Neuropharmacology Exam PDF

Pregnancy - Safest Pregnancy – Absolute Contraindication Lamotrigine? Valproic Acid (BBW) Gabapentin Phenobarbital (D) Desmopressin (diabetes, not nocturia) Lamotrigine, Topiramate – cleft palate Montelukast Valbenazine – animal studies not promising Naltrexone Losartan (BBW) Physostigmine? (B) or e...

Pregnancy - Safest Pregnancy – Absolute Contraindication Lamotrigine? Valproic Acid (BBW) Gabapentin Phenobarbital (D) Desmopressin (diabetes, not nocturia) Lamotrigine, Topiramate – cleft palate Montelukast Valbenazine – animal studies not promising Naltrexone Losartan (BBW) Physostigmine? (B) or edrophonium (lower dose) Lisinopril (BBW) Oxybutynin (B) Aliskiren (BBW) Epinephrine Clonidine (BBW) Albuterol preferred SABA Hydroxyzine (early) Dopamine? Icatibant (C) Labetalol Alprazolam (D) Metoprolol Diphenhydramine (B) Sumatriptan (second line) Drug MOA Indication ADR/BBW/Contra Dosing & Food Impacted Diagnostics Monitor ANTICONVULSANTS Lamotrigine Triazine derivative BPD Inhibits release of glutamate and inhibits voltagesensitive Na channels -> Stabilizes neuronal membranes Focal (partial) onset and generalized onset seizures Causes increased availability of GABA to brain neurons, enhance the action of GABA or mimic its action at postsynaptic receptor sites Blocks voltagedependent Na channels, which results in suppression of high-frequency repetitive neuronal firing Draw trough just BEFORE next dose Caution hep and renal impairment LFT, renal function test, serum levels of concurrent anticonvulsants Suicide ideation, depression, unusual behavior changes, or signs of aseptic meningitis Withdrawal – taper Cleft palate/lip in preg Weak inhibitory effect on the 5-HT3 receptor Valproic Acid BBW: SJS (increased if coadministration of valproate Nausea BPD Focal (partial) onset and generalized onset seizures Migraine prophylaxis BBW: Hepatotoxicity peds < 2 who have POLG or AHS, pancreatitis, major congenital malformations (spina bifida), decreased IQ, neurodevelopment disorders Contra: hepatic disease, urea cycle disorders, prevention of migraine in pregnant women/women not using effective contraception, known mitochondrial disorders caused by IV only Take with food to prev GI upset LFT, CBC w platelets, PT/PTT, serum ammonia Suicide ideation, depression, behavior changes mutations in mitochondrial DNA polymerase gamma (POLG, AlpersHuttenlocher syndrome [AHS]) Headache, drowsiness, dizziness, insomnia, nervousness Alopecia N/V/D, abd pain, dyspepsia, anorexia Thrombocytopenia Infection Tremor, asthenia Diplopia, visual disturbance Flu-like sx Phenobarbital Long-acting barbiturate with sedative, hypnotic, and anticonvulsant properties Depress the sensory cortex, decrease motor activity, alter cerebellar function, produce Sedation Seizures – generalized tonic clonic, status epilepticus, partial Alcohol withdrawal Accidental injury Dependence, abuse, or tolerance Geriatric Patients High-Risk Medication > Beers Criteria Contra: marked hepatic impairment, dyspnea or airway obstruction, porphyria, hx No intra-arterial or subQ LFT, CBC w/ diff, renal function, blood levels Asses for hx of suicide ideation or addiction Signs of toxicity (slurred speech, unsteady gait, or sustained nystagmus) drowsiness, sedation, and hypnosis sedative/hypnotic addiction, nephritic patients In high doses-> anticonvulsant activity Withdrawal - taper IV Use: Monitor vital signs, respiratory status, and CNS status Bradycardia, hypotension, syncope, thrombophlebitis Ataxia, CNS depression SJS Oliguria Agranulocytosis, thrombocytopenia, megaloblastic anemia Hyperkinesia, laryngospasm Caution in debilitated, fever, peds Gabapentin High affinity gabapentin binding sites correspond to voltage-gated Ca channels possessing the alpha-2-delta-1 subunit Modulate the release of Postherpetic neuralgia Seizures, focal (partial) onset (IR) Alcohol dependence Respiratory depression