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Pharm Exam 1
Olol pharm exam 1
237
Medical
Undergraduate 1
09/09/2016

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Term
drug
Definition
any chemical that affects physiologic processes of a living organism
Term
pharmacology
Definition
study or science of drugs
Term
Who regulates OTC and prescription drugs?
Definition
FDA, DEA
Term
Who can prescribe prescription drugs?
Definition
Medical doctors, Doctors of osteopathy, dentists, podiatrists, PA's and APRN/s
Term
Who regulates new drug development?
Definition
FDA
Term
Informed consent?
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
Term
What happens in each phase?
Definition
Term
Examples of medical errors
Definition
Misdiagnosis, patient misidentification, lack of pt monitoring, wrong-site surgery, and med erros
Term
Medication error
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
Term
High alert meds
Definition
Drugs that have potentially toxic nature, require special care when prescribing, dispensing, and/ or administering
Term
SALAD
Definition
Sound alike look alike drugs
Term
Chemical name
Definition
Describes the drug chemical composition and molecular structure
Term
Generic name (nonproprietary name)
Definition
used by most official drug compendiums to list drugs
Term
trade name (proprietary name)
Definition
drug's registered trademark and indicates that its commercial use is restricted to the owner of the patent fro the drug
Term
ways drugs are classifed
Definition
structure or therapeutic use
Term
Differences btw generic vs trade names
Definition
generic is often much shorter and simpler to remember compared to the chemical name while the trade name is created by the manufacter
Term
Important factors btw generic and trade
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
Term
OTC medications- nonprescription
Definition
Meds that are legally available w/o prescription
Term
why are OTC meds. so dangerous?
Definition
own toxicity profiles, abuse
Term
important considerations of OTC
Definition
review safety labels, pros/ cons of meds
Term
dietary supplement
Definition
broad term for orally administered alternative medicines and includes the category of herbal supplements
Term
Herbs
Definition
come for nature and have been used for thousand of years to help maintain good health
Term
herbal medicine
Definition
lost ground to new synthetic medicines during the early part of the 20th century
Term
Commonly used herbal products?
Definition
aloe, black cohosh, garlic, ginger, valerian, saw palmetto
Term
What are important nursing implications to consider w/ pts using herbal products?
Definition
consider pregnancy, breastfeeding, infants, children
Term
Pharmaceutics
Definition
the science of preparing and dispensing drugs including dosage form design
Term
Pharmacokinetics
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
Term
PharmacoDynamics
Definition
study of the biochemical and physiologic interactions of drugs at their sites of activity
Term
Pharmacotherapeutics
Definition
treatment of pathologic conditions through the use of drugs
Term
Toxicology
Definition
study of poisons including toxic drug effects and applicable treatments
Term
Pharmacognosy
Definition
the study of drugs that are obtained from natural plant and animal sources
Term
Pharmacoeconomics
Definition
the study of economic factors impacting the cost of drug therapy
Term
Absorption
Definition
movement of a drug from its site of administration into the bloodstream from distribution to the tissues
Term
bioavailabilty
Definition
used to express the extent of drug absorption
Term
1st pass effect
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).
Term
what factors affect absorption?
Definition
how drug is given, its route, affects the rate and extent of absorption of that drug
Term
When will the nurse administer medications if ordered with food or on an empty stomach??
Definition
Within 20-30 minutes; 1 hr before and 2 hr after; administer w/food , shortly after meal w/ 6-8 oz of water
Term
List the 3 routes of drug administration.
Definition
topical- patches, paste, eyedrops, parenteral- around gi tract, enteral- gi tract
Term
Define enteral route
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.
Term
Name several forms of medications that are included in the enteral route.
Definition
Hydralazine, lithium, oral opiods, lithium propenotol, NSAID, iron, sublingual, buccal, rectal
Term
Define parenteral route?
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.
Term
Name several forms of medications administered via the parenteral route.
Definition
IV, irritating drugs, antibotics, steroids, transdermal, intramuscular
Term
distribution
Definition
Refers to the transport of a drug by the bloodstream to its site of action
Term
What system is responsible for distribution?
Definition
Circulatory, heart, liver, kidneys, brain- rapid distribution
Muscle, skin, feet- slow distribution
Term
protein binding
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
Term
metabolism
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
Term
What is the main organ is responsible for metabolism?
