PHARM 1 EXAM #2 Flashcards
Explain major responses to stimulation of adrenergic receptors
Differentiate between selective and nonselective adrenergic agonists.
Contrast the uses of alpha blockers and beta blockers
Compare the indications and general side effects of adrenergic agonists and adrenergic
blockers
Describe nursing interventions, including patient teaching, associated with adrenergic agonists and adrenergic blockers.
Apply the nursing process for the patient taking beta-adrenergic blockers
Compare the responses of cholinergic agonists and anticholinergic drugs
Cholinergic agonists — stimulate PSN/mimic neurotransmitter ACh
—Receptors: Musarinic (smooth muscles), Nicotinic (skeletal muscles)
Anticholinergic agonists — inhibit
GU drug: Tolterodine tartrate (Detrol)
Gotta go RIGHT NOW
Is an anticholinergic/antimuscarinic agent that is used to treat overactive bladder symptoms
The purpose of Atropine
Action
—Increases pulse, decreases motility and peristalsis, decreases salivary secretions
Side effects/adverse reactions
—Tachycardia, palpitations, nasal congestion, flushing, photophobia, blurred vision, dry mouth and skin, abdominal distention, urinary retention, impotence
Contraindicated in glaucoma
— Because anticholinergic drugs can increase intraocular pressure, they should not be administered to patients diagnosed with glaucoma.
RN Interventions for Atropine
Monitor vital signs, urine output, bowel sounds.
Monitor safety: bedside rails, driving motor vehicles.
Provide mouth care and eye drops.
Avoid hot environments.
Avoid alcohol, cigarettes, caffeine, and aspirin at bedtime.
Wear sunglasses in bright light.
Differentiate between direct-acting and indirect-acting cholinergic agonists
Direct-acting — muscarinic receptors (Heart, GI, GU, glands)
Drugs: Metoclopramide (Reglan); Pilocarpine (Pilocar)[Glaucoma]; Bethanoechol chloride (Urecholine) (check for hx of peptic ulcer, urinary obstruction, or asthma — contraindications)
Indirect-acting — Cholinesterase inhibitors inactivate the enzyme acetylcholinesterase (cholinesterase), thus permitting acetylcholine to react to the receptor.
Drugs: Achetylcholinesterase- inhibitor
Contrast the indications and major side effects of cholinergic agonists and antagonists
Cholinergic agonists = too wet, too drooly
Cholinergic antagonists = too dry, dilate eyes, bronchoconstrict lungs
Differentiate the uses of cholinergic agonists and antagonists
What drug is used for a patient post anesthesia
given as a short-term only, <2hr for acute respiratory insufficiency r/t COPD
Dopram is a prescription medicine used to treat the symptoms of COPD Associated with Acute Hypercapnia, Respiratory Depression Postanesthesia, and Drug-Induced CNS Depression
Apply the nursing process, including patient teaching associated with cholinergic agonists
and anticholinergic
Apply the nursing process for the patient taking neostigmine, a reversible cholinesterase
inhibitor
Edrophonium (Tensilon) is a VERY short-acting and often used for diagnostic purposes.
— Neostigmine methylsulfate and ambenonium chloride are used to treat myasentenia gravis.
— Physostigmine salicylate is used to treat anti-cholinergic syndrome or glaucoma.
Explain the effects of stimulants on the central nervous system (CNS)
What are the medically approved uses for CNS Stimulants?
— Attention deficit/hyperactivity disorder (ADHD)
— Narcolepsy
— Reversal of respiratory distress
Compare attention deficit/hyperactivity disorder and narcolepsy
ADHD
— Pathophysiology: Dysregulation of transmitters (Serotonin, Norepinephrine, Dopamine)
Characteristics
— Inattentiveness, inability to concentrate, restlessness, hyperactivity, inability to complete tasks, impulsivity
______________VS_________________________
Narcolepsy
Characteristics:
— Inability to control sleep/stay awake
— Recurrent attacks of drowsiness and sleep during daytime
— Falls asleep while driving, talking, eating, standing
Amphetamine drugs vs. Amphetamine-like drugs
Amphetamines:
— amphetamine sulfate (Adderall); destroamphetamine sulfate (Desedrine); lindexamfetamine dimesylate (Vyvanse)
VS
Amphetamine-like:
—methylphenidate HCl (Ritalin); modafinil (Provigil); dexmethylphenidate (Focalin); amodafinil (Nuvigil)
RN Implications/Interventions when taking *Methylphenidate (Ritalin)
— Give before breakfast and lunch (30-45 minutes)
— Report irregular heartbeat
— Watch growth in children who take this drug; ensure they’re growing at the standard pace
— Record height, weight, and growth + development of children.
