Pharmacology Exam 2

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Pharmacology Exam 2
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2011-03-20 17:10:48
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Pharmacology Anitconvulsants ANS Endocrine Drugs
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Pharm Exam 2
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  1. Tonic-Clonic Seizures
    • aka Grand-Mal
    • Sustained muscled contraction followed by intermittent spasms.
    • Usually an Aura that something is about to happen then loss of consciousness then seizure.
  2. Generalized absence -simple or complex seizures
    • aka Petit mal
    • Usually occurs in children
    • Temporary lapse of consciousness-maybe a blank stare or a very brief loss of consciousness
  3. Partial Simple Motor
    • aks Jacksonian
    • Simple motor or sensory phenomena
    • No loss of consciousness
    • Usually lasts less than 1 minute
  4. Paritcal Complex Seizure
    • aka Psychomotor
    • Some alteration of consciousness
    • Tempermental changes followed by confusion
  5. Status Epilepticus
    • A state of continuous seizure activity or a condition in which seizures recur in rapid succession without return to consciousness.
    • A neurologic emergency with a 10-20% mortality rate.
  6. Phenytoin
    1.Classification
    2. Clinical Use
    3.Adverse Effects
    4. Drug-Drug Interactions
    5. Implications
    • 1. Anticonvulsant; Dilantin
    • 2. Tonic-Clonic and Complex Partial seizures = oral. Status Epilepticus= IV
    • 3. CNS- nystagmus, ataxia, slurred speech; Gingival hyperplasia (Increased plaque growth); Folate and Vit D deficiency; Hirsutism (manly tough features, increased hair); Hypersensitivity- skin rash
    • 4. Many-especially other anticonvulsants- can lead to increased suicide risk
    • 5. Dose-100 mg tid po and 300 mg hs if tolerated; Dose IV- no faster than 50 mg/min to avoid cardiotoxicity; Not for pregnant females, Absorption depends on formulation; Titrate to effective dose. Follow IV injection with NS to avoid skin irritation. Do not use IM because it crystalizes in tissues
  7. Fosphenytoin
    1.Classification
    2. Clinical Use
    3.Adverse Effects
    4. Drug-Drug Interactions
    5. Implications
    • 1. Anticonvulsant; same as phenytoin except not oral
    • 2. Status Epilepticus
    • 3. Cardio Vascular toxicity (inject slowly); CNS- nystagmus, ataxia, slurred speech; Gingival hyperplasia (Increased
    • plaque growth); Folate and Vit D deficiency; Hirsutism (manly tough
    • features, increased hair); Hypersensitivity- skin rash
    • 4. Avoid other anticonvulsants- increases suicide risk
    • 5. Use in place of phenytoin when IM injection needed because it doesn't crystalize in tissues. Also better for IV injection. Pro Drug that transforms to phenytoin in the body.
  8. Carbamazepine
    1.Classification
    2. Clinical Use
    3.Adverse Effects
    4. Drug-Drug Interactions
    5. Implications
    • 1. Anticonvulsant
    • 2. Tonic-Clonic and Complex Partial Seizures
    • 3. CNS-dizziness, ataxia, nystagmus; Rare hepatic and hematologic (bone marrow) disorders
    • 4. Other anticonvulsants; Grapefruit juice
    • 5. Other uses- trigeminal neuralgia pain (sharp pain in face) and bipolar disorder
  9. Phenobarbital
    1.Classification
    2. Clinical Use
    3.Adverse Effects
    4. Drug-Drug Interactions
    5. Implications
    • 1. Anticonvulsant
    • 2. Tonic-Clonic and Complex Partial Seizures
    • 3. CNS-sedation and drowsiness (but tolerance develops); Folate and Vit D deficiency
    • 4. Other Anticonvulsants
    • 5. Drug of choice for neonatal seizures
  10. Valproic Acid
    1.Classification
    2. Clinical Use
    3.Adverse Effects
    4. Drug-Drug Interactions
    5. Implications
    • 1. Anticonvulsant
    • 2. Absence seizures (Can also be used in Tonic-Clonic and Complex partial Seizures)
    • 3. N&V; GI distress, BLACK BOX warning-Hepatic toxicity (increased risk in children less than 2); Thrombocytopenia (decreased platelets and increased bleeding)
    • 4. Other anticonvulsants
    • 5. Take with food. Can also be used for bipolar disorder. Start at lowest dose and increase at weekly intervals.
