Term
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Definition
| any chemical that affects physiologic processes of a living organism |
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Term
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Definition
| study or science of drugs |
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Term
| Who regulates OTC and prescription drugs? |
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Definition
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Term
| Who can prescribe prescription drugs? |
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Definition
| Medical doctors, Doctors of osteopathy, dentists, podiatrists, PA's and APRN/s |
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Term
| Who regulates new drug development? |
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Definition
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Term
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Definition
| involves the careful explanation to the human test patient or research subject of the purpose of the study, the procedures to be used, the possible benefits, and the risks involved |
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Term
| What happens in each phase? |
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Definition
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Term
| Examples of medical errors |
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Definition
| Misdiagnosis, patient misidentification, lack of pt monitoring, wrong-site surgery, and med erros |
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Term
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Definition
| any preventable adverse drug events involving inappropriate meds used by a patient or health care professional- may or may not cause harm to pt |
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Term
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Definition
| Drugs that have potentially toxic nature, require special care when prescribing, dispensing, and/ or administering |
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Term
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Definition
| Sound alike look alike drugs |
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Term
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Definition
| Describes the drug chemical composition and molecular structure |
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Term
| Generic name (nonproprietary name) |
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Definition
| used by most official drug compendiums to list drugs |
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Term
| trade name (proprietary name) |
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Definition
| drug's registered trademark and indicates that its commercial use is restricted to the owner of the patent fro the drug |
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Term
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Definition
| structure or therapeutic use |
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Term
| Differences btw generic vs trade names |
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Definition
| generic is often much shorter and simpler to remember compared to the chemical name while the trade name is created by the manufacter |
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Term
| Important factors btw generic and trade |
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Definition
| Generic is for NCLEX testing only, common general name, lowercase, less expensive agent, difficult to spell and say; Trade is pharmaceutical indenitified, capitilized, trademarked, expensive, active ingredient |
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Term
| OTC medications- nonprescription |
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Definition
| Meds that are legally available w/o prescription |
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Term
| why are OTC meds. so dangerous? |
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Definition
| own toxicity profiles, abuse |
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Term
| important considerations of OTC |
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Definition
| review safety labels, pros/ cons of meds |
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Term
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Definition
| broad term for orally administered alternative medicines and includes the category of herbal supplements |
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Term
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Definition
| come for nature and have been used for thousand of years to help maintain good health |
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Term
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Definition
| lost ground to new synthetic medicines during the early part of the 20th century |
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Term
| Commonly used herbal products? |
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Definition
| aloe, black cohosh, garlic, ginger, valerian, saw palmetto |
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Term
| What are important nursing implications to consider w/ pts using herbal products? |
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Definition
| consider pregnancy, breastfeeding, infants, children |
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Term
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Definition
| the science of preparing and dispensing drugs including dosage form design |
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Term
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Definition
| study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body |
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Term
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Definition
| study of the biochemical and physiologic interactions of drugs at their sites of activity |
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Term
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Definition
| treatment of pathologic conditions through the use of drugs |
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Term
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Definition
| study of poisons including toxic drug effects and applicable treatments |
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Term
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Definition
| the study of drugs that are obtained from natural plant and animal sources |
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Term
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Definition
| the study of economic factors impacting the cost of drug therapy |
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Term
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Definition
| movement of a drug from its site of administration into the bloodstream from distribution to the tissues |
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Term
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Definition
| used to express the extent of drug absorption |
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Term
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Definition
| drug that is absorbed from the intestine must 1st pass through the liver before it reaches the systemic circulation; If a large proportion of a drug is chemically changed into inactive metabolites in the liver, then a much smaller amount of drug will pass into the circulation (i.e., will be bioavailable). |
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Term
| what factors affect absorption? |
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Definition
| how drug is given, its route, affects the rate and extent of absorption of that drug |
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Term
| When will the nurse administer medications if ordered with food or on an empty stomach?? |
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Definition
| Within 20-30 minutes; 1 hr before and 2 hr after; administer w/food , shortly after meal w/ 6-8 oz of water |
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Term
| List the 3 routes of drug administration. |
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Definition
| topical- patches, paste, eyedrops, parenteral- around gi tract, enteral- gi tract |
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Term
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Definition
| drug is absorbed into the systemic circulation through the mucosa of the stomach and/or small or large intestine. Orally administered drugs are absorbed from the intestinal lumen into the blood system and transported to the liver. Once the drug is in the liver, hepatic enzyme systems metabolize it, and the remaining active ingredients are passed into the general circulation. |
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Term
| Name several forms of medications that are included in the enteral route. |
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Definition
| Hydralazine, lithium, oral opiods, lithium propenotol, NSAID, iron, sublingual, buccal, rectal |
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Term
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Definition
| general term meaning any route of administration other than the GI tract. It most commonly refers to injection. Intravenous injection delivers the drug directly into the circulation, where it is distributed with the blood throughout the body. Drugs given by intramuscular injection and subcutaneous injection are absorbed more slowly than those given intravenously. These drug formulations are usually absorbed over a period of several hours; however, some are specially formulated to be released over days, weeks, or months. |
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Term
| Name several forms of medications administered via the parenteral route. |
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Definition
| IV, irritating drugs, antibotics, steroids, transdermal, intramuscular |
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Term
