RT RT Course

Pharmacology Study Worksheet
Page 1 — Rights of Medication / Routes / Pharmacokinetics vs. Pharmacodynamics
  1. Right
  2. Right
  3. Right
  4. Right
  5. Right
MEDICATION FREQUENCY
every day
2x a day
3x a day
4x a day
immediately
before meals
after meals
as needed
at bedtime
in the morning
Oral Route Pts that can't tolerate ; un responsive to inhaled meds; non compliant patients; ; absorbed slower; more side effects
Inhalation GI tract; lungs; doses; resp meds to work; smaller ; to lungs
Parenteral Quicker actions; emergency meds is preferred;
Intraosseous Bone ; when can't be established/ other unavailable; HAZARDS
x IV dose
N
A
V
E
L
- what the body does with med
A
D
M
E
- how the med effects the body; agnostic versus antagonistic; stimulates versus blocks
Page 2 — Receptors / Autonomic Nervous System

How drugs, hormones chemical substances and neurotransmitters can exert / act upon SPECIFIC receptor sites

is the KEY holding the message

The is the LOCK receiving the message

PARASYMPATHETIC NERVOUS SYSTEM
CHOLINERGIC PATHWAY
ReceptorNuerotransmitterRest and Digest.

; stimulates receptors responding to acetylcholine

blocks receptors from responding to acetylcholine

  1. Anti-cholinergic meds stimulation of M1/M3; results in bronchodilation

Muscarinic Receptors:
M1/ M3 causes BRONCHOSCONSTRICTION
M2, when stimulated, will decrease the amount of ach released

SYMPATHETIC NERVOUS SYSTEM
ADRENERGIC PATHWAY (Adrenaline)
Receptor Neurotransmitter Fight or Flight. ↑ HR & BP redirect blood flow to muscles, heightens senses. ADRENERGIC / ACTION
Adrenergic; stimulates receptors that respond to epi/ norepinephrine Anti- adrenergic; blocks receptors responding to epi/ norepinephrine
receptors
found in the heart, lungs and vasculature
WHEN will cause
vasoconstriction and increased HR
B1 1 HEARTBEAT
located in heart and kidneys
causes
constriction/ contraction
↑HR and ↑ myocardial contractility 		B2 TWO LUNGS
Found in lungs, the guts, and arteriolar smooth muscle
STIMULATION
Causes
↓BP vasodilation
Example:
VASOPRESSORS
Example: DOBUTAMINE used in cardiogenic shock or heart failure Example:
ALBUTEROL
LEVALBUTEROL
ALPHA ANTI ADRENERGIC MEDS
↓ arteriolar resistance
↓ blood pressure (vasodilation)
  • ZOSINs: Prazosin Doxazosin Terazosin
 BETA ANTI ADRENERGIC MEDS beta blockers
Block effects of epi and norepinephrine
↓ HR and BP
  • LOL drugs: atenolol, metoprolol, labetalol
Page 3 — Drug Dose Calculations / Respiratory Meds
CALCULATING DRUG DOSES

= (%)(mL)( )

- what's being dissolved (mg)

- where it's dissolved (mL)

- the mixture of solute dissolved in solvent (% or % conc.)

% concentration (mg/mL)

x : y = ( ) *

Racemic Epinephrine Epinephrine
Indications Upper airway swelling/ inflammation, bronchiolitis, post extubation stridor, epiglottitis, croup, Systemic vasoconstriction, primary treatment for anaphylaxis, cardiac stimulant, asthma exacerbation
Nebulized or instilled through bronchoscope Sub-q injection (cardiac) Inhalation (asthma) IM (epipen)
Short Acting Beta2 Agonist (SABA) Short Acting Muscarinic Antagonist (SAMA) Long Acting Muscarinic Antagonist (LAMA) Combination
Example(s) most frequent class of resp meds
 Salmeterol, Formoterol Tiotropium Bromide ( ) , Combivent
Indications Rescue treatment
Medication of choice for exacerbation.
prior to exercise
Can be used in conjunction with steroids		 for moderate-severe asthma in patients >5 years; COPD; ; management of chronic airway disease & reactivity Maintenance of COPD, emphysema, and chronic bronchitis Slows rate of progression of , Improves and PTs quality of life COPD pt requiring additional bronchodilation
; tremors, palpitations, tachycardia, hypertension Commonly paired with / Duration is up 6 hours Duration is 24 hours Duration is 4-6 hours
Page 4 — Peak Flow / Xanthines

: Determines airflow obstruction and trending patterns

Flow is based on

RECORD THE BEST OF EFFORTS

normal, no action required
Administer bronchodilator and possibly oral steroids
Administer bronchodilator; call doc, and call 9-1-1

Xanthine's ( )

