Exam 2 Flashcards
Heart failure
The heart muscle (myocardium) weakens and enlarges causing decreased ability to pump the blood through the heart and into systemic circulation
CHF
Compensatory mechanisms fail and the peripheral tissues and lungs become congested (fluid overload)
Diastolic heart failure (EF, etc)
normal EF
heart doesn’t relax or fill enough
systolic heart failure (EF, etc)
low EF <55%
doesn’t pump strong enough
left sided HF S&S (5)
pulmonary congestion, dyspnea, cough, oliguria, weight gain
right sided HF S&S (3)
peripheral edema, JVD, weight gain
cardiac glycosides MOA
inhibits sodium-potassium pump
increased ICF sodium
cardiac fibers contract more efficiently
inotrope and chronotrope of cardiac glycosides
+ inotrope (increases CO)
- chronotrope (decreases HR by decreasing AV conduction)
What do cardiac glycosides do
Increases CO which increases renal perfusion and increased fluid excretion and less edema
Lanoxin (digoxin) use and 2 routes
2nd line treatment for HF
used for afib/aflutter
slows down HR not BP
PO/IV
therapeutic window of digoxin
0.5-2 ng/ml
SMALL
who can’t take digoxin (4) and half life
people with low protein (malnourished)
renal insufficiency (low dose)
thyroid issues (HYPO=low dose)
watch creatinine (excreted by kidneys)
long half life accumulation can occur from long HL
Digoxin toxicity
bradycardia, anorexia, N/V/D, visual changes, confusion, delirium, ventricular dysrhythmias, yellow halos
digoxin antidote
digibind, ovine
drug interactions of digoxin
K+ loss diuretics increase risk of toxicity
cortisone taken PO/IV increases hypokalemia increasing risk of toxicity
antacids decrease absorption, stagger doses
nursing considerations of digoxin
obtain apical pulse before administration
assess for toxicity and monitor levels of drug and potassium
primacor (milrinone) inocor (class, MOA, route)
Phosphodiesterase inhibitor
increases SV, CO, and vasodilation (+ inotrope)
increases HR
IV
what are we concerned about with Primacor (milrinone) inocor
cardiac dysrhythmia (check EKG)
drop in BP since we’re vasodilating and getting rid of fluid
vasodilators in terms of HF
decrease venous blood return to the heart, decrease preload
arterial dilators for HF
decrease afterload increasing cardiac output, increased renal perfusion by dilating arterioles, improve circulation to muscles
ACE inhibitors for HF
dilate venules, arterioles, improve renal blood flow, decrease blood volume, certain ARBS also (diovan, atacand)
aldactone (spironolactone) for HF
K+ sparing diuretic, blocks the secretion of aldosterone causing decreased fluid retention
natrector for HF
Inhibits ADH, promotes vasodilation, diuresis (acute CHF), BiDil (hydralazine and isosorbide dinitrate)
left arm pain
heart
right arm pain
gallbladder
classic (stable) angina
occurs with stress or exertion
unstable (preinfarct) angina
occurs frequently with progressive severity unrelated to activity
variant (prinzmetal, vasospasm) angina
occurs during rest
how to antianginals work
increases blood flow to the heart by increasing supply or decreasing demand
3 types of antiaginals
nitrates
beta-blockers
Ca+ channel blockers
what do nitrates do
cause generalized vascular and coronary vasodilation increasing blood flow to coronary arteries, reducing ischemia
important stuff about nitroglycerin
don’t touch the med (drops BP)
patches go everywhere except chest
SL 0.4mg or 1/150 gr
take 3 times q5 min, call 911
keep away from light and heat and children
DO NOT SWALLOW SL
pharmacodynamics of nitroglycerin
acts on smooth muscle of blood vessels causing relaxation and dilation
decreases preload and afterload and myocardial O2 demand
remove patch for 8-12 hours
side effects of nitroglycerin
HA, hypotension, dizziness, weakness, and faintness
adverse effects of nitroglycerin
reflex tachycardia if not tapered off
drug interactions of nitroglycerin
not taken with BB, Ca+ blockers, vasodilators, and ETOH may cause hypotension
not taken w viagra
beta blockers use
decrease HR and contractility, reducing O2 demands and angina
used for stable angina
things to avoid in BB and what happens if d/c abruptly
avoid in 2nd and 3rd degree AV block (lower HR)
taper dose to avoid reflex tachy, recurrent angina, and SOB
side effects of BB
Mild and transient bradycardia, AV block, hypotension, bronchoconstriction, mask symptoms of hypoglycemia, inhibit glycogenolysis
Ca+ channel blockers
used for variant and stable angina
Relax peripheral arterioles and coronary spasm decreasing myocardial O2 demand (dilates coronary arteries)
decreases contractility, afterload, PVR, workload
Ca+ channel blocker side effects
bradycardia, dizziness, hypotension, constipation
Lowers BP AND HR
P wave
atrial activation
QRS
ventricular depolarization
T
ventricular repolarization
P-R interval
AV conduction time
Q-T
ventricular action potential
what are dysrhythmias caused by
MI, hypoxia, hypercapnia, thyroid disease, CAD, electrolyte imbalance (K+, Mg++)
class 1 antidysrhythmics
3 types
decreases sodium influx into cardiac cells
decreased conduction velocity, automaticity, and ectopy
class IA antidysrhythmic
quinidine, procainamide, disopyramide
slows conduction and prolongs repolarization (PAT, SVT)
class IB antidysrhythmic
lidocaine (IV), mexiletine HCL (oral)
slows conduction and shortens repolarization (VT, vfib)
class IC antidysrhythmic
flecainide
class 2 antidysrhythmic
Decrease conduction velocity, automaticity and recovery time
Examples: Propranolol (Inderal), acebutolol (Sectral), esmolol (Brevibloc), Sotalol (betapace)
BETA BLOCKERS
acebutolol (sectral)
class II antidysrhythmic
beta1 blocker
for refractory VT, recurrent stable VT, angina, HTN
contraindications of acebutolol (sectral)
2nd-3rd degree HB, bradycardia, HF, cardiogenic shock
caution for acebutolol (sectral)
undergoing major surgery, renal or hepatic impairment, labile mellitus
interactions of acebutolol (sectral)
increased effects with diuretics, prolonged hypoglycemia
antagonist effect with albuterol, terbutaline, and metaproterenol
may increase ALT, AST, ALP, BUN, K+
side effects of acebutolol (Sectral)
dizziness, nausea, HA, hypotension, diaphoresis, fatigue, bradycardia
Class III antidysrhythmic
increase refractory period and prolong action potential
amiodarone (cordarone) for afib or vtach
Monitor thyroid and pulmonary function (may cause pulmonary fibrosis)
Class IV antidysrhythmics examples
Ca+ channel blockers (ONLY ONES THAT LOWER CONDUCTION)
verapamil (calan, isopitin), diltiazem (cardizem)
Class IV antidysrhythmics MOA
blocks Ca+ influx, decreasing excitability and contractility, increases refractory period of AV node, decreasing ventricular response
Class IV antidysrhythmics contraindications and side effects
contra: AV block and heart failure
side effects: hypotension, orthostatic hypotension, bradycardia, heart block
LDLs (tight or loose, what are they for, what increases them)
tight
carried by proteins that enter circulation, broken down for energy
diabetes and alcohol increase risk of LDLs
HDLs (tight or loose, what are they for, what increases them)
loose
used for energy, pick up remnants of fat left in periphery by LDL breakdown
Exercise!
