• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/121

Click to flip

121 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
Cholingeric agent antidotes?
•Atropine
•(Protopam) Pralidoxime (pral·i·dox·ime)
Cholingeric Agents
Urecholine is used for?
Urinary retention
Cholingeric Agents
The expected PO onset of action for urecholine?
(30-90 min)
Cholingeric Agents
When is the expected sq onset of action for urecholine?
(5-15 min)
Cholingeric Agents
Drugs to diagnose and treat myasthenia gravis (x3) ?
• (Tensilon) to dx
• (Prostigmin) to tx
• (Mestinon) to tx
Cholingeric Agents
How does (prostigmin)neostigmine work?
↑ amt of acetylcholine
Cholinesterase inhibitor for diagnosis/treatment of myasthenia gravis
Cholingeric Agents
Adverse effects: SLUDGE
•Salivation↑
•Lacrimation
•Urination↑
•Diaphoresis
•GI secretions↑
•Elimination/emesis/diarrhea
Cholingeric Agents
Cholinergic actions?
Constrict pupils/bronchioles
Stimulates Secretion/dilation of salivary glands
↓HR/strength
↑stomach/intestine motility
Contract bladder/Relax sphincter
Cholinergic blocking agents act to?
Interrupt parasympathetic nerve impulses in the CNS/ANS; compete with acetylcholine at muscarinic receptor sites
Atropine is the prototype of?
Cholinergic blocking agents
Atropine Actions
Dilate pupils
Anticholinergic
Antispasmodic
Antisudorific an·ti·su·dor·if·ic (inhibiting the secretion of sweat)
Cholinergic blocking agents
Adverse reactions/Side Effects of Cholinergic blocking agents
↓accommodation, salivation, bronchial/GI secretions, gastric/intestinal motility, sweating,
↑ heat stroke, HR, artial ventricular arrhythmias
Urinary retention
3-D Effect
Dry
↓GI Motility
Dilated Pupils
Cholinergic blocking agents
How cholinergic blocking agents treat bradycardia?
Large IV doses given rapidly will block the vagal effect
Cholinergic blocking agents
Atropine is contraindicated with?
Glaucoma
Reflux esophagitis
CAD
Myasthenia gravis
Renal/GI obstructive disease
Cholinergic blocking agents or Anticholinergics
Anticholinergic teaching?
30 min a (before) meals & at hs (bedtime) for GI spasticity
Cool room
Monitor VS & T q4hrs
↑ GI secretion ċ (with) late night snack/milk
Measure I & 0
Good oral hygiene
Cholinergic blocking agents
How to cope with dry mouth?
Sugarless gum
Candy
Ice/saliva substitutes
Cholingeric blocking agents
How to cope with constipation?
Water
Exercise
Cholingeric blocking agents
When is Probanthine Indicated?
Duodenal/Peptic ulcers
IBS
Neurogenic Bladder
Urinary incontinence
Cholingeric blocking agents
NI for bronchoconstriction:
Keep respiratory equip nearby
Auscultate breathing
Monitor VS
Cholingeric Agents
Nursing Interventions
Atrophine is the antidote for the following s/sx:
↓ B/P
Shock
Cardiac arrest
Cholingeric Agents
Administration procedures
If treating an ocular condition monitor the clients?
Visual acuity
Cholingeric Agents
Qday Monitoring/Measurement
NI: Monitor ______ & ______ qday when using cholingeric agents
BP & pulse
Cholingeric Agents
Qday Monitoring/Measurement
Signs of excessive/toxic cholinergic activity to report are:
Dysphasia
Respiratory weakness
Fasciculation (uncontrollable twitching of single muscle group)
Cholingeric Agents
Qday Monitoring/Measurement
After giving urecholine monitor for ______. The patient should void within ___ ______.
Urination
1 hr
Cholingeric Agents
Qday Monitoring/Measurement
When using cholingeric agents for muscle, monitor/record changes in muscle strength ______. Should have ↓______, improved ↑______ & ______,
clear ______.
