402 Exam #2

Question 1

Contraindications for bethanechol? (there are 7)

Answer 1

asthma, epilepsy, parkinsonism, hyperthyroidism, peptic ulcer disease, bradycardia, physical obstruction of urinary tract (i.e. BPH)

Question 2

When should bethanechol be used with caution?

Answer 2

If patient has suspected urinary obstruction or COPD

Question 3

What drugs interact with bethanechol?

Answer 3

• cholinesterase inhibitors because they increase cholinergic effects
• procainamide, quinidine, atropine, and epinephrine because they decrease cholinergic effects

Question 4

what is specific antidote to bethanechol overdose?

Answer 4

atropine sulfate

Question 5

what should be monitored when patient is taking parasympathomimetics?

Answer 5

• liver enzymes
• I&O
• blurred vision
• orthostatic hypotension

Question 6

What is a cholinergic crisis?

Answer 6

Too many secretions! Too much urine, salivation, lacrimation, diarrhea, sweating, and pupil constriction

Question 7

Drug used to stop a cholinergic crisis?

Answer 7

anti-cholinergics: ATROPINE
- stops rest and digest; turns on fight or flight

Question 8

What drug treats anti-cholinergic toxicity?

Answer 8

physostigmine

Question 9

How does donepezil work for Alzheimer’s?

Answer 9

Increases the amount of ACh in cholinergic synapses in the brain, which improves memory and cognitive function.

The AChE inhibitors do not, however, cure or slow the progress of Alzheimer’s disease

Question 10

What are nursing considerations for anticholinergics?

Answer 10

Monitor muscle strength/weakness
ptosis, diplopia, chewing monitoring
schedule around mealtimes

Question 11

Drugs that interact with atropine?

Answer 11

antihistamines. TCAs, quinidine, procainamide (increase effects)
aloe, saw palmetto, buckthorn

Question 12

What happens with overdose of atropine?

Answer 12

CNS stimulation OR depression. Convulsions, coma

Question 13

What are 2 treatments for atropine overdose?

Answer 13

barbiturate or diazepam to control convulsions; physostigmine to quickly reverse coma

Question 14

In the sympathetic nervous system, which neurotransmitter is released from postganglionic nerve terminals?

Answer 14

Norepinephrine

Question 15

Seizures are a symptom of an underlying disorder, not a disease itself, T or F?

Answer 15

True

Question 16

What 2 types of seizures include an aura?

Answer 16

Tonic-clonic and complex partial

Question 17

Seizure type with sensory hallucinations

Answer 17

Simple partial

Question 18

Seizure type most common in children, staring into space and does not respond to verbal commands (only lasts a few seconds)

Answer 18

Absence

Question 19

What neuron is most affected by AEDs?

Answer 19

GABA

Question 20

How do AEDs suppress seizures?

Answer 20

By increasing GABA activity, which decreases neuronal firing

Question 21

What 5 ways do AEDs work to suppress seizures (think of electrolytes and neurotransmitters)?

Answer 21

• An increase in the activity of GABA in the brain (increasing influx of chloride ions)
• Inhibition of the influx of sodium into neurons
• Inhibition of the influx of calcium into neurons
• Correcting neurotransmitter imbalance
• Blocking of glutamate receptors in the brain.

Question 22

_________ = inhibitory neurotransmitter; _________ = excitatory neurotransmitter

Answer 22

GABA; Glutamate

Question 23

What drugs potentiate (increase) GABA to reduce seizures?

Answer 23

phenobarbital (barbiturate), clonazepam, diazepam, lorazepam (benzos); gabapentin, topiramate

Question 24

Steven-Johnson syndrome (SJS) is an adverse effect of which AED drug class?

Answer 24

Barbiturates

Question 25

AED that is schedule IV drug, pregnancy category D, and should not be used for pain relief because it can increase pain?

Answer 25

Phenobarbital

Question 26

Myoclonic and absence seizures are indicated to be treated with what drug class?

Answer 26

Benzodiazepines