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Pharm II > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Why would epinephrine cause stinging at the injection site?

A

Because it causes vasoconstriction which irritates the vessels in the surrounding tissue as they constrict

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2
Q

What makes hyperkalemia a medical emergency? What causes hyperkalemia? Why? What are s/s?

A

causes cardiac arrhythmias leading to cardiac arrest

any cellular damage: burns, crush injuries, DKA, rhabdomyolysis, renal failures, meds

most of K+ is intracellular so damage to cells causes the release of K+

peaked T wave, muscle and abdominal cramps, weakness, paralysis, oliguria, low BP dysrhythmias

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3
Q

What are s/s of hypokalemia?

A

arrhythmias (tachy, brady, irregular rhythm), shallow respirations, dyspnea, irritability, lethargy, thready pulse, N/V

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4
Q

What are normal potassium levels?

A

3.5-5 mEq/L

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5
Q

What are normal sodium levels?

A

135-145 mEq/L

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6
Q

What are s/s of hypernatremia?

A

flushed skin, irritability, restless, high BP, high pulse, edema, fever (low grade), low cardiac contractility

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7
Q

What are s/s of hyponatremia?

A

mental status change, lethargic, confusion, HA, loss of consciousness, seizure, death, bounding pulse, low BP

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8
Q

What are normal calcium levels?

A

9-10.5 mg/dL

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9
Q

What are s/s of hypercalcemia?

A

Muscle weakness, high fatigue, diminished deep tendon reflexes (hyporeflexia), mental status changes, headache, kidney stones

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10
Q

What are s/s of hypocalcemia?

A

“CATS” Convulsions, Arrhythmias, Tetany; spasms & stridor, positive Chvostek’s sign, Trousseau’s sign, increased deep tendon reflexes, seizures

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11
Q

How is the heart controlled by the ANS? What neurotransmitters are involver? What is the result?

A

Parasympathetic control through the Vagus Nerve, using Acetylcholine as the neurotransmitter, causing Bradycardia.

Sympathetic control through the Sympathetic ganglion chain using Epinephrine or Norepinephrine causing Tachycardia

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12
Q

What are 2 other names for adrenergic agonists?

A

Sympathomimetic,
Catecholamines

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13
Q

What are 2 other names for adrenergic antagonists?

A

Sympatholytics,
\Adrenergic blockers

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14
Q

What are 2 other names for cholinergic agonists?

A

Parasympathomimetics,
Muscarinic agonists

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15
Q

What are 3 other names for anticholinergic drugs?

A

Parasympatholytics,
Muscarinic antagonists,
Cholinergic blockers

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16
Q

What neurotransmitters are involved with “fight or flight” (sympathetic)? Where do they come from? What are their effects?

A

epinephrine and norepinephrine

adrenal gland

Pupillary dilation,
accelerated heart rate and increased contractility, bronchodilation of lungs,
stimulates release of glucose from liver,
inhibits salivation,
inhibits digestion,
inhibits contractions of bladder muscle,
inhibits sex organs

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17
Q

What is the function of adrenergic drugs?

A

stimulate the sympathetic nervous system by stimulating the adrenergic alpha or beta receptors

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18
Q

What are the 3 neurotransmitters (catecholamines) of the sympathetic nervous system?

A

dopamine
norepinephrine
epinephrine

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19
Q

What breaks down catecholamines?

A

COMT (catechol methyltransferase)
MAO (monamine oxidase)

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20
Q

What are influenced by alpha 1 receptors? What is the response?

A

all sympathetic organs besides the heart

constriction of blood vessels
dilation of pupils
relaxes bladder sphincter

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21
Q

What is influenced by the alpha 2 receptor? What is the response?

A

brain stem adrenergic terminals

inhibition of norepinephrine release
causes vasodilation

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22
Q

Where is the location of beta 1 receptors? What is the response?

A

heart and kidneys

increased heart rate and force of contraction
release of renin

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23
Q

Where is the location of beta 2 receptors? Response?

A

all sympathetic organs except heart

inhibition of smooth muscle contraction
bronchodilation
uterine relaxation

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24
Q

What is used if norepinephrine is extravasated into tissue?

