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Pharmacology for Paramedics Jeremy Maddux, NREMTP, I/C Historical Trends In 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

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pharmacology for paramedics

Pharmacology for Paramedics

Jeremy Maddux, NREMTP, I/C

historical trends in pharmacology
Historical TrendsIn 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 in pharmacology3
Historical TrendsIn 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
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 names5
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 ®
sources of medications
Sources of Medications
  • Plants
    • morphine sulfate, atropine
  • Animals and/or Humans
    • insulin, ACTH
  • Minerals
    • sodium bicarb, calcium
  • Synthetic (Chemical Substances)
    • lidocaine, diazepam
drug classification
Drug Classification
  • By Body System
    • Sympathetic Agonist, Anticholinergic
  • Class of Agent
    • Antidysrhythmic, Analgesic
  • Mechanism of Action
    • Calcium Channel Blocker, Diuretic
sources of drug information
Sources of Drug Information
  • Physicians Desk Reference (PDR)
  • Hospital Formulary (HF)
  • Drug Inserts
  • Other texts/sources
    • Brady
    • Internet
    • Mosby
medication regulation licensing
Medication Regulation & Licensing
  • Pure Food & Drug Act (1906)
    • Improve 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 licensing10
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 schedules
Schedule I

Heroin, LSD

NO accepted medical use

Schedule II

Opium, Cocaine

Accepted medical use

Severe dependence

Schedule III

Tylenol with Codeine

Low dependence

Schedule IV

Diazepam

Limited dependence

Schedule V

Opiods (cough)

Drug Schedules
scope of management
Scope of Management
  • You are held responsible for safe and therapeutically effective drug administration
  • Personally responsible for each drug you administer
    • Legally
    • Morally
    • Ethically
scope of management13
Use correct precautions and techniques

Observe and document effects of drugs

Keep knowledge base current

Establish & maintain professional relationships

Understand pharmacology

Identify drug indications and contraindications

Seek drug reference literature

Take a drug history from patients

Consult with medical direction

Scope of Management
the six rights of medication administration
The “Six Rights” of Medication Administration
  • Right Medication
  • Right Dose
  • Right Time
  • Right Route
  • Right Patient
  • Right Documentation
autonomic pharmacology
Autonomic Pharmacology
  • Central Nervous System (CNS)
  • Peripheral Nervous System
    • Somatic Nervous System
    • Autonomic Nervous System (ANS)
      • Sympathetic Branch
      • Parasympathetic Branch
autonomic nervous system characteristics
Autonomic Nervous System Characteristics

“Feed or Breed”

“Fight or Flight”

ans anatomy physiology
ANS 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
sympathetic versus parasympathetic
Sympathetic versusParasympathetic
  • 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 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
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
neurotransmitters
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
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
Norepinephrine
  • For adrenergic synapses norepinephrine molecules combine with adrenergic receptor molecules
    • Alpha Receptors
      • Blood vessels
    • Beta Receptors
      • Heart
      • Lungs
catecholamines related substances
Catecholamines &Related Substances
  • Dopamine
    • Raises pain threshold & increases tolerances to pain
  • Epinephrine
    • Emergency hormone releases by the adrenal medulla
catecholamines related substances30
Catecholamines &Related Substances
  • Norepinephrine
    • Important transmitter of nerve impulses
  • Serotonin
    • Released by injured tissues
      • Enhances pain at local level
      • Inhibits pain when it acts on the CNS
brain peptides
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
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
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

Absorption
distribution
Distribution
  • Drug reservoirs
    • Plasma protein binding (molecules)
    • Tissue binding (adipose or fat)
  • Barriers
    • Blood-brain barrier
    • Placental barrier
biotransformation
Biotransformation
  • Also known as metabolism where a drug is chemically converted to a metabolite
    • Active metabolites
    • Inactive metabolites
excretion
Excretion
  • Organs of excretion
    • Kidneys
    • Intestine
    • Lungs
    • Sweat & salivary glands
    • Mammary glands
drug forms
Liquid

Solutions

Tinctures

Suspensions

Spirits

Emulsions

Elixirs

Syrups

Solid

Pills

Powders

Tablets

Suppositories

Capsules

Gas

Drug Forms
routes of drug administration
Routes ofDrug 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)

Enteral Routes
parenteral routes
Endotracheal

Inhalation (Neb)

Instillation

Intradermal

Intramuscular (IM)