Caution in renal impairment CrCl 2 years IR; >6 years XR) Alcohol dependence Paresthesia, fatigue, drowsiness, dizziness, memory impairment Contra: metabolic acidosis taking concomitant metformin Decreased serum bicarbonate (metabolic acidosis), hyperammonemia (encephalopathy), weight loss Abdominal pain, anorexia, dysgeusia, nausea, diarrhea URI, Fever Glaucoma w/ secondary angle closure, maculopathy, myopia Hyperthermia Suicidal ideation Cleft palate/lip in preg Ketogenic diet may increase the possibility of acidosis and/or kidney stones Avoid alcohol use with XR within 6 hours prior to and 6 hours after administration Elderly dose adjustment Electrolytes (sodium bicarbonate), serum creatinine, ammonia levels Monitor weight, visual changes Withdrawal - taper Caution in renal impairment ANTI-PARKINSONS & OTHER MVMT DISORDERS Carbidopa No pharmacologic activity alone Parkinsonism (with Levodopa) Depression Dyskinesias Inhibits the peripheral decarboxylation of levodopa to dopamine Impulse control disorders Melanoma Does not cross the BBB – effective brain concentrations of dopamine produced with lower doses of levodopa Avoid with use of nonselective MAO inhibitor therapy with or within prior 14 days Administer with meals to decrease GI upset Hallucinations False-positive reaction for urinary glucose with Clinitest®; falsenegative reaction using Clinistix®; false-positive urine ketones with Acetest®, Ketostix®, Labstix® CBC, LFT, renal function; blood pressure, mental status IOP (in patients with wide-angle glaucoma) Periodic skin examinations Abnormal Coombs' test Somnolence HTN, HOTN, MI Contra: narrow angle glaucoma No breastfeeding Abrupt withdrawal – neuroleptic malignant syndrome Levodopa Circulates in the plasma to the BBB Converted by striatal enzymes to dopamine Parkinsonism Contra: narrow angle glaucoma Orthostatic hypotension Dizziness, headache, depression Absorption decreased with highfat, high-calorie or high-protein meal Avoid high protein diets False-positive reaction for urinary glucose; falsenegative reaction using glucoseoxidase tests for glucosuria; falsepositive urine LFT, BUN, creatinine, and CBC Periodic skin examinations BP standing & sitting/supine Nausea, constipation Dyskinesia, increased creatine phosphokinase Increased blood urea nitrogen Abrupt withdrawal – neuroleptic malignant syndrome Take tablet with food to decrease GI upset Avoid concurrent use with nonselective monoamine oxidase inhibitors (MAOIs) or use within the last 14 days Melanoma Reversible inhibitor of the human vesicular monamine transporter type 2 (VMAT-2) Decreases the uptake of monoamines (dopamine, serotonin, NE, histamine) into synaptic vesicles and depletes the monoamine stores Chorea associated with Huntington disease BBW: depression and suicidality URI Canada: Tourette syndrome Nausea Drowsiness, sedation, depression, extrapyramidal sx, fatigue, insomnia, akathisia, anxiety, falling Avoid hepatic impairment Dyskinesias, mental status changes Cardiac function IOP (in patients with glaucoma) Drowsiness or sleepiness Signs of depression (including suicidal thoughts) Sx of peripheral neuropathy Body fluid discoloration: Urine, saliva, or sweat red, brown, black Tetrabenazine ketones; false diagnosis for pheochromocytoma (rare) based on plasma and urine levels of catecholamines Avoid coadministration of MAOIs or use of tetrabenazine within 2 weeks of MAOI therapy and coadministration with reserpine within 20 days Changes in psychiatric status, symptoms of depression Signs of neuroleptic malignant syndrome Orthostatic hypotension CYP2D6 genotyping for evaluation of metabolizer status (for patients requiring >50 mg/day) Hydroxytetrabenaz ine (HTBZ) also inhibits VMAT-2 Weak binding affinity for dopamine D2 receptors Valbenazine Reversible inhibition of vesicular monoamine transporter 2 (VMAT2), a transporter that regulates monoamine uptake from the cytoplasm