Exam #2

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serious6
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105871
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Exam #2
Updated:
2011-10-03 11:58:05
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Adrenergic Agonists Antagonists
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Pharm Prototype Drugs
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  1. What is the therapeutic and pharmacologic classifications of Phenylephrine (Neo-Synephrine)?
    • Therapeutic: Antihypotensive, nasal decongestant
    • Pharmacological: Alpha-adrenergic agonist
  2. What is the therapeutic effects and uses of Phenylephrine (Neo-Synephrine)?
    prevent or reverse acute hypotension, slow HR, dilate pupils without causing significant cycloplegia, reduces nasal congestion
  3. What are the adverse effects for Phenylephrine (Neo-Synephrine)?
    • stinging of the nasal mucosa, sneezing, rebound congestion, anxiety, restlessness, tremor
    • serious: reflex bradycardia, reduced blood flow to peripheral tissue
  4. What are the contraindications/precations for Phenylephrine (Neo-Synephrine)?
    severe HTN, preexisting bradycardia, angina, narrow-angle glaucoma, hyperthyroidism, diabetes
  5. What are the pharmacokinetics of Phenylephrine (Neo-Synephrine)?
    • Route(s): UM, subcut, IV, intranasal, ophthalmic
    • Absorption: Not absorbed in the GI tract; well absorbed when given IM or subcut
    • Distribution: Unknown
    • Metabolism: Hepatic by MAO
    • Excretion: Unknown
  6. What is the mechanism of action of Phenylephrine (Neo-Synephrine)?
    • directly activates alpha1-adrenergic receptor in the peripheral nervous system
    • it has weak beta-adrenergic activity at high doses
  7. What are the drug interactions for Phenylephrine (Neo-Synephrine)?
    • antihypertenives, MAOIs, ergot alkaloids and tricyclic antidepressants, adrenergic agnoists, including amphetamines or cocaine, halothane, digoxin
    • Herbal.Food: St. John's Wort, caffeine
  8. What is the treatment of overdose for Phenylephrine (Neo-Synephrine)?
    antidysrhythmic agents
  9. What are the nursing responsibilties for Phenylephrine (Neo-Synephrine)?
    • Determine the reason the pt is taking med
    • assess the pt for preexisting conditions
    • establish baseline VS, and monitor frequently
    • examine IV sites
    • advise the pt to remove contacts before ophthalmic admin
    • advise pt to wear dark eye protection after ophthalmic admin
  10. What are the patient and family education for Phenylephrine (Neo-Synephrine)?
    • carefully read and follow the instructions
    • do not give to children or infants
    • do not use OTC products containing this drug
    • do not share nasal spray
    • do not use decongestant nasal sprays for longer than three days
    • report symptoms of excessive use to this drug such as rapid, irregular, or pounding heartbeat, nervousness, or insomnia
    • limit or eliminate the use of caffeine
  11. What is the pregnancy category for Phenylephrine (Neo-Synephrine)?
    Category C
  12. What is the therapeutic and pharmacologic classification for Isoproterenol (Isuprel)?
    • Therapeutic: Bronchodilator
    • Pharmacologic: Nonselective beta-adrenergic agonist
  13. What are the therapeutic effects and uses for Isoproterenol (Isuprel)?
    increase the strngth of myocardial contraction, improve cardiac output, cardiogenic or bacteremic shock, cardiac arrest, Adams-Stokes syndrome, and certain types of ventricular dysrhythmias
  14. What is the mechanism of action for Isoproterenol (Isuprel)?
    potent activator of both beta1 and beta2 adrenergic receptors throughout the body
  15. What are the pharmacokinetics of Isoproterenol (Isuprel)?
    • Route(s): IV
    • Absorption: N/A
    • Distribution: to most of the tissues; it is unknown if it crosses the placenta or is secreted in breast milk
    • Metabolism: Hepatic by COMT and MAO
    • Excretion: Renal: (40-50% unchanged)
  16. What are the adverse effects for Isoproterenol (Isuprel)?
    • headache, nausea, vomiting, tremors, anxiety, insomnia
    • serious: serious dysrhythmias
  17. What are the contraindications/precautions for Isoproterenol (Isuprel)?
    severe cardiac disease, dysrhythmias, HTN, hyperthyroidism, diabetes
  18. What are the drug interactions for Isoproterenol (Isuprel)?
    beta-adrenergic blockers, bronchodilators or adrenergic agonist such as epi or dopamine, MAOIs, tricyclic antidepressants, potassium wasting diuretics, digoxin, dysrhythmias
