Exam 1

Acetylcholinesterase Inhibitor Drugs have what common suffix

"Stigmine"

What medications are Inhibitors?

"azole" AcE "mycins" amiodarone diltiazem verapamil

a-1 specific antagonist adverse effects

"first dose" hypotension reflex tachycardia rebound hypertension (if stopped suddenly) Orthostatic/postural hypotension Sexual dysfunction

Neuro-muscular Blocker uses

"paralyzing" Suppress gag reflex Paralyze all muscles including diaphragm Will receive before intubation.

Alpha 1 blocker drugs ends in

"sin"

Alpha 1 Antagonist drugs have what common suffix?

"sin" Tamsulosin Prazosin

Anticholinergic agent common suffix

"tropine"

Adverse Effects of B1 Antagonists

(Metoprolol tartrate) Orthostatic Hypotension (Dizziness/ Fall Risk) Bradycardia Precipitation of heart failure exacerpation (Fluid build up in lungs) Masks S/S of hypoglycemia

Total bilirubin normal range

0.3-1.0 mg/dL (liver)

When should you administer pyridostigmine?

1 hour before a meal OR 2 hours after

When do you administer a direct acting cholinergic agent

1 hour before meals OR 2 hours after a meal.

What are the nine "rights"?

1) right drug 2) right dose 3) right time 4) right route of administration 5) right patient 6) right documentation 7) right reason 8) right response 9) right of patient to refuse

Albumin normal range

3.5-5 g/dL (liver)

Normal Urine Output

30 mL/hr

normal range of alkaline phosphatase (ALP) and in what organ?

30-120 units/L (liver)

Normal range alanine aminotransferase (ALT) and in what organ?

4-36 units/L (Liver)

Consider a drug removed after how many half lives?

4-5

A nurse is caring for a 1-month-old infant who weighs 3500 g and is prescribed a dose of cephazolin 50 mg/kg by intermittent IV bolus three times daily. How many mg should the nurse administer per day? (Numeric value only. Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) ________ mg/day

525 mg/day

blood urea nitrogen (BUN) normal range organ?

8-20 mg/dL Kidneys

Estimated Glomerular Filtration Rate (eGFR) normal range and organ

90-120 ml/min Kidneys (Glomerular)

What is malignant hyperthermia?

A side effect of general anesthesia - tachycardia, hypertension, acid-base and electrolyte abnormalities, muscle rigidity, hyperthermia

A client is to receive oral guaifenesin twice a day. Today, the nurse was busy and gave the medication 2 hours after the scheduled dose was due. Which right did the not adhere to? A. Right time B. Right dose C. Right route D. Right medication

A.

What lab values can be used to test for liver impairment?

AST ALT ALP{ albumin total bilirubin

Which of the following values would suggest impaired liver function? BUN of 12 mg/dL SCr of 2.5 mg/dL GFR of 120 ml/min AST of 86 units/L ALT of 200 units/L Potassium of 4.2 mEq/L ALT of 12 units/L

AST of 86 units/L ALT of 200 units/L Potassium of 4.2 mEq/L

What do you expect to find in liver impairment tests?

AST- Elevated (above 35 units/L) ALT-Elevated (above 26 units/L) ALP- Elevated (>120 units/L) Bilirubin- Elevated (>1 mg/dL) Albumin- DECREASED (<3.5 g/dL)

Controlled Substances are ranked by

Abuse/Misuse Potential Medical Use Dependency Potential

Indirect Acting Cholinergic Agents are also called

Acetycholinesterase Inhibitors

Parasympathetic/ Cholinergic Division Key

Acetylcholine (ACh)

Direct acting cholinergic agonists produce effects that mimic

Acetylcholine (Ach)

Pyridostigmine is a

Acetylcholinesterase inhibitor

Whatis Isotretinoin used to treat?

Acne

Sympathetic/ Adrenergic Division Key

Adrenaine (Epinephrine)

Category C drugs and pregnancy

Adverse effects reported in the animal fetus; information on humans not available

assessment/recognizing cues

Age Medications Polypharmacy Lab test results History of smoking and alcohol Dietary habits Deficits ETC

Older Adult Considerations: Metabolism

Aging liver produces fewer enzymes, affecting drug metabolism Reduced blood flow to the liver

Pyridostigmine (Indirect Acting Cholinergic Agents) is used to treat

Alzheimer's REverse Anticholinergic Effects Myasthenia Gravis Reverse Effecs of Neuromuscular Blocking Agents

Atropine (Anticholinergic Agent) MOA

Antagonist at various muscarinic receptors in parasympathetic division particularly in the heart allowing sympathetic to take control.

Atropine is what kind of drug?

Anticholinergic Agent

Warfarin is an

Anticoagulant

What is a contraindication?

Any condition that renders a particular form of treatment improper or undesirable

How is someone relaxing after a meal illistrated?

