Exam 3 Notes Flashcards
nursing care for anxiolytics & hypnotics
- Assess for drug abuse prior to therapy
- Fall safety precautions
- Do not drive/operate machinery
- Do not mix c alcohol
- Withdraw drugs slowly
depression caused by deficiency in…
norepinephrine, dopamine, or serotonin
4 classes of antidepressants
- Tricyclic antidepressants (TCAs)
- Monoamine oxidase inhibitors (MAOIs)
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin norepinephrine inhibitors (SNRIs)
dry mouth, blurred vision, photophobia, urinary hesitancy, tachycardia, constipation
anticholinergic effects
foods containing tyramine
- Dairy products
- Aged cheese
- Sour cream
- Yogurt
- Meats
- Liver
- Pepperoni
- Salami
- Sausage
- Bologna
- Hotdogs
- Meat extracts
- Fruits
- Banana
- Raisins
- Papaya
- Avocado
- Figs
- Pickled foods
- Red wine, beer
- Chocolate, coffee
- Fava beans
- Yeast
- Soy sauce
why is there an increased risk for suicide as pt begins antidepressants
when meds are started on pts with major depression, pts then have the energy to carry through with suicidal intent
Confusion; difficulty concentrating; fever; agitation; anxiety; hallucinatons; incoordination; hyperreflexia; diaphoresis; tremors; hyperactive bowels
serotonin syndrome
serotonin syndrome begins…
2-72 hours after beginning drug
interventions for serotonin syndrome
withhold drug
contact Dr
typical recovery for serotonin syndrome
w/i 24 hours
nursing care for antidepressants
- Obtain med history - prevent interactions
- Assess for suicidal tendency
- May take 2-4 weeks to see improvement in symptoms
- Monitor BP, anticholinergic effects, seizures
- Do not stop abruptly
3 classes of psychotherapeutics
antipsychotics
mood stabilizers
CNS stimulants
block dopamine receptors - limit stimuli in brain
conventional/typical antipsychotics
conventional antipsychs treat ____ sx
positive
nursing care for conventional antipsychs
- Ensure meds are taken - some pts refuse
- Avoid skin contact c liquid meds
- Dilute liquids c fruit juice
- Protect meds from light
- Admin oral drugs c food/milk
- Record urine output
- Avoid direct sunlight
- High fiber foods, liquids
- Hard candy & lozenges for dry mouth
- Instruct abt length of time for drug to work
- Don’t stop drug abruptly
block dopamine & serotonin receptors
treat + and - sx
atypical antipsychs
first line schizophrenia drugs
atypical antipsychs
abnormal posture & movement as a side effect of drugs
extrapyramidal symptoms
stooped posture; shuffling gait; rigidity; bradykinesia; tremors at rest; pill rolling motion
Parkinsonism (EPS)
restlessness; trouble being still; pacing; constant motion
akathisia (EPS)
facial grimacing; involuntary upward eye movement; muscle spasm of tongue, face, neck, back; laryngeal spasms
acute dystonia (EPS)
protrusion & rolling of tongue; smacking sounds of lips; chewing motion; facial dyskinesia; involuntary movements of body
tardive dyskinesia (EPS)
life threatening idiosyncratic reaction
neuroleptic malignant syndrome
Muscle rigidity (“lead pipe”)
sudden high fever
altered mental status
autonomic dysfunction (BP changes; tachycardia; dysrythmias; temp change)
incontinence
seizures
organ failure
neuroleptic malignant syndrome
NMS does not have ____ sx
GI
mortality rate for NMS is (high/low)
high
3 drugs used to treat sx of NMS
Benzodiazepines
levodopa
bromocriptine
mechanism of antiseizure meds
stabilize nerve cell membranes by manipulating ion influx
antiseizure meds achieve control in ___% pts
70
- Low margin of safety
- High potential for dependence
- High incidence of adverse effects
- Discontinue gradually
barbituates
nursing care for antiseizures (3)
- Promote compliance
- Environmental protection from injury
- Medic-alert bracelet/necklace
important to keep regular dental appts with ______ drugs
hydantoin
goal of pharmacotherapy for parkinson
increase ability to perform ADLs - do not cure
antiparkinsons reduce ________ dominance
acetylcholine
Painful, intense muscle contractions
spasms
injury to muscular system vs permanent injury to CNS
MS - muscle spasms
CNS - muscle spasticity
example of muscle spasticity
cerebral palsy
define pain
sensory & emotional experience of actual or potential tissue damage
nonpharm tx for pain
- Warmth
- Massage
- Positioning
- Acupuncture
- Meditation
- Relaxation techniques
selection of pain meds based on…
- Effectiveness
- Duration of action
- Duration of therapy
- Drug interactions
- Hypersensitivity of pt
- Available routes
opioids work on…
nonopioids work on…
CNS
nocioceptors or COX
opioid receptors respond to… (naturally)
naturally occurring peptides - endorphins & other chemicals
produce euphoria
opioid agonists