— Avoid alcohol, caffeine
— Use sugarless gum/ice chips to relieve dry mouth.
— Do not stop abruptly; taper off to avoid withdrawal symptoms b/c changes the CNS neuro-chemicals chemistry**
— Counseling must also be used.
— Do not give after 2-3pm…will have insomnia
Side/Adverse Effects for Methylphenidate (Ritalin)
— Tachycardia, palpitations, dizziness, hypertension
— Sleeplessness, restlessness, nervousness, tremors, irritability
— Increased hyperactivity
— Anorexia, dry mouth, vomiting, diarrhea, weight loss
— Thrombocytopenia = decreased platelet count in blood
What are Extrapyramidal Symptoms (EPSs)
akathisia, dystonia, psuedoparkinsonism, and dyskinesia, are drug-induced side effects that can be problematic for persons who receive antipsychotic medications (APMs) or other dopamine-blocking agents. Pseudoparkinsonism, or neuroleptic-induced parkinsonism, includes slow pill-rolling finger tremors, masklike facial expression, weakened voice, absence of arm swing when walking, stiff stooped posture, and an impaired shuffling gait. Cogwheeling rigidity, assessed frequently in the arms, is a ratchet-like motion of the extremities during extension.
Drugs used for Parkinsonism
Drugs used - Anticholinergic/antiparkinsonism
— Benztropine (Cogentin)
— Biperiden (Akineton)
— Trihexyphenidyl HCl (Artane)
Action
Decreases involuntary movement, tremors, muscle rigidity
— These drugs (that decrease acetylcholine) can be used alone early in Parkinson’s, later they are combined with levodopa/cabidopa (which increases dopamine).
What are the contraindications for taking Methylphenidate (Ritalin)
Patients who have a history of heart disease, hypertension, hyperthyroidism, parkinsonism, or glaucoma.
Side/Adverse Effects of Amphetamines
— Tachycardia, palpitations, hypertension
Sleeplessness, restlessness
— Irritability
— Anorexia, dry mouth, weight loss, diarrhea, constipation
— Impotence (no el sexo)
Methylphenidate (Ritalin) MOA + Uses + Interactions
MOA
— Modulates serotonergic pathways by affecting changes in dopamine transport
USES
— ADHD, fatigue, narcolepsy
INTERACTIONS
— Caffeine may increase effects (decrease or eliminate, plsss)
— Decreased effects when using with decongestants, anti-HTN’ves, barbiturates
— May alter insulin effects
Drugs used for Narcolepsy
Methylphenidate (Ritalin)
Modafinil (Provigil) — don’t fully understand the MOA
Uses: increases the amount of time patients with narcolepsy feel awake
Drugs used for ADHD
Amphetamines MOA: stimulate release of norepinephrine + dopamine
high abuse potential due to euphoria-feeling
Amphetamine-Like drugs: Methylphenidate (Ritalin), Dexmethylphenidate (Focalin)
Differentiate the action of drugs used for attention deficit/hyperactivity disorder and
narcolepsy
Amphetamines & Amphetamine-Like Drugs
— MOA: stimulate release of norepinephrine + dopamine; has a paradoxical effect to be able to increase attention span and cognitive performance
Runs potential for abuse/addiction
___________________
For Narcolepsy
— MOA:
Contrast the common side effects of amphetamines, anorexiants, analeptics, doxapram, and
caffeine
Respiratory CNS Stimulants for Adults
Drug — Doxapram (Dopram)
Uses — Respiratory depression caused by overdose, pre/post-anesthetic respiratory depression, and hx of COPD; trying to get off ventilators and need a little push to help you become more awake
Onset of action — 20-40 seconds, peak within 2 minutes
Side Effects — HTN, Tachycardia, trembling, convulsions
Analeptic Drugs, Use, + Side Effects
Drugs — Caffeine, Theophylline
Uses — Stimulate respiratory effort in newborns
Side Effects
— Restlessness, tremors, twitching, palpitations, insomnia
