Pharmacology Notes PDF

Statins Hydroxymethylglutaryl-coenzyme (HMG-CoA) reductase inhibitors Examples: Simvastatin, atorvastatin, rosuvastatin Notice the “statin” suffix Reduce the production of cholesterol Common side effects: Headache, dizziness, blurred vision, constipation, diarrhea, nausea, myopathy> muscl...

Statins Hydroxymethylglutaryl-coenzyme (HMG-CoA) reductase inhibitors Examples: Simvastatin, atorvastatin, rosuvastatin Notice the “statin” suffix Reduce the production of cholesterol Common side effects: Headache, dizziness, blurred vision, constipation, diarrhea, nausea, myopathy> muscle weakness, skin rashes, Myalgia> muscle pain Lifespan considerations: Contraindicated in those who are pregnant or breastfeeding or those under 10 years of age. Use caution with older adults: increased risk of myopathy>muscle weakness Beta Blockers Hypertension, angina, MI and dysrhythmias Block beta1 receptors in the heart, slowing conduction and reducing myocardial contractility Contraindicated in decompensated heart failure and serious conduction disturbances, can cause block of beta 2 blockers. Used with caution in patients with asthma Can mask tachycardia Side effects: Hypotension, bradycardia, dizziness, fatigue, wheezing, dyspnea Examples: Atenolol, lebatalol, metoprolol Notice the “olol” suffix  ACE inhibitors Angiotensin-converting Enzyme inhibitors TE: Block the production of salt and water in the nephron Blocks the conversion of Angiotensin 1 into Angiotensin 2 Prevent/ stop the Vasoconstriction of Angiotensin and the absorption of Na and water by inhibiting aldosterone secretion Used in Hypertension, heart failure, post MI Also protective of kidney Examples: captopril, lisinopril, ramipril- all end in pril CANNOT GIVE IN IV Suffix: “pril” Most ACE inhibitors are prodrugs Can cause significant fetal morbidity and mortality Side effects: fatigue, dizziness, headaches, dry cough, hypotension, hyperkalemia, ANGIOEDEMA Angioedema- IF SOMEONE HAS ACE INHIBITOR REACTION SUCH AS THIS MUST STOP THE DRUG Angioedema- rare but potentially fatal side effect Swelling beneath the skin, unlike hives, which are on the top of the skin  Non-pitting edema affecting the lips, face, oral cavity, larynx and gut |” ?CFds Angiotensin 2 receptor blocker (ARB) Also works on the RAAS system MOA: Block angiotensin 2 at the site of the receptor Examples: losartan, candesartan, telmisartan Notice the “sartan” Blocks vasoconstriction and the release of aldosterone Do not cause cough Indications: hypertension, adjunctive for heart failure Contraindications: Pregnancy and lactation, caution in older adults and renal dysfunction Side effects: headache, dizziness, fatigue, hyperkalemia much less likely  Calcium Channel Blockers 3 classes within Calcium is used in the process of triggering heart and vascular smooth muscle cells Blocking calcium channel prevents muscle contraction and relaxes the smooth muscle- causes arterial definition Slow the SA node, decrease conduction through AV node Indications: angina, hypertension, some dysrhythmias, migraine headaches and Raynaud's disease Contraindications: acute MI, some hearts blocks Side effects: Peripheral edema, STEVEN-JOHNSON, ARRHYTHMIAS Examples: Diltizem (benzothiazepine), amlodipine (dihydropyridine), verapamil (phenylalkylamine) Diuretics For the treatment of heart failure, hypertension, fluid overload Different categories within this class: carbonic anhydrase inhibitors,  loop diuretics, Loop diuretics: most common is furosemide Blocks Water and sodium resorption Also though to activate kidney prostaglandins which cause vasodilation systemically Prolonged use can cause ototoxicity- tinnitus, hearing loss Side effects: Hypokalemia (potassium wasting), dizziness, dehydration, other electrolyte imbalances Gives off Potassium Potassium-sparing diuretics: spironolactone most common Competitively binds with aldosterone receptors, block resorption of sodium and water Not as strong as thiazide and loop diuretics Side effects: dizziness, headache, cramps, hyperkalemia, urinary frequency, weakness> Anything that messes with your electrolytes + water Thiazide and thiazide-like diuretics  Thiazide diuretics contain the word thiazide- most common is hydrochlorothiazide Inhibit the reabsorption