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NURS 3303 > Neuropharmacolgy > Flashcards

Neuropharmacolgy Flashcards

1
Q

Bethanechol (Urecholine) mechanism of action

A

binds to muscarinic cholinergic receptors to relax trigone and sphincter muscles

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2
Q

Bethanechol (Urecholine) adverse effects

A

hypotension, bradycardia, “see, pee, spit, shit”, N/V/D, increased respiratory secretions and bronchospasm

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3
Q

Bethanechol (Urecholine) nursing considerations

A

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

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4
Q

Pilocarpine mechanism of action

A

binds to muscarinic cholinergic receptors to reduce intraocular pressure and excessive xerostomia

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5
Q

Pilocarpine adverse effects

A

miosis and blurred vision
sweating
hypotentsion and bradycardia
“see, pee, spit, shit”
syncope, HA, seizure, sweating
inc. respiratory secretions and bronchospasm

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6
Q

Pilocarpine nursing considerations

A

apply lacrimal pressure for 1-2 minutes post-administration
separate from other opthalamic medications

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7
Q

Pilocarpine patient education

A

dangers of driving at night and other hazardous occupations with poor illumination

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8
Q

Atropine (AtroPen) mechanism of action

A

block action of acetylcholine at muscarinic receptors to prevent effects of acetylcholine (primarily heart, exocrine glands, smooth muscles, and eyes)

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9
Q

Atropine (AtroPen) adverse effects

A

anticholinergic effects (can’t see, can’t pee, can’t spit, can’t sit)

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10
Q

Atropine (AtroPen) nursing considerations

A

treat OD with symptomatic and supportive therapy
if delirium, hallucinations, or coma occurs administer physostigmine

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11
Q

Oxybutynin (Ditropan XL) mechanism of action

A

block activation of M3 receptors on the detrusor muscle to cause muscle relaxation

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12
Q

Oxybutynin (Ditropan XL) adverse effects

A

anticholinergic effects (can’t see, pee, spit, shit)
older adults have higher risk of hallucinations, confusion, and sedation

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13
Q

Oxybutynin (Ditropan XL) nursing considerations

A

concurrent use with other anticholinergic medications can intensify effects,
monitor mental status closely in older adults

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14
Q

Mirabegron (Myrbetriq) mechanism of action

A

activates beta-3 receptor to cause detrusor muscle relaxation

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15
Q

Mirabegron (Myrbetriq) adverse effects

A

angioedema,
dose-related CV effects (HTN, tachycardia, and palpitations),
urinary retention

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16
Q

Pyridostigmine (Mestinon) mechanism of action

A

prevent breakdown of ACh by AChE via binding to increase amount of ACh available to activate receptors

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17
Q

Pyridostigmine (Mestinon) adverse effects

A

Excessive muscarinic stimulation: SLUDGE, Killer B’s
neuromuscular blockade

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18
Q

Pyridostigmine (Mestinon) nursing considerations

A

promote compliance,
assess ability to take PO meds prior to admin

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19
Q

Donepezil (Aricept) mechanism of action

A

prevents reversible breakdown to ACh by AChE to increase availability of ACh at cholinergic synapses

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20
Q

Donepezil (Aricept) adverse effects

A

GI effects - N/V/D and dyspepsia
CV effects - symptomatic bradycardia, prolonged QT waves, Torsades de pointes

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21
Q

Donepezil (Aricept) nursing considerations

A

place patient on fall precautions
monitor CV status and report symptomatic bradycardia and telemetry changes

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22
Q

Donepezil (Aricept) patient education

A

education on patient and family role in condition management
(this medication is used for AD treatment)

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23
Q

Rivastigmine (Exelon) mechanism of action

A

prevents irreversible breakdown of ACh by AChE to increase availability of ACh at cholinergic synapses

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24
Q

Rivastigmine (Exelon) adverse effects

A

GI effects- N/V/D and dyspepsia
CV effects- symptomatic bradycardia

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25
Q

Rivastigmine (Exelon) nursing considerations

A

place pt on fall precautions
monitor CV status closely and report symptomatic bradycardia
change patch every 24 hours

