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156 Cards in this Set
- Front
- Back
Introduction to Narcotics (Opiates):
-what is pain -what is endorphans |
pain
- is an unpleasant sensation disturbing patient's comfort, thought sleep or normal daily activity and is symptomatic of an underlying disease process - is the 5th vital sign Endorphans are the body's own internal analgesic. When opiates stimulate the endorphan receptors the perception of pain is blocked. |
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Narcotics (Opiates) Mechanism of Action
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Endorphans --> blocks perception of pain when stimulated.
people's endorphan varies, some produce more, some less. so pain threshold varies b/w individuals the more endorphans the less pain |
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therapeutic uses of Narcotics
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analgesia (moderate to severe)
antitussive - blocks cough reflex antidiarrheal - side effect of narcotic is constipation. it slows down the GI. not good for Bacterial diarrhea. |
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Pharmacology of Narcotic (Opiates): CNS
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-analgesia without loss of consciousness (moderate to sever)
-drowsiness -behavioral changes (euphoria with Heroin IV, and dysphoria) -depress cough reflex -nauseant and emetic (esp. injectible ones. makes the patient nauseous so the solution is add another drug) **BUT THIS ONLY WORKS FOR NO MORE THAN 3 DAYS** |
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Pharmacology of Narcotic (Opiates): CNS
-toxicities -head injury |
-toxic effects:
respiratory depression and miosis (pupil constriction) this indicates that the pt. od'ed on Narcotics -head injury: pts. who had head injury should not be given narcotics because or the already low resp. drive. |
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Pharmacology of Narcotics: Cardio
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SPECIFIC FOR IV MORPHINE
-orthostatic hypotension -bp goes down when pt. moves -Morphine effects: IV administration decrease cardiac workload during MI ...good property or bad? GOOOD!! during heart attack (MI) we want to decrease heart workload to decrease the demand of O2 in the heart |
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Pharmacology of Narcotics: Gastrointestinal
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-decrease peristalsis = stomach and intestines = decrease diarrhea, increase constipation
-increases biliary pressure. good or bad property of narcotics for pts. with gall stones? -----> BAD! why? because narcotics INCREASES biliary pressure. |
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Pharmacology of Narcotics MISC.
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Uterus - prolongs labor - do not give high doses ..it can stop labor.
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Narcotic Analgesics:
-3 drugs and what they do. |
MORPHINE - intermediate action, but can be given sustained release. decreases cardiac workload (IV). long acting sustained release narcotics for terminal pts.
MEPERIDINE - short acting. used after surgery FENTANYL - extremely potent. dose in mcg because of resp. depression. patch form is available for terminal pts. --> patch is 72 hours. |
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NARCOTIC ANTAGONIST
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-Blocks opiate receptor --works IMMEDIATELY -- pulls narcotic and replaces and blocks it.
-Short acting (45 min.) --> pts. who OD on long acting narcotics goes back and OD again. -precipitates withdrawal. no use for addicts. severe withdrawal immediately - Naloxone (Narcan) |
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Narcotic Agonist/Antagonist
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-stimulates or blocks receptors -- no surge to the brain (100% stimulation) only 50% is being stimulated
-not effective in severe pain -advantages : decrease abuse potential, and decrease addictive potential. less change of causing problems in labor and gall stone pts. -drawback : not for severe pain |
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Narcotic (Opiates): Antidiarrheal
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-effective in non-infectious diarrhea
-decreases GI motility to decrease diarrhea - but will retain toxins and bacteria |
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Narcotic (Opiates): Antitussive
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-why we give antitussive to pt.?
1. so they can sleep, 2. for people with chronic dry unproductive cough. -decreases cough reflex -decreases sternal pain to encourage deep breathing |
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Narcotic (Opiates): Pain control concepts
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-pt controlled analgesia - leads to less use
-chronic terminal pain - addiction is not a concern -post-operative use is a recommendation - not adequately utilized to promote healing --should not be used more than 3 days (addiction potential) |
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Name 9 Narcotic Analgesics (Sched. II)
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-Morphine Sulfate (MS Contin)
-Meperidine (Demerol) is very short acting -Hydromorphone (Dilaudid) -Codeine -also found in combination (eg. Tylenol/Codeine Sched. III) -Hydrocodone (Vicodin) in combo with acetaminophen -sched III -Fentanyl (Sublimaze, Duragesic) inj., patch --use very low dose -Methadone (Dolophine) -Oxycodone (Percodan, Percocet, Tylox, Oxycontin) -Propoxyphene (Darvon) Sched IV |
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Name 3 Narcotic Agonist/Antagonist Analgesics
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-Pentazocine (Talwin) ---why sched. IV? --> Talwin Nx
-Butorphanol (Stadol) - not sched. -Nalbuphine (Nubain) - not sched. |
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Name 1 Narcotic Antagonists
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-Naloxone (Narcan) pure antagonist **CANNOT BE TAKEN ORALLY. only works for IV.
