Pharm #3 Flashcards
1
Q
Effects the sympathetic nervous system
A
Adrenergic
2
Q
Sympathomimetics-
A
adrenergic agonists
3
Q
Adrenergic antagonist-
A
sympatholytic
4
Q
Brain
Spinal Cord
A
Central Nervous System (CNS)
5
Q
Peripheral Nervous System (PNS) is made up of
A
Autonomic Nervous System
Somatic Nervous System
6
Q
Visceral System (Smooth muscle and glands)
A
Autonomic Nervous System
7
Q
Voluntary System (skeletal muscles)
A
Somatic Nervous System
8
Q
Autonomic Nervous System Controls
A
Cardiac and respiratory systems
GI tract
Bladder
Eyes
Glands
9
Q
Smooth muscle- digestion
Involuntary system
A
Autonomic Nervous System
10
Q
Dominant in Stressful Situations (“Fight or Flight” response)
A
Sympathetic Nervous System
11
Q
Adrenergic system- transmitting epinephrine and norepinephrine
A
Sympathetic Nervous System
12
Q
Dominant in Peaceful Situations, hemostasis
A
Parasympathetic Nervous System
13
Q
Sympathetic Nervous System (Adrenergic system): 4 Types of Receptor Cells:
A
Alpha 1
Alpha 2
Beta 1
Beta 2
14
Q
Parasympathetic Nervous system (Cholinergic System): 2 Types of Receptor Cells:
A
Muscarinic
Nicotinic
15
Q
Drugs can mimic neurotransmitters: (adrenergic agonist)
A
Norepinephrine
Acetylcholine
16
Q
Will have opposite effects on the same organ
A
adrenergic antagonist
17
Q
Drugs can be:
A
Sympathomimetics
Sympatholytic
Parasympathomimetic
Parasympatholytic
18
Q
If there are one or more adrenergic receptor sites located in the cells of the muscle-
A
heart, bronchiole walls, GI, Bladder, Ciliary muscles of the eye (constricting and dilating)
19
Q
Sympathetic Stimulants =
A
Sympathomimetics (mime), adrenergic, adrenergic agonists
20
Q
Sympathetic Depressants =
A
Sympatholytic, Adrenergic blockers, adrenolytic, adrenergic antagonists
21
Q
Parasympathetic Stimulants (2 categories)
A
Direct-acting and Indirect-acting
22
Q
Direct acting –
A
parasympathomimetic, cholinergic, cholinergic agonists
23
Q
Indirect acting –
A
cholinesterase inhibitors
24
Q
Parasympathetic Depressants =
A
Parasympatholytics, anticholinergics, cholinergic antagonists, antispasmodics
25
Function of adrenergics: Eye
Dilates Pupil
26
Function of adrenergics: Lungs
Dilates bronchioles
27
Function of adrenergics: Heart
Increased HR
28
Function of adrenergics: Blood vessels
Constrict
29
Function of adrenergics: Gastrointestinal
Relax
30
Function of adrenergics: Bladder
Relax
31
Function of adrenergics: Uterus
Relax
32
Increases cardiac contractility, vasoconstriction
Alpha1 receptors
33
Dilates pupils, decreases salivary gland secretion
Alpha1 receptors
34
Increases bladder and prostate contraction
Alpha1 receptors
35
Inhibits norepinephrine release
Alpha2 receptors
36
Promotes vasodilation and decreased BP
Alpha2 receptors
37
Decreases GI motility and tone
Alpha2 receptors
38
blood vessels, eyes, bladder, and prostate
Alpha 1 Adrenergic-
39
Alpha 1 receptors activates-
venules and arterioles=contraction
40
Increased cardiac contractility, blood pressure, return of blood circulation to the heart, blood flow to vital organ
Alpha 1 receptors
41
If too much stimulation= decrease in blood flow to other areas
Alpha 1 receptors
42
sympathetic nerve endings, releasing norepinephrine, decreases blood pressure and causes vasodilation
Alpha 2 receptors
43
Increases cardiac contractility, heart rate
Beta1 receptors
44
Increases renin secretion and increases BP
Beta1 receptors
45
Decreases GI tone and motility
Bronchodilation
Increases blood flow in skeletal muscles
Relaxes smooth muscles of uterus
Activates liver glycogenolysis
Increases blood glucose
Beta2 receptors
46
Beta 1= 1 heart, increasing myocardial contractility, increasing HR and renin secretion from kidneys to increase BP
Beta 1=
47
2 lungs, found in lungs also GI tract, liver and uterine muscle. Stimulated it causes bronchodilation (Abuterol).
Decrease GI tone and motility.
