Exam 1 Flashcards
90% of nursing time is spent doing what 3 things?
- assessing patients
- supervising unlicensed people
- administering medications
5 core aspects of medication knowledge
- classification
- safe dose range
- correct method of administration
- expected therapeutic effects
- adverse effects
controlled drugs I-V
I: LSD, heroin II: Narcotic analgesics III: sedatives, anabolic steroids IV: sedative - hypnotics V: Partially controlled: Lomotil
pharmacotherapeutics
the desired therapeutic or beneficial use of the drug
“off label” use
pharmacokinetics - 4 components
I. absorption
II. distribution
III. biotransformation
IV. excretion
3 key factors for absorption
- route of administration
- drug solubility and concentration
- site conditions
serum half-life
the time it takes for the serum concentration of a drug to decrease by 50%
- depends on rate of metabolism and excretion
- short half life = more frequent administration
- may take 4-5 doses for equilibrium
- max therapeutic effect occurs with equilibrium
- hepatic and/or renal failure may lengthen the half life
medication effects: therapeutic (6 components)
- palliative
- curative
- supportive
- substitute
- chemotherapeutic
- restorative
drug effects on the fetus (ABCDX)
A: studies done on pregnant women: no risk
B: animal studies: no risk
C: animal studies - potential risk (take only if benefits outweigh the risks)
D: evidence of human fetal risk
X: Risk outweighs any potential benefit
characteristics of autonomic drugs
- either stimulate or block the SNS or PSNS
- effect the entire body
- effect depends on which branch of ANS is stimulated or blocked
- drugs are being designed to stimulate or block very particular receptors
What OTC drug category should be avoided/used cautiously with people that have hypertension anima?
Adrenergic
Drug category that can decrease nasal congestion by way of vasoconstriction?
Adrenergic
Drug that stimulates both Alpha and Beta?
Epinephrine (adrenergic)
Drug that blocks both Beta 1 and Beta 2?
Propanerolol
If the patient is bradycardic and fatigued?
Alpha and beta blockers
If I tell you the patient is having cardiac arrhythmias and hypertension?
Adrenergic or anticholingerics
Dry mouth tachycardia urine constipation
Anticholinergic
Teach the patient to increase their fiber and fluid?
Anti-cholinergic (think DRY)
What category of drug do we keep the patient from stopping abruptly?
Beta Blockers
What drug might produce Tachycardia and Hypertension?
Anticholingeric and beta 1
What two categories of drugs would we cause for potential bradycardia and hypotension?
Cholingeric and anti-adrenergic (Alpha and Beta)
Stimulation of the alpha 1 receptors?
Peripheral Vasoconstriction
3 things that occur with blockage of Beta 1 receptors?
- Decrease in heart rate
- Negative inotropic
- Negative dromotropic
Simulation of cholinergic receptors?
Decreased heart rate, increased secretions, increased salivate, GI secretions, GI motitlity, release of sphincters, more sweating, urinations (think WET)
What 2 things happen when you give a medication that stimulates Beta 2 receptors?
- Bronchodilatation
2.
What 3 things happen when you give a medication that stimulates Beta 1 receptors?
- Positive chronotropic (increased heart rate)
- Positive inotropic
- Increased dromotropic
What is the first line of drug for treating bradycardia?
Anticholinergic
What category of autonomic would you give for patient with myasthenia gravis (skeletal muscle weakness)?
Cholinergic
For patients that have hypertension, what category of Autonomic drug would be best?
Anti-adrenergic (either alpha blockers or beta blockers – recommended as first line for heart issues/hypertension)
For a patient that has asthma and COPD, what category of autonomic drug might be best?
