Pharm Cards Final

• Continued sedation
• Continued pain mgmt
• Continued tube security

SVC/IVC > RA > Tricuspid Valve > RV > Pulmonary semilunar valve > Pulmonary artery > Lungs > LA > Bicuspid > LV > Aortic semilunar > Aorta > Body

SA node > Internodal > AV node > Bundle of His > R & L bundle branches > Purkinje Fibers

Conduction tract in the heart that originates @ SA node & conducts action potentials to the LA

• Sodium Channel Blockers
• Slow conduction & decrease repolarization rate

• IA
• Quinidine, Procainamide & Disopyramide

• Sodium Channel Blockers
• Lidocaine (xylocaine)
• Phenytoin (Dilantin)
• Tocainide (Tonocard)
• Mexiletine (Mexitil)

• Increased rate of repolarization
• Reduced automaticity in ventricular cells

• Widened QRS
• Prolonged QT

• Widened QRS
• Prolonged QT

• Flecainide (Tambocor)
• Propefenone (Rythmol)

• Decrease conduction velocity thru Atria, ventricles, bundle of His & purkinji network
• Delay ventricular repolarization

• Decreases conduction velocity
• Depresses myocardial contractility
• Blocks Na influx during fast potential depolarization
• Class I miscellaneous

• Propranolol (Inderal)
• Acebutolol (Sectral)
• Esmolol (Brevibloc)

• Propranalol
• Beta1 receptors in the heart

Tachycardias resulting fr excessive sympathetic stimulation

Blocking Beta1 blocks Ca channels preventing gradual influx of Ca in phase 0 of slow potential

• Bretylium (bretylol)
• Amiodarone (Cordarone)

• K channel blockers
• Blocks efflux of K in fast channels

• V Fib
• Refractory V Tach

• IV
• Beta-Blockers

• Verappamil (calan)
• Diltiazem (cardizem)

• Ventricular conduction
• Superventricular tachycardias

• Hypotension
• Bradycardia

• Endogenous nucleoside w/ a very short half life (about 10 secs)
• Both K & Ca channels; ^ K efflux & inhibiting Ca influx

• Facial Flushing
• SOB
• Chest Pain
• Marked Bradycardia

In pts taking adenosine blockers such as aminophylline or caffeine

In pts taking adenosine uptake inhibitors such as dypyridamole (Persantine) or Carbamazapine (Tegretol)

• Decreases intrinsic firing rate in the SA node
• Decreases conduction velocity in the AV node
• ^ cardiac contractility

Dig causes a decrease in the effective refract period & ^ automaticity

• Bradycardias
• AV blocks
• PVCs
• V Tach
• V Fib
• A Fib

• A Fib w/ rapid ventricular conduction
• Chronic treatment of CHF

A polymorphic V Tach

Magnesium

BP=Cardiac output x peripheral vascular resistance

Cardiac output = HR x Stroke Volume

Drug used to reduce circulating blood vol by ^ amt of urine

• Loop or High ceiling diuretics
• Thiazides
• K sparing diuretics

Lasix

Left ventricular heart failure (CHF)

• Lasix
• By blocking Na reabsorption in the ascending loop of Henle decreasing the pull of H2O fr the tubule & into the capillary bed

• Hyponatremia
• Hypovolemia
• Hypokalemia
• Dehydration

Thiazides mechanism affects the early part of distal convoluted tubule & therefore cannot block as much Na fr reabsorption

Hydrochlorothiazide

They depend on glomerular filtration rate

Na absorption is affected be inhibiting the effects of aldosterone on the distal tubules or the specific Na/K exchange mechanism

Spironolactone (Aldactone)

• Beta adrenergic antagonists
• Centrally acting adrenergic inhibitors
• Peripheral adrenergic neuron blocking agents
• Alpha1 antagonists
• Combined Alpha/Beta antagonists

Metoprolol (Lopressor)

Propranolol (Inderal)

• Clonidine aka Catepres
• Drowsiness & Dry Mouth

Reserpine aka Serpalan

Prazosin aka Minipress

Competitively blocks Alpha1 receptors inhibiting sympathetically mediated increases in peripheral vascular resistance

Decreasing Alpha mediated vasoconstriction & the Beta1 blockade decreases HR, contractility & rennin release fr kidneys

• Labetalol (normodyne)
• Carvedilol (Coreg)

Interrupt the rennin-angiotensin-aldosterone-sys by preventing the conversion of angiotensin1 to angiotensin2 leading to a decrease in peripheral vascular resistance

Catopril (Capoten)

• Enalapril (Vasotec) & Lisinipril (Zestril)
• Catopril (Capoten)

• Dihydropiridines
• Nifedipine (Procardia, Adalat)

Heart condition characterized by fainting, blackouts & fainting while sitting

Hydralazine (Apresoline)

It decreases peripheral vascular resistance & afterload therefore BP.

