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Pharmacology Exam 3 Briefing Document
1. Pharmacology of Cardiovascular, Respiratory, and
Hematologic Drugs
This section details the pharmacology of various drug classes, including their indications, therapeutic actions, side effects, contraindications, and nursing considerations.
Cardiac Glycosides (e.g., Digoxin)
Aspect Description Indications Heart Failure (HF) as a secondary drug, Atrial Fibrillation, Atrial Flutter. Actions Inhibits the sodium-potassium pump, increasing intracellular sodium and leading to an influx of calcium. This results in: Positive Inotropic Effect: Increases myocardial contractility and stroke volume, enhancing cardiac output. Negative Chronotropic Effect: Decreases heart rate. Negative Dromotropic Effect: Decreases conduction through the heart muscle. Side Effects Dizziness, bradycardia, pounding pulse, syncope. Toxicity S/S: Anorexia, nausea, vomiting, diarrhea, bradycardia, cardiac dysrhythmias, headaches, visual disturbances (halos around lights, tinnitus), confusion, delirium. Contraindica tions Caution should be used in children. Drug interactions with diuretics, glucocorticoids, and antacids can increase toxicity or decrease absorption. Nursing Consideratio ns Therapeutic Level: 0.5 to 2.0 ng/mL. Assessment: Check apical pulse before giving; hold if pulse is < 60/min. Monitor serum digoxin and potassium levels. Assess for signs of peripheral and pulmonary edema. Patient Education: Teach patient how to take their pulse. Advise them to report side effects and to consume foods high in potassium, as
hypokalemia increases the risk of digoxin toxicity. The antidote for toxicity is Digoxin immune Fab (Digibind).
Alpha and Beta-Adrenergic Blockers
Aspect Description Indications Hypertension, Angina Pectoris, Cardiac Dysrhythmias. Selective alpha₁- blockers are also used for benign prostatic hypertrophy. Actions Alpha-Blockers (e.g., Doxazosin, Prazosin): Block alpha-adrenergic receptors, causing vasodilation and decreased blood pressure. Beta- Blockers (e.g., Metoprolol, Propranolol, Atenolol): Decrease the sympathetic nervous system response by blocking catecholamines, which reduces heart rate, blood pressure, contractility, and renin release. Nonselective (β₁ and β₂): Affect heart and cause bronchoconstriction. Cardioselective (β₁): Primarily affect the heart, reducing heart rate with less risk of bronchoconstriction. Side Effects Alpha-Blockers: Orthostatic hypotension, nausea, headache, drowsiness, nasal congestion, edema, weight gain. Beta-Blockers: Bradycardia, hypotension, dizziness, fatigue, insomnia, depression, nightmares, sexual dysfunction. Nonselective beta-blockers can cause bronchospasm. Contraindic ations Nonselective Beta-Blockers: Chronic Obstructive Pulmonary Disease (COPD),. Cardioselective Beta-Blockers: Use with caution in patients with diabetes mellitus. Nursing Considerati ons Assessment: Measure BP before administration. Patient Education: Do not stop medications abruptly, as this can cause rebound hypertension, angina, or dysrhythmias. Instruct patients to change positions slowly to avoid orthostatic hypotension. BETA BLOCKERS 1 & 2 – NURSING PHARMACOLOGY CHART, ADDITIONAL INFO Category Details
Nursing Considerations – Patient Education
- Take medication as prescribed
- Monitor pulse
- Report dizziness or fainting
- Rise slowly from lying/sitting positions
- Avoid abrupt discontinuation
- Monitor blood glucose if diabetic
- Report depression symptoms
- Avoid alcohol
- Keep regular follow-up appointments Special Populations
- Elderly: Start with lower doses
- Renal impairment: Dose adjustment may be needed
- Diabetics: Monitor glucose levels closely
Calcium Channel Blockers (CCBs)
Aspect Description Indications Hypertension, Angina Pectoris, Cardiac Dysrhythmias. Actions Block the calcium channel in vascular smooth muscle cells, which promotes vasodilation. They relax coronary artery spasms and peripheral arterioles, decrease cardiac contractility and afterload, and reduce the workload of the heart. Side Effects Headache, hypotension, dizziness, flushing of the skin, reflex tachycardia, peripheral edema, bradycardia, and AV block. Contraindications Immediate-release nifedipine has been associated with an increased incidence of sudden cardiac death in high doses. Nursing Considerations Patient Education: Advise patients to avoid ingestion of grapefruit juice, as it can intensify the drug's effect.
