Exam #2

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serious6
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104444
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Exam #2
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2011-10-02 20:59:00
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Cholinergic Agnoists Antagonists
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Pharm Protorype Drugs
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  1. What are the Therapeutic and Pharmacologic Classifications of Bethanechol chloride (Duvoid, Urecholine)?
    • Therapeutic: Drug to restore peristalsis or treat urinary retention
    • Pharmacologic: Cholinergic agonist, muscarinic agonist (direct acting)
  2. What are the Therapeutic Effects of Bethanechol chloride (Duvoid, Urecholine)?
    • Stimulated smooth muscle contraction. Restore smooth muscle tone and peristalisis following general anesthesia. Relaxes urinary sphincters and causes detrusor muscle of the bladder to contract (resulting in voiding)
    • Off label: treatment of adynamic ilius and gastric atony
  3. What is the mechanism of action of bethanechol chlordie (Duvoid, Urecholine)?
    interacts indirectly with muscarinic receptors to cause body responses typical of parasympathetic stimulation. It is not destroyed by AchE; therefore, its actions are more prolonged than those of Ach.
  4. What are the Pharmacokinetics of bethanechol chloride (Duvoid, Urecholine)?
    • Route(s): PO, subcut
    • Absorption: Poorly absorbed PO, well absorbed subcut
    • Distribution: Widely distributed; does not cross the blood brain barrier
    • Primary metabolism: Unknown
    • Primary excretion: renal
    • Onset of Action: PO: 30 min; subcut 5-15 min
    • Duration of action: PO: 1-6 h; subcut: 2h
  5. What are the contraindications/precautions of bethanechol chloride (Duvoid, Urechoine)?
    use with extreme caution in patients with disorders that could be aggravated by increased contractions of the GI tract, such as suspected bowel obstruction, recent GI surgery, an active ulcer, or an inflammatory disease urinary obstruction, recent bladder surgery, cystitis, asthma or COPD, MI, severe bradycardia, hypotension, hypertension, peritonitis, epilepsy, and parkinson's disease
  6. What are Drug Interactions of bethanechol chloride (Duvoid, Urecholine)?
    • Concurrent use of AchE inhibitors should be avoided because it also stimulated muscarinic reseptors and excessive parasympathetic activity will result
    • Concurrent use of ganglionic blockers may result in a rapid fall in BP
    • Procainamide, quinidine, atropine, and epinephrine antagonize the effects of bethanechol
    • Herbal/Food interactions: Unknown
  7. What is the Pregnancy Class of bethanechol choride (Duvoid, Urecholine)?
    Category C
  8. What is the Treatment of Overdose for bethanecho cholride (Duviod, Urecholine)?
    Administration of atropine quickly reverse most symptoms (N&V, abd cramping, salivation, and hypotension)
  9. What are the nursing responsibilities for a pt taking bethanechol chloride (Duvoid, Urecholine)?
    • monitor BP and pulse, observe for adverse effects for at least one hour following subcut admin
    • monitor for early signs of overdose, which include salivation, sweating, flushing, abd cramping, and nausea
    • Observe and record pts response
    • monitor resp status
    • when ambulating, supervise the pt because of poss blurred vision
  10. Describe some patient and family education for a patient taking bethanechol chloride (Duvoid, Urecholine)
    • Make position changes slowly to prevent dizziness and poss fainting
    • Do not stand still for prolonged periods; sit or lie down at first indication of faintness
    • Do not drive because of poss drowsiness or dizziness
    • Do not breast-feed without approval of health care provider
  11. Drugs that are similar to bethanechol chloride (Duvoid, Urecholine)
    • Carbachol (Isopto Carbachol, Miostat)
    • Cevimeline (Evoxac)
    • Pilocarpine (Isopto-Carpine, Ocusert, Salagen)
  12. What is the Therapeutic and Pharmacologic Classification fo Neostigmine (Prostigmin)?
    • Therapeutic: Agent for MG
    • Pharmacologic: Indirect-acting cholinergic agonist, AchE inhibitor
  13. What are the Therapeutic Effects and Uses of Neostigmine (Prostigmin)?
    • increases the strength of skeletal muscle contractions and delays fatigue
    • increases peristalsis, bronchoconstriction, bradycardia, and hypotension
    • relieving postoperative abd distension and urinary retension and in reversing the effects of nondepolarizing muscle relaxants
  14. What is the mechanism of action for Neostigmine (Prostigmin)?
    inhibits the action of AchE at cholinergic synapses, which allows Ach to accumulate and cause a greater effect.
