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Nursing Pharm - ANS, Analgesics, Anxiety

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olanjones's version from 2016-06-13 03:16

ANS I

Question Answer
In what 4 ways do drugs alter ANS function?1. Increase/decrease NT production 2. Increase/decrease NT release 3. Prevent normal destruction or uptake of NT 4. Bind to NT receptor site to increase/inhibit function
How do Sympathomimetics/Adrenergic Agents work?By stimulating sympathetic NS, think mimic adrenaline (fight/flight reaction)
What do drugs like phenylephrine/Neo-Synephrine (prototype- adrenergic agonist) treat?Conditions such as hypotension, asthma, allergies, shock, cardiac arrest
Because adverse effects of phenylephrine are typically dose-related what would NC and PE be?NC- Assess & monitor vitals, Assess CNS changes for s/s of toxicity. PE- Report tremors, dizziness, urinary retention, & anorexia
What PE would the nurse give about phenylephrine in regards to glucose and vision?Glucose levels may be elevated, carefully monitor if diabetic. Pupil dilation may cause light sensitivity or blurriness (avoid driving until vision clears)
How do Adrenergic Antagonists/Sympatholytics work?By inhibiting the sympathetic NS, think antagonize (block) adrenaline
What do drugs like prazosin/Minipress (prototype- sympatholytic) treat?Primarily hypertension - usually blocking alpha (prazosin) or beta actions
Because prazosin is metabolized by the liver and excreted by kidneys, what would NC and PE be?NC- Monitor hepatic/renal function before and during tx. PE- Have blood work/assessments done as ordered
Common SE of prazosin include dizziness, HA, fatigue, palpitations, what are NC and PE?NC- Monitor CV status, wt gain, edema, dyspnea, cough. PE- Monitor BP & wt, report SE, dizziness precautions
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ANS II

Question Answer
How do Cholinergic Agents/Parasympathomimetics work?By stimulating the PSNS, think mimic colon (rest/digest reaction); Stimulate smooth muscle of bowel/urinary tract & effect Ach receptors in skeletal muscles & CNS
What do drugs like bethanechol/Duvoid (prototype- parasympathomimetic) treat?Condition such as dry mouth, urinary retention, MG, Alzheimer's, to reverse anticholinergics effects
The use of bethanechol is contraindicated what conditions?Obstruction of GI/GU tract, asthma, bradycardia, hypotension, Parkinson's
What are PE points for bethanechol?Take as directed (don't stop abruptly), Return for f/u labs, Report SE (tremors, palpitations, BP changes, salivation, sweating, extreme fatigue, dyspnea)
What is the antidote for bethanechol OD?atropine
How do Anticholinergics/Parasympatholytics work?By inhibiting the PSNS, think anti colon
What do drugs like atropine/Atro-pen (prototype- anticholinergic) treat?GI disorders (gastritis, diarrhea, diverticulitis, ulcerative colitis), ophthalmic procedures, bradycardia, pre-anesthesia, asthma
Because urinary retention/constipation and dry mouth are NC, what would PE points be for atropine?Increase fluid/fiber consumption, report difficulty with urination, use sugar-free candy or ice chips
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Analgesic I

Question Answer
Opioid agonists like morphine (prototype) are first-line drugs for uncontrolled moderate-severe pain, what are other indications for use?cough suppression, sedation, decrease GI motility for severe diarrhea
Major SE of morphine include respiratory depression, sedation, hypotension, N&V, constipation, dependence, and itching, what are NC and PE?NC- VS & LOC, pain level, BS & UO. PE- hold if excessive drowsiness, confusion, decreased respirations, Report N&V, stool changes, abd pain/distention, dyspnea
What should be included in the initial assessment prior to morphine use?VS, OLD CAART, allergies, meds (esp ETOH & CNS depressants), hx of respiratory conditions, ICP, seizures, & liver or kidney disease
What is the antidote for morphine OD?naloxone (opioid antagonist), *remember* no effect on LOC or RR if intoxication is nonopioid
When should naloxone be administered?if respirations are less than 10 per minute
Because naloxone reverses effects of morphine what NC apply?Analgesic effects will also be terminated, withdrawal symptoms will occur in patients who are opioid dependent (chills, N&V, wheezing, CNS stimulation, HA)
How do opioids of mixed action work?By acting as agonists at kappa opioid receptors, and as agonists at mu receptors
What can occur if an opioid of mixed action is used in an opioid dependent patient?Withdrawal symptoms, increased cardiac work.
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Analgesic II

Question Answer
Drugs like aspirin (prototype- nonopioid analgesic) are drugs of choice for milder to moderate pain, what are other indications for use?Antipyretic, anti-inflammatory, and anti-platelet actions
What are NC associated with aspirin use?Observe and educate patient to take with food and report s/s bleeding or tinnitus. Monitor labs (esp. renal function), avoid use in children under 18 (Reye's Syndrome)
What is the primary goal of antimigraine drugs like sumatriptan/Imitrex (prototype)?To stop migraines in progress or prevent recurrence (first-line drugs to abort migraine include Tylenol or NSAIDs)
When should antimigraine drugs be taken?Before migraine becomes severe
What NC are associated with sumatriptan?Monitoring of neuro status regularly (other conditions such as meningitis or stroke may have migraine-like symptoms), Use is contraindicated in CVD or DM
What PE points are associated with sumatriptan?Report severe dizziness (SE) or syncope, Report HA of different quality/intensity, s/s of rash, fever, stiff neck
How does ibuprofen (prototype NSAID) differ from aspirin?Not indicated for prevention of CV conditions, actually carries increased risk of cardiac events
The most common SE of NSAIDs is GI ulcer/bleeds, what are NC and PE?NC- Get hx for PUD, bleeding, monitor CBC, BUN/creatinine, ALT, AST. PE- No ETOH or smoking, take with food, report s/s of bleeding
How does acetaminophen (prototype- antipyretic) differ from NSAIDs?Therapeutic actions are antipyretic and analgesic but NOT anti-inflammatory and no anti-platelet effect
What is a major NC with acetaminophen?Potential for liver toxicity, obtain baseline LFTs, monitor for s/s of liver disease
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Anxiety & Insomnia

