Midterm 2 Flashcards
Adverse effects of Methylxanthines?
-CNS stimulation - anxiety, insomnia, seizures
-CV stimulation:
Palpitations (increased force of contraction/fast HR
Sinus tachycardia (increased HR)
Ventricular dysrhythmias
GI distress-Nausea, vomiting
What is physical dependence? How do we see this? What must happen in order to maintain normal function? How is it managed?
-State that develops in which an abstinence syndrome will occur if a drug is abruptly withdrawn
-We see this when people abruptly stop using, and we see withdrawals symptoms (nothing to do with addiction)
-Drug must be administered to maintain normal function (wards off withdrawal symptoms)
-We taper the doses and use meathdone and Buprenorphine + naloxone
What are antihistamines used for?
-Allergic rhinitis
-Cough
-Cough and cold preparations
What kind of drug is Salbutamol (ventialan)? What is it used for?
It is a selective short-acting Bronchodilator drug that effects B2-agonist drug that activates the airway of smooth muscle B2 receptors
-It is an emergency medication
-Used for accurate attacks
-Needs to be used in combination of other medications because it can worsen attacks
Potassium Treatment?
Oral preparations and IV administration
CLient implications on Antihypertensive Agents: Vasodilators?
-Drugs should not be taken abruptly
-may cause rebound hypertensive crisis, and perhaps lead to stroke
-Clients should avoid smoking and eating salty food
What kind of drug is montelukast?
-It is a leyukotrine modulator
-Generally used for the treatment of asthma
What is the normal concentration of sodium outside the cells?
135 to 140mmo/L
What are the contradictions of use for Acetaminophen?
*severe hepatic disease (liver issues)
severe renal disease
alcoholism
drug allergy
How do organic nitrates work?
-They cause vasodilation (relaxation of vascular smooth muscles)
1.) Dilate coronary arteries (increased coronary blood flow)
2.) Reduces cardiac preload (relax/dilate veins) and after load (relax systemic arteries)
What interactions do we need to bear in mind when administering analgesic opioids?
Main one is CNS depressants as they have cumulative effects
Ex.) Antipsychotics, sedatives, benzodiazepines, barbiturates, antihistamine, and alcohol
Where do Adrenergic Agents hypertension drugs act on?
-Not used as first line treatment
-They are a1 peripherally acting adreoceptor Antagonists
they are a2 central acting adrenoceptor agonists (brain)
What kind of effects do traditional antihistamines have?
-Refered to as older drugs because they were produced a while ago
-They are antagonists of H1 receptors
*Have anticholinergic effects
-Used in nighttime relief (downside)
What is naloxone (narcan) used for?
Used for complete or partial reversal of opioid-induced respiratory depression
What is considered the “standard” of analgesics opioids? What is it used for?
-Morphine
-Used for acute and chronic pain
What are Angiotensin II Receptor Blockers - ARBs? What don’t they cause?
Similar to ACEIs (but not identical)
-Don’t cause dry cough, generally not combined with ACEIs
Main goals of Antianginal drugs?
Broad treatment goals
1.)Improve flow in coronary circulation
2.)Reduce heart muscles metabolic demands (main one, make heart work less hard)
or BOTH
How are organic nitrates used?
Acute relief of angina – few min, lasts ~ 1 hour
SL tablet or spray
Prophylaxis in situations that may provoke angina eg excercise
SL, oral
Long-term prophylaxis of angina
transdermal patches (nitroglycerin)
oral (nitroglycerin, isosorbide mononitrate)
Inhaled Glucocorticoids: Adverse Effects?
*Oral fungal infections
-Dry mouth
-Coughing
-Systemic effects are rare
due to low doses used for inhalation therapy
What is the mechanism of action for b-agonist drugs?
-Dilation of airways
-relaxes smooth muscles of the airway and results in bronchial dilation and increases airflow
Beta-Blockers adverse effects?
Body System Effects
Cardiovascular: Bradycardia, hypotension second- or third-degree heart block; heart failure
Metabolic: Altered glucose and lipid metabolism
CNS: Dizziness, fatigue, mental depression, lethargy, drowsiness, unusual dreams
Other: Impotence, wheezing, dyspnea
What is used for treating opioid addictions?
-Methadone program
-Buprenorphine + naloxone (Suboxone)
With treatment of sodium abnormalities what must we monitor?
MONITOR SERUM ELECTROLYTE LEVELS DURING THERAPY
Monitor infusion rate, appearance of fluid or solution, infusion site
Observe for infiltration, other complications of IV therapy
When are ACE inhibitors not given?
Not given during pregnancy!!
Inidcations of use for vasodilators for hypertensions?
Act on muscles cells directly relax arteriolar smooth muscles
What is codeine often combined with?
Often combined with acetaminophen in Tylenol 1, Tylenol 2,
Tylenol 3
What kinds of drugs are the best anti-inflammatory drugs? Why are they referred to as steroid drugs?
Glucocorticoids because they ca be given long term for asthma and COPD
-Because they are made with cortisol
What does analgesia act on?
U (um) and K (kappa) receptors
What is a nociceptive stimulus? Acute pain?
Acute: Sudden in onset, usually subsides once treated
Nociceptive: Stepping on a nail, causes acute pain via activation of nociceptive pathways
3 major groups of antianginal drugs?
