Mod 2 Flashcards
(100 cards)
1
Q
What dose sludge stand for (anticholinesterase agents)?
A
Salivation Lacrimation Urination Diaphoresis GI secretions increased Elimination/diarrhea
2
Q
What is an Agonist?
A
An agonist is a chemical that binds to a receptor and activates the receptor to produce a biological response.
3
Q
What is the major neurotransmitter?
A
Acetylcholine
4
Q
What are the two types of cholinergic receptors?
A
- Muscarinic which stimulate smooth muscle and slow the heart rate when stimulated will cause intense vomiting, diarrhea, nervousness, severe stomach pains, labored resp., slow and irreg pulse, delirum, even fatality
- Nicotinic which effect skeletal muscles when stimulated will cause tachycardia, elevate B/P, peripheral vasoconstriction, resembles the effects of nicotine
5
Q
edrophonium (Tensilon)
A
Used to diagnose Myasthenia Gravis, drug of choice because of short duration; parenteral IV or IM (makes acetylcholine available at the synapsis where the nerves can communicate) take 3-4 times a day.
6
Q
neostigmine (Prostigmin)
A
Diag and tx Myasthenia Gravis, prevent and tx post-op distention and urinary retention; po and injectable; antidote for neuromuscular blockers
7
Q
pyridostigmine bromide (Mestinon)
A
Tx Myasthenia Gravis, antidote for neuromuscular blockers (must be given on time)
8
Q
Adverse effects of ANTICHOLINESTERASE AGENTS?
A
- Eye: blurred vision, decreased accommodation (near to far vision), miosis
- Skin: diaphoresis
- GI: increased salivation, belching, nausea, vomiting, intestinal cramps, diarrhea, increased GI secretions
- Respiratory: bronchoconstriction, including shortness of breath, tightness in chest, wheezing, increased bronchial secretions (not for patients with COPD)
- Cardiovascular: vasodilation and hypotension, bradycardia
- CNS: irritability, anxiety, seizures
- Urinary: increased voiding
9
Q
bethanechol ( Urecholine)
A
Stimulates smooth muscle of GI tract and urinary bladder, tx urinary retention: po
10
Q
carbachol (Carbacel, Isopto Carbachol, Miostat)
A
Tx IOP ( glaucoma)
11
Q
pilocarpine ( Isopto Carpine, Pilocar)
A
Tx IOP
12
Q
What are cholinergic agonist used for?
A
- Reduce IOP in glaucoma (causes miosis, increasing outflow of aqueous humor)
- Treat atony of GI tract or bladder (urinary retention)
- Diagnose myasthenia gravis
- Antidote for
a.neuromuscular blocking agents
b. tricyclic antidepressants
c. Belladonna alkaloids
13
Q
How do cholinergic agonist work?
A
- Work by stimulation of cholingeric receptors by mimicking acetylcholine (cholinergic agonist)
- inhibition of enzyme acetylcholinesterase to prolong action of acetylcholine (anticholinerestase agents )
14
Q
When are anticholinerestase agents Contraindicated?
A
GI or urinary obstruction, peritonitis
15
Q
When should you use Precautions when giving an anticholinerestase agents like atropine?
A
In patients with ulcers, GI inflammation, pregnancy, coronary disease, hyperthyroidism, asthma, cardiac arrhythmias, epilepsy
G.Drug interactions
16
Q
What are the cholinergic fibers of the parasympathetic system?
A
Acetylcholine
17
Q
What are the adrenergic fibers of the sympathetic system?
A
Norepinephrine, epinephrine, dopamine
18
Q
What happens to the pupils when the parasympathetic system is stimulated?
A
Constriction (myosis)
19
Q
What happens to the salivary glands when the parasympathetic system is stimulated?
A
Stimulation of secretion and dilation
20
Q
What happens to the heart when the parasympathetic system is stimulated?
A
Decreases rate and strength of contractions
21
Q
What happens to the stomach and intestines when the parasympathetic system is stimulated?
A
Increased motility
22
Q
What happens to the bladder when the parasympathetic system is stimulated?
A
Contraction of muscular walls
23
Q
What happens to the bladder sphincter when the parasympathetic system is stimulated?
A
Relaxation causing stimulation of urination
24
Q
What happens to the Bronchioles when the parasympathetic system is stimulated?
A
constriction
25
What happens to the pupils when the sympathetic system is stimulated?
dilation
26
What happens to the Sweat glands when the sympathetic system is stimulated?
stimulates secretion
27
What happens to the Salivary glands when the sympathetic system is stimulated?
vasoconstriction & decreased secretion
28
What happens to the heart when the sympathetic system is stimulated?
increased rate & strength,dilation
29
What happens to the stomach and intestines when the sympathetic system is stimulated?
