NUR 119 Mod 3

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TomWruble
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157583
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NUR 119 Mod 3
Updated:
2012-07-17 09:11:23
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nur119 mod3 autonomic ans
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Maddie's (not) study guide
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  1. What drugs are contraindicated for a glaucoma Pt?
    Any that cause mydriasis.

    Adrenergic or Anticholinergic

    Note that sympatholytics & parasympathemimetics do NOT
  2. Nursing responsibilities related to admin of antiadrenergic drugs.
    Assess why med was chosen based on history

    Contraindications

    HR & BP OK and Pt voiding OK

    Discuss stress relieving measures
  3. Indications of

    Parasympatholytics
    • Indications:
    • - Decrease Gl motility (Colitis, peptic ulcer disease,diverticulitis)
    • - Antispasmodic (cystitis, urethritis prostatitis, urgency tovoid)

    • Contraindications:
    • - Glaucoma
    • - Prostatic hypertrophy
    • - Tachycardia
    • - Ml
    • - CHF
  4. Drugs of

    Parasympatholytics
    • Prototype:
    • - Atropine

    • Other drugs:
    • - Bentyl (decrease Gl motility)
    • - Robinul (decrease Glmotility)
    • - Pro-Banthine (decrease Gl motility)
    • - Detrol & Detrol LA (decrease secretions)
    • - Homatropine (dilate pupils)
    • - Atrovent (bronchodilator)
    • - Artane (Parkinsons)
    • - Cogentin (Parkinson's)
    • - Scopolamine (CNS depression, decreases secretions)
  5. Actions of

    Parasympathetic Depressant

    Parasympatholytics

    Anticholinergics

    Cholinergic Antagonist

    Antispasmotics
    • Increase Pulse rate
    • Decrease mucous secretions
    • Decrease Gl motility
    • Increase urinary retention
    • Dilate pupils
  6. Indications of

    Parasympathomimetics
    • Indications:
    • - Dx & Tx myasthenia gravis
    • - Reverse curare
    • - Alzheimer's
    • - Glaucoma

    • Contraindications:
    • - Urinary tract obstruction
    • - Asthma
    • - CAD
  7. Drugs of

    Parasympathomimetic
    • Prototype:
    • - Prostigmin (myasthenia gravis, antidote for curare)

    • Direct Acting Drug:
    • - Urecholine (relieve unnary retention)

    • Indirect Acting Drug:
    • - Tensilon (dx myasthenia gravis or cholinergic crisis)
    • - Mestinon (Tx myasthenia gravis long acting)
    • - Prostigmin

    • Cholinesterase Inhibitors:
    • - Cognex (Alzheimer's)
    • - Ancept (Alzheimer's)
  8. Receptors of

    Parasympathomimetic
    • Muscarinic 1,2,3 & 4
    • - Stimulate smooth muscle
    • - Slow heart rate

    • Nicotinic 1 & 2
    • - Affect skeletal muscle
  9. Neurotransmitters of

    Parasympathomimetic
    Acetylcholine
  10. Actions of:

    Parasympathetic Stimulants

    Parasympathomimetic

    Cholinergic

    Cholinergic Agonist
    • ↓ BP
    • ↓ Pulse rate
    • Dilate blood vessels
    • ↓ Heart rate
    • ↑ secretions of Gl, lung, skin
    • ↑ Gl movement
    • Bladder contraction
    • Skeletal contraction
    • Constrict bionchi
    • Constrict pupils
  11. Dx of Myasthenia gravis
    If admin of Tensilon (of edrophonium chloride) improves muscle contraction, then Dx myasthenia gravis
  12. Myasthenia gravis
    Muscle weakness

    Fatigue

    Difficulty chewing

    Drooping eyelid

    Drooling

    Resp failure possible

    Hypotension
  13. Beta Blockers & Indications of

    Sympatholytics:
    • Beta-blockers:
    • - Lower HR (negative chronotrophy)
    • - Decrease force of contraction (negative inotrophy)
    • - Decrease conduction and cardiac output
    • - Bronchoconstriction

    • Adverse affects:
    • - Blocks symptoms of tachycardia related to hypoglycemia
    • - Don't stop abruptly -> rebound HTN
    • - Bradycardia OD -> atropine
    • - CHF (Dx dyspnea, fatigue, edema)
    • - Bronchoconstriction Ax-> bronchodialators
    • Prototype:
    • - Inderal [beta1&2](HTN, angina pectoris)

    • Other drugs:
    • - Tenormin [beta1](prevent Ml)
    • - Lopressor [beta1](prevent Ml)
    • - Timpotic (glaucoma)
    • - Betopic [beta1](glaucoma)
    • - Corgard (HTN, angina)
    • - Clonidine (HTN)

