PHARMACOLOGY

OPIOIDS

• PAIN RELIEF.
• MOST OF THE TIME PRESCRIBED FOR PATIENTS POST. OP – NOT USUALLY LONG TERM USE.
• MORPHINE-LIKE SUBSTANCES: FENTANYL, HYDROCODONE, OXYCODONE, HYDROMORPHONE.
• ADDICTIVE, MORE MEDICINE IS REQUIRED TO WORK WITH TIME.
• ADVERSE EFFECTS: DROWSINESS, SLOWNESS, NARCOTIC, ADDICTION, TOLERANCE,
DEPENDENCE, BRADYCARDIA.
• ASK PATIENT TO TAKE MEDS 30 MINUTES BEFORE THERAPY TO DECREASE PAIN.
• PRECAUTIONS: GIVING INSTRUCTIONS (FOR HEP – THEY CAN'T REMEMBER) AND GAIT
TRAINING (DUE TO DROWSINESS) TO PATIENTS ON OPIOIDS.
 NSAIDS/ACETAMINOPHEN

• COX 1 AND COX 2 INHIBITORS: ASPIRIN-LIKE MEDICINE – ASPIRIN (COX 1/BLOOD THINNER),
IBUPROFEN, CELEBREX (COX 2), NAPROSYN, NAPROXEN.
• MILD TO MODERATE PAIN RELIEF, ANTI-INFLAMMATORY, INHIBITS PROSTAGLANDINS - COX2
(PAIN/INFLAMMATION). ACETAMINOPHEN (TYLENOL – ANTI-PYRETIC AND ANALGESIC).
• ADVERSE EFFECTS: GI ISSUES (STOMACH PAIN, PEPTIC ULCERS, HEMORRHAGE – INHIBITS
PROTECTIVE – COX 1 – PROSTAGLANDINS THAT INHIBIT ACID PRODUCTION AND PROMOTE
MUCOUS PRODUCTION), PERIPHERAL EDEMA, EASY BRUISING, BLEEDING, LESSEN THE EFFECTS OF
ANTI-HYPERTENSIVES, HEADACHE, DIZZINESS, LIGHTHEADEDNESS, INSOMNIA, TINNITUS,
CONFUSION AND DEPRESSION.
• ADDICTION HASN'T BEEN REPORTED.
• WORKS AT THE CELLULAR LEVEL OF INJURY (LOCAL) - VS OPIOIDS THAT WORK AT A MORE
CENTRAL LEVEL (CNS).
 CARDIAC MEDICATIONS
• BETA-BLOCKERS (CARVEDILOL, LABETALOL, ATENOLOL, METOPROLOL, PROPRANOLOL)
• BLOCK BETA-ADRENERGIC RECEPTOR IN THE HEART – DECREASES SYMPATHETIC STIMULATION, BP AND SV.
• DECREASE CARDIAC STRESS, MYOCARDIUM OXYGEN DEMAND BY DECREASING HR AND CONTRACTILITY. COMPETE WITH
EPINEPHRINE AND NOREPINEPHRINE FOR BETA ADRENERGIC RECEPTORS IN THE HEART. CONTRAINDICATED IN ASTHMA,
COPD.
• INDICATION: HYPERTENSION, CAD, ANGINA, ARRHYTHMIAS, HEART FAILURE, MIGRAINES, ANXIETY.
• USE RPE FOR EXERCISE INTENSITY INSTEAD OF HR (BETA-BLOCKERS CAUSE BLUNTED HR RESPONSE).

• ACE-INHIBITORS (CAPTOPRIL, ENALAPRIL, LISINOPRIL, RAMIPRIL)

