Final Exam Flashcards
1
Q
Adrenergic Agonists (Sympathomimetics)
A
Stimulate Fight or Flight
2
Q
Albuterol
A
Bronchodilator
3
Q
Epinephrine
A
Emergent – Bronchodilation
4
Q
Pseudoephedrine HCL (Sudafed)
A
Decongestants
5
Q
Adrenergic Blockers (Antagonists) - Sympatholtyics
A
Block effects of adrenergic neurotransmitters - suppresses Fight or Flight
6
Q
Atenolol
A
Selective Beta1 Blocker
7
Q
Carvedilol
A
Blocks beta1 and beta2adrenergic receptor sites
8
Q
Labetalol
A
Management of hypertensionBlocks beta1
9
Q
Metoprolol tartrate
A
Blocks bet1 – does not usually affect beta2 adrenergic receptors
10
Q
Cholinergic Agonists (Parasympathomimetics) Effects of Drugs - (S&S seen in patients)
A
Stimulate bladder and GI tone, constrict pupils, and increase neuromuscular transmission – Decreased HR & BP, Increased salivary, GI, and Bronchial glandular secretions
11
Q
Bethanechol CL (Urecholine) What to monitor for Pts
A
Stimulates cholinergic receptors - used for urinary retention
i. Monitor Vitals.
ii. Monitor I&O
iii. Monitor electrolyte levels
12
Q
MetoclopramideHCl (Reglan)
A
nausea, headache, migraine, GERD
13
Q
Donepezil Hal (Aricept)
A
a. Acetylcholinesterase (AChE) inhibitors.
b. Moderate Alzheimer’s disease.
14
Q
Rivastigmine (Exelon)
A
a. Decreased dementia (temporary) associated with Alzheimer’s disease and Parkinson’s Disease.
b. Acetylcholinesterase inhibitors
15
Q
Use of Anticholinergics
A
- The major body tissues and organs affected at the heart, respiratory tract, GI tract, urinary bladder, eyes and exocrine glands
- Decrease GI motility, Salivation, Dilation of pupils and Increase in Pulse.
16
Q
Side Effects of Anticholinergics
A
- Tachycardia, urinary retention, constipation, dry mouth, and blurred vision
17
Q
Atropine
A
a. Increases HR, Decreased GI and Respiratory secretions, reversal of muscarinic effects
Used to reverse tachycardia.
18
Q
Benztropine mesylate (Cogentin) is contraindicated in..
A
Angle-Closure glaucoma
19
Q
Benztropine mesylate (Cogentin) is used for? What is its goal?
A
Reduction of rigidity and tremors.
20
Q
Benztropine mesylate (Cogentin) side effects.
A
Blurred vision, dry eyes, Constipation, dry mouth, urinary retention, hallucinations, sedation, weakness, mydriasis, arrhythmias, hypotension, palpitations, tachycardia
21
Q
Dicyclomine Hal (Bentyl)
A
Decreased GI motility
22
Q
Scopolamine
A
Antihistamine for motion sickness.
23
Q
Tolterodine tartrate (Detrol) contraindicated in..
A
Urinary retention = prevent incontinence
Uncontrolled angle-closure glaucoma.
24
Q
Ipratropium bromide (Atrovent)
A
Maintenance treatment of bronchospasm associated with COPD
25
Oxybutynin (Ditropan) is used for..
Increased bladder capacity, Delayed desire to void, Decreased urge incontinence, urinary urgency, and frequency and decreased number of urinary accidents associated with overactive bladder
26
Mehtylphenidate Hal (Ritalin)
```
ADHD = increased attention span,
Narcoleptic = increased motor activity, mental alertness, and diminished fatigue
```
27
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Amphetamine Sulfate (Adderall)
When should this medication be administered?
```
For ADHD:
Taken 30-45 minutes before meals, children twice daily (before breakfast and lunch) and should be given 6 hours or more before sleeping (insomnia).
28
Amphetamine Sulfate (Adderall)
Who should manage this medication?
Is this a controlled substance?How is it monitored or prescribed?
