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173 Cards in this Set
- Front
- Back
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How do anticholinergics function? |
- Block the effects of acetylcholine
- Depresses salivary & bronchial secretions, dilates bronchi, inhibits vagal influences on heart |
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What are anticholinergics used for? |
- used in cardiac emergencies
- bradycardia, preanesthesia |
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What are the adverse affects of anticholinergics? |
- tachycardia, blurred vision |
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How do direct acting cholinergic drugs function? |
- increase bladder tone, relax spincters |
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What are direct acting cholinergics used for? |
- urinary retention
- neurogenic bladder (ex. spinal cord injuries) |
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Who should not take direct acting cholinergic drugs? |
- CAD, MI, heart block, intestinal obstruction, respiratory disorders |
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How do indirect acting cholinergics function? |
- inhibit action of acetylcholinesterase & prolongs effects of acetylcholine |
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What is acetylcholinesterase? |
- Enzyme that breaks down acetylcholine and improves cholinergic neurotransmission in the brain |
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What are indirect acting cholinergics used for? |
- Myasthenia gravis, bladder distention, paralytic ileus |
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What class of drug is Prostigmin and what is it used for? |
- will cause an increase in tone and strength of muscle |
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______________ is used to diagnose Myasthenia Gravis? |
- Tensilon |
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Who should not use indirect acting cholinergics? |
- Parkinson's, intestinal/bladder obstructions, respiratory disorders, ulcerative colitis, bradycardia |
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What are the adverse effects of indirect acting cholinergics? |
- hypotension, bradycardia, intestinal spasm, respiratory arrest, vasodilation |
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Do you need to monitor I/O for indirect acting cholinergics?
Yes/No? |
Yes
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______________ increase acetylcholine in the brain |
Reversible indirect-acting cholinergics |
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What are reversible indirect-acting cholinergics used for? |
- Alzheimer's
- Dementia w/ memory loss |
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What is the goal of Aricept (reversible indirect-acting cholinergic)? |
- slow the disease process
*needs to be given early in the disease process to see results |
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In 15-30% of cases, there were noticeable (but temporary) effects with what drug? |
- Aricept |
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How do urinary antispasmodics function? |
- relax smooth muscle
- inhibit acetylcholine at muscarinic receptors |
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_____________ are used for bladder instability and to relieve a spastic bladder |
urinary antispasmodics |
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How do benzodiazepines function? |
- release GABA substances
- inhibit the transmission of impulses in the central nervous system |
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_____________ have replaced barbituates as the drug of choice for insomnia |
- benzodiazepines |
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What are benzodiazepines used for? |
- anxiety, insomnia, alcohol withdraw
- break status epilepticus |
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Which benzodiazepine is used preop? |
Versed
* used for conscious sedation |
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__________ is the most commonly prescribed drug for anxiety |
Xanax |
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What are the side effects of benzodiazepine? |
- over-sedation
- hangover
- decreased respiration |
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To reverse the effects of benzodiazepines, _______________ is used. |
Romazicon
(most often seen postop when given too much Versed) |
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Ambien is a ________-term sleep aid |
short-term |
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_______________ has been reported to cause problems w/ sleep walking & doing things while sleep walking |
Ambien |
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___________ is a sleep agent that can be used longer than Ambien |
Lunesta |
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What drug was initially an antihistamine, but can also be used as a sleep agent? |
- Benadryl
(because of drowsiness) |
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____________ depress polysynaptic reflexes in the CNS |
- skeletal muscle relaxants |
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What are skeletal muscle relaxants used for? |
- acute musculoskeletal pain
- musculoskeletal spasticity relief
- adjunct to other therapies |
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What are the adverse effects of skeletal muscle reactants? |
- drowsiness, dizziness, N/V
- flaccid muscles
- psychological/physical dependence |
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_________ is a commonly abused skeletal muscle relaxant |
- Soma |
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Physical therapy should be used in conjunction with the use of what class of drugs? |
- skeletal muscle relaxants |
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_____________ interferes w/ the release of Ca+ from the sarcoplasmic reticulum, weakening the force of the muscle contraction |
- Dantrium |
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What is malignant hyperthermia? |
- autosomal dominant genetic disease
- causes fast rise in body temp & severe muscle contractions
- certain anesthesia = circulatory collapse |
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____________ is used to treat malignant hyperthermia. |
Dantrium |
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What is Dantrium used for? |
- malignant hyperthermia
- spasticity w/ MS - cerebral palsy - stroke |
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How do anti-seizure drugs function? |
- decrease movement of ions in to nerve cells, altering activity of neurotransmitters |
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When the brain is in a persistent state of seizure (> 5 minutes), the condition is known as ___________. |
- Status epilepticus |
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____________ stabilizes nerve membranes in order to prevent seizures |
