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Peripheral Nervous

Peripheral Nervous System....Autonoics

TermDefinition
alpha 1 receptors eyes, blood vessels, males sex organs, prostatic capsule, bladder (trigone & sphincter)
Peripheral Nervous System (PNS) made up of the parasympathetic ns and sympathetic ns
parasympathetic ns rest & digest-decrease HR, Increased gastric secretions, bladder emptying, bowl emptying, focus for near vision, pupil constriction, bronchial smooth muscle contractin
sympathetic ns flight or fight: inc. HR, shunt blood away from skin into muscle, dilate bronchi, dilate pupils, mobilize stored energy
alpha 2 receptor located on nerve terminals, not organs innervated by the ANS
CNS comprised of brain and spinal cord
PNS comprised of somatic motor and ANS (PSNS, SNS)
somatic motor regulate voluntary movement of muscle
SNS function maintain blood flow to the brain, redistribution of blood flow during exercise, vasoconstriction for loss of blood
4 neruotransmitters ACH, NE, Epi, dopamine
ACH released by all pre- & post ganglia neurons of both PSNS< SNS, and post ganglia of SNS for sweat glands and cell motor neurons
NE released by all postganglionic neurons of SNS except sweat glands
Epi released by adrenal medulla
Drugs that stimulate the PSNS cholinergic agonist, cholinomimets, parasympathomimetics, they mimic ACH
Cholinergic receptor mediated by ACH
Adrenergic receptor mediated by Epi and NE
Cholinergic receptor subtypes Nicotinic N, Nicotinic M, Muscarinic
Adrengeric receptor subtypes Alpha1, alpha2, beta1, beta2, beta3, dopamine
Nicotinic N receptors located in the ganglia aof both PSNS and SNS
Nicotinic M receptors located at the neuromuscular junctions
Muscarinic receptors located postsynaptically in PSNS @ smooth muscle, cardiac muscle, glands of PS fibers, effector organs of cholinergic symp fibers
Direct acting cholinergic agonists bind to cholinergic receptors, causing stimulation
Indiect-acting cholinergic agonists inhibit the enzyme "acetylcholinersterase" which causes more ACH available at the receptors=enzyme responsible for metabolism is inhibited
Effect of Cholinergic Agents "SLUDGE" salivation, lacrimation, urinary incontinence, diarrhea, GI cramps, erection or emesis
Muscarinic receptor M1 located on salivary gland (salivation), CNS (enhanced cognition) when blocked = dry mouth, confusion, hallucinations
Muscarinic receptor M2 located on the heart (bradycardia), when blocked = tachycardia
Muscarinic receptor M3 salivary glands, bladder detrusor, GI smooth muscle, iris sphincter, ciliary muscle, lachrymal gland, when blocked = dry mouth, decreased bladder pressure, constipation, mydriasis, blurred vision, dry eyes
Muscarinic Agonists BETHANECHOL, cevimeline, pilocarpine, acetylcholine, Muscarine
Uses of Muscarinic Agonist urinary retention, GERD, Ileus, postoperative abd distension
Adverse Effects of Muscarinic Agonists hypotension, bradycardia, excessive salivation, increased gastric secretions, bladder rupture, asthma, dsyrhythmias
Muscarinic Poisoning caused by mushrooms or overdose of direct-acting muscarinic agonists or cholinesterase inhibitors
Symptons of Muscarinic Poisoning salivation, lacrimation, visual disturbances, bronchospasm, diarrhea, bradycardia, hypotension
Treatment of muscarinic poisoning muscarinic blocking agent....atropine
Muscarinic Antagonists blocks the action of ACH at the muscarinc receptors
