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Pharm 3
PNS, Opioids
| Question | Answer |
|---|---|
| Acetylcholine | Responsible for transmitting nerve impulses across PNS |
| Catecholamines- Stimulate PNS | Absorbed rapidly, Naturally produced in the body & Vasoconstrictors, Can increase heart rate |
| Types of medications in Catecholamines? | Norepinephrine, Epinephrine, Adrenalin, Inotropin, Levophed and Dopamine |
| Treatment for Catecholamines? | They decrease the heart rate, decrease cardiac output and reverse heart block |
| Synthetic agents Dobutamine? | Pts who go home with severe heart problems, will go home on a dobutamine drip |
| Myocardial ischemia (MI) | heart attack |
| Congestive heart failure (CHF) | decrease in cardiac output |
| Non catecholamines – Stimulate the SNS | Used for asthma and decongestant, Hypotension |
| Ephedrine is used as a? | bronchodilator, decongestant |
| Albuterol is used for? | Increases heart rate, used as a bronchodilator |
| Severe allergies pt will need an EpiPen | administer in thigh, hold for 10 seconds, always have an extra EpiPen available |
| Flonase | mess up mucous membrane |
| Sweating is a sign | increase temperature and your body fighting off the heat |
| Adrenergic Blocking agents | Causes nerve cells and Blood vessels to relax |
| Group 1 Alpha | Floomax, Tamsolusin, Pazosin |
| flomax or tamsolusin | dilate the arteries and veins so you are able to urinate, Used for pt with urinary retention. |
| Pazosin mini press | Dilate arteries and veins of HEART |
| Vasodilation of vascular smooth muscle | means they relax arteries and veins which increase blood flow but decreases blood pressure |
| Alpha interrupts | Interrupt interactions of epinephrine and norepinephrine. |
| Peripheral vascular disease | No blood flow into lower extremities |
| Side effects for Alpha | Nasal congestion, Rebound tachycardia (Angina, chest pain), Postural hypotension (Orthostatic hypertension, Take VS Laying, sitting, standing) Monitor for numbness and tingling of fingers and toes, Limit caffeine |
| Beta adrenergic | prevent stimulation of heart, decrease heart rate and heart contractivity Prevent angina |
| Asthma pts should not take these | Tenormin=(Atenolol, Generic) Inderal=(propranolol, Generic) Lopressor=(Metoprolol,Generic) drugs that end in oLoL, building blocks/going to block everything) |
| Beta is used for | Hypertension, Angina, MI, Tachyarrhythmias, Headaches, |
| Side effects for taking Tenormin=(Atenolol, Generic) Inderal=(propranolol, Generic) Lopressor=(Metoprolol,Generic) | Hypogycemia, Impotence (ED) (can cause sexual disfunction/ED) Bronchospasm in asthma/COPD pt, Depression |
| Monitor for | EKG and vital signs Monitor for wheezing (Sign of close airway) Do not use with decongestants, *Avoid alcohol |
| Ganglionic | block sns and pns which in turn decreases cardiac output and decreases heart rate |
| Central acting | Affects the CNS , decreases activity of the sympathetic nervous system and prepare your body for fight or flight |
| Central acting medication | Clonidine – comes in tablets or patches (Use gloves, take old one off first, Initial, date and time |
| Clonidine | Hypertension, hypertensive crisis Side effects: Dizziness, drowsiness, syncope (Fainting) |
| Peripherally acting antiadrenergic drugs | Doxazosin, Tamsulosin |
| Peripherally acting drugs are used for | Hypertension, BPH Beningn prostatic Hyperplasia (Enlarge prostate) |
| You can not take ED if you take | Doxazosin, Tamsulosin |
| Cholinergic agents | mimic neurotransmitter acetylcholine |
| Bladder atony | when the bladder contracts and makes it difficult to urinate, improved bladder function. |
| Used to improve bladder function medication | Urecholine/bethanechol (generic), |
| When administrating Urecholine/bethanechol (generic), | Have atropine at bedside, used for overdose |
| Anticholinesterase agents | Tensilon |
| Tensilon | used to diagnose pt has myasthenia gravis |
| myasthenia gravis | may have weakness and fatigue and muscle |
| Cholinergic blocking agents | Atropine (Decrease saliva production), Levsin= Both Used in hospice (Helps dry up mucous, drops) Scopolamine= Behind the ear patch |
| Scopolamine patch | Used for N,V, motion sickness, transdermal patch. Blocks signal to the brain that cause nausea and vomiting. Patch can last up to 72 hours |
