Exam 2 Drugs Flashcards
Epinephrine
Category Class:
-Nonselective adrenergic agonist- A1, B1, B2
Mechanism of Action:
-increases BP & HR, opens airway
Indication:
- IM/SubQ: allergic reaction (anaphylaxis)
- IV: cardiac arrest, severe hypotension (shock)
- Aerosol: airway obstruction (bronchospasm)
Adverse reactions:
- High risk for extravasation
- Antidote: phentolamine mesylate
Side effects:
- Hypertension: pulmonary edema, dyspnea
- Tachycardia: dysrhythmias/palpitations
- Worsening prostate disease (BPH): urinary retention
- If it crosses BBB (large dose): tremors, restlessness, dizziness, fall
- Mydriasis: worsening glaucoma, photophobia
- Hypercoagulability: DVT, PE, CVA, MI
- Lower GI motility/secretions: poor absorption, N/V, constipation, xerostomia (dry mouth), hypoactive bowel sounds
- Blood shunting: acute kidney injury, ischemic bowel, cold skin
- Glycogenolysis: hyperglycemia particularly in DM
Atropine
Category Class:
-anticholinergic
Indication:
- IV: symptomatic bradycardia
- PO drop: to reduce saliva (pre-op, palliative)
- Ophthalmic drop: to produce mydriasis & cycloplegia (pre-op)
- IM: reversal for cholinergic OD (OD with MG drugs)
Contraindication:
- Glaucoma
- BPH
- MG
Side effects, Adverse reactions:
- Tachycardia
- Palpitations
- Nasal congestion
- Photophobia
- Blurred vision
- Dry mouth and skin
- Constipation
- Urinary retention
- Impotence
- Memory impairment
- Coma
Bethanechol
Category Class:
-direct-acting parasympathomimetic (cholinergic)
Mechanism of Action:
-tone of detrusor muscle
Therapeutic Use (Indication):
- Hypotonic bladder
- Urinary retention
- Neurogenic bladder
Contraindication:
-peptic ulcer
Side effects, Adverse reactions:
- GI distress
- Dizziness
- Fainting (low HR & BP)
Patient Education:
-take on empty stomach
Methylphenidate
Category Class:
- Amphetamine- Like Drugs
- CNS stimulant
- Schedule II
Mechanism of Action:
- Increase dopamine & norepinephrine
- Increase attention span & cognitive performance (reading, memory)
Indication:
- ADHD
- Narcolepsy
Medication Administration: PO, transdermal patch
Nursing Interventions (monitoring):
- Give early in the day (it’s a stimulant –> insomnia)
- Record height, weight, and growth of children (weight loss)
Patient Education:
- Report irregular heartbeat, palpitation, HTN
- Use sugarless gum to relieve dry mouth
- Do not stop abruptly: taper off to avoid withdrawal symptoms
- N/V, muscle weakness, headache, depression
- Counseling must also be used
- Long term use causes dependence and abuse-disorder
- Excreted in breast milk (avoid while breastfeeding)
- May cause tics (report to provider)
Interactions:
-Avoid alcohol, caffeine, nicotine, ETOH
Modafinal and Armodafinil
Category Class:
- Amphetamine- Like Drugs
- CNS stimulant
- Schedule IV
Indication:
- Narcolepsy
- Jet lag
- ADHD
- Sleep apnea
Nursing Interventions (monitoring):
- Give early in the day (it’s a stimulant –> insomnia)
- Record height, weight, and growth of children (weight loss)
- Armodafinil has less risk for abuse
Patient Education:
- Report irregular heartbeat, palpitation, HTN
- Use sugarless gum to relieve dry mouth
- Do not stop abruptly: taper off to avoid withdrawal symptoms
- N/V, muscle weakness, headache, depression
- Counselling must also be used
- Long term use causes dependence and abuse-disorder
- Excreted in breast milk (avoid while breastfeeding)
- May cause tics (report to provider)
Interactions:
-Avoid alcohol, caffeine, nicotine, ETOH
Theoyphylline
Category Class:
-CNS stimulant
Mechanism of Action:
- stimulation of the brain stem
- Bronchodilator
