Exam 1 Study Guide Flashcards
What should you monitor in patients taking Cholinergic drugs?
Monitor for therapeutic effects of:
Myasthenia gravis
Alzheimers (decreased confusion, etc.)
Postop patients w/ decreased GI peristalsis (increased bowel sounds, flatulence, bowel movements)
Patients w/ urinary retention (should urinate w/in 60 minutes).
What should you monitor in patients taking Anti-Cholinergic Drugs?
Monitor for therapeutic effects in:
Patients with Parkinson’s (fewer tremors and decreased salivation and drooling)
Patients with urologic problems (improved urinary patterns, less hyper-motility, increased time between voiding)
Monitoring for Cholinergic Crisis
SLUDGE (salivation.lacrimation.urinary incontinence.diarrhea.GI cramps.emesis) Bloody diarrhea CA Circulatory collapse Hypotension, shock
Treatment for Cholinergic crisis
For early treatment: atropine is used. For severe cardiovascular reactions of bronchoconstriction: epinephrine is used
Monitoring a patient taking an adrenergic drug
Monitor for therapeutic effects on the cardiovascular system (decreased edema, increased urinary output, return to normal VS, improved skin color and temp, increased LOC) and respiratory system (normal RR, improved breath sounds, increased air exchange, less dyspnea, decreased cough, improved blood gases, increased activity tolerance)
Monitoring a patient taking an adrenergic blocking drug
Monitor for decreased chest pain in patients with angina.
Return to normal BP and HR.
Adrenergic Blocking Drugs include
Beta Blockers (Atenolol) Alpha Blockers (Phentolamine, prazosin, tamsulosin)
What are adverse effects of Atenolol?
bradycardia, depression, constipation, impotence
What are the nursing implications for patients taking Atenolol?
Inform patient tor export weight gain of more than 2 pounds in 1 day or 5 pounds in 1 week, edema of the feet or ankles, SOB, excessive fatigue or weakness, syncope or dizziness to their HCP.
Important Cholinergic blocking drugs include:
Dicyclomine and oxybutynin
Dicyclomine
Cholinergic blocking drug.
Used primarily in the treatment of functional disturbances of GI motility such as irritable bowel syndrome.
Oxybutynin
Anticholinergic drug.
Used for the treatment of an overactive bladder.
What are adverse effects of Dicyclomine?
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What are adverse effects of oxybutynin?
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What are nursing implications for patients taking Dicyclomine?
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What are nursing implications for patients taking oxybutynin?
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What is a Cerebrovascular accident?
Impairment of one or more vessels in the cerebral circulation -> interrupts blood supply -> ischemia of brain tisssue
What is the purpose for the use of warfarin in patients with a CVA?
Prevents the formation of clots and keeps existing clots from getting bigger.
What are adverse effects of warfarin?
Bruising, bleeding, N/V, stomach pain, bloating, gas, or altered taste.
What is used to reverse too much warfarin?
Vitamin K
Is there any OTC herbal products that can interact with anticoagulant therapy?
Ginseng
Types of Seizures
a. Generalized seizure
b. Simple partial seizure
c. Complex partial seizure
Generalized seizure
Seizures originating simultaneously in both cerebral hemispheres.
Simple partial seizure
No impaired consciousness Motor symptoms Hallucinations of seeing, hearing or taste along with tingling. ANS responses Personality changes.
Complex partial seizure
Impaired consciousness Memory impairment Behavioral effects Purposeful behaviors Aura, chewing, and swallowing movements, unreal feelings and bizarre behavior. Tonic, clinic or tonic-clinic seizures.
What are the types of antiepileptic drugs?
Phenytoin
Phenobarbital
What are therapeutic effects of phenytoin?
desensitizes sodium channels
What are the therapeutic effects of phenobarbital?
Changes the actions of GABA (neurotransmitter inhibitor)
What are the adverse effects of phenobarbital?
dependence, drowsiness, vitamins deficiencies and laryngospasm.
High potential for dependence and low margin for safety.
What are the adverse effects of phenytoin?
CNS depression, gingival hyperplasia, skin rash, cardiac dysrhythmias, hypotension.
What should you monitor in patients taking phenobarbital and phenytoin drugs?
Serum-drug levels
Signs of toxicity
Blood dyscrasias and bleeding disorders.
Liver an kidney function (fatal hepatotoxicity can occur)
What drugs are typically used for status epilepticus?
