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1. Pharmacology Bullet Review Nursing Board Examination Review

2. Drug classification Nursing process applied to pharmacology Pharmacokinetics Pharmacodynamics

4. Diuretics Comparison Hypokalemia Ototoxicity Loop of Henle 3. Loop diuretics Hypovolemia & hypotension Glomerulus 5. Osmotic diuretic Hyperkalemia Distal tubule 4. Potassium sparing Hyperuricemia Hypokalemia Proximal tubule 2. Thiazide and thiazide like Acidosis Proximal tubule 1. Carbonic anhydrase inhibitor Special Side effect (s) Major site of action Diuretic class

5. Diuretics Comparison Hypercalcemia 3. Loop diuretics Increased ICP LITHIUM TOXICITY 5. Osmotic diuretic CHF taking digoxin 4. Potassium sparing Nephrolithiasis due to calcium stones Hypocalcemia 2. Thiazide and thiazide like Mountain sickness Meniere’s disease 1. Carbonic anhydrase inhibitor Special Uses Diuretic class

12. Loop Diuretics

16. Potassium sparing diuretics

31. CNS DRUGS

40. The BENZODIAZEPINES Special uses Panic attack Alprazolam (Xanax) Alcohol withdrawal Chlordiazepoxide (Librium) Status epilepticus Diazepam (Valium)

71. GIT DRUGS

73. Drugs affecting secretions: anti ulcer Misoprostol Prostaglandin analog Sucralfate Mucosal protectants Omeprazole Proton pump inhibitors AlOH and MgOH Antacids Cimetidine Histamine (H2) receptor antagonist/blockers Prototype Anti-ulcer drugs

75. General time of administration of the drugs affecting gastric acid secretion Misoprostol WITH MEALS Prostaglandin analog Sucralfate BEFORE MEALS Mucosal protectants Omeprazole BEFORE MEALS Proton pump inhibitors AlOH and MgOH Usually after meals Antacids Cimetidine With FOOD or ONE hour after ANTACID Histamine (H2) receptor antagonist/blockers Prototype Best time to give Anti-ulcer drugs

76. Pharmacology of Anti-ulcer drugs Inhibit Proton Pump in parietal cell decreasing secretion and acidity Proton pump inhibitors- “ Prazoles” Omeprazole, pantoprazole Block Histamine receptor causing decreased secretion and acidity H2-Blockers- “ tidine ” Cimetidine , Ranitidine Neutralize Gastric ACIDITY Antacids- AlOH, MgOH Mechanism of Action Drug

77. Pharmacology of Anti-ulcer drugs Prostaglandin Analogue, causes secretion of MUCUS Misoprostol (Cytotec) Coats the mucosal lining Sucralfate (Carafate) Blocks VAGUS nerve, decreases secretion Anti-cholinergic- Prophanteline Bromide Mechanism of Action Drug

128. laxatives

129. Laxatives Lubricating the intestinal material to promote passage through the GIT Docusate Lubricants Increased fluid content of the fecal material causing stimulation of the local reflex Lactulose Mechanical (bulk) stimulants Direct stimulation of the GIT nerves Irritant laxatives Bisacodyl (Dulcolax) Chemical stimulants Action Prototype Type

146. The Anti-diarrheals Stops GIT spasm by CNS action Opium derivatives (paregoric) Central acting agent Directly inhibits the intestinal muscle activity to SLOW peristalsis Loperamide Local anti-motility Locally coats the lining of the GIT to soothe irritation that may stimulate the reflex Bismuth subsalicylate Local reflex inhibitor Action Prototype Type

165. ANTIEMETICS Dronabinol, hydroxyzine Miscellaneous “ setron”- dolasetron Serotonin Receptor blockers Meclizine, buclizine Anticholinergics and Antihistaminics Metoclopramide Non-phenothiazines Prochlorperazine, promethazine Phenothiazines Common examples Anti-emetic types

166. ANTIEMETICS Act in the CNS , either in the medulla or in the cortex Miscellaneous Centrally and locally inhibits the serotonin receptors Serotonin receptor blockers Block the transmission of the impulses to the medulla Anticholinergics Reduces the responsiveness of the nerve cell in the medulla Non-phenothiazine Centrally block the vomiting center in the medulla Phenothiazines Pharmacodynamics Types

167. ANTIEMETICS N/V associated with chemotherapy Miscellaneous N/V associated with chemotherapy Serotonin-receptor Blockers N/V associated with motion sickness Anticholinergics N/V associated with chemical stimulation Non-phenothiazine N/V associated with anesthesia, intractable hiccups Phenothiazines Clinical Use Types