Adrenergic (prototype: epinephrine)
Opioid Agnoist prototype
Morphine
Opioid Agonists/antagonists prototype
Pentazocin (Talwin)
Opioid Antagonist prototype
Naloxone (Narcan)
Treatment of opioid withdrawal prototype, other option
Methadone Buprenorphine (suboxone)
Acetylsalicylic acid prototype
Aspirin
NSAID prototype
ibuprofen (advil)
Acetaminophen prototype
Tylenol
Cox-2 inhibitor prototype
Celecoxib (Celebrex)
Barbiturates prototype
Phenobarbital
Benzodiazepine prototype
Diazepam (Valium)
Benzodiazepine antidote
Flumazenil (Romazicon)
Miscellaneous sedative/hypnotic anti-anxiety prototype
buspirone (Buspar)
Sedative-Hypnotic prototype
zolpidem (Ambien)
Catecholamines prototype
epinephrine (Adrenalin)
Non-catecholamines prototype
ephedrine
Alpha Adrenergic blocker - prototype
prazosin (Minipres)
Beta Adrenergic blockers - prototype
propranolol (Inderal)
Cholinergic prototype
Neostigmine (Prostigmine)
Anticholinergic prototype
Atropine
Absorption, distribution, and excretion may be decreased by:
Hypotension
Which one of the following would you NOT include in your teaching plan for your patient on Demerol (opiate)?
Bland, low residue diet
Aspirin has been ordered for all of these patients seen today in the Emergency Department. Which one of the following patients should be given the aspirin without questioning the order?
An adult patient who came in with an elbow injury and resulting tendonitis.
For which of the following reasons should a prescribed Valium dose be held?
If the patient is lethargic and drowsy
Your patient has a preoperative order for Atropine 0.4mg IM. This medication has the same effect on the human body as:
Inhibiting the PSNS
Which one of the following medication effects is NOT found in acetaminophen?
Anti-inflammatory
Inderal is contraindicated in a patient with:
Obstructive airway disease
When a patient uses a beta 2 agonist bronchodilators, such as Bronkosol, you will assess for the possibility of:
Tachycardia
Your patient has a Dopamine (adrenergic) drip infusing via the left antecubital vein. While assessing him, you notice his IV has infiltrated. Your priority intervention is to:
Stop the Dopamine drip
Your patient with Myasthenia Gravis is being treated with Neostigmine (Phyostigmin). An adverse effect to assess for is:
Diaphoresis (sweating)
Which of the following metabolic effects may be a consequence of Epinephrine (Adrenalin) administration?
Hyperglycemia
Orthostatic hypotension
a change in BP of > 15 mmHg from lying to sitting or sitting to standing
Vasoconstriction
- constriction of the blood vessels
- can lead to HTN (hypertension) and ↑ CO (cardiac output)
Vasodilatation
- blood vessels dilate
- can lead to hypotension
Catecholamine
Adrenergic agonists (activate the Adrenergic receptors) that cannot be taken orally, have a brief duration, and cannot cross the BBB
Main types are: dopamine, norepinephrine, epinephrine
Non-catecholamine
Adrenergic agonists (activate the Adrenergic receptors) that don’t contain the catechol nucleus but still activate the A and B receptors (indirectly or directly)
- can be taken orally
- longer lasting
- can cross the BBB
Ex: ephedrine, amphetamine
Decongestants – pseudoephedrine
Diet pills – ephedrine
Asthma treatment - Beathine
Inotropic – effect on the force of cardiac contraction
“+” or positive inotropic effect → ↑ in force of heart contraction
“-“ or negative inotropic effect → ↓ in force of heart contraction
Chronotropic – effect on the heart rate
“+” or positive chronotropic effect → ↑ in heart rate
“-“ or negative chronotropic effect → ↓ in heart rate
Nursing Interventions for Adrenergics
- Set of VS before, during, and after administration
- Promote sleep
- Frequent bathing
- Small frequent meals
- For IV infusions
Nursing Diagnoses: Adrenergics
- Ineffective airway clearance
- Decreased C.O.
