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66 Cards in this Set
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Autonomic Nervous System (ANS) |
involuntary, automatic, self-governing - sympathetic: "alert-system" can quicky ready your body to face emergencies - parasympathetic: "resting and digesting" automatically helps to maintain the normal body functions again without your conscious effort |
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Sympathetic Nervous System (SNS) - the emergency room used to mobilize the body for quick response and action "fright, fight, and flight" |
Catecholamines = Chemical substances (neurotransmitters) released at the sympathetic nerve endings (norepinephrine and dopamine) |
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Neurotransmitters: chemical substances that are released at the nerve endings within these systems to transmit the nerve impulses from nerve to nerve at the synapses or from nerve to smooth muscle or glands |
Drugs that affect the function of the ANS are divided into 4 categories 1. Adrenergics 2. Adrenergic blockers 3. Cholinergics 4. Cholinergic blockers |
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Adrenergics (sympathomimetics = mimic sympathetic responses) |
Adrenergic blockers (alpha- and beta-blockers = block sympathetic responses) |
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Cholinergics (parasympathomimetics = mimic parasympathetic responses) |
Cholinergic blockers (anticholinergics = block parasympathetic responses) |
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Adrenergics: drugs that mimic the action of the sympathetic nervous system called sympathomimetic |
Actions of Adrenergic include - cardiac stimulation - increased blood flow to skeletal muscles - peripheral vasoconstriction - bronchodilation - dilation of the pupils (mydriatic action) |
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Uses of Adrenergics include - restoring rhythm in cardiac arrest - elevating blood pressure in shock - constricting capillaries - dilation bronchioles in acute asthmatic attacks, bronchospasm or anaphylactic reaction - ophthalmic procedures |
Side effects of the adrenergics may include - palpitations (rapid strong irregular heartbeat due to agitation, exertion or illness) - nervousness or tremor - tachycardia (abnormal rapid heartbeat) - cardiac arrhythmias (abnormal heart rhythm) - anginal pain - hypertension - hyperglycemia - tissue necrosis - headache and insomnia |
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Precautions/Contraindications with adrenergics - angina - coronary insufficiency - hypertension - cardiac arrhythmias - angle-closure glaucoma - organic brain syndrome (decreased mental function) - hyperthyroidism |
Caution for Adrenergics - give subcutaneous, IM (deltoid) or IV - small amounts only |
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Interactions of adrenergics may occur with - CNS drugs - propranolol (Inderal) or other beta-adrenergic blockers - Terazosin (Hytrin) or other alpha-adrenergic blockers |
Anaphylactic shock - severe allergic reaction that occurs suddenly and is commonly caused by food, medication, or latex allergies, severe insect bites or stings |
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Adrenergic Blockers - drugs that block the action of the sympathetic nervous system - most commonly used: alpha-blockers and beta-blockers |
Most commonly used Adrenergic drugs - alpha-blockers - beta-blockers - alpha- and beta-adrenergic blockers |
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Uses of Beta-blockers include treatment of the following - hypertension - cardiac arrhythmias - angina pectoris - migraine headache - tremor |
Side effects of beta-blockers may include - hypotension - bradycardia - fatigue or lethargy - bronchospasm - nausea and vomiting - hypoglycemia - confusion |
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Precautions/Contraindications apply to the use of beta-blockers with - abrupt discontinuation (decrease over several weeks) - congestive heart failure or atrioventricular block - hypotension - asthma, COPD - diabetes (can mask signs of hypoglycemia) |
Interactions of beta-blockers may occur with - digoxin - insulin or oral anti-diabetic agents - theophylline - MAOIs and tricyclic antidepressants - Epinephrine (causes hypertensive response) - Phenothiazines |
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The parasympathetic nerve fibers synthesize and liberate _________ as the mediator |
acetylcholine |
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Cholinergic drugs (parasympathomimetic) |
drugs that mimic the action of the parasympathetic nervous system (e.g. bethanechol, neostigmine, pilocarpine and pyridostigmine) |
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Actions of cholinergics include |
- increased gastrointestinal (GI) peristalsis - increased contraction of the urinary bladder - increased secretions (sweat, saliva and gastric juices) - increased skeletal muscle strength - lowered intraocular pressure - constriction of the pupils - slowing of the heart |
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Uses of the cholinergics include treatment of - nonobstructive urinary retention (bethanechol) - neuromuscular blockade reversal (neostigmine) - myastenia gravis (pyridostigmine) - xerostomia (dry mouth) (pilocarpine-Salagen) - open-angle glaucoma (pilocarpine) |
Side effects of the cholinergics may include - nausea, vomiting and diarrhea - muscle cramps and weakness - slowing of the heart and hypotension - sweating, excessive salivation, lacrimation (discharge of tears) and flushing - respiratory depression and bronchospasm |
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Precautions/Contraindications with cholinergics apply to those with - benign prostatic hyperplasia (BPH) - Asthma - Cardiac disorders - hyperthyroidism |
Interactions with cholinergics may include with - procainamide and quinidine (have anticholinergic properties) - local anesthetics (inhibit neuronal transmission in skeletal muscles) |
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Drugs that block the action of the parasympathetic nervous system = Cholinergic blockers or anticholinergics aka Parasympatholytic |
Example of cholinergic blocker - atropine |