176. Pharmacology of the Selected Endocrine Drugs Nursing Review

197. STEROIDS Use for the treatment of immune-related diseases, control of asthma and allergic symptoms Other steroids Use to induce the formation of lung surfactant Dexamethasone Clinical use Steroid

204. Cardiovascular drugs

247. Anti-hypertensive drugs Depression Stimulates CNS alpha 2 receptor Clonidine Central alpha agonist Urination Blocks alpha receptor in BV causing vasodilatation Prazozin Alpha blockers HEADACHE Dilates veins and arteries Nitroglycerin Vasodilator Headache, flushing, reflex tachycardia Blocks Ca entry into cell Nifedipine Ca channel blockers Headache, Cough, flushing Prevents A1 to AII conversion Captopril ACE Inhibitors Bradycardia, hypoglycemia Blocks B1 receptor in the heart Propranolol Beta-blocker Hypokalemia Decreases blood volume Furosemide Diuretics Side effects MOA Prototype Class

248. Anticoagulants SE: Bleeding SE: bleeding, decreased platelets Antidote: Vit. K Antidote: Protamine sulfate Small molecule CANNOT be given to pregnant Large molecule, can be given to pregnant Monitor for PT and INR Monitor for aPTT Acts within days Acts within minutes Action is to INHIBIT Vitamin-K dependent clotting factors (10,9,7,2) Action is to enhance natural anti-thrombin III in the blood Oral Parenteral (SQ and IV) WARFARIN HEPARIN

260. Psychiatric Medications

263. Anti-Psychotics/Neuroleptics quetiapine Risperidone Olanzapine Clozapine Atypical drugs Pimozide Diphenylbutlypiperidine Molindone Dibenzoxapine thirothixene Chlorprothixene Thioxanthines droperidol Haloperidol Butyrophenones Thioridazine, Fluphenazine, Perphenazine Chlorpromazine Phenothiazines Others Prototype Class

264. Anti-Psychotics/Neuroleptics Reduced flattening of affect 6 Relief of emotional turmoil 5 Reduced agitation resulting to calmness 4 Decreased ambivalence, reduced delusion 3 CNS sedation and emotional slowing 2 Reduced hallucination and illusions 1 Desired Effects

265. Anti-Psychotics/Neuroleptics Safety, no machine operation Sedation Monitor EEG Seizure Instruct to report sore throat and fever, monitor WBC Agranulocytosis Change position slowly, lie prone for 1 hour after drug intake, monitor BP Postural hypotension Sunglasses, sunscreen, avoid sun Photosensitivity Sugarless gum, bed rest Anticholinergic effects Nursing Interventions Common SE

266. Anti-Psychotics/Neuroleptics Notify physician, prepare to administer dantrolene Neuroleptic Malignant syndrome= elevated temp, treme muscle rigidity No treatment except discontinue drug Tardive Dyskinesia= irreversible drooling, tongue movement and shuffling gait Verbalize understanding of the condition, administer anti-EPS Akathisia= motor restlessness Remain with client, administer anti-EPS Dystonia- torticollis, contraction of face and tongue Avoid abrupt withdrawal, give anti-EPS drugs like Cogentin Parkinsonism-Tremor, rigidity, bradikinesia Nursing Intervention Extra-Pyramidal Syndrome

268. Comparison of the Sympathetic and Parasympathetic Nervous system Rest and Digest Fight or flight General response Acetylcholine-ESTERASE MAO, COMT Enzyme for NTA Acetylcholine Epi and NE Post-ganglionic NTA Short axon Long axon Post-ganglionic neuron Near target organ Next to spinal cord Ganglia location Acetylcholine Acetylcholine Pre-ganglionic NTA Long axon Short axon Pre-ganglionic neuron Cranio-Sacral spinal cord Thoraco-lumbar spinal cord CNS origin Parasympathetic Sympathetic Characteristics

273. The autonomic drugs: Pharmacologic use depends on their EFFECTS on the body Used for HYPERTENSION and Tachycardia Decreases BP and heart rate Used for SHOCK where there is LOW BP Increases BP Therapeutic use Effect on the body

315. Drugs for the parasympathetic system (cholinergic drugs)

326. The Cholinergic Agonists: evaluate effectiveness Urination/ relief of bladder distention Betanechol/Carbachol Decreased IOP in glaucoma Pilocarpine effectiveness Drug

337. Atropine Used in partly to control diarrhea (in Lomotil ) Constipation Used in Cholinergic and Organophosphate poisoning Reverses cholinergic toxicity Used in BRADYCARDIA and heart block Inhibits vagal response in the heart Used in cataract surgery Cyclopledia Used in cataract surgery Mydriasis Used as pre-op med Decreases bronchial secretions Used as pre-op med Depresses salivation Clinical use effects