exam-1-review-pharm-ii.pdf

lOMoARcPSD|40142722 Exam 1 Review (Pharm II) Pharmacology II (Arizona College of Nursing) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by James Jonez ([email protected]...

lOMoARcPSD|40142722 Exam 1 Review (Pharm II) Pharmacology II (Arizona College of Nursing) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 1. Parasympathetic nervous system effects a. Rest & digest (peaceful) 2. Sympathetic nervous system a. Fight or flight (stressful) 3. Anticholinergic: a. MOA: inhibits PNS impulses (also increases fight or flight/SNS) b. Indications/used to treat: GI disorders, ophthalmic procedures (mydriasis), cardiac rhythm abnormalities, anesthesia adjuncts, asthma, COPD, overactive bladder (urge incontinence), Parkinson's, cardiac diseases c. Name the drugs & their MOA: i. ipratropium bromide (Atrovent): respiratory medication (inhaled), relaxes airway ii. tiotropium (Spiriva): COPD iii. scopolamine (transdermal patch): motion sickness iv. dicyclomine (Bentyl): IBS 4. Cholinergic: a. MOA: increase PNS (rest & digest) b. Indications/used to treat: urinary retention, starting GI system, myasthenia gravis c. Primary neurotransmitter: acetylcholine (ACh), doesn’t last long d. bethanechol (Urecholine): urinary retention medication e. s/e: cholinergic crisis (SLUDGE) i. Salivation ii. Lacrimation iii. Urination iv. Defecation v. GI issues (cramping) vi. Emesis 1. Treatment for sludge: atropine (Atropen), which can also be used for low HR 5. Neurodegenerative diseases & patho a. Alzheimer’s: unknown causes b. Parkinson’s: loss of dopamine (PD) c. Multiple sclerosis: demyelination of myelin sheath 6. Alzheimer’s: a. s/s: memory loss, b. Treatment: cholinesterase Inhibitors i. MOA: inhibits cholinesterase (enzyme that destroys ACh) ii. Alzheimer’s drugs: 1. donepezil (Aricept) Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 2. rivastigmine (Exelon) 3. galantamine (Razadyne) 4. s/e: n/v/d 5. Take 2-4 weeks to start working iii. Also treats: myasthenia gravis & glaucoma c. CAM: ginkgo biloba 7. Parkinson's: a. s/s: tremors, Tremors, muscle rigidity , bradykinesia , posterior instability, lat affect b. Treatments: i. Levodopa + Carbidopa (Sinemet) helps increase dopamine (1st line) 1. Cannot be given to anyone who take an MAOI in the last two weeks (depression) 2. Pyridoxine (B vitamins) interacts negatively, counteracts 3. Side effects: uncontrolled movements, n/v, loss of appetite a. A/e: orthostatic hypotension 4. Do not abruptly stop taking ii. All dopamine agonist: 1. apomorphine (Apokyn) 2. bromocriptine (Paralodel) 3. ropinral (Requip) iii. 2nd line Amantadine (Symmetrel) 1. Release the stores of dopamine already in body iv. 3rd line COMT inhibitors: destroy enzymes that get rid of dopamine 1. Entacapone (Comtan) 2. Tolcapone (Tasmar) v. 3rd line MAO-B inhibitors (Monoamine Oxidase B) destroy enzymes that get rid of dopamine 1. Rasagiline (azilect) 2. Selagitine (zelapar) vi. 4th benztropine: anticholinergic, symptom control of dopamine vii. CAM: ginkgo biloba c. Wearing off effect: as patient gets closer to their next dose, they start to see symptoms get worse 8. Multiple sclerosis a. s/s: fatigue, pain, spasticity (spasm), impaired cognitive functions, dizziness, visual disturbances b. Types: i. RR: relaxing remitting ii. PR: progressive relapsing iii. SP: secondary progressive Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 iv. PP: primary progressive c. Interferons (first line), don't need to know MOA: i. Beta 1a (Avonox) ii. Beta 1b (Betaseron) iii. Subcutaneous or IM iv. s/e: flu like, fever, chills v. Toxic to liver vi. CANNOT TAKE: Chemotherapeutics & bone marrow suppressants d. Glatiromer (Capoxone) i. Prevents breakdown of myelin sheath ii. Injectable (subcutaneous or IM) e. Fingolimod (gilenya) i. Reduces frequency of flare ups ii. Oral medication 9. Adrenergic Receptors (pg 139 chart) a. Types: i. Alpha1: 1. Actions: a. closure of bladder sphincter b. Increased peripheral resistance (blood flow) c. Mydriasis (pupil dilation) d. Vasoconstriction 2. Agonists (activating) drugs treat: a. Nasal congestion: oxymetazoline (Afrin) & phenylephrine b. Hypotension c. Ophthalmic hyperemia 3. Antagonist (blocking) drugs