LDL levels
risk for MI or CVA <70
Optimal: <100
normal: 100-129
borderline: 130-159
high: 160-189
very high: >=190
HDL levels
Good: >=60
low: <40
triglyceride levels
normal: <150
borderline: 150-199
high: 200-499
very high: >=500
drugs for hyperlipidemia (5)
Bile acid sequestrants
HMG-CoA inhibitors
Fibrates
Niacin
Cholesterol absorption inhibitors
Bile acid sequestrants MOA
Bind bile acids in the intestine, allow excretion in feces instead of reabsorption
cholesterol iodized in the liver and serum cholesterol levels begin to fall
bile acid sequestrants indications and 3 examples
For patients with primary hypercholesterolemia and pruritus associated with partial biliary obstruction
Examples: Welchol, Questran, Prevalite
bile acid sequestrants adverse effects
HA, fatigue, and drowsiness
Direct GI irritation: nausea and constipation
Increased bleeding times
Vitamin A and E deficiencies bc fat soluble and we’re preventing fat absorption
drug-to-drug interactions of bile acid sequestrants
malabsorption of fat soluble vitamins
HMG-CoA inhibitors actions
decreases serum cholesterol, LDLs, and triglycerides
increases HDL
indications of HMG-CoA inhibitors
hyperlipidemia, prevention of MI, CVA
examples of HMG-CoA inhibitors
-statins
HMG-CoA inhibitors contraindications and caution
allergy
metabolized by cytochrome P450 3A4
active liver disease or alcoholic liver disease
pregnancy and lactation
caution: impaired endocrine function
adverse effects of HMG-CoA inhibitors
myopathy
liver failure
rhabdomyolysis
drug to drug interactions of HMG-CoA inhibitors
grapefruit juice BAD
rosuvastatin (crestor)
prototype
indication: decreases lipids, especially LDL and triglycerides
inhibits HMG-CoA reductase
side effects of rosuvastatin (crestor)
HA, constipation, diarrhea, myalgia
adverse effects of rosuvastatin (crestor)
rhabdomyolysis, photosensitivity, hyperglycemia, elevated LFTs
contraindications of rosuvastatin (crestor)
pregnancy, lactation, liver disease
adverse effects of zetia
abdominal pain and diarrhea
HA, dizziness, fatigue, URI, back pain
muscle aches and pain
niacin
vitamin B3, inhibits release of fatty acids from adipose tissue
increases rate of triglyceride removal
chest and face swell up
fenofibrates
inhibit triglyceride synthesis in the liver, decreases LDL
increases uric acid secretion, stimulates triglyceride breakdown
gemfibrozil
inhibits peripheral breakdown of lipids
reduces production of triglycerides and LDL
increases HDL
2 PSK9 inhibitors
alirocumab (praluent)
evolocumab (repatha)
-CUMAB
2 times to use injectable lipid lowering therapy
intolerable to -statins
patients goal is not achievable with highest statin dose
patient education for injectable lipid lowering therapy (how long to leave it outside the fridge)
take out of the fridge 30 min prior
peripheral vasodilators and 2 examples
increase blood flow to extremities in PAD and PVD
effective in raynaud’s or buerger’s disease
cilostazol (pletal)
trental
pletal class and trade name
peripheral vasodilator
cilostazol
pletal contraindications and caution
contraindications: CHF class III-IV, arterial bleeding, severe hypotension, postpartum, tachy
caution: bleeding disorders, tachy
pletal interactions and route
hypotension with antihypertensives
PO
therapeutic effects of pletal
increased circulation caused by PVD, raynaud’s, cerebral vascular insufficiency
inhibits platelet aggregation, causes vasodilation
side and adverse effects of pletal
S/E: N/V, dizziness, syncope, blood in the eye, HA, abd pain, abnormal stools, peripheral edema
A/E: tachy, palpitations
nursing considerations of pletal
obtain baseline VS
assess for signs of inadequate blood flow to extremities, pallor, coldness, and pain
monitor for tachy and hypotension
arterial blood clot (what type of cells and caused by what)
WBC and RBC
platelet aggregation
blood coagulation
venous blood clot (what type of cells, caused by what, CAN cause what, and prophylaxis)
RBC and PLT
blood stasis or slow flow
occurs rapidly
can cause DVT and PE
give heparin or lovenox
what to consider for artificial valves
pts HAVE to be on anticoagulants bc the body will attack the foreign object causing clotting and a stroke
anticoagulants given for what type of stroke
ischemic
fragmin class
anticoagulants
indication of heparin
rapid anticoagulation for thrombosis such as DVT, PE, CVA
during surgery to prevent thrombosis
DIC
DVT/PE prophylaxis
afib when off coumadin
MOA of heparin
Combines with antithrombin III, prevents formation and doesn’t break the clot
Inhibits conversion of fibrinogen to fibrin which prevents fibrin clot formation
prolongs PTT (effectiveness of heparin, bleeding is a worry)
Nomogram
like insulin sliding scale but for heparin
pharmacodynamics of heparin
poorly absorbed GI
destroyed by heparinase in the liver
IV or SQ
fast half life
flow sheet so nurses know how much to administer
How is lovenox administered
2 inches away from the umbilicus, MAINTAIN AIR BUBBLE
side effects of heparin (3)
bruising
itching
burning
adverse effects of heparin
bleeding
ecchymosis
thrombocytopenia (low platelets during allergic reaction so they start clotting, biggest concern)
hemorrhage
contraindications of heparin
bleeding disorder
peptic ulcer
hepatic or renal disease
hemophilia (clotting takes long)
CVA (hemorrhagic)
drug and food interactions of heparin
increased effect with ASA, NSAIDS, thrombolytics, and probenecid
decreased effect with nitroglycerin and protamine sulfate
antidote for heparin
protamine sulfate
nursing considerations of heparin
obtain history of abnormal clotting, ETOH, or renal or liver disease
check PTT q4 hours when changed
check stool melena
check H&H if they’re losing blood
indications of warfarin (coumadin)
bleeding disorder
peptic ulcer
hepatic or renal disease
hemophilia (clotting takes long)
CVA (hemorrhagic)
same as heparin!
