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Neuro part 2 classes Flashcards

1
Q

Alpha & Beta adrenergic agonists MEDS and prototype

A
  • Epinephrine (adrenalin): shock, glaucoma, prolongs effects of regional anesthetic
  • Norepinephrine (Levophed) : tx shock or during cardiac arrest to get sympathetic activity
  • Dopamine: shock
  • Dobutamine: congestive heart failure
  • Ephedrine: seasonal rhinitis, hypotensive episodes

PROTOTYPE: DOPAMINE
Ectopic beats

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2
Q

MOA of Alpha & Beta adrenergic agonists

A

Effects mediated by receptors in target organs
HR increases
Bronchi dilate, RR increases
Blood vessels constrict, BP increases
IOP decreases, pupils dilate
Glycogenolysis occurs
Sweating occurs

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3
Q

Indications and CI of alpha and beta agonists

A

Indications:
Hypotension, hypotensive shock
Bronchospasm, asthma

Ci:
Pheochromocytoma
Tachyarrhythmia, v fib
Hypovolemia
Peripheral vascular disease

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4
Q

AE and DDI alpha and beta agonists

A

AE:
Cardiac – htn arrhythmia, palpitation, angina
Resp – dyspnea
GI – n/v/c
CNS – h/a, sweating, tension, piloerection
Labs - hypokalemia

DDI:
TCAs, MAOIs
HTN causing meds, OTCs, herbals

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5
Q

Alpha selective adrenergic agonists MEDS and prototype

A
  • Clonidine (catapres): essential htsn, chronic pain, opiate w/d
  • Dexmedetomidine (precedex): sedation of intubated/ ventilated clients
  • Guanfacine (intuniv): ADHD
  • Midodrine (orvaten): otho hypotension
  • Phenylephrine: cold/allx, preoperative, hypotsn, CVT, glaucoma, OM, vasodilatory shock

PROTOTYPE: Phenylephrine

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6
Q

MOA and CI to Alpha selective adrenergic agonists

A

MOA:
Stimulate alpha receptors

CI:
Severe HTN
Narrow angle glaucoma
Hypotension, bradycardia
CV disease, vasomotor spasm
Thyrotoxicosis, DM
Renal / Hepatic impairment

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7
Q

AE and DDI to alpha selective agonists

A

AE:
Cardiac – arrhythmia, BP changes, PV problems
GI – n/v, anorexia
GU – decreased UOP, sexual dysfunction
CNS – anxiety, restlessness, fatigue, depression, blurred vision, sensitivity to light

DDI:
TCAs, MAOIs
CNS depressants
Antihypertensives
Digoxin

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8
Q

Nursing implications to alpha selective agonists

A

taper for d/c (2-4 days), monitor GI, UOP

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9
Q

Beta selective adrenergic agonists
MEDS and prototype

A

Albuterol: bronchospasm
Levalbuterol (Xopenex): asthma, bronchospasm
Isoproterenol: Treatment of shock, cardiac standstill, prevention of bronchospasm during anesthesia. Reserved for emergencies due to adverse effects. Short duration = not generally used for tx. Of asthma
Metaproterenol: asthma, bronchospasm
Salmeterol (serevent diskus): asthma, bronchospasm, COPD
Terbutaline: asthma, bronchospasm

PROTOTYPE: Isoproterenol
Monitor pulmonary, thyroid, cv, cns

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10
Q

MOA and indications of beta selective agonists

A

MOA:
Stimulate beta receptors
Increase heart rate, conductivity, and contractility, bronchodilation, blood flow to skeletal muscles, and relaxation of uterus

Indications:
Bronchospasm

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11
Q

CI to beta selective agonists

A
  • Pulm HTN, tachyarrhythmia, angina, DM, thyroid dz, vasomotor dz, CVA
  • Eclampsia/uterine hemorrhage/IU death
  • Pregnancy
  • Renal / Hepatic impairment
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12
Q

AE to beta selective agonists

A

Cardiac – tachycardia, angina, MI, palpitations
Resp – SOB, cough, bronchospasm, pulm edema
GI – n/v, anorexia
Labs - hypokalemia
CNS – anxiety, restlessness, fatigue, fear, tremor, h/a, sweating, pupil dilation

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13
Q

DDI to beta selective agonists

A

Sympathomimetics
Beta-adrenergic blockers

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14
Q

Nonselective adrenergic blockers
MEDS and prototype

A
  • Amiodarone (cordarone): ventricular arrhythmia, afib
  • Carvedilol (coreg): Hypertension, congestive heart failure (adult), Left ventricular dysfunction after MI
  • Labetalol (normodyne, trandate): Hypertension, HTN assoc. with pheochromocytoma, clonidine withdrawal

PROTOTYPE: Labetalol
Gastric pain

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15
Q

MOA and indications of Nonselective adrenergic blockers

A

MOA:
- Competitively block the effects of norepinephrine at the alpha and beta receptors throughout the SNS
- Prevents norepinephrine from activating the receptor lower blood pressure, slower pulse, and increased renal perfusion

