Pharmacology: Characteristiccs of Drug classes, Part 2

Adrenergic bronchodilators and phosphodiesterase inhibitors may both be classified as _______.

Adrenergic bronchodilators treat asthma how? By what mechanism?

Phosphodiesterase inhibitors treat asthma how? By what mechanism?

How are corticosteroids used in the treatment of asthma?

_____ produce bronchodilation by decreasing intracellular levels of cGMP

How are leukotriene receptor antagonists and mast cell stabilizers used in the treatment of asthma?

What classes of drugs fall under the category of antiasthmatics?

During what time frame should a rapid acting bronchodilator be administered in anticipation of exercise?

An asthma patient is switching from oral to inhaled corticosteroids. What assessments are important for the Nurse to make?

What are the general, primary uses of the anticoagulant class of drugs?

True or False: Anticoagulants are used in the management of MI sequentially or in combination with thrombolytics and/or antiplatelet agents.
True False

True or False: Anticoagulants dissolve clots
True False

What are the two most commonly used anticoagulants? (route and drug name)

In pharmacotherapy involving anticoagulants, therapy is often started with ______ because of its rapid onset of action, while maintenance therapy consists of ______.

_____ are mostly used to prevent deep vein thrombosis after certain surgical situations in which there is an increased risk of thromboembolism.

What common post-surgical situation puts the patient at risk for thromboembolism and requires prophylactic treatment with the drug above?

_____, an anticoagulant, takes several days to produce therapeutic effects.

In serious or severe thromboembolytic events, what sort of therapy will proceed therapy with anticoagulants?

True or False: Anticoagulants are contraindicated in patients with active bleeding.
True False

True or False: Hypertension is a common side effect of the anticoagulants.
True False

A patient on anticoagulant therapy notices they have black, tarry stools. What should the nurse do?

____ are used in the treatment of various forms of endogenous depression, often in conjunction with psychotherapy.

Other than treatment of depression, what other uses might drugs in the antidepressant have? (what other conditions might they treat?)

In general, what mechanism of action do antidepressant most likely have?

What are the two major antidepressants?

In regards to antidepressants: most _____ agents possess significant anticholinergic and sedative properties, which explains many of their side effects.

True or False: Systemic side effects may occur with both oral and topical use of antidepressants.
True False

How many days should patients be off other antidepressants before they begin MAOI therapy? How many days must they be off MAOI therapy before they begin therapy with other antidepressants?

Some antidepressants may cause ____ side effects, such as dystonia, akathisia, and psuedoparkinsonism. How should these side effects be dealt with?

____ is used in the management of type 1 DM.

____ may be used in type 2 diabetes mellitus when diet and/or oral medications fail to adequately control blood sugar.

How does the healthcare provider go about choosing what sort of insulin to prescribe (rapid acting, intermediate acting, long acting)?

Oral antidiabetics are used primarily in _____ DM, when diet therapy alone fails to control blood glucose or symptoms or when patients are not amenable to using insulin.

Describe how insulin acts to treat both type 1 and type 2 Diabetes Mellitus.

This hormone produced in the pancreas promotes the conversion of amino acids to proteins in muscle, stimulates triglyceride formation, and inhibits the release of free fatty acids.

In what situations would patients who are stabilized on a diabetic program require the administration of insulin?

True or False: Mixed insulins should never be used in a pump or for IV infusion.
True False

What insulins may be administered via IV?

What should the nurse advise the DM patient to do if they become hypoglycemic?

What two tests should be performed often on DM patients during periods of stress or illness?

What are the possible mechanisms by which antidiarrheals act?

______ acts to decrease blood glucose levels while _____ acts to increase blood glucose levels. Both are secreted by what?

Name 3 drug classes that have a hyperglycemic affect on the blood.

Name 4 drugs that have a hypoglycemic effect on the blood.

______ results from the autoimmune destruction of pancreatic beta cells, resulting in a lack of insulin secretion.

Type 1 diabetes mellitus is also referred to as _______ DM.

What are the typical signs and symptoms of type 1 DM (7)?

Untreated diabetes mellitus can cause long term damage to the arteries, which can lead to what diseases?

Is insulin always, sometimes, or never used to treat type 1 DM?

In what case would a patient suffering from type 2 diabetes mellitus need insulin?

Why is it important for nurses to know the time of peak action of any insulin?

When might hypoglycemia occur in the type 1 DM patient?

How should patients who participate in competitive sports keep their blood glucose levels normal?

_____ is the more common form of diabetes mellitus, accounting for 90-95% of people with the disorder.

What is the primary physiologic characteristic of type 2 Diabetes Mellitus?

True or False: In Type 2 Diabetes Mellitus, the pancrease does not produce enough insulin for the body to make use of the glucose in the blood stream.
True False

True or False: Patients with poorly managed type 1 and type 2 DM both have the same complications, including retinopathy, neuropathy, and nephropathy.
True False

What causes type 2 diabetes mellitus?

Oral hypoglycemics are mainly used to treat _____. At what point in the disease process are they usually prescribed?

At what point is insulin added to the regimen for a Type 2 diabetic?

The oral hypoglycemic ______ acts by stimulating the release of insulin from pancreatic islet cells and by increasing the sensitivity of insulin receptors on target cells.

_____ are oral hypoglycemics that decrease the hepatic production of glucose (gluconeogenesis) and reduce insulin resistance (it does not promote insulin release from the pancreas).

The oral hypoglycemics ____ act by blocking enzymes in the small intestine that are responsible for breaking down complex carbohydrates into monosaccharides, thus delaying the digestion of glucose.

