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Pharmacology Test 2

Pharmacology Test 2 Mod. 1,3,10,16, & 14

4 Major Regions of the Brain Cerebrum, Diencephalon, Cerebellum, & Brain Stem.
Cerebrum 2 hemispheres-right & left. Cerebral cortex-outermost layer & contains gray matter-high cognitive func. (memory storage, recall, conscious understanding of sensation, vision, hearing, & motor func. 4 lobes (frontal, parietal, temporal, & occipital).
Diencephalon Relay center. Thalamic stuctures (thalamus, eoithalamus, & hypothalamus).
Cerebellum Posture & equillibrium- each hemisphere is responsible for coordination of movement of the same side of the body.
Brain Stem Midbrain, pons, & medulla oblongota-the divisions of the brain stem. Control resp, cardiovascular, & vegatative func. Conains the RAS (responsible for arousal from sleep, attention, & perception of sensory output. Contains cranial nerves.
The Peripheral Nervous System Spinal nerves (31 pairs, innervate specific dermatomes. Motor pathways. Sensory pathways. Reflex.
MS Disease of the myelin, inhibit proper nerve transmission. S/S- diplopia, blindness, paresthesias, proprioceptive deficeit, motor prob., SLURRED SPEECH, INTENTION TREMORS, NYSTAGMUS, SPASMS.
Seizures Abn electri activ in brain. Partial focal- occur on one side & spread. Generalized (all over brain). Absense (petit mal)- period of unconciousness, usu child. Atonic (drop attack). Tonic-clonic (grand mal)- common. generalized, may loose bladder ctrl.
Barbituates Action, SE, NI Act: Depress CNS, potentiates GABA (inhibitory). SE: Drowsiness, laryngospasm, HoTN, dependence. NI: Don't abrubtly stop. Avoid other CNS depressants. Follow lvls.
Barbituates Drugs -bital. Pentobarital, phenobarbital, secobarbital, primidone.
primidone pro drug for phenobarbital. Same SE + may cause excitability in children, blood dyscrasias, & megaloblastic anemia, folate deficiency. NI: same + insure folic acid in diet.
Benzodiazapines Act, SE, NI -zolam, -zepam. Act: GABA agonist (inhibitory), CNS depression. SE: N/V/D/C, rash, dependence. NI: hangover effect, falls risk, avoid grapefruit.
Benzo Drugs alprazolam (Xanax), diazepam (Valium), clonazapam (Klonopin), lorazepam (Ativan).
MISC Anticonvulsants Enhance GABA. (Inhibitory) SE: Same + chest pain, visual disturbances, nausea, rash, arthralgia, tremors/ataxia. NI: Wear med alert bracelet, give ketogenic diet- high carb, low fat.
Hydantoin/phenytoin like: Act, SE, & NI Act: limit seizure propagation. SE: agitation, cerebral edema, CNS depression. NI: Med alert bracelet.
MISC Anticonvulsant Drugs gabapentin (Neurontin), tigabine (Gabitril), topirmate (Topamax), pregabalin (Lyrica).
Hydantoin/phenytoin Drugs, Use, SE, & NC phenytoin (Dilantin), fosphenytoin (Cerebyx) Use: tonic-clonic & complex partial seizures. SE: Visual disturbances, bone marrow suppression, Steven's Johnson syndrome, hirsutism, gingivitis. NC: PREG D
Hydantoin Drug- lamotrigine (Lamictal) Use & SE Use: Treatment of partial complex seizures. SE: Same + nausea, photosensitivity.
Hydantoin Drug- carbamazepine (Tegretol) & oxcarbazepine (Trileptal) Use & SE Used for all types of seizures in children. SE: heart failure, vision disturbance, hyponatremia, Steven's Johnson syndrome.
Hydantoin Drug- divalproex (Depakote) & valproic acid (Depakene) Use: simple & complex partial seizures. SE: hepatotoxcity, bone marrow suppression, vision disturbances. NI: CBC, take med same time daily.
Seizure drugs requiring lvls phenytoin, barbituates, carbamazepine, valproic acid.