Parents, or patients older than 16
| Yes, it is a controlled substance. It is monitored by frequency of refills.
29
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Amphetamine Sulfate (Adderall)
What medications should you avoid while on this medication?
```
MAO inhibitors, Adrenergics and Thyroid preparations. Drugs that alkalinize urine. Beta Blockers, Tricyclic antidepressants.
30
Barbiturate: Long-Acting
| Phenobarbital (Luminal)
Seizures
31
Benzodiazepines
| Alprazolam (Xanax)
Relief of anxiety.
32
Benzodiazepines
| Temazepam (Restoril)
Relief of insomnia
33
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Nonbenzodiazepines
Zopidem Tartrate (Ambien)
```
Short-term treatment (less than 10 days) for insomnia
34
Nonbenzodiazepines
| Eszopiclone (Lunesta)
Insomnia
35
Importance of adherence to maintenance Anticonvulsant medications for seizures?
Seizure activity will resume, and could be worse.
36
Phenobarbital
Anticonvulsant and Sedation.
37
Barbiturates Antidote.
| What do you do in cases of overdose?
a. There are no known antagonists to counteract the effects of barbiturates or other sedative-hypnotic drugs.
- Activated Charcoal
a. Give activated Charcoal – It prevents the drug from doing further damage.
b. Monitor respiratory status, pulse and BP – S&S of angioedema.
c. Have resuscitation and artificial ventilation equipment readily available
38
Clonazepam (Klonopin)
Prevent Seizures
39
Dizepam (Valium)
Relief of anxiety, Sedation, Amnesia, Skeletal muscle relaxation, decreased seizure activity.
40
Lorazepam (Ativan)
Decreased Seizures, Sedation, Decreased Anxiety
41
Anticonvulsant Benzodiazepines: How do these medications work in the body?
They increase the action of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) to the GABA receptors.
42
Anticonvulsant Benzodiazepines:
| Why are these medications used for seizures?
They reduce neuron excitability - decreasing or preventing seizure activity.
43
Hydantoins
* First anticonvulsants used phenytoin.
| * Inhibits sodium influx, stabilizing cell membranes, reducing repetitive neuronal firing, and limiting seizures.
44
Fosphenytoin (Cerebyx)
Diminshed seizure activity
45
Phenytoin (Dilantin)
| What do you need to teach patients about this medication?
* Be cautious of folic acid and vitamin D – lower serum levels which increases risk of seizures.
* Lower intake of protein.
* Phenytoin decreases blood levels
* Suppresses sodium influx
* Severe Side effects include: Slurred speech, confusion, depression, thrombocytopenia, leukopenia, gingival hyperplasia (overgrowth of gum tissues or reddened gums that bleed). Hyperglycemia.
* Avoid Antacids, calcium, antipsychotic medications and herbs
46
Phenytoin (Dilantin)
What do you need to teach women about this medication?
Process of discontinuing medication..
Do NOT use this drug with pregnant because it can have a teratogenic effect on the fetus.
Wean off the medication.. Do NOT stop abruptly.
47
Carbamazepine (Tegretol)
Prevent seizures, relief of pain in trigeminal neuralgia, and deceased mania.
48
Adrenergic Agonists
| Sympathomimetics
Stimulate adrenergic receptors to Enhance fight or flight response
2. Given to manage shock and open airways.
3. Watch urine output when giving as a critical drip due to nephrotoxicity
4. May need to institute fall precautions.
5. Elevate heart rate, and blood pressure, and open airways.
49
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Adrenergic Blockers (Antagonist)
