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Ivy Tech Nursing > Pharm Exam 3 > Flashcards

Pharm Exam 3 Flashcards

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2
Q

adrenergic drug nursing intervention

A

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.

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3
Q

adrenergic drugs: Contraindications

A

known drug allergy, severe hypertension

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4
Q

alpha-adrenergic drugs: Adverse effects

A

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).

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5
Q

adrenergic drugs- (Dobutamine) Beta 1 adrenergic Indication

A

increases cardiac output used for pt’s w/ heart failure.

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6
Q

adrenergic drugs- (dopamine) Beta1 adrenergic indication

A

low doses-dilate blood vessels in brain, heart, kidneys, and mesentary.
higher dose rates- improve cardiac contractility and output.
Highest doses- vasoconstriction

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7
Q

adrenergic drugs- (epinephrine) Alpha and Beta adrenergic indication

A

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.

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8
Q

adrenergic drugs- (Fenoldopam) Dopamine 1 agonist indication

A

lower BP, short term treatment of severe hypertension.May have beneficial effects on renal function because it increases renal blood flow.

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9
Q

adrenergic drugs- (Midodrine) Alpha 1 adrenergic indication

A

symptomatic orthostatic hypotension

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10
Q

adrenergic drugs (norepinephrine) Alpha and Beta adrenergic indication

A

hypotension and shock

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11
Q

adrenergic drug (phenylephrine) Alpha adrenergic indication

A

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.

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12
Q

beta adrenergic drugs: Adverse effects

A

CNS- mild tremors, headache, nervousness, dizziness.CV- increased HR, palpitations, fluctuations in BP.sweating, nausea, vomiting, muscle cramps.

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13
Q

adrenergic drugs: Interactions

A

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.

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14
Q

adrenergic drug phenylephrine indication

A

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.

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15
Q

adrenergic alpha blocker Contraindications

A

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

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16
Q

adrenergic alpha blocker adverse effects

A

First-dose phenomenon (sudden drop in BP after administration)Orthostatic hypotensionGI upsetabnormal ejaculation, rhinitis

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17
Q

adrenergic alpha blocker Interactions

A

Warfarin- risk of bleedingantihypertensives- risk of hypotension epinephrine reduced phentolamine effectsErectile dysfunction drugs, beta blockers, calcium channel blockers and alcohol- profound hypotension

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18
Q

adrenergic alpha blockers (phentolamine) indications

A

reduces peripheral vascular resistancetreat hypertensiontreat high BPdiagnose catecholamine-secreting tumor.

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19
Q

adrenergic alpha blockers (tamsulosin) indications

A

exclusively for male pt’streat BPH, hypertension

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20
Q

adrenergic beta blocker Contraindications

A

known drug allergiesheart failurecardiogenic shockheart block or bradycardiapregnancysevere pulmonary diseaseReynaud’s disease

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21
Q

adrenergic beta blocker Adverse effect

A

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

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22
Q

adrenergic-blocking drug nursing intervention

A

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.

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23
Q

adrenergic beta blocker Interaction

A

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

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24
Q

adrenergic beta blocker (atenolol) indication

A

treat hypertension and angina.Manage thyrotoxicosis blocks excessive thyroid activity.

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25
Q

adrenergic beta blocker (carvedilol) indication

A

treat heart failurebeneficial for hypertension and angina.

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26
Q

adrenergic beta blocker (esmolol) indication

A

used in acute situations to provide rapid temporary control of the ventricular rate in pt’s with supraventricular tachydysrhythmias.

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27
Q

adrenergic beta blocker (labetalol) indication

A

treat severe hypertension and hypertensive emergencies to quickly lower BP.

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28
Q

adrenergic beta blocker (metoprolol) indication

A

used in pt’s AFTER MI.

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29
Q

adrenergic beta blocker (propranolol) indication

A

treat tachydysrhythmias associated with cardiac glycoside intoxication.treat of hypertrophic subaortic stenosis, pheochromocytoma, thyrotoxicosis, migraine headaches, essential tumor.

