216 Midterm Topics Summary PDF

216 Midterm Topics Summary Autonomic Nervous System Sympathetic system – fight or flight Neuro transmitter – epinephrine, adrenaline Receptors – alpha and beta Alpha 1 – blood vessel constriction Alpha 2 – control Beta 1 – heart ( increase heart beat)...

216 Midterm Topics Summary Autonomic Nervous System Sympathetic system – fight or flight Neuro transmitter – epinephrine, adrenaline Receptors – alpha and beta Alpha 1 – blood vessel constriction Alpha 2 – control Beta 1 – heart ( increase heart beat) Beta 2 – lungs ( bronchodilation)  Parasympathetic system – Rest and digest Neuro transmitter – acetylcholine Receptors – nicotinic and muscarinic Nicotinic – skeletal muscle contraction Muscarinic – secretions and smooth muscle contraction Sympatomimetic Drugs 1. Alpha agonist Alpha 1 adrenergic agonist – will contrict the blood vessels- BP Example: phenylephrine, epinephrine Alpha 2 adrenergic agonist – vasodilation = BP Example – Clonidine – centrally acting alpha 2 adrenoceptors 2. Beta adrenergic agonist Beta 1 adrenergic agonist – will cause increase in myocardial contractility ( increase heartbeat) Beta 2 adrenergic agonist – salbutamol, albuterol Side effects - palpitations  Sympatholytics – clockers, antagonist 1. Alpha adrenergic blockers 2. Beta adrenergic blockers Drug classes: non-selective: propanolol (Inderal)timolol pindolol (Visken) – avoid giving to patient with respiratory problem, will cause bronchoconstriction selective (β1): metoprolol (Neobloc, Betaloc, Cardiosel) atenolol (Tenormin, Cardioten, Durabeta) esmolol (Brevibloc) – least likely to precipitate bronchoconstriction Parasympatholytics – parasympathetic antagonist 1. Muscarinic Receptor Antagonists 2. Scopolamine – for motion sickness atropine->preop med; for organophosphate poisoning uses: preoperatively given to reduce salivation and gastric secretions  CENTRAL NERVOUS SYSTEM (CNS) MEDICATIONS A. CNS Stimulants STIMULANT – increase the release of and block the reuptake of excitatory neurotransmitters. Amphetamines – release epinephrine, increase wakefulness ( should not be taken before sleeping time to avoid insomnia. Uses: 1. Narcolepsy 2. Endogenous obesity 3. Attention Deficit hyperactivity Disorder (ADHD) – amphetamine will increase attention span, decrease hyperactivity and decrease impulsiveness.  Nursing Consideration - If diabetic, check whether insulin or hypoglygemic agents may be reduced Explains to the patient that consuming food or beverages containing caffeine together with amphetamine drug may exacerbate cardiac dysrhythmias.  2. Anorexiants Action: suppress the appetite by acting on the hypothalamus Side effects – loss of appetite - Nursing Diagnosis: Imbalanced nutrition less than body requirements. 3. ANALEPTICS Action: stimulates the CNS by acting on the cerebral cortex and the medulla to stimulate respiration Respiratory stimulationà primary use Caffeinism usually occurs when consumption of caffeine reaches 1–1.5 grams per day.  CNS Depressants Sedative-hypnotics Anesthetics Anticonvulsants Anxiolytics Antidepressants 1. Barbiturates contraindicated w/ patients with acute intermittent porphyria, shock (hypotension) 2. Benzodiazepine can cause anterograde amnesia 3. Ketamine hydrochloride contraindicated for patients with glaucoma and hypertension 4. Propofol can cause respiratory depression  4. Anticonvulsants ANTICONVULSANT – substance that prevents, reduces, or stops the severity of epileptic or other convulsive disorders. It increases the amount of the neurotransmitter gamma-aminobutyric acid (GABA) Hydrantoin derivatives Prototype drug: phenytoin (Dilantin) Use: 1st line drug therapy for all types of seizure except absence (petit mal) seizures Report to the doctor if the respiratory rate is below 8 breaths / min RESPIRATORY AGENTS