NURS3804 Exam 1 Drugs to Know

What class is epinephrine?

adrenergic agonist/sympathomimetics

Which best describes epinephrine?

a. direct-acting

b. indirect-acting

c. mixed-acting

d. all of the above

a. direct-acting

Is epinephrine a catecholamine or a noncatecholamine?

catecholamine (endogenous)

What is the brand name for epinephrine?

Adrenalin

Is epinephrine selective or nonselective?

nonselective: acts on alpha and beta receptors

What receptors are affected by epinephrine?

- alpha 1

- beta 1

- beta 2

What are the 3 effects of epinephrine?

1. inotropic

- strengthens myocardial contraction

- increased CO

2. vasoconstrictor

- increased BP and HR

- reduced renal perfusion

3. promotes bronchodilation

What are indications for epinephrine?

- anaphylaxis and anaphylactic shock

- bronchospasms and status asthmaticus

- cardiogenic shock and cardiac arrest

What is the speed of epinephrine's onset and peak?

rapid

What are contraindications for epinephrine?

- tachydysrhythmias

- closed angle glaucoma

- hypertension

- diabetes mellitus

- hyperthyroidism

- benign prostatic hypertrophy (BPH)

- hypovolemia

- Parkinsonism

What are side effects of epinephrine?

- agitation

- restlessness

- tremors

- hyperglycemia

- oliguria

- dizziness

- headache

- weakness

What are adverse reactions of epinephrine?

- cardiac dysrhythmias

- palpitations

- tachycardia

- hypertension

- vfib

- pulmonary edema

What drugs interact with epinephrine?

- beta blockers

- digoxin

- TCAs and MAOIs

- decongestants

What occurs when epinephrine is taken with beta blockers?

epinephrine's action is decreased

What occurs when epinephrine is taken with digoxin?

cardiac dysrhythmias

What occurs when epinephrine is taken with TCAs and MAOIs?

epinephrine's effects are intensified and prolonged

What occurs when epinephrine is taken with decongestants?

additive effect

What is the antidote for epinephrine?

phentolamine mesylate (Regitine)

What are nursing implications for epinephrine?

- monitor BP, HR, and urine output

- report tachycardia, palpitations, tremors, dizziness, and hypertension to provider

- avoid cold medicines and diet pills if pt is hypertensive, diabetic, has CAD, or dysrhythmic

- avoid continuous use of other adrenergics

What class is atenolol?

adrenergic blockers/antagonists

Is atenolol selective or non-selective?

selective for beta-1

What are indications for atenolol?

- hypertension

- arrhythmia

- angina

- acute myocardial infarction

What are contraindications for atenolol?

- bradycardia

- heart block

- cardiogenic shock

- acute heart failure

- asthma

- renal dysfunction

- diabetes mellitus

- bronchospasm

- myasthenia gravis

- pheochromocytoma

- pulmonary edema

- pregnancy

- lactation

- COPD

What are side effects of atenolol?

- drowsiness/fatigue

- dizziness

- headache

- depression

- nausea

- diarrhea

- erectile dysfunction

What are adverse effects of atenolol?

- bradycardia

- tachycardia

- hypotension

- chest pain

- heart failure

- dyspnea

- bronchospasm

- renal failure

- dysrhythmia

- thrombocytopenia

What drugs interact with atenolol?

- nonsteroidal anti-inflammatory drugs (NSAIDs)

- other hypertensive drugs

- anticholinergics

- insulin

- sulfonylureas

What occurs when NSAIDs are taken with atenolol?

blood pressure lowering effects of atenolol are reduced

What occurs when atenolol is taken with other hypertensive medications?

hypotension

What occurs when atenolol is taken with anticholinergics?

absorption of atenolol is increased

What occurs when atenolol is taken with insulin or sulfonylureas?

increased risk of hypoglycemia

What is the brand name for doxazosin mesylate?

