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Nur210 Drugs

Pharmacology fluid balance

What are some types of drug metabolism? Accelerated drug excretion - active drug/metabolism/inactive drug Drug inactivation - active drug/metabolism/inactive drug Activation of prodrugs - inactive drug/metabolism/active drug
What are the opioid receptors in the brain? Mu - analgesic, respiratory depression, sedation, euphoria, dependence, decrease GI motility Kappa - analgesic, sedation, decrease GI motility Delta - opioids do not interact with these
What are pure opioid agonists? Morphine - strong Codeine - moderate
What is a pure opioid antagonist? Blocks the opioid receptor site Narcan (naloxone) is the prototype Given when someone ODs on morphine and they will wake up, but morphine kicks it back down
What are side effects of opioids? Decreased respiratory rate Oversedation Nausea, vomiting Hypotension Constipation Urinary retention
How are drugs metabolized? Liver is primary site of drug metabolism Biotransformation Enzymatic alteration of drug structure
How is the therapeutic index calculated? TI = LD/ED; want TI to be larger; more safe
What is pharmacokinetics? How the body affects drugs.
What is Gate Control Theory? Close-off pathway of pain to the brain. i.e. rubbing a Charlie horse Analgesics close the gate
What is an opioid? Natural or synthetic drug with similar action of morphine (prototype).
What are opiates? Compounds present in opium products.
What is an agonist-antagonist opioid? Talwin is the prototype Blocks (antagonist) the Mu receptors and allows (agonist) the Kappa Less potential for abuse Less respiratory distress Less analgesic effect
Tolerance, Dependence, Addiction Tolerance - decreasing drug effect over time Dependence - physiologic symptoms when drug is discontinued (withdrawal) Addiction - obsession with obtaining and using the drug
ADRs of NSAIDs GI bleeding Altered drug metabolism - liver Affect renal function; blocks prostaglandins Take with food or glass of water Do not chew or crush tablets
What do prostaglandins do? Promote inflammation Protect gastric mucosa Cause platelet aggregation Maintain renal blood flow COX-2 = protect inflammation; COX-1 are the other three
First generation of NSAIDs ASA Ibuprofen Naproxen Toradol (IM) Block both Cox-1 and Cox-2
Second generation NSAIDs Block Cox-2 Celebrex Only one left on market; rest pulled for causing cardiac arrhythmia
Acetominophen (NSAID) Not anti-inflammatory Usage can lead to liver toxicity
How can drugs be excreted? Kidney - urine GI - stool Lungs - air
What is pharmacodynamics? The effect of drugs on the body (and how they do it)
What effects can drugs have on the body? Binding at receptor sites (agonist/antagonist) Chemical reactions Selective toxicity Modify cell environment Psychological effect Therapeutic ADRs Allergic response
What are common ADRs? Cardiac arrhythmia Blood dyscrasias (bleeding) Hepatic toxicity Renal damage Ulceration of GI tract Dermatologic Ototoxicity Sexual function
What are properties of an ideal drug? Effectiveness Safety Selective Reversibility Predictability Ease of administration Minimal ADRs
What are some cognitive behavioral interventions? Alters interpretation and perception of pain Relaxation Distraction Imagery
What are ways to interrupt the pain pathways? Cutaneous stimulation Cold application = ice Massage Acupuncture Acupressure TENS = electrical stimulation device
What occurs in the four phases of clinical drug trials? Phase I - how the drug is metabolized; few subjects Phase II - therapeutic effects; more subject with disease Phase III - dosages; even more subjects with disease Phase IV - find more side effects on general population; post-marketing surveillance
What is the goal of drug therapy? Maximum benefit with minimal harm
Concentration (of drug) at the site of action is influenced by what? Absorption - rate of Distribution - efficiency of Metabolism Excretion
What can affect distribution? First by-pass effect - liver metabolizes some of drug Blood flow to tissues Ability of drug to exit vessels and enter circulatory system Tissue binding - drugs like fat tissue
What is distribution? Getting the medication to the site where it needs to go. It has to get into the circulatory system.