Succinimides Act, Use, & SE ethosuximide, Use: Absence seizure. Act: Elevatates seizure threshold. SE: Increases tonic-clonic seizures, N/V/D, discolored urine, vaginal bleeding, SJS, bone marrow supp.
Drug Classes for Parkinson's Disease Dopaminergics: Used to restore Dopamine & block acetylcholine. Anticholinergics: Decrease cholinergic activity & reduces rigidity of tremors.
Dopaminergic Drugs ropinirole (Requip), pramipexole (Mirapex), Use: Mild Parkinson's & RLS. amantadine (Symmetrel), bromocriptine (Parlodel), levodopa, & MAIN DRUG- carbidopa/levodopa (Sinemet), tolcapone (Tasmar), entacapone (Comtan), selegiline- USE WHEN SINEMET FAILS.
carbidopa/levodopa (Sinemet)- Main Parkinson's Drug SE: Involuntary movement, palpiations, dark sweat & urine, eat after med admin, high protein effects reaction, don't stop abruptly. NC: 1-4 wks int. effect, 6 mo full effect, avoid herbal supp.
ropinirole (Requip) & mramipexole (Mirapex) Special SE: Drowsiness, hallucinations, confusion, constipation, dry mouth, compulsive behavior.
Dopaminergic Drug SE & NC May fall asleep unexpectedly, take w/ meal, make cause orthostatic HoTN, follow renal/liver func test.
Anticholinergic Drugs used for Parkinson's Reduce muscle rigidity in tremors. benztropine (Cogentin), trihexyphenidyl (Artane).
Alzheimer's Disease Drug Class & Drugs w/ SE Cholinergic (acetylcholinesterase inhibitors). donepezil (Aricept)- long half-life, galantamine, rivastigmine (Exelon)- SE: weight loss, tacrine (Cognex)- SE: liver toxicity. MAY USE ANTIPSYCOTICS.
Drug classes for Multiple Sclerosis Immunosuppressants, Immunostimulants, Myelin Protein Builders, Alpha-adrenergic, Dopaminergic, Anti-seizures,Glucocorticoids.
Multiple Sclerosis Immunostimulants interferons- slow accumilation of physical diability. Reduce frequency of clinical exacerbations & relapse.
Multiple Sclerosis Myelin Protein Builders glatiramer (Copaxone)- SE: muscle stiffness, anxiety, chest pain, pain, erythema, swelling, & itching.
Multiple Sclerosis Alpha-adrenergics Drugs modafinil (Provigil)
Multiple Sclerosis Anti-seizure Drugs & Use gabapentin (Neurontin) Use: Neuropathy SE: migraines
Multiple Sclerosis Glucocorticoid Drugs methylprednisolone Use: inflammation.
Hydantoin like Seizure Med- Levetiracetam (Keppra) SE SE: Drowsiness
lioseral (Baclofen) Use Use: Muscle spasms from MS or spinal cord injury.
diazepam (Valium) Use Use: Many uses, relieve spasms from paraplegia & cerebral palsy.
psyclobenzoprine (Flexeril) Use Use: Short term treatment of muscle spasms.
metaxelone (Skelaxin) Use Use: Acute pain & muscle spacicity.
Toxic Phenytoin Lvl > 30
Define: Compliance A measure of elasticity, expandability, & distendablity of the lungs and thoracic structures.
Define: Respiration The process by which gases are exchanged.
Define: Ventilation Process of moving air into & out of lungs,
Define: Bronchi Tube distal to trachea.
Define: Bronchioles Distal to bronchi, lined w/ smooth muscle allowing then to change diameter (an autonomic response).
Define: Bronchodilitation Sympathomemetic response (beta-2). Bronchioles relax & increase air flow.
Define: Bronchoconstriction Parasympathetic response which constricts bronchioles & restricts air flow.
Define: Bronchospasms Rapid bronchconstriction, may result in emergent resp distress.