Sympatholytics
```
a. Lower Heart rate, and blood pressure
b. May need interventions to calm nervousenss
c. Given to resolve hypertension or tachycardia
d. Hold if systolic BP is below 100 or if pulse is below 60
e. Block Adrenergic receptors to Suppress fight or flight response
50
Cholinergic Agonists
| Parasympathomimetics
1. Stimulate acetylcholine receptors to Enhance rest digest response.
2. Given to reverse paralysis or anticholinergic
3. Give with MD present due to risk of bradycardia and wheezes
4. Have commode or urinal available due to bowel and bladder urgency
5. Increase bowel and bladder contractility and cause salivation
51
Anticholinergics
1. Cause constipation, urine retention, pupil dilation and dry mouth
2. Do not feed after giving this IM or IV. Keep lights dim.
3. Given to slow bowel and bladder and dry mouth
4. Contraindicated for people with glaucoma or urine retention problems
5. Block acetylcholine receptors to Suppress rest digest response.
52
Valproate (Depakote) is contraindicated for use in
Hepatic impairment = Liver disease
53
Acetazolamide (diamox)
Control seizures
54
Gabapentin (Neurontin)
Decrease incidence of seizures, postherpetic pain and leg restlessness.
55
Lamotrigine (Lamictal)
Decrease incidence of seizures, delayed time to recurrence of mood episodes in bipolar disorder
56
Levetiracetam (Keppra)
Decreased incidence and severity of seizures
57
Topiramate (Topamax)
Decreased incidence of seizures, and migraine headaches.
58
Pregabalin (Lyrica)
Decreased partial-onset seizures
59
Benztropine Messlatte (Cogentin)
Reduction of rigidity and tremors.
| Contraindicated in glaucoma.
60
Carbidopa and Levodopa
Relief of tremor and rigidity in Parkinson’s syndrome.
61
Pramipexole Dihydrochloride (Mirapex)
Decreased temor and rigidity in Parkinson’s disease, and leg restlessness.
62
Ropinirole HCL (Requip)
Decrease leg restlessness, tremor and rigidity in Parkinson’s disease
63
Donepezil (Aricept)
Temporarily lesson some dementia associated with Alzheimer’s disease
64
Acetylcholinesterase Inhibitors
| Cholinergic medication - What effects do these types of medications have on the body?
Inhibits acetylcholinesterase thus improving cholinergic function by making more acetylcholine available.
65
Rivastigmine (Exelon)
Acetylcholinesterase Inhibitors
- Forms of administration
- Patient teaching
- PO: mild to moderate dementia associated with Alzheimer’s disease
Transdermal: Treatment of mild, moderate or severe dementia associatd with Alzheimer’s disease and mild to moderate dementia associated with Parkinson’s disease.
- PO: administer in the morning and evening with food. Take at regular intervals!
Transdermal: apply patch to clean, dry, hairless area that will not be rubbed by tight clothing. Upper or lower back is recommended; upper arm or chest works also.
66
Memantine (Namenda)
Decrease symptoms of dementia/cognitive decline. Cognitive enhancement
67
Diazepam (Valium)
Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways.
68
Methocarbamol (Robaxin)
Skeletal muscle relaxation, probably as a result of CNS depression
69
Cyclobenzaprine (Flexeril)
Reduction in muscle spasm and hyperactivity without loss of function.
70
Cyclobenzaprine (flexeril)
| Patient Teaching
* Administer with meals to minimize gastric irritation, Swallow extended-release capsules whole; do not open, crush or chew
* Assess for serotonin syndrome and notify professional immediately.
* Good oral hygiene, frequent mouth rinses and sugarless gum or candy may help relieve dry mouth.
* Take as directed, do not take more than prescribed.
* Use caution while driving.
71
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Desmopressin Acetate (DDAVP)
What do you need to assess with a patient taking this medication and why?
```
Antidiuretic Medication
• Monitor Vital signs. Increased HR and decreased SBP can indicate fluid volume loss resulting from decreased ADH production. With less ADH secretion, more water is excreted, decreasing vascular fluid (hypovolemia)
• Record urinary output. Increased output can indicate fluid loss caused by a decrease in ADH.
72
Levothyroxine sodium (Synthroid)
Reduces hypothyroidism to restore normal hormonal balance.
73
Levothyroxine (Synthroid)
What labs do you observe?
When do you advise Pt to take medication?
• Monitor thyroid function studies prior and during therapy.
• Monitor Thyroid-stimulating hormone serum levels
• Monitor blood and urine glucose in diabetic patients
- Take on an empty stomach a half hour to an hour before eating.