1.) Organic Nitrates
2.) Beta-blockers
3.) CCBs
Verapamil/Diltiazem Adverse Effects?
On the heart you will have a fall in blood pressure (hypotension, dizziness) and most notibatly flushing (increased redness in face, increased dilation of blood vesicles)
*Main one is on the GI tract and effects contractibility of the GI system and and can cause constipation
What is required for the activation of oxycodone? What is widely used in combination? What does it have a high potential of?
Metabolism is required for activation
-widely used in combination with acetaminophen (Percocet)
-High abuse potential
What are the u(mu) receptors? what are K(kappa) receptors? Where are they located?
U (mu)- Brain (cortex, medulla, thalamus, limbic system, amygdala) and spinal cord
Analgesia
K(kappa)-Brain and spinal cord
-Analgesia
dysphoria and hallucinations
All opioid analgesics are?
Full agonists or partial agonists at µ and κ receptors
What drug decreases the effects of theophylline?
Phenytoin (anti-seizure drug)
increases metabolism of xanthines
What is the main caution of use for morphine?
-Severe asthma or other respiratory insufficiency
RESPIRATORY depression
Ex of Antihypertensive Agents: Vasodilators?
hydralazine
-Given IV and are reserved for the management of hypertensive emergencies
What are the 2 main balance pressures?
Hyrostatic pressure (BP)
Colloid Osmotic pressure (plasma proteins)
What do Thiazide Diuretics do?
It is used as a anti hypertension drug
Decrease the plasma and extracellular fluid volumes and Decreased workload of the heart, and decreased blood pressure
What can respiratory depression be manifested by?
-Respiratory rate of less than 12 per minute
-Dyspnea
-Diminished breath sounds
Shallow breathing
How do Angiotensin II Receptor Blockers - ARBs work? (mechanisms of action)
-Ang II receptor antagonist
Block receptors that angiotensin II activates
-Blocks ang II-mediated vasoconstriction and blocks the release of aldosterone
What do Crystalloids contain? What don’t they contain?
They contain water, electrolytes, small molecules (glucose, lactate) (cheapest method)
-They contain small molecules (solutions of electrolytes and other molecules)
Do not contain large proteins molecules.
Implication of use for Antihistamines?
Use of traditional antihistamines
Instruct clients to report excessive sedation, confusion, or hypotension
Avoid driving or operating heavy machinery
Do not consume alcohol or other CNS depressants
What is considered the “standard” of analgesics opioids? What is it used for?
-Morphine
-Used for acute and chronic pain
CLass 1b Na channel blockers for anti DysRhyth? Whar are they used for?
Lidocaine (block sodium channels)
-Used for ventricular dysrhythmias only
What is colchicine used for? What does it do?
Is it used for acute gout attacks(occurring right now)
It reduces the inflammatory response to the deposits of urate crystals (reduces the formation)
How does Acetaminophen work? What is the main advantage of it VS NSAIDs? What does it not have?
1.) It inhibits COX (only present in CNS)
2.) It has no peripheral therapeutic sites of action
Absence of adverse effects associated with NSAIDs
no GI ulceration, excessive bleeds
What is Naloxone and what is it used for? What kind of drug is it?
AKA(Narcan), naltrezone (one suffix)
-Used for complete or partial REVERSAL of opioid-induced respiratory depression
-Largely used IM but also used via nasal application
-It is an Antagonist (acts on receptors, able to bind to the same receptors as morphine but it has a different effect)
-Receptor antagonist
What are antitussives?
-Drugs used to stop or reduce coughing
antitussives
opioids
Used for nonproductive coughs
How is ASA (asprin) an Analgesic and a antipyretic?
It is an analgesic because it works on a localized spot and is used for pain relief
Client implications for Beta-Blockers?
Medications should never be abruptly discontinued
rebound hypertensive crisis
physical dependence
Long-term prevention of angina
NOT for acute exacerbations of angina
Indications of use for colloids?
Used to bring up BP
-Trama, burns, sepsis, hypovolaemic shock (same as crystalloids)
What must we teach clients to do after using inhaled glucocorticoids?
Teach clients to gargle and rinse the mouth with water afterward to prevent the development of oral fungal infections
How do we give blood and blood products?
1.) Whole blood (as is)
2.) RBC products carry oxygen (we can separate blood from RBC’s and plasma)
3.) Increase supply of various products (clotting factors from plasma)
4.) Plasme
What is the anticholinergic effect of traditional antihistamines?
It is a drying effect that reduces:
-nasal
-lacrimal gland secretions (runny nose, tearing, and itching eyes)
-salivary
NSAIDs- What negative effects does Salicylate toxicity cause in adults and kids?
In adults tinnitues and hearing loss
In children hyperventilation (CNS stimulation)
What is nociception? Pain?
Nociception: Detection of noxious stimuli or stimuli that are capable of damaging tissue
Pain: Unpleasant sensory and emotional experience associated with actual or potential tissue damage (personal and individual experience, everyone is different)
What is Hyponatremia? Symptoms? Causes?
-Depletion of sodim levels below 135mmo/L
-Lethargy, stomach cramps, hyptertention, vomiting, diarrhea and seizures
-Caused by prolong diarrhea or coming or renal disorders
Antitussives: Mechanism of Action? example?
