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129 Cards in this Set
- Front
- Back
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agonist
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stimulates a response
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antagonist
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inhibits a response
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glycogenolysis
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breaking down of sugar causing low blood sugar; effect of BETA2 RECEPTOR
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necrosis
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skin dies and turns black; usually caused by infiltration at IV site from dopamine/intropin - ALPHA ADRENERGIC DRUGS dopaminergic
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extravasation
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leakage of medication to surrounding tissue; can cause necrosis if high doses of dopamine/intropin
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titration
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increasing or decreasing concentration of dose based on bp; dopamina and dobutamine ADRENERGICS; notify MD if tachycardia or dysrhythmias
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adrenergic receptor effects ALPHA1
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vasoconstriction, increase bp, mydriasis (pupil dilation), bladder contraction
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adrenergic receptor effects ALPHA2
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decrease: GI motility and tone, vasoconstriction, bp
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adrenergic receptor effects BETA1
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increase: heart rate, bp, myocardial contracility, renin secretion
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drugs that stimulate the sympathetic nervous system (SNS)
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Adrenergics, Adrenergic agonists, Sympathomimetics
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adrenergic receptor effects BETA2
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LUNGS: bronchodilation, relax smooth muscles. ARTERIOLES OF SKELETAL MUSCLES: increase blood flow. UTERINE MUSCLE: decrease uterine contraction, gi tone and motility.
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dopaminergic receptor effects -ONLY ACTIVATED BY DOPAMINE
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RENAL vessels dilate, blood flow increase
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intropin/ dopamine
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CLASS sympathomimetic agent; receptor = low dose dopamine, ACTION: renal blood vessel dilation, USED FOR shock, heart failure
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albuterol sulfate/ Proventil
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CLASS beta2 adrenergic agonist, ACTION relaxes bronchial smooth muscle, USE asthmatics, bronchospasm, copd, SE/CON tremors, dizziness, severe cardiac disease, DM (glycogenolysis), htn.*cardiac dysrhythmias -- sustained release 3-4x a day
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Isuprel
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CLASS adrenergic agent - BETA1: increase heart rate and BETA 2: bronchodilation. excessive use-severe tachycardia
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Catapres/ clonodine
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CLASS adrenergic alpha2 receptor stimulants USE htn ACTION regulate release of norepinephrine by inhibiting its release, decrease bp. monitor vs
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Aldomet/ methyldopa
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CLASS adrenergic alpha2 receptor stimulants USE htn ACTION regulate release of norepinephrine by inhibiting its release, decrease bp. monitor vs
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atenolol/ Tenormin
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CLASS beta1 adrenergic blocker ACTION blocks beta 1, decrease hr/bp USE htn, angina pectoris, mi. *agranulocytosis, cardiac dysrhythmias
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Lopressor/ metropolol
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CLASS beta1 blocker, ACTION slow hr, decrease bp USE htn, post mi, angina. *SE bradycardia, orthostatic hypotension.
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Coreg/ carvedil
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CLASS alpha1 beta1 beta 2 blocker USE htn, mild to mod heart failure. use alone or with thiazie diuretic
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labetalol/ Normodyne Trandate)
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CLASS alpha1 beta1 beta2 blocker USE mild to severe htn, angina pectoris. during surgery
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Inderal
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CLASS beta1 beta2 blocker USE angina, htn, dysrhythmias ACTION decrease hr/bp, bronchoconstriction
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adrenergic blockers/ antagonists at receptor sites
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alpa1- decrease bp
beta1- decrease hr/p/force of contraction beta2- constricts bronchioles |
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adrenergic blockers
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block effects of norepinephrine,
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alpha adrenergic blockers/ sympatholytics
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inhibit response at alpha adrenergic receptor sides (alpha blockers)
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selective alpha blockers
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block alpha1
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nonselective alpha blockers
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block alpha1 and alpha2
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alpha blockers
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treat bp, S&S of BPH- benign prostatic hypertrophy, peripheral vascular disease- Raynaud's Disease (cold, white blue hands) SE o htn, reflex tachycardia
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beta blockers
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block beta1- decrease hr, bp
block beta2- bronchoconstriction |
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selective beta blockers
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block beta1 - decrease p/bp
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nonselective beta blockers
