If we have the majority of the neuropharmacological agents there gonna change their effect by altering what?

Synaptic transmission

If we have a drug used to increase receptor activation, are those that do what?

Produce their effect the same as the naturally occurring neurotransmitter.

If your giving a drug that activates a beta 1 receptor, what would the expected response be?

Increased hr and bp

What receptor activates the skeletal muscle?

Nicotinic M

What is the major subtype of a cholinergic receptor?

Muscarinic receptors

What do cholinergic receptors stimulate?

Parasympathetic nervous to stimulate rest and digest, which decreases hr and bronchoconstriction

If giving a drug that inhibits acetylcholinesterase, how is it going to affect autonomic activity?

Increase parasympathetic effects

What are the main effects of a muscarinic agonist like Bethanechol/Urecholine?

Stimulates PNS, contracts bladder/detrusor muscle

When should we not give Bethanechol/Urecholine?

To people who has urinary obstruction or Myasthenia Gravis

What medication do we give for bradycardia?

Atropine

How do we minimize the side effects of a medication if taking it multiple times a day?

Take it at night, taking one dose (extended release medications/longer acting)

Why do we give atropine pre op?

So their HR doesn't get too low.

What happens when you get anesthesia?

Relaxes the whole body so not uncommon for people to get bradycardia during surgery

What med do we give to treat Myasthenia Gravis?

Neostigmine

What is Neostigmines primary action?

Blocks binding of acetylcholine

When treating a patient with Myasthenia gravis, we know that they have reached their target dose of medication by what?

They are able to raise they eyelids and better muscle tone

How do we differentiate between myasthenic crisis and cholinergic crisis?

You give edrophonium to watch and see the response

Prior to giving a cholinesterase inhibitor, what's the primary responsibility to monitor as a nurse?

Assess patients swallowing ability

How do we determine if a patient is in a cholinergic crisis?

Salivation, sweating

A patient is paralyzed with a neuromuscular blocker, what would you expect that patient to be like?

Conscious but unable to move any muscle including diaphragm to move breath

Succinylcholine, what are we monitoring for?

Malignant hyperthermia

Where does malignant hyperthermia occur?

Intraop and Postop

What is the mechanism that adrenergic agonists commonly activate in adrenergic receptors?

Bind to the direct receptor

When assessing your patient that has received medication that activated an alpha 1 receptor, what would we find in your patient?

High BP because its a vasoconstrictor

Who does a beta 1 agonist benefit?

Heart failure

What do we give patients with an anaphylactic reaction?

Epinephrine

If you're giving dopamine, and that medication is extravagant (went out of IV site and into tissues instead of vessels), what should your top priority be?

Stop the medication and contact the provider. Switch IV sites

What does dopamine do?

Increased contractility and decreases HR (increase)

Who are we giving dopamine to?

Heart failure or Afib patients, giving to support BP

What is the difference in absorption between IV and SubQ?

IV is quicker

If you have an adrenergic antagonist, we give it to a patient with benign prostatic hypertrophy (enlarged prostate), why do we give it to them?

Allows them to pee by blocking alpha 1 receptors and relaxing smooth muscle.

When do we give prazosin?

At night because of orthostatic hypotension

If your patient is taking a beta blocker that is new, they get short of breath and swelling in their legs, what would you do as the nurse?

Tell them to come in and be seen or contact the healthcare provider.

What medication do we give if a patient has asthma and needs a beta blocker?

Metoprolol because its selective and more tolerated

What does epinephrine do to a diabetic patient?

Increases blood sugar

What can propranolol do to a patient who is diabetic?

Masks hypoglycemia, so they can't recognize they are having hypoglycemic episodes

What foods can cause adverse effects to a person taking lasix?

Grapefruit

Which foods can prevent adverse effects to a person taking lasix?

Bananas, spinach, potatoes, foods high in potassium

What foods or dietary items should the person taking spironolactone avoid?

Added salt and salt substitutes because salt substitutes have potassium in it

If my patient has a high potassium level above 5, what patient would you question the provider on?

Spironolactone

What medication for an antibiotic does not get along well with lasix?

Gentamicin

Ending for a proton pump inhibitor?

Prazole

How much does a Liter of water weigh?

2.2 lbs/1 kg

If we are giving a patient captopril (ACE inhibitor), what system does it impact?

Angiotensin I from converting Angiotensin II

What is the prime function of an ACE Inhibitor?

Lower BP by causing vasodilation

Calcium channel blockers work the same as what other group of meds?

Beta blockers

What medication do we give to patients who have an emergency situation with high blood pressure?

Sodium Nitroprusside

What do you have to assess when giving digoxin?

Apical pulse

When should you not give digoxin?

HR is less than 60 bpm

What is the side effect that digoxin can give?

Yellow halos, toxicity

What do cholesterol medications cause in patients?

Neck and back pain (myopathy)

What side effect do you get when taking nitroglycerin?

Headache, educate patient that they will probably get a headache

How long do we take sublingual nitroglycerin?

