NSG3280/ NSG 3280 Exam 2 (2026/ 2027 Updated) Pathophysiology for Nurses I Review | Questions & Answers| Grade A| 100% Correct (Verified Solutions)- Galen

NSG3280/ NSG 3280 Exam 2 (2026/ 2027 Updated) Pathophysiology for Nurses I Review | Questions & Answers| Grade A| 100% Correct (Verified Solutions)- Galen Q. What substance is a synthetic catecholamine ANSWER dobutamine Q. What occurrence is an effect of beta-1 adrenergic receptor stimulation ANSWER increased renin secretion Q. Which body parts are regulated by the ANS smooth muscles and glands ANSWER -eyes -heart -urinary bladder -respiratory system -GI tract Q. Stimulation of what receptor will cause increased heart rate ANSWER Beta 1 Q. Drugs that stimulate the PNS ANSWER cholinergic agonists (by mimicking ACH) Q. Complications of anticholinergic drugs ANSWER dry mouth, tachycardia, blurred vision (due to blockage of cholinergic receptors) Q. What would a nurse monitor while observing the activation of muscarinic receptors ANSWER increased bronchial secretion Q. Cholinergic drugs that stimulate muscarinic receptors are indicated for: ANSWER lowering intraocular pressure in a pt with glaucoma Q. Antidote for overdose of atropine (flushing, dry skin and mucous membranes, mydriasis, alt mental status, fever) ANSWER physostigmine Q. Antidote for benzodiazepines ANSWER Flumazenil Q. When should you not give bethanechol ANSWER if the pt has low BP (hypotension) Q. Which drug is used for myasthenia gravis ANSWER neostigmine (prevents inactivation of ACH at neuromuscular junction, causing increased nerve transmission and skeletal muscle activation) Q. Opthalamic disorder caused by paralysis of the ciliary muscles ANSWER cycloplegia (loss of accommodation) Q. What drug is a direct-acting cholinergic agonist commonly used to treat glaucoma ANSWER pilocarpine hydrochloride Q. What NSAID can be administered through IV ANSWER Ketorolac (can also be transmitted orally) Q. Gout ANSWER metabolic disorder of uric acid and purines; inflammatory condition of joints and tendons. caused by accumulation of uric acid and creates tophi, pain in joints Q. Foods containing salicylates ANSWER prunes, raisins, licorice, paprika, curry Q. Prostaglandin function ANSWER -vasodilation -inc capillary permeability -inc platelet aggregation (inflammation) Q. Cardinal signs of inflammation ANSWER redness, swelling, heat, pain, loss of function Q. A pt is at an increased risk for a stroke. The nurse anticipates that the health care provider will prescribe: ANSWER aspirin (low dose) Q. Antiinflammatories inhibit what substance ANSWER prostaglandin Q. Which physiological change occurs during the delayed process of inflammation ANSWER infiltration of leukocytes into the site Q. Pathophysiology of pain ANSWER chemical mediators sensitize the pain receptors Q. A pt with migraine headaches who is on SSRI therapy is prescribed sumatriptan. what possible complication might the nurse see in the pt ANSWER serotonin syndrome (manifested by inc serotonin levels in the blood) Q. Which lab levels should the nurse monitor for a pt receiving acetaminophen therapy ANSWER INC potassium, bilirubin, LDH, dec. WBC. RBC, platelets, albumin, ALP, ALT Q. Which med would a nurse administer to a pt admitted for tx of an opioid addiction ANSWER methadone Q. Which narcotic drug is the drug of choice for pain relief during childbirth ANSWER meperidine Q. What medication is contraindicated for a pt with a head injury ANSWER nalbuphine Q. Adjuvant analgesics ANSWER used to treat chronic pain with neuropathic nature. used with opioids and nonopioids, anticonvulsants, antidepressants, corticosteroids, local anesthetics Q. superficial pain ANSWER Pain that originates from the skin or mucous membranes Q. Deep pain ANSWER pain that occurs in tissues below skin level Q. Somatic pain ANSWER Pain that originates from skeletal muscles, ligaments, or joints. Q. Visceral pain ANSWER pain that originates from organs or smooth muscles Q. Cluster headaches ANSWER -severe unilateral, nonthrobbing pain -located around eye -series of cluster attacks -more common in males Q. Migraine headaches ANSWER -unilateral throbbing head pain, accompanied by nausea, vomiting and photophobia -triggers: cheese, chocolate, red wine, aspartame, fatigue, stress, monosodium glutamate, missed meals, odors, light, hormone changes, drugs, weather, sleep Q. Migraine and Cluster Headaches ANSWER Prevention: Beta-adrenergic Blockers: -propranolol -atenolol Q. Anticonvulsants: ANSWER -valproic acid -gabapentin Q. Tricyclic antidepressants: ANSWER -amitriptyline -imipramine Function of adrenergics -dilates pupils -dilate bronchioles -inc HR -vasoconstriction -relax GI -relax bladder -relax uterus Sympathomimetic