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131 Cards in this Set

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Adrenergic Antagonist Drugs
(blockers/sympatholytics)
- drugs that BLOCK the effects of the sympathetic neurotransmitters
-therapeutic uses of alpha, and beta, adrenergic blockers
- drugs that are anti-dopaminergic reduce the level of dopamine in the brain and are often used as anti-anxiety and anti psychotic agents
drugs that influence the autonomic nervous system fall into 4 categories
1) adrenergic agonists (sympathomimetics)

2) adrenergic antagonists (sympatholytics)

3) cholinergic agonists (parasympathomimetics/ acetylcholinesterase inhibitors = more free acetylcholine)

4) cholinergic antagonists (parasympatholytics)
the sympathetic nervous system's effects on body tissue
- eye= pupils dilate
- lungs = bronchioles dilate
- heart = increase in HR
- blood vessels = constricts, BP increases
- GI = relaxes smooth muscles of GI
- bladder= relaxes bladder muscles
- uterus = relaxes uterine muscle
- salivary gland = dry
FIGHT RESPONSE
THE PARASYMPATHETIC NERVOUS SYSTEMS EFFECTS ON TISSUE
- eyes= pupils constrict
- lungs= bronchioles constrict/ increase secretions
- heart = decrease in HR
- blood vessels = dilates, decrease in BP
- GI = increased peristalsis
- bladder = muscles constrict
- uterus = no effect
- salivary gland = increase in salivation
FLIGHT RESPONSE
beta 1 receptors
- located primarily in the heart
- stimulation increases myocardial contractility and heart rate increase
- norepinephrine, epinephrine, and/or dopamine are released
- intra-ocular pressure increased
assess for tacycardia and high BP
beta 2 receptors
- found mostly in lungs, skeletal muscles, and uterine muscle
- stimulation causes relaxation of the smooth muscles of the lungs = bronchodilation
- an increase in blood flow to skeletal muscles (albuterol)
- relaxation of uterine muscle = decrease in uterine contraction

* epinephrine released
alpha 1 receptors
- located in vascular vessels of muscles = VASOCONSTRICTION

- when stimulated the arterioles and venules constrict, increasing peripheral resistance and blood return to the heart

- BP increases, pupil dilation

- norepinephrine, epinephrine, and dopamine released
alpha 2 receptors
- located in the postganglionic sympathetic nerve endings

- stimulated = inhibits release of norepinephrine = decrease in vasoconstriction

- the release of norepinephrine and/or epinephrine is inhibited
when dopaminergic receptors are stimulated
the coronary, renal, and visceral arterial vessels are dilated to supply oxygenated blood to these organs. the peripheral arterial vessels are vasoconstricted to shunt blood from the extremities to the major organs (sympathetic system)
adrenergic agonist drugs mimic...
norepinephrine
epinephrine
dopamine

sympathetic system
adrenergic agonists act on the receptor sites...
alpha 1
alpha 2
beta 1
beta 2
dopaminergic
adrenergic agonist drugs do what? (sympathomimetics)
mimic the sympathetic nervous system
- dry up secretions
- vasoconstriction
- increase cardiac contraction
- brochiole dilation
- increase intraocular pressure (keep in mind with glaucoma patients)
- urinary retention
exmples adrenergic agonists are...
- direct-acting (catecholamines)

- sympathetic amines (non-catecholamines)
teratogenic categories
A = no evidence of risk

B = assumed that there is little to no risk to the fetus

C = given if the potential benefits to the mother outweigh the potential risk to fetus (no human studies)
D = evidence that there is risk to fetus. may be given if potential benefits to the mother outweighs the potential risk to fetus.

X = risk to fetus outweighs the potential benefits to the mother
excretion in pharmokinetic phase
renal disease: the kidneys are impaired in excreting the metabolized drug; the elderly often have a decrease in the number of functioning nephrons, therefore are slower to exrete drugs
pharmokinetic phase - part 1
- characterized by movement of the drug
- first aspect phase is absorption: defined as site of entry into the bloodstream

