Nur 212/Pharmacology Exam 2
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| 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.
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| 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.
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| Intrathecal continued... | Implantable drug pumps are used for outpatient basis for pts with chronic pain syndromes.
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| 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.
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| 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.
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| 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).
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| 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.
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| benzocaine (Dermoplast, Lanacane, Solarcaine) | Route- topical, aerosol & spray.
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| cocaine | Route-topical
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| dibucaine (Nupercainal) | Route- Injection & topical
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| dyclonine (Dyclone, Sucrets) | Route- Topical
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| ethyl chloride (Chlorethane) | Route- Topical
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| lidocaine (Lidoderm) | Route- topical
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| proparacaine (Alcaine, Ophthetic) | Route- ophthalmic
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| prilocaine/lidocaine (EMLA) | Route- topical
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| tetracaine (Pontocaine) | Route- injection, topical & ophthalamic.
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| 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.
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| Effects of general anesthetics on cardiovascular system | Depressed myocardium; hypotension & tachycardia; bradycardia in response to vagal stimulation
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| Effects of general anesthetics on cerebrovascular system | Increased intracranial blood volume & increased intracranial pressure.
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| Effects of general anesthetics on GI system | Reduced hepatic blood flow & thus reduced hepatic clearance.
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| Effects of general anesthetics on renal system | Decreased glomerular filtration.
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| Effects of general anesthetics on skeletal muscles | Skeletal muscle relaxation
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| Effects of general anesthetics on cutaneous circulation | Vasodilation
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| Effects of general anesthetics on CNS | CNS depression; blurred vision; nystagmus; progression of CNS depression to decreased alertness, sensorium, & decreased LOC
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| 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.
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| 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.
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| 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.
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| 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.
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| Adverse effects of Barbiturates: phenobarbital, primidone | Dizziness, drowsiness, lethargy, paradoxical restlessness.
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| Adverse effects of Hydantoins: phenytoin, fosphenytoin | Nystagmus, ataxia, drowsiness, rash, gingival hyperplasia, thrombocytopenia, agranulocytosis, hepatitis.
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| Adverse effects of Iminostilbenes: carbamazepine, oxcarbazepine | Nausea, headache, dizziness, unusual eye movements, visual change, behavioral changes, rash, abd pain, abnormal gait.
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| Adverse effects of valproic acid & derivatives including valproate sodium & divalproex sodium | Dizziness, drowsiness, GI upset, weight gain, hepatotoxicity, pancreatitis.
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| Adverse effects of gabapentin | Dizziness, drowsiness, nausea, visual & speech changes, edema
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| Adverse effects of pregabalin | Dizziness, drowsiness, peripheral edema, blurred vision
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| Adverse effects of lamotrigine | Drowsiness, ataxia, headache, nausea, blurred/double vision
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| Adverse effects of levetiracetam | Dizziness, drowsiness, hyperactivity, behavioral changes (anxiety, hostility, agitation, suicidal ideation), uncoordination.
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| Adverse effects of Succinimides: ethosuximide | Nausea, abd pain, dizziness, drowsiness
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| Adverse effects of tiagabine | Dizziness, drowsiness, agitation, asthenia, GI upset, abd pain, rash, tremor
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| Adverse effects of topiramate | Dizziness, drowsiness, GI upset, ataxia
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| Adverse effects of zonisamide | Drowsiness, anorexia, ataxia, confusion, agitation, cognitive impairment
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| Normal therapeutic range for valproic acid (Depakote) | 50-100 mcg/mL
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| Normal therapeutic range for carbamazepine (Tegrotol) | 4-12 mcg/mL
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| Normal therapeutic range for phenytoin (Dilantin) | 10-20 mcg/mL
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| Adrenergic receptor responses to stimulation- Blood vessels | Alpha1- vasoconstriction; Beta2- vasodilation
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| Adrenergic receptor responses to stimulation- cardiac muscle | Beta1- increased contractility
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| Adrenergic receptor responses to stimulation- Atrioventricular node | Beta1- increased heart rate
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| Adrenergic receptor responses to stimulation- Sinoatrial node | Beta1- increased heart rate
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| Adrenergic receptor responses to stimulation- Liver | Alpha1, beta2- glycogenolysis
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| Adrenergic receptor responses to stimulation- Kidney | Beta1- increased renin secretion
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| Adrenergic receptor responses to stimulation- GI muscle | Alpha1, beta2- decreased motility (relaxation of GI smooth muscle)
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| Adrenergic receptor responses to stimulation- Bladder sphincter | Alpha1- constriction
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| Adrenergic receptor responses to stimulation- Penis | Alpha1- Ejaculation
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| Adrenergic receptor responses to stimulation- Uterus | Alpha1- contraction; Beta2- relaxation
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| Adrenergic receptor responses to stimulation- Bronchial muscles | Beta2- Dilation (relaxation of bronchial smooth muscles)
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| Adrenergic receptor responses to stimulation- Pupillary muscles of the iris | Alpha1- mydriasis (dilated pupils)
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| dobutamine (Dobutrex) | Class- Beta1, adrenergic; Indications- Cardiac decompensation
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| dopamine (Intropin) | Class- Beta1, adrenergic; Indications- Shock syndrome, cardiopulmonary arrest
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| epinephrine (Adrenalin) | Class- Alpha & beta adrenergic; Indications- anaphylaxis, cardiopulmonary arrest
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| fenoldopam (Corlopam) | Class- dopamine 1 agonist; Indications- hypertensive emergency in hospital
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| midodrine (ProAmatine) | Class- Alpha1-adrenergic; Indications- orthostatic hypotension
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| norepinephrine (Levophed) | Class- Alpha & beta-adrenergic; Indications- hypotensive states
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| phenylephrine (Neo-Synephrine) | Class- Alpha-adrenergic; Indications-hypotension or shock
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| Beta blockers adverse effects- cardio | Atrioventricular block, bradycardia, & HF
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| Beta blockers adverse effects- CNS | Dizziness, fatigue, depression, drowsiness, & unusual dreams.