A

phentolamine

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25
Q

Why are bronchodilators used before other inhalers when treating asthma?

A

albuterol/salbutamol cause immediate bronchodilation which allows other inhaled medications to be deposited further into the bronchiole tree , thus increasing their effectiveness.

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26
Q

What is the nature of 1st dose phenomenon? When is a good time to take med to deal with 1st dose effect?

A

Sudden & Severe decrease in blood pressure

Syncope or loss of consciousness

Give the dose at bedtime to prevent falls & subsequent injury

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27
Q

What are the cardiac rules?

A

Change positions slowly

BP <90/60 hold the medication, call the HCP

HR <60 hold the medication, call the HCP

Never abruptly stop a cardiac medication

Daily weights: Weight gain or loss of more than Two pounds a day or 5 pounds a week call your HCP

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28
Q

What does the parasympathetic division manage?

A

“rest and digest”
Activated under less stressful conditions, promotes relaxation & body maintenance

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29
Q

What are parasympathetic responses?

A

Constricts pupil, simulates salivation, slows heart, constricts breathing, stimulates digestion, stimulates gallbladder, contracts bladder, stimulates sex organs

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30
Q

Where are muscarinic receptors? Response?

A

Locations: Parasympathetic target organs (other than the heart???), heart

Selected Response: Stimulation of smooth muscle and exocrine gland secretions. Decreased heart rate and force of contraction

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31
Q

Where are nicotinic receptors located? Response?

A

Locations: Postganglionic neurons and neuromuscular junctions of skeletal muscle

Selected Response: Stimulation of smooth muscle and gland secretions

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32
Q

What do niconic recptors most importantly influence?

A

the somatic system or neuromuscular junction

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33
Q

What do muscarinic receptors most importantly influence?

A

Stimulation of smooth muscle and gland secretions

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34
Q

What is myasthenia gravis? What are s/s?

A

Loss of functioning Ach in the neuromuscular junction. Ach receptor antibodies decrease Ach receptor sites by up to 80%

S/S: Generalized muscle weakness & fatigue. First Signs: Eyelid muscle weakness, ptosis of eyelids & fatigue

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35
Q

What are neuro muscular blocker agent? What are their timeframe of paralysis?

A

Nondepolarizing : Skeletal muscle paralytic, intubation, ventilation, seizure control, lengthy procedures
Action: blocks ACh at the neuromuscular junction
Nursing Consideration?

Pancuronium(Pavulon) long acting 60-90 minutes
Rocuronium (Zemuron) short acting 15 minutes
Vecuronium (Norcuron) medium acting 30-45 minutes

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36
Q

What receptors are in the SNS?

A

adrenergic

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37
Q

What receptors are in the parasympathetic NS?

A

cholernergic

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38
Q

What drugs turn on the sympathetic nervous system?

A

Adrenergic agonists

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39
Q

What drugs turn off the sympathetic nervous system?

A

Adrenergic antagonists, mimics parasympathetic response

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40
Q

What drugs turn on the parasympathetic nervous system?

A

Cholinergic agonists

41
Q

What drugs turn off the parasympathetic nervous system?

A

Cholinergic antagonists or anticholinergics

42
Q

What are agonists?

A

Drugs that occupy receptors and activate them

43
Q

What are antagonists?

A

Drugs that occupy the receptors but do not activate them. Antagonist also block activation by agonists

44
Q

What are ANS drugs called? What do they affect?

A

Neuropharmacology. Drugs that help the systems that work without conscious input E.g. smooth muscle control, cardiac contraction, salivary, blood glucose, gastric, bronchial, respirator rate, etc.

45
Q

What are some s/s of the effects of the sympathetic nervous system? how may it present?

A

Dilated pupils = blurry vision
Inhibited saliva = dry mouth
Inhibit GI = shuts off peristalsis, constipation, ileus of the bowel (from stopping of bowel movements)
Increased heart rate = tachycardia, high blood pressure, vasoconstriction
Relaxing of airways = bronchioles will dilate
Relaxation of bladder = urinary retention from sphincter closing
** Increased blood sugar levels = for more available energy

46
Q

Who do you worry about in fight or flight mode? Why?

