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211 Cards in this Set
- Front
- Back
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What is the nonselective adrenergic agonists
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epinephrine, norepinephrine
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what is the alpha-1 adrenergic agonists
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phyenlephrine, methoxamine
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what is the alpha-2 adrenergic agonist
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chonidine
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what are the beta adrenergic agonists
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dopamine
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what is the dopaminergic agonist
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fenoldopam
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what is the alpha-adrenergic antagonists
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prazosin (P), alfuzosin, doxazosin, tamsulosin, terazosin
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what are the beta-adrenergic antagonists
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propranolol (P) anything that ends with olol r lol
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what does the ANS do
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involuntary control of the smooth muscle
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what are the neurotransmitters in the ANS
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acetylcholine, norepinephrine and epinephrine
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how does a neuropharmacologic drug work
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by increasing or decreasing receptor activation in the ANS
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in the SNS what mediates the pre and postganglionic transmission
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acetylcholine mediates preganglionic transmission and postganglionic is mediated by nerepinephrine
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what do alpha-1 receptors respond to and where are they located
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they respond to epinephrine, norepinephrine, and dopamine and they are located throughout the body
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what do alpha-2 receptors respond to and where are they located
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they respond to epinephrine and NE and are located throughout the body
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what do beta-1 receptors respond to and where are they located
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they respond to epinephrine, NE, and dopamine and are located in the heart
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what do beta-2 receptors respond to and where are they located
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they respond only to epinephrine and are located in the lungs
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what is the most frequent use for adrenergic agonists
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shock - the result of inadequate tissue perfusion, leaving the cells without the oxygen and nutrients they need to function normally and survive. Many types of shock.
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what are the two groups of adrenergic agonists drugs
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catecholoamines and noncatecholamines
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What is the difference between catecholoamines and noncatecholamnies
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catacolomines have a short duration of action so they have to be given with an IV, they can't be given orally and the don't cross the blood-brain barrier. Noncatecholamines do the opposite
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how are the adrenergic agonists classified
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their selectivity. nonselective-acting drugs stimulate both alpha and beta receptors. selective acting drugs target a specific receptor
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what are the pharmacotherapeutics of epinephrine
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many things, asthma shock ect.
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what are the pharmacokinetics for epinephrine
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Administered: parentally, topically, or inhaled. Absorbed into the tissues.
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what are the pharmacodynamics of epinephrine
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effects all adrenergic receptors and has adverse effects on cardiovascular system and CNS
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what are the contraindications and precautions of epinephrine
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sulfite sensitivity, closed angle glaucoma and its use during labor
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what are the adverse effects of epinephrine
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hypertensive crisis, angina, cerebral hemorrhage and cardiac arrhythmia
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what are the drug interactions of epinephrine
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tricyclic antidepressants, oxytocics, halogenated anesthetics and beta blockers
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what should you do to educate a person on epinephrine
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keep it simple and non-complex because they are acutely ill
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what are alpha-1 adrenergic agonists
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drugs that stimulate the alpha-1 receptor directly
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What is the pharmacotherapeutics for Phenylephrine
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Used parentally for vascular failure in shock. Used topically for relief of nasal and nasopharyngeal mucosal congestion
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what are the pharmacokinetics of Phenylephrine
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Given parenterally or topically and has is apparent within 15-20 minutes and lasts for 1 to 2 hours
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what are the contraindications and precautions of Phenylephrine
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sulfite-sensitivity, severe hypertension, ventricular tachycardia and closed-angle glaucoma
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what are the adverse effects of phenylephrine
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headache, restlessness, excitability and the reflex bradycardia
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what are the drug interactions of Phenylephrine
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monoamine oxidase inhibitors, tricyclic antidepressants and oxytocics used in labor
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how do you maximize the effects and minimize adverse effects of phenylephrine
