PHARMACOLOGY AMPHETAMINES

increase the release of catecholamines

JOHN J. TEODORO PTRP, RN (NE from stored sites in nere terminals)
Block the re-uptake of dopamine & NE
Analgesics
following release into the synapse, &
1. NARCOTIC AGONISTS
inhibit the action of MAO
2. NARCOTIC PARTIAL AGONISTS; NARCOTIC
Increase stimulating effect on cerebral
ANTAGONISTS
cortex & RAS
3. NON-STEROIDAL ANTI-
DOXAPRAM (DOPRAM)
INFLAMMATORY
METHYLPHEMDATE Hcl (Ritalin)
4. MISCELLANEOUS ANALGESIC AGENTS
PEMOLINE (Cylert)
CAFFEIN
Anxiolytics
Librium watch for signs of leukopenia,
Anticholinergic med
hypotension
Equanil metabolizes extensively in the liver &
benztropine mesylate (Cogentin), biperiden
interferes w/ liver function tests.
HCl (Akineton) Trihexyphenidyl HCl (Artane),
- decreases PT if on coumadin
scopolamine, atropine
Atarax - does not cause tolerance & can be
*Block cholinergic receptors in the CNS,
used
thereby suppressing
temporarily when other anti-
acetylcholine activity
anxiety
*A/R: blurred vision, dry mouth & secretions,
agents have been abused
urinary retention,
Serax useful for treating elderly clients. Does
constipation, restlessness & confusion
not rely on liver for metabolism
*Client to have regular eye check up for
increase in IOP
Anticonvulsants
*Avoid aspirin, caffeine, smoking & ROH to
BARBITURATES
decrease gastric
*treat grandmal seizures ; tonic-clonic
acidity
seizure
BENZODIAZEPINES
CARDIAC DRUGS
*diazepam is DOC for Rx of STATUS
EPILIPTICUS
Beta adrenergic Blockers
*clorazepate is use w/ other
*Inhibit response to beta-adrenergic
antiepileptic agents to control partial seizures
stimulation
HYDANTOINS
*Block release of epi & NE thus decreasing HR
*Used to depress abnormal neuronal
& BP
charges & prevent spread of seizures
*Used for angina, dysrhythmias, prevention of
*also used to treat dysrhythmias
MI & glaucoma
*A/R: gingival hyperplasia, alopecia,
*A/R: bradycardia, hypotension, weakness &
hyperglycemia, blood dyscracias
fatigue
*Seizure precaution & dental hygiene
*Hold if BP & HR not within parameters
*Give IV with normal saline & never
prescribed by MD
with dextrose
*Not to D/C meds abruptlyrebound HPN,
tachycardia, angina
CNS STIMULANTS
*Early signs of hypoglycemia such as
tachycardia & nervousness can be masked by
these drugsmonitor blood sugar
BETA- BLOCKING AGENTS anesthetics to promote prolonged anesthetic
BETA1 ADRENERGIC ( CARDIO SELECTIVE) action by
BLOCKING AGENTS decreased blood flow to area
-acebutolol (Sectral) Adrenergic Agonist
-atenolol (Tenormin, Atenol, isoproterenol (Isuprel)
Premorphine) *Stimulates beta receptors & used for cardiac
-metoprolol (apo-metoprolol, betaloc) stimulation &
BETA1 & 2 ADRENERGIC (nonselective) bronchodilation
BLOCKING AGENTS norepinephrine (Levophed)
-nadolol (corgard) *Stimulates heart in cardiac arrest
-pindolol (visken) *Vasoconstricts & increases BP during
-propranolol( inderal, novopranol) hypotension & shock
-timolol (blocadren, betin, temserin) *A/R: tachycardia, angina, restlessness
*If extravasation occurs, infiltrate with normal
Calcium channel blocker saline &
verapamil (Calan, Isoptin), nifedipine phentolamine (Regitine)
(Procardia) Antianginal meds
felodipine (Plendil), diltiazem (Cardizem) NITRATES
*Decrease cardiac contractility by relaxing nitroglycerin (Nitrostat, Nitrolingual)
smooth muscle nitroglycerin ointment 2% (Nitrol, Transderm-
and the workload of the heartthus Nitro)
decreasing need for O2 *Produce vasodilation & improved myocardial
*Promote vasodilation of coronary & O2 consumption