What does parenteral mean? Outside of the GI tract IM, SubQ, IV, Intradermal (TB test) Topical - sublingual, dermal, rectal, vaginal, inhalation
What does enteral mean? Through the GI tract; orally
What is absorption? How much and how fast the drug leaves the site of administration and is delivered into the circulatory system.
What are the first three scheduled drugs that came from the Controlled Substance Act of 1970? Schedule I - nonresearch use banned (i.e. heroin) Schedule II - need to be written on a special prescription pad; usually narcotic in nature; no telephone orders; i.e. Ritalin Schedule III - need to be reordered every 6 months; antidepressants
What are the last two scheduled drugs that came from the Controlled Substance Act of 1970? Schedule IV - penalties vary if caught in possession Schedule V - not prescription, but need to go to pharmacy to obtain (i.e. drugs used to make methamphetamine)
What is a drug? A chemical that is capable of interacting with a living organism to produce a biologic effect.
What are risk factors for fluid volume excess (FVE)? Hypervolemia Increased fluid intake Decreased output - renal failure, decreased cardiac output Symptoms: Weight gain, bounding pulses, peripheral edema, rales with auscultation
What are risk factors for fluid volume deficit (FVD)? Hypovolemia - dehydrated - sunken eyes, cracked tongue Age - infants and elderly become dehydrated easily Increased fluid loss - GI distress; flu, vomit, diarrhea Decreased intake
What lab values can be used to assess fluid balance? BUN (8-20 mg/dL) - higher values indicate possible kidney issues; comes from breakdown of protein Creatinin (0.6 - 1.3 mg/dL) - higher values are better indicator of kidney problems Hematocrit - less solvent increases solute concentration
What two hormones regulate kidney function? ADH (anti-diuretic hormone) and aldosterone ADH results in retaining water, and thus retaining sodium ion Aldosterone results in retaining sodium ion, and thus water (renin-angiotensin loop) Results in increased BP
What is the distribution of body fluids? 75% ICF 25% ECF - 20% in the interstitial spaces and 5% in the vessels Some people look "wet" but they have low BP; sign that excess fluid is in the interstitial spaces (the third space)
What are some uses for cholinergic blockers (anticholinergics? Used for overactive bladder Combat diarrhea Dramamine - motion sickness Dilate pupils at optometrist Given prior to surgical procedures to decrease oral secretions
What are organ effects with sympathetic stimulation? (adrenergics) Cardiac - increase HR Respiratory - dilate Bladder - no affect Colon - no affect Eyes - dilate Arteries - vasoconstrict
What are organ effects with parasympathetic stimulation? (cholinergics) Cardiac - slows HR Respiratory - contraction Bladder - increase activity Colon - increase activity Eyes - constrict Arteries - vasodilate
What are side effects of anticholinergics? Can't see, spit, shit or pee
What are the target organs of anticholinergics (cholinergic antagonists)? Cardiac - mild increase in HR Respiratory - mild bronchial dilator Mucus membrane - decreased secretions (xerostomia = dry mouth) Colon - decrease motility Ocular - dilate pupils
What are ADRs of cholinergic agents? Frequent urination Diarrhea Blurred distance vision (from constriction) Diaphoresis
What are the target organs of parasympathetic cholinergic agents? Cardiac - slows HR Colon - stimulates peristalsis Bladder - increased bladder tone Ocular - constriction; decreased intraocular pressure - to treat glaucoma Cholinergic - colon - slows everything down; rest and digest
What is the parasympathetic nervous system's effects? Digestion of food Excretion of wastes Also affects vision and reduces cardiac work
What are the adrenergic receptors? Beta-1 = cardiac Beta-2 = lungs Alpha = arteries Adrenergic = ADD energy
What are side effects of adrenergic agents? Tachycardia Hypertension Palpitation - heart jumping out of chest (flight or fight) Nervousness, insomnia, fine tremors
What do sympathetic adrenergic agents do (target organs)? Epinephrine is the prototype Cardiac - increased HR Respiratory - bronchial dilation Eyes - dilate Arteries - vasoconstriction
