Exam 2 Flashcards
Why would epinephrine cause stinging at the injection site?
Because it causes vasoconstriction which irritates the vessels in the surrounding tissue as they constrict
What makes hyperkalemia a medical emergency? What causes hyperkalemia? Why? What are s/s?
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
What are s/s of hypokalemia?
arrhythmias (tachy, brady, irregular rhythm), shallow respirations, dyspnea, irritability, lethargy, thready pulse, N/V
What are normal potassium levels?
3.5-5 mEq/L
What are normal sodium levels?
135-145 mEq/L
What are s/s of hypernatremia?
flushed skin, irritability, restless, high BP, high pulse, edema, fever (low grade), low cardiac contractility
What are s/s of hyponatremia?
mental status change, lethargic, confusion, HA, loss of consciousness, seizure, death, bounding pulse, low BP
What are normal calcium levels?
9-10.5 mg/dL
What are s/s of hypercalcemia?
Muscle weakness, high fatigue, diminished deep tendon reflexes (hyporeflexia), mental status changes, headache, kidney stones
What are s/s of hypocalcemia?
“CATS” Convulsions, Arrhythmias, Tetany; spasms & stridor, positive Chvostek’s sign, Trousseau’s sign, increased deep tendon reflexes, seizures
How is the heart controlled by the ANS? What neurotransmitters are involver? What is the result?
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
What are 2 other names for adrenergic agonists?
Sympathomimetic,
Catecholamines
What are 2 other names for adrenergic antagonists?
Sympatholytics,
\Adrenergic blockers
What are 2 other names for cholinergic agonists?
Parasympathomimetics,
Muscarinic agonists
What are 3 other names for anticholinergic drugs?
Parasympatholytics,
Muscarinic antagonists,
Cholinergic blockers
What neurotransmitters are involved with “fight or flight” (sympathetic)? Where do they come from? What are their effects?
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
What is the function of adrenergic drugs?
stimulate the sympathetic nervous system by stimulating the adrenergic alpha or beta receptors
What are the 3 neurotransmitters (catecholamines) of the sympathetic nervous system?
dopamine
norepinephrine
epinephrine
What breaks down catecholamines?
COMT (catechol methyltransferase)
MAO (monamine oxidase)
What are influenced by alpha 1 receptors? What is the response?
all sympathetic organs besides the heart
constriction of blood vessels
dilation of pupils
relaxes bladder sphincter
What is influenced by the alpha 2 receptor? What is the response?
brain stem adrenergic terminals
inhibition of norepinephrine release
causes vasodilation
Where is the location of beta 1 receptors? What is the response?
heart and kidneys
increased heart rate and force of contraction
release of renin
Where is the location of beta 2 receptors? Response?
all sympathetic organs except heart
inhibition of smooth muscle contraction
bronchodilation
uterine relaxation
What is used if norepinephrine is extravasated into tissue?
phentolamine
Why are bronchodilators used before other inhalers when treating asthma?
albuterol/salbutamol cause immediate bronchodilation which allows other inhaled medications to be deposited further into the bronchiole tree , thus increasing their effectiveness.
What is the nature of 1st dose phenomenon? When is a good time to take med to deal with 1st dose effect?
Sudden & Severe decrease in blood pressure
Syncope or loss of consciousness
Give the dose at bedtime to prevent falls & subsequent injury
What are the cardiac rules?
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
What does the parasympathetic division manage?
“rest and digest”
Activated under less stressful conditions, promotes relaxation & body maintenance
What are parasympathetic responses?
Constricts pupil, simulates salivation, slows heart, constricts breathing, stimulates digestion, stimulates gallbladder, contracts bladder, stimulates sex organs
Where are muscarinic receptors? Response?
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
Where are nicotinic receptors located? Response?
Locations: Postganglionic neurons and neuromuscular junctions of skeletal muscle
Selected Response: Stimulation of smooth muscle and gland secretions
What do niconic recptors most importantly influence?
the somatic system or neuromuscular junction
What do muscarinic receptors most importantly influence?
Stimulation of smooth muscle and gland secretions
What is myasthenia gravis? What are s/s?
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
What are neuro muscular blocker agent? What are their timeframe of paralysis?
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
What receptors are in the SNS?
adrenergic
What receptors are in the parasympathetic NS?
cholernergic
What drugs turn on the sympathetic nervous system?
Adrenergic agonists
What drugs turn off the sympathetic nervous system?
Adrenergic antagonists, mimics parasympathetic response
What drugs turn on the parasympathetic nervous system?
Cholinergic agonists
What drugs turn off the parasympathetic nervous system?
Cholinergic antagonists or anticholinergics
What are agonists?
Drugs that occupy receptors and activate them
What are antagonists?
Drugs that occupy the receptors but do not activate them. Antagonist also block activation by agonists
What are ANS drugs called? What do they affect?
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.
What are some s/s of the effects of the sympathetic nervous system? how may it present?
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
Who do you worry about in fight or flight mode? Why?
Diabetic. Increase of glucose levels
What will adrenergic antagonists do?
Decrease blood pressure, constrict airflow, etc.
What are the adrenoreceptors?
A1, A2, B1, B2
What are the agonist (turn on) effects of A1? Where are the receptors found? What would be the effect? What does the antogonis do?
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
What should you remember for alpha 1?
