Pharmacology

Front 1

List 5 Adrenergics

Back 1

Epinepherine
Norepinepherine
Dopamine
Albuterol
Clonidine

Hint 1

E
N
D
A
C

Front 2

List Anticholinergics

Back 2

Atropine
Oxybutmin
Hyoscyamine

Hint 2

AOH

Front 3

List Cholinergics

Back 3

Bethanechol
Neostignine
Edrophonium
Organophosphates

Hint 3

BNEO

Front 4

List Antiadrenergic

Back 4

Doxazosin
Propranolol
Labetalol
Atenolol

Hint 4

DPLA

Front 5

Epinephrine
Classification:
Use:
Receptor type:

Back 5

Adrenergic, Adrenergic agonist
Management of airway disease, allergic reaction and cardiac arrest.
Receptor type: Alpha and beta adrenergic receptors

Front 6

Norepinephrine

MOA:
Use:
Receptor type:
Nursing actions:

Back 6

Adrenergic agonist,
Increase BP, cardiac output in shock.
Receptor type: Alpha 1 and 2
MOA: Causes contraction of arterial smooth muscle. Signal transduction
Nursing actions: Plasma volume should be corrected first. Monitor BP continuously until stable. Monitor cardiac ECG. Monitor urine output. Monitor IV site.

Front 7

Use for Dopamine

Back 7

Increase BP, cardiac output in shock and renal flow.
Dose dependant response. dopaminergic at low doses to increase urine output. Medium doses are beta adrenergic, increasing heart rate and contractility.
Higher doses are alpha adrenergic, for increasing blood pressure, vasoconstriction
Receptor type: Alpha 1 and Beta 1 and Beta2
MOA: Signal transduction
Dopaminergic, adrenergic

Front 8

Albuterol
Classification:
Use:
Receptor type:

Back 8

Adrenergic Beta 2 agonist
Use: Bronchodilation.
Receptor type: Beta 2

Front 9

Clonidine
Classification:
Use:
Receptor type:

Back 9

Adrenergic alpha 2 agonist
Centrally acting to decrease blood pressure.
Used in alcohol withdrawal to reduce blood pressure response.
Receptor type: Alpha 2

Front 10

Doxazosin (Cardura)
Classification:
Use:
Receptor type:
MOA:
Nursing actions:

Back 10

Alpha 1 adrenergic antagonist
Treatment of hypertension, Benign prostatic hyperplasia (BPH). Vasodilation.
MOA: Blocks post synaptic alpha 1 adrenergic receptors.
Nursing actions: Monitor BP and pulse, orthostatic hypertension or syncope

Front 11

Propranolol
Classification:
Use:
Receptor type:
Nursing actions:

Back 11

Beta 1 and Beta 2 adrenergic antagonist.
Management of hypertension, angina, arrhythmias. Decreases heart rate and contractility. Decreases blood pressure.
Receptor type: Beta 1 and beta 2
Nursing actions: Take apical pulse prior to administering. If less than 50, hold. Monitor for bronchoconstriction side effect. Monitor I and O and watch for fluid overload.

Front 12

Labetalol
Use:
Receptor type:
MOA:

Back 12

Beta adrenergic antagonist. Non selective
Use: Antianginal, anti-hypertension
Receptor type: Beta 1, Beta 2 and Alpha 1
MOA: Blocks stimulation of myocardial and pulmonary receptor sites.

Front 13

Atenolol
Classification:
Use:
Receptor:

Back 13

Beta adrenergic antagonist. Selective for Beta 1, myocardial) receptors.
Management of hypertension to decrease blood pressure, heart rate.

Front 14

Bethanechol
Classification:
Use:
MOA:

Back 14

Cholinergic
Use: Non-obstructive urinary retention
MOA: Synthetic choline. Stimulates cholinergic receptors to produce smooth muscle contractions. Relax sphincter and contract bladder wall.

