UCO Pharm Exam 1

Cholinergic Crisis

severe muscle weakness and respiratory paralysis due to excessive acetylcholine - hyper-salivation - small pupils - muscle twitching - unusual paleness - sweating - muscle weakness - difficulty breathing

Factors affecting drug absorption include (select all that apply)

stomach pH, lipid solubility of drug, route of administration, drug dissolution

For a client receiving IV morphine sulfate, which action would the nurse immediately take when noting a client's respiratory rate is 8 breaths per min?

stop administering the med

the nurse notes a child is showing symptoms of lightheadedness, drowsiness, and hallucinations while infusing an opioid. which action would the nurse take next?

stop administration of the medication

Overstimulation of the parasympathetic branch leads to: (select all that apply)

sweating, hyper-salivation, bradycardia

A patient is started on a norepinephrine drip. What side effects can this medication cause? Select all that apply:

tachycardia, hypertension

which advice will the nurse provide to the client after a health care provider prescribes aspirin for a client with severe arthritis?

take the med with meals

Pharmacokinetics

the study of drug movement throughout the body

An antihypertensive (to treat high blood pressure) drug belongs to which of the following classification?

therapeutic classification

therapeutic vs pharmacological classification

therapeutic: class of medication (e.g. antihypertensive, anticoagulant, antihyperlipidemic) pharmacological: how it works to lower BP or thin blood

Acetaminophen reduces fever by direct action at the level of the hypothalamus

true

Acetylcholine binds with muscarinic receptors in organs targeted by the parasympathetic nervous system.

true

Anticholinergics act by blocking the effects of acetylcholine at muscarinic receptors

true

Aspirin and ibuprofen-related drugs inhibit both COX-1 and COX-2.

true

Lipid soluble are better absorbed than water soluble drugs.

true

long term therapy with Ibuprofen can cause stomach ulcers.

true

A medication can be part of more than one class

true (e.g. Aspirin: analgesic,- antipyretic, anti-inflammatory, and anti-platelet)

which statement by the student nurse indicates the need for further education about medication administration?

"I should advise the certified medical assistant to administer IV medication"

which response would the nurse give to a client taking ibuprofen for rheumatoid arthritis who asks the nurse if acetaminophen can be substituted?

"Ibuprofen has anti-inflammatory properties, and acetaminophen does not."

COX-1

- protects stomach lining - decreases fever - promotes platelet aggregation (blood clotting)

COX-2

- triggers inflammation and pain

Opioids Analgesics

-Act Centrally (CNS) -Morphine like substances, for moderate to severe pain -They are Narcotics -Binds to the opioids receptors in the brain to sedate the body -Produce analgesia and CNS depression.

which therapeutic outcome is expected after administering ibuprofen?

1. pain relief 2. temperature 3. reduced inflammation

1 kg = ? lbs

2.2 lbs

1 tsp = ? mL

5 mL

Acetaminophen should NOT be administer to which of the following patients?

A 34- year patient with history of liver cirrhosis

Route of administration

A drug's route of administration affects the rate and extent of absorption of that drug. The three routes are: - Enteral (GI tract) - Parenteral - Topical

First-pass effect

A medication given orally must first passthrough the liver before reaching the circulation. If a drug is given IV, the liver is bypassed and more drug reaches circulation/ more of the drug is bioavailable.

Agonist

A substance that acts like another substance and therefore stimulates an action

Neurotransmitters (parasympathetic)

Acetylcholine (ACh)

Beta blocker medications such as propranolol and atenolol work by preventing neurotransmitters from stimulating which type of receptor?

Adrenergic receptors

Drug Potency

Amount of drug required to produce an effective, therapeutic response This doesn't mean it is "better," it just takes less of it to work. Dilaudid vs Morphine - dilaudid is more potent, smaller dose to get the same effect

NSAIDs

Aspirin, Ibuprofen, Naproxen, Indomethacin,and Ketorolac -Can help decrease inflammation by inhibiting prostaglandins synthesis -Side Effects: GI Upset, GI Bleeding, Bronchospasm, Renal toxicity, Increase Blood pressure, possible headache.

Cholenergic crises is treated with

Atropine

The sympathetic and parasympathetic nervous systems are two divisions of the _____.

Autonomic nervous system

A client who is receiving atenolol for hypertension frequently reports feeling dizzy. Which effect of atenolol is responsible for this response?