VASCULAR
What are the agonist effects on A2? Where are the receptors found? What would be the effect? What does the antagonist do?
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
What are the agonist effects on B1? Where are the receptors found? What would be the effect? What does the antagonist do?
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
What do you need to remember with B1?
1 HEART
What are the agonist effects on B2? Where are the receptors found? What would be the effect? What does the antagonist do?
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
What should you remember about B2?
2 LUNGS
What helps relax the uterus to stop labor?
Terbutaline
What are 3 adrenergic agonists? What is another name for an adrenergic agonist?
Epinephrine, norepinephrine, dopamine
Sympathomimetics (mimics the sympathetic)
Epinephrine can be used for which indications? Why?
Cardiac arrest, severe bronchoconstriction, decongestion, anaphylaxis
Because it can turn on all adrenergic receptors (A1, A2, B1, B2)
Why is there stinging at the injection site with epinephrine?
Because it causes vasoconstriction
What is a contraindication for adrenergic agonists? Why?
Glaucoma. Increasing pressure can happen in the eyes too
What is important about storing epi pens?
.
They do not need to be refrigerated. They need to be on your person. Store in a cool, dark place.
How is epinephrine administered?
IV, IM and inhalation
What med is contraindicated for a person with Raynaud’s disease? Why? What is Raynaud’s disease?
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
What is an indication of norepinephrine? Why? How is it administered
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
What are similar drugs to phenylephrine? What is an important patient teaching?
Oxymetazoline (Afrin), pseudoephedrine (Sudafed)
Limit use for 3-5 days because of rebound congestion
What are the side effects of clonidine? Why?
Orthostatic hypotension, increased risk for bleeding (because of vasodilation)
It’s an A2 agonist and reduces sympathetic outflow
What is the one alpha 2 agonist drug?
Clonidine
What receptors does isoproterenol affect?
B1 an B2
What are LABA (long acting beta agonists)? What are they not used for?
Formoterol, olodaterol, salmterol
Emergency situations because they are longer acting
What lowers potassium in the bloodstream because it pulls the K+ into the cells with it?
Albuterol
Is albuterol short acting? Does it last long? What is it followed up with?
Yes,
No, it does not last long.
steroid
What are adverse effects of abuterol?
Palpitations, HA, throat irritations, tremors, nervousness, tachycardia, insomnia, dry mouth, hypokalemia
What is a critically high blood pressure? What is the lowest normal BP?
180/120
90/60
What is a first dose phenomenon?
it more reactive with the first dose. Extremely low BP and can be at an unsafe level
fainting, orthostatic hypotension, syncope, LOC
What is similar to clonidine? What is the difference in the indications? Recepors?
prazosin
BPH
alpha 2 agonist = clonadine
alpha 1 blocker = prazosin
what is the nature of reflex tachycardia?
regular BP but high HR, pulse
What does a nonselective beta blocker do? How does it manifest? what is a drug?
acts on all beta receptors in the body
constricts the bronchioles as well as the heart
propranolol
What can beta blockers mask?
hypoglycemia or septic shock
What is the most common beta blocker? why?
Metoprolol
safest because it is selective and only affects the heart
What is angina?
chest pain
caused by ischemia to the heart tissue, low blood flow to the heart tissue
What is miosis?
pupils constricting
pinpoint pupils
what is mydriasis?
dilated pupils
What is the neurotransmitter of the parasympathetic?
Acetycholine
What is a cholernergic agonsit? what is it used for? Do we give it wit meals?
bethanechol
urinary retention
no, it affects its effectiveness
What is myasthenia gravis? Features? What is it treated with?
neuromuscular junction disease. Destroys Ach receptors
drooping eyelids
weak arms and legs
drooling
change of voice
pyridostigmine
How can a myasthenia gravis mimic? How is it distinguished?
cholernergic crisis
edrophonium, if there is improvement then it is myasthenia gravis
What do you do before giving pyridostigmine?
give small drink of water to test their swallowing
What can cause a cholinergic overload?
organophosphate poisening from pesticides
What are s/s of a cholernergic overdoes? SLUDGEM
S salic
L lacrimation
U urination
D dirrhea
G GI effects, cramping
E emesis
M miosis, muscle twitching
What is given for a cholnergic overdoes?
atropine
cholernergic antagonist, muscarinic antagonist, anticholnergic
what are the TD patch similar to atropine? What is an important nursing consideration. Is it an adrenergic drug?
scopolamine
wear gloves
no. it blocks the parasympathetic receptors which mimics the sympathetic but that does not make it a sympathetic drug
What is the order of using a paralytic?
sedatation, intubation, paralytics
What paralytic is the shortest?
succinycholine
What is malignant hyperthemia? What is the antidote?
HTN, muscle rigidity, tachycardia
dantrolene
What is hyperkalemia contraindicated with succinylcholine?
it keeps the cells depolarized by stooping the potassium from entering the cell. Can exasperate hyperkalemia
What is a long-acting paralytic? What is the reversal agent? What is a contraindiction?
pancuronium
neostigmine
sensitivity to bromide ion
What is
chronotropic
inotropic
dromotropic
c: lower rate, decrease in resistance
i: less force,, decrease in workload
d: less beats, decrease in cardiac output
What are the 4 main dangers of beta blockers (4 Bs)?
bradtcardia, hold with low BP
breathing problems, from vasoconstriction
bad for HF, worsening crackles
blood sugar masking
