Topic 5 & 6 Flashcards
what are ways a drug can be called if they stimulate the sympathetic nervous system
sympathomimetic
adrenergic agonist
parasympatholytic
anticholinergic (cholinergic-blocking)
what are ways a drug can be called if they stimulate the parasympathetic nervous system
parasympathomimetic
cholinergic agonist
sympatholytic
adrenergic blocker (alpha and beta blocker)
sympathetic nervous system
fight or flight;
adrenergic
parasympathetic nervous system
rest and digest;
cholinergic
sympathetic: eye
dilates pupil (mydriasis)
sympathetic: lung
bronchodilation
sympathetic: heart
increases heart rate
sympathetic: blood vessel
constrict- increase BP
sympathetic: GI
relaxes (decreases GI secretions and GI motility)
sympathetic: bladder
relaxes bladder
constricts bladder sphincter
sympathetic: uterus
relax
a1 receptors
increase cardiac contractility, vasoconstriction
dilate pupil
decrease salivary secretion
increase bladder and prostate contraction
(think AC = Alpha Constrict; 1’s always constrict)
a2 receptors
inhibits norepinephrine (OPPOSITE RESPONSE)
promotes vasodilation and decrease BP (OPPOSITE RESPONSE)
decrease GI motility and tone
(2’s always dilate)
b1 receptors
increase cardiac contractility, HR
increase renin secretion and increase BP
(think 1 heart)
b2 receptors
decrease GI tone and motility
BRONCHODIALATION
increase blood flow to sk. muscles, relax smooth muscles of uterus
activates liver glycogenolysis (increase blood glucose)
(think 2 lungs)
direct acting adrenergic agonists
directly stimulates adrenergic receptor
(epi and norepi)
indirect acting adrenergic agonist
stimulates release of norepi from terminal nerve endings
(amphetamine)
mixed acting adrenergic agonist
stimulates adrenergic receptor sites AND stimulate release of norepinephrine from terminal nerve endings
(ephedrine)
what are the two types of adrenergic agonists
catecholamines and noncatecholamines
endogenous catecholamines
(produced naturally in the body)
epi, norepi, dopamine
synthetic catecholamines
isoproterenol, dobutamine
noncatecholamines
Most have longer duration of action than endogenous and synthetic
Phenylephrine, metaproterenol, albuterol
adrenergic antagonists
block effects of adrenergic neurotransmitters
(alpha and beta blockers)
when giving epi IV what is important
watch the IV site as it can cause tissue necrosis
epi is most often given which route
IV & sub-q
nasal decongestants and epi can…
further increase BP
a1 blockers can cause
vasodilation, dizziness
orthostatic hypotension, reflex tachycardia
pupil constriction
suppress ejaculation
reduces contraction of sm. muscles in the bladder sphincter and prostate
b1 blockers can cause
reduce cardiac contractility
decrease pulse (HR)
b2 blockers can cause
bronchoconstriction
contract uterus (given in labor)
inhibit glycogenolysis (could lead to hypoglycemia)
selective alpha adrenergic antagonist
selectively blocks a1
nonselective alpha adrenergic antagonist
block a1 and a2
what is the action of an alpha adrenergic antagonist
promote vasodialation (decrease BP)
what is the action of an alpha adrenergic antagonist
promote vasodialation (decrease BP)
what is the use for alpha adrenergic antagonist
decrease symptoms of benign prostatic hyperplasia (BPH)
beta blocker drugs end in…
“lol”
beta blocker action
Decrease BP and pulse
nonselective beta blockers
blocks b1- decrease BP and pulse
blocks b2- bronchoconstriction (use w caution in pt w COPD and asthma)
cholinergic agonists
drugs that stimulate the parasympathetic nervous system
muscarinic receptors
affect smooth muscle and slow the heart rate
nicotinic receptors
affect skeletal muscles
parasympathetic: eye
constricts pupil
parasympathetic: lungs
bronchoconstriction
increase secretions
parasympathetic: heart
decrease HR and BP
parasympathetic: blood vessels
vasodialate
parasympathetic: GI
increase peristalsis, motility and secretions
parasympathetic: bladder
contracts bladder
relax bladder sphincter
parasympathetic: glands
increase salivation
increase perspiration and tears
direct acting cholinergic agonist
drug reacts directly on receptor sites at target tissue level, mimicking action of ACh
indirect acting cholinergic agonists
Inhibit the enzyme acetylcholinesterase, which breaks down ACh
Results in more ACh available at the receptors and prolongs the action of naturally occurring ACh
anticholinergic toxidrome
happens if given too much anticholinergics
Mad as a hatter (Altered mental status)
Blind as a bat (Mydriasis)
Red as a beet (vasodilation, flushed)
Hot as a hare (febrile)
Dry as a bone (no secretions/diaphoresis)
what are the medically approved uses for CNS stimulants?