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Definition
| Refers to the transport of a drug by the bloodstream to its site of action |
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Term
| What system is responsible for distribution? |
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Definition
Circulatory, heart, liver, kidneys, brain- rapid distribution
Muscle, skin, feet- slow distribution |
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Term
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Definition
| when taking 2 medication that are highly protein bound and the meds may compete for binding sites, blood-brain barrier-physiologic barriers that make it diffiult for drugs to pass through the brain |
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Term
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Definition
| also referred to as biotransformation. It involves the biochemical alteration of a drug into an inactive metabolite, 26a more soluble compound, a more potent active metabolite (as in the conversion of an inactive prodrug to its active form), or a less active metabolite |
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Term
| What is the main organ is responsible for metabolism? |
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Definition
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Term
| List factors that increase or decrease metabolism. |
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Definition
| Fast acetylatoyr ,phenytoin, barbiturates;CV dysfunction, renal insufficiency, starvation, obstructive jaundice, slow acetylator |
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Term
| What is the danger with increased or decreased metabolism of medications? |
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Definition
| Increased metabolism may require higher dosages of meds, decreased metabolism leads to decreased blood flow and enzyme production |
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Term
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Definition
| elimination of drugs from the body |
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Term
| main organ involved in excretion? |
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Definition
| Kidney, bilary excretion, enterohepatic recirculation |
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Term
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Definition
| time required for 50% of a given drug to be removed from the body |
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Term
| how many half-lives does it take for most meds to be effectively removed from the body? |
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Definition
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Term
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Definition
| Physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each dose |
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Term
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Definition
| processes involved in the interaction btw a drug and a cell |
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Term
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Definition
| physiologic reactions of the body to the drug |
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Term
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Definition
| time required for the drug to elicit a therapeutic response |
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Term
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Definition
| time required for a drug to reach its max. therapeutic response |
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Term
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Definition
| length of time that the drug concentration is sufficient to elicit a therapeutic response |
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Term
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Definition
| lowest blood level of a drug |
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Term
| 3 ways that drugs act on the body |
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Definition
| through receptors, enzymes, and nonselective interactions |
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Term
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Definition
| involves more intensive drug treatment& is implemented in the acutely ill (rapid onset of illness) or critically ill, needed to sustain life or treat disease |
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Term
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Definition
| does not eradicate pre-existing problems the patient may have, but will prevent progression of a disease or condition. It is used for the treatment of chronic illnesses such as hypertension. |
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Term
| Supplemental/replacement therapy |
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Definition
| supplies the body with a substance needed to maintain normal function. This substance may be needed either because it cannot be made by the body or because it is produced in insufficient quantity. |
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Term
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Definition
| to make the pt as comfortable as possible; relief from the symptoms, pain, and stress of a serious illness |
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Term
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Definition
| maintains the integrity of body functions while the pt is recovering from illness or trauma |
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Term
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Definition
| provided to prevent illness or other undesirable outcome during planned |
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Term
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Definition
| based on clinical probabilities, involves drug administration when a certain pathologic condition has a high likelihood of occurrence based on the pt.'s initial presenting symptoms |
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Term
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Definition
| Any pt. condition esp. a disease state that makes the se of the given medication dangerous for the pt. |
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Term
| black box warning and who assigns them |
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Definition
| black box warning and who assigns them? (Chapter 4, see slide %) Appears in a drug’s prescribing information and required by the FDA to alert prescribers of serious adverse events that have occurred w/ the given drug (voluntary recall); FDA |
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Term
| Clinical Response or therapeutic effect |
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Definition
| effectiveness of the therapy |
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Term
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Definition
| predictable adverse drug reactions |
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Term
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Definition
| The ratio of a drug's toxic level to the level that provides therapeutic benefits |
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Term
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Definition
| important tool for evaluating the clinical response to drug therapy |
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Term
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Definition
| pt’s concurrent diseases or other medical conditions |
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Term
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Definition
| decreasing response to repeated drug doses |
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Term
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Definition
| physiologic or psychological need for a drug |
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Term
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Definition
| alteration of the action of 1 drug by another |
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Term
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Definition
| 4 types- any reaction to a drug that is unexpected& undesirable& occurs at therapeutic drug dosages; pharmacologic reaction, hypersensitivity, idiosyncratic, drug interaction |
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Term
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Definition
| when 2 drugs w/ similar actions are given together |
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Term
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Definition
| occur when 2 drugs administered together interact in such a way that their combined effects are greater than the sum of the effects for each drug given alone |
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Term
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Definition
| occur when the combination of 2 drugs results in drug effects that are less than than the sum off the effects for each drug given alone |
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Term
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Definition
| most commonly used to describe parenteral drugs, occurs when 2 parenteral drugs or solutions are mixed together& the result is a chem. Deterioration of 1 or both of the drugs or the formation of a phys. precipate |
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Term
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Definition
| perm. Changes in the composition of living organisms& consist of alterations in chromosome structure, the # of chromosomes, or the genetic code of the DNA molecule |
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Term
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Definition
| result in structural defects in the fetus |
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Term
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Definition
| cancer-causing effects of drugs, other chemicals, radiation, and viruses |
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Term
When/why are medications dangerous to pregnant women?
