Lesson 3; Power point questions
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Lesson 3; Power point questions
Lesson Power point questions
Lesson 3; Power point questions
What is the basic principal of Adrenergic drugs?
They stimulate the SNS & are also called sympathomimetics or adrenergic agonists
What are the characteristics of Adrenergic drugs?
The mimic the effects of the SNS neurotransmitters.
What are the neurotransmitters of the SNS?
Where are the Adrenergic receptors located?
t/o the body
Name the Adrenergic receptors:
Alpha 1 & 2
Beta 1 & 2
: respond only to domapine
What are the effects of the Alpha 1 Adrenergic receptor sites?
<salivary gland secretion
^bladder & prostate contraction
What are the effects of the Alpha 2 Adrenergic receptor sites?
Inhibit norepinephrine release
<GI motility & tone
What are the effects of the Beta 1 Adrenergic receptor sites?
^cardiac contractility & ^HR
^renin secretion = ^BP
What are the effects of the Beta 2 Adrenergic receptor sites?
^blood flow in skeletal muscles
<GI motility & tone
Activates liver glycogenolysis which ^blood glucose
What are the effects of the Dopaminergic Adrenergic receptor sites?
Vasodilation ^blood flow
What are the classifications of Adrenergics?
Direct-acting sympathomimetic (Epinephrine)
Indirect-acting sympathomimetic (Amphetamine)
Mixed-acting sympathomimetic (Ephedrine)
Catecholamines produce what types of sympathomimetic responses?
Noncatecholamines produce what types of sympathomimetic responses?
act on Beta 2
^blood flow in skeletal muscles
What is the action of Epinephrine (Adrenalin)?
Vasoconstriction (alpha 1)
^BP (beta 1)
Promote bronchodilation (beta 2)
Why would Ephinephrine (Adrenaline) be used?
What types of patients would Epinephrine be contraindicated in?
What are the s/e of Epinephrine (Adrenalin)?
What are the adverse reactions to Epinephrine (Adrenalin)?
Ventricular Fibrillation (V-fib)
: work opposite of beta-blockers)
What are the nursing interventions for Epinephrine (Adrenalin)?
Monitor BP, PULSE, Urine output
Report tachycardia, palpitations, tremors, dizziness, HTN
Avoid cold meds/diet pills if HTN, diabetic, CAD, or dysrhythmias
Avoid adrenergics when nursing infants
Avoid continuous use of adrenergic nasal sprays
Monitor IV site for infiltration
What receptor sites does Albuterol (Proventil) & Salmeterol (Serevent) effect?
Beta 2 adrenergic receptors
What is Albuterol (Proventil) & Salmeterol (Serevent) used for?
Albuterol (Proventil) is only used what?
Tx of ACUTE bronchospasms
ONLY a rescue inhaler
Salmeterol (Serevent) is used for short or long term?
long term, routine inhaler
What are the s/e or a/r to Albuterol (Proventil) & Salmeterol (Serevent)?
What are the nursing implications for Albuterol & Salmeterol?
Avoid factors that exacerbate their condition
Encourage fluid intake to loosen thick mucosal secretions
Educate on proper dosing & equipment
If the patient is using another inhaler that is a
, what should the nurse instruct the patient to do?
Give bronchodilator first (Albuterol or Salmeterol) & wait 5 minutes before giving corticosteroid.
This helps open up the airways for better absorption of the corticosteroid (potent anti-inflammatory)
What should the nurse monitor for with the use of Albuterol or Salmeterol?
Return to normal respiratory rate
Improved breath sounds
Check pulse Ox
What is Dopamine used for?
Dobutamine is used for?
to Tx cardiac decompensation
Pseudoephedrine (Sudafed, Afrin) are used to Tx what?
What can happen with over use of Afrin?
What is Terbutaline (Brethine) used for?
Tx of bronchospasms
What is the basic action of Adrenergic Blockers?
Block the effects of adrenergic neurotransmitter
What ways can Adrenergic blockers block the effects of adrenergic neurotransmitters?