miosis
pupil constriction
antitussive opioid
codeine
fentanyl _____x more powerful than morphine
50-100
hydrocodone + acetaminophen
Norco/Vicodin
oxycodone + acetaminophen
Percocet
oxycodone + aspirin
Percodan
for cancer and trauma pain…
schedule doses of pain meds
harder to control once it is very intense
teach pt opioid safety precautions (5)
- Do not get out of bed alone
- Use call light
- Change position slowly
- Do not use machinery
- Do not mix c alcohol or CNS depressants
PCA
patient-controlled analgesia
safety mechanisms in the PCA
maximum dose
lockout interval
4-hour limit
schedule II prescribing limitations in MO (7)
- Signed in original ink if written
- Verbal orders in emergency by Dr only
- If injectable, may fax to long term care or hospice
- No refills
- Prescription only valid for 6 months
- Quantity usually limited to 30 days
- NPs can prescribe 5 days of hydrocodone only
anesthesia to mucous membranes
topical
direct injection into tissue/surgical site blocking specific nerves
infiltration anesthesia
injected into tissue proximal to surgical site
nerve block
injected into CSF of spine
spinal anesthesia
injected into epidural space of spinal cord
epidural anesthesia
neuromuscular blockers require…
advanced cardiac life support & mechanical ventilation CONSTANTLY
fight or flight - conditions of stress
sympathetic NS
rest and digest - nonstressful conditions
parasympathetic NS
effect of sympathetic NS on…
HR
BP
liver
skeletal muscles
bronchi
pupils
raises HR
raises BP
liver produces glucose
blood to skeletal muscles
bronchodilation
pupil dilation
neurotransmitter involved with sympathetic NS
norepinephrine
effect of parasympathetic NS on…
HR
BP
bronchi
bladder
GI tract
pupils
decreased HR
decreased BP
bronchoconstriction
bladder contracts
GI motility
pupils constrict
4 groups of autonomic NS drugs
- Adrenergic agonists / Sympathomimetics
- Adrenergic antagonists/blockers / Sympatholytics
- Cholinergic agonists / Parasympathomimetics
- Anticholinergics / cholinergic antagonists / Parasympatholytics
drug classes that promote sympathetic effects
adregenic agonists/sympathomimetics
anticholinergics/cholinergic antagonists/parasympatholytics
drug classes that promote parasympathetic NS
adrenergic antagonists/blockers/sympatholytics
cholinergic agonists/parasympathomimetics
stimulate SNS - mimic norephinephrine & epinephrine - act on adrenergic receptor sites
adrenergic agonists
indications for adrenergic agonists
- Nasal congestion
- Hypotension
- Cardiac arrest; heart failure; shock
- Asthma
- Premature labor contractions
block either alpha or beta receptors - inhibit norephineprine or epinephrine
adrenergic antagonists
stimulate PSNS - mimic acetylcholine
cholinergic agonists
indications for cholinergics
- anticholinergic toxicity
- atonic bladder
- dry mouth
- glaucoma
- myasthenia gravis
- Alzheimer’s
2 types of cholinergics
direct acting
indirect acting
action of direct cholinergics
activate tissue response at receptors
action of indirect cholinergics
inhibit cholinesterase, permitting ACh to accumulate at receptor site
- Monitor liver enzymes, bilirubin, serum amylase
- Auscultate bowel & breath sounds
- Have IV atropine available as antidote
cholinergic agonists
inhibit ACh by occupying receptors
anticholinergics
indications for parasympatholytics (5)
- Bradycardia
- Preop to reduce salivation
- Overactive bladder
- Asthma
- IBS
- Oral care
- Pt avoid hot environments & excess activity
- Darkened room, sunglasses
- Do not drive if vision blurred
anticholinergics
adrenergic receptors
alpha 1
alpha 2
beta 1
beta 2
alpha 1 function
vasoconstriction; pupil dilation
alpha 2 function
inhibits norepinephrine release
beta 1 function
acts on the heart
increases HR; increases force of contraction; releases renin
beta 2 function
inhibits smooth muscle of lungs
cholinergic receptors
nicotinic
muscarinic
nicotinic receptor function
stimulates smooth muscle; stimulates gland secretions
muscarinic receptor function
decreases HR; decreases force of contraction; stimulates smooth muscle; stimulates gland secretions
vagus and other cranial nerves are involved in the parasympathetic or sympathetic NS?
parasympathetic
only use oxymetazoline (Afrin) for ___ days, or else _______ will occur
3
rebound effects
sympathomimetic contraindication
hypertension
sympathomimetic drugs (2)
phenylephrine (Neo-Synephrine)
oxymetazoline (Afrin)
sympatholytic drugs (3)
propranolol
metoprolol (Lopressor, Toprol)
prazosin (Minipress)
parasympathomimetic drugs (4)
bethanechol (Urecholine)
pilocarpine (Pilocar)
pyridostigmine (Mestinon)
donepezil (Aricept)
parasympatholytic drug (1)
atropine (Atropair)
