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86 Cards in this Set
- Front
- Back
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Sympathomimetics help with? SubQ, IM IV inhalation.
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ACUTE BRONCHOSPASM! Almost every asthma Pt uses these drugs. long duration of use when used alone increases risk of asthma related death.
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Sympathomimetics contraindications?
Adverse effects? |
Pts with arrhythmias, diabetes, cardiac disease. Increased HR, BP, CNS stimulation, nervousness, tremor, GI upset, nausea, ... etc.
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Drug to drug for Sympathomimetics?
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general anesthesics.
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Anticholinergic Bronchodilators? (off label use for asthma.)
inhaled, PO. 30 sec onset 6m peak 6h duration |
Ipratropium (Atrovent) & Tiotropium (Spiriva) -COPD
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Pts with peanut allergy should avoid which drugs?
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Atrovent HFA & Combivent b/c of Soya.
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Adverse effects of Anticholinergic drugs?
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anything anticholinergic effects - dizziness, headache, fatigue, nervousness, dry mouth, sore throat, palpitations, urinary retention, CV effects.
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Inhaled Steroids i.e Glucocorticoids (asthma).
inhaled IV or PO. |
Budesonide (Pulmicort), Fluticasone (Flovent), Treamcinolone (Azmacort). All Pts with severe asthma should use daily.
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Glucocorticoids can take how long to reach max effects?
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2 to 3 weeks.
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AE for Glucocorticoids?
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sore throat, adrenal suppression and bone loss, oropharyngeal candidiasis and dysphoria. retardation of growth. increase risk of cataracts and glaucoma in prolonged therapy.
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Leukotriene Receptor Antagonists?
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Zafirlukast (Accolade) & Montelukast (Singulair).
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Leukotriene Receptor Antagonists? main use?
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prophylaxis and chronic Tx of asthma. Asthma allergies.
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AE in leukotriene receptor antagonists?
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headache, dizziness, myalgia, nausea, diarrhea, abd pain, vomiting, liver toxicity, generalized pain.
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Drug to Drug in leukotriene receptor antagonists?
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propanolol, theophylline, warfarin, aspirin, any Ca+ Ch. blockers, and cyclosporine. LOOK FOR ELEVATED ENZYMES
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Mast Cell Stabilizers? Inhaled. Prevent! Alt. to inhaled glucocorticoids prevent attacks not help during. Chronic asthma Tx.
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Cromolyn (Intal) & Nedocromil (Tilade) NO BRONCHODILATOR - suppresses bronchial inflammation.
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Uses? Mast Cell Stabalizers?
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Chronic asthma. No in pts allergic. Never acute attacks! Rare AE.
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An ED physician has ordered a sympathomimetic (epinephrine) for a Pt who is having an acute asthma attack. The nurse is aware that this classification of drug will:
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Cause dilation of the bronchi with increased rate and depth of respirations.
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A Pt is going home with a new Rx for Propanolol the Nurse should include what info when teaching the Pt about this drug?
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Change positions slowly d/t possible hypotension.
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Which of the following Pts should be advised by the RN that OTC cold and allergy preps may contain Phenylephrine and should be avoided? 47 yr with hypertension 52yr with Type 2 diabetes 17yr with symptoms of Upper Resp Infection 62y. with gout?
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47 yr old with hypertension
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When caring for a Pt recieving Bethanechol the RN will include which teaching points?
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Take med in divided doeses during the day.
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Pt taking Advair which is a glucocorticoid and Beta2 agonist combine drug used for asthma prophylaxis? T or F?
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True.
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What are the four primary neurotransmitters of the PNS?
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epi, norepi, dopamine, and acetylcholine.
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Primary physiologic effects when PNS is activated?
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pupil constriction, decreased rate and force of contractility in <3, bronchoconstriction & secretions, sphincter relaxation and increased pressure (urination), increased peristalsis.
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Primary physiologic effects when SNS is activated?
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pupil dilation, increased rate and force of contractility in <3, bronchodilation, sphincter contraction, decreased peristalsis, contraction of the prostate.
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what neurotransmitter activates muscarinic receptors?
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acetylcholine
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what are the four subtypes of adrenergic receptors?
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alpha 1 and 2 and beta 1 and 2.
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What neurotransmitters activate adrenergic receptors?
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epi, norepi, and dopamine
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What type of drug is Bethanechol and what is it used for?
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muscarinic agonist. parasympathomimetic, used to Tx urinary retention.
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What AE can be seen after admin. of Bethanechol?
