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Nurs 330 - Test #2

Pharmacology for Nursing

QuestionAnswer
Which opioid receptor is responsible for sedation? Kappa
Which opioid receptor is responsible for dysphoria and hallucinations? Delta
Which opioid receptor is associated with euphoria (some good shit), respiratory depression, and dependence (all the bad shit)? Mu
Which opioid receptor is associated with endocrine and behavioral effects, along w/ somatic pain? Sigma
What are the pharmacological effects (and side effects) of opioids? Analgesia, euphoria/dysphoria, nausea (stim+depress), cough depression, neuroendocrine, miosis, and increase bile duct pressure
What are the drug-interactions of concern with opioids? Any CNS depressant, will increase depressant effects.
T/F Pain is considered a respiratory stimulant? True
What is the risk of respiratory failure in a client taking appropriate dosage(s) of an opioid? <1% risk for respiratory failure as long as opioid levels are maintained within therapeutic range
How common is hypotension in clients receiving opioids? Postural (orthostatic) hypotension is much more common than if the client were supine and well-hydrated
If a client experiences withdrawal symptoms from D/C of opioids, it is considered: A) Tolerance, B) Dependence, C) Addiction B) Dependence
T/F: Risks of addiction to opioids, even when taken in high doses is <1%. True
In terms of nursing implications, which is most important: sedation or respiratory rate? Sedation
What is the name(s) for the narcotic antagonist used in case of drug OD? **Naloxone (Narcan)
T/F: Kids can have MS IV for pain. Yes, even children (e.g. Jake) can have Morphine Sulfate IV
What should one be watching for when administering Morphine Sulfate IV? Allergy (histamine; caution with asthma), sedation, nausea
After administering 2-4mg (adult) MS IV; how long does one wait to re-assess their pain? 5-10 minutes (I assume this is exclusive for IV, but notes do not say)
What is the major contradiction for Meperidine? Meperidine (Demerol) is contradicted with MAOI anti-deoressants
What is the big bummer about Meperidine (Demerol) toxicity? Cannot be treated with Narcan
What is the different between Fentanyl Sublimaze and Duragesic (transdermal)? Fentanyl Sublimaz is short acting (conscious sedation, IV analgesia, etc) and Fentanyl Duragesic is longer acting (1 patch q.72.h)
What is the name of the ultra-short acting Fentanyl? Remifentanil
What is the name of the Fentanyl "lollipop" for breakthrough pain? Actiq
What is Hydromorphone? Dilaudid--PO, IV, IM; alternative to Demerol; similar to MS
What's up w/Codeine? Opioid analgesic. Available PO (has synergistic effects w/ Tylenol) and as an elixir for kids; has cough suppressant properties
What is Hydrocodone (and maybe some other names/additives)? Opioid analgesic. Forms include: Vicodin (with acetmpn), Norco (same amt of hydrocodone; low dose acetmpn), Lortabs (acetmpn), Lortab ASA (aspirin), Vicoprofen (ibuprofen)
What are the names of opioid analgesics containing Oxycodone, and their respective additives? Percodan (ASA), Percocet (acetampn), Tylox (acetampn), Oxycontin (a sustained release version...people will crush and sniff to by-pass the slow onset)
Tramadol (Ultram)...description...anyone? Selective MU receptor agonist (weak) thus slow onset, some tolerance and dependence, not controlled, low respiratory depression (but it can happen)
Describe (ant)agonistic and other effects of Butorphanol (Stadol) Competitive Mu antagonist/Kappa agonist; increases cardiac work load (avoid in CHD). Bonus: can use nasal for severe migraines
Why is Naloxone our friend? ***Naloxone (Narcan) is an opioid antagonist, and can be used to reverse the effects of narcotics in the case of an OD...game on!
What happens when one ODs on Tramadol? Tramadol (Ultram) toxicity presents a major risk of seizures, especially with MAOIs (contradiction? -check)
What is the goal of combination drugs containing both opioid agonist + antagonists? (e.g. Butorphanol [Stadol]) Analgesia w/o respiratory depression.
T/F: Anti-emetics can sometimes help reduce pain when given with narcotics? False. Anti-emetics (e.g. Zofran, Phenegran) have NO analgesic properties, nor will they increase sedation.
