Nursing Care of Child Bearing Families Session: 4

I this is the fourth session of the class and we discussed some of the changes that a woman will face during the pregnancy, and started talking about the fetal heart monitor and how to read it. The next post for this class will be a review guide of the information that may be on the next text. Happy studying.

-Peter

Session 4

Normal phys changes in pregnancy

  • hematologic
    • increase in plasma and RBC
      • blood is diluted
      • Hbg goes down as well as Hct
      • fetus is storing iron so there may not be as much going to make RBC
    • immunocompromise
      • increased WBC
  • MSK
    • loose joints and tendons from relaxin
  • Vena Cava syndrome
    • lean to her left side so there is decreased pressure on the vena cava

Fetal assessment

All women should be offered genetic testing

Amniocentesis

  • .5% chance of loss

CVS – chorionic villi sampling

  • does not detect neural tube defects
  • 1% chance of loss

electronic fetal monitoring

  • know how to read these will
  • the purpose is to prevent fetal hypoxic ischemic injury
  • vocabulary
    • common language so that there are fewer miscommunications
    • frequency – the start of one contraction to the start of another
      • dark vertical lines are a minute on the EFM
    • duration
      • length of time of the contraction
    • Intensity: of contractions
      • cannot tell the intensity from an external monitor
      • must palpate, and get subjective data to get contractions
      • IUPC – intrauterine pressure catheter measures the intensity as well
    • Category 1
    • Category 2
    • Category 3
    • Montevideo units -MVU total intensity of each contraction (from baseline)added up in a 10 min period. 200 MVU is the pressure needed for 90% of labors to move forward.  
    • normal fetal HR is 110-160
      • make sure you compare this to the mother’s pulse to be sure that you are not reading the mother’s pulse as the baby’s
      • listen to FHR during the contraction through doppler and for 30 seconds after contraction
    • US transducer
      • placed in area of max intensity of FHR
      • use gel when applying
    • Tocotransducer
      • has a button on the bottom
    • Fetal scalp electrode
      • fetal ECG from a spiral electrode hooking gently into baby’s skin
    • Intrauterine Pressure catheter
      • measures frequency, duration and STRENGTH of contractions.
    • Meconium fluid is baby poop
    • autonomic nervous system
    • Vagus stimulation will slow down HR and increase peristalsis to cause meconium
    • Placenta produces estrogen, progesterone, hPl, and hCG
    • tachysystole is rapid contractions with small rest periods
    • FHR baseline to the nearest 5 BPM
    • variability
      • absent – flat line
        • associated with sleep
      • minimal – less than or equal to 5 bpm of variance from baseline
      • Moderate – best rhythm(best parasympathetic/sympathetic teeter-totter), 6-25 bpm variance from baseline
      • Marked variability – more than 25 bpm from base, usually does not last long
      • Accelerations are always good
        • greater than 15 seconds and shorter than 2 min
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Pharmacology Session 9:

Analgesics and anesthetics, lots of narcotics, and sedation. These are information packed and there is a lot that is not in the notes so be sure to double check with your own resources. Thanks for reading!

-Peter

Analgesics and Anesthetics

Analgesics – treat pain, w/out loss of consciousness

Anesthetics – block conduction along the axon to stop sensation

  • General – loss of consciousness for surgery
  • Regional – targets nerves, larger body region such as an arm or abdomen.
  • Local – very small region like a hand

Acute pain has an identifiable current issue

Chronic long term, and the cause may not be identifiable

Assess the patient’s eyes(PERRLA), and allergies very close

Narcotic are potentially addictive and scheduled

  • act on CNS

and non narcotic are not addictive

  • act on the peripheral nervous system

Opioid Analgesics

  • resp. depression
  • mu site has resp depression
  • Kappa site has no resp depression
  • delta
  • sigma

Narcotics adverse effects

  • resp rate is 12-20 breaths in a min
    • low is under 8
  • takes effect in about 7 mins IV
  • can develop tolerance
  • constipation
  • hypOtension
  • cannot make legal decisions
  • fall risk
  • Overdose
    • pinpoint pupil
      • from CNS over stimulation
    • Coma
    • Bradypnea
    • Narcan is antidote

analgesic ladder from the WHO

  • non-opioid analgesic
    • NSAIDS
  • mild opioid
    • codeine
  • opioid
    • morphine
  • Morphine
    • narcotic
      • moderate to severe pain
      • can be given through almost all routes
      • cross BBB
      • S/E: resp depression, constipation, nausea, Miosis(pinpoint pupils)
      • morpheus god of sleep
      • give before the pain occurs if possible
      • PCA pump allows for the patient to not fall out of the TPR
        • is better than PRN, or fixed schedule
        • decreases overdoses
        • can use smaller doses
        • empowers patient
      • Tolerance to other opiates
  • Meperadine (demoral)
    • narcotic
      • same action as morphine with a shorter action
      • treats post anesthesia shivers or rigors that can occur
      • no cough suppression effect
  • Fentanyl
    • narcotic
      • one hundred times stronger than morphine
      • Lollipop form in some cases for chronic pain (cancer)
        • will kill a kiddo!
  • Diacetylmorphine (heroin)
  • Methadone
    • narcotic
      • longest duration of action
      • long QT interval
      • for coming off of narcotics and given in clinics
  • Codine
    • Narcotic
      • 1/10th power of morphine
      • 5x power of aspirin, or acetaminophen
  • Hydrocodone (vicodin)
    • analgesic and antitussive
        • moved up to a schedule 2 drug
        • high level of abuse
  • Oxycodone
    • ten times more powerful than codeine
    • extended release is oxycontin
    • schedule 2 as well
  • Hydromorphone (dilaudid)
    • strong opiate
  • nonopiate CNS actinganalgesic
    • Tramadol
      • schedule 4
      • not an opiate but binds to the receptor
  • clonidine
      • alpha 2 Agonist
      • not for patients with opiate dependence
      • NSAID
      • more potent than codeine and less potent than
      • side effects: dizzy, sedation, less resp

non opiate

  • COX inhibitors
    • COX 1: promotes Platelet aggregation, GI protection, renal fxn, (GOOD)
    • COX 2: promote inflammation (bad)
  • NSAID
    • gen 1: inhibit COX one and two
      • inhibit inflammation
      • inhibits prostaglandins in the stomach, so there is a higher chance for ulcers
    • Gen 2:
    • some studies show slowed healing of muscle, bone and ligament injuries.
  • ASA (aspirin)
    • gen 1 NSAID
    • inhibits platelet aggregation until there is a reproduction of more platelets
      • irreversible in the platelets that it affects
    • anti prostaglandin (inflammation)
    • do not use in kiddos
    • s/e: salicylism (ringing in ears points towards OD), reye’s syndrome, Renal impairment
    • Too Much? Tinnitus, respiratory depression, HypERthermia, can cause metabolic acidosis, then resp alkalosis to compensate.
  • Ibuprofen (advil, Motrin)
    • S/E: can cause renal damage, and GI bleeding, Retention of NA and H2O (watch out for HF patients)
  • Ketorolac (toradol)
    • one of the oldest NSAIDS
      • strong! acute up to severe pain
  • COX 2 inhibitors
    • celecoxib
      • similar strength to ibuprofen
      • less stomach ulcers than other NSAIDs (some evidence)
  • acetaminophen (Tylenol)
    • anti-prostaglandin
      • metabolized in liver (watch out for this)
        • 3 g per day is the most dose per day
      • works in CNS
      • low GI
      • irritation
      • can be used with kids
      • s/e: liver damage with ETOH is a high risk,
      • toxicity: 25 grams for adult
        • top cause of acute liver failure
        • the OD patient will die in 3-5 days from the liver damage
  • medical marijuana
    • schedule 1
      • two drugs: Dronabinol, nabilone, sativex
      • for pain, appetite, nausea, glaucoma, seizures
      • preg. risk