Blocking the adrenergic response

Atropine Prototype

Blocks what systems activity: parasympathetic actions of ACh and induces symptoms of the flight-or-fight response Effects on pupils: dilate during eye exams Effects on GI tract: treat hyper-motility diseases such as IBS Effects on glands: decrease secretions

Opioids Serious Side Effects (Killer)

CNS sedation Respiratory depression -Low RR -Hold dose for RR below 10 -Hypotension (Vasodilation) -Low BP -orthostatic hypotension Urinary retention GI upset and constipation Black box warning

Neuropathic Pain

Caused by direct injury to the nerve Example: Back pain due to compressed nerve, Sciatica, Phantom pain -Analgesic treatment of this pain may not be successful or very high doses might be needed which can be toxic. -This type of pain respond well to adjuvant pain therapy like the use of: Antiseizure drugs and antidepressants (not pain medications) Gabapentin is an antiseizure drug used to relieve the pain of diabetic neuropathy (numbness or tingling due to nerve damage in people who have diabetes)

Bethanechol Chloride (Urecholine) Prototype

Class: Cholinergic Muscarinic Agonist Action: stimulates Acetylcholine receptor sites Use: Urinary retention Side effects: decrease HR/BP, bronchial constriction, abdominal cramping Contraindications: asthma, peptic ulcers, GI/GU obstruction, decrease HR/BP Antidote: Atropine (cholinergic Antagonist) Considerations: monitor side effects, monitor intake and output

Acetaminophen (Tylenol) Prototype

Class: antipyretic and analgesic Action: reduces fever by direct action at the level of the hypothalamus and dilation of peripheral blood vessels Not effective treating arthritis: has no anti-inflammatory properties Admin Alerts: liquid forms available in varying concentrations, never administer to pts consuming alcohol daily, found in many OTC products (try not to duplicate doses by taking several concurrently) Acute poisoning: anorexia, nausea, vomiting, dizziness, lethargy, diaphoresis (sweating), chills, abdominal pain, and diarrhea High dose concern: liver damage Black Box: severe or fatal liver injury and allergic reactions (angioedema, difficulty breathing, itching, rash) Lab Test to monitor: Transaminases (ALT, AST) and bilirubin Antidote: N-acetylcysteine

chemical name

Describes the drug's chemical composition and molecular structure [e.g. (RS)-2-(4-(2-methylpropyl)phenyl) Propanoicacid ]

Distribution

Distribution involves the transport of drug throughout the body after they have been absorbed or injected. Depends on: - drug-protein complex - Special barriers such as the placenta and brain barrier.

Factors that Affect Absorption

Drug Formulation (Liquids better absorbed than tablets) Dose (higher doses are absorbed faster) Route of administration Size of the drug molecule Digestive motility Blood flow Lipid solubility : lipid soluble are better absorbed than water soluble drugs.

Opioids agonists

Drugs that activates both mu and kappa receptors (opioids receptors) (morphine and codeine)

A patient is discharged home with a prescription of oxycodone with acetaminophen. What teaching should the nurse provide to this patient based on the side effects of the medication?

Encourage increased fluids and fiber in the diet.

Role of cholinesterase

Enzyme that hydrolyses acetylcholine into Acetyl CoA and Choline.

You are caring for a client who has diabetes complicated by kidney disease. You will need to make a detailed assessment when administering medications because this client may experience problems with:

Excretion

Nursing Considerations and Patient Education Notes

Food interactions: Watch for notes on: - Milk - Grapefruit juice - Empty stomach OR take with food (this impacts the acidity of the stomach) Drug interactions Watch for notes on: - Antacids (impacts the acidity of the stomach) - Drug classes - it could be dangerous to give two drugs that have the same effect

which life-threatening complication may occur in clients taking high dose or long term ibuprofen?

GI bleeding

The nurse is giving a medication that has a high first-pass effect. The physician has changed the route from IV to PO. The nurse expects the oral dose to be:

Higher because of the first-pass effect.

The parenteral route of drug administration means the drug is aministerred via which routes? Select all that apply

IM, SC, IV

A patient is complaining of severe pain and has orders for morphine sulfate. The nurse knows that the route that would give the fastest pain relief would be which route?

IV

Nonopioids Analgesics

Include NSAIDs and few centrally acting drugs, (eg. Acetaminophen) -NSAIDs: Non Steroidal Anti-Inflammatory Drugs. Inhibit cyclooxygenase (COX), an enzyme responsible for the formation of prostaglandins (pain mediator) -Given for mild to moderate pain -Fever -Inflammation

Which of the following effects are mediated by the sympathetic nervous system?

