Pharm Exam 2

lowers IOP by facilitating aqueous humor flow
side effects: heightened brown pigmentation of iris, eyelid and eyelashes

lowers IOP indirectly by contraction of ciliary muscle and production of miosis
side effects: local irritation, eye pain, brow ache, renal detachment and decrease in visual acuity

Side effects of optic administration of beta blockers
Hint: local & systemic

a water-soluble dye that detects lesions of the corneal epithelium. abrasions and other defects turn bright green
Used topically or IV to assess aqueous humor flow -- IV used to facilitate retinal blood vessels, evaluate diabetic retinopathy and other abnormalities of the retinal vasculature

a prokinetic drug that increases GI tone and motility
used to suppress postoperative N&V, emesis associated w/ cancer chemotherapy, radiation therapy, toxins and opioids
indications: GERD, CINV and diabetic paraesis

motility antispasmodics

antibiotic cocktail to treat ulcers

acts topically to disrupt cell wall ofH. pylori, thereby causing lysis and death
antibiotic
#1 side effect is black hairy tongue and black stool

effective antiulcer medication that promotes ulcer healing by creating a protectibe barrier against acid and pepsin
antiulcer drug/ a mucosal protectan
dosage 1gm 4x/day, taken 1 hour before meals and at bedtime

this type of treatment are antisecretory agents that suppress acid secretion by blocking (a certain type of) receptors on parietal cells

Examples of (antisecretory agents) H2 receptor antagonists

an antisecretory agent that enhances mucosal defenses
an antiulcer drug that prevents gastric ulcers caused by long-term therapy of NSAIDs, helps protect stomach by suppressing secretion of gastric acid, serves as a replacement for endogenous prostaglandins
side effects: diarrhea, abdominal pain

prevention and treatment of duodenal ulcers; prevpack pack contains lansoprazole, amoxicillin and clarithromycin
taken immediately before meals; 15 or 30 mg 1x/day
side effects: diarrhea, abdominal pain, nausea

an antibiotic for ulcer therapy
disrupts cell wall and is good when given with Omeprazole (prilosec, a PPI)

examples of proton pump inhibitors

suppresses acid secretion by inhibiting H+, K+ - ATPase, the enzyme that makes gastric acid

an H2 receptor antagonist
promotes secretion of gastric acid, reduces both volume of gastric juice and its hydrogen ion concentration, suppresses basal acid secretion and secretion stimulated by gastrin and acetylcholine
since this drug produces selective blockade for H2 receptors, the drug cannot reduce symptoms of allergy
promotes healing of gastric and duodenal ulcers, drug of choice to relieve s/s of GERD, promote healing of ulcers in pt's w/ Zollinger-Ellsion syndrome, prevents aspiration pneumonitis
side effects: confusion, hallucinations CNS depression or excitation, etc in elderly pt's w/ hepatic or renal impairment

releases carbon dioxide in stomach to cause belching and flatulence
side effects: constipation, hypercalcemia, metabolic alkalosis, soft tissue calcification and impaired renal function

Drugs to control and induce vomiting a diarrhea; examples of antiemetics

an opioid, nonspecific antidiarrheal agent, ANTIEMETIC
used only for diarrhea, taken orally, no significatn side effect on CNS

antiemetic
used to prevent N&V associated w/ radiotherapy and anesthesia by blocking serotonin (5-HT) peripherally, centrally, and in small intestines; very effective by itself but even more effective when combined w/ dexamethasone (glucocorticoid used for nausea associated w/ chemotherapy)
side effects: N/A

used to treat diarrhea and reduce the volume of discharge from ileostomies by suppressing bowel motility and from suppressing fluid secretion into the intestinal lumen

antihistamine, H1 receptor antagosits (sedative), and antiemetic
acts on CTZ (chromoreceptor trigger zone) to decrease vomiting, increases CNS stimulation; acts on blood vessels, GI and respiratory ssytem; decreases allergic response
side effects: dizziness, drowsiness, poor coordination, fatigue, euphoria, confusion, parasthesia, neuritis, EPS, and neuroleptic malignant syndrome

drugs to relieve constipation

soften stool and reduce painful elimination
leisure, relatively mild effect

prompt fuid eevacuation out of bowel
effect: relatively fast and intense

4 types of laxatives

a laxative safe for people w/ cardiovascular or renal problems and if they are dehydrated
osmotic + bulk-forming laxative

produces soft, formed stool 1-3 days after onset of treatment

produces a soft stool several days after onset of treatment

produces a semi-fluid stool w/in 6-12 hours

produces a soft or semi-fluid stool in 6-12 hours

a stimulant laxative
site of action in colon; stimualtes peristalsis and softens feces by increaing secretion of water and electrolytes into intestine and decreasing water and electrolyte absorption
unique among stimulant laxatives b/c it can be administered recal suppository and orally

examples of 5-HT3 receptor antagonists

receptors located in the CTZ and on afferent vagal neurons in upper GI tract; relieves CINV
what additional drug would you expect to administer concurrently w/ these type of drugs

