Neuropharmacolgy Flashcards
Bethanechol (Urecholine) mechanism of action
binds to muscarinic cholinergic receptors to relax trigone and sphincter muscles
Bethanechol (Urecholine) adverse effects
hypotension, bradycardia, “see, pee, spit, shit”, N/V/D, increased respiratory secretions and bronchospasm
Bethanechol (Urecholine) nursing considerations
administer on an empty stomach to prevent N/V
assess for gastric obstruction if being used for GI motility issues
monitor for response
admin atropine if OD is suspected
Pilocarpine mechanism of action
binds to muscarinic cholinergic receptors to reduce intraocular pressure and excessive xerostomia
Pilocarpine adverse effects
miosis and blurred vision
sweating
hypotentsion and bradycardia
“see, pee, spit, shit”
syncope, HA, seizure, sweating
inc. respiratory secretions and bronchospasm
Pilocarpine nursing considerations
apply lacrimal pressure for 1-2 minutes post-administration
separate from other opthalamic medications
Pilocarpine patient education
dangers of driving at night and other hazardous occupations with poor illumination
Atropine (AtroPen) mechanism of action
block action of acetylcholine at muscarinic receptors to prevent effects of acetylcholine (primarily heart, exocrine glands, smooth muscles, and eyes)
Atropine (AtroPen) adverse effects
anticholinergic effects (can’t see, can’t pee, can’t spit, can’t sit)
Atropine (AtroPen) nursing considerations
treat OD with symptomatic and supportive therapy
if delirium, hallucinations, or coma occurs administer physostigmine
Oxybutynin (Ditropan XL) mechanism of action
block activation of M3 receptors on the detrusor muscle to cause muscle relaxation
Oxybutynin (Ditropan XL) adverse effects
anticholinergic effects (can’t see, pee, spit, shit)
older adults have higher risk of hallucinations, confusion, and sedation
Oxybutynin (Ditropan XL) nursing considerations
concurrent use with other anticholinergic medications can intensify effects,
monitor mental status closely in older adults
Mirabegron (Myrbetriq) mechanism of action
activates beta-3 receptor to cause detrusor muscle relaxation
Mirabegron (Myrbetriq) adverse effects
angioedema,
dose-related CV effects (HTN, tachycardia, and palpitations),
urinary retention
Pyridostigmine (Mestinon) mechanism of action
prevent breakdown of ACh by AChE via binding to increase amount of ACh available to activate receptors
Pyridostigmine (Mestinon) adverse effects
Excessive muscarinic stimulation: SLUDGE, Killer B’s
neuromuscular blockade
Pyridostigmine (Mestinon) nursing considerations
promote compliance,
assess ability to take PO meds prior to admin
Donepezil (Aricept) mechanism of action
prevents reversible breakdown to ACh by AChE to increase availability of ACh at cholinergic synapses
Donepezil (Aricept) adverse effects
GI effects - N/V/D and dyspepsia
CV effects - symptomatic bradycardia, prolonged QT waves, Torsades de pointes
Donepezil (Aricept) nursing considerations
place patient on fall precautions
monitor CV status and report symptomatic bradycardia and telemetry changes
Donepezil (Aricept) patient education
education on patient and family role in condition management
(this medication is used for AD treatment)
Rivastigmine (Exelon) mechanism of action
prevents irreversible breakdown of ACh by AChE to increase availability of ACh at cholinergic synapses
Rivastigmine (Exelon) adverse effects
GI effects- N/V/D and dyspepsia
CV effects- symptomatic bradycardia
Rivastigmine (Exelon) nursing considerations
place pt on fall precautions
monitor CV status closely and report symptomatic bradycardia
change patch every 24 hours
Rivastigmine (Exelon) patient education
educate pt and family on role in condition management
(this med is used for treatment of AD)
Memantine (Namenda) mechanism of action
modulates the effects of glutamate at NMDA receptors by blocking calcium entry
Memantine (Namenda) adverse effects
generally well tolerated;
CNS effects- dizziness, HA, confusion;
psychometric effects- agitation, delusions, and hallucinations
Memantine (Namenda) nursing considerations