BP low HR low RR low GI activity high Skin=warm Pupils constricted Miosis

SOFT drugs contraindication

BPH Glaucoma Urinary retention/hesitation

Tamsulosin (Flomax) has two main uses. What are they?

Benign prostatic Hyperplasia (BPH) Bladder Outlet Obstruction (Kidney Stones)

What are the 7 inducers?

CSPRSPO- Carbamazepine Smoking Phenytoin Rifampin St John's Wart Phenobarbital Oxcarbazepine

Adverse Effects of Atropine (Anticholinergic Agents)

Cant See Cant Pee Cant Spit Cant Shit Canot Schvitz (Sweat)

Adverse effects of SOFT drugs

Cant see Cant Pee Cant Spit Cant Shit Cant Schvitz

Adverse effects of Epinephrine on the heart(Vasopressors)

Cardiac complications Tachycardia Dysrhythmia ischemia- MI

What are the different pregnancy safety categories?

Category A Category B Category C Category D Category X

What defines Nephrotoxicity?

Certain drugs may be harmful to the kidneys and the resulting damage is named Nephrotoxicity.

Muscarinic receptors are what kind of receptor?

Cholinergic

What are potentials complications of Highly Protein Bound Drugs?

Deficiency in protein/Albumin Competition (Two drugs can result in toxicity)

direct acting cholinergic agent Bethanechol MOA

Directly stimulates the parasympathetic division mainly located in the bladder

Which part of Pharmacokinetics is primarily influenced by liver function?

Distribution Metabolism

What is Phase IV of a clinical trial?

Drug reaches the market (gen pop) Post marketing surveillance

Which part of Pharmacokinetics is influenced by kidney function?

Elimination

What is the therapeutic index/range?

Enough drug is present to produve therapeutic response, but not enough to be toxic

In which step of the nursing process does the nurse determine the outcome of medication administration?

Evaluation

Category X drugs and pregnancy

Fetal abnormalities have been reported and positive evidence of fetal risk in humans; not to be used during pregnancy

How many schedules of controlled substances are there?

Five

What happens if you give Warfarin with Fluconazole?

Fluconazole is an inhibitor so higher levels of the Other drug

The nurse knows that which factors will affect the absorption of orally administered medications? (Select all that apply.) Form of drug preparation Time of day pH of stomach Patient in high-Fowler's position Presence of food in the stomach

Form of drug preparation Time of Day pH pf stomach Presence of food in stomach

Most cholinergic drugs target

GI Tract Bladder Eyes Heart

Pediatric Considerations : Absorption

Gastric pH less acidic Gastric emptying is slowed Topical absorption faster through the skin Intramuscular absorption faster and irregular First-Pass elimination by liver is reduced

Pediatric Considerations: Distribution

Greater total body water means lower fat content Decreased level of protein binding Immature blood-brain barrier—more drugs enter the brain

How is someone who is threatened illistrated?

HR increase RR rapid and deep Skin= cold/ sweaty Pupils dilate

LABetalol is used to treat

HTN management in pregnant pts. so LABor and delivery

Epinephrine Beta 1 activation

Heart + /chronotropic (HR) + Inotropic (CO)

Beta 1 receptors

Heart kidneys eyes

What is Symptomatic Bradycardia? What is one of the first drugs given?

Heart is in constant battle between Sympathetic and Parasympathetic nercous system Atropine blocks the Vagus Nerve's influence on the heart

Metoprolol tartrate is used to treat

Heart- current or hx of MI Hypertension Angina Dysthymias Heart failure Hyperthyroidism Migraine prophylaxis Glaucoma (drops)

Explain "Can't Shit" for Anticholinergic Adverse Effects

Increase Fiber and fluid intake Exercise

"Stigmine" or Pyridostigmine MOA

Inhibits acetylcholinesterase not at the receptors, which increases acetylcholine's activity in the parasympathetic system.

What is an AKI (acute kidney injury)?

Injury to the kidney which results in SUDDEN elevated SCr/BUN and decreased eGFR/CrCl

What are ways to avoid the "First Pass Effect"?

Intravenous, intramuscular, and sublingual

Pediatric Considerations; Excretion

Kidney immaturity affects glomerular filtration rate and tubular secretion Decreased perfusion rate of the kidneys may reduce excretion of drugs

Primary site of elimination

Kidneys

What organ does CYP450 target?

Liver enzymes

Primary organ of Metabolism

Liverpool

Older Adult Consideration: Distribution

Lower total body water percentages Increased fat content Decreased production of proteins by the liver, resulting in decreased protein binding of drugs Increased circulation of free drugs

Epinephrine Beta 2 activation

Lungs- Bronchdialation

Intended outcome taking pyridostigmine for Alzheimer's disease?

Maintain cognition

Serum Creatinine (SCr) normal range. What organ?

