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N5334 FINAL STUDY GUIDE REVISION EDITION
The tricyclic antidepressants should be prescribed cautiously in patients with - CAD Atropine - Cause pupil finalization in eye exam Bethanechol (Urecholine) - GI/GU stimulation following surgery, parasympathomimetic Pyridostigmine (Mestinon) - Category: Cholinergic, Anticholeristinase, Use: Myasthenia Gravis, Precautions: May cause cram,ps, increased peristalsis Doxazosin (Cardura) - Hypertension, BPH Albuterol - Asthma inhaler Scopolamine (Transderm Scop) - Anticholinergic (drying effects) Used for motion sickness Can cause sedation, anticholinergic effects Phenylephrine - Sudafed PE; sympathomimetics Propranolol (Inderal) - Beta adrenergic blocker for hypertension
Dobutamine (Dobutrex) - sympathomimetic Indication: short term management of heart failure Action: Dobutamine has a positive inotropic effect (increases cardiac output) with very little effect on heart rate. Stimulates Beta1 receptors in the heart. Nursing Considerations:
- Monitor hemodynamics: hypertension, ↑HR, PVCs
- Skin reactions may occur with hypersensitivity
- Beta blockers may negate therapeutic effects of dobutamine
- Monitor cardiac output
- Monitor peripheral pulses before, during, and after therapy
- DO NOT confuse dobutamine with dopamine Acetylcholine binds to both _____ and ______ receptors - nicotinic and Muscarinic Prescribing basics - Prescribing is regulated by state BON Proper RX - Providers name and address, Telephone DEA Pt name/DOB/Addres Name of Drug, strength, SIG(directions) with indication/Route and frequency, Quantity and signature.
half life - Time required for the amount of a drug in the body to decline by 50%, drugs with shorter half lives must be administer frequently. 4.5-5.5 times the half life to get steady state and to be limited from the body what the body does to the drug - absorption, distribution, metabolism, excretion Distribution - movement of absorbed drug in bodily fluids throughout the body to target tissue. Properties affecting: lipid/water solubility, PH affects ionization of drug, protein binding, size of molecule (smaller molecules are more able to diffuse) Tissue: fat, bone, blood/brain barrier (only lipid soluble will pass), placental barrier (many drugs can pass) Protein binding - unbound drug is free which is active, crosses membrane. Low plasma proteins result in more free drug. Competition: when 2 highly bound drugs are given it increases the level of both drugs Metabolism - take place in the liver mostly. Chemical change of a drug structure to: Enhance excretion, inactivate the drug, increase therapeutic action, active a prodrug (inactive until metabolized in the body into the active compound, ex: levodopa), increase or decrease toxicity CYP450 - enzymes constitutes the most important of the phase I metabolizing enzymes (account for about 75% of drug metabolism in the liver)
Phase 2: conjugation reaction occur leading to large increases in hydrophilicity of the substrates rendering them more readily excretable Substrate - an agent that is metabolized by an enzyme into a metabolite and product and eventually excreted Inhibitors - compete with other drugs for a particular enzyme affecting the metabolism (decreased) of the substrate and decreases the excretion of the substrate and increasing the circulating drug inducer - competes with other drugs for a particular enzyme affecting metabolism of the substrate (increases) decreasing the efficacy of the drug excretion - renal: passive glomerular filtration, active tubular secretion, tubular reabsorption, gi tract, lung, sweat and salivary, mammary genomics - study of the complete set of genetic information present in a cell, an organism, or species pharmacogenetics - the study of the influence of hereditary factors on the response of individual organisms to drugs, and the study of variations of DNA and RNA characteristics as related to drug response Pharmacogenetics tests - Mentioned on drug labels can be classified as "test required," "test recommended," and "information only." Currently, four
What is included in application guidelines for topical anesthetics - avoid wrapping the site and heating the site, avoid application to open skin Which medication will not cause rebound headaches from overuse? - propranolol (preventative) What is the best option for menstural migraine? - low dose estrogen about 3 days prior to menses What food can trigger migraines? - Hot dog d/t nitrates What medication is a Seratonin 1B1D receptor agonist? - Sumatriptan Butterbur can help as prevention for migraine therapy. What side effect can occur? - Liver damage What are the 3 main classes of opiod receptors? - Mu kappa delta Which of the following will reserve he effects caused by opioid agonist? - naloxone Which of the medications are used to treat OIC? - Naloxegol, methylinaltrexone, lubiprostone