— Diuresis, tinnitus, nausea, diarrhea
— Psychological dependence
Anorexiant Drugs + Side Effects
— Benzphetamine HCl (Didrex)
— Diethylpropion HCl (Tenuate)
— Phentermine HCl (Suprenza)
— Phentermine-topiramate (Qsymia)
— Phendimetrazine (Bontril)
— Lorcaserin (Belviq)
Side effects
Nervousness, restlessness, irritability, insomnia, heart palpitations, and hypertension
___________________
NOTE: tolerance and abusive tendencies may arise if on the drug long enough therefore not chosen often
Apply the nursing process for the patient taking CNS stimulants
Apply the nursing process for the patient taking doxapram (Dopram)
MOA — stimulates the medullary respiratory centre both by a direct action and by peripheral stimulation of the carotid body
Uses — Respiratory depression caused by overdose, pre/post-anesthetic respiratory depression, and hx of COPD; trying to get off ventilators and need a little push to help you become more awake
Onset of action — 20-40 seconds, peak within 2 minutes
Side Effects — HTN, Tachycardia, trembling, convulsions
Differentiate the types and stages of sleep
— Rapid eye movement (REM)
— Nonrapid eye movement (NREM)
________________________________
NOTE: It is difficult to arouse someone who is in REM sleep)* therefore interrupting a person’s sleep (before reaching REM cycle), results in the person having to go through these stages from the beginning in order to reach REM**
COHORT YOUR CARE TO PREVENT THIS
Explain several nonpharmacologic ways to induce sleep
— No daytime naps
— Warm fluids to drink
— Caffeine avoided 6 hr before bedtime
— Heavy meals and exercise avoided before bedtime
— Warm bath, reading, listening to music
Differentiate among these adverse effects: hangover, dependence, tolerance, withdrawal
symptoms, and rapid eye movement (REM) rebound, respiratory depression, & hypersensitivity
Hangover — residual drowsiness
Dependence — results in withdrawal symptoms
Tolerance — need to increase dosage to get desired effect
Withdrawal symptoms — due to being dependent on a drug
Rapid eye movements (REM) rebound — vivid dreams and nightmares
Respiratory depression — suppression of respiratory center in the medulla; CNS depressants/EtOH/opioids = need ambubag
Hypersensitivity — skin rashes
Sedative/Hypnotic effect is determined by the _____. Differentiate between the two.
Dose
________
Sedative = give a smaller dose
Hypnotic = give a larger dose
Sedative-Hypnotic Drugs
Sedatives produce mildest form of CNS depression
Drugs — Barbiturates, Benzodiazepines, Nonbenzodiazepines
OTC Sedative-Hypnotics
— Sominex
— Tylenol PM
— Diphenhydramine (Benadryl)
Difference between the 1st generation antihistamines vs. the 2nd
1st generation — crosses the BBB —> drowsiness
— e.g. Diphenhydramine (Benadryl)
2nd generation — does NOT cross the BBB —> no drowsiness/non-sedating
— e.g. Claritin, Zyrtec, Xyzal, Allegra
Discuss the uses of benzodiazepines
Drugs used as hypnotics —
— Flurazepam (Dalmane)
— Alprazolam (Xanax)
— Temazepam (Restoril)
— Triazolam (Halcion)
— Estazolam (ProSom)
— Quazepam (Doral)
Drugs used for anxiety
— Lorazepam (Ativan); can give higher dose to abort seizures
— Diazepam (Valium)
________
**NOTE: high doses = hypnotic-sedatives vs. low doses = anxiolytic
Apply the nursing process for the patient taking benzodiazepines for hypnotic use
Benzodiazepines
— When using as a sedative — anxiolytic to reduce anxiety
— When using as a hypnotic — Tx insomnia (increasing dose)
Side Effects — Respiratory depression (very old/young, outside normal BMI)
What is the difference between anterograde amnesia vs. retrograde amnesia? Why is this a benefit in the hospital regarding a side effect?
