Med Chart 5 Flashcards
what classification is Epinephrine and Ephedrine
Nonselective Adrenergic Agonist
What is Epinephrine and Ephedrine used for?
- Bronchodilator for bronchospasms, asthma attack.
- Cardiac Arrest with CPR
- Used to treat HYPOTENSION
- Antishock
- Antianaphylaxis
What is the MOA for Epinephrine and Ephedrine?
Activate both Alpha and beta receptors
What are Alpha 1 Adrenergic Agonist?
Phenylephrine (Neo-Synephrine)
Pseudophedrine (Sudafed) Nasal Congestion
Tetrahydrozoline (Visine) Ocular Use
What are the drugs below used for?
- Phenylephrine (Neo-Synephrine)
- Pseudophedrine (Sudafed) Nasal Congestion
- Tetrahydrozoline (Visine) Ocular Use
Nasal congestion, Hypotension, May be used to produce mydriasis (pupil dilation) during ophthalmic exam
What is the MOA for the drugs below?
- Phenylephrine (Neo-Synephrine)
- Pseudophedrine (Sudafed) Nasal Congestion
- Tetrahydrozoline (Visine) Ocular Use
Activate Alpha 1 adrenergic receptors
Nursing concerns for Alpha Adrenergic Agonists:
- Examine IV site frequently
- Remove Contact Lenses and dark eye protection after ophthalmic use
- Use in limited 3-5 day intervals for nasal decongestion
What drug is an Alpha 2 Agonist?
Clonidine
What is Clonidine used for?
to treat hypertension
What is Clonidine’s MOA?
Act thru non-automatic (Centrally) mechanisms
What drug is a Beta 1 Agonist?
Dopamine (Intropin)
What is Dopamin (Intropin) used for?
- Critical care drug for heart attack (M.I)
- Heart failure
- Shock
What is Dopamin (Intropin) Adverse Effect?
has powerful effects on heart
What drugs are Beta 2 Agonist?
Albuterol(Proventil)
Terbutaline (Brethine)
What is Albuterol (Proventil) used for?
Asthma attacks
What is Terbutaline (Brethine) used for?
Reduce preterm labor contractions of uterus
Adverse effects for ALL Adrenergic Agonist:
Epinephrine (Adrenaline) Ephedrine (Efedron) Phenylephrine (Neo-Synephrine) Pseudophedrine (Sudafed) Tetrahydrozoline (Visine) Clonidine Dopamine (Intropin) Albuterol (Proventil) Terbutaline (Brethine)
- Headache R/T blood vessel dilation
- Restlessness & Insomnia R/T CNS
- Euphoria
- Palpitations
- Dysrhythmias
- Tachycardia
- Hypertension
- Pulmonary Edema
- Cardiac Arrest
Nursing concerns for ALL Adrenergic Agonist:
Epinephrine (Adrenaline) Ephedrine (Efedron) Phenylephrine (Neo-Synephrine) Pseudophedrine (Sudafed) Tetrahydrozoline (Visine) Clonidine Dopamine (Intropin) Albuterol (Proventil) Terbutaline (Brethine)
- Assess for underlying problem and Preexisting condition
- Establish baseline and vital signs: H.R., R.R., and BP changes
- Monitor Resp. Status
- Use Cardiac/ Resuscitation monitor including BP
- Inform Prescriber of changes in I&O
What drugs are Alpha 1 Antagonist?
Prazosin (Minipress)
Phentolamine (Regitine)
What are Prazosin (Minipress) and Phentolamine (Regitine) used for?
- Hypertension
- BPH (Benign Prostatic Hypertrophy) Will relax urinary obstruction, but you can only cure it through surgery
-Can reduce Hypertension from Pheochromocytoma (tumor over adrenal glands)
-Excessive secretion of catecholamine by adrenal glands .
↓ vasospasms to fingers and toes on Raynaud’s Disease
MOA of Prazosin (Minipress) and Phentolamine (Regitine) used for?
BLOCK Alpha 1 Adrenergic Receptors Selectively
Adverse Effects for Prazosin (Minipress) and Phentolamine (Regitine) used for?
-First dose phenomenon: orthostatic hypotension
More for alpha 1 antagonists bc they are so potent
This leads to ↓ blood flow to the brain and syncope (loss of consciousness R/T no blood flow)
-Sexual Dysfunction
-N/V and abdominal cramping
-Incontinence & increased urine frequency
-Depression
-Lethargy
-Vivid Dreams
Nursing Concerns for Prazosin (Minipress) and Phentolamine (Regitine)
- Initial therapy should be a low dose and given at bed time to prevent first dose phenomenon
- Assess for syncope
- Give w/ food
- Monitor urine hesitancy
- Monitor BP
- Advise about OTC drugs that may cause drug-drug interactions
What drugs are Beta Adrenergic Antagonist?
