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Pharmacology I > unit 3- concepts > Flashcards

unit 3- concepts Flashcards

1
Q

adrenergic neurons

A
  • nerve fibers that carry SNS information

* nts are adrenalin/NE

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2
Q

cholinergic neurons

A
  • nerve fibers that carry PSNS information

* nt is ACh

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3
Q

stimulation of PSNS nerves causes…

A
  • slowing of HR
  • vasodilation (dec. BP)
  • inc. gastric secretion
  • bladder emptying
  • bowel emptying
  • pupil constriction (focus)
  • bronchial mscl. ctx
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4
Q

cholinergic receptors

A 
•mediate responses to ACh
•Nicotinic N
•Nicotinic M
•Muscarinic
*PSNS
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5
Q

cholinergic drugs

A
  • influence activity of cholinergic receptors

* mimic or block ACh

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6
Q

cholinesterase inhibitors

A
  • indirectly prevent breakdown of ACh

* act like cholingergics

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7
Q

cholinergic receptor toxins

A
  • nicotine
  • insecticides
  • chemical warfare
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8
Q

Nicotinic M receptors

A

•ctx of skeletal muscles

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9
Q

Muscarinic receptors activation causes…

A
  • increased glandular secretions
  • ctx of smooth muscle
  • slowing HR
  • miosis (near vision)
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10
Q

SNS fxns

A

•regulation of CV system
•regulation of body temp.
•fight or flight
*adrenergic

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11
Q

SNS receptors

A
  • alpha 1
  • alpha 2
  • beta 1
  • beta 2
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12
Q

alpha 1 receptor fxn

A
  • mydriasis
  • vasoconstriction
  • bladder ctx
  • ejaculation
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13
Q

beta 1 receptor fxn

A 
•inc. HR
•inc. FOC
•inc. impuls thru AV node
•kidney release of renin
*heart
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14
Q

beta 2 receptor fxn

A
  • bronchial dilation
  • rlx uterine smooth muscle
  • vasodilation
  • glycogenolysis
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15
Q

drugs that stimulate ANS activity

A 
•sympathomimetic
•adrenergics
•alpha-adrenergic agonists
•cholinergics
•beta adrenergic agonists
*mimic nt
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16
Q

drugs that block SNS activity

A
  • sympatholytics
  • anti-adrenergics
  • beta-adrenergic blockers
  • alpha-adrenergic blockers
  • anti-cholinergics
  • cholinergic blockers
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17
Q

muscarinic poisoning

A
  • excessive activation of muscarinic receptors

* tx w/ atropine

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18
Q

xerostomia

A

•dry mouth

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19
Q

anhidrosis

A

•no sweat

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20
Q

anti-cholinergics often used for…

A

*tx for overactive bladder
•oxybutynin (ditropan)
•solifenacin (vesicare)
•tolterodine (Detrol)

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21
Q

pts at high risk w/ cholinergic drugs

A
  • peptic ulcer disease (PUD)
  • Urinary Tract Obstruction
  • Intestinal Obstruction
  • Coronary insufficiency
  • hypotension
  • asthma
  • hyperthyroidism
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22
Q

neuromuscular blocking agents

A

•block nicotinic M (cholinergic) receptors on skeletal muscle
•cause muscle relaxation
•can be non depolarizing or depolarizing
*DONT treat pain (must sedate first)

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23
Q

tubocurarine and hyperkalemia

A

•reduced paralysis

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24
Q

tubocurarine and hypokalemia

A

•enhanced paralysis

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25
Q

2 ultimate things ANS drugs do

A
  • mimic ANS hormones

* block ANS hormones

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26
Q

neostigmine toxicity

A
  • cholinergic crisis
  • respiratory depression
  • tx w/ atropine
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27
Q

adrenergic agonists

A
  • sympathomimetics
  • activate adrenergic receptors
  • mimic/prevents uptake of NE and epi
  • catecholamines or non-catecholamines
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28
Q

catecholamines

A
  • epi, NE, isoproterenol, dopamine, dobutamine
  • can’t be used PO
  • brief duration (MAO)
  • can’t cross BBB
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29
Q

non-catecholamines

A
  • ephedrine, phenylephrine, terbutaline
  • can be given PO
  • slowly metabolized (no MAO)
  • may cross BBB
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30
Q

alpha-1 adrenergic drug therapeutics

A 
•hemostasis (constriction vessels)
•nasal decongestion (constrict mucous)
•adjunct local anesthesia (slower abs.)
•elevate BP (constriction)
•mydriasis (dilation)
•anaphylaxis 
***artery effect
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31
Q

