Pharmacology Chapters 12-18
What is noreponephrine liberated by?
adrenergic fibers-
What are the nursing implications for sedative-hypnotic therapy?
Vital signs sleep pattern anxiety environmental nutrition alcohol intake exercise respiratory rate
What are the signs and symptoms of Parkinson's
muscle tremors slowness of movement when performing ADL's muscle weakness with rigidity alterations in posture and equallibrium
Common side effects of dopamine agonist drugs? Serious adverse effects?
nausea, vomiting, anorexia Chewing motions, bobbing, facial grimacing, rocking movements (extrapyramidal symptoms), sudden sleep events, nightmares, depression, confusion, hallucinations, tachycardia, palpitations
What are the two major neurotransmitters of the autonomic nervous system?
norepinephrine and acetylcholine
What type of patient education needs to be given when giving levodopa
orthostatic hypotension- advise to rise slowly if feeling faint sit or lay down monitor blood pressure daily
What is transient insomnia?
sleep disturbance that lasts only a few days
How do MAO-B drugs help treat parkinson's
slowing progression of deterioration of dopaminergic nerve cells
Andrenergic fibers are part of what system?
sympathetic nervous system
What is early awakening with the inability to fall asleep again?
terminal insomnia
What is a neurotransmitter?
the activity of chemical signals
What are beta and alpha blockers for?
treatment of hypertension,
What are nursing implications for non-benzo sedative hypnotics?
uPremedication assessment uAvailability, dosage, and administration uCommon adverse effects uNeurologic (hangover, sedation, lethargy) uCardiovascular (transient hypotension when arising) uPsychological (restlessness; anxiety) uDrug interactions: Fluvoxamine, rifampin, food
What are the two types of alzheimers medications
•Acetylcholinesterase inhibitors •N-methyl-d-aspartate (NMDA) inhibitor
Cholinergic fibers are part of what system?
parasympathetic nervous system
What does a hypnotic do?
A drug that produces sleep
The stimulation of alpha-1 receptors cause what generally?
vasoconstriction of blood vessels
What do adrengenic agents do to the heart rate?
Increase it
Why are the newer, nonbenzodiazepine medications for insomnia preferred over older medications?
They interfere less with natural sleep cycles
What does the stimulation of alpha-1 receptors cause?
vasoconstriction of blood vessels
What are some common beta-blockers?
Atenolol, carvedilol, metoprolol
What is insomnia?
The inability to sleep Most common sleep disorder
Which conditions are potentially more sensitive to the effects of adrenergic agents?
Thyroid disease, Impaired hepatic function, heart disease
What is intermittent insomnia?
inability to stay asleep
What is rebound sleep?
When compensatory REM sleep occurs even when hypnotic agents are used for only 3 to 4 days
Why does Dopamine increase urine output?
stimulation of specific receptors in the kidneys- better renal profusion
What does the hypothalamus do?
sympathetic nerve signals to adrenal gland gives off adrenaline and epinephrine travels through the body by blood binds protein in the liver
What is initial insomnia?
Inability to fall asleep when desired
What is the PNS?
Peripheral nervous system- peripheral nerves subdivided into afferent and efferent nerves.
Which common adverse effects might a patient experience when taking an anticholinergic agent?
Urinary retention, blurry vision, dry mouth
What kind of drug is donepazil?
ACH inhibitors •Primary therapeutic outcome: Improved cognitive skills •Common adverse effects: Gastrointestinal (nausea, vomiting, dyspepsia, diarrhea) •Serious adverse effect: Cardiovascular (bradycardia)
What does COMT do?
Action: Reduces destruction of dopamine in peripheral tissues, allowing more to reach the brain Use: Added to treatment when carbidopa-levodopa becomes less effective and adverse effects develop Common adverse effects:Diarrhea; sedative effects; urine discoloration (brownish-orange)
Which condition is dopamine commonly used to treat
Shock and hypertension
What is an adverse effect in beta blockers?
Can cause hypoglycemia- monitor blood sugars when giving respiratory issues, vasoconstriction
Why are carbidopa and levodopa given together?