Intraosseous (IO)

Intravenous (IV)

Nasal

Subcutaneous (SQ)

Transdermal

Umbilical

Parenteral Routes
mechanics of drug action
Mechanics ofDrug 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 action44
Pharmaceutical

Disintegration of dosage form

Dissolution of drug

Pharmocokinetic

Absorption

Distribution

Metabolism

Excretion

Pharmacodynamic

Drug-receptor interaction

Mechanics ofDrug Action

Concentration of the drug at its site of action is influenced by various processes

pharmaceutical effects
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
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 interaction
Drug Receptor Interaction
  • 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 interaction48
Drug Receptor Interaction
  • 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
Type of Receptors
  • Beta 1
  • Beta 2
  • Alpha 1
  • Alpha 2
  • Dopaminergic
alpha receptors
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
    • Inhibit further release of norepinephrine
    • Mediate vasoconstriction
beta receptors
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
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
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
Factors Altering Drug Response
  • Age
    • Infants – 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 response56
Factors Altering Drug Response
  • Environment
    • Changes in temperature or altitude
  • Time of Administration
    • Presence or absence of food in GI tract
    • Biological rhythms
      • Sleep-wake cycles
  • Pathological State
    • Illness or injury
    • Underlying disease processes
factors altering drug response57
Factors Altering Drug Response
  • Genetic
    • Lack of specific enzymes
    • Lowered basal metabolic rate
  • Psychological
    • If the patient believes it will work it will work
predictable responses
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
Unpredictable Adverse Reactions
  • Allergic Reaction
    • Activates the Immune System
  • Anaphylactic Reaction
    • Severe allergic reaction
  • Idiosyncracy
    • Drug effect unique to individual
    • Different than expected
unpredictable adverse reactions60
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 reactions61
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 reactions62
Unpredictable Adverse Reactions
  • Drug Dependence
    • State in which withdrawal of a drug produces intense physical or emotional disturbance
  • Drug Interaction
    • Beneficial or detrimental effects of one drug by the prior or concurrent administration of another drug
unpredictable adverse reactions63
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 reactions64
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 interactions
Drug Interactions
  • Intestinal absorption
  • Competition for plasma protein binding
  • Drug metabolism or biotransformation
  • Action at the receptor site
  • Renal excretion
  • Alteration of electrolyte imbalance
drug drug interactions
Drug-Drug Interactions
  • 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 interactions
Other Drug Interactions
  • 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 storage
Drug Storage
  • Drug potency can be effected by
    • Temperature
    • Light
    • Moisture
    • Shelf life
  • Security of controlled medications
    • Double lock & key
components of a drug profile
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
  • Indications
    • Why a drug is appropriate
components of a drug profile70
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 profile71
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
special considerations in drug therapy
Special Considerationsin 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
special considerations in drug therapy73
Special Considerationsin Drug Therapy
  • Geriatric Patients
    • Significant changes in pharmacokinetics may occur in patients older than about 60 years
pregnant patients
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 patients75
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)
    • Indicates drugs that may have documented problems in animals and/or humans during pregnancy
pediatrics
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
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

Length-BasedResuscitation Tape
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

