DISEASES Muscle Spasms Involuntary contractions of a muscle or groups of muscles.

The muscles become tightened and develop a fixed pattern of resistance, resulting in diminished levels of function. Severe muscle spasms seen in patients who have other disorders such as stroke, injury, neurodegenerative diseases, cerebral palsy. A single prolonged contraction is a tonic spasm. Multiple, rapidly repeated contractions are clonic spasms. Other causes of muscle spasms include overmedication with antipsychotic drugs, epilepsy, hypocalcemia, pain and neuro disorders. Spasticity: muscles in a continuous state of contraction; usually contracted muscles become still with increased muscle tone; other signs and symptoms include pain, muscle spasms, involuntary crossing of the legs, and fixed joints. Etiologies for spasticity: cerebral palsy, head injury, spinal cord injury, stroke. Dystonia: chronic neuro disorder; involuntary muscle contraction that forces body parts into abnormal/painful positions and postures. Medications alone are not adequate in reducing the complications of spasticity. Physical therapy is needed, including strengthening and stretching exercises. Alzheimers AD is responsible for 70% of all dementia. Dementia is a degenerative disorder with signs of progressive memory loss, confusion, and an inability to think or communicate effectively. Consciousness and perception usually unaffected. Associated with cerebral atrophy/structural changes of the brain. Patients generally live 5-10 years following a DX of AD, which is the 4th leading cause of death. Etiology of AD remains mostly unknown. Early onset form of the disease is associated with chromosomal defects. Amyloid plaques/neurofibrillary

tangles are found in nearly all patients with AD, upon autopsy. Loss in both the number and function of neurons. AD patients experience a loss in the ability to perform tasks that require acetylcholine as the neurotransmitter. Acetylcholine is a major neurotransmitter in the area of the brain responsible for learning/memory, neuronal function is affected. Symptoms of AD are as follows: impaired memory/judgement; confusion/disorientation; inability to recognize friends/family; aggressive behavior; depression; psychoses, paranoia, delusions; anxiety. Parkinsons Degenerative disorder of the CNS caused by death of neurons that produce the brain neurotransmitter dopamine. The second most common degenerative disease of the nervous system. Pharmacotherapy often successful at reducing some of the symptoms of this disease. Progressive disease, and full symptoms take many years to show. Symptoms include: tremors, when the hands and head are shaky at rest, patients rub the thumb and forefinger together as if a pill were between them; muscle rigidity, stiffness may resemble symptoms of arthritis, difficulty bending over or moving limbs, become more obvious in later years; bradykinesia, marked by difficulty chewing, swallowing, speaking, patients with Parkinsons have problems initiating movement and controlling fine muscle movement, walking becomes difficult, patients shuffle their feet without taking normal strides; postural instability, patients may be humped over and easily lose balance; affective flattening, patients often have masked face with little facial expression or blinking of eyes. Symptoms develop due to the destruction of dopamine-producing neurons in the area of the brain that controls unconscious muscle movement. Balance, posture, muscle tone and involuntary movement depend on a balance of dopamine (inhibitory) and acetylcholine (stimulatory) in the brain. If dopamine is absent, then acetylcholine has a more dramatic effect.

Drug therapy for parkinsonism focuses on restoring dopamine function and blocking the effect of acetylcholine. Extrapyramidal Side Effects (EPS) develop for the same reasons as Parkinsons disease. Antipsychotic drugs act through a blockade of dopamine receptors. Treatment with certain antipsychotic drugs can induce parkinsonism-like symptoms, or EPS, by interfering with the same neural pathway and functions affected by the lack of dopamine. EPS may occur suddenly and become a medical emergency. With acute EPS, patients mescles may spasm or become locked up. Fever and confusion are other signs. Give IV Benadryl. Schizophrenia A type of psychoses characterized by abnormal thoughts and thought processes, disordered communication, withdrawal from other people, and a high risk for suicide. It is the most common psychotic disorder, and affects 1-2% of the population. Symptoms appear in early adulthood, and they may appear quickly or take several years. Other symptoms include: hallucinations, delusions, paranoia; strange behavior, communicating in rambling statements of made-up words; alternating between extreme hyperactivity and stupor; indifference/detachment toward life activities; strange/irrational actions; deterioration of personal hygiene, job/school performance; withdrawal from social interactions, interpersonal relationships. Nurses should look for both positive and negative symptoms. Positive symptoms ar those that add on to normal behavior (hallucinations, delusions, disorganized thought and speech patterns); while negative symptoms are those that subtract from normal behavior (lack of interest and motivation, lack of response, no pleasure in daily activities). Cause not known for sure, but there may be a genetic link. May be caused by imbalances in neurotransmitters in areas of the brain. Overactive dopaminergic pathways in the area of the brain that controls neuro activity. Symptoms of schizophrenia seem to be associated with the dopamine type 2

(D2) receptors. All antipsychotic drugs act by entering the dopaminergic synapses and competing with dopamine. By blocking a majority of the D2 receptors, antipsychotic drugs reduce the symptoms of schizophrenia. Schizoaffective Disorder: patient feels schizo symptoms and mood disorders. Acute Achizoaffective pt will have hallucinations followed by extreme depression. Insomnia The inability to fall asleep or stay asleep. This is bad because the body repairs itself during sleep. Deals with electrical charging and discharging of the brain. The brain needs time to process and file new information collected throughout the day. Sleeping and waking are synchronized to bodily functions like temperature, blood pressure, hormone levels, respiration. Increased levels of the neurotransmitter serotonin help initiate the various processes of sleep. Insomnia is sometimes associated with anxiety. Short-term/behavioral insomnia: when a hectic lifestyle inhibits sleep because the mind is too active. Caffeine and some foods may interrupt sleep. Tobacco products might make someone edgy and restless. Alcohol causes people to fall asleep, but can cause vivid dreams and frequent awakening. Ingesting a large meal high in protein and fat can interfere with sleep due to the increased metabolic rate needed to digest the food. Long-term insomnia is often caused by depression, manic disorders, chronic pain. Long-term use of sleep meds is likely to worsen insomnia and may cause physical or psychologic dependence. Rebound insomnia: when a sedative drug is discontinued abruptly after it has been taken for a long time, symptoms become much worse. When PRN meds are required for sleep, the nurse needs to conduct an individualized assessment of the individual, as well as follow-up evaluation and documentation of the medications effect on the patient. Insomnia linked to type 2 diabetes.

Depression Characterized by a sad or despondent mood. Symptoms include lack of energy, sleep disturbances, abnormal eating patters, feelings of despair, hopelessness, guilt. Most common mental health disorder among elderly adults. Major Depression: affects up to 10% of adults in the U.S.; to diagnose the disorder, the patient should have a depressed affect and at least 5 of the following symptoms lasting for a minimum of 2 weeks: difficulty sleeping or sleeping too much; extremely tired, without energy; abnormal eating patterns; vague physical symptoms like GI pain, muscle pain, headaches; inability to concentrate/make decisions; feelings of despair/guilt/misery, lack of self-worth; obsessed with death; avoiding interpersonal relations; lack of interest in appearance; delusions or hallucinations. Psychotic Depression: intense mood shifts and unusual behavior. Loss of contact with reality, hallucinations, delusions, disorganized speech patterns. Seizures Clinically detectable sign of epilepsy. A disturbance of electrical activity in the brain that may affect consciousness, motor activity, and sensation. Cause by abnormal or uncontrolled neuronal discharges. Uncontrolled charges may remain in one focus or propagate to other areas of the brain. Electroencephalogram (EEG) is useful in diagnosing seizure disorders. Seizure and convulsion are not synonymous. Convulsions refer to involuntary, violent spasms of the large skeletal muscles of the face, neck, arms, and legs. Not all seizures involve convulsions. All convulsions are seizures, but not all seizures are convulsions. Antiseizure Drugs: treat some/all symptoms related to seizures, including signs of epilepsy. A seizure is a symptom of an underlying disease, not the disease itself. Triggers include exposure to strobe/flickering lights, or fluid and electrolyte imbalances. Seizures can be acute or chronic, and can be caused by too-high

doses of come meds for mood disorders, or with drug abuse from cocaine or while withdrawing from alcohol. Known causes of seizures include: infectious diseases like meningitis and encephalitis that cause inflammation in the brain; trauma, like a physical blow to the skull, which may increase intracranial pressure, or chemical trauma such as the presence of toxic substances or poison; metabolic disorders, such as changes in fluid and electrolytes (hypoglycemia, hyponatremia, water intoxification); vascular diseases, such as changes in oxygenation caused by respiratory hypoxia and carbon monoxide poisoning, changes in perfusion caused by hypotension, cerebral vascular accidents, shock, cardiac dysrhythmias. Pediatric disorders, such as a rapid increase in body temperature. Neoplastic disorders, such as tumors, especially rapidly gorwing ones that may increase intracranial pressure and damage brain tissue by disrupting blood flow. Several antiseizure durgs decrease the effectiveness of birth control. If the patient is pregnant, some antiseizure drugs can cause folate deficiency. Simple Partial Seizure: Olfactory, auditory and visual hallucinations; intense emotions; twitching of arms, legs and face. Complex Partial: aura preceding the seizure; brief period of confusion or sleepiness afterward with no memory of the seizure; fumbling with or attempting to remove clothing; no response to verbal commands. General, absence seizure, or petit mal: Lasting a few seconds; seen most often in children when the child stares into space and doesnt respond but has fluttering eyelids or jerking movements; misdiagnosed as ADD or daydreaming. General, atonic seizures, or drop attacks: Falling or stumbling for no reason; lasting a few seconds. General, tonic-clonic seizure, or grand mal: Aura preceding the seizure; intense muscle contraction (tonic phase) followed by alternating contraction and relaxation of muscles (clonic phase); crying at beginning as air leaves the lungs, loss of bowel/bladder control; shallow breathing with periods of