By blocking the alpha or beta sites:
: by occupying receptors
: by inhibiting release of neurotransmitters epinephrine & norepinephrine
What are other names for the Adrenergic Blockers?
Sympatholytics ("lyse" or inhibit SNS)
The Alpha-Adrenergic Blockers work by doing what?
Blocking either Alpha 1 receptors (selective), or by blocking Alpha 1 & 2 receptors (Non-selective).
Alpha 1 Blockers can cause what?
Miosis (pupil constriction)
<contraction of smooth muscles in bladder neck & prostate.
The action of Alpha Blockers causes what to happen?
Arterial & venous dilation-->reducing peripheral vascular resistance & BP
Effects receptors on the prostate gland & bladder causing <resistance to urinary outflow (^possibility of incontinence)
Name some Alpha Blockers & what they are used for.
*HTN & BPH
*HTN & PTSD
* HTN & BPH
What suffix indicates Alpha-Adrenergic Blockers?
With the Alpha Blockers the nurse should warn the patients first starting these meds of what effect?
The "first dose effect": may cause orthostatic hypotention, dizziness, & syncope
What are the effects of Adrenergic Blockers at the beta 1 & 2 sites?
Beta 1; <cardiac contractility, <pulse
Beta 2; Bronchoconstriction, Contracts Uterus, Inhibits glycogenolysis
What are indications for Beta Blockers use?
: <demand for myocardial oxygen
: Inhibits stimulation from circulating catecholamines
Class II Antidysrhythmics
Heart Failure (only some)
Tx of Migraine HA
Explain the action of
beta blockers verses
Selective Beta blockers
: <BP & Pulse
Nonselective Beta blockers:
Blocks Beta 1
: <BP & Pulse
Blocks Beta 2
Name some Beta Blockers.
Timolol (Blocadren, Timoptic
The "olol" drugs are what type of drugs?
Propranolol is a nonselective beta blocker, when is it contraindicated?
in patients with COPD
Propranolol is a nonselective beta blocker, what are it's s/e or a/r?
Metoprolol (Lopressor), & Atenolol (Tenormin) are
beta adrenergic blockers. Which receptor do they block and what are the effects?
*<BP & Pulse
What are the s/e of
Beta1 adrenergic blockers like Metoprolol, or Atenolol?
What are the nursing implications with Adrenergic Blockers (Alpha & Beta blockers)?
: Allergies, Hx of COPD, Hypotension, Cardiac dysrhythmias, Bradycardia, Heart Failure, etc. cardio problems.
NEVER stop taking abruptly d/t REBOUND TACHYCARDIA
Teach pt's to change position slowly
Avoid caffeine, alcohol & hazardous activites until blood levels become stable
Nurses should monitor patients on Adrenergic Blocking drugs (Alpha & beta blockers) for what?
***BP & PULSE
The nurse knows that a client on Beta Blockers should be educated to report what s/e?
Weight gain of >2#/1day, or >5#/1week.
Edema of feet or ankles
Excessive fatigue or weakness
Syncope or dizziness
What are Cholinergic Drugs?
Drugs that stimulate the PNS
Mimic the effects of the PNS neurotransmitter (ACh; Acetylcholine)
There are two different Cholinergic receptors, what are they?
Muscarinic & Nicotinic
What effects do Cholinergics have?
: <BP & pulse, vasodilation, slows conduction of AV node
: ^tone & motility, ^parastalsis, relaxed sphincter muscles
: Contract bladder, ^uterer tone, relax sphincter muscles, stimulate urination
: Miosis (pupil constriction), ^accommodation
: Bronchial constriction, ^secretions
: ^salivation, ^perspiration, ^tears
: ^neuromuscular transmission
Name a few Direct-acting Cholinergics & what they are used for.
: Metoclopramide (Reglan)
*Tx of GERD & Gastroparisis (^gastric emptying)
: Bethanachol (Urecholine)
*Stimulate urination (1-2hrs after taken)
*Tx of glaucoma
*topical app d/t poor oral absorbtion
What are some diseases that Indirect-acting Cholinergics are prescribed for?