Indications:
Htsn, arrhythmia

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16
Q

CI to Nonselective adrenergic blockers

A

Bradycardia/heart block/HF
DM
Bronchospasm/asthma
Pregnancy / Lactation

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17
Q

AE to Nonselective blockers

A

CNS – dizziness, paresthesia, insomnia, depression, fatigue, vertigo
GI – n/v/d, anorexia
Card – arrhythmia, hypotension, HF, pulmonary edema, CVA
Resp – bronchospasm, cough, rhinitis
Lab – hypoglycemia, hepatic injury

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18
Q

DDI to nonselective blockers

A

Antidiabetic agents
CCBs
QT prolonging antiarrhythmics

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19
Q

Nonselective alpha adrenergic blocker
MED

A

Phentolamine (Reitine, Oraverse) :
- Prevention of cell death/tissue sloughing after extravasation of NE, dopamine
- Prevention of severe HTN during pheochromocytoma surgery
- Reversal of anesthesia

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20
Q

MOA of Phentolamine

A
  • Blocks postsynaptic alpha1 adrenergic receptors (Decreased sympathetic tone in vasculature :Vasodilation)
  • Blocks presynaptic alpha2 receptors (Prevents feedback NE release : Increase in reflex tachy d/t hypotension_
  • Local vasodilation and return of blood to site of injection
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21
Q

Indications, CI, AE of Phentolamine

A

Indications:
Htsn, prevention of cell death

CI:
CAD/MI
Preg/lact

AE:
Extension of therapeutic effects
CV – hypotension, angina, MI, flushing, tachycardia, arrhythmia, CVA
CNS – h/a, weakness, dizziness
GI - n/v/d

22
Q

DDI to nonselective alpha blockers

A

Ephedrine/epinephrine
EtOH

23
Q

Alpha 1- selective antagonists

A

Doxazosin: BPH, htsn
Prazosin : htsn
Terazosin: BPH, htsn
Tamsulosin/Alfuzosin: BPH
Silodosin: BPH

PROTOTYPE: Doxazosin
Sexual dysfunction

24
Q

MOA alpha 1 antagonists

A

Block the postsynaptic alpha 1- receptor sites
decrease in vascular tone and vasodilation = decrease BP
Block the smooth muscle receptors in the prostate and urinary bladder
relaxation of bladder and prostate, improved flow of urine