Question Answer
What classes of drug are used as anxiolytics?Antidepressants, CNS depressants, Seizure drugs, Emotional & Mood disorder drugs, Antihypertensives, Antidysrhythmias
What is the connection between anxiety and insomnia?Sleep deprivation can be root cause of anxiety, sleep hygiene should be evaluated prior to med use, Also evaluate for conditions such as sleep apnea, seizure activity, depression, dementia
lorazepam/Ativan (prototype- benzodiazepine) is a drug of choice in anxiety/insomnia, what are other use indications?Pre-anesthetic agent, status epilepticus, ETOH withdrawal (diazepam/Valium also used for ETOH)
What is the antidote for a benzodiazepine OD?flumazenil/Romazicon which is a benzodiazepine antagonist. Half-life is shorter so monitoring for re-sedation must be done
How do drugs like lorazepam work?By potentiating GABA, a natural inhibitory neurotransmitter, Major advantage high safety margin: excessive amounts do not produce severe respiratory depression even in combo with other CNS depressants
Why are barbiturates no longer used for sedation/insomnia treatment?They depress the CNS at all levels, withdrawal is extreme & can be fatal; Tolerance develops quickly, including cross-tolerance to other CNS depressants such as opioids
What beta-blockers are commonly used for anxiety/insomnia?propranolol/Inderal & atenolol/Tenormin
What OTC drugs are commonly used for anxiety/insomnia?diphenhydramine/Benadryl & hydroxyzine/Vistaril; both block histamine & have sedative effects along with anticholinergic activity
What is the indication for zolpidem/Ambien (prototype- nonbenzo/nonbarabit)?Short-term insomina (7-10 days), Must be taken immediately prior to sleep (onset 7-27 minutes); SE include: daytime sedation, confusion, amnesia, & dizziness
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Seizures

Question Answer
Seizures are symptomatic of underlying disorder, what are some common causes?Meningitis, Trauma-head injury, Metabolic disorders (hyponatremia), Vascular disease (CVA), Pediatric disorders (rapid increase in temp)
What are the 3 general mechanisms of anti-seizure drugs?Potentiate GABA action (barbiturates, benzos, newer GABA-related drugs), Delay Sodium influx (hydantoins, phenytoin-like drugs), Delay Calcium influx (succinimides)
Seizure drugs affect neuronal firing, what NC are associated with this?Initial doses are low; Second med should be added in small dose while reducing the first drug; Weaning must occur over 6-12 weeks prior to discontinuing
What are NC in regards to pregnancy & anti-seizure meds?They decrease BCP effectivness; are preganancy category D (can cause neural tube defects from folate deficiency); Eclampsia poses seizure risk from 20th week - 1 week post-partum
Drugs like phenobarbital/Luminal (prototype- Barbiturate) cause profound CNS depression, what are other NC?Decreased margin of safety, increased potential for dependence, Increased adverse risk for infants r/t breastfeeding
What types of seizures is phenobarbital indicated for?All major seizure types except absence
What types of seizures is diazepam/Valium (prototype- Benzodiazepine) indicated for?absence, myoclonic, & status epilepticus; It is also used as adjuncts to other drugs for short-term control
Why is the limiting of caffiene and smoking a PE point with the use of drugs like diazepam ?Caffeine & nicotine decrease effectiveness
Drugs like gabapentin/Neurontin (prototype- Newer GABA-Related drug) are also used to treat neuropathic pain, what SE should the nurse educate the patient about?severe rashes, the potential for sudden unexplained death in epilepsy
Drugs like phenytoin/Dilantin (prototype- Hydantoins) are effective against most seizure types (except absence), what is a benefit of this type of drug?No abuse potential or CNS suppression
What are some of the NC associated with phenytoin?Narrow therapeutic range (needs careful dose monitoring), Increased risk for oral infections and gingival hyperplasia
Drugs like valproic acid/Depakote (prototype- Phenytoin-like drugs) are indicated for tonic/clonic, partial, and absence seizures, what other disorder are they used to treat?Bipolar disorder
Most anti-seizure drugs carry a risk for hepatotoxicity, what additional risk does valproic acid pose?Can cause pancreatitis, Increased risk for oral infections and gingival hyperplasia
Succinimides (prototype- ethosuximide/Zarontin) raise the seizure threshold by keeping neurons from firing too quickly, what types of seizure are they indicated for?Drug of choice for absence seizures, Used in combination with other med for tonic/clonic seizures
Barbiturates, drugs with GABA action, hydantoins, & phenytoin-like drugs decrease absorption of vitamins K, D, B, & folic acid, what PE point would the nurse use?Advise patient to increase intake of foods rich in these nutrients
What NC can help in the prescribing of the correct seizure med?Identify patients at risk for seizures; identify pattern & type; implement safety precautions
Why is it important to avoid ETOH and other CNS depressants with the use of anti-seizure meds?They may increase adverse effects such as drowsiness, dizziness, decreased BP & impaired mental & physical abilities
Neurologic changes may indicate overmedication or adverse SE, what PE point can the nurse use?Have patient/family/caregiver report increasing lethargy, confusion, slurred speech, mood changes
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