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Nursing 2590 > Exam 1 Chapter 15 Adrenergics +review of other > Flashcards

Exam 1 Chapter 15 Adrenergics +review of other Flashcards

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1
Q

Primary transmitter of sympathetic nervous system (SNS)

A

Norepinephrine

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2
Q

Receivers of the SNS

A

Alpha 1 and 2, Beta 1 and 2

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3
Q

Reconciliation of medications (online)

A

The process of identifying:
The most accurate list of all medications that the patient is taking.
This includes:
medication name
dosage,
frequency, and
route,
By comparing the medical record to an external list of medications obtained from a patient, hospital, or other provider.

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4
Q

Reconcilation of medications

A

Confirming that everything on the drug list is:
1. Updated with the patient.
2. No drug or CAM is missing.
3.The doses are correct.
4. You answer any questions the patients may have about the medications.

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5
Q

What is first pass effect?

A

Involves metabolism. If there is a significant first pass effect, less medication is available.

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6
Q

Bisphosphonates are the most commonly prescribed drug class for what diagnosis?

A

Osteoporosis.

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7
Q

What is the important patient teaching for bisphosphonates?

A

Patient must take with water and stay upright for 30 minutes so it doest not create esphophageal erosion.

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8
Q

What is the common ending for osteoporosis drugs?

A

ONATE

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9
Q

What are contraindications for bisphosphonates?

A

Hypocalcemia
Inability to sit upright for 30 minutes
Reduced kidney function
Pregnancy

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10
Q

What other classes of medications are available to treat osteoporosis?

A

CERNS - but risk - hot flashes,
Contraindication: no history of DVT’s due to estrogen content.

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11
Q

What are long term effects of bisphosphonates?

A

Femur fractures and jaw necrosis.

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12
Q

S/S of a DVT?

A

Swelling in one leg (unilateral)
Leg tender
Leg pain
Leg coolness, could be warmth over clot
Leg weak
Leg pulse diminished,
This is a priority patient.

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13
Q

What 3 things can DVT’s lead to?

A

Stroke, PE, and heart attack.

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14
Q

What ingredient increased the risk of developing blood clots and in what type of medications are they found they found?

A

Estrogen:

CHC products (combined hormonal contraception)/birth control,

hormonal replacements/menopause,

CERVS/osteoporosis

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15
Q

What are contraindications for patients taking estrogen products?

A

Pregnancy,
smoking,
family or personal history of DVT,
liver disease,
breast cancer, and
breastfeeding.

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16
Q

What does BPH stand for?

A

Benign prostatic hyperplasia

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17
Q

What are the 3 classes of medications to treat BPH?

A

5-Alpha Reductase Inhibitors. (alpha1 agonist contracts prostate)
PDE (phosphodiesterase inhibitors)
alpha 1 adrenergic blockers

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18
Q

What are the side effects of 5-Alpha reductase inhibitors?

A

Erectile dysfunction

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19
Q

How long does it take for 5-Alpha reductase inhibitors to work?

A

Up to 6 months.

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20
Q

How long do you hold an epi pen in?

A

3 seconds

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21
Q

What class of drug is Sildenafil? Tadalafil?

A

Phospho-di-esterase inhibitor (PDE),
vasodilator, example -viagra

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22
Q

“AFIL” - What is the common ending AFIL drug class?

A

phosphodiesterase inhibitors (PDE)

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23
Q

How do PDE inhibitors work?

A

They block the release of PDE
increase cGMP which relaxes smooth muscle and
increases blood flow to the corpus cavernosum

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24
Q

Side effects of PDE inhibitors that need medical attention?

A

Priapism
painful urination, and
vision changes.

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25
Q

After administering EPI pen what do you do next?

A

Call 911

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26
Q

What does the sympathetic nervous system do?

A

Stimulates the fight or flight mechanism

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27
Q

Autonomic nervous system’s goal?

A

homeostasis, one system may have to dominate.