Male- 0.6-1.2 mg/dL Female- 0.5-1.1 mg/dL Kidnets

Pyridostigmine "stigmine" adverse Effects

Minor DUMBBBELS Drop in BP Drop in HR Cholinergic Crisis

Evaluation of "Sin" drugs (Nursing Process)

Monitor BP 2-6 hours after initiation Monitor Urine Output Monitor Urinary retention symptoms

Parasympathetic (Cholnergeic) Autonomic receptors (Locks)

Muscarinic (M) Nicotinic (N)

Direct Acting Cholinergic agent lock

Muscarinic Receptor

Explain "Can't See" for Anticholinergic Adverse Effects

Mydriasis (too much light, even at night) Blurred vision Dry eyes increased IOP

Direct Acting Cholinergic Agents Key

Natural AcetylCHOLINE

What drug type would cross into breastmilk?

Non-Polar Lipid-Soluble

What type of drug would reach the brain?

Non-Polar Lipid-Soluble

Which type of drug would reach a developing fetus?

Non-Polar Lipid-Soluble

Asthma/COPD is a contraindication for what blocker drugs

Non-selective Beta Blockers

Plan/Implementation for "sin" drugs

Often given at night educate about "First Dose Phenomenon" Never Stop suddenly Educate about sexual dysfunction

First Pass Effect only effects what kind of drugs?

Orally given

Oxybutynin, solifenacin, tolterodine are all used to treat

Overactive Bladder (OAB) Urinary Incontinence

What is a mnemonic used for remembering drug inhibitors?

PACMAN loves Grapefruit Juice?

What are seven main drug inhibitors?

PACMAN loves Grapefuit juice Protease inhibitor (HIV) Antifungals (that end in 'azole) Cimetidine (H2RAs) Macrolides (ACE, ends in'mycin) Non-DHP Calcium Channel Blockers (diltiazem, verapamil) Grapefruit Juice

PROpanolol is used to treat

PROfessions (Hypertension)

Adverse effects of Neuro-Muscular Blockers

Paralysis Malignant Hyperthermia

Muscarinic receptors are part of what division?

Parasympathetic

nicotinic receptors are part of what division

Parasympathetic

Parasympathetic = P for

Peace

What is Clozapine's REMS program?

Prescriber enrolls pt into Clozapine registry.

Which of the following factors primarily influence Distribution? -Protein Binding -Alzheimer's Disease -Lipid Soluble Drugs -Hepatic Necrosis -Drug Interaction with Liver Enzyme Inducers -Acute Kidney Injury

Protein Binding Lipid Soluble Drugs

Seven Key Elements of Medication orders

Pt Name + 2nd identifier Date drug order was written Name of drug drug dosage amount drug dosage frequency route of administration Prescribers signature

Explain "Can't Schvitz" for Anticholinergic Adverse Effects

Pts may overheat and develop hyperthermia Be careful in hot heat

Indirect-Acting Cholinergic/ Parasympathetic Drugs

Pyridostigmine

What is the intended outcome when taking pyridostigmine for Myasthenia Gravis

REcovery of muscle strangth

The nurse is interpreting data from a client's laboratory blood draw. Which step does this illustrate in the clinical judgement measurement model? Prioritize hypothesis Recognize cues Analyze cues Take-action

Recognize cues

What is the REMS program?

Risk Evaluation and Mitigation Strategy (REMS) - FDA requirement for drug manufacturers to develop strategies to assure safe use of a specific drug Benefits>Risk

Which of the following factors influence Absorption? -Hepatic Necrosis -Protein Binding -Drug Interaction with Liver Enzyme Inducers -Route -Heart Failure -Acute Kidney Injury -Gut Malabsorption Issue

Route Gut Malabsorption Issue

A pt has been prescribed Vancomycin, an antibiotic that is renally eliminated and known to cause kidney damage. The prescriber incorrectly orders a dose that is too high. What will lab numbers look like?

SCr- Elevated BUN- Elevated CrCl- Decreased eGFR- Decreased Urine Output- Decreased

What are you expected to find within lab values to determine renal impairment?

SCr- Elevated (Male- >.2. Female- >1.1) BUN- Elevated >20 mg/dL) CrCl- Decreased (<120 ml/min) eGFR- Decreased (<120 ml/min) Urine output- <30 ml/hr

Anticholinergic agents for OAB

SOFT Bladder Solifenacin Oxybutynin Finally Tolterodine

Remember Meds for Overactive Bladder using the Mnemonic

SOFT Bladder "Too much urination, need to dry up" Solifenacin Oxybutynin Finally Tolterodine

Metoprolol is a ___________ blocker

Selective Beta 1 blocker

What lab values can be used to determine renal function?

Serum Creatinine (SCr) Blood Urea Nitrogen (BUN) Creatinine Clearance (CrCl) Estimated Glomerular Filtration Rate (eGFR) Urine Output

What factors affect pediatric drug dosages?

Skin- think and permeable Stomach- lacks acid to kill bacteria Body temp- less well regulated Dehydration occurs more easily Liver and Kidneys- immature, impairing drug metabolism and excretion

First step to treating malignant Hyperthermia.