Muscarinic Antagonist Drugs ATROPINE, scopalomine, ipatropium, dicyclomine, pirenzepine and Telezipine, trihexyphenidyl, benztropine
Actions of ATROPINE inc HR, dec secretions, relax bronchi, dec bladder tone, dec GI tone and motility, dilate pupils, CNS excitation
Uses of ATROPINE preanesthetic medication, disorders of the eye, bradycardia, intestinal hypermotility, muscarinc agonist poisoning, asthma, biliary colic, peptic ulcer disease
Adverse effects of ATROPINE dry mouth (xerostomia), blurred vision, urinary retention, photophobia, IOP, constipation, tachycardia, anhydrosis (lack of sweating)
Overactive Bladder urinary urgency, urinary frequency, nocturia, urge incontinence Tx: anticholinergics Adverse effects: depends on receptor selectivity, do not cross BBB
Drugs to treat Overactive Bladder Darifenacin (Enablex), Oxybutynin (Ditropan), Solifenacin (Vesicare), Tolterodine (Detrol), Trospium (Sanctura)
Scopolamine anticholinergic used for antiemesis
Ipratropium (Atrovent) anticholinergic used for asthma
Dicyclomine (Antispas) anticholinergic used for IBS
Pirenzepine & Telenzipine anticholinergic used for Gastric acid secretions
Trihexyphenidyl (Artane), Benztropine (Cogentin) anticholinergic used for Parkinson's
Methscopolamne (Pamine); Propantheline (Pro-Banthine) anticholinergic used for peptic ulcer
Atropine, homatropine, scoplamine, cyclopentolate, tropicamide anticholinergice used for optho procedures (mydrisi)
Antimuscarinic Poisoning Symp: dry mouth, blurred vision, photophobia, hyperthermia, CNS effects, hot, dry, flushed skin Tx: Cholinesterase inhibitor-PHYSOSTIGMINE, syrup of Ipecac followed by activated charcoal
Cholinersterase Inhibitors prevent the breakdown of ACH by acetylcholinesterase
Reversible cholinesterase inhibitor NEOSTIGMINE
NEOSTIGMINE pharmocologic effects Used to treat Myasthenia Gravis Pharmacologic effects: muscarinic responses, neuromuscular effects, CNS repsonse-CNS depression
NEOSTIGMINE used to tx Myasthenia Gravis adverse effects: excessive muscarinic stimuatlion, neuromuscular blockade drug interactions: muscarinic antagonists, nondepolarizing neuromuscular blockers, depolarzing neurouscular blockers
Cholinergic Crisis acute toxicity of "reversible cholinesterase inhibitor" Tx: respiratory support and atropine
Other Reversible Cholinesterase Inhibitors Physostigmine, ambenonium, endrophonium, pryidostigmine, and drugs for Alzheimers: Donepezil, Rivastigmine
Irreversible Cholinersterase Inhibitors same action as reversible inhibitors, longer acting, commonly used as insecticides and biological weapons.
ECHOTHIOPHATE only irreversible cholinesterase inhibitor used clinically. used for treatment of glaucoma
Organophosphate Cholinesterase Inhibitor Poisoning produces state of cholinergic crisis Tx: oxygen, mechanical ventilation, atropine, pralidoxime (2PAM)
Myasthenia Gravis neuromuscular disorder with fluctuating muscle weakness and rapid fatigue. Symp: ptosis, diffculty swallowing, skeletal muscle weakness Tx: resp support, NEOSTIGMINE or CHOLINESTERASE INHIBITOR
Neuromuscular blocking agents block ACH from activating nicotinicM receptors on skeletal muscle, cause muscle relaxation uses: sx for muscle relaxation, endotrachal intubation, mechanical ventilation, other dx procedures
Neuromuscular blocking agents actions structurally similar to ACH must be administerd parentally (not absorbed via GI) poorly lipid soluble, limited entry to CNS
TOBOCURANINE info neuromuscular blocking agent I: quaternary nitrogen drug, always carries + charge competes with ACH for binding to nicotinicM receptor
