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NSG > Pharm #3 > Flashcards

Pharm #3 Flashcards

1
Q

Effects the sympathetic nervous system

A

Adrenergic

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2
Q

Sympathomimetics-

A

adrenergic agonists

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3
Q

Adrenergic antagonist-

A

sympatholytic

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4
Q

Brain
Spinal Cord

A

Central Nervous System (CNS)

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5
Q

Peripheral Nervous System (PNS) is made up of

A

Autonomic Nervous System
Somatic Nervous System

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6
Q

Visceral System (Smooth muscle and glands)

A

Autonomic Nervous System

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7
Q

Voluntary System (skeletal muscles)

A

Somatic Nervous System

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8
Q

Autonomic Nervous System Controls

A

Cardiac and respiratory systems
GI tract
Bladder
Eyes
Glands

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9
Q

Smooth muscle- digestion
Involuntary system

A

Autonomic Nervous System

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10
Q

Dominant in Stressful Situations (“Fight or Flight” response)

A

Sympathetic Nervous System

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11
Q

Adrenergic system- transmitting epinephrine and norepinephrine

A

Sympathetic Nervous System

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12
Q

Dominant in Peaceful Situations, hemostasis

A

Parasympathetic Nervous System

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13
Q

Sympathetic Nervous System (Adrenergic system): 4 Types of Receptor Cells:

A

Alpha 1
Alpha 2
Beta 1
Beta 2

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14
Q

Parasympathetic Nervous system (Cholinergic System): 2 Types of Receptor Cells:

A

Muscarinic
Nicotinic

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15
Q

Drugs can mimic neurotransmitters: (adrenergic agonist)

A

Norepinephrine
Acetylcholine

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16
Q

Will have opposite effects on the same organ

A

adrenergic antagonist

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17
Q

Drugs can be:

A

Sympathomimetics
Sympatholytic
Parasympathomimetic
Parasympatholytic

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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)

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19
Q

Sympathetic Stimulants =

A

Sympathomimetics (mime), adrenergic, adrenergic agonists

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20
Q

Sympathetic Depressants =

A

Sympatholytic, Adrenergic blockers, adrenolytic, adrenergic antagonists

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21
Q

Parasympathetic Stimulants (2 categories)

A

Direct-acting and Indirect-acting

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22
Q

Direct acting –

A

parasympathomimetic, cholinergic, cholinergic agonists

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23
Q

Indirect acting –

A

cholinesterase inhibitors

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24
Q

Parasympathetic Depressants =

A

Parasympatholytics, anticholinergics, cholinergic antagonists, antispasmodics

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25
Q

Function of adrenergics: Eye

A

Dilates Pupil

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26
Q

Function of adrenergics: Lungs

A

Dilates bronchioles

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27
Q

Function of adrenergics: Heart

A

Increased HR

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28
Q

Function of adrenergics: Blood vessels

A

Constrict

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29
Q

Function of adrenergics: Gastrointestinal

A

Relax

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30
Q

Function of adrenergics: Bladder

A

Relax

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31
Q

Function of adrenergics: Uterus

A

Relax

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32
Q

Increases cardiac contractility, vasoconstriction

A

Alpha1 receptors

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33
Q

Dilates pupils, decreases salivary gland secretion

A

Alpha1 receptors

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34
Q

Increases bladder and prostate contraction

A

Alpha1 receptors

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35
Q

Inhibits norepinephrine release

A

Alpha2 receptors

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36
Q

Promotes vasodilation and decreased BP

A

Alpha2 receptors

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37
Q

Decreases GI motility and tone

A

Alpha2 receptors

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38
Q

blood vessels, eyes, bladder, and prostate

A

Alpha 1 Adrenergic-

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39
Q

Alpha 1 receptors activates-

A

venules and arterioles=contraction

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40
Q

Increased cardiac contractility, blood pressure, return of blood circulation to the heart, blood flow to vital organ

A

Alpha 1 receptors

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41
Q

If too much stimulation= decrease in blood flow to other areas

A

Alpha 1 receptors

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42
Q

sympathetic nerve endings, releasing norepinephrine, decreases blood pressure and causes vasodilation

A

Alpha 2 receptors

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43
Q

Increases cardiac contractility, heart rate

A

Beta1 receptors

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44
Q

Increases renin secretion and increases BP

A

Beta1 receptors

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45
Q

Decreases GI tone and motility
Bronchodilation
Increases blood flow in skeletal muscles
Relaxes smooth muscles of uterus
Activates liver glycogenolysis
Increases blood glucose

A

Beta2 receptors

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46
Q

Beta 1= 1 heart, increasing myocardial contractility, increasing HR and renin secretion from kidneys to increase BP