Tolerance is defined as - increased does of a med needed to obtain the same response Which medication is used for opioid abuse? - Naltrexone Euphoria induced by morphine: - An exaggerated sense of well-being caused by the activation of mu receptors Which medication is given nasally for migraines? - Butorphanol Which of the following describes the mechanism of NSAIDs? - Inhibition of the cyclo-oxygenase enzyme Second generation COX 2 inhibitors: - Suppress inflammation and cause less risk for gastric ulceration than COX 1, increase risk for heart disease Which of the following medications should not be given with ASA? - Glucocorticoids Which medication is given for acetaminophen overdose? - Acetylcysteine What are non endocrine therapeutic uses for glucocorticoids? - RA, SLE, IBS, Bursitis, OA, Gout, disorders of the eye
Aspirin - Non-selective inhibitor of COX, therapeutic use analgesic, fever, mensural cramps, anti-inflammatory, Alzheimer disease. Risk for bleeding is too high. Increased secretion of acid and pepsin therefore ruins all the protective lining of the stomaching. Pt at risk: alcoholics, smoking, older people, or people who have had PUD. Risk of ASA is not advised in pt younger than 18 r/t Reyes syndrome, pregnancy because it cause ductus arteriosis, if given with Ibuprofen it can decrease effects of ASA. first generation non-ASA NSAIDS - inhibit COX 1 and 2, given for RA and OA, no protection against MI or stroke. ex. Ibuprofen, alieve, diclophinac. Indicated for mild to moderate pain, antiinflammaroty and analgesic effects. risk of GI bleed Celebrex - second generation non ASA nsaids, lower risk for GI but can still cause renal impairment. given for OA, RA, dysmenorrhea. S/E: abdominal pain, renal impairment, sulfa allergies. Drug interaction: warfarin, Decrease effects of furosemide, (increases)lithium, ACE inhibitors. Acetaminophen - Analgesic and antipyretic. Hepatotoxicity risk. No more than 3 g in 24 hr period. for overdose: acetylesistine. Can blunt immune response of vaccines glucocosteroids - Risk for Cushings disease, diabetes, OA, risk for GI bleeds. If given over 7 days, needs to be tapered off unless on inhaled Corticorsteriods. Used in labor to mature lungs of infants. Therapeutic use: allergic condition, asthma and immune suppression.
RA - very different from OA. Autoimmune disease.Symmetrical morning stiffness that last for over an hour. Shortens life span of patients. Increases risk for CVD and stroke. When testing these patient, you want to do a full immunological test because it comes with other autoimmune diseases.
- First line treatment are NSAIDS and first line DMARD (methotrexate, minocycline) Gout - Monoarticular arthritis, d/o r/t kidney don't excrete enough uric acid. Only way to diagnosis is joint aspiration and look for the uric crystals Prevention is best Gout preventions - Migraines - trial and error of medication and triggers. start with over the counter and move to more aggressive over time. +2 a month, preventative medication is okay. Abortive medications: NSAIDS, ergoalcoloids (cause vasoconstriction), triptans (Seratonin 1b1d receptor agonist) Sumitriptan, cause vasoconstrictions, maximum dose is 200mg a day. can cause coronary vasospasm Preventative: Beta blockers, antiseizure medications (depikote and topimax), tricyclic antidepressants, Calcium Channel blockers, botox, vitamin b2/Co Q enzyme and butterbur. cluster headaches - intensely painful headaches that affect one side of the head and may be associated with tearing of the eyes and nasal congestion, occur in series, 5-15 minutes
Dry mouth Dizziness Headache Excessive sweating Other possible side effects may include: Tiredness Constipation Insomnia Changes in sexual function, such as reduced sexual desire, difficulty reaching orgasm or the inability to maintain an erection (erectile dysfunction) Loss of appetite Brupropion (wellbutrin) - stimulate, appetite suppressant, helps with sexual side effects of SSRIs, S/E: dry mouth, constipation and increase risk of seizure disorder St. John's Wart (Hypericum perforatum) - don't want to give this to patients with SSRIs, a lot of drug reactions, dosed at 300mg TID, CYP450 inducer lithium - Excretion is reduced with sodium levels are low. S/E: GI disturbances, n/v/d, ataxia, thirst, tremor, high urine output, death. Very narrow therapeutic index Benzodiazepines - drugs that lower anxiety and reduce stress: alprazolam, diazepam
