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Pharm1 17-20extra
Pharm1 Chapters 17-20 extra
| Question | Answer |
|---|---|
| positive inotropic effect | increased force of contraction |
| positive chronotropic effect | inc heart rate |
| positive dromotropic effect | increased conduction through the AV node |
| what is pseudoephedrine? | sudafed--constricts dilated arterioles in the nose acts as decongestant (alpha 1 vasoconstrictors inc BP). Its also a broncodialator. |
| What do B1 and B2 refer to with adrenergic drugs? | B1's act on the heart. B2's are bronchdialators. |
| Phenylephedrine (neo-synephrine)? | A1-vasoconstrictor, raises BP, no cardiac stimulation |
| What is salmeterol used for? | prevention of asthma attcks |
| What does inhaled isoproterenol do (important for patient teaching)? | turns sputum or saliva pink |
| LOC | level of consciousness |
| What happens when the adrenergic dopaminergic receptors are stimulated with dopamine? | At low doses, vessels of the renal, mesenteric, coronary, and cerebral arteries dilate--increasing blood flow to these areas. At higher doses, dopamine can improve contractility and cardiac output. |
| What breaks down catecholamines stopping adrenergic reactions? | they are metabolized (broken down) by Monoamine oxidase (MAO) and catechol ortho-methyltransferase (COMT). They can also be taken back up by the nerve ending by active transport. If adrenergics are used with MAOI's hypertensive crises can occur. |
| Which receptors are responsible for decreasing insulin release from the pancreas? | when Alpha-2 receptors are adrenergically stimulated less insulin is released |
| What is useful for the tx of glaucoma? | Adrenergics, they cause mydriasis (pupil dilation) and reduce intraocular pressure. They also are used to temporarily relieve conjunctival congestion by causing the blood vessels to constrict(relieves redness and itching) |
| What are the adverse effects of adrenergics? | chest pain, palpitaions, blurred vision, headaches, seizures or hallucinations should be reported right away. Dysrhythmias, anorexia, dry mouth, N, V, sometimes taste changes may also occur. |
| What is used to treat infiltration of dopamine? | Phenotolamine (Regitine)--an alpha blocker causes the vessels to dilate--restores blood flow. |
| What are example of alpha-blocking drugs that are used as antihypertensives b/c they cause vasodilation? | doxazosin, prazosin, and terazosin. Tamsulosin is the alpha blocker used exclusively to treat BPH, b/c it dilates the vessels related to the bladder and urethra. |
| The ergot alkoloids are a different type of alpha bocker, what do they do? | constrict blood vessels (dilated arterioles) in the brain to ease pain of migrains also used as oxytoxics to control post-partum bleeding, whereas most alpha blockers dilate blood vessels. |
| What is pheocarcinoma? And what 3 other syndromes in addition to it all benefit from alpha-blockers? | An epi. Secreting tumor that sits on the adrenal gland. Raynaud's disease, acrocyanosis, and frost bite. Phenoxybenzimine is the alpha-blocker of choice for these syndromes. |
| Which drugs end in -olol? | Beta blocking drugs. |
| What do beta blockers do in the lungs? | Cause bronchioles to constrict leading to shortness of breath |
| Beta 1 blockers do wht in the heart? | So conduction at the SA node and the AV node |
| What is given via IV for the management of bradycardia induced from oral overdose of beta-blockers? | Atropine, an anticholinergic med aka antimuscarinic (the stomach should also be emptied asap, beta-blockers may also be removed by dialysis). Atropine is also used preoperatively to reduce salivation and GI secretions, as is glycopyrrolate. |
| What adrenergic-blocking drug is given to pt's immediately following MI? | Acebutolol (sectral)--said to be carioprotective against the catecholamines that are released from the heart during MI. Metoprolol (Lopressor) is another beta-blocker that may be used. |
| What is the newest beta-blocker that is most commonly added to digoxin, furosemide, and ACE inhibitors to treat hear failure? | Carvedilol (Coreg) |
| When taking beta-blockers, what should pt's contact their doctor for in regard to side effects? | if they experience palpitations, chest pain, confusion, weight gain, dyspnea, N, V, swelling in the feet/ankles, SOB, excessive fatigue, dizziness, and syncope |
| What should PT's on beta-blockers be advised to do to avoid sycope or dizziness? | change positions slowly. Exercise, exposure to heat in the environment (sauna or tanning bed), and alcohol--all of these may lead to greater vasodilation and further drop in BP). |
| What is meant by "cardioselective beta-blockers"? | They block only the Beta1-adrenergic receptors to decrease heart rate and cardiac conduction. There is no bronchoconstriction. |
| What must a PT coming off a beta blocker do to avoid rebound hypertension? | wean off the med slowly |
| At just the right dosages cholineric med stimulate the muscarinic receptors, what happens when the doses are high? | The nicotinic receptors are stimulated and many of the undesirable effects occur. |
