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NS373—Pharmacology > Exam 3 Notes > Flashcards

Exam 3 Notes Flashcards

1
Q

nursing care for anxiolytics & hypnotics

A
  • Assess for drug abuse prior to therapy
  • Fall safety precautions
  • Do not drive/operate machinery
  • Do not mix c alcohol
  • Withdraw drugs slowly
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2
Q

depression caused by deficiency in…

A

norepinephrine, dopamine, or serotonin

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3
Q

4 classes of antidepressants

A
  • Tricyclic antidepressants (TCAs)
  • Monoamine oxidase inhibitors (MAOIs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin norepinephrine inhibitors (SNRIs)
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4
Q

dry mouth, blurred vision, photophobia, urinary hesitancy, tachycardia, constipation

A

anticholinergic effects

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5
Q

foods containing tyramine

A
  • 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
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6
Q

why is there an increased risk for suicide as pt begins antidepressants

A

when meds are started on pts with major depression, pts then have the energy to carry through with suicidal intent

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7
Q

Confusion; difficulty concentrating; fever; agitation; anxiety; hallucinatons; incoordination; hyperreflexia; diaphoresis; tremors; hyperactive bowels

A

serotonin syndrome

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8
Q

serotonin syndrome begins…

A

2-72 hours after beginning drug

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9
Q

interventions for serotonin syndrome

A

withhold drug

contact Dr

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10
Q

typical recovery for serotonin syndrome

A

w/i 24 hours

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11
Q

nursing care for antidepressants

A
  • 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
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12
Q

3 classes of psychotherapeutics

A

antipsychotics

mood stabilizers

CNS stimulants

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13
Q

block dopamine receptors - limit stimuli in brain

A

conventional/typical antipsychotics

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14
Q

conventional antipsychs treat ____ sx

A

positive

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15
Q

nursing care for conventional antipsychs

A
  • 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
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16
Q

block dopamine & serotonin receptors

treat + and - sx

A

atypical antipsychs

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17
Q

first line schizophrenia drugs

A

atypical antipsychs

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18
Q

abnormal posture & movement as a side effect of drugs

A

extrapyramidal symptoms

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19
Q

stooped posture; shuffling gait; rigidity; bradykinesia; tremors at rest; pill rolling motion

A

Parkinsonism (EPS)

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20
Q

restlessness; trouble being still; pacing; constant motion

A

akathisia (EPS)

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21
Q

facial grimacing; involuntary upward eye movement; muscle spasm of tongue, face, neck, back; laryngeal spasms

A

acute dystonia (EPS)

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22
Q

protrusion & rolling of tongue; smacking sounds of lips; chewing motion; facial dyskinesia; involuntary movements of body

A

tardive dyskinesia (EPS)

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23
Q

life threatening idiosyncratic reaction

A

neuroleptic malignant syndrome

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24
Q

Muscle rigidity (“lead pipe”)

sudden high fever

altered mental status

autonomic dysfunction (BP changes; tachycardia; dysrythmias; temp change)

incontinence

seizures

organ failure

A

neuroleptic malignant syndrome

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25
Q

NMS does not have ____ sx

A

GI

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26
Q

mortality rate for NMS is (high/low)

A

high

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27
Q

3 drugs used to treat sx of NMS

A

Benzodiazepines

levodopa

bromocriptine

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28
Q

mechanism of antiseizure meds

A

stabilize nerve cell membranes by manipulating ion influx

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29
Q

antiseizure meds achieve control in ___% pts

A

70

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30
Q
  • Low margin of safety
  • High potential for dependence
  • High incidence of adverse effects
  • Discontinue gradually
A

barbituates

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31
Q

nursing care for antiseizures (3)

A
  • Promote compliance
  • Environmental protection from injury
  • Medic-alert bracelet/necklace
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32
Q

important to keep regular dental appts with ______ drugs

A

hydantoin

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33
Q

goal of pharmacotherapy for parkinson

A

increase ability to perform ADLs - do not cure

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34
Q

antiparkinsons reduce ________ dominance

A

acetylcholine

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35
Q

Painful, intense muscle contractions

A

spasms

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36
Q

injury to muscular system vs permanent injury to CNS

A

MS - muscle spasms

CNS - muscle spasticity

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37
Q

example of muscle spasticity

A

cerebral palsy

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38
Q

define pain

A

sensory & emotional experience of actual or potential tissue damage

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39
Q

nonpharm tx for pain

A
  • Warmth
  • Massage
  • Positioning
  • Acupuncture
  • Meditation
  • Relaxation techniques
40
Q

selection of pain meds based on…

A
  • Effectiveness
  • Duration of action
  • Duration of therapy
  • Drug interactions
  • Hypersensitivity of pt
  • Available routes
41
Q

opioids work on…

nonopioids work on…

A

CNS

nocioceptors or COX

42
Q

opioid receptors respond to… (naturally)

A

naturally occurring peptides - endorphins & other chemicals

43
Q

produce euphoria

A

opioid agonists

44
Q

miosis

A

pupil constriction

45
Q

antitussive opioid

A

codeine

46
Q

fentanyl _____x more powerful than morphine

A

50-100

47
Q

hydrocodone + acetaminophen

A

Norco/Vicodin

48
Q

oxycodone + acetaminophen

A

Percocet

49
Q

oxycodone + aspirin

A

Percodan

50
Q

for cancer and trauma pain…

A

schedule doses of pain meds

harder to control once it is very intense

51
Q

teach pt opioid safety precautions (5)