Cardura

What is the drug class for doxazosin mesylate?

adrenergic antagonist/blocker

Is doxazosin mesylate selective or non-selective?

selective for alpha 1

What are indications for doxazosin mesylate?

- hypertension

- benign prostatic hypertrophy (BPH)

What are side effects of doxazosin mesylate?

- hypotension

- headache

- fatigue/asthenia

- edema

- visual impairment

- erectile dysfunction

- dizziness

Why is doxazosin mesylate often given with a diuretic?

to help reduce sodium and water retention

What is the brand name for bethanechol chloride?

Urecholine

What drug class is bethanechol chloride?

cholinergic agonist/parasympathomimetic

What does bethanechol chloride do?

directly stimulates muscarinic receptors to increase bladder tone which increases urination

What are the indications for bethanechol chloride?

increases urination for:

- urinary retention

- neurogenic bladder

What are the contraindications for bethanechol chloride?

- bradycardia

- hypotension

- COPD

- asthma

- peptic ulcers

- parkinsonism

- hyperthyroidism

- intestinal or urinary obstruction

- irritable bowel syndrome (IBS)

- seizures

What are adverse effects of bethanechol chloride?

- tachycardia

- bronchospasm (life threatening)

- wheezing

- seizures

What are side effects of bethanechol chloride?

- nausea and vomiting

- diarrhea

- abdominal cramps

- hypersalivation

- diaphoresis

- headache

- dizziness

- flushing

- urinary urgency and frequency

- miosis

- lacrimation

- hypotension

What drugs interact with bethanechol chloride?

- antidysrhythmics

- atropine

- flavoxate

- opiates

- ganglionic blocking agents

What occurs when bethanechol chloride is taken with an antidysrhythmic?

the effect is decreased

What occurs when bethanechol chloride is taken with atropine, flavoxate, or opioids?

they counteract the action of bethanechol chloride

What occurs when bethanechol chloride is taken with ganglionic blocking agents?

hypotension and severe abdominal symptoms

What are nursing indications for bethanechol chloride?

- monitor urine output

- monitor for urinary obstruction

- administer 1 hr before or 2 hrs after a meal

- auscultate lungs for crackles

What drug class is atropine?

anticholinergic (parasympatholytic)

What does atropine do?

- inhibits Ach by occupying muscarinic receptors

- increases HR

- decreases motility and peristalsis

- decreases salivary secretions

What are indications for atropine?

- decrease secretions preop

- increase HR in bradycardia

- dilate pupils for ocular exam

- antidote for muscarinic agonist poisoning

What are contraindications for atropine?

- glaucoma

- obstructive GI, paralytic ileus, ulcerative colitis

- tachycardia

- benign prostatic hypertrophy (BPH)

- myasthenia gravis

- renal, hepatic, or respiratory impairment

- COPD

- cardiovascular disease

- myocardial ischemia

- hyperthyroidism

- urinary retention

- dysrhythmias

- hypertension

- diarrhea

What drugs interact with atropine?

- phenothiazines

- antihistamines

- TCAs

- amantadine

- quinidine

What occurs when atropine is taken with phenothiazines, antihistamines, TCAs, amantadine, or quinidine?

increased anticholinergic effect

What are side effects of atropine?

- drowsiness

- dizziness

- nausea

- xerostomia: dry mouth

- headache

- confusion

- insomnia

- amnesia

- constipation

- flushing

- restlessness

- blurred vision

- mydriasis

- anxiety

- photophobia

- palpations

- urinary retention

- hyperreflexia

- ataxia

- weakness

- dehydration

- injection site reaction

What are adverse reactions of atropine?

- tachycardia

- paradoxical bradycardia

- hypertension

- hypotension

- angina

- pulmonary edema

- respiratory depression

- ileus

- seizures

- dysrhythmias

- laryngospasm

- coma

What is the brand name for benztropine?

