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Exam 2 Study Guide

Nur 212/Pharmacology Exam 2

QuestionAnswer
Spinal/intraspinal anesthesia Anesthetic drugs are injected into the area near the spinal cord within the vertebral column. Intraspinal anesthesia is commonly accomplished by 1 of 2 techniques: intrathecal & epidural.
Intrathecal anesthesia Injection of anesthetic in the subarachnoid space. Commonly used for pts undergoing major abd. or limb surgery that the risks of general anesthesia are too high or they prefer this technique instead of complete loss of consciousness.
Intrathecal continued... Implantable drug pumps are used for outpatient basis for pts with chronic pain syndromes.
Epidural anesthesia Injection via small catheter into the epidural space without puncturing the dura. Commonly used to reduce maternal discomfort during labor ad delivery & to manage postoperative acute pain after major abd. or pelvic surgery. Popular route for opioids.
Infiltration Small amounts of anesthetic are injected into the tissue that surround the site. Commonly used for wound suturing & dental surgery. Often drugs that constrict the local blood vessels (epinephrine, cocaine) are also administered to local area.
Nerve block Anesthetic injected at the site where nerve innervates a specific area such as tissue. Allows large amounts of anesthetic to a specific area without affecting the whole body. Reserved for more difficult to treat pain (cancer or chronic orthopedic pain).
Topical anesthesia Anesthetic applied directly onto the surface of the skin, eye, or any mucous membrane to relieve pain or prevent pain. Commonly used for diagnostic eye examinations & skin suturing.
benzocaine (Dermoplast, Lanacane, Solarcaine) Route- topical, aerosol & spray.
cocaine Route-topical
dibucaine (Nupercainal) Route- Injection & topical
dyclonine (Dyclone, Sucrets) Route- Topical
ethyl chloride (Chlorethane) Route- Topical
lidocaine (Lidoderm) Route- topical
proparacaine (Alcaine, Ophthetic) Route- ophthalmic
prilocaine/lidocaine (EMLA) Route- topical
tetracaine (Pontocaine) Route- injection, topical & ophthalamic.
Effects of general anesthetics on respiratory system Depressed muscles & patterns of respiration; altered gas exchange & impaired oxygenation; depressed airway-protective mechanisms; airway irritation & possible laryngospasm.
Effects of general anesthetics on cardiovascular system Depressed myocardium; hypotension & tachycardia; bradycardia in response to vagal stimulation
Effects of general anesthetics on cerebrovascular system Increased intracranial blood volume & increased intracranial pressure.
Effects of general anesthetics on GI system Reduced hepatic blood flow & thus reduced hepatic clearance.
Effects of general anesthetics on renal system Decreased glomerular filtration.
Effects of general anesthetics on skeletal muscles Skeletal muscle relaxation
Effects of general anesthetics on cutaneous circulation Vasodilation
Effects of general anesthetics on CNS CNS depression; blurred vision; nystagmus; progression of CNS depression to decreased alertness, sensorium, & decreased LOC
Lifespan considerations for the elderly pts and anesthesia Adversely affected more due to organ system deterioration, declining liver function & metabolism of drugs, decreased renal function & drug excretion. Increased risk for toxicity. More sensitive to drugs that affect CNS.
Lifespan considerations for the elderly pts and anesthesia continued... If cardiac/respiratory disease is present, pt is at higher risk for dysrhythmias, hypotension, respiratory depression, atelectasis, pneumonia during postanesthesia/operative phases. Elderly usually on many meds, at risk for adverse reactions/interactions.
Lifespan considerations for the ped pts and anesthesia More sensitive due to immature liver & kidneys. CNS is also more sensitive. Due to the lack of ability to excrete, the pt is at risk for respiratory & cardiac depression, atelectasis, pneumonia, & cardiac abnormalities. Careful check on calculations.
Lifespan considerations for the neonate pts and anesthesia Are at higher risk for upper airway obstruction. Laryngospasm is a risk during intubation because the larynx & respiratory structures of neonates. They have a higher metabolic rate & smaller airway diameter.
Adverse effects of Barbiturates: phenobarbital, primidone Dizziness, drowsiness, lethargy, paradoxical restlessness.
Adverse effects of Hydantoins: phenytoin, fosphenytoin Nystagmus, ataxia, drowsiness, rash, gingival hyperplasia, thrombocytopenia, agranulocytosis, hepatitis.
