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Pharmacology I > unit 3- concepts > Flashcards

unit 3- concepts Flashcards

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1
Q

adrenergic neurons

A
  • nerve fibers that carry SNS information

* nts are adrenalin/NE

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2
Q

cholinergic neurons

A
  • nerve fibers that carry PSNS information

* nt is ACh

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3
Q

stimulation of PSNS nerves causes…

A
  • slowing of HR
  • vasodilation (dec. BP)
  • inc. gastric secretion
  • bladder emptying
  • bowel emptying
  • pupil constriction (focus)
  • bronchial mscl. ctx
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4
Q

cholinergic receptors

A 
•mediate responses to ACh
•Nicotinic N
•Nicotinic M
•Muscarinic
*PSNS
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5
Q

cholinergic drugs

A
  • influence activity of cholinergic receptors

* mimic or block ACh

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6
Q

cholinesterase inhibitors

A
  • indirectly prevent breakdown of ACh

* act like cholingergics

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7
Q

cholinergic receptor toxins

A
  • nicotine
  • insecticides
  • chemical warfare
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8
Q

Nicotinic M receptors

A

•ctx of skeletal muscles

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9
Q

Muscarinic receptors activation causes…

A
  • increased glandular secretions
  • ctx of smooth muscle
  • slowing HR
  • miosis (near vision)
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10
Q

SNS fxns

A

•regulation of CV system
•regulation of body temp.
•fight or flight
*adrenergic

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11
Q

SNS receptors

A
  • alpha 1
  • alpha 2
  • beta 1
  • beta 2
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12
Q

alpha 1 receptor fxn

A
  • mydriasis
  • vasoconstriction
  • bladder ctx
  • ejaculation
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13
Q

beta 1 receptor fxn

A 
•inc. HR
•inc. FOC
•inc. impuls thru AV node
•kidney release of renin
*heart
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14
Q

beta 2 receptor fxn

A
  • bronchial dilation
  • rlx uterine smooth muscle
  • vasodilation
  • glycogenolysis
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15
Q

drugs that stimulate ANS activity

A 
•sympathomimetic
•adrenergics
•alpha-adrenergic agonists
•cholinergics
•beta adrenergic agonists
*mimic nt
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16
Q

drugs that block SNS activity

A
  • sympatholytics
  • anti-adrenergics
  • beta-adrenergic blockers
  • alpha-adrenergic blockers
  • anti-cholinergics
  • cholinergic blockers
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17
Q

muscarinic poisoning

A
  • excessive activation of muscarinic receptors

* tx w/ atropine

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18
Q

xerostomia

A

•dry mouth

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19
Q

anhidrosis

A

•no sweat

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20
Q

anti-cholinergics often used for…

A

*tx for overactive bladder
•oxybutynin (ditropan)
•solifenacin (vesicare)
•tolterodine (Detrol)

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21
Q

pts at high risk w/ cholinergic drugs

A
  • peptic ulcer disease (PUD)
  • Urinary Tract Obstruction
  • Intestinal Obstruction
  • Coronary insufficiency
  • hypotension
  • asthma
  • hyperthyroidism
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22
Q

neuromuscular blocking agents

A

•block nicotinic M (cholinergic) receptors on skeletal muscle
•cause muscle relaxation
•can be non depolarizing or depolarizing
*DONT treat pain (must sedate first)