  19. What is the pregnancy category for Isoproterenol (Isuprel)?
    Category C
  20. What is the treatment of overdose for Isoproterenol (Isuprel)?
    due to the relatively short t1/2 of the drug, discontinuing the infusion is often enough to reverse symptoms, although supportive cardiac drugs may be necessary
  21. What are the nursing responsibilities for Isoproterenol (Isuprel)?
    • determine reason why pt is taking med
    • assess the pt for preexisiting conditions
    • assess for therapeutic effectiveness
    • establish baseline VS
    • check the pulse before and during IV infusion
    • monitor for drug tolerance
  22. What are the patient and family educations for Isoproterenol (Isuprel)?
    • notify PCP of asthma, diabetes, mellitus, overactive thyroid, and pheochromocytoma
    • Report adverse effects (palpitations, marked decrease in BP, decrease in urine output, ischemia)
    • do not breast feed
    • immediately report pregnancy
  23. What are the therapeutic and pharmacologic classifications of Prozosin (Minipress)?
    • Therapeutic: Antihypertensive
    • Pharmacologic: Selective alpha1-adrenergic antagonist
  24. What are the therapeutic effects and uses of Prozosin (Minipress)?
    • reduces BP
    • off label: symptomatic BPH, prevention of Raynaud's disease, hypertensive emergencies associated with pheochromocytoma
  25. What is the mechanism of action for Prozosin (Minipress)?
    • competes with NE at alpha-adrenergic on vascular smooth muscles in arterioles and veins.
    • it is selective for alpha1-adrenergic receptors and has no activity at alpha2
  26. What are the pharmacokinetics of Prozosin (Minipress)?
    • Route(s): PO
    • Absorption: Well absorbed
    • Distribution: Completely; small amounts secreted in breast milk
    • Metabolism: Hepatic
    • Excretion: Primarily bile and feces, with small amounts by the kidneys
  27. What are the adverse effects of Prozosin (Minipress)?
    prior sensitivity to the drug
  28. What are the drug interactions for Prozosin (Minipress)?
    • antihypertensives, diuretics, alcohol, erectile dysfunction agents
    • Herbal/Food: Hawthorn
  29. What is the pregnancy category for Prozosin (Minipress)?
    Category C
  30. What is the treatment of overdose for Prozosin (Minipress)?
    • vasopressors such as levarterenol or dopamine may be necessary to increase BP
    • fluid expanders may be administered to raise BP, and renal function should be monitored
  31. What are the nursing reponsibilies for Prozosin (Minipress)?
    • establish baseline VS
    • assess for HTN, Raynaud's disease, or BPH
    • Admin the first dose at bedtime
    • monitor for drug-related adverse effects
    • give meds with food
    • monitor BP
    • assess for full therapeutic effect
  32. What is the patient and family education for Prozosin (Minipress)?
    • avoid situations that could result in injury if fainting should occur
    • sit or lie down if you feel dizzy, lightheaded, have blurred vision, or feel faint
    • make position changes slowly
    • do not take the drug at the same time each day
    • consult the prescriber before taking OTC meds for cold, cough, allergy remedies
    • expect adverse effects to diminished with continued therapy
  33. What are the thearpeutic and pharmacologic classifications for Propranolol (Inderal)?
    • Therapeutic: Antipertensive, antidysrhythmic
    • Pharmacologic: Nonselective beta-adrenergic blocker
  34. What are the therapeutic effects and uses for Propranolol (Inderal)?
    hypertension, angina pectoris, dysrhthmias, migraine prophylaxis, prophylaxis for MI
  35. What is the mechanism of action for Propranolol (Inderal)?
    nonselective beta-adrenergic antagonist, affecting both beta1- and beta2-receptors
  36. What are the pharmacokinetics of Propranolol (Inderal)?
    • Route(s): Usually PO; IV for severe dysrhythmias
    • Absorption: Completely
    • Distributed: Widely distributed; including the CNS and placenta; secreted in breast milk; 90% bound to plasma protein
    • Metabolism: Hepatic
    • Excretion: 90-95% renal
  37. What are the adverse effects of Propranolol (Inderal)?
    • Nausea, vomiting, and diarrhea, fatigue, insomnia, drowsiness, bradycardia, confusion, impotence, loss of libido
    • serious: agranulicytosis, bronchospams, Stevens-Johnson syndrome, anaphylaxis
    • if discontinued suddenly: palpitations, rebound HTN, life-threatening dysrhythmias, MI
  38. What are the contraindications/precautions for Propranolol (Inderal)?
    cardiogenic shock, sinus bradycardia, greater than first-degree heart block, severe heart failure, COPD, asthma, diabetes, reduced renal output
