Pharm Ch 16, 17, 18, 19

What does COPD stand for?

Chronic obstructive pulmonary disease

Never increase oxygen input for a patient without an order, because...

it may cause hypoxia to stimulate the breathing, which will stop!!! Requires a physician's order.

Within the mast cells are beta2 receptors. When they are stimulated by certain sympathomimetic agents...

there is an increase in heart rate, uterus relaxation, vasoconstriction, and bronchodilation.

Beta1 is the...?

Heart

Beta2 are the...?

Lungs

Patients on sympathomimetics should not use MAO inhibitors, because?

MAOIs do not ever combine with other drugs, in order to avoid catastrophic toxicity

What are the four smooth muscles that are connected in the body?

Heart, lungs, blood vessels, and uterus

What are two common Xanthine Bronchodilators?

Aminophylline and Theophylline

This chemical class of agents include caffeine, theophylline, and their derivatives (e.g. coffee and tea)?

Xanthine Bronchodilators

Xanthines have been found to produce?

Diuresis (increased urine)

With Xanthine Bronchodilators, it is important to monitor this every four hours?

Patient's heart rate and rhythmn

Xanthines have been found to stimulate the?

CNS (Central Nervous System)... thus, patient should be monitored for insomnia (disturbs REM sleep), hyperexcitability, and the potential for seizure activity

What is dyspnea?

Shortness of breath

When administering neuroleptic or antipsychotic agents, every 30 days the patient must be monitored for?

AbnormalInvoluntaryMovementScreening

These agents have become one of the most popular and effective agents in combating manifestations of Asthma?

Leukotriene Receptor Antagonists

What contributes to airway edema, smooth muscle constriction, and altered cellular activity?

Leukotrienes

Antagonists to leukotrines...

decrease bronchial edema and inflammation

What are the side effects of leukotriene receptor antagonists?

Occasional headaches, drowsiness, fatigue, and gastrointestinal disturbances

What is important to know about 5-lipoxygenase inhibitors?

They inhibit the formation of leukotrienes

Anticholinergics: Upon inhalation, anticholinergic drugs such as "atropine" and "Atrovent", antagonize the action of what?

Acetycholine, thus resulting in bronchodilation

What is the antagonist drug for magnesium?

Calcium gluconate

What do mucolytics do?

They reduce the thickness and the stickiness of pulmonary secretions, so that removal by cough is facilitated & pulmonary ventilation improved

A common mucolytic agent?

acetylcysteine (Mucomyst)

Mucolytics are usually administered how?

By nebulization

Considering that acetylcysteine is capable of reacting with copper and rubber, what should be taken in precaution?

Nebulization equipment should be plastic, glass, aluminum, or stainless steel parts

Mucolytics should not be used with patients who...?

Have a cough associated with asthma, emphysema, or smoking; contraindicated for the treatment of coughs with excess secretions

What is status asthmaticus?

Severe, continuous asthma attack that may result in exhaustion

Corticosteriods are also used in the treatment of bronchial asthma, and are administered how?

Systemically or in an aerosol form; they are rarely ever used long term

The CNS breaks down into what two systems?

Peripherial and somatic

The autonomic system contains what?

The sympathetic and parasympathetic system

Drugs that stimulate norepinephrine are?

Adrenergic

Cholinergics are drugs that stimulate?

Acetycholine

The sympathetic nervous system does what?

Accelerates heart rateDilates bronchiolesVasoconstriction (BP goes up)Uterus muscles relax

The parasympathetic nervous system does what?

Brings everything back to normal, i.e. "homeostasis

What are the signs of respiratory distress?

Pallor, cyanosis, labored breathing

Sinus rhythms are generated by?

The SA node

The nodal rhythms are generated by?

AV node

The right side of the heart produces what if blocked?

Full body edema

The left side of the heart, if blocked, will have what affect on the body?

Pulmonary failure

The heart rate is primarily controlled by what?

ANS

What is the inotropic effect on cardiac action?

Affects the force/power of myocardial contraction

What is the chronotropic effect of cardiac action?

Rate of heart

What is the dromotropic effect of cardiac action?

The conductivity of the heart

What is the most common cardiac glycosides?

Digoxin

Cardiac glycosides are primarily used for the treatment of what?

Heart failure

Heart failure is often characterized by what?

Cardiac distentionCardiac "hypertrophy" Sodium and water retention

What is cardiac hypertrophy?

