Amphetamines (anorexiant)
PROTOTYPE: Dexedrine (dextramphetamine) USE: to treat narcolepsy SE: increased B/P, arrhythmia, nervousness, sweating, paranoia, restlessness, impotence, insomnia & death w/ excessive dose
Respiratory stimulants (analeptics)
PROTOTYPE: Doxapram (dopram) USES: stimulate breathing ACTION: medulla - increase peripheral carotid chemoreceptors which regulate respirations by sensing CO2 SE: HTN, arrhythmia
Analgesic Agonist (opioids)
PROTOTYPE: Morphine Sulfate ACTION: binds to opiate receptor sites in CNS & alters response to & perception of pain. PRODUCES CNS DEPRESSION EFFECTS: Analgesia, feeling of well-being, euphoria ADVERSE EFFECTS: Respiratory depression, tolerance & addiction
Narcotic Antagonist
PROTOTYPE: Narcan (naloxone hydrochloride) USE: after surgery to reverse effects of anesthesia & on overdoses of narcotics **
IS KEPT ON THE EMERGENCY CART
** Can be given IM, IV, SC
Anxiolytic/Antianxiety Drugs - Benzodiazepines
PROTOTYPE: Valium (diazepam) USES: Produce sedation in pts who are restless, nervous, irritable, or overreacting to stimuli, prevents feelings of tension or fear *
Must inject into large vein.
* DO NOT MIX with another medication or IV fluid. SE/ADVERSE E
Hypnotics - Benzodiazepines
PROTOTYPE: Valium (diazepam) USES: helps pts fall asleep by sedation ***CAUTIONS: allergy to medication, alcohol intoxication, elderly, presence of renal failure
Hypnotics - Barbiturates
PROTOTYPE: Phenobarbital (Luminal) ***CONTRAINDICATIONS/CAUTIONS: High addiction rate, respiratory depression, pregnancy NURSING INDICATIONS: Monitor respirations, monitor sedation, LOC
Other Anxiolytic & Hypnotic Drugs
Buspirone (BuSpar) ADVANTAGES: No sedative effect, no anticonvulsant properties, no muscle relaxant properties
Antidepressant Drugs
CLASSIFIED INTO 3 GROUPS: **Tricyclics, Monamine Oxidase Inhibitors (MAOs), Selective Serotonin Reuptake Inhibitors (SSRIs), AND Atypical antidepressants which don't fall into the other 3 groups
Antidepressant - Tricyclics
PROTOTYPE: Tofranil (imipramine) USES: to elevate mood & alleviate symptoms assoc. w/ depression ACTION: inhibits reuptake of the neurotransmitters NE (norepinephrine) and 5HT (serotonin) SE: Teratogenic -DO NOT USE IN PREGNANCY, orthostatic hypotension,
Antidepressant - Monamine Oxidase Inhibitors (MAOs)
PROTOTYPE: Nardil (phenelzine) USES: recommended when tricyclics or SSRIs are not tolerated ***CAUTION: These drugs require a lot of attention. DO NOT TAKE W/ OTHER ANTIDEPRESSANTS OR OTC DRUGS. The pt must not take over-the-counter drugs that can raise B
Antidepressant - Selective Serotonin Reuptake Inhibitors (SSRIs)
PROTOTYPE: Prozac (fluoxetine) INDICATIONS: Tx of depression, OCDs, bulimia, PMDD, pain d/os; unlabeled uses include chronic pain, alcoholism, neuropathies, obesity ACTION: blocks the reuptake of serotonin (5HT) w/ little known effect on norepinephrine AD
Atypical Antidepressants
ACTION: varying effects on reuptake of dopamine, serotonin and norepinephrine. Desyrel (trazodone), Wellbutrin (bupropion) - at low doses effective in smoking cessation, Effexor (venlafaxine)
Antipsychotics/Neuroleptic Drugs
PROTOTYPE: Thorazine USES: Treat disorders that involve thought processes - schizophrenia, hyperactivity, combative behavior ADVERSE EFFECTS: Extra-pyramidal syndrome (pseudoparkinsonism), dystonia, akathisia (inability to sit still, restlessness & agitat
Antimanic Drugs
PROTOTYPE: Lithium USE: Treatment of manic episodes of bi-polar disorder ACTION: Inhibits the release of norepinephrine & dopamine but NOT SEROTONIN. Increases stores of norepinephrine & dopamine slightly. Alters sodium transport in nerve & muscle cells.
