesired effects of beta-1:

Back 48

Tachycardic
Dysrhthmias
Angina pectoris (d/t increased cardiac work)

Front 49

Beta-2 stimulation

Back 49

Bronchodilation
Uterine relaxation
Glycogenolysis

Front 50

Beta-2 stimulation desired effects:

Back 50

Bronchodilation = asthma, COPD
Delay of labor

Front 51

Beta-2 stimulation undesired effects:

Back 51

Hyperglycemia = diabetics
Delay of labor at full term
Tremor

Front 52

Dopamine (intropin)

Back 52

Mixed alpha and beta-1
+ chronotropic
+ inotropic
Increases CO w/ minimal increase in myocardial O2 consumption

Front 53

Dopamine effects on adrenerginc receptors in dose-dependent fashion

Back 53

Low dose = effects dopamine receptors = dilate renal and mesenteric vessels
Moderate dose = affects beta-1 receptors = increase HR and contractility; some increase BP
High dose = affects alpha receptors = increase BP, vasoconstriction

Front 54

Dopamine uses

Back 54

Treat hypotension in shock
Severe CHF or cardiogenic shock = improve contractility

Front 55

Dopamine nursing implications

Back 55

Monitor:
Arterial BP, CO
IV site for extravasation
Administer IV via pump only
Cardiac monitoring
Urine output for renal function

Front 56

Dobutamine (Dobutrex)

Back 56

Similar to dopamine
Used in heart failure to improve cardiac contractility

Front 57

Dobutamine adverse effects

Back 57

Tachycardia
Angina d/t increased cardiac work

Front 58

Dobutamine nursing implications

Back 58

Monitor BP, cardiac rhythm, CO
Administer via IV pump

Front 59

Bronchodilators

Back 59

Non-specific beta adrenergic agonists

Front 60

Metaproterenol (Metaprel)

Back 60

Bronchodilator
Used for bronchodilation in asthma by metered-dose or nebulizer

Front 61

Adverse effects of metaproterenol

Back 61

Tachycardia and tremor
Used much less d/t beta-1 stimulation

Front 62

Nursing implications for metaproterenol

Back 62

Monitor lung sounds and pulse
Teach proper use of MDI, when, how to use
Teach to contact HCP if ineffective (do not overuse)

Front 63

Selective beta agonists

Back 63

Goal = therapeutic effects w/ fewer adverse effects

Front 64

Types of Beta-2 agonists

Back 64

Albuterol (PRoventil, Ventolin)
Bitolterol (Tornalate)
Pirbuterol (Maxair)
Levalbuterol (Xopenex)
Long acting:
Salmeterol (serevent)
Formoterol (Foradil)
Indacaterol (Arcapta)
Oral:
Albuterol
Terbutaline (Brethine)

Front 65

Beta-2 agonists teaching:

Back 65

Proper use of inhalers
Use short-acting for acute ashtma, long-acting for maintenance
Do not over-use inhaler!! (increased asthma deaths)
Terbutaline can be PO/IV, also used to suppress premature labor

Front 66

Beta adrenergic antagonists

Back 66

May reduce sympathetic activity in brain vasomotor center
Reduced sympathetic stimulation of beta receptors on arterioles
May reduce renin = reduce angiotensin II
Reduce:
HR = slow AV conduction velocity
Force of contraction
BP, dilate coronary arteries

Front 67

Beta adrenergic antagonists uses:

Back 67

HTN, angina, dysrhythmias
Control HR in pheochromocytoma
Prevent migraines/ "vascular headaches"
Glaucoma
Sympathetic blockade (prevent "stage fright")

Front 68

Beta adrenergic antagonists adverse effects:

Back 68

Bradycardia, CHF, bronchospasm
Mask symptoms of hypoglycemia in diabetics
Blocks glycogenolysis
Depression, impotence
Lowers HDL
Increase cholesterol and triglycerides

Front 69

Beta adrenergic antagonists nursing implications:

Back 69

Monitor BP; hold for systolic <100
Monitor pulse: hold for pulse <60
Watch for s/s CHF = edema, fluid in lungs
Teach! How to take, monitor BP, report adverse effects
Diabetics: monitor BG, watch for OTHER signs of hypoglycemia

Front 70

Nonselective (beta 1 and 2 effects) contraindicated w/ asthma and COPD

Back 70

Propranolol (inderal)
Timolol (Blocadren)
Pindolol (Visken)
Carteolol (Cartrol)

Front 71

Cardioselective

Back 71

Beta-1 blockers only
Safer w/ COPD, asthma, diabetics
Lose selectivity at high doses

Front 72

Cardioselective drugs:

Back 72

Metoprolol (Lopressor, Toprol)
Atenolol (Tenormin)
Acebutolol (Sectral)
Esmolol (Brevibloc)

Front 73

Labetolol (Normodyne, Trandate)

Back 73

Beta and alpha-1 blocker
Used IV in HTN crisis