545 Exam 1 study outline

bethanechol type of drug

direct acting cholinergic agonist

bethanechol adverse effects

abdominal cramps, diarrhea, nausea, sweating, flushing and increased salivation.

bethanechol other considerations

• Monitor intake and output closely with urinary retention 

• Take 1 hour before or 2 hours after meal to prevent nausea 

• Giving via IV or IM can trigger cardiac collapse 

• Atropine can be used as reversal

Atropine type of drug

cholinergic anatagonist

atropine used in what environment?

pre-op

atropine Adverse Effects

dry mouth, dry eyes, constipation, photophobia, visual disturbances, elevated intraocular pressure and urinary retention.

atropine Other Considerations:

• Given in pre-op to reduce secretions

• Do not give with preexisting tachycardia (increases HR)

• Contraindicated in angle-closure glaucoma, GI obstruction and severe myocardial ischemia.

Cholinergic Antagonists.

What side effects would we expect to see with these medications?

• dry mouth, dry eyes, constipation, tachycardia, blurred vision, urinary hesitancy or retention. 

what kind of medication is vecuronium

antinicotinic

what is vecuronium used for

muscle relaxation during surgery

vecuronium adverse effects

•  hypotension, respiratory arrest, muscle weakness, and altered heart rate

• Pyridostigmine what kind of drug

cholinesterase inhibitor

• Pyridostigmine adverse effects

• stomach cramps, diarrhea, nausea, excessive saliva, sweating, and muscle twitching

• Pyridostigmine other considerations

• Monitor ability to swallow for oral preparations 

• Can give with food or milk to prevent AEs and do not crush or chew tablets

• Monitor for cholinergic crisis (overdose) or myasthenic crisis (underdose); atropine is reversal for overdose

• Carbidopa-Levodopa (for parkinsons) 

  • Mechanism of Action

Levodopa crosses the BBB to convert itself into dopamine. Carbidopa inhibits breakdown to ensure that more active medication reaches the brain.

• Carbidopa-Levodopa (for parkinsons)  Other Considerations

• Change positions slowly 

• Protein binds to levodopa which takes away space for the drug 

• Iron supplements decrease absorption

• Memantine used for what dz?

Alzheimers

Carbidopa-Levodopa used for what dz?

parkinsons

memantine mechanism

Blocks calcium influx caused by excess glutamate while also preserving normal functioning

phenytoin used for ?

anticonvulsant for seizures

phenytoin other considerations

• Avoid alcohol (increases likelihood of toxicity) 

• Speeds up liver break down of oral contraceptives 

• Can monitor blood levels to maintain therapeutic level

baclofen other considerations

• Do not stop abruptly. can cause seizures, hallucinations, and mood changes 2a3 

• Monitor for hypotension and excessive sedation 

• For intrathecal use: monitor test doses via pump and titrate appropriately 

• Extrapyramidal Effects. what is it

• Involuntary movement disorders caused by blocked dopamine receptors 

baclofen use?

muscle relaxant

• What are the EPS effects themselves of taking antipsychotic drugs

• Bradykinesia

• Spasms 

• Shuffling gait 

• Poor posture 

• Akathisia

• What drugs are used to treat EPS effects

Benzodiazepines

Haloperidol/Haldol used for?

antipsychotic for schizophrenia

Haloperidol/Haldol adverse effects

• Dizziness

• Drowsiness 

• Weight gain 

• Insomnia 

• Constipation 

• Dry mouth

• Prolonged QT interval

Haloperidol/Haldol other considerations

• Monitor tele for changes in cardiac rhythm 

• Dosing is important; monitor for any EPS symptoms 

• Fall precautions and seizure protocols

pharmacodynamics definition

• how a drug interacts with the body

What factors can influence pharmacodynamics

• age, genetics, coexisting diseases, drug interactions, etc. 

pharmacokinetics defintion

• absorption, distribution, metabolism and excretion of a drug

absorption

movement of drug from administration site to blood

distribution

• movement of the drug from blood to tissues to cells 

metabolism

chemical alteration of the drug structure so it can be excreted more easily. Usually in the liver

excretion

movement of drugs and their metabolites out of the body. Urine, bile, seat, saliva, breast milk, or expired air.