Non-Depolarizing NM Drugs Info competitive against NACH receptors at NMJ prevent depolarization by ACH, causes flaccid paralysis Toxicity: histamine release, hypotenstion, prolonged apnea Tx: maintain ventilation Caution with myasthenia graivs cause electrolyte imbalance = inc para
PANCURONIUM NM paralysis 35-45 mins, no histamine release, ganglionic blockade, hypotension
ATRACURIUM NM paralysis 20-35 mins, histamine release, hypotension, eliminated by cholinesterase
Non-Depolarizing NM Drugs Pancuronium, Atacurium, Cistatacurium, Rocuronium, Vecuronium
Non-Depolarizing NM Drugs ending "ronium" or "ium"
CISATRACURIM no histamine release, eliminated by spontaneous degradation
ROCURONIUM no histamine release, muscle relaxation in 1-3 mins
VERCURONIUM no histamine relase
Deploarizing NM Agents SUCCINYLCHOLINE
SUCCINYLCHOLINE-mechanism of action agonist at nACH receptor at NMJ, causes depolarization (transient muscle contractions) prevent end plate from repolarizing = paralysis
SUCCINYLCHOLINE effect-rapid and prolonged flaccid paraylsis uses: placement of tubes Toxicity: arrythmias, apnea, hyperkalemia, inc intra-abd pressure and IOP, malignant hyperthermia lasts-5 mins Caution: pts with cholinesterase inhibition (delays activation of succ
Ganglionc Blocking Agent: MECAMYLAMINE block nicotinicN in autonomic ganglia used for essential hypertension AE: parasympathetic blockade, othostatic hypotsn, CNS effect
Adrenergic Agonists: ISOPROTEERENOL stimulate beta 1&2, used for bronchospasm, asthma, cardiac problems AE: angina pectoris, hyperglycemia
Adrenergic Agonist: EPINEPHRINE stimulate alpha1, beta 1&2, tx anaphylatic shock, tx asthma AE: HTN, aggravating angina pectoris, tissue necrosis, hyperglycemia
Adrenergic Agonist: NOREPINEPHRINE stimulates alpha1 and beta1, tx: shock or hypotension
Adrenergic Agonist: TERBUTALINE stimulates beta2, tx: asthma, delay PTL AE: tremor, tachycardia
Adrenergic Agonist: DOPAMINE stimulates beta1 and dopamine, and alpha at high does, Tx: cardiogenic shock, heart failure, and acute renal failure AE: tachycardia, angina pectoris, arrhythmia
Adrenergic Agonist: DOBUTAMINE stimulate beta 1, some dopamine, used to inc contractility and tx heart failure AE: tachycardia
Adrenergic Agonist: PHENYLEPHRINE stimulate alpha1, tx nasal congestion, pupil dilation
Alpha Blockers: Nonselective PHENTOLAMINE, PHENOXYBENZAMINE
Selective Alpha 1 Blocker "zosin drugs" decrease BP, nasal congestion, prostatic smooth muscle relaxation
Selective Alpha 1 Blocker: PRAZOSIN, TERAZOSIN treat hypertension
Selective Alpha 1 Blocker: DOXAZOSIN, TAMSULOSIN, ALFUZOSIN treat BPH, relax smooth muscle of the bladder neck and prostate
Beta Blockers-Non-selective "olol drugs" PROPRANOLOL, NADOLOL, PINDOLOL, TIMOLOL, CARVEDILOL, LABETALOL
Cardioselective Beta Blocker "olol drugs" METOPROLOL, ATENOLOL, ESMOLOL, NEBIVOLOL
Beta blockade used for angina, cardia arrhythimas, HTN, heart failure, hyperthyroidism, prophylactic tx of migraines, glaucoma AE: dec HR, make asthma worse, dec cardiac output, rebound cardiac excitation when stopped abruptly, blockade of hypoglycemia symptoms in dia
Alpha1 activation activated by Epi, NE, phenylephrine, ephedrine, DA, causes vasoconstriction and mydriasis, used for: hemostasis, nasal decongestion, adjunct to local anesthesia, inc blood pressure, eye exams
Adverse Effect of Alpha1 activation HTN, necrosis at injection site, bradycardia