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30
Q

adrenergic beta blocker (sotalol) indication

A

used for management of difficult-to-treat dysrhythmias.

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31
Q

Cholinergic Drug- Contraindications

A

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.

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32
Q

Cholinergic Drug- Adverse effects

A

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

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33
Q

Cholinergic Drug signs of overdose

A

abdominal cramps, salivation, flushing of the skin, nausea, and vomiting. Transient syncope, transient complete heart block, dyspnea and orthostatic hypotension is possible.

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34
Q

Cholinergic Drug Nursing Interventions

A

Encourage ambulation, increase intake of fluid and fiber. Be honest about Alzheimer’s disease and explain there is no cure.

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35
Q

Cholinergic drug interactions

A

Anticholinergics (atropine), antihistamines, sympathomimetics may antagonize. Other cholinergic drugs may have additive effects

36
Q

(Memantine) Indications

A

not a cholinergic drug but works to treat alzheimer’s dimentia.Classified as an N-methyl-D-aspartate (NMDA)

37
Q

Cholinergic drug- (Bethanechol) Indications

A

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

38
Q

(Memantine) Indications

A

not a cholinergic drug but works to treat alzheimer’s dimentia.Classified as an N-methyl-D-aspartate (NMDA)

39
Q

Adrenergic alpha-blocking drug overdose indication

A

more prominent adverse effects.

Administer activated charcoal to bind with drug and remove it from stomach.

40
Q

Adrenergic beta-blocking drug overdose indication

A

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.

41
Q

Cholinergic drug overdose indication

A

transient blurring and dimming vision.

atropine can be administered but is rarely required.

42
Q

teaching pt about use of Midrodine

A

requires careful monitoring of blood pressure in supine position

43
Q

What can happen with overuse of inhaled forms of beta2 agonists?

A

severe cardiovascular, CNS, and cerebrovascular adverse effects and stimulation

44
Q

What should be monitored closely with the use of adrenergic drugs?

A

stimulation of the systems that are affected, such as cardiac and the CNS

45
Q

What can happen with overuse of nasal preparations?

A

rebound nasal congestion or ulceration of the nasal mucosa

46
Q

Cholinergic-Blocking Drug Contraindications

A

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)

47
Q

Cholingeric-Blocking Drug adverse effects

A

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

48
Q

Cholinergic-Blocking Drug interactions

A

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

49
Q

When would it be important for the nurse to contact the prescriber immediately for a pt taking adrenergic blocking drugs?

A

(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

50
Q

Cholinergic Blocking Drug (atropine) indication

A

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.

51
Q

Cholinergic Blocking Drug (glycopyrrolate) indication

A

most commonly used drug for pre-op to reduce salivation and excessive secretions in the respiratory and GI tracts.

52
Q

Cholinergic Blocking Drug (glycopyrrolate) indication

A

most commonly used drug for pre-op to reduce salivation and excessive secretions in the respiratory and GI tracts.

53
Q

Cholinergic Blocking Drug (oxybutynin) indication

A

treats an overactive bladder.

Also used as an antispasmodic associated with spinal cord injuriers and congenital conditions such as spina bifida.

54
Q

Cholinergic Blocking Drug (tolterodine) indication

A

treats urinary frequency, urgency, and urge incontinence caused by bladder (detrusor) overactivity.

55
Q

How often should pt’s taking alpha and beta blockers weigh themselves?

A

Must be done every day….must also increase intake of fluids and fiber

56
Q

Cholinergic Blocking Drug (tolterodine) indication

A

treats urinary frequency, urgency, and urge incontinence caused by bladder (detrusor) overactivity.

57
Q

How long can it take for a therapeutic response to occur with some Alzheimer’s drugs?

A

up to 6 weeks

58
Q

Nurses need to be aware that beta1 drugs can cause what effect?

A

increased cardiac contractility

59
Q

Antihypertensive-adrenergic drugs Interactions

A

cause additive CNS depression when combined with alcohol, benzodiazepines, and opioids.