What are the Indirect-acting Cholinergics that are used for Alzheimer's Dementia?
***NOT A CURE***
Used to improve memory in A.D., helps slow progression of disease
What are the s/e & nursing implications for Cholinergics?
: Assess BP
: Assess HR
: Assess Lungs
: Oral Hygeine
^Gastric acid secretion & abdominal cramps
: check GI system
: Safety concerns
Assess I & O
What should a nurse teach a client who is about to start taking a Cholinergic drug?
Proper gtts admin
***DO NOT ABRUPTLY STOP TAKING***
Spread doses evenly apart to optimize the effects
Therapeutic effects of
may not occur for up to
What is a special nursing implication in patients taking Bethanechol?
Should void w/in 60min of administration
What is a special nursing implication for a post-op patient with <GI peristalsis on Metoclopramide
Watch for: ^BP, are they passing gas, COCA poop
Which drugs cause interactions with Cholinergic drugs?
Anticholinergics, Antihistamines, sympathomimetics
*b/c they antagonize cholinergic drugs, resulting in <responses
What are Anticholinergics? (cholinergic blocking agents)
Drugs that block or inhibit the actions of acetylcholine (ACh) in the PSNS (parasympathetic nervous system)
How do Anticholinergics effect the body?
: Lg doses ^pulse, small doses <pulse
: Bronchodilation, <secretions
: Relax smooth muscle tone, <motility & peristalsis, <secretions
ilate pupils (Mi
: <salivation, <perspiration
: <tremors & rigidity
What is the Anticholinergic Atropine used for?
Pre-op med to <salivary secretions
: <GI peristalsis
^HR (high doses)
: used for SEVERE bradycardia, or heart block
What is the Anticholinergic Scopolamine & Dramamine used for?
What is the Anticholinergic Hyoscyamine (
spaz) used for?
Tx of Urinary bladder spasms
Tx of IBS & peptic ulcers
Tolterodine (Detrol), is an Anticholinergic used for what?
Tx for Urinary frequency (gotta go, gotta go)
urgency & incontinence
The Anticholinergic drug Ipratropium (Atrovent) is used for what?
Tx of COPD, Asthma, bronchospasms
: causes bronchodilation
Benztropine (Cogentin), & Trihexyphenidyl (Artane) are Anticholinergics used to treat what?
Parkinsonism & drug induced parkinsonism
*<muscle rigidity & muscle tremors
What medication groups do Anticholinergics interact with?
When given with other Anticholinergic drugs what happens?
Additive effect: ^effects of meds
What are the s/e of Anticholinergics?
DRY DRY DRY!!!
^intraocular pressure (IOP)
Visual disturbances--blurred vision
Tachycardia (in high doses)
What are the nursing interventions for the s/e of Anticholinergics?
: good oral hygeine/hard candies
: NS eye gtts PRN
: Monitor pulse
: avoid driving at NOC & wear sunglasses
: Assess bowel fxn regularily
: Assess I&O
What are the nursing implications for Anticholinergics?
Monitor for confusion/drowsiness (*elderly)
: <fluid balance=heat stroke cautions
Adequate fluid intake
When Parkinsonism patients are taking an Anticholinergic like Cogentin what does the nurse need to watch for?
Ensuring the med is working by noting if there is a <in tremors & salivation/drooling
With the Anticholinergic drug Detrol, what is the nurse monitoring for?
Improved urinary patterns
^time between voids
CNS stimulants like Amphetamines, caffeine, Analeptics & Anorexiants are used for what types of issues?
Reversal of respiratory depression
CNS stimulants are in 3 categories, what are they?
What is the possible pathophysiology of ADHD?
A dysregulation of the transmitters serotonin, norephinephrine, & dopamine.
ADHD typically occurs in what age group?
children, & usually starts before the age of 7
What are the characteristics of ADHD?
