Pharmacology Study Guide - Exam 4 PDF

Noradrenergic sympathomimetic anorexiants - Stimulates release of norepinephrine and dopamine - Prototype -- Phentermine (adipex) - Action is it inhibits re-uptake of both serotonin and norepinephrine causing appetite suppression - Used for speedy weight loss in short-term duration,...

Noradrenergic sympathomimetic anorexiants - Stimulates release of norepinephrine and dopamine - Prototype -- Phentermine (adipex) - Action is it inhibits re-uptake of both serotonin and norepinephrine causing appetite suppression - Used for speedy weight loss in short-term duration, must be 16 years or older - Causes nervousness, palpitations, tachycardia, and hypertension - Do not use with hypertension, cardiovascular diseases, hyperthyroidism, glaucoma, and pregnancy Lipase Inhibitors - Prototype -- Orlistat (Xenical, Alli) - Action is it inhibits lipases by slowing absorption of dietary fats - Used by clinically obese by BMI to reduce absorption of dietary fats and decreases cholesterol - Causes GI pain, fecal urgency, flatulence, and fatty stools - Do not use with gallbladder disease Antacids - Prototype -- aluminum hydroxide magnesium hydroxide simethicone (Mylanta) - Action is it neutralizes acid while minimally absorbed systemically - Used to prevent or decrease pain from GERD by neutralizing gastric acid with pain relief as treatment goal - Causes constipation, long term ingestion of aluminum may cause hypophosphatemia and ostemalacia, magnesium may cause hypermagnesemia and diarrhea, older adults may experience neuromuscular effects - Contraindication is it can affect the absorption of oral iron, fluoroquinolones, and cardiac drugs. Has renal dosing Histamine 2 receptor antagonist - Prototype -- Cimetidine - Action is it inhibits histamine 2 receptors in stomach reducing gastric acid - Used in PUD, GERD, esophagitis, and GI bleeds - Causes diarrhea and confusion in older adults - Do not give to impaired renal and haptic function patients Proton Pump Inhibitors - Prototype -- omeprazole (Prilosec) - Action is it irreversibly binds the gastric pump preventing the release of gastric acid - Used is PUD, GERD and symptom specific dosing - Causes nausea, diarrhea, headache, and in long term use greater than 1 year is associated with hip fractures in older adults due to calcium absorption Miscellaneous weight loss drugs - Lorcaserin - Bupropion -- naltrexone - Liraglutide Adjuvant Meds For PUD - Misoprostol - Action is it inhibits gastric secretions and increases mucus and bicarbonate secretions, mucosal blood flow, and mucosal repair - \*\*BBW: Pregnancy\*\* - Sucralfate - Used to prevent or treat PUD - Requires 4-8 weeks unless healing is confirmed by exam Phenothiazine - Prototype -- Promethazine (Phenergan) - Other meds -- Prochlorperazine (Compazine) - Action is it is a CNS depressant - Used in prevention and treatment of nausea and vomiting - Causes blurred vision, urinary retention, dry mouth, photosensitivity, drowsy, and confusion - Use cautiously with glaucoma - \*\*BBW: do not use in children under 2, do not give SubQ, avoid IVP (need to be diluted) because can cause ulceration if it leaks into tissues\*\* Antihistamines - Prototype -- Hydroxyzine (Vistaril) - Other meds -- diphendramine (Benadryl), dyphendydrinate (meclizine) - Action is it blocks acetylcholine in the brain by blocking H1 receptors - Used for nausea, vomiting, motion sickness, anxiety, and in combo of other drugs for anesthesia - Causes drowsiness, dizziness, dry mouth, blurred vision, and urinary retention - Do not use in renal and hepatic impairment 5-HT3 receptor antagonist - Prototype -- Ondansetron (Zofran) - Action is it antagonizes serotonin receptors - Used to prevent and treat nausea and vomiting - 1^st^ line choice for post op nausea and vomiting - Causes if anything mild diarrhea, headache, or dizziness - Do not give if patient on class I or III antidysrhythmics Bulk Forming Laxatives - Prototype -- Psyllium - Must be taken with water to avoid obstruction - Action is it adds mass to feces which stimulates peristalsis and defecation - Used to treat constipation - Causes severe flatulence and bloating - Do not use if patient has undiagnosed abdominal pain because inflamed organs