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36 Cards in this Set
- Front
- Back
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Describe the medication education needed for the pt with myasthenia gravis prescribed a cholinergic medication.
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*Meds should be taken exactly as ordered; 30 min before meals to minimize GI upset
*Intervals between doses of meds should be timed consistently to optimize therapeutic effects and minimize AE and toxicity |
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Myasathenia Gravis:
When to call HCP |
Increased muscle weakness
Abd cramps Diarrhea Dizziness Ataxia Difficulty breathing |
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Myasathenia Gravis:
s/s of improvement |
Decrease in or absence of ptosis (eyelid drooping) and diplopia (double vision
Less difficulty swallowing and chewing Improvement in muscle weakness |
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Cholinergic meds:
Contraindications |
Known drug allergy
GI or GU tract obstruction Bradycardia Defects in cardiac impulse conduction Hyperthyroidism Epilepsy Hypotension COPD Parkinson's disease |
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Cholinergic meds:
Adverse Effects |
CV -- Bradycardia, hypotension, conduction abnormalities (AV block and cardiac arrest)
CNS -- h/a, dizziness, convulsions GI -- Abd cramps, increased secretions, nausea, vomiting Resp -- Increased bronchial secretions, bronchospasms Other -- Lacrimation, sweating, salivation, loss of ocular accommodation, miosis |
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Cholinergic meds:
Antidote |
Atropine
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Anti-cholinergic meds:
Mechanism of Action |
Block the action of neurotransmitter acetylcholine at the muscarinic receptors in the PNS. Acetylcholine released from a stimulated nerve fiber is then unable to bind to the receptor site and fails to produce a cholinergic effect.
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Anti-cholinergic meds:
Indications |
Insert something here |
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Anti-cholinergic meds:
Contraindications |
Known drug allergy
Angle-closure glaucoma Acute asthma or other resp distress myasthenia gravis acute CV instability GI or GU tract obstruction |
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Anti-cholinergic meds:
Adverse Effects |
CV -- increased HR, dysrhythmias
CNS -- CNS excitation, restlessness, irritability, disorientation, hallucinations, delirium Eye -- Dilated pupils, decreased visual accommodation, increased intraocular pressure GI -- Decreased salivation, gastric secretions, motility GU -- Urinary retention Glandular -- Decreased sweating Resp -- Decreased bronchial secretions |
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Adrenergic Alpha-Blockers:
Mechanism of Action |
Interrupt the stimulation of the SNS at the alpha(1)-adrenergic receptors. They work either by direct competition with the SNS neurotransmitter norepinephrine or by a noncompetitive process.
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Adrenergic Alpha-Blockers:
Indications |
Respiratory
Topical nasal decongestants Opthalmic (open-angle glaucoma) CV (support CV system during cardiac failure) |
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Adrenergic Alpha-Blockers:
Intended Effects |
Stimulation of beta(2) adrenergic receptors located on the bronchial, uterine and vascular smooth muscles (asthma, bronchitis). Nasal and opthalmic causes the constriction of dilated arterioles and a reduction in nasal blood flow, decreasing congestion (opthalmic is same)
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Adrenergic Alpha-Blockers:
Nursing Implications |
Patient hx
HTN CV dysrhythmias CV disease VS Peripheral pulse Skin color Cap refill |
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Adrenergic Alpha-Blockers:
TX of BPH and HTN |
Insert something here |
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Betamethazone |
Pre-term labor |
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Hep B Vaccination Contraindicated for allergy to . . . |
Yeast |
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Gentamicin TC: Anti-infectives PC: Aminoglycosides |
TX of serious gram-neg bacillary infections and infections caused by staphylococci when PCNs or other less toxic drugs are contraindicated. In combo with other agents in the mgmt of serious enterococcal infections. AE: ataxia, ototoxicity, nephrotoxicity. Inactivated by PCNs. Report s/s of tinnitus, vertigo, hearing loss, rash, dizziness or difficulty urinating. Drink plenty of fluids. |
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Vasopressin TC: Hormones PC: Antidiuretic hormones |
IND: Central diabetes insipidus d/t deficient antidiuretic hormone. Action: Alters the permeability of the renal collecting ducts, allowing reabsorption of water; directly stimulates musculature of GI tract; in high doses acts as a non-adrenergic peripheral vasoconstrictor. AE: Dizziness, pounding sensation in head, MI, angina, chest pain, N/V/D, abd cramps NI: Monitor BP, HR, ECG. For Diab Insip--monitor urine osmolality and urine volume; assess for s/s of dehydration. Monitor urine specific gravity. |
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Prednisone TC: antiasmatics, corticosteroids PC: cordicosteroids (systemic) |
Glucocorticoid Serum K levels decrease BG levels increase |
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Methotrexate TC: antineoplastics, antirheumatics (DMARDs), immunosuppressants PC: antimetabolites |