agent that mimics the effects of the sympathetic nervous system Parasympatholytic agent blocking or inhibiting the effects of the parasympathetic nervous system Alpha 1 receptors -inc cardiac contractility; vasoconstriction (inc BP) -dilates pupils, dec salivary gland secretion -inc bladder and prostate cx Alpha 2 receptors -inhibits NE release (promotes vasodilation and dec BP) -dec GI motility and tone Beta 1 receptors -inc cardiac contractility, HR -inc renin secretion and BP beta 2 receptors -dec GI tone and motility -bronchodilation -inc blood flow in skeletal muscles -relaxes smooth muscles of uterus -activates liver glycogenolysis (inc blood glucose) Direct acting adrenergic agonists directly activates adrenergic receptor (epinephrine, norepinephrine, dopamine) indirect acting adrenergic agonists stimulates release of NE from terminal nerve endings (amphetamine) mixed acting adrenergic agonists stimulates adrenergic receptor sites and stimulates release of NE from terminal nerve endings (ephedrine) adrenergic agonists Catecholamines: produce sympathetic response - endogenous (epinephrine, NE, dopamine) -synthetic (isoproterenol, dobutamine) Noncatecholamines: stimulate adrenergic receptors. most have longer duration of action than endogenous and synthetic (phenylephrine, metaproterneol, albuterol) Epinephrine -CLASSIFICATION: adrenergic agonist -USES: anaphylaxis, bronchospasms, status asthmaticus, cardiac arrest -ACTION: Alpha1 inc BP, Beta1 inc HR, Beta2 promotes bronchodilation -CONTRAINDICATIONS: cardiac dysrhythmias, hypertension, hyperthyroidism, DM, pregnancy -SIDE/ADVERSE EFFECTS: cardiac (palpitation, tachycardia, hypertension), restlessness, hyperglycemia, dyspnea, tissue necrosis at IV site, vfib, PE -INTERACTIONS: beta blockers, digoxin, TCA and MAOIs -INTERVENTIONS: monitor IV site, monitor vitals and EKG, monitor I&Os and assess for bladder distention, avoid nausea and vomiting for pt, monitor blood glucose in pt with DM adrenergic antagonists block effects of adrenergic neurotransmitter (block alpha and beta receptor sites) -alpha-adrenergic agonists and beta adrenergic agonists alpha1 blockers -vasodilation/dizziness -orthostatic hypotension, reflex tachycardia -pupil constrict -suppress ejaculation -dec cx of smooth muscles in bladder, neck, and prostate beta1 blockers -dec cardiac contractility -dec pulse beta2 blockers -bronchoconstriction -cx uterus -inhibits glycogenolysis (leads to hypoglycemia) alpha adrenergic antagonists drugs that inhibit a response at alpha-adrenergic receptor site -selective (block alpha1) -nonselective (block alpha1 and alpha2) -action (promote vasodilation) -use (dec symptoms of BPH) albuterol -CLASSIFICATION: beta2 adrenergic agonist -USE: tx of asthma, prophylactic tx for asthma, tx of bronchospasms -ACTION: stimulates beta2 adrenergic receptors in lungs (relaxes bronchial smooth muscle) bronchodilation Beta-adrenergic agonists -dec BP and pulse -nonselective beta blockers blocks beta1: dec BP and pulse blocks beta2: bronchoconstriction, use with caution w pt with COPD or asthma atenolol -CLASS: beta adrenergic agonist -USE: tx of hypertension, angina, and prophylaxis and tx of acute MI -ACTION: selectively blocks beta1-adrenergic receptor sites, dec sympathetic outflow to the periphery, suppresses RAAS cholinergic agonists drugs that stimulate PNS -cholinergic receptors: muscarinic (smooth muscles, slow HR), nicotinic (skeletal muscles) -direct acting (activate) -indirect acting (inhibits) Effects of Cholinergic Agonists -constrict pupil, inc accommodation -constrict bronchioles and inc secretions -dec HR and BP -vasodilation -inc peristalsis, motility and secretions (inc diarrhea) -cx bladder (stimulates urination) -inc salivation -inc ureter tone bethanechol CLASS: parasympathomimetic USE: tx urinary retention and neurogenic bladder ACTION: stimulates cholinergic receptors (cx bladder), inc GI secretions and peristalsis, constrict of pupil and bronchoconstriction CI: intestinal and urinary tract obstruction, IBS, peptic ulcer, severe bradycardia, hypotension, COPD, parkinsonism, hyperthyroidism, seizures, active asthma SIDE/ADVERSE EFFECTS: blurred vision, GI effects, urinary frequency and urgency, bronchoconstriction, weakness, bronchospasm INTERVENTIONS: monitor BP and HR, tell pt to rise slowly from lying pos., auscultate breath sounds, record I&Os, monitor pt for overdose Effects of anticholinergics -heart: inc HR (large doses) dec HR (small doses) -lungs: bronchodilation, dec secretions -GI: relaxes smooth muscle tone, dec motility and peristalsis -GU: relaxes detrusor muscle, inc internal sphincter constrict -Eye: dilates pupil, dec accommodation -Glands: dec salivation and perspiration -CNS: dec tremors and muscle rigidity, drowsiness, disorientation, and hallucinations (Mad as a hatter, Blind as a bat, Red as a beet, Hot as a hare, Dry as a bone) Atropine sulfate CLASS: parasympatholytic (anticholinergic) -USE: pre-operative med to dec salivation, inc HR for bradycardia, dilate pupils for dx exams -ACTION: inhibits ACH by occupying receptors, inc HR by blocking vagal stimulation, promotes pupil dilation by blocking iris sphincter muscle -CI: glaucoma, obstructive GI disorders, ulcerative colitis, tachycardia, BPH, myasthenia gravis, myocardial ischemia, renal or hepatic disorders, COPD, heart failure -SIDE/ADVERSE EFFECTS: dry mouth, constipation, dry skin, blurred vision, photophobia, urinary retention, tachycardia, paradoxic bradycardia, hypertension, hypotension, angina, PE, seizures, dysrhythmias, laryngospasm, Stevens-Johnson syndrome, coma INTERVENTIONS: monitor vitals, monitor I&Os, assess bowel sounds, provide mouth care and eye drops, avoid hot env. wear sunglasses in bright light after dilation CNS stimulants -med approved uses: ADHD, narcolepsy, reversal of resp. distress -categories: Amphetamines and caffeine (act on cerebral cortex) Analeptics, caffeine (act on brainstem and medulla) Anorexiants (act on satiety center in hypothalamic and limbic areas) ADHD patho dysregulation of transmitters (serotonin, NE, dopamine) ADHD epidemiology Usually occurs in children before age 7. More common in boys Narcolepsy characteristics recurrent attacks of drowsiness and sleep during daytime. falling asleep while driving, talking, eating, standing. sleep paralysis amphetamines -stimulate the release of NE and dopamine -inhibit reuptake of these transmitters -causes: euphoria, inc alertness, cardio probs -high potential of abuse, tolerance and dependence -excessive use may lead to psychosis insomnia management tx: sedative hypnotics -non-pharm: wake up at specific time in AM, limit naps, avoid caffeine, alcohol etc 6hrs before bed, avoid heavy meals, large amount of fluid, loud noise and intense exercise before bed, take warm bath, read, listen to quiet music, drink warm milk before bed sedatives used to tx sleep disorders sedative hypnotics drugs that cause calmness, sleepiness, and slow down bodily functions (barbiturates, benzodiazepines, nonbenzodiazepines) sedative hypnotic side effects -drowsiness (hangover) -vivid dreams -drug dependence/tolerance -excessive depression -respiratory depression -hypersensitivity Alprazolam (Xanax) CLASS: benzodiazepine USE: tx anxiety and panic disorders ACTION: CNS depression, binds receptors in limbic system and reticular formation, inc GABA and GABA receptors, shift of chloride ions leads to less excitability and stabilizes neuronal membranes CI: resp depression, acute alcohol intoxication, psychotic reactions, recent resp depressants, suicidal ideation, drug abuse SIDE/ADVERSE EFFECTS: drowsiness, dizziness, amnesia, memory impairment, GI effects, depression, tolerance, dependence, withdrawal, hypotension, tachycardia, seizures, hepatic failure, Stevens-Johnson syndrome INTERVENTIONS: observe for adverse reactions, nonpharm method education, report adverse reactions, should be gradually withdrawn antidote: Flumazenil Kava Kava Stress and anxiety, sedative effects shouldn't be taken with other CNS depressants, may inc sedative effects Valerian insomnia. when taken with alcohol and other CNS depressants, may inc sedative effects chamomile to tx sleeplessness, anxiety and stomach or intestinal ailments zolpidem (Ambien) CLASS: sedative hypnotic, non-benzodiazepine USE: tx insomnia ACTION: CNS depression, neurotransmitter inhibition CI: hypersensitivity to benzodiazepine, resp depression, lactation, renal/liver dysfunction, depression, suicidal ideation, pregnancy, children, older adults, debilitates ind. SIDE/ADVERSE EFFECTS: hangover, memory impairment, nightmares, binge eating, tolerance, psych or physical dependence, withdrawal, sleep-related behavior, hypotension, angioedema, depression, suicidal ideation, PE, heart failure INTERVENTIONS: monitor vitals for resp depression, bed alarm for elderly, avoid alcohol, antidepressants, antipsychotics and narcotics, med takes effect within 15-20 mins!!! Anesthetics (general) depresses CNS, alleviates pain, causes loss of consciousness anesthetics (local) pain relief in limited area, no loss of consciousness -dental procedures, suturing skin lacerations, ST surgery at localized area, nerve block below insertion of spinal anesthetic, dx procedures, regional blocks anesthetics routes Inhalation IV Topical Local Spinal topical anesthetics - used for mucous membranes, broken or unbroken skin surfaces, burns -solution, liquid spray, ointment, cream, gel, powder -dec