Qday
↓Weakness
↑Breath & swallowing
Speech
Qday Monitoring/Measurement
NI for myasthenia gravis?
Stress need to take drugs on time.
Cholingeric Agents
Qday Monitoring/Measurement
Drugs that ↑anticholinergic effects?
Antidepressants, antivertigo, antipsychotics, antiemetics, antidyskinetics - as in tic or spasm
Cholinergic Blocking Agents
Teaching implications
Cholinergic agonists or anticholinesterase drugs are cholinesterase ______?
Antagonists
Cholinergic Blocking Agents
Teaching implications
When using atropine, monitor ___ & ___ in elderly or surgical patients because may cause urinary retention
I & O
Cholinergic Blocking Agents
NI
Caution patients that ______ impairs heat regulation. Strenuous activity in a hot environment may cause heat stroke.
Atropine
Cholinergic Blocking Agents
Teaching implications
Pedi: Instruct parents or caregivers that ______ may cause fever and to notify health care professional before administering to a febrile child.
Atropine
Cholinergic Blocking Agents
Teaching implications
When giving ______, changes in urinary stream should be reported to health care professional.
Atropine
Pharmacologic: anticholinergics
Patient/Family Teaching
______ may cause drowsiness.
Atropine
Pharmacologic: anticholinergics
Patient/Family Teaching
Instruct patient that oral rinses, sugarless gum or candy, and frequent oral hygiene may help relieve dry mouth when taking ______,
Atropine
Pharmacologic: anticholinergics
Patient/Family Teaching
Caution patients that ______ impairs heat regulation. Strenuous activity in a hot environment may cause heat stroke.
Atropine
Pharmacologic: anticholinergics
Patient/Family Teaching
Instruct patient to consult health care professional before taking any OTC medications or herbal products concurrently with ______.
Atropine
Pharmacologic: anticholinergics
Patient/Family Teaching
Pedi: Instruct parents or caregivers that ______ may cause fever and to notify health care professional before administering to a febrile child.
Atropine
Pharmacologic: anticholinergics Patient/Family Teaching
Geri: Inform male patients with benign prostatic hyperplasia that ______ may cause urinary hesitancy & retention. Changes in urinary stream should be reported to HCP.
Atropine
Pharmacologic: anticholinergics Patient/Family Teaching
______ is indicated for adjunctive therapy in the treatment of PUD. Unlabelled Use: Antisecretory or antispasmodic agent.
Pro-Banthine
Pharmacologic: anticholinergics
Indications
Tensilon is used to dx ______ ______. It helps to ↓ muscular ______.
Myasthenia gravis
Weakeness
Cholinergic Agents
______ & ______ are used to treat myasthenia gravis, post-op retention/urinary retention.
Prostigmin & Mestinon
Cholinergic Agents
______ & ______ are used as an antidote for neuromuscular blockers.
Prostigmin & Mestinon
Cholinergic Agents
What would indicate an effective outcome for giving Prostigmin & Mestinon?
↓weakness
Ambulation
Effective chewing/swallowing
Cholinergic Agents
______ is the antidote for cholinergic drug overdose.
Atropine
Cholinergic Agents
↓BP, shock, and cardiac arrest after administration of cholingeric agents would indicate the usage of ______ for an antidote.
Atropine
Cholingeric Agents
Antidote/Antagonist
______ receptors regulate cardiac, arteriolar, bronchial, and GI smooth muscle.
Adrenergic
ADRENERGIC AGENTS
Effects of drugs – expected
Adrenergic Receptor Stimulation
Catecholamines and other direct-acting adrenergic; stimulate alpha and beta-adrenergic receptors directly
ADRENERGIC AGENTS
Effects of drugs – expected
Adrenergic Receptor Stimulation
Nonreepinephrine and alpha-agonists; act mainly on alpha-receptors, causing vasoconstriction of arterioles in skin, kidneys, mesentery, and splanchnic area;
ADRENERGIC AGENTS
Effects of drugs – expected
Adrenergic Receptor Stimulation
Beta-agonists - cause vasodilatation of arterioles supplying brain, heart, and skeletal muscles
ADRENERGIC AGENTS
Effects of drugs – expected
Adrenergic Receptor Stimulation
Epinephrine: acts on both alpha-and beta-receptors, causing a combined response of vasoconstriction and vasodilatation
ADRENERGIC AGENTS
Effects of drugs – expected
Adrenergic Receptor Stimulation
Dopamine and dopaminergic agonists: act on dopamine receptors in CNS: also act indirectly, stimulating norepinephrine release
ADRENERGIC AGENTS
Adverse effects of adrenergic drugs?
