Exam 1 Flashcards
1
Q
What are the neurotransmitters for the SNS?
A
Epinephrine and norepinephrine
2
Q
What are the groups of drugs that affect the SNS?
A
Adrenergic agonists, adrenergic antagonists
3
Q
What is another name for adrenergic agonists?
A
Sympathomimetics
4
Q
What is another name for adrenergic antagonists?
A
Adrenergic blockers or sympatholytics
5
Q
What is another name for the SNS?
A
Adrenergic system
6
Q
Adrenergic receptor organ cells are of ______ types
A
Four
7
Q
What are the names of the receptors for the adrenergic system?
A
Alpha1, Alpha 2, Beta 1, Beta 2
8
Q
What drugs stimulate the SNS?
A
Adrenergic agonists, adrenergic, or sympathomimetics (all the same thing)
9
Q
Where are the alpha-adrenergic receptor cells located?
A
Blood vessels, eyes, bladder, and prostate
10
Q
What happens when the Adrenergic Alpha 1 receptors are stimulated?
A
Arterioles and Venuoles constrict—> increase BP, mydriasis, bladder relax, prostate contracts
11
Q
Where are the Adrenergic Alpha 2 receptors located?
A
In the postganglionic sympathetic nerve endings
12
Q
What happens when the Adrenergic Alpha 2 receptors are stimulated?
A
Inhibit release of norepinephrine=vasodilation—>decrease in BP, decrease GI tone and motility
13
Q
Where are the Adrenergic Beta 1 receptors located?
A
Primarily in the heart, but also in kidneys
14
Q
What happens when the Adrenergic Beta 1 receptors are stimulated?
A
Increases myocardial contractility and angiotensin production= inc BP and HR
15
Q
Where are the Adrenergic Beta 2 receptors located?
A
Mostly in smooth muscles of Lungs, GI tract, liver, and uterine muscle
16
Q
What happens when the Adrenergic Beta 2 receptors are stimulated?
A
Bronchodilation, decrease in GI tone and motility, Glycogenolysis in liver=increase in blood glucose,decrease in uterine contraction
17
Q
What is the function of Adrenergics?
A
Stimulate the SNS and act on adrenergic receptor sites (i.e. shock)
18
Q
What kind of response do catecholamines produce?
A
Sympathomimetic response Through direct-acting
19
Q
What are the two types of catecholamines?
A
Endogenous (made in the body)
Synthetic
20
Q
Noncatecholamines simulate _______
A
Adrenergic receptors for a longer reaction; can be direct, indirect, or mixed-acting
21
Q
What kind of receptors are dopaminergic?
A
Adrenergic receptors
22
Q
Where are dopaminergic receptors located and what do they do?
A
Renal, mesenteric, coronary, and cerebral arteries; vasodilation and increased blood flow- only dopamine can activate these receptors
23
Q
What are the three categories of sympathomimetic drugs?
A
Direct-acting, indirect-acting, and mixed-acting
24
Q
What do Direct-acting sympathomimetics do?
A
Directly stimulate Adrenergic receptor (i.e. epinephrine and norepinephrine)
25
What do indirect-acting sympathomimetics do?
Stimulate release of norepinephrine from terminal nerve endings (i.e. amphetamine)
26
What do mixed-acting sympathomimetics do?
Both direct- and indirect-acting; stimulate adrenergic receptor sites and stimulate release of norepinephrine from terminal nerve endings. (I.e. Pseudoephedrine)
27
What is a catecholamine?
Chemical structures of a substance that produce sympathomimetic responses. Two types- endogenous and synthetic
28
What are some examples of endogenous catecholamines?
Epinephrine, norepinephrine, and dopamine
29
What are some examples of synthetic catecholamines?
Isoproterenol and dobutamine
30
What is a noncatecholamine?
Stimulate adrenergic receptors and (most of the time) have a longer duration of action
31
What are some examples of noncatecholamines?
Phenylephnrine, metaproterenol, and albuterol
32
T/F: adrenergic agonists can not stimulate more than one adrenergic receptor sites
False
33
What is an example of an Adrenergic agonist that stimulates more than one receptor?
Epinephrine (Alpha1, Beta1, and Beta2)
34
Is Epinephrine selective or non selective?
Nonselective
35
What receptors does epinephrine act on?
Alpha 1, Beta 1, and Beta 2
36
What effects does epinephrine have when it binds to the receptors?
Increase BP, pupil dilation, tachycardia, and bronchodilation
37
What can epinephrine be used for?
