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Pharmacology: Davis Drug Guide Pharmacologic Drug Classifications 2023/2024 Complete Solution 100%
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Pharmacology: Davis Drug Guide Pharmacologic Drug Classifications 2023/2024 Complete Solution 100% Anti-Alzheimer's Agents Use: Management of Alzheimer's dementia Mode of Action: All agents act by increasing the amount of acetylcholine in the CNS by inhibiting cholinesterase. No agents to da...

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  • May 4, 2023
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  • 2022/2023
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  • pharmacology davis drug guide pharmacologic drug classifications 20232024 complete solution 100 anti alzheimers agents use management of alzheimers dementia mode of action all agents ac

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Pharmacology: Davis Drug Guide Pharmacologic
Drug Classifications 2023/2024 Complete
Solution 100%
Anti-Alzheimer's Agents
Use: Management of Alzheimer's dementia

Mode of Action: All agents act by increasing the amount of acetylcholine in the CNS by
inhibiting cholinesterase. No agents to date can slow the progression of Alzheimer's
dementia. Current agents may temporarily improve cognitive function and therefore
improve quality of life.

Side Effects: Cholinergic effects, watch for n/v, diarrhea, weight loss, GI bleed.

Contraindications: hypersensitivity

>> Use cautiously in patients with a history of "sick sinus syndrome" or other
supraventricular cardiac conduction abnormalities (may cause bradycardia). Cholinergic
effects may result in adverse GI effects (nausea, vomiting, diarrhea, weight loss) and
may also increase gastric acid secretion resulting in GI bleeding, especially during
concurrent NSAID therapy. Other cholinergic effects may include urinary tract
obstruction, seizures, or bronchospasm.<<

Interactions: additive effects with other cholinergics, exaggerate effects of
succinylcholine-type muscle relaxation during anesthesia, decrease effects of
anticholinergics

Potential Nursing Diagnoses:
> Disturbed thought process
> Imbalanced nutrition: less than body requirements
> Deficient knowledge, related to disease process and medication regimen

Assess: Assess cognitive function while on medication, monitor n/v anorexia, and
weight loss.
Anti-anemics
Use: Prevention and treatment of anemias

Mode of Action: iron is required for the production of hemoglobin, which transports
oxygen to cells

Contraindications: Hypersensitivity. Undiagnosed anemias. Hemochromatosis,
hemosiderosis, hemolytic anemia (Iron). Uncontrolled hypertension (darbepoetin,
epoetin, and peginesatide).

,>> Use parenteral iron (ferric carboxymaltose, ferric pyrophosphate citrate, ferumoxytol,
iron dextran, iron sucrose, sodium ferric gluconate complex) cautiously in patients with a
history of allergy or hypersensitivity reactions.<<

Interactions: Oral iron can decrease the absorption of tetracyclines, fluoroquinolones,
or penicillamine. Vitamin E may impair the therapeutic response to iron. Phenytoin and
other anticonvulsants may decrease the absorption of folic acid. Darbepoetin and
epoetin may increase the requirement for heparin during hemodialysis.

Potential Nursing Diagnoses:
> Activity intolerance
> Imbalanced nutrition: less than body requirements
> Deficient knowledge, related to disease process and medication regimen

Assess: Assess patient's nutritional status and dietary history to determine possible
causes for anemia and need for patient teaching.
Anti-Anginals
Indications: Nitrates are used to treat and prevent attacks of angina. Only nitrates
(sublingual, lingual spray, or intravenous) may be used in the acute treatment of attacks
of angina pectoris. Calcium channel blockers, beta blockers, and ranolazine are used
prophylactically in long-term management of angina

Mode of Action:
> Nitrates dilate coronary arteries and cause systemic vasodilation (decrease preload).
> Calcium channel blockers dilate coronary arteries (some also slow heart rate).
> Beta blockers decrease myocardial oxygen consumption via a decrease in heart rate.
> Ranolazine decrease myocardial oxygen consumption.
> Therapy may be combined if selection is designed to minimize side effects or adverse
reactions.

Contraindications: Hypersensitivity. Avoid use of beta blockers or calcium channel
blockers in advanced heart block, cardiogenic shock, or untreated HF.

>> Beta blockers should be used cautiously in patients with diabetes mellitus,
pulmonary disease, or hypothyroidism. <<

Interactions: Nitrates, calcium channel blockers, and beta blockers may cause
hypotension with other antihypertensives or acute ingestion of alcohol. Verapamil,
diltiazem, and beta blockers may have additive myocardial depressant effects when
used with other agents that affect cardiac function. Verapamil and ranolazine have a
number of other significant drug-drug interactions.

