2. reverse neuromuscular blockers used during surgeries
3. antidote for cholinergic poisoning
AE of neostigmine?
resp arrest/paralysis r/t receptors becoming less sensitive b/c of too much stimulation
Use for echothiopate?
8 anticholinergic drugs?
CAR BAD AS
2 anticholinergic drugs used for Parkinsons?
cogentin & artane
Use for robinul?
Use for bentyl
2 antidotes for anticholinergics?
neostigmine & phyostigmine
Action of neuromuscular blockers?
prevent Ach from acting at neuromuscular junctions
2 neuromuscular blocking agents?
What antiparkinsonian drug requires low protein diet and avoidance of vitamin B6?
What anti-epileptic drug may be used to Tx trigeminal neuralgia pain?
2 uses for tubocruarine?
1. immobility for surgery
2. electroconvulsive therapy
Use for anectine?
used for short procedures - short-acting
Hemorheologic med that is used to decrease pain ass. with intermittent claudication?
Concerns with anectine?
can increase K levels - check before admin
neostigmine antidote doesn't work on it
AE of anectine?
1. mus contraction
2. malignant hyperthermia
SNS releases ___, ___, & ____.
EPI, NE, & dopamine
Why does EPI have many effects?
nonselective SNS agonist - stimulates all SNS receptors
RA medication that is CI with live virus vaccines?
2 main uses of SNS agonists?
1. CPR resusitation
2. anaphylactic shock
EPI important considerations/AE?
1. infiltration = tissue necrosis
2. can increase BP, pulse, & RR
3. need cont. EKG monitoring
4. must be on pump for IV admin
SQ admin of EPI 2 interventions?
1. aspirate to prevent IV admin of SQ dose
2. massage site for 10 seconds to prevent local vasoconstriction
Antidote for EPI infiltration?
regitine - alpha blocker that dilates BV
Tx for hypertensive crisis caused by EPI admin?
alpha-adrenergic blocking agent like prazosin
Half life of EPI?
short - usually no antidote needed
Prototype alpha I adrenergic agonist?
phenyllephrine - causes vasoconstriction
2 uses for phenyllephrine?
1. vascular failure & shock
2. nasal decongestant
AE of phenyllephrine?
HTN with reflex bradycardia
Prototype alpha II adrenergic agonist?
clonidine - antihypertensive
Prototype beta I receptor agonist?
Use for dopamine?
Action of dopamine?
increases CO, BV dilation, & tissue perfusion
Advantage of dopamine?
increases renal perfusion
What pain med requires BP check before & 1 h after admin?
Monitoring for dopamine?
4 adrenergic agonist drugs?
1. dopamine - beta 1
2. EPI - all4
3. phenylephrine - alpha 1
4. clonidine - alpha 2
Cogentin & artane Tx ____.
3 adrenergic antagoinists?
1. prazosin - alpha blocker
2. propranolol - beta 1 & 2 blocker
3. metoprolol - beta 1 blocker
2 uses for prazosin?
1. decrease BP
2. increases urine flow in benign prostatic hyperplasia
3 AE prazosin?
1. ortho BP & tachycardia to compensate
Propranolol drug type and use?
beta 1 & 2 blocker that affects lungs & CV
used for antianginal, cardioprotective, anti-arrhythmic, & antihypertensive
AE of propranolol?
2. can mask s/s of hypoglycemia
4. bradycardia and rebound tachycardia
5. decreases production of glucose
CI for propranolol?>
3. Hx of asthma
Why may metoprolol be used with asthma instead of propranolol?
metoprolol is beta 1 blocker only - does not affect lungs
propranolol is a beta 1 & 2 blocker - affects heart and lungs
Drug interaction with propranolol?
Ca channel blockers increase bradycardia
What must be done prior to the admin of imitrex?
Why should pt never stop propranolol or metoprolol abruptly (beta 1 action)?
can cause rebound tachycardia
S/S that may indicate CHF dev with a beta blocker & should be reported to MD?
weight gain of 2 lb in 24 h
HR of pt taking a beta blocker that requires reporting to MD?