how to adjust the dose of warfarin
according to pt/INR
check INR within 3 days of antibiotics
ranges of INRs for warfarin (afib, DVT/PE/mechanical valves)
afib: 2-3
DVT/PE/mechanical valve: 2.5-3.5
antidote for warfarin
vitamin K
novel anticoagulants
no antidote
no INR to monitor
for afib, DVT/PE, NOT MECHANICAL VALVES (use warfarin)
examples of NOAC
xarelto, eliquis, pradaxa
high incidence of bleeding but less than warfarin
dabigatran etexilate (pradaxa) use
thromboembolism (DVT/PE) treatment and prophylaxis, stroke prophylaxis (non-valvular afib)
MOA of dabigatran etexilate (pradaxa)
inhibits thrombin
important info about dabigatran etexilate (pradaxa)
excreted by kidneys, decrease dose in CKD, avoid in hemodialysis
side effects of dabigatran etexilate (pradaxa)
bleeding, bruising, gastritis (leads to bleeding)
adverse effects of dabigatran etexilate (pradaxa)
hemorrhage, hematoma, thrombocytopenia
black box warning of dabigatran etexilate (pradaxa)
increase thrombotic event and stroke risk when d/c prematurely, epidural and spinal hematoma risk PARALYSIS!!
antidote for dabigatran etexilate (pradaxa)
praxbind
MOA of antiplatelets
used to prevent thrombosis in arteries by suppressing platelet aggregation
indications of antiplatelets
prevention of MI, CVA, or TIA
examples of antiplatelets
ASA
ticagrelor (brilinta) must use with 100 mg ASA, or less usually 81mg
(prasugrel) effient
clopidogrel (plavix)
pletal
agrylin
reopro
integrilin
pletal is an antiplatelet for WHERE
peripheral, NOT heart
use of agrylin
If we’re concerned about MI or clots
clopidogrel (plavix) class, dose
antiplatelet
loading dose 300-600mg then 75 mg daily, check P2Y12
indications of clopidogrel (plavix)
prevent recurrence of CVA, vascular death
MOA of clopidogrel (plavix)
inhibits platelet aggregation
contraindications and caution of clopidogrel (plavix)
contra: intracranial hemorrhage, peptic ulcer
caution: liver disease, GI bleeding, surgery (talk to cardiologist if not brain or spinal), bleeding from trauma
side effects and adverse of clopidogrel (plavix)
S/E: URI, flu-like symptoms, dizziness, HA, fatigue, CP, diarrhea, bruising, bleeding
A/E: HTN, bronchitis
interactions of clopidogrel (plavix)
May increase bleeding when used with NSAIDS
Interferes with the metabolism of phenytoin, warfarin, fluvastatin, tamoxifen, tolbutamide, NSAIDS, and torsemide
May increase bleeding when taken with ginger, garlic, gingko, feverfew
thrombolytics MOA
STRONGEST
promotes fibrinolytic mechanism
converts plasminogen to plasmin DESTROYING fibrin in the clot
disintegrates within 4 hours
use of thrombolytics
MI, PE, DVT, CVA
must be EMBOLIC stroke
ending of thrombolytics
-ase
remember -ase is enzymes which speed things up and thrombolytics are strong and fast
Alteplase (tPA) drug class and indications
thrombolytic
dissolves clot following AMI, PE, acute ischemic stroke
for emergency situations!
MOA of Alteplase (tPA)
promotes conversion of plasminogen to plasmin, digesting the fibrin matrix of clots, initiating fibrinolysis
side and adverse effects of Alteplase (tPA)
S/E: bleeding
A/E: intracerebral hemorrhage, stroke, atrial or ventricular dysrhythmias
contraindications of Alteplase (tPA)
internal bleeding, bleeding disorders, recent CVA, surgery or trauma, bacterial endocarditis, severe liver dysfunction, uncontrolled HTN
drug-food interactions of Alteplase (tPA)
increased bleeding with anticoags, NSAIDS, cefotetan, plicamycin
Sodium-glucose Co-transporter 2 (SGLT-2) inhibitors ending
-flozin
MOA of Sodium-glucose Co-transporter 2 (SGLT-2) inhibitors
induced glucosuria independent of insulin secretion
reduces ability of renal tubules to absorb glucose, allows increased insulin sensitivity, decreased gluconeogenesis
used for diabetes and HF (low EF) even without diabetes
contraindications of Sodium-glucose Co-transporter 2 (SGLT-2) inhibitors
type 1 DM, DKA, severe renal disease (GFR <30), on HD
adverse effects of Sodium-glucose Co-transporter 2 (SGLT-2) inhibitors
hyperkalemia, mycotic infections, UTI, renal insufficiency, hypotension, fungal infection
empagliflozin (jardiance) dosing
10mg PO in the morning, titrate up to 25 mg
D/C if GFR persistently below 45
dapagliflozin (farxiga) dosing
5 mg can increase to 10
D/C if GFR <60
canagliflozin (invokana) dosing
100 mg before 1st meal of the day
increase to 300 for pt with normal renal function (GFR >60)
sacubitril/valsartan (entresto) indication
heart failure with reduced EF, NYHA class II-IV
sacubitril/valsartan (entresto) side effects
hypotension, dizziness, cough, hyperkalemia, renal failure
sacubitril/valsartan (entresto) adverse effects
hypersensitivity, angioedema, severe hypotension, renal failure
sacubitril/valsartan (entresto) black box warning
fetal toxicity
Chronic bronchitis
constriction
bronchiectasis
obstruction of airflow
asthma
Constriction and inflammation of bronchial tubes
Increased mucus production
restrictive lung disease
prevents lungs from expanding
causes of chronic bronchitis
smoking
chronic lung infections
lung sounds in chronic bronchitis
rhonchi
examples of beta2 adrenergic agonists
albuterol/proventil (ONLY RESCUE MED)
ventolin
metaproterenol
Xopenex
like proventil
less rapid HR
good for pts with afib or tachy
how to use aerosol inhaler
Insert medication canister into plastic mouthpiece
Shake inhaler before using, remove cap from mouthpiece
Breath out through mouth, place mouthpiece 1-2 inches from or in mouth (don’t wrap your lips around mouthpiece)
Take slow, deep breath while pressing top of medication canister once
Hold breath for a few seconds, exhale slowly through pursed lips
Wait two minutes, repeat starting from shaking again
Spacer can be used for kids or elderly (or anyone having trouble)
bronchodilators and steroid inhalers
Administer bronchodilator first, wait 5 minutes then steroid inhaler
ipratropium (spiriva)
anticholinergic
for bronchospasm of COPD
EVERY DAY
relaxes smooth muscle of bronchioles
when to administer spiriva with beta-agonists and cromolyn/steroids
Administer 5 minutes after beta-agonist (if also using)
Administer 5 minutes before steroid or cromolyn (this allows the bronchioles to dilate so the steroids or cromolyn can be deposited in the bronchioles
SE of spiriva
dry mouth, hoarseness
AE of spiriva
angioedema, dehydration, hyperglycemia
contraindications and caution of spiriva
contra: pregnancy or peanut allergy
caution: lactose sensitivity, hypersensitivity, narrow-angle glaucoma, breastfeeding