Restlessness, anxiety, dizziness, HA, insomnia, vertigo, palpitations, arrhythmias, tachycardia
ADRENERGIC AGENTS
Indications for dobutamine
Dobutamine (Dobutrex) IV only, it used to increase cardiac output in CHF and Cardiac open heart surgery.
ADRENERGIC AGENTS
Indications for dopamine
Dopamine is given IV for CHF and shock. It increases cardiac output (CO); monitor v/s, pulse-pulse and b/p should increase with systolic above 90.
ADRENERGIC AGENTS
Extravasation
happens when extravasted intravenous; tingling and numbness at IV site, change in color of skin and change in peripheral pulses. DC stat and start new IV.
ADRENERGIC AGENTS
What agents may be ordered initially for Parkinson's disease?
Anticholinergic agents
Antiparkinsonian Agents
relax skeletal muscles by disrupting nerve impulse transmission.
Neuromuscular Blocking Agents
Neuromuscular Blocking Agents
pt is conscious and aware of pain while on these blocking agents.....................
Neuromuscular Blocking Agents
Neuromuscular Blocking Agents
mimics acetylcholine to depolarize postsynaptic muscle membrane, resulting in repeated contractions followed by muscle paralysis
Depolarizing agent
Neuromuscular Blocking Agents
What agents block acetylcholine at cholinergic receptors in skeletal muscle membrane, preventing depolarization and contraction?
Nondepolarizing agents
Neuromuscular Blocking Agents
Pancuronium/Pavulon, Vecuronium/Norcuron
Nondepolarizing agents. Used as muscle relaxants. Called also competitive drugs
Neuromuscular Blocking Agents
Beta1
B1 receptors are located mainly in the heart
Adrenergic Agents
Beta 2
B2 receptors mediate the actions of catecholamines on smooth muscle, especially bronchioles and arterial smooth muscle
Adrenergic Agents
B-adrenergic activity
Cardiac acceleration and increased contractility (B1)
Vasodilatation of arterioles supplying skeletal muscles (B2)
Bronchial relaxation (B2)
Uterine relaxation (B2)
Adrenergic Agents
What is the Beta 1 activity of Dobutrex?
Dobutamine ( Dobutrex) IV only; increases cardiac output in CHF
Adrenergic Agents
Beta 1 activity
Norepinephrine (Levophed) tx of hypotension and shock; watch for extravasation
Adrenergic Agents
Beta 1 activity
Epinephrine IV IM SQ - bronchiodilation; asthma attacks, anaphylactic reaction, cardiac arrest
Adrenergic Agents
Beta 1 activity
Isoproterenol (Isuprel) - long acting, least toxic that epinephrine; tx asthma, shock, & cardiac arrest
Adrenergic Agents
Beta 2 activity
Epinephrine - vasodilatation
Ritodrine (Yutopar) - preterm labor; decrease contractions
Adrenergic Agents
What is the Beta 2 activity of adrenergic drugs Brethine/Bricanyl and Bronkosol?
Terbutaline (Brethaire, Bricanyl) - Bronchiodilation, Management of preterm labor
Isoetharine (Bronkosol) Bronchodilator
Adrenergic Agents
Ergotamine
tx of migraines, given medication earlier to maximize effect, 2 mg Po of SL the 2 mg q 30min PRN until relieved or a max dose of 6 mg
Adrenergic Blocking Agents
Levodopa
Is the most effective dopaminergic drug; make take several weeks or months to reach it maximum effectiveness.
