Pharmacology Final Exam Study Guide PDF

Pharmacology Final Exam Study Guide It is recommended to also be familiar with antidotes. This is NOT Transdermal Patches- RN considerations - Remove old patch (if applicable); fold in half on itself i...

Pharmacology Final Exam Study Guide It is recommended to also be familiar with antidotes. This is NOT Transdermal Patches- RN considerations - Remove old patch (if applicable); fold in half on itself implying that all drugs have antidotes, because they do not; it’s implying - Discard per facility policy that if a drug is mentioned to have an antidote, it would be worth it to - Document the removal and where the old patch was removed memorize for patient safety from on the patient - Cleanse the skin of the area where old patch was; observe for LAB Specific Content (11 Questions) signs of skin irritation Administration of Otic Medications: Child & Adult differences and - ROTATE SITES OF APPLICATION FOR EACH NEW PATCH - Ideally, place the new patch in a hairless, free from scratches area Proper Administration of - When removing a patch from packaging, remove the backside, - Place pt in a side-lying position with affected ear facing up careful to avoid touching the medication with finger - DO NOT CUT TRANSDERMAL PATCHES; it causes all the ★ For those OLDER than 3 years, pull the pinna UP AND BACK. medication to be released at once which can lead to overdoses ★ For those YOUNGER than 3 years, pull the pinna DOWN and - Ensure edges of patch are flat and adhered to patient’s skin; RN back can hold a palm over the patch for 10 seconds this can help it adhere by trapping heat inside the palm - Document the SITE of new patch location - Hold dropper 1 cm above ear canal and direct drops along the NITROGLYCERIN is a type of vasodilator. It relaxes blood sides of the ear canal vessels, causing increased blood and oxygen supply to your heart. - Instruct patient to lie on current side for 5-10 minutes This medicine is used to prevent chest pain. It should not be used - Cotton may be inserted loosely to prevent medication from for immediate relief during an angina attack. flowing out ○ Do not give this if your patient has rashes, calluses, or - If cerumen or drainage is present in the outer ear canal, remove it broken skin in the area of application carefully WITHOUT pushing it back into ear canal ○ Monitor BP before and during therapy; do not give if systolic < 100 Administration of Rectal Suppositories: Pt positioning and Contraindications Consideration for Administration of Nasal Medications - Suppositories are contraindicated in pts with active rectal - Explain that temporary burning/stinging may occur bleeding, diarrhea, low platelet counts, or untreated cardiac - Have they had any nasal surgeries or trauma? arrhythmias - Have patient blow nose to clear passages (unless contraindicated - Place patient in LEFT LATERAL SIMS POSITION such as in increased ICP or recent nasal surgery) - Use ONLY WATER BASED lubricant Nasal Drops: ⇩⇩ - Insert suppository into rectum AT LEAST 4 inches beyond ○ Hold dropper ½ inch above desired nostril internal sphincter ○ Instil # of drops per order, per nare - Pt to remain on their LEFT side for 15-20 minutes to allow the ○ Maintain supine position for 5 minutes at minimum medication to absorb ○ *Infants are nose breathers. Administer nasal - Retention enemas need to be held for 30 min to 1 hour drops 20 to 30 min- BEFORE a feeding - Enemas are contraindicated in Neutropenia, etc. Nasal Spray: ⇩⇩ Administration of Vaginal Suppositories ○ Patient sitting UPRIGHT - Ask pt to empty bladder before administration ○ Occlude one nostril with gloved finger - Can take 4-12 hours for these meds to be absorbed ○ Point tip toward SIDE OF NOSE; NOT toward center - USE ONLY WATER BASED LUBRICANT of nose - Place pt in LITHOTOMY POSITION ○ Squeeze spray bottle as pt inhales through nose - Pt to remain in supine position for 5-10 minutes to allow absorption Ophthalmic (Eye Drop) Administration - For yeast infection vaginal creams/suppository, the RN and 1. Pull lower eyelid down with one hand patient to understand that a burning sensation, while unpleasant, 2. With other hand, hold eye drops 1 to 2 cm above conjunctival sac is normal and will pass. DO NOT TOUCH THE TIP OF DROPPER TO THE EYE OR WITH YOUR FINGER! Considerations for Administration of Topical/Transdermal