- Dilantin |
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____________ is highly bound to protein, so therapeutic drug levels must be monitored |
- Dilantin |
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Dilantin is used for all kinds of seizures except __________ seizures. |
- absence seizures |
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Who should not receive Dilantin? |
- severe kidney/liver disease
- elderly |
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The therapeutic range for Dilantin is ___ - ____ mcg/mL |
5 - 20 mcg/mL |
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What are the adverse side effects of Dilantin? |
- gingival hyperplasia (swelling of gums)
- cardiovascular collapse w/ rapid IV dose |
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Why do we need to be careful when administering Dilantin IV? |
- extremely caustic to the veins
- needs to be diluted |
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Why can Dilantin NOT be diluted with dextrose? |
- the mixture will crystallize |
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Generic and trade brands of __________ are not always the same. |
- Dilantin
* need to stick w/ this medication unless doctor changes it |
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If somebody abruptly stops taking anti-seizure medications, what could happen? |
- they will have seizures
(status epilepticus could occur) |
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In IV form, _____________ can also be used to treat sever recurrent seizures and status epilepticus |
- Benzodiazepines |
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What anti-seizure medication can also be used to control chronic pain? |
- Neurotin |
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What is the function of barbituates? |
- depress the CNS |
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What are barbituates used for? |
- treat seizures
- promote anesthesia |
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____________ are very rarely used today because they can result in serious dependence and withdraw |
- Barbituates |
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Patients who take ___________ are at risk for suicidal ideations |
- Barbituates |
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What are the adverse effects of barbituates? |
- hangover - drowsiness - decreased respiration*
* not used much any more b/c of this |
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What is the goal of antiparkinson drugs? |
- strengthen dopaminergic action or decrease cholinergic action
* increases the amount of dopamine concentration |
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___________ is the dopaminergic antiparkinson drug. |
- Sinemet |
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What are the side effects of dopaminergic antiparkinson drugs? |
- N/V, anorexia - anxiety, depression - orthostatic hypertension, dizziness - involuntary movements (later) - akinetic spells (no body movement) |
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Why is carvadopa added to levadopa to make Sinemet? |
- carvadopa allows more levadopa to reach the brain |
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______________ is reserved for patients w/ significant Parkinson's symptoms because of severe side effects. |
- Sinemet |
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What types of patients should not take antiparkinson drugs? |
- narrow angle glaucoma - melanoma - GI obstruction - heart disease |
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Parkinson's patients may notice more pronounced symptoms during what time of day? |
- in the morning, before medication is taken |
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What is the "wearing off effect" when discussing antiparkinson drugs? |
- period of effectiveness with each dose may become shorter and shorter |
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What class of drugs should not be taken with large amounts of protein? |
- antiparkinson drugs |
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What are the safety implications for Parkinson's patients? |
- aspiration (trouble swallowing)
- orthostatic hypotension & dizziness when drug is first started = FALLS |
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How do anticholinergic Parkinson's drugs work? |
- counteract the cholinergic activity in the brain |
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What class of drugs should be used alone in Parkinson's patients? |
- anticholinergics |
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What are the nursing implications for anticholinergic Parkinson's drugs? |
- monitor I&O (urinary retention) - taper drug (so no withdraw) - watch heat (decreases sweating) - increase fiber/water (constipation) |
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What class of drugs decreases perspiration? |
- Anticholinergic Parkison's drugs
* need to watch exposure to heat/sun |
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What 2 drugs are used to treat episodic and situational panic attacks? |
- Zoloft
- BuSpar |
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What anti- anxiety medication needs to be taken on a schedule and not as needed? |
BuSpar |
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____________ is an antidepressant by classification, but can also be used for panic attacks |
Zoloft
* actually is first-line treatment now |
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What causes the pain associated with a migraine? |
- dilation of the arteries of the scalp and face |
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Ergot alkaloids are used to treat what? |
- migraines DURING the attack |
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How do ergot alkaloids function? |
- reduce extracranial bloodflow |
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What are the adverse effects of Ergot alkaloids? |
- decreased circulation to the extremities
- confusion
- N/V, cramps |
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Who should not take Ergot alkaloids? |
- pregnant - severe hypertension - coronary artery disease |
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What is the function of triptans/serotonin agonists? |
- stimulate receptors on the basilar artery to vasoconstrict the vessels of the dura matter
- used for migraines |
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What is the main concern with triptans/serotonin agonists? |
- they are vasoconstricting = HYPERTENSION |
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Do not give triptans/serotonin agonists within 24 hours of _______________. |
- Ergot alkaloids
* both cause vasoconstriction = hypertension |
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___________ and ____________ are mainly used for seizures, but can also be used to prevent migraines |
