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What are the two types of nervous systems?
- Central nervous system
- Peripheral nervous system
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What is int he central nervous system?
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What is in the peripheral nervous system?
- Afferent nerons (to the brain)
- Efferent neurons (away from the brain)
- Autonomic nervous system (parasympathetic branch and sympathetic branch)
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What are the two divisions of the autonomic nervous system?
- Parasympathetic branch
- Sympathetic branch
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What are afferent neurons?
To the brain
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What are efferent neurons?
away from the brain
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What is the purpose of the autonomic nervous system?
To regulate involuntary vital functions
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How does the sympathetic nervous system effect the body?
- Fight or flight
- accelerates heart rate
- constricts blood vessels
- relaxes bronchial smooth muscle
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How does the parasympathetic nervous system effect the body?
- Feed or breed
- slows heart rate
- increases intestinal peristalsis
- increases gladn activity
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What is norepinephrin?
- It is a neurotransmitter for sympathetic system.
- It stimulates beta 1, beta 2 and alpha receptors.
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What is a Beta 1 receptor?
- Located in cardiac muscle
- Increases heart rate and ventricular contractility
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What is a Beta 2 receptor?
- Located in bronchial smooth muscle
- Relaxes smooth muscle in the airway
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What is an Alpha receptor?
- Located in arteriole walls
- Causes vasoconstriction
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What is Acetylcholine?
- It is a neurotransmitter for the parasympathic system
- Stimulates cholinergic receptors
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What is a cholinergic receptor?
- Located in heart, airway walls, various other places
- When stimulated, decreases heart rate and causes bronchoconstriction
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What is sympathomimetic drug?
- Chemical that causes stimulation of the sympathetic nervous system
- Also called Adrenergic agonist
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What is Sympatholytic drug?
- Chemical that blocks a sympathic response
- Also called a beta blocker
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What is a cholinergic drug?
Chemical that causes stimulation of the parasympathetic response
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What is an anticholinergic drug?
- Chemical that blocks a parasympathetic response
- Also called parasympatholytic
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What are effects of anticholinergic drugs?
- Bronchodilation
- Drying of secreations
- Treatment of bradycardia
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What are some examples of anticholinergic or parasympatholytic drugs?
- Atropine
- Atrovent (ipratropium bromide)
- Spiriva (tiotrpium bronide)
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What are effects of sympathomimetic drugs?
- Bronchodilation
- Increase cardiac contractility
- Increase heart rate
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What are some examples of sympathomimetic or adrenergic agonist drugs?
- Epinephreine
- Albuterol
- Dopamine
- Salmeterol
- Dobutamine
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What are indications of sympathomimetic bronchodilators?
Relieve bronchoconstriciton of obstructive airway disease where it has been shown to improve airflow
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What is mode of action of sympathomimetic bronchodilators?
- Stimulate beta 2 receptors
- cause relaxation of smooth muscles in airway wall
- can improve mucociliary clearance
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Epinepherine
- Powerful alpha and beta effects
- Nebulized, IV drip, IM or ETT
- Short acting
- Powerful cardiac effect
- Drug choice for cardiac arrest
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Epinephrine dosage
- SVN: 1% solution 0.25 mL - 0.5 mL qid
- MDI: 0.22 mg/puff prn
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Albuterol sulfate
- name brands: Proventil, Ventolin, ProAir
- Beta 2 preferential
- Little cardiac effect
- Nebulizer, MDI, PO
- Effects up to 6hrs
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Albuterol dosage
- MDI: 90 mcg/puff, 2 puffs tid, qid or as needed
- SVN: 0.5% solution, 2.5mg tid, qid or as needed
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Pirbuterol
- Name brand: Maxair Autohaler
- MDI
- Short onset
- Beta 2 preferential, little beta 1 effect
- Effects last about 5hrs
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Pirbuterol dosage
- MDI: 200 mcg/puff
- 2 puffs q4-6
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Levalbuterol
- Beta 2 selective, no beta 1
- Short onset
- Effects last 5-8 hrs
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Levalbuterol dosage
- MDI: 45 mcg/puff, 2 puffs q4-6 hr or as needed
- SVN: 0.31mg, 0.63 mg, 1.25 mg dose tid or as needed
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Salmeterol
- Name brand: Serevent
- Long acting
- Effects last up to 12hrs
- Beta 2 preferential, little beta 1 effects
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Formoterol
- Name brand: Foradil, Preformist
- Long acting
- Effects last about 12hrs
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Arforoterol Tartrate
- Name brand: Brovona
- Long action
- Effects last about 12hrs
- Selective beta 2, little beta 1 effects
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Racemic epinephrine
- Short onset
- Effects last about 2hrs
- Alpha and beta effects
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Indacterol
- Brand name: Arcapta
- long acting beta 2 adrenergic agonist bronchodilator
- FDA approved for COPD
- used as DPI
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What are some side effects of sympathomimetics?