The ______ reduce blood glucose by decreasing insulin resistance and inhibiting hepatic gluconeogenesis. Hypoglycemia is not a side effect of this class, and they may take months to have an effect.

A class of hypoglycemics that act by stimulating the release of insulin from pancreatic cells in a manner similar to that of the sulfonylureas.

What are the six classes of drugs that fall under the category of oral hypoglycemics/ antidiabetics?

_____ are hormones that signal the pancreas to increase insulin secretion and the liver to stop producing glucagon. Several new oral hypoglycemics act by effecting this hormone.

Glucagon is released by the _____ and has what action?

Glycogen is produced by the ____ and performs what role?

____ is the stopping of blood flow, and is an essential mechanism that protects the body from both external and internal injury.

What are the basic steps in the process of blood clotting?

When collagen is exposed a the site of injury, the damaged cells initiate a series of complex reactions called the ______.

___ occurs when fibrin threads create a meshwork that traps blood constituents so that they develop a clot.

Normal blood clotting occurs in about _____ minutes.

Finish filling in this flow chart about blood clotting:

Prothrombinase converts ______ to _______ -----> converts fibrinogen to ________, which provides a framework for the clot.

The process of clot removal is called _____. It is initiated within how long of clot formation? How long does it continue?

Finish filling in this flow chart about blood clot removal:

Fibrin clot is formed, nearby blood vessels secrete ______ ---> converts plasminogen to ______ -----> digests the fibrin strands to remove the clot

____ disorders occur when the body forms undesirable clots.

A thrombus in an arterial vessel often grows larger as more _____ is added, and are particularly problematic why? What can they cause?

Pieces of thrombi may break off and travel through the blood stream to other vessels. A traveling clot is called a(n) ______.

Thrombi in the venous system usually form in the veins of the _____ in susceptible patients die to sluggish blood flow. What is this condition called?

Bleeding disorders are commonly characterized by abnormal clot formation. What is the is the most common nonhereditary bleeding disorder? What does it involve?

_____ are bleeding disorders caused by a genetic deficiency is specific clotting factors. They are typified by prolonged ____ which result in persistent bleeding that can be acute.

The classic form of Hemophilia, ______, accounts for 80% of cases of hemophilia and is caused by a lack of what clotting factor?

How is hemophilia treated?

______ is the most common inherited bleeding disease.

How is von Willebrand's disease treated?

_____ work by either inhibiting specific clotting factors in the coagulation cascade or diminishing the clotting action of platelets.

____ are used to prevent the formation of clots, while _____ are used to dissolve clots that have already formed.

_____ promote the formation of clots by inhibiting the normal removal of fibrin, thus keeping the clot in place for a longer period. What are they commonly used for?

______ are used to prolong bleeding time, and thereby prevent blood clots from forming. Chemically speaking, how do they exert their effects?

What is the traditional drug of choice for parenteral anticoagulation?

What is the mechanism of action of Heparin?

The heparin molecule has been shortened and modifed to create a newer class of drugs called ________. What is the mechanism of action of these drugs?

What are the advantages to using LMWHs (low molecular weight heparins)

What is the drug of choice for the prevention of DVT following surgery?

What four drug classes encompass the parenteral anticoagulants?

_____ are parenteral anticoagulants that act on circulating thrombin as well as on thrombin that has already bound to a clot. They have limited therapeutic uses.

__a__ is an unusual drug used as a parenteral anticoagulant that is obtained from genetically engineered goats that secrete human ____a____ in their milk.

___a___ is indicated for the prevention of peri-operative and peri-partum thromboembolytic events in hereditary __a___ deficient patients.

What is the most commonly prescribed oral anticoagulant?

Warfarin acts by inhibiting the hepatic synthesis of what coagulation factors?

Often, patients begin anticoagulation therapy with ____ and are switched to ____ when their condition stabilizes. Explain how the transition between these drugs is accomplished.

What is the most frequent and potentially serious adverse effect of all the anticoagulants? What patients should not take anticoagulants?

Pentoxifylline (Trental) is a _______. By what mechanism does it work?

_____ can cause an anticoagulant effect by interfereing with platelet aggregation. How do these differ from the anticoagulants?

____ prevent thrombosis in arteries while _____ prevent thrombosis in veins.

What four types of drugs are classified as antiplatelet drugs?

Desrcibe Aspirin's antiplatelet activity.

What are the uses of Aspirin?

_____ irreversibly alter the plasma membane of latelets, changing the binding of ADP to its receptor on platelets so that they are unable to recieve the chemical signals telling them to aggregate.

Endogenous __a__ is an enzyme necessary for platelet aggregation. ____a____ receptor agonists are the most effective antiplatelet agents, but also the most expensive and can only be given via IV.

These antiplatelets are the most effective and are used to prevent thrombi in patients experiencing a recent MI, stroke, or percutaneous transluminal coronary angioplasty (PTCA).

_____ is a condition caused by lack of sufficient blood flow to skeletal muscles in the lower limbs. This ischemia causes severe pain on walking, particularly in the calf muscles.

What do thrombolytics do?

_____ promote fibrinolysis by converting plasminogen to plasmin.

These medications are administered for disorders in which an intravascular clot has already formed, such as in acute MI, pulmonary embolism, acute ischemic CVA, and deep vein thrombosis.

The therapeutic effects of thrombolytics are greatest when they are administered as soon as possible after clot formation occurs, preferably within _____ hours.

Do thrombolytics have a narrow or wide margin of safety? Explain.

True or False: When a patient is receiving thrombolytic pharmacotherapy, vital signs must be monitored continuously and sign of bleeding should be recorded and the time noted.
True False

Hemostatics, also called ________ have what sort of affect on the body?

What are patients who experience excessive bleeding after surgery treated with?