Alpha2 Activation activated by Epi, NE inhibits NE release, little to no clinical significance in CNS: dec sympathetic outflow to heart and blood vessels, decrease pain
Beta1 Activation activated by Epi, NE, isoproterenol, DA, dobutamine, ephedrine uses: tx cardiac arrest, heart failure, shock, atrioventricular heart block AE: tachycardia or dysrrhythmias, aggravate angina pectoris
Beta1 Activation activated by Epi, isoproterenol, albuterol Tx: asthma, delay PTL AE: hyperglycemia, tremor
Beta3 Activation : MIRABERGON activated by Epi, NE Tx: OAB-relax detrusor, increase bladder capacity first drug in class AE: GI disturbances, inc HR, inhibit CYP2D6
Dopamine activation activated by DA dilation of vasculature of kidneys, increasing renal blood flow, important in tx of shock
Multiple Receptor Activation used to anaphylactic shock: hypotension, bronchial constriction, edema of glottis Tx: Epi, injected IM or IV
Adrenergic Agonist: EPHEDRINE activates Alpah 1&2, beta 1&2 used for nasal decongestion AE: HTN, hyperglycemia, arrhythmias, angina
Adrenergic Antagonists direct blockade of adrenergic receptors, Two groups: alpha-adrenergic blocking agents, beta-adrenergic blocking agents
Alpha-Adrenergic Antagonist Agents (block alpha1) Tx: essential HTN, reverse toxicity form alpha1 agonists, BPH, pheochromcytoma, raynauds's disease AE: Orthostatic hypotension, relex tachycardia, nasal congestion, inhibition of ejaculation, Na+ retention & inc blood vol., first dose hypotension
Selective Alpha1 Blockers "osin" PRAZOSIN, TERAZOSIN, DOXAZOSIN, TAMSULOSIN, ALFUZOSIN, SILODOSIN
Nonselective Alpha Blockers "amine" PHENTOLAMINE, PHENOXYBENZMINE
Beta-Adrenergic Antagonist (block beta1) Tx: angina pectoris, HTN, cardiac dysrrhythmias, MI, HF, hyperthyroidism, migraine, stage fright, pheochromocytoma, glaucoma
Beta-Adrenergic Antagonist (block beta 1) Adverse Effects bradycardia, dec cardiac output, precipitation of HF, inc risk of AV heart block, rebound cardiac excitation, can block hypoglycemic symptoms (tachycardia)
Beta-Adrenergic Antagonist (block beta 2) AE: bronchoconstrition-AVOID in asthma pts, inhibit glycogenolysis-careful in use with DM
Nonselective Beta-Adrenergic Antagonist "olol" PROPRANOLOL, CARTELOLO, CARVEDILOL, LABETALOOL, NADOLO, PINDOLOL, SOTALOL, TIMOLOL
Beta blockers that block alpha receptors too LABETALOL AND CARVEDILOL
Cardioselective Beta Blockers METROPOLOL, ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, ESMOLOL
NEBIVOLOL highly cardioselective and also a vasodilator, used to tx HTN and HF
Indirect-Acting Antiadrenergic Agents prevent stimulation of peripheral adrenergic receptors two groups: adrenergic neuron-blocking agents, centrally acting alpha2 agonist
Adrenergic neuron-blocking agents decrease NE release RESERPINE, GUANETHIDINE, GUANADREL
Centrally acting alpha2 agonists CLONIDINE, GUANABENZ, GUANFACINE, METHYLDOPA
Centrally acting alpha 2 agonist: CLONIDINE, GUANABENZ, GUANFACINE, METHYLDOPA tx HTN AE: drowsiness, sedation, rebound HTN, dry mouth
METHYLDOPA drug of choice for HTN in pregnancy SE: positive coombs test, hemolytic anemia, hepatoxicity
CLONIDINE used in various withdrawl symptoms
H1 Stimulation vasodilation, edema, bronchoconstriction, CNS effects, itching, pain, secretion of mucus
H2 Stimulation secretion of gastric acids, promote acid release
Role of Histamine in Allergic Response mild allergy rxn-rhinitis, itching, local edema Severe anaphylatic rxn: bronchoconstriction, hypotension, edema of glottis