• ANGIOTENSIN: REGULATES BP. RELEASED BY ↓ IN BP. CAUSES VASOCONSTRICTION, ↑ BP, RELEASE ALDOSTERONE FROM THE
ADRENAL CORTEX.
• BLOCK PRODUCTION OF ACE ENZYME THAT CONVERTS ANGIOTENSIN I TO II... DECREASING BP AND AFTERLOAD – BETTER
CO.
• INDICATION: CHF AND HYPERTENSION.
• BLUNTED BP EXERCISE RESPONSE. WATCH OUT FOR ORTHOSTATIC HYPOTENSION (AVOID SUDDEN CHANGES IN POSITIONS).
• ADVERSE EFFECTS: HYPOTENSION, DIZZINESS, DRY COUGH, HYPERKALEMIA, HYPONATREMIA.
 CARDIAC MEDICATIONS
• DIGITALIS (DIGOXIN)
• PRIMARILY USED IN CHF; MANAGEMENT OF ARRHYTHMIAS.
• DECREASE CHF SYMPTOMS, DECREASE PRELOAD AND MYOCARDIAL OXYGEN DEMAND, IMPROVE CO. NO EFFECT IN
BP IN REST OR DURING EXERCISE.
• INCREASE CONTRACTILITY OF CARDIAC TISSUE, DECREASE HR (FEWER BUT BETTER CONTRACTION OF THE HEART) - PR
INTERVAL PROLONGED. MAY PRODUCE SHORTENING OF THE QT INTERVAL AND DEPRESSION IN THE ST SEGMENT
(DURING EXERCISE), FLAT T WAVES.
• ADVERSE EFFECTS: FATIGUE, HEADACHE, WEAKNESS, BRADYCARDIA, SVT OR VT ARRHYTHMIAS, V-FIB.

• SINUS BRADYCARDIA: OCCURS FROM BETA-BLOCKERS, DURING SLEEP, PHYSICALLY FIT PEOPLE, ACUTE MI, CAROTID SINUS
PRESSURE, IN RESPONSE TO INCREASED VAGAL TONE DUE TO PAIN.

• SINUS TACHYCARDIA: OCCURS FROM EXCITEMENT, PAIN, FEVER, HYPOXIA, EXERCISE, STIMULANTS (THINGS THAT
INCREASE SYMPATHETIC ACTIVITY).
 CARDIAC MEDICATIONS
• ANTI-COAGULANTS (HEPARIN, COUMADIN, LOVENOX (ENOXAPARIN)
• INHIBIT PLATELET AGGREGATION AND THROMBUS FORMATION.
• INDICATION: CABG, DVT, PULMONARY EMBOLISM, THROMBOTIC DISORDERS.
• ADVERSE EFFECTS: HEMORRHAGE, INCREASED RISK OF BLEEDING, GI DISTRESS WITH ORAL MEDS,
HEMATURIA, ECCHYMOSIS (SKIN DISCOLORATION AND HEMORRHAGING).
• AVOID INJURIES DUE TO RISK OF EXCESSIVE BLEEDING, PATIENT EDUCATION ON COMMON ADVERSE
EFFECTS.
• NITRATES (NITROSTAT, ISORDIL, AMYL NITRATE SOLUTION FOR INHALATION)
• DECREASE ISCHEMIA THROUGH SMOOTH MUSCLE RELAXATION AND DILATION OF PERIPHERAL VEINS,
INCREASE HR AND DECREASE BP, PRELOAD AND OXYGEN DEMANDS.
• INDICATION: ANGINA PECTORIS.
• ADVERSE EFFECTS: HEADACHES, DIZZINESS, ORTHOSTATIC HYPOTENSION, NAUSEA, VOMITING.
• EDUCATE PATIENT ON STANDING SLOWLY, SUBLINGUAL TABLETS IS THE PREFERRED METHOD TO TREAT
ACUTE ANGINA.
 CARDIAC MEDICATIONS

• DIURETIC AGENTS (LASIX – FUROSEMIDE, THIAZIDE, POTASSIUM SPARING – ALDACTONE)

• INCREASE EXCRETION OF SODIUM AND URINE CAUSING A REDUCTION IN PLASMA VOLUME WHICH DECREASES BP. NO EFFECTS
ON HR AT REST OR DURING EXERCISE.
• INDICATION: HYPERTENSION, EDEMA ASSOCIATED WITH CHF, GLAUCOMA, PE.
• ADVERSE EFFECTS: DEHYDRATION, HYPOTENSION, ELECTROLYTE IMBALANCE.
• THIAZIDE: ORTHOSTATIC HYPOTENSION, DIZZINESS, DROWSINESS, LETHARGY, WEAKNESS, HYPOKALEMIA (INCREASE PVCS),
INCREASE IN LIPID LEVELS, HYPERCALCEMIA – AVOID IN OLDER PATIENTS.
• INCREASED RISK OF FALLS AND DIZZINESS, MONITOR CLOSELY FOR SIGNS/SYMPTOMS OF MUSCLE WEAKNESS, ELECTROLYTE
IMBALANCE. MAY CAUSE PVCS AT REST AND FALSE-POSITIVE EXERCISE TEST RESULTS IF HYPOKALEMIA OCCURS. MAY CAUSE PVCS
DURING EXERCISE IF HYPOMAGNESEMIA OCCURS.