Breast-feeding? |
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Definition
Risk of drug transfer
1st and last trimester, fetal exposure
Drugs cross through placenta |
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Term
| How is pharmacokinetics different |
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Definition
| Pediatric pts. Has lower maturity rate of vital organs, processes are still developing |
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Term
| List the ways that absorption, distribution, metabolism and excretion of medications is different in neonates and pediatric patients. |
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Definition
| . Gastric pH is less acidic, slower gas emptying, faster and irregular intramuscular absorption; fat content is lower due to greater total body water, protein binding is decreases, more drugs enter the brain; increased metabolism& require higher dosages, genetic differences; GFR, tubular secretion, resorption are decreased due to kidney immaturity, perfusion of kidneys may be decreased |
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Term
| What are factors that affect drug dosing in pediatrics? |
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Definition
| Thinner skin, lack of stomach acid, weaker mucous barriers in lungs, body temp. is less well regulated, immature kidneys and liver |
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Term
| How are medications dosed in pediatrics? |
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Definition
| Drug order, pt’s wt in kg, per manufacturer |
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Term
| Age elderly begins? Concerns for meds |
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Definition
| 65, Lack of adequate patient education, use of multiple prescribers and pharmacies, polypharmacy |
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Term
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Definition
| Simultaneous use of multiple medications |
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Term
| What are some of the causes and solutions of polypharmacy |
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Definition
| Adverse effects of other drugs, noncompliance w/ prescribed medication regimens |
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Term
| What information should the nurse gather in regards to medications and culture? |
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Definition
| Verbal/ nonverbal communication, family ties, biologic variations, common health beliefs |
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Term
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Definition
| Meds that relieve pain w/o causing loss of conscious, known as painkillers |
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Term
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Definition
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Term
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Definition
pain relieving drugs, Also classified by mechanism of action
Drugs that bind to the opiate receptors to relieve pain |
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Term
| where opioids originate from? |
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Definition
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Term
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Definition
| causes an action to occur, Binds to an opioid pain receptor in the brain and causes an analgesic response- reduction of pain sensation |
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Term
Mild agonist
codeine-
Hydrocodone (Lortab) |
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Definition
| only agonist to produce ceiling effect |
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Term
Strong agonist
Morphine
MS Contin |
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Definition
| (sustained/long-acting 8-12 hrs) |
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Term
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Definition
| 8 times more potent than morphine |
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Term
Oxycodone (Percocet)
Oxycontin |
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Definition
| (sustained release for 12 hrs)- contin means continuously |
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Term
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Definition
|
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Term
| fentanyl (Duragesic) (See fentanyl transdermal patch box) |
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Definition
| used a lot on oncology floors, palliative care |
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Term
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Definition
| used in a lot of rehab/ addiction centers, used on chronic pain |
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Term
| Define agonist-antagonist ,partial agonist |
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Definition
binds to a pain receptor and causes a weaker pain response than does a full agonist
Not generally used for chronic pain
Prevent overmedication and reduce post-treatment addictive cravings
Combo products treat addiction
Lower risk for resp. depression
Similar to agonist, but lower risk of misuse and addiction
Not used as 1st line anaglesic |
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Term
| List ways agonist- antagonists may be better than agonist |
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Definition
| Useful in pain management of obstertical ptients |
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Term
| type of agonist-antagonist |
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Definition
|
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Term
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Definition
| Binds to a pain receptor but does not reduce pain signals |
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Term
| How might they be used with opioids? |