  15. What are the Pharmacokinetics of neostigmine (prostigmin)?
    • Route(s): PO, IM, IV, and subcut
    • Absorbtion: PO: only 1-2% is absorbed. The oral dose is about 30 times higher than at parenteral dose
    • Distribution: Does not appear to cross the placental; is not secreted in breast milk; 15-25% bound to plasma protein
    • Primary metabolsim: Hepatic; by cholinesterases
    • Primary excretion: Kidneys
    • Onset of Action: PO: 2-4 hrs; IM/IV: 10-30 mins
    • Duration of action: t1/2: 50-90 mins
  16. What are the adverse effects of neostigmin (prostigmin)?
    • due to its ability to stimulate the parasympathetic nervous system
    • Common: involuntary contraction or twitching of muscles, N&V, miosis, and increased salivation.
    • Potentially Serious: bradycardia, hypertension, dyspnea, and death due to paralysis of respiratory muscles
  17. What are contraindications/precautions of neostimin (prostigmin)?
    • used with caution in pts with disorders that could be aggravated by increased contractions o the GI tract, such as suspected bowel obstruction or active ulcers
    • urinary obstruction, asthma and COPD,recent MI
  18. What are Drug Interactions for neostigmine (prostigmin)?
    • other cholinergic agnoists, drugs interfere with neuromuscular transmission, such as local anesthetics, some general anestheitcs, and antidysrhythmic agents,corticosteriods or NSAIDS
    • herbal/food interactions: unknown
  19. What is the pregnancy category for neostigmine (prostigmin)?
    Category C
  20. What is the treatment of overdose for neostigmine (prostigmin)?
    • Overdose is life threatening because it can cause respiratory failure
    • Admin of atropine reverses most overdose symptoms
  21. What are the nursing responsibilities for a pt taking neostigmine (prostigmin)?
    • monitor pulse, respiration, BP regularly (if below 60 contact physician)
    • ensure atropine is available to restore heart rate or treat cholinergic crisis
    • report onset of myasthenic symptoms (ocular motor disturbances, ptosis, diplopia, oropharyngeal muscle weakness, difficulty chewing, swallowing, or talking)
  22. What is the patient and family education for neostigmine (prostigmin)?
    • take drug with milk or food to minimize gastric irritation
    • be aware that regulation dosage interval is extremely difficult
    • take larger portions of the total dose at times of greater fatigue
    • certain times might increase size or frequency of dose (physical or emotional stress, infection, menstration, surgery)
    • keep a diary of "peaks and valleys"
    • immediately report: difficulty breathing, dizziness, difficulty moving, muscle cramps or spasms, slow or irregular heart beat, or vomiting
    • wear a medic-alert braclet or other device describing your disease and details of medicatins
  23. Drugs that are similar to neostigmine (prostigmin) include:
    • Ambenonium (Mytelase)
    • Edrophonium (Tensilon)
    • Pyridostigmine (Mestinon)
  24. What are the Therapeutic and Pharmacologic Classifications of Atropine?
    • Therapeutic: Agent for bradycardia, antidote of muscarinic agonist overdose
    • Pharmacologic: Anticholinergic, muscarinic antagonist
  25. What are the therapeutic effects and uses for atropine?
    • increase heart rate
    • relax smooth muscle in the GI, GU, and respiratory tracts
    • decreases the quantity of exocrine secretions (suppress secretions of the salivary glands and respiratory tract during surgical procedures)
    • topically to the eye: mydriasis and paraylyze the ciliary muscle, causing cyclaplegia (during eye exams)
    • antidote used to reverse symptoms of toxicity due to overdose of cholineric angonists
  26. What is the mechanism of action of atropine?
    • atropine blocks the parasympathetic activation by Ach and induces sympotms of the fight-or-flight response
    • at high doses, the drug may block nicotinic receptors in the ganglias and on skeletal muscle
  27. What are the Pharmacokinetics of atropine?
    • Route(s): PO, IV, subcut, inhalation, or opthalmic
    • Absorption: well absorbed by all routes
    • Distributed; crosses the BBB and placenta; small amounts are in breast milk
    • Primary metabolism: hepatic
    • Primary excretion: Renal
    • Onset of action: subcut/IM: 15 min; PO: 30 min; IV: 2-4 min
    • Duration of action: t1/2: 2-3 hours
  28. What are the adverse effects of atropine?
    • drying of the oral and nasal mucosa, constipation, urinary retention, increased heart rate, blurred vision, photophobia