apnea, usually lasting 1-2 minutes; disorientation and deep sleep after seizure. Myoclonic Seizure: large jerking movements of a major muscle group, such as an arm; falling from a sitting position or dropping what is held. Status epilepticus: a medical emergency; continuous seizure activity, which can lead to coma and death. Asthma One of the most common chronic conditions in the U.S. Characterized by acute bronchospasm, it can cause intense breathlessness, coughing and gasping for air. An acute inflammatory response stimulates histamine secretion, which increases mucus and edema in the airways. Some patients experience asthma when exposed to certain triggers, and others experience the disorder when exercising. Status asthmaticus is a severe, prolonged disorder that may lead to respiratory failure. The goals of drug therapy are to terminate acute bronchospasms in progress and to reduce the frequency of asthma attacks. Beta2-adrenergic agonists (beta agonists, sympathomimetics) are effective bronchodilators to manage asthma and other pulmonary diseases. They are the drug of choice for acute bronchoconstriction. Beta-adrenergic agonists activate the sympathetic nervous system, relaxing bronchial smooth muscles, and resulting in bronchodilation. Beta1 receptors are located primarily in the heart. Beta2 receptors are located in smooth muscle of the lung, uterus, and other organs. These have no anti-inflammatory properties, which is why other classes of drugs are used to control chronic asthma. Short-acting beta agonists have a rapid onset of action, usually several minutes, and are most frequently prescribed as rescue agents for aborting or terminating an acute asthma attack. Their effects only last 2-6 hours, however.

Intermediate duration beta agonists like albuterol and levelbuterol have effects that last approximately 8 hours and long-acting agents last up to 12 hours. The intermediate and long-acting agents are used in combination with inhaled corticosteroids for the prophylaxis of moderate to severe, persistent asthma. Taking a long-acting beta agonist can result in death if a person takes it for an acute attack. Osteoporosis The skeletal system is the primary repository for calcium. It is the primary mineral responsible for maintaining bone health throughout the lifespan. It is also critical to proper functioning of the nervous, muscular, and CV systems. Calcium balance in the body is regulated by parathyroid hormone (PTH), calcitonin, and vitamin D. In response to low levels of calcium in the bloodstream, PTH is released which stimulates the release of calcium from bones and increased calcium reabsorption from the kidneys. Higher levels of calcium in the bloodstream trigger calcitonin release by the thyroid which leads to calcium being added to bone, and decreased absorption of calcium in the small intestine. Vitamin D and calcium disorders are often associated. Vitamin D is increased by exposure to sunlight, and it is eventually etabolized to calcitriol which increases calcium absorption from the GI tract. Dietary calcium is absorbed more efficiently in the presence of active vitamin D and parathyroid hormone. Osteoporosis is the most common metabolic bone disorder. It is usually asymptomatic until bones begin to break. The following are risk factors for osteoporosis: menopause, high alcohol/caffeine consumption; anorexia; tobacco use; physical inactivity; low vitamin D and calcium; corticosteroid use, anticonvuldants use and immunosuppressants tha lower the serum calcium levels. Greatest risk factor is menopause because estrogen secretion declines, and bones become weak. Bone demineralization is accelerated, resulting in loss of bone density. Drug therapies include calcium and vitamin

D, estrogen replacement therapy, estrogen receptor modulators, statins, etc. The most common drug class for treating osteoporosis is the biphosphonates, which inhibit the breakdown of bone. They suppress osteoclast activity which increases bone density and reduces the incidence of fractures. Bone mass density increases rapidly during the first year of therapy and then plateaus. Patient must take med with adequate calcium and vitamin D in the diet. Dysrhythmias Abnormalities of electrical conduction that may result in alterations in heart rate or cardiac rhythm. Some produce no symptoms and others are life threatenening and require immediate treatment. Symptoms include dizziness, weakness, decreased exercise tolerance, shortness of breath, fainting. They may experience palpitations or that their heart has skipped a beat. Atrial fibrillation, a complete disorganization of rhythm, is the most common dysrhythmia. Those that originate in the ventricles are generally more serious. The following conditions are associated with dysrhythmias: HTN, cardiac valve disease/mitral stenosis, coronary artery disease, digoxin use, low potassium levels in the blood, MI, stroke, DM, CHF. Atrial/Ventricular Tachycardia: HB more than 100 in adults. Atrial/Ventricular Flutter: rapid, regular heartbeats, may range between 200300 per minute, usually not fatal if atrial but ventricular requires immediate treatment. Atrial/Ventricular Fibrillation: rapid, uncoordinated beats; complete disorganization of rhythm, lack of adequate cardiac contraction; requires immediate attention. Heart Block: area of nonconduction in the myocardium. Premature atrial/premature ventricular contractions: An extra beat originating from a source other than the SA node; normally not serious unless its frequent. Sinus bradycardia: slow HB, less than 60 BPM, may require a pacemaker.

Glaucoma An eye disease caused by damage to the optic nerve, resulting in a gradual loss of vision, possibly advancing to blindness. Usually the disorder is accompanied by increased intraocular pressure. Glaucoma occurs when the IOP is so high that it causes damage to the optic nerve. Glaucoma as a primary condition without an identifiable cause is most frequently found in persons older than 60. This disease can be associated with genetic factors, it can be congenital and in young children. It can also be secondary to eye trauma, infection, diabetes, inflammation, hemorrhage, tumors, and cataracts. The long-term use of topical corticosteroids can cause glaucoma, in addition to some anti-hypertensives, antihistamines, and antidepessants. Other risk factors for glaucoma include HTN, migraines, high degrees of near-or-farsightedness, and normal aging. It is the leading cause of preventable blindness. Closed-angle glaucoma: not as common. Can be caused by stress, impact injury, or meds. Displacement of the iris due to pressure inside the eye. Causes dull to severe eye pain, headaches, bloodshot eyes, and a bulging iris. Open-angle glaucoma: most common type. Cause is not known, and many people dont have symptoms. Usually bilateral. Develops over years. Patient is treated when their IOP is high or they present with signs of optic nerve damage or visual field changes. When beginning meds for this, a target IOP is identified and the IOP is reevaluated after 2-4 months. Some antiglaucoma meds take up to 8 weeks to reach peak effect. It is common to add a 2nd drug if just one is not working. The meds work by either increasing the outflow of aqueous humor or decreasing the formation of aqueous humor. Many glaucoma meds work by affecting the autonomic nervous system. Peptic Ulcer Disease Parietal cells secrete intrinsic factor, which is essential for the absorption of vitamin b12. Parietal cells also secrete hydrochloric acid every day, which helps to break down food, activates pepsinogen and kills microbes. Chief cells secrete pepsinogen, which chemically breaks down proteins.

The combined secretion of the chief and parietal cells gastric juice is the most acidic fluid in the body, having a PH of 1.5-3.5. To pretect against this acid, cells on the surface of the stomach secrete a thick mucous and bicarbonate ion to neutralize the acid. An ulcer is an erosion of the mucosa layer of the GI tract, usually associated with inflammation. The duodenum is a common ulcer site although they can happen anywhere in the alimentary canal. Peptic Ulcer refers to a lesion in either the stomach (gastric) or the small intestine (duodenal). Peptic Ulcer Disease is associated with a family history of the disease; blood group O; smoking tobacco; beverages with caffeine; corticosteroids, NSAIDs, aspirin; psychological stress; infection with H. Pylori. The primary cause of PUD is infection by H. Pylori. In noninfected patients, the most common cause of PUD is NSAID usage. The classic symptom of a duodenal ulcer is burning and upper abdominal pain that occurs 1-3 hours after a meal. The pain is worse when the stomach is empty and often disappears with the ingestion of food. Most heal spontaneously. Gastric Ulcers are less common and have different symptoms. Although relived by food, the pain may continue even after a meal. Anorexia, weight loss, and vomiting are more common. Follow-up for gastric ulcers should continue for several years, as they can become cancerous. Gastric ulcers are more common in women older than 60. Ulceration in the distal small intestine is known as Crohns Disease, and erosions in the large intestine are called ulcerative colitis. GERD A common condition in which the acidic contents of the stomach move upward into the esophagus. It causes intense burning (heartburn) and is sometimes accompanied by belching. In some cases, untreated GERD can lead to esophagal complications. Can occur in adults and infants. The cause of GERD is usually a weakening of the lower esophageal sphincter it may no

longer close tightly, thereby allowing contents of the stomach to move up when the stomach contracts. GERD is associated with obesity, and losing weight may eliminate the issues. Other lifestyle changes that can improve GERD symptoms include elevating the head of the bed, avoiding fatty or acidic foods, eating smaller meals at least 3 hours before sleep, and eliminating use of tobacco/alcohol. Many drugs used for PUD can be used for GERD, with the primary goal being to reduce gastric secretions. Constipation Constipation is a decrease in the frequency of bowel movements. Stools may become dry, hard, and difficult to evacuate without straining. When waste material remains in the colon for too long, too much water is reabsorbed, leading to small, hard stools. Constipation can cause abdominal distention, discomfort and flatulence. It is a symptom of an underlying disorder. May be related to a lack of exercise, insufficient food/fiber intake; or drugs that reduce intestinal motility. Opioids, anticholinergics, antihistamines, certain antacids and iron supplements can cause constipation. Foods that can cause constipation inclue alcohol, white flour products, dairy, and chocolate. Hypothyroidism, diabetes and IBS can also cause constipation. Hypertension Most common CV disease. Consistent elevation of systemic arterial blood pressure. Greater than 140/99. Blood pressure changes through the lifespan, rising with age. Factors responsible for creating the pressure are cardiac output, blood volume and peripheral resistance. The volume of blood pumped per minute is cardiac output, and the higher the cardiac output, the higher the BP. Friction in the arteries that can reduce the velocity of blood is called peripheral resistance, and more resistance will create a higher BP. The normal blood

