Pharmacology

for Paramedics
Jeremy Maddux, NREMTP, I/C
Historical Trends
¡n Pharmacology
· Ancient health care
÷ Herbs & minerals used to treat sick & injured
÷ Documented use as long as 2,000 B.C.
÷ Ancient Egyptians, Arabs, & Greeks
· The renaissance period
÷ Pharmacology became a distinct and growing
discipline
÷ Separate from medicine
Historical Trends
¡n Pharmacology
· Modern health care
÷ Last 50 years have seen explosion in growth of biological
sciences and associated medicine and pharmacology
· The present period of change
÷ Research directed to discover new treatments, cures and
prevention of disease
· New trends in health care and
pharmaceutics
÷ Orphan drugs developed to treat rare and chronic
diseases
Drug Names
· Chemical Name
÷ Precise description of the drug's chemical
composition and molecular structure
÷ 7-chloro-1, 3-dihydro-1methyl-5-phenyl-2H-1, 4-
benzodiazepin-2-one
· Generic Name (Non-proprietary Name)
÷ Official name approved by the FDA
÷ Usually suggested by the first manufacturer
÷ diazepam
Drug Names
· Official Name
÷ The name assigned by the USP
÷ diazepam, USP
· Trade Name (Proprietary Name)
÷ The brand name registered to a specific
manufacturer or owner
÷ Valium ®
8ources of Medications
· Plants
÷ morphine sulfate, atropine
· Animals and/or Humans
÷ insulin, ACTH
· Minerals
÷ sodium bicarb, calcium
· Synthetic (Chemical Substances)
÷ lidocaine, diazepam
Drug Classification
· By Body System
÷ Sympathetic Agonist, Anticholinergic
· Class of Agent
÷ Antidysrhythmic, Analgesic
· Mechanism of Action
÷ Calcium Channel Blocker, Diuretic
8ources of Drug
¡nformation
· Physicians Desk Reference (PDR)
· Hospital Formulary (HF)
· Drug Ìnserts
· Other texts/sources
÷ Brady
÷ Ìnternet
÷ Mosby
Medication
Regulation & Licensing
· Pure Food & Drug Act (1906)
÷ Ìmprove quality of labeling
· Harrison Narcotic Act (1914)
÷ Regulated importation, manufacture, sale,
& use of opium and cocaine
· Federal Food, Drug, & Cosmetic Act
(1938)
÷ Empowered the FDA (standards)
Medication
Regulation & Licensing
· Durham-Humphrey Amendments (1951)
÷ Required prescriptions
÷ New category (over-the-counter)
· Controlled Substances Act (1970)
÷ Replaced the Harrison Narcotic Act
÷ Created 5 Drug Schedules
Drug 8chedules
· Schedule Ì
÷ Heroin, LSD
÷ NO accepted
medical use
· Schedule ÌÌ
÷ Opium, Cocaine
÷ Accepted medical
use
÷ Severe dependence
· Schedule ÌÌÌ
÷ Tylenol with Codeine
÷ Low dependence
· Schedule ÌV
÷ Diazepam
÷ Limited dependence
· Schedule V
÷ Opiods (cough)
8cope of Management
· You are held responsible for safe and
therapeutically effective drug
administration
· Personally responsible for each drug
you administer
÷ Legally
÷ Morally
÷ Ethically
8cope of Management
· Use correct
precautions and
techniques
· Observe and
document effects of
drugs
· Keep knowledge base
current
· Establish & maintain
professional
relationships
· Understand
pharmacology
· Ìdentify drug
indications and
contraindications
· Seek drug reference
literature
· Take a drug history
from patients
· Consult with medical
direction
The º8ix Rights" of
Medication Administration
· Right Medication
· Right Dose
· Right Time
· Right Route
· Right Patient
· Right Documentation
Autonomic Pharmacology
· Central Nervous System (CNS)
· Peripheral Nervous System
÷ Somatic Nervous System
÷ Autonomic Nervous System (ANS)
· Sympathetic Branch
· Parasympathetic Branch
Autonomic Nervous
8ystem Characteristics
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AN8
Anatomy & Physiology
· The nerves of the ANS exit the CNS
and subsequently enter specialized
structures called autonomic ganglia"
÷ Preganglionic fibers
· Pass between the central nervous system
and the ganglia
÷ Postganglionic fibers
· Pass between the ganglia and the effector
organ
8ympathetic versus
Parasympathetic
· Sympathetic ganglia
÷ Located close to the spinal cord or
midway between the spinal cord and the
effector organ
· Parasympathetic ganglia
÷ Located close to or within the walls of the
target organs
Cholinergic and
Adrenergic Fibers
· Cholinergic
÷ Fibers that release acetylcholine
÷ All preganglionic and postganglionic of
the parasympathetic division
· Adrenergic
÷ Fibers that release norepinephrine
÷ Most postganglionic fibers of the
sympathetic division are adrenergic, but
some are cholinergic
Neurochemical
Transmission
· No actual physical connection exists
between two nerve cells or between a nerve
cell and the organ it innervates
÷ Syanpse
· Space between nerve cells
÷ Neruroeffector junction
· Specialized synapse between two nerve cells or a
nerve cell and an organ
÷ Neurotransmitter
· Chemical messenger that conducts a nervous impulse
across a synapse
Neurotransmission
Neurotransmitters
· Acetylcholine
÷ Preganglionic nerves of sympathetic
nervous system
÷ Preganglionic and postganglionic nerves
of the parasympathetic nervous system
· Norepinephrine
÷ Postganglionic nerves of the sympathetic
nervous system
Acetylcholine
· For cholinergic synapses acetylcholine
molecules combine with cholinergic
receptor molecules
÷ Nicotinic Receptors
· Produces an excitatory response
÷ Muscarinic Receptors
· Produce an excitatory or inhibition, depending
on where the target receptors are found
Norepinephrine
· For adrenergic synapses
norepinephrine molecules combine
with adrenergic receptor molecules
÷ Alpha Receptors
· Blood vessels
÷ Beta Receptors
· Heart
· Lungs
Catecholamines &
Related 8ubstances
· Dopamine
÷ Raises pain threshold & increases
tolerances to pain
· Epinephrine
÷ Emergency hormone releases by the
adrenal medulla
Catecholamines &
Related 8ubstances
· Norepinephrine
÷ Ìmportant transmitter of nerve impulses
· Serotonin
÷ Released by injured tissues
· Enhances pain at local level
· Ìnhibits pain when it acts on the CNS
Brain Peptides
· Enkephalin
÷ Weak analgesic effect that binds with opiate
receptors
· Endorphin
÷ Higher analgesic effect that's highly
concentrated in the hypothalamus and spinal
cord
· Dynorphin
÷ Analgesic effects fifty times than others
General Properties
of Drugs
