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ice13j
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ice13j
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2010-11-07 22:34:10
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ice13j Pharm test
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Pharm Test #2
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  1. Adranergic drugs produce effects on
    • Heart
    • Blood Vessels
    • Lungs
  2. Adranergic drugs produce effects similar to
    SNS
  3. Mechanism of Action for Adranergic Drugs they are
    • 1. Selective
    • 2. Nonselective
  4. 3 mechanisms of action for adranergic drugs
    • 1. Interact DIRECTLY with Alpha 1 or Beta adranergic receptors on target organs/tissues
    • 2. Indirect effects on adranergic receptors which increases release of norepinephrine=then stimulating alpha and beta receptors
    • 3. Mixed action- combo of direct and indirect
  5. Drug Effects for Adranergic
    • Activation of:
    • Alpha 1
    • Beta 1
    • Beta 2
    • Altpha 2
  6. Activation of Alpha 1 receptors by Adranergic drugs causes:
    • Vasoconstriction of peripheral Vessels = increased blood pressure
    • causes decrease in nasal mucosa thru vasoconstriction of mucous membranes
  7. Effects of Activation from Beta 1 receptors from Adranergic Drugs:
    • Causes (+) effects on heart:
    • 1. Inotropic- force of contraction
    • 2. Chronotropic - Increase Rate
    • 3. Dromotropic - Increase speed of electrical conduction thru AV node
  8. Activation of Beta 2 by Adranergic Drugs-
    Lungs- Bronchodilation
  9. Activation of Alpha 2 by Adranergic Drugs
    • causes reverse effect
    • not commonly used
  10. Indications or use for Adranergic Drugs
    • Anaphylactic Shock
    • CPR
    • Hypotension and Shock
    • Nasal Congestion
    • Relaxation of uterine muscles and inhibition of uterine contractions
  11. Anaphylactic Shock
    • results in bronchospasm, hypotension, and shock
    • caused by Histamine release
    • never occurs 1st time exposed to drug or allergen (occurs 2nd or 3rd time)
  12. Adranergic Drug of Choice for Anaphylactic Shock
    Epinephrine
  13. Action of Epinephrine
    • Increase HR
    • Opens airway (main effect) - BRONCHODILATION
    • Increase BP
    • Works against Histamine (antagonist)
  14. Adjunct Medications for anaphylactic shock:
    Steroids, Bronchodilator (known as breathing tx)

    Usually pts carry Epi Pen
  15. Why use Epinephrine for CPR?
    Peripheral Vasoconstriction allows shunting of blood to heart and brain and raise BP
  16. Contraindications for Adranergic Drugs
    • Angina
    • Dysrhythmias (abnormal Heart rhythm)
    • Hypertension
    • Hyperthyroidism
    • Cerebrovascular Disease
  17. Epinephrine (adrenaline) Action:
    • This is the prototype for Adranergic Drugs
    • Stimulates Alpha 1 and Beta Receptors
    • In normal levels of Epi- Beta activity is DOMINANT
    • Once normal levels are exceeded- Alpha activity is the predominant effect
    • (TRY to stay within normal levels to stay with Beta)
  18. Routes of Epinephrine
    IV, IM, Inhalation, Topical
  19. Can Epi be given Orally?
    No - it is destroyed by GI system
  20. Epi given by IV causes:
    • almost immediate increase in BP
    • causes positive inotropic
    • causes positive chronotropic effects on myocardium
  21. Epi concentration and administration routes:
    • Inhalation 1%
    • SubQ 0.1% - 0.5%
    • IV 0.01%
    • ID (combo w/local anasthetics) 0.001%
  22. Ephedrine actions
    • stimulates both alpha 1 and beta and causes release of norepinephrine
    • actions are less potent but longer lasting that those of epi
  23. ephedrine produces more
    • CNS stimulation than other adranergic drugs
    • can be used in treatment of bronchial asthma to prevent bronchospasm
    • it is less effective than epi for acute brochospansm and resp distress
  24. Routes of Ephedrine
    • orally or parenterally
    • orally - effects within 1 hour and last 3 to 5 hours
    • subQ- acts in approx 20 min and lasts 60 min
    • IM - act 10-20 min effects less than 60 min