Retrograde: “Oh, I forgot what I did yesterday.”
Anterograde: Forget what’s happening coming up/what’s going to happen
Why? Forget what’s happening presurgery, pre-chemo, preprocedure therapy b/c don’t want patient to feel miserable during the incoming process
Which drugs are safer Barbiturates or Benzodiazepines? Why?
Benzodiazepines
Enhance patient’s own GABA to quiet the brain, and increase efficacy of own GABA neurotransmitters
Barbiturates = mimic GABA so adding more towards brain = increase in abuse potential
Barbiturates
These drugs directly mimic GABA, the principal inhibitory neurotransmitter, in the CNS = “putting brain to sleep”
Scheduled II & III = highly addictive/abusive potential
____________
— Long-acting
— Intermediate-acting
— Short-acting
— Ultrashort-acting
— Restricted to short-term use (2 weeks or less) because of side effects, including drug tolerance
Interactions — alcohol, opioids, other sedative-hypnotics
Sedative + Hypnotics for Older Adults
— Identify cause.
— Use nonpharmacologic methods first.
— Use short- to intermediate-acting benzodiazepines such as estazolam (ProSom), temazepam (Restoril), and triazolam (Halcion).
— Avoid benzodiazepines such as flurazepam, quazepam (Doral), and diazepam (Valium).
— Eszopiclone (Lunesta) – benzo-like drug
These drugs will INCREASE fall risk
Sedative-Hypnotics drug interactions + RN Interventions
Drug interactions
— Alcohol, CNS depressants
Nursing interventions
— First use nonpharmacologic methods.
— Be attentive to safety.
— Avoid alcohol, other CNS depressants.
— Take 15 to 45 minutes before bedtime.
— Report hangover effect.
— Monitor BP, RR.
— Withdraw gradually
Drug interactions + nursing interventions: Melatonin agonist hypnotics
— Ramelteon (Rozerem)
— First FDA-approved hypnotic not classified as a controlled substance
— Selectively targets melatonin receptors to regulate circadian rhythm in the treatment of insomnia
— Not been shown to decrease REM sleep
Adverse effects: drowsiness, dizziness, fatigue, headache, nausea, and suicidal ideation
Also used as an antianxiety (anxiolytic) drug — great for older adult population to reduce abuse potential with other drugs
Name the routes of anesthesia
Inhalation
Intravenous (IV)
Topical
Local
Spinal
Spinal Anesthesia
— Go through menengial covering
— injected medication into the cerebral spinal fluid and may circulate/drift upward
Interventions
— Have HOB slightly raised (medication may move up higher into the spinal cord and don’t want to happen); DO NOT WANT TO HAVE A NUMB DIAPHRAGM!
Compare the stages of anesthesia
Stage 1: Analgesia (don’t sense pain)
Stage 2: Excitement or delirium (acute loss of sensorium; don’t know what’s going on around you)
Stage 3: Surgical
Stage 4: Medullary paralysis — (TOXIC)
In order to perform surgery, must past stages 2 + 3 (pain perception)
Define balanced anesthesia
Several drugs used to ensure smooth induction and adequate muscle relaxation in your patient (prior/during procedure) to make it as pleasant as possible for the patient
May include
— A hypnotic given the night before to ensure adequate rest
— Premedication with an opioid analgesic or benzodiazepine (e.g., midazolam [Versed]) plus an anticholinergic (e.g., atropine) given about 1 hour before surgery to decrease secretions
— A short-acting barbiturate such as thiopental sodium (Pentothal)
— An inhaled gas—often a combination of nitrous oxide and oxygen; for anxious children to start an IV
— A muscle relaxant given as needed
Drugs used for inhalation anesthesia
Inhalation anesthetics + its uses
— Methoxyflurane, enflurane (Ethrane), isoflurane (Forane), desflurane (Suprane), and sevoflurane (Ultane)
— Usually combined with a barbiturate (e.g., thiopental), a strong analgesic (e.g., morphine), and a muscle relaxant (e.g., pancuronium)
— Adverse effects: respiratory depression, hypotension, dysrhythmias, and hepatic dysfunction
— Malignant hyperthermia (genetic)
Explain the problems with malignant hyperthermia. What is the antidote?