- Ineffective breathing pattern
- Altered tissue perfusion
- Sleep pattern disturbance
- Anxiety
- Potential for injury
- Alteration in comfort
adverse drug effects of epinephrine
- tachycardic arrhythmias
- Angina, CAD
- Hypertension
- Cerebral vascular disease
- Common ADE: Anxiety, nervousness, insomnia
epinephrine contraindications
- tachycardic arrhythmias
- Angina
- Hypertension
- Cerebral vascular disease
- Allergy to the medication
use epinephrine cautiously in patients…
with anxiety, insomnia, psych disorders, elderly
Non-catecholamines (characteristics, examples)
act the same as catecholamines, but effects last longer and are effective orally, OTC medications available (though this can be dangerous)
Examples:
- Ephedrine
- Albuterol (Proventil, Ventolin)
- Pseudoephedrine (Sudafed)
- Terbutaline (Brethine)
Endogenous catecholamines (ADRENERGICS)
Prototype: epinephrine (Adrenalin)
Norepinephrine
Dopamine
Used in emergency treatment: Cardiac arrest Hypotension Shock Bronchial asthma Obstructive pulmonary disease
Exogenous catecholamines (ADRENERGICS)
Isoproterenol (Isuprel)
Dopamine (Dobutrex)
Used in emergency treatment: Cardiac arrest Hypotension Shock Bronchial asthma Obstructive pulmonary disease
Adrenergic effects: B1
heart rate
Adrenergic effects: B2
Bronchi, Feelings, increased Blood sugar, increased Fatty acids
Adrenergic effects: A
Blood vessels, pupils, GI system, increased sweating, increased coagulation
Alpha adrenergic receptors
predominantly effects the extremities: arms and legs
Peripheral vasoconstriction in the arms and legs
- Prototype: prazosin (Minipress)
- Alpha 1: act primarily in the skin, mucous membranes, intestines, kidneys to prevent adrenergic mediated vasoconstriction, can improve urinary flow by relaxing the sphincter
- Lower blood pressue
- If clinical use is treatment of hypertension, the common adverse effect could be hypotension (signs: lethargy, weakness, etc.)
- Serious ADE – to avoid this, give it as the last thing before bed (generally always given at bedtime)
Beta 1 adrenergic receptors
effect the cardiac (heart)
- increased HR (positive chronotropic)
- increased force of contraction (positive inotropic)
Beta 2 adrenergic receptors
effects the lungs
- Bronchodilation
Effects of adrenergics
- Raise heart rate (+ chronotropic), force of contraction (+ inotropic), rate of the AV node (+ dromotropic)
- Vasoconstriction, increase BP + CO, increased blood flow to the brain, heart (2 most vital organs to preserve) and skeletal muscles
- Bronchodilation
- Dilated pupils (mydriasis)
- Subjective feelings of tensions
- Decreased GI activity
- Increased blood sugar
- Glycogenolysis – breakdown of glycogen to form glucose
- Gluconeogensis – making glucose from non-carbohydrate sources (fat + protein)
- Increased fatty acids
- Increased sweating
- Increased blood coagulation
Adverse effects of adrenergics
- Tachycardia, arrhythmias, palpitations
- Looks pale, feels cool, hypertension (HTN)
- Restlessness, tremors, insomnia
- May lead to nausea/vomiting, anorexia, constipation, ulcers, GI bleeding
- Increased FBS, increased insulin needs for diabetic pts
- Increased lipids (cholesterol)
- Fluid loss, sweaty/clammy
- Increased risk of MI and stroke
Anti-cholinergic
Cholinergic blockers
Parasympatholytic
Same effect as blocking (inhibiting) the PSNS
Prototype: Atropine
THINK DRY
Cholinergic
Parasympathominetic
Same effect as stimulation of the PSNS
Prototype: Neostigmine (Prostigmine)
- 90% of the PSNS fibers are in the vagus nerve
- 2 ways that cholinergic medications can work
- some mimic the action of acetylcholine – they have rather limited use, but highly varied use
- used to relieve urinary retention
THINK WET
Anti-Adrenergic or adrenergic blockers
Same effect as blocking (inhibiting) the SNS
Adrenergic
Adrenergic agonists (Alpha-adrenergic agonists, Beta-adrenergic agonists) Sympathomimetic
Same effect as stimulation of the SNS
-Prototype: Epinephrine (adrenalin)
Potential adverse effects of Anti-Adrenergics or Alpha/Beta Blockers
- Bradycardia
- Hypotension
- Orthostatic or postural hypotension (from laying to sitting, a drop in systolic pressure of more than 20 mm Hg or more in less than 3 minutes)
- Fatigue, lightheadedness, pale, decreased level of consciousness, feelings of weakness, lethargy, depression
- Shortness of breath (SOB)
When you are taking care of any patient on cholinergic or anti-cholinergic medication, note the following 4 things
- these drugs impact places outside the specific location