    common ingredient in OTC asthma and nasal decongestants
  25. Pseudoepedrine (Sudafed) Action
    • stimulates alpha 1 and beta
    • used for allergies and colds
    • Used as a bronchodilator and nasal decongestant
    • Tight controls of this drug bc of meth production
    • given orally
  26. 2 examples of Mixed acting adrenergic drugs
    • 1. Ephedrine
    • 2. Pseudoephedrine
  27. Individual adranergic drugs and which receptor they effect"
    • Ephedrine - Mixed
    • Psedoephedrine- Mixed
    • Epinephrine - In normal doses - Beta is dominant. In high doses - Alpha is dominant
    • Phenylephrine - Alpha
  28. Phenylephrine (Neo-Synephrine)
    • action- act on alpha receptors to produce vasoconstriction = increased BP
    • uses- MAIN - common cold preparations
    • alpha 1 - stops secretions in nose due to vasoconstriction
  29. Antiadrenergic drugs
    • block effects of andranergic drugs
    • decrease or block the effects of the SNS, endogenous cateecholamines (epi) and adranergic drugs
    • Main treatment- hypertension and other cardovascular disorders
    • remember- adranergic is used for hypOtension
    • antiadranergic used for hypERtension
  30. Mechanism of action of anti adranergic drugs
    Effects occur when alpha 1 or beta receptors are blocked by adranergic antagonists or when alpha 2 receptors are stimulated by agonist drugs
  31. alpha adrenergic agonists mechanisms of action:
    • Agonists:
    • Alpha 2- inhibit release of norepi in the brain, decreasing SNS activity = decreases BP Clonodine is the main drug that does this
    • Alpha 2 also supresses insulin sectretions in pancreas
    • Blockers:
    • Alpha 1 blockers - prevent vasoconstriction
    • prevent contraction of smooth muscles in nonvascular tissues
    • main reason for people with BPH (Benign Prostatic Hypertrophy) - enlarged prostate
    • works with urinary flow of men that have this condition
    • helps bc it decreases urinary retention and improves urine flow by relaxing muscles in the prostate and urinary bladder.
  32. Mechanism of action for Beta Adenergic Blockers
    • Beta 1 receptor blockers:
    • Negative chronotropic- decrease rate
    • negative inotropic - decrease force
    • negative dromotropic - slows conduction of AV node

    • Beta 2 receptor blockers-
    • Bronchoconstriction - especially in those wtih asthma and chronic lung disorders
  33. Indications for use:
    • Hypertension - Alpha 2 agonists
    • BPH- alpha 1 adrenergic blockers
    • Cardiovascular disease - Beta Blockers
    • Glaucoma- beta blockers to decrease pressure behind eye
  34. Alpha 2 - Adrenergic Agonists
    • Clonidine (Catapress) prototype (not used often)
    • Methyldopa -(Aldomet) - older drug
  35. Alpha 1 - Adrenergic Antagonists
    Prazosin (Minipress) can give for BP

    • Tamsulosin (Flomax) - used to decrease urinary retention (Works very well) for BPH
    • ***This is drug of choice for BPH****
  36. Beta Adrenergic Blockers
    • Propranolol (Inderal)- oldest and most widely tested but not used much anymore
    • Metoprolol - (Lopressor) used more often
  37. Alpha beta blocking agents:
    • Carvedilol (Coreg) - Cardioselective
    • administration is unique** Given before breakfast bc food makes this ineffective
    • commonly used for HF
    • Decreases sudden death
  38. Issues related to admin of antiadrenergics:
    Alpha 1 blocking agents - may cause first dose syncope - BP gets too low

    Alpha 2 agonist - risk for rebound hypertension

    Beta Blockers - start with low dose and do not stop abruptly
  39. Cholinergic Drugs
    • Stimulate parasympathetic nervous system in the same manner as acetycholine
    • Some act directly on teh cholinergic receptors while others act by inhibiting the enzyme acetylcholinesterase
  40. Mechanism of action for Cholinergic Drugs
    • Direct acting cholinergic drugs- mainly effect the periphery
    • these drugs are resistant to acetylcholinesterase
    • Decrease HR
    • Vasodilation
    • Increased tone and contractility of GI smooth muscle and relaxation of sphincters
    • increase tone and contractility of detrusor muscle (bladder) ** MAIN USE
    • increased tone adn contractility of bronhial smooth muslce
    • Increased respiratory secretions
    • Constriction of pupils
  41. Indirect acting cholinergic or anticholinesterase drugs mechanism of action:
    • decrease deactivation of acetycholine
    • reversible vs irriversible cholinergic drugs
  42. Indication of use for anticholinesterase drugs:
    • Myasthenia Gravis - muscle weakness (autoimmune) receptors for acetylcholine is destroyed
    • used to improve muscle control and weakness