- Tachycardia
- Tremor
- Nervousness
- Headache
- Insomnia
- Nausea
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What do anticholinergic drugs do?
- Block parasympathetic action and dilates the airways
- Also called parasympatholytic
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Anticholinergic drug indications
relieve bronchoconstriciton associated with COPD
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What are some examples of anticholinergic or parasymaptholytic drugs?
- Ipratropium bromide (Atrovent)
- Tiotropium bromide (Spiriva)
- Atropine sulfate
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ipratropium bromide
- Name brand: atrovent
- Powerful bronchodilator in COPD
- Effects last 4-6 hrs
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tiotropium bromide
- Name brand: Spriiva
- Long acting
- Effects last about 24hrs
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Aclidinium bromide
- Name brand: Tudorza Pressair
- Long acting anticholinergic bronchodilator
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Atropine sulfate
- no longer used
- early anticholinergic
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What are side effects to anticholinergic drugs?
- Dry mouth and upper airway
- Urinary retention
- Mucocilary slowing
- Inhibition of tear formation
- Worsening of glaucoma
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What are combination drugs?
- Combivent (albuterol sulfate and ipratropium bromide)
- Duoneb (albuterol sulfate and ipratropium bromide)
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What falls under drug information?
- Clinical pharmacology
- Indications and usage
- Contraindications
- Drug interactions
- Adverse reactions
- Dosage and administration
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Drug administration
Method by which the drug is made avalibe to the body
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What are routes of administration?
- Enternal-oral
- Parenteral-injectable
- Transdermal-absorbed through the skin
- Inhilation-inhaled aerosol
- Topical-n the skin or mucous membranes
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Outline the movement of the drug through the body
- Absorption
- Distribution
- Metabolism
- Elimination
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What is the difference between loading dose and subsequent dose?
- Loading dose is the initial dose to create desired level of concentration
- Subsequent dose maintain concentration
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What is the first-pass effect?
orally delivered drug enter bloodstream from stomach, follows portal vein directly to liver where metabolism takes place
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Half-life
tire required to decrease amount of drug in the body by one half, through elimination
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Maintenance dose
Subsequent dosing equal to the rate of elimination to maintain a steady level of drug in the body
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Structure-activity relation
Relationship between a drug's chemical structure and its clinical effect
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Drug receptors
Proteins whos shape or electrical charge match a drug's chemical shape or charge
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Therapeutic range
- Blood concentration range, within which a drug has a therpeutic effect
- Concentrations above this range can be toxic
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Agonist
A drug that binds to a corresponding receptor and produces a clinical effect
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Antagonist
- Drug that can bind to a corresponding receptor, but produces no clinical effect
- Blocks the agonist
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Potentiation
One drug has no effect but increases the effect of another drug
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Synergism
Two drugs hae the same effect, but by different mechanisms or actions
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Additivity
Two drugs both act on the same receptors and their combined effect is additive
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What must every drug order include?
- Drug name
- Dose
- Route
- Requency
- Dr. signature
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