Where are the different of cholinergic receptors located? Nocinitic N-All ganglia, Adrenal Medulla; Nicotinic M- Neuromuscular junction; Muscarinic- parasympathetic target organs (eyes, heart, lungs, etc)
What is another term for cholinergic agent? Parasympathomimetic
What is Bethanechol (Urecholine)? A cholinergic agent (parasympathomimetic) used to speed things (urinary, GI) up post-operatively, or after pregnancy.
What are contradictions with Bethanechol (Urecholine)? Urinary blockage, paralytic ileus are the big two...also asthma, peptic ulcer disease, hyperthyroidism
What kind of nursing implications come with Bethanechol (Urecholine)? Observe for the good: void/defection; Teach: taking between meals to reduce the bad (nausea)
What are MIOTICS, and what do they treat? Muscarinic agonists; constrict pupils, reduce intra-olcular pressure by increasing flow of aqueous humor. Used to tx glaucoma.
Describe Acetylcholine (Miochol) and it's uses. Parasympathomimetic, specially a muscarinic agonists; thus used to reduce intra-ocular pressure in glaucoma.
What are other terms for anti-cholinergic agents? Muscarinic antagonists, antimuscarinics, cholinergic blockers, and parasympatholytics
What is the purpose of an anti-cholinergic agent? Prevention of parasympathetic receptor activation by ACh; usually selective blockade of specific muscarinic receptors
What are the effects of anti-cholinergic agents? *DOSE DEPENDENT: Increased: HR. DECREASED: saliva production, urination, GI mobility, CNS excitation (delirium)
What are the adverse effects of anti-cholinergic agents? Tachycardia, urinary retention, dry mouth, restlessness, sedation, delirium, blurred vision. (Remember: many drugs can have these side effects)
What is Atropine, available routes, and what is it used for? Anti-cholinergic agent, comes IV or inhaled, used to excite the SA node of the heart.
What is Scopolamine, and how is it used? Scopolamine (Transderm Scope)—is a patch used for motion sickness (seen a lot as a prophylactic for post-op motion sickness)
What is Tolteradine (Detrol), and what is it prescribed for? Anti-cholinergic agent; specifically a muscarinic receptor antagonist used to relax smooth muscle in UT; Rx: overactive bladder issues.
Why are anti-cholinergic agents used in GI therapy? Decrease mobility for IBS, abdominal cramping
How are anti-cholinergic agents used in opthalmic treatment? Mydriasis and cycloplegia (paralize ciliary muscle) for retinal exam; keratitis
What is the mechanism of action of a nicotinic agent? Stimulate sympathetic ganglia and adrenal medulla → promote release of Norepinephrine and Epinephrine
What are the general effects nicotine agents? Vasoconstriction; INCREASED: HR/force of contraction, GI secretion/motility (thus N,V-not digestion), CNS stimulation, tolerance and dependence
What forms does Nicotine come in, and what does it treat? Gum, patch, inhaler; used to tx nicotine addiction
What is the name for the nicotine agonist that produces unwanted neuropsychiatric effects (including suicide)? Varenicline (Chantix); blocks access of nicotine to receptors
What's the story with Acetylcholinesterase Inhibitors? They Prevent breakdown of Ach—Nonselective (Muscarinic & Nicotinic), thus are indirect-acting cholinergics
What are Acetylcholinesterase Inhibitors used for? Reversal agents for neuromuscular blockers, Atropine, and other anticholinergic drugs
What are the S/S of cholinergic crisis? Weakness, paralysis, bradycardia, salivation. Tx: atropine, oxygen
What is Neostigmine (Prostigmin)? Reversible acetylcholinesterase inhibitor. It is used to improve muscle tone in MG, and to reverse anticholinergic drugs.
What is Physostigmine (Antilirium)? Acetylcholinesterase inhibitor used to reverse the effects of anticholinergics such as Atropine, Scopolamine, etc.
What do neuromuscular blockers do? (Hint: antinicotinic) Block ACh at neuromuscular junction (Nicotinic-M)
What are neuromuscular blockers used for? Conjunct w/anesthesia and/or mechanical ventilation
T/F?: Neuromuscular blockers do NOT alter conscious. True: patient is awake and paralyzed, thus sedation and analgesics are required.