Anesthetics

  • General – loss of consciousness for surgery
  • Regional – targets nerves, larger body region such as an arm or abdomen.
  • Local – very small region like a hand
  • preanesthetics will treat the negative effects of anesthesia
  • two classes to allow a lower dose to be used for each
    • inhalation
    • IV
  • stages
    • there are 4
    • 1 is the beginning and 4 is close to death
    • 3 is the stage for operation
  • NM blocker
    • Depolarizing neuromuscular blocker
      • Succinylcholine
        • ultra short acting agent
        • period of mm contractions before flaccid paralysis
        • no CNS effect
        • S/E: prolonged apnea, hyperthermia, mm pain post op,
  • balance is important
    • one analgesic, and one anesthetic
  • Propofol
    • rapid onset and short duration
    • no analgesic effect
    • s/e: resp depression, rhabdo
  • Ketamine (ketalar)
    • dissociative anesthetic
      • abuse potential
      • a lot of s/e so not used as much anymore
  • Local anesthesia
    • -caine
    • fingers, ears,nose, toes, and those

Nursing care of child bearing Families Session 3:

This is OB session 3, we finally came around to more involved information, and there is more information that needs to be known in this session. Happy studying!

-Peter

Session 3

    • Gestational age starts from the first day of the last menstrual period.
      • the fetal age is about two weeks after that: the time to ovulation.
    • any infections can cause preterm labor, so these infections will be treated more aggressively than in a nonpregnant woman
    • advanced maternal age is greater than 35 and paternal age is greater than 50
    • SAB = spontaneous abortion or miscarriage
    • hCG human chronotropic gonadotropin
    • KNOW THE SIGNS OF PREGNANCY
      • Presumptive
        • subjective things that point towards pregnancy but are not diagnostic
          • ie amenorrhea, QUICKENING (movement of baby)
      • Probable
        • objective: changes in uterus size, braxton hicks, enlargement of abdomen, subtle dark skin on face and linea alba from estrogen, pregnancy test, palpation of fetal outline.
      • Positive
        • Fetal heart beat, movement, ultrasound of fetal.
    • Pregnancy term
      • 10 lunar months each 28 days (40 weeks)
        • 38 weeks to 42 due to ovulation variability
      • 266 days after ovulation
      • 280 after LMP
    • Abortion
      • more than 20 weeks and less than 37 6/7 weeks
    • Dating pregnancy
      • EDD/EDC/EDB- estimated date of…
      • Naegele’s rule
        • one year minus three months plus 7 days
          • +- two weeks (due month)
        • LMP 7/4/13: 7-3= 4 + 7days =april 11 2015
        • LMP 2/1/13: EDD 11/8/13
        • LMP 10/31/13: 10-3=7(july) + 7 days = august 7 14
      • think of it like a “Due month” not day. Due to the date +- 2 weeks
      • Don’t change the due date after it is calculated.
        • this helps us know that a baby is growing to fast or too slow.
    • get a good health history
      • previous preg
      • STI
      • + normal health history
      • DM, thyroid, clotting Dx, HTN
      • C sections are sugery
    • NSVD – normal spontaneous vaginal delivery
    • GA – gestational age
    • PPD – postpartum depression
    • epis – episiotomy, cutting the posterior perineum to allow for the baby’s head (not often done)
    • abruption is when the placenta tears from the uterine wall.
    • VBAC – vaginal birth after cesarean
      • risk of uterine rupture due to the previous scar of C section
    • Labs:
  • RH factor, blood type, ABS
    • CBC with hgb/hct/ plt
    • chlamydia, gonorrhea
    • wet prep for vaginal discharge
    • bacterial culture
    • TORCH – infections: toxoplasmosis, other, rubella, cytomegalovirus, herpes
  • Lab changes that are normal
    • increased WBC with left shift
    • increased fibrinogen
    • some anemia due to iron deficiency
    • increased alkaline phosphatase
    • Lower BUN and Creatinine due to more urine (from more blood circulation)
    • trace protein and glu in urine
    • Blood types
      • the actual blood does not cross the placenta (in a perfect world)
      • Rh + baby has a Rh- mom
        • the first baby has the mom make antibodies aginst the Rh factor, but does not harm baby
        • the second baby that is Rh + will be attacked by the IgG and identified by the antibodies.
        • Rh immune Globulin (rhogam) given to Rh – women who have not yet been sensitized by a Rh-baby.
          • IM or IV
          • it is a very small dose of Rh anti-D antibodies, this trick the woman’s body into thinking that there are enough antibodies so the mom’s body does not make any more.
          • given at 26-28 weeks, and postpartum if the baby is Rh +
          • given in the first pregnancy so the mom is never sensitized and doesn’t make her own antibodies.
            • given after any sign or chance of bleeding
          • do not give to a mom who has been sensitized
            • it will show up in the blood test with the Rh + antibodies (the Rhogam will not last long into a blood test of the next baby)
      • TORCH infections
  • PREVENT!
      • can cause fetal death
      • do not eat raw or uncooked meat
      • toxoplasmosis
        • watch for cats that go outside, there is a risk for toxoplasmosis in their poop.
      • Parovirus
        • high risk in day care workers
    • Evaluation of risk
      • BMI – the amount of weight that a person should gain goes down with increase in mom’s weight
      • head to toe exam
      • uterine exam
      • for how the uterus feels, and how far it is up from the symphysis pubis to the umbilicus  
    • Clinical pelvimetry
      • false pelvis is the iliac crest
      • true pelvis is below the iliac crest
      • the mid pelvis is the most narrow (ischial spines)
    • 1st trimester weight gain is 3-5 lbs
      • .5 – 1 lbs per week after 1st trimester
    • Heart rate symptoms
      • headache, scotoma, vaginal bleeding, loss of fetal movements,
    • fetal wellbeing
      • Heartbeat at 6 weeks on ultrasound, 10 week GA for the doppler
      • fetal movement at 18-22, it is sooner in women who have been pregnant previously, (multips)
      • fetal kick counts measure fetal wellbeing
      • US are usually completed in the 2nd or 3rd trimester
        • for presentation, fetal #
        • GI issues: can see an omphalocele, or gastroschisis (organs outside of the body)
        • Cardiac issues: transposition, 2 chamber heart
    • visit every four week from 26 to 38 weeks every 2 weeks till 40, and every week after that.
    • when traveling make sure there is a good medical center, and bring your medical records
      • walk around a lot to prevent DVT
    • die hair ok, massage by a trained person for pregnant women, no hot tubs, pedicure ok, can still have sex.
    • work changes: may need extra breaks, put feet up.
    • can pain room with safe paint without fumes
  • Layers of the pregnancy
  • Fetus, amnion, chorion (synonymous with placenta)
  • chorionic villi exchange the blood products with the mother’s blood vessels.
  • chorionic villi come from the trophoblast and the trophoblast line the chorionic villi
    • by 10 weeks all of the systems/organs have formed
    • Heartbeat at 6 weeks on ultrasound, 10 week GA for the doppler
    • fetal movement at 18-22, it is sooner in women who have been pregnant previously, (multips)
    • Breathing of the fluid starts around, 16 weeks (visible at 24-40 weeks)
  • 2 arteries and a vein and are in the umbilical cord, three total
  • the arteries carry the DEoxygenated blood away from baby
  • the vein carries OXYgenated blood to the baby
  • wharton’s jelly is inside the cord and keeps the cord from kinking
    • Placenta
      • maternal part is the ….
      • the fetal par is the chorionic
      • hormone function
        • produces: hPL, HCG estrogen, progesterone
  • Gravidity – any pregnancy (have to count current pregnancy!!!!)
  • parity – the # of births after 20 weeks regardless of outcome  (twins = 1 as well)
  • Nulligravida – never been pregnant
  • primapara – given birth to a fetus less than 20 week GA
  • multigravida – multiple pregnancies
  • TPAL
  • Term – # babies >37 6/7 weeks
  • Preterm – # babies < 37 6/7 weeks
  • Abortions – Miscarriages, or therapeutic
  • Living children –
  • the format for this will look like G1P1
    • one pregnancy, and one birth
  • G3P1112
    • 3 pregnancies, one full term baby, one preterm, one abortion, 2 living children.