can rupture, intestinal obstructions, or impaction Lubricant Laxatives - Prototype -- Mineral oil - Not an oral laxative of choice, best used as an enema to soften hard, dry feces - Action is it lubricates the fecal mass and slows colonic absorption of water from the fecal mass - It may interfere with absorption of fat-soluble vitamins - If aspiration occurs may result in lipid aspiration pneumonia which is very severe Surfactant Laxatives - Prototype -- Docusate calcium/sodium - Action is it decreases the surface tension of the fecal mass to allow water and fat to penetrate the stool making it softer and easier to expel - Used to prevent straining Cathartic Stimulant Laxatives - Prototype -- Bisacodyl - Action is it irritates the GI mucosa to pull water into the colon and stimulates peristalsis - This laxative can produce a watery stool that may lead to fluid, electrolyte, and acid base imbalances - Used to relieve constipation and for bowel prep for exams or surgeries - Causes abdominal pain, cramping, and diarrhea - Strongest and most abused laxative Saline Laxatives - Prototype -- Mag citrate - Others -- Milk of Magnesia - Action is it increases the osmotic pressure in the intestinal lumen causing water retention that distends the bowel and stimulates peristalsis. - Produces a semi-fluid stool that may lead to fluid and electrolyte imbalances - Do not use in CHF, renal impairment, or long term - \*\*Polyethylene glycol-electrolyte solution -- used for rapid bowel cleaning prior to colonoscopy Miscellaneous Saline Laxatives - Lactulose -- not orally absorbed, pulls water into lumen to treat constipation and hepatic encephalopathy from ammonia accumulation - Lubiprostone -- used for IBS-C - Linaclotide -- used for IBS-C, give on empty stomach, \*\*BBW- do not give to younger than 6\*\* Opiate-related Antidiarrheal Agent - Prototype -- Diphenoxylate with atropine (Lomotil) - Schedule 5 controlled substance - Other meds -- Loperamide (Imodium A-D) - Action is it slows peristalsis - Causes tachycardia, dizziness, headache, flushing (anticholinergic effects) - Use extreme caution when giving with hepatic and renal disease - Do not give if patient has toxic diarrhea which usually starts as ulcerative colitis - \*\*BBW: for loperamide may cause torsades de pointe or cardiac arrest if higher that recommended dose used\*\* Adjuvant Meds for Diarrhea - Bismuth Subsalicylate (Pepto Bismol) - Bismuth salts have antibacterial and antiviral activity. Also has antisecretory and anti-inflammatory effects because of its salicylate component - Octreotide acetate (Sandostatin) - A synthetic form of somatostatin that may be effective in treatment of diarrhea because it decreases GI secretions and motility - Polycarbophil (Fibercon) and Psyllium - Are occasionally used in diarrhea treatment to absorb toxins and water which decreases the fluidity of stools - Cholestyramine (Questran) and Colestipol (Colestid) - Are useful in diarrhea treatment because of bile salt accumulation in Crohn's or surgical excision of Ileum PUD - Is ulcer formation in esophagus, stomach, or duodenum that are exposed to gastric acid and pepsin. - Can be caused from H. Pylori infection or long-term use of NSAID's - Stress can precipitate ulcer formation - Gastric and duodenal more common than esophageal - Gastric ulcers occur more often with older adults - Duodenal occur more often with H. Pylori infection and NSAID use and can occur at any age - Nursing intervention is to promote well balanced diet, rest, and exercise Salicylates - Prototype -- Acetylsalicylic Acid (Aspirin) - Is an analgesic, antipyretic, and anti-inflammatory - Action is it blocks pain impulses from CNS and PNS, reduces fever by acting on hypothalamus, diminishes inflammation, and suppresses platelet aggregation - Can be given PO or rectally - Causes GI distress, nausea, dyspepsia (indigestion), heartburn, GI bleeding and bruising - Low doses used to manage ischemic strokes, TIA, angina, and MI - Give with full glass of water, with or after food to lessen GI upset - Do not give to children because can cause Reye's syndrome, pregnant, known bleeding risks - Acute overdose can cause resp. alkalosis, hyperpnea, tachypnea, hemorrhage, confusion, pulmonary