Decreased motility
30
What happens to the bladder when the sympathetic system is stimulated?
relaxation of muscular wall
31
What happens to the bladder sphincter when the sympathetic system is stimulated?
increased tone (remember 30 ml per hr meds are working)
32
What happens to the Bronchioles when the sympathetic system is stimulated?
dilate (to get more air)
33
What happens to the Blood Vessels, Skin and Visceral organs (except heart & lungs)when the sympathetic system is stimulated?
constriction
34
What happens to the Skeletal muscle when the sympathetic system is stimulated?
dilate
35
What happens to the Arrector pili of hair follicles when the sympathetic system is stimulated?
contraction – results in erection of hair
36
what cranial nerves are impacted by cholinergic agents?
III oculomotor - innervates the eye, pupillary and ciliary muscles
VII facial - lacrimal and salivary glands, mucous membranes of nose and mouth
IX glossopharyngeal - parotid gland
X vagus - organs affected: lung, heart, stomach, liver, small
37
what is the antidote for anticholinesterase agents?
atropine (Cholinergic blocking agent)
| EX. if a patient has taken to much Tensilon give them atrpoine
38
what do you want to keep on hand when administering cholinergic agonists?
- keep respiratory support equipment nearby
- have atropine available for use as an antagonist or antidote (0.6 mg in a syringe) Sx to be alert for: decreased B/P, shock, cardiac arrest
39
what is priority to monitor when administering cholinergic agonists?
monitor vital signs and auscultate lung sounds while administering the cholinergic agonist (because they can bronchoconstriction, including shortness of breath, tightness in chest, wheezing, increased bronchial secretions)
40
what are signs of a cholinergic crsis?
dysphagia, resp weakness, fasciculations (uncontrollable twitching of a single muscle group. ex in the heart is fibrillation) and myosis, pallor, sweating, vertigo, abd cramping, diarrhea, ex salivation
41
What is the expected onset and duration of ediphonium (tensilon)?
IV 30-60 sec
IM 2-10 min
Duration 10-30 min
42
After giving urecholine how long will it be until the patient voids?
1 hr ( then 30 ml per hour)
43
If giving an anticholinerestase agent for Myasthenia Gravis you should see what if it is effective?
speech will be clear not slurred, able to handle own oral secretions, breathing status adeq
44
What are points for client teaching to a patient taking cholinergic agonists?
- how to instill cholinergic agent into eye
- may affect visual acuity, impacts accommodation
- how to assess and record changes in muscle strength
- help client on anticholinesterase therapy to develop a system for recording each dose and its effect
- take drugs on time ( may be several times daily in MG to prevent muscle weakness)
45
How do Cholingeric Blocking Agents effect the parasympathetic system?
interrupt parasympathetic nerve impulses in the central and ANS. They compete with acetylcholine at muscarinic receptor sites
46
What are Cholingeric blocking agents used to treat?
- Spasticity of GI or urinary tract
- Cardiac arrhythmias, bradycardia ( blocks vagal effects of the SA node )
- Motion sickness
- Parkinsonism
- Chronic asthma
- Used as preanthesia medications to dry up secretions (Atropine)
- Relaxants for GI tract during diagnostic procedures (ERCP, EGD )
- Dilate eye during surgery (mydriatic)
47
atropine – prototype
po,IV,IM, used to treat bradycardia, minimizes vagal reflexes, blocks vagal effects on the heart, preanesthesia to decrease secretions
48
belladonna
decreases GI motility in IBS, treats bladder spasms after a TURP (B&O supp)
49
scopolamine (Transderm Scop)
used to prevent motion sickness, placed behind ear, 72 hour duration
50
- dicyclomine (Antispas, Bentyl)
| - propantheline (Pro-Banthine)
GI and GU spasmolytic
51
benztropine (Cogentin)
used to tx Parkinsonism ( must be careful this drug is often used for the older population, which do not sweat often and can increase the risk for heat stroke)
52
ipratropium bromide (Atrovent)
tx COPD by blocking action of acetylcholine at bronchial smooth muscle sites, promoting bronchodilation(acetylcholine causes bronchoconstriction)
53
ditropan (Detrol LA)
GU spasmolytic ( stops bladder spasms)
54
trihexyphenidyl (Artane)
antiparkinson drug
55
ipratropium bromide (Atrovent)
tx COPD by blocking action of acetylcholine (acetylcholine causes bronchoconstriction)
56
what are the Adverse effects of cholingeric blocking agents?