- Neurotin
- Topamax |
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What are the 3 phases of general anesthesia? |
1. Induction of anesthesia 2. Maintenance of anesthesia 3. Recovery
* Different meds used at different times throughout |
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When are IV anesthetics used? |
When RAPID induction and maintenance are needed |
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___________ is an an anesthetic used in critical care units for patients that are mechanically ventilated |
Diprivan |
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___________ are volatile liquids or gases that are vaporized or mixed with oxygen to induce anesthesia |
Inhaled anesthetics |
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_____________ prevent the patient from moving during surgery |
Neuromuscular blocking agents |
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____________ are used in critical care when a patient needs the metabolic demands decreased |
Neuromuscular blocking agents |
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If someone receives a neuromuscular blocking agent in the ICU, they also need to be given (a) ______________. |
Sedative |
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What are moderate or conscious sedation drugs used for? |
- endoscopy, interventional radiology
- pediatric/NICU procedures |
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____________ do not cause a complete loss of consciousness or respiratory arrest |
Moderate/conscious sedation |
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What is the advantage of moderate/conscious sedation? |
- patient will feel a lot better than if they were given general anesthetics |
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Intubation capabilities must be available when administering what type of drugs? |
- General anesthesia
- Moderate/conscious sedation |
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What class of drugs does not cause paralysis of respiratory function? |
- local anesthesia |
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___________is a type of local anesthesia where the drug is injected in to the surrounding tissue |
- infiltration |
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______________ is a type of local anesthesia where a large number of nerves in the anesthesized area are blocked at once |
- field block |
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_____________ is a type of local anesthesia injected directly in to or around the nerve |
- nerve block |
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With a ___________, the patient can still move the appendage/body part, they just have no sensation |
- nerve block |
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What type of anesthesia is injected directly in to the epidural or intrathecal space of the spine? |
- spinal, epidural/intrathecal
* used often in child birth |
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What are CNS stimulants used for? |
- ADHD
- narcolepsy
- weight reduction |
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What are the side effects of CNS stimulants? |
- nervousness, irritability, headache
* stimulants speed up the body process |
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CNS stimulants are Schedule ____ drugs |
II |
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Which CNS drug is not a controlled substance b/c it lacks addictive properties? |
- Strattera
* does have a warning for suicidal tendencies |
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____________ is used to combat alcohol abuse |
- Antabuse
- won't cause any symptoms unless person drinks (flushing, tachycardia, bronchospasm, N/V) |
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What is the most widely abused drug? |
Alcohol |
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__________ blocks the euphoria produced by opioids and prevents overdose |
Methadone |
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___________ are used to treat psychosis. |
Neuroleptics |
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What are the 1st generation "typical" neuroleptics? |
- Phenothiazines
- Nonphenothiazines |
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The 2nd generation of neuroleptics consists solely of ________________. |
- Nonphenothiazines
* tend to be better tolerated |
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How do phenothiazines function? |
- occupy or block dopamine receptors |
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What are phenothiazines used to treat? |
- schizophrenia
- acute mania
- psychotic depression |
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Which phenothiazine has fallen out of favor because of its EPS symptoms? |
- Thorazine |
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What is the main concern (side effect) of phenothiazines? |
- EPS symptoms |
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What is akathisia? |
- compulsive, involuntary restlessness
*EPS symptom |
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___________ is classified as uncoordinated, bizarre movements of the neck, face, eyes, and tongue |
Dyskinesia |
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Smacking/sucking of the lips, tongue profusion, and facial grimacing are an extrapyramidal symptom known as _______________ |
- Tardive dyskinesia |
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What class of drugs can be given to combat EPS? |
- Antiparkinson |
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People on ____________ need to have their liver function monitored |
Phenothiazines |
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Phenergan is a ______________ that is usually used to control N/V |
- phenothiazine |
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What class of drugs is used to control the symptoms of schizophrenia? |
- typical nonphenothiazines |
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Why are typical nonphenothiazines contraindicated in the elderly? |
- b/c it can cause cardiovascular incidents (EKG changes) |
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A mother's use of ___________ during the last trimester of pregnancy can cause EPS in newborns. |
- Haldol |
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If ___________ are administered IM, they need to be injected deeply. |
- Typical nonphenothiazines |
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Typical nonphenothiazines should not be taken with _____________. |
- other CNS depressants |
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What are some other nursing implications for typical nonphenothiazides? |
- monitor vital signs (can cause hypotension)
- PO needs to be taken with food
- photosensitivity |
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What is the difference between typical and atypical nonphenothiazines? |