- know exactly why the patient is taking it
- know what other medications the patient is taking
- the higher the dose, the longer the patient takes it, the greater the adverse effects
5 ways opiates are given
PO (mouth)
IM (intramuscular)
IV (intravenous)
Patch
PCA (patient controlled analgesia)
Opiate agonists (6)
- morphine
- demerol
- codeine
- dilaudid
- fentamyl
- oxycodone
Opiate antagonists
Naloxone (narcan)
Opiate agonists/antagonists prototype
Pentazocine (Talwin NX)
3 most common clinical uses of opiates
- relief of moderate to severe pain
- acute pulmonary edema
- severe nonproductive cough
CAUTION:
- respiratory depression
- chronic lung disease
- increased intracranial pressure
therapeutic effects of opiates
interferes with pain impulses = decreased level of pain
adverse effects of opiates
- depresses CNS (sedation, dizziness, decreased resp. more serious)
- depresses GI tract (N/V, constipation)
- alters psychological responses to pain
- produces euphoria
3 categories for pain management
- opiates/opioids
- nonopiates: acetaminophen, salicityates (ASA, NSAID)
- adjuvant: benzo, corticosteroids
Don’t use beta blockers with a patient who has…
Asthma
endogenous pain relief
a system of opioid peptides: endorphins, serotonins, GABA
activated by exercise, massage, visualization, prayer, meditation, therapeutic touch
exogenous pain relief
morphine-like drugs that bind to opiate receptors in the CNS
acetaminophen-induced hepatotoxicity (signs, symptoms, treatment)
1-24 hours post: N/V, diaphoresis, malaise
24-48 hours post: decreased urine output, pain in the RUQ abdomen
2-6 days post: encephalopathy, renal failure, ecchymosis, jaundice, elevated bilirubin and liver enzymes
serious adverse drug effects of acetaminophen
hepatotoxicity (in large doses, in therapeutic doses with alcohol), renal toxicity, contraindicated with patients with severe liver disease
common adverse drug effects of acetaminophen
rash, urticaria, nausea
pathogenic prostaglandin
inflammation
edema
leukocytosis
release of cytokines
physiologic prostaglandin
GI
renal
regulates smooth muscle
regulates blood clotting
How long do NSAIDs bind to platelets?
only for the time the NSAID is in circulation
salisilate poisoning (signs, symptoms, treatment)
SIGNS:
- confusion, restlessness, drowsiness
- sweating
- thirst
- hyperventilation
treatment:
- general tx of s+s
- gastric lavage
- IV fluids
ASA adverse drug effects
tinnitus Reye's syndrome N/V GI system Bleeding: epistaxis, ecchymosis, hematuria, hematemosis, hemoptysis, melena, bleeding gums During pregnancy ASA sensitive asthma
what is the anxiety neurotransmitter?
GABA (gamma-aminobutyric aci) which inhibits or slows the excitement of the nerve pathways
what benzo is used for pre-op sedation?
Midazolam (Versed)
3 effects of how Barbiturates, Benzodiazepines and misc. depress the CNS:
- skeletal muscle relaxation
- sedative effect
- anti-convulsant
adverse drug effects of Barbiturates, Benzodiazepines and misc. - serious and common
paradoxical reaction is serious
drowsiness, confusion, ataxia is common
contraindications for Barbiturates, Benzodiazepines and misc.
- serious respiratory disorders
- severe liver and or kidney disease
- history of allergies or drug abuse with this class
- potentially addictive
4 ways to treat overdose of Barbiturates and Benzodiazepines
- respiratory support
- nasogastric lavage
- IV fluids and diuretics
- flumazenil (Romazicon)
in what circumstances should you hold alpha and beta adrenergic blockers
Hold if systolic BP
in what circumstances should you hold alpha and beta adrenergic blockers
Hold if systolic BP
hypokalemia
deficiency of potassium in the bloodstream
teratogenic
Able to disturb the growth and development of an embryo or fetus
parenteral route of administration
Taken into the body or administered in a manner other than through the digestive tract, as by intravenous or intramuscular injection
peristalsis
a series of wave-like muscle contractions that moves food to different processing stations in the digestive tract. The process of peristalsis begins in the esophagus when a bolus of food is swallowed
ataxia
the loss of full control of bodily movements
orthopnea
shortness of breath (dyspnea) which occurs when lying flat
hypervolemia
where there is too much fluid in the blood
antecubital
in front of the elbow; at the bend of the elbow
extravasated
leakage - when a fluid is let/forced out from the vessel that naturally contains it into the surrounding area