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28
Q

Neurotransmitters are ….

A

messengers

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29
Q

What space is between two nerve endings?

A

Synaptic cleft

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30
Q

What are the structures that receives the messages from the messengers (neurotransmitters)?

A

Receptors.

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31
Q

Three primary neurotransmitters of SNS

A

1.Norepinephrine (Primary) Neurotransmitters=Norepinephrine
2.Epinephrine,
3.Dopamine

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32
Q

Receivers of SNS adrenergic agonist receptors?

A

Apha 1, 2, Beta 1, 2

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33
Q

How do you remember what system adrenergic is from?

A

Adrenergic-adrenaline. SNS.

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34
Q

Global effect of Adrenergic agonist effects

A

Eyes (dilate),
Lungs (bronchodilation),
Heart (tachycardia).
Blood Vessels (vasoconstriction),
GI (gastroperistalisis relaxed),
Bladder (relaxes, no contraction to release urine),
Uterus (relaxes).

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35
Q

Name the four Alpha 1 Receptor locations

A

Blood Vessels - constrict - inc. BP, inc. heart contractility
Eyes - dilate
Bladder - relax
Prostate - constrict

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36
Q

Name the two Beta 1 Receptor locations

A

One Heart - inc. heart contraction, inc. HR
Two Kidneys - inc renin, inc angiotensin, inc. BP

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37
Q

Alpha 1 -

A

Increases BP

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38
Q

Beta 1 -

A

Increases BP and HR

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39
Q

Name the four Beta 2 Receptor locations

A

BETA 2
One Liver - inc glycogenesis - inc. glucose
Two Lungs - bronchodilation
GI -dec tone and motility
Uterus - relaxation of smooth muscle

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40
Q

How are neurotransmitters inactivated?

A

1.Reuptake/Recycled by neuron
2.Enzyme transformation or degradation

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41
Q

What enzymes breakdown neurotransmitters

A

MAO monoamine oxidase
COMT Catechol-O-methyltransferase

42
Q

Medications that stimulate the SNS

A

agonist
adrenergic agonist
sympathomimetic

43
Q

Medication that inhibit the SNS

A

antagonist
adrenergic antagonist
sympatholytics

44
Q

What type of adrenergic agonist is EPINEPHRINE?

A

Nonselective

44
Q

What type of adrenergic agonist is EPINEPHRINE?

A

Nonselective

45
Q

When is Epi used?

A

analyphalaxis
shock
bronchospasms
cardiac arrest

46
Q

How long does epi pen stay in for?

A

3 seconds, then massage for 10 secs., then call 911
might need a 2nd injection in 30 minutes

47
Q

Where is the epi pen inserted?

A

middle of outer glute

48
Q

Beta 1 - what is the change in vitals

A

increased HR - one heart, 2 lungs

49
Q

Beta 2 - what is the change in body

A

Two LUNGS decreased RR/brochodilation
One LIVER increased glucose

50
Q

Alpha 1 - what is the change in the vitals

A

inc BP with vasoconstriction

51
Q

Non-selective means there is ______ than one receptor

A

Non-selective means there is MORE than one receptor.

52
Q

Routes for EPI

A

IV, Epi pen - immediate
Inhalation -1-5 min.
IM, SQ -5-10 min.
Intracardiac

53
Q

What angle do you insert the epi pen

A

90 degrees, right angle

54
Q

Name a common NON-SELECTIVE adrenergic AGONIST

A

EPINEPHRINE

55
Q

Name a Beta 2 agonist

A

ALBUTEROL

56
Q

Which is a Beta 2 AGONIST? Albuterol or Epinephrine?

A

ALBUTEROL

57
Q

Is ALBUTEROL selective or non-selective?

A

SELECTIVE
to BETA 2.
TWO LUNGS ONE LIVER

58
Q

Caution for which patients with ALBUTEROL?