| Parkinson’s disease | depletion of dopamine, produced in brain and leads to issues with movement. |
| Atropine,Levsin, and scopolamine | constipation and urinary retention |
| CNS | Function is to relay messages, process messages, compare, analyze info and use neurons to conduct impulses. Spinal cord carries from the body to the brain, the brain receives message, analyze and interpret and send response. |
| Anorexiants | Phentermine,Benzphentamine,Methamphetamine, |
| Phentermine and Benzphentamine | Take to lose weight |
| Methamphetamine | treats adhd |
| Amphetamine | increase neurotransmitters levels in cns |
| Drugs in Amphetamine | Adderall and Ritali |
| Adderall and Ritali | Used for adhd and narcolepsy(Fall asleep) |
| when you use Adderall and Ritali | Use cautiously in pts with glaucoma, since a side effect IOP (interocular pressure, build up of fluid behind the eye) , Cardiac structure abnormalities – speed up heart rate |
| Side effects Adderall and Ritali | Restless, talkative, pacing, palpitations and tachycardia |
| Muscle relaxants | decrease the number of muscle spasms |
| Muscle relaxants Drugs | Baclofen, Clarisoprodol (Soma), Metaxalone (Skelaxin) and Flexeril |
| Baclofen (Lioresal) | for multiple sclerosis pts |
| Adverse reactions from Baclofen (Lioresal), Clarisoprodol (Soma), Metaxalone (Skelaxin) and Flexeril | M/S reaction cause drowsiness, hypotension and seizures |
| overdose given the “Holy Trinity” | Muscle relaxant combined opioid and benzo The muscle relaxant will help relax your heart muscle. Opioid will slow breathing Benzo will calm anxiety and relax you. |
| Antiepileptic/Anticonvulsants | Used to treat seizures, all types of epilepsy |
| Drug used to treat seizures | Phenytoin/Dilantin Level 10-20 mcg/mL |
| Adverse reaction Phenytoin/Dilantin | gingival hyperplasia (enlarge gums) |
| Do not abruptly stop taking what medication? | Phenytoin/Dilantin; you will start having seizures again) monitor LFT |
| Nursing diagnosis: for pt taking Phenytoin/Dilantin for seizures? | pt with seizure is risk for fall, risk for injury (top two nursing dx) |
| Benzodiazepines (pam driving benz) | Clonazepam(Klonopin) diazepam (Valium) lorazepam (Ativan) |
| Clonazepam, diazepam, lorazepam adverse reactions | apnea, cardiac arrest, confusion, lethargy |
| Lorazepam antidote | flumazenil (romazicon) |
| When given Benzos IV | Monitor Respiratory depression, cardiac arrest. |
| Miscellaneous meds | Lamotrigine (Lamicatal), Levetiracetam (Keppra), Pregabalin (Lyrica), Topiramate (Topamax) |
| Lamotrigine (Lamicatal), Levetiracetam (Keppra), Pregabalin (Lyrica), Topiramate (Topamax) | Used to treat partial seizures, epilepsy and migraine headaches |
| Keppra and Topamax are used for | migraines |
| Lyrics is like a controlled substance because? | Side effects (Somnolence (sleepiness), dizziness and confusion ) |
| Antiparkinsonian | Carbidopa, levodopa |
| Carbidopa, levodopa | be given separate, or combination drug RLS, Parkinson |
| RLS | Irresistible urge to move leg |
| Parkinson's | they have a depletion of dopamine, produced in the brain and can lead to loss of muscle movement |
| Adverse reactions Carbidopa, levodopa | Dizziness, hypotension, constipation increased hand tremors Choreiform movements, Dystonic movements (muscle contract involuntary) * mental status changes. |
| Choreiform movements | (jerking and twitching) |
| Dystonic movements | muscle contract involuntary |
| Levodopa | May have darker urine, saliva and tears |
| Dopamine receptor agonist | Ropinirole (requip), Pramipexole, Mirapex |
| Ropinirole (requip), Pramipexole, Mirapex | Mimic the effect of dopamine in the brain, Used for Parkinson, RLS Monitor for drowsiness, take with meals to minimize nausea |
| Antianxiety, sedatives, hypnotics | Benzos – alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan) |
| Benzos – alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan) | Used for anxiety, alcohol withdraw and seizure. |
| Antidote for Benzos | flumazenil (Romazicon) |
| If Benzos are given via IV, | monitor for respiratory depression or cardiac arrest because their body has been relaxed too much. |
| alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan) | No alcohol, No pregnancy or in labor can cause floppy baby syndrome |
| Monitor vital signs before and after administering Benzos | Need a baseline, |