of sodium, potassium and chloride Also relax arterioles Efficacy of the drug decreases with decreasing kidney function-contraindicated in severe kidney failure Can cause hypokalemia and hypercalcemia Side effects: Dizziness, headache, blurred vision, nausea, vomiting, diarrhea Diuretics Across The Lifespan Thiazide diuretics cross the placenta and small amounts are distributed in breastmilk Children are at a greater risk for side effects and toxicity and should be closely monitored Diuretics should not be given in the evening to prevent nocturia, especially in older adults- this should not stop administration in emergency situations Help those that take diuretics to move slowly Position should be changed slowly d/t the risk of orthostatic hypotension Vasodilators Work directly on vascular smooth muscle to cause relaxation Most common is hydralazine Minoxidil is also in this category Contraindications: Hypotension, cerebral edema, head injury, acute myocardial infarction and coronary artery disease> Do not want to change pressure in the head Side effects: Dizziness, anxiety, tachycardia, edema, nausea  Cardiovascular part 2 1.Drugs affecting the Cardiovascular and Renal Systems a.Define key terms related to the cardiovascular and renal systems b.Compare the mechanisms of action, pharmacokinetics, indications, contraindications, adverse effects and toxicity to selected classes of drugs: i.Cardiac glycosides. ii.Antianginal drugs. iii.Antihypertensives. iv.Diuretics. v.Heart failure drugs vi.Antidysrhythmic drugs vii.Fluid and electrolytes c.Identify considerations and implications of using cardiovascular and renal drugs across the life span d.Identify related drug categories by the suffix of the generic name where applicable Angina SUBLINGUAL DO Not shake Nitroglycerin most common Many different preparations Dilate all blood vessels by relaxing vascular smooth muscle cells Very potent dilating effect of coronary arteries Contraindicated in severe head injury, hypotension, severe anemia, inferior myocardial infarction, simultaneous use of erectile dysfunction medication If vasodilation occurs too rapidly, can cause reflex tachycardia – overcompensation  Often given sublingual for more immediate effect – 1-3 minutes Transdermal patches can provide long, slow dosing. Heart Failure Heart is unable to effectively pump blood Can be right sided, left sided or both Right sided – blood can’t effectively be pumped to the lungs Left sided – blood can’t effectively be pumped to the body Common S&S – peripheral edema, shortness of breath Common classes of drugs used in heart failure that we have already covered: diuretics, ACE inhibitors, ARBs, beta blockers, nitroglycerin Cardiac Glycosides DIGOXIN; Some of the oldest drugs Synthesized from foxglove (digitalis) – digoxin, also an antiarrhythmic Reduces heart rate and increases contractility (positive inotropic, negative chronotropic) Prolonged rest between beats Side effects: bradycardia, tachycardia, hypotension, ARRHYTHMIA Signs of toxicity: headache, confusion, coloured vision, halo vision, anorexia, nausea, vomiting Low therapeutic index Drug levels need to be monitored  Dysrhythmia Antidysrhythmics Many different heart rhythms Huge category Most common: a-fib You will most commonly see beta blockers, calcium channel blockers, blood thinners Electrolytes Chemical compounds that dissociate into ions in water Can conduct electrical current Electrolytes we commonly see or give: sodium (Na+), Chloride (Cl-), Potassium (K+), Calcium (Ca2+), Magnesium (Mg2+) and Phosphate (HPO42-) DON'T NEED TO REMEMBER THIS CHART Potassium  Can be supplemented PO or IV Short and long acting – the liquid is *foul* - mix it with juice Beware of “salt substitutes” Dose can be expressed in milimoles or milliequivalents (mmol or mEq) – these are equal units Sodium polystyrene sulfonate (Kayexalate or Solystat) for hyperkalemia Causes sodium and potassium exchange in the resin, excreted in the bowel Coagulation Modifiers NEED TO KNOW ANTICOAGULANTS AND THE DIFFERENCE BETWEEN ANTIPLATELETS. 