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26
Q

Rivastigmine (Exelon) patient education

A

educate pt and family on role in condition management
(this med is used for treatment of AD)

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27
Q

Memantine (Namenda) mechanism of action

A

modulates the effects of glutamate at NMDA receptors by blocking calcium entry

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28
Q

Memantine (Namenda) adverse effects

A

generally well tolerated;
CNS effects- dizziness, HA, confusion;
psychometric effects- agitation, delusions, and hallucinations

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29
Q

Memantine (Namenda) nursing considerations

A

don’t crush or chew ER preparations
monitor cognitive and functional outcomes

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30
Q

Vecuronium (Norcuron) mechanism of action

A

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

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31
Q

Vecuronium (Norcuron) adverse effects

A

respiratory arrest and hypotension

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32
Q

Vecuronium (Norcuron) nursing considerations

A

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

33
Q

Succinylcholine (Anectine) mechanism of action

A

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

34
Q

Succinylcholine (Anectine) adverse effects

A

prolonged apnea
malignant hyperthermia
hyperkalemia
post-op muscle pain

35
Q

Succinylcholine (Anectine) nursing considerations

A

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

36
Q

Lidocaine (Xylocaine) mechanism of action

A

stop axonal conduction by blocking sodium channels in the axonal membrane

37
Q

Lidocaine (Xylocaine) adverse affects

A

CNS depression and excitation;
CV suppression- bradycardia, heart block, decreased contractility, and cardiac arrest;
allergic reactions

38
Q

Lidocaine (Xylocaine) nursing considerations

A

injected form has higher risk of systemic effects
monitor for vasoconstriction s/s if used with epinephrine
monitor neurological and CV status with admin

39
Q

Nitrous Oxide mechanism of action

A

enhance transmission at inhibitory synapses and depress transmission at excitatory synapses through binding with the NMDA receptor

40
Q

Nitrous Oxide adverse effects

A

respiratory and cardiac depression;
malignant hyperthermia;
aspiration of gastric contents;
hepatotoxicity;
post-op N/V

41
Q

Nitrous Oxide nursing considerations

A

often used supplementally with other anesthetic agents;
monitor for adverse effects;
assess and treat post-op pain and N/V

42
Q

Midazolam (Versed) mechanism of action

A

enhance transmission at inhibitory synapses and depress transmission at excitatory synapses through activation of receptors for GABA

43
Q

Midazolam (Versed) adverse effects

A

respiratory depression,
hypotension,
cardiac arrest,

44
Q

Midazolam (Versed) nursing considerations

A

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

45
Q

Propofol (Diprivan) mechanism of action

A

enhance transmission at inhibitory synapses and depresses transmission at excitatory synapses through activation of receptors for GABA

46
Q

Propofol (Diprivan) adverse effects

A

respiratory depression and hypotension
higher risk for bacterial infection
propofol injection syndrome- metabolic acidosis, renal failure, cardiac failure, and rhabdomyolysis
clinician abuse

47
Q

Propofol (Diprivan) nursing considerations

A

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

48
Q

Ketamine (Ketalar) mechanism of action

A

enhance transmission at inhibitory synapses and depress transmission at excitatory synapses through activation of receptors for GABA

49
Q

Ketamine (Ketalar) adverse effects

A

respiratory depression and hypotension;
psychological reactions- hallucinations, disturbing dreams, and delirium;
potential for abuse

50
Q

Ketamine (Ketalar) nursing considerations

A

reduce risk for psychological reactions by pre-medicating with diazepam or midazolam
assess for prior psychiatric illness
frequently used in changing of burn dressing

51
Q

Epinephrine (Adrenalin/EpiPen) MOA

A

adrenergic agonist class medication with actions at b1, b2, a1, and a2 receptors to produce bronchodilation

52
Q

Epinephrine (Adrenalin/EpiPen) adverse effects

A

CV- hypertension, dysrhythmia, angina pectoris;
Necrosis;
IV line extravasation;
Hyperglycemia