- second aspect is distribution: movement from the blood stream to the interstitial space of tissues and then into cells
pharmacodynamic phase
- bio-chemical actions of drugs and physiological response to drugs
- drugs modifyt existing functions of target tissues. they can stimulate (agonists) or inhibit (antagonists) cellular function in the body
WHAT THE DRUG DOES TO THE BODY
pharmacokinetic phase - part 2
the drug is on the move again. the 3rd aspect of phase is metabolism (biotransformation). The drug undergoes enzymatic transformation in the liver. the 4th aspect of the pharmacokinetic phase is excretion. during metabolism, the drug is transformed to a water soluble form so it can be excreted by the kidneys
variables that affect the pharmacodynamic phase
- binging with receptors
- inhibitin the action of enzymes/hormones
- polypharmacy - therapeutic index
- dose response - loading dose
- efficacy
-tolerance
- weight
- age
- gender
- pharmacogenetics
- psycho-social factors
- 1/2 life
- time of day
- onset of actions
- peak action
- duration of action
variables that affect pharmokinetic phase
absorption
metabolism
excretion
distribution
variable that affect the pharmaceutical phase
type of drug preparation

pH of the gastric fluid

incomplete swallowing
type of drug prepartion with oral medication that affects pharmaceutical phase
- some tablets and capsules have properties that allow rapid disintegration and dissolution while others have properties that delay theses processes
* sustain release preparations have coatings that dissolve at variable rates

* enteric coated preparations are designed to resist disintegration in the acid environment of the stomach, but will break down in the alkaline environment of the small intestine

- XL, SR

- breaking/crushing enteric/sustain release will lost function
affect of pH of the gastric fluid on oral medications
(pharmaceutical phase)
most oral drugs are disintegrated and dissolve more readily in fluid with a low pH (acidic) such as that found in the stomach

*anacids intefere with medicationbc it won't be dissolved
incomplete swallowing
(pharmaceutical phase)
tablets and capsules can stick to the tongue, lodge in the buccal space or become stuck in the esophagus. this must be monitored closely with elderly, debilitated and confused clients
bioavailability
(pharmacokinetic phase)
the percent of the drug dose that reaches the sytemic circulation affected by the route of administration, the degree of first pass effect and the degree of second-pass effect
which route of administration has the best availability and the worst?
IV - greates bioavailability delivered right to bloodstream

oral - least bioavailability because drugs have to go thru stomach first
degree of 1st-pass effect

(pharmocokinetic phase)
- decreases bioavailability
* hepatic first pass
- some oral drugs do not absorb directly into the bloodstream but pass from the intestinal lumen to the liver via the portal vein

- the drug is partially inactivated by the liver before reaching the systemic circulation

* some drugs would have no effect if given orally, find another route
degree of second - pass effect

pharmokinetic phase
* increases bioavailability
- occurs when the liver excretes unmetabolized drug into the bile

- the gut will reabsorb the drug from the bile
# of mucosal microvilli in the small intestine

(pharmokinetic phase)
- oral drugs pass thru the mucosal microvilli which absorbs the drug

- decreased microvilli = reduced surface area for absorption
pharmaceutical phase
- drugs administered by gastro-intestinal tract; taken by mouth, naso-gastric, gastric, duodenal, or jejunal tubes
drugs in solid form are disintegrated and dissolved by fluids in the stomach and small intestine. drugs in liquid form (suspension and elixirs) are already disintegrated.
gastric motility

pharmokinetic phase
rapid movement of a drug from the stomach to the small intestine speeds the absorption process while slow movement of a drug from the stomach to the small intestine delays absorption
Food-Drug
Drug-Drug Interactions

Pharmo-kinetic phase
- milk reduces absorption of iron and tetraycline
- OJ enhances absorption of iron
- grapefuit and grapefruit juice slows the metabolism of calcium channel blockers, statins, and certain other drugs

- products containing antacids decrease the absorption of most most drugs
distribution

pharmokinetic phase
- circulation of blood
- degree of plasma protein binding
* the amount of drug that is bound to protein is inactive while the amount of free drug is active

* highly protein bound drugs = slow onset

* low protein beinding drugs = rapid onset

*plasma portein levels: low levels of plasma proteins = less binding sites = more free drug=toxicity

- presence of tumors or abscesses
metabolism/ pharmokinetic phase
- liver disease: most drugs are metabolized by the liver; liver disease can not metabolize drugs as well
- the length of the half-life: the longer the 1/2 life, the longer it takes the liver to metabolize the drug
5 Rights
Right:
-patient
-drug
-dose
- route
- time
*documentation
In order for a script to be valid it must have
Patient's name
time & date when written
name of drug (generic preferred)
dose of drug
route
time interval to be admin
signature
cholinergic antagonists have the effect of....
- increase HR
- bronchodialation
- decreased bronchial secretions
- decreased salivation
- GI motility and gastric acid secretion are decreased
- bladder tone is decreased
- urinary sphincter tone increases
- intra-ocular pressure increases
examples of cholinergic antagonists
- atropine sulfate
- glycopyrrolate
- ipratropium bromide
- dicyclomine HCL
- benztropine mesylate
nursing considerations for parasympatholytics
- dry mouth likely to occur
- dehydration possible
- constipation possible
- urinary retention possible
- intra-ocular pressure can increase
- blurry vision can occur
cholinergic antagonists (anticholinergics/parasympatholytics)
- inhibit the action of acetylcholine by competeing with it for space on the acetylcholine receptors