IND: Cx; RA Action: Interferes with folic acid metabolism AE: anorexia; hepatotoxicity; N/V; stomatitis; anemia; leukopenia; thrombocytopenia; nephropathy DI: NSAIDs, salicylates, sulfonylureas Monitor: VS, s/s pulmonary toxicity, gout, I/Os, renal & hepatic fxn |
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Statins Atorvastatin (Lipitor) Antilipemic drugs |
IND: Inc. HDL and dec LDL CI: Liver dz; elevated liver enzymes AE: H/A; dizziness; blurred vision; fatigue; nightmares; insomnia; constipation; diarrhea; nausea; changes in bowel fxn; myalgias; skin rashes. (AE)Rhabdomyolysis: breakdown of muscle protein |
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Morphine TC: opioid analgesics PC: opioid agonists Schedule II |
IND: Severe pain; pulmonary edema AE: confusion; sedation; respiratory depression; hypotension; constipation; urinary retention; flushing; itching; sweating Monitor: VS; hold for RR<10 |
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Baclofen TC: antispasticity agents, skeletal muscle relaxants |
IND: TX of severe spasticity of cerebral palsy |
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Hydromorphone (Dilaudid) TC: allergy, cold and cough remedies (antitussives), opioid analgesics; PC: opioid agonists Schedule II |
IND: moderate to severe pain; ER product for opioid-tolerant pts requiring around-the-clock mgmt of persistent pain NI: Assess BP, P, RR before admin; if RR <10/min, assess level of sedation |
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Codeine TC: allergy, cold and cough remedies, antitussives, opioid analgesics PC: opioid agonists |
IND: mgmt of mild to moderate pain AE: confusion; sedation; blurred vision; diplopia; hypotension; constipation; nausea; vomiting; urinary retention NI: Assess BP |
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-prils |
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Beta Blockers |
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Zidovudine (AZT) TC: antiretrovirals PC: nucleoside reverse transcriptase inhibitors |
IND: HIV
AE: Seizures; h/a; weakness; depression; syncope; hepatomegaly; pancreatitis; abd pain; N/V/D; anemia; granulocytopenia NI: Monitor CBC q2weeks; monitor serum amylase, lipase and triglycerides (elevation = pancreatitis); lactic acidosis may occur with hepatic toxicity PtE: Notify HCP immediately if SOB, muscle aches, sx of hepatitis or pancreatitis or other unexpected rxns occur |
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Epoetin Alfa Epogen, Procrit PC: Human recombinant hormone analogue |
IND: chemo-induced anemia; anemia associated with chronic renal failure; AZT therapy (HIV); reduction of need for blood transfusions in surgical pts. Action: causes the progenitor cells in the bone marrow to manufacture large numbers of immature RBCs and to greatly speed up their maturation; pts should also receive iron supplement AE: hypertension; edema; anorexia; N/V/D; alopecia; rash; cough; dyspnea; sore throat; fever; blood dyscrasias; h/a; bone pain |
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Carvedilol TC: antihypertensives PC: beta blockers |
IND: HTN; HF /c digoxin, diuretics and ACE inhibitors; left ventricular dysfxn after MI. Action: Blocks stimulation of beta1 (myocardial) and beta2 (pulmonary, vascular, uterine) -adrenergic receptor sites. Therapeutic effects: dec HR and BP; improved cardiac output, slowing of the progression of HF; decreased risk of death AE: Dizziness, fatigue, weakness, blurred vision; bradycardia; HF; pulmonary edema; diarrhea; S-J syndrome; toxic epidermal necrolysis; hyperglycemia; anaphylaxis; angioedema NI: Monitor BP, P; assess for orthostatic hypotension; monitor I/Os; may cause inc BUN, serum lipoprotein, K, triglyceride & uric acid levels PtE: Do not abruptly stop meds |
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Salicylates Aspirin TC: antipyretics, nonopioid analgesics PC: salicylates |
IND: inflammatory d/o; RA; OA; mild to mod pain; fever; prophylaxis of transient ischemia attacks and MI AE: tinnitus; GI bleeding; dyspepsia; epigastric distress, nausea; anemia; hemolysis; inc bleeding time; anaphylaxis; laryngeal edema NI: Assess for rash (S-J) PtE: EtOH may inc risk of GI bleeding |
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Acetaminophen |
Chronic excessive use of >4g/day (2g in chronic alcoholics) may lead to hepatotoxicity, renal or cardiac damage |
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Neostigmine (Prostigmin) TC: antimyasthemics PC: cholinergics |
IND: Improvement in muscle strength in symptomatic tx of myasthenia gravis AE: bronchospasm; seizures; excess secretions; bradycardia; hypotension; abd cramps; N/V/D; excess salivation; sweating Antidote: atropine |
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Amitriptyline TC: antidepressants PC: tricyclic antidepressants |
Action: Potentiates the effect of serotonin and norepinephrine in the CNS; has significant anticholinergic properties; antidepressant action. Contraindicated: angle-closure glaucoma AE: suicidal thoughts; lethargy; sedation; blurred vision; dry eyes; dry mouth; arrhythmias; hypotension; constipation NI: Assess fasting glucose and cholesterol levels in overweight individuals; monitor BP & P, notify HCP of decreases in BP (10-20 mmHg) or sudden increase in P; monitor mental status; assess for suicidal tendencies |
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Theophylline TC: bronchodilators PC: xanthines |
IND: long-term control of reversible airway obstruction caused by asthma or COPD AE: Seizures; anxiety; arrhythmias; tachycardia; nausea; vomiting |