1.Anticoagulants – Inhibit the action of various clotting factors. – No effect on a clot already formed. a.Example: Heparin, Warfarin, dalteparin, enoxaparin. b.Heparin: aPTT – activated partial thromboplastin time(NEED TO KNOW HOW LONG DOES IT TAKE FOR THE BLOOD TO CLOT) c.Warfarin – INR – International normalized ratio – prothrombin time / control prothrombin time 2.Antiplatelets drugs – inhibit platelet aggregation (happens before the clotting cascade) a.Aspirin (acetylsalicylic acid) – effect lasts the lifetime of the platelet 3.Therapeutic effect: decreased clotting 4.Adverse effects: bleeding Question 1 Match each description to its mechanism of action: 1. Stimulating the gallbladder and biliary system to increase excretion of dietary cholesterol. 2. Binding to the bile in the intestinal tract, forming an insoluble complex that is excreted in the feces.  3. Inhibiting HMG-CoA reductase, the enzyme responsible for the synthesis of cholesterol in the liver. 4. Decreasing the amount of HDL and LDL absorbed from dietary intake. Correct answers: 1. (Mechanism 1 description does not match a common drug class action.) 2. (Mechanism 2 matches bile acid sequestrants like cholestyramine.) 3. (Mechanism 3 matches statins like atorvastatin.) 4. (Mechanism 4 description is incorrect as HDL is not targeted this way.) Question 2 Muscle pain and weakness can be a sign of muscle deterioration caused by statin medications. Answer: True Question 3 Diuretic medications should be taken at night so they have longer to work, making them more effective. Answer: False (Taking diuretics at night can cause sleep disturbances due to frequent urination.) Question 4 Match the suffix with the drug class: Beta blockers: D. -olol Angiotensin-converting enzyme (ACE) inhibitors: B. -pril Angiotensin II receptor blockers (ARBs): A. -sartan Cholesterol-lowering drugs: C. -statin Question 5 Loop diuretics commonly cause electrolyte imbalance? Answer: Hypokalemia (low potassium) Question 6 Angioedema is a potentially life-threatening swelling around the airway that is a known adverse effect of which drug class? Answer: Angiotensin-converting enzyme (ACE) inhibitors. Question 7 Nitrates relieve angina pain by dilating blood vessels, particularly those that serve heart muscle. Answer: True Question 8 Beta blockers can be given to treat hypertension (high blood pressure), angina, and heart failure. Answer: True Question 9 If a patient has been taking digoxin, a cardiac glycoside, for a long time, they no longer require serum drug monitoring. Answer: False (Monitoring is still needed due to the narrow therapeutic range.) Question 10 When given a potassium supplement, the nurse knows that the unit millimoles (mmol) is 10 times larger than millie equivalents (mEq). Answer: False (The relationship between mmol and mEq depends on the valence of the electrolyte.) Question 11 Anticoagulants and antiplatelet drugs are the same class of drug and require the same lab levels to monitor them - aPTT. Answer: False (Anticoagulants like heparin use aPTT, while antiplatelets like aspirin do not.) Week #8 Pharmacology For Dermatology Guest speaker 1. Steorida 2. Antifungals 3. Retinoids 4. Vitamin D analogues 5. Calcineurin inhibitors Steroids MOA: Suppress the inflammatory response and the immune response AE: Telangiectasia- development of small blood vessels Clinical Pearl: Use sparingly! Short-term use recommended Grade 1 is the strongest and Grade 7 is the weakest Retinoids MOA: Suppresses inflammation, inhibits breakdown of collagen and elastin, regulates sebum production. Adverse Effects: *Teratogenic*-Birth defects- can no give to pregnant person, contact dermatitis, photosensitivity, hives (START LOW AND GO UP) Clinical Pearl: Start low, go slow (with concentration and frequency) Calcineurin Inhibitors MOA: Immunomodulator Adverse Effects: Skin irritation, altered Ca2+ regulation Vitamin D MOA: Immunomodulator Clinical Indication: Plaque psoriasis AE: Skin irritation Antifungals MOA: Antimycotic agent, for skin infections caused by yeast, mold, and dermatophytes Clinical Indications: Tinea pedis (athlete's foot), yeast infections, ringworm, Cutaneous drug reactions High risk drugs: Antibiotics, Anti-gout medications, NSAIDS, Antiepileptics Week #8 Learning Objectives. Identify key terms related to the integumentary, ophthalmic and otic systems. b. Compare the mechanisms of action, pharmacokinetics, indications, contraindications, adverse effects and