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NURS 3303 > Neuropharmacolgy > Flashcards

Neuropharmacolgy Flashcards

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1
Q

Bethanechol (Urecholine) mechanism of action

A

binds to muscarinic cholinergic receptors to relax trigone and sphincter muscles

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2
Q

Bethanechol (Urecholine) adverse effects

A

hypotension, bradycardia, “see, pee, spit, shit”, N/V/D, increased respiratory secretions and bronchospasm

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3
Q

Bethanechol (Urecholine) nursing considerations

A

administer on an empty stomach to prevent N/V
assess for gastric obstruction if being used for GI motility issues
monitor for response
admin atropine if OD is suspected

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4
Q

Pilocarpine mechanism of action

A

binds to muscarinic cholinergic receptors to reduce intraocular pressure and excessive xerostomia

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5
Q

Pilocarpine adverse effects

A

miosis and blurred vision
sweating
hypotentsion and bradycardia
“see, pee, spit, shit”
syncope, HA, seizure, sweating
inc. respiratory secretions and bronchospasm

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6
Q

Pilocarpine nursing considerations

A

apply lacrimal pressure for 1-2 minutes post-administration
separate from other opthalamic medications

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7
Q

Pilocarpine patient education

A

dangers of driving at night and other hazardous occupations with poor illumination

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8
Q

Atropine (AtroPen) mechanism of action

A

block action of acetylcholine at muscarinic receptors to prevent effects of acetylcholine (primarily heart, exocrine glands, smooth muscles, and eyes)

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9
Q

Atropine (AtroPen) adverse effects

A

anticholinergic effects (can’t see, can’t pee, can’t spit, can’t sit)

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10
Q

Atropine (AtroPen) nursing considerations

A

treat OD with symptomatic and supportive therapy
if delirium, hallucinations, or coma occurs administer physostigmine

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11
Q

Oxybutynin (Ditropan XL) mechanism of action

A

block activation of M3 receptors on the detrusor muscle to cause muscle relaxation

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12
Q

Oxybutynin (Ditropan XL) adverse effects

A

anticholinergic effects (can’t see, pee, spit, shit)
older adults have higher risk of hallucinations, confusion, and sedation

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13
Q

Oxybutynin (Ditropan XL) nursing considerations

A

concurrent use with other anticholinergic medications can intensify effects,
monitor mental status closely in older adults

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14
Q

Mirabegron (Myrbetriq) mechanism of action

A

activates beta-3 receptor to cause detrusor muscle relaxation

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15
Q

Mirabegron (Myrbetriq) adverse effects

A

angioedema,
dose-related CV effects (HTN, tachycardia, and palpitations),
urinary retention

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16
Q

Pyridostigmine (Mestinon) mechanism of action

A

prevent breakdown of ACh by AChE via binding to increase amount of ACh available to activate receptors

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17
Q

Pyridostigmine (Mestinon) adverse effects

A

Excessive muscarinic stimulation: SLUDGE, Killer B’s
neuromuscular blockade

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18
Q

Pyridostigmine (Mestinon) nursing considerations

A

promote compliance,
assess ability to take PO meds prior to admin

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19
Q

Donepezil (Aricept) mechanism of action

A

prevents reversible breakdown to ACh by AChE to increase availability of ACh at cholinergic synapses

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20
Q

Donepezil (Aricept) adverse effects

A

GI effects - N/V/D and dyspepsia
CV effects - symptomatic bradycardia, prolonged QT waves, Torsades de pointes

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21
Q

Donepezil (Aricept) nursing considerations

A

place patient on fall precautions
monitor CV status and report symptomatic bradycardia and telemetry changes

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22
Q

Donepezil (Aricept) patient education

A

education on patient and family role in condition management
(this medication is used for AD treatment)

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23
Q

Rivastigmine (Exelon) mechanism of action

A

prevents irreversible breakdown of ACh by AChE to increase availability of ACh at cholinergic synapses

