Pharmacology MDA 224 PHARMACOLOGY; Drug Action, Uses and Caution 2020

) Calcium Channel Blockers Action: "a very nice drug" blocks calcium access to the cells, causing: amlodipine (Norvasc) dec heart contractility verapamil (Calan Isoptin) dec conductivity of the heart nifedipine (Procardia) dec demand for oxygen diltiazem (Cardizem) 4) Alpha Blockers Action: end in -azosin stimulate central alpha-receptors, which dec sympathetic outflow from the CNS doxazosin (Cardura) causing a dec in peripheral vascular resistance + a slight dec in cardiac output prazosin (Minipress) 5) Angiotensin II Receptor Blockers (ARBs) Action: end in -tan blocks the action, but not the production, of angiotensin II losartan (Cozcar) blocks the access of angiotensin II to receptors in the olmesartan (Benicar) heart, blood vessels + adrenals, causing vasodilation valsartan (Diovan) 6) NITROGLYCERIN Action: "helps widen heart vessels" nitrate vasodilator relaxes vascular (arterial + venous) system with more quick onset, 2-5 min: IV, SL, translingual spray prominent effects on veins, which dec preload slow onset, 10-30 min: nitro-bid (patch), ointments, sustined-release capsulesarteriolar relaxation reduces systemic vascular resistance, which dec afterload these actions dec cardiac oxygen demand routes: IV, PO, SL, transdermal 7) ANTIDYSRHYTHMICS Action: Sodium Channel Blockers block sodium, slowing the impulse in the atria, ventricles, and nodal + Purkinje systems WATCH FOR: diarrhea, cinchonism, cardiotoxicity, arterial embolism ex: lidocaine, quinidine, procainamide Beta-Blockers reduce calcium entry and automaticity in the sino-atrial (SA) node slow conduction velocity in the atrioventricular (AV) node reduce contractility in the atria + ventricles WATCH FOR: hypotension, bradycardia, AV block, bronchospasm ex: propanolol (Inderal) Potassium Channel Blockers delay repolarization of fast potentials prolong action potential duration and effective refractory period WATCH FOR: pulm toxicity, visual impairment, AV block + GI upset ex: amiodarone (Cordarone) Calcium Channel Blockers reduce the automaticity in the SA node delay conduction through the AV node delay reduction of myocardial contractility WATCH FOR: bradycardia, AV block, hypotension + constipation ex: verapamil, diltiazem Adenosine + Digoxin decrease conduction through the AV node reduce automaticity of the SA node WATCH FOR: bradycardia, dyspnea, facial flushing, chest discomfort digoxin may cause cardiotoxicity 8) Digitalis, Digoxin Action: "has the power to control cardiac output + affects the mechanical and electrical actions of the heart, which inc myocardial ventricular response in atrial fib" contractility and cardiac output alters the electrical activity in non-contractile tissue and ventricular muscle (ex: automaticity, refractoriness, impulse conduction) inhibits Na-K ATPase is classified as a cardiac glycoside 9) Statins (HMG-CoA Reductase Inhibitors) Action: end in -statin anti-hyper-lipidemics atorvastatin (Lipitor) lower cholesterol levels by inhibiting the formation of HMG-CoA reductase, simvastatin (Zocor) which is an enzyme that is required for the liver to produce/synthesize cholesterol rosuvastatin (Crestor) effective in dec LDL + inc HDL levels pravastatin (Pravachol) lovastatin (Mecavor) 10) Lidocaine Toxicity: "SAMS" Pathophysiology: Slurred/difficult speech Lidocaine is rapidly metabolized by the liver Altered CNS why is it given IV? Muscle twitching if administered orally, the dose would be inactivated on the first pass through the liver Seizures plasma drug levels are easily controlled its therapeutic range is 1.5 to 5.0 mcg/ml in higher doses + at toxic levels, the CNS and resp systems will be affected 11) Drugs for Bradycardia + dec BP: "IDEA" Isoproterenol (Isuprel) Dopamine Isoproterenol Classification: Classification: Dopamine sympathomimetic, catecholamine sympathomimetic, catecholamine Epinephrine Atropine Action: Action: inc heart rate + cardiac output low dose: causes renal dilation causes bronchodilation moderate dose: INCREASES: cardiac contractility, stroke volume + cardiac output high dose: INCREASES: peripheral vascular resistance, BP + renal vasoconstriction Adverse Effects: Adverse Effects: tachycardia + angina tachycardia can cause hyperglycemia in pts with diabetes dysrhythmias vasoconstriction leading to tissue necrosis with extravasation anginal pain CNS 1) ANTIEPILEPTIC DRUGS Action: "anti-seizure meds" suppresses discharge of neurons within a seizure focus area + decreases the management of tonic-clonic + partial seizure activity spread of seizure activity to other areas of the brain carbamazepine (Tegretol) PO phenytoin (Dilantin) PO, IV valproic acid (Depakote) PO, IV 2) Promethazine (Phenergan) Action: blocks histamine receptors in the neuronal pathway, leading from the vestibular class: anti-emetic, anti-histamine apparatus of