Pharmacotherapeutics/Lifespan
Pharmacokinetics (ADME) is the impact of the body on the drug and pharmacodynamics is the impact of the drug on the body. What does ADME stand for?
The four major pharmacokinetic processes are
1. Absorption
2.Distribution
3. Metabolism
4. Excretion
What two systems make up the autonomic nervous system?
What are the sympathetic and parasympathetic nervous systems.
Calcium Channel Blockers are (Very Nice Drugs) verapamil (Calan) (constipation), amlodipine (Norvasc) (flushing & reflex tachycardia), & diltiazem – (constipation, flushing, & heart block). They promote vasodilation by preventing calcium ions from entering the cells. What are they used to treat – Name 1?
What is Angina pectoris, HTN, & cardiac dysrhythmias (a-Fib, a-flutter, & SVT)
Most frequently prescribed loop diuretic and most effective in producing the greatest urine output. Therapeutic use includes treatment of CHF, Edematous states, & HTN. Name that drug?
What is furosemide (Lasix)
What is the common practice when converting the patient from oral steroids to inhaled steroids?
What is taper the pills gradually.
When describing pharmacodynamics we look at selectivity, onset, peak, duration, and trough. State the meaning of peak and trough?
Peak=the time it takes for a drug to reach its maximum therapeutic response
Trough=lowest drug blood level
What happens to bronchi in a sympathetic nervous system response
What is dilate and relax (more air flow)
Angiotensin-Converting Enzyme (ACE) Inhibitors – reduce levels of Angiotensin II & increase levels of bradykinin, they are used to treat HTN, heart failure, MI, & DM nephropathy. State 2 side effects?
What is: hypotension, cough, headache, hyperkalemia (use cautiously with K+ sparing diuretics), & angioedema – edema of tongue, glottis, & pharynx (never take again if occurs)
*Prils *Review ARB’s mechanism of action???
This drug is a thiazide diuretic with the mechanism of action in the distal convoluted tubule, 1st line drug to treat HTN, same side effects as furosemide. Name this drug?
What is hydrochlorothiazide (HydroDiuril) HCTZ
2 Main drug classes used in the treatment of Asthma?
What are corticosteroids & bronchodilators
What oral preparation provides the fastest absorption?
What is liquid, elixirs, syrups
Oral Prep: Listed from fastest to slowest
1. suspension solutions (elixirs)
2. powders
3. capsules
4. tablets
5. coated tablets
6. enteric-coated tablets
Parkinson’s disease is a neurodegenerative disorder of the extrapyramidal system disrupting the regulation of voluntary movements. The treatment goal is increased control of voluntary movement, what is the treatment med of choice?
What is Levodopa + Carbidopa
*only lipid soluble agents cross the BBB & it may take months to see a response to treatment.
Need to review on/off phenomenon, drug holiday, and Adverse effects: N/V, postural hypotension, low protein diet with medication
Hypertension is preferred to be treated with lifestyle changes 1st but what is the #1 medical regimen (2 classes)?
What are Thiazide diuretics (HCTZ) & Beta Blocker (propanolol – Inderal)
ACE or ARB also good with diuretic
*Less effective in African Americans, give carefully in asthmatics, & always check a pulse prior.
*Propranolol – give with caution in DM – may mask the signs of hypoglycemia. caution with Asthma.
High-Ceiling loop diuretics have the following adverse effects of hypotension which causes tachycardia & hypokalemia. Name 2 others adverse effects of loop diuretics?
What is ototoxicity (if given too fast IVP), hyperglycemia, hyperuricemia, potentiates drug interactions such as Digoxin & K-sparing diuretics.
We know the most effective drug for relief of acute bronchospasms is nebulized albuterol (bronchodilator). The S/E associated are tachycardia, nervousness, angina, & tremors. Name a long acting bronchodilator that is used for maintenance treatment?
What is salmeterol inhaler
When giving medications to newborns state 2 challenges that must be considered in respect to ADME.
Pediatric organs are immature leading to similar problems as the elderly due to organ degeneration.
Absorption-variable depending on surface
Distribution-decreased due to albumin levels
Metabolism-decreased due to immature hepatic function
Excretion-decreased due to immature renal function
Dilantin (Phenytoin) is an antiepileptic agent used for partial and tonic-clonic seizures. The adverse effects are nystagmus, sedation, ataxia, & gingival hyperplasia. What are the therapeutic and toxic drug levels?
What is Therapeutic 10-20 mcg/ml & Toxic- 30-50 mcg/ml.
*Never stop any of these drugs abruptly, they must be weaned or increased seizures will occur.
Vasodilator used for its selective dilation of arterioles, used to treat essential HTN & HTN crisis, with the side effect of reflex tachycardia & the rare S/E of Systemic Lupus Erythematosus (LUPUS)
What is Hydralazine (Apresoline)
*Sodium Nitroprusside (Nitropress) fastest acting -works on dilation of arterioles and veins- used for HTN emergencies. S/E:Hypotension & Cyanide poisoning.