Malignant hyperthermia (MH) is a rare, genetically determined, life-threatening reaction to general anesthetics. Coadministration of succinylcholine, a neuromuscular blocker, increases the risk of the reaction.
ANTIDOTE: dantrolene (Dantrium) – muscle relaxant; comes in po & IV – IV used to treat MH
___________________
Dantrolene = generic
(Dantrium), (Ryanodex) = brand/trade name
Explain the uses for topical anesthetics
Use
— Mucous membranes, broken or unbroken skin surfaces, and burns
Forms
— Solution, liquid spray, ointment, cream, gel, and powder
— Decrease the sensitivity of nerve endings of the affected area
Cocaine often used for anesthesia of the ear, nose & throat – causes vasoconstriction also…good for epistaxis
Differentiate general and local anesthetics and their major side effects
General anesthetics:
— Purpose: depress the CNS, alleviate pain, and cause a loss of consciousness
__________________________
Local anesthetics
— Purpose: analgesia in limited area
Dose related r/t effects: lose sensation order first pain, then temperature, touch, and finally motor sensation
Name the order in which sensation is lost when given anesthesia
Perception of pain is lost first, followed in order by perception of cold (temperature), warmth, touch and deep pressure.
NOTE: Blocks not only sensory but also motor neurons, which is why you can’t smile when you leave the dentist
Contrast the two international classifications of seizures with characteristics of each type
- Focal onset
- Generalized onset
Differentiate between the types of seizures
GENERALIZED = grand-mal & petit mal
Tonic-clonic — aka grand mal
— most common; tonic = rigidity & clonic =spasms w/ jerkiness
Tonic seizure = “drop attack” losing muscle tone
Absence (petit mal):
— aka petit mal
— a brief LOC (for 10 seconds or less)
— usually occurs in children
______________________________
PARTIAL (Focal Onset Seizure)
—Psychomotor = repetitive behavior (e.g. chewing/swallowing motions)
— Behavioral changes
— Motor seizures
Simple Partial = remains conscious
Complex Partial = lose consciousness w/ potential of 2ndary results leading to—> Generalized
Summarize the pharmacokinetics, side effects and adverse reactions, therapeutic plasma,
contraindications for use, and drug interactions of phenytoin (Dilantin)
Pharmacokinetics:
Side Effects:
Adverse Rxns:
Therapeutic plasma:
Contraindications:
Drug Interactions
Summarize the pharmacokinetics, side effects and adverse reactions, therapeutic plasma,
contraindications for use, and drug interactions of phenytoin (Dilantin)
Pharmacokinetics:
Side Effects: gingival hyperplasia (gum will grow upward)
Adverse Rxns:
Therapeutic plasma: 10-20 mcg/mL must keep blood level within range in order for the drug to remain effective and not toxic for patient
Contraindications: DO NOT USE during pregnancy (teratogenic)
Drug Interactions:
TEACHING: brush teeth with soft toothbrush and brush downward
What is a febrile seizure and when do they occur?
— Seizures associated with fever usually occur in children between the ages of 3 months and 5 years.
— Temperature = >102.2 ºF (39ºC) for when seizures may occur
Do febrile seizures increase risk for developing epilepsy? T/F.
FALSE
— Epilepsy develops in approximately 2.5% of children who have had one or more febrile seizures.
— Febrile common from 6 months to 5 years; does not really increase risk of developing epilepsy
What is the prophylactic anticonvulsant Tx?