Increased heart rate

A patient who has acute kidney injury (AKI) may have a diminished capacity to excrete medications. The nurse must assess the patient more frequently for what development?

Increased risk for drug toxicity

Myelinated A-delta fibers:

Myeline sheets help messages get to the brain quickly; immediate sharp pain

which treatment would the nurse anticipate administering to a toddler who has acetaminophen poisoning?

N-acetylcysteine

Which of the following is a narcotics/opioids antagonist?

Naloxone

Physiology of Pain.

Once pain impulse reaches the spinal cord a neurotransmitter called substance P is secreted an is responsible for the continuation of pain

Opioid Agonists

Opioids agonist include -MOrphine Sulfate (the prototype) -HydrOmOrphone (Dilaudid) -OxycOdOne -COdeine -Fentanyl Given for moderate to severe Pain They work by binding to opioids receptors in theCNS -Onset of action of IV morphine: 1-2 min -Peak: 5-15 min -Half live 2 hours

Opioids

Opioids also called narcotics, or controlled substances -Natural like morphine (from Poppy plants ) -Synthetic like meperidine -Opioids exert their effects by attaching to opioid receptors (mu, kappa, delta and noceceptin) on nerve cells in the brain, spinal cord, gut, and other parts of the body. -When this happens, the opioids block pain messages sent from the body through the spinal cord to the brain.

Antidote for opioids

Opioids antagonist -Naloxone (brand name Narcan) When to give : -If RR is below 10 to reverse respiratory depression -If patient un-arousable (fall asleep while talking) -O2 saturation 90% or below -other signs pinpoint pupils with some opioids Naloxone reverse sedation and causes agitation , hypertension and tachycardia

Chronic Pain

Persist for weeks, months, or years -Pain lasting for more than 6 months can interfere with ADL -Causes hopelessness and helplessness (eg. depression)

A patient is complaining of severe pain and has orders for morphine sulfate. The nurse knows that the route that would give the slowest pain relief would be which route?

SC

Other Uses of Opioids

Suppress the cough reflex (eg. codeine) Slowing the GI motility (for Diarrhea) Sedation for minor procedure Intense relaxation Side effects -Nausea, vomiting, constipation, dependence.

Absorption: Ionization

The ability to become ionized depends on the surrounding pH - acids are best absorbed in acids - bases are best absorbed in bases A medication that becomes ionized (in an environment with the opposite pH) becomesLESS lipid-soluble.

Trade name (proprietary name)

The drug has a registered trademark; use of the name is restricted by the drug's patent owner (usually the manufacturer) (e.g. Motrin®, Advil®)

prototype

The first drug of a particular drug class to be developed. Drugs from the same class or family can be compared to this drug. For example: Penicillin is the prototype of the beta-lactamantibacterial drugs - So if a drug if a Beta-lactam antibiotics you know that its properties are similar to penicillin

Absorption

The movement of a drug from its site of administration across the body membranes to circulation. The more rapid the absorption, the faster the onset of the drug

Division of the Nervous System

The nervous system 1. The central nervous system (CNS) - a. Brain and spinal cord 2. Peripheral Nervous system (PNS) - a. Sensory Neuron: Carry Signals from SensoryOrgans - b. Motor Neurons : Carry signals from muscle and glands

Pharmacodynamics

The study of what the drug does to the body

Pharmacokinetics (ADME)

absorption, distribution, metabolism, excretion

A woman in the parking lot near you accidentally slams her hand in the door. As she screams for help, you quickly note that her pain is categorized as .

acute

Naloxone Prototype (opioid)

class: treatment of acute opioid overdose or misuse Action: bind with both mu and kappa receptor sites to produce profound analgesia Routes of Admin: PO, rectally, SC, IM, IV Administration Alert: oral can be given sublingually, causes peripheral vasodilation (orthostatic hypotension), never open capsules or crush extended release forms of opioids Reversal Signs: agitation, hypertension and tachycardia

Unmyelinated C fibers:

conducts signals much more slowly, but has many branches so that it reports to the brain from many different areas of the body; diffuse pain

unmyelinated C fibers carry nerve impulses in a very fast manner

false

Which organ has only beta-1 receptors?

heart

Catecholamines

hormones secreted by the adrenal medulla that affect the sympathetic nervous system in stress response -norepinephrine -epinephrine -dopamine

The main organ responsible for drug excretion from body is/ are:

kidneys

which result would the nurse monitor in a client with acetaminophen overdose?

liver function tests

a client develops gastric bleeding and is hospitalized. which area would the nurse assess closely during the history?

medications taken routinely or recently

which adverse effect of morphine indicates the need for naloxone administration?

respiratory depression

5 rights of medication administration

right patient, right medication, right route, right dose, and right time.