Definition
liver
Term
List factors that increase or decrease metabolism.
Definition
Fast acetylatoyr ,phenytoin, barbiturates;CV dysfunction, renal insufficiency, starvation, obstructive jaundice, slow acetylator
Term
What is the danger with increased or decreased metabolism of medications?
Definition
Increased metabolism may require higher dosages of meds, decreased metabolism leads to decreased blood flow and enzyme production
Term
excretion
Definition
elimination of drugs from the body
Term
main organ involved in excretion?
Definition
Kidney, bilary excretion, enterohepatic recirculation
Term
half-life
Definition
time required for 50% of a given drug to be removed from the body
Term
how many half-lives does it take for most meds to be effectively removed from the body?
Definition
5
Term
Define steady state
Definition
Physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each dose
Term
define drug actions
Definition
processes involved in the interaction btw a drug and a cell
Term
drug effect
Definition
physiologic reactions of the body to the drug
Term
onset
Definition
time required for the drug to elicit a therapeutic response
Term
peak
Definition
time required for a drug to reach its max. therapeutic response
Term
duration
Definition
length of time that the drug concentration is sufficient to elicit a therapeutic response
Term
trough
Definition
lowest blood level of a drug
Term
3 ways that drugs act on the body
Definition
through receptors, enzymes, and nonselective interactions
Term
Acute therapy
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
Term
Maintenance therapy
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.
Term
Supplemental/replacement therapy
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.
Term
Palliative therapy
Definition
to make the pt as comfortable as possible; relief from the symptoms, pain, and stress of a serious illness
Term
supportive therapy
Definition
maintains the integrity of body functions while the pt is recovering from illness or trauma
Term
prophylactic therapy
Definition
provided to prevent illness or other undesirable outcome during planned
Term
empiric therapy
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
Term
contraindications
Definition
Any pt. condition esp. a disease state that makes the se of the given medication dangerous for the pt.
Term
black box warning and who assigns them
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
Term
Clinical Response or therapeutic effect
Definition
effectiveness of the therapy
Term
adverse effects
Definition
predictable adverse drug reactions
Term
therapeutic index
Definition
The ratio of a drug's toxic level to the level that provides therapeutic benefits
Term
drug concentrations
Definition
important tool for evaluating the clinical response to drug therapy
Term
pt's condition
Definition
pt’s concurrent diseases or other medical conditions
Term
tolerance
Definition
decreasing response to repeated drug doses
Term
Dependence
Definition
physiologic or psychological need for a drug
Term
interactions
Definition
alteration of the action of 1 drug by another
Term
adverse drug reactions
Definition
4 types- any reaction to a drug that is unexpected& undesirable& occurs at therapeutic drug dosages; pharmacologic reaction, hypersensitivity, idiosyncratic, drug interaction
Term
Additive effect
Definition
when 2 drugs w/ similar actions are given together
Term
Synergistic effect
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
Term
Antagonistic effect
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
Term
incompatibility
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
Term
Mutagenic
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
Term
Teratogenic
Definition
result in structural defects in the fetus
Term
carcinogenic
Definition
cancer-causing effects of drugs, other chemicals, radiation, and viruses
Term
When/why are medications dangerous to pregnant women?
Breast-feeding?
Definition
Risk of drug transfer
1st and last trimester, fetal exposure
Drugs cross through placenta
Term
How is pharmacokinetics different
Definition
Pediatric pts. Has lower maturity rate of vital organs, processes are still developing
Term
List the ways that absorption, distribution, metabolism and excretion of medications is different in neonates and pediatric patients.
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
Term
What are factors that affect drug dosing in pediatrics?
Definition
Thinner skin, lack of stomach acid, weaker mucous barriers in lungs, body temp. is less well regulated, immature kidneys and liver
Term
How are medications dosed in pediatrics?
Definition
Drug order, pt’s wt in kg, per manufacturer
Term
Age elderly begins? Concerns for meds
Definition
65, Lack of adequate patient education, use of multiple prescribers and pharmacies, polypharmacy
Term
polypharmacy
Definition
Simultaneous use of multiple medications
Term
What are some of the causes and solutions of polypharmacy
Definition
Adverse effects of other drugs, noncompliance w/ prescribed medication regimens
Term
What information should the nurse gather in regards to medications and culture?