    Alzheimers disease

    GI- Increase peristalsis

    Urinary retention **main use*** help to increase normal urination
  43. Contraindications for Cholinergic drugs
    • Urinary or GI obstruction - cause damage to structures above obstruction
    • Asthma - they cause bronchoconstriction and increase in respiratory secretions
    • PUD- peptic ulcer disease - makes ulcer worse by increase of acids
  44. Individual Cholinergic Drugs
    • Direct acting:
    • Bethanechol (urecholine) - used for urinary retention - direct acting cholinergic
    • Reversible indirect acting cholinergic (anticholinesterase)
    • Neostagmine (Prostigmin) Indirect acting cholinergic Prototype anticholinesterase agent - used for long term treatment of Myasthenia Gravis
    • Pyridostigmine (Mestinon) Indirect acting cholinergic
    • Donepezil (Aricept) used for alzheimers (VERY POPULAR) - indirect anti cholinesterase acting
  45. Anticholinergic Drugs
    • Block the action of acetycholine in the PNS/
    • Most act on muscarinic receptors in teh brain, secretory glands, heart and smooth muscle
    • Muscarinic are very responsive to acetycholine
  46. Mechanism of action for Anticholinergic drugs
    • Binds to receptor sites on target organs - makint them less responsive to acetycholine
    • decreased response to vagal stimulation =decreased HR
    • bronchodilation and decreased resp secretions
    • antispasmodic effects in the GI tract
    • Can create severe CNS depression - negative effect
  47. Anticholinergic drug Indications for use:
    • GI disorders- not used much anymore
    • GU disorders- bladder spasms - DRUG of CHOICE
    • Respiratory disorders
    • Cardica- bradycardia and heart block
    • Parkinsons
    • Opthalmology - sx or glaucoma
  48. Individual Anticholinergic drugs
    • Atropine (prepared synthetically) - atropine sulfate
    • DRUG OF CHOICE to treat symptomatic sinus bradycardia
    • Caution - as it can increase myocardial o2 demand
    • no effect on BP
    • Very short duration of action- does not work long
  49. Individual Anticholinergic Drugs
    • Ipatropium (atrovent)
    • Rhinorrhea - nasal spray
    • Bronchodilation - inhalation


    • Tiotropium Bromide (Spiriva)
    • Bronchodilation - inhalation - not used as rescue inhaler*** this is used for maintenance of asthma
    • Use cautiously if renal disease

    • Oxybutynin (Ditropan)
    • Extended Release and transdermal
    • side effects- drowsiness, dry mouth, constipation
    • used for urinary frequency - increases capacity of bladder