Activates glycogenolysis in the liver= Increase of blood glucose, relax uterine muscles
Beta 2 =
48
located in the renal, mesenteric, coronary, and cerebral arteries
Dopaminergic receptors–
49
Vasodilation
Increases blood flow
Dopaminergic receptors–
50
Activated by dopamine
Causing vasodilation
Dopaminergic receptors–
51
Reuptake of transmitter back into neuron
Neurotransmitter Inactivation
52
Neurotransmitter Inactivation: Enzymatic transformation or degradation
MAO inside neuron
COMT (chemical break down of the drug) outside neuron
53
Diffusion away from the receptor
Neurotransmitter Inactivation
54
Drugs halt termination of neurotransmitter by inhibiting
Norepinephrine reuptake
Norepinephrine degradation
55
Body sending out neurotransmitters body has to tell to stop releasing
Neurotransmitter Inactivation
56
Drugs can block stimulation of transmitters
Neurotransmitter Inactivation
57
Reuptake of transmitter back into neuron-
Plays more of an important role of the enzyme activity of the drug
58
Out rules the liver
Neurotransmitter Inactivation
59
Drugs can prolong the action of the neurotransmitter by
inhibiting reuptake (blocking) or
inhibiting metabolism of the drug itself (staying in the system longer)
60
Classification of Adrenergic Agonists
Direct-acting, Indirect-acting, Mixed-acting
61
Direct-acting-
directly stimulating adrenergic receptors (epinephrine, norepinephrine)
62
Indirect-acting-
stimulating the release of norepinephrine (amphetamine)
63
Mixed-acting-
doing both directly the adrenergic receptors and release of norepinephrine (ephedrine)
64
Produce sympathetic response
Catecholamines
65
Catecholamines types
Endogenous and Synthetic
66
Endogenous
Epinephrine, norepinephrine, dopamine
67
Synthetic
Isoproterenol, dobutamine
68
all synthetic
Noncatecholamines-
69
Stimulate adrenergic receptors
Noncatecholamines-
70
Most have longer duration of action than catecholamines
Noncatecholamines-
71
Phenylephrine, metaproterenol, albuterol
Noncatecholamines-
72
Chemical structure or a substance-
endogenous (body makes it) or synthetic (artificially) produces a sympathomimetic response
73
Epinephrine (Adrenaline) is
nonselective
74
Epinephrine (Adrenaline) action
Alpha1 increases the blood pressure.
Beta1 increases heart rate.
Beta2 promotes bronchodilation.
75
Epinephrine (Adrenaline) contraindications and caution
Cardiac dysrhythmias, hypertension
Hyperthyroidism, diabetes mellitus
Pregnancy
76
Catecholamine, non-selective adrenergic agonist- effects multiple things
Pupil dilation
Epinephrine (Adrenaline)
77
Inotropic- increasing the force of the cardiac output and contraction
Vasoconstrictor
Bronchodilator
Epinephrine (Adrenaline) action
78
Epinephrine (Adrenaline) uses
Anaphylaxis, anaphylactic shock
Bronchospasms, status asthmaticus
Cardiogenic shock, cardiac arrest
79
Goal with shock, because of non selectivity
Epinephrine (Adrenaline)
80
Producing several different desired effects on one person
Epinephrine (Adrenaline)
81
Drug of choice for anaphylaxis, bronchospasms if no other choice
Epinephrine (Adrenaline)
82
Epinephrine (Adrenaline) side effects/adverse reactions
Cardiac dysrhythmias, palpitations
Tachycardia, hypertension
Dizziness, headache, sweating
Insomnia, restlessness, tremors
Hyperglycemia
83
Epinephrine (Adrenaline) Drug interactions
Beta blockers (antagonist, blocks beta receptors)
Decrease epinephrine action
Digoxin
Causes cardiac dysrhythmias
TCAs and MAOIs intensify and prolong effects
84
Renal vasocontraction- less circulation and blood flow to kidneys effects excretion (output)
Epinephrine (Adrenaline)
85
Monitor for urinary output
Epinephrine (Adrenaline)
86
IV epinephrine extravasation
Blocks alpha receptors relaxing vascular smooth muscle & increasing blood flow to area
87
Epinephrine (Adrenaline) antidote
phentolamine mesylate (blocker receptors)
88
If epinephrine leaks out into tissues it causes significant tissue damage causing necrosis within only 12 hours
Make sure IV lines are patent
Causes constriction to the tissue area
IV epinephrine extravasation
89
Albuterol is
Selective
90
Acts on beta2-adrenergic receptors
Promotes bronchodilation
Albuterol
91
Albuterol uses
Treats bronchospasm, asthma, bronchitis, COPD
92
Albuterol caution
Severe cardiac disease
Hypertension, hyperthyroidism
Diabetes mellitus, pregnancy
Renal dysfunction
93
Selective drugs =
fewer side effects
94
If high doses= can increase the sensitivity
Albuterol
95
Stimulates the livers= glycogenolysis= increase in blood glucose
Albuterol
96
Albuterol side effects/adverse reactions
Tremors, nervousness, restlessness
Dizziness, tachycardia
Palpitations, cardiac dysrhythmias
97
Albuterol drug interactions
May increase effect with other sympathomimetics, MAO inhibitors, and tricyclic antidepressants
Antagonize effect with beta blockers
98
Getting other drugs like a beta blocker cannot take
albuterol
99
Adrenergic Agonists assessment
baseline vital signs, other drug history, baseline glucose (increases glucose)
