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Central Nervous System
the body's primary nervous system that consists of the brain & spinal cord
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Peripheral Nervous System
located outside of the brain & spinal cord, is made up of two divisions: the autonomic & the somatic
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Autonomic Nervous System
also called the visceral system, innervates (acts on) smooth muscles & glands.
its function include control and regulation of the heart, respiratory system, GI tract, bladder, eyes & glands
involuntary nervous system over which a person has little or no control
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Somatic Nervous System
voluntary system that innervates skeletal muscles over which there is control
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Sympathetic Nervous System (also called the Adrenergic system)
at one time was believed that adrenaline was the neurotransmitter that innervated smooth muscle.
the neurotransmitter however is norepinephrine
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Parasympathetic Nervous System (also called the Cholinergic System)
the neurotransmitter at the end of the neuron that innervates the muscle is acetylcholine
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Adrenergic Blockers (symphatholytics or adrenergic antagonists)
effects epinepherine
drugs that block the effects of the adrenergics neurotransmitter
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Adrenaline Blockers
- *block Alpha and Beta Receptor sites
- 'directly: by occupying receptors
- 'indirectly: by inhibiting release of eurotransmitters epinephrine and norepinephrine
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Adrenaline
acute stress response system
response to high stress or exciting situations
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Norepinephrine
fight or flight response
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Acetylcholine
neurotransmitter located at the ganglions and the parasympathetic terminal nerve endings
it innervates the receptors in organs, tissues, and glands
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Adrenergic receptors
*located through out body
* Alpha1 & alpha2
*Beta1 & beta2
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Alpha1 effects
increase cardiac contractility, vasoconstriction, dilate pupils, decrease salivary gland secretion, increase bladder and prostae constraction
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Alpha2 effects
- Inhibit norepinephine release, promotes vasodilation--> decrease BP
- Decrease GI motility and tone
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Alpha Blocker (alpha adrenergic blockers)
drugs that block or inhibit a respinse at the alpha adrenergic receptor site
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ALPHA1 Effects of adrenergic blockers @ receptors
vasodilation, decrease, reflex tachycardia, pupil dilation, suppresses ejaculation, reduces contraction of smooth muscles in bladder adn neck
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(alpha blockers) Drugs that inhibit a reponse at alpha adrenergic receptor site
- *selective
- 'block Alpha1
- *Nonselective
- 'block alpha1 & alpha2
- *Action
- 'cause both arterial & venous dilation--> reducing peripheral vascular resistance & BP
- 'effects receptors on prostate gland & bladder-decrease resistance to urinary outflow
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Alpha Blockers examples
*Doxazosin (cardura)-used for HTN & BPH
*Prazosin (Minipress)- used for HTN
*Terazosin (Hytrin)- used for HTN & BPH
*SE: 1st dose orthostatic hypotension, dizziness, syncope
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Beta1 effects
*Effects HEART
*Increase cardiac contractility & HR, increase renin secretion-->Inc BP
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Beta2 effects
- *Effects LUNG
- *Bronchiodilation
- *increase blood flow in skeletal muscles
- *Decrease uterine flow
- *ALSO: decreases GI tone and motility and activates live glycogenolysis which increase blood glucose
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Beta Blockers (Beta adrenergic blockers)
decreases heart rate, decrease in BP usually follows
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Beta 1 Blocker (beta 1 adrenergic blocker) effect at receptors
*Reduces cardiac contractility
*Decreases pulse
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Beta 2 blocker (adrenergic blockers) effects at receptors
*Bronchoconstriction
*contracts uterus
*inhibits glycogenolysis
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Beta Blockers--indications
*antianginal: decreases demand for myocardial oxygen
*cardioprotective: inhibits stimulation from circulating catecholamines
*Class II antidysrhythmics
*Antihypertensives
*some are used to tx heart failure
*tx of migraine headaches.