· Drugs do not confer any new functions on a
tissue or organ, they only modify existing
functions
· Drugs in general exert multiple effects rather
than a single effect
· Drug action results from a physiochemical
interaction between the drug and a
functionally important molecule in the body
Pharmokinetics
· Mechanisms that affect pharmokinetics
÷ Absorption
÷ Distribution
÷ Biotransformation
÷ Excretion
Absorption
· Variables
÷ Route of
Administration
÷ Solubility of the
Drug (H2O)
÷ Drug Concentration
(ionize)
÷ pH
· Mechanisms
÷ Diffusion
÷ Osmosis
÷ Filtration
Distribution
· Drug reservoirs
÷ Plasma protein binding (molecules)
÷ Tissue binding (adipose or fat)
· Barriers
÷ Blood-brain barrier
÷ Placental barrier
Biotransformation
· Also known as metabolism where a
drug is chemically converted to a
metabolite
÷ Active metabolites
÷ Ìnactive metabolites
Excretion
· Organs of excretion
÷ Kidneys
÷ Ìntestine
÷ Lungs
÷ Sweat & salivary glands
÷ Mammary glands
Drug Forms
· Liquid
÷ Solutions
÷ Tinctures
÷ Suspensions
÷ Spirits
÷ Emulsions
÷ Elixirs
÷ Syrups
· Solid
÷ Pills
÷ Powders
÷ Tablets
÷ Suppositories
÷ Capsules
· Gas
Routes of
Drug Administration
· Effects the rate at which the onset of
action occurs and may effect the
therapeutic response that results
÷ Route is crucial in determining the
suitability of a drug
· First pass metabolism
÷ Drugs are given for either their local or
systemic effects
Enteral Routes
· Buccal
· Oral (PO)
· Orogastric
· Nasogastric
· Rectal (PR)
· Sublingual (SL)
Parenteral Routes
· Endotracheal
· Ìnhalation (Neb)
· Ìnstillation
· Ìntradermal
· Ìntramuscular (ÌM)
· Ìntraosseous (ÌO)
· Ìntravenous (ÌV)
· Nasal
· Subcutaneous (SQ)
· Transdermal
· Umbilical
Mechanics of
Drug Action
· To produce optimal effect or therapeutic
effects, a drug must reach appropriate
concentrations at its site of action
· Molecules of the chemical compound must
proceed from point of entry into the body to
the tissues with which they react
· The magnitude of the response depends on
the dosage and the time course of the drug
in the body
Mechanics of
Drug Action
· Pharmaceutical
÷ Disintegration of
dosage form
÷ Dissolution of drug
· Pharmocokinetic
÷ Absorption
÷ Distribution
÷ Metabolism
÷ Excretion
· Pharmacodynamic
÷ Drug-receptor
interaction
Concentration of the drug at its site of action
is influenced by various processes
Pharmaceutical Effects
· Disintegration of dosage form
÷ Solid or liquid form
÷ Enteric coated
· Dissolution of drugs
÷ Rate at which a solid drug goes into a
solution after ingestion
÷ The faster the rate of dissolution, the
more quickly the drug is absorbed
Pharmacodynamics
· The study of how a drug acts on a
living organism, including the
pharmacological response observed
relative to the concentration of the
drug at an active site in the organism
Drug Receptor ¡nteraction
· Affinity
÷ Drug's propensity to bind or attach itself
to a given receptor site
· Efficacy (intrinsic activity)
÷ Drug's ability to initiate biological activity
as a result of binding to a receptor site
Drug Receptor ¡nteraction
· Agonists
÷ Drug that binds to a receptor site and
causes a physiological response
· Antagonists
÷ Drug that binds to a receptor site and
prevents a physiological response or
prevents another drug from binding to a
receptor site
Type of Receptors
· Beta 1
· Beta 2
· Alpha 1
· Alpha 2
· Dopaminergic
Alpha Receptors
· Alpha 1 Receptors
÷ Postsynaptic receptors located on effector
organs
÷ Stimulate contraction of smooth muscle
÷ Results in increase in BP
· Alpha 2 Receptors
÷ Found on presynaptic & postsynaptic nerve
endings
÷ Ìnhibit further release of norepinephrine
÷ Mediate vasoconstriction
Beta Receptors
· Beta 1 Receptors
÷ Located primarily in the heart
÷ Cause increases in inotropy & chronotopy
· Beta 2 Receptors
÷ Located primarily in the lungs
÷ Dilate bronchioles & blood vessels
÷ Relax smooth muscle
Dopaminergic Receptors
· Drugs that effect dopaminergic
receptors are classified as
÷ Those that release dopamine
÷ Those that increase brain levels of
dopamine
÷ Dopaminergic agonists
Plasma Level
Profile of a Drug
· Demonstrates the relationship
between the plasma concentration and
the level of therapeutic effectiveness
over time
Factors Altering
Drug Response
· Age
÷ Ìnfants ÷ liver & kidney not fully developed
÷ Elderly ÷ liver & kidney function deteriorates
· Body Mass
÷ More body mass = more fluid available to dilute
drug
· Gender
÷ Differences in the relative proportions of fat and
water
Factors Altering
Drug Response
· Environment
÷ Changes in temperature or altitude
· Time of Administration
÷ Presence or absence of food in GÌ tract
÷ Biological rhythms
· Sleep-wake cycles
· Pathological State
÷ Ìllness or injury
÷ Underlying disease processes
Factors Altering
Drug Response
· Genetic
÷ Lack of specific enzymes
÷ Lowered basal metabolic rate
· Psychological
÷ Ìf the patient believes it will work it will
work
Predictable Responses
· Desired Action
÷ Action or effect is seen that is consistent
with why the drug was given
· Side Effects
÷ Undesirable and often unavoidable
effects of a drug
÷ Action or effect other than those for which
the drug was given
Unpredictable
Adverse Reactions
· Allergic Reaction
÷ Activates the Ìmmune System
· Anaphylactic Reaction
÷ Severe allergic reaction
· Ìdiosyncracy
÷ Drug effect unique to individual
÷ Different than expected
Unpredictable
Adverse Reactions
· Tolerance
÷ Physiologic response that requires a drug
dosage to be increased to produce the
same effect
· Cross Tolerance
÷ Tolerance after administration of a
different drug
· Morphine and other opiod agents
Unpredictable
Adverse Reactions
· Tachyphylaxis
÷ Rapidly occurring tolerance to a drug
÷ Common in decongestant and
bronchodilation agents
· Cumulative Effect
÷ Tendency for repeated doses of a drug to
accumulate in the blood stream often
causing toxic effects
Unpredictable
Adverse Reactions
· Drug Dependence
÷ State in which withdrawal of a drug
produces intense physical or emotional
disturbance
· Drug Ìnteraction