100
Adrenergic Agonists Nursing Interventions
monitor IV site
administering antagonist if necessary
document vital signs
monitoring EKG
reporting and documenting any side effects
urinary output (adequate hourly or bladder distention)
offer food to avoid nausea
101
Adrenergic Agonists Education
about epi pen, follow up after ER, effects more than one body effect, side effects, adverse effects
102
Central-Acting Alpha Agonists
Clonidine, Methyldopa
103
Selective alpha2-adrenergic agonist
Used primarily to treat hypertension
Clonidine
104
Produce vasodilation by stimulating alpha 2 receptors in the Central Nervous System
Clonidine
105
Clonidine Main side effects-
bradycardia, hypotension, sedation, and dry mouth
106
decreasing in the sympathetic outflow to reduce peripheral resistance (CNS)
Methyldopa
107
Alpha-adrenergic agonist that acts within the CNS
Methyldopa
108
Alpha2 activation leads to vasodilation and decreased BP
Methyldopa
109
Methyldopa Side effects
Drowsiness, headache, nasal congestion
Nightmares, edema, constipation
Ejaculation dysfunction
Elevated liver enzymes
110
Does not pair well with people, a lot of side effects
Methyldopa
111
Block effects of adrenergic neurotransmitters
Adrenergic Antagonists
112
Block alpha and beta receptor sites
Adrenergic Antagonists
113
Directly by occupying receptors
Adrenergic Antagonists
114
Indirectly by inhibiting release of neurotransmitters epinephrine and norepinephrine
Adrenergic Antagonists
115
Adrenergic Antagonists Types
Alpha-adrenergic antagonists
Beta-adrenergic antagonists
116
Drugs that inhibit a response at alpha-adrenergic receptor site
Alpha Adrenergic Antagonists
117
Alpha Adrenergic Antagonists: Selective
Block alpha1
118
Alpha Adrenergic Antagonists: Non-selective
Block alpha1 and alpha2
119
Alpha Adrenergic Antagonists: Action
Promote vasodilation, decreasing BP
120
Alpha Adrenergic Antagonists; Use
Decrease symptoms of BPH, PVD
121
Orthostatic hypotension = risk factor
Alpha Adrenergic Antagonists
122
Can treat peripheral vascular disease- vasodilate
Alpha Adrenergic Antagonists
123
Reynolds disease- tight constriction of blood vessels in hands when it gets cold- helps vasodilate
Alpha Adrenergic Antagonists
124
Beta-Adrenergic Antagonists Action
Decrease BP and pulse
125
needed to be used with caution with COPD, asthma, chronic bronchitis
Nonselective beta blockers-
126
Nonselective beta blockers blocks beta 1
Decrease BP and pulse
127
Nonselective beta blockers blocks beta 2
Bronchoconstriction
Use with caution in patients with COPD or asthma
128
Nonselective beta blockers: Propranolol HCl, uses
Angina, cardiac dysrhythmias, hypertension, heart failure
129
Metoprolol, atenolol
Selective beta blockers
130
Blocks beta1 only
Decrease BP and HR
Fewer side effects
Selective beta blockers
131
Selective beta blockers: Encourage pts to report side effects/adverse reactions related to heart
Bradycardia, hypotension, dysrhythmias
Headaches, dizziness, fainting
Fatigue, drowsiness, depression
Nausea, vomiting, diarrhea
Heart failure
Decreased libido and impotence
(HF)
132
Specific of the heart, blocking receptors involving BP and HR
Fewer side effects
Masks S/Sx of hypoglycemia- watch blood sugars
Selective beta blockers
133
Decreased effects with
NSAIDs- decreased effects in beta blocker
Beta-Adrenergic Blockers Drug interactions
134
Increased effects with
Atropine and other anticholinergics- increased effect too much of parasympathetic
Beta-Adrenergic Blockers Drug interactions
135
Increased risk of hypoglycemia with
Insulin, sulfonylureas
Beta-Adrenergic Blockers Drug interactions
136
Cause can increased or decreased effects
Beta-Adrenergic Blockers Drug interactions
137
Adrenergic Neuron Antagonists: Blocking the neuron release of norepinephrine
Used to decrease BP
138
Reserpine: closely resembles an alpha and beta adrenergic beta blocker
Blocking the neuron release of norepinephrine example
139
Reduces the serotonin and catecholamine transmitters. Depletion of these neurotransmitters may lead to severe mental depression
Blocking the neuron release of norepinephrine example
140
Herbal supplement that interacts with everything= st johns wart, hypertensive crisis
Need to know what they are taking before giving this
Adrenergic Neuron Antagonists
141
Adrenergic Neuron Antagonists Assessment
vital sign and ekg baseline, med history, health history,
142
Adrenergic Neuron Antagonists nursing interventions
monitoring BP and HR, report and document side effects or complaints of dizziness, chest pain, assisting change of positions because of ortho
143
Adrenergic Neuron Antagonists Education
may take 2-3 weeks for the med to be effective and keep a log of vital signs, rising slowly, avoid operating heavy machinery until any potential drug effects are known
144
When teaching a patient who has been prescribed metoprolol about side/adverse effects, which is the highest priority teaching point?