A

Two lungs/One liver (blood sugar)
Severe Cardiac disease (crossover to Beta 1)
Hyperthyroidism
Diabetes Mellitus
Pregnancy

59
Q

WHAT IS ALBUTEROL USED TO TREAT

A

BRONCHOSPASM
BRONCHITIS
ASTHMA

60
Q

You have just administered epinephrine, what vitals would you expect to see change?

A

HR up
BP up
RR down

61
Q

SIDE EFFECTS of ALBUTEROL

A

Tremors
Nervousness
Restlessness

Beta 1 cross over. ONE HEART
Cardiac dysrhythmias

62
Q

DRUG interactions with ALBUTEROL

A

Beta blockers will decrease effectiveness
Sympathomimetics - HR and BP up more

63
Q

List 3 other ADRENERGIC AGONISTS

A

Norepinephrine - more selective to Beta, inc. HR
Dopamine
Phenylephrine - OTC nasal spray,

64
Q

ADRENERGIC AGONISTS ARE CONTRAINDICATED FOR ___

A

Hypertension

65
Q

If you have hypertension and need OTC Adrenergic Agonist which one should you choose ?

A

Coricidin for patients that have hypertension, no sympathomimetics in it
sympathomimetics - will increase the BP

66
Q

Adrenergic OTC nasal sprays, patient teaching

A

sit upright
insert so against septum
breath in
max 3-5 days, or more than twice a day or can causerebound congestion.

67
Q

What aspect of glucose needs monitoring with adrenergic agonists? (epi)

A

Hyperglycemia

68
Q

What aspect of urine output needs monitoring with adrenergic agonists? (epi)

A

Decreased urine output - Alpha1, relaxes bladder, so no constriction to promote urination

69
Q

After auto injecting an epipen what to do next?

A

Call 911 can only do 2 injections w/o supervision of a HCP

70
Q

Can Beta 2 adrenergic agonists also affect B1 receptors?

A

Yes - crossover if dose high enough

71
Q

Nurse gives patient ALBUTEROL and monitors for what 3 things?

A

Albuterol Selective Beta 2 AGONIST
Want Bronchodilation when taking it….
Problems that could have:
Beta 1 crossover
Palpitations - crossover to Beta 1
Hypertension - crossover to Beta 1
Hyperglycemia One Liver -(glycogenesis)
Bronchospasm Two lungs (Bronchodilation)

72
Q

Beta 1 receptor stimulation causes
1. ____ 2. ____
Beta 2 receptor stimulation causes
1.___2.____3.___4.___

A

Beta 1 receptor stimulation causes One HEART, Two Kidneys
1. inc HR, cardiac (myo) contractility
2. inc BP, release of renin, then aldosterone

Beta 2 receptor stimulation causes
1. dec RR,
2. Inc blood sugar,
3. dec uterine contraction,
4. dec Gi motility

73
Q

Name 3 ADRENERGIC ANTAGONISTS

A

Alpha blockers
Beta blockers
Alpha/Beta blockers

74
Q

“Beta-Adrenergic Blockers end in ____

A

“OL”. toporol

75
Q

What do Beta-Adrenergic Blockers (BAB) do?

A

Block action of neurotransmitter at beta receptor sites

76
Q

Beta-Andrenergic Blockers caution

A

Diabetes
Asthma - bronchoconstriction
COPD - bronchoconstriction non- selective beta blockers

77
Q

Can Beta Blockers be selective or non-selective?

A

Yes they can be either

78
Q

Beta blockers and diabetics what can happen?

A

masks hypoglycemia may decrease blood sugar
s/s dizzy, shaky, sweating, inc HR, SNS stimulated

79
Q

Name a selective Beta-Adrenergic Blocker (Beta 1) and INDICATIONS….

A

Atenolol
CAD,
MI,
Hypertension,
Tachycardia,
CHF

80
Q

How does a Beta blocker work? (Beta 1) 1 heart 2 kidneys

A

Decrease
HR,
BP,
RR no change

81
Q

Side Effects of Beta Blockers?