Anticonvulsants
PROTOTYPE: Dilantin (phenytoin) USES: treat seizures & bi-polar disorder GOAL: Stabilize the cell membrane excitability in the brain, depressing cortical activity SE: GI upset, drowsiness, hypotension, confusion, fatigue CAUTION: Blood levels must be moni
Antiparkinsonism Drugs
TWO TYPES: Dopaminergics and Anticholinergics
Antiparkinsonism - Dopaminergics
PROTOTYPE: Levodopa ADVERSE EFFECTS: N/V, increased abnormal movements
Antiparkinsonism - Anticholinergis
PROTOTYPE: Biperiden (Akineton) ADVERSE EFFECTS: Mental confusion, agitation and hallucinations
Anesthetic Drugs - Local
PROTOTYPE: Lidocaine (Xylocaine) USE: for topical anesthesia or regional anesthesia & as an antirrhythemic drug *
FOUND ON THE EMERGENCY CART
* ACTION: causes a temporary interruption in the production and conduction of nerve impulses ADVERSE EFFECTS: HA,
Anesthetic Drugs - General (Barbiturates)
PROTOTYPE: Thiopental (Pentothal) INDICATIONS: Induction of anesthesia, maintenance of anesthesia; induction of a hypnotic state ACTIONS: Depresses the CNS to produce hypnosis and anesthesia without analgesia. Administered IV bolus. Rapid onset, ultrashor
Anesthetic Drugs - General (Inhalation agents)
PROTOTYPE: Halothane (fluothane) Nonexplosive, nonflammable liquid used in conjunction with nitrous oxide and muscle relaxants INDICATIONS: induction & maintenance of general anesthesia ACTIONS: depresses the CNS causing anesthesia; relaxes muscles; sensi
Muscle relaxants
Used to suppress muscle tone & facilitate intubation. Relaxes vocal chords 1. Succinylcholine chloride (Anectine) parenteral 2. Tubocurarine chloride (tubarine) parenteral 3. Vecuronium (Norcuron) parenteral ADVERSE REACTIONS: Hypotension, arrhythmias, ca
Cardiovascular Drugs: 3 Types
Inotropic, Chronotropic and Dromotropic
Inotropic Drugs (also called cardiotonic agents)
Simplified mech of action - increase contractility of heart tissue, leads to increased cardiac output. Increased cardiac output leads to increased renal blood perfusion. Increased renal blood perf. leads to increased urine production which results in decr
Inotropic
process that influences the contractility of muscular tissue (can be positive or negative)
Chronotropic
process that influences the heart rate (can be positive or negative)
Dromotropic
process that influences the conduction velocity of nerve or muscle fibers (can be positive or negative)
2 classes of Inotropic Drugs
Cardiac Glycosides (best choice) AND Phosphodiesterase Inhibitors
Cardio Glycosides
PROTOTYPE: Digoxin (lanoxin) USE: CHF, tachycardia & associated arrhythmias ADVERSE EFFECTS: HA, N/V, yellow "halo" vision, blurred vision, fatigue NURSING IMPLICATIONS: Monitor apical pulse for 1 min before administering, if less than 60bpm, hold med for
Phosphodiesterase Inhibitors
PROTOTYPE: Inamrinone (Inocor) USE: Short term treatment of CHF that has not responded to digoxin, and other medications ADVERSE EFFECTS: N/V, hypotension, chest pain, arrhythmias NURSING IMPLICATIONS: Administered IV only; must be on telemetry; 1st dose
Antiarrhythmic Drugs
drugs that alter the action potential of the heart cells & interrupt arrhythmias. Long-term treatment of arrhythmias may actually cause cardiac death, so these drugs are now indicated only for the short-term treatment of potentially life-threatening ventr
Antiarrhythmic Drugs
Simplified mechanism of action - these drugs aid in assisting the heart to return to a normal rhythm, at the cellular level
