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A blueprint for the final exam of the course Nurs350 Pharmacological Therapeutics. It covers topics such as Principles of Drug Administration, Pharmacokinetics and Pharmacodynamics, Drugs administration throughout the lifespan, Cholinergic and Anticholinergic Drugs, and Drugs for Seizures. information on the types of cholinergic receptors, parasympathomimetic drugs, and atropine. It also covers anti-seizure medications such as phenobarbital and benzodiazepines. contraindications, interactions, adverse effects, and nursing interventions for each drug.
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1. CHOLINERGIC DRUGS (4-6 questions) - Two types of cholinergic receptors: - Nicotinic receptors (named this because nicotine binds to these receptors) o Located at ganglionic synapse in both sympathetic and parasympathetic divisions o Response stimulate smooth muscle and gland secretion - Muscarinic receptors (named this because muscarine from poisonous mushrooms binds to these receptors) o Located in the parasympathetic target organs expect the heart (decreases HR and force of contraction. - Parasympathomimetic - Direct acting: Bind to cholinergic receptors to produce the rest-and- digest response o Motor for I&Os, blurred vision, and orthostatic hypotension o Decrease HR, BP; increase GI, constriction of the pupil - Indirect acting: Inhibit the action of A C h E; High potential for serious adverse effects - Bethanechol (Urecholine) – Direct Acting - Mechanism of action : to activate the parasympathetic nervous system directly/indirectly, induce rest/digest response - Uses : glaucoma, urinary retention, myasthenia gravis, Alzheimer disease - Adverse effects : profuse salivation, sweating, increased muscle tone, urinary frequency, bradycardia, diarrhea - Administration Alerts o Never administer I M or I V; 5mg 3-4 times day PRN o Monitor blood pressure, pulse, and respirations before administration and for at least 1 hour after subcutaneous administration o Do not take with milk or food, administer with empty stomach to induce absorption o Pregnancy category C - Contraindications: Patients with:
o asthma
o Monitor for increased ease of urination, muscle strength and coordination improved, lessened ptosis, improved swallowing o CHLOLINERGIC CRISIS : increase salivation, constrict pupils, muscle twitching, unusual paleness, sweating, muscle weakness, and difficulty breathing, diarrhea, profuse sweating, urinary urgency,
2. ANTICHOLINERGIC DRUGS (2-4 questions) o Drugs that inhibit parasympathetic impulses o Suppression of parasympathetic division induces fight-or-flight symptoms o Uses are predictable extension of parasympathetic-blocking effects o Effects include: i. Pupil dilation (mydriasis) ii. Increasing heart rate iii. Drying glandular secretions iv. Relaxing bronchi (asthma) o Uses include: i. Peptic ulcer disease – helps with abdominal cramping ii. Ophthalmic procedures iii. Heart rhythm abnormalities iv. Anesthesia adjunct v. Asthma and C O P D vi. Overactive bladder vii. Parkinson disease a. Atropine (Atro-Pen)
by general anesthetics.
xii. Assess for desired therapeutic effects dependent on the reason for the drug (e.g., increased ease of breathing, cardiac rhythm stable, B P within normal range). xiii. Continue frequent and careful monitoring of vital signs, urinary output and cardiac monitoring as appropriate. xiv. Assess for and promptly report adverse effects: tachycardia, hypertension, dysrhythmias, tremors, dizziness, headache, or decreased urinary output. xv. Seizures or ventricular tachycardia may signal drug toxicity and should be immediately reported.