Tx: anaphylaxis, bronchospasm, cardiac arrest, status asthmatics
38
What are the routes that epinephrine can be given?
Topical, inhalation, SC, IV, IM, enterocardiac
39
What should the nurse monitor when giving a patient epinephrine?
BP, blood glucose, and HR
40
What is a Beta blocker?
The opposite of an adrenergic agonist- lowers BP and HR
41
What med can cause cardiac dysrhythmias if given with epinephrine?
Digoxin
42
What meds can affect the duration of epinephrine?
TCAs(tricyclic antidepressants) and MAOIs (monoamine oxidase inhibitors) (antidepressants)- prolong and intensify duration
43
What Beta 2 agonist did we talk about in class?
Albuterol
44
What does albuterol do?
Short acting beta agonist that is selective(Beta 2) and bronchodilates
45
What are the most common side effects of albuterol?
Tremors, headache, and nervousness
46
What are some side effects of albuterol?
Tremors, headaches, nervousness/restlessness, N/V, tachycardia, palpations, dizziness, dysrhythmia, urinary retention
47
What are some adverse effects of albuterol?
Reflex tachycardia and cardiac dysrhythmias
48
How do you know if a drug is a beta blocker?
Ends in -olol
49
What is an Adrenergic antagonist?
Sympatholytics or blockers, that block effects of adrenergic neurotransmitter
50
How many types of adrenergic antagonists are there?
Two (alpha and beta)
51
How do sympatholytics block the actions of an Adrenergic agonist?
Directly occupying receptors-block and inhibit epi and norepi release
52
What are some adverse effects of epinephrine?
Palpitations, tachycardia, HTN, Dyspnea, MI, renal insufficiency, injection site reaction, dysrhythmias, pulmonary edema
53
What are some side effects of epinephrine?
N/V, restlessness, tremor, agitation, headache, pallor, oliguria, weakness, dizziness, hypo/hyperglycemia, paresthesia
54
What kind of onset and peak concentration times does epinephrine have?
Rapid
55
What kind of drug is Prazosin?
Adrenergic antagonist(blocker) that vasodilates and treats HTN
56
Side effects of prazosin?
Orthostatic Hypotension, lethargy, dizziness, nausea, headache, peripheral edema
57
Adverse effects of Prazosin?
Palpitations, tachycardia, lethargy ; avoid alcohol—> lowers BP and take with Food
58
Nursing considerations for Prazosin?
Monitor VS and no fenylephrine or pseudophed; take before bed
59
What can be used to treat BPH?
Tamsulosin
60
What are some concerns for Adrenergic agonists?
Tachycardia, HTN, and hyperglycemia
61
What should the nurse teach the patient to do when on an adrenergic blocker like prazosin?
Dangle their legs and move slowly (orthostatic hypotension)
62
What is a contraindication for nonselective beta blockers? Why?
Respiratory disorders- Beta 2 receptors are responsible for bronchodilation and secretions
63
What is the parasympathetic nervous system is called?
Cholinergic system
64
What is the neurotransmitter for the cholinergic system?
Acetylcholine
65
What is another name for a cholinergic agonist?
Muscarinic agonists or parasympathomimetics
66
What is another name for the cholinergic antagonists?
Muscarinic antagonist, parasympatholytics, or anticholinergics
67
What are the two types of the cholinergic receptors?
Nicotinic and Muscarinic
68
How many types of receptors are in the cholinergic system?
Two
69
What neurotransmitter stimulates the receptor cells to produce a response?
Acetylcholine
70
What inactivates acetylcholine before it reaches the receptor cell?
Acetylcholinesterase (enzyme)
71
Parasympathomimetic drugs _______ heart rate
Decreases
72
Parasympatholytic drugs ______ heart rate
Increases
73
Sympathomimetic drugs ____ Heart rate
Increase
74
What does the Muscarinic receptors stimulate?
Smooth muscle and slows heart rate
75
What does a nicotininc receptor stimulate?
Skeletal muscles (neuromuscular)
76
How many types of cholinergic agonists are there and what are they?
Two; direct acting and indirect acting
77
What do direct acting cholinergic agonists do?
Act on receptors to activate a tissue response
78
What do cholinergic indirect acting agonists do?
Inhibit the action of enzyme cholinesterase (ChE) - also called acetylcholinesterase (AChE) by forming a chemical complex that allows acetylcholine to persist and attach to receptor
79
What are the two categories of cholinesterase inhibitors?