3 ways antiepileptic drugs work?
1. decrease Na into cell
2. inhibit Ca into cell
3. increase GABA effects
What 2 NT are released when an action potential occurs to either excite or inhibit the NS?
glutamate - excitation
GABA - inhibits
Action of GABA?
lets Cl into cell -> prevents depolarization
3 things that cause a seizure?
high level of glutamate or low level of GABA
Action of dilantin?
decreases influx of Na into the cell -> decreases firing of neurons
Dilantin memory help?
Princess Di had a seizure that stopped abruptly. (stop causes status epilepticus) She was very dizzy when she woke up so she went to see Dr Steven Johnson even though he has hair all over him from a birth defect. He saw that she was bleeding out all her red & white blood cells from her swollen gingiva so he gave her a slow IV admin.
What type of seizures cannot be treated by dilantin?
How may dilantin be used for status epilepticus Tx?
after/concurrent with benzo
need separate IV line
3 off-label uses for dilantin?
2. seizures in eclampsia
3. trigeminal neuralgia pain
Serum therapeutic drug level of dilantin?
10 to 20
Half-life & therapeutic index of dilantin?
long half life and narrow therapeutic index
When should dilantin drug levels be checked?
w/in 7 days of dose change
Avoid giving dilantin with ______.
continuous enteral tube feeding
need to stop feeding for 1 h before and 1 h after dilanting admin
IM dilantin admin?
slow absorption - precipitate forms at injection site
Dilantin dose change consideration?
needs titrating r/t narrow therapeutic index
6 Black Box warnings with dilantin?
1. IV admin slowly (1 h )
2. direct IV max 50mg over 1 minute
3. flush with NS
4. DO NOT mix with other solutions except NS
5. caustic to tissue
6. increased risk for suicidal thoughts
What may occur if dilantin in given too fast IV?
hypotension & CV collapse
2 CI for dilantin?
1. sinus bradycardia
2. heart block
Diuretic that crystallizes easily?
if stop abruptly can cause status epilepticus
Dilantin pregnancy category and effects?
Why is it given for eclampsia?
preg cat D -
1. skull & face abnormalities
2. underdeveloped nails
3. growth deficiencies
4. mild developmental delays
may be used in 3rd trimester but not first
AE of dilantin?
1. dizziness & ataxia - risk for falls
2. gingival hyperplasia
4. impaired vit D met. -> fatigue
Serious AE of dilantin?
2. aplastic anemia
3. Stevens Johnson Syndrome
CBC monitoring with dilantin?
monthly X 3 mo then periodically
S/S of Stevens Johnson syndrome
will get fever & sore throat then dev ulcers on MM
Intervention for Stevens Johnson syndrome?
stop all meds
Drug interaction with dilantin?
decreases effects of oral contraceptives
3 uses for carbamazepine?
2. psych disorders
3. trigeminal neuralgia
2 black box warnings for carbemazepine?
1. increased suicidal thoughts
2. blood dyscrasias
4 uses for depakote?
1. all types of seizures
2. Tx mania part of bipolar
3. migraine HA
4. status epilepticus
Black box warning with depakote?
increased suicidal thoughts
3 life-threatening AE of depakote?
3. liver toxicity
Monitoring that will be done with depakote?
liver function tests
Keppra differences from other anti-seizure meds?
can be used in CH & does not require titration - can start on therapeutic dose
Zarontin action & uses?
decreases Ca influx into cell
used only for absence seizures
AE of zarontin?
Anti-epileptic action of benzos?
increase GABA effects
2 groups of ppl that may need decreased dose of benzos?
elderly & Asians
Consideration with IV diazepam?
reacts with plastic tubing -> decreases drug to pt
Benzo that may be used for acute alcohol withdrawal?
CNS disorder caused by decreased dopamine & increased Ach
Action of dopaminergics?
increase dopamine levels
What med crosses the BBB then turns into dopamine?
b/c dopamine cannot cross BBB
Action of levadopa & carbidopa in sinemet?
carbidopa inhibits DDC & COMT - enzymes that B/D levadopa
levadopa crosses BBB & turns into dopamine
Goal of drug therapy in Parkinsons?
balance Ach & dopamine
2 uses for sinemet/
Parkinsons & restless leg syndrome
How long does it take sinemet to take effect?