÷ Beneficial or detrimental effects of one
drug by the prior or concurrent
administration of another drug
Unpredictable
Adverse Reactions
· Drug Antagonism
÷ Effects of two drugs is less than the sum
of drugs acting separately
· 1+1 = 0
· Summation
÷ Combined effect of two drugs that the
total effect equals the sum of the
individual effects of each agent
· 1+1 = 2
Unpredictable
Adverse Reactions
· Synergism
÷ The combined action of two drugs such that the
total effects exceeds the sum of the individual
effects of each agent
· 1+1 = 3
· Potentiation
÷ The enhancement of effect caused by the
concurrent administration of two drugs in which
one drug increases the effect of the other drug
Drug ¡nteractions
· Ìntestinal absorption
· Competition for plasma protein binding
· Drug metabolism or biotransformation
· Action at the receptor site
· Renal excretion
· Alteration of electrolyte imbalance
Drug-Drug ¡nteractions
· The following drugs are clinically significant
for drug-drug interactions
÷ Blood thinners
÷ Tricyclic antidepressants
÷ Monoamine oxidase (MAO) inhibitors
÷ Amphetamines
÷ Digitalis glycosides
÷ Diuretics
÷ Antihypertensives
Other Drug ¡nteractions
· Drug induced malabsorption of foods
and nutrients
· Food induced malabsorption of drugs
· Alteration of enzymes
· Alcohol consumption
· Cigarette smoking
· Food initiated alteration of drug
excretion
Drug 8torage
· Drug potency can be effected by
÷ Temperature
÷ Light
÷ Moisture
÷ Shelf life
· Security of controlled medications
÷ Double lock & key
Components of
a Drug Profile
· Name
÷ Generic, Chemical, & Trade Names
· Classification
÷ Broad group to which the drug belongs
· Mechanism of Action
÷ The way in which a drug causes it's
effects
· Ìndications
÷ Why a drug is appropriate
Components of
a Drug Profile
· Pharmacokinetics
÷ How a drug enters & leaves the body
· Side Effects
÷ Untoward or undesired effects
· Routes of Administration
÷ How can the drug be given
· Contraindications
÷ Why a drug cannot be given
Components of
a Drug Profile
· Dosage
÷ Amount of drug that should be given
· Contraindications
÷ Why a drug should not be given
· Special Considerations
÷ Pediatric patients
÷ Geriatric patients
÷ Pregnant patients
8pecial Considerations
in Drug Therapy
· Pregnant Patients
÷ Changes in mother's anatomy &
physiology
÷ Potential for drugs to harm the fetus
· Pediatric Patients
÷ Several physiological factors affect
pharmacokinetics in
· Newborns
· Children
8pecial Considerations
in Drug Therapy
· Geriatric Patients
÷ Significant changes in pharmacokinetics
may occur in patients older than about 60
years
Pregnant Patients
· A drug's possible benefits to the
mother must clearly outweigh its
potential risks to the fetus
· Changes in heart rate, cardiac output,
and blood volume increases
÷ May affect the onset & duration of action
of many medications
Pregnant Patients
· First Trimester
÷ Teratogenic Drugs
· Medications that may deform or kill the fetus
· Third Trimester
÷ Drugs may pass through the placenta to the
fetus
· FDA Categories (A, B, C, D, & X)
÷ Ìndicates drugs that may have documented
problems in animals and/or humans during
pregnancy
Pediatrics
· Absorption of oral medications is less
due to gastric pH and emptying times
· Diminished plasma protein
concentrations
÷ Drugs that bind to proteins will have
higher "free drug availability"
· Proportion of drug available to to cause either
desired or undesired effects
Neonates
· Higher percentage of extracellular fluid
(nearly 80%)
÷ Less expected protein binding
÷ May require larger doses
· Premature infants
÷ Susceptible to drugs penetrating the blood-brain
barrier"
· Low metabolic rate & incompletely
developed hepatic system
÷ Higher risk of toxic interactions
Length-Based
Resuscitation Tape
· Broselow Tape
÷ Calculations based
on height with the
assumption that
child is in the fifth
percentile for his
height
Geriatric Patients
· May absorb oral
medications slower
due to decreased
gastrointestinal
motility
· Decreased plasma
protein
concentration
· Fat increases &
muscle mass
decreases
· Depressed liver
function
· May take multiple
medications
· Underlying disease
Drugs by Classification
· Analgesics and
antagonists
· Anesthetics
· Antianxiety,
sedative, and
hypnotic drugs
· Anticonvulsants
· Central nervous
system stimulants
· Psychotherapeutic
drugs
· Antidepressant
therapy
Narcotic Analgesics
· Pain has two categories
÷ Sensation of pain (nerve pathways)
÷ Emotional response (anxiety)
· Most block pain at the CNS level
· Opiates are drugs that contain opium
÷ Morphine
÷ Demerol
÷ Darvon
Narcotic Analgesics
· Undesired effects
÷ Nausea and/or vomiting
÷ Constipation
÷ Orthostatic hypotension
÷ Respiratory depression
÷ CNS depression
Narcotic Antagonists
· Block the effects of "opiod¨ narcotics
and their undesired effects
÷ Respiratory depression
÷ CNS depression
· Displace analgesics from their receptor
sites
÷ Examples: Naloxone (Narcan) &
Nalmefene (Revex)
Nonnarcotic Analgesics
· Act by a peripheral mechanism that
interferes with local mediators
released when tissue damage occurs
÷ Damaged nerve endings are stimulated
less often
· Example: Ketorolac (Toradol)
Anesthetics
· CNS depressants that have a
reversible action on nervous tissue
· Three general categories
÷ General
÷ Regional
÷ Local
8tages and 8igns
of General Anesthesia
Antianxiety, 8edative,
& Hypnotic Drugs
· Used to reduce the feelings of
apprehension, nervousness, worry,
and/or fearfulness
· Depress the CNS, produce a calming
effect, and help induce sleep
8edatives
versus Hypnotics
· Sedative
÷ A small dose of an agent administered to
calm a patient
· Hypnotic
÷ A larger dose of the same agent sufficient
to induce sleep
Benzodiazepines
· Thought to work by binding to specific
receptors in the cerebral cortex and limbic
system
· Have four actions
÷ Anxiety reduction
÷ Sedative-hypnotic
÷ Muscle relaxing
÷ Anticonvulsant
· Common Benzodiazepines
÷ Ativan, Valium, Versed
Benzodiazepine Antidote
· Flumazenil (Romazicon)
÷ Benzodiazepine receptor antagonist