Antihistamine: H1 Antagonists tx: mild allergic disorders selective blockade of H1 receptor
Antihistamine: H2 Antagonists tx: gastric and duodenal ulcers selective blockade of H2 receptors not used for allergies
H1 Receptor Antagonists tx: allergic conditions, can tx N/V (motion sickness) SE: sedative effect, some anticholinergic effects...urinary retention, blurred vision Some used for local anesthetics
H1 Receptor Antagonist Agents PROMETHAZINE, DIPHENHYDRAMINE, CHLORPHENIRAMINE, CLEMASTINE, DIMEHYDRINATE, HYDROXYZINE, MECLIZINE
2nd generation H1 antagonists no anit-emetic properties, tx allergies, no sedation, fewer anticholinergic effects
2nd generation H1 anatagonists Agents FEXOFENADINE (ALLEGRA), LORATADINE, DESLORATAINE (CLARINEX), CETIRZINE (ZYRTEC), AZELASTINE (nasal spray), OLOPATADINE (nasal spray)
Treatment for asthma Anti-inflammatory-prevent inflammation (glucocorticoids, mast cell stabilizers, leukotriene inhibitors, antibodies (IGE blockers)) Bronchodilators: Beta Agonist, anticholinergics, methylxanthines
Glucocorticoids MOA most effective drug for asthma, block production of imflammatory cytokines, block mast cell migration, block release of various mediators, dec bronchial reactivity, improv pul fxn, prophylaxis for chronic asthma, FIXED SCH DOSING
Glucocorticoids administration by MDI, but an be IV and oral, stays in lungs
Glucocorticoid Agents FLUTICASONE (flovent), BECLOMETHASONE, TRIAMCLINOLONE, FUNISOLIDE, BUDESONIDE (pulmicort)
Side Effects of Long-term use of Glucocorticoids inc lipolysis (redistribution of fat), water retention, dec Calcium absorption from gut, stimulate gastric acid production, mood changes, adrenal suppression, stunt growth in children
Leukotriene Inhibitors oral agents, 2nd line tx for asthma, can cause depression, suicidal ideation
LTD4 (leukotriene) receptor blocker ZAFIRLUKAST-cause HA and GI upset, inhibits CYP enzymes
LOX (lipooyygenase) inhibitor ZILUTON-potential for liver toxicity, inhibits CYP1A2
Mast Cell Stabilizers suppress inflammation, prevent release of histamine used for prophylaxis, not quick relief No effect on airway Cannot reverse asthmatic bronchospasms
CROMOLYN SODIUM (nebulizer)-mast cell stabilizer also used in allergic rhinitis and exercised-induced bronchospasms NOT a rescue drug
Antibodies in Asthma Tx: OMALIZUMAB-anti IgE antibody 12yrs or older, tx mod-severe asthma that is allergy related and not controlled with inhaled glucocoriticoid AE: hypersensitivity and anaphylaxis, observe pts for 2hrs after injection, need EPIPEN, rxn can occur up to 4 days later
Bronchodialtor: Beta2 Agonist-asthma tx inhaled, orally, SC, relax bronchial smooth muscle. DOES NOT alter inflammatory process.
SABA short acting bronchodilator used to abort acute attacks
LABA long acting bronchodilator used for pts not responding to other first-line tx FIXED dose scheduling usually given with glucocorticoids for asthma and stable COPD
SABA agents ALBUTEROL, LEVABUTEROL all have potential for tremor, tachycardia, and nausea
LABA agents SALMETEROL- inhaled, FORMOTEROL-inhaled, ARFORMOTEROL-inhaled, INDACEROL-used in COPD all have potential for: tremor, insomnia, inc HR, nausea, inc glucose, dec K+
Oral Beta2 Agonists ALBUTEROL, TERBUTALINE
Glucocorticoid/LABA combination agents indicated for long term maintenance in adults and children, not recommended for initial therapy FLUTCASON/SAMETEROL (Advair) BUDESONIDE/FORMOTEROL (Symbicort) MOMETASONE/FORMOTEROL (Dulera)