1.) Opioids, suppresses the cough reflex
Ex.) Codeine
What is the half life of Naloxone? How is it administered?
Shorter half life (2 hrs) than morphien and some other opioids
-Give IV, OM, SC and nasal administration
-IM or nasal in narcan rescue kits
What are the uses of IV fluid administration?
1.) Dehydration
2.) Electrolyte Imbalances
3.) Blood component Deficiencies
4.) Nutrion
What is Verapamil? What group does it belong to?
Calcium Chanel blocker that belongs to Phenylalkamines group that effects calcium chennels in cardiac and vascular structures
What is ASA? what is it most commonly referred to as?
Standard NSAID against which all others are compared
most commonly referred to as aspirin’ (trade name) from acetalation spiraea
How are analgesic opioids used in cancer pain?
-Used in chronic pain:
requires fixed schedule around-the-clock (ATC) treatment
opioids
NSAIDs
adjuvants
3 major groups of antianginal drugs?
1.) Organic Nitrates
2.) Beta-blockers
3.) CCBs
What should oral forms analgesic opioids be taken with? why?
Oral forms should be taken with food to minimize gastric upset
-Take with adequate fluid and fibre intake in order to reduce constipation (still softer) (use for all analgesic opioids)
What are Angiotensin II Receptor Blockers - ARBs? What don’t they cause?
Similar to ACEIs (but not identical)
-Don’t cause dry cough, generally not combined with ACEIs
How do Nonsedating/Peripheraly Acting Antihistamines act? Why where they developed?
-Developed to eliminate unwanted adverse effects (sedation)
-Work peripherally (doesn’t cross the blood brain barrier as much)
*Longer duration of action (increases adherence)
What are selective COX-2 inhibitors? Ex? how do we identify them?
COX-2 is responsible for inflammatory medications (help inhibit this to block prostaglandins)
Celecoxib (Celebrex)-Has a sulfa component to it so allergies can occur
How are glucocorticoids used as an anti-infmatory?
-Inhaled - used for chronic asthma and COPD
-Oral or IV for severe/short-term treatment
-May take several weeks for full therapeutic effect
*Not symptomatic used- used for prevention
What are Immunological agents (biologics)? Ex? How are they administered?
The are antibodies that are very selective against inflammatory mediators
-Via IM in a hospital
Ex.) infliximab
When do we not want to use NSAIDs?
Conditions with bleeding
Severe renal or hepatic disease
Breastfeeding
Salicylates are NOT to be given to kids under age 12 because of Reye’s syndrome
What do Morphine-like action compounds bind to?
Bind to opioid receptors on nerve endings
What kind of drugs are histamines? What do they act on? How do they also act as?
They are antagonists and compete with histamine for receptor site
-some also act as anticholinergic drugs
that act on H1 receptor sites
What do non-selective NSAIDs do?
inhibit COX-1 and COX-2
alleviate mild to moderate pain
-Suppress inflammation but pose risk of serious harm
Contradictions of use for morphine?
-Elevated intracranial pressure (ICP)
-Hepatic dysfunction
-Pregnancy
What is hypokslemia? What is its major cause?Symptoms?
Major cause is the use of medications (thiazide and loop diuretics), vomiting and diarrhea
-eficiency of potassium
<3.5 mmol/L
Excessive potassium loss (rather than poor dietary intake)
-Patient awareness, irregular pulse, muscle weakness
Example of angina beta-blocker? How are they used?
Atenolol
-Bea-blockers are used for long-term prevention of angina (not used for emergency situation)
What is naloxone (narcan) used for?
Used for complete or partial reversal of opioid-induced respiratory depression
Example of angina beta-blocker?
Atenolol
What is the main use for analgesics opioids? What is it often given with?
Main use: to alleviate mild to moderate to severe pain
often given with adjuvant analgesic agents to assist the primary agents with pain relief
What are the u(mu) receptors? what are K(kappa) receptors? Where are they located?
U (mu)- Brain (cortex, medulla, thalamus, limbic system, amygdala) and spinal cord
Analgesia
K(kappa)-Brain and spinal cord
-Analgesia
dysphoria and hallucinations
What is Bronchial Asthma? When does it occur?
-It is a recurrent and reversible shortness of breath
-Occurs when lung airways narrow: Bronchospasms and Inflammation of the bronchial mucosa
What kind of drug is amlodipine? What group does it belong to?
It is a calcium channel blocker that belongs to Dihydropyridines (DHP) and they only effect vascular muscle cells
What other drugs are used for the treatment of RA? what umbrella term for drug treatment are they used for?
DMARDs
1.)Glucocorticoids
Short term use
2.)Other Immunosuppressant drugs
gold salts
What agents are used as a first line treatment for angina?
CCB’s
What are NSAIDs used for?
Relief of mild to moderate pain
-Major use for gout
What Nitroglycerin? What is it used for? What is SL and IV form used for?
-It is a organic nitrate
-Has large first-pass effects
-Used for an emergency manganic attack
-Used SL (not PO) for symptomatic treatment
IV form is used for BP control and hypertension emergencies
-Given patch and PO for a prolong preventative use
Antihistamine and histamine effects?