A

Beta 1=

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47
Q

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

A

Beta 2 =

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48
Q

located in the renal, mesenteric, coronary, and cerebral arteries

A

Dopaminergic receptors–

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49
Q

Vasodilation
Increases blood flow

A

Dopaminergic receptors–

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50
Q

Activated by dopamine
Causing vasodilation

A

Dopaminergic receptors–

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51
Q

Reuptake of transmitter back into neuron

A

Neurotransmitter Inactivation

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52
Q

Neurotransmitter Inactivation: Enzymatic transformation or degradation

A

MAO inside neuron
COMT (chemical break down of the drug) outside neuron

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53
Q

Diffusion away from the receptor

A

Neurotransmitter Inactivation

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54
Q

Drugs halt termination of neurotransmitter by inhibiting

A

Norepinephrine reuptake
Norepinephrine degradation

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55
Q

Body sending out neurotransmitters body has to tell to stop releasing

A

Neurotransmitter Inactivation

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56
Q

Drugs can block stimulation of transmitters

A

Neurotransmitter Inactivation

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57
Q

Reuptake of transmitter back into neuron-

A

Plays more of an important role of the enzyme activity of the drug

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58
Q

Out rules the liver

A

Neurotransmitter Inactivation

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59
Q

Drugs can prolong the action of the neurotransmitter by

A

inhibiting reuptake (blocking) or
inhibiting metabolism of the drug itself (staying in the system longer)

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60
Q

Classification of Adrenergic Agonists

A

Direct-acting, Indirect-acting, Mixed-acting

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61
Q

Direct-acting-

A

directly stimulating adrenergic receptors (epinephrine, norepinephrine)

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62
Q

Indirect-acting-

A

stimulating the release of norepinephrine (amphetamine)

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63
Q

Mixed-acting-

A

doing both directly the adrenergic receptors and release of norepinephrine (ephedrine)

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64
Q

Produce sympathetic response

A

Catecholamines

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65
Q

Catecholamines types

A

Endogenous and Synthetic

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66
Q

Endogenous

A

Epinephrine, norepinephrine, dopamine

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67
Q

Synthetic

A

Isoproterenol, dobutamine

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68
Q

all synthetic

A

Noncatecholamines-

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69
Q

Stimulate adrenergic receptors

A

Noncatecholamines-

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70
Q

Most have longer duration of action than catecholamines

A

Noncatecholamines-

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71
Q

Phenylephrine, metaproterenol, albuterol

A

Noncatecholamines-

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72
Q

Chemical structure or a substance-

A

endogenous (body makes it) or synthetic (artificially) produces a sympathomimetic response

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73
Q

Epinephrine (Adrenaline) is

A

nonselective

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74
Q

Epinephrine (Adrenaline) action

A

Alpha1 increases the blood pressure.
Beta1 increases heart rate.
Beta2 promotes bronchodilation.

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75
Q

Epinephrine (Adrenaline) contraindications and caution

A

Cardiac dysrhythmias, hypertension
Hyperthyroidism, diabetes mellitus
Pregnancy

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76
Q

Catecholamine, non-selective adrenergic agonist- effects multiple things
Pupil dilation

A

Epinephrine (Adrenaline)

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77
Q

Inotropic- increasing the force of the cardiac output and contraction
Vasoconstrictor
Bronchodilator

A

Epinephrine (Adrenaline) action

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78
Q

Epinephrine (Adrenaline) uses

A

Anaphylaxis, anaphylactic shock
Bronchospasms, status asthmaticus
Cardiogenic shock, cardiac arrest

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79
Q

Goal with shock, because of non selectivity

A

Epinephrine (Adrenaline)

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80
Q

Producing several different desired effects on one person

A

Epinephrine (Adrenaline)

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81
Q

Drug of choice for anaphylaxis, bronchospasms if no other choice

A

Epinephrine (Adrenaline)

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82
Q

Epinephrine (Adrenaline) side effects/adverse reactions

A

Cardiac dysrhythmias, palpitations
Tachycardia, hypertension
Dizziness, headache, sweating
Insomnia, restlessness, tremors
Hyperglycemia

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83
Q

Epinephrine (Adrenaline) Drug interactions

A

Beta blockers (antagonist, blocks beta receptors)
Decrease epinephrine action
Digoxin
Causes cardiac dysrhythmias
TCAs and MAOIs intensify and prolong effects

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84
Q

Renal vasocontraction- less circulation and blood flow to kidneys effects excretion (output)

A

Epinephrine (Adrenaline)

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85
Q

Monitor for urinary output

A

Epinephrine (Adrenaline)

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86
Q

IV epinephrine extravasation

A

Blocks alpha receptors relaxing vascular smooth muscle & increasing blood flow to area

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87
Q

Epinephrine (Adrenaline) antidote

A

phentolamine mesylate (blocker receptors)

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88
Q

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

A

IV epinephrine extravasation

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89
Q

Albuterol is

A

Selective

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90
Q

Acts on beta2-adrenergic receptors
Promotes bronchodilation

A

Albuterol

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91
Q

Albuterol uses

A

Treats bronchospasm, asthma, bronchitis, COPD

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92
Q

Albuterol caution

A

Severe cardiac disease
Hypertension, hyperthyroidism
Diabetes mellitus, pregnancy
Renal dysfunction