Propranolol (Inderal)
Metoprolol (Lopressor/Toprol)
Atenolol (Tenormin)
What is Propranolol (Inderal) used for?
- Hypertension
- Angina
- Glaucoma
- Dysrhythmias
- Protect against MI
What is the MOA for Propranolol (Inderal)
Block BOTH Beta 1 and beta 2
Adverse effects for Propranolol (Inderal)
Increase side effects
Nursing concerns for Propranolol (Inderal)
CAUTION for patients with Asthma and COPD
What is Metoprolol (Lopressor/Toprol)
Atenolol (Tenormin) used for?
- Hypertension
- Angina
- H.F.
MOA for Metoprolol (Lopressor/Toprol)
Atenolol (Tenormin)
Block ONLY Beta 1 receptor
Adverse Effects of Metoprolol (Lopressor/Toprol)
Atenolol (Tenormin)
decrease side effects
Nursing Concerns for Metoprolol (Lopressor/Toprol)
Atenolol (Tenormin)
SAFE for patients with Asthma and COPD
Adverse effects for ALL Beta Adrenergiv Antagonist
- A.E. most likely: elderly and impaired renal function pts
- Interactions: EtOH and OTC Antacids
- Depression
Nursing Concerns for ALL Beta Adrenergic Antagonist
-Thorough medical history: allergies, asthma, & COPD
-Vital Signs: BP
-Labs: Kidneys, Liver, Hematologic, Cardiac Functions
-I&O and daily weight
-Educate pt. about interactions w/ EtOH and Antacids
-Caution for diabetics (hypoglycemia)
Can mess with their liver function even more
-Watch for depression
-Discontinue drug SLOWLY
What drug is Directly Acting Cholinergic Agonist
Bethanechol (Urecholine)
What is Bethanechol (Urecholine) used for?
- Increase tone of urinary bladder
- Relaxation of sphincter
- Increase Gastric Motility
- Restores peristalsis or urinary retention
MOA for Bethanechol (Urecholine)
Inhibit Acetylcholinesterase to allow more Acetylcholine to reach Cholinergic Receptors
What are the nursing concerns for Bethanechol (Urecholine)
use precautions for patients with obstructive GI and GU diseases
What drug is Indirectly Acting Cholinerigc Agonist
Neostigmine (Prostigmine)
What is Neostigmine (Prostigmine) used for?
- Myasthenia Gravis (a condition causing abnormal weakness of certain muscle)
- Alzheimer’s (mental deterioration)
- Glaucoma (gradually losing eye sight)
- Helps with swallowing function if taken before eating
- Protect against bioterrorist attack with nerve gases
- Make more acetylcholine available
MOA for Neostigmine (Prostigmine)
Inhibit Acetylcholinesterase to allow more Acetylcholine to reach Cholinergic Receptors
Nursing Concerns for Neostigmine (Prostigmine)
Use precaution to prevent cholinergic crisis (overdose)
Adverse Effects for ALL Cholinergic Agonists
CV: -Hypotension -Syncope -Bradycardia -Complete Heart Block GI: -Abdominal Cramps -↑ Salivation -↑ Sweating N/V -Eye: -Miosis -Blurred Vision Resp: -↑ Bronchial Secretions -Acute Bronchospasms
Nursing Concerns for ALL Cholinergic Agonists
- Assess: HR, RR, & BP for at least 1 hr following administration
- Monitor for early sign of overdose
- Ensure Atropine is available for overdose
- NO OTC preparation (interactions)
- Monitor I&O, urinary, and bladder distention
- Instruct pt be near toilet after taking
- Safety precautions for blurred vision
What drug is Muscarinic Antagonist
Atropine
What is Atropine used for
- Bradycardia
- Anti-dose for Muscarinic Agonist Overdose
MOA for Atropine
- Block Muscarinic Receptors at therapeutic doses
- May block muscarinic and nicotinic receptors at high doses
- Induce symptoms of fight or flight
Adverse Effects for Atropine?
Drying or oral & nasal mucosa Constipation Urinary Retention ↑ HR and arrhythmias Blurred vision and photophobia Heat Stroke (R/T ↑ HR)
Nursing Concerns for Atropine
- Monitor VS: HR & BP
- Particularly for paradoxical bradycardia
- Monitor I&O
- Assess CNS status for changes
- Pt teaching:
- Avoid Outdoor Activities (Heat Stroke)
- No OTC meds
- Monitor for anticholinergic crisis:
- Fever