Define: Alveoli Sacs where gas exchange occurs. Most distal part of the airways. Abundant w/ capillaries, lined w/ surfactant to keep open & increase lung compliance.
Define: Surfactant Lines the alveoli and increases elasticity in the lungs.
Define: Lung elasticity Connective tissue in lungs. In normal compliance, lungs & thorax easily stretch & distend. Decreased compliance lungs are "stiff".
Define: Cheyne-Stokes Breathing pattern of increased & decreased rate & depth of resp, followed by periods of apena.
Define: Kussmaul's Typer of hyperventilation where body attempts to rid itself of excess body acids by blowing off CO2 through deep & rapid breathing.
Lung Scan (VQ Scan) Use radioactive nucleotide to determine, ventilation, perfusion, or both. Used to rule out pulmonary embolism.
CT Scan Radiation
MRI Magnetic Resonance Imaging
Sputum Studies Coughed up from resp tract. Taking in AM. Culture sensitivity, cytology. May do AFB (Acid Fast Bacteria) TB test. May require suctioning if unable to cough up sputum.
ABG Arterial Blood Gas. Arterial puncture, must hold pressure for 5 min after or else hemotoma.
Normals ABG pO2 80-100, pCO2 35-45, pH 7.35-7.45, HCO3- 22-26, SaO2 93-100%.
Pulse Oximeter Noninvasive SaO2
PFT Pulmonary Function Test. Assess pulmonary function.
Allergy related disorders. Mast cell injured & chemical mediators released (histamine, leukotrienes) secondary to allergy. It causes inflammation.
Status asthmaticus Severe prolonged asthma may lead to resp failure.
COPD Chronic Obstructive Pulmonary Disease- progressive lung disease usually related to smoking. Spectrum of chronic bronchitis, emphysema, & asthma.
Chronic Bronchitis Chronic lower resp condition of increased mucous, impaired gas exchange, & cough. Often associated w/ smoke or other pollutants.
Emphysema Chronic inflammation, loss of compliance, alveolar dilitation, dyspnea on exertion.
Sinusitis Inflammation of sinus cavities.
Influenca Acute resp infection transmitted by droplets, incubation 18-72 hrs, elderly susceptible.
Pharyngitis Sore throat, inflammation of the pharynx, viral or bacterial strep throat, irritants.
Tonsillitis Inflammation of the palatine tonsils, adenoids may be inflamed as well.
Laryngitis Inflammation of the larynx. May have edematous vocal chords. Over use of voice can cause, also irritants.
Epiglottitis Inflammation of the epiglottis. May be airway emergency, most often in children.
Respiratory drugs: antihistamines block histamines, dry secretions. Drugs: diphenhydramine (Benadryl), hydroxyzine (Vistaril) -used 4 vertigo, cetirizine (Zyrtec), fexofenidine (Allegra), loratadine (Claritin). SE: drowsy, dry, tachy, HoTN, urinary frequency. NI: push fluids
Respiratory drugs: sympathomimetics. In this case, alpha agonists (decongestants) pseudoephedrine (Sudafed). oxymetazoline (Afrin). SE: rebound congestion if taken >3 days. NI: may cause urinary retention with BPH.
Respiratory drugs: B2 adrenergic agonists (subset of sympathomimetics) Use: bronchodilater. action: bronchiole relaxation & improves flow. albuterol, levabuterol, salmeterol, fomoterol, terbutaline, isoproterenol, metaproterenol. B2=rescue drugs. SE: chest pain. NI: tachycardia, dysrythymia, rinse & spit. interact MAOI
Respiratory drugs: Xanthines theophylline (Theodur), aminophylline.theophylline therapeutic range =10-20, can cause toxicity and dysrhythmias. Avoid coffee and char broil.
Respiratory drugs: anticholergic ipratropium (Atrovent), tiotropium (Spriva). Use: maintenance therapy COPD, asthma. Act as bronchodilators. SE: HA, dizzy, anxiety, palpiations.
Respiratory drugs: glucocorticoids reduce inflammation. prednisone
Respiratory drugs: mast cell stabilizers prevent degranulation of mast cells (release of their contents) cromolyn Intal), neocromil (Tilade).
