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NRSG 213 > Lecture 8 > Flashcards

Lecture 8 Flashcards

1
Q

sedatives

A

decrease nervousness, irritability, and excitability without causing sleep

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2
Q

hypnotics

A

induce sleep

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3
Q

three groups of sedative/hypnotics

A

1) barbituates
2) benzodiazepenes
3) misc

all can be sed or hypn dependent on dose

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4
Q

Barbiturate action

A 
depresses the CNS in areas of reticular formation, leading to reduction in nerve impulses in the cerebral cortex.
increases GABA (inhibitory)
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5
Q

Barbiturate uses

A

treating seizure, short-term anesthesia in large doses

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6
Q

Barbiturate s/e

A

many unwanted sfx

  • CNS depression, deprives pt of REM sleep
  • habit forming
  • easily and rapidly toxic (narrow therapetuic index; s/s resp depression and hypotension)
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7
Q

Barbiturate dosage management

A

low dose –> sedation

higher dose –> hypnotic fx

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8
Q

Barbiturate interactions

A
  • interferes with enzymes needed for other meds
  • interacts w other meds such as Warfarin, Theophylline, Dilantine (work faster, but less time)
  • DO NOT mix with alcohol
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9
Q

Barbiturate medication to remember

A

Pheonbarbital

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10
Q

Benzodiazepene action

A

inhibits stimulation of the brain; calms CNS by enhancing GABA

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11
Q

Benzodiazepene uses

A

induce sleep, control agitation, control anxiety, alcohol withdrawal/detox treatment, anesthetic, control of epilepsy

often called “safe” sleeping pills

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12
Q

Benzodiazepene s/e

A

few; won’t depress REM sleep or interfere w enzymes/meds

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13
Q

Benzodiazepene Medicatios to remember

A

Temazepam (Restoril)

Diazepam (Valium)

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14
Q

Miscellaneous/Non-Benzo. Hypnotics action/use

A

newer version of sleeping meds; chemically diff from Benzos but seem to also enhance GABA

“Z” medications

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15
Q

Miscellaneous/Non-Benzo. Hypnotics medications to remember

A

Zaleplon (Sonata)
Zolpidem (Ambien)

both very short acting; sleepwalking noted with Ambien

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16
Q

The sympathetic nervous system…

A

provides checks and balances on homeostatis of autonomic fn of the body

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17
Q

Adrenergic medications

A

stimulate the SNS

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18
Q

adrenergic blockers

A

block stimulation of SNS at receptor sites

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19
Q

Adrenergic receptors throughout the body are bound/stimulated by…

A

norepinephrine, epinephrine, and dopamine

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20
Q

Alpha1 and 2 receptors respond to…

A

norepinephrine.

Located on nerves

Alpha1: cells, muscles, organs receiving stimulus
Alpha2: on nerve terminals that will stimulate these areas

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21
Q

Beta 1 and 2 receptors respond to…

A

epinephrine

beta1: located on the heart
beta2: located in lungs, GI, uterus

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22
Q

Dopaminergic receptors respond to…

A

dopamine

located on kidneys, GI, coronary arteries, cerebral arteries

23
Q

4 steps of normal SNS stimulation

A

1) all 3 catecholamines are stored in the ends of the nerves
2) when nerve is stimulated, norepi and epi are released into the snaptic cleft
3) neutrotansmitters bind to receptor site, receptor organ/nerve responds
4) enzymes metabolize extra neutrotransmitters OR reuptake pump draws excess back to original nerve end.

24
Q

Adrenergic medications mimic ______ to stimulate the SNS, by…. (3 things)

A

all 3 neurotransmitters

1) direct action (binds itself to receptors)
2) indirect action (stimulation of neurotransmitters to stimulate)
3) or both mixed together