Cardiovascular (small blood vessels)
Histamine action
Dilation and increased permeability
swelling (fluid from plasma into interstitial fluid)
Antihistamine effect
Reduce dilation of blood vessels
Reduce increased permeability of blood vessels
Client implications for nitroglycerin?
-Client removal of old medications
-Never chew or swallow SL form….will feel no therapeutic effects
CCBs: DHPs Adverse Effects?
1.) Hypotnetion from relaxation of blood vesicles
2.) can create tachycardia and flushing
3.) Very little constipation in contrast to DHP’s
What was ASA the first of?
It was the first NSAID discovered
Ex of class 3 potassium channel blocker for anti DysRhyth?
Amiodarone
-Used for Ventricular tachycardia or fibrillation, atrial fibrillation or flutter
-Effects SA node contractility
-Effective short term but if used long term 75% have serious consequences
Inhaled Glucocorticoids: Adverse Effects?
*Oral fungal infections
-Dry mouth
-Coughing
-Systemic effects are rare
due to low doses used for inhalation therapy
What kind of drug is ipratropium bromide?
-It is an anticholinergic
-It is used to prevent bronchoconstriction
-It is a slower action and NOT used alone for acute exacerbations
-It is primarily used for people with COPD and mild to moderate cases of acute asthma
When are ARBs not used?
During pregnancy
Example of a traditional antihistamines?
diphenhydramine (Benadryl)
What medication do we need to be careful with if it interacts with Methylxanthines? Why?
-Ciprofloxacin
-Inhibits liver CYP metabolism
-Cut back on caffeine
Stable Vs Unstable Angina?
Stable: Predictable (excursive, excitement)
Unstable: Occurs without activity
What is the recommended antidote for Sceaminophen overdose? What does it do?
*Acetylcysteine (Mucomyst)
mucolytic usually used to decrease the viscosity of bronchial secretion
Protects the liver from acetaminophen-induced damage
Max protection is given within 9-10 hrs via IV or PO can be given in late presentation even above 24hrs.
Anything over a day it is to late to try and treat an overdose. It must be administered fast
What is Rheumatoid Arthritis? (RA) What does it lead to?
Autoimmune and inflammatory disorder
It is a progressive degenerative disorder (it attacks the synovial membranes of the joints)
-Joint swelling, pain, systemic symptoms
-Eventual fusing of bones
What is fluticasone? What is it combined with?
It is used alone (Flovent)
-Used in combination of Advair Diskus
combo with long-acting β2- agonist salmeterol
Indications of use for β-adrenoceptor Blockers? What can you happen?
1.)Hypertention
2.)Angina
3.)Dysrhtimas
4.)HF
-Intolerance to exercise (don’t have the cardiac abilitly to bring it up to that level) and Is avoided for use with patients with asthma
What do opioids bind to?
Opioid receptors, this covers all natural and synthetic forms
What are the indications of use for inhaled Glucocorticoids?
Prophylaxis treatment of:
Bronchospastic disorders eg asthma
What is hyperkalemia? What causes it? Symptoms?
excessive serum potassium level >5 mmol/L
-Potassium-sparing diuretics
Cardiac rhythm irregularities (V fib)
Muscle weakness, parestheisa (tingling)
Example of Nonsedating/Peripherally Acting Antihistamines?
Loratadine (Claritin) or desloratadine (aeruis)
Anesthetic pain medication?
Local anaesthetic: Blocks nerve conduction and all local sensations (including pain)
General anaesthetics: Cause loss of sensations and unconsciousness
What does the term opiate refer to?
-Any drug derived from opium, e.g. morphine, codeine
Opium – “juice” of the poppy
Disadvantages to colloids?
may cause altered coagulation
bleeding
no oxygen-carrying capacity (you’ve boosted blood volume but not the red blood cells that carry O2)
What is hypovolemic shock? What do we use to treat it?
Is is a major loss in blood pressure and we give crystalloids to treat it to bring up BP
When do we contact a physician and without use when using analgesic opioids?
Withhold dose and contact physician if there is a decline in the client’s condition or if VS are abnormal
- especially if respiratory rate is less than 12 breaths/minute*
What is a common physiological result of chronic opioid treatment?
Opioid Tolerance
How is ASA (asprin) different from other NSAIDs?
It irreversibly inhibits COX while other NSAIDs reversibly inhibit COX
-It is sn Antiplatelet (lasts for 8 days because it an irreversible action of ASA)
Client Care with potassium?What do we never do? What must we do?
Never give as an IV bolus or undiluted
rate should not exceed 10mmol/hr
-Must be given orally, diluted in fruit juice to minimize GI disturbances
-Monitor for GI pain, bleeding or nausea
What is Hypernatremia? Symptoms? Causes?
Sodium levels excess 145mmo/L
-Edema, hypertention
-Red flushed skin (dry), Sticky mucous membrane, Increased thirst, evaluated temp, decreased urine output
-Caused by kidney malfunction (dehydration)
Other than an antiinflammatory responses, what else are NSAIDs used for? What does it inhibit?
They are also used as an antipyretic (reduce fever)
They inhibit Prostaglandin E2 production within the area of the brain that control temperature(hypothalamus)
What is often given with analgesics opioids? Why?
often given with adjuvant analgesic agents to assist the primary agents with pain relief
what are NDATDs? What kind of inhibitors are they?