How do non-depolarizing neuromuscular blockers work? Compete with ACh at nicotinic receptors causing skeletal muscle relaxation
How do depolarizing neuromuscular blockers work? Attach to receptor causing sustain depolarization --> paralysis
What is Vecuronium (Norcuron)? A non-depolarizing neuromuscular blocker
What is Succinylcholine (Anectine)? A depolarizing neuromuscular blocker
Are are the adverse effects of neuromuscular blockers? Hypotension, bradycardia. Others: prolonged paralysis, malignant hyperthermia (children), muscle pain --> fasciculations, muscle rigidity (emergent)
What is an important consideration when administering reversal agents (e.g. Neostigmine, Physostigmine) to tx paralysis caused by neuromuscular blockers? These reversal agents do not last as long, thus if a client does not maintain therapeutic levels, they may have re-occuring paralysis
How does one assess recovery from paralysis r/t NM blocker toxicity? Ptosis—Hold eyes open for 5 seconds; Hand Grip—Sustain for 5 seconds; Raise Head—Hold 5 seconds
What is pre-load? End diastolic stretch of muscle fiber (diastolic pressure-ish); venous return to the heart.
What is after-load? Tension in ventricular wall during systole (pretty much arterial pressure)
What do ACE Inhibitors do? Prevent conversion of Angiotensin I to Angiotensin II, and increase activation of bradykinin (vasodilator); thus inhibiting Aldosterone and high BP
What is Angiotensin II? Potent vasoconstrictor & stimulant of Aldosterone release
T/F?: ACE inhibitors effect both pulse, and BP. False. ACE inhibitors do NOT affect pulse
T/F?: ACE inhibitors have a slow onset? True, unless Na+ or H20 depleted
How do ACE inhibitors affect the kidneys? Nephro-protective, also cause renal retention of potassium.
What happens to Na+ and H20 when taking ACE inhibitors? Increased secretion (no net change in electrolytes)
What are ACE inhibitors used for? Pretty much hypertension, sometimes CHF (w/diuretics), and in diabetes to reduce renal failure (contradicted, however with CKD/ESRD).
What are some adverse effects of ACE inhibitors? Renal failure (decrease dose in CKD/ESRD), hypotension (1st dose effect)
How are ACE inhibitors named? Ending in -pril- e.g. ***Lisinopril (Prinivil, Zestril)
What are important nursing implications with administration of ACE inhibitors? Must monitor BP, kidney function (BUN, creatinine, electrolytes...K+!!) Must use caution with K+ sparing diuretics; contraindicated in pregnancy
What are angiotensin II receptor blockers? Selectively blocks binding of Angiotensin II at the receptor, blocks vasoconstriction and aldosterone secretion; similar effects as ACE inhibitors
How are ARB's named? Ending in -arton- e.g. **Losartan (Cozaar)
How do renin inhibitors work? Direct renin inhibitor→ decreasing plasma renin activity (PRA) and inhibiting the conversion of angiotensinogen to Angiotensin I
Name a central acting agent used as an anti-hypertensive. **Clonidine (Catapres): Can be used PO for hypertensive crisis, or transdermal patch—7 days (may see contact dermatitis)
What is Clonidine used for besides hypertension? Tx of addiction to ETOH, cocaine, narcotics, nicotine
What are beta adrenergic blockers method of action? Reduce sympathetic activity in brain vasomotor center, reduce sympathetic stimulation of beta receptors on arterioles reduce renin→ reduce angiotensin II
What are the goals of beta blocker administration? Reduces blood pressure, pulse, cardiac output→ reduces myocardial contractility
What are beta blockers used to treat? Hypertension, chest pain
What are the side-effects of beta blockers? Bradycardia, CHF, bronchospasm, mask hypoglycemia in diabetics, depression, impotence, lowers HDL, increase cholesterol & triglycerides
What are important nursing implications for clients taking beta blockers? Monitor BP (>100), P (>60), S/S of CHF (edema), BG (diabetics)
How are beta blockers named? Ending in -olol- e.g. **Propranolol (Inderal)
Name a non-selective (b1 +b2) beta blocker. **Propranolol (Inderal)
What class of drug is **Metoprolol (Lopressor, Toprol)? (hint: be specific) Cardioselective Beta-1 blocker; anti-hypertensive; better for lungs, lipid panels, and possibly insulin sensitivity in type I diabetes.
