Pharm Exam 3 Flashcards
adrenergic drug nursing intervention
obtain past and present medication history. Perform thorough head-to-toe physical assessment, gather baseline VS, Focus on cardiac and respiratory systems.
Overdose-seizures, hypotension or hypertension, dysrhythmias, palpitations, nervousness, dizziness, fatigue, malaise, insomnia, headache, tremor, dry mouth, nausea.
Half life is short so manage symptoms and these should go away relatively quickly.
adrenergic drugs: Contraindications
known drug allergy, severe hypertension
alpha-adrenergic drugs: Adverse effects
CNS-headache, restlessness, excitement, insomnia, euphoria.CV- chest pain, vasoconstriction, hypertension, tachycardia, palpitations or dysrhythmias,anorexia (loss of appetite), dry mouth, nausea, vomiting, taste changes (rarely).
adrenergic drugs- (Dobutamine) Beta 1 adrenergic Indication
increases cardiac output used for pt’s w/ heart failure.
adrenergic drugs- (dopamine) Beta1 adrenergic indication
low doses-dilate blood vessels in brain, heart, kidneys, and mesentary.
higher dose rates- improve cardiac contractility and output.
Highest doses- vasoconstriction
adrenergic drugs- (epinephrine) Alpha and Beta adrenergic indication
Low dose- increases force of contraction and HR and treat acute asthma and anaphylactic shock.
High dosages- vasconstriction elevating BP.prototypical druge for advanced cardiac life support.
adrenergic drugs- (Fenoldopam) Dopamine 1 agonist indication
lower BP, short term treatment of severe hypertension.May have beneficial effects on renal function because it increases renal blood flow.
adrenergic drugs- (Midodrine) Alpha 1 adrenergic indication
symptomatic orthostatic hypotension
adrenergic drugs (norepinephrine) Alpha and Beta adrenergic indication
hypotension and shock
adrenergic drug (phenylephrine) Alpha adrenergic indication
short term treatment to raise BP in pt’s in shockcontrol some dysrhythmias.produce vasoconstriction in regional anesthesia.adminstered topically as ophthalmic drug and nasal decongestant.
beta adrenergic drugs: Adverse effects
CNS- mild tremors, headache, nervousness, dizziness.CV- increased HR, palpitations, fluctuations in BP.sweating, nausea, vomiting, muscle cramps.
adrenergic drugs: Interactions
DD- anesthetic drugs increase cardiac dysrhythmias.Tricyclic antidepressants increase vasopressor effects, acute hypertensive crisis.MAOIs- life-threatening hypertensive crisis.Antihistamines and thyroid drugs- increase effects of adrenergic drugs.
adrenergic drug phenylephrine indication
short term treatment to raise BP in pt’s in shockcontrol some dysrhythmias.produce vasoconstriction in regional anesthesia.adminstered topically as ophthalmic drug and nasal decongestant.
adrenergic alpha blocker Contraindications
known drug allergy, peripheral vascular disease, hepatic and renal disease, coronary artery disease, peptic ulcer, sepsis, history of MI, currrent use of ED (erectile dysfunction) drugs
adrenergic alpha blocker adverse effects
First-dose phenomenon (sudden drop in BP after administration)Orthostatic hypotensionGI upsetabnormal ejaculation, rhinitis
adrenergic alpha blocker Interactions
Warfarin- risk of bleedingantihypertensives- risk of hypotension epinephrine reduced phentolamine effectsErectile dysfunction drugs, beta blockers, calcium channel blockers and alcohol- profound hypotension
adrenergic alpha blockers (phentolamine) indications
reduces peripheral vascular resistancetreat hypertensiontreat high BPdiagnose catecholamine-secreting tumor.