peripheral vessels *C/I in client with severe hypotension
*A/R: bradycardia, hypotension, dizziness & *A/R: H/A, orthostatic hypotension, dizziness,
lightheadedness weakness & faintness
*Instruct client how to take HR & to inform SUBLINGUAL:
MD if dizziness *Offer sips of H2O since dryness may inhibit
Persists absorption
*Leave under tongue until fully absorbed, not
Adrenergic agonist swallowed
dobutamine (Dobutrex) *Take 1 tab for pain ff q5 mins for a total of 3
*Increases myocardial force & C.O. through doses. If pain not relieved in 15 minutes, seek
beta receptors MD help.. may indicate MI
stimulation *Stinging/burning feeling means tablet is fresh
*Used in clients with CHF TOPICAL
dopamine (Intropin) *Remove ointment from previous dose, rotate
*Increases BP & C.O. & increases renal outflow sites & avoid
through its touching ointment & hairy areas
action on alpha & beta receptors *Squeeze ribbon into prescribed length on
*Treat mild renal failure due to decreased C.O. applicator paper
epinephrine (adrenalin) *Sites: chest, back, abdomen, upper arm &
*Cardiac stimulation during cardiac arrest, anterior thigh
bronchodilation TRANSDERMAL PATCH
asthma & allergy, mydriasis *Apply patch to hairless area, using new patch
*Promotes vasoconstriction when combined & different
with local site every day
*Remove patch after 12-14 hours, allowing 10-
12 patch-
free hours daily to prevent tolerance
*Stand away from microwave ovens
Digitalis
DIGITALIS TOXICITY
* loss of apetite, nausea, extreme
fatigue, weakness of the arms & legs,
psychiatric disturbances (nightmares,
agitation, listlessness, or hallucination) or
visual disturbances ( hazy, or blurred vision,
difficulty reading & green color)
N.I.
1. Take APICAL PULSE 1 full minute
*dont give for Adult <60/min;
child < 90 bts/min
*monitor potassium level
specially diuretics
digoxin (Lanoxin)
*Inhibit sodium-potassium pump
*positive inotropic action
*negative chronotropic action
*A/R: anorexia, N/V, visual disturbances
*Monitor serum therapeutic level 0.5-2.0
ng/ml; increased
risk of toxicity in clients with hypokalemia
*Used for CHF, atrial tachycardia, atrial
fibrillation & flutter
*Increase K+ rich food: fresh & dried fruits,
fruit juices,
vegetables & potatoes
*Monitor HR & hold if below 60 & above 100
(adults)
*Antidote: digoxin immune FAB (Digibind)
*Life threatening toxicity: ventricular
tachycardia, fibrillation, severe sinus
bradycardia
*80% DIGOXIN excreted by kidneys; half life is
36-120H
*90% DIGITOXIN metabolized by liver; half life
is 120-210H
Anticoagulants
*Prevent the extension & formation of clots by
inhibiting
factors in the clotting cascade & decreasing
blood
coagulability
*Used for thrombosis, pulmonary embolism &
MI
*C/I in active bleeding except in disseminated
intravascular
coagulation (DIC), bleeding disorders, ulcers
*A/R: hemorrhage, hematuria, epistaxis,
ecchymosis,
bleeding gums, thrombocytopenia
heparin Na (Liquaemin Na)
*Prevents thrombin from converting
fibrinogen to fibrin
*Prevents thromboembolism
*Therapeutic dose does not dissolve clots, but
prevents
new thrombus formation
*Blood levels: normal APTT is 20-36 seconds;
maintain APTT is 1.5-2.5 times normal; APTT
therapy should be measured q 4-6H during
initial therapy & then daily
heparin Na
*Monitor clotting time; normal is 8-15
minutes; maintain
clotting time 15-20 minutes
*Observe for signs of bleeding
*Inject SQ into the abdomen with 25-28g at 90
degrees
angle; dont aspirate or rub injection site
*Antidote is protamine SO4
warfarin Na (Coumadin)