What are the three main functions of the sympathetic nervous system? Temperature control Flight-or-fight response Regulate the cardiovascular system
What are the influences on the heart and blood vessels by the sympathetic nervous system? HR increases; increased cardiac output Blood vessels vasoconstrict BP increases
If you do not drink enough H2O or lost a lot of H2O, how would this affect these systems? Renal perfusion - decrease Renal blood pressure - decrease Glomerular filtration rate - decrease ADH secretion - increase Urine output - decrease Aldosterone level - increase Blood pressure - decreased
What are causes of third space fluid retention? Water not being held in by albumin in cells; decreased colloid pressure Fluid overload Increased hydrostatic blood pressure forces fluid out of the cells
Isotonic, hypotonic, hypertonic Isotonic = 0.9% NS or 0.9% NaCl Hypotonic = fewer electrolytes, more H2O; water into cells Hypertonic = more electrolytes, less H2O; water out of cells If you're dehydrated, want to give a hypotonic solution
What are some properties of potassium ion? ECF levels of 3.5 - 5 mEq/L Major intracellular ion Responsible for transmission of nerve impulses - cardiac and skeletal 90% of K+ gets excreted in urine
What are some causes of hyperkalemia? > 5 mEq/L Excess intake Decreased loss Shifting K+ out of cells and H+ in; acidosis Massive tissue damage - crushing and burns
What are symptoms of hyperkalemia? GI - hyperactive bowel sounds, nausea, vomiting, diarrhea CNS - numbness, paresthesia Muscles - irritability, hyperactive reflexes Cardiovascular - Peak T waves, ventricular fibrilation, cardiac arrest Kidneys - oliguria
What are nursing interventions for hyperkalemia? Monitor blood levels and signs/symptoms Give Lasix - promotes K+ loss Insulin and dextrose infusion will bring K+ from ECF into ICF and "hide" it Dialysis - last resort to pull out K+ Ion exchange resin enema (replace K+ with Na+)
What are some causes of hypokalemia? < 3.5 mEq/L Decreased intake Increased loss (taking Lasix, vomiting, diarrhea, long-term steroid use) Shift of K+ into cells and H+ out (metabolic alkalosis) Oliguria
What are side effects of hypokalemia? Cardiovascular - Flattened T waves (U waves), EKG changes Kidneys - renal damage, diminished capacity to concentrate urine GI - anorexia, nausea, paralytic ileus = quiet bowel sounds CNS - lethargy, confusion, diminished DTRs Muscles - paralysis
What are nursing interventions for hypokalemia? Stop loss Monitor blood level and signs/symptoms Food replacement Oral supplement - GI irritant, so take with food IV therapy - irritating to vein, needs to be dilute; IV push would kill patient
What are some causes of hypernatremia? > 145 mEq/L Decreased water intake (NPO) Increased water output - diarrhea, diaphoresis, fever, diabetes insipidus Increased Na+ intake - IV solution, near-drowning in sea water
What are some side effects of hypernatremia? > 145 mEq/L Excessive thirst Skin and mucous membranes - red, dry tongue, flush skin, nonelastic skin turgor, sticky membranes (mouth is dry) CNS - restlessness, agitation Renal - anuria, oliguria
What are nursing interventions for hypernatremia? > 145 mEq/L Stop cause Monitor blood level and signs/symptoms Replace H2O to dilute Na+ - oral intake or IV hypotonic solution Protect patient if confused Decrease diet intake = salty food
What are some caused of hyponatremia? < 135 mEq/L Loss of Na+ without H2O loss; excess H2O but low Na+ Increased H2O intake - Na+free IV fluids, tap water enema Decreased H2O output - renal disease Increased Na+ loss - vomiting, irrigating NG tube with water Decreased Na+ intake
What are effects of hyponatremia? < 135 mEq/L GI - absence of thirst, abdominal cramping Skin and mucous membranes - clammy skin, finger printing on sternum CNS - disorientation, headache Muscle - fatigue
What are nursing interventions for hyponatremia? Stop the cause Monitor blood levels, signs/symptoms Decrease water intake Fluid replacement with Na+ (oral and IV) Irrigate NG tube with NaCl
Created by: ssbourbon



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