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Beta blockers (BBs) action
decreases Bp & P
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Non selective Beta Blockers
*Blocks Beta 1: decrease BP & P
*Blocks Beta 2: bronchoconstriction
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Beta Blockers examples
*Propanolol (Inderal)
*Atenolol (Tenormin)
*Metoprolol (Lopressor)
*carvedilol (coreg)
*Nadolol (corgard)
*Timolol (blocadren, timoptic)- timpotic used for glaucoma
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Non selective (beta blocker)--Propanolol
*Contradictions: COPD
*SE/AE: wt gain, impotence, decreased libido, reversible alopecia
*Drug Interactions: decr drug effects with several drugs, Heart block may occur with digoxin, calcium channel blockers
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Selective beta blocker (Beta Adrenergic Blocker) metoprolol (Lopressor), atenolol (tenormin)
- *blocks beta 1 only
- 'Dec BP & P
- 'fewer side effects
- *SE/AE:
- 'bradycardia, hypotension, dysrhythmias, CHF, dizziness, fainting, fatigue, mental depression, hypoglycemia
* assess bp & p before give
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Beta Adrenergic Blockers Drug interactions
*dec effects with NSAIDs
*Inc effects with alpha blockers, atropine, anticholinergics
*inc risk of hypoglycemia-insulin, sulfonylureas
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Adrenergic blockers (alpha & beta) NRSG implications
- *assess for allergies & hx of COPD, hypotension, cardiac dysrhythmias, bradycardia, heart failure, or other cardiovascular problems
- *beta blockers should never be stopped abruptly
- *teach to change position slowly to prevent or minimize postural hypotension
- *avoid caffeine & alcohol
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B Blocker drug NRSG implications
- report to physician:
- *weight gain of more than 2 pounds in 1 day or 5 pounds in a week
- *edema of feet or ankles (fluid retention)
- *SOB
- *excessive fatique or weakness
- *syncope or dizziness
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possible drug interactions with adrenergic blocking drugs
- antacids
- antimuscarinics/anticholinergics
- diuretics an cardiovascular drugs
- neuromuscular blocking drugs
- oral hypoglycemic drugs
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Classifications of Adrenergics
*direct-acting sympathomimetic
*Indirect-acting sympathomimetic
*mixed-acting sympathomimetic
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Catecholamines
*chemical structure of a substance that can produce a sympathomimetic response
*Endogenous- epinepherin, norepinepherin, & dopamine
*Synthetic- dobutamine & isoproternol
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Catecholamines effects
increase HR, cause casoconstriction, brochial dilation, dilates pupils
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Sympatholyics
inhibits the postganglionic functioning of the SNS
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Sympathomimetics
effects transmitter substances in the SNS
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Cholinergic Blocking Agents (anticholinergics, parasympatholytics)
drugs that inhibit the actions of acetylcholine by occupying the acetylcholine receptors
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Parasympathomimetics (cholinergic agonists)
drugs that stimulate the parasympathic nervous system
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Neurotransmitter
norepinephrine & dopamine
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Amphetamines
stimulate the release of neurotransmitters from the brain and sympathetic nervous system
ordinarily cause euphoria and alertness, nut they can also cause sleeplessness, restlessness, temors, and irritability
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ADHD (Attention Deficit Hyperactivity Disorder)
problem of not being able to focus, being over active, not being able to control behavior, or a combination of these
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Narcolepsy
sleep disorder that causes excessive sleepiness and frequent daytime name attacks
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Barbiturates
drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia.
They are also effective as anxiolytics, hypnotics, and anticonvulsants
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Benzodiazepines
minor tranquilizer or anxiolytic sedative or hypnotic for inducing sleep
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Anesthetics
general or local
depress the CNS, alleviate pain, and cause a loss of consciousness
Nitro oxide (laughing gas) was the first
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Drugs that decrease nervousness, excitability & irritability
Benzodiazepines
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Drugs that cause sleep
Hypnotics/sedatives
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Avoid use of alcohol when taking these medications
CNS stimulants
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Zaleplon (Sonata), Zolpiden (Ambien) & eszoplicone (Lunesta) are examples of these drugs
nonbenzodiazepine hypnotics
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Act to relive pain associated with skeletal muscle spasms
muscle relaxants
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Temazepam (restoril) & triazolam (halcion) are examples of these drugs
Benzodiazepines
