Pharmacology MOD II

•Atropine
•(Protopam) Pralidoxime (pral·i·dox·ime)

Urinary retention

(30-90 min)

(5-15 min)

• (Tensilon) to dx
• (Prostigmin) to tx
• (Mestinon) to tx

↑ amt of acetylcholine
Cholinesterase inhibitor for diagnosis/treatment of myasthenia gravis

•Salivation↑
•Lacrimation
•Urination↑
•Diaphoresis
•GI secretions↑
•Elimination/emesis/diarrhea

Constrict pupils/bronchioles
Stimulates Secretion/dilation of salivary glands
↓HR/strength
↑stomach/intestine motility
Contract bladder/Relax sphincter

Interrupt parasympathetic nerve impulses in the CNS/ANS; compete with acetylcholine at muscarinic receptor sites

Cholinergic blocking agents

Dilate pupils
Anticholinergic
Antispasmodic
Antisudorific an·ti·su·dor·if·ic (inhibiting the secretion of sweat)

↓accommodation, salivation, bronchial/GI secretions, gastric/intestinal motility, sweating,
↑ heat stroke, HR, artial ventricular arrhythmias
Urinary retention

Dry
↓GI Motility
Dilated Pupils

Large IV doses given rapidly will block the vagal effect

Glaucoma
Reflux esophagitis
CAD
Myasthenia gravis
Renal/GI obstructive disease

30 min a (before) meals & at hs (bedtime) for GI spasticity
Cool room
Monitor VS & T q4hrs
↑ GI secretion ċ (with) late night snack/milk
Measure I & 0
Good oral hygiene

Sugarless gum
Candy
Ice/saliva substitutes

Water
Exercise

Duodenal/Peptic ulcers
IBS
Neurogenic Bladder
Urinary incontinence

Keep respiratory equip nearby
Auscultate breathing
Monitor VS

↓ B/P
Shock
Cardiac arrest

Visual acuity

BP & pulse

Dysphasia
Respiratory weakness
Fasciculation (uncontrollable twitching of single muscle group)

Urination
1 hr

Qday
↓Weakness
↑Breath & swallowing
Speech

Stress need to take drugs on time.

Antidepressants, antivertigo, antipsychotics, antiemetics, antidyskinetics - as in tic or spasm

Antagonists

I & O

Atropine

Atropine

Atropine

Atropine

Atropine

Atropine

Atropine

Atropine

Atropine

Pro-Banthine

Myasthenia gravis
Weakeness

Prostigmin & Mestinon

Prostigmin & Mestinon

↓weakness
Ambulation
Effective chewing/swallowing

Atropine

Atropine

Adrenergic

Catecholamines and other direct-acting adrenergic; stimulate alpha and beta-adrenergic receptors directly

Nonreepinephrine and alpha-agonists; act mainly on alpha-receptors, causing vasoconstriction of arterioles in skin, kidneys, mesentery, and splanchnic area;

Beta-agonists - cause vasodilatation of arterioles supplying brain, heart, and skeletal muscles

Epinephrine: acts on both alpha-and beta-receptors, causing a combined response of vasoconstriction and vasodilatation

Dopamine and dopaminergic agonists: act on dopamine receptors in CNS: also act indirectly, stimulating norepinephrine release

Restlessness, anxiety, dizziness, HA, insomnia, vertigo, palpitations, arrhythmias, tachycardia

Dobutamine (Dobutrex) IV only, it used to increase cardiac output in CHF and Cardiac open heart surgery.

Dopamine is given IV for CHF and shock. It increases cardiac output (CO); monitor v/s, pulse-pulse and b/p should increase with systolic above 90.

happens when extravasted intravenous; tingling and numbness at IV site, change in color of skin and change in peripheral pulses. DC stat and start new IV.

Anticholinergic agents

Neuromuscular Blocking Agents

Neuromuscular Blocking Agents

Depolarizing agent

Nondepolarizing agents

Nondepolarizing agents. Used as muscle relaxants. Called also competitive drugs

B1 receptors are located mainly in the heart

B2 receptors mediate the actions of catecholamines on smooth muscle, especially bronchioles and arterial smooth muscle

Cardiac acceleration and increased contractility (B1)
Vasodilatation of arterioles supplying skeletal muscles (B2)
Bronchial relaxation (B2)
Uterine relaxation (B2)

Dobutamine ( Dobutrex) IV only; increases cardiac output in CHF

Norepinephrine (Levophed) tx of hypotension and shock; watch for extravasation

Epinephrine IV IM SQ - bronchiodilation; asthma attacks, anaphylactic reaction, cardiac arrest

Isoproterenol (Isuprel) - long acting, least toxic that epinephrine; tx asthma, shock, & cardiac arrest

Epinephrine - vasodilatation
Ritodrine (Yutopar) - preterm labor; decrease contractions

Terbutaline (Brethaire, Bricanyl) - Bronchiodilation, Management of preterm labor
Isoetharine (Bronkosol) Bronchodilator

tx of migraines, given medication earlier to maximize effect, 2 mg Po of SL the 2 mg q 30min PRN until relieved or a max dose of 6 mg

Is the most effective dopaminergic drug; make take several weeks or months to reach it maximum effectiveness.