toxicity to selected classes of drugs: i. Antiglaucoma agents. ii. Topical skin agents. c. Explain considerations and implications associated with the use of drugs affecting the integumentary, ophthalmic and otic systems throughout the lifespan. d. Identify related drug categories by the suffix of the generic name where applicable Topical Drugs Antibiotics Antifungals Antivirals Topical Anesthetics Anti-inflammatory Corticosteroids OPHTHALMIC DRUGS Glaucoma Antibiotics Antivirals  Anti-inflammatories Anti-histamines For all ophthalmic drugs the applicator (what you stick inside someone's eye) *must be sterile. Glaucoma Disorders that can damage the eye Elevated levels of water Pressure against the retina-destroys neurons. Drugs that treat Glaucoma are: CHOLINERGICS (eye drops) They work by stimulating the parasympathetic nervous system How they work: MOA Pupil constriction Vasodilation around blood vessels around the eye Constriction of ciliary muscles Drainage of aqueous humor Reduced IOP How they don't work: AE Localized Blurred vision, stinging Lacrimation Reduced night vision B-Adrenergic Receptors How they work: MOA Reduce formation of aqueous humor Example: timolol Can be used alone in combination with other medications How they don't work: AE Blurring Blurred vision PROSTAGLANDIN AGONIST How they work: MOA Reduce IOP by increasing the outflow of aqueous fluid Example: Lantroprost How they don't work: AE Sensation of foreign body Increased eyelash growth Brown pigmentation of iris OCULAR ANTIBIOTICS, ANTIVIRALS, ANTIFUNGALS How they work: MOA Topical antibiotics helps prevent antibiotic resistance from systemic use Aminoglycosides, macrolides, polypeptides, quinolones and other classes How they don't work: AE Irritation  ANTI-INFLAMMATORIES How they work: MOA Relief of inflammation NSAIDs or corticosteroids Should not be used for minor abrasions or wounds – immunosuppressant Corticosteroid – dexamethasone NSAID - ketorolac How they don't work: AE Burning Extended corticosteroid use: cataracts, increased IOP, optic nerve damage, systemic side effects in large doses TOPICAL ANAESTHETICS How they work: MOA Alleviate eye pain Should only be given by healthcare professionals Short duration of action, minimal systemic absorption Tetracaine Use caution after administration How they don't work: AE Burning Redness Lacrimation Blurred vision ANTIHISTAMINES, DECONGESTANTS How they work: MOA Improve redness, itching, tearing Vasoconstriction in and around the eye – redness, burning, irritation How they don't work: AE Burning Rebound hyperemia Systemic effects OTIC MEDICATIONS Antibiotics Antifungals Earwax emulsifiers Anesthetics, analgesics, antiinflammatories, corticosteroids Combination drugs  VESTIBULAR REFLEX Warm ear drops, for those that are brain dead Drugs Affecting the Central and Autonomic Nervous Systems 1.Drugs affecting the Central and Autonomic Nervous Systems a.Define key terms related to the central nervous system and autonomic nervous system b.Differentiate between different classes of analgesic drugs c.Compare the mechanisms of action, pharmacokinetics, indications, contraindications, adverse effects and toxicity to selected classes of: i.Analgesics ii.Central nervous system depressants iii.Central nervous stimulants iv.Antiepileptic drugs v.Antiparkinsonian drugs vi.Psychotherapeutic drugs vii.Adrenergic drugs viii. Antiadrenergic drugs ix.Cholinergic drugs x.Anticholinergic drugs d.Include considerations and implications of using central and autonomic nervous system drugs across the lifespan e.Identify related drug categories by the suffix of the generic names where applicable Week #9 Analgesics= Pain Medications Work at different parts of the nociception Can be managed with pharmacological and non-pharmacological methods Opioid Drugs - Analgesic MOA: Bind to opioid receptors in the CNS Alter perception and response to pain Are synthetic or partially synthetic AKA narcotic Codeine> Can cause diarrhea, morphine, Hydromorphone, Oxycodone, Fentanyl- notice the “ine” and “one” AE: Slows everything down: Nausea/ vomiting is also very common. Can lead to tolerance, opioid naive, dependence, withdrawal, toxicity or overdose Significant respiratory depression- stop breathing Naloxone or Narcan- opioid