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61 Cards in this Set

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List 5 Adrenergics
Epinepherine
Norepinepherine
Dopamine
Albuterol
Clonidine
E
N
D
A
C
List Anticholinergics
Atropine
Oxybutmin
Hyoscyamine
AOH
List Cholinergics
Bethanechol
Neostignine
Edrophonium
Organophosphates
BNEO
List Antiadrenergic
Doxazosin
Propranolol
Labetalol
Atenolol
DPLA
Epinephrine
Classification:
Use:
Receptor type:
Adrenergic, Adrenergic agonist
Management of airway disease, allergic reaction and cardiac arrest.
Receptor type: Alpha and beta adrenergic receptors
Norepinephrine

MOA:
Use:
Receptor type:
Nursing actions:
Adrenergic agonist,
Increase BP, cardiac output in shock.
Receptor type: Alpha 1 and 2
MOA: Causes contraction of arterial smooth muscle. Signal transduction
Nursing actions: Plasma volume should be corrected first. Monitor BP continuously until stable. Monitor cardiac ECG. Monitor urine output. Monitor IV site.
Use for Dopamine
Increase BP, cardiac output in shock and renal flow.
Dose dependant response. dopaminergic at low doses to increase urine output. Medium doses are beta adrenergic, increasing heart rate and contractility.
Higher doses are alpha adrenergic, for increasing blood pressure, vasoconstriction
Receptor type: Alpha 1 and Beta 1 and Beta2
MOA: Signal transduction
Dopaminergic, adrenergic
Albuterol
Classification:
Use:
Receptor type:
Adrenergic Beta 2 agonist
Use: Bronchodilation.
Receptor type: Beta 2
Clonidine
Classification:
Use:
Receptor type:
Adrenergic alpha 2 agonist
Centrally acting to decrease blood pressure.
Used in alcohol withdrawal to reduce blood pressure response.
Receptor type: Alpha 2
Doxazosin (Cardura)
Classification:
Use:
Receptor type:
MOA:
Nursing actions:
Alpha 1 adrenergic antagonist
Treatment of hypertension, Benign prostatic hyperplasia (BPH). Vasodilation.
MOA: Blocks post synaptic alpha 1 adrenergic receptors.
Nursing actions: Monitor BP and pulse, orthostatic hypertension or syncope
Propranolol
Classification:
Use:
Receptor type:
Nursing actions:
Beta 1 and Beta 2 adrenergic antagonist.
Management of hypertension, angina, arrhythmias. Decreases heart rate and contractility. Decreases blood pressure.
Receptor type: Beta 1 and beta 2
Nursing actions: Take apical pulse prior to administering. If less than 50, hold. Monitor for bronchoconstriction side effect. Monitor I and O and watch for fluid overload.
Labetalol
Use:
Receptor type:
MOA:
Beta adrenergic antagonist. Non selective
Use: Antianginal, anti-hypertension
Receptor type: Beta 1, Beta 2 and Alpha 1
MOA: Blocks stimulation of myocardial and pulmonary receptor sites.
Atenolol
Classification:
Use:
Receptor:
Beta adrenergic antagonist. Selective for Beta 1, myocardial) receptors.
Management of hypertension to decrease blood pressure, heart rate.
Bethanechol
Classification:
Use:
MOA:
Cholinergic
Use: Non-obstructive urinary retention
MOA: Synthetic choline. Stimulates cholinergic receptors to produce smooth muscle contractions. Relax sphincter and contract bladder wall.
Synthetic derivative of choline
Neostigmine
Classification:
Use:
MOA:
Receptor:
Nursing actions:
Cholinergic
Anti-cholinesterase (Reversible indirect action)
Use: Improves muscle strength in myasthenia gravis. Prevents post operative urinary retention or ileus and reverses nondepolarizing neuromuscular blockers.
MOA: Inhibits the breakdown of acetylcholine. Acetylcholine remains in the synapse.
Receptor: Acts indirectly by binding to cholinesterase which breaks down acetylcholine.
Nursing actions: Contraindicated in mechanical obstruction of GI/GU tract.
(Reversible indirect action)
Edrophonium
used to diagnose Myasthenia gravis. (Tensilon test).
(Tensilon)
Organophosphates
Classification:
Use:
MOA:
Receptor:
Nursing actions:
(Cholinergic)
Irreversible anti-cholinesterase agent.
Use: Insecticides or nerve gas. Produces excessive stimulation of muscarinic and nicotinic receptors.
MOA: Cholinesterase is inactivated and acetylcholine remains in the cholinergic synapses.