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block beta1 and beta2
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Epinephrine
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CLASS sympatomimetic- beta2, alpha1, beta1 ACTION increase bp, hr- cardiac stimulation, bronchodilation, pupil dilation USE anaphylaxis, asthma SE vasoconstriction from alpha1- htn crisis, continuous heart mon, vs to MD, anorexia, dysrhythmias **not orally, metabolized in liver and GI tract
less effect with methyldopa, beta blockers, alpha adrenergic blockers |
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adrenergic drugs nsg process
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ASSESS vs
drug interactions (beta blockers lessen effect of epi) assess health history NSG DX decreased cardiac output, risk for impaired tissue integrity PLAN closely monitor vs INTER report high bp, p; inused for shock through IV check bp q3-5 min for severe htn, check ur output and blad distention from high dose, monitor for infiltration (antidote- Regitine), offer food for n/v |
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adrenergic drugs pt teaching
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nasal spray cold meds- head upright to avoid systemic absorption
continued use can cause nasal congestion rebound not for nursing moms (breast milk), DM, CAD, dysrhythmias avoid excessive bronchodilator spray use- tachycardia (beta1,2) |
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beta blockers pt teaching
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do not stop taking abruptly!- rebound htn, tachycardia
monitor hr, bp slowly rise from supine or sitting to standing- avoid orthostatic, postural hypotension mood changes, low libido, impotence |
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sympathetic nervous system
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adrenergic system, norepinephrine RESPONSE increase hr, constrict blood vessels, relax bladder/uterine, dilate pupils/bronchioles FIGHT OR FLIGHT
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parasympathetic nervous system
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cholinergic systern, acetylcholine RESPONSE constricts pupils/bronchioles, increase lung secretions/peristalsis/hr, dilates blood vessels, constrict bladder, increase salivation
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cholinergic effects on organs
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decrease bp, p
constrict bronchioles, pupils (miosis) increase ur bladder contractions, peristalsis, secretions, salivation |
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cholinergics/ parasympathomimetics
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cholinergic stimulants
cholinergic agonists cholinomimetics |
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anticholinergics/parasympatholytics, cholinergic antagonists
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drugs that block the effect of acetylcholine
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direct acting cholinergic
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act on receptors to activate tissue response
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indirect acting cholinergic
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inhibit action of cholinesterase, allow Ach to attach so more is available. USE increase muscle tone in MG, glaucoma, increase memory in Alzheimer's
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Reglan
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CLASS direct acting cholinergic USE gerd- gastric esophogeal reflux disease ACTION increase gastic emptying time
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Pilocarpine
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CLASS direct acting cholinergic drug USE treat glaucoma by relieving iop in eye ACTION nicotinic receptor
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Urecholine
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CLASS cholinergic/ parasympathomimetic USE increase urination in ur retention and abd distention ACTION muscarinic receptor, contract bladder, increase urination/ GI peristalsis/ GI secretion, pupillary constriction, bronchoconstriction SE n/v diarrhea, severe bradycardia & o htn- decrease bp/p ANTIDOTE atropine sulfate not IM or IV
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Urecholine nsg process
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assess baseline vs
ur output health history problems of peptic ulcer, ur obstruction, or asthma- cholinergics can aggravate these s&s NSG DX ur retention, anxiety PLAN increase bladder & GI tone after, increase neuromuscular strength |
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Urecholine nsg interventions
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VS - for ortho hypotentsion
I/O report - ur obstruction 1 hr before /2 hr after meals assess for bowel sounds, rales, rhonchi, diaphoresis ANTIDOTE atropine sulfate IV for cholinergic overdose* |
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Urecholine pt teaching
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take med as prescribed *on time
report SE- low p, bp, dizziness teach to rise slowly maintin po hygiene report difficulty breathing, changes in muscle strength |
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Cholinergic Crisis/ cholinergic overdose
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S&S- miosis, pallor, muscular weakness, *invol. muscle twitching (fasiculations); complication of MG, respiratory arrest, respi paralysis, increase salivation
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neostigmine/ Prostigmine
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short acting - reversible cholinesterase inhibitors USE pupillary constriction in glaucoma, increase muscle strength in MG
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Mestinon
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moderate acting - reversible cholinesterase inhibitors USE pupillary constriction in glaucoma, increase muscle strength in MG
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Tensilon- AChE inhibitor
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short acting for diagnostic purposes - reversible cholinesterase inhibitors USE pupillary constriction in glaucoma, increase muscle strength in MG (can distinguish bet MG and cholinergic crisis- makes muscles weaker in cholinergic crisis
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Anticholinergic/ Parasympatholytics
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cholinergic blocking agents/ antagonists.