Hint 14

Synthetic derivative of choline

Front 15

Neostigmine
Classification:
Use:
MOA:
Receptor:
Nursing actions:

Back 15

Cholinergic
Anti-cholinesterase (Reversible indirect action)
Use: Improves muscle strength in myasthenia gravis. Prevents post operative urinary retention or ileus and reverses nondepolarizing neuromuscular blockers.
MOA: Inhibits the breakdown of acetylcholine. Acetylcholine remains in the synapse.
Receptor: Acts indirectly by binding to cholinesterase which breaks down acetylcholine.
Nursing actions: Contraindicated in mechanical obstruction of GI/GU tract.

Hint 15

(Reversible indirect action)

Front 16

Edrophonium

Back 16

used to diagnose Myasthenia gravis. (Tensilon test).

Hint 16

(Tensilon)

Front 17

Organophosphates
Classification:
Use:
MOA:
Receptor:
Nursing actions:

Back 17

(Cholinergic)
Irreversible anti-cholinesterase agent.
Use: Insecticides or nerve gas. Produces excessive stimulation of muscarinic and nicotinic receptors.
MOA: Cholinesterase is inactivated and acetylcholine remains in the cholinergic synapses.
Receptor: Acts indirectly by binding to cholinesterase which breaks down acetylcholine
Nursing actions: Antidotes are Atropine, an anticholinergic and Pralidoxime a cholinesterase reactivator.

Hint 17

Produces excessive stimulation of muscarinic and nicotinic receptors.

Front 18

Atropine
Use:
MOA:
Receptor:
Nursing actions:
IV dose:

Back 18

Anticholinergic
Used for treatment of bradycardia. Causes cycloplegia,
MOA: Blocks parasympathetic vagal stimulation.
Affects the cardiac sinoatrial node.
Receptor: Muscarinic
Nursing actions: IV dose, 0.4-1.0 mg.

Hint 18

Blocks parasympathetic vagal stimulation.

Front 19

Oxybutynin (Ditropan)
Classification:
Use:
MOA:
Receptor:
Nursing actions:

Back 19

Anticholinergic, urinary tract antispasmodic.
Use: Treatment of neurogenic bladder, frequency, urgency, nocturia, and incontinence.
MOA: Blocks acetylcholine in the bladder walls and sphincter so the bladder is less irritable. Also used for post prostate resection.
Receptor: Postgangleonic
Nursing actions: Monitor voiding pattern, I and O. Assess for distention.

Hint 19

Treatment of neurogenic bladder

Front 20

Hyoscyamine (Levsin)
Classification:
Use:
MOA:
Receptor:
Nursing actions:

Back 20

Classification: Anticholinergic
Use: Control of GI, irritable bowel pain
MOA: Inhibits acetylcholine at muscarinic receptors.
Receptor: Muscarinic.
Nursing actions: Monitor heart rate, I and O. Assess for bowel sounds and distention. Monitor for constipation.

Hint 20

Inhibits acetylcholine at muscarinic receptors

Front 21

4 Nursing actions for ANS drugs

Back 21

Monitor heart rate for sympathetic adrenergics or the cholinergic drugs
Monitor BP (Except for cholinergic)
Monitor bowel and bladder effect
Check selective effects

Front 22

Effect on heart rate
Adrenergic will ...
Antiadrenergic will...
Cholinergic will ...
Anticholinergic will ...

Back 22

Adrenergic will increase heart rate.
Antiadrenergic will decrease
Cholinergic will decrease heart rate
Anticholinergic will increase heart rate

Front 23

Effect on blood pressure
Adrenergic will ...
Antiadrenergic will ...
Cholinergic will ...

Back 23

Adrenergic will increase blood pressure (alpha 1)
Antiadrenergic will decrease blood pressure
Cholinergic will not effect BP. No cholinergic receptors on vessels.

Front 24

Effect on bowell and bladder tone
Adrenergic will ...
Antiadrenergic will ...
Cholinergic will ...
Anticholinergic will ...

Back 24

Adrenergic will decrease bowel and bladder tone
Antiadrenergic will increase bowel and bladder tone
Cholinergic will increase bowel tone.
Anticholinergic will decrease bowel tone.