volume is 5L, and more blood in the system will exert additional pressure on the walls of the arteries and raise BP. IV fluids increase blood volume and raise BP, like when hypotension is being treated due to shock; diuretics can cause fluid loss through urination, declining blood volume and lowering BP. Hypotension can cause dizziness and lack of adequate urine formation, wheras HTN can cause blood vessels to rupture, or restrict blood flow to critical organs. The vasomotor center in the medulla oblongata regulates blood pressure. Nerves travel from the vasomotor center to the arteries, where smooth muscle is either directed to constrict, raising BP, or relax, lowering BP. Baroreceptors that also control BP are deteriorated with diabetes. Emotions have an effect on BP; anger and stress can cause BP to rise, where as depression and lethargy cause it to fall. Strong emotions can cause chronic HTN. Antidiuretic hormone ADH is a potent vasoconstrictor that can increase BP by raising blood volume. HTN having no identifiable cause is primary/idiopathic/essential, and is 90% of all cases. Secondary HTN is a result of certain diseases like Cushings disease, hyperthyroidism, and chronic renal disease. Drugs that cause HTN include corticosteroids, oral contraceptives, and erythropoietin. The therapeutic goal for secondary HTN is to treat or remove the underlying condition, which will often cure the HTN. Chronic HTN may produce no symptoms. Four target organs affected are the heart, the brain, the kidneys and the retina. The heart must work harder to pump blood to the organs and tissues, and excessive cardiac workload can cause the heart to fail and the lungs to fill with fluid, which is known as heart failure. High BP also adversely affects the vascular system, and damage to the blood vessels supplying blood and oxygen to the brain can result in transient ischemic attacks and stroke. It can also lead to a loss of renal function. Vessels in the retina can rupture or become occluded, leading to blindness. It is

important to treat this in the pre-HTN stage, bc if it is allowed to progress it may be irreversible.

CHF One of the most common/fatal of the CV diseases. It is the inability of the ventricles to pump enough blood to meet the bodys metabolic demands. The amount of blood received by the right side should be exactly that sent out by the left side of the heart. If the heart is unable to completely empty the left ventricle, HF may occur. Can be caused by any disorder that affects the hearts ability to receive or eject blood. Can be caused or accelerated by coronary artery disease; mitral stenosis; MI; HTN; DM. There is no cure for HF, so the goals are to treat, prevent, or remove the underlying causes when possible. Controlling lipid levels and keeping BP WNL reduces the incidences of CAD and MI. Maintaining glucose WNL reduces the CV consequences of diabetes. HF is a preventable disease for many patients. Pharmacotherapy is targeted at prevention and slowing the progression of HF. Drugs that increase heart contractility are called positive inotropic agents, and examples of these are epinephrine, norepinephrine, thyroid hormone, and dopamine. Drugs that decrease contractility are called negative inotropic agents, and examples include quinidine, and beta-adrenergic antagonists such as propranolol. In HF, the myocardium becomes weakened and the heart cannot eject all the blood it receives. It can occur on the left, right, or both sides. If it occurs on the left side, excess blood accumulates in the left ventricle. The wall of the left ventricle thickens and enlarges (hypertrophy). Blood backs up in the lungs, resulting in the classic symptoms of cough and shortness of breath. Left failure is sometimes called congestive heart failure. The right side can also weaken, although left is more common. In right HF, blood backs up into the veins, resulting in peripheral edema and engorgement of organs such as the

liver. Lung congestion causes cough and orthopnea; pulmonary edema causes the pt to feel as if they are suffocating and extreme anxiety may result, and the condition often worsens at night. The nurse must stress the importance of sodium restriction and drug adherence to maintain a properly functioning heart. HF is treated with: ACE inhibitors; angiotensin II receptor blockers; diuretics; beta-adrenergic blockers; direct vasodilators; cardiac glycosides; phosphodiesterase inhibitors. Angina Angina is acute chest pain caused by insufficient oxygen to a portion of the myocardium. The classic presentation is steady, intense pain in the anterior chest, sometimes accompanied by a crushing or constricting sensation. The pain may radiate to the left shoulder and down the left arm and extend to the posterior thoracic spine or move up to the jaw. Angina pain is usually precipitated by physical exertion or emotional excitement, events associated with increased myocardial oxygen demand. Narrowed coronary arteries containing atherosclerotic plaques prevent the proper flow of oxygen and nutrients to the stressed cardiac muscle. Angina episodes are usually short in duration and subside in 5-10 minutes with rest. Psoriasis Chronic, noninfectious, inflammatory skin disorder; affects 1-2% of the population; is generally established by age 20 but may occur later. Plaques

are seen on the skin due to an extremely fast skin turnover rate, with skin cells reaching the surface in 4-7 days instead of the usual 14 days. Underlying skin becomes inflamed and irritated. Has both genetic and autoimmune components. About 50% have a genetic base. Factors such as stress, smoking, alcohol, climate changes and infections can cause flare ups. Certain drugs like ACE inhibitors, beta-adrenergic blockers, tetracyclines and NDAIDs can act as triggers. Topical corticosteroids are the first treatment for psoriasis. Topical immunomodulars can also be used. Calcipotrient can induce hypocalcemia and is not used typically on an extended basis. Hypogonadsism Androgens include testosterone and related hormones that support male reproductive function. Other androgens include androstenedione and DHEA. Therapeutically, androgens are used to treat hypogonadism and certain cancers. Lack of sufficient testosterone secretion by the tested can result in hypogonadism, which may be congenital or acquired later in life. Primary Hypogonadism is when it is caused by a testicular disorder. Disease states that may cause primary testicular failure include mumps, testicular trauma or inflammation, and certain autoimmune disorders. Secondary Hypogonadism is when the pituitary is not secreting sufficient amounts of FSH and LH. Lack of these secretions may be caused by Cushings syndrome, thyroid disorders, estrogen secreting tumors, and therapy with GnRH agonists like Lupron. Symptoms of male hypogonadism include sparse facial and pubic hair, increased subcutaneous fat; and small testicles. In adult men, lack of testosterone can lead to erectile dysfunction and disinterest in sex. In young men, a lack of testosterone can delay puberty.

It is treated with replacement therapy using testosterone or other androgens and libido is improved within days or weeks. Male sex characteristics reappear, which is called virilization. Depression resolves and muscle strength improves. BPH BPH affects 50% of men older than 60 and 90% of men older than 90. Only a few drugs are available for BPH. An enlarged prostate gland decreases the outflow of urine by obstructing the urethra. Urination is difficult. S&S: urinary frequency with drops of urine; increased urgency to pee; leakage; excessive night-time urination/nocturia; decreased force of urine stream; sensation that bladder did not fully empty. The obstruction can lead to urinary infections and renal failure. Surgery can be done to restore patency of urethra. Static Factors of BPH are related to the prostate doubling/tripling its size with aging and causing block of urine. Dynamic Factors are due to an excessive number of alpha1adgrenergic receptors in the urinary bladder and prostate; when activated, the alpha1 receptors compress the urethra and obstruct urine flow. Alpha-adrenergic meds like pseudoephedrine and phenlephrine can worsen symptoms. Anticholinergic drugs like antihistamines, TCAs, may also worsen urinary retention. Testosterone/anabolic steroids can enlarge the prostate. Goal of therapy is focused on minimizing urinary obstruction and preventing complications. Drugs can only treat symptoms. They cant reverse or cure BPH. Not all BPH is progressive and many pts never experience advanced symptoms. Pt should avoid caffeine and alcohol. Restrict fluids close to bedtime.

Alpha1-adrenergic blockers are the first choice for treating moderate symptoms. These relax smooth muscle in the prostate and bladder and urethra and ease urination. Cardura and Hytrin are good for men with BPH and HTN. Flomax is just good for BPH, and it is an alpha1 blocker. Symptoms should improve within 2 weeks; primary AEs are dizziness, fatigue, and headache. Reflex tachy is common with alpha blockers due to stimulation of baroreceptors. Pts unable to take alpha1 blockers can take Proscar, a 5-alpha-reductase inhibitor, which blocks an enzyme in the testoterone metabolic pathway and eliminates the hormonal signal for prostate growth. Proscar can take months to work and cause sexual side effects.

CONCEPT
Inhalation Respiratory system is a rapid/efficient mechanism for delivering drugs. Almost instantaneous action for inhaled substances. Aerosol therapy is used often. Delivers pulmonary drugs to their immediate site of action and reduces systemic effects. Anesthesia Pain Selective/nonselective Fight or flight Rest and digest Phagocytosis Inflammatory response Anaphylaxis A potentially fatal condition when the body defenses produce a hyperresponse to a foreign substance known as an antigen or allergen. During anaphylaxis the body releases massive amounts of histamine and other mediators of the inflammatory response. Itching, hives and a tightness in the throat/chest may occur. The larynx swells causing a nonproductive cough and a hoarse voice. The pt experiences a rapid fall in BP and cant breathe due to bronchoconstriction. The hypotension causes reflex tachycardia. Anaphylaxis can lead to shock, which is often fatal.