Geriatric Patients
drugs by classification
Analgesics and antagonists

Anesthetics

Antianxiety, sedative, and hypnotic drugs

Anticonvulsants

Central nervous system stimulants

Psychotherapeutic drugs

Antidepressant therapy

Drugs by Classification
narcotic analgesics
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 analgesics82
Narcotic Analgesics
  • Undesired effects
    • Nausea and/or vomiting
    • Constipation
    • Orthostatic hypotension
    • Respiratory depression
    • CNS depression
narcotic antagonists
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
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
Anesthetics
  • CNS depressants that have a reversible action on nervous tissue
  • Three general categories
    • General
    • Regional
    • Local
antianxiety sedative hypnotic drugs
Antianxiety, Sedative,& 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
sedatives versus hypnotics
Sedatives 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
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
Benzodiazepine Antidote
  • Flumazenil (Romazicon)
    • Benzodiazepine receptor antagonist
    • Effective in reversing benzodiazepine induced sedation
barbiturates
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
barbiturates93
Barbiturates
  • Divided into four classes according to their duration of action
    • Intermediate 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 sedatives hypnotics
MiscellaneousSedatives & 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 hydroxyzine (Vistaril, Atarax)
anticonvulsants
Anticonvulsants
  • Used to treat seizure disorders, mainly epilepsy
  • Exact mode and site of action of these drugs are not understood
  • In general these drugs depress the excitability of of neurons that fire to initiate seizure activity
anticonvulsants96
Anticonvulsants
  • Classifications
    • The choice of drug depends on the type of seizure disorder (generalized, partial, or status)
      • Hydantoins
      • Barbiturates
      • Succinimides
      • Benzodiazepines
central nervous system stimulants
Central NervousSystem Stimulants
  • 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
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
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
Psychotherapeutic Drugs
  • Include antipsychotic agents, antidepressants, and lithium
  • Used to treat psychoses and affective disorders, especially schizophrenia, depression, and mania
antipsychotic agents
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
Antidepressants
  • Used to treat affective disorders (mood disturbances), including depression, mania, and elation
    • Depression
      • Tricyclic antidepressants
      • Monoamine Oxidase (MAO) Inhibitors
    • Mania
      • Lithium
tricyclic antidepressants
Tricyclic Antidepressants
  • Thought to treat depression by increasing levels (blocking reuptake) of the neurotransmitters norepinephrine and serotonin
  • Examples
    • Imipramine (Tofranil)
    • Amitriptyline (Elavil)
  • Overdoses can be reversed with Sodium Bicarbonate administration
mao inhibitors
MAO Inhibitors
  • 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
    • Isocarboxazid (Marplan)
    • Phenelzine (Nardil)
lithium
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
  • In addition lithium enhances some of the actions of serotonin and may decrease levels of norepinephrine and dopamine
drugs for specific cns peripheral dysfunctions
Drugs for Specific CNS-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
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
Huntington’s Disease
  • An inherited disorder characterized by
    • Progressive dimentia
    • Involuntary muscle twitching
  • Thought to be related to an imbalance between dopamine, acetylcholine, and other neurotransmitters
drugs with central anticholinergic activity
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
Drugs that AffectBrain Dopamine
  • Three classifications
    • Those that release dopamine
    • Those that increase brain levels of dopamine
    • Dopaminergic agonists
drugs that affect brain dopamine111
Drugs that AffectBrain Dopamine
  • Levodopa (L-Dopa)
    • Increases brain levels of dopamine
    • Drug of choice in movement disorders associated with dopamine-acetylcholine imbalance
  • Two types of MAO Inhibitors
    • Monoamine Oxidase A
      • Metabolizes norepinephrine & serotonin
    • Monoamine Oxidase B
      • Metabolizes dopamine
drugs that affect the parasympathetic nervous system
Drugs that Affect the Parasympathetic Nervous System
  • Four Classifications
    • Cholinergic Drugs
    • Cholinergic Blocking Drugs
    • Ganglionic Stimulating Drugs
    • Ganglionic Blocking Drugs
cholinergic drugs parasympathomimetic
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 blocking drugs anticholinergic
Cholinergic Blocking Drugs (Anticholinergic)
  • Types of anticholinergic receptors
    • Muscarinic
    • Nicotinic
      • Nicotinic N (neuron)
      • Nicotinic M (muscle)
cholinergic blocking drugs anticholinergic116
