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MOA

alpha 1 stimulated (sympathetic)

vasoconstrictors

decrease swelling of mucous membranes

Uses- sinus infections
Drugs

oxymetazoline(Afrin ®)

pheniramine(Dristan ®)

phenylephrine (Neo-Synephrine®)

pseudophedrine (Sudafed®)

Side Effects
increase blood pressure and heart rate.. careful use if you are hypertensive

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MOA

prevent cough center in brain from being stimulated

Drugs Narcotics

hydrocodone (Hycodan ®) these both cause drowsiness

codeine/guaifenasin (Robitussin AC®)

Non-Narcotics

dextromethorphan/guaifenasin (Robitussin DM®)

benzonatate (Tessalon Pearles ®)

Side Effects

drowsiness and can slow down respiration

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MOA

increase respiratory secretions/liquify mucous

Drugs
guaifenasin (Robitussin ®, Mucinex®, Organidin®)
Best to drink plenty of water to drain mucous

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MOA

Inhibit Inflammatory Response

Used for asthma and rhinitis

Drugs

budesonide (Rhinocort ® or Pulmacort®)

mometasone (Nasonex ® or Asamnex®)

fluticasone (Flonase® or Flovent ®)

triamcinolone (Nasacort ® Azmacort®)

Side effecrts
Rinse after use or flush will occur

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MOA

inhibits leukotrines and formation of prostogladnins

Drug

montelukast (Singuliar ®)  -prevents asthma attacks, used for URI, and bronchitis

Side Effects

Headache and nausea

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Refer to first slide
Also used for asthama
Included is a combo
Drug is ipratropium bromide and albuterol(Combivent ®)
Side Effect - dries mucous membrane may want a saline spray

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MOA

increase cyclic AMP (sympathetic)

Drugs

theophylline (Theo-Dur®)

aminophylline (Paladron ®)

Uses

asthma, mucous clearing

Side Effects
GI disturbance, N/V, urination, vasodialation

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MOA

b2 agonist for asthma, copd, bronchitis

Drugs
refer to beta 2 agonist slide

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GEN 1 Sedating
MOA

block histamine from h-1 receptors

Drugs

brompheniramine ( Dimetapp ®)

cholrpheniramine (Chlor-Trimeton ®)

clemastine (Tavist ®)

diphenhydramine (Benadryl ®)

hydroxyzine (Atarax ®)

promethazine (Phenergan ®)

azelastine (Astelin or Astepro ®)

GEN 2 Non-Sedating

loratadine (Claratin ®)

fexofenadine ( Alllegra®)

cetrizine  (Zyrtec®)

Can be used for -

bites, sleep, hives, dermatitis, cold, itching, N/V, motion sickness

Side Effects

drowsiness, xerostomia

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MOA

Inhibits mast cell release of histamine

Drug

cromolyn sodium (Intal ®,  Nasalcrom ®) either oral or nasal

Uses

For chronic rhinitis prohylaxis

Side Effects

nasal itching, burning, nausea, drowsiness, and headache

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Histamine Receptors
H1 (Allergies) Found

blood vessels bronchial smooth muscle

intestinal smooth muscle

Cns

H2 (GI)  found

stomach

heart

uterine tissue

blood vessels

Mast cells release histamine

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Made up of smooth muscle
Parasympathetic- muscarining receptors, B2 cells... no NE activity
Treat with steroids, bronchodialators, antihistamines, and antiallergies

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MOA

Decreases number of impulses from the spinal cord to be able to produce a contraction

Drugs

cyclobenzaprine (Flexeril ®)

carisiprodol (Soma ®)

methocarbamol (Robaxin ®)

orphenadine citrate (Norflex ®)

chlorzoxazone (Parafon Forte DSC®)

metaxalone (Skelaxin ®)

Uses

muscle spasms, injury, and tension

Side Effects

blurred vision, fatigue,  decreased mental alertness, hypotension, and avoid alcohol

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(Depolarizing MOA

binds to nicotinic 2 receptor site and alters it to not bind with ACH

Drugs
succinylcholine- used for intuabtion in anesthesia and has no antiodote
Side Effects include fasciculation's, jaw rigidity, and hypotension
Non-Depolarizing MOA

no depolarization occurs

n2 is binded with drug and ach cant bind, no contractions

Drug

rocuronium bromide (Zemuron ®) -intubation

SIde Effects- jaw rigidity, hypotension, respiratory depression

Direct Acting
MOA

inhibits skeletal muscle contraction

blocks calcium channels

Drug

dantrolene (Dantrium ®)- used for cerebral palsy, multiple sclerosis, and spinal cord injuries

Side Effects
Hard on the liver = do not use if you have liver disease, also vomiting and fatigue

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Voluntary System
Involves Nm receptors at the NMJ on skeletal muscle
ACH is main NT Involved

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MOA

binds to cholinergic receptors and block them

Drugs/Uses

atropine- antidote for cholinergic poisoning

dicyclomine  (Bentyl ®) -cramps, ibs, gi secretions

ipratropium bromide (Atrovent ®)- bronchodialator

Side Effects

dry mouth,  urinary retention, constipation, tachycardia

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MOA

inhibits ach destroying enzyme to increase the amount of ACH in the synapse

Drug

neostigimine (Prostigmin ®)

Use

commonly used for reversal of paralysis from anesthesia and treating and autoimmune disorder called Myasthenia Gravis which attacks nictonic receptors of Nm

***side effects of Cholinergics
SLUDGE
salivation, sweating, lacrimation, increased urination, Diarrhea , emesis, GI upset