Definition
Verbal/ nonverbal communication, family ties, biologic variations, common health beliefs
Term
analgesics
Definition
Meds that relieve pain w/o causing loss of conscious, known as painkillers
Term
two types of analgesics
Definition
Opioids and nonopioids
Term
opioid analgesics
Definition
pain relieving drugs, Also classified by mechanism of action
Drugs that bind to the opiate receptors to relieve pain
Term
where opioids originate from?
Definition
opium poppy plant
Term
Agonist-
Definition
causes an action to occur, Binds to an opioid pain receptor in the brain and causes an analgesic response- reduction of pain sensation
Term
Mild agonist
codeine-
Hydrocodone (Lortab)
Definition
only agonist to produce ceiling effect
Term
Strong agonist
Morphine
MS Contin
Definition
(sustained/long-acting 8-12 hrs)
Term
hydromorphone (Dilaudid
Definition
8 times more potent than morphine
Term
Oxycodone (Percocet)
Oxycontin
Definition
(sustained release for 12 hrs)- contin means continuously
Term
meperidine (Demerol)
Definition
not used as often
Term
fentanyl (Duragesic) (See fentanyl transdermal patch box)
Definition
used a lot on oncology floors, palliative care
Term
methadone (Dolophine)
Definition
used in a lot of rehab/ addiction centers, used on chronic pain
Term
Define agonist-antagonist ,partial agonist
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
Term
List ways agonist- antagonists may be better than agonist
Definition
Useful in pain management of obstertical ptients
Term
type of agonist-antagonist
Definition
butorphanol (Stadol)
Term
antagonists
Definition
Binds to a pain receptor but does not reduce pain signals
Term
How might they be used with opioids?
Definition
Also known as competitive antagonists
Term
type of antagonist
Definition
Naloxone hydrochloride (Narcan)- drug of choice for reversal of resp. depression and acute opioid overdose
Term
4 indications of opioids
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)
Term
List patient situations where opioid analgesics would be contraindicated and why?
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
Term
List major adverse effects of opioid analgesics.
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
Term
What is the most serious adverse effect that leads to respiratory depression? Opioid analgesics
Definition
CNS depression
Term
What is the serious adverse effect from toxicity? opioid analgesics
Definition
Resp. depression, Used in management of opioid overdose and addiction
Consider withdrawal symptoms
Term
What drug class can be used to treat toxicity and overdose
Definition
Naloxone (Narcan), naltrexone (ReVia)
Term
Define opioid withdrawal/opioid abstinence syndrome-
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
Term
opioid tolerance
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)
Term
Physical dependence
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.)
Term
psychological dependence
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).
Term
nonopioid analgesics
Definition
Acetaminophen (Tylenol)is most widely used
Term
What class of medication is this drug often combined with.
Definition
Analgesic
Term
What type of affect does this drug have?
Definition
Analgesic and antipyretic effects
Little to no antiinflammmatory effects
Able over the counter and in combination products with opioids
Very dangerous
Term
mechanism of action for acetaminophen
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
Term
indications for acetaminophen
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
Term
Acetaminophen: Contraindications/Interactions
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
Term
Acetaminophen: Dosage
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)
Term
How can overdose happen of this OTC drug? (Acetaminophen)
Definition
Depressed patients (especially adolescents) may intentionally overdose on the drug as an attention-seeking gesture without realizing the grave danger involved
Term
Antidote of acetaminophen, important teaching
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
Term
misc. anaglesics
Definition
tramadol (Ultram)- weak bond to pain receptors and inhibits reuptake of norepinephrine and serotonin, used in moderate to severe pain, chronic pain
Term
misc. anaglesics
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
Term
adjuvant drugs
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
Term
Adjuvant drugs for neuropathic pain
Definition
Amitriptyline (Elavil) -antidepressant
Gabapentin (Neurontin) or pregabalin(Lyrica) anticonvulsants
Term
Anesthetics
Definition
Drugs that …… depress the CNS or peripheral nerves to produce decreased or loss of consciousness, or muscle relaxation
Term
Anesthesia is the state of
Definition
loss ability to feel pain resulting from the administration of an anesthetic drug
Term
Differentiate between general and local effects in the body
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
Term
What are general anesthetics
Definition
drugs that are used to produce profound neurosensory depression to allow for surgical procedures.
