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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. |
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