adrenergic alpha blockers (tamsulosin) indications
exclusively for male pt’streat BPH, hypertension
adrenergic beta blocker Contraindications
known drug allergiesheart failurecardiogenic shockheart block or bradycardiapregnancysevere pulmonary diseaseReynaud’s disease
adrenergic beta blocker Adverse effect
CV- atrioventricular block, bradycardia, heart failureCNS- Dizziness, fatigue, depression, drowsiness, unusual dreamsGI- Nausea, vomiting, constipation, diarrheaHemtologic- Agranulosytosis, thrombocytopeniaMetabolic- Hyperglycemia and/or hypoglycemia, hyperlipidemiaOther- Impotence, alopecia, bronchospasm, wheezing, dry mouth
adrenergic-blocking drug nursing intervention
Take thorough medical history especially focus on cardiac and respiratory diseases. Assess intake and output, daily weights, breath sounds, blood glucose levels especially if pt has diabetes.
adrenergic beta blocker Interaction
Antacids- decreased beta blocker activity Antimuscarinics, anticholinergics- reduced beta blocker effectsdigoxin- enhanced bradycardic effectsDiuretics, CV drugs, alcohol- additive hypotensive effectsNMBD- Prolonged neuromuscular blockadeOral hypoglycemic drugs, insulin- delayed recovery from hypoglycemia
adrenergic beta blocker (atenolol) indication
treat hypertension and angina.Manage thyrotoxicosis blocks excessive thyroid activity.
adrenergic beta blocker (carvedilol) indication
treat heart failurebeneficial for hypertension and angina.
adrenergic beta blocker (esmolol) indication
used in acute situations to provide rapid temporary control of the ventricular rate in pt’s with supraventricular tachydysrhythmias.
adrenergic beta blocker (labetalol) indication
treat severe hypertension and hypertensive emergencies to quickly lower BP.
adrenergic beta blocker (metoprolol) indication
used in pt’s AFTER MI.
adrenergic beta blocker (propranolol) indication
treat tachydysrhythmias associated with cardiac glycoside intoxication.treat of hypertrophic subaortic stenosis, pheochromocytoma, thyrotoxicosis, migraine headaches, essential tumor.
adrenergic beta blocker (sotalol) indication
used for management of difficult-to-treat dysrhythmias.
Cholinergic Drug- Contraindications
known drug allergy, GI or genitourinary (GU) tract obstruction, bradycardia, defects in cardiac impulse conduction, hyperthyroidism, epilepsy, hypotension, COPD, peptic ulcer, active bronchial asthma Parkinson’s disease is a precaution to these drugs.
Cholinergic Drug- Adverse effects
overstimulation of PNSCV- Bradycardia or tachycardia, hypotension or hypertension, syncope, av block, cardiac arrest.CNS- Headache, dizziness, convulsions, ataxiaGI- abdominal cramps, increased secretions, nausea, vomiting, diarrheaRespiratory- Increased bronchial secretions, bronchospasmOther- Lacrimation, sweating, salivation, miosis
Cholinergic Drug signs of overdose
abdominal cramps, salivation, flushing of the skin, nausea, and vomiting. Transient syncope, transient complete heart block, dyspnea and orthostatic hypotension is possible.
Cholinergic Drug Nursing Interventions
Encourage ambulation, increase intake of fluid and fiber. Be honest about Alzheimer’s disease and explain there is no cure.
Cholinergic drug interactions
Anticholinergics (atropine), antihistamines, sympathomimetics may antagonize. Other cholinergic drugs may have additive effects
(Memantine) Indications
not a cholinergic drug but works to treat alzheimer’s dimentia.Classified as an N-methyl-D-aspartate (NMDA)
Cholinergic drug- (Bethanechol) Indications
used to treat acute postop and postpartum nonobstructive urinary retention as well as urinary retention due to atony of bladder.treat postop GI atony and gastric retention, chronic refractory heartburndiagnostic testing for infantile cystic fibrosis
(Memantine) Indications
not a cholinergic drug but works to treat alzheimer’s dimentia.Classified as an N-methyl-D-aspartate (NMDA)
Adrenergic alpha-blocking drug overdose indication
more prominent adverse effects.
Administer activated charcoal to bind with drug and remove it from stomach.
Adrenergic beta-blocking drug overdose indication
bradycardia, severe hypotension, seizures.