- Anti-inflammatory effects (–> reverse corticosteroid resistance)
- Dilates coronary & pulmonary circulation, diuretic
Indication:
- IV: neonatal apnea (stimulate respiration in newborns)
- IV: emergency respiratory depression (caused by CNS depressant OD)
- IV: anesthetic recovery
- IV/PO: bronchodilator (for asthma, COPD, status asthmaticus):
- Not well controlled by inhaled corticosteroids/long-acting B2 agonists
Side effects:
- Restlessness, tremors, twitching, insomnia, seizure
- Diuresis, tinnitus
- Dependence, withdrawal symptoms
- Tachycardia, palpitations, dysrhythmia
- N/V, HA, dysrhythmia –> hypotension, seizure, cardiopulmonary collapse, GIB, hyperglycemia “Hay Nadia & Vlad Did Have Some Cool Children God Bless Hallelujah”
Nursing Interventions (monitoring): -narrow therapeutic range (high risk of toxicity or underdosing)
Phenobarbital
Category Class:
- CNS depressant
- schedule IV
- barbiturates
Mechanism of Action:
-GABA stimulation (an inhibitory neurotransmitter)
Indication:
- Antiepileptic
- Sedative
- Hypnotic
Contraindication:
- Pregnancy
- With other sedative-hypnotics (alcohol, opioids)
Side effects, Adverse reactions:
- Respiratory depression, bradycardia, ataxia
- Dependence & tolerance (wean off to avoid withdrawal symptoms and seizures)
- Only for short-term use (2 weeks or less)
- REM rebound (vivid dreams & nightmares), hangover effect, skin eruption, constipation
- Paradoxical effects
- Decreased effect of oral contraceptives (use a secondary method)
Nursing Interventions (monitoring):
- No reversal agent, often replaced by benzodiazepines
- Narrow therapeutic range
Benzodiazepines (-pam & -lam)
Medication:
- Lorazepam (Ativan)
- Epilepsy
- Diazepam (Valium)
- Epilepsy
- Chlordiazepoxide (Librium):
- Prophylaxis for alcohol withdrawal
- scheduled & PRN
- long onset of action
- safest Benzodiazepine
- Alprazolam (Xanax)
- Temazepam (Restoril)
- Clonazepam (Klonopin)
- Epilepsy
- Midazolam (Versed)
- Pre-operative
Category Class:
- CNS depressant
- Schedule IV
Mechanism of Action:
-GABA stimulation
Indication:
- Sedative (anxiolytic) –> preventing alcohol withdrawal symptoms (DTs)
- Epilepsy (antiepileptic)
- Primarily prescribed for treating acute status epilepticus
- Must be administered IV to achieve the desired response
- Due to tolerance other anticonvulsants need to be given or dose adjustments within 6 months
- Spasms (centrally acting muscle relaxant)
- Insomnia (hypnotic)
- Anesthesia induction (sedative/hypnotic)
Nursing Interventions (monitoring):
- Overdose: Flumazenil
- Protect airway and breathing (intubation/ventilation)
- Support BP
- If oral within the last hour gastric lavage
Zolpidem
Category Class:
- CNS depressant
- Nonbenzodiazepine hypnotic
- schedule IV
Mechanism of Action:
-GABA enhancer
Indication:
- short-term use (less than 10 days)
- Only PRN for insomnia
Contraindication:
- Sleep-apnea, chronic respiratory disorders
- Children, pregnancy, breastfeeding
- Concurrent use with other CNS depressant
Side effects, Adverse reactions: -Hypotension -Hangover effect (daytime sleepiness, HA) -Lightheadedness, fall “Falling Head Hits Lightswitch”
Medication Administration (specific route if indicated): -PO, SL
Nursing Interventions (monitoring): -Duration of action: at least 8 hours
Inhaled Anesthetics
Medication:
- Inhaled gas: nitrous oxide (NO)
- Inhaled volatile liquids: isoflurane
Adverse reactions:
- Anesthesia awareness (under-sedation)
- Overdose: respiratory depression, hypotension, brady-dysrhythmia
- HA, confusion
- N/V
- Shivering/chills
- Malignant hyperthermia