Drugs 3. Drop prescribed # of drops into conjunctival sac - Gloves to be worn at all times - Punctal occlusion = usually done when giving a medication - STERILE gloves to be used if applying topical medication to who has glaucoma; you will take the finger and occlude the OPEN SKIN LESIONS lacrimal punctum - Apply to clean, DRY, irritation-free skin - If needed, remove residuals with soap/water; completely dry! Ophthalmic Ointment Administration - If medication is in a jar/tub, remove it with a tongue depressor - Same as eye drop admin except: and apply to your gloved hand; DO NOT CONTAMINATE THE - RN will gently squeeze medication tube starting from CONTAINER WITH YOUR FINGER the inner canthus moving toward outer - Apply with long, smooth, gentle strokes the follow the direction of hair growth canthus to apply an even strip of medication (about 1 - Elderly skin is more thin and fragile, be gentle!! to 2 cm) along the border of the conjunctival sac With both drops and eye ointments, nurse may need to apply gently pressure to the patient’s nasolacrimal duct for 30-60 seconds with a gloved finger wrapped in a tissue; this will help reduce systemic absorption of the drug through the nasolacrimal duct What are the 10 medications rights? What is Supplemental Therapy? Treatment that provides necessary 1. Right Drug substances the body lacks. 2. Right Dose (e.g., A patient with anemia is prescribed iron supplements.) 3. Right Time 4. Right Route & Form Pharmacokinetics & Primary Organs Involved in Each Stage 5. Right Patient 6. Right Documentation Absorption: movement of a drug from the site of administration into the bloodstream 7. Right Indications Bioavailability: used to determine the extent of absorption 8. Right Response AFTER the first pass effect 9. Right To Refuse 10. Right Education Distribution: transport of a drug by the bloodstream to its site of action Drugs will compete with one another for protein binding sites What should the RN do if ANY kind of error is made? RN should consider pt albumin levels if a drug is highly protein - Report them!! DO NOT IGNORE OR TRY TO FIX IT!!! bound - This even includes ‘near-misses’ or ‘close-calls’ ○ Albumin carries the majority of protein bound drug molecules ○ Unbound drug portion is “free-drug” and active Understand the administration of the following: Intramuscular (IM): Areas of RAPID Distribution Include: heart, liver kidneys, brain - Sites: Deltoid, Ventrogluteal, Vastus lateralis. d/t them being HIGHLY vascularized - Angle: 90° Areas of SLOWER distribution include: muscle, skin, fat, and bone d/t DECREASED blood flow/vascularity Subcutaneous (SubQ): - Sites: Upper outer arm, Abdomen, Thigh. Metabolism: the biochemical alteration of a drug into an inactive - Angle: 45-90° metabolite/a more soluble compound The LIVER is the major site of drug metabolism Hepatic metabolism also involves activity of Cytochrome P-450 Intradermal (ID): enzyme or P-Glycoprotein plasma membrane protein; when a pt - Sites: Forearm, Upper back. has a deficiency in either, there may be an alteration in drug - Angle: 15° metabolism Chs. 1-3 (5 Questions including Ch. 5) Excretion: elimination of drugs from the body The KIDNEYS are the main organ responsible for excretion What is ½ life? ½ life plays a major role in medication excretion The amount of time that is needed for the drug dose to be What is Pharmacokinetics? reduced/eliminated from the blood by half the original dose What the body does to the drug amount What is Pharmacodynamics? Q: A nurse administers a drug with a half-life of 6 hours at 0800. At what What the drug does to the body time will half of the drug remain in the patient’s system? 1400 What is Parenteral Administration? What do they bypass? What are the types? Fastest route for a drug to be absorbed What is the First-Pass Effect? BYPASSES the FIRST-PASS Effect A phenomenon in which a drug gets metabolized at a specific Includes Injections (i.e., IV, IM, SubQ, Intrathecal, Intraarterial, location in the body that RESULTS in a REDUCED Intraarticular) concentration of the active drug upon reaching its site of action or systemic circulation. Supplies Used for PO Meds Medicine Cups Pharmacotherapeutics Souffle Cups What is Empiric Therapy? Treatment given before a specific diagnosis is Calibrated Dropper confirmed, based on experience or clinical judgment. Syringe (e.g., A patient with a fever and cough is given antibiotics while awaiting culture results.) What is Prophylactic Therapy? Treatment aimed at preventing a disease or condition. (e.g., A patient takes aspirin daily to prevent a heart attack.) What is Definitive Therapy? Treatment aimed at curing the identified cause of a disease. (e.g., A patient with a bacterial infection is given antibiotics tailored to the identified bacteria.) PO Forms of Medication Buccal: side of mouth What is Palliative Therapy? Treatment focused on relieving symptoms Sublingual: under tongue rather than curing the disease. (e.g., A cancer patient is given pain medication to manage discomfort.) Medication Considerations for Elderly > 65 y/o Chs. 10-13, & 44 (10 Questions) Elderly have decreased senses Start with lowest possible dose FIRST, then titrate the dosage up What are the Adverse Effects with Opioid use? if needed to LIMIT adverse effects, BUT still have a therapeutic CNS depression leading to respiratory depression response “Start low and go slow” Pruritus, flushing, orthostatic hypotension, N/V, constipation, and Polypharmacy is common in the elderly population urinary retention What is Polypharmacy? Understand the best methods for addressing pain Taking multiple medications concurrently; especially high doses - Every hour assessment of pain - Proper timing of analgesics Medication Considerations for Infant Population - Treat pain early! Educate pts of this Consider immaturity of organs - Re-assessment of pain level post during administration ○ This leads to an increased drug potency - 15 minutes when given parenterally MOST medications for children are weight based in KGs - 30-60 minutes for PO admin - Use pain scales (Understand the use of pain scales) The taste of medications can be problematic for administration, what are some ways to administer medication to children? What medication would you administer for a barbiturate Mix with small amounts of food or drink (if allowed). (pentobarbital or phenobarbital) OD? Use flavored liquid formulations. - Provide rewards Allow pt to play an active part in administration What medication would you administer for an opioid OD? - Naloxone What does the RN NOT do for medication administration for a child? Do NOT mix medication with essential foods (e.g., formula). Understand the differences between the following: Do NOT force-feed the child. General anesthesia: e.g., propofol anesthesia that requires Do NOT skip proper identification checks. intubation Do NOT administer without verifying dosage and compatibility. Local anesthesia: e.g., lidocaine; used for local numbing Conscious sedation: e.g., midazolam; sedation that calms Ch. 5 Medication Errors (5 questions w/ Chs. 1-3) RN Duties when pt is under General anesthesia What is an Adverse Drug Reaction (ADR)? - Monitor V/S frequently Unexpected, UNINTENDED, or excessive response to - Preparation of surgical site medications given AT A THERAPEUTIC DOSAGE - Advocate for the patient during surgery - Check pt’s positioning to prevent sores, blood flow, etc. What is Medication Reconciliation? - DOCUMENTATION Medications are reviewed at all points of entry and exit to/from a - Circulating nurses lead time outs health care entity; includes assessing a pt’s hx of meds and - Watch for sterile field being broken physician-prescribed meds - Give report to PACU nurse Med. Recon. is to occur: 1) at entry into a healthcare facility, 2) upon transfer from surgery, 3) upon transfer into or out of ICU, Spinal Anesthesia and 4) at discharge - Pt will need to be on strict bed rest for a certain period of time (per Doctor's. order) Roles of Organ Systems with Medications CNS Stimulants (Pt education regarding use of and interactions) Stomach: Breaks down medication for absorption. - ETOH and beverages with caffeine are to be avoided Liver: Metabolizes drugs (first-pass effect). - Avoid an abrupt or sudden withdrawal of medications Small Intestines: Absorbs most medications into the For drugs used to treat ADHD (ref. pg 211 in textbook) bloodstream. - For maximal drug effects, take meds on an empty stomach 30-45 Kidneys: Excretes drugs and metabolites. minutes before eating - Weaning process with supervision for d/c drugs Communication between healthcare providers requires clarity!! Use SBAR format to do so. Understand SBAR! For anorexiant drugs (ref. pg 