Study Guide Exam 3 (lacking Diabetes) Flashcards
Symptoms of Parkinsons
Tremors Muscle rigidity Bradykinesia Postural instability Affective flattening
goals of drug therapy for Parkinsons and seizures
Drug Therapy for Parkinsonism
Restores dopamine function
Blocks acetylcholine
Difference between simple and complex Partial (focal) seizures
Simple
• Olfactory, auditory, and visual hallucinations
• Intense emotions
• Twitching of arms, legs, and face
Complex
• Aura (preceding)
• Brief period of confusion or sleepiness afterward with no memory of seizure (postictal confusion)
• Fumbling with or attempting to remove clothing
• No response to verbal commands
Difference between Absence (petit mal), Atonic (drop attacks), and Tonic-clonic (grand mal) seizures?
Absence (petit mal)
• Lasting a few seconds
• Seen most often in children (child stares into space, does not respond to verbal stimulation, may have fluttering eyelids or jerking)
• Misdiagnosed often (especially in child) as ADD or daydreaming
Atonic (drop attacks)
• Falling or stumbling for no reason
• Lasting a few seconds
Tonic-clonic (grand mal)
• Preceeded by aura
• Intense muscle contraction (tonic phase) followed by alternating contraction and relaxation of muscles (clonic phase)
• Crying at beginning as air leaves lungs; loss of bowel/bladder control; shallow breathing with periods of apnea; usually lasting 1–2 minutes
• Disorientation and deep sleep after seizure (postictal state)
Symptoms of Myoclonic Seizures?
- Large jerking movements of a major muscle group, such as an arm
- Falling from a sitting position or dropping what is held
Neurotranmitters - Norepinephrine (NE)
• binds with adrenergic receptors
o alpha (1 and 2)
o beta (1 and 2)
• Sympathetic (energetic, fight or flight)
Neurotransmitters - Acetylcholine (Ach)
• binds with cholinergic receptors
o muscarinic (muscle/heart)
o nicotinic (neuromuscular)
• Parasympathetic (rest and digest)
Drugs that mimic the effect of norepinephrine (other names for them)
- sympathomimetics
* Adrenergic agonists
Drugs that block the effects of norepinephrine (other names for them)
- sympatholytics
- adrenergic blockers
- adrenergic antagonists
Drugs that mimic acetylcholine
(other names for them)
- parasympathomimetics
- cholinergic agonists
- cholinergic drugs
Drugs that block acetylcholine (other names for them)
- parasympatholytics
- anticholinergics
- Cholinergic antagonists/blockers
- muscarinic blockers
Epinepherine acts on more than one receptor (nonselective)…. so what does it do where? (so, for example, explain to a patient all the effects it might have)
– Alpha1, increases the blood pressure
– Beta1, increases heart rate (tachycardia)
– Beta2, promotes bronchodilation
Steroids
Glucocorticoids - Used for short-term therapy for severe inflammation… are immunosuppressants. Examples: dexamethasone and prednisone.