    • serious: ventricular fibrillation, dilirium, and coma
  29. What are the contraindications/precations of atropine?
    • patients with acute angle-closure glaucoma
    • safely has not been estabilished during pregnancy
    • preexisting cardiopulmonary disease (COPD), MI, heart failure, HTN, hyperthyriodism, ulcerative colitis and illius, GERD, hiatal hernia experience decreased stomach emptying
    • pts with Downs are sensitive due to structural differences in the CNS
  30. What are the drug interactions for atropine?
    • anticholinergic actions, such as antihistamines, tricyclic antidepressants, quinidine, and phenothiazines because their anticholenergic effects would be additive
    • Herbal/Food: aloe, senna, buckthorn, and cascara sagrada may increase effects
  31. What is the pregnancy category for atropine?
    Category C
  32. What are the nursing responsibilities for a pt taking atropine?
    • monitor VS, assess HR changes, rhythm, and quality, changes in RR, BP, temp
    • observe of systemic changes with frequent or overuse of eye med
    • Monitor I&Os, observe abd distention
    • assess CNS status, can manifest drowsniess or stimulation
    • monitor S&S of atropine fever (hyperpyrexia, due to suppression fo perspiration and heat loss) increased risk of heat stroke
  33. What is the patient and family teaching for atropine?
    • prevent or relieve dry mouth by drinking plenty of water; use small frequent mouth rinses; practice meticulous mouth and dental hygiene; chew sugarless gum or suck on hard candys
    • use lubricating eye drops if eyes become dry and irritated
    • increase fiber too prevent or correct constipation
    • avoid driving
    • do not breast-feed
  34. What are similar drugs to atropine?
    • Antisecretory agents
    • Antispasmodic agents
    • Asthma agents
    • Central acting agents
    • Ophthalmic agents
    • Scopolamine (Hyoscine, Transderm-Scop)
    • Urge incontinence agents
  35. What are the Therapeutic and Pharmacologic Classifications of Mecamylamin (Inversine)?
    • Therapeutic: Antihypertensive
    • Pharmacologic: Ganglionic blocker, nicotinic receptor antagonist
  36. What are the therapeutic effects and uses of Mecamyline (Inversine)?
    • reduce BP (Rare)
    • Tourette's syndrome
    • treating cocaine and nicotine addictions
  37. What is the mechanism of action for Mecamyaline (Inversine)?
    • A potent, long acting nicotinic receptor antagonist that blocks neurotransmission at both sympathetic and parasympathetic ganglia by competing with Ach for cholinergic receptor sites on postsynaptic membranes
    • Readily crosses the BBB and inhibits the release of dopamine and NE
  38. What are the pharmacokinetics of Mecamylamine (Inversine)?
    • Route(s): PO
    • Absorption: Almost completely absorbed from the GI tract
    • Distribution: Crosses the BBB and placenta; secreted in breast milk
    • Primary metabolism: Hepatic
    • Primary Excretion: Renal
    • Onset of Action: 30 min-2 hrs
    • Duration of action: 6-12 hrs
  39. What are Adverse Effects of Mecamylamine (Inversine)?
    • weakness, fatigue, sedation, headache, mydriasis, blurred vision, decreased libido, impotence, urinary retention
    • serious: orthostatic hypotension, precipitation of angina, choreiform movement, adynamic ileus
  40. What are Contraindications/Precautions of Mecamylamine (Inversine)?
    • impaired renal function
    • coronary insufficiency, pyloric stenosis, glaucoma, recent MI, mild labile HTN, unreliable clients
    • Herbal/Food: unknown
  41. What are Drug Interactions for Mecamylamine (inversine)?
    alcohol, bethanecho, thiazise diuretics, acetazolamide, sodium bicarb
  42. What is the Pregnancy Category for Mecamylamine (Inversine)?
    Category C
  43. What is the treatment of overdose for Mecamylamine (Inversine)?
    treated with vasopressors
  44. What are the nursing responsibilities for Mecamylamine (Inversine)?
    • Monitor VS, especially BP
    • Assess for orthostatic hypotension
    • Assess and report constipation, frequent loose stools with abd distention, or decreased bowel sounds
  45. What is the patient and family education for Mecamylamine (Inversine)?
    Position change slowly, lie down immediately if dizzy or light-headed, do not drive, relieve dry mouth with rinses, water, or hard candy, do not breast feed, never discontinue abruptly because it can result in severe rebound HTN