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Name 2 Narcotic Antidiarrheals
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-Diphenoxylate with Atropine (Lomotil) Sched. V --> Atropine is an anticholinergic= slow down GI
-Loperamide (Imodium) no abuse potential. OTC |
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Name 4 Narcotic Cough Preparations
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-Hydromorphone (Dilaudid) Sched II
-Hydrocodone (Hycodan) Sched III -Codeine (Robitussin AC) Sched V -Dextromethorphan (Robitussin DM) OTC no abuse potential (only one on this list) |
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Name 5 Non-Narcotic Analgesics (eg. Salicylates)
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4 SALICYLATES:
-Acetylsalicylic Acid - Aspirin (Bayer, Anacin, Alka Seltzer) -Enteric Coated Aspirin (Ecotrin) -Salsalate (Disalcid) -Choline Salicylate (Arthropan) liquid -Acetaminophen (Tylenol, Anacin III) -*NOT A SALICYLATE |
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Salicylates Therapeutic Properties - all salicylates have these properties
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-Analgesia =mild to moderate pain
-Antipyretic =lowers febrile temperature for fever -Anti-inflammatory =arthritis -Anti-platelet =**Acetylsalicylate only |
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Salicylate: Antiplatelet properties
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-acetylsalicylate only
-transient ischemic attacs (TIA) -post heart attack - lowers possibility of having a second MI -cardiac valve replacement (CVR)=thrombosis. --aspirin = less clotting **that's the new use of baby aspirin. it's now for adults, it's never used for children. and use only in VERY LOW dose of Aspirin |
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Salicylates: GI Effects
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-nausea/vomiting
-Ulcerations -enteric coating to bypass stomach |
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Salicylates: Toxicities
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-tinnitus= early warning- salicylate in the blood is too high
-metabolic acidosis -dehydration |
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Salicylates: Uricosuric Properties
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-higher doses =uricosuric
-uric acid is pushed from the blood to the urine = helpful for gout pts. -retains uric acid at LOW DOSES |
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note to remember about the doses for Salicylates
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LOW DOSES = retain uric acid
HIGH DOSES = uricosuric |
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Salicylates: Hypersensitivity
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-higher incidence in women
-higher incidence in asthmatics -cross sensitivity with some NSAIDs (pts. may also be allergic to Motrin, Aleve)... |
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Salicylates: Doses
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LOW DOSE for Antiplatelet
HIGH DOSE for Anti-inflammatory LOW DOSE to retain uric acid HIGH DOSE for uricosuric |
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Salicylates: Other Uses
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-topical use
1. keratolytic =dissolve on top layer of skin. treatment of warts 2. counter irritant for muscle pain = sports cream --no lactic acid before pain |
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Salicylates: Products
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-Acetylsalicylate =possesses antiplatelet properties
-Salsalate =low incidence of GI irritation (remember its side effects? ulcerations) -Methylsalicylate =extremely TOXIC -your sports creams -NO liquid form of Aspirin -must use Alka Seltzer -liquid aspirin |
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Acetaminophen (not a Salicylate) Properties
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-Analgesic
-Antipyretic -do not have anti inflammatory and platelet properties -dont exceed more than 4g/day -why cough adult syrups are not used for toddlers now? |
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Acetaminophen Toxicities
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-Hepatotoxicities : fatal doses at 25 grams (or 50 strong Tylenol)
-Antidote - must be within 6 hours of OD. --> Acetylcysteine (Mucomyst) have also been used for resp. therapy |
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Rheumatoid Arthritis Intro
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-Auto-immune disease
-progressive -destruction and deformities of joints -juvenile to adult onset -Step therapy (less toxic to more toxic): --> salicylate, NSAIDs. progressively more toxic |
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NSAIDs Properties (Antiarthritic)
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-Analgesic, antipyretic, anti-inflammatory
-has a little bit of antiplatelet property but not used for that, like Aspirin, it can make a pt. bleed |
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NSAIDs Side effects (Antiarthritic)
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-GI effects : nausea, ulcerations
-Na & H2O retention = NSAIDs can increase BP -Decreased renal function -Anti-Platelet = must discontinue prior to a procedure |
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NSAIDs : Indomethacin, Ketorolac, Sulindac (Antiarthritic)
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-Indomethacin =side effects of severe frontal headaches
-Ketorolac =inj. for acute pain, no abuse potential. -Sulindac =low incidence of decreasing renal function (least used) |
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what is the only inj. analgesic in the market that is NOT controlled substance?
