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120 Cards in this Set
- Front
- Back
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What are the 2 sites ACh works on
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muscarinic and nicotinic
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what site has parasympathetic response
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muscarinic site
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What is urecholine
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parasympathetic drug
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indications of urecholine
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used for urinary retention to contract sphincter and cause urination and to increase GI motility
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Side effects of urecholine
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bradycardia, miosis, GI cramp and diarrhea, decreased blood glucose, bronchioconstriction
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What is pilocarpine/ salagen tablets
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parasympathetic drug
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What is the indications for pilocarpine/salagen
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reverses dry mouth (xerostomia) and to test for cystic fibrosis
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Side effects of pilocarpine/salagen
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parasympathomemtic side effects
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What do anticholinesterase drugs do
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block the enzyme anticholinesterase to increase ACh
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What are anticholinesterase drugs used for?
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myastehnia gravis, or post op to reverse the use of muscle relaxants
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What types of drugs are anticholinesterase drugs
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H2O soluble
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Side effects of anticholinesterase drugs
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blocks Ach at both sites/ parasympathetic side effects
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What are the anticholinesterase drugs?
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Neostigmine (Prostigmin) and pyridostigmine (mestinon)
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What are lipid soluble anticholinesterase drugs
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tacrine and aricept
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What is aricept used for
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alzheimers disease/ senile dementia
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What are used for alzheimers/senile dementia
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aricept and tacrine (cognex)
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How do anticholinesterase drugs work
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increase Ach by destroying the enzyme that destroys ACh
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What occurs in alzheimers
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tau protein builds up and brain cells tangle up
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What are anticholinesterase drugs used as insectisides
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organophosphates
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What warfare item is made from organophosphates
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nerve gas
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What is the cure for organophosphates
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atropine and immediate is 2pam
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What does organophosphates do
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increase ACh causing paralysis and so you must remake the enzyme acetylcholinesterase
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What are anticholinergic drugs
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they are competitive blockers with Ach at muscarinic site
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What is the prototype anticholinergic drug
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atropine
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What is atropine
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prototype anticholinergic drug that is h2o soluble
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What are the 3 belladone alkaloids
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atripine, hyoscyamine, scopolamine
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WHat is the difference between scopalomine and the prototype atropine
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scopolamine is lipid soluble
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What does scopolamine do
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decrease GI motility and acid secretion, decrease N and V, decrease diarrhea, helps with urinary urganecy, ulcers, and psych drugs
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What are the side effects of anticholinergics
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sympathomimetic side effects: overheat, decreased generalized sweating, blurred vision, decreased salivation, crosses BBB in high doses and causes hallucinations
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Saying for side effects of anticholinergics
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hot as a hare, blind as a bat, dry as a bone, mad as a hatter
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Antidote for anticholinergics
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anticholinesterase
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What are teh synthetic agents of anticholinesterase
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dicyclomien (bentyl) and propantheline (probanthine)
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What are nursing considerations for anticholinergics
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caution in diabetic patients because tehy block the parasympathetic and cause symp. response causing increased in blood sugar and contraindicated with glaucoma
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What is wide angle glaucoma
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increased production of acqueous humor which plugs the drain and the acqueous humor builds up
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What is narrow angle glaucoma
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intense pain, close to lens and defect in the iris, bumps against the iri and pressure builds up and can't drain: cuts the back of the iris
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Where is acqueous humor made by?
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ciliary processes in the post chamber and goes to the anterior chamber
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What is the point of acqueous humor?
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bring nutrients to the eye
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What is normal intraocular pressure
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10-12 mmHg
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What type of glaucoma is medical emergency
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narrow angle
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What is a drug for glaucoma
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pilocarpine/ parasympathetic drug that causes miosis (constriction)
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What are the side effects of pilocarpine
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It binds to the protein melanin and if you don't close off the putamin, it can go to the blood, cause bronchioconstriction (bad for ashmatics)
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Another med for glaucome
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carachol
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What is the drug of choice for glaucoma
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beta antagonist: timoptic
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What decreases acqueous humor production
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timoptic
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What are 2 other beta antagonists for glaucoma
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betopic, betagan
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What is the 2nd drug of choice for glaucoma
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Xalaton: prostaglandin analog: makes eyelashes grow and makes light eyes dark
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What are meds contraindicated in glaucoma
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sympathomemetic (be cause they cause dilation and build up pressure) and anticholinergics
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What is alpha stimulation
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eyes, peripheral blood vessels
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Beta stimulation
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heart, central blood vessels, blood glucose, adn lungs
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What can beta stimulation cause
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tachycardia
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What is epinephrine (adrenaline)
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catacholimines (sympathetic drug)
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What is epinephrine used for?
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code blue: stimulates heart (B1) and for anaphylactic shock (increases BP) bronchodilation for asthma)
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Side effects of epinephrine
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tachycardia, increased blood sugar
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What is cuation with epinephrine
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diabetics, heart disease, peripheral vascular disease (further vasoconstriction)
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Can you take epinephrine orally?
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no its protein and is digested
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HOw can you take epinhephrine?
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inhalation or injection
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What makes xylocaine work longer?