Instruct the patient how to take a pulse.
145
Stimulation of which adrenergic receptor results in dilation of vessels and decrease in blood pressure?
Alpha2
146
The nurse is teaching the patient about the side effects of propranolol. These include
bronchospasm.- do not give to asthma or copd
147
A nurse is administering epinephrine to a patient during a cardiac arrest. The primary desired action of this medication is to
stimulate a heart rate.
148
A patient is receiving epinephrine intravenously. Which drug should the nurse have available to treat extravasation and tissue necrosis?
Phentolamine mesylate
149
Vitamin definition
Needed to compose and comprise different things of out body, can get them synthetically or naturally, tissue growth and healing.
150
Populations in need of increased vitamins
rapid body growth, inadequate diet, malabsorptive issues, pregnant and breast feeding, chronic illness, and restrictive diet
151
Fat-soluble vitamins-
A,D, E and K- stored in the fatty tissue, excreted at a lower rate. Too much of the vitamins= toxicity because it cannot be excreted like a water soluble vitamins
152
Water-soluble vitamins-
vitamin b complex, C, B12 and folic acid. Not stored in the fat. Faster excretion in the kidneys because it is water.
153
If a well balanced diet should acquire all of the
vitamins and minerals
154
Vitamin A Function
Bone growth, skin, eyes, and hair maintenance
155
Vitamin A Food Source
milk, butter, eggs, leafy greens veggies, yellow and orange veggies
156
Vitamin A Deficiency
Night blindness, corneal ulceration, skin lesions, dysfunction of mucous membranes
157
Vitamin A excess doses
Liver damage, hair loss, peeling skin, GI upset, lethargy
158
Too much vitamin A in pregnancy can cause too much harm for
the fetus
159
Vitamin D function
Regulates calcium & phosphorus metabolism
160
Vitamin D food sources
Carbsterginroe, salmon, evaporated milk
161
Vitamin E function
Antioxidant properties
Protects cellular components from being oxidized and RBCs from being hemolyzed
162
Vitamin E food sources
green leafy vegs, sweet potato, papaya, mango, nuts, seeds
163
Vitamin E deficiency
Increased breakdown of RBCs
164
Vitamin E excess doses
Fatigue, GI upset, HA, breast tenderness, bleeding- prolonging the prothrombin time
165
Vitamin E interaction
Iron- interferes with the absorption of vitamin E
166
Vitamin K function
Synthesis of prothrombin and clotting factors
167
Vitamin K food sources
green leafy veggies
168
Vitamin K deficiency
Spontaneous hemorrhage
169
Vitamin K excess doses
Blood clotting time too quick, risk for stroke, HA, occlusion, decreased circulation
170
Babies are vitamin K deficient-
vitamin K1 (phytonadione) shot for clotting- within in first 1 hour in life
171
Can be used for clotting antidote- warfarin
vitamin K
172
Adapt warfarin dose if they eat
spinach
173
Vitamin B Complex
B1—thiamine
B2—riboflavin
B3—nicotinic acid or niacin
B6—pyridoxine
174
B1—thiamine-
given to alcoholic patients (AUD)
175
B1—thiamine- deficiencies
Polyneuritis (peripheral nerves), cardiac pathology(dysrhythmias, HA), edema, neurologic disorders, ataxia(impaired coordination), diplopia(double vision), alcoholism
176
B2—riboflavin-
given to manage dermatologic problems, larger doses to treat migraines
177
B2—riboflavin- deficiencies
Sore throat, cheilosis, skin cracks at corners of the mouth, migraines, dry skin
178
B3—nicotinic acid or niacin-
Given for Hyperlipidemia
179
B3—nicotinic acid or niacin- Deficiencies-
Hyperlipidemia, Pellagra(inflammation of areas that are exposed to the sun), diarrhea, mouth sores, skin redness(flushing)
180
B6—pyridoxine-
Given for B6 deficiency because of inadequate diet. If they cannot metabolize B6. energy
181
B6—pyridoxine- deficiencies
Neuritis, seizure, anemia, depression, confusion, seborrheic dermatitis
182
Water soluble vitamins
Usually not toxic unless taken in extreme amount
Vitamin B Complex
183
Vitamin C function
Aids in absorption of iron and conversion of folic acid
Increases wound healing and tissue repair
Protein and lipid synthesis
184
Vitamin C food sources
citrus fruits
185
Vitamin C deficiency
Scurvy- poor wound healing, bleeding gums, abnormal bone and tooth development
186
Vitamin C excess doses
GI upset, crystalluria (aspirin interaction), decreased effects of oral anticoagulants
187
Folic Acid (Folate) function
Essential for body growth
Needed for DNA synthesis
188
Folic Acid (Folate) Food sources-
legumes, asparagus, eggs, leafy green veggies, fortified cereals
189
Folic Acid (Folate) Deficiency
GI upset, stomatitis, fatigue, alopecia
Leukopenia, thrombocytopenia, neural tube defects
190
Folic Acid (Folate) Excess doses: Increased risk for seizures
Can lower phenytoin levels
Mask vitamin B12 deficiency
Most a risk population- older adults
