Neuro part 2 classes Flashcards
Alpha & Beta adrenergic agonists MEDS and prototype
- Epinephrine (adrenalin): shock, glaucoma, prolongs effects of regional anesthetic
- Norepinephrine (Levophed) : tx shock or during cardiac arrest to get sympathetic activity
- Dopamine: shock
- Dobutamine: congestive heart failure
- Ephedrine: seasonal rhinitis, hypotensive episodes
PROTOTYPE: DOPAMINE
Ectopic beats
MOA of Alpha & Beta adrenergic agonists
Effects mediated by receptors in target organs
HR increases
Bronchi dilate, RR increases
Blood vessels constrict, BP increases
IOP decreases, pupils dilate
Glycogenolysis occurs
Sweating occurs
Indications and CI of alpha and beta agonists
Indications:
Hypotension, hypotensive shock
Bronchospasm, asthma
Ci:
Pheochromocytoma
Tachyarrhythmia, v fib
Hypovolemia
Peripheral vascular disease
AE and DDI alpha and beta agonists
AE:
Cardiac – htn arrhythmia, palpitation, angina
Resp – dyspnea
GI – n/v/c
CNS – h/a, sweating, tension, piloerection
Labs - hypokalemia
DDI:
TCAs, MAOIs
HTN causing meds, OTCs, herbals
Alpha selective adrenergic agonists MEDS and prototype
- Clonidine (catapres): essential htsn, chronic pain, opiate w/d
- Dexmedetomidine (precedex): sedation of intubated/ ventilated clients
- Guanfacine (intuniv): ADHD
- Midodrine (orvaten): otho hypotension
- Phenylephrine: cold/allx, preoperative, hypotsn, CVT, glaucoma, OM, vasodilatory shock
PROTOTYPE: Phenylephrine
MOA and CI to Alpha selective adrenergic agonists
MOA:
Stimulate alpha receptors
CI:
Severe HTN
Narrow angle glaucoma
Hypotension, bradycardia
CV disease, vasomotor spasm
Thyrotoxicosis, DM
Renal / Hepatic impairment
AE and DDI to alpha selective agonists
AE:
Cardiac – arrhythmia, BP changes, PV problems
GI – n/v, anorexia
GU – decreased UOP, sexual dysfunction
CNS – anxiety, restlessness, fatigue, depression, blurred vision, sensitivity to light
DDI:
TCAs, MAOIs
CNS depressants
Antihypertensives
Digoxin
Nursing implications to alpha selective agonists
taper for d/c (2-4 days), monitor GI, UOP
Beta selective adrenergic agonists
MEDS and prototype
Albuterol: bronchospasm
Levalbuterol (Xopenex): asthma, bronchospasm
Isoproterenol: Treatment of shock, cardiac standstill, prevention of bronchospasm during anesthesia. Reserved for emergencies due to adverse effects. Short duration = not generally used for tx. Of asthma
Metaproterenol: asthma, bronchospasm
Salmeterol (serevent diskus): asthma, bronchospasm, COPD
Terbutaline: asthma, bronchospasm
PROTOTYPE: Isoproterenol
Monitor pulmonary, thyroid, cv, cns
MOA and indications of beta selective agonists
MOA:
Stimulate beta receptors
Increase heart rate, conductivity, and contractility, bronchodilation, blood flow to skeletal muscles, and relaxation of uterus
Indications:
Bronchospasm
CI to beta selective agonists
- Pulm HTN, tachyarrhythmia, angina, DM, thyroid dz, vasomotor dz, CVA
- Eclampsia/uterine hemorrhage/IU death
- Pregnancy
- Renal / Hepatic impairment
AE to beta selective agonists
Cardiac – tachycardia, angina, MI, palpitations
Resp – SOB, cough, bronchospasm, pulm edema
GI – n/v, anorexia
Labs - hypokalemia
CNS – anxiety, restlessness, fatigue, fear, tremor, h/a, sweating, pupil dilation
DDI to beta selective agonists
Sympathomimetics
Beta-adrenergic blockers
Nonselective adrenergic blockers
MEDS and prototype
- Amiodarone (cordarone): ventricular arrhythmia, afib
- Carvedilol (coreg): Hypertension, congestive heart failure (adult), Left ventricular dysfunction after MI
- Labetalol (normodyne, trandate): Hypertension, HTN assoc. with pheochromocytoma, clonidine withdrawal
PROTOTYPE: Labetalol
Gastric pain
MOA and indications of Nonselective adrenergic blockers
MOA:
- Competitively block the effects of norepinephrine at the alpha and beta receptors throughout the SNS
- Prevents norepinephrine from activating the receptor lower blood pressure, slower pulse, and increased renal perfusion
Indications:
Htsn, arrhythmia
CI to Nonselective adrenergic blockers
Bradycardia/heart block/HF
DM
Bronchospasm/asthma
Pregnancy / Lactation
AE to Nonselective blockers