    • Tolterodine (Detrol)
    • Extended Release
    • Side effects - dry mouth and consipation
  50. Colonization
    the presence of normal microbial flora or transient environmental organisms that do not harm the host
  51. Opportunistic Infections
    • caused by immunosuppression'
    • Antimicrobial therapy
    • Suppression of normal flora
    • commonly affect HIV pts
  52. Common Gram + Bacteria
    • Staphylococcus Aureus
    • Streptococci
    • Enterococci
  53. Common Gram (-) Bacteria
    • E.Coli
    • Klebsiella
    • Pseudomonas
    • Proteus
  54. CAI - Community Acquired Infection
    • Not as resistant when compared to nosocomial
    • Less severe
    • Easier to treat
  55. HAI - (Nosocomial) Hospital Acquired
    • More Severe
    • Often caused by resistant organisms
    • More resistant
  56. MRSA
    Methycilin Resistant Staph
  57. Broad Spectrum
    • affect the bacteria for which they are prescribed
    • transient organisms
    • other pathogens
    • normal flora
    • when normal flora is suppressed, space and nutrients become available to support growth of organisms resistant to teh effects of th at anitbiotic - can cause superinfections
  58. VRSA
    Vancomyosin Resistant Staph
  59. VRE
    Vancomycin Resistant Enterocci
  60. MDRTB
    Multi drug resistant TB
  61. MDR Gram Negative Bacteria (ESBL)
    • Klesbiella
    • Acinetobacter
    • Pseudomonas
  62. Antibiotic Resistance
    • exposure to subtherapeutic levels of antibiotics ( a dose that does not kill them)
    • ie- person starts to feel better than then stops meds
    • caused by overuse of antibiotics
    • resistance can be spread fro one bacteria to another as well as other species of bacteria
  63. There are new antibiotics developing for gram + bacteria
    However, for gram -
    There are no new developments for MDR gram - bacteria
  64. Antimicrobial Drugs Mechanism of Action:
    • Inhibition of bacterial Cell wall synthesis
    • Inhibition of protein synthesis
    • Disruption of microbial cell membranes
    • Inhibition of organism reproduction
    • Inhibition of cell metabolism and growth
    • Bacteriostatic or bactericidal - kills bacteria
  65. Bacteriostatic
    inhibits growth and our immune system takes over to kill it - this does not work when pt has decreased immune system
  66. Inidications for use of Antimicrobial Drugs:
    • Treat Infections
    • Prevent Infections for pts with :
    • Cardiac valve disease
    • TB in pts with latent TB infection
    • Periopertive infections - before and after sx w/in 24 hrs
    • (Never go past 24 hrs bc you want to cover them for critical period - if we go on wtih meds we could be setting them up for a resistant infection
    • Recurrent UTI
  67. Broad Spectrum
    • Effective against a wider range of organisms
    • More side effects involved with broad spectrum bc it kills normal flora (diarrhea, GI tissues)
  68. Narrow Spectrum
    • Only effective against a very narrow group of organisms
    • This is the ideal***
    • Always choose narrow if you know the organism
    • Most antibiotics are one or the other
  69. Are antibiotics always required in an infection?
    No - let immune system try to work first
  70. Culture First!!! if you can
    24 hrs at the earliest a culture can be read
  71. Always culture before giving -
    • antibiotics
    • bc the first dose can kill off some of the bacteria - making you unable to obtain an accurate culture
  72. Empiric Therapy
    • Know local patterns of drug resistant organisms
    • ie pt comes into hospital wtih signs of pneumonia - start pt on antibiotic based on clinical experience for thsi condition- may change once we get the culture back
    • It is using clinical judgement
    • Also have to follow CDC recommendations
  73. Culture identifies
    the causative organism
  74. Sensitivity determines
    which drugs are likely to be effective against the organism
  75. MIC
    • Minimum Inhibitory Concentration
    • the lowest concentration of an antibiotic that prevents visible growth of microorganisms
  76. Susceptible organisms have low or moderate MIC's that can be attained by giving usual doses of an antibicrobial agent. For the drug to be effective:
    its serum adn tissue concentrations should usually exceed teh MIC of an organism for a period of time
  77. Postantibiotic Effect
    • Aminoglycosides that get into low range still have an inhibitory effect on organisms. Therefore, its not required to maintain high lefvels of antibiotic in system when using these drugs
    • Susceptibility of organism to antibiotic also depends on site of infection and teh clinical status of the patient
  78. Indications for Combination Therapy
    • Multiple Organisms
    • HAI - Sometimes use multiple antibiotics bc of how resistnat these are
    • Serious Infections
    • Likely emergence of a drug resistance organism
  79. Superinfection
    • Second Infection usually resulting from treatment of another infection
    • Often related to resistant organisms
    • Major diff is these people are not immunosuppressed when compared to opportunistic infections
  80. Antimicrobial Toxicity
    • Most common: Nausea, vomiting, diarrhea = due to disruption of normal flora of GI system
    • Nephrotoxicity - aminoglycosides, vancomycin
    • Ototoxicity- aminoglycosides - attach 8th cranial nerve, cause deafness
    • Hepatoxicity - liver damage
    • Bone marrow depression
  81. Antimicrobial Therapy
    • Highest incidence of drug allergies involve antibiotics - due to common exposure
    • pt may have had unknow previous exposure
    • pts with history of allergies are at great risk
    • cross sensitivities in teh same drug class - ie - erythromycin and azithromycin
  82. Implemtation of antimicrobial tx
    • culture first
    • know pts allergy status
    • know renal and hepatic function

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