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Definition
| Also known as competitive antagonists |
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Term
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Definition
| Naloxone hydrochloride (Narcan)- drug of choice for reversal of resp. depression and acute opioid overdose |
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Term
|
Definition
Moderate to severe pain, often postoperative pain
Used in combination with anesthetics during surgery
Cough center suppression
Treatment of diarrhea due to slowing of the GI tract (diphenoxylate/ atropine- Lomotil) |
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Term
| List patient situations where opioid analgesics would be contraindicated and why? |
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Definition
Drug allergy- side effects
Severe asthma- Resp. depression
Use w/ extreme caution in pts with:
Resp. insufficiency- Resp. depression
Elevated ICP- CNS Depression
Morbid obesity and/or sleep apnea- Resp. depression
Paralytic ileus- GI tract already slowed down
Pregnancy- possible harm to the baby |
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Term
| List major adverse effects of opioid analgesics. |
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Definition
| Orthostatic hypotension, bradycardia, flushing- can be due to histamine release (redness), sedation, nausea, vomiting, urinary retention, itching, rash, CNS depression lead to resp. depression, constipation |
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Term
| What is the most serious adverse effect that leads to respiratory depression? Opioid analgesics |
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Definition
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Term
| What is the serious adverse effect from toxicity? opioid analgesics |
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Definition
Resp. depression, Used in management of opioid overdose and addiction
Consider withdrawal symptoms |
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Term
| What drug class can be used to treat toxicity and overdose |
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Definition
| Naloxone (Narcan), naltrexone (ReVia) |
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Term
| Define opioid withdrawal/opioid abstinence syndrome- |
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Definition
| the extent of opioid tolerance is most visible when an opioid drug is discontinued abruptly or when an opioid antagonist is administered- joint pain, anxiety, confusion, diarrhea, vomiting, abdominal cramps, hot flashes and chills, lacrimination (fear), diaphoresis |
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Term
|
Definition
| (A normal physiologic condition that results from long-term opioid use, in which larger doses of opioids are required to maintain the same level of analgesia and in which abrupt discontinuation of the drug results in withdrawal symptoms (same as physical dependence) |
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Term
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Definition
| (A condition in which a patient takes a drug over a period of time and unpleasant physical symptoms (withdrawal symptoms) occur if the drug is stopped abruptly or smaller doses are given. The physical adaptation of the body to the presence of an opioid or other addictive substance.) |
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Term
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Definition
| A pattern of compulsive use of opioids or any other addictive substance characterized by a continuous craving for the substance and the need to use it for effects other than pain relief (also called addiction). |
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Term
|
Definition
| Acetaminophen (Tylenol)is most widely used |
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Term
| What class of medication is this drug often combined with. |
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Definition
|
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Term
| What type of affect does this drug have? |
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Definition
Analgesic and antipyretic effects
Little to no antiinflammmatory effects
Able over the counter and in combination products with opioids
Very dangerous |
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Term
| mechanism of action for acetaminophen |
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Definition
Blocks peripheral pain impulses by inhibition of prostaglandian synthesis
Lowers febrile body temps by acting on hypothalamus
Don’t cause aspirin related GI tract, irritation or bleeding |
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Term
| indications for acetaminophen |
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Definition
| Treatment of mild to moderate pain and fever, alternative for aspirin, antipyretic drug of choice in children and adolescents with flu symptoms due to aspirin risk of Reye’s Syndrome |
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Term
| Acetaminophen: Contraindications/Interactions |
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Definition
Should not be taken in the presence of……
Severe liver disease (liver dysfunction), drug allergy, genetic disease (G6PD), possible liver failure
Dangerous interactions may occur if taken with alcohol or other drugs that are hepatotoxic
In heavy drinkers, limit 3 drinks per day and 2000 mg of acetaminophen |
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Term
|
Definition
Potentially lethal drug when taken in overdose
Maximum daily dose for healthy adults is being lowered to 3000 mg/day
2000 mg for elderly or those with liver disease
325 mg limit in combo products (hydrocodone, oxycodone)
Inadvertent excessive doses may occur when different combination drug products are taken together
Be aware of the acetaminophen content of all medications taken by the patient (OTC and prescription) |