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KETOROLAC
no more than 5 days of drug therapy = renal damage also used for drug abusers |
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Cox 2 Inhibitors -Cyclooxygenase 2 receptors) Cox 1 and Cox 2 (Antiarthritic)
-Properties |
**not always prescribed for ulcer pts. because its too expensive only prescribed when 1. severe ulcer 2 no other drug works
PROPERTIES -decreases inflammation with lesser effects on GI tract -specifically inhibits cyclo-oxygenase 2 receptors |
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Cox 1 and Cox 2?
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Cox 1 =production of a muco-protective coating in the intestinal tract (against ulcers) --side effect of pts using this for arthritis?. but less.
Cox 2 =causes inflammation of joints |
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Hydroxychloroquine (Antiarthritic)
-onset of action -misc. -side effects |
-onset of action : 3 months ...add another drug
-also possesses anti-malarial properties (what its originally used for) -side effects: 1.reversible coreal opacity -like cataract 2. irreversible retinal damage -destroys the nerve of the eye, pt. can lose their vision so they have to go to eye exams when on this drug. |
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Intra-Articular Steroids (Antiarthritic)
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-useful if only a few joints involved
-biggest risk is infection and antibiotics don't go to joints easily. -limit on how many joints |
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Systemic Steroids (Antiarthritic)
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-consequences of prolonged use:
adrenal suppression, cataracts, ulcers, depression |
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Gold Therapy (Antiarthritic)
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-inj. =1/month. pill= 1/day but with greater risks of adverse reactions
-gold sodium thiomalate and auranofin -onset of action is 3 moths =add another drug -may slow progression of Rheumatoid arthritis -Adverse reactions : renal damage, and bone marrow depression |
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MISC. Disease modifying antirheumatic drugs (DMARD's)
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-all may slow disease progression
-the following drugs increases the risk of lymphoma and leukemia -Anakinra (Kineret) =inhibits interleukin1 inflammation -Etanercept (Enbrel) =inhibits tumor necrosis factor (TNF) inflammation -Leflunamide (Arava)=inhibits immune modulator inflammation |
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Chemotherapeutic Agents for Rheumatoid Arthritis
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examples: Azathioprine, Methotrexate, Cyclophosphamide
-inhibits immune response- what we want for RA -adverse reactions : carcinogenic (can cause cancer), bone marrow depression, low immune response |
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Gouty Arthritis
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-in-born metabolic error
-over production of urates -under excretion of urates through kidneys -extra uric acid cristalizes in the joint where immune system tries to attack it. -may be secondary to other disease or drug therapy: 1. sickle cell anemia --> (destruction of RBC realease RNA=purines =uric acid) 2. thiazide and loop diuretics can increase uric acid |
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Acute therapy for Gouty Arthritis
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Colchicine (0.6mg)
-blocks migration of granulocytes to inflamed area, causing less urate deposits -side effects: (toxicity) severe diarrhea -dose: is every hour until symptomatic relief or side effects. |
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Prophylactic Therapy for Gouty Arthritis
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-diet-low purine/high carbs: avoid beans, pease, spinach, mushrooms.... restrict meat, fish, seafood, and alcohol....increase intake of H2O.
-Allopurinol (Zyloprim) =decrease metabolic formation of uric acid for over producers -Probenecid (Benemid) or Sulfinpyrazone (Anturane) =uricosuric agents where uric acid is pushed to the urine for under excreters |
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Migraine
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-recurrent headache with N/V
-contraction of intracranial vessels lead to an aura -serotonin causes a compensatory vasodilations that impinges on nerves -contributing factors : 1 tension, 2 medications (birth control pills), 3 food (chocolate, milk) |
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Acute therapy for Migraine
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-medications cause severe vasoconstriction--> not specific for blood vessels in the brain = heart attack
-Ergotamine (Caffergot)= 2dose/24hours -Triptans= warning is no more than 2 dose/24 hours |
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Prophylactic Therapy for Migraine
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-Propranol (Inderal) - beta blocker
-everyday use mechanism is still unknown |
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Name 12 NSAIDs/Antiarthritic/Cox1&2 Inhibitors
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-Indomethacin (Indocin)
-Ibuprofen (Motrin, Advil, Nuprin) -Tolmetin (Tolectin) -Naproxen (Naprosyn, Aleve) -Diclofenac (Voltaren) -Ketorolac (Toradol) -Fenoprofen (Nalfon) -Sulindac (Clinoril) -Etodolac (Lodine) -Piroxicam (Feldene) -Ketoprofen (Orudis) -Meclofenamate (Meclomen) |
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Why do pts. in NSAIDs get ulcers?