ADHD
narcolepsy
reversal of respiratory distress
what are the three categories of CNS stimulants?
amphetamines and caffeine
analeptics and caffeine
anorexiants
amphetamines and caffeine act on…
the cerebral cortex
analeptics and caffeine act on…
the brainstem and medulla
anorexiants act on…
the satiety center in the hypothalamic and limbic areas
what is the patho of ADHD
disregulation of transmitters (serotonin, norepi, dopamine)
what is the epidemiology of ADHD
usually occurs in children before the age of 7
more common in boys
what are the characteristics of ADHD
Inattentiveness, inability to concentrate, restlessness, hyperactivity, inability to complete tasks, impulsivity, poor coordination
EEG findings in an individual with ADHD may be…
abnormal
______ is usually not affected in individuals with ADHD, but _______ are often present
intelligence
learning disabilities
what are the actions of amphetamines
recurrent attacks of drowsiness and sleep during normal waking activities
sleep paralysis
what do amphetamines cause
euphoria
increased alertness
cardiovascular problems
what are the risks with amphetamines
there is a high potential for abuse, tolerance and dependence
excessive use may lead to psychosis
what are the two stages of sleep
rapid eye movement (REM)
non rapid eye movement (NREM)
insomnia
recurring problems in falling or staying asleep
what patients is insomnia more common in?
females
what are the treatments for insomnia
try nonpharmalogic methods first
sedative hypnotics
what are some nonpharmalogic methods for insomnia
arise at a specific hour in the morning
limit daytime naps
avoid caffeine, alcohol and nicotine 6 hours before bedtime
avoid heavy meals, large amount of fluid, long noise, strenuous exercise before bed
take warm bath, read , listen to quiet music, drink warm milk before bed
limit screen time before bed
benzodiazepines end in
-pam or -lam
what are the three classifications of sedative hypnotics?
barbiturates
benzodiazepines
nonbenzpdiazepines
what are the general side effects of sedative hypnotics
Residual drowsiness (hangover)
vivid dreams, nightmares
drug dependance
drug tolerance
excessive depression
respiratory depression
hypersensitivity
which CAMS should not be taken in combo with CNS depressants?
kava kava
valerian
chamomile
kava kava combined with CNS depressant can..
increase sedative effect
Valerian is used for what?
insomnia
valerian combined with alcohol or CNS depressant can..
increase sedative effect of prescribed drug
What is chamomile used for?
treat sleeplessness, anxiety, and stomach or intestinal ailments
what side effects are possible with chamomile and sedative hypnotics?
allergic reactions
zolpidem is often used for ________ ______ treatment
short term, 10 days
what is the duration of action for zolpidem
6-8 hours
what is the onset of zolpidem
30 mins
sedative hypnotics in older adults
TRY NONPARMACOLOGIC METHODS FIRST
short to intermediate acting benzodiazepines are considered safer for older adults
AVOID long acting benzodiazepines
to avoid side effects, what should an older adult taking a sedative hypnotic do?
use 4x/week or less
what are two types of anesthetics and what do they do?
general: depress the CNS, alleviate pain, cause LOC
local: pain relief in limited areas
what are the common routes of anesthetics?
inhalation
IV
topical
local
spinal
epidural
topical anesthetics use is limited to…
mucous membranes, broken or unbroken skin surfaces, and burns
what forms do topical anesthetics come in?
solution, liquid spray, ointment, cream, gel, powder
what is the action of topical anesthetics
decreases sensitivity to nerve endings of affected areas where drug s given
consciousness is maintained
what are the common uses for local anesthetics
dental procedures, suiting skin laceration
short term minor surgery at localized area
blocking nerve impulses (nerve block) below insertion of spinal anesthetic
diagnostic procedures such as lumbar puncture and thoracentesis
regional blocks
anesthetics: assessment
obtain drug &health history, noting drugs that affect cardiopulmonary system
anesthetics: nursing diagnosis
Acute pain related to injury
Ineffective breathing pattern related to central nervous system depression
anesthetics: planning
patient will participate in preoperative preparation and will understand post op care
anesthetics: nursing interventions
Monitor patient’s level of consciousness postop
Monitor vital signs (HR, BP, RR).
Monitor urine output (pre and post op)
Administer analgesics cautiously until patient fully recovers.
what is epilepsy
seizure disorder
abnormal electric discharges from cerebral neurons
what are the characteristics of epilepsy
LOC
involuntary, uncontrolled movements
what are the causes of epilepsy
unknown
secondary to brain trauma or anoxia, infection, stroke
isolates seizures due to fever, electrolyte or acid-base imbalance, alcohol or drugs
what do anti seizure drugs do?
stabilize nerve cell membranes
suppress abnormal electric impulses in cerebral cortex
what are the specific actions an anti seizure drug can take?
suppress sodium influx
suppress calcium influx
enhance action if GABA
anti seizure drugs and pregnancy
seizure episodes increase by 25% in pregnant women
antiseizure drugs are teratogenic (refers to potential to cause birth defects), inhibit vitamin K, and increase the loss of folate (folic acid) in pregnant patient
anti seizure medication that inhibits vitamin K in pregnant women…
contribute to infant hemorrhage soon after birth
vit K can be given during last few days of pregnancy or given infant soon after birth
anti seizure medication that increase loss of folate in pregnant women…
need daily folate supplements
muscle relaxants are used for muscle spasms to…
reduce pain and increase range of motion
muscle relaxants have a _____ effect
sedative
what should muscle relaxants NOT be taken with
barbiturates
narcotics
alcohol
primary anxiety
not caused by medical condition or drug use
managed with short-term anxiolytics
secondary anxiety
It is related to selected drug use, medical or psychiatric conditions.
Medications are not usually given for secondary anxiety.
what is the etiology of depression
genetic predisposition
social and environmental factors
what are the patho theories of depression
decrease levels of monoamine neurotransmitters
what are the s/s of depression
depressed mood, dispair, weight loss or gain
loss of interest in normal activites
fatigue, insomnia, hypersomnia
inability to think or concentrate
suicidal thoughts
which CAMS should be discontinued with depression and depression medications
ginkgo biloba and St. johns wort
what are the antidepressant groups
tricyclic antidepressants (TCAs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin Norepi Reuptake Inhibitors (SNRIs)
atypical antidepressants
Monoamine oxidase inhibitors (MAOIs)