antagonist, bind to receptor sites, block opioids Non-Opioid - Analgesics  Tylenol and Fever Does not treat inflammation Can also treats fevers (antipyretic) AE: Potentially lethal when taken at toxic levels, hepatotoxicity NSAIDS - Analgesic Anti-inflammatory, analgesic> PAIN, antipryretic> FEVER MOA: Inhibits prostaglandin synthesis by inhibiting cyclooxygenase enzymes (COX) (COX) inhibition also causes decreased stomach lining production Can compromise kidney function their disruption of prostaglandin function ANTI-INFLAMMATORY, ANTILEGICS, ANTIPYRETIC Aspirin Unique, irreversible inhibitor of COX receptors in platelets> reduced formation Increasing dose does not increase therapeutic effect Can compromise kidney function due to distribution of prostaglandin function Analgesic Drugs- Lifespan Considerations Older adults are more susceptible to toxic levels of opiates Older adults more sensitive to CNS depressants of all kinds Reduced hepatic and renal clearance- caution with acetaminophen and ibuprofen Codeine is contraindicated for children All medication for children is weight based Children are often under dosed, especially at home Ibuprofen is not recommended under 6 months of age CNS Depressants  Sedatives, hypnotics and sedative-hypnotics Sedatives Reduce anxiety, excitability, irritability without causing sleep Can become hypnotic in large enough dose Hypnotics: cause sleep- much more potent Drugs that can act as either depending on dose: Sedative-hypnotics 3 main classes: barbiturates, benzodiazepines and nonbenzodiazepines sedatives Zolpidem and Zopiclomne are benzodiazepine- like drugs, used for sleep Muscle relaxants Action is within the CNS for treatment of skeletal muscle spasms Similar in structure and action to other CNS depressants, most do not actually work directly on the skeletal muscle Thought to enhance GABA’s effect at the level of spinal cord A good rule with CNS depressants- Do not mix and match Benzodiazepines→ Really common way to have seizure Sedative-hypnotics→ (treatment of anxiety) MOA: Modulate CNS, inhibit overstimulation Suffix “pam” AE: Confusion, ataxia, amnesia and drowsiness “Hangover” effect Tolerance and dependence can occur with long term use Examples: lorazepam, diazepam, clonazepam Notice the “pam” ending Barbiturates→ Used for seizure Sedative, reduce the nerve impulses There are ton of drug to drugs interactions Can cause dependence Can be used as a sedative or for the treatment of seizures  Stimulate the action of enzymes in the liver, causing other drugs to be broken down more quickly Other CNS Depressants Zolpidem and Zopiclone are benzodiazepine-like drugs, used for sleep Action is within the CNS for treatment of skeletal muscle spasms ○ Similar in structure and action to other CNS depressants, most do not actually work directly on the skeletal muscle ○ Thought to enhance GABA’s effects at the level of the spinal cord ⚘ A good rule with CNS depressants – don’t mix and match ○ What might not work and play well together? CNS Stimulants Do not give to someone with cardiac abnormalities If CNS depressants slow everything down, what do we see in CNS stimulants Simulate parts of the brain Caffeine, Ritalin (methylphenidate), methamphetamine  Used for ADD, ADHD, narcolepsy, obesity, respiratory depression post-anesthesia, migraines Stimulants work by increasing the effect of norepinephrine and dopamine in the CNS synapse by increasing their release and blocking their reuptake CNS- Lifespan Considerations Stimulates should be avoided in those with known structural cardiac abnormalities, cardiomyopathy, dysrhythmias or coronary artery disease Blood pressure and heart rate should be monitored May cause transient weight loss and slowing of growth Anti-epileptic Drugs→ Do not suddenly stop these drugs Barbiturates, Hydantoins Phenytoin- first antiseizure drug Interrupt sodium channels in the brain AE: Diplopia, nystagmus, nausea, gingival hyperplasia, ataxia, LIFETHREATING DERM REACTIONS, HEPATIC FAILURE, SUICIDAL THOUGHTS Cannot stop this drug suddenly Iminostilbenes Carbamazepine Also thought to inhibit sodium channels in neurons Many drug-drug interaction s Ataxia, drowsiness, LIFETHREATING DERM REACTIONS, SUICIDAL THOUGHTS, LIVER TOXICITY, PANCREATITIS Epilepsy