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The medically approved reasons to use these drugs include ADHD, narcolepsy & weight loss
CNS stimulants
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Baclofen (lioresal), cyclobenzaprine (flexeril), dantrolene (Dantrium), tizanidine (zanaflex) are examples of these drugs
muscle relaxants
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Amphetamine (addrell), methylphenidate (concerta, ritalin) & sibutramine (meridia) are examples of these drugs
CNS stimulants
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Seldomly used as sedatives/hypnotics today due to their side effet profile- respiratory depression, decreased REM sleep & N&V
Barbiturites
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'pam, lam, or am" drugs- used for sedative/hyonotic effect, anxiolytic effect
Benzodiazepines
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Can occur after the prolonged use of sedatives/hypnotics
Rebound REM
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What patient teaching should be included regarding administering the CNS stimulants for ADHD
take before meals, monitor weight loss, monitor for onset tourette syndrome in children, monitor for tachycardia & palpitations, don't stop abruptly
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the drugs cause pupil dilation, bronchiodilation, vasoconstriction
Adrenergic drugs
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the "Fight or Flight" system
Sympathetic Nervous System
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Referred to as the "Rest & Digest" or "Rest & Relax" system
Parasympathetic Nervous System
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Nursing implications & patient teaching for this group of drugs would include: use of sunglasses for photophobia (following dilation of eyes); elderly patients be cautious of heat stroke; report SE: urinary hesitancy and/or retention, constipation
anticholinergic drugs
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The cardioselective type of the drugs will cause a decrease in HR and decreases mycardial contractility, thus reducing myocardial oxygen demand
Beta blockers
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Dopamine, dobutamine and epinepherine are all examples of cardioselevtive
adrenergic blocking drugs
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these drugs are used to decrease salivary excretions, treat urinary frequencym and motion sickness
anticholinergic drugs
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these drugs end in "lol" or "olol"
beta blockers
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Doxazosin, Prazosin, Terazosin are all examples of this type of drug
alpha blockers
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The "first dose effect" of hpotension can occur with the use of this group of drugs
alpha blockers
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side effects of these drugs are tachycardia, headache, nervousness, palpitations
adrenergic drugs
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side/adverse effects of these drugs include hypotension, bradycardia, impotence & decreaced excercise tolerance
alpha blockers
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thes drugs are also known as Cholinergic agonists
cholinergic drugs
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it is important to assess for allergies and history of COPD, hypotension, cardiac dysrhythmias, bradycardia, heart failure, or other cardiovascular problems with thes drugs
adrenergic blocking drugs
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"SLUDGE" is an acronym for the side effects for these drugs
Cholinergic drugs
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the side effects of these drugs cause: dry mouth, constipation, urinary retention, orthostatic hypotension
Anticholinergic Drugs
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These drugs cause pupil dilation constriction, slowed heart rate, bronchiole constriction, vasodilation
adrenergic blocking drugs
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Adrenergic Drugs and Adrenogeneric Blocking drugs effect this system
Sympathetic Nervous System
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Another name for these drugs is Sympathomimetics
Adrenergic Drugs
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Cholinergic Drugs and Anticholinergenic drugs affect this system
Parasympathetic Nervous System
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Ipratropium (Atrovent), Benztropine (Cogentin), and Trihexyphenidyl (Artane) are all examples of this type of of drugs
Anticholinergic Drugs
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The primary effect of in creased heart rate and force of contraction occurs when these receptors are stimulated
beta 1 Adrenergic Receptors
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The primary effect of bronchodilation occurs when these recepors are stimulated
beta 2 adrenergic receptors
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Albuterol (Proventil/Ventolin) & Salmeterol (Serevent) are _________ that are used to treat illnesses such as ________ & ________
* bronchiodilators
* Asthma & COPD
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When administering a bronchodilator inhaler & a corticosteroid inhaler which should be administered first?
Bronchodilator inhaler
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The opthlamic adrenergic drugs are u sed to trea what disease of the eye?