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anticholinergics effects on organs
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increase bp,p
dilates bronchioles, pupils (mydriasis) decrease bronchial secretions, salivation, perpiration, peristalsis relaxes GI muscle, ur bladder contractions constriction or internal sphincter- ur retention |
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atropine sulfate
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CLASS anticholinergic USE pre-op (aspiration/salivation), antispasmodic to treat peptic ulcers, relaxes smooth muscles of GI tract, decrease peristalsis, increase hr in bradycardia SE dry mouth, constipation
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atropine sulfate nsg process
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ASSESS vs
ur output for ur retention me/drug hx DX ur retention constipation impaired mucous membrane PLAN less secretions before surgery |
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atropine sulfate nsg interventions
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i/o report
assess bowel sounds encourage fiber/fluids for constipation oral care |
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atropine sulfate pt teaching
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avoid hot environments
not for glaucoma pt, iop increases |
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scopolamine
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CLASS antihistamine-anticholinergic USE treating motion sickness, (hospice) placed behind ear to control drooling SE dry mouth, nausea, constipation CONTR glaucoma (increases IOP)
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anticholinergic pt teaching
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avoid hot environment and excess physical exertion
glaucoma pts should avoid check hr diet- fiber and fluids |
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ADHD/ attention deficit hypersensitivity disorder
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CAUSE disregulation of transmitters (serotonin, norep, dopamine)
S&S hyperactivity, short attention span MED ritalin CLASS amphetamine-like |
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ritalin/ methylphenidate
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amphetamine-like drug, CNS stimulant, ADHD- help focus/cognitive performance and decrease hypersensitivity, restlessness SE nervousness
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migraines and cluster
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CAUSE inflammation and dilation of the blood vessels in the cranium
S&S unilateral throbbing head pain accompanied by nausea, vomiting and photophobia MEDS (depends on pain) imitrex SE dizzy, fainting |
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imitrex/ sumatriptan
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selective serotonin receptor agonist, CNS stimulant, for acute migraine
ACTION vasoconstriction of cranial carotid arteries |
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narcolepsy
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S&S falling asleep during normal walking hours such as driving a car or talking to someone
MEDS provigil/modafinil |
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modafinil/ provigil
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amphetamine-like, CNS stimulant
ACTION increases amount of time awake (narcolepsy) |
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obesity
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MEDS- anorexiants (suppresses appetite-
didrex, dexedrine SE nervousness, insomnia, no self med TEACH emphasize diet, exercise |
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respiratory depression
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CAUSE drug overdose, anesthesia
MEDS respiratory CNS stmulants, analeptics (cns stimulants) |
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analeptics - xanthines, doxapram
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CNS stimulant to stimulate breathing muscles
SE nervousness, restlessness USE newborns, anesthesia, drug overdose |
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REM rebound
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results in vivid dreams, nightmares, abruptly stopping a drug
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acute insomnia
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cns depressants- sedative hypnotics - nonbenzodiazephines (short term). ACTION enhance the action of GABA in the CNS, (rapid onset) prolong sleep and decrease awakenings.
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insomnia
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cns depressants- sedative hypnotics- benzodiazephines- anxiolytics. ACTION induce and sustain sleep MED restoril/ temazepam SE no longer than 3-4 weeks, can cause tolerance/ rem rebound.
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seizures/ status epilepticus (persistent seizures)
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cns depressants- sedative hypnotics- benzodiazephines. MEDS ativan/ lorazepam
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CNS depressants
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sedative-hypnotics, anesthetics- balanced anesthesia
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sedative hypnotics (3)
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barbituates
benzodiazepines nonbenzodiazepines |
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sedative hypnotics
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enhance the action of GABA (sleep disorders). SE dependence, tolerance, excessive depression, resp depression, hypersensitivity, teratogenic
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short acting hypnotics
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useful in achieving sleep and allow pt to awaken without lingering SE
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intermediate acting hypnotics
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useful for sustaining sleep, pt may experience residual drowsiness or hangover
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barbituates
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cns depressants. CLASS schedule II drug USE long, intermediate, short, ultra shorting acting SE tolerance (only used as ultra short term) MEDS seconal, pentothal, propofol (diprivan). PT TEACH right before bed
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non-pharm sleep methods
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before sedatice-hypnotics or OTC sleep aids.