25
Alpha-adrenergic receptor sites stimulation leads to...
1. vasoconstriction 2. relax GI smooth muscle 3. bladder sphincter contraction 4. male ejaculation 5. dilation of pupils 6. decreased insulin response
26
Beta2-adrenergic receptor site stimulation leads to...
1. relaxation of bronchi 2. GI relaxation 3. glycogenolysis 4. blood vessel dilation
27
Beta1-adrenergic receptor site stimulation leads to...
1. cardiac stimulation 2. increased HR 3. increased renin secretion
28
Adrenergic medication uses...
key: EXCITE (FFF) systemic actions: 1. dilate bronchial tree 2. support heart during HF localized/topical actions: 1. decrease intraocular psi and pupil dilation 2. nasal decongestants 3. decrease eye redness (vasoconstriction)
29
s/e Alpha1 adrenergic meds
HA, restlessness, excitement, palpitations, tachycardia, HTN, vasoconstriction
30
s/e beta1 and beta2 adrenergic meds
tremors, HA, nervousness, sweating, N/V, same cardiac s/e as alpha1
31
Adrenergic medications to remember
Epinephrine: systemic action used in emergency situations; increased BP, acute asthma, and anaphylactic shock Albuterol: beta2 only; bronchodilator Phenylephrine (Neo-Synephrine): nasal medication; s/e HTN (pseudoephedrine [sudafed]) IV for increasing BP
32
Adrenergic Blockers/Alpha Blockers functions....
1) compete for alpha receptor sites before neurotransmitters can get there OR 2) bind with neurotransmitters at the site and make them less active
33
Alpha Blocker actions
vasodilation and relaxation are KEY 1. vasodilation 2. relaxation of smooth muscle; bladder and uterus 3. decreased BP 4. constricting pupils 5. suppress ejaculation
34
Alpha Blocker uses
treatment of HTN | decrease resistance to urinary flow
35
Alpha Blocker S/E
- exaggerated action (too relaxed) - first dose phenomenon -- sudden/severe decrease BP - dizziness, palpitations, orthostatic hypotension, tachycardia, incontinence, etc DO NOT USE caffene or alcohol
36
Alpha blocker meds to know
Clonidine (Catapress) | Prazosine (Minipress)
37
Beta-blocker function...
block action at beta receptors Cardioselective = heart only; Nonspecific = any beta site
38
Beta-blocker actions
CONSTRICTION and CARDIAC DEPRESSION key 1. decreases HR and use of O2 by heart (tx angina) 2. slows conduction nof AV node (tx cardiac arrhythmias) 3. can cross the BBB and constrict blood vessels (tx migraines) 4. constricts circulation of eye (tx glaucoma)
39
Beta-blocker s/e
exaggerated fx, esp dizziness and fainting constriction of bronchioles and blood vessels not given w acute asthma
40
Beta-blocker meds to know
Propranolol (Inderal) Metoprolol (Lopressor) Atenolol (Tenormin)
41
Parasympathetic nervous system...
opposes sympathetic nervous system neurotransmitter: acetylcholine, cholinergic receptors
42
Acetylcholine/cholinergic receptor stimualtion actions...
opposite of FFF slows heart, stimulates GI, constricts pupils, promotes secretions, relaxes sphincters, dilates blood vessels
43
Cholinergic functions
stimulate PNS 1) bind to cholinergic receptors and activate them OR 2) stimulate production of more acetylcholine OR 3) prevent acetylcholine breakdown by eliminating cholinesterase (enzyme breaks down acetylcholine)
44
Cholinergics actions
"rest and digest" 1. stimulates intestines, secretions, bladder = increased peristalsis, relaxed sphincter for constipation 2. constricts pupils = decreased intraocular psi for glaucoma 3. salivation and sweating 4. bradycardia and vasodilation 5. lungs constrict, airways constrict/narrow
45
Cholinergic toxicity: SLUDGE
``` Salivation Lacrimation Urinary incontinence Diarrhea GI cramps Emesis (all basically overstim. of PNS) ```
46
Cholinergic med to remember
Bethanechol (Urecholine) increases bladder tone and relaxes sphincters; tx of urinary retention oral
47
Cholinergic-Blocking Agents (Anticholinergics) function
block action of acetylcholine act at the muscarinic receptors in PNS "competitive agents" -- competes for binding sites to block
48
Anticholinergic actions and uses
- dilate pupils for eye exam - decreases GI motility, secretion, and salivation (ulcer treatment) - increases HR when too slow - decreases bladder contraction (tx incontinence) - decreases sweating - dries mucous membranes (prior to surgery) - relax muscles (stiffness/tremors Parkinson's) - opens airways - balances acetylcholine and norepinephrine in the emetic center of the brain (motion sickness)
49
Anticholinergic s/e or toxicity
exaggerated actions; very narrow therapeutic range - easy to get too much can't pee, can't see, can't spit, can't shit
50
Anticholinergic medications
Atropine: often used in surgery to dry secretions; reallly increases HR (antidote: physotigmine salicylate) Scopolamine: often used to prevent motion sickness; patch behind ear Tolterodine (Detrol): decreases bladder contractions that cause urge incontinenece
51
Anticholinergics are not used for patients with...
prostate enlargement, glaucoma, tachycardia, MI, CHF, intestinal obstruction, children under 3 yrs
52
Anticholinergic teach patient...
don't drive d/t blurry vision light sensitivity no alcohol if taking for GI problems gum for dry mouth
53
miotic eye medications...
constrict pupil | treatment for glaucoma
54
mydriatic eye medications....
dilat pupil | to examine retina

NRSG 213 (9 decks)

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