Receptor: Acts indirectly by binding to cholinesterase which breaks down acetylcholine
Nursing actions: Antidotes are Atropine, an anticholinergic and Pralidoxime a cholinesterase reactivator.
Produces excessive stimulation of muscarinic and nicotinic receptors.
Atropine
Use:
MOA:
Receptor:
Nursing actions:
IV dose:
Anticholinergic
Used for treatment of bradycardia. Causes cycloplegia,
MOA: Blocks parasympathetic vagal stimulation.
Affects the cardiac sinoatrial node.
Receptor: Muscarinic
Nursing actions: IV dose, 0.4-1.0 mg.
Blocks parasympathetic vagal stimulation.
Oxybutynin (Ditropan)
Classification:
Use:
MOA:
Receptor:
Nursing actions:
Anticholinergic, urinary tract antispasmodic.
Use: Treatment of neurogenic bladder, frequency, urgency, nocturia, and incontinence.
MOA: Blocks acetylcholine in the bladder walls and sphincter so the bladder is less irritable. Also used for post prostate resection.
Receptor: Postgangleonic
Nursing actions: Monitor voiding pattern, I and O. Assess for distention.
Treatment of neurogenic bladder
Hyoscyamine (Levsin)
Classification:
Use:
MOA:
Receptor:
Nursing actions:
Classification: Anticholinergic
Use: Control of GI, irritable bowel pain
MOA: Inhibits acetylcholine at muscarinic receptors.
Receptor: Muscarinic.
Nursing actions: Monitor heart rate, I and O. Assess for bowel sounds and distention. Monitor for constipation.
Inhibits acetylcholine at muscarinic receptors
4 Nursing actions for ANS drugs
Monitor heart rate for sympathetic adrenergics or the cholinergic drugs
Monitor BP (Except for cholinergic)
Monitor bowel and bladder effect
Check selective effects
Effect on heart rate
Adrenergic will ...
Antiadrenergic will...
Cholinergic will ...
Anticholinergic will ...
Adrenergic will increase heart rate.
Antiadrenergic will decrease
Cholinergic will decrease heart rate
Anticholinergic will increase heart rate
Effect on blood pressure
Adrenergic will ...
Antiadrenergic will ...
Cholinergic will ...
Adrenergic will increase blood pressure (alpha 1)
Antiadrenergic will decrease blood pressure
Cholinergic will not effect BP. No cholinergic receptors on vessels.
Effect on bowell and bladder tone
Adrenergic will ...
Antiadrenergic will ...
Cholinergic will ...
Anticholinergic will ...
Adrenergic will decrease bowel and bladder tone
Antiadrenergic will increase bowel and bladder tone
Cholinergic will increase bowel tone.
Anticholinergic will decrease bowel tone.
Propofol (Diprivan)
Use:
Use: A hypnotic used in balanced general anesthesia, conscious sedation and deep sedation. It is similar to IV barbiturates and has an anti-emetic effect.
It is fast acting, with full effect in 1-3 minutes. Its distribution half life is 2-8 minutes and its elimination half life is 30-60 minutes. It has to be emulsified in lipids.
Halothane (Fluothane)
Use:
Nursing actions:
Use: For general anesthesia with rapid induction and rapid recovery. No analgesic effect. Doesn’t irritate the mucosa. Can only be used one time.
Nursing actions: Monitor cardiovascular for dysrhythmias. Sensitizes the heart to catecholamines. May produce hypoxemia, respiratory acidosis (hypercarbia). Depresses kidney, liver function. May cause malignant hyperthermia
Isoflurane (Forane)
Use:
Use: Similar to halothane but without cardiac dysrhythmias or hepatotoxicity.
Nitrous Oxide
Use: Analgesic, weak anesthetic, given with oxygen to prevent hypoxia. Few adverse effects. It cannot produce surgical anesthesia by itself.
Midazolam (Versed)
Use:
Nursing actions:
Onset:
Use: A short acting benzodiazepine. Amnesiac and reduces doses of opioid needed. Used for preoperative sedation, induction and in general anesthesia. May be used in short procedures. Rapid onset and short duration
Nursing actions: Monitor for apnea, respiratory depression.
Alfentanil (Alfenta)
Use:
A rapid acting opioid analgesic, anesthetic.

Nursing actions: Same as for opioid.
Succinylcholine (Anectine)
Use:
MOA:
Nursing actions:
Cholinergic
Depolarizing, cholinergic receptor agonist. Neuromuscular blocking agent used to produce skeletal muscle paralysis. Paralyses muscles of respiration, Short acting. Antidote is plasma pseudocholinesterase.