sensitivity of nerve endings of affected area nursing process: anesthetics -Assessment: get drug and health hx -DX: pain, acute related to injury, breathing pattern, ineffective related to CNS depression -Planning: pt will participate in preop prep and will understand post op care -Interventions: monitor post op state of sensorium, observe preop and postop urine output, monitor vitals for hypotension and resp depression, administer analgesic with caution until full recovery epilepsy seizure disorder (abnormal elec. discharges from cerebral neurons) epilepsy characteristics loss of consciousness, involuntary, uncontrolled movement epilepsy cause Unknown Secondary to trauma, anoxia, infection, stroke Isolated seizures due to fever, electrolyte, or acid-base imbalance antiseizure drugs stabilize nerve cell membranes, suppress abnormal electric impulses in cerebral cortex -specific actions: suppress Na influx, suppress Ca influx, enhance action of GABA Phenytoin (Dilantin) CLASS: anticonvulsant: Hydantoin USE: prevent tonic-clonic and partial seizures and status epilepticus ACTION: dec motor cortex act. by alt ion transport CI: pregnancy (teratogenic), hypersensitivity, heart block, bradycardia... caution w hyponatremia, hypotension, hypoglycemia, suicidal ideation, thyroid disease, alcoholism, DM, renal and hepatic impairment, Asian culture SIDE/ADVERSE EFFECTS: gingival hyperplasia, N/V, fatigue, headache, drowsiness, dizziness, leukopenia, hepatic impairment, depression, hyperglycemia, bradycardia, peripheral neuropathy, purple glove syndrome, aplastic anemia, thrombocytopenia, stevens johnson syndrome, hypotension, vfib, suicidal ideation INTERVENTIONS: monitor serum drug levels (10-20mcg/mL), use additional contraception method, use determine if client is getting enough nutrition, Cyclobenzaprine (Flexeril) CLASS: muscle relaxant USE: s-t tx of muscle spasms ACTION: relieves spasms through central action CI: CV (acute MI, bradycardia, heart block, cardiac arrhythmias, HTN, heart failure... Endo (DM, hyperthyroidism), cerebral palsy, hypokalmia, paralytic ileus, concurrent use with MAOIs... caution w seizures, alcohol, CNS depressants, glaucoma, BPH, urinary retention, hepatic disease, lactation SIDE/ADVERSE EFFECTS: anticholinergic effects, arrhythmias, CNS effects, unpleasant taste, allergic reactions, angioedema, MI, seizures, ileus primary anxiety -not caused by medical condition or drug use -managed with short-term anxiolytics secondary anxiety It is related to selected drug use, medical or psychiatric conditions. Medications are not usually given for secondary anxiety. Lorazepam (Ativan) CLASS: anxiolytic benzodiazepine USE: control anxiety, tx status epilepticus, sedation induction for insomnia ACTION: potentiates GABA effects by binding to specific benzodiazepine receptors and inhibiting GABA neurotransmission SIDE/ADVERSE EFFECTS: CNS effects, ataxia, amnesia, GI distress, hallucinations, bradycardia, hypo/hypertension, seizures, suicidal ideation, NMS, resp depression INTERVENTION: monitor VS, encourage support from family, don't drive while taking anxiolytics, don't consume alcohol or CNS depressant -highly protein bound, take for 3-4mo, gradually dec over several days depression patho dec level of monoamine neurotransmitters ginkgo biloba alt therapy for depression. discontinue 1-2 weeks before surgery, don't take with rx antidepressants antidepressant groups Tricyclic antidepressants (TCA) Selective serotonin reuptake inhibitors (SSRIs) Serotonin/norepinephrine reuptake inhibitors (SNRIs) Monoamine oxidase inhibitors (MAOIs) Atypical antidepressants TCA inhibit reuptake of serotonin, NE and histamine SSRI inhibits reuptake of serotonin SNRI inhibit reuptake of serotonin and NE tricyclic antidepressants action blocks uptake of neurotransmitters NE and serotonin in brain -elevates mood, inc interest in ADLs, dec insomnia -blocks histamine receptors leads to sedation -blocks cholinergic receptors leads to anticholinergic effects tricyclic antidepressants use major depression and agitated depression tricyclic antidepressants interactions alcohol and other CNS depressants potentiate CNS depression, MAOIs may lead to toxic psychosis, cardiotoxicity, anti-thyroid drugs may inc dysrhythmias tricyclic antidepressants side/adverse effects drowsiness, dizziness, blurred vision -dry mouth and eyes, GI distress -urinary retention, sexual dysfunc -weight gain, seizures -sleep related behaviors, suicidal ideation -orthostatic hypotension, dysrhythmias SSRI action Block uptake of neurotransmitter serotonin SSRI uses major depression, anxiety disorders, prevention of migraines, dec premenstrual tension syndrome Fluoxetine (Prozac) CLASS: SSRI USE: tx