Test 2 Study Guide
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| What is the antidote for a dopamine infusion infiltration? | Phentolamine (Regitine), dopamine must be infused through a large vein to minimize risk for infiltration.
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| Main neurotransmitter for: Fight or flight | epinephrine, norepinephrine, and dopamine
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| Main neurotransmitter for: Rest & Digest | Acetylcholine
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| Main target organ for beta 1 | Heart
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| Main target organ for beta 2 | Lungs
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| What is an epi-pen used for and what purpose | Anaphylactic shock, it bronchodilates the alveoli and increase the force of contractions to the heart.
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| 3 actions of the beta 1 being stimulates by an andrenergic | Increased contractility, increased HR, and increased renin secretion.
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| Adverse effect of Levophed because of vasoconstriction action. | Extravasion, leaking of fluid from blood vessels into surrounding tissue.
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| What is a prodrug | The drug is converted in the liver to its active form
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| Midodrine (ProAmatine), why cant you give it at night? | To prevent insomnia and supine hypertension
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| Mydriasis what is it and why drug is used to make this occur? | Dilation of the pupils, Pilocarpine (Alpha 1 agonist)
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| What is Pheochromocytoma? | Adrenal gland tumor that secretes norepinephrine and epinephrine, causes CNS stimulation and increases BP.
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| what class of meds relieve symptoms of Pheochromocytoma? | Alpha-blockers, it blocks alpha adrenergic stimulation causing dilation of the blood vessels and decreasing BP.
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| What is Reynaud's | Narrowing of small arteries, causing numbness in extremities.
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| What meds are use for symptom relief in Reynaud's? | Phenoxybenzamine, alpha-blocker used to vasodilate.
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| What class of meds can cause 1st dose phenomenon and why is it a safety risk? what are Nursing interventions to prevent this? | Alpha blockers, it is a severe drop in BP. Warning the pt, help pt out of bed, give them time to adjust to new positions.
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| Alpha blockers used for both HTN & BPH. | Doxazine, prazosin, terazosin.
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| Baseline data collected before giving any beta blocker. | Allergies, past & present med condition, med history, BP, auscultate lungs, resp, HR, I&O, daily weights, and blood glucose levels.
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| Med condition considered when giving a beta blocker | Will cause bronchoconstriction, dont give to someone with asthma, emphysema, bronchitis, or any other bronchial constriction disease.
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| Metoprolol indicated for pt w/MI, what class is it? | Ability to reduce stimulation of heart by decreasing HR & force of myocardial contractions, Beta 1 antagonist.
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| Cholinergic drugs are also known as what because they mimic the effects of acetylcholine? | Parasympathomimetic
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| Bethonacol, what are the indications for this med | Increase in bladder and GI tone, increasing movement, used for chronic refactory heart burn, or testing for cystic fibrosis.
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| When would Bethanechol be contraindicted for pt? | Drug allergy, hyperthyrodism, peptic ulcer, active bronchial asthma, cardiac disease, or coronary artery disease, epilepsy, and Parkinson's
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| Receptor primary stimulted by cholinergic drugs with recommended drugs | Cholinergic receptors
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| Antidote for pesticide poisoning | physostigmine
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| symptoms of cholinergic poisoning | SLUDGE, salvation, lacrimation, urinary incontinence, diarrhea, GI cramping, and emesis. Makes you wet!
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| Med used to treat and diagnose MG | Physostigminem indirect drug increases ACh concentration.
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| What is a cholinergic crisis? | Severe overdose of ACh
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| What is Pilocarpine nd how does it help treat glaucoma? | Direct acting drug, it reduces intraccular pressure.
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| what is Alzheimers disease | Neuro disorder where pts have a decreased level of ACh.
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| Why is cholinesterase used to manage the symptoms of Alzheimers? | It stops the breakdown of ACh
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| Why is Aricept an indirect acting drug? | Works by acting on the receptor site, it stops the breakdown of ACh to help increase ACh levels.
