NCLEX Review

Pharmacology

Charlene Natale, BSN, RN

Drug Action

Three phases
Pharmaceutic Phase
Pharmacokinetic Phase
Pharmacodynamic Phase
Please Don’t Rush The Drugs in the Dark

Right… Right…
• Patient • Documentation
• Drug • Administration rate
• Route • to Refuse
• Time • to Know
• Dose
Adrendergic Receptor Sites
 Alpha 1 - receptors  Alpha 2 - receptors
 Blood vessels  Blood vessels
 Vasoconstriction  vasodilates
 Increased blood pressure  Decreased blood
 Increased contractility pressure
 Eye  Smooth muscle/GI
 Mydriasis (pupil dilation) tract
 Bladder  Decreased tone
 Contraction  Decreased motility
 Prostate
 Contraction
Alpha 1 adrenergic agonists
 Midodrine (ProAmatine)
 Phenylephrine HCL (12 hr nasal spray)
 Oxymetazoline HCL (Neo-Synephrine)

Alpha 1 and Beta 1 adrenergic agonist

Pseudoephedrine HCL (Sudafed)
Alpha 2 adrenergic agonist
 Clonidine (Catapres)
 Methyldopa (Aldomet)
 Guanfacine HCL (Tenex, Intuiv)
 Guanaben 2 acetate (Wytensin)
Alpha 1 and mixed Adrenergic Blockers
 Alpha 1 blockers
 Phentolamine mesylate (Regitine)
 Doxazosin mesylate (Cardura)
 Prazosin HCL (Minipress)
 Terazosin HCL (Hytrin)
 Alpha 1, Beta 1, Beta 2 blockers
 Carvedilol (Coreg)
 Labetalol (Normodyne Trandate)
Beta Receptor sites
 Beta 1 – receptors  Beta 2 - receptors
 Heart
 Increased heart rate
 Increased contractility
 Kidney
 Increased renin
secretion
 Increased angiotensin
 Increased blood
pressure
 Smooth muscle/GI tract
 Decreased tone
 Decreased motility
 Lungs
 Bronchodilation
 Uterus
 Relaxes uterine smooth muscle
 Liver
 Activation of glycogenolysis
 Increased blood sugar
Beta 1 Adrenergic Agonists
 Dobutamine HCL (Bobutrex)
 Isoetharine HCL ( Bronkosol)

Beta 1 and Beta 2 (nonselective)

Isoproterenol (Isuprel)
Beta 2 adrenergic agonist
 Albuterol Sulfate (Proventil, Ventolin)
 Isoetharine HCL ( Bronkosol)
 Terbutaline (Brethine)
 Metaproterenol sulfate (Alupent)

Beta 1 and Beta 2 (nonselective)

Isoproterenol (Isuprel)
Adrenergic Blockers
 Beta 1 blockers
 Metoprolol tartrate (Lopressor)
 Atenolol (Tenormin)
 Acebutolol HCL (Sectral)
 Bataxolol (betoptic)
 Bisoprolol fumarate (Zebeta)
 Esmolol HCL (Brevibloc)
Adrenergic Blockers
 Beta 1, Beta 2 Blockers
 Carteolol HCL ( Cartrol)
 Penbutolol (Levatol)
 Propranolol HCL (Inderal)
 Nadolol (Corgard)
 Pindolol (Visken)
 Sotalol (Betapace)
 Timolol maleate (Blocadren)
Autonomic Nervous system Agents
 Adrenergic Agonists
 Sympathetic stimulant
 Increase blood pressure
 Increase pulse rate
 Relax bronchioles
 Dilate pupils
 Relax uterine muscles
 Increase blood sugar
 Cholinergic Agonists
 Parasympathetic stimulant
 Decrease blood pressure
 Decrease pulse rate
 Constrict bronchioles
 Constrict pupils
 Increase uterine contraction
 Increase peristalsis
Cholinergic Miotics
 Carbachol (Isopto Carbachol)
 Pilocarpine HCL (Isopto Carpine)
 Pilocarpine nitrate (Ocusert pilo -20, Pilo-40)
 Echothiophate iodide (Phospholine Iodide)
Antihyperlipidemics
 Statins (HMG-COA Reductase Inhibitors)
 Atorvastatin (Lipitor)
 simvastatin (Zocor)
 Fluvastatin sodium (Lescol)
 Lovastatin (Mevacor)
 Pravastatin sodium (Pravachol)
 Rosuvastatin calcium (Crestor)
 Pitavastatin (Livalol)
CNS Depressants
 Common side effects
 Hangover
 REM rebound
 Dependence
 Tolerance
 Excessive depression
 Respiratory depression
 Hypersensitivity
CNS Depressants