Bronchodilator: METHYLXANTHENE inhibits phospodiesterase=dec cAMP levels block adenosine receptors = bronchodilation THEOPHYLLINE and AMINOPHYLLINE
THEOPHYLLINE & AMINOPYLLINE oral agent, THEOPHYLLINE no longer used in COPD, used for maintenance of stable chronic asthma metabolized in liver = drug interactions narrow therapeutic window AE: N/V
Bronchodilators: Muscarinc Receptor Antagonist (Anticholinergic) used for COPD, off label use for asthma IPRATROPIUM (atrovent), TROTROPIUM (spiriva), ACLIDINIUM-maintenance therapy
IPRATROPIUM (atrovent)- Muscarinic Receptor Antagonist-anticholinergic off label use for asthma, tx COPD AE: dry mouth, glaucoma, CV effects
TROTOPIUM (spiriva)-Muscarinic Receptor Antagonist-anticholinergic tx: COPD, off label use for asthma AE: dry mouth
Emphysema chronic infection or irritation of the lungs causing stretching or destruction of airway walls takes energy to exhale lungs become enlarged
COPD walls b/t air sacks in lungs get destroyed, loss of elasticity, sputum production, cough, airway inflammation associated with cigarette smoke poorly responsive to inhaled steroids progressive loss of pulmonary fxn
Tx of COPD Beta Agonist (SABA, LABA) IPRTROPIUM/TIOTROPIUM CROMOLYN SODIUM THEOPHYLLINE CORTICOSTERIODS
Allergic Rhinitis inflammatory disorder affecting upper airway, lower airway and eyes caused by activation of H1 receptors vasodilation, congestion, edema, inflammation Tx: antihistamines, inhaled steroids, bronchodilators
Agents to Tx Allergic Rhinitis: Glucocorticoids BECLOMETHASONE, BUDESONIE (rhinocort), FLUNISOLIDE, MOMETASON (nasonex), TRIAMCINOLONE (nasocort)
Agents to Tx Allergic Rhinitis: Decongestants aka: sympathomimetics: constrict nasal vessels causing shrinkage of swollen membranes. ONLY relieve stuffiness, NOT rhinorrhea, sneezing or itching AE: rebound congestion when topical agents used more than a few days
Topical Decongestants PHENYLEPHRINE, PSEUDOEPHEDRINE (sudafed)
Other agents used to Tx Allergic Rhinitis anti-tussives-suppress cough: DEXGROMETHORPHAN, CODEINE, BENZONATE (numb stretch sensors in lungs) expectorants-aids in expelling mucus: GUAIFENESIN
H2 receptor Antagonist: Uses/AE uses: gastric and duodenal ulcers, GERD, Zollinger-Ellison Syndrome, heart burn, acid indigestion, sour stomach AE: impotence, reduced libido, gynecomastia, CNS effects, risk for pneum, drug interactions- esp cimetidne, available OTC
H2 recpetor Antagonist Agents CIMETIDINE (tagmet), RANITIDINE (zantac), FAMOTIDIEN (pepcid), NIZATIDINE
Proton Pump Inhibitors MOA inhibit gastric secretions by binding irreversibly to H+, K+- ATPase (proton pump) of parietal cells
Proton Pump Inhibitors Agents "azole" OMPEPRAZOLE (prilosec), LANSOPRAZOLE (prevacid), PANTOPRAZOLE (protonix), RABEPARZOLE, ESOMEPRAZOLE (nexium)
H2 receptor Antagonist MOA inhibit gastric acid secretion by competing with histamine at parietal cells
Proton Pump Inhibitors: Uses/AE uses: gastric and duodenal ulcers, GERD, hypersecretory conditions (Zollinger-Ellison synd.) AE: well tolerated short-term- some n/d.....long-term-increased risk of gastric CA
Anticholinergic Agents for GI disorders PIRENZEPINE- selective M1 blockade decrease gastric acid AE: dry mouth
Prostaglandin Agonist for GI disorders MISOPROSTOL (cytotec)-inhibit gastric secretion, promote secretion of bicarbonate and mucus, promote submucosal blood flow AE: dose related diarrhea Category X drug-causes uterine ctx
