SNS Drugs Indications: Hypotension, CHF

ADRENERGIC DRUGS
MGNT:
A. ALPHA AND BETA AGONISTS
 V/S: HR and BP – monitored regularly
 Epinephrine (adrenaline cl)  For accuracy: infusion pump
 Norepinephrine (levophed)  Antidote: Phentolamine (Regitidine, Regitine)
Action: stimulates Alpha 1: vasoconstriction – increases  Prevent extravasation
BP -tendency to leak; (+) leakage
Beta 1 – bronchodilation -vein: large
Beta 2 – increases HR and BP -tubing: mini drip
Indicated: Hypotension related to shock -if (+) extravasation: STOP INFUSION
Cardiac arrest
Anaphylaxis – bronchospasm; allergic E. BETA 2 AGNONISTS – Bronchodilators
reaction Action: relaxes the bronchus
MGNT: Effect: Dilation
 V/S: HR and BP – monitored regularly -Refer to first drug in respi
 Antidote: Phentolamine (Regitidine) or Regitine
 Route: Community: SQ ANTICHOLINERGIC DRUGS
Hospital: IV  Atropine sulfate- popular
 Epinephrine:  Glycopyrrolate (Robinul)
o DOC of: Anaphylaxis, Bronchospasm, Action: blocks Ach – blocks PNS = SNS effect
Status asthmaticu -pupul dilation for eye exam
-decrease GIT contraction:
B. ALPHA AGONISTS decreases Hcl for PUD
 Phenylephrine (Neo-Syneprhine) -decreases oral secretions: prevent aspiration;
Action: stimulates Alpha 1: vasoconstriction indicated as a pre-op med and procedure like
Indicated: nasal constriction Electroconvulsive therapy, or ECT
MGNT: S/E: SNS
 Avoid IV overdose MGNT:
 Caution: Hypertension or Hypertensive Crisis  Given: preop (before surgery)
and Dysrythmias  Contraindicated: Glaucoma
 Diet: Increase fiber: FOWL
C. BETA 1 and 2 AGONIST (NONSELECTIVE)  DOC:
 Isoproterenol (Isuprel) o Bradycardia: Atropine Sulfate (0.5-1mg)
 Ritrodine (Yutopar)
Actions: B1: increase HR and BP PNS Drugs
B2: bronchodilation
S/E: SNS; dry mouth, increase VS, constipation, urinary ADRENERGUC BLOCKING AGENTS
retention
MGNT: A. ALPHA BLOCKERS
 V/S: HR, BP  Phentolamine (Regitine)
 DOC for preterm labor: Yutopar (relaxes  Ergotamine tartrate (Ergomar)
uterus); also can be used as bronchodilator Action: Blocks alpha 1 = vasodilation which decreases
BP
D. BETA 1 AGONISTS (SELECTIVE) Indications: HPN Crisis DOC is Phentolamine
 Dopamine Hcl (Inotropin) Angina
Action: B1- increase HR, BP and Cardiac Output – MI
alternative for CHF For Pheochromocytoma: DOC is Phentolamine
S/S: PNS – decrease vital signs, increase salivation, Indicated: Myasthenia gravis problem: decrease Ach
increase GIT S/E: PNS
MGNT:
 VS: BO  DX drug: Edrophonium Chloride (Tensilon)
 C/I: caution to pregnant – ergotamine can cause Route: IM/IV
uterine contraction Onset: 1 min to diagnose
(+) MG = sudden increase of muscle strength
B. BETA BLOCKERS Duration: short duration: 5-20mins
(cannot be used as maintenance)
If dx already: to differentiate Myasthenic crisis
from cholinergic crisis

 Refer to cardio Myasthenic Crisis Cholinergic Crisis (PNS)