Front 25

Propofol (Diprivan)
Use:

Back 25

Use: A hypnotic used in balanced general anesthesia, conscious sedation and deep sedation. It is similar to IV barbiturates and has an anti-emetic effect.
It is fast acting, with full effect in 1-3 minutes. Its distribution half life is 2-8 minutes and its elimination half life is 30-60 minutes. It has to be emulsified in lipids.

Front 26

Halothane (Fluothane)
Use:
Nursing actions:

Back 26

Use: For general anesthesia with rapid induction and rapid recovery. No analgesic effect. Doesn’t irritate the mucosa. Can only be used one time.
Nursing actions: Monitor cardiovascular for dysrhythmias. Sensitizes the heart to catecholamines. May produce hypoxemia, respiratory acidosis (hypercarbia). Depresses kidney, liver function. May cause malignant hyperthermia

Front 27

Isoflurane (Forane)
Use:

Back 27

Use: Similar to halothane but without cardiac dysrhythmias or hepatotoxicity.

Front 28

Nitrous Oxide

Back 28

Use: Analgesic, weak anesthetic, given with oxygen to prevent hypoxia. Few adverse effects. It cannot produce surgical anesthesia by itself.

Front 29

Midazolam (Versed)
Use:
Nursing actions:
Onset:

Back 29

Use: A short acting benzodiazepine. Amnesiac and reduces doses of opioid needed. Used for preoperative sedation, induction and in general anesthesia. May be used in short procedures. Rapid onset and short duration
Nursing actions: Monitor for apnea, respiratory depression.

Front 30

Alfentanil (Alfenta)
Use:

Back 30

A rapid acting opioid analgesic, anesthetic.

Nursing actions: Same as for opioid.

Front 31

Succinylcholine (Anectine)
Use:
MOA:
Nursing actions:

Back 31

Cholinergic
Depolarizing, cholinergic receptor agonist. Neuromuscular blocking agent used to produce skeletal muscle paralysis. Paralyses muscles of respiration, Short acting. Antidote is plasma pseudocholinesterase.
MOA: Blocks the effect of acetylcholine at the neuromuscular junction.
Nursing actions: Assess respiratory status. Monitor ECG, heart rate, BP.

Front 32

Pancuronium (Pavulon)
Use:
MOA:
Nursing actions:

Back 32

A non-depolarizing neuromuscular blocker. Long acting. It is used for general anesthesia, intubation or facilitating compliance in mechanical ventilation.
It is reversed by neostigmine, an anticholinergic. Action lasts about 60 minutes.
MOA: Blocks the effect of acetylcholine at the neuromuscular junction so there is no muscle contraction.
Nursing actions: Has no effect on consciousness or pain threshold. Use with analgesia, anesthesia. Protect eyes with artificial tears. Monitor respiratory cardiovascular, ECG status. Should only be used in conjunction with intubation. Monitor neuromuscular response.

Front 33

Vecuronium (Norcuron)
Use:
MOA:
Nursing actions:

Back 33

Use: : A non-depolarizing neuromuscular blocker. Short acting. It is used for intubation or facilitating compliance in mechanical ventilation. It is reversed by neostigmine, an anticholinergic. Action lasts about 15-30 minutes.
MOA: Blocks the effect of acetylcholine at the neuromuscular junction so there is no muscle contraction.
Nursing actions: Has no effect on consciousness or pain threshold. Use with analgesia, anesthesia. Protect eyes with artificial tears. Monitor respiratory cardiovascular, ECG status. Should only be used in conjunction with intubation. Monitor neuromuscular response.

Front 34

Bupivacaine (Marcaine)
Use:
MOA:
Nursing actions:

Back 34

Use: Lidocaine/cocaine type anesthetic.
MOA: Inhibits sensory nerve impulse by altering influx of sodium and efflux of potassium. Slows or stops pain sensation.
Nursing actions: Assess for toxicity, orthostatic hypotension. Epinephrine keeps the drug in the injected area.

Front 35

Atropine
Use:

Back 35

Use: An anticholinergic used to prevent vagal effects during anesthesia (bradycardia, hypotension) It also dries secretions.