Nursing Care of Child Bearing Families Session 1+2:

Its the first session of OB! This is a great start to the class, and the first two sessions honestly started off somewhat slowly due to forces out of our control. The notes are short due to this, and there is a lot of information that is not a part of this, and it should only be supplemental for your studying.

-Peter

OB/GYN

Session 1

the U.S. is 50 out of 50 for industrialized nations for Maternal mortality

  • no consistent prenatal care

Labor induced is not the safest birth type

  • 50% increase in the chance of a c-section

39-42 weeks is the normal term of pregnancy

Childbirth in the U.S. is NOT safer now than ever before.

95% of deliveries in the 1800-1900 are at the home, and usually done by midwives.

1912 Flexnar report’s take power away from midwives, given to doctors.

1920’s medicated births

  • increase in infant mortality rates during/after this but due to birth injury and fever.

1935  antibiotics for fever

Session 2

Attendants

  • FOC is father of child
  • Doula – a medical information/positional/emotional resource that is on call 2 weeks before the due date up until the birth and some time after.

ethical issues –  maternal/fetal conflict, assisted reproductive tech, abortion, stem cell research, when to resuscitate a preterm on the edge of viability

The pregnancy related mortality ratio is going up in the US and is 31st in developed countries.

  • need access to prenatal care

A low birth weight baby can be full term or otherwise

Do not assume that a pregnant woman knows specific information about pregnancy

  • no drinking is ok during pregnancy

Morbidity and mortality

  • Maternal
  • Infection, Hemorrhage, HTN, Embolism
  • Neonatal/Fetal
  • Congenital anomalies, short gestation/low birthweight, SIDS, Consequences of maternal Dx, Unintentional injuries.

pre birth cervix looks like a doughnut with a dot/hole (os) in the middle. after pregnancy the hole tends to look like a slit.

effacement – the distance between the internal and external os decreases

Ligaments hold up the uterus (round ligament) and stretch to accommodate the weight and size

  • can cause pain.

retroverted uterus – uterus pointed backwards.

symphysis pubis – cartilage connection of the pelvis in the anterior

More than one ductal opening on the nipple. 15-20.

estrogen types

  • Estradiol
    • in the reproductive years
  • Estriol
    • only during pregnancy
  • Estrone
    • Menopause

Progesterone

  • hormone of pregnancy

FSH – stimulates the follicle and that allows the egg to mature

LH – Converts the empty follicle that produced the egg into the corpus luteum, which supports

Ovarian cycle

  • follicular Phase days 1-14
  • growth of follicle
  • estrogen dominance
  • LH surge releases the egg
  • variable amount of time
  • Luteal Phase 15-28
  • Progesterone dominance

Menstrual cycle

  • Menstrual cycle (bleeding)
  • Proliferative phase
    • estrogen dom
  • Secretory phase
    • Progesterone dom
  • ischemic phase if no pregnancy

Pharmacology Session 8

So this maybe the longest post to date and there are a lot of very complex topics discussed. We go over antibiotics, antivirals, and anti-fungals. There is a very strong correlation to each class and their prefix or suffix, so pay close attention to the minor differences between them. Within each class there is very little deviation from the prototype drug discussed so as long as the class can be identified then the other traits should be easy to understand. Happy studying!

-Peter

Session 8

Pharmacology

  1. how are people exposed to antibiotics in their environment?
    1. in  the drinking water and in the food we eat.
  1. why do some people not finish their antibiotics?
    1. feel better, the dosing schedule, and can give you are yeast infection
  1. the most important action to prevent the spread of infection is to
    1. wash hands
  2. John is an alcoholic and develops cellulitis. whis is the factors that increase johns susceptibility to infection?
    1. poor nutritional status (could be poor circulation if the cellulitis is in the periphery)
  3. Monitoring you pt given a penicillin type drug, what should be especially assessed.
    1. allergic reaction
  4. why use Augmentin vs, amoxicillin alone for otitis media
    1. bacterial susceptibility is increased because augmentin can stop beta lactamase
  5. vancomycin pt should be monitored for what?
    1. ototoxicity
  6. what is a common side effect of Clindamycin
    1. frequent, bloody, watery stool
  7. fluoroquinolones are classified as_____ and are especially effective against _____
    1. antibacterial, P. aeruginosa
  8. life threatening systemic fungal infections may be treated with
    1. amphotericin B
  9. Most common bacteria that cause UTI?
    1. E. coli
      1. outpatient: Klebsiella, Proteus, Pseudomonas, Enterobacter
      2. In patient: Staph, Enterococci, 80% E. coli.

Basic principles of antimicrobial therapy

Antibiotic – kill (bactericidal) or weaken (bacteriostatic)

Selective toxicity – the trait of an antibiotic that can harm/kill a bacteria while leaving the host (patient) unharmed.

  • This is the basis for their therapeutic use.

Classify the antibiotic to choose more effective medication

  • susceptibility of the organism
    • aerobic vs anaerobic, Gram+ vs Gram-, and the different classes of bacteria
  • narrow versus broad spectrum
    • Narrow: Penicillin, erythromycin, Clindamycin
    • Broad: Ampicillin, tetracyclines, cephalosporins 3 and 4 gen, fluoroquinolones
  • MOA(mechanism of action) inhibitors
    • Bactericidal:
      • stop cell wall synthesis
        • Penicillin, cephalosporin, and vancomycin
      • stop protein synthesis which is bactericidal and bacteriostatic.
        • Aminoglycosides, Macrolides, tetracyclines
      • inhibit nucleic acid synthesis
        • Fluoroquinolones and Metronidazole
      • viral enzyme inhibitors? (either maybe)
    • Bacteriostatic:
      • Change cell membrane permeability
        • Antifungal and Amphotericin B
      • stop the metabolites of the bacteria
        • sulfonamides
    • getting a great pt hx is important to the treatment of the disease
    • admin of antimicrobials
      • GI upset is not an allergy
      • IV watch for extravasation, and phlebitis
      • IM can cause necrosis w/ some of the antimicrobials
      • S/E and allergic reactions
        • allergic: penicillins are the most common then cephalosporins and sulfonamides.
          • don’t give the drug if allergic
          • patient should have ID band to show that they are allergic
  • always ask for allergies before giving antibiotic!!
      • Superinfections are most common with broad spectrum antibiotics that are not selective enough and kill the patient’s normal flora as well.
  • PT education
    • complete the entire therapy
    • q12 hr is different than twice a day
  • minimum bactericidal concentration is the least amount of the drug needed to kill the bacteria
  • minimum inhibitory concentration is the least amount of drug needed to inhibit bacterial growth
  • misuses of antimicrobial drugs
    • viral or fungal infections
    • fever, if there is no next step to try and identify the bacteria or source
    • improper dose
    • no culture of the bacteria
    • no surgical drainage of