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| What enzyme does Aricept inhibit? | Cholinesterase
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| What is Namenda | Used to help Alzheimer damentia, it blocks the stimulation of NMDA receptors & reduces the pts degenerative cognitive symptoms.
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| What class of drug is Namenda? | NMDA receptor antagonist
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| Cholinergic blocking drugs are also known as? | Parasympatholytics
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| Adverse reactions Parasympatholytics might have on elderly | Excitation, restlesness, irritability, disorientation, hallucinations, delirium, ataxia, drowsiness, sedation, or confusion.
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| What is Atropine? | anticholinergic/Cholinergic, blocking drug
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| What are the indications of Atropine? | manage cardio disorders, optitalmic uses
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| What baseline data should you get for Atropine? | Allergies, glaucoma, eye conditions, GERD, poor intestinal mobility, obstructions of GI/GU, severe colitis, meds currently on, contradictions to med, VS, I&O.
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| What is Atropine the antidote of? | Cholinergic crisis
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| What are the indications of Scopolamine. | Prevent motion sickness, balancing ACh & NE in brain.
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| What food should be avoided while on Scopolamine? | Alcoholic beverages
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| How long does it take for Scopolamine to take effect? | Apply patch 4-5 hours before traveling.
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| What should you recommend to a pt on anticholinergic drugs for dry mouth? | Regular & thorough oral hygiene, push fluids, saliva drops/gum, sugar free candy, water pick, and regular dentist checkups.
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| If sedation or drowsiness occurs with anticholinergics, advise pts to avoid what? | Alcohol, meds that cause further sedation, and other drugs.
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| Oxybutynin (Ditropon) indicated which conditions? | Treatment of over reactive bladder, antispasmodic for neurogenic bladder associated with spinal cord injuries or congenital conditions, spina bifida.
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| What is a community acquired infection? | Acquired by people who have not been hospitalized or had a medical procedure recently.
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| What is a hospital acquired infection? | Acquired during the course of receiving treatment for another condition in a health care facility.
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| What is a superinfection? | Occurs during antimicrobial treatment for another infection, resulting from over growth of an organism not susceptible to the antibiotic used.
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| What is empiric therapy? | Administration of antibiotics based on the practitioners judgement of the cause of infection, presumptive treatment to avoid treatment delay.
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| What is prophylactic therapy? | Antibiotics are taken before anticipated exposure to an infectious organism in an effort to prevent the development of infection.
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| What is G6PD? | Inherited disorder which RBCs are partially or completely deficient in glucose-6-phosphate dehydrogenase, critical enzyme in the metabolism of glucose.
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| What populations need to be observed with G6PD? | Most likely to occur in the Jewish population.
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| Main intervention for stopping the spread of infection. | Washing hands
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| Signs of C-Diff infection | Pt who previoualy treated with antibiotics and develops watery diarrhea.
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| What is a Beta-lactamase ring? | Group of enzymes produced by bacteria that catalyze the chemical opening of the crucial beta lactam ring structures in beta-lactam antibiotics, when it occurs it makes the antibiotic not effective.
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| What is MRSA? | Mathicillin-resistant Staphylcoccus Aureus. Most common hospital acquired infection.
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| Education nurses give to pts to stop drug resistant infections. | Main mode of transmission is contact, wash hands often and use antiseptic or disinfectant foam or gel.
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| What drug is considered a possible cross allergy for PCN? | Cephalorsporins
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| What is Visceral pain? | Originates from organs of smooth muscle.
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| What is vascular pain? | Results from pathology of the vascular or perivascular tissues.
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| What is neuropathic pain? | Result of disturbance of function or patho change in a nerve.
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| What is somatic pain? | Skeletal muscles, ligaments, or joints.
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| What is acute pain? | Sudden onset, usually subsides when treated, lasts less than 6 weeks.
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| What is chronic pain? | Persistent of recurring that's often difficuly to treat, >3-6 months.