Eye winking

Pyridoxine (B6) and demerol

↓of rigidity & tremors

Succinylcholine /Anectine

•To relax skeletal muscles during surgery
•To reduce intensity of muscle spasms in drug or electrically induced convulsions
•paralyze diaphragm and intercostals muscles

Nondepolarizing agents

Succinylcholine suc·ci·nyl·cho·line (anectine)

within 30-60 seconds

Bronchospastic Diseases (emphysema and asthma)
Do not use in emphysema

CHF, sinus bradycardia, heart block, cardiogenic shock, bronchospastic disease (such as asthma or emphysema). Use precaution when pt is diabetic

The triptans bind to serotonin (5-HT) receptors, producing vasoconstriction, which is effective in aborting a migraine headache. They treat migraines by constricting cranial vessels.

Phentolamine (Regitine)
Ergoloid (Hydergine)
Ergotamine (Ergotamine)

Reynaud’s disease, HTN secondary to pheochromocytoma, and migraine

If discontinued, ↓ dose gradually. Abrupt withdrawal can produce confusion, exhaustion, exacerbation of symptoms.

Instruct pt that frequent rinses, sugarless gum or candy, and good oral hygiene may help relieve dry mouth.

May cause drowsiness. Caution pt to avoid driving or other activities requiring alertness until response to medication is known.

Check apical pulse rate before administering beta-blocker; if less than 50 bpm inform physician before proceeding

On-off syndrome refers to a complication following prolonged levodopa therapy (2 yrs or more). During therapy, the client fluctuates from being symptom free “on” to demonstrating full-blown Parkinson’s symptoms “off”.

If pt is switching from levodopa alone to carbidopa-levodopa, discontinue levodopa for at least 8 hrs before starting combination therapy

Levodopa may cause harmless darkening of urine and sweat

serum K

5 minutes

Endotracheal equipment, suction, O2, and mechanical ventilator available for emergency to protect the airway

Dantrium

Dantrium

combination drug; allows more levadopa to be converted to dopamine in the brain;

8 hours

A/R Fasciculation - muscle twinking is first sign of overdose.

30 min

within 1 hr

Cyclobenzaprine hydrochloride (Flexeril)

Do NOT mix with D5W -

If D5W is dripping, flush lock with N/S before and after IVP Dilantin

Suspect Stevens-Johnson Syndrome - Rash turns into blisters. Immediately DC Dilantin and call doc.

Ataxia, slurred speech, confusion, nystagmus, blurred vision, gigival hyperplasia, N/V, blood disorders, hepatitis, hirsutism.

Cimetidine, allopurinol, disulfiram, fluconazole, isoniazid, omeprazole, sulfonamides, oral anticoagulants, chloramphenicol, valproic acid, amiodarone.

Hormonal Contraceptives (use another BC), Oral Anticoagulants, levodopa, amiodarone, corticosteroids, doxycycline, methadone, metyrapone, quinidine, theophylline, thyroid hormone, valproic acid, cyclosporine, and carbamazepine.

Stabilize nerve cells to prevent overexcitedness.

Elevate seizure threshold by decreasing postsynaptic excitation.

Drowsiness.

Makes sense - it puts the brain (and nerve connections) partly to sleep to keep them from going haywire.

Except for Stevens-Johnson syndrome, never discontinue any seizure med abruptly - can CAUSE seizures.

Fever (Febrile)
Hypoglycemic (Low Blood Sugar)

Always take with food - can cause upset stomach.

NONE. Do not decrease, ELIMINATE drinking.

Gingival Hyperplasia / Gum hypertrophy - gum overgrowth. Brush, floss, see the dentist.

Big Veins - stay away from back of hands. It is very irritating to veins.

Can CAUSE
Bradycardia, hypotension, and cardiac arrest with IV administration.
Cause deressed arial and ventricular conduction.
Toxic - Ventricular fibrillation.

EKG,vital signs, blood pressure, watch for rash - Stevens-Johnson syndrome.

Nondepolarizing agents

Blind as a bat, dry as a bone, hot as a hare, mad as a hatter