- opposite effect of cholinergic agonists
nursing considerations for sympathomimetics
1) assess for tachycardia and hypertension
2) use caustiously with coronary artery disease and hypertensive disease
3) assess for peripheral vasoconstriction: don't want to stop circulation
4) IV dopamine, norepinephrine and phenylephrine should be infused thru a central venous line: too much vasoconstriction equals gangrene
5) over use of vasoconstriction nasal sprays can cause a rebound vasodilating of nasal mucosa
direct acting catecholamines are...
endogenous substances norepinephrine, epinephrine, and dopamine. The action of a particular drug depends on which receptor site it stimulates

* can produce a sympathomimetic response
sympathomimetics = mimicing sypathetic system

* acts directly on receptors
sympathetic amines
(non-catecholamines)
(sympathomimetics)
- albuterol
- terbutaline
- phenylephrine HCL
- pseudoephedrine
* stimulate adrenergic receptors
alpha 1 adrenergic blockers
- vasodilate arterioles
- used for hypertension, peripheral vascular disease, and BPH
- relaxes smooth muscles of uretha = improves urine flow
- decrease the force of cardiac contraction = some may experience congestive heart failure

- tacycardia can occur if the BP is decrease too much, too rapidly
beta adrenergic blockers
- slow the heart rate
- decreases BP thru vasodilation and decreases renin from kidneys
- cardiac contraction decreases
- treats tachycardia, hypertension, and coronary heart disease
* b/c of the cardiac contraction certain patients can be predisposed to congestive hear failure
nursing consideration for sympatholytics (blockers)
1) monitor BP, hypotension can occur
2) monitor for tachycardia with alpha 1 blockers; BP drops too quickly
3) assess for signs of decreased cardiac output
4) assess for bradycardia with beta 1 blockers
5) assess for bronchoconstriction with beta adrenergic blockers
cholinergic agonists (parasympathomimetrics/ acetylcholinesterase inhibitors)
- cholinergic drugs stimulate the parasympathetic nervous system

- mimic acetylcholine
2 types of cholinergic receptors
1) muscarinic receptors that affect smooth muscle

2) nicotinic receptors that affect skeletal muscles
when the cholinergic system is stimulated
- HR increase
- BP increases
- bronchoconstriction occurs
- bronchial secretions increase
- salivation increases
- peristalsis increases
- bladder tone increases
- urinary sphincter relaxes
- sweating increases
- intra-ocular pressure decreases
- gastric acid secretions decrease
cholinergic agonist examples are....
direct-acting

or

acetylcholinesterase inhibitors
nursing considerations for parasympathomimetics/ acetylcholinesterase inhibitors
1) abdominal cramping can occur
2) diarrhea can occur
3) assess for bronchoconstriction and increases bronchial secretions; esp. with COPD
4) watch for "cholinergic crisis" which is characterized by extreme muscles weakness and respiratory distress
5) meds for myasthenia gravis should be given exactly on time
prediabetic blood glucose range
100 - 125 mg/dL

> 5.8 HbA1C

* normal HbA1C = 4 - 5.8%
sulfonylureas

aka

secretagogues
- sulfur based-check for allergy
- stimulate beta cells to release endogenous insulin
- 1st oral diabetic drug
- problems: hypoglycemia, weight gain, long term failure, takes several weeks to work
Glyburide/Glipizide
onset: 15-30 mins
Peak 1-2 hours
duration: 24 hours
target blood glucose for DM patients
bf meal: < 110 mg/dL

after meal < 140 mg/dL

HbA1C less than/or equal to 7%; prefer 6.5%

(HbA1C x 33.3) -86 = blood glucose average
blood glucose of untreated DM
less than or equal to 126 mg/dL, 8 hours after a meal

less than or equal to 200 mg/dL at anytime
anti-seizure agents do what?
- raise the seizure threshold by inhibiting excitatory activity in the motor cortex of the brain
- drugs exert a therapeutic effect thru 1 of 3 ways