Reversible and irreversible
80
What do the reversible cholinesterase inhibitors do?
Bind the ChE for several minutes to hours
81
What to irreversible cholinesterase inhibitors do?
Bind the ChE permanently
82
What is the major response of cholinergic agonists?
Stimulate bladder and GI tone, constrict pupils of eyes (miosis), and increase neuromuscular transmission
83
What are responses of the cholinergic agonists?
Decreased heart rate and BP, increased salivary, GI, bronchial secretions
84
What do cholinergic agonists do?
Increase all secretions, GI motility, constrict bronchi, decreases HR and BP (vasodilation), increase ureter tone and contract bladder, miosis, maintain strength of striated muscle
85
What are the three common cholinergic agonists?
Metoclopramide, pilocarpine, bethanechol chloride
86
What is metoclopramide used for?
Increase gastric emptying; tx for GERD, gastroparesis, N/V
87
What is pilocarpine used for?
To treat glaucoma , promote miosis in eye surgery and examination; relieves intraocular fluid pressure
88
What is bethanechol chloride used for?
Increase urination, Tx for urinary retention and neurogenic bladder
89
Side effects/adverse reactions for cholinergic agonists?
Miosis, bronchoconstriction, increased secretions, SLUDGES
90
Contraindications for cholinergic agonists?
Respiratory conditions (COPD), heart failure, intestinal/urinary tract obstructions
91
What does SLUDGES stand for?
Cholinergic side effects- salivation, lacrimation, urinating, diarrhea, Gastric upset, emesis, sweating
92
What are two selective beta blockers talked about in class and which beta receptor do they blocK?
Metoprolol and atenolol; beta 1 only
93
What is metoprolol?
Adrenergic beta 1 blocker that lowers HR and BP; tx for HTN, A.Fib, heart failure, MI, adverse tachycardia
94
Side effects/adverse effects of metoprolol?
Bradycardia, orthostatic hypotension, decreased CO, AV block, rebound cardinal HTN/tachycardia
95
What are the nursing considerations for selective beta adrenergic blockers?
Monitor HR and BP for decreases, if HR < 50, hold. Do not stop med abruptly —-> taper= if not rebound myocardium excitation, change positions slowly,EKG baseline needed
96
Propranolol
Nonselective beta blocker (beta 1 and 2), avoid using with respiratory patients; monitor BGL - hypoglycemia, interacts with antihypertensives and calcium channel blockers
97
Cholinergic agonist nursing considerations
Monitor HR and BP, I/O, respiratory status (increased secretions), monitor for overdose (increased salivation, sweating, flushing, ABD cramps)
98
What is the antidote for a cholinergic overdose?
Atropine- anticholinergic
99
How do anticholinergics function?
Block responses by occupying acetylcholine receptors
100
Anticholinergic effects
Increase HR, decrease secretions, bronchodilation, smooth muscles relax (GI), mydriosis, drowsiness/sedation on CNS
101
How can you remember the anticholinergic effects?
Can’t see(blurred vision), can’t pee(urinary retention), can’t poop(constipation), can’t spit (dry mouth)
102
What does atropine do?
Increase HR, decrease motility and peristalsis and diarrhea; decrease cholinergic crisis
103
How would you recognize an atropine overdose?
Mad as a hatter, dry as a bone, red as a beet, blind as a bat
104
Side effects/adverse effects for atropine
Tachycardia, mydriosis, dry eyes, constipation, decrease secretions, retention
105
What are contraindications for atropine?
Glaucoma, urinary and bowel obstructions, tachycardia
106
What shoulda patient on atropine avoid?
Heat! Can’t sweat, heat stroke risk
107
What are some nursing interventions and pt teaching for atropine?
Increase fiber, exercise and fluids! Drowsiness and safety, mouth care (candies for dry mouth), sunglasses-photophobia
108
What are the most common uses of atropine?
Decrease salivation and respiratory secretions pre operative and sinus bradycardia TX
109
What is an antihistamine?
Anticholinergic
110
What is scopolamine
An anticholinergic classified as an antihistamine used for motion sickness; typically a skin patch placed behind ear
111
How is transdermal scopolamine delivered?
Over 3 days, applied 4 hours before motion sickness activity
112
Scopolamine side effects?
Can’t see, cant pee, cant spit, cant poop
113
what is pharmacokinetics?
Movement of drug in the body
114
What is pharmacodynamics?
What the drug does to the body
115
When is the peak of a drug measured?
