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Nur210 Drugs
Pharmacology fluid balance
| Question | Answer |
|---|---|
| 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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