1) suppression of sodium influx
2) supression of calcium influx
3) potentiation of GABA in the brain
nursing considerations for anti-convulsant/anti-seizures
1) monitor seizure activity
2) watch for drowsiness when giving sedating agents
3) monitor therapeutic blood levels for those agents with a narrow therapeutic index, like hydantoins
4) monitor liver enzymes for those agents that are hepatotoxic, like hydantoins and valproic acids
5) special dental care may be indicated; hydantoing = gingival hyperplasia
6) assess for depressed deep tendon reflexes drowsiness, muscle weakness and depressed respirations when giving magnesium sulfate. Frequent blood tests for mag. sul. should be done
7) preg. cat. c or d; folic acide supplement needed
what causes depression and what is the aim of pharmacotherapy
depression is caused by the depletion of the neurotransmitters serotonin, dopamine, and norepinephrine due to excessive reuptake or by excessive breakdown by monoamine oxidase (MAO).
pharmacotheraphy aims to increase the transmission of one or more of these neurotransmitters. how this is accomplished differs among the various classifications. Usually takes about 4 weeks to work and people generally have to try a variety of drugs.
classifications of antidepressants
- tricyclic anti-depressants (TCAs)

- monoamine oxidase inhibitors (MAOIs)

- selective serotonin reuptake inhibitors (SSRI)
tricyclic anti-depressants (TCAs)
- reduces the reuptake of serotonin 5HT and norepinephrine by the pre-synaptic region
- should be taken at bedtime or small doses during day with largest dose at bedtime
Problems:
sedation
lowered seizure threshold
orthostatic hypotension
anti-cholinergic effects
increased appetite
inorgasmia
don't eat grapefruit
monoamine oxidase inhibitors (MAOIs)
- the enzyme monoamine oxidase breaks down the serotonin, norepinephrine, and dopamine; by inhibiting MAO there is less destruction of these neurotransmitters
- very effective but have many drug-drug and food-drug (tyramine rich food) interactions that can raise BP to dangerous levels

tyramine rich food = cheese, beer, wine, bananas, chocolate
problems:
sedation
lowered seizure threshold
heart block with lrg doses
orthostatic hypotension
hyperpyrexia
inorgasma
increased appetite
anti-cholinergic effects
Selective Serotonin Reuptake Inhibitors (SSRIs)
- increase the level of serotonin in the brain by decreasing pre-synaptic neural reuptake
-fewer side effect because of selective nature
problems
-weight loss
-loss of appetite
-decreased sexual function
- fluoxetine (prozac) can cause aggression and suicidal ideation
nursing considerations for anti-depressants
1) inform client that it may take 4-6 weeks to see the effects of the anti-depressants
2) therapy with anti-depressants should be at least 6 months to 1 year to prevent an exacerbation of depression
3) watch for signs of suicidal ideation. clients may have wanted to commit suicide before, but didn't have the energy
4) for client's taking TCAss, the intake of grapefruit should be limited to prevent toxicity
pain management; analgesics
- narcotic analegesics (opiods) bind with opiate receptors in the CNS altering perception of and emotional response to pain. Activation of cells in the brain containing serotonin also occurs with some opiods

- can also be used to suppress cough, slow respiratory rate, decreases peristalsis

- pre-medication before surgery

- opiod antagonists/agonists
pain as a vital sign
assess location, intensity, quality, pattern, precipitating factors, alleviating factors, association of symptoms, coping mechanisms, acute/chronic
- meds more effective b/f severe pain
- chronic pain better managed thru scheduled doses rather than PRN
- addiction unlikely in presence of pain
- better controlled with PCA IV pump
- opiod script should come with a laxative script; increase water, increase fiber
nursing considerations for analgesics
1) check for harmful allergies
2) take b/f pain is severe
3) do not give in head trauma
4) do not give in shock (decrease BP)
5) do not give in severe resp. depression
6) use with caution with addicts
7) use caustiously with urinary retention
8) use cautiously with asthma
9) watch for constipation
dopaminergic drugs for parkinson's
- if dopamine is absent then acetylcholine excessively stimulates the corpus striatum resulting in tremors, muscle rigidity, postural instability, and bradykinesia
- dopaminergic drugs are used to increase dopamine levels in the substantia nigra
Nursing considerations:
- administer on time or symptoms worsen
- abrupt discontinuation can lead to crisis
- foods high in B6 can decrease effects
- change positions slowly to avoid faintness or dizziness
anticholinergic drugs for Parkinson's
used to inhibit the stimulatory action of acetylcholine
nursing considerations:
monitor for anti-cholinergic effects such as blurred vision, dry mouth, urinary retention, constipation, and tachycardia
drugs for Alzheimer's
TREAT NOT CURE

