Exam 3 Notes Flashcards by Samantha Boyer

nursing care for anxiolytics & hypnotics

Assess for drug abuse prior to therapy
Fall safety precautions
Do not drive/operate machinery
Do not mix c alcohol
Withdraw drugs slowly

How well did you know this?

Not at all

Perfectly

depression caused by deficiency in…

norepinephrine, dopamine, or serotonin

How well did you know this?

Not at all

Perfectly

4 classes of antidepressants

Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitors (MAOIs)
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin norepinephrine inhibitors (SNRIs)

How well did you know this?

Not at all

Perfectly

dry mouth, blurred vision, photophobia, urinary hesitancy, tachycardia, constipation

anticholinergic effects

How well did you know this?

Not at all

Perfectly

foods containing tyramine

Dairy products
- Aged cheese
- Sour cream
- Yogurt
Meats
- Liver
- Pepperoni
- Salami
- Sausage
- Bologna
- Hotdogs
- Meat extracts
Fruits
- Banana
- Raisins
- Papaya
- Avocado
- Figs
Pickled foods
Red wine, beer
Chocolate, coffee
Fava beans
Yeast
Soy sauce

How well did you know this?

Not at all

Perfectly

why is there an increased risk for suicide as pt begins antidepressants

when meds are started on pts with major depression, pts then have the energy to carry through with suicidal intent

How well did you know this?

Not at all

Perfectly

Confusion; difficulty concentrating; fever; agitation; anxiety; hallucinatons; incoordination; hyperreflexia; diaphoresis; tremors; hyperactive bowels

serotonin syndrome

How well did you know this?

Not at all

Perfectly

serotonin syndrome begins…

2-72 hours after beginning drug

How well did you know this?

Not at all

Perfectly

interventions for serotonin syndrome

withhold drug

contact Dr

How well did you know this?

Not at all

Perfectly

typical recovery for serotonin syndrome

w/i 24 hours

How well did you know this?

Not at all

Perfectly

nursing care for antidepressants

Obtain med history - prevent interactions
Assess for suicidal tendency
May take 2-4 weeks to see improvement in symptoms
Monitor BP, anticholinergic effects, seizures
Do not stop abruptly

How well did you know this?

Not at all

Perfectly

3 classes of psychotherapeutics

antipsychotics

mood stabilizers

CNS stimulants

How well did you know this?

Not at all

Perfectly

block dopamine receptors - limit stimuli in brain

conventional/typical antipsychotics

How well did you know this?

Not at all

Perfectly

conventional antipsychs treat ____ sx

positive

How well did you know this?

Not at all

Perfectly

nursing care for conventional antipsychs

Ensure meds are taken - some pts refuse
Avoid skin contact c liquid meds
Dilute liquids c fruit juice
Protect meds from light
Admin oral drugs c food/milk
Record urine output
Avoid direct sunlight
High fiber foods, liquids
Hard candy & lozenges for dry mouth
Instruct abt length of time for drug to work
Don’t stop drug abruptly

How well did you know this?

Not at all

Perfectly

block dopamine & serotonin receptors

treat + and - sx

atypical antipsychs

How well did you know this?

Not at all

Perfectly

first line schizophrenia drugs

atypical antipsychs

How well did you know this?

Not at all

Perfectly

abnormal posture & movement as a side effect of drugs

extrapyramidal symptoms

How well did you know this?

Not at all

Perfectly

stooped posture; shuffling gait; rigidity; bradykinesia; tremors at rest; pill rolling motion

Parkinsonism (EPS)

How well did you know this?

Not at all

Perfectly

restlessness; trouble being still; pacing; constant motion

akathisia (EPS)

How well did you know this?

Not at all

Perfectly

facial grimacing; involuntary upward eye movement; muscle spasm of tongue, face, neck, back; laryngeal spasms

acute dystonia (EPS)

How well did you know this?

Not at all

Perfectly

protrusion & rolling of tongue; smacking sounds of lips; chewing motion; facial dyskinesia; involuntary movements of body

tardive dyskinesia (EPS)

How well did you know this?

Not at all

Perfectly

life threatening idiosyncratic reaction

neuroleptic malignant syndrome

How well did you know this?

Not at all

Perfectly

Muscle rigidity (“lead pipe”)

sudden high fever

altered mental status

autonomic dysfunction (BP changes; tachycardia; dysrythmias; temp change)

incontinence

seizures

organ failure

neuroleptic malignant syndrome

How well did you know this?

Not at all

Perfectly

NMS does not have ____ sx

mortality rate for NMS is (high/low)

high

3 drugs used to treat sx of NMS

Benzodiazepines levodopa bromocriptine

mechanism of antiseizure meds

stabilize nerve cell membranes by manipulating ion influx

antiseizure meds achieve control in \_\_\_% pts

* Low margin of safety * High potential for dependence * High incidence of adverse effects * Discontinue gradually

barbituates

nursing care for antiseizures (3)

