Test 2 Flashcards
Cholinergic drug indications, side/adverse effects
Indication: Stimulate urination, dry mouth, myasthenia gravis (destruction of nicotinic receptors) alzheimer’s disease.
Side/adverse effects: Cholinergic crisis (too much ach) hypersalivation, shortness of breath, bradycardia, diaphoresis, hypotension, muscle twitching/weakness, fatigue
Anticholinergic drug indications, side effects, nursing care
I: Wide application. Given before surgery (reduce respiratory & gastric secretions) and prevent drop in HR r/t vagal nerve stimulation, Parkinson’s disease, bradycardia, IBS (diarrhea, constipation, or both
S/E: dry mouth, blurry vision, constipation, urinary retention, photophobia, ortho hypotension
NC: increase fluid, fiber, hard candy or ice for dry mouth. monitor urine output, hr, and bp
Adrenergic drug indications, alternative name (what else are they called), side effects, nursing care
I: shock, hypotension, anaphylaxis (type of shock), allergic rhinitis (hay fever), pre term labor,
N: (Agonists)/Sympathomimetic-most common name
Catecholamines- share the same chemical structure as norepinephrine (NE). epinephrine (Adrenalin), phenylephrine (Neo-synephrine), isoproterenol (Isuprel)
Noncatecholamines – dextroamphetamine (Adderall)
S/E: Increased HR, BP, and RR, muscle tremors, anorexia (decrease in appetite), Dry mouth, Constipation or urinary retention, Suppressed appetite
NC: close monitoring , usually in icu setting, take before 4 due to insomnia risk.
Indications, nursing care for patients taking metoprolol (Lopressor)
I: acute MI, HTN, heart failure
NC: Check HR prior to if less than 60 don’t give, or BP systolic less 100 check vitals after
-instruct pt to stand slowly by sitting up and waiting. listen to lungs, catheterize, etc.
-educate on exercise intolerance.
How do you know a drug is a beta-blocker?
End with -lol Beta blockers - used primarily in CV system, lowers HR and decreases myocardial contractility. Overall decreases sympathetic tone.
Alternative terms (what else are they called) for benzodiazepine, indications
(typically ends in zolam or zepam) -
AT: GABA Receptor Agonists. Names: lorazepam (Ativan), alprazolam (Xanax), diazepam (Valium)
I: treats insomnia, seizure control, anxiety, muscle relaxation, etc.. increases gaba receptor sensitivity= Gaba decreasing CNS activity.
zolpidem (Ambien) indication, nursing care, adverse effects
I: used as a hypnotic to treat insomnia via gaba receptor agonist
NC: Instruct patients on prolonged treatment not to discontinue medication without consulting their physician.
- Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. Use care if driving or in other activities that require strong concentration.
- Caution patient and family/caregivers that “sleepwalking” and other complex activities including driving a car (sleep driving) may occur while completely asleep. Care should be taken to monitor such activities and prevent access to motor vehicles while under the influence of this drug.
- Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.
Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged GI problems (nausea, vomiting, diarrhea), abnormal thoughts, or other bizarre behaviors.
S/E: causes amnesia and sleepwalking to ingest carbs
What is the antidote for an overdose of benzodiazepines?
flumazenil (Romazicon).
- Blocks binding of benzos/non benzos to gaba receptors by competitive inhibition.
What is the patient teaching about all antidepressant medications? What assessment data is priority?
Black Box Warnings are in place for all classes of antidepressants used with children, adolescents, and young adults for a higher risk of suicide. All patients receiving antidepressants should be monitored for signs of worsening depression or changing behavior, especially when the medication is started or dosages are changed
Patient teaching for MAOI drugs
MAO inactivates norepinephrine, dopamine, epinephrine, and serotonin. By inhibiting MAO, the levels of these transmitters rise.
-Patients should be careful to take medications as directed.
-They should avoid abrupt cessation of therapy to avoid withdrawal symptoms. —Patients should avoid alcohol, other CNS depressants, and tyramine-containing products (an amino acid in foods like chocolate, avocado, aged cheeses, aged meats, soy, beer.) for two weeks after therapy is discontinued.
-Patients should be advised regarding the signs of hypertensive crisis and to immediately report headache, chest or throat tightness, and palpitations to the provider.
-Tyramine is broken down by MOA so inhibiting MOA causes a buildup of tyramine, which can spike blood pressure.
What are phenothiazines and atypical antipsychotics used for? Adverse/side effects and pt. teaching?
Typical
-I: Phenothiazines: Treating schizophrenia by blocking dopamine receptors
-A/S/E: decrease dopamine=too much ach=increase parasympathetic=Sedation, drowsiness, dizziness, EPS (too much ach=excessive postural and automatic movements), constipation, photosensitivity, orthostasis (ortho hypo.), urinary retention
-NC: Gradually withdraw over 2-3 weeks. Pregnancy category c. take 7-8 weeks to improve.
Atypical
Nonphenothiazines (atypical antipsychotics);
-I: paranoia. treat schizophrenia with less adverse effects i.e sedation but has worse Extrapyramidal symptoms (EPS) - of movement disorders
-A/S/E: EPS, Neuroleptic Malignant Syndrome
(NMS) rare
-NC: Do not abruptly discontinue, there are injectable preps for noncompliant patients.
Extrapyramidal symptoms-dystonia, akathisia,
secondary parkinsonism, tardive dyskinesia
-I: Dopamine system stabilizers
-A/S/E: side effects: nausea, constipation, anxiety No motor side effects i.e)eps
-NC: Schizophrenia requires long-term treatment. Do not stop taking aripiprazole, even when you feel better.
For aripiprazole to work properly, it should be taken every day as ordered by your health care provider.
Avoid drinking alcohol or using illegal drugs while you are taking aripiprazole. They may decrease the benefits (e.g., worsen your confusion) and increase adverse effects (e.g., sedation) of the medication.
Know all the extrapyramidal side effects (EPS)
- EPS*
*Acute dystonia
- muscle spasms (back, neck, tongue, and face), dislocate joints, impair respirations due to laryngospasm
-Akathisia (inability to rest or relax)
Paces, trouble sitting still, or difficulty sleeping, Repetitive movements: rocking or crossing/uncrossing arms and legs. May be mistaken for anxiety and agitation. *Symptom management with beta-adrenergic blockers, anticholinergics, or benzodiazepines
-Parkinsonism
Tremor, loss of fine motor skills, muscle rigidity, stooped posture, shuffling gait
-Tardive dyskinesia (TD)
Involuntary and unusual tongue and face movements. Lip smacking, rapid eye blinking, and wormlike motions of tongue. Symptoms may worsen or become permanent when drug is withdrawn
NMS- Neuroleptic Malignant Syndrome
High Fever, Diaphoresis, Muscle rigidity, Tachycardia, BP fluctuations, Stupor or coma, (Idiosyncratic reaction, rare)
Serotonin Syndrome
Shivering and diarrhea
Muscle rigidity, fever, seizures
Mechanism of action, and overall purpose of drugs used to treat Alzheimer’s disease
Alzheimers is typically treated with donepezil, galantamine, and rivastigmine which are cholinesterase inhibitors.
Mechanism of action: selectively and reversibly inhibits the acetylcholinesterase enzyme, which normally breaks down acetylcholine. Donepezil raises ACh concentrations in the brain. It is believed that the increased levels of acetylcholine make up for loss of functioning cholinergic brain cells. It does not stop the progress of the disease and only produces modest results in treating it.