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23
Q

tubocurarine and hyperkalemia

A

•reduced paralysis

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24
Q

tubocurarine and hypokalemia

A

•enhanced paralysis

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25
2 ultimate things ANS drugs do
* mimic ANS hormones | * block ANS hormones
26
neostigmine toxicity
* cholinergic crisis * respiratory depression * tx w/ atropine
27
adrenergic agonists
* sympathomimetics * activate adrenergic receptors * mimic/prevents uptake of NE and epi * catecholamines or non-catecholamines
28
catecholamines
* epi, NE, isoproterenol, dopamine, dobutamine * can't be used PO * brief duration (MAO) * can't cross BBB
29
non-catecholamines
* ephedrine, phenylephrine, terbutaline * can be given PO * slowly metabolized (no MAO) * may cross BBB
30
alpha-1 adrenergic drug therapeutics
``` •hemostasis (constriction vessels) •nasal decongestion (constrict mucous) •adjunct local anesthesia (slower abs.) •elevate BP (constriction) •mydriasis (dilation) •anaphylaxis ***artery effect ```
31
AE of alpha 1 activation
* hypertension * necrosis * bradycardia (r/t elevated BP)
32
beta-1 adrenergic drug therapeutics
``` •cardiac arrest (not preffered) •HF (pos. ionotropic) •shock (inc. HR) •AV block (inc. conduction) •raise BP •anaphylaxis ***heart ```
33
AE of beta-1 activation
* altered HR/rhythm | * angina
34
beta-2 adrenergic drug therapeutics
•asthma •delay of pre-term labor •anaphylaxis ***lungs
35
AE of beta-2 activation
* hyperglycemia | * tremor
36
terbutaline
* beta2 agonist * treats bronchospasm * treats pre-term labor
37
phenylephrine
* alpha 1 agonist * nasal decongestant * raises BP * dilates pupils
38
adrenergic drug at risk patients
* hyperthyroidism * hypertension * dysrhythmias
39
alpha adrenergic blocker therapeutics
* essential HTN * reversal of alpha-1 agonist activity * tx of pheochromacytoma * tx of Raynaud's
40
AE of alpha adrenergic blockers
* ortho hypotension * reflex tachy * nasal congestion * inhibition of ejaculation * Na retention (-> inc. BP)
41
AE of beta1 blockade
* Bradycardia * Reduced cardiac output * Precipitation of heart failure * AV heart block * Rebound cardiac excitation
42
AE of beta2 blockade
* Bronchoconstriction | * Inhibition of glycogenolysis
43
monoamine oxidase
* NZ important in the breakdown of proteins * inactivates neurotransmitters * reason why epi and NE are ineffective if given PO
44
protamine sulfate
* heparin antidote (for OD) * immediate effects * 2 hr duration * IV slow injection
45
normal activated partial thromboplastin time (APTT)
* 30-40 sec * goal w/ heparin is 60-80 sec (1.5-2x normal) * BEST way to look at effectiveness of heparin therapy
46
significance of Warfarin being 99% protein bound?
* interacts with basically every other drug | * if on other meds, MD follows pt closely
47
anticoagulants and herbal medicine
•interact w/ the "Gs"
48
warfarin antidote
* vitamin K | * PO, IV, SubQ
49
normal prothrombin time (PT)
•11-13 seconds •goal w/ Warfarin is 22-26 (2-3 x normal) *BEST way to follow effectiveness of Warfarin
50
normal international normalized ratio (INR)
•0.8-1.1 •goal w/ Warfarin is 2-3 *BEST way to follow effectiveness of Warfarin
51
foods to avoid during Warfarin tx
* swiss chard * collards * kale * turnip greens * mustard greens * parsley * canola oil * mayonnaise * soybean oil
52
HIT
* heparin induced thrombocytopenia | * puts take argatroban for anticoagulation
53
prodrug
•activated upon metabolism
54
what does lysis mean?
•dissolution or destruction
55
what does lytic mean?
* produces/causes lysis * clot buster * thromboLYTICS NOT anti-coagulants
56
what lab value should nurse monitor in order to evaluate the effectiveness of heparin sodium drip?
•aPTT
57
heparin sources
•lungs of cattle •intestines of pigs *important when considering allergies
58
important part of health hx
* herbal products, especially the "Gs" (and cranberry juice) | * AE when combined w/ anticoagulants
59
PT 38, PTT 39, INR 5.9; which action should RN implement
•admin vit. K
60
warfarin and PG
* category X * contraindicated in PG and lactating * teratogenic and bleeding risk
61
when on Warfarin avoid...
* uses of non-electric razors * firm toothbrush * injury
62
IV site starts to ooze blood around catheter, what does RN do?
* apply direct pressure over puncture site | * DONT stop the infusion
63
altepase antidote
* aminocaproic acid (Amicar) | * only given if death risk
64
SLUDGE BAM
``` *muscarinic agonist drug effects Salivation/sweating/secretions Lacrimation Urination Defecation Gastrointestinal Upset Emesis ``` Bradycardia Abdominal cramps Miosis
65
miosis
•constriction of pupil
66
opioid analgesics
* natural or synthetic drug that has actions similar to morphine * act on Mu or Kappa receptors * does NOT remove pain, just takes away sensation
67
Mu receptor activation
``` •analgesia •resp. depression •miosis •dec. peristalsis •euphoria •physical dependence *morphine activates ```
68
Kappa receptor activation
``` •analgesia •resp. depression •miosis •sedation *activated by agonist-antagonist ```
69
pure agonist opioids
* activates mu and kappa receptors * strong- morphine * moderate- Codeine
70
agonist-antagonist opioids
•mu antagonist •kappa agonist *less powerful than pure
71
pure antagonist opioids