Statins (HMG-CoA Reductase Inhibitors)
Aspect Description Indicatio ns Hyperlipidemia (to reduce LDL cholesterol). Examples include atorvastatin, simvastatin, lovastatin, pravastatin, rosuvastatin. Actions Decrease the synthesis of lipids in the liver. Side Effects Headache, rash, constipation, diarrhea. Adverse Effects: Liver impairment and rhabdomyolysis (skeletal muscle disorder), rebound hyperlipidemia. Contraind ications Liver disease. Nursing Consider ations Monitor liver enzymes. Instruct patients to report any unexplained muscle tenderness, weakness, fever, or malaise, as these can be signs of rhabdomyolysis.
Nitrates (e.g., Nitroglycerin)
Aspec t Description Indica tions Angina Pectoris (acute cardiac pain). Action s Cause generalized vascular and coronary vasodilation, increasing blood flow through coronary arteries to the myocardium. This reduces myocardial ischemia. Side Effect s Headache (most common), hypotension, dizziness, reflex tachycardia.
Carbonic Anhydrase Inhibitors (CAIs)
Aspect Description Indicatio ns Primarily used to decrease intraocular pressure (IOP) in patients with open- angle (chronic) glaucoma. Example: Acetazolamide. Actions Block the enzyme carbonic anhydrase, which is needed for acid-base balance. Inhibition causes increased excretion of sodium, potassium, and bicarbonate. Side Effects Fluid and electrolyte imbalance, metabolic acidosis, nausea, vomiting, confusion, orthostatic hypotension, crystalluria, hemolytic anemia, renal calculi. Contraind ications Contraindicated during the first trimester of pregnancy. Nursing Consider ations Monitor for electrolyte imbalances and signs of metabolic acidosis.
Angiotensin II Receptor Blockers (ARBs)
Aspect Description Indication s Hypertension, Heart Failure (for patients who cannot tolerate an ACE inhibitor). Examples end in "-sartan" (e.g., Losartan, Valsartan). Actions Block angiotensin II from its receptors (AT₁), preventing the release of aldosterone. This causes vasodilation and decreases peripheral resistance.
Side Effects Dizziness, drowsiness, blurred vision, headache, diarrhea, insomnia. Unlike ACE inhibitors, ARBs do not cause an irritated cough. Contraindi cations Should not be taken during pregnancy. Less effective as monotherapy for African-American and older adults. Nursing Considera tions Monitor blood pressure and for side effects like dizziness.
Lidocaine
Aspect Description Indicatio ns Acute ventricular dysrhythmias. Actions Class IB sodium channel blocker. It decreases sodium influx into cardiac cells, slows conduction velocity, and shortens repolarization. Side Effects Less Serious: Dizziness, lightheadedness, confusion. High Doses: Cardiovascular depression, bradycardia, hypotension, seizures, blurred or double vision. Contraind ications N/A in source context. Nursing Consider ations Monitor ECG and blood pressure closely during administration. All antidysrhythmic drugs are potentially prodysrhythmic.
Nursing Considerations Patient Education: Advise patients to increase fluid intake to at least 8 glasses per day to help loosen mucus. Hydration is the best natural expectorant.
Mucolytics
Aspect Description Indications Conditions with thick mucous secretions, such as in asthma, hyperactive airway disease, or cystic fibrosis. Example: Acetylcysteine. Actions Act like detergents to liquefy and loosen thick mucous secretions so they can be expectorated. Side Effects Nausea, vomiting, stomatitis (mouth sores), "runny nose." Contraindications N/A in source context. Nursing Considerations Administered by nebulization. A bronchodilator should be given 5 minutes before the mucolytic. Should not be mixed with other drugs. Also serves as an antidote for acetaminophen overdose if given within 12-24 hours.
Decongestants
Aspect Description Indicati ons Nasal congestion due to common cold, sinusitis, or allergies. Examples: Pseudoephedrine, Ephedrine, Oxymetazoline.
Actions Stimulate alpha-adrenergic receptors, producing vascular constriction of capillaries within the nasal mucosa. This shrinks nasal mucous membranes and reduces fluid secretion. Side Effects Jitteriness, nervousness, restlessness, hypertension, hyperglycemia. Frequent use of nasal sprays can lead to tolerance and rebound nasal congestion. Contrai ndicati ons N/A in source context. Nursing Consid eration s Patient Education: Emphasize limiting use of nasal sprays and drops to no more than 3-5 days to avoid rebound congestion. May interact with caffeine, increasing restlessness and palpitations.