MOA: Blocks the effect of acetylcholine at the neuromuscular junction.
Nursing actions: Assess respiratory status. Monitor ECG, heart rate, BP.
Pancuronium (Pavulon)
Use:
MOA:
Nursing actions:
A non-depolarizing neuromuscular blocker. Long acting. It is used for general anesthesia, intubation or facilitating compliance in mechanical ventilation.
It is reversed by neostigmine, an anticholinergic. Action lasts about 60 minutes.
MOA: Blocks the effect of acetylcholine at the neuromuscular junction so there is no muscle contraction.
Nursing actions: Has no effect on consciousness or pain threshold. Use with analgesia, anesthesia. Protect eyes with artificial tears. Monitor respiratory cardiovascular, ECG status. Should only be used in conjunction with intubation. Monitor neuromuscular response.
Vecuronium (Norcuron)
Use:
MOA:
Nursing actions:
Use: : A non-depolarizing neuromuscular blocker. Short acting. It is used for intubation or facilitating compliance in mechanical ventilation. It is reversed by neostigmine, an anticholinergic. Action lasts about 15-30 minutes.
MOA: Blocks the effect of acetylcholine at the neuromuscular junction so there is no muscle contraction.
Nursing actions: Has no effect on consciousness or pain threshold. Use with analgesia, anesthesia. Protect eyes with artificial tears. Monitor respiratory cardiovascular, ECG status. Should only be used in conjunction with intubation. Monitor neuromuscular response.
Bupivacaine (Marcaine)
Use:
MOA:
Nursing actions:
Use: Lidocaine/cocaine type anesthetic.
MOA: Inhibits sensory nerve impulse by altering influx of sodium and efflux of potassium. Slows or stops pain sensation.
Nursing actions: Assess for toxicity, orthostatic hypotension. Epinephrine keeps the drug in the injected area.
Atropine
Use:
Use: An anticholinergic used to prevent vagal effects during anesthesia (bradycardia, hypotension) It also dries secretions.
PSVT
Paroxysmal supraventricular tachycardia. Common arrhythmia that may revert with vagal maneuvers. Pt. talking, conscious.
Sodium Channel Blockers
Block sodium influx into the cell. Stabilizes the cell membrane and decreases the formation and conduction of electrical impulses.
Used to maintain NSR after conversion.
Procainamide
Quinidine
Lidocaine
PQL
Procainamide
Use:
MOA:
Nursing actions:
Use: To maintain NSR after conversion. Ventricular ectopic beats and Ventricular tachycardia
MOA: Block sodium influx into the cell. Decreases myocardial excitability. Slows conduction velocity. Prolongs refractory period.
Nursing actions: Monitor heart rate, ECG, BP, measure intervals, monitor Na, K, Ca.
Block sodium influx
Quinidine
Use:
MOA:
Nursing actions:
Use: To maintain NSR after conversion. Ventricular ectopic beats and Ventricular tachycardia
MOA: Block sodium influx into the cell.
Nursing actions: Monitor heart rate, ECG, BP, measure intervals, monitor Na, K, Ca.
Block sodium influx
Beta Adrenergic Blockers
Propranolol (Inderal)
Esmolol
olol
Propranolol (Inderal)
Use:
MOA:
Use: Management of angina, arrhythmias, supraventricular tachycardia, atrial fibrillation/flutter and PSVT. Decreases heart rate.
MOA: Blocks beta receptors. Blocks the sympathetic nervous system effect on the SA and AV nodes and increasing the refractory period. Decreases automaticity.
Esmolol
Use:
MOA:
Management of supraventricular tachycardia, atrial fibrillation/flutter and
MOA: Blocks beta receptors. Blocks the sympathetic nervous system effect on the SA and AV nodes and increasing the refractory period. Decreases automaticity
Potassium Channel blockers

MOA:
Name one:
Prolong the action potential and slow repolarization and prolong the refractory period. Potassium cant get back into the cell, so they slow repolarization.

Amiodarone
Amiodarone
Use:
MOA:
Nursing actions:
IV use for Ventricular fibrillation/tachycardia.
PO use for recurrent ventricular tachycardia and to maintain NSR with atrial fibrillation/flutter.
MOA: Potassium cant get back into the cell, so they slow repolarization
Nursing actions: Many adverse effects and interactions, so they cant be prescribed for longer than 6 months. Need liver, renal and creatinine tests.