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Term
| How can overdose happen of this OTC drug? (Acetaminophen) |
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Definition
| Depressed patients (especially adolescents) may intentionally overdose on the drug as an attention-seeking gesture without realizing the grave danger involved |
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Term
| Antidote of acetaminophen, important teaching |
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Definition
Acetylcysteine (mucomyst) , works by preventing the hepatotoxic metabolites of acetaminophen from forming, most effective when given
Within 10 hours of an overdose, bad taste, rotten egg odor, vomiting of oral dose common |
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Term
|
Definition
| tramadol (Ultram)- weak bond to pain receptors and inhibits reuptake of norepinephrine and serotonin, used in moderate to severe pain, chronic pain |
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Term
|
Definition
Lidocaine (Lidoderm)- patch used to treat postherpetic neuralgia, painful skim after outbreak of shingles,
Apply to pain area, local relief, up to 3 patches may be applied, take off after 12 hours |
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Term
|
Definition
Drugs that are added for combined therapy with a primary drug and may have additive or independent analgesic properties, or both
NSAIDS Antidepressants
Anticonvulsants
Corticosteroids |
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Term
| Adjuvant drugs for neuropathic pain |
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Definition
Amitriptyline (Elavil) -antidepressant
Gabapentin (Neurontin) or pregabalin(Lyrica) anticonvulsants |
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Term
|
Definition
| Drugs that …… depress the CNS or peripheral nerves to produce decreased or loss of consciousness, or muscle relaxation |
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Term
| Anesthesia is the state of |
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Definition
| loss ability to feel pain resulting from the administration of an anesthetic drug |
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Term
| Differentiate between general and local effects in the body |
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Definition
General-Involves complete loss of consciousness and loss of body reflexes including resp. muscles, require mechanical ventilation
Local-Doesn’t involve paralysis of resp. function, only elimination of pain sensation in the tissues innervated by anesthetized nerves |
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Term
| What are general anesthetics |
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Definition
| drugs that are used to produce profound neurosensory depression to allow for surgical procedures. |
|
|
Term
| when are general anesthetics used |
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Definition
| Given only under controlled situations by anesthesia providers |
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Term
| Who administered these medications? general anesthetics |
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Definition
| Anesthesiologist, CRNA, anesthesia assistant |
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Term
|
Definition
| liquids or gases that are vaporized or mixed with O2 and inhaled to induce anesthesia |
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Term
|
Definition
| - given intravenously and used for induction and/or maintenance of general anesthesia, induction of amnesia, and as adjuncts to inhalation-type anesthetics |
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Term
| What are adjunct anesthetics? |
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Definition
| Any drug that enhances clinical therapy when used simultaneously w/ another drug, used simultaneously w/ general anesthetics for anesthesia initiation, sedation, reduction of anxiety, and amnesia |
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Term
|
Definition
| Simultaneous use of both general anesthetics and adjuncts |
|
|
Term
| Describe the overall affect and stages of anesthesia |
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Definition
| Progressive reduction of sensory and motor CNS functions; loss of consciousness |
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Term
| Indications of anesthesia |
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Definition
They are indicated for…. Relaxation of skeletal and visceral smooth muscles for surgical procedures
To produce…. Unconsciousness, skeletal muscle relaxation, visceral smooth muscle relaxation
Rapid onset, quickly metabolized
Contraindications vary according to drug |
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Term
| Adverse Effects of anesthesia |
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Definition
| Vary according to dosage and drug used, Myocardial depression is commonly seen |
|
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Term
| What are the sites primarily affected? anesthesia |
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Definition
| Heart, peripheral circulation, liver, kidneys, and resp. tract |
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Term
| Why is N/V, confusion seen less often? anesthesia |
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Definition
| Due to balanced anesthesia ( use of generals and adjuncts) |
|
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Term
| How can anesthesia affect elderly vs. pediatrics, patients with a history of substance abuse? |
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Definition
| Predispose a patient to complications, may need dose adjustments |
|
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Term
| define malignant hyperthermia |
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Definition
Uncommon, but potentially fatal, genetically linked adverse metabolic reaction to general anesthesia
Occurs during or after general anesthesia or use of the NMBD succinylcholine