Spironolactone (Aldactone) blocks aldosterone in the distal nephron leading to K+ retention and increased excretion of sodium & H2O. Name one significant adverse effect?
What is hyperkalemia.
*Remember to use with caution with ACE inhibitors*
Inhaled glucocorticoids such as QVAR is used prophylactically and to suppress inflammation in asthma. State 2 common side effects?
What is oropharyngeal candidiasis, dysphonia – hoarseness & speaking difficulty, and promotes bone loss.
The ADME effects during pregnancy are:
absorption and distribution increase due to decreased GI motility=prolonged transit
metabolism increased
excretion is increased as renal blood flow doubles (Inc. in GFR)
With these changes in ADME, what needs to happen to medication dosing in pregnant women?
Medications dosed need to have an increased
On the WHO analgesic ladder for pain treatment, Step 1 is mild pain with non-opioids such as NSAIDS & Tylenol, Step 2 mild to moderate pain add opioid such as oxycodone or hydrocodone, Step 3 moderate to severe pain add morphine or fentanyl + adjuvant (amitriptyline). Name 2 S/E’s of Morphine and the antagonists for overdose?
What is: resp. depression, coma, pinpoint pupils, constipation, hypotension.
* Overdose= Naloxone (Narcan)
*Remember opioids are more effective on a fixed schedule.*
Digoxin (Lanoxin) is a cardiac glycoside which has a positive inotropic action on heart, therefore increasing myocardial contractility. Name 3 nursing measures that are important to monitor in your newly diagnosed CHF pt. taking digoxin?
What is: *Cardiac monitor & Apical HR. *K+ levels between 3.5-5meq/ml. *Assess for A-V Block. *Monitor for anorexia, N/V, fatigue & visual disturbances.
*Treat Dig toxicity with digibind.
These nursing education needs to be provided to patients taking diuretics: Take med in AM or before 1400, may take with food to reduce GI upset. Name 2 more patient education tips:
What is monitor BP, HR, weigh daily, rise slowly to standing position, observe for signs of dehydration (light headedness, dizzy, thirst, confusion), monitor FSBS
Cromolyn (Intal) – acts to stabilize the cytoplasmic membrane mast cells (suppresses inflammation) NOT a bronchodilator, used for prophylaxis of asthma. State 2 patient education tips regarding the use of this med?
Routine use or scheduled dosing – not for emergencies.
15 min. prior to exercise for most beneficial effect.
Therapeutic effects may take several weeks.
Describe ADME in relation to the elderly?
Absorption-gastric pH less less acidic (or increased pH level)
Distribution-less body water=reduced fat content and protein binding sites
Metabolism-liver blood flow decreases which decreases production of protein (albumin)
Excretion-GFR decreases because the # of intact nephrons are decreased
Under treatment of pain is a major concern – the goal should be to have a pain level reduced to a level agreed upon by both the patient and provider. Using the acronym A,B,C,D,E state the pain management strategy?
• ASK about pain regularly & assess pain systematically
•BELIEVE the patient and family in their reports of pain and what relieves it
•CHOOSE pain control options appropriate for the patient, family, and setting
•DELIVER interventions in a timely, logical, coordinated fashion
•EMPOWER patients and their families and Enable patients to control their treatment to the greatest extent possible
Anticoagulants such as heparin & warfarin (Coumadin) – disrupt the coagulation cascade & thereby suppress production of fibrin – preventing venous thrombus. Heparin’s effects are monitored by aPTT levels (60-80 sec) and overdose is treated with protamine sulfate. Name the mechanism of action of warfarin and what are overdoses treated with?
What is decrease prothrombin activity & prevents use of vitamin. K by the liver
Vitamin K is the antidote for overdose
*Don’t forget Low-molecular wt. Heparins like enoxaparin (Lovenox)– Fixed dosing, cheaper, & NO bloodwork.
*Review Anti-platelets – ASA & Thrombolytics – Streptokinase.
A patient with CHF complains of shortness of breath and has crackles heard on auscultation of the lungs. What class of medication can be given that would improve the patients symptoms quickly?
What is a loop diuretic such as furosemide or torsemide
Name one drug class used to treat allergic rhinitis and its mechanism of action and common drug?
1.Anticholinergic – blocks muscarinic receptors in the bronchi (bronchial dilation) = ipratropium bromide Atrovent)
2. Oral antihistamines – H1 receptor antagonists = diphenhydramine (Benadryl)
3. Intranasal Glucocorticoids –suppress inflammation = fluticasone (Flonase)
4. Intranasal Cromolyn – Suppress release of histamine 1= NasalCrom
5. Sympathomimetics (oral/nasal) – Activate alpha-1 in nasal blood vessels = vasoconstriction=reduce stuffiness= oxymetazoline (Afrin) or pseudoephredrine (Sudafed).