53
Q

Epinephrine (Adrenalin/EpiPen) nursing considerations

A

continually monitor V/S and IV sites;
Increased insulin therapy needed for pts w/ existing diabetes;
Caution in high-risk patients;
numerous medication interactions

54
Q

Norepinephrine (Levophed) MOA

A

adrenergic agonist class medication with actions at b1, a1, and a2 to cause vessel constriction

55
Q

Norepinephrine (Levophed) adverse effects

A

altered heart rate and rhythm
chest pain
local necrosis

56
Q

Norepinephrine (Levophed) nursing considerations

A

monitor CV status
assess access sites and extremities for signs of ischemia

57
Q

Dopamine MOA

A

adrenergic agonist class medication with dose dependent effects ranging from dopamine receptors, b1 and a1 receptors; effects ranging from renal vasodilation to cardiac stimulation

58
Q

Dopamine adverse effects

A

CV- tachycardia, dysrhythmias, anginal pain;
necrosis and localized vasoconstriction

59
Q

Dopamine nursing considerations

A

monitor CV status;
monitor I/Os to monitor renal function;
stop infusion and administer phentolamine if extravasation occurs

60
Q

Albuterol (Ventolin) MOA

A

adrenergic agonist class medication with actions selective at b2 receptors only BUT it can sometimes effect b1 to cause bronchodilation for obstructive pulmonary conditions

61
Q

Albuterol (Ventolin) adverse effects

A

hyperglycemia in diabetic pts
tremors (due to inc. muscle contraction)

62
Q

Albuterol (Ventolin) nursing considerations

A

monitor for cardioselective activity from increased HR;
monitor glucose in pts with DM

63
Q

Albuterol (Ventolin) patient education

A

education on proper inhalation technique if used as a PRN SABA and assess home use

64
Q

Prazosin (Minipress) MOA

A

adrenergic antagonist medication with actions selective for a1 receptors for treatment for high BP in essential HTN

65
Q

Prazosin (Minipress) adverse effects

A

orthostatic hypotension,
reflex tachycardia,
nasal congestion,
inhibition for ejaculation,
sodium retention and increased blood volume

66
Q

Prazosin (Minipress) nursing considerations

A

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,

67
Q

Tamsulosin (Flomax) MOA

A

adrenergic antagonist class medication with actions selective for a1 receptors in the bladder neck for treatment of BPH

68
Q

Tamsulosin (Flomax) adverse efffects

A

headache and dizziness
abnormal ejaculation

69
Q

Tamsulosin (Flomax) nursing considerations

A

monitor BP
evaluate urinary habits to monitor for response

70
Q

b1 blockers

A

propranolol (Inderal) - 1st gen
metoprolol (Lopressor) - 2nd gen
carvedilol (Coreg) - 3rd gen

71
Q

beta blockers MOA

A

adrenergic antagonist class medication
1st gen: nonselective
2nd gen: cardioselective
3rd gen: vasodilating actions

72
Q

beta blocker adverse effects

A

b1: bradycardia, reduced CO, HF, AV heart block, reduced
cardiac excitation;
b2: bronchoconstriction, hypoglycemia;
bradycardia and respiratory distress in neonates

73
Q

beta blocker nursing considerations

A

monitor hear rhythm, BP, and HR prior to admin;
monitor for respiratory distress in pts with obstructive respiratory conditions and myocardial suppression-related HF

74
Q

beta blockers patient education

A

education on possible signs of hypoglycemia due to symptom masking

75
Q

Clonidine (Catapres) MOA

A

activates a2 receptors in the CNS to reduce sympathetic outflow to blood vessels and heart

76
Q

Clonidine (Catapres) adverse effects

A

drowsiness,
xerostomia,
rebound HTN,
potential for abuse,
potential for fetal harm

77
Q

Clonidine (Catapres) nursing considerations

A

monitor BP and HR prior to admin
assess for history of illicit drug and opioid abuse

78
Q

Clonidine (Catapres) patient education

A

educate on using gum, hard candy, and hydration to limit xerostomia
warn about rebound hypertension

79
Q

Mirabegron (Myrbetriq) nursing considerations

A

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

NURS 3303 (10 decks)

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