| zolpidem | Take on an empty stomach at night |
| Salicylates | Aspirin, Ecotrin, Bufferin (Synthetic form) |
| Aspirin can be given after a MI | Aspirin can be used as a blood thinner, Several years low dose 81mg, Recent MI 350mg |
| Aspirin, Ecotrin, Bufferin (Synthetic form) Action? | Analgesic, Antipyretic, Anti-inflammatory, Reduces risk of TIA and stroke |
| Analgesic | (Pain relief) Relief of mild to moderate pain |
| Antipyretic | Decrease fever) Reducing elevated body temperature when used in conjunction with tepid bath |
| Tepid bath | Submerge your pt in cool water till their neck |
| Anti-inflammatory | Decrease swelling, Treating inflammatory conditions like OA and rheumatic fever by reducing inflammatory response |
| Reduces risk of TIA and stroke | Prevents platelet aggregation (Cloth formation) |
| When taking aspirin make sure you ask for any allergies | Food sensitivity/ intolerance, common problems difficult to diagnose (Allergy) |
| Side effect of aspirin | Gastric upset, Anorexia, tinnitus(ringing in the air), Hyperventilation( Rapid breathing) |
| Avoid with Aspirin | Can’t be given with NSAIDs (Non-steroids anti-inflammatory drugs.) Avoid licorice, tea and paprika (contain salicylate) Garlic increases risk of bleeding |
| If you have a GI bleed | It can affect Platelet count must be 100,000 |
| Non-Salicylates | Tylenol (Acetaminophen) Preferred drug with bleeding tendency |
| Tylenol | Mild to moderate pain (monitor patient) Reduction of elevated body temperature |
| Hemolytic anemia | RBC are destroyed faster than made |
| Do not exceed how much Tylenol for normal & kidney failure | Do not exceed 4 grams daily in normal patients Do not exceed 2 grams daily in those with liver or kidney failure |
| Liver failure | monitor LFTs (Jaundice, yellow skin, nails) |
| Hepatotoxicity | most serious, drug induce liver disease (acute or chronic) |
| Tylenol Acute, Chronic Chronic | Acute-Hepatitis, after medication overdose or poison Chronic- Cirrhosis of liver |
| Tylenol antidote | Mucomyst (acetylcysteine) |
| Mucomyst (acetylcysteine) | Helps decrease liver damage by altering the hepatic levels. Give with flavor water or soda=nasty |
| Mucomyst (acetylcysteine) purpose | Bends mucose and restore Glutathione level= Produced in kidneys and is a antioxidant Monitor: Liver damage, frequent ALT, AST, |
| NSAIDs (Non-Steroidal Inflammatory Drugs) | Ibuprofen, Motrin, Aleve, meloxicam, Celebrex, Toradol, Advil |
| Ibuprofen, Motrin, Aleve, meloxicam, Celebrex, Toradol, Advil | Pain associated with musculoskeletal disorders (Arthritis, joint) Mild to moderate pain Fever reduction Primary dysmenorrhea (Painful period) |
| If allergic to sulfa or have cardiac hx , peptic/gastric ulcers, GI bleed | Do not take NSAIDS |
| NSAIDS Side effects | Nausea MC Drowsiness MC Stomatitis MC *Take 2-4 weeks for NSAIDS to be effective |
| NSAIDS adverse effects | Intestinal ulceration (Sore of the lining of the stomach, small intestine or esophagus) Makes you sick Hematuria (Blood in the urine) Diplopia (Double vision) |
| Interact with NSAIDS | Beta blockers, diuretics, ACE inhibitors, Digoxin (They increase your blood pressure) |
| Opioid Analgesic | Codeine (Oxycotin) Hydrocodone, oxycodone, tramadol, oxymorphone,Morphien, Methadone( used w/pt abuse drugs), |
| Codeine | Mild and moderate pain, in some cold medicine COLD meds |
| Fentanyl Patch | Acute and chronic pain, 50-100 stronger than morphine |
| Opioids cause | CNS depression, slow breathing Euphoric feeling, feeling high SEEKING |
| Use Opioids | Moderate to severe pain Treatment of opiate dependence (methadone) Decrease anxiety Supports anesthesia Relief of persistent cough |
| Given EOL | Respiratory comfort (morphine) Given to EOL (End of life) Hospice, Increase respiratory breathing, increase secretions, labored breathing. Die with comfort |
| If allergic to Morphine give | Deloted, phentnal (Patch, IV, lollipop) |
| Chronic pain | 6 months or longer, depends on diagnosis |
| Use cautiously with | Elderly, High risk respiratory depression |
| When ordering a opioid or narcotic | order a stool softener, High fiber diet to prevent constipation Drink plenty of fluids (Flush it out) |
| Diaphoretic | decrease respiration, shallow breath, Lower than 10 respiration, NARCAN When taking a opioid |