drugs by MOA

  • drugs that weaken the cell wall through stopping synthesis of the wall
      • Penicillins
        • bactericidal in gram positive bacteria
        • safe to humans b/c we do not have cell walls
        • D/D interactions with anticoags increase bleeding, contraceptives with estrogen can cause PEN to no be effective
        • beta lactam ring weakens the cell wall
          • beta lactamASE is used by some bacteria, breaks up the ring in the drug to make the drug ineffective
        • unstable absorption when taken orally
        • very thick and viscous IM needs to be givin Z track. it is thick and a lot of pressure is needed to administer.
        • few side effects, but 5% of the population has an allergic reaction
        • PenASE (beta lactamase) makes bacteria resistant to Penicillins
        • Classes of Pen.
          • Pen G
            • Benzylpenicillin
              • narrow specturom, and sensitive to penASE
              • Bac-cidal to G+
              • prophylaxis in dental/invasive procedures for endocarditis and syphilis
          • Dicloxacillin
            • Narrow, PenASE resistant
            • Treat staph
          • Aminopenicillins
            • Ampicillin, Amoxicillin (broad spectrum)
            • G+ and some G- are treated
            • S/E: rash and Diarrhea
          • Extended spectrum Penicillins
            • Ticarcillin
            • Piperacillin
            • less important Carbenicillin indanyl, and mezlocillin
        • Ampicillin and sulbactam is Unasyn
        • Amoxicillin and Clavulanic acid is Augmentin
      • Cephalosporins
        • break down cell wall, for G+ and an increasing effectiveness with G-
        • bactericidal, and more resistant to PenASE than penacilin
        • spectrum broadens from gen 1 and 2 (narrow) to gen 3 and 4 are broad
        • ADME: poorly absorbed through PO route, no metabolism, excreted in kidneys and stool
        • allergy in 10% of people w/ the pen allergy
        • four generations: they all have the Cef- or Ceph- prefix.
      • Cabapenems
        • Imipenem (primaxin)
        • broad spectrum
        • resistant to beta lactam break down (penASE resistant)
        • used in Pseudomonas aeruginosa
        • Superinfections are an adverse effect as well and an allergic RXN
      • Aztreonam
        • Narrow, G-, Renal elimination, and given parenterally
      • Vancomycin (Lyphocin)
        • inhibit Cell wall synthesis
        • most used antibiotic in the US
        • for MRAS, C diff, G+, prophylaxis endocarditis
        • ADME: PO is ok with this drug, altered taste, Ototoxicity, redneck syndrome if given to quick IV
  • bacteriostatic inhibitors of protein synthesis
      • Tetracycline
        • Broad spectrum
  • Effective through PO route
        • for acne, lyme Dx, H. pylori, Cholera, Riskettsia, cholera
        • chelation occurs when calcium, Iron, and magnesium containing supplements and foods inactivate the tetracycline and cause it to be inactive
          • do not take with meals!
          • one hour before or two hours after meals to avoid chelation
  • S/E: photosensitivity, brown teeth, not ok for mothers pregnant and breastfeeding moms, do not give to kiddos.
      • Macrolides (Erythromycin)
        • Broad spectrum
        • inhibits bacterial protein synthesis
        • use is allergic to penicillin
        • for G+
        • long QT interval
        • S/E: GI upset, cholestatic hepatitis, superinfection
        • D/D: interacts with CCB, HIV protease inhibitors, and antifungal increase the serum levels of erythromycin
      • Clindamycin (Cleocin)
        • inhibits protein synthesis
        • only for anaerobic infections such as in the gums, colon, sepsis
          • not effective in the CNS
        • Can give orally (IM,IV as well)
        • S/E: pseudomembranous colitis severe bloody diarrhea, Hepatic and renal toxicity, hypersensitivity
  • inhibit protein synthesis and are bactericidal
      • Aminoglycosides
  • can cause injury to ear and kidney
  • oto-(nonreversible) and nephrotoxicity
        • narrow spectrum G-
  • Draw peak and trough
  • Draw peak at 30mins after administration
  • trough at 1 hour before the next dose is given
        • bactericidal
      • Types:
        • Gentamicin
          • for G- serious infections
          • nephro and ototoxicity
        • Neomycin is the most toxic and causes rash as well
  • Amikacin patient may respond better to this drug if other aminoglycosides are not working.
  • Disrupt synthesis of folic acid, Antimetabolites
      • TMP/SMZ
        • Bactrim or Septra
  • Sulfa drug
            • inhibits folic acid
          • broad spectrum
          • collect urine sample before giving any antibiotic
          • used in UTI G+ or G-
          • Hypersensitivity reaction results in stevens- johnson syndrome
            • Bc it is a sulfa drug
        • UTI is usually caused by e. coli
          • some elderly pts can have bacteria in the bladder and be asymptomatic and done not necessarily need to be treated.
      • Phenazpyridine
        • turns urine and contact lenses reddish orange
    • MAC: mycobacterium avium complex infection.
      • people with HIV have this ½ the time
      • 2 bacteria: M. avium, and M. intracellulare
      • -thromycin for prophylaxis  
    • Fluoroquinolones:
      • CiproFLOCACIN
        • Broad spectrum
        • inhibits DNA gyrase in bacteria
        • Tendon rupture!!! do not give to kiddos under 18
        • undergo chelation just like
    • antibacterial and antiprotozoal drug
      • flagyl
        • works in anaerobes, breaking the DNA helix
          • H. pylori, protazoa
        • parenteral route
        • adverse effects
          • neurotoxicity, allergy, superinfections, disulfiram reaction if take w/ alcohol life threatening nausea and vomiting
  • nephrotoxic, infusion rxn,
    • Amphotericin B
      • used for mycoses that are potentially fatal, admin parenterally
      • it is very toxic
      • binds -sterols which are also found in the human body (cholesterol) which causes the renal dammage.
      • S/E: infusion reaction fever and chills, nephrotoxic
      • ADME: can be found up to a year later in the pt body
    • Nystatin
      • Candidiasis only
      • alters the permeability of the membrane
    • KetoCONAZOLE (Nizoral)
      • antifungal
      • used in less severe fungal reactions
      • MOA is it inhibits the synthesis of ergosterol which is a part of the fungal cell membrane
        • this also affects the body’s sterols (sex hormones)
  • drugs for ringworm
    • Clotrimazole—topical
    • Griseofulvin—oral
      • still in the -azole class
        • just for superficial (skin infections), not systemic
        • inhibits fungal mitosis
  • anti-viral
    • very specific to viruses
      • Acyclovir (Zocirax)
        • similar to a purine nucleoside, and suppresses protein synthesis
        • S/E: phlebitis, nephrotoxic, stinging sensations.
    • Hep B
      • there is a vax
      • transmission through blood and semen
      • Drugs:
        • interferon Alpha 2b – to treat the symptoms, but also causes flu like symptoms
        • Lamicudine (Epivir-HBV) hep b is not resistant to this
        • Tenofovir (viread)
    • Hep C
      • 6 genotypes
      • transmission same as B
      • cause flu like symptoms
      • treat with interferons as well
        • plus these three interferon, ribavirin, and a protease inhibitor
    • Influenza
      • prevention is better than treatment
      • no Vax for people with egg allergy
    • Measles
      • outbreak in 2015 dt unvaxed kiddos
        • 1:20 will develop viral pneumonia
    • HIV
      • Reverse transcriptase, protease, and intefrase are main targets of treatment to disrupt the virus.
      • HAART therapy – highly active antiretroviral therapy. two nucleoside reverse transcriptase inhibitors, and a protease inhibitor.
      • six classes of drugs to treat HIV
        • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Nucleoside reverse transcriptase inhibitors (NRTIs) Protease inhibitors (PIs) Fusion inhibitors, CCR5 antagonists or entry inhibitors (CCR5s) Integrase strand transfer inhibitors (INSTIs)
        • focus on the first three plus the fusion inhibitors
          • examples
            • NRTI: Zidovudine (Retrovir)
              • stops replication, slows the Dx, and increases the white blood cell (CD4) levels
            • NNRTI: Nevirapine (Viramune) Efavirenz (sustiva)
              • binds reverse transcripase and stops the transcription
            • PI: Indinavir (Crixivan)
              • very effective
            • FI: Fuzeon, T-20
              • stops HIV from fusing with a CD4 cell
        • ELISA test for HIV