Clonidine- increases hypotensive effects.
doxazosin- increases hypotension, increases serum prazosin levels.

60
Q

When a drug is characterized as having a negative chronotropic effect, what should the nurse expect to see?

A

a decreased heart rate

61
Q

Antihypertensive- adrenergic drugs Contraindications

A

known drug allergy, acute heart failure, concurrent use of MAOIs, sever mental depression, peptic ulcer, severe liver or kidney disease.

62
Q

Antihypertensive- adrenergic drugs Adverse effects

A

bradycardia with reflex tachycardia, postural and postexercise hypotension, dry mouth, drowsiness, dizziness, depression, edema, constipation, sexual dysfunction, headaches, sleep disturbances, nausea, rash, palpitations.

63
Q

Antihypertensive-adrenergic drugs Interactions

A

cause additive CNS depression when combined with alcohol, benzodiazepines, and opioids.

Clonidine- increases hypotensive effects.
doxazosin- increases hypotension, increases serum prazosin levels.

64
Q

Antihypertensive-adrenergic Alpha1 agonist (doxazosin) indication

A

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).

65
Q

Antihypertensive-adrenergic Alpha2 agonist (clonidine) indication

A

used primarily for its ability to decrease blood pressure.

also useful in managing opioid withdrawal.

66
Q

Antihypertensive- ACE inhibitor (Captopril) indication

A

minimizing or preventing left ventricular dilations and dysfunction.

Can also improve PT’s chance of survival after an MI.

67
Q

Antihypertensive- Angiotensin II Receptor Blocker (ARB)- (losartan) indication

A

benificial for pt’s with hypertension and heart failure.

68
Q

Antihypertensive- ACE inhibitor Contraindication

A

known drug allergy,
pt’s with hyperkalemia (these drugs promote increased potassium.

lactating women

children and pt’s w/ bilateral renal artery stenosis

69
Q

Antihypertensive- ACE inhibitor Adverse effects

A

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.

70
Q

Antihypertensive- ACE inhibitor overdose indication

A

hypotension. Treat by pushing fluid to increase blood volume.

71
Q

Antihypertensive- ACE inhibitor interactions

A

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.

72
Q

Antihypertensive Angiotensin II Receptor Blockers (ARB) Contraindications

A

known drug allergy
Pregnancy
Lactation
use cautiously in elderly pt’s and pt’s w/ renal dysfunction.

73
Q

Antihypertensive- ARB adverse effects

A

upper respiratory infections, and headache

Occational dizziness, inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, and fatigue can occur.

74
Q

Antihypertensive- ARB overdose indication

A

hypotension, tachycardia

administer IV fluids to increase Blood volume

75
Q

Antihypertensive- ARB (losartan) indication

A

beneficial to pt’s w/ hypertension and heart failure.

ARBs are more tolerated than ACE inhibitors for pt’s after MI.

76
Q

Antihypertensive- Calcium Channel Blocker- contraindication

A

known drug allergy, hypotension, cerebral edema, head injury, acute MI, coronary artery disease.

77
Q

Antihypertensive- Calcium Channel Blocker- Adverse effects

A

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

78
Q

Antihypertensive- Calcium Channel Blocker- Overdose indication

A

hypotension, tachycardia, headache, generalized skin flushing.

Push IV fluids, administer beta blockers to control tachycardia

79
Q

Antihypertensive- Calcium Channel Blocker- interactions

A

Hydralazine can prodcue additive hypotensive effects when given with other adrenergic or other antihypertensive drugs.

80
Q

Antihypertensive- Calcium Channel Blocker- hydralazine indication

A

oral route treats routine cases of essential hypertension.

injectable form used for hypertensive emergencies

81
Q

What is positive inotropic effect?

A

Increased force of contraction

82
Q

What is positive chronotropic effect?

A

Increased heart rate

83
Q

What is positive dromotropic effect?

A

Increased conduction through AV node

84
Q

What is anaphylaxis?

A

serious allergic reaction rapid in onset can result in death.

85
Q

Primary treatment of anaphylaxis?

A

epinephrine

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