Adverse effects of Iminostilbenes: carbamazepine, oxcarbazepine Nausea, headache, dizziness, unusual eye movements, visual change, behavioral changes, rash, abd pain, abnormal gait.
Adverse effects of valproic acid & derivatives including valproate sodium & divalproex sodium Dizziness, drowsiness, GI upset, weight gain, hepatotoxicity, pancreatitis.
Adverse effects of gabapentin Dizziness, drowsiness, nausea, visual & speech changes, edema
Adverse effects of pregabalin Dizziness, drowsiness, peripheral edema, blurred vision
Adverse effects of lamotrigine Drowsiness, ataxia, headache, nausea, blurred/double vision
Adverse effects of levetiracetam Dizziness, drowsiness, hyperactivity, behavioral changes (anxiety, hostility, agitation, suicidal ideation), uncoordination.
Adverse effects of Succinimides: ethosuximide Nausea, abd pain, dizziness, drowsiness
Adverse effects of tiagabine Dizziness, drowsiness, agitation, asthenia, GI upset, abd pain, rash, tremor
Adverse effects of topiramate Dizziness, drowsiness, GI upset, ataxia
Adverse effects of zonisamide Drowsiness, anorexia, ataxia, confusion, agitation, cognitive impairment
Normal therapeutic range for valproic acid (Depakote) 50-100 mcg/mL
Normal therapeutic range for carbamazepine (Tegrotol) 4-12 mcg/mL
Normal therapeutic range for phenytoin (Dilantin) 10-20 mcg/mL
Adrenergic receptor responses to stimulation- Blood vessels Alpha1- vasoconstriction; Beta2- vasodilation
Adrenergic receptor responses to stimulation- cardiac muscle Beta1- increased contractility
Adrenergic receptor responses to stimulation- Atrioventricular node Beta1- increased heart rate
Adrenergic receptor responses to stimulation- Sinoatrial node Beta1- increased heart rate
Adrenergic receptor responses to stimulation- Liver Alpha1, beta2- glycogenolysis
Adrenergic receptor responses to stimulation- Kidney Beta1- increased renin secretion
Adrenergic receptor responses to stimulation- GI muscle Alpha1, beta2- decreased motility (relaxation of GI smooth muscle)
Adrenergic receptor responses to stimulation- Bladder sphincter Alpha1- constriction
Adrenergic receptor responses to stimulation- Penis Alpha1- Ejaculation
Adrenergic receptor responses to stimulation- Uterus Alpha1- contraction; Beta2- relaxation
Adrenergic receptor responses to stimulation- Bronchial muscles Beta2- Dilation (relaxation of bronchial smooth muscles)
Adrenergic receptor responses to stimulation- Pupillary muscles of the iris Alpha1- mydriasis (dilated pupils)
dobutamine (Dobutrex) Class- Beta1, adrenergic; Indications- Cardiac decompensation
dopamine (Intropin) Class- Beta1, adrenergic; Indications- Shock syndrome, cardiopulmonary arrest
epinephrine (Adrenalin) Class- Alpha & beta adrenergic; Indications- anaphylaxis, cardiopulmonary arrest
fenoldopam (Corlopam) Class- dopamine 1 agonist; Indications- hypertensive emergency in hospital
midodrine (ProAmatine) Class- Alpha1-adrenergic; Indications- orthostatic hypotension
norepinephrine (Levophed) Class- Alpha & beta-adrenergic; Indications- hypotensive states
phenylephrine (Neo-Synephrine) Class- Alpha-adrenergic; Indications-hypotension or shock
Beta blockers adverse effects- cardio Atrioventricular block, bradycardia, & HF
Beta blockers adverse effects- CNS Dizziness, fatigue, depression, drowsiness, & unusual dreams.
Beta blockers adverse effects- GI N/V/D & constipation
Beta blockers adverse effects- Hematologic Agranulocytosis, thrombocytopenia
Beta blockers adverse effects- Metabolic Hyperglycemia, hypoglycemia, hyperlipidemia
Beta blockers adverse effects- other Impotence, alopecia, bronchospasm, wheezing, & dry mouth
Alpha blockers adverse effects- Cardio Palpitations, orthostatic hypotension, tachycardia, edema, & chest pain.
Alpha blockers adverse effects- CNS Dizziness, headache, anxiety, depression, weakness, numbness, & fatigue.
