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the neurotransmitter in the sympathetic nervous system
norepinephrine
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Receptors located on target organs are called adrenergic because when they are activated
adrenalin-like response occurs
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Name the adrenergic receptors
- alpha receptors
- beta receptors
-
Constricts blood vessels and dilation of pupils.
Used in the treatment of nasal congestion, hypotension
alpha1
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Inhibition of release of norepinephrine. Used in the treatment of hypertension
alpha2
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Increased HR and force of contraction, release of renin.
Used in the treatment of cardiac arrest, heart failure, and shock
beta1
-
Inhibition of smooth muscle.
Used in the treatment of asthma and premature labor contractions
beta2
-
Lipolysis, relaxation of the detrusor muscle. Used in the treatment of overactive bladder
beta3
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fight or flight uses which nervous system?
sympathetic nervous system
-
rest and digest uses which nervous system
parasympathetic nervous system
-
cholinergic drugs induce which response?
- rest and digest
- decrease HR
- constrict bronchioles
-
adrenergic blockers induce which response?
- rest and digest
- decrease heart rate
- constrict bronchioles
-
adrenergic drugs induce which response?
- fight or flight
- elevate the HR
- dilate the pupils
- dilate the bronchioles
-
anticholinergic drugs induce which response?
- fight or flight
- elevate the HR
- dilate the pupils
- dilate the bronchioles
-
degenerative and destruction of dopamine-producing neurons
Parkinson's disease
-
Absence of dopamine allows acetylcholine stimulation which causes the following symptoms in Parkinson's
- Tremors
- Muscle rigidity
- Bradykinesia
- Postural instability
- Flat affect
- dementia
-
Used in the treatment of Parkinson's a substance that is converted into dopamine by an enzyme in the brain
-
why is carbidopa-levopoa more effective in treating Parkinson's?
because carbidopa prevents levodopa breakdown making more levodopa available to enter the CNS
-
Name reasons the anticholinergic (trihexyphenidyl "Artane") is used in Parkinson's
- Used in early stage
- Blocks acetylcholine
- Inhibits overactivity in the brain
-
Alzheimer’s Disease drug therapy goal to inhibit anti cholinesterase
- Delay progression of disease
- Improve ADL’s
- Improve behavior
- Improve cognition
-
Alzheimer's disease drugs
"An excellent cognition is remembered"
- aricept
- exelon
- cognex
- reminyl
-
Name two drugs used for muscle spasms
- dantrolene (Dantrium) – direct acting antispasmodic
- cyclobenzaprine (Flexeril) – centrally acting muscle relaxant
-
name the action of dantrolene (Dantrium)
relaxes muscle spasms by interfering with the release of calcium ions from storage areas inside skeletal muscle.
-
name the side effects of dantrolene (Dantrium)
muscle weakness, drowsiness, anticholinergic effects, dizziness, nausea, diarrhea, tachycardia, erratic BP, photosensitivity, urinary retention
-
name anticholinergic effects of dantrolene (Dantrium)
dry mouth, urinary retention, tachycardia
-
name the action of cyclobenzaprine (Flexeril)
inhibits upper-motor-neuron activity in the brainstem
-
name the side effects of cyclobenzaprine (Flexeril)
CNS depression, hepatic toxicity, physical dependence, anticholinergic effects, low BP
-
name the anticholinergic side effects of cyclobenzaprine (Flexeril)
dry mouth, urinary retention, or hesitancy, blurred vision, constipation
-
name the action of alendronate (Fosamax)
lowers ALP, the enzyme associated with bone turnover
-
name the side effects of alendronate (Fosamax)
diarrhea, constipation, flatulence, nausea, vomiting, metallic taste, hypocalcemia, hypophosphatemia, abdominal pain, dyspepsia, arthralgia, myalgia, headache, rash.
-
Name some items of patient teaching for alendronate (Fosamax)
- Take on an empty stomach preferable 2 hours before breakfast
- Take with a full glass of water only
- Remain in an upright position for at least 30 min
- Encourage limited amounts of sun exposure daily without sunscreen, discourage prolonged sun exposure
- Calcium, iron, antacids, and certain mineral supplements interfere with absorption of alendronate and may decrease effectiveness – take 2 hours or more after alendronate
-
Name the action of Heparin
inhibit specific clotting factors to prevent formation or enlargement of clots
-
Name the side effects of heparin
abnormal bleeding, thrombocytopenia
-
Name the action of warfarin (Coumadin)
- inhibit specific clotting factors to prevent formation or enlargement of clots
- Interferes with Vitamin K synthesis in liver affecting clotting factors
-
Name the side effects of warfarin (Coumadin)
abnormal bleeding
-
Name some nursing considerations or warfarin (Coumadin)
- Do not use in pregnancy (category X)
- Monitor PT/INR
- Not recommended in pts with prosthetic heart valves
- Occasional or binge drinking tends to raise INR
-
Name important patient teaching for patients on warfarin (Coumadin)
- Do not take any NSAID’s, ASA, Herbs (ginkgo, garlic)
- Monitor intake of vitamin K-rich foods (garlic, beans, broccoli, cabbage, cheese, fish, milk, rice, spinach, yogurt, soybeans, asparagus)
-
purpose of enoxaparin (Lovenox)?