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93
Q

Selective drugs =

A

fewer side effects

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94
Q

If high doses= can increase the sensitivity

A

Albuterol

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95
Q

Stimulates the livers= glycogenolysis= increase in blood glucose

A

Albuterol

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96
Q

Albuterol side effects/adverse reactions

A

Tremors, nervousness, restlessness
Dizziness, tachycardia
Palpitations, cardiac dysrhythmias

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97
Q

Albuterol drug interactions

A

May increase effect with other sympathomimetics, MAO inhibitors, and tricyclic antidepressants
Antagonize effect with beta blockers

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98
Q

Getting other drugs like a beta blocker cannot take

A

albuterol

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99
Q

Adrenergic Agonists assessment

A

baseline vital signs, other drug history, baseline glucose (increases glucose)

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100
Q

Adrenergic Agonists Nursing Interventions

A

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

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101
Q

Adrenergic Agonists Education

A

about epi pen, follow up after ER, effects more than one body effect, side effects, adverse effects

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102
Q

Central-Acting Alpha Agonists

A

Clonidine, Methyldopa

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103
Q

Selective alpha2-adrenergic agonist
Used primarily to treat hypertension

A

Clonidine

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104
Q

Produce vasodilation by stimulating alpha 2 receptors in the Central Nervous System

A

Clonidine

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105
Q

Clonidine Main side effects-

A

bradycardia, hypotension, sedation, and dry mouth

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106
Q

decreasing in the sympathetic outflow to reduce peripheral resistance (CNS)

A

Methyldopa

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107
Q

Alpha-adrenergic agonist that acts within the CNS

A

Methyldopa

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108
Q

Alpha2 activation leads to vasodilation and decreased BP

A

Methyldopa

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109
Q

Methyldopa Side effects

A

Drowsiness, headache, nasal congestion
Nightmares, edema, constipation
Ejaculation dysfunction
Elevated liver enzymes

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110
Q

Does not pair well with people, a lot of side effects

A

Methyldopa

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111
Q

Block effects of adrenergic neurotransmitters

A

Adrenergic Antagonists

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112
Q

Block alpha and beta receptor sites

A

Adrenergic Antagonists

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113
Q

Directly by occupying receptors

A

Adrenergic Antagonists

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114
Q

Indirectly by inhibiting release of neurotransmitters epinephrine and norepinephrine

A

Adrenergic Antagonists

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115
Q

Adrenergic Antagonists Types

A

Alpha-adrenergic antagonists
Beta-adrenergic antagonists

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116
Q

Drugs that inhibit a response at alpha-adrenergic receptor site

A

Alpha Adrenergic Antagonists

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117
Q

Alpha Adrenergic Antagonists: Selective

A

Block alpha1

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118
Q

Alpha Adrenergic Antagonists: Non-selective

A

Block alpha1 and alpha2

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119
Q

Alpha Adrenergic Antagonists: Action

A

Promote vasodilation, decreasing BP

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120
Q

Alpha Adrenergic Antagonists; Use

A

Decrease symptoms of BPH, PVD

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121
Q

Orthostatic hypotension = risk factor

A

Alpha Adrenergic Antagonists

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122
Q

Can treat peripheral vascular disease- vasodilate

A

Alpha Adrenergic Antagonists

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123
Q

Reynolds disease- tight constriction of blood vessels in hands when it gets cold- helps vasodilate

A

Alpha Adrenergic Antagonists

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124
Q

Beta-Adrenergic Antagonists Action

A

Decrease BP and pulse

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125
Q

needed to be used with caution with COPD, asthma, chronic bronchitis

A

Nonselective beta blockers-

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126
Q

Nonselective beta blockers blocks beta 1

A

Decrease BP and pulse

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127
Q

Nonselective beta blockers blocks beta 2

A

Bronchoconstriction
Use with caution in patients with COPD or asthma

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128
Q

Nonselective beta blockers: Propranolol HCl, uses

A

Angina, cardiac dysrhythmias, hypertension, heart failure

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129
Q

Metoprolol, atenolol

A

Selective beta blockers

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130
Q

Blocks beta1 only
Decrease BP and HR
Fewer side effects

A

Selective beta blockers

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131
Q

Selective beta blockers: Encourage pts to report side effects/adverse reactions related to heart

A

Bradycardia, hypotension, dysrhythmias
Headaches, dizziness, fainting
Fatigue, drowsiness, depression
Nausea, vomiting, diarrhea
Heart failure
Decreased libido and impotence
(HF)

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132
Q

Specific of the heart, blocking receptors involving BP and HR
Fewer side effects
Masks S/Sx of hypoglycemia- watch blood sugars

A

Selective beta blockers

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133
Q

Decreased effects with
NSAIDs- decreased effects in beta blocker

A

Beta-Adrenergic Blockers Drug interactions

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134
Q

Increased effects with
Atropine and other anticholinergics- increased effect too much of parasympathetic