Corticosteroids (Glucocorticoids)
Aspect Description Indicatio ns Inhaled (e.g., Fluticasone, Beclomethasone): Prophylactic and maintenance therapy for asthma unresponsive to bronchodilators; allergic rhinitis. Systemic (Oral/Injectable): Acute asthma exacerbations. Actions Anti-inflammatory action. Side Effects Inhaled: Throat irritation, hoarseness, dry mouth, coughing, oropharyngeal Candida albicans infections. Oral/Injectable: Headache, euphoria, confusion, hyperglycemia, insomnia, nausea, peptic ulcer, loss of bone density, psychosis. Contrain dications Inhaled glucocorticoids are not helpful for a severe, acute asthma attack.
Indications Bronchospasm associated with COPD and asthma. Actions Relax the smooth muscles of the bronchi and bronchioles to open the airways. Classes Sympathomimetics (e.g., Epinephrine, Albuterol): Increase cyclic AMP (cAMP), causing bronchodilation. Selective beta₂ agonists are preferred for chronic asthma/COPD. Anticholinergics (e.g., Ipratropium, Tiotropium): Dilate bronchioles. Used for maintenance treatment. Methylxanthine Derivatives (e.g., Theophylline): Relax smooth muscles of the bronchi by inhibiting phosphodiesterase, resulting in increased cAMP. Side Effects Sympathomimetics: Tremors, nervousness, tachycardia, palpitations, hypertension, hyperglycemia. Anticholinergics: Dry mouth, constipation, headache, peripheral edema. Xanthines: Nervousness, irritability, insomnia, dizziness, tachycardia, palpitations, seizures. Contraindic ations Xanthines: Seizure disorders, cardiac, renal, or liver disease. Nursing Considerati ons Patient Education: Teach correct use of inhalers (MDI/DPI). If using a beta-agonist with an anticholinergic or steroid, use the beta-agonist first and wait 5 minutes. Xanthines: Have a narrow therapeutic range (10- 20 mcg/mL); require serum level monitoring. Toxicity occurs > 20 mcg/mL.
Vasodilators
Aspect Description Indications Hypertension (especially hypertensive crisis), Heart Failure. Actions Direct-Acting (e.g., Nitroprusside, Hydralazine): Relax the smooth muscles of blood vessels (mainly arteries), causing vasodilation and increased blood flow. Other Classes: Nitrates,
ACE inhibitors, ARBs, and Alpha-blockers also have vasodilator effects. Side Effects Reflex tachycardia, palpitations, edema, nasal congestion, headache, dizziness, confusion. Contraindications N/A in source context. Nursing Considerations Beta-blockers are often prescribed concurrently to decrease reflex tachycardia. Monitor for profound hypotension.
Thrombolytics
Aspect Description Indications Acute Myocardial Infarction (MI), Ischemic Stroke, Pulmonary Embolism (PE). Used to dissolve existing clots. Examples: Alteplase (tPA), Streptokinase. Actions Convert plasminogen to plasmin, which destroys the fibrin in a blood clot, effectively dissolving it. Side Effects Hemorrhage (major complication), vascular collapse, allergic reactions (more frequent with streptokinase). Contraindi cations Hemorrhagic stroke, recent surgery (especially intracranial or spinal), active internal bleeding, peptic ulcers, bleeding disorders. Nursing Considerat ions Monitor for bleeding (gums, urine, stool, bruising). Avoid venipuncture and arterial sticks for 72 hours after administration. Avoid anticoagulants and antiplatelets until the effect has passed. The reversal agent is aminocaproic acid.
Indicati ons Prophylactic use to prevent arterial thrombosis, especially after MI, stroke, or heart surgery. Actions Suppress platelet aggregation. Aspirin (ASA): Inhibits cyclooxygenase, an enzyme needed to synthesize thromboxane A₂. ADP Antagonists (e.g., Clopidogrel): Inhibit platelet aggregation. Side Effects Bleeding. Contrai ndicati ons History of peptic ulcer disease or current bleeding. Nursing Consid eration s Patient Education: Advise patients not to smoke. They should inform their doctor/dentist before any procedures. Herbal products can interact and increase bleeding risk.