edema, seizures, tetany, metabolic acidosis, fever, coma, and cardiovascular collapse - Salicylism is toxicity associated with chronic use of ASA that causes dizziness, tendonitis, difficulty hearing and confusion - Overdose treated with gastric lavage and activated charcoal or IV sodium Bicarb - Patient teaching: enteric and capsules should be swallowed whole, do not crush or chew. Do not take with alcohol due to increased risk of bleeding - Use cautiously with patients on low sodium diets -- 1 aspirin has 553 mg of sodium Acetaminophen - Is an analgesic and antipyretic - Can be taken PO (tablet or liquid) or rectal suppository - Children and older adults can take if no liver damage or chronic alcohol abuse - Overdose signs and symptoms: (early) anorexia, nausea, vomiting, diaphoresis - After 24 hours liver function test shows increased levels - Late signs are jaundice, vomiting, CNS stimulation with excitement, delirium, coma, death - Overdose can be nephrotoxic causing liver damage or fatal liver necrosis - Antidote is acetylcysteine which is most beneficial if given 8-10 hours after ingestion occurred. Does not reverse damage. Gastric lavage if detected 4hours after ingestion Miscellaneous Antiemetics - Olanzapine (Zyprexa) -- 2^nd^ generation antipsychotic - Dronabinol (Marinol) -- synthetic cannabinoid - Nabilone - Phosphorated carbohydrate solution (Emetrol) - Scopolamine (patch) -- transdermal that stays on for 72 hours Androgenic Hormone - Prototype -- Testosterone - Schedule III controlled substance - Used to treat androgen deficiency - Can be taken PO, IM, transdermal, gel, pellets - Causes acne, changes in sex drive, hair loss, headache, bitter taste, mouth irritation, gum tenderness, priapism, hypercalcemia, jaundice, edema - Do not give to pregnant, liver disease, or prostate disorders - Increases the effects of cyclosporine and warfarin -- avoid combos - Decreases effects of barbiturates and calcitonin - Abuse of testosterone can cause issues with cardiovascular, liver, CNS, reproductive, metabolic, and dermatologic - Not used in older adults because of cardiovascular disorders and uinary retention 5-Alpha Reductase Inhibitors - Prototype -- Finasteride (Proscar) - Other meds -- dutasteride (Avodart) - Action is it blocks the effects of endogenous androgens preventing conversion of testosterone - Used in treatment of BPH and hair growth - Can cause sexual dysfunction, impotence, gynecomastia, reduced libido, ejaculatory disorders - Do not give to known sensitivity, pregnancy, or lactating - AVOID handling if pregnant - Patient teaching: take same time same day, wear gloves when administering, may take 6-12 months to see improvement - Careful use in older adults because of hypotensive and hypothermic effects Alpha-Adrenergic Blockers - Prototype -- Tamsulosin - Action is it blocks the activity of androgen hormones at target tissue receptors (prostate) - Used for symptomatic relief of obstruction caused by BPH - Causes hypotension, weakness, drowsy, premature ejaculation - Increased effects by cimetidine and other alpha blocker meds Phosphodiesterase 5 Inhibitors - Prototype -- Sildenafil (Viagra) - Other meds -- Tadalafil (onset 12hours duration of 24-36 - Other meds -- Vardenafil (peak 1 hour duration 4 hours; prolongs QT intervals) - Used for erectile dysfunction - Action is it helps to maintain erection by increasing blood flow to penis - Causes headache, flushing, dyspepsia (indigestion), nasal congestion, dizziness, priapism (rare), sometimes vision or hearing loss - Increased affects by alcohol, alpha adrenergic blockers, antihypertensives, erythromycin, and protease inhibitors - Food interactions are grapefruit juice and saw palmetto, fatty foods - Do not give with nitrates -- will cause hypotension and MI - Onset 20-60 minutes with 1 hour duration Prostaglandins - Prototype -- Alprostadil - Used as adjuvant medication to treat erectile dysfunction - Action is it relaxes cavernosal smooth muscle and dilates arterioles to increase blood flow - Can be taken by intraurethral pellets or intracavernosal injection Herbal Meds for Men's Health - Saw palmetto -- used to treat BPH and alopecia - Can cause GI upset, headache, back pain, dysuria - Serenoa repens and sabal serrulata