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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
Q

Alpha-adrenergic receptor sites stimulation leads to…

A
  1. vasoconstriction
  2. relax GI smooth muscle
  3. bladder sphincter contraction
  4. male ejaculation
  5. dilation of pupils
  6. decreased insulin response
26
Q

Beta2-adrenergic receptor site stimulation leads to…

A
  1. relaxation of bronchi
  2. GI relaxation
  3. glycogenolysis
  4. blood vessel dilation
27
Q

Beta1-adrenergic receptor site stimulation leads to…

A
  1. cardiac stimulation
  2. increased HR
  3. increased renin secretion
28
Q

Adrenergic medication uses…

A

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
Q

s/e Alpha1 adrenergic meds

A

HA, restlessness, excitement, palpitations, tachycardia, HTN, vasoconstriction

30
Q

s/e beta1 and beta2 adrenergic meds

A

tremors, HA, nervousness, sweating, N/V, same cardiac s/e as alpha1

31
Q

Adrenergic medications to remember

A

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
Q

Adrenergic Blockers/Alpha Blockers functions….

A

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
Q

Alpha Blocker actions

A

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
Q

Alpha Blocker uses

A

treatment of HTN

decrease resistance to urinary flow

35
Q

Alpha Blocker S/E

A
  • 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
Q

Alpha blocker meds to know

A

Clonidine (Catapress)

Prazosine (Minipress)

37
Q

Beta-blocker function…

A

block action at beta receptors

Cardioselective = heart only; Nonspecific = any beta site

38
Q

Beta-blocker actions

A

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
Q

Beta-blocker s/e

A

exaggerated fx, esp dizziness and fainting
constriction of bronchioles and blood vessels
not given w acute asthma

40
Q

Beta-blocker meds to know

A

Propranolol (Inderal)
Metoprolol (Lopressor)
Atenolol (Tenormin)

41
Q

Parasympathetic nervous system…

A

opposes sympathetic nervous system

neurotransmitter: acetylcholine, cholinergic receptors

42
Q

Acetylcholine/cholinergic receptor stimualtion actions…

A

opposite of FFF

slows heart, stimulates GI, constricts pupils, promotes secretions, relaxes sphincters, dilates blood vessels

43
Q

Cholinergic functions

A

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
Q

Cholinergics actions

A

“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
Q

Cholinergic toxicity: SLUDGE

A 
Salivation
Lacrimation
Urinary incontinence
Diarrhea
GI cramps
Emesis (all basically overstim. of PNS)
46
Q

Cholinergic med to remember

A

Bethanechol (Urecholine)

increases bladder tone and relaxes sphincters; tx of urinary retention

oral

47
Q

Cholinergic-Blocking Agents (Anticholinergics) function

A

block action of acetylcholine

act at the muscarinic receptors in PNS
“competitive agents” – competes for binding sites to block

48
Q

Anticholinergic actions and uses

A
  • 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
Q

Anticholinergic s/e or toxicity

A

exaggerated actions;
very narrow therapeutic range - easy to get too much

can’t pee, can’t see, can’t spit, can’t shit

50
Q

Anticholinergic medications

A

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
Q

Anticholinergics are not used for patients with…

A

prostate enlargement, glaucoma, tachycardia, MI, CHF, intestinal obstruction, children under 3 yrs

52
Q

Anticholinergic teach patient…

A

don’t drive d/t blurry vision
light sensitivity
no alcohol if taking for GI problems
gum for dry mouth

53
Q

miotic eye medications…

A

constrict pupil

treatment for glaucoma

54
Q

mydriatic eye medications….

A

dilat pupil

to examine retina

NRSG 213 (9 decks)

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