Potential Nursing Diagnoses:
> Acute pain
> Ineffective tissue perfusion
> Deficient knowledge, related to disease process and medication regimen

,Assess: Assess location, duration, intensity, and precipitating factors of patient's
anginal pain. Monitor BP and pulse periodically throughout therapy.
Anti-Anxiety Agents
Indications: Antianxiety agents are used in the management of various forms of
anxiety, including generalized anxiety disorder (GAD). Some agents are more suitable
for intermittent or short-term use (benzodiazepines) while others are more useful long-
term (buspirone, doxepin, fluoxetine, paroxetine, sertraline, venlafaxine).

Mode of Action: generalized CNS depression.

Contraindications: Hypersensitivity. Should not be used in comatose patients or in
those with pre-existing CNS depression. Should not be used in patients with
uncontrolled severe pain. Avoid use during pregnancy or lactation.

>> Use cautiously in patients with hepatic dysfunction, severe renal impairment, or
severe underlying pulmonary disease (benzodiazepines only). Use with caution in
patients who may be suicidal or who may have had previous drug addictions. Patients
may be more sensitive to CNS depressant effects; dosage ↓ may be required.<<

Interactions: Mainly for benzodiazepines; additive CNS depression with alcohol,
antihistamines, some antidepressants, opioid analgesics, or phenothiazines may occur.
Most agents should not be used with MAO inhibitors.

Potential Nursing Diagnoses:
> Risk for injury
> Deficient knowledge, related to disease process and medication regimen

Assess: Monitor BP, pulse, and respiratory status frequently throughout IV
administration. Prolonged high-dose therapy may lead to psychological or physical
dependence. Restrict the amount of drug available to patient, especially if patient is
depressed, suicidal, or has a history of addiction.
Anxiety: Assess degree of anxiety and level of sedation (ataxia, dizziness, slurred
speech) before and periodically throughout therapy.
Anti-Arrhythmics
Indications: Suppression of cardiac arrhythmias.

Mode of Action: Correct cardiac arrhythmias by a variety of mechanisms, depending
on the group used. The therapeutic goal is decrease symptomatology and increase
hemodynamic performance. Choice of agent depends on etiology of arrhythmia and
individual patient characteristics. Treatable causes of arrhythmias should be corrected
before therapy is initiated (e.g., electrolyte disturbances, other drugs). Antiarrhythmics
are generally classified by their effects on cardiac conduction tissue (see the following
table). Adenosine, atropine, and digoxin are also used as antiarrhythmics.

Mechanisms by Class:

, - Class 1A (quinidine, procainamide, disopyramide): sodium channel blockers, increase
action potential duration and effective refractory period, decrease membrane
responsiveness
- Class 1B (lidocaine, phenytoin, mexiletine): sodium channel blockers, decrease action
potential duration and effective refractory period
- Class 1C (flecainide, propafenone): Profound slowing of conduction by blocking
sodium channels, markedly depress phase 0; propafenone also has beta-blocking
properties
- Class 2 (esmolol, propranolol, metoprolol): Beta-blockers; decrease AV nodal
conduction, decrease automaticity
- Class 3 (amiodarone, dofetilide, dronedarone, ibutilide, sotalol): potassium channel
blockers; amiodarone and dronedarone also have sodium channel, beta-receptor, and
calcium-channel blocking properties; sotalol also has beta-blocking properties
- Class 4 (diltiazem, verapamil): Non-dihydropyridine calcium channel blockers;
decrease AV nodal conduction

Contraindications: Differ greatly among various agents. See individual drugs.

>> Differ greatly among agents used. Appropriate dosage adjustments should be made
in elderly patients and those with renal or hepatic impairment, depending on agent
chosen. Correctable causes (electrolyte abnormalities, drug toxicity) should be
evaluated. See individual drugs.<<

Interactions: Differ greatly among various agents. See individual drugs.

Potential Nursing Diagnoses:
> Decreased cardiac output
> Deficient knowledge, related to disease process and medication regimen

Assess: Monitor ECG, pulse, and BP continuously throughout IV administration and
periodically throughout oral administration. Take apical pulse before administration of
oral doses. Withhold dose and notify physician or other health care professional if heart
rate is <50 bpm.
Anti-Asthmatics
Indications: Management of acute and chronic episodes of reversible
bronchoconstriction. Goal of therapy is to treat acute attacks (short-term control) and to
decrease incidence and intensity of future attacks (long-term control). The choice of
modalities depends on the continued requirement for short term control agents.

Mode of Action: Adrenergic bronchodilators and phosphodiesterase inhibitors both
work by increasing intracellular levels of cyclic-3', 5'-adenosine monophosphate
(cAMP); adrenergics by increasing production and phosphodiesterase inhibitors by
decreasing breakdown. Increase levels of cAMP produce bronchodilation.
Corticosteroids act by decreasing airway inflammation. Anticholinergics (ipratropium)
produce bronchodilation by decreasing intracellular levels of cyclic guanosine
monophosphate (cGMP). Leukotriene receptor antagonists and mast cell stabilizers

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