30-60 min after infusion is complete
116
When is the trough of a drug measured?
30 minutes before the next dose (but has to result first)
117
Which administration route has the highest bioavailability?
IV
118
What role do proteins play in medication administration?
They bind to drugs as a carrier to take them to receptors
119
What is displacement?
When two drugs compete for protein binding, but one has a higher affinity for proteins and that drug “kicks off” the other drug
120
What can happen with displacement?
Drug toxicity of the drug that does not bind to the proteins and become “free drugs”
121
Where does metabolism take place?
Liver; it converts it to the inactive form
122
What labs are used to measure kidney function?
BUN (10-20), creatinine (0.5-2), and GFR(90-120). A high BUN and creatinine is bad and a low GFR is bad
123
What is a half-life?
The amount of time it takes for half of a drug to be excreted
124
What organs affect the half life of a drug?
Liver and kidneys (dysfunction of either increases the half life which increases the chances of toxicity)
125
What are enteric coated tablets?
Tablets that are extended release, slow release, and long release- are absorbed in the small intestine not stomach
126
How do pharmacokinetics in pediatrics differ?
They are physically immature which (affects the doses(immature liver until age 2), absorption(skin- absorbed faster), distribution (less protein and higher water percentage), excretion (immature kidneys until 1-2 Years)
127
How should orals meds be given to young children?
Oral syringes to the cheek or droppers
128
Where should children be given injections?
Vastus lateralis
129
What age group should suppository medications be given to?
Infants
130
How should you interact with a toddler for medication adminstration?
Involve them, give short explanations, involve parents, fave drink afterwards, give them choices of drink or bandaid
131
Where should toddlers and preschoolers be given injections?
Ventrogluteal
132
What should schoolage and adolescents be monitored and how should they be administered medications?
Understanding that they have increasing independence and we should monitor for risky behaviors
133
Should doses be lowered or increased for pediatric patients?
Lowered
134
What should be preserved in older adults?
Independence, as long as it is safe to do so
135
What are some physiologic changes in older adults?
Dysphagia, lower BMI and functions
136
What is something a nurse can keep in mind when educating an older adult about their medication?
Adherence decreases- how can you help them to remember and stick to medication schedules?
137
Older adults have ____ protein, so doses should be _____
Lower; lower
138
What should be remembered regarding dosage and older adults?
“Start low and go slow”
139
What is the BEERS criteria?
A list of medications where the risks of harm from the medication outweighs the potential benefits of the medication
140
what types meds should be given to older adults and why?
Generic, because it is cheaper and universally recognized
141
How can we prevent adverse effects of medications in older adults!
Assess, educate, and provide medication administration aids ; monitor renal and liver function ; “How do you take this med?”
142
Pregnancy categories
A no fetal risk in controlled studies
B no risk to human fetus despite possible animal risk or no risks in animal studies but human studies lacking
C human risk cannot be ruled out. Animal studies may or may not show risk
D evidence of risk to human fetus
X contraindicated in pregnancy
143
What pregnancy category means that it is safe to give?
A- no fetal risk in controlled experiments
144
Which pregnancy category means that potential benefits and potential harm must be compared/weighed?
D-evidence of risk to fetus
145
Which pregnancy category means that you cannot give it to a pregnant woman?
X- contraindicated in pregnancy
146
What are the rights of medication administration?
Right client, right med, right dose, right route, right time, right documentation
147
Medication reconciliation
Should be done at arrival, admission, transfer, and discharge; visit/checkup/follow up
148
What Gauge and size needle is used for IM injections?
18-26G 1- 1 1/2 inch
149
What method is used to administer an IM injection?
Z track method
150
What syringe/needle is used for an ID injection?
Tuberculin
151
How do you know if an ID is given successfully?
Formation of a wheal or bleb
152
What is the degree of angle used for an IM injection?
90 degrees
153
What is the degree of angle used for an ID injection?
10-15 degrees
154
What is the Z track method?
Displacing the skin 1 inch before IM injection to avoid leakage of irritating and discoloring meds into subcutaneous tissue and prevent leakage into needle track and avoid discomfort
155
What should be done before a transdermal medication is administered?
Wear gloves, Take old one off and rotate sites where patch is placed. Site must be hairless, clean, and dry. AVOID HEAT
156
Where are sublingual medications administered?
Under the tongue against mucous membrane
157
Where are buccal medications administered?
Between the cheek and the gum
158
Are eyedrops sterile or clean application?