• CALCIUM-CHANNEL BLOCKERS (ISRADIPINE, NICARDIPINE, NIMODIPINE, DILTIAZEM, VERAPAMIL, NIFEDIPINE, AMLODIPINE)

• BLOCK CALCIUM ENTRY INTO CARDIAC MUSCLE TISSUE, CAUSING VASODILATION AND DECREASED VASCULAR RESISTANCE.
• DECREASE HR AND CONTRACTILITY – BETTER BLOOD SUPPLY TO THE HEART, DECREASED BP.
• WATCH OUT FOR ORTHOSTATIC HYPOTENSION, SLOWS METABOLISM (AS ANTI-GOUT DRUGS LIKE ALLOPURINOL).
 CARDIAC MEDICATIONS

• ANTICHOLINERGIC AGENT (ATROPINE)

• IT BLOCKS THE ACTION OF ACETYLCHOLINE AT PARASYMPATHETIC SITE IN SMOOTH MUSCLE, SECRETORY
GLANDS AND THE CNS. BLOCKS VAGAL EFFECTS ON SA AND AV NODES. PRODUCES ↑ IN HR AND
CONTRACTILITY AND IS USED TO TREAT SYMPTOMATIC SINUS BRADYCARDIA AND EXERCISE-INDUCED
BRONCHOSPASM. (ACETYLCHOLINE IN THE HEART IT IS PARASYMPATHETIC AND VAGUS NERVE ACTIVATION
THAT RELEASES IT ONTO SA NODE. THIS WILL ↓ PACEMAKER RACE BY ↑ POTASSIUM AND ↓ CALCIUM AND
SODIUM – HR ↓).
• ADVERSE EFFECTS: PALPITATIONS, HEADACHE, RESTLESSNESS, ATAXIA, DRY MOUTH, BLURRED VISION.
• ANTI-DIURETIC (VASOPRESSIN, ALDOSTERONE)
• RETAINS WATER, CONSTRICTS BLOOD VESSELS, RAISES BP.
• ADVERSE EFFECTS: HYPERTENSION, EDEMA, CHF.
• ANTI-ARRHYTHMIC DRUGS (QUINIDINE)
• REDUCE HR, FACILITATE THE BETA-BLOCKERS.
 PULMONARY PHARMACOLOGY
• ANTI-HISTAMINE (BENADRYL, ALLEGRA, ZYRTEC)
• BLOCK EFFECTS OF HISTAMINE, RESULTING IN DECREASED NASAL CONGESTION, ALLERGIES, ETC.
• INDICATION: SEASONAL ALLERGIES, RHINITIS, MOTION SICKNESS, PD, CONJUNCTIVITIS.
• ADVERSE EFFECTS: ARRHYTHMIAS, POSTURAL HYPOTENSION, HEADACHE, BLURRED VISION, FATIGUE.
• INCREASE GUARDING WHEN PATIENT IS RISING, MONITOR THE PATIENT CLOSELY DURING EXERCISE.

• ANTI-INFLAMMATORY (AEROBID – FLUNISOLIDE, NASALCROM – CROMOGLICIC ACID, QVAR -

BECLOMETASONE DIPROPIONATE)
• PREVENTS INFLAMMATORY MEDIATED BRONCHOCONSTRICTION BY INHIBITING PRODUCTION OF
INFLAMMATORY CELLS, SUPPRESSING RELEASE.
• INDICATION: ASTHMA, BRONCHOSPASM.
• ADVERSE EFFECTS: DAMAGE OF SUPPORTING SYSTEMS, SKIN BREAKDOWN, NASAL IRRITATION, SNEEZING,
COUGH.
• EDUCATE THE PATIENT TO CONTACT THEIR PHYSICIAN IF THEY HAVE SIGNS/SYMPTOMS OF LIVER
DYSFUNCTION, RINSE MOUTH WITH WATER AFTER USING THE INHALER.
 PULMONARY PHARMACOLOGY

• MUCOLYTIC AGENTS (PULMOZYME – DORNASE ALFA, MUCOSIL)

• DECREASE VISCOSITY OF MUCUS BY ALTERING COMPOSITION, CONSISTENCY OF MUCUS, ADMINISTERED
BY NEBULIZER.
• INDICATION: VISCOUS MUCUS SECRETIONS DUE TO PNA, CF, EMPHYSEMA, CHRONIC BRONCHITIS.
• ADVERSE EFFECTS: PHARYNGITIS, ORAL MUCOSA INFLAMMATION, RHINITIS, CHEST PAIN.
• PERFORM AIRWAY CLEARANCE WITHIN ONE HOUR AFTER DRUG ADMINISTRATION.

