402 Exam #2 Flashcards
Contraindications for bethanechol? (there are 7)
asthma, epilepsy, parkinsonism, hyperthyroidism, peptic ulcer disease, bradycardia, physical obstruction of urinary tract (i.e. BPH)
When should bethanechol be used with caution?
If patient has suspected urinary obstruction or COPD
What drugs interact with bethanechol?
- cholinesterase inhibitors because they increase cholinergic effects
- procainamide, quinidine, atropine, and epinephrine because they decrease cholinergic effects
what is specific antidote to bethanechol overdose?
atropine sulfate
what should be monitored when patient is taking parasympathomimetics?
- liver enzymes
- I&O
- blurred vision
- orthostatic hypotension
What is a cholinergic crisis?
Too many secretions! Too much urine, salivation, lacrimation, diarrhea, sweating, and pupil constriction
Drug used to stop a cholinergic crisis?
anti-cholinergics: ATROPINE
- stops rest and digest; turns on fight or flight
What drug treats anti-cholinergic toxicity?
physostigmine
How does donepezil work for Alzheimer’s?
Increases the amount of ACh in cholinergic synapses in the brain, which improves memory and cognitive function.
The AChE inhibitors do not, however, cure or slow the progress of Alzheimer’s disease
What are nursing considerations for anticholinergics?
Monitor muscle strength/weakness
ptosis, diplopia, chewing monitoring
schedule around mealtimes
Drugs that interact with atropine?
antihistamines. TCAs, quinidine, procainamide (increase effects)
aloe, saw palmetto, buckthorn
What happens with overdose of atropine?
CNS stimulation OR depression. Convulsions, coma
What are 2 treatments for atropine overdose?
barbiturate or diazepam to control convulsions; physostigmine to quickly reverse coma
In the sympathetic nervous system, which neurotransmitter is released from postganglionic nerve terminals?
Norepinephrine
Seizures are a symptom of an underlying disorder, not a disease itself, T or F?
True
What 2 types of seizures include an aura?
Tonic-clonic and complex partial
Seizure type with sensory hallucinations
Simple partial
Seizure type most common in children, staring into space and does not respond to verbal commands (only lasts a few seconds)
Absence
What neuron is most affected by AEDs?
GABA
How do AEDs suppress seizures?
By increasing GABA activity, which decreases neuronal firing
What 5 ways do AEDs work to suppress seizures (think of electrolytes and neurotransmitters)?
- An increase in the activity of GABA in the brain (increasing influx of chloride ions)
- Inhibition of the influx of sodium into neurons
- Inhibition of the influx of calcium into neurons
- Correcting neurotransmitter imbalance
- Blocking of glutamate receptors in the brain.
_________ = inhibitory neurotransmitter; _________ = excitatory neurotransmitter
GABA; Glutamate
What drugs potentiate (increase) GABA to reduce seizures?
phenobarbital (barbiturate), clonazepam, diazepam, lorazepam (benzos); gabapentin, topiramate
Steven-Johnson syndrome (SJS) is an adverse effect of which AED drug class?
Barbiturates
AED that is schedule IV drug, pregnancy category D, and should not be used for pain relief because it can increase pain?
Phenobarbital
Myoclonic and absence seizures are indicated to be treated with what drug class?
Benzodiazepines