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bradycardia, hypotension, bronchoconstriction (asthmatics) and abd cramping.
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What is the prototype muscarinic antagonist (anticholinergic)?
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atropine
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What are reasons why atropine is administered?
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vagal induced bradycardia, preop to decrease secretions, counteract side effects of cholinergic meds.
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What is the prototype adrenergic agonist? why is it used?
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epi. to increase BP during schock states, anaphylaxis, cardiac arrest, local use to reduce peripheral bleeding.
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How does the prototype adrenergic agonist work to counteract the symptoms of anaphylaxis?
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epi. activates all four adrenergic receptors but primarily vasoconstricts vessels to decrease swelling, angioedema, and increase BP.
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Adrenergic agonists like Daxozosin and Przosin are primarily used for what conditions? How do they work?
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Block alpha 1 receptors to couse vasodilation and or prostate relaxation to treat Hypertension and BPH.
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When would topical nasal steroid decongestants be contraindicated?
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Active infections.
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What is the definition of asthma? What happens in the lungs during an attack?
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Chronic disease characterized by exacerbations airway inflammation, constricion and mucus production. obstructive disorder.
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What are MDIs? DPIs? Nebulizers? What is the appropriate way to use each device?
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MDI- handheld deliver set dose with each puff. DPI handheld, breath activated, delivers set does with each inhalation, counts actuations.Nebulizer converts drug solution into ist may req mask
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Beta2 adrenergic agonists (asthma drug)
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Albuterol. Prophylaxis and acute atttack.
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Xanthines (asthma drug)
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Theophylline prophylaxis.
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Glucocorticoids (asthma drug)
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Pulmicort, Flovent, Beclovent prophylaxis
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Mast Cell Stabalizers (athma drug).
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Cromolyn prophylaxis.
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Leukotriene modifiers (asthma drug)
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Singulair prophylaxis.
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Muscarinic antagonists (asthma drug)
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Atrovent prophylaxis
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What are H2 antagonists? what are their effects and possible side effects?
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Cimetidien. decrease the volume of acid released from histamine cells in the lining of the stomach Used for PUD, GERD, surgical prophylaxis, SE increased risk of pneumonia.
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What are proton pump inhibitors? what are their effects and possible side effects?
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Omperazole (prilosec) decrease gastric acid production used for PUD, GERD.
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How do antacids work? Why are they given?
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Alkaline compounds that contain magnesium or aluminum to neutralize acids in the somtach, Used for PUD GERD surgical prophylaxis.
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Do not give laxatives when?
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sudden symptoms of n/v and abd cramping b/c it could be related to bowel obstruction.
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How do the diff types of laxatives work?
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Bulk forming- increas vol of fecal matter causing peristalsis
Stimulant- increase water secretion stim. peristalsis Osmotic-draws water into intestine and stim. peris. (like stimulant). Surfactant-break down fecal mass to allow water to penetrate(opp. of bulk forming) |
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Drug int. with Adrenergic agonists(epi) alpha1 specific agonists(phenylephrine) &alpha2specific agonists(clonidine)
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Other drugs that stimulate SNS --- MAOIs, Tricyclics.
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Drug interactions of adrenergic antagonists(Lebatolol)?
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Diabetic agents, Ca+ Ch. blockers.
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Drug ints. of Alpha1 specific blockers (Doxazosin)?
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Antihypertensive agents, vasodilators
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Antitussive drug Intx.
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Alcohol, other sedatives.q
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Neuropharmacology
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study of drugs that alter processes controlled by the NS.
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Sympathetic Nervous System contains? (3).
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adrenergic, sympathomimetic, catecholamines.
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PNS contains? (3).
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Cholinergic, muscarinic, parasympathomimetic.
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cholinergic for what neurotransmitter?
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acetylcholine
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adrenergic for what neurotransmitters?
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epi and norepi.
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Muscarinic Agonists (Parasympathomimetics). ? and AE?
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Bethanechol, Pilocarpine, Pyrostigmine. AE nausea, vomiting, cramps, bradycardia, involuntary defecation, heart block, hypotenstion, dysrhythmias in hyperthyroid pts.
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Muscarinic Antagonists? Tx of? Anticholinergics. Used to block PNS.
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Atropine. Tx of preanesthetic med, disorders of the eye, bradycardia, intestinal hyperonicity, and muscarinic agonist poisoning. Overactive bladder Tx. Caution with antihistamines, antipsychotics, tricyclic antidepressents.