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correct any blood losses prior to administration
IV through large vein, avoid driving at night because of blurred vision |
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what are the pharmacotherapeutics of dopamine
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used to correct the hemodynamic imbalances present in shock and many heart problems
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what are the pharmacokinetics of dopamine
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Onset is within 5 minutes and duration is less than 5 minutes. Distribution is throughout tissues. Metabolism is in kidney, liver, and plasma
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what are the pharmacodynamics of dopamine
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It is a pre-cursor to norepinephrine. It stimulates alpha-1 and beta-1 receptors (through direct methods and indirectly through the release of stored epinephrine), this increases the cardiac output
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what are the contraindications and precautions of dopamine
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pheochromocytoma, uncorrected tachyarrhythmias, and ventricular fibrillation and ventricular fibrillation
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what are the adverse effects of dopamine
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ectopic beats, nausea and vomiting, tachycardia, angina, palpitation, dyspnea, headache
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what are the drug interactions of dopamine
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guanethidine, halogenated hydrocarbon anestertics, methyldopa, monoamine oxidase inhibitors, oxytocic drugs, phenytoin, tricyclic antidepressants
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how do you maximize the therapeutic effects and minimize the adverse effects of dopamine
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administer using an infusion pump to regulate flow and titrate dose to desired effect
monitor IV site. Assess for disproportionate rise in diastolic blood pressure |
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where should dopamine be environment
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in acute care setting because it is an IV drug
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what dopamine receptors mediate responses in the adrenergic nervous system
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dopamine-1 and dopamine-2
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what are the pharmacotherapeutics for Fenoldopam
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Short-term management of sever hypertension
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what happens when you stimulate DA1 and DA2
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peripheral vasodilation
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what are the pharmacokinetics of fenoldopam
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administered: parenterally. Metabolism: by conjugation Steady state: 20 minutes
excreted in urine and feces |
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What are the Pharmacodynamics of fenoldopam
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selective peripheral DA1 agonist.provides rapid vasodilation to the coronary, renal, mesenteric, and peripheral arteries
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what are the contraindications and precautions of fenoldopam
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hypersensitivity to sulfites
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what are the adverse effects of fenoldopam
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symptomatic hypotension, tachycardia, abdominal or back pain, GI effects, sweating, and CNS effects, such as insomnia, dizziness, nervousness, or anxiety
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what are drug interactions of fenoldopam
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beta blocker and diuretics
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where should fenoldopam be administered
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in the acute care hospital setting.
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how do you maximize therapeutic effects and minimize adverse effects
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dilute with .9% sodium chloride or 5% dextrose. administered using an infusion pump. titrate dose to effect.
start at low doses and titrate up |
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What are the 3 subtypes of Alpha-1 receptors
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alpha-1a, alpha-1b, and alpha-1d.
Alpha-1a - mediate human prostatic smooth muscle contraction alpha1-b and 1-d involved in vascular smooth muscle contraction. |
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what are the prazosin pharmacotherapeutics
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used to treat congestive heart failure, raynaud vasospasm, and prostatic outflow obstruction
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what are the pharmacokinetics of prazosin
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it is given orally and excreted in bile, feces, and urine. It crosses the placenta and may enter breast milk
Onset: 1 hour Duration: 10 hour |
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what are the pharmacodynamics of prazosin
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selectively blocks postsynaptic alpha-1 adrenergic receptors, lowers supine and standing blood pressure
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what are the contraindications and precautions of prazosin
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hypersensitivity and angina because hypotension can worsen
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what are the adverse effects of prazosin
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light-headness, dizziness, headache, drowsiness, weakness, lethargy, nausea, and palpitations
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what are the drug interaction of prazosin
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antihypertensive medications
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how do you maximize and minimize therapeutic and adverse effects
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take the first dose just before bedtime, monitor weight and check for edema
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olol ending in a drug indicates what
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beta blocker
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What happens if a beta blocker stimulates beta-1 only
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tachycardia, increased lipolysis, inotropy
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What happens if a beta blocker stimulates beta-1 and beta-2
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vasodilation, decreased peripheral resistance, bronchodilation
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what are the pharmacotherapeutics of Propranolol