A

Diabetic. Increase of glucose levels

47
Q

What will adrenergic antagonists do?

A

Decrease blood pressure, constrict airflow, etc.

48
Q

What are the adrenoreceptors?

A

A1, A2, B1, B2

49
Q

What are the agonist (turn on) effects of A1? Where are the receptors found? What would be the effect? What does the antogonis do?

A

Vasoconstriction
Increased peripheral resistance
Increased blood pressure
Mydriasis
Increased closure of bladder spincter

Vascular system and bladder sphincter

Increase blood pressure, help with hypotension
(antagonist) Vasodilation, help with HTN
(antagonist) BPH, open up the sphincter wider and circumvent the pressure from the prostate blockage

50
Q

What should you remember for alpha 1?

A

VASCULAR

51
Q

What are the agonist effects on A2? Where are the receptors found? What would be the effect? What does the antagonist do?

A

Does the opposite of what you would expect
Inhibits release of norepinephrine (used to cause vasoconstriction)
Will see vasodilation
Inhibits acetylcholine release
Inhibits insulin release

Located in the adrenal glands

There are no A2 drugs

52
Q

What are the agonist effects on B1? Where are the receptors found? What would be the effect? What does the antagonist do?

A

Tachycardia, increased HR, contractility, increased blood pressure
Increased lipolysis
Increased release of renin

All over the heart, kidneys

(antagonist) beta blockers = lowered HR, decreased contractility, decreased BP
“lol” drugs
Used for HTN, dysrhythmias, heart failure

53
Q

What do you need to remember with B1?

A

1 HEART

54
Q

What are the agonist effects on B2? Where are the receptors found? What would be the effect? What does the antagonist do?

A

Vasodilation
Decreased peripherial resistance
Bronchodilation
Increased muscle and liver glycogenolysis
Increased release of glucagon

Receptors are in the lungs

Used to open up airways
Can lower the blood pressure by causing vasodilation
No B2 antagonist drugs

55
Q

What should you remember about B2?

A

2 LUNGS

56
Q

What helps relax the uterus to stop labor?

A

Terbutaline

57
Q

What are 3 adrenergic agonists? What is another name for an adrenergic agonist?

A

Epinephrine, norepinephrine, dopamine
Sympathomimetics (mimics the sympathetic)

58
Q

Epinephrine can be used for which indications? Why?

A

Cardiac arrest, severe bronchoconstriction, decongestion, anaphylaxis

Because it can turn on all adrenergic receptors (A1, A2, B1, B2)

59
Q

Why is there stinging at the injection site with epinephrine?

A

Because it causes vasoconstriction

60
Q

What is a contraindication for adrenergic agonists? Why?

A

Glaucoma. Increasing pressure can happen in the eyes too

61
Q

What is important about storing epi pens?
.

A

They do not need to be refrigerated. They need to be on your person. Store in a cool, dark place.

62
Q

How is epinephrine administered?

A

IV, IM and inhalation

63
Q

What med is contraindicated for a person with Raynaud’s disease? Why? What is Raynaud’s disease?

A

Phenylephrine

It’s an alpha 1 agonist. It turns on vasoconstriction. It will increase their symptoms

Vasoconstriction of the peripheral arteries. white, cold, painful. Affects the heart as well

64
Q

What is an indication of norepinephrine? Why? How is it administered

A

Hypotension, sepsis, cardiac failure

It vasoconstricts and elevates the BP because it works on an alpha 1 receptor

IV only, slow drip, short half-life, titrate

65
Q

What are similar drugs to phenylephrine? What is an important patient teaching?

A

Oxymetazoline (Afrin), pseudoephedrine (Sudafed)
Limit use for 3-5 days because of rebound congestion

66
Q

What are the side effects of clonidine? Why?

A

Orthostatic hypotension, increased risk for bleeding (because of vasodilation)
It’s an A2 agonist and reduces sympathetic outflow

67
Q

What is the one alpha 2 agonist drug?

A

Clonidine

68
Q

What receptors does isoproterenol affect?