depression, BPD, bulimia, OCD, panic disorder, premenstrual dysphoric disorder ACTION: serotonin is inc in nerve cells because of blockage from nerve fibers CI: hypersensitivity... caution w MI if taken w MAOIs, dehydration, lactation, suicidal ideation, liver disease, osteoporosis, glaucoma, seizure disorder, DM, malnourished, anticoagulant therapy, diarrhea SIDE/ADVERSE EFFECTS: CNS effects, memory impairment, tremors, dry mouth, blurred vision, GI effects, ED!!!, seizures, angioedema, hyponatremia, hypokalemia, hyperkalemia, hypoglycemia, dehydration, bleeding osteoporosis, Stevens-Johnson syndrome, hepatic dysfunction, suicidal ideation INTERACTIONS: grapefruit (lead to toxicity), alcohol and CNS depressants (inc effects of CNS and resp depression), aspirin, NSAIDs and Anticoagulants (inc bleed potential), MAOIs and SSRIs (inc risk of serotonin syndrome), St. Johns wort (inc risk of serotonin syndrome, inc effects of hypoglycemia) Serotonin Syndrome With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures. SNRIs Inhibit reuptake of both serotonin and norepinephrine SNRIs uses major depression, GAD, social anxiety disorder Venlafaxine (Effexor) CLASS: SNRI USE: tx depression, GAD, social anxiety disorder, panic disorder ACTION: serotonin and NE are inc in nerve cells due to blockage from nerve fibers SIDE/ADVERSE EFFECTS: CNS effects, euphoria, amnesia, anticholinergic effects, weakness, diarrhea, anorexia, tachycardia, seizure, HTN, serotonin syndrome, suicidal ideation, NMS, renal failure, Stevens Johnson syndrome CI: hypersensitivity... caution while taking MAOIs, CNS depressants, anticoagulation therapy, renal and hepatic impairment, pregnancy and lactation, narrow angle glaucoma, seizures, hypokalemia, hyponatremia, hyperthyroidism, MI, heart failure INTERACTIONS: alcohol and CNS depressants (inc CNS effects, resp depression, hypotension), anticoagulants and aspirin (inc bleeding), taking with other SNRIs, SSRIs (inc risk for NMS), MAOIs (hypertensive crisis and death), St Johns wort (serotonin syndrome) Monoamine Oxidase Inhibitors (MAOIs) action inactivate NE, dopamine, epinephrine, serotonin MAOI use depression not controlled by TCAs and second gen antidepressants MAOI drug interactions CNS stimulants (vasoconstrictors and cold meds containing phenylephrine and pseudoephedrine) can cause hypertensive crisis when taken with MAOI MAOI side effects/ adverse effects -agitation, restlessness, insomnia -anticholinergic effects -orthostatic hypotension -hypertensive crisis from tyramine interaction foods with tyramine aged cheese, cream, yogurt, coffee, chocolate, bananas, raisins, liver pickled foods, sausage, soy sauce, yeast, beer, and red wine acute pain pain that is felt suddenly from injury, disease, trauma, or surgery chronic pain episode of pain that lasts for 6 months or longer; may be intermittent or continuous Non-opioid analgesics mild-moderate pain; effective for dull throbbing pain (headaches, dysmenorrhea, minor abrasion, inflammation, muscular aches, pain, mild-moderate arthritis) NSAIDs action analgesic, antipyretic, antiinflammatory (aspirin, ibuprofen, indomethacin, ketorolac) inhibition of prostaglandins (both COX enzymes) acetaminophen CLASS: non-opioid analgesic ACTION: inhibits prostaglandin synthesis USES: muscular aches and pain, fever -max dose:4g/day; 2g/day if taken frequently SIDE EFFECTS/ADVERSE EFFECTS: rash, headache, insomnia, low incidence of GI distress, hepatotoxicity, thrombocytopenia, hemolytic anemia, leukopenia neutropenia INTERVENTION: liver enzyme tests, keep out of children's reach, avoid alcohol ingestion, report side effects, check serum acetaminophen level if toxicity is suspected Indomethacin (Indocin) CLASS: para-chlorobenzoic acid NSAID USE: mild-severe pain, gout, tendinitis, osteoarthritis, RA, ankylosing spondylitis SIDE/ADVERSE EFFECTS: dizziness, headache, GI distress/bleeding Ketorolac (Toradol) CLASS: NSAID USE: s-t pain management (5 days or less) SIDE/ADVERSE EFFECTS: CNS effects, edema, GI distress/bleed, perforation, elevated hepatic enzyme levels Tramadol (Ultram) CLASS: non-opioid analgesic USE: moderate-severe pain CI: severe alcoholism, use of opioids or CNS depressants SIDE EFFECTS: GI effects, headache, CNS effects w anxiety, agitation opioid analgesics use Moderate and severe pain Many opioids possess antidiarrheal effects opioid analgesic action act on CNS (suppress pain impulses, suppress resp and coughing by acting on resp and cough centers in medulla) opioid analgesic contraindications head injury, resp disorders, hypotension fetanyl CLASS: opioid analgesic USE: moderate to severe pain, anesthesia induction and maintenance -longer duration than morphine -transderm patch, IM, IV (most