Front 36

PSVT

Back 36

Paroxysmal supraventricular tachycardia. Common arrhythmia that may revert with vagal maneuvers. Pt. talking, conscious.

Front 37

Sodium Channel Blockers

Back 37

Block sodium influx into the cell. Stabilizes the cell membrane and decreases the formation and conduction of electrical impulses.
Used to maintain NSR after conversion.
Procainamide
Quinidine
Lidocaine

Hint 37

PQL

Front 38

Procainamide
Use:
MOA:
Nursing actions:

Back 38

Use: To maintain NSR after conversion. Ventricular ectopic beats and Ventricular tachycardia
MOA: Block sodium influx into the cell. Decreases myocardial excitability. Slows conduction velocity. Prolongs refractory period.
Nursing actions: Monitor heart rate, ECG, BP, measure intervals, monitor Na, K, Ca.

Hint 38

Block sodium influx

Front 39

Quinidine
Use:
MOA:
Nursing actions:

Back 39

Use: To maintain NSR after conversion. Ventricular ectopic beats and Ventricular tachycardia
MOA: Block sodium influx into the cell.
Nursing actions: Monitor heart rate, ECG, BP, measure intervals, monitor Na, K, Ca.

Hint 39

Block sodium influx

Front 40

Beta Adrenergic Blockers

Back 40

Propranolol (Inderal)
Esmolol

Hint 40

olol

Front 41

Propranolol (Inderal)
Use:
MOA:

Back 41

Use: Management of angina, arrhythmias, supraventricular tachycardia, atrial fibrillation/flutter and PSVT. Decreases heart rate.
MOA: Blocks beta receptors. Blocks the sympathetic nervous system effect on the SA and AV nodes and increasing the refractory period. Decreases automaticity.

Front 42

Esmolol
Use:
MOA:

Back 42

Management of supraventricular tachycardia, atrial fibrillation/flutter and
MOA: Blocks beta receptors. Blocks the sympathetic nervous system effect on the SA and AV nodes and increasing the refractory period. Decreases automaticity

Front 43

Potassium Channel blockers

MOA:
Name one:

Back 43

Prolong the action potential and slow repolarization and prolong the refractory period. Potassium cant get back into the cell, so they slow repolarization.

Amiodarone

Front 44

Amiodarone
Use:
MOA:
Nursing actions:

Back 44

IV use for Ventricular fibrillation/tachycardia.
PO use for recurrent ventricular tachycardia and to maintain NSR with atrial fibrillation/flutter.
MOA: Potassium cant get back into the cell, so they slow repolarization
Nursing actions: Many adverse effects and interactions, so they cant be prescribed for longer than 6 months. Need liver, renal and creatinine tests.

Front 45

List 3 Calcium Channel Blockers

Back 45

Block the flow of calcium into the cells of conductile and myocardial. Slows conduction and prolongs refractory period. Ca blockers for hypertension use.
Diltiazem (Cardizem)
Verapamil
Adenosine (Adenocard)

Front 46

Diltiazem (Cardizem)
Use:
MOA:

Back 46

Use: IV for PSVT
MOA: Block the flow of calcium into the cells of conductile and myocardial. Slows conduction and prolongs refractory period

Front 47

Verapamil
Use
MOA:
Nursing actions:

Back 47

Use: PO for chronic suppression of PSVT and atrial fibrillation/flutter.
MOA: Block the flow of calcium into the cells of conductile and myocardial. Slows conduction and prolongs refractory period
Nursing actions: Do not use IV with IV Propranolol.

Front 48

Adenosine (Adenocard)
Use:
MOA:
Nursing actions:
Dose:

Back 48

Use: Restore NSR after PSVT .
MOA: Reduces conduction of AV node.
Nursing actions: Inject IV in 1 second.
they go into asystole.
6 mg, 12 mg, 12mg.

Hint 48

Use: Restore NSR after PSVT .

