Drug facts, autonomic nervous system

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Drug facts, autonomic nervous system
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2012-07-01 09:32:17
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  1. Key facts about cholinergic agonists (4)
    [Ex: Bethanechol (Duvoid, Myotonachol), pilocarpine (Isopto Carpine, Pilocar)]
    • 1. directly stimulate cholinergic receptors
    • 2. mimic the action of acetylcholine
    • 3. metabolized by cholinestrerases in plasma and liver
    • 4. excreted in urine
  2. When to use cholinergic agonists (5)
    [Ex: Bethanechol (Duvoid, Myotonachol), pilocarpine (Isopto Carpine, Pilocar)]
    • glaucoma
    • atonic bladder
    • postoperative and postpartum urinary retention
    • abdominal distention and GI atony
    • salivary gland hypofunction
  3. When NOT to use cholinergic antogonists (6)
    [Ex: Bethanechol (Duvoid, Myonachol), pilocarpine (Isopto carpine, Pilocar)]
    • prostate enlargement
    • possible urinary or G obstruction
    • hyperthyroidism
    • bradycardia or AV conduction defects
    • Asthma
    • Coronary artery disease
  4. Adverse reactions of cholinergic agonists
    [Ex: Bethanechol (Ducoid, Myonachol), pilocarpine (Isopto Carpine, Pilocar)]
    hypotension, h/a, sweating, increased salivation, abdominal cramps, nausea, vomiting, diarrhea, blurred vision, urinary frequency, decreased HR, SOB
  5. key nursing actions for cholinergic agonists (5)
    [Ex: Bethanechol (Duvoid, Myonachol), pilocarpine (Isopto Carpine, Pilocar)]
    • assess urinary status
    • assess bowel sounds and abdomen
    • Administer P.O. or subQ; never give I.V. or I.M.
    • Observe pt for 20-60 min after subQ administration
    • Monitor for toxicity; administer atropine as an antidote as prescribed
  6. Key facts about acetylcholinestrase inhibitors (3)
    [Ex: Ambenonium (Mytelase), edrophonium (Enlon, Reversol, Tensilon), neostigmine (Prostigmine (Antilirium), pyridostigmine (Mestinon, Regonol)
    • inhibit acetylcholinesterase, the enzyme that inactivates acetylcholine; as acetylcholine builds up it stimulates the cholinergic receptors
    • metabolized in plasma
    • excreted in urine
  7. When to use acetylcholinesterase inhibitors
    [Ex: amenonium (MYetelase), edrophonium (Enlon, Reversol, Tensilon), neostigmine (Prostigmine, Antilirium), pyridostigmine (Mestinon, Regonol)
    • myastenia gravis
    • glaucoma
    • anticholinergic poisoning
    • paralytic ileus
  8. When NOT to use acetylcholinesterase inhibitors
    [Ex: amenonium (Myetelase), edrophonium (Enlon, Reversol, Tensilon), neostigmine (Prostigmine, Antilibrium), pyridostigmine (Mestinon, Regonol)
    Possible urinary or GI obstruction
  9. Adverse reactions of acetylcholinesterase inhibitors [Ex: amenonium (Myetelase), edrophonium (Enlon, Reversol, Tensilon), neostigmine (Prostigmine, Antilibrium), pyridostigmine (Mestinon, Regonol)
    N/V/D, dyspnea, arrhythmias, insomnia, h/a, anorexia, seizures, insomnia, prutitis, urinary frequency, and noturia
  10. Key nursing actions for acetylcholinesterase inhibitors (4)
    [Ex: amenonium (Myetelase), edrophonium (Enlon, Reversol, Tensilon), neostigmine (Prostigmine, Antilibrium), pyridostigmine (Mestinon, Regonol)
    • assess the pt's neuromuscular status before and during therapy
    • monitor for drug toxicity; administer atropine as an antidote as prescribed
    • Monitor vital signs and breath sounds every 4 hr
    • Take seizure precautions
  11. Key facts about Alzheimer's drugs (3)
    [Ex: donepezil (Aricept), galantamine (Razadyne), memantine (Namenda), rivastigmine (Exelon)]
    • Inhibit cholinesterase, leading to elevated acetylcholine levels in the cortex
    • Metabolized in the liver
    • Excreted in feces and urine
  12. When to use Alzheimer's treatment drugs (2)
    [Ex: donepezil (Aricept), galantamine (Razadyne), memantine (Namenda), rivastigmine (Exelon)]
    • Mild to moderate Alzheimer's-type dementia
    • Moderate to severe Alzheimer's-type dementia (memantine)
