Pharmacology Ans Review

* Difference in Somatic and Autonomic Nervous System * The somatic nervous system consists of nerves that provide VOLUNTARY control over skeletal muscles * The autonomic nervous system exerts INVOLUNTARY control over the contraction of smooth muscle, cardiac muscle, and glandular activity. * Basic function of the Sympathetic VS Parasympathetic Systems * Sympathetic system= “fight of flight” * Parasympathetic system= “rest and digest” * Both autonomic branches are required for body homeostasis * Five mechanisms that medications can affect synapses in the ANS 1.

Increase/decrease the synthesis of the neurotransmitters in the presynaptic nerve 2. Prevent the storage of the neurotransmitters in vesicles within the presynaptic nerve 3. Influence the release (stimulation) of the neurotransmitter from the presynaptic nerve 4. Prolong the normal destruction of the neurotransmitter (stays in synapse longer) 5. Bind to postsynaptic receptors and stimulate target tissue * Classification and naming of meds that works in the ANS * Four classes of autonomic drugs: adrenergic agents, cholinergic agents, adrenergic-blocking agents, and cholinergic-blocking agents.

* Adrenergic agents (Sympathomimetrics) stimulate the sympathetic nervous system and causes “fight or flight” symptoms, common for treating shock and hypotension. * Adrenergic-blocking agents (Sympatholytics) inhibit the sympathetic nervous system and causes “rest and digest” responses, used to treat hypertension. * Cholinergic agents (parasympathetic) are mimic the “rest and digest” response * Cholinergic-blocking agents (anticholinergics) are drugs that inhibit the parasympathetic impulses, increase “fight or flight” symptoms.

* Sympathomimetrics- produce symptoms of “fight of flight” …… (stimulate) * Sympatholytics- produce symptoms of “rest and digest” …… (inhibit) 1. Stimulate the sympathetic nervous system: adrenergic agents/sympathomimetrics (Natural response agents-catecholamines & synthetic agents- noncatecholamines) 2. Inhibition of the sympathetic nervous system: adrenergic-blocking agents (antagonist) and sympatholytics 3. Stimulate parasympathetic nervous system: cholinergic/parasympathomimetics 4.

Inhibition of the parasympathetic nervous system: cholinergic-blocking agents, anticholinergic, parasympatholytics, or muscarinic blockers. * Review signs and symptoms a patient might experience based on the effects of the different classes of meds that work through the ANS Adrenergic or Sympathomimetrics * Tachycardia, hypertension, CNS excitement, dry mouth, seizures, dysrhythmias, nausea, anorexia, disturbed sleep pattern, asthma, nasal congestion, unawareness to surroundings * Pain assessment * Pain varies from patient to patient.

Must understand cause of the pain in order to properly assess and appropriately treat the pain (depends on nature and characteristic of the pain) * Tools to use include: numeric scales and survey instruments. Acute pain: an intense pain occurring over a brief amount of time, usually from injury/recovery Chronic pain: persist over a longer period of time (disease) that interferes with daily living * Non-pharmacologic pain relief actions- acupuncture, massage, heat/cold packs, meditation, prayer, hypnosis, energy/art/relax therapies, transcutaneous electrical nerve stimulation, etc.

* Opioid agonists and antagonists * Opiod Agonists-used to relieve moderate to severe pain; some used for anesthesia * Opiod Antagonist- used to reverse symptoms of opioid addiction, toxicity, overdose * Medications for migraine headaches * Antimigrane drugs are classified as serotonin agonists * The two major drug classed are triptans and ergot alkaloids * NSAIDS – major side effects * DRUG TOXICITY * Stomach ulcers and gastrointestinal bleeding * Increased blood pressure * Delayed digestion * Dizziness * Tinnitus (ringing in the ear) * Headache * Depression * Kidney damage

* Non-opioid analgesics – major side effects, two major problems with Acetominophen * Side effects: heart failure, confusion, asthma attacks, rash, GI bleeding & upset, headache, high blood pressure, salt and fluid retention * Acetominophen increases bleeding time, should not be given with anti-coagulant * Acetominophen- overdose can lead to liver failure * Parkinson’s disease – primary cause of the disease and major symptoms, secondary symptoms * Parkinson’s disease is caused by the progressive deterioration of nerve cells in the substantia nigra of the brain.

These neurons produce dopamine, without dopamine it will cause abnormal nerve functioning and the ability to control body movements. * Symptoms: Tremors (trembling), Gait (difficulty walking), slowed movement (bradykinesia), rigid muscles, speech change, impaired posture and balance * Drug therapy – choices, side effects * Dopaminergic- restores dopamine function or stimulates dopamine receptors * Side effects: hypotension, tachycardia, drug toxicity, Parkinson’s crisis * Avoid food and drugs high in pyridoxine * Anticholinergic- inhibit the action of acetylcholine in the brain (cholinergic blockers).

* Side effects: dry mouth, GI upset, light sensistivity, hypotension, insomnia * NO ALCOHOL & should not take revastigmine (Exelon) * Alzheimer’s disease – general symptoms, how meds are used for this disease, goals of treatment * Symptoms: memory loss, confusion, inability to think or communicate efficiently, anxiety, paranoia, delusions, aggressive behavior, horrible judgement * Drugs are used to slow memory loss and other symptoms of dementia * Some drugs are associated with depression, anxiety and psychoses. * Acetylcholinesterase Inhibitors intensify the effect of ACH at a cholinergic level * parasympathomimetics.