Class 1 Antiarrythmics (sodium channel blockers)
PROTOTYPE: Lidocaine (xylocaine) ACTION: block sodium channels, depress "0" of the action potential, and generally prolong the action potential, leading to a slowing of conduction and automaticity USES: treatment of potentially life-threatening ventricula
Class II Antiarrythmics (beta adrenergic blockers)
PROTOTYPE: Inderal (propranolol) ACTION: are beta-adrenergic receptor blockers that prevent sympathetic stimulation USES: slow heart rate, decrease B/P, angina ADVERSE/SIDE EFFECTS: dreams, fatigue, hypotension, bradycardia, SOB, N/V, decreased libido NUR
Class III Antiarrythmics (potassium channel blockers) AND block phase 3 of the action potential
PROTOTYPE: Sotalol (betapace) USES: converting arrhythmias to normal rhythm; treatment of potentially life-threatening rhythms (is stronger than both Class I or Class II ADVERSE/SIDE EFFECTS: *****
Photosensitivity
******, hypotension, bradycardia NURSING
Class IV Antiarrhythmics (calcium channel blockers)
PROTOTYPE: Cardizem (diltiazem) ACTION: Shortens the action potential, disrupting ineffective rhythms and rates USES: slow heart rate, angina ADVERSE/SIDE EFFECTS: are related to their vasodilation of blood vessels throughout the body. CNS: dizziness, wea
Antianginal Drugs
goal is to restore the supply and demand ratio in oxygen delivery to the heart. Angina can be treated by drugs that either increase the supply of oxygen or decrease the heart's workload, which decreases the demand for oxygen
Nitrates
PROTOTYPE: Nitroglycerin (nitrostat) ACTION: Relaxes & dilates veins and arteries, allowing increased blood flow (which results in more O2 to heart). Dilation of the vessels also causes B/P to lower, which decreases the workload of the heart, so that the
Beta Blockers
PROTOTYPE: Metoprolol (Toprol) ACTION: block beta-adrenergic receptors and vasoconstriction (thereby stopping an increase in B/P) & prevent the increase in HR and increased intensity of myocardial contraction that occur w/ symp. stim. such as exertion or
Calcium channel blockers
PROTOTYPE: Cardizem (diltiazem) ACTION: block muscle contraction in smooth muscle & decrease the heart's workload, relax the spam in Prizmetal's angina & possibly block the proliferation of the damaged endothelium in coronary vessels ADVERSE EFFECTS: dizz
Diuretics
PROTOTYPE: Hydrochlorothiazide (HydroDIURIL) ACTION: decrease sodium levels & increases the excretion of water from the kidney. USE: for edema from CHF, pulmonary edema, liver dz ****
FIRST DRUG USUALLY TRIED (AFTER LIFESTYLE MODS) IN TREATING MILD HTN
**
Alpha1-Selective Adrenergic Blocking Agent
PROTOTYPE: Doxazosin (Cardura) ACTION: alter the symp. response & lead to vascular dilation & decreased pumping power of the heart USES: Tx of HTN & benign prostatic hypertrophy ADVERSE/SIDE EFFECTS: CNS (dizziness, weakness, fatigue, drowsiness & depress
Hypertension Drugs
(1) Diuretics (2) Sympathetic Nervous System Blockers (Alpha1-Selective Adrenergic Blocking Agents & Beta-Adrenergic Blocking Agents) (3) ACE Inhibitors) (4) Angiotensin II Receptor Blocker (ARBs), (5) Calcium Channel Blockers (6) Vasodilators
Beta-Adrenergic Blocking Agents
PROTOTYPE: Propranolol (Inderal) ACTIONS: competitively blocks beta-adrenergic receptors in the heart and juxtaglomerular apparatus; reduces vascular tone in the CNS ADVERSE/SIDE EFFECTS: CNS (fatigue, dizziness, depression, paresthesias, sleep disturbanc
ACE Inhibitors