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because it blocks Cox 1
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Name 1 Cox 2 Inhibitor
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Celocoxib (Celebrex)
-given to pts. with higher risk of ulcers. very expensive |
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Name 7 DMADs
-slows progression of the disease but are MORE toxic |
-Hydroxychloroquine (Plaquenil)
-Gold Sodium Thiomalate (Myochrisine) -Auranofin (Ridaura) -Etanercept (Enbrel) -Anakinra (Kineret) -Methotrexate (Rheumatrex) chemo drug -Leflunomide (Arava) |
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Name 4 Gout Therapy Drugs
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-Colchicine
-Allopurinol (Zyloprim) -Probenecid (Benemid) -Sulfinpyrazone (Anturane) |
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Name 4 Acute Migraine Drugs
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-Ergotamine (Caffergot)
-Sumatriptan (Imitrex) -Rizatriptan (Maxalt) -Zolmitriptan (Zomig) |
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What are the warnings when using Migraine Therapy Agents?
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make cause heart attack
...drug mechanism = non specific vasoconstriction = increase cardiac workload = heart attack |
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1 Prophylactic Migraine Drug
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Propranolol (Inderal)
-taken every day -taken before aura/migraine |
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Autonomic Nervous System Intro
-Purpose/primary function |
-maintain stable internal environment by coordinating, adjusting, and regulating the body's visceral activity
-examples include: digestion, body temperature, heart reate -primary function is to maintain homeostasis. |
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ANS Parasympathetic division
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-cranio-sacral system
-conserve and restore energy increase GI and sweat decrease BP |
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ANS Sympathetic Division
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-Thoraco-lumbar system
-Prepares body for stress and emergency -also non-stress regulation increase BP and sweat decreases GI |
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Neurofiber Anatomy
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-Pre-ganglionic and post-ganglionic fibers
-neurotransmitter vesicles -junctional spaces -receptors |
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Parasympathetic Fiber
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-post-ganglionic neurotransmitter: Acetylcholine
-receptor site: Muscarinic -Activity stopped by Acetylcholine esterase |
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Sympathetic Fiber
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-Post-ganglionic neurotransmitter: Norepinephrine (Catecholamine)
-Receptor Site: alpha, beta1, beta 2 -Activity stopped by: Reuptake (primary mechanism) and Mono amine oxidase (MAO) destroys NE |
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Neurohormonal Transmission: Acetylcholine
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-released by all pre-ganglionic fibers (stimulates nicotinic receptors)
-post ganglionic parasympathetic fibers (stimulates muscarinic receptors) |
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Neurohormonal Transmission:
Norepinephrine |
-post ganglionic sympathetic fibers (stimulates alpha, beta 1 and beta 2 receptors)
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Parasympathetic effects in the Eye
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-miosis (pupil constriction)
-lacrimation (tear secretion) -accommodate for near vision (fixed for reading) -decreased intra-ocular pressure (decrease symptoms of glaucoma) |
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Parasympathetic effects in the Digestion
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-increase saliva secretion
-increase stomach acid = ulcer -increase peristalsis = diarrhea |
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Parasympathetic effects: cardio, lungs, and bladder
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-decrease heart rate
-bronchial constriction (asthmatics) =bad property--> muscarinic receptor stimulates this--> antiasthmatic drugs = blocks muscarinic =anticholinergic = asthma -Enhances urination: bladder contraction, and sphincter relaxation |
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Parasympathomimetic Agents
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-Bethanechol =stimulates GI motility and bladder (specific for GI & bladder contraction) - for pts who came out of surgery and to stimulate them
-Pilocarpine =ophthalmic - lowers intra-ocular pressure =gluacoma pts. |
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Parasympathomimetic Agents Contraindications
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-asthma
-cardiac insufficiency -peptic ulcer -eye drps may still be used with precaution (make sure it does not drain and get in the blood stream) |
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Acetylcholine Esterase Inhibitors
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-blocks acetylcholine esterase enzyme from breaking down acetylcholine
-pharmacology will be similar to parasympathomimetic agents, just mechanism of action differs |