• LONG-ACTING BETA-2 AGONIST (SEVERENT)

• BRONCHODILATION. ADVERSE EFFECTS: TACHYCARDIA, PALPITATIONS, GI STRESS, NERVOUSNESS,
TREMOR, HEADACHE AND DIZZINESS.

• SHORT-ACTING BETA-2 AGONIST (ALBUTEROL, VENTOLIN – RESCUE DRUGS)

• BRONCHODILATION. ADVERSE EFFECTS: SAME AS LONG-ACTING BETA-2 AGONIST.
 PULMONARY PHARMACOLOGY

• METHYLXANTHINE (THEOPLYLLINE, AMINOPHYLLINE)

• BRONCHODILATION.
• ADVERSE EFFECTS: SEIZURES, CARDIAC ARRHYTHMIAS, GI STRESS, TREMOR, HEADACHE.

• ANTI-CHOLINERGIC (ATROVENT)
• BRONCHODILATION.
• ADVERSE EFFECTS: THROAT IRRITATION, DRYING OF TRACHEAL SECRETIONS, TACHYCARDIA AND
PALPITATIONS.
 CORTICOSTEROIDS
• DECREASE MUCOSAL EDEMA AND INFLAMMATORY RESPONSES.
• ADVERSE EFFECTS: ELEVATED BP IN THE EYES (GLAUCOMA), FLUID/SODIUM RETENTION, SWELLING IN THE LOWER LEGS,
HIGH BP, PSYCHOLOGICAL EFFECTS, WEIGHT GAIN (FAT DEPOSITS IN THE ABDOMEN, FACE AND BACK OF NECK), LOSS
OF POTASSIUM, ADRENOCORTICOSUPPRESSION, MOON FACE, ULCERS IN STOMACH, BUFFALO HUMP.
• LONGE-TERM ADVERSE EFFECTS: CLOUDING OF THE LENS IN ONE OR BOTH EYES (CATARACTS), HIGH BLOOD SUGAR,
INCREASED RISK OF INFECTIONS, OSTEOPOROSIS, SUPPRESSED ADRENAL GLAND HORMONE PRODUCTION, THIN SKIN,
SKIN BREAKDOWN, MUSCLE WASTING, BRUISING AND SLOW WOUND HEALING DUE TO THE INHIBITION OF THE
PRODUCTION OF FIBROBLASTS AND INHIBITION OF INFLAMMATORY PROTEINS (CYTOKINES – MAIN CHEMICAL SIGNAL
FOR ACTIVATING VARIOUS INFLAMMATORY CELLS AS T-LYMPHOCYTES AND FIBROBLASTS), INHIBITS THE PRODUCTION OF
PROSTAGLANDINS, ADRENAL NECROSIS OF HIP JOINT.
• INHALED CORTICOSTEROIDS --> FUNGAL INFECTION OF MOUTH (ORAL THRUSH), HOARSENESS. TOPICAL
CORTICOSTEROIDS --> THIN SKIN, RED SKIN LESIONS, ACNE. INJECTED CORTICOSTEROIDS --> SKIN THINNING AND LOSS
OF COLOR OF THE SKIN AROUND THE AREA OF INJECTION, FACIAL FLUSHING, INSOMNIA, HIGH BLOOD SUGAR – USE
GENTLE MOVEMENTS DURING PT.
• ANABOLIC STEROID USE: RAPID WEIGHT GAIN, ELEVATED BP, ACNE ON FACE/UPPER BACK, MUSCLE HYPERTROPHY,
BRUISING, NEEDLE MARKS, MALE BREAST ENLARGEMENT, FEMALE WITH MALE CHARACTERISTICS AND MENSTRUAL
IRREGULARITIES. JAUNDICE OR MOOD SWINGS MAY DEVELOP.
 OTHER MEDICATIONS
• BACLOFEN
• TREAT HYPERTONIC ISSUES (CP, SCI, UMN LESION).
• DECREASES TONE AND SPASTICITY.
• ORAL OR INTRATHECAL PUMPS.