perks of spiriva
less systemic effects
more tolerable
Methylxanthine (xanthine) derivatives
treatment of asthma
stimulates CNS and respirations, dilates coronary artery and pulmonary vessels
diuresis
Methylxanthine (xanthine) derivatives examples
aminophylline
theophylline
caffeine
therapeutic range of Methylxanthine (xanthine) derivatives
NARROW
10-20 mcg/ml
contraindications of theophylline
GI problems, coronary disease, respiratory dysfunction, renal or hepatic disease, alcoholism, and hyperthyroidism
adverse effects of theophylline
if levels >20 mcg/ml
Range from GI upset, nausea, irritability, and tachycardia to seizure, brain damage, coma, and even death
Leukotriene receptor antagonists and synthesis inhibitors
EVERY DAY, NOT A RESCUE MED
not for asthma attacks
exercise induced asthma
moves eosinophils (seasonal asthma) and mast cells
Leukotriene receptor antagonists prototype montelukast (singulair)
inhibits smooth muscle contraction and bronchoconstriction
side effects of Leukotriene receptor antagonists prototype montelukast (singulair)
fever, HA, dizziness, fatigue, nasal congestion, cough, sore throat
contraindications of Leukotriene receptor antagonists prototype montelukast (singulair)
hypersensitivity, severe asthma attack, status asthmaticus
caution in Leukotriene receptor antagonists prototype montelukast (singulair)
severe liver disease
black box warning for Leukotriene receptor antagonists prototype montelukast (singulair)
FOR KIDS
INCREASED RISK OF PSYCHOSIS AND SUICIDAL IDEATION
Glucocorticoids
can be used for asthma and COPD
causes hyperglycemia, adrenal suppression, ulcer formation, immunosuppression if long term PO
why are inhaled steroids better
less systemic effects
use of Glucocorticoids (inhaled)
prevents COPD/asthma exacerbations
ant inflammatory
used if bronchodilator therapy doesn’t work or maximum dose of theophylline or adrenergics used
synergistic with beta2 agonist
takes 1-4 weeks
preferred
should Glucocorticoids be taken with food
yes to prevent ulcers
what are Glucocorticoids combined with to alleviate constriction
advair
side effects of oral Glucocorticoids
Generally local, throat irritation, hoarseness, dry mouth
Oral and pharyngeal fungal infections, reversed with d/c and antifungal treatment
Candida albicans (fungal infections) can be prevented by using a spacer, rinse mouth out with water after each dose, wash the apparatus daily with warm water
cromolyn (intal) indications
prophylactic treatment of bronchial asthma (NOT for acute attacks)
daily inhalation
MOA of cromolyn (intal)
inhibits release of histamine
side effects of cromolyn (intal)
bad taste (drink water after)
rebound bronchospasm (don’t D/C abruptly)
nedocromil MOA
suppresses release of histamine, leukotrienes, and mediators from mast cells
NOT for acute asthma attack
more effective than cromolyn
less SE and bad taste
SE of nedocromil
bad taste, rinse mouth
mucomyst (acetylcysteine)
loosens mucus
administered by nebulizer
orally diluted
used as adjunct to bronchodilators when excess secretions are happening
antidote for acetaminophen if within 12-24 hours
5min after bronchodilators
SE of mucomyst (acetylcysteine)
N/V, stomatitis (oral ulcers), and runny nose
smells nasty
common cold
rhinovirus
1-4 days before onset of symptoms, transmission from contaminated surfaces
watery discharge
21 day course
acute rhinitis
acute inflammation of the mucous membranes accompanies common cold
sinusitis
inflammation of the sinuses, usually viral so we have to let it run its course; can be bacterial so we use abx
acute pharyngitis
usually viral, similar to cold
antihistamines
block nasal secretions
h1 blocker/antagonist
H1
when stimulated, the extravascular smooth muscle in the nasal cavity are constricted
H2
when stimulated, increase gastric secretions
1st gen antihistamines
can cause dry mouth, drowsiness and other anticholinergic symptoms. OTC.
Example: Benadryl
2nd gen antihistamines
non-sedating antihistamines, fewer anticholinergic effects
Examples: zyrtec (cetirizine), allegra (fexofenadine), loratadine (claritin)
Less side effects, better dosing profile, or better efficacy
diphenhydramine (benadryl)
treats allergic rhinitis and itching, prevents motion sickness, sleep aid, antitussive, decreases swelling and secretions
diphenhydramine (benadryl) contraindications
acute asthma attack, severe liver disease, lower respiratory disease, neonate, MAOIs, COPD, asthma
Dries secretions, we don’t want to thicken secretions
limit use in BPH bc urinary retention
anticholinergic effects (4 big)
constipation
dry mouth
urinary retention
orthostatic hypotension
diphenhydramine (benadryl) contraindications interactions
increased CNS depression with ETOH, narcotics and hypnotics, and barbiturates
avoid with MAOI
side effects and AR of diphenhydramine (benadryl)
SE: drowsiness, dizziness, fatigue, urinary retention, constipation, dry mouth and throat, decreased secretions, excitation in children
AR: life-threatening agranulocytosis, hemolytic anemia,
thrombocytopenia
benadryl in kids
used to make u sleep, might give paradoxical reaction (more awake)
pharmacokinetics of antitussives
rapid absorption
metabolized in liver
excreted in urine
contraindications of antitussives
patients who need to cough to maintain the airway (trach patients)
head injury
impaired CNS (coma or sedation)
caution of antitussives
hypersensitivity or history of narcotic addiction (codeine)
adverse effects of antitussives
drying effect on the mucous membranes, drowsiness and sedation (CNS effects), and GI upset
centrally acting
sedating
Dextromethorphan hydrobromide prototype (robitussin, sucrets cough control, benylin, vicks 44)
temporary suppression of a non-productive cough, reduces viscosity of tenacious secretions, dries up mucous membranes, sedative
contraindications of Dextromethorphan hydrobromide
COPD, chronic productive cough, hypersensitivity, MAOIs, and children under 2, HTN, cardiac pts should take something else (vasoconstriction), diabetic patients need to look for diabetic-safe version
SE and AE of Dextromethorphan hydrobromide
SE: nausea, dizziness, drowsiness, sedation
AE: hallucinations at high doses (codeine), HTN crisis
topical nasal decongestants action
Sympathomimetic
Affect sympathetic nervous system to cause vasoconstriction esp in the nose
Cause less inflammation of the nasal membrane
topical nasal decongestants indications
Relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis (decrease in secretions when we constrict blood vessels)
topical nasal decongestants contraindications
lesion or erosion in mucous membranes
caution in topical nasal decongestants
may cause CVA, HTN, renal failure
not big worry bc not systemic
AE of topical nasal decongestants
local stinging and burning
rebound congestion (use only when sick)
sympathomimetic effects
2 drugs to avoid with topical nasal decongestants
cyclopropane and halothane
indications of Prototype topical nasal decongestants
Symptomatic relief of nasal and nasopharyngeal mucosal congestion due to the common cold, hay fever, or other respiratory allergies; adjunctive therapy of middle ear infections to decrease congestion around the eustachian ostia
actions of Prototype topical nasal decongestants
Sympathomimetic effects, partly due to release of norepinephrine from nerve terminals; vasoconstriction leads to decreased edema and inflammation of the nasal membranes
adverse effects of Prototype topical nasal decongestants
Disorientation, confusion, light-headedness, nausea, vomiting, fever, dyspnea, rebound congestion
action of oral decongestants
Shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptors in the nasal mucous membranes
Vasoconstrict to decrease secretions
indications of oral decongestants
Promote drainage of the sinuses and improve air flow
Decrease inflammation in sinuses, causing them to drain
VERY drying, increase fluid intake
contraindications of oral decongestants
Any condition that might be exacerbated by sympathetic activity (HTN, stroke, cardiovascular disease, etc)
adverse effects of oral decongestants
rebound congestion
sympathetic effects
drug-to-drug interactions of oral decongestants
OTC products that contain pseudoepinephrine (not anymore bc abuse) concurrent can cause serious SE
indications of nasal steroid decongestants
seasonal allergic rhinitis
inflammation after removal of nasal polyps
contraindications and caution of topical nasal steroid decongestants
contra: acute infection
caution: active infection + avoid exposure to airborne infections
AE of topical nasal steroid decongestants
Local burning, irritation, stinging, dryness of the mucosa, and headache
Suppression of healing can occur in a patient who has had nasal surgery or trauma
indications of prototype topical nasal steroid decongestants
Treatment of seasonal allergic rhinitis for pts who are not getting any response from other decongestant preparations; relief of inflammation after the removal of nasal polyps
actions of prototype topical nasal steroid decongestants
Anti-inflammatory action, which results from the ability to produce a direct local effect that blocks many of the complex reactions responsible for the inflammatory response
adverse effects of prototype topical nasal steroid decongestants
local burning, irritation, stinging, dryness of the mucosa, headache, increased risk of infection
actions of expectorants
Enhances the output of the respiratory tract fluids by reducing the adhesiveness and surface tension of these fluids, allowing easier movement of the less viscous secretions
Hydration is the best natural expectorant
Help the body cough more effectively by decreasing the viscosity of secretions
When secretions are thinner, they can be drained easier
indications of expectorants
Symptomatic relief of respiratory conditions characterized by a dry, non-productive cough
guaifenesin
prototype expectorant
Symptomatic relief of respiratory conditions characterized by dry, nonproductive cough and in the presence of mucus in the respiratory tract
action of guaifenesin
Enhances the output of the respiratory tract fluid by reducing the adhesiveness and surface tension of the fluid, facilitating the removal of viscous mucus
adverse effects of guaifenesin
N/V, HA, dizziness, rash
mucolytics action
Work to break down mucus in order to aid the high-risk respiratory patient in coughing up thick, tenacious secretions
Decreases thickness so pts can cough them or drain them out easier
mucolytics indications
Patients who have difficulty coughing up secretions
Patients who develop atelectasis (alveoli become deflated or filled with fluid)
Patients undergoing diagnostic bronchoscopy
Postoperative patients
Patients with tracheostomies
Nebulization or direct instillation into the trachea
caution and adverse effects of mucolytics
Cautions: Acute bronchospasm, peptic ulcer, and esophageal varices
Adverse effects: GI upset, stomatitis, rhinorrhea, bronchospasm, rash
acetylcysteine
prototype mucolytic
Mucolytic adjunctive therapy for abnormal, viscid, or inspissated mucous secretions in acute and chronic bronchopulmonary disorders; to lessen hepatic injury in cases of acetaminophen toxicity
acetylcysteine actions
Splits links in the mucoproteins contained in the respiratory mucus secretions, decreasing the viscosity of the secretions; protects liver cells from acetaminophen effects
adverse effects of acetylcysteine
Nausea, stomatitis, urticaria, bronchospasm, rhinorrhea
phenothiazine (phenergan)
antiemetic
blocks H1, inhibits chemoreceptor trigger zone
phenothiazine (phenergan) contraindications
hypersensitivity, narrow-angle glaucoma, severe liver disease, intestinal obstruction, bone marrow depression
phenothiazine (phenergan) caution
CV disease, liver dysfunction, asthma, respiratory dysfunction, HTN, older adults, and debilitated patients
phenothiazine (phenergan) side effects and adverse reactions
Side effects: drowsiness, confusion, anorexia, dry mouth and eyes, constipation, blurred vision, photosensitivity, HTN, transient leukopenia, urinary retention
OLDER ADULTS GET VERY TIRED FROM THIS
Adverse reactions: extrapyramidal syndrome (tardive dyskinesia, akathisia)
Like Parkinson’s, uncontrollable movements, lip smacking, eye rolling, tongue protruding
drug interactions and labs of phenothiazine (phenergan)
Drug interactions: increases CNS depression and anticholinergic effects when taken with ETOH and other CNS depressants (also increases risk of respiratory depression
lab: false + pregnancy
non-pharm antiemetics
Weak tea
Flattened carbonated beverage (cola)
Gelatin (gives you electrolytes and fluid, citrus flavors help, even just sniffing them)
Gatorade (lots of sugar so it might make everything worse so dilute it by half)
Pedialyte (not as much sugar, replaces electrolytes and has some salt, ice pops!)