likely to be abused) Hydromorphone (Dilaudid) CLASS: opioid analgesic USE: moderate-severe pain -analgesic effects -faster onset and shorter duration -PO, rectal, SQ, IM, IV -6x faster onset than morphine Oxycodone (Oxycontin) CLASS: opioid analgesic USE: moderate-severe pain, when morphine doesn't provide relief -avoid over extended pd. of time -take with food -taper off of med Oxycodone w/ Acetaminophen (Percocet) CLASS: opioid analgesic USE: moderate-severe pain -take with food SIDE EFFECTS: oxycodone and acetaminophen side effects opioids taken with __________ may increase sedation kava, valerian, st johns wort PCA meds used: morphine, fetanyl, hydromorphone loading dose: predetermined safety limits -lockout mechanism: near constant analgesic level Transdermal Opioid Analgesics Provide a continuous "around-the-clock" pain control that is helpful to patients who suffer from chronic pain -fetanyl adjuvant therapy used along with non-opioid and opioid analgesics Opioid agonist-antagonist opioid antagonist added to opioid agonist -not given for cancer pain -safe for use during labor nalbuphine CLASS: opioid agonist-antagonist USE: relief of moderate-severe pain and anesthesia induction and maintenance CI: hypersensitivity... caution w hx of alcohol/drug abuse, resp insufficiency, head injury, inc ICP, biliary tract disease, renal/hepatic dysfunction SIDE/ADVERSE EFFECTS: CNS effects, GI effects, dry mouth, diaphoresis, bradycardia, tachycardia, hypotension, hypertension, dyspnea, resp depression INTERACTIONS: CNS depression greater with alcohol or other CNS depressants INTERVENTIONS: monitor VS, check bowel sounds, determine urine output Opioid Antagonists action blocks receptor and displaces opioud Opioid Antagonists use Antidote for opiate overdoses Reverse effects of opiates, including respiratory depression, sedation, hypotension Respiratory distress, respiratory depression opioid antagonists side effects/adverse effects -reversal of analgesia -agitation, GI effects -hypo/hypertension, tachycardia -elevated PTT opioid antagonists interventions monitor VS (especially BP) and bleeding continuously Sumatriptan (Imitrex) ACTION: causes vasoconstriction of cranial arteries USE: tx migraine and cluster headaches SIDE EFFECTS: CNS effects, GI effects, seizures, dysrhythmias, thromboembolism, heart attack, stroke, suicidal ideation INTERVENT: notify provider of htn inflammatory phases -vascular phase: occurs 10-15 mins after injury, vasodilation and inc capillary permeability, fluid and blood substances move to injury site -Delayed phase: leukocytes infiltrate inflamed tissue COX enzyme converts arachidonic acid into prostaglandins -COX1: protects stomach lining and regulates blood platelets -COX2: triggers inflamm and pain antiinflammatory drug groups Nonsteroidal antiinflammatory drugs (NSAIDs) Corticosteroids Disease-modifying antirheumatic drugs Antigout drugs action of NSAIDs Inhibit biosynthesis of prostaglandins Analgesic effect Antipyretic effect Inhibit platelet aggregation Mimic effects of corticosteroids Inhibit COX enzyme first generation NSAIDs Salicylates Parachlorobenzoic acid Phenylacetic acids Propionic acid derivatives Fenamates Oxicams second generation NSAIDs Selective COX-2 inhibitors second generation antidepressants SSRIs, SNRIs (target specific) Aspirin (ASA) CLASS: salicylate ACTION: anti-inflamm, antiplatelet, antipyretic -therapeutic level: 15-30mg/dL -mild toxicity: 30mg/dL -severe toxicity: 50mg/dL INTERACTIONS (DRUG): inc bleeding w anticoagulants and other NSAIDs, risk for hypoglycemia w oral antidiabetics, inc gastric ulcer risk w glucocorticoids, dec effects of ACE inhibitors, loop diuretics, probenecid, salicylate effects dec by corticosteroids INTERACTIONS (LAB): inc PT, INR, uric acid, dec cholesterol, T3,T4 level INTERACTIONS (FOOD): prunes, raisins, licorice, curry, paprika SIDE/ADVERSE EFFECTS: CNS effects, tinnitus, GI distress, bleeding, blood disorders, hepatotoxicity, Reye syndrome, hypersensitivity, bronchospasm INTERVENTIONS: monitor serum salicylate level, observe for signs of bleeding, don't take with alcohol or warfarin to prevent inc bleeding, discontinue 7 days before surgery, notify provider about tinnitus antiseizure considerations -taken over a life time -use good oral hygiene -use backup protection aspirin cautions don't take with other NSAIDs, avoid during last trimester of pregnancy, don't give to children with flu or virus symptoms (can lead to Reye syndrome) most widely used NSAID ibuprofen ibuprofen (PO- advil) CLASS: NSAID ACTION: inhibits prostaglandin synthesis USE: pain, osteoarthritis, RA SIDE EFFECTS: CNS effects, gastric distress/bleeding, nephrotoxicity INTERACTIONS: inc bleeding w warfarin, inc