Chronic, recurrent pattern of seizures More commonly now called a seizure disorder  Seizure Excessive and uncontrolled discharge or neurons in the brain Sudden, spontaneous, uncontrolled depolarization Causes abnormal motor and/ or sensory activity Many different types Convulsion Involuntary spasmodic contraction of muscles throughout the body Antiepileptic drugs are also called anticonvulsants The goal of drug therapy is to maximally reduce seizures activity while minimizing the adverse effects of medication therapy Work in 3 ways: 1. Increase the threshold for activity in the motor cortex- harder for the neuron to be stimulated 2. Suppress the transmission from one nerve to the next 3. Decrease the speed of transmission within a neuron; may enhance the action of GABA in the brain or increase the levels of GABA Iminostilbenes Carbamazepine Inhibit sodium channels in neurons AE: Ataxia, drowsiness, LIFETHREATING DERM REACTIONS, SUICIDAL THOUGHTS, LIVER TOXICITY, PANCREATITIS Pregabalin Structurally similar to GABA Binds to alpha2 delta receptors- influence calcium channels in CNS tissues Used for commonly used for neuropathic pain Lamotrigine Binds to sodium channels and inhibits the release of certain neurotransmitters Gabapentin  Thoughts to increase the synthesis and accumulation of GABA Very common treatment for nerve pain. Lifespan Considerations Can cause harm to the fetus of a pregnant individual Fall risks increase with age and may be exacerbated by antiepileptic drugs Some antiepileptic drugs have a narrow therapeutic range and must be monitored- dosage in older adults may need to be decreased Young children and older adults with more sensitivity and are more likely to have paradoxical reactions Antiparkinsonian Drugs Progressive, neurodegenerative disorder affecting the dopamine- producing neurons in the brain Imbalance of dopamine (inhibitory) and acetylcholine (excitatory) neurotransmitters in the extrapyramidal system which is responsible for motor function Destruction of the part of the brain that produces dopamine Classic symptoms: TRAP- Tremor, Rigidity, Akinesia and postural instability Levodopa-Carbidopa Levodopa is a precursor to dopamine Carbidopa inhibits the breakdown of levodopa in the periphery, allowing it to get to the CNS Becomes less effective over time, especially with older adults- may need to increase the dose Levodopa-Carbidopa Is a precursor to dopamine Carbidopa inhibits the breakdown of levodopa in the pns allowing it to get to the cns Becomes less effective over time, especially with older adults- may need to increase the dose over time  Psychotherapeutic Drugs Many theories of the causes of mental disorders - one theory is an imbalance of neurotransmitters in the brain Mental health disorders are broad topic and medication is not the only therapy Broad classes will discussed Benzodiazepines - reduce anxiety by reducing CNS overactivity, discussed earlier in the class Antidepressants Tricyclic antidepressants - first gen Believed to block presynaptic uptake of neurotransmitters Now more commonly used to treat neuropathic pain or insomnia Many side effects - most common are anticholinergic Can also causes changes in cardiac conduction Overdose are notoriously lethal Suffix - tyline Antidepressants MAOIs- Also first gen Rarely used as antidepressants, more commonly treat Parkinson’s atypical depression Inhibits enzyme that breaks down the substances like dopamine, serotonin, norepinephrine Many food and drug interactions  Can cause a hypertensive crisis when taken with stimulants or tyramine-containing foods Secondhand Generation Antidepressants SSRIs- selective serotonin Reuptake inhibitors Inhibit reuptake of serotonin in the brain Fluoxetine, sertraline, citalopram, escitalopram SNRIs- Serotonin-Norepinephrine Reuptake Inhibitors Inhibits reuptake of serotonin and norepinephrine Examples: Venlafaxine, mirtazapine In general, side effects can include: Insomnia, weight gain, sexual dysfunction May cause worsening depression or suicidality Serotonin Syndrome Antipsychotic Drugs Used in the treatment of many mental health disorders such as schizophrenia and bipolar disorder Block dopamine receptors in part of the brian, decreasing dopamine concentration in the CNS Typical and atypical