Act like stimulants by:

  • Increasing heart contractility
  • Increase respiratory muscle endurance
  • Increase CNS alertness
  • Diuresis
Theophylline
CONTRINDICATED IN ACUTE EXACERBATIONS
Asthma - ;
maintenance of mild/persistent		 COPD exacerbation when other medications have failed

Stimulates breathing
Increases CNS alertness
Toxic effects to be monitored
  1. Nausea
  2. Arrythmias
  3. Seizures
 Oral or intravenous administration
Page 5 — Mucus-Controlling Meds / Corticosteroids
Mucus-Controlling Medications

Decrease secretions; reduce infection; improve gas exchange

Diseases with abnormal

  • Cystic fibrosis
  • Bronchitis
  • Pneumonia
  • Asthma
  • Bronchiolitis
  • Primary Ciliary Dyskinesia
Corticosteroids
  • Primary drugs for asthma contraindicated for exacerbations
  • Given orally, IV, is preferred for respiratory meds
  • Long lasting given BID
  • Commonly paired with in a single treatment like Symbicort
  • Side effects: a decline in the ability of a treatment to produce the desired, maximum intended effect from hypertensive and diabetic medications
    • Potential growth stunting in kids
    • Oral yeast infection - THRUSH -
    USE A AND AFTER MED.
(Mucomyst) Dornase Alfa ( ) ( )
Indications in mucus.
Tylenol (acetaminophen) overdose		 Cystic Fibrosis management
↓ reduces risk for resp infection
Improves pulmonary function
*Selectively of mucus		 Induces cough/ mobilizes secretions
  • Helps with sputum collection
Hazards Airway irritation, bronchospasm, airway obstruction-thin mucus, nausea-sulfur smell
Photosensitive; Refrigerate; cannot be mixed to nebulize with another med in the same cup
Page 6 — Antimicrobials / Nonsteroidal Anti-Asthma Agents
* * *
Indications Treatment for (PCP) common in AIDS infected patients Infants with severe Respiratory Syncytial Virus Chronic Pseudomonas Aeruginosa (common treatment for CF patients)
GRAM NEGATIVE ORGANISM
Administration Negative flow room with HEPA filter
Negative effects Bronchospasm, SOB, Bronchial irritation Hematologic, CNS, GI Fetal abnormalities, voice alteration, tinnitus, hearing loss, impaired renal function
Nonsteroidal Anti-Asthma Agents

Used in conjunction with anti-inflammatory therapy

Controller medication, not a symptom reliever or for exacerbations!

  1. (allergen) enters body
  2. Immune cells that promote inflammation are released
    1. Leukotrienes
      1. Anti leukotrienes
        1. Zafirlukast ( ) long-term treatment of asthma in patients 5 years and older
        2. Montelukast ( ) long-term treatment of asthma in patients >12 months
        3. (Zyflo) long-term treatment of asthma in patients 12 years and older
          1. Liver damage susceptibility- liver enzymes checked regularly!
    2. Histamine
      1. Anti histamines
        1. Reduce secretions and their consistency in allergies and upper airway diseases
          1. Long acting drying effects
            1. NON SEDATING:
            2. SEDTAING:
  3. Mast Cell Stabilizers
    1. , making them more resistant to breaking. This neutralizes the release of inflammatory substances like histamine, prostaglandins, and leukotrienes. decreases the severity and frequency of asthma and COPD exacerbations.
Page 7 — Pulmonary Vasodilators / NMBAs
PULMONARY VASODILATORS

INOMax -

Indicated for

> weeks

Treatment < days normally at <20 ppm

Given via ventilator or high flow nasal cannula

Risk for methemoglobin

WEANY SLOWLY - rebound

DEPOLARIZING AGENTS NON-DEPOLARIZING AGENTS
only agent in this category
the acetylcholine receptors acetylcholine receptors
Acts in seconds and lasts for minutes most ideal for patients requiring intubation Action depends on the dose can take as long as minutes and will last around minutes preferred to paralyze vented patients
NEOSTIGMINE
Dry eyes, arrythmias (tachy), cardiac arrest (from excess potassium excreted from muscle cells), hypotension, muscle pain / weakness, hyperthermia Inadequate ventilation- the respiratory muscles are paralyzed
By blocking the nerve that slows the heart, this triggers a faster heartbeat (tachycardia) and raises overall blood pressure.
Mast cells release histamine triggering a hypotensive response
NEUROMUSCULAR BLOCKING AGENTS (NMBAs)