- degenerative process in cerebral cortex
- drugs used:
- donepezil: increase levels of acetylcholine
- memantine HCL: decreases binding of glutamate with receptor sites
nursing considerations:
1) taking of drugs should be supervised due to memory impairment of client
2) works best in early to middle stages
drugs for myasthenia gravis
- auto-immune neuromuscular disease that causes extreme muscle weakness caused by lack of acetylcholine

- acetylcholinesterase inhibitors help to relieve symptoms

- drugs used
- ambenonium: long acting
- pyridostigmine: immediate acting
nursing considerations
administer exactly on time, too early and cholinergic crisis may result; too late extreme muscle weakness may occur
regular insulin
(humulin R, novolin R)
appearance: clear
route: subQ, IV
onset: 30 min - 1 hour
peak: 2-4 hours
duration: 6-8 hours
action: short
administer: 30 mins bf mealtime
Lispro Insulin
(Humalog)
appearance: clear
route: subQ
onset: 5-15 mins
peak: 30-90 mins
duration: 2-4 hours
action: rapid
administer 5 minutes before mealtime
Lente
(humulin L, novilin L)
appearance: cloudy
route: subQ
onset: 2-4 hours
peak: 8-12 hours
duration: 18-24 hours
Action: intermediate
* zinc is added

may be given alone or in combination (clear bf cloudy)
NPH Insulin
(neutral protamine hagedorn)
(Humulin N, Novolin N)
appearance: cloudy
route: subQ
onset: 1-2 hours
peak: 6-12 hours
duration: 18-24 hours
action: intermediate
Insulin Detemir
(Levemir)
appearance: cloudy
route: subQ
onset: 1 hour
peak: none --> steady all day
duration: 24 hours - long acting

*should be given with evening meal or at bedtime
* cannot be mixed with any other insulin in the same syringe
insulin glargine (Lantus)
appearance: cloudy
route: subQ
onset: 1 hour
peak: none --> less likely to cause hypoglycemic reactions
duration: 24 hours - long acting

* given at bedtime
* cannot be mixed with any other insulin in the same syringe
s/s of ketoacidosis (hyperglycemic)
extreme thirst
polyuria
fruity breath odor
kussmaul breathing -> dyspnea, labored, distressed
rapid, thready pulse
poor skin tugor
dry mucous membranes
blood sugar level 250 mg/dL
s/s of hypoglycemia
nervousness
tremors
confusion
sweating
increased pulse rate
lack of coordination
cold and clammy skin
headache
combative and incoherent
blood sugar level <60 mg/dL
normal blood glucose
70 - 100 mg/dL
(fasting)

(4-5.8 % HbA1C)
glycopeptides
- vancomycin -> used for MRSA, staph
- very dangerous; WILL KILL KIDNEYS
- narrow therapeutic index; peak and trough will be drawn bf 3rd dose
- monitor for ototoxicity
- monitor for nephrotoxicity
- monitor for blood dyscrasias, decrease WBC
- preg. cat. C
- red man syndrome: erythema of face, neck, and chest with fever and chills and decreased blood pressure; usually caused by infusing too quickly in IVPB
agents used to treat hyperthyroidism
iodide, iodines, & thiomides

- all these can cause HYPOthyroidism
- using lithium at the same time can increase chance of developing HYPO
- thiomides: decrease WBC - low grade fever, sore throat; increase the effects of coumadin, digoxin, theophyllon
iodides and iodines
- take thru straw --> discolors teeth
- should be diluted and taken after meals
- don't use with ACE inhibitors or potassium sparing diuretics or it can result in hyperkalemia
drugs used to treat hypothyroidism
- daily life-long replacement therapy
- take bf breakfast, absorption is better on an empty stomach; taking it later in the day could cause insomnia
- can induce HYPERthyroidism; tachycardia, nervousness
- don't give with any other meds, vitamins, or herbs
- synthroid has a more therapeutic effect than generic levothyroxine
cepahlosporins
- closely related to PCN
- check for allergy if allergic to PCN
- increased bleeding time

4 generations
broad ---> broadest
* adverse reactions can occur if alcohol is ingested while being treated --> disulfiram reaction

* nephrotoxicity can occur in geriatric clients or clients with pre-existing renal disease