Protective Barriers for GI disorders SUCRALFATE- forms protective barrier against acid and pesin for up to 6hrs uses: duodenal and gastric ulcers AE: constipation Drug Interaction: if acid pH above 4 can cause ineffectiveness, can dec absorption of DIGOXIN, PHENYTOIN, FLUOROQUINOLONES, WA
ANTIACIDS alkaline compouds that neutralize stomach acid
Aluminum-containing ANTIACID ALUMINUM-CARBONATE (baseljel)
Calcium-containing ANTIACID CALCIUM-CARBONATE (Tums)
Magnesium-contating ANTIACID MAGENSIUM HYDROXIDE (milk of magnesium)
Combination ANTIACIDS ALUMINUM & MAGNESIUM (maalox, mylanta)
Bulk-forming laxatives: METHYLCELLULOSE (citrucel) PSYLLIUM (metamucil) MOA: similar to taking fiber, absorbs water to increase bulk, distends bowel, acts in large and small intestine Uses: constipation, IBS, diverticulitis AE: esophageal obstruction, impaction, intestinal obstrction, electrolyte imbalances
Surfactant laxatives: DOCUSATE SODIUM (colace) MOA: softens stool and lubricates, promote more water and faxt in stool acts in large and small intestine Uses: constipation, facilitation of BN in anorectal conditions AE: skin rashes, dec absorption of vitamins, electrolyte imbalances
Stimulant laxative: BISACODYL (dulcolax, correctol) SENNA (ex-lax, senokot), CASTOR OIL MOA: inc osmotic pressure in colon and small intestine, causing more water to intestines, bowel distention, inc peristalisis and evacuation Uses: constipation, dx/sx bowel preps AE: nutrient malabsorption, skin rashes, gastric, rectal, irritation, elec
Osmotic laxative: MILK OF MAGNESIA (mom) POLYETHYLENE GLYCOL (MiraLax), POLYETHYLENE GLYCOL-electolyte solution (coLyte) MOA: increase fecal water content, small and large intestine, bowel distention, inc peristalsis and evacuation Uses: chronic constipation, dx/sx prep AE: electrolyte imbalances
Chloride Channel Activator as a Laxative promotes secretions of chloride-rich fluid into intestine, enhances motility, mainly used in IBS
Long term use of laxatives result in decreased bowel tone and may lead to dependency
How to take laxatives all tablets swallowed whole, not crushed or chewed, especially enteric coated
Anti-emetic: Dopamine Receptor Antagonist Agents PROCHLORPERAZINE, PROMETHAZINE, METOCLOPRAMIE, DOMPERIDONE, HALOPERIDOL OR DROPERIDOL
Anti-emetic: Dopamine Receptor Antagonist block DA receptor AE: extrapyramidal effects, anticholinergic effects, sedation, hypotension, prolonged QT
Anti-emetic: Serotonin Receptor Antagonist Agents "setron" ONDANSETRON (zofran), GRANISETRON, DOLASETRON, PALONOSETRON
Anti-emetic: Serotonin Receptor Antagonist "setron" block 5-HT3 receptor in CTZ and on afferent vagal nerve fibers more effective when used with DEXAMETHASONE AE: HA, diarrhea, dizziness
Anti-emetic: Cannabinoids Agent DRONABINOL (marinol)
Anti-emetic: Cannabinoids: DRONABINOL agonist against cannabinoid receptors, agent in marijuana uses: antiemetic in cancer chemo, stimulate appetite in AIDS pts AE: dissociation, temporal disintegration, dysphoria, depersonalization, contraindicated in psychiatric pts
Anti-emetics: Benzodiazepines LORAZEPAN (ativan) DIAZEPAN (valium)
Anti-emetic: Glucocorticoids DEXAMETHASONE (decadron) METHYLPREDNISOLONE (solu-medrol)
Anti-emetic: Substance P/Neurokinin1 Antagonist APREPITANT (emend): NEW enhances responses of other anti-emetics, prolonged half-life NETUPITANT...NEW...used in combination
Agents for Motion Sickness: Anticholinergics SCOPOLAMINE MOA: muscarinic antagonist, suppresses nerve traffic that connects the inner ear to vomiting center AE: dry mouth, blurred vision, drowsiness