Prophylactic anticonvulsant treatment such as phenobarbital or diazepam may be indicated for high-risk patients.
What drug should NOT be given to children who suffer from febrile seizures?
Valproic acid should not be given to children younger than 2 years because of its possible hepatotoxicity
Name the RN interventions (teaching) for patient taking Hydantoins class medication phenytoin (Dilantin)
— Shake suspension well for 5 minutes
— Monitor serum drug levels
— Safety: Protect env’tal hazards, driving
— Warn female patient taking oral contraceptives to use additional contraception
— Warn patient to avoid certain herbs, EtOH, and other CNS depressants
— Warn patient not to discontinue abruptly
—Patient will need to frequent oral hygiene and dental check-ups; brush with soft toothbrush, brush downward to prevent gingival hyperplasia
— Diabetics must monitor glucose levels
— Tell each patient to take drug at same time every day
— Warn of harmless pinkish/red or brown urine
— Teach patient to report sore throat, bruising, nosebleeds
— Encourage patient to wear medical-alert identification
__________________
Note
GENERIC NAME: PHENYTOIN
BRAND/TRADE NAME: DILANTIN
Benzodiazepines drugs used for AEDs
— Clonazepam
— Clorazepate dipotassium
— Diazepam (Valium)
Types of Barbiturates
Phenobarbital
RN Interventions for Phenobarbital
— Shake suspension well for 5 minutes.
— Treats partial seizures, grand mal seizures, acute episodes of status epilepticus seizures, meningitis, toxic reactions, and eclampsia
— Therapeutic serum range of phenobarbital is 20 to 40 mcg/mL.
— Risks–sedation and patient tolerance to the drug
— Discontinuance of phenobarbital should be gradual to avoid recurrence of seizures.
What are the therapeutic serum levels for AEDs from least to greatest margins
— Carbamazepine: 5 to 12 mcg/mL
— Hydantoins: 10 to 20 mcg/mL
— Phenobarbital: 20 to 40 mcg/mL
— Ethosuximide (Zarontin): 40-100 mcg/mL
— Valproic acid: 50 to 150 mcg/mL
What is the purpose of Anticonvulsants/Antiepileptic Drugs (AEDs)? What are their MOAs?
To suppress abnormal neuron firing
What is the drug of choice for active repetitive seizures and/or *status epilepticus? Route?
— Diazepam (Valium) OR Lorazepam (Ativan) administered IV
— Followed by IV administration of phenytoin (Dilantin) = essential
What is an orphan drug?
A pharmaceutical agent that has been developed specifically to treat a rare medical condition, the condition itself being referred to as an orphan disease.
What medication is used for continued seizures? Goals?
Midazolam (Versed) or propofol (Diprivan)
_________
Goals:
— Maintain ventilation
— Terminate seizures
— Correct hypoglycemia
— Initiate or continue long term suppression medication
Which AED medication is short/long acting? Which is preferred?
Short-acting: Diazepam
Long-acting: Lorazepam w/ effects lasting up to 72 hours — generally preferred
______________________
Note: If diazepam is used follow up treatment with a long acting drug is essential (i.e. Dilantin or fosphenytoin/Cerebyx)
What is DIASTAT AcuDial? What is it used for?
It is a diazepam rectal gel that has a unique locking mechanism that ensures that your patients receive the correct dose
_________________
NOTE: Remind your patients and their caregivers to inspect each DIASTAT AcuDial syringe BEFORE leaving the pharmacy.
Phenobarbital
— Mechanism of Action:
Enhances GABA activity
— Use: Tonic–clonic, partial, myoclonic seizures, status epilepticus
— Therapeutic serum range:
20 to 40 mcg/mL
— Side effects:
Sedation, tolerance
— Discontinuation:
Should be gradual
What are the drugs that suppress sodium influx for anticonvulsants/anti-epileptic drugs (AEDs)?