Acetylcholine and Cholinergic Transmission

• Acetylcholine (ACh): is secreted into the synaptic cleft, as a result of a stimulus where it diffuses across to find nicotinic or muscarinic receptors. • ACh in the synaptic cleft is rapidly destroyed by the enzyme acetylcholinesterase (AChE), and choline is reused. • Choline is taken up by the presynaptic neuron to make more ACh, and the cycle is repeated. • Drugs can affect the formation, release, receptor activation, or destruction of ACh.

Cholinergic Drugs

• Parasympathomimetics are divided into two sub-classes: direct acting and indirect acting • Direct acting like Bethanecol (Uricholine) - Muscarinic receptor agonist • The indirect-acting parasympathomimetics, like neostigmine (Prostigmin) - Cholinesterase inhibitor: prevent the destruction of ACH thus prolonging its action

The nurse administers morphine 4 mg IV to a patient for treatment of severe pain. Which assessment require immediate nursing interventions?

The patient's respiratory rate is 10 breaths per minute.

Non-pharmacological Pain Management

-Acupuncture -Art or music therapy -Biofeedback therapy -Chiropractic manipulation -Guided imagery -Heat or cold packs -Massage -Meditation or prayer -Natural agents applied to the skin to produce a warming sensation -Relaxation therapy -Transcutaneous electrical nerve stimulation (TENS).

Ibuprofen Prototype

-Class: analgesic, anti-inflammatory, antipyretic -Admin Alerts: give drug on empty stomach unless nausea or vomiting occurs, patients with asthma may have hypersensitivity -Adverse effects: low dose (nausea, heartburn, epigastric pain, dizziness) Rare (aplastic anemia, leukopenia, and anaphylaxis) High dose or long term (GI ulcer/ bleeding) -Black Box: increased risk of thrombotic events, MI, and stroke -Contraindications: pts with active peptic ulcers should not take -Affects on antihypertensives: may be reduced when taking Ibuprofen

Aspirin Prototype

-Class: nonopioid analgesic, NSAID, anti-inflammatory -Action: inhibits prostaglandin synthesis in the processes of pain and inflammation and produces mild to moderate relief -should be discontinued 1 week before surgery because platelet aggregation inhibition is irreversible -Adverse effects: Gastric discomfort and bleeding -Contraindications: Because it increases bleeding time, it should not be given to pts receiving anticoagulant therapy such as warfarin and heparin -Antacid effect: decrease aspirin effects -Effect of PT: prolong, by decreasing prothrombin production -Treatment for overdose: activated charcoal, gastric lavage, laxative, or drug therapy

Autonomic Nervous System

-Exert involuntary control over the contraction of cardiac muscle and smooth muscle as well as glandular activity. It is divided into: 1. Sympathetic division 2. Parasympathetic division -Organs and glands receive nerves from both branches of the ANS.

Therapeutic uses of anticholinergic

-GI Disorders: decrease secretion of gastric acid in peptic ulcer disease; slow intestinal motility -Ophthalmic Procedures: cause mydriasis for eye examination or other procedures or cyclopegia -Cardiac Rhythm Abnorms: accelerate heart rate in pts experiencing bradycardia -Anesthesia Adjuncts: when combined with other meds= decrease excessive respiratory secretions and reverse bradycardia caused by general anesthesia -Asthma & COPD: Aclidinium, ipratropium, and tiotropium are useful in treating asthma and symptoms of COPD because they can dilate the bronchi -Overactive Bladder: oxybutynin (Ditropan, Oxytrol) treat this; urge incontinence Parkinson's Disease: benzotropine are used to treat pts with this disease or those that have tremors

Acute Pain

-Intense pain -Occurs over a short period -Lasts from time of injury until tissue repair (like surgery or sports injury)

Opioids (Black box warning)

-Life threatening risk of respiratory depression -Risk for abuse and addiction -Assess pain level, Vital signs especially respiratory rate and status -Give IV opioids very slowly over 2-3 min. -Fast push is fast death