Crackers/dry toast (no butter or anything)
IV fluids with severe dehydration
Cool rag on forehead or neck
Lemon ice (you can’t eat it very quickly which is good)
Ginger
OTC antihistamine antiemetics
Dimenhydrinate (dramamine), mostly used for motion sickness, take beforehand, works better
Meclizine hydrochloride (antivert), for vertigo (room is spinning)
Diphenhydramine hydrochloride (benadryl), stabilizes inner ear and helps with nausea and motion sickness
antihistamine antiemetics indication
used to prevent motion sickness, nausea, vomiting, and dizziness (vertigo)
Not effective treatment for severe vomiting R/T anticancer agents, radiation or toxins
Benadryl also indicated to prevent or alleviate allergic reactions to insect bites, allergens, or foods (antagonist to histamine receptors H1)
side effects of antihistamine antiemetics
drowsiness, dry mouth, constipation
don’t use for pregnancy
tremethobanzamide
antiemetic
preg category C don’t use unless it threatens mother or baby health
pepto-bismol contraindication
DON’T take if allergic to ASA
pepto-bismol
shake it up
chalky
acts on gastric mucosa to suppress V/D
guaiac
blood in stool
when to and not to use emetics
If someone ingested a substance that could be toxic to them
If someone ingested too much of something
HAS TO BE ALERT AND ORIENTED (aspiration risk)
No longer than 24 hours (or 60 min in some cases)
NOT IF SOMEONE INGESTED A CAUSTIC SUBSTANCE LIKE BLEACH, DYE, OILS (body can’t break it down), CLEANERS
USE ACTIVATED CHARCOAL INSTEAD
Ipecac
to induce vomiting when pt is alert and within 1 hr
stimulates CTZ and acts directly on gastric mucosa
what kind of ipecac should pts take
syrup only (fluid potent)
take with glass of water
if ipecac doesn’t work what to do
wait 15 min, use absorbent
ipecac in EDs
cardiomyopathy, vfib from hypokalemia, death
causes of diarrhea
Spicy foods (irritation and increased secretions)
Spoiled foods (bacteria)
Bacteria or virus
Laxative abuse (INCREASE GI MOTILITY)
Bowel tumor (“CAUTION”, the “C” is “change in bowel habits”)
IBS (crohn’s disease, ulcerative colitis)
Stress/anxiety
Malabsorption syndrome (celiac!)
risks of diarrhea
Dehydration (losing fluid in vomit and diarrhea)
Electrolyte imbalance (lose K+, Mg++, and vit K)
Can be serious in the elderly or young children (unable to compensate)
nonpharm ways to treat diarrhea
Avoid milk products/rich foods (gravies, things with flavor)
Gatorade, pedialyte - DILUTE GATORADE WITH WATER TO DECREASE SUGAR INTAKE
IV solutions if serious
Yogurt because it replaces good bacteria in the gut (d/c if pt has more diarrhea after having yogurt)
travelers diarrhea
from E. coli in contaminated water, fruit, veggies, meat
treatment: immodium or fluoroquinolones if infectious
four classes and examples of antidiarrheals
Opiates- opiate related
Ex: camphorated opium tincture (paregoric), deodorized opium tincture (lomotil, motofen)
Somatostatin analogue
Ex: octreotide acetate (sandostatin)
Absorbents
Bismuth subsalicylate (pepto-bismol, kapectolin, kaopectate)
Miscellaneous
Ex: rifaximin (xifaxan)
opiate prototype (lomotil)
slows intestinal motility
lomotil SE and AE
Side effects: drowsiness, dizziness, constipation, dry mouth, weakness, flush, rash, blurred vision, urine retention, confusion, sedation
Adverse reactions: angioneurotic edema
lomotil contraindications and LT reactions
Contraindications: hepatic or renal disease, glaucoma, severe electrolyte imbalance, children <2
Life threatening: paralytic ileus, toxic megacolon, severe allergic reaction
lomotil drug/food interactions and labs
Drug/food interactions: increased CNS depression with ETOH, antihistamines, narcotics, MAOIs (lots of drug-to-drug/food interactions) may enhance HTN crisis
Labs: increased LFTs, amylase
somatostatin analogue
decreases motility and gastric movements
octreotide (sandostatin)
Inhibits gastric acids, pepsinogen, gastrin, cholecystokinin, serotonin secretions, and intestinal fluid
Prescribed for diarrhea resulting from metastatic cancer or chemo
example of an absorbent
pepto-bismol
caution with ASA allergy
false + guaiac
four types of laxatives/cathartics
Osmotics (saline)
Ex: glycerin, lactulose, magnesium citrate, MOM, sodium biphosphate
Stimulants (contacts or irritants)
Ex: bisacodyl (dulcolax), castor oil (neolid, purge), senna (senokot)
Bulk-forming
Fiber, increases size of the stool
Ex: polycarbophil (fibercon), methylcellulose (citrucel)
Emollients (stool softeners)
Ex: docusate sodium calcium (colace, surfak, dialose)
what to use instead of osmotic laxatives for HF pts
golytely (refrigerate to improve taste)
stimulant laxatives
bisacodyl
short term treatment of constipation or bowel prep
effects smooth muscle of intestine
bisacodyl contraindications
hypersensitivity, fecal impaction, intestinal/biliary obstruction, appendicitis, abdominal pain, N/V, rectal fissures
bisacodyl SE, AR, and LT
Side effects: anorexia, N/V/D, cramps
Adverse reactions: dependence, hypokalemia
Life threatening: tetany
drug food interactions of bisacodyl
decreased effectiveness with antacids, histamine2 blockers, milk
Most frequently used and abused laxative in anorexic and bulimic patients
castor oil
NOT to be used on early pregnancy (stimulates contractions and abortion)
bulk forming laxative
psyllium (metamucil)
TAKE WITH 8 OZ OF WATER AND FOLLOW (intestinal obstruction)
contraindications of metamucil
hypersensitivity, fecal impaction, intestinal obstruction, abdominal pain
SE, AR, LT of metamucil
Side effects: anorexia, N/V/D, cramps
Adverse reactions: esophageal or intestinal obstruction if not taken with adequate water
Life-threatening: bronchospasm, anaphylaxis
nursing considerations of laxatives
Store suppositories in less than 86℉ (30℃) (looks like little waxy bullets, make sure they’re cold so they aren’t too soft)
Do not take within 1 hr of any other drugs
D/C if rectal bleeding, N/V or cramping occurs
triple therapy for ulcers
Flagyl
Omeprazole (PPI)
Clarithromycin
what is GERD treated with
H2 blockers and PPIs
nonpharm management of ulcers, avoid
Smoking (increases acid production in stomach)
Alcohol (acidic and destroys stomach lining)
Hot, spicy, and greasy foods (increase acid production)
NSAIDS (increased risk of ulcer formation), steroids
Raise the head of the bed (pressure on sphincter increased, lets everything come up)
Do not eat before bed
Wear loose fitting clothes (sphincter pressure when you wear tight clothes)
tranquilizers and example
antiulcer
decreases vagal stimulation and anxiety
librium combined with quarzan (anticholinergic)
anticholinergics for ulcers
decreases GI motility
pro-banthine (propantheline bromide)
antacids for ulcers
neutralize HCL acid, decreased pepsin
Ex: amphojel, Ca+ carbonate (tums), maalox, mylanta, gaviscon
H2 blockers for ulcers
Ex: cimetidine (tagamet), famotidine (pepcid), nizatidine (axid), ranitidine (zantac)
PPIs for ulcers
Ex: prevacid, prilosec, nexium, protonix
aluminum hydroxide (amphojel)
