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Drugs with "car" in them.
What effect of alpha stimulation is a big deal for diabetics?
they decrease insulin secretion which increases BGL
What does alpha stimulation increase?
afterload, workload, BP, BGL
Why is there a decrease in coronary outflow with alpha stimulants?
because they cause constriction of the coronary (and cerebral) arteries
What do alpha stimulants decrease?
- insulin secretion
- GI motility
What is SC epinephrine used for?
to control topical superficial bleeding or delay absorption of local anesthetics
Side effects of alpha adrenergic agonists.
- increased BP
- Necrosis if given IV (due to vasoconstriction)
- bradycardia (reflex slowing of heart)
How would an ANS drug treat angina?
- increase BF
- decrease HR, contractility, & workload of heart
How would an ANS drug treat heart FAILURE?
- increase contractility (pump harder to get more blood out), dilate aorta
- decrease after load
How do ANS drugs treat BPH? (Benign Prostatic Hypertrophy)
decrease squeeze, increase flow
How would an ANS drug help in anaphylactic shock?
Which organs only receive SYMPATHETIC innervation?
- sweat glands
- pilorector muscles
- most BV
What are the adverse effects of B1 stimulation?
What are the effects of B1 stimulants?
- Stimulates HEART to increase:
- C.O. & force of contraction
- -also stimulates renin release & lipolysis
Side effects & adverse effects of B2 adregnergic agonists.
- *increases BGL*
- headache/flushing of face
- ADVERSE: tremors, hyperglycemia
What is a drug given for pre-term labor?
terbutaline (IV or PO) - a B2 stimulant
Effects of B2 stimulants.
- decreased bronchial secretions
- dilates arterioles to skeletal muscle, heart, & lungs
- glycogenolysis (*can deplete glycogen stores)
- relaxes detrusor muscle of bladder w/ difficulty urinating
How does a beta-blocker affect a diabetic differently than someone without diabetes?
It blocks the s/s of hypoglycemia
What type of drugs cannot cross the BBB?
Catecholamines (Epi, NE, Dopa)
Adrenergic agonist catecholamines are rapidly degraded by what?
By what route are catecholamines administered?
Which adrenergic agonists have a short half-life?
Which adrenergic agonists are not broken down by MAO?
noncatecholamines (terbutaline, ephedrine)
Which adrenergic agonists can be given PO?
noncatecholamines (terbutaline, ephedrine)
What are the side effects of beta-1 adrenergic agonists?
- altered rhythms of heart:
Adrenergic agonists are given with CAUTION to patients with what?
How do adrenergic agonists interact with MAOI's?
epinephrine is NOT inactivated (so the levels increase)
How do adrenergic agonists interact with tricyclic antidepressants?
blocks re-uptake of NE
How do adrenergic agonists interact with general anesthetics?
May sensitize heart, increasing risk of severe dysrhythmias
With adrenergic agonists, what should a nurse do when administering drugs with alpha activity?
- Check BP q 2-5 inutes til stable, then q15 min
- -adjust dosage to maintain systolic BP between 80-100
- Dilute meds
- Evaluate IV site continuously - no IVP thru that line!
- Monitor:-PULSE rate
- -if > 110, decrease flow rate
- -EKG strip for dysrhythmias
- -UOP -should be 30 ml/hr
Why is it important to know if a med is selective or nonselective?
nonselective can also affect the respiratory system
What med is nonselective?
Why should you evaluate an IV site continuously when adinistering adrenergic agonists with alpha activity?
tissue necrosis may result from infiltration (vasoconstriction)
Antidote for a muscarinic agonist (poisoning).
Antidote for an irreversible cholinesterase inhibitor.
Antidote for heparin.
What kind of drug is atropine?
What do anticholinergics cause?
- can't pee (dilated bladder)
- can't see (dilated & dry eyes)
- can't spit (dry mouth)
- can't shit (dry stool)
What kind of drug is used preanesthesia to decrease secretions?
Antidote for cholinergic poisoning.
Muscarinic antagonist (physostigmine)
Drug used to reverse non depolarizing neuromuscular blockade.
Parasympathetic stimulant (anticholinesterase inhibitors)
At what level of the drug is a side effect usually seen?
How do you calculate the therapeutic index?
lethal dose divided by effective dose
Does a high or low therapeutic number indicate it is safer?