  39. What are the drug interactions of Propranolol (Inderal)?
    • beta blockers, calcium channel blockers such as verapamil (Calan, and dilitiazem (Cardizem), Phenothiaines, MAOIs, ethanol, antacids containing aluminum hydroxide, beta-adrenergic agonists such as albuterol (Proventil)
    • Herbal/Food: large doses of vitamin C, hawthorn
  40. What is the pregnancy category for Propranolol (Inderal)?
    Category C
  41. What are the nursing responsibilities for Propranolol (Inderal)?
    • Monitor VS
    • Obtain thorough medical hx
    • evaluate response to therapy
    • monitor for drug-related adverse effects
    • assess lab tests
    • monitor I&Os
    • consult prescriber regarding salt restrictions
    • examine the pt for impaired circulation
  42. What is the patient and family education for Propranolol (Inderal)?
    • take radial pulse before each dose
    • if you have diabetes, remember that the drug suppresses signs of hypoglycemia
    • take med exactly as prescribed
    • do not abruptly stop taking med
    • make position changes slowly
    • avoid prolonged exposure to cold
    • do not drive
    • to not take any medication, herbals, supplements without consulting your doctor
    • inform your dentist, ophthalmologist, surgeon, and other health care providers you are taking a beta blocker
    • do not breast feed
    • notify doctor if pregnant
  43. What are the therapeutic and pharmacologic classifications for Metoprolol (Lopressor, Toprol)?
    • Therapeutic: Antihypertensive
    • Pharmacologic: Selective beta1-adrenergic antagonist
  44. What are the therapeutic effects and uses of Metoprolol (Lopressor, Toprol)?
    • HTN, decreases in HR, cardiac output and BP
    • off label: stable, symptomatic HF, essential tremor, migraine prophlylaxis, and the control of HR in pts with atrial dysrhythmias
  45. What is the mechanism of action for Metoprolol (Lopressor, Toprol)?
    • selective beta1-adrenergic antagonist that competes with endogenous catecholamines at adrenergic receptors in cardiac muscle.
    • at high doses, it may affect beta2 receptors in bronchial smooth muscle
  46. What are the pharmacokinetics of Metoprolol (Lopressor, Toprol)?
    • Route(s): Usually PO; IV for MI
    • Absorption: well absorbed
    • Distribution: Completely; including CNS and placenta; secreted in breast milk; 12% bound to plasma proteins
    • Metabolism: Hepatic
    • Excretion: renal
  47. What are the adverse effects of Metoprolol (Lopressor, Toprol)?
    • nausea, vomiting, dizziness, fatigue, insomnia, bradycardia, heartburn, and dyspnea
    • serious: agranularcytosis, laryngospasm, compete heart block, thyroid storm in pts with thyrotoxicosis, dysrhythmias, severe HTN, MI, bronchospams, dyspnea
  48. What are the contraindications/precautions of Metoprolol (Lopressor, Toprol)?
    preexisting cardiac disease, cardiogenic shock, severe bradycardia, heart block greater than first degree, severe hepatic disease, asthma, hx of bronchospasms
  49. What are drug interactions for Metoprolol (Lopressor, Toprol)?
    calcium channel blockers, antihypertensive drugs including cimetidine and oral contraceptives, sympathomimetics, lidocaine
  50. What is the pregnancy category for Metoprolol (Lopressor, Toprol)?
    Category C
  51. What is the treatment of overdose for Metoprolol (Lopressor, Toprol)?
    plasma volume expanders or vasopressors, atropine, isoproterenol
  52. What is the treatment of overdose for Propranolol (Inderal)?
    plasma volume expanders, atropine, isoproterenol
  53. What is the nursing responsibilities for Metoprolol (Lopressor, Toprol)?
    • assess VS
    • monitor BP
    • monitor labs
    • max effects seen in 1 week
    • monitor pts with CHF for impending HF
    • discontinue if pt develops mental depression
    • this drug masks hyperthyroidism in pts with thyrotoxicosis
    • record I&Os
  54. What is the patient and family education for Metoprolol (Lopressor, Toprol)?
    • take radial pulse before dose
    • immediately report changes in vision
    • avoid late evening doses
    • if you have diabetes, remember that the drug suppresses signs of hypoglycemia
    • do not drive
    • take med as prescribed
    • report cold, painful, or tender feet or hands or other symptoms of Raynaud's disease
    • discontinue med slowly over 1-2 weeks
    • relieve dry mouth with rinses, hard candies, gum
    • relieve dry eyes with OTC drops
    • do not breast feed
    • report pregnancy

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