Cogentin

What receptors are affected by benztropine?

muscarinic

What drug class is benztropine?

anticholinergic (antiparkinson)/cholinergic antagonists/parasympatholytic

What are indications for benztropine?

- Parkinson's disease

- drug-induced extrapyramidal reactions

What are contraindications for benztropine?

- dementia

- children

- tachycardia

- cardiac disease

- autonomic neuropathy

- benign prostatic hyperplasia (BPH)

- psychosis

- glaucoma

- myasthenia gravis

- hyperthermia

- alcohol use disorder

- urinary retention/obstruction

What are side effects of benztropine?

- nausea

- vomiting

- xerostomia: dry mouth

- constipation

- anhidrosis: decreased sweating

- dizziness

- headache

- drowsiness

- blurred vision

- confusion

- depression

- hallucinations

- weakness

- hyperthermia

- paresthesia

- mydriasis

- urinary retention

- photophobia

What are adverse effects of benztropine?

- tachycardia

- ocular hypertension

- ileus

- coma

What drugs interact with benztropine?

- other anticholinergics

- phenothiazines

- tricyclic antidepressants (TCAs)

What occurs when benztropine is taken with other anticholinergic, phenothiazines, or tricyclic antidepressants (TCAs)?

anticholinergic effects are increased

What class is tolterodine tartrate?

antimuscarinic/anticholinergic

What is the brand name for tolterodine tartrate?

Detrol

What are indications for tolterodine tartrate?

- urinary frequency

- urinary urgency

- incontinence

What are contraindications of tolterodine tartrate?

- urinary retention

- gastric paresis

- GI obstruction

- glaucoma

- hypothyroidism

- cardiovascular disease

- bradycardia

- heart failure

- GERD

- ulcerative colitis

- myasthenia gravis

- prostatic hypertrophy

- renal dysfunction

- hepatic dysfunction

- hypokalemia

- hypocalcemia

What occurs when tolterodine tartrate is taken with grapefruit?

drug levels may increase

What are side effects of tolterodine tartrate?

- drowsiness

- dizziness

- dry mouth and eyes

- headache

- blurred vision

- confusion

- diarrhea

- abdominal pain

- constipation

- dyspepsia

- dysuria

- fatigue

- weight gain

- arthralgia

- hallucinations

- urinary retention

What are adverse reactions of tolterodine tartrate?

- angioedema

- chest pain

- tachycardia

- peripheral edema

- Stevens-Johnson syndrome

What is the brand name for clonidine?

Catapres

What drug classification is clonidine?

central-acting adrenergic alpha 2 agonist

Is clonidine selective or nonselective?

selective for alpha 2

What is the main indication for clonidine?

hypertension: causes vasodilation to decrease BP

What are side effects of clonidine?

- xerostomia: dry mouth

- sedation

- bradycardia

- hypotension

- sodium and water retention

What are characteristics of clonidine?

- long duration of action

- often given with a diuretic

- not given with a beta blocker because this will increase the effect

What drug class is rivastigmine?

acetylcholinesterase inhibitor

What is the main indication for rivastigmine?

dementia

What is the action of rivastigmine?

- inhibits acetylcholinerase from breaking down acetylcholine

- this increases the amount of acetylcholine at synapses

What are contraindications for rivastigmine?

- liver disease

- renal disease

- urinary tract obstruction

- orthostatic hypotension

- bradycardia

- asthma

- COPD

- seizures

- peptic ulcer disease

What are side effects of rivastigmine?

- anorexia

- abdominal pain

- GI distress

- nausea

- vomiting

- diarrhea

- constipation

- weight loss

- dizziness

- headache

- depression

- confusion

- peripheral edema

- dry mouth

- dehydration

- nystagmus

- photophobia

What are adverse effects of rivastigmine?

- seizures

- bradycardia

- orthostatic hypotension

- cataracts

- myocardial infarction

- heart failure

- hepatotoxicity

- dysthymias

- suicidal ideation

- Steven-Johnson syndrome