To treat, epinephrine is given SQ or IM because it causes vasoconstriction and can relieve bronchoconstriction. Dose can be repeated up to 3 times at 10-15 minute intervals. Crystalloids/colloids can be used for volume depletion. Antihistamines can be administered IV or IM to prevent further release of histamine. Albuterol can be used to relieve acute SOB. High-flow oxygen also usually administered. Glutocorticoids given to dampen the inflammatory response that may occur several hours after the initial event. The most common drugs causing anaphylaxis include: antibiotics (penicillins, cephalosporins, sulfonamides); NSAIDs (aspirin, ibuprofen, naproxen); ACE inhibitors; opioid analgesics; iodine-based contrast media. Pts can be pretreated with antihistamines or glucocorticoids to suppress inflammatory response. Betalactam ring The portion of penicillin that is responsible for its antibacterial activity is the betalactam ring. Some bacteria secrete an enzyme called beta-lactamase or penicillinase which splits the beta-lactam ring. This structural change allows the bacteria to become resistant to the effects of most penicillings. Cephalosporings, carbapenems and monobactams also contain the betalactam ring. Several drugs are available that inhibit the bacterial beta-

lactamase enzyme and when combined with penicillin protect the penicillin from destruction. These include Augmentin and Timentin. (Inhibitor names are clavulanate, sulbactam, tazobactam.) Pharmacokinetics The study of drug movement throughout the body. How the body deals with meds. The plasma membranes determine movement of drugs throughout the body. The four components of pharmacokinetics are absorption, metabolism, distribution, and excretion. Pharmacodynamics Concerned with how drugs produce CHANGE in patients, and the differences in pt responses to meds. Therapeutic indexes = represent the margin of safety of a drug. The higher the therapeutic index, the safer the drug. Graded doseresponse relationship = how the therapeutic response to a drug changes as the med dose is increased. Potency = dose required to produce a response. Efficacy = magnitude of maximal response to drug. Drug-receptor theory = explains the MOA of many meds. Agonists, partial agonists and antagonists are substances that compete with drugs for receptor binding and can cause drug-drug and food-drug interactions. Pharmacology of the future will likely be tailored to match the genes of each pt. Oral contraceptives Female reproductive function is controlled by the secretion of GnRH from the hypothalamus and FSH and LH from the pituitary. Estrogens are secreted by ovarian follicles and responsible for the maturation of the sex organs and 2ndary sex characteristics of the female.

Progestins prepare the endometrium for implantation. Low doses of estrogens ad progestins prevent conception by blocking ovulation. Emergency contraception prevents implantation of fertilized eggs. Uterine contractions can be stimulated to expel an implanted embryo. Estrogen-Progestin combos used for hormone replacement therapy during and after menopause; may have serious effects. Progestins can be used for uerine bleeding. Also used as antineoplastics. Oxytocins stimulate uterine contractions and induce labor. Tocolytics slow labor. With heavy bleeding, high estrogen doses may be used for 3 weeks and then progesterone is added. D&C may be necessary if that does not work. Estrogen proliferates the endometrium and progesterone limits and stabilizes endometrial growth. Anabolic steroids Testosterone-like compounds with hormonal activity. Taken inappropriately by athletes who hope to build muscle mass and strength, thereby obtaining a competitive edge. If taken in large doses for long periods of time, these can cause adverse effects that last for months after stopping the drug. Cholesterol levels will rise and sperm counts will be lowered in men. Females will start to look like men. Oral androgens are hepatotoxic and permanent liver damage may result. Behavioral changes include aggression and psychologic dependence. Most androgens are schedule 3.

High doses of androgens are occasionally used as a palliative measure to treat certain types of breast cancer in combo with other antineoplastics. Virilization will occur in most patients. Androgens shouldnt be prescribed for older men unless the possibility of prostate cancer has been ruled out, as prostate carcinomas are dependent on testosterone. Patients with prostate carcinoma are sometimes given a GnRH agonist like Lupron to reduce circulating testosterone levels. Crystalloid vs. Colloid For treating shock with IV fluid therapy. Hypovolemic shock, triggered by: Hemorrhage Burns Dehydration Vomiting/diarrhea Diuretic therapy Immediate maint. of blood volume through IV infusion of fluid and electrolytes or blood products is essential. Admin of whole blood to expand volume has been largely replaced by fluid infusion therapy. Colloids & Crystalloids used when up to a third of an adults BV has been lost. Colloids are proteins or other large molecules. They stay suspended in the blood a long time bc too large to cross membranes. Draw water from the cells and into the blood vesssels, increase plasma osmotic pressure. Colloids: Albumin; Plasma; Globulins. Can treat shock, burns, acute liver failure, neonatal diseases. Crystalloids are IV solutions; contain electrolytes that resemble the concentrations in plasma.

Crystalloids can readily leave the blood and enter cells. Replace fluids that have been lost and promote urine output. Normal saline; lactated Ringers; Plasmalyte; hypertonic saline.

DRUG
Certain drugs, such as glucocorticoids, levodopa and oral contraceptives can cause the same symptoms as depression, and the health care provider should rule out this possibility. Dilantin The oldest and most commonly prescribed antiseizure med is phenytoin (Dilantin). It is a broad-spectrum hydantoin drug, useful in treating all types of epilepsy except absence seizures. Doesnt have the abuse potential or CNS depression associated with barbiturates. Dosages are individualized. There is a very narrow range between a therapeutic dose and a toxic dose, so patients must be carefully monitored. Dilantins therapeutic class is as an antiseizure and antidysrhythmic drug. The Pharm class is hydantoin, sodium-influx suppressing drug. Phenytoin acts by desensitizing sodium channels in the CNS responsible for neuronal response. This prevents the spread of disruptive electrical charges that produce seizures. (Doesnt work for absence seizures.) It has antidysrhythmic activity similar to lidocaine, and an unlabeled use is for digitalis-induced dysrhythmias. When giving IV, mix with only saline. Flush IV lines before hanging as a piggyback because traces of dextrose solution can cause emboli. Use an IV line with a filter. Injectable version causes local tissue damage, so do not give IM. Dont inject into hand veins or they will turn purple. The drug may cause dysrhythmias, hypotension, and hyperglycemia. It may cause CNS reactions (nystagmus, ataxia, confusion); peripheral neuropathy

may occur with long-term use; it can cause agranulocytosis and aplastic anemia. Skin rashes and S-J syndrome may occur. Can cause lupus, gingival hypertrophy, other connective tissue reactions. Dont use if the pt has sinus bradycardia or a rash. Dont use with these drugs: oral anticoagulants; glucocorticoids; H2 antagonists; antituberculin drugs; folic acid; calcium; vitamin D. If used with a tricyclic, it can cause seizures. Carbamazepine (Tegretol) is a phenytoin-like medication used for tonicclonic and partial seizures. Levodopa Antiparkinsonism agents are given to restore the balance of dopamine and acetylcholine in the brain. Meds used include dopaminergic drugs and anticholinergics. Dopaminergics either restore dopamine function or stimulate the brains dopamine receptors, and they are used for the initial treatment of Parkinsons. The goal of med therapy for PD is to increase the pts ability to perform daily ADLs. Meds should restore the balance of dopamine and acetylcholine; dopaminergic drugs are used to increase dopamine. Levodopa is the drug of choice for parkinsonism; and it can cross the bloodbrain barrier which dopamine cannot. Its sometimes combined with carbidopa.

Adverse Effects: dizziness; light-headedness; difficulty concentrating; confusion; anxiety; headache; sleep dysfunction; fatigue; n&v; constipation; ortho hypo; dystonia; dyskinesia. Really bad AEs include: MI, shock, neuroleptic malignant syndrome; agranulocytosis; depression/suicidal thoughts; EPS; liver failure; liver cell injury. Pt can take with food, but not high-protein bc it will impair absorption and reduce effectiveness. Possible dizziness when standing up quickly. Change positions slowly, dangle legs before getting out of bed, use elastic stockings. B6 and multivitamins OK to take. Watch for neuroleptic malignant syndrome, which also happens in pts receiving antipsychotic meds. S&S are muscle rigidity, fever, delirium. Elevated CPK. Morphine Opioid analgesic. Binds with both mu and kappa receptor sites to produce analgesia. Causes euphoria, constriction of the pupils, stimulation of cardiac muscle. Used for acute and chronic pain. Used as a pre-anesthetic medication to relieve SOB associated with HF and pulmonary edema. Used for acute chest pain connected with MI. Causes peripheral vasodilation, which results in ortho hypo. May cause dysphoria (restlessness, depression, anxiety); hallucinations, nausea, constipation, dizziness, itching. OD can result in resp depression and death. Tolerance develops to the sedative, nausea-producing and euphoric effects of the drug. Cross-tolerance develops for heroin, methadone. Drug may intensify or mask pain of gallbladder disease due to biliary tract spasms. Avoid in pts with severe asthma, GI obstruction, hepatic or renal

failure. Dont use with other CNS depressants; or antidepressants like MAOIs and tricyclics which increase the risk of resp depression. Codeine Opioid agonist with moderate effectiveness. Adverse effects include sedation, nausea, constipation, dizziness. Serious side effects include liver damage, respiratory depression, circulatory collapse, coma. Codeine is most often prescribed as a cough suppressant. For coughing, codeine is considered an antitussive. Antitussives are drugs used to dampen the cough reflex when treating allergies and colds; a dry, hacking cough can be irritating to the membranes of the throat and can deprive a patient of much-needed rest. Opioids are the most effective antitussives, and they act by raising the cough threshold in the CNS. Codeine and hydrocodone are the most frequently used opioid antitussives. Doses needed to suppress the cough are low, so there is not as much of a risk for dependence. Care must be taken when using these meds in patients with asthma, because bronchoconstriction may occur. They can be combined with nonopioid antitussives like antihistamines and decongestants. Codeine suppresses the cough reflex by direct action on the cough center in the medulla. Codeine can also be used for mild to moderate pain other than from coughing. To administer, give with milk or meals to avoid GI upset. Dont use with other CNS depressants, anesthetics, MAOIs, tricyclics. Dont use with alcohol. Take caution when using with pts who have head injuries or increased intracranial pressure, hepatic/renal disease, seizures, COPD. Breast-feeding mothers shouldnt use it. Reassess pain level 15-30 minutes after admin. Give drug before intense pain sets in.