Front 49

Nitroglycerin
Use:
MOA:
Dose:

Back 49

Use: Angina and episodic chest pain.
MOA: Dilate smooth muscle. Converts to nitric oxide which activates enzyme for cGMP. Causes decrease Ca in smooth muscle. Keeping Ca out keeps it dilated.
Causes dilation of arterioles and veins so will decrease pre and afterload.
Nursing actions: Check BP, heart rate, burning sensation under tongue indicates effectiveness.
Dose: take every 5 minutes up to three times.
Ointment is for chronic use.

Front 50

Indirectly treat angina by reducing workload of the heart, increasing oxygen delivery. Prevent exercise induced angina or tachycardia. They decrease heart rate and increase blood flow to the coronary arteries.

Back 50

Beta Adrenergic Blockers MOA

Front 51

Used to treat angina by acting on contractile tissue, dilate coronary artery and reduce work load of the heart. Diltiazem. (Not Verapamil)

Back 51

Calcium Channel Blockers

Front 52

Diltiazem

Back 52

Used for A. fib/flutter to decrease ventricular rate. Hypertension to decrease peripheral vascular resistance. Do not use with low heart rate and blood flow

Nursing Actions:
Check ECG for evidence of MI ie, t wave inversion, ST elevation, q wave, HR, BP, route of administration for angina

Front 53

Classification: Beta blocker (non-selective), Antianginal, antiarrhythmic, antihypertensive.
Effect: Decreases heart rate and blood pressure, suppresses arrhythmias. Used in the prevention of MI.
MOA: Blocks stimulation of beta 1(myocardial) and beta 2( pulmonary) adrenergic receptors.
Contraindications: Uncompensated CHF, Pulmonary edema, Cardiogenic shock, bradycardia or heart block.
Adverse effects: Arrhythmias, bradycardia, CHF, pulmonary edema, fatigue, weakness.
Drug interactions: Additive bradycardia with digoxin, additive hypotension with antihypertensives, ETOH or nitrates. Concurrent use with epinephrine, norepinephrine, pseudoephedrine may cause unopposed alpha adrenergic stimulation (hypertension, bradycardia).
Nursing actions: Take apical pulse before administering. If less than 50, or arrhythmia occurs, hold and notify physician. Monitor BP and pulse. Monitor I and O ratios and daily weights. Watch for fluid overload.

Back 53

Propranalol (Inderal)

Front 54

Classification:. Calcium channel blocker, Antianginal, antiarrhythmic, antihypertensive.
Effect: Used in the management of supraventricular arrhythmias and rapid ventricular rates in atrial flutter and fibrillation. Vasodilation decreases BP, angina. Suppresses ventricular tachyarrhythmias.
MOA: Inhibits Ca transport into the myocardium and inhibits contraction. Decreases SA and AV conduction and prolongs AV node refractory period. Used in management of hypertension.
Contraindications: 2nd or 3rd degree heart block, BP less than 90, CHF, severe ventricular dysfunction, cardiogenic shock unless associated with supraventricular tachyarrhythmias.
Use caution with: Serious ventricular arrhythmias or CHF.
Adverse effects: Arrhythmias, CHF
Drug interactions: May increase serum digoxin levels.
Nursing actions: Monitor pulse, BP. Monitor ECG. May cause prolonged P-R interval. Assess for signs of CHF.

Back 54

Verapamil

Front 55

Verapamil

Back 55

Classification:. Calcium channel blocker, Antianginal, antiarrhythmic, antihypertensive.
Effect: Used in the management of supraventricular arrhythmias and rapid ventricular rates in atrial flutter and fibrillation. Vasodilation decreases BP, angina. Suppresses ventricular tachyarrhythmias.
MOA: Inhibits Ca transport into the myocardium and inhibits contraction. Decreases SA and AV conduction and prolongs AV node refractory period. Used in management of hypertension.
Contraindications: 2nd or 3rd degree heart block, BP less than 90, CHF, severe ventricular dysfunction, cardiogenic shock unless associated with supraventricular tachyarrhythmias.
Use caution with: Serious ventricular arrhythmias or CHF.
Adverse effects: Arrhythmias, CHF
Drug interactions: May increase serum digoxin levels.
Nursing actions: Monitor pulse, BP. Monitor ECG. May cause prolonged P-R interval. Assess for signs of CHF.

