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• Heart
• Blood Vessels
• Lungs

SNS

• 1. Selective
• 2. Nonselective

• 1. Interact DIRECTLY with Alpha 1 or Beta adranergic receptors on target organs/tissues
• 2. Indirect effects on adranergic receptors which increases release of norepinephrine=then stimulating alpha and beta receptors
• 3. Mixed action- combo of direct and indirect

• Activation of:
• Alpha 1
• Beta 1
• Beta 2
• Altpha 2

• Vasoconstriction of peripheral Vessels = increased blood pressure
• causes decrease in nasal mucosa thru vasoconstriction of mucous membranes

• Causes (+) effects on heart:
• 1. Inotropic- force of contraction
• 2. Chronotropic - Increase Rate
• 3. Dromotropic - Increase speed of electrical conduction thru AV node

Lungs- Bronchodilation

• causes reverse effect
• not commonly used

• Anaphylactic Shock
• CPR
• Hypotension and Shock
• Nasal Congestion
• Relaxation of uterine muscles and inhibition of uterine contractions

• results in bronchospasm, hypotension, and shock
• caused by Histamine release
• never occurs 1st time exposed to drug or allergen (occurs 2nd or 3rd time)

Epinephrine

• Increase HR
• Opens airway (main effect) - BRONCHODILATION
• Increase BP
• Works against Histamine (antagonist)

Steroids, Bronchodilator (known as breathing tx)

Usually pts carry Epi Pen

Peripheral Vasoconstriction allows shunting of blood to heart and brain and raise BP

• Angina
• Dysrhythmias (abnormal Heart rhythm)
• Hypertension
• Hyperthyroidism
• Cerebrovascular Disease

• This is the prototype for Adranergic Drugs
• Stimulates Alpha 1 and Beta Receptors
• In normal levels of Epi- Beta activity is DOMINANT
• Once normal levels are exceeded- Alpha activity is the predominant effect
• (TRY to stay within normal levels to stay with Beta)

IV, IM, Inhalation, Topical

No - it is destroyed by GI system

• almost immediate increase in BP
• causes positive inotropic
• causes positive chronotropic effects on myocardium

• Inhalation 1%
• SubQ 0.1% - 0.5%
• IV 0.01%
• ID (combo w/local anasthetics) 0.001%

• stimulates both alpha 1 and beta and causes release of norepinephrine
• actions are less potent but longer lasting that those of epi

• CNS stimulation than other adranergic drugs
• can be used in treatment of bronchial asthma to prevent bronchospasm
• it is less effective than epi for acute brochospansm and resp distress

• orally or parenterally
• orally - effects within 1 hour and last 3 to 5 hours
• subQ- acts in approx 20 min and lasts 60 min
• IM - act 10-20 min effects less than 60 min

common ingredient in OTC asthma and nasal decongestants

• stimulates alpha 1 and beta
• used for allergies and colds
• Used as a bronchodilator and nasal decongestant
• Tight controls of this drug bc of meth production
• given orally

• 1. Ephedrine
• 2. Pseudoephedrine

• Ephedrine - Mixed
• Psedoephedrine- Mixed
• Epinephrine - In normal doses - Beta is dominant. In high doses - Alpha is dominant
• Phenylephrine - Alpha

• action- act on alpha receptors to produce vasoconstriction = increased BP
• uses- MAIN - common cold preparations
• alpha 1 - stops secretions in nose due to vasoconstriction

• block effects of andranergic drugs
• decrease or block the effects of the SNS, endogenous cateecholamines (epi) and adranergic drugs
• Main treatment- hypertension and other cardovascular disorders
• remember- adranergic is used for hypOtension
• antiadranergic used for hypERtension

Effects occur when alpha 1 or beta receptors are blocked by adranergic antagonists or when alpha 2 receptors are stimulated by agonist drugs

• Agonists:
• Alpha 2- inhibit release of norepi in the brain, decreasing SNS activity = decreases BP Clonodine is the main drug that does this
• Alpha 2 also supresses insulin sectretions in pancreas
• Blockers:
• Alpha 1 blockers - prevent vasoconstriction
• prevent contraction of smooth muscles in nonvascular tissues
• main reason for people with BPH (Benign Prostatic Hypertrophy) - enlarged prostate
• works with urinary flow of men that have this condition
• helps bc it decreases urinary retention and improves urine flow by relaxing muscles in the prostate and urinary bladder.