Stop the drug

Sympathetic = S for

Stress

Category B drugs and pregnancy

Studies indicate no risk to the animal fetus; information on humans not available

Two kinds of Neuromuscular Blockers

SuccinylCHOline Vercuronium

Depolarizing NMB Drug

Succinylcholine

Metoprolol tartrate boxed warning

Sudden stoppage can increase risk for Heart Attack

Assessment rules for suffix "sin" drugs

Take BP before you administer Hold if <90/60

What is onset of a drug?

The amount of time it takes a drug to elicit a therapeutic response.

What is the duration of a drug?

The time a drug concentration is sufficient to elicit a therapeutic response.

Schedule I drugs

These drugs have NO accepted medical use in the united states. These drugs have the highest abuse and dependency potential.

Schedule V drugs

These drugs have less potential for abuse than schedule II, III, and IV drugs.

Schedule IV drugs

These drugs may be refilled 5 times in a 6 month period. These drugs have less potential for abuse/dependence than schedule II/III drugs. Limited physical or psychological dependency potential

Schedule III drugs

These drugs may be refilled 5 times in a six month period. These drugs have less potential for abuse/dependence than schedule I or schedule II drugs Moderate to low physical or high psychological dependency potential

_____is an eye drop that helps treat Glaucoma

Timolol

Pilocarpine/ carbaCHOL/ BethaneCHOL are used to treat

Urinary retention Neurogenic bladder

Explain "Can't Pee" for Anticholinergic Adverse Effects

Urinary retention/hesitation Report a distended bladder Do not give to pts with enlarged prostate (BPH)

What is the intended use for BethaneCHOL

Urination- specifically after a procedure/surgery)

Which of the following values would suggest impaired kidney function? AST of 86 Potassium of 4.2 mEq/L Urine Output of 40 ml over 2 hours SCr of 2.5 mg/dL BUN of 12 mg/dL CrCl of 30 ml/min GFR of 120 ml/min

Urine Output of 40 ml over 2 hours SCr of 2.5 mg/dL CrCl of 30 ml/min

Epinephrine Alpha 1 activation

Vascular Smooth Muscle- Vasoconstriction (Increased BP)

Non-Depolarizing NMB drug

Vecuronium

Polar Drugs are ___ soluble

Water

What is toxicity?

When plasma drug levels climb too high, toxicity occurs

Isotretinoin is in what pregnancy category?

X

Explain "Can't Sput" for Anticholinergic Adverse Effects

Xerostomia Avoid alcohol based mouthwash Avoid Sugar gum/candy if possible to reduce risk of cavities.

PilocarPine is used to treat

Xerostomia (caused by radiation or Sjogrens Syndrome) Glaucoma (Eye Drops)

dopamine receptor locations

blood vessels to kidneys

Alpha 1 receptor locations

blood vessels, eyes, bladder, prostate, nose

Alpha 2 receptor locations

brain (pre-synaptic receptor) Nose

Glycogenolysis

breakdown of glycogen to glucose

Agonist synonyms

cholinergic parasympathetic parasympathomimetic

What defines Chronic Kidney Disease?

chronically elevated SCr/BUN and decreased eGFR/CrCl

Vasopressors include the drugs

epinephrine/adrenaline

Pyridostigmine can be used as a pre-treatment for

exposure to nerve gas

sympathetic catch phrase

fight or flight

How many clinical trial phases are there?

four

most pharmacokinetic experts agree that steady state is achieved after

four half lives

Timolol is used to treat

glaucoma (eye drops)

What is the "filter" of the kidneys?

glomerulus

What is Peak Level?

highest blood level of a drug

Water Soluble drugs typically remain in

highly vascularized spaces and can easily leave the body via elimination.

Before giving a neuro-muscular blocker you must

hook the pt up to oxygen

Prazosin's main use is to treat

hypertension

Adverse effects of vasopressors on the vasculature systeme

hypertension- can lead to MI/stroke.

There are subtype A1 receptors found in the...

peripheral vascular smooth muscles (arteries) Bladder/Urethra/Prostate

Atropine is used to treat

poisoning by Cholinergic drugs/agents Reduce salivation/secretions Symptomatic Bradycardia

To help prevent vasodilator-induced reflex tachycardia pts can be...

pretreated with a beta blocker, which blocks sympathetic stimulation of the heart

A1 Antagonists MOA

prevents activation of A1 receptors and some subtype A1 receptors) Some A1 blockers are selective or non-selective

Non selctive beta blocker drugs

propranolol carvedilol labetalol

Myasthenia Gravis medication

pyridostigmine

What are adverse effects of all BP medications?

rebound hypertension if stopped suddenly Orthostatic/postural hypotension sexual dysfunction