Front 56

Dopamine
Classification:

Back 56

Classification: Vasopressor, inotropic, beta-adrenergic

Hint 56

Monitor pulse, BP, pulse pressure, ECG, pulmonary capillary wedge pressure, cardiac output continuously. Report changes

Front 57

Nitroprusside (Nipride)
Classification:
Effect:
MOA: .
Contraindications:
Adverse effects:
Drug interactions:
Nursing actions: .

Back 57

Classification:. Vasodilator, antihypertensive
Effect: Rapid lowering of blood pressure. Decreases preload and afterload.
MOA: Produces peripheral vasodilation by acting on smooth muscle.
Contraindications:. Decreased cerebral perfusion
Use caution with.
Adverse effects: Dizziness, headache,
Drug interactions: Antihypertensives,
Nursing actions: Monitor BP, heart rate and ECG. Monitor for rebound when discontinuing therapy.

Hint 57

Contraindications:. Decreased cerebral perfusion

Front 58

Digoxin (lanoxin)
Classification:. .
MOA:
Contraindications:.

Use caution with:
Adverse effects:
Drug interactions:
Nursing actions:
Therapeutic serum levels

Back 58

Classification:. Digitalis glycoside, positive inotropic, antiarrhythmic
Effect: Increases cardiac output.
MOA: Increases the force of myocardial contraction. Prolongs refractory period of the AV node and decreases conduction through the SA and AV nodes.
Contraindications:. Uncontrolled ventricular arrhythmias, AV block, constrictive pericarditis,
Use caution with: Electrolyte abnormalities may predispose to toxicity.
Adverse effects: Arrhythmias, bradycardia, ANV, fatigue.
Drug interactions: Thiazide and loop diuretics may increase the risk of toxicity. Verapamil may lead to toxicity.
Nursing actions: Monitor apical pulse for one full minute before administering. Withhold if less than 60. Monitor BP, electrolytes.
Therapeutic serum levels range from 0.5-2 ng/ml.

Front 59

Enalapril (Vasotec)
Classification:
Effect:
MOA:
Adverse effects:
Drug interactions:

Back 59

Angiotensin converting enzyme inhibitor
Antihypertensive
Effect: Systemic vasodilation. Lowers BP. Decreases afterload in CHF
MOA: Blocks conversion of angiotensin 1 to vasoconstrictor angiotensin 2.
Adverse effects: Hypotension, cough, proteinuria.
Drug interactions: Excessive hypotension with diuretics, antihypertensives, nitrates. Hyperkalemia may result from use of potassium supplements, potassium sparing diuretics. Increases risk of digitalis toxicity.

Front 60

Lidocaine

Effect:
MOA: .
Contraindications:
Adverse effects:
Drug interactions: .
Nursing actions:

Back 60

Classification:. Antiarrhythmic
Effect: Controls ventricle arrhythmias
MOA: Alters flux of sodium ions across cell membrane with little effect on heart rate. Suppresses automaticity and spontaneous depolarization of the ventricles during diastole.
Contraindications:. Advanced AV block
Adverse effects: Cardiac arrest, seizures,
Drug interactions: Beta blockers may increase risk of toxicity.
Nursing actions: Monitor ECG, BP and respiratory status. Monitor for toxicity.

Hint 60

Monitor ECG, BP and respiratory status. Monitor for toxicity.

Front 61

Streptokinase
Classification:
Effect:
MOA:
Contraindications:.
Use caution with.
Adverse effects:
Drug interactions:
Nursing actions:

Back 61

Thrombolytic, plasminogen activator
MOA: Converts plasminogen to plasmin which degrades fibrin in clots
Contraindications: History of CVA, uncontrolled hypertension, bleeding.
Use caution with. Recent surgery, left heart thrombus,
Adverse effects: Intracranial hemorrhage, reperfusion arrhythmias, GI bleeding.
Drug interactions: Blood thinners,
Nursing actions: Monitor vitals, monitor for coronary thrombosis q 4 hours. Assess for bleeding.