Antiparkinsonian Agents
What is a s/sx of an OD of Levodopa?
Eye winking
Antiparkinsonian Agents
Drugs that should be avoided when using Levodopa are?
Pyridoxine (B6) and demerol
Antiparkinsonian Agents
What are the therapeutic effects of Cogentin?
↓of rigidity & tremors
Antiparkinsonian Agents
______ act as a depolarizing agent.
Succinylcholine /Anectine
Neuromuscular Blocking Agents
Examples of expected responses of neuromascular blocking agent
•To relax skeletal muscles during surgery
•To reduce intensity of muscle spasms in drug or electrically induced convulsions
•paralyze diaphragm and intercostals muscles
Neuromuscular Blocking Agents
Hypotension, bronchospams, ↑bronchial & salivary secretions are adverse effects of ______ ______.
Nondepolarizing agents
Neuromuscular Blocking Agents
The drug of choice for short term muscle relaxation for intubation or ECT
Succinylcholine suc·ci·nyl·cho·line (anectine)
Neuromuscular Blocking Agents
Onset of action of Succinylcholine (suk″sĭ-nil-ko´lēn)
within 30-60 seconds
Neuromuscular Blocking Agents
Beta blockers use with caution in?
Bronchospastic Diseases (emphysema and asthma)
Do not use in emphysema
Adrenergic Blocking Agents
Beta-blockers - when are they contraindicated?
CHF, sinus bradycardia, heart block, cardiogenic shock, bronchospastic disease (such as asthma or emphysema). Use precaution when pt is diabetic
Adrenergic Blocking Agents
Therapeutic effects of adrenergic blocking agent drugs?
The triptans bind to serotonin (5-HT) receptors, producing vasoconstriction, which is effective in aborting a migraine headache. They treat migraines by constricting cranial vessels.
Adrenergic Blocking Agents
Types of adrenergic blocking drugs
Phentolamine (Regitine)
Ergoloid (Hydergine)
Ergotamine (Ergotamine)
Adrenergic Blocking Agents
Adrenergic Blocking Agents treat?
Reynaud’s disease, HTN secondary to pheochromocytoma, and migraine
Adrenergic Blocking Agents
Teaching involved with anticholinergics?
If discontinued, ↓ dose gradually. Abrupt withdrawal can produce confusion, exhaustion, exacerbation of symptoms.
Antiparkinsonian Agents
Coming off drug
Teaching involved with anticholinergics regarding dry mouth?
Instruct pt that frequent rinses, sugarless gum or candy, and good oral hygiene may help relieve dry mouth.
Antiparkinsonian Agents
Teaching involved with anticholinergics regarding alertness?
May cause drowsiness. Caution pt to avoid driving or other activities requiring alertness until response to medication is known.
Antiparkinsonian Agents
Parameters to hold beta-blockers
Check apical pulse rate before administering beta-blocker; if less than 50 bpm inform physician before proceeding
Teaching regarding "On-off" syndrome for Levadopa?
On-off syndrome refers to a complication following prolonged levodopa therapy (2 yrs or more). During therapy, the client fluctuates from being symptom free “on” to demonstrating full-blown Parkinson’s symptoms “off”.
Antiparkinsonian Agents
Teaching aspects for adding carbidopa to Levadopa?
If pt is switching from levodopa alone to carbidopa-levodopa, discontinue levodopa for at least 8 hrs before starting combination therapy
Antiparkinsonian Agents

Teaching about urine color regarding Levadopa?
Levodopa may cause harmless darkening of urine and sweat
Antiparkinsonian Agents
The lab value to monitor during succinylcholine infusion?
serum K
Neuromuscular Blocking Agents
Duration of action of Succinylcholine (anectine)
5 minutes
Neuromuscular Blocking Agents
Interventions to protect the airway of patient using Neuromuscular Blocking Agents?
Endotracheal equipment, suction, O2, and mechanical ventilator available for emergency to protect the airway
Neuromuscular Blocking Agents
acts directed on skeletal muscle, causing relaxation by decreasing calcium release from sarcoplasmic reticulum in muscle cells.