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 anticholinergic117
Cholinergic Blocking Drugs (Anticholinergic)
  • Scopolamine (belladonna anticholinergic)
    • Similar to atropine but also causes sedation and antiemesis
    • Used to treat motion sickness
  • Ipratropium Bromide (Atrovent)
    • Inhaled anticholinergic used to treat asthma
cholinergic blocking drugs anticholinergic118
Cholinergic Blocking Drugs (Anticholinergic)
  • Nicotinic Cholinergic Antagonists
    • Block acetylcholine at nicotinic sites
    • Include 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 anticholinergic119
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 sympathetic nervous system
Drugs Affecting the Sympathetic Nervous System
  • Adrenergic Drugs
    • Direct acting
    • Indirect acting
    • Dual acting (direct and indirect)
direct acting
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
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
Beta Effects
  • Cardiac acceleration and increased contractility
  • Vasodilation of arterioles supplying the skeletal muscle
  • Bronchial relaxation
  • Uterine relaxation
indirect acting dual acting drugs
Indirect 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
AdrenergicBlocking Drugs
  • Classified into two categories
    • Alpha Blocking Drugs
    • Beta Blocking Drugs
      • Selective Blocking Drugs
      • Nonselective Blocking Drugs
alpha blocking drugs
Alpha Blocking Drugs
  • Block the vasoconstricting effects of catecholamines
  • Used in
    • Cases of hypertension
    • Prevent tissue necrosis when norepinephrine (Levophed) and dopamine (Intropin) have extravasated into the tissues
beta blocking drugs
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 drugs128
Beta Blocking Drugs
  • Nonselective Blocking Drugs
    • Block both Beta1 and Beta2 receptor sites
      • Beta1 receptors in the heart
      • Beta2 receptors in the lungs
    • Propranolol (Inderal)
    • Labetalol (Trandate)
      • Also has some alpha-blocking activity
skeletal muscle relaxants
Skeletal 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
Central-ActingMuscle 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
Direct-ActingMuscle Relaxants
  • Work directly on the skeletal muscle
  • Produce muscle relaxation, resulting in a decrease in muscle contraction
    • Dantrolene (Dantrium)
neuromuscular blockers
Neuromuscular Blockers
  • Produce complete muscle relaxation and paralysis by binding to the nicotinic receptor for acetylcholine at the neuromuscular junction
  • Used for
    • Endotracheal Intubation
    • Muscle spasms of the larynx
    • Breathing control by a respirator
neuromuscular blockers133
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 system
Drugs that Affect theCardiovascular System
  • Antidysrhythmics
  • Antihypertensives
  • Cardiac Glycosides
  • Vasodilators
  • Antihemorrheologic Agents
antidysrhythmics
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
AntidysrhythmicClassifications
  • Class I
    • Sodium channel blockers that work to slow conduction
    • Further divided into
      • Class Ia
      • Class Ib – decrease or have no effect on conduction
      • Class Ic – profoundly slow conduction and are indicated only for life-threatening dysrhythmia
antidysrhythmic classifications137
AntidysrhythmicClassifications
  • Class II
    • Beta blocking agents which reduce adrenergic stimulation of the heart
      • Propranolol (Inderal)
antidysrhythmic classifications138
AntidysrhythmicClassifications
  • Class III
    • 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 classifications139
AntidysrhythmicClassifications
  • Class IV
    • 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 (Isoptin)
      • Diltiazem (Cardizem)
antihypertensives
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
antihypertensives141
Antihypertensives
  • Diuretics
  • Sympathetic Blocking Agents
  • Vasodilators
  • Angiotensin-Converting Enzyme (ACE) Inhibitors
  • Calcium Channel Blockers
diuretics
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
diuretics143
Diuretics
  • Thiazides
    • Moderately effective in lowering BP
    • Help prevent side effects of hypertensive agents that retain sodium and water
      • Hydrochlorothiazide (HCTZ)
diuretics144
Diuretics
  • Loop Diuretics
    • Powerful and short acting
    • Inhibit sodium and chloride reabsorption in the Loop of Henle
    • Cause excessive loss of potassium
    • Increase in excretion of sodium and water
      • Furosemide (Lasix)
diuretics145
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)
sympathetic blocking agents
SympatheticBlocking Agents
  • Classified as:
    • Beta Blocking Agents
    • Adrenergic Inhibiting Agents
  • Result in a lowered blood pressure
sympathetic blocking agents147
SympatheticBlocking Agents
  • Beta Blocking Agents
    • Decrease cardiac output
    • Inhibit the secretion of renin by the kidneys
      • Result in a lowered blood pressure
    • Compete with epinephrine for available beta receptor sites
      • Inhibits 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 (Inderal)