neutralizes gastric acidity
not daily
decreases phosphate
contra of amphojel
hypersensitivity to aluminum products, hypophosphatemia
Caution in older adults
SE and AR of amphojel
SE: constipation
AR: hypophosphatemia, long term use can cause GI obstruction
nursing considerations of antacids
Avoid administering with other oral drugs, antacid may delay absorption
Give antacid 1-2 hours after other medications
Shake suspension well before administering, drink water after dose
Tell pt to report pain, coughing, or vomiting of blood
Alert healthcare provider if taking >2 weeks
Avoid taking with milk or foods high in vitamin D (can increase acidity)
Stools may become speckled white (medication is very white and chalky)
H2 blockers for GERD
ranitidine (zantac)
prevents and treats ulcers
inhibits gastric acid secretion
BEFORE meals
zantac contraindications and caution
contra: hypersensitivity, severe renal and liver disease
caution: preg and lactation
zantac SE and AR
Side effects: HA, constipation, confusion, N/D, vertigo, depression, rash, blurred vision, malaise, may increase effects of oral AC
Adverse reaction: hepatotoxicity and blood dyscrasia which can both be life threatening
drug interactions of zantac
decreased absorption with antacids, decreased absorption of ketoconazole, toxicity with metoprolol
This med got discontinued because of high incidence of cancer
nursing considerations of zantac
Administer drug before meals to decrease acid secretions
Reduce drug for older adults
Instruct client to report pain, coughing, or vomiting of blood
Avoid smoking and poor lifestyle habits, may decrease drug effectiveness
Separate dose from antacid by 1 hour
esomeprazole (nexium)
PPI
treats peptic and duodenal ulcers, GERD, erosive esophagitis, h. pylori, and zollinger-ellison syndrome
suppresses gastric acid secretion by inhibiting H+ and K+ in gastric parietal cells
SE and AR of nexium
Side effects: HA/dizziness, fatigue, thirst, increased appetite, anorexia, N/D/C, rash, thrombocytopenia
Adverse reaction: elevated AST, ALT
makes aspirin less acidic so aspiration PNA when throwing up
nexium drug interactions and use
Drug interactions: may increase theophylline levels, decreased prevacid with sucralfate, may interfere absorption of ampicillin, ketoconazole, digoxin, plavix
PLAVIX IS FOR PPL WITH STENTS, HEART ATTACKS CAN HAPPEN, H2 BLOCKERS INSTEAD
Usually used as prophylaxis against ulcer formation (hospitals cause stress and stuff so it makes you likely to develop an ulcer)
pepsin inhibitor sucralfate (carafate)
non-absorbable and combines with protein to cover ulcer and protect it
4x/day, before meals, and at bedtime
contraindications of sucralfate
hypersensitivity and renal failure
SE of sucralfate
dizziness, N/C, dry mouth, rash, pruritus, back pain, sleepiness
nursing considerations of sucralfate
Administer on empty stomach
Administer antacids 30 min before or after sucralfate
Allow 1-2 hours between sucralfate and other drug
Avoid smoking and ETOH
Proper diet
starting SE of anticonvulsants (4)
dizziness, slurred speech, ataxia, confusion
three MOA of anticonvulsants
Suppressing Na+ influx through drug binding to inactivated sodium channel, prolonging Na+ channel activation, preventing neuron firing
Suppressing Ca+ influx , preventing electrical current generated by ca+ ions to T-type channel
Increasing the action of gamma aminobutyric acid (GABA), which inhibits neurotransmitters
hydantoins
inhibit Na+ influx, stabilizes cell membranes, reducing repetitive neuronal firing
NOT DURING PREGNANCY (cleft lip and palate)
therapeutic range of hydantoins
10-20 mcg/ml
dilantin
prevents seizures
reduces motor cortex activity by altering transport of ions
dilantin contraindications
hypersensitivity, heart block, psychiatric disorders, pregnancy
dilantin SE and AR
Side effects: HA, diplopia (seeing double), confusion, dizziness, sluggish, ↓coordination, ataxia, slurred speech, rash, anorexia, N/V, hypotension (after IV administration), pink-red/brown color of urine, fevers
Adverse reactions: leukopenia, hepatitis, depression, gingival hyperplasia (overgrown gums), gingivitis, nystagmus, hirsutism, osteoporosis
nursing considerations for dilantin
Utilize seizure precautions
Advise female patients taking oral contraceptives must use a back up contraception
Monitor CBC
Shake suspension well before dispensing
Advise patient to avoid driving or other hazardous activities initiating therapy
CAN’T drive until cleared by neurologist
Need to be seizure free for 6 months
Avoid alcohol and other CNS depressants
Do not stop drug abruptly, obtain medic alert bracelet
phenobarbital
for seizures, meningitis, toxic reaction eclampsia
reduces seizures by enhancing GABA
less SE than dilantin, less teratogenic
can be used for preeclampsia
succinimides
ethosuximide (zarontin)
treats seizures, in combination
decreases Ca+ influx through t-type Ca+ channels
zarontin therapeutic range
40-100 mcg/ml
zarontin adverse effects
blood dyscrasia, renal and liver impairment, SLE
diazepam, clonazepam
for seizures
high risk for abuse
used for status epilepticus IV
breakthrough seizures
diazepam,clonazepam therapeutic range
5-12 mcg/ml
2 antianginals lower BP AND HR, which one only lowers BP?
nitrates
Iminostilbenes
example: Carbamazepine (tegretol)
treats seizures when not responding to other therapies, bipolar disorders, trigeminal neuralgia, ETOH withdrawal
therapeutic range of tegretol
5-12 mcg/ml
what to AVOID with tegretol and why
avoid grapefruit juice
metabolized by cytochrome P450 3A4
valproic acid
for seizures
important things about valproic acid
avoid in children <2 and pts with liver disease
monitor LFTs
start low and go slow
Levetiracetam (Keppra)
prevents hypersynchronization of epileptiform burst firing
for seizures
pregnancy risks and adverse reactions of keppra
low teratogenic risk but may need to lower dose bc of intrauterine growth restriction
AR: aggression (lower dose)
which two meds are linked to cleft lip and palate
dilantin and tegretol (keppra is an alternative but doesn’t always work)
what vitamin do anticonvulsants inhibit
vitamin K (clotting factor)
given to pregnant woman if on anticonvulsant during last week of pregnancy, then 10 days later
also given to baby!
febrile seizures
occurs in children between 3 months and 5 years
epilepsy more common in ppl with febrile seizures
NO VALPROIC ACID
from rapid change in temp, not high fever
three major features of parkinsonism
Bradykinesia: slow movement and tremors
Rigidity: increased muscle tone w/increased movement
Posture: forward leaning, shuffle gait (fall risk, may need to d/c anticoags)
dopamine and acetylcholine in parkinsonism
low dopamine and high acetylcholine
WANT TO INCREASE DOPAMINE AND DECREASE ACETYLCHOLINE
nonpharm treatments for parkinsonism
exercise
diet with fiber and hydration
support groups
anticholinergics for parkinson’s examples
ex: artane, congentin, norflex, parsidol, BENADRYL?