effects with phenytoin, sulfonamides, warfarin, cephalosporins, dec effect w aspirin INTERVENTIONS: observe pt for bleeding gums, petechiae, ecchymoses, black tarry stools, GI discomfort, don't take w alcohol Celecoxib (Celebrex) CLASS: cox2 inhibitors ACTION: selectively inhibits cox2 enzyme without inhibition of cox1 USE: osteoarthritis, RA, ankylosing spondylitis, pain, dysmenorrhea SIDE EFFECTS: CNS effects, sinusitis, GI distress/ulceration, hypertension, renal dysfunc NSAIDs in older adults -drug interactions more common due to polypharmacy -Greater incidence of GI distress, ulceration -Reduced dose decreases risk of side effects -inc fluid intake corticosteroids action Control inflammation by suppressing or preventing many of the components of the inflammatory process at the injured site corticosteroids use -arthritic flare ups (not drug of choice) -discontinue by tapering off over 5-10 days DMARD uses -alleviate symptoms of RA when other tx fail -osteoarthritis, ankylosing spondylitis -psoriatic arthritis, severe psoriasis -chrons disease, ulcerative colitis immunosuppressive agents use refractory RA unresponsive to anti-inflamm drugs immunomodulators classifications -interleukin 1 receptor antagonists -tumor necrosis factor immunomodulators action disrupt inflamm process, delay disease progression, neutraluze TNF immunomodulators use RA, psoriatic arthritis, psoriasis, spondylitis, ulcerative colitis, chrons disease Infliximab (Remicade) CLASS: immunomodulator- TNF blocker ACTION: binds to TNF, and blocks it from attaching to TNF receptors -IV infusion given over 2hrs -CI: hypersensitivity, heart failure purine containing foods organ meats, sardines, salmon, gravy, herring, liver, meat soups, and alcohol (especially beer) colchicine CLASS: antigout drug ACTION: inhibits migration of leukocytes to inflamed site USE: alleviate SYMPTOMS of gout SIDE EFFECTS: GI distress (take w food) CI: severe renal, cardiac, or GI probs Allopurinol CLASS: antigout drug ACTION: dec uric acid synthesis USE: prevents future gout attacks SIDE EFFECTS: GI distress, anemia and GI bleeding INTERVENTIONS: record urine output, monitor labs for renal and hepatic func. inc fluid intake to inc drug and uric acid excretion, avoid purine foods, advise for yearly eye exam a nurse will monitor the pt taking albuterol for what conditions palpitations, hypertension, bronchospasm A patient is given epinephrine, an adrenergic agonist (sympathomimetic). The nurse should monitor the patient for which condition? a. Decreased pulse b. Pupil constriction c. Bronchial constriction d. Increased blood pressure D A patient who is taking epinephrine is also taking several other medications. The nurse should realize that there is a possible drug interaction with which drugs? beta blockers ginkgo may decrease the effects of what drug phenytoin what drug is a propionic acid derivative ibuprofen Tramadol does not result in ___________. take for ____________ respiratory depression; 5 days or less what do you do if aspirin upsets the stomach take an enteric coated tablet Direct acting adrenergic agonists epinephrine and norepinephrine Directly stimulates adrenergic receptor Indirect acting adrenergic agonists amphetamine Stimulates release of norepinephrine from terminal nerve endings mixed acting adrenergic agonists Ephedrine Stimulates adrenergic receptor sites and stimulates release of norepinephrine from terminal nerve endings What is the classification of epinephrine Sympathomimetic: adrenergic agonist uses of epinephrine Anaphylaxis anaphylactic shock Bronchospasms status asthmaticus Cardiogenic shock cardiac arrest Action of epinephrine on alpha 1 receptors increases BP Action of epinephrine on Beta 1 receptors increases HR Action of epinephrine on Beta 2 receptors promotes bronchodilation Side effects of epinephrine tachycardia palpitations hypertension restlessness hyperglycemia life threatening side effects of epinephrine ventricular fibrillation pulmonary edema Epinephrine Nursing Interventions monitor vitals and ECG monitor IV site monitor urinary output (for distention) in DM patients monitor blood glucose Effects of alpa 1 adrenergic antagonists vasodilation dizziness orthostatic hypotension pupil constriction Effects of beta 1 adrenergic antagonists reduces cardiac contractility decreases pulse Effects of beta 2 adrenergic antagonists bronchoconstriction inhibits glycogenolysis (no real medical use for this drug. we never want to make it harder for out patients to breath) Classification of albuterol beta 2 adrenergic agonist use of albuterol Asthma bronchospasm Classification of Atenolol beta blocker uses of atenolol Treatment of hypertension, angina, and prophylaxis and treatment of