don’t crush or chew ER preparations
monitor cognitive and functional outcomes
Vecuronium (Norcuron) mechanism of action
competitively binds to nitotinic M receptors on the motor end plate to block activation by ACh, causes muscle relaxation and persists as long as medication is sufficient to prevent receptor occupation by ACh
Vecuronium (Norcuron) adverse effects
respiratory arrest and hypotension
Vecuronium (Norcuron) nursing considerations
reversal agent is neostigmine;
use with caution in pts with MG;
doesn’t cross BBB- doesn’t effect LOC or perception of pain;
monitor pts on MV and promote comfort
Succinylcholine (Anectine) mechanism of action
competitively binds to nicotinic M receptors on the motor end plate to block activation by ACh to produce state of constant depolarization; clinically proven to provide muscle relaxation during surgery, MV, ET intubation
Succinylcholine (Anectine) adverse effects
prolonged apnea
malignant hyperthermia
hyperkalemia
post-op muscle pain
Succinylcholine (Anectine) nursing considerations
use with caution in pts with MG;
unable to cross BBB- doesn’t effect LOC or perception of pain;
monitor pts on MV and promote comfort;
ice packs, cold IV saline, and IV dantrolene for malignant hyperthermia
Lidocaine (Xylocaine) mechanism of action
stop axonal conduction by blocking sodium channels in the axonal membrane
Lidocaine (Xylocaine) adverse affects
CNS depression and excitation;
CV suppression- bradycardia, heart block, decreased contractility, and cardiac arrest;
allergic reactions
Lidocaine (Xylocaine) nursing considerations
injected form has higher risk of systemic effects
monitor for vasoconstriction s/s if used with epinephrine
monitor neurological and CV status with admin
Nitrous Oxide mechanism of action
enhance transmission at inhibitory synapses and depress transmission at excitatory synapses through binding with the NMDA receptor
Nitrous Oxide adverse effects
respiratory and cardiac depression;
malignant hyperthermia;
aspiration of gastric contents;
hepatotoxicity;
post-op N/V
Nitrous Oxide nursing considerations
often used supplementally with other anesthetic agents;
monitor for adverse effects;
assess and treat post-op pain and N/V
Midazolam (Versed) mechanism of action
enhance transmission at inhibitory synapses and depress transmission at excitatory synapses through activation of receptors for GABA
Midazolam (Versed) adverse effects
respiratory depression,
hypotension,
cardiac arrest,
Midazolam (Versed) nursing considerations
rapid onset and short durations = monitor sedation and mental status as it can change quickly;
slow injection administration to help minimize adverse effects;
monitor respiratory and CV status closely;
flumazenil is antidote for OD
Propofol (Diprivan) mechanism of action
enhance transmission at inhibitory synapses and depresses transmission at excitatory synapses through activation of receptors for GABA
Propofol (Diprivan) adverse effects
respiratory depression and hypotension
higher risk for bacterial infection
propofol injection syndrome- metabolic acidosis, renal failure, cardiac failure, and rhabdomyolysis
clinician abuse
Propofol (Diprivan) nursing considerations
rapid onset and ultrashort durations = monitor sedation and mental status closely;
monitor respiratory and CV status closely;
monitor for s/s of propofol injection syndrome;
follow facility protocol on disposing of vials
Ketamine (Ketalar) mechanism of action
enhance transmission at inhibitory synapses and depress transmission at excitatory synapses through activation of receptors for GABA
Ketamine (Ketalar) adverse effects
respiratory depression and hypotension;
psychological reactions- hallucinations, disturbing dreams, and delirium;
potential for abuse
Ketamine (Ketalar) nursing considerations
reduce risk for psychological reactions by pre-medicating with diazepam or midazolam
assess for prior psychiatric illness
frequently used in changing of burn dressing
Epinephrine (Adrenalin/EpiPen) MOA
adrenergic agonist class medication with actions at b1, b2, a1, and a2 receptors to produce bronchodilation