Carbidopa reduces the metabolism of levodopa so more of administered levodopa reaches receptor sites
What does dobutamine do to cardiac cells
Cardiac stimulant
What do alpha-2 receptors do?
Mediators of negative feedback and preventing further release of norepinephrine
Cholinergic drug pyridostigmine is used to treat what disease?
Myasthenia Gravis- reversal of nondepolarizing muscle
What are common adverse effects of benzos?
Neurologic (drowsiness, hangover, sedation, lethargy) Cardiovascular (transient hypotension when arising
What is a sleep disturbance that lasts less than 3 weeks called?
Short term insomnia
What is the action of entacapone, and MAOI's in relation to Parkinsons disease
Slows the deterioration of dopaminergic nerve cells
Which NREM stage of sleep accounts for the largest amount for adults?
Stage 2- produces about 50 % of sleep
Which effect may occur with medications that stimulate the beta-2 receptors?
Stimulation of beta-2 receptors causes relaxation of smooth muscle in the uterus, as well as in the smooth muscle in the bronchi (bronchoconstriction). Stimulation of beta-2 receptors causes relaxation of smooth muscle in the peripheral arterial blood vessels (vasodilation). Stimulation of beta-1 receptors causes an increase in the heart rate.
What kind of drug is memantine
NMDA receptor inhibitor •Primary therapeutic outcome: Improved cognitive skills •Common and serious adverse effects: Neurologic (headache, dizziness, akathisia, insomnia, restlessness, increased motor activity, excitement, agitation
What is the expected outcome of Parkinsonian medications?
Reduction of symptoms
What is the adrenergic side of the autonomic nervous system subdivided into?
alpha receptors, beta receptors, dopaminergic receptors
What other types of medications assist with sleep that are not in a catergory?
anticonvulsants anti-anxiety sedative hypnotics
How long does insomnia need to occur to be considered chronic insomnia?
at least one month of sleep disturbance
What is important for patient education about sleep?
bedtime nutrition avoid big meals personal comfort environmental control activity/exercise stress management health maintenance should be self assessing
What are some adverse effects of anticholinergic drugs?
blurred vision, constipation, urinary retention, dryness, dry mouth, SLUDGE
Anticholinergic drugs do what for Parkinson symptoms?
can provide symptomatic releif from increased acetylcholine
What are similar to what acetylcholine produces called?
cholinergic agents
What are some serious adverse effects of anticholinergic drugs?
confusion, depression, hallucinations, nightmares, glaucoma, palpitations, dysrhythmias
How does carvidolol work?
decreases cardiac response to sympathetic nervous system
What must be done before giving beta blockers?
Blood pressure must be checked
What is the drug that reverses benzodiazepines?
Flumazenil- used in accidental overdose and when used in general anesthesia
Anticholinergic drugs are used for what diseases?
Parkinsons, gastric issues, opthalmic, cause pupil constriction They block ach in parasympathetic system
What is sedative-hypnotic therapy used for?
Temporary treatment of insomnia, decrease anxiety and increase relaxation and/or sleep before diagnostic or operative procedures, anticonvulsive agents
What does norepinephrine do and is used for?
Causes vasoconstriction, used for shock and hypotension
What does the autonomic nervous system do?
Controls motor function, maintains homeostasis
What neurotransmitter do benzodiazepines affect?
GABA receptors
What are the two types of Parkinsons
Primary- unknown cause secondary- related to head trauma, infection, tumor, drug exposure
What do the afferent nerves do?
Send signals away from the body
A patient taking albuterol (Proventil) has also started taking an over-the-counter (OTC) cold medication. Which symptom does the nurse monitor for in this patient?
Tachycardia The concurrent use of albuterol and OTC cold medications may have an additive effect and cause tachycardia as well as chest pain. The OTC medication will not have an effect on the bronchi. The concurrent use of albuterol and OTC cold medication will not decrease heart rate or increase fluid retention.
What causes the effects of Parkinson disease?
deterioration of dopaminergic neurons resulting in deficiency in dopamine
What does carbidopa and levodopa do to the neurotransmitters?
dopamine receptor agonist
What are severe adverse reactions to adrenergic drugs?
dysrhythmia, chest pain, severe hypotension, anginal pain, nausea, vomiting
What is the CNS
Central Nevous system- brain and spinal cord
What are some examples of anticholinergic drugs?
