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Pharmacology Review II Chapters 28 - 38 All Materials in this presentation come from: Karch, A. (2008). Focus on: nursing pharmacology. New York, NY: Lippincott.

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Presentation on theme: "Pharmacology Review II Chapters 28 - 38 All Materials in this presentation come from: Karch, A. (2008). Focus on: nursing pharmacology. New York, NY: Lippincott."— Presentation transcript:

1 Pharmacology Review II Chapters 28 - 38 All Materials in this presentation come from: Karch, A. (2008). Focus on: nursing pharmacology. New York, NY: Lippincott Williams & Wilkins.

2 Sympathetic response Stress Causes Release of Norepinephrine Heart pounds Hormones released Breath hard Eyes wide open

3 Sympathetic response Stress Causes Release of Norepinephrine Beta 1 receptors Alpha 2 receptors Beta 2 receptors Alpha 1 receptors (1 heart) (2 lungs)

4 Sympathetic response Stress Causes Release of Norepinephrine Alpha 1 receptors Beta 1 Receptors Alpha 2 receptors Beta 2 Receptors

5 Sympathetic response Stress Response Alpha 1 receptors Dilate pupils Close bladder spinchter Vasoconstrict blood vessels Alpha 2 receptors Regulate norepinephrine Moderate insulin release Beta 2 receptors Dilate bronchi Breakdown glycogen Relax uterine muscle Beta 1 receptors Increase heart rate Breakdown fat for energy

6 Sympathetic response Stress Response Alpha 1 receptors Agonists “ine” Blockers “zosin” Alpha 2 receptors Clonidine Beta 2 receptors Blockers “olols” Beta 1 receptors Blockers “olols”

7 Parasympathetic Response Acetylcholine responses Heart slows Digestion starts Bladder works Eyes constrict Bronchi constrict

8 Parasympathetic Response Muscarinic Receptors (Smooth muscle) Pupils, bladder, GI motility Heart vessels Nicotinic Receptors NMJ Muscle constractions

9 Heart Rate medications Too Low Too fast Adrenergic Agonists Epinephrine Dopmaine Dobutamine Adrenergic Blockers Amiodarone Bretylate Carvediol

10 Adrenergic Agonists - “ine” Ephedrine Dopamine Dobutamine Aramine Norepinephrine Epinephrine David Price “ine” it to win it! The race against time with shock

11 Case Study # 1 Adrenergic Agonists Your patient, 70 yr old diabetic, suddenly goes into shock….. knowing that diabetes contributes to nephropathy… You quickly tell the rapid response team because they will want to use what? Instead of epinephrine for him…….

12 Dopamine Dopamine stimulates heart and blood pressure and Increases blood flow to the kidneys to prevent renal shutdown Help me! I need oxygen…

13 Case Study # 2 Adrenergic Blockers Daniel’s grandfather told him to start taking saw palmetto for BPH. Daniel is not old enough to be worried about BPH, but since he knows grandpa is hypertensive and has CHF… He warns him about…..

14 Increased adrenergic efffects Herbs, teas, and alternative medicines (like saw palmetto) can cause serious arrhythmias or blood pressure changes Carvediol (Coreg) is used for hypertension and CHF

15 Case Study # 3 Adrenergic Blockers Stephanie, a new nurse, forgot to take Mrs. Jones’ HR before giving her her morning dose of amiodarone. Now, her heart rate is very low, 49 bpm… Why?

16 Adrenergic Blockers Amiodarone and carvedilol work to slow the heart rate. Mrs. Jones’ may have had bradycardia and it has become worse. Patients in shock, CHF or with asthma should also avoid these drugs.

17 Alpha Adrenergic Blockers Doxazosin Alfuzosin Terazosin Tamulosin Prazosin (Minipress) That patient is not “dozin” on the floor! Orthostatic hypotension Is a side effect of Prazosin (anti-hypertensive)

18 Case Study # 4 Adrenergic blockers Speaking of prostrates and BPH, Which adrenergic blocker used to treat hypertension is also effective in the treatment of BPH?