  11. Gabapentin
    1.Classification
    2. Clinical Use
    3.Adverse Effects
    4. Drug-Drug Interactions
    5. Implications
    • 1. Anticonvulsant
    • 2. Partial Simple seizures
    • 3. CNS- somnolence, dizziness, ataxia, nystagmus
    • 4. Antacids. (Does not interact with other anticonvulsants so good for combination therapy)
    • 5. Other uses- neuropathic pain, migraine prophlaxis, bipolar disorder, postherpetic neuralgia (post- shingles), diabetic neuropathy
  12. Lamotrigine
    1.Classification
    2. Clinical Use
    3.Adverse Effects
    4. Drug-Drug Interactions
    5. Implications
    • 1. Anticonvulsant
    • 2. Partial Simple seizures
    • 3. Stevens-Johnson syndrome (skin separates from underlying tissues); rash; CNS- dizziness, diplopia, blurred vision, ataxia, nausea;
    • 4. Very many with other anticonvulsants except gabapentin.
    • 5. Be careful of any rash and report to Dr immediately but don't stop drug. Start with low dose and work up to therapeutic dose. Also used for bipolar disorder.
  13. Diazepam
    1.Classification
    2. Clinical Use
    3.Adverse Effects
    4. Drug-Drug Interactions
    5. Implications
    • 1. Valium; anticonvulsant; benzodiazepine
    • 2. Status Epilepticus
    • 3.Respiratory and Caridiac depression
    • 4.
    • 5. Dose- 5-10 mg IV to max 30 mg. Infuse slowly no faster that 5 mg/min to avoid resp and cardiac depression. Short acting so monitor for additional seizures and switch to phenytoin or fosphenytoin if long term infusion needed. Do not mix with other drugs or dilute in other solutions.
  14. Parasympathetic v Sympathetic
    1. Neurotransmitter (post ganglionic)
    2. Pharmacologic
    3. Functional Characteristics
    4. Receptors
    • 1. Acetylcholine - Norepinephrine
    • 2. Cholinergic - Adrinergic
    • 3. Feeding and Breeding - Fight or Flight
    • 4. Muscarinic and Nicotinic (neuromusc junct) - Alpha 1 & 2 and Beta 1 & 2
  15. Clinical Uses of Cholinergic Drugs (4)
    • 1. Restore muscle tone in Myasthenia Gravis
    • 2. Curare drug antagonist- stops the muscle paralysis
    • 3. Constrict Pupils- Miosis
    • 4. Stimulate atonic bladder or intestine.
  16. Adverse Effects of Cholinergic Drugs
    • -Bradycardia
    • -Hypotension
    • Sweating (sympathetic response with parasympathetic receptors)
    • Salivation
    • Vomiting
    • N & D
    • Cramps
    • Diarrhea
  17. Neostigmine
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Cholinergic (parasympathomimetic)
    • 2. Myasthenia Gravis, Curare antidote, Miosis, Stimulate atonic bladder/intestine
    • 3. Bradycardia, Hypotension, Sweating, Salivating, N&D, Diarrhea, Cramps.
    • 4.
    • 5. [blocks acetylcholinesterase]
  18. Polocarpine
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Cholinergic
    • 2. Open angle glaucoma by decreasing intraocular pressure
    • 3. cholinergic A.E.
    • 4.
    • 5. Eye drops used by opthamologist
  19. Pharmacologic Effects of Anticholinergic Drugs
    • Relax smooth muscles
    • Inhibit secretions of duct glands
    • Dilate pupils (Mydriasis) and paralyze accommodation muscle (cycloplegia)
    • CNS stimulant (large doses)- excitement & restlesness
    • Cardiac- increase HR, conduction velocity, and contractibility
    • GI- decrease motility/contraction and muscle tone
  20. Clinical Uses of Anticholinergics
    • Preanesthesia medications- decreases secretion to prevent swallowing/gag reflex
    • Mydriatic and Cycloplegics in opthalmology
    • Antispasmodic-in GI
    • Sinus Bradycardia- inc HR
    • Parkinsons Disease(early stage)
    • Extrapyramidal Symptoms
  21. Adverse Effects of Anticholinergics
    • Dry Mouth
    • Blurred Vision
    • Urinary Retention
    • Constipation
    • Palpitations (bradycardia)
  22. Contraindications for Anticholinergics
    • Narrow angle glaucoma
    • Prostatic Hypertrophy
    • Careful with Cardiac patients
  23. Atropine
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1.Anticholinergic (parasympatholytic)
    • 2. Preoperative preanesthetic, Bradycardia, Antispasmodic, Parkinsons, EPS
    • 3. Dry mouth, blurred vision, urinary retention, constipation, palpitations
    • 4.