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Edrophonium
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-Acetylcholine Esterase Inhibitor
-short acting reversible = minutes. only used for diagnosis. -diagnose myasthenia gravis -muscle weakness. theory is body does not produce enough Ach |
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Intermediate acting reversible agents
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-Neostigmine and Pyridostigmine:
treatment of myasthenia gravis -Physostigmine: ophthalmic agent -lower intra-ocular pressure (glaucoma) -Donepezil, Galantamine, Rivastigmine: temporarily lessen symptoms of Alzheimer's Disease - theory is the body not producing enough Ach. |
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Long Acting Irreversible Agents
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Echothiophate and Isofluorphate:
-Organophosphate (used in pesticides, bannned in US) toxic agents --powerful treatment for glaucoma but cant go to blood stream -Must use precaution when administering by placing pressure on the corner of the eye -only utilized as an ophthalmic agent |
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Anticholinergics
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-blocks muscarinic receptor so that acetylcholine cannot bind and stimulate
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Anticholinergic effect on the eye
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-dry eye
-accommodate for far vision -mydriasis -dilate pupil -increase intra-ocular pressure |
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Anticholinergic effect on digestion
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-decreased saliva production
-decreased acid production = decrease ulcer -decreased peristalsis =constipation |
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Anticholinergic effect: cardio, pulmonary, and urinary
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-increased heart rate (good for bradycardia)
-urinary retention especially in BPH (esp. prostatic pts) -bronchodilation (asthmatics) |
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Anticholinergic order of sensitivity (by dose)
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-secretory (saliva, sweat, stomach acid)
-eye -heart -GI motility (highest dose, but more side effects and secretory, eye, heart, are being affected) |
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Anticholinergic Therapeutic Use
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1. Natural Alkaloids
-prior to procedure (decrease aspiration) to avoid secretions and infection during procedure -sinus bradycardia -motion sickness -GI cramping to slow down peristalsis 2. Antispasmodic (bladder/GI) 3. Mydriatic (dilates eyes) and Cycloplegic (far vision) -opthalmic exam (eye drops for testing) |
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Anticholinergic Contraindications
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-Myasthenia gravis b/c body does not make enough Ach so we wanna save s many Ach as possible
-Narrow angle glaucoma : most have wide angle -unstable cardiovascular system: we don't want to keep stimulating the heart -intestinal atony: don't have bowel sounds= no peristalsis |
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Sympathetic (Adrenergic)
Alpha, Beta 1, Beta 2 properties |
Alpha
-vasoconstriction= increase BP = good for shock -stimulate sweat and salivary gland -decrease intra-ocular pressure Beta 1 -increase heart rate and force of contraction= shock pts = increase cardiac output Beta 2 -bronchodilation, smooth muscle relaxation for asthmatics and for uterus to relax. used for premature labor to slow/delay it. |
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Epinephrine: Alpha, Beta 1, 2
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Alpha
-decrease IOP -prolong action of local anesthetics and decrease bleeding (very small amount for its alpha properties) Beta 1 -increase blood pressure in shock Beta 2 -relieve bronchospasm -status asthma -non-stop asthma and anaphelactic shock (ex. "epipen") |
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Advantages of Alpha properties of Epinephrine?
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1. constricts BV = no bleeding
2. constricts BV =anesthetic stays in that area |
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Levarterenol
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Alpha
-very strong vasoconstriction --too strong that it can cause heart failure -reversed by Alpha blocker so no strain on the heart. alpha property of Levarterenol is not wanted so we add another drug to block it. Beta 1 -increases blood pressure in shock |
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Isoproterenol
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Beta 1
-increase blood pressure = shock Beta 2 -bronchodilation =asthma (inhaled or injected) |
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Dopamine
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Dopamine (outside CNS)
-Renal Artery Dilation for shock pts. =urine output is decreased during shock Beta 1 -increase blood pressure =shock Alpha -very strong vasocontriction (dose rate dependent) =decrease infusion rate of Dopamine so it does not reach alpha level |
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Dobutamine
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Beta 1
-cardiogenic shock |