- Low-molecular-weight heparin
- Duration of action is 2-4 times longer than heparin
- Fewer f/u labs
- Pts and caregivers can give at home
- Less likely to cause thrombocytopenia
-
Why is diet important in patients on blood thinners?
May increase the risk of bleeding or inhibit the therapeutic effects of blood thinner
-
Why to drug-drug interactions matter when taking blood thinners?
- certain drugs may increased effect of blood thinners
- NSAID’s
- ASA
- Vitamins/herbs/vaccines (gingko, vitamin k)
- SSRIs/antidepressants
- Steroids
- antibiotics
-
antidote to warfarin (Coumadin) overdose:
vitamin K
-
antidote to heparin?
protamine sulfate
-
what do antiplatelet drugs do?
block platelets from aggregating
-
what does pentoxifylline (Trentol) do?
Reduces the viscosity of RBC’s
-
what does alteplase (Activase) do?
- thrombolytic
- converts plasminogen to plasmin, which digests fibrin and dissolves clot
-
Why do we check INR?
- used to monitor warfarin therapy
- High values indicate a risk for bleeding and dose may need to be reduced
-
Why do we monitor aPTT?
- used to monitor heparin pharmacotherapy
- high values indicate a risk for bleeding and dose may need to be reduced
-
Labs used to monitor coagulation
- RBC's
- PT/INR
- aPTT
- LFT's
- platelets
- CBC
-
what is the action of epoetin alfa (Epogen/Procrit)?
stimulates erythropoiesis (RBC production)
-
what are the side effects of epoetin alpha (Epogen/Procrit)
- hypertension
- headache
- fever
- nausea
- diarrhea
- edema
-
what are some nursing considerations of epoetin alfa (Epogen/Procrit)?
- education on routine and frequency of labs
- encourage increased water intake and healthy diet
- encourage adequate rest – educate on low hgb, hct
- monitor BP/HR transportation
- extra-curricular activities
-
RBC have diminished capacity to deliver oxygen to tissues is called?
anemia
-
causes of
anemia?
- blood loss due to hemorrhage
- increased erythrocyte destruction
- decreased erythrocyte production
-
signs and symptoms of anemia
- pallor of skin and mucous membranes
- decreased exercise tolerance
- fatigue and lethargy
- dizziness and fainting
- increased respiratory rate and HR
- heart failure
-
classification of anemia are based on what?
Description of the erythrocyte’s size and color
-
vitamin b12 or folic-acid deficiency are what type of anemia?
pernicious anemia
-
this type of anemia is due to one of the following:
acute or chronic blood loss, ulcer, heavy menstruation, pregnancy, intensive athletic training
iron deficiency anemia
-
what does cyanocobalamin (Nascobal) treat?
pernicious anemia
-
Iron therapy nursing considerations:
- Periodic labs to monitor RBC’s, Hct, Hgb
- Dietary iron rich, b-12, and folic acid foods
- Administration of meds, side effects
- Monitor for s/s of hypokalemia
- Increase fiber intake – iron may constipate
- Adequate rest
- Keep out of children's reach
-
what is the action of ferrous sulfate?
supplements iron needed by body
-
what are the side effects of ferrous sulfate?
- nausea
- heartburn
- constipation
- dark/black stools
-
what is the action of oprelvekin (Neumega)
stimulates the production of megakaryocytes and thrombopoietin
-
what are the side effect of oprelvekin (Neumega)
- edema
- fever
- headache
- dizziness
- dyspnea
- fatigue
- rash
- nausea
- vomiting
-
what is the action of filgrastim (Neupogen)?
- increase neutrophil production in the bone marrow
- enhance the phagocytic and cytotoxic functions of existing neutrophils
-
what are the nursing considerations in filgrastim (Neupogen)?
- adverse effects
- lab monitoring
- high risk for infection
- respiratory distress
- dizziness
- encourage rest
- increased water intake…
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