÷ Effective in reversing benzodiazepine
induced sedation
Barbiturates
· Divided into four classes according to
their duration of action
÷ Ultra short acting
· Within a few seconds
÷ Short acting
· Onset 10 to 15 minutes
· Peak in 3 to 4 hours
Barbiturates
· Divided into four classes according to
their duration of action
÷ Ìntermediate acting
· Onset 45 to 60 minutes
· Peak in 6 to 8 hours
÷ Long acting
· Requires over 60 minutes for onset
· Peak in 10 to 12 hours
Miscellaneous
8edatives & Hypnotics
· Number of antianxiety and sedative-
hypnotic drugs that occasionally are used
do not fall into the previously discussed drug
classes
· More similar to barbiturates than
benzodiazepines
· Examples
÷ Chloral Hydrate (Noctec)
÷ Antihistamines such as ydroxyzine (Vistaril,
Atarax)
Anticonvulsants
· Used to treat seizure disorders, mainly
epilepsy
· Exact mode and site of action of these
drugs are not understood
· Ìn general these drugs depress the
excitability of of neurons that fire to
initiate seizure activity
Anticonvulsants
· Classifications
÷ The choice of drug depends on the type
of seizure disorder (generalized, partial,
or status)
· Hydantoins
· Barbiturates
· Succinimides
· Benzodiazepines
Central Nervous
8ystem 8timulants
· Classified by where they exert their
major effects in the nervous system
÷ Cerebrum
÷ Medulla and brain stem
÷ Hypothalamic limbic regions
· Work to increase excitability by
blocking activity of inhibitory neurons
or their respective neurotransmitters
Anorexiant Drugs
· Appetite suppressants used to treat
obesity
· Produce a direct effect on the
hypothalmic and limbic regions
· Examples
÷ Phendimetrazine (Plegine)
÷ Mazindol (Mazanor, Sonorex)
Amphetamines
· Stimulate the cerebral cortex and
reticular activating system
· Primarily used to treat attention deficit
disorder (ADD) with hyperactivity and
narcolepsy
· Examples
÷ Methamphetamine (Desoxyn)
÷ Methylphenidate (Ritalin)
Psychotherapeutic Drugs
· Ìnclude antipsychotic agents,
antidepressants, and lithium
· Used to treat psychoses and affective
disorders, especially schizophrenia,
depression, and mania
Antipsychotic Agents
· Primarily used to treat schizophrenia
· May be used to treat
÷ Tourette's Syndrome
÷ Alzheimer's Disease
· Effective antipsychotic (neuroleptic)
drugs block dopamine receptors in the
CNS
Antidepressants
· Used to treat affective disorders (mood
disturbances), including depression,
mania, and elation
÷ Depression
· Tricyclic antidepressants
· Monoamine Oxidase (MAO) Ìnhibitors
÷ Mania
· Lithium
Tricyclic Antidepressants
· Thought to treat depression by increasing
levels (blocking reuptake) of the
neurotransmitters norepinephrine and
serotonin
· Examples
÷ Ìmipramine (Tofranil)
÷ Amitriptyline (Elavil)
· Overdoses can be reversed with Sodium
Bicarbonate administration
MAO ¡nhibitors
· Central acting monoamines, especially
norepinephrine and serotonin, are thought
to cause depression and mania
· MAO inhibitors block monoamine enzymes
which stop the metabolism of
norepinephrine
· Examples
÷ Ìsocarboxazid (Marplan)
÷ Phenelzine (Nardil)
Lithium
· Monovalent cation that is closely related to
sodium
· Thought to work by remaining in the
intracellular fluid thereby reducing the
amount of sodium within the cells and
improving the manic state
· Ìn addition lithium enhances some of the
actions of serotonin and may decrease
levels of norepinephrine and dopamine
Drugs for 8pecific CN8-
Peripheral Dysfunctions
· Several movement disorders result
from an imbalance of dopamine and
acetylcholine.
· Two most common
÷ Parkinson's Disease
÷ Huntington's Disease
Parkinson's Disease
· Characterized by
÷ Rigidity of voluntary muscles
÷ Tremor of fingers and extremities
· Most often affects people over 60
· May occur in younger people, especially
after
÷ Acute encephalitis
÷ Cases of carbon monoxide poisoning
÷ Use of illicit drugs
Huntington's Disease
· An inherited disorder characterized by
÷ Progressive dimentia
÷ Ìnvoluntary muscle twitching
· Thought to be related to an imbalance
between dopamine, acetylcholine, and
other neurotransmitters
Drugs with Central
Anticholinergic Activity
· Anticholinergic
÷ Drugs that block or inhibit acetylcholine
· Work to restore the normal dopamine-
acetylcholine balance in the brain
Drugs that Affect
Brain Dopamine
· Three classifications
÷ Those that release dopamine
÷ Those that increase brain levels of
dopamine
÷ Dopaminergic agonists
Drugs that Affect
Brain Dopamine
· Levodopa (L-Dopa)
÷ Ìncreases brain levels of dopamine
÷ Drug of choice in movement disorders
associated with dopamine-acetylcholine
imbalance
· Two types of MAO Ìnhibitors
÷ Monoamine Oxidase A
· Metabolizes norepinephrine & serotonin
÷ Monoamine Oxidase B
· Metabolizes dopamine
Drugs that Affect the
Parasympathetic Nervous 8ystem
· Four Classifications
÷ Cholinergic Drugs
÷ Cholinergic Blocking Drugs
÷ Ganglionic Stimulating Drugs
÷ Ganglionic Blocking Drugs
Cholinergic Drugs
{Parasympathomimetic_
· Act directly (choline esters) by combining
with cholinergic receptors in postsynaptic
membranes and indirectly by inhibiting the
enzyme that degrades acetylcholine
· Result in accumulation of acetylcholine,
which causes a prolonged and intensified
response at various effector sites
· Generally not considered emergency
medications
Cholinergic Drugs
Cholinergic Blocking
Drugs {Anticholinergic_
· Types of anticholinergic receptors
÷ Muscarinic
÷ Nicotinic
· Nicotinic N (neuron)
· Nicotinic M (muscle)
Cholinergic Blocking
Drugs {Anticholinergic_
· Also known as parasympatholytics
· Block the muscarinic effects of
acetylcholine reducing acetylcholine's
actions at effector sites
· Atropine
÷ Functions as a competitive antagonist
÷ Occupies muscarinic receptor sites
Cholinergic Blocking
Drugs {Anticholinergic_
· Scopolamine (belladonna
anticholinergic)
÷ Similar to atropine but also causes
sedation and antiemesis
÷ Used to treat motion sickness
· Ìpratropium Bromide (Atrovent)
÷ Ìnhaled anticholinergic used to treat
asthma
Cholinergic Blocking
Drugs {Anticholinergic_