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Bronchodilators
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Beta 2 Stimulation
Beta 1 Spill over can increase heart rate, sweat, solution=inhalation* -best avoided by giving via inhaled route and utilizing a beta 2 specific agent (ex. Albuterol ) |
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Alpha Stimulants
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Opthalmic Decongestants
-getting congestant out of eye =getting red eye out =Visine warning*: do not use moe than 3 days--> autonomic rebound effect and eyes will get redder than ever Nasal Decongestant -oral products may also increase BP -topical nasal sprays should not be used for more than 3 days - can cause addiction |
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Alpha blocking agents
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Pheochromocytoma
-disease/tumor in the adrenal gland -secretes NE that increases BP Reverse Alpha properties of Levarterenol -Phentolamine |
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Beta Blockers
|
-Utilized to block beta 1 receptors
-all will have beta 2 spill over, some more than others (asthmatic will have problem with this -->blocking B2 = bronchoconstriction) |
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Beta Blockers Use
|
-Arrythmia (tachycardia) =B1 blockade slows BP
-Hypertension (decrease renin release) high renin hypertension = block or decrease release of renin -angina = blocker decrease 02 demand = B1 blocked = decrease HR = decrease O2 demand diminishes -post MI = beta blocker increases survival (used prophylactically) -migraine also used prophylactically |
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Beta blocker caution
|
-Asthma =use Beta 1 specific
-insulin dependent diabetic = masks symptoms of hypoglycemia -peripheral vascular disease = poor blood flow to the lower extremities |
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Hypertension Intro
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-afflicts over 60 million americans
-diagnosis -diastolic > 90 systolic > 140 -age, # of readings (best taken in the morning) -etiology: essential (primary), and secondary (high renin, Cushing's, drugs) |
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Hypertension long term consequences
|
-renal, cardiac, vascular
-non-pharmacologic therapy -diet = decrease weight, decrease Na, decrease alcohol, decrease fats -decrease smoking -increased exercise -relaxation techniques |
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Hypertension: Pharmacologic Therapy
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short term benefits versus long term
-VHA Coop Study = benefits demonstrated -mortality and morbidity consequences |
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Causes of Therapeutic failures : coop study
|
-compliance = drug side effects
-insufficient dose -non-compliance to diet/exercise -drug interactions -acquired resistance |
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step approach : hypertension step 1
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-diuretic
-beta blocker -alpha adrenergic blocker -ace inhibitor -calcium channel blocker |
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step approach : hypertension step 2
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-sympatholytic
-beta blocker -alpha adrenergic blocker -ace inhibitor -calcium channel blocker |
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step approach : hypertension step 3
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-vasodilator
|
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step approach : hypertension step 4
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-sympatholytic --> Guanethidine
|
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Diuretics
-Definition -Use |
Definition = increases formation of urine
Use = -management of edema (worse lungs) - CHF, cranial, ascites (fluid build up in the abdominal area) -hypertension -maintain urine flow -shock -protect from nephrotoxic agent -glaucoma |
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Osmotic Diuretics (1st category)
|
-non -electrolyte
-freely filterable at glomerulus -pharmacologically inert = no receptors = no side effects -osmotically pull active particles into blood stream and into uring -no effect on serum electrolyte balance |
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Osmotic Diuretics
-toxicities -use |
toxicities
-increased cardiac work load use -maintain urine volume during shock/renal failure -protect against nephrotoxic agents -glaucoma -intraocular pressure decreased -cerebral edema - often trauma |
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Carbonic Anhydrase Inhibitors (2nd category)
|
Pharmacology
-increases loss of bicarbonate in urine and loss of sodium -diuretic effects works for only 3 days (short term) -decrease intraocular pressure effects continues indefinitely if used more than 3 days can cause metabolic acidosis and resp. complications |
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Carbonic Anhydrase Inhibitors
-toxicities -use |
toxicities
-drowsiness -metabolic acidosis therapeutic use -short term diuretic -glaucoma |
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Thiazide Diuretics
|
pharmacology
-blocks reabsorption of Na and H20 in distal tubule of kidney -Metolazone also blocks reabsorption in the proximal tubule of kidney -increases secretion of K into urine |