AE of alpha 1 activation

A
  • hypertension
  • necrosis
  • bradycardia (r/t elevated BP)
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32
Q

beta-1 adrenergic drug therapeutics

A 
•cardiac arrest (not preffered)
•HF (pos. ionotropic)
•shock (inc. HR)
•AV block (inc. conduction)
•raise BP
•anaphylaxis
***heart
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33
Q

AE of beta-1 activation

A
  • altered HR/rhythm

* angina

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34
Q

beta-2 adrenergic drug therapeutics

A

•asthma
•delay of pre-term labor
•anaphylaxis
***lungs

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35
Q

AE of beta-2 activation

A
  • hyperglycemia

* tremor

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36
Q

terbutaline

A
  • beta2 agonist
  • treats bronchospasm
  • treats pre-term labor
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37
Q

phenylephrine

A
  • alpha 1 agonist
  • nasal decongestant
  • raises BP
  • dilates pupils
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38
Q

adrenergic drug at risk patients

A
  • hyperthyroidism
  • hypertension
  • dysrhythmias
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39
Q

alpha adrenergic blocker therapeutics

A
  • essential HTN
  • reversal of alpha-1 agonist activity
  • tx of pheochromacytoma
  • tx of Raynaud’s
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40
Q

AE of alpha adrenergic blockers

A
  • ortho hypotension
  • reflex tachy
  • nasal congestion
  • inhibition of ejaculation
  • Na retention (-> inc. BP)
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41
Q

AE of beta1 blockade

A
  • Bradycardia
  • Reduced cardiac output
  • Precipitation of heart failure
  • AV heart block
  • Rebound cardiac excitation
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42
Q

AE of beta2 blockade

A
  • Bronchoconstriction

* Inhibition of glycogenolysis

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43
Q

monoamine oxidase

A
  • NZ important in the breakdown of proteins
  • inactivates neurotransmitters
  • reason why epi and NE are ineffective if given PO
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44
Q

protamine sulfate

A
  • heparin antidote (for OD)
  • immediate effects
  • 2 hr duration
  • IV slow injection
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45
Q

normal activated partial thromboplastin time (APTT)

A
  • 30-40 sec
  • goal w/ heparin is 60-80 sec (1.5-2x normal)
  • BEST way to look at effectiveness of heparin therapy
46
Q

significance of Warfarin being 99% protein bound?

A
  • interacts with basically every other drug

* if on other meds, MD follows pt closely

47
Q

anticoagulants and herbal medicine

A

•interact w/ the “Gs”

48
Q

warfarin antidote

A
  • vitamin K

* PO, IV, SubQ

49
Q

normal prothrombin time (PT)

A

•11-13 seconds
•goal w/ Warfarin is 22-26 (2-3 x normal)
*BEST way to follow effectiveness of Warfarin

50
Q

normal international normalized ratio (INR)

A

•0.8-1.1
•goal w/ Warfarin is 2-3
*BEST way to follow effectiveness of Warfarin

51
Q

foods to avoid during Warfarin tx

A
  • swiss chard
  • collards
  • kale
  • turnip greens
  • mustard greens
  • parsley
  • canola oil
  • mayonnaise
  • soybean oil
52
Q

HIT

A
  • heparin induced thrombocytopenia

* puts take argatroban for anticoagulation

53
Q

prodrug

A

•activated upon metabolism

54
Q

what does lysis mean?

A

•dissolution or destruction

55
Q

what does lytic mean?

A
  • produces/causes lysis
  • clot buster
  • thromboLYTICS NOT anti-coagulants
56
Q

what lab value should nurse monitor in order to evaluate the effectiveness of heparin sodium drip?