— Phenytoin (Dilantin)
— Fosphenytoin
— Carbamazepine
— Oxcarbazepine
— Valproic acid
— Topiramate
— Zonisamide
— Lamotrigine
IMINOSTILBENE
— Carbamazepine: effective in Tx’ing refractory seizure d/o’s that have not responded to other anticonvulsant therapies
A derivative of Iminostilbene
_________________________
— Used to control grand-mal + partial seizures and a combination of these seizures
— Also used for psychiatric d/o (e.g. bipolar d/o), trigeminal neuralgia (as an analgesic), and alcohol withdrawal
— Therapeutic serum range of carbamazepine: 5-12mcg/mL
— An interaction may occur when grapefruit juice is taken with Carbamazepine (Tegretol) causing possible toxicity
Most common neuro adverse effects for Iminostilbene (Carbamazepine)
Nystagmus, ataxia, diplopia, drowsiness, dizziness, headache
RN Interventions for Iminostilbene (Carbamazepine)
— Water retention can be dangerous in those with heart failure
— Periodic CBC should be done due to risk (though rare) of hematologic side effects which can include aplastic anemia
What are the drugs that suppress calcium influx for anticonvulsants/anti-epileptic drugs (AEDs)?
— Valproic acid (Depakane)
— Ethosuximide
If you perform multimodal approach to a problem, you will have an enhanced pharmacodynamic effect? T/F
TRUE
VALPROATE
Brand/Trade names: Dyzantil, Epilim, Episenta, Epival
MOAction:
Valproic acid: Used to treat petit mal, grand mal, and mixed types of seizures
— Safety and efficacy of this drug has not been established for children younger than 2 years of age.
— Caution in patients with liver disorders, because hepatotoxicity is one of the possible adverse reactions. — Liver enzymes should be monitored.
—Therapeutic serum range is 50 to 150 mcg/mL
Mechanism of Action: Hydantoins
— Stabilizes neuronal membranes by decreasing sodium and calcium ion influx into the neurons
— Also decreases post-tetanic potentiation and repetitive discharge.
Mechanism of Action: Long-acting Barbiturates
Enhances GABA activity
Mechanism of Action: Succinimides
Decreases calcium influx
MOA: Oxazolidones
Binding P site, inhibition of initiation complex and also translocation of peptidyl-tRNA from A site to P site
MOA: Benzodiazepines
— They act by facilitating the binding of the inhibitory neurotransmitter GABA at various GABA receptors throughout the CNS
— Results in the sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties for which the drugs are prescribed.
MOA: Iminostilbenes
— Enhancement of sodium channel inactivation by reducing high-frequency repetitive firing of action potentials
— Action on synaptic transmission.
MOA: Valproate
— Inhibit succinic semialdehyde dehydrogenase
— This inhibition results in an increase in succinic semialdehyde which acts as an inhibitor of GABA transaminase ultimately reducing GABA metabolism and increasing GABAergic neurotransmission.
Apply the nursing process to anticonvulsants, including patient teaching
ASSESSMENT
DIAGNOSIS
PLANNING
IMPLEMENTATION
EVALUATION
If you perform multimodal approach to a problem, you will have an enhanced pharmacodynamic effect? T/F
TRUE
Mechanism of Action: Long-acting Barbiturates
Enhances GABA activity
What is DIASTAT AcuDial? What is it used for?
It is a diazepam rectal gel that has a unique locking mechanism that ensures that your patients receive the correct dose
_________________
NOTE: Remind your patients and their caregivers to inspect each DIASTAT AcuDial syringe BEFORE leaving the pharmacy.
Do febrile seizures increase risk for developing epilepsy? T/F.
FALSE
—
— Febrile common from 6 months to 5 years; does not really increase risk of developing epilepsy
Do febrile seizures increase risk for developing epilepsy? T/F.
FALSE
—
— Febrile common from 6 months to 5 years; does not really increase risk of developing epilepsy
What are the contraindications for taking Methylphenidate (Ritalin)
Methylphenidate (Ritalin) is contraindicated in patients who have a history of heart disease, hypertension, hyperthyroidism, parkinsonism, or glaucoma.