Atypical are newer, target a more specific receptor> more effective, safer Typical: Haloperidol Atypical: Olanzapine, quetiapine, risperidone Typical side effects: Lightheadedness, sedation, drowsiness, dry mouth , Extra Serotonin Syndrome→ Everything gets increased Mental Status: Agitation, anxiety, disorientation, restlessness, excitement Neuromuscular: Tremors, clonus, hyperreflexia, muscle rigidity, bilateral Babinski sign, opsoclonus Autonomic Nervous System: Diaphoresis, tachycardia, hyperthermia, hypertension, vomiting, diarrhea Extrapyramidal symptoms- involuntary motor symptoms similar to parkinson’s disease Psychotherapeutic Drugs→ Lifespan considerations Older adults more sensitive to anticholinergic effects of TCAs TCAs should not used in children or those who are pregnant or lactating Children are more likely to experience adverse effects from psychotherapeutic drugs Orthostatic hypotension, anticholinergic effect, sedation and EPS are more common in older adults taking psychotherapeutic drugs CNS Depressants- Lifespans considerations Can create a significant fall risk in older adults Children and older adults are more likely to experience paradoxical reactions to benzodiazepines Contraindicated in pregnancy and in children under 1 month Barbiturates are not recommended for older adults Older adults are more susceptible to CNS depressants, caution should be used Drugs Acting On The ANS  Nicotine Receptor Agonists Nicotine, patch, gum, inhaler Not recommended for children, pregnant individuals May cause vivid dreams or sleep disturbances- remove patch overnight if occurs Rotate patch sites May cause irregular heartbeat or palpitations Alpha 1 Agonists> Tamsulosin Stimulate alpha receptors in the respiratory tract Constrict blood vessels, shrink swollen nasal mucosa Used for relief in upper respiratory infections Pseudoephedrine and phenylephrine May cause hypertension, urinary retention, anxiety, dizziness Tamsulosin Cause smooth muscle relaxation Decrease peripheral vascular resistance- there are also alpha- adrenergic receptors in the prostate and bladder not recommended for children under 2 Older adults may need a dose adjustment depending on renal function  May cause orthostatic hypotension, especially after the first dose Adrenergic Drugs Mimic the effects of SNS neurotransmitters norepinephrine, epinephrine and dopamine Most are only seen in critical care settings Epinephrine works on both alpha and beta receptors Used for anaphylaxis, acute bronchospasm during asthma attacks, cardiac resuscitation, hypotension or local injection to control superficial bleeding Epipen - blue to the sky, orange to the thigh Antiadrenergic Drugs Cholinergic Drugs Anticholinergic Drugs An older adult patient prescribed a benzodiazepine for insomnia should be monitored for which potential adverse effect? Answer: Unsteady gait. Goal of pharmacologic therapy with anticonvulsant medications in treating seizure disorders: Answer: To maximally reduce seizure activity while minimizing the adverse effects of medication therapy. Muscle relaxants work directly on skeletal muscles: Answer: False. Central nervous system stimulants, like caffeine, should be used cautiously in individuals with which condition? Answer: Cardiac dysrhythmias. Important information about the proper use of ear drops: Answer: The ear drops should be warmed to room temperature before administration. Statement indicating a need for further teaching regarding eye drop administration: Answer: "I will rinse the eyedropper with tap water after each use." Matching terms with definitions: Opioid Naive: C. Patients who are receiving opioid analgesics for the first time or intermittently and who are not accustomed to their effects. Opioid Tolerant: B. A progressively decreased responsiveness to opioid drugs resulting in a need for a larger dose to achieve the effect originally obtained by a smaller dose. Dependence: A. A physiological or psychological need for a drug. Withdrawal: D. A collection of symptoms that occur when a substance that an individual is dependent on is suddenly stopped. Acetaminophen should be used with caution in those with hepatic impairment: Answer: True. Topical medication that should not be used in pregnancy: Answer: Retinoids.