Beta Blocking Agents
sympathetic blocking agents149
SympatheticBlocking Agents
  • Adrenergic Inhibiting 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 inhibiting agents
Centrally Acting Adrenergic Inhibitors

Clonidine (Catapres)

Methyldopa (Aldomet)

Peripheral Adrenergic Inhibitors

Guanethidine Sulfate (Ismelin)

Reserpine (Sandril, Serpasil)

AdrenergicInhibiting Agents
vasodilator drugs
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 drugs152
Arteriolar Dilator Drugs

Diazoxide (Hyperstat IV)

Hydralazine (Apresoline)

Minoxidil (Loniten)

Arteriolar and Venous Dilator Drugs

Sodium Nitroprusside (Nipride)

Nitro SL (Nitrostat)

Nitro IV (Tridil)

Vasodilator Drugs
angiotensin converting enzyme ace inhibitors
Angiotensin-ConvertingEnzyme (ACE) Inhibitors
  • Angiotensin II is a powerful vasocontrictor
    • Raises blood pressure and causes a release of aldosterone, which contributes to sodium and water retention
  • ACE Inhibitors prevent the conversion of Angiotensin I to Angiotensin II which results in a lowered blood pressure
    • Catopril (Capoten)
    • Enalapril (Vasotec)
calcium channel blockers
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 (Isoptin)
      • Diltiazem (Cardizem)
cardiac glycosides
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
Digitalis Glycosides
  • Affect the heart in two ways
    • Increase 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 side effects
Digitalis GlycosidesSide 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
Digitalis GlycosidesToxic 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
Antihemorrheologic Agents
  • Used to treat peripheral vascular disorders caused by pathological or physiological obstruction (arteriosclerosis)
  • Improve blood flow and delivery of oxygen to ischemic tissues
    • Pentoxifylline (Trental)
drugs that affect the blood
Drugs that Affect the Blood
  • Anticoagulants
  • Thrombolytics
  • Blood Components
anticoagulants
Anticoagulants
  • Drugs that interfere with platelet aggregation
  • Also known as anitplatelet or antithrombic drugs
    • Aspirin
    • Dipyridamole (Persantine)
    • Clopidrogrel (Plavix)
thrombolytics
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
Antihemophilic Agents
  • Hemophilia A (classic hemophilia)
    • Results from a deficiency of factor VIII
  • Hemophilia B (Christmas Disease)
    • Results from a deficiency of factor IX
  • Therapy aimed at replacement of the missing clotting factor
    • Factor VIII (Factorate)
    • Factor IX (Konyne)
hemostatic agents
Hemostatic Agents
  • Hasten clot formation to reduce bleeding
    • Systemic Hemostatic Agents
      • Amicar
      • Cyklocapron
    • Topical Hemostatic Agents
      • Gelfoam
      • Novacell
blood blood components replacement
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
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 system
Drugs that Affect the Respiratory System
  • Mucokinetic Drugs
  • Bronchodilator Drugs
  • Xanthine Derivatives
  • Prophylactic Asthmatic Drugs
mucokinetic 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
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
bronchodilators170
Nonselective Adrenergic Drugs

Epinephrine inhalation aerosol (Bronkaid Mist, Primatene Mist)

Racemic Epi

Nonselective Beta Adrenergic Drugs

Adrenalin

Isuprel

Selective Beta2 Drugs

Albuterol (Proventil)

Isoetharine (Bronkosol)

Bronchodilators
xanthine derivatives
Xanthine Derivatives
  • Include 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
Prophylactic Asthmatic Drugs
  • Reduce allergic or inflammatory response to stimuli and have a effect on bronchial smooth muscle
    • Beclomethasone Dipropionate (Vanceril)
    • Dexamethasone (Decadron)
    • Ipratropium (Atrovent)
drugs that affect the respiratory center
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 center174
Drugs that Affect the Respiratory Center
  • Reflex Respiratory Stimulants
    • Spirits of Ammonia
    • Noxious odor stimulates respirations through afferent messages to the brain
  • Respiratory Depressants
    • Include opium and barbiturate drugs
    • Seldom given to intentionally inhibit rate and depth of respiration
drugs that affect the respiratory center175
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 center176
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 center177
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 center178
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 center179
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 center180
Drugs that Affect the Respiratory Center
  • Antiserotonins (serotonin antagonists)
    • Inhibit responses to serotonin and its influence on other drugs & disease states
      • Block smooth muscle contraction and vasoconstriction
      • Inhibit 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 system
Drugs that Affect the Gastrointestinal System
  • Categorized into
    • Drugs that affect the stomach
    • Drugs affecting the lower gastrointestinal tract
drugs that affect the stomach
Drugs that Affectthe Stomach
  • 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 stomach183
Drugs that Affectthe Stomach
  • 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 stomach184
Drugs that Affectthe Stomach
  • Emetics
    • Used to induce vomiting for overdose or poisonings
      • Syrup of Ipecac
  • Antiemetics
    • Treat nausea and vomiting
      • Promethazine (Phenegran)
      • Prochlorperazine (Compazine)
drugs that affect the stomach185
Drugs that Affectthe Stomach
  • 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
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 tract187
Drugs Affecting the Lower Gastrointestinal Tract
  • Antidiarrheals
    • Reduce an abnormal frequency of bowel evacuation
    • Including bacterial or viral invasion and irritable bowel syndrome
      • Adsorbents (Pepto-Bismol)
      • Anticholinergics (Donnatal)
      • Other Agents (Lomotil and Imodium)
opthalmic drugs
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
Mydriatic andCycloplegic 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
Antiinfective and/or Antiinflammatory Agents
  • Use to treat conjunctivitis, sty, and keratitis (corneal inflammation caused by bacteria)
    • Bacitracin (Baciguent)
    • Chloramphenicol (Chloroptic)
    • Erythromycin (Ilotycin)
    • Natamycin (Natacyn)
topical anesthetic agents
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
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 Isopropyl Alcohol (Aurocaine 2)
drugs affecting the pituitary gland
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
Drugs Affecting the Parathyroid & Thyroid
  • Thyroid Drugs
    • Used to treat hypothyroidism and prevent goiters
      • Thyroid
      • Iodine Products
  • Parathyroid Drugs
    • Used to treat hyperparathyroidism
      • Vitamin D
      • Calcium Supplements
drugs that affect the adrenal cortex
Drugs that Affect the Adrenal Cortex
  • Glucocorticoids
    • Raise blood glucose and suppress inflammatory reaction
  • Mineralocorticoids
    • Regulate electrolyte and water balance
  • Adrenal Steroid Inhibitors
drugs affecting the pancreas
Insulin Preparations