· Nicotinic Cholinergic Antagonists
÷ Block acetylcholine at nicotinic sites
÷ Ìnclude ganglionic blocking agents that
block the nicotinic (neuro) receptors in the
autonomic ganglia
÷ Neuromuscular blocking agents that block
nicotinic (muscle) receptors at the
neuromuscular junction
Cholinergic Blocking
Drugs {Anticholinergic_
· Ganglionic Blocking Agents
÷ Competitive antagonism with acetylcholine at the
nicotinic (neuro) receptors in the autonomic
ganglia
÷ Can turn off the entire Autonomic Nervous
System
÷ Side effects include those similar to atropine
overdose
· Dry mouth, blurred vision, urinary retention, and
tachycardia
Drugs Affecting the 8ympathetic
Nervous 8ystem
· Adrenergic Drugs
÷ Direct acting
÷ Ìndirect acting
÷ Dual acting (direct and indirect)
Direct Acting
· Mimic the effects of the three naturally
occurring catecholamines in the body
÷ Epinephrine
÷ Norepinephrine
÷ Dopamine
· Stimulate the effects of alpha and beta
sites within the ANS
Alpha Effects
· Vasoconstriction of arterioles, resulting
in an increase in blood pressure and a
shunting of blood from the periphery to
the brain and heart
· Pupil dilation
· Relaxation of the gut
Beta Effects
· Cardiac acceleration and increased
contractility
· Vasodilation of arterioles supplying the
skeletal muscle
· Bronchial relaxation
· Uterine relaxation
¡ndirect Acting &
Dual Acting Drugs
· Act indirectly on receptors by triggering
the release of the catecholamines
norepinephrine and epinephrine which
then activates the alpha and beta
receptors
· Example
÷ Ephedrine Sulfate
Adrenergic
Blocking Drugs
· Classified into two categories
÷ Alpha Blocking Drugs
÷ Beta Blocking Drugs
· Selective Blocking Drugs
· Nonselective Blocking Drugs
Alpha Blocking Drugs
· Block the vasoconstricting effects of
catecholamines
· Used in
÷ Cases of hypertension
÷ Prevent tissue necrosis when
norepinephrine (Levophed) and
dopamine (Ìntropin) have extravasated
into the tissues
Beta Blocking Drugs
· Selective Blocking Drugs
÷ Block Beta1 or Beta2 receptors
÷ Also known as cardioselective blockers"
because they block the Beta1 receptors
in the heart
· Metoprolol (Lopressor)
÷ Selectivity may not be 100% and may
affect the lungs and vise versa
Beta Blocking Drugs
· Nonselective Blocking Drugs
÷ Block both Beta1 and Beta2 receptor
sites
· Beta1 receptors in the heart
· Beta2 receptors in the lungs
÷ Propranolol (Ìnderal)
÷ Labetalol (Trandate)
· Also has some alpha-blocking activity
8keletal
Muscle Relaxants
· Skeletal muscle contraction is evoked
by a nicotinic cholinergic transmission
process
· Classified as
÷ Central-Acting Muscle Relaxants
÷ Direct-Acting Muscle Relaxants
Central-Acting
Muscle Relaxants
· Used to treat muscle spasms
· Thought to work by producing CNS
depression in the brain and spinal cord
· Antispastic Agents
÷ Baclofen (Lioresal)
÷ Cyclobenzaprine (Flexeril)
÷ Diazepam (Valium)
Direct-Acting
Muscle Relaxants
· Work directly on the skeletal muscle
· Produce muscle relaxation, resulting in
a decrease in muscle contraction
÷ Dantrolene (Dantrium)
Neuromuscular Blockers
· Produce complete muscle relaxation
and paralysis by binding to the
nicotinic receptor for acetylcholine at
the neuromuscular junction
· Used for
÷ Endotracheal Ìntubation
÷ Muscle spasms of the larynx
÷ Breathing control by a respirator
Neuromuscular Blockers
· Produce complete paralysis
÷ Ventilatory support must be provided
÷ Efficacy of ventilation and oxygenation closely
monitored
· Do not inhibit pain or seizure activity
· Examples
÷ Pancuronium (Pavulon)
÷ Vecuronium (Norcuron)
÷ Succinylcholine (Anectine)
Drugs that Affect the
Cardiovascular 8ystem
· Antidysrhythmics
· Antihypertensives
· Cardiac Glycosides
· Vasodilators
· Antihemorrheologic Agents
Antidysrhythmics
· Used to treat and prevent disorders of
cardiac rhythm
· May suppress dysrhythmias by direct
action on the cardiac cell membrane
÷ Lidocaine
· May suppress dysrhythmias by indirect
action that affects the cell
÷ Propranolol
Antidysrhythmic
Classifications
· Class Ì
÷ Sodium channel blockers that work to
slow conduction
÷ Further divided into
· Class Ìa
· Class Ìb ÷ decrease or have no effect on
conduction
· Class Ìc ÷ profoundly slow conduction and
are indicated only for life-threatening
dysrhythmia
Antidysrhythmic
Classifications
· Class ÌÌ
÷ Beta blocking agents which reduce
adrenergic stimulation of the heart
· Propranolol (Ìnderal)
Antidysrhythmic
Classifications
· Class ÌÌÌ
÷ Produce potassium channel blockade,
which increases contractility
÷ Do not suppress automaticity and have
no effect on conduction velocity
÷ Thought to terminate dysrhythmias that
result from reentry of blocked impulses
· Bretylium (Bretylol)
· Amiodarone (Cordarone)
Antidysrhythmic
Classifications
· Class ÌV
÷ Calcium channel blockers
÷ Block the inflow of calcium through the
cell membranes of cardiac and smooth
muscle cells
÷ Depress muscle contraction, automaticity,
and in some cases conduction velocity
· Verapamil (Ìsoptin)
· Diltiazem (Cardizem)
Antihypertensives
· Exact mechanism of action of many of these
drugs is unknown
· The ideal antihypertensive drug should
÷ Maintain BP within normal limits
÷ Maintain or improve blood flow
÷ Reduce workload of the heart
÷ Have no undesirable effects
÷ Permit long-term administration without
intorlerance
Antihypertensives
· Diuretics
· Sympathetic Blocking Agents
· Vasodilators
· Angiotensin-Converting Enzyme (ACE)
Ìnhibitors
· Calcium Channel Blockers
Diuretics
· Use of these drugs results in a loss of
sodium and water by renal excretion
÷ Decrease in plasma and extracellular fluid
volume (decreases preload and stroke
volume)
÷ Direct effect on arterioles
· Result in a lowered blood pressure
Diuretics
· Thiazides
÷ Moderately effective in lowering BP
÷ Help prevent side effects of hypertensive
agents that retain sodium and water
· Hydrochlorothiazide (HCTZ)
Diuretics
· Loop Diuretics
÷ Powerful and short acting
÷ Ìnhibit sodium and chloride reabsorption
in the Loop of Henle
÷ Cause excessive loss of potassium
÷ Ìncrease in excretion of sodium and water
