Lecture 11 Nursing 100 Flashcards Preview

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Flashcards in Lecture 11 Nursing 100 Deck (44)
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1
Q

Parasympathetic

A

Acetylcholine (Cholinergic)

Rest and Digest

2
Q

Sympathetic

A

Norepinephrine (Adrenergic)

Flight or Fight&laquo_space;survival

3
Q

Cholinergic Agonist

A

Parasympathomimetic
Mimics acetylcholine
Used in Glaucoma, GI statsis, Urine Bladder Dysfunction
Reglan (metoclopramide)

4
Q

Reglan

A

Sensitizes tissue to effect of acetycholine
Increases gastric emptying (DM statsis)
Facilitates GI intubation
Aid passing of Barium after procedure
Reduces nausea r/t chemo or radiation therapy

5
Q

Reglan Interactions

A

Increased effect with:
anticholinesterase- also has cholinergic effects
ganglionic blockers
Decreased effect with:
cholinergic blockers (atropine, scopolamine)
Sympathomimetics (opposite effect)
Anticholinergics

6
Q

Effects of Parasympathetic System

A

pupils constrict; increased salivation; bronchial constriction; heart rate decrease; GI tract increased secretions and motility; bladder tone better= voiding

7
Q

Reglan

Adverse Reactions

A

Undesired parasympathetic effects
CNS - drowsy, fatigue, agitation
GI - N/D, constipation, dry mouth
Overstimulation can lead to circulatory collapse hypotension, shock, cardiac arrest

8
Q

Reglan

Nursing Implications

A
Give po 1 hr ac or 2 hr pc (dec nausea)
Check amlyase and lipase levels for elevation
Check for urinary retention
Check Bowel sounds
Atropine is antidote (prn)
9
Q

Pilocarpine

A

cholinergic agonist
mimics acetycholine action
binds to receptor sites of smooth muscles
Reduces intraocular pressure
Used in glaucoma and ophalmologic surgery

10
Q

Pilocarpine

Adverse Reactions

A

Blurred vision
Lid pain
Rare systemic effects, abd. cramps, increased salivation

11
Q

Pilocarpin

Nursing Implications

A

Do not give in acute iritis, corneal abrasion
Caution with asthma, ulcers, Parkinson’s
Teach pt to take gtts at night b/c blurred vision

12
Q

Anticholinesterase Agents

A

Prostigmine & Tensilon
Facilitate acetylcholine action by inhibiting its destruction by actylcholinesterase enzyme
Used to Dx and Tx myasthenia gravis

13
Q

Cholinergic Blocking Agents

A

Block action of acetylcholine in parasympathetic Nervous System
Refereed to as Belladonna alkaloids
Wide spread effects from actions at many target sites

14
Q

Atropine

A
Greatest effect to increase heart rate
Drug of choice for sinus bradycardia
prevents vagal stimulation (keeps HR up)
Decreases secretions, peristalsis
Causes urinary retention
Bronchial dilation and decreases secretions
15
Q

Scopolamine

A

Greatest effect in the CNS 1st excitement then depression
pupillary dilation
decreased salivation

16
Q

Scopolamine

Therapeutic Uses

A
Spastic conditions of the GI & Urinary tract
Chronic Asthma
Preanesthia - decreases salivation
Decreases excitement
Produces amnesia
Dysrhythmias
17
Q

Effects of Cholinergic Blockers

A
brain- excitement followed by depression
eyes- pupill dilation; poorer visoin
salivation- decreased
bronchi- dilated, decreased secretions
heart-rate increased
GI tract- decreased secretion & motility
bladder- poor muscle tone; urine retention
18
Q

Cholinergic Blockers Drug Interactions

A

Slows GI motility = dec. absorption
Inc. contact with GI increases adverse effects
Antacids & antidiarreals decrease absorption
Cholinergic agents cancel effect
Anticholinergics may give added effects

19
Q

Cholinergic Blockers Adverse Reactions

A

Dose is critical - small therapeutic range to toxicity
Small Dose - decrease salivation, decrease perspiration, heat intolerance
Mod. - Hi Dose - pupils dilate, decrease visual accommodation, heart rate up, hallucinate
Higher Dose- not able to urinate, no GI motility or secretions

20
Q

OD symptoms

cholinergic Blockers

A
all Sx exaggerated
HOT as a hare
BLIND as a bat
DRY as a bone
MAD as a hatter
21
Q

Cholinergic Blockers

Unpredictable Adverse Reactions

A

Increased intraocular pressure
Eye Pain
Blindness

22
Q

Cholinergic Blockers

Nursing Implications

A

Use cautiously in pt with CAD, CHF, dysrhymmias
Monitor urine output
Monitor temperature esp. if hot
Avoid substances the inc. gastric acidity
(ETOH, nicotine, caffeine, ASA)
Screen for glaucoma
Teach about signs of toxicity