Non-Steroidal Anti-inflammatory Drugs
NSAIDs
-The reduce the signs of inflammation (
-anti-inlfmmatory non steriod drug
-Blocks the production of prostaglandins
Cyclooxygenase Inhibitors (except acetaminophen)
Indications of used for Fresh Frozen Plasma (FFP)?
Used to increase clotting factor levels in clients with demonstrated deficiency = coagulation disorder
What is the underlying cause of Gout?
The body being unable to break up Uric acid from plasma which then produces the formation of uric crystals (gout)
What are the principle ECF and ICF electrolytes?
ECF: Na+ and Chloride
ICF: K+
What can all antidysrhythmic drugs cause?
Can cause dysrhythmias, can create new and/or worsen existing ones
What kind of drugs are bronchodilators?
They act on B2-adrenergic agonists to relax the respiratory tract
-They are a bronchodilator that stimulate bronchial smooth muscle B2-adrenergic muscles
What are NSAIDs and Adjuvants?
NSAIDs: The most common non-narcotic analgesic
Adjuvants:
-Antidepressants
-Antiseziure
-Glucocorticoids
What is isosorbide mononitrate?
It is a organic nitrate
-Only given PO
-Has a lower first pass metabolism effect
What are ACE inhibitors? (ACEIs)
-What do they end in for identification?
They are used as a first line agents for HF and hypertension, it is often combined with thiazide diuretics or calcium channel blockers
-They are the drug of choice in hypertensive clients with heart failure
Pril
What receptors does morphine act on? How is it administered?
Act primarily on mu (U) opioid receptors (brain and spinal cord)
-Given IV, IM, SC, PO, intrathecal
What are the adverse effects of anticholinergics?
-Dry mouth or throat- can effect different glands and receptors because when the drug is not properly inhaled it sits on the glands
-Systemic effects are minimal because it is VERY poorly absorbed which is a GOOD thing
What are the adverse effects of ASAs (asprin)
Gastrointestinal (gastric ulceration-erosions)*Main problem)
-GI bleeding Main problem
-Prostaglandin produces PGE2 and PGI2 which help protect the stomac lining and ASAs can stop this production
Reduction in creatine clearance and acuye tubular necrosis with renal failure
-Influenza and chickenpox in kids/teens due to the possibility of Reye’s syndrome
-Do not give to kids when they are sick during a viral infection
-Vomiting
-Liver damage
-CNS problem-
What must clients watch for when taking NSAIDs?
Watch closely for the occurrence of any unusual bleeding, such as in stool (dark or back color , tarry)
Enteric coated
How does tolerance effect organic nitrates?
Can develop over hours, we need to ensure that the body has a period of drug free(usually when sleeping)
-Patch on and. off, critical to have drug free period of time
What is the half life of Naloxone?
-Has a shorter half life (2 hrs) than morphine and some other opioids
What do Leukotriene Modulators do?
Suppress leukotriene effects:
Prevent smooth muscle contraction of the
bronchial airways
Decrease mucus secretion
Prevent vascular permeability
Decrease neutrophil and other leukocyte infiltration to the lungs, preventing inflammation
What is normal level of potassium? How much of the body potassium is intracellular?
Normal ECF- 3.5 to 5mmol/L
95%
Ex of angina medication CCB?
Diltazem
What is distribution of fluid in ECF determined by?
Bulk flow
What must we make sure we don’t do when administering enteric-coated tablets?
They need to make sure that the tablet should not be crushed as molecules could get trapped in folds of stomach or GI tract because it can worsen or lead to ulser
Client care for administering fluids?
1.) Administer colloids slowly
2.) Monitor for fluid overload and possible heart failure
3.) Monitor closely for signs of transfusion reactions
What is Methylodpa used for?
-1st line therapy for hypertension in pregnancy
Pro-drug
It is a centrally acting a2 Receptor Agonists (treatment of hypertensio
What kind of medication is Diltiazem? What category does it belong to?
It is a Calcium Channel Blocker that belongs to the Benzothiazepines group
can effect in calcium Chanels levels in cardiac vascular structures (contractibility)
What is breakthrough pain?
-transient episodes of pain while chronic pain is controlled
-access to rescue medication
what does Analgesic pain medication selectively block?
Selectively blocks the sensation of pain without blocking other symptoms or loss of consciousness
What is Methotrexate? What is it used to treat?
It is a DMARDs
It is the most common medication used for the treatment of RA; it can be used alone or in combination of other drugs.
-It can be used in cancer chemotherapy (in larger doses) and can also cause cancer at the same time
Ex of class 2 β-adrenoceptor antagonist for anti DysRhyth?
-Metoprolol,
Reduce or block sympathetic nervous system stimulation
(AV Block)
What interactions of Methylxanthines do we need to bear in mind?
Increased effects of theophylline
-Large amounts of caffeine can intensify adverse effects
What are the properties of NSAIDs? (Actions)
-analgesic (pain)
-anti-inflammatory
-antipyretic (anti fever drug)
Mechanisms of action for ACE inhibitors (how do they work)?