Dont use when cough is beneficial, such as after thoracic surgery. Assess for constipation. May delay gastric emptying; GI distress can be eased with milk or meals. Narcan Naloxone. For the treatment of acute opioid overdose and misuse. Pharm Class: Opioid receptor antagonist. Drug is a pure opioid antagonist, blocking both mu and kappa receptors. Used for complete or partial reversal of opioid effects in emergency situations/opioid ODs. Given IV, can reverse CNS and respiratory depression within minutes. Will immediately cause withdrawal symptoms in pts physically dependent on opioids. Also used to treat post-op opioid depression. Can also reverse hypotension caused by septic shock. Administer when RR is less than 10 per minute. Narcan is not toxic but the withdrawals it might cause can lead to increased BP, pain, hyperventilation, n&v and drowsiness. Only for resp depression caused by opioids. OD of this is treated with oxygen, IV fluids, vasopressors. Robinol Glycopyrolate. Used in combo with other meds to treat ulcers. It is anticholinergic. Decreases stomach acid production. Usually taken 2-3 times per day. Take on an empty stomach, at lease 2-3 hours from meal time. Can cause paralytic ileus. Dont use with megacolon or ulcerative colitis or myasthenia gravis. Overdose symptoms may include weak or shallow breathing, feeling cold,
jerky muscle movements, or seizure (convulsions). Glycopyrrolate can decrease sweating and you may be more prone to heat stroke. Dont use with Haldol, levodopa or digoxin.

Atropine Anticholinergic. Antispasmodic. Antidysrhythmic. Inhibits acetylcholine. Acts on heart, exocrine glands, smooth muscles, eye. Incr. HR; decreases secretions; dilates pupils; lowers GI motility. Hot as a hare (temp rises); mad as a hatter (delirium); red as a beet )flished face); dry as a bone (decreased secretions and thirst). Blocks vagal response during surgery. Serious AEs = bradycardia, anaphylaxis. Dont use with antacids; other anticholinergics; levodopa; potassium tabs; not for pts with glaucoma; GI obstruction patients shouldnt use; nor pts with CV disease; or myasthenia gravis. Causes urinary retention. Pt may be sensitive to sunlight. Albuterol Beta-Agonist/Sympathomimetric. 2 inhalations every 4-6 hours as needed. Max is 12 inhalations per day. Proventil, Ventolin, VoSpire. May cause headache, dizziness, tremor, nervousness, throat irritation, drug intolerance. Inhaled beta agonists produce minimal systemic toxicity because only small amounts of the drug are absorped. When given orally, a longer duration of action is achieved, but systemic adverse effects are more frequently experienced. Systemic effects may include activation of beta1 receptors in the heart, which could cause an angina attack or a dysrhythmias in patients with cardiac impairment. Tolerance may develop to bronchodilation effect with long-term use. Increased use of the drug is an indication that the patients condition is deteriorating. Can also be used to prevent exercise-induced bronchospasm by taking 15 mins before exercise.

Method of Action: Relaxes bronchial, uterine and vascular smooth muscle by stimulating beta2 receptors. Dont use with CNS stimulants; may decrease digoxin levels; if used with MAOIs and tricyclics, it may increase adverse CV effects; propranolol and other beta blockers may cancel the albuterol out and vice versa. Drug may decrease the patients potassium level. Tell patient to shake the inhaler, clear nasal passages and throat, breathe out, expelling as much air from the lungs as possible, place mouthpiece well into mouth, seal lips around mouthpiece, and inhale deeply as you release a dose from the inhaler. Hold breath for several seconds, remove mouthpiece and exhale slowly. Tell patient to wait at least 2 minutes before repeating procedure. If patient is also on a corticosteroid inhaler, tell them to use the bronchodilator first and wait about 5 minutes before using the corticosteroid. This lets the bronchodilator open the air passages for maximal effectiveness of the corticosteroid. Wash inhaler after removing canister, wash at least once a week with soapy water. Atrovent Can be used for asthma, COPD and nasal congestion. It is a bronchodilator and anticholinergenic. Delivered by inhalation and intranasal routes. Relieves/prevents bronchospasms seen with asthma and COPD. Combined with albuterol to treat COPDs. Off-label for asthma. Alternative to short-acting beta agonists, for pts with severe acute probs. Can be comined with beta agonists. Provides relief within minutes, although peak effect may take 1-2 hours. Effect can continue for 6 hours.

InWhen used for runny nose, it inhibits nasal secretions but doesnt have decongestant action. Treatment limited to 3 weeks. Not for pts allergic to lecithin, soybean, peanuts. Dont use with other anticholinergics. Dextromethorphan Estrogen and Estrogen Antagonist (tamoxifen) Oral antiestrogen preferred drug for treating metastatic breast cancer. Effective against breast tumor cells that require estrogen for growth, which are known as estrogen receptor positive cells. Blocks estrogen receptors on breast cells but tamoxifen activates estrogen receptors in other parts of the body, resulting in typical estrogen like effects such as reduced LDL levels and increased mineral density of bone. One antineoplastic approved for prevention of breast cancer. For high risk pts at risk of developing the disease. Adjust therapy in women following mastectomy to decrease potential for cancer in opposite breast. Give with food/fluids to decrease GI irritation. Do not crush or chew drug. Avoid antacids fr 1-2 hours following PO dose. Pregs category D. Side effects include n and v, little serious toxicity. Association of tamoxifen therapy with incr. risk of endometrial cancer and thromboembolic disease such as strokes and pulm embolisms. Hot flashes, fluid retention, vag discharges are common. Tumor flare initially, increase in tumor size but is expected. Hypertension and edema occur in 10% of people taking this. Dont use with anticoagulants. History of thromboembolitic disease a no-no; no pregs or lactation; precaution in pts with blood disorders, visual disturbances, cataracts, hypercalcemia, hypercholesterolemia. Dont use estrogens. Labs: calcium levels may increase.

Serious neurotox dysrhythmias may occur with OD. Cialis Erectile dysfunction. Promotes smooth muscle relaxation, promotes blood flow to the corpus cavernosum. Dont use w nitrates, alpha blockers, rifampin, erythromycin, grapefruit, alcohol. Not for pts with unstable angina. Or for pts with retinal disorders. Dont use if pt has bleeding disorder. Sickle cell anemia, ultiple myeloma, leukemia will predispose them to priapism. Sex can increase cardiac risk. Pt should seek immediate med help if chest pain occurs after taking drug. Or if erection lasts more than 4 hours. Take 60 mins before sex. Drug has no effect without sexual stim. Notify doc of hearing or vision changes. Timolol For angina and MI. For glaucoma. For HTN. For migraines. Non-selective beta-adrenergic blocker. Lowers IOP in open angle glaucoma, reduces the formation of aqueous humor. Can take 2-4 weeks to work. As oral med, it can treat mild HTN, stable angina, prophylaxis of MI and migraines. Can mask signs of hypoglycemia. Common to have burning/stinging on instillation. Vision may temporarily blur. HypoTN and dysrhythmias are possible but uncommon. Not for pts with asthma, COPD, bradycardia, AV block, heart failure. Using w epinephrine can cause HTN followed by severe bradycardia.

Tetracycline Inhibs gram pos and neg. Inhibs bacterial protein synthesis. Slows microbial groth. Bacteriostatic, some can enter CSF. Dont take w milk or iron. Broad spectrum. Can cause yellow teeth in young kids. Fetal bone disruption. Risk of superinfection. High dose = hep toxic. Old pills = kidney toxic. Prazosin Used for BPH and HTN. Antiypertensice and Adrenergic-Blocking Agent. Selective alpha1 antagonist & compets with norepinephrine on smooth muscles of arterioles and veins. Rapid decrease in peripheral resistance, reduces BP. Little effect on cardiac output or HR. Tolerance to HTN lowering effect can occur. Often used with beta blockers/diuretics. Taken 2-3 times per day dur to short half life. Like other alpha blockers, can cause ortho hypo dur to alpha 1 inhibition. Rarely can cause unconsciousness 30 mins after 1st dose. First dose should be low at at bedtime. Reflex tachy may occur from fall in BP. May cause nasal congestion or inhibit ejaculation.