    • 5.
  24. Scopolamine
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Anticholinergic
    • 2. Motion Sickness (transdermal patch), preanesthetic, parkinsons, bradycardia, antispasmodic.
    • 3. Dry mouth, blurred vision, palpatations, urinary retention, constipation. Drowsiness
    • 4.
    • 5. Most anticholinergics cause restlessness and excitement but this does not so it works well for calming pts and for motion sickness.
  25. Adrenergic pharmacologic effects
    1. Alpha activity
    2. Beta activity
    3. Other effects
    • 1.Vasoconstriction-skin
    • pupil dilation
    • relaxation of GI tract- sphincter
    • 2. Cardiac acceleration and increased contraction (Beta1)
    • Vasodilation (Beta2)
    • Bronchial Relaxation (Beta 2)
    • Uterine Relaxation (Beta 2)

    Overall Beta 1 controls heart and Beta 2 bronchioloes and arterial smooth muscles

    • 3. CNS stimulation- more alert, nervousness, anxiety
    • Metabolic- inhibits insulin
    • High Doses treats inc BP
    • Low Doses dec BP
  26. Adverse Effects of Adrenergics
    • Tachycardia
    • CNS stim- HA, nervousness, anxiety
    • HTN - large doses
    • Concentration of doses in ratios so be careful of 10x increase
  27. Epinephrine
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Adrenergic (sympathomimetic); acts on Alpha and Beta receptors
    • 2. localizes anesthetic by vasoconstriction, relieves congestion/swelling associated with allergic rxn, treats anaphylactic shock, cardiac arrest, mydriasis, acute asthmatic attack
    • 3. toxicity, tachycardia, CNS stim, HTN
    • 4.
    • 5. Precaution in HTN pts and those with hyperthyroidism. Solution is unstable and reactive to light and air. Make sure there is no precipitate formed.
  28. Norepinephrine
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Adrenergic (sympathomimetic) alpha effect on blood vessels
    • 2. Potent vasoconstrictor, stimulates heart, for acute hypotensive situations such as shock
    • 3. vasoconstriction, HTN, CNS stimulant, tachycardia
    • 4.
    • 5. Usually IV but be careful of no leaking into surrounding tissues. Not for use in IV in the hand or foot due to vasoconstriction.
  29. Pseudoephedrine/Ephedrine
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Adrenergic (Sympathomimetic)
    • 2. Pseudoephedrine-Decongestant, Hay fever, cough, allergy treatment with antihistamine. Ephedrine- mydriatic eye drop, bronchodilator, nasal decongestant.
    • 3. Tachycardia, Stroke, CNS stimulation
    • 4.
    • 5. Precaution- rebound congestion when used too long.Use instead of epinephrine because its more stable and can be taken orally. Less potent but longer acting.
  30. Ergotamine Tartrate
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Antiadrenergic (sympatholytic) Alpha Blocker and Cerebral Vasoconstriction (direct effect)
    • 2. Treatment of migraines (not alpha blocker effect)
    • 3. Ergotism- toxicity from ergot alkaloid - sx include- numbness/tingling, gangrene, muscle pain/weakness, detrimental to fetus
    • 4.
    • 5. Assess for signs of Ergotism.
  31. Clinical Uses of Antiandrenergic beta blockers
    • angina
    • cardiac dysrhythmias
    • hypertension- cardiac and renin mechanisms
    • migraine prevention
    • open angle glaucoma (eye drops not propanolol) - dec aqueous humor production
    • post MI to decrease chance for 2nd MI
  32. Adverse effects of Antiadrenergic Beta Blockers
    • Nausea and Vomiting
    • CNS- lightheadedness, dizziness, depression
    • Bradycardia and Hypotension
    • Bronchospasm
    • Hypoglycemia (careful with DM1)
  33. Contraindications and Precautions of Antiadrenergic Beta Blockers
    • Asthma and COPD
    • CHF
    • beta-blocker withdrawal- must taper- will have excess sympathetic stimulation if stopped too fast because Beta Receptor build-up
    • Diabetics
  34. Propranolol
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Inderal Antiadrenergic Beta Blocker
    • 2. Angina, cardiac dysrhythmias, hypertension (mostly through renin control in kidney), migraines, open angle glaucoma.