191
Babies in the womb- pregnant women and planning on becoming pregnant take it to prevent neural tube defects
Folic Acid (Folate)
192
Vitamin B12 function
Essential for DNA synthesis
Aids in conversion of folic acid to its active form
RBC development, Myelin integrity
193
Intrinsic factor- gastric cells that is necessary for vitamin b12 absorption. If not they can get pernicious anemia
Vitamin B12
194
Vitamin B12 food sources-
Clams, liver, fish, king crab, beef, fortified cereals
195
Vitamin B12 Deficiency
Paresthesia, weakness, fatigue
Anorexia, loss of taste, diarrhea
Memory loss, mood changes
Poor growth, Psychosis, megaloblastic anemia (RBCs become too enlarged to function properly, cannot circulate or carry o2)
196
Vitamins Assessment
Assess for diet history, blood serum levels of the vitamins- know their baseline
197
Vitamins Nursing Interventions
administer vitamins with food for absorption, monitory blood levels for deficiencies or overdoses
198
Vitamins Education
Teaching pts about vitamin safety, keep vitamin containers to keep out of light
Educate about foods in their environment
Discourage taking large doses over long period to time
199
Minerals
Iron, Copper, Zinc, Chromium, Selenium
200
Iron function
Vital for Hgb regeneration
201
Iron Food sources-
Liver, lean meats, egg yolks, dried beans, spinach, fruit
202
Iron Deficiency
Anemia, fatigue, weakness, shortness of breath, pallor, GI bleeding
203
Iron toxicity- risk for
Child populations
204
Iron toxicity
Hemorrhage, shock, can be fatal in 12-48 hours
Educate pts if they have kids and they are taking iron put the containers out of reach
205
Main causes of anemia
Pregnant women should take an __ supplement
iron
206
___ slows the absorption of iron
Food and antacids
207
___ increases absorption of iron
Vitamin C
208
Copper Function
Needed for formation of RBCs and connective tissue
Neurotransmitter production
209
Copper Food sources-
shellfish, liver, nuts, seeds, legumes, coco
210
Copper Deficiency
Anemia, decrease in WBCs (infection risk)
Decrease in skin and hair pigmentation
Glucose intolerance, intellectual disabilities (young populations)
211
Copper Excess
Wilson’s disease- error in body metabolism of copper
Too much can Accumulate in the liver, kidneys, brain and cornea
212
Zinc Function
Growth, appetite, testicular maturation, skin integrity, mental activity, wound healing, immunocompetence
213
Zinc Food source-
beef, lamb, eggs, potatoes, carrots
214
Zinc Deficiency
Weight loss, unhealing wounds, lack of alertness, decreased smell and taste, diarrhea, loss of appetite. Associated with diets High unrefined cereal, unleavened bread, TPN, intestinal disease, alcoholism, and pregnancy
215
Zinc Excess doses
Copper deficiency
Decrease in HDL cholesterol
Weakened immune system
216
Most common deficiency in someone who is on total parental nutrition, lost in the stool
Zinc
217
Help with immune system (colds)
Zinc
218
Can Inhibit absorption of antibiotics
Zinc
219
Nasal spray can have zinc and cause a loss of smell in nasal passage
Zinc
220
Chromium Function
Carb, lipid, and nucleic acid metabolism
221
Chromium Food sources-
meat, whole grain cereals, brewers yeast
222
Chromium Deficiency
Low blood sugar, dizziness, sleepiness, craving for sweet food, excessive thirst. Common in diets with High in refined foods and TPN
223
Chromium excess doses
GI bleeding, coagulopathy, seizures, pulmonary dysfunction
224
Selenium Function
Reproduction, thyroid hormone metabolism, DNA synthesis
225
Selenium Food sources-
liver, seafood, poultry, grains
226
Selenium Deficiency
Hypothyroidism, muscle weakness, myalgia, increased RBC fragility, pancreatic degeneration, pseudo albinism
227
Selenium Excess doses
Weakness, GI upset, hair loss, dermatitis
Garlic-like odor from skin and breath
228
Iron Assessment-
Diet, drug history, when, watching for anemia
229
Iron Education-
educating proper diet to make sure there is enough iron, could be administering iron (IM). Advise to increase fluids, activity, and increase fiber bulk to avoid constipation
230
Iron toxicity is a serious cause of poisoning in children. It may be fatal because of an ulcerogenic effect, resulting in which of the following?
Hemorrhage
231
Which does the nurse identify as signs and symptoms of vitamin A toxicity? (Select all that apply.)
Hair loss
Lethargy
Vomiting and diarrhea
232
A patient is admitted to the emergency department after taking high doses of vitamin B and vitamin D. The nurse is more concerned about the vitamin D because
vitamin D is fat-soluble.
233
A patient with pernicious anemia most likely has a deficiency of
vitamin B12.
234
A patient is taking iron supplementation. It is most important for the nurse to instruct the patient to
increase fiber and fluid intake to avoid constipation.