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Common use of anticholinergics is - scopolamine transdermal patches to treat or prevent seasickness by decreasing gastric secretions and motility |
Anticholinergics most commonly used as preoperative medications include atropine and glycopyrrolate (Robinul) - reduce secretions of the mouth, pharynx, bronchi and GI tract and reduce gastric activity |
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Anticholinergics also used to - prevent cholinergic effects during surgery such as hypotension, or bradycardia and some cardiac arrhythmias associated with general anesthetics or vagal stimulation |
Vagus nerve is the major nerve of the parasympathetic nervous system - can be stimulated during intubation procedures and surgery - only atropine acts as a bronchodilator and reduce incidence of laryngospasm that can occur during general anesthesia |
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Actions of anticholinergics include - drying (all secretions decreased) - decreased GI and genitourinary (GU) motility - dilation of the pupils |
Uses of the anticholinergics include - antispasmodic and antisecretory for GI or GU hypermotility - preoperative and preanesthetic uses - antidote for insecticide poisoning, cholinergic crisis or mushroom poisoning - emergency treatment of bradycardia and atrioventricular heart block with hypotension - dilation of the pupils (mydriatic) - prevention and treatment of bronchospasm (bronchodilator, e.g. Atrovent HFA inhaler) |
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Side Effects of anticholinergics may include - fever or flushing - blurred vision and headache - dry mouth, constipation and urinary retention - falls, delirium and cognitive impairment, esp in older adults - palpitations and tachycardia (abnormally fast heartbeat) |
Interactions with potentiation of sedation and drying occur with - antihistamines (e.g. diphenhydramine) |
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Precautions/Contraindications apply to use of atropine for those with |
- asthma and other COPD atropine type inhalations of aerosols are recommended rather than oral or parenteral administration - can reduce dry bronchial secretions and obstruct airflow- angle-closure glaucoma - GI or GU obstruction - Cardiac arrhythmias - Hypertension - Hypothyroidism and hepatic or renal disease |
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Drugs that affect the function of the Autonomic Nervous System |
Adrenergics Adrenergic blockers Cholinergic Cholinergic blockers |
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Chapter 14 |
Antineoplastic Drugs |
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Tumors can be classified as - benign (non-cancerous) - malignant (cancerous) |
Antineoplastic (against new tissue formation) - agents that counteract the development, growth, or spread of malignant cells - can treat various types of cancers |
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Chemotherapy - drugs and drug combinations used for palliative effects (alleviation of symptoms) or for long-term or complete remissions in early treatment of cancer |
Antineoplastic drugs cytotoxic (destructive to cells) especially to cells that are proliferating - many possess immunosuppressive properties (by decreasing production of white blood cells and antibodies and reduce inflammatory reaction) = increased susceptibility to infection |
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Antineoplastic agent groups are - Antimetabolites - Alkylating agents - Mitotic inhibitors - Antitumor antibiotics - Hormones and hormone modifiers - Biological therapies - Targeted cancer therapies - Vaccines - Radioactive isotopes |
Antineoplastic drugs are frequently administered in high doses on an intermittent schedule |
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Antimetabolites work by |
interfering with DNA synthesis, repair, and cellular replication and are used in treatment of various malignancies, especially involving rapid proliferating neoplasms (new growth) |
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Examples of injectable Antimetabolites: |
methotrexate and fluoruracil |
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Side effects of antimetabolites can include |
anorexia, nausea, vomiting, diarrhea, ulceration and bleeding or oral mucosa and GIT tract bone marrow suppression rash, itching, photosensitivity and scaling |
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Precautions/Contraindications with antimetabolites apply to |
renal and hepatic disorders pregnancy GI ulcers |
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Alkylating agents |
used in treatment of a wide range of cancers - include cisplatin and cyclophosphamide = prevent cell growth by damaging DNA needed for reproduction |
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Side effects of Alkylating agents can include |
nausea, vomiting, diarrhea mucosal ulceration bone marrow suppression neurotoxicity (headache, vertigo, seizures) hemorrhagic cystitis with cyclophosphamide rash and alopecia pulmonary fibrosis |
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Precautions and Contraindications with alkylating agents apply to |
debilitated patients pregnancy renal disease |
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Plant Alkaloids (Mitotic inhibitors) |
are often plant alkaloids and other compounds derived from natural products that block mitosis treat many different types of cancer - used in combination with other chemotherapeutic agents in treatment of various malignancies Plant alkaloid examples: vinblastine, vincristine, and paclitaxel |
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Side Effects of plant alkaloids can include |
neurotoxicity severe constipation or diarrhea, nausea, vomiting oral or GI ulceration rash, phototoxicity, alopecia Leukopenia Necrosis of tissue if intravenous |
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Precautions/Contraindications with plant alkaloids apply to |
pregnancy hepatic dysfunction infection geriatric patients |
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Taxanes |
structurally different from other antineoplastic agents - used as second-line or subsequent therapy in patients with metastatic breast or ovarian carcinoma refractory to conventional chemotherapy |
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Paclitaxel (example of taxane) is adminstered only by IV under constant supervision of an oncologist with frequent monitoring of vital signs |