Pain Assessment

-Pain is subjective -The Numeric Pain Rating Scale (adult) mild (1-2); moderate (4-6); severe (7-10) "Please indicate the intensity of current, best, and worst pain levels over the past 24 hours on a scale of 0 (no pain) to 10 (worst pain imaginable)"

Lipid soluble drugs

-Passive transport - Faster absorption/onset -Plasma membranes have a lipid bilayer, permeable to lipid soluble molecules

Prostaglandins

-Prostaglandins are pain mediators. -Prostaglandins are formed with the help of 2 enzymes 1. Cyclooxygenase type 1 (COX-1) 2. Cyclooxygenase type 2 (COX-2). -Aspirin and ibuprofen inhibit both COX-1 and COX-2. -They are non-selective NSAIDs

Nonopioids Analgesics

-Reduce inflammation -Treatment of mild to moderate pain and fever -Eg. Aspirin, NSAIDs, COX-2 inhibitors

Cholinergic

-Referring to cells that use acetylcholine as their synaptic transmitter. a. Nicotinic receptors: located in both parasympathetic and sympathetic divisions of the ANS b. Muscarinic receptors: located on target tissues in the parasympathetic nervous system.

Selective NSAIDs COX-2 [Celecoxib (Celebrex)]

-Used to decrease pain and inflammation -Because they are selective for COX-2 inhibition, they do not have the GI side effects like the non-selective NSAIDs (i.e. ibuprofen) -Used for osteoarthritis and rheumatoid arthritis -Increased risk of thrombosis leading to clot formation, Deep vein thrombosis, MI, and PE.

Nociceptor pain

-pain resulting from the activation of nerve ending that receive and transmit pain to the brain (CNS) further divided into: 1. Somatic pain- sharp, well localized sensations in the body 2. Visceral pain- generalized dull and internal throbbing or aching pain

Select the correct statements about opioids (select all that apply)

1. Opioids have the potential to cause physical and psychologic dependence 2. Opioids are used for moderate to extreme pain that cannot be controlled with other classes of analgesics 3. Opioids are effective at suppressing the cough reflex

Classification and Naming of Cholinergic Drugs

1. Stimulation of the parasympathetic nervous system • Cholinergic drugs or parasympathomimetics: produce the characteristic symptoms of the rest-and-digest response .• Example: a cholinergic drug (parasympathomimetic)decreases the heart rate • Remember: mimetic = mimics 2. Inhibition of the parasympathetic nervous system • cholinergic-blocking drugs or anticholinergics.

Neuropathic pain is commonly described as steady _______ , electric shock, or ________ sensations. When tissue is damaged, ________ are released locally, including histamine, _________ , and prostaglandins.

1. burning 2. pins and needles 3. chemical mediators 4. bradykinin

which action is the nurse's responsibility when administering prescribed opioid analgesics?

1. count the client's respirations 2. document the intensity of the clients pain 3. verify thee number of doses in the locked cabinet before administering the prescribed dose

which information must be clearly described in the medication administration record (MAR) before administering a medication?

1. dosage and route 2. clients full name 3. time to be administered 4. frequency of administration 5. full name of prescribed medication

The ______ nervous system is activated under conditions of stress and produces a set of actions called the _______. The _________ nervous system is activated under non stressful conditions and produces symptoms called the _______ response.

1. sympathetic 2. fight-or-flight 3. parasympathetic 4. rest-and-digest

Enteral drug administration routes

1. tablet, capsule, or liquid 2. sublingual (under tongue) 3. buccal (cheek) 4. nasogastric and gastrostomy

Absorption: Ionization pt 2

Acids are ionized in a basic environment (where the pH is high) Bases are ionized in an acidic environment (where the pH is low) Aspirin (ASA) is an example of a medication that is acidic. - Once the acid aspirin moves into the basic environment of the intestines, it does not pass through the plasma membrane as easily. Aspirin needs to be absorbed in the stomach.

Parasympathetic Nervous System

Activated under non-stressful conditions - The rest-and-digest response. • HR, BP decline • Digestive and urinary system promoted • Bronchi constrict The neurotransmitter of the (PNS) is acetylcholine • In general the PNS is the opposite of the SNS, but not always • The two branches cooperate to achieve a balance of readiness and relaxation.