Prevents Ang II vasoconstriction
-Prevents aldosterone release
Also prevent the breakdown of bradykinin (this is a vasodilator)
Adverse effects of traditional antihistamines?
Anticholinergic effects:
-Dry mouth (reduced salivary secretions)
-Difficulty urinating
-Constipation
-Changes in vision (dilated pupils, blurred vision)
What are other uses of opioids except for the treatment of moderate to severe pain?
Cough centre suppression (codiene)
Treatment of diarrhea (loperamide)
Balanced anaesthesia (fentanyl)
What do we do for treatment or prevention of sodium deletion when dietary measures are inadequate?
Mild: Treated with oral sodium chloride and/or fluid restriction
Severe: IV normal saline or lactated Ringer’s solution
what is the toxicity of Acetaminophen? What is hepatic necrosis? What can long term ingestion cause?
Overdose- can cause enough damage to the liver that can cause death (can be intentional or by accident)
Hepatic Necrosis: Drug-induced hepatitis
Long-term ingestion of large doses also causes nephropathy.
What kind of solution is sweat?
Hypotonic solution
Adverse effects to analgesic opioids?
1 main in is Respiratory depression
2.) Main one is constipation (no tolerance development)
3.))CNS depression (possible coma)
4.)Nausea and vomiting
Other ones include:
-Hypotention
-Histamine release (itchiness, rash)
-Urinary retention
-Pupil constriction
What are the mechanisms of action for Methylxanthines (how do they work)?
Bronchodilation
Quick relief of bronchospasm - greater airflow into and out of the lungs
In the inflammatory response, what is the primary thing that tissue injury releases?
Prostaglandins (they effect local blood vessles and nerve endings where damage occurs and causes them to dilate and cause the inflation process)
-The involve multiple chemicals/enzymes
What is the maximum amount of Acetaminophen can an adult take day? When must we bear extreme caution with the use of Acetaminophen?
-4000mg per day per healthy adults (healthy liver)
-Extreme caution in alcohol abusers
Adverse effects of organic nitrates?
1.) Headache -classic and predictable in all patients
2.) Postural hypotension
3.)Reflex tachycardia (may combine with B-blocker, partially offset beneficial effects
What are some pharmacological properties of opioids?
1.)ANALGESIA (μ and κ receptors)
2.)SEDATION and `MENTAL CLOUDING‘
3.)EUPHORIA and TRANQUILLITY (δ and μ receptors) involves central dopaminergic pathways
4.)ANTITUSSIVE - depresses cough reflex by acting on a cough centre in the medulla
5.) DEPRESSION OF RESPIRATORY CENTRE (μ-receptors) direct effect on brainstem respiratory centre
6.)NAUSEA, VOMITING Stimulation of chemoreceptor trigger zone of the medulla
7.)MIOSIS (PIN POINT PUPIL) (μ and κ receptors) excitatory action of the parasympathetic nerve innervating the pupil
8.)TOLERANCE AND SERIOUS DEPENDENCE (μ receptors)
9.)CONSTIPATION (μ and δ receptors) increase GI muscle tone to point of spasm, increase tone of anal sphincter
10.)POSTURAL HYPOTENSION inhibition of baroreceptor reflex
11.) DILATION OF CUTANEOUS BLOOD VESSELS (WARM SKIN) may involve release of histamine and lead to sweating and itching
12.)URINARY URGENCY BUT DIFFICULTY IN URINATION inhibits urinary voiding reflex
13.)BILIARY COLIC AND EPIGASTRIC DISTRESS Tone ⇑ in sphincter of Oddi ⇑ tone in bile duct (increases pain of gall stones)
What is Metoprolol?
-They are a beta 1 selective beta blocker (effect cardiac receptors)
-More commonly used because of their selectivity to only have effects on heart
What is the use of Methadone and Buprenorphine + naloxone
(suboxone)?
Used to help treat Opioid addiction
Methadone can be used to help withdrawals symptoms and is considered an opioid as it acts on the receptors
Buprenorphine and nalxone are used in combination to treat opioid addiction( it is combined with nalxone so the person does not feel any effects of the opioid, it is taken SL due to absorption)
When do we Leukotriene Modulators (indications of use)?
Prophylaxis and chronic treatment of asthma in adults and children
montelukast in children ages 2 and older (Canada)
It is not used for acute attacks!! it is a profolactic use!, used on a continuous schedule
What do you have an increase risk of with selective COX-2 inhibitors? What are the benefits?
Increased risk of MI and stroke
just as effective as traditional NSAIDs in suppressing inflammation and pain
Perhaps lower risk for GI adverse effects
Opioids Analgesics examples?
1.)Morphine
2.)Octcodone
3.)Codeine
Heroin
Fentanyl
In terms of Analgesics and Cancer Pain, what is used for the treatment of pain?
-Sustained release morphine (MS Contin) Around The Clock (ATC)
-Other analgesics when needed (Including for breakthrough pain)
-NSAIDs and adjuvant medications
What do we give to reduce NSAIDs and GI Ulceration? What is it?
-Misoprostol, it is a synthetic prostaglandin that is used in combination with NSAIDs to reduce stomach ulceration
Can be given as a separate tablet or combined directly in the the selective COX-2
How do NSAIDs act? (mechanism of actions)
-Blocking either or both cyclooxygenase (COX) enzymes
-Limits the undesirable inflammatory effect of PGs (prostaglandins) and related substances
-They are non-selective
What do a2 adrenergic agents act on?