_______ _______ is commonly seen with anti-hypertensive drugs that do no work directly on the heart

reflex tachycardia

Parasympathetic is illistrated in a person who ______

relaxes after a meal

if a pt refuses to take a medication that has been prescribed, you should

report to the pt;s physician and charge nurse

Parasympathetic catch phrase

rest and digest

Metoprolol MOA

selective beta 1 antagonist (heart) Eyes- miosis (lowers IOP)

Minor Metabolism roles

skeletal muscle kidneys lungs plasma intestinal mucosa

Direct Acting Cholinergic Agent Agonists

stimulates a response

Malignant Hyperthermia is associated with

surgery drugs

Two reasons reflex tachycardia is undesirable

tachycardia can put an unacceptable burden on the heart If a vasodilator were given to reduce BP, the tachycardia would raise the BP and negate the desired effect

What is a drug substrate?

target drug

What is Minimum Effective Concentration (MEC)

the plasma drug level below which therapeutic effects will not occu

Bethanechol is used to treat

urinary retention (The goal is to reverse the retention and allow someone to void)

Anti-adrenergic drugs are also called

• Also called adrenergic-blocking anyagonists

Older Adult Considerations: Excretion

•GFR decreased •The number of working nephrons decreased Drugs are cleared less effectively because of decreased excretion

Goal of Cytochrome P-450

convert drugs to become hydrophilic and polar

S/S of impaired liver function

dark urine Jaundice Swelling of abdomen bruising/bleeding fatigue Ammonia can concentrate

If pupil constriction occurs, then IOP ________

decreases

Reflex tachycardia is caused by

dilation of arteries/veins causing a sudden drop in BP

What is mydriasis?

dilation of the pupil

Pilocarpine is a

direct acting cholinergic agonist

What is Steady State?

drug in=drug out When the amount of drug removed equals the amount of drug absorbed

Lipid soluble drugs

easily distribute into fatty tissues where they may store or concentrate.

Isotretinoin REMS program is called

iPLEDGE

What are "pro-drugs"?

inactive drugs which become active after being metabolized

What is Phase III of a clinical trial?

includes a large number of volunteers to establish a drug's clinical effectiveness, safety, and dosage range SAFETY and EFFECTIVENESS

What is Phase I of a clinical trial?

includes a small number of people (10-80) to evaluate the drug's safety, TESTS SAFETY

What is Phase II of a Clinical trial?

includes a small number of pts who have the intended disease trying to treat. Determines EFFECTIVENESS and adverse effects (Optimal Dosage) (drug interactions)

Goal of bethanechol

increase urine outcome (>30ml/hr)

Pilocarpine intended outcomes.

increased Saliva Decreased IOP

If pupil dialtion occurs this _____ IOP

increases

The Sympathetic system is illistrated by a person who

is threatened

All "sin" drugs (Alpha 1 Antagonist blockers) have what adverse effect?

lightheadedness/dizzy Orthostatic Hypotension

Non-polar drugs are ____ soluble

lipid

B1 antagonists are ___phillic

lipo

Cytochrome P-450 typically target

lipophilic and nonpolar

Beta blocker drugs end in ____

lol

Some A1 blockers are selective or non-selective. This means that a drug that targets the bladder may also

lower someone's blood pressure

Beta 2 receptors

lungs skeletal muscle uterine smooth muscle liver

CARvedilol is used to treat

mainly CARdiac conditions

Selective Beta 1 Blocker drug

metoprolol

Never stop taking _______ suddenly

metoprolol tartrate/ Selective B1 Blockers

Parasympathetic Direct Acting Agents are typically agonists at

muscarinic receptors in various organs (not skeletal muscle)

Bethanechol works by binding to what receptors?

musclarinic

Parasympathetic Indirect Acting Agents are typically agonists at

nicotinic receptors (skeletal muscles)

Schedule II drugs have

no refills

Category A drugs and pregnancy

no risk to fetus

The "LOL"s that are NOT metoprolol tartrate are considered

non-selective B Blockers

Epinephrine binds ____ to _____

nonselectively to alpha and beta receptors

Adrenergic drugs produce effects that mimic

norepinephrine or epinephrine

Potential Alterations of metaboism

other drugs Certain foods (Grapefruit) Smoking Alcohol Diseases Genetics Age

Lipid soluble drugs have the potential to cross the

Blood brain Barrier Placenta

Adverse effects of Non-selective B Blockers. B1

Bradycardia leading to decreased CO Hypotension Precipitation of Heart failure (fluid retention) Masks the S/S of diabetes (tremors. palpitations)

Epinephron Alpha 2 activation

Brain- No sig. results

Adverse effects of non-selective Beta Blockers B2

Bronchoconstriction (bad for asthma) Prevent glycogenolysis in liver (complicates hypoglycemia)

The nurse is performing an assessment of a newly admitted client. Which is an example of objective data? (Select all that apply) -Weight 255 pounds -The client states, "I'm really dizzy." -Client is alert and oriented to name, place, and time -The client reports that he uses the herbal product St. John's Wart -Blood pressure 158/96 mmHg