* if BUN and creatinine levels are elevated question the prescription --> may be the only 1 that will save the patient; better to lose the kidneys then die
Penicillin
- allergic reactions range from rash to shock
- GI problems such as anusea, vomiting, diarrhea, & stomatitis occur
- superimposed fungal infections are common
- effectiveness of oral contraceptives might be reduced
- urine might show false positive for glucose
- preg. cat. B --> safe for mom and babe
- irritating to the veins when given IV --> dilute in IVPB, push 5-10 mins
- use large muscle masses when injecting IM
- high doses can increase the time it takes for blood to clot, leading to bleeding disorders
- short 1/2 life
- benedryl, epinephrine, glucocorticoid may be given in allergic reactions
drug interactions with insulin/glucose
tricyclic antidepressants
MAOIs
Aspirin products
oral anti coagulants

all decrease insulin needs
thiazide diuretics
glucocorticoids
thyroid agents
estrogen

increase blood glucose
tetracyclines
* often prescribed wheen PCN allergy is present

- preg. cat. D - will not kill or deform fetus, but teeth and bone formation is affected

- do not take with products containing AL, Fe, or Ca, these will prevent absorption
- take on empty stomach with water
- children < 8 years of age will affect teeth
- photosensitivity
- nephrotoxic
- hepatotoxic

* decrease effectiveness of oral contraceptives
- can damage vestibular part of ear -> bad equilibrium
- decompose when exposed to heat and light
* out of date drug b/c TOXIC
sulfonamides
- topical sulfonamides for burns
- opthalmic sulfonamides for eye infections
- GI disturbances common

* give at least 2000 mL of H2O daily or it can result in crystalluria which can rip nephrons

- hematuria
- blood dyscrasias
- rashy itching, and exfoliative dermatitis
- photosensitivity
- headache and dizziness a possibility
- preg. cat. C
* might increase effects of oral anti-coagulants, oral anti-diabetic agents, and anti-seizure agents
*renal failure patients & CHF patients should not use
adrenal insufficiency
Addison's disease
- hyposecretion of glucocorticoids and the mineralcorticoids
- weakness, HYPERKALEMIA, hypoglycemia, hypotension, hyponatremia

*adrenal gland atrophy or sudden withdrawal of exogenous glucocorticoids
- hydrocortisone, fludrocortisone

- if addison's; daily replacement therapy is life long
- if caused by withdrawal of exogenous glucocorticoids, then restart and taper off

- take in the morning b/t 6 - 9 to mimic diurnal rhythm
benzodiazepines
(anti-convulsant use)
- work by potentiating GABA and inhibiting impulses subcortically in the limbic system, thalamus, and hypothalamus
examples
diazepam (valium)
clonazepam (klonopin)
lorazepam (ativan)
valproic acids
- suppress sodium and calcium influx by potentiating GABA
- used for generalized, partial, and absent
- also bipolar and migraine headaches
- liver enzymes must be drawn b/c these drugs can be heptatotoxic
-use with caution with children and elderly
examples
divalproex sodium
succinnides
- used for absence seizures
- work by reducing the synaptic nerve response to low-frequency repetitive stimulation
examples
ethosuximide
methsuximide
anti-manic agents
* lithium carbonate
- used for bipolar disorder
- decreases maniac episodes by blocking the release of dopamine and norepinephrine
- has a very narrow therapeutic index
- a fluid intake of 2500-3000 mL per day and an adequate sodium intake are very important to promote elimination of this drug
- PREG. CAT. D
* anti-convulsants divaloproex sodium or carbamazepine are usually tried before lithium
drugs used for anxiety and sleep disorders
2 categories
-anxiolytics
-somnifacients
- used to relieve anxiety, to produce sedation, induce sleep
- NOT PAIN RELIEVER, but can be used as adjuncts to pain relievers
* should not be used long-term, no more than 3 weeks
* suppresses awake part of brain
* very addictive
categories for anxiety and sleep disorders
- benzodiazepines
- non-benzodiazepine anxiolytic
- non-benzodiazepine somnifacients
- hormones
benzodiazepines
- produces CNS depression by potentiating GABA and inhibiting impulses subcortically in the limbic system, thalamus, and hypothalamus

* all benzos cause respiratory depression
* do not stop abruptly, will cause physical and psychological effects
Nursing Considerations
- controlled substance schedule IV
- if coma or respiratory depression occurs the antidote FLUMAZENIL may be given IV and works in 1-2 minutes. Might cause w/drawal for those who are dependent
non-benzodiazepine anxiolytic
buspirone (BuSpar): binds to serotonin and dopamine receptors in the CNS resulting in decreased transmission of these neurotransmitters
Nursing Considerations:
- monitor for extrapyramidal side effects, like Parkinsons, NON-REVERSIBLE
Non-Benzodiazepine Somnifacients
- potentiate GABA
- less residual effect and causes less physiological and psychological dependence then benzos.
-schedule IV
- work quickly

Examples
sonata
ambien
lunesta
hormones
melatonin helps control the sleep-wake cycle. synthesized from serotonin and secreted by the pineal gland. secretion is stimulated by darkness and suppressed by light.