PROTOTYPE: Captopril (capoten) ACTION: prevent the conversion of angiotensin I to angiotensin II in the lungs USES: CHF, HTN ******************SIDE EFFECTS: A dry, hacking cough is COMMON. Hyperkalemia, renal tubular damage, decreased B/P, dizziness, naus
Angiotension II Receptor Blockers (ARBs)
PROTOTYPE: Losartan (Cozaar) ACTION: prevent the body from responding to angiotensin II. ARBs selectively bind the angiotensin II receptors in blood vessels to prevent vasoconstriction and in the adrenal cortex to prevent the release of aldosterone that i
Calcium Channel Blockers
ACTION: Interfere w/ the ability of muscles to contract and lead to vasodilation. See "Antiarrhythmic Drugs
Vasodilators (fyi - no test questions on this)
PROTOTYPE: Nitroprusside USE: for severe HTN Used in emergency situations; only administered IV
Anticoagulants
PROTOTYPE: Heparin (generic) administered IV or SQ, Warfarin (Coumadin) administered PO ACTION: works on clotting cascade. Heparin: enhances actions of anti-thrombin III. Coumadin: depresses liver synthesis of clotting factors - II, VII, IX, X USES: preve
Antidote for Warfarin (coumadin)
Injectable vitam K
Antidote for Heparin (generic)
protamine sulfate (generic)
Low-Molecular Weight Heparins
PROTOTYPE: enoxaparin (Lovenox) ACTION: inhibit thrombus & clot formation by blocking factors Xa and IIa. USES: Prevention of clots & emboli after certain surgeries or prolonged bedrest. *****
Because of the size and nature of their molecules, these drugs
Antiplatelets
PROTOTYPE: Aspirin (generic) and Plavix (clopidogrel) USES: decreases the incidence of TIA and strokes and decreases the risk of nonfatal heart attacks in pts w/ hx of MI or angina ADVERSE/SIDE EFFECTS: bleeding, increased bruising, HA, dizziness, weaknes
Thrombolytic Agents
PROTOTYPE: streptokinase (Streptase, Kabikinase) ACTION: breaks down or lyses pre-formed clots in the blood vessel that supplies the coronary arteries. Breaks down fibrin. USES: vein thrombosis, PE, coronary artery thrombosis (Acute MI) ADVERSE/SIDE EFFEC
Upper Respiratory Tract Conditions
(1) common cold; (2) seasonal rhinitis; (3) sinusitis; (4) pharyngitis and laryngitis
Lower Respiratory Tract Conditions
(1) atelectasis; (2) pneumonia [bacterial, viral & aspiration]; (3) bronchitis [acute and chronic]; (4) bronchiectasis; and (5) the obstructive disorders [asthma, COPD, cystic fibrosis, and respiratory distress syndrome (RDS)]
Opioid antitussives (Rx opioid analgesic)
PROTOTYPE: codeine (generic only) and hydrocodone (Hycodan) USES: suppresses cough ACTION: acts on cough center in medulla, slows the GI tract SIDE EFFECTS: floating feeling, dysphoria, euphoria, blurred vision, hypotenso, and constipation, physical and p
Non-opioid antitussives
PROTOTYPE: dextromethorphan (Benylin, Robitussin) ACTION: acts on cough center. No analgesic effect, no addictive qualities
Non-opioid antitussives
Benzonatate (Tessalon) ACTION: anesthetizes the stretch receptor cells on the respiratory tract
Topical Decongestants
PROTOTYPES: ephedrine (Pretz-D) USES: shrink engorge nasal mucous membranes & relieves nasal stuffiness r/t colds, sinusitis, allergic rhinitis & flu ACTION: constricts small blodd vessels (alpha adrenergic "all over") therefore decreasing the blood flow
Topical Nasal Steroid Decongestants
PROTOTYPES: flunisolide (AeroBid) ACTION: anti-inflammatory USES: tx of allergic rhinitis, effective in pts who are no longer getting a response w/ other decongestants SIDE EFFECTS: local burning, irritation, stinging, dryness of the mucosa, HA, increased