treat: a. BPH b. Hypertension 4. Drugs: phenylephrine & Afrin used for nasal congestion ii. Alpha 2: 1. Actions: a. controlled release of NE 2. Agonists (activating) drugs treat: a. hypertension 3. Antagonist (blocking) drugs: a. Erectile dysfunction (phentolamine) b. Pheochromocytoma: catecholamine secreting tumor, life threatening hypertension, sudden drop in BP following parenteral admin of phentolamine Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 iii. Beta1: (1 heart) 1. Actions: heart stuff a. increased AV conduction velocity , increased cardiotonic effect, increased renin release 2. Agonists (activating) drugs treat: a. Activating B1 makes heart beat faster b. Bradycardia, heart failure, shock 3. Antagonist (blocking) drugs treat: a. Blocking B1 helps slow it down b. Acute MI, angina, hypertension, dysrhythmia c. Main Beta1 Blocker Drug: metoprolol (can also be used for anxiety) iv. Beta2 (2 lungs) 1. Actions: bronchodilation, increase blood glucose, relax bladder and smooth muscles 2. Agonists (activating) drugs treat: a. Allergic reactions, asthma, COPD b. Drug: albuterol 3. Antagonist (blocking) drugs v. Beta3: bladder stuff 1. Actions: 2. Agonist (activating) drugs treat: a. Overactive bladder 3. Antagonist (blocking) drugs treat: b. Primary receptors: norepinephrine i. MOA: c. Primary n 10. Beta Blockers a. Uses: ADHD, heart failure, hypertension 11. Alpha blockers a. Uses: prostate issues 12. Types of Seizures (& drugs) a. Partial i. Simple ii. Complex b. Generalized: i. Tonic-clonic: full body convulsions ii. Absence: loss of consciousness with or without motor function (tx: succinimide) c. Special Syndromes: i. Status epilepticus: ongoing seizure activity for extended period of Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 time (beyond 5-15 minutes), medical emergency 1. Treated with phenytoin 13. What can cause seizures? a. Fever, infectious disease, tumors, trauma, vascular disease, eclampsia 14. Seizures interfere with quality of life: such as driving 15. Seizures Meds (MOA like effect WITH GABA & side effects) a. Gabapentin: i. MOA: GABA agonist, potentiate (makes breaks stronger to stop) slow things down b. Phenobarbital: i. MOA: barbiturate, potentiates GABA ii. Preferred for neonates c. Benzodiazepines: i. MOA: GABA agonist ii. Meds: diazepam, lorazepam iii. also used for anxiety iv. Antidote: flumanezil d. Valproic acid: i. also used for bipolar disorders e. Hydantoin meds: i. MOA: desensitizing sodium channels, therefore slows things down in brain to treat seizures ii. Phenytoin 1. Related drugs: carbamazepine, levetiracetam, valproic acid, lamotrigine iii. Fosphenytoin f. Acutely ending seizure drugs: diazepam & lorazepam g. Prophylactic drugs for long term prevention: levetiracetam h. ALL anti-seizure meds make birth control less effective i. Taper off medication cause it can cause seizures 16. Shock: inadequate blood flow (perfusion) at cellular level a. Anaerobic metabolism: end up with lactae (lab test you can test for) b. s/s: change in LOC & blood pressure (hypotension/low), pallor, rapid & shallow breathing, low temperature, thirst, restlessness, anxiety, lethargy, tachycardia c. Know which drugs are for each types of shock, when to give certain types of fluids, and know route (central line, IV, or parenteral) for each d. Know extravasation precautions (drugs leak out of vein into body) 17. Types of Shock: a. Hypovolemic: low volume i. Trauma, dehydration, burns, vomiting, MI, HF Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 ii. Treatment Blood (ATI) & fluids: (what types are for what) 1. Platelets: used for thrombocytopenia (low platelet count) 2. Whole blood 3. PRBC (packed RBC) & whole blood is most common for trauma 4. Plasma (FFP): volume replacement, coagulation factors iii. Blood Admin: given through Y connective tubing (RN or higher must be higher for first 15 minutes, check temp at starts & 15 minutes after) 1. Checking for acute hemolytic reaction (chills, fever, tachycardia, tachypnea, hypotension) a. fatal if not corrected b. first 50 ml of blood c. Immediately stop, disconnect from patient, notify provider, keep y cross infusion iv. Know nursing interventions for central line and IV issues