25
Indications, CI, AE of alpha 1 antagonists
Indications: BPH and htsn CI: CHF / renal failure Pregnancy / lactation AE: CNS – h/a, dizziness, weakness, fatigue, depression GI – n/v/d, abdominal pain GU – retrograde ejaculation, priapism CV - arrhythmias, hypotension, edema, CHF, and angina URT – rhinitis, nasal congestion
26
DDI to alpha 2 antagonists
Vasodilators or antihypertensive drugs PDE-4 inhibitors
27
Nonselective beta antagonists MEDS and prototype
Propranolol: HTN, angina, reinfarct after MI, migraine, stress reaction, tremors Nadolol: htsn, angina Nebivolol: htsn Sotalol: ventricular arrhythmia, Afib/flutter Timolol: HTN, reinfarct after MI, migraine, open-angle glaucoma Levobunolol: open angle glaucoma PROTOTYPE: Propranolol
28
MOA Nonselective beta antagonists
- Competitive blocking of the beta-receptors in the SNS - Decrease heart rate Decrease myocardial contractility & rate of conduction, decrease cardiac workload - Block of beta receptors in the heart and in the juxtaglomerular apparatus of the nephron
29
CI to nonselective beta antagonists
- Bradycardia/heart block, HF - Bronchospasm/asthma - Pregnancy / lactation - DM
30
AE to nonselective beta antagonists
CNS – h/a, fatigue, dizziness, depression, sleep disturbances, memory loss, disorientation CV - bradycardia, heart block, orthostatic hypotension, HF, hypotension, peripheral vascular insufficiency Pulm - bronchospasm, pulmonary edema, dyspnea, coughing GI – n/v/d, stomach upset GU - decrease libido, impotence Decreased exercise tolerance
31
DDI to nonselective antagonists
CCB, NSAIDs, ergot alkaloids, antidiabetic agents
32
Beta 1 selective antagonists MEDS and prototype
Metoprolol: htsn, reinfarct after MI, HF Atenolol: MI, angina, htsn Bisoprolol: htsn Esmolol HCL: SVT, afib/flutter PROTOTYPE: Atenolol
33
MOA and indications of beta 1 selective antagonists
MOA: Selectively block beta 1 receptors in the SNS Indications: Hypertension, angina, some cardiac arrhythmias
34
CI to beta 1 selective antagonists
DM, thyroid dz, COPD Bradycardia, heart block, cardiogenic shock, HF, hypotension Pregnancy / lactation
35
AE to beta 1 selective antagonists
CNS – h/a, fatigue, dizziness, paresthesia, depression, sleep disturbances, memory loss, disorientation CV - bradycardia, heart block, HF, hypotension, peripheral vascular insufficiency Pulm - bronchospasm, rhinitis, dyspnea, coughing GI – n/v/d, stomach upset GU - decrease libido, impotence Decreased exercise tolerance
36
DDI to beta 1 selective antagonists
NSAIDs/rifampin/barbiturates CCB, H2, thyroid suppressing
37
Direct-Acting Cholinergic Agonists (Muscarinic) MEDS and prototype
Bethanechol: Treat postop or postpartum urinary retention; neurogenic bladder atony. Diagnose and treat reflux esophagitis Carbachol: Induce miosis or pupil constriction. Relieve intraocular pressure of glaucoma. Perform certain surgical procedures Cevimeline/Pilocarpine: Used to treat symptoms of dry mouth in pt with Sjogren’s syndrome. Reduce IOP in angle-closure glaucoma. Induce miosis PROTOTYPE: Bethanechol
38
MOA to Direct-Acting Cholinergic Agonist (Muscarinic)
- Act at cholinergic receptors in the peripheral nervous system to mimic the effects of ACh and parasympathetic stimulation - Increase contraction of the detrusor muscle of the bladder and relaxes the bladder sphincter - To induce miosis
39
CI Direct-Acting Cholinergic Agonists (Muscarinic)
Any condition that would be exacerbated by parasympathetic effects--bradycardia, hypotension, CAD Peptic ulcer disease, intestinal obst, recent GI surgery Asthma Bladder obstruction Epilepsy and parkinsonism
40
AE and DDI to Direct-Acting Cholinergic Agonists (muscarinic)
AE: CV – bradycardia, heart block, hypotension GI – n/v/d, increased salivation, involuntary defecation, swallowing issues GU – urgency CNS – flushing, sweating DDI: ACh inhibitors
41
Direct-Acting Cholinergic Agonists (Nicotinic) MEDS
Bupropion: smoking cessation Nicotine (habitrol, nicoderm, nicotrol): smoking cessation Varenicline: smoking cessation
42
MOA, CI and indications of Direct-Acting Cholinergic Agonists (Nicotinic)
MOA: Act at nicotinic cholinergic receptors Inhibit reuptake of NE, dopamine Chantix stimulates nicotinic receptors and blocks nicotine from activating receptors Indications: smoking cessation CI: Bupropion - sz
43
AE and DDI Direct-Acting Cholinergic Agonists (Nicotinic)
AE: CV – tachycardia, HTN CNS – (bupropion/varenicline) – depression, mania, agitation, anxiety, paranoia, hallucinations, delusions, dizziness GI – n, dry mouth DDI: Bupropion – MAOI, SNRI, SSRI, BB
44
Indirect-Acting Cholinergic Agonists MOA and indications
- Blocks acetylcholinesterase at the synaptic cleft - allows the accumulation of ACh released from the nerve endings and leads to increased and prolonged stimulation of ACh. Indications: MG and Alzheimer’s
45
CI and AE of Indirect-Acting Cholinergic Agonists
CI: Bradycardia, intestinal/urinary tract obs Any condition exacerbated by cholinergic stimulation Asthma, CAD, PUD, arrhythmia, sz, parkinsonism AE: CV – bradycardia, heart block, hypotension GI – n/v/d, increased salivation, involuntary defecation GU – urgency CNS – flushing, sweating, miosis, blurred vision, h/a, dizziness
46
DDI to Indirect-Acting Cholinergic Agonists
DDI: NSAIDS
47
MEDS to tx MG and prototype
neostigmine: Has a strong influence at the neuromuscular junction (Antidote : pralidoxime available as an auto injection to military personnel at risk) pyridostigmine : Has a longer duration of action than neostigmine (can be given IV for patients who can’t swallow) edrophonium: Diagnostic agent for myasthenia gravis (short-acting) PROTOTYPE: pyridostigmine
48
MEDS to tx alzheimers and prototype
Galantamine: stops progression Rivastigmine Donepezil: once a day dosing PROTOTYPE: Donepezil Atropine antidote for Indirect-Acting Cholinergic Agonists
49
Anti- Cholinergic (atropine) MOA and indications
MOA: Used to block the effects of acetylcholine block effects of the PNS; also called parasympatholytic agents Indications: Decrease GI activity and secretions (treat ulcers) Bronchospasm/COPD OAB, incontinence, neurogenic bladder IBS, PUD, n/v
50
CI to anticholinergic
Glaucoma Stenosing PUD, paralytic ileus, GI obs, ulcerative colitis BPH, bladder obs MG Arrhythmia, tachycardia ischemia
51
AE and DDI to anti- cholinergics
AE: CNS – blurred vision, pupil dilation, photophobia, cycloplegia, increased IOP, weakness, dizziness, insomnia, psychosis, decreased sweating, heat prostration GI – dry mouth, b/c, heartburn CV – tachycardia, palpitations GU – hesitancy, retention DDI: Other drugs with anticholinergic properties

Pharmacology (13 decks)

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