A

•aPTT

57
Q

heparin sources

A

•lungs of cattle
•intestines of pigs
*important when considering allergies

58
Q

important part of health hx

A
  • herbal products, especially the “Gs” (and cranberry juice)

* AE when combined w/ anticoagulants

59
Q

PT 38, PTT 39, INR 5.9; which action should RN implement

A

•admin vit. K

60
Q

warfarin and PG

A
  • category X
  • contraindicated in PG and lactating
  • teratogenic and bleeding risk
61
Q

when on Warfarin avoid…

A
  • uses of non-electric razors
  • firm toothbrush
  • injury
62
Q

IV site starts to ooze blood around catheter, what does RN do?

A
  • apply direct pressure over puncture site

* DONT stop the infusion

63
Q

altepase antidote

A
  • aminocaproic acid (Amicar)

* only given if death risk

64
Q

SLUDGE BAM

A 
*muscarinic agonist drug effects
Salivation/sweating/secretions
Lacrimation
Urination
Defecation
Gastrointestinal Upset
Emesis

Bradycardia
Abdominal cramps
Miosis

65
Q

miosis

A

•constriction of pupil

66
Q

opioid analgesics

A
  • natural or synthetic drug that has actions similar to morphine
  • act on Mu or Kappa receptors
  • does NOT remove pain, just takes away sensation
67
Q

Mu receptor activation

A 
•analgesia
•resp. depression
•miosis
•dec. peristalsis
•euphoria
•physical dependence
*morphine activates
68
Q

Kappa receptor activation

A 
•analgesia
•resp. depression
•miosis
•sedation
*activated by agonist-antagonist
69
Q

pure agonist opioids

A
  • activates mu and kappa receptors
  • strong- morphine
  • moderate- Codeine
70
Q

agonist-antagonist opioids

A

•mu antagonist
•kappa agonist
*less powerful than pure

71
Q

pure antagonist opioids

A
  • antagonize mu, kappa, and delta receptors

* Ex: Narcan

72
Q

A patient with severe burns is admitted to the burn unit. She rates her pain as 10 on a scale from 1-10. She has a past history of morphine abuse. Can we treat her with opioids?

A
  • yes, b/c her pain is so severe

* will gradually reduce off once she starts getting relief

73
Q

s/sx opioid toxicity

A
  • coma
  • resp. depression
  • pinpoint pupils (miosis)
74
Q

The nurse is caring for a client with a patient-controlled analgesia pump (PCA) that has morphine sulfate as the medication. The client has been out of surgery for 1 ½ hours. He complains that his hands itch and he has a rash. What would you do first?

A
  • discontinue PCA

* Benadryl

75
Q

what are sedative hypnotic drugs used for

A 
•sedation
•insomnia
•induce sleep
•anxiolytic
*DEPRESS CNS
76
Q

short term tx of sleep disorders

A
  • sedative hypnotics
  • suppress REM
  • lose effectiveness after 3 wks
  • r/o rebound insomnia
77
Q

benzodiazepine antagonist

A
  • flumazenil (Anexate, Romazicon)

* given IV

78
Q

buspirone (BuSPar)

A
  • non-benzo/non-barb sedative
  • anxiolytic
  • minimal CNS depressant
79
Q

Zolpidem (Ambien)

A
  • non-benzo/non-barb sedative

* short-term toxic insomnia

80
Q

Zaleplon (Sonata)

A
  • non-benzo/non-barb sedative

* used for difficulty falling asleep

81
Q

general anesthetics produce

A

•unconsciousness
•dec. pain response
•loss of sensation
*IV or inhalation

82
Q

balanced anesthesia

A
  • combo of muscle relaxants, analgesics, and short-acting barbiturates
  • goal is smooth & rapid analgesia/loc/muscle rlx
83
Q

stage I anesthesia

A
  • onset of administration until •unconsciousness
  • analgesia
  • muscle relaxation
84
Q

stage II anesthesia

A
  • LOC
  • delirium
  • loss of muscle activity
85
Q

stage III anesthesia

A
  • deep unconsciousness
  • resp. depression
  • suppressed reflexes
86
Q

stage IV anesthesia

A
  • all spontaneous resp. lost

* anesthetic OD

87
Q

s/sx abstinence syndrome

A
  • cramping
  • hypertension
  • N/V
  • analgesia reversal
88
Q

minimal alveolar concentration (MAC)