235
Drugs that stimulate the PNS
Cholinergic Agonists
236
Cholinergic receptors
Muscarinic
Nicotinic
237
Muscarinic receptors-
smooth muscles like the heart, slow HR
238
Nicotinic receptors-
effecting skeletal muscles
239
Types of cholinergic agonists- stimulating parasympathetic response
Direct acting
Indirect acting
240
Direct acting-
act on the receptors to activate the tissue response
241
Indirect acting-
inhibit the action of the enzyme cholinesterase (breaking down acetylcholine, inhibits reaching receptor sites) can be reversible or irreversible
242
Mimicking the parasympathetic system
Cholinergic Agonists
243
PNS is called cholinergic - end of the neurotransmitters innervates the muscle
with acetylcholine
244
Produce responses opposite to each other – epinephrine increase- cholinergic
decreases hr
245
Effects of Cholinergic Agonists: Eyes
Constricts pupil
246
Effects of Cholinergic Agonists: Lungs
Constructs bronchioles and increase secretions
247
Effects of Cholinergic Agonists: Heart
HR decreases
248
Effects of Cholinergic Agonists: Blood vessel
dilates
249
Effects of Cholinergic Agonists: Gastrointestinal
increases peristalsis and secretions
250
Effects of Cholinergic Agonists: Bladder
contracts
251
Effects of Cholinergic Agonists: Salivary gland
increased salivation
252
Rest and digest system
Normal homeostatic bodily functions
Cholinergic Agonists
253
Primarily selective to muscarinic receptors
Direct-Acting Cholinergic Agonists
254
Muscarinic receptors located in smooth muscles
Direct-Acting Cholinergic Agonists
255
Metoclopramide
Pilocarpine
Bethanechol chloride
Direct-Acting Cholinergic Agonists
256
Metoclopramide
Used to increase gastric emptying
Treats gastroparesis, nausea, GERD
257
Pilocarpine
Tx glaucoma due to relief of intraocular fluid pressure
Used to constrict pupils (used during eye surgery exams), pupils constrict miosis), dry up oral secretions associated with radiation Txs
258
Bethanechol chloride
classic cholinergic agonist
Used to increase urination, unincary retention problems
259
Selective muscarinic receptors
GI and GU tract, glands and the heart-
260
Bethanechol Side effects/adverse reactions (overstimulation of the parasympathetic system)
N/V/D
Hypersalivation
Diaphoresis
HA
Dizziness
Flushing
Urinary urgency/frequency
Bronchoconstriction/Increased bronchial secretions
Miosis (pupil constriction)
Lacrimation
261
Bethanechol (overstimulation of the parasympathetic system) Contraindications
Intestinal or urinary tract obstructions, IBS, severe bradycardia, hypotension, COPD/Asthma, peptic ulcer, hyperthyroidism, seizures, parksonism
262
If overdosed = nausea because of gastric motility
Bethanechol (overstimulation of the parasympathetic system)
263
Bethanechol Assessment-
normal urine output >1500 mL per day, health history (urinary obstruction, asthma, peptic ulcers),
264
Bethanechol Nursing Interventions-
monitoring vital sings
intake/output
give one hour before meal or two hours after meal
check liver enzymes
auscultating lungs = bronchoconstriction can develop pneumonia
if giving bed side= antidote= atropine, watching for cholinergic crisis,
265
Bethanechol Education-
educate about home use= orthostatic hypertension
266
Indirect-Acting Cholinergic Agonists Functions
Inhibit the action of cholinesterase enzyme causing more acetylcholine
Allow ACh to activate muscarinic and nicotinic cholinergic receptors
267
Indirect-Acting Cholinergic Agonists Effects
Skeletal muscle contraction, increased tone (contractures)
Greater GI motility, bradycardia, miosis (do not give to a pt with urinary/bowel obstruction/constipation)
Bronchial constriction, promote urination
268
Indirect-Acting Cholinergic Agonists Contraindications:
intestinal and urinary obstruction
269
Not directly acting on the receptor site
Skeletal system effect- muscle tone
Indirect-Acting Cholinergic Agonists
270
Reversible Cholinesterase Inhibitors Uses
Produce pupil constriction in glaucoma
Increase muscle strength in myasthenia gravis
271
Reversible Cholinesterase Inhibitors Examples
Neostigmine- Short acting- increase muscle strength In MG
Pyridostigmine- moderate acting, also reverse actions of muscle relaxants and treat MG
Ambenonium chloride (tensolon)- short acting, diagnosing something with MG,
Edrophonium
Physostigmine
Donepezil- treats Alzheimer diease bc decreased levels of acetylcholine
272
Reversible Cholinesterase Inhibitors Side effects
Muscle cramps, bradycardia, hypotension
Blurred vision, hypersalivation, seizures
273
Acting time frames
Short acting- increase muscle strength In MG