Sudden elevation in body temperature, greater than 104 degrees |
|
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Term
| nitrous oxide- laughing gas |
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Definition
| inhaled gas used as general anesthetic, weakest, used in dental procedures |
|
|
Term
| malignant hyperthermia signs and symptoms |
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Definition
| Rapid rise in body temp., tachycardia, tachypnea, muscular rigidity |
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Term
| medication used to treat malignant hyperthemia |
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Definition
| cardiorespiratory supportive care and dantrolene (Dantrium) (skeletal muscle relaxant) |
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Term
|
Definition
IV only, Produces dose dependent CNS depression
Commonly used daily in OR settings
General anesthetic used for induction and maintenance, sedation for mechanical ventilation in ICU
Weight based, resp. depression if given in excess |
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Term
| moderate sedation/ conscious sedation |
|
Definition
Doesn’t cause complete LOC and normally not resp. distress
Relax, reduce anxiety, respond to verbal commands and maintain own airway
Rapid recovery compared to general anesthesia
Combination of an IV benzodiazepine (e.g., midazolam (Versed) and an opiate analgesic (e.g., fentanyl or morphine, sometimes propofol used) |
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Term
| pt affects of moderate sedation and when it is used |
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Definition
| Allows patient to relax and have markedly reduced or no anxiety, yet still maintain own airway and respond to verbal commands; surgeries |
|
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Term
| who can administer moderate sedation |
|
Definition
|
|
Term
| Mild amnesia from moderate sedation is due to what med? |
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Definition
|
|
Term
| local anesthetics reduce pain where? |
|
Definition
| level of peripheral nerves |
|
|
Term
| local anesthetics difference btw general anesthetics |
|
Definition
|
|
Term
| When are local anesthetics used? |
|
Definition
| Clincial settings in which loss of consciousness is undesirable or unnecessary, childbirth, spinal anesthesia, dental procedures, suturing, diagnostics –lumbar puncture, biopsy |
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Term
|
Definition
Spinal is injected into the area near the spinal cord with the vertebral column (IV or spinal injection)
Topical is applied directly onto the surface of the skin, eye, or any mucous membrane to relieve pain or prevent it from being sensed |
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Term
| How is spinal considered a local anesthetic? |
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Definition
| It doesn’t depress the CNS at a level that causes loss of consciousness |
|
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Term
| Local anesthetic drug effects: paralysis |
|
Definition
First, autonomic activity is lost
Then pain and other sensory functions are lost
Last, motor activity is lost
As local drugs wear off, recovery occurs in reverse order (motor, sensory, then autonomic activity are restored |
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Term
| adverse effects of local anesthetic |
|
Definition
Usually limited
Adverse effects result if:
Inadvertent intravascular injection
Excessive dose or rate of injection
Slow metabolic breakdown
Injection into highly vascular tissue |
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Term
|
Definition
| (Box 11-9) result of penetration into and through the dura mater of the spinal cord, a leakage of CSF occurs from the insertion site, occurs in 70%of inadvertent Dural puncture during epidural |
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|
Term
| treatment for spinal headache |
|
Definition
Bedrest and analgesics
Blood patch in severe cases |
|
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Term
|
Definition
lidocaine (Lidoderm)- pain patch
prilocaine/lidocaine (EMLA)- numbing cream
lidocaine (Xylocaine)- common, used alone or in combo w/ epinephrine, used in infiltration and nerve block, parenteral form used to treat cardiac dysrhythmias
- caine means local anesesthia |
|
|
Term
| Neuromuscular Blocking Drugs (NMBDs) |
|
Definition
| Prevent nerve transmission in skeletal and smooth muscles leading to temporary paralysis |
|
|
Term
| when are Neuromuscular Blocking Drugs (NMBDs) used? |
|
Definition
| As adjuncts w/ general anesthetics for surgical procedures |
|
|
Term
| Why are NMBDs high alert medications? |
|
Definition
| Leads to death or severe injury |
|
|
Term
|
Definition
| bind to cholinergic receptors in place of acetylcholine, mimic response, act as competitive agonist |
|
|
Term
|
Definition
| bind to ACh receptors but block instead of mimic, competitive antagonist so as a result…muscle fibers are not stimulated, skeletal muscle contraction does not occur |
|
|
Term
|
Definition
First sensation is muscle weakness, followed by total flaccid paralysis
Small, rapidly moving muscles affected first (fingers, eyes), then limbs, neck, trunk, then intercostal muscles and diaphragm affected, resulting in resp arrest and pt cannot breath on own
Recovery of muscular activity usually occurs in reverse order
Do not cause sedation, relieve pain or anxiety |
|
|
Term
|
Definition
Maintaining skeletal muscle paralysis
Short acting? Facilitate intubation w/ an endotracheal tube |
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Term
|
Definition
Few when used appropriately, depends on drug used and patient
Increase or decrease in BP and HR
Bronchospasm, excessive bronchial and salivary secretions
Key is to use only enough to block the neuromuscular
receptors
Robinol- pg.338- used to decrease secretions |
|
|
Term
|
Definition
Respiratory muscle paralysis occurs with these drugs