Facilitate intubation, surgery, vent synchrony, ↓ ICP, ↓ O2 consumption

NMBAs WORK TO PARLYZE AND RELAX ONLY

Page 8 — Diuretics / Fluid Resuscitation / Hypotension
DIURETICS
Urine Output
Normal30-60 mL/hr
AnuriaNo urine output (renal failure)
Oliguria< 30-60 mL/hr
Polyuria>60 mL/ hr
  1. IV resuscitation fluid overload
  2. CONGESTIVE HEART FAILURE
  3. Hypertension
  4. Pulmonary / cerebral edema, renal dysfunction
    1. Contraindications:
      Hypovolemia, pregnant/ breastfeeding women

Fluid resuscitation: hypotension, hypovolemia,

  • Dizziness on standing or suddenly sitting up
    • Verify by mearing BP in supine and standing position (or sitting up)
  • Shock
    • Inadequate delivery of O2 to organs to meet their demands
      • Low flow: cardiogenic and hypovolemic
      • High flow: vascular, septic, anaphylactic

Treatments
are volume expanders Albumin and Hydroxyethyl Starch
Crystalloids are carriers and expanders is the most common
Norepinephrine, dopamine, etc…
Trendelenburg

Inhibitor Osmotic Thiazide Sparing
Acetazolamide, Methazolamide, and Dichlorphenamide , Glycerol and Urea )- most commonly used for CHF! Chlorothiazide, Hydrochlorothiazide Amiloride, Spironolactone
Diuretic Effects Side Effects
  1. production
  2. Fluid
  3. blood pressure
  1. volemia
  3. abnormalities

Hypotension: BP < 90/65 mmHg
caused by dehydration : Decreased blood volume. Caused by: diuretics, ↓ sodium intake, diarrhea or excessive sweating, drugs impairing diuretic administration; and can be treated with rehydration

INDICATIONS:
Sinus tachycardia; decreased CO and SV; dizziness, extreme thirst, excessive mouth dryness, decrease or dark urine output, constipation

NOT SYNONYMOUS WITH

Page 9 — Analgesics / Sedation / Anxiolytics

Analgesics provide the absence of sensibility to pain without loss of consciousness.

  1. NSAIDs most and
    1. Ibuprofen, naproxen, salicylates/ aspirin, Celebrex
      1. TREATS MODERATE PAIN
        1. Given orally or IV multiple routes
  2. TYLENOL
    1. Commonly used for moderate pain
      1. Doesn't address inflammation
Sedation
Works fast; provides analgesia and sedation Restful state; calming effect
Treat anxiety and tension
*must be used with 		Tranquilizer agent
Anxiety, panic attacks
insomnia and seizures
Adverse Effects
Examples Morphine, Hydromorphone, Fentanyl, meperidine, Codeine lower RESP depress. Sodium thiopental (Pentothal)
Etomidate (Amidate)
  • Conscious sedation
  • TBI patients
Haloperidol (Haladol) 		Midazolam (Versed) *most commonly used
Lorazepam (Ativan)
Alprazolam (Xanax)
Diazepam (Valium)
Propofol (Diprivan) *decreased LOC and lack of memory for events
Administration Multiple routes IM, IV, Oral, derm
Page 10 — Cardiac Drugs / Antiarrhythmics / Inotropes

: Treat when a vagal maneuver doesn't work
Decreases AV node conduction slowing impulse transmission

: indicated in AFib, VFib, and VTach
Slows conduction and delays repolarization

: indicated in sinus brady, asystole, , and
Increases HR and the force of atrial contractions

(inotrope): Indicated for hypotension with S/S of shock drug for bradycardia
Increases myocardial contractility, increases cardiac output cerebral vasodilation, and peripheral arterial and venous vasoconstriction

(inotrope): ADRENALIN
Stimulates adrenergic receptors producing vasoconstriction, increasing BP, HR, and improves cerebral and cardiac perfusion
Indicated for

  1. Cardiac arrest ventricular fibrillation
  2. PULSELESS VTACH
  3. Asystole
  4. PEA
  5. Symptomatic Bradycardia
  6. SEVERE hypotension
  7. first line therapy
    1. An allergic reaction which involves shock and airway obstruction
      1. Treated by
        1. first line therapy
        2. Antihistamine injection
        3. Corticosteroid injection
        4. Fluids
        5. Trendelenburg

: Treats ventricular arrhythmias.

*Alternative antiarrhythmic to amiodarone in cardiac arrest from vtach/ vfib

Increases electrical stimulation threshold; depresses ventricular electrical activity

: Manages Torsade's de Pointe or hypomagnesemia
Prolongs conduction time caused by hypomagnesemia

(inotrope):
LEVOPHED
Treats SHOCK vasogenic, septic, neurogenic
Alpha-adrenergic stimulation
vaso increases blood flow and thus increases BP

: Treats decreased arterial thus restricting the level available for cells to produce energy (ATP) for the heart to contract
PREVENTS CELLULAR AND TISSUE