Asthma, diabetes, cardiac disease, obstruction of the GI or GU system= contraindications
Reversible Cholinesterase Inhibitors
274
Irreversible Cholinesterase Inhibitor
Potent agents due to long-lasting effects
Main use is to produce pupillary constriction
Does not undo action
275
Anticholinergics Action
Inhibit action of ACh by occupying ACh receptors
276
Cholinergic Antagonists
Anticholinergics
277
Effects of anticholinergics heart
Large doses increase HR; small doses decrease HR
278
Effects of anticholinergics lungs
Bronchodilation, decrease secretions
279
Effects of anticholinergics GI
Relax smooth muscle tone, decrease motility and peristalsis, decrease secretions
280
Irritible bowel syndrome treatment
Salivation decrease
Dilation of pupils
Similar to adrenergic agonist
anticholinergics
281
Effects of anticholinergics GU
Relax detrusor muscle, increase sphincter constriction
282
Effects of anticholinergics Eye
Dilate pupils, decrease accommodation
283
Effects of anticholinergics Glands
Decrease salivation and perspiration
284
Effects of anticholinergics CNS
Decrease tremors and rigidity of muscles (Parkinson meds)
285
Atropine
Anticholinergics
286
Atropine action
Increase heart rate
Decrease GI motility, spasms, peristalsis, salivary and gastric secretions
287
Atropine Side effects/adverse reactions
Tachycardia, photophobia, headache, blurred vision
Abdominal distention, nausea, constipation
Dry mouth and skin, decreased sweating
Urinary retention, impotence
Palpitations, dysrhythmias
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Contraindicated in glaucoma
Atropine
289
Main use= increase HF in bradycardia, can use preoperatively to decrease secretions to decrease aspiration during anesthesia
Atropine
290
Nerve block= can be used as a reversal agent
Atropine
291
Dilate pupils or ocular exams
Atropine
292
Serves as antidote for cholinergic drugs
Atropine
293
Can be used in liquid drops- hospice setting, dry up secretions (death rattle)
Atropine
294
Cant see, pee, spit, poop
Atropine
295
Atropine Assessment-
obtain baseline vital signs (bradycardia), urine output, contraindications
296
Atropine Nursing Interventions-
determining fluid intake and output, assessing bowel sounds, decreasing motility- paralytic ileus
297
Atropine Education-
constipation
mouth care (secretions, without it can cause infections, cracks)
if diagnosed with glaucoma talk to HC provider to stop
avoiding hot environments= not as much sweating= body cannot thermoregulate as well, increase fluid and fiber
Watching urine output, can use eyedrops, hard candy, ice or gum to help moisten mouth
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Antiparkinsonism–Anticholinergics
Benztropine
299
Benztropine Main Action
Decreases involuntary movement, tremors, muscle rigidity
300
Benztropine Use
Parkinson’s disease- caused by imbalance of dopamine and acyetylcholine
Pseudoparkinsonism
301
Blocks action of acetylcholine
Benztropine
302
Benztropine Side effects
Tachycardia, headache
Blurred vision, ocular hypertension
Dry mouth/skin, constipation
Urinary retention
303
Contraindications
Glaucoma= ocular hypertension, constriction
Tardive dyskinesia
Benztropine
304
Anticholinergics for Treating Motion Sickness, Antihistamine
Scopolamine
305
Treats motion sickness, nausea, vomiting
Transdermal patch delivers dose over 3 days
Scopolamine
306
Scopolamine Side effects
Tachycardia, hypotension
Dry mouth, constipation
Blurred vision, flushing
Muscle weakness, drowsiness
Urinary retention
307
Educate- hand hygiene
Wear gloves
Scopolamine
308
A patient has received atropine. It is most important for the nurse to assess the patient for which effect?
C. Urinary retention
309
A nurse has just administered atropine to a patient. It is most important for the nurse to assess the patient for the development of which effect?
Tachycardia
310
A patient is ordered to receive bethanechol chloride for urinary retention. Which health condition would serve as a contraindication for this medication?
Asthma
311
A patient received atropine as a preoperative medication 30 minutes ago. The nurse evaluates the medication as effective if the patient states,
“My mouth feels dry.”
312
A patient is prescribed scopolamine. It is most important for the nurse to assess the patient for a history of which condition?
Glaucoma
313
Atropine is most useful in the treatment of which cardiovascular condition?
Sinus bradycardia
314
Insomnia-
Inability to fall asleep or remain asleep. More commonin female populatiom
315
Stages of Sleep
REM and NREM
316
REM-
rapid eye movement, most vivid dreams that they can recall the best.
