-
acetylcholine
- chemical secreted by neuron at synapses
- stimulates
- inhibits or modifies receptor proteins in membrane of adjacent neuron or muscle
-
acetylcholinesterase
enzyme that breaks down acetylcholine
-
anti-acetylcholinesterase
substance that inhibits the breakdown of acetylcholine by acetylcholinesterase
-
antimuscarinic
agent that inhibits stimulation of muscarinic receptors; also called anticholinergic or parasympatholytic
-
autonomic nervous system
involuntary visceral function
-
Function of Plasma:
- Prevent blood loss
- Carries RBCs that transport O2
- Aids in gamma globulins
-
-
-
dromotropic
- HR
- automaticity
- **AV node**
-
-
Extrinsic
Faster process activated when blood is exposed to “tissue extracts”
-
Intrinsic
slow process initiates with blood coming in contact with collagen in vessel walls
-
thrombosis
local coagulation or clotting of the blood in a part of the circulatory system
-
Hematopoiesis
formation of blood cells
-
Erythrocyte Sedimentation Rate (ESR)
- Plasma proteins and fibrinogen
- -->final step
-
patho between renal failure and anemia
When kidneys are diseased or damaged, they do not make enough EPO. As a result, the bone marrow makes fewer red blood cells, causing anemia.
-
-
DVT
Homan’s sign: calf pain w/ dorsiflexion of the foot
-
homan's sign
- calf pain w dorsiflexion of foot
- DVT
-
patients who have undergone coronary artery bypass grafting (CABG) should consider taking what drug?
-
Atherosclerosis
plaque in arteries
-
prostacyclin
natural baseline in coagulation cascade
-
atherosclerosis vs prostacyclin
- atherosclerosis creates plaque
- plaque prevents prostacyclin
- inhibitory effect on coagulation
-
heparin vs prostacyclin
natural checks in cascade
-
heparin vs factors x
inhibition
-
heparin vs thrombin
inhibition
-
what does heparin block?
factor X & thrombin
-
ototoxicity + nephrotoxicity
-
anticholinesterase agent
indirect-acting cholinergic agonist
-
warfarin MAO
- blocks vit K
- inhibits Prothrombin
- prevents thrombin
-
-
warfarin vs. prothrombin
blocks
-
warfarin vs. thrombin
prevents
-
-
INR
international Normalized Ration
-
INR risk levels
- basic 2.0-3.0
- high 2.5-3.5
-
vit K vs Prothrombin
prothrombin --> thrombin
-
PCNs
- G
- naf-, dicloxa
- ampi-, amoxa
- Ticar-, Pipera-
-
narrow spectrum
sensitive
PCN G
-
narrow spectrum
vancomycin
-
narrow spectrum
penicillinase resistant
-
-
-
cephalosporins
- 1st cephalothin
- 2nd cefamandole
- 3rd ceftriaxone
- 4th cefepime
-
ceph-
cef-
cephalosporins
-
-
treat c.diff & MRSA
vancomycin
-
drugs that weaken cell wall
- PCN
- cephalosporins
- carbapenums
- vancomycin
-
bactrim
sulfamethoxazole-trimethropin
-
sulfamethaxozole-trimethropin MOA
ADR
- block DNA synthesis
- steven johnsons syndrome
-
fluoroquinolones
- miscellaneous
- broad spectrum
- C.diff
- thrush
- photosensitivity
-
ciprofloxacin
fluoroquinolones
-
-floxacin
fluoroquinolones
-
cephalosporins
across generations
- low to high
- activity against Gram (-) bacteria
- B-lactamase resistance
- BBB
-
if a patient has allergic rxn to PCN, what drug should u consider admin?
macrolides
-
-
preferred -omycin
erthromycin
-
drug that carries highest risk for c. diff?
clindamycin
-
reserved for MRSA/VRE?
linezolid
-
what drug has wash out phase?
gentamicin
-
aminoglycosides
gentamicin
-
gentamicin
- wash out phase
- dose 1x day
- low intervals
- prevents irreversible otoxicity
-
why does tetracycline have nephrotoxicity and hepatotoxicity?
- enterohepatic recirculation
- renal excretion
-
why does tetracycline cause permanent discoloration in kids?
Ca2+ binding
-
c.diff + thrush
- tetracycline
- fluoroquinolones
-
aminoglycosides + PCN
increases effects
-
why would cephalosporins and carbapenums be considered nephrotoxic?
only one type in 3rd generation is metabolized the liver
-
drug that weakens cell wall without a beta lactam ring?
vancomycin
-
protein binders?
- tetracycline
- macrolides
- clindamycin
- aminoglycosides
-
what trend in toxicity would you expect to see in drugs that prohibit protein synthesis indicate and why?
nephrotoxicity because they bind to protein and thereby undergo renal excretion
-
Cephalosporins & carbapenems have what Nursing implications?
- bleeding:
- blocks Vit K --> inhibits prothrombin
Caution: anticoagulants and NSAID
-
cytochrome P450
- warfarin + macrolides
- warfarin + rifampin
-
different ADR between Cephalosporin than Carbapenem?
ETOH intolerance
-
drugs that inhibit bacterial synthesis of DNA or RNA
Sulfamethoxazole-trimethroprim (Bactrim)
fluoroquinolones
metronidazole
-
2 Drug regimen for c.diff?
Metronidazole + Vancomycin
-
2 drug regimen for h. pylori
metronidazole + Tetracycline
-
rule for antimycobacterial agents
req long treatment >6 mo
-
Latent TB treated with _______ for 6-9 months
INH
-
Latent TB treated with _________ and _____ for 3 months
INH and rifampin
-
-
-
-
Pyrazinamide
Ethambutol
TB
-
Red/orange discoloration of body fluids (warn the patient!)
rifampin
-
why would rifampin have hepatoxicity?