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Used in treatment of hypertension, angina, irregular cardiac rhythms, paroxysmal atrial tachycardias pheochromocytoma and migrane
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what are the pharmacokinetics of propranolol
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Administered: parenterally and orally
Onset and duration varies on route of administration |
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what are the pharmacodynamics of propranolol
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decreased cardiac output and blood pressure
Slower of atrioventricular conduction and suppression of automaticity |
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what are the contraindication and precautions propranolol
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sever bradycardia, cardiogenic shock, airway diseases, raynaud syndrome, and use of antidepressant drugs
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what are the adverse effects of propranolol
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cognitive dysfunction, hypoglycemia, diarrhea, and weight gain
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what are the direct acting muscarinic agonists
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pilocarpine (P) carbachol
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What are the direct acting nicotinic drugs
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nicotine
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what are the indirect acting cholinergic agonists
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neostigmine
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what are the cholinergic antagonists
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atropine
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what are the presynaptic and postsynaptic neurotransmitters in the PNS
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Acetylcholine
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what are the cholinergic receptors
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nicotinic (nicotinic-n and nicotinic-m) and muscarinic
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what happens when there is activation of nicotinic-n receptors in the adrenal medulla
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release of epinephrine
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what happens when there is stimulation of nicotinic-m receptors
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skeletal muscle contractions
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what happens when there is stimulation of the muscarinic receptors
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vasodilation resulting in decreased blood pressure
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what are the pharmacotherapeutics of pilocarpine
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Used for open-angle glaucoma, angle-closure glaucoma, induction of miosis
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what are the pharmacokinetics of pilocarpine
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Administered: topically or orally
Onset: depends on route of administration |
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what are the pharmacodynamics of pilocarpine
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it stimulates the cholinergic receptors and produces miosis. It also stimulates secretions of the exocrine glands which increases salivary flow
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what are the contraindications and precautions of pilocarpine
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retinal detachment and airway disease
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what are the adverse effects of pilocarpin
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Ocular: stinging and burning, tearing and ciliary spasm
Oral: hypertension, tachycardia, bronchiolar spasm, pulmonary edema, salivation and sweating and nausea and vomiting |
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what are the two classes of nicotinic stimulants
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ganglionic stimulants and neuromuscular nicotinic stimulants
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what are the pharmacotherapeutics of nicotine
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Nicotine therapy, to quit smoking
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what are the pharmacokinetics of nicotine
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administered, buccal, nasal and transdermal. Excreted: kidneys. Onset and duration: vary with dosage formulation
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what are the pharmacodynamics of nicotine
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potent ganglionic and CNS stimulant
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what are the contraindications and precautions of nicotine
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acute cardiac conditions
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what are the drug interactions of nicotine
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adenosine and lithium carbonate
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what are the adverse effects of nicotine
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vasoconstrictions, tachycardia, headache, paresthesias, fatigue
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what clears away acetylcholine from the synaptic gap after the neurotransmitter crosses the synaptic gap and binds to a receptor
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acetylcholinesterase
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What are the pharmacotherapeutics of Neostigmine
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Myasthenia gravis: enhanced muscle contraction
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what are the pharmacokinetics of Neostigmine
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Administered: orally and parenterally
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what are the pharmacodynamics of neostigmine
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acts as a cholinergic agent by increasing the synaptic presence of acetylcholine
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what are the contraindications and precautions of Neostigmine
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Gastrointestinal obstruction or ileus and urinary tract obstruction
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what are the adverse effects of Neostigmine
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cholinergic crisis, nausea, vomiting, diarrhea, miosis, salivation, diaphoresis, bradycardia, and bronchospasm
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what are the drug interactions of neostigmine
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steroids, aminoglycoside, depolarizing muscle relaxants, and magnesium
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what is the clinical importance of cholinergic antagonists
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decreasing blood pressure