    • Indications:
    • - Angina
    • - HTN
    • - Tachycardia
    • - Glaucoma

    • Contraindications:
    • - Bradycardia
    • - Heart block
    • - CHF
    • - Asthma
    • - Pulmonary condition with vasoconstriction
  14. Alpha Blockers & Indications

    of Sympatholytics:
    • Alpha blockers:
    • - Vasodilation
    • - decrease BP
    • - Constrict pupils
    • - Othostatic hypotension
    • - Reflex tachycardia

    • Prototype:
    • - Prozosin 1st dose syncopy (fainting)

    • Other drugs:
    • - clonidine HCl (Catapres) (decrease BP)
    • - Methyldopa (peak effect in 2days)
    • - Cardura (mild HTN, BPH (benign prostatic hypertrophy)
    • - Minipress [prazosin HCl] (HTN)
    • - Hytrin

    • Indications:
    • - HTN
    • - Improve blood flow
    • - Reynaud's disease
    • - Frostbite
    • - Prevent necrosis of vasoconstricting drugs

    • Contraindications:
    • - Angina
    • - Stroke
    • - Ml
  15. Actions of:

    Sympathetic Depressant

    Sympatholytics

    Antiadrenergic

    Adrenergic Blockers
    • ↓ Pulse rate
    • ↓ BP
    • Constrict Bronchioles
    • Constrict pupils
  16. Indications for Adrenergics:
    • Indications:
    • - Cardiac emergency
    • - Respiratory emergency
    • - Allergic reactions
  17. Contraindications:
    • - HTN
    • - Angina
    • - Stroke
    • - Glaucoma
    • - Hyperthyroidism
  18. Drugs for Adrenergic:
    • Prototype:
    • - Epinephrine (cardiac arrest, acute bronchospasm and laryngeal edema)

    • Other drugs:
    • - Albuterol (bronchospasm)
    • - Sudafed (decongestant)
    • - Isuprel
    • - NeoSynephrine (nasal congestion, cold)
    • - Dexatrim
    • - Dopamine (hypotension)
    • - Ephedrine (HTN, bronchspasm)
  19. Receptors for Adrenergic:
    • Alpha 1:
    • - Vasoconstriction
    • - ↑ BP
    • - ↑ contractility of heart
    • - Pupil dilation
    • - Bladder contraction
    • - Prostate contraction

    • Alpha 2:
    • - ↓ BP(reduce norepinephnne)
    • - ↓ GI motility

    • Beta 1:
    • - ↑ HR and force of contraction

    • Beta 2:
    • - Bronchoditation of lungs
    • - ↓ Gl motility
    • - Relax uterus
    • - Activates glycogenolysis in liver
    • - ↑ blood sugar
  20. Actions of:

    Sympathetic Stimulants

    Sympathomimetic

    Adrenergic

    Adrenergic Agonist
    • ↑ BP
    • ↑ pulse rate
    • ↑ blood flow/fight or fnght
    • ↑ metabolism
    • ↑ breakdown of glycogen
    • ↑ increase blood sugar
    • ↑ mental activity
    • ↑ muscle strength
    • ↑ blood coagulation
    • ↑ respiratory rate
    • Pupil dilates to help with vision
  21. Indications/Contra for alpha blockers?
    • IND:
    • Tx HTN

    Improve blood flow

    Raynauds disease & frostbite

    • CONTRA:
    • Decreases BP, reflex tachycardia might result

    Angina

    MI

    Stroke
  22. Why are alpha blockers not Rx as often as beta blockers?
    They can cause orthostatic hypotension leading to reflex tachycardia.

    Note: The body has several feedback mechanisms to maintain adequate blood flow and blood pressure. If blood pressure decreases, the heart beats faster in an attempt to raise it. This is called reflex tachycardia.
  23. What are antiadrenergic drugs?
    They are: Sympatholytic

    Decrease or block the effects of sympathetic nerve stimulation
  24. Dopamine
    Adrenergic

    Treatment of hypotension & shock

    Also causes improved urinary output - looking for a kinimum of 30 mL/hr
  25. Dexatrim
    Adrenergic

    Appetite suppressant/decongestont
  26. Neo-Synepherine
    Adrenergic

    Decongestont

    Watch for increased BP & reflex bradycardia
  27. Isuprel
    Adrenergic

    Cardiac stimulant, used for bronchospasm / bronchodilator

    Adverse reaction - tachycardia

    May have pink tinged sputum
  28. Sudafed
    Adrenergic

    Bronchodilation decongestant effects

    Excessive use can cause rebound nasal congestion
  29. Beta2 Blocker Risks
    Constricts broncholes, could lead to trouble breathing for COPD & asthma Pt
  30. Beta1 Blocker risks
    Decreases HR

    Reduces force of contractions
  31. Ephedrine?
    Adrenergic

    Less potent than albuterol, longer acting

    Used to treat hypotension from anesthesia
  32. ALBUTEROL?
    Adrenergic

    ↓BRONCHOSPASM → bronchodilation
  33. Prototype Adrenergic drug:


    EPINEPHRINE
    Stimulates both alpha and beta receptors.