to the synaptic vesicle for storage and release No appreciable binding affinity for VMAT1 or dopaminergic, serotonergic, adrenergic, histaminergic or muscarinic receptors Tardive dyskinesia Avoid renal and caution hepatic impairment High-fat meals decrease absoprtion Drowsiness, fatigue, sedation – caution driving Depression, suicidal ideation Parkinsonism QT Prolongation Avoid breastfeeding during therapy or until 5 days after the last dose VASOACTIVE PEPTIDES LFT EKG in patients at risk for QT prolongation Abnormal Involuntary Movement Scale (AIMS) or Dyskinesia Identification System Condensed User Scale (DISCUS) Signs of depression or suicidal ideation Losartan Angiotensin II receptor antagonist (ARB) HTN BBW: Fetal Toxicity Proteinuric CKD, diabetic Not effective in black pop for HTN and LVH Blocks the vasoconstrictor and aldosteronesecreting effects of angiotensin II Angioedema Avoid concomitant use with aliskiren in pt w/ DM Take at the same time every day Hypotension Lisinopril Increases urinary flow rate, natriuretic and kaliuretic, increases excretion of chloride, magnesium, uric acid, calcium, and phosphate Competitive inhibitor of angiotensinconverting enzyme (ACE) Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor BP Signs of angioedema HF - within 1-2 weeks initiation, reassess BP (including postural blood pressure changes), renal function, serum potassium Hyperkalemia Do not affect response to bradykinin Renal function tests, electrolytes, urinalysis Renal function deterioration Avoid use in renal or hep impairment, hyponatremia, CHF HFrEF BBW: Fetal Tox HTN Hypotension STEMI Dizziness Cough Angioedema Cholestatic jaundice Hyperkalemia Avoid concomitant use with aliskiren in pt w/ DM BUN, serum creatinine, CBC with diff, LFT BP, HR Avoid coadministration with or within 36 hours of switching to or from a neprilysin inhibitor (eg, sacubitril) Signs of angioedema HF: within 1-2 weeks after initiation, reassess renal function and serum potassium Increase in plasma renin activity and a reduction in aldosterone secretion Renal function deterioration No breastfeeding Not effective in black pop, increased risk of angioedema CNS mechanism > hypotensive effect as angiotensin II increases adrenergic outflow from CNS Aliskiren Vasoactive kallikreins may be decreased in conversion to active hormones by ACE inhibitors, thus reducing blood pressure Decreases plasma renin activity and inhibits conversion of angiotensinogen to angiotensin I Contra: angioedema related to previous tx with an ACE inhibitor, idiopathic or hereditary angioedema HTN (not initial) >6 years BBW: Fetal Tox Contra: peds decreased urine volume and increased urine osmolality Increases plasma levels of von Willebrand factor, factor VIII, and tPA contributing to Diabetes insipidus Hemophilia A Von Willebrand disease Type I Nocturia (intranasal) Primary nocturnal enuresis (oral) BBW: hyponatremia Xerostomia Fluid retention Hypotension Thrombotic events Contra: hx of hyponatremia, renal impairment, polydipsia, primary nocturnal enuresis, concomitant use with loop diuretics or glucocorticoids, syndrome of inappropriate antidiuretic hormone (SIADH) secretion, fluid or electrolyte imbalance, heart failure, uncontrolled HTN Symptom relief Laryngeal symptoms or airway obstruction (immediate medical attention required in addition to icatibant therapy) Inhibits bradykinin from binding at the B2 receptor -> treating the sx associated with acute attack Desmopressin Increase ALT/AST Elderly and peds should decrease fluid intake -> water intoxication and hyponatremia Fluid intake and urine volume, urine specific gravity, plasma and urine osmolality, serum electrolytes Diabetes insipidius Factor VIII coagulant activity, factor VIII ristocetin cofactor activity, factor VIII antigen levels, aPTT, von Willebrand antigen levels, and bleeding time – hemophilia A, von Willebrand Serum electrolytes nocturnal