-Blood pressure 158/96 mmHg -Client is alert and oriented to name, place, and time -Weight 255 pounds

Client is a 56-year-old man with a past medical history of hypertension, hyperlipidemia, and gout. Client arrived at the emergency department at 1730. Client states, "my stomach has been hurting for the past week." RN asked client to rate pain 1-10 on numeric pain scale. Client rated his pain a 7 out for 10. RN auscultated client's abdomen; bowel sounds were absent in all quadrants. MD ordered abdominal X-ray. Xray suggestive of severe constipation. RN discussed findings with the client. Client states, "I have not had a bowel movement in 10 days." -Client states, "my stomach has been hurting for the past week." RN asked client to rate pain 1-10 on numeric pain scale. -Client is a 56-year-old man with a past medical history of hypertension, hyperlipidemia, and gout. -Client states, "I have not had a bowel movement in 10 days." -Xray suggestive of severe constipation -RN auscultated client's abdomen; bowel sounds were absent in all quadrants. -RN asked client to rate pain 1-10 on numeric pain scale. Client rated his pain a 7 out for 10.

-Client states, "my stomach has been hurting for the past week." RN asked client to rate pain 1-10 on numeric pain scale. -Client states, "I have not had a bowel movement in 10 days."

Considerations for Older Adults

-Decline in organ function occurs with advancing age. -Drug therapy in older adults is most likely to result in adverse effects and toxicity.

Bethanechol is a

-Direct cholinergic agonist

Older Adult Considerations: Absorption

-Gastric pH less acidic -Gastric emptying slowed -Movement through GI tract slowed because of decreased muscle tone and activity -Blood flow to GI tract reduced -Absorptive surface of GI tract reduced

high alert drugs

-anticoagulants (Warfarin, Heparin) -insulin -opioids and narcotics (Morphine) -potassium -Antibiotics (penicillin) -Cardiac Medications (Epi, metoprolol)

Normal Range Aspartate aminotransferase (AST) and in what organ?

0 to 35 units/ L (Liver)

The prescriber as order that a client receive an antibiotic every 6 hours to treat their pneumonia. If the last medication was administered at 0700, what time is the next dose due? 1200 1300 1500 1600

1300

Creatinine Clearance (CrCl) normal range and organ

90-120 ml/min Kidneys, but more specifically in the Glomerular

What is a partial drug agonist?

A drug that binds to a receptor and the results are diminished compared to an agonist.

What is a drug antagonist?

A drug that binds to the receptor, there is no response.

What is a drug agonist?

A drug that binds to the receptor. There is a response.

What is a noncompetitive antagonist?

A drug that combines with different parts of the receptor and inactivates it. The agonist then has no response.

What is a competitive antatgonist?

A drug that competes with the agonist for binding to the receptor. If it binds, there is no response.

When a patient has impaired kidney function, what are some potential different medical terms? ototoxicity acute kidney injury anuria hepatotoxicity akathesia paresthesia oliguria declined renal function nephrotoxicity tardive dyskinesia chronic kidney disease

AKI Anuria oliguria declined renal function nephrotoxicity chronic kidney disease

Which of the following factors influence Elimination? -Acute Kidney Injury -Chronic Kidney Disease -Heart Failure -Gut Malabsorption Issue -Hepatic Necrosis -Alzheimer's Disease -Grapefruit Juice -Drug Interaction with Liver Enzyme Inducers -Hypertension

AKI Chronic Kidney Disease

Contolled substances are

ANY drug that are found to have any dependency or abuse potential

A pt is taking Tylenol (acetaminophen) but has exceeded the maximum dosage. Exceeding the maximum dosage is known to harm the liver.. What are some lab values to observe?

AST ALT

Types of liver function tests

AST ALT ALP Albumin Total bilirubin

Sympathetic (Adrenergic) Autonomic Receptors (Locks)

Alpha 1 (a1) Alpha 2 (a2) Beta 1 (B1) Beta 2 (Beta 2) Dopamine (DA)- Rare

What is a dug interaction?

Alteration in the pharmacologic or kinetic activity of a given drug caused by the presence of one or more additional drugs. Usually related to the effects on the enzymes required for metabolism of the involved drugs.

a1 antagonists focus on what three areas?

Arteries Prostate Bladder

What are potential lab values that can be used to assess liver function?

Aspartate AminoTransferase (AST) Alanine Aminotransferase (ALT) Alkaline Phosphatase (ALP) Albumin Bilirubin Potassium

The nurse monitors the fulfillment of goals, and may revise them, during which phase of the nursing process?

Assessment

5 steps of the nursing process

Assessment Diagnosis Planning Implementation Evaluation

Five phases of the nursing process

Assessment Diagnosis Planning Implementation Evaluation

Contra-indication of bethaneCHOL

Asthma

Contra-indication of carbaCHOL

Asthma

Contra-indication of pilocarpine

Asthma

Contraindications of "lol" drugs

Asthma/COPD

When do we draw a Trough?