I. DRUGS FOR UPPER RESPIRATORY DISORDER 1. Antihistamines (H1 blockers or H1 antagonists) A. 1st generation antihistamines meclizine (Bonamine) – for vertigo, controls motion sickness Diphenhydramine - acts as an inverse agonist at the H1 receptor, thereby reversing the effects of histamine on capillaries, reducing allergic reaction symptoms. B. 2nd generation antihistamines: cetirizine (Virlix, Zyrtec) loratidine (Claritin, Lordex, Claricort, Clarinase) cetirizine Nursing Considerations Second generation have lower incidence of drowsiness. Avoid ingesting alcohol 2. DECONGESTANTS (sympathomimetic amines) A substance that eliminates or reduces congestion or swelling, especially in the mucous membrane Action: stimulate the alpha-adrenergic receptors → vasoconstriction of capillaries within nasal mucosa → shrink nasal mucous membranes → ↓ fluid secretion II. DRUGS FOR LOWER RESPIRATORY DISORDER Asthma – heightened airway reactivity resulting to narrowing and swelling of the airway and may produce extra mucus. Status asthmaticus - acute, severe prolonged asthma attack and is unresponsive to usual treatment. DRUGS USED TO TREAT LOWER RESPIRATORY DISORDERS Bronchodilators – dilate the bronchioles Monitor for palpitations, nervousness Monitor for tachycardia, tremors 1. Sympathomimetics ( Beta 2- Adrenergic Agonists) – it dilates the bronchioles a. Albuterol 2. Xanthine derivatives (Methylxanthines) Common drugs: aminophylline – available only in IV theophylline  3. Anticholinergics Action: blocks Ach-muscarinic receptors; bronchodilation Common drugs: Ipratropium bromide (Atrovent, Combivent) ANTI INFLAMMATORY 1. Glucocorticoids - anti-inflammatory effect prednisone methylprednisolone parenteral: hydrocortisone, methylprednisone inhaled: beclomethasone , budesonide , fluticasone Nursing interventions: Do not administer the drug to treat an acute attack. Use bronchodilator before corticosteroid aerosol. (Salbutamol then Budesonide) Shake the inhaler well just before use Monitor for side effects like impaired immune response, hyperglycemia 1. Leukotriene Receptor Antagonist – act to block production of a component of SRSA Most beneficial in treating asthma. Mechanism of action - combination of both bronchodilator and anti- inflammatory effects. Common Drugs: zafirlukast (Accolate) and montelukast (Singulair);  GASTROINTESTINAL AGENTS 1. Anti emetics – MOA - Depressing hyperactive vomiting reflex CNS is the body system that will have the MOST side effects from taking this medicine. Metoclopramide – for nausea and vomiting Phenothiazine - blocking dopamine-2 and 5-HT receptors in the chemoreceptor trigger zone 2. Anti diarrheal drugs Example : Loperamide – MOA - inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall directly effects on the muscles of the colon to decrease peristalsis Acid suppressing drugs – indicated for patients with gastric ulcers Antacids Types of Antacids Calcium carbonate Magnesium aluminum hydroxide - least likely to cause adverse effects H2 receptor antagonists / blockers Examples : Cimetidine , Ranitidine, Pepcid Nursing consideration – monitor for cardiac arrythmias ( potentially serious adverse effect  Proton pump inhibitors - suppress gastric acid secretion by specifically inhibiting the hydrogen–potassium adenosine triphosphatase (H,K ATPase) enzyme system on the secretory surface of the gastric parietal cells Examples: Omeprazole –primary drug for gastric ulcer 5-HT3 receptor blockers - helpful in treating nausea and vomiting associated with radiation therapy Example: Ondansetron -  Nursing Considerations: 1. if the patient is taking other drugs while taking Cimetidine, he has to take medications one hour apart for better absorption of the drugs. 2. Taking Antacids with Amoxicillin or Clarithromycin will stop the acid production and will kill the bacteria 3. Chew the drug before swallowing. 