Respiratory drugs: leukotriene inhibitors block release of leukotrienes. monteleukast (Singulair), zarifleukast (Accolate)
Respiratory drugs: antitussives cough suppressants. narcotics, benzonatate (Tessalon), dextromethorphan (OTC),
Respiratory drugs: expectorants thin mucous and help cough it out. guaifenesin (Robitussin)
Respiratory drugs: mucolytics breaks down mucous to help rid body of mucous. N acetyl cysteine (Mucomyst)
Respiratory drugs: intranasal glucocorticoids fluticasone (Flonase), triamcinolone (Nasacort AQ), budesonide (Rhinocort), mometosone (Nasonex). Act: reduce inflammation (locally) SE: dry nose/irritation.
Respiratory drugs: inhalation therapy examples/methods aerosol:(MDI(spacer)/nebs) very small particles susp in gas) if using B2 drug, immediate relief of bronchospasm. Neb is air compressor using venturi effect to aerosolize drug. DPI (dry powder inhaler) fine powder inhaled into bronchial tree.
General respiratory attack. NI Use "rescue" drugs first (B2). Then may follow with others. Other drugs do not work as fast.
Gram + retains purple Gram stain. Ex: Staphylococcus, Streptococcus
Gram - does not retain purple Gram stain. Ex: E. coli, Haemophilus influenza, Niesseria meningiditis
Mechanisms of antibacterial action Inhibit cell wall creation, alter membrane permeability, inhibit protein synthesis, inhibit DNA/RNA synthesis, interference with cellular metabolism.
Define: virulence degree of pathogenicity
Define: virus Small pathogen, uses cell to reproduce. Enter's health cells and uses cell's machinery to make more virus particles.
Virus families Herpes. cytomegalovirus. adenovirus. - papovavirus. HIV.
Fungi (myco) Yeast and molds. Candida albicans (yeast infection). Systemic fungal infections require aggressive drug therapy. Opportunistic infections occur in immunocompromised patients (CA pt). Most fungi resistant to abx.
Dermatophyte infections Fungal infection of skin, mucous membranes, or nails. Candida albicans - normally found on mucous membranes. Occurs in immunocompromised patients. Candidiasis of mouth=thrush.
Bioterrorism Use of infectious diease agents to purposefully cause disease in a population. Ex: anthrax - affects skin, GI, lungs - symptoms - fever/chills/HA N/V, nasal cogestion, cough, SOB, malaise, arthralgias, stiffness. Trt w cipro, doxy, pcn.
HIV - things to know Affects a type of T-cell lympocyte called CD4 cells. Follow CD4 counts with HIV/AIDs. CD4<200 + opportunistic infection = AIDs.
Aminoglycocides tobramycin, gentamycin, amikacin, neomycin. use: very serious infections. SE: oto/nephrotoxic. NI: must follow levels, CBC. Monitor for tinnitis, vertigo. bacteriocidal
Betalactam class of antiotics general Cell wall inhibitors. -cidal. penicillins, cephalosporins, and carbapenems Crossclass allergies. Renal clearance. NI: superinfections. Notify if blood in stool. Monitor seizure, pseudomembranous colitis, anaphylaxis, CBC, LFT blood in BM, phlebitis
Carbapenem drugs meropenem, ertapenem, doripenem. use for serious infections.
Cephalosporins 1st/2nd/3rd/4th gen -cidal. 4 Generations: 1st cephalexin (Keflex) G+. 2nd cefaclor (Ceclor) H flu, Nisseria sp. 3rd ceftazidine (Fortaz) ceftriaxone (Rocephin) G-, 4th cefepime (Maxipine) G+/G-
Cephalosporin use, SE, NC Use:OM, LRI, UTI, GC (Gonnococcus or gonnorhea), NI: betalactam (general) + NO EtOH UP TO 72 HOURS.
penicillins -cillins. penicillin, amoxicillin, ampicillin, nafcillin, oxacillin, dicloxacillin, piperacillin, ticarcillin
floroquinolones -floxacin. -cidal. ciprofloxacin, levofloxacin. Use for anthrax. Monitor insomnia & confusion, HA, LFT, CBCwdif, FSBS. Teach to use sunscreen. Alert HCP of vaginitis, pain in tendon, crystaluria.
oral contraception while on abx With betalactams, may need backup method while on abx.