Term
when are general anesthetics used
Definition
Given only under controlled situations by anesthesia providers
Term
Who administered these medications? general anesthetics
Definition
Anesthesiologist, CRNA, anesthesia assistant
Term
Inhalational anesthetics
Definition
liquids or gases that are vaporized or mixed with O2 and inhaled to induce anesthesia
Term
Parenteral anesthetics-
Definition
- given intravenously and used for induction and/or maintenance of general anesthesia, induction of amnesia, and as adjuncts to inhalation-type anesthetics
Term
What are adjunct anesthetics?
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
Term
balanced anesthesia
Definition
Simultaneous use of both general anesthetics and adjuncts
Term
Describe the overall affect and stages of anesthesia
Definition
Progressive reduction of sensory and motor CNS functions; loss of consciousness
Term
Indications of anesthesia
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
Term
Adverse Effects of anesthesia
Definition
Vary according to dosage and drug used, Myocardial depression is commonly seen
Term
What are the sites primarily affected? anesthesia
Definition
Heart, peripheral circulation, liver, kidneys, and resp. tract
Term
Why is N/V, confusion seen less often? anesthesia
Definition
Due to balanced anesthesia ( use of generals and adjuncts)
Term
How can anesthesia affect elderly vs. pediatrics, patients with a history of substance abuse?
Definition
Predispose a patient to complications, may need dose adjustments
Term
define malignant hyperthermia
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
Term
nitrous oxide- laughing gas
Definition
inhaled gas used as general anesthetic, weakest, used in dental procedures
Term
malignant hyperthermia signs and symptoms
Definition
Rapid rise in body temp., tachycardia, tachypnea, muscular rigidity
Term
medication used to treat malignant hyperthemia
Definition
cardiorespiratory supportive care and dantrolene (Dantrium) (skeletal muscle relaxant)
Term
propofol (Diprivan)
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
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)
Term
pt affects of moderate sedation and when it is used
Definition
Allows patient to relax and have markedly reduced or no anxiety, yet still maintain own airway and respond to verbal commands; surgeries
Term
who can administer moderate sedation
Definition
ACLS professionals
Term
Mild amnesia from moderate sedation is due to what med?
Definition
Midazolam and propofol
Term
local anesthetics reduce pain where?
Definition
level of peripheral nerves
Term
local anesthetics difference btw general anesthetics
Definition
No LOC
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
Term
Topical vs spinal
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
Term
How is spinal considered a local anesthetic?
Definition
It doesn’t depress the CNS at a level that causes loss of consciousness
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
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
Term
spinal headache
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
Term
treatment for spinal headache
Definition
Bedrest and analgesics
Blood patch in severe cases
Term
topical anesthetics
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
Depolarizing drugs
Definition
bind to cholinergic receptors in place of acetylcholine, mimic response, act as competitive agonist
Term
Nondepolarizing drugs
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
NMBDs
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
NMBDs indications
Definition
Maintaining skeletal muscle paralysis

Short acting? Facilitate intubation w/ an endotracheal tube
Term
NMBDs: Adverse Effects
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
NMBDs: Safety/Overdose
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
NMBDs- drug to know
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
Sedative-hypnotics
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
REM interference
Definition
prolonged sedative- hypnotic use may reduce the cumulative amount of REM sleep
Term
REM rebound
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
Hangover effect
Definition
daytime sleepiness
Term
Why shouldn't benzos be stopped suddenly?
Definition
Rebound insomina
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
Benzos to know
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
Muscle Relaxants
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
substance abuse
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
CNS stimulants
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
Drugs for ADHD
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
Drugs for Narcolepsy
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
Anorexiants/Antiobesity
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
Parkinson's Drug Classes
Definition
Indirect-Acting Dopaminergic Medications (MAO-B Inhibitor) selegiline (Eldepryl)- breakdown of catecholamines
Term
Parkinson's
Definition
Direct-Acting Dopamine Receptor Agonists- amantadine (Symmetrel)-antiviral used to treat influenza, blocks reuptake of dopamine
Term
Parkinson's
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
Parkinson's
Definition
Direct Acting Dopamine Replacement Drugs- carbidopa-levodopa (Sinemet)- required by brain for dopamine synthesis, cannot pass through blood-brain barrier
Term
Parkinson's
Definition
Direct-Acting Anthicholinergics- benztropine mesylate (Cogentin)-treats muscle tremors and rigidity
Term
Anxiolytic Drugs
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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