· Furosemide (Lasix)
Diuretics
· Potassium-sparing Agents
÷ Promote sodium and water loss without
an accompanying loss of potassium
÷ Used to treat hypertensive patients that
become hypokalemic with other diuretics
÷ May be used to treat some edematous
states such as cirrhosis of the liver with
ascites
· Spironolactone (Aldactone)
8ympathetic
Blocking Agents
· Classified as:
÷ Beta Blocking Agents
÷ Adrenergic Ìnhibiting Agents
· Result in a lowered blood pressure
8ympathetic
Blocking Agents
· Beta Blocking Agents
÷ Decrease cardiac output
÷ Ìnhibit the secretion of renin by the
kidneys
· Result in a lowered blood pressure
÷ Compete with epinephrine for available
beta receptor sites
· Ìnhibits tissue and organ response to beta
stimulation
Beta Blocking Agents
· Beta1 Blocking
Agents
(Cardioselective)
÷ Acebutolol (Sectral)
÷ Atenolol (Tenormin)
÷ Metoprolol
(Lopressor)
· Beta1 and Beta2
Blocking Agents
(Nonselective)
÷ Labetalol (Trandate)
÷ Nadolol (Corgard)
÷ Propranolol
(Ìnderal)
8ympathetic
Blocking Agents
· Adrenergic Ìnhibiting Agents
÷ Sympathetic stimulation results in
· An increase in heart rate and myocardial
contraction
· Constriction of arterioles and venules
· A release of renin by the kidneys
÷ Blocking this sympathetic stimulation can
reduce blood pressure
Adrenergic
¡nhibiting Agents
· Centrally Acting
Adrenergic
Ìnhibitors
÷ Clonidine
(Catapres)
÷ Methyldopa
(Aldomet)
· Peripheral
Adrenergic
Ìnhibitors
÷ Guanethidine
Sulfate (Ìsmelin)
÷ Reserpine (Sandril,
Serpasil)
Vasodilator Drugs
· Act directly on the smooth muscle walls of
the arterioles, veins, or both
÷ Lowering peripheral resistance and BP
· Stimulate the sympathetic nervous system
resulting in an increase in
÷ Heart rate
÷ Cardiac output
÷ Renin release
· Combined therapy is usually prescribed to
inhibit the sympathetic response
Vasodilator Drugs
· Arteriolar Dilator
Drugs
÷ Diazoxide
(Hyperstat ÌV)
÷ Hydralazine
(Apresoline)
÷ Minoxidil (Loniten)
· Arteriolar and
Venous Dilator
Drugs
÷ Sodium
Nitroprusside
(Nipride)
÷ Nitro SL (Nitrostat)
÷ Nitro ÌV (Tridil)
Angiotensin-Converting
Enzyme {ACE_ ¡nhibitors
· Angiotensin ÌÌ is a powerful vasocontrictor
÷ Raises blood pressure and causes a release of
aldosterone, which contributes to sodium and
water retention
· ACE Ìnhibitors prevent the conversion of
Angiotensin Ì to Angiotensin ÌÌ which results
in a lowered blood pressure
÷ Catopril (Capoten)
÷ Enalapril (Vasotec)
Calcium Channel Blockers
· Reduce peripheral vascular resistance
by inhibiting the contractility of smooth
muscle
÷ Dilate coronary arteries (increase oxygen
supply to the heart)
÷ Decrease afterload (myocardial oxygen
demands of the heart)
· Verapamil (Ìsoptin)
· Diltiazem (Cardizem)
Cardiac Glycosides
· Naturally occurring plant substances
that have characteristic effects on the
heart
· Work by blocking ionic pumps in the
cellular membrane, which indirectly
increases the calcium concentration to
the contractile proteins
÷ Digoxin (Lanoxin)
Digitalis Glycosides
· Affect the heart in two ways
÷ Ìncrease the strength of contraction
(positive inotropic effect)
÷ Dual effect on the electrophysiological
properties of the heart
· Modest negative chronotropic effect (slowing
of heart rate)
· Profound negative dromotropic effect
(decreasing conduction velocity)
Digitalis Glycosides
8ide Effects
· May be neurological, visual,
gastrointestinal, cardiac, or psychiatric
· Often vague and and easily attributed
to a viral syndrome
÷ Anorexia
÷ Nausea and vomiting
÷ Visual disturbances
÷ Cardiac rhythm disturbances
Digitalis Glycosides
Toxic Effects
· Dose related and increased by presence of
other drugs, such as diuretics
· Dysrhythmias may include
÷ Bradycardia
÷ Tachycardia
÷ Ventricular Fibrillatin
· Treatment aimed at correction of electrolyte
imbalance, neutralization of the free drug,
and use of antidysrhythmics
Antihemorrheologic
Agents
· Used to treat peripheral vascular
disorders caused by pathological or
physiological obstruction
(arteriosclerosis)
· Ìmprove blood flow and delivery of
oxygen to ischemic tissues
÷ Pentoxifylline (Trental)
Drugs that
Affect the Blood
· Anticoagulants
· Thrombolytics
· Blood Components
Anticoagulants
· Drugs that interfere with platelet
aggregation
· Also known as anitplatelet or
antitrombic drugs
÷ Aspirin
÷ Dipyridamole (Persantine)
÷ Clopidrogrel (Plavix)
Thrombolytics
· Dissolve clots after their formation by
promoting the digestion of fibrin
· Used for reestablish blood flow, acute
pulmonary embolism, and DVT
÷ Streptokinase (Streptase)
÷ Tissue Plasminogen Activator (t-PA)
÷ Retivase (Retavase)
Antihemophilic Agents
· Hemophilia A (classic hemophilia)
÷ Results from a deficiency of factor VÌÌÌ
· Hemophilia B (Christmas Disease)
÷ Results from a deficiency of factor ÌX
· Therapy aimed at replacement of the
missing clotting factor
÷ Factor VÌÌÌ (Factorate)
÷ Factor ÌX (Konyne)
Hemostatic Agents
· Hasten clot formation to reduce
bleeding
÷ Systemic Hemostatic Agents
· Amicar
· Cyklocapron
÷ Topical Hemostatic Agents
· Gelfoam
· Novacell
Blood & Blood
Components {Replacement_
· Replacement of the blood component that is
deficient
÷ Whole blood (rarely used)
÷ Packed red blood cells
÷ Fresh-frozen plasma
÷ Platelets
÷ Coagulation factors
÷ Albumin
÷ Fibrinogen
Antihyperlipidemic Drugs
· Hyperlipidemia refers to the excess of
lipids in the plasma
· Several types associated with elevated
levels of cholesterol and triglycerides
÷ Atorvastatin (Lipitor)
÷ Niacin (Nicobid)
÷ Simvastatin (Zocor)
Drugs that Affect the
Respiratory 8ystem
· Mucokinetic Drugs
· Bronchodilator Drugs
· Xanthine Derivatives
· Prophylactic Asthmatic Drugs
Mucokinetic Drugs
· Used to move respiratory secretions,
excessive mucus, and sputum along
the tracheobronchial tree
· Alter the consistency of secretions
÷ Dilutents (water, saline solution)
÷ Aerosols
÷ Mucolytic Drugs
÷ Expectorants (Mucomyst)
Bronchodilators
· Administered via inhalation via a nebulizer
or a pressurized cartridge
· Sympathomimetics categorized by receptor
action