3. Anti-Seizure Medications (5-8 questions) - Convulsions Involuntary violent spasm of large muscles of face, neck, arms, and legs; Not synonymous with seizure - Known Causes of Seizures: fever, infectious diseases, metabolic disorders, neoplastic disease, trauma, vascular diseases, medications, high doses of local anesthetics, eclampsia, drug abuse, withdrawal syndromes from alcohol or sedatives- hypnotics drugs - Epilepsy Seizures occurring chronically o International Classification of Epileptic Seizures ▪ Partial (focal) - Simple Partial o Olfactory, auditory, and visual hallucinations o Intense emotions o Twitching of arms, legs, and face - Complex partial o Aura (preceding) o Brief period of confusion or sleepiness afterward with no memory of seizure (postictal confusion) o Fumbling with or attempting to remove clothing o No response to verbal commands
▪ Generalized - Absence (petit mal) **o** Lasting a few seconds **o** Seen most often in children (child stares into space, does not respond to verbal stimulation, may have fluttering eyelids or jerking) **o** Misdiagnosed often (especially in children) as attention deficit/hyperactivity disorder (A D H D)
or daydreaming
▪ Primary use: controlling seizures ▪ Adverse effects: dependence, drowsiness, vitamin deficiencies, laryngospasm ▪ Monitor patient’s condition ▪ Liver and kidney function ▪ Pregnancy category D ▪ Common side effects ▪ Therapeutic Class: Antiseizure drug; sedative ▪ Pharmacologic Class: Barbiturate; G A B A (^) A receptor agonist ▪ Actions and Uses
▪ High potential for dependence ▪ Cause profound C N S depression ▪ Overall effective against all major seizure types except absence seizures ▪
▪ Pharmacologic Class : Hydantoin; sodium influx– suppressing drug ▪ Mechanism of action: to desensitize sodium channels ▪ Primary use: treating all types of epilepsy except absence seizures ▪ Adverse effects: C N S depression, gingival hyperplasia, skin rash, cardiac dysrhythmias, and hypotension ▪ Adverse Effects
o Use with caution with antiseizure medications, phenothiazines, and antidepressants o Pregnancy risk—pregnancy category C o Prototype drug: ethosuximide (Zarontin) ▪ Mechanism of action: suppress calcium influx ▪ Primary use: for absence seizures ▪ Adverse effects: rare but include drowsiness, dizziness, lethargy ▪ Very rare but serious side effects: systemic lupus erythematosus, aplastic anemia, agranulocytosis, pancytopenia ▪ Administration Alerts
- isotonic, hypertonic, hypotonic solutions o Hypertonic intravenous fluid Water moves from interstitial space to plasma ▪ More solutes than water ▪ Fluids will move out of the cell ▪ 5% Dextrose in 0.9% NaCl (D5 NaCl), 3% Saline, 5% saline, 10% Dextrose in water (D10W), 5% Dextrose in LR ▪ Treats: Hyponatremia, Cerebral edema, ▪ Overload can cause fluid overload and HTN. ▪ Increased in Osmolality
o Hypotonic intravenous fluid Water moves from plasma to interstitial space ▪ Have more water than solutes ▪ Fluids move into the cell ▪ 0.45% NaCl (1/2), 0.255% NaCl (1/4), 0.33% NaCl (1/3), 5% Dextrose in water (D5W) ▪ DO NOT GIVE TO INTRACRANIAL PRESSURE because will cause brain swelling; Also do not give to burn or trauma patients with hypovolemia (loss of blood/fluid volume) ▪ Treat hypernatremia and cellular dehydration, DKA ▪ Too much can cause peripheral edema or hypotension ▪ Decreased in Osmolality o Isotonic intravenous fluid No fluid shift ▪ 0.9% NS, 5% Dextrose (D5W), 5% Dextrose in 0.225% NS, Lactated Ringer’s
- colloids vs crystalloids o Crystalloids ▪ I V solutions with electrolytes ▪ Used to replace fluids and promote urine output ▪ Capable of leaving plasma and moving to interstitial spaces and intracellular fluid ▪ Compartment entered depends on tonicity of intravenous fluid ▪ Sodium is the most common added ▪ Some contain Dextrose 2.5%, 5%, and 10% for nutritional value o Colloids ▪ Molecules too large to easily cross capillary membrane ▪ Draw water from intracellular fluid and interstitial spaces into plasma (hypotonic effect) ▪ Prototype drug: dextran 40 (Gentran 40, L M D, others) ▪ Mechanism of action: to raise oncotic pressure of blood; expands plasma volume within minutes of administration ▪ Primary use: as fluid replacement with hypovolemic shock from hemorrhage, surgery, severe burns ▪ Adverse effects: hypersensitivity reactions, fluid overload, hypertension ▪ Indications include :
o High net water loss (inadequate water intake, watery diarrhea, fever, burns) o High doses of corticosteroids or estrogens
▪ Hyponatremia Sodium level below 135 m E q/L
o Actions and uses: ▪ administered for hyponatremia when serum levels fall below 130 m E q/L. ▪ Normal saline (0.9% N a C l)- used to treat mild hyponatremia. When serum sodium falls below 115 m E q/L, highly concentrated (9% N a C l) solution may be infused. ▪ Other concentrations include 0.45% and 0.22%, and both hypotonic and isotonic solutions are available. ▪ For less severe hyponatremia 1g tablets are available by P O. o Pharmacokinetics ▪ Because sodium ion is a natural electrolyte, it is not possible to obtain accurate pharmacokinetic values. o Adverse effects ▪ Patients receiving N a C l infusions must be monitored frequently to prevent symptoms of hypernatremia, which include lethargy, confusion, muscle tremor or rigidity, hypotension, and restlessness. o Contraindications: ▪ This drug should not be administered to patients with hypernatremia, heart failure, or impaired kidney function. o
- NURSING ROLES: Assess sodium and electrolyte balances, Be alert for hypo/hypernatremia, Monitor serum sodium level, urine specific gravity, serum and urine osmolarity, teach patient o Potassium ▪ Essential for proper nerve and muscle function ▪ Maintaining acid–base balance ▪ Influenced by aldosterone ▪ For each sodium ion reabsorbed, one potassium ion secreted into renal tubules ▪ Imbalances can be serious, even fatal ▪ Hyperkalemia Potassium level above 5 m E q/L