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Mod 2 Flashcards

1
Q

What dose sludge stand for (anticholinesterase agents)?

A 
​Salivation
​Lacrimation
​Urination
​Diaphoresis
​GI secretions increased
​Elimination/diarrhea
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2
Q

What is an Agonist?

A

An agonist is a chemical that binds to a receptor and activates the receptor to produce a biological response.

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3
Q

What is the major neurotransmitter?

A

Acetylcholine

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4
Q

What are the two types of cholinergic receptors?

A
  • Muscarinic which stimulate smooth muscle and slow the heart rate when stimulated will cause intense vomiting, diarrhea, nervousness, severe stomach pains, labored resp., slow and irreg pulse, delirum, even fatality
  • Nicotinic which effect skeletal muscles when stimulated will cause tachycardia, elevate B/P, peripheral vasoconstriction, resembles the effects of nicotine
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5
Q

edrophonium (Tensilon)

A

Used to diagnose Myasthenia Gravis, drug of choice because of short duration; parenteral IV or IM (makes acetylcholine available at the synapsis where the nerves can communicate) take 3-4 times a day.

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6
Q

neostigmine (Prostigmin)

A

Diag and tx Myasthenia Gravis, prevent and tx post-op distention and urinary retention; po and injectable; antidote for neuromuscular blockers

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7
Q

​pyridostigmine bromide (Mestinon)

A

Tx Myasthenia Gravis, antidote for neuromuscular blockers (must be given on time)

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8
Q

​Adverse effects of ​ANTICHOLINESTERASE AGENTS?

A
  1. ​Eye: blurred vision, decreased accommodation (near to far vision), miosis
  2. ​Skin: diaphoresis
  3. ​GI: increased salivation, belching, nausea, vomiting, intestinal cramps, diarrhea, increased GI secretions
  4. ​Respiratory: bronchoconstriction, including shortness of breath, tightness in chest, wheezing, increased bronchial secretions (not for patients with COPD)
  5. ​Cardiovascular: vasodilation and hypotension, bradycardia
  6. ​CNS: irritability, anxiety, seizures
  7. ​Urinary: increased voiding
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9
Q

bethanechol ( Urecholine)

A

Stimulates smooth muscle of GI tract and urinary bladder, tx urinary retention: po

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10
Q

carbachol (Carbacel, Isopto Carbachol, Miostat)

A

Tx IOP ( glaucoma)

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11
Q

​pilocarpine ( Isopto Carpine, Pilocar)

A

Tx IOP

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12
Q

What are cholinergic agonist used for?

A
  1. ​Reduce IOP in glaucoma (causes miosis, increasing outflow of aqueous humor)
  2. ​Treat atony of GI tract or bladder (urinary retention)
  3. ​Diagnose myasthenia gravis
  4. ​Antidote for

​​a.​neuromuscular blocking agents

b. ​tricyclic antidepressants
c. ​Belladonna alkaloids

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13
Q

How do cholinergic agonist work?

A
  • Work by stimulation of cholingeric receptors by mimicking acetylcholine (cholinergic agonist)
  • inhibition of enzyme acetylcholinesterase to prolong action of acetylcholine (anticholinerestase agents )
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14
Q

When are anticholinerestase agents Contraindicated?

A

GI or urinary obstruction, peritonitis

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15
Q

When should you use Precautions when giving an anticholinerestase agents like atropine?

A

In patients with ulcers, GI inflammation, pregnancy, coronary disease, hyperthyroidism, asthma, cardiac arrhythmias, epilepsy
G.​Drug interactions

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16
Q

What are the cholinergic fibers of the parasympathetic system?

A

Acetylcholine

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17
Q

What are the adrenergic fibers of the sympathetic system?

A

Norepinephrine, epinephrine, dopamine

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18
Q

What happens to the pupils when the parasympathetic system is stimulated?

A

Constriction (myosis)

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19
Q

What happens to the salivary glands when the parasympathetic system is stimulated?