÷ Nonselective adrenergic drugs
÷ Nonselective beta adrenergic drugs
÷ Selective beta2 receptor drugs
÷ Catecholamine beta2 receptor drugs
÷ Noncatecholamine beta2 receptor drugs
Bronchodilators
· Nonselective
Adrenergic Drugs
÷ Epinephrine
inhalation aerosol
(Bronkaid Mist,
Primatene Mist)
÷ Racemic Epi
· Nonselective Beta
Adrenergic Drugs
÷ Adrenalin
÷ Ìsuprel
· Selective Beta2
Drugs
÷ Albuterol (Proventil)
÷ Ìsoetharine
(Bronkosol)
Xanthine Derivatives
· Ìnclude caffeine, theophylline, and
theobromine
· Relax smooth muscle, stimulate cardiac
muscle and the CNS, increase
diaphragmatic contractility, and promote
diuresis
÷ Amoline
÷ Sompophyllin
÷ Bronkodyl
Prophylactic
Asthmatic Drugs
· Reduce allergic or inflammatory
response to stimuli and have a effect
on bronchial smooth muscle
÷ Beclomethasone Dipropionate (Vanceril)
÷ Dexamethasone (Decadron)
÷ Ìpratropium (Atrovent)
Drugs that Affect the
Respiratory Center
· Oxygen Therapy
÷ Use to treat hypoxia and hypoxemia
÷ Essential for sustaining life
· Direct Respiratory Stimulants
÷ Also known as analeptics
÷ Act directly on the medullary center of the
brain to increase the rate and depth of
respiration
· Doxapram (Dopram)
Drugs that Affect the
Respiratory Center
· Reflex Respiratory Stimulants
÷ $pirits of Ammonia
÷ Noxious odor stimulates respirations
through afferent messages to the brain
· Respiratory Depressants
÷ Ìnclude opium and barbiturate drugs
÷ Seldom given to intentionally inhibit rate
and depth of respiration
Drugs that Affect the
Respiratory Center
· Cough Suppressants
÷ Prescribed for nonproductive cough or
prolonged coughing
÷ Coughing is a protective reflex
÷ Opiod Antitussive Drugs
· Codeine
÷ Nonopiod Antitussive Drugs
· Benzonatate (Tessalon)
· Diphenhydramine (Benadryl)
Drugs that Affect the
Respiratory Center
· Nasal Decongestants
÷ Constrict nasal capillaries
÷ Alpha1 agonists
· Phenylephrine
· Pseudoephedrine
÷ Topical administration reduces systemic
effects
÷ Rebound congestion with prolonged use
Drugs that Affect the
Respiratory Center
· Antihistamines
÷ Compete with histamines for receptor
sites, thereby preventing the physiological
action of histamine
· H1 Receptors (blood vessels & bronchioles)
· H2 Receptors (gastrointestinal tract)
÷ Also have anticholinergic or atropine-like
action
Drugs that Affect the
Respiratory Center
· Antihistamines
÷ Used for allergic reactions, motion
sickness, or as a sedative or antiemetic
· Dimenhydrinate (Dramamine)
· Diphenhydramine (Benadryl)
· Promethazine (Phenegran)
· Loratadine (Claritin)
· Fexofenadine (Allegra)
Drugs that Affect the
Respiratory Center
· Serotonin
÷ Naturally occurring vasoconstrictor found
in platelets and cells of the brain
÷ Not administered as a drug but as a
major influence on other drugs and some
disease states
· Helpful in repairing blood vessels
· Stimulate smooth muscle contraction
· Acts as a neurotransmitter in the CNS
Drugs that Affect the
Respiratory Center
· Antiserotonins (serotonin antagonists)
÷ Ìnhibit responses to serotonin and its
influence on other drugs & disease states
· Block smooth muscle contraction and
vasoconstriction
· Ìnhibit the action of serotonin in the brain
÷ May be used to treat vascular headaches
and allergic disorders
· Lysergic Acid Diethylamide (LSD)
Drugs that Affect the
Gastrointestinal 8ystem
· Categorized into
÷ Drugs that affect the stomach
÷ Drugs affecting the lower gastrointestinal
tract
Drugs that Affect
the 8tomach
· Antacid Combinations
÷ Buffer or neutralize hydrochloric acid
÷ Peptic ulcer, gastritis, and heartburn
· Alka-Seltzer, Gaviscon, Rolaids
· Antiflatulents
÷ Prevent the formation of gas
÷ Common condition in diverticulitis, ulcer disease,
and irritable colon
· Simethicon (Mylicon)
Drugs that Affect
the 8tomach
· Digestants
÷ Promote digestion
÷ Release small amounts of digestive enzymes
· Pancrelipase (Pancrease)
· Cytoprotective Agents
÷ Protect cells from damage
÷ Peptic ulcer disease (protect mucosa)
· Sucralfate (Carafate)
· Misprostol (Cytotec)
Drugs that Affect
the 8tomach
· Emetics
÷ Used to induce vomiting for overdose or
poisonings
· Syrup of Ìpecac
· Antiemetics
÷ Treat nausea and vomiting
· Promethazine (Phenegran)
· Prochlorperazine (Compazine)
Drugs that Affect
the 8tomach
· H2 Receptor Antagonists
÷ Block H2 receptors and reduce the
volume of gastric acid secretion
÷ Examples
· Cimetidine (Tagament)
· Ranitidine (Zantac)
· Famotidine (Pepcid)
Drugs Affecting the Lower
Gastrointestinal Tract
· Laxatives
÷ Produce defecation
÷ Used to evacuate the bowel and to soften
hardened stool
÷ Examples
· Saline Laxatives (Milk of Magnesia)
· Stimulant Laxatives (Dulcolax, Ex-Lax)
· Lubricant Laxatives (Metamucil)
· Fecal Moistening Agents (Colace)
Drugs Affecting the Lower
Gastrointestinal Tract
· Antidiarrheals
÷ Reduce an abnormal frequency of bowel
evacuation
÷ Ìncluding bacterial or viral invasion and
irritable bowel syndrome
· Adsorbents (Pepto-Bismol)
· Anticholinergics (Donnatal)
· Other Agents (Lomotil and Ìmodium)
Opthalmic Drugs
· Antiglaucoma Agents
÷ Pressure of the fluid in the eye causes
compression on the eye's blood vessels
÷ Drugs that dilate the pupil
· Pilocarpine
÷ Drugs that constrict the pupil
÷ Drugs that slow the secretion of aqueous
fluid
· Acetazolamide
Mydriatic and
Cycloplegic Agents
· Applied topically to cause dilation of
the pupils and paralysis of
accommodation of light
· Used routinely during eye exam or for
ocular surgery
÷ Atropine Ophthalmic Solution
÷ Oxymetazoline (OcuClear)
Antiinfective and/or
Antiinflammatory Agents
· Use to treat conjunctivitis, sty, and
keratitis (corneal inflammation caused
by bacteria)
÷ Bacitracin (Baciguent)
÷ Chloramphenicol (Chloroptic)
÷ Erythromycin (Ìlotycin)
÷ Natamycin (Natacyn)
Topical Anesthetic Agents
· Prevent pain during surgical
procedures and eye examinations
· Have rapid onset (within 20 seconds)
and last 15 to 20 minutes
÷ Proparacaine HCl (Opthaine)
÷ Tetracaine HCl (Pontocaine)
Drugs Affecting the Ear
· Antibiotics
÷ Used to treat infections
· Chloramphenicol (Chloromycetin Otic)