    • 3. Nausea and Vomiting, CNS- dizziness, lightheadedness, depression, bradycardia, hypotenstion, bronchospasms, hypoglycemia
    • 4.
    • 5. Blocks both Beta 1 & 2 (resp depression) receptors
  35. Metoprolol
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Antiadrenergic Beta Blocker (selctive for B1 receptors)
    • 2. CHF
    • 3. Less resp effects than propranolol
    • 4.
    • 5. Longer duration and action than propranolol. At normal dosages there will be less respiratory depression than Inderal because it selects for Beta 1 receptors which mostly control heart function.
  36. Atenolol
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Antiadrenergic Beta Blocker (selective for Beta 1 receptor)
    • 2.angina, cardiac dysrhythmias, hypertension, migraine prevention, open angle glaucoma, post MI
    • 3. Does not pass BBB so there are less CNS effects but still other antiadrenergic AE - vomiting, bradycardia, hypotension, bronchospasms, hypoglycemia.
    • 4.
    • 5. Longest Beta Blocker duration of action (qday dosage); good for chronic use with less CNS effects and better pt compliance.
  37. Thyroid Gland Functions
    • Regulates basal metabolic rate
    • Growth
    • Maturation
    • CNS development
    • Carb, Fat and Protein Metabolism
    • GI Motility
    • Fluid/Electrolyte Balance
    • Cardiovascular Stimulation
    • Temperature Control
    • Lactation
    • Reproduction
  38. Hypothyroidism
    • Insufficient production of thyroid hormones to meet the body's demands
    • -Cretinism
    • -Myxedema
    • Sx-Lethargy, Sluggishness, Muscle Weakness, Mental dampening, puffy face/eyes, weight gain, decreased response to cold
  39. Thyroid, dessicated
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Thyroid Hormone
    • 2. Hypothyroidism- cretinism, myxedema
    • 3. Cardiac stimulation, HA, GI stimulation, insomnia, weight loss and other symptoms of Hyperthyroidism
    • 4. Warfarin- affects concentration of warfarin in body
    • Diabetic Drugs- decreases blood sugar too
    • 5. Contains both T4 and T3 in varying concentrations, inexpensive but not used very often. Start with low dose and work up slowly.
  40. Levothyroxine
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Thyroid hormone. (T4 Thyroxine)
    • 2. Hypothyroidism- cretinism, myxedema
    • 3. Cardiac Stimulation, GI stimulation, HA, insomnia, weight loss, intolerance to heat, increased apetite, other Hyperthyroidism sx.
    • 4. Warfarin, Diabetic Drugs
    • 5. Long half life (qday); start slowly with low dose and gradually increase; sensitive to light and moisture; Convreted to T3 in body.
  41. Liothyronine
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Thyroid Hormone (T3- Triiodothyronine)
    • 2. Hypothyroidism-cretenism, myxedema
    • 3. More cardiac adverse effects than levothyroxine, other Hyperthyroidism sx.
    • 4. Warfarin, Diabetic drugs
    • 5. Shorter acting, more potent (requires multiple dosing); difficulty in monitoring levels; Used instead of T4 prior to cheimcal analysis since its half life is shorter and won't change values; also used for initiation of therapy as test dose.
  42. Hyperthyroidism
    • Occurs whenever excess thyroid hormones are released
    • -Grave's disease
    • Sx- Cardiac stimulation, weight loss, restlessness, bulging eyes
  43. Propylthiouracil (PTU)
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Anti-Thyroid Hormone therapy
    • 2. Hyperthyroidism- Grave's Disease
    • 3. loss of taste, N/V, dizziness, leukopenia, agranulocytosis. Crosses placenta-fetal hypothyroidism
    • 4.
    • 5. Precaution in pregnancy; of well controlled in 6-12 months try to discontinue drug; inhibits synthesis of thyroid hormone.