A

Stimulation of secretion and dilation

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20
Q

What happens to the heart when the parasympathetic system is stimulated?

A

Decreases rate and strength of contractions

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21
Q

What happens to the stomach and intestines when the parasympathetic system is stimulated?

A

Increased motility

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22
Q

What happens to the bladder when the parasympathetic system is stimulated?

A

Contraction of muscular walls

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23
Q

What happens to the bladder sphincter when the parasympathetic system is stimulated?

A

Relaxation causing stimulation of urination

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24
Q

What happens to the Bronchioles when the parasympathetic system is stimulated?

A

constriction

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25
Q

What happens to the pupils when the sympathetic system is stimulated?

A

dilation

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26
Q

What happens to the Sweat glands when the sympathetic system is stimulated?

A

stimulates secretion

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27
Q

What happens to the Salivary glands when the sympathetic system is stimulated?

A

vasoconstriction & decreased secretion

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28
Q

What happens to the heart when the sympathetic system is stimulated?

A

increased rate & strength,dilation

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29
Q

What happens to the stomach and intestines when the sympathetic system is stimulated?

A

Decreased motility

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30
Q

What happens to the bladder when the sympathetic system is stimulated?

A

relaxation of muscular wall

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31
Q

What happens to the bladder sphincter when the sympathetic system is stimulated?

A

increased tone (remember 30 ml per hr meds are working)

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32
Q

What happens to the Bronchioles when the sympathetic system is stimulated?

A

dilate (to get more air)

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33
Q

What happens to the Blood Vessels, Skin and Visceral organs (except heart & lungs)when the sympathetic system is stimulated?

A

constriction

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34
Q

What happens to the Skeletal muscle when the sympathetic system is stimulated?

A

dilate

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35
Q

What happens to the Arrector pili of hair follicles when the sympathetic system is stimulated?

A

contraction – results in erection of hair

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36
Q

what cranial nerves are impacted by cholinergic agents?

A

III oculomotor - innervates the eye, pupillary and ciliary muscles
VII facial - lacrimal and salivary glands, mucous membranes of nose and mouth
IX glossopharyngeal - parotid gland
X vagus - organs affected: lung, heart, stomach, liver, small

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37
Q

what is the antidote for anticholinesterase agents?

A

atropine (Cholinergic blocking agent)

EX. if a patient has taken to much Tensilon give them atrpoine

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38
Q

what do you want to keep on hand when administering cholinergic agonists?

A
  • keep respiratory support equipment nearby
  • have atropine available for use as an antagonist or antidote (0.6 mg in a syringe) Sx to be alert for: decreased B/P, shock, cardiac arrest
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39
Q

what is priority to monitor when administering cholinergic agonists?

A

monitor vital signs and auscultate lung sounds while administering the cholinergic agonist (because they can bronchoconstriction, including shortness of breath, tightness in chest, wheezing, increased bronchial secretions)

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40
Q

what are signs of a cholinergic crsis?

A

dysphagia, resp weakness, fasciculations (uncontrollable twitching of a single muscle group. ex in the heart is fibrillation) and myosis, pallor, sweating, vertigo, abd cramping, diarrhea, ex salivation

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41
Q

What is the expected onset and duration of ediphonium (tensilon)?

A

IV 30-60 sec
IM 2-10 min

Duration 10-30 min

42
Q

After giving urecholine how long will it be until the patient voids?

A

1 hr ( then 30 ml per hour)

43
Q

If giving an anticholinerestase agent for Myasthenia Gravis you should see what if it is effective?

A

speech will be clear not slurred, able to handle own oral secretions, breathing status adeq

44
Q

What are points for client teaching to a patient taking cholinergic agonists?

A
  • how to instill cholinergic agent into eye
  • may affect visual acuity, impacts accommodation
  • how to assess and record changes in muscle strength
  • help client on anticholinesterase therapy to develop a system for recording each dose and its effect
  • take drugs on time ( may be several times daily in MG to prevent muscle weakness)
45
Q

How do Cholingeric Blocking Agents effect the parasympathetic system?