Cause: under medication Over medication
C. CHOLINERGIC DRUGS
 Pilocarpine (Akarpine) S/S: Weakness Weakness
Action: Stimulate PNS (increases Ach)
– stimulates pupil constriction for Give tensilon: (+) MC if (+) CC if worsens
Glaucoma improved or increase muscle weakness
S/E: PNS; diarrhea, salivation, decreases VS, erection muscle strength
Caution: BRONCHOOCONSTRICTION –mag-ingat
MGNT:
MGNT:
 Given: before meal (30 minutes before)
 Antidote: Atropine Sulfate
 Given on time: to maintain the therapeutic level
 If given for glaucoma: LIFETIME
-if early: high risk for cholinergic crisis
 DOC:
-if late: high risk for myasthenic crisis
o Urinary retention: Bethanecol (increase UO)
 Antidote: Atropine Sulfate
o Glaucoma
-Miotics: pupil constriction
-Cholinergic
-Optic Beta blockers
 Timolol (Pupil constriction,
inhibit aqueous humor
production)
-Carbonic Anhydrase Inhibitor
 Diamox – inhibit aqueous
humor production which ANTIALZHEIMERS
decreases the IOP; this drug is  Tacrine (cognex)
nephrotoxic and hepatotoxic  Donepezil (Aricept)
 Monitor BUN; ALT  Galantamine (reminyl)
 Rivastigmine (Exelon)
D. ANTICHOLINESTERASE Action: increases Ach
 tigmine Pathophysio:
 neostigmine (Prostigmin) Alzheimers
 Pyridostigmine (Mestinon) Cause: plaques and tangles which damages dendrites
Action: Increases Ach level and affects Ach
Effectiveness: Increase muscle strength
-increase chewing ability
-louder speech
S/E: PNS  Toxic signs: Slurred speech/ sedation
MGNT: Ataxia – uncoordinated movement
Taken: bedtime – Aricept Nystagmus – jerky movement of the eye
1st drug: Cognex – hepatotoxic: may cause jaundice S/E: Gingival Hyperplasia
Lab: ALT
DOC: Aricept MGNT:
 Hygiene: Oral
ANTIPARKINSON AGENTS (soft toothbrush, dental check up every 6mos,
A. DOPAMINERGIC rinsing of the mouth: nonalcoholic base
 Dopa mouthwash)
 Levodopa (laradopa)  Urine color: brown
Action: increase dopamine level in brain  Prevent precipitation: route – IV
Effect: decreases tremors (initial) o Flush: NSS/ NaCl 0.9%
S/E: Postural hypotension – priority: SAFETY
Anorexia C. OTHER ANTICONVULSANTS
N/V  Carbamazepine (tegretol)
Gastric Irritation  Valproic acid (Depakene)
 If dopamine given IV: cannot cross BBB
 If oral: it can cross then converts to dopamine D. ANXIOLOYTICS/ANTIANXIETY
MGNT  Benzodiazepine
 Given with meal: due to Gastric irritation  Am/pam
 Lifetime  Diazepam (valium)
 Urine color: dark or brown (Expected)  Lorazepam (Ativan)
 Avoid: Action: Increases GABA – inhibit anxiety and seizure
o Vitamin B6 – it decreases the  DOC for Status epilepticus (uninterrupted
absorption of dopamine seizure)
Eg. Crops, peanuts
o MAOI – it can cause D-D interaction GENERAL MGNT:
o Protein (limit or restrict) - it decreases  Avoid activities that requires alertness
the absorption of dopamine o Driving
o Operating machines
B. DOPAMINE AGONIST  Taper – gradually stop
 Amantadine (symmetrel) -to prevent status epilepticus
Action: helps or stimulate in dopamine production  Epilepsy (chronic recurrent; pabalik-balik)
: Phenobarbital
ANTICONVULSANTS  Grand mal Seizure: Phenytoin
Action: slows CNS transmission (impulse)  Status epilepticus: Diazepam
 Tic Douloureaux: Carbamazepine (Tegretol)
A. BARBITURATES
 Bital
 DOC: Epilepsy

S/E: CNS depressant:

sedation, drowsiness, dizziness, lethargy

B. HYDANTOINS
 Toin
 Phenytoin (Dilatin)
 Normal Blood level: 10-20mcg/ml
MUSCULOSKELETAL Drugs B. ALLOPURINOL (ZYLOPRIM)
Action: prevent uric acid production/ formation/
MUSCLE RELAXANTS synthesis
 Baclofen (lioresal) Effect: Decreases serum uric acid
 Succinylcholine (Anectine) DOC: Chronic Gouty
 DOC: Multiple Sclerosis S/E: GI upset – irritation
Action: inhibits Calcium release into the muscles MGNT:
Thus it relaxes the muscles  Full effect: 1 week (1-2 weeks)
Effect: Decreases the spasm or decreases spasticity  Given: with meal
 Nephrotoxic – increase fluid
S/E: CNS depression; sedation, drowsiness, lethargy Avoid:
MGNT: o Alcohol
 Route: o Beer
o Baclofen – oral or intrathecal (into the -These contain purine
spine) o Sun exposure (photosensitivity)
o Dantrolene: oral o Excessive vitamin c
Dose: (high risk for stone formation – uric acid)
15-20mg – baclofen
100mg – dantrolene C. URICOSURIC
 Priority: Safety  Probenicid (Benemid)
 Avoid: DRIVING and operating machines Action: promote excretion of uric acid
MGNT:
BIPHOSPHONATES  Given if inflammation subsides
 Dronate  Increase fluids – facilitate secretion of UA
 Alendronate (Fosamax) DOC for Osteoporosis  Avoid ASA – aspirin decrease absorption
Action:
prevent Calcium resorption (Calcium: bone to blood)
thus calcium stays in the bone
S/E: Esophagitis