Atropine, dicyclomine, glycopyrrolate
What is an important nursing intervention for nutritional needs for patients with Parkinsons
6 small meals- assists with digestion, because of weak muscles smaller meals will make patient less tired after eating
What does a sedative do?
A drug that relaxes, not put to sleep
What does Parkinson have to do with neurotransmitters?
increase in acetylcoline and decrease in dopamine
What are common side effects to andrenergic drugs?
increased heart rate, palpitations, tachycardia, flushed skin, dizziness, tremors, orthostatic hypotension
The alpha-2 receptors appear as what?
mediators of negative feedback- preventing further release of norepinephrine
What must be done for assessment prior to giving MAO-B medications?
premedication assessment, availability and dose of medication and administration
What are some serious adverse effects of benzos?
uPsychological (confusion, agitation, hallucinations, amnesia) uExcessive use or abuse uBlood dyscrasias (routine lab studies should be run) uHepatotoxicity (abnormal liver function tests)
Prior to the administration of metoprolol, a beta-adrenergic blocking agent, which is most important for the nurse to assess? a. Blood pressure b. Lung sounds c. Mental status d. Urine output
ANS: A Beta-adrenergic blocking agents cause vasodilation and decreased heart rate, resulting in lowering of the blood pressure. A premedication assessment is to take baseline heart rate and blood pressure. Fluid retention may occur as a serious adverse effect but is not the most important assessment prior to the administration of a beta-adrenergic blocking agent. Mental status and urine output are not the most important assessments prior to the administration of a beta-adrenergic blocking agent.
A patient is being discharged on an adrenergic bronchodilator. Which common adverse effect(s) will the nurse include in discharge teaching? (Select all that apply.) a. Palpitations b. Dizziness c. Orthostatic hypotension d. Hypoglycemia e. Tremors f. Bradycardia
ANS: A, B, C, E Common adverse effects of adrenergic agents are palpitations, rapid heart rate, dizziness, orthostatic hypotension, and tremors. Adrenergic agents may cause hyperglycemia in the patient with diabetes mellitus. Adrenergic agents may cause tachycardia, not bradycardia, in the patient
Neurotransmitter(s) include: (Select all that apply.) a. gamma aminobutyric acid. b. acetylcholine. c. serotonin. d. glucose. e. histamine. f. epinephrine.
ANS: A, B, C, E, F The CNS is composed of systems of different types of neurons that secrete separate neurotransmitters. Gamma aminobutyric acid, acetylcholine, serotonin, histamine, and epinephrine are examples. Glucose is a sugar that is the body's main source of energy.
Which adverse effect(s) is/are common when a patient is receiving a cholinergic agent? (Select all that apply.) a. Nausea b. Hypertension c. Dizziness d. Bradycardia e. Constipation
ANS: A, C, D Cholinergic agents produce effects similar to those of acetylcholine. Cholinergic actions increase gastrointestinal (GI) motility and secretions that can cause nausea, vomiting, diarrhea, and abdominal cramping. GI symptoms tend to be dose related and may be controlled by decreasing the dosage. Dizziness is a common adverse effect and can be minimized by rising slowly from a sitting or supine position. Cholinergic agents slow the heart rate, have a hypotensive effect, increase GI motility, and result in diarrhea and cramping
Which body function(s) is/are controlled by the autonomic nervous system? (Select all that apply.) a. Blood pressure b. Skeletal muscle contraction c. GI secretion d. Body temperature e. Urination
ANS: A, C, D, E Blood pressure, GI secretion, body temperature, and urinary bladder function are body functions controlled by the autonomic nervous system. The autonomic nervous system maintains control over most tissue function, with the exception of skeletal muscle.