- Decreases in salivation, bronchial secretions, and sweating, increased risk of heatstroke; bronchial dilation
- Dilatation of pupils with reduction in accommodation
- Increased heart rate; atrial and ventricular arrhythmias
- Urinary retention
- Decreased intestinal and gastric motility, decreased GI secretions
- CNS toxicity manifested by restlessness followed by depression, irritability, disorientation, delirium
57
what are SX of toxicity of atropine?
hot as a hare- increased temp because they don't diaphoresis
dry as a bone- decreased secretions
mad as a hatter- delirium
blind as a bat - reduction of accommodation
58
when are cholinergic blocking agents Contraindicated?
glaucoma, coronary artery disease, renal or GI obstructive disease, reflux esophagitis, myasthenia gravis
* remember it blocks acetylcholine*
59
what does the 3D effect stand for?
- Drying
- Decreased motility of GI & GU tracts
- Dilated pupils
60
If a cholinergic blocking agents is prescribed for GI spasticity when should it be administered?
30 minutes before meals
61
why should you keep a clients keep client's room cool when taking cholinergic blocking agents?
because they don't diaphoresis, increasing body temp
62
when should a Transderm scopolamine patch be applied?
prior to motion sickness occurring, apply 4 hours prior to travel
63
what should you as a nurse monitor daily while the patient is taking cholinergic blocking agents?
- watch for signs of heatstroke and dehydration (flushing, altered LOC)
- measure fluid intake and output, particularly in clients with benign prostate enlargement. Monitor for urinary retention - frequency and voiding small amounts
- monitor for constipation, teach prevention
- good oral hygiene to decrease periodontal disease caused by decreased salivation, sugarless gum, hard sugarless candies or ice to reduce dry mouth, saliva substitute.
64
How do Adrenergic agents work?
cause responses similar to those produced by activation of sympathetic nervous system (SNS), a large part of the ANS
65
what are the two groups of Adrenergic agents?
cathecholamines
| noncathecholamines
66
what does endogenous mean?
produced by the body
67
what does exogenous mean?
synthetic
68
what do catecholamines and other direct-acting adrenergics do?
stimulate alpha-and beta-adrenergic receptors directly
69
what do norepinephrine and alpha-agonists do?
act mainly on alpha-receptors, causing vasoconstriction of arterioles in skin, kidneys, mesentery, and splanchnic area; raising blood pressure; dilating the pupils; and relaxing the gut
70
what do beta-agonists do?
cause vasodilation of arterioles supplying brain, heart, and skeletal muscle; induce cardiac stimulation, bronchial and uterine (smooth muscle) relaxation
71
what does Epinephrine do?
acts on both alpha-and beta-receptors, causing a combined response of vasoconstriction and vasodilation
72
Why are Adrenergic agents prescribed?
- To treat hypotension, shock (norepinephrine and alpha-agonists are vasoconstrictive)
- To treat bradycardia, heart block, insufficient cardiac output (beta1-agonists)
- To treat asthma, emphysema, bronchitis, and acute drug hypersensitivity (beta2-agonists)
- To treat allergic reactions, anaphylactic shock, acute hypotension, shock, and cardiac arrest (epinephrine)
- To treat nasal and ophthalmic congestion (catecholamines, because of their vasoconstrictive effects)
73
Why are Adrenergic agents prescribed?
- To treat hypotension, shock (norepinephrine and alpha-agonists are vasoconstrictive)
- To treat bradycardia, heart block occurring with Stokes-Adams syndrome and carotid sinus syndrome, insufficient cardiac output (beta1-agonists)
- To treat asthma, emphysema, bronchitis, and acute drug hypersensitivity (beta2-agonists)
- To treat allergic reactions, anaphylactic shock, acute hypotension, shock, and cardiac arrest (epinephrine)
- To treat nasal and ophthalmic congestion (catecholamines, because of their vasoconstrictive effects)
74
what are the Endogenous catecholamines?
- epinephrine (prototype sympathomimetic)
- norepinephrine
- Dopamine (Intropin)
75
what are the Exogenous (synthetic) catecholamines?