- TYPICAL = control symptoms of schizophrenia
- ATYPICAL = newly diagnosed schizophrenia |
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How do atypical nonphenothiazines function? |
- blocks dopamine & serotonin receptors in the brain |
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What class of drugs are now used as the first-line treatment for schizophrenia? |
- ATYPICAL nonphenothiazines
*do not cause EPS |
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____________ can cause agranulocytosis (destruction of WBCs) |
- Clozaril
(atypical nonphenothiazine) |
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What class of drugs can cause weight gain in excess of 20-30 lbs? |
- atypical nonphenothiazines |
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Patients using atypical nonphenothiazines need to have what lab done before they start taking the medication? |
- baseline WBC count (agranulocytosis)
* pharmacy keeps track of these records. Need evidence of lab test
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Lithium is used to treat __________. |
- bipolar disorder
- prevents manic episodes |
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____________ alters sodium transport in the nerves (i.e. need to monitor Na levels) |
- Lithium |
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Use of lithium is contraindicated for who? |
- significant cardiac/renal disease - hyponatremia - pregnancy - leukemia |
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What other drugs does lithium interact with? |
- SSRIs - NSAIDs - diuretics - alcohol |
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The therapeutic drug levels of lithium are ____ - _____ mEq/L |
0.5 - 1.2 mEq/L
( >2.5 = multi-organ toxicity) |
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Why wouldn't a person who is on lithium also take diuretics? |
- B/c sodium is lost with diuretics |
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Patients taking ___________ need to drink 8-12 glasses of water per day |
- Lithium |
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How do tricyclic antidepressants (TCAs) work? |
- decrease reuptake of serotonin & norepinephrine |
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What is another use for tricyclic antidepressants (TCAs)? |
bed-wetting |
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Depression can be attributed to _________ or ___________ abnormalities |
receptor or neurotransmitter abnormalities |
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What are the adverse effects of TCAs? |
- effects mimic panic attacks
- suicidal thoughts |
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TCAs should not be taken with ____________. |
- St. John's Wort
(herbal OTC product that patient may try first) |
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____________ are now the first choice for treating depression and insomnia. |
- SSRIs |
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What are SSRIs used to treat? |
- depression
- OCD
- Bulimia |
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Why do SSRIs take several weeks to work? |
- HIGHLY protein bound
* need a steady drug level |
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_________ do not produce the cardiac problems and sedation that TCAs do. |
SSRIs |
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SSRIs are contraindicated for who? |
- those taking MAOIs
- anticoagulants |
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How do MAOIs function? |
- Prevent the metabolism of neurotransmitter molecules |
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Who uses MAOIs? |
- those that do not respond to medications or electroconvulsive treatment |
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____________ has/have many interactions w/ tyramine foods). |
- MAOIs
* limits what patients can eat, so they don't it |
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What is another major reason why MAOIs are not commonly used anymore? |
- they have many drug interactions |
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Wellbutrin CANNOT be taken by who? |
- people that have seizures |
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What 2 things is Wellbutrin used for? |
- depression
- smoking cessation |
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___________ is similar to an SSRI, but has more CNS sedation & cardiac issues |
- Effexor |
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_____________ cannot be used w/ significant alcohol abuse because of the risk for liver damage. |
- Cymbalta |
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___________ is used in older patients to gain weight |
- Romeron |
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What are Betadine and Chlorprep used for? |
- prepare the skin for a procedure
(ex. to start an IV) |
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_____________ carries a black box warning for its pregnancy X classification |
- Accutane
* can cause spontaneous abortions |
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How often is Accutane prescribed and why? |
- only prescribed 1 month at a time
* because of pregnancy X classification |
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What does a female patient need to provide before she can be prescribed Accutane? |
- 2 negative pregnancy tests
(and stringent contraceptive methods) |
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Why should someone press & hold their lacrimal duct for 3-5 minutes when administering eye drops? |
- to prevent systemic absorption
* especially important w/ beta blockers b/c of cardiac side effects |
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Glaucoma is defined as visual field loss as a result of damage to the ___________. |
- optic nerve
(increased interocular pressure w/in the eye) |
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How does a beta blocker treat glaucoma? |
- decreases production of aqueous humor |
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How does a cholinergic agent treat glaucoma? |
- Increases outflow of aqueous humor |
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How does an alpha 2 adrenergic agonist treat glaucoma? |
- decreases interocular pressure |
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Why do critical care patients with glaucoma need to be restarted on their meds ASAP? |
- glaucoma meds are prescribed for life
- need to be restarted immediately to prevent further damage |
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___________ is given to newborns at birth to treat neonatal conjunctivitis |
- Erythromycin |
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___________ is given to treat pink eye. |
Ciloxan |
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What drug is given to dilate the eye before a procedure? |
- atropine sulfate |