1 to 2 months
3 CI with sinemet?
1. malignant melanoma or undiagnosed skin lesions
2. closed angle glaucoma
AE of sinemet?
1. GI effects and weight loss
2. orthostatic hypotension
3. abnormal movements
4. neuroleptic malignant syndrome - caused by abrupt cessation
cannot take with HT3 antagonist antiemetics: zofran, kytril, anzemet, aloxil - will cause decreased BP & LOC
2 things that may cause NMS?
abrupt cessation of sinemet or antipsychotic drugs
2 drug interactions with sinemet?
1. high protein diet decreases absorption - need low protein diet
2. avoid vitamin B6
3 cultural groups that require a larger dose of sinemet?
2 dopaminergic agents that are different from sinemet?
AE of amantidine?
What is it?
livedo reticularis: reddish-blue netlike mottling of the skin that is benign & disappears when stop med
AE of eldepryl?
Med that can decrease occurance of on-off syndrome in sinemet?
Catecholemine O-methyl transferase inhibitors?
inhibit enzyme that breaks down dopamine = more dopamine -> Tx for parkinsons
AE of tasmar and comtan?
tasmar causes hepatotoxicity but comtan does not
2 anticholinergic drugs for parkinsons?
cogentin & artane
Mixed agonist-antagonist pain med?
2 advantages for morphine use for pain?
decreases anxiety and workload of heart
Important consideration with methotrexate and other DMARDS?
cause bone marrow suppression: blood dyscrasias
When may morphine be used for dyspnea?
with left ventricular failure & pulmonary edema
Drug interaction with lithium?
ibuprofen -> lithium toxicity
CI for narcotics?
1. increased ICP
2. CNS/resp depression or any airway problems
2 things to assess before admin of morphine?
RR & BP
Ibuprofen and loop diuretic interaction?
ibuprofen reduces effects of diuretic
4 s/s of opiate w/d?
basically the opposite of the effects of the opiate
Drug interaction with ibuprofen and aminoglycoside ABX?
can cause aminoglycoside to build up r/t decreased GFR
Ibuprofen effects on beta blockers?
decrease antihypertensive effects
How long for fentanyl patch to work?
3 drug interactions with fentanyl?
1. p450 inhibitors
2. ketoconazole antifungal
all increase levels of fentanyl and increase AE & resp depression
Interaction with acet & warfarin?
acet can increase warfarin levels
Interaction with ibuprofen & SSRI?
risk for GI bleed increases
Why are codeine & hydrocodone CI for asthma, emphysema, & post surgery pt?
no cough reflex -> accumulate fluids-> pneumonia & narrowed airways
Drug interaction with codeine besides CNS depressants?
histamine-2 receptor antagonists: ranitidine, cimetidine, etc. increase resp depression
Interaction with hydrocodone & hydantoins/dilantin?
can increase risk for hepatotoxicity
3 narcotic agonist/antagonists?
Consideration if given to person with opiate addiction?
can cause w/d s/s r/t antagonist action
high first pass effect
2 contraindications for talwin, nubain, & stadol?
1. increased intracranial pressure
2. MI r/t increased workload of heart
AE of talwin and stadol?
talwin - euphoria
stadol - somnolence
2 drugs that have similar effects to morphine?
nubain & hydromorphone
Ibuprofen interaction with antifungals?
increases NSAID adverse effects
S/S of salicylate poisoning?
1. resp distress
2. F&E & pH imbalances
3. high temp
5. shock, coma, & death
Education with imitrex?
1. s/s of ischemic events: MI & stroke
2. no heavy machine until know effects
How long does anti-platelet action of ASA last?