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Alpha and Beta Adrenergic Agonists? Drug to drug?
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Epi, norepi, dopamine, dobutamine, ephedrine. NO AMO inhibitors. general anesthetics, alpha adrenergic blocking agents, beta adrenergic blocking agents.
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Adrenergic Agonists? (SNS)
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Catecholamines-epi,norepi, dopamine, debutamine. (not PO cannot cross bbb) Noncatecholamines- ephedrine, phenylephrine, trebutamine. (cross bbb).
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Whats dangerous with alpha beta agonist drugs?
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OTC meds with phenylephrine and ephedrine. Alpha1 monitor carefully (<3).
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Adrenergic Antagonist Alpha1 selective adrenergic blocking agents
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Prazosin (essential hypertension), Doxazosin (hypertesion, BPH). Tamsulosin (BPH only) ALWAYS SCREEN FOR TOXICITY!!
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Beta adrenergic blocking agents
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Propranolol nonselective. decreases <3 contractility and chance of arrhythmias. Also for fainting and stage fright.
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Beta selective adrenergic blocking agents PO, IV.
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Metoprolol. and Atenolol. Use wijth Pts with asthma, smokers, seasonal rhinnitis. drug- not with lidocaine!
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Indirect acting antiadrenergic agents?
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Reserpine. nonspecific. used for hypertension. AE:SEVERE DEPRESSION.
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Indirect acting antiadrenergic agents besides reserpine...
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Clonidine. use for hypertension. PO or transdermal patch. AE drowsiness, rebound hypertenstion. NO inprego.
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Peptic ulcers main cause? any other aggressors?
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H. Pylori but not all ppl with have ulcers. Yes. NSAIDS, gastric acid, pepsin, and smoking(delays ulcer healing)
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Histamine2 antagonist(Peptic ulcers)...AE..
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Cimetidien, Ranitidine, and Famotidine. food decreases absorption. pneumonia rare. hallucinations, confusion, dizziness, etc.
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antibacterial drugs.. and a couple AE.
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Amoxicillin (AE diarrhea). Clarithromycin (suppress growth) Bismuth (blk discoloration to tongue and stool) Tetracycline (stain devel. teeth)
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Proton Pump inhibitors.. what do they do?
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Omeprazole, Esomeprazole, Lansoprazole(app. in children) block enzymes.
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Proton pump inhibitors cant be what?
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prescribed more than one at a time.
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Antiulcer agents
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sucralfate promotes ulcer healing. MINIMAL Side effects. drug to drug antacids atleast 30m b4 2hr apart from phenytoin theophylline, digoxin, warfarin, antibiotics.
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prostaglandins? what does it do?
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misoprostol. prevention of NSAID induced gastric ulcers. AE may induce labor and cause abortions!!!!
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Antacids? What do they do?
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Sodium bicarbonate. calcium carbonate, magnesium salts. neutralizes stomach acid.not with anything that might affect absorption.
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Bulk laxatives
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polycarbophil (fibercon) and psyllium(metamucil) temp Tx. in Pts with IBS and Diverticulosis.
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Surfactant Laxatives
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Docusate "cleaner" prior to procedure. With full glass water!
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Chemical Stimulant Laxatives
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Bisacodyl(Ducolax) Castor Oil
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Osmotic laxatives
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magnesium salts, polyethylene glycol AE electrolyte imbalance, dehydration
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Antiemetics.
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Ondansetron(Zofran), Prochlorperazin, and Metoclopramide. Controlling N/V. work within brain. IV or suppository.
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Serotonin Receptor Antagonist (antiemetic)
ACUTE EMESIS. |
Ondansetron (Zofran). helps with drug induced n/v. even more effective with dexamethasone.
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Dopamine Antagonist(phenothiazones) antiemetic...
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Prochlorperazine (compazine) AE: sedation
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Dopamine Antagonists (Nonphenothiazines) antiemetic...Pt with a lot of nausea.
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Metoclopramide (reglan) speeds gastric emptying.AE can affect absorption.
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In Antiemetics. Nursing considerations
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Monitor I&O, CNS effects, and lab values.
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Antidiarrheal drugs
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loperamide(Imodium), Bismuth Subsalicylate (Pepto-Bismol) and Opium Derivatives.
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Caution with antidiarrheals in?
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Prego. GI obstruction, abd pain, diarrhea d/t poisoning..
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Prokinetic agent (GI stimulants)
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metoclopramide (reglan) (also a dopamine antagonist). Helps speed gastric emptying. GERD. After Barium...
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