CNS – dizziness, paresthesia, insomnia, depression, fatigue, vertigo
GI – n/v/d, anorexia
Card – arrhythmia, hypotension, HF, pulmonary edema, CVA
Resp – bronchospasm, cough, rhinitis
Lab – hypoglycemia, hepatic injury
DDI to nonselective blockers
Antidiabetic agents
CCBs
QT prolonging antiarrhythmics
Nonselective alpha adrenergic blocker
MED
Phentolamine (Reitine, Oraverse) :
- Prevention of cell death/tissue sloughing after extravasation of NE, dopamine
- Prevention of severe HTN during pheochromocytoma surgery
- Reversal of anesthesia
MOA of Phentolamine
- Blocks postsynaptic alpha1 adrenergic receptors (Decreased sympathetic tone in vasculature :Vasodilation)
- Blocks presynaptic alpha2 receptors (Prevents feedback NE release : Increase in reflex tachy d/t hypotension_
- Local vasodilation and return of blood to site of injection
Indications, CI, AE of Phentolamine
Indications:
Htsn, prevention of cell death
CI:
CAD/MI
Preg/lact
AE:
Extension of therapeutic effects
CV – hypotension, angina, MI, flushing, tachycardia, arrhythmia, CVA
CNS – h/a, weakness, dizziness
GI - n/v/d
DDI to nonselective alpha blockers
Ephedrine/epinephrine
EtOH
Alpha 1- selective antagonists
Doxazosin: BPH, htsn
Prazosin : htsn
Terazosin: BPH, htsn
Tamsulosin/Alfuzosin: BPH
Silodosin: BPH
PROTOTYPE: Doxazosin
Sexual dysfunction
MOA alpha 1 antagonists
Block the postsynaptic alpha 1- receptor sites
decrease in vascular tone and vasodilation = decrease BP
Block the smooth muscle receptors in the prostate and urinary bladder
relaxation of bladder and prostate, improved flow of urine
Indications, CI, AE of alpha 1 antagonists
Indications:
BPH and htsn
CI:
CHF / renal failure
Pregnancy / lactation
AE:
CNS – h/a, dizziness, weakness, fatigue, depression
GI – n/v/d, abdominal pain
GU – retrograde ejaculation, priapism
CV - arrhythmias, hypotension, edema, CHF, and angina
URT – rhinitis, nasal congestion
DDI to alpha 2 antagonists
Vasodilators or antihypertensive drugs
PDE-4 inhibitors
Nonselective beta antagonists MEDS and prototype
Propranolol: HTN, angina, reinfarct after MI, migraine, stress reaction, tremors
Nadolol: htsn, angina
Nebivolol: htsn
Sotalol: ventricular arrhythmia, Afib/flutter
Timolol: HTN, reinfarct after MI, migraine, open-angle glaucoma
Levobunolol: open angle glaucoma
PROTOTYPE: Propranolol
MOA Nonselective beta antagonists
- Competitive blocking of the beta-receptors in the SNS
- Decrease heart rate Decrease myocardial contractility & rate of conduction, decrease cardiac workload
- Block of beta receptors in the heart and in the juxtaglomerular apparatus of the nephron
CI to nonselective beta antagonists
- Bradycardia/heart block, HF
- Bronchospasm/asthma
- Pregnancy / lactation
- DM
AE to nonselective beta antagonists
CNS – h/a, fatigue, dizziness, depression, sleep disturbances, memory loss, disorientation
CV - bradycardia, heart block, orthostatic hypotension, HF, hypotension, peripheral vascular insufficiency
Pulm - bronchospasm, pulmonary edema, dyspnea, coughing
GI – n/v/d, stomach upset
GU - decrease libido, impotence
Decreased exercise tolerance
DDI to nonselective antagonists
CCB, NSAIDs, ergot alkaloids, antidiabetic agents
Beta 1 selective antagonists MEDS and prototype
Metoprolol: htsn, reinfarct after MI, HF
Atenolol: MI, angina, htsn
Bisoprolol: htsn
Esmolol HCL: SVT, afib/flutter
PROTOTYPE: Atenolol
MOA and indications of beta 1 selective antagonists
MOA:
Selectively block beta 1 receptors in the SNS
Indications:
Hypertension, angina, some cardiac arrhythmias
CI to beta 1 selective antagonists
DM, thyroid dz, COPD
Bradycardia, heart block, cardiogenic shock, HF, hypotension
Pregnancy / lactation
AE to beta 1 selective antagonists
CNS – h/a, fatigue, dizziness, paresthesia, depression, sleep disturbances, memory loss, disorientation
CV - bradycardia, heart block, HF, hypotension, peripheral vascular insufficiency
Pulm - bronchospasm, rhinitis, dyspnea, coughing
GI – n/v/d, stomach upset
GU - decrease libido, impotence
Decreased exercise tolerance
DDI to beta 1 selective antagonists