A

B1 an B2

69
Q

What are LABA (long acting beta agonists)? What are they not used for?

A

Formoterol, olodaterol, salmterol

Emergency situations because they are longer acting

70
Q

What lowers potassium in the bloodstream because it pulls the K+ into the cells with it?

A

Albuterol

71
Q

Is albuterol short acting? Does it last long? What is it followed up with?

A

Yes,
No, it does not last long.
steroid

72
Q

What are adverse effects of abuterol?

A

Palpitations, HA, throat irritations, tremors, nervousness, tachycardia, insomnia, dry mouth, hypokalemia

73
Q

What is a critically high blood pressure? What is the lowest normal BP?

A

180/120
90/60

74
Q

What is a first dose phenomenon?

A

it more reactive with the first dose. Extremely low BP and can be at an unsafe level

fainting, orthostatic hypotension, syncope, LOC

75
Q

What is similar to clonidine? What is the difference in the indications? Recepors?

A

prazosin

BPH

alpha 2 agonist = clonadine
alpha 1 blocker = prazosin

76
Q

what is the nature of reflex tachycardia?

A

regular BP but high HR, pulse

77
Q

What does a nonselective beta blocker do? How does it manifest? what is a drug?

A

acts on all beta receptors in the body

constricts the bronchioles as well as the heart

propranolol

78
Q

What can beta blockers mask?

A

hypoglycemia or septic shock

79
Q

What is the most common beta blocker? why?

A

Metoprolol

safest because it is selective and only affects the heart

80
Q

What is angina?

A

chest pain

caused by ischemia to the heart tissue, low blood flow to the heart tissue

81
Q

What is miosis?

A

pupils constricting
pinpoint pupils

82
Q

what is mydriasis?

A

dilated pupils

83
Q

What is the neurotransmitter of the parasympathetic?

A

Acetycholine

84
Q

What is a cholernergic agonsit? what is it used for? Do we give it wit meals?

A

bethanechol

urinary retention

no, it affects its effectiveness

85
Q

What is myasthenia gravis? Features? What is it treated with?

A

neuromuscular junction disease. Destroys Ach receptors

drooping eyelids
weak arms and legs
drooling
change of voice

pyridostigmine

86
Q

How can a myasthenia gravis mimic? How is it distinguished?

A

cholernergic crisis

edrophonium, if there is improvement then it is myasthenia gravis

87
Q

What do you do before giving pyridostigmine?

A

give small drink of water to test their swallowing

88
Q

What can cause a cholinergic overload?

A

organophosphate poisening from pesticides

89
Q

What are s/s of a cholernergic overdoes? SLUDGEM

A

S salic
L lacrimation
U urination
D dirrhea
G GI effects, cramping
E emesis
M miosis, muscle twitching

90
Q

What is given for a cholnergic overdoes?

A

atropine

cholernergic antagonist, muscarinic antagonist, anticholnergic

91
Q

what are the TD patch similar to atropine? What is an important nursing consideration. Is it an adrenergic drug?

A

scopolamine

wear gloves

no. it blocks the parasympathetic receptors which mimics the sympathetic but that does not make it a sympathetic drug

92
Q

What is the order of using a paralytic?

A

sedatation, intubation, paralytics

93
Q

What paralytic is the shortest?

A

succinycholine

94
Q

What is malignant hyperthemia? What is the antidote?

A

HTN, muscle rigidity, tachycardia

dantrolene

95
Q

What is hyperkalemia contraindicated with succinylcholine?

A

it keeps the cells depolarized by stooping the potassium from entering the cell. Can exasperate hyperkalemia

96
Q

What is a long-acting paralytic? What is the reversal agent? What is a contraindiction?

A

pancuronium

neostigmine

sensitivity to bromide ion

97
Q

What is
chronotropic
inotropic
dromotropic

A

c: lower rate, decrease in resistance
i: less force,, decrease in workload
d: less beats, decrease in cardiac output

98
Q

What are the 4 main dangers of beta blockers (4 Bs)?

A

bradtcardia, hold with low BP
breathing problems, from vasoconstriction
bad for HF, worsening crackles
blood sugar masking

Pharm II (8 decks)

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