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Succinylcholine promotes the release of
potassium from tissues.
Significant hyperkalemia is most likely to develop in patients with major burns, multiple trauma, denervation of skeletal muscle, or upper neuron injury
All NM blocking agents can cause
cause respiratory arrest.
They do not cause decreased urinary output, hyperglycemia, or hypoglycemia.
Succinylcholine is an ultrashort-acting
acting NM blocker used to facilitate mechanical ventilation in patients whose spontaneous respirations fight the rhythm of the respirator.
It does not provide pain relief or loss of consciousness.
It is not indicated for the treatment of status epilepticus.
What is a rare and potentially fatal complication of succinylcholine and inhalation anesthesia
- Treatment includes discontinuation
- of succinylcholine and anesthesia; cooling blankets and ice packs; and intravenous (IV) dantrolene, a muscle relaxant
epinephrine will decrease
local blood flow and delay systemic absorption of the anesthetic. This will prolong the effects of the anesthesia at the site of action and reduce the risk of systemic toxicity.
epinephrine is a vasoconstrictor
Procaine is an
Ester anesthetics pose a greater risk of
allergic reactions than the amide-type anesthetics.
Hypotension is the most common complication with
epidural anesthesia. Monitoring blood pressure is an essential nursing intervention
Local anesthetics can cause
CNS excitation followed by depression when large enough amounts are absorbed in the system. This can lead to drowsiness, loss of consciousness, and death
Halothane is an
These drugs are taken in by the lungs, distributed to areas with high blood flow by the circulation, and eliminated by the lung
Hypotension is a potential adverse effect of most
inhaled anesthetics, including isoflurane. Hyperglycemia, kidney dysfunction, and tachypnea are not expected adverse effects with this drug
At therapeutic doses nitrous oxide
does not have serious adverse effects, such as longer central nervous system (CNS) depression or cardiac/respiratory depression.
The major problem with this drug is postoperative nausea and vomiting.
An opioid will enhance
analgesia and reduce the required dosage of the general anesthetic.
Opioids are not
They can cause respiratory depression and do not necessarily decrease the adverse effects of surgery.
Diprivan is an
an intravenous (IV) sedative-hypnotic used for sedation during mechanical ventilation.
It can cause profound respiratory depression and hypotension.
It does not improve excursion or oxygenation nor decrease secretions.
It does not have analgesic or muscle relaxant properties
Naloxone is a
narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics
Morphine can cause
urinary hesitancy and urinary retention
Liver toxicity is not a common adverse effect of morphine
Codeine provides both
analgesic and antitussive therapeutic effect
Narcotic analgesics reduce
- intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can help manage this
- adverse effect
Full analgesic effects can take up to
24 hours to develop with fentanyl patches.
Most patches are changed every 72 hours.
Fentanyl has the same adverse effects as
other opioids, including respiratory depression.
- Patients should avoid exposing the patch to external
- heat sources since this may increase the risk of toxicity
a partial agonist
a moderate to strong agonist, may cause respiratory depression but not as often and serious as morphine.
(ACE) inhibitors, such as captopril, can cause
ACE inhibitors can cause
hyperkalemia, renal insufficiency in some patients, and hypotension.
First-dose hypotension is a serious potential adverse effect of
(ACE) inhibitors, such as enalapril.
Monitoring blood pressure will be a priority nursing intervention.
Calcium channels are coupled to
beta1-adrenergic receptors in the heart.
For that reason, calcium channel blockers have effects on the heart that are similar to beta blockers
a calcium channel blocker from the dihydropyridine family.
As such, it blocks calcium channels in the blood vessels but less in the heart.
It is used to treat angina and hypertension but not cardiac dysrhythmias
Nifedipine, amlodipine, and isradipine are
dihydropyridine calcium channel blockers and cause less risk of constipation than diltiazem and verapamil
Diltiazem and verapamil have a risk for
Verapamil causes peripheral and cardiac
vasodilation, which leads to decreased blood pressure and improved coronary perfusion.
Vasodilators may cause
postural hypotension and reflex tachycardia.
Patients should be taught to move slowly when changing positions to avoid dizziness
Hydralazine is a
vasodilator causing arteriolar dilation, decreased resistance, and decreased blood pressure.