NSAIDs/rifampin/barbiturates
CCB, H2, thyroid suppressing
Direct-Acting Cholinergic Agonists (Muscarinic) MEDS and prototype
Bethanechol: Treat postop or postpartum urinary retention; neurogenic bladder atony. Diagnose and treat reflux esophagitis
Carbachol: Induce miosis or pupil constriction. Relieve intraocular pressure of glaucoma. Perform certain surgical procedures
Cevimeline/Pilocarpine: Used to treat symptoms of dry mouth in pt with Sjogren’s syndrome. Reduce IOP in angle-closure glaucoma. Induce miosis
PROTOTYPE: Bethanechol
MOA to Direct-Acting Cholinergic Agonist (Muscarinic)
- Act at cholinergic receptors in the peripheral nervous system to mimic the effects of ACh and parasympathetic stimulation
- Increase contraction of the detrusor muscle of the bladder and relaxes the bladder sphincter
- To induce miosis
CI Direct-Acting Cholinergic Agonists (Muscarinic)
Any condition that would be exacerbated by parasympathetic effects–bradycardia, hypotension, CAD
Peptic ulcer disease, intestinal obst, recent GI surgery
Asthma
Bladder obstruction
Epilepsy and parkinsonism
AE and DDI to Direct-Acting Cholinergic Agonists (muscarinic)
AE:
CV – bradycardia, heart block, hypotension
GI – n/v/d, increased salivation, involuntary defecation, swallowing issues
GU – urgency
CNS – flushing, sweating
DDI:
ACh inhibitors
Direct-Acting Cholinergic Agonists (Nicotinic) MEDS
Bupropion: smoking cessation
Nicotine (habitrol, nicoderm, nicotrol): smoking cessation
Varenicline: smoking cessation
MOA, CI and indications of Direct-Acting Cholinergic Agonists (Nicotinic)
MOA:
Act at nicotinic cholinergic receptors
Inhibit reuptake of NE, dopamine
Chantix stimulates nicotinic receptors and blocks nicotine from activating receptors
Indications: smoking cessation
CI: Bupropion - sz
AE and DDI Direct-Acting Cholinergic Agonists (Nicotinic)
AE:
CV – tachycardia, HTN
CNS – (bupropion/varenicline) – depression, mania, agitation, anxiety, paranoia, hallucinations, delusions, dizziness
GI – n, dry mouth
DDI:
Bupropion – MAOI, SNRI, SSRI, BB
Indirect-Acting Cholinergic Agonists
MOA and indications
- Blocks acetylcholinesterase at the synaptic cleft
- allows the accumulation of ACh released from the nerve endings and leads to increased and prolonged stimulation of ACh.
Indications: MG and Alzheimer’s
CI and AE of Indirect-Acting Cholinergic Agonists
CI:
Bradycardia, intestinal/urinary tract obs
Any condition exacerbated by cholinergic stimulation
Asthma, CAD, PUD, arrhythmia, sz, parkinsonism
AE:
CV – bradycardia, heart block, hypotension
GI – n/v/d, increased salivation, involuntary defecation
GU – urgency
CNS – flushing, sweating, miosis, blurred vision, h/a, dizziness
DDI to Indirect-Acting Cholinergic Agonists
DDI: NSAIDS
MEDS to tx MG and prototype
neostigmine: Has a strong influence at the neuromuscular junction
(Antidote : pralidoxime available as an auto injection to military personnel at risk)
pyridostigmine : Has a longer duration of action than neostigmine (can be given IV for patients who can’t swallow)
edrophonium: Diagnostic agent for myasthenia gravis (short-acting)
PROTOTYPE: pyridostigmine
MEDS to tx alzheimers and prototype
Galantamine: stops progression
Rivastigmine
Donepezil: once a day dosing
PROTOTYPE: Donepezil
Atropine antidote for Indirect-Acting Cholinergic Agonists
Anti- Cholinergic (atropine) MOA and indications
MOA:
Used to block the effects of acetylcholine
block effects of the PNS; also called parasympatholytic agents
Indications:
Decrease GI activity and secretions (treat ulcers)
Bronchospasm/COPD
OAB, incontinence, neurogenic bladder
IBS, PUD, n/v
CI to anticholinergic
Glaucoma
Stenosing PUD, paralytic ileus, GI obs, ulcerative colitis
BPH, bladder obs
MG
Arrhythmia, tachycardia ischemia
AE and DDI to anti- cholinergics
AE:
CNS – blurred vision, pupil dilation, photophobia, cycloplegia, increased IOP, weakness, dizziness, insomnia, psychosis, decreased sweating, heat prostration
GI – dry mouth, b/c, heartburn
CV – tachycardia, palpitations
GU – hesitancy, retention
DDI: Other drugs with anticholinergic properties