glaucoma
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Overuse of nasal decongestants, such as Afrin, may cause _________
Rebound Congestion
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Terosin (Hytrin) & Tamsulosin (Flomax) are both used to treat _____
BPH
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These drugs should never be stopped abruptly
cholinergic drugs
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When takine beta blockers a petient should be taught to report of weight gain of ______ _______, or edema of the feet and ankles as this may indicate ________ ________
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Tacrine (Cognex), Donepezil (Aricept), Memantine (Namenda) are all _______ drugs used to treat ____ _____
* indirect active Cholinergic
*ALzheimer's Dementia
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"SLUDGE" stands for ____, _____, _____, _____, ____,_____ (side effects of cholinergic drugs)
- *salivation
- *lacrimation
- *urination
- *defecation
- *GI upset
- *emesis
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Therapeutic effects of Anti- Alzheimer's drugs may occur for up to ______
6 weeks
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Two ways to administer General Anesthetics
general & local
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Anesthetic type that causes a certain part of body to be insensitive to pain without loss of consciousness ______
local anesthetic
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This type of anethetic would be used for stitching a small laceration on the patient's arm ____
Local anesthetic
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Two main types of Local Anesthetics
esters & amides
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Spinal or epidural are examples of this type of anesthetic
injectable (IV) anesthetic
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This type of anesthetic would be used for more serious or complicated surgeries
general anesthetic
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Anesthetic type that produces unconsciousness, skeletal & smooth muscle relaxation
general anesthetic
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This type of anesthetic may be used to numb a sore throat
topical anesthetic
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used for diagnostic procedures such as a colonoscopy and minor surgical procedures
moderate or conscious sedation
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When using this a patient can; maintain their own airway; will not recall the procedure; will have decreased anxiety & sensitivity to pain
moderate & conscious sedation
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A potentially serious side effect of general anesthetics characterized by high fever and tachycardia
malignant hyperthermia
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Which category of antipyschotics are MOST effective in treating both positive and negative symptoms associated with schizophrenia?
atypical antipsychotics
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A person taking MAOI (antidepressant) can have what serious side effect if he or she eats aged cheeses, drinks wine or takes it concurrently with an SSRI
hypertensive crisis
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Pseudoparkinsonism or Extrapyramidal Symptoms (EPS)
Characterized by stooped posture, tremor, rigidity, pill rolling
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Akathisia
Characterized by restlessness, pacing, unable to stand still, constant movement
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Tardive Dyskinesia
characterized by lip smacking, tongue protrusion, involuntary bodily movements
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Neuroleptic Malignant Syndrome
Characterized by high fever, rigidity, altered mental status
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Typical or 1st Generation Anitpsychotic Drugs
*Chlorpromazine (Thorazine)
*Haloperidol (Haldol)
*Fluphenazine (Prolixen)
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Atypical or 2nd Generation Antipsychotic Drugs
*Clozapine (Clozaril)
*Risperidone (Risperidal)
*Quetiapin (Seroquel)
*Ziprasidone (Geodon)
*Aripiprazole (Abilify)
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Which Antipsychotics requires close monitoring of the WBCs
Clozapine (Clozaril)
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Which are the "pam, am, or lam" drugs
Benzodiazepines
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which antipsychotics are used to treat anxiety
*Benzodiazepines
*Buspirone (Buspar)
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which group of antipsychotics is used to treat bipolar disorder
*lithium
*SSIRs
*MAOIs
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which antipsychotics are used to treat bipolar disorder has a narrow therapeutc index
lithium
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What medications are SSRIs
*Sertraline (Zoloft)
*Fluoxetine (Prozac)
*Paroxetine (Paxil)
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which medications are TCAs
Amitriptyline (Elavil)
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which group of antidepressant medications can cause a "cheese effect"
MAOIs
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Adrenergic Drugs
*Drugs that stimulate the sympathetic nervous system (SNS)
*"Hitting Deer"
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Epinephrine (Adrenaline) action
- *vasoconstriction (alpha 1)
- *Increase HR (Beta 1)
*promotes bronchiodilation (beta 2)
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Epinephrine Routes
SQ, IV, topical, inhalation, intracardiac
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Epinephrine actions
- *anaphylaxis, anaphylactic shock
- *Bronchospasms
- *cardiac arrest
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Epinephrine Contraindications & caution
- *cardiac dysrhythmias, hypertension
- *hyperthyroidism, pregnancy
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Epinephrine Side Effects & Adverse Reactions
*SE: N&V, hypertension, tachycardia, nervousness, tremors, agitation
*AE: Ventricular fibrillation & pulmonary edema
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Epinephrine Drug Interactions
Beta- blockers (BBs)- Decreases epinephrine action
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Epinephrine Nrg interventions
- *Monitor BP, Pulse, Urine output (kidney funtioning)
- *report SE
- *Avoid cold medications/diet pills if hypertensive, DM, CAD, or dyrhythmias
- *avoid adrenergics when nrg infant
- *avoid continuous use of adrenic nasal sprays
- * monitor IV site for infilration
- 'antidote:phentolamine mesylate (regitine)
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Albuterol (provetnil) & Salmeterol (serevent)
*Selective: acts on B2 adrenergic receptors, promotes bronchodilation
*Uses: treat/prevent bronchospasms, asthma, bronchitis, COPD
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Albuterol (Proventil) Dosage/uses
*ACUTE ATTACK- quicker
- *PO, inhalation, nebulizer
- *treat bronchospams (short-acting/ rescue inhaler)
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Salmeterol (Serevent)
*inhalation (powder or inhaler)
*prevent bronchospasms (long acting-routine inhaler)
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Albuterol (proventil) & Salmeterol (servent) SE/AE/Caution
*SE/AE: tremors, nervousness, restlessness, dizziness, reflex tachycardia, hallucinations, cardiac dysrhythmias
*Caution: severe cardiac disease, HTN, Hyperthyroidis, DM, pregnancy
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Albuterol (proventil) & Salmeterol (Serevent)
NRSG implications
*Instruct to avoid factors that exacerbate condition
*encourage fluid intake (up to 3000ml per day) if permitted
*educate about proper dosing, use of equiment & care
*salameterol (serevent) is indicated for prevention of bronchospasms, not managemtn of acute sx.