  46. What is the Therapeutic and Pharmacologic Classifications of Succinlcholine (Anectine)?
    • Therapeutic: Skeletal muscle relaxant
    • Pharmacologic: Neruomuscular blocker (depolarizing type)
  47. What are the therapeutic effects and uses for Succinylcholine (Anectine)?
    first noted as muscle weakness and muscle spasms, then muscle paralysis occurs
  48. What is the mechanism of action for Succinylcholine (Anectine)?
    binds to cholinergic receptors at neuromuscular junctions (nicotinic)
  49. What is the pharmacokinetics of Succinylchonine (Anectine)?
    • Route(s): IM, IV
    • Absorption: Well absorbed, IM
    • Distribution: Completely, including crossing the placenta
    • Primary metabolism: Plasma by pseudocholinesterase
    • Primary Excretion: Renal
    • Onset of Action: IV: less than 1 min; IM 2-3 min
    • Duration of Action: IV: 2-3 min; IM: 10-30 min
  50. What are the Adverse Effects for Succinylcholine (Anectine)?
    • can cause complete paralysis of the diaphram and intercostal muscles, inhibit nerve transmission at ganglia causing tachycardia, hypotension, and urinary retention
    • malignant hyperthermia
    • respiratory depression, apnea, and dysrhythmias
  51. What are the contraindications/precautions of Succinylcholine (Anectine)?
    hx of malignant hyperthermia, preexisting electrolyte imbalances, heart failure, pulmonary or metabolic disorders, kidney disease, glaucoma, children
  52. What is the pregnancy category for Succinylcholine (Anectine)?
    Category C
  53. What are the drug interactions for Succinlcholine (Anectine)?
    • clindamycin, phemothiazine, aminoglycosides, furosemide, lithum, quinidine, lidocaine, anesthetics halthane or nitrous oxide, digoxin, opiods
    • Herbal/Food: Melatonin
  54. What are the nursing repsonsibilities for Succinylcholine (Anectine)?
    • Monitor VS
    • Obtain baseline labs
    • Monitor for transient apnea
    • Prepare for emergency endotracheal intubation, articial respiration, and assisted or controlled respiration with O2
    • sore throat and hoarseness are common
    • report persistent muscle weakness
  55. What is a drug tat is similar to Succinylchoine (Anectine)?
    Succinlycholine is the only deporarizing neuromuscular blocker
  56. What is the Therapeutic and Pharmacologic Classification of Tubocurarine?
    • Therapeutic: Skeletal muscle relaxant
    • Pharmacologic: Neuromuscular blocker (nondepolarizing)
  57. What are the therapeutic effects and uses of Tubocurarine?
    skeletal muscle relaxation of paralysis
  58. What is the mechanism of action for Tubocurarine?
    • competes with Ach for nicotinic receptor sites at motor end plates in skeletal muscle
    • blocking nerve transmission to skeletal muscle prevents the muscles from contracting
    • produces its effects without depolarizing the muscle cell membrane.
    • drug will block Ach synapses at the ganglia at higher doses
  59. What are the pharmacokinetics for Tubocurarine?
    • Route(s): IV
    • Absorption: N/A
    • Distribution: Completely distributed; does not cross the BBB; crosses the placenta
    • Primary metabolism: Hepatic
    • Primary Excretion: Renal; with smaller amounts in bile and feces
    • Onset of action: 1 min
    • Duration of action: t1/2: 1-3 hrs
  60. What are the adverse effects of Tubocurarine?
    • death due to paralysis of the respiratory muscles
    • malignant hyperthermia (rare)
    • bronchospasm, hypotension, muscle weakness, increased salivation
  61. What are the contraindications/precautions for Tubocurarine?
    preexisting hyperthermia, preexisting electrolyte imbalances, heart failure, pt with acidosis, kidney disease
  62. What are the drug interactions for Tubocurarine?
    • drugs that block calcium channels or otherwise deplete calcium, including aminoglycoside and tetracycline antibiotics and calcium channel blockers
    • procainamide, quinidine, clindamycin, amphotericin B, and diuretics
    • Herbal/Food: Unknown
  63. What is the pregnancy category for Tubocurarine?
    Category C
  64. What is the treatment of overdose for Tubocurarine?
    • drug is discontinued and assisted ventilation is provided until the effects of the drug wear off.
    • Neostigmine may be administered to more rapidly reverse the neuromuscular blockade.
    • Supportive therapy may be used to treat symptoms caused by histamine release
  65. What are the nursing responsibilities of Tubocurarine?
    • Monitor VS
    • Obtain baseline labs
    • note selective muscle paralysis
    • measure and record I&Os
    • check for bowel sounds
  66. What is the patient and family teaching for tubocurarine?
    report residual muscle weakness to the health care provider

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