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| What is opioid tolerance? | Adaptation in which exposure to a drug causes changes in drug receptors that result in reduced drug effects over time.
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| Baseline needed to be collected for opioid analgesic administration. | Pain level, BP,HR, RR, LOC, meds on, allergies, last BM.
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| Meperidine (Demerol), why should it not be used in children and elderly? | If kidneys are not fully developed or there is issues with them, an active metabolite normeperidine can accumulate to toxic levels and lead to seizures.
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| Common adverse effect of opioids caused by histamine release. | Itching, rash, puritus and hemodynamic changes, can also cause flushing and orthostatic hypotansion.
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| Most serious adverse effect of opioids. | CNS depression
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| Antidote for opioids. | Naloxone (narcan) or Naltrexone (revia).
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| Why might Naloxone be admin. more than once in a pt who has overdosed on methadone or fentanyl patches? | Naloxone is short lived (about an hour) resp depressant might reappear and another dose is needed.
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| Demerol should not be given to pt taking Selegiline (MAOI). | It can lower seizure threshold when taken together, increasing the risk of seizures.
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| Pt that is opioid maive should not take fentanyl, why? | The pt is not use to the effects, so pt will have more significant adverse side effects. Esp with Fentanyl, its more potent than morphine.
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| What is opioid tolerant? | Pt has been on opioids for a period of time and greater risk of opioid withdrawl syndrome with sudden discontinuation.
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| Daily limit of Tylenol (Acetaminophen). | 4000 mg for adult, 2000 mg or less for elderly or liver dysfunction.
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| Contraindications for Acetaminophen. | Allergies, liver disease, genetic disease G6PD, alcohol use.
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| Normal GGT (liver function) level for African Americans. | AA can have double the value of a white & still be considered normal. 16-76 units/L is normal value.
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| Normal ALT level and what does it show? | 4-36 units/L, if injury or disease to liver cells it will release ALT, an enzyme, into the blood. If liver isn't functioning correctly then meds sent to liver won't be metabolized=toxicity.
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| Med used for Benzodiazepine overdose. | Flumazenil
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| Drug/food interaction that needs to be avoided with benzodiazepines. | Grape fruit juice, it decreases metabolism resulting in prolonged action.
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| Adverse effects for elderly taking benzodiazepines. | Significant fall hazard, use lowest dose.
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| Primary inhibitory neurotransmitter for the brain | GABA
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| Main adverse effect of ambien | Somnambulation or sleepwalking.
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| Is Ramelteon (Rozerem) a controlled substance? and hormone it is related to? | No it is non habit forming, related to melatonin.
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| Contraindications for muscle relaxants such as Baclofen (Cioresal). | Allergy and severe renal impairment
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| How do amphetamines and phenidates increase the effect of norepinephrine and dopamine? | The increase the NE and DA in the CNS synapse by increasing their release and blocking their reuptake.
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| what time should a pt take Methylphenidate (Ritalin). | Taken on an empty stomach 30-45 mins before eating.
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| What drug is used for ADHD that is non-controlled? | Atamoxetine (Stratera)
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| Contraindications for the use of caffene as analeptics. | Drug allergy, peptic ulcer disease, serious cardiovascular conditions.
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| Why would CODP pt take an analeptic, Theophylline, after surgery. | Control resp by stimulating the medulla and spinal cord (CNS). Also inhibit enzyme CAMP, it relaxes smooth muscle tissue in resp tract, dilation of pulmonary arterioles, and stimulent of the CNS in general.
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| What is abortive therapy of migraines? | The migraine is already there and the med is getting rid of it.
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| What is the 1st line med for treatment of migraines? | Serotonin receptor agonist.
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| Adverse effect with overuse of abortive therapy for migraines | Rebound headaches
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| What is status epliepticus | Seizure disorder characterized by generalized tonic-clonic convulsions that occur repeatedly. multiple seizures w/o recovery between them. W/o treatment it can head to hypotsn, hypoxia, brain damage, and death.