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MOA

stimulate muscarinic receptors

Mimics ACH

Drugs and Specific Use

acetylcholine - used for pupil constriction in prep for eye procedures

pilocarpine (Pilocar ®)- decreases fluid in eye for glaucoma

bethanecol (Urecholine ®) - urinary retention and prevents constipation

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Parasympathomimetic- mimics or agonist
Parasympatholytics-anti-cholinergics

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MOA

stimulates Beta 2 Receptors

Relaxes smooth muscle causing the airways to open

And relaxes the uterus

Uses

Asthma, respiratory illnesses, and even preterm labor

Drugs

albuterol (Ventolin ®)

terbutaline (Brethine ®)

formoterol (Foradil ®)

Side Effects

Tachycardia, Headaches, Tremors

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Selective MOA   "olol"

Bocks B1

Decreases Cardiac output, HR, BP, Force of Contraction

Drugs

atenolol (Tenormin ®)

metoprolol (Lopressor ®)

Uses

Treats Hypertension, angina, migraines, tachycardia, and glaucoma

Side Effects

drowsiness, depression, bradycardia, GI Upset, and CNS Depression

Non-Selective Beta Blockers MOA

blocks both b1 and b2

decreases force of contraction, hr, and bp

can cause bronchoconstriction not severe

Uses

For arrhythmia's, tachycardia, angina, glaucoma, and heart failure

Drugs

nadolol (Cogard ®)

propanolol (Inderol ®)

timolol (Blocarden ®)- used for glaucoma reduces rate of aqueous humor

Side Effects

not good to use if asthmatic

drowsiness, bradycardia, weight gain

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MOA

Low Dose- stimulates dopaminergic receptors in the kidneys to increase renal blood flow

Moderate Dose- stimulates B1 receptors on heart to increase force of contraction= increased Cardiac output

High Dose- Includes stimulation of A1 receptors to increase blood pressure and flow throughout the body

Drugs

dobutamine

Side Effects

Could lead to over stimulation of Heart

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• Sympathetic

Adrenergic

or know as "Fight or Flight"

Body Wide Affect

Long post ganglionic as ganglia is far from target organ

Parasympathetic

Cholinergic

or known as "Rest and Digest"

Long Pre-Ganglionic Neuron/ Short Post

Stimulates one specific body part

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What do they do?

Keep impulses traveling, Chemicals that stimulate and organ or gland by binding to receptors to create a change

Sympathetic (Adrenergic)- all Released to nerve endings from postganglionic neuron
NT's

1. Epinephrine (EPI)- released from the adrenal medulla ( part of Hypothalamus)

2. Norepinephrine (NE)- released from the adrenal medulla

3. Dopamine ( a precursor in the sympathetic system to NE)

Parasympathetic (Cholinergic)

NT's

1. Acetylcholine (ACH)- released at pre and post ganglionic nerve endings

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Alpha 1

Found on glands, smooth muscles, eyes, most arteries and veins

Stimulated by NE and EPI

Can Cause smooth muscle contraction & vasoconstriction

Alpha 2

Negative feedback system that regulates sympathetic activity that decreases the amount of NE released on the nerve ending

Beta 1

Found on the heart

When stimulated can lead to and increase of- Heart Rate, Force of Contraction, and Conduction

Beta 2

Found on smooth muscle, Lungs, Skeletal Muscles, Arteries, and Coronary Arteries

Can cause smooth muscle relaxation, Bronchodialation, Vasodilatation, and uterine Relaxation

Only Stimulated by EPI not NE

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Receptors- (Cholinergic) ACH Stimulates ALL

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Receptors- (Cholinergic) ACH Stimulates ALL

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Muscarinic

Found on the Heart, Smooth Muscle, and Glands and at the post ganglionic Neuron

Stimulated by ACH

Can Cause Decreased heart rate, Bronchoconstriction, Pupillary Constriciton, Increased GI secretion, Increased Urination, and Increase in Digestion

Nicotinic 1

Found at ganglia for both PARA & Sympathetic Nerves

Stimulated by ACH

Nicotinic 2 or Nm

Found on the neuromuscular junction of the skeletal muscle

Includes Voluntary Control When Activated

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Sympathomimetics- Mimic action of the sympathetic system (Agonist)
Sympatholytics- act against, known as adrenergic blocking

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MOA

Blocks Alpha 1 Receptors from stimulation of NE or EPI

Relaxes Smooth Muscle

Increased Vasodialation

Increased Uterine Flow

Uses

Hypertension, Benign Prostatic Hyperplasia

Drugs

1. prazosin (Minipress ®)

2. terazosin (Hytrin ®)

3. doxazosin (Cardura ®)

Side Effects

Be careful with quick motion/position changes possibility of fainting

increased Urinatiom

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MOA

Stimulates all Alpha 1 receptors

Causing contraction of smooth muscle, blood vessels

Vasoconstriction of nasal passage acting decongestant

Drugs

ephedrine

phenylephrine (Neo-Synephrine ®)

Clinical Uses

1. To increase Blood pressure

2. Decongestant

Side Effects

Slow digestion

Nasal Dryness.. Not good to use phenylephrine if you have HBP

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MOA

Stimulates all alpha and beta receptors

Cardiac Stimulant

Bronchodialator

Drug

epinephrine (Adrenaline®)

Uses

Severe Allergic Reactions, Shock, arrhythmia's, and anaphylaxis

Side Effect

Systemic blood pressure increased