* Promote compliance * Environmental protection from injury * Medic-alert bracelet/necklace

important to keep regular dental appts with ______ drugs

hydantoin

goal of pharmacotherapy for parkinson

increase ability to perform ADLs - do not cure

antiparkinsons reduce ________ dominance

acetylcholine

Painful, intense muscle contractions

spasms

injury to muscular system vs permanent injury to CNS

MS - muscle spasms CNS - muscle spasticity

example of muscle spasticity

cerebral palsy

define pain

sensory & emotional experience of actual or potential tissue damage

nonpharm tx for pain

* Warmth * Massage * Positioning * Acupuncture * Meditation * Relaxation techniques

selection of pain meds based on…

* Effectiveness * Duration of action * Duration of therapy * Drug interactions * Hypersensitivity of pt * Available routes

opioids work on… nonopioids work on…

CNS nocioceptors or COX

opioid receptors respond to… (naturally)

naturally occurring peptides - endorphins & other chemicals

produce euphoria

opioid agonists

miosis

pupil constriction

antitussive opioid

codeine

fentanyl \_\_\_\_\_x more powerful than morphine

50-100

hydrocodone + acetaminophen

Norco/Vicodin

oxycodone + acetaminophen

Percocet

oxycodone + aspirin

Percodan

for cancer and trauma pain…

schedule doses of pain meds harder to control once it is very intense

teach pt opioid safety precautions (5)

* Do not get out of bed alone * Use call light * Change position slowly * Do not use machinery * Do not mix c alcohol or CNS depressants

PCA

patient-controlled analgesia

safety mechanisms in the PCA

maximum dose lockout interval 4-hour limit

schedule II prescribing limitations in MO (7)

* Signed in **original ink** if written * **Verbal orders in emergency** by Dr only * If injectable, **may fax** to long term care or hospice * **No refills** * Prescription only valid for **6 months** * Quantity usually limited to **30 days** * NPs can prescribe **5 days of hydrocodone** only

anesthesia to mucous membranes

topical

direct injection into tissue/surgical site blocking specific nerves

infiltration anesthesia

injected into tissue proximal to surgical site

nerve block

injected into CSF of spine

spinal anesthesia

injected into epidural space of spinal cord

epidural anesthesia

neuromuscular blockers require…

advanced cardiac life support & mechanical ventilation CONSTANTLY

fight or flight - conditions of stress

sympathetic NS

rest and digest - nonstressful conditions

parasympathetic NS

effect of sympathetic NS on… HR BP liver skeletal muscles bronchi pupils

raises HR raises BP liver produces glucose blood to skeletal muscles bronchodilation pupil dilation

neurotransmitter involved with sympathetic NS

norepinephrine

effect of parasympathetic NS on… HR BP bronchi bladder GI tract pupils

decreased HR decreased BP bronchoconstriction bladder contracts GI motility pupils constrict

4 groups of autonomic NS drugs

1. Adrenergic agonists / Sympathomimetics 2. Adrenergic antagonists/blockers / Sympatholytics 3. Cholinergic agonists / Parasympathomimetics 4. Anticholinergics / cholinergic antagonists / Parasympatholytics

drug classes that promote sympathetic effects

adregenic agonists/sympathomimetics anticholinergics/cholinergic antagonists/parasympatholytics

drug classes that promote parasympathetic NS

adrenergic antagonists/blockers/sympatholytics cholinergic agonists/parasympathomimetics

stimulate SNS - mimic norephinephrine & epinephrine - act on adrenergic receptor sites

adrenergic agonists

indications for adrenergic agonists

* Nasal congestion * Hypotension * Cardiac arrest; heart failure; shock * Asthma * Premature labor contractions

block either alpha or beta receptors - inhibit norephineprine or epinephrine

adrenergic antagonists

stimulate PSNS - mimic acetylcholine

cholinergic agonists

indications for cholinergics

* anticholinergic toxicity * atonic bladder * dry mouth * glaucoma * myasthenia gravis * Alzheimer's

2 types of cholinergics

direct acting indirect acting

action of direct cholinergics

activate tissue response at receptors

action of indirect cholinergics

inhibit cholinesterase, permitting ACh to accumulate at receptor site

* Monitor liver enzymes, bilirubin, serum amylase * Auscultate bowel & breath sounds * Have IV atropine available as antidote

cholinergic agonists

inhibit ACh by occupying receptors

anticholinergics

indications for parasympatholytics (5)

* Bradycardia * Preop to reduce salivation * Overactive bladder * Asthma * IBS

* Oral care * Pt avoid hot environments & excess activity * Darkened room, sunglasses * Do not drive if vision blurred

anticholinergics

adrenergic receptors

alpha 1 alpha 2 beta 1 beta 2

alpha 1 function

vasoconstriction; pupil dilation

alpha 2 function

inhibits norepinephrine release

beta 1 function

acts on the heart increases HR; increases force of contraction; releases renin

beta 2 function

inhibits smooth muscle of lungs

cholinergic receptors

nicotinic muscarinic

nicotinic receptor function

stimulates smooth muscle; stimulates gland secretions

muscarinic receptor function

decreases HR; decreases force of contraction; stimulates smooth muscle; stimulates gland secretions

vagus and other cranial nerves are involved in the parasympathetic or sympathetic NS?

parasympathetic

only use oxymetazoline (Afrin) for ___ days, or else _______ will occur

3 rebound effects

sympathomimetic contraindication

hypertension

sympathomimetic drugs (2)

phenylephrine (Neo-Synephrine) oxymetazoline (Afrin)

sympatholytic drugs (3)

propranolol metoprolol (Lopressor, Toprol) prazosin (Minipress)

parasympathomimetic drugs (4)

bethanechol (Urecholine) pilocarpine (Pilocar) pyridostigmine (Mestinon) donepezil (Aricept)

parasympatholytic drug (1)

atropine (Atropair)