Diazepam Fosphenytoin Lorazepam Phenobarbital Phenytoin
What are adverse effects of drugs used to treat status epilepticus?
Apnea
Hypotension
Somnolence
Cardiac Dysrhythmias
What is Parkinson’s disease?
Progressive loss of dopamine. Can cause tremors, muscle rigidity, abnormal movement and posture.
What are the drugs used to treat Parkinson’s disease?
Levodopa and levodopa-carbidopa
What are the therapeutic effects of levodopa and levodopa-carbidopa?
increases biosynthesis of dopamine within nerve terminals (restore balance of dopamine)
What is the main focus of drug therapy in treating Parkinson’s disease?
Restores balance of dopamine (restores dopamine function) and ACh in the brain (blocks ACh).
What are the adverse effects of levodopa and levodopa-carbidopa?
Dizziness, light-headedness, sleep dysfunction, fatigue, nausea vomiting, constipation, orthostatic hypotension, dystonia, dyskinesia.
What drugs are used to treat Parkinson’s disease?
Dopaminergic Drugs (levodopa, levodopa-carbidopa) Anticholinergic Drugs
What is Alzheimer’s Disease?
Progressive loss of brain function including memory loss, dementia and confusion.
What drugs are used to treat Alzheimer’s?
Acetylcholinesterase inhibitors (Donepezil)
What are the therapeutic effects of donepezil?
Is an acetylcholinesterase inhibitor -> prevents the breakdown of ACh -> enhances transmissions of neurons -> slows progression of Alzheimer’s
What are the adverse effects of donepezil?
N/V dizziness, headache, bronchoconstriction, liver injury.
What should you monitor for in patients taking donepezil?
Monitor: hypotension, baseline vitals, changes in mental status or mood, adverse effects.
What is the Pathophysiology of myasthenia gravis?
Autoimmune disease; An IgG antibody is produced against ACh receptors. (ACh receptor antibodies)
What is the Pathophysiology of multiple sclerosis?
Demyelenation of Neurons in CNS. -> Progressive weakness, visual disturbances, mood alterations and cognitive deficits.
What are the assessment findings of a patient with amytrophic lateral sclerosis?
Leads to progressive weakness -> respiratory failure and death. Pt has normal intellectual and sensory function until death.
Acute Pain
Sudden onset. Sharp. Duration is limited (ends). Physiological Effects
Chronic Pain
Slow. Duration (never ends). Dull persistent ache.
Acetaminophen (Tylenol)
Nonopioid analgesic and has antipyretic effects.
Treats pain and fever.
Little to no anti-inflammatory effects.
Therapeutic Effects of Acetaminophen
Blocks Pain impulses peripherally by inhibiting prostaglandin synthesis.
What are the contraindications of acetaminophen?
G6PD deficiency
Drug allergy
Liver dysfunction/possible liver failure (Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen!)
What are signs and symptoms of salicylate toxicity?
Tinnitus**, hearing loss, increased HR, N/V/D
Are there concerns giving a child aspirin if he/she has a virus with accompanying fever. If so, what is the concern and are there other options?
- There is concern because it increases the risk of them developing Reye’s Syndrome (inflammation of the liver and brain) -> progressive Neurologic deficits.
- Aspirin (is a salicylate) can be substituted with Acetaminophen.
NSAIDs include
Salicylates (Aspirin)
Acetic Acid Derivatives (Indomethacin, Ketorolac)
Proponent Acid Derivatives (ibuprofen, naproxen)
COX-2 inhibitors (celecoxib)
Enolic Acid Derivatives (Nabumetone)
Therapeutic Effects of NSAIDs
Has antipyretic, analgesic, anti-inflammation, aspirin – platelet inhibition.
NSAIDs: MOA
Inhibits Leukotriene pathway, the prostaglandin pathway or both. Also blocks chemical activity off the enzyme COX.
Adverse Effects of NSAIDs
**GI: heartburn to severe GI bleeding/ulceration; **tinnitus, hearing loss; renal failure, hepatotoxicity
Contraindications of NSAIDs
GI lesions, PUD, bleeding disorders
What are opioids?
Synthetic drugs that binds to opiate receptors to relieve pain.
Opioids include
Codeine, Hydrocodone Hydromorphone Morphine Oxymorphone Oxycodone Meperidine Fentanyl Methadone
Therapeutic effects of opioids
Reduction of pain sensation
Adverse Effects of opioids
CNS depression (leads to respiratory depression.