They are cenerally acting receptor agonists that decreases blood pressure and SNS outflow from CNS is decreased
-Vasodialtion
What are crystalloids used to treat? What are their indications of use?
Used to treat dehydration and as replacement/maintenance fluids
-Acute liver failure, acute nephrosis, burns, etc
What are DMARDs used for?
They are used for the treatment of RA to slow down the progression of RA and have a slow honest of action that can take up to several weeks to come into effect
Diabetics BP?
130/80, we want it to be below this and is situational dependant
What are colloids used for?
Main purpose of use is to mimic plasma proteins where they will draw fluid from outside of the plasma
They boost plasma volume to help restore BP to normal
-More narrow spectrum of use
NSAID adverse effects?
*Gastrointestinal ulceration
*Blockage of platelet aggregation (bleeding problems)
-Hyper sensitivity reactions
Adverse effects of organic nitrates?
1.) Headache -classic and predictable in all patients
2.) Postural hypotension
3.)Reflex tachycardia (may combine with B-blocker, partially offset beneficial effects
What is a common physiological result of chronic opioid treatment?
Opioid Tolerance
Main goals of Antianginal drugs?
Broad treatment goals
1.)Improve flow in coronary circulation
2.)Reduce heart muscles metabolic demands (main one, make heart work less hard)
or BOTH
What are the effects of histamine?
Mast cells (and others) release histamine and other substances and cause symptoms of allergic reactions (sneezing, blocked up, calm hay fever effects), can be used for allergic reactions that are not part of the respiratory tract (skin)
-Can also be used for motion sickness and sleep disorders
Higher centres site of action of opioids(where do they work)?
What is Modulation?
1.) higher centres to alter the psychological response to pain
-pain can still be felt but produces less suffering
-perception
Modualtion: reduce neurotransmitter release from terminals pain fibres in dorsal horn of spinal cord
What are the adverse effects of β-Agonists?
Cardiac stimulation-Tachycarida
-Decrease receptor selectivity – stimulates β1 adrenergic receptors in heart
What do you need to monitor when taking β-Agonists?
Monitor for therapeutic effects
Decreased dyspnea
Decreased wheezing, restlessness, and anxiety
Improved respiratory patterns with return to normal rate and quality
Improved activity tolerance
How do Calcium channel blockers affect vascularo muscles cells?
Creates less resitance to blood flow and cause relaxation. It inhibits Ca entry into arteriolar vascular smooth muscle cells
What is Captopril?
It is an ACE inhibitor and has the shortest half life of typically 2-3 doses per day
What drug is a glucocorticoid that is used for asthma? How is it prepared? What drug it usually combined with?
budesonide- (pulmicort)
-Combination Preparations
*Glucocorticoid + long-acting β2-agonist (LABA)
-Budesonide + formoterol (Symbicort)
Indications of use for blood products?
*Used to increase oxygen-carrying capacity
(Anemia. substantial hemoglobin deficits
*Blood loss - 25% of total blood volume
What do Non-ASA NSAIDs do? What do you not mix them with?
They reduce antiplatelet effects of ASA
We do not mix NSAIDs with ASA for used for antiplatelet effe t
What is Dextromethorphan? (Benylin) Used during dry cough
It is another antitussive, chemically it looks like an opioid but does NOT act on the receptors
Antitussives: Mechanism of Action? example?
1.) Opioids, suppresses the cough reflex
Ex.) Codeine
Adverse effects of ACE inhibitorss?
*Dry nonproductive cough
-Can faint after first dose(first dose hypotensive effect)
-Possible hyperkalemia
What negative interactions can occur with ASA (Asprin)?
*Increased bleeding with anticoagulants
-With glucocorticoids, they can lead to gastric ulcers
hydrochlorothiazide?
It is a long acting thiazide diuretic that is the first line in drug guide lines for HTN
Can cause hypokalemia if combined with digoxin
What drugs are Methylxanthines? How they administered?
-They are a third line of treamtent, not commonly used
-Theophylline - Given oral
Aminophylline-Mosr water soluble from theophylline and given via IV
What are the two basic types of cough?
1.)Productive cough:
-Congested, removes excessive secretions
2.)Nonproductive cough
-Dry cough
What is required for the activation of oxycodone? What is widely used in combination? What does it have a high potential of?
Metabolism is required for activation
-widely used in combination with acetaminophen (Percocet)
-High abuse potential
Adverse effects of crystalloids?
Edema (fluid overload) Going in faster than the kidneys can handle!
May dilute plasma proteins
Effects may be short lived
When do we use antitussives?
Used to stop cough reflex when the cough is nonproductive and/or harmful
What is allopurinol used for? How is it used?
-It is an antigout agent
-It is used in a prophylactic manner (preventative)
What kind of solution would we give a hypertonic solution?
We give them a hypotonic solution because we want to reverse the hyper solution! same would be for vice versa
Examples of moderate analgesic opioids?
Codeine
-Oxycodone
-Buprenorphine
What do Leukotrienes cause?
inflammation
bronchoconstriction
mucus production
leucocyte recruitment
Cause coughing, wheezing, SOB (shortness of breath)
What is Losartan?
