Pharmocology Midterm #2

Front 1

They are medicines that work by stimulating the sympathetic nervous system (SNS).

Back 1

Adrenergic drugs

eg. epinephrine, dopamine, norepinephrine

Front 2

What is the therapeutic classification of epinephrine?

Back 2

Catecholemine-Sympathomimetic

-Anti-ashmatic, broncodialtor, vasopressor

Front 3

What is the difference between selective-agonist adrergic drugs and nonselective-agonists adrenergic drugs?

Back 3

Selective-agonists

-only affects one receptor subtype

eg. alpha 2, or beta 1, ect

Nonselective-agonists

-they have action on both alpha and beta-receptors or subtypes

Front 4

the SNS has the "_____ &______" response, while the PNS has the "______&_____" response.

Back 4

SNS=fight or flight

PNS= rest or digest

Front 5

Why would epinephrine be used?

Back 5

***-Anaphylaxis

-Bronchodialator (relive broncospams)

-Acute asthma, chronic bronchitis, COPD

-Cardiac arrest (restore cardiac rhythm)

-As an adjunct in anesthetics

Front 6

Where are the alpha receptors located & what is their action?

Back 6

Alpha 1=located post-synaptically (smooth muscle contractions)

-Vasoconstriction effect (High doses increases BP)

Alpha 2= pre-synaptically ( Control the release of neurotransmitter norepinepherine, smooth muscle contraction)

Front 7

Where are the Beta receptors located & what is their action?

Back 7

Beta 1 = heart (Body has 1 heart)

-Increases the force of contraction and heart rate

Beta 2 = Lungs (Body has 2 lungs)

-Bronchodilatory effects

Front 8

What is the purpose of epinephrine during anaphylaxis?

Back 8

-Acts on both Alpha and Beta receptors

-Causes bronchial smooth muscle relaxation

-Counters the vasodilaton and high vaso-permiability that occurs during anaphalyxis

Front 9

What does the suffix -terol, -ol mean?

Back 9

beta 2 agonist (broncodilator)

Front 10

Define agonist

Back 10

Drugs that bind to and stimulate the activity of one or more receptor in the body

Front 11

what is Salbutamol used for?

Back 11

-Causes smooth muscle relaxation of bronchial muscle fibers by stimulating Beta 2-adrenergic receptors in bronchial smooth muscle fibers.

-Asthma, chronic bronchitis, and other bronchopulmonary disorders

Front 12

This is a class of drugs that block beta-adrenergic substances such as adrenaline (epinephrine), a key agent in the "sympathetic" portion of the autonomic (involuntary) nervous system.

Back 12

Adrenergic blocking drugs

also referred to as antagonists

also referred to as sympatholytics because they lyse, or inhibit, SNS stimulation

Front 13

Define sympatholytics

Back 13

Sympath/o = sympathetic nervous system

-lytic = to reduce, destroy, separate (breakdown)

Front 14

Define sympathomimetic

Back 14

Mimic the effects of the SNS neurotransmitters norepinephrine, epinephrine, and dopamine (catecholamines).

Front 15

What is the drug tamsulosin (flomax) used for?

Back 15

-Selective Alpha 1 Blocker in the prostate and bladder

-Used for Benign prostatic hyperplasia

-Reduces smooth muscle contraction of the bladder neck and the prostatic portion of the urethra

-Caution for orthostatic hyoptension

Front 16

What are the 7 main categories of Anti-hypertensive drugs?

Back 16

1)Diuretic

2)Adrenergic drugs

3)Angiotensin-converting Enzyme (ACE) Inhibitors

4)Angiotensin II Receptor Blockers (ARBs)

5)Calcium Channel Blockers (CCBs)

6) Vasodilators (although all antihypertensives have some kind of vasodilating effect [except diuretics])

7)Direct Renin Inhibitors

Front 17

What is a common adverse effect of antihypertensive drugs?

Back 17

Sexual dysfunction in male pt

-common reason for non-adherence

Front 18

What is a diuretic?

Back 18

Promotes the formation of urine in the kidney therfore causing a pt to "lose water" (inhibiting the kidney's ability to reabsorb sodium, thus enhancing the loss of sodium and consequently water in the urine)

-decreases volume of plasma and extracellular fluid = decreased preload = decrease of cardiac output & total peripheral resistance = decreased workload of the heart

Front 19

what does the suffix -pril mean?

Back 19

ACE inhibitor (antihypertensive)

Front 20

What do ACE inhibitors do?

What should you as the nurse look our for?

Back 20

ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance in your body that narrows your blood vessels and releases hormones that can raise your blood pressure. This narrowing can cause high blood pressure and force your heart to work harder.

