402 Exam 2 Study Guide Flashcards
Which nerves release the parasympathetic neurotransmitter acetylcholine
Cholinergic nerves
Which medication class produces the characteristics symptoms of the rest and digest response
Parasympathomimetic (cholinergic)
What should be monitored prior to administration of bethanechol
BP, HR, and RR
What side effect does bethanechol have on liver enzymes
May increase them. (ALT, AST)
Which medication stimulates smooth muscle contraction of bladder and GI
Bethanechol
What type of drug is bethanechol
Cholinergic
What kind of drug is Physostigmine, how does it work, what is it used for
It is an acetylcholine esterase inhibitor Antidote for anti cholinergic toxicity. (Like too much Atropine)
Inhibits the destruction of ACh.
5-10 min onset.
What are administration alerts and contraindications for physostigmine
Admin slowly over 5 minutes to avoid seizures and respiratory distress
Contraindicated for aspirin or salicylate allergy, and those with severe asthma.
Side effects for physostigmine
Bradycardia
ASystole
Seizures
Urinary frequency
Hypotension, sweat, lacrimation, fast gut motility. (Cholinergic wet symptoms)
What is atropine used for and do
Anticholinergic medication.
Antidote for anticholinesterase poisoning (ediphonium, neostigmine)
It can be given pre operatively to decrease secretions.
Blocks parasympathetic actions of Ach
Induces fight or flight.
Side effects of atropine
Dry mouth
Constipation
Urinary retention
Tachycardia
What is monitored prior to atropine admin
Monitor BP, HR, and RR
What is Neostigmine(Prostigmin) used for and do
Cholinesterase inhibitor
Indicated for Myasthenias Gravis and
post up urinary retention
It stimulates skeletal muscle contraction
What are catecholamines
Neurotransmitters that bind to the same target tissue as adrenaline thus creating an adrenaline-like response.
Natural examples: Norepinephrine, epinephrine, dopamine
Synthetic examples: isoproterenol and dobutamine
What are examples of non-catecholamine drugs and how are they different from catecholamine drugs
Ephedrine, phenylephrine, and terbutaline
These can be direct, indirect, or dual acting and do not contain catechol where catecholamine drugs are primarily direct acting.
Which adrenergic receptor is located in the heart and kidneys
Beta 1
Which adrenergic receptor is located in all sympathetic target organs except heart and is responsible for constricting blood vessels and dilation of pupils
Alpha1
Which adrenergic receptor is located in all sympathetic target organs except the heart and is responsible for inhibition of smooth muscle?
Beta2
Which adrenergic receptor is located in the presynaptic adrenergic nerve terminals and is responsible for the inhibition of release of norepinephrine
Alpha 2
Which adrenergic receptor is located in the adipose tissue and urinary bladder
Beta3
What are the drug phenylephrine uses and its side effects
Nasal decongestant
Mydriatic eye drop
Antihypotensive IV in critical care for BP support
It is an adrenergic drug.
Side effects:
Anxiety
Tremor
High IV doses can cause reflex bradycardia
What is the drug Prazosin (minipress) used for, its mode of action, administration alerts, and side effects
It is an adrenergic blocking agent- it competes with norepinephrine on smooth muscles, causing rapid decrease in peripheral vascular resistance.
It is an antihypertensive.
Short half life, taken 2-3 times a day
Give low dose first to avoid hypotension
Side effects:
Orthostatic hypotension
Dizziness
Reflex tachycardia
Which adrenergic receptor will be targeted in the treatment of asthma and bronchoconstriction?
Beta 2
Phentolamine (Regitine) is used for what
Used in the diagnosis of pheochromocytoma (tumor of adrenal medulla that increases catecholamine) in a hypertensive patient where it is suspected.
It will cause a sudden reduction in BP that was created by excess catecholamines.
Can be used for hypertensive emergency caused by overuse of phenylephrine.
What type of drug is Clonidine and what are its uses
Adrenergic drug targets alpha 2 in CNS
Indicated for hypertension, ADHD, and pain.
What is propranolol, class, what it’s used for and side effects
It is a beta adrenergic antagonist (non selective) it decreases cardiac workload.
Side effects:
Hypotension
Bradycardia
SOB
Fatigue
Depression
What type of seizure last a few seconds, is seen most often in children “staring into space”, misdiagnosed as ADHD or daydreaming
Absence seizure
What type of seizure involves major muscle groups with large jerking movements, falling from a sitting position, or dropping when held
Myoclonic
What type of seizure is caused by rapid increase in body temp and usually occurs in children 3mo-5 years old
Febrile.
What kind of seizure can be preceded by auras, includes intense muscle contraction followed by relaxation, can involve loss of bowel/bladder control, has periods of apnea and is followed by disorientation
Tonic Clonic (Grand mal)
What is phenobarbital used for, its mode of action, and side effects
Anti seizure med
GABA receptor agonist
It is first line treatment for status epilepticis
Side effects:
Dizziness
Confusion
Drowsiness
Somnolence (sleepy)
What is Diazepam (Valium) used for and the side effect
It is a benzodiazepine
Used for seizure prevention in alcohol withdrawal
Side effects:
Drowsiness
Sedation
Respiratory depression
Tolerance/dependency
Phenytoin (Dilantin, Phenytek) is what kind of drug, used for what, and what administration alerts does it have
It is an anti seizure drug. In the Hydantoin class; it is a sodium influx-suppressing drug.
It is effective in most seizures except absent.
Infuse slowly max rate of 50mg/min (there is a risk for severe hypotension)
It has a narrow therapeutic range of 10-20mcg/mL
Always flush IV with saline (soft tissue irritant)
Toxicity signs effects:
Ataxia, slurred speech, nystagmus- all should be reported to HCP.