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epinephrine because it constricts peripheral vascular
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What is another name for norepinhephrine?
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levophed
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What are the MOA for NE?
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alpha and beta1
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What is the MOA for E
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alpha and beta 1 and beta 2 and mimics the ENTIRE sympathetic nervous system
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Can NE be taken orally?
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no its a protein and is digested
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What are indications for NE
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cardiac arrest if E fails, shock
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Side effects of NE
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extended effect, tachycardia
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What must you do with levophed drip?
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always watch to make sure it does not leak into tissues
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What happens if NE leaks into tissues
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causes intense vasoconstriction and necrosis and gangrene
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What is the antidote if NE leaks onto tissues?
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alpha blocker
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What is isoproterenol (isuprel)
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beta stimulants
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MOA of isoproterenol
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for cardiac arrest (B1) and for asthma to dilate (B2)
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Can isoproternol be taken orally
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no, its a protein and will be digested
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Side effects of isoproternol
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tachycardia
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What causes peripheral vasoconstriction
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E and NE
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What causes bronchodilation with no midriesis?
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isoproterenol
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What increases HR and glucose
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epinephrine and isoproterenol
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What causes peripheral vasoconstriction, increased HR, and increased glucose
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epinephrine
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What is terbutaline/ brethine?
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beta stimulant
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What is the MOA of terbulaine/ brethine?
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asthma or premature labor (relaxes uterus)
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Can brethine be taken orally?
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yes
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What is albuterol (proventil/ventolin)?
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selective beta stimulant
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What is albuterol selective for?
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B2 > B1: want bronchodilation not tachycardia
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What is ritordine/ yutopar?
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OB: Beta stimulant: relaxes uterus
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What is dobutamine/ dobutrex?
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selective beta stimulant: B1> B2 for the heart
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What is the MOA of dopamine/intropin?
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works on dopamine, alpha, and B1 receptors
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Indications of dopamine/intropin
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blood vessels to the kidneys dilate and cause urination
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What is left and right handed
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ephedrine/ ma huang
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WHat is the MOA of ephedrine
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acts like oral epinephrine: a, B1, B2
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Indications of ephedrine
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asthma, rhinitis (nose run), nocturnal inuresis (not really), almost exactly like amphetamines
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How does ephedrine help rhinitis?
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constricts peripheral blood vessels
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What is pseudoephedrine/ sudafed?
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alpha stimulant: optical isomer of ephedrine: helps runny nose and nasal decongestant
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Entrance of pseudoephedrine
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IV drip, nasal spray
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What is another alpha stimulant
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phenylpropanolamine
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What is the MOA of alpha blockers
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frost bite, peripheral vascular disease (causes vessels to dilate)
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What are some alpha blockers?
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pheoxybenzamine (dibensyline) and phentolamine (regitine)
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What is the alpha blocker used if levophed is leaked on skin
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regitine
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What does regitine do?
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causes pupils to constrict and increases blood flow for impotency and vasodilation
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Whats the down side of regitine for impotency
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injetion into penis
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WHat is the MOA of Ergot
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vasoconstriction gangrene, miscarriage, no dilation, vasoconstriction, smooth muscle contractions
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What are the indications of Ergot
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migraine headaches, post delivery
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Side effects of Ergot
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chornic ergot toxicity (peripheral vascular tingling and muscle cramps and gangrene)
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What are contraindications of ergot
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will induce labor and abortion: DO NOT TAKE DURING PREGNANCY
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What is caffergot?
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product of ergot: hydrogine: safe with no vasconstriction, makes the brain use more glucose: good for memory
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What is the ergot used in Ob?
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methergine: used to control post partum bleeding and causes vasoconstriction to reduce blood loss and causes the uterus to involute after delivery
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What is the prototype of triptans?
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sumatriptan/ IMITREX
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What is imitrex
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5 HT antangonist; DRUG OF CHOICE FOR MIGRAINES
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What is drug of choice for migraines?
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imitrex
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What is the MOA of beta blockers
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blocks Beta receptors
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What are the indications for beta blockers?
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headaches, increased BP, angina
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What are side effects of beta blockers?
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bradycardia
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What are contraindications of beta blockers
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asthma, peripheral vascular disease, diabetic (can cause hypoglycemia and then mask the symptoms), and never suddenly stop it can cause myocardial infarction
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Why do those with peripheral vascular disease need to worry with beta blockers
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unopposed alpha
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What is the prototype beta blocker?
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propanolol (inderal)
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What are indications of inderal
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heart disease, increased BP, hyperthyroid
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What are the dose of inderal dependent on
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hepatic first pass effect
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What will inderal do
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make you drowsy: hepatic first pass effect: crosses BBB
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What is a nonselective beta blocker?
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inderal: blocks beta 1 and 2
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What is a selective beta blocker that blocks B1>B2?
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metoprolol (lopressor)
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What is metoprolol used for?
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to lower BP
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What is another selective B blocker
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timolol (blocadren, timoptic)
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Some other beta blockers
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acebutolol (sectral), pindolol (visken)
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What helps make BP normal and is an alpha and beta blocker
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normodyne (labetalol/ trandate)
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What is the drug of choice for hypertensive crisis
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normodyne
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