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64 Cards in this Set

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Selectively stimulates beta2 receptors to cause bronchodilation and alleviate bronchospasms in COPD (asthma, emphysema). Given PO, by inhaler or aerosol. By prescription.

albuterol
(Proventil):
Stimulates beta2 receptors. Used for bronchodilation to relieve bronchospasms caused by COPD and also used to slow or stop contractions in pre-term labor. PO, SC. By prescription.
terbutaline
(Brethine)
Stimulates alpha1 receptors. Can be given parenterally to treat acute hypotensive states. Mostly used to produce nasal mucosal vasoconstriction to relieve nasal stuffiness caused by colds and allergies. Is found in PO OTC cold and allergy preparations.
phenylephrine HCL
(Neo-Synephrine)
(in OTC cold remedies): Primarily stimulates alpha1 receptors. Slightly stimulates beta1 receptors. Produces nasal mucosal vasoconstriction to relieve nasal stuffiness caused by colds and allergies. OTC. PO.
psuedoephedrine
1) phenylephrine HCL
(Neo-Synephrine)

2) psuedoephedrine

3) terbutaline
(Brethine)

4) albuterol
(Proventil)
Sympathetic Amines
Non-catecholamines)
1)epinephrine (Adrenaline)

2) norepinephrine (Levophed)

3) dopamine (Intropin)

4) dobutamine (Dobutrex)
Direct-Acting (Catecholamines)
the endogenous substances norepinephrine, epinephrine and dopamine
Catecholamines
Stimulates alpha1, beta1 and beta2 receptors.
Usually used for bronchospasms. The beta2 stimulation causes bronchodilation. Can be given for cardiac standstill. The beta1 stimulation can initiate cardiac contractions. The stimulation of alpha1 and beta1 receptors can cause the adverse effects of increaased heart rate and BP. Can be given IM, IV, SC, and by inhalation
epinephrine (Adrenaline)
Stimulates alpha1 and beta1 receptor sites. Used for severe hypotension due to cardiac causes. Can compromise renal, visceral and peripheral blood flow by vasoconstricting the arterioles too much. IV only.
norepinephrine (Levophed)
Stimulates dopaminergic, alpha1 and beta1 receptors. Used for acute hypotensive states. Increases peripheral vasoconstriction while vasodilating the vessels supplying blood to the major organs. Can be used to improve renal perfusion due to the vasodilation of the renal arteries. Increases cardiac output. IV use only.
dopamine (Intropin)
Stimulates beta1 receptors. Increases cardiac output by increasing the force of the cardiac contraction and slightly decreases peripheral vascular resistance. Used for cardiogenic shock; not hypovolemic shock. IV use only.
dobutamine (Dobutrex)
1) albuterol (Proventil)

2) terbutaline (Brethine)

3) phenylephrine HCL (Neo-Synephrine)

4) psuedoephedrine (in OTC cold remedies)
Sympathetic Amines
(Non-catecholamines)
1) isoxsuprine (Vasodilan)

2) doxazosin mesylate (Cardura)

3) phentolamine mesylate (Regitine)
Examples of Alpha1 Adrenergic Blockers
1) Propranolol HCL (Inderal)

2) Metoprolol (Lopressor, Toprol XL)

3) Timolol Opthalmic Drops (Timoptic)
Examples of Beta Adrenergic Blockers are
Blocks beta1 & beta2 receptors. Used for tachycardia, hypertension and coronary artery disease. Can cause bronchoconstriction due to beta2 receptor blocking action. Use cautiously in COPD. PO.
Propranolol HCL (Inderal)
Blocks beta1 receptors. Used for hypertension and coronary artery disease. Acts only on the heart with low to moderate doses. Can cause bronchoconstriction at high doses. PO.
Metoprolol (Lopressor, Toprol XL)
Blocks beta1 receptors. Used for open-angle glaucoma
Timolol Opthalmic Drops (Timoptic)
agents slow the heart rate, decrease blood pressure through vasodilation and decreased release of renin from the kidneys. The force of the cardiac contraction is decreased. They are useful in the treatment of tachycardia, hypertension and coronary artery disease. Like alpha adrenergic blockers, by decreasing the force of the cardiac contraction, certain clients can be predisposed to congestive heart failure.
Beta Adrenergic Blockers
Stimulates urination and increases gastric motility. Used post-operatively, post partum or in neurological disorders that decrease peristalsis or bladder tone. PO, SC. Direct-acting
bethanechol (Urecholine):
Used for Alzheimer’s Disease. Alzheimer’s Disease is thought to be partially caused by a lack of acetylcholine. PO. ACE-inhibitor
donepezil (Aricept)
1. Dry mouth likely to occur.