Monitoring blood pressure and heart rate would receive the highest priority for assessment
Hydralazine is a vasodilator that lowers blood pressure but can trigger
Beta blockers, such as propranolol, are added to the regimen to normalize the heart rate.
minoxidil is reserved for patients who have
failed to respond to safer drugs.
- The only cardiovascular indication for minoxidil is
- severe hypertension
a diuretic, is often combined with nitroprusside to decrease the risk of edema and fluid retention.
Furosemide does not decrease reflex tachycardia
Vasodilators can cause serious
Many antihypertensive medications can produce
adverse sexual effects, including impotence.
Hypertension is the most common complication of pregnancy, occurring in about 10% of pregnant women. When drug therapy is initiated during pregnancy
methyldopa is the traditional agent of choice because of its limited effects on the fetus.
- Women with pre-existing hypertension can typically continue taking antihypertensives they were
- previously prescribed except for
angiotensin-converting enzyme (ACE) inhibitors, such as captopril; angiotensin II receptor blockers (ARBs), such as valsartan; and direct renin inhibitors, such as aliskiren
Preferred antihypertensives for patients with diabetes include
- (ACE) inhibitors (enalapril),
- and calcium channel blockers
ACE inhibitors are particularly useful since they slow progression of diabetic nephropathy in addition to lowering blood pressure.
Thiazide diuretics promote hyperglycemia and are used with caution.
Medication therapy is not indicated until blood pressure (BP) is greater than
140 systolic or 90 diastolic.
Thiazide diuretics lower BP by
reducing blood volume and arterial resistance. They are considered initial first-line therapy for most patients.
Which of these medications should a nurse administer first to a patient who is exhibiting hypotension, laryngeal edema, and bronchospasm after eating peanuts?
Tiotropium is an anticholinergic medication used to relieve bronchospasm associated with COPD. The most common adverse effect is
dry mouth, and patients can suck on sugarless hard candy for symptomatic relief
use a daily stool softener, or wear protective clothing when taking
Rebound congestion develops in topical
Anticholinergic effects (dry mouth, constipation) are uncommon with
Antihistamines are the most effective when taken
Expectorant drugs are used to reduce the
viscosity of secretions, allowing them to be more easily expectorated
Oxymetazoline (Afrin) is an effective nasal decongestant, but overuse results in worsening, or
rebound, congestion. It should not be used more often than every 4 hours for several days
Intranasal glucocorticoids are the most effective when taken for the
prevention and treatment of allergic rhinitis.
Cromolyn is best suited for prophylaxis and should be given
before symptoms start since responses may take a week or two to develop
Pseudoephedrine (Sudafed) is a sympathomimetic that activates
alpha1 receptors and causes vasoconstriction
A nurse instructs a patient that which of these nonprescription medications will require patient identification and a signature for purchase?
Ephedrine is a sympathomimetic agent associated with abuse since it can be converted to methamphetamine
Cold remedies should not be used for children under the age of
2 years because of the risk of harm with little evidence of efficacy
analgesia, respiratory depression, euphoria, sedation
with constipation blood goes into the intradominal area, then with relaxation massive blood return involves a stroke and respiratory depression
Pure Opioid agonist
Pure opiod agonists
pure opioid agonist
blocks euphoria from heroin and morphine
What should you caution with a head injury
what is used for an MI
what is used for post operative pain
Benadryl is what generation
Benedryl (Diphenhydramine) relieves symptoms of
Blocks release of histamine
Why don't you want to give benedryl to an older adult who is confuesed
problem is older adults have a lack of acetylcholine and benedryl is an anticholinergic which blocks even more acetylcholine
What is the only antihistamine that is a nasal spray
2nd generation antihistamine is used to
- relieve symptoms associated with seasonal and perennial
- allergic rhinitis, conjunctivitis
- uncomplicated urticaria
2nd generation antihistamines physiologic action
selective, blocks the effects of histamine at the H1-receptor sitesf
has some anticholinergic and antipruritic effect
Intranasal glucocorticoids most effective drugs for the
Prevention and treatment of seasonal and perennial rhinitis
Decongestant drugs activate
alpha 1 adrenergic receptors on nasal blood vessels
Sudafed relives the
pressure of otitis media by promoting drainage
Because Sudafed activates alpha 1 what does that mean for the pt
raises BS and HR
not for the anxious pt
caution diabetes, glaucome (IOP), BPH (death grip of urethra)
Main side effect for decongestent Afrin nasal spray
discontinue drug use in one nostril at a time to decrease the rebound congestion
Antitussive drugs are
Dextromethorphan is a
antitussive drug and nonopioid
Do not treat pts cough resulting from emphysema and asthma
can act as a halucigenic
Tessalon Perles (Bensonatate); what kind of pts should you watch out for
Kids and elderly risk for choking
works by numbing the stretch receptors in the lungs that during breathing elicit a cough
Codeine is an
Hydrocodone is more
sedating than codeine
Codeine can make people
sick and a lot of people dont prefer it
Codeine should have a catious use for
head injuries because...