  13. When NOT to use Alzheimer's treatment drugs (5)
    [Ex: donepezil (Aricept), glantamine (Razadyne), memantine (Namenda), rivastigmine (Exelon)]
    • Sick sinus syndrome
    • GI bleeding
    • Seizures
    • Asthma
    • Severe hepatic and renal impairment 
  14. Adverse reactions of Alzheimer's treatment drugs
    [Ex: donepezil (Aricept), glantamine (Razadyne), memantine (Namenda), Rivastigmine (Exelon)]
    • insomnia, fatigue, dizziness, confusion, ataxia, depression, syncope, bradycardia, nausea, comiting, diarrhea, anorexia, and abdominal pain
    • Hepatotoxicity (donepezil)
    • Hypertension (memantine)
  15. Key nursing actions for Alzheimer's treatment drugs
    [Ex: donepezil (Aricept), glantamine (Razadyne), memantine (Namenda), Rivastigmine (Exelon)]
    • Establish a functional baseline
    • Notify the surgeon about the use of Alzheimer's treatment drugs if surgery is planned
    • Teach the pt that these drugs will not cure, only slow the progression of the disease
    • Administer donepezil daily HS
  16. Key facts about anticholinergics [Ex: atropine, belladonna, gylcopyrrolate, benztropine (Cogentin), dicyclomine (Antispas, Bentyl), oxybutynin (Ditropan)]
    • Interrupt parasympathetic nerve impulses in the CNS and ANS and prevent acetylcholine from stimulating cholinergic erceptors
    • Metabolized in the liver
    • Excreted in feces and urine
  17. When to use anticholinergics [Ex: atropine, belladonna, glycopyrrolate (Robinul), benztropine (Cogentin), dicyclomine (Antispas, Bentyl), oxybutynin (Ditropan)]
    • Reduce oral , gastric, and respiratory secretions
    • Reverse heart lock
    • Paralyze ciliary muscles
  18. When NOT to use anticholinergics [Ex: donepezil (Aricept), glantamine (Razadyne), memantine (Namenda, Rivastigm,ine (Exelon)]
    • Angle-closure glaucoma, uncontrolled tachycardia, urinary or GI tract obstruction, COPD, severe ulcerative colitis, myasthenia gravis, acute or severe hemorrhage, and unstable cardiovascular status
    • Breat-feeding women
  19. Adverse reactions for anticholinergics [Ex: atropine, belladonna, glycopyrrolate (Robinul), benztropine (Cogentin), dicyclomine (Antispas, Bentyl), oxybutynin (Ditropan)]
    Comonly dose-related
  20. Key nursing actions for anticholinergics[Ex: atropine, belladonna, glycopyrrolate (Robinul), benztropine (Cogentin), dicyclomine (Antispas, Bentyl), oxybutynin (Ditropan)]
    • Administer before meals
    • Monitor fr adverse reactions
    • Teach the pt to consult the practitioner before taking non-prescription drugs
    • Advise the pt on how to reduce dry mouth and constipation
    • Monitor intake and output
  21. Key facts about catecholamines [Ex: Dobutamine (Dobutrex), dopamine (Intropin), epinepherine (Adrenalin), isoproterenol (Isuprel), norepinephrine (Levophed)]
    • Stimulate nervous ssytem by combining with either alpha-adrenergic or beta-adrenergic receptors
    • Metabolize primarily in the liver
    • Excreted in urine
  22. When to use catecholamines [Ex: Dobutamine (Dobutrex), dopamine (Intropin), epinepherine (Adrenalin), isoproterenol (Isuprel), norepinepherine (Levophed(]
    • Bradycardia, heart blocks, and decreased cardiac output
    • Acute hypotension and shock
    • Acute drug-induced allergic reaction
  23. When NOT to use catecholamines [Ex: Dobutamine (Dobutrex), dopamine (Intropin), epinepherine (Adrenalin), isoproterenol (Isuprel), norepinepherine (Levophed)]
    • Acute MI or tachyarrhythmias
    • During pregnancy
    • With caution in pt with diabetes, atherosclerosis, Raynauds-disease, and cardiac insufficiency
  24. Adverse reactions of catecholamines [Ex: Doutamine (Dobutrex), dopamine (Intropin), epinepherin (Adrenalin), isoproterenol (Isuprel), norepinepherine (Levophed)]
    • Arrhythmias, tachycardia, angina
    • Restlessness, anxiety, dizziness
    • H/a, hypertension, stroke
  25. Key nursing actions of catecholamines [Ex: Dobutamine (Dobutrex), dopamine (intropin), epinepherine (Adrenalin), isopreterenol (Isuprel), norepinepherine (Levophed)]
    • Monitor ECG, hemodynamic parameters, vital signs and urine output