acute myocardial infarction Types of parasympathetic receptors cholinergic: muscarinic and nicotinic Effects of Cholinergic Agonists constricts pupils lowers BP lowers HR stimulates digestion and peristalsis contracts bladder, relaxes sphincter causes vasodilatation increases salivation constricts bronchioles Classification of bethanechol (urecholine) Parasympathomimetic use of bethanechol (urecholine) urinary retention and neurogenic bladder Contraindications of bethanechol Bradycardia hypotension COPD peptic ulcer parkinsonism hyperthyroidism asthma side effects of bethanechol blurred vision GI effects bronchoconstriction life threatening reaction to bethanechol bronchospasm use of atropine sulfate pre-operative medication to decrease salivation increase HR dilate pupils for diagnostic exams side effects of atropine sulfate dry mouth constipation dry skin blurred vision photophobia urinary retention What medication do we NOT give turmeric with What do NSAIDs do? analgesic: stops inflammation antipyretic: stops fever anti-inflammatory: inhibits biosynthesis of prostaglandins inhibits COX enzymes What does COX enzymes do converts arachidonic acid into prostaglandins Cox-1 protects stomach lining and regulates blood platelets Cox-2 triggers inflammation and pain Morphine Sulfate classification Opioid Analgesic What is morphine used for? moderate to severe pain (antidiarrheal effects) What is the antidote for morphine Naloxone (Narcan) side effects of morphine CNS effects, euphoria depression GI distress, constipation urinary retention dependance respiratory depression When should drug reconciliation happen? as soon as possible so physicians can check for interactions Non pharmacologic measures to help with sleep - wake up at the same time each morning - limit/ do not take naps - avoid caffeine, alcohol and nicotine 6 hours before bed - avoid heavy meals, large amounts of fluid, strenuous exercise and loud noise before bedtime - take a warm bath, read, listen to quiet music or drink warm milk before bed How do OTC sleep aids work the main ingredient in OTC sleep aids is diphenhydramine or Benadryl which is a histamine blocker with the side effect of drowsiness What is the Harrison Act? a narcotics act that states you must have a prescription to get opiates How frequently can we give Tylenol every 4-6 hours How often do we need to check blood glucose levels in our diabetic patients every 15 minutes What foods cant be eaten with MAOIs and why foods that contain tyramine: aged cheese, cream, yogurt, coffee, chocolate, bananas, raisins, liver, pickled foods, soy sauce, yeast, beer, red wines causes sympathomimetic effects that can cause a hypertensive crisis What are the normal (therapeutic) ranges of aspirin 15-30 mg/dL What is the antidote for benzodiazepines such as alprazolam (Xanax) Flumazenil Morphine will react with what CAMs that increase sedation Kava Valerian St. Johns Wort What opioid is often used for chronic pain, and how is it administered fentanyl, transdermal patch list some triggers of a migraine headache cheese, chocolate, red wine, stress, fatigue, too much or too little sleep, light, odors, hormone changes or drugs What is the main use for bethanechol (urecholine) urinary retention and neurogenic bladder what class of drug is bethanechol (urecholine) parasympathomimetic, cholinergic agonist what is the main use for atropine decrease salivation preoperatively, dilate pupils for exams, increase HR what classification of drug is atropine Anticholinergic what is the main use for alprazolam (Xanax) anti anxiety and panic disorders what classification of drug is alprazolam (Xanax) benzodiazepines, CNS depressants what is the main use for lorazepam (Ativan) what classification of drug is lorazepam (Ativan) Benzodiazepine, CNS depressant What is the main use for zolpidem (ambien) to treat Insomnia what classification of drug is zolpidem (ambien) benzodiazepines, CNS depressant Phenytoin (Dilantin) classification Anticonvulsant, Hydantoin therapeutic range of phenytoin 10-20 mcg/mL What is the generic name of Ativan Lorazepam what is the generic name of flexeril cyclobenzaprine what is the general name of prozac fluoxetine what is the generic name of Xanax Alprazolam what is the generic name of Urecholine Bethanechol what is the generic name of dilaudid hydromorphone what is the generic name for OxyContin oxycodone what two generic drugs make up Percocet oxycodone and acetaminophen What are CNS depressants CAMs gingko biloba and st johns wort What type of benzos are safer for older adults short to intermediate acting we want to avoid long acting benzos since renal and hepatic function decreases in older adults Do benzos need to be gradually withdrawn Yes