4. Antacids should be given in between doses of sucralfate. 5. If Phenothiazines are given to patient with severe nausea and vomiting. a.Side effects - Drowsiness, dystonia, and blurred vision  6. Mucosal protective agents Digestive enzyme replacement therapy – the patient is at RISK for Imbalanced Nutrition Example : Sucralfate – Gastric protective agents - Action – It prevents intestinal ulcers by forming a paste-like substance, coating the stomach mucosa, thus preventing gastric acid irritation Nsg Considerations : Take the drug 1 hour before meals. Misoprostol - primarily used in patients who are at high risk for complications from a gastric ulcer CARDIOVASCULAR AGENTS ANTIHYPERTENSIVE DRUGS – most hypertensive drugs will be maintained or taken for the remainder of the patients life. 1. Angiotensin-converting enzyme inhibitors - expand blood vessels by lowering levels of angiotensin II, a potent vasoconstrictor that drives blood pressure up. ACE inhibitors are used to treat high blood pressure, heart failure and heart attacks. a. avoid excess intake of K-rich foods and K supplements b. “pril” – enalapril, lisinopril, captopril 2. Angiotensin II receptor blockers –(ARBS) prevent angiotensin II from having any effects on the heart and blood vessels by blocking the receptors it usually binds to. Effectiveness of the drug can be manifested by decreasing BP. The “sartan” – Losartan, Valsartan 3. Beta-blockers - decrease the heart rate and the final cardiac output. This lowers blood pressure and heart rate. a.atenolol, bisoprolol, metoprolol, propranolol and sotalol. b.Serious complication – expiratory wheezes 4. Calcium channel blockers - stop the movement of calcium into the cells of the heart and blood vessels. This relaxes the vessels and reduces blood pressure. a.amlodipine, felodipine, nifedipine and varapamil. CARDIAC GLYCOSIDES Digoxin - Inotropic drugs digoxin (Lanoxin) positive inotropic effect (myocardial contraction) Negative chronotropic effect (lower heart rate) Therapeutic level – 0.5 – 2.0 ng / ml Adverse reactions: digitalis toxicity Visual disturbances such as seeing yellow spots and blurring of vision. Decrease heart rate below 60- Assess the radial pulse, if low, next step will be to assess apical pulse. Antidote: digoxin immune fab (Digibind)  ANTIANGINAL DRUGS – for patient complaining of chest pain. 1. Vasodilators – effects : open or dilate blood vessels, decrease bp, decrease vascular resistance E.g. nitroglycerine Used to terminate acute attack of angina Mechanism of action : relaxes vascular smooth muscle with resultant decrease in venous return and arterial BP. Patient instructions: Take 1 tablet, then an additional tablet every 5 minutes, for a total of 3 tablets. Calls the physician if pain persist after 3 tablets. NSG CONSIDERATIONS: 1. DO NOT give more than 3 tablets!!! If chest pain persists for more than 15 minutes, hospital consultation should be done immediately 2. Follow a low cholesterol diet - avoid fried food, internal organs ( high in cholesterol) 3. Provide patient teaching regarding drug, dosage, adverse effects, signs and symptoms of problems to report, and safety precautions. 4. Monitor blood glucose and serum electrolytes 5. Monitor BP closely during administration  Tissue plasminogen activator - thrombolytic drug for stroke treatment, which converses plasminogen into plasmin, leading to fibrinolysis. Priority nursing intervention – monitor for signs of bleeding. Hydrochlorothiazide – maintenance antihypertensive drug, the patient will take for the remainder of her life. Search in the Drug Handbook 1. albuterol Sulfate 2. Diphenhydramine hydrochloride 3. Digoxin 4. Laxatives 5. Metoprolol succinate / tartate 6. Omeprazole Magnesium 7. Losartan potassium 8. Budesonide