enuresis for >7 days BP and pulse a shortened activated partial thromboplastin time (aPTT) and bleeding time Nesiritide Binds to guanylate cyclase receptor on vascular smooth muscle and endothelial cells, increasing intracellular cyclic GMP -> smooth muscle cell relaxation Acutely decompensated heart failure (HF) Contra: hypotension (SBP inhibiting platelet aggregation Selective leukotriene receptor antagonist Inhibits the cysteinyl leukotriene receptor Analgesic, antipyretic, and anti-inflammatory Revascularization procedures Ischemic stroke, TIA, acute coronary syndromes (STEMI, NSTEMI, unstable angina), secondary prevention after ACS, and management of stable ischemic heart disease Avoid breastfeeding Contra: asthma, rhinitis, and nasal polyps, use in children or teenagers for viral infections, with or without fever Administer with food or a full glass of water to minimize GI distress Baseline Cr Serum drug levels Avoid 1-2 weeks prior to surg Salicylate sensitivity Tinnitus UGI ulcers Reye’s syndrome Hemorrhage Caution in hep/renal impairment Allergic rhinitis (perennial or seasonal) Eosinophilia and vasculitis Asthma Neuropsychiatric events Bronchoconstricti on, exerciseinduced (prevention) Avoid in acute asthma, status asthmaticus, aspirin sensitivity When treating asthma, administer dose in the evening Mental and mood status - depression, hallucinations, irritability, agitation, suicide ideation Numbness or tingling to extremities, muscle weakness or pain, tremors, shaking SEDATIVES Alprazolam Binds to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron Enhancement of the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions Anxiety disorders Panic disorder Preoperative anxiety BBW: Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death Contra: narrow angle glaucoma Drowsiness, fatigue, sedation, ataxia, memory impairment, irritability, cognitive dysfunction, dysarthria, dizziness, depression Skin rash Weight gain, weight loss, decreased libido Increased appetite, decreased appetite, constipation, xerostomia Difficulty in micturition No breastfeeding Tolerance Withdrawal – taper Caution in elderly, debilitated, obese Cigarette smoking decrease concentrations up to 50% Contra: concurrent use with ketoconazole, itraconazole, or other potent CYP3A4 inhibitors. CNS depression Assess for history of addiction Buspirone High affinity for serotonin 5-HT1A and 5-HT2 receptors, without affecting benzodiazepineGABA receptors Generalized anxiety disorder Dizziness Akathisia CNS depression Serotonin Syndrome Caution in hep and renal impairment Buspirone has moderate affinity for dopamine D2 receptors Withdrawal - taper Imidazopyridine hypnotic Administered with or without food, but must be consistent. HYPNOTICS Zolpidem Contra: concomitant use of MAOIs intended to treat depression or within 14 days of discontinuing MAOIs Insomnia BBW: Complex sleep behaviors Enhances the activity of GABA via selective agonism at the benzodiazepine-1 (BZ1) receptor; CNS depression Increased Cl conductance, neuronal hyperpolarization , inhibition of the action potential, and a decrease in neuronal excitability -> sedative and hypnotic effects Withdrawal – taper Abnormal thinking and behavior Contra: hx of complex sleep behaviors Caution in debilitated, elderly, females, peds Mental status, symptoms of anxiety sx of serotonin syndrome Eszopiclone Minimal anxiolytic, myorelaxant, and anticonvulsant properties Interacts with GABAbenzodiazepine receptor complex Insomnia Beers Criteria BBW: Complex sleep behaviors Contra: hx of complex sleep behaviors Do not take with, or immediately following, a high-fat meal (may delay onset) CNS depression Assess for history of addiction Monitor for excessive CNS depression, abnormal thinking, and behavior changes Abnormal thinking and behavior Headache Dysgeusia Withdrawal – taper Caution depression, drug abuse, hepatic or renal impairment