Epinephrine (Adrenalin/EpiPen) adverse effects
CV- hypertension, dysrhythmia, angina pectoris;
Necrosis;
IV line extravasation;
Hyperglycemia
Epinephrine (Adrenalin/EpiPen) nursing considerations
continually monitor V/S and IV sites;
Increased insulin therapy needed for pts w/ existing diabetes;
Caution in high-risk patients;
numerous medication interactions
Norepinephrine (Levophed) MOA
adrenergic agonist class medication with actions at b1, a1, and a2 to cause vessel constriction
Norepinephrine (Levophed) adverse effects
altered heart rate and rhythm
chest pain
local necrosis
Norepinephrine (Levophed) nursing considerations
monitor CV status
assess access sites and extremities for signs of ischemia
Dopamine MOA
adrenergic agonist class medication with dose dependent effects ranging from dopamine receptors, b1 and a1 receptors; effects ranging from renal vasodilation to cardiac stimulation
Dopamine adverse effects
CV- tachycardia, dysrhythmias, anginal pain;
necrosis and localized vasoconstriction
Dopamine nursing considerations
monitor CV status;
monitor I/Os to monitor renal function;
stop infusion and administer phentolamine if extravasation occurs
Albuterol (Ventolin) MOA
adrenergic agonist class medication with actions selective at b2 receptors only BUT it can sometimes effect b1 to cause bronchodilation for obstructive pulmonary conditions
Albuterol (Ventolin) adverse effects
hyperglycemia in diabetic pts
tremors (due to inc. muscle contraction)
Albuterol (Ventolin) nursing considerations
monitor for cardioselective activity from increased HR;
monitor glucose in pts with DM
Albuterol (Ventolin) patient education
education on proper inhalation technique if used as a PRN SABA and assess home use
Prazosin (Minipress) MOA
adrenergic antagonist medication with actions selective for a1 receptors for treatment for high BP in essential HTN
Prazosin (Minipress) adverse effects
orthostatic hypotension,
reflex tachycardia,
nasal congestion,
inhibition for ejaculation,
sodium retention and increased blood volume
Prazosin (Minipress) nursing considerations
obtain BP and HR prior to admin,
educate pts on changing positions after starting med,
can be administered with or without food,
monitor for higher risk of falls,
Tamsulosin (Flomax) MOA
adrenergic antagonist class medication with actions selective for a1 receptors in the bladder neck for treatment of BPH
Tamsulosin (Flomax) adverse efffects
headache and dizziness
abnormal ejaculation
Tamsulosin (Flomax) nursing considerations
monitor BP
evaluate urinary habits to monitor for response
b1 blockers
propranolol (Inderal) - 1st gen
metoprolol (Lopressor) - 2nd gen
carvedilol (Coreg) - 3rd gen
beta blockers MOA
adrenergic antagonist class medication
1st gen: nonselective
2nd gen: cardioselective
3rd gen: vasodilating actions
beta blocker adverse effects
b1: bradycardia, reduced CO, HF, AV heart block, reduced
cardiac excitation;
b2: bronchoconstriction, hypoglycemia;
bradycardia and respiratory distress in neonates
beta blocker nursing considerations
monitor hear rhythm, BP, and HR prior to admin;
monitor for respiratory distress in pts with obstructive respiratory conditions and myocardial suppression-related HF
beta blockers patient education
education on possible signs of hypoglycemia due to symptom masking
Clonidine (Catapres) MOA
activates a2 receptors in the CNS to reduce sympathetic outflow to blood vessels and heart
Clonidine (Catapres) adverse effects
drowsiness,
xerostomia,
rebound HTN,
potential for abuse,
potential for fetal harm
Clonidine (Catapres) nursing considerations
monitor BP and HR prior to admin
assess for history of illicit drug and opioid abuse
Clonidine (Catapres) patient education
educate on using gum, hard candy, and hydration to limit xerostomia
warn about rebound hypertension
Mirabegron (Myrbetriq) nursing considerations
alternative agent for pts that cannot tolerate anticholinergic agents,
can be used with other anticholinergic agents for OAB,
stop med if angioedema occurs
monitor BP closely in pts with pre-existing HTN