*if using another type of inhaler use bronchiodilator first- wait 5 min- than administer the corticosteriod.
*ALWAYS rinse mouth after corticosteriod -->kills normal bacteria in mouth
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albuterol & salmeterol therapeutic effects
- *Return to normal resp rate
- *improve breathsounds, fewer crackles/wheezes
- *increase air exchange- check pox (normal >95%
- *decrease cough
- *less dyspnea
- *improve blood gases
- *increase activity tolerance
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other Adrenergic Drugs
- *Dopamine- used to inc BP- mostly used in ICU
- *dobutamine- used to treat cardiac decompenstion- ICU
- *pseudoepinephrine (sudafed, Afrin (use 1 week @ most)- usd to treat nasal congestion
- over use can cause rebound congestion
- *terbutaline (brethine) used to tx bronchospasms
- *phenylpropanolamine (dimetapp, dristan) taken off market d/t inc cardiac events
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cholinergic drugs
*drugs that stimulate the PNS
*mimic the effects of the PNS neurotransmitter: acetylcholine
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Cholinergic Receptors
*muscarinic receptors: affect smooth muscles
*Nicotinic receptor: affect skeletal muscles
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effects of Cholinergics
- *cardiovascular: dec BP & P, vasodilation, slows conduction of av node
- *GI: inc tone & motility, inc peristalsis, relax sphincter muscles
- *GU: contract bladder, inc ureter tone, relax sphincter muscle, stimulate urination
- *EYE: inc pupil contriction, inc accomodation
- *lungs: bronchial constriction, inc secretions
- *glands: inc salivation, perspirations, tears
- *striated muscle: inc neuromuscular transmission
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Direct acting cholinergics
- *GI: Metoclopramide (reglan)-used to tx GERD & to tx gastroparesis (inc gastric emptying)
- *GU: Bethanechol (Urecholine)-used to stimulate urination (for tx of urinary retention)
- *EYES: Pilicarpine- used to tx glaucoma, topical application due to poor oral absorption
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Indirect acting cholinergics
*MYASTHENIA GRAVIS: physostigmine, Pyridostigmine, Neostigmine-improves muscle strength
- *ALZHEIMER'S DEMENTIA: tacrine (cognex), Donepzil (Aricept), Memantine (Namenda)-used to improve memory in AD. (helps to slow progression of the disease
- - NOT A CURE FOR AD
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Chloinergics Drug SE/NRSG implications
- *hypotension
- *bradycardia
- *bronchoconstriction
- *excessive salivation
- *inc Gastric acid secretion
- *abd cramps
- *blurred vision
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cholinergics nrsg implications
- *assess I & O
- *teach procedure for administering eye gtts
- *medications should be taken as ordered and not abruptly stopped
- *doses should be spread evenly apart to optimize the effects of med
- *therapeutic effects of anti alzheimers drugs may not occur for up to 6 weeks
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Cholinergics -Monitor theraperutic effects:
- *alleviated s/sx of myasthenia gravis
- *in pts with urinary retention/hypnotic bladder, urination should occur within 60 minutes of bethanechol adminstration
- *Metoclopramide: inpostoperative pts with dec GI peristalsis, look for: Inc bowel sounds, passage of flatus, occurrence of bowel movements
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cholinergic interactions
- *anticholinergics, anti histamines, sympathomimetics-antagonize cholinergics drugs, results in decrease responses
- *other cholinergic drugs-additive effects
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