Study Guide 11 Flashcards
A type of drug that increases the levels of certain chemical s in the brain and increase alertness, attention, energy, and physical activity.
CNS Stimulants
3 Classes Of CNS Stimulants
Amphetamines
Analeptics
Anorexiants
Drugs used to treat children with ADHD
Amphetamines
What are the actions of analeptics?
Drugs that stimulate the respiratory center of the brain and cardiovascular system, used with narcolepsy and as an adjuvant treatment for obstructive sleep apnea.
What are examples of analeptics
Armodafinil (Nuvigil) – Narcolepsy, obstructive sleep apnea, sleepiness cause by shift work
Caffeine (Cafcit, 5 hour, energy, Vivarin)- Fatigue drowsiness, as adjunct in analgesic formulation, premature apnea, respiratory depression
Doxa pram (Dopram)- Respiratory depression: post anesthesia, drug induced, acute respiratory insufficiency super imposed on COPD
How do analeptics affect the cardiac and skeletal muscles
May cause cardiac stimulation, dilation of coronary and peripheral blood vessels, constriction of cerebral blood vessels, and skeletal muscle stimulation.
CNS are used for
*ADHD
*Drug induced respiratory depression
*Post anesthesia respiratory depression, without reduction of analgesia
*Narcolepsy
*Obstructive sleep apnea
*Exogenous obesity
*Sleep-wake disturbances (caffeine)
*Alzheimer’s apathy
Adverse reactions to CNS Stimulants
Neuromuscular System Reactions:
*Excessive CNS stimulation headache, dizziness
*Apprehension, disorientation, hyperactivity
Other reactions:
*Nausea, vomiting, cough, dyspnea
*Urinary retention, tachycardia palpitations
CNS Stimulants Contraindications
Contraindicated with known hypersensitivity or convulsive disorders in those with ventilation disorders. Do not administer CNS stimulants to clients with cardiac problems, severe hypertension or hyperthyroidism.
CNS Stimulants pre admission Assessment
Objective Data:
*Description of general appearance, resistance to infection
*Vital signs
*Weight and height especially for ADHD and obesity treatment, calculate BMI
*Female clients testing for pregnancy or inquiry regarding lactation if postnatal
*Respiratory depression note the depth of the respirations and any pattern to the raspatory rate
Respiratory Depression
Happens when the lungs fail to exchange carbon dioxide and oxygen efficiently
When CNS stimulant therapy causes insomnia, teach the caregiver to administer the drug early in the day (when possible) to diminish sleep disturbances.
Disturbed sleep patterns
Give examples of other stimulants:
Other stimulants, such as coffee, tea, or cola drinks, are avoided. Be aware that energy drinks such as Red Bull, Rockstar, and Monster all contain caffeine in addition to the herbal products and vitamins marketed
What are some nursing considerations?
In some clients, nervousness, restlessness, and palpitations may occur. Check vital signs every 6–8 hours or more often if tachycardia, hypertension, or palpitations occur. The adverse drug reactions that may occur with amphetamine use may be serious enough to require discontinuation of the drug.
What about Doxapram?
Urinary retention may result from doxapram administration; be sure to measure intake and output, and notify the primary health care provider if the client cannot void or the bladder appears to be distended on palpation.
What are the nursing considerations for ADHD drugs?
drug holidays (not taking over weekends/holiday breaks)
take last dose of meds at least 4-6 hrs prior to bedtime
gradually stop drug use (not abrupt)
How would a client avoid insomnia?
Amphetamines and anorexiants: These drugs are taken early in the day to avoid insomnia
Doxapram
Dopram Respiratory depression: postanesthesia, drug-induced, acute respiratory insufficiency superimposed on COPD
Amphetamine
Evekeo Narcolepsy, ADHD, exogenous obesity
Phentermine
Adipex-P Obesity
Strattera
atoMOXetine ADHD (acts like antidepressant rather than stimulant)
is the primary substance that transmits nerve impulses across the sympathetic branch of the autonomic nervous system.
Norepinephrine
drugs that block beta-adrenergic receptors. These drugs produce their greatest effect on the beta receptors of adrenergic nerves, primarily the beta receptors of the heart.
Beta Adrenergic
drugs produce the direct opposite effect of an adrenergic drug with alpha activity.
Alpha Adrenergic Blockers
Alpha Adrenergic Blockers uses
▪ Hypertension caused by pheochromocytoma (a tumor of the adrenal gland that produces excessive amounts of epinephrine and norepinephrine)
▪ Hypertension during preoperative preparation
▪ Reduce ocular pressure during laser surgery
▪ Prevent or treat tissue damage caused by extravasation of the drug—dopamine
Blocking nerve impulses a B-adrenergic nerves does what?