the inner ear to the vomiting center in the medulla routes: IV, PO, IM, PR 3) Midazolam (Versed) Action: "Moments not remembered" produces unconsciousness and amnesia the pt can hear + respond to simple commands but will not remember other benzodiazepines (all are sedatives) "CCLAD" chlordiazepoxide (Librium) - anxiety, alcohol withdrawal, tremors clonazepam (Klonopin) - anxiety, panic disorder + seizures lorazepam (Ativan) - anxiety + seizures alprazolam (Xanax) - anxiety + panic disorder diazepam (Valium) - anxiety, alcohol withdrawal, muscle spasms + seizures 4) Non-Benzodiazepines (to help you catch some "z's" lol) Action: zolpidem (Ambien) potentiate actions of inhibitory neurotransmitters throughout the CNS zaleplon (Sonata) depress neuron function in the CNS by enhancing the action of an inhibitor eszopiclone (Lunesta) of neurotransmission (gamma-aminobutyric acid [GAMA]) acts as agonist at the benzodiazepine receptor site 5) Ondansetron (Zofran) Action: granisetron (Granisol) prevents nausea + vomiting by blocking type 3 serotonin receptors (5-HT receptors) dolasetron (Anzemet) located in the chemoreceptor trigger zone (CTZ) and on afferent vagal neurons in palonosetron (Aloxi) the upper GI tract does not cause extrapyramidal effects (ex: akathisia, acute dystonia), as seen with class: antiemetic (serotonin receptor antagonist) phenothiazide antiemetics DIURETICS 1) Loop + Thiazide diuretics Action: LOOP diuretics: LOOP diuretics: inhibit Na + chloride reabsorption through direct action primarily in the bumetanide ascending loop of Henle but also in the proximal + distal tubules furosemide (Lasix) torsemide THIAZIDE diuretics: act primarily on the distal tubules, inhibiting Na + chloride reabsorption THIAZIDE diuretics: hydrochlorothiazide (HydroDiuril) routes: PO, IV, IM 2) Spironolactone (Aldactone) Action: remember, too little or too much K+ will cause weakness has a direct effect on the distal tubules in the kidney in muscles, including the heart competes with aldosterone for cell-receptor sites in the distal tubules while inducing urinary excretion of Na and reducing excretion of K+ and hydrogen ions "PASTE" blocks the aldosterone in the kidney potassium-sparing diuretics: amiloride basically, it saves potassium and gets rid of sodium + water spironolactone triamterene eplerenone class: potassium-sparing diuretic ENDOCRINE 1) Types of Insulin Short Duration: Rapid Acting Onset (min) goal: to prevent hypoglycemia Insulin lispro (Humalog) 15-30 know the onset, peak + duration of insulins! Insuling aspart (NovoLog) 10-20.0 Insulin glulisine (Apidra) 10-15.0 Short Duration: Slow Acting Regular insulin (Humulin R, Novolin R) 30-60 Intermediate Duration NPH insulin (Humulin N, Novolin N) 60-120 Insulin detemir (Levemir) 6-8.0 Long Duration Insulin glargine (Lantus) 70 2) Sulfonylureas Action: 1st Generation: "helps beta cells produce insulin with a little bit of stimulus" chlorpropamide (Diabinese) stimulates the beta cells of the pancreas to inc the release of insulin tolazamide (Tolinase) inc the sensitivity of peripheral insulin receptors, which inc insulin binding tolbutamide (Orinase) in the peripheral tissues second-generation meds act the same but are stronger 2nd Generation: glipizide (Glucotrol) glimepiride (Amaryl) glyburide (DiaBeta) 3) Metformin (Glucophage) Action: inhibits/slows down glucose production in the liver class: oral hypoglycemic reduces/blocks glucose absorption in the intestines sensitizes insulin receptors at sites in fat + skeletal muscle Metformin helps the muscles use the sugar more efficiently 4) Corticosteroids Action: the #1 antiinflammatory corticosteroids end in "ONE" suppresses the inflammatory+immune systems by inhibiting synthesis of chemical mediators: prednisone prostaglandins, leukotrienes + histamine cortisone dec inflammation, which then reduces swelling, warmth, redness, and pain dexamethasone class: adrenocorticosteroid, glucocorticoid 5) Levothyroxine (Synthroid) Action: increases basal metabolic rate class: thyroid hormone, synthetic preparation of thyroxine (T4) enhances gluconeogenesis stimulates protein synthesis GASTROINTESTINAL 1) H2 Blockers Action: end in "dine", so think of food -- GI meds histamine H2-antagonists inhibit histamine action on H2-receptors, ranitidine (Zantac) which are found on the gastric parietal cells famotidine (Pepcid) this action reduces the secretion of gastric acid, as well as hydrogen ion concentration cimetidine (Tagamet) 2) Psyllium (Metamucil) Action: mixes with food + water acts similar to dietary fiber this bulk fiber gathers poop, forms it + moves it out this med is not digested or absorbed after ingestion, it will form a viscous solution/gel to soften the fecal mass + inc the bulk class: bulk-forming laxative a fecal mass stretches the intestinal wall to stimulate peristalsis + passage of a soft-formed stool in 1-3 days