Inability to concentrate
Inability to complete tasks
What are the characteristics of Narcolepsy?
Recurrent attacks of drowsiness during daytime
Unable to control sleep
Falling asleep while
: Driving, Eating, Standing,
What are the Amphetamines, Adderall & Dexedrine used for?
: ADHD & Narcolepsy
The CNS stimulants in Adderall & Dexadring from the Amphetamines category act by doing what?
Stimulating the release of norepinephrine & dopamine.
What are the actions of Amphetamines Adderall & Dexedrine?
Adderall & Dexedrine
^wakefulness in narcolepsy
<hyperactivity, impulsiveness & restlessness of ADHD
Tx of obesity
What are the s/e of a/r of Amphetamines?
Tachycardia, palpitations, hypertension
Anorexia, dry mouth, Wt loss, diarrhea, constipation
What are some
& what are their uses?
Methylphenidate (Ritalin) CSS II
What are the s/e of
wide range, dose related
What are the nursing interventions for Amphetamines & Amphetamine-Like drugs?
Take before breakfast & lunch
**Record Height, Weight, Growth of children**
Avoid alcohol & caffeine
Use sugarless gum for dry mouth
- do not abruptly stop
List a few Anorexiants.
Orlistat (Xenical or Alli)
How do Anorexiants work?
What are the s/e of Anorexiants?
nervousness, restlessness, irritability, insomnia, palpitation, HTN
What is the primary use for Analeptics?
To stimulate respirations
Name some Analeptics.
Caffeine (NoDoz, Coffee, Chocolate, Cold meds)
What are the Analeptics
Caffeine & Theophylline
: Stimulate respirations in newborns
: Relaxes bronchioles
What are the s/e of Analeptics?
Restlessness, tremors, twitching, palpitations, insomnia, tinnitus, nausea, diarrhea
The CNS Depressants: Sedatives are drugs that do what?
Diminishes physical & mental response
The CNS Depressants: Hypnotics do what?
**A sedative can become a hypnotic if given in a large enough dose**
How does dosing affect the effect of Sedatives & Hypnotics?
: Calm CNS w/o inducing sleep
: Calm CNS to the point of causing sleep
What are the categories of Sedative-Hypnotics?
What do the OTC Sedative-Hypnotics Nytol, Sleep-eze & Tylenol PM have in common?
What are the categories of Barbitruates?
Benzodiazepines are Antianxiety agents, name them. (pam, am or lam)
Certain long-acting Benzodiazepines are used for alcohol withdrawal, which ones are they?
Temazepam (Restoril) is a Hypnotic that is generally used long or short term?
Which Nonbenzodiazepines are used as Hypnotics for short term use of insomnia?
What are the general s/e of Sedative-Hypnotics?
Residual drowsiness (Hang-over effect)
Sedative-Hypnotics like ALL CNS depressents interact with what things?
Other CNS depressants
What are the nursing interventions for Sedative-Hypnotic drugs?
Attempt Non-pharm methods 1st
Take 15-45min before bed
Report hang-over effect
Be attentive to safety
Avoid alcohol & other CNS depressants
Monitor BP, Resp, withdrawal s/s
What are the 2 classifications of Anesthetics?
What is the purpose of General Anesthesia?
Loss of consciousness
What is the purpose of Local Anesthesia?
Analgesic in limited area
Balanced Anesthesia is a combination of drugs given at varying times before, & during sx used for what purpose?
<Amount of general anesthetic needed
What are the routes used for Anesthetics?
With Inhalation (General) Anesthetics like gas or volatile liquid what are the a/r to watch for?
Which Anesthetic causes LESS respiratory distress than General Anesthetics?
How do Topical Anesthetics work & name a few.
they <sensitivity of the affected area
How do Local Anesthetics work & what are they used for?
Block pain at the site where drug is given
used for dental procedures & other minor Sxs
List the Spinal Anesthetic types.
What are the nursing interventions for Anesthetics?
What is the action of Antipsychotics?