Oral Decongestants
PROTOTYPE: pseudoephedrine (Sudafed) USE: decrease nasal congestion r/t the common cold, sinusitis and allergic rhinitis; to relieve the pain of otitis media ACTION: shrinks mucous membranes; stimulates the ALPHA-ADRENERGIC RECEPTORS in the nasal mucous m
Antihistamines (Histamine 1 antagonist/blocker)
PROTOTYPE: diphenhydramine (Benadryl) USES: allergy symptoms ACTIONS: blocks the effects of histamine at the histamine-1 receptor sites, decreasing allergic responses. Anticholinergic effects include drying of the respiratory and Gi mucous membranes. GI u
Expectorants (administered orally)
PROTOTYPE: guaifenesin (Mucinex) USES: decrease viscosity making it easier for the pt to cough up secretions ACTION: reduces the adhesiveness and surface tension of respiratory tract fluids SIDE EFFECTS: N/V, taste perversion, GI irritation, enlarged thyr
Mucolytics (administered by nebulization)
PROTOTYPE: Mucomyst (acetylcysteine) USES: acute and chronice broncho-pulmonary dz. Reduces viscosity (thickness) of mucous (acts directly on mucous), helps to remove secretions in acute and chronic broncho-pulmonary dz. Used in pts w/ difficulty mobilizi
Xanthines Bronchodilators
PROTOTYPE: theophylline (Theo-Dur) USE: symptomatic relief or prevention of bronchial asthma and reversible bronchospasm assoc w/ chronic bronchitis and emphysema ACTION: directly relaxes bronchial smooth muscle, causing bronchodilation and increasing vit
Sympathomimetic Bronchodilators
PROTOTYPE: epinephrine (Sus-Phrine, Epi-pen) ****
DRUG OF CHOICE IN EMERGENCY FOR TX OF ACUTE BRONCHOSPASM, INCLUDING THAT CAUSED BY ANAPHYLAXIS
***. PROTOTYPE: albuterol (Proventil) long acting, inhaled or PO. USES: acute asthma to quickly reduce airway
Anticholinergic Bronchodilators
PROTOTYPE: ipratropium (Atrovent) USES: Pts who cannot tolerate the sympathetic effects of epinephrine ACTION: block the action of vagus nerve causing relaxation of smooth muscle in the bronchi, leading to vasodilation ADVERSE EFFECTS: dizziness, nervousn
Corticosteroids/Anti-inflammatory
PROTOTYPES: budesonide (Pulmicort) - inhalation. *fewer systemic s/e with inhaled steroids. dexamethasone (Decadrone) - PO, IM, IV USES/INDICATIONS: chronic asthma & bronchospasm ACTION: used to decrease the inflammatory response in the airway, decrease t
Leukotriene Receptor Agonists (fyi - no test questions on this drug)
PROTOTYPE: montelukast (Singulair) ACTION: locks many symptoms of asthma CAUTION: USE CAUTIOUSLY IN PTS W/ HEPATIC OR RENAL IMPAIRMENT B/C THESE CONDITIONS CAN AFFECT THE DRUG'S METABOLISM AND EXCRETION AND DO NOT USE DURING PREGNANCY!**
Lung Surfactants
PROTOTYPE: beractant (Survanta) ACTION: reduces the surface tension within the alveoli, allowing expansion of the alveoli for gas exchange USES: replaces the surfactant that is missing in the lungs of neonates with RDS (Respiratory Distress Syndrome)
Mast cell stabilizers (epinephrine inhalers)
PROTOTYPE: Intal (chromolyn) USES: asthma prophylaxis (Stabilizes asthma pts so they don't have to use their rescue inhaler) ACTION: prevents the release of inflammatory and bronchoconstricting substances when the mast cells are stimulated SIDE EFFECTS: w
Selective toxicity
the ability to affect certain proteins or enzyme systems that are used by the infecting organism but not by human cells
Broad-spectrum anti-infectives
drugs that interfere with biochemical reactions in many different kinds of microorganisms. Useful in the treatment of a wide variety of infections.