211 in textbook) - Some of these meds may impair alertness and the ability to think Rules for Receiving Verbal Orders - Use ice chips, sugarless gum, and/or hard candies to minimize Write it, Read it back, Receive Confirmation “RBTO” dry mouth and/or unpleasant taste of medication Prescriber’s signature required within 24 hours For antimigraine drugs (ref. pg 211 in textbook) - Avoid food/beverages that trigger migraine - Avoid things that may trigger/worsen migraine (try turning off lights, sounds, etc.) NSAIDS e.g., acetaminophen, ibuprofen MonoAmine Oxidase Inhibitors (MAOIs) Contraindications: ginkgo and warfarin MOA: inhibit MAO enzyme system in CNS; this leads to a build ○ Hepatic failure up of dopamine, serotonin, and NE, THUS alleviation of Indications: pain and inflammation depression symptoms Patient Education Regarding NSAIDS and other OTC drugs: ○ Educate pt on acetaminophen toxicity Indications: RARELY used as antidepressant; used to treat Bleeding or easy bruising, loss of energy, Parkinson’s Disease; used as a last resort therapy for depression fever, sore throat ○ Antidote for acetaminophen: acetylcysteine ○ Educate on Fall precautions Interactions: ○ Maximum 24 hours dosage allowed (3,000 mg) ○ May cause HYPERTENSIVE CRISIS when taken with TYRAMINE-CONTAINING foods or other stimulants When taking NMBDs, pt’s must ALWAYS have ventilatory support!! Hypertensive urgency: > 180/110 ONLY advanced practice practitioners can administer general anesthesia!! Hypertensive emergency: > 180/120 Ch. 16 Psychotherapeutics (6 Questions) ○ CANNOT take MAOIs if pt is also taking meperidine What mental health disorders are commonly involved with ○ Variety of OTC meds can interact with MAOIs psychotherapeutics? - anxiety, depression, bipolar disorder, psychosis Nursing Considerations: ○ 2-5 week washout period when switching from an Define and understand the patho of the following: SSRI/SNRI to a new MAOI Tardive Dyskinesia: Involuntary, repetitive movements (e.g., facial Taper SSRI out while gradually introducing grimacing, lip smacking) caused by long-term use of dopamine new MAOI drug receptor-blocking agents (antipsychotics). - Patho: Dopamine receptor hypersensitivity due to prolonged dopamine blockade in the basal ganglia. TYRAMINE-Containing Foods To Avoid W/ MAOIs: ○ Aged mature cheeses; aged or fermented meats; red Ataxia: Lack of voluntary muscle coordination affecting gait, balance, and wines; avocado, chocolate, caffeinated beverages, movements. fruit (figs, bananas, raisins, grapes, pineapple, - Patho: Damage to the cerebellum or pathways controlling motor oranges); yogurt; sour cream; soy sauce; beer function (e.g., from stroke, toxins, or medications). ★ Selegiline Transdermal Patch (MAOI) Extrapyramidal Symptoms (EPS): Motor symptoms like dystonia, ○ Indicated for major depression akathisia, parkinsonism, and bradykinesia caused by dopamine blockade in ○ Comes in 3 strengths: 3 mg; 6 mg; and 12 mg; /24 hrs the nigrostriatal pathway. ○ The lowest strength can be used WITHOUT dietary - Patho: Imbalance between dopamine and acetylcholine in the restrictions central nervous system. Nursing Considerations: Serotonin Syndrome: Potentially life-threatening condition from excessive Patients need to AVOID exposing the patch serotonergic activity (e.g., with SSRIs, MAOIs). to external sources of HEAT or prolonged - Patho: Overactivation of serotonin receptors in the CNS and SUNLIGHT PNS, leading to autonomic, neuromuscular, and cognitive effects. Because heat INCREASES absorption rate Mania: Abnormally elevated mood, energy, or irritability, often part of bipolar disorder. - Patho: Dysregulation of neurotransmitters (e.g., dopamine, norepinephrine) and structural brain changes. Depression: Persistent low mood and loss of interest in activities. - Patho: Deficiency or dysregulation of serotonin, norepinephrine, and dopamine in the brain. Bipolar Disorder: Mood disorder characterized by alternating episodes of mania and depression. - Patho: Abnormalities in neurotransmitters (serotonin, norepinephrine, dopamine) and brain circuitry involving the amygdala and prefrontal cortex. 