The Sympathetic Nervous System

Activated under stress produces "fight-or-flight response". As a result: -HR, BP : Increase sending more blood to muscles -Liver produce more glucose for energy -Bronchi dilates for more air into lungs -Pupils dilates for better vision. The neurotransmitter of the Sympathetic (SNS) is Norepinephrine also called (Epinephrine, Adrenalin)

Opioid antagonist

Drugs that block both mu and kappa receptors; - Example, Naloxone (Evzio, Narcan)

A medication lowers blood pressure by dilating peripheral blood vessels. Another medication prevent blood clots by acting on the coagulation cascade in the body. The above descriptions are:

The pharmacologic classification of the drugs

Metabolism

Is the process of chemically converting a drug to a form that is easily removed from the body(inactive metabolite is one example) - Primary site of drug metabolism is Liver this function affects drug action

The Neural Mechanism of Pain

The nociceptors are free nerve endings located throughout the body. -Their role is to tell the body "this hurts" -There are many different kinds of nociceptors; some detect harmful chemicals (like chili peppers), others harmful temperatures (like the surface of a hot stove), and others to detect bodily harm. -The nociceptors can be of two forms Myelinated A-delta fibers Unmyelinated C fibers

which med is indicated for management of clinical manifestations associated with an opioid overdose?

Naloxone

Generic name (nonproprietary name)

Name given by the United States Adopted Name Council (e.g. ibuprofen)

The sympathetic nervous system postganglionic neuron releases what neurotransmitter?

Norepinephrine

Catecholamines are responsible for the body's "fight-or-flight"response. which of the following is/ are natural catecholamines: Select all that apply.

Norepinephrine, Epinephrine, Dopamine

Adjuvant Analgesics

Not analgesics but can provide pain relief Classifications: antidepressant, anti-seizure, sedative, or anti-inflammatory. -For cancer pain -For neuropathic pain (damaged nerve) -neuropathic pain in diabetes -herpes zoster infections, acute trauma, cancer, and certain autoimmune conditions

Absorption Considerations

Oral: - Dissolution: to be absorbed oral drug must dissolve (the quicker the dissolution the faster the absorption. PH of Stomach: - Presence of food - Taking a medication that decreases stomach acid First-pass effect Perfusion - if blood flow is decreased to the skin, and an injection is given SQ, what will happen to the rate of absorption? Digestive Motility: Either increases or decreases absorption based on in what part of the intestines the drug is absorbed High fat meals may slow motility and impact absorption

Excretion

The process by which drugs are removed from body. Kidneys are the main organ for drug excretion - If the kidneys are impaired, the drug may accumulate. What would need to happen to the dosage? **pH in kidney environment very important factor in excretion/reabsorption **some drugs will be excreted quicker if the pH of the filtrate changes

Opioid Prototype Drug: Morphine (Astramorph PF)

class: Opioid analgesic action: binds with both opioid receptor sites to produce profound analgesia. Causes euphoria, constriction of the pupils, and stimulation of cardiac muscle Conditions: heart failure, pulmonary edema, and acute chest pain associated with MI peak action: 60 min PO, 20 min IV adverse effects: hallucinations, nausea, constipation, dizziness, itching, severe respiratory depression or cardiac arrest, tolerance contraindications: may intensify or mask pain of gallbladder disease, due to biliary tract spasm; avoid if you have acute/severe asthma, GI obstruction, & sever liver or kidney impairment Black Box Warning: when administered as an epidural, patients must be observed for 24 hours Drug food interaction: alcohol, other opioids, sedatives, and antidepressants (lead to severe respiratory depression and death)

Prazosin Prototype

class: antihypertensive action: rapid decrease in peripheral resistance that reduces blood pressure Uses: in combination with other drugs, such as beta-blockers or diuretics, in the pharmacotherapy of hypertension Acts on: Alpha1 Main side effect: orthostatic hypotension First dose: given at bedtime Overdose treatment: fluid expanders (normal saline) or vasopressors (dopamine, dobutamine)

What happens to the pupils when stimulated by the sympathetic nervous system?

dilate

What happens to GI motility when stimulated by the parasympathetic nervous system?

increases

receptors of the parasympathetic nervous system

muscarinic and nicotinic

Neurotransmitters (sympathetic)

norepinephrine and epinephrine

________: the time it take for the drug to start working ________: drug reaching its maximum effect ________: is the time required for half of the drug to be metabolized and eliminated from the body.

onset of medication peak action plasma half-life

Anticholinergics may be ordered for which conditions? (Select all that apply.)

peptic ulcer disease, irritable bowel syndrome, bradycardia