19 Adrenergic Blockers - “zosins” Doxazosin (Cadura)1 - 8 mg PO/day treats hypertension, BPH Tamsulosin (Flomax) BPH only lfuzosin (Uroxatral) BPH only Have the PSA level checked regularly

20 Beta Blockers Treat –hypertension –Angina –Migraines –Reinfarction after MI –Syncope –Cardiac arrhythmias –Stage fright These block the “fight or flight” response…. Inderal… kick in about now!!!

21 Beta Blockers - “olols” Carteolol Nadolol - Corgrad Penbutolol - Levator Pindolol Propranolol - Inderal Sotalol - Betapace Timolol What’s all that “lol” crap on the cell phone. I got all the “lols” I need For my hypertension

22 Beta Blockers Timolol*, also a beta blocker, is used to treat glaucoma. Do not use if patient has bradycardia *(Material in ATI prep) Apply cotton ball here to prevent Systemic effect

23 Case Study # 5 Beta Blockers Kasey’s mom has been taking Nadolol (Corgard) to control her hypertension and angina (she’s a nurse and it’s stressful). The family went on a picnic to enjoy all the spring flowers in Knoxville…. Now she’s in ER because she can’t breathe… what’s going on?

24 Beta blockers Remember: Beta 2 receptors dilate the lungs Beta blockers inhibit this response Bronchospam, COPD, Asthma, diabetes and hypoglycemia are all contraindicted Kasey’s mom’s lungs were unable to dilate with the inflammation caused by the pollen

25 Beta 1 blockers If you work in East Tennessee, get use to : Sectral (acebuterol) Zebeta (bisoprolol Lopressor (metropolol) Toprol Atenolol for COPD, hypertension and seasonal rhinitis

26 Case Study # 6 Cholinergic agents Mrs. Brown had a bladder lift surgery (urethral sling). She has high expectations but right now she can’t even pee…. The doctor prescribes: Urecholine (bethanechol). How will you monitor her progress?

27 Cholinergics Monitor her BP, ECG, urine output and lung sounds These drugs stimulate the parasympathetic system. Side effects include: increased salivation, diarrhea, GI upset

28 Case Study # 7 Indirect acting cholinergics If you have myasthenia gravis and become exposed to nerve gas… Good News ! Why?

29 Pyridostigmine Pyridostigmine acts as an antidote. This drug allows Ach to accumulate in the synaptic cleft to give patients some control of muscles. Nerve gas causes paralysis as ACH accumulates at the NMJ.

30 Prostigmin (neostigmine) Another cholinergic for mysastenia gravis that increases GI motility Side effects: urinary frequency Incontinence (on ATI practice exam) Know this!

31 Case Study # 8 Alzheimer’s Disease Many older patients are now taking Aricept (donepezil) for mild to moderate Alzheimer’s. How would you counsel the caregiver of a patient starting Aricept?

32 Aricept (donepezil) 5 -10 mg PO at bedtime Eat frequent small meals to offset nausea, vomiting Side effects do include insomnia and fatigue Increased risk of GI bleeding with NSAIDs

33 Anticholinergics Inhibit vagal responses in the heart Relaxes the GI Inhibits GI secretions Causes mydriasis, cyclopegia Treats parkinsonism “Can’t see, can’t pee, can’t eat!”

34 Case Study # 9 Anticholinergics What are the contraindications? Think of any condition that could be aggravated by blocking the parasympathetic system…..

35 Anticholinergics Contraindications: Glaucoma, Paralytic ileus Tachycardia Myasthenia gravis Side effects: Blurred vision Pupil dilation Weakness Insomnia Dry mouth Constipation Urine retention example: Atropine Dries you out like a desert..

36 Case Study # 10 Vasopressin


38 Case Study # 11 Glucocrticoids Laura hurt her knee running the mini- marathon. Her doctor prescribed short term treatment with prednisone and told her to come back in two weeks to see if she needed knee surgery…. Should she go ahead and get her chicken pox vaccine for nursing school while she’s there?