• Constriction � Arterioles & veins
• Mydriasis � eye
• Ejaculation � penis

Inhibits release of norepi in presynaptic terminals

• ^ HR, conductivity, automaticity, contractility � heart
• Renin release � kidneys

• Bronchodilation � lungs
• Dilation � arterioles
• Inhibition of contractions � uterus
• Tremors � skeletal muscle

Lipolysis � adipose tissue

Vasodilation � kidney

All antidysrhythmics have the ability to cause dysrhythmias

• Digoxin (Lanoxin)
• Digitoxin (Crystodigin)

By ^ myocardial contractility & cardiac output

• Fatigue
• Anorexia
• Nausea
• Vomiting
• Blurred vision w/a yellowish haze & halos around dark objects

• Epinephrine
• Ephedrine

• Albuterol (Ventolin, proventil)
• Metaproterenol (Alupent)
• Terbutaline (Brethine)
• Levalbuterol (Xopenex)

Saslmeterol (Serevent)

• CNS stimulants w/ additional bronchodilatory properties
• Theophylline & Aminophylline

• Atropine
• Ipratropium (Atrovent)

• Beclomethasone (Beclovent)
• Flucticasone (Flovent)
• Triamcinolone (Azmacort)

Prednisone (deltasone)

• Methyprednisolone (solu-medrol)
• Dexamethasone (Decadron)

• Zafirlukast (Accolate)
• Zileuton (Zyflo)

Cromolyn (Intal)

Bronchoconstriction & Inflammation

• SOB
• Wheezing
• Coughing

Pet dander, mold, dust etc.

False

Beta2 specific agents

Relax bronchial smooth muscle resulting in bronchodilation & relief fr bronchospasm

Albuterol

Inflammation of nasal lining w/ symptoms nasal congestion, itching, redness, sneezing & rhinorrhea (runny nose)

Alpha 1 agonists including phenylephrine, pseudoephedrine, phenylpropanolamine

A form of tolerance that is caused by long term use of nasal decongestants.

Med that arrests the effects of histamine by blocking its receptors

An endogenous substance that affects a wide variety of organ systems.

• Benadryl
• Seldane
• Claritin
• Zyrtec
• Allegro

Sedation

B/c they do not cross the blood brain barrier

B/c they can thicken bronchial secretions

No b/c it is performing a useful function

Pulse Rate & BP

Med that suppresses a stimulus to cough in the CNS

Med intended to ^ the productivity of a cough

Med intended to make mucus more watery

• Peptic ulcers
• Constipation
• Diarrhea & emesis
• Digestion

An imbalance between factors in the gastrointestinal sys that ^ acidity & those that protect against acidity

• Helicobacter pylori bacterium infestation in the space between the endothelial cells & the mucus lining of the stomach & duodenum
• Often found in pts w/ failing gall bladders

• Cimetidine (Tagamet)
• Ranitidine (Zantac)
• Famotidine (Pepcid)
• Nizatidine (axid,pulvulex)

• Omeprazole (prilosec)
• Lansoprazole (prevacid)

• H2 receptor antagonists
• Proton pump inhibitors
• Antacids
• Aluminum, Magnesium or Na compounds
• Anticholinergics

Pirenzepine (gastrozepine)

• Bulk forming
• Stimulant
• Osmotic
• Surfactant

Med used to decrease a stools firmness & ^ its water content

Substance that decreases surface tension

• Methylcellulose
• Citrucel

• Phenolphtalein
• Ex-lax

Milk of magnesia

Colace

• Anticholinergic
• Serotonin antagonists
• Dopamine antagonists
• Cannabinoids

Ondansetron (zofran)

• Compazine
• Phenergan
• Inapsine
• Reglan

• Marinol
• Cesamet

• Fight & flight
• Thoracolumbar

• Feed & breed
• Craniosacral

Near the spine

Ganglia are in or near target organs

• Ach
• NE

ACh & Ach

Pertaining to the neurotransmitter Ach

Pertaining to the neurotransmitter NE.