Adminster atropine to manage bradycardia
vasopressors are titrated until desired BP and HR are achieved for severe hypotension.
Diazepam is administered via IV for seizures.
Cholinergic drug overdose indication
transient blurring and dimming vision.
atropine can be administered but is rarely required.
teaching pt about use of Midrodine
requires careful monitoring of blood pressure in supine position
What can happen with overuse of inhaled forms of beta2 agonists?
severe cardiovascular, CNS, and cerebrovascular adverse effects and stimulation
What should be monitored closely with the use of adrenergic drugs?
stimulation of the systems that are affected, such as cardiac and the CNS
What can happen with overuse of nasal preparations?
rebound nasal congestion or ulceration of the nasal mucosa
Cholinergic-Blocking Drug Contraindications
known drug allergy, narrow angle glaucoma, acute asthma or other respiratory distress, myasthenia gravis, acute cardiovascular instability, GI or GU tract obstruction (e.g. benign prostatic hyperplasia)
Cholingeric-Blocking Drug adverse effects
Increased HR, tachycardia, palpitations,
Excitation, restlessness, irritability, disorientation, hallucinations, delirium ataxia, drowsiness, sedation, confusion,
Dilated pupils, increased intraocular pressure,
Decreased salivation, gastric secretions and motility, urinary retention
Decreased sweating, Decreased bronchial secretions
Cholinergic-Blocking Drug interactions
additive effects from amantadine, antihistamines, and tricyclic antidepressants.
Reduced antipsychotic effects of phenothiazines.
Effects of digoxin are increased when taken with Anticholinergic (Cholinergic-Blocking) drugs
When would it be important for the nurse to contact the prescriber immediately for a pt taking adrenergic blocking drugs?
(1) pt is dizzy, lightheaded, or fainting (2) systolic BP lower than 100mm Hg, diastolic lower than 80 mm Hg (3) pulse rate lower than 60 bpm. Pt should also report muscle weakness, SOB, weight gain, edema in lower extremities
Cholinergic Blocking Drug (atropine) indication
Works directly with SA and AV nodes for
sinus bradycardia that is accompanied by hemodynamic compromise and ventricular asystole.
diminish tremors.
used pre-op to reduce salivation and GI secretions.
Cholinergic Blocking Drug (glycopyrrolate) indication
most commonly used drug for pre-op to reduce salivation and excessive secretions in the respiratory and GI tracts.
Cholinergic Blocking Drug (glycopyrrolate) indication
most commonly used drug for pre-op to reduce salivation and excessive secretions in the respiratory and GI tracts.
Cholinergic Blocking Drug (oxybutynin) indication
treats an overactive bladder.
Also used as an antispasmodic associated with spinal cord injuriers and congenital conditions such as spina bifida.
Cholinergic Blocking Drug (tolterodine) indication
treats urinary frequency, urgency, and urge incontinence caused by bladder (detrusor) overactivity.
How often should pt’s taking alpha and beta blockers weigh themselves?
Must be done every day….must also increase intake of fluids and fiber
Cholinergic Blocking Drug (tolterodine) indication
treats urinary frequency, urgency, and urge incontinence caused by bladder (detrusor) overactivity.
How long can it take for a therapeutic response to occur with some Alzheimer’s drugs?
up to 6 weeks
Nurses need to be aware that beta1 drugs can cause what effect?
increased cardiac contractility
Antihypertensive-adrenergic drugs Interactions
cause additive CNS depression when combined with alcohol, benzodiazepines, and opioids.
Clonidine- increases hypotensive effects.
doxazosin- increases hypotension, increases serum prazosin levels.
When a drug is characterized as having a negative chronotropic effect, what should the nurse expect to see?
a decreased heart rate
Antihypertensive- adrenergic drugs Contraindications
known drug allergy, acute heart failure, concurrent use of MAOIs, sever mental depression, peptic ulcer, severe liver or kidney disease.
Antihypertensive- adrenergic drugs Adverse effects
bradycardia with reflex tachycardia, postural and postexercise hypotension, dry mouth, drowsiness, dizziness, depression, edema, constipation, sexual dysfunction, headaches, sleep disturbances, nausea, rash, palpitations.
