Chapter 12 & 13 Prototype Drugs
Cholinergic Drugs
bethanechol (Urocholine)
Contraindications
hypersensitivity
mechanical obstruction of the GI or GU tract
Caution ->
history of asthma
ulcer disease
cardiovascular disease
epilepsy
hyperthyroidism
sensitivity to cholinergic agents or effects
Drug-Drug Interactions
Quinidine
Procainamide
cholinesterase inhibitors
ganglionic blocking agents
depolarizing neuromuscular blocking agents
anticholinergics
Adverse Effects
Heart block
syncope
cardiac arrest
bradycardia
hypotension
Mechanism of Action
Stimulate cholinergic receptors
contraction of the bladder
decreased bladder capacity
increased frequency of ureteral peristaltic waves
increased tone and peristalsis in the GI tract
increased pressure in the lower esophageal sphincter
increased gastric secretions
Treatment of Overdose
Atropine sulfate
Side Effects
Headache, malaise
lactimation, miosis
bronchospasm
abdominal discomfort, diarrhea, nausea, salivation, vomiting
urgency
flushing, sweating, hypothermia
Uses
Stimulate bladder emptying
Cholinergic Blocking Drugs
atropine (Atro-Pen)
Drug-Drug Interactions
anything that accentuates the PNSlytic response, ie. procainamide, TCA
Mechanism of Action
antimuscarinic
increase HR
bronchodilates
decreases gastric motility
mydriasis
Uses
antidote for anticholinesterase poisoning
Adverse Effects
dry mouth
constipation
urinary retention
increase HR
CNS excitement leading to delirium
Administration Alerts
monitor BP
monitor pulse
monitor respirations 1 hour before and after
Treatment of Overdose
physostigmine (Antilirium)
Contraindications
glaucoma patients
obstruction patients
BPH
MG
Selective Adrenergic Agonist Drugs
phenylephrine (Neo-synephrine)
Drug-Drug Interactions
MaOi use can result in hypertensive crisis
Administration Alerts
tissue injury (extravasation)
damage to soft contact lenses
Uses
intranasal use/decongestant
dilates pupils
reverse hypotenstion
Contraindications
narrow angle glaucoma patients
heart disease patients
Adverse Effects
hypertension
increased HR leading to severe reflex bradycardia
rebound congestion
narrow angle glaucoma due to secondary mydriatic effect
burning of nasal mucosa
Mechanism of Action
constricts small blood vessels
effects related to fight or flight response
dilates pupils
BLACK BOX WARNING
Death if used IV
Adrenergic Blocking Drugs
prazosin (Minipres)
Mechanism of Action
competes with NE at alpha receptor to block binding
Adverse Effects
orthostatic hypotension
reflex tachycardia
nasal congestion
Uses
decreases BP, no effect on HR
Administration Alerts
short half life, must be given 2-3x/day
start with a low dose to avoid hypotension
Treatment of Overdose
fluid expanders (saline)
vasopressors (dopamine, dobutamine)
Contraindications
caution in elderly patients
caution in those with known allergies to drug
Drug-Drug Interactions
additional anti-hypertensives
diuretics