2nd Generation Antidepressants: SSRIs and SNRIs Alpha 2 MOAs: Location: presynaptic nerve terminals ○ SSRIs: ↑ serotonin by inhibiting serotonin reuptake Function: When activated, they inhibit further release of ○ SNRIs: ↑ norepinephrine by inhibiting NE reuptake neurotransmitters (like norepinephrine), acting as a feedback mechanism to decrease sympathetic nervous activity. They Indications: depression and a variety of other mental/physical generally have a calming or suppressive effect on the body's disorders response to stress. Contraindications: Beta 1 vs Beta 2 Receptors ○ Use of an MAOI within 14 days Beta 1 (Think HEART) ○ Other antipsychotics (thioridazine and mesoridazine) Location: cardiac muscle, AV/SA node, kidneys ○ Bupropion (BuSpar) Function: Activation leads to increased heart rate (chronotropy), ○ Known drug allergy increased contractility (inotropy), and increased renin release (which can increase blood pressure). Adverse Effects: insomnia, weight gain, sexual dysfunction, ○ (+) Inotropic; (+) Chronotropic; (+) Dromotropic serotonin syndrome - Serotonin syndrome: elevated levels of serotonin; may occur Beta 2 (Think LUNGS) with the use of any psychotic drug Location: bronchial muscles; blood vessels; liver; muscle - S/S include agitation, sweating, tachycardia, shivering, Function: bronchodilation; vasodilation; uterine relaxation; delirium, muscle spasms relaxation of smooth muscles - Increased suicide ideations need to be monitored and reported What effects are seen for the Adrenergic Agonist Drugs? Positive inotropy (increased force) Interactions and Considerations: Positive chronotropy (increased HR) ○ These drugs are highly protein bound to albumin Positive dromotropy (increased AV conduction) ○ Compete with other protein-bound drugs (e.g., What will the nurse anticipate seeing after administration of an warfarin, phenytoin) for albumin binding. adrenergic agonist drug? (Think V/S) Stimulation of alpha-adrenergic receptors on smooth muscle ○ Increases free drug levels → enhances drug effects. results in (think Fight or Flight): ○ Vasoconstriction (↑ BP); Tachycardia; Tachypnea; ○ 2-5 week washout period when switching from an ↑ O2 sat; Cooler skin SSRI/SNRI to a new MAOI ○ Relaxation of GI smooth muscle/ ↓ GI motility; Taper SSRI out while gradually introducing Constriction of bladder sphincter; Contraction of new MAOI drug uterus; Male ejaculation; Pupil dilation ○ linezolid is structurally similar to MAOIs and so Consider in what patient conditions could an should be avoided with the use of SSRIs adrenergic drug be given? Why? ○ St. John’s Wort Epinephrine (A prototypical nonselective adrenergic agonist) MOA: acts directly on alpha and beta adrenergic receptors Chs. 18-21 (5 Questions Total) ○ Alpha 1: causes vasoconstriction ○ Beta 1: (+) inotropy; ↑ HR Ch. 18 Adrenergic/Sympathomimetic Drugs ○ Beta 2: vasodilation Sympathomimetics promote effects of the sympathetic nervous system Indications: emergency situations e.g., anaphylactic reactions or Normal Role of Neurotransmitters/Catecholamines in the Body cardiovascular reactions Epinephrine: Primarily involved in the "fight or flight" response, it increases heart rate, dilates airways, and boosts energy by Adverse Effects: tachycardia; arrhythmias; anxiety; tremors raising blood sugar. Dobutamine (Beta 1 selective vasoactive adrenergic agonist) Dopamine: Affects mood, reward, and movement; it's involved MOA: stimulates beta 1 receptors on myocardium; increases in pleasure, motivation, and motor control. cardiac output but increasing contractility ((+) inotropy) ○ Increases stroke volume, especially in HF Norepinephrine (NE): Helps regulate attention, alertness, and the ○ Structurally similar to dopamine/activates dopamine stress response; it also increases heart rate and blood pressure ○ Beta 1: (+) inotropy; ↑ HR during stress or danger. ○ Beta 2: vasodilation Indications: HF; cardiogenic shock Alpha 1 vs Alpha 2 Receptors Alpha 1 Norepinephrine Location: blood vessels; muscle; bladder sphincter; penis; uterus; MOA: stimulates alpha-adrenergic receptors and directly pupillary muscles of iris (eye); liver; stimulates beta 1 adrenergic receptors on the heart ○ Alpha 1: causes vasoconstriction Function: When activated, they cause vasoconstriction ○ Beta 1: (+) inotropy; ↑ HR (narrowing of blood vessels), leading to increased blood pressure, ○ Beta 2: vasodilation (does not stimulate receptors of pupil dilation, and contraction of smooth muscles in various the lungs) organs. Indications: hypotension and shock Nursing Implications for ALL Adrenergic