| Codeine (Oxycotin) Hydrocodone, oxycodone, tramadol, oxymorphone,Morphien, Methadone( used w/pt abuse drugs), | Should NOT TAKE OTC cough/cold preps, alcohol, antihistamines, antidepressants, sedatives, barbiturates |
| Codeine, Hydrocodone, oxycodone, tramadol, oxymorphone, Morphien, Methadone ANTIDOTE? | Narcan |
| Opioid Antagonist | Narcan (Bind and reverse effects) |
| Narcan can be used as a? | Injectable or nasal spray Affects breathing rate, cause long term development problems |
| Do not administer narcan when? | Do not administer to neonates who are addicted to opioids (affects breathing rate, cause long term development problems) Do not administer concurrently with valium and Ativan during acute phase of withdrawals |
| Side effects of Narcan | Tachycardia Hypertension Nausea Hypotension |
| Anesthetic Drugs | Used for anesthesia Local |
| Local | Sensation free state in a small specific region (Minor) Can be given topically or as a local infiltration |
| Local contains | May contain epinephrine; therefore, never inject epi or epi containing products into the fingers and toes as it will cause vasoconstriction leading to decreased perfusion and cellular death of tissues. |
| What drug classifications consist of the Holy Trinity? | Benzodiazepines, muscle relaxer, and an opioid. It is used when several drugs have been used and the patient has overdosed. |
| What neurotransmitter has a depletion in párkinson patients that causes párkinson disease? | Dopamine |
| How long does it take for NSAIDS to be effective in the patient’s system? | 2-4 weeks |
| What medications do you give an unconscious type 1 diabetic patient? | Glucagon/dextrose |
| What are the benefits of scopolamine patches? How long do they last? Where should they be placed? | They help with nausea and vomiting. Especially with motion sickness. They will last up to 72 hours. Should be placed behind the ear. Rotate sites. |
| What is a patient controlled analgesic pump (PCA)? | A machine (pump) that allows patients to control their medication. The pump has settings that will prevent patients from getting too much medication. |
| What medication is used for opioid overdose? | Narcan |
| What medication is used for Tylenol overdose? | Mucomyst |
| What adverse reactions can occur with taking baclofen (Lioresal) a skeletal muscle relaxant? | Drowsiness Seizures Hypotension |
| What is the therapeutic levels for Dilantin? | 10-20 |
| A wound that requires stitches would require what type of anesthesia? | Local |
| When teaching a patient to use an Epipen, where should the injection be administered? | In the thigh |
| The medication Bethanechol is used for benign prostatic hyperplasia (BPH). What is BPH? What is the benefit of using this medication for these patients? | It’s an enlarged prostate. The goal is to improve bladder function |
| What is the goal of epinephrine being used during a code blue? | To increase the blood flow to the heart and brain. |
| The medication Tensilon is used to diagnosis what disease? | Myasthenia gravis |
| What is rebound congestion? | A condition that develops from the overuse of nasal decongestant sprays or drops. The stuffy nose worsens b/c of the use of nasal products so much. |
| Should patients take erectile dysfunction medications with BPH? | No |
| What are the most common adverse reactions for Levodopa? | Dustonic reactions, choreiform movements, and increased hand tremors |
| As the nurse, when the physician orders a narcotic, what else should you make sure is ordered? | A stool softener |
| When patients are prescribed stool softeners, what patient teaching should you include? | To eat plenty of fiber and drink water or fluids |
| What is a side effect for patients taking salicylism? | Tinnitus |
| What is the maximum amount of Tylenol a patient should receive in a day? How about a patient with liver disease? | 4 grams or 4000 mg 2 grams or 2000 mg |
| What narcotic medication will be therapeutic in treating a patient with a cough and headache? | Codeine |
| A seizure patient or patients taking opioids or anxiety medications are at higher risk for | Falls. Safety will be the nurses primary concern. |
| What classification of medication can cause gingival hyperplasia? | Anti-seizure medications |
Created by:
golds_berry
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