Heparin Nitroglycerin For treatment/prevention of angina. Can cause fatal hypotension when used with Viagra. A potent vasodilator in vascular smooth muscle. Relaxes arteries and veins, which reduces the amount of blood returning to the heart and chambers

contain a lower volume. Myocardial oxygen demand is lowered. Chest pain is fixed and angina happens less often w use. Tolerance is a problem. Stop drug overnight. Can cause hypoTN, anaphylaxis, syncope. Lasix Can be used for pulmonary edema. It is a loop diuretic. Hypotension is a poss. Side effect but pt doesnt have to stay in bed. Diureses is expected to start within an hour and peak over 2. If IV, the onset is 5 minutes and peak is half an hour. Pt needs easy access to a toilet. Inhibits reabsorption of sodium and chloride in the loop of Henle and distal renal tubules. Nurse should monitor BP, I&O, monitor K, weigh pt daily, dont give right before bedtime; encourage K foods. Digoxin Cardiac glycoside used for treating congestive HF and atrial fib, flutter or tachy. Has direct effect on the heart so pt must take accurate pulse measures before admin. Withhold if HR less than 60. Take resting HR. MOA = decreases HR and increases force of contraction. Can cause bradycardia, anorexia, n&v, dysrhythmias, diaphoresis. Nurse should know baseline VS Check for toxicity = visual disturbances, GI upset, confusion. Take apical for 1 minute. Withhold and notify doc if HR lower than 60. Obtain 12-lead ECG. Inhibits sodium-potassium activated adenosine triphosphates, producing movement of calcium from extracellular to intracellular and strengthening myocardial contraction. Also acts on CNS.

Use caution when combining w anticholinergics, beta/calcium channel blockers. Can cause hypercalcemia and hypomagnesemia. Therapeutic level = .125-.5 mg or .8-2 nanograms. Insulin Regular (Humulin R/Novolin R) Short Action. Onset is 30-60 mins. Peak is 1-5 hours. Give SQ 30-60 min before a meal. Can mix with NPH, sterile water, normal saline. Promotes cellular uptake of glucose, amino acids, and potassium. Promotes protein synthesis, glycogen formation/storage, fatty acid storage as triglycerides; conserves energy stores by promoting utilization of glucose for energy needs. Inhibits gluconeogenesis. Since it is short-acting, it is often used in combo with intermediate or longacting insulin. Do not mix with Lantus. Can be used as emergency treatment for diabetic ketoacidosis, for gestational diabetes, and in combo with oral antidiabetic agents for Type 2 pts. The only type of insulin that can be used IV. Pts with hypokalemia should be monitored carefully bc insulin may worsen this condition. Insulin Glargine (Lantus) Long acting. Onset 1.1 hour. No peak. Give SQ, 1 time a day, same time each day. Dont mix with any other insulin or dilute with solutions. For Type 1 and Type 2 diabetes. Reduces glucose by stimulating peripheral glucose uptake, esp. by muscle and fat; inhibits hepatic glucose production. Common serious side effect is hypoglycemia. Serious drug interaction dont use with MAOIs. Dont use with oral antidiabetics. Due to prolonged duration, it isnt the insulin to be used for diabetic ketoacidosis. Treat mild hypoglycemia with oral glucose tabs. If solution is cloudy, discard vial. Use only if clear/colorless. Avoid alcohol bc it lowers the glucose levels. Avoid vigorous exercise after injection.

Ibuprofen Therapeutic class is as an analgesic/anti-inflammatory and antipyretic. Pharm class is as an NSAID. Can treat mild to moderate pain, fever, and inflammation. Effectiveness is equal to aspirin and other NSAIDs. Inhibits synthesis of prostaglandins, which are lipids found in all tissues and promote inflammation. Give drug on an empty stomach as tolerated. OK to give with food if GI upset occurs. Pts with asthma or allergies might have hypersensitivity reaction to ibuprofen. Side effects mild. GI ulcers with occult blood may occur if pts take high doses for long periods of time. Pts with PUD shouldnt take this. Chronic use can lead to renal impairment. Dont use for peri-op pain for coronary bypass due to risk for stroke or MI. Dont use with pts who have renal/hepatic impairment. Not for pts with nasal polyps, angioedema, or bronchospasm. Use cautiously in pts with HF, HTN or history of stroke/MI. Avoid while taking anticoagulants bc it can affect platelet function. Aspirin can decrease ibuprofens anti-inflamm effect. Ibuprofen can cause lithium toxicity. GI events can occur if taken w other NSAIDs, alcohol or corticosteroids. May incr. bleeding time, AST and ALT levels, and may decrease HB and HCT. Aspirin/Salicylic Acid Aspirin. The large doses of aspirin needed for severe inflammation may result in adverse effects on the digestive system. It increases gastric secretion and irritates the stomach lining. Can cause GI pain, heartburn, bleeding/ulcers. Enteric coating minimizes GI effects. Salicylism is a syndrome that includes tinnitus, which is ringing in the ears; dizziness; headaches; excessive sweating. Aspirin interferes with clotting by keeping a platelet-aggregating substance from forming. Can cause thrombocytopenia and leucopenia; hepatitis; angiodema; Reye Syndrome. Dont use with Heparin bc it may increase bleeding. Dont use with pts who have bleeding disorders. Reye Syndrome can develop in children recovering from chicken pox. Can cause hyperthermia;

dehydration; tinnitus; vertigo; headache; confusion & drowsiness; diaphoresis; hyperventilation; vom & runs. Buffered aspirin contains sodium. Take with food/antacid/milk/water to avoid GI probs. Aspirins significant anticoagulant activity give it the ability to reduce the risk of mortality following an MI, and to reduce the incidence of strokes. It has also been found to reduce the risk of colorectal cancer. Discontinue aspirin 1 week before elective surgery. Excreted in urine and affects urine testing for glucose. Acetaminophen Prednisone Anti-inflammatory agent. Glucocorticoid. When used for inflammation, therapy is limited to 4-10 days. For long-term therapy, alternate-day dosing is used. Occasionally used to terminate acute bronchospasm in pt with asthma and as an antineoplastic agents for prs with certain cancers. When using for more than 10 days, dose must be gradually withdrawn. Short-term use has few side effects. Long-term use can result in Cushings and gastric ulcers. Dont take if have an active viral, bacterial, fungal or protozoan infection. When used to treat inflammation, the doses are many times higher than the amount naturally in the body. Most effective meds for severe inflammatory disorders. Inhibit biosynthesis of prostaglandins, suppress histamine, inhibits functions of lymphocytes and phagocytes. Acetylcholine Potassium Chloride

CATEGORY Central muscle relaxant These drugs generate their effects by inhibiting motor neurons within the brain and/or spinal cord. This means the origin is within the central nervous system. It is believed they generate their effects within the brain and/or spinal cord by inhibiting upper motor neuron activity, causing CNS depressant effects, or altering simple spinal reflexes. All the centrally acting agents have the potential to cause sedation. Adverse effects can include drowsiness; dizziness; dry mouth; sedation; ataxia; lightheadedness; urinary hesitancy or retention; hypotension; bradycardia. Serious adverse effects can include edema of the tongue; anaphylactic reaction; respiratory depression; coma; laryngospasm; cardiovascular collapse. Prototype for centrally active skeletal muscle relaxants: Clobenzaprine (Cycoflex, Flexeril). Causes relaxation in causes of acute muscle spasticity, but not effective for cerebral palsy or diseases of the brain/spinal cord. Meant to provide therapy for only 2-3 weeks. Maximum effects may take 1-2 weeks. Use with caution in patients with MI, dysrhythmias, CV disease. Dont take with alcohol or MAO inhibitors (hyperpyretic crisis/convulsions may occur). Antiepileptic/Antiseizure For the treatment ofall seizure-related symptoms, including signs of epilepsy. Once a med is selected, the patient is placed on a low initial dose, and it is gradually increased until seizure control is achieved or until drug side effects prevent additional dose increases. If seizures continue, a second drug is added and the first is slowly reduced. Seizures are likely to occur if antiseizure drugs are abruptly withdrawn, so they are usually withdrawn over a period of 6-12 weeks. An FDA report analyzing newer nontraditional drugs showed that 11 popular meds might double the risk of suicidal behavior among patients. Most patients only need one drug, though two is OK.

The goal of antiseizure therapy is to suppress the neuronal activity just enough to prevent abnormal or repetitive firing. The drugs either stimulate an influx of chloride ions, an effect associated with the neurotransmitter GABA; or they delay an influx of sodium; or they delay an influx of calcium. The drugs should control the movement of electrolytes across neuronal membranes or if they are affecting neurotransmitter balance. An influx of sodium or calcum into the neuron enhances neuronal activity, while an influx of chloride or an efflux of potassium suppresses neuronal activity. Some drugs change the activity of GABA (primary inhibitory neurotransmitter of the brain). These drugs mimic the effect of GABA by stimulating an influx of chloride ions that interact with GABA receptors. Chloride ions move into the cell and suppress the firing of neurons. Barbiturates, benzodiazepines, etc. reduce seizure activity by intensifying GABA action. Several drugs dampen CNS activity by delaying an influx of sodium ions across neuronal membranes. Hydantoins act by this mechanism. Sodium ion movement is the major factor that determines if a neuron will undergo an action potential. If these channels are temporarily inactivated, neuron activity will be suppressed. Hydantoin and phenytoin drugs block/desensitize the sodium channels, and neuronal activity completely stops. Drugs that suppress calcium influx: bind to neuronal membrances and stimulate the entry of calcium and without calcium influx, neuronal transmission would not be possible. Succinimides delay entry of calcium into neurons by blocking calcium channels, increasing the electrical threshold of the neuron and reducing the liklihood that an action potential will be created. Succinimides keep neurons from firing too quickly. Acetylcholinesterase inhibitors (Cholinergics, Parasympathomimetrics) Stimulation of the parasympathetic nervous system: These drugs are called cholinergic agents or parasympathomimetrics. They produce the characteristic symptoms of the rest-and-digest response.

