Week 3 - Neuro Flashcards
SNS receptor - pupils
Alpha 1
SNS receptor - Heart rate
Beta 1
SNS receptor - Heart contraction
Beta 1
SNS receptor - coronary arteries
Alpha 1
Beta 2
SNS receptor - peripheral blood vessels
Alpha 1
Beta 2
SNS receptor - bronchi
Beta 2
SNS receptor - intestinal blood vessels
Alpha 1`
SNS receptor - bladder body
Alpha 1
SNS receptor - bladder sphincter
Alpha 1
SNS receptor - uterus
Alpha 1
Beta 2
Neurotransmitter of SNS
NE
Epinephrine category class
Adrenergic Agonist
What is epinephrine’s expected pharmacological Action?
- antagonize A1, B1 and B2 receptor sites
- increased vascular resistance
- decrease mucosal edema
- decrease mast cell and basophil action
Epinephrine’s therapeutic uses?
anaphylaxis treatment
bronchospasm
local vasoconstriction
Epinephrine complications
- tremor
- palpitations
- anxiety
- restlessness
- tachycardia
- dysrythmias
- HTN
Epinephrine medication administration
Subcutaneous
IM
IV
Local injection
epinephrine contraindications/precautions
no absolute contraindications
precaution - preexisting tachy/dysrhythmia
Nursing interventions - epinephrine
- manage airway (pt should be connected to cardiac monitor, listen to lung sounds)
- reassessment
- O2
- BP
Interactions - epinephrine
none
Evaluation of medication effectiveness - epinephrine
- improvement of symptoms
- lack of localized bleeding (localized vasoconstriction and decreased blood flow to area) (with intra-dermal injection)
Client education - epinephrine
- always carry auto-injector
- how to use auto-injector
- unpredictability of anaphylaxis
- use with H1 and H2 blockers
atenolol category class
anti hypertensive beta adrenergic blockers (sympatholytics)
Expected pharmacological action - atenolol
decreased HR
decreased peripheral resistance
Decreased BP
Therapeutic use - atenolol
HTN - esp. with aldosterone-mediated fluid retention
Long term treatment of angina pectoris
may be used to prevent reinfarction following an MI
Complications - atenolol
Hypotension (at baseline and orthostatic hypotension)
Bradycardia
Medication administration - atenolol
PO: give one dose per day
IV: administer slowly
Contraindications/precautions - atenolol
Contraindicated:
- sinus bradycardia
- first degree heart block (conduction delay)
- cardiac failure shock
- orthostatic hypotension
Precaution: history of asthma; obstructive lung disease; DM (both)
Interactions - atenolol
Ca++ channel blockers
– Esp. Verapamil and Diltiazem
Nursing interventions - atenolol
Monitor HR before and after administration
Hold medication if HR is below 60 bpm and report
Monitor BP before and after treatment
Monitor for signs of HF
Client education - atenolol
Do not discontinue without consulting provider
Avoid sudden changes in position
Do not crush or chew extended release tabs
self monitor BP and HR
Evaluation of Medication effectiveness - atenolol
Absence of chest pain
Absence of dysrhythmias
Normotensive BP
Control of HR s/s
Why is a heart block a risk of atenolol?
There are multiple B 1 sites on the heart so different levels of heart block can occur with beta blockers (verify)
Why is atenolol not the best drug for those with DM?
It can block the signs and symptoms consistent with hypoglycemia - (shaky, nervous, anxious, fast heart rate)
Why is atenolol not the best drug for those with DM?
It can block the signs and symptoms consistent with hypoglycemia
bethanechol category class
Cholinergic agonist
Expected pharmacological action - bethanechol
Increase acetylcholine in circulation
increase urinary bladder muscle tone
stimulates gastric motility
Therapeutic use - bethanechol
urinary retention
Complications - bethanechol
wheezing (bronchospasm)
hypotension
Bradycardia
peptic ulcer
dizziness
fainting
Medication administration - bethanechol
PO
Contraindications/precautions - bethanechol
Contraindicated -
- hyperthyroidism
- PUD
- asthma
- CAD
- Parkinson’s
Precaution - UTIs
Interactions - bethanechol
Acetylcholinesterase inhibitors
betablockers
Nursing interventions - bethanechol
vital signs (HR and BP)
I’s & O’s
Implementation of fall risk
Interventions
Evaluation of medication effectiveness - bethanechol
increased UOP/GI
Client education - bethanechol
Pregnancy category C*
Report difficulty breathing
Check BP and HR
Don’t take if allergic
Report dizziness or passing out
oxybutynin - category class
anticholinergic
Expected pharmacological action - oxybutynin
blocks muscarinic receptors in detrusor muscles (relaxes)
causes contraction of the internal sphincter of the bladder
Therapeutic use - oxybutynin
overactive bladder
neurogenic bladder
complications - oxybutynin
- Xerostomia
- constipation
- pupil dilation
- drowsiness
contraindications - urinary retention, blurry vision, fever
methods of administration - oxybutynin
PO (extended release - never crushed)
Transdermal patch (rotate site)
What should transdermal patch administration education include?
rotating the site as it could irritate the epidermis if it’s placed on the same site more than once for an extended time
Contraindications - oxybutynin
Angle-closure glaucoma
Mysthenia gravis (decreased cholinergic activity at neuromuscular junction)
GI obstruction
GU obstruction
Active cardia dysfunction (dysrhythmia or MI)
Precautions: UTI, Hyperthyroidism, HTN, BPH, Liver or
Nursing interventions - oxybutynin
Monitor UOP
Monitor bowel elimination patterns
Monitor for urinary pattern (retention)
Interactions - oxybutynin
grapefruit juice
phenytoin
Evaluation of medication effectiveness - oxybutynin
prevention of release of urine at undesired times
client education - oxybutynin
hard candy for dry mouth
increase fluid and fiber intake
report urinary retention/infection
report dizziness or fainting
Why shouldn’t oxybutynin be given to someone with narrow angle glaucoma?
Anticholinergic medications can cause increase in ocular pressure
Why shouldn’t oxybutynin be given to someone previously diagnosed with Mysthenia gravis?
It can cause acute exacerbation
Why shouldn’t oxybutynin be given to someone with GI obstruction
It can worsen obstruction by decreasing GI motility
Why shouldn’t oxybutynin be given to someone with GU obstruction?
It can cause urinary retention
Anticholinergic side effects
can’t pee, can’t see, can’t spit, can’t poop
What can urinary retention cause?
UTI