Examples
melatonin
rozerem
Nursing Considerations for Hormones and Non-benzodiazepine anxiolytic
1) drugs act rapidly; take right b/f bed
2) food in stomach decreases bioavailability
3) short term amnesia can occur with zolpidem
4) alcohol intake can increase the action of these drugs
Drugs for Psychosis and Agitation
- decrease dopamine, decrease serotonin; the anti-dopamineergic activity is responsible for the therapeutic effect
- ** Haldol: chemical restraint in nursing homes
Nursing Considerations
1) monitor for a decrease in alertness
2) monitor for anti-cholinergic effects
3) blood glucose may increase
4) monitor for abnormal movements
5) drugs such as benztropine and trihexphen might be given to lessen effects or abnormal movements, but increase anticholinergic effects
opioid agonists/antagonists
- lower addiction potential
- less likely to cause respiratory depression
- can cause withdrawal symptoms if given to a dependent client
- antagonists used for opioid overdoses b/c they compete with opiates for binding sites
CNS stimulants
- used to treat ADHD, narcolepsy, hypersomnia, and obesity by stimulating the corticals area of brain and the reticular activating system
-stimulates CNS, but have calming affect on children
Nursing Considerations
- monitor for nervousness and insomnia
- monitor for nausea, anorexia, weight loss
- monitor for increase in BP
- controlled substances, dependence
Centrally Acting Skeletal Muscle Relaxants
- used for muscle spasticity, which can be caused by direct injury to the muscle or by damage to the area of the CNS that controls muscle activity
- the relaxants interfere with the reflexes that cause spasticity
Nursing Considerations
- monitor for muscle weakness, drowsiness
- monitor for psychological and physical dependence
3) discontinue baclofen in tapering doses over a 1-2 week period to avoid psychosis and hallucinations
types of seizures
all seizures are caused by abnormal electric activity in the brain

- generalized seizures: begin in 1 part of the brain and the spread

- partial seizures: often referred as focal seizures; only involve 1 part of the brain; exhibited thru a single muscle mvmnt , repetitive behavior (lipsmacking) or sensory alterations like hallucinations
tonic-clonic seizure
generalized; intense, loss of consciousness, self-limiting, only last a few minutes
status epilepticus seizure
generalized; protracted period of time time and recur frequently and can result in hypoxia
absence seizures
period of unconsciousness lasting 3-5 secs; no tonic clonic movements
classification of anti-seizure agents
hydantoins
iminostilbenes
barbituates
benzodiazepines
valproic acids
succinides
hydantoins
decrease excitability in the motor cortex of the brain by suppressing sodium influx thru the sodium channels, decreasing neural action potential
- narrow therapeutic index
- can be heptatoxic
- used for both generalized and partial seizures
- cause less drowsiness that other anti-convulsants
- neeed to monitor teeth every 6 months

Examples
phenyTOIN
fosphenyTOIN
iminostilbenes
- suppress sodium influx thru sodium channels
- used for generalized and partial seizures
- can also be used for bipolar disorder

Examples
carbamazepine
oxcarbazepine
barbituates
- work by potentiating GABA and decreasing the conduction of impulses in the ascending reticular formation of the brain
- used for generalized and partial seizures
- sedating and can be used w/ other anti-convulsants

example
phenobarbital
anti-fungal drugs
-polyenes: toxic, can cause nephrotoxicity

- azoles: can kill liver

- anti-metabolites: absorbed for GI tract
anti-protozoal agents
- GI disturbances
- often causes metallic taste in mouth
- can cause urine to turn a reddish, brown color
- can cause candidiasis superimposed infections

*no alcohol products after treatment for 48 hours

* Preg. Cat. B
lipopeptides
- treat MRSA, complicated skin/structure
- may cause GU disturbances including pseudomembranous colitis
- may cause dizziness
- Preg. Cat. B