narcotics suppress the respriatory drive so you dont blow off co2 a retaining it will increase pressure
change position slowly
Guaifenesin gets rid of the
Mucomyst (Acetylcysteine) is used for
acetaminophin OD (Tylenol overdose)
Sympathomimetic (albuterol ventolin proventil) are
beta 2 adrenergic agonists
fight or flight drug and palpitations
Ipratropium Bromide (spiriva, atroven, combivent, duineb) will not
abort an asthma attack in progress
the most effective anti-inflammatory drugs available for the management for respiratory disorders
Peak effect in 1-2 weeks of regular use
________use first to open up airway then ____ to really get in lungs then _____
- Beta agonist
- Rinse mouth
Cromolyn Sodium teach pts to use
15-20 minutes prior to engaging in precipitant to bronchospasm
Decreases peripheral vascular resistance and lowers blood pressure; vasodilatation
Cardiac output is increased but there is no increase in the heart rate
Angiotensin II Receptor Antagonists (ARBs):
- Blocks action angiotensin II which results in
- vasodilatation, excretion of Na+ and water, retention K+
Direct Renin Inhibitor
- Binds tightly with renin inhibiting conversion of
- angiotensinogen into angiotensin I
nifedipine (Procardia, Adalat)
drops bp not used to stop arrythmias, peripheral edema
Act on arterioles
Calcium channel blocker
affect heart, constipation, pheripheral edema
Act on arterioles and heart
Calcium channel blocker
affect heart cause constipation and peripheral edema
Act on arterioles and heart
Calcium channel blocker
Side effect of Verapamil and Diltiazem:
Orthostatic hypotension, peripheral edema, constipation, bradycardia, heart failure, dysrhythmias, acute toxicity
Other drugs in the class: Minoxidel (Loniten), Diazoxide (Hyperstat)
Big therapeutic use for Hydralaxin and Minoxidel
Hydralaxin and Minoxidel Physiologic Symptoms
- Produces direct smooth muscle relaxation of the
- arterioles, which results in decreased BP and decreased Peripheral vascular resistance (arterial heart trying to pump blood out)
- Little to no effect on the veins
- frequently coadministered with a diuretic
Hydralaxin side effects
- reflex tachycardia, fluid retention (aldosterone), systemic lupus erythematosus (SLE)mimics lupus
- sometimes can cause joint and muscle pain butterfly rash
Minidoxel Side effects
- serious fluid retention, pericardial effusion, cardiac tamponade (fluid pressing on heart
- medical emergency), can worsen angina pectoris
Hypertrichosis (increased hair) (Rogaine)
sodium Nitroprusside (Nipride)
Directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins
Big side effect with Sodium Nitroprusside
cyanide poisoning if it is infusing rapidly (pts with liver disease and low store of thyosulfate),
Selective Peripherally Acting Alpha-1 Blockers
Therapeutic use is for BPH
prazosin (Minipress) Side effect
Significant first-dose effect of hypotension, especially orthostatic hypotension (really educate pt)
Take first dose at bedtime (because they are having hypotensive at least they are laying down)
Beta Adrenergic Blockers:
Propanolol (Inderal) (used to try to protect heart
Big side effect with propanolol
Blockade of Beta 2 (be careful in pts with asthma):
- hypoglycemia you don’t get fight or flight like sweating so you have no idea be very careful
- with pts in diabetes and asthmatics. You cannot get your hr up if you are an athlete, complaints with sexual functions
Peripherally Acting Antiadrenergics:
Reserpine: depression, sedation suicide is big with this drug watch out
Centrally Acting Alpha-2 Agonists:
Used in step 3 or step 4 antihypertensive therapy
Can be administered orally or transdermally problem with patch is they come off
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