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what are the pharmacotherapeutics of atrpine
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cardiac arrhythmia's, decrease respiratory secretions
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what are the pharmacokinetics of atropine
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intamuscular administration or IV
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what are the pharmacodynamics of atropine
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competitive inhibitor of cholinergic receptors
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what are the contraindications of atropine
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myasthenia gravis
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what are the adverse effects of atropine
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blurred vision, dry mouth, constipations and urinary retention
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what are the drug interactions of atropine
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phenothiazine antipsychotics and haloperidol
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what are the general anesthetic inhalant agents
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isoflurane. anything that ends in flurane and nitrous oxide
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what are the general anesthetic parenteral agents
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propofol
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what are the local anesthetic agents
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lidocaine. anything that ends in caine
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what are the nondepolarizing neuromuscular blocking agents
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tubocurarine
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what are the depolarizing neuromuscular agents
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succinylcholine
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what does general anesthesia do
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characterized by a state of unconsciousness, analgesia and amnesia with skeletal muscle relaxation
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what do local anesthesia do
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sensory transmission from a specific area of the body to the CNS is blocked
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what do neuromuscular blocking agents do
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paralysis
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what are the sub divisons of neuromuscular blocking agents
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nondepolarizing drugs which induce paralysis by muscle flaccidity and depolarizing drug which excite muscles and promote contraction leading to paralysis
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how do nondepolarizing drugs work
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prevent neural communication
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how do depolarizing drugs work
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cause muscle depolarization and prevent repolarization
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what is the first stage on anesthesia
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analgesia: patient remains conscious
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what is stage II of anesthesia
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excitement: patient may experience excitation and delirium
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what is stage III of anesthesia
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surgical anesthesia: may have four levels characterized by differential responses
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what is stage IV of anesthesia
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medullary depression: the respiratory and vasomotor centers are depressed and spontaneous respiration has ceased
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what is balanced anesthesia
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relies on a combination of drugs to reduce loss of consciousness
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what are the pharmacotherapeutics of isoflurane
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used to induce and maintain anesthesia
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what are the pharmacokinetics of isoflurane
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Administered: inhalation. produces anesthesia within 7 to 10 minutes
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what are the pharmacodynamics of isoflurane
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unknown
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what are the contraindications and precautions of isoflurane
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malignant hyperthermia, post-anesthesia respiratory distress
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what are the adverse effects of Isoflurane
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hypotension, malignant hyperthermia, postanethesia respiratory depression
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what are the drug interactions of Isoflurane
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labetalol: hypotensive effect occurs
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what are the pharmacotherapeutics of propofol
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used for anesthesia in ICU
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what are the pharmacokinetics of propofol
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administered parenterally, on set is 40 seconds, duration is 3-5 minutes
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what are the pharmacodynamics of propofol
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mediate activity of the gamma-aminobutyric acid receptors
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what are the contraindications and precautions of propofol
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pregnancy and lactation
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what are the adverse effects of propofol
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nausea, vomiting, involuntary muscle movement hypotension, apnea
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what are the drug interactions of propofol
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benzodiazepines, droperidol, CNS depressents
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what are local anesthetic agents divided into
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esters-relatively unstable in solution
emulsion-does not contain preservatives |
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what are the pharmaco therapeutics of Lidocaine
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local anesthetic
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what are the pharmacokinetics of lidocaine
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administered:topically, orally, subcutaneously, intradermally, submucosally and IV.