A

interrupt parasympathetic nerve impulses in the central and ANS. They compete with acetylcholine at muscarinic receptor sites

46
Q

What are Cholingeric blocking agents used to treat?

A
  • Spasticity of GI or urinary tract
  • Cardiac arrhythmias, bradycardia ( blocks vagal effects of the SA node )
  • Motion sickness
  • Parkinsonism
  • Chronic asthma
  • Used as preanthesia medications to dry up secretions (Atropine)
  • Relaxants for GI tract during diagnostic procedures (ERCP, EGD )
  • Dilate eye during surgery (mydriatic)
47
Q

atropine – prototype

A

po,IV,IM, used to treat bradycardia, minimizes vagal reflexes, blocks vagal effects on the heart, preanesthesia to decrease secretions

48
Q

belladonna

A

decreases GI motility in IBS, treats bladder spasms after a TURP (B&O supp)

49
Q

scopolamine (Transderm Scop)

A

used to prevent motion sickness, placed behind ear, 72 hour duration

50
Q
  • dicyclomine (Antispas, Bentyl)

- propantheline (Pro-Banthine)

A

GI and GU spasmolytic

51
Q

benztropine (Cogentin)

A

used to tx Parkinsonism ( must be careful this drug is often used for the older population, which do not sweat often and can increase the risk for heat stroke)

52
Q

ipratropium bromide (Atrovent)

A

tx COPD by blocking action of acetylcholine at bronchial smooth muscle sites, promoting bronchodilation(acetylcholine causes bronchoconstriction)

53
Q

ditropan (Detrol LA)

A

GU spasmolytic ( stops bladder spasms)

54
Q

trihexyphenidyl (Artane)

A

antiparkinson drug

55
Q

ipratropium bromide (Atrovent)

A

tx COPD by blocking action of acetylcholine (acetylcholine causes bronchoconstriction)

56
Q

what are the Adverse effects of cholingeric blocking agents?

A
  • Decreases in salivation, bronchial secretions, and sweating, increased risk of heatstroke; bronchial dilation
  • Dilatation of pupils with reduction in accommodation
  • Increased heart rate; atrial and ventricular arrhythmias
  • Urinary retention
  • Decreased intestinal and gastric motility, decreased GI secretions
  • CNS toxicity manifested by restlessness followed by depression, irritability, disorientation, delirium
57
Q

what are SX of toxicity of atropine?

A

hot as a hare- increased temp because they don’t diaphoresis
dry as a bone- decreased secretions
mad as a hatter- delirium
blind as a bat - reduction of accommodation

58
Q

when are cholinergic blocking agents Contraindicated?

A

glaucoma, coronary artery disease, renal or GI obstructive disease, reflux esophagitis, myasthenia gravis
* remember it blocks acetylcholine*

59
Q

what does the 3D effect stand for?

A
  • Drying
  • Decreased motility of GI & GU tracts
  • Dilated pupils
60
Q

If a cholinergic blocking agents is prescribed for GI spasticity when should it be administered?

A

30 minutes before meals

61
Q

why should you keep a clients keep client’s room cool when taking cholinergic blocking agents?

A

because they don’t diaphoresis, increasing body temp

62
Q

when should a Transderm scopolamine patch be applied?

A

prior to motion sickness occurring, apply 4 hours prior to travel

63
Q

what should you as a nurse monitor daily while the patient is taking cholinergic blocking agents?

A
  • watch for signs of heatstroke and dehydration (flushing, altered LOC)
  • measure fluid intake and output, particularly in clients with benign prostate enlargement. Monitor for urinary retention - frequency and voiding small amounts
  • monitor for constipation, teach prevention
  • good oral hygiene to decrease periodontal disease caused by decreased salivation, sugarless gum, hard sugarless candies or ice to reduce dry mouth, saliva substitute.
64
Q

How do Adrenergic agents work?