- Dantrolene IV to treat, watch for liver failure
Nursing Interventions (monitoring):
- Fast induction & fast reversal/recovery
- No metabolism; eliminated by ventilation
- Reversal agent: deep respiration; intubation/ventilation
“Anesthetics Are Only Helpful Cause Nadia & Vlad Studied Carefully Making Headway”
IV Anesthetics
Medication:
- Etomidate
- Propofol
- Ketamine
Contraindication:
-Propofol: allergy to egg/soybean
Side effects, Adverse reactions:
- Ketamine: paradoxical
- Cause hallucination, delirium, confusion
Nursing Interventions (monitoring): -Propofol: high risk of infection, use vial within 6 hours
Regional Anesthetics
Medication:
- Procaine (Novocaine)
- Lidocaine (Xylocaine)
Category Class:
-Sodium channel blocker
Mechanism of Action:
-prevent conduction of nerve impulses at injection site (motor, sensory, autonomic)
Medication Administration:
-injection close to nerve (spine, local nerves)
Nursing Interventions (monitoring): -no LOC (you may use benzodiazepines or opioids for sedative effect)
Carbidopa-Levadopa
Category Class:
-Dopaminergic
Mechanism of Action:
- Dopamine replacement
- Gradual lower effectiveness after about 5 years of treatment
Indication:
-Parkinson’s Disease
Side effects, Adverse reactions:
- Dystonia
- Dyskinesia
- Akathisia - Psychosis: hallucinations, nightmares, paranoia, severe depression, SI
- PNS effects (anticholinergic)
Nursing Interventions (monitoring):
- When levodopa is used alone, only 1% reaches the brain
- 99% converts to dopamine while in the PNS
- Hence mixed with carbidopa - Carbidopa inhibits conversion of levodopa to dopamine in the periphery
- More levodopa would cross the BBB and reach the brain
- Short duration (4-5 hours; t1/2 50min) –> must take frequent doses
- “wearing off” or “off” episodes may happen at any time lasting minutes to hours (even at high doses)
- Warn of harmless brown discoloration of urine & sweat
- Monitory skin for malignant melanoma
- Monitor blood cell counts
- Leukocytopenia, thrombocytopenia
Patient Education:
- Do not abruptly discontinue
- N/V: may activate vomiting center in the brain, warn, report
Interactions (with drugs/food/UV light):
- Avoid CNS depressants and dopamine-blockers (antipsychotics)
- Avoid pyridoxine B6 reduces drug effects)
- Fortified cereals, meat, poultry, fish, soybean (protein foods are high in B6)
“Wearing Daisy Dukes Always Prompts Penises But Nadia & Vlad Prefer Male Models Like Thor”
Amantadine
Category Class:
-Dopamine Agonists
Mechanism of Action:
- Also antiviral drug for influenza A
- Improve dopamine action
Indication: Parkinson’s Disease
Side effects:
- Livedo reticularis (temporary skin discoloration while on amantadine)
- Anticholinergic effects
Nursing Interventions (monitoring):
- Drug tolerance develops
- Only temporary improvement of symptoms
- Do not discontinue abruptly
Benztropine
Category Class:
-Centrally acting anticholinergic
Mechanism of Action:
-inhibits the release of acetylcholine in CNS
Indication: Parkinson’s Disease
Contraindication:
-history of Alzheimer or MG
Side effects, Adverse reactions:
- Dystonia involuntary abnormal posture stiffness, contraction, twitching, distortions, spasms
- May affect PNS (anticholinergic)
“Don’t Call Tom, Sad Day”
Donepezil and Memantine
Category Class:
-Cholinesterase Inhibitor (AChE-I)
Mechanism of Action:
- Prevents the breakdown of Ach –> more Ach in neuron synapses
- Improve cognitive function
Indication: Alzheimer
Side effects, Adverse reactions:
- Dizziness
- Insomnia
- HA
- Anorexia
- Muscle cramps
“I’m Done Having Absent Memory”