Alpha blockers adverse effects- GI N/V/D, constipation, & abd pain
Alpha blockers adverse effects- other Incontinence, dry mouth, pharyngitis
phentolamine (Regitine) Class- Alpha blocker; Indications- Hypertensive episodes with pheochromocytoma.
tamsulosin (Flomax) Class- Alpha1 blocker; Indications- Benign prostatic hyperplasia
atenolol (Tenormin) Class- Beta1 blocker; Indications- Hypertension angina
carvedilol (Coreg) Class- Alpha & beta blocker; Indications- HF, angina, hypertension
esmolol (Brevibloc) Class- Beta1 blocker; Indications- Supraventricular tachydysrhythmias
labetalol (Normodyne, Trandate) Class- Alpha1 & beta blocker; Indications- Hypertension, severe hypertension
metoprolol (Lopressor, Toprol XL) Class- Beta1 blocker; Indications- Hypertension, late MI, early MI
propranolol (Inderal) Class- Beta blocker; Indications- Angina, hypertension, dysrhythmias, post MI, migraine
sotalol (Betapace) Class- Beta blocker; Indications- Life-threatening ventricular dysrhythmias
Cholinergic agonists drug effects- Bronchi Muscarinic- Increased secretions, constriction; Nicotinic- none
Cholinergic agonists drug effects- Blood vessels Muscarinic- Dilation; Nicotinic- Constriction
Cholinergic agonists drug effects- Heart rate Muscarinic- Slowed; Nicotinic- Increased
Cholinergic agonists drug effects- BP Muscarinic- Decreased; Nicotinic- Increased
Cholinergic agonists drug effects- Eye Muscarinic- Miosis (pupil constriction), decreased accommodation; Nicotinic- same
Cholinergic agonists drug effects- GI tone Muscarinic- Increased; Nicotinic- Increased
Cholinergic agonists drug effects- GI motility Muscarinic- Increased; Nicotinic- Increased
Cholinergic agonists drug effects- GI sphincters Muscarinic- relaxed; Nicotinic- relaxed
Cholinergic agonists drug effects- GU tone Muscarinic- increased; Nicotinic- increased
Cholinergic agonists drug effects- GU motility Muscarinic- increased; Nicotinic- increased
Cholinergic agonists drug effects- GU sphincter Muscarinic- relaxed; Nicotinic- relaxed
Cholinergic agonists drug effects- glandular secretions Muscarinic- increased intestinal lacrimal, salivary, & sweat gland secretion; Nicotinic- none
Cholinergic agonists drug effects- skeletal muscle Muscarinic- none; Nicotinic- increased contraction
bethanechol (Urecholine) Class- muscarinic (direct-acting); Indications- post-op & postpartum functional urinary retention
donepezil (Aricept) Class- Anticholinesterase (indirect-acting); Indications- Alzheimer's dementia
memantine (Namenda) Class- NMDA-receptor antagonist; Indications- Alzheimer's dementia
physostigmine (Antilirium) Class- Anticholinesterase (indirect-acting); Indications- Reversal of anticholinergic drug effects & tricyclic antidepressant overdose.
pyridostigmine (Mestinon) Class- Anticholinesterase (indirect-acting); Indications- Myasthenia gravis, antidote for neuromuscular blocker toxicity.
Cholinergic blocking drug effects- Cardio Small doses- decrease HR; Large doses- increase HR
Cholinergic blocking drug effects- CNS Small doses- decrease muscle rigidity & tremors; Large doses- cause drowsiness, disorientation, halluciations
Cholinergic blocking drug effects- Eye Dilate pupils (mydriasis), decrease accommodation by paralyzing ciliary muscles (cyclopegia)
Cholinergic blocking drug effects- GI Relax smooth muscle tone of GI tract, decrease intestinal & gastric secretions, decrease motility & peristalsis
Cholinergic blocking drug effects- GU Relax detrusor muscle of bladder, increase constriction of internal sphincter; these two effects may result in urinary retention
Cholinergic blocking drug effects- Glandular Decrease bronchial secretions, salivation, & sweating
Cholinergic blocking drug effects- Respiratory Decrease bronchial secretions, dilate bronchial airways
Cholinergic blockers adverse effects- Cardio Increased HR, dysrhythmias (tachycardia, palpitations)