Lincosamides -static. Gm+ cocci. clindamycin (Cleocin) Use: skin infect, resp infect, septicemia, GYN infections, osteomyelitis, & prevent endocarditis. SE: dizzy, H/A, vertigo, N/V/D, bitter taste. NC: Fall risk, arrythmias & HoTN refrain frm vag intercource
Macrolides -static. *note 1/2 life of Zithromax. Monitor for dizziness, seizures, drowsiness, H/A, cardiac assess for chest pain & HoTN, liver func test, melena in stool, oral candidiasis, check hearing.
Anti-infective -cidal. Drugs: vancomycin Treats: Gm+ & potentially life threatening infection. Monitor hearing loss, HoTN, kidney damage. *Rapid IV= RED-MAN SYNDROME. Teach: report tinnitus, vertigo, hearing loss.
Anti-viral Agents Nonnucleoside Reverse Transcriptase Inhibitors (NNRT's), Nucleoside Reverse Transcriptase Inhibitors (NRTI's), Protease Inhibitors, Fusion Inhibitors, CCR5 Coreceptor Antagonist, Integrase Strand Transfer Inhibitor (INSTI)
Nonnucleoside Reverse Transcriptase Inhibitors Drugs Efavirenz (Sustiva), Delavirdine (Rescriptor), Nevirapine (Viramune), Etravirine (Intelence), Relpivirine (Eduant)
Nonnucleoside Reverse Transcriptase Inhibitors (NNRTI) SE & NC Assess for changes in mental health, impaired concentration, N/V, anorexia, hematuria/pruritus, LFT, viral load, CD4 cell count regularly. Inhibits HIV DNA synthesis Teach client to be compliant & this is no cure!
Nucleoside Reverse Transcriptase Inhibitor (NRTI) Drugs & NC Abacavir (Ziagen), Didanosine (Videx), Zidovudine (AZT, Retrovir), Lamivudine (Epivir, 3TC), Tenofovir (Viread) NC: Assess for changes in severity of HIV symptoms. Assess for hypersensitivity reaction - FATAL REACTION, facial lipoatropy.
Protease Inhibitor NC -avir. Inhibits HIV protease which acts like scissors to cut DNA chain to correct length. Assess for redistribution of body fat, seizures, N/V/D, & Stevens Johnsons syndrome.
Fusion Inhibitor Drug, SE, NC Drug: Enfuvirtide (Fuzeon) Use: Prevents entry of HIV-1 into cells by interfering w/ fusion of the virus w/ cellular membrane. Used in combination w/ pogressive HIV-1 replication. SQ (route)
CCR5 Coreceptor Antagonist Drug, Act, NC Drug: maraviroc (Selzentry) Act: blocks specific receptor on the CD4 & T cell surfaces that prevent CCR5 HIV-1 from entering healthy cell. Black box warning: Assess for hepatotoxicity- stop drug & notify HCP
Integrase Strand Transfer Inhibitor (INSTI) Drug, Act, NC Drug: raltegravir (Isentress) Act: Inhibits HIV-1 intergrase, which is required for viral replication. NC: Notify HCP if depressive or suicidal thoughts.
Antifungal Agents Drugs Fluconazole (Diflucan), Amphotericin B (Amphotec, Fungizone, Ketoconazole (Nizoral), Nystatin (Mycostatin)
Antifungal Agents Use & NC Use: fungal infecions. NC: Assess VS q 15-30 mins during test dose & q 30 mins for 2-4 hrs after admin of Amphotericin. May need to premedicate w/ meperidine, dantrolene, & diphenhydramine. Assess resp. status daily after admin of Amphotericin.
Created by: mojoshare