Humulin 70/30

Lente Insulin

Ultralente

Hyperglycemic Agents

Glucagon

Dextrose

Oral Hypoglycemic Agents

Dymelor

Diabinese

Glucophage

Glucotrol

Micronase

Tolinase

Orinase

Drugs Affecting the Pancreas
drugs affecting the female reproductive system
Female Sex Hormones

Supplemental Estrogen

Progesterone (synthetic progestin)

Oral Contraceptives

“The pill”

Combination of estrogen and progesterone

Ovulatory Stimulants

Gonatropins

Clomid

Drugs Affecting the Female Reproductive System
drugs for labor and delivery
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 system
Drugs Affecting the Male Reproductive System
  • Testosterone
    • Used for the treatment of hormone deficiency
      • Testicular Failure
      • Impotence
      • Delayed Puberty
      • Female Breast Cancer
    • Methyltestoserone (Metandren)
drugs that affect sexual behavior
Drugs that Affect Sexual Behavior
  • Drugs used to impair libido and sexual gratification
    • Interfere with sympathetic nervous stimulation
      • Antihypertensives
      • Antidepressants
  • Drugs used to enhance libido and sexual gratification
    • Levodopa (L-Dopa)
    • Sildenafil Citrate (Viagra)
antineoplastic agents
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 infectious disease inflammation
Drugs Used in Infectious Disease & Inflammation
  • 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 infectious disease inflammation203
Drugs Used in Infectious Disease & Inflammation
  • 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)

Antibiotics
drugs used in infectious disease inflammation205
Drugs Used in Infectious Disease & Inflammation
  • 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)

Antifungal and Antiviral Drugs
other antimicrobal and antiparasitic drugs
Other Antimicrobal and Antiparasitic Drugs
  • Antimalarial Medications
  • Antituberculous Agents
  • Antiamebiasis Agents
  • Anthelmintic Agents
  • Leprostatic Agents
nonsteroidal antiinflammatory drugs
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)
serums vaccines and immunizing agents
Serums, Vaccines, and Immunizing 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)
serums vaccines and immunizing agents210
Serums, Vaccines, and Immunizing 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 immunologic system
Drugs Affecting the Immunologic System
  • Immunosuppressants
    • Reduce the activity of the body’s immune system and activity of lymphocytes
    • Usually prescribed to prevent rejection of foreign tissues after transplant surgery
  • Immunodulating Agents
    • Increase the efficiency of the immune system
    • Some enhance the ability of a vaccine to stimulate the immune system
dermatologic drugs
Dermatologic Drugs
  • Used to treat skin irritations
  • Common over-the-counter medications
  • Include baths, soaps, solutions, cleansers, emollients, and skin protectants
  • Sunscreen is included in this category
antidotes overdoses
Antidotes & Overdoses
  • Treatment of poisoning and overdose aimed at
    • Eliminating the substance by emptying the gastric contents
    • Increasing gastric motility
    • Alkalinizing the urine
    • Filtering the substance from the blood
questions

QUESTIONS?

Jeremy Maddux

ncmedix@msn.com