*Decreases prothrombin activity & prevents
the use of vitamin K by the liver
*Used for long-term anticoagulation
*Prolongs clotting time & monitor PT
(prothrombin time)
*Used mainly to prevent thromboembolitic
conditions such
as thrombophlebitis, pulmonary embolism,
embolism
caused by heart valve damage, atrial
fibrillation & MI
*Given 2-3 months after an MI to prevent DVT
warfarin Na (Coumadin)
*Average PT is 9.6 to 11.8 seconds & normal
INR is 1.3-2.0
Goal is to raise the INR to 2 to 3
*Observe for signs of bleeding
*Antidote: Vitamin K (AquaMEPHYTON)
THROMBOLYTIC MEDS
*Monitor for bleeding, hypotension &
tachycardia
*Avoid injections; apply pressure to puncture
site for 20-30 minutes
*Handle clients minimally & let clients use
electric razors & brush teeth gently
*Antidote: aminocaproic acid (Amicar)
Respiratory Drugs
Bronchodilator
* Used for allergic rhinitis, acute
bronchospasm, acute & chronic asthma,
bronchitis, COPD, emphysema
Caution with clients with glaucoma &
HPN
* A/R: palpitations, tachycardia, nervousness,
tremors, restlessness & HA
Give RTC to maintain therapeutic
blood level
* Avoid caffeine products
ANTIHISTAMINES
astemizole (Hismanal), diphenylhydramine
(Benadryl)
loratadine (Claritin)
*Histamine antagonists or H1 blockers;
compete with histamine
for receptor sites preventing histamine
response thus
constricting smooth muscles
*Decrease nasopharyngeal secretions &
decreases itching which
causes sneezing
*Used for common colds, rhinitis, urticaria,
nausea & vomiting,
motion sickness & sleep aid
*CNS depressant with ROH, narcotics,
barbiturates & sedatives
*Caution with COPD clients & Benadryl C/I in
clients with
glaucoma
*A/R: dizziness, dry mouth, blurred vision
GIT DRUGS
Antacids and Mucousal Lining protectives
*react with gastric acid to produce neutral
salts or salts of low
acidity
*inactivate pepsin and enhance mucosal
protection but do not coal ulcer to protect
from acid & pepsin
*used for patients with PUD & GRF
(gastroesophageal reflex disease)
*antacid tablets should be chewed and
followed with glass of H2O or milk
*administer 1 hour apart from other meds to
minimize the chance of drug interactions
sucralfate (Carafate)
*creates a protective barrier against acid &
pepsin
*given po & on an empty stomach
*A/R: constipation, impede absorption of
warfarin Na,
phenytoin, theophylline, digoxin & some
antibiotics
administer 2 hours apart from these meds
magnesium hydroxide (Milk of Magnesia)
*rapid acting & A/R is diarrhea
*usually combined with aluminum hydroxide
to counter diarrhea
(MAALOX)
aluminum hydroxide (Amphojel, Alu-cap)
*slow acting & A/R: constipation
*with significant Na contentcaution in clients
with HPN &
heart failure; reduce effect of tetracyclines,
warfarin Na &
digoxin
*reduce phosphate absorption
calcium carbonate (Tums)
*rapid acting & A/R: constipation
sodium bicarbonate
*rapid onset
*A/R: liberates CO2 & increases intra-
abdominal pressure
causing flatulence, caution in clients with HPN
& heart
failure, systemic alkalosis in clients with renal
failure
H2 RECEPTOR ANTAGONIST

*suppress secretion of gastric acid

*indicated for PUD & heart burn & for GRF
disease
cimetidine (Tagamet)
*taken on an empty stomach
*administered 1 hour apart from antacids
*crosses the blood-brain barrier & may cause
mental confusion, agitation, anxiety &
disorientation
*dosages of these meds are reduced when
taken together:
warfarin Na, phenytoin, theophyllin &
lidocaine
ranitidine (Zantac)
*not affected by food
*S/E are uncommon & does not cross blood-
brain barrier