Red Blood Cell Stimulants
Aspect Description Indication s Severe anemia, especially in patients with kidney failure where blood transfusions are not an option. Example: Epoetin alfa (Erythropoietin). Actions A glycoprotein hormone that stimulates the production of red blood cells. Side Effects Myocardial infarction, thrombophlebitis, stroke, hypertension, pain at injection site. Contraindi cations Heart failure, low blood cells in cancer patients, anticoagulants.
Nursing Considerat ions Patient must have adequate iron levels for the drug to be effective.
2. Use of Inhalers and Nebulizers Bronchodilator Inhalers (Metered-Dose [MDI] or Dry Powdered [DPI]) - Indications: Treatment of bronchospasm associated with chronic asthma or COPD. - Directions for Use: Shake the inhaler, remove the cap, breathe out fully, place lips around the mouthpiece to form a tight seal, and breathe in slowly while activating the device. A spacer can be used to improve drug delivery to the lungs. - Precautions: Overuse or high doses of beta₂-agonists may cause nervousness, tremor, and increased pulse rate. If relief is not effective, the technique may be faulty or the canister may be empty. Steroid-Based Inhalers - Indications: Used for asthma that is unresponsive to bronchodilator therapy or for patients having an asthma attack while on maximum doses of other drugs. It is a prophylactic and maintenance therapy. - Directions for Use: If used with a bronchodilator, the bronchodilator should be administered 5 minutes before the steroid inhaler. This opens the airways and allows the steroid to penetrate deeper into the lungs. - Precautions: Not effective for a severe, acute asthma attack, as it may take 1 to 4 weeks to reach full effect. Patients must rinse their mouth and throat with water after each dose to prevent oropharyngeal fungal infections ( Candida albicans ). Nebulizing Treatments - Indications: Administration of drugs like the mucolytic acetylcysteine to patients with asthma or hyperactive airway disease who have increased secretions obstructing airways. - Directions for Use: The drug is aerosolized and inhaled. It should not be mixed with other drugs in the nebulizer.
4. Process for Administering a Steroid-Based Inhaler 1. If a bronchodilator inhaler is also prescribed, administer the bronchodilator 5 minutes before the steroid inhaler to open the airways for better steroid penetration. 2. Use a spacer device attached to the inhaler. This improves drug delivery to the lungs and reduces the amount of drug deposited in the mouth and throat. 3. After inhaling the dose, instruct the patient to rinse their mouth and throat with water and spit it out. This is critical to prevent oral fungal infections ( Candida albicans ). 4. The spacer should be washed daily with warm water and allowed to air dry. 5. Medications for Status Asthmaticus The provided source materials describe treatments for acute, severe asthma attacks, which are characteristic of status asthmaticus. - Epinephrine: A nonselective sympathomimetic (alpha₁, beta₁, and beta₂) given in emergencies. It is considered a first line of defense to restore circulation and increase airway patency. It is typically administered subcutaneously. - Systemic Glucocorticoids: Patients with acute asthma exacerbations are usually given systemic (oral or injectable) glucocorticoids in large doses for rapid anti- inflammatory effectiveness. - Selective Beta₂-Adrenergic Agonists: These drugs, such as terbutaline, can be administered by inhalation, orally, or subcutaneously to relax the smooth muscle of the bronchi. 6. Medications for Tuberculosis (TB) The primary medications used to treat tuberculosis include: First-Line TB Drugs: Isoniazid Action: Inhibits mycobacteria metabolism and reproduction, even during dormancy Administration: Oral, IV, or IM
Rifampin Action: Prevents TB reproduction by blocking RNA transcription from DNA Notable side effect: Causes reddish-orange staining of body fluids and secretions Pyrazinamide Action: Reduces intracellular pH in WBCs to inhibit TB reproduction Particularly effective in early disease stages Ethambutol Action: Bacteriostatic effect through unknown mechanism Must be used with other TB medications Common Side Effects: General: Diarrhea, headache, nausea, vomiting, sleep difficulties Liver toxicity (most serious) Peripheral neuropathy (especially with isoniazid) Vision changes (with ethambutol) Anemia (with rifampin) Length of Therapy: Standard treatment typically requires 6-12 months of combination therapy. Drug Resistance: MDR TB: Resistant to isoniazid and rifampin XDR TB: Resistant to first-line and some second-line drugs Alternative treatments include bedaquiline, pretomanid, and linezolid Supplemental Vitamin Therapy: Pyridoxine (Vitamin B6) should be given with isoniazid to prevent peripheral neuropathy, particularly important for: Malnourished patients Diabetic patients Alcoholics Pregnant women HIV-positive patients