Emergency ventilation equipment must be immediately available
Overdose causes prolonged paralysis requiring prolonged mechanical ventilation
Cardiovascular collapse may occur |
|
|
Term
|
Definition
Succinylcholine (Anectine)
Works similarly to neurotransmitter acetylcholine (Ach) causing depolarization
Metabolism is slower than Ach so as long as its present, repolarization cannot occur |
|
|
Term
| Nursing Implications pf NMBDs |
|
Definition
Assess: allergies, prescriptions, OTC, herbals, supplements, use of alcohol, smoking, illicit drugs, opioids
Respiratory and neurological assessment, height/weight,
diagnostics/lab testing, pregnancy?
Surgical history or problems with anesthesia, personal or family history of malignant hyperthermia
Monitor VS, temperature, pain, return of sensation
Implement safety measures, reorient your patient
Each perioperative phase has its own complex and very specific nursing actions
Provide preoperative teaching about the surgical procedure and anesthesia |
|
|
Term
| CNS Depressants- Sedatives |
|
Definition
Depress the CNS to reduce…..
Nervousness
Excitability
Irritability
does not cause sleep, but can become a hypnotic if given in large enough doses |
|
|
Term
| CNS Depressants- Hypnotics |
|
Definition
Cause sleep
Much more potent effect on CNS than sedatives
Many drugs can act as either depending on dose and patient response so they are sedative-hypnotics |
|
|
Term
|
Definition
dose dependent
At low doses calm the CNS without inducing sleep
At high doses calm the CNS to the point of causing sleep |
|
|
Term
| 3 drug groups of CNS depressants |
|
Definition
| barbiturates, benzodiazepines, and miscellaneous drugs |
|
|
Term
|
Definition
| prolonged sedative- hypnotic use may reduce the cumulative amount of REM sleep |
|
|
Term
|
Definition
| patient has an abnormally large amount of REM sleep, often lead to frequent and vivid dreams |
|
|
Term
| 2 ways Benzodiazepines are classified |
|
Definition
sedative- hypnotics
Anxiolytics |
|
|
Term
| Benzodiazepines: Sedative-Hypnotic Types- drugs to know |
|
Definition
Long-acting
diazepam (Valium)- anxiety, sedation, anesthesia adjunct, anticonvulsant, skeletal muscle relaxant following ortho
Intermediate-acting
alprazolam (Xanax)
lorazepam (Ativan)
temazepam (Restoril)- long onset, older drug
Short-acting
midazolam (Versed)- moderate sedation, amnesia, reduced anxiety, sedation |
|
|
Term
| Benzodiazepines: Mechanism of Action |
|
Definition
Depress CNS activity
Affect hypothalamic, thalamic, and limbic systems of the brain
Ability to inhibit stimulation of the brain
Benzodiazepine receptors
Gamma-aminobutyric acid (GABA) or others
Do not suppress rapid eye movement (REM) sleep as much as barbiturates do
Do not induce hepatic enzyme activity like barbiturates do |
|
|
Term
| Benzodiazepines: Indications |
|
Definition
*short-term use for insomnia
Sedation
Relief of agitation or anxiety
Skeletal muscle relaxation
Anxiety- related depression
Treatment and prevention of alcohol withdrawal
Sleep induction
Treatment of acute seizure disorders |
|
|
Term
| Benzodiazepines: Adverse Effects |
|
Definition
Headache, drowsiness, dizziness, lethargy, cognitive impairment, vertigo
Harmful if given in excess with alcohol
Fall hazard for elderly, use lowest effective dose |
|
|
Term
|
Definition
|
|
Term
| Why shouldn't benzos be stopped suddenly? |
|
Definition
|
|
Term
| Benzodiazepines: Toxicity and Overdose |
|
Definition
Somnolence, confusion, diminished reflexes, coma
Don’t cause hypotension and resp. depression unless taken with other CNS depressants such as alcohol and barbiturates
Usually not lethal unless taken with other CNS depressants such as alcohol and barbiturates
Treatment symptomatic and supportive |
|
|
Term
|
Definition
| flumazenil (Romazicon)-as an antidote |
|
|
Term
| Benzodiazepines: Interactions |
|
Definition
CNS depressants- reduce bp, reduce resp. rate, sedation, confusion, diminished reflexes
grapefruit juice and grapefruit- alter drug metabolism via inhibition of the cytochrome P-450 sys. And can result in prolonged effect, increased effect, and toxicity |
|
|
Term
| Nonbenzodiazepine Hypnotics |
|
Definition
Share many characteristics of benzodiazepines
Used to treat insomnia |
|
|
Term
| Nonbenzodiazepine Hypnotics drugs to know |
|
Definition
zolpidem (Ambien, Ambien CR- for long term, releases drug to induce hypnotics more rapidly and again slowly throughout the night, sleepwalking, lower doses in women and elderly )
eszoplicone (Lunesta) – long term use, provide full 8 hours of sleep
zaleplon (Sonata)- used in nursing homes |
|
|
Term
| Barbiturates: Mechanism of Action |
|
Definition
CNS depressants
Site of action: Brainstem (reticular formation)
Effects are dose related
Reduce nerve impulses traveling to the cerebral cortex
Inhibit nerve impulse transmission |
|
|
Term
| Barbiturates: Drug Effects |
|
Definition
Low doses: sedative effects
High doses: hypnotic effects (lower resp. rate) |
|
|
Term
| Notorious enzyme inducers |
|
Definition
| Shortened duration of action, stimulate liver enzymes that cause metabolism or breakdown of other drugs |
|
|
Term
| Barbiturates: Indications |
|
Definition
| Same as sedative- hypnotic effects Or when are they used? Ultrashort acting, short acting, intermediate acting, long acting |
|
|
Term
| Barbiturates: Adverse Effects |
|
Definition
Drowsiness, lethargy, dizziness, hangover, paradoxical excitement
Reduced REM sleep, resulting in agitation, inability to deal w/ normal stress |
|
|
Term
| Describe what barbiturates do to rem sleep, rem rebound. ? |
|
Definition
| Deprive ppl of REM sleep leading to agitation, rebound phenomenon may occur when stopped and REM sleep is increased and nightmares often ensue |
|
|
Term
| How do barbiturates affect the elderly? What might the dose be? |
|
Definition
| Increase in falls, reduced by half |
|
|
Term
| Barbiturates: Toxicity and Overdose |
|
Definition
CNS depression from sleep to coma, death
Resp. depression progresses to cyanosis |
|
|
Term
| How might Barbiturates: Toxicity and Overdose be treated? |
|
Definition
