pharm quiz 3

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  1. Purpose of IV solutions
    • Provide daily maintenance fluid therapy
    • Replace prior deficits
    • Replace concurrent losses
  2. Types of frequently ordered IV solutions
    • Dextrose (D)
    • Normal saline (NS)
    • Lactated ringers (L/R) solution
    • Example:
    • -5D=5%
    • -A number indicates the % of grams of solute per 100 mL of dextrose or 5 grams of dextrose per 100 mL of solution
  3. Hypotonic IV solutions
    • 2.5% dextrose in water (2.5% DW)
    • 0.45% NaCl (Sodium Chloride) solution 0.45 NS, 1/2 NS, or 1/2 strength NS)
  4. Isotonic IV solutions
    • 5% dextrose in water (D5W or 5DW)
    • Normal saline (NS) solution (0.9%  NaCl solution)
    • Lactated Ringer's solution (L/R, R/L or LRS)
    • 290mOs
  5. Hypertonic IV solutions
    • 10% dextrose in water or 10DW
    • 5DW in 0.45% NaCl solution or D5W in 1/2 NS
    • D5LR or D5RLS
  6. Determining infusion durations
    • If the rode states mL per hr such as 120 mL per hr, and a liter (1000 mL) will be supplied:
    • 1. Determine the hours of duration first (total mL/mL per hour)
    • 2. Convert any remainder of hours to minutes using a conversion factor
  7. IV administration sets
    • The main types of specialized IV tubing are:
    • Primary (main tubing)
    • Secondary, shorter tubing that connects to the primary tubing at a port
    • Blood administration sets with special filters and a Y connector for NS solution 
    • Extension tubings that are used when more length is needed
  8. selection of gravity infusion administration sets
    • Macrodrip (large diameter tubing)
    • -DF of 10, 15, 20
    • Microdrip (narrow tubing)
    • -DF of 60
    • -Delivers tiny drops from needlelike projection
    • -60 drops/mL
  9. calculating flow rates for piggyback gravity
    • infusions in drops per minute to infuse in less than 1 hour
    • ordered: IVPB antibiotic 50 mL over 30 minutes DF 10 
    • 10 drops/1 mL x 50 mL/30 mins. =16.6 or 17 drops per minute
  10. IV intermittent solution delivery systems
    • intermittent solutions may be delivered in 5 ways:
    • -IV piggyback solutions
    • -volume control devices (Ex: calibrated burette chamber)
    • -IV (direct) push with syringe
    • -syringe pumps
    • -PCA (patient controlled analgesic) pumps
  11. adrenergic drugs
    • drugs that stimulate the sympathetic nervous system
    • AKA adrenergic agonists, sympathomimetics
  12. characteristics of adrenergic drugs
    • mimic the effects of SNS NTs (catecholamines)
    • -norepinephrine (NE)
    • -epinephrine (EPI)
    • -dopamine
  13. adrenergic receptors
    • located throughout the body
    • are receptors for the sympathetic NTs
    • -Alpha-adrenergic receptors
    • -beta-adrenergic receptors
    • -dopaminergic receptors: respond only to dopamine
  14. alpha-adrenergic receptors
    • divided into alpha1, alpha2 receptors
    • differentiated by their location on nerves
  15. alpha1-adrenergic receptors
    located on postsynaptic effector cells (the cell, muscle or organ that the nerve stimulates)
  16. alpha2-adrenergic receptors
    • located on presynaptic nerve terminals (the nerve that stimulates the effector cells)
    • control the release of NTs
  17. alpha-adrenergic agonist responses
    • vasoconstriction
    • CNS stimulation
  18. beta-adrenergic receptors
    • all are located on postsynaptic effector cells
    • -beta1 adrenergic receptors-located primarily in the heart
    • -beta2 adrenergic receptors-located in smooth muscle of the bronchioles, arterioles and visceral organs
  19. beta-adregnergic agonist responses
    • bronchial, GI, and uterine smooth muscle relaxation
    • Glycogenolysis
    • cardiac stimulation
  20. dopaminergic receptors
    • an additional adrenergic receptor
    • stimulated by dopamine
    • causes dilation of the following blood vessels, resulting in increased blood flow
    • -renal
    • -mesenteric
    • -coronary
    • -cerebral
  21. responses to stimulation
    • Cardiovascular:
    • blood vessels-alpha1, beta2-constriction/dilation
    • cardiac muscle-beta1-increased contractility
    • AV node-beta1-increased heart rate
    • SA node-beta1-increased heart rate
    • GI:
    • Muscle-beat2 and alpha-decreased motility
    • Sphincters-alpha1-constriction
    • Genitourinary:
    • Bladder sphincter-alpha1-constriction
    • Penis-alpha1-ejaculation
    • Uterus-alpha1, beta2-alpha contraction, beta relaxation
    • Respiratory:
    • bronchial muscles-beta2-dilation
    • liver-beta2-glycogenolysis
    • pupils-alpha1-dilation
  22. catecholamines
    • substances that can produce a sympathomimetic response
    • endogenous
    • -epinephrine, norepinephrine, dopamine
    • Synthetic
    • -dobutamine, phenylephrine
  23. mechanism of action: catecholamine
    • direct-acting sympathomimetic
    • -binds directly to the receptor and causes a physiologic response
    • indirect-acting sympathomimetic
    • -causes release of catecholamine from storage sites (vesicles) in nerve endings
    • -catecholamine then binds to receptors and causes a physiologic response
    • Mixed-acting sympathomimetic
    • -directly stimulates the receptor by binding to it and indirectly stimulates the receptor by causing the release of stored NTs from vesicles in the nerve endings