Inhibition of the sympathetic nervous system: These drugs are called adrenergic-blocking agents, or adrenergic antagonists, or sympatholytics. They produce actions opposite of sympathomimetics. Produce mane of the same rest-and-digest symptoms as the parasympathomimetrics and have a wide therapeutic application in the treatment of HTN. The classic parasympathomimetic is acetylcholine, the neurotransmitter at cholinergic synapses in the ANS. However, it has almost not therapeutic use because it is rapidly destroyed after administration and produces many side effects. Acetylcholine in the synaptic cleft is rapidly destroyed by acetylcholinesterase AchE and choline is reused, and taken up by the presynaptic neuron to make more Ach. Direct-acting parasympathomimetics are relatively resistant to AchE and have a longer duration than Ach. Directacting parasympathomimetics can also be described as muscarinic agonists because they are moderately selective to muscarinic receptors. Indirectacting parasympathomimetics such as neostigmine inhibit the action of AchE, which allows endogenous Ach to avoid rapid destruction and remain on cholinergic receptors for a longer time, prolonging its action. The indirect meds are also called cholinesterase inhibitors and are nonselective, and affect all Ach sites, including ganglia, muscarinic receptors, skeletal muscle, and Ach sites in the CNS. These are used sparingly due to many side effects. Used in ophthalmology to reduce intraocular pressure in glaucoma patients and for stimulatory effects on the smooth muscle of the bowel or urinary tract. Used for myasthenia gravis, a disease characterized by the destruction of nicotinic receptors in skeletal muscles. Paras stimulate skeletal muscle contraction and reverse severe muscle weakness. Aricept and Cognex are used to treat AD because they increase the amount of acetylcholine binding to receptors located in the CNS. Opioids

Analgesics are meds used to relieve pain. The two categories of analgesics are opioids and nonopioids. Opioids are narcotic substances, meaning they produce numbness or stupor-like symptoms. Opioids exert their actions by interacting with at least 6 types of receptors. Drugs that stimulate a particular opioid receptor are called opioid agonists. Those that block an opioid receptor are called opioid antagonists. Opioid blockers like Narcan inhibit both mu and kappa receptors, the most important ones when dealing with opioids. Morphine is a prototype opioid agonist used to treat severe pain. It is considered the standard by which the effectiveness of other opioids are compared. Other than analgesia, opioid are effective at suppressing the cough reflec and slowing the motility of the GI tract for cases of severe diarrhea. Opioids also cause sedation , and some people experience euphoria and relaxation which is why the drugs are sometimes abused. Adverse effects include respiratory depresson, sedation, nausea and vomiting. Barbiturates Powerful CNS depressants prescribed for their sedative, hypnotic, and antiseizure effects. Until benzodiazepines, barbiturates were the drug of choice for treating anxiety and insomnia. They are now rarely prescribed for anxiety and insomnia because of significant adverse effects and the availability of more effective meds. The risk of dependence is high, and several are schedule 2 drugs. The withdrawal syndrome is severe and can be fatal. OD results in respiratory depression, hypotension and shock. They act by binding to GABA receptors and intensifying the effect of GABA throughout the brain. Low doses reduce anxiety and cause drowsiness; moderate doses inhibit seizure activity; higher doses can induce anesthesia. With repeated use, tolerance develops to the sedative effects of barbiturates but not the respiratory depressant effects. Include Nembutal, Seconal, Amytal, Alurate, Luminal for treating insomnia/anxiety.

Phenobarbital is able to suppress abnormal neuronal discharges without causing sedation; it is inexpensive, long-acting, and produces a low incidence of side effects. It is the drug of choice when treating neonatal seizures. Overall, barbiturates are effective against all major seizure types except absence seizures. Amobarbital is an intermediate-acting barbiturate given IM or IV to terminate status epilepticus. Amobarbital is not given orally as an antiseizure med. SSRI Drugs that slow the reuptake of serotonin into presynaptic nerve terminals are the SSRIs, which have become the drugs of choice in the treatment of depression because of a better side-effect profile. Serotonin is important to several body functions, including cycling between NREM and REM sleep, pain perception, and emotional states. Lack of serotonin can lead to depression. Serotonin is metabolized to a less active substance by the enzyme monoamine oxidase (MAO). While tricyclics inhibit the reuptake of both norepinephrine and serotonin, the SSRIs selectively target serotonin. SSRIs have the same efficacy at relieving depression as MAOIs and tricyclics, but the advantage of SSRIs is their greater safety. Sympathomimetic effects like increased heart rate and HTN; and anticholinergic effects like dry mouth, blurred vision, urinary retention and constipation are less common with this drug class. Sedation is also less common and cardiotoxicity is not observed. One common side effect is sexual dysfunction, and up to 70% of men and women experience this. Other common side effects include nausea, headache, weight gain, anxiety, and insomnia. Serotonin syndrome may occur, and this is when serotonin accumulates in the body. Symptoms begin as early as 2 hours after taking the first dose, or several weeks after starting the med. Symptoms of SS include mental status changes like confusion, anxiety, and restlessness; hypertension; tremors; sweating; hyperpyrexia, and ataxia. Discontinue SSRIs and provide supportive care if this happens. Mechanical ventilation and muscle relaxants might be used in extreme cases. Can cause death if left untreated. Zoloft is an SSRI. Lexapro is an SSRI, along with Celexa, Prozac,

Luvox and Paxil. SSRIs can cause nausea, dry mouth, insomnia, headache, nervousness, anxiety, GI disturbances, dizziness, anorexia, fatigue, sexual dysfunction, SS, stephens-johnson. MAOI Anticholinergic blocking Beta adrenergic agonist and antagonist Alpha adrenergic agonist Symmpathomimetics

Antitussive Dampen the cough reflex. Treats coughs due to allergies or the common cold. For dry, hacking, nonproductive cough, which can be irritating to the throat and deprive a patient of sleep. Opioids are the most effective antitussives. They raise the cough threshold in the CNS. Rarely, opioid cough remedies can cause respiratory depression. Use caution with asthma patients as bronchoconstriction may occur. The most frequently used nonopioid antitussive is dextromethorphan, which is OTC. Chemically similar to opioids, and also acts on the CNS. In large doses, it can cause slurred speech, dizziness, drowsiness, euphoria, lack of motor coordination. Mucolytic Acetylcysteine (Mucomyst) is one of the few drugs available to directly loosen thick bronchial secretions. It is a mucolytic, which is a class that breaks down the chemical structure of mucous molecules. Mucus becomes thinner and can be removed more easily by coughing. It is delivered via the inhalation route and not available OTC. Used with pts who have cystic fibrosis, chronic

bronchitis, or any disease that causes this bronchial secretions. It can trigger bronchospasm and has an odor resembling rotten eggs. Another mucolytic, called dornase alfa breaks down DNA molecules in the mucous, thinning it. Acetadote is also administered oral/IV to patients who ODd on acetaminophen. Antihistamine H1-Receptor Antagonists. Block the actions of histamine at the H1 receptor. OTC for allergy symptoms, motion sickness, insomnia. Histamine is released from mast cells & basophils and causes itching, increased mucus secretions, congestion. May cause bronchoconstriction, edema, hypotension, anaphylaxis. (H1 receptors = allergic symptoms/H2 receptors = gastric mucosa/peptic ulcers). Antihistamines selectively block the actions of histamine at the H1 receptor and alleviate symptoms. Most effective when taken to prevent allergic symptoms. Cause typical anticholinergic effects. Anticholinergic effect = drying of mucous membranes. Dont take alcohol with these because sedating effects may be addictive. Some pts can exhibit CNS stimulation though, causing insomnia/nervousness. Anticholinergic effects = dry mouth, dry mucous membranes, urinary hesitancy. Diphenhydramine and clemastine produce the greatest incidence of anticholinergic effects. Astelin causes less drowsiness bc it is applied locally to the mucous membranes. Bronchodilators Beta2 adrenergic agonists (beta agonists) are effective bronchodilators and are the drug of choice for ACUTE bronchoconstriction. They activate the sympathetic nervous system, which relaxes smooth muscle resulting in bronchodilation. Effective at widening the airway but provide no inflammation relief. Not good for chronic asthma. Short-acting beta agonists abort acute attacks and are rescue agents. Intermediate beta agonists include albuterol. Dont use LABAs to abort an asthma attack, it wont work (like Severent). Minimal systemic toxicity if inhaled. Adverse effects more common

if taken PO because they can act on beta1 receptors in the heart and cause angina or dysrhythmias in pt with heart disease. Glucocorticoid Inhaled glucocorticoids (corticosteroids) are used for long-term prevention of asthmatic attacks. Oral corticosteroids may be used for the short-term mgmt of acute severa asthma. Most potent anti-inflammatory substance known. Dampen the activity of inflammatory cells and increase production of antiinflammatory mediators. They are not bronchodilators, but sensitize the smooth muscle to be more responsive to beta-agonists. Reduce bronchial hyper-response that causes some asthma attacks. Inhaled corticosteroids can cause hoarseness, dry mouth, cough, sore throat, candidiases, hypercorticism, hypersensitive reactions. (Other anti-inflamm drugs for asthma: Mast cell stabilizers can cause nausea, sneezing, nasal stinging. Anapylaxis, bronchospasm; leukotriene modifiers can cause headache, dizziness, diarrhea, liver toxicity, increased AST.) Prototype inhaled corticosteroid is beclomethasone (Beconase, Qvar). Preferred therapy for PREVENTING asthma attachs; when inhaled daily, they suppress inflammation without major side effects. May take 4-8 weeks to see improvements. Must be taken daily; wont work for acute episodes. For severe asthma, prednisone may be prescribed to take orally. Inhaled corticoid steroids produce few side effects, but when taken PO they cause many. Some side effects from the oral form include adrenal gland atrophy, peptic ulcers, osteoporosis, hyperglycemia. Glucocorticoids R/T the endocrine system The adrenal cortex secretes three classes of steroid hormones: glucocorticoids, mineralocorticoids, gonadocorticoids. The term CORTICOSTEROID imples that the drug has both glucocorticoid and mineralocorticoid. The drugs are used as replacement therapy for patients with adrenocortical insufficiency and to dampen inflammatory and immune responses. They are short, intermediate, and long-acting.