Agents for Motion Sickness: Antihistamines DIMENHYDRINATE, MECLIXINE (antivert) MOA: block H1 receptor that connects inner ear with vomiting center AE: sedation
Agents for Motion Sickness: Antihistamines: ACYCLIZINE, DOXYLAMINE + B6 used for nausea with pregnancy
Antidiarrheal Agents: Opioids DIPHENOXYLATE + ATROPINE (lomotil) LOPERMIDE (immodium, kaopectate) DIFENOXIN + ATROPINE PAREGORIC OPIUM TINCTURE MOA: activate opioid receptor in GI tract, dec intestinal motility, more time for fluids/electrolytes to be absorbed
Irritable Bowel Syndrome (IBS) crampy abd pain, associated with diarrhea and constipation
Agents to TX IBS DICYCLOMINE-antispaodic PSYLLIUM-bulk forming agent LOPERAMIDE-antidirraheal TRICYCLIC ANTIDEPRESSANTS ATNIBIOITIC + ACID SUPPRESSANTS ALOSETRON TEGASEROD (zelnorm)
Agents to tx Bowel Disease-Crohns & ulcertive colitis aminosalicylates: SULFASALAZINE, mesalamine, olsalazine, balsalazide Glucocorticoids Immunomodulators: AZATHIOPRINE + MERCAPTOPURINE CYCLOSPORINE INFLIXAMAB
Agents to dissolve gallstones CHENODIOL (chenix) URSODIOL dec hepaptic production of cholesterol and cause gradual dissolution of cholesterol gallstones prolonged therapy
Aqueous Humor produces in ciliary body and secreted into the posterior chamber of the eye circulates aroun the iris exits the anterior chamber via tabecular network and canal of Schlemm if outflow impeded = IOP if production decreases = IOP decreases
Glaucoma Tx: Beta-adrenergic blocker (topical) TIMOLOL, BETAXOLOL, CARTEOLOL, LEVOBUNOLOL, METIPRANOLOL MOA: decrease production of AH
Glaucoma Tx: Prostaglandin Analog (topical) "prost" LANTANOPROST MOA: increase AH outflow by relaxing ciliary muscle other drugs: TRAVOPROST, BIMATROPROST, TAFLUPROST
Glaucoma Tx: Alpha 2 adrenergic Agonist (topical) BRIMONIDINE (long term use) APRACLONIDNE (short term use) MOA: lower IOP by reducing AH production and increase AH outflow
Glaucoma Tx: Alpha 2 Agonist/Beta Blocker Combination (topical) fixed dose combination BRIMONIDINE & TIMOLOL (Combigan)
Glaucoma Tx: Cholinergic agonists PILOCARPINE (topical) lowers IOP by causing miosis and contraction of ciliary muscle
Glaucoma Tx: Cholinesterase Inhibitor ECHOTHIOPHATE (topical) lowers IOP by decreasing breakdown of ACH thus causing miosis and contx of ciliary muscle
Glaucoma Tx: Carbonix Anhydrase Inhibitors (CAIs) DORZOLAMIE BRINZOLAMIDE both topical, both decrease IOP by decreasing AH production
Anterior Uveitis Tx PREDNISONE or related steroids to reduce T-cell activity CYCLOPENTOLATE until a few days of mydriasis
Cyclolegics drugs that paralyze the ciliary muscle can be produced by a anticholinergic agent
Mydriatics drugs that dilate the pupil can be produced by a anticholinergic agent
Anticholinergics for eyes ATROPINE, CYCLOPENTOLATE, HOMATROPINE, SCOPOLAMINE, TROPICAMIDE MOA: mydriasis = block muscarinic receptor that promote contraction of iris sphincter Cycloplegia = block muscarinic receptor that promote contraction s of ciliary muscle
Adrenergic Agonists for eyes PHENYLEPHRINE-mydriaic agent works by activating alpha1 receptors on radial muscle of iris. DOES NOT cause cycloplegia, therefore it can increase IOP
Management of ARMD antioxitdants and zinc slow progression Vitamin C, E, Beta-Carotene, Copper OCUVITE
Management of Wet ARMD angiogenesis inhiborts that will inhibit growth of new vessels AFLIBERCEPT, RANIBIZUMAB, BEVACIZUMAB, PEGAPTANIB
Created by: julzbanks