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56 Cards in this Set

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CNS: Voluntary or Involuntary?
Voluntary
ANS: Voluntary or Involuntary?
Involuntary
Neurotransmitter for CNS
Acetylcholine, Epinephrine
Neurotransmitter for ANS
Noreepinephrine
Sympathetic
Inducer: Action
Induces enzymes in gut and small bowel

Speeds up metabolism of drug and lowers drug level

Basically speeds up drug
Inducer: I.E.
St John's Wort lowers level of OCS
Inhibitor: Action
Blocks enzymes in the gut and small bowel

Lowers metabolism of drug and can cause toxic levels
Inhibitor: I.E.
Grapefruit juice: Naringin
Category A
Studies fail to show risk

(Tylenol)
Category B
Only if clearly indicated
Category C
Adverse Effects
Category D
Positive evidence
Category X
Demonstrated fetal abnormalities

Ace Inhibitors, Tholitimide
Pharmacokinetic Interactions
Diminished drug delivery to site of action

Increased drug delivery to site of action
Pharmacodynamic Interaction
Additive/Synergistic effect (anticoag/NSAID)

Antigonistic effect (clonidine and doxepin) One is object drug, other is precipitant drug.
Cholingergic Drug: System and neurotransmitter
Parasympathomimetic (parasympathetic), acetylcholine
Cholingergic Drug: Effect
Increased secretions
Decreased blood pressure and heart rate
Parasympathomimetic: Actions
Mimic effect of PNS
Mimics acetylcholine
Cholinergic Drug
Slow or inhibit pns activity by activating or inhibiting muscarinic receptor that are normally activated by acetylcholine using enzyme acetylcholinesterase
Cholinergic Agonists: I.E.
bethanechol (Urecholine, Duvoid, Myotonachol
pylocarpine (Pilocar, Isopto Carpine)
Cholinergic Agonists: Indications
Glaucoma (pilocarpine)
non-obs urinary retention, urogenic bladder, adynamic colon (bethanecol)
Cholinergic Agonists: Contraindications
Urinary or GI obstruction, prostate enlargement, pregnancy
Cholinergic Agonists: Adverse Effects
hypotension, headache, flushing, sweating, abdominal cramps, nausea, vomiting, diarrhea, increased salivation
Cholinergic Agonists: Interactions
If used with atropine-like drugs, parasympathomimetic actions inhibited
Cholinergic Agonists: Nursing Actions
Assess urinary and Gi status
Observe for s/s of toxicity (bradycardia, excessive secretions, respiratory depression, urinary urgency)
Acetylcholinesterase Inhibitors: I.E.
neostigmine (Prostigmin)
physostigmine (Antillirium)
pyridostigmine (Mestinon, Regonol)
edrophonium (Tensilon)

(Most r/t anesthesia)
Acetylcholinesterase Inhibitors: Indications
Post op ileus (neostigmine)
glaucoma and anticholinergic poisonings including tricyclic antidepressant overdosage (physostigmine)
diagnosis of myasthenia gravis (edrophonium)
treatment of m/g (neostigmine and pyridostigmine)
Acetylcholinesterase Inhibitors: Contraindications
urinary or gi obstruction
Acetylcholinesterase Inhibitors: Adverse Effects
nausea and vomit, diarrhea, bradycardia, hypotension, diaphoresis, miosis, muscle crams, fatigue, weakness, paralysis, hypertension, respiratory depression (nicotinic)
Acetylcholinesterase Inhibitors: Interactions
neostigmine and nondepolarizing neuromuscular blocking drugs (eg tubocurarine) decreases actions of latter drugs