-Look out for hyperkalemia (because this drug promotes potassium reabsorption in the kidneys)

Front 21

What does the suffix -sartan mean?

Back 21

Angiotension II receptor antagonists (ARBs)

Front 22

What is a characteristic side effect of ACE inhibitors?

Back 22

-Dry non-productive cough

Front 23

Why would an Angiotension II receptor antagonist (ARB) be prescribed over an Angiotensin-converting Enzyme (ACE) Inhibitor?

Back 23

-ARBs do not cause a cough

-Hyperkalemia is less likely to occur with ARBs

-ARBs are used primarily in pts who have been intolerant of ACE inhibitors.

Front 24

What are calcium channel blockers (CCBs) primarily used for?

Back 24

Hypertension and Angina

-Used as a 1st line defense drug for treatment of hypertension due to the effectiveness and safety of the drug.

Front 25

What are direct renin inhibitors used for?

Back 25

Renin inhibitors block the activity of renin and cause vasodilatation. Renin is an enzyme that converts angiotensinogen to angiotensin I, which is then converted to angiotensin II by angiotensin converting enzyme. Angiotensin II is a potent vasoconstrictor that causes the BP to rise, therefore, direct renin inhibitors cause the decrease of BP

Front 26

What are the 3 classes of drugs used to treat angina?

Back 26

-Beta-Blockers

-Nitrates

-Calcium channel Blockers (CCBs)

Front 27

What is the overall goal of antianginal drug therapy?

Back 27

To increase blood flow to the ischemic myocardium, decrease myocardial oxygen demand, or both.

Front 28

Nitroglycerin: what is it used for and what does is its mechanism of action?

Back 28

-Used for the prevention and treatment of angina

-Mechanism of action

-Causes vasodilation due to the relaxation of smooth muscles

-Potent dilating effect on the coronary arteries

-Results: Oxygen to ischemic myocardial tissue and reduction of angina symptoms.

Front 29

Tolerance to nitrates is common when taken around the clock. How is tolerance prevented?

Back 29

Allowing regular free-nitrate period to allow for certain enzyme pathways to replenish.

Front 30

What are antianginal Beta-blockers used for?

Back 30

Prophylactic (prevention) treatment of angina

Front 31

What do Beta-blockers do to the heart?

Back 31

β1-receptors on the heart cause an increased contractibility and increased heart rate. Therefore, blocking these β1-receptors on the heart then results in: slowing the heart rate and decreasing the contractibility, thereby decreasing oxygen demand.

Front 32

What is the mechanism of action of Calcium Channel Blockers in regards to angina?

Back 32

-Cause coronary artery vasodilation

-Cause peripheral arterial vasodilation, thus decreasing systemic vascular resistance

-Reduce the workload of the heart

-Result: decreased myocardial oxygen demand

Decrease calcium influx into the smooth muscle, causing vascular relaxation.

Front 33

What food interaction should generally be avoided when on antianginals?

Back 33

Grapefruit

Front 34

What drugs are used for heart failure treatment?

Back 34

-Angiotensin-converting enzyme inhibitors

-Angiotensin receptor blockers

-ß-Blockers

-Aldosterone Antagonists (Diuretics)

-Omega – 3 Polyunsaturated Fatty Acids (Obtained mainly through diet)

-Positive Inotropic Drugs (Drugs that increase the force of myocardial contraction)

-Digoxin**

Front 35

What is Digoxin used for?

Back 35

Treatment of mild to moderate heart failure.

-digoxin increases left ventricular ejection fraction and improves heart failure symptoms

Overall: Slows heart rate down. Pumps more blood with each beat

Front 36

What is a common sign of digoxin toxicity?

Back 36

Hyperkalemia

Digoxin inhibits the Sodium-Potassium ATPase pump. Digoxin toxicity is worsened in states of hypokalemia (low potassium) since digoxin normally binds to the Sodium-Potassium ATPase pump on the same site as potassium. Digoxin and K+ compete for the sites. So, when potassium levels are low, more sites are available for the Digoxin to bind to; therefore, digoxin can more easily bind to the ATPase pump exerting the inhibitory effects. Hypercalcemia: High levels of calcium may increase the risk of a toxic reaction to digoxin, a medication used to treat irregular heart rhythms. Calcium antagonizes the effects of both potassium and magnesium at the cell membrane. For this reason it is extremely useful for treating the effects of hyperkalemia and hypermagnesemia. So, thinking about digoxin competing with K+ for binding sites. If hypercalcemia, then more antagonizing of K, so less available to bind, and more binding sites for digoxin. Therefore, more at risk for digoxin toxicity.