317
NREM-
non rapid eye movement- 4 stages and then it ends in REM
Occurs in 90 minute intervals
318
If the cycle is interrupted it starts over
Stages of Sleep
319
If they experience REM and NREM they are able to
perform better
320
Nonpharmalogical management
Arise at specific hour in morning
Limit daytime naps to avoid tiredness
Avoid caffeine, alcohol, and nicotine 6 hr before bedtime
Avoid heavy meals, large amounts of fluids, loud noise, and strenuous exercise before bedtime
Take warm bath, read, listen to quiet music, or drink warm milk before bedtime- relaxation techniques
321
Sedatives:
calm or slow brain activity, diminish physical and mental response of the person. If increase the dose it can produce a hypnotic effect
322
Hypnotics:
cause sleep
323
Short-acting Hypnotics:
Help to fall asleep and produces less drowsiness effect in the morning
324
Intermediate-acting- Hypnotics:
keeping someone asleep, staying asleep, more drowsiness effect in the morning
325
OTC sleep aids- primary ingredient
Antihistamines (diphenhydramine)
326
Pharmacological management
Most commonly prescribed- Sedatives and Hypnotics
327
Sedative-Hypnotics General side effects
Residual drowsiness (hangover)
Vivid dreams, nightmares
Drug dependence- have to have it
Drug tolerance- increase dose
Excessive depression-
Respiratory depression- too much of med
Hypersensitivity
328
Hypnotic therapy= short term event, don’t wanna create
dependence or tolerance
329
Abruptly stopping a hypnotic=
withdrawal symptoms
330
Respiratory disorders avoid
hypnotics
331
Barbiturates Classified by length of action
Long-phenobarbital(seizures)
intermediate-maintain long periods of sleep(Butabarbital)
short- procedure sedation, closely monitor vital signs,
ultrashort- sleep
332
Restrict to short-term use: 2 weeks or less
Barbiturates
333
Barbiturates Interactions
Alcohol, opioids, other sedative-hypnotics
Decreases effects of oral anticoagulants, glucocorticoids, tricyclic antidepressants, quinidine
334
Sleep- restricted time frame
Barbiturates
335
Scheduled 2 meds
short acting
336
Schedule 3 meds
Intermediate-
337
Schedule 4 med
Long acting-
338
Benzodiazepines used as hypnotics:
Flurazepam, alprazolam
Temazepam, triazolam
Estazolam, quazepam
339
For sleep disorders and anxiety (more common)
Lorazepam and diazepam
340
Benzodiazepines action
Interacts with neurotransmitter GABA to reduce neuron excitability
341
Benzodiazepines Use
Reduce anxiety, treat insomnia
342
Lam or pam
Short term use drugs
Can treat insomnia
To decrease excitability of the neurons
Benzodiazepines
343
Benzodiazepines Assessment-
throughout drug history, complementary or alt medications. History-insomnia, anxiety. Renal function- low levels= prolong drug action
344
Benzodiazepines Nursing Interventions-
continue to monitor vital signs, watching for adverse effects, bed alarm for fall risk.
345
Benzodiazepines Education-
Encourage to avoid alcohol, antidepressant, antipsychotics, and opioids if on a benzodiazepine
346
If take alcohol on a benzo they cannot remember an action
They cannot decide just to not take it anymore- can cause painful and dangerous withdrawal effect
Educate- do not operate machinery, driving cars, risk
Benzodiazepines
347
Zolpidem
nonBenzodiazepines
348
Zolpidem Action
Neurotransmitter inhibition
Duration of action is 6 to 8 hours
349
Zolpidem Use:
Treat short-term (less than 10 days) insomnia
350
Differes in the chemical structure
Schedule 4 drug- tolerance and dependence can occur
If given to an older adult the dose should be decreased
Zolpidem
351
Sedative-Hypnotics (Non-Benzodiazepines) Assessment-
Obtain vital signs, labs, drug history
352
Sedative-Hypnotics (Non-Benzodiazepines) Education-
don’t take it with food- slows the absorption process, takes longer to work.
Avoid alcohol, opioids, antidepressants.
Take it 30 mins before bed time.
Suggesting to empty bladder before bed. Use caution if they drive (do not)
353
Ramelteon
Melotonin Agonists
354
First FDA-approved hypnotic not classified as a controlled substance
Ramelteon
355
Selectively targets melatonin receptors to regulate circadian rhythm to treat insomnia
Ramelteon
356
Not been shown to decrease REM sleep
Ramelteon
357
Use nonpharmacologic methods first
Sedatives and Hypnotics for Older Adults
357
Ramelteon Adverse effects/side effects
Drowsiness, dizziness, fatigue, headache, nausea, and suicidal ideation (nsg interventions)
358
Sedatives and Hypnotics for Older Adults Short to intermediate-acting benzodiazepines
Estazolam
Temazepam
Triazolam
359
Sedatives and Hypnotics for Older Adults Avoid long-acting benzodiazepines
Flurazepam
Quazepam
Diazepam
360
Main goal- nonpharmacological intervention
What is causing the sleep disorder
Barbiturates should not be used in older adults due to cns side effects
Use benzodiazepines for older adult- no longer than 4 weeks (tolerance, dependence)
Most common- frequently wake up, (pee, pain)
Sedatives and Hypnotics for Older Adults
361
Which nursing intervention would be most appropriate for a patient taking temazepam?
D. Tell patient to ask for help before standing.
362
What would indicate to the nurse that a patient taking a sedative-hypnotic requires more teaching?
D. The patient requests a cup of kava kava tea to help her get to sleep faster.
363
An older adult complains of insomnia. Which suggestion would be most appropriate for the nurse to provide as an initial method to deal with this issue?
B. “Drink warm milk or chamomile tea before bedtime.”
364
A patient is taking a hypnotic nightly to enhance sleep. The patient experiences vivid dreams and nightmares. This may be associated with
D. REM rebound.