A

Beta-Adrenergic Blockers Drug interactions

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135
Q

Increased risk of hypoglycemia with
Insulin, sulfonylureas

A

Beta-Adrenergic Blockers Drug interactions

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136
Q

Cause can increased or decreased effects

A

Beta-Adrenergic Blockers Drug interactions

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137
Q

Adrenergic Neuron Antagonists: Blocking the neuron release of norepinephrine

A

Used to decrease BP

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138
Q

Reserpine: closely resembles an alpha and beta adrenergic beta blocker

A

Blocking the neuron release of norepinephrine example

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139
Q

Reduces the serotonin and catecholamine transmitters. Depletion of these neurotransmitters may lead to severe mental depression

A

Blocking the neuron release of norepinephrine example

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140
Q

Herbal supplement that interacts with everything= st johns wart, hypertensive crisis
Need to know what they are taking before giving this

A

Adrenergic Neuron Antagonists

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141
Q

Adrenergic Neuron Antagonists Assessment

A

vital sign and ekg baseline, med history, health history,

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142
Q

Adrenergic Neuron Antagonists nursing interventions

A

monitoring BP and HR, report and document side effects or complaints of dizziness, chest pain, assisting change of positions because of ortho

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143
Q

Adrenergic Neuron Antagonists Education

A

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

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144
Q

When teaching a patient who has been prescribed metoprolol about side/adverse effects, which is the highest priority teaching point?

A

Instruct the patient how to take a pulse.

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145
Q

Stimulation of which adrenergic receptor results in dilation of vessels and decrease in blood pressure?

A

Alpha2

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146
Q

The nurse is teaching the patient about the side effects of propranolol. These include

A

bronchospasm.- do not give to asthma or copd

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147
Q

A nurse is administering epinephrine to a patient during a cardiac arrest. The primary desired action of this medication is to

A

stimulate a heart rate.

148
Q

A patient is receiving epinephrine intravenously. Which drug should the nurse have available to treat extravasation and tissue necrosis?

A

Phentolamine mesylate

149
Q

Vitamin definition

A

Needed to compose and comprise different things of out body, can get them synthetically or naturally, tissue growth and healing.

150
Q

Populations in need of increased vitamins

A

rapid body growth, inadequate diet, malabsorptive issues, pregnant and breast feeding, chronic illness, and restrictive diet

151
Q

Fat-soluble vitamins-

A

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
Q

Water-soluble vitamins-

A

vitamin b complex, C, B12 and folic acid. Not stored in the fat. Faster excretion in the kidneys because it is water.

153
Q

If a well balanced diet should acquire all of the

A

vitamins and minerals

154
Q

Vitamin A Function

A

Bone growth, skin, eyes, and hair maintenance

155
Q

Vitamin A Food Source

A

milk, butter, eggs, leafy greens veggies, yellow and orange veggies

156
Q

Vitamin A Deficiency

A

Night blindness, corneal ulceration, skin lesions, dysfunction of mucous membranes

157
Q

Vitamin A excess doses

A

Liver damage, hair loss, peeling skin, GI upset, lethargy

158
Q

Too much vitamin A in pregnancy can cause too much harm for

159
Q

Vitamin D function

A

Regulates calcium & phosphorus metabolism

160
Q

Vitamin D food sources

A

Carbsterginroe, salmon, evaporated milk

161
Q

Vitamin E function

A

Antioxidant properties
Protects cellular components from being oxidized and RBCs from being hemolyzed

162
Q

Vitamin E food sources

A

green leafy vegs, sweet potato, papaya, mango, nuts, seeds

163
Q

Vitamin E deficiency

A

Increased breakdown of RBCs

164
Q

Vitamin E excess doses

A

Fatigue, GI upset, HA, breast tenderness, bleeding- prolonging the prothrombin time

165
Q

Vitamin E interaction

A

Iron- interferes with the absorption of vitamin E

166
Q

Vitamin K function

A

Synthesis of prothrombin and clotting factors

167
Q

Vitamin K food sources

A

green leafy veggies

168
Q

Vitamin K deficiency

A

Spontaneous hemorrhage

169
Q

Vitamin K excess doses

A

Blood clotting time too quick, risk for stroke, HA, occlusion, decreased circulation

170
Q

Babies are vitamin K deficient-

A

vitamin K1 (phytonadione) shot for clotting- within in first 1 hour in life

171
Q

Can be used for clotting antidote- warfarin

172
Q

Adapt warfarin dose if they eat

173
Q

Vitamin B Complex

A

B1—thiamine
B2—riboflavin
B3—nicotinic acid or niacin
B6—pyridoxine

174
Q

B1—thiamine-

A

given to alcoholic patients (AUD)

175
Q

B1—thiamine- deficiencies

A

Polyneuritis (peripheral nerves), cardiac pathology(dysrhythmias, HA), edema, neurologic disorders, ataxia(impaired coordination), diplopia(double vision), alcoholism