Which category of medications is used for peripheral vascular diseases characterized by excessive vasoconstriction, such as Raynaud's disease? a. Adrenergic agents b. Alpha-adrenergic blocking agents c. Beta-adrenergic blocking agents d. Cholinergic agents
ANS: B Alpha-adrenergic blocking agents interfere with the stimulation of alpha-1 and alpha-2 receptors. Because the primary action of alpha receptor stimulation is vasoconstriction, alpha-adrenergic blocking agents are indicated for patients with diseases associated with vasoconstriction. Adrenergic drugs cause vasoconstriction. Beta-adrenergic blocking agents are used to treat hypertension and dysrhythmias. Cholinergic drugs are used to treat ocular diseases such as glaucoma, respiratory tract disease, and urinary system diseases.
A patient with a history of type 1 diabetes after myocardial infarction has been placed on a beta-adrenergic blocking agent. Which statement by the patient indicates a need for further teaching? a. "This medication should not be discontinued suddenly." b. "This medication lowers my blood pressure by helping me get rid of fluid." c. "I may not have my usual symptoms of a hypoglycemic reaction while on this drug." d. "This medication may take a few weeks to work."
ANS: B Beta-adrenergic blocking agents decrease the heart rate and dilate blood vessels to lower blood pressure. Sudden discontinuation of beta-adrenergic blocking agents may result in an exacerbation of angina symptoms. Beta-adrenergic blocking agents may mask symptoms of hypoglycemia. Beta-adrenergic blocking agents may take several days to weeks to show optimal improvement.
Which nerve endings liberate norepinephrine? a. Cholinergic b. Adrenergic c. Anticholinergic d. Muscarinic
ANS: B Nerve endings that secrete norepinephrine are called adrenergic fibers. These nerve endings liberate acetylcholine. Anticholinergic describes the action of certain medications that inhibit the transmission of parasympathetic nerve impulses and thereby reduce spasms of smooth muscle (e.g., as in the bladder). Muscarinic receptors are those membrane bound acetylcholine receptors that are more sensitive to muscarine than to nicotine.
A patient with chronic obstructive pulmonary disease (COPD) reports having insomnia and a racing heart after starting terbutaline therapy. Which explanation by the nurse is most accurate? a. "The symptoms are typical and indicate that the medication is at a therapeutic level." b. "The symptoms will tend to resolve with continued therapy." c. "The symptoms are unusual and need to be reported to the health care provider immediately." d. "The symptoms are indicative of toxicity."
ANS: B Terbutaline, an adrenergic agent effective for bronchodilation, can cause excessive central nervous system (CNS) stimulation. Adverse effects such as palpitations, tachycardia, flushed skin, dizziness, and tremors tend to be mild and resolve with continued therapy. The therapeutic level can only be determined by analyzing a blood sample. These are common symptoms and should only be reported if they persist. Symptoms of toxicity are chest pain, persistent palpitations, and tachycardia.
Which statement(s) is/are true about efferent nerves? (Select all that apply.) a. They transmit signals to the spinal cord and brain. b. They leave the CNS to carry impulses to other body parts. c. They are part of the peripheral nervous system. d. They transmit signals that control contractions of smooth and skeletal muscle. e. They transmit signals that control contractions of some glandular secretions.
ANS: B, C, D, E Efferent nerves leave the CNS and carry impulses to other body parts that control contractions of smooth and skeletal muscles, as well as some glandular secretions. The efferent nerves, together with afferent nerves, make up the peripheral nervous system.
Which instruction(s) given by the nurse will assist a patient to cope with the common adverse effects of anticholinergic medications? (Select all that apply.) a. "Take the medication with meals." b. "Increase fluids daily." c. "Decrease fiber in the diet." d. "Suck on candy or ice chips." e. "Monitor blood glucose."
ANS: B, D Anticholinergic medications cause dryness of mucous membranes. Increasing fluids, sucking on candy or ice chips, or chewing gum helps alleviate the dryness of the mouth, nose, and throat. Taking the medication with meals and decreasing fiber in the diet will not help patients cope with the adverse effects. Anticholinergics do not affect blood glucose levels
A patient with Parkinson's disease asks the nurse why anticholinergics are used in the treatment. Which response by the nurse is most accurate? a. "These drugs help you urinate." b. "These drugs will decrease your eye pressure." c. "These drugs inhibit the action of acetylcholine." d. "These drugs will assist in lowering your heart rate."