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| importance for good oral hygiene with Dilantin (Phonytoin) | The drug side effect is gingival hyperplasia (overgrowth of gum tissue).
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| Drug choice for status epilepticus | Diazepam or Lorazepan
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| Vitamin that should be given to long term Dilantin (Phenytoin) use. | Vit D, osteoporosis is a common consequence
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| Why Dilantin should be dosed lower for malnourished of low albumin pts. | Show to exaggerate Dilantin effects, with low levels of albumin more free unbound active Dilantin will be present in the blood.
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| Miscellaneous drug used for neuropathic pain and epilepsy. | Gabapentin
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| Precautions for pt placed newley on Gabapentin | Requires a thorough neuro assessment with attention to baseling energy levels, visual inractnedd, sensory and motor functioning, and any changes in speech.
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| Advantage of valporic acid (depakote sprinkles) | Long acting granules that can be opened and sprinkled on food.
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| Main activity epileptic pts cant do, how long seizure free must they be to do this activity again. | Driving, 6 months depending on states DMV.
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| Diet restrictions for carbidopa-levodopa | Reducing protein improves the effectiveness of levodopa, protein decreases the absorption of levodopa.
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| How B6 (Pyridoxine) interacts with carbidopa-levodopa | It decreases the effects of levodopa
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| Anticholinergic drug Benztropine (Cogentin) used in parkinson's as an adjunct med to treat | Tremors
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| Antihistamine with anticholinergic properties used to treat SLUDGE in Parkinson's pts. | Benadryl
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| In elderly, what anticholinergic adverse effects must be monitered | Dry mouth, urinary retention, constipation, dry eye, dry skin, decreased sweating (hyperthermia)
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| What does selegiline protect from breaking down? | prevent the breakdown of dopamine, has less effect of the cheese effect happening (selective).
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| What is the cheese effect? | Eats foods/drinks with tyramine can cause hypertansive crisis 210/110. Foods: beer, wine, cheese, aged smoked meats.
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| Selegiline is contraindicated for which opioid for risk of hyperpyrexia and delirium | Demerol
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| Antiviral med found useful in treating early stages of parkinson's | Amantadine (Symmetrel)
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| Main disorder lithium is used for | Bipolar diorder
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| Lab that must be checked before administering lithium | Sodium level
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| Most serious adverse effect of lithium toxicity | Cardiac dysrhythmias
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| S&S of serotonin syndrome | Delirium, agitation, tachycardia, sweating, muscle spasme, hyperreflexia, shivering, coarse tremors, extensor plantar muscle responses
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| Foods avoided with MAOIs | Aged cheese, smoked/pickled meats, aged.fermented meats, yeast extracts, red wines, italian broad beans
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| Benzodiazepine also indicated for panic disorder | Xanax
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| Anxiolytic drug | Antianxiety
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| TCA (amitriptyline) Elquil can block muscarinic receptors and cause potent _______ effects, can cause constipation and urinary retention | Anticholinergic
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| TCAs and what frink will cause overdose resulting in death in 70-80% of pts before they reach the hospital | Alcohol
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| Antidote for TCA poisoning | None, supportive care, activated charcoal, sodium bicarb, diazepam for seizures, antidysthythmics
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| When MAOI is given with TCA drug what crisis may occur | Hyperpyretic crisis (high fever)
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| Antidepressant that is also used for smoking cessation | Zyban
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| Adverse effects of antipsychotic drugs include: Neuroleptic malignant syndrome | Fever, cardio instability, and myoglobinemia
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| Adverse effects of antipsychotic drugs include: Tardive dyskinesia | Abnormal and distressing involuntary body movements and muscle tension
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| Adverse effects of antipsychotic drugs include: Extrapyramisal Symptoms | Similar motor disorders seen in Parkinson's disease
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| Bradycardia occurs with all antipsychotics, what test and electrolyte panal should be done before giving Haldol? | EKG, potassium and magnesium levels
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