176
Q

B2—riboflavin-

A

given to manage dermatologic problems, larger doses to treat migraines

177
Q

B2—riboflavin- deficiencies

A

Sore throat, cheilosis, skin cracks at corners of the mouth, migraines, dry skin

178
Q

B3—nicotinic acid or niacin-

A

Given for Hyperlipidemia

179
Q

B3—nicotinic acid or niacin- Deficiencies-

A

Hyperlipidemia, Pellagra(inflammation of areas that are exposed to the sun), diarrhea, mouth sores, skin redness(flushing)

180
Q

B6—pyridoxine-

A

Given for B6 deficiency because of inadequate diet. If they cannot metabolize B6. energy

181
Q

B6—pyridoxine- deficiencies

A

Neuritis, seizure, anemia, depression, confusion, seborrheic dermatitis

182
Q

Water soluble vitamins
Usually not toxic unless taken in extreme amount

A

Vitamin B Complex

183
Q

Vitamin C function

A

Aids in absorption of iron and conversion of folic acid
Increases wound healing and tissue repair
Protein and lipid synthesis

184
Q

Vitamin C food sources

A

citrus fruits

185
Q

Vitamin C deficiency

A

Scurvy- poor wound healing, bleeding gums, abnormal bone and tooth development

186
Q

Vitamin C excess doses

A

GI upset, crystalluria (aspirin interaction), decreased effects of oral anticoagulants

187
Q

Folic Acid (Folate) function

A

Essential for body growth
Needed for DNA synthesis

188
Q

Folic Acid (Folate) Food sources-

A

legumes, asparagus, eggs, leafy green veggies, fortified cereals

189
Q

Folic Acid (Folate) Deficiency

A

GI upset, stomatitis, fatigue, alopecia
Leukopenia, thrombocytopenia, neural tube defects

190
Q

Folic Acid (Folate) Excess doses: Increased risk for seizures

A

Can lower phenytoin levels
Mask vitamin B12 deficiency
Most a risk population- older adults

191
Q

Babies in the womb- pregnant women and planning on becoming pregnant take it to prevent neural tube defects

A

Folic Acid (Folate)

192
Q

Vitamin B12 function

A

Essential for DNA synthesis
Aids in conversion of folic acid to its active form
RBC development, Myelin integrity

193
Q

Intrinsic factor- gastric cells that is necessary for vitamin b12 absorption. If not they can get pernicious anemia

A

Vitamin B12

194
Q

Vitamin B12 food sources-

A

Clams, liver, fish, king crab, beef, fortified cereals

195
Q

Vitamin B12 Deficiency

A

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
Q

Vitamins Assessment

A

Assess for diet history, blood serum levels of the vitamins- know their baseline

197
Q

Vitamins Nursing Interventions

A

administer vitamins with food for absorption, monitory blood levels for deficiencies or overdoses

198
Q

Vitamins Education

A

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
Q

Minerals

A

Iron, Copper, Zinc, Chromium, Selenium

200
Q

Iron function

A

Vital for Hgb regeneration

201
Q

Iron Food sources-

A

Liver, lean meats, egg yolks, dried beans, spinach, fruit

202
Q

Iron Deficiency

A

Anemia, fatigue, weakness, shortness of breath, pallor, GI bleeding

203
Q

Iron toxicity- risk for

A

Child populations

204
Q

Iron toxicity

A

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
Q

Main causes of anemia
Pregnant women should take an __ supplement

206
Q

___ slows the absorption of iron

A

Food and antacids

207
Q

___ increases absorption of iron

208
Q

Copper Function

A

Needed for formation of RBCs and connective tissue
Neurotransmitter production

209
Q

Copper Food sources-

A

shellfish, liver, nuts, seeds, legumes, coco

210
Q

Copper Deficiency

A

Anemia, decrease in WBCs (infection risk)
Decrease in skin and hair pigmentation
Glucose intolerance, intellectual disabilities(young populations)

211
Q

Copper Excess

A

Wilson’s disease- error in body metabolism of copper
Too much can Accumulate in the liver, kidneys, brain and cornea

212
Q

Zinc Function

A

Growth, appetite, testicular maturation, skin integrity, mental activity, wound healing, immunocompetence

213
Q

Zinc Food source-

A

beef, lamb, eggs, potatoes, carrots

214
Q

Zinc Deficiency

A

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
Q

Zinc Excess doses

A

Copper deficiency
Decrease in HDL cholesterol
Weakened immune system

216
Q

Most common deficiency in someone who is on total parental nutrition, lost in the stool

217
Q

Help with immune system (colds)

218
Q

Can Inhibit absorption of antibiotics

219
Q

Nasal spray can have zinc and cause a loss of smell in nasal passage

220
Q

Chromium Function

A

Carb, lipid, and nucleic acid metabolism

221
Q

Chromium Food sources-

A

meat, whole grain cereals, brewers yeast

222
Q

Chromium Deficiency

A

Low blood sugar, dizziness, sleepiness, craving for sweet food, excessive thirst. Common in diets with High in refined foods and TPN

223
Q

Chromium excess doses

A

GI bleeding, coagulopathy, seizures, pulmonary dysfunction

224
Q

Selenium Function

A

Reproduction, thyroid hormone metabolism, DNA synthesis

225
Q

Selenium Food sources-

A

liver, seafood, poultry, grains

226
Q

Selenium Deficiency

A

Hypothyroidism, muscle weakness, myalgia, increased RBC fragility, pancreatic degeneration, pseudo albinism

227
Q

Selenium Excess doses

A

Weakness, GI upset, hair loss, dermatitis
Garlic-like odor from skin and breath

228
Q

Iron Assessment-

A

Diet, drug history, when, watching for anemia

229
Q

Iron Education-

A

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
Q

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?