Common side effect: gingival hyperplasia,
What is Valproic acid, side effects, and admin alerts.
Valproate; anti seizure drug
It is a GI irritant.
do not take with carbonated beverages as it can trigger immediate release and cause severe throat and mouth irritation
Side effects:
Sedation/drowsiness
Prolonged bleeding time
Hepatotoxicity
Ethosuximide(Zarontin) is what kind of drug, admin alerts, side effects
It is a succinimide, and the preferred drug for absence seizures.
Do not abruptly withdrawal, it may induce tonic clonic seizures.
Side effects:
Psychosis
Mood swings
Dizziness.
What is carbamazepine used for, its side effects and how it works
It is a phenytoin related drug. Anticonvulsant for all seizure except absence.
It affects threshold of neuronal firing.
Side effects:
Dizziness
Headache
Cardiac Arrest!
Agranulocytosis (very low neutrophil count-risk for severe infection)
What kind of pain is caused by direct injury to a nerve
Neuropathic pain
What kind of pain is caused by direct damage to tissue
Nociceptor pain
What do you call pain that is generalized, dull and internal; throbbing or aching
Visceral
What do you call pain that is localized in the body and often described as sharp
Somatic
What kind of drug is fentanyl and its side effects
Opioid agonist with high effectiveness
Side effects:
Drowsiness
Pruritis
Constipation
Severe respiratory depression
Cardiac arrest
Oxycodone (OxyContin) is what kind of drug and has what side effects
Opioid agonist with moderate effectiveness
Side effects:
Constipation
Sedation
Nausea
Respiratory depression
Hepatotoxicity
Morphine is what kind of drug with what side effects
Opioid agonist with severe effectiveness
Side effects:
Constipation
Severe respiratory depression
Nausea
Naloxone is what kind of drug and has what side effects
Opioid antagonist and reverses effects of opioids
Side effects
Anxiety
Sleep disturbances
Withdrawal symptoms
Hepatotoxicity
Nausea /vomiting
What kind of drug is sumatriptan (imitrex)
Its mode of action; side effects and adverse effect warning
Anti migraine medication.
5-HT (serotonin) receptor drug; vasoconstrictor of intracranial arteries.
Side effects:
Dizziness
Drowsiness
Vasoconstriction
-admin alert- may produce cardiac ischemia and hypertension (caused by. Vasoconstriction)
What kind of anesthesia causes a loss of sensation to a part of the body without loss of consciousness (and how does it work)
Local anesthesia
Work by blocking sodium channels
What kind of anesthesia causes a loss of sensation to the entire body with loss of consciousness
General anesthesia
What is the drug lidocaine and its mode of action; serious adverse effects…
Local anesthetic and antidysrhythmic
Blocks sodium channels
Serious adverse effects: cardiac arrest, respiratory depression, convulsions
What does lidocaine toxicity symptoms are…
Irritability and confusion
What kind of drug is Proprofol; how and why is it used and what are the side effects
General anesthesia without analgesic properties.
NMDA receptor agonist
IV admin only - resulting in immediate sedation
Side effects:
Respiratory depression
Apnea
Hypotension
Isoflurane is what kind of drug with what side effects
Inhaled general anesthetic. (Volatile liquid)
GABA and glutamate receptor
Used for rapid onset of induction.
Side effects:
Respiratory depression
Hypotension
Malignant hyperthermia
What is the drug succinylcholine, its use, duration and side effects
Skeletal muscle paralytic, neuromuscular blocker. Blocks acetylcholine at neuromuscular junctions.
Used during intubation
Lasts only a few minutes after discontinuing (it is broken down quickly).
Side effects: paralysis of diaphragm, so mechanical vent is needed when in use.
Malignant hyperthermia
How many mL is 1 cup
240mL
How many mL is one tsp
5mL
How many ounces are in 1 pound
16oz
What does the term neuroleptanalgesia mean
Basically conscious sedation where the client is dissociated but able to follow commands
A patient receives propofol for a surgical procedure and is showing signs of metabolic acidosis. What is the patient most likely developing
Propofol infusion syndrome.
Propofol should be discontinued and another anesthesia agent should be used instead.
What is the method of local anesthetic that is often used before dental procedures and involves direct injection into tissue immediate to the surgical site to block a specific group of nerves in a small area.
Infiltration (field block) anesthesia
What is the method of local anesthesia that involves direct injection I to tissue that may be distant from the operation site and block sensation to a large area of the face it a limb
Nerve block.
A patient who received an amide local anesthetic develops anxiety. For which reason should the nurse suspect the patient is experiencing an allergic reaction?
Sulfites
If a patient is allergic to soybeans or eggs, which general anesthetic would be avoided
Propofol
The nurse assesses blanching in a patient who received a local anesthetic. What should the nurse determine from this finding
Epinephrine was also used. Does not indicate a problem.
Which inhaled anesthetic has a low metabolism and high safety and effectiveness for general anesthesia
Isoflurane (Forane)
What are contraindications for the medication bethanechol
Epilepsy
Parkinsons disease
Hyperthyroid
PuD
Bradycardia
What kind of side effects would you expect from a cholinergic antagonist
Slow peristalsis
Drying effects
Photosensitivity
How long until a patient feels the effects of the drug bethanechol
30-60 minutes. With a 6 hour duration
What drug would be anticipated to treat symptoms of IBS, such as cramping and diarrhea.
Dicyclomine (a gastrointestinal antispasmodic)
What muscarinic antagonist would you anticipate being prescribed for a patient with urge urinary incontinence.
Oxybutynin (limits the smooth muscle spasms in bladder)