* Multiple Sclerosis – main signs and symptoms, treatment goals with meds. * A chronic, typically progressive disease involving damage to the sheaths of nerve cells in the brain and spinal cord * Symptoms: fatigue, heat sensitivity, neuropathic pain, spasticity, impaired cognitive, bowel/bladder irregularities, dizziness, vertigo, vision problems, and slurred speech. * No cure- drugs mainly provide relief with reoccurring symptoms * Slow progression of the disease and modify severity/frequency of symptoms * Immunomodulators or disease modifying drugs.

* Muscle spasms – non-pharmacological treatment methods * Immobilization of the affected muscle, application of heat/cold, hydrotherapy, ultrasound, supervised exercises, massage, and manipulation. * Goals of meds for muscle spasms * To inhibit the motor neurons within the brain and spinal chord * Causes Central Nervous System depressant effects or alter simple spinal reflexes * Antispasmodics – risks of Botox * Used to offer significant relief for dystonia (muscle spasms) symptoms * Can act as a (food) poision in high quanitiies.

* Causes extreme weakness, therapy is usually needed to improve muscle strength. * Endocrine system control – anterior and posterior pituitary hormones; hormones and function * Anterior pituitary (adenohypophysis) consist glandular tissue and secretes ACTH, thyroid-stimulating hormone, growth hormone, prolactin, follicle-stimulating hormone and leuteinizing hormone. * Posterior pituitary (neurohypophysis) contains nerve tissues store antidiuretic hormone and oxytonin. * Target Endocrine organs – Pineal gland, pituary gland, hypothalamus, thyroid, thymus, parathyroid, adrenal gland, pancreas, and gonad/ovary.

Thyroid – hypo and hyper, key signs and symptoms and meds to treat * Hypothyroidism caused by poor functioning of thyroid gland/low secretion from pituitary * Symptoms: general weakness, muscle cramps, dry skin, slurred speech, bradycardia, weight gain, decreased sense of taste and smell, intolerance to cold environments. * Treated with thyroid drugs (T3 or T4) requires careful readjustments * Hyperthyroidism caused by overactivity of the thyroid gland * Symptoms: increased metabolism, tachycardia, weight loss, body temperature, anxiety * Drugs: propylthiouracil and methimazole.

* Drugs used to lower the activity of the thyroid gland * ADH – treatment, Prototype drug ? * Adrenal glands – Cushing’s syndrome and Addison’s disease- key signs and symptoms * Addison’s disease symptoms: chronic fatigue, muscle weakness, inability to digest food, low blood pressure, change in skin color, hypoglycemia, moodiness, irritability, and depression, intolerance to heat or cold and craving of salty foods *.

Cause of Cushing’s- long term therapy with high doses of glucocorticoids (cortisol) * Symptoms of Cushing’s- weight gain, pink stretch marks, fragile skin, acne, fatigue, muscle weakness, depression, anxiety and irritability, cognitive difficulties, high blood pressure, headache, bone loss, leading to fractures over time .*

What does the Pancreas secrete? * Glucagon and insulin. * Insluin DECREASE blood glucose & glucagon INCREASE blood glucose levels * Diabetes Mellitus – signs and symptoms * Type 1 Diabetes * Frequent urination * Unusual thirst * Extreme hunger * Unusual weight loss * Extreme fatigue and Irritability.

* Type 2 Diabetes * Any of the type 1 symptoms * Frequent infections * Blurred vision * Cuts/bruises that are slow to heal * Tingling/numbness in the hands/feet * Recurring skin, gum, or bladder infections * Long term complications * Vision problems * Sores and infections (skin and gums) * Tingling and loss of feeling from nerves * This can lead to heart attack, stroke, and other problems * Digestion, constipation * kidney damage * Heart disease * Osteoporosis/osteoarthritis * Alzheimer’s disease * Differences in Type I and II.

* Type 1 formerly (juvenile onset) is caused when the pancreas, the organ that secretes insulin, is destroyed by autoantibodies, that’s why people with type 1 diabetes always need insulin, either injected or through an insulin pump. * Type 2 diabetes (adult onset) is due to ‘insulin resistance. ‘ Body still produces insulin, just the ineffective type. Treatment includes change in diet, lifestyle and exercise. Oral medication and insulin is optional depending on the patient’s status. * Insulin types – onset, peak, and duration.

* Onset-the length of time before insulin reaches the bloodstream and begins to lower blood sugar) * Peak- the time period when the insulin is the most effective in lowering blood sugar) * Duration- how long insulin continues to lower blood sugar) * Teaching patients about insulin – important points, managing diet with insulin * Short-acting insulin: for meals eaten within 30-60 minutes * Intermediate-acting insulin: usually combined with rapid- or short-acting insulin and covers insulin needs for about half the day or overnight.

* Long-acting insulin: covers insulin needs for about one full day. * Rapid-acting insulin: for meals eaten at the same time as the injection, and is used with longer-acting insulin. * Type 1 diabetes must have injections of insulin every day. * Exact dose of insulin: if the blood glucose levels are low, the patient is suffering from an overdose. If blood glucose levels are high, the patient didn’t have enough insulin. * Oral antidiabetic meds – which classes can cause hypoglycemia * Used for Diabetes Type 2 (obese patients) * Precribed after failure from diet and exercise.

* Periordic monitoring of blood glucose levels is necessary 1. Sulfonylureas 2. Biguanides 3. Meglitinides 4. Thiazolidinediones (glitazones) 5. Alpha-glucosidase inhibitors 6. Incretin therapy * Major problem with Metformin (Glucophage) administration * Lactic acidosis (a buildup of lactate in the blood) * gastrointestinal upset (anorexia, nausea, diarrhea) * Decreses the production of glucose and reduces insulin resistance * Does not cause weight gain or hypoglycemia * Can cause lactic acidosis in patients with impaired liver functions * Immediate release, once a day dosing.

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