    • Corect hypovolemia
    • Administer through a large vein to prevent extravasation. Always administer wtih an infusion pump
    • Monitor for a sudden drop in BP after stopping the drug
  26. Key facts about noncatecolamines [Ex: Albuterol (Proventil), ephedrine, isoetharine, mephentermine, metaproterenol (Alupent), phenylephrine (neo-Synephrine), terbutaline (Brethine)]
    • Stimulate sympathetic nervous system by directing stimulating alpha or beta receptors or indirectly afecting adrenergic receptors
    • metabolized in the liver
    • excreted in urine
  27. When to use noncatecholamines [Ex: Albuterol (Proventil), ephedrine, isoetharine, mephentermine, metaproterenol (Alupent), phenylephrine (neo-Synephrine), terbutaline (Brethine)]
    • Hypotension and severe shock
    • Preterm labor
    • Bronchodilation treatment
    • Nasal congestion
  28. When NOT to use noncatecholamines [Ex: Albuterol (Proventil), ephedrine, isoetharine, mephentermine, metaproterenol (Alupent), phenylephrine (neo-Synephrine), terbutaline (Brethine)]
    • Teachyarrhythmias, hypotension, coronary artery disease, history of stroke, angle-closure glaucoma, and thyrotoxicosis
    • With caution in elderly pts and those wit diabetes, hyperthyroidism, angina, or a history or seizures
  29. Key nursing actions for noncatecholamines [Ex: Albuterol (Proventil), ephedrine, isoetharine, mephentermine, metaproterenol (Alupent), phenylephrine (neo-Synephrine), terbutaline (Brethine)]
    • If given via inhalation, administer the bronchodilator inhaler, wait 2 minutes and administer the corticosteroid inhaler
    • Monitor respiratory status
  30. Key facts about alpha-adrenergic blockers [Ex: Doxazosin (Cardura), ergotamine (Cafergot), phenoxybenzamine (Dibenzyline), phentolamine (Regitine), prazosin (minipress), terazosin (Hytrin)]
    • interrupt the action of epinepherine and norepinepherine at the alpha-receptors
    • Metabolized by the liver
    • Excreted in feces
  31. When to use alpha-adrenergic blockers [Ex: Doxazosin (Cardura), ergotamine (Cafergot), phenoxybenzamine (Dibenzyline), phentolamine (Regitine), prazosin (minipress), terazosin (Hytrin)]
    • peripheral vascular disorders
    • Raynauds's disease
    • Vascular headaches
    • Adrenergic excess
  32. When NOT to use alpha-adrenergic blockers [Ex: Doxazosin (Cardura), ergotamine (Cafergot), phemoxybenzamine (Dibenzyline), phentolamine (Regitine), prazosin (mniipress), terazosin (Hytrin)]
    • MI
    • Coronary insufficiency
    • Evidence or coronary artery disease
    • Pregnancy
  33. Adverse rections of alpha-adrenergic blockers [Ex: Doxazosin (Cardura), ergotamine (Cafergot), phenoxybenzamine (Dibenzyline), phentolamine (Regitine), prazosin (minipress), terazosin (Hytrin)]
    Orthostatic hypotension, tachycardia, dizziness, arrhythmias, ergotism (characterized by numbness, tingling or fingers and toes, weakness, and blindness)
  34. Key ursing actions of alpha-adrenergic blockers [Ex: Doxazosin (Cardura), ergotamine (Cagergot), phenoxybenzamine (Dibenzyline), phentolamine (Regitine), prazosin (minipress), terazosin (Hytrin)]
    • Monitor BP ro signs of orthostatc hypotension,as appropriate
    • Instruct pt to change position slowly to minimize othostatic hypotension
    • Administer drug with milk or food
    • If pt experiences a shock-like state, place in the Trendelenburg position, notify practitioner, and begin emergency resuscitation, as appropriate
  35. Key facts about beta-adrenergic blockers [Ex: aceutolol (Sectral), atenolol (Tenormin), metroprolol (Lopressor), carvedilol (Coreg), labetalol (Trandate), levobunolol (Betagan), propanolol (inderal)]
    • Prevent stimulation of sympathetic nervous system
    • Usually metabolized in the liver
    • Excreted in feces and urine
  36. When to use beta-adrenergic blockers [Ex: acebutolol (Sectral), atenolol (Tenormin), metroprolol (Lopressor), carvedilol (Coreg), labetalol (Trendate), levobunolol (Betagan), propanolol (Indural)]
    • Hypertension
    • Angina
    • Tachydysrrhythmias