3 times every 5 minutes as needed, if get to the 3rd dose they should call 911

Who should we not give nitroglycerin to?

Male patients with erectile dysfunction taking meds like viagra or cialis

What lab levels do we test for coumadin?

PT and INR

What lab levels do we test for Heparin?

aPPT

Who do we give protamine sulfate to?

Overdose on heparin, symptoms may be blood in stool or in mouth

What is the cutoff for TPA?

4 hours max, because it's not gonna fix whatever is wrong

What do patients who take coumadin not take for a headache?

Aspirin or NSAIDS because they can cause bleeding

Your patient is prescribed NPH insulin, what should that look like?

Cloudy

Which do you draw up first?

Clear so you can tell if they mix

What side effect does synthroid or levothyroxine call the provider for?

Chest pain or insomnia, because it may indicate hyperthyroidism because it may flip from being too low to too high

What lab do we monitor for synthroid?

Thyroid stimulating hormone

How do you dilute lugol's solution?

With fruit juice

What do amoxicillin and tetracycline do to treat a peptic ulcer?

Get rid of the bacteria in the h pylori

Which over the counter laxative is most abused by the public?

bisacodyl (Dulcolax), because it is a stimulant laxative and takes 1-3 days to work

What do you not take dulcolax with?

Antacids

What does lactulose get rid of?

Ammonia

    who do we use lactulose on?

Those with liver failure (cirrhosis)

The nurse identifies which of the following laxatives as having the added response of ridding the body of ammonia?

Lactulose

What anti nausea do we use for patients undergoing chemotherapy?

Zofran

Who cannot use reglan (metoclopramide)?

Anyone with a bowel obstruction or anything wrong with the bowel

Which statement about metoclopramide [Reglan] does the nurse identify as true?

The drug is contraindicated in patients with GI obstruction, perforation, or hemorrhage.

What do antifungals end with?

Azoles

What is candida or thrush considered?

Superinfection

If you take an antibiotic and feel better after 3 days and you begin to feel better, what should you do?

Continue for the full treatment time

When you give penicillin what does it do?

Disrupts cell walls and then the cell ruptures

When doing an antibiotic what do we want to do as a nurse before you start it?

Check allergies, antibiotics highest amt of allergies

If the patient is getting IV cephalosporin and they are complaining of pain even though the site looks fine what should you do?

Change IV sites, known to be irritating to vessel

What side effects can vancomycin give?

Red man syndrome

A patient with heart failure is taking vancomycin and lasix, when do they want to notify their provider?

Ototoxicity like tinnitus (ringing in ears) or dizziness

If your patient is allergic to penicillin what other med would you give?

Biaxin or mefoxin

What foods do you avoid if taking tetracycline?

Dairy

What taking tetracycline what should you do?

Wear sunscreen, makes you photosensitive so you can burn very easily

When do we draw lab work to check the peak of an aminoglycoside (amikin)? How soon after we infuse that do we check the serum level?

30 minutes

If taking a sulfamide, what is the major side effect you can get?

Steven johnsons syndrome

A patient is prescribed cimetidine [Tagamet] and aluminum hydroxide [Maalox] for the treatment of peptic ulcer disease. What should the nurse teach the patient to do?

Wait at least 1 hour between administration of the two medications

If taking a medication for thyroid replacement such as synthroid or levothyroxine, what indicates that the patient understands?

They will have to take it lifelong

What indicates a need for further teaching with a patient taking levothyroxine? 

If a patient tells you they should only take maalox or mylanta for indigestion (heart burn)

What is Glucotrol (Glipizide)?

Use to manage type 2 diabetes; its a type of sulfonylurea

You're teaching your patient taking Glucotrol/Sulfonylurea, when do they need further teaching?

If they say the biggest side effect is a drop in my blood sugar.       

What is the best bloodwork to test for diabetes control?

Hemoglobin A1C, used for 3 months

What can propranolol do if you're a diabetic?

Mask symptoms of hypoglycemia

What is Byetta?

GLP1 agonist, helps suppress appetite

If your patient is taking byetta and the patient says to you “this drug is going to increase the rise in my blood sugar after they eat a meal”, do they need further teaching?

Yes, giving byetta to keep their blood sugar lower

What are signs of hyperglycemia?

polydipsia (want to drink all the time), polyurea (pee all the time), polyphagia (want to eat all the time), fatigue

If we control our blood sugar, what are some of the long term complications of diabetes not being controlled?

Reduces risk of having eye and nerve damage

What lab test would be a big concern if your patient who is diabetic is taking glucophage or metformin?

They have a high creatinine level

What classification of medications for a patient with hyperthyroidism be on if they have tachycardia along with synthroid?

Beta blocker, helps lower their heart rate

What does NPH insulin look like?

Cloudy

If you have a patient who has higher blood sugar, not totally diagnosed as type 2 diabetic, why would we give them metformin?

In high risk individuals, it can hopefully prevent pt from developing type 2 diabetes