arise specific hour in AM decrease loud noises few or no naps no caffeine 6 hrs before bed avoid heavy meals avoid exercise before bed warm bath, warm milk read/listen to music |
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seconal
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cns depressant- barbituate- schedule II drug
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pentothal
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cns depressant- barbituate- schedule II drug
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propofol
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cns depressant- barbituate- schedule II drug
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benzodiazepines
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minor tranquilizers or anxiolytics
rapid onset of action intermediate to long acting effects not used more than 3-4 weeks to prevent rem rebound not with alcohol/ narcotics, may cause additive depressive cns response ex. librium, valium (diazepam), xanax (alprazolam), versed (midazolam) |
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anxiolytics
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benzodiazepines that reduce excessive anxiety when it becomes disabling, long term use can cause tolerance
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romazicon/ flumazenil
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CLASS benzodiazepine antagonist USE benzodiazepine overdose
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restoril/ temarzepam
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benzodiazepam. USE to treat insomnia SAFETY pt must be instructed to call for help before getting oob after administration (disoriented)
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ativan/ lorazepam
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benzodiazepine. USE treat seizures/ persistent seizure
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amphetamine/ amphetamine-like
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stimulate release of norepinephrine and dopamine CAUSE euphoria and alertness SE restlessness, insomnia, cardiac arrythmmias if continued use USE narcolepsy, adhd, obesity PT TEACH monitor height, weight, growth of children, nervousness, avoid driving, MED/FOOD maois, caffeine, dilantin, coumadin, otc cold meds
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nonbenzodiazepines
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cns depressant- sedative hypnotic
MED ambien |
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ambien
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nonbenzodiazepine.
USE short term treatment of insomnia to prolong sleep and decrease awakenings SE daytime sleepiness, lightheadedness, hangover, irritability AR tolerance, dependence ACTION enhance action of GABA in CNS PT TEACH take befoore bed, at least 8 hrs of sleep |
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anesthetics
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balanced anesthesia
inhalation anesthesia neuromuscular blocking agents intravenous anesthetics topical anesthetics spinal anesthesia |
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anesthetics
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classified as general or local
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balanced anesthesia
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combination of drugs
minimizes cv problems decrease general anesthesia reduce post op n/v minimize disruption of organ function increase recovery from anesthesia |
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aldrete scores
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immediate post op period following general/ balanced anesthesia:
airway vs pupillary reflexes mobility sensation need high score to be released after surgery |
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succinylcholine cl/ anectine
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neuromuscular blocking agent
ACTION block acetylcholine at the neuromuscular junction resulting in muscle relaxation and hypotension, do not cross the blood brain barrier to complete paralysis can be achieved without LOC or decreased pain sensation USE for endotracheal anesthesia SE resp arrest from paralysis, hypotension, malignant hyperthermia |
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malignant hyperthermia/ hyperpyrexi
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a rare life-threatening condition that is usually triggered by exposure to certain drugs used for general anesthesia (succ/ anectine)
S&S muscular rigidity, tachycardia, increased respirations, rapid temp (109) |
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dantrium/ dantrolene
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used to treat malignant hyperthermia
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IV anesthetics
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propofol (diprivan)- have rapid onsets and short durations of action, can support microbial growth discard vial after open 6hrs
conscious sedation- versed/ fantanyl |
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conscious sedation
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altered state of consciousness that minimizes pain and discomfort through the use of pain relievers and sedatives
pt can speak/ respond during procedure brief period of amnesia can erase memory of procedure USE wisdom teeth, colonoscopy, orthoscopic surgery |
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spinal anesthesia
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local anesthesia injected in subarachnoid space at the 3rd or 4th lumbar space
SE spinal headaches AR resp distress/ failure |
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spinal/ epidural headaches
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treatment: caffeine, bedrest flat for 24-48 hours, dark room, IV hydration, blood patch
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blood patch
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15-20 mls of own blood injected into epidural space to clot and seal the whole in the dura which stops csf from leaking
USE to relieve severe headaches from puncture in dura |
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anticonvulsants/antiepileptics/ hydantoins
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used to treat seizures associated with epilepsy
cns depressants ACTION slow entrance of sodium and calcium back into neuron and extending time it takes for nerve to return to its active state, suppress seizure activity do not eliminate cause of seizure on meds for life |