Front 37

How is digoxin toxicity treated?

Back 37

digoxin immune Fab (ovine) (DigiFab)

-Digoxin immune Fab is an antibody that recognizes digoxin as an antigen and forms an antigen–antibody complex with the drug, thus inactivating the free digoxin.

Front 38

This system is commonly used to classify antidysrhythmic drugs, based on the electrophysiological effect of particular drugs on the action potential.

Back 38

Vaughan Williams Classification

-4 major classes of drugs

-Class I = Fast Na Channel Blockers. Membrane stabilizing drugs.

-Class II = Beta-Blockers

-Class III = Increases action potential duration (APD). Potassium (K+) Channel Blockade

-Class IV = Slow Ca++ Channel Blockers

Front 39

What food interaction should a pt avoid when on antidysrthymials?

Back 39

Grapefruit juics

Front 40

This drug classification inhibits the formation of clotting factors and therefore, prevents clots (thrombus) from forming.

Back 40

Anticoagulants

Front 41

What common lab tests are done when pt are on warfarin?

Back 41

PT (prothrombin Time) & INR (International Normalized Ratio)

-Medication dosages are adjusted accordingly

Front 42

What is the therapeutic INR range with warfarin?

Back 42

2-3 Secs

Front 43

What is the main complication of anticoagulant drug therapy?

Back 43

Bleeding

Front 44

If a pt experiences heparin toxicity, how is it managed?

Back 44

1) stop anticoagulant (remember heparin has a short half life)

2) Severe cases: Protamine sulfate

Front 45

If a pt experiences warfarin toxicity, how is it managed?

Back 45

1)Discontinue warfarin

2) Phytonadione (Vit K)

Front 46

What do antiplatelet drugs do? What are some examples of platelet drugs?

Back 46

Prevent platelet plugs from forming by inhibiting platelet aggregation

-Can be beneficial in preventing heart attacks & strokes

-Prevents platelet adhesion to the site of blood vessel injury which occurs before the clotting cascade.

Ex. Acetylsaliclic acid (ASA), Clopidogrel (Plavix)

Front 47

These are drugs that lyse (breakdown), preformed clots (thrombi) in the coronary arteries.

Back 47

Thrombolytic drugs

ex. Alteplase (Activase rt-PA) , Tenecteplase (TNKase), Streptokinase which is discontinued

Front 48

This drug classification prevents the lysis of fibrin, resulting in promotion of clot formation.

Back 48

Antifibrinolytic drugs

Front 49

What are antifibrinolytic drugs used for?

Back 49

used for the prevention and treatment of excessive bleeding resulting from hyperfibrinolysis or surgical complications.

-Treatment of hemophilia A or type I von willebran's disease with desmopressin

Front 50

What drug classes are used in the treatment of clot formation?

Back 50

-Anticoagulants

-Antiplatlets

Front 51

What drug class is used in for the removal of existing clots?

Back 51

-Thrombolytics

Front 52

What drug classes are used for the promotion of clot formation?

Back 52

-Antifibrinolytics

-Clotting factors

Front 53

This is the term for any abnormal lipid levels?

Back 53

Dyslipidemia

Front 54

Define hyperlipidemia

Back 54

Abnormally elevated levels of any or all lipids and/or lipoproteins in the blood

Front 55

This drug type is used in the promoting a reduction of lipid levels in the blood

Back 55

Antilipemics

Front 56

What is the mechanism of action of HMG-CoA (Hydroxymethylgutaryl-coenzyme A) reductase Inhibitors? What is it used for?

Back 56

-inhibits HMG-CoA reductase, which is used by the liver to produce cholesterol, therefore lowering the rate of cholesterol production.

-Used commonly used to reduce "bad" cholesterol and raising the "bad" cholesterol levels; reducing the risk of MI and strokes in PTs with coronary artery disease and those at risk for it.

Front 57

What is a common adverse reaction of atrovastatin (HMG-CoA reductase inhibitor)?

Back 57

Myopathy (muscle pain) which can lead to Rhabdomyolysis (breakdown of muscle protein & the urinary elimination of muscle protien myoglobin)

Front 58

What are the different types of Diuretic drugs?

Back 58

-Carbonic anhydease inhibitors (CAI's)-not commonly used as a diuretic

-Loop diuretics - K+ spilling

-Osmotic diuretics- prevent H2O and small amounts of Na+

-Potassium-sparing diuretics - K= gets reabsorbed

-Thiazide and thiazide-like diuretics- K+ pilling