Agonists - Phentolamine is used to reverse vasoconstriction from Check IV site Q1 hr for infiltration catecholamines Use clear IV solutions only when mixing - MOST COMMONLY USED to treat the extravasation of Use an infusion pump (increases safe drug admin) vasoconstricting drugs such as NE, EPI, and dopamine Infuse drug slowly (per MD orders) to avoid dangerous cardiovascular effects tamsulosin: alpha antagonist Monitor cardiac rhythm (APPLY TELEMETRY) Indications: treats BPH in male pts What is an EpiPen used for? Contraindications: Concurrent use of erectile dysfunction drug - Anaphylactic reactions (e.g., BEEEEE STINGGGSSS) (e.g., sildenafil) - EpiPen contains epinephrine so it may cause anxiety, tachycardia, etc. (refer to epinephrine above^^) Adverse Effects: headache, abnormal ejaculation, rhinitis Ch. 19 Adrenergic Antagonist Drugs/Sympatholytics (4 Questions) carvedilol: dual acting beta and alpha 1 blocker Sympatholytics inhibit the effects of the sympathetic nervous system MOA: has a double effect to produce BOTH a decreased HR and reduce BP What are other names used for Adrenergic Antagonists? Sympatholytics Indications: HF, HTN, angina Alpha/Beta/Alpha-Beta blockers ○ Slows the progression of HF ○ Most commonly added (adjunct therapy) to digoxin, What catecholamines are affected with use of adrenergic blockers? furosemide, or ACE inhibitors when treating HF Norepinephrine Epinephrine metoprolol: selective beta 1 adrenergic antagonist MOA: reduces/blocks sympathetic nervous system stimulation to What EFFECTS are seen for the adrenergic blockers? What will the heart and heart’s conduction system nurse anticipate to see after administering an adrenergic blocker? ○ Decreased HR Vasodilation; decreased cardiac workload ○ Delayed AV node conduction Low BP; slow HR; reduced heart contractions; smooth muscle ○ Reduced myocardial contractility relaxation ○ Decreased myocardial automaticity Orthostatic hypotension, improved urine flow; fatigue/weakness Patient Education When Taking Beta Blockers Has cardioprotective quality that prevent Rebound HTN or chest pain may occur if medication is abruptly catecholamine-mediated actions on the heart discontinued Instruct patients to notify their physician if they become ill and (-)inotropic, (-) chronotropic, (-) and dromotropic unable to take medications Pts may notice a decrease tolerance for exercise (e.g., dizziness, Nursing Considerations When Administering Adrenergic Blockers fainting) Obtain BP BEFORE administering ○ If pt notices these symptoms, notify physician ○ Hold if Systolic is < 100 and/or HR < 60 Adverse Masking Effects of Beta Blockers Teach pt to change positions SLOW to prevent postural NON-selective beta blockers may interfere or cover up normal hypotension responses to HYPOglycemia (such as tremor, tachycardia, or nervousness) Instruct pt to avoid caffeine (basically equals out medication) THUS, use with caution in pts with diabetes mellitus Instruct pt to avoid ETOH ingestion and hazardous activities until Indications for Taking Beta Blockers blood levels become stable Angina: decreases demand on myocardial O2 Instruct pt to notify their physician if palpitations, dyspnea, nausea, or vomiting occurs. Cardioprotective: inhibits stimulation from circulating catecholamines Notify physician if weight gain more than 2 lb in 1 day or 5 lb in 1 week while on beta blockers Dysrhythmias: Class II antidysrhythmic Do NOT abruptly d/c Migraine headache: lipophilicity allows entry into CNS Pt education regarding s/s that HF may be starting HTN, HF, glaucoma (topical use) Shortness of breath, swelling in the feet, ankles, legs, or abdomen; fatigue or unusual weakness, rapid or irregular Phentolamine: alpha antagonist heartbeat, coughing or wheezing, especially at night, decreased MOA: quickly reverses the potent vasoconstrictive effects of appetite or nausea, difficulty sleeping due to breathlessness. vasopressors such as EPI and NE; restores blood flow and prevents tissue necrosis ○ Decreased peripheral vascular resistance Indications: HTN Contraindications: known hypersensitivity, MI, CAD  Ch. 20 Cholinergic Drugs (5 Questions) Ch. 21 Anticholinergic Drugs (5 Questions) Turns ON the PARAsympathetic nervous system responses BLOCKS the PARAsympathetic nervous system responses What is Acetylcholine (ACh)? Overall Indications Primary neurotransmitter of the