At the lowest point. Check 30 minutes to 1 hour prior to the next dosing interval

Antidote to "Stigmine" overdose

Atropine

antidote to cholinergic crisis

Atropine

Treatment for a Cholinergic Crisis

Atropine (cholinergic antagonist)

A nurse makes an error when administering a medication to a client. Which action by the nurse would require immediate intervention by the charge nurse? A. The nurse completes an incident report B. The nurse informs the health care provider (HCP) of the error C. The nurse documents adverse effects to the medication error D. The nurse records the completion of an incident report in the client's electronic health record (EHR)

B

The day shift charge nurse is making rounds. A client tells the nurse that the night shift nurse never administered the medication he normally takes for his high cholesterol. Which action should the nurse perform first to determine whether the medication was given? A. Call the night nurse at home B. Check the medication administration record (MAR) C. Call the pharmacy D. Review the night nurse's end of shift note that is documented in the electronic health record (EHR)

B

When giving epinephrine, regardless of route, what would you monitor? Why?

BP and HR drug increases the O2 demand on the heart and may lead to angina or dysrhythmia. Improves the gas exchange in the lungs.

Why does orthostatic/postural hypotension occur when given an anti-hypertensive medication?

Because of venous relation, gravity causes blood to pool in the veins decreasing venous return to the heart which in turn causes a decrease in cardiac output and a decrease in BP

Direct Acting Cholinergic Agent Drug

BethaneCHOL

Three Direct Acting Cholinergic Agents

BethaneCHOL Pilocapine carbachol

Direct ACting Parasympathetic. Cholinergic Drugs

Bethanechol Pilocarpine

Succinylcholine MOA

Binds to receptors at the neuromuscular Junction (NMJ). Once bound it depolarizes the cells and stays in place causing them to be stuck.

Muscarinic Receptors are mainly located in the

Bladder

Non-selective B blockers MOA

Block Beta 1 receptors on heart May block Beta 2 receptors in lungs. May block alpha 1 receptors in arteries.

Vecuronium MOA

Blocks acetylcholine from binding to nicotinic receptors at the neuromuscular Junction If acetylcholine cannot work normally on muscles they become paralyzed

What are potential lab values that can be used to assess kidney function?

Blood Urea Nitrogen (BUN) Urine Output Creatine Clearance (CrCl) Serum Creatine (SCr)

The nurse answers a client's call light and finds the client sitting up in bed and requesting pain medication. Which action should the nurse perform first? A. Check the prescriber order and give the client the requested pain medication B. Provide non-pharmacological comfort measures to the client C. Assess the client's pain and pain level D. Evaluate the effectiveness of previous pain medications

C

Nicotinic receptors are what kind of receptor

Cholinergic

What is a Mnemonic for remembering drug inducers?

Clumsy Sally's Palm Releases and Shatters Priceless Objects (Used to remember that inducers DROP levels of other drugs)

What is the extra adverse effect of an Anticholinergic Agent

Confusion- can potentially hallucinate

Which of the following would suggest renal impairment? SELECT ALL THAT APPLY CrCl of 120 ml/min Urine Output of 200 ml over 2 hours CrCl of 30 ml/min BUN of 40 mg/dL SCr of 1 mg/dL BUN of 10 mg/dL SCr of 2 mg/dL Urine Output of 40 ml over 2 hours

CrCl of 30 ml/min BUN of 40 mg/dL SCr of 2 mg/dL Urine Output of 40 ml over 2 hours

How can we estimate Glomerular Foltration Rate (GFR)?

Creatinine Clearance (CRCL) Estimated Glomerular Filtration Rate (eGFR)

The "lol"s are used to treat

Current or hx of MI Hypertension Angina Dysthymias Heart Failure Symptoms of Hyperthyroidism Anxiety

The client's medication administration record (MAR) lists the client's antiepileptic medication that is due at 0900 as an oral tablet, but the client is NPO (nothing to eat or drink) pending a barium swallow evaluation. Which action should the nurse perform next? A. Give the tablet with a small sip of water B. Override the medication dispensing system and administer the same medication in intravenous (IV) form C. Hold the medication until the client has returned from the procedure D. Call the health care provider (HCP) to clarify the order

D

Parasympathetic involves the ___ activities

D (Digestion, Defecation, Diuresis)

If overdosed on a Cholinergic Drug what do you expect to see?

DUMBBBELS Defecation/ Diarrhea Urination Miosis (Pupil Constriction) Bradycardia Bronchspasm Bronchorrhea (Mucus w/in lungs) Emesis (vomiting) Lacrimation Salivation/Secretions

Signs of Muscarinic Overactivation

DUMBBBELS Defecation/Diarrhea Urination Miosis Bradycardia Bronchospasm Bronchorrhea Emesis Lacrimation Salivation/Secretions

Adverse Effects of BethaneCHOL (rare at normal doses)

DUMBBBELS Increased salivation, Gastric Acid secretion Abdominal cramps Diarrhea Exacerbation of asthma- (in rest and digest state the lungs are now constricted)

Atropine can be considered and anti-

DUMBBBELS drug

What drug counters malignant hyperthermia?