Define balanced anesthesia
Several drugs used to ensure smooth induction and adequate muscle relaxation in your patient (prior/during procedure) to make it as pleasant as possible for the patient
May include
— A hypnotic given the night before
— Premedication with an opioid analgesic or benzodiazepine (e.g., midazolam [Versed]) plus an anticholinergic (e.g., atropine) given about 1 hour before surgery to decrease secretions
— A short-acting barbiturate such as thiopental sodium (Pentothal)
— An inhaled gas—often a combination of nitrous oxide and oxygen; for anxious children to start an IV
— A muscle relaxant given as needed
Drugs used for inhalation anesthesia
Methoxyflurane, enflurane (Ethrane), isoflurane (Forane), desflurane (Suprane), and sevoflurane (Ultane), Nitrous Oxide
Differentiate Nitrous Oxide with other inhaled anesthetics
— Also known as “laughing gas”
— Very low anesthetic potency
— Very high analgesic potency
— Never used as primary anesthetic
— Frequently combined with other inhalation agents to enhance analgesia
— 20% nitrous oxide = Pain relief of morphine
— No serious side effects (nausea and vomiting)
___________
NOTE: Because of its low anesthetic action, cannot produce surgical anesthesia alone – even if administered at 100% (not enough to cause respiratory depression)
Intravenous (IV) Anesthetics
Trying to consciously sedate person for a procedure; do not want them anxious or in pain
— Droperidol (Innovar), etomidate (Amidate), ketamine hydrochloride (Ketalar)
— Rapid onsets and short durations of action
— Midazolam (Versed) and propofol (Diprivan)
— Induction and maintenance of anesthesia or conscious sedation for minor surgery or procedures like mechanical ventilation or intubation
— Patients are sedated and relaxed but responsive to commands.
Risks/Benefits when using Proprofol
— Short-acting, lipophilic intravenous general anesthetic. The drug is unrelated to any of the currently used barbiturate, opioid, benzodiazepine, arylcyclohexylamine, or imidazole intravenous anesthetic agents.
— With propofol - unconsciousness develops within 60 seconds and lasts 3–5 minutes; can cause profound respiratory depression
Risks for propofol abuse:
— Schedule 4 drug
— Supplies are not closely monitored
— Widely available in operating rooms and other areas of hospitals and clinics
— No “high”
— Instantaneous but brief sleep period
— Patients awaken “refreshed” and talkative; many report feeling elated and even euphoric
Purpose of Local Anesthetics
Block pain at the site where the drug is administered
Consciousness is maintained.
Use:
— Dental procedures, suturing skin lacerations, short-term (minor) surgery at a localized area, blocking nerve impulses (nerve block) below the insertion of a spinal anesthetic, and diagnostic procedures such as lumbar puncture and thoracentesis
Location + side effects of spinal anesthesia
Location
— Local anesthetic injected in the subarachnoid space at the third or fourth lumbar space
Side effects/adverse reactions
—Respiratory distress, headache, hypotension (hence the IV is needed)
Differentiate between the 2 groups regarding local anesthetics
Esters
— higher percentage of allergic rxns
e.g.
— Procaine (Novocain) – since 1905
— Cocaine – since 1884
— Benzocaine
Amides
— have a very low incidence of allergic reaction (MUCH safer)
e.g.
Procaine hydrochloride (Novocain)
Lidocaine hydrochloride (Xylocaine) — 1948
Bupivacaine (Marcaine)
Dibucaine
Differentiate the types of Spinal Blocks
— Spinal block: penetration of the anesthetic into the subarachnoid membrane, the second layer of the spinal cord
—Epidural block: placement of the local anesthetic in the outer covering of the spinal cord, or the dura mater
— Caudal block: placed near the sacrum
— Saddle block: administered at the lower end of the spinal column to block the perineal area
Nursing interventions for Anesthetics
Monitor patient’s level of consciousness.
Monitor vital signs (respirations, HR, BP)
Respiratory status
Cardiovascular status (check for HoTN)
Monitor pre-and post-operative urine output.
Administer analgesics cautiously until patient fully recovers.
Dosage may need to be decreased.