Sterile
159
What can you do to prevent the medication in eyedrops from going systemic?
Lacrimal pressure
160
What is BUN normal range?
10-20
161
What is the normal creatinine range?
0.5-1.2
162
What is the normal GFR?
90-120
163
Is it good or bad if the BUN or creatinine is high?
Bad
164
Is it good or bad if the GFR is high?
Good
165
What is a half-life?
The amount of time it takes for half of the drug to be excreted
166
What steps make up the absorption process?
Disintegration and dissolution
167
What is disintegration?
Breakdown of oral drug into smaller particles
168
What is dissolution?
Combining small drug particles with liquid to make a solution
169
What two steps must occur for absorption to take place? Is there an exception and why?
Disintegration and dissolution; if meds are already in liquid form it skips some steps before absorption
170
What is an excipient?
Fillers and inert substances added to enhance the solution
171
What type of GI fluids absorb faster than the other?
Acidic
172
Who has more alkaline gastric fluids?
Very old or young patients
173
What are the drug absorption methods?
Diffusion, facilitated diffusion, active transport, and pinocytosis
174
Which injection is slower than an IM injection in terms of absorption rates?
SC
175
Where do drugs go to be filtered when taken by mouth?
Portal vein->liver
176
If a patient has lower protein levels, how will this affect medication adminstration?
Lower the dose because their receptors are few= toxicity
177
Do water or lipid soluble drugs pass membranes easier?
Lipid
178
Can water soluble drugs pass the blood-brain barrier?
No
179
What is another word for metabolism ?
Biotransformation
180
what is a prodrug?
Metabolized into active form, exception to rule of metabolism
181
Steady state
Amount of drug administered is the same amount that is excreted
182
Loading dose
Large initial dose used to reach steady state quicker
183
What organ dysfunction can affect half-life?
Liver and kidney
184
What happens if a patient has kidney dysfunction?
Med is not excreted, so it recirculates in the body= toxicity
185
What happens if a patient has liver dysfunction?
Drug is not converted to inactive form, stays active= toxicity
186
ADME
Absorption, distribution,metabolism,excretion; process of pharmacokinetics
187
Fluid shift and edema affects what pharmacokinetic phase?
Distribution - hypovolemia makes it difficult for sites to be reached
188
Primary effect of a drug
Desired effect, why we are giving it to them
189
Secondary effect of a drug
Can be desirable or undesirable, can be unexpected
190
Potency
Amount of drug needed to elicit specific physiologic response
191
Maximal efficacy
Increase in dosage no longer increases therapeutic response
192
Therapeutic index
Relationship between ED50(therapeutic dose) and TD50 (toxic dose)
193
Therapeutic range
Concentration range of drug in plasma where the drug is effective without causing toxic effects in most people
194
Onset
Time it takes for drug to reach minimum affective concentration
195
Peak
Highest concentration in the blood
196
Duration
Length of time drug exerts therapeutic effect before decreasing again
197
Trough
Lowest drug concentration in the blood, just before next dose; taken 15-30 min before next dose
198
When do you monitor for the peak after an oral administration?
2-3 hours after
199
When do you monitor a peak for an IM injection?
2-4 hours after injection
200
When do you monitor a peak for an IV infusion?
30-60 min after completion of infusion
201
Nonselective drug effects
Multiple receptors can be affected
202
Nonspecific drug effects
Effect receptors in multiple systems
203
Agonists
Activate receptors and produce desired response
204
Partial agonist
Moderate response when binding to receptors
205
Antagonist
Prevent receptor activation or block response
206
Tolerance
Decreased response over a course of time even after increasing the dosage until max dose is reached
207
Tachyphylaxis
Rapid decrease in response to drug after one or several doses
208
Placebo effect
Drug response not attributed to drug chemical properties
209
What is poly pharmacy?
When 5 more more prescriptions are taken, typically older adults
210
What are the pharmacodynamic drug effects?
Synergistic, additive, antagonist, drug-nutrient, drug-laboratory, and drug induced photosensitivity effects
211
Synergistic effect:
One drug heightens the effect of another
212
Additive effect
Sum of both drugs acting together is greater than one
213
Antagonistic effect
One drug blocks or reduces effect of another drug- desirable or undesirable
214
Drug-nutrient effect
Food can increase or decrease or delay drug response effect
215
Drug-laboratory effect
Drugs affect lab results
216
Drug induced photosensitivity
Skin reaction (drug induced) with severe sunburns when in sunlight
217