23
Q

Adrenergic Agents

A

Sympathomimetics
Cause Flight or Fight
Catecholamines - one type
Example - Epinephrine

24
Q

Adrenergic Agents

Site and Actions

A

Alpha receptors= Blood Vessels - constriction
Beta 1 receptors = Heart - increase
Beta 2 receptors = Bronchial dilation
May be combinations of all three actions

25
Q

Adrenergic Agents

Therapeutic Uses- ALPHA

A

relieve hypotension, anaphylactic shock

26
Q

Therapeutic Uses- BETA 1

A

bradycardia, heart block

27
Q

Therapeutic Uses- Beta 2

A

asthma, emphysema, allergic reaction

28
Q

Therapeutic Uses- dopaminergic receptors

A

dilates renal arteries in ARF (acute renal faliure)

29
Q

Adrenergic Agents

Drug Interactions

A
Additive Effect
Sympathomimetics
Cholinergic Blockers
Decreased Effect 
Cholinergic Agonist
MAO inhibitors, Digoxin (decrease heart rate), Antihistamines (dry dry dry)
30
Q

Adrenergic Agents
Adverse reactions
CNS, Cardiac, Skeletal Muscle, GI

A

CNS - common HA, restless, nervous, anxious
Cardiac - palpitations, tachycardia, BP fluctuations, angina

Skeletal Muscle- weakness, tremors
GI - N, severe vomiting, diarrhea

31
Q

Adrenergic Agents

Nursing Implications

A

Cautiously in elderly, dysrhymmias, confused or CVA
Cautiously in HTN, DM, Parkinson’s
Monitor for signs of OD - HA, V, hypotension or HTN, chest pain
Prolonged use - edema, oliguria, hemorrhage
Teach to rinse mouth to decrease dryness

32
Q

Noncatecholamines

A

Action maybe direct effect on sympathetic receptor
most typical for bronchiodilators
nose bleed- topically- constricuts bleeding vessels
Indirect by stimulating release of norepinephrine
Absorbed well po
Often given by inhalation to decrease systemic effects

33
Q

Noncatecholamines

Therapeutic Uses

A

Bronchodilator - Asthma, Emphysema, Ch. Bronchitis
Vasoconstriction - Hypotension, Nose bleeds
Cardiac Stimulation - bradycardia
Smooth muscle relaxant - stop labor

34
Q

Direct Acting

ex’s (2)

A

Alupent - beta 2 selective bronchodilator for asthma
Brethine (terbutaline) direct acting beta 2 selective for asthma
Used in OB to delay delivery by relaxing uterus in PTL (Tocolytic)

35
Q

Noncatecholamines

Drug interactions

A

MAO inhibitors
Beta Blockers
Sympathomimetics
Many others OTC have many additive effects

36
Q

Noncatecholamines

Adverse reactions

A

CNS- HA, restless, insomnia, dizziness
C-V - HTN or low BP, palpitations, bradycardia, tachycardia, arrest
Skel-Mus.- weakness, cramps
Resp.- bronchial spasms
Nursing Implications - same as catecholimines

37
Q

Adrenergic Blockers (sympatholytics)

A

Disrupt sympathetic nervous function
Interrupts action of adreneric
Decreases available norepinephrine
Specific to sign of block - alpha or beta

38
Q

Alpha Adrenergic Blockers (2)

A

erogtamine
regitine
Smooth muscle relaxation
Peripheral vasodilatation (lowers BP)
Migraine Headaches
Used for peripheral vascular disease - Raynaud’s
Frost bite, Septic shock (not primary Rx in HTN)

39
Q

Alpha Adrenergic Blockers

Drug Interactions

A

Cholinergic agonist- synergistic

Sympathomimetics - opposite

40
Q

Alpha Adrenergic Blockers

Adverse Reactions

A

Orthostatic Hypotension
Angina - MI
CNS - tingling, numbness, HA
some Anemias, rashes, allergic reactions

41
Q

Alpha Adrenergic Blockers

Nursing Implications

A
Do not use in pt with MI, CHF, angina,
Caution with renal insuff., ulcers, CAD
Assess signs of vascular insuff.
Monitor BP sitting, standing
Advise - no ETOH, other OTC
Take early if for migraine HA
42
Q

BETA Adrenergic Blockers

A
Inhibit action of Catecholamines
Maybe selective or non-selective
Inderal (propranolol)- for HTN, Angina, dysrhymmias
Lopressor (metoprolol) - HTN & MI
Timoptic (timolol) glaucoma
LOL
43
Q

Beta Blockers

Adverse reactions

A

low in frequency
dose dependent
more for IV use, elderly, hepatic or renal insuff.
Bradycardia and Hypotension

44
Q

Beta Blockers

nursing implications

A

Assess C-V system
Check Apical Pulse notify MD if <60/min and hold
Teach pt & Family effects & adverse effects
No ETOH, smoking, OTC
Not for pt with respiratory conditions = bronchospasm

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