• Beta 1 receptor blockers:
• Negative chronotropic- decrease rate
• negative inotropic - decrease force
• negative dromotropic - slows conduction of AV node

• Beta 2 receptor blockers-
• Bronchoconstriction - especially in those wtih asthma and chronic lung disorders

• Hypertension - Alpha 2 agonists
• BPH- alpha 1 adrenergic blockers
• Cardiovascular disease - Beta Blockers
• Glaucoma- beta blockers to decrease pressure behind eye

• Clonidine (Catapress) prototype (not used often)
• Methyldopa -(Aldomet) - older drug

Prazosin (Minipress) can give for BP

• Tamsulosin (Flomax) - used to decrease urinary retention (Works very well) for BPH
• ***This is drug of choice for BPH****

• Propranolol (Inderal)- oldest and most widely tested but not used much anymore
• Metoprolol - (Lopressor) used more often

• Carvedilol (Coreg) - Cardioselective
• administration is unique** Given before breakfast bc food makes this ineffective
• commonly used for HF
• Decreases sudden death

Alpha 1 blocking agents - may cause first dose syncope - BP gets too low

Alpha 2 agonist - risk for rebound hypertension

Beta Blockers - start with low dose and do not stop abruptly

• Stimulate parasympathetic nervous system in the same manner as acetycholine
• Some act directly on teh cholinergic receptors while others act by inhibiting the enzyme acetylcholinesterase

• Direct acting cholinergic drugs- mainly effect the periphery
• these drugs are resistant to acetylcholinesterase
• Decrease HR
• Vasodilation
• Increased tone and contractility of GI smooth muscle and relaxation of sphincters
• increase tone and contractility of detrusor muscle (bladder) ** MAIN USE
• increased tone adn contractility of bronhial smooth muslce
• Increased respiratory secretions
• Constriction of pupils

• decrease deactivation of acetycholine
• reversible vs irriversible cholinergic drugs

• Myasthenia Gravis - muscle weakness (autoimmune) receptors for acetylcholine is destroyed
• used to improve muscle control and weakness

Alzheimers disease

GI- Increase peristalsis

Urinary retention **main use*** help to increase normal urination

• Urinary or GI obstruction - cause damage to structures above obstruction
• Asthma - they cause bronchoconstriction and increase in respiratory secretions
• PUD- peptic ulcer disease - makes ulcer worse by increase of acids

• Direct acting:
• Bethanechol (urecholine) - used for urinary retention - direct acting cholinergic
• Reversible indirect acting cholinergic (anticholinesterase)
• Neostagmine (Prostigmin) Indirect acting cholinergic Prototype anticholinesterase agent - used for long term treatment of Myasthenia Gravis
• Pyridostigmine (Mestinon) Indirect acting cholinergic
• Donepezil (Aricept) used for alzheimers (VERY POPULAR) - indirect anti cholinesterase acting

• Block the action of acetycholine in the PNS/
• Most act on muscarinic receptors in teh brain, secretory glands, heart and smooth muscle
• Muscarinic are very responsive to acetycholine

• Binds to receptor sites on target organs - makint them less responsive to acetycholine
• decreased response to vagal stimulation =decreased HR
• bronchodilation and decreased resp secretions
• antispasmodic effects in the GI tract
• Can create severe CNS depression - negative effect

• GI disorders- not used much anymore
• GU disorders- bladder spasms - DRUG of CHOICE
• Respiratory disorders
• Cardica- bradycardia and heart block
• Parkinsons
• Opthalmology - sx or glaucoma

• Atropine (prepared synthetically) - atropine sulfate
• DRUG OF CHOICE to treat symptomatic sinus bradycardia
• Caution - as it can increase myocardial o2 demand
• no effect on BP
• Very short duration of action- does not work long

• Ipatropium (atrovent)
• Rhinorrhea - nasal spray
• Bronchodilation - inhalation

• Tiotropium Bromide (Spiriva)
• Bronchodilation - inhalation - not used as rescue inhaler*** this is used for maintenance of asthma
• Use cautiously if renal disease