How to give Dilantin IV
IV is not compatible with other drugs… only with Normal Saline Solution (NS)… give it slowly
Pathology of Cancer
- Characterized by rapid, uncontrolled growth of cells
- Cells lose normal functions and invade normal tissues
- Metastasize: travel to another location
Growth Fraction
- Measure of how many cells are undergoing mitosis
• Ratio of replicating cells to resting cells - Solid tumors have low growth fraction; thus less sensitive to chemotherapy
- Leukemias and lymphomas have high growth fraction; thus chemotherapy more effective
- Hair follicles, bone marrow, gastrointestinal tissue have high growth factor—this explains many adverse effects
Principles of Chemotherapy
- Transported through blood
- Has potential to reach each cancer cell
- Some drugs can cross blood-brain barrier
- Some drugs distilled directly into body cavities (ex: bladder)
- Often combined with or done after surgery and radiation to increase chance of cure
* Called adjuvant therapy
Side effect for Alkylating Agents
can cause significant bone-marrow suppression
immunosuppressant effects, thrombocytopenia
Nausea, vomiting, anorexia, diarrhea
Alopecia (hair loss), hemorrhagic cystitis
Side effects for Antimetabolites
fatal bone-marrow toxicity at high doses
• Hemorrhage and bruising, low platelet counts
• Nausea, vomiting, anorexia
• Gastrointestinal ulceration, intestinal bleeding
Side effects for Antitumor Antibiotics
cardiotoxicity, dysrhythmias
Irreversible heart failure, lower blood-cell counts
Nausea, vomiting
Side effects for Hormones/Hormone Antagonists
nausea and vomiting
• Association with increased risk of endometrial cancer and thromboembolic disease
• Hot flashes, fluid retention, vaginal discharges common
Development of cross-gender secondary sexual characteristics
• Common, yet distressing, side effects of sex-hormone therapy
Side effects for Natural Products
nervous system toxicity, numbness and tingling in limbs
• Muscular weakness, loss of neural reflexes, pain
• Paralytic ileus, constipation, alopecia
gastric ulcer
- lesion in stomach
- Less common than the duodenal
Loss of appetite, weight loss and vomiting are more common
duodenal ulcer
- lesion in small intestine
- Characteristic symptom is a gnawing or burning, upper abdominal pain that occurs 1 to 3 hours after a meal.
May lead to bleeding that may be evident as either bright red blood in vomit or black, tarry stools
Associated with several risk factors for peptic ulcer disease
Family history, type O blood
Tobacco use and caffeine
Glucocorticoids and NSAIDs
Psychological stress
GURD
- Gastroesphageal Reflux Disease’
- Caused by loosening of sphincter between esophagus and stomach
- Associated with obesity
- Acidic stomach contents move up into esophagus
- Causes intense burning (heartburn)
- May lead to esophageal ulcers, esophagitis, or strictures
- Lifestyle changes can improve GERD symptoms
Categories of drugs for Acid Reflux Disease
H2 - Receptor Blockers (ie. Zantac, Pepcid, Tagamet)
- work by blocking H2-receptors in stomach to decrease acid production
- administered after meals
Proton Pump Inhibitor (i.e. Priolosec)
- administered 30 min before meals, on empty stomach, may be administered with other antacids
- reduces acid secretion in stomach by binding irreversibly to enzyme H1, K1-ATPase
- more expensive
Antacids (i.e. Amphojel, tums)
- neutralizes stomach acid by raising pH of stomach contents
Constipation
Common condition caused by
-Diminished fluid intake
-Slow motility of waste material
through large intestine
-Certain foods, medications, diseases
-Lack of exercise
-Insufficient dietary fiberDiarrhea
- Increase in frequency and fluidity of bowel movements
- Occurs when colon fails to reabsorb enough water
- Is a type of body defense
- Eliminates toxins and pathogens
- Eliminates certain medications and infections
- If prolonged, can lead to fluid, electrolyte, and acid-base imbalance
Categories of Laxatives
- Stimulant Laxatives
Increase peristalsis by irritating sensory nerve endings in the intestinal mucosa
Examples : (Correctol,bisacodyl (Dulcolax), Senokot) - Osmotic (saline) laxatives
Hyperosmolar…pull water into the colon and increase water in the feces to increase bulk that causes peristalsis.
(Phospho-soda, Milk of magnesia, magnesium citrate, Potassium phosphate) - Bulk Laxatives
Natural fibrous substances that promote large, soft stools by absorbing water into the intestine, increasing bulk and peristalsis
Examples: (Fibercon, Citrucel, Metamucil) - Emollients (stool softeners)
lowers surface tension and promote water accumulation in the intestine and stool
Examples: Ducusate sodium (colace), Mineral oil
Osmotic laxatives are contraindicated in what kind of patients?
renal failure and CHF
Milk of Magnesium is what kind of Laxative?