Block action of dopamine
What are Antipsychotics used for?
Other types of psychosisis
What are the two major categories of Antipsychotic drugs?
Typical (1st generation/older drugs)
Atypical (2nd gen/newer drugs)
Typical Antipsychotic drugs are most effective for Positive s/s, name a few of these drugs.
What are the s/e with Typical (1st Gen) Antipsychotics?
Drowsiness, Anticholinergic effects (dry, dry)
Extrapyramidal s/s (parkinson like s/s)
Temors, rigidity, pill rolling, shuffling gait,
: Benztropine (Cogentin)
Tongue movements, foot tapping, shoulder
: stop drug
Neuroleptic Malignant Syndrome (NMS)
High fever, ^^CPK, muscle rigidity
: stop drug, call DR!
What are the advantages of Atypical Antipsychotics?
Effective in Tx of both positive & negative s/s of Schizophrenia
Less likely to cause EPS or Tardive Dyskinesia
Name a few Atypical Antipsychotics.
: s/e Agranulocytosis- ^infection d/t <WBC (monitor CBC)
What should a nurse monitor a client for when taking 2nd Gen Atypical Antipsychotics?
Give w/food or milk
: EPS, NMS, TD
Assess WBC w/Clozaril
**NEED TO TAPER OFF MED NOT D/C ABRUPTLY**
How long could it take for Atypical Antipsychotics drugs to achieve effectiveness?
Anxiolytics (Antianxiety drugs) like the Benzodiazepines are used for a variety of issues, what are they?
Tx of Alcohol withdrawal
What are the two major Mood Disorders & how are they characterized?
: Loss of interest in normal activities, sad affect, vegetative symptoms
: mood swings from mania to depression
What are the major Antidepressant Agents?
Most Common d/t less s/e
SSRIs (Selective serotonin reuptake inhibitors)
*Fluoxetine (Prozac), Sertraline (Zoloft)
*Duloxetine (Cymbalta), Paroxetine (Paxil)
Serotonin/Norepinephrine reuptake inhibitors
*Bupropion (Wellbutrin), Trazodone
Not used much:
Tricyclic Antidepressants (TCAs)
*Amitriptyline (Elavil), Nortriptyline (Pamelor)
Monoamine Oxidase Inhibitors (MAOIs)
*Isocraboxide (Marplan) or Phenelzine (Nardil)
SSRIs (Selective Serotonin Reuptake Inhibitors) like Fluexetine (Prozac), Sertraline (Zoloft), & Paroxetine (Paxil) are used for what?
Major depression, Anxiety disorders
OCD, Panic, Phobias
What are the s/e of the SSRIs like Paxil & Prozac?
HA, Nervousness, Restlessness, Insomnia/drowsiness= depending on person
Tremors, GI distress, Sexual dysfunction, Seizures, suicidal ideation
*s/e often <after 2-3wks
What are TCAs (Tricyclic Antidepressants) like Amitriptyline (Elavil) & Nortriptyline (Pamlor) used for?
What are the s/e of TCAs?
: Dizziness, blurred vision, dry mouth & eyes, urinary retention, constipation
Wt gan, GI distress, Sexual dysfunction
Ortho hypotension, dysrhythmias, EPS, blood dyscrasias
What are Mood Stabilizer drugs used for?
Anticonvulsants (Tegretol, Depakote, Lamictal)
Name a few Mood Stabilizer drugs.
Valproic Acid (Depakote)
What is the biggest concern with Lithium?
the narrow therapeutic index
What are the s/e of Lithium?
HA, drowsiness, dizziness, hypotension, restlessness, slurred speech, dry mouth, metallic taste, tremors, muscle weakness, GI distress, edema of hands & ankles, ^urination, dysrhythmias, blood dyscrasias, nephrotoxicity
What are some nursing interventions for clients on Lithium?
Lithium levels Q1-2 months
urine output, rena fxn tests
What is the therapeutic range for Lithium?
What should a client taking Lithium wear?
Medic alert bracelet