ALCOHOL USE DISORDER Naltrexone Antagonizes various opioid receptors Alcohol Use Disorder N/V Myalgia HA, insomnia, anxiety Rash Suicidality, depression Contra: opioid/alcohol use or dependence Sx of depression, suicidality Hepatotoxicity Acamprost Restore balance between neuronal excitation & inhibition via effects on GABA & glutamate Alcohol Use Disorder N/V/D Cr at baseline Insomnia, anxiety, asthenia, paresthesia Sx depression or suicidality Diaphoresis Suicidality, depression Disulfiram Inhibits aldehyde dehydrogenase Alcohol Use Disorder Avoid CrCl < 30 Rash, acne Avoid ETOH use within 12 hours Drowsiness, HA, psychosis, peripheral neuropathy LFTs at baseline & after 14 days, CBC, serum chemistries Impotence Metallic taste Optic neuritis Hepatotoxicity Contra: breastfeeding, psychosis, CAD CHOLINOMIMETICS – ACETYLCHOLINESTERASE INHIBITORS Edrophonium Inhibits destruction of acetylcholine by acetylcholinester ase Diagnosis of myasthenia gravis Differentiation of cholinergic crises from myasthenia crises Cholinergic crisis: wheezing, chest tightness, fever, itching, bad cough, blue skin color, seizures, swelling of Pre- and post injection strength HR, RR, BP Administration for MG is supervised by a neurologist; Facilitates transmission of impulses across myoneural junction Neostigmine Increased cholinergic responses: miosis, increased tonus of intestinal and skeletal muscles, bronchial and ureteral constriction, bradycardia, and increased salivary and sweat gland secretions Inhibits destruction of acetylcholine by acetylcholinester ase Reversal of nondepolarizing neuromuscular blockers face, lips, tongue, or throat Contra: GI or GU obstruction Avoid reverse nondepolarizing neuromuscular blockade in patients with myasthenia gravis - may exacerbate muscular weakness Reversal of effects of nondepolarizing neuromuscular blocking agents after surgery Contra: peritonitis or mechanical obstruction of the intestinal or urinary tract Facilitates transmission of impulses across myoneural junction Trouble sleeping Direct cholinomimetic effect on skeletal muscle and possible on autonomic ganglion cells and Xerostomia N/V HA Cholinergic crisis: wheezing, chest tightness, fever, itching, bad cough, blue skin color, neuromuscular blocking agent is supervised by an anesthesiologist Monitor closely during and following procedure for cholinergic crisis Atropine antidote ECG, BP, HR Monitor peds closely neurons of the CNS Physostigmine Inhibits destruction of acetylcholine by acetylcholinester ase Facilitates transmission of impulses across neuromuscular junction seizures, swelling of face, lips, tongue, or throat Myasthenia gravis (oral only) Reversal of nondepolarizing muscle relaxants (injection only) Military use: Pretreatment for Soman nerve gas exposure Bradycardia, HOTN, dysrhythmias Trouble breathing Slow heartbeat N/V/D, abdominal cramps Drooling Small pupils Sweating Muscle cramps, twitching, muscle weakness ECG, BP, HR When used to reverse neuromuscular block, monitor patient safety until full return of neuromuscular functioning Assess bladder and sphincter adequacy prior to treatment Monitor for cholinergic crisis Cholinergic crisis: wheezing, chest tightness, fever, itching, bad cough, blue skin color, seizures, swelling of face, lips, tongue, or throat Contra: intestinal or urinary obstruction Echothiopate Long-acting inhibition of cholinesterase Accommodative esotropia Cholinergic crisis: wheezing, chest tightness, fever, Baseline anterior chamber angle Atropine enhances activity of endogenous acetylcholine. Reduced degradation of acetylcholine leads to continuous stimulation of the ciliary muscle producing miosis; other effects include potentiation of accommodation and facilitation of aqueous humor outflow, with attendant reduction in intraocular pressure. Elevated IOP Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS Antidote: for anticholinesterase