2. Dehydration possible.

3. Constipation possible. Advise client to increase fluid and fiber intake.

4. Urinary retention possible. Use cautiously in clients with enlarged prostates.

5. Intra-ocular pressure can increase. Use very cautiously in clients with glaucoma.

6. Blurry vision can occur.
Nursing Considerations for Parasympatholytics
These drugs inhibit the action of acetylcholine by competing with it for space on the acetylcholine receptors. These drugs have the opposite effect of the cholinergic agonists. The heart rate increases, bronchodilation occurs, bronchial secretions decrease, salivation is decreased, gastro-intestinal motility and gastric acid secretion are decreased, bladder tone is decreased and urinary sphincter tone is increased. Intra-ocular pressure is increased.
Cholinergic Antagonists (Anticholinergics/Parasympatholytics)
Used to treat the tremors of Parkinson’s Disease and Parkinson-like syndromes. There are many anti-dopaminergic drugs that can induce a Parkinson-like syndrome. PO, IM, IV.
benztropine mesylate (Cogentin)
Used for bronchodilation. Inhaler, aerosol, intra-nasal
ipratropium bromide (Atrovent)
gamma aminobutyric acid (GABA)
serotonin
norepinephrine
dopamine and acetylcholine
CNS neurotransmitters affected by pharmacotherapy
raise the seizure threshold by inhibiting excitatory activity in the motor cortex of the brain
ANTI-SEIZURE AGENTS (Anti-Convulsants)
1) suppression of sodium influx
2) suppression of calcium influx or
3) potentiation of gamma aminobutyric acid (GABA) in the brain
Anti-seizure drugs exert a therapeutic effect through one of three mechanisms
These agents exert their pharmacological effect by potentiating GABA and decreasing the conduction of impulses in the ascending reticular formation of the brain. They are used for generalized and partial seizures. These drugs are sedating
Barbituates
These agents exert their pharmacological effect by potentiating GABA and inhibiting impulses subcortically in the limbic system, thalamus and hypothalamus
Benzodiazepines
suppressing sodium and calcium influx and by potentiating GABA. They can also be used for bipolar disorder and for prophylaxis of migraine headaches. Moderately hepatotoxic. Liver enzymes must be drawn on a regular basis. Minimally sedating. They are used very cautiously in children and the elderly.
Valproic Acids
Valproic Acids
valproic acid
divalproex sodium (Depakote)
When given parenterally, causes CNS depression, smooth muscle and skeletal muscle depression. Used to control seizures in eclampsia that can occur during late pregnancy
magnesium sulfate
depression is thought to be a depletion of the neurotransmitters serotonin, dopamine and norepinephrine. Depletion of these neurotransmitters is thought to occur due to excessive reuptake or by excessive breakdown by monoamine oxidase (MAO)
ANTI-DEPRESSANTS
The enzyme monoamine oxidase (MAO) breaks down the serotonin, norepinephrine and dopamine. They are very effective but have many drug-drug and food-drug (tyramine-rich foods) interactions that can raise BP to dangerous levels. Avoid Tyramine-rich foods.
Monoamine Oxidase Inhibitors (MAOIs)
produce CNS depression by potentiating GABA and inhibiting impulses subcortically in the limbic system, thalamus and hypothalamus
BENZODIAZEPINES
These drugs also potentiate GABA. They have less residual effect and are thought to cause less physiological and psychological dependence than benzodiazepines. However, they are controlled substance schedule IV (CSS IV).
NON-BENZODIAZEPINE SOMNIFACIENTS
increase the force of the cardiac contraction by:
1) increase the movement of calcium ions across the myocardial cell membranes. Calcium is directly involved in muscle contraction
2)increase the concentration of catecholamines in the myocardium
3)inhibition of the enzyme phosphodiesterase
Improved cardiac output will increase renal perfusion and urine output.
Positive Inotropic Agents
increases movement of calcium ions across the myocardial cells. slow impulses through the electrical conduction system (negative dromotropic effect) which will slow the heart rate (negative chronotropic effect).has an affinity for the same receptor sites as potassium. will cause toxicity. Hypercalcemia will potentiate the effects of while hypocalcemia will decrease its effects.
digoxin (Lanoxin)
Stimulates beta1 adrenergic receptors. Used in severe CHF
dobutamine (Dobutrex)
Stimulates beta1 adrenergic receptors. Might be used in cardiogenic shock.
dopamine (Intropin)
relaxes vascular smooth muscle.
nitroglycerine (NTG)
Vasodilators decrease peripheral vascular resistance by relaxing the vessel walls. Arterial vasodilation is usually the aim of pharmacotherapy with vasodilators. Venous dilation also occurs with many of these drugs. There are several classifications of vasodilators.
Vasodilators
1. Can vasodilate cerebral arteries resulting in headache, dizziness or syncope.
2. Instruct the client to move from a lying to a standing position slowly to avoid ↓ BP.