v. Stored in citrate: whole & PRBC (pt gets calcium) vi. Assess pt for: lung sounds for fluid overload vii. When giving fluids, initial stabilizing factor is 1. Airway, breathing, circulation b. Distributive: high dilation, increased vasodilation i. Neurogenic ii. Treatment: vasoconstrictor, vasopressors (meds): 1. phenylephrine (Veo synephrine)/NEUROGENIC: alpha 1 agonist 2. norepinephrine (Levophed) SEPTIC first choice: beta 1 (increases cardiac output), can also act on beta 2, alpha 1, alpha 2 agonist (mcg/min), central line 3. epinephrine/ANAPHYLAXIS (1:1000): beta 1, beta 2, alpha 1, alpha 2 agonist (mcg/min), IM or SubQ 4. dopamine: a. Low dose: activates dopaminergic (DA) receptors increases perfusion to kidneys, does not increase blood pressure (possibly could decrease bp) b. Medium: beta 1, beta 2, alpha 1, alpha 2, DA (acts as norepinephrine & epinephrine) c. High: alpha 1 (acts as phenylephrine) d. Dosed in mcg/kg/min e. Cause dysrhythmias (tachy) f. IV & IO only g. Always on IV pump Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 h. BLACK BOX WARNING: extravasation which causes necrosis to tissue i. If possible admin through central line 5. ALL VASOPRESSORS: slowly taper off to get to normal bp, hr (NEVER abruptly stop) iii. Anaphylactic Shock 1. treat respiratory distress 2. Epinephrine (extreme), IM or SubQ a. EPI 1:1000 3. Mild: a. diphenhydramine (Benadryl) b. Albuterol (Proair) c. Oxygen d. Steroids c. Cardiogenic: low cardiac output (pump failing, assembly line workers) i. Treatment: vasopressor increase constriction & inotropic (heart beating harder, faster, stronger ii. Only use inotropic agents 1. Dobutamine (short time, IV) 2. Digoxin (long term, PO & IV) d. Obstructive: collapsed lung & pericardial tamponade i. Treatment: treat obstruction 18. Interactions: CNS depressant drugs cannot be taken with alcohol 19. Which drugs cannot be taken with birth control? 20.Which drugs cannot be taken while pregnant? (put pt on birth control) 21. Muscle relaxant drugs & the drug classes a. Interactions, what you can't take with these b. CAM: capsaicin (cayenne pepper) c. dantrolene (calcium blocker) d. Clonidine (alpha 2 agonist) 22. Neuromuscular blockers (paralytics): don’t treat pain, used for intubation a. Rocuronium (-inium): nondepolarizing: go area of action potential and block it, long acting (30-45 minutes) b. Succinylcholine: depolarizing, turn off (discharge) action potential, short acting (few minutes) i. May develop malignant hyperthermia 1. Very tachycardic, high temperature (fever), muscle rigidity, muscle breakdown & increased acid content, can cause hyperkalemia, (pt will die if not reversed) 2. Treated with dantrolene 23. Botox (onabotulinumtoxina): blocking acetylcholine Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 a. Injection locally at target problem area (SubQ & IM) b. Use: hyperhidrosis (excess sweating), cervical dystonia, cosmetics, overactive bladder, migraine c. a/e: difficulty breathing, muscle weakness, dysrhythmia, i. Minutes, hours, weeks after 24. CAM drugs: a. capsaicin (cayenne pepper): reduces sensation of pain for muscle spasms b. ginkgo biloba: Alzheimer’s & Parkinson’s 25. Hematopoiesis is the process of blood cell formations. It occurs primarily in red bone marrow and requires B vitamins, vitamin C, copper, iron, and other nutrients. a. Erythropoiesis: RBC formation b. Leukopoiesis: WBC formation 26. Epoetin alfa (Epogen) a. MOA & class: erythropoietin hormone that stimulates erythropoiesis b. 2 week duration c. Lab made erythropoietin i. Increase RBC production but not in acute setting, used for long term d. Black box warning: serious cardiovascular and thromboembolic events 27. CSF colony stimulating factors a. Filgrastim i. Signals body to create WBC ii. Works faster than E.A (hours vs weeks) iii. Used for rapid increased neutrophil count for immunosuppression iv. Dose: depends on neutrophil count v. 7 days 28.Oprelvekin a. s/e fluid retention b. Indication: risk for thrombocytopenia due to chemo c. Duration of 7 days d. 5-9 days on set e. Keep giving til platelet count back to at least 50k (150k-400k) 29. Anemia: lack of oxygen carrying capacity (hgb/hemoglobin) a. Causes: blood loss, not