3,7,9,10

• SLUDGE
• Salivation, Lacrimation, Urination, Defacaction, Gastric Motility, Emesis

By stimulating the effects of Ach by binding w/ cholinergic receptors

The parasympathetic NS

• Phenelzine (Nardil)
• Octamoxen (Ximaol, Nimadol)
• Caroxazone (Surodil, Timostenil)
• Linezolid (Zyvox, Zyvoxam, Zyvoxid)

• Antidysrhythmics
• Antihypertensives
• Hemostatic Agents
• Anyihyper-lipidemic Agents

• Procainamide
• Lidocaine

Chemical used to diagnose, treat or prevent disease

Study of drugs & their interaction w/ the body

• Chemical
• Generic
• Official
• Brand

• US Pharmacopeia
• PDR
• Drug Info
• Monthly prescribing reference
• AMA Drug eval

• Name
• Classification
• Mechanism of Action
• Indications
• Pharmacokinetics
• Side effects/ Adverse reactions
• Routes of Admin
• Contraindications
• Dosage
• How Supplied
• Special considerations

• High abuse potential
• Possible severe dependance
• No medical indication
• Used for research, analysis or instruction only

Heroin, LSD, Mescaline

• High abuse potential
• Possible severe dependance
• Accepted medical indications

Morphine, Codeine, Oxycodone, Methadone, cocaine

• Less abuse potential than Schedule I & II
• May lead to moderate to low physical dependance or high psychological dependance
• Has acceptable medical uses

• Limited opioid amts or combined w/nonctrled substances
• Vicodin
• Tylenol w/codeine

• Low abuse potential
• Limited psychological &/or physical dependance
• Accepted medical indications

Diazepam, Lorazapam, phenobarbital

• Low abuse potential
• May lead to limited physical or psychological dependance
• Accepted Medical indications

• Limited amts of opioids
• Often for cough or diarrhea

Test that determines the amt & purity of a given chemical in a preparation in a laboratory

Relative therapeutic effectiveness of chemically equivalent drugs

Test to ascertain a drugs availability in a biological model

Dose Packaging

Teratogenic Drug

The proportion of a drug available in the body to cause either desired or undesired effects

How a drug is absorbed, distributed, metabolized (biotransformed) & excreted; how drugs are transported into & out of the body

How a drug interacts w/ the body to cause its effects

Process in which carrier proteins transport lg molecules across the cell membrane

Diffusion

The movement of solvent in a solution fr and area of lower solute concentration to an area of higher solute concentration

Molecules across a membrane fr an area of higher pressure to an area of lower pressure

• Absorption
• Distribution
• Biotransformation
• Elimination

That is still active after it reaches its target tissue

Tight junctions of the endothelial cells in the CNS vasculature thru which only non protein bound highly lipid soluble drugs can pass

Biochemical barrier at the maternal/fetal interface that restricts certain molecules

Metabolism

Biotransformation

A med that isnt active when administered, but whos biotransformation converts it into active metabolites

The livers partial or complete inactivation of a drug b/f it reaches the systemic circulation

The loss of hydrogen atoms or the acceptance of an O2 atom ^ pos charge on the molecule

breakage of a chem bond by adding H2O or by incorporating a hydroxyl group into 1 fragment & a hydrogen atom into the other

Through the intestinal tract

Outside the gastrointestinal tract, typically using needles to inject directly into the circulatory sys or tissue

• PO
• Orogastric/Nasogastric Tube (OG/NG)
• SL
• Buccal
• PR

• IV
• ET
• IO
• Umbilical
• IM
• SC
• Inhalation/Neb
• Topical
• Transdermal
• Nasal
• Instillation
• Intradermal

• Pills
• Powders
• Tablets
• Suppositories
• Capsules

• Solutions
• Tinctures
• Suspensions
• Emulsions
• Spirits
• Elixers
• Syrups

A pill is a drug shaped spherically where as a tablet is compressed powder

Gelatinus container filled w/ powder or tiny pills

Liquid drug preparation using an alcohol extraction process

Drug suspension w/ an oily substance in the solvent

Drug solution of a volatile drug in alcohol

Alcohol & water solvent usually w/ flavoring to improve taste

• Binding to a receptor site
• Changing physical props of cells
• Chemically combining w/other chemicals
• Altering normal metabolic pathway

Specialized protein that combines w/ a drug resulting in a biochemical effect

Force of attraction between a drug and receptor

A drugs ability to cause the expected response

Participates in complex cascading reactions that eventually cause a drugs desired effect

Down Regulation

Up-regulation

binds to a receptor but does not cause it to initiate the expected response

binds to a receptor but does not cause it to initiate the expected response

stimulates some of its effects but blocks others

binds to a receptor & causes the expected effect while also blocking another drug fr triggering the same receptor

The binding of an antagonist causes a deformity of the binding site that prevents an agonist fr fitting & binding

Competitive antagonist permanently binds w/a receptor site

Unintended response to a drug

• Allergic reaction
• Idiosyncrasy
• Tolerance
• Cross-tolerance
• Tachyphylaxis
• Cumulative Effect
• Drug dependance
• Drug interaction
• Drug antagonism
• Summation
• Synergism
• Potentiation
• Interference

Antigenic & activates the immune sys, causing effects that are normally more profound than seen in general population