It is an Angiotensin II Receptor Blockers - ARBs
What are the 4 classes of Vaughan Williams classification?
Class I – Na channel blockers
Class II – β blockers
Class III – K channel blockers (+ others)
Class IV - Calcium channel blockers
Nursing implications of antitussives?
*Cough that lasts more than a week
*Fever
-Rash
-Persistent headache
How do organic nitrates work?
-They cause vasodilation (relaxation of vascular smooth muscles)
1.) Dilate coronary arteries (increased coronary blood flow)
2.) Reduces cardiac preload (relax veins) and after load (relax systemic arteries)
How do Nonsedating/Peripheraly Acting Antihistamines act? Why where they developed?
-Developed to eliminate unwanted adverse effects (sedation)
-Work peripherally (doesn’t cross the blood brain barrier as much)
*Longer duration of action (increases adherence)
Examples of NON-opioid Analgesics? What kind of effects do they have? When are they used?
Ex.) Acetaminophen (eg Tylenol
-They have little to no anti-inflammatory effects (THEY ARE NOT AN NSAID)
*Anagesic (pain)
*antipyretic(lowers fever)
-No antiplatelet effect
-They are used as an alternative for those who can’t take NSAIDs
Client implications for nitroglycerin?
-Client removal of old medications
-Never chew or swallow SL form….will feel no therapeutic effects
What are -β-adrenergic receptor drugs?
They are antagonist blockers that act primarly in the heart and have a B1-blockade
-Reduce heart rate
-Decrease force of heart muscle contraction (reduce stroke volume)
*Both of these lead to a decrease of cardiac output
*Have olol on the end for identification
What kind of drug is amlodipine? What group does it belong to?
It is a calcium channel blocker that belongs to Dihydropyridines (DHP) and they only effect vascular muscle cells
Examples of NSAIDs
acetylsalicylic acid (ASA) – Aspirin
-ketorolac (Toradol)
-sodium salicylate
Ibuprofen (Motrin, Advil)
-Naproxen (aleve)
Adverse effects of Antitussives?
1.) Codiene
Sedation, nausea, vomiting, lightheadedness, constipation
2.) Dextromethorphan (Benylin)
Dizziness, drowsiness, nausea
much less than CNS effects of codiene
Adverse effect of blood products?
1.) Transfusion reaction (blood type and cross-match)
2.) Transmission of pathogens to recipient (hep B & C, HIV)
What does codeine have less of? how much is the liver metabolism of morphine?
Less analgesia and respiratory depression
liver metabolism to morphine (~10% of oral dose), unpredictable effect
*Antitussive
What don’t Non-ASA NSAIDs protect against? What do they inhibit?
They have fewer GI, renal and hemorrhagic affects then ASA
Do not protect against MI and Stroke.
Inhibit COX-1 and COX-2: Inhibition is reversible (unlike with ASA)
What is Dextran and Hetastarch?
Colloids
Dextran: 40 or 70 big glucose polymers
Hetastarch (synthetic)
-Albumin (like in our blood)
What is allopurinol used for?
It is used to prevent gout attacks that is given in a profolactic manner which reduce the production of uric acid
What is Angina?
Supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart
-Sensations of chest pain
What are ACE inhibitors not given with?
They are not given with K-sparing diuretics
What are the implications of Opioid Analgesics
-Oral forms should be taken with food to minimize gastric upset
With hold dose and contact physician if there is a decline in the client’s condition or if VS are abnormal
*Especially if respiratory rate is less than 12 breaths/minute (look at rate and if it’s shallow)
*Constipation -take with adequate fluid and fibre intake (take stool softener)
Indications of use for adrenergic agents?
Centrally acting α2-receptor agonists
Treatment of hypertension, either alone or with other agents
Usually used after other agents have failed or in combination with other drugs
due to adverse effects
sedation and dry mouth
What is Opioid Tolerance? What
A common physiological result of chronic opioid treatment
-When the opioid receptors have been activated over extended periods of time they gain a tolerance (can be any drug and not just opioids)
-You develop a resistance to depression, meiosis is effect and constipation
Stable Vs Unstable Angina?
Stable: Predictable (excursive, excitement)
Unstable: Occurs without activity
What is Digoxin and Adenosine?
They are Unclassified antidysrhythmics
What does Adenosine do? What kind of drug is it? How is it administered? What is the half-life? What might it cause?
Unclassified Antidysrhythmics
Slows conduction through the AV node
AV block
*Short half life - 10 -20 sec, it is only administered as a FAST IV push
May cause asystole for a few seconds (stop the heart)
Adverse effects of Antidysrhythmic drugs?
ALL antidysrhythmics can cause dysrhythmias!
What are the nursing implication of antidysrhythmics?
Ensure that the client knows to notify health care provider of any worsening of dysrhythmia and:
Shortness of breath
Edema
Dizziness
Syncope
Possible signs of toxicity of the drug
Clients taking B-Blockers or digoxin, and other agents should be taught how to take their own radial pulse for 1 full minute
notify their physician if the pulse is less than 60 beats/minute before taking the next dose of medication
Example of Cardiac glycosides?
Digoxin
