EKU NSC 330 - pharm week 2 (14 pages)

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pharm week 2



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pharm week 2

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Pages:
14
School:
Eastern Kentucky University
Course:
Nsc 330 - Clinical Drug Therapy
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Drugs Affecting Adrenergic Function Autonomic Nervous System Involuntary system responsible for control of smooth muscles Bronchi Blood vessels GI tract Cardiac muscles Exocrine gastric sweat and salivary SNS and PSNS Effects on the Body Medication function Pharmacological drugs work on the receptors by either Increase Agonist Decrease Antagonists anti Neurotransmitters of ANS Acetylcholine Dopamine Norepinephrine Epinephrine Adrenergic Agonists Fight or Flight System These drugs mimic the action of the sympathetic nervous system 2 groups Catecholamine o Short duration action o Cannot be given orally o They do not cross the blood brain barrier Non catecholamine Classified according to their selectivity Nonselective acting Selective acting Adrenergic Receptors Alpha 1 Alpha 2 Beta 1 Beta 2 Adrenergic Receptors Alpha 1 Arteries Veins Bladder Eyes Male Sex Organs Alpha 2 Inhibits Norepinephrine Release Adrenergic Receptors Beta 1 Heart Kidney Beta 2 Bronchi Skeletal Muscle Arterioles Uterus Dopamine Kidneys Non Selective Prototype Epinephrine Pharmacotherapeutics Wide variety of indications asthma shock anaphylactic reaction ventricular fibrillation Pharmacokinetics Adminstered parenterally topically or by inhalation Metabolized in the liver and excreted through the kidneys Pharmacodynamics It stimulates all adrenergic receptors except dopaminergic and causes the greatest adverse effects in the cardiovascular system and CNS Epinephrine Contraindications and precautions Absolute contraindications to epinephrine include hypersensitivity sulfite sensitivity closed angle glaucoma and its use during labor Adverse effects hypertensive crisis angina cerebral hemorrhage cardiac arrhythmias elevated serum glucose J Drug interactions Beta blockers Selective adrenergic agonists Nonselective acting Activate both alpha and beta receptors Selective acting Alpha 1 Arteries veins bladder eyes Male sex organ Alpha 2 Inhibits norepinephrine release Beta 1 Heart Kidney Beta 2 Arterioles Bronchi liver skeletal muscles Uterus Dopamine 1 Dopamine 2 Epinephrine Maximizing therapeutic effects Minimizing adverse effects Requires close monitoring of vital signs and careful monitoring for adverse effects Take as prescribed When treating anaphylactic shock monitor blood pressure Assisting the patient with menu planning may help to promote appetite and counteract the anorectic influence of epinephrine Alpha 1 Adrenergic Agonist Prototype Phenylephrine Allerest Sudafed PE Neo Synephrine Preparation H Remember where Alpha 1 receptors are located Phenylephrine Pharmacotherapeutics Used parenterally for vascular failure in shock Used topically and orally to shrink tissues for relief of nasal mucosal congestion hemorrhoids Pharmacokinetics Administered parenterally or topically because of poor absorption from GI tract Metabolized by liver Excreted in urine Phenylephrine Pharmacodynamics A powerful alpha 1 adrenergic agonist Very little activity on beta receptors Vasoconstrictor Predominant actions are in vascular system Phenylephrine Contraindications Hypersensitivity severe hypertension ventricular tachycardia closed angle glaucoma sulfite sensitivity Use Cautiously with Hyperthyroidism pregnancy asthma myocardial disease arteriosclerosis diabetes asthma Phenylephrine Adverse Effects Headache Restlessness Excitability Reflex bradycardia following increase in B P Rebound congestion Drug interactions Antihypertensive Meds Antidepressants MAOI Tricyclic Oxytocics Phenylephrine Maximizing Therapeutic Effects Minimizing Adverse Effects Correct blood loss fluid deficits Proper technique for administration Use as prescribed Phenylephrine Minimizing Adverse Effects Maximizing Adverse Effects Administer through large vein Frequent IV site assessment Avoid driving at night Good sleep hygiene Watch for drug drug interactions Safety Watch for rebound congestion Alpha 2 Agonist Prototype clonidine catapres Remember alpha 2 receptors Clonidine Pharmacotherapeutics Antihypertensive Symptoms of withdrawal ADHD Pain Pharmacokinetics Administered parenterally topically or orally Clonidine Pharmocodynamics Inhibits release of norepinephrine opposite effect vasodilation Clonidine Contraindications and precautions Coronary insufficiency Recent MI Recent CVA Adverse effects dry mouth sedation dizziness constipation Clonidine Maximizing Therapeutic Effects Minimizing Adverse Effects Monitor B P Safety Client education Avoid abrupt discontinuation Beta Adrenergic Agonists Beta adrenergic agonists Stimulates beta receptors Selective versus non selective Mimic action of the SNS Terms you should know Inotropic strength of contraction Chronotropic increased heart rate Beta Adrenergic Agonists Prototype Dopamine Intropin Stimulation of beta 1 receptors Increased HR Increased force of contraction Increased cardiac output Dopamine Pharmacotherapeutics Used to correct the hemodynamic imbalances present in shock Also used at low dose to improve renal function Pharmacokinetics IV only Onset 5 minutes Duration 10 minutes Metabolized Liver kidneys plasma Excreted in the urine Pharmacodynamics Has the capability to stimulate all adrenergic receptors Strong beta 1 stimulation Dopamine Contraindications and precautions Uncorrected tachyarrhythmias Ventricular fibrillation Adverse effects Ectopic beats dyspnea nausea and vomiting headache tachycardia hypotension angina vasoconstriction palpitation Dopamine Maximizing Therapeutic Effects Minimizing Adverse Effects Administer IV dopamine via infusion pump Start at low doses Monitor B P UOP CO PWP Monitor IV insertion site Monitor peripheral tissue perfusion When stopping gradually decrease dose Dobutamine Dobutrex Similar to Dopamine BUT Does not raise HR It does help with contraction and raises peripheral resistance Now the antagonists Drug Therapy for Hypertension Regulation of Blood Pressure Classification of Hypertension Lifestyle Modification and Hypertension Diet DASH Low Na limited alcohol intake Regular exercise Smoking cessation Weight reduction Alpha Adrenergic Antagonists Block the stimulation of alpha receptors Vasculature Prostate Prototype drug prazosin Minipress Prazosin Pharmacotherapeutics Used to treat congestive heart failure Raynaud syndrome and prostatic outflow obstruction such as BPH Pharmacokinetics Administered oral Metabolized in Liver Excreted in bile feces urine Pharmacodynamics Blocks alpha 1 adrenergic receptors decreased BP decreased prostate swelling Prazosin


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