    Drug of choice for acute bronchospasm and laryngeal edema

    Used in cardiac arrest

    Not given orally/destroyed by enzymes in the GI tract and liver

    Increases blood sugar
  34. When should adrenergic drugs be used cautiously?
    anxiety
  35. When are adrenergic drugs contraindicated?
    High BP

    Angina

    Stroke

    Glaucoma

    Hyperthyroidism
  36. When are adrenergic drugs indicated?
    Epinephrine (never PO becaue it is wholly metabolized by the liver) for anphylaxis.

    Albuterol for asthma.
  37. HR ↑200. How to treat?
    Either a

    adrenolytic

    or a

    Cholinergic
  38. Discuss adrenergic drug therapy.
    Sympathomimetic

    Exogenous

    Selective or non-selective
  39. Cholinergic receptors:
    nicotinic 1 & 2

    muscorinic 1 - 4
  40. Adrenergic receptors:
    • alpha1
    • - vasoconstriction, ↑BP, ↑HR
    • - Mydriasis (pupil dilation)

    • alpha2
    • - ↓ BP (via reduced norepinephrin)
    • - ↓ GI

    • beta1
    • - ↑ HR & force of contraction
    • - ↑ BP (via ↑angiotensin to kidney)

    • beta2
    • - ↓ GI
    • - ↑ Bronchdilation
    • - ↑ Vasodilation
    • - ↑ blood sugar (via glycogenolysis)

    dopamine
  41. The main neurotransmittor of the parasympathetic nervous system is AAAA, which has BBBB effects. Nerve fibers secreting acetylcholine are called CCCC.
    • A: acetylcholine
    • B: inhibitory
    • C: cholinergic
  42. The main neurotransmittor of the sympathetic nervous system is AAAA which has BBBB effects. Nerve fibers secreting norepinephrine are called CCCC.
    • A: norepinehrine
    • B: excitatory
    • C: adrenergic
  43. Parasympathetic transmitters, receptors and synonyms
    • Tx:
    • - ACETYLCHOLINE

    • Syn:
    • - CHOLINERGIC
    • - INHIBITORY

    • Rx:
    • - Muscarinic
    • - Nicotinic
  44. Sympathetic transmitters, receptors and synonyms
    • Tx:
    • - NOREPINEPHRINE
    • - DOPAMINE

    • Syn:
    • - ADRENERGIC
    • - EXCITATORY

    • Rx:
    • - alpha 1
    • - beta 1&2
    • - dopamine
  45. Stimulation of the parasympathetic causes:
    1. Dilate blood vessels

    2. ↑ secretions - GI, lung, skin

    3. ↓ HR

    4. ↑ GI

    5. No blood sugar effects

    6. No chg mental activity

    7. No chg muscle strength

    8. No chg blood coagulation

    9. Bronchi constriction

    10. Pupil constriction

    11. Bladder contraction

    12. Skeletal contraction
  46. Anticholinergic effects on

    CNS
    Decreases tremors and rigidity of muscles.

    Drowsiness, disorientation and hallucinations can result from large doses.
  47. Anticholinergic effects on

    Bronchial
    Dilates the bronchi, and decreases bronchial secretions.
  48. Anticholinergic effects on

    Glandular
    Decreases salivation, perspiration, and bronchial secretions.
  49. Anticholinergic effects on

    Ocular
    Dilates pupils (mydriasis) and paralyzes ciliary muscle (cycloplegia), causing a decrease in accommodation.
  50. Anticholinergic effects on

    Urinary tract
    • Relaxes the bladder detrusor muscle
    • and increases constriction of the internal sphincter.

    Urinary retentioncan result.
  51. Anticholinergic effects on

    GI
    Relaxes smooth muscle tone of Gl tract

    Decreasing Gl motility and peristalsis.

    Decreases gastric and intestinal secretions.
  52. Anticholinergic effects on

    Cardiovascular
    Increases heart rate with large doses.

    Small doses can decrease heart rate.
  53. Stimulation of sympathetic causes:
    1. ↑ BP/cardiac output

    2. ↑ blood flow for "fight or flight"

    3. ↑ metabolism and use of O2

    4. ↑ breakdown of glycogen

    5. ↑ blood sugar

    6. ↑ mental activity

    7. ↑ muscle strength

    8. Blood coagulation increased

    9. ↑ respiratory rate

    10. Pupil dilation to help vision

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