A

Hemorrhage

231
Q

Which does the nurse identify as signs and symptoms of vitamin A toxicity? (Select all that apply.)

A

Hair loss
Lethargy
Vomiting and diarrhea

232
Q

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

A

vitamin D is fat-soluble.

233
Q

A patient with pernicious anemia most likely has a deficiency of

A

vitamin B12.

234
Q

A patient is taking iron supplementation. It is most important for the nurse to instruct the patient to

A

increase fiber and fluid intake to avoid constipation.

235
Q

Drugs that stimulate the PNS

A

Cholinergic Agonists

236
Q

Cholinergic receptors

A

Muscarinic
Nicotinic

237
Q

Muscarinic receptors-

A

smooth muscles like the heart, slow HR

238
Q

Nicotinic receptors-

A

effecting skeletal muscles

239
Q

Types of cholinergic agonists- stimulating parasympathetic response

A

Direct acting
Indirect acting

240
Q

Direct acting-

A

act on the receptors to activate the tissue response

241
Q

Indirect acting-

A

inhibit the action of the enzyme cholinesterase (breaking down acetylcholine, inhibits reaching receptor sites) can be reversible or irreversible

242
Q

Mimicking the parasympathetic system

A

Cholinergic Agonists

243
Q

PNS is called cholinergic - end of the neurotransmitters innervates the muscle

A

with acetylcholine

244
Q

Produce responses opposite to each other – epinephrine increase- cholinergic

A

decreases hr

245
Q

Effects of Cholinergic Agonists: Eyes

A

Constricts pupil

246
Q

Effects of Cholinergic Agonists: Lungs

A

Constructs bronchioles and increase secretions

247
Q

Effects of Cholinergic Agonists: Heart

A

HR decreases

248
Q

Effects of Cholinergic Agonists: Blood vessel

249
Q

Effects of Cholinergic Agonists: Gastrointestinal

A

increases peristalsis and secretions

250
Q

Effects of Cholinergic Agonists: Bladder

251
Q

Effects of Cholinergic Agonists: Salivary gland

A

increased salivation

252
Q

Rest and digest system
Normal homeostatic bodily functions

A

Cholinergic Agonists

253
Q

Primarily selective to muscarinic receptors

A

Direct-Acting Cholinergic Agonists

254
Q

Muscarinic receptors located in smooth muscles

A

Direct-Acting Cholinergic Agonists

255
Q

Metoclopramide
Pilocarpine
Bethanechol chloride

A

Direct-Acting Cholinergic Agonists

256
Q

Metoclopramide

A

Used to increase gastric emptying
Treats gastroparesis, nausea, GERD

257
Q

Pilocarpine

A

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
Q

Bethanechol chloride

A

classic cholinergic agonist
Used to increase urination, unincary retention problems

259
Q

Selective muscarinic receptors

A

GI and GU tract, glands and the heart-

260
Q

Bethanechol Side effects/adverse reactions (overstimulation of the parasympathetic system)

A

N/V/D
Hypersalivation
Diaphoresis
HA
Dizziness
Flushing
Urinary urgency/frequency
Bronchoconstriction/Increased bronchial secretions
Miosis (pupil constriction)
Lacrimation

261
Q

Bethanechol (overstimulation of the parasympathetic system) Contraindications

A

Intestinal or urinary tract obstructions, IBS, severe bradycardia, hypotension, COPD/Asthma, peptic ulcer, hyperthyroidism, seizures, parksonism

262
Q

If overdosed = nausea because of gastric motility

A

Bethanechol (overstimulation of the parasympathetic system)

263
Q

Bethanechol Assessment-

A

normal urine output >1500 mL per day, health history (urinary obstruction, asthma, peptic ulcers),

264
Q

Bethanechol Nursing Interventions-

A

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
Q

Bethanechol Education-

A

educate about home use= orthostatic hypertension

266
Q

Indirect-Acting Cholinergic Agonists Functions

A

Inhibit the action of cholinesterase enzyme causing more acetylcholine
Allow ACh to activate muscarinic and nicotinic cholinergic receptors

267
Q

Indirect-Acting Cholinergic Agonists Effects

A

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
Q

Indirect-Acting Cholinergic Agonists Contraindications:

A

intestinal and urinary obstruction

269
Q

Not directly acting on the receptor site
Skeletal system effect- muscle tone

A

Indirect-Acting Cholinergic Agonists

270
Q

Reversible Cholinesterase Inhibitors Uses

A

Produce pupil constriction in glaucoma
Increase muscle strength in myasthenia gravis