example of dopaminergics
carbidopa-levodopa (GOLD STANDARD)
relieves tremors and rigidity
dopamine agonists
stimulate dopamine receptors
dopamine agonists
stimulate dopamine receptors
ex: amantadine, bromocriptine, Mirapex, requip
MAO B inhibitors
ex: eldepryl and azilect
examples of comt inhibitors
comtan and tasmar
anticholinergics
reduce rigidity and tremors
little effect on bradykinesia
inhibits release of acetylcholine
SE of anticholinergics
dry mouth, dry secretions, urinary retention, constipation blurred vision, ↑HR, restlessness, confusion
contraindications of anticholinergics
glaucoma
dopaminergics (carbidopa-levodopa/sinemet) drug interactions
increased HTN crisis with MAOIs
decreased effect with anticholinergics, avoid foods with vit b6 (protein)
contraindications of dopaminergics (carbidopa-levodopa/sinemet)
narrow angle glaucoma, severe cardiac, renal, or hepatic disease, suspicious skin lesions (malignant melanoma activated)
SE of dopaminergics (carbidopa-levodopa/sinemet)
anorexia, nausea, vomiting, dysphagia, fatigue, dizziness, headache, dry mouth, bitter taste, twitching, blurred vision, insomnia, dark urine
AR and LT of dopaminergics (carbidopa-levodopa/sinemet)
Adverse reactions: Involuntary movements, palpitations, orthostatic hypotension, urinary retention, priapism, psychosis, severe depression with suicidal ideation, hallucinations
Life threatening: Agranulocytosis, hemolytic anemia, thrombocytopenia, cardiac dysrhythmias, neuroleptic malignant syndrome
nursing considerations of sinemet
Symptoms of parkinsonism will be decreased or absent after 1-4 weeks of drug therapy
Instruct client to rise slowly to avoid orthostatic hypotension
Administer with low protein foods, high proteins diets interfere with drug transport to CNS
Avoid abrupt discontinuation rebound parkinsonism can occur
Urine and perspiration may darken
dopamine agent (amantadine hydrochloride [symmetrel])
taken alone or with levodopa or anticholinergic
treats symptoms
tolerance develops fast
side effects of symmetrel
well tolerated but side effects increase with combinations of drugs, orthostatic hypotension, confusion, urinary retention, constipation
dopamine agonist mirapex and requip side effects
Less side effects than the older drugs: may cause nausea, dizziness, somnolence, weakness and constipation
SUPER tired
Intensify dyskinesia and hallucinations
dopamine agonist bromocriptine (parlodel)
more effective than symmetrel, not as much as carbidopa-levodopa
when pts can’t tolerate carbidopa-levodopa
SE of parlodel
nausea, orthostatic hypotension, palpitations, chest pain, LE edema, nightmares, delusions, confusion
MAO-B inibitors
selegiline
prolongs action of levodopa
used for new diagnosis
MAO-B inhibitors food-drug interactions
large dose prevents metabolism of tyramine (red wine, bananas, aged cheeses) causing HTN crisis
severe reaction with TCA and SSRIs
comt inhibitor
increases levadopa in brain
tasmar
1st comt inhibitor, for advanced parkinson’s
monitor LFTs (turns urine bright yellow)
entacapone (comtan)
comt inhibitor
no effect on liver
dark yellow-orange urine
acetylcholine in alzheimer’s
low
WANT TO INCREASE (A for acetylcholine and alzheimer’s)
what do alzheimer’s drugs act like
CHOLINERGIC DRUGS
acetylcholinesterase inhibitor
rivastigmine (exelon)
improves memory loss
contraindications of exelon
liver/renal dx, urinary tract obstruction, orthostatic hypotension, bradycardia
drug interactions of exelon
increased effects OF theophylline
increased effect WITH cimetidine
SE of exelon
Anorexia, N/V/D/C, HA, dizziness, rhinitis, depression, myalgia, peripheral edema, dry mouth, Restless leg, dehydration, dry mouth
AR and LT of exelon
Adverse reactions: bradycardia, orthostatic hypotension, MI, HF
Life threatening: Hepato-toxicity, suicidal ideation, stevens-Johnson syndrome
myasthenia gravis
lack of acetylcholine receptor sites
ineffective muscle contraction and weakness
thymus gland involved, shrinks
THYMIC HYPERPLASIA (remove thymus)
symptoms of myasthenia gravis
dysphagia, dysarthria respiratory muscle weakness, respiratory failure
Early symptoms ptosis (drooping eyelids), diplopia (double vision)
pyridostigmine bromide (Mestinon)
cholinesterase inhibitor
controls and treats myasthenia gravis
prevents destruction of Ach
contraindications of pyridostigmine bromide (Mestinon)
GI and GU mechanical obstruction, severe renal dx
caution of pyridostigmine bromide (Mestinon)
asthma, hypotension, bradycardia, peptic ulcer, cardiac dysrhythmias, renal dysfunction, hyperthyroidism and pregnancy
SE of pyridostigmine bromide (Mestinon)
N/V/D, HA, dizziness, abdominal cramps, excessive saliva, sweating and rash, miosis
AR and LT of pyridostigmine bromide (Mestinon)
AR: hypotension and brady
LT: resp depression, bronchospasm, seizures
overdosing=CHOLINERGIC CRISIS (extreme muscle weakness, salivation, tears, sweating, miosis, ANTIDOTE IS ATROPINE)
MS
attacks myelin sheath fibers in brain and spinal cord (lesions cause plaques)
affects caucasian women 20-40
MS symptoms
diplopia, weakness or spacticity
drugs to avoid with MS
Histamine 2 H2 blockers such as cimetidine and ranitidine
Indomethacin
BB
meds for spasticity
Baclofen (lioresal), diazepam (valium), dantrolene (dantrium), tizanidine (Zanaflex)
used for 1-3 weeks bc of high tolerance and dependence
centrally acting muscle relaxants
cyclobenzaprine (flexeril) contraindications
Acute MI, BBB (bundle branch block), AV block, cardiac arrhythmias, HF, hypothyroid, paralytic ileus, MAOI use within 14 days
drug interactions with flexeril
increased CNS depression with ETOH, narcotics, sedative –hypnotics, Kava Kava, Valerian
SE and AR of flexeril
Side effects: anticholinergic effects (drowsiness, dizziness, HA, constipation, dry mouth, tachycardia, urinary retention), fever, abd pain
Adverse effects: angioedema, MI, seizures, paralytic ileus
nursing considerations for skeletal muscle relaxants for spasticity
Do not stop abruptly, taper over 1 week to avoid rebound spasm
Do not drive or operate machinery
Do not take for longer than 3 weeks
Avoid alcohol and CNS depressants
Contraindicated with nursing or pregnant mothers
Take with food to avoid GI upset