poisoning Increases cardiac output, dries secretions itching, bad cough, blue skin color, seizures, swelling of face, lips, tongue, or throat Routine ocular exams Cardiac irregularities Report immediately: vision changes, eye pain, severe eye irritation, fast/slow/abnormal heartbeat, diarrhea, bladder incontinence, drooling, muscle weakness, sweating a lot, or shortness of breath Contra: angle-closure glaucoma without iridectomy, active uveal inflammation No breastfeeding Burning, stinging, blurred vision, eye redness, eyelid twitching, watery eyes IOP at different times of the day HA ANTI-CHOLINERGICS Adjuvant use with anticholinesterase s (eg, edrophonium, neostigmine) to decrease their adverse effects during reversal of neuromuscular blockade High-Risk Med: Geriatrics HR, BP, pulse, mental status Hyperthermia Use cardiac monitor for IV Psychosis Blurred vision, Sensitivity to light, enlarged pupils Constipation, N/V Assess for tachycardia and hypotension Sx of signifcant reaction: wheezing, chest tightness, fever, itching, bad Reverses the muscarinic effects of cholinergic poisoning by competitive antagonist of acetylcholine at muscarinic receptors No effect on the nicotinic receptors responsible for muscle weakness, fasciculations, paralysis Trospium Antagonizes the effects of acetylcholine on muscarinic receptors in cholinergicinnervated organs Treatment of symptomatic sinus bradycardia, atrioventricular (AV) nodal block (not type II seconddegree or thirddegree AV block, asystole or pulseless electrical activity) Dry mouth, nasal dryness, flushing, Headache Injection site pain Preoperative/prean esthetic medication to inhibit salivation and bronchial secretions Overactive bladder Beers Criteria Xerostomia CNS effects (driving) Contra: urinary retention, gastric retention, uncontrolled narrowangle glaucoma, severe renal impairment Reduces the smooth muscle tone of the bladder Caution: hepatic impairment, AD Dicyclomine Blocks the action of acetylcholine at parasympathetic cough, blue skin color, seizures, swelling of face, lips, tongue, or throat Irritable bowel syndrome Beers Criteria Contra: obstructive diseases of the GI Avoid consuming any alcohol within 2 hours of taking XR (increases serum conc.) Absorption decreased with a high-fat meal IR: administer 1 hour prior to meals or an empty stomach ER: administer in the morning with a full glass of water Voiding patterns at baseline and periodically during therapy Anticholinergic effects (eg, dry mouth, constipation, dizziness) Renal function, postvoid residual (PVR) urine volume, UTI prior to initiation of therapy Anticholinergic effects, urinary output, GI symptoms sites in smooth muscle, secretory glands and the CNS tract, severe UC, reflux esophagitis, unstable cardiovascular status in acute hemorrhage, obstructive uropathy, glaucoma, MG breastfeeding women, activates inhibitory neuron -> reduced sympathetic outflow from the CNS -> decreased peripheral resistance, renal vascular resistance, HR, BP Epidural: pain relief at spinal presynaptic and postjunctional alpha-2 adrenoceptors by preventing pain signal transmission ADHD: unknown, postsynaptic alpha-2 agonist stimulation regulates subcortical activity in the prefrontal ADHD (ER) Beers Criteria HTN (IR, transdermal) - not first line BBW: obstetrical or postpartum pain due to risk of hemodynamic instability Contra (epidural administration): injection site infection, concurrent anticoagulant therapy, bleeding diathesis, administration above the C4 dermatome, pediatric Drowsiness, headache, fatigue, dizziness Transient skin rash, contact dermatitis Xerostomia, upper abdominal pain Withdrawal – taper Avoid concurrent drug therapy with medications known to cause bradycardia Discontinue oral IR within 4 hours of surgery, then restart ASAP afterward Positive Coombs' test; may lead to false-positive aldosterone/renin ratio BP, standing and