List 3 Calcium Channel Blockers
Block the flow of calcium into the cells of conductile and myocardial. Slows conduction and prolongs refractory period. Ca blockers for hypertension use.
Diltiazem (Cardizem)
Verapamil
Adenosine (Adenocard)
Diltiazem (Cardizem)
Use:
MOA:
Use: IV for PSVT
MOA: Block the flow of calcium into the cells of conductile and myocardial. Slows conduction and prolongs refractory period
Verapamil
Use
MOA:
Nursing actions:
Use: PO for chronic suppression of PSVT and atrial fibrillation/flutter.
MOA: Block the flow of calcium into the cells of conductile and myocardial. Slows conduction and prolongs refractory period
Nursing actions: Do not use IV with IV Propranolol.
Adenosine (Adenocard)
Use:
MOA:
Nursing actions:
Dose:
Use: Restore NSR after PSVT .
MOA: Reduces conduction of AV node.
Nursing actions: Inject IV in 1 second.
they go into asystole.
6 mg, 12 mg, 12mg.
Use: Restore NSR after PSVT .
Nitroglycerin
Use:
MOA:
Dose:
Use: Angina and episodic chest pain.
MOA: Dilate smooth muscle. Converts to nitric oxide which activates enzyme for cGMP. Causes decrease Ca in smooth muscle. Keeping Ca out keeps it dilated.
Causes dilation of arterioles and veins so will decrease pre and afterload.
Nursing actions: Check BP, heart rate, burning sensation under tongue indicates effectiveness.
Dose: take every 5 minutes up to three times.
Ointment is for chronic use.
Indirectly treat angina by reducing workload of the heart, increasing oxygen delivery. Prevent exercise induced angina or tachycardia. They decrease heart rate and increase blood flow to the coronary arteries.
Beta Adrenergic Blockers MOA
Used to treat angina by acting on contractile tissue, dilate coronary artery and reduce work load of the heart. Diltiazem. (Not Verapamil)
Calcium Channel Blockers
Diltiazem
Used for A. fib/flutter to decrease ventricular rate. Hypertension to decrease peripheral vascular resistance. Do not use with low heart rate and blood flow

Nursing Actions:
Check ECG for evidence of MI ie, t wave inversion, ST elevation, q wave, HR, BP, route of administration for angina
Classification: Beta blocker (non-selective), Antianginal, antiarrhythmic, antihypertensive.
Effect: Decreases heart rate and blood pressure, suppresses arrhythmias. Used in the prevention of MI.
MOA: Blocks stimulation of beta 1(myocardial) and beta 2( pulmonary) adrenergic receptors.
Contraindications: Uncompensated CHF, Pulmonary edema, Cardiogenic shock, bradycardia or heart block.
Adverse effects: Arrhythmias, bradycardia, CHF, pulmonary edema, fatigue, weakness.
Drug interactions: Additive bradycardia with digoxin, additive hypotension with antihypertensives, ETOH or nitrates. Concurrent use with epinephrine, norepinephrine, pseudoephedrine may cause unopposed alpha adrenergic stimulation (hypertension, bradycardia).
Nursing actions: Take apical pulse before administering. If less than 50, or arrhythmia occurs, hold and notify physician. Monitor BP and pulse. Monitor I and O ratios and daily weights. Watch for fluid overload.
Propranalol (Inderal)
Classification:. Calcium channel blocker, Antianginal, antiarrhythmic, antihypertensive.
Effect: Used in the management of supraventricular arrhythmias and rapid ventricular rates in atrial flutter and fibrillation. Vasodilation decreases BP, angina. Suppresses ventricular tachyarrhythmias.
MOA: Inhibits Ca transport into the myocardium and inhibits contraction. Decreases SA and AV conduction and prolongs AV node refractory period. Used in management of hypertension.
Contraindications: 2nd or 3rd degree heart block, BP less than 90, CHF, severe ventricular dysfunction, cardiogenic shock unless associated with supraventricular tachyarrhythmias.
Use caution with: Serious ventricular arrhythmias or CHF.
Adverse effects: Arrhythmias, CHF
Drug interactions: May increase serum digoxin levels.
Nursing actions: Monitor pulse, BP. Monitor ECG. May cause prolonged P-R interval. Assess for signs of CHF.
Verapamil
Verapamil
Classification:. Calcium channel blocker, Antianginal, antiarrhythmic, antihypertensive.
Effect: Used in the management of supraventricular arrhythmias and rapid ventricular rates in atrial flutter and fibrillation. Vasodilation decreases BP, angina. Suppresses ventricular tachyarrhythmias.