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24
Q

Rivastigmine (Exelon) adverse effects

A

GI effects- N/V/D and dyspepsia
CV effects- symptomatic bradycardia

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25
Rivastigmine (Exelon) nursing considerations
place pt on fall precautions monitor CV status closely and report symptomatic bradycardia change patch every 24 hours
26
Rivastigmine (Exelon) patient education
educate pt and family on role in condition management (this med is used for treatment of AD)
27
Memantine (Namenda) mechanism of action
modulates the effects of glutamate at NMDA receptors by blocking calcium entry
28
Memantine (Namenda) adverse effects
generally well tolerated; CNS effects- dizziness, HA, confusion; psychometric effects- agitation, delusions, and hallucinations
29
Memantine (Namenda) nursing considerations
don't crush or chew ER preparations monitor cognitive and functional outcomes
30
Vecuronium (Norcuron) mechanism of action
competitively binds to nitotinic M receptors on the motor end plate to block activation by ACh, causes muscle relaxation and persists as long as medication is sufficient to prevent receptor occupation by ACh
31
Vecuronium (Norcuron) adverse effects
respiratory arrest and hypotension
32
Vecuronium (Norcuron) nursing considerations
reversal agent is neostigmine; use with caution in pts with MG; doesn't cross BBB- doesn't effect LOC or perception of pain; monitor pts on MV and promote comfort
33
Succinylcholine (Anectine) mechanism of action
competitively binds to nicotinic M receptors on the motor end plate to block activation by ACh to produce state of constant depolarization; clinically proven to provide muscle relaxation during surgery, MV, ET intubation
34
Succinylcholine (Anectine) adverse effects
prolonged apnea malignant hyperthermia hyperkalemia post-op muscle pain
35
Succinylcholine (Anectine) nursing considerations
use with caution in pts with MG; unable to cross BBB- doesn't effect LOC or perception of pain; monitor pts on MV and promote comfort; ice packs, cold IV saline, and IV dantrolene for malignant hyperthermia
36
Lidocaine (Xylocaine) mechanism of action
stop axonal conduction by blocking sodium channels in the axonal membrane
37
Lidocaine (Xylocaine) adverse affects
CNS depression and excitation; CV suppression- bradycardia, heart block, decreased contractility, and cardiac arrest; allergic reactions
38
Lidocaine (Xylocaine) nursing considerations
injected form has higher risk of systemic effects monitor for vasoconstriction s/s if used with epinephrine monitor neurological and CV status with admin
39
Nitrous Oxide mechanism of action
enhance transmission at inhibitory synapses and depress transmission at excitatory synapses through binding with the NMDA receptor
40
Nitrous Oxide adverse effects
respiratory and cardiac depression; malignant hyperthermia; aspiration of gastric contents; hepatotoxicity; post-op N/V
41
Nitrous Oxide nursing considerations
often used supplementally with other anesthetic agents; monitor for adverse effects; assess and treat post-op pain and N/V
42
Midazolam (Versed) mechanism of action
enhance transmission at inhibitory synapses and depress transmission at excitatory synapses through activation of receptors for GABA
43
Midazolam (Versed) adverse effects
respiratory depression, hypotension, cardiac arrest,
44
Midazolam (Versed) nursing considerations
rapid onset and short durations = monitor sedation and mental status as it can change quickly; slow injection administration to help minimize adverse effects; monitor respiratory and CV status closely; flumazenil is antidote for OD
45
Propofol (Diprivan) mechanism of action
enhance transmission at inhibitory synapses and depresses transmission at excitatory synapses through activation of receptors for GABA
46
Propofol (Diprivan) adverse effects
respiratory depression and hypotension higher risk for bacterial infection propofol injection syndrome- metabolic acidosis, renal failure, cardiac failure, and rhabdomyolysis clinician abuse
47
Propofol (Diprivan) nursing considerations
rapid onset and ultrashort durations = monitor sedation and mental status closely; monitor respiratory and CV status closely; monitor for s/s of propofol injection syndrome; follow facility protocol on disposing of vials
48
Ketamine (Ketalar) mechanism of action
enhance transmission at inhibitory synapses and depress transmission at excitatory synapses through activation of receptors for GABA
49
Ketamine (Ketalar) adverse effects
respiratory depression and hypotension; psychological reactions- hallucinations, disturbing dreams, and delirium; potential for abuse