What sort of effects to alpha-1 blockers have? relax vascular smooth muscle, no effect on cholesterol, cardiac output or heart rate, reduces afterload, increases plasma volume→edema, ***requires diuretic, 1st-dose effect--dose at night
How are alpha-1 blockers named? Ending in -azosin- e.g. **Prazosin (Minipress)
How do calcium channel blockers work? Block Ca+ exchange across cell membrane, decrease afterload (vasodilation)
What are the two types of calcium channel blockers? 1) Cardioselective (nondihydropyridine) 2) Dihydropyridine
What class of drugs end in -pine-? Dihydropyridine (calcium channel blockers) e.g. Amlodipine (Norvasc) NOT CARDIOSELECTIVE CHANNEL BLOCKERS
Give an example of a cardioselective (nondihydropyridine) calcium channel blocker. **Diltiazem (Cardizem, Tiazac), also Verapamil (Calan, Isoptin)
What are calcium channel blockers used for? Hypertension, angina, supraventricular dysrhythmias, a-fib
Which calcium channel blocker slows contractility AND can worsen CHF? Cardioselective agents,e.g. Diltiazem, Verapamil
What are important nursing implications of calcium channel blockers? Observe for s/s CHF, monitor edema; monitor BP—frequently if IV administration; hold for pulse < 60; BP < 90 systolic
What is **Hydralazine (Apresoline)? A vasodilator that directly relaxes arterial and venous smooth muscle
What can happen as a result of taking Hydralazine? Reflex tachycardia (stimulation of renin, Na+ H20 retention, etc).
Hydralazine is most effective when given with ____ ________, and _________. Beta blockers and diuretics (can otherwise cause reflex tachycardia)
What are the target levels of antilipemic drugs? Lower total cholesterol <200mg/dl; LDL < 130 mg/dl
How do bile-acid binding resins work? All work is done in the gut (not absorbed into blood; oldest/safest way); bind with bile acids in intestine → excreted in stools; increase in cholesterol oxidated to bile acids --> excretion
What are the end-results of bile-acid binding resins? LDL & cholesterol decrease secondary to Increased clearance of LDL from plasma
What are bile-acid binding resins used to treat? Rx: primary type II hyperlipoproteinemia
What are some side effects of bile-acid binding resins? DOSE DEPENDENT... Constipation (common); others: abd bloating, flatulence, nausea, vomiting, diarrhea, indigestion
What class of drugs is contraindicated with the use of fat-soluble vitamins? Bile-acid binding resins
What are some contraindications of bile-acid binding resins? Use of fat-soluble vitamins, digoxin, thiazides, lasix, warfarin, STATINS
What class of drug is **Cholestyramine (Questran)? An anti-lipemic (specifically, a bile-acid binding resin)
What do Hmg-CoA deductase inhibitors do? (Hint, also referred to as “The Statins”) Lower total and LDL cholesterol—up to 20-50% depending on agent and dose; lower TG’s, especially with very high TG’s
What are important nursing implications for clients taking Hmg-CoA deductase inhibitors? Monitor cholesterol, and liver enzymes (AST, ALT for 1st three months if healthy). Know that muscle aches, and weakness are BAD; so is pregnancy.
What is the classification of Atorvastatin (Lipitor)? Antilipemic; specifically a Hmg-CoA deductase inhibitor
What are the therapeutic effects of Niacin (Nicotinic acid)? Lowers serum LDL and VLDL & increases HDL, decreases triglycerides 20-50%; higher than vitamin B3 doses; mechanism not clear
What drug is thought to affect cyclic AMP (control activity of lipase), and thus lipolysis? Niacin (Vitamin B3)
What are some adverse effects of taking prescription strength Niacin? GI upset--N/V, bloating, gas, hunger, elevate hepatic function tests, flushing--face and neck (transient; goes away), pruritis, and INSULIN RESISTANCE
What is the big idea behind ***Extended Release Niacin (Niaspan)? Less flushing, not really sure what else.