ANS: C Anticholinergic agents inhibit the action of acetylcholine in the parasympathetic nervous system. These drugs occupy receptor sites at the parasympathetic nerve endings, preventing the action of acetylcholine. Inhibition of acetylcholine facilitates stimulation of the dopaminergic receptors, which relieves the symptoms associated with Parkinson's disease. Anticholinergic agents cause urinary retention, increase intraocular pressure, and increase the heart rate
Which condition would alert the nurse of the need to use beta-adrenergic blockers cautiously? a. Hypertension b. Raynaud's phenomenon c. Emphysema d. Cardiac dysrhythmias
ANS: C Beta-adrenergic blockers can produce severe bronchoconstriction. Selective beta-1 antagonists are used to treat hypertension. Alpha-adrenergic blocking agents are used to treat patients with Raynaud's disease. Beta-adrenergic blocking agents are indicated for patients with cardiac arrhythmias.
Why are beta blockers used cautiously in patients with respiratory conditions? a. They mask the signs and symptoms of acute hypoglycemia. b. They cause extensive vasodilation and cardiac overload. c. They may produce severe bronchoconstriction. d. They increase hypertensive episodes.
ANS: C Nonselective beta blockers, such as Inderal, and larger doses of selective beta antagonists will readily affect the beta-2 receptors of the bronchi, causing bronchoconstriction. Therefore, beta blockers must be used with extreme caution in patients with respiratory conditions such as bronchitis, emphysema, asthma, or allergic rhinitis. Beta blockers affect blood glucose by inducing the hypoglycemic effects of insulin. Vasodilation relieves cardiac overload. Beta blockers induce hypotensive effects.
A long-term care resident is taking an anticholinergic agent. The nurse observes the resident to be disoriented and hallucinating. The priority nursing action is to a. report development of alterations to the charge nurse. b. assess blood glucose. c. provide for resident's safety. d. medicate with antianxiety medication.
ANS: C Serious psychological side effects of anticholinergic agents include confusion, depression, nightmares, and hallucinations. The priority nursing action at onset of confusion and hallucinations is safety. Once the resident is safe, development of alterations may be reported. Blood glucose may be monitored once safety is established. If appropriate medications are ordered by the physician, they can be provided once the resident is calm and safe.
What is the primary response to alpha-1 receptor stimulation? a. Bronchodilation b. Tachycardia c. Vasoconstriction d. Uterine relaxation
ANS: C Stimulation of the alpha-1 receptors causes vasoconstriction of all blood vessels throughout the body. Alpha-1 receptor stimulation causes bronchoconstriction. Alpha-1 receptor stimulation does not cause tachycardia. Beta-2 receptor stimulation produces relaxation of smooth muscle tissue, such as the uterus.
Which disorder(s) would indicate the use of anticholinergic agents? (Select all that apply.) a. Glaucoma b. Benign prostatic hypertrophy c. Bradycardia d. Parkinson's disease e. Preparation for surgery f. Stimulation of the vagus nerve
ANS: C, D, E Anticholinergic drugs are used to treat bradycardia and Parkinson's disease and are used as drying agents in preparation for surgery and anesthetic administration. Anticholinergic drugs are not used to treat glaucoma, are contraindicated in cases of prostatic hypertrophy, and block vagal stimulation.
A patient hospitalized in an acute care setting reports to the nurse that since starting on an adrenergic medication, he has been feeling "dizzy and weak." The most appropriate action for the nurse is to a. immediately notify the physician. b. teach the patient to move slowly from standing to sitting. c. discontinue the adrenergic blocker. d. monitor the blood pressure in both the supine and standing positions.
ANS: D Although infrequent and generally mild, adrenergic agents may cause some degree of orthostatic hypotension manifested by dizziness and weakness, particularly when therapy is initiated. This is anticipated and does not require the physician to be immediately notified.
The nurse is caring for a patient taking a cholinergic agent. When auscultating lung sounds, the nurse notes inspiratory and expiratory wheezing bilaterally. The best action for the nurse to take would be to a. provide the next dose of the cholinergic agent immediately. b. assess heart rate and blood pressure. c. reposition the patient. d. withhold the next dose and notify the physician.