 Sedatives – hypnotics
 Barbituates
 Benzodiazepines
 Anesthetics
Barbituates
 Long Acting
 Mephobarbital (Mebaral) class IV
 Intermediate acting
 Butabarbital sodium (Butisol sodium) Class III;
 Short acting
 Pentobarbital sodium (Nembutal Sodium) Class II;
 Secobarbital sodium (Seconal Sodium) Class II
Containdicated in severe hepatic disease or resp.
depression. Careful use with elderly
Benzodiazepines
 Generic names end in …pam, or …lam
 Flurazepam (Dalmane)
 Alprazolam (Xanax)
 Temezepam (Restoril)
 Triazolam (Halcion)
 Estazolam (ProSom)
 Quazepam (Doral)

 Note flumazenil (Romazicon) is a Benzo antagonist and

used to manage benzo overdose and reverse sedative
effects with general anesthetics
Ace Inhibitors
 Generic names end in …pril
 Enalapril (Vasotec)
 Lisinopril (Prinivil, Zestril)
 Quinapril (Accupril)
 Benazepril (Lotensin)
 Captopril (Capoten)
 Fosinopril (Monopril)
 Moexipril (Univasc)
 Perindopril (Aceon)
 Ramipril (Altace)
 Trandolapril (Mavik)
Calcium Channel Blockers
 Generic names end in … pine
 Nifedipine (Procardia)
 Nisoldipine (Sular)
 Amlodipine (Norvasc)
 Diltiazem (Cardizem, Tiazac)
 Verapamil HCL (Calan, Isoptin)
Metered dose Inhaler - MDI
Macrolides
 Azithromycin (Zithromax)
 Clarithromycin (Biaxin)
 Erythromycin base (E-Mycin
 Ethylsuccinate (E.E.S., Pediamycin)
 Erythromycin stearate (erythrocin stearate)
 Erythromycin IV (erythrocin lactobionate)
 Fidaxomicin (Dificid)
Glycopeptides
 Vancomycin HCL (Vancocin)
 Telavancin (Vibativ)
Sulfa
 S unlinght sensitivity
 U ndesirable effects – rash renal
toxicity
 L ook for urine output, fever,
sore throat and bleeding
 F luids galore
 A norexia, anemia
Fluoroquinolones - Quinolones
 Generic names end with.. Oxacin
 Ciprofloxacin (Cipro)
 Lomefloxacin (Maxaquin)
 Nalidixic acid (Neg-Gram)
 Norfloxacin (Noroxin)
 Ofloxacin (Floxin)
GERD
 Non pharmacologic measures
 Avoid Tobacco use
 Avoid alcohol
 Obesity
 Avoid hot spicy or greasy foods
 Raise the head of the bed
 Do not eat before bed
 Wear loose fitting clothing
Anti Ulcer agents – Histamine blockers
 Generic names end in …dine
 Cimetidine (Tagamet)
 Famotidine (Pepcid)
 Nizatidine (Axid)
 Rantidine (Zantac)
Anti Ulcer Drugs – Proton Pump Inhibitors
 Omeprazole (Prilosec)
 Lansoprazole (Prevacid)
 Esomeprazole (Nexium)
 Pantoprazole (Protonix)
 Rabeprazole (Aciphex)
Uric Acid Biosynthesis Inhibitors
 Allopurinol (Zyloprim)
 Febuxostat (Uloric)
Bisphosphonates
 Alendronate (Fosamax)
 Ibandronate sodium (Boniva)
 Risedronate (Actonel)
 Reclast
Cardiac Emergency drugs
 Oxygen
 Nitroglycerin
 Morphine sulfate
 Atropine Sulfate
 Isoproternol
 Epinephrine
 lidocaine
Cardiac Emergency drugs
 Adenosine
 Verapamil
 Diltiazem
 Amiodarone
 Magnesium Sulfate
 Procainamide HCL
 Sodium Bicarb
 Vasopressin
Corticosteroids
 Generic name ends in …sone
 Beclamethasone
 Prednisone
 Prednisolone
 dexamethasone
lactulose
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