* antagonize mu, kappa, and delta receptors | * Ex: Narcan
72
A patient with severe burns is admitted to the burn unit. She rates her pain as 10 on a scale from 1-10. She has a past history of morphine abuse. Can we treat her with opioids?
* yes, b/c her pain is so severe | * will gradually reduce off once she starts getting relief
73
s/sx opioid toxicity
* coma * resp. depression * pinpoint pupils (miosis)
74
The nurse is caring for a client with a patient-controlled analgesia pump (PCA) that has morphine sulfate as the medication. The client has been out of surgery for 1 ½ hours. He complains that his hands itch and he has a rash. What would you do first?
* discontinue PCA | * Benadryl
75
what are sedative hypnotic drugs used for
``` •sedation •insomnia •induce sleep •anxiolytic *DEPRESS CNS ```
76
short term tx of sleep disorders
* sedative hypnotics * suppress REM * lose effectiveness after 3 wks * r/o rebound insomnia
77
benzodiazepine antagonist
* flumazenil (Anexate, Romazicon) | * given IV
78
buspirone (BuSPar)
* non-benzo/non-barb sedative * anxiolytic * minimal CNS depressant
79
Zolpidem (Ambien)
* non-benzo/non-barb sedative | * short-term toxic insomnia
80
Zaleplon (Sonata)
* non-benzo/non-barb sedative | * used for difficulty falling asleep
81
general anesthetics produce
•unconsciousness •dec. pain response •loss of sensation *IV or inhalation
82
balanced anesthesia
* combo of muscle relaxants, analgesics, and short-acting barbiturates * goal is smooth & rapid analgesia/loc/muscle rlx
83
stage I anesthesia
* onset of administration until •unconsciousness * analgesia * muscle relaxation
84
stage II anesthesia
* LOC * delirium * loss of muscle activity
85
stage III anesthesia
* deep unconsciousness * resp. depression * suppressed reflexes
86
stage IV anesthesia
* all spontaneous resp. lost | * anesthetic OD
87
s/sx abstinence syndrome
* cramping * hypertension * N/V * analgesia reversal
88
minimal alveolar concentration (MAC)
* amount of anesthetic in alveoli needed to immobilize pt | * LOWER MAC= MORE POTENT
89
malignant hyperthermia
* acute, life-threatening complication of anesthetics | * s/sx: elevated temp; muscle rigidity
90
malignant hyperthermia tx
* stop procedure and remove from anesthesia * bag pt * give IV Dantrolene muscle relaxant given for malignant hyperthermia * may also have to give sodium bicarbonate * lavage organs with cold water (addresses high temp)
91
pre-anesthesia medications
* benzodiazepines * barbiturates * opioids * clonidine * anti-cholinergics * neuromuscular blockers
92
post-anesthesia drugs
* analgesics * anti-emetics * muscarinic agonists
93
voltile anesthetics
* HalothANE (Fluothane) * EnflurANE (Ethrane) * DesflurANE (Suprane) * SevoflurANE (Ultane) * IsoflurANE (Forane)
94
gaseous anesthetics
* nitrous oxide | * AE of N/V
95
spinal anesthesia
* regional injection into SUBARACHNOID space of spinal column * insensitivity to pain in lower part of body
96
epidural
•regional injection into EPIDURAL space of spinal cord •insensitivity to pain in lower part of body *monitor BP throughout infusion
97
why is epinephrine give w/ local anesthetic?
•causes vasoconstriction, preventing the anesthetic from spreading *contra if local in extremities b/c can lead to gangrene
98
s/sx CNS excitation
•seizure -> resp. depression -> LOC
99
why do AEDs decrease effects of BC, warfarin, steroids
•b/c causes induction of hepatic NZs
100
AEDs that don't induce hepatic NZ
•Gabapentin •Ethosuximide *safe/effective w/ other AEDs
101
cholinergic crisis
* results from insecticide toxicity * s/sx: salivary/bronchial secretions, urinary/stool incontinence, diaphoresis, laryngospasm, bronchoconstriction, miosis, paralysis, death
102
what does edema surrounding epinephrine IV site indicate?
* infiltration | * admin phentolamine (Regitine) to prevent tissue necrosis d/t vasoconstrictor extravasation
103
amide anesthetics
* lidocaine (Xylocaine) * prilocaine (Citanest) * meprivacaine (Polocaine)
104
ester anesthetics
•procaine (Novocaine) •tetracaine (Pontocaine) •cocaine hydrochloride (Procaine) *greater r/o allergic rxn than amide
105
what opioid can result in buildup of toxic metabolite with repetitive dosing and shouldn't be used for more than 48 hrs
* Meperidine (Demerol) * active metabolite has long t1/2 * causes dysphoria (nervous, anxious)
106
why agonist-antagonist over pure opioid agonist (why give kappa receptor activator, rather than Mu)?
•Kappa not as risky (not as strong of effect)
107
how is opioids used therapeutically
* antitussive- cough syrup w/ codeine- provides cough suppression * diarrhea tx w/ small doses * enhances analgesia and reduces the required dosage of the general anesthetic
108
s/sx ICP
``` •HA •LOC changes -less alert -disoriented *issue w/ opioids b/c have to determine if ICP or opioid toxicity ```
109
Abstinence syndrome
•occurs w/ rapid withdrawal from physically dependent drug, such as opioids •early- Rhinorrhea, Yawning, Sweating •late- Anorexia, Goose Bumps, Tremors, Sneezing, Cramps, N/V, Muscle Spasm And Pain *why you can't quit morphine cold turkey
110
anti-cholinergic AEs
can't pee can't see can't spit (dry mouth) can't poop
111
repeated doses of Demerol puts pt a risk for...
* seizures * confusion * agitation

Pharmacology I (9 decks)

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