ANS: D Serious respiratory adverse effects of cholinergic agents include bronchospasm and wheezing. If these symptoms present, the next dose of the cholinergic agent should be withheld until the patient is evaluated by a health care provider.
Before the initiation of anticholinergic medications, it is important for the nurse to screen patients for which condition? a. Hypertension b. Infectious diseases c. Diabetes d. Closed-angle glaucoma
ANS: D The inhibition of cholinergic activity (anticholinergic effects) causes pupil dilation, which increases intraocular pressure in patients with glaucoma. In patients with closed-angle glaucoma, anticholinergic medications can precipitate an acute attack. Anticholinergic agents may produce increased heart rate but not hypertension. Anticholinergic agents do not affect infections or diabetes.
An older adult patient is to receive atenolol, a beta-adrenergic blocking agent. Prior to administration of the drug, the nurse assesses an apical pulse rate of 58 and notes ankle edema. Which action will the nurse take first? a. Determine the therapeutic blood level. b. Encourage the patient to decrease water intake. c. Elevate the patient's legs. d. Withhold the medication.
ANS: D These signs and symptoms are indicative of serious adverse effects, and the medication should be held or discontinued until the patient is evaluated by a health care provider. Determining the therapeutic blood level, encouraging the patient to decrease water intake, and elevating the patient's legs are not the first actions that should be taken.
A patient taking labetalol (Normodyne) has also been prescribed procainamide (Procanbid). Which symptom does the nurse monitor for in this patient?
Bradycardia This combination of medications may significantly decrease the patient's heart rate. This combination of medications will not cause an increase in the patient's blood pressure or heart rate and should not have an effect on sodium or potassium levels.
The autonomic nervous system can be subdivided into which types of adrenergic receptors? a. Nicotinic and muscarinic b. Afferent and efferent c. Alpha and beta d. Agonists and antagonists
C The autonomic nervous system can be subdivided into alpha- and beta-adrenergic receptors. Nicotine and muscarine are specific agonists of one type of cholinergic receptor. Afferent and efferent are sensory and motor nerves. An agonist is a molecule that activates a receptor by reproducing the effect of the neurotransmitter. An antagonist acts against and blocks a function. DIF:
What do non-benzodiazepine sedative hypnotics do? What are common side effects?
Cause CNS depression Common adverse effects: Hangover, sedation, lethargy, decreased level of alertness, transient hypotension on arising, restlessness, anxiety
What do beta receptors do?
Causes an increased heart rate, stimulation of beta-2 which causes relaxation of smooth muscle in the bronchi, uterus and peripheral arterial blood vessels
What are common and adverse effects of MAO-B medications?
Common side effects: constipation, upset stomach Adverse effects: •Neurologic (chorea, confusion, hallucinations) •Cardiovascular (orthostatic hypotension)
What is done if too counteract an overdose of beta blockers?
Give glucagon
What are beta-adrenergic blockers used for?
HTN, chest pain, cardiac dysfunction, hyperthyroidism
What types of drugs are used for Parkinson's disease symptoms?
MAOB's rasagiline, safinamide, selegiline Dopamine agonist- carbidopa-levodopa, ropinerole, pramipexole, rotigotine, apomorphine, amantadine
Which medications that may inhibit therapeutic activity for a patient receiving adranergic agents
bretylium tosylate or beta-adrenergic blocking agents, such as propranolol, with adrenergic agents is not recommended because these drugs can inhibit the therapeutic activity of adrenergic agents. Omeprazole, diphenhydramine, and aspirin are not known to inhibit the therapeutic activity of adrenergic agents.
Which patients would the nurse expect an anticholinergic agent to be ordered
pt with nocturnal enuresis, tachycardia, parkinsons disease, pt who needs endotracheal tube Anticholinergic agents are used clinically in the treatment of Parkinson's disease and genitourinary disorders like nocturnal enuresis. Anticholinergic agents are used to prevent vagal stimulation from skeletal muscle relaxants or placement of an endotracheal tube. Anticholinergic agents are used clinically in the treatment of bradycardia, not tachycardia. Beta-adrenergic blocking agents are used extensively to treat hypertension.