Unique to the individual; different than seen or expected i the population in general

Decreased response to the same amt of drug after repeated administrations

Tolerance for a drug that develops after administration of a different drug

Tachyphylaxis

Cumulative Effect

When a pt becomes accustomed to the drugs presence in his body & will suffer fr w/d symptoms upon its absence; psychological or physical

Drug interaction

Block, response

2 drugs that both have the same effect are given together; 1+1=2

2 drugs w/ the same effect are given together & produce a response > the sum of their individual responses; 1+1=3

1 drug enhances the effect of another

The direct biochemical interaction between 2 drugs; 1 drug affects the pharm of another

Correlation of different amts of a drug to clinical response

Describes lengths of onset, duration & termination of action as well as the drugs min effective concentration & toxic levels

Time from administration until a med reaches its minimum effective concentration

Minimum level of a drug needed t cause a given effect

The length of time a drug remains above its minimum effective concentration

Time fr when a drugs level drops below its minimum effective level until it is eliminated fr the body

Ratio of a drugs lethal dose for 50% of the population to its effective dose for 50% of the population

Time the body takes to clear 1/2 of a drug.

Drug that exhibits a classes common properties & illustrates its particular characteristics

Morphine

Med that relieves the sensation of pain

The absence of the sensation of pain

Absence of all sensations

Agent that enhances the effects of other drugs

Brain & spinal cord

Everything that doesn't fall into the CNS

Ctrls voluntary or motor functions

• Involuntary or automatic functions
• Sympathetic & parasympathetic nervous sys

• Analgesia
• Euphoria
• Sedation
• Miosis

Decreases preload & afterload

• Salcylates (ie aspirin)
• NSAIDS (ie ibuprofen)
• Para-aminophenol derivates (ie acetaminophen)

Drug that completely binds w/opiod receptors w/o causing the effects of opiod bonding. (ie Narcan)

• Drug that displays both agonist & antagonistic props.
• ie Nubain decreases pain response w/o resp & addictive side effects

Med that induces loss of sensation to pain or touch

Anesthesia that combines decreased sensation of pain w/amnesia while pt remains conscious

State of decreased anxiety & inhibitions

Instigation of sleep

Romazicon dosed @ 0.2 mg up to 1mg

State of hyperactivity in either a section of the brain or all of the brain

Periods of muscle rigidity (tonic stage) followed by spazmotic twitching (clonic stage) then flaccidity & a gradual return to consciousness (postictal stage)

They inhibit the influx of Na into the cell decreasing the cells ability to depolarize & propagate seizures

They inhibit influx of Ca in Ca channels in the hypothalmus

• Phentoin aka Dilantin
• Carbamazapine aka Tegratol

Valproic Acid

They interact w/the GABA receptor-chloride ion channel complex. They hyperpolarize the membrane of the CNS neurons decreasing their response to stimuli

• Lorazapam aka Ativan
• 2-4 mg IM, 0.5-2mg IV for sedation
• 2mg slow IV/PR for status epilepticus

• Lorazapam
• 2-4mg IM, 0.5-2mg IV for sedation
• 2 mg slow IV/PR for status epilepticus
• Diazepam
• 5-10mg IV/IM seizure
• 2-5mg IV/IM acute anxiety
• 5-15mg IV premed

• Antianxiety
• Hypnotic
• Anesthetic
• Anticonvulsant
• Sedative

• ^ release or effectiveness of exicitatory neurotransmitters
• Decrease release or effectiveness or inhibitory neurotransmitters

Treating drowsiness, fatigue & appetite suppressant

• Tachycardia & Dysrhythmias
• Hypertension
• Convulsions
• Insomnia
• Psychosis w/hallucinations & agitation

Methylphenidate aka Ritalin

Caffeine even tho it has few clinical uses

• Extrapyramidal Symptoms
• Dystonic Reaction
• Caused by brain damage & antipsychotic drugs

By blocking the reuptake or nor-epi & serotonin thus extending the duration of their action

By selectively blocking the reuptake of serotonin but they do not affect dopamine or nor-epi

Sodium Bicarbonate

• Prozac
• Sertaline (Zoloft)
• Paroxetine (Paxil)

Inhibiting monoamine oxidase & blocking monoamines breakdown thus ^ their availability

• Phenelzine (Nardil)
• They aren't commonly used but when they are its usually for treating depression refractory to TCAs & SSRIs.

A nervous disorder caused by the destruction of dopamine releasing neurons in the substantia nigra, part of the basal ganglia, which is a specialized area of the brain that crtl fine motor movement

Disfunctional movements such as involuntary tremors, unsteady gait & postural instability

Levodopa b/c it can readily cross the blood brain barrier where it is absorbed by dopamine releasing neuron terminals