50
Ketamine (Ketalar) nursing considerations
reduce risk for psychological reactions by pre-medicating with diazepam or midazolam assess for prior psychiatric illness frequently used in changing of burn dressing
51
Epinephrine (Adrenalin/EpiPen) MOA
adrenergic agonist class medication with actions at b1, b2, a1, and a2 receptors to produce bronchodilation
52
Epinephrine (Adrenalin/EpiPen) adverse effects
CV- hypertension, dysrhythmia, angina pectoris; Necrosis; IV line extravasation; Hyperglycemia
53
Epinephrine (Adrenalin/EpiPen) nursing considerations
continually monitor V/S and IV sites; Increased insulin therapy needed for pts w/ existing diabetes; Caution in high-risk patients; numerous medication interactions
54
Norepinephrine (Levophed) MOA
adrenergic agonist class medication with actions at b1, a1, and a2 to cause vessel constriction
55
Norepinephrine (Levophed) adverse effects
altered heart rate and rhythm chest pain local necrosis
56
Norepinephrine (Levophed) nursing considerations
monitor CV status assess access sites and extremities for signs of ischemia
57
Dopamine MOA
adrenergic agonist class medication with dose dependent effects ranging from dopamine receptors, b1 and a1 receptors; effects ranging from renal vasodilation to cardiac stimulation
58
Dopamine adverse effects
CV- tachycardia, dysrhythmias, anginal pain; necrosis and localized vasoconstriction
59
Dopamine nursing considerations
monitor CV status; monitor I/Os to monitor renal function; stop infusion and administer phentolamine if extravasation occurs
60
Albuterol (Ventolin) MOA
adrenergic agonist class medication with actions selective at b2 receptors only BUT it can sometimes effect b1 to cause bronchodilation for obstructive pulmonary conditions
61
Albuterol (Ventolin) adverse effects
hyperglycemia in diabetic pts tremors (due to inc. muscle contraction)
62
Albuterol (Ventolin) nursing considerations
monitor for cardioselective activity from increased HR; monitor glucose in pts with DM
63
Albuterol (Ventolin) patient education
education on proper inhalation technique if used as a PRN SABA and assess home use
64
Prazosin (Minipress) MOA
adrenergic antagonist medication with actions selective for a1 receptors for treatment for high BP in essential HTN
65
Prazosin (Minipress) adverse effects
orthostatic hypotension, reflex tachycardia, nasal congestion, inhibition for ejaculation, sodium retention and increased blood volume
66
Prazosin (Minipress) nursing considerations
obtain BP and HR prior to admin, educate pts on changing positions after starting med, can be administered with or without food, monitor for higher risk of falls,
67
Tamsulosin (Flomax) MOA
adrenergic antagonist class medication with actions selective for a1 receptors in the bladder neck for treatment of BPH
68
Tamsulosin (Flomax) adverse efffects
headache and dizziness abnormal ejaculation
69
Tamsulosin (Flomax) nursing considerations
monitor BP evaluate urinary habits to monitor for response
70
b1 blockers
propranolol (Inderal) - 1st gen metoprolol (Lopressor) - 2nd gen carvedilol (Coreg) - 3rd gen
71
beta blockers MOA
adrenergic antagonist class medication 1st gen: nonselective 2nd gen: cardioselective 3rd gen: vasodilating actions
72
beta blocker adverse effects
b1: bradycardia, reduced CO, HF, AV heart block, reduced cardiac excitation; b2: bronchoconstriction, hypoglycemia; bradycardia and respiratory distress in neonates
73
beta blocker nursing considerations
monitor hear rhythm, BP, and HR prior to admin; monitor for respiratory distress in pts with obstructive respiratory conditions and myocardial suppression-related HF
74
beta blockers patient education
education on possible signs of hypoglycemia due to symptom masking
75
Clonidine (Catapres) MOA
activates a2 receptors in the CNS to reduce sympathetic outflow to blood vessels and heart
76
Clonidine (Catapres) adverse effects
drowsiness, xerostomia, rebound HTN, potential for abuse, potential for fetal harm
77
Clonidine (Catapres) nursing considerations
monitor BP and HR prior to admin assess for history of illicit drug and opioid abuse
78
Clonidine (Catapres) patient education
educate on using gum, hard candy, and hydration to limit xerostomia warn about rebound hypertension
79
Mirabegron (Myrbetriq) nursing considerations
alternative agent for pts that cannot tolerate anticholinergic agents, can be used with other anticholinergic agents for OAB, stop med if angioedema occurs monitor BP closely in pts with pre-existing HTN

NURS 3303 (10 decks)

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