Antihypertensive-adrenergic drugs Interactions
cause additive CNS depression when combined with alcohol, benzodiazepines, and opioids.
Clonidine- increases hypotensive effects.
doxazosin- increases hypotension, increases serum prazosin levels.
Antihypertensive-adrenergic Alpha1 agonist (doxazosin) indication
reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels.
Beneficial in treatment of hypertension and the relief of the symptoms of obstructive BPH (benign prostatic hyperplasia).
Antihypertensive-adrenergic Alpha2 agonist (clonidine) indication
used primarily for its ability to decrease blood pressure.
also useful in managing opioid withdrawal.
Antihypertensive- ACE inhibitor (Captopril) indication
minimizing or preventing left ventricular dilations and dysfunction.
Can also improve PT’s chance of survival after an MI.
Antihypertensive- Angiotensin II Receptor Blocker (ARB)- (losartan) indication
benificial for pt’s with hypertension and heart failure.
Antihypertensive- ACE inhibitor Contraindication
known drug allergy,
pt’s with hyperkalemia (these drugs promote increased potassium.
lactating women
children and pt’s w/ bilateral renal artery stenosis
Antihypertensive- ACE inhibitor Adverse effects
fatigue, dizziness, mood changes, headaches.
dry cough which is reversible by discontinuing therapy.
first dose hypotensive effect.
loss of taste, hyperkalemia, rash, anemia, neutropenia, thrombocytosis, agranulocytosis.
Antihypertensive- ACE inhibitor overdose indication
hypotension. Treat by pushing fluid to increase blood volume.
Antihypertensive- ACE inhibitor interactions
NSAIDs (ibuprofen) can reduce antihypertensive effects. Concurrent use can also cause renal failure.
Concurrent use with other hypertensives can cause hypotension.
Concurrent use with lithium can cause lithium toxicity.
Don’t take potassium suppliments or potassium sparing diuretics concurrently w/ ACE inhibitors this causes hyperkalemia.
Antihypertensive Angiotensin II Receptor Blockers (ARB) Contraindications
known drug allergy
Pregnancy
Lactation
use cautiously in elderly pt’s and pt’s w/ renal dysfunction.
Antihypertensive- ARB adverse effects
upper respiratory infections, and headache
Occational dizziness, inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, and fatigue can occur.
Antihypertensive- ARB overdose indication
hypotension, tachycardia
administer IV fluids to increase Blood volume
Antihypertensive- ARB (losartan) indication
beneficial to pt’s w/ hypertension and heart failure.
ARBs are more tolerated than ACE inhibitors for pt’s after MI.
Antihypertensive- Calcium Channel Blocker- contraindication
known drug allergy, hypotension, cerebral edema, head injury, acute MI, coronary artery disease.
Antihypertensive- Calcium Channel Blocker- Adverse effects
dizziness, headache, orthostatic hypotension, dysrhythmias, sodium and water retention, nausea, vomiting, hyperglycemia in diabetic pt’s.
anxiety, tachycardia, edema, dyspnea, hepatitis, systemic lupus erythematosus (SLE), vitamin B6 deficiency, rash
Antihypertensive- Calcium Channel Blocker- Overdose indication
hypotension, tachycardia, headache, generalized skin flushing.
Push IV fluids, administer beta blockers to control tachycardia
Antihypertensive- Calcium Channel Blocker- interactions
Hydralazine can prodcue additive hypotensive effects when given with other adrenergic or other antihypertensive drugs.
Antihypertensive- Calcium Channel Blocker- hydralazine indication
oral route treats routine cases of essential hypertension.
injectable form used for hypertensive emergencies
What is positive inotropic effect?
Increased force of contraction
What is positive chronotropic effect?
Increased heart rate
What is positive dromotropic effect?
Increased conduction through AV node
What is anaphylaxis?
serious allergic reaction rapid in onset can result in death.
Primary treatment of anaphylaxis?
epinephrine