39 Glucocoticoids and vaccines No! Laura! Glucocorticoids block the immune response and cause a risk of infection to live virus vaccines. Live Vaccines: Measles Mumps Rubella Polio Varicella (chicken pox)

40 Case Study # 12 Glucocorticoids Pat goes from doctor to doctor. She has no idea how long she’s been taking prednisone for back pain. She’s had hydrocortisone injections in both knees. Now, Pat is taking prednisolone for her asthma…besides gaining a ton of weight… what else is going on?

41 Glucocorticoids Prolonged use causes risk of: Adrenal insufficiency (ACTH depleting) Diabetes (glucose elevating) Fluid retention (weight gaining) Protein breakdown (muscle shrinking) Immunosuppression (germs getting) Osteoporesis (bone shrinking)

42 Case Study # 13 What does Katy Perry (Pink) have in common with the thyroid? Hint: “Your hot, then your cold, up then your down!” The thyroid regulates????

43 Thryoid function Thyroid hormones affect: Heat production Body temperature Oxygen consumption Cardiac output Blood volume Metabolism Hey, don’t forget us! The parafollicular cells Reduce clacium resoprtion

44 Thyroid function Hypo Most common Women over 50 Elderly Goiter, obesity, lethargy, coarse skin, thick tongue Hyper Graves’ disease Tachycardia Palpitations Intolerance to heat Flushing hypertension Treat with Levothyroxine (Synthroid) Treat with PTU (propylthiouracil)

45 Case Study # 14 Joan has typical Graves’ disease symptoms: puffy eyes, increased body temp., tachycardia and hypertension. You tell her that PTU treatment will help her attention span and focus* but she needs to know…… (*this info from ATI material, not textbook)

46 Graves’ disease PTU causes an increased risk for bleeding with oral anticoagulants Monitor serum levels of digoxin, metoprolol, and propranolol as patient heart rate returns to normal (euthyroid state).

47 Case Study # 15 Antihypercalcemic agents Christine’s mom has been taking Fosamax (Alendronate) for several weeks. She says, “I know I need it for my bones, but it upsets my stomach awful…” Christine finds out her mom has been taking it with breakfast and then lays back down for awhile…should she stop taking it?

48 Fosamax (alendronate) Christine tells her mom: For maximum effect with Fosamax, Take it 30 minutes before breakfast and remain upright at least 30 minutes. Christine is going to order the newspaper for her mom to read before breakfast.

49 Hyperglycemia Blood sugar > 126 mg/dL Can contribute to: Atherosclerosis Retinopathy Neropathy Nephropathy Watch for: Fruity breath Fatigue Irritation Itchy skin Dehydration Kussmaul’s respirations

50 Hypoglycemia Blood Sugar < 40 mg/dL Recognize these signs: Headache Blurred vision Tachycardia Hunger, nausea Diaphoresis, cool clammy skin Patient may appear drunk !

51 Case Study # 16 Antidiabetic agents Brittany’s aunt is diabetic. The doctor has warned her to monitor her sugar carefully. Her HBA1c was 9%. She has been stopping by Krispee Kreme again. How can Brittany tell?


53 HbA1c Glycosylated hemoglobin levels provides 3-month average of glucose levels. No fasting is required. 6% indicates a pre-diabetic level Should be < 7%

54 Case Study # 15 Antidiabetic agents The nurse gave Mr. Greene 1 mg glipizide before breakfast as usual. The trays at the nursing home were delayed because the chef was late to work. Mr. Greene is shaky and in a cold sweat. What should be done?

55 Antidiabetics Give Mr. Greene 4 oz. of orange juice or some form of 10-15 g of carbohydrate Then check his blood glucose level and vital signs Patients on beta blockers may also have hypoglycemic and hyperglycemic episodes but warning signs are blocked

56 Case Study # 16 Antidiabetic Michelle is a high school sophomore with Type I diabetes. She has had several recent hypoglycemic episodes. You, the school nurse, meet with Michelle to ask her how often she is checking her blood glucose level… How often should she check it? Breakfast

57 Type I Diabetes Michelle needs to be checking her blood glucose level 3 -5 times per day.

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