common, chronic inflammatory disorder of the airways (airway inflammation results from immune respnse to known allergens)

identify 2 current treatments options for asthma

small, hand-held, pressurized device that delivers a measured dose of drug w/ each actuation
must begin to inhale prior to activating device, wait 1 minuted between puffs if 2 puffs are need, typically 1-2 puffs, hand-lung coordination required
1 expansion

these devices are available to be used w/ MDI devices and attach directly to the MDL. they increase delivery of the drug to the lungs and decrease deposition of the drug on oropharyngeal mucosa. some of these devices contain one-way valves that activate upon inhalation, so a person needs good hand-lung coordination. some of the devices have alarms that'll sound when inhalation is too rapid

small machines used to convert a drug solution into a mist for inhalation. droplets in mist are much finer than those in inhalers. inhalation done w/ facemask or mouthpiece. takes several minutes to deliver the same amount of the drug contained in 1 puff from an inhaler.
USED WHEN PT'S ARE RESISTANT TO BRONCHODILATERS. BRONCHODILATION - LUNGS KEEP EXPANDNG AND EXPANDING compared to an inhaler where you only get 1 expansion

drugs most commonly used in inhalers

this drug is used for prophylaxis of asthma; suppresses bronchial inflammation
what would you expect patient outcome to be?

relaxes smooth muscles of bronchi, bronchioles, and pulmonary blood vessels; inhibits the enzyme phophodiesterase, thus increasing cyclic AMP, which promotes bronchodilation
this drug is a methylxanthine employed in asthma, has a narrow therapeutic index therefore dosage must be controled
side effects: GI disturbances, nervousness, irritability, cardiac dysrythmias, tachycardia, palpitations and hyperglycemia

appropriate plasma levels for theophylline
considered toxic at what level?

makes cough more productive by stimulating the flow of respiratory tract secretions (guiafesin)
(stimulates flow of respiratory tract secretions to make cough more productive)

suppresses cough, some act w/ CNS and some act peripherally (dextromethorphan)

reacts directly w/ mucous to make it more watery (mucomyst) to help make cough more productive
(makes mucous more watery to make cough more productive)

effects of antihistamines in mild allergic reactions

effects of antihistamines in severe allergic reactions

side effects of antihistamines on allergic reactions

these 2 things differ in antihistaminic efficacy and the ability to cause sedation and muscarinic blockade

CNS depression (SEDATION)
side effects: dry mouth, urinary hesitancy, drowsiness

nonsedating antihistamines, poor cross of BBB, largely devoid anticholinergic effects, now available OTC

inhibits leukotriene formation; bronchodilator; pt's will be able to breathe easier

glucocorticoids, msot effective in antiansthma drug available
teaching?
side effects?

reduced outflow of aqueous humor through chamber angle, causing IOP to gradually increase since fuid cannot leave the eye at the rate it is produced OR narrowed angle and forward displacement of iris

fuid pressure w/in the eye

powerful suppressant of acid secretion; approved for short-term therapy of duodenal ulcers, gastric ulcers, erosive esophagitis, and GERD. long-term therapy for Zollinger-Ellison synfrome
dosing: take before meal

approved for treatment and prevention of duodenal ulcers and treatmet of gastric ulcers, GERD, and hypersecretory states (Zollinger-Ellison syndrome)

this drug is similar to Prilosec - a powerful suppressant of acid secretion; approved for short-term therapy of duodenal and gastric ulcers, erosive esophagitis, and GERD. long-term therapy fr hypersecretory states (Zollinger-Ellison syndrome)
this drug achieves higher BP, lasts longer
side effects: headache, diarrhea

antibiotic
very effective against sensitive strains of H. pylori/ resistance
do not take if pregnant and don't consume alcohol

surfactant laxative, type 3
alter stool consistency by lowering surface tension, which facilitates penetration of water into feces
produces a soft stool after several days of onset treatment

prototype surfactant
docusate sodium

dopamine antagonists
suppresses emesis by blocking dopamine receptors in CTZ. reduces emesis associated w/ surgery, cancer chemotherapy and toxins
what are the extrapyrimidal symptoms?

helps colon absorb water to soften feces and increase thier mass; effect is leisurely and relatively mild

a PPI
for duodenal and gastric ulcers, GERD and hypersecretory states (Zollinger-Ellison syndrome)

2nd generation (nonsedating) H1 antagonist antihistamine, poorly cross BBB, administered orally and through nasal spray
a metered spray used for allergic fhinits

for allergic rhinitis and chronic idiopathic urticaria, causes more sedation than other 2nd generation antihistamines, but less sedation that 1st generation antihistamines
side effects: drowsiness, fatigue, dry mouth/nose/throat

a sympathomimetics that is used for nasal decongestion; causes vasoconstriction (shrinks swollen membranes), only relieves stuffiness
what do you combine sympathomimetics with?

for allergic rhinites, asthma and common cold; blockade of cholinergic receptors inhibits glandular secretions, thereby decreasing rhinorrhea; does not readily cross membranes
side effects: nasal drying and irritation