• DISEASE-MODIFYING ANTIRHEUMATIC DRUGS

• FOR RA --> GOLD SODIUM THIOMALATE, METHOTREXATE - FOLEX (↓ IN PAIN AND SWELLING AND ↑ ROM).

• ERYTHROPOIETIN: ↑ PRODUCTION OF RED CELLS IN HYPOXIA (KIDNEYS SECRETE).

• SUBSTANCES RELEASED IN THE STOMACH:
• PROSTAGLANDINS: INHIBIT GASTRIC ACID, PROTECT LINING OF STOMACH.
• GASTRIN: ↑ SECRETION OF GASTRIC ACID (HYDROCHLORIC ACID), AIDS IN DIGESTION OF PROTEINS.
• ATAXIA: SIDE EFFECT ASSOCIATED WITH ANTIDEPRESSANTS, OPIOID ANALGESICS, AND
ANTICONVULSANTS.
 OTHER MEDICATIONS
• DIAZEPAM: USED TO CALM SEVERE ANXIETY AND AGITATION. IN A GERIATRIC POPULATION, THE LIVER
METABOLIZES DIAZEPAM VERY SLOWLY AND THE KIDNEYS EXCRETE IT SLOWLY – PATIENT MAY EXPERIENCE
POTENTIALLY TOXIC MEDICATION LEVELS. SEDATION IS A SIDE EFFECT. OTHER SIDE EFFECTS: IMPAIRED BALANCE, ↓
NEUROMUSCULAR FUNCTION AND CENTRAL PROCESSING.
• TRICYCLIC ANTIDEPRESSANT (AMITRIPTYLINE): ANTICHOLINERGIC AND SEDATION PROPERTIES – LETHARGY,
SEDATION, ARRHYTHMIAS, HYPOTENSION, BLURRED VISION (↑ FALL RISK - ANTIHYPERTENSIVES,
ANTIARRHYTHMICS, DIURETICS, OPIOIDS – ALSO ↑ FALL RISK). WHEN IN COMBINATION WITH MONOAMINE
OXIDASE (MAO) INHIBITOR MAY CAUSE HYPERTENSION, TACHYCARDIA AND CONVULSIONS.
• PHENOBARBITAL (BARBITURATE): PREVENT SEIZURES – ADVERSE EFFECTS: SEDATION, VITAMIN DEFICIENCIES,
NYSTAGMUS, AND ATAXIA.
• ANTITUBERCULIN: AFTER 2 WEEKS PATIENT IS NON-INFECTIOUS AND NO PRECAUTIONS NEEDED ANYMORE.
• RALOXIFENE: OSTEOPOROSIS TREATMENT.
• LYRICA (PREGABALIN): HELP TREAT DIABETIC NEUROPATHY. ADVERSE EFFECTS: HEART FAILURE, GREAT DIFFICULTY
WALKING LONG DISTANCES, LYMPHEDEMA.
 OTHER MEDICATIONS
• LEVODOPA (SINEMET): CAUSES DYSKINESIA (INVOLUNTARY MOVEMENTS), GI DISTURBANCES
(NAUSEA, VOMITING), MENTAL DISTURBANCES (RESTLESSNESS, GENERAL OVERACTIVITY, ANXIETY,
DEPRESSION). REFER PATIENT BACK TO PHYSICIAN FOR MEDICATION ADJUSTMENTS.
• ANTIRETROVIRAL THERAPIES: ADVERSE EFFECTS: RASH, VOMITING, NAUSEA, DIARRHEA, SLEEP
DISTURBANCES, HEADACHES, DIZZINESS, MUSCLE PAIN, WEAKNESS, FATIGUE ALONG WITH PAIN,
NUMBNESS, TINGLING OF HANDS/FEET. KIDNEY STONES, ↑ CHOLESTEROL AND BLOOD SUGAR.
• IMMUNOSUPPRESSANTS (CYCLOSPORINE): POSSIBLE EFFECTS: MYOPATHY, PERIPHERAL
NEUROPATHY, QUADRIPARESIS (SPASTICITY WITH MORE SPREAD PARESIS), LEUKOPENIA (↓ WBC).
• GI DRUGS:
• PROTON PUMP INHIBITORS: OMEPRAZOLE (PRILOSEC): ↓ ACID.
• H2 BLOCKERS: RANITIDINE (ZANTAC).
• ANTACIDS: TUMS.