74
Glucocorticoids/Corticosteriods
- Prednisone (Deltasone)
- Methylprednisone (Solu-Medrol)
- Prenisolone
- Dexamethasone (Decadron)
• CONTRAINDICATED in active untreated infections,
Used for inflammation and pain in Chronic Diseases.
• Cushingoid appearance (moon face, buffalo hump)
75
What do you need to watch for on those taking glucocorticoids?
Assess for signs of adrenal insufficiency. – hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness
Monitor serum electrolyte levels
76
Glucocorticoids/Corticosteriods
What do these types of medications do to your body?
What happens to wound healing?
What could happen if stopped abruptly?
They suppress inflammation and modify the normal immune response.
Wound healing decreases
Could lead to adrenal insufficiency
77
Insulin administration, **Tissue typs, what size needle, and technique
* Insulin syringes must be used for accurate dosing
* Roll (do not shake) cloudy insulin (NPH-intermediate) bottles to ensure that the insulin and its ingredients are well mixed.
* More insulin is needed with infections and high fever
* It is administered subQ, at a 45- to 90-degree angle. 90-degree angle is made by raising the skin and fatty tissue
* the insulin is injected into the pocket between the fat and the muscle
* THIN person with little fatty tissue, the 45- to 60-degree angle is used.
* REGULAR insulin is the only type that can be administered IV
* Rotate the inject sites and have a site rotation pattern to avoid lipodystrophy
78
Hyperglycemia (Diabetic Ketoacidosis)
extreme thirst, polyuria, fruity breath odor, kussmaul breathing (deep, rapid, labored, distressed, dyspneic) rapid, thready pulse, dry mucous membranes, poor skin turgor, blood sugar level 250mg/dL
79
Hypoglycemia
Nervousness, tachycardia, lightheadedness, trembling, lack of coordination, cold and clammy skin, complaints of headaches, slurred speech, memory lapse, confusion, seizures, blood sugar level <60mg/dL, combative and incoherent.
a. Give sugar orally or IV increases the use of insulin, and symptoms disappear immediately.
80
What do you do if someone is hypoglycemic?
Alert?
Unconscious?
A: give something with sugar in it: orange juice, peanut butter, apple juice, glucose.
U: oral glucose in the cheek or IV saline to lower insulin levels.
81
What happens to blood sugars when a diabetic patient is taking glucocorticoids and how would you compensate?
Glucocorticoids, thiazide diuretics, thyroid agents and estrogen increase the blood sugar, therefore the insulin dosage may need adjustment.
82
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Rapid-Acting Insulin
Insulin Lispro (HumaLog) &
Insulin Aspart (NovoLog)
```
Onset: 5-15 min need to be administered before a meal
Peak: 30-90min
Duration: 2-5hr
SubQ
Insulin dependent need Intermediate-acting insulin as well
83
Short-Acting Insulin
| Regular Insulin
Onset: 30 min to 1 hour before meals
Peak: 2.5-5hr
Duration: 6-8hr
SubQ and IV
84
Intermediate-Acting Insulin
NPH (Neutral Protamine Hagedorn)
Lente, Humulin N
Onset: 1-2 hr
Peak: 6-12hr
Duration: 18-24hr
SubQ
85
```
Long-Acting Insulin
Insulin Glargine (Lantus)
Insulin Detmir (Levemir)
```
Onset: 1hr
Peak: none, and 6-8hr
Duration: 24hr and 12-24hr
Pre-filled 3mL cartridge for the "OptiPen One" insulin pen device
86
Glipizide (Glucotrol)
Lowering of blood sugar in diabetic patients
87
Glyburide (Micronase)
Lowering of blood sugar in diabetic patients.
88
Glimepiride (Amaryl)
Lowering of blood sugar in diabetic patients
89
Metformin (Glucophage)
Maintenance of blood glucose
90
Metformin (Glucophage)
| What risks are there with this medication give with a sulfonylurea?
The risk of lactic acidosis and the potential need for discontinuation of metformin therapy if a severe infection, dehydration or severe or continuing diarrhea occurs or if medical tests or surgery is required.