making enough RBC, body destroying RBC b. s/s: pallor, fatigue, exercise intolerance, lethargy, dizziness, fainting c. Types: i. Vitamin B12 deficiency (pernicious anemia): cause lack of intrinsic factor (absorbed into intestines), develops over decades 1. s/s: neurological, memory loss, confusion, hallucinations 2. Tx: give B12 (IM injection, monthly) once achieved Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 therapeutic level > PO or intranasal route 3. s/e: rare 4. pregnancy category A 5. On for the rest of their life ii. Folic acid/folate (B Vitamin) required for DNA/RNA synthesis 1. Common in women that are pregnant or trying to become pregnant 2. Treatment: a. first resh green veggies, dried beans, wheat products b. Second take folic acid supplement iii. Ferrous sulfate (iron deficiency) ( most common type of anemia) 1. Treatment: diet (meat products) 2. Takes about 48 hours to achieve goal (may last a few months) 3. PO & IM 4. Pregnancy Category A 5. Pt education: commonly causes GI upset (constipation), increase fiber and fluid intake to prevent constipation, needs to be taken 1 hour before or 2 hours after a meal (won’t work), interacts with a lot of different drugs, may darken stool 6. Black box warning: cause unintentional fatal overdose in children 7. Food Considerations: Dairy will inhibit absorption, foods high in vitamin C will increase potency 30.Cancer is uncontrolled cell division (carcinoma -oma) 31. Metastasis: cancer starts in one place and moves to lymph nodes and travel throughout the body a. Leading causes: a. #1 smoking b. Alcohol use c. UV light (sunlight) d. Viruses (HIV, hepatitis) e. Genetics b. Worst types f. Lung cancer is the most fatal cancer g. Pancreatic h. liver c. Treatments: i. Surgery j. radiation Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 k. Chemotherapy: treatment of cancer with pharmacotherapy Goals: cure, control, palliative 32. Chemoprophylaxis: preventative Chemotherapeutic agent: usually taken in hospital a. s/e: alopecia (hair loss) and is reversible, difficulty eating/swallowing, severe n/v/d, infections, infertility in both male & female b. Treat nausea: benzos and steroids c. Treat fever: immediately given antibiotics 33. Nadir: lowest point of trough 34. All chemotherapy drugs have nadir for WBC, how susceptible to get infection 35. Vasicents: damaging to local area/cells, should be given through a central line 36. Drug Classes for Cancer (pg 580) a. Alkalytic (alkylating) agents b. Antimetabolites c. Antitumor antibiotics d. Natural products e. Hormones & hormones antagonist f. Biologic response modifiers and targeted therapies (also used to treat asthma & arthritis) g. Miscellaneous antineoplastic drugs 37. cyclophosphamide (alkylating agent): a. MOA: attach to dna and disrupt replication b. Also used: to purposefully immunosuppress pt before transplant rheumatoid arthritis, systemic lupu c. Most at risk for infection (NADIR) 9-15 days 38.methotrexate/Rheumatrex (antimetabolite) a. MOA: blocking synthesis of folic acids b. Used for: arthritis, UC (ulcerative colitis), induce abortion c. Black box warning: fetal demise, opportunistic infections/infections the normal healthy person does not get(AIDS, PCP pneumonia), severe dermatologic issues (toxic epidermal necrolysis, stevens johnson syndrome) 39. doxorubicin (antitumor abx) a. MOA: preventing DNA/RNA synthesis b. Best drugs against solid tumor c. Black box warning: adverse cardiac events (dysrhythmias, heart failure) 40.vincristine/Oncovin (natural product) a. MOA: prevent ability to complete mitosis b. Not as nearly immunosuppressant c. Black Box Warning: extravasation, treat with heat compress (avoid cold) Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 41. tamoxifen (hormone blocker/estrogen antagonist) a. First line for metastatic breast cancer b. MOA: blocks estrogen receptors in breast cancer cells c. Used for chemo prophylaxis in patients at high risk, following surgical mastectomy (or single mastectomy) d. s/e: hot flashes, fluid retention, vaginal discharge e. Black box warning: increased risk of uterine cancer 42. MOSTLY SHOCK QUESTIONS 43. Chapter 32 & Chapter 38 (20% of test) Downloaded by James Jonez ([email protected])