PSNS - To decrease muscle rigidity and tremors Slows HR; enhances salivation, gastric secretions, and intestinal - Parkinson’s disease motility; constricts pupils (miosis); stimulates smooth muscle - Low doses decrease HR and high doses increase HR activity; and causes bronchoconstriction Acts on muscarinic receptors Toxicity and OD: physostigmine (a cholinergic) Receptors to Consider Understand Adverse Effects of anticholinergics (drying) Muscarinic Receptors: Found in parasympathetic target organs (heart, smooth muscles, glands). Activated by ACh, causing rest atropine sulfate: antimuscarinic drug and digest effects (e.g., lowering heart rate, stimulating MOA: inhibits muscarinic ACh receptors digestion). Indications: antidote for anticholinesterase inhibitor Nicotinic Receptors: Found in skeletal muscles and autonomic toxicity AND cholinergic crisis or poisoning; used ganglia. Activated by ACh, leading to muscle contraction and preoperatively to reduce salivation and GI secretions to decrease autonomic nervous system activation. aspiration risks Cholinergic: Refers to anything involving acetylcholine (ACh), Contraindications: angle-closure glaucoma, advanced hepatic including muscarinic and nicotinic receptors or drugs that and renal dysfunction, hiatal hernia associated with reflux mimic/block ACh's effects. esophagitis, intestinal atony, obstructive GI or GU conditions, and severe ulcerative colitis bethanechol: direct-acting cholinergic drug MOA: increases tone and motility of bladder and GI tract ○ Relaxes sphincters in bladder and GI tract allowing them to empty scopolamine transdermal patch is an anticholinergic; this drug is ○ Helpful for post surgical atony of the bladder and GI discussed above in Ch. 16 tract Indications: for URINARY RETENTION oxybutynin: synthetic antimuscarinic drug ○ Treatment of acute postoperative and postpartum MOA: muscarinic inhibitor in the bladder nonobstructive urinary retention and for the management of urinary retention associated w/ Indications: overactive bladder neurogenic atony of the bladder ○ Antispasmodic for neurogenic bladder associated w/ spinal cord injuries and congenital conditions such as Contraindications: known drug allergy, hyperthyroidism, peptic spina bifida ulcer, active bronchial asthma, cardiac disease or CAD, epilepsy, and parkinsonism Contraindications: drug allergy, urinary or gastric retention, and uncontrolled angle-closure glaucoma Cholinergic Crisis (Toxicity): Treated w/ Atropine Salivation; Lacrimation; Urination; Defecation; GI upset; Emesis Bradycardia, Bronchospasms, and Bronchorrhea dicyclomine: synthetic antispasmodic anticholinergic Indications: functional disturbances of GI motility such as donepezil: anticholinesterase irritable bowel syndrome MOA: cholinesterase inhibitor to increase ACh levels Contraindications: known hypersensitivity to anticholinergics, Indications: management of mild to moderate Alzheimer’s angle-closure glaucoma, GI tract obstruction, myasthenia gravis, paralytic ileus, GI atony, and toxic megacolon pyridostigmine: indirect acting cholinesterase inhibitor MOA: increases ACh by inhibiting acetylcholinesterase enzyme Nursing Implications and Patient Education for Anticholinergics Patients may experience photosensitivity Indications: myasthenia gravis; reverses NMBD effects; When giving ophthalmic solutions, apply pressure to the inner treatment for severe OD of tricyclic antidepressants canthus to prevent systemic absorption Ginkgo: Why does the nurse need to know if the pt is taking ginkgo? Chew hard candy or gum to address dry mouth Gingko may cause Gi upset, headache, and bleeding Pt to check with MD when taking other medications OTC Potential interactions include: aspirin, NSAIDs, anticoagulants, and anticonvulsants Anticholinergics taken by older adults have higher risk for heat stroke Teach patients to limit physical exertion and avoid high temps Emphasize the importance of adequate fluid/salt intake Pts should report: urinary hesitancy or retention; constipation; tachycardia; palpitations; tremors; confusion; sedation; hallucinations; and decreased sweating (leading to hot dry skin)  Ch. 22-26, 28 Cardiac Drugs (10 Questions) Overall Considerations for Anti-Hypertensive Use - MUST TAKE A BP AND HR BEFORE ADMINISTERING AN Nitroglycerin (Vasodilator) ANTIHYPERTENSIVE MEDICATION!! - Hold for systolic BP