Cholinergic blockers adverse effects- CNS Excitation, restlessness, irritability, disorientation, hallucinations, delirium, ataxia, drowsiness, sedation, confusion
Cholinergic blockers adverse effects- Eye Dialted pupils (blurred vision), increased intraocular pressure
Cholinergic blockers adverse effects- GI Decreased salivation, gastric secretions, & motility (causing constipation)
Cholinergic blockers adverse effects- GU Urinary retention
Cholinergic blockers adverse effects- Glandular Decrease sweating
Cholinergic blockers adverse effects- Respiratory Decreased bronchial secretions
atropine (generic) indications Tx of bradycardia; anticholinesterase effect for organophosphate or carbamate poisoning (insecticides); cardiopulmonary resuscitation
dicyclomine (Bentyl) Tx of irritable bowel syndrome; preoperative control of secretions
glycopyrrolate (Robinul) Preoperative control of secretions; reversal of neuromuscular blockade
oxybutynin (Ditropan, Ditropan XL, Oxytrol-transdermal patch) Antispasmodic for neurogenic bladder (following spinal cord injury), overactive bladder
scopolamine (generic injection; Transderm-Scop patch) Preoperative control of secretions, motion sickness prevention
tolterodine (Detrol, Detrol XL) Tx of overactive bladder
Neurotransmitter involved in N/V- Acetylcholine (ACh) VC in brain; vestibular & labyrinthine pathways in inner ear
Neurotransmitter involved in N/V- Dopamine (D2) GI tract & CTZ in brain
Neurotransmitter involved in N/V- Histamine (H1) VC in brain; vestibular & labyrinthine pathways in inner ear
Neurotransmitter involved in N/V- Prostaglandins GI tract
Neurotransmitter involved in N/V- Serotonin (5-HT3) GI tract; CTZ & VC in brain
Antiemetic drugs: mechanism of action- Anticholinergics Block ACh receptors in vestibular nuclei&reticular formation. Indications-motion sickness, secretion preop, N/V. SE-dizziness, drowsiness/disoriented, tachycardia, blurred vision, dilated pupils, dry mouth, difficult urination, constipation, rash/erythema
Antiemetic drugs: mechanism of action- Antihistamines Block H1 receptors-prevent ACh binding to receptors in vestibular nuclei. Indications-motion sickness, nonproductive cough, sedation, rhinitis/allergies, N/V. SE-dizziness, drowsiness/confusion, blurred vision/dilated pupils, dry mouth, urinary retention
Antiemetic drugs: mechanism of action- Antidopaminergics Block dopamine in CTZ & ACh. Indications-Psych disorders(mania/schizo./anxiety), intractable hiccups, N/V. SE- ortho hypotension, tachycardia, EPS, tardive dyskinesia, HA, blurred vision/dry eyes, urinary retention, dry mouth, N/V, anorexia, constipation
Antiemetic drugs: mechanism of action- Prokinetics Block dopamine in the CTZ or stimulate ACh receptors in the GI tract. Indications- delayed gastric emptying, gastroesophageal reflux, N/V. SE- hypotension, supravent tachycardia, sedation, fatigue, restlessness, HA, dystonia, dry mouth, N/V/D
Antiemetic drugs: mechanism of action- Serotonin blockers Block serotonin receptors in the GI tract, CTZ & VC. Indications- N/V associated with chemotherapy, postoperative N/V. SE- HA, diarrhea, rash, bronchospasm, prolonged QT
Antiemetic drugs: mechanism of action- Tetrahydrocannabinoids Inhibit effects on reticular formation, thalamus & cerebral cortex. Indications- N/V assoc. with chemo, anorexia assoc. with weight loss in pts with AIDS & cancer. SE- drowsiness, dizziness, anxiety, confusion, euphoria, visual disturbances, dry mouth.
Complete nutritional formulations: Indications Inability to consume or digest normal foods; accelerated catabolic status; undernourishment because of disease.
Incomplete nutritional formulations: Indications Genetic metabolic enzyme deficiency; hepatic or renal impairment
Infant nutritional formulations: Indications Sole nutritional intake for premature & full-term infants; supplemental nutritional intake for older infants receiving solid foods; supplemental nutritional intake for breastfed infants.