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what are the pharmacodynamics of lidocaine
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produces its analgesic effects through a reversible nerve conduction blockade, which diminishes the nerve membrane's permeability to sodium
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what are the adverse effects of lidocaine
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urticaria, angioedema, bronchospasm, anaphylatic shock, erythema, edema, and dysesthesia
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what are the drug interactions of lidocaine
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antihypertensice agints, cholinesterase inhibitors, monoamine oxidase inhibitors, and opiate agonists
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how do you minimize the adverse effects of lidocaine
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preparations with adrenaline should not be administered in areas such as fingers, toes, nose or penis because vasoconstriction ay damage these areas
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what is the pharmacotherapeutics of tubocurarine
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skeletal muscle relaxant used as an adjunct to general anesthetics or in ICU to decrease patient movement
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what are the pharmacokinetics of tubocuraine
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administered: IV Onset: 2 minutes
Peak: 3-5 minutes |
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what are the pharmacodynamics of tubocuraine
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antagonists of acetylcholine, compete with the neurotransmitter for the cholinergic receptor sites at the motor end plate
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what are the adverse effects of tubocuraine
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immobility, decreased GI tone, respiratory difficulty
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what are the drug interactions of tubocuraine
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carbamazepine and hydantoins and theophylines decrease it's effects
antibiotics, inhalation anesthetics, ketamine, magnesium, sals, quinne derivatives, thiopurines, trimethaphan, and veramil |
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what are the contraindications and precautions of tubocuraine
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early pregnancy
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what are the pharmacotherapeutics of succinylcholine
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used primarily for rapid endotracheal intubation and endoscopic procedures
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what are the pharmacokinetics of succinylcholine
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Administered: IV or IM.
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what are the pharmacodynamics of succinylcholine
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It acts as an agonist at the cholinergic nicotinic receptors of the motor end plate
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what are the contraindications and precautions of succinylcholine
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history of malignant hyperthermia
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what are the adverse effects of succinylcholine
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can cause histamine release, effects are associated with muscle paralysis
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what are the drug interactions of succinylcholine
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aminoglycosides, anticholinesterases, procaine and trimethaphan
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how do you minimize the adverse effects of succinylcholine
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to decrease muscle fasciculations: give a small dose of a nondepolarizing NMJ blocker
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what are the centrally acting muscle relaxants
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cyclobenzaprine
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what are the centrally acting spasmolytics
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baclofen
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what are the peripherally acting spasmolytics
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dantrolene
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what is a tonic spasm
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cramp, characterized by an unusually prolonged and strong muscular contraction
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what is a muscle spasm
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a sudden, violent involuntary contraction of a muscle or group of muscles. related to a localized skeletal muscle injury or an imbalance in electrolytes
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what is spasticity
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condition in which certain muscles are continuously contracted
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what are the pharmacotherapeutics of cyclobenaprine
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used to manage muscle spasms associated with acute musculoskeletal disorders
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what are the pharmacokinetics of cyclobenaprine
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administered orally. Excreted: urine and bile. Onset: 1 hour. Duration 12-24 hours
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what are the pharmacodynamics of cyclobenaprine
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relieves muscle spasms through a central action
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what are the contraindications and precautions of cyclobenaprine
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hyperthyroidism
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what are the adverse effects of cycolbenzaprine
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CNS depression and anticholinergic activity , arrhythmia's seizures and MI's
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what are the drug interactions of cyclobenzaprine
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tramadol, guanethidine, MAOI's histamine blocking agents and various herbal remedies
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what are the pharmacotherapeutics of baclofen
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relieves some components of spinal spasticity. MS cerebral palsy and spinal injury
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what are the pharmacokinetics of baclofen
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administered: orally, crosses blood-brain barrier, Peaks 2-3 hours
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what are the pharmacodynamics of baclofen
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act specifically at the spinal end of the upper motor neurons at GABA-b receptors to cause hyperpolarization
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what are the contraindications and precautions of baclofen
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spasticity of cerebral origin, if they have huntington chorea or parkinsonism
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what are the adverse effects of baclofen
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drowsiness, weakness, dizziness and hightheadedness, headache, nausea and vomiting
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what are the drug interactions of baclofen
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CNS depressants or TCAs
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Who is more prone to adverse effects of baclofen and cycobenzaprine
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older patients
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how do you maximize the therapeutic effects and minimize the adverse effects
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take with full glass of water at evenly spaced intervals, coordinate with meals
do not abruptly stop medication |
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what are the pharmacotherapeutics of dantrolene