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| Beta blockers adverse effects- GI | N/V/D & constipation
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| Beta blockers adverse effects- Hematologic | Agranulocytosis, thrombocytopenia
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| Beta blockers adverse effects- Metabolic | Hyperglycemia, hypoglycemia, hyperlipidemia
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| Beta blockers adverse effects- other | Impotence, alopecia, bronchospasm, wheezing, & dry mouth
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| Alpha blockers adverse effects- Cardio | Palpitations, orthostatic hypotension, tachycardia, edema, & chest pain.
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| Alpha blockers adverse effects- CNS | Dizziness, headache, anxiety, depression, weakness, numbness, & fatigue.
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| Alpha blockers adverse effects- GI | N/V/D, constipation, & abd pain
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| Alpha blockers adverse effects- other | Incontinence, dry mouth, pharyngitis
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| phentolamine (Regitine) | Class- Alpha blocker; Indications- Hypertensive episodes with pheochromocytoma.
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| tamsulosin (Flomax) | Class- Alpha1 blocker; Indications- Benign prostatic hyperplasia
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| atenolol (Tenormin) | Class- Beta1 blocker; Indications- Hypertension angina
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| carvedilol (Coreg) | Class- Alpha & beta blocker; Indications- HF, angina, hypertension
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| esmolol (Brevibloc) | Class- Beta1 blocker; Indications- Supraventricular tachydysrhythmias
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| labetalol (Normodyne, Trandate) | Class- Alpha1 & beta blocker; Indications- Hypertension, severe hypertension
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| metoprolol (Lopressor, Toprol XL) | Class- Beta1 blocker; Indications- Hypertension, late MI, early MI
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| propranolol (Inderal) | Class- Beta blocker; Indications- Angina, hypertension, dysrhythmias, post MI, migraine
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| sotalol (Betapace) | Class- Beta blocker; Indications- Life-threatening ventricular dysrhythmias
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| Cholinergic agonists drug effects- Bronchi | Muscarinic- Increased secretions, constriction; Nicotinic- none
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| Cholinergic agonists drug effects- Blood vessels | Muscarinic- Dilation; Nicotinic- Constriction
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| Cholinergic agonists drug effects- Heart rate | Muscarinic- Slowed; Nicotinic- Increased
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| Cholinergic agonists drug effects- BP | Muscarinic- Decreased; Nicotinic- Increased
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| Cholinergic agonists drug effects- Eye | Muscarinic- Miosis (pupil constriction), decreased accommodation; Nicotinic- same
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| Cholinergic agonists drug effects- GI tone | Muscarinic- Increased; Nicotinic- Increased
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| Cholinergic agonists drug effects- GI motility | Muscarinic- Increased; Nicotinic- Increased
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| Cholinergic agonists drug effects- GI sphincters | Muscarinic- relaxed; Nicotinic- relaxed
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| Cholinergic agonists drug effects- GU tone | Muscarinic- increased; Nicotinic- increased
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| Cholinergic agonists drug effects- GU motility | Muscarinic- increased; Nicotinic- increased
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| Cholinergic agonists drug effects- GU sphincter | Muscarinic- relaxed; Nicotinic- relaxed
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| Cholinergic agonists drug effects- glandular secretions | Muscarinic- increased intestinal lacrimal, salivary, & sweat gland secretion; Nicotinic- none
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| Cholinergic agonists drug effects- skeletal muscle | Muscarinic- none; Nicotinic- increased contraction
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| bethanechol (Urecholine) | Class- muscarinic (direct-acting); Indications- post-op & postpartum functional urinary retention
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| donepezil (Aricept) | Class- Anticholinesterase (indirect-acting); Indications- Alzheimer's dementia
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| memantine (Namenda) | Class- NMDA-receptor antagonist; Indications- Alzheimer's dementia
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| physostigmine (Antilirium) | Class- Anticholinesterase (indirect-acting); Indications- Reversal of anticholinergic drug effects & tricyclic antidepressant overdose.
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| pyridostigmine (Mestinon) | Class- Anticholinesterase (indirect-acting); Indications- Myasthenia gravis, antidote for neuromuscular blocker toxicity.