A
  • 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
52
Q

PCA

A

patient-controlled analgesia

53
Q

safety mechanisms in the PCA

A

maximum dose

lockout interval

4-hour limit

54
Q

schedule II prescribing limitations in MO (7)

A
  • 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
55
Q

anesthesia to mucous membranes

A

topical

56
Q

direct injection into tissue/surgical site blocking specific nerves

A

infiltration anesthesia

57
Q

injected into tissue proximal to surgical site

A

nerve block

58
Q

injected into CSF of spine

A

spinal anesthesia

59
Q

injected into epidural space of spinal cord

A

epidural anesthesia

60
Q

neuromuscular blockers require…

A

advanced cardiac life support & mechanical ventilation CONSTANTLY

61
Q

fight or flight - conditions of stress

A

sympathetic NS

62
Q

rest and digest - nonstressful conditions

A

parasympathetic NS

63
Q

effect of sympathetic NS on…

HR

BP

liver

skeletal muscles

bronchi

pupils

A

raises HR

raises BP

liver produces glucose

blood to skeletal muscles

bronchodilation

pupil dilation

64
Q

neurotransmitter involved with sympathetic NS

A

norepinephrine

65
Q

effect of parasympathetic NS on…

HR

BP

bronchi

bladder

GI tract

pupils

A

decreased HR

decreased BP

bronchoconstriction

bladder contracts

GI motility

pupils constrict

66
Q

4 groups of autonomic NS drugs

A
  1. Adrenergic agonists / Sympathomimetics
  2. Adrenergic antagonists/blockers / Sympatholytics
  3. Cholinergic agonists / Parasympathomimetics
  4. Anticholinergics / cholinergic antagonists / Parasympatholytics
67
Q

drug classes that promote sympathetic effects

A

adregenic agonists/sympathomimetics

anticholinergics/cholinergic antagonists/parasympatholytics

68
Q

drug classes that promote parasympathetic NS

A

adrenergic antagonists/blockers/sympatholytics

cholinergic agonists/parasympathomimetics

69
Q

stimulate SNS - mimic norephinephrine & epinephrine - act on adrenergic receptor sites

A

adrenergic agonists

70
Q

indications for adrenergic agonists

A
  • Nasal congestion
  • Hypotension
  • Cardiac arrest; heart failure; shock
  • Asthma
  • Premature labor contractions
71
Q

block either alpha or beta receptors - inhibit norephineprine or epinephrine

A

adrenergic antagonists

72
Q

stimulate PSNS - mimic acetylcholine

A

cholinergic agonists

73
Q

indications for cholinergics

A
  • anticholinergic toxicity
  • atonic bladder
  • dry mouth
  • glaucoma
  • myasthenia gravis
  • Alzheimer’s
74
Q

2 types of cholinergics

A

direct acting

indirect acting

75
Q

action of direct cholinergics

A

activate tissue response at receptors

76
Q

action of indirect cholinergics

A

inhibit cholinesterase, permitting ACh to accumulate at receptor site

77
Q
  • Monitor liver enzymes, bilirubin, serum amylase
  • Auscultate bowel & breath sounds
  • Have IV atropine available as antidote
A

cholinergic agonists

78
Q

inhibit ACh by occupying receptors

A

anticholinergics

79
Q

indications for parasympatholytics (5)

A
  • Bradycardia
  • Preop to reduce salivation
  • Overactive bladder
  • Asthma
  • IBS
80
Q
  • Oral care
  • Pt avoid hot environments & excess activity
  • Darkened room, sunglasses
  • Do not drive if vision blurred
A

anticholinergics

81
Q

adrenergic receptors

A

alpha 1

alpha 2

beta 1

beta 2

82
Q

alpha 1 function

A

vasoconstriction; pupil dilation

83
Q

alpha 2 function

A

inhibits norepinephrine release

84
Q

beta 1 function

A

acts on the heart

increases HR; increases force of contraction; releases renin

85
Q

beta 2 function

A

inhibits smooth muscle of lungs

86
Q

cholinergic receptors

A

nicotinic

muscarinic

87
Q

nicotinic receptor function

A

stimulates smooth muscle; stimulates gland secretions

88
Q

muscarinic receptor function

A

decreases HR; decreases force of contraction; stimulates smooth muscle; stimulates gland secretions

89
Q

vagus and other cranial nerves are involved in the parasympathetic or sympathetic NS?

A

parasympathetic

90
Q

only use oxymetazoline (Afrin) for ___ days, or else _______ will occur

A

3

rebound effects

91
Q

sympathomimetic contraindication

A

hypertension

92
Q

sympathomimetic drugs (2)

A

phenylephrine (Neo-Synephrine)
oxymetazoline (Afrin)

93
Q

sympatholytic drugs (3)

A

propranolol
metoprolol (Lopressor, Toprol)
prazosin (Minipress)

94
Q

parasympathomimetic drugs (4)

A

bethanechol (Urecholine)
pilocarpine (Pilocar)

pyridostigmine (Mestinon)
donepezil (Aricept)

95
Q

parasympatholytic drug (1)

A

atropine (Atropair)

NS373—Pharmacology (18 decks)

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