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used to trat malignant hyperthermia
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what are the pharmacokinetics of dantrolene
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administered: oral or IV
Peak: 5 hours |
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what are the pharmacodynamics of dantrolene
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reduces the amount of calcium released from the sarcoplasmic reticulum, thereby relaxing the muscle
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what are the contradications and precautions of dantrolene
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liver disease
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what are the adverse effects of dantrolene
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muscel weakness, fata hepatitis, seizures and pleural effusion with pericarditis
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what are the drug interactions of dantrolene
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CNS depressants, clofibrate, estrogens, veramil, and warfarin
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how do you maximize the therapeutic effects and minimize the adverse effects of antrolene
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administer with food or milk to avoid gastric distress
titrate dose to maximum effectiveness |
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what are antiparkinson drugs
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carbidopa-levodopa
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what are anti MS drugs
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glatiramer
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and what anti-ALS drugs
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riluzole
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what are the myasthenia gravis drugs
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neostigmine and pyridostigmine
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what are the huntington disease drugs
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haloperidol and phenothiazines
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what are the drugs for tourette syndrome
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clonidine and fluphenazine
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what is the extrapyramidal system responsible for
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coarse control of voluntary muscles
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what makes up the extrapyramidal system
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basal ganglia, cortical areas of the brain
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what causes parkinsons
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dopamine imbalance and excess acetylcholine
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what are the types of MS
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relapsing-remitting, primary progressive, secondary progressive, and progressive-relapsing
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what are the pharmacotherapeutics of carbidopa-levodopa
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Used in treating parkinsons
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what are the pharmacokinetics of carbidopa-levodopa
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Administered: oral
Matabolism: peripherally Onset: 1-2 months |
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what are the pharmacodynamics of carbidopa-levodopa
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diffuses levodopa into the CNS where it is converted to dopamine
Carbidopa is administered in combination to prevent the conversion of levodopa to dopamine in the periphery |
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what are the contraindications and precautions of carbidopa-levodopa
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undiagnosed pigment lesions
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what are the adverse effects of carbidopa-levodopa
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nausea, vomiting, anorexia, orthostatic hypotension, abnormal movement, cardiac arrhythmias, bruxism, and ballismus
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what are the drug interactions of carbidopa-levodopa
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hydantoins, MAOIs, phenothiazine, or tricyclic antidepressants
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what can interfere with absorption of carbidopa-levodopa
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protein
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how do you maximize the therapeutic effects and minimize the adverse effects of carbidopa-levodopa
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take on empty stomach, monitory diet for high protein and pyridoxine
administer at evenly space intervals and titrate the dose |
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how do centrally acting anticholinergic drugs work
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blocking the access of acetylcholine to cholinergic receptors in the striatum
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what are the pharmacotherapeutics for Riluzole
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treating ALS because it slows down its progression
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what are the pharmacokinetics of Riluzole
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Administered: Oral Duration: 3-5 days
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what are the pharmacodynamics of Riluzole
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unknown
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what are the adverse effects of Riluzole
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muscle fatigue, nausea, dizziness, diarrhea, anorexia, vertigo, somnolence, and hepatic injury
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what are the drug interactions of riluzole
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hepatotoxic drugs
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what culture affects the clearance of Riluzole
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japanese
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how do you maximize the therapeutic effects and minimize the adverse effects
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take with full glass of water on empty stomach
Teach patients not to drive due to dizziness or sedation |
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what are the drugs called that are used to affect the progress of MS
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ABC therapy
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what are the pharmacotherapeutics of glatiramer
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used to reduce the frequency of MS attacks
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what are the pharmacokinetics for glatiramer
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administered subcutaneously
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what are the pharmacodynamics of glatiramer
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action unclear
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what are the contraindications and precautions of glatiramer
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IV administration and hypersensitivity to mannitol
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what are the adverse effects of glatiramer
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chest pain or tightness, breathing difficulties, hives or severe rash, pounding heart beat, and unusual muscle weakness or tiredness
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what are the drug interactions of glatiramer
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no known but can alter test results of a papanicolaou test
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how do you maximize the therapeutic effects and minimize the adverse effects of glatiramer
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store in fridge, administer at room temp
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