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classification of seizures
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grand mal (tonic clonic)
petit mal (absence) psychomotor |
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phenytoin/ dilantin
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CLASS anticonvulsants/antiepileptics/ hydantoins
USE treat seizures RISK teraogenic (D damage fetus) take with food SE gingival hyperplasia (gum overgrowth) NSG INTER meticulous oral hygiene |
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Dilatin/ anticonvulsants/ antiepileptics/ hydantoins
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DRUG INT decrease effects of anticoagulants and contraceptives, antihistamines, decrease dose if on bcp; antacids, calcium preparations decrease absorption; antipsychotics, certain herbs increase seizure activity
NSG IMP administer 50mg/1min, high rates may cause hypotension (cardiac arrythmias) PT TEACH take with food, shake will if liquid, do not stop abruptly!, dental checks soft bristles, urine pink/brownish, do not drive, check lab values |
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diazepam/ lorazepam/ dilantin
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anticonvulsants
RX status epilepticus- rapid succession of seizure activity |
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anticonvulsants and pregnancy
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teratogenic- highest incidence of birth defects with combination therapies
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Parkinsonism
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dopamine and acetylcholine imbalance
rigidity, tremors, bradykinesia. akinesia DRUGS used reduce symptoms or replace dopamine deficit CLASS anticholinergics, dopaminergics, dopamine agonists |
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Alzheimer's disease
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CAUSE degeneration of cholinergic neuron and acetycholine deficit
MEDS donepezil/ aricept (improves memory loss by elevation acetylcholine concention) |
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Parkinson's Disease nonpharm.
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exercise- tai chi
nutrition- fiber/ fluids to decrease constipation, limit protein group support |
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Dopaminergics (Parkinson's)
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convert to dopamine
low protein diet therapy may take few weeks for symptoms avoid vit B6 can inhibit conversion of levodopa to dopamine |
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Carbidopa- Levodopa/ Sinemet
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combination allows levodopato cross bbb so more dopamine reaches brain
SE n/v, involuntary abnormal movement, o hypotension |
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donepezil/ aricept
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Alzheimer's. improves memory loss by elevation acetylcholine concention
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Parkinson's meds
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anticholinergics- artane/ Cogentin
block the cholinergic receptors, reduce rigidity, tremors |
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Artane/ Cogentin
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anticholinergic used for psuedoparkinsonism- reversible syndrome resembling parkinsonism that may result from dopamine-blocking actino of antipsychotic drugs
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glucocorticoids/ methylprednisone
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for acute attacks (multiple sclerosis)
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dantrium/ dantrolene
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RX for multiple sclerosis
ACTION decrease inflammatory process of nerve fibers and improve conduction of demyelinating axons |
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Multiple Sclerosis
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autoimmune disorder that attacks the myelin sheath of nerve fiber in brain and spinal cord causing lesions called plaques
REM/EXAC acute attack, chronic progressive S&S diplopia, weakness, spasticity PT TEACH avoid histamine blockers- tagamet, zantec, NSAIDS, beta blockers- propanolol |
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Myasthenia Gravis
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autoimmune disease- lack of acetylcholine reaching cholinergic receptors causing ineffecting muscle contraction
S&S weakness, fatigue of skeletal muscles, diplopia, ptosis |
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AChE (cholinesterase inhibitors and anticholinesterase)= Mestinon
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controls and treats MG by preventing destruction of ach
SE hypotension, n/v, urticaria *MEDS SHOULD BE ADMINISTERED ON TIME TO PREVENT MUSCLE WEAKNESS |
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AChE (cholinesterase inhibitors and anticholinesterase)= Prednisone
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decreases MG symptoms, used for pts not responding to Mestinon
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Imuran/ azathioprine
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immunosuppressive agent used in conjunction with prednisone
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Myasthenic Crisis
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muscle weakness after therapy, due to inadequte dosing
death could result from paralysis of resp muscles neostigmine- fast acting AChE inhibitor |
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Muscle spasms
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spasticity- muscular hyperactivity that causes contraction of the muscles, resulting in pain, limited mobility
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muscle relaxants
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alleviates muscle spasm assoc with acute painful ms conditions
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Diazepam (valium)
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benzodiazepine used to treat muscle spasticity
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Flexeril
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used as muscle relaxant
SE cns depression, drowsiness; avoid alcohol, barbituates, sedative hypnotics, TCAs |