Supportive
Activated charcoal may be needed
Can be therapeutic |
|
|
Term
| Barbiturates: Drug Interactions |
|
Definition
| Additive effects with/ Alcohol, antihistamines, benzodiazepines, opioids, and tranquilizers |
|
|
Term
| How does barbiturates affect the P450 metabolizing enzyme system ? |
|
Definition
| Increase the activity of hepatic microsomal or cytochrome P-450 enzymes |
|
|
Term
| Common Barbiturates- drugs to know |
|
Definition
pentobarbital (Nembutol)- short acting, preop anxiety, sedation, status epileptics
Phenobarbital- long acting, prevention of tonic-clonic seizures, fever induced, convulsions, monitor therapeutic blood levels (10-40 mcg/mL, above 40 may be toxic |
|
|
Term
|
Definition
Act in the CNS to relieve pain associated with skeletal muscle spasms
Relaxation of striated muscles, weakness of skeletal muscles, decreased force of muscle contraction, muscle stiffness, cns depression…sedation, somnolence, ataxia, resp and cardiac depression
Most effective when used with rest and physical therapy
Indicated for relief of painful muscle spasms often following injuries, muscle spasticity in chronic disorders |
|
|
Term
| Muscle Relaxants: Adverse Effects |
|
Definition
Euphoria
Lightheadedness
Dizziness
Drowsiness
Fatigue
Confusion
Muscle weakness |
|
|
Term
| Muscle Relaxants - DRUGS TO KNOW |
|
Definition
baclofen (Lioresal)- often used in baclofen pump to treat chronic spastic muscular conditions, paralysis
cyclobenzaprine (Flexeril)- common after muscle injury, can cause marked sedation
carisoprodol (Soma)- high abuse potential
dantrolene (Dantrium)-tx of malignant hyperthermia |
|
|
Term
|
Definition
| The use of a mood- or behavior-altering substance in a maladaptive manner that often compromises health, safety, and social and occupational functioning, and causes legal problems. |
|
|
Term
| Differentiate between physical and psychological dependence. |
|
Definition
A condition characterized by physiologic reliance on a substance, usually indicated by tolerance to the effects of the substance and development of withdrawal symptoms when use of the substance is terminated
A condition characterized by strong desires to obtain and use a substance |
|
|
Term
|
Definition
| stimulate a specific area of the brain/spinal cord; act by simulating excitatory neurons in the brain |
|
|
Term
| CNS stimulants classified according to |
|
Definition
| chemical structure similarities or site of therapeutic action on CNS |
|
|
Term
| CNS 5 major therapeutic categories |
|
Definition
| Anti-attention deficit, antinarcoleptic, anorexiant, antimigraine, analeptic drugs |
|
|
Term
|
Definition
amphetamine (Dexedrine (dextroamphetamine aspartate)-single component, amphetamine aspartate, methylphenidate (Ritalin)- 1st prescription drug for ADHD, atomoxetine (Strattera)-nonstimulant
May cause suicidal thinking and behavior |
|
|
Term
|
Definition
| amphetamines- promotes wakefulness by stimulating areas of brain associated with mental alertness; modafinil (Provigil) Schedule IV, low abuse potential, alters mood, perception, thinking, protein bound, 90% metabolized in liver |
|
|
Term
|
Definition
| suppresses appetite, phentermine (Lonamin)-CNS stimulant (Schedule IV), orlistat (Xenical, Alli (OTC)) |
|
|
Term
| Antimigraine Drugs- overuse may result in rebound tenderness |
|
Definition
| triptans/SSRA- serotonin receptor agonist, stimulate serotonin receptors in brain. naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex); Ergot Alkaloids- cafergot (Ergotamine tartrate w/caffeine), dihydroergotamine mesylate (DHE45, Migranal) |
|
|
Term
| Analeptic drugs-stimulate areas of CNS that control respiration |
|
Definition
| Theophylline, aminophylline, caffeine, doxapram; methylxanthines-cause build up of cAMP |
|
|
Term
| Antiepileptic drugs- anticonvulsants, used to reduce the incidence of seizures |
|
Definition
| 1st Line- Barbiturates-phenobarbital (cns depressant), primidone (Mysoline), Hydantoins (phenytoin (Dilantin), Iminostilbenes- carbamazepine (Tegretol) Misc. AEDs- lacosamide (Vimpat), tiagabine (Gabitril), valproic acid (Depakene, Depakote) |
|
|
Term
| 2nd line antiepileptic drugs |
|
Definition
| diazepam (Valium), gabapentin (Neurontin), pregabalin (Lyrica), lamotrigine (Lamictal), levetiracetam (Keppra), topiramate (Topamax), clonazepam (Klonopin) |
|
|
Term
|
Definition
| Indirect-Acting Dopaminergic Medications (MAO-B Inhibitor) selegiline (Eldepryl)- breakdown of catecholamines |
|
|
Term
|
Definition
| Direct-Acting Dopamine Receptor Agonists- amantadine (Symmetrel)-antiviral used to treat influenza, blocks reuptake of dopamine |
|
|
Term
|
Definition
| Direct-Acting: Nondopamine Receptor Agonists- ropinirole (Requip)-used to treat restless leg syndrome, bromocriptine (Parlodel)-Ergok alkaloid-activate dopamine receptors to stimulate production of more dopamine |
|
|
Term
|
Definition
| Direct Acting Dopamine Replacement Drugs- carbidopa-levodopa (Sinemet)- required by brain for dopamine synthesis, cannot pass through blood-brain barrier |
|
|
Term
|
Definition
| Direct-Acting Anthicholinergics- benztropine mesylate (Cogentin)-treats muscle tremors and rigidity |
|
|
Term
|
Definition
| benzodiazepines- depress activity in brainstem/limbic system, buspirone (BuSpar) |
|
|
Term
| Benzodiazepines/Anxiolytic drugs |
|
Definition
| alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), flumazenil (Romazicon)- used to reverse benzodiazepine effects |
|
|
Term
| Tricyclic Antidepressants |
|
Definition
| amitriptyline (Elavil)- used to treat insomnia; imipramine (Tofranil), nortriptyline (Pamelor) |
|
|
Term
| Misc. 2nd generation antidepressants |
|
Definition
| trazodone (Desyrel, Oleptro)- sleep,strong sedative qualities; bupropion (Wellbutrin)-used in smoking cessation, mirtazapine (Remeron)- reduce sexual dysfunction, appetite stimulant |
|
|
Term
| drugs to treat Alzheimer's |
|
Definition
| donepezil (Aricept)- cholinesterase in- hibitor; memantine (Namenda)-non cholinergic drug- reduce degenerative cognitive symptoms |
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