A

cause responses similar to those produced by activation of sympathetic nervous system (SNS), a large part of the ANS

65
Q

what are the two groups of Adrenergic agents?

A

cathecholamines

noncathecholamines

66
Q

what does endogenous mean?

A

produced by the body

67
Q

what does exogenous mean?

68
Q

what do catecholamines and other direct-acting adrenergics do?

A

stimulate alpha-and beta-adrenergic receptors directly

69
Q

what do norepinephrine and alpha-agonists do?

A

act mainly on alpha-receptors, causing vasoconstriction of arterioles in skin, kidneys, mesentery, and splanchnic area; raising blood pressure; dilating the pupils; and relaxing the gut

70
Q

what do beta-agonists do?

A

cause vasodilation of arterioles supplying brain, heart, and skeletal muscle; induce cardiac stimulation, bronchial and uterine (smooth muscle) relaxation

71
Q

what does Epinephrine do?

A

acts on both alpha-and beta-receptors, causing a combined response of vasoconstriction and vasodilation

72
Q

Why are Adrenergic agents prescribed?

A
  • To treat hypotension, shock (norepinephrine and alpha-agonists are vasoconstrictive)
  • To treat bradycardia, heart block, insufficient cardiac output (beta1-agonists)
  • To treat asthma, emphysema, bronchitis, and acute drug hypersensitivity (beta2-agonists)
  • To treat allergic reactions, anaphylactic shock, acute hypotension, shock, and cardiac arrest (epinephrine)
  • To treat nasal and ophthalmic congestion (catecholamines, because of their vasoconstrictive effects)
73
Q

Why are Adrenergic agents prescribed?

A
  • To treat hypotension, shock (norepinephrine and alpha-agonists are vasoconstrictive)
  • To treat bradycardia, heart block occurring with Stokes-Adams syndrome and carotid sinus syndrome, insufficient cardiac output (beta1-agonists)
  • To treat asthma, emphysema, bronchitis, and acute drug hypersensitivity (beta2-agonists)
  • To treat allergic reactions, anaphylactic shock, acute hypotension, shock, and cardiac arrest (epinephrine)
  • To treat nasal and ophthalmic congestion (catecholamines, because of their vasoconstrictive effects)
74
Q

what are the Endogenous catecholamines?

A
  • epinephrine (prototype sympathomimetic)
  • norepinephrine
  • Dopamine (Intropin)
75
Q

what are the Exogenous (synthetic) catecholamines?

A
  • isoproterenol (Isuprel)

- dobutamine (Dobutrex)

76
Q

what are the noncatecholamines?

A

albuterol, isoetharine, terbutaline

77
Q

phenylephrine (Neo-Synephrine)

A

Dual acting agents for TX shock, IV; rhinitis & allergies in nasal spray, causes mydriasis, not used in glaucoma

78
Q

what dose Beta1 activity do?

A

increases heart rate and strength of contraction

79
Q

Beta1: dobutamine (Dobutrex)

A

IV only, used to increase cardiac output in CHF and cardiac bypass surgery

80
Q

Beta1: norepinephrine (Levophed)

A

tx acute hypotension and shock, observe for extravasation

81
Q

Beta1: epinephrine

A

IV, IM SQ hemostasis, cardiac arrest

82
Q

Beta1: isoproterenol (Isuprel)

A

Long acting, less toxic than epinephrine; tx cardiac arrest

83
Q

Beta1: dopamine (Intropin)

A

shock, improve cardiac output, improve renal blood flow

84
Q

what is a renal dose of dopamine?

A

Small doses stimulate dopaminergic receptors, producing renal vasodilation.

85
Q

What is a heart dose of dopamine?

A

Larger doses stimulate dopaminergic and beta1 adrenergic receptors producing cardiac stimulation and renal vasodilation.