Esophagostomy Feeding tube surgically inserted into the esophagus
Gastrostomy Feeding tube surgically inserted directly into the stomach
Jejunostomy Feeding tube surgically inserted into the jejunum
Nasoduodenal Feeding tube placed from the nose to the duodenum
Nasojejunal Feeding tube placed from the nose to the jejunum
Nasogastric Feeding tube placed from the nose to the stomach
Oral Nutritional supplements delivered by mouth
Peripheral parenteral nutrition characteristics Supplemental (total if moderate to low needs); <14 days; Hyperosmolar (600-900 mOsm/L); Fluid tolerance must be high; Dextrose <10%; Amino acids <3%; Fats 10%-20%; Calories <2000 kcal/day
Central parenteral nutrition characteristics Total nutrition; >7days; Hyperosmolar (600-900 mOsm/L); Can be fluid restricted; Dextrose 10%-35%; Amino acids >3%-7%; Fats 10%-20%; Calories >2000 kcal/day
Malignant hyperthermia Emergency occurs during/after general anesthesia or use of NMBD succinylcholine. Sudden increase in temp. (>104 degrees F). S/s- tachypnea, tachycardia, muscle rigidity. Tx- cardiorespiratory supportive care & dantrolene (skeletal muscle relaxant).
Moderate Sedation (conscious sedation/procedural sedation) Combo of IV benzo (midazolam) & opiate (fentanyl/morphine). Anxiety & pain reduced and amnesia related to midazolam. Pt is able to maintain own airway & respond to verbal commands.
Standards for moderate sedation Personnel administering must have ACLS. One personnel must be exclusively monitoring pt. Someone must be able to intubate. Emergency equipment must be in room.
Infiltration & epinephrine together indications Prevent systemic absorption of anesthetic, confine local anesthetic to injected area, & reduce local blood loss.
Neuromuscular Blocking Drugs (NMBDs) Prevent nerve transmission in certain muscles. Used as adjuncts with general anesthetics during surgery. Mechanical ventilation is required due to paralysis of respiratory & skeletal muscles. Do NOT cause sedation/pain relief. Pt may be conscious.
Succinylcholine- Depolarizing NMBD Works similar to ACh, causes sustained depolarization (paralysis). Metabolism is slower than ACh, repolarization cannot occur. Reversal agent Anticholinesterase drugs.
NMBDs- Nonpolarizing Drugs Short acting, intermediate acting & long acting. Prevent ACh from acting at neuromuscular junctions. Nerve cell membrane is not depolarized & muscle fibers are not stimulated. Skeletal muscle contraction does not occur.
NMBDs Indications Main- facilitating controlled ventilation during surgical procedures. Endotracheal intubation (short-acting). Reduce muscle contraction in an area that needs surgery. Dx drugs for myasthenia gravis.
Overdose of NMBDs Causes prolonged paralysis & prolonged mechanical ventilation. Cardiovascular collapse can occur. Conditions may increase sensitivity to NMBDs. Reversal agents- anticholinesterase drugs (neostigmine, pyridostigmine).
Nursing Implications for anesthetics Assess Hx of surgeries & response to anesthesia, Hx of allergies & meds, use of alcohol, illicit drugs, opioids. Assess preop, intraop, & postop- ABCs, vitals, baseline labs, ECG, O2 sat, body systems (neuro, respiratory, cardio, renal/GU, & GI).
Nursing Implications for recovery of anesthesia Monitor for cardio/respiratory depression, and for complications. Implement safety measures. Reorient pt to surroundings. Teach pt about post op turning, coughing, & deep breathing.
Long term use of phenytoin (Dilantin) adverse effects May cause gingival hyperplasia, acne, hirsutism & Dilantin facies.
Autoinduction Process in which over time a drug stimulates the production of enzymes that enhance its own metabolism, which leads to lower than expected drug concentrations.
Nursing Implications for Oral AEDs Take regularly, same time each day. Take with meals. Don't crush, chew, or open XL forms. If pt is NPO contact Dr. Teach to wear med alert tag. Should not stop suddenly. Follow driving recommendations. Teach it's long term. Monitor adverse effects.
Nursing Implications for IV AEDs Follow manufacturer's recommendations for delivery- usually slowly. Monitor vitals. Avoid extravasation of fluids. Use ONLY NS with IV phenytoin (Dilantin).
Adverse effects of AEDs Mental status changes, mood changes, changes in LOC or sensorium, eye problems, visual disorders, sore throat, fever (blood dyscrasias may occur with hydantoins).
Alpha-Adrenergic Agonist Response Vasoconstriction & CNS stimulation
Beta-Adrenergic Agonist Responses Bronchial, GI, & uterine smooth muscle, glycogenolysis, & cardiac stiumlation.
Adrenergic blocking agents used post MI Inhibits stimulation from circulating catecholamines
Adrenergic blocking agents used post MI Inhibits stimulation from circulating catecholamines
What is important to consider for a pt with DM Beta blockers mask s/s hypoglycemia
Antidote for cholinergics Atropine
Created by: STorrez2