8 days- life of platelet
Why may renal toxicity occur with any prostaglandin inhibitor (ASA & IBU)?
prostaglandins normally inhibit vasoconstriction of renal arteries
What arthritis med can cause multiple sclerosis & optic neuritis?
disalcid and ASA diff?
has antiinflammatory but no antiplatelet or antipyretic
Black Box Warning with all NSAIDS?
CV thrombotic events: increases risk for MI & stroke
Use for cytotec in pain management?
decreases GI AE of NSAIDs
3 drug interactions with ASA?
What will occur?
ASA will increase effects of:
2. oral hypoglycemics
7 drug interactions with ibuprofen?
1. salicylates & heparin
2. aminoglycoside ABX
4. beta blockers
5. loop diuretics
Pt at increased risk for GI bleeds with ibu admin?
pt over 60
Serotonin-selective drugs are AKA ____ & are used to TX ______.
3 migraine drugs?
Action of triptans?
vasoonstriction of BV in brain to decrease inflammation
CI for triptans/imitrex?
1. any problem with heart, BV, or brain/stroke
Common AE of imitrex/triptans?
dizziness & vertigo & warm/tingling sensation
3 DMARDs drugs?
arrest progression of RA
Memory help for methotrexate?
Metho made some meth out of a FA supplement and sunblock. (photosensitivity) It made him feel like he was in a fog and he couldn't breathe. (pulmonary probs) He fell down and was bleeding so badly that he got blood dyscrasias. He got an infection in his wound and it would not heal. (immunosuppression) He tried eating good and not drinking caffeine, but the meth had already damaged his liver & he died.
Action of methotrexate?
interferes with FA met -> inhibits DNA synth and cell reproduction
CI for methotrexate?
1. blood dyscrasias & immunosuppression
2. alcoholism & liver disease
Diuretic that may cause ototoxicity?
AE of methotrexate?
1. methotrexate fog
3. blood dyscrasias & immunosuppression
2 life-threatening AE of methotrexate?
1. severe myelosuppression
2. pulmonary fibrosis or interstitial pneumonitis
Important methotrexate monitoring/assessments?
Requires follow-up q 4 to 6 weeks for what 4 tests?
2. liver and renal function
3. chest x-ray for pulmonary probs
2. liver profile
Why does albumin need to be monitored for methotrexate?
malnourishment can increase blood dyscrasias and immunosuppression AE
Pt education for methotrexate?
1. decrease caffeine
2. good nutrition
3. take vitaminB/FA supplement to decrease AE
4. wear sunblock
Why methotrexate pt not need to have caffeine?
can interfere with the med
Tumor Necrosis Factor Inhibitor drug?
binds to TNF & inactivates it -> decreases inflammation mediated by TNF
Admin of enbrel?
Use for enbrel?
delay damage ass. with RA
CI with enbrel?
current active infection
AE of enbrel?
1. can induce multiple sclerosis & optic neuritis
2. upper resp infections
3 serious AE of enbrel?
1. severe infections
2. blood dyscrasias
3. induction of multiple sclerosis & optic neuritis
Pt teaching with enbrel?
no live virus vaccines
too much adrenocortical secretion
CI for prednisone?
fungal infections r/t increased BG with prednisone admin
3 most important considerations with prednisone?"
1. supresses immune system
2. raises BG
3. can decrease serum K
Best time to take glucocorticoids?
Main drug class used for CHF?
3 types of drugs given for CHF?
BP/cardiac med that should be used cautiously in CHF pt?
Tx contractility of the heart
affect conduction of current in the heart
AE of digoxin?
dose related and due to toxicity
Most frequent cause of digoxin toxicity?
3 s/s of digoxin toxicity?
1. GI disturbances: anorexia, NV
2. cardiotoxicity: irregular pulse, peripheral edema/weight gain
3. CNS toxicity: blurred/yellow vision, fatigue
IV push digoxin?
pushing too fast can cause dropped HR & death
Which diuretic requires filtered tubing?
EPI & beta blockers?
EPI will not resusitate a person on beta blockers because it blocks epi
Relationship of K & digoxin?
use the same receptors
K down = digoxin effects up
Antihypertensive drug that prevents reflex tachycardia?