If a drug has a TI (therapeutic index) of ______ it has highly increased mortality.
less than 1
Why do babies have more unbound drugs when administered?
they have less plasma proteins
increased levels of _____ in pregnant women cause decrease in gastric tone and intestinal motility and delayed gastric emptying.
How is absorption rate affected in pregnant women?
they have delayed gastric emptying, which meand drugs remain in GI tract longer and extends absorption time
How does preganancy affect respiratory drugs?
- progesterone increases pulmonary BF, tidal volume and minute volume by 40%,
- so respiratory agents are absorbed in larger quantities
Beta-blockers antagonize the effects of _______ which means what for heart?
- decreased HR, force, & conduction
Antidote to BB?
atropine or isoproterenol (B-agonist)
Alpha blockers are used to treat what?
- Migraines (prevents, doesn't treat)
- Stage fright
Renin release is normally stimulated by ______, which is why ______ inhibit their release.
What do MAOs do?
break down catecholamines
What does an anticholinesterase do?
stops breakdown of ACh
How does ACh affect the HR?
What type of drugs are used to treat glaucoma?
- Muscarinic agonists
Function of muscarinics
- relieve intraocular pressure (glaucoma)
- relieve urinary retention
- promote GI motility
What kind of drugs act to decrease BP in an emergency and nonselectively inhibit the entire ANS?
Three things that a neuromuscular blocker can cause.
- Hyperkalemia (transient release of K+ due to depolarization)
- increased intraocular pressure
- decreased BP
Antidote for muscarinic antagonists (atropine).
How does ACh affect the muscles?
activates skeletal muscles
Tetracycline has an affinity for _____.
bone (calcium) which can make teeth dark gray and can stain teeth in young kids
______ inhibits the P450 system which increases the ______ of a drug.
If a drug decreases the P450 system, what does that mean?
metabolism is decreased
What is the P450 system?
Drug metabolism that takes place in the liver
________ drugs go back into the bloodstream; while _____ drugs get urinated out.
______ drugs are NOT filtered by the glomeruli.
What is Lovenox?
a low-molecular-weight heparin (SQ)
How is the dosage for Lovenox calculated?
based on pt's wt
Thrombolytics are more effective if given within ____ of clot formation.
How is hemophilia treated?
- By replacing the missing clotting factor or
- by inhibiting coagulation
Examples of CCBs.
- amlodipine (Norvasc)
- diltiazem (Cardizem)
What is significant about adenosine?
it opens K+ channels and can stop the heart
What are CCBs used for?
angina and High BP (vasodilate coronary arteries)
What are Na+ channel blockers used for?
to suppress cardiac arrythmias
What is lodocaine?
a sodium channel blocker
What drug blocks K+ channels?
What are SSRIs?
- treat depression; ex:
- -Prozax & Luvox
What is Lasix?
a loop diuretic to increase urine and Na+ output for treatment of edema
If the peak of a drug is too high or too low, what does that mean?
adjust the dose
If the trough of a drug is too high or too low, what does that mean?
adjust the time interval
If the peak of a drug is normal, but trough is too high, how do you fix it?
space out the doses
______ is a platelet enhancer that is not given within 24 hours of chemotherapy.
Concurrent use of ____ with thiazide or loop diuretics may cause serious hypokalemia.
neumega (platelet enhancer)
What type of WBC is stimulated by G-CSF?
What type of WBC is stimulated by GM-CSF?
Neutrophils & Macrophages
What is the ADP receptor blocker prototype drug?
______ disorders are caused by too much clotting.
_______ disorders are caused by too little clotting.
When are thrombolytics such as streptokinase given?
stemi in progress
Nimotop (nimodipine) drugs work on _____ ______.
What kind of drug would you give to a pt to stop spasming after brain surgery, or a closed head injury?
A side effect of CCB (veinous).
persistent peripheral edema
A side effect of a CCB (arterial).
How does a CCB interact with digoxin?
increases serum digoxin levels
Action of centrally acting adrenergic inhibitors.
- inhibit alpha -1 stimulation
- decrease BP
- decrease HR, & contraction
Centrally acting adrenergic inhibitors exacerbate the action of ______.
other CNS depressants
What major side effect can occur after a few days of Nipride (vasodilator, IV)?
CNS toxicity, cyanide toxicity in RF