271
Q

Reversible Cholinesterase Inhibitors Examples

A

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
Q

Reversible Cholinesterase Inhibitors Side effects

A

Muscle cramps, bradycardia, hypotension
Blurred vision, hypersalivation, seizures

273
Q

Acting time frames
Short acting- increase muscle strength In MG
Asthma, diabetes, cardiac disease, obstruction of the GI or GU system= contraindications

A

Reversible Cholinesterase Inhibitors

274
Q

Irreversible Cholinesterase Inhibitor

A

Potent agents due to long-lasting effects
Main use is to produce pupillary constriction
Does not undo action

275
Q

Anticholinergics Action

A

Inhibit action of ACh by occupying ACh receptors

276
Q

Cholinergic Antagonists

A

Anticholinergics

277
Q

Effects of anticholinergics heart

A

Large doses increase HR; small doses decrease HR

278
Q

Effects of anticholinergics lungs

A

Bronchodilation, decrease secretions

279
Q

Effects of anticholinergics GI

A

Relax smooth muscle tone, decrease motility and peristalsis, decrease secretions

280
Q

Irritible bowel syndrome treatment
Salivation decrease
Dilation of pupils
Similar to adrenergic agonist

A

anticholinergics

281
Q

Effects of anticholinergics GU

A

Relax detrusor muscle, increase sphincter constriction

282
Q

Effects of anticholinergics Eye

A

Dilate pupils, decrease accommodation

283
Q

Effects of anticholinergics Glands

A

Decrease salivation and perspiration

284
Q

Effects of anticholinergics CNS

A

Decrease tremors and rigidity of muscles (Parkinson meds)

285
Q

Atropine

A

Anticholinergics

286
Q

Atropine action

A

Increase heart rate
Decrease GI motility, spasms, peristalsis, salivary and gastric secretions

287
Q

Atropine Side effects/adverse reactions

A

Tachycardia, photophobia, headache, blurred vision
Abdominal distention, nausea, constipation
Dry mouth and skin, decreased sweating
Urinary retention, impotence
Palpitations, dysrhythmias

288
Q

Contraindicated in glaucoma

289
Q

Main use= increase HF in bradycardia, can use preoperatively to decrease secretions to decrease aspiration during anesthesia

290
Q

Nerve block= can be used as a reversal agent

291
Q

Dilate pupils or ocular exams

292
Q

Serves as antidote for cholinergic drugs

293
Q

Can be used in liquid drops- hospice setting, dry up secretions (death rattle)

294
Q

Cant see, pee, spit, poop

295
Q

Atropine Assessment-

A

obtain baseline vital signs (bradycardia), urine output, contraindications

296
Q

Atropine Nursing Interventions-

A

determining fluid intake and output, assessing bowel sounds, decreasing motility- paralytic ileus

297
Q

Atropine Education-

A

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

298
Q

Antiparkinsonism–Anticholinergics

A

Benztropine

299
Q

Benztropine Main Action

A

Decreases involuntary movement, tremors, muscle rigidity

300
Q

Benztropine Use

A

Parkinson’s disease- caused by imbalance of dopamine and acyetylcholine
Pseudoparkinsonism

301
Q

Blocks action of acetylcholine

A

Benztropine

302
Q

Benztropine Side effects

A

Tachycardia, headache
Blurred vision, ocular hypertension
Dry mouth/skin, constipation
Urinary retention

303
Q

Contraindications
Glaucoma= ocular hypertension, constriction
Tardive dyskinesia

A

Benztropine

304
Q

Anticholinergics for Treating Motion Sickness, Antihistamine

A

Scopolamine

305
Q

Treats motion sickness, nausea, vomiting
Transdermal patch delivers dose over 3 days

A

Scopolamine

306
Q

Scopolamine Side effects

A

Tachycardia, hypotension
Dry mouth, constipation
Blurred vision, flushing
Muscle weakness, drowsiness
Urinary retention

307
Q

Educate- hand hygiene
Wear gloves

A

Scopolamine

308
Q

A patient has received atropine. It is most important for the nurse to assess the patient for which effect?

A

C. Urinary retention

309
Q

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?

A

Tachycardia

310
Q

A patient is ordered to receive bethanechol chloride for urinary retention. Which health condition would serve as a contraindication for this medication?

311
Q

A patient received atropine as a preoperative medication 30 minutes ago. The nurse evaluates the medication as effective if the patient states,

A

“My mouth feels dry.”

312
Q

A patient is prescribed scopolamine. It is most important for the nurse to assess the patient for a history of which condition?

313
Q

Atropine is most useful in the treatment of which cardiovascular condition?

A

Sinus bradycardia

314
Q

Insomnia-

A

Inability to fall asleep or remain asleep. More commonin female populatiom

315
Q

Stages of Sleep

A

REM and NREM

316
Q

REM-

A

rapid eye movement, most vivid dreams that they can recall the best.