SySymptoms of adrenocortical insufficiency: hypoglycemia; fatigue; hypotension; increased skin pigmentation; anorexia; vomiting; diarrhea. Addisons Disease is primary adrenocortical insufficiency, is quite rare, and is a deficiency of glucocorticoids and mineralocorticoids. Addisons is caused by autoimmune destruction of the adrenal glands. Secondary adrenocortical insufficiency occurs when corticosteroids are suddenly withdrawn as a med. When glucocorticoids are taken for a long time, the adrenal cortex shrinks and causes adrenal atrophy. Symptoms of acute adrenocortical insufficiency include nausea, vomiting, lethargy, confusion, coma. Treatmeant is IV therapy with hydrocortisone. To avoid, discontinue glucocorticoids gradually. Insulin Released by the pancreas to decrease blood glucose levels. After meals, the pancreas recognizes rising serum glucose and releases insulin. Without insulin, glucose stays in the blood and cant enter cells. Cells can be surrounded by glucose but cant use it without insulin. Insulin is said to have a hypoglycemic effect because it causes glucose to leave the blood and enter the cells, therefore there is less glucose in the blood. Insulins actions are as follows: promotes entry of glucose into cells; provides storage of glucose, as glycogen; inhibits breakdown of fat and glycogen; increases protein synthesis and inhibits gluconeogenesis (the production of new glucose from noncarb molecultes). Type 1 DM = severely deficient in insulin production and insulin therapy is required in normal physiologic amounts. Type 2 DM = insulin needed for those who cant manage their glucose levels with diet, exercise and oral antidiabetic meds. The right amount of insulin must be available to cells when glucose is available in the blood; admin when glucose is NOT available can lead to serious hypoglycemia and coma. This happens when a person admins insulin correctly but then skips a meal the insulin is available to cells but glucose is not. Serious effects can also occur it the person exercises heavily the insulin was admin on schedule and food was eaten, but the muscles quickly used all

the glucose in the blood and the patient becomes hypoglycemic. Pts with diabetes should consume food/sports drinks prior to activity. If pts skip or forget their insulin dose, glucose from a meal can build up in high levels and cause hyperglycemia and possible coma. Time of peak action of insulin is when risk for hypoglycemia is greatest. Must be given by injection or insulin pump. Primary adverse effect is too much insulin, resulting in hypoglycemia. If a pt is hypoglycemic, they will have pale, cool, moist skin with blood glucose less than 50 mg/DL and sudden onset of symptoms. Anticoagulant Antibiotics Diuretics (thiazide, loop, potassium sparing) Chemotherapeutic Aminoglycosides ACE Inhibitors Penicillins
Bactericidal disrupts and weakens the cell wall, leading to cell lysis and death. Types include narrow spectrum that are penicillinase sensitive penicillin G, penicillin V. Penicillinase-resistant include nafcillin, oxacillin, dicloxacilin Broad-spectrum include ampicillin, amoxicillin, Augmentin. Extended-spectrum penicillins include ticarcillin, piperacillin Side effects: Allergic reactions: rash, itching, hives, anaphylaxis. Nursing considerations: Contraindicated in pts with hypersensitivity to penicillin, cephalosporins, or

carbapenems; not for neonates either. Not for neonates. Monitor pt for 30 mins after admin. Cephalosporins

Each generation has increasing bactericidal activity to break down gramnegative bacteria and anaerobes, as well as reach the cerebrospinal fluid. Cephalosporins interfere with bacterial cell wall synthesis and are considered broad-spectrum. The cell weakens, swells, bursts, and dies as a result of increased osmotic pressure inside the cell. Side effects: Rash, priritus, fever, nausea, vomiting, diarrhea Uncommon side effects: anorexia, flatulence, some of these may cause bleeding tendencies. Taking cefotetan and drinking alcohol may cause a serious reaction. Adverse effects: Hypersensitivity reactions such as rash, pruritus, fever. Possible suprainfection. Nursing considerations: Contraindicated in patients allergic to penicillins. Monitor rate of infusion; check labeling for rate of IV infusion. Monitor renal and hepatic studies throughout therapy. If GI upset occurs, patient can take med with food. Evaluate IM and IV sites for reaction, such as abcess and thrombophlebitis. Minimize complication of thrombophlebitis by rotating injection sites and slowly injecting a dilute solution. Monitor for bleeding. IM injections are frequently painful, so warn the patient. Patient teaching: Advise patient to hydrate; notify health care provider if patient is experiencing diarrhea Teach patient to refrigerate oral suspensions Instruct patient to report signs of allergy such as skin rash, itching, hives.

Antiviral Viruses are non-living. Infect bacteria, plants, animals. None of the cellular organelles necessary for self-survival. Quite primitive even compared to simplest cell. Surrounded by protective coat. Capable of remarkable feats. Infect host by locating and entering a target cell and using machinery of the host to replicate. Intracellular parasites. Antivirals the least effective of all anti-infective drugs. Pharm therapy challenging bc of rapid mutation rate of viruses. Quickly render drugs ineffective. Intracellular nature of virus makes it difficult to eliminate pathogen without injuring normal cells. Narrow spectrum of activity. Usually limited to one type of virus. Laxatives

PPIs Prilosec, Nexium. Act by blocking the enzyme responsible for secreting hydrochloric acid in the stomach. Drugs of choice for short-term therapy of PUD and GERD. PPIs reduce acid secretion to a greater extent than the H2 receptor antagonists and have a longer duration of action. PPIs heal more than 90% of duodenal ulcers within 4 weeks and about 90% of gastric ulcers in 6-8 weeks. Several days of therapy may be needed before the pt feels relief from ulcer pain. The typical length of therapy is 4 weeks. Some are used concurrently with antibiotics to eradicate H. pylori. Serious adverse effects from drugs in this class are uncommon and all PPIs have similar efficacy and adverse effects. Headache, abdominal pain, diarrhea, nausea, and vomiting are the most frequently reported symptoms. H2 Blockers

Widely used in the treatment of hyperacidity disorders of the GI tract. Tagamet, Pepcid, Zantac (prototype). Histamine has two receptors, H1 and H2. H1 produces the symptoms of inflammation and H2 increase acid secretion in the stomach. The H2-receptor antagonists suppress the volue and acidity of parietal cell secretions. These drugs are used for GERD and PUD. All H2-receptor antagonists have similar safety profiles and adverse effects are minor: patients taking high doses or with renal/hepatic disease may experience confusion, restlessness, hallucinations, depression. Tagamet is used less frequently than the others because of numerous drug-drug reactions, as it inhibits hepatic drug-metabolising enxymes. Dont take antacids with these drugs bc the absorption of the H2-receptor antagonist will be diminished.

VOCABULARY Identify the key components included in a Complete Blood Count to include normal value ranges RBC (erythrocyte) (4.5-5.5)
Hemoglobin (12-16 g/dL): Protein molecule of blood that carries oxygen Hematocrit: Percentage of RBC by volume 38-54% WBC (4,000-10,0000) Platelets (thrombocyte) (140,000-500,000) Red Blood Cell Count (4.5-5.5) Closely related to the HGB and HCT levels and represents a different way of evaluating the number of RBCs. Used in pts with ongoing bleeding or to evaluate anemic pts. Test counts the number of circulating RBCs in a small amount of venous blood. Low values can be caused by many things, like hemmorhage, hemolysis, dietary deficiency, genetics, drugs, marrow failure, chronic illness. Hematocrit Critical values: Lower than 15% or higher than 60% An indirect measurement of RBC number and volume. Used as a rapid measurement of RBC count. Integral part of evaluation of anemic patients. Normal values vary with age. Pregnancy can decrease values. HCT falsely elevated in dehydration. Decreased in overhydration. Hemoglobin Critical values: Less than 5 g/DL or more than 20 g/DL Measures the total amount of hemoglobin in the blood. Used as a rapid direct measurement of RBC count. Used to evaluate anemic patients. Living at high altitudes causes increased HGB. Hemoglobin serves as a vehicle for oxygen and carbon dioxide transport. The oxygen carrying capacity of the blood is determined by the HGB concentration. Other Key Components WBC-differential: Determines the percent of different types of WBCs Neutrophils (54-75%) of WBCs Lymphocytes (25-40%) of WBC Reticulocyte Count: Response to erythropoiesis

NA-values Potassium-values Creatinine what does it measure? Autonomic Tinnitus Mast Cell Histamine Prostaglandin Leukotriene