A
  • amount of anesthetic in alveoli needed to immobilize pt

* LOWER MAC= MORE POTENT

89
Q

malignant hyperthermia

A
  • acute, life-threatening complication of anesthetics

* s/sx: elevated temp; muscle rigidity

90
Q

malignant hyperthermia tx

A
  • stop procedure and remove from anesthesia
  • bag pt
  • give IV Dantrolene muscle relaxant given for malignant hyperthermia
  • may also have to give sodium bicarbonate
  • lavage organs with cold water (addresses high temp)
91
Q

pre-anesthesia medications

A
  • benzodiazepines
  • barbiturates
  • opioids
  • clonidine
  • anti-cholinergics
  • neuromuscular blockers
92
Q

post-anesthesia drugs

A
  • analgesics
  • anti-emetics
  • muscarinic agonists
93
Q

voltile anesthetics

A
  • HalothANE (Fluothane)
  • EnflurANE (Ethrane)
  • DesflurANE (Suprane)
  • SevoflurANE (Ultane)
  • IsoflurANE (Forane)
94
Q

gaseous anesthetics

A
  • nitrous oxide

* AE of N/V

95
Q

spinal anesthesia

A
  • regional injection into SUBARACHNOID space of spinal column
  • insensitivity to pain in lower part of body
96
Q

epidural

A

•regional injection into EPIDURAL space of spinal cord
•insensitivity to pain in lower part of body
*monitor BP throughout infusion

97
Q

why is epinephrine give w/ local anesthetic?

A

•causes vasoconstriction, preventing the anesthetic from spreading
*contra if local in extremities b/c can lead to gangrene

98
Q

s/sx CNS excitation

A

•seizure -> resp. depression -> LOC

99
Q

why do AEDs decrease effects of BC, warfarin, steroids

A

•b/c causes induction of hepatic NZs

100
Q

AEDs that don’t induce hepatic NZ

A

•Gabapentin
•Ethosuximide
*safe/effective w/ other AEDs

101
Q

cholinergic crisis

A
  • results from insecticide toxicity
  • s/sx: salivary/bronchial secretions, urinary/stool incontinence, diaphoresis, laryngospasm, bronchoconstriction, miosis, paralysis, death
102
Q

what does edema surrounding epinephrine IV site indicate?

A
  • infiltration

* admin phentolamine (Regitine) to prevent tissue necrosis d/t vasoconstrictor extravasation

103
Q

amide anesthetics

A
  • lidocaine (Xylocaine)
  • prilocaine (Citanest)
  • meprivacaine (Polocaine)
104
Q

ester anesthetics

A

•procaine (Novocaine)
•tetracaine (Pontocaine)
•cocaine hydrochloride (Procaine)
*greater r/o allergic rxn than amide

105
Q

what opioid can result in buildup of toxic metabolite with repetitive dosing and shouldn’t be used for more than 48 hrs

A
  • Meperidine (Demerol)
  • active metabolite has long t1/2
  • causes dysphoria (nervous, anxious)
106
Q

why agonist-antagonist over pure opioid agonist (why give kappa receptor activator, rather than Mu)?

A

•Kappa not as risky (not as strong of effect)

107
Q

how is opioids used therapeutically

A
  • antitussive- cough syrup w/ codeine- provides cough suppression
  • diarrhea tx w/ small doses
  • enhances analgesia and reduces the required dosage of the general anesthetic
108
Q

s/sx ICP

A 
•HA
•LOC changes
-less alert
-disoriented
*issue w/ opioids b/c have to determine if ICP or opioid toxicity
109
Q

Abstinence syndrome

A

•occurs w/ rapid withdrawal from physically dependent drug, such as opioids
•early- Rhinorrhea, Yawning, Sweating
•late- Anorexia, Goose Bumps, Tremors, Sneezing, Cramps, N/V, Muscle Spasm And Pain
*why you can’t quit morphine cold turkey

110
Q

anti-cholinergic AEs

A

can’t pee
can’t see
can’t spit (dry mouth)
can’t poop

111
Q

repeated doses of Demerol puts pt a risk for…

A
  • seizures
  • confusion
  • agitation

Pharmacology I (9 decks)

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