What are fibric acids (fibrates) all about? Used for lowering triglycerides (VLDL), some lowering of LDL, increased HDL
What are the side effects of fibric acids (fibrates)? GI: N, D, abd pain, Increased risk of gallstones, myopathy—report muscle pain, weakness, DON'T COMBINE w/ STATINS, hepatotoxicity—monitor liver enzymes, potentiate oral anticoagulants (monitor INR levels)
Given an example of a fibric acid (fibrate). **Fenofibrate (Tricor)
What are diuretics used for? Increase in: rate of urine formation, and urine volume; net loss of solute (electrolytes) and water
What's an indication for diuretics? Mobilization of edema
What are the mechanisms for osmotic diuretics? Increase osmotic pressure of tubular filtrate, fluid moves from ICF→ECF, inhibits renin release (decrease ICP), increases renal blood flow (prevents nephrotoxicity) excretion of electrolytes—Na, K, Ca, Mg, Cl, HCO3, phosphate
What is Mannitol (Osmitrol) used for? Reduce CSF pressure (pre/post neuro surgery), Reduce intraocular pressure (glaucoma/post-op), nephrotoxicity prevention (diluting urine)
What are the adverse effects of Mannitol (Osmitrol)? (osmotic diuretic) H/A, N, V; contraindicated w/ CHF (too much ECF!!!!) can cause renal failure, liver failure...BAD, BAD, BAD
Important nursing implications r/t osmotic diuretics? "Give IV via filter" (WTF that is), monitor output (looking for diuretic effect), BP, lung sounds (fluid overload), serum osmolality (electrolytes; not too high), ICP (couple of ways= LOC, catheters, etc.)
What is the mechanism of action in carbonic anhydrase inhibitors? MAKE YOU PEE BiCARB; Inhibit secretion of H+ (retains H+), Increase excretion of Na+ and bicarbonate --> urine alkalinizes, metabolic acidosis a risk, marked potassium excretion, reduce aqueous humor production
What is **Acetazolamide (Diamox) used for? Carbonic anhydrase inhibitor (pee bicarb, K+); alkalinize urine for drug excretion (of acidic drugs) altitude sickness (prevention; inhibits hyperventilation, thus metabolic alkalosis)
What special precautions does **Acetazolamide (Diamox) have? It's a sulfanamide (check allergies), can cause hypokalemia, and renal calculi, ➢ Metabolic acidosis → contraindicated with COPD (retain CO2; Resp. Acidosis), ALSO IT MAKES BEER TAST LIKE METAL!
What are some precautions with thiazide diuretics? Sulfa-derivative; electrolyte loss (spec. K+), hyperglycemia (in diabetics), and hyper-lipidemia
What is **Hydrochlorothiazide (HCTZ, Hydrodiuril)? Thiazide diuretic --> sulfa-derivitive causing loss of water, potassium, BG, and other electrolytes
What are the affects of loop diuretics Inhibit electrolyte reabsorption in ascending loop of Henle, weak carbonic anhydrase effects, Increase renal blood flow (to improve excretion), Increase loss of K+, Mg, acid, ammonia
What are loop diuretics used for? Edema (heart, liver, kidney), acute pulmonary edema, nephrotic syndrome (stage 1 CKD), and HTN
What are the precautions for loop diuretics? Sulfa allergy (except Ethacrynic acid), Ototoxicity (esp. E. acid), hypotension (give slow IV), loss of Na+, and K+
When should Furosemide (Lasix)*** be given? Early in the day... has long half life, given PO q.8.h
What are aldosterone agonists used for? They are potassium sparing diuretics (e.g.**Spironalactone); Hypertension, edema, drug of choice for edema and ascites with hepatic disease (blocks the very cause for acites
What are adversed effects of **Spironalactone? Potassium sparing diuretics; hyperkalemia; problems with girls and boys parts
What are some precautions of aldosterone agonists? Caution when combined with other diuretics, ACE inhibitors or in renal disease, no potassium supplements; teach—do not use salt substitutes--(most contain KCl)
What are some effects of Nitrates?
Created by: scottheadrick