Pharm Session 7:

Alzheimers, Parkinsons, and Migraines

There are some drug interactions that should be noted with the triptans and the MAO inhibitors, also the first questions were asked in class and here are the answers.

Happy studying!

-Peter

    1. What is the medical term for the visual aura before a migraine.
      1. scotoma
  • Why can’t a 60 year old female with HTN continue to take her triptan for migraines?
    1. HTN
  1. In alzheimer’s Dx what neurotransmitter is decreased up to 90%?
    1. acetylcholine
  2. AD pt needs more drug teaching if?
    1. will i stop losing memory with the drug?- 
      1. the meds only slow deterioration

Headaches and Migraines

    • have triggers
    • not migranes
    • types
      • Tension
        • squeezing sensation
      • sinus
        • in the sinuses
      • cluster
        • pain terrible and is usually on one side
      • Migraine
        • no known cause for migraine and cluster
        • throbbing, debilitating pain
        • one sided 60% of the time
        • can have an “aura” before the migraine but not everyone
        • triggers can be from flashing lights, loud noises, or changes in pressures
          • menstrual cycles (in the middle of the cycle)
          • Foods
          • physical activities
        • Patho
          • trigeminal nerve depol
        • scotoma – is the aura
        • meds should be taken asap to have best results
  • DO NOT GIVE opiates to releave pain
          • ½ life of opiates is shorter than the migraine
            • rebound pain is extreme!
        • OTC meds are most effective
          • excedrin migraine
            • .25g acetaminophen, .25g aspirin and 65mg caffeine, nothing special
            • basic and effective
        • Ergot Alkaloid
          • Ergotamine
            • for migraines, Alpha blocker
            • S/E: HTN, MI trigger
              • increased risk of stillborn pregnancy increased uterine stim, and decreases the blood flow to the placenta
              • seperate 24hrs between the use of ergotamine and sumatriptan.
            • related to ACID
        • Serotonergic Drugs
          • Triptans
            • sumatriptan and zolmitriptan
              • stim 5 – HT in the brain
              • it vasoconstricts and inhibits inflammation
              • not for prophylaxis of migraines
              • S/E: stroke, MI, cerebral hemorrhage
  • don’t take within 24 hours of ergotamine
                • toxicity w/ other 5-ht blockers, prozac,paxil, zoloft
  • wait 2 weeks to use a MAO-I med
      • Reglan is great to help migraines and is an antiemetic
      • prevention
        • Beta blockers
        • Anti seizure
          • valproic acid, and topiramate
            • prevent gen depol of the cortex

Parkinson’s Disease

there needs to be a balance of neurotransmitters to prevent this

    • too little dopamine and too much acetylcholine
    • focus on improving gait, bradykinesia, and ADL
      • tremor and rigidity is not how they measure when to change doses
    • no real cures
    • Meds: Dopaminergic and anticholinergic agents
      • dopamine is the most common
        • Levodopa (Dopar)
      • anticholinergic
        • Benztropine (Cogentin)
    • Issues:
      • unpredictable in GI absorption and BBB crossing
        • changing # of sensitive receptors
    • MAO-B inhibitors are used in patients with mild symptoms
      • Selegiline and rasagiline
      • when the symptoms are increased, given meds change to levodopa and Dopamine agonist
      • S/E: drooling, constipation
    • Levodopa
      • best effect in the first two years
      • take time off the drug “holiday”
      • many d/d interactions
  • vitamin B6 allows less levodopa to get to the CNS
    • Carbidopa
      • no bad effects on its own
      • increase usable levels of levodopa in the CNS
        • Is the CAR that drives levodopa to the CNS
    • levodopa/carbidopa/entacapone can come in one pill
    • Pramipexole (Mirapex)
      • dopamine agonist
      • S/E: sexy grandpa/grandma
    • MAOI
      • 2 kinds
        • MAOA helps metabolize norepinephrine and serotonin
        • MAOB metabolizes dopamine
      • food interactions: aged cheeses and meats, yeast, bread, BEER
      • Selegiline (Eldepryl)
  • stop antidepressants 2-7 weeks befor using
  • Anticholinergic
    • Benzotropine (Cogentin) and trihexyphenidyl (Artane)
      • similar to atropine, antimuscarinic

Alzheimers

connection to chromosome 21 (and Down’s tri21)

statins may be helpful to slow onset and progression

research is looking at decreasing the “tangles”

  • disorganized web formation that is seen upon autopsy in the patient’s brain
    • thought of like a road block for neural impulses

Risk factors

  • Low education
  • smoking
  • physical inactivity
  • depression
  • HTN
  • DM
  • risk slightly reduced by
    • brain training, mediterranean diet and low ETOH
    • Not effective: gingko and Vit E

meds focus on increasing ACH levels, but are not very effective

  • all for early dementia, late dementia is not benifited by these drugs and the side effects are too much.

Acetylcholinesterase inhibitors

  • donepezil (Aricept)
    • stop ACHesterase, increasing ACH
    • treatment of early dementia

Cholinesterase inhibitors

  • works in 1:12 patients
  • S/E: diarrhea, Headache, dreams, bronchoconstriction
    • bradycardia and AV block

Pharmacology Test 2 study guide:

Finally the test two study guide is here. The list has information the was given to us as well as supplementary info that I think is important. There are drugs on this list that have more information than others and that is in concurrence with how important or complex that drug or concept is and hopefully how important it is. This list may have errors so please comment with any additions or subtractions that you see, and I will edit the post as soon as I get a chance. Thank you so much for reading and happy studying!