The muscle of the heart gets thicker, the chambers get smaller, resulting in congestive heart failure

What is the herbal supplement similar to cardiac glycosides?

Purple foxglove

What kind of dosing is used for cardiac glycosides when trying to rapidly bring serum levels up to a desirable therapeutic level?

A loading, or "digitalizing" dose

What is important to remember about Digoxin?

Taking with meals may decrease gastric irritationCheck apical pulse (do not administer less than 60 beats/min)Report any irregular rhythmObserve for symptoms of toxicity

What is the therapeutic blood level of Digoxin?

0.5 - 2 mg/mL

What are symptoms of toxicity from Digoxin?

Headaches, visual disturbances, nausea, vomiting, anorexia, or disorientation

What kind of therapeutic index do cardiac glycosides have?

A low therapeutic level; i.e. the therapeutic dose is very close to the toxic dose, requiring close patient monitoring

Cardiac glycoside toxicity effects include:

Gastrointestinal distress (nausea, vomiting, anorexia, diarrhea)Neurological effects (restlessness, irritability, headache, weakness, lethargy, drowsiness, and confusion)Cardiac effects (development of a cardiac dysrhythmia)

Assess a patient's apical pulse for one minute before administering?

Antiarrhythmic/Antidysrhythmic Agents

What is a dysrhythmia?

Rhythm disturbance

Although principally heart rhythm is controlled by the heart's pacemaker, the SA node...

spontaneous electrical discharge or "automaticity" may occur under certain conditions

Phenytoin (Dilantin) is used as...

An anticonvulsion and antiarrhythmic drug; should only be administered IV for arrhythmias

Beta-Adrenergic Blocking Agents treat?

Hypertension, and blocks sympathetic (adrenergic) stimulation, producing a reduction in heart rate, reduces the contractility, and slows electrical conduction in the heart

There is only how long of a window after a stroke occurs?

Eight hours!

What is the primary calcium channel blocker?

Verapamil HCl

Calcium channel antagonists reduce?

Influx of calcium into the cell, resulting in relaxation of cascular smooth muscle and lowered blood pressure

Adenosine leaves the body how fast?

In five seconds! It has a short half-life.

Adenosine is one of the most effective cardioversion drugs for use in terminating?

PSVT (paroxysmal supraventricular tachycarida)

Adrenergic (sympathomimetic) drugs are agents that mimic the action of what?

Norepinephrine

Glycogenolysis is what?

The breakdown of what is stored in the liver into glucose, raising the blood level)

Coronary vasoconstriction lead to?

Ischemic (lack of blood flow) leading to hypoxia (inadequate tissue oxygentation), leading to pain

Substernal pain or sense of constriction often radiating in neck or arms; produced by insufficient blood supply to the myocardium to mmet its oxygen demands at the time of pain?

Angina pectoris

What is often used in the symptomatic relief of angina?

Nitroglycerin

It is a sublingual tablet, dilates coronary arteries, does not mix with other drugs, may have an occurence of a headache associated with it, and must remain by the patient's bedside by law?

Nitroglycerin

A supply of nitroglycerin must be replenished how often?

Every 3 months

If relief of angina by Nitroglycerin is not observed after five minutes with the use of one tablet, what do you do next?

A second tablet may be taken, wait five minutes; if pain persists, take a third tablet, wait five minutes... After third tablet, if angina still remains, contact health care provider or 911 immediately!

Vasodilation from Nitroglycerin may cause what sort of effects?

Burning and stinging, which is normal

Nitroglycerin is only administered when?

As soon as the onset of pain is felt, not before

Nitroglycerin is contraindicated in patients with?

Head trauma, cerebral hemorrhage, hypertension, or glaucoma

Anorexia means?

Loss of appetite

Syncope means?

Fainting

Beta-adrenergic blocking agents may treat?

Angina pectoris

Amyl nitrate is administered by what route?

Inhalation (e.g. fainting)

Acute myocardial infarctions (AMIs) occur when?

An area of the heart muscle dies as a result of insufficient oxygen

The goal of care for the patient with an AMI?

To limit damage to the myocardium to preserve enough myocardial function to sustain life by preventing and treating cardiogenic shock

Cardiogenic means?

Heart malfunction

The four smooth muscles need calcium to contract; thus these agents cause?

Blood vessels to dilate, and BP goes down

Three major ways to treat blood pressure?