By blocking the nerve impulse of beta-adrenergic nerves it decreases the heart rate and dilates the blood vessels
Beta adrenergic receptors found where
Mainly in the heart
Beta adrenergic decreases heart rate and
Dilates blood vessels
Beta adregernic can also treat
glaucoma of the eye
Beta adrenergic adverse reactions
▪ Generalized reactions that affect the body include orthostatic hypotension, bradycardia, dizziness, vertigo, and headache.
▪ Gastrointestinal (GI) reactions include hyperglycemia, nausea, vomiting, and diarrhea.
▪ Bronchospasm (especially in those with a history of asthma).
Alpha/Beta-Adrenergic blocking Resulting in
resulting in peripheral vasodilation.
Alpha/Beta-Adrenergic blocking drugs examples
The two drugs in this category are carvedilol (Coreg) and labetalol.
is used to treat essential hypertension and in HF to reduce progression of the disease.
Carvedilol
is used in gestational hypertension, either alone or in combination with another drug, such as a diuretic.
Labetalol
Alpha/Beta-Adrenergic blocking adverse reactions
General body system adverse reactions include fatigue, dizziness, hypotension, drowsiness, insomnia, weakness, diarrhea, dyspnea, chest pain, bradycardia, and skin rash.
Tenormin Hypertension, angina, acute MI
Atenolol
Lopressor, Toprol-XL Hypertension, angina, MI, HF
Metoprolol
Inderal Cardiac arrhythmias, MI, angina, hypertension, migraine prophylaxis, hypertrophic subaortic stenosis, pheochromocytoma, essential tremor
Propranolol
Timoptic is for treatment of
Glaucoma
carvedilol Hypertension, HF, left ventricular dysfunction
Coreg
Catapres, Catapres-TTS (transdermal) Hypertension, ADHD, severe pain in clients with cancer, opiate withdrawal (supervised only)
Clonidine
Minipress Hypertension
Prazosin
Hypertension, BPH, dislodge ureteral stones
Terazosin
Antiparkinson Drugs
Drugs used to treat parkinsonism (or more frequently called Parkinson-like symptoms) are called antiparkinson drugs
Achalasia
failure to relax; usually referring to the smooth muscle fibers of the gastrointestinal (GI) tract, especially failure of the lower esophagus to relax, causing difficulty swallowing and a feeling of fullness in the sternal region
Akathisia
extreme restlessness and increased motor activity
Choreform movement
involuntary twitching of the limbs and facial muscles
Extrapyramidal symptoms (EPS)
Group of adverse reactions involving parietal portion of the nervous system causing abnormal muscle movements especially the akathisia
Dopaminergic
affect the Dopamine content of the brain.
Adv rxns with levodopa:
nausea, dizziness, headache, and somnolence.
Levodopa treat
treat parkinson’s disease and restless leg syndrome.
levodopa and carbidopa
dry mouth and difficulty swallowing anorexia, abdominal pain and constipation and increased hand tremor, headache and dizziness.
If a client is taking Levadopa what would they avoid?
foods with vitamin B 6
Dopamine receptor agonists
Signs and symptoms of parkinson’s disease also used for restless leg syndrome
Dopamine receptor agonists Adverse reactions
nausea , dizziness and vomiting, somnolence , hallucinations, postural hypotension , abnormal involuntary movement and headache.
COMT Inhibitors
the drugs to prolong the effect of levodopa.
blocking the enzyme, comt, which eliminates
Dopamine
COMT Inhibitors actions
prolong the effect of levodopa.
Anticholinergics: or cholinergic blocking drugs:
Drugs with Cholinergic blocking activity block Anticholinergics and CNS enhancing dopamine transmission.
Name a potent COMT inhibitor
Tolcapone is associated with liver damage and liver failure.
Anticholinergics: or cholinergic blocking drugs:
Drugs with Cholinergic blocking activity block Anticholinergics and CNS enhancing dopamine transmission.
Anticholinergics: or cholinergic blocking drugs: adverse reactions
can’t pee, can’t see, can’t spit, can’t “shpoop”
Dry mouth , blurred vision, dizziness, mild nausea and nervousness.
Drugs with Parkinson like reactions
Skin rash, urticaria, urinary retention, dysuria , tachycardia, muscle weakness, disorientation and confusion.
give trade name Tasmar is associated with liver injury.
Tolcapone
What would you monitor with tolcapone
high fever and severe rigidity
What would you see in your assessment if the client had this condition Parkinson’s
Drooling , difficulty in chewing and swallowing, changes in thought process, postural deformities.
hallucination occurs in older adults than younger adults receiving anti
anti parkinson’s drugs.
How does Vitamin B6 interfere with Levodopa?
it reduces the effect of levodopa
Antidiabetic Drugs
Insulin is a hormone produced by the Pancreas . It is required for the proper use of Glucose and metabolism.