Dantrium
Skeletal muscle Relaxants
______ is a drug that reduces release of calcium.
Dantrium
Skeletal muscle relaxants
Why is (Sinemet) Carbidopa-levodopa used in combination?
combination drug; allows more levadopa to be converted to dopamine in the brain;
Antiparkinsonian Agents
If patient is switching from levodopa alone to sinemet wait at least ___ hrs before staring the combination therapy.
8 hours
Antiparkinsonian Agents
What is the first sign of overdose when using Sinemet?
A/R Fasciculation - muscle twinking is first sign of overdose.
Antiparkinsonian Agents
Methocarbamol (Robaxin) PO onset
30 min
Skeletal muscle Relaxants
Cyclobenzapine hydrochloride (Flexeril)- PO onset
within 1 hr
Skeletal muscle Relaxants
What skeletal muscle relaxant drug is taken short term, No longer than 3 weeks?
Cyclobenzaprine hydrochloride (Flexeril)
Skeletal muscle Relaxants
Phenytoin (Dilantin)
Can not be administered with
Do NOT mix with D5W -

If D5W is dripping, flush lock with N/S before and after IVP Dilantin
A pt starts developing rash after receiving Phenytoin (Dilantin) what may the RN expect to see next, and what should the RN do about it?
Suspect Stevens-Johnson Syndrome - Rash turns into blisters. Immediately DC Dilantin and call doc.
Anticonvulsants
Phenytoin (Dilantin) Side effects
Ataxia, slurred speech, confusion, nystagmus, blurred vision, gigival hyperplasia, N/V, blood disorders, hepatitis, hirsutism.
Anticonvulsants
Dilantin toxicity increases with these drugs
Cimetidine, allopurinol, disulfiram, fluconazole, isoniazid, omeprazole, sulfonamides, oral anticoagulants, chloramphenicol, valproic acid, amiodarone.
These drugs are made less effective when taken with a hydantoin (Dilantin)
Hormonal Contraceptives (use another BC), Oral Anticoagulants, levodopa, amiodarone, corticosteroids, doxycycline, methadone, metyrapone, quinidine, theophylline, thyroid hormone, valproic acid, cyclosporine, and carbamazepine.
Anticonvulsants work (mostly) in 2 major ways:
Stabilize nerve cells to prevent overexcitedness.

Elevate seizure threshold by decreasing postsynaptic excitation.
Be alert for this with seizure meds:
Drowsiness.

Makes sense - it puts the brain (and nerve connections) partly to sleep to keep them from going haywire.
When should seizure meds be discontinued? How?
Except for Stevens-Johnson syndrome, never discontinue any seizure med abruptly - can CAUSE seizures.
For which seizures are anticonvulsant meds NOT used?
Fever (Febrile)
Hypoglycemic (Low Blood Sugar)
When should you eat with a seizure med?
Always take with food - can cause upset stomach.
How much alcohol can safely be consumed with anticonvulsants?
NONE. Do not decrease, ELIMINATE drinking.
Why is mouth care important with Dilantin?
Gingival Hyperplasia / Gum hypertrophy - gum overgrowth. Brush, floss, see the dentist.
Anticonvulsants
Where can you give Dilantin IV?
Big Veins - stay away from back of hands. It is very irritating to veins.
What do hydantoins (including Dilantin) do to the heart?
Can CAUSE
Bradycardia, hypotension, and cardiac arrest with IV administration.
Cause deressed arial and ventricular conduction.
Toxic - Ventricular fibrillation.
Dilantin IV - alert for what S/S
EKG,vital signs, blood pressure, watch for rash - Stevens-Johnson syndrome.
Anticholinergic drugs that compete with acetylcholine at cholinergic receptors. Used as muscle relaxants are called?
Nondepolarizing agents
These saying help the RN student recall Cholinergic blocking agents' adverse reactions that suggest CNS toxicity?
Blind as a bat, dry as a bone, hot as a hare, mad as a hatter