Dantrolene

A pt is taking Tylenol (acetaminophen) but has exceeded the maximum dosage. Exceeding the maximum dosage is known to harm the liver. What is a medical term for this?

Drug Induced Liver Injuruy Acetaminophen Toxicity

What is a protein-bound drug?

Drugs that attach to protein and stays in the bloodstream. Cannot get to extravascular space to its target.

B1 Antagonists (metoprolol tartrate) are used to treat what heart related issues?

Dysrhythmias MI Heart Failure Hypertension Symptoms of Hyperthyroidism

The sympathetic nervous system involves _____ activities

E (Exercise, Excitement, Emergency, Embarrassment)

A pt is taking Tylenol (acetaminophen) but has exceeded the maximum dosage. Exceeding the maximum dosage is known to harm the liver. What will the lab numbers look like?

Elevated

"sin" (a1 blockers) are commonly given when and why?

Generally given at bedtime to reduce the risk for postural/orthostatic hypotension

Lifespan considerations of SOFT drugs

Geriatric Pts are very susceptible to developing adverse effects of anticholinergics

Lifespan considerations of Atropine

Geriatric pts are susceptible to developing adverse effects of anticholinergics

B1 Antagonists (metoprolol tartrate) are used to treat what non-heart related issues?

Glaucoma Anxiety Hyperthyroidism

Atropine Contraindications

Glaucoma Benign Prostatic Hyperplasia (BPH) Urinary retention/hesitancy

Which of the following factors influence Metabolism? -Grapefruit Juice -acute kidney injury -Gut Malabsorption Issue -Hepatic Necrosis -Drug Interaction with Liver Enzyme Inducers -Heart Failure -Alzheimer's Disease -Hypertension -Chronic Kidney Disease

Grapefruit Juice Hepatic Necrosis Drug Interactions w/ Liver Enzyme Inducers

Extremely Rare adverse effects of BethaneCHOL (Cholinergic agent)

Hypotension Bradycardia This drug enhances PARAsympathetic- Decreased BP or HR

Pediatric Considerations: Metabolism

Immature liver, does not produce enough enzymes Older children may have increased metabolism, requiring higher doses than infants

Vasopressor infiltration drug (antidote)

Phentolamine

Most common highly protein bound drug

Phenytoin

What happens if you give Warfarin with Phenytoin

Phenytoin is in inDucer so it Drops levels of the other drug

Category D drugs and pregnancy

Possible fetal risk in humans has been reported; in selected cases consideration of potential benefit vs. risk may warrant use

When a patient has impaired liver function, what are some potential different medical terms? cirrhosis anuria nephrotoxicity paresthesia declined renal function hepatic necrosis hepatotoxicity oliguria drug induced liver injury tardive dyskinesia

cirrhosis hepatic necrosis hepatotoxicity drug induced liver injury

Examples if some drug classes that we do not change manufacturers for

Thyroid Epilepsy Transplant

What is a Free Drug?

Unbound; it can leave capillaries when it wants. It is not bound to a protein. (Active)

Intended outcome for Acetylcholinesterase Inhibitors

Urinary Retention Relief

Adrenergic drugs are generally agonists at ____ receptors

a or B

Schedule II drugs

a type of drug with medicinal uses that is highly addictive and have a high abuse potential and only available with a prescription

Tamsulosin (Flomax) is what kind of drug?

a1 blocker

When do we draw a Peak?

about 30 mins after a dose

Indirect Cholinergic Acting Agents inhibit

acetylcholinesterase (An enzyme that breaks down acetylcholine)

Beta Blocker eye drops block ______

adrenaline in the eye.

Pilocarpine MOA

agonist at cholinergic (muscarinic) receptors which causes secretions (sweating, salivation, GI tract) EYE= causes Miosis, decrease intra-ocular pressure

Adrenergic drugs are

agonists

Prazosin is what type of drug?

alpha 1 blocker

Nicotinic Division Receptors are important for _____

anesthesia/paralyzing agent drugs. Important for ED,ICU, OR, Anesthesia

Orthostatic/postural hypotension is commonly seen with _____ medications

anti-hypertensive

What is clozapine?

antipsychotic that lowers Absolute Neutrophil Count (ANC) which increases the risk for infection

4 Anti-Cholinergic Drugs

atropine, oxybutynin, solifenacin, tolterodine

When administering Pilocarpine

avoid taking with high fat meal and stay hydrated

Indirecting Acting Cholinergic Agents do no

bind to receptors

Alpha 1 Antagonists address ______ and _____ conerns

bladder and prostate

If patient is allergic to morphine, this is considered a _______ of morphine.

contraindication