due to its severe adverse reactions |
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Antitumor antibiotics |
can treat a wide variety of malignancies Ex: doxorubicin, daunorubicin, bleomycin, daunorubicin, mitomycin, and others
(frequently used in combination of other drugs) |
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Side effects of antitumor antibiotics can include |
anorexia, nausea, vomiting and diarrhea bone marrow suppression cardiotoxicity pneumonitis and dyspnea; ulceration of the mouth or coon alopecia, rash, scaling |
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Precautions/contraindications with antitumor antibiotics apply to |
pregnancy liver disorders cardiac disease |
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Hormone used to treat cancer |
Example: Corticosteroids - used primarily for their suppressant effect on lymphocytes in Leukemias and Lymphomas (such as prednisone) |
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Side effects with prolonged use of corticosteroids |
fluid retention, edema Cushingoid features (moon face) Nausea/vomiting, gastritis and GI bleeding Osteoporosis with fractures |
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Hormone modifier include |
antiestrogen - hormonal therapy for metastatic estrogen receptor–positive breast cancer and palliative treatment antiandrogen agents - hormonal therapy in the treatment of endometriosis and metastatic prostate cancer |
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Antiestrogen |
nonsteroidal agent belonging to a class of drugs called selective estrogen-receptor modifiers (SERMs) - |
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Example of Antiestrogen |
Tamoxifen: binds to estrogen receptors in various tissues - also stimulates estrogen receptors in bones and may help prevent osteoporosis |
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Antiandrogen drugs include |
leuprolide acetate, - suppresses testosterone production in the testes and usually administered IM or SC on monthly regiments for prostate cancer |
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Side effects of antiandrogens can include |
impotence hot flashes, generalized pain, infection, constipation and nausea - continue drug even when signs or symptoms of disease improve |
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Biological therapies (immunotherapy, biotherapy or biological response modifier therapy) |
designed to repair, stimulate or enhance cancer patients' natural immune systems to more effectively recognize and attack cancer cells |
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Types of immunotherapy (biological therapy) |
active or direct type (such as interferons) - stimulates the body's own immune system to fight the disease passive or indirect type (such as monoclonal antibodies) - uses immune system components created outside the body |
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Interferons Alfa (Intron A) |
the type most widely used in cancer treatments - a complex combination of many proteins that boost immune system response - treats certain leukemias, melonoma, Kaposi's sarcoma and non-Hodgkin's lymphoma. - also used to treat hepatitis B and C, multiple sclerosis and other conditions |
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Adverse side effects of interferons (most common side effects) |
flulike syndrome GI symptoms Nervous system effects hematological effects dyspnea alopecia |
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Colony-stimulating factors (CSFs) |
usually do not directly affect tumor cells (such as erythropoietin - encourage bone marrow stem cells to divide and develop into red and white blood cells and platelets |
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Monoclonal Antibodies (MABs) |
are exogenous (outside of body) antibodies genetically engineered in the lab - designed to target only cancer cells, sparing normal tissues - reduces host toxicity while simultaneously increasing toxicity to cancer cells |
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Side effects of MABs can include |
fever and chills, headache and dizziness nausea, vomiting itching, rash, and generalized pain |
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Targeted cancer therapies |
drugs or other substances that block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression - focus on molecular and cellular changes that are specific to cancer |
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Signal Transduction Inhibitors (STIs) |
one of the newer and largest grouping of targeted therapy drugs block specific enzymes and growth factor receptors that signal cancer cell proliferation |
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Vaccines |
medicines that boost the immune system's natural ability to protect the body against "foreign invaders" mainly infectious agents that may cause disease |
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two types of cancer vaccines |
preventive (prophylactic) - intended to prevent cancer from developing in healthy people treatment (therapeutic) intended to treat an existing cancer by strengthening the body's natural defenses against cancer |
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Radioactive Isotopes |
used in treatment of certain types of cancer - sometimes radioactive material is injected into the affected site or implanted in body in the form of capsule, needles or seeds - |
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Cautions and Responsibilities for Antineoplastic Drugs |
Medications should be given on time and exactly as prescribed Intravenous sites must be checked with great care Intravenous fluids containing antineoplastic agents should not be allowed to get on the skin or into the eyes of the patient or administrator |
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What medication is useful in minimizing side effects nausea and vomiting from treating lymphoma from chemotherapy> |
Tositumomab (Bexxar) with iodine 131 |
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what medication is a prototype for antihypertensive that works via the ANS? |
propranolol |
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what medication type is used for hypertension? |
Beta-blocker (adrenergic blocker) |