Powerful inducer of cytochrome P450 enzymes
-
what is ADR diff between rifampin and ethambutol?
rifampin is more hepatotoxic due to liver excretion and ethambutol has kidney excretion
-
Amphotericin B (Nystatin)
Fluconazole
antifungals
-
antifungals
- amphotericin B (nystatin)
- fluconazole
-
Acyclovir
Ganciclovir
- antiviral non-HIV
- Tx Herpes
-
-
-
-
-
direct-acting muscarinic agonist
-
bethanechol
direct-acting muscarinic agonist
-
-
betheanechol ADR
- hypotension
- bradycardia
- excessive salivation
-
bethanechol contra?
bowel and urinary obstruction
-
neostigmine
irreversible cholinesterase inhibitor
-
-
neostigmine ADR
cholinergic crisis
-
MG crisis nursing implication?
lower dose of neostigmine
-
tensilon
diff between cholinergic crisis and myasthenic crisis
-
indirect-acting muscarinic agonist
tensilon
-
-
atropine
muscarinic antagonist
-
atropine Tx
- smooth muscle:
- mydriasis for eye exam
- bradycardia
-
atropine ADR
- xerostomia
- blurred vision
- urinary retention
- constipation
- tachycardia
- asthma
-
pralidoxene
irreversible cholinesterase inhibitor
-
-
type 2 hypersensitivity Dx
- MG
- acute organ rejection
- hemolytic anemia
- blood mismatch (Rh factor)
- heparin-induced thromboctyopenia
-
type 4 hypersensitivity Dx
chronic organ rejection
-
final step blocker
- abciximab
- eptifibatide
- +
- dabigatran
-
abciximab
eptifibatide
- final step blocker
- glycoprotein antagonists
-
abciximab
eptifibatide
Tx
- pts w/ acute coronary syndrome
- prevention of ischemic events
-
arachidonic pathway blocker
ASA
-
-
-
VW disease Tx
Factor VIII
-
VW disease vs coagulation cascade
adhesion
-
-
ticlopidine
clopidogrel
Tx
- phrohylaxis
- --> atherosclerosis
- --> MI/Stroke RISK FOR
- --> CABG surgery ("g" for graft)
-
Factor X blocker
- heparin
- LMW Heparin
- warfarin
-
Heparin LMW vs unfractionated Heparin
- no dual effect
- only blocks X Factor
-
dabigatran
- final step blocker
- direct thrombin inhibitor
- fibrinogen blocker
-
fibrinogen blocker
dabigatran
-
dabigatran Tx
- A Fib
- unofficially preventing strokes
-
dabigatran vs warfarin
alternative to warfarin
-
ticlopidine ADR
thrombocypenia
-
thrombocytopenia
thrombolytic purpura "purple"
-
thrombocytopenia vs thrombocytopathia
- decreased platelet production
- vs
- platelet fxn
-
thrombocytopenia
- depressed bone marrow production
- splenomegaly
- Ab-mediated
- type 2 hypersensitivity
-
heparin causes what type of hypersensitivity
type II
-
thromobocytopathia inherited
Tx
factor VIII
-
thrombocytopathia Dx
VW Disease
-
thrombocytopathia acquired Dx
-
Disseminated Intravascular Coagulation (DIC)
consumption of factors
-
-
inherited coagulation defects Tx
give factors
-
-
sickle cell
patho
- obstruction in microcirculation
- hyper-adhesive
- hemorrhagic stroke stroke
-
-
hemolytic anemia s/s
jaundice
-
acquired hemolytic anemia
- Ab-mediated
- type 2 hypersensitivity
- s/s jaundice
-
stem cell transplant
aplastic anemia
-
-
pernicious anemia
- megaloblastic
- normochromic
- B12 deficiency
-
chemotherapy-induced anemia
- aplastic anemia
- acquired neutropenia
-
-
-
G-CSF
granulocyte colony stimulating factor
-
EPO Tx
- renal failure induced anemia
- (RBC #s)
- chemotherapy induced anemia
- (bone marrow depression)
-
ALPHA 1
- Target:
- Eyes
- Blood vessels
- Urinary
- Action:
- Mydriasis“d” for dilation
- Vasoconstriction
- nasal decongestant
- urinary retention
-
ALPHA 2
- INDIRECT ACTING
- NEUROTRANSMITTER: noradrenialine
-
BETA 1
- TARGET: heart & kidney
- ACTION: CARDIOSELECTIVE
- increase HR
- RAAS
-
BETA 2
- TARGET: lung, heart, & kidney
- ACTION: BRONCHO-SELECTIVE
- Bronchodilatation
- Vasodilatation
- Glycogenolysis
-
pancytopenia
dx
patho
- dx aplastic anemia
- bottoming out of blood cells- RBC, WBC, & platelets
-
s/s neuro
tx b12 inj
pernicious anemia
-
dyspnea
increased HR
syncope
iron deficiency anemia
-
neutropenia
depressing neutrophils
-
pernicious anemia lab test will show an absence in what?
intrinsic factor
-
sickle cell patho
obstruction to microciruclation
-
For anemias due to bone marrow failure, such as aplastic anemia EPO is not particularly helpful. Why?
pancytopenia
-
anemias due to bone marrow failure
- aplastic anemia
- chemo-radiation induced anemia
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