-Peter

ACE Inhibitor

  • Angiotensin converting enzyme inhibitors
    • stops RAAS system stop hypertension
    • step 1 for HTN meds
    • African population tend to respond poorly to ACE inhibitors

adenosine (Adenocard)

      • slows AV node conduction
  • for PSVT Paroxysmal supra ventricular tachycardia
    • rate of delivery is over 3 seconds by an MD, Very unique

Alpha blocker

  • Block the Alpha receptors which cause vessels to dilate
    • Lower BP

alprazolam (Xanax)

  • Anti anxiety
    • schedule IV, pregnancy class D
    • S/E: Dizzy, Lethargy, Drowsiness, CNS depression
    • grapefruit increases increases effects and the measurable levels of the drug

amiodarone (Cordarone)

  • Group III K channel blockers: delay repolarization
    • delays ventricular repol at qt
    • prolongs action potential
    • increases effective refractory period
  • Pulmonary toxicity
  • grapefruit interaction
  • Side effects: thyroid issues, blue grey skin,
  • D/D interactions: increase effect Digoxin, anticoags, statins, dilantin
  • life threatening dysrhythmias

Angiotensin Receptor Blocker

  • for HTN
  • blocks angiotensin II receptor from binding and causing vasoconstriction
  • ex.
    • Losartan (Cozaar)
      • Actions – more specific than ACE

Antacids

Antacids that can be bought over the counter (the goal is to bring pH of the stomach to about 3.5): Tums, Caltrate, OsCal, Viactiv(not w/ coumadin), Citracal (not w/ KD)

  • Action: increase stomach pH
  • indications: Peptic ulcer, GERD, hernia
  • ADME:
    • onset: 20-40 min (give 1-3hr before meal + night)
    • not meant to absorb, just buffer the acid
    • excreted in the feces
  • reduces Absorption of other drugs (chelation) due to the raise in stomach pH
  • S/E: constipation, bone deg, increased acid secretion, Kidney failure, Diarrhea
    • increased Ca, K and NA, decreased Mg
    • Kidney failure in chronic use

Antibiotics

  • used to treat H.pylori with bismuth and proton pump inhibitors
    • lasts for 2, and then the Antibiotics and bismuth drop off and the PPI is prescribed for 4 more weeks, about 90% of people are recovered after this treatment.
    • antibiotic- induced Diarrhea for the elimination of C. diff with the antibiotic fidaxomicin (Dificid)

antidysrhythmic drugs

Antidysrhythmic drug classes or group (listen to heart for 1 min)

  • I – quck Na channel blockers (broken up into three classes, but do not need to know that for the test
    • Ia – quinidine
      • procainamide (more side effects)
    • Ib – lidocaine
    • Ic – flecainide  
  • II – Beta Blockers
    • Propanolol
    • metoprolol
  • III – K channel blockers
    • Amiodarone
  • IV – Ca channel blockers
    • Verapamil
    • Dilitiazem
  • V – variable mechanism
    • Adenosine
    • Digoxin
    • Magnesium sulfate

Antiemetics

  • Action: Block CTZ (chemoreceptor trigger zone)
    • relieve nausea and vomiting
  • Anticholinergic: Scopolamine (Transderm-Scop)
    • for motion sickness
    • Side effects: Blurred vision, dry mouth and CNS depression
  • Antihistamines
    • Diphenhydramine (Benadryl)
    • Dimenhydrinate (Dramamine)
      • H1 blocker (antihistamine), CNS depression
  • Phenothiazine:
    • Prochlorperazine (compazine)
      • similar to atropine
  • Dopamine receptor blocker
    • Metoclopramide (Reglan)
      • Drousie, extrapyramidal effects, Diarrhea
  • Cannabinoid
    • Dronabinol (Marinol)
      • Made from THC

Anti-inflammatory

  • NSAID’s
  • Steriods
  • C-reactive protein levels reflect inflammation
    • high levels associated w/ increased risk of CV problems

Antiseasickness pills

Antiemetics will help, but not all.

    • Action: Block CTZ (chemoreceptor trigger zone)
      • relieve nausea and vomiting
  • Anticholinergic: Scopolamine (Transderm-Scop)
  • for motion sickness
  • Side effects: Blurred vision, dry mouth and CNS depression
  • Antihistamines
    • Diphenhydramine (Benadryl)
    • Dimenhydrinate (Dramamine)
      • H1 blocker (antihistamine), CNS depression

Atorvastatin (Lipitor)

  • Class: HMG-CoA reductase inhibitors
    • Action:block the synthesis of cholesterol
      • inhibits HMG-CoA reductase: so the pathway for cholesterol synthesis is blocked.
    • Indications: Hypercholesterolaemia, Coronary heart disease, Stroke, MI and chest pain
    • S/E: Rhabdomyolysis (ask about muscle pain and tell the patient to report any pain or weakness), Angioneurotic edema
    • stronger than simvastatin, not as strong and Rosuvastatin

Atropine

  • Anticholinergic/antiarrhythmic
    • Action: blocks vagal stimulation, which increases (HR) SNS
      • blocks Acetylcholine at prostaglandin sites
      • Tachy arrhythmias, Pulmonary edema, physostigmine is the antidote for an OD
      • side effects: red as a beet, mad as a hatter, hot as a hare,

Benzodiazepine drugs

    • for insomnia, anxiety, seizures, alcohol withdrawals
  • for acute use not chronic (does not cure Dx, can develop tolerance and dependence)
  • 14 days tops
      • schedule IV (most)
      • may be related
      • patho: increases the effect of GABA, calming, sedative
          • GABA receptors are dense in the limbic system, which messes with your emotions
  • abnormal non-REM sleep
        • BZ1 receptor: cerebellum: controls anxiety
        • BZ2 receptor: basal ganglia, and hippocampus: MM relaxation
      • side effects and interactions: Smoking decreases effectiveness, parental rout can cause cardiovascular issues and must adhere strictly to the rate, hypotension depression of RR(with IV), and CNS, Pregnancy risks.
  • IV, give slowly, needs to be monitored
      • make resp issues worse
    • will not cure, or meant to cure the symptoms
    • used for conscious sedation (colonoscopy)
    • Withdrawal: starts in 1 to 3 days and peaks in 1 to 2 weeks (depends if short or long acting drug)
      • weight loss, anxiety, weakness, insomnia, and tremors
    • ex: diazepam (Valium),
      • used for: Calms a person down so they don’t puke as much before chemo, alcohol withdrawal
      • the metabolites can collect over time and cause CNS depression
        • Resp. ↓ and hypotension
      • when given IV the vessel gets irritated  
        • burns in IV so dilute or slow down the rate of admin
      • #1 drug in the US
    • ex: lorazepam (Ativan)
      • similar to diazepam
      • for status epilepticus
      • dosing too fast can lead to bradycardia, RR depression, and apnea about 2 mg/min

Beta blockers

  • reduces heart rate and force of contraction and therefore O2 demand
  • long term only
  • makes vasospastic angina worse (prinzmetal)
  • Non-selective – decrease Cardiac contractility, drops bp and renin release
    • HTN, tachycardia, and angina
  • Some are more lipid soluble and more water soluble
  • Education – don’t change the regimen
    • OTC cold meds with pseudoephedrine/ phenyleprine
    • HR <45 don’t give
    • orthostatic hypotension
  • don’t stop the regime or the opposite effects happen, HTN, rapid HR

Bile acid sequestrants

  • Colesevelam (Welchol)
    • binds bile acid so it cannot reabsorb
    • does not decrease vitamin absorption and not many other meds
    • Not absorbed
    • for hyperlipidemia and high LDL
    • take with lots of fluids
  • cholestyramine (Questran)
    • Binds bile so it cannot be reabsorbed
    • used with statins
    • take with lots of fluids

Bismuth subsalicylate (Pepto-Bismol)

  • Antidiarrheal
    • promotes absorption in the intestines to decrease diarrhea  
    • bismuth is not absorbed, subsalicylate is
    • S/E constipation, grey stool,
    • OTC
    • if taken with ASA increases toxicity risk

Bulk-laxatives

psyllium (metamucil)

  • encreases stool size and softens by absorbing water, this increases the size of the bolus and pushes against the wall of the intestine to stimulate peristalsis
  • takes 12hr -3 days work
  • excreted in stool
  • NEED fluid for it to work!