sitting/supine, mental status, HR Epidural: monitor infusion pump, inspect catheter tubing for obstruction or dislodgement, catheter-related infection Hypertension: Target BP reduced hyperactivity, impulsiveness, and distractibility Stimulates alpha-, beta1-, and beta2adrenergic receptors Relaxation of smooth muscle of the bronchial tree, cardiac stimulation (increasing myocardial oxygen consumption), and dilation of skeletal muscle vasculature Small doses can cause vasodilation via beta2-vascular receptors Large doses may produce constriction of skeletal and vascular smooth muscle Bradycardia, hypotension, resp depression Hypersensitivity Hypotension/shoc k Mydriasis during intraocular surgery (product specific) Angina pectoris, cardiac arrhythmias Extravasation Pulmonary edema, dyspnea Decreased urine output may occur Anxiety, apprehension, cerebral hemorrhage, disorientation, dizziness, drowsiness, exacerbation of Parkinson disease, headache, memory impairment, panic, paresthesia, psychomotor agitation, asthenia, restlessness, tingling sensation, tremor Diaphoresis, gangrene of skin, pallor, piloerection Hyperglycemia, hypoglycemia, hypokalemia, insulin resistance, lactic acidosis BP, HR Correct blood volume optimally prior to starting IV Infusion pump, continuous cardiac and hemodynamic monitoring, and frequent assessment of IV site is required. Assess intravascular volume prior to and during therapy in treating hypotension N/V Albuterol Relaxes bronchial smooth muscle by action on beta2-receptors with little effect on heart rate Bronchospasm Exercise-induced bronchospasm Excitement, nervousness FEV1, peak flow, PFT, BP, HR, Tremor CNS stimulation URI, rhinitis, bronchospasm, pharyngitis, exacerbation of asthma Serum glucose, serum potassium, serum creatinine Contra: severe hypersensitivity to milk proteins (dry powder inhalers) Dopamine Stimulates both adrenergic and dopaminergic receptors Lower doses are mainly dopaminergic stimulating and produce renal and mesenteric vasodilation, higher doses also are both dopaminergic and beta1-adrenergic stimulating and produce cardiac stimulation and renal vasodilation Hemodynamic support: Adjunct in the treatment of shock due to bradycardia or aortic regurgitation Arterial or capillary blood gases, lactate Continuous ECG monitoring - IV BBW: Antidote for peripheral ischemia, If extravasation occurs, infiltrate w Phentolamine should be administered as soon as possible after extravasation is noted to prevent sloughing/necrosis Serum electrolytes prior to and during glucose, potassium, and magnesium Contra: pheochromocytoma, uncorrected tachyarrhythmias, ventricular fibrillation Continuous cardiac, hemodynamic, infusion pump and frequent assessment of IV site monitoring required for inpatient Arrhythmias Extravasation Anxiety, headache Renal function tests and urine output BP, HR, ECG, CVP, RAP, and MAP Large doses stimulate alphaadrenergic receptors Gangrene (high dose), piloerection If pulmonary artery catheter is in place, monitor CI, PCWP, SVR, and PVR N/V Azotemia Increased intraocular pressure, mydriasis Polyuria Dyspnea ADRENOCEPTOR ANTAGONIST Prazosin Labetalol Competitively inhibits postsynaptic alpha-adrenergic receptors which results in vasodilation of veins and arterioles and a decrease in total peripheral resistance and blood pressure HTN (not first line) Blocks alpha 1-, beta 1-, and beta 2adrenergic receptor sites HTN (not first line) Elevated renins are reduced Dizziness Cardiac status and BP Orthostatic HOTN Priapism Orthostatic hypotension, rash, drowsiness, nausea, or vomiting Angina Hypertension: Target BP 65 years of age - dose reductions BBW: Ischemic heart disease following abrupt cessation of therapy exacerbations of angina pectoris, myocardial infarction Dizziness, fatigue Withdrawal - taper Contra: 2nd or 3rd degree heart block, severe bradycardia, cardiogenic shock, decompensated HF, SSS, PAD, SBP