MOA: Inhibits Ca transport into the myocardium and inhibits contraction. Decreases SA and AV conduction and prolongs AV node refractory period. Used in management of hypertension.
Contraindications: 2nd or 3rd degree heart block, BP less than 90, CHF, severe ventricular dysfunction, cardiogenic shock unless associated with supraventricular tachyarrhythmias.
Use caution with: Serious ventricular arrhythmias or CHF.
Adverse effects: Arrhythmias, CHF
Drug interactions: May increase serum digoxin levels.
Nursing actions: Monitor pulse, BP. Monitor ECG. May cause prolonged P-R interval. Assess for signs of CHF.
Dopamine
Classification:
Classification: Vasopressor, inotropic, beta-adrenergic
Monitor pulse, BP, pulse pressure, ECG, pulmonary capillary wedge pressure, cardiac output continuously. Report changes
Nitroprusside (Nipride)
Classification:
Effect:
MOA: .
Contraindications:
Adverse effects:
Drug interactions:
Nursing actions: .
Classification:. Vasodilator, antihypertensive
Effect: Rapid lowering of blood pressure. Decreases preload and afterload.
MOA: Produces peripheral vasodilation by acting on smooth muscle.
Contraindications:. Decreased cerebral perfusion
Use caution with.
Adverse effects: Dizziness, headache,
Drug interactions: Antihypertensives,
Nursing actions: Monitor BP, heart rate and ECG. Monitor for rebound when discontinuing therapy.
Contraindications:. Decreased cerebral perfusion
Digoxin (lanoxin)
Classification:. .
MOA:
Contraindications:.

Use caution with:
Adverse effects:
Drug interactions:
Nursing actions:
Therapeutic serum levels
Classification:. Digitalis glycoside, positive inotropic, antiarrhythmic
Effect: Increases cardiac output.
MOA: Increases the force of myocardial contraction. Prolongs refractory period of the AV node and decreases conduction through the SA and AV nodes.
Contraindications:. Uncontrolled ventricular arrhythmias, AV block, constrictive pericarditis,
Use caution with: Electrolyte abnormalities may predispose to toxicity.
Adverse effects: Arrhythmias, bradycardia, ANV, fatigue.
Drug interactions: Thiazide and loop diuretics may increase the risk of toxicity. Verapamil may lead to toxicity.
Nursing actions: Monitor apical pulse for one full minute before administering. Withhold if less than 60. Monitor BP, electrolytes.
Therapeutic serum levels range from 0.5-2 ng/ml.
Enalapril (Vasotec)
Classification:
Effect:
MOA:
Adverse effects:
Drug interactions:
Angiotensin converting enzyme inhibitor
Antihypertensive
Effect: Systemic vasodilation. Lowers BP. Decreases afterload in CHF
MOA: Blocks conversion of angiotensin 1 to vasoconstrictor angiotensin 2.
Adverse effects: Hypotension, cough, proteinuria.
Drug interactions: Excessive hypotension with diuretics, antihypertensives, nitrates. Hyperkalemia may result from use of potassium supplements, potassium sparing diuretics. Increases risk of digitalis toxicity.
Lidocaine

Effect:
MOA: .
Contraindications:
Adverse effects:
Drug interactions: .
Nursing actions:
Classification:. Antiarrhythmic
Effect: Controls ventricle arrhythmias
MOA: Alters flux of sodium ions across cell membrane with little effect on heart rate. Suppresses automaticity and spontaneous depolarization of the ventricles during diastole.
Contraindications:. Advanced AV block
Adverse effects: Cardiac arrest, seizures,
Drug interactions: Beta blockers may increase risk of toxicity.
Nursing actions: Monitor ECG, BP and respiratory status. Monitor for toxicity.
Monitor ECG, BP and respiratory status. Monitor for toxicity.
Streptokinase
Classification:
Effect:
MOA:
Contraindications:.
Use caution with.
Adverse effects:
Drug interactions:
Nursing actions:
Thrombolytic, plasminogen activator
MOA: Converts plasminogen to plasmin which degrades fibrin in clots
Contraindications: History of CVA, uncontrolled hypertension, bleeding.
Use caution with. Recent surgery, left heart thrombus,
Adverse effects: Intracranial hemorrhage, reperfusion arrhythmias, GI bleeding.
Drug interactions: Blood thinners,
Nursing actions: Monitor vitals, monitor for coronary thrombosis q 4 hours. Assess for bleeding.