Calcium carbonate (TUMS)

  • Action: increase stomach pH
  • indications: Peptic ulcer, GERD, hernia
  • ADME:
    • onset: 20-40 min (give 1-3hr before meal + night)
    • not meant to absorb, just buffer the acid
    • excreted in the feces
  • reduces Absorption of other drugs (chelation) due to the raise in stomach pH
  • S/E: constipation, bone deg, increased acid secretion, Kidney failure, Diarrhea
    • increased Ca, K and NA, decreased Mg
    • Kidney failure in chronic use

CCBs

  • Diltiazem (Cardizem)
  • Verapamil (Calan)
  • Calcium channel blockers
    • used in stable vasospastic angina, Arrhythmias, HTN
    • Slows HR

Cimetidine (Tagamet)

  • Peptic ulcer Drug
  • Acid-Neutralizing Drugs
  • H2 receptor blocker

digoxin

– positive inotropic, negative chronotrope, neg dromotrope

  • increased cardiac contractility
  • decreased conduction
  • indications: CHF, AFIB
  • use loading doses
  • SE: bradycardia, av block, anorexia, vision issues, green- yellow tint, halo around lights, gynecomastia with long term use.

dopamine (Intropin)

  • catecholamine (sympathomimetic)
    • increase BP, CO, vasoconstriction (B1, A2)
    • Very toxic to tissues
    • need large bore IV
    • For Cardiogenic shock primarily and vasoconstriction (neurogenic shock)

epinephrine

  • catecholamine (sympathomimetic)
  • Bronchodilation, vasoconstriction
  • A1, vaso constriction
  • Beta1, increase BP
  • can have a paradoxical bronchospasm

Eszopiclone (Lunesta)

  • Benzo-like drug
    • for sleep only, not anxiety
    • for increasing the duration of sleep
    • S/E sleepwalking, driving and such
      • Bitter after taste

Flumazenil

  • Benzo antagonist
    • no effect on a person not on a benzodiazepine
    • antidote for benzo OD or excessive effect
    • short half life so it is given through a drip or multiple IVP
    • S/E: hypotension, decreased respers, and cardiac arrest

H2 Blockers

  • Cimetidine (tagamet)
  • ranitidine (Zantac) fewer side effects and strogerew
    • Better value to prevent ulcer than PPI
    • Action: Lowers H2 secretion by stopping histamine from stimulating H2 receptors
    • Prevents PUD, acid reflux, hypersecretion

IV fluids

Lactulose

  • Osmotic Laxatives
  • and milk of magnesia
    • sugar, and salt that don’t absorb well and then attract water to induce peristalsis.
    • ↓serum Ammonia in people with chronic liver disease
    • works in 1-3 days and not much is absorbed into the body

Lidocaine (Xylocaine)

  • Group IB Na channel blockers
    • ↓ depol of mm contraction (decreases the time of action potential)
      • monitor on EKG
    • works first on the tissues with the issues
    • for Ventricular dysrhythmias acutely  
    • narrow therapeutic range
      • the maximum dose is 3mg/kg
    • Side effects – CARDIAC ARREST, confusion, tremors, twitching, blurry vision, tinnitus, dizziness, fainting, Bradycardia
    • D/D interactions with propranolol and cimetidine increase the drug levels

Lovastatin (Mevacor)

  • HMG-CoA reductase inhibitors
  • Stops the pathway for the synthesis of cholesterol
    • for hyperlipidemia when diet is not enough
    • Side effects: MYALGIA, can lead to mm damage, Kidney injury
      • more risky when taken w/ niacin or gemfibrozil
    • Grapefruit interaction, increase the level of the med

Melatonin

  • remelton (Rozerem)
    • activates melatonin receptors
    • hypnotic, for falling asleep
    • effect in 30mins, ok for chronic use
    • no dependence symptoms when stopped
    • safe for long term use

Metoclopramide ( Reglan)

Dopamine receptor blocker

  • gastric stimulant
    • Drousie, extrapyramidal effects, Diarrhea
    • S/E: Gynecomastia, bone marrow suppression

Misoprostol (Cytotec)

  • Prostaglandin
    • cytoprotective agent
    • PG E1 analog – ↓Acid secretion, ↑ Bicarb (HCO3) and mucus secretion
    • Category X, miscarriage
    • Prevents NSAID ulcers

Mylanta or Maalox liquids

  • Aluminum and magnesium antacid
    • neutralizes acid in the stomach increasing pH
    • may affect absorption of some drugs and foods

Narcan

  • Opiate Antagonist
    • Antidote for opiates
      • reverses the CNS and Respiratory effects of opioids
    • S/E V. fib

Niacin

  • nicotinic agent, lipid lowering agent
    • coenzymes for lipid metabolism
    • increased risk of myopathy with Statins
    • Flushing occurs
    • Vitamin B 3

Nitrates

Nitroglycerin SL, ointment, patch (NTG)

  • Organic Nitrate Vasodilators
    • nitroglycerin
      • both short and long term
      • vasodilates peripheral and coronary arteries
        • does not dilate the atherosclerotic vessels (so the elderly may not respond well)
        • Hypotension Fall risk
        • will get a headache and that’s OK
        • taken sublingual(minutes), ointment (half hour to hour and can cause tolerance)
      • wear gloves when applying the patch to avoid headache
  • Use for chest pain emergency
      • one SL wait 5mins
      • if after second dose pain is still happening call 911
      • take no more than 3 doses
    • Capsules
      • sustained release
    • Ointment
      • apply to hairless chest wall and cover with plastic
    • transdermal patch
      • don’t soak in water
  • rotate placement of patch
  • 10-12 hr time w/out patch
    • D/D interactions: any hypertension meds
      • nicotine
      • Phosphodiesterase
    • Light and heat will break down the drug and make it ineffective
  • Others for chronic angina
    • Beta blockers
      • reduces heart rate and force of contraction and therefore O2 demand
      • long term only
      • makes vasospastic angina worse (prinzmetal)
    • Calcium channel blockers
      • used in stable vasospastic angina

NSAIDs

  • Non steroidal anti inflammatory
    • Ibuprofen, ASA, acetaminophen
    • can cause ulcers
      • misoprostol and sucralfate can prevent these ulcers

Omega 3 fatty acids

    • fish oil
    • RX is Lovaza
    • not complete evidence in: dementia, Diabetes

Omeprasole (Prilosec)