Insulin lowers blood glucose levels how?
by inhibiting glucose production by the liver.
What causes hyperglycemia?
insulin insufficiency results in elevated blood glucose levels.
What diseases are diabetics at risk for?
Myocardial infarction, cerebrovascular accident ( stroke) blindness, kidney disease, vascular and neurological impairment in the extremities
formerly known as insulin dependent diabetes mellitus or IDDM
Type I
Formerly known as non insulin dependent diabetes mellitus or NIDDM
Type II
What are symptoms of Type I?
DO not produce enough insulin.
Risk factors for Type 2 are?
Obesity, older age , family hx of diabetes , history of gestational diabetes , impaired glucose intolerance.
when insulin first begins to act in the body.
Onset
when the insulin is exerting maximum action.
Peak
the length of time the insulin remains in effect.
Duration
Adverse reactions with anti diabetic
Hypoglycemia( low blood glucose or sugar level ) and hyperglycemia ( elevated blood glucose or sugar levels).
Hypoglycemia may occur when?
● the clients eats to little food or goes too long between meals
● the client has drastically increased demands ( activity or illness)
● the insulin given is incorrectly measured and is greater than that prescribed.
Hyperglycemia may occur when
- The client eats too much food
- Too little or no insulin is given
- The client experiences emotional stress, infection, surgery, pregnancy, or an acute illness
How does a person become insulin resistant?
An individual can become insulin resistant because antibodies develop against insulin. These clients have impaired receptor function and become so unresponsive to insulin that the dose requirement may be in excess of 500 units/day, rather than the usual 40 to 60 units/day.
Oral antidiabetics
(also called hypoglycemics) are used to reduce glucose blood levels in clients with type 2 diabetes. These drugs are not effective for treating type 1 diabetes.
Actions of Sulfonylureas
Sulfonylureas appear to lower blood glucose by stimulating the beta cells of the pancreas to release insulin Give 2 Examples: glipizide, and glyburide
Actions of Non sulfonylureas
sensitizes the liver to circulating insulin levels, reduces intestinal glucose absorption, and reduces hepatic glucose production.
Give 1 example: Biguanides
Explain Metformin and glucocorticoids
There is an increased risk of lactic acidosis when metformin is administered with the glucocorticoids.
Discuss glycosylated hemoglobin (HbA 1C)
The glycosylated hemoglobin (HbA1c) test is a blood test used to monitor the client’s average blood glucose level throughout a 3- to 4-month period. When blood glucose levels are high, glucose molecules attach to hemoglobin in the red blood cell.
stress and insulin changes
Exposure to stress, such as infection, fever, surgery, or trauma, may cause a loss of control of blood glucose levels in clients who have been stabilized with oral antidiabetic drugs. Should this occur, the primary health care provider may discontinue use of the oral drug and administer insulin product.
Why is insulin not given orally?
Insulin cannot be administered orally, because it is a protein and readily destroyed in the GI tract. Insulin must be administered by the parenteral route, usually the subcutaneous (subcut) route.
Glargine=________is given how and when?
is given subcut once daily at bedtime.
Drawing up 2 types of insulin
If the two insulins are to be given in the same syringe, the short-acting insulin (regular or lispro) is drawn into the syringe first.
a sign of Hypoglycemia
Acute confusion
Methods of terminating a hypoglycemic reaction:
● 4 ounces of orange juice or other fruit juice
● hard candy or one tablespoon of honey
● glucose gel or glucose tabs
● glucagon by the subcut or iv route
● glucose 10% or 50% iv
Glucagon
is a hormone produced by the alpha cells of the pancreas. It acts to increase blood glucose by stimulating the conversion of glycogen to glucose in the liver.
Deficient Fluid Volume
state or condition where the fluid output exceeds the fluid intake.
Ineffective Breathing Pattern
When taking metformin the client is at risk for lactic acidosis.
What about a teaching plan for diabetics:
● identification
● diet
● blood glucose or urine testing
● Hypoglycemia/ hyperglycemia
● personal hygiene
● exercise
● traveling
Regular Insulin:
Is human
NPH
is an insulin medication to treat and manage diabetes which is a significant risk factor for coronary artery disease.
Glargine
is given subcut once daily at bedtime, this type of insulin product maintains a steady blood level and is used in treating adults and children with type 1 diabetes and in adults with type 2 diabetes who need long acting insulin for the control if hyperglycemia
Glipizide
stimulates the release of the insulin from the pancreas and directs the blood sugars.
Glyburide
treats the high blood sugar levels caused by diabetes mellitus type 2 diabetes metformin.
Actos
is an oral diabetes medication that helps control blood sugar levels and is used together with diet and exercise.
Avandia
is an oral antidiabetic agents which acts primarily by increasing insulin sensitivity.