3. Nitroglycerine tablets are administered sublingually.
4. Nitroglycerine tablets must be kept in a dry, dark container to prevent deterioration.
5. Remove old nitroglycerine paste and transdermal patches before applying new ones.
Nursing Considerations
Vasodilators
This classification of drugs is sympatholytic. They block the alpha1 adrenergic receptors resulting in vasodilation. Renal blood flow is augmented. They decrease very low-density lipoprotein (VLDL), low-density lipoprotein (LDL) and increase high-density lipoprotein (HDL).
Alpha Adrenergic Blockers
Examples of Alpha1 Adrenergic Blockers
doxazosin mesylate (Cardura)
prazosin HCL (Minipress)
terazosin (Hytrin)
1. Can cause orthostatic hypotension, especially at the beginning of therapy. Hypotension can cause headache, dizziness and/or syncope. Best to schedule these drugs at bedtime.
2. Can cause tachycardia due to sudden drop in blood pressure.
3. Can cause sodium and water retention resulting in edema. Diuretics may be added to treatment plan.
4. Can decrease myocardial contractility which can predispose client to heart failure.
5. Can cause nasal stuffiness due to nasal vasodilation.
6. Can cause GI disturbances.
Nursing Considerations:
Alpha1 Adrenergic Blockers
sympatholytic. also reduce renin release from the kidneys. Renin is the precursor to angiotensin which is a potent vasoconstrictor.
Beta Adrenergic Blockers
metoprolol (Lopressor, Toprol)*
Beta Adrenergic Blockers
Selective
propranolol HCL (Inderal)
Beta Adrenergic Blockers
Non-Selective
1. Can cause hypotension resulting in headache, dizziness and syncope.
2.Often causes bradycardia.
3.Can cause fatigue.
4.Those agents that block beta2 can cause bronchoconstriction with wheezing.
5. Can decrease myocardial contractility which can predispose client to heart failure.
Nursing Considerations
Beta Adrenergic Blockers
These drugs are sympatholytic on both the alpha1 and beta1 receptors.
Alpha1 and Beta1 Adrenergic Blockers
1. Can cause orthostatic hypotension.
2. Can cause fatigue.
Nursing Considerations:
Alpha1 and Beta1 Adrenergic Blockers
drugs inhibits the influx of calcium ions into the myocardium and the smooth muscle cells. A reduction of free calcium in the smooth muscle cells decreases peripheral vascular resistance and promotes vasodilation. *African - Americans often respond to calcium channel blockers better than beta-adrenergic blockers
Calcium Channel Blockers
1.Can cause hypotension resulting in headache, dizziness and syncope.
2.Can cause bradycardia.
3.Grapefruit and grapefruit juice should be avoided. The presence of grapefruit in the body can raise the levels of calcium channel blockers to toxic levels.
4. Can decrease myocardial contractility which can predispose client to heart failure.
Nursing Considerations
Calcium Channel Blockers
The Renin-Angiotensin System The enzyme responsible for converting angiotensin I to angiotensin II is blocked. Aldosterone release by the adrenal cortex is reduced which promotes sodium and water excretion. However, by decreasing aldosterone release from the adrenal cortex, potassium is retained. This could result in hyperkalemia, especially for clients with renal insufficiency. Giving a diuretic along with an ace-inhibitor is often indicated.
Angiotensin - Enzyme Converting Inhibitors (ACE Inhibitors
This classification of drugs selectively blocks the binding of Angiotensin II to specific tissue receptors found in the vascular smooth muscle and the adrenal glands. This blocks the vasoconstricting effect of Angiotensin II as well as diminishing the release of aldosterone which promotes sodium and water excretion. Hyperkalemia can occur.
Angiotensin II Receptor Blockers (ARBs)
Vitamin K (Aqua Mephyton)
antidote for coumarins
Diuretics: Loop (High-Ceiling. Act on the proximal and distal tubules and the Loop of Henle in the kidney. They are sometimes referred to as high-ceiling diuretics.more potent than thiazide or thiazide-like diuretics and are indicated when a large fluid loss is desired. They can also be used to treat hypercalcemia or to stimulate urine output in renal insufficiency.Glucose and uric acid can be increased.
furosemide (Lasix)
1.Administer in the morning to avoid urination during the night if taken on a daily basis. May be given at any time in urgent or emergency situations.
2. Monitor urine output. Diuresis should occur within 10 - 20 minutes after IV administration. If diuresis is inadequate after 1 hour, dosage should be repeated.
3. Monitor for drop in blood pressure.
4. Monitor weight. Weigh early in the morning. Be alert to a gain of more than 2 pounds in a day.
5. Monitor for dehydration.
Nursing Considerations
Examples of Loop Diuretics
Anitdonte for Benzodiazapines. No antagonists are known to counteract the effects of barbiturates or other sedative-hypnotic drugs
Romazicon
Antidone for Opioids
Narcon
Antidote for norepinephrine (Levophed) and dopamine.
phentolamine mesylate (Regitine)
Antidote for Heparine
Protamine
Antidote for Coumadin
Vitamin K