  44. Treatment for Hyperthyroidism
    • 1. Propylthiouracil
    • 2. Radioactive iodine-so hormones can't be made
    • 3. Surgery-Subtotal/total throidectomy
  45. Adrenal hormones (3)
    • 1. Gluccocorticoids (cortisol)
    • 2. Mineralocorticoids (aldosterone)
    • 3. Androgens
  46. Pharmacologic Effects of Corticosteroids
    • Metabolic (fat, CHO, proteing metabolism)
    • Antiinflammatory
    • Immunosuppressive- decreased lymph activity
    • Sodium Retention with Potassium loss (careful with HTN and CHF)
  47. Adverse Effects of Corticosteroids (9)
    • 1. Drug induced Cushing's syndrome-redistribution of fat-trunk obesity
    • 2. Hyperglycemia
    • 3. Mood changes- euphoria, steroid psychoses
    • 4. Osteoporosis
    • 5. Peptic Ulcer
    • 6. Increased susceptibility to infection
    • 7. GI Upset
    • 8. Muscle weakness/wasting-cuz of protein breakdown
    • 9. Cataracts
  48. Adrenal Suppression
    • Sudden withdrawal of steroids may cause acute adrenal insufficiency. Body cannot increase cortisol demands fast enough.
    • -To minimize supression during long term therapy
    • 1. Alternate day theory-body still keeps up adrenal function
    • 2. Early morning administration when adrenal glands are producing the most cortisol to follow the circadian rhythm.
    • 3. Long term use of drugs
  49. Clinical Uses of Corticosteroids (9)
    • 1. Replacement therapy-for addison's disease
    • 2. Antiinflammatory
    • 3. Allergic States
    • 4. Collagen diseases (SLE)
    • 5. Dermatological diseases-topical to reduce itching
    • 6. Neoplastic diseases -Ca- Combination therapy to decrease lymph production
    • 7. Rheumatic diseases- RA, Osteoarthritis- decreases joint inflammation
    • 8. GI diseases- ulcerative colitis, Crohn's disease- decreases GI inflammation
    • 9. Asthma
  50. Precautions/Contraindications of Corticosteroid therapy (3)
    • 1. Peptic Ulcers
    • 2. HTN-if drug has mineralization properties (Increased Na); CHF
    • 3. Diabetes-interferes with diabetic drugs
  51. Drug-Drug interactions with Corticosteroids (3)
    • 1. Oral anticoagulants-warfarin
    • 2. Antidiabetics- blood sugar effects leading to hyperglycemia
    • 3. Salicylates-Aspirin- can lead to GI upset and bleeding.
  52. Hydrocortisone.
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Glucocorticoid
    • 2. Replacement therapy for Addison's disease, like natural hormones in activity.
    • 3. Most mineralized drug so has highest Na increase and potassium loss-CHF and HTN
    • 4. Oral anticoagulants-warfarin; antidiabetics; salicylates
    • 5. Dose- IM/IV 100-500 mg q2-10 hr; 5-30 mg bid-qid po; Available OTC, Shortest Acting; Take with food/milk
  53. Prednisone, Methylprednisolone
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Glucocorticoid
    • 2. Replacement therapy; antiinflammatory; allergic states; collagen diseases (SLE); Dermatological diseases; Neoplastic diseases; Rheumatic diseases; GI distress; Asthma
    • 3. More antiinflammatory and less sodium retention. Metpred- less sodium retention.
    • 4. Oral Anticoagulants-warfarin; Antidiabetics; Salicylates
    • 5. Pred-only oral; Metpred- injectable/oral, slightly less potency; Both Intermediate acting; Take with food/milk
  54. Triamcinolone
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1.Glucocorticoid
    • 2. Orthopedics; dermatology; inhalers; good for intraarticular injections (decreases inflam in joints)
    • 3. No Mineralcorticoid prop so ok in HTN and CHF
    • 4. Oral anticoagulant; salicylates; antidiabetics
    • 5. Intermediat acting- slightly longer than prednisone; take with food/milk
  55. Dexmethasone
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug interactions
    5. Implications
    • 1. Glucocorticoid
    • 2. Most potent antiinflammatory; additional use- cerebral edema but may not be that effective
    • 3. No sodium retention;
    • 4. Oral anticoagulant; Antidiabetic; Salicylates (Aspirin)
    • 5. Longest acting; Oral/Injectable; Take with food/milk
  56. Risk factors for Diabetes (4)
    • Obesity
    • Viruses-liked to mumps/rubella
    • Drugs
    • Genetic Factors
  57. Symptoms of Diabetes (7)
    • Hyperglycemia-110-125-prediabetes; >126 diabetes
    • Glycosuria-sugar in urine
    • Polyuria-because need to dilute sugar
    • Polydipsia
    • Polyphagia
    • Weight Loss
    • Itching
  58. Complications of Diabetes (8)
    • Eye damage
    • Kidney damage
    • Nerve damage
    • Blood vessel damage
    • Coronary artery disease
    • Incr susceptibility to infection
    • decreased wound healing
    • gangrene

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