A

In the beginning, fatigue
HA (headache)
Depression
Impotence
Bradycardia - HR less than 6
Hypotension - Systolic less than 90
Hypoglycemia can be masked

82
Q

Fight or flight - 3 organs

A

Lungs, Heart, Brain

83
Q

Epinephrine - Side effects to kidney?

A

Decreased blood flow, dec urine,

84
Q

Epinephrine - side effects to blood sugar?

A

Hyperglycemia, liver gycogenesis

85
Q

Nurse giving epi - vital signs

A

Epi -
Beta 1. ONE HEART 2 KIDNEYS Beta 2 - 2 Lungs, 1 liver
HR inc. 60 could go up to 80-110, receptors receptors
BP inc, renin released, vaso constriction
RR dec. , Bronchodilation

86
Q

If patient receives 2 sympathomimetics -
How do vital signs change

A

A greater increase in HR and BP
could put patient at risk

87
Q

If patient is taking a beta blocker and then you give them epi what happens?

A

Can blunt the response of the sympathomimetic.
Cardiac arrest, epi may not work as well.

88
Q

EPI can be in different concentrations? T or F

A

True

89
Q

Drug interactions with Beta Blockers

A

NSAIDS as will increase BP
EPI - effects decreased
Always take vital signs before hand

90
Q

Albuterol can have beta1 crossover when?

A

those who have a sensitivity to drug
at higher doses more in the hospital
BP will increase

91
Q

Beta 2 Blocker can cause _______ in the lungs

A

Vasoconstriction. Not good for COPD and Asthma

92
Q

Non-selective Beta blockers do not give to ____

A

COPD
Asthma
Due to Bronchoconstriction
There are no Beta 2 blockers cause bronchoconstriction
Already bradacardic if HR is 40 do not give them atenolol
Pregnant

93
Q

Patient Education for Beta Blockers

A

Teach how to take their pulse, less than 60 call HCP
Avoid quick changes in positions, postural hypotensions
Review potential side effects (impotence, headache, heart attack)
Do not discontinue without directions

94
Q

You have a patient with 63 year old male admitted for gallbladder surgery.
History: Hypertension, COPD, obesity
Medication:
What BP medication would be contraindicated?

A

Non-selective beta blocker (beta 1 and beta 2)
Beta 2 could cause bronchoconstriction for COPD patient

95
Q

Non-Selective Beta blockers and Diabetes
2 things to be aware of.

A

Patient Education for Diabetics on beta blockers
Normal Hypoglycemia s/s
dizzy, shaking, sweating, signs need to eat
SNS stimulation.
Patients may NOT get these initial signs of HYPOGLYCEMIA.

Beta blockers - diabetics will not get the message that blood sugar is low.
suggest checking glucose more often
have candy with them at all times

Could see blood sugar decrease. Beta 2 - Liver receptors are blocked. So patient would need LESS insulin since there is LESS sugar.

96
Q

Atenolol is a BETA ONE ________Blocker

A

Atenolol is a BETA ONE SELECTIVE Blocker
so HR, BP go down, RR stays the same.

97
Q

Patient prescribed Atenolol
Take vitals before 80/50
Do give the atenolol?

A

NO
hypotensive is systolic below 90
need to notify HCP who prescribed it
document that you did not give the drug
sometimes BP drugs may have paramenters -
ie hold for HR less then 60 BP less than 90

98
Q

MUST KNOW THE MOST COMMON SELECTIVE BETA BLOCKERS

A

ATENOLOL and METOPROLOL

99
Q

MUST KNOW THE MOST COMMON
NON-SELECTIVE BETA BLOCKERS

A

CARVEDILOL,
LABETALOL,
PROPANOLOL HCL,
SOTALOL,
TIMOLOL (eye drops)

100
Q

Teach patient if HR is less than ______
Do not take your BP medication

A

HR less than 60 do not take your BP medication.
Notify HCP.

Nursing 2590 (6 decks)

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