Constipation
N/V, urinary retention, miosis, diaphoresis and flushing, itching
What is an antidote for opioids?
Naloxone and Naltrexone
What is depression?
Disorder characterized by a sad or despondent mood.
What are the antidepressant classes?
Tricyclamine Antidepressants, SNRIs, SSRIs, MAOIs
SSRI’s: MOA
Delays or prevents the Reuptake of serotonin back into the presynaptic nerve terminal -> increases serotonin in the synapse. (Low serotonin levels can cause depression)
What are the therapeutic effects of SSRI’s?
Treats depression
What are the adverse effects of SSRI’s?
Most common include sexual dysfunction, nausea, HA, weight gain anxiety and insomnia. Serotonin syndrome.
Tricyclic Antidepressants include
Amitriptyline
Nortriptyline
Imipramine
Tricyclic Antidepressants: MOA
Slows the reuptake of norepinephrine and serotonin. Treats depression. Amitriptyline can also be used in anesthesia?
What are the adverse effects of tricyclic antidepressants?
Dry mouth, constipation, Tachycardia, urinary retention, blurred vision, dysrhythmias, orthostatic hypotension. Overdose mainly effects the CNS and the heart. (Dysrhythmias and seizures)
Monitoring for Serotonin Syndrome
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Are there concerns with patients taking OTC St. John’s Wart for SSRIs?
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MAO Inhibitors: MOA
Antidepressants that work by preventing Monoamine oxidase enzymes from oxidizing neurotransmitters. Therefore increasing the amount of neurotransmitters in the presynaptic nerve terminal.
What are MAOI’s indicated for?
Parkinson’s Disease and depression as a last resort.
What are the adverse effects of MAOIs?
Orthostatic hypotension, diarrhea insomnia and HA
What should be avoided in patients taking MAOIs?
Tyramines (dairy, fruits, alcohol, meats) and other antidepressant drugs can cause hypertensive crisis -> cerebral hemorrhage, stroke, coma, or death.
Antihypertensives (hypotension)
Patients with diabetes (interacts with glucose)
What is anxiety?
An unpleasant state of mind characterized by a sense of dread and fear.
What are the types of anxiety?
PTSD OCD Social Phobia Simple Phobia General Anxiety Disorder Panic Disorder
What drugs can be used to treat anxiety?
Benzodiazepines
Buspirone (BuSpar)
What are migraine headaches?
Pulsation quality with pain that worsens with each pulse.
Most commonly UNILATERAL but may occur on both sides.
What are the symptoms of a migraine?
Photophobia
Phonophobia
N/V
Aura
What can be used to treat migraines?
Triptans and ergot alkaloids.
Triptans: MOA
Stimulates 5-HT (serotonin) receptors in the cerebral arteries, causing vasoconstriction. -> reduces headache symptoms.
Reduces the production of inflammatory neuropeptides.
What are the adverse effects of triptans?
Vasoconstriction, irritation to injection site, tingling, flushing, GI upset
What are the contraindications for triptans?
Patients with serious CVD
What are the classes of medications used for migraine prophylaxis?
Anti-seizure drugs
Beta-adrenergic blockers(propranolol)
CCB (verapamil)
Tricyclic antidepressants (amiriptyline)
Are there any OTC herbal products available to help migraine headaches? If so, any concerns?
Feverfew
What is insomnia?
A sleep disorder that may be caused by anxiety
What medications can be used to treat insomnia?
Benzodiazepines (Diazepam, alprazolam, lorazepam) and Zolpidem
Benzodiazepines MOA
Depresses the CNS. Does so by enhancing the effect of GABA (neurotransmitter inhibitor) -> Depresses limbic system and brain stem (reticular activating system)
What are the adverse effects of zolpidem?
headache, drowsiness, dizziness, coma
Adverse Effects of benzodiazepines?
Decreased CNS Activity & sedation. Hypotension, drowsiness, loss of coordination, dizziness, headaches; N/V, dry mouth and constipation
What are the contraindications for zolpidem?
Respiratory impairment, high risk suicide, older adults and concurrent use of CNS depressants
What are the contraindications for benzodiazepines?
Drug allergies, narrow angled glaucoma and pregnancy
Benzodiazepines Indications
Muscle spasms Insomnia Alcohol withdrawal Seizures Adjunct for anesthesia and depression, anxiety
