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.
Levodopa
is used to treat Parkinsons in combination with carbidopa
Mechanism of action: Crosses the blood-brain barrier where the process of decarboxylation converts it into dopamine. This allows for more dopamine to be transported around the CNS to decrease involuntary movements. Its overall purpose is to treat the symptoms of Parkinson’s disease by restoring some motor control.
S/S of toxicity: severe dizziness, irregular heartbeat, mental/mood changes (such as agitation).
What is the mechanism of action of levodopa-carbidopa? What signs and symptoms may be an indication of levodopa/carbidopa toxicity?
Mechanism of action: Levodopa is a metabolic precursor of dopamine. When metabolized through decarboxylation to dopamine, dopamine levels in the brain increase. When given alone, 99% of a dose is decarboxylated before ever entering the CNS.
S/S of toxicity: severe dizziness, irregular heartbeat, mental/mood changes (such as agitation).
Seizure medication patient teaching, valproic acid (Depakote) patient teaching
Depakote is Gaba agonist= CNS depressant by decreasing electrical activity
-Use reliable contraception
-Immediately report pregnancy
-Report excessive signs of bleeding (decreases bone marrow platelet synthesis=less platlets=more bleeding/no clot)
-Report drowsiness and bone pain
-Get regular dental care and use good oral hygiene. Dilantin can cause gingival hyperplasia.
-Avoid alcohol, OTC drugs, and herbal medications
-Avoid nicotine
-Avoid driving and hazardous activities
-Rebound seizures can occur if discontinued abruptly
-Take with food
-Drug often used illegally
-Strict compliance with drug regimen is vital for seizure control
What are the side effects of cyclobenzaprine, patient teaching? (muscle relaxant)
Increases norepinephrine via blocking norepinephrine reuptake in turn decreasing ACh, causing an anticholinergic effect.
S/E: Common side effects include drowsiness, dizziness, and xerostomia (dry mouth), tachycardia, orthostatic hypotension, syncope, palpitations
Patient teaching:
-Do not discontinue medication quickly. Insomnia, nausea, headache, spasticity, tachycardia will occur. Should be tapered over 1-2 weeks
Do not take with alcohol or CNS depressants
-Avoid hazardous activities if drowsiness/dizziness occurs
Avoid using OTC medication unless directed by prescriber.
Use gum and water sips for dry mouth.
Notify prescriber of serotonin syndrome.
What are the indications and dangers associated with botulinum toxin?
Indications: strabismus (cross-eyed), blepharospasm (eye-twitching), hemifacial spasms, cervical dystonia/spasmodic torticollis (neck muscles contracting turning head), cosmetic use, axillary hyperhidrosis, chronic migraines
Dangers: block nerve functions and can lead to respiratory and muscular paralysis
Dantrolene contraindications
antispasmodic
-Depresses Ryanodine receptor binding. Ryanodine receptors control the release of calcium. Decreasing excitability of Ryanodine receptors will inhibit the release of calcium from the sarcoplasmic reticulum, causing muscles to relax.
-Hypersensitivity (hyperactive immune system), hepatic disease, hepatitis
-Precautions: Pregnancy, breastfeeding, geriatric, peptic ulcer disease, renal/cardiac/hepatic, stroke, seizure disorder, diabetes mellitus, ALS, COPD, MS, mannitol/gelatin hypersensitivity, labor, lactase deficiency, extravasation
Adderall side effects, patient teaching
S/E: irritability, insomnia, nervousness, palpitations, elevated blood pressure, tachycardia. (Black box warning: sudden death in children w/ pre-existing cardiac abnormalities)
Patient teaching: avoid caffeine and melatonin, notify MD of abdominal pain, jaundiced sclera, clay-colored stool, discolored urine, rash, take earlier in the day to avoid insomnia monitor BP and weight, be careful of dependence and abuse, chlorpromazine may be given for OD, phentolamine for severe HTN
Frequent migraine pharmacological options, general mechanism of action, what drug(s) are used acutely and what are their side effects?
Pharm Options:
-Mild: NSAIDs, Tylenol, caffeine serotonin 5-HT agonists (Triptan/ergot alkaloids)
-Moderate: oral, intranasal, subcutaneous serotonin (5-HT) agonists
If ineffective/contraindicated, then dopamine agonists are prescribed
-Severe:
Subcutaneous, IM, or IV serotonin agonists
Second choice parenteral dopamine agonist
Narcotic analgesic for refractory pain
General mechanism of action:
Serotonin (5-HT1) receptor agonist: Sumatriptan (Imitrex, Onzetra)
Acute episodes treated with vasoconstrictors
Triptans - sumatriptan (Imitrex)
Ergot alkaloids
Stimulate serotonin
-Side effects: mild, transient dizziness nausea, diarrhea, myalgia, inflammation or pain at injection site, headache recurrence, serious cardiac effects, hypertension
Benefits of nonopioid analgesics and why are nonopioids used in combination with opioids?
Reduces the risk of dependency, tolerance and withdrawal. Combination is used because of the potential to increase analgesic efficacy through different modes of action. Allows pain relief with less opioids.