Neostigmine potentiates depolarizing muscle relaxants increasing the length of time of muscle paralysis
Acetylcholinesterase Inhibitors: Nursing Actions
assess pt's neuromuscular status, gait, muscle strength, reflexes
Random Facts
Acetylcholinesterase Inhibitors
Curare: paralysis
(poison darts)
Parasympatholytic: Definition
Anticholinergic or cholinergic blocking drugs, block the action of acetylcholine at muscarinic receptors in the parasympathetic nervous system
Parasympatholytic: I.E.
Atropine, benztropine (Cogentin)
glycopyrrolate (Robinul)
propantheline (Promabthine)
thrihexylphenidyl (Artane)
Parasympatholytic: Indications
bradyarrhythmias (atropine and glycopyrrlate)
dyskinesis and parkinsonism (benzotropine and trihexphenidyl)
peptic ulcer and bowel spasm ( propantheline and glycopyrrlate)
mydriasis, acetylcholine antidote (atropine)
decrease saliva and bronchial secretions (atropine, scopolamine and glycoprrlate)
Parasympatholytic: Contraindications
narrow angle glaucoma, severe hemorrhage, uncontrolled tachycardia urinary or GI Obstruction
Parasympatholytic: Adverse Effects
tachycardia, constipation, urinary retention, dry mouth, blurred vision, photophobia
Parasympatholytic: Interactions
Antacids decrease absorption

tricyclic antidepressants may cause additive toxicity (anticholenergic effect)
Parasympatholytic: Nursing Actions
Monitor I/O
Admin ac and hs when used to decrease GI motility
Monitor OTC meds to prevent inx
Random
Anticholinergic
Belladonna (Constricts pupils)
Chantix
Used for smoking cessation.
more effective than Zyban
Chantix Dosages and Forms
Oral capsule One week titration
0.5mg once daily on days 1-3
0.5mg twice daily days 4-7
1mg twice a day for 12 weeks
Chantix Adverse Effects
N & V headache, insomania, dysgeusia (change in taste)
Adrenergics: Actions
Mimic or inhibit sympathetic act by activation or blocking alpha and beta receptors which are activated by the neurotransmitter norepinephrine or dopamine receptor activated by dopmine
Adrenergics: Actions cont
norepinephrine (focus)
dopamine (joy, attn, pleasure, too much, paranoia, cocaine acts pleasure circuit and prevents reabs of dopamine/ build up = euphoria)
Adrenergics: Prototype
epinephrine (Adrenalin)

sympathominmetic
Adrenergic agonist (sympathomimetics) alpha adrenergic agonist: Actions
Tx hypotension, increase blood pressure, eg norepinephrine (levophed)
Beta I adrenergic agonist: Action
Treat heart failure
increase cardiac output
heart rate
myocardial contractility and accelerate atrioventricular conduction eg dobutamine (Dobutex)
Beta II adrenergic agonist: Action
Treat asthma and allergies
cause bronchodilitation and peripheral vasodilation, eg albuterol (Proventil, Ventolin) and epinephrine (Adrenalin)
Dopamine agonist: Action
Treat mild renal failure caused by decreased cardiac output and dilate renal arteries in low doses eg dopamine (Intropin)
Alpha Adrenergic blocking drugs: Action
Treat peripheral vascular disorders, Raynaud's disease, vascular headaches by acting as smooth muscle relaxants and vasodilators
eg phentolamine (Regitine) and ergotamine tartrate with caffeine (Cafergot)
Beta Adrenergic blocking drugs: Action
Treat hypertension
prevent migraine headaches
MI
glaucoma
acute anxiety reaction (stage fright) by blocking myocardial stimulation and causing vasodilation reduced glycogenolysis and bronchodilation eg atenolol (Tenormin) and metaprolol (Lopressor)
CNS Stimulants: Action
Increase neurotransmitter levels in the CNS causing CNS and respiratory stimulation, pupil dilation, increased motor activity, mental alertness, decreased fatigue
CNS Stimulants: I.E.
dextroamphetamine (Dexedrine)
methylphendiate hydrochkirude (Ritalin, Concerta ER) Potential for abuse
Strattera
atomoxetine

increases norepinephrine for ADHD
in rare cases causes liver damage, not habit forming
CNS Stimulants: Indications
narcolepsy (dextroamphetamine)
ADHD (methylphendiate HCL)
respiratory stimulation after anesthesia (doxapram, Dopram)
Botulinum Toxin
inhibits release of acetylcholinesterase from motor neurons.
lasts 2-6 months
reduces involuntary muscle contraction