    • Migraines
    • MI
    • Glaucoma
    • Acute anxiety reaction
    • Mild to severe heart failure
    • Left ventricular dysfunction after MI
  37. When NOT to use beta-adreneregic blockers [Ex: acebutolol (Secral), atenolol (Tenormin), Metroprolol (Lopressor), carvedilol (Croeg), labetalol (Trendate), levobunolol (Betagan), propanolol (Indural)]
    • Bradyarrhythmias
    • COPD
    • Heart block
    • Asthma
  38. Adverse reactions for beta-adrenergic blockers [Ex: acebutolol (Secral), atenolol (Tenormin), Metroprolol (Lopressor), carvedilol Coreg), labetalol (Trendate), levobunolol (Betagan), propanolol (Indural)]
    • Bradycardia
    • bronchospasm
    • nausea
    • vomiting
    • diarhea
    • hypotension
  39. Topics for pt discussion for beta-adrenergic blockers [Ex: acebutolol (Sacral), atenolol (Tenormin), Metroprolol (Lopressor), carvedilol (Coreg), labetalol (Trendate), levobunolol (Betagan), propanolol (Indural)]
    • medication regimen, including proper administration
    • Methods to assess pulse and blood pressure
    • Signsa dn symptoms of adverse reactions
    • avoidace of over-the-counter drugs
    • Importance of carrying identification about disease and drug regimen
    • Follow-up care
  40. Key nursing actions for beta-adrenergic blockers [Ex: acebutolol (Sacral), atenolol ( Tenormin), Metroprolol (Lopressor), carvedilol (Coreg), labetalol (Trendate), levobunolol (Betagan), propanolol (Indural)]
    • Assess pulse rate: withhold drug andnotify practitioner if rate is below 50 BPM (or according to hospital policy)
    • Advise pt receiving long-term therapy not to discontinue the drug suddenly because of the risk of MI or arrhythmias
  41. Key facts about nonolarizing drugs [Ex: Cisatracurium (Nimbex), pancuronium, vecuronium (Norcuron)
    • Complete with acetylcholine at cholinergic receptor sites of skeletal muscle membrane, thereby blocking acetylcholine transmitter action and preventing muscle membranes from depolarizing
    • Partially metabolized in the liver
    • excreted in urine
  42. When to use nonpolarizing drugs [Ex: Cisatracurium (Nimbex), pancuronium, vecuronium (Norcuron)]
    prolonged or nermediate muscle relaxation for surgery or ET intubation
  43. When NOT to use nonpolarizing drugs [Ex: Cisatracurium (Nimbex), pancurium, vecuronium (Norcuron)]
    • Hypersensitivity
    • Neonates
    • Pregnancy
    • Breast-feeding
  44. Adverse effects of nonpolarizing drugs [Ex: Cisatracurium (Nimbex), pancurium, vecuronium (Norcuron)]
    • APnea
    • hypotension
    • skin reactions
    • bronchospasms
    • excessive bronchial or salivary excretions
  45. Key nursing actions for nonpolarizing drugs [Ex: Cisatracurium (Nimbex), pancurium, vecuronium (Norcuron)]
    • monitor for adverse reactions
    • Have O2 and ET and suction equipment available
    • Monitor respirations frequently until the pt is fully recovered
    • Suction the pt as needed
    • Frequently check the mechanical ventilator settingsand function to ensure proper functioning
    • Always administer with sedation or general anesthesia
  46. Key facts about depolarizing drugs [Ex: succinylcholine (Anectine, Quelicin)]
    • Cause persistenet depolarization followed by muscel fasciculations and paralysis or flaccidity
    • Metabolized in the liver and plasma
    • Excreted in urine
  47. When to use depolarizing drugs [Ex: succinylcholine (Anectine, Quelicin)]
    Skeletal muscle relaxation for surgery or mechanical ventilation
  48. When NOT to use depolarizing drugs [Ex: succinylcholine (Anectine, Quelicin)]
    • Hypersensitivity
    • Genetic disorder or plasma pseudocholinesterase
    • Hx of malignant hyperthermia
    • Myopathies associated with elevated creatine phosphokinase levels
    • acute angle-closure glaucoma
    • Penetrating eye injuries
  49. Adverse effects of depolarizing drugs [Ex: succinylcholine (Anectine, Quelicin)]
    • Prolonged apnea and cardiovascular effects
    • Hypotension
    • Muscular pain
    • Increased intraocular pressure

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