- isoproterenol (Isuprel)
| - dobutamine (Dobutrex)
76
what are the noncatecholamines?
albuterol, isoetharine, terbutaline
77
phenylephrine (Neo-Synephrine)
Dual acting agents for TX shock, IV; rhinitis & allergies in nasal spray, causes mydriasis, not used in glaucoma
78
what dose Beta1 activity do?
increases heart rate and strength of contraction
79
Beta1: dobutamine (Dobutrex)
IV only, used to increase cardiac output in CHF and cardiac bypass surgery
80
Beta1: norepinephrine (Levophed)
tx acute hypotension and shock, observe for extravasation
81
Beta1: epinephrine
IV, IM SQ hemostasis, cardiac arrest
82
Beta1: isoproterenol (Isuprel)
Long acting, less toxic than epinephrine; tx cardiac arrest
83
Beta1: dopamine (Intropin)
shock, improve cardiac output, improve renal blood flow
84
what is a renal dose of dopamine?
Small doses stimulate dopaminergic receptors, producing renal vasodilation.
85
What is a heart dose of dopamine?
Larger doses stimulate dopaminergic and beta1 adrenergic receptors producing cardiac stimulation and renal vasodilation.
86
What does Beta 2 activity do?
skeletal muscle, bronchioles of the lungs (bronchodilation), large arteries of the legs (vasodilation), smooth muscle of the uterus and GI tract (relaxation)
87
what does Beta 2 activity do?
skeletal muscle, bronchioles of the lungs (bronchodilation), large arteries of the legs (vasodilation), smooth muscle of the uterus and GI tract (relaxation)
88
Beta 2: epinephrine
bronchodilation, asthma attacks, anaphylactic reaction
89
Beta 2: terbutaline (Brethine, Bricanyl)
bronchodilation, stops pre-term labor
90
Beta 2: albuterol (Proventil, Ventolin)
bronchospasm, po or inhalation MDI or HHN
91
what are the adverse effects of Adrenergic agents?
- CNS: restlessness, anxiety, dizziness, headache, insomnia, vertigo
- Cardiovascular: palpitations, cardiac arrhythmias, tachycardia, hypertension, cerebrovascular accidents, angina, flushing
- Skeletal muscle: weakness, tremors
- GI: nausea, severe vomiting, diarrhea
- Skin: local necrosis and tissue sloughing from extravasated intravenous (IV) catecholamines (epi, norepinephrine (Levophed), dopamine)
92
when are Adrenergic agents contraindicated?
cardiovascular disease, pheochromocytoma, hypertension
93
what is the Drug interactions for Adrenergic agents?
Alpha-blockers (e.g., phentolamine {Regitine}): antagonism of alpha-agonists, resulting in hypotension
94
what if the antidote for Adrenergic agents ?
phentolamine {Regitine}
95
How should Dopamine be administered?
administer dopamine only by intravenous infusion, using a dedicated line, IV pump not gravity drip
96
why do you want to Measure glucose levels in client with diabetes when taking Adrenergic agents ?
because the liver is dumping glucose so the brain can function. the brain feeds off glucose.
97
What should the nurse be monitoring for with a patient that is on Adrenergic agents?
- Measure glucose levels
- Monitor electrocardiogram, blood pressure, cardiac rate, and cardiac rhythm during infusion
- Have O2 and emergency equipment available
- Monitor serum K+ level for hypokalemia if prolonged infusion of terbutaline(Brethine) for pre-term labor
- Place client in left lateral recumbent position to prevent hypotension during IV infusion of terbutaline
- Infuse IV into a large vein to avoid extravasation, monitor site every 10 – 15 min.
- Observe for pain at infusion site
- Monitor urinary output, notify MD if decreased
98
what are Symptoms of extravasation and what should you do if this happens?
- IV site coldness, hardness, pain
- If extravasation occurs, inject the area within 12 hours with 10-15 ml of normal saline solution containing Regitine 5-10 mg, as prescribed
99
what is routinely monitored with vasoconstrictors such as dopamine?
- Monitor vital signs continuously, want to see an increase in pulse and B/P. Keep SBP above 90, don’t want tachycardia.
- Monitor hourly urine output; output should increase since drug improves perfusion to vital organs.
- Monitor peripheral pulses at least every 2 – 4 hours; assess temp, color, tingling or numbness of fingers or toes.
- When titrating off vasoconstrictors, monitor for drop in B/P
100
what are key Points for client teaching on Adrenergic agents?
- Teach client how to measure pulse rate and when to report it
- Show client how to use inhalant device
- Advise client to use smallest number of inhalations to accomplish drug administration and to minimize dry mouth by rinsing mouth after inhalation
- Teach about rebound nasal congestion if vasoconstrictors (NeoSynephrine or epinephrine) are used too often or too long as nasal spray
- Teach use of Epi pen
