Exam 4 Meds Flashcards
Atropine
Anticholinergic - Inhibits acetylcholine by occupying its receptors. Reduces signaling from the parasympathetic nervous system
*** Contraindicated in closed-angle glaucoma, obstructive GI disorders, paralytic ileus, and ulcerative colitis.
***Antidote - Physostigmine salicylate
TREAT:
- Bradycardia in neurogenic shock
- Heart block - Increases AV nodal conduction by blocking vagal stimulation
- Reduces oral and respiratory secretions - Often used preoperatively (reduces the risk of aspiration), Can also be used to treat the “death rattle” associated with end-of-life patients
- Antidote for cholinergic crisis - Decreases acetylcholine signaling, Emergency drug to reverse toxic effects of organophosphate (cholinesterase inhibitor) poisoning
- Pupil dilation for ocular exams - Promotes pupil dilation by blocking iris sphincter muscle,
SE:
Anticholinergic effects = Stops “rest and digest” system
Dry mouth, Decreased sweating, Blurred vision, dry eyes, Constipation (Increase fiber and fluid intake), Urinary retention (watch UO in elderly), Mydriasis (dilated pupils), Tachycardia, Palpitations/dysrhythmias (Continuous cardiac and BP monitoring),
TEACH:
Avoid the heat and hydrate appropriately - decreased perspiration causes the body temperature to rise and puts patient at higher risk for heatstroke
Carbamazepine (Tegretol)
Drug class: Anticonvulsants
Blocks sodium channels, stabilizing the rapid firing that occurs during seizure activity
Clinical Uses
Trigeminal Neuralgia - Severe facial pain involving the trigeminal nerve (cranial nerve V). Also used for other neuropathic pain syndromes
Seizures: Tonic-clonic and partial seizures
Bipolar Disorder
Side Effects and Adverse Reactions
Agranulocytosis: Black box warning, Low white blood cell count, Increased risk of infection, Report signs of fever or sore throat, Patient will require monthly CBC monitoring
Steven-Johnson’s Syndrome: Black box warning, Report signs of rash
Food-drug interactions may cause carbamazepine toxicity: Avoid grapefruit juice, Avoid benzodiazepines
dimenhyDRINATE (Dramamine)
Antiemetic, antihistamine, anticholinergic
Uses
Chiefly in prevention and treatment of motion sickness. Management of vertigo, nausea, and vomiting associated with radiation sickness, labyrinthitis, Ménière’s syndrome, stapedectomy, anesthesia, and various medications.
Contraindications
Narrow-angle glaucoma, prostatic hypertrophy. Safe use during pregnancy (category B), lactation, or in children <2 y is not established.
Interactions
Drug: Alcohol and other CNS DEPRESSANTS enhance CNS depression, drowsiness; TRICYCLIC ANTIDEPRESSANTS compound anticholinergic effects (Alprazolam (Xanax),
Cautious Use - Convulsive disorders.
Nursing Implications
Use side rails and supervise ambulation; drug produces high incidence of drowsiness.
Note: Tolerance to CNS depressant effects usually occurs after a few days of drug therapy; some decrease in antiemetic action may result with prolonged use.
Monitor for dizziness, nausea, and vomiting; these may indicate drug toxicity.
Patient & Family Education
Do not drive or engage in other potentially hazardous activities until response to drug is known.
Take 30 min before departure to prevent motion sickness; repeat before meals and upon retiring.
Do not breast feed while taking this drug without consulting physician.
Levetiracetam (Keppra)
Drug class: Anticonvulsant/Antiseizure
Action: Depresses the CNS
Clinical Uses
Seizures: Tonic-clonic, partial, and myoclonic seizures. Preferred antiepileptic medication as it has minimal side effects and drug interactions compared to other antiseizure drugs
Side Effects and Adverse Reactions
Sedation, drowsiness, fatigue
A common side effect as a result of depressing the CNS that usually resolves within 4-6 weeks
Do not take with other CNS depressant medications or alcohol
Stevens-Johnson Syndrome: Report rash immediately
Increased suicidal ideation
Report any changes in mood or anxiety
Renal toxicity
Cyclobenzaprine (Flexeril)
Skeletal muscle relaxant, central acting
ACTION:
Reduction of tonic muscle activity at the brain stem; may be related to antidepressant effects
CONTRAINDICATIONS
Acute recovery phase of MI, dysrhythmias, heart block, HF, hypersensitivity, child <12 yr, intermittent porphyria, thyroid disease
Bumetanide (Bumex)
Loop diuretic, antihypertensive
ACTION:
Acts on the ascending loop of Henle in the kidney to inhibit the reabsorption of the electrolytes sodium and chloride. Causes both potassium and magnesium wastage.
CONTRAINDICATIONS
Hypersensitivity to sulfonamides, anuria, hepatic coma