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| Cholinergic blocking drug effects- Cardio | Small doses- decrease HR; Large doses- increase HR
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| Cholinergic blocking drug effects- CNS | Small doses- decrease muscle rigidity & tremors; Large doses- cause drowsiness, disorientation, halluciations
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| Cholinergic blocking drug effects- Eye | Dilate pupils (mydriasis), decrease accommodation by paralyzing ciliary muscles (cyclopegia)
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| Cholinergic blocking drug effects- GI | Relax smooth muscle tone of GI tract, decrease intestinal & gastric secretions, decrease motility & peristalsis
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| Cholinergic blocking drug effects- GU | Relax detrusor muscle of bladder, increase constriction of internal sphincter; these two effects may result in urinary retention
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| Cholinergic blocking drug effects- Glandular | Decrease bronchial secretions, salivation, & sweating
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| Cholinergic blocking drug effects- Respiratory | Decrease bronchial secretions, dilate bronchial airways
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| Cholinergic blockers adverse effects- Cardio | Increased HR, dysrhythmias (tachycardia, palpitations)
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| Cholinergic blockers adverse effects- CNS | Excitation, restlessness, irritability, disorientation, hallucinations, delirium, ataxia, drowsiness, sedation, confusion
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| Cholinergic blockers adverse effects- Eye | Dialted pupils (blurred vision), increased intraocular pressure
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| Cholinergic blockers adverse effects- GI | Decreased salivation, gastric secretions, & motility (causing constipation)
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| Cholinergic blockers adverse effects- GU | Urinary retention
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| Cholinergic blockers adverse effects- Glandular | Decrease sweating
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| Cholinergic blockers adverse effects- Respiratory | Decreased bronchial secretions
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| atropine (generic) indications | Tx of bradycardia; anticholinesterase effect for organophosphate or carbamate poisoning (insecticides); cardiopulmonary resuscitation
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| dicyclomine (Bentyl) | Tx of irritable bowel syndrome; preoperative control of secretions
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| glycopyrrolate (Robinul) | Preoperative control of secretions; reversal of neuromuscular blockade
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| oxybutynin (Ditropan, Ditropan XL, Oxytrol-transdermal patch) | Antispasmodic for neurogenic bladder (following spinal cord injury), overactive bladder
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| scopolamine (generic injection; Transderm-Scop patch) | Preoperative control of secretions, motion sickness prevention
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| tolterodine (Detrol, Detrol XL) | Tx of overactive bladder
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| Neurotransmitter involved in N/V- Acetylcholine (ACh) | VC in brain; vestibular & labyrinthine pathways in inner ear
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| Neurotransmitter involved in N/V- Dopamine (D2) | GI tract & CTZ in brain
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| Neurotransmitter involved in N/V- Histamine (H1) | VC in brain; vestibular & labyrinthine pathways in inner ear
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| Neurotransmitter involved in N/V- Prostaglandins | GI tract
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| Neurotransmitter involved in N/V- Serotonin (5-HT3) | GI tract; CTZ & VC in brain
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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.
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| Complete nutritional formulations: Indications | Inability to consume or digest normal foods; accelerated catabolic status; undernourishment because of disease.
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| Incomplete nutritional formulations: Indications | Genetic metabolic enzyme deficiency; hepatic or renal impairment
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| 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.
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| Esophagostomy | Feeding tube surgically inserted into the esophagus
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| Gastrostomy | Feeding tube surgically inserted directly into the stomach
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| Jejunostomy | Feeding tube surgically inserted into the jejunum
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| Nasoduodenal | Feeding tube placed from the nose to the duodenum
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| Nasojejunal | Feeding tube placed from the nose to the jejunum
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| Nasogastric | Feeding tube placed from the nose to the stomach
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| Oral | Nutritional supplements delivered by mouth
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| 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
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| 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
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| 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).
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| 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.
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| 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.
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| Infiltration & epinephrine together indications | Prevent systemic absorption of anesthetic, confine local anesthetic to injected area, & reduce local blood loss.
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| 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.
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| Succinylcholine- Depolarizing NMBD | Works similar to ACh, causes sustained depolarization (paralysis). Metabolism is slower than ACh, repolarization cannot occur. Reversal agent Anticholinesterase drugs.
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| 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.
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| 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.
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| 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).
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| 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).
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| 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.
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| Long term use of phenytoin (Dilantin) adverse effects | May cause gingival hyperplasia, acne, hirsutism & Dilantin facies.
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| 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.
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| 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.
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| 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).
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| 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).
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| Alpha-Adrenergic Agonist Response | Vasoconstriction & CNS stimulation
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| Beta-Adrenergic Agonist Responses | Bronchial, GI, & uterine smooth muscle, glycogenolysis, & cardiac stiumlation.
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| Adrenergic blocking agents used post MI | Inhibits stimulation from circulating catecholamines
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| Adrenergic blocking agents used post MI | Inhibits stimulation from circulating catecholamines
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| What is important to consider for a pt with DM | Beta blockers mask s/s hypoglycemia
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| Antidote for cholinergics | Atropine
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