MGNT: Alondronate
 Position patient UPRIGHT (HIGHFOWLERS)
30mins after taking the drug
 Taken with a glass of water
 Given AM (morning) before breakfast
Avoid:
-Crushing
ANALGESICS
-Mixing with food
A. NON NARCOTICS
1. Acetylsalicylic acid (Aspirin) – NSAIDs
ANTIGOUT
Actions:
A. COLCHICINE (COLGOUT)
o Analgesic
Action: prevent deposition of uric acid to the joints
o Anti-inflammatory
It interferes inflammation
DOC: Acute Gouty -prevent prostaglandin synthesis:
MGNT: 1 decrease pain 2 inflammation
 Given after meals o Antipyretic – regulates hypothalamus –
 Toxic sign: DIARRHEA – STOP decrease fever and temperature
o Antiplatelet – prevent coagulation; prevent
platelet aggregation
  Given with meal
Indicated:  Caution: Disorders like PUD
MI – to prevent thrombus  Choice for PDA – indomethacin (if gamay ra ang
CVA buslot)
Effect: 1-3 weeks  Choice for dysmenorrhea – Ibuprofen
S/E: GI irritation, abdominal distention
 Taken: With MEAL 4. Cyclooxygenase 2 Inhibitors
 Normal blood level: 20-30mg/dl  coxib
 Toxic signs: Ototoxicity – tinnitus, hearing loss  Rofecoxib (Vioxx)
(bilateral) Action: prevent prostaglandin synthesis
 Avoid: -decrease pain
o Contact sports S/E: Tiredness
o Anticoagulants/thrombolytic unless Ulceration
needed GI irritation (lesser compare to NSAIDs)
o Rectal procedures MGNT:
o Viral infection combine with ASA can  With meal
cause Reye’s Syndrome  Cross allergy = aspirin and NSAIDs
o Edge razor – blade
B. NARCOTICS/OPIATES/OPIOIDS
2. Acetaminophen (Tylenol)  Morphine (morphine sO4)
Action:  Meperidene hcl (Demerol)
o Analgesic  Fentanyl (Duragesic)
o Antipyretic Action: blocks pain impulses (CNS)
-prevents prostaglandin synthesis that Indicated: severe pain
decreases the pain o MI
A/E: HEPATOTOXIC S/S: Jaundice o Pancreatitis
MGNT: o Cholecystitis
 Dosage: 625mg o Post-op pain
 Avoid: Alcohol o Advance CA pain
 Antidote: Acetylcysteine (Musocmyst) S/E: Respiratory Depression; <12RR
 Normal blood level: 10 -20mcg/ml Constipation
 Lab: ALT – alanine transaminase (SGPT – serum MGNT:
glutamic pyruvic transaminase)  V/S: RR – if below 12RR; withhold drug
 Route: IV/oral
3. NSAIDS -morphine – 1 is to 3 (1:3)
 Naprosyn (Flanax) Eg: 2mg : 6mg
-to prevent tolerance
 Naloxone (Narcan)
 Avoid alcohol: it’s a CNS depressant
 Safety precautions
Common board Question
 DOC
 Advance CA pain: Morphine
 Anxiety in pulmonary edema: morphine
Action: prevent prostaglandin synthesis
 Opioids withdrawal: methadone
= pain and inflammation decreases
 Urinary analgesic: Pyridium
Indication: Mild pain
 Less respiratory depression: Codeine
-arthritis, wound
S/E: GI irritation
MGNT:
ANTIBIOTICS ANTIVIRALS
Action: prevents protein (building block of the cell) and  vir
cell wall synthesis  Acyclovir (Zovirax)
-it kills the bacteria  Intended for viral infection, varicella (chicken
pox, shingles)
1. AMINOGLYCOSIDES
 Mycin Antiretrovirals
 It is OTOTOXIC – tinnitus, hearing loss  Vudine
 Zidovudine (AZT, Retrovir)
2. CEPHALOSPORINS  For HIV-AIDS
 Ceph/cef
Action: prevent replication/duplication of the virus
3. FLUOROQUINOLONES -it will NOT kill the virus
 Floxacin S/E: constipation
 DOC: Anthrax: Ciprofloxacin A/E: bone marrow suppression; decrease plt, rbc, wbc;
Nephrotoxic
4. MACROLIDES MGNT:
 Thromycin  Lab: creatinine and BUN, CBC
 Azithromycin  Diet: increase fiber
 Herpes: if ointment: every 3 HRS
5. PENNICILLINS
 Cillin ANTIPROTOZOAL
 Amoxicillin  Metronidazole (Flagyl)
Action: kills protozoa
6. SULFONAMIDES Indications:
 Sulf o Amoebiasis
 Sulfur-based drugs o PCP (Pneumocystis Carinii Pnremonia)
 Avoid sun exposure NEW: Jiroveci
S/E:
7. TETRACYLCLINE o Headache
 Cycline o Anorexia
o Nausea
GENERAL MGNT: o Dry mouth
 Nephrotoxicity: increase BUN and crea; MGNT:
decrease UO  Avoid Alcohol – cause disulferam like reaction
 Ototoxicity: vertigo, tinnitus, hearing loss  Urine color: brown
 SKIN TEST: to assess allergy  Given with meal
 Culture and sensitivity  Teratogenic: avoid pregnant
-to determine the exact microorganism and
exact antibiotic
 Monitor urine output
 Lab: BUN, Creatinine (serum)
 Hearing and balance – ototoxicity
 Increase fluid intake
 Best taken on empty stomach to increase
absorption; with food if pt have GI problems