What types of labs would we consider monitoring with general drug use

• CMP over BMP because it includes liver function 

• Creatine, BUN, GFR

adverse effects definition

• unwanted and/or harmful physical response to a medication 

Examples of adverse effects of drugs

• anaphylaxis, liver failure, cardiac arrhythmias, respiratory depression, drowsiness, fatigue, headaches, etc. 

Paradoxical effect

• does opposite of intended effect 

Idiosyncratic effect:

• unusual reaction that doesn’t occur in most people 

How can we expect a provider to dose medication for a pediatric client vs. an adult

• based on body weight 

Why would we dose this way

• different proportions change absorption, distribution, metabolism and elimination of drugs. 

• What labs might we consider monitoring with drug use in older adults

• Renal and kidney 

Patient Education for Older Adults Pearls

• Take a complete drug history

• Check all drugs taken for interactions and common components. 

• Use STOPP criteria or Beers list to identify inappropriate drugs

• Monitor clinical responses and labs to identify potential adverse drug reactions early 

• Accommodate for age-related sensory issues like decreased vision or hearing. Include a family member if needed. 

• Encourage disposal of all old drugs.

• Health Literacy

  • What is the definition of this term

• ability to understand and use health information to make informed decisions about one’s health. 

• Cultural Competence

  • How is this important to nursing & why is it necessary for practice

individuals communicate and build relationships differently across different cultures. Needed due to changes in demographics, ensures patient safety, closes health disparities, and decreased healthcare workforce shortages.

• Fluoxetine

  • Know what drug class this medication is a part of

SSRI

Fluoxetine Other Considerations

• Has black box warning for increased risk of SI

• Can take at least 3-4 weeks before improvement in s/s

• Monitor for serotonin syndrome with concurrent use of other drugs

• Black Box Warnings

  • Which medications/drug classes carry a warning for increased risk of SI

• SSRIs, SNRIs, and tricyclic antidepressants

• Venlafaxine

  • Know what drug class this medication is a part of 

SNRIs

• Venlafaxine Adverse Effects 

• Hypertension 

• N/V

• Dry mouth 

• Dizziness 

• Insomnia 

• Weight changes

•  Sweating 

• Sexual dysfunction

• Venlafaxine Other Considerations

• Black box warning 

• Routine monitoring of patient BP due to risks for constrict blood vessels raising levels 

• Dosage reductions required for renal or hepatic impairment

• MAO Inhibitors (drug class)

  • What foods are avoided with use of these medications & why

• Tyramine-risk foods because they can raise BP (aged cheese, cold cuts, smoked fish, soy, red wine, beer, and certain liquors)

• Avoid ____ containing foods with MAO inhibitors 

tyramine

_____ foods cause stomach upset with SSRIs

high-fat/greasy foods

mixing serotonin agents leads to_______?

serotonin syndrome

______ speeds up drug breakdown  with antidepressants

St. John’s wort

________  alters liver metabolism of some antidepressants

Ginkgo biloba

• Lithium

  • Adverse Effects

• Stomach upset, increased thirst and urination, weight gain and fatigue 

• Lithium toxicity: poor coordination, confusion, sedation, hand tremor, N/V and diarrhea

Lithium Other Considerations

• Maintain balanced sodium intake (sudden drops can cause body to retain medication) 

• Avoid NSAID use; slows kidney’s filtration of lithium 

• Lithium orotate is an OTC used for mood support

Zolpidem Other Considerations

• Front-line choices for short term treatment of insomnia disorders 

• Monitor breathing with use; can lead to sleep apnea or respiratory depression 

• Give on an empty stomach and right before bedtime (cuz its supposed to make u sleep duh)

• Alprazolam (benzodiazepine) 

  • Other Considerations

• Flumazenil is reversal agent 

• Use is indicated for short-term/acute conditions and social anxiety disorder scenarios 

• Ensure fall precautions are in place for all patients 

• Buspirone (non benzodiazepine)

  • Other Considerations

• If transitioning from a benzo, stop use completely before starting this medication

• Avoid grapefruit juice (can increase blood levels) 

• Requires a 14 day washout period if previously taking MAOIs

• Adderall

  • Adverse Effects

• Weight loss, restlessness, chest pain, insomnia, dry mouth, increased HR, HA, dizziness