· Steroid / Antibiotic Combinations
÷ Used to treat superficial bacterial infections
· Hydrocortisone (Cortisporin Otic)
· Drugs used to treat ear wax accumulation,
inflammation pain, and other conditions
÷ Boric Acid in Ìsopropyl Alcohol (Aurocaine 2)
Drugs Affecting
the Pituitary Gland
· Anterior Pituitary Gland Drugs
÷ Used to treat growth failure in children
caused by growth hormone deficiency
· Somatrem (Protropin)
· Somatropin (Humatrope)
· Posterior Pituitary Gland Drugs
÷ Used to treat symptoms of diabetes
insipidus resulting from ADH deficiency
· Vasopressin (Pitressin)
Drugs Affecting the
Parathyroid & Thyroid
· Thyroid Drugs
÷ Used to treat hypothyroidism and prevent
goiters
· Thyroid
· Ìodine Products
· Parathyroid Drugs
÷ Used to treat hyperparathyroidism
· Vitamin D
· Calcium Supplements
Drugs that Affect
the Adrenal Cortex
· Glucocorticoids
÷ Raise blood glucose and suppress
inflammatory reaction
· Mineralocorticoids
÷ Regulate electrolyte and water balance
· Adrenal Steroid Ìnhibitors
Drugs Affecting
the Pancreas
· Ìnsulin Preparations
÷ Humulin 70/30
÷ Lente Ìnsulin
÷ Ultralente
· Hyperglycemic
Agents
÷ Glucagon
÷ Dextrose
· Oral Hypoglycemic
Agents
÷ Dymelor
÷ Diabinese
÷ Glucophage
÷ Glucotrol
÷ Micronase
÷ Tolinase
÷ Orinase
Drugs Affecting the Female
Reproductive 8ystem
· Female Sex
Hormones
÷ Supplemental
Estrogen
÷ Progesterone
(synthetic progestin)
· Oral Contraceptives
÷ "The pill¨
÷ Combination of
estrogen and
progesterone
· Ovulatory
Stimulants
÷ Gonatropins
÷ Clomid
Drugs for Labor
and Delivery
· Oxytocics
÷ Drugs that increase uterine contraction
· Pitocin
· Syntocinon
· Tocolytics
÷ Drugs that inhibit uterine contractions
· Terbutaline (Brethine)
· Ritodrine (Yutopar)
Drugs Affecting the Male
Reproductive 8ystem
· Testosterone
÷ Used for the treatment of hormone
deficiency
· Testicular Failure
· Ìmpotence
· Delayed Puberty
· Female Breast Cancer
÷ Methyltestoserone (Metandren)
Drugs that Affect
8exual Behavior
· Drugs used to impair libido and sexual
gratification
÷ Ìnterfere with sympathetic nervous stimulation
· Antihypertensives
· Antidepressants
· Drugs used to enhance libido and sexual
gratification
÷ Levodopa (L-Dopa)
÷ Sildenafil Citrate (Viagra)
Antineoplastic Agents
· Used in cancer chemotherapy to prevent
proliferation of malignant cells
· Nonselective and are injurious to all cells in
the body
· Side effects include infection, nausea and
vomiting, and hemorrhage
· Toxicity may affect the pulmonary,
cardiovascular, and renal systems
· Prehospital care is aimed at providing
comfortable measures & emotional support
Drugs Used in ¡nfectious
Disease & ¡nflammation
· Antibiotics
÷ Penicillins
· Most effective and least toxic
· Effective against gram-positive and some
gram-negative bacteria
÷ Cephalosporins and related products
· Active against both gram-positive and gram-
negative bacteria
· Widely used to treat ear, throat, and
respiratory infections
Drugs Used in ¡nfectious
Disease & ¡nflammation
· Antibiotics
÷ Macrolide Antibiotics
· Used to treat infections of the skin, chest,
throat, and ears
· Useful in the treatment of pertussis
÷ Tetracyclines
· Active against many gram-negative and
gram-positive organisms
· Commonly used to treat acne, bronchitis,
syphilis, and gonorrhea
Antibiotics
· Penicillins
÷ Amoxicillin (Amoxil)
÷ Ampicillin (Amcil)
· Cephalosporins
÷ Cefazolin (Ancef)
÷ Cephalothin (Keflin)
· Macrolides
÷ Erythromycin (E-
Mycin)
÷ Azithromycin
(Zithromax)
· Tetracyclines
÷ Doxcyline
(Vibramycin)
÷ Tetracycline
(Achromycin)
Drugs Used in ¡nfectious
Disease & ¡nflammation
· Antifungal Drugs
÷ Broadly classified into superficial
infections, subcutaneous infections, and
immunosuppressant
· Antiviral Drugs
÷ Many agents have been tested but few
have proven effective without toxic effects
Antifungal and
Antiviral Drugs
· Antifungal
÷ Tolnaftate (Tinactin)
÷ Fluconazole
(Diflucan)
÷ Nystatin
(Mycostatin)
· Antiviral
÷ Acyclovir (Zovirax)
÷ Zidovudine
(Retrovir, AZT)
÷ Lamivudine (Epivir)
Other Antimicrobal and
Antiparasitic Drugs
· Antimalarial Medications
· Antituberculous Agents
· Antiamebiasis Agents
· Anthelmintic Agents
· Leprostatic Agents
Nonsteroidal
Antiinflammatory Drugs
· Analgesic-Antipyretic Drugs
÷ Drugs that reduce fever or mild pain
· Acetylsalicylic Acid (Aspirin)
· Acetaminophin (Tylenol)
· Nonsteroidal Antiinflammatory Drugs
÷ Prescribed for various inflammatory conditions
· Acetylsalicylic Acid (Aspirin)
· Naproxen (Naprosyn)
· Ketorolac (Toradol)
8erums, Vaccines, and
¡mmunizing Agents
· Serums
÷ Clear fluid that separates from blood
when it clots
÷ Contain salts, glucose, and other proteins
(including antibodies formed by the
body's immune system to protect against
infection)
÷ Prepared from the blood of a person (or
in rare cases an animal)
8erums, Vaccines, and
¡mmunizing Agents
· Vaccines
÷ Contain killed or modified microorganisms
("live attenuated organisms¨) that usually
do not cause disease
÷ Produce specific immunity to a disease
causing bacterial toxin, virus, or
bacterium
÷ Examples include vaccines for measles,
mumps, rubella, yellow fever, and polio
Drugs Affecting the
¡mmunologic 8ystem
· Ìmmunosuppressants
÷ Reduce the activity of the body's immune system
and activity of lymphocytes
÷ Usually prescribed to prevent rejection of foreign
tissues after transplant surgery
· Ìmmunodulating Agents
÷ Ìncrease the efficiency of the immune system
÷ Some enhance the ability of a vaccine to
stimulate the immune system
Dermatologic Drugs
· Used to treat skin irritations
· Common over-the-counter medications
· Ìnclude baths, soaps, solutions,
cleansers, emollients, and skin
protectants
· Sunscreen is included in this category
Vitamins & Minerals
Antidotes & Overdoses
· Treatment of poisoning and overdose
aimed at
÷ Eliminating the substance by emptying
the gastric contents
÷ Ìncreasing gastric motility
÷ Alkalinizing the urine
÷ Filtering the substance from the blood
OUE8T¡ON8?
eremy Maddux
ncmedix@msn.com



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