317
Q

NREM-

A

non rapid eye movement- 4 stages and then it ends in REM
Occurs in 90 minute intervals

318
Q

If the cycle is interrupted it starts over

A

Stages of Sleep

319
Q

If they experience REM and NREM they are able to

A

perform better

320
Q

Nonpharmalogical management

A

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
Q

Sedatives:

A

calm or slow brain activity, diminish physical and mental response of the person. If increase the dose it can produce a hypnotic effect

322
Q

Hypnotics:

A

cause sleep

323
Q

Short-acting Hypnotics:

A

Help to fall asleep and produces less drowsiness effect in the morning

324
Q

Intermediate-acting- Hypnotics:

A

keeping someone asleep, staying asleep, more drowsiness effect in the morning

325
Q

OTC sleep aids- primary ingredient

A

Antihistamines (diphenhydramine)

326
Q

Pharmacological management

A

Most commonly prescribed- Sedatives and Hypnotics

327
Q

Sedative-Hypnotics General side effects

A

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
Q

Hypnotic therapy= short term event, don’t wanna create

A

dependence or tolerance

329
Q

Abruptly stopping a hypnotic=

A

withdrawal symptoms

330
Q

Respiratory disorders avoid

331
Q

Barbiturates Classified by length of action

A

Long-phenobarbital(seizures)
intermediate-maintain long periods of sleep(Butabarbital)
short- procedure sedation, closely monitor vital signs,
ultrashort- sleep

332
Q

Restrict to short-term use: 2 weeks or less

A

Barbiturates

333
Q

Barbiturates Interactions

A

Alcohol, opioids, other sedative-hypnotics
Decreases effects of oral anticoagulants, glucocorticoids, tricyclic antidepressants, quinidine

334
Q

Sleep- restricted time frame

A

Barbiturates

335
Q

Scheduled 2 meds

A

short acting

336
Q

Schedule 3 meds

A

Intermediate-

337
Q

Schedule 4 med

A

Long acting-

338
Q

Benzodiazepines used as hypnotics:

A

Flurazepam, alprazolam
Temazepam, triazolam
Estazolam, quazepam

339
Q

For sleep disorders and anxiety (more common)

A

Lorazepam and diazepam

340
Q

Benzodiazepines action

A

Interacts with neurotransmitter GABA to reduce neuron excitability

341
Q

Benzodiazepines Use

A

Reduce anxiety, treat insomnia

342
Q

Lam or pam
Short term use drugs
Can treat insomnia
To decrease excitability of the neurons

A

Benzodiazepines

343
Q

Benzodiazepines Assessment-

A

throughout drug history, complementary or alt medications. History-insomnia, anxiety. Renal function- low levels= prolong drug action

344
Q

Benzodiazepines Nursing Interventions-

A

continue to monitor vital signs, watching for adverse effects, bed alarm for fall risk.

345
Q

Benzodiazepines Education-

A

Encourage to avoid alcohol, antidepressant, antipsychotics, and opioids if on a benzodiazepine

346
Q

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

A

Benzodiazepines

347
Q

Zolpidem

A

nonBenzodiazepines

348
Q

Zolpidem Action

A

Neurotransmitter inhibition
Duration of action is 6 to 8 hours

349
Q

Zolpidem Use:

A

Treat short-term (less than 10 days) insomnia

350
Q

Differes in the chemical structure
Schedule 4 drug- tolerance and dependence can occur
If given to an older adult the dose should be decreased

351
Q

Sedative-Hypnotics (Non-Benzodiazepines) Assessment-

A

Obtain vital signs, labs, drug history

352
Q

Sedative-Hypnotics (Non-Benzodiazepines) Education-

A

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
Q

Ramelteon

A

Melotonin Agonists

354
Q

First FDA-approved hypnotic not classified as a controlled substance

355
Q

Selectively targets melatonin receptors to regulate circadian rhythm to treat insomnia

356
Q

Not been shown to decrease REM sleep

357
Q

Use nonpharmacologic methods first

A

Sedatives and Hypnotics for Older Adults

357
Q

Ramelteon Adverse effects/side effects

A

Drowsiness, dizziness, fatigue, headache, nausea, and suicidal ideation (nsg interventions)

358
Q

Sedatives and Hypnotics for Older Adults Short to intermediate-acting benzodiazepines

A

Estazolam
Temazepam
Triazolam

359
Q

Sedatives and Hypnotics for Older Adults Avoid long-acting benzodiazepines

A

Flurazepam
Quazepam
Diazepam

360
Q

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)

A

Sedatives and Hypnotics for Older Adults

361
Q

Which nursing intervention would be most appropriate for a patient taking temazepam?

A

D. Tell patient to ask for help before standing.

362
Q

What would indicate to the nurse that a patient taking a sedative-hypnotic requires more teaching?

A

D. The patient requests a cup of kava kava tea to help her get to sleep faster.

363
Q

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?

A

B. “Drink warm milk or chamomile tea before bedtime.”

364
Q

A patient is taking a hypnotic nightly to enhance sleep. The patient experiences vivid dreams and nightmares. This may be associated with

A

D. REM rebound.

NSG (13 decks)

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