Narrow-spectrum anti-infectives
Drugs so selective in their action that they are effective against only a few microorganisms with a very specific metabolic pathway or enzyme.
Bacteriostatic
anti-infectives that are not as aggressive against invading organisms; interfere with the ability of the cells to reproduce or divide.
Bactericidal
Anti-infectives so active against the infective microorganisms that they cause the death of the cells they affect.
In 1920s, first scientist to work on developing a synethic chemical that would be effective only against infection-causing cells, not human cells
Paul Ehrlich
In 1920s, scientists discovered
penicillin in a mold sample
Opportunistic infection
an infection where opportunist pathogens were kept in check by the "normal" bacteria.
Opportunistic infections are also known as
superinfections
Examples of superinfections
Vaginal or GI yeast infections
Septicemia
blood infection
The sulfonamides were introduced in?
1935
Antibiotics
chemicals that inhibit specific bacteria
Gram positive bacteria
the cell wall retains a stain or resists decolorization with alcohol. Frequently found in respiratory infections.
Gram negative bacteria
the cell wall loses a stain or is decolorized by alcohol. Frequently found in GI and GU infections.
Aerobic bacteria
Depend on O2 for survival
Anaerobic bacteria
Do not use O2
Aminoglycosides
Powerful antibiotics used to treat serious infections caused by gram-negative aerobic bacilli
Aminoglycosides
PROTOTYPE: gentamicin (Garamycin) ACTION: inhibits protein synthesis in susceptible strains of gram negative bacteria. Reserved for use in serious infections because of potentially serious adverse effects. NURSING IMPLICATIONS: Monitor for ototoxicity, re
Cephalosporins
a large group of antibiotics, similar to penicillin, that are effective against a wide range of bacteria
Cephalosporins
PROTOTYPE: Cefaclor (ceclor). Four generations have been introduced over time, each group with its own spectrum of activity. They are both bacteriostatic and bactericidal, depending on the dose and drug used. INDICATIONS: for the tx of infections caused b
Fluoroquinolones
PROTOTYPE: ciprofloxacin (Cipro) New class of antibiotic w/ a broad spectrum of activity. ACTION: interferes w/ the action of DNA enzymes necessary for the growth & reproduction of the invading bacteria, leading to cell death b/c the DNA is damaged and th
Macrolides
PROTOTYPE: erythromycin (Ery-Tab, Eryc) a class of older antibiotics that can be bactericidal or bacteriostatic USES: tx of URIs and urinary tract infections (UTIs), and are often used when pts are allergic to penicillin NURSING IMPLICATIONS: Monitor for
Penicillins
PROTOTYPE: amoxicillin (Amoxin). One of the oldest classes of antibiotics, and many resistant strains have developed. The penicillinase-resistant antibiotics were created to combat bacteria that produce an enzyme which destroys penicillin. ACTION: inhibit
Viruses
particles of DNA or RNA surrounded by a protein coat that survive by injecting their own DNA or RNA into a healthy cell and taking over its functioning