Beta blockersAngiotensin-converting enzyme (ACE)Calcium channel blockers

Beta blockers what?

Reduce the heart's oxygen demand by decreasing heart rate

Angiotensin-converting enzyme (ACE) what?

ACE inhibitors help reduce the risk for death or development of congestive heart failure following a AMI

Diuretics are used when?

For simple blood pressure issues, such as sodium retention

Peripheral vasodilators may act by affecting?

The sympathetic nervous system or by a direct action on the vascular smooth music

Minoxidil, when administered orally, is used for?

Blood pressure

Minoxidil, when applied topically on the head, is used for?

Regrowing hair (Rogaine)

Kidneys produce?

Renin

What is peripheral circulation?

Heart and major blood vessels

These agents inhibit the action or formation of one or more clotting factors; none, however, are capable of exerting a fibrinolytic effect on existing clots...?

Anticoagulants

An agent found in mast cells located throughout the body; a potent inhibitor of the clotting process?

Heparin

Heparin potentiates the inhibitory activity of?

antithrombin III on coagulation factors

This is a physical finding, you must find the underlying cause?

Anemia

Heparin indirectly interferes with?

The conversion of prothrombin to thrombin; which prevents conversion of fibrinogen to fibrin; thus inhibiting clot formation

Heparin can only be administered how?

Subcutaneously, Intraveneously, and continuous IV infusion

What is a hematoma?

Mass of blood outside of a blood vessel, ususally following a hemorrhage

Heparin must be used with caution with diseases where there is an increased risk of?

Hemorrhage (such as hypertension, hemophilia, petic ulcer, ulcerative colitis, dissecting aneurysm, and threatened abortion) as well as those patients undergoing major surgery or using other drugs that may induce bleeding

What is hemophilia?

Bleeding disorders where it takes blood a long time to clot

What is dissecting aneurysm?

Localized dilation of an artery (an aneurysm) in which the wall of the artery rips (dissects) longitudinally

What is an ulcerative colitis?

Type of inflammatory bowel disease (IBD) that affects the colon and rectum

Overdosage of heparin can be treated with what antagonist?

(slow infusion of 1%) protamine sulfate

What is a low molecular weight heparin anticoagulant drug related to heparin that is only used SC?

Enoxaparin

These agents inhibit blood clotting by interfering with the synthesis of vitamin K-dependent clotting factors in the liver?

Oral Anticoagulants

What happens if the body is deficient in Vitamin K?

Depression of blood clotting mechanisms in the body is observed

What is the antagonist drug for cumadin?

Vitamin K

What food produce Vitamin K?

Deep, dark green leafy vegetables

What tests are performed for Heparin?

PT/PTT

What tests are performed for sodium warfarin?

PT/INR

What forms a clot?

Platelets in the blood sticking together

What agents are used to inhibit the aggregation (or sticking together) of platelets?

Antiplatelet agents

Antiplatelet agents are primarily used for what?

Patients who have experienced CVAs or myocardial infarctions

What are common antiplatelet drugs?

Aspirin, dipyridamole, and sulfinpyrazone

What agents act to convert the substance known as plaminogen to the enzyme fibrinolysin, which dissolves fibrin clots, as well as other plasma proteins?

Thrombolytic agents

What are the two thrombolytic enzymes currently available?

urokinase and streptokinase

What is another term for a Cerebrovascular Accident (CVA)?

Stroke

What agent is one that improves blood flow by decreasing blood viscosity?

Hemorheologic agents

These agents are useful in the treatment of an occlusion of the arteries of the limbs?

Hemorheologic agents

These agents stop the flow of blood in excessive bleeding (e.g. in surgery)?

Hemostatic agents

What does "eccyhmotic" mean?

Bruising

After administering a heparin dose, what should you NOT do?

Massage or rub the site

What are indications of internal bleeding while a patient is on anticoagulants?

Headache, tarry stools, and changes in neurological status

When a patient is taking anticoagulants, what should they avoid?

Aspirin and aspirin-containing products, situations that could lead to trauma, drastic changes in diet, laxatives, and mineral oil

For a patient taking anticoagulants, what would be a smart thing for them to carry or wear?

A MedicAlert tag

Nitroglycerin may have what effect on heparin?

Decrease heparin's effect

A thrombosis is fixed, while an embolus is?

Free floating in the circulatory system