alcohol abuse - nicotine abuse - Prior to starting antidepressants, patients should have what lab testing to rule out
- hypothyroidism A 32 yo male is starting paroxetine for depression. He is complaining of not being able to obtain an erection. What can the NP do to help? - add bupropion A 6 yo us being treated with ethosuximide. She should be monitored for: - Blood dycrasias which are uncommon but possible. Sandy is taking lamotrigine for seizures and wants an rx for OCPs which can interact with lamotrigine and cause: - reduced lamotrigine levels, requiring an increase in the dose of lamotrigine Norepinephrine binds to both ____ and ____ receptors - alpha and beta Atropine is considered to be the antidote to ______ toxicity - Cholinergic Sympathomimetic is the same as _______ agonist - adrenergic
Alpha 2 agonist such as clonidine will _____ BP? - lower A ______ inotrope will increase contractility; a ______ chronotrope will decrease HR; while a _______ dromotrope will decrease conduction via the AV node? - positive, negative, negative Epinephrine is used in many emergency situations, such _______, Cardiac______ and hypo_______ - anaphylaxis, cardia arrest, hypotension what "onset of actions symptoms" should be reviewed with patients who have been newly prescribed an SSRI? - they can feel a bit of nausea but this resolves in about 1 week Jaycee has been on Escitalopram for a year and is willing to try tapering off the SSRI. What is the initial dosage adjustment when starting to taper off antidepressants? - reduce the dose by 50% for 3-4 days One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as: - GI problems, drowsiness and nausea, seizures and coma are serious problems. monitoring of a patient on gabapentin to treat seizures includes: - Recording seizure frequency, duration and severity
Sam, aged 65, is started on L-dopa for his Parkinson's disease (PD). He asks why this is necessary. You tell him: - the primary goal of therapy is to replace depleted stores of dopamine A 55yo patient develops parkinson's disease characterized by unilateral tremors only. The NP will refer the patient to a neurologist and should expect initial treatment to be - Ropinirole (lesser symptoms need lighter drug) Inattention and sleep-wake cycle disturbance are hallmark symptoms of: - delirium 3 types of information needed for neuropharmacologic drugs: - type or types of receptors through which the drug acts. Normal response to the activation of those receptors (Agonist vs antagonist) What the drug in question does to receptor function cholinergic receptors and adrenergic receptors are mediated each by? - Cholinergic by acetylcholine and adrenergic by epinephrine and norepinephrine what are the subtypes of cholinergic and adrenergic receptors? - cholinergic: nicotinic and mu Adrenergic: Alpha1, alpha2, beta1, beta 2 and dopamine what are the functions of alpha1 receptors? - Vasoconstriction, ejaculation and contraction of bladder neck and prostate
Side effects of anticholinergics - dry mouth, blurred vision, constipation, photophobia, urinary retention "I can't see, can't pee, can't spit, can't shit" understand alzheimer's medications - understand parkinsons medications - Know psychiatric drugs (1st and 2nd line) for: depression anxiety bipolar OCD - Sterling's Law of the Heart - the more the cardiac muscle is stretched, the stronger the contraction Calcium Channel Blockers - agents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent or treat angina pectoris, some arrhythmias, and hypertension s/e: constipation, lower extremity edema, increased risk of heart block and gingival hyperplasia
Know the stages of hypertension/heart failure - bond williams classification - Renin Inhibitors - Aliskiren (Tekturna) binds tightly with renin and inhibits the cleavage catalyzes the conversion of angiotensin i (inactive) to angiotensin II (highly active) ACE inhibitors - contstricts renal blood vessels acts on the Kidney to promote retention of sodium and water and excretion of potassium "PRIL" Captopril, Enalapril, Afosiopril Antihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases BP, Decreased Aldosterone secretions, Sodium and fluid loss. Check BP before giving (hypotension) *Orthostatic Hypotension ARBS - block access of angiotensin II cause dilation of arterioles and veins