Osmotic
Metamucil is what kind of Laxative
Bulk Laxative
Nursing Implication for Bulk Laxative:
They decrease absorption of multiple other drugs including dig, and anticoagulants. Separate by 2 hours.
phenytoin (Dilantin) (Category, MOA, and Side Effects)
Category: Hydantoin
MOA: desensitizes NA+ channels
Side effects: CNS depression, gingival hyperplasia, skin rash, cardiac dysrhythmias, and hypotension
Nursing Implications for Dilantin
Monitor serum-drug levels
Monitor for signs of toxicity
Monitor for blood dyscrasias and bleeding disorders
Monitor liver and kidney function
Fatal hepatotoxicity can occur
Monitor lab values
Patients with hypersensitivity to hydantoin products should be cautious.
Rash, seizures due to hypoglycemia, sinus bradycardia, and heart block
What is Dilantin used for?
All types of epilepsy except absence seizures
Valproic acid (Depakene, Depakote)
used for?, category?, MOA? side effects?
Used for: absence seizures
category: Phenytoin-like drug
MOA: desensitize NA+ channels
Side effects: limited CNS depression, visual disturbances, ataxia, vertigo, headache, gastrointestinal effects, hepatotoxicity, pancreatitis
Nursing Implications for Valproic Acid?
Monitor serum-drug levels
Monitor for signs of toxicity
Monitor for blood dyscrasias and bleeding disorders
Monitor liver and kidney function
Fatal hepatotoxicity can occur
Patients with hypersensitivity to hydantoin products should be cautious.
Rash, seizures due to hypoglycemia, sinus bradycardia, and heart block
levodopa and carbidopa (Sinemet)
Dopaminergic drugs - used to treat parkinsen’s
MOA: Increases biosynthesis of dopamine within nerve terminals
Side effects: dizziness, light-headedness, sleep dysfunction, fatigue, nausea, vomiting, constipation, orthostatic hypertension, dystonia, dyskinesia
Infliximab (Remicade)
Suppresses inflammation in autoimmune disorders…. is an antibody immunosuppresant.
Toxic to bone marrow
Increase risk of infections and lymphoma
Nursing Implications for Remicade (aka for immunosuppresants)
Contraindicated in client with leukemia, metastatic cancer, active infection, renal or liver disease or those who are pregnant
Obtain vital signs and results of lab testing to provide baseline data
Monitor for indications of infection
Monitor degree of bone-marrow suppression (thrombocytopenia and leukopenia)
Monitor clients taking azathioprine (Imuran) for development of secondary malignancies
methotrexate (Folex, Mexate, others)
Category: Antimetabolites
MOA: blocks synthesis of folic acid (vitamin B9) to inhibit replication
Side effects: **fatal bone-marrow toxicity at high doses
• Hemorrhage and bruising, low platelet counts
• Nausea, vomiting, anorexia
• Gastrointestinal ulceration, intestinal bleeding
tamoxifen (Nolvadex)
Category: Hormones/Hormone Antagonists
MOA: blocks estrogen receptors on breast cancer cells
Side effects: nausea and vomiting
• Association with increased risk of endometrial cancer and thromboembolic disease
• Hot flashes, fluid retention, vaginal discharges common
Development of cross-gender secondary sexual characteristics
• Common, yet distressing, side effects of sex-hormone therapy
ranitidine (Zantac)
H2 Receptor blocker - works by blocking H2 receptors in stomack to decrease acid production. Give after you eat.
Adverse effects: possible reduction in number of red and white blood cells and platelets, impotence or loss of libido in men
Hydroxyzine (Vistaril)
Antihistamine, given post op with narcotics to decrease nausea.
drowsiness and dry mouth are expected.
Psyllium muciloid (Metamucil)
Bulk-type laxative;
Natural fibrous substances that promote large, soft stools by absorbing water into the intestine, increasing bulk and peristalsis
They decrease absorption of multiple other drugs including dig, and anticoagulants. Separate by 2 hours.
Diphenoxylate (Lomotil)
Opiate drug used for Diarrhea, that has less potential for dependence than other opioids.
Compazine
phenothiazine-like antinausea medicine that is given prior to chemotherapy…. causes dry eyes, blurred vision, dry mouth, constipation, drowiness, phtosensitivity, extrapyrradmidla symptoms, neuroleptic malignany dyndrome, agranulocytiosis.
