Drugs
Propanolol
Class: nonselective B1 & B2 adrenergic antagonist
MOA:nonselective blocking B1/B2 receptors, decrease HR/BP, decrease contractility
SE: fatigue, hypotension, sexual dysfunction, bradycardia, bronchospasm
Nursing: monitor respiratory status & vitals, caution in diabetic/respiratory patients
drug doses for pediatric patients
based on body weight, immature liver/kidneys, monitor closely
what is a loading dose
large initial dose given to achieve therapeutic levels quickly
How do drug doses differ btwn neonates, infants, & children over 1 yr?
neonates- limited drug metabolism due to imbalance liver enzyme systems, drug half lives are longer
infants: metabolism improves, still slower
children: may metabolize drugs faster than adults, higher more frequent doses, after 2 metabolism gradually slows to adult level
"Good drug" qualities
Effectiveness
Safety
Selectivity
Generic name vs trade name
generic: standard name given to the active ingredient in the drug (nurses use)
trade: the name the drug company gives the medicine to market it
muscarinic agonists mimic the effects of ____ while muscarinic antagonist block these effects
Aceylcholine
Routes of medication
1. oral
2. intravenous
3. intramuscular
4. subcutaneous
5. sublingual
6. topical
7. inhalation
What college sports did everyone play in this room?
Softball and Tennis
Neostigmine
Class: cholinesterase inhibitor
MOA: reversible acetylcholinesterase inhibition - promotes muscle contraction
AE: Bradycardia, salivation, diarrhea, cramp
Contraindications: GI & GU obstruction, asthma, inflammation of the belly
Nursing: monitor respiratory status, muscle strength, HR, Atropine available
Epinephrine
Class: adrenergic agonist (A1, B1, B2)
MOA: stimulates vasoconstriction (A1), Increase HR (B1), bronchodilation (B2)
SE: tremor, anxiety, arrythmias, tachycardia, hypertension
Contraindications: hyperthyroidism, CV disease
Nursing: monitor vitals & ECG, rotate injection sites
Pharmacokinetics
Pharmacodynamics
Pharmacotherapeutics
- the study of what the body does to the drug
- The study of what the drug does to the body
- Why was the drug given, what are the therapeutic uses and effects
unintentional vs intentional med non- adherence
unintentional causes: forgetfullness, nonadherance, cost, physical limitations
intentional causes: feeling the drug is unnecessary, misunderstanding directions, bad effects
considerations when giving med to prego or breastfeeding patient
- use only if benefit outweighs the risk
- avoid teratogenic drugs weeks 3-8
- consider altered pharmacokinetics
- time doses to avoid peak levels while nursing
- monitor infant for adverse effects
Atropine
class: muscarinic antagonist
MDA: block Acetylcholine (aCh) @ muscarinic receptor, inhibits PNS activity
AE: dry mouth, blurred vision, photophobia, urine retention, tachycardia, constipation
Contraindications: Benign Prostatic Hyperplasia (BPH), myasthenia gravis, GI obstruction
Nursing: eye ball pressure, monitor BP/HR, urination, caution with smokers and old ppl
Bethanechol
Class: muscarinic agonist
MOA: stimulating muscarinic receptors in GI & Urinary tract, promotes smooth muscle contraction
AE: salivation, abdominal cramping, diarrhea, hypotension, bradycardia
Contraindications: asthma, urinary/intestinal obstruction
Nursing: empty stomach, monitoring cholinergic overdose
The process of drug elimination
excretion- removal of drugs from body,by kidneys
1. glomerular filteration
2. passive tubular reabsorption
3. active tubular secretion
Drug Elimination process
1. glomerular filteration
2. passive tubular reabsorption
3. active tubular secretion
Factors influencing excretion: kidney function, age, hydration, drug characteristics
What to look for when asking a patient for drug history
- all medications they are on including OTC
- allergies
- use of alc, tobacco, recreational drugs
-
Metoprolol
Class: selective B1 adrenergic antagonist
MOA: selectively cardiac B1 - reduce HR, contractility, BP, decrease renin release
AE: bradycardia, hypotension, depression, dizzy, fatigue, cold extremities
Contraindications: severe bradycardia, AV block, heart failure
Nursing: check apical HR/BP before dose, monitor ECG, input/output
drugs that targets A1, A2, B1, B2 and indications
- adrenergic receptors (mediate SNS, trigger fight or flight)
A1 - eyes, arterioles, vains, bladder
A2 - presynaptic nerve
B1 - BB, heart and kidneys
B2 - BB, lungs
propanol - B1/B2
Epinephrine- all 4
prazosin - A1
metoprolol - B1
what is the nonselective adrenergic agonstis used for anaphylaxis and cardiac arrest?
Epinephrine
What are the 7 drugs for this exam?
Propanol
Metoprolol
Neostigmine
Atropine
Bethanechol
Atropine
Bethanechol
Factors that affect the distribution of medications
Lipid solubility
blood flow to tissues
ability of the drug to exit the vascular system
protein binding
ability to enter cells
Prazosin
Class: adrenergic antagonist
MOA: blocks A1 - lowers BP, reduces smooth muscle tone
AE: orthostatic hypotension, hypersensitivity
Contraindications: history of orthostatic hypotension
Nursing: monitor BP/HR, first does @ bedtime, assist with ambulation