86
Q

What does Beta 2 activity do?

A

skeletal muscle, bronchioles of the lungs (bronchodilation), large arteries of the legs (vasodilation), smooth muscle of the uterus and GI tract (relaxation)

87
Q

what does Beta 2 activity do?

A

skeletal muscle, bronchioles of the lungs (bronchodilation), large arteries of the legs (vasodilation), smooth muscle of the uterus and GI tract (relaxation)

88
Q

Beta 2: epinephrine

A

bronchodilation, asthma attacks, anaphylactic reaction

89
Q

Beta 2: terbutaline (Brethine, Bricanyl)

A

bronchodilation, stops pre-term labor

90
Q

Beta 2: albuterol (Proventil, Ventolin)

A

bronchospasm, po or inhalation MDI or HHN

91
Q

what are the adverse effects of Adrenergic agents?

A
  • CNS: restlessness, anxiety, dizziness, headache, insomnia, vertigo
  • Cardiovascular: palpitations, cardiac arrhythmias, tachycardia, hypertension, cerebrovascular accidents, angina, flushing
  • Skeletal muscle: weakness, tremors
  • GI: nausea, severe vomiting, diarrhea
  • Skin: local necrosis and tissue sloughing from extravasated intravenous (IV) catecholamines (epi, norepinephrine (Levophed), dopamine)
92
Q

when are Adrenergic agents contraindicated?

A

cardiovascular disease, pheochromocytoma, hypertension

93
Q

what is the Drug interactions for Adrenergic agents?

A

Alpha-blockers (e.g., phentolamine {Regitine}): antagonism of alpha-agonists, resulting in hypotension

94
Q

what if the antidote for Adrenergic agents ?

A

phentolamine {Regitine}

95
Q

How should Dopamine be administered?

A

administer dopamine only by intravenous infusion, using a dedicated line, IV pump not gravity drip

96
Q

why do you want to Measure glucose levels in client with diabetes when taking Adrenergic agents ?

A

because the liver is dumping glucose so the brain can function. the brain feeds off glucose.

97
Q

What should the nurse be monitoring for with a patient that is on Adrenergic agents?

A
  • Measure glucose levels
  • Monitor electrocardiogram, blood pressure, cardiac rate, and cardiac rhythm during infusion
  • Have O2 and emergency equipment available
  • Monitor serum K+ level for hypokalemia if prolonged infusion of terbutaline(Brethine) for pre-term labor
  • Place client in left lateral recumbent position to prevent hypotension during IV infusion of terbutaline
  • Infuse IV into a large vein to avoid extravasation, monitor site every 10 – 15 min.
  • Observe for pain at infusion site
  • Monitor urinary output, notify MD if decreased
98
Q

what are Symptoms of extravasation and what should you do if this happens?

A
  • IV site coldness, hardness, pain
  • If extravasation occurs, inject the area within 12 hours with 10-15 ml of normal saline solution containing Regitine 5-10 mg, as prescribed
99
Q

what is routinely monitored with vasoconstrictors such as dopamine?

A
  • Monitor vital signs continuously, want to see an increase in pulse and B/P. Keep SBP above 90, don’t want tachycardia.
  • Monitor hourly urine output; output should increase since drug improves perfusion to vital organs.
  • Monitor peripheral pulses at least every 2 – 4 hours; assess temp, color, tingling or numbness of fingers or toes.
  • When titrating off vasoconstrictors, monitor for drop in B/P
100
Q

what are key Points for client teaching on Adrenergic agents?

A
  • Teach client how to measure pulse rate and when to report it
  • Show client how to use inhalant device
  • Advise client to use smallest number of inhalations to accomplish drug administration and to minimize dry mouth by rinsing mouth after inhalation
  • Teach about rebound nasal congestion if vasoconstrictors (NeoSynephrine or epinephrine) are used too often or too long as nasal spray
  • Teach use of Epi pen

Pharmacology (9 decks)

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