  24. drug effects
    • Stimulation of alpha-adrenergic receptors on smooth muscles results in
    • -vasoconstriction of blood vessels
    • -relaxation of GI smooth muscles (decreased motility)
    • -constriction of bladder sphincter
    • -contraction of uterus
    • -male ejaculation
    • -contraction of pupillary muscles of the eye (dilated pupils)
  25. drug effects
    • Stimulation of beta1-adrenergic receptors on the myocardium, AV node, and SA node results in cardiac stimulation
    • -Increased force of contraction (positive inotropic effect)
    • -Increased heart rate (positive chronotropic effect)
    • -Increased conduction through AV node(positive dromotropic effect)
  26. drug effects
    • Stimulation of beta2-adrenergic receptors on the airways results in
    • -bronchodilation (relaxation of the bronchi)
    • Other effects of beta2-adrenergic stimulation
    • -uterine relaxation
    • -glycogenolysis in the liver
    • -increased renin secretion in the kidneys
    • -relaxation of GI smooth muscles (decreased motility)
  27. Treatment of asthma and bronchitis
    • Bronchodilators: drugs that stimulate beta2-adrenergic receptors of bronchial smooth muscles, causing relaxation, resulting in bronchodilation
    • Examples: albuterol, ephedrine, epinephrine, formoterol, levalbuterol, metaproternol, pirbuterol, salmeterol and terbutaline (used to stop premature labor-causes relaxation of uterine smooth muscle)
    • Reduction of intraocular pressure and dilation of pupils: treatment of open-anlge glaucoma
    • -alpha-adrengic receptors
    • -Examples: epinephrine and dipivefrin 
    • Temporary relief of conjunctival congestion (eyes)
    • -Alpha-adrengergic receptors
    • -Examples: epinephrine, naphazoline, phenylephrine, tetrahydrozoline
    • Treatment of nasal congestion
    • -Intranasal (topical) application causes constriction of dilated arterioles and reduction of nasal blood flow, thus decreasing congestion
    • -Alpha1-adrenergic receptors
    • -Ex: epinephrine, ephedrine, naphazoline, oxymetazoline, phenylephrine, and tetrahydrozoline
  28. Vasoactive Adrenergics (Pressors, inotropes)
    • Also called cardioselective sympathomimetics 
    • Used to support the heart during cardiac failure or shock; various alpha and beta receptors affected 
    • Examples: dobutamine, ephedrine, fenoldopam, methoxamine, dopamines, epinephrine, epinephrine, phenylephrine, norephinephrine
  29. alpha-adrenergic adverse effects
    • CNS: Headache, restlessness, excitement, insomnia, euphoria
    • Cardiovascular: palpitations (dysrhythmias), tachycardia, vasoconstriction, hypertension
    • Other: loss of appetite, dry mouth, nausea, vomiting, taste changes (rare)
  30. beta-adrenergic adverse effects
    • CNS: mild tremors, headache, nervousness, dizziness
    • Cardiovascular: increased heart rate, palpitations (dysrhythmias), fluctuations in BP
    • Other: sweating, nausea, vomiting, muscle cramps
  31. interactions: adrenergic drugs
    • Anesthetic drugs, tricyclic antidepressants, MAOIs, antihistamines
    • Thyroid preparations, antihypertensives
    • Will directly antagonize another adrenergic drug, resulting in reduced effects
  32. nursing implications: adrenergic drugs
    • assess for allergies and history of hypertension, cardiac dysrhythmias, or other cardiovascular disease
    • assess renal, hepatic, and cardiac function before treatment 
    • perform baseline assessment of vital signs, peripheral pulses, skin color, temperature, and capillary refill; include postural blood pressure and pulse
    • follow administration guidelines carefully
  33. nursing implications: adrenergic drugs IV administration
    • check IV site often for infiltration
    • use clear IV solutions
    • Use and infusion pump
    • Infuse drug slowly to avoid dangerous cardiovascular effects
    • monitor cardiac rhythm
  34. Nursing implications: with chronic lung disease
    • Instruct patients to avoid factors that exacerbate their condition 
    • encourage fluid intake (up to3000 mL/day) if permitted
    • educate patients about proper dosing, use of equipment (MDI, space, nebulizer) and equipment care
  35. nursing implications: adrenergic drugs
    • Salmeterol is indicated for prevention of bronchospasms, not management of acute symptoms
    • Overuse of nasal decongestants may cause rebound nasal congestion or ulcerations
    • avoid OTC or other medications because of possible interactions
    • Administering two adrenergic drugs together may precipitate severe cardiovascular effects such as tachycardia or hypertension
  36. Nursing implications: monitor therapeutic effects (cardiovascular uses)
    • Decreased edema
    • increased urinary output
    • return to normal vital signs
    • improved skin color and temperature
    • increased LOC
  37. Nursing implications: monitor therapeutic effects (asthma)
    • Return to normal respiratory rate
    • improved breath sounds, fewer crackles
    • increased air exchange
    • decreased cough
    • less dyspnea
    • improved blood gases
    • increased activity tolerance
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pharm quiz 3
pharm quiz 3-make up on April 1st
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