• Oxybutynin (Ditropan)
• Extended Release and transdermal
• side effects- drowsiness, dry mouth, constipation
• used for urinary frequency - increases capacity of bladder

• Tolterodine (Detrol)
• Extended Release
• Side effects - dry mouth and consipation

the presence of normal microbial flora or transient environmental organisms that do not harm the host

• caused by immunosuppression'
• Antimicrobial therapy
• Suppression of normal flora
• commonly affect HIV pts

• Staphylococcus Aureus
• Streptococci
• Enterococci

• E.Coli
• Klebsiella
• Pseudomonas
• Proteus

• Not as resistant when compared to nosocomial
• Less severe
• Easier to treat

• More Severe
• Often caused by resistant organisms
• More resistant

Methycilin Resistant Staph

• affect the bacteria for which they are prescribed
• transient organisms
• other pathogens
• normal flora
• when normal flora is suppressed, space and nutrients become available to support growth of organisms resistant to teh effects of th at anitbiotic - can cause superinfections

Vancomyosin Resistant Staph

Vancomycin Resistant Enterocci

Multi drug resistant TB

• Klesbiella
• Acinetobacter
• Pseudomonas

• exposure to subtherapeutic levels of antibiotics ( a dose that does not kill them)
• ie- person starts to feel better than then stops meds
• caused by overuse of antibiotics
• resistance can be spread fro one bacteria to another as well as other species of bacteria

There are no new developments for MDR gram - bacteria

• Inhibition of bacterial Cell wall synthesis
• Inhibition of protein synthesis
• Disruption of microbial cell membranes
• Inhibition of organism reproduction
• Inhibition of cell metabolism and growth
• Bacteriostatic or bactericidal - kills bacteria

inhibits growth and our immune system takes over to kill it - this does not work when pt has decreased immune system

• Treat Infections
• Prevent Infections for pts with :
• Cardiac valve disease
• TB in pts with latent TB infection
• Periopertive infections - before and after sx w/in 24 hrs
• (Never go past 24 hrs bc you want to cover them for critical period - if we go on wtih meds we could be setting them up for a resistant infection
• Recurrent UTI

• Effective against a wider range of organisms
• More side effects involved with broad spectrum bc it kills normal flora (diarrhea, GI tissues)

• Only effective against a very narrow group of organisms
• This is the ideal***
• Always choose narrow if you know the organism
• Most antibiotics are one or the other

No - let immune system try to work first

24 hrs at the earliest a culture can be read

• antibiotics
• bc the first dose can kill off some of the bacteria - making you unable to obtain an accurate culture

• Know local patterns of drug resistant organisms
• ie pt comes into hospital wtih signs of pneumonia - start pt on antibiotic based on clinical experience for thsi condition- may change once we get the culture back
• It is using clinical judgement
• Also have to follow CDC recommendations

the causative organism

which drugs are likely to be effective against the organism

• Minimum Inhibitory Concentration
• the lowest concentration of an antibiotic that prevents visible growth of microorganisms

its serum adn tissue concentrations should usually exceed teh MIC of an organism for a period of time

• Aminoglycosides that get into low range still have an inhibitory effect on organisms. Therefore, its not required to maintain high lefvels of antibiotic in system when using these drugs
• Susceptibility of organism to antibiotic also depends on site of infection and teh clinical status of the patient

• Multiple Organisms
• HAI - Sometimes use multiple antibiotics bc of how resistnat these are
• Serious Infections
• Likely emergence of a drug resistance organism

• Second Infection usually resulting from treatment of another infection
• Often related to resistant organisms
• Major diff is these people are not immunosuppressed when compared to opportunistic infections

• Most common: Nausea, vomiting, diarrhea = due to disruption of normal flora of GI system
• Nephrotoxicity - aminoglycosides, vancomycin
• Ototoxicity- aminoglycosides - attach 8th cranial nerve, cause deafness
• Hepatoxicity - liver damage
• Bone marrow depression

• Highest incidence of drug allergies involve antibiotics - due to common exposure
• pt may have had unknow previous exposure
• pts with history of allergies are at great risk
• cross sensitivities in teh same drug class - ie - erythromycin and azithromycin

• culture first
• know pts allergy status
• know renal and hepatic function