* may use if patient is septic
agents used for hypo and hyper parathyroidism
monitor serum calcium levels and bone pain

signs of hypocalcemia include muscle twitching and burning/tingling

monitor renal function --> renal caculi can occur with hypercalcemia

hypo --> calcitriol (vit. D 3)
hyper--> calcitonin (salmon)
oxytocin
brand name: Pitocin
used to induce or enhance uterine contractions or to facilitate milk let-down

if for labor the goal is contractions every 2-3 mins and last 40-60 seconds

---> can cause hypertonicity of the uterus which can deprive the fetus of oxygen or rupture the uterus

- anti-diuretic effect
anti-diuretic hormone

(desmopressin and vasopressin)
used to decrease excessive urine output in diabetes

type 1 diabetes is caused by a ADH defiency

monitor I & O
goal is decrease urine output and greater concentration of urine

* pituitary gland disorder
octreotide acetate & bromocriptine
inhibits secretion of growth hormone ---> pituitary gland disorder
somatropin
growth hormone used for children who have growth failure --> pituitary gland disorder
- must given bf the closure of epiphyseal plate which occurs in adolesence
- long term use may elevate blood sugar and diminish the secretion of thyroid hormone
- should not be used for body building because it can cause hyerglycemia
anti-viral agents
prevent or delay the spread of a viral infection

if taking a flu vaccine check for egg allergy
oxazolidinones
- used for overwhelming infections

* avoid lrg quantities of tyramine- rich foods such as cheese; can lead to hypertensive crisis

- can cause blood dyscrasias

* GI disturbances, including pseudomonas colitis
- Preg. Cat. C
stretogramins
- used for vancomycin resistant enteroccocus
- watch for signs of inflammation at infusion site --> dilute w/ 250 - 750 mL
- can cause myalgia and arthralgia
- can cause GI disturbances
- preg. cat. B
fluoroquinolones
considered controlled substance
*effective against anthrax
- should be given on empty stomach
- administer IV over a 1 hr period
-photosensitivity
- GI disturbances
- nephrotoxcity possible
- encourage fluid intake
*preg. cat. C ---> x at term

- be alert to behavioral changes like insomnia, nervousness

- be alert to neurological changes --> dizziness, seizures, hallucinations
macrolides
* PCN substitute when PCN allergy is present
- excreted in bile and feces more than in urine, so they can be used in renal insufficiency
* contradicted in liver disease
- GI disturbances likely
- food decreases absorption, not given with food; take 1-2 hours AC or 2-3 hours PC
- phlebitis likely with these drugs, always mix in IVPB of at least 100 mL ---> need a lot of fluid
- preg. cat. B
*heptatoxic in high doses
--> look for pain, weakness, and fatigue

example
Z-pack
erythromycin
anti-tubercular agents
- used a combo of 2 or 3
- therapy lasts 9-24 months
- isoniazid given prophylactically - 6 months
- categorized as 1st or 2nd line agents
- pyridoxine (B6) supplements should be given to prevent peripheral neuropathy when giving INH
- heptatoxicity can occur
- urine becomes orange, stool red, rusty color
-ototoxicity
- discontinuing drugs can reactivate the disease
- continually check for the presence of the baccilus
lincosamides
* function like macrolides, but more toxic
* used as a PCN substitute when allergy is present
- rash may occur
- preg. cat B --> safe for mom and babe
- GI disturbances: nausea, vomiting, diarrhea, and esophagitis
- *pseudomembranous colitis: 20-20 stools a day, dehydration, dysrrthymias
- blood dyscrasias--> RBC harmed
- lincomycin
ketolides
- treat respiratory infections
- hepatotoxic
- GI disturbances
- visual disturbances
- suprainfections --> yeast infections
* can lead to an exacerbation of myasthenia gravis
calculating the hourly infusion rate
divide the blood glucose by 100 and round to the nearest 0.5 unit

blood sugar = 340

340/100 = 3.4 or 3.5
alpha glucosidase inhibitors
- slow glucose absorption
- take with 1st bites of meal
- used alone does NOT equal hypoglycemia but will if used wtih sulfonylureas or meglitinides

*severe gas
* acarbose ---> gas/bloating
* miglitol --> better tolerated
incretin mimetic
- improve insulin secretion
- suppress glucagon secretion
- slow gastric emptying --> reduces food intake which causes weight loss
biguanides (metformin)
- decrease hepatic glucose output
- decrease intestinal glucose absorption
- increase peripheral glucose utilization

- give 2 or 3 times a day with meals
- hypoglycemia not a problem alone, but when combined with sulfonylureas or miglitinides

* does not stimulate insulin release