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Thiazide Diuretics other metabolic effects
|
-increases blood uric acid (gout pts), sugar, cholesterol, and triglyceride
-increases blood Ca -decreases blood K, and Magnesium |
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Thiazide Diuretics
-Use |
-hypertension
-management of Edema (Metolazone with or without a loop diuretic) -contraindication: hypercalcemia |
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Loop Diuretics (4th Category)
|
pharmacology
-blocks reabsorption of Na and H2O in ascending loop of henle (more powerful diuretic) -increases secretion of K into urine |
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Loop Diuretics
-toxicities -other metabolic effects |
toxicities
-Ototoxicity, nephrotoxicity other metabolic effects -increases blood uric acid, sugar, cholesterol, and triglyceride -decreases blood Ca * -decreases blood K and Magnesium |
|
Loop Diuretics
-Use |
-hypertension
-management of Edema -treatment of hypercalcemia |
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Potassium Sparing Diuretics (5th Category)
-direct acting -indirect acting |
direct acting
-Triamterene -Amiloride -blocks reabsorption of Na and H2O in collecting duct of nephron indirect acting -Spironolactone -competetive inhibitor of Aldosterone |
|
Potassium sparing diuretics
-pharmacology |
-minimal diuretic effects
-decreases secretion of K into urine |
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Potassium sparing diuretics
-use and therapeutic alternatives |
therapeutic use
-spare K loss of diuretics -additional uses of Spironolactone (block aldosterone) =edema with liever failure and congestive heart failure therapeutic alternatives -foods high in K -K supplement - caution with IV administration |
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Potassium sparing diuretics
-toxicities |
-hyperkalemia = therefore K is not administered concurrently
|
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Sympatholytics (6th category)
|
Step 2 therapy
Side effects -Na and H2O retention -postural hypotension -constipation -dry mouth -impotency |
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Sympatholytic Agents
|
Clonidine
- rebound hypertension if not compliant -patch alternative -may be used for acute high BP Methyldopa Reserpine -noted to cause breast CA Guanethidine -4th step due to diarrhea |
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Hypertension : Beta Blockers
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-blocks renin release
-caution: diabetics (masks hypoglycemia) and asthmatics (effect of Beta 2) |
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Hypertension : Alpha Adrenergic Blockers
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-Dual mechanism = blocks alpha receptor and directly causes vascular smooth muscle vasodilation
-no rebound tachycardia -first dose effect = caution for syncope |
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Hypertension : Alpha Adrenergic Blockers
-uses |
-hypertension
-prostate hyperthropy -shrinks prostate |
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Hypertension : Vasodilator (Step 3)
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-direct relaxation of vascular smooth muscle
-rebound tachycardia (beta blocker 1) -Na and H2O retention |
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Hypertension :Vasodilator Agents
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Hydralazine
-side effect= lupus like syndrome= affects joints and skin. dose related Minoxidil -side effect = hair growth Nitroprusside (used for hypertensive emergency) -dilates arterioles and venules -therapy cannot exceed 3 days or leads to thiocyanate poisoning (muscle spasm, stupor) Diazoxide -side effect =hyperglycemia -very poor control of the lowering of blood pressure |
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Hypertension : Angiotensin Converting Enzyme Inhibitor
|
-blocks conversion of angiotensin 1 to angiotensin 2
-side effects = non productive cough -use = hypertension, congestive heart failure, diabetic renal sparing |
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Hypertension: Angiotensin Receptor Blocker
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-utilized for pts. that cannot tolerate side effects of ACE inhibitors
-examples: Losartan, Irbesartan |
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Hypertension: Calcium Channel Blocker
|
-blocks entry of Ca into cells
-prevents contraction of vascular smooth muscles use -hypertension -angina -arrhythmia |
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Name 2 Parasympathomimetic Agents (cholinergic drugs)
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-Bethanechol (Urecholine) = stimulate GI motility and bladder
-Pilocarpine (Pilocar) = short acting glaucoma drug |
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Name 7 Anticholinesterase agents (Acetylchilinesterase inhibitors)
|
-Edrophonium (Tensilon) = diagnosis for myasthenia gravis
-Neostigmine (Prostigmin) = treatment for myasthenia gravis -Physostigmine (Eserine) -Pyridostigmine (Mestinon) =treatment for myasthenia gravis -Donepezil (Aricept) -treatment for Alzheimer's disease -Galantamine (Reminyl) -treatment for Alzheimer's disease -Rivastigmine (Exelon) =treatment for Alzheimer's disease |
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Name 4 Anticholinergic drugs : Natural Alkaloids
|