  • Proton pump inhibitor
  • better at repairing ulcers than H2 blocker
  • Blocks acid secretion
    • Blocks ATPase at the parietal cells that would produce H2
    • treats: esophagitis from GERD, Duodenal ulcer, long term HTN
    • quick onset, 2h to peak, and ends effectiveness at 3-4 days
    • Side effects are: Heartburn, weakness, dizziness, C.diff risk increases, also cannot absorb Ca as efficiently
  • Ulcers can heal in a matter of weeks

Ondansteron (Zofran)

  • Block serotonin 5 HT3 receptors, antiemetic
    • D-D interaction with apomorphine causing hypotension
    • monitor EKG in patients with hypoK and Mg, HF, brady arrhythmias
    • can be hepatotoxic over 8mg for day  

Osmotic laxatives

  • lactulose and milk of magnesia
    • sugar, and salt that don’t absorb well and then attract water to induce peristalsis.
    • ↓serum Ammonia in people with chronic liver disease
    • works in 1-3 days and not much is absorbed into the body
  • polyethylene glycol (Golytely) (Glycerin sup in children)
    • draws water into intestine (sugar, salt, and PEG)
    • Cleansing before colonoscopy
    • (Other) metoclopramide (Reglan)
  • ↑ ACH, stim PSNS
  • ↑secretions, and motility
  • for GERD, risk of ileus, and to eliminate barium
  • Contra indicated in patient with intestinal blockage

Oxygen

Pancreatic enzymes (Prancrelipase)

    • ind: Pancreas insufficiency (pancreatitis, cystic fibrosis, Pancreatectomy)
    • Act: increased digestion in GI (enzymatic)
    • Enteric coated
    • S/E all abdominal, Fibrosing
    • hold if NPO, give before meals (dose based on calories)

Phenobarbital

    • Barbiturate
    • patho: increases the effect of GABA, calming, sedative
    • used in addition to anesthesia
    • for insomnia, seizures, anxiety (acutely)
  • develop tolerance to the therapeutic effect, but not to the side effects
  • liver makes more enzymes to break down the drug, and lowers the therapeutic half life.
    • used to treat neonatal kiddos to use this increased metabolic effect w/ hyperbilirubinemia.
  • S/E: ↓ CNS, cardiovascular function, and RR.
    • hangover, porphyria (werewolf?), suicide
  • withdrawal: seizures (if they have epilepsy), anorexia, weakness, chills, poor sleep
    • This is called abstinence syndrome

Phenothiazine antiemetics

  • Prochlorperazine (compazine)
    • antiemetic
    • management of nausea and vom.
    • depresses the CTZ, changes the effect of dopamine  
    • S/E: Neuroleptic malignant syndrome, and med leads to Reye’s syndrome in kids younger than 16
      • dry eyes and mouth, pink or reddish brown urine, agranulocytosis
  • similar to atropine

Phenytoin (Dylantin)

  • For tonic clonic seizures
    • blocks Na channels selectively
    • take often (tid)
    • low therapeutic index
      • half life is variable even in the same patient: 8-60 hr
    • S/E: gingival hyperplasia, CV effects, cognition issues, steven johnson syndrome and toxic epidermal necrolysis (like being burned inside out)
    • screws up Vitamins: deficiencies Folic acid, D and k

Pravastatin (Pravachol)

  • HMG-CoA reductase inhibitor, lipid lowering agent
    • Blocks synthesis of cholesterol
    • additive med for the prevention of CV disease in people that already have CHD
    • S/E: Rhabdomyolysis,
    • least impactful to most impactful
      • Lova-, Prava-, Simva-, Atorva-, Rosuva-
      • rosuvastatin newest, strongest, most side effects
      • HDL changes start at simvastatin

Promethazine (Phenergan)

  • Antiemetic
    • CTZ depression,  changes the effect of dopamine
    • S/E: agranulocytosis, neuroleptic malignant syndrome
      • dry eyes and mouth, blurry vision, and constipation

Propranolol

  • propranolol(only one that is not beta 1 selective), acebutolol, esmolol, sotalol
    • Decreases contractility, automaticity in SA, and slows conduction
    • cardioprotective for post MI and HF? this is now uncertain, and may not be true
    • slows conduction, HR, renin, BP,
    • increases cardiac output

Proton Pump Inhibitors (PPIs)

omeprazole (Prilosec) -prazole

  • better at repairing ulcers than H2 blocker
  • Blocks acid secretion
    • Blocks ATPase at the parietal cells that would produce H2
    • treats: esophagitis from GERD, Duodenal ulcer, long term HTN
    • quick onset, 2h to peak, and ends effectiveness at 3-4 days
    • Side effects are: Heartburn, weakness, dizziness, C.diff risk increases, also cannot absorb Ca as efficiently
  • Ulcers can heal in a matter of weeks

Ramelteon (Rozerem)

  • Hypnotic
    • melatonin agonist (activates receptors)
    • for insomnia, works in 30mins
    • more selective and effective than supplement of melatonin
    • D/D interactions: Fluvoxamine, Liver Dx’s, and alcohol
    • S/E: basically getting too sleepy, also amenorrhea

Ranitidine (Zantac)

ranitidine (Zantac) fewer side effects and strogerew

  • H2 receptor blocker
  • Better value to prevent ulcer than PPI
  • Action: Lowers H2 secretion by stopping histamine from stimulating H2 receptors
  • Prevents PUD, acid reflux, hypersecretion

Rosuvastatin (Crestor)

  • Strongest Statin
    • this means that it also has the most severe side effects
    • HMG-CoA reductase inhibitors

Sildenafil (Viagra)

    • erectile dysfunction and vasodilation
      • can treat pulmonary artery HTN
  • contraindicated use with Nitrates (nitroglycerin)
  • causes hypotension
    • S/E: MI, hepatic toxicity

Sodium Nitroprusside (Nipride)

  • vasodilation
    • breaks down into Nitrous oxide

Statins

  • HMG-CoA reductase inhibitors
  • Not all statins are alike
    • least impactful to most impactful
      • Lova-, Prava-, Simva-, Atorva-, Rosuva-
      • rosuvastatin newest, strongest, most side effects
      • HDL changes start at simvastatin

Stimulant laxatives

bisacodyl (Dulcolax)

  • stimulate peristalsis by affecting the muscle and mucus secreting cells
  • works in 6-8hr
  • can cause fluid loss (watery discharge), cramping, and dependence

Stool softeners

  • Docusate sodium
    • absorbent, water is pulled into fecal matter
    • causes the retention of water and electrolytes not letting them be absorbed into the body
    • takes 12 hours to 3 days

Sucralfate (Carafate)

  • anti ulceral, GI protectant
  • Protects ulcer by forming a barrier with the ulcer cells from acid in the stomach.
  • For PUD, and protect other ulcers from forming. (NSAID’s)

Tetanus

  • Caused muscle spasms including high HR and HTN
    • vaccination is Tdap

Zaleplon (Sonata)

  • Benzo-like drug
    • for sleep only, not anxiety
    • for falling asleep
    • S/E: sleepwalking, driving and such
    • rebound insomnia after tolerance is built over a time of longer than a week
    • Motor Paralysis “locked in”

Zolpidem (Ambien)

  • Benzo-like drug
    • for sleep only, not anxiety
    • for falling asleep and asleep and staying asleep
    • S/E: sleepwalking, driving and such
    • rebound insomnia after tolerance is built over a time of longer than a week