| Cholineric drugs stimulate muscle contraction and inhibit AChE, making them useful for what 2 purposes? | for tx of myasthenia gravis (they should experience less ptosis (eyelid drooping) and diplopia (dbl vision) and reversal of NMBAs. |
| What is considerd to be the antidote for anticholinergic poisining as well as poisining by irreversible cholinesterase inhibitors such as the organophosphates and carbonates of insecticides? | physostigmine |
| What cholinergic is often used on alzheimers PTs to increase the concentrations of Ach in the brain? | Donepezil (Aricept), Razadyne (galantamine--caution should be exercised with this drug for pts with renal or hepatic issues), and Memantine (Nomenda--a NMDA drug), and rivastigmine (Exelon) |
| What makes the use of cholinergic contraindicated? | GI or GU obstruction, bradycardia, defects in cardiac impulse, hyperthyroidism, epilepsy, COPD, and PD |
| What are the signs of cholinergic crises? | circulatory collapse, hypotension, bloody diahrrea, shock, and cardiac arrest. |
| Which cholinergi is used for sever tricyclic antidepressant overdoses and to reverse NMBAs? | physostigmine (Antilirium) |
| What will help PT's to avoid negative side effects after surgery? | Walking, have PT's ambulate as early as possible to avoid gastric and urinary retention and to maximize the therpuetic effects of cholinergic meds. |
| What is used to treat xerostomia (dry mouth)? | Cevimeline (Evoxac) a cholineric med |
| How soon after administering bethanecol (Urecholine) should a PT with hypotonic bladder w/ urinary retention be expected to void? | within about 60 minutes |
| Where are the muscarinic receptors located? | postsynaptically, on the muscles and glands (nicotinic receptors are on the preganglionic nerve fibers) |
| PT's with Glaucoma should not used what type of meds? | Cholinergic-blockers b/c they increase occular pressure |
| What do cholinergic drugs do to the heart at low doses? | slow it down--they block the vaga's inhibitory effects altogether at higher doses causes an increased HR. |
| Besides an overdose of beta-blockers, what else is Atropine used for? | CV disorders, 2nd degree AV block, provision of advanced life support, and tx of sinus bradycardia |
| What are commonly used for the tx of IBS and GI hypersecretory states? | cholineric-blockers |
| What meds when used with cholinergic blockers have additive effects and therefore should not be coadministered? | antihistamiones, phenothiazines, tricyclic antidepressants, MAOIs |
| What do cholinergic drugs do to the eyes? | dilates the pupils, increases introculat pressure (contraindicated for glaucoma), decreases accomidation by paralyzing ciliary muscles (cycloplegia) |
| What is considered to be the antidote for cholinergic-blockers (although its use is consered controversial due to bad side effects like seizures)? | physostigmine (for the o/d induced delirium, haalucinations, coma, and cardiac dysrythmias) |
| What is considered to be the most potent antimuscarinic for the prevention of motion sickness? | scopolamine (Transderm-Scop)--apply 4 to 5 hours before travel |
| What cholinergic blocker is used for the tx of overactive bladder? | Solifenacin succinate (Vesicare), and oxybutynin (ditropan--watch for liver toxicity, and take 1 -2 hours before meals with water), and Tolterodine (Detral) |
| Why would PTs on cholinergic-blockers be instructed to have regular dental visits? | b/c of the association of dry mouth with dental carries |
| What conditions make the use of cholinergic-blockers contraindicated? | BPH, glaucoma, tacycardia, MI, HF, and hiatal hernia |
| The nurse should be monitoing for which adverse effects in a PT on cholinergic-blockers? | Constipation, tachycardia, tremors, confusion, hallucinations, CNS depression (which occurs with Lg. doses of Atropine), sedation, urinary retention, hot and dry skin, and fever. |
| What should be included as PT teaching for those taking beta-blockers? | monitor the apical pulse for 1 full minute (should not be less than 60), monitor the BP (systolic no less than 100), and PT should report it if they gain 2lbs or more in 24 hrs or if they gain more than 5lbs in a week. |
| Nonselective beta-blockers may be used to tx what? | supraventricular arrythmias (they may exacerbate HF, COPD, and heart block) |
| What is an example of a cardioselective beta-blocker? | atenolol |
| What do ergot alkaloids do? | block alpha2-receptors causing vasoconstriction |
| What does Propanolol (Inderal) do? | Its an effective non-selective beta-adrenergic antagonist |
| During assessment of a PT with pheochromocytoma the nurse auscultates a BP of 210/110 mm Hg, What med would the nurse give? | Phentolamine--its effective in PTs with pheochromocytoma |
| What do beta blockers treat? | Hypertension, Angina pectoris, and cardiac dysrhytmias |
| What would the priority nursing dx for the use of metoprolol (Lopressor) be? | ineffective tissue perfusion (cerebral and cardiovascular r/t med. Use) |
| What is the recommended dose of Atropine for bradycardia? | 0.5-1mg (1-3mg is recommended for insectacide poisoning) |
| The nurse monitors a PT taking dicyclomine (Bentyl) for which therapuetic effect? | Decline in GI motility (tx of IBS) |
Created by:
cspearsall
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