-Atropine = used before surgery to dry up secretion. found in crash carts for bradycardia
-Belladonna =dilates eyes. intestinal cramping -Hyoscyamine =for intestinal cramping -Scopolamine (Hyoscine) =before procedure to dry out secretions. patch form is used for motion sickness |
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Name 3 Synthetic Antispasmodic Drugs (anticholinergic)
|
-Dicyclomine (Bentyl) =specific for intestinal cramping
-Oxybutynin (Ditropan) =specific for bladder contractions/incontinence -Tolterodine (Detrol) =specific for bladder contractions/incontinence |
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Name 3 Synthetic Anticholinergic drugs
|
-Glycopyrrolate (Robinul) =use before surgery to dry secretions
-Propantheline (Pro-Banthine) =not commonly used because of its too many side effects. but some still used for ulcers -Ipratropium (Atrovent) =inhaler for asthma |
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Name 5 Mydriatics and Cycloplegics
|
-Atropine =long acting m&c
-Cyclopentolate (Cyclogyl) =short acting m&c -Homatropine (Homatrocel) =short acting m&c -Scopolamine (Hyoscine) =short acting m&c -Tropicamide (Mydriacyl) =mydriasis only |
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Name 5 drugs used in shock (Sympathomimetic/Adrenergic)
|
-Epinephrine (Adrenalin)
-Isoproterenol (Isuprel) -Levarterenol (Levophed) -Dopamine (Intropin) -Dobutamine (Dobutex) |
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Name 5 Adrenergic Bronchodilatros/ Beta 2 bronchodilators
|
-Metaproterenol (Alupent)
-Pirbuterol (Maxair) -Albuterol (Ventolin, Proventil) = "rescue inhalers" for acute =draw back is it can't be over use = beta 1 spill over =heart attack -Terbutaline (Brethine, Bricanyl) -Salmeterol (Serevent) =Prophilactic and sometimes mixed with steroids, Advair. should only be inhaled 2/day |
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Name 3 Nasal Decongestant
|
-Phenylephrine (Neo-Synephrine)
-Oxymetazoline (Afrin) -Pseudoephedrine (Sudafed) =long term pts. with high BP cannot use this |
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Name 2 Alpha blocking agents
|
-Phenoxybenzamine (Dibenzyline) =Pheochromocytoma disease
-Phentolamine (Regitine) =reverese Alpha properties of Levarterenol |
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Name 5 Beta Blocking Agents (Beta1/2 non selective)
|
-Propranolol (Inderal)
-Nadolol (Corgard) -Timolol (Blocadren) -Pindolol (Visken) =also ISA activity -Labetalol (Normodyne, Trandate) =also alpha blocking activity |
|
Name 3 Beta Blocking agents (Primarily Beta 1 activity)
|
-Atenolol (Tenormin)
-Metoprolol (Lopresor) -Acebutolol (Sectral) =also ISA activity |
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Name 3 Opthalmic (Topical) Sympathetic Blocking Agents
|
-Timolol (Timoptic)
-Betaxolol (Betoptic) -Levobunolol (Betagan) =primarily beta 1 |
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Name 3 Osmotic Diuretics
|
-Mannitol =can be used for glaucoma, shock and nephrotoxic kidneys
-Hetastarch (Hespan) =shock -Albumin =naturally occurring protein in our blood stream |
|
Name 3 Carbonic Anhydrase Inhibitor
|
-Acetazolamide (Diamox)
-Methazolamide (Neptazine) -Dorzolamide (Trusopt) =ophth drop =less potential for side effects if use for glaucoma |
|
Name 4 Thiazide Diuretics
|
-Chlorthiazide (Diuril)
-Hydrochlorthiazide (Hydrodiuril) -Metolazone (Zaroxolyn) = **works on both proximal/distal tubule making it synergistic with the loop diuretics |
|
Name 4 High ceiling loop diuretics
|
-Ethacrynic Acid (Edecrin)
-Furosemide (Lasix) -Bumetanide (Bumex) -Torsemide (Demadex) |
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Name 3 Potassium sparing diuretics
|
-Spironolactone (Aldactone)
-Triamterene (Dyrenium) -Amiloride (Midamor) |
|
Name 5 Sympatholitic Antihypertensives
|
-Methyldopa (Aldomet)
-Clonidine (Catapres) -also topical -Reserpine (Serpasil) -Guanabenz (Wytensin) -Guanethidine (Ismelin) =4th step drug |
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Name 8 Beta blocking Antihypertensive Agents
|
-Propranolol (Inderal)
-Metoprolol (Lopresor, Toprol XL) -Nadolol (Corgard) -Timolol (Blocadren) -Atenolol (Tenormin) -Pindolol (Visken) -Acebutol (Sectral) -Labetalol (Normodyne) |
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Name 3 Alpha Adrenergic Blocking Agents
|
-Prazosin (Minipres)
-Terazosin (Hytrin) -Doxazosin (Cardura) |
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Name 4 Vasodilators
|
-Hydralazine (Apresoline)
-Minoxidil (Loniten) -Diazoxide (Hyperstat) -Nitroprusside (Nipride) |
|
Name 7 Angiotensin Converting Enzyme Inhibitor
|
-Captopril (Capoten)
-Enalapril (Vasote) -Lisinopril (Zestril, Prinivil) -Benazepril (Lotensin) -Fosinopril (Monopril) -Quinapril (Accupril) -Ramipril (Altace) |
|
Name 5 Angiotensin receptor blocker
|
-Irbesartan (Avapro)
-Losartan (Cozaar) -Valsartan (Diovan) -Candesartan (Atacand) -Telmisartan (Micardis) |
|
Name 9 Calcium Channel Blocking Agents
|
-Diltiazem (Cardizem)
-Diltiazem SR (Cardizem SR) -Diltiazem Long Acting (Cardizem CD, Dilitrate XR) -Felodipine (Plendil) -Nicardipine (Cardene) -Nifedipine (Procardia, Adalat) -Nifedipine XL (Procardia XL, Adalat CC) -Verapamil